After Acute Ischemic Stroke Research Articles

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.

Early or late initiation of dabigatran versus vitamin-K-antagonists in acute ischemic stroke or TIA: The PRODAST study.

The optimal timing of initiating or resuming anticoagulation after acute ischemic stroke (AIS) or transient ischemic attack (TIA) in patients with atrial fibrillation (AF) is debated. Dabigatran, a non-vitamin K oral anticoagulant (NOAC), has shown superiority against vitamin K antagonists (VKA) regarding hemorrhagic complications. In this registry study, we investigated the initiation of dabigatran in the early phase after AIS or TIA. PRODAST (Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA) is a prospective, multicenter, observational, post-authorization safety study. We recruited 10,039 patients at 86 German stroke units between July 2015 and November 2020. A total of 3,312 patients were treated with dabigatran or VKA and were eligible for the analysis that investigates risks for major hemorrhagic events within 3 months after early (⩽ 7 days) or late (> 7 days) initiation of dabigatran or VKA initiated at any time. Further endpoints were recurrent stroke, ischemic stroke, TIA, systemic embolism, myocardial infarction, death, and a composite endpoint of stroke, systemic embolism, life-threatening bleeding and death. Major bleeding event rates per 10,000 treatment days ranged from 1.9 for late administered dabigatran to 4.9 for VKA. Early or late initiation of dabigatran was associated with a lower hazard for major hemorrhages as compared to VKA use. The difference was pronounced for intracranial hemorrhages with an adjusted hazard ratio (HR) of 0.47 (95% confidence interval (CI): 0.10-2.21) for early dabigatran use versus VKA use and an adjusted HR of 0.09 (95% CI: 0.00-13.11) for late dabigatran use versus VKA use. No differences were found between early initiation of dabigatran versus VKA use regarding ischemic endpoints. The early application of dabigatran appears to be safer than VKA administered at any time point with regards to the risk of hemorrhagic complications and in particular for intracranial hemorrhage. This result, however, must be interpreted with caution in view of the low precision of the estimate.

Trends and In-Hospital Outcomes in Patients with Vocal Fold Paralysis after Ischemic and Intracerebral Hemorrhagic Stroke: A Propensity Matched 20-Year Analysis of the Nationwide Inpatient Sample

Laryngeal manifestations of stroke have been sparsely described in the literature, specifically vocal fold paralysis (VFP). This study aimed to identify the prevalence, characteristics, and in-hospital outcomes of patients presenting with VFP after acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). A query of the 2000-2019 Nationwide Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63) and ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for VFP on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. A total of 10,415,286 patients with AIS were included; 11,328 (0.1%) had VFP. Of 2,000,868 patients with ICH 2,132 (0.1%) had in-hospital VFP. Multivariable analysis revealed that patients with VFP after AIS were less likely to be discharged home (AOR 0.32; 95%CI: 0.18-0.57; p<0.001) and elevated total hospital charges (β coefficient=59,684.6; 95%CI=18,365.12-101,004.07;p=0.005). Patients with VFP after ICH were less likely to experience in-hospital mortality (AOR 0.53; 95%CI: 0.34-0.79; p=0.002) with longer hospital stays (1.99 days; 95%CI: 1.78-2.21; p<0.001) and elevated total hospital charges (β coefficient=53,905.35; 95%CI=16,352.84-91,457.85;p=0.005) CONCLUSION: Vocal fold paralysis in patients with ischemic stroke and ICH; although an infrequent complication, is associated with functional impairment, longer hospital stay, and higher charges.

Effect of different ventilation modalities on the early prognosis of patients with sleep apnea after acute ischemic stroke–––protocol for a prospective, open-label and randomised controlled trial

BackgroundSleep apnea is highly prevalent after acute ischemic stroke (AIS) and has increased stroke-related mortality and morbidity. The conventional sleep apnea treatment is continuous positive airway pressure (CPAP) ventilation. However, it is poorly tolerated by patients and is not used in all stroke patients. This protocol describes the impact of high-flow nasal cannula (HFNC) oxygen therapy compared to nasal continuous positive airway pressure (nCPAP) ventilation or usual care on the early prognosis of patients with sleep apnea after AIS.MethodsThis randomised controlled study will be conducted in the intensive care unit of the Department of Neurology at the Wuhan Union Hospital. According to the study plan, 150 patients with sleep apnea after AIS will be recruited. All patients are randomly allocated in a 1:1:1 ratio to one of three groups: the nasal catheter group (standard oxygen group), the HFNC group, and the nCPAP group. Patients receive different types of ventilation after admission to the group, and their tolerance while using the different ventilation is recorded. Patients will be followed up by telephone three months after discharge, and stroke recovery is recorded. The primary outcomes were 28-day mortality, the incidence of pulmonary infection and endotracheal intubation.DiscussionThis study analyses different ventilation modalities for early interventions in patients with sleep apnea after AIS. We will investigate whether nCPAP and HFNC reduce early mortality and endotracheal intubation rates and improve distant neurological recovery in patients.Trial registrationThis trial was registered at ClinicalTrials.gov (NCT05323266; 25 March 2022).

