Search Results for: L'imaging nella urolitiasi

Stroke, Volume 56, Issue Suppl_1, Page ATMP78-ATMP78, February 1, 2025. Background:Successful recanalization following endovascular thrombectomy (EVT) in vertebrobasilar artery occlusions (VBAOs) does not uniformly translate into favorable functional outcomes. Identifying predictors of futile recanalization is critical for improving patient selection and treatment strategies. This study aimed to compare patients with good versus poor functional outcomes despite successful recanalization in VBAO and to establish predictive factors for futile recanalization.Methods:We retrospectively analyzed patients who achieved successful recanalization after EVT for VBAO from a prospectively maintained database between 2014-2024. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days; dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcomes. Demographic data, clinical characteristics, procedural variables, and imaging findings were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify predictors of futile recanalization.Results:Among the 163 patients who qualified for final analysis, 73 (44.8%) had good functional outcomes, while 90 (55.2%) had poor outcomes despite successful recanalization. Age (72 years vs. 64 years, p=0.0014), baseline NIHSS score (22 vs. 14, p

Stroke, Volume 56, Issue Suppl_1, Page A35-A35, February 1, 2025. Introduction:AI imaging decision support software is recommended by UK and USA stroke guidelines to facilitate identification and transfer of stroke patients eligible for endovascular therapy (EVT) but the impact on thrombectomy delivery is unclear. This prospective observational study evaluated the impact of Brainomix 360 Stroke software in four stroke networks (28 hospitals) in England’s National Health Service (NHS). The primary outcome was percentage of acute stroke patients receiving EVT (the EVT rate); door-in door-out (DIDO) times were assessed as a secondary outcome.Methods:Data were collected prospectively from the Sentinel Stroke National Audit Programme. The impact of Brainomix 360 Stroke software was assessed in two ways: comparison of EVT rates at the 28 evaluation sites and non-evaluation NHS sites before and after implementation (pre-implementation: Jan 2019-Feb 2020; post- : Jan 2022-Feb 2023); comparison of EVT rates and DIDO times at evaluation sites after implementation in patients for whom AI software was used and in those it was not. Multivariate regressions were used to evaluate whether AI use was a predictor of EVT or DIDO time, accounting for other clinical variables (e.g., age, NIHSS, day of week, time of day, time since onset).Results:The dataset included 71,327 patients from 28 evaluation hospitals. Figure 1 shows the change in EVT rates over time in evaluation (blue) and non-evaluation sites (yellow). EVT rate at evaluation sites increased from 2.3% pre-implementation to 4.6% post-implementation (p

Stroke, Volume 56, Issue Suppl_1, Page ATMP112-ATMP112, February 1, 2025. Introduction:Both histological and transcriptomic analyses of acute ischemic stroke (AIS) clots have identified features associated with mechanical thrombectomy (MT) outcome. However, few studies have explored how fluorescence histology and mRNA sequencing from the same clot can pinpoint specific biological phenomena associated with MT failure.Hypothesis:Joint analysis of paired clot immunofluorescence histology and mRNA sequencing will identify Neutrophil Extracellular Trap (NET) enrichment as a biomarker of MT first pass (FP) outcome.Methods:We performed paired histological and transcriptomic analysis of 32 stroke clots retrieved by MT (n=16 each of FP success and failure). Immunofluorescence histology was completed by co-staining 4µm clot tissue sections with antibodies against NET components (neutrophil elastase [ELANE], citrullinated histone [CitHis]) and super resolution imaging with instant structured illumination microscopy (ISIM) at 100X magnification. Differentially expressed genes (DEGs) were identified between transcriptomes of FP success and failure using the criteria of logFC≥1.5 and q

