Search Results for: L'imaging nella urolitiasi

Introduction
A quarter of breast cancers show human epidermal growth factor-2 (HER2) overexpression, where targeted therapy dramatically improves survival. However, cancer therapy-related cardiac dysfunction (CTRCD) occurs in up to 15% of patients. With the interruption of HER2 therapy, if necessary, and the initiation of heart failure therapy (HFT), HER2 CTRCD recovers in over 80% of cases. The need to continue HFT in ‘recovered’ HER2 CTRCD following completion of HER2 therapy is unclear and there are potential significant impacts on patient’s quality of life (QoL). The Randomised Controlled Trial for the Safety of Withdrawal of Pharmacological Treatment for Recovered HER2 Targeted Therapy Related Cardiac Dysfunction (HER-SAFE) aims to evaluate whether HFT can be safely withdrawn in non-high cardiovascular (CV) risk patients with ‘recovered’ HER2 CTRCD.

Methods and analysis
This is a multicentre, open-label randomised controlled trial investigating whether withdrawal of HFT is non-inferior to continuation in non-high CV risk, breast cancer survivors with recovered HER2 CTRCD after cancer treatment completion. The primary endpoint is the incidence of guideline-defined cardiac dysfunction or clinical heart failure. Secondary endpoints include changes in cardiac blood biomarkers, cardiovascular magnetic resonance (CMR)-derived strain and tissue mapping and heart failure symptom questionnaires. The study will recruit 90 participants who will undergo serial clinical assessment over 12 months with advanced cardiovascular imaging (CMR scans with automated analysis at baseline, 6 and 12 months), cardiac biomarker measurement (six time points over 12 months), plus complete heart failure QoL and medication disutility questionnaires. This is the first multicentre study to address this significant clinical issue.

Ethics and dissemination
This study was approved by the research ethics committee (London—London Bridge, 23/LO/0152). The results will be disseminated in peer-reviewed scientific journals.

Trial registration number
NCT05880160.

Functional lumen imaging probe (FLIP) Panometry provides assessment of the esophagogastric junction (EGJ) opening and esophageal body contractile activity during an endoscopic procedure and is increasing being incorporated in comprehensive esophageal motility assessments. We aimed to provide a standardized approach and vocabulary to the procedure and interpretation and update the motility classification scheme.

Many medical schools offer courses designed to “train the eye,” bringing students and physicians into museums to look carefully at art. Just as for decades images of artworks graced the covers of JAMA, reminding us medicine is an art while stimulating our visual imaginations, such courses invite us to describe accurately what we see. The implications for physicians, from dermatologists who must recognize rashes based on appearance to radiologists who must discern patterns on imaging to make diagnoses, are perhaps more obvious than the subtleties of perspective and composition. The same kind of close attention is characteristic of poetry, as the poem “Joanne” vividly demonstrates: the keenly observed details are striking and reveal more than mere depictions of objects and people. The comparison between the pink gown the speaker is given to wear in the mammography suite and the sunset enveloping Joanne is not just lovingly rendered, but also evokes the vulnerability and need for comfort undergoing evaluation of a breast lump engenders. The recurring colors of pinks and reds suggest not just searching for warmth and reassurance, but also returning for repeated surveillance. The speaker scrawling “I wuz here” on a childhood chalkboard is at once startlingly clear-eyed, but also reminds us how, when we identify with patients, we ourselves may feel as exposed and helpless as children. Ultimately, it is not just opening our eyes to see what is before us that encounters with art and poetry teach, but also that the very act of close observation sparks empathy.

