Search Results for: Nota 13 AIFA - Guida pratica

Stroke, Volume 56, Issue Suppl_1, Page AWMP35-AWMP35, February 1, 2025. Introduction:Spinal cord infarction (SCI) is a rare condition that accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies [1]. We aim to figure out the diagnostic and therapeutic challenges clinicians face with spinal cord infarction given scarcity of published data, overlapping clinical and neuroimaging findings with alternate etiologies for acute myelopathy, and utility of spinal diffusion weighted imaging (DWI) sequences in differentiating between different causes of acute myelopathy.Methods and Material:Retrospective review of electronic medical records was done. Patients with discharge diagnosis of spinal stroke with DWI imaging evidence of infarction, challenging cases with positive DWI imaging but different pattern of clinical presentation and exam findings were included in the study. Cases without spinal DWI imaging were excluded.Results:Among the 34 DWI-positive patients included in the study with suspected SCI, the average age at presentation was 60 years, and 22 patients (64.7%) had vascular risk factors. A rapid onset of severe deficits, reaching their peak within 12 hours, was observed in 14 patients (41.1%), while 20 patients (58.8%) experienced a gradual decline. Sensory involvement was noted in 26 patients (76.4%), with 13 of these patients (50%) selectively retaining vibration and proprioception. Out of the 34 suspected SCI cases, 15 patients (44.1%) initially received alternative diagnoses, such as TM, NMOSD, Metastatic disease, Post-traumatic cord injury, or Post-laminectomy syndrome. However, after repeated imaging and continuous outpatient follow-up, 7 patients (46.6%) were eventually diagnosed with SCI. The mean MRS score at presentation was 1, at 3 months it was 4, and at 1 year it was 4.Conclusion:Although the overall incidence of SCI is low, it should be considered in patients presenting with acute progressive myelopathic symptoms, even in the absence of vascular risk factors. Factors such as patient demographics and MRI lesion characteristics—including lesion location and ADC correlation—can help differentiate acute demyelinating conditions from SCI. Additionally, a third diagnosis should be considered, beyond just TM and SCI, as not all strokes follow typical patterns, and clinical presentation can vary significantly among patients. Furthermore, recovery outcomes can differ widely, emphasizing the need for individualized patient management.

Stroke, Volume 56, Issue Suppl_1, Page AWMP21-AWMP21, February 1, 2025. Introduction:Blood-brain barrier (BBB) dysfunction is increasingly recognized as a key factor in the pathogenesis of cerebral small vessel disease (cSVD). Typical brain Magnetic Resonance Imaging (MRI) findings of cSVD include white matter hyperintensities (WMH). Based on their anatomical locations, WMH can be classified as Periventricular WMH (PVWMH), which are immediately adjacent to the ventricles, or deep WMH (DWMH), which are subcortical. This study aimed to investigate the relationship between BBB permeability as measured by Dynamic Susceptibility Contrast (DSC) MRI, and changes in total WMH, PVWMH, and DWMH volume over 10-13 years in asymptomatic individuals enriched for vascular risk factors.Hypothesis:Higher K2 measurements, which reflect leakage of contrast due to increased BBB permeability, derived from second MRI will corelate with increases in WMH, DWMH, and PVWMH volume that occurred over the previous decade.Methods:We included 100 volunteers from GeneSTAR, an ongoing family-based study of families enriched for vascular risk factors and cardiovascular disease, age = 63.3 ± 9.5 years, 60% females, 63% Hypertension, 22% African Americans. Two MRI’s were obtained 10-13 years apart using 3T scanners. At each visit total WMH, PVWMH and DWMH volumes were determined using automated software with consistent co-registration (Figure 1). K2 was measured for each individual by averaging the highest 100 voxels (hotspots) within the regions of interest in each individual lesion using a gadolinium-based DSC-MRI at the second visit (Figure 2). Linear regression models used to analyze the relationship between K2 and volume changes in total WMH, PVWMH, and DWMH, adjusting for age, systolic blood pressure, race, sex, and education.Results:Positive correlations between K2 at time point two and changes in volume were statistically significant for total WMH (R-squared = 0.497, p = 0.006), PVWMH (R-squared = 0.461, p = 0.0085), but did not reach significance for DWMH (R-squared = 0.394, p = 0.08) (Figure 3).Conclusion:The robust correlation between K2 and overall WMH volume change underscores the potential of K2 as a biomarker for monitoring ongoing disease activity for subclinical cerebrovascular changes in at-risk populations.

