Risultati per: World Alzheimer Report 2015

Stroke, Volume 56, Issue Suppl_1, Page ATP395-ATP395, February 1, 2025. Introduction:Ischemic stroke is one of the leading causes of death in the United States and is a known risk factor for Alzheimer’s Disease (AD) development. One of the characterizations of AD is the accumulation of β-amyloid peptide due to the proteolysis of Amyloid Precursor Protein (APP) by the protein Presenilin 1 (PS1) among others. In APP/PS1 mice, which contain an additional human copy of APP and PS1, a 15-minute Middle Cerebral Artery Occlusion (MCAO) model was developed. Here we investigate the effects of increased β-amyloid peptide on motor coordination when subjected to local ischemia.Methods:APP/PS1or Wt male mice are initially subjected to either a 15-minute MCAO or Sham surgery. Injury volume using MRI is assessed at 3-days using T2 imaging. To test motor coordination the mice went through a tapered beam analysis at the 7-day time point. Following the tapered beam test, Cresyl Violet was used to stain brain slices. All mice were 8-12 weeks old at the time of surgery. Differences between groups were determined by Welch’s T-Test. Significance was determined as p < 0.05.Results:No significant difference in infarct volume was observed between the APP/PS1-MCAO and Wt-MCAO groups. In the hind legs, it was observed that there is a significant difference in the number of slips off the tapered beam in the APP/PS1-MCAO group when compared to the Wt-MCAO group (9.4 ± 3.356, n=7, p < 0.05 and 2.5 ± 0.289, n=4, p < 0.05 respectively). No significant difference was found in the Cresyl Violet staining.Conclusions:Our study shows motor deficit in the APP/PS1-MCAO experimental group when compared to the Wt-MCAO group as measured on hind-limb coordination. Therefore, further studies are warranted to assess the interaction between ischemia and β-amyloid peptide on histological injury and functional recovery.

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 AWP61-AWP61, February 1, 2025. Background:Retinal vasculopathy had been reported across the continuum of neurodegeneration. Retinal color fundus photography coupled with automated retinal vascular analysis offers potential to non-invazively screen for Alzheimer’s disease (AD) neurodegeneration. Amyloid positron emission tomography (PET) and apolipoprotein 4 (APOE4) carrier status are known biomarkers of AD risk. Herein, we examined the relationship between retinal vascular fractal dimensions in non-mydriatic color fundus photographs, amyloid-PET burden and APOE4 carrier status in a cohort of cognitively intact individuals.Methods:Our dataset included 91 macula-centered and 39 optic disc-centered images from 96 cognitively intact participants (29% male). 25 (26%) were amyloid-PET positive, defined as amyloid-PET standardized uptake value ratio centiloid cut-off > 20. AutoMorph software automatically determined retinal arteriolar and venular density, tortuosity and width, among other fractal dimensions. To test the effect of amyloid-PET status on the retinal vascular parameters, we used a generalized linear model compensated for age, sex and the interaction between APOE4 carrier and amyloid-PET status. We also compared amyloid-PET positive and negative subjects for vascular fractal dimensions correcting for age and gender. We adjusted for multiple comparisons using the False Discovery Rate correction and reported significant P values less than 0.05.Results:Compared to amyloid-PET negative, cognitively intact amyloid-PET positive cohort had greater mean age (71 vs 66 years, P=0.06), more males (60% vs 35%, P=0.02), more APOE4 carriers (P0.05 for all) and significantly lower macular vessel tortuosity density (P=0.019). The amyloid-PET positive status had a significant effect on the retinal artery distance tortuosity (corrected P=8.75E-04, β=13.9, 95% CI [7.75-19.99]) and artery squared curvature tortuosity (corrected P=8.91E-10, β=464, 95% CI [359.10-569.15]).Conclusions:Automatically determined retinal vascular fractal dimension on non-mydriatic color fundus photographs predicts amyloid-PET burden in cognitively intact individuals. Future longitudinal studies should asssess the utility of automated quantitative retinal vasculopathy analysis to screen for presymptomatic AD.

