Risultati per: Colite ulcerosa negli adulti: review

Stroke, Ahead of Print. Background:Despite the prevalence of cognitive impairment poststroke, there is uncertainty regarding interventions to improve cognitive function poststroke. This systematic review and meta-analysis evaluate the effectiveness of rehabilitation interventions across multiple domains of cognitive function.Methods:Five databases were searched from inception to August 2019. Eligible studies included randomized controlled trials of rehabilitation interventions for people with stroke when compared with other active interventions or standard care where cognitive function was an outcome.Results:Sixty-four randomized controlled trials (n=4005 participants) were included. Multiple component interventions improved general cognitive functioning (MD, 1.56 [95% CI, 0.69–2.43]) and memory (standardized MD, 0.49 [95% CI, 0.27–0.72]) compared with standard care. Physical activity interventions improved neglect (MD, 13.99 [95% CI, 12.67–15.32]) and balance (MD, 2.97 [95% CI, 0.71–5.23]) compared with active controls. Noninvasive brain stimulation impacted neglect (MD, 20.79 [95% CI, 14.53–27.04) and functional status (MD, 14.02 [95% CI, 8.41–19.62]) compared with active controls. Neither cognitive rehabilitation (MD, 0.37 [95% CI, −0.94 to 1.69]) nor occupational-based interventions (MD, 0.45 [95% CI, −1.33 to 2.23]) had a significant effect on cognitive function compared with standard care.Conclusions:There is some evidence to support multiple component interventions, physical activity interventions, and noninvasive brain stimulation improving cognitive function poststroke. Findings must be interpreted with caution given the overall moderate to high risk of bias, heterogeneity of interventions, and outcome measures across studies.

Stroke, Ahead of Print. The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without effective and widely implemented primordial and primary stroke prevention measures, including those on the individual level. The unprecedented growth of smartphone and other digital technologies with digital solutions are now being used in almost every area of health, offering a unique opportunity to improve primordial and primary stroke prevention on the individual level. However, there are several issues that need to be considered to advance development and use this important digital strategy for primordial and primary stroke prevention. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we provide a systematic review of the current knowledge, challenges, and opportunities of digital health in primordial and primary stroke prevention.

Stroke, Volume 53, Issue Suppl_1, Page ATMP74-ATMP74, February 1, 2022. Introduction:Direct oral anticoagulants (DOACs) have emerged as a potential anticoagulant therapy for patients with cerebral venous thrombosis (CVT). We conducted a systematic review and meta-analysis comparing DOACs versus vitamin K antagonists (VKAs) for treatment of CVT.Methods:We registered the review in PROSPERO (registration number CRD42021228800). We searched Medline, Embase, CINAHL, and the Web of Science Core Collection from January 1, 2007, to May 26, 2021. We included randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) evaluating key outcomes for efficacy (recurrent venous thromboembolism [VTE] and complete recanalization) and safety (major hemorrhage). We assessed risk of bias using the Cochrane Risk of Bias Tool 2.0 (for RCTs) and the ROBINS-I tool (for NRCSs). Where studies were sufficiently similar, we performed meta-analyses using random-effects models. This review was funded by Brown Neurology.Results:Of 8213 identified records,10 studies (1 RCT and 9 NRCSs) with a total of 662 patients (33% DOAC and 67% VKAs) met the inclusion criteria. We will present our risk of bias assessment at the conference. DOACs and VKAs had comparable efficacy: recurrent VTE (risk ratio [RR] 1.00, 95% confidence interval [CI] 0.44-2.23; I2=0%; 10 studies) and complete recanalization (RR 1.00, 95% CI 0.77-1.28; I2=0%; 6 studies). DOAC and VKA also had comparable safety: major hemorrhage (RR 0.89, 95% CI 0.37-2.14; I2=0%; 9 studies).Conclusions:Studies comparing DOACs with VKAs in patients with CVT consist mostly of small, non-randomized, poorly controlled studies. While the two treatments appear comparable for major efficacy and safety outcomes, large, rigorously conducted studies, preferably randomized, are needed to overcome these limitations and permit development of clinical practice guidelines for the use of DOACs in patients with CVT.