Stroke, Volume 56, Issue Suppl_1, Page AWP315-AWP315, February 1, 2025. Objective:We sought to investigate the consequences of alcohol intake on intracerebral hemorrhage (ICH) and cerebral small vessel disease (cSVD) in patients with spontaneous ICH.Methods:We compared markers of cSVD [Figure 1], features of ICH, and outcomes among consecutive spontaneous ICH patients with different alcohol use strata admitted to a tertiary care center between 2003-2019. Alcohol intake was categorized as none/mild (5 drinks/day). We performed descriptive statistics and bivariate/multivariate analyses based on demographic and radiologic data.Results:We included 1590 patients (53% male, median age 74 years [IQR 64-82]). Among them, 82.6% had none/mild alcohol intake, 14.2% moderate/severe, and 3.3% heavy alcohol intake. Heavy alcohol users were 13 years younger at time of ICH than none/mild users (median [IQR], 62 [57-70] vs 75 [65-83], p

Stroke, Volume 56, Issue Suppl_1, Page AWP310-AWP310, February 1, 2025. Background:Vascular risk factors, particularly in midlife, are associated with an increased risk of dementia, and smoking has been inversely associated with Parkinson’s disease (PD) risk, but the role of these factors in PD-dementia (PDD) is less clear. This study explores whether midlife vascular risk factors are associated with risk of PDD in the community-based ARIC cohort.Methods:ARIC participants were evaluated for vascular risk factors (hypertension, diabetes, hypercholesterolemia, smoking, and obesity) in 1987-1989 (ages 44-64) and followed through 2016. PD cases were identified using participant medications, self-reported physician diagnosis, hospitalization and death surveillance, and PD diagnostic data provided by participants and physicians. Dementia was defined by in-person and phone-based cognitive assessment, informant interviews, and hospitalization codes. PDD was defined as having both a PD and dementia diagnosis, with the PD diagnosis occurring first. We excluded participants with missing covariates, on neuroleptic medications, or with PD or dementia at baseline. Adjusted Cox proportional hazards models examined the associations between midlife vascular risk factors (combined in one model) and incident PDD, PD/no dementia, and dementia/no PD, vs no PD/no dementia. We explored effect modification by race.Results:Of 13,875 participants (25% Black, 54% female), 179 developed PD at a mean age of 73.4 yo, 94 devleoped PDD at a mean age of 79.2 yo, and 1,791 developed dementia/no PD at a mean age of 79.7 yo. Midlife current smoking (HR 0.41, 95% CI 0.18-0.95, Figure) was signficantly associated with a lower risk of PDD; other vascular risk factors had nonsignficiant associations. Older age, APOEe4, male sex, and low education were significantly assoiated with an increased risk of PDD. Smoking, diabetes, hypertension, obesity, Black race, age, low education, male sex, and APOEe4 were associated with an increased risk of dementia/no PD. There was effect modification by race for smoking and obesity, which were significant risk factors for dementia/no PD in White but not Black participants (Table).Conclusions:Smoking in midlife was significantly associated with a lower rate of PDD vs no PD/no dementia. Other vascular risk factors were not associated with PDD, but demographic associations were similar to dementia. Future studies should evaluate these vascular risk factors over the life course and the mechanisms underlying these associations.

