Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATMP57-ATMP57, February 1, 2025. Introduction:Literature demonstrates that nearly one-third of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) or severe stenosis arrive at the emergency room with mild symptoms, attributed to favourable collateral status. However, approximately 20~40% of patients with mild symptoms due to LVO or severe stenosis are at risk of early neurological deterioration (END) as a consequence of subsequent collateral failure post arrival. This study aimed to identify the difference of collateral patterns between mild stroke patients with END and those without.Methods:AIS patients presenting within 24 hours from last known well, with a baseline NIHSS≤5 and anterior circulation LVO or severe stenosis were included. Patients who underwent endovascular treatment before END were excluded. END was defined as an increase in total NIHSS≥4 or NIHSS≥2 for any item within 72 hours, without evidence of parenchymal hemorrhage. Collateral flow was rated as the Tan scale (leptomeningeal collaterals) and cerebral blood volume (CBV) index (cerebral blood flow reserve). A good leptomeningeal collateral score (goodCS) was defined as Tan scale≥2 (poorCS: Tan scale 6s lesion over the mean CBV of Tmax0.735 and poorCS (group 4) were most likely to present with END (logistic OR[95%CI]: 5.18[1.22,22.18] P=0.026).Conclusions:Higher CBVindex and poor leptomeningeal collaterals were independent predictors of END in patients with mild symptoms due to anterior circulation LVO or severe stenosis. Therefore, we hypothesize that though higher CBVindex reflects favorable collaterals at baseline, higher CBVindex combined with the absence of goodCS indicates insufficient blood flow reserve, leading to collapse of collateral flow during acute phase, therefore, the occurrence of END.

Stroke, Volume 56, Issue Suppl_1, Page ATP115-ATP115, February 1, 2025. Background:Mechanical thrombectomy (MT) as treatment for acute ischemic stroke (AIS) has demonstrated superior functional outcomes compared to intravenous thrombolysis (IVT). Yet AIS survivors often experience a range of unstudied post-stroke complications which negatively affect patient reported outcomes. To inform clinical practice, we assessed 90-day differences in the medical management of common stroke post-complications among patients treated with MT vs. IVT.Methods:A retrospective cohort of hospitalized AIS patients treated with IVT or MT were identified from Electronic Medical Records of 92 large healthcare organizations (01/2015-09/2024). Matched propensity scores were used to adjust for baseline differences across 36 factors. Outcomes included the use of medication(s) for the management of fatigue, spasticity, mood, sleep, seizure, neurogenic bowel&neurogenic bladder. Pre-specified subgroup analyses included differences in post-stroke sequelae management stratified by NIHSS scores of ≤9 (mild AIS) or >9 (moderate/severe AIS)&differences in post-stroke sequelae between AIS patients treated with MT vs MT + IVT.Results:The final cohort consisted of n=87,819 AIS patients treated with either IVT (n=82,534) or MT (n=5,285). PS matching resulted in 5,285 matched pairs with good balance across all baseline covariates. At 90-days, AIS patients treated with MT were more likely to receive medications for spasticity (RR: 1.15, 95%CI: 1.01, 1.31), mood (RR: 1.06, 95%CI: 1.01, 1.13)&neurogenic bowel (RR: 1.11, 95%CI: 1.09, 1.14) (Table 1). Approximately 7% (n=6,344) of AIS patients had NIHSS scores – PS matching resulted in 877 matched pairs with NIHSS ≤9&848 matched pairs with NIHSS >9. Following stratification, AIS patients treated with MT were significantly more likely to receive treatment of neurogenic bowel&bladder (Table 2). For the MT vs MT + IVT comparison, patients treated with MT were 5% less likely to receive treatment for neurogenic bowel RR: 0.95 (95%CI: 0.92, 0.99) among 1,900 matched pairs (Table 3).Discussion:Using real world data, AIS patients treated with MT (vs IVT) were more likely to receive treatment for spasticity, mood&neurogenic bowel. Among patients with documented NIHSS scores, differences remained significant for treatment of neurogenic bowel and bladder after stratifying by stroke severity. Healthcare providers should screen for these post-stroke sequelae, which substantially affect quality of life for AIS survivors.

