Risultati per: Sindromi coronariche acute

Stroke, Volume 53, Issue Suppl_1, Page ATP210-ATP210, February 1, 2022. Introduction:Collateral flow in acute ischemic stroke is known as a predictor of acute treatment outcome and long-term prognosis. However, studies on the factors which determine the degree of initial collateral flow are not well known. We investigated the factors related to collateral degree in acute ischemic stroke caused by large vessel occlusion (AIS-LVO) and further analyzed the results according to stroke subtype.Methods:This was a retrospective cohort using prospective stroke registry data from October 2014 to May 2021. Patients admitted within 48 hours of symptom onset with middle cerebral artery M1 occlusion on multiphasic CT angiography were included. Collateral score was graded on a six-point scale according to pial arterial filling.Results:A total of 74 patients was enrolled (mean age=72.2±11.7 years; men=37.8%). Of whom 57 (77%) were in the cardioembolism (CE) group and 17 (23%) were in the large artery atherosclerosis (LAA) group. In ordinary logistic regression analysis, initial systolic blood pressure (SBP) was associated with the score of collateral flow (odds ratio [OR]=0.982; 95% confidence interval [CI]=0.968-0.997; p=0.017). Considering multivariate models adjusted for age, sex, and atrial fibrillation, initial SBP was an independent predictor of the score of collateral flow (OR=0.977; 95% CI=0.961-0.992; p=0.011). In subgroup analysis, the lower score of collateral flow was independently associated with increased initial SBP in CE group (OR=0.965; 95% CI=0.945-0.983; p

Stroke, Volume 53, Issue Suppl_1, Page AWP48-AWP48, February 1, 2022. Objective:Many U.S. emergency departments (EDs) lack access to stroke neurologists to support decision-making for thrombolytics and identification of thrombectomy-eligible patients. We outline a strategy to identify hospitals where telestroke might improve access and estimate potential gains in both the number of patients receiving reperfusion treatment and lives saved.Methods:We identified all EDs that provided ischemic stroke care for a Medicare beneficiary during 2018. We then excluded those with clear stroke expertise or with another ED with stroke expertise within 20 miles. At these EDs, we used annual ischemic stroke volumes and previously-derived risk ratios to quantify estimated marginal benefits (additional patients receiving reperfusion and additional lives saved) with the introduction of telestroke.Results:Among 4657 US EDs that provided stroke care in 2018, 1057 had limited stroke capabilities in their ED or within 20 miles. Of these 1057 EDs, 83.1% were in rural communities, and they cared for a median of 6 ischemic stroke patients per year. We estimate telestroke introduction to all 1057 would lead to 164 (95% CI 93-247) additional patients receiving reperfusion treatment and 90 (95% CI 2-180) additional lives saved annually (Figure). If only 263 EDs in the the top quartile of marginal benefit were targeted, this would capture over half of the estimated benefits.Conclusions:We estimate that approximately a quarter of U.S. EDs, primarily small rural EDs, would benefit most from new telestroke capacity. Our strategy may be used to improve stroke systems of care and maximize specialist access for the U.S. population.

Stroke, Volume 53, Issue Suppl_1, Page ATP139-ATP139, February 1, 2022. Background and Purpose:Intracerebral hemorrhage can occur in acute ischemic stroke patients receiving alteplase (recombinant tissue plasminogen activator). Antifibrinolytic medications such as the synthetic lysine analogs tranexamic acid and ε;-aminocaproic acid that inhibit fibrinolysis by attaching to the lysine-binding site of the plasminogen molecule have been utilized. However, the efficacy of antifibrinolytic medication in prevention of hematoma expansion is not known.Methods:We analyzed the effect of antifibrinolytic medication in acute ischemic stroke patients with intracerebral hemorrhage associated with Alteplase from 2012 to 2017. The Region-of-Interest method on a Horos Open Source Medical Image Viewer (Version 3.3.6) was utilized for volume measurement. We compared the change in hemorrhage volume in patients who did and did not receive antifibrinolytic medication.Results:A total of 36 patients (mean age 72.7±11.5, 56% were men) who received intravenous alteplase with subsequent intracerebral hemorrhage were identified. Fourteen patients received antifibrinolytic treatment; five patients had reduction or stabilization in hematoma volume (overall pre-treatment volume 13.87±15.74 cm3and post-treatment volume 16.74±29.67 cm3). Mean fibrinogen level in the antifibrinolytic medication group was 297 mg/dL; two patients had levels < 200 mg/dL. In the cohort of patients did not receive antifibrinolytics, 15 out of 22 patients had reduction or stabilization in hematoma volume (overall pre-treatment volume 19.25±33.33 cm3and post-treatment volume 17.41±26.56 cm3). Mean volume difference in the group that received antifibrinolytic medication was 36% and 9% in the group that did not receive antifibrinolytic medication. [Figure 1]Conclusion:We did not identify any advantage of antifibrinolytic treatment in reduction or stabilization in hematoma volume in patients with Alteplase-associated intracerebral hemorrhages.

