Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATP114-ATP114, February 1, 2025. Background and Aims:Globally, 87% of stroke patients are left with disability in low and middle-income countries. Continual rehabilitation is significant to maximize functional recovery. However, heterogeneity exists due to lack of guidelines, low prioritization of rehabilitation services, inadequate numbers of skilled rehabilitation specialists, limited health literacy, financial constraints and transportation limitations which leads to suboptimal rehabilitation. In this study we have presented tele-rehabilitation model of care for post stroke patients.Methods:IMPETUS stroke is an ongoing multicentric, prospective, multiphase, mixed-method, quasi- experimental implementation study intended to examine changes in a select set of stroke care-related indicators over time within 23 medical colleges in India. As a part of study, low cost model of tele-rehablitation services initiated using WhatsApp video communication. Periodic meetings with the collaborators and Rehabilitation teams had been done to outline the different strategies. Audio-visual training materials such as rehabilitation video and teaching manual are used as a study tool. Short specific videos had been crafted and finalized with the rehabilitation experts and collaborators specifically directed towards the post stroke recovery rehabilitation. Feasibility assessment will be done based upon the caregiver responses on the Client Satisfaction Questionnaire . Barthel Index, Stroke Rehabilitation Assessment of Movemement (STREAM) assessment and Modified Rankin Scale (mRS) will be used to assess the motor and functional outcomes.Results:A total of 731 patients provided the telerehabilitation services through live WhatsApp video conferencing after discharge. Initial assessments were done using Barthel Index, Stroke Rehabilitation Assessment of Movement assessment and Modified Rankin Scale at the time of discharge. Tailor-made exercise programs were prepared for each patient based upon the impairments. Primary caregivers were trained through on-patient demonstration and rehabilitation videos. One on one interactive and guided sessions were conducted on the 7th, 15th, 30th day of discharge in one month and then every once in a month for the next 2 months. The patient outcome data will be presented.Conclusions:The aforementioned tele-rehabilitation model of care will help to optimize motor and functional outcomes of the patient. Understanding the limitations and success of these interventions will be helpful.

Stroke, Volume 56, Issue Suppl_1, Page ATMP58-ATMP58, February 1, 2025. Introduction:An apparent diffusion coefficient (ADC) threshold of ≤ 620 × 10-6 mm2/s identifies irreversible infarcts and guides endovascular thrombectomy (EVT) decisions. However, in hyperacute ischemic infarcts, diffusion-weighted imaging (DWI) hyperintense lesions can show varying ADC values. This study investigates DWI-ADC mismatch, defined as the significant difference between DWI hyperintense lesion volume and ADC ≤ 620 × 10-6 mm2/s volume.Methods:This retrospective, single-center study included patients with acute large vessel occlusion in the anterior circulation who: (1) underwent MRI within 24 hours of stroke onset, (2) received EVT, and (3) had follow-up MRI within 5 days of EVT from January 2018 to January 2020. Neuroradiologists segmented DWI hyperintense infarcts with ADC hypointensity on pre- and post-EVT MRI, using Fluid-attenuated inversion recovery (FLAIR) sequences to avoid T2 shine-through effects. The DWI/ADC volume ratio was calculated by dividing DWI volume by ADC ≤ 620 × 10-6 mm2/s volume. DWI-ADC mismatch was defined as a DWI/ADC ratio ≥ 2, with no mismatch indicated by a ratio < 2. Final infarct segmentation included hemorrhagic transformation. DWI lesion reversal (DWIR) was defined as the volume of normal-appearing voxels on follow-up DWI but previously hyperintense. DWIR% = (DWIR/baseline DWI volume) × 100 was calculated. We compared demographics, radiological findings, clinical outcomes, and follow-up results between mismatch and no mismatch groups.Results:Among 73 patients, 20 (27.4%) had DWI-ADC mismatch. Baseline demographics and National Institutes of Health Stroke Scale (NIHSS) were similar between groups. The DWI/ADC ratio was higher in the mismatch group (2.9 vs. 1.5, P < 0.0001). Follow-up lesion volumes and functional outcomes were similar; however, the mismatch group showed a slower infarct growth rate (3.8 ml/h vs. 7.5 ml/h, P = 0.04), a higher likelihood of parent artery stenosis (65% vs. 20.8%, P < 0.001), and increased need for angioplasty or stenting (50% vs. 17%, P < 0.001). The mismatch group also had a higher DWIR% (37.7% vs. 21.2%, P = 0.02).Conclusions:DWI-ADC mismatch is associated with slower infarct growth, greater likelihood of parent artery stenosis, increased need for angioplasty or stenting, and more DWI lesion reversal in anterior circulation large vessel occlusion patients undergoing EVT. These findings suggest DWI-ADC mismatch could be important in EVT decision-making and outcome prediction.

