Risultati per: Sindromi coronariche acute

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

Stroke, Volume 56, Issue Suppl_1, Page ATMP81-ATMP81, February 1, 2025. Introduction:Using oral anticoagulation (OAC) at baseline is hypothesized to increase the risk of hemorrhagic transformation after endovascular thrombectomy (EVT). However, several prior studies evaluating EVT in patients on OAC demonstrated conflicting results regarding functional and safety outcomes. We aimed to characterize the association between baseline use of OAC and EVT outcomes from SELECT, a multicenter, prospective cohort study.Methods:From SELECT study, patients with acute ischemic stroke and large vessel occlusion within 24 hours from onset who received EVT were identified. Patients were stratified based on baseline OAC use, and their clinical and imaging characteristics and functional and safety outcomes were described and compared.Results:Forty-three (15%) out of 285 patients used OAC at baseline, 29 (10%) were on vitamin K antagonists (VKA), and 14 (5%) were on direct oral anticoagulants (DOAC). OAC users were older (median age 75 years old vs 65) and had higher comorbidities – hypertension (88.4% vs 71.3%), diabetes mellitus (41.9% vs 25.7%), atrial fibrillation (64.3% vs 28.2%), and congestive heart failure (23.8% vs 9.6%), had smaller ischemic core volume at baseline (median [IQR]: 0cc [0-12] vs 11cc [0-32][SS1] ), and received alteplase less often (46.5% vs 69.0%, P 0.05 for both; table 2).Conclusion:Almost 1 in 7 patients receiving EVT had baseline use of OACs, with higher comorbidities. OAC use at baseline was not associated with poor functional outcomes. We also did not observe symptomatic intracranial hemorrhage among EVT patients with baseline OAC use, suggesting limited safety concerns due to hemorrhagic transformation. There was no difference in outcome between VKA users and DOAC users.

Stroke, Volume 56, Issue Suppl_1, Page ATMP60-ATMP60, February 1, 2025. Background:Identifying optimal candidates for endovascular treatment (EVT) remains an ongoing priority to maximize treatment efficacy. The recent large core trials have called into question the use of infarct volume alone for selecting patients. This study aimed at exploring the feasibility of using routinely acquired Computed Tomography Perfusion (CTP) to capture how lesion location impacts brain connectivity and how this in turn affects the ability to benefit from EVT.Methods:Consecutive patients from a multi-centric stroke imaging registry were included in this study if they had a proven anterior circulation large vessel occlusion (LVO) and available baseline CTP data. Hypoperfusion (Tmax >6 seconds) and ischemic core (relative cerebral blood flow

Stroke, Volume 56, Issue Suppl_1, Page ATP122-ATP122, February 1, 2025. Background:Classification of etiologic ischemic stroke subtype guides post-stroke care and secondary prevention. Etiologic ischemic stroke subtypes are often not clearly documented in post-stroke care plans especially when transferring from one facility to another. In 2021, AHA/ASA published updated secondary stroke prevention guidelines recommending identifying etiologic ischemic stroke subtypes when possible. The impact of this on post-stroke care is unknown.Methods:Charts of all patients ages 18 and up, admitted from 1/1/20 to 5/23/21 and from 1/1/22 to 5/23/23 to 3 long-term acute care (LTAC) facilities, on antiplatelet therapy, and with an ascertainable history of stroke within 90 days of admission, were retrospectively reviewed to assess for documentation of ischemic stroke subtype at discharge/transfer to an LTAC facility and to assess for appropriateness of secondary stroke prevention therapies. Care plans from those two time periods were compared to assess for any impact the 2021 guidelines may have had on discharge practices.Results:Subtypes were not defined for the majority of ischemic strokes. Classification by etiologic subtype was observed in 33% of cases. Classification by territory or location was more common (Fig. 1). One-quarter of patients were on dual antiplatelet therapy (DAPT) and 75% of patients were on single antiplatelet therapy (SAPT) with more patients on DAPT in the latter time period (Fig. 2A). Rationale for DAPT were not provided for the majority of patients and NIHSS and ABCD2 scored were also not commonly provided for patients on DAPT (Fig. 2B). Close to 90% of patients were treated with antihypertensives and statin therapy at discharge to LTAC; 71% of patients were treated with diabetic therapies at discharge; stroke education at discharge to LTAC was documented for 43% of patients; and LDL was documented in 56% of patients (Fig. 3).Conclusions:Etiologic ischemic stroke subtypes were not documented for the majority of patients transferred to LTACs. Despite recent guideline revisions, an increase in documentation of stroke subtype was not observed. Optimal secondary stroke prevention strategies were difficult to assess without this information including appropriate antiplatelet regimens. Our findings highlight the importance of the need to improve post-stroke care plans at discharge and transfer including documentation of etiologic ischemic stroke subtypes to facilitate optimal post-stroke care across all transitions.

