Search Results for: L'imaging nella urolitiasi

Stroke, Volume 56, Issue Suppl_1, Page ATP120-ATP120, February 1, 2025. Introduction:AI-based Stroke Care Coordination Platforms (AI-SCCP) have been shown to improve patient transfer decisions and provide access to the highest quality standards of care for all patients. Since strokes happen everywhere and anytime, we examine the economic benefits of implementing AI-SCCPs for two different hospital types: CSC – a comprehensive 24/7 stroke program inclusive of endovascular surgical care and PSC – “Acute Stroke Ready” facilities with radiological imaging and thrombolytic medication treatment capacities but no endovascular surgical care and patients/families.Methods:Using 2021 Medicare MS-DRG payment averages, we calculate the AI-SCCP’s PSC break-even point, its effects on CSC finances, and the reduced transfers’ economic benefits for the patient and family.Results:Avoided transfers enable the PSC to continue caring for the patient locally, increasing patient volume and resulting in increases in total contribution margin and net revenues beyond the costs of the AI-SCCP. While these retained patients decrease the CSC patient transfer volume, the CSCs will still provide care to all PSC patients needing surgical interventions and patients with MS-DRGs 61-66 who arrive at their locations via initial presentation in their emergency departments. Only 1.7% of all non-surgical stroke discharges were from PCS rural/small-town community hospitals (15% of all US hospitals), illustrating that there is room to avoid more futile transfers. Futile transfers have financial costs for family members, such as hotels, transportation, meals, and lost wages during the patient’s care and increased negative impacts on the patient’s health. Futile transfers increase the episode of care costs to the healthcare system through added ambulance transfers and physician and facility bills, adding out-of-pocket patient costs without adding health outcomes or value.Conclusions:AI-SCCPs offer financial benefits to the PSC and CSC by ensuring patients are at the facility, which provides the best possible benefits for them, a triple “win” for the PCS, CSC, and patients/families. For financially strained PCSs, the retained revenue is critical. Using AI-SCCPs ensures that local hospital/emergency departments can provide timely, expert stroke care for patients and their families in situ. In cases of necessary transfer, the receiving CSC team is prepared and ready to treat these patients, saving valuable time and brain immediately.

Stroke, Volume 56, Issue Suppl_1, Page ATMP88-ATMP88, February 1, 2025. Introduction:Pediatric and young adult cerebrovascular disease is more commonly associated with genetic conditions compared to in adults. This pilot study aims to characterize utility of genetic testing in a pediatric and young adult neurovascular clinic.Methods:This was a single center cohort study of pediatric and young adult patients (age

Stroke, Volume 56, Issue Suppl_1, Page ATMP85-ATMP85, February 1, 2025. Introduction:Neonatal deep medullary vein (DMVT) is an increasingly recognized etiology of brain injury in term and preterm infants. However, long-term outcomes remain poorly described, and the prognostic significance of the radiographic findings is uncertain.Methods:We extracted demographics and clinical variables for all infants with DMVT at our institution from 2007 to 2023. MRIs were scored as mild if there was isolated DMVT with no or only punctate parenchymal injury; moderate if there was DMVT with focal, unilateral ischemic or hemorrhagic injury, and severe if there was bilateral, confluent ischemic or hemorrhagic injury. The primary outcome was the presence of moderate-to-severe neurodevelopmental impairment (NDI), defined as a composite of any of the following at 2 years of age a) score < 70 on Bayley II/III/IV cognitive/language; cerebral palsy with GMFCS > 1; or profound vision or hearing impairment. We preformed univariate and multivariate logistic regression to evaluate whether moderate-to-severe initial imaging was associated with the likelihood of developing NDI.Results:64 infants had DMVT, of whom 30/64 (47%) were preterm. The median age of presentation was 2.5 days (1-8), and presenting symptoms included seizures (29/64, 45%), encephalopathy (24/64, 38%), respiratory distress (21/64, 33%), and abnormal tone (15/64, 23%). Neonatal comorbidities included congenital cardiac disease (14/64, 22%) and infection (12/64, 19%), but concurrent cerebral venous sinus (3/64, 5%) or systemic (5/64, 8%) thromboses were rare. Most infants had moderate (21/64, 33%) or severe (20/64, 31%) injury on initial MRI. Of 27 infants with follow up imaging at a median of 5.5 (4-19) days after the initial scan, only 3 had radiographic worsening. Most (54/64, 85%) survived to discharge. In the univariate analysis, the odds of NDI were 7-fold higher for moderate/severe MRI patients (OR: 8.182, 95% CI: 2.018 – 55.647, p=0.0092). Patients with moderate or severe initial MRI had 5-fold higher odds of developing NDI compared to those with mild MRI, after adjusting for confounding factors (OR: 6.356, 95% CI: 1.423 – 45.358, p=0.0283).Conclusions:While mortality after symptomatic DMVT is low, nearly half of survivors will develop moderate to severe neurodevelopmental impairment by 2 years of age. Moderate-to-severe injury on initial MRI is associated with a 5-fold higher odds of developing moderate to severe neurodevelopmental impairment at 2 years of age.