Stroke, Volume 53, Issue Suppl_1, Page AWMP97-AWMP97, February 1, 2022. Background and Purpose:Recent evidence suggests that patients with atrial fibrillation (AF) detected after stroke (AFDAS) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke (KAF). We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF.Methods:We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until 30-June-2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death.Results:We included 21 studies comprising 22,566 patients with ischemic stroke or transient ischemic attack. Patients with AFDAS had a lower CHA2DS2-VASc score (standardized mean difference [SMD] -0.47, 95% confidence interval [95% CI] -0.60, -0.34), and lower prevalence of vascular comorbidities including coronary artery disease (odds ratio [OR] 0.50, 95%CI 0.42, 0.61), congestive heart failure (OR 0.37, 95% CI 0.31, 0.44), peripheral artery disease (OR 0.44, 95%CI 0.29, 0.68), and previous stroke (RD 0.38, 95% CI 0.25, 0.58). Patients with AFDAS had a higher left ventricular ejection fraction (SMD 0.25, 95% CI 0.20, 0.30) and smaller mean atrial diameter (SMD -0.65, 95% CI -0.99, -0.31) than those with KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types.Conclusions:We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum.

Stroke, Volume 53, Issue Suppl_1, Page A135-A135, February 1, 2022. Background:Endovascular thrombectomy is the gold standard treatment for acute ischemic strokes with large vessel occlusions (LVO). Manual image analysis is often time consuming and requires clinicians to be skilled in reading perfusion scans, as well as vessel images. RapidAI software has an automated processor to detect LVO of the middle cerebral artery and is analyzed in this study. A novel metric, number-needed-to-review (NNR), is introduced to assess the clinical efficiency of this software.Methods:This is a retrospective review of patients with a suspected ischemic stroke and an image processed by RapidAI software from 11/1/2020 to 4/30/2021 at a regional hospital system. Only M1 LVOs were included. Sensitivities, specificities, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the following: Rapid LVO detection, gaze deviation (GD), hyperdense sign (HDS), Tmax >6 seconds, and NIHSS at presentation. The NNR was calculated for an M1 occlusion.Results:559 patients were included in this study. M1 occlusion was detected in 42 (7.5%) cases. Rapid LVO detection software was found to have a sensitivity of 71%, specificity of 94%, PPV of 49%, and NPV of 92% for a M1 occlusion. When both GD and HDS were combined with Rapid LVO, the specificity and PPV increased to 100% for a M1 occlusion. A negative LVO software combined with either a low (6s) or high (6s) Tmax threshold were found to have a specificity and PPV of 100% for no M1 occlusion. The combination of GD, HDS, Rapid LVO+ (for M1 occlusion) and Rapid LVO- with a low Tmax threshold (for no M1 occlusion) yielded 24 images NNR per 100 cases. When the combination of GD, HDS, Rapid LVO+ was combined with Rapid LVO- and a high Tmax threshold, the NNR per 100 cases was 16. With the addition of NIHSS6s threshold, the NNR is significantly decreased. As few as 9 images per 100 would be needed to be manually reviewed by a clinician during stroke triage.