Stroke, Volume 56, Issue Suppl_1, Page ATP165-ATP165, February 1, 2025. Background:Posterior circulation (PC) large-vessel occlusion (LVO) strokes have significant morbidity and mortality, but patient selection for acute interventions remains understudied. Multiple computed tomography (CT)-based scores exist, including the CT-perfusion-based CAPS score, CT-angiogram(CTA)-based BATMAN and PC-CTA scores, and CTA source image or non-contrast-CT-based PC-ASPECTS score, but their predictive values for long-term outcomes after thrombectomy have not been directly compared.Methods:We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions treated with endovascular thrombectomy. Four CT-based scores were assessed: PC-ASPECTS, BATMAN, PC-CTA, and CAPS. The primary outcome of interest for the study was favourable functional outcome at 3 months (mRS of 0-3). We generated receiver operating characteristic curves measuring area under the curve (AUC) for poor functional outcomes and compared AUCs with non-parametric methods.Results:98 patients were included for analysis, with an average age of 64.9±15.6 years.The median National Institute of Health Stroke Severity Score (NIHSS) was 13.5 (IQR 7.0 – 23.0). AUC values were highest for the CAPS score (AUC 0.72 (95%CI 0.63 – 82)), and lowest for the pc-CTA score (AUC 0.57 (95%CI 0.45 – 0.68)), p=0.019. There was a trend towards the CAPS score outperforming the BATMAN (AUC 0.66 (95%CI 0.55 – 0.77) and PC-ASPECTS scores (AUC 0.63 (95%CI 0.52 – 0.75)), though this difference was not statistically significant (p=0.29 and p=0.23, respectively). However, the CAPS score was the only score with 100% specificity for predicting inability to achieve good functional outcome after thrombectomy: 0/12 patients with CAPS score of 4-6 went on to have a good functional outcome at 3 months after thrombectomy.Conclusion:Our analysis demonstrated that the CT-perfusion-based CAPS score outperformed three other imaging-based scores for predicting outcomes after 3 months. The CAPS score could be implemented to inform patient selection for endovascular thrombectomy in basilar artery occlusions.

Stroke, Volume 56, Issue Suppl_1, Page A33-A33, February 1, 2025. Introduction:Net water uptake (NWU) is a novel biomarker which measures edema and tissue injury from the degree of hypoattenuation on non-contrast CT and may serve as a precision tool for predicting outcomes after acute ischemic stroke (AIS). Using our recently developed algorithm, this study aimed to evaluate the relationship between NWU and post-stroke neurologic outcomes, including language impairment and motor weakness.Methods:Consecutive patients treated for AIS at certified stroke centers in Houston, TX were included. Patients’ precise functional outcomes at hospital discharge were recorded including decreased level of consciousness, presence of language impairment, visual deficit, arm and leg weakness, need for walking assistance, and gastrostomy placement. The primary outcome for this study was the performance of calculated NWU and clinical variables to predict language impairment at discharge. Baseline characteristics were compared, and then univariate and multivariate logistic regression were used to evaluate the association between clinical variables, imaging data, and the precise neurological outcomes.Results:Among 776 patients with AIS, average age was 67.0 +/- 14.8, 47.8% were female, median NIHSS was 10 [5,18], median ASPECTS was 9 [7,10], 42.6% received tPA, and 67.1% had a large vessel occlusion (see Table 1). In univariate logistic regression, higher NWU (OR 1.45, CI 1.30-1.63) and lower ASPECTS (OR 0.68, CI 0.63-0.74) were both significantly associated with higher likelihood of language impairment and other deficits at discharge (see Table 2). Additionally, higher NWU in all ten regions was significantly associated with deficit at discharge. In multivariate logistic regression, certain clinical and imaging variables remained significantly associated as described in Table 3. The ASPECTS and NWU-based regression models were directly compared when predicting language impairment using ROC curve analysis, and areas under the curve were 0.838 vs. 0.851 respectively (p = 0.152 with Delong test, see Figure 1).Conclusion:The novel NWU biomarker was significantly associated with precise post-AIS outcomes at discharge. When controlling for confounders, NWU was non-inferior to ASPECTS. Moving forward, region-based and overall NWU will need to be studied with long-term patient outcomes. Ultimately, this novel and open-access imaging biomarker could be used in the emergency setting to guide treatment decision-making and patient counseling.

