Stroke Database Research Articles

Neuroimaging markers of early neurological deterioration in acute isolated pontine infarction.

Imaging indicators of early neurological deterioration (END) in patients with acute isolated pontine infarctions (AIPI) remained ambiguous. We aimed to find more specific neuroimaging markers for the development of END in patients with AIPI. Patients with AIPI within 72 h of stroke onset were screened from a stroke database from January 2018 to July 2021 in the First Affiliated Hospital of Zhengzhou University. Clinical characteristics, laboratory tests, and imaging parameters were collected. The layers having the largest infarct area on diffusion-weighted imaging (DWI) and T2 sequences were chosen. On the transverse plane of DWI and sagittal plane of T2-Flair images, the maximum length (a, m) and maximum width (b, n) vertical to the length of the infarcted lesions were measured respectively. On the sagittal plane of T2-Flair image, the maximum ventrodorsal length (f) and rostrocaudal thickness (h) were measured. On the sagittal plane, lesions were evenly split into upper, middle, and lower types based on the lesion's location in the pons. The ventral and dorsal types of location were separated based on whether the ventral borders of the pons were involved on transvers plane. END was defined as a ≥2 point increase in the National Institutes of Health Stroke Scale (NIHSS) total score or a ≥1 point increase in the motor items within 72 h after admission. Multivariate logistic regression analyses were used to explore risk factors associated with END. The receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) was performed to estimate the discriminative power and determine the optimal cut-off points of imaging parameters on the prediction of END. A total of 218 patients with AIPI were included in the final analysis. END occurred in 61 cases (28.0%). Multivariate logistic regression analysis showed that the ventral type of lesion location was associated with END in all models adjusted. In addition, in Model 1, b (odds ratio (OR) 1.145, 95% confidence interval (95% CI), 1.007-1.301) and n (OR 1.163, 95% CI 1.012-1.336); in Model 2, b*n (OR 1.010, 95% CI 1.002-1.018); in Model 3, n (OR 1.179, 95% CI, 1.028-1.353); and in Model 4, b (OR 1.143, 95% CI 1.006-1.298) and n (OR 1.167, 95% CI 1.016-1.341) were found to be associated with END respectively after different adjustments. ROC curve analysis with END showed that the AUC, the optimal cut-off value, and its sensitivity and specificity were 0.743 (0.671-0.815), 9.850 mm, and 68.9% and 79.0% for b; 0.724 (0.648-0.801), 10.800 mm, and 57.4% and 80.9% for n; and 0.772 (0.701-0.842), 108.274 mm2, and 62.3% and 85.4% for b*n, respectively (b*n vs b: P =0.213; b*n vs n: P =0.037; b vs n: P =0.645). Our study revealed that besides the ventral type of lesion location, the maximum width of lesion on the transverse plane of DWI and sagittal plane of T2 image (b, n) may be imaging markers for the development of END in AIPI patients, and the product of the two (b*n) showed a better prediction value on the risks of END.

Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes.

There are limited data from the Middle East on sex-related differences in short- and long-term stroke outcomes. We present 8 years of experience based on the Qatar stroke database. The Qatar stroke database prospectively collects data on all stroke patients admitted to Hamad General Hospital. For this study, we compared female and male acute ischemic stroke patients on their characteristics at admission, short-term outcomes [modified Rankin Scale (mRS) score], and long-term outcomes [incidence of major adverse cardiovascular events (MACEs)]. A total of 7,300 patients [F: 1,406 (19.3%), M: 5,894 (80.7%); mean age 55.1 ± 13.3 (F: 61.6 ± 15.1, M: 53.5 ± 12.3; p < 0.001)] were admitted with acute ischemic stroke. Significantly fewer women presented within 4.5 h of onset (F: 29% vs. M: 32.8%; p = 0.01). Although women were more likely to experience severe stroke (NIHSS >10; F: 19.9% vs. M: 14.5%; p < 0.001), fewer were treated with thrombolysis (F: 9.8% vs. M: 12.1%; p = 0.02). Women experienced more medical complications (F: 11.7% vs. M: 7.4%; p < 0.001) and tended to have a more prolonged length of stay in the hospital (F: 6.4 ± 7.6 days vs. M: 5.5 ± 6.8 days; p < 0.001). Good outcomes at 90 days (mRS score of 0-2) were less frequent in women (F: 53.3% vs. M: 71.2%; p < 0.001). Fewer female patients were taking antiplatelets (F: 78% vs. M: 84.8%; p < 0.001) or statins (F: 81.2% vs. M: 85.7%; p < 0.001). Significantly more female patients experienced a MACE (F: 12.6% vs. M: 6.5%; p < 0.001). Older age at presentation contributes to poor outcomes following acute stroke in women. Other contributing factors include delays in admission to the hospital, lower rates of thrombolysis, and lower rates of provision of preventative treatments.

