Search Results for: Report aggiornato sulla qualità dell’aria in Europa (2015)

Stroke, Volume 56, Issue Suppl_1, Page ATP115-ATP115, February 1, 2025. Background:Mechanical thrombectomy (MT) as treatment for acute ischemic stroke (AIS) has demonstrated superior functional outcomes compared to intravenous thrombolysis (IVT). Yet AIS survivors often experience a range of unstudied post-stroke complications which negatively affect patient reported outcomes. To inform clinical practice, we assessed 90-day differences in the medical management of common stroke post-complications among patients treated with MT vs. IVT.Methods:A retrospective cohort of hospitalized AIS patients treated with IVT or MT were identified from Electronic Medical Records of 92 large healthcare organizations (01/2015-09/2024). Matched propensity scores were used to adjust for baseline differences across 36 factors. Outcomes included the use of medication(s) for the management of fatigue, spasticity, mood, sleep, seizure, neurogenic bowel&neurogenic bladder. Pre-specified subgroup analyses included differences in post-stroke sequelae management stratified by NIHSS scores of ≤9 (mild AIS) or >9 (moderate/severe AIS)&differences in post-stroke sequelae between AIS patients treated with MT vs MT + IVT.Results:The final cohort consisted of n=87,819 AIS patients treated with either IVT (n=82,534) or MT (n=5,285). PS matching resulted in 5,285 matched pairs with good balance across all baseline covariates. At 90-days, AIS patients treated with MT were more likely to receive medications for spasticity (RR: 1.15, 95%CI: 1.01, 1.31), mood (RR: 1.06, 95%CI: 1.01, 1.13)&neurogenic bowel (RR: 1.11, 95%CI: 1.09, 1.14) (Table 1). Approximately 7% (n=6,344) of AIS patients had NIHSS scores – PS matching resulted in 877 matched pairs with NIHSS ≤9&848 matched pairs with NIHSS >9. Following stratification, AIS patients treated with MT were significantly more likely to receive treatment of neurogenic bowel&bladder (Table 2). For the MT vs MT + IVT comparison, patients treated with MT were 5% less likely to receive treatment for neurogenic bowel RR: 0.95 (95%CI: 0.92, 0.99) among 1,900 matched pairs (Table 3).Discussion:Using real world data, AIS patients treated with MT (vs IVT) were more likely to receive treatment for spasticity, mood&neurogenic bowel. Among patients with documented NIHSS scores, differences remained significant for treatment of neurogenic bowel and bladder after stratifying by stroke severity. Healthcare providers should screen for these post-stroke sequelae, which substantially affect quality of life for AIS survivors.

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 ATP107-ATP107, February 1, 2025. Introduction:The intricate network of neurons orchestrates essential functions within the human body. Ischemic stroke, a major neurological disorder, challenges this network, leading to irreversible damage and functional impairment due to the limited regenerative capacity of neuronal tissues. Stem cells, with their unique properties of self-renewal and differentiation into various cell types, present a promising therapeutic avenue. This systematic review evaluates the efficacy and safety of stem cell therapies in treating ischemic stroke, aiming to restore neuronal structure and function.Objective:Our goal is to provide insights into the therapeutic potential of stem cell interventions for ischemic stroke, specifically their impact on clinical outcomes, functional recovery, and quality of life. This review synthesizes evidence from randomized clinical trials conducted between 2015 and 2024.Methods:A comprehensive search of databases such as PubMed, MEDLINE, and Cochrane Library identified relevant randomized clinical trials involving stem cell therapy for ischemic stroke.Results:Current data shows that various types of stem cell therapy are safe for treating neurological diseases, particularly ischemic stroke. While these therapies have enhanced motor recovery and neuroplasticity, their effectiveness in reducing scar size remains to be conclusively demonstrated. Notable improvements in patient outcomes include significant enhancements in the Modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Additionally, imaging studies have shown increased neurogenesis and enhanced integrity of the corticospinal tract in the peri-infarct area.Conclusion:The review highlights a remarkable finding: a single administration of stem cells can yield measurable clinical improvements lasting at least 12 months post-treatment. This long-term effect is unprecedented among non-device or non-acute treatments for ischemic stroke, challenging current therapeutic approaches like thrombolysis.This systematic review underscores the transformative potential of stem cell therapy in addressing the challenges of ischemic stroke. Despite significant advancements, further research is essential to fully understand the mechanisms, optimize treatments, and fully harness the regenerative capabilities of stem cells, paving the way for innovative treatments that offer renewed hope for stroke patients.

