Risultati per: Sindromi coronariche acute

Stroke, Volume 53, Issue Suppl_1, Page AWP93-AWP93, February 1, 2022. Introduction:The delivery of mechanical thrombectomy in acute stroke can be challenging because it requires coordination between patient travel and multiple stroke team members across different locations in the hospital. A Real Time Location System (RTLS) can facilitate a streamlined workflow by determining a patient’s location, but the required infrastructure can be costly to set up. We investigated the feasibility of a machine learning based RTLS using an Internet Of Things (IOT) device prototype to coordinate acute stroke endovascular intervention.Methods:In this proof-of-concept study, study investigators programmed an IOT device to collect WiFi signals from different hospital zones relevant to the mechanical thrombectomy workflow. Different machine learning (ML) algorithms were trained on location labelled training WiFi signals to predict location. The accuracies of the different ML algorithms to predict unlabeled testing WiFi signals collected on a separate day were measured, in percentages.Results:The training and testing datasets contained 1,179 and 293 samples respectively, with 2,516 and 2,618 unique WiFi signals detected in each dataset. The trained neural network, random forest, support vector machine, K-nearest neighbors, decision tree and ensemble classifiers achieved accuracies of 96.6%, 96.2%, 97.3%, 97.3%, 83.6% and 97.3% on the testing dataset respectively. Additionally, the neural network model produced estimates of uncertainty, which were significantly associated with the correctness of predictions based on logistic regression analysis (p < 0.001).Conclusions:An IOT based real time location system with machine learning can accurately predict locations within the hospital, demonstrating immense potential for the future applications of streamlining delivery of acute stroke endovascular intervention.

Stroke, Volume 53, Issue Suppl_1, Page AWP6-AWP6, February 1, 2022. Introduction:One in 3 strokes occur in patients with pre-stroke disability. This excludes many from acute treatment trials, but whether these patients benefit from aggressive treatment is unknown.Methods:A prospective stroke center registry (10/2019-04/2021) of consecutive adult patients with acute stroke was queried for patients with pre-stroke modified Rankin Scale (mRS) of 0-4. Multivariable logistic regression was used to estimate odds of full functional recovery (FFR) at 90 days (mRS 0-2 or return to pre-stroke mRS), comparing those with significant pre-stroke disability (mRS 3, 4) to those without (mRS 0-2).Results:Of 1228 patients, 1190 (97%) had pre-stroke mRS 0-4, with 856 (70%) included patients also having 90d follow-up mRS. The median age was 68y (IQR 59-78), with a median NIH Stroke Scale (NIHSS) of 5 (IQR 2-17). Compared to those with mRS 0-2 (n=722), patients with a pre-stroke mRS of 3 (n=96) or 4 (n=38) had more frequent comorbidities and were less likely to achieve FFR (Table). After multivariable adjustment, the odds of FFR was no less for patients with prestroke mRS of 3 (ORadj 1.37, 95%CI 0.80-2.34) or 4 (ORadj 0.59, 95%CI 0.25-1.39). In that model, FFR was less likely among the elderly (ORadj per year 0.96, 95%CI 0.95-0.97) and higher NIHSS (ORadj per point 0.89, 95%CI 0.88-0.91). Thrombolysis was strongly associated with FFR (ORadj 2.70, 95%CI 1.59-4.60).Conclusions:In this single center analysis, stroke recovery in the setting of pre-existing disability was driven by age and stroke severity. Thrombolysis remained predictive of FFR irrespective of age and stroke severity, but was underutilized in patients with pre-stroke disability.

Stroke, Volume 53, Issue Suppl_1, Page ATP171-ATP171, February 1, 2022. Sturge-Weber syndrome (SWS) is a neurovascular disorder characterized by facial Port-wine stain and intracranial capillary malformations. Patients can have multiple neurological complications including seizures, headaches, and stroke-like episodes, often leading to multiple hospital presentations. Published reports have shown conflicting results on whether patients with SWS with acute neurological complaints have positive imaging findings. Small case reports have described acute ischemic or hemorrhagic changes in SWS patients, whereas larger case series have not identified such imaging findings. Our aim was to report imaging findings in a cohort of SWS patients who presented with acute neurological complaints. We performed a retrospective analysis on all MRI studies performed on SWS patients presenting to our institution with acute neurological symptoms between August 1999 and July 2018. Imaging studies were initially evaluated by the radiologists on-call, and subsequently reviewed by a separate neuroradiologist to confirm the diagnoses. Only studies that were interpreted as having acute findings by both radiologists were counted as positive. During the study period, 23 patients with SWS presented to our institution with acute neurological complaints, of which 13 (56.5%) were male, median age 3 years, with 50 MRI obtained. Seizures were the most common indication for acute imaging (58%), followed by stroke-like episodes (32%), headache (6%), lethargy (2%) and vomiting (2%). Acute changes on MRI were found in 8 studies (16%), with restricted diffusion in 5 patients (of which 4 were presumed to be due to stroke and 1 due to ongoing seizure activity), brain edema in 2 patients and a subdural fluid collection in 1 patient. Of the patients with acute imaging findings, 4 presented with seizures, 3 with stroke-like episodes, and 1 with lethargy. In conclusion, SWS patients with acute neurological complaints can have acute findings on MRI consistent with stroke or other acute injuries. Imaging appears to be an important tool in the management of acute episodes in SWS patients. Restricted diffusion in SWS patients may represent venous congestion or other hemodynamic changes leading to acute injury.