Stroke, Volume 56, Issue Suppl_1, Page ATP360-ATP360, February 1, 2025. Introduction:Infections account for one-third of stroke deaths. Kynurenine pathway metabolites can modulate the immune response in other contexts. We previously reported a preliminary univariate analysis that showed only significantly elevated kynurenine concentrations among patients who developed a post-stroke infection (PSI), but no differences in other pathway metabolites. This study further characterizes the association between kynurenine and PSI.Methods:Using whole blood samples from acute ischemic stroke patients in the University of Colorado Emergency Medicine Specimen Bank, high throughput mass spectrometry determined kynurenine concentrations. Multivariable linear regression modeled the association between kynurenine and characteristics that could predispose patients to a PSI or alter kynurenine levels (age, sex, NIHSS score, time from sample collection to last known well, and a history of smoking, foley placement or mechanical ventilation, dysphagia, diabetes mellitus, immunosuppression, and chronic kidney disease). Multivariable logistic regression modeled the association between kynurenine and PSI while controlling for the above covariables.Results:Of 75 patients, 32% developed a PSI. Those without a PSI were similar in mean age (64.7+/-12.1years) and race (72.6% white) compared to those with a PSI (age: 69.5+/-13years; 58.3% white). However, patients varied in terms of sex (without PSI: 37.3% female; with PSI: 62.5% female; p=0.04), immunosuppression (without PSI: 5.9% immunosuppressed; with PSI: 20.8% immunosuppressed; p=0.05), and median NIHSS (without PSI: 3.3, IQR 3-7; with PSI: 6.5, IQR 6-7; p=0.03). Only age (point estimate 0.02, p=0.04) and history of chronic kidney disease (point estimate 7.57, p

Stroke, Volume 56, Issue Suppl_1, Page ATMP75-ATMP75, February 1, 2025. Funding:The INSIGHT Registry is funded by Penumbra.Introduction:Thrombi have shown to modify and be modified by their microenvironment throughout the pathogenesis of ischemic stroke. The molecular mechanisms by which this occurs and how it corresponds to symptomatic presentation is unknown. Here, we identify a transcriptomic signature in thrombi associated with increased NIHSS severity at presentation, suggesting a mechanistic role for immune clearance in clinical severity of ischemic stroke.Methods:The INSIGHT registry is a prospective, multicenter, multi-omic registry focused on elucidating the molecular underpinnings of stroke from analysis of clot and interarterial blood. RNA sequencing of 10,990 genes from 292 thrombi from patients undergoing thrombectomy was aligned, normalized, and residualized using Rsubread, edgeR, sva, and limma/voom. Signed co-expression modules were constructed using WGCNA, and each module eigengene (a measure of a module’s principal component) was correlated with NIHSS at presentation using Pearson’s correlation. Networks were visualized and analyzed in cytoscape. Hub genes were determined by number of undirected edges. Network enrichments were conducted using Gene Ontology biological processes and cellular components.Results:The mean NIHSS in this cohort was 15.14± 7.45. 3 co-expression modules out of 26 total modules detected in the data significantly inversely correlated with NIHSS at presentation. These networks corresponded to downregulation of neuronal activation (p=0.042), interferon signaling (p=0.039), and T cell activation (p=0.023), respectively. Major hub genes in each module includedKCNAB2,a potassium channel associated with epilepsy and implicated in susceptibility to poor stroke outcomes in aged mice brains,SRSF11,associated with cognitive decline,PNISR,associated with interferon signaling, andZAP70,associated with T-cell differentiation.Conclusion:The association of immune downregulation with increased NIHSS severity suggests that robust immune clearance may mitigate poor outcomes in ischemic stroke, and that thrombi-mediated modification of the local immune environment may exacerbate symptomatic presentation. Conversely, the association of major hub genes with known cognitive decline suggests that thrombi are modified by the neurovascular unit and neurons of surrounding tissues and post-thrombectomy sequencing may provide insight into the underlying health of the surrounding parenchyma.