Stroke, Volume 53, Issue Suppl_1, Page AWMP57-AWMP57, February 1, 2022. Background:There is limited data regarding the safety of acute ischemic stroke (AIS) treatments in patients with solid organ malignancy (SOM). We aimed to evaluate the nationwide use of acute stroke interventions and clinical outcomes in this patient population.Methods:Adult hospitalizations with primary diagnosis of AIS were identified from the Nationwide Readmissions Database 2016-2018. Logistic regression was used to compare the differences in interventions and clinical outcomes in patients with and without SOM. Survival analysis was used to evaluate recurrent AIS after discharge.Results:There were 1385840 hospitalizations due to AIS (mean±SD age 70.4±14.0 years, female 50.2%). Of these, 50553 (3.7%) had a concurrent diagnosis of SOM. Patients with SOM were older, more likely to be male, and had a lower prevalence of comorbid cerebrovascular risk factors, except atrial fibrillation and tobacco use. The five most common malignancies were of lung, prostate, breast, pancreas, and colorectal origins. After adjustment for baseline differences, patients with SOM were more likely to have intraparenchymal hemorrhage (IPH) [odds ratio (OR): 1.1, 95% confidence interval (CI): 1.0-1.2], in-hospital mortality (OR: 2.1, 95% CI: 2.0-2.2), and discharge disposition other than to home (OR: 1.6, 95% CI: 1.6-1.7). The risk of IPH was higher only in pancreatic cancer, in-hospital mortality in all types except prostate cancer, and adverse discharge disposition in all types except prostate and breast cancers. Patients with SOM were less likely to receive intravenous thrombolysis (tPA) but more likely to undergo endovascular thrombectomy (ET). Among the subgroups of patients treated with tPA or ET, outcomes were comparable between patients with and without SOM, except patients with lung cancer remained at a higher risk of mortality and adverse disposition despite these interventions. Patients with SOM had higher risk of readmission due to recurrent AIS within 1 year of discharge (hazards ratio: 1.2, 95% CI: 1.1-1.3), and this risk was entirely driven by lung and pancreatic cancers.Conclusion:Clinical outcomes of AIS in the setting of SOM vary according to the malignancy site. Acute stroke interventions when performed, appear to be safe in most patients with SOM.