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy.

The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age- and sex-matched patients with first-ever ischemic strokes without PSE after 90days served as controls for the VLSM analysis. The stroke database contained 809 patients (mean age: 68.4±14.2years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p<.05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.

Diagnostic Yield of Extended Cardiac Patch Monitoring in Cryptogenic Stroke Patients (P11-5.032)

<h3>Objective:</h3> To evaluate the diagnostic yield of detecting atrial fibrillation (AF) and/or atrial flutter (AFL) with extended cardiac patch monitoring in our cryptogenic stroke population. <h3>Background:</h3> Cryptogenic stroke accounts for 15–40% of yearly strokes with increased incidence in younger patients. It is standard of care at our comprehensive stroke center located in the stroke belt to discharge cryptogenic stroke patients with a 14-day continuous cardiac monitoring patch (Zio) to evaluate for paroxysmal AF/AFL. <h3>Design/Methods:</h3> We propose to conduct a retrospective chart review from January 2019 to June 2022 (3.5 years) of all adult stroke patients with a discharge diagnosis of ischemic stroke using the Get With The Guidelines stroke database at our institute. We will be analyzing all cryptogenic stroke patients who were discharged with a Zio patch. The following data points will be collated; demographics, baseline stroke risk factors, left atrium volume, Zio patch results including wear time, analyzed time, AF burden, duration the first episode of AF detected, patient events, and other irregular arrhythmias. Our preliminary data from January 2021 to June 2022 (18 months), observed 270 cryptogenic stroke discharges. Out of which, 165 met the eligibility criteria and were discharged with a Zio patch. <h3>Results:</h3> AF/AFL was detected in 14 patients (8.5%). The mean duration before the first episode of paroxysmal AF (PAF) was 3.7 days and the median duration was 1.5 days. 43 percent of PAF occurred after 48 hours. <h3>Conclusions:</h3> The preliminary data demonstrated a relatively low yield of AF/AFL detection with Zio patch monitoring in our cryptogenic stroke population. We plan to complete the prespecified data collection period to achieve a larger sample size and further analyze independent risk factors for AF/AFL detection and patient compliance. <b>Disclosure:</b> Dr. Rice has nothing to disclose. Dr. Lucioni has nothing to disclose. Mr. Aiello has nothing to disclose. Dr. Ranasinghe has nothing to disclose.

Women and Stroke: Disparities in Clinical Presentations, Severity, and Short and Long-Term Outcome (P6-5.003)

<h3>Objective:</h3> There is limited data on sex-related short-term and long-term stroke outcomes from the Middle East. We present the eight years of our Qatar stroke database. <h3>Background:</h3> NA <h3>Design/Methods:</h3> The Qatar stroke database is a prospective study, which began enrolling patients in 2014. We collected data on the demographics, clinical presentation, investigations, treatments, hospital complications and outcome (measured as 90-days modified Rankin Score [mRS]) on all patients admitted with acute stroke to the Hamad General Hospital where ~95% of stroke patients in Qatar are admitted. Multivariate analysis of risk factors, stroke type and severity, and in-hospital complications were compared to determine 90-days and one-year outcome in men and women. <h3>Results:</h3> 7300 patients (F: 1406 {19.3%} and M: 4894 {80.7%}, mean age 55.1±13.3 {F 61.6±15.1, M 53.5±12.3; p&lt;0.001}) were admitted with acute ischemic stroke. Significantly fewer females presented within the 4.5 hours of onset [F: 29% versus M: 32.8%; p = 0.01]. Women had more severe stroke [NIHSS &gt;10; F: 19.9 % versus M: 14.5 %; P &lt;0.001]. Thrombolysis was less likely to be offered to women [F: 9.8% versus M: 12.1%; p 0.02]. Medical complications were more common in women [F: 11.7% versus M: 7.4%; p&lt;0.001] and females had a prolonged length of stay in hospital [F: 6.4±7.6 versus M: 5.5±6.8; p&lt;0.001]. 90-days good recovery was less frequent in women [mRS of 0–2: F: 53.3% versus M: 71.2%; p&lt;0.001]. Poor prognosis increased with age. <h3>Conclusions:</h3> In this large series of prospectively collected acute stroke patients from Qatar, our study reveals that women are more likely to have a poor outcome when compared to men. Although there was a higher incidence of obesity and previous CAD in women, we were unable to explain the reasons for the poor outcome at 90 days and one year. <b>Disclosure:</b> Ms. Naveed has nothing to disclose. Miss Almasri has nothing to disclose. Mr. Kazani has nothing to disclose. Miss Nauman has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Al Jerdi has nothing to disclose. Dr. Akhtar has nothing to disclose. Dr. Shuaib has nothing to disclose.