Stroke, Volume 56, Issue Suppl_1, Page ATP334-ATP334, February 1, 2025. Introduction:Studies have reported racial disparities in acute stroke treatment and follow-up care in young patients which lead to less desirable outcomes for minorities. This study aimed to identify potentially modifiable factors for better stroke treatment and prevention in minority populations.Methods:Young patients aged 18-50 years who were admitted with ischemic stroke during 09/2016-12/2022 were retrospectively identified and stratified as non-Hispanic White (WH), non-Hispanic Black (BL), and Hispanic (HS). Racial differences in risk factors, stroke etiology, acute intervention, and follow-ups were examined using Chi-square and Kruskal-Wallis tests as appropriate. Cumulative probabilities of stroke recurrence were estimated using the Kaplan-Meier (KM) method and tested with the Log-rank (Mantel-Cox) test. A logistic regression was used to evaluate the odds ratio of favorable functional outcomes (mRS ≤2) by 90 days. A backward stepwise Cox regression was conducted to identify predictors of stroke recurrence reported as hazard ratio (HR) and a 95% confidence interval (CI).Results:A total of 318 patients were identified with a median age of 43 and 57.5% male, covering 57.2% WH, 22.3% BL, and 20.4% HS. Compared to WH, more BL and HS were comorbid with diabetes, hypertension, and prior stroke (p

Stroke, Volume 56, Issue Suppl_1, Page ATP101-ATP101, February 1, 2025. Background and objective:Cerebral amyloid angiopathy (CAA) is one of the major causes of intracranial hemorrhage (ICH) and consequent functional impairments in the elderly. Currently, there is a lack of predictors of functional prognosis for CAA patients suffering after lobar ICH event. This study aimed to assess the clinical and neuroimaging factors that can predict functional outcomes in patients survived CAA-related ICH.Methods:Conducted as a retrospective cohort study from May 2014 to May 2022, this research included ICH survivors meeting the Boston criteria 2.0 of probable CAA. Rehabilitation metrics and neuroimaging features from MRI, including lobar cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), perivascular spaces of the centrum-semiovale, and white matter hyperintensities (WMHs), were systematically assessed and subjected to analysis. CAA score was computed as a sum of these markers. Prognostic indicators, comprising the modified Rankin Scale (mRS) and Barthel Index at one month after ICH were evaluated. The data were analyzed with generalized linear models and logistic regression to examine the associations between the identified parameters and the prognostic indicators. The incidences of recurrent ICH or mortality within a six-month follow-up window were also assessed using survival analyses.Results:A total of 73 patients were included. In the multivariate analysis, predictive factors for higher mRS included impaired initial sitting balance (p

