After Acute Ischemic Stroke Patients Research Articles

Red blood cell distribution width as a predictor of mortality and poor functional outcome after acute ischemic stroke: a meta-analysis and meta-regression

BackgroundThis study aimed to review evidence on the ability of red cell distribution width (RDW) to predict mortality and poor functional outcomes after acute ischemic stroke (AIS).MethodsDatabases of PubMed, CENTRAL, Scopus, Embase, and Web of Science were searched online from inception to 25th Jul 2023 for all studies reporting the association between RDW and outcomes as adjusted ratios. A random-effects meta-analysis was done. Meta-regression was conducted using multiple moderators.Results15 studies with 14,968 patients were included. Meta-analysis found that RDW, both as a categorical variable (OR: 2.10 95% CI: 1.74, 2.55 I2 = 42%) and continuous variable OR: 1.16 95% CI: 1.05, 1.28 I2 = 64%) was a significant predictor of mortality after AIS. Age and number of hypertensives were found to be significant moderators in the meta-regression. Also, high RDW, as a categorical variable (OR: 1.68 95% CI: 1.20, 2.35 I2 = 84%), was associated with significantly higher odds of poor functional outcomes after AIS, but not as a continuous variable (OR: 1.07 95% CI: 0.99, 1.16 I2 = 61%). Meta-regression showed that the association was stronger in small sample-sized studies.ConclusionRDW can be a useful, readily available, and cost-effective biomarker to rapidly stratify AIS patients at risk of poor outcomes. High RDW was consistently associated with an increased risk of mortality after AIS, however, its ability to predict poor functional outcomes needs to be verified by further studies.

Time‑dependent changes in blood cells, NIHSS and mRS according to reperfusion treatment type in stroke patients who developed hemorrhagic complication.

Hemorrhagic complications may be seen following reperfusion therapy with rtPA and/or thrombectomy after acute ischemic stroke (AIS). Neutrophils, lymphocytes, and platelets have important roles in the inflammatory and immune responses that develop in these patients. We investigated time‑dependent changes in blood cells, NIHSS and mRS values according to type of reperfusion therapy in AIS patients who developed cerebral hemorrhage. In AIS patients who underwent rtPA and/or thrombectomy and developed cerebral hemorrhage within the first 24 hours after treatment, leukocyte, neutrophil, lymphocyte, platelet counts and their ratios were recorded on admission, 1st, 3rd, and 7th days. NIHSS values on admission, 3rd days and mRS values on admission, discharge, and the 3rd month were recorded. These values were compared according to the type of reperfusion therapy. Out of 436 AIS patients, rtPA was applied in 50.5%, thrombectomy in 28.2%, and rtPA+thrombectomy in 21.3%. Hemorrhage developed in 25.5% of the patients. Patients treated with thrombectomy had a greater rate of cerebral hemorrhage. Pre‑stroke mRS values were lower in all therapy types than mRS scores at discharge and the 3rd month. The NIHSS scores did not differ significantly in 3 days. Depending on the type of reperfusion treatment, there are a few time‑dependent significant changes observed in the blood cell counts and ratios. In conclusion, there is a relation between the type of reperfusion therapy and the time‑dependent changes in blood cells and ratios as well as mRS scores among AIS patients who have undergone rtPA and/or thrombectomy and developed cerebral hemorrhage.

Abstract WP205: Development and Validation of a Prediction Model for Outcome in Mechanical Thrombectomy for Large-Vessel Occlusion Anterior Circulation Stroke With Low ASPECTS