Stroke, Volume 56, Issue Suppl_1, Page AWP17-AWP17, February 1, 2025. Background:Edaravone dexborneol is a multitarget brain cytoprotection composed of antioxidation and anti-inflammation. We aimed to assess the effect of edaravone dexborneol on functional outcome in patients with acute ischemic stroke receiving reperfusion therapy.Methods:This study was a post hoc analysis of the EXPAND (The Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke) study, which was a prospective, multicenter cohort study that enrolled 4684 patients from January 2023 to October 2023 at 72 centers in China. Of these 4 684 patients, 1 035 patients aged 18 years or older, had a clinically diagnosed acute ischemic stroke symptom from onset to admission within 14 days, received reperfusion therapy (either intravenous treatment or endovascular treatment or intravenous bridging endovascular treatment), modified Rankin Scale (mRS) score of 0-1 prior to onset, and the ability to provide informed consents. Patients were divided into two groups (edaravone dexborneol or no edaravone dexborneol). The primary outcome was the proportion of patients with a favorable outcome based on 90-day mRS that was adjusted for baseline stroke severity (an mRS socre of 0 in patients with baseline National Institutes of Health Stroke Scale [NIHSS] score of 0 to 7; an mRS of 0 to 1 in patients with a baseline NIHSS score of 8 to 14; and an mRS score of 0 to 2 in patients with a baseline NIHSS score greater than or equal to 15). The secondary outcome was the score on the mRS score (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days. Data were analyzed using multivariate regression after adjusting for the potential confounding factors.Results:Of 1 035 patients (of whom 706 were men [68.2%]; median [interquartile] age, 65 [56-72] years) were recruited into the study, 629 were treated with edaravone dexborneol and 406 were not. A 90-day favorable functional outcome occurred in 301 patients (47.8%) in edaravone dexborneol group and 159 patients (39.2%) in no edaravone dexborneol group (adjusted odds ratio, 1.38; 95% CI, 1.06-1.80). The distribution of the mRS score showed that good functional outcome favoring the edaravone dexborneol group (adjusted common odds ratio, 1.30; 95% CI, 1.02-1.64).Conclusions:For patients with acute ischemic stroke receiving reperfusion therapy, edaravone dexborneol use was associated with a higher proportion of patients achieving a favorable functional outcome compared with no use.

Stroke, Volume 56, Issue Suppl_1, Page AWP12-AWP12, February 1, 2025. Introduction:Following the results of the WAKE-UP trial, the AHA and Japanese guidelines were revised in 2019 to recommend IV rt-PA for ischemic stroke patients who have unclear time of onset >4.5 hours from last known well, when MRI DWI-FLAIR mismatch is identified. Here, we investigated the actual implementation rate, efficacy, and safety of IV rt-PA in patients with unclear onset time ischemic stroke in an area with extremely high MRI prevalence.Methods:Using data from the K-NET Registry, a multi-center stroke registry in Kanagawa Japan, we investigated 2,021 patients who underwent IV rt-PA between January 2018 and December 2021. The patients included were divided into two groups: those with unclear onset time and >4.5 hours from last known well (UO) and those with clear onset time (CO), and their clinical backgrounds, treatment outcomes, and complications were compared.Results:The UO group consisted of 88 patients, which accounted for 4.4% of the included patients, while the CO group 1,933 patients. The UO group patients were significantly older (median age 81 vs 77 years, p