Stroke, Volume 56, Issue Suppl_1, Page ATP104-ATP104, February 1, 2025. Introduction:Post-acute care (PAC) facilities across Iowa, Montana, Nebraska, and North Dakota are engaged in the American Heart Association’s Mission: Lifeline Stroke PAC Initiative, a quality improvement initiative focused on enhancing stroke rehabilitation through evidence-based practice. Participants across these states collaborate to improve patient care, identify gaps in current practices, and enhance stroke specific education.Purpose:In a 2023 survey of healthcare professionals (HCPs) in Iowa, 48% (n=120) of respondents identified professional education as a missing resource that could help them provide rehabilitation care to stroke survivors. Through the initiative, education was developed to address this identified need.Methods:A variety of free educational opportunities were offered throughout the Mission: Lifeline Stroke Initiatives. These included in-person stroke conferences and workshops, virtual learning modules, online courses, and discipline specific rehabilitation certifications. 760 HCPs participated in 12 different educational offerings across Midwest states. Attendees were surveyed to assess the perceived benefits of the offerings, utility to their current role, and improvements in knowledge and confidence providing rehabilitation care to stroke patients.Results:Following the completion of the educational offerings, 93 attendees completed a post-survey. The large majority of respondents reported they were extremely or mostly confident in identifying signs of a stroke (95%), describing common deficits after a stroke (96%), and implementing evidenced-based practices to address these deficits (90%). Most respondents agreed the trainings improved their knowledge of the relationship between treatment and stroke rehab patient outcomes (91%) and their understanding about key issues related to working with stroke rehab patients (91%). Overall, 78% of respondents reported they always or often use the knowledge and skills learned from the trainings and 95% were satisfied with the content of the trainings. Respondents also identified additional educational needs for cognitive rehabilitation strategies, aphasia interventions, caregiver education, community integration, and general stroke rehabilitation.Conclusions:Mission: Lifeline Stroke educational offerings benefitted HCPs by improving their knowledge and confidence to provide care to stroke patients. Education on additional stroke specific topics were also identified.

Stroke, Volume 56, Issue Suppl_1, Page ATP123-ATP123, February 1, 2025. Background:Around one in three strokes are experienced by people living with disability or dementia (PLWD), yet there is currently no consensus to guide physicians in evaluating baseline status in this patient population and determining goals of care. We sought to understand how physicians currently approach this complex issue and what challenges they encounter as a critical step towards informing evidence-based best practices for PLWD.Methods:Through separate recruitment strategies, we invited physicians involved in stroke care to participate in semi-structured, in-depth interviews and an online survey, inquiring into perspectives on evaluation and management of PLWD. Interviews were recorded, transcribed, and analyzed applying an interpretive grounded theory approach, using constant comparison throughout the coding process to establish themes and subthemes. Results were triangulated with findings from a descriptive analysis of survey responses.Results:Twenty-eight physicians participated in interviews, while 134 provided survey data, representing 17 countries and 10 medical specialties. Among factors most frequently rated as extremely important in stroke care decision-making (by ≥40% of respondents) were severity of pre-existing dementia/disability and baseline quality of life. Concurrently, interviews highlighted considerable challenges in assessing these factors given time constraints in the acute setting and crudeness of popular screening measures, which fail to capture relevant nuances in patients’ baseline status. Participants further spoke to uncertainties in determining goals of care that align with patients’ best interest. Here, emphasis was placed on the inappropriateness of a mainstream conceptualization of a favorable outcome as maintaining independence, and the need to consider variability in personal and cultural values, support networks, and the broader socioeconomic context. In navigating the complexities of patient-centric care for PLWD who are often unable to voice their wishes, family input and advanced care directives were identified as key facilitators.Conclusions:This mixed-methods study highlights the need for creating evidence-based, tailored strategies for assessing pre-stroke status and defining favourable outcomes for PLWD. Achieving these goals relies on future research co-production with PLWD and their families, ensuring integration of patient priorities and appropriate operationalization of relevant post-stroke outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP124-ATP124, February 1, 2025. Value-based medicine places the patient and their health status at the center of the intervention through the use of Patient-Reported Outcome Measures (PROMs). The ideal would be that these outcome measurements were answered directly by the patient but in many cases it is a caregiver or a healthcare professional who collects the person’s health status perception. This reason could lead to a bias in the results.Our aim was to compare whether there were differences in the perception of health status depending on who answered these questionnaires.Stroke patients discharged from six European hospitals were included in a 1-year follow-up program based on a holistic communication tool (web platform for professionals and app for patients/caregivers) called NORA. PROMs at 7-90 days were collected through NORA-app. In case that the patient or caregiver didn’t have access to a smartphone, the data collection was carried out by a professional healthcare who contacted them to manage PROMs by a phone call.Main outcome measures include: HAD-depression and HAD-anxiety (defined as pathological by a score ≥10 points in each of the subscales) and PROMIS-10 (cut-offs raws values of normality were defined as: Physical-PROMIS >13 and Mental-PROMIS >11). Median scores per collector were compared. In addition, a social questionnaire was collected from app-users’.Over two years, 5116 stroke patients were included in Harmonics project, 60% were men with a mean age of 70.2 years and median mRS of 2(1- 3) at hospital discharge. From them, 2432 were actively monitored and 1498 reported PROMs (428 patients (28.6%), 376 (25.1%) caregivers and 694 (46.3%) professionals). P-value < 0.05 was considered significant for all tests at 90 days. Median PROMs results are shown in Table-1.The social questionnaire (Figure-1) showed significant differences between male and female patients. From the total, 26.6% women and 11.7% men leave alone (p-value = 0.005).At the patients group 77.9% women considered they can take care of their basic needs’ vs 85.9% men (p-value= 0.036).Significant differences were found between the three groups of collectors, with professionals being the ones who perceive a better state of patient health through the collected PROMs collected. Among patients and caregivers groups, worse outcomes were reported by the last one.When using PROMs the collector should avoid bias in reporting the results and direct patient response should be encouraged.