Stroke, Volume 56, Issue Suppl_1, Page ATP367-ATP367, February 1, 2025. Background:Ischemic preconditioning (IPC) is a robust protective phenomenon in which a brief ischemic exposure confers tolerance against a subsequent prolonged ischemic challenge. Elucidating the mechanisms of IPC is a critical challenge in the stroke field. Innate immune pathways, particularly type I interferon (IFN) signaling, in microglia are critical in establishing protection in both grey and white matter. Our previous studies demonstrated that type I IFN receptor (IFNAR1) in microglia is required for both IPC-induced axonal protection and interferon stimulated gene (ISG) expression. We also showed that exposure of primary microglia to either IFN-beta or ischemia/reperfusion-like conditions results in phosphorylation of STAT1, a key signaling kinase downstream of IFNAR1. Therefore, we hypothesized that STAT1 is a critical mediator of the microglial response to IPC. Here we report the impact of systemic STAT1 knock-out on microglial responses after IPC.Methods:We performed a transient (15 min) middle cerebral artery occlusion on 4 wild-type (WT) and 4Stat1-/-mice and collected tissue 72 hours later. We processed tissue for single nucleus RNA-sequencing using 10X Genomics kits. We captured ~10,000 nuclei per sample and sequenced at a depth of 25,000 reads. We performed comparative analysis between ipsilateral and contralateral hemispheres to identify focal changes in microglial subpopulations and gene expression due to IPC. We performed immunofluorescent microscopy and quantitative stereology to validate IPC-induced changes in microglial number/morphology and expression of ISG protein products such as IFITM3.Results:We describe global in vivo transcriptomic changes in microglial subpopulations after IPC and found that STAT1-deficiency alters both the distribution of microglial subpopulations and cluster-specific transcriptional profiles. We identify and define an interferon responsive microglial cluster induced by IPC that is dependent on STAT1. We also provide data demonstrating how ischemia/reperfusion and innate immune signaling affect STAT1 phosphorylation signaling dynamics in microglia in vitro. We show that phosphorylation is dependent on both Toll-like receptor 4 (TLR4) and IFNAR1.Conclusions:Our results support a central role for STAT1 in mediating microglial phenotype in vivo following IPC. Our findings indicate that STAT1 is an important regulator of microglial type I IFN signaling in the context of ischemia.