Introduction: Recent randomized control trials suggested that mechanical thrombectomy (MT) was associated with good functional outcomes after acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in patients presenting with low Alberta Stroke Program Early CT Score (ASPECTS) (defined as ASPECTS 2-5). The aim of this study is to develop and validate a stroke prediction tool for outcome in MT for AIS patients with low ASPECTS using data from an ongoing international multicenter registry, the Stroke Thrombectomy and Aneurysm Registry (STAR). Methods: 236 AIS patients with low ASPECTS caused by LVO who undertook MT between January 2010 and December 2022 were retrospectively investigated. Univariate and multivariate logistic regression results were used to screen model predictors and construct nomograms of 90-day modified Rankin Scale scores (mRS) 0-3. The performance of the model was detected by using receiver operating characteristic analysis. The bootstrap resampling method was considered internal validation of the model. Results: Age (< 70 years), premorbid status (mRS 0), National Institutes of Health Stroke Scale (NIHSS) (< 20), and recanalization status after the MT (modified Thrombolysis in Cerebral Ischemia [mTICU] ≥2b) were related to 90-day mRS 0-3. Predictive score was calculated by adding 1 point for age (< 70 years), premorbid status (mRS 0), and NIHSS < 20 and 3 points for a mTICI ≥2b (ranging 0-6). 90-day mRS 0-3 was observed in 0% of patients with a score of 0 or 1, 6.3% with a score of 2, 17.7% with a score of 3, 22.2% with a score of 4, 45.7% with a score of 5, and 73.7% with a score of 6. The score showed relatively high performance in predicting 90-day mRS0-3 (area under the curve: 0.79 [95% CI 0.73-0.79] and 0.78 [95% CI 0.78-0.78] for derivation and validation cohorts, respectively). Conclusions: This study indicates the STAR score can be calculated with baseline and periprocedural characteristics to predict the 90-day outcome after MT in AIS patients with low ASPECTS.

Early antithrombotic therapy in patients with postinterventional cerebral hyperdensity reduces early neurological deterioration after mechanical thrombectomy

BackgroundInitiation of early antithrombotic therapy after acute ischemic stroke (AIS) is crucial. We aimed to investigate whether early antithrombotic therapy influences early neurological deterioration (END) in AIS patients with postinterventional cerebral hyperdensity (PCHD) immediately after mechanical thrombectomy (MT).MethodsWe retrospectively analyzed 108 consecutive anterior circulation AIS patients with PCHD immediately after MT. All patients were divided into END group and non-END group and END was defined as an increase of four points or more on the postinterventional National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h after MT. Early antithrombotic therapy was defined as patients with PCHD who received antithrombotic therapy within 24 h after MT. Statistical analyses were performed to evaluate the association between early antithrombotic therapy and the risk of END.ResultsAmong 108 patients, 27 (25%) patients developed END. Multivariate regression analysis revealed that early use of antithrombotic therapy (OR = 0.229, 95%CI = 0.083–0.626, P = 0.004) was an independent protector of END and postinterventional low density shadow exceeding 1/3 of the vascular territory (OR = 4.000, 95%CI = 1.157–13.834, P = 0.029) was an independent risk factor for END.ConclusionAntithrombotic therapy within 24 h after MT maybe associated with the reduced risk of END in anterior circulation AIS patients with PCHD.

Oral anticoagulants status after acute ischemic stroke and prognosis in patients with atrial fibrillation

ObjectivesTo investigate the oral anticoagulants (OACs) use after acute ischemic stroke (AIS) and prognosis of patients with atrial fibrillation (AF). MethodsThis was a real-world follow-up research of AIS patients with AF admitted to 5 hospitals in northwestern China. We visited these individuals every 6 months to check the type, dosage of OACs, and to record IS recurrence, bleeding, and death events and modified Rankin Scale (mRS) scores until December 2022. When one of the following occurring first was endpoint: IS recurrence, death or study end. Patients were divided into continuous anticoagulation group and non-continuous anticoagulation group based on whether they continued to take OACs from the moment they were discharged until the endpoint. We further analyzed the association between anticoagulation persistence and outcomes. ResultsAmong all 250 patients with OACs indication, 147 patients (58.8 %) received OACs at discharge. Only 37.9 % of patients (39/103) started OACs after discharge. Of the 147 patients treated with OACs, 21.8 % (32/147) discontinued anticoagulation after discharge. 239 of the 250 patients had completed the median 40-month follow-up with 91 patients in continuous anticoagulation group and 148 patients in non-continuous anticoagulation group. In the multivariate COX regression, non-continuous anticoagulation was an independent risk factor for poor prognosis (mRS>2) in AIS patients with AF (1.452[1.011, 2.086], p = 0.043). ConclusionsThis study revealed an upward trend in the use rate of OACs, but low OACs rates that meet guideline-based criteria and low anticoagulation persistence in AF patients after AIS in the northwestern China. Discontinuous anticoagulation was associated with an increased risk of poor prognosis in these patients.

Down-Regulation of miRNA-1303 Promotes the Angiogenesis of HUVECs via Targeting THSD7A.