Stroke, Volume 53, Issue Suppl_1, Page AWP200-AWP200, February 1, 2022. Introduction:Delineating predictors of dementia among ischemic stroke survivors is critical to reduce dementia burden and to improve quality of life in this population.Methods:A Metaanalysis compliant with Preferred Reporting Items for Systematic Reviews and Metaanalysis was conducted. Analysis included absolute risk, incidence rates and patient level predictors (demographics, CVD history,TIA, stroke location, disability, chronic brain changes and stroke mechanism). Additional predictors included study setting, method of dementia diagnosis and inclusion of patients with recurrent or first ever stroke. A random effects meta-analysis was undertaken.Results:4,325 studies were screened and a total of 21 studies were included in metaanalysis, representing 55183 patients with ischemic stroke, with average age of 70 years (range 65-80 years) and average followup of 29 months. Overall rate of dementia after ischemic stroke was 13.0 per 1000 py (95% CI 6.0, 36.0). Incidence rates were eight times higher in hospital based studies (17.0, CI 8.0, 36.0) compared to registry-based studies (1.8, CI 0.8, 4.0). Absolute dementia risk after stroke was 20% at 5 year, 30 at 15 years and 48 at 25 years of follow-up. There was 33 difference in dementia incidence in the later study periods (2007-2009) compared to (1996-2006). Statistically significant predictors of dementia after ischemic stroke included female gender (OR 1.2, CI 1.1-1.4), hypertension (1.4 CI 1.1-2.0), diabetes mellitus (1.6 CI 1.3-2.1), atrial fibrillation (1.9 CI 1.2-3.0), previous stroke (2.0 CI 1.6-2.6), presence of stroke lesion in dominant hemisphere (2.4 CI 1.3-4.5), brain stem (0.5, CI 0.3-0.9) frontal lobe (3.7 CI 1.2-12.0), aphasia (7.9, CI 2.4-26.0), dysphasia (5.8 CI 3.0-11.3), gait impairment (1.7, CI 1.1-2.7), white matter hyperintensities (3.2 CI 2.0-5.3), medial temporal lobe atrophy (3.9 CI 1.9-8.3) and transient ischemic attack as the predisposing aetiology for ischemic stroke (0.44 CI 0.22-0.88).Conclusions:Factors routinely collected at time of admission are key in monitoring patients at highest risk of progression to dementia after acute ischemic stroke, in particular stroke location and presence of stroke related disability.

Stroke, Volume 53, Issue Suppl_1, Page AWP221-AWP221, February 1, 2022. Background:Early diagnosis through symptom recognition is vital in acute stroke management. However, women who experience stroke are more likely than men to receive a missed or delayed diagnosis.Aims:To assess sex differences in the symptom presentation of stroke and whether these differences are associated with a delayed or missed diagnosis.Methods:PubMed, EMBASE and the Cochrane Library were systematically searched up to January 2021 for all studies that reported on symptoms in both adult women and men with diagnosed stroke (ischaemic or haemorrhagic) and transient ischaemic attack and were published in English. Sex-stratified proportions for each symptom were extracted and pooled. The relative risk (RR) of a symptom being present in women relative to men with 95% confidence intervals (CI) was also calculated and pooled, as well as the RR of a delayed or missed stroke diagnosis.Results:Pooled results from 21 eligible articles showed that the top three symptoms were similar between women and men – limb weakness (72% vs. 66%), hemiparesis (56% vs. 55%), and weakness of the face, arm or leg (55% vs. 55%). However, the top 4th and 5th symptoms found in women were generalised non-specific weakness (49%) and motor deficit (46%), whereas in men these were motor deficit (46%) and ataxia (44%). In addition, crude RR showed that women were more likely to have higher risk than men of presenting with confusion (RR 1.16, CI 1.01-1.32), dysphagia (RR 1.29, CI 1.13-1.48), dysphasia (RR 1.11, CI 1.00-1.24), fatigue (RR 1.42, CI 1.05-1.92), generalised weakness (RR 1.56 CI 1.23-1.98), headache (RR 1.14, CI 1.01-1.30), urinary incontinence (RR 1.25, CI 1.17-1.33), loss of consciousness (RR 1.30, CI 1.12-1.51), and mental status change (RR 1.37, CI 1.18-1.58), and lower risk of presenting with dizziness (RR 0.87, CI 0.80-0.95), dysarthria (RR 0.89, CI 0.82-0.95), imbalance (RR 0.68, CI 0.57-0.81), paraesthesia (RR 0.74, CI 0.58-0.93), and trouble walking (RR 0.83, CI 0.70-0.99). Finally, pooled RR of delayed or missed diagnosis for women compared to men was not statistically significant (RR 1.19, CI 0.94-1.49).Conclusion:Though women and men commonly presented with similar symptoms, some sex differences were present which needs consideration in stroke evaluation.