Stroke, Volume 53, Issue Suppl_1, Page AWP154-AWP154, February 1, 2022. Introduction:The optimal blood pressure (BP) in patients with large vessel occlusion (LVO) acute ischemic stroke (AIS). Here, we explore the relationship between CT perfusion (CTP) predicted infarct volumes and those seen on follow up MRI, to examine whether infarct growth is related to presentation BP.Methods:From our prospectively collected multi-institutional registry, we identified patients with LVO AIS seen at 4 comprehensive stroke centers from January 2018 to March 2021. Patients were included if they contained anterior circulation LVO (defined as occlusion of the intracranial ICA, MCA or ACA) defined by CTA, included if they underwent CTP with RAPID (IschemiaView) post-processing at the time of presentation, and had final infarct volume (FIV) imaging with MRI 48-72 hours later. Infarct growth was defined as increase in infarct volume of at least 10 mL from CTP-RAPID core volume prediction to FIV. The primary outcome was the effect of presentation mean arterial blood pressure (MAP) on likelihood of infarct growth.Results:Among 329 patients that met inclusion criteria, median age was 68 [IQR 58-70], median NIHSS was 15 [IQR 10-20] and 49% were female. Median ASPECTS was 8 [6-9], median CTP-RAPID core was 6 mL [0-36 mL] and median FIV was 19 mL [5-57 mL]. Median arrival systolic BP was 153 mmHg [132-174 mmHg], diastolic was 83 mmHg [73-92 mmHg] and MAP was 105 mmHg [95- 118]. 161 (49%) of patients presented in the early time window. Infarct growth of at least 10 mL was seen in 23 (7%) of patients. FIV correlated with CTP-RAPID core more clearly for patients in the early vs. late window (R=0.77 vs 0.34, early vs. late window). In the subset of patients presenting in the early time window, those who underwent infarct growth of at least 10 mL were more likely to present with greater MAPs (mean MAP 118 vs. 106, infarct growth vs. no growth, p

Stroke, Volume 53, Issue Suppl_1, Page ATP116-ATP116, February 1, 2022. Introduction:Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission of acute stroke, IPC of the legs with DVT may cause migration of the thrombi resulting in pulmonary emboli. Therefore, whole-leg ultrasonography to detect DVT should be performed at admission; however, it is not always done in many institutions. Therefore, risk factors to estimate DVT presence at admission are necessary.Hypothesis:The frequency of DVT at admission is high, and IPC should not be used in patients with significant factors of DVT presence at admission.Methods:We included patients admitted within 24 h of stroke onset between 2016 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers. We evaluated variables with significant differences between groups of DVT presence and absence, excluded variables with multicollinearity, and conducted multiple logistic regression analyses to identify independent discriminants of DVT presence from absence. The threshold values of discriminants were identified by receiver operating characteristic curves.Results:Of 1936 stroke patients, 1461 met our inclusion criteria. DVT was detected in 255 patients (17.5%). Compared to patients without DVT (n=1206), patients with DVT were older, female sex, lower body weight, higher C-reactive protein levels, lower albumin or triglyceride levels, higher National Institutes of Health Stroke Scale score, and higher pre-stroke modified Rankin stroke scale score. Female sex, low albumin, high C-reactive protein, low triglycerides, and old age were independent DVT-presence discriminants. The threshold values of albumin, C-reactive protein, triglycerides, and age were ≤ 37g/L, ≥ 3450 ug/L, ≤ 1.569 mmol/L, and ≥ 79 years, respectively.Conclusion:The DVT-presence frequency of 17.5% at admission was high, and significant DVT-presence factors at admission were female sex, low albumin, high C-reactive protein, low triglyceride levels, and old age. Therefore, in patients with the five significant factors, IPC should be avoided, or whole-leg ultrasonography should be performed before IPC.

Stroke, Volume 53, Issue Suppl_1, Page ATP24-ATP24, February 1, 2022. Objectives:Evidence suggests an association of increased cerebrovascular accidents frequency in patients diagnosed with the novel coronavirus disease, COVID-19. Coagulopathy resulting from the 2019 novel coronavirus (SARS-CoV-2) infection is suspected. This study aims at evaluating thrombotic markers in relation to stroke severity and functional outcomes in a patient cohort of acute ischemic stroke (AIS) with concurrent COVID-19.Methods:We performed a retrospective observational cohort study of 28 patients who tested positive for SARS-CoV-2 via polymerase chain reaction and concomitant AIS confirmed by brain imaging. We analyzed data regarding initial stroke presentation, markers of coagulopathy, and 90-day functional outcomes.Results:The patient cohort displayed high rate of comorbidities with 78.6% having at least 1 vascular risk factor. NIHSS had a median of 16 at initial presentation and median stroke volume of 52 mL. Median NIHSS at discharge or prior to death was 19, and median 90-day mRS was 4. Highest fibrinogen level recorded showed a median of 759.54 mg/dL (IQR 653.75-940.75), D-dimer and lactate dehydrogenase (LDH) showed a median highest recorded value 24,106 ng/mL (IQR 6105.00-80165.00) and 442 ng/mL (IQR 277.00-545.50), respectively. LDH (p=0.0008), D-dimer (p=0.001), and maximum fibrinogen levels (p=0.049) near the time of stroke significantly predicted final NIHSS and functional outcome 90-days after discharge.Conclusions:Adult patients with acute ischemic stroke and concurrent COVID-19 disease exhibited abnormally high markers of coagulopathy, and LDH, D-Dimer, and fibrinogen levels were predictors of morbidity and neurological disability at 90-days in this patient population. Further research is necessary to establish a definitive pattern and assess the ability to use these markers as prognostic elements of 90-day functional outcome.