Stroke, Volume 56, Issue Suppl_1, Page ATMP81-ATMP81, February 1, 2025. Introduction:Using oral anticoagulation (OAC) at baseline is hypothesized to increase the risk of hemorrhagic transformation after endovascular thrombectomy (EVT). However, several prior studies evaluating EVT in patients on OAC demonstrated conflicting results regarding functional and safety outcomes. We aimed to characterize the association between baseline use of OAC and EVT outcomes from SELECT, a multicenter, prospective cohort study.Methods:From SELECT study, patients with acute ischemic stroke and large vessel occlusion within 24 hours from onset who received EVT were identified. Patients were stratified based on baseline OAC use, and their clinical and imaging characteristics and functional and safety outcomes were described and compared.Results:Forty-three (15%) out of 285 patients used OAC at baseline, 29 (10%) were on vitamin K antagonists (VKA), and 14 (5%) were on direct oral anticoagulants (DOAC). OAC users were older (median age 75 years old vs 65) and had higher comorbidities – hypertension (88.4% vs 71.3%), diabetes mellitus (41.9% vs 25.7%), atrial fibrillation (64.3% vs 28.2%), and congestive heart failure (23.8% vs 9.6%), had smaller ischemic core volume at baseline (median [IQR]: 0cc [0-12] vs 11cc [0-32][SS1] ), and received alteplase less often (46.5% vs 69.0%, P 0.05 for both; table 2).Conclusion:Almost 1 in 7 patients receiving EVT had baseline use of OACs, with higher comorbidities. OAC use at baseline was not associated with poor functional outcomes. We also did not observe symptomatic intracranial hemorrhage among EVT patients with baseline OAC use, suggesting limited safety concerns due to hemorrhagic transformation. There was no difference in outcome between VKA users and DOAC users.