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 ATMP114-ATMP114, February 1, 2022. Gene expression changes in peripheral blood reflect injury and repair processes occurring post ischemic stroke (IS). Our study explored the dynamic time-dependent expression of key genes involved in the immune response after IS to better understand the biology and to identify specific diagnostic biomarkers. Using RNA-sequencing, we analyzed gene expression profiles of 38 IS patients and 18 controls with at least one vascular risk factor (VRFC) including diabetes and/or hypertension and/or hypercholesterolemia in isolated monocytes, neutrophils and whole blood. We used two approaches: Weighted Gene Co-expression Network Analysis (WGCNA) with respect to time after stroke onset; and differential expression analyses with subject samples split into time points (TPs) from stroke onset (TP0=VRFC; TP1=0-24 h; TP2=24-48 h; and TP3≥48 h). In WGCNA, highly interconnected “hub” genes were identified for modules significant to time (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 A35-A35, February 1, 2022. Introduction:Many patients arrive beyond the guideline-recommended time window for treatment with IV alteplase. For most of these patients, few treatment options exist. There is a need to understand the characteristics, outcomes, and healthcare costs of patients in this population in order to develop new treatments options.Methods:We analyzed patients ≥65 years old with a primary diagnosis of AIS arriving within 24 hours of time last known well (LKW) but not treated with IV alteplase at Get With The Guidelines-Stroke Hospitals in the United States (Jan 2016 – Dec 2016). We report clinical characteristics, 90-day and 1-year outcomes including Medicare costs, stratified by time from LKW to arrival (≤4.5 hours, >4.5-6 hours and >6-24 hours).Results:Of 39,760 patients (80.0% White, 10.5% Black, 4.1% Hispanic, 2.2% Asian), 20,369 (51.2%) presented from 4.5 – 24 hours of LKW. Compared to patients arriving within ≤4.5 hours, patients arriving within 4.5 – 24 hours of LKW were more likely to be Black, Hispanic, or Asian (≤4.5 hours: 9.4% Black, 3.8% Hispanic, 1.9% Asian; >4.5 – 6 hours: 11.7% Black, 4.1% Hispanic, 2.4% Asian; >6 – 24 hours since LKW: 11.6% Black, 4.4% Hispanic, 2.6% Asian; p < 0.001). The most common discharge location for those arriving within ≤4.5 hours was home; for those arriving >4.5 hours since LKW the most common discharge location was inpatient rehab (IRF) or skilled nursing facility (SNF) (≤4.5 hours: 44.7% home vs 42.3% IRF or SNF; >4.5 – 6 hours: 35.4% home vs 51.7% IRF or SNF; >6 – 24 hours: 35.8% home vs 51.0% IRF or SNF). The 90-day and 1-year mortality rates were 18.9% and 30.0% in those arriving within ≤4.5 hours, 19.0% and 29.8% in those arriving between 4.5 – 6 hours, and 19.1% and 29.1% in those arriving between 6 – 24 hours. Median 90-day inpatient costs were highest among those arriving 6 – 24 hours from LKW (≤4.5 hours: $9,471 [IQR: 5,622-21,356]; >4.5 – 6 hours: $10,884 [IQR: 6,036-25,992]; 6 -24 hours: $11,162 [6,073-26,372]).Conclusions:Results show the importance of timely hospital arrival, as well as a need to address racial disparities in arrival times, reduce costs, and develop new treatment options for patients with AIS arriving after 4.5 hours from last known well time.