Stroke, Volume 53, Issue Suppl_1, Page AWMP53-AWMP53, February 1, 2022. Introduction:Venous thromboembolism (VTE) is a common medical complication following acute ischemic stroke (AIS). Studies have suggested that VTE rates were higher among patients with a history of COVID-19. We examined the risk of VTE in AIS patients with and without a history of COVID-19 among Medicare beneficiaries.Methods:We identified Medicare fee-for-service (FFS) beneficiaries aged ≥65 years with AIS hospitalizations from 04/01/2020 to 06/30/2021. COVID-19 cases were identified by the first diagnosis of COVID-19 on a claim at any health care setting. We defined AIS with COVID-19 if the dates of COVID-19 diagnoses were earlier than AIS admission dates. To identify VTE for each AIS admission, we used the following secondary diagnoses codes: ICD-CM-10: I80, I81, I82, I26. We compared the prevalence ratio (PR) of VTE between AIS patients with and without a history of COVID-19.Results:Among 178,830 Medicare FFS beneficiaries with AIS admissions, 6.1% had a history of COVID-19 and 2.6% had VTE as a complication. VTE prevalence among AIS patients with a history of COVID-19 was 3.98% (95% confidence interval (CI), 3.62-4.36%) and 2.53% (95% CI, 2.46-2.61%) among patients without a history of COVID-19. The adjusted PR of VTE was 1.55 (95% CI, 1.40-1.70, p50% increased risk of VTE than those without a history of COVID-19 (Adjusted PR, 1.59, 95% CI, 1.42-1.78 for Non-Hispanic White, 1.58, 95% CI, 1.28-1.94 for Non-Hispanic Black, p

Stroke, Volume 53, Issue Suppl_1, Page A92-A92, February 1, 2022. Background:Delirium in-hospital (DIH) is common among the critically ill. However, DIH incidence and outcomes are not well characterized among ischemic stroke (IS) patients, particularly those treated with intravenous tissue plasminogen activator (tPA) and / or mechanical thrombectomy (MT).Methods:Utilizing data from a healthcare system with standardized delirium screening protocols, DIH was determined by a positive 4AT / CAM-ICU screen or diagnosis codes. IS patients with tPA or MT were flagged and a subset with available 90-day modified Rankin Scale (mRS) were analyzed for shifts in mRS scores associated with DIH, via ordinal logistic regression models adjusted for age, stroke severity, tPA or MT, Charlson Comorbidity Index [CCI], prior stroke and sepsis / infections. Common odds ratios (OR) and 95% confidence intervals (CI) are reported.Results:Between May 2016 and June 2021, IS was the primary discharge diagnosis in 12,415 encounters (10,878 unique patients). DIH was documented in 41.6% of IS encounters, compared to 20.0% of non-IS encounters. Stroke-DIH patients (vs no-DIH Stroke) were older (median: 75 vs 65 years), more frequently female (53.3% vs 48.7%), with higher comorbidity burden (median CCI: 7 vs 5), longer hospital stays (median: 6 vs 3 days), higher in-hospital mortality (3.1% vs 0.5%), and fewer home discharges (36.2% vs 75.2%). Among a sub-cohort of 2,785 IS patients with 90-day mRS, fully adjusted model indicated lower mRS (OR, CI: 0.48, 0.41-0.57) for those with tPA or MT, and worse outcomes for DIH patients (OR, CI: 2.70, 2.26-3.23). Among 948 treated IS patients, DIH remained a significant risk for worse outcomes (OR, CI: 2.54, 1.89-3.43).Conclusion:Delirium was twice as common in IS patients and was a negative prognostic indicator of short and long-term outcomes among non-treated and treated IS patients. Active screening and management of DIH is critically important to improve stroke outcomes.