Stroke, Volume 56, Issue Suppl_1, Page ATP369-ATP369, February 1, 2025. Introduction:The cholinergic anti-inflammatory pathway regulates immune responses through the alpha7 nicotinic acetylcholine receptor (α7nAChR), found in neurons, macrophages, and monocytes. α7nAChR activation via agonists or Vagus nerve stimulation (VNS) reduces pro-inflammatory cytokines in disease models. In young mice, pharmacological activation or stimulation of the Vagus nerve has been shown to mitigate ischemic stroke injury by reducing brain and peripheral inflammation and oxidative stress. However, the role of α7nAChR in long-term stroke outcomes remains unclear.Methods:Young (8-12 weeks) male wild-type (WT) and α7nAChR knockout (KO) mice underwent middle cerebral artery occlusion (MCAO) for 60 minutes. After 24 hours, brain acetylcholine levels and α7nAChR expression were assessed by mass spectrometry and western blot respectively. Microglia, macrophage counts, and TNF-α expression were evaluated using flow cytometry. Long-term behavioral tests included the Barnes maze (days 7 and 30), novel object recognition (day 10), and object location tests on day 20. A second cohort was euthanized on day 7 for brain-infiltrated immune cell analysis.Results:At 24 hours post-MCAO, brain α7nAChR expression decreased significantly without changes in acetylcholine levels. WT MCAO mice showed reduced microglia, increased microglial TNF-α expression, and fewer α7nAChR-positive microglia compared to shams (p

Stroke, Volume 56, Issue Suppl_1, Page ATMP51-ATMP51, February 1, 2025. Introduction:Strokes lead to acute deficits with wide-ranging severity. Genetic variation may explain some of these inter-subject differences. The current report examined the relationship that candidate genetic variants have with acute injury and acute behavioral deficits. We hypothesized that variants known to be associated with poorer stroke recovery would also be associated with more a severe acute presentation.Methods:Infarcts were outlined on clinical scans acquired during acute stroke admission as part of the STRONG (“Stroke, sTress, RehabilitatiON, and Genetics”) study and resampled to MNI152 brain standard space. Multivariable linear regression modeling was used to examine association with genetic measures known to be related to stroke outcome: 3 single nucleotide polymorphisms (SNPs): BDNF (rs6265), ACE (rs4291), and FAAH (rs324420), plus ApoE e4 and ApoE e2; a dopamine polygene score was also explored. Acute injury (infarct volume) and acute deficits (NIHSS score, grip strength, and acute stress disorder inventory (ASDI)) were each examined as the dependent measure in separate models that used age, gender, and ancestry as covariates. To understand where in the brain these relationships occurred, voxel lesion symptom mapping (VLSM) was used to test for associations between acute injury and each genetic measure.Results:In 448 subjects (age 63.4±14.4 yr (mean±SD), 43.1% females), lesion volume ranged from 0.46 to 535.13 cc and involved cortical grey matter in 63% of patients. Larger lesion volume was associated with presence of the ACE SNP (β=8.77, p=0.03); lower NIHSS score, with ApoE e4 (β=-1.69, p=0.04); greater grip strength, with ApoE e2 SNPs (β=6.78, p=0.03); and higher ASDI, with the ACE SNP (β=0.56, p=0.05). VLSM revealed that acute injury to the postcentral gyrus was significantly more likely in the presence of the ACE SNP (z=-3.5), and that acute injury to the calcarine fissure was significantly more likely in the presence of the BDNF SNP (z=-2.53).Conclusions:Genetic variants known to be associated with differences in stroke recovery are also related to acute stroke deficits and injury. In particular, a common variant in the gene for ACE was associated with differences in lesion volume and location, findings that may suggest a personalized medicine approach to acute therapy. Measures of genetic variability may be useful to understand inter-subject differences in acute injury and symptom severity, and may have therapeutic implications.