Stroke, Volume 56, Issue Suppl_1, Page A36-A36, February 1, 2025. Background:Intracranial atherosclerotic disease (ICAD), a common cause of stroke, is associated with cerebral atrophy and cognitive impairment, but the underlying pathophysiology remains unknown. We sought to determine if common age-related neuropathologies modified the association between ICAD and cerebral atrophy.Methods:This cross-sectional analysis included deceased participants from the National Alzheimer’s Coordinating Center database who had MRI morphometry and autopsy assessments for vascular pathologies and Alzheimer’s disease (AD). We represented ICAD, arteriolosclerosis, and AD dichotomously based on autopsy-determined Circle of Willis atherosclerosis (none-mild vs moderate-severe), arteriolosclerosis (none-mild vs moderate-severe), and National Institute of Aging-Alzheimer’s Association ABC score (none-low vs intermediate-high likelihood of AD), respectively. Our primary outcome of interest was total cortical thickness (mm) on MRI. We conducted adjusted linear regression to determine the association between ICAD and cortical thickness, then tested for multiplicative interaction between arteriolosclerosis and AD substrata.Results:Among 449 included participants (age at enrollment 77 years [interquartile range 70-83], 45% female, 87% non-Hispanic white), 39% had ICAD, 56% had arteriolosclerosis, and 72% had AD. In fully adjusted models, we found ICAD and AD to be independently associated with cortical thinning (ICAD β-estimate [95% confidence interval, CI] = -2.89 [GJD1] [-5.65, -0.13]; AD β-estimate [95% confidence interval, CI] = -5.61 [-8.44, -2.78]). In interactions models, we found significant associations between ICAD and cortical thickness only in subgroups with coexistent arteriolosclerosis or AD pathology, [GJD2] but we did not detect a significant multiplicative interaction (arteriolosclerosis, p = 0.50, AD, p = 0.35).Conclusion:In this cross-sectional study, we found ICAD to be independently associated with cortical thinning. Coexistent arteriolosclerosis and AD pathologies did not seem to modify the effect of ICAD on cortical thickness, but we may have been limited by sample size.

Stroke, Volume 56, Issue Suppl_1, Page AWP22-AWP22, February 1, 2025. Background:While alteplase (tPA) remains the only FDA-approved thrombolytic for acute ischemic stroke (AIS), emerging data suggest that tenecteplase (TNK) offers similar safety and efficacy, with potential superiority in large vessel occlusion (LVO) cases. Our academic institution is a statewide telestroke network hub which implemented system-wide shift from tPA to TNK in August 2023. This study reports on the real-world experience of this transition in rural South Carolina within primary and telestroke centers.Methods:This retrospective study analyzed prospectively collected data from our institution’s telestroke network (1 Hub, 16 spoke centers) for confirmed AIS patients treated with thrombolytics between 2022 and 2024. We compared outcomes between patients treated with tPA or TNK, with subgroup analyses for LVO and spoke center patients. The analysis focused on treatment times, safety, and functional outcomes. Data are presented as n (%) or median (IQR) for categorical and continuous variables, with p-values calculated using the Wilcoxon and Fisher’s exact tests.Results:Among 1644 patients diagnosed with AIS, 302 patients (18%) received thrombolytic therapy; 144 (47.7%) received TNK and 158 (52.3%) received tPA. There was no statistical difference in baseline characteristics between both groups. Door-to-needle times were similar: 45 min IQR (32-66) vs. 42 min (30-66), p=0.6. There were no significant differences in symptomatic hemorrhagic transformation (4.2% vs. 1.9%, p=0.32), discharge NIHSS scores, or hospital length of stay. Subgroup analysis of spoke center patients showed comparable safety, treatment times, and outcomes. Among LVO patients treated at the institution’s Hub, there was no difference in door-to-groin time for MT: 78 min (55-106) vs. 79 min (52-103), p=0.9. TNK patients had fewer MT passes (1[1-2] vs. 2 [1-3], p=0.04) and similar successful reperfusion rates TICI 2b-3 (96.1% vs 91.3%, p=0.4) and pre-MT spontaneous recanalization rates (p=0.6). TNK-treated LVO patients were more likely to be discharged with mRS ≤3 (75.4% vs. 54.4%, p=0.02).Conclusions:The transition to TNK in the South Carolina Telestroke network was associated with similar safety profiles and treatment times with notable improvements in procedural efficiency and functional outcomes for patients with LVO. These findings support the broader adoption of TNK as a viable alternative to tPA in acute ischemic stroke management, particularly in telestroke networks.