Stroke, Volume 53, Issue Suppl_1, Page AWP179-AWP179, February 1, 2022. Background and Purpose:Prolonged cardiac rhythm monitoring can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation (AF). We sought to evaluate the potential utility of available prolonged cardiac rhythm monitoring strategies with respect to secondary stroke prevention.Methods:We searched Medline and Scopus databases to identify randomized controlled clinical trials (RCTs) comparing AF detection, anticoagulation initiation and stroke recurrence rates in patients with history of recent IS or transient ischemic attack (TIA) receiving cardiac rhythm monitoring with implantable loop recorders (ILRs), 30-days external loop recorders or Holter monitors. We performed a network meta-analysis to combine direct and indirect evidence for any given pair of monitoring devices that were evaluated within a trial and reported effect estimates with risk ratios (RRs) and corresponding 95% confidence intervals (95%CIs).Results:We identified 5 RCTs including a total of 2202 patients (mean age 68 years, 40% women). In indirect analyses the likelihood of AF detection and anticoagulation initiation was higher for both ILR (RR=8.48, 95%CI: 3.41, 21.06; RR=3.29, 95%CI: 1.70-6.39) and external loop recorders (RR=3.06, 95%CI: 1.66, 5.61; RR=1.63, 95%CI: 1.03-2.58) compared to Holter devices. The probability of AF detection and anticoagulation initiation was lower for Holter and external loop recorders compared to ILR devices (RR=0.36, 95%CI: 0.15, 0.85 and RR=0.50, 95%CI: 0.25-0.98, respectively). No difference in the risk of stroke recurrence was found in the indirect comparisons of different cardiac rhythm monitoring strategies.Conclusion:The likelihood of AF detection and anticoagulation initiation after an ischemic stroke or TIA is higher with ILRs compared to both external loop recorders and Holter devices.

Stroke, Volume 53, Issue Suppl_1, Page AWP209-AWP209, February 1, 2022. Background:The optimal timing for the initiation of anticoagulation in patients with acute ischemic stroke (AIS) related to atrial fibrillation (AF) remains uncertain. Observational studies assessing early anticoagulant initiation (≤14 days after index AIS) have provided conflicting results from the early use of non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs).Methods:We performed a meta-analysis of prospective observational studies and RCTs to assess the efficacy and safety of early anticoagulation in AF-related AIS. We also compared the efficacy and safety between NOAC and VKA regimens. A random-effects model was used to pool the individual risk ratios (RRs) and corresponding 95% confidence intervals (CIs) between the two groups. Recurrent ischemic stroke was defined as the primary outcome.Results:Nine eligible studies (7 observational, 2 RCTs) were identified, including 6,840 patients with AF-related AIS (pooled mean baseline NIHSS score: 5.5; 95%CI: 3.7-7.2) who received early anticoagulation. The overall ischemic stroke recurrence rate was 5% (95%CI: 3.3-7%) and differed (p=0.05) between studies reporting anticoagulation initiation within a week (2.5%, 95%CI: 0.2-7.4%) or two weeks (6.7%, 95%CI:4.6-9.1%) from index event. The corresponding proportions of patients experiencing a fatal outcome, symptomatic or asymptomatic ICH were 4% (95%CI: 1.6-7.5%), 1.2% (95%CI: 0.3-2.6%) and 13.2% (95%CI: 6.4-22.1%), respectively. Of the 2 identified RCTs, 136 and 135 patients were randomized to early anticoagulation with NOAC or VKA, respectively. Both groups had a similar risk for ischemic stroke recurrence (RR=0.78; 95%CI: 0.32, 1.91; p=0.59). No significant differences were uncovered between early NOAC or early VKA treatment initiation for the outcomes of mortality (RR=0.57; 95%CI: 0.11, 2.97; p=0.51), symptomatic ICH (RR=0.38; 95%CI: 0.02, 9.10; p=0.55) or asymptomatic ICH (RR=1.10; 95%CI: 0.73, 1.67; p=0.64).Conclusions:Preliminary evidence from RCTs on early anticoagulation after AF-related AIS suggest that NOACs have comparable efficacy to VKAs in preventing ischemic stroke recurrence. Large scale RCTs are warranted to evaluate the potential superiority of NOACs in terms of safety endpoints.