Stroke, Volume 56, Issue Suppl_1, Page ATMP87-ATMP87, February 1, 2025. Introduction:Mechanical thrombectomy (MT) is increasingly being performed in children with stroke due to large and medium vessel occlusion (LVO and MeVO). While retrospective series suggest favorable outcomes after MT, selection criteria for the pediatric population have not been defined. We aimed to analyze characteristics of children with LVO and MeVO and describe reasons for not pursing MT in children with acute vascular occlusion.Methods:The Stanford Pediatric Stroke Registry retrospectively enrolled pediatric patients with acute arterial ischemic stroke (AIS) admitted to our tertiary care center between 2007-2024. For this analysis, we included patients age 29 days-21 years with acute neuroimaging and clinical documentation available for direct review. LVO was defined as occlusion of the extra-/intracranial Internal Carotid Artery (eICA/iICA), Middle Cerebral Artery (MCA)-M1, Anterior Cerebral Artery (ACA)-A1, vertebral artery (VA) or basilar artery (BA). MeVO was defined as occlusion of the MCA-M2, MCA-M3 or ACA-A2. Patient charts were reviewed for documentation of medical decision-making, and reasons for forgoing MT were assigned by two pediatric neurologists trained in stroke (SL) and neurocritical care (EM). Clinical and imaging characteristics were compared using chi-squared or Fishers Exact test for categorical variables and Mann-Whitney U test or t-test for continuous variables. Results were reported using descriptive statistics.Results:Among 208 children with acute AIS, 82 (39.4%) had LVO/MeVO (Figure 1); 14 children had multiple occlusions for a total of 114 vascular occlusions (90 LVO, 24 MeVO). Patients with LVO/MeVO were older, had higher NIHSS and more often underwent contrast perfusion imaging compared to non-LVO/MeVO patients (Table 1). Among LVO/MeVO patients, Moyamoya Arteriopathy (MMA) was the final diagnosis in 10 (5 with a pre-existing diagnosis). Excluding those, 72 patients (34.6%) had a non-MMA vascular occlusion. MT was performed in 18 patients; of the 64 who did not undergo MT, the most common primary reasons intervention was not pursued were 1) concern for arteriopathy or infection (n=15) and 2) completed/large infarct burden (n=14, Figure 2).Conclusions:LVO/MeVO is not uncommon in children. In our cohort, LVO/MeVO was diagnosed in over 1/3 of children with acute AIS, and a quarter of those underwent MT. Further multicenter prospective studies are needed to define MT selection criteria in this unique population.

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 ATMP64-ATMP64, February 1, 2025. Introduction:Hematoma expansion (HE) is strongly associated with mortality and disability in intracerebral hemorrhage (ICH). While it is accepted that the majority of this expansion occurs early after onset, there is limited data on HE and associations with outcome in the ultra-early time window (within 3 hours of symptom onset). We aimed to (a) estimate the incidence of HE within the ultra-early period of ICH, (b) describe hematoma growth dynamics over time, and (c) investigate the associations between ultra-early HE and clinical outcomes after ICH.Methods:We performed a planned secondary analysis of the STOP-MSU international multicenter randomized controlled trial. The trial compared tranexamic acid (TXA) with placebo in 201 patients with primary ICH presenting within 2 hours of symptom onset. Repeat CT imaging 1 hour after treatment commencement was optional, and patients who underwent this ultra-early re-imaging were included in this descriptive study. Hematoma expansion was defined as growth by either >33% or >6ml from the baseline hematoma volume.Results:We included 105 patients with ultra-early re-imaging (median age 66 years, 40% female, 53% TXA). Median time from onset to baseline imaging was 74min (IQR 56-87min), and between baseline and ultra-early re-imaging was 95min (IQR 74-132min). Forty-one patients (39%) had ultra-early HE. These patients had larger baseline hematoma volumes (15.9ml vs 9.1ml, p=0.03) and similar rates of intraventricular hemorrhage (22% vs 29.7%, p=0.38), compared to those without ultra-early HE. No effect of TXA on ultra-early HE was observed (TXA 41.1% vs placebo 36.5%, p=0.61).Of 92 patients with both ultra-early and 24 hour re-imaging available, 31 patients had ultra-early HE. Of these, 9 (29%) had further growth at 24 hours, compared to 4/61 patients (6.6%) with no ultra-early growth (p