Stroke, Volume 56, Issue Suppl_1, Page AWMP18-AWMP18, February 1, 2025. Background:Cerebral microbleeds (CMBs) are associated with incident dementia, but the impact of specific CMB patterns is unclear. CMBs in lobar regions suggest cerebral amyloid angiopathy (CAA), which is sometimes accompanied by superficial siderosis (SS), while subcortical CMBs indicate hypertensive origins. This study investigates the association between CMB patterns and dementia risk in the community-based longitudinal Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).Methods:All ARIC-NCS participants with a 3T research MRI at visit 5 (2011-13; aged 67-90) without intracerebral hemorrhage or dementia were included. CMB and SS presence and location were coded from T2* GRE sequences. Individuals were classified into one of four patterns: no CMBs, only subcortical, mixed (lobar and/or SS + subcortical), and only lobar and/or SS. Incident dementia diagnoses were defined by cognitive testing (in-person and telephone), informant interviews, and hospital discharge codes or death certificates. Cox proportional-hazards models assessed the association between the presence, patterns, and frequency of CMBs (0,1,2,3+), presence of SS, and incident dementia from visit 5 through 2020. Model covariates included demographics, vascular risk factors, and imaging markers of small vessel disease.Results:Among 1609 participants, 364 had CMBs (Table 1). Participants with CMBs tended to be older and female compared to those without CMBs. Compared to individuals with no CMBs, presence of any CMBs was associated with an increased risk of dementia (Table 2). Compared to individuals without CMBs, individuals with only lobar CMBs and/or SS had an increased risk of incident dementia, as did individuals with mixed CMBs, but individuals with subcortical-only did not. Participants with ≥3 CMBs of any variant had an increased risk of incident dementia vs no CMBs. Although SS was infrequent, its presence (vs no SS) was associated with an elevated risk of dementia.Conclusion:CMBs, particularly in a mixed or lobar and/or SS-only pattern, are linked to an increased risk of incident dementia. The number of recurrent CMBs and any SS also showed an increased dementia risk. These data support that dementia risk is high in individuals with a CAA-type CMB pattern, but also emphasize that a mixed pattern, not typical of CAA alone, is associated with a high risk of dementia. Further studies should evaluate mechanisms by which these different patterns contribute to dementia.

Stroke, Volume 56, Issue Suppl_1, Page AWP37-AWP37, February 1, 2025. Introduction:Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database.Methods:We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type MMD who underwent surgical revascularization across 13 academic institutions in North America. Data were collected and analyzed on a per-hemisphere basis, covering patient demographics, disease characteristics, procedural details, and outcomes. Statistical analyses were performed using Stata (V.17.0), comparing baseline characteristics, and using univariable and multivariable logistic regression to identify predictors of perioperative stroke.Results:A total of 301 patients with ischemic-type MMD underwent surgical revascularization, with 34 patients (11.3%) experiencing perioperative stroke. Patients who experienced perioperative stroke had a mean age of 43.6 years (SD 14.0) compared to 40.0 years (SD 13.9) in those without perioperative stroke (P=0.16). Hypertension was significantly more prevalent in the perioperative stroke group (73.5% vs. 47.9%, P=0.005). Smoking was also more common in the perioperative stroke group (55.8% vs. 38.2%, P=0.04). Multivariate logistic regression identified hypertension as a significant independent predictor of perioperative stroke (OR 2.4, 95% CI 1.06 to 5.45, P=0.03).Conclusion:Hypertension is a significant predictor of perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization. Further prospective studies are needed to validate these findings.