Stroke, Volume 56, Issue Suppl_1, Page ATP333-ATP333, February 1, 2025. Introduction:Diabetes Mellitus (DM) is a significant risk factor for acute ischemic stroke (AIS) and the incidence of newly diagnosed DM in AIS is higher in certain ethnicities. We aim to examine prescribing patterns of anti-hyperglycemic medications (anti-DM) in hospitalized AIS patients with newly diagnosed with DM. We also examine ethnic disparities in prescribing patterns amongst Hispanic and Non-Hispanic patients.Methods:We retrospectively examined prospectively collected data from an IRB-approved stroke registry at two academic Comprehensive Stroke Centers (CSCs). We included patients with a new diagnosis of AIS with no documented history of DM between 1/1/2013 and 6/30/2024. We examined baseline demographics, comorbidities, ethnicity, insurance status, acute stroke treatment, NIHSS, A1c, blood glucose and their association with anti-DM prescribing patterns. We also evaluated prescribing differences in Hispanic versus Non-Hispanic groups. Data was analyzed using correlation matrix, Pearson’s and Spearman’s correlation coefficients, and Chi-squared and t test, as appropriate.Results:A total of 2870 AIS patients were identified in the study period. Of these, 20.1% (n=578) were Hispanic, 42.5% (n=1219) were female, and 47.8% (n=1373) had Medicare as their payment source. New diagnosis of DM occurred in 6.0% (n=52/863), and 52.0% (n=27) were prescribed anti-DM at discharge. Overall, only a history of previous stroke was independently associated with prescribing anti-DM on discharge (p=0.03). Of patients with new DM, Hgb A1c (p=0.01) and blood glucose (p=0.006) were significantly associated with prescribing anti-DM on discharge. Patients with Medicaid (p=0.04) and no previous medical history (p=0.02) were less likely to receive anti-DM. Mean Hgb A1c was higher in patients that were prescribed anti-DM vs not prescribed anti-DM (8.82 vs. 7.13; p=0.007, 95% CI: -2.87 to -0.52). There was no difference in prescribing anti-DM in Hispanic vs. Non-Hispanic groups.Conclusions:In this study at two academic CSCs, there was no significant difference in prescribing anti-DM medications in Hispanic vs. Non-Hispanic groups, but insurance status may be associated with prescribing patterns. The provision of systematic care helped reduce healthcare disparity in AIS patients with newly diagnosed DM.

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

Stroke, Volume 56, Issue Suppl_1, Page ATP123-ATP123, February 1, 2025. Background:Around one in three strokes are experienced by people living with disability or dementia (PLWD), yet there is currently no consensus to guide physicians in evaluating baseline status in this patient population and determining goals of care. We sought to understand how physicians currently approach this complex issue and what challenges they encounter as a critical step towards informing evidence-based best practices for PLWD.Methods:Through separate recruitment strategies, we invited physicians involved in stroke care to participate in semi-structured, in-depth interviews and an online survey, inquiring into perspectives on evaluation and management of PLWD. Interviews were recorded, transcribed, and analyzed applying an interpretive grounded theory approach, using constant comparison throughout the coding process to establish themes and subthemes. Results were triangulated with findings from a descriptive analysis of survey responses.Results:Twenty-eight physicians participated in interviews, while 134 provided survey data, representing 17 countries and 10 medical specialties. Among factors most frequently rated as extremely important in stroke care decision-making (by ≥40% of respondents) were severity of pre-existing dementia/disability and baseline quality of life. Concurrently, interviews highlighted considerable challenges in assessing these factors given time constraints in the acute setting and crudeness of popular screening measures, which fail to capture relevant nuances in patients’ baseline status. Participants further spoke to uncertainties in determining goals of care that align with patients’ best interest. Here, emphasis was placed on the inappropriateness of a mainstream conceptualization of a favorable outcome as maintaining independence, and the need to consider variability in personal and cultural values, support networks, and the broader socioeconomic context. In navigating the complexities of patient-centric care for PLWD who are often unable to voice their wishes, family input and advanced care directives were identified as key facilitators.Conclusions:This mixed-methods study highlights the need for creating evidence-based, tailored strategies for assessing pre-stroke status and defining favourable outcomes for PLWD. Achieving these goals relies on future research co-production with PLWD and their families, ensuring integration of patient priorities and appropriate operationalization of relevant post-stroke outcomes.