Stroke, Volume 56, Issue Suppl_1, Page ATP336-ATP336, February 1, 2025. Improvements in acute stroke treatment, including EVT and critical care management, have increased survival rates post-stroke. However, many stroke survivors have significant post-stroke disability and cognitive impairment. Despite this, the chronic progression and long-term sequelae of ischemic stroke pathology remains understudied.Methods:We examined the chronicity of neurobehavioral recovery and progressive neuropathology in young male (3 month) and middle-aged male and female (14 month) C57Bl/6 mice at 3 and 6 months after a 60-minute transient middle cerebral artery occlusion (tMCAO) or sham surgery (n = 10-20/group). Behavioral testing included NORT, fear conditioning (FC), and tail suspension. Immunohistochemistry (IHC) was performed on mouse brains, as well as post-mortem human brain samples from patients with a chronic infarct (n = 6/group), to assess demyelination (MBP), neuronal apoptosis (TUNEL/NeuN), and amyloid burden (Aβ-42). Flow cytometry was performed on the ipsilateral mouse brain hemisphere. RNA isolated from the ipsilateral hemisphere was sent for gene profiling.Results:In both young and middle-aged mice, depressive-like behavior persisted for 6 months post-stroke (PS) (p=

Stroke, Volume 56, Issue Suppl_1, Page ATMP50-ATMP50, February 1, 2025. Introduction:The advent of wireless monitoring technologies to detect stroke onset during sleep has the potential to accelerate reperfusion treatment in the 20-25% of patients with wake-up stroke. Monitoring technologies will hasten stroke detection in patients who sleep through stroke onset but not in patients who are awakened by stroke onset. The relative frequencies patients who stay asleep after onset compared with patients who wake up with onset has not been welldelineated.Methods:We performed a systematic search and meta-analysis of studies comparing diffusion-weighted imaging–fluid-attenuated inversion recovery (DWI-FLAIR) mismatch frequencies in wake-up stroke (WUS) compared with clear onset time stroke (COS). Differences in WUS vs COS decay curves in frequency of FLAIR-DWI mismatch with longer time from symptom detection to imaging were used to estimate the time of stroke onset during sleep.Results:Two studies of WUS and COS patients met selection criteria, collectively enrolling 443 patients (201 WUS, 242 COS). The frequencies of FLAIR-DWI mismatch at different intervals from symptom-detection-to-imaging are shown in Figure 1. For COS patients, frequency of mismatch presence declined gradually:

Stroke, Volume 56, Issue Suppl_1, Page ATP119-ATP119, February 1, 2025. Introduction:Informed consent is a cornerstone of modern clinical research, though ensuring consent has long been recognized as problematic. This is especially true for acute stroke trials, where the time-sensitive nature of treatment challenges traditional consent practices. The era of platform adaptive trials will likely add further complexity to acute stroke consent. Therefore, we sought to survey the literature for any empirical studies documenting research participants’ preferences around what content is most important to include in consent forms.Methods:We conducted a systematic review of the literature to identify empirical studies reporting patients’ opinions about what content is most important to include in consent forms for research participation. Eligible studies included surveys, focus groups, or interviews. Based on a review of consent form templates, we identified 18 elements that commonly appear in consent forms, and used these to guide our extraction of potential content.Results:Of the 1,444 studies screened by title and abstract, 35 were sent to full text review, and data were extracted from 17 studies. To determine the ubiquity of the importance of these topics, we counted if each of these topics appeared in the 17 papers. The most commonly mentioned items included risks (65%, 11/17 studies), potential benefits (53%, 9/17 studies), study procedures e.g. blood draws and imaging (47%, 8/17 studies), confidentiality (47%, 8/17 studies), study rationale (41%, 7/17 studies), and voluntariness (41%, 7/17 studies). The least important elements included information about the condition and investigator conflicts of interest.Conclusion:In the era of adaptive platform trials for acute stroke, there is the potential for consent forms to become incredibly lengthy and complex. This is the first systematic review of which we are aware that seeks to identify what information is most important to be included in consent forms to participate in research studies. Unfortunately, data are limited but they suggest that consent form optimization is possible. Only risks and potential benefits were identified as important in a majority of studies.