Stroke, Volume 56, Issue Suppl_1, Page AWMP19-AWMP19, February 1, 2025. Background:The Brain Care Score (BCS) is a novel tool developed to address modifiable risk factors for the incidence of age-related brain diseases such as stroke, dementia, and late-life depression (LLD)(Fig 1). Previous data showed that a lower baseline BCS is associated with higher disease risks. This study examines the associations between longitudinal BCS changes on the incidence of these three outcomes.Methods:UK Biobank (UKB) participants with primary care data available for longitudinal assessment of a 19-point modified BCS were included. We evaluated baseline BCS and changes over time (delta BCS), applying a weighted model to standardize changes relative to the time interval between assessments. Participants were grouped by mean delta BCS into i) improvement, ii) no change, or iii) deterioration. A logistic regression model was employed to assess the impact of BCS deterioration on outcomes, adjusting for baseline BCS, age, and sex. Multivariate Cox models evaluated associations between baseline BCS, 5-point improvement in BCS over time, and outcomes, adjusting for age and sex. Secondary analyses stratified individuals by genetic risk, using polygenic risk scores for stroke and LLD, and APOE e4 status for dementia.Results:Among 176,693 participants (54.1% females, 45.9% males), the mean age was 56.9 years, with a median follow-up of 12 years (IQR 11-13). A total of 70.84% had improvement in BCS, 17.86% experienced deterioration and 11.2% had no significant change. Participants with BCS deterioration had an increased risk of stroke (OR 1.29; 95%CI 1.11-1.50), LLD (OR 1.60; 95%CI 1.31-1.94), and a trend for dementia (OR 1.09; 95%CI 0.93-1.27). A 5-point increase in BCS over time significantly reduced the risk of all three diseases: stroke (HR 0.73; 95%CI 0.67-0.79), dementia (HR 0.79; 95%CI 0.79-0.96) and LLD (HR 0.60; 95%CI 0.56-0.64)(Fig 2), independently of baseline BCS, age and sex. Secondary analyses demonstrated that an incremental 5-point increase in the BCS significantly reduced the risk of stroke (HR 0.61, 95%CI 0.54–0.71) and LLD (HR 0.62, 95%CI 0.55–0.70), even among individuals with the highest genetic predisposition(Fig 3).Conclusions:Higher BCS can mitigate the risk of stroke, dementia, and LLD. Improvements in BCS over the 12-year observation period significantly lowered the incidence of these outcomes even in those with high genetic predisposition, supporting the effectiveness of the BCS as a tool for brain health.

Stroke, Volume 56, Issue Suppl_1, Page AWMP46-AWMP46, February 1, 2025. Both left hemisphere (LH) and right hemisphere (RH) stroke can cause contralesional viewer-centered neglect (VCN) or stimulus-centered neglect (SCN). Studies using perfusion imaging have shown that in acute stroke, hypoperfusion beyond the infarct contributes to deficits, including neglect. However, perfusion imaging is not always available. FLAIR hyperintense vessel (FHV; Fig. 1) number and site estimate the volume and site of hypoperfusion. We hypothesized that FHV rating in the right parietal cortex would contribute to VCN.A series of 256 consenting acute stroke patients (82 LH and 174 RH) completed a neglect task with 30 ovals – 10 full, 10 with a gap on the left, and 10 with a gap on the right. Patients were asked to circle full ovals and cross out ovals with a gap on either side. We defined VCN as >10% of ovals unmarked after the most extreme mark (Fig. 2), and SCN as neglecting or incorrectly marking >10% of contralesional gaps (Fig. 3). On FLAIR sequences, we identified FHVs in 4 MCA regions: frontal, temporal, parietal, and insular, as well as ACA and PCA territories. Each region was scored from 0 to 2: 0 = no FHVs; 1 = 1-2 FHVs on 1-2 slices; 2 = 3 or more vessels on 1 slice or 3 or more slices with at least 1 FHV (total=0-12). Infarct volume was calculated after manual tracing of lesions on DWI. We used multivariable logistic regression, with the presence of VCN or SCN as the dependent variable, and FHV ratings in each territory, infarct volume, and age as independent variables. We used chi squared tests to test associations between dichotomous variables.In LH stroke, SCN was more common than VCN (21% vs. 5%; X2= 9.3; p=0.002). VCN was more common in RH than LH stroke (13% vs 5%; X2= 4.1; p=0.04). In RH stroke, left VCN was independently predicted by age (p=0.005), volume of infarct (p