Stroke, Volume 53, Issue Suppl_1, Page AWP121-AWP121, February 1, 2022. Background:Traditionally, bed rest after emergency ischemic stroke treatments has been defined as 24 hours hours. The scientific basis for this timeline has not been established and practices may vary. We sought to determine bed rest practices following emergency stroke therapy in centers across the United States.Methods:We surveyed hospitals in the StrokeNet system regarding bed rest practices following acute stroke thrombolysis and/or thrombectomy. An anonymous survey (SurveyMonkey®) was sent out by the central coordinating center to all StrokeNet participating centers across the United States. Survey questions included stroke center designation, location of admission, whether a formal bed rest protocol was in place, minimum bed rest period required, which person first mobilized the patient, average duration of bed rest, which factors would alter duration of bed rest.Results:48 centers responded to the survey including 45 Comprehensive Stroke Centers and 3 Primary Stroke Centers. Most patients were admitted to a neuro-intensive care unit (69%), and others to a general medical/surgical ICU or stroke ward. 60% of respondents indicated that a formal bed rest policy was in place. Minimum bed rest requirements after thrombolysis alone ranged from 0-24 hours (43% with a 24 hour bed rest protocol, 20% with no minimum, 15% with a 12 hour minimum, 5% with an 8 hour minimum, 5% with a 6 hour minimum, and 12% with an indeterminate response). Similar variations were reported in patients undergoing thrombectomy with ranges from 0-24 hours bed rest. First mobilization was by a nurse 52% of the time and by a physical therapist 48% of the time. Actual mobilizations ranged from 0-36 hours after treatment. The most common factors that altered bed rest duration were: hemodynamic factors ( > 90% of respondents depending on the scenario) and NIHSS score ( > 65% depending on the scenario).Conclusion:Bed rest practices following emergency ischemic stroke treatment vary significantly across stroke centers. Mobilization of patients is performed primarily by nurses and therapists. Major factors that influence bed rest duration include hemodynamic factors and NIHSS score. Further study regarding an optimal approach for bed rest is warranted.

Stroke, Volume 53, Issue Suppl_1, Page AWP76-AWP76, February 1, 2022. Introduction:Video telestroke consultations are increasingly utilized to provide acute stroke care virtually, yet it remains uncertain whether patients are satisfied with this medium of care. We aimed to evaluate patient perception of their care during video telestroke consultations in a HUB and SPOKE telestroke network.Methods:Patients from Yale New Haven Health System and affiliate hospitals evaluated by video telestroke were screened for enrollment and contacted between 7-14 days from telestroke encounter to administer a telephone survey. Patients were excluded if the suspicion for cerebrovascular event was low, if primary language was not English, if in hospice, and if patient had confusion, cognitive impairment or aphasia during telestroke encounter or survey. The survey asked patients to rate the quality of the telestroke encounter and their satisfaction with various aspects of clinical care (Figure). Patient responses were evaluated using Chi-square analysis with SPSS v23.Results:A total of 325 video telestroke consultations occurred between May 8, 2021 and August 5, 2021. Eighty-nine patients met criteria to be contacted for a follow up survey. Of those, thirty-one patients responded to the survey (15 female, mean age of 58.9 years old) and 80.6% of patients did not have any prior telemedicine experiences. Only 6.7% of patients perceived shortcomings in the ability of the emergency staff to use videoconference equipment and 13.3% observed difficulties with audio quality. Difficulties with equipment and audio quality were not associated with patient’s ability to understand their diagnosis (p=0.787 and p=0.782) and treatment recommendations (p=0.558 and p=0.684). All patients expressed good or very good satisfaction with video telestroke use and perceived that the video consultation was as good as a bedside visit.Conclusions:Despite encountering some technical difficulties, patients expressed satisfaction with video telestroke encounters.

Stroke, Volume 53, Issue Suppl_1, Page AWMP4-AWMP4, February 1, 2022. Background and Purpose:Tenecteplase is being evaluated as an alternative intravenous (IV) thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized controlled clinical trials. However, several research teams have published their real-world experience with tenecteplase for the treatment of AIS.Methods:We searched Medline and Scopus for non-randomized clinical trials and observational cohort studies (prospective or retrospective) comparing IV tenecteplase (at any dose) to IV alteplase for patients with AIS. We calculated the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95%CI) for the association of tenecteplase vs. alteplase use and outcomes of interest. We pooled estimates using random-effects models. The primary outcome was the probability of modified Rankin scale (mRS) score of 0-2 at 90 days. Non-inferiority of tenecteplase vs. alteplase for the primary outcome in the meta-analysis was set at margins of 1.3% and 5% based on a recent survey.Results:We identified 6 studies comparing IV tenecteplase (n=583) to IV alteplase (n=904). Patients receiving tenecteplase had higher odds of successful recanalization (OR=2.82, 95%CI: 1.12, 7.11; adjusted OR=2.38, 95%CI: 1.18, 4.81) and early neurological improvement (OR=4.88, 95%CI: 2.03, 11.71; adjusted OR=7.60, 95%CI: 1.97, 29.41) when compared to alteplase. Tenecteplase was non-inferior (when applying the 5% non-inferiority margin) to alteplase for the primary outcome of mRS 0-2 at 90 days (absolute risk difference=0.06, 95%CI: -0.04, 0.15; OR=1.20, 95%CI: 0.86, 1.67; adjusted OR=1.24, 95%CI: 0.88, 1.76). No difference in the risk of symptomatic intracranial hemorrhage was uncovered between the two groups (OR=0.96, 95%CI: 0.45, 2.07; adjusted OR=0.92, 95%CI: 0.47, 1.81).Conclusion:Real world evidence suggests that tenecteplase has a comparable efficacy and safety profile to alteplase for the treatment of AIS, while being possibly superior in achieving successful reperfusion and early neurological improvement.