Stroke, Volume 53, Issue Suppl_1, Page AWMP15-AWMP15, February 1, 2022. Purpose:To evaluate age and sex-specific trends in prevalence of infectious and non-infectious complications (comps) following acute ischemic stroke (AIS) admissions in the United States (US) from 2006 to 2017.Methods:We identified all admissions with a primary AIS diagnosis (weighted n= 5,190,311) in the 2006-2017 National Inpatient Sample. We quantified the prevalence of infectious [pneumonia, sepsis, and urinary tract infection (UTI)] and non-infectious [acute kidney injury (AKI), acute myocardial infarction (AMI), deep venous thrombosis (DVT), pulmonary embolism (PE), gastrointestinal bleeding (GIB) hemorrhage and acute myocardial infarction (AMI)] comps in subgroups categorized by age and sex. Logistic regression models were used to evaluate trends in prevalence over time.Results:Across the study period, 24.3% of all AIS admissions had at least one comp but prevalence increased with age. UTI (12.2%) was the most common comp, but this was driven mainly by its high prevalence in older females (f) 60-79 y (16.0%) and F >=80 y (22.9%). AKI was the second most common comp (8.9%) in all patients, followed by pneumonia (3.3%) and AMI (2.7%). GIB (1.1%), DVT (0.9%), and PE (0.5%) were the least common. Any comp risk increased from 20.8% in 2006 to 25.9% in 2017. Risk of UTI and pneumonia declined over time (p 3-fold increase in risk across the study period (figure 1). After multivariable adjustment, AKI, AMI, PE, pneumonia, sepsis, and GIB were associated with increased odds of in-hospital death while UTI and DVT were inversely associated with mortality (all p-values < 0.01).Conclusion:Infectious comps declined, while noninfectious comps, particularly AKI, increased following AIS admissions from 2006 to 2017. Additional efforts are needed to minimize comp risk following AIS.

Stroke, Volume 53, Issue Suppl_1, Page ATP163-ATP163, February 1, 2022. Objective:To investigate the effect of renal impairment on clinical outcomes among acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT).Methods:We performed a retrospective analysis from January to December 2020 involving AIS patients with CKD and premorbid modified Rankin Scale (mRS) ≤2, undergoing EVT in two large academic comprehensive stroke centers. Our primary efficacy outcome of interest was mRS at 90 days. Secondary outcomes included: inpatient mortality, length of hospitalization and reperfusion status based on Thrombolysis in Cerebral Infarction (TICI) score. CKD was defined as estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60-89 mL/min), moderate (eGFR 30-59 mL/min) or severe (eGFR 15-29 mL/min). We performed ordinal regression, multinomial logistic regression and binomial logistic regression analyses. In our subgroup analysis, we compared outcomes among AIS patients diagnosed with mild, moderate and severe CKD. We additionally performed a sensitivity analysis comparing patients with treated with combined intravenous thrombolysis (IVT) and EVT vs EVT only.Results:A total of 484 AIS patients underwent EVT at both stroke centers during the study period. After excluding patients for missing data and baseline mRS >2, total of 300 AIS patients who underwent EVT (176 CKD and 124 patients with normal renal function) were included. Patients with CKD was associated with worse clinical outcomes [4 (2-6) vs 3 (1-6)]; adjusted odds ratio [aOR] 1.70, 95% confidence interval [CI] 1.10 – 2.61,p=0.02] based on 90-day mRS shift analysis and increased odds of in-hospital mortality (aOR 2.63, 95% CI; 1.08-6.38,p=0.03). Rates of TICI 2b/3 reperfusion (p=0.84) and length of stay (p=0.42) were similar between the two groups. Subgroup analyses found no difference between CKD and normal renal function groups for primary and secondary outcomes (allp >0.05). Similarly, sensitivity analyses demonstrated no difference in clinical outcomes between patients receiving combined IVT and EVT compared to EVT only (allp >0.05).Conclusion:Among AIS patients undergoing EVT, renal impairment was independently associated with worsening functional outcomes at 90 days and a higher rate of inpatient mortality.