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

Stroke, Volume 56, Issue Suppl_1, Page ATMP73-ATMP73, February 1, 2025. Background:The therapeutic time window of endovascular therapy (EVT) for acute ischemic stroke (AIS) has been expanded up to 24 hours of onset. Patients with AIS beyond 24 hours may also benefit from EVT, but the actual status of this clinical issue is unknown.Purpose:To evaluate the real-world status of EVT for AIS beyond 24 hours of onset using a nation-wide stroke registry, Japan Stroke Data Bank (JSDB). JSDB is an ongoing hospital-based multicenter prospective registry of hospitalized patients with acute stroke or transient ischemic attack within 7 days of onset.Methods:From the JSDB dataset, patients with AIS who underwent EVT from 1996 through 2021 were analyzed. Patients were divided into 3 groups according to time from onset to hospital arrival (early: 24 hour). Outcomes included the favorable outcome (mRS 0–2 or return to pre-stroke mRS at discharge) and in-hospital mortality.Results:Among the 256,293 stroke patients, 91,907 AIS patients available for analysis were included in the present study. EVT was implemented in 6.9% (6,356/91,907) (median age 78 years; 41.6% women; median NIHSS score 16). The EVT rate by time window groups was 11.8% (4,258/36,044) for the early, 5.3% (1,676/31,328) for the late, and 1.7% (422/24,535) for the very late group. In the very late group with EVT, baseline NIHSS score was lowest (median 17 points in the early group, 14 points in the late group, and 5 points in the very late group), cardioembolism was least common (67.2%, 53.5%, and 22.0%, respectively), and large artery atherosclerosis was most common (17.9%, 30.8%, and 55.7%, respectively). Favorable outcome was more frequently achieved in the very late group (52.9%) than in the early (41.6%) and late (36.5%) groups. Symptomatic intracranial hemorrhage was more frequently seen in the very late group (6.0%) compared to the early (2.9%) and late (3.8%) groups, but in-hospital mortality was comparable among the time window groups (8.1% in the early group, 7.1% in the late group, and 6.6% in the very late group).Conclusions:Outcomes after EVT for patients with AIS beyond 24 hours were not necessarily worse than for patients with AIS up to 24 hours, but the patient profile in the very late group with EVT differed significantly from that in the early and late groups; developing optimal patient selection strategies for very late AIS may be required.