Stroke, Volume 53, Issue Suppl_1, Page ATP250-ATP250, February 1, 2022. Introduction:Omega-3 (n-3) fatty acids (FAs), specifically docohexaenoic acid (DHA) and eicosapentaenoic acid (EPA), act as bioactive unsaturated lipids with pleiotropic effects, affording neuroprotection in ischemic brain injury.Hypothesis:We reported that n-3 FAs injected acutely as triglyceride (TG) emulsions provide neuroprotection after ischemic brain injury. We now questioned whether novel lipid emulsions made from n-3 diglycerides (DG) would improve the delivery and effectiveness of n-3 FAs in brain after injury.Methods:We evaluatedin vitrointeractions of DG (DG-DHA) vs TG (TG-DHA) in phosphatidylcholine (PC) bilayer liposomes, as a model membrane system, by NMR spectroscopy. We compared thein vitrokinetics of DG vs TG hydrolysis by lipoprotein lipase. We investigated the neuroprotective effects of DG emulsions in a Vannucci murine model of hypoxic-ischemic (HI) brain injury.Results:NMR spectra of PC liposomes incubated with DG-DHA showed an additional peak, adjacent to the phospholipid carbonyl region, indicating a higher incorporation into PC bilayers and a narrower peak at almost the same position in a more fluid phase. In contrast, spectra of liposomes incubated with TG-DHA showed narrow peaks well-separated from PC resonances, representing phase-separated oil droplets. In lipolysis assays, DG emulsions had more efficient hydrolysis than TGs. Neonatal mice treated with DG-EPA, DG-DHA, or the combination of both (DG-DHA+EPA) after HI injury showed up to 3X better reduction in infarct volumes compared to TGs (p

Stroke, Volume 53, Issue Suppl_1, Page AWP9-AWP9, February 1, 2022. Objective:Intracranial tumor is considered a contraindication to IV tPA for presumed acute ischemic stroke (AIS), though evidence differentiating rate of intracranial hemorrhage (ICH) in benign versus malignant neoplasm is lacking. A systematic review of published cases of standard-dose IV tPA for AIS within 4.5 hours of symptom onset and intracranial tumor was performed.Methods:PubMed, Embase, and Cochrane were used to identify articles for inclusion. Case reports, letters to the editor, conference proceedings, cohort studies, case series, literature reviews, and case-control studies that included patients given standard dose IV tPA for presumed AIS within 4.5 hours of symptom onset, who were found to have an intracranial tumor, were included. The primary outcome measure was the rate of ICH.Results:Twenty-three studies met inclusion criteria, involving 495 patient cases. One of the included case-control studies presented data only in the form of an odds ratio (OR), with OR 0.72 (p=0.16) for risk of ICH out of 297 benign brain tumors as compared to controls. They found an OR for ICH of 2.33 (p value