Circulation, Ahead of Print. BACKGROUND:Dilated cardiomyopathy (DCM) appears to be diagnosed twice as often in male than in female patients. This could be attributed to underdiagnosis in female patients or sex differences in susceptibility. Up to 30% of cases have an autosomal dominant monogenic cause, where equal sex prevalence would be expected. The aim of this systematic review, meta-analysis, and population study was to assess the sex ratio in patients with DCM, stratified by genetic status, and evaluate whether this is influenced by diagnostic bias.METHODS:A literature search identified DCM patient cohorts with discernible sex ratios. Exclusion criteria were studies with a small (n

Introduction
Stroke is a major cause of acquired disability globally, yet the neural mechanisms driving motor recovery post-stroke remain elusive. Recent research has underscored the growing significance of subcortical pathways in neural plasticity and motor control. Among these, the cortico-reticulospinal tract (CRST) has gained attention in rehabilitation due to its unique ascending and descending structural features as well as its cellular properties which position it as an excellent candidate to compensate for inadequate motor control post-stroke. However, the optimal strategies to harness the CRST for motor recovery remain unknown. Non-invasive modulation of the CRST presents a promising though challenging, therapeutic opportunity. Acoustic startle priming (ASP) training and intermittent theta burst stimulation (iTBS) are emerging as potential methods to regulate CRST function. This study aims to investigate the feasibility of segmentally modulating the cortico-reticular and reticulospinal tracts through ASP and iTBS while evaluating the resulting therapeutic effects.

Methods and analysis
This is a randomised, blinded interventional trial with three parallel groups. A total of 36 eligible participants will be randomly assigned to one of three groups: (1) iTBS+ASP group, (2) iTBS+non-ASP group, (3) sham iTBS+ASP group. The trial comprises four phases: baseline assessment, post-first intervention assessment, assessment after 3 weeks of intervention and a 4-week follow-up. The primary outcomes are the changes in the Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale after the 3-week intervention. Secondary outcomes include neurophysiological metrics and neuroimaging results from diffusion tensor imaging and resting-state functional MRI.

Ethics and dissemination
The trial is registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400085220) and Medical Ethics Committee of Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology (Registration No.TJ-IRB20231109). It will be conducted in the Departments of Rehabilitation Medicine and Radiology at Tongji Hospital in Wuhan, China. The findings will be disseminated through peer-reviewed journal publications and presentations at scientific conferences.

Trial registration number
ChiCTR2400085220.

Objective
To examine longitudinal trends in infertility management in women attending general practice.

Design
Cohort study using the national general practice dataset, MedicineInsight.

Setting
Australian general practice.

Intervention(s)
Not applicable.

Participants
The cohort included 2 552 339 women aged 18–49 years with one or more general practice clinical encounters between January 2011 and December 2021.

Primary and secondary outcome measures(s)
The primary outcome assessed was the proportion of women who had a clinical encounter related to infertility, stratified by year and age group. Second, the proportions of women receiving relevant clinical management actions, including selected pathology tests, imaging ordered and selected medications, were calculated. Univariable logistic regression analyses compared the likelihood of women having a documented clinical encounter related to infertility and receiving selected management actions based on individual characteristics. We also examined practice-level variation in the proportion receiving selected management for infertility by stratifying proportions based on practice site.

Results
A total of 2 552 339 women had one or more clinical encounters with their general practitioner (GP) between January 2011 and December 2021, of which 27 671 (1.1%) had a clinical encounter related to infertility management. The rate of infertility encounters increased from 3.4 per 1000 in 2011 to 5.7 per 1000 in 2021. Over episodes of care, half (50.9%) of women presenting for an infertility encounter had at least one specified pathology test, and almost a quarter (23.1%) had a specified imaging test. A relatively small proportion of infertility encounters (5.4%) resulted in prescribing of a selected infertility medication by the GP.
Large variation in clinical management (pathology, imaging and medication prescribing) was evident according to both individual characteristics and also at the clinical-practice level. Factors associated with increased likelihood of being provided infertility medications included younger age, holding a Commonwealth concession card (indicating low income), lower socioeconomic status and living outside a major city.

Conclusions
Clinical encounters related to infertility are increasing in primary care, with large variation evident in corresponding clinical management. These findings support the development of clinical practice guidelines to enhance standardised and equitable approaches towards the management of infertility in primary care.

This cohort study assesses the feasibility and safety of a community-based magnetic resonance imaging (MRI) diagnostic strategy in men with suspected prostate cancer using 3-year active monitoring.