Stroke, Volume 56, Issue Suppl_1, Page ATMP80-ATMP80, February 1, 2025. Introduction:In 2015, mechanical thrombectomy (MT) was established as an essential treatment for large-vessel occlusion ischemic stroke (LVO). Since then, trials have expanded the population eligible for MT by demonstrating its benefit in patients with LVO who present later to care and with more extensive infarct. As the eligibility criteria for MT ease, more patients will undergo the procedure who have risk factors for complications – such as malignant edema or hemorrhagic conversion – that require decompressive craniectomy (DC). Though MT and DC in ischemic stroke have been studied independently, the outcomes of patients who undergo both procedures is unknown. We present a case series using a national database of patients who underwent MT and required DC to understand their profile and health outcomes.Methods:Using the National Inpatient Sample (NIS), an all-payer national healthcare utilization database, patients admitted between the years 2016 and 2021 for ischemic stroke who underwent MT and required DC were identified via ICD-10 codes. Logistic regression was performed to identify patient factors independently associated with DC after MT.Results:Of the 31,234 patients admitted for LVO who received MT between 2016-2021, 764 (2%) underwent DC (Table 1). Younger age (p < 0.001), non-white race (p < 0.001), a higher NIHSS (p < 0.001), and lower rates of atrial fibrillation were independently associated with DC after MT. Although the number of patients undergoing MT plus DC increased annually, this rise was proportional to the overall number of MT patients. Admissions with MT and DC were nearly 2.5 times longer than those with MT alone (20 days versus 8.4 days, p < .001, Table 2) and associated with increased rates of mortality (25% versus 12%, p < 0.001) and a higher level of care after discharge (p < 0.001).Conclusion:Rates of DC after MT did not change following extension of the thrombectomy window to 24 hours. DC after MT resulted in a heavy burden of morbidity and mortality, similar to levels previously published for DC after ischemic stroke without MT. In conclusion, our findings suggest that expansion of MT eligibility criteria has not increased the risk for DC and that practice guidelines developed from trials in stroke patients who underwent DC but not MT may also be applicable to patients with DC after MT. Recent large core trials have further expanded the MT population, necessitating continued examination of the relationship between MT and DC.

Stroke, Volume 56, Issue Suppl_1, Page A21-A21, February 1, 2025. Introduction:For stroke survivors, blood pressure (BP) reduction significantly lowers the risk of recurrence; a 10mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite the magnitude of this benefit, existing data quantifying post-stroke BP control is limited to small cohorts, national surveys relying on self-report of stroke, and cross-sectional surveys from closed health systems. We aim to determine rates of post-stroke BP control from a broader population within the first year of stroke from multiple cohorts of patients, including from a large US fee-for-service health system, TriNetX (global data source), and two randomized control trials.Methods:We analyzed rates of uncontrolled BP ( >140/90 mmHg) after stroke in 4 cohorts of individuals 18 years or older: 1) patients in the Yale New Haven Health System (YNHHS) between 2015-2020 at 6 months after stroke (both ischemic and hemorrhagic) hospitalization, 2) patients in TriNetX from 01/01/20 to 07/20/2024 with hypertension (ICD-10 code I10) and a hospital diagnosis of ischemic stroke (ICD-10 code I63), 3) participants with ischemic stroke in the Insulin Resistance Intervention after Stroke (IRIS) trial, and 4) the control arm of the blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomized trial. For TriNetX, IRIS, and SPS3, BP was evaluated at one year after hospitalization.Results:Among YNHHS patients with stroke [n=3,339; mean age 67, 21% Black race, 10% Hispanic ethnicity, 49% male], the rate of uncontrolled BP was 31%. Ischemic strokes accounted for 83.2% of population, while hemorrhagic strokes accounted for 16.8%. In TriNetX [n= 495,474; mean age 69, 17.7% Black race, 5.9% Hispanic ethnicity, 48.6% male], the rate of uncontrolled BP was 33.4%. In the IRIS trial [n=3,135; mean age was 63, 11% Black race, 4% Hispanic ethnicity, and 67% male], 29% of participants were classified with uncontrolled BP. In the SPS3 trial [n=1,519; mean age was 63, 17% Black race, 31% Hispanic ethnicity, 65% male], 40.1% of participants were classified as uncontrolled BP.Conclusion:Among individuals with stroke in clinical trial and real-world cohorts, the rate of uncontrolled BP post-stroke ranged from 29 to 41%. These results support the tremendous need for improved BP management strategies for stroke survivors.