Nicotine Treatment Ameliorates Blood-Brain Barrier Damage After Acute Ischemic Stroke by Regulating Endothelial Scaffolding Protein Pdlim5.

Analysis of a National Institutes of Health (NIH) trial shows that cigarette smoking protected tissue plasminogen activator (tPA)-treated patients from hemorrhage transformation (HT); however, the underlying mechanism is not clear. Damage to the integrity of the blood-brain barrier (BBB) is the pathological basis of HT. Here, we investigated the molecular events of BBB damage after acute ischemic stroke (AIS) using in vitro oxygen-glucose deprivation (OGD) and in vivo mice middle cerebral artery occlusion (MCAO) models. Our results showed that the permeability of bEND.3 monolayer endothelial cells was significantly increased after being exposed to OGD for 2 h. Mice were subjected to 90-min ischemia with 45-min reperfusion, and BBB integrity was significantly damaged, accompanied by tight junction protein occludin degradation, downregulation of microRNA-21 (miR-21), transforming growth factor-β (TGF-β), phosphorylated Smad (p-Smad), plasminogen activator inhibitor-1 (PAI-1), and the upregulation of PDZ and LIM domain protein 5 (Pdlim5), an adaptor protein that has been shown to regulate TGF-β-Smad3 pathway. In addition, pretreatment with two-week nicotine significantly reduced AIS-induced BBB damage and its associated protein dysregulation via downregulating Pdlim5. Notably, AIS did not significantly induce BBB damage in Pdlim5 deficit mice, but overexpression of Pdlim5 in the striatum with adeno-associated virus produced BBB damage and associated protein dysregulation which could be ameliorated by two-week nicotine pretreatment. More important, AIS induced a significant miR-21 decrease, and miR-21 mimics treatment decreased AIS-induced BBB damage by decreasing Pdlim5. Together, these results demonstrate that nicotine treatment alleviates the AIS-compromised integrity of BBB by regulating Pdlim5.

Prevalence of myocardial injury in patients after acute ischaemic stroke according to standard criteria.

This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan-Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.

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.

Endovascular Thrombectomy Beyond 24 Hours from Stroke Onset: A Systematic Review and Meta-Analysis (S24.001)

<h3>Objective:</h3> To assess the safety and efficacy of endovascular thrombectomy (EVT) &gt;24-h and compare clinical outcomes with patients treated &lt;24-h. <h3>Background:</h3> Trials have demonstrated the benefit of EVT up to 24-hours after acute ischemic stroke (AIS) onset. Recently, real-world observational studies reported that EVT was effective and safe beyond 24-h from AIS onset with comparable outcomes to EVT within 24-h. <h3>Design/Methods:</h3> A systematic search was performed in MEDLINE and EMBASE for studies published from inception to July 2022. Studies including patients with AIS who received EVT beyond 24-h from stroke onset were selected. We also included patients treated with EVT (&gt;24-h and &lt;24-h) from our institutional retrospective data. Outcomes of interest included functional independence (90-day mRS 0–2), successful recanalization (mTICI 2b-3), symptomatic intracerebral hemorrhage (sICH), and all-cause mortality at 90 days. First, a single-arm meta-analysis (MA) of proportions was conducted for studies with EVT &gt;24-h. Then, we performed a comparative MA between the &lt;24-h and &gt;24-h groups to calculate pooled odds ratios (OR) for each outcome. Statistical heterogeneity across studies was assessed with I² statistics. <h3>Results:</h3> Five studies with 298 patients treated &gt;24-h were included. Functional independence rate was 39% (95%CI 27–54%; I²=68%) and successful recanalization rate was 79% (95%CI 75–83%; I²=0%). Mortality and sICH rates were 25% (95%CI 20–30%; I²=0%) and 6% (95%CI 4–9%; I²=0%), respectively. We included 3272 patients (&gt;24-h = 179; &lt;24-h = 3093) in the comparative analysis. There was no significant difference in functional independence (OR 0.76; 95%CI 0.41–1.32), successful recanalization (OR 0.6; 95%CI 0.44–1.0), and mortality (OR 1.18; 95%CI 0.7–1.9) rates between patients who underwent EVT &lt;24-h versus &gt;24-h. <h3>Conclusions:</h3> Our findings prove that EVT beyond 24-h is safe and effective. Also, this MA did not demonstrate a significant difference between EVT beyond and within 24-h from stroke onset regarding functional independence, successful recanalization, and mortality. <b>Disclosure:</b> Dr. Rodriguez-Calienes has nothing to disclose. Mr. Vivanco-Suarez has nothing to disclose. Dr. Galecio-Castillo has nothing to disclose. Cynthia Zevallos has nothing to disclose. Mr. Malaga has nothing to disclose. Dr. Farooqui has nothing to disclose. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for SVIN. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Siemens. The institution of Dr. Ortega Gutierrez has received research support from IschemiaView. The institution of Dr. Ortega Gutierrez has received research support from Medtronic.