90-Days Outcomes In Patients With Minor Strokes Or Transient Ischemic Attacks Discharged On Single Vs Dual Anti Platelet-Therapy In the Middle East (P7-5.019)

<h3>Objective:</h3> To compare the 90-day outcome in patients with minor stroke (MIS) or transient ischemic attack (TIA) who were discharged on single versus dual anti-platelet therapy after index event in the multiethnic Middle Eastern community. <h3>Background:</h3> Recent studies have shown that dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is effective for secondary prevention after minor ischemic stroke (MIS) or transient ischemic attack (TIA). However, there is paucity of data from middle east regarding role of such intervention and outcome of these patients <h3>Design/Methods:</h3> We inquired all Ischemic stroke and TIA patients from our prospectively collected stroke database admitted since January 2014. We separated them into two groups-discharged on single(SAP) vs DAPT. High risk group for recurrence was defined as patients with ABCD2 score of ≥ 4 or more and NIHSS ≤ 3 at index event. We assessed the outcome as measured with modified Rankin Score (mRS), recurrent ischemic stroke, and other vascular events. <h3>Results:</h3> The data provided yielded 1357 (16.8%) patients with TIAs and 6725 (83.2%) with MIS. Of these only 35% (1481/4219) of high risk patient were discharged on DAPT (38.5% of TIA patients and 30.0% MIS patients). DAPT was initiated within 24 hours of arrival at hospital in 86.3% of patients (p&lt;0.001) with a mean duration of 12.5 ±15.6 hours (p&lt;0.001). Poor outcome (mRS 3–6) (27.9% vs 15.1%, p&lt;0.001), and increased mortality (2.2% vs 1.1%, p&lt;0.001) was more significant in patients discharged on SAP versus DAPT. <h3>Conclusions:</h3> The rates of DAPT in patients with TIA and MIS is low. Patients with high risk TIA and MIS discharged on DAPT has better outcome at 90-days in ethnically diverse group of patients in the Middle East. <b>Disclosure:</b> Ms. Naveed has nothing to disclose. Dr. Akhtar has nothing to disclose. Dr. Shuaib has nothing to disclose. Dr. Al Jerdi has nothing to disclose.

Outcome of Lacunar vs Non-lacunar Infarcts in a Prospective Stroke Database (P14-5.029)

<h3>Objective:</h3> To prospectively compare recovery outcomes, presentation with NIH stroke scale and modified ranking scale (MRS) in the study population with follow up at discharge. <h3>Background:</h3> Earlier studies suggested lacunar stroke has a better prognosis compared to other strokes, but recent studies show prognosis of lacunar stroke is simiar or worse when compared to large strokes. <h3>Design/Methods:</h3> We prospectively collected demographic information, admission NIH stroke scale, and modified ranking scale with serial measurements during hospitalized course in single tertiary care hospital in six-month period(n=74). We also collected information on discharge disposition between lacunar and non-lacunar stroke groups. Two groups adjusted for sex and race. Independent t-test is used for comparing continuous variables and chi-square test for comparing categorical variables. <h3>Results:</h3> There were 30 lacunar stroke patients and 44 non-lacunar stroke patients with mean age of 60 years for lacunar stroke patients and 70 for non-lacunar stroke patients. Mean admission NIH stroke scale was 11 in the non-lacunar group with MRS of 0.4 compared to 6 (p= 0.009) and 1(p=0.006), respectively in the lacunar group. Discharge NIH and MRS values were 7 and 2.3 respectively for the non-lacunar group compared to 4(p=0.03) and 2.2(p=0.88) for the lacunar group. ΔNIH (admit-discharge) is 4 and 2 for non-lacunar and lacunar group, respectively. ΔMRS (admit-discharge) is −1.9 and −1.3 for non-lacunar and lacunar group, respectively. Discharge to home was 46.7% &amp; 37% (p=0.03) in non-lacunar group and lacunar group, respectively. Discharge to Skilled nursing facility was 13.3% and 18.5%(p=0.03) in non-lacunar group and lacunar group, respectively. <h3>Conclusions:</h3> Despite the relatively small volume of infarct associated with lacunar stroke compared to typically large infarcts seen with non-lacunar stroke, we found that the outcome was similar if not worse in terms of recovery for lacunar type stroke based upon prospective information collected in our six-month database extending from May 2021 to November <b>Disclosure:</b> Dr. Buchhanolla has nothing to disclose. Dr. PANDEY has nothing to disclose. Dr. Bir has nothing to disclose. Dr. Javalkar has nothing to disclose. Dr. Kelley has nothing to disclose.