Angiogenesis promotes neurological recovery after acute ischemic stroke (AIS), and microRNAs play crucial roles in cerebral angiogenesis. This study found that Homo sapiens-microRNA-1303(miR-1303) was reduced in blood specimens of AIS patients and human umbilical vein endothelial cells after suffering from oxygen-glucose deprivation/reperfusion. The experiment detected the effect of miR-1303 on angiogenesis by wound healing assay, tube formation assay, and transwell assay. Down-regulation of miRNA-1303 promotes angiogenesis in vitro experiments, while miR-1303 over-expression reverses this effect. Based on bioinformatics analyses and dual-luciferase reporter assay, the thrombospondin type 1 domain containing 7A (THSD7A) was investigated and further validated as the downstream gene of miR-1303. Furthermore, the knockdown of miR-1303 decreased the protein translation and mRNA transcript levels of THSD7A. Our results reveal a novel miR-1303/THSD7A pathway for angiogenesis and further imply that miR-1303 can be a promising biomarker and therapeutic target for AIS.

No Sex Differences in Mechanical Thrombectomy Time Metrics and Outcomes in Saskatchewan.

Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial registry. Clinical data of all AIS patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan were captured in the Canadian OPTIMISE registry and supplemented with patient data from administrative data sources. Patient baseline characteristics, transport time metrics, and technical EVT outcomes between female and male EVT patients were compared. Three-hundred-three patients underwent EVT between 2017 and 2022: 144 (47.5%) women and 159 (52.5%) men. Women were significantly older (median age 77.5 [interquartile range: 66-85] vs.71 [59-78], p < 0.001), while men had more intracranial internal carotid artery occlusions (48/159 [30.2%] vs. 26/142 [18.3%], p = 0.03). Last-known-well to comprehensive stroke center (CSC)-arrival time (median 232 min [interquartile range 90-432] in women vs. 230 min [90-352] in men), CSC-arrival-to-reperfusion time (median 108 min [88-149] in women vs. 102 min [77-141] in men), reperfusion status (successful reperfusion 106/142 [74.7%] in women vs. 117/158 [74.1%] in men) as well as modified Rankin score at 90 days did not differ significantly. This held true after adjusting for baseline variables in multivariable analyses. While women undergoing EVT in the province of Saskatchewan were on average older than men, they were treated just as fast and achieved similar technical and clinical outcomes compared to men.

Association between Triglyceride-Glucose Index and 1-Year Recurrent Stroke after Acute Ischemic Stroke: Results from the Xi’an Stroke Registry Study of China

Introduction: The triglyceride-glucose (TyG) index is reported to be related to poor functional outcomes and all-cause mortality post-stroke. However, the association between TyG index and recurrent stroke after acute ischemic stroke (AIS) has not been well described. We aimed to identify whether the TyG index was associated with 1-year recurrent stroke after AIS. Methods: Baseline patient information was collected at admission, and the TyG index was calculated. Recurrent stroke events were followed up at 1, 3, 6, and 12 months after diagnosis. We then examined the association between the TyG index and risk of 1-year recurrent stroke using multivariable Cox regression models and restricted cubic spline analyses. Results: Among 2,288 participants, the mean TyG index was 8.8 ± 0.7. Those in the fourth quartile (Q4) demonstrated higher recurrent stroke risk than those in Q1 (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI], 0.98–2.72; p = 0.059). Subgroup analysis revealed a sex-specific association between TyG index and recurrent stroke (p for interaction = 0.022). Additionally, restricted cubic splines analyses showed a nonlinear association between the TyG index and 1-year recurrent stroke. In females, patients in the Q4 had a 2.95-fold increased recurrent stroke risk than did patients in the Q1 (adjusted HR = 2.95; 95% CI: 1.09–7.94; p = 0.032); the risk increased when the TyG index was >8.73. However, no significant correlation was observed in males. Conclusion: A nonlinear association was found between the TyG index and 1-year recurrent stroke risk. Subsequently, a high TyG index could predict an increased 1-year recurrent stroke risk in female AIS patients.

Continued Infarction Growth and Penumbral Consumption After Reperfusion in Vaccine-Naïve Patients With COVID-19: A Case-Control Study.