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 P598: Highly Purified Eicosapentaenoic Acid Use Can Reduce Neurological Severity at the Onset of Ischemic Stroke in Patients With Hyperlipidemia

Introduction: Functional outcomes after acute ischemic stroke (AIS) are related to initial neurological severity (NS). Therefore, neuroprotective drugs against ischemic injury are promising. Not only statins but also eicosapentaenoic acid (EPA) have neuroprotective effects. Hypothesis: Highly purified EPA (hp-EPA) pre-stroke may reduce NS at the onset of AIS. Methods: We retrospectively included patients with AIS and hyperlipidemia admitted to our institution between July 2012 and March 2019 from the prospectively and consecutively enrolled institutional stroke registry database. Hyperlipidemia was defined as serum values of low-density lipoprotein cholesterol (LDL-C) at arrival ≥140 mg/dl or triglycerides ≥150 mg/dl. We excluded patients: (1) admitted to our institution 24 h after AIS onset, (2) who did not stay in the hospital, and (3) in whom dyslipidemia drugs pre-stroke except the hp-EPA were administered. We collected data on age; sex; pre-stroke statin use, antiplatelets, anticoagulants, antihypertensives, and antidiabetic drugs; serum albumin, glucose, glycated hemoglobin (HbA1c), cholesterol, triglycerides, and c-reactive protein levels; pre-stroke modified Rankin scale and the National Institutes of Health Stroke Scale (NIHSS) scores; stroke subtypes at admission; hospitalizations; and home discharge. We performed a multivariable linear regression analysis to identify significant variables of NIHSS scores at arrival. Results: Of the 2,199 patients with AIS and hyperlipidemia during the study period, 691 met our inclusion and exclusion criteria, their median age was 75 years, and 18 (2.6%) received pre-stroke hp-EPA. In patients with and without pre-stroke EPA use, the median NIHSS scores were one and three, respectively. Multivariable regression analysis showed that the glucose, mRS, age, LDL-C, and anticoagulants increased the NIHSS score, albumin, HbA1c, high-density lipoprotein cholesterol, antihypertensives, antidiabetic drugs, and hp-EPA use decreased the NIHSS score. Conclusion Pre-stroke hp-EPA use reduced NS at the AIS onset in patients with hyperlipidemia and without other dyslipidemia drugs.

Development and Validation of a Novel Score for Predicting Long-Term Mortality after an Acute Ischemic Stroke.

Long-term mortality prediction can guide feasible discharge care plans and coordinate appropriate rehabilitation services. We aimed to develop and validate a prediction model to identify patients at risk of mortality after acute ischemic stroke (AIS). The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular death. This study included 21,463 patients with AIS. Three risk prediction models were developed and evaluated: a penalized Cox model, a random survival forest model, and a DeepSurv model. A simplified risk scoring system, called the C-HAND (history of Cancer before admission, Heart rate, Age, eNIHSS, and Dyslipidemia) score, was created based on regression coefficients in the multivariate Cox model for both study outcomes. All experimental models achieved a concordance index of 0.8, with no significant difference in predicting poststroke long-term mortality. The C-HAND score exhibited reasonable discriminative ability for both study outcomes, with concordance indices of 0.775 and 0.798. Reliable prediction models for long-term poststroke mortality were developed using information routinely available to clinicians during hospitalization.

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 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 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.

Deep learning-based personalised outcome prediction after acute ischaemic stroke

BackgroundWhether deep learning models using clinical data and brain imaging can predict the long-term risk of major adverse cerebro/cardiovascular events (MACE) after acute ischaemic stroke (AIS) at the individual level...

Predictive Value of CT Perfusion in Hemorrhagic Transformation after Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Background: Existing studies indicate that some computed tomography perfusion (CTP) parameters may predict hemorrhagic transformation (HT) after acute ischemic stroke (AIS), but there is an inconsistency in the conclusions alongside a lack of comprehensive comparison. Objective: To comprehensively evaluate the predictive value of CTP parameters in HT after AIS. Data sources: A systematical literature review of existing studies was conducted up to 1st October 2022 in six mainstream databases that included original data on the CTP parameters of HT and non-HT groups or on the diagnostic performance of relative cerebral blood flow (rCBF), relative permeability-surface area product (rPS), or relative cerebral blood volume (rCBV) in patients with AIS that completed CTP within 24 h of onset. Data Synthesis: Eighteen observational studies were included. HT and non-HT groups had statistically significant differences in CBF, CBV, PS, rCBF, rCBV, and rPS (p < 0.05 for all). The hierarchical summary receiver operating characteristic (HSROC) revealed that rCBF (area under the curve (AUC) = 0.9), rPS (AUC = 0.89), and rCBV (AUC = 0.85) had moderate diagnostic performances in predicting HT. The pooled sensitivity and specificity of rCBF were 0.85 (95% CI, 0.75−0.91) and 0.83 (95% CI, 0.63−0.94), respectively. Conclusions: rCBF, rPS, and rCBV had moderate diagnostic performances in predicting HT, and rCBF had the best pooled sensitivity and specificity.