111 Improved Functional Outcomes of Stroke Patients Undergoing Mechanical Thrombectomy After Arriving via Mobile Stroke Unit

INTRODUCTION: Mobile stroke units (MSUs) have been implemented worldwide for stroke care, but outcome data is lacking to show their efficacy specifically in patients undergoing mechanical thrombectomy (MT). METHODS: A retrospective review of a stroke database was performed to identify patients who underwent MT after arrival via MSU from August 2019 to December 2020. Demographic factors, past medical history, stroke characteristics, treatment variables, complications, and functional outcomes were recorded. These were compared to date-matched patients who underwent MT after arrival via conventional means. RESULTS: Seven patients were treated with MT after arriving by MSU. These were compared to 50 date- matched patients who underwent thrombectomy after arrival through conventional means. No statistically significant difference between cohorts was observed in terms of demographic variables, co-morbidities, stroke characteristics, or tPA administration. Patients from the MSU cohort had significantly shorter time from symptom onset to groin puncture time (191.33 mins ± 77.53 vs 483.51 mins ± 322.66, p = 0.034). Importantly, MSU-transferred patients had significantly better discharge functional status measured by modified Rankin Scale (mRS) (1.86 ± 1.35 vs 3.57 ± 1.88, p = 0.024). No significant difference in final TICI score, complications, length of stay, or mortality was observed. CONCLUSIONS: Our pilot study demonstrates the efficacy of the MSU in decreasing door-to-puncture time and a concordant improvement in discharge mRS. Further prospective studies are needed to assess cost-efficacy and optimal protocol for MSUs in stroke care.

Impact of sex in stroke in the young.

Limited data is available on sex differences in young stroke patients describing discrepant findings. This study aims to investigate the sex differences in young stroke patients. Prospective cohort study comparing risk factors, etiology, stroke localization, severity on admission, management and outcome in patients aged 16-55 years with acute ischemic stroke consecutively included in the Bernese stroke database between 01/2015 to 12/2018 with subgroup analyses for very young (16-35y) and young patients (36-55y). 689 patients (39% female) were included. Stroke in women dominated in the very young (53.8%, p<0.001) and in men in the young (63.9%, p<0.001). As risk factors only sleep-disordered breathing was more predominant in men in the very young, whereas arterial hypertension, diabetes and atrial fibrillation did not differ in women and men older than 35y. The higher frequency of stroke in women in the very young may be explained by the sex specific risk factors such as pregnancy, puerperium, the use of oral contraceptives, and hormonal replacement therapy. Stroke severity at presentation, etiology, stroke localization, management, and outcome did not differ between women and men. The main finding of this study is that sex specific risk factors in women may contribute to a large extent to the higher incidence of stroke in the very young in women. Important modifiable stroke risk factors, such as arterial hypertension, diabetes mellitus and atrial fibrillation did not differ in women and men, either in the young as well as in the very young. These findings have major implications for primary preventive strategies of stroke in young people.

Current status and future aspects in the Japan Stroke Data Bank.

The Japanese National Plan for the Promotion of Measures Against Cerebrovascular and Cardiovascular Diseases was formulated on October 27, 2020. One purpose of this plan was to promote research on cerebrovascular and cardiovascular diseases. Therefore, it is necessary to clarify the actual status of stroke treatment in Japan and operate a national stroke database with high public interest completely and accurately. The Japan Stroke Data Bank (JSDB; https://strokedatabank.ncvc.go.jp/en/) was established by the Ministry of Health, Labor and Welfare Scientific Research in Shimane University (Shimane, Japan) in 1999 and was transferred to the National Cerebral and Cardiovascular Center (Osaka, Japan) as a part of the Cardiovascular Disease Registry in 2015. More than 200,000 of stroke cases have been registered using individual forms from more than 100 nationwide stroke centers over ~20 years. Since there are few large-scale stroke registries with nationwide coverage in Asia, including Japan, compared with those in Europe and North America, the role of the JSDB in the plan will be important in the future. To construct a high-quality stroke registry, we aimed to (1) collect detailed data through individual questionnaires for each participating stroke center, (2) link to external databases (e.g., insurance claims and public death registries), (3) improve the quality of treatment at participating hospitals through benchmarking, and (4) obtain stable funding through sustained support from government and academic societies. We also describe the history of the JSDB and changes in the trend of real-world stroke treatment in Japan based on the results of analysis of data in the JSDB.