Stroke, Volume 56, Issue Suppl_1, Page ATP366-ATP366, February 1, 2025. Introduction:In stroke clots, neutrophil extracellular traps (NETs) promote thrombosis, enhance clot stability, and decrease clot amenability to thrombectomy and thrombolysis.Objective:We examine the relationship between NET enrichment and clot mechanical characteristics, radiomics, and histological microstructure.Methods:White blood cells (WBCs) were concentrated from human donor whole blood. Platelet-rich plasma and red blood cells (RBCs) were isolated by centrifugation and mixed with WBCs to produce 0%, 20%, and 40% RBC clot analogs. Lipopolysaccharide (LPS) was added (0μL, 2μL, 6μL into 1mL dH2O) to enrich clots with varying NET amounts. CaCl2 induced clotting. Clots were incubated while rotating at 37°C. Clot analogs were assessed mechanically by uniaxial stretch tester and stress-strain curves, radiomically through high-resolution microCT and radiomic feature analysis, and histologically through whole-slide imaging of H&E-stained tissue and immunofluorescence (Citrullinated Histone Antibody and DAPI counterstain) to quantify NETs. Statistical analysis assessed what mechanical, radiomic, and histological features were significantly different among clots of various NET enrichment. unsupervised clustering was performed on radiomic and histological features to identify signatures unique to NET-enriched clots.Results:LPS addition produced clots with increasing NET enrichment and microstructural complexity. For fibrin-platelet rich clots (0% RBC), NET enrichment produced significant increase in mechanical stiffness, measured by breaking strength (max load) and Young’s Modulus. For each percent composition, radiomic and histomic profiling clustered clot analogs well by NET-enrichment, with NET-enriched clots demonstrating distinct radiomic and histological feature trends. See Figure 1.Conclusion:NET enrichment produces mechanically stiffer clot analogs with distinct microstructure, radiomic, and histological profiles.

Stroke, Volume 56, Issue Suppl_1, Page ATMP59-ATMP59, February 1, 2025. Introduction:Diffusion-weighted imaging (DWI) is key for detecting acute ischemic brain lesions but struggles with hyperacute or small lesions that mimic artifacts. This randomized crossover trial assessed whether an artificial intelligence (AI) solution enhances diagnostic accuracy for these challenging lesions compared to conventional interpretation.Methods:From February 2017 to November 2021, 4,071 suspected acute ischemic stroke patients underwent initial and follow-up DWI. A neurologist assessed ischemic stroke based on medical records, and a neuroradiologist established the ground truth using the neurologist’s evaluation, MRI reports, and AI-marked DWI images. The accuracy of AI and MRI reports was then evaluated against this ground truth.For a reader performance study, 874 challenging cases were selected: (1) infarct volume < 0.5 mL in the posterior circulation on follow-up DWI or (2) initial DWI within 3 hours of onset with infarct volume < 1.0 mL in the anterior circulation. Additionally, 80 negative and 40 positive control cases were included. Five readers (a neuroradiologist, two radiology residents, and two neurology residents) interpreted the DWIs, half with AI assistance and half without. After a 4-week washout, cases were re-evaluated with the groups reversed. We compared the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and Dice similarity coefficient (DSC) between readings with and without AI.Results:Of 3,981 patients, 3,465 had acute ischemic strokes, and 516 had MRI-negative transient ischemic attacks. The AI alone showed a positive predictive value (PPV) of 93.1% and a negative predictive value (NPV) of 81.3%. The PPV of AI varied significantly with predicted infarction volume: 81.7% for ≤ 0.5 mL vs. 99.5% for > 0.5 mL. With AI, the sensitivity of MRI reports could potentially increase from 98.5% to 99.7%, ensuring identification of all false negatives.In the challenging case reader study, AI significantly increased AUC (0.848 vs. 0.927; p < 0.001) and sensitivity (74.59% to 90.59%; p < 0.001), with minimal impact on specificity (88.75% vs. 84.00%; p = 0.0496). AI-assisted segmentation also showed higher DSC compared to non-AI segmentation (0.742 vs. 0.523; p < 0.001).Conclusions:AI significantly improved the diagnostic performance for challenging acute ischemic lesions on DWI, demonstrating the potential to enhance stroke care.

