Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

This survey study investigates the results of a multi-institutional clinical forensic dermatology training for residents.

Stroke, Volume 56, Issue Suppl_1, Page ATP304-ATP304, February 1, 2025. Introduction:Stroke is a common complication of infective endocarditis (IE), affecting 16–25% of cases, and can be the initial or sole manifestation of the condition. This study aims to analyze annual mortality trends and demographic factors related to stroke in IE patients in the U.S. and Texas from 1999 to 2020, to guide public health initiatives and enhance prevention strategies.Methods:The data was analyzed from the CDC’s WONDER database from 1999 to 2020, focusing on stroke and IE-related mortality (ICD-10 Code I64.0 “Stroke”&Code I33.0 “IE”) in adults aged ≥65 years, annual percent changes (APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex, race/ethnicity, age) subgroups was calculated.Results:The AAMR for stroke-related mortality in IE cases reduced in the US from an adjusted rate (AR) 448.7 in 1999 to 171.6 in 2018 (APC: -8.09%; 95% CI: -9.00% to -6.81%) and then it increased to 183.5 in 2020 (APC: 3.07%; 95% CI: 1.22% to 4.69%). In Texas, AAMR for stroke-associated IE-related mortality overall decreased from AR 485.7 in 1999 to 176.2 in 2020 (APC: -5.23%; 95% CI: -5.50% to -4.96%). Males had higher consistently higher AAMRs than females (196.4 vs. 172). The AAMR in the US men decreased from 468.6 in 1999 to 176.7 in 2018(APC: -7.55%; 95% CI: -8.51% to -6.21%), then it increased to 196.4 in 2020(APC: 4.99%; 95% CI: 2.93% to 6.81%). The AAMR in the US women decreased from 431.5 in 1999 to 165.6 in 2018(APC: -8.25%; 95% CI: -9.15% to -6.97%) after which it increased to 172 in 2020(APC: 1.48%; 95% CI: -0.31% to 3.06 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (278.7), followed by the NH White with an AAMR (179) and the NH American Indian or Alaska Native population with an AAMR (165.4). The low-risk populations were the Hispanic or Latino (143.6) and the NH Asian or Pacific Islander (135.2). AAMR also varied by region (overall AAMR: Midwest: 200.8; South: 193.9; Northeast: 166.2; West: 162.8) and non-metropolitan areas had higher AAMR (non-core areas: 233.4; micropolitan areas: 224.5) than metropolitan areas (large fringe metro areas: 170.5; large central metropolitan areas:160.4).Conclusions:The stroke-related mortality in infective endocarditis cases has overall risen in the United States than in Texas over the past two decades, specifically men and (NH) Black or AA, (NH) White and (NH) American Indian or Alaska Native are at high risk.

Stroke, Volume 56, Issue Suppl_1, Page ATMP84-ATMP84, February 1, 2025. Introduction:Complete reperfusion (TICI 2c/3) with the fewest number of passes remains the target for EVT techniques, but at present, rates remain relatively low. Prior studies have demonstrated that switching techniques between passes may improve rates of reperfusion. Here we assess the efficacy of technique switching after the first pass failed reperfusion in a large multi-center cohort.Methods:All consecutive patients treated with EVT from 12 centers across the US were prospectively collected between 10/2018 – 12/2021 (SVIN Registry). Patients were included if they underwent EVT for occlusion of the M1 or ICA-T. Exclusion criteria included incomplete data. EVT technique was categorized as Stent-Retriever (SR), Contact Aspiration (CA), or a Combined Technique (CT). The primary outcome was the likelihood of achieving TICI 2c/3 with or without switching the thrombectomy technique and was determined using multivariable logistic regression adjusted for the use of balloon guide catheter, occlusion location, age, and co-morbid medical conditions.Results:Among 2,891 patients in the SVIN registry included in this analysis, the median age was 69 years [IQR, 58-80], 49.9% were female and median NIHSS was 17 [IQR, 12-22]. Occlusion location was ICA-T in 18.4% and M1 in 81.6%. As shown in Figure 1a, for patients with ICA-T occlusions, first-pass TICI 2c/3 occurred in 32.7% with SR, 23% with CA, and 31.2% with CT. As shown in Figure 1b, for patients with M1 occlusions, first-pass TICI 2c/3 occurred in 37.7% with SR, 35.9% with CA, and 35.4% with CT. Switching from CA to SR or CT for the 2nd pass was associated with increased point estimates of 2nd pass TICI 2c/3 for patients with ICA-T occlusions (27% vs 12%, second pass SR vs. second pass CA, p=0.06). In multivariable logistic regression, odds of TICI 2c/3 were significantly greater (OR 3.7, CI 95% [1.1 – 12.4]) after switching to SR or CT after a failed first pass with CA in patients with ICA-T occlusion.Conclusions:Switching from CA to SR-based techniques was associated with improvement in TICI 2c/3 reperfusion rates among patients with Internal Carotid Artery Terminus occlusions.