Introduction
Postsurgical hypoparathyroidism (PoSH) is an iatrogenic condition that occurs as a complication of several different procedures with thyroid surgery being the most common. PoSH has significant short- and long-term morbidities. The volume of thyroid surgery is increasing, and PoSH is therefore likely to increase. Some studies have shown promising results using near-infrared fluorescence (NIRF) imaging in reducing the risk of PoSH which has the potential to significantly reduce morbidity and costs associated with monitoring and treatment.

Methods and analysis
NIFTy is an unblinded, parallel group, multicentre, seamless phase II/III randomised controlled trial in patients undergoing total or completion thyroidectomy. The trial incorporates a process evaluation (IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up framework) 2a) to inform the trial protocol, a phase II (IDEAL 2b) analysis using a surrogate primary outcome of 1 day transient hypocalcaemia to determine early futility and phase III (IDEAL 3) assessment of the primary outcome of PoSH at 6 months after surgery. 454 participants will be randomised on a 1:1 basis to evaluate thyroid surgery with NIRF and indocyanine green against standard thyroid surgery in reducing PoSH at 6 months after surgery, with the phase II analysis occurring once data are available for 200 participants. Analysis in both phases will be using multilevel logistic regression incorporating random effects with respect to surgeon and adjusting for minimisation factors. Phase III secondary outcomes include protracted hypoparathyroidism, hypercalcaemia, complications, length of stay, readmissions and patient reported quality of life using the Short Form 36 Health Survey Questionnaire and Hypoparathyroid Patient Questionnaire instruments.

Ethics and dissemination
NIFTy is funded by National Institute for Health and Care Research Efficacy and Mechanism Evaluation Programme (Grant Ref: 17/11/27) and approved by a Research Ethics Committee (reference: 21/WA/0375) and Health Research Authority (HRA). Trial results will be disseminated through conference presentations, peer-reviewed publication and through relevant patient groups.

Trial registration number
ISRCTN59074092.

Stroke, Volume 56, Issue Suppl_1, Page ATMP33-ATMP33, February 1, 2025. Introduction:Acute ischemic stroke (AIS) with large vessel occlusion (LVO) benefits from mechanical thrombectomy (MT), but the majority of Americans require interhospital transfer for MT. Thrombolysis at the spoke hospital with the patient transferred to the hub for MT is a model known as “drip-and-ship.” In contrast, “mothership” patients present directly to MT capable centers and have immediate access to MT. We sought to evaluate the effects of thrombolysis dwell time (time for the drug to work) and drip-and-ship versus mothership status on recanalization rates.Methods:Among 385 patients who received thrombolysis for AIS at our academic comprehensive stroke center from January 1, 2023 to June 30 2024, 76 patients had LVO and repeat vessel imaging available to evaluate for recanalization status. Thrombolysis dwell time was defined as the timefrom administration of thrombolysis to repeat vascular imaging. Recanalization was defined as complete resolution of the occlusion. Partial recanalization was defined as some recanalization (i.e. M1 transformed into M2). Patients without vascular imaging or without repeat vessel imaging were excluded. Data was collected on demographics, last known normal time (LKN), National Institutes of Health Stroke Scale (NIHSS), thrombolysis administration time, and repeat vascular imaging results.Results:Among 76 AIS LVO patients, the mean age was 68.8 years (range, 25.1 to 96.8), and 40 (52.6%) were women. The mean initial NIHSS was 14.7 (range, 0 to 34). Twenty-three (30%) were mothership and 53 (69.7%) were drip-and-ship. The mean time from LKN to thrombolysis was 2.2 hours (range, 0 to 4.9). The site of LVO occlusion was as follows: 56 (76.7%) M1, 8 (10.5%) M2s occlusions, 5 (6.6%) carotid terminus, 5 (6.6%) basilar, and 2 (2.6%) PCA occlusions. In 69 (90.8%), repeat vascular imaging was cerebral angiogram. There were 7 (9.2%) complete recanalization, and 20 (26.2%) partial recanalization. Mothership status was associated with lower rates of partial recanalization (8.7% vs 34%, p 0.016) and shorter mean thrombolysis dwell time (0.9 hours vs 2.7 hours, p < 0.0001) compared to drip-and-ship status.Conclusions:In LVO AIS patients who receive thrombolysis, drip-and ship status is associated with higher partial recanalization rates and longer thrombolysis drug dwell time compared to mothership status. This may impact strategy for recruitment of sites in clinical trials.