Stroke, Volume 53, Issue Suppl_1, Page A43-A43, February 1, 2022. Introduction:Despite pharmacological and practical advantages for tenecteplase (TNK) over alteplase (ALT), no differences were observed in percent of symptomatic intracranial hemorrhage (sICH) in randomized trials (fewer than 900 total patients for either treatment). We compared rates of sICH in patients treated with either drug, using a large, multicenter, international registry.Methods:The CERTAIN collaboration is an ongoing registry of deidentified patient-level data of thrombolytic treated ischemic stroke from various hospitals/programs in New Zealand, Australia, and the United States that have used ALT or TNK since July 1, 2018. Standardized data were abstracted and harmonized from local or regional clinical registries. We defined sICH as clinical worsening of at least 4 points on NIHSS, attributed to parenchymal hematoma, subarachnoid or intraventricular hemorrhage. We used logistic regression for binary variables, adjusting sICH differences for age, baseline NIHSS, thrombectomy, and source hospital network and Mann-Whitney test for continuous baseline variables.Results:A total of 7891 patients were included in the initial analysis. The TNK group was older, more likely to be male, had higher NIHSS, and more frequently underwent mechanical thrombectomy (Table. Sample Characteristics). The sICH rate was 3.71% for ALT and 2.13% for TNK: adjusted OR (95%CI) = 0.49 (0.31-0.76) p=0.002. For patients not undergoing thrombectomy after thrombolytic, the sICH rate was 3.00% for ALT and 1.74% for TNK, adjusted OR (95%CI) = 0.48 (0.27-0.87), p=0.016. For thrombectomy treated cases, sICH rate was 6.80% for ALT and 2.80% for TNK, adjusted OR (95%CI) 0.60 (0.31-1.16), p=0.129.Conclusion:In this preliminary analysis from a large, multicenter registry, ischemic stroke treated with tenecteplase was associated with a lower rate of sICH than with alteplase. An updated analysis with patient data from additional sites will be presented at the Conference.

Stroke, Volume 53, Issue Suppl_1, Page ATP101-ATP101, February 1, 2022. Background:Estimation of infarction based on computed tomographic perfusion (CTP) remains challenging, mainly due to noise associated with CTP data and variability in reported thresholds ischemic core esstimation. Commercial software companies have attempted to establish CTP thresholds; for example, a relative cerebral blood flow (rCBF) of

Stroke, Volume 53, Issue Suppl_1, Page AWMP12-AWMP12, February 1, 2022. Introduction:Disparities in acute ischemic stroke (IS) care due to patients’ pre-stroke disabilities remain understudied. Using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study, we aimed to understand the differences in acute stroke presentation and care according to patients’ pre-stroke functional status.Methods:We ascertained all hospitalized IS patients ≥18 years old presenting to emergency departments in the GCNK region in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46; all cases were physician-reviewed. Trained nurses ascertained pre-stroke functional status from the medical record. Acute IS presentation, time metrics, and treatment were compared between patients with pre-stroke mRS 0-1 vs ≥2 using Wilcoxon rank-sum or chi-square tests. Logistic regression was used to evaluate the association between pre-stroke mRS and intravenous thrombolysis (IVT) and endovascular treatment adjusting for age, presenting NIHSS, time to presentation, and baseline anticoagulation use.Results:Of 2191 patients with IS, 1134 had a pre-stroke mRS ≥2. Patients in the latter group were older, more likely be female, had higher rates of medical comorbidities, had higher presenting NIHSS (3[1-8] vs 2[1-5], p

Stroke, Volume 53, Issue Suppl_1, Page AWP2-AWP2, February 1, 2022. Introduction:Stroke accounts for 4% of patients with acute vertigo, which is missed in up to one third of cases.Hypothesis:We hypothesized that detection of stroke underlying acute vertigo using HINTS plus (head-impulse test, nystagmus type, test of skew, hearing loss) can be improved by videooculography for automated analysis of head-impulse test (V-HIT).Materials and Methods:We evaluated patients with acute vestibular syndrome (AVS) presenting to the emergency room using HINTS plus and V-HIT-assisted HINTS plus in a randomized sequence. In addition, patients underwent cranial MRI and caloric testing. Image-confirmed posterior circulation stroke or vertebrobasilar TIA were defined as reference standard to calculate accuracy of applied vertigo assessment protocols. After study completion, we repeated statistical analysis for a third protocol that was composed post hoc by replacing the results of head-impulse test with those derived from caloric testing in the HINTS plus protocol.Results:We included 30 AVS patients (ages 55.4 ± 17.2 years, 14 females). Of these, 11 (36.7%) had MRI-confirmed posterior circulation ischemic stroke (n=4) or vertebrobasilar TIA (n=7). Conducting V-HIT-assisted HINTS plus as part of the emergency work up was feasible and displayed a tendency toward higher accuracy than conventional HINTS plus (sensitivity: 81.8%, 95%CI 48.2-97.7%; specificity 31.6%, 95%CI 12.6-56.6% vs. sensitivity 72.7%, 95%CI 39.0-94.0%; specificity 36.8%, 95%CI 16.3-61.6%). (Figure) The new caloric-supported algorithm displayed high accuracy (sensitivity 100%, 95%CI 66.4%-100%; specificity 66.7%, 95%CI 41%-86.7%).Conclusions:Our study provides pilot data on the capacity of videooculography to improve accuracy of acute vertigo assessment using HINTS plus and indicates potential value of acute caloric testing as integrative part of standardized AVS emergency work up.