Stroke, Volume 56, Issue Suppl_1, Page ATP117-ATP117, February 1, 2025. Background:Uncontrolled high blood pressure is a risk factor for acute stroke and a predictor of poor stroke outcomes. Less is known about the efficacy and safety of early ambulance-delivered blood pressure reduction on clinical and functional outcomes in patients with undifferentiated acute stroke.Methods:PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials that compared intervention (with glyceryl trinitrate) to usual blood pressure care or sham in patients with undifferentiated acute stroke; the outcomes of day 90 modified Rankin scale (mRS) maximum score of 6, EuroQol-5D score, National Institutes of Health Stroke Scale (NIHSS ) score at hospital admission, death within 90 days, Barthel index at 90 days, and home time. Heterogeneity was examined using I2statistics.Results:We included 3 RCTs with 3547 Patients, of whom 388 received intervention with glyceryl trinitrate. The pooled results of the included 3 RCTs comparing Intervention with glyceryl trinitrate to usual care or sham treatment showed that the death within 90 days (21.9% vs 21.1% respectively; OR = 1.05; 95% CI [0.89, 1.24]; I2= 0%; p = 0.546), EuroQol-5D-5L score (MD = -0.00; 95% CI [-0.03, 0.03]; I2= 0%; p = 0.98), NIHSS score at hospital admission (MD = 0.18; 95% CI [-0.70, 1.06]; I2= 0%; p = 0.69), day 90 mRS maximum score at 6 (MD = 0.01; 95% CI [-0.25, 0.27]; I2= 0%; p = 0.94), NIHSS score at 24 hours (MD = 0.56; 95% CI [-0.16, 1.27]; I2= 0%; p = 0.13), Barthel index at 90 days (MD = -2.56; 95% CI [-7.90, 2.78]; I2= 0%; p = 0.35), and home time (MD = 0.22 days; 95% CI [-5.02, 5.46]; I2= 0%; p = 0.93) were not statistically different between the intervention and the usual care groups.Conclusion:These findings suggest that early ambulance-delivered blood pressure reduction does not have superior efficacy and safety profiles for clinical and functional outcomes compared with usual care or sham treatment in patients with undifferentiated acute stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP116-ATP116, February 1, 2025. Background and aims:Conventional approaches for stroke rehabilitation primarily involve static muscle strengthening exercises, weight bearing and shifting by therapists. Robot-assisted gait training facilitates the learning of reproducible symmetric gait patterns and reduces expenditure. The GTR-A (HUCASYSTEM, Korea), a robotic gait rehabilitation device for both upper and lower limbs, utilizes end-effector-based movement and provides training to enhance gait function. In this study, we aim to elucidate the clinical efficacy of rehabilitation therapy using GTR-A in subacute/chronic stroke patients.Methods:This study was a prospective, randomized, controlled clinical trial. There were 14 participants in total, with 7 in each of the experimental and control groups (table. 1). The gait abilities were evaluated using the berg balance scale (BBS), 6-minute walk test (6MWT) and cardiopulmonary exercise testing. Over period of 4 weeks, the experimental group underwent 10 sessions of robot-assisted rehabilitation for 30minutes/day, 3times/week in addition to conventional physical therapy for 30min/day, 5times/week. The control group received 10 sessions of only conventional physical therapy for 60minutes/day, 5times/week.Results:In the experimental group, significant improvements were observed in both BBS and 6MWT. However, there was no significant increase in maximal oxygen consumption. In contrast, the control group did not show significant functional improvements (table. 2).Conclusion:The combination of conventional rehabilitation therapy and robotic gait training using GTR-A showed superior outcomes in the recovery of gait function compared to conventional therapy alone.

Stroke, Volume 56, Issue Suppl_1, Page ATP105-ATP105, February 1, 2025. Stroke is the leading cause of serious long-term disability in the United States. Stroke recovery is greatly varied since the long term effect is determined by the site and size of the initial lesion. Specifically, post stroke motor impairments occur due to damage to the corticospinal tract and maladaptive upregulation of the cortico-reticulospinal tract. Transcranial direct current stimulation (tDCS) may be an effective treatment for stroke rehabilitation. However, conventional tDCS is limited by spatial resolution to precisely target a specific brain region. To improve its spatial resolution, this study used targeted high-definition tDCS (HD-tDCS) navigated by paired-pulse transcranial magnetic stimulation. In a double-blind randomized crossover study, stroke participants (n=12) had three visits 1) anodal HD-tDCS stimulation of the arm region of the primary motor cortex (M1) to improve function of the corticospinal tract in the lesioned hemisphere, 2) cathodal stimulation of the arm region of the dorsal premotor (PM) cortex to inhibit maladaptive use of the cortico-reticulospinal tract in the contralesional hemisphere, and 3) sham. The effect was measured by quantitative electroencephalogram (qEEG) metrics delta alpha ratio (DAR) and delta theta alpha beta ratio (DTABR), calculated from a pre and post 3-minute EEG. Acute changes in brain activity of these power bands have been associated with the severity of motor impairment post stroke. The results demonstrate that anodal (p=0.026) and cathodal (p=0.0108) stimulation significantly decreased the DAR compared to the sham. The reducation of DAR value is associated with the improvement of Fugl-Meyer Upper Extremity score. However, there were no significant differences found in the DTABR. These results indicate that both anodal and cathodal HD-tDCS may improve brain function following stimulation. However, future work is required on the use of qEEG metrics and its use as a marker of stroke recovery. This work is important as qEEG could be used as a more objective method, compared to clinical assessments, to track stroke rehabilitation.