Stroke, Volume 56, Issue Suppl_1, Page ATMP76-ATMP76, February 1, 2025. Background and Purpose:In randomized trials, carotid artery stent (CAS) may have higher risk of periprocedural risk compared with carotid endarterectomy (CEA) if performed within the first 7 days after the onset of symptoms.Methods:We analyzed the data from Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). The time interval between the most recent qualifying ischemic event and CAS/CEA procedure was divided in four strata: 1-7 days, 8-14 days, 15-30 days and >30 days. We analyzed the effect of time interval strata between most recent qualifying ischemic event and procedure and procedure type (CEA versus CAS) on peri-procedural stroke and/or death after adjusting for age, gender, symptomatic status and initial severity of stenosis (≥70% versus 30 days (CAS 7.8% versus CAE 4.3%, p=0.12), after the most recent qualifying event. In the multivariate analysis, patients who underwent CAS had higher rate of peri-procedural stroke and/or death (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.25- 4.66) but timing of procedure were not associated with higher rate of peri-procedural stroke and/or death after adjustment for potential confounders. The interaction between procedure type and timing of procedure was not significant. The rate of peri-procedural stroke and/or death was significantly higher in CAS patients who received clopidogrel bolus (without 48-hour maintenance dose) among patients treated 7 days or less after the qualifying event compared with those undergoing CEA (6.6% versus 0%, p=0.012) but was not different between CAS patients who received 48 hours of clopidogrel maintenance and those undergoing CEA (0% versus 0%).Conclusions:The higher rate of peri-procedural stroke and/or death seen with CAS (compared with CEA) within the first 7 days may be attributed to factors such as inadequate pre-procedure antiplatelet medication use. The results of CAS and CEA may become comparable within the first 7 days after the qualifying ischemic event with use of newer generation P2Y12 platelet inhibitors that achieve rapid antiplatelet inhibition.

Stroke, Volume 56, Issue Suppl_1, Page ATP351-ATP351, February 1, 2025. An acute ischemic stroke (AIS) triggers rapid mobilization of immune cells from bone marrow, leading to the infiltration of circulating immune cells into the brain. Among these immune cells, monocytes, which are pivotal in both adaptive and innate immune responses, play a crucial role in stroke injury and recovery in a temporal manner. Previous research indicates that tissue injury such as AIS causes acute monocytosis. However, it remains unclear if this upregulation persists during the recovery phase. Given the diverse roles of monocytes during post-stroke recovery, we hypothesize that their numbers remain elevated during chronic recovery.In this study, we will analyze the effect of stroke duration on monocytosis and the factors affecting this process after AIS.We recruited consecutive AIS patients (58-90 years) undergoing endovascular clot retrieval and age-matched healthy control subjects of both sexes, with informed consent obtained from all participants. Flow cytometric analysis of whole blood-derived immune cells, including monocytes, was performed at 0–2 days (acute, n=20), 3–7 days (subacute, n=20), and 65±20 days (chronic, n=14) after stroke onset. These were compared with healthy subjects (n=20 per age group). A pure monocyte population was isolated using a side and forward scatter plot with cell-surface markers, such as HLA-DR, CD45, CD11b, CD14, and CD16, along with a negative gating strategy. Plasma samples were analyzed for various secreted cytokine levels using the Millipore multiplex array. scRNA-seq analysis was employed to support the evidence of monocytosis using total immune cells of these subjects.We found that the total monocyte count (% of total immune cells) progressively increased during recovery in AIS patients (P

Stroke, Volume 56, Issue Suppl_1, Page ATP332-ATP332, February 1, 2025. Introduction:Subclinical hyperthyroidism has been linked to an increased risk of atrial fibrillation, which elevates the likelihood of cardioembolism, cryptogenic stroke (CS), and embolic stroke of undetermined source (ESUS). However, the broader relationship between thyroid function abnormalities and acute ischemic stroke remains uncertain. This study aims to investigate whether patients with acute ischemic stroke due to cardioembolism, CS, or ESUS are more likely to have abnormal thyroid-stimulating hormone (TSH) levels compared to those with ischemic strokes from other etiologies, as classified by the TOAST criteria.Methods:Utilizing data from the Get With The Guidelines Database, we conducted a retrospective chart review of patients admitted to our single comprehensive stroke center, diagnosed with an acute ischemic stroke between August 2022 and January 2023. The Kruskal-Wallis rank sum test was employed to assess differences in TSH, Free T4, and, if available, one year follow-up TSH levels among patients with ischemic stroke etiologies of small vessel disease, large artery atherosclerosis, cardioembolism, CS, and ESUS.Results:A total of 211 patients were included in the analysis, the distribution of stroke etiologies included 33 (16%) with small vessel disease, 51 (24%) with large artery atherosclerosis, 77 (36%) with cardioembolism, 13 (6.2%) with an undetermined/cryptogenic etiology, and 25 (12%) with ESUS. The majority of patients had normal TSH levels, accounting for 82% of the total cohort, the overall mean TSH level was 2.52 (reference range 0.27-4.2uIU/mL). No significant differences were observed in the mean TSH (p = 0.066), Free T4 (p = 0.13), or follow-up TSH (p = 0.79) levels across each stroke subtype.Conclusions:Our findings suggest that thyroid function does not significantly differ across the various etiologies of acute ischemic stroke, as classified by TOAST criteria. While further large-scale studies are warranted, our results indicate that routine evaluation of thyroid function may not be essential in the determination of stroke etiology.