Stroke, Volume 53, Issue Suppl_1, Page AWP3-AWP3, February 1, 2022. Objective:To investigate the effect of early hyperchloremia on 90-day outcomes in acute ischemic strokeMethods:We analyzed data from Albumin in Acute Ischemic Stroke (ALIAS) Part 1 and 2 trials which recruited patients with acute ischemic stroke within 5 hours of onset. Patients with hyperchloremia (defined as 110 mmol/L or greater) at baseline, 24, or 48 hours after randomization were identified. We trichotomized patients into 3 groups; no instances, one instance, and two or more instances of measured hyperchloremia within the first 48 hours. Serum creatinine levels at baseline, 24, and 48 hours were used to identify acute kidney injury (AKI) via the Acute Kidney Injury Network (AKIN) classification. Logistic regressions were performed to determine the effects of hyperchloremia on outcomes defined by modified Rankin scales or National Institutes of Health Stroke Scale scores at 90 days and mortality at 90 days.Results:Among the total of 1275 patients analyzed, zero, one and two or more occurrence of hyperchloremia within 48 hours were observed in 976, 191 and 108 patients respectively. Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia at significantly higher odds of non-favorable outcomes within 90 days after adjustment for age, NIHSS score, initial systolic blood pressure, and ALIAS treatment group (albumin or placebo) (OR 3.0, 95%, CI 1.8-5.0). Patients with two or more occurrences of hyperchloremia also presented higher odds of death within 90 days vs the non-hyperchloremia group. Patients with one occurrence of hyperchloremia were not at higher odds for non-favorable outcomes at 90 days. There was no association between occurrence of two or more occurrence of hyperchloremia and AKI (OR 0.8, 95% CI 0.3-1.9).Conclusions:The independent association between sustained hyperchloremia and non-favorable outcomes at 90 days suggest that avoidance of hyperchloremia may increase the rate of favorable outcomes in patients with acute ischemic stroke.

Stroke, Volume 53, Issue Suppl_1, Page AWP219-AWP219, February 1, 2022. Background:Stroke is a sudden-onset, unexpected life event over which individuals have little control. These features can make the experience of having a stroke extremely stressful, which may potentiate its debilitating effects. Yet the role of lifetime stress/trauma exposure (LSE) and post-stroke acute stress (AS) have received limited attention in research seeking to identify factors influencing stroke-related disability.Hypothesis:Higher lifetime trauma and AS symptoms are associated with poorer post-stroke modified Rankin (mRS) and Fugl-Meyer scores.Method:Multi-site national study of patients admitted for a new stroke. Interviews were conducted at 2-10 days (N=763) & 3 months (N=513) post-stroke. Assessments included admission Acute Stress Disorder Interview, day-90 mRS, day-90 upper extremity motor Fugl-Meyer scale (affected side), and LSE. Structural Equation Modeling examined relationships among LSE, AS, and outcomes, controlling for admission NIHSS score, IV TPA treatment, and demographics.Results:After controlling for key covariates, AS immediately post-stroke and LSE were both associated with poorer day-90 mRS scores (p