Stroke, Volume 53, Issue Suppl_1, Page ATP14-ATP14, February 1, 2022. Vascular dementia (VaD) is the second-most common form of dementia, accounting for 20% of all dementia cases. Although the pathobiology of VaD is poorly understood and lacks effective treatment, clinically relevant factors such as age and sex are rarely considered in preclinical modeling. This places efforts to develop future therapies at a severe disadvantage, as clinically relevant translation of underlying pathobiology may be lost. We reviewed common morphological and physiological outcomes in six major rodent models of VaD in a total of 258 full-text publications: 1) chronic cerebral hypoperfusion, 2) high fat diet, 3) diabetes, 4) hypertension, 5) carotid arterial calcification, and 6) and CADASIL (Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy), and evaluated translational features relevant to human pathophysiology with an analysis of timepoints of observed pathology and rodent sex and age. We found that all models of VaD shared common features of decreased CBF and upregulation of inflammatory signaling molecules such as TNF-α, IL-1β, and IL-6, and reactive oxygen species (ROS) such as SOD and NOX, consistent with clinical presentations of VaD. Only the carotid artery calcification model showed inconsistent evidence for brain endothelial tight junction loss, astrogliosis, and macrophage reactivity, in disagreement with other models. We conclude that improved translational insight may critically depend on 1) inclusion of a constellation of comorbidities in preclinical modeling instead of modeling each in isolation to better capture human disease pathogenesis, 2) increased use of middle-aged and aged preclinical rodent models which are sensitive to clinically relevant disease presentation in middle-age and elderly individuals, and 3) inclusion of female animals in disease models as sex is a relevant biological factor which may better define future therapeutic strategy in real-world populations.

Stroke, Volume 53, Issue Suppl_1, Page AWMP26-AWMP26, February 1, 2022. Background and Purpose:When reviewing Code Stroke workflow data early in the COVID pandemic, a delay in obtaining CT brain imaging for stroke patients was identified. This study was aimed at improving Door-to-CT and Door-to-IVtPA bolus times by developing an Emergency Department (ED) led process improvement (PI) team to identify and track root causes for delays, provide feedback after fallouts, and recognize care teams after successful cases. Our primary goal was to demonstrate improved trends for performance metrics utilizing a novel method of process improvement, data collection, analysis, and dissemination.Methods:All ED patients activated as a Code Stroke were included in a weekly workflow review conducted by the PI team. Patients with a Door-to-CT of > 20 minutes were analyzed by the team via an in-depth chart review to identify the root cause of the delay. Specific metrics analyzed included Door-to-CT times and Door-to-IVtPA bolus times, along with the percentage of cases that met process metric time goals. Implementation of the weekly review began September 31, 2020, with the pre-implementation period corresponding to the prior nine months and the post-implementation period being the ensuing nine months. Metrics were analyzed using a control chart based on monthly metric averages, standard deviations (SD), and both an upper and lower control limit defined as 1 sigma level of variability from the average.Results:The average Door-to-CT time pre-implementation was 30.6 minutes versus 22.8 minutes post-implementation, with a percentage goal within 20 minutes pre- and post-implementation of 47% and 66%.The average Door-to-IVtPA Bolus time pre-implementation was 40.1 minutes versus 31.5 minutes post-implementation, with a percentage goal

Stroke, Volume 53, Issue Suppl_1, Page ATMP49-ATMP49, February 1, 2022. Objectives:Acute respiratory distress syndrome (ARDS) is a frequent complication seen in patients after aneurysmal subarachnoid hemorrhage (aSAH), but its prevalence, timing, and influence on neurological outcome is unclear. We aimed to investigate the prevalence, timing, risk factors, and outcome of ARDS in patients with aSAH.Methods:PubMed and four other databases (Embase, Cochrane Library, Web of Science Core Collection, and Scopus) from inception to July 6, 2020. We included all randomized controlled trials (RCTs) and observational studies of patients older than 18 years old. Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for RCTs, the Newcastle-Ottawa Scale for cohort and case-control studies. High-grade aSAH was defined as admission Glasgow coma scale 3-5 and/or modified fisher scale >=3 and/or Hunt Hess grade >=3. Good neurological outcome was defined as Glasgow Outcome Scale ≥ 4. Random-effects meta-analyses were conducted to estimate pooled outcome prevalence and their 95% confidence intervals (CI).Results:Nine observational studies (n=2,039) met the inclusion criteria, with the median age of 55 years (range=50-61, 28% male) and 71% patients suffered high-grade aSAH. Overall, 16% patients (95% CI=0.05-0.28, I2=94%) had ARDS after aSAH. The median time from SAH to ARDS was 3 days (range=2-6 days). Overall survival at discharge was 79% (95% CI=0.71-0.87; I2=95%) and good neurological outcome at any time was achieved in 65% of aSAH patients (95%CI=0.61-0.69; I2= 0.02%). aSAH cohort without ARDS had higher proportion of survival compared to those with ARDS (79% vs. 49%, p=0.028). Male sex, patients with high-grade aSAH, patients who developed pneumonia and systemic inflammatory response syndrome during hospital admission were at higher risk of developing ARDS.Conclusions:In this meta-analysis, approximately one in six patients developed ARDS after aSAH with the median time of 3 days from initial presentation and is associated with increased mortality. Further research to better understand the prevention and treatment strategy is necessary.