Abstract Number ‐ 188: Rescue Stenting for Intracranial Stenosis In ELVO patients Using Neuroform Atlas Stent Through Gateway Balloon

Introduction Management of acute large vessel occlusion due to intracranial stenosis remains challenging with high complication and poor recanalization rates. Morbidity is also related to the intracranial exchange that is required for stent placement after the rescue angioplasty. We aim to present our initial experience of deployment of Neuroform Atlas stent through the lumen of a Gateway angioplasty balloon to avoid microcatheter exchange. Methods Patients were identified from prospectively collected mechanical thrombectomy stroke database from Feb 2019 to July 2021. Demographic and clinical information was collected. Primary outcomes were favorable functional outcome at hospital discharge (modified Rankin Scale (mRS) score of 0–3), and the rate of intracranial hemorrhage (ICH). Good angiographic recanalization (TICI ≥ 2b), and mortality at 30 days were other outcomes. Results We identified 5 patients treated with this approach [mean age 54 ± 14 years, all were men] who presented with large vessel occlusion of middle cerebral artery. Initial median NIHSS was 8 (range 6–16) with one patient received IV t‐PA. Patient initially underwent mechanical thrombectomy using the Solumbra technique. Due to reocclusion or impending occlusion with evidence of atherosclerotic plaque, rescue angioplasty with stent placement was performed. Patients were loaded with 650 mg of aspirin and 180 mg of ticagrelor through nasogastric tube prior. Balloon angioplasty was performed using the gateway balloon size ranging from 1.5 to 3 mm which was inflated to subnominal pressures over 1 minutes. This was followed by placing Neuroform atlas stent through the gateway balloon with size ranging from 3 to 4 mm diameter and length ranges from 21–24 mm. TICI ≥ 2b was achieved in 4 patients. Mean time from symptoms onset to revascularization was (336 ± 90) minutes. One patient had asymptomatic ICH. 2 patients had mRs 0–3 at the time of discharge and one patient was dead at 1 month Conclusions Our preliminary experience showed lower risk of guidewire perforation as well as potentially decreased operative time and early reperfusion by deploying the Neuroform stent through a compatible gateway balloon microcatheter. This should be investigated further in a large multicenter study

Abstract TP192: Compared To Men, Women Have Worse Outcome In Acute Stroke: An Eight-years Prospective Study From Qatar

Hypothesis: There is considerable evidence that women have poor outcome following acute stroke when compared to men. We report our experience from a large prospective stroke database from Qatar. Methods: The Qatar stroke database is a prospective study, which began enrolling patients in 2014. We collected data on the demographics, clinical presentation, investigations, treatments, hospital complications and outcome (measured as 90-days modified Rankin Score [mRS]) on all patients admitted with acute stroke to the Hamad General Hospital where ~95% of stroke patients in Qatar are admitted. Multivariate analysis of risk factors, stroke type and severity, and in-hospital complications were compared to determine 90-days and one-year outcome in men and women. Results: There were 7300 stroke patients (women:1406 [19.3%], men:5894 [80.7%] admitted between 2014-2021. Multivariate analysis revealed significantly higher rates of obesity (OR 2.51), increasing age (age&gt;65 years [OR 3.79]) and atrial fibrillation (OR 1.26) in women, p&lt;0.001. In women, thrombolysis was less frequent and poor outcome (mRS 3-6) was more frequent (OR 1.62, p&lt; 0.001) after adjustment for risk factors, stroke severity and in-hospital complications. The one-year mortality was significantly higher in women (11.7% versus men: 5.1%, p&lt;0.001). Conclusions: In this large series of prospectively collected acute stroke patients from Qatar, our study reveals that women are more likely to have a poor outcome when compared to men. Although there was a higher incidence of obesity and previous CAD in women, we were unable to explain the reasons for the poor outcome at 90 days and one year.

Abstract 101: Direct Transfer To Angiosuite Versus Ct Scanner On Arrival To Endovascular Capable Centers; More Risks Or More Benefits

Background and Objectives: Endovascular therapy (EVT) is standard treatment for large vessel occlusion strokes. To reduce inter-hospital times, most patients are usually transferred directly to the angio suite (DTAS) but some transfers are initially taken to the CT scanner (DTCT) to re-evaluate. The objective of our study is to compare outcomes in patients DTAS vs DTCT. Methods: This is retrospective study of LVO stroke from 2017 to 2021 transferred to our CSS from outside hospitals for mechanical thrombectomy (MT). Recruitment was done from the University of Toledo/Promedica stroke database and specific variables were included from chart review. Patients were divided into two cohorts, DTAS and DTCT. Results were calculated with SPSS software. Results: Total of 246 patients were transferred from an outside hospital for MT, 55.6% patients were DTAS vs 44.3% patients to DTCT. There was no significant difference between basic demographics. In both groups, most common vessels involved were M1 (38.4% vs 39.4%), followed by M2 (25.4% vs 29.4%) then ICA terminus (19.6% vs 16.5%). DTAS had significant shorter door to puncture time (35 vs 62 mins, p=0.03), onset to recanalization time (346 vs 583 mins, p=0.012) and onset to groin puncture (329 vs 557 mins, p&lt;0.01). There was no statistically significant difference in puncture to recanalization between two groups (35.6 vs 22.8, p=0.05). Successful MT (mTICI ≥2b) was more in DTAS vs DTCT (91.9% vs 86.9%, p=0.02). At discharge, DTAS group had more decrement in NIHSS, compared to presentation and discharge (Δ13, NIHSS 18.1 to 5) compared to DTCT group (Δ9, NIHSS 16 to 7). Both groups had statistically non-significant rates of functional dependence at discharge (mRS 0-2, 18% vs 13%, p=0.23), at 90 days (mRS 0-2, 35% vs 36%) and mortality at 90 days (34% vs 36%, p=0.56). Rate of complications in DTAS vs DTCT, hemorrhagic transformation (29.1% vs 23.9%, p=0.23) and intracranial hemorrhage (5.2% vs 8.3%, p=0.54) was not significant. Conclusion Our study concluded that DTAS has better reperfusion rates, time matrices and decrement of NIHSS compared to DTCT. Functional outcomes at discharge, 90 days and mortality at 90 days was not significantly difference between two groups.