Stroke, Volume 56, Issue Suppl_1, Page AWP36-AWP36, February 1, 2025. Background:Up to 5% of patients with infective endocarditis (IE) develop intracranial mycotic aneurysms (MA) with nearly 25% of these patients having multiple intracranial aneurysms. Mortality rates have been reported up to 30% for unruptured and 80% for unruptured MA. Therefore, accurate diagnosis of intracerebral aneurysms is critical. CT angiography (CTA) is widely used to detect mycotic aneurysms (MA), yet data are sparse in the literature regarding diagnostic accuracy of CTA compared with the gold standard of 3D rotational digital subtraction angiography (DSA). In this study, we compare CTA to DSA particularly focusing on how the size of aneurysms may change sensitivity of CTA. Based on these results, we offer a practical strategy for the detection and monitoring of MAs.Methods:This retrospective chart review included all patients admitted to Boston Medical Center between January 1, 2014 and December 31, 2023. 883 patients with IE were identified by ICD-9 and ICD-10 code. 77 intracranial aneurysms were identified by DSA with accompanying CTA within 1 month. An experienced neuroradiologist reviewed each CTA and DSA. Using DSA as the gold standard, sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated. To avoid bias and increase clinical relevance, these calculations were based on the final clinical interpretation at the time of the study. For the analysis based on aneurysm size, the review of our study neuroradiologist was used.Results:Of the 77 aneurysms identified by CTA or DSA, test results were as follows: 53 true negative (CTA -, DSA-), 13 true positive (CTA +, DSA +), 5 false positive (CTA +, DSA -), and 8 false negative (CTA -, DSA +). Including all aneurysms, the sensitivity of CTA was (62%), and the specificity was (91%). The positive and negative predictive values were 72% and 87%, respectively. The sensitivity of CTA for aneurysms ≥ 5mm was 100%. For aneurysms ≥ 4, the sensitivity was 88%. For aneurysms ≤ 3mm, the sensitivity of CTA was 46%.Conclusions:Sensitivity of CTA for intracranial aneurysms is low, however, it varies depending on size and is excellent for aneurysms ≥ 5mm. Based on this information, we present a strategy that uses a combination of DSA and CTA to detect and monitor MAs.

Stroke, Volume 56, Issue Suppl_1, Page AWP317-AWP317, February 1, 2025. Introduction:Atrial fibrillation (AF), which can be easily identified through electrocardiogram (ECG), is a well-established predictor of ischemic stroke (IS) in comparison to other stroke subtypes. However, there is a paucity of literature surrounding other objective ECGs features and their discriminative abilities between stroke subtypes. This study explores the prevalence of ECG abnormalities and their potential associations with stroke and its subtypes.Methods:Our analysis included 10,363 IS cases, 3,055 hemorrhagic stroke (HS) cases, and 13,488 matched controls from the INTERSTROKE case-control study. The ECG abnormalities investigated included AF, recent ST-elevation myocardial infarction (STEMI), left ventricular hypertrophy (LVH), right ventricular hypertrophy (RVH), P-pulmonale, and P-mitrale. Multivariate logistic regression, and multinomial regression by stroke severity, was performed and adjusted for covariates. Analyses were conducted using R version 4.3.1.Results:In the population presenting with stroke, 19.26% exhibited ECG abnormalities (19.69% IS, 18.10% HS) compared to 7.1% of the controls. AF (7.4%) and LVH (11%) were the most reported abnormalities with recent STEMI, RVH, P-pulmonale and P-mitral each having a ≤1% prevalence (table 1). Regional variation was observed, with Africa having the highest detection of LVH (18%), and Western Europe/North America/Australasia having the highest detection of AF (9.2%).Univariate and multivariate logistic regression analysis revealed AF as the strongest predictor of IS (OR 4.80, 95% CI 4.02–5.74), while LVH was the strongest predictor of HS (OR 5.35, 95% CI 4.06–7.04) (table 2). AF on presentation, significantly reduced the odds of a HS diagnosis (OR 0.22, 95% CI 0.14–0.33) compared to IS, while the converse was true of LVH (OR 1.76, 95% CI 1.35–2.29). Patients with LVH were significantly younger in age at stroke onset (61.0 ± 13.3 years vs. 62.3 ± 13.6 years, p < 0.001), particularly in the HS cohort (57.4 ± 12.8 years). LVH was most associated with severe stroke, defined as a modified Rankin score (mRS) of 4-6 on presentation (OR 1.20, 95% CI 1.03–1.41), compared to matched mild stroke cases.Conclusion:ECG abnormalities are commonly detected in patients presenting with stroke, and substantive differences between stroke subtypes was demonstrated. These findings suggest that ECG could play a critical role in rapid stroke differentiation and aid in the development of future clinical prediction tools.