Stroke, Volume 53, Issue Suppl_1, Page ATP157-ATP157, February 1, 2022. Background:The evidence for mechanical thrombectomy in posterior circulation strokes is unclear. This systematic review and meta-analysis will summarise the available evidence for the use of mechanical thrombectomy in acute basilar artery occlusion.Objectives:To assess the effect of mechanical thrombectomy in acute basilar artery occlusion on disability, mortality, reperfusion and adverse events compared to best medical treatment (BMT).Search:We conducted a systematic review of randomised and prospective, clinically controlled trials using MEDLINE and EMBASE. We reviewed the Cochrane Central Register of Controlled Trials (CENTRAL), grey literature sources and reviewed the reference lists of key papers. No time limits or language restrictions were used.We used the modified Cochrane Collaboration tool to assess the risk of bias for randomised controlled trials and the The Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for prospective non-randomised clinical trials.Results:Five studies met the inclusion criteria (n = 1416). Three were cohort studies and two were randomised controlled trials. We used the random-effects model to combine the data. We found better functional outcome (mRS 0-3, 1.90 [1.07-3.35] p=0.03) and a trend towards decreased mortality (0.75 [0.62-0.91], p= 0.003) in the mechanical thrombectomy (MT) group. The improved outcomes were in the context of significant statistical heterogeneity driven by the difference in methodology between the trials. The improved outcomes were seen in the cohort studies. No significant difference in disability or mortality were found in the randomised controlled trials. We found higher reperfusion rates (TICI 2b/3: 4.75 [1.70-13.28] p=0.003) in the mechanical thrombectomy group with higher rates of symptomatic intracranial bleeding (3.90 [1.03-14.79] p=0.04).Conclusions:Our study reflects the complex nature of posterior circulation strokes and the lack of large randomised controlled trials in this field. We did find a trend towards better mortality and functional outcomes in the included cohort studies but this was not reflected in the randomised controlled trials. We also found higher reperfusion rates in the intervention groups with higher levels of sICH.

Stroke, Volume 53, Issue Suppl_1, Page AWP62-AWP62, February 1, 2022. Introduction:Despite aerobic exercise (AE) testing being a key recommendation for stroke rehabilitation, less than half of physical therapists working with individuals post-stroke perform this practice. Concern for adverse cardiovascular events and inadequate guidance on how to conduct AE testing for individuals with stroke and comorbidity are key barriers. This review aims to describe submaximal AE testing protocols with evidence of safety, defined as less than 11% occurrence of serious adverse events, for people with subacute stroke and comorbidity.Methods:MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTDiscus were searched from inception to October 29, 2020. Published studies that involved submaximal AE testing with individuals with subacute stroke and reported on adverse events during testing were included. Two reviewers independently conducted title and abstract, and full-text screening. One reviewer conducted data extraction, verified by a second reviewer.Results:Sixteen studies involving 595 participants were included. Hypertension (35%), cardiovascular disease (14%) and atrial fibrillation (8%) were the most common cardiovascular comorbidities, while, diabetes (25%), dyslipidemia (23%) and smoking history (11%) were the most common general comorbidities affecting participants with stroke. Evidence of safety for individuals with stroke and comorbidity was found for incremental bicycle (n=5), recumbent stepper (n=3), body weight support treadmill (n=1) and upper extremity ergometer (n=1) protocols; constant load bicycle (n=1) and body weight support treadmill (n=1) protocols; and field (n=10) protocols. Heart rate (95%), blood pressure (82%) and oxygen consumption (72%) monitoring were most frequently done. Test termination criteria based on volition/fatigue (59%) and heart rate (55%) were most commonly reported.Conclusion:A range of submaximal AE testing protocols utilizing diverse exercise modalities can be safely conducted on people with subacute stroke and comorbid conditions that are perceived to increase the risk for serious adverse events. These protocols can be used to guide the development of more specific clinical practice guidelines for conducting AE testing on individuals with stroke and comorbidity.