Background: Neurologic sequelae of SARS-CoV-2 include potentially malignant cerebrovascular events arising from complex hemodynamic, hematologic, and inflammatory processes occurring in concert. Objective: This study concerns the hypothesis that, despite angiographic reperfusion, COVID-19 promotes continued consumption of at-risk tissue volumes after acute ischemic stroke (AIS) unlike what is seen with COVID-negative individuals, yielding critical insights into prognostication and monitoring paradigms in vaccine-naïve patients experiencing AIS. Methods: This retrospective study compared 100 consecutively presenting patients with COVID-19 and AIS between March 2020 and April 2021 with a contemporaneous cohort of 282 patients with AIS who did not have COVID-19. Reperfusion classes were dichotomized into positive (extended thrombolysis in cerebral ischemia [eTICI] score = 2c-3) and negative (eTICI score < 2c) groups. All patients underwent endovascular therapy following initial CT perfusion imaging (CTP) to document infarction core and total hypoperfusion volumes. Results: Ten COVID-positive (mean age ± SD, 67 ± 6 years; seven men, three women) and 144 COVID-negative patients (mean age, 71 ± 10 years; 76 men, 68 women) undergoing endovascular reperfusion with antecedent CTP and follow-up imaging comprised the final dataset. Initial infarction core and total hypoperfusion volumes were 1.5 ± 18 mL and 85 ± 100 mL in COVID-negative patients and 30.5 ± 34 mL and 117 ± 80.5 mL in COVID-positive patients, respectively. Final infarction volumes were significantly larger in patients with COVID-19, with median volumes of 77.8 mL versus 18.2 mL among control patients (p = .01), as were normalized measures of infarction growth relative to baseline infarction volume (p = .05). In adjusted logistic parametric regression models, COVID positivity emerged as a significant predictor for continued infarct growth (OR, 5.1 [95% CI, 1.0-25.95]; p = .05). Conclusion: These findings support the potentially aggressive clinical course of cerebrovascular events in patients with COVID-19, suggesting greater infarction growth and ongoing consumption of at-risk tissues, even following angiographic reperfusion. Clinical Impact: SARS-CoV-2 infection may promote continued infarction progression, despite angiographic reperfusion, in vaccine-naïve patients with large-vessel occlusion AIS. The findings carry potential implications for prognostication, treatment selection, and surveillance for infarction growth among revascularized patients in future waves of infection by novel viral strains.

High total bilirubin-to-uric acid ratio predicts poor sleep quality after acute ischemic stroke: a prospective nested case-control study.

Sleep disorders are prevalent after stroke, resulting in high recurrence rates and mortality. But the biomarkers of sleep disorders in stroke patients remain to be elucidated. This study aimed to explore the relationship between total bilirubin-to-uric acid ratio (TUR) and sleep quality after acute ischemic stroke (AIS). Three hundred twenty-six AIS patients were recruited and followed up 1 month after stroke in our study. Serum total bilirubin and uric acid levels were obtained within 24 h after admission. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality 1 month after stroke. We conducted receiver operating characteristic (ROC) curve analysis and screened the optimal biomarker to differentiate sleep disorders after stroke. Then the TUR was stratified according to the best cut-off value (0.036) of the ROC and further analysed by binary logistic regression analysis. Additionally, the interaction was used to explore the difference in its effect on post-stroke sleep quality in different subgroups. Three hundred thirty-one patients (40.2%) were considered as having poor sleep quality during the one-month follow-up. Compared to patients with good sleep, patients with poor sleep were more likely to have higher TUR (IQR), 0.05 (0.03-0.06) versus 0.03 (0.02-0.04), P < 0.001. After adjusting for confounding factors, binary regression analysis demonstrated that a high TUR (≥0.036) was independently related to post-stroke poor sleep quality (OR = 3.75, 95% CI = 2.02-6.96, P < 0.001). High TUR is associated with an increased risk of poor sleep quality in AIS patients, especially in females, diabetics, and patients with hyperlipidaemia.

Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis

BackgroundDifferent studies have demonstrated the benefit of endovascular treatment (EVT) up to 24 hours after acute ischemic stroke (AIS) onset. Recent cohort observational studies suggest that patients with large vessel...

Efficacy of Scalp Acupuncture with the Long-Stay Method on Motor Dysfunction in Patients with Acute Ischemic Stroke: A Randomized Controlled Trial.