Stroke, Volume 56, Issue Suppl_1, Page AWP39-AWP39, February 1, 2025. Background:Moyamoya disease (MMD) is a cerebrovascular disorder marked by the progressive steno-occlusion of the bilateral internal carotid arteries and the formation of abnormal collateral vessel networks at the base of the brain. Previous studies have attempted to identify risk factors predictive of postoperative complications to improve patient management. This study aims to identify pretreatment factors associated with symptomatic stroke in MMD patients.Methods:This study is a multicenter retrospective analysis conducted across 13 academic institutions in North America. A total of 518 patients with MMD were included. Data collected included patient demographics, disease characteristics, and follow-up duration. Stroke-free survival was analyzed using Kaplan-Meier curves. Univariate and multivariable Cox regression analyses were used to identify risk factors for symptomatic stroke.Results:The median age of the patients was 43 years (IQR, 34–52 years), and 370 (71%) were females. Hypertension was present in 255 (49%) patients, diabetes mellitus in 144 (28%), and 192 (37%) were smokers. Multivariable Cox regression identified advanced age (HR 1.03, 95% CI 1.01–1.05, p = 0.011), female sex (HR 2.03, 95% CI 1.00–4.11, p = 0.049), diabetes mellitus (HR 2.03, 95% CI 1.14–3.63, p = 0.016), smoking status (HR 2.27, 95% CI 1.27–4.05, p = 0.006), and incidental findings (HR 0.37, 95% CI 0.15–0.93, p = 0.034) as significant factors associated with symptomatic stroke.Conclusion:Advanced age, female sex, diabetes mellitus, and smoking status were significant predictors of symptomatic stroke in MMD patients. Patients with incidental findings had a reduced risk of stroke. These findings emphasize the importance of managing modifiable risk factors and the potential benefits of early detection in improving clinical outcomes for MMD patients. Further prospective studies are needed to validate these findings.

Stroke, Volume 56, Issue Suppl_1, Page AWP301-AWP301, February 1, 2025. Introduction:While intracranial hemorrhage (ICH) is uncommon in young adults (18-55), its incidence is on the rise. While the reasons for this increase are multifactorial, there is likely a contribution from the known rise in traditional vascular risk factors (VRFs) among the general young adult population. We aimed to examine the prevalence of VRFs among young patients with ICH and evaluate for racial and sex disparities in VRF burden.Methods:Data of patients hospitalized with stroke between January 2014 and December 2023 were collected by Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry. Young patients aged 18-55 with a diagnosis of ICH were included and separated into two age groups: 18-35 and 36-55. VRFs included hypertension, diabetes, kidney disease, smoking, drug or alcohol abuse, antithrombotic medication use, and sleep apnea. Polymorbidity was defined as the presence of three or more VRFs.Results:9541 young ICH patients were included (39% female, 41% White, 17% Hispanic, 33% non-Hispanic Black), and 1240 (13%) of these patients were aged 18-35. The prevalence of each VRF was higher among patients aged 36-55 vs 18-35 (all p values

Stroke, Volume 56, Issue Suppl_1, Page AWMP16-AWMP16, February 1, 2025. Background:The patterns of neural functional changes induced by chronic hypoperfusion resulting from intracranial arterial stenosis and their relationship to cognitive performance are not yet fully understood, with unilateral asymptomatic middle cerebral artery stenotic-occlusive disease (MCAs/o) serving as an ideal model for investigation.Methods:We established a discovery-validation research pipeline to identify functional abnormalities in the hypoperfused regions of MCAs/o patients and quantify them into a machine learning-based data-driven biomarker, i.e. hypoperfusion-based functional abnormalities (HFA). Pseudocontinuous arterial spin labeling imaging was used to identify hypoperfused regions (HypoR) in the discovery cohort. Functional changes within HypoR, including regional homogeneity (ReHo) and functional connectivity, were analyzed and quantitatively integrated using a logistic regression machine learning model to calculate the HFA after feature extraction. The correlation between HFA and cognitive scores was then assessed, and the findings were validated in the independent cohort(Figure 1).Results:The discovery cohort included 44 MCAs/o patients (LMCAs/o: n=22, age 56±11 years, 13 male; RMCAs/o: n=22, age 49±14 years, 16 male) and 35 matched normal controls (age 52±11 years, 15 male), in which MCAs/o patients showed poorer performance on bilateral hand-grooved pegboard tests (GPT) compared to controls (p