Stroke, Volume 56, Issue Suppl_1, Page ADP4-ADP4, February 1, 2025. Introduction:Intravenous thrombolysis with alteplase (tPA) or tenecteplase (TNK) is a first-line treatment for acute ischemic stroke. The most serious risk associated with IV thrombolytics is symptomatic intracranial hemorrhage (sICH). Patients are usually monitored in intensive care units for neurologic decline signaling sICH for 24 hours, after which follow up neuroimaging is performed and antithrombotic secondary prevention may be initiated. However, the evidence surrounding the onset of neurologic decline in post-thrombolytic sICH is limited. The current study seeks to provide data regarding onset of clinical worsening in post-thrombolytic sICH, and to identify a subset of patient characteristics for a future clinical trial to test whether earlier imaging, transfer from ICU, and initiation of secondary prevention is feasible and safe.Methods:The current study is a multi-center collaboration between University of Texas – Dell Medical Center, Ascension Seton, and Ascension Saint Thomas. We reviewed stroke databases from 2017 to 2024 for patients who received IV thrombolysis with either tPA or TNK and developed sICH within 36 hours of treatment. sICH was defined as a hemorrhage that caused an increase in NIHSS by 4 or more points. Patient charts were reviewed to determine if a decline in neurologic exam prompted neuroimaging that discovered sICH, and for documentation of the timing of clinical worsening that prompted neuroimaging.Results:40 patients were identified during the study period to have sICH. Of those, 25 patients were discovered to have sICH after a decline in neurologic exam. 7 patients received tPA and 18 patients received TNK. The median time to documented neurologic decline in all patients was 251 mins (range: 7 mins to 1185 mins). For patients with pretreatment NIHSS < 10, the median time to documented neurologic decline was 134 mins (range: 57 to 259 mins).Discussion:All patients with neurologic decline resulting in neuroimaging and discovery of sICH had this decline documented within 20 hours. Among patients with NIHSS < 10, all patients had this decline within 5 hours. Our preliminary data suggests that there may be patients who receive IV thrombolysis who may be candidates for expedited neuroimaging or transition to step-down units and secondary preventive measures. Candidates would likely require stable neurologic exams that could be tracked over time. Further investigation to confirm these results on a larger sample is planned.

Stroke, Volume 56, Issue Suppl_1, Page ADP2-ADP2, February 1, 2025. Introduction:Tirofiban has shown a potential effect in reducing early neurological deterioration and improving clinical outcomes in selected patients with non-embolic stroke. We aim to analyze the effect of tirofiban versus standard acute therapy on 90-day outcomes in patients with presumed non-embolic stroke.Methods:Multicentric retrospective cohort study including consecutive AIS patients presenting within 24h from symptom onset, baseline mRS 0-1, absence of cortical symptoms, identifiable vessel occlusion or other imaging features suggestive of embolic stroke; anticoagulated patients were excluded from the analysis. Patients received either tirofiban (±ASA) or standard acute therapy (IVT or oral antiplatelets). Primary outcome was functional independence at 90 days (mRS 0-2); secondary efficacy and safety outcomes included: excellent outcome (mRS 0-1); sICH, systemic bleeding and neurological deterioration (4 point increase in NIHSS). Exploratory subgroup analysis was performed for severity (NIHSS ≥5 vs

Stroke, Volume 56, Issue Suppl_1, Page ATP373-ATP373, February 1, 2025. Objectives:Cerebral autosomal-dominant arteriopathy, subcortical infarcts, and leukoencephalopathy (CADASIL) is a leading monogenic cause of cerebral small-vessel disease. This study aimed to evaluate the functional integrity of long white matter tracts in CADASIL transgenic mice and assess the potential of tocotrienol (T3) as a therapeutic agent.Methods:Optical resting-state functional connectivity imaging and behavioral examinations were employed to characterize white matter tracts in CADASIL transgenic mice, both with and without focal white matter lesions in the corpus callosum. Functional connectivity and behavioral outcomes were compared between Notch3R169Cand Notch3WTmice. The efficacy of T3, a neuroprotective vitamin E derivative, was also evaluated based on findings from previous clinical trials in small vessel disease.Results:After performing stepwise elimination using the Akaike Information Criterion (AIC), the diet variable was removed from the model and we pooled the data in the two diet arms for subsequent analyses of interhemispheric homotopic connectivity. At baseline, resting-state interhemispheric functional connectivity was significantly reduced in Notch3R169Cmice compared to Notch3WTmice (p=0.004). No significant differences between genotypes were observed on day 1 and day 7 post-lesion. Behavioral analysis using the grid walk test revealed an increased number of foot faults in Notch3R169Cmice at baseline, with similar increases observed in both genotypes one week after lesion induction. Lesion volumes on day 7 did not differ between genotypes.Conclusions:The Notch3R169CCADASIL model demonstrated impaired resting-state functional connectivity and increased foot faults, indicating significant functional and behavioral deficits. Future research will focus on evaluating therapeutic and preventive interventions in CADASIL models using these parameters.