Stroke, Volume 56, Issue Suppl_1, Page ATMP69-ATMP69, February 1, 2025. Introduction:Cerebral Amyloid Angiopathy (CAA) is caused by the progressive deposition of β-amyloid in the walls of small to medium-sized cerebral vessels. Although seizures represent a debilitating manifestation of CAA, little is known about their prevalence or associated factors. We aim to fill this gap by determining the prevalence of seizures in CAA and identify factors associated with an increased risk of seizures.Methods:We identified consecutive patients with CAA, evaluated within the Mayo Clinic health system between January 2010 and December 2023 using the ICD-10 code. Data on demographics and comorbidities were compared between those with and without seizures using the chi-square test for categorical variables and independent samples t-test for continuous variables. Odds ratios (OR) were estimated after adjusting for age, sex, and race in multivariable logistic regression.Results:We included 1,914 patients with CAA with a mean age of 75.4 ± 8.6 years, of whom 52.3% were female and 87.5% were white. Seizures were observed in 347 patients (18.1%). Individuals with seizures were significantly younger (mean age 67.7 ± 9.1 vs. 77.2 ± 7.5 years, p < 0.001). Multivariable modeling identified alcohol abuse (OR 1.92, 95% CI 1.03-3.56, p=0.04), diabetes mellitus (OR 2.14, 95% CI 1.13-4.06, p=0.02), hypertension (OR 1.79, 95% CI 1.33 - 2.41, p=

Stroke, Volume 56, Issue Suppl_1, Page A22-A22, February 1, 2025. Introduction:Though clinical practice guidelines support high repetitions of walking after stroke, practice is slow to change with low levels of walking activity in stroke rehabilitation units. We undertook an implementation trial to change practice; we enabled entire stroke units to use the Walk ‘n Watch protocol and determined the effect of implementation on the 6 Minute Walk Test (6MWT) at hospital discharge.Methods:This 12-site clinical trial across 7 Canadian provinces used a stepped-wedge cluster design to randomize when each site switched from Usual Care to the Walk ‘n Watch protocol. At the start of the Walk ‘n Watch phase, we trained all front-line physical therapists on the unit with training workshops, manuals, hands-on practice, and videos. Each site was provided onboarding materials to address staff changes so therapists who did not attend the initial training could adopt the protocol. Each site also identified a ‘protocol champion’ to facilitate initial weekly huddles with therapists to discuss barriers to implementation. Therapists were trained to complete safety screening and to determine eligibility. The Walk ‘n Watch protocol focused on completing a minimum of 30-minutes of daily weight-bearing, walking-related activities that progressively increased in intensity informed by activity trackers measuring heart rate and step number. Blinded assessors completed the outcomes at baseline and 4-weeks later (near discharge). Primary analysis used a linear mixed-effects model adjusted for stratum, date of enrollment, age, sex and baseline 6MWT.Results:The total number of participants was 306 (162 Usual Care, 144 Walk ‘n Watch, 188 males/118 females) with a mean(SD) age of 68(13), 29(17) days since stroke, and a baseline 6MWT of 152(106) m. The improvement on the 6MWT was 43.6m (95%CI 12.7, 76.1) greater in the Walk ‘n Watch group compared to the Usual Care group. Further, the Walk ‘n Watch group improved quality of life (EQ5D), balance and mobility (Short Physical Performance Battery) and gait speed.Conclusions:The implementation trial design enabled the protocol to be tested under real-world conditions, involving all therapists on each unit to deliver the protocol. The trial had a deliberate aim to facilitate changes in practice that resulted in clinically meaningful improvements in walking and quality of life.