Abstract TMP5: Intravenous Thrombolysis Influence After Successful Mechanical Thrombectomy For Large Vessel Occlusion; Not To Skip Tpa Yet!

Background: Despite the high rates of successful reperfusion in the randomized mechanical thrombectomy (MT) trials, only 27% of large vessel occlusion (LVO) patients treated successfully with MT achieved functional independence at 90 days. One proposed theory is impaired distal reperfusion with persistent small thrombi within the microcirculation despite complete recanalization “the no-Reflow phenomenon”. These distal small thrombi would be more suitable to dissolve by thrombolytics. Methods: This is a retrospective cohort obtained from Get with the guidelines stroke (GWGS) database available at Medical University of South Carolina Comprehensive Stroke Center (CSC) for LVO patients presented within 4.5 hours of last known well (LNW) between January/2018- June/2022. We aim to investigate the influence of intravenous thrombolysis (IVTPA) on the functional independence mRS (0-2) after a successful MT defined as modified thrombolysis score (mTICI2c-3). Results: Of 188 LVO patients who achieved successful reperfusion (TICI2c-3) during the study period, 93 (49%) arrived at our CSC within 4.5 hours of LSW, of them 40 patients (43%) received IVTPA. There was no difference in age, gender, race and initial NIHSS between patients who received IVTPA and those who did not receive IVTPA. Patients received IVTPA arrived at the CSC earlier [median LNW 60 min IQR (51 - 151) vs 165 min (IQR 103- 214), p = &lt;0.001), and had higher ASPECTS score [median 9, IQR (8-10) vs 7, IQR (7-10) p= 0.027]. There was no difference in the collaterals score, clot burden score, site of LVO, tandem nature, door to reperfusion times, post-procedural intracranial hemorrhage or stroke etiology between the two groups. Discharge functional independence mRS (0-2) was achieved more in IVTPA group 65% vs 42% p= 0.025. After adjusting for ASPECTS score, IVTPA patients had higher odds of achieving mRS (0-2) at discharge compared to patients who did not receive IVTPA within 4.5 hours of LNW [aOR 2.42, 95%CI (1.02- 5.75), p= 0.046]. Conclusion: Intravenous thrombolysis can still influence LVO stroke patients' outcomes with complete revascularization. This positive effect might be related to distal microthrombi thrombolysis and subsequent improvement of the microcirculation flow beyond the occlusion site

Abstract WP157: Prognostic Impact Of Pulse Pressure At Admission On Functional Outcomes Post-thrombectomy For Acute Ischemic Stroke

Introduction: Prior studies showed that pulse pressure (PP) correlates with cerebral collateral status, but the prognostic impact of widened PP on thrombectomy outcomes following acute ischemic stroke (AIS) is unclear. We hypothesized that patients with AIS undergoing thrombectomy with a presenting PP of &gt; 60 on admission would be less likely to have successful revascularization and have worse functional outcomes. Methods: Patients treated with a thrombectomy from our institutional retrospective stroke database between 2018 to 2022 were included. Patient demographics and post-thrombectomy outcomes were analyzed using nonparametric t-tests and Chi-Square analysis, with variables &lt;0.20 p-value being included in regression analysis. Results: Of the 134 AIS patients, 60% had a PP &gt; 60. Patients with PP &gt; 60 were older [age 77 (interquartile range (IQR) 68-87) vs 67 (IQR (57-78), p&lt; 0.0001]. There was no difference in the distribution of sex [male 53% vs 52%, p=0.94], M1 occlusion [56% vs 58%, p=0.78], time from last known well to arterial access [306 min (IQR 155-764) vs 242 min (IQR 155-583), p=0.61], NIHSS [17 (IQR 10-23) vs 18 (IQR 11-22), p=0.90], thrombolysis [40% vs 40%, p=0.97], in patients with PP &gt; 60 vs those with a PP ≤ 60 respectively. Discharge mRS was 4 (IQR 4-5) in patients with PP &gt; 60 vs 4 (IQR 4-4) in patients with PP ≤ 60, p=0.02. In this study, 40% lacked a discharge mRS, and no significance was found on 90-day mRS [PP &gt; 60 4 (IQR 2-5) vs 3 (IQR 3-4) PP ≤ 60]. A trend of more patients with PP ≤ 60 having TICI2B/TICI3 was found [75% vs 87%, p=0.06]. In regression analysis, patients with PP &gt; 60 were less likely to have TICI2b/TICI3 after controlling for age [OR 0.23 (95% CI 0.06 - 0.70), p=0.02], but no significant association was found with discharge mRS. Conclusions: The impact of PP on collateral flow in AIS and functional outcome should be studied further in larger AIS cohorts.