In China, acupuncture has been widely used in treating cerebrovascular diseases since time immemorial. Scalp acupuncture using the long-stay method is a traditional acupuncture treatment. However, previous studies have concluded that the clinical efficacy of scalp acupuncture for the treatment of stroke remains uncertain. In addition, no randomized controlled trials have been conducted on scalp acupuncture using the long-stay method. This study aimed to evaluate the efficacy and safety of the long-stay method of scalp acupuncture for limb movement dysfunction in patients after acute ischemic stroke (AIS). Seventy-two patients with acute strokes were randomly divided into treatment and control groups. The control group received conventional acupuncture with a half-hour needle stay each time, whereas the treatment group underwent scalp needling using a long retention method, with each retention of needles lasting 24 hours. Both groups received acupuncture treatment for 2 weeks and were followed up for 6 months. Cerebrovascular reserve (CVR), breath-holding index (BHI), pulsatility index (PI), Fugl-Meyer, and Barthel index (BI) were assessed at baseline, week 1, week 2, and during follow-up. Compared with the baseline, both groups showed a significant improvement in CVR, Fugl-Meyer, BI, PI, and BHI (P < 0.05). Compared with the control group, the treatment group showed more significant improvements in Fugl-Meyer scores, BI, CVR, PI, and BHI (P < 0.05). Correlation analysis showed that Fugl-Meyer and BI scores increased significantly with CVR recovery over the course of treatment. Scalp acupuncture with the long-stay method can improve neurological deficits and the ability to perform daily activities among AIS patients, which may be related to the improvement of CVR function in patients.

Systemic inflammatory response syndrome deteriorates the outcomes of mechanical thrombectomy in acute stroke (P14-5.031)

<h3>Objective:</h3> In this retrospective research, we investigated the association of the systemic inflammatory response syndrome and its impact on the outcomes of mechanical thrombectomy in acute stroke. <h3>Background:</h3> Systemic inflammatory response syndrome (SIRS) has been associated with poor outcomes after acute ischemic stroke (AIS). The primary goal of this study was to determine whether SIRS status on admission correlated with functional outcomes in AIS treated with mechanical thrombectomy (MT). <h3>Design/Methods:</h3> Consecutive patients from September 2015 to April 2019 were retrospectively reviewed for SIRS on admission. SIRS was defined as the presence of ≥2 of the following: temperature &lt; 36 °C or &gt; 38 °C, heart rate &gt; 90, respiratory rate &gt; 20, and white blood cell count &lt;4000/mm or &gt; 12,000 mm. <h3>Results:</h3> Of 202 patients, 188 met inclusion criteria. 49 patients (26%) had evidence of SIRS. Neither basic patient demographics nor standard stroke risk factors predicted the development of SIRS. However, presentation with SIRS was correlated with higher rates of death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2–5.5) as well as lower rates of favorable functional outcomes at discharge (OR, 0.09; 95% CI, 0.02–0.40) and 3-month follow up (OR 0.12; 95% CI 0.03–0.43). These results remained significant even after adjustment for age, sex, baseline NIHSS, recanalization status, and prior co-morbidities. <h3>Conclusions:</h3> In our sample population, SIRS was associated with worse outcomes and higher rates of mortality in AIS patients treated with MT. Recognition of key risk factors can provide better prognostication and possible future therapeutic targets. <b>Disclosure:</b> Dr. Jafari has nothing to disclose. Mr. Katlowitz has nothing to disclose. Dr. De la Garza has nothing to disclose. Dr. Sellers has nothing to disclose. Shawn Moore, MD has nothing to disclose. Dr. Hall has nothing to disclose. Aaron Desai, MD, MBBS has nothing to disclose. Vikramjeet Singh has nothing to disclose. Rahul Damani has nothing to disclose.

Abstract P474: Sex-Specific Prevention of Stroke Through Reproductive Risk Factors and Sex Hormone Effects (STOP STROKE): Preliminary Findings