Stroke, Volume 56, Issue Suppl_1, Page ATP163-ATP163, February 1, 2025. Introduction:Imaging features are increasingly relevant for predicting response to endovascular treatment in acute ischemic stroke (AIS) patients. Collateral status is a well-documented marker of reperfusion and mortality in patients with large vessel occlusion (LVO) anterior circulation strokes, which account for approximately one-third of AIS. There is ongoing investigation into optimal collateral status determination, with single and multiphase computed tomography angiography (mCTA) and CT perfusion parameters under consideration. To assess the utility of these parameters, we evaluated their association with the American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score standard on digital subtraction angiography (DSA).Methods:We retrospectively evaluated AIS patients treated at our institution between January 2017 and January 2023. Inclusion criteria were: (i) CTA-confirmed anterior circulation LVO; (ii) diagnostic CT perfusion was performed; (iii) mechanical thrombectomy was attempted with documented DSA collateral score. Modified Treatment in Cerebral Ischemia (mTICI) score was used to determine reperfusion status, with mTICI > 2b considered successful. Univariate and multivariate logistic regression analyses were conducted to determine associations of demographic/clinical factors and collateral status with ASITN and reperfusion status.Results:A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) met inclusion criteria. On univariate analysis, PM2 occlusion site (p=9.78E-7), Alberta Stroke Programme Early CT Score (p=0.006), mCTA (p=1.82E-10), cortical vein opacification score (p=4.18E-7), and clot burden score (CBS, p=3.01E-13) were associated with ASITN score of three or greater, signifying complete collateral flow. On multivariate regression adjusted for race, occlusion site, radiologic features, and admission NIH stroke score, PM2 occlusion site (aOR 1.19, p=0.049), mCTA (aOR 3.59, p=6.03E-5), and CBS (aOR 1.37, p=0.03) were associated with ASITN ≥ 3 (Table 1). No radiologic features were associated with successful reperfusion (Table 2).Conclusion:Multiphase CTA and clot burden score show a stronger association with favorable DSA collateral scores than do CT perfusion parameters, including cerebral blood volume and hypoperfusion intensity ratio. Further studies are needed to evaluate these measures in outcome prediction to aid clinical decision-making for AIS patients with anterior circulation LVOs.