Stroke, Volume 56, Issue Suppl_1, Page A29-A29, February 1, 2025. Introduction:Early identification of the etiology of ischemic stroke is crucial for secondary prevention. Recent publications on dedicated ECG-gated cardiac CT showcase the potential to detect sources of cardiac embolism.Photon-counting CT (PCCT) uses semiconductors to convert X-ray photons into electrical signals directly. This allows for improved image quality and lower radiation dose compared to conventional CT. Exploiting PCCT technology with a high-pitch dual-source image acquisition may render an exceptionally high temporal resolution.We hypothesized that non-ECG-gated high-pitch dual-source PCCT angiography from the diaphragm to the brain might provide added clinical value in detecting cardiac stroke sources during initial stroke imaging while maintaining optimal brain and neck image quality.Methods:Consecutive patients with a clinical suspicion of acute stroke imaged with a PCCT system between October 4th, 2023 and April 13th, 2024 at a Swedish comprehensive stroke center were included. Diaphragm to brain coverage was obtained in an acquisition time of 1.3 seconds; on average, yielding a dose-length product of 360 mGy*cm for the study participants (2.34 mSv). Image quality was graded using a 4-point Likert scale. Images were assessed for cardiac stroke sources. Where available, reference standard echocardiography results were collected.Results:Of 249 consecutive stroke investigations, 193 included cardiothoracic imaging, which constituted the study population. 126 scans (65.3%) were cases with imaging confirmed ischemic stroke. The median age was 74 (IQR, 61-81) years, 99 were male (51.3%). In total, 39.4% underwent follow-up echocardiography.Image quality of the heart was excellent in 19 scans (9.8%) good in 97 (50.3%), moderate in 72 (37.3%), and poor in 5 scans (2.6%). Fourteen (7.3%) certain or probable interatrial septal defects were found in the study population. In the imaging-confirmed ischemic stroke subgroup, six certain or probable cardiac thrombi were found (4.8%). Additionally, a possible cardiac thrombus was found in 31 instances (24.6%). Three aortic valve vegetations were found (2.4%), all confirmed by echocardiography.Conclusions:Non-ECG-gated high-pitch dual-source PCCT angiography typically provides images of high quality, at virtually no time expense while maintaining a reasonably low radiation exposure. Non-gated PCCT angiography is a promising technique to be used as a primary screening method for cardioembolic stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP160-ATP160, February 1, 2025. Background and Purpose:Deep tiny flow voids (DTFVs) are a specific type of collaterals surrounding chronic steno-occlusive middle cerebral artery (MCA), which can be identified on high-resolution magnetic resonance imaging (HR-MRI). This study aimed to investigate the presence of DTFVs in patients with acute MCA occlusion and their relevance to clinical outcomes.Methods:Using data from two multicenter cohort studies, we examined the presence of DTFVs in patients with acute MCA occlusion and analyzed their clinical and imaging characteristics. Univariable and multivariable logistic and linear regression analyses were conducted to assess the correlation between DTFVs and the 90-day modified Rankin Scale (mRS) scores. We further studied the mediating effect of residual flow distal to MCA occlusion on the relationship between DTFVs and 90-day mRS scores using mediation analysis.Results:One hundred and twenty-three patients with acute MCA occlusion were included. The median age was 61 years (interquartile range [IQR], 51-67 years), and 73.73% of the patients were male. The median time from symptom onset to imaging was 44 hours (IQR, 25-67 hours). Sixty-six patients (53.66%) exhibited DTFVs on HR-MRI. Lower baseline NIHSS scores (4.5 [2-8] vs. 10 [4-14]) and smaller infarct volumes (5.76 [2.79-15.34] cm3vs. 19.01 [7.16-83.59] cm3) were observed in patients with DTFVs compared to those without. Both multivariable logistic regression (odds ratio [OR]: 6.22, 95% confidence interval [CI]: 1.82 to 21.29, p = 0.004) and linear regression analysis (β: -0.60, 95% CI: -1.06 to -0.14, p = 0.012) indicated that patients with DTFVs exhibited better 90-day functional outcomes. The mediating effect analysis showed that the effect of DTFV on 90-day mRS scores was partially mediated by residual flow distal to MCA occlusion, with a proportion of 30.66% (95% CI: 8.97 to 69.29, p = 0.002).Conclusions:In our study population, the presence of DTFVs was associated with a favorable outcome in patients with acute MCA occlusion, which may exert a protective effect partly by contributing to the formation of distal residual flow at the occlusion sites. Future studies are needed to investigate the potential of DTFVs in guiding individualized treatment strategies.