Stroke, Volume 56, Issue Suppl_1, Page AWP189-AWP189, February 1, 2025. Background:Imaging definitions of large core infarction are highly variable. Here, we assess the performance characteristics of non-contrast head CT versus CT perfusion at predicting final infarct volume (FIV) in patients with large core acute ischemic stroke (AIS) undergoing endovascular therapy (EVT).Methods:From our prospectively collected multi-center registry across four comprehensive stroke centers (CSC) in the Greater Houston area, we identified patients from 2017 to 2023 with LVO AIS who received EVT. FIV was defined using MRI DWI at 48 hours. Large infarct core was defined by CTP as exceeding 70 ml or by CT ASPECTS < 6. Kappa statistics assessed agreement between NCHCT ASPECTS, and CTP-RAPID predicted core values (rCBF < 30%). Receiver operating characteristic (ROC) analyses were used to compare the ability of NCHCT ASPECTS and CTP Core to identify large core infarct populations against MRI FIV.Results:Among 264 patients with LVO AIS who underwent thrombolysis and met the inclusion criteria, median NIHSS was 16 [IQR, 11-20], MRI FIV was 17.67 [IQR, 6.53-56.45], ASPECTS was 8 [IQR, 6-9], CTP-RAPID predicted core was 6.5 [IQR, 0-29]. 15.2% of patients had an MRI FIV greater than 100 ml. CTP Core measurements and NCHCT ASPECTS agreed 87.5% of the time, with a kappa statistic of 0.3346 (p-value < 0.0001). In 33 cases with discordant results between CTP Core and NCHCT ASPECTS, MRI FIV identified 21 patients as having a large core, aligning with CTP Core but not NCHCT ASPECTS. Conversely, in 12 patients, MRI FIV agreed with NCHCT ASPECTS but not with CTP Core. Both NCHCT ASPECTS and CTP Core showed moderate accuracy in identifying large core infarcts, with similar AUC values of 0.63. Additionally, both methods demonstrated similar discriminatory power (AUC = 0.62) in identifying patients with a modified Rankin Scale (mRS) score of 0-3 after adjusting for age and NIHSS. Sensitivity analysis confirmed similar discriminatory power between NCHCT ASPECTS and CTP Core in identifying large core infarcts (ROC = 0.62) and mRS 0-3 (ROC = 0.59) after adjusting for age and NIHSS, with an 86.58% agreement rate (p-value < 0.001).Conclusions:Both NCHCT ASPECTS and CTP core volumes are similarly effective in distinguishing large core infarcts and predicting good outcomes suggesting that either NCHCT or CTP imaging techniques are equally useful for identifying patients with large core infarcts in clinical practice.

Stroke, Volume 56, Issue Suppl_1, Page AWP185-AWP185, February 1, 2025. Introduction:Branch atheromatous disease involving the lenticulostriate artery (LSA) is strongly associated with early neurological deterioration. We aimed to investigate whether an apparent thalamostriate vein (TSV) or brush sign on susceptibility-weighted imaging (SWI) can predict infarct growth.Methods:Consecutive patients with the small subcortical infarction of the LSA presenting within 24 h of onset were retrospectively evaluated. MRI, including SWI, was performed on admission and within 1 week of admission. An apparent TSV was defined as a difference in the diameter of the TSV between the right and left sides on SWI upon admission. Infarct growth was defined as an increase in infarct size on axial or coronal diffusion-weighted imaging from 1 point.Results:Of the 76 patients (median age, 76 [67.25–82] years, 48 male) with the small subcortical infarction of the LSA, 22 (median age, 75.5 [64.75–82.5] years, 13 male) presented with an apparent TSV and/or brush sign. On univariable logistic analysis, only the presence of apparent TSV and/or brush sign (OR, 3.12; 95% CI, 1.11–8.73;p=0.03) was associated with infarct growth. In multivariable logistic regression analysis, age (OR, 1.07; 95% CI, 1.01–1.14;p=0.02) and infarct growth (OR, 4.46; 95% CI, 1.37–14.54;p=0.01) were independently associated with progressive paralysis.Conclusion:An apparent TSV or brush sign could indicate infarct growth in cases of the small subcortical infarction of the LSA.