Stroke, Volume 56, Issue Suppl_1, Page ATP142-ATP142, February 1, 2025. Introduction:Coronary atherosclerotic disease (CAD) carries the highest risk of recurrent stroke, up to 15% annually, and individuals with coronary heart disease are twice as likely to have a stroke. This study aims to analyze annual mortality trends and sociodemographic factors related to stroke in CAD patients in the U.S. and Texas from 1999 to 2020, to inform public health policies.Methods:Using the CDC’s WONDER database from 1999 to 2020, focusing on stroke and CAD-related mortality(ICD-10 code I64.0 “Stroke”&Code I25.1 “Atherosclerotic heart disease ”) in adults aged ≥45 years, annual percent changes(APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex, race/ethnicity, age) subgroups were calculated.Results:The AAMR for stroke-related mortality in CAD cases reduced in the US from an adjusted rate(AR) 174.5 in 1999 to 105.2 in 2009(APC: 5.48%; 95% CI: -6.09% to -5.24%) after which it reduced further to 69.4 in 2018(APC: -7.87%; 95% CI: -8.77% to -6.53%) then it increased to 75.9 in 2020(APC: 4.38%; 95% CI: 2.63% to 5.88%). In Texas, AAMR for stroke-associated CAD-related mortality overall decreased from AR 189.7 in 1999 to 73.5 in 2020(APC: -4.96%; 95% CI: -5.27% to -4.66%). Males had higher consistently higher AAMRs than females (83 vs. 69.5). The AAMR in the US men decreased from 183.7 in 1999 to 72.9 in 2018(APC: -7.23%; 95% CI: -8.22% to -5.92%), then it increased to 83 in 2020(APC: 6.40%; 95% CI: 4.31% to 8.19%). The AAMR in the US women decreased from 166.3 in 1999 to 65.7 in 2018(APC: -7.89%; 95% CI: -8.79% to -6.63%) after which it increased to 69.5 in 2020(APC: 2.38%; 95% CI: 0.49% to 4.06 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (122), followed by the NH American Indian or Alaska Native with an AAMR (76.8) and the NH White population with an AAMR (72.9). The low-risk populations were the Hispanic or Latino (58.8) and the NH Asian or Pacific Islander (54.2). AAMR also varied by region (overall AAMR: Midwest: 82.1; South:82; Northeast:67.1; West:66.4)&non-metropolitan areas had higher AAMR (non-core areas:98.5; micropolitan areas:94) than metropolitan areas (large fringe areas:69.3; large central metropolitan areas:66.7).Conclusions:The stroke-related mortality in CAD cases has overall risen in the US compared to Texas over the past two decades, specifically men and (NH) Black or AA, (NH) American Indian or Alaska Native and (NH) White are at high risk.

Stroke, Volume 56, Issue Suppl_1, Page ATP389-ATP389, February 1, 2025. Background:The variations in stroke volume are large and behavioral deficits are short-lived in rodent stroke models. These issues pose a challenge when using a rodent stroke model to test therapeutic interventions. The objective of this study is to explore composite analysis of multi-category behavioral outcomes for increasing the drug testing utility of the mouse middle cerebral artery occlusion (MCAO) model.Methods:Mice were subjected to 0 (sham), 20, 40, and 60 min MCAO, followed by 21 days of recovery. The rCBF was maintained at

Stroke, Volume 56, Issue Suppl_1, Page AWMP59-AWMP59, February 1, 2025. Background and Purpose:External counterpulsation (ECP) is a novel noninvasive method used to improve the perfusion of vital organs, which may benefit ischemic stroke patients. We aimed to test the hypothesis that ECP may improve disability in addition to best medical treatment in atherosclerotic stroke patients within 7 days of symptom onset.Methods:The trial was a multi-centre, randomized, controlled trial. Patients with cerebral large artery occlusive disease were randomized to 35 one-hour sessions of ECP group or no-ECP control group, in addition to best available evidence-based medical and rehabilitation treatment. Primary outcome was modified Rankin scale (mRS) grade at month 3, defined as a good outcome with a mRS≦2. Secondary outcomes were the scores of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI), stroke recurrence, overall mortality and the occurrence of vascular events by 3 months (recurrent stroke, acute coronary syndrome, deep vein thrombosis and hemorrhagic transformation or intracerebral hemorrhage).Results:In the randomized 189 patients from three hospitals, totally 5 patients were lost to follow-up at month 3. Therefore, 184 patients (97.4%) with moderate neurological deficit (mean NIHSS, 8.2) were included into the intention-to-treat analysis (90 ones in ECP group and 94 ones in No-ECP group, respectively). The groups were balanced in all demographic data. At month 3, there were no significant differences in the proportion of patients with good outcome (ECP 42.2% vs no-ECP 35.1%, P=0.322) and the secondary outcomes, except the incidence of vascular events with a favorable trend (ECP 3.3% vs no-ECP 8.5%, P=0.139). After adjusting for the factors not complying with trail design, a significant lower incidence of vascular events was found in 0.0% of 65 patients in ECP group compared to 9.1% of 88 patients in no-ECP group (P=0.021) at month 3 in per-protocol analysis.Conclusion:ECP did not statistically significantly improve disability in atherosclerotic stroke within 7 days of symptom onset in the RCT trial. However, per-protocol analysis showed that completion of total 35 one-hour sessions of ECP treatment is beneficial for reducing the incidence of new vascular events in atherosclerotic stroke after 3 months of onset.Registration number: ChiCTR-TRC-07000706