Stroke, Volume 56, Issue Suppl_1, Page AWP98-AWP98, February 1, 2025. Introduction:Acute treatment for stroke often requires emergent interhospital transfer for access to advanced therapies not available at the initial hospital. Prolonged transfer times have been associated with worse outcomes. Door-in-door-out time (DIDO: the amount of time a patient spends in the transferring emergency department [ED]) is an important quality metric in acute stroke care, with current recommendations for DIDO times ≤ 120 minutes. We sought to characterize trends and predictors of DIDO times for interhospital stroke transfers using the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS).Methods:We utilized data from the GCNKSS, a population-based epidemiologic stroke study, from the following time points: 1999, 2005, 2010, 2015, and 2020. Patients ≥18 years with acute ischemic stroke (AIS) or hemorrhagic stroke (HS) who presented to an initial ED and were not admitted but were transferred to another hospital were included. The primary outcome was DIDO time. Temporal trends in DIDO time were tested using the Mann-Kendall trend test. Generalized linear mixed effects models with hospital-specific random intercepts were constructed to evaluate the associations between patient- and hospital-level covariates and DIDO time.Results:Of 13,678 stroke cases over the time periods studied, 1574 patients met inclusion criteria for the overall stroke group (mean age 64.7 [SD: 15.6], 51.6% female), with 851 (54.1%) having AIS and 723 (45.9%) HS. Over the time periods examined, the median DIDO time for the overall stroke group was 213 minutes (IQR 142-305), and DIDO times significantly increased over time (Figure 1; P

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

Stroke, Volume 56, Issue Suppl_1, Page ATMP91-ATMP91, February 1, 2025. Introduction:Mechanical circulatory support (MCS) carries a high risk of neurologic complications, with estimates of arterial ischemic stroke (AIS) to be between 5 and 30%. We report our cohort of children on Ventricular Assist Device (VAD) or Extracorporeal Membrane Oxygenation (ECMO) support who suffered AIS, and describe stroke treatment and outcomes in this high-risk population.Methods:The Stanford Pediatric Stroke Registry retrospectively and prospectively enrolled children aged 30 days-22years admitted to our quaternary care pediatric hospital between 2007-2024 with confirmed AIS on neuroimaging. Demographic, clinical, radiographic, treatment and outcome data were collected via chart review and entered into a secure, HIPAA-compliant RedCAP database. Children on MCS at the time of stroke were compared with non-MCS patients and analyzed using descriptive statistics.Results:A total of 35/207 (16.9%) patients were identified as having an AIS while on MCS; demographics and clinical characteristics are shown in Table 1. Overall, MCS patients were younger and were more likely to have congenital or acquired heart disease than non-MCS patients. Stroke presentation, treatment and outcomes are shown in Table 2. Stroke symptoms were detected upon weaning sedation in the majority of MCS patients (37.1%), and clinical exam was confounded by paralysis or sedation in 82.9%. Over half of MCS patients had peri-procedural strokes, and stroke was detected within 24 hours in 45.8%. Large Vessel Occlusion (LVO) was detected in over half of MCS patients; however, less than a third underwent vessel imaging as part of their initial stroke neuroimaging. Intravenous thrombolysis was contraindicated in all MCS patients. Thrombectomy was performed on 2 MCS patients after ECMO decannulation and was not pursued for most MCS-LVO patients primarily due to large core or completed stroke (Figure 1). Mortality and morbidity were high in the MCS cohort, with 45.5% of MCS patients having an mRS of 5-6 on discharge, compared to 14.4% of non-MCS patients.Conclusions:Pediatric AIS on MCS carries a high risk of morbidity and mortality and can be challenging to recognize acutely, with the post-procedural period being particularly high-risk. Advanced neuroimaging and neuromonitoring may play an important role in earlier detection of stroke and eligibility for thrombectomy in this population.