Stroke, Volume 53, Issue Suppl_1, Page ATP67-ATP67, February 1, 2022. Background and Purpose:Stroke is among the leading causes of death and disability worldwide. Despite the prevalence of cognitive impairment post-stroke, there is uncertainty regarding the optimal type of rehabilitation intervention to improve cognitive functioning in people post-stroke. This systematic review and meta-analysis evaluates the effectiveness of rehabilitation interventions across multiple domains of cognitive function, namely, memory, attention, executive function, perception, apraxia and neglect, as well as general cognitive functioning.Methods:Five databases were searched from inception to August 2019. Eligible studies included randomised controlled trials (RCTs) of rehabilitation interventions for people with stroke when compared to other active interventions or standard care where cognitive function was an outcome.Results:Sixty-four RCTs (n= 4,005 participants) were included. Multiple component interventions improved general cognitive functioning (MD:1.56, 95% CI 0.69 to 2.43) and memory (SMD:0.49, 95% CI 0.27 to 0.72) compared to standard care. Physical activity interventions improved neglect (MD:13.99, 95% CI 12.67 to 15.32) and balance (MD:2.97 to 95% CI 0.71, 5.23) compared to active controls. Non-invasive brain stimulation (NIBS) impacted neglect (MD:20.79, 95% CI 14.53 to 27.04) and function (MD:14.02, 95% CI 8.41 to 19.62) compared to active controls. Neither cognitive rehabilitation (MD:0.37, 95% CI -0.94 to 1.69) or occupational-based interventions (MD:0.45, 95% CI -1.33 to 2.23) had a significant effect on cognitive function compared to standard care.Conclusion:The evidence regarding the effects of rehabilitation interventions for improving cognitive deficits post-stroke is uncertain. Finings must be considered in the context of moderate and high risk of bias across various methodological domains. There is some evidence to support multiple component interventions, physical activity interventions and NIBS protocols. However, findings must be interpreted with caution given the heterogeneity of interventions and outcome measures used across studies.

Stroke, Volume 53, Issue Suppl_1, Page AWMP73-AWMP73, February 1, 2022. Background and Purpose:Cardiac surgery is indicated in more than half of patients with infective endocarditis (IE); however, it is performed in only 60% of the indicated cases. Majority of patients with surgical indications who were denied surgery due to certain reasons die within 30 days. Intracranial hemorrhage (ICH) is one of the main causes for denial of surgery despite the presence of surgical indications. We aimed to evaluate the impact of early surgery (within 30 days) in IE-patients with ICH on postoperative outcome and to elucidate the risk of 30-day mortality in patients for whom surgery was denied.Methods:Three libraries (MEDLINE, EMBASE and Cochrane Library) were assessed for studies evaluating the postoperative outcome in early vs. late surgery in IE-patients with preoperative ICH. The primary outcome was all-cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed.Results:We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early vs. late) and were included in the meta-analyses. Only one study examined the fate of IE-patients with ICH who were treated conservatively despite of having an indication for cardiac surgery, showing higher mortality rates than those who were operated (11.8 % vs. 2.5 %). We found no significant association between early surgery, regardless of its definition, and a higher mortality (relative risk [RR]= 1.46; 95% confidence interval [CI]: 0.98-2.17). However, early surgery was associated with higher risk for neurological deterioration (RR= 1.97; 95% CI: 1.15-3.38).Conclusions:Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with increased rate of neurological deterioration. Thirty-day mortality in IE-patients with ICH for whom surgery was denied has not yet been sufficiently investigated. This patient group should be analysed in future studies in more detail.