Stroke, Volume 56, Issue Suppl_1, Page AWP331-AWP331, February 1, 2025. Introduction:Stroke is the second leading cause of death worldwide,around 50,000 U.S. residents with valvular heart disease experiencing a stroke annually. This study examines trends in stroke-related mortality due to mitral valve disorders (MVD) in the U.S. from 1999 to 2020, with a focus on demographic factors and racial disparities. The goal is to inform public health strategies and improve prevention and treatment efforts.Methods:We analyzed death certificate data from the CDC’s WONDER database from 1999 to 2020, focusing on stroke and MVD-related mortality (ICD-10 code I64.0 “Stroke” and Code I34.0 “MVD”) in adults aged ≥25 years. Using joint point regression analysis, we calculated annual percent changes (APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex,race/ethnicity,age) subgroups.Results:The AAMR for stroke due to MVD-related mortality decreased in the US from an adjusted rate (AR) 98.6 in 1999 to 92.9 in 2001 (APC: -2.64%; 95% CI: -4.18% to -1.35%),after which it decreased to 59.6 in 2009 (APC: -5.47%; 95% CI: -6.20% to -5.19%) then it further reduced to 50.1 in 2015 (APC: -2.84%; 95% CI: -3.27% to -1.78%).The AAMR decreased in 2018 to 40.2 (APC: -7.28%; 95% CI: -8.08% to -6.22%) after which it increased to 43.9 in 2020 (APC: 4.15%; 95% CI: 2.56% to 5.59%). Males had higher consistently higher AAMRs than females (47.8 vs. 40.3).The AAMR in the US men decreased from 103.6 in 1999 to 51.5 in 2015 (APC: -2.62%; 95% CI: -3.04% to -1.49%) after which it decreased further to 42.2 in 2018 (APC: -6.75%; 95% CI: -7.72% to -5.48%)&then it increased to 47.8 in 2020 (APC: 6.11%; 95% CI: 4.10% to 7.85%).The AAMR in the US women decreased from 94.1 in 1999 to 48.3 in 2015 (APC: -3.05%; 95% CI: -3.51% to -1.75%) after which it decreased further to 38.2 in 2018 (APC: -7.57%; 95% CI: -8.81% to -6.18%) and then it increased to 40.3 in 2020 (APC: 2.32%; 95% CI: -0.26% to 4.49%).The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (69.2), followed by the NH American Indian or Alaska Native with an AAMR (44.2) and the NH White population with an AAMR (42.4).The low-risk populations were the Hispanic or Latino (33.6) and the NH Asian or Pacific Islander(31).Conclusions:The mortality rates from stroke due to MVD have overall increased in the United States over the past two decades, specifically men&(NH) Black or AA, NH American Indian or Alaska Native, and (NH) White are at high risk.