Stroke, Volume 56, Issue Suppl_1, Page ATMP109-ATMP109, February 1, 2025. Background:The Stroke Preclinical Assessment Network (SPAN), a multi-center network consisting of a coordinating center and testing laboratories, was created to enhance the rigor of preclinical research, including testing of potential therapies in animals of different species, sex, age, and co-morbidities, with blinding and randomization. SPAN evaluated six potential therapies with the goal of identifying one or more efficacious agents to advance toward a clinical trial. Remote ischemic post-conditioning (RIC) was selected as a candidate therapy for testing.Methods:In Stage I, young, healthy mixed-sex mice were randomized into treatment groups by the coordinating center. In Stage II, aged mice, mice with high-fat diet-induced obesity, and spontaneously hypertensive rats were utilized. Each stage included 25% of the study population and efficacy/futility was determined after each stage. RIC was bilaterally administered as the first session occurred immediately after reperfusion, and the second session occurred as close as possible to 12 ± 2 hours at post-MCAo, using an automated blood pressure cuff that delivered 200-mmHg to the hindlimbs for 4 cycles x 5 minutes/cycle and then once per day x 5 days under anesthesia. Sham-conditioned animals were treated with a cuff that did not inflate. The primary outcome measure was a modified corner test on days 7 and 30 post-stroke. MRI was performed at 48 hours and 30 days. Probabilistic index models, which adjusted for covariates of interest, were fit to estimate the probability of a lower corner test index (better outcome) between sham and RIC.Results:A total of 266 mice (132 sham, 134 RIC) were enrolled in the study, with 50 sham and 51 RIC-treated mice dying within 5 days of stroke. Analysis of all data revealed no significant differences in day 30 alternative corner test index between sham and RIC-treated mice after stroke in young, healthy mice (p=0.449), aged mice (p=0.079), mice with diet-induced obesity (p=0.135), or in spontaneously hypertensive rats (p=0.807). The secondary analysis found that RIC improved day 30 tissue infarction volume by MRI in young, healthy mice (p=0.024 vs. sham) but not in other co-morbid conditions.Conclusions:After advancing through Stages I and II, RIC was deemed futile at the end of Stage II, as determined by the modified corner test on day 30. The requirement for repeated daily general anesthesia during RIC administration may have been a complicated factor.

Stroke, Volume 56, Issue Suppl_1, Page ATMP94-ATMP94, February 1, 2025. Introduction:Previous single-center studies have found a higher prevalence of mental health disorders in parents of children with pediatric stroke compared to general population prevalences of 5% with depression and 6% with anxiety. Social determinants of health may influence mental health outcomes. We aimed to measure associations between social determinants of health and parental report of mental health symptoms following their child’s diagnosis of ischemic stroke.Methods:We performed a multicenter, international prospective study through the International Pediatric Stroke Study (IPSS). From 2016 to 2021, parents of children within 3.5 years after arterial ischemic stroke enrolled and completed validated and standardized surveys on anxiety (Beck’s Anxiety Inventory II), depression (Beck’s Depression Inventory), post-traumatic stress disorder (PTSD) (Post-Traumatic Stress Disorder Checklist for DSM-5), severity of their child’s stroke deficits (Recovery and Recurrence Questionnaire), and social determinants of health. For our statistical analysis we employed a linear mixed-effects model, both unadjusted and adjusted.Results:Fifty-two parents (13 fathers, 39 mothers) of 39 children enrolled. Of the 39 children 21 (54%) had perinatal stroke and 18 (46%) had childhood stroke. Median time from stroke diagnosis to parental survey completion was 1.3 years (interquartile range [IQR] 1.0-2.0). On parental surveys, parents scored in the clinical range for: depression in 35% of mothers and 23% of fathers; anxiety in 2% of mothers and 0% of fathers; PTSD in 26% of mothers and 8% of fathers. Lower parental education was significantly associated with higher levels of depression both in our unadjusted (0.02) and adjusted (0.03) models. Interestingly, the child’s functional outcome and parental income were not significantly associated with any parental mental health outcomes.Conclusion:Among social determinants of health, parental education level may be associated with depression in parents of children with pediatric arterial ischemic stroke and needs further exploration. Parents of children with pediatric arterial ischemic stroke had higher rates of depression and PTSD compared to general population estimates. Further research in this area will help facilitate understanding and development of interventions to prevent these mental health outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATMP95-ATMP95, February 1, 2025. Children who suffer arterial ischemic stroke (AIS) while hospitalized are often critically ill and may have distinct acute and chronic risk factors, stroke characteristics and outcomes compared to those with outpatient strokes. We sought to evaluate demographic, clinical and imaging profiles of children with inpatient versus outpatient strokes, and compare mortality between the two groups.Methods:The Stanford Pediatric Stroke Registry retrospectively and prospectively enrolled children with acute AIS who were admitted to our tertiary care pediatric hospital between 2007-2024. For this analysis we included patients who met the following criteria: 1) age 30 days-18 years old; 2) new diagnosis of AIS; 3) acute neuroimaging available for direct review. Inpatient strokes were defined as strokes that occurred while the child was hospitalized, either at our center or at an outside facility prior to transfer. Demographic, clinical and radiographic data were compared using chi-squared or Fishers Exact test for categorical variables and Mann-Whitney U test or t-test for continuous variables. Outcomes were reported using descriptive statistics due to the hypothesis-generating nature of the report.Results:A total of 208 children with acute AIS met inclusion criteria; 99 (47.6%) experienced a stroke while hospitalized. Inpatient stroke patients were overall younger and had higher rates of congenital heart diease and cancer than children with outpatient strokes, while trauma was more common in outpatient strokes (Table 1). There were no significant differences in imaging characteristics between groups. Cardioembolism and periprocedural strokes were more prevalent in inpatient strokes, whereas arteriopathy and cryptogenic stroke were the most common stroke etiologies in outpatients (Table 2). A significantly higher proportion of inpatient stroke patients died compared to outpatient strokes (27.3% vs 3.7%, p