Stroke, Volume 56, Issue Suppl_1, Page ATMP93-ATMP93, February 1, 2025. Introduction:Flow-directed catheters are popular for their low profile and ease of navigability, making them a favorable option for catheterization of tortuous, small-caliber feeding vessels. These catheters have been FDA-approved for adults, but no catheter has been indicated for pediatric use. However, high-flow pediatric cerebrovascular lesions are often difficult to treat due to their extensive small-caliber arterial supply. As a result, flow-directed microcatheters like the MAGIC (Balt, Montmorency, France) have been used off-label since their introduction to the market. Here, we characterize our longitudinal experience with the MAGIC microcatheter in pediatric neurointervention.Methods:A single-center retrospective chart review from 1995 to 2024 identified all patients under the age of 18 with cerebrovascular pathology (dural and pial arteriovenous fistula, Vein of Galen malformation (VOGM), intracranial and extracranial arteriovenous malformation (AVM)) that required treatment with the MAGIC microcatheter. Clinical data, imaging, and procedural parameters including anatomic approach, embolic material used, complications and technical success were reviewed.Results:2,172 MAGIC microcatheters were utilized in 923 procedures to treat cerebrovascular pathology in 341 pediatric patients. The median patient age was 3.26 years and patients underwent an average of 2.71 ± 2.31 endovascular procedures requiring the MAGIC. The MAGIC was most frequently navigated in conjunction with a 4F Berenstein guide catheter (60.3%) or a 5F Envoy distal access catheter (24.9%). The most common pathology treated was VOGM (44.4%), followed by intracranial AVM (42.6%). The MAGIC was typically navigated by transarterial approach (97.0%) and was able to successfully catheterize selected pedicles with a 91.4% success rate. The MAGIC was able to successfully embolize in 845 (91.5%) cases: n-BCA was utilized in 96.3% of embolizations. Intraprocedural complications (wire perforation, contrast extravasation, etc.) occurred in 28 (1.3%) catheter uses, of which 5 (0.2%) were catheter-related (retention/rupture).Conclusion:We report a large cohort of MAGIC usage in the treatment of pediatric cerebrovascular disease over approximately 3 decades. The MAGIC flow-directed catheter is safe and effective with an important niche in pediatric neurointervention.