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 ATMP59-ATMP59, February 1, 2025. Introduction:Diffusion-weighted imaging (DWI) is key for detecting acute ischemic brain lesions but struggles with hyperacute or small lesions that mimic artifacts. This randomized crossover trial assessed whether an artificial intelligence (AI) solution enhances diagnostic accuracy for these challenging lesions compared to conventional interpretation.Methods:From February 2017 to November 2021, 4,071 suspected acute ischemic stroke patients underwent initial and follow-up DWI. A neurologist assessed ischemic stroke based on medical records, and a neuroradiologist established the ground truth using the neurologist’s evaluation, MRI reports, and AI-marked DWI images. The accuracy of AI and MRI reports was then evaluated against this ground truth.For a reader performance study, 874 challenging cases were selected: (1) infarct volume < 0.5 mL in the posterior circulation on follow-up DWI or (2) initial DWI within 3 hours of onset with infarct volume < 1.0 mL in the anterior circulation. Additionally, 80 negative and 40 positive control cases were included. Five readers (a neuroradiologist, two radiology residents, and two neurology residents) interpreted the DWIs, half with AI assistance and half without. After a 4-week washout, cases were re-evaluated with the groups reversed. We compared the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and Dice similarity coefficient (DSC) between readings with and without AI.Results:Of 3,981 patients, 3,465 had acute ischemic strokes, and 516 had MRI-negative transient ischemic attacks. The AI alone showed a positive predictive value (PPV) of 93.1% and a negative predictive value (NPV) of 81.3%. The PPV of AI varied significantly with predicted infarction volume: 81.7% for ≤ 0.5 mL vs. 99.5% for > 0.5 mL. With AI, the sensitivity of MRI reports could potentially increase from 98.5% to 99.7%, ensuring identification of all false negatives.In the challenging case reader study, AI significantly increased AUC (0.848 vs. 0.927; p < 0.001) and sensitivity (74.59% to 90.59%; p < 0.001), with minimal impact on specificity (88.75% vs. 84.00%; p = 0.0496). AI-assisted segmentation also showed higher DSC compared to non-AI segmentation (0.742 vs. 0.523; p < 0.001).Conclusions:AI significantly improved the diagnostic performance for challenging acute ischemic lesions on DWI, demonstrating the potential to enhance stroke care.

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

Stroke, Volume 56, Issue Suppl_1, Page ADP1-ADP1, February 1, 2025. Background:Cerebral amyloid angiopathy (CAA) is a hemorrhagic cerebrovascular disease that is thought to be due to excess protein deposition in vessel walls that lead to fragility and increase the risk of rupture. Whether intravenous thrombolysis (IVT) is safe and effective for acute ischemic stroke (AIS) patients with CAA is largely unknown.Methods:This was an explorative analysis of a nationwide database of hospitalizations in the United States. AIS patients with CAA were identified by ICD-10 codes and included in the study, and cases were divided into IVT and no-IVT groups. Propensity score matching was performed to balance treatment groups, and additional multivariable logistic regressions were used for doubly robust analyses. Primary outcome was routine discharge to home with self-care. Secondary outcomes include discharge to home, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).Results:5,100 patients were identified; 498 (9.8%) received IVT. After propensity score matching and doubly robust analyses with additional multivariable logistic regression, IVT was associated with better discharge outcomes (Figure 1), with significantly higher odds of routine discharge (adjusted OR 1.77 [95%CI 1.12-2.80], p=0.015) despite higher odds of ICH (aOR 4.00 [95%CI 2.79 to 5.75], p

Stroke, Volume 56, Issue Suppl_1, Page ATP160-ATP160, February 1, 2025. Background and Purpose:Deep tiny flow voids (DTFVs) are a specific type of collaterals surrounding chronic steno-occlusive middle cerebral artery (MCA), which can be identified on high-resolution magnetic resonance imaging (HR-MRI). This study aimed to investigate the presence of DTFVs in patients with acute MCA occlusion and their relevance to clinical outcomes.Methods:Using data from two multicenter cohort studies, we examined the presence of DTFVs in patients with acute MCA occlusion and analyzed their clinical and imaging characteristics. Univariable and multivariable logistic and linear regression analyses were conducted to assess the correlation between DTFVs and the 90-day modified Rankin Scale (mRS) scores. We further studied the mediating effect of residual flow distal to MCA occlusion on the relationship between DTFVs and 90-day mRS scores using mediation analysis.Results:One hundred and twenty-three patients with acute MCA occlusion were included. The median age was 61 years (interquartile range [IQR], 51-67 years), and 73.73% of the patients were male. The median time from symptom onset to imaging was 44 hours (IQR, 25-67 hours). Sixty-six patients (53.66%) exhibited DTFVs on HR-MRI. Lower baseline NIHSS scores (4.5 [2-8] vs. 10 [4-14]) and smaller infarct volumes (5.76 [2.79-15.34] cm3vs. 19.01 [7.16-83.59] cm3) were observed in patients with DTFVs compared to those without. Both multivariable logistic regression (odds ratio [OR]: 6.22, 95% confidence interval [CI]: 1.82 to 21.29, p = 0.004) and linear regression analysis (β: -0.60, 95% CI: -1.06 to -0.14, p = 0.012) indicated that patients with DTFVs exhibited better 90-day functional outcomes. The mediating effect analysis showed that the effect of DTFV on 90-day mRS scores was partially mediated by residual flow distal to MCA occlusion, with a proportion of 30.66% (95% CI: 8.97 to 69.29, p = 0.002).Conclusions:In our study population, the presence of DTFVs was associated with a favorable outcome in patients with acute MCA occlusion, which may exert a protective effect partly by contributing to the formation of distal residual flow at the occlusion sites. Future studies are needed to investigate the potential of DTFVs in guiding individualized treatment strategies.