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

Stroke, Volume 56, Issue Suppl_1, Page AWP63-AWP63, February 1, 2025. Introduction:Visual impairments occur frequently in patients with cerebrovascular disease, particularly with carotid artery disease, which contributes to the development of vascular contributions to cognitive impairment and dementias (VCID). However, patients with VCID usually do not realize their vision loss until the postoperative period to improve their arterial circulation. These visual difficulties can be caused by the effects of dementia on the brain or an eye condition. Our study aimed to determine if our mouse model of VCID shows retinal alterations in the eye.Methodology:In our lab, we used the bilateral carotid artery stenosis model (BCAS) in aged mice as a model of VCID. We implanted a 0.16 mm diameter micro-coil in each carotid artery in 17-month-old C57BL/6 mice of both sexes. Mice were maintained for two months until they were used for experiments. Then, mice were tested for open field, elevated plus maze, tail suspension, and fear conditioning. After euthanasia, their eyes were analyzed by immunohistochemistry and electron microscopy.Results:We did not find significant differences in velocity and distance moved in the open field test, nor the elevated plus maze and tail suspension, but we did observe that BCAS significantly reduced the percentage of freezing time, compared with sham mice. Examination of the retina of the experimental mice revealed that BCAS mice showed a significantly reduced (p=0.02) synaptic layer or outer plexiform layer (OPL) area in the outer retina, compared with sham mice. Interestingly, the OPL in the retina of BCAS mice showed a significant reduction of horizontal cell bodies (p=0.023), an increase in the rod (p=0.054) and cone (p=0.033) sprout length, loss of cone terminals (p=0.037) and a reduction of pre- and post-synaptic protein expression (p=0.06), compared with the retina of sham mice.Conclusions:Our study indicates that BCAS mice exhibit cognitive impairment, specifically associated with conditioning memory. However, they do not show anxiety-like behavior. Furthermore, the eyes of BCAS mice show an ectopic distribution of rod and cone synapsis in the retina, which occurs with natural aging and consequently leads to vision loss. Thus, BCAS can exacerbate aging-associated phenotypes in the retina of aged mice. Our study is the first to report vision impairments in aged BCAS mice, which makes it a feasible model to identify the molecular mechanisms that govern visual impairments in VCID patients.