Stroke, Volume 56, Issue Suppl_1, Page ATP372-ATP372, February 1, 2025. Introduction:Ischemic stroke is highly heterogeneous, with patient-to-patient differences in infarct location, severity, and degree of reperfusion, among other factors. Incorporating this variability in preclinical stroke models is useful to more comprehensively recapitulate the patient population. Prior studies employ Longa (complete reperfusion) or Koizumi (chronic hyporeperfusion) murine models of stroke interchangeably over a range of ischemic durations. These models represent distinct stroke phenotypes, but the unique features of each model warrant further definition. Therefore, we sought to differentiate the pathology of these models to more accurately model patient heterogeneity.Methods:Transgenic mice expressing a fluorescent neutrophil marker (Ly6G-TdTomato) were subject to the Longa or Koizumi temporary middle cerebral artery occlusion (tMCAO) model of ischemic stroke. Ischemic duration was varied to model strokes of mild (30 min), moderate (60 min) and high (90 min) severity (n = 6-10 per experimental model). Laser speckle contrast imaging (LSCI) was performed at baseline, prior to and after reperfusion, and at endpoint to quantify cerebral blood flow (CBF) using a custom-made pixel assignment algorithm. Brains were collected at 24h or 72h and imaged via confocal microscopy to evaluate neutrophil infiltration in the ischemic hemisphere.Results:Mortality significantly increased with ischemic duration in the Koizumi model at 24h, 48h, and 72h, but did not differ across the Longa models. LSCI demonstrated a 2-to-5-fold increase in the area of profound ischemia (lowest quintile of pixel values) in the Koizumi model compared to the Longa model and with increasing ischemic duration. Additionally, the Koizumi model exhibited less restoration of CBF following reperfusion and more variability in CBF within the ischemic hemisphere regardless of ischemic duration. The number of infiltrating neutrophils increased 10-fold between the 30- and 90-min Longa and Koizumi models, but the Koizumi model demonstrated increased variability in the number of neutrophils at 24h and 72h.Conclusions:Our findings demonstrate differences in mortality, CBF, and immune response between stroke models of varying ischemic duration and reperfusion status. These unique pathological features can be linked to the physiological perturbations defining each model to establish a phenotypic spectrum that can be exploited to more thoroughly represent human stroke patient heterogeneity.

Stroke, Volume 56, Issue Suppl_1, Page ATP395-ATP395, February 1, 2025. Introduction:Ischemic stroke is one of the leading causes of death in the United States and is a known risk factor for Alzheimer’s Disease (AD) development. One of the characterizations of AD is the accumulation of β-amyloid peptide due to the proteolysis of Amyloid Precursor Protein (APP) by the protein Presenilin 1 (PS1) among others. In APP/PS1 mice, which contain an additional human copy of APP and PS1, a 15-minute Middle Cerebral Artery Occlusion (MCAO) model was developed. Here we investigate the effects of increased β-amyloid peptide on motor coordination when subjected to local ischemia.Methods:APP/PS1or Wt male mice are initially subjected to either a 15-minute MCAO or Sham surgery. Injury volume using MRI is assessed at 3-days using T2 imaging. To test motor coordination the mice went through a tapered beam analysis at the 7-day time point. Following the tapered beam test, Cresyl Violet was used to stain brain slices. All mice were 8-12 weeks old at the time of surgery. Differences between groups were determined by Welch’s T-Test. Significance was determined as p < 0.05.Results:No significant difference in infarct volume was observed between the APP/PS1-MCAO and Wt-MCAO groups. In the hind legs, it was observed that there is a significant difference in the number of slips off the tapered beam in the APP/PS1-MCAO group when compared to the Wt-MCAO group (9.4 ± 3.356, n=7, p < 0.05 and 2.5 ± 0.289, n=4, p < 0.05 respectively). No significant difference was found in the Cresyl Violet staining.Conclusions:Our study shows motor deficit in the APP/PS1-MCAO experimental group when compared to the Wt-MCAO group as measured on hind-limb coordination. Therefore, further studies are warranted to assess the interaction between ischemia and β-amyloid peptide on histological injury and functional recovery.