Background: There are known associations between sex-specific reproductive health factors such as reproductive lifespan and stroke risk. The relation of endogenous sex hormones, specifically sex hormone binding globulin (SHBG), to stroke risk remains uncertain, however, despite some data showing an inverse association between SHBG and stroke. We conducted a pilot case-control study to evaluate SHBG as a stroke risk factor, to report SHBG levels in the period immediately after acute ischemic stroke (AIS), and to demonstrate the feasibility of collecting data on sex hormones and reproductive history in this study population. Methods: In STOP STROKE, postmenopausal women were enrolled from a single large healthcare system in the northeast between July 2020 and May 2022. Case participants were postmenopausal women ≥50 years old newly admitted with AIS to a large stroke center; controls were postmenopausal women without a history of stroke recruited from an outpatient clinic in the same healthcare system. Among others, exclusion criteria included use of menopausal hormone therapy within 10 years, prior stroke, surgical menopause, and history of hormone-related cancers. We ascertained data on stroke risk factors and collected blood samples between 24 and 72 hours after stroke onset or at the time of enrollment for controls. Serum SHBG was measured using enzyme-linked immunosorbent assays. Following descriptive analyses, age- and BMI-adjusted SHBG levels were compared between cases and controls using multiple linear regression. Multiple logistic regression was then performed to assess associations between SHBG, clinical risk factors, and the outcome of AIS, with covariates chosen a priori based on prior literature. Results: In total, 32 cases and 30 controls were enrolled; median age was 69.0 years (IQR 64.5-82.0) for cases vs. 62.0 (IQR (59.0-68.0) for controls. The mean SHBG of AIS cases was 68.8 (SD 36.1) nmol/L compared to 56.6 (SD 30.0) nmol/L among controls (p=0.16). In models adjusted for age and body mass index (BMI), SHBG was similar between cases and controls (beta = 3.0, 95%CI -15.0 - 21.1, p=0.74). Adjusted for age, BMI, history of hypertension, history of diabetes, and age at menarche and menopause, there was a positive association between SHBG and AIS (OR 1.04, 95%CI 1.004-1.071, p=0.03). Conclusions: Our pilot study demonstrates the feasibility of enrolling newly admitted AIS patients and controls among postmenopausal women in the catchment area of our comprehensive stroke center. To understand initial findings of a positive association between SHBG and AIS, work is ongoing to measure estrogens and androgens at study baseline and all hormones in follow-up specimens (3-6 months post stroke).

Abstract TMP34: Association Of Post-stroke Cognitive Impairment With Long-term Patient-reported Outcome Measures

Introduction: Post-stroke cognitive impairment/dementia (PSCID) is highly prevalent and associated with poor long-term outcomes after acute ischemic stroke (AIS). Recognition of early determinants of PSCID allows for individualized interventions to reduce long-term disability. Furthermore, investigating the relation between PSCID and patient-reported outcomes provides insight into personalized impact of post-stroke cognitive dysfunction. We aimed to identify clinical determinants of PSCID and association with patient-reported outcome measures (PROMs) at 3- and 12-month after AIS. Methods: 138 AIS patients with no previous history of dementia were included. Clinical variables were acquired on hospital admission. Patients underwent a telephone interview at 3- and 12-months post-stroke including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI) and PROM-10 questionnaires. PSCID was defined as TICS &lt; 36 at 12-month post-stroke. Linear regression analyses were performed to identify predictors of 12-month TICS score and association with 3- and 12-month PROMs. Results: At 12 months post-stroke, 113 participants (82%) had PSCID. AIS patients with PSCID had higher rates of mRS ≥ 2 at 3-months (61.8% vs. 32%, p = 0.01), worse BI at 12-months (93.12 vs. 102, p &lt; 0.01) and lower 12-month PROMs T Mental scores (48.22 vs. 52.41, p &lt; 0.05). In linear regression analysis, worse functional and patient-reported outcomes at 3- and 12-months were independently associated with lower 12-month TICS (Table) . Conclusions: Large proportion of AIS patients experience PSCID at 12-months after stroke. 3-month PROMs, especially in the physical domain, are independently associated with worse cognitive measures at 12-months post-stroke. Moreover, PROMs at 12-months after AIS are strongly associated with PSCID. Incorporating PROMs in the ambulatory setting may offer additional insight into cognitive impairment after stroke.

Abstract TP105: Intra-individual Blood Pressure Variability For The Duration Of Hospitalization And Subsequent Clinical Outcome After First-ever Ischemic Stroke