Stroke, Volume 56, Issue Suppl_1, Page ATP190-ATP190, February 1, 2025. Background:The prognostic significance of the affected hemisphere in hemorrhagic stroke remains uncertain. We aimed to determine the relationship between the affected hemisphere (right or left) and differences in non-motor outcomes (pain, mood) in patients with acute intracerebral hemorrhage (ICH). These non-motor outcomes are often overlooked in studies following ICH but impact patient recovery and well-being.Methods:A post-hoc analysis of the MISTIE III study–a randomized, multicenter, placebo-controlled trial of participants with spontaneous, nontraumatic, supratentorial ICH of 30 mL or more that evaluated minimally invasive surgery (MIS) with thrombolysis compared to standard medical care. Prespecified outcomes included modified Rankin scale (mRS) scores, EuroQol Visual Analogue Scale (EQ-VAS), and EQ-5D 3 level version (EQ-5D-3L, composite and individual components) at 30, 180, and 365 days post-ICH. The association of ICH laterality with clinical outcomes was estimated using multiple linear regression models. Prespecified clinical covariates included gender, race (black, white, Asian, other), ethnicity (Hispanic or non-hispanic), premorbid mRS, randomization group (MIS or medical arm), and ICH severity index.Results:A total of 493 participants were eligible for analysis at day 30 post-ICH. In multivariable analyses, patients with a right hemispheric ICH were more likely to report problems with pain and discomfort at days 30 (β=0.257, [0.131, 0.383], p

Stroke, Volume 56, Issue Suppl_1, Page ATMP102-ATMP102, February 1, 2025. Background:Atrial Fibrillation (AF) occurs in about one-fourth of patients with Embolic Stroke of Undetermined Source (ESUS). Accurate prediction of post-stroke AF upon discharge from an index stroke admission informs a personalized post-stroke monitoring strategy of AF and interventions. While clinical risk scores predict AF, machine learning (ML) models have shown superior performance.However, traditional ML approaches only use expert-derived predictors available in an electronic health record (EHR) and thus may miss variables that would potentially increase the accuracy of prediction.Aims:This study aims to enhance AF prediction by augmenting expert-derived predictors with an unbiased selection of full diagnostic codes and medication histories up to index strokes. Through embedding learning with hypergraph neural networks, we generate compact representations of high-dimensional data to improve prediction accuracy by capturing complex feature interactions.Methods:We analyzed data from 510 ESUS patients (55.3% female, mean age 61.4 years) from 2015 to 2023 at Emory Healthcare. We focus on experiments using a logistic regression (LR) model to predict AF from different sets of features. At baseline, we use 58 clinically motivated predictors, including comorbidities characterized by 17 ICD codes manually extracted based on literature, and 41 other features extracted from lab results, echocardiographic and ECG. To directly model the full history of comorbidities and medications, another baseline uses the full 1530 ICD codes plus the 41 other features (1571 in total). In contrast, the embedding method uses the full 1530 ICD codes to generate condensed, informative embedding vectors (32-dimensional), eventually getting 32+41=73 features. To generate the embedding, a hypergraph neural network was trained on a larger stroke cohort (n=7956) to model the interactions between the 1530 ICD codes. A nested cross-validation approach was employed within 5-fold splits, and ROC-AUC scores were recorded.Result:Among 510 ESUS patients, 107 (21.0%) developed AF (mean age 67.9 years, 57% female). We compared the performance of LR model with different features from ICD codes (Table 1). The results show that the learned 32-dim embedding vectors improves the prediction of post-ESUS AF.Conclusion:The embedding technique can significantly enhance predictive performance by integrating comprehensive medical information, maximizing the use of available data for improved outcomes.