Stroke, Volume 56, Issue Suppl_1, Page ATP164-ATP164, February 1, 2025. Background:Ischemic stroke is a leading causes of death and disability and imaging is essential when determining treatment. Currently, both computed tomography (CT) and magnetic resonance (MR) are accepted as options for first imaging of stroke. Whether MR or CT is more advantageous for first stroke imaging has yet to be determined in a randomized study. The goal of this study was to determine feasibility of randomizing code stroke patients to MR or CT.Methods:Multisite, randomized, prospective study of code stroke patients presenting within a 12-week window to 4 certified stroke centers. Hospital-level cluster randomization assigned each site 6 CT-first weeks, and 6 MR-first weeks. Patients ≥18 years presenting with stroke symptoms < 24 hours with active code strokes at time of first imaging were included. Patients transferred from another hospital or who received prior imaging at an outside facility were excluded. Demographics, clinical stroke variables, and workflow metrics were extracted from the local stroke database or patient electronic health records. A univariate logistic regression model was used to evaluate the primary outcome: compliance (i.e. proportion of patients scanned according to assigned imaging). We hypothesized compliance would be comparable to that seen when MR-first was the preferred standard of care, ≥60%, demonstrating feasibility.Results:406 patients (199 females; mean age 67 years, range 24 - 103) were included in the analysis (Table 1). Compliance with assignment to CT was 90%, compliance with MR was 66%. Those assigned to MR were significantly less likely to be scanned as assigned (OR: 0.21, 95% CI [0.12-0.36]). Reasons for non-compliance included both process-related (e.g. MR scanner in use) and patient-related reasons (e.g. medically unstable). Most frequently, the reason for non-compliance was not documented.Conclusion:This study is the first step in evaluating feasibility for a large-scale randomized clinical trial to determine whether MR or CT is preferable as the first stroke imaging modality. Compliance with assignment (MR or CT) our preset threshold of 60%, with significantly higher compliance when CT was assigned compared to MR. With mitigation of process-related barriers to randomization compliance, these results inform next steps in optimizing a future trial.

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 A27-A27, February 1, 2025. Introduction:The combination of verbal and non-verbal cognitive dysfunction in post-stroke aphasia (PSA) patients may ultimately affect social interactions. However, the underlying neural mechanisms of both verbal and non-verbal cognitive impairment remain unclear. This study aimed to investigate the activity and functional abnormalities of local and remote brain regions and their relationship with cognitive behaviour, to provide more effective guidance in future clinical therapy.Methods:We recruited 46 PSA patients and 40 normal controls(NCs) matched for general characteristics in this study and evaluated their verbal and non-verbal cognitive functions. Functional magnetic resonance imaging(fMRI) was used to examine the fractional amplitude of low-frequency fluctuations(fALFF), regional homogeneity(ReHo), and functional connectivity(FC) in PSA patients. Independent two-sample t-tests were used to identify differences in these measures between two groups. Moreover, partial correlation analyses were performed to determine the correlation between FC from the affected brain regions and language and cognitive performance in PSA patients.Results:This study revealed that PSA patients presented significantly lower fALFF and ReHo values in right cerebellum superior (CRBL.Superior.R), left thalamus(THA.L), and left middle frontal gyrus(MFG.L). Moreover, the FC in the MFG.L-left inferior frontal gyrus, orbital part was significantly lower among PSA patients and was positively correlated with language and cognitive performance(p< 0.05). The CRBL. Superior. R-left caudate nucleus and right lenticular nucleus FC were also decreased and were associated with cognitive function(p< 0.05). In addition, PSA patients were further divided into fluent and nonfluent groups. The results revealed that nonfluent patients performed worse in verbal and non-verbal cognitive performance(p< 0.05) and had weaker performance in the THA.L and left supplementary motor area FC(p< 0.001).Conclusions:This study provides new evidence that abnormal neural activity and functional connectivity within specific brain regions may play crucial roles in language and cognitive processing. The underlying mechanisms of impaired linguistic function accompanied by decline in cognition may be a partial overlap between language and cognitive-related brain networks. In future, combining cognitive and linguistic functions and designing a comprehensive treatment plan will be the focus of rehabilitation.