Background: The association of in-hospital blood pressure variability (BPV) with readmission or survival after acute ischemic stroke (AIS) have not been fully investigated. We evaluated the relationship between intra-individual systolic blood pressure (SBP) variability (SBPV) for the duration of hospitalization, mean SBP, maximal SBP reached and readmission-free survival, all-cause readmission, or all-cause mortality to one year after hospitalization for a new acute ischemic stroke (AIS). Methods: We measured mean SBP, maximal SBP reached, and SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) across a median of 16 SBP readings per patient, every 4 hours, for the duration of hospitalization in 862 patients (age (mean±SD) 75±15 years, 55% females) with AIS admitted from 2003 to 2018, followed-up to 2019. Results: At 1 year, readmission-free survival was 51%, readmission rate was 39%, and mortality was16%. The mean ± SD in mmHg for SBP 146±20, maximal SBP reached 163±26, SD 16±6, and CV 10±5. Adjusted hazard ratios for the highest vs. lowest quartiles of SD or CV were 1.44 (95% confidence interval 1.04 - 1.81) or 1.29 (0.94 - 1.64) for readmission-free survival; 1.29 (0.9 - 1.78) or 1.29 (0.94 - 1.78) for readmission; 1.15 (0.71 - 1.87) or 0.86 (0.55 - 1.36) for mortality. The results remained consistent with mean SBP. However, maximal SBP was inversely associate with readmission-free survival. The accompanying figure shows Kaplan-Meier survival analysis of cumulative incidence of three outcomes by quartiles of SD (upper panel) and CV (lower panel) of SBP. Conculsions: Among patients hospitalized with a new AIS, higher in-hospital SBPV was associated with no decrease in readmission-free survival or increase in rates of readmission or mortality to 1 year. We recommend less emphasis on treating blood pressure and more focus on guideline-directed high-value care for the management AIS patients.

Abstract WMP57: Brain Frailty Mediates The Relationship Between Age And 90-day Functional Outcome After Endovascular Therapy: Analysis Of The Escape-na1 Trial

Introduction: Age is a predictor of functional outcome after acute ischemic stroke (AIS). Frailty increases with age and comorbidities, and imaging markers of brain-frailty (e.g. atrophy, small-vessel-disease) are associated with outcomes. However, the extent to which the association of age and 90-day outcome is mediated by brain-frailty is unknown. We explored this mediation in AIS patients receiving endovascular therapy (EVT), with a particular interest in neuroimaging. Methods: In this post-hoc analysis of the ESCAPE-NA1 trial, in which all patients underwent EVT, we assessed brain atrophy (subcortical/cortical), white-matter disease (periventricular/deep) and the number of lacunes and chronic infarctions. Structural equation modelling (SEM) was used to create 3 latent variables: “imaging-frailty” (above-mentioned markers), “clinical-frailty” (e.g. pre-stroke mRS, cardiovascular risk factors, cancer) and “total-frailty” (imaging + clinical markers). We created 3 models ( figure1) including each latent variable as a potential mediator of the association of age and 90-day outcome, adjusting for baseline ASPECTS, NIHSS, onset-to-puncture-time, nerinetide and alteplase. Results: Among 1,092 patients, the indirect effect of age on 90-day outcome, mediated by imaging-frailty, contributed 96% of the total effect(β=0.047;p=0.02), while the indirect effect through clinical-frailty accounted for only 21%(β=0.01;p=0.001) of the total effect. When including both frailty constructs, the indirect pathway accounted for 86% of the total effect(β=0.06;p&lt;0.01). These proportions were similar when imaging features were assessed on MRI. Conclusions: Brian frailty mediates the association of age and 90-day outcome after EVT, with most of the effect mediated by imaging as opposed to clinical markers of frailty. This work underscores the importance of considering brain-frailty, as opposed to chronological age alone, in predicting post-stroke outcomes.

Effects of Hyperferritinemia on Functional Outcome in Acute Ischemic Stroke Patients with Admission Hyperglycemia

Introduction: Hyperferritinemia, presented as elevated serum ferritin level, is an indicator of high iron status which plays roles in secondary brain injury after acute ischemic stroke (AIS). However, the effects of hyperferritinemia and poor outcomes remain uncertain. Additionally, admission hyperglycemia quite frequently accompanies AIS patients, which is associated with unfavorable outcome. Thus, we aimed to investigate the effects of hyperferritinemia on 3-month and 1-year functional outcomes in AIS patients and especially those with admission hyperglycemia. Methods: AIS patients within 24 h of onset were enrolled at West China Hospital from October 2016 to December 2019. Serum ferritin and blood glucose levels were tested on admission. Poor functional outcome at 3 months and 1 year was defined as modified Rankin Scale score ≥3. Multivariable analysis was used to investigate the associations between hyperferritinemia and 3-month and 1-year outcomes. Subgroup analysis was performed in patients with and without hyperglycemia. Results: Of 723 patients (mean age 68.11 years, 60.6% males) finally included, 347 (48.0%) had hyperferritinemia. The incidence of poor outcome was 45.2% at 3 months and 41.2% at 1 year. Patients with hyperferritinemia had a higher frequency of poor 3-month outcome (51.8% vs. 39.2%, p = 0.001) and poor 1-year outcome (46.8% vs. 36.1%, p = 0.004). In all AIS patients, hyperferritinemia was not independently associated with poor functional outcome at 3 months or 1 year after adjusting for confounders (all p > 0.05). In AIS patients with hyperglycemia, hyperferritinemia was an independent factor correlated with poor 3-month outcome (OR = 1.711, 95% CI 1.093–2.681, p = 0.019) but not with poor 1-year outcome (p > 0.05). Conclusions: High iron status, presented as hyperferritinemia, is associated with poor 3-month functional outcome in AIS patients with hyperglycemia. Evaluating serum ferritin level may be conducive to assess the risk of short-term poor outcome in AIS patients with hyperglycemia. Further studies will be required to confirm our findings.