Stroke, Volume 56, Issue Suppl_1, Page AWP133-AWP133, February 1, 2025. Background:Ischemic thalamic stroke often leads to cognitive and emotional dysfunctions, yet the link between these deficits and structural brain changes remains unclear. This study explores the association between gray matter volume alterations and neuropsychological assessments in ischemic thalamic stroke patients, aiming to elucidate the structural basis of neuropsychiatric deficits.Methods:Patients with first-time unilateral ischemic thalamic stroke were recruited from West China Hospital, Sichuan University (October 2021 – December 2023). Inclusion criteria included MRI-confirmed diagnosis, subacute phase (7 days to 1 month), completion of cognitive and structural MRI evaluations, and informed consent. MRI scans were processed using CAT12 and SPM12. Cognitive assessments included MoCA-BJ, STT, Stroop, and CAVLT tests; psychological status was evaluated using HAMA and HAMD scales. Partial Least Squares (PLS) regression analyzed the relationship between gray matter volume (170 ROIs) and neuropsychological scores (11 indicators). Data were standardized, with the optimal number of components determined by MSE using 5-fold cross-validation. Model performance was assessed using R2.Results:PLS regression revealed significant associations between gray matter volume and neuropsychological outcomes. The optimal number of components was determined to be two through 5-fold cross-validation, with the model showing good fit as indicated by the R2 and residual plots. Specific brain regions, including the Left Inferior Parietal Gyrus (lIPG), Right Cerebellar Lobule VI (rCER6), and Right Cerebellar Crus I (rCERCRU1), were significantly associated with cognitive and emotional assessment scores. VIP scores and loading matrix analyses highlighted these regions as key areas.Conclusions:This study, using PLS regression, identifies significant relationships between gray matter volume changes and neuropsychological assessments in ischemic thalamic stroke patients. Key regions such as lIPG, rCER6, and rCERCRU1 are closely linked to cognitive and emotional functions, including attention, spatial cognition, memory, and emotional regulation. These findings provide critical insights into the structural basis of neuropsychiatric deficits post-stroke and support the development of personalized rehabilitation strategies. Future research should validate these regions’ roles across rehabilitation stages and explore targeted interventions.

Stroke, Volume 56, Issue Suppl_1, Page ATP273-ATP273, February 1, 2025. Introduction:Patients suffering from transient ischemic attack (TIA) are at high risk of ischemic stroke (IS). This study describes clinical characteristics and outcomes in patients with a first non-cardioembolic TIA.Methods:Using two US administrative claims databases (MarketScan and Optum’s de-identified Clinformatics® Data Mart Database [CDM]) converted to the Observational Medical Outcomes Partnership (OMOP) common data model, we conducted an observational, retrospective cohort study of adults with a first diagnosis of non-cardioembolic TIA between 2012 and 2022. Demographic and clinical characteristics were described at baseline, and incidence rates of IS, intracranial bleeding, and bleeding leading to hospitalization with sensitivity analyses at different time points were calculated.Results:Overall, 203,757 patients were included in the study, 97,481 from MarketScan, 106,276 from CDM. Mean age was 62 years in MarketScan and 72 years in CDM. Patients were mostly women (57.6% in MarketScan, 59.3% in CDM). At baseline, prevalence of comorbidities was high (hypertension 66% and 84%, hyperlipidemia 53% and 75%, coronary artery disease 18% and 31%, diabetes 25% and 38% in MarketScan and CDM, respectively). Median follow-up time was 569 days in MarketScan and 716 days in CDM. At 1 year follow-up, incidence rates per 100 person-years of IS, intracranial bleeding, and bleeding leading to hospitalization were 10.9, 0.9, and 4.2, respectively, in MarketScan and 20.2, 1.6, and 7.6 respectively, in CDM. Sensitivity analyses showed that most IS events occurred within 7 days of the index event. Additional event rates and sensitivity analyses are shown in Table 1.Conclusion:Results from two US claims databases show that the annual risk of IS is higher than expected following a first TIA diagnosis, especially when including the first 7 days in the ascertainment. Implementation of guideline directed antiplatelet therapies, or new antithrombotic strategies, is needed.