Stroke, Volume 56, Issue Suppl_1, Page ATP161-ATP161, February 1, 2025. Introduction and Hypothesis:New bleeding in cerebral cavernous malformations (CCM) heralds increased risk of future hemorrhage for several years, yet conventional imaging only detects new bleeding that occurred in the prior weeks. A biomarker of hemorrhage could help identifying high risk lesions. An increase of mean lesional quantitative susceptibility mapping (QSM) ≥6% on MRI has been adjudicated as reflecting new bleeding in CCM during longitudinal follow-up. However, mean lesional QSM from a single acquisition could not diagnose or prognosticate a bleed. We hypothesize that machine learning (ML) may identify diagnostic and prognostic features of bleeding within QSM maps at a single point in time.Material and Methods:Two hundred and sixty-five QSM maps of CCM lesions were acquired in 120 patients enrolled in National Institute of Health (NIH) multisite trial readiness project (NCT03652181). Each map was classified (Yes/No) in association with symptomatic hemorrhage (SH) and/or biomarker event with QSM increase ≥6% in the prior (diagnostic association) and subsequent (prognostic association) year. Twenty-eight features were extracted including 14 texture, 5 first-order statistical, as well as 3 size, shape, and morphological. Five-fold cross-validation was conducted on a support-vector machine (SVM) with linear stepwise kernel for both diagnostic and prognostic associations. Performance of individual features and composite classifiers was evaluated using student t-test (p

Stroke, Volume 56, Issue Suppl_1, Page ADP3-ADP3, February 1, 2025. Background:Current guidelines for ischemic stroke recommend initiating intravenous thrombolytic therapy within 4.5 hours after stroke onset or the last known well time. However, advancements in imaging techniques, such as CT perfusion and perfusion-diffusion magnetic resonance imaging (MRI), have improved diagnostic accuracy. These modalities can identify viable brain tissue beyond the 4.5-hour window, and reperfusion through thrombolysis has been shown to enhance functional outcomes in patients with salvageable brain tissue beyond this timeframe.Objective:The aim of this study is to assess the efficacy and safety of thrombolysis administered more than 4.5 hours after the onset of ischemic stroke.Methods:We conducted a comprehensive search of the Cochrane Central Registry of Controlled Trials, PubMed, Embase, Web of Science, and clinicalTrials.gov databases for all randomized controlled trials (RCTs) published up to July 2024 comparing thrombolysis (TPA) > 4.5 h to standard of care. The primary functional outcome was the absence of disability measured as a modified Rankin scale of 0-1. The secondary clinical endpoints included symptomatic intracranial hemorrhage (ICH), 90-day mortality, reperfusion at 24 hours, and functional independence at 90 days. The odds ratio (OR) with a 95% confidence interval (CI) was calculated for the outcomes of interest. The protocol was registered in PROSPERO (CRD42024564522).Results:Four RCTs were included in the analysis, comprising a total of 1,268 patients (TPA > 4.5h, n = 643; standard, n = 625) with a mean age of 70 years and 56% males. TPA > 4.5h was associated with a 42% reduction in the frequency of functional disability (OR: 1.42 [95% CI, 1.12-1.82]; p = 0.004; I2= 0%). There was also a 35% increase in functional independence at 90 days (OR: 1.35 [95% CI, 1.08-1.69]; p = 0.009; I2= 0%), and a 46% increase in reperfusion at 24 hours (OR: 1.46 [95% CI, 1.14-1.87]; p = 0.003; I2= 0%). There was, however, a significant increase in the risk of symptomatic ICH (OR: 2.82 [95% CI, 1.25-6.38]; p = 0.01; I2= 14%), but there was no significant difference in 90-day mortality (OR: 1.11 [95% CI, 0.80-1.53]; p = 0.53; I2= 0%).Conclusion:Thrombolysis administered beyond 4.5 hours after the onset of ischemic stroke is associated with improved functional outcomes and increased reperfusion rates. However, this benefit is accompanied by a higher risk of symptomatic intracranial hemorrhage.