Stroke, Volume 56, Issue Suppl_1, Page AWP184-AWP184, February 1, 2025. Objective:High calcium (Ca), low phosphate(P), and Ca-P product (CPP) levels are associated with cardiovascular disease and coronary artery atherosclerosis in patients with chronic kidney disease. However, whether this relationship persists in individuals with carotid artery atherosclerosis of acute ischemic stroke is unknown. We investigated the association of serum Ca, P, and CPP to carotid artery atherosclerotic plaque assessed by high-resolution MR vessel wall imaging in acute ischemic stroke patients.Methods:A total of 251 ischemic stroke participants with carotid artery atherosclerosis (mean age 68 years old, male 80.1%) were consecutively included in a comprehensive stroke center. Serum Ca, and P were obtained from blood tests after admission, and carotid artery plaque characteristics including plaque burden and vulnerability were evaluated using high-resolution MR vessel wall imaging, then the association between serum Ca, P, CPP, and atherosclerosis plaque characteristics was analyzed in multi-variate linear or logistic regression analysis； Finally, the consistency was also explored in different subgroups.Results:The mean±SD of serum Ca and P in this population is 2.26±0.11 and 1.16±0.19 individually. Serum P and CPP were associated with carotid artery plaque burden, presented as maximum wall thickness (max WT), wall area, and lipid-rich necrotic core (LRNC), in univariate analysis, with β=-0.205，95% CI (-0.348,-0.061), β=-0.258，95% CI (-0.405,-0.113), OR=0.182, 95% CI (0.034,0.975) for P, and β=-0.203，95% (-0.346,-0.059), β=-0.221，95% CI (-0.366,-0.074), OR=0.466, 95% CI (0.237,0.915) for CPP, respectively. In multivariate regression analysis, after further correction of age, sex in model 1 and cardiovascular risk factors in model 2, P level is associated with wall area independently, β=-0.211, 95% CI (-0.367, -0.052), while CPP is associated with wall area marginally, with β=-0.147, 95%CI (-0.300, 0.008) in model 1, and β=-0.157, 95%(-0.314, 0.004) in model 2. In subgroup analysis, the independent relationship between P and wall area can still be consistent in age＞65 years (β=-0.222, 95%CI [-0.400, -0.011]), male (β=-0.219， 95%CI [-0.446,-0.045], and hypertension (β=-0.314， 95%CI [-0.513, -0.130] subgroups.Conclusion:Lower serum P was associated with increased carotid artery plaque burden presented with wall area, and this relationship could differ in different age, sex, and hypertension subgroups.