Stroke, Volume 56, Issue Suppl_1, Page ATP239-ATP239, February 1, 2025. Background:There are limited therapy options in case of failed reperfusion after stent-retriever and/or aspiration based endovascular treatment (EVT) for acute ischemic stroke. Despite the absence of data supporting its use, rescue angioplasty (RA; with or without stent implantation) is often utilized in such cases. Studies are limited to large vessel occlusions, while the outcomes and complications after RA in medium/distal vessel occlusions (MDVOs) have not been reported. This study aims to report the outcomes of RA in MDVO stroke patients.Methods:We performed a retrospective sub-analysis of the “Blood pressure and Antiplatelet medication management after reScue angioplasty after failed Endovascular treatment in Large and distal vessel occlusions with probable IntraCranial Atherosclerotic Disease” (BASEL ICAD) registry. All MDVO stroke patients were included in the analysis.Results:Out of 718 patients, 92 (12.8%) presented with an MDVO. Sixty-one patients (65.9%) presented with an occlusion of the M2 segment of the middle cerebral artery. Rescue stenting (RS) was performed in 83 patients (90.2%) and balloon angioplasty alone was performed in 9 patients (9.8%). Successful reperfusion (modified thrombolysis in cerebral infarction (mTICI) score ≥ 2b) before RA was achieved in 34 patients (36.9%) and after RA in 76 (82.6%) patients. Symptomatic intracranial hemorrhage (sICH) occurred in 8 patients (9.1%) and post-treatment stent occlusion in 14 patients (16.7%). 90 days mortality was 24.1%. Twenty-nine patients (34.9%) achieved functional independence at 90 days (modified Rankin Scale 0 – 2).Conclusion:Rescue Angioplasty might be a viable treatment option in case of failed reperfusion after conventional EVT in selected MDVO patients. However, safety concerns remain.

Stroke, Volume 56, Issue Suppl_1, Page A137-A137, February 1, 2025. Introduction:Stroke is the fifth leading cause of death and long-term disability in the United States with an estimated prevalence of 7 million individuals affected as of 2019. Protocols for stroke management established by the American Heart Association (AHA) and American Stroke Association (ASA) include a 25-minute timeframe from door to CT time (DTCT). Adapting to challenges during the COVID-19 pandemic likely increased the DTCT in acute stroke patients from various sociodemographic backgrounds.Methods:We aimed to identify factors affecting the DTCT time for a cohort of over 23,000 patients between January 2018 and August 2022. The primary endpoint was DTCT ≤25 minutes upon arrival to hospital for all patients suspected of acute ischemic stroke. Race and ethnicity were self-reported.Results:We have identified patient race and post-COVID timing of care as two factors with statistically significant effects on DTCT time. 4,468 patients (19.1%) had DTCT times less than or equals to 25 minutes, and 16,464 patients (70.5%) had DTCT times more than 25 minutes. Patients in the pre-COVID, COVID, and post-COVID phases were 6,852 (29.3%), 13,593 (58.2%) and 2,919 (12.5%), respectively. In our cohort, Black (OR 1.35; 95% CI 1.23-1.49) and Asian patients (OR 1.33; 95% CI 1.01-1.74) were more likely to have DTCT >25 minutes compared to White patients. Hispanic patients (OR 1.20; 95% C1 1.07-1.34) were more likely to have DTCT >25 minutes compared to non-Hispanics. Patients presenting during COVID (OR 1.45; 95% CI 1.34-1.57) and post-COVID period (OR 1.46; 95% CI 1.30-1.65) were more likely to have DTCT >25 minutes compared to the pre-COVID period.Conclusion:Therefore, we demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population. We also observed an increase in DTCT time after the start of COVID-19 which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time. Identifying disparities can help address inequities and ensure that all patients, regardless of background, receive timely care.