Stroke, Volume 56, Issue Suppl_1, Page ATP362-ATP362, February 1, 2025. Introduction:Menopause increases the risk and severity of ischemic stroke (IS), while endogenous 17β-estradiol (E2) naturally protects premenopausal women against IS. The female sex hormone E2 is a potent neuro- and cognitive-protective agent. Studies have shown that periodic E2 or estrogen receptor subtype-beta (ER-β) agonist pre-treatments every 48 hours before an ischemic episode ameliorated ischemic brain damage in young ovariectomized or reproductively senescent (RS) aged female rats. The current study investigates the underlying mechanism of ER-β agonist-mediated neuroprotection.Methods:Retired breeder (9–10 months) Sprague–Dawley female rats were considered RS after remaining in constant diestrus phase for more than a month. The RS rats were exposed to transient middle cerebral artery occlusion (tMCAO; 90 mins) and treated with either ER-β agonist (beta 2, 3-bis(4-hydroxyphenyl) propionitrile; DPN; 1 mg/kg; s.c.) or DMSO vehicle at 4.5 hours after induction of tMCAO. Subsequently, rats were treated with either ER-β agonist or DMSO vehicle every 48 hours (48-h) for ten injections. Forty-eight hours after the last treatment, animals were tested for cognitive deficits via the Morris water maze. At 1-month post-tMCAO, brains were collected for histopathological analysis. A second cohort of RS rats underwent DPN or DMSO treatment for a month; 48-h after last injection, brains were collected for unbiased global metabolomic analysis (conducted by Metabolon Inc.). The metabolomic study was complemented with western blot analysis and enzyme activity measurements of key altered pathways.Results:Data showed significant (p

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

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

Stroke, Volume 56, Issue Suppl_1, Page ATMP83-ATMP83, February 1, 2025. Introduction:Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.Methods:This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications.Results:A total of 177 patients were analyzed (88 MM and 89 EVT). Baseline characteristics were balanced using Inverse Probability of Treatment Weighting (IPTW). EVT showed a statistically significant improvement in 90-day mRS scores (OR=0.55, 95% CI=0.30 to 1.00, P=0.048), functional independence (OR=2.52, 95% CI=1.02 to 6.20, P=0.045), and a reduction in 90-day mortality (OR=0.12, 95% CI=0.03 to 0.54, P=0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups.Conclusion:EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. These findings emphasize on the potential benefits of EVT in this understudied patient group, highlighting the need for randomized controlled trials to further validate these results.