Stroke, Volume 56, Issue Suppl_1, Page ATP127-ATP127, February 1, 2025. Introduction:Stroke is the leading cause of long-term disability and fifth leading cause of death in the United States. Social isolation (SI) and loneliness are known risk factors for stroke and may be linked to worse functional outcomes. Previous animal studies have demonstrated enhanced outcomes associated with socialization. The impact of SI following stroke may be clinically relevant for therapeutic intervention.Hypothesis:Stroke patients experiencing social isolation will exhibit worse outcomes compared to those with social support networks.Aim:This retrospective analysis aims to compare stroke outcomes during the COVID-19 visitation restrictions with outcomes during the preceding years when visitation was permitted.Methods:Data were collected from the Patient Cohort Explorer, a de-identified database within our institution’s Research Data Warehouse. Patients were divided into two groups based on date: the isolation group and the control group. The control group included patients admitted from December 1, 2018, to January 1, 2019, during normal visitation policies, while the isolation group comprised patients admitted from December 1, 2020, to January 1, 2021, during visitation restrictions. Two-proportion Z-tests were conducted to analyze differences in demographic data, and two-sample T-tests were used to assess outcomes, including length of stay and discharge disposition.Results:A total of 725 unique patients met the inclusion criteria, with demographic characteristics such as sex and race well-matched between the isolated and control groups, except for a notable age difference (p-value .011). Significant differences in mortality rates were observed, with the control group showing a higher likelihood of returning home (p-value < .001) and the isolation group having a greater proportion of deaths (p-value .003). Additionally, there was a statistically significant difference in hospital stay length, with the control group able to discharge earlier (p-value .001).Conclusion:Social isolation can result in longer hospital stays, poorer outcomes, and increased mortality for patients with acute infarcts. Since the data was gathered during the COVID-19 pandemic, it's challenging to eliminate the virus as a confounding factor in these outcomes. However, the findings suggest that patients lacking social support may face worse functional recovery and different recovery trajectories compared to those with support.

Stroke, Volume 56, Issue Suppl_1, Page ATP118-ATP118, February 1, 2025. Introduction:Despite advancements in the management of acute ischemic strokes, readmissions continue to impact both healthcare costs and patient outcomes. The objective of our study was to evaluate factors associated with 30- and 90-day readmissions after acute ischemic stroke including the impact of early transitional care outpatient follow-up by a centralized specialty stroke clinic.Methods:We retrospectively identified all acute ischemic stroke patients discharged from the largest healthcare system in the state of Georgia from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with 30- and 90-day inpatient readmission.Results:Of 2191 acute ischemic stroke patients discharged during the study period, 177 (8.1%) and 304 (13.9%) had 30- and 90-day all cause readmissions to the healthcare system, respectively. Increasing age, Charlson Comorbidity Index score, and history of diabetes were independently associated with 30- and 90-day readmission; history of heart failure, obesity, and discharge to inpatient rehabilitation or skilled nursing facility (versus home) were also independently associated with 90-day readmission. Completion of a subspecialty stroke clinic follow-up within 30 days of discharge was associated with a lower likelihood of 30-day (OR 0.64, 95% CI 0.41-0.96; p=0.04) and 90-day readmission (OR 0.69, 95% CI 0.49-0.94; p=0.02).Conclusion:While acute ischemic stroke patients who are older, have comorbid conditions and disability are at an increased likelihood of 30- and 90-day readmission after acute ischemic stroke, our study found that early (

Stroke, Volume 56, Issue Suppl_1, Page ATMP74-ATMP74, February 1, 2025. Background:Ischemic stroke is the most common cerebrovascular disease worldwide and the leading cause of permanent disability, which imposes a heavy burden on society and families. Currently, there are still limited treatments for improving long-term recovery after cerebral infarction. Recent studies have found that the development and prognosis after stroke are closely related to abnormal tryptophan metabolism. In this study, we aimed to identify tryptophan metabolites with ischemic protective effects in stroke patients and animal models and determine their mechanisms of action.Methods:Metabolomics analysis using liquid chromatography-mass spectrometry was performed to identify differentially bioactive metabolites in plasma samples from 46 acute ischemic stroke (AIS) patients and 35 healthy controls and validated in experimental animals, identifying decreased levels of 3-hydroxy-kynurenamine (3-HKA) after stroke. We then examined the role of 3-HKA in stroke mice and performed proteomic analysis to elucidate the molecular mechanisms of 3-HKA.Results:Supplementation of 3-HKA improves long-term sensory and motor recovery in ischemic stroke and increases ipsilateral cerebral blood flow. 3-HKA can also promote angiogenesis, stimulate the formation of functional blood vessels, and repair the blood-brain barrier, thereby enhancing post-stroke remodeling. Meanwhile, 3-HKA inhibits the activation of neurotoxic (A1-like) astrocytes but promotes the polarization of neuroprotective (A2-like) astrocytes. Mechanistically, 3-HKA inhibited the activation of AIM2 inflammasomes, and AIM2 expression was increased mainly in astrocytes at 7 and 14 days after stroke, suggesting that 3-HKA may regulate astrocyte-mediated vascular remodeling. Consistently, in primary mouse brain microvascular endothelial cells and astrocyte co-culture, 3-HKA promoted angiogenesis after oxygen-glucose deprivation (OGD). In astrocytes, the effects of 3-HKA on enhancing vascular remodeling in vitro and in vivo were abolished after lentiviral or AAV overexpression of AIM2. Overexpression of AIM2 in astrocytes by lentivirus or AAV counteracted the effect of 3-HKA on augmenting vascular remodeling in vitro and in vivo.Conclusions:Our results suggest that tryptophan metabolism is disturbed after stroke, with decreased 3-HKA levels. Supplementation of 3-HKA may foster vascular remodeling by regulating the activation of A1/A2 astrocytes after stroke, thereby improving long-term neurological recovery.