Stroke, Volume 56, Issue Suppl_1, Page A143-A143, February 1, 2025. Introduction:Clinical trials of acute stroke are often conducted at Comprehensive Stroke Centers (CSC). Limiting enrollment to CSCs can result in slower recruitment, diminished enrollment diversity, and decreased dwell time for recanalization medications. We report the impact of remote telemedicine (TM)-based enrollment at Acute Stroke Ready and Primary Stroke Centers (Non-CSC) in the TIMELESS and FASTEST trials.Methods:Both trials were conducted in 2 large health systems with CSC and spoke Non-CSC. Non-CSCs were enabled via video-based TM to remotely screen, consent, randomize and administer study drug locally with a possible transfer to CSC. Follow ups were conducted in person, over the phone or via video TM. Data were retrospectively gathered from the TIMELESS (entire study period) and FASTEST (August 1, 2023-March 31, 2024) studies. Baseline demographics, clinical trial enrollment time metrics, adverse events, missed follow ups and protocol deviations and violations were collected. Data were analyzed with Chi-Square and Kruskall-Wallis.Results:96 patients were enrolled: 75 in TIMELESS and 21 in FASTEST. Twenty-three (24%) were enrolled at Non-CSC:19 (82.6%) in TIMELESS and 4 (17.4%) in FASTEST. There were no differences between CSC vs. Non-CSC enrollments in age, gender, door to consent, door to randomization, door to study drug order placement, door to study drug administration, major adverse events, death at 90 days, protocol violations and missed follow up visits. There was higher racial diversity at Non-CSC enrollments: 30.4% Asian and 17.4% Black vs. CSC: 5.5% Asian and 11.0% Black (p=0.022). There were more protocol deviations identified at the CSC (45.2%) vs. Non-CSC (17.4%) p=0.02. Patients enrolled in TIMELESS at a Non-CSC had a longer median drug dwell time before thrombectomy: 52.0 mins (IQR 35.0-69.0) vs CSC: 9.5 mins (IQR 1.5-26.0) p

Stroke, Volume 56, Issue Suppl_1, Page ATP268-ATP268, February 1, 2025. Introduction:Xylitol, a sugar alcohol with a global market estimated at 161,500 metric tons, has been linked to increased thrombosis and risk of stroke and heart attack. Older adults with obesity and metabolic syndrome may have decreased elimination of the xylitol metabolite xylose, which may explain the higher observed risk of thrombosis and stroke in older adults who consume foods with sugar alcohols. MicroRNAs (miRs) have been associated with thrombosis and the blood clotting cascade and can provide additional insight about pathogenesis or biomarkers to help establish safe dietary intake guidelines. However, multiomics studies of both xylitol metabolites and these miRs in humans have not been done. This study aims to measure these associations in a sample of adults with obesity and metabolic syndrome.Methods:We analyzed data from a subset ofN=70 obese adults with metabolic syndrome who had both baseline metabolome and miR data from the PRYSMS randomized controlled trial. Pearson’s correlations were used to test associations between xylitol, xylose, and 20 miRs associated with thrombosis and the clotting cascade, using the false discovery rate method to adjust for multiple comparisons.Results:Participants were 55 ± 6 years (range 32-65) and 24% male. The mean BMI was 35.2 ± 7.4 kg/m2, HbA1c was 5.9% ± 0.4, fasting blood glucose was 103 ± 13 mg/dL, HDL cholesterol was 49 ± 10 mg/dL, and triglycerides were 173 ± 63 mg/dL. Xylose concentrations were inversely correlated with six miRs (miR-15b, miR-151a-3p, miR-151a-5p, miR-151b, miR-24-3p, and miR-27a-3p). Relevant target proteins of these miRs may include Factor XI (F11), Fibrinogen Alpha (F1 or FGG_A), Coagulation Factor VIII (F8), Von Wilebrand Factor (VWF), and Toxoplasma gondii (TFP1).Conclusion:Our findings demonstrate an inverse association between xylose levels and six miRs associated with thrombosis and the clotting cascade in adults with obesity and metabolic syndrome. Xylitol metabolite concentration was not associated with any miRs in our sample, suggesting that circulating xylose may be a better indicator of clotting risk. Dietary intake of xylitol-containing foods may provide additional detail about these associations. Future research should explore multiomics relationships to refine and validate these results, to provide a more complex understanding of the biological processes involved for people at risk of T2D and stroke, and to help establish safe guidelines for dietary xylitol intake.