Serum inflammatory cell adhesion molecules predict malignant cerebral edema and clinical outcome early after mechanical thrombectomy in stroke

BackgroundEarly prediction of life-threatening malignant cerebral edema (MCE) after mechanical thrombectomy (MT) is of clinical importance. Although inflammatory cell adhesion molecules (CAMs) and anti-inflammation factor Kruppel-like transcription factor (KLF) 4 are induced after acute ischemic stroke (AIS), the relationship between expressions of these molecules after MT and MCE as well as outcome in AIS patients have rarely been explored. MethodsWe retrospectively reviewed the data of all AIS patients with large-vessel occlusion in anterior circulation who underwent MT from our stroke centers. The serum levels of CAMs and KLF4 were determined at 12 h after MT. MCE was assessed on follow-up head computed tomography within 5 days after MT. ResultsOf 91 included patients, 18 (19.8 %) patients experienced MCE. Patients with MCE were more likely to have higher levels of E-selectin and inter-cellular adhesion molecule 1 (ICAM-1) than those without MCE (P < 0.05). More specifically, elevated E-selectin, but not of vascular cell adhesion molecule 1 (VCAM-1), ICAM-1 and KLF4, was significantly associated with MCE after adjusting for hypertension, admission NIHSS, Alberta Stroke Program Early CT Scores, serum glucose, collateral circulation and onset to recanalization time respectively (P < 0.05). ROC curve suggested that E-selectin had considerable discrimination to predict MCE (AUC=0.7, 95 % CI: 0.55–0.83). Moreover, after adjusting by confounders, serum levels of E-selectin and ICAM-1 were independently associated with 3-month outcome in AIS patients after MT (both P < 0.05). ConclusionsThese data indicate that of three CAMs, serum E-selectin level early after MT is the best predictor for MCE and outcome in AIS.

Swallowing function after acute ischemic stroke: Development and validation of a novel clinical prognostic model.

BackgroundPredicting the duration of dysphagia after acute ischemic stroke (AIS) is important for clinical treatment decisions.ObjectiveThe purpose of this study is to assess the swallowing function of AIS patients and to develop and validate a prognostic model for the need for nasogastric tube (NGT) in these patients.Materials and methodsWe included 554 AIS patients during 2018–2019 as the development group and had 186 AIS patients as the external validation group. The primary end point of the study was the retention of NGT in patients 1 week after admission (Functional Oral Intake Scale ≤ 4). Swallowing function and stroke-associated pneumonia (SAP) at 1 month post-onset were also the objectives of this study. The volume-viscosity swallow test (V-VST) was used to assess the patient’s impaired swallowing function. The Predictive model was built by logistic regression.ResultsOverall, a total of 104 patients required indwelling NGT at 1 week of AIS onset in development group. The final prognostic model includes 5 variables: age (OR: 1.085, 95%CI: 1.049–1.123), neutrophil-to-lymphocyte ratio (NLR) (OR: 1.332, 95%CI: 1.090–1.626), NIHSS (OR: 1.092, 95%CI: 1.025–1.164), history of drinking (OR: 2.532, 95%CI: 1.452–4.417) and stroke location (Subtentorial vs. Supratentorial, OR: 1.954, 95%CI: 1.088–3.509). The prediction model had an AUC of 0.810, while the external validation group was 0.794.ConclusionIn stroke patients, it is very important to decide early whether to indwell a NGT. The nomogram will support decision making for NGT insertion and help these patients recover from their condition.