Stroke, Volume 56, Issue Suppl_1, Page ATP158-ATP158, February 1, 2025. Background:Research suggests that the absolute number of strokes among people with diabetes is increasing as the population with diabetes grows. Stroke patients with poorly controlled diabetes are more likely to experience poor functional recovery, longer recovery times, recurrent stroke, and higher risk of death. In response to a finding from the 2021 Joint Commission survey for not addressing an HbA1c=9.3, we launched a quality improvement project to enhance diabetic management among patients admitted for ischemic stroke.Methods:This interdisciplinary collaboration involved endocrinology, hospital medicine, and neurology. For patients admitted to our Thrombectomy-Capable Stroke Center for ischemic stroke with an HbA1c ≥ 9.0% or blood glucose glucoses≥250mg/dl, a mandatory inpatient endocrine consult would be provided, in addition to diabetic educator consult. The patient’s HbA1c levels were followed every 3 months for a year.Results:A total of 66 patients were admitted in 2022 (n=32) and 2023 (n= 34) for ischemic stroke with HbA1c ≥ 9.0%. The median HbA1C for 2022 cohort dropped from 11.2% (range 9.0% – 16.6%) to 8.5% (range 5.0% – 14.1%) in a year (p

Stroke, Volume 56, Issue Suppl_1, Page A33-A33, February 1, 2025. Introduction:Net water uptake (NWU) is a novel biomarker which measures edema and tissue injury from the degree of hypoattenuation on non-contrast CT and may serve as a precision tool for predicting outcomes after acute ischemic stroke (AIS). Using our recently developed algorithm, this study aimed to evaluate the relationship between NWU and post-stroke neurologic outcomes, including language impairment and motor weakness.Methods:Consecutive patients treated for AIS at certified stroke centers in Houston, TX were included. Patients’ precise functional outcomes at hospital discharge were recorded including decreased level of consciousness, presence of language impairment, visual deficit, arm and leg weakness, need for walking assistance, and gastrostomy placement. The primary outcome for this study was the performance of calculated NWU and clinical variables to predict language impairment at discharge. Baseline characteristics were compared, and then univariate and multivariate logistic regression were used to evaluate the association between clinical variables, imaging data, and the precise neurological outcomes.Results:Among 776 patients with AIS, average age was 67.0 +/- 14.8, 47.8% were female, median NIHSS was 10 [5,18], median ASPECTS was 9 [7,10], 42.6% received tPA, and 67.1% had a large vessel occlusion (see Table 1). In univariate logistic regression, higher NWU (OR 1.45, CI 1.30-1.63) and lower ASPECTS (OR 0.68, CI 0.63-0.74) were both significantly associated with higher likelihood of language impairment and other deficits at discharge (see Table 2). Additionally, higher NWU in all ten regions was significantly associated with deficit at discharge. In multivariate logistic regression, certain clinical and imaging variables remained significantly associated as described in Table 3. The ASPECTS and NWU-based regression models were directly compared when predicting language impairment using ROC curve analysis, and areas under the curve were 0.838 vs. 0.851 respectively (p = 0.152 with Delong test, see Figure 1).Conclusion:The novel NWU biomarker was significantly associated with precise post-AIS outcomes at discharge. When controlling for confounders, NWU was non-inferior to ASPECTS. Moving forward, region-based and overall NWU will need to be studied with long-term patient outcomes. Ultimately, this novel and open-access imaging biomarker could be used in the emergency setting to guide treatment decision-making and patient counseling.