Stroke, Volume 56, Issue Suppl_1, Page A161-A161, February 1, 2025. Background:Intestinal immune response plays a detrimental role following a stroke. The objective of this study aims to investigate if cooling the gut can protect the brain against ischemic injury.Methods:Mice were subjected to 60 min middle cerebral artery occlusion (MCAO) followed by 7 days of reperfusion. The experimental groups were: (i) normothermic group (NT) (n=11); (ii) colon cooling (CC) group (n=13); and (iii) surface cooling (SC) group (n=15). A temperature management catheter was inserted via the rectum into the descending colon to maintain the colon temperature at 37°C (NT group) and at 15°C (CC group), while the esophageal temperature was kept as close to 37°C as possible for both groups. In the SC group, both esophageal and colon temperatures were maintained at the same level as the esophageal temperature in the CC group. Temperature management was initiated at 30 min reperfusion and continued for 3 hours. The regional cerebral blood flow (rCBF) was measured during the peri-MCAO period. Bodyweight, behavioral deficits (nesting, pole test, and Y-maze), and neurological scores were examined daily until the 7-day endpoint. At the endpoint, mice were perfusion-fixed for histopathological analysis.Results:The rCBF was reduced below 10% of the preischemic level during the entire 60 min MCAO period. It returned to the preischemic level at 10 min post-MCAO but gradually declined to 50% of the preischemic level in CC and SC groups and to 70% in NT group by the end of temperature management. Stroke volume was the smallest in CC, smaller in SC, but the largest in NT group. Bodyweight continuously declined in SC and NT but recovered in CC group post-MCAO. Nest building activity and pole test deficits improved in CC but remained in NT or SC group. Neurological score deficits were recovered in CC, partially recovered in SC, but not recovered in NT group. The mortality rate was the lowest in CC, lower in SC, and the highest in NT group. Stroke volumes and behavioral deficits were significantly reduced in the CC compared to the NT group (p

Stroke, Volume 56, Issue Suppl_1, Page AWP42-AWP42, February 1, 2025. Background and Objectives:Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.Methods:This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching (PSM) was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp).Results:A total of 497 patients were included, including 90 that had bilateral revascularization and 407 that had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs. 2.4%; OR 4.41, 95% CI 1.73 to 11.19, p = 0.002) and higher rates of excellent functional outcomes (mRS 0-1) at discharge (92.2% vs. 79.1%; OR 3.12, 95% CI 1.39 to 7, p = 0.006). After PSM, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs. 8.7%; OR 1.95, 95% CI 0.61 to 6.22, p = 0.26). No significant differences were noted in mRS 0-1 and 0-2 scores at discharge, NIHSS at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, p = 0.15).Conclusion:This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.

Stroke, Volume 56, Issue Suppl_1, Page AWMP29-AWMP29, February 1, 2025. Purpose:Recruiting participants for acute ischemic stroke trials is challenging due to difficulties in obtaining written informed consent in urgent settings. Alternative consent methods, like deferred consent and Exemption from Informed Consent (EFIC), have been proposed to facilitate timely intervention and improve trial feasibility. This review examines the impact of these methods on recruitment efficiency in both ischemic stroke and ICH trials.Methods:A scoping review of trials on acute ischemic stroke and ICH interventions (enrollment ≤24 hours from onset) published between January 2013 and March 2023 was conducted. Studies were categorized by consent methods, and trial characteristics were analyzed to compare recruitment efficiency. The review protocol was pre-registered on the Open Science Framework (https://osf.io/5rkc2).Results:A total of 170 trials met our inclusion criteria. Of these, 118 trials used conventional written informed consent (Conventional group), while 52 trials (30.6%) adopted alternative consent methods including deferred consent and EFIC (Alternative group). In univariable analysis, the Alternative group had a significantly shorter maximum allowable time from onset/LKW to randomization/enrollment compared to the Conventional group (6 hours [IQR 4-12] vs. 9 hours [IQR 5-24], p=0.03). There were no significant differences between the groups in terms of the number of participating countries, sites, or overall enrollment duration. However, the number of withdrawals (in counts) was significantly higher in the Alternative group (2.8 ± 5.8 vs. 9.3 ± 13, p