Stroke, Volume 56, Issue Suppl_1, Page ATMP34-ATMP34, February 1, 2025. Introduction:Stroke misdiagnosis is not uncommon and Black people have a higher odds of stroke misdiagnosis than White people. Little is known about the reasons for misdiagnosis or how diagnostic pathways lead to error.Hypotheses:To explore possible explanations for race differences in stroke diagnosis, we examine two hypotheses. First, to understand where diagnostic pathways may err we quantified, whether race predicted whether receipt of initial imaging (ie. CT/MRI), hypothesizing that black people receive less imaging. Second, amongst individual that receive imaging, we hypothesized that Black people will be less likely to receive stroke diagnoses or be admitted to the hospital.Methods:We used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2011-2021. Our primary study population was adults with any neurologic chief complaint, defined using reason for visit (RFV) data. Our primary exposure was Black race. For each outcome, we built unadjusted, minimally adjusted, and fully adjusted survey-weighted logistic regression models to predict outcomes: receipt of imaging, stroke diagnoses and hospital admission. The minimally adjusted model added age, sex, and insurance to race/ethnicity. The fully adjusted model added vital signs, arrival by ambulance, triage level, episode of care, vascular risk factors, prior vascular disease and RFV-based characterization of stroke probability.Results:The mean age was across the ~146,000 emergency room visits 47.8 ± 19.7 and black people comprised 24.9% of the sample. Amongst individuals with a neurologic RFV, black people were less likely to get a CT (OR 0.79, 95% CI 0.72-0.88), MRI (OR 0.64, 95% CI 0.47-0.89), or any imaging (OR 0.78, 95% CI 0.71-0.86 ) in the unadjusted model. These effects persisted or were strengthened in the fully adjusted model: Black race-imaging association (OR 0.67, 95% CI 0.45-0.99). Conditioned on receiving imaging after full adjustment, there was no association between Black race and stroke diagnoses (OR 1.1, 95% CI 0.63-1.9) or hospital admission for stroke (OR 1.19, 95% CI 0.46-3.08).Conclusion:We found that Black people were less likely to receive imaging when presenting with neurologic reasons for visit, but that conditioned on receiving imaging, there were no differences in stroke diagnosis or hospitalization. This suggests that race differences in stroke diagnosis likely occur at or prior to the time of initial imaging selection.

Stroke, Volume 56, Issue Suppl_1, Page AWP181-AWP181, February 1, 2025. Background:Timely intervention is crucial for patients with acute ischemic stroke. The RapidAI imaging system (RAPID) was implemented to enhance the speed and efficiency of care delivery. We evaluated the impact of RAPID on various metrics in the patient care pathway.Methods:In this retrospective observational study, we analyzed consecutive patients who presented to our hospital ER with acute ischemic stroke and who were treated with Intravenous Thrombolysis (IVT) or mechanical thrombectomy between December 20, 2014, and April 20, 2024. Patients were divided into pre-RAPID (n =186) and post-RAPID (n =264) groups based on the implementation date of the RAPID system (September 1, 2019). We compared Door to Non-contrast CT (NCCT), Door to CT Angiography (CTA) / Perfusion Imaging, Door to IVT, and Door to Puncture / first pass for thrombectomy, between the two groups using Fisher’s exact test.Results:For Door to CT, no significant difference was observed between pre-RAPID and post-RAPID groups; 74% of patients in the post-RAPID group and 71% in the pre-RAPID group received NCCT within 45 minutes (p= 0.44). Significant improvements were observed in Door to CTA/Perfusion times; 90% of patients received vessel or perfusion imaging within 150 minutes post-RAPID compared to 70% pre-RAPID (p= 0.01), and 87% received imaging within 120 minutes post-RAPID compared to 70% pre-RAPID (p= 0.031). For Door to IVT, 96% of patients received treatment within 120 minutes post-RAPID compared to 82% pre-RAPID (p= 0.015). For thrombectomy, there was a trend toward faster door to puncture post-RAPID; 70% of patients were treated within 150 minutes post-RAPID compared to 62% pre-RAPID (p= 0.36), and 90% were treated within 210 minutes post-RAPID compared to 81% pre-RAPID (p= 0.12). Similarly, a trend toward faster Door to First Pass times was observed post-RAPID, with 88% treated within 240 minutes compared to 80% pre-RAPID (p= 0.20).Conclusions:RapidAI Implementation was associated with significant improvements in key workflow metrics, notably in Door to Vessel/Perfusion Imaging and Door to IVT. These findings suggest that RAPID enhances the efficiency of patient care delivery in acute ischemic stroke. Further studies with larger sample sizes are warranted.