Abstract 5: Malignant Venous Outflow Profile Predicts Futile Recanalization After Endovascular Thrombectomy.

Objective: To explore the association of baseline venous outflow from the occluded cerebral territory and futile recanalization (FR) in patients with acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation. Methods: Consecutive patients from a prospectively maintained stroke database were included in this study if they presented with a multimodal CT-confirmed LVO in the anterior circulation and underwent thrombectomy within 24 hours after stroke onset. Excellent recanalization of the occluded artery, defined as final mTICI 2c-3 on digital subtraction angiography, was considered to be futile if patients fail to achieve functional independence (modified Rankin Scale of 0-2) at 90 days. Baseline venous outflow profile was determined by a 7-point semi-quantitative scoring system which assessed ipsilateral venous opacification of the vein of Labbe, Trolard and superficial middle cerebral vein on single-phase CTA source images. Hypoperfusion intensity ratio (HIR, defined as delay time &gt;6 seconds/delay time &gt;3 seconds) was applied to evaluate tissue-level collateral status. Results: 145 patients met the inclusion criteria. Multivariable logistic regression analysis showed that malignant venous outflow (OR 4.30 [95% CI 1.41-14.57]; p =0.013) was independently associated with functional dependence regardless of age, glucose, HIR, early neurologic deterioration, hemorrhagic transformation and final infarct volume. FR was observed in 24/52 (46%) recanalized patients. Stepwise logistic regression revealed a poor venous outflow profile at presentation as an independent predictor of FR (OR 7.04 [95% CI 1.29-50.16]; p =0.03) adjusted for baseline NIH Stroke Scale score, HIR and presence of hemorrhagic transformation. Conclusion: A malignant venous outflow profile at baseline is associated with FR in patients with LVO. The mechanism by which poor venous outflow from the occluded territory hinders clinical recovery despite prompt successful thrombectomy remains to be determined.

Abstract TP174: The Impact Of Serum Triglycerides On Stroke Severity And Prognosis. Analysis In 6558 Patients (2014-2022)

Hypothesis: Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller with HT. We explored the relationship between triglyceride and stroke risk factors, severity and outcome in a large prospective database. Methods: We interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between vascular risk factors, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with and without HT. Results: 6558 patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) with normal (&lt;1.7 mmol/L) in 4161 (63.4%) and high (≥1.7 mmol/L) in 2397 (36.6%) were analyzed. Patients with HT were younger (53.1 ±11.4 versus 55.4 ±13.6, p &lt;0.001), and had more diabetes, obesity, and active smoking. Stroke severity was higher with normal triglycerides (NIHSS: &lt;1.7 mmol/l - 5.5 ±5.6 vs. &gt;1.7 mmol/l - 4.4 ±4.6; p&lt;0.001). Lacunar stroke was more common with HT (53.4% vs. 45.7%, p&lt;0.001). mRS of 3-6 was more common with normal triglycerides (i.e. poorer outcome) at discharge (42% vs 35.5 p&lt;0.001) and 90-days (31.7% vs 25.5%, p&lt;0.001). Multivariate analysis showed that age, hypertension, HT, obesity, active smoking, and diabetes were independently associated with stroke severity. Conclusion: Onset of stroke occurs earlier in HT. The lower severity of symptoms and better prognosis evident with HT may in part be related to higher rates of lacunar stroke. Long-term MACE are however more frequently seen in HT subjects.