Stroke, Volume 56, Issue Suppl_1, Page ATP396-ATP396, February 1, 2025. Exosomes have been used for therapeutic purposes to target stroke and other disorders. Repeated administration of mesenchymal stem cell (MSC)-derived exosomes in rats showed improved functionality and reduced stroke injury. However, exosomes from endothelial progenitor cells (EPCs) have not been tested in any stroke model, and in vivo bio-distribution study is lacking.Targeted delivery of IV-administered exosomes has been a great challenge. Modifying the exosomal surface to carry different ligands or peptides has been tried to increase delivery to target tissues. However, the overall results are not encouraging. Delivery of exosomes to the brain is a daunting task, and a blood-brain barrier(BBB)-penetrable peptide is being considered. However, a method that can deliver naïve (unmodified) exosomes to the site of stroke without destroying host tissues, disrupting BBB, or the membranes of the delivery vehicles (such as exosomes) will be a breakthrough.Low-intensity pulsed ultrasound (LIPUS) is approved for clinical use in musculoskeletal and physiotherapy clinics. The use of focused LIPUS to deliver exosomes has yet to be explored in stroke. The objectives of the proposed studies were to determine whether LIPUS-mediated increased delivery of EPC exosomes enhances stroke recovery and functional improvement in mice with tMCAo stroke. In this study, we used EPC-derived exosomes for stroke treatment. To enhance exosome delivery to the stroke area, we utilized focused LIPUS, which temporarily disrupts BBB. We evaluated stroke volume with MRI at different time points. We also conducted behavioral studies in parallel to MRI to determine the recovery. In the end, we studied the brain tissue with immunohistochemistry studies to evaluate the extent of stroke and tissue regeneration.In vivo, imaging showed a higher accumulation of EPC exosomes following focused LIPUS without any damage to the underlying brain tissues. Four groups (Vehicle, LIPUS only, EPC-exosomes only, and LIPUS+EPC-exosomes) of aged animals were enrolled in the studies. The focused LIPUS + EPC exosomes group showed a decreased stroke volume (p=0.08) on day 7, decreased FluoroJade+ cells, and significantly higher numbers of neovascularization in and around the stroke areas although rCBF was not increased compared to that of other groups. There were no differences in the white matter tract volumes, ventricular volumes, astrogliosis, or neurobehavioral functions among the treated groups.

Stroke, Volume 56, Issue Suppl_1, Page ATMP67-ATMP67, February 1, 2025. Background and Objective:The simplified Edinburgh CT criteria allowed a diagnosis of cerebral amyloid angiopathy (CAA) in spontaneous lobar intracerebral hemorrhage (ICH) for patients with limited accessibilities to MRI. However, its applicability to Asian populations remains uncertain. This study evaluated the diagnostic accuracy of the simplified Edinburgh CT criteria in Asian lobar ICH and to propose modifications if the performance is suboptimal.Methods:We analyzed patients with spontaneous lobar ICH (≥ 50 years) from 2015 to 2022 who underwent an acute CT and an MRI. The CT images were assessed according to the LINCHPIN CT RATING FORM. Demographic and imaging parameters were compared between probable CAA and non-CAA groups with modified Boston criteria as reference standards, and were selected to establish a logistic regression model. The modified version of CT criteria was evaluated by diagnostic accuracy, inter-rater reliability and decision curve analysis.Results:A total of 87 lobar ICHs were included (ICH volume 20.1 [10.0-39.9] ml, 46.0% probable CAA). The presence of subarachnoid hemorrhage (SAH, 47.5% vs 21.3%, p=0.010), but not finger-like projection (FLP, 42.5% vs 23.4%, p=0.057), showed significant difference between probable CAA and non-CAA groups. The simplified Edinburgh CT criteria yielded only moderate diagnostic accuracy for CAA (AUC 0.66). To enhance the diagnostic performance, we identified additional CT markers that are related to CAA including cortical atrophy and deep atrophy; absent old striatocapsular insult, old lacune or vascular lesions (all p