Stroke, Volume 53, Issue Suppl_1, Page A75-A75, February 1, 2022. Background:Faster treatment with endovascular thrombectomy (EVT) in patients with acute ischemic stroke is associated with better functional outcome at 90 days on the modified Rankin Scale. Whether speed of treatment is associated with improvements in patient-reported outcomes such as health-related quality of life is not well known.Methods:We used data from the ESCAPE-NA1 randomized trial which tested the effect of nerinetide in patients with large vessel occlusion undergoing EVT. We calculated EuroQol 5-dimension 5-level (EQ-5D-5L) index scores at 90 days using country-specific value sets. Using quantile regression, we evaluated the association between time from hospital arrival to EVT groin puncture (door-to-puncture) and EQ-5D-5L index score and visual analogue scale (EQ-VAS), adjusting for age, sex, stroke severity, ASPECTS, alteplase treatment, and nerinetide treatment. Using logistic regression, we determined the association between door-to-puncture time and reporting no/slight symptoms in each domain (mobility, self-care, usual activities, pain, and anxiety/depression) or all domains concurrently.Results:There were 1045 patients receiving EVT with EQ-5D values at 90 days. Median door-to-puncture time was 59 minutes (interquartile range 42-84). There was a strong association between faster door-to-puncture time and higher EQ-5D index score and EQ-VAS (Figure A-C). Faster time was also associated with higher probability of no/slight problems in each of five domains and all domains concurrently, with approximately 10% increase in probability for each hour of faster treatment (Figure D-I).Conclusion:Faster door-to-puncture EVT time is strongly associated with greater health-related quality of life across all domains in patients with large vessel occlusion. These results support the beneficial impact of speed of EVT on patient-reported outcomes and encourage efforts to improve quality of life in patients by optimizing workflows.

Stroke, Volume 53, Issue Suppl_1, Page A93-A93, February 1, 2022. Background:Acute ischemic stroke (AIS) remains a leading cause of mortality and disability worldwide, with stroke etiology having an important role in work-up, management, and prognosis. The current AHA/ASA guidelines cite routine echocardiography as reasonable but not mandatory for the work-up of ischemic stroke. We sought to identify how often transthoracic echocardiogram (TTE) results would show a potentially treatment-altering finding.Methods:Using the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) for years 2005, 2010, and 2015, we selected patients with a new diagnosis of AIS using ICD-9/10 codes in adults ≥18yrs of age presenting to the emergency department and who had a TTE with stroke etiology of Cardioembolic, Small Vessel, or Large Vessel. All cases were physician reviewed and stroke etiology determined based on our epidemiologic criteria. Demographic information, medical history, electrocardiograms with atrial fibrillation (Afib), and TTE features were collected for each patient and compared across stroke etiology groups using Wilcoxon rank sum test and chi-square test, or Fisher’s exact test, as appropriate.Results:There were 5,490 patients presenting with AIS in the GCNKSS in 2005, 2010, and 2015 and 3,984 (73%) had a TTE performed. Of those with TTE, 2,422 (61%) had a presumed etiology of Small Vessel, Large Artery Atherosclerosis (LAA), or Cardioembolic (120 identified as “Other,” 1442 identified as “Undetermined”). Potential findings of TTE that could change management were 1% in Small Vessel, 2% in LAA, and 7% in Cardioembolic etiology strokes.Conclusion:In patients presenting with Small Vessel or LAA stroke etiologies, routine inpatient TTE rarely had management-changing findings. Future studies are needed in order to assess cost effective use of TTE in patients with established stroke etiology.

Stroke, Volume 53, Issue Suppl_1, Page AWMP66-AWMP66, February 1, 2022. Background:Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 to 24 hours is established as a standard of care among patients selected by multiparametric neuroimaging. Therefore, we aimed to explore neuroimaging parameters in late window AIS large vessel occlusion (LVO) patients and the association between findings in non-contrast computed tomography (NCCT) and multiparametric CT.Methods:We included consecutive AIS patients within 6-24 hours from symptoms onset with CTA-LVO. We studied potential associations between computed tomography mismatch defined by DAWN and/or DEFUSE-3 neuroimaging criteria (CTP-MM), infarct volume on CTP, and ASPECTS on NCCT. We also analyzed the association between neuroimaging parameters and outcome determined by 90-day mRS.Results:We included 206 patients, of which 176 (85.4%) presented CTP-MM and 184 (89.3%) presented with an ASPECTS ≥ 6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥ 6, as compared with 40.9% in those with low ASPECTS[Figure 1A]. The ASPECTS correlated with infarct core, determined by Cerebral Blood Flow