Abstract WP62: Skilled Nursing Facilities As A Bridge For Acute Rehabilitation In Acute Stroke Patients Who Are Not Immediate Candidates For Intensive Therapy

Background: Rehabilitation after hospital discharge is an essential component of stroke recovery. However, many stroke patients are not immediately ready for an Inpatient Rehabilitation Facility (IRF) after hospital discharge because of poor endurance, weakness, cognitive status, or medical condition. The purpose of this study is to demonstrate the efficacy of skilled nursing facilities (SNF) as a bridge to improve the number of post-stroke IRF admissions, and better understand the factors that allow transfer from a SNF to IRF by assessing differences between patients who are discharged from a SNF with vs. without an IRF referral. Methods: We included subjects with a primary diagnosis of ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage who were admitted to an urban CSC and discharged to a SNF from 1/2015 to 12/2021. Baseline demographics including gender, race, age, and risk factors were abstracted. Data were retrieved from both our EMR and Get With the Guidelines Stroke Database. Wilcoxon rank sum tests and chi square tests were used to analyze the data. Results: 1120 patients with a stroke diagnosis were discharged to a SNF, of which 173 (15%) received an IRF referral after SNF discharge. Nine to 19% (mean=15, SD=3) of SNF patients received an IRF referral between 2015 and 2021. Patients with an IRF referral were younger (mean age: 61.90, SD=14.05 vs 73.09, SD=12.12; p &lt; 0.0001). There were no statistically significant differences in length of stay, discharge mRS, and prevalence of hypertension, diabetes mellitus, coronary artery disease, dyslipidemia, heart failure, and smoking. Men more frequently received an IRF referral (20% vs 11%, p &lt; 0.0001). Racial differences in referral patterns were not significant (p = 0.19). Conclusions: SNFs are an effective bridge between the hospital and IRF settings, given that 15% of all stroke patients discharged to a SNF were ultimately referred to an IRF. SNFs should be considered as an alternate route for post-stroke patients who are not immediately ready for IRFs after hospital discharge but may still benefit from IRF therapy.

Abstract TP156: Neurological Outcomes After Perinatal Stroke: A Single Center Cohort Study

Introduction: Neurological outcomes in pediatric stroke survivors have been described in observational studies. The Pediatric Stroke Outcome Measures (PSOM) was the first tool validated in children to describe outcomes specifically in stroke (Kitchen et al, 2012). Patients diagnosed with a perinatal stroke comprised 24% of this cohort, while the remainder of patients had suffered from a childhood stroke. Most patients (~ 65%) had no or mild neurological deficits after 5 years of follow-up, represented with a total PSOM score of 0-1. We examined whether perinatal stroke patients would have similar trajectories to the outcomes previously described in pediatric stroke that occurred beyond the perinatal period. Methods: We conducted a retrospective review of our pediatric stroke database at Massachusetts General Hospital. Perinatal stroke survivors were identified, and data extracted from longitudinal follow-up clinic visits. PSOM scores were acquired at: discharge, visits between 2-4 years, 5-7 years, and beyond 7 years. Results: Patients who had endured a perinatal stroke with subsequent PSOM measures recorded were identified (N= 78). Neuroimaging was obtained in the neonatal period (n = 50) or at initial clinical presentation (n = 28; presumed perinatal stroke). Preliminary analyses show that perinatal stroke patients trended towards having increased PSOM scores over extended follow-up beyond 7 years from the index clinical encounter. Discussion: Interval monitoring will unmask deficits throughout development for perinatal stroke patients and can trend towards accrual of further neurological disability. This is in contrast with prior cohorts of childhood stroke where most patients endured stroke beyond the perinatal period and had total PSOM scores of 0-1 beyond 5 years of follow up. Further analyses are underway to establish effect of stroke mechanism, size, and laterality. Separate analyses to map lesion topography to structural and functional network disruptions that occur after perinatal stroke will be performed. Understanding the relationship between these disruptions and functional outcomes will aid in deficit prediction and trajectory modelling, to guide individualized interventions for the youngest of stroke survivors.

Factors Contributing to Complete Oral Intake in Dysphagic Stroke Patients with Enteral Feeding Tubes in Convalescent Rehabilitation Wards

This study investigated the factors contributing to complete oral intake (COI) in dysphagic stroke patients with enteral feeding tubes in the local clinical setting. Data of patients with percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NGT) feeding on admission to convalescent rehabilitation wards (CRWs) were extracted from the Kaga Regional Cooperation Clinical Pathway for Stroke database for multiple centers including 19 acute care hospitals and 11 hospitals with CRWs. Patients were divided into two groups based on their status regarding COI or incomplete oral intake (ICOI) at discharge. Logistic regression analysis with forced-entry variables was used to identify factors contributing to COI. On discharge from CRWs, COI and ICOI were observed in 140 and 207 cases, respectively. The COI group was younger, had a higher rate of initial stroke, higher Functional Oral Intake Scale (FOIS) scores, higher Functional Independence Measure (FIM) motor and cognitive scores, higher Body Mass Index (BMI), lower rate of patients with PEG, and shorter stays in acute care wards. Logistic regression analysis with forced entry revealed that younger age; initial stroke; higher FOIS score, FIM cognitive score, and BMI; and shorter stay in the acute care ward contributed to COI. The primary factors contributing to COI in dysphagic stroke patients with enteral feeding tubes were younger age, initial stroke, higher swallowing and cognitive function, good nutritional status, and shorter stay in the acute care ward.