Stroke, Volume 56, Issue Suppl_1, Page ATMP38-ATMP38, February 1, 2025. Background:Randomized clinical trials have demonstrated that IV thrombolysis (IVT) can be administered safely in wake-up stroke (WUS) after MRI- or CT-based imaging selection to improve clinical outcomes. The objective of this study was to evaluate the utilization of IVT to treat WUS using a standardized WUS protocol across a healthcare system.Methods:A WUS protocol using MRI-based imaging selection was implemented across an academic healthcare system with 6 acute care hospitals in the state of Georgia. We prospectively identified all WUS patients who underwent the WUS protocol over a 12 month period through August 15, 2024. Patients were eligible for the WUS protocol if they presented with disabling symptoms identified on awakening, had a CT head without contrast showing no hypodensity to explain clinical symptoms and had CT angiography of the head and neck demonstrating no large vessel occlusion as a cause of symptoms. All patients underwent expedited brain MRI sequences (DWI, T2w FLAIR, GRE) without contrast and IVT was administered at the discretion of the treating neurologist.Results:During the study period, the WUS protocol was activated for 27 patients of which 6 (22%) received IVT (median NIHSS 10, IQR 5-15). Reasons for not receiving IVT included lack of DWI-FLAIR mismatch on MRI (n=11), DWI negative MRI (n=8), IVT declined by patient (n=1) and IVT contraindication (n=1). A modified Rankin scale of 0-1 at 90 days was achieved in 67% of WUS patients treated with IVT and no symptomatic intracerebral hemorrhages. Door-to-needle time within 60 minutes was significantly less likely in WUS compared with non-WUS cases (0% vs 69%, p=0.001). IVT administration in WUS patients made up 2% of all acute ischemic stroke patients receiving IVT.Conclusions:An MRI-based WUS protocol was able to identify a small subset of acute ischemic stroke patients who met eligibility criteria for IVT outside of the 4.5 hour time window. IVT was associated with good clinical outcomes and not associated with any complications.

Stroke, Volume 56, Issue Suppl_1, Page ATP312-ATP312, February 1, 2025. Background/Objectives:Perioperative stroke is a significant cause of morbidity and mortality in patients undergoing cardiac, vascular, and neurosurgical procedures. We assessed the rate, characteristics, risk factors and survival outcomes of perioperative stroke following surgical resection of glioma.Design:This is a retrospective chart review of a single quaternary care center of patients with glioma between 2005-2021 who underwent resection. Stroke within 30 days of surgical resection was identified based on the radiology read of MRI brain for ischemic stroke and CT brain for hemorrhagic stroke that was obtained as part of clinical care. This was then confirmed retrospectively by a neurologist who reviewed imaging and medical records, excluding expected post-operative changes. Descriptive analysis and logistic regression were conducted. Overall survival was estimated with Kaplan-Meier methods from the date of surgery to death and compared with the log rank test.Results:Out of 738 patients who underwent surgical resection of their glioma and underwent brain MRI or CT head, 20 (2.71%) had radiographic evidence of strokes, with the mean (SD) time from surgery to stroke 5.4 (16.2) days. Of these, 13 (65%) had ischemic strokes, 7 (35%) had hemorrhagic strokes. Out of all perioperative strokes, 9 (45%) were symptomatic (total incidence of 1.2%), and 11 (55%) were asymptomatic. Patients who had a stroke were older [mean (SD); 60.4 (13.7) vs. 52.8 (15.0) years; p=0.026], had a higher rate of atrial fibrillation (p= 0.002), and had comorbid hyperlipidemia (p=0.039) and hypertension (p=0.047). Descriptive analysis of this cohort is summarized in Table 1. Older age, carrying a diagnosis of atrial fibrillation, and having hyperlipidemia were associated with higher odds of having a perioperative stroke (Table 2). In an attempt to generate a multivariate logistic model, stepwise selection yielded no significant results likely due to the low number of strokes in this cohort. The median survival for patients with stroke was 24.6 months (95% CI:21.8-32.1), which was lower than for patients who did not suffer a stroke (29.3 months, 95% CI: 25.6-32.9) (p=0.052).Conclusion:Older age, atrial fibrillation, hyperlipidemia, and hypertension were associated with perioperative stroke risk after glioma resection. Future studies should evaluate underlying mechanisms and stroke etiologies to better identify high risk patients.