Stroke, Volume 56, Issue Suppl_1, Page ATP113-ATP113, February 1, 2025. Background:Persistent gait impairments affect nearly half of stroke survivors six months post-stroke, despite standard rehabilitation. Intermittent theta burst stimulation (iTBS), a specialized form of repetitive transcranial magnetic stimulation (TMS), has shown promise in enhancing neural circuit activity and promoting long-term potentiation. While traditionally targeting the primary motor cortex, recent studies suggest that cerebellar iTBS may further improve gait and balance by modulating cerebello-cortical pathways.Aim:This meta-analysis aims to evaluate the efficacy of cerebellar iTBS in improving gait and balance in stroke patients.Methods:We conducted a systematic search in PubMed, Embase, and the Cochrane Library until August 2024, following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Included studies were peer-reviewed randomized controlled trials (RCTs) that assessed the effects of cerebellar iTBS on balance, assessed using the Berg Balance Scale; gait, measured through 3D gait analysis and the Timed Up and Go (TUG) test; and activities of daily living, assessed via the Barthel Index, in post-stroke patients with persistent gait and balance impairments. Meta-analyses were performed using a random-effects model.Results:Seven RCTs involving a total of 230 post-stroke patients (iTBS group, n=115) were included in this meta-analysis. The analysis revealed a significant improvement in balance (standardized mean difference [SMD] = 1.20, 95% confidence interval [CI] 0.12 to 2.29, p = 0.03). However, the TUG test did not demonstrate a significant change (SMD = 0.04, 95% CI: -0.37–0.46, p = 0.83), potentially reflecting variability in baseline gait performance. The 3D gait analysis showed a favorable but non-significant trend towards step length improvement (SMD = 0.71, 95% CI: -0.82–2.23, p = 0.37). Notably, a significant enhancement was observed in activities of daily living (SMD = 1.24, 95% CI: 0.49–1.98, p = 0.001).Conclusions:This meta-analysis suggests that cerebellar iTBS significantly enhances activities of daily living in post-stroke patients, with a potential but less consistent impact on balance and gait. These findings highlight the promise of cerebellar iTBS as an adjunctive therapy in stroke rehabilitation, though further high-quality RCTs are needed to clarify its specific therapeutic benefits.

Stroke, Volume 56, Issue Suppl_1, Page ATP108-ATP108, February 1, 2025. Introduction:Upper extremity impairment is common after stroke. The Neofect Smart Glove is a novel virtual reality-based portable rehabilitation system that may help restore hand and arm function.Objective:To assess the effect of the Smart Glove on functional recovery and total dose of rehabilitation among subacute and chronic stroke patients with upper extremity impairment.Design:Multi-center, prospective, randomized, open-label, blinded-endpoint (PROBE) phase 2 trial consisting of a 12-week active treatment period followed by a 12-week follow-up period.Methods/Interventions:Patients in the intervention group were instructed to use the Smart Glove for at least one session per day for at least 5 days per week in addition to their usual care during the 12-week active treatment period. Patients in the control group received their usual care only.Outcomes:The change from baseline to week 12 in the Jebsen-Taylor Hand Function Test (JTHFT) was the primary efficacy outcome and the change in the Upper Extremity Fugl-Meyer Assessment (UE-FMA) was secondary. Feasibility was assessed by determining the total dose of rehabilitation.Statistics:Differences between treatment arms were compared using analysis of covariance (ANCOVA) in the overall population and, separately, in the subset of patients with mild to moderate upper extremity impairment (baseline JTHFT ≤ 500).Results:During the 12-week active treatment period, there were no differences between the intervention (n = 18) and control (n = 24) groups in the change in the JTHFT (median -64 vs. -69 sec,P= 0.88), the change in the UE-FMA (median 8 vs. 8 points,P= 0.61), or the total dose of rehabilitation (median 1434 vs. 584 min,P= 0.18) (Figure 1). Among the subset of patients with mild to moderate symptoms (baseline JTHFT ≤ 500, n = 31), Smart Glove assignment was associated with a greater improvement in the JTHFT (median -72 vs. -40 sec,P= 0.01) and a greater dose of rehabilitation (median 1739 vs. 510 min,P= 0.04) during the active treatment period (Figure 2). There was a trend toward a greater improvement in the UE-FMA (median 10 vs. 8 points,P= 0.15).Conclusion:While the trial did not show a benefit in the overall study population, Smart Glove use was associated with enhanced recovery of hand and arm function and a higher dose of rehabilitation among patients with mild to moderate upper extremity impairment, suggesting that the Smart Glove may be an effective treatment in this population.

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