Stroke, Volume 56, Issue Suppl_1, Page ATP347-ATP347, February 1, 2025. Background:Stroke remains a leading cause of death globally, with significant sex differences in post-stroke outcomes. Additionally, post-stroke infections and sepsis are linked to differences in innate immune responses. The glycosidase, Chitotriosidase 1 (CHIT1), has emerged as an important regulator of innate immunity and lower levels of CHIT1 and chitinases-like proteins are associated with disease severity and progression including multiple sclerosis. However, whether CHIT1 plays a role in the response to acute ischemic stroke is unknown.Hypothesis:We hypothesized that sex-specific alterations in pro-inflammatory factors, including CHIT1, contribute to differential patterns of phagocytosis and post-stroke outcomes.Methods:We examined the effects of acute ischemic stroke (AIS) in older men and women, specifically circulatory cytokine production, circulatory phagocytosis assessment utilizing fluorescent bead engulfment assay, and if these correlated with post-stroke complications in peripheral blood mononuclear cells (PBMCs). We examined relationships with stroke severity, as measured by the NIH Stroke Scale (NIHSS) in patients with a NIHSS >6.Results:Our findings reveal that older women exhibit lower levels of CHIT1 activity correlating with poorer survival outcomes in AIS (p

Stroke, Volume 56, Issue Suppl_1, Page ATMP80-ATMP80, February 1, 2025. Introduction:In 2015, mechanical thrombectomy (MT) was established as an essential treatment for large-vessel occlusion ischemic stroke (LVO). Since then, trials have expanded the population eligible for MT by demonstrating its benefit in patients with LVO who present later to care and with more extensive infarct. As the eligibility criteria for MT ease, more patients will undergo the procedure who have risk factors for complications – such as malignant edema or hemorrhagic conversion – that require decompressive craniectomy (DC). Though MT and DC in ischemic stroke have been studied independently, the outcomes of patients who undergo both procedures is unknown. We present a case series using a national database of patients who underwent MT and required DC to understand their profile and health outcomes.Methods:Using the National Inpatient Sample (NIS), an all-payer national healthcare utilization database, patients admitted between the years 2016 and 2021 for ischemic stroke who underwent MT and required DC were identified via ICD-10 codes. Logistic regression was performed to identify patient factors independently associated with DC after MT.Results:Of the 31,234 patients admitted for LVO who received MT between 2016-2021, 764 (2%) underwent DC (Table 1). Younger age (p < 0.001), non-white race (p < 0.001), a higher NIHSS (p < 0.001), and lower rates of atrial fibrillation were independently associated with DC after MT. Although the number of patients undergoing MT plus DC increased annually, this rise was proportional to the overall number of MT patients. Admissions with MT and DC were nearly 2.5 times longer than those with MT alone (20 days versus 8.4 days, p < .001, Table 2) and associated with increased rates of mortality (25% versus 12%, p < 0.001) and a higher level of care after discharge (p < 0.001).Conclusion:Rates of DC after MT did not change following extension of the thrombectomy window to 24 hours. DC after MT resulted in a heavy burden of morbidity and mortality, similar to levels previously published for DC after ischemic stroke without MT. In conclusion, our findings suggest that expansion of MT eligibility criteria has not increased the risk for DC and that practice guidelines developed from trials in stroke patients who underwent DC but not MT may also be applicable to patients with DC after MT. Recent large core trials have further expanded the MT population, necessitating continued examination of the relationship between MT and DC.