Stroke, Volume 56, Issue Suppl_1, Page AWP25-AWP25, February 1, 2025. Background:Edaravone dexborneol is a novel cytoprotective agent widely used for acute ischemic stroke patients in clinical practice in China. It is unclear whether minor stroke patients benefit from edaravone dexborneol treatment.Methods:The present analysis was a post hoc analysis based on a prospective, multicenter EXPAND (The Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke) cohort study which conducted at 72 hospitals in China between December 2022 to October 2023. Inclusion criteria included patients diagnosed as acute ischemic stroke, aged 18 years or older, National Institutes of Health Stroke Scale [NIHSS] score ≤5, within 14 days of acute ischemic stroke, and modified Rankin Scale score of 0-1 prior to onset. Patients were divided into two groups (edaravone dexborneol or no edaravone dexborneol). The primary outcome was excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The secondary outcome was the score on the modified Rankin Scale (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days. Data were analyzed using multivariate regression after adjusting for the potential confounding factors. Furthermore, we performed a 1:1 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analysis to assess the robustness of the results.Results:A total 2 608 patients were included in this analysis. Overall, the median age of patients was 65 years old (interquartile, 56-72), and 1748 (67.7%) were men. Of these, 1838 were treated with edaravone dexborneol and 770 were not. At 90 days, 79.8% of patients in the edaravone dexborneol group and 74.4% of patients in the no edaravone dexborneol group had an excellent functional outcome (adjusted odds ratio, 1.31; 95% CI, 1.06-1.62). The median 90-day modified Rankin Scale score was 1 (interquartile, 0-1) in the edaravone dexborneol group and 1 (interquartile, 0-2) in the no edaravone dexborneol group (adjusted common odds ratio, 1.32; 95%CI, 1.12-1.54). The results were consistent in 1:1 PSM and IPTW analysis.Conclusions:Among patients with minor stroke, edaravone dexborneol was associated with higher odds for excellent functional outcome, as compared with no use.

Stroke, Volume 56, Issue Suppl_1, Page AWMP17-AWMP17, February 1, 2025. Introduction:Intracranial arterial calcifications (IAC) are considered a surrogate for intracranial large artery atherosclerosis but IAC can also represent non-atherosclerotic arterial aging. People with IAC have an increased risk of dementia. Nonetheless, the interplay between IAC, atherosclerosis, luminal stenosis and arterial stiffness as determinants of neurodegeneration remains unclear.Methods:We analyzed 161 brain autopsy cases from the Brain Arterial Remodeling Study. We dissected each of the components of the circle of Willis and stained all arterial segments with H&E, elastic van-Gieson (to semi-quantify elastin content) and trichrome (to semi-quantify collagen content) stains. We rated calcification using H&E as present or absent and classified calcifications as scattered, media calcifications, coalescent or a combination of the above. We obtained ipsilateral brain cuts and stained with H&E to measure the arteriolar wall thickness and lumen. We used immunohistochemistry to stain for beta amyloid, phospho-tau and Iba1, a measure of activated microglia. Each stained slide was processed automatically to quantify the number of amyloid plaques and microglial (Iba1+) cells per 100u2and percentage of tissue area stained positive by phospho-tau. We related calcification in the circle of Willis to parenchymal measure of neurodegeneration using mixed hierarchical models, adjusting for age, demographics and vascular risks.Results:Among 161 cases (mean age 81±16 years), 52% were female, 78% non-Hispanic white, 52% had hypertension, 11% diabetes, and 54% died with diagnosed dementia. Presence of any calcification was associated with increased number of Aβ plaques per 100 µ2, greater percentage of tissue area stained by phospho-tau, higher number of microglial cells and higher lumen to wall ratio (Table 1). The results were most consistent for IAC that had combined scattered and coalescent calcifications. The association between IAC and neurodegeneration markers attenuated after adjusting for elastin loss and collagenosis, both markers of arterial stiffness, but not after adjusting for atherosclerosis or luminal stenosis.Conclusion:IAC are associated with pathology markers of neurodegeneration, specifically Alzheimer’s disease. The association was independent of atherosclerosis and luminal stenosis, but attenuated partially after adjusting for markers of arterial stiffness. Hemodynamic studies in living persons are needed to replicate these associations.

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

Stroke, Volume 56, Issue Suppl_1, Page AWMP10-AWMP10, February 1, 2025. Introduction:Tenecteplase (TNK) has 14-times greater specificity for fibrin and a longer half-life compared to alteplase (ALT), offering practical advantages for ease of administration and cost effectiveness in managing acute ischemic stroke (AIS). Studies regarding safety and efficacy have shown TNK to be non-inferior to ALT, with some analyses showing greater improvements in AIS recovery with TNK compared to ALT. Our study investigated outcomes following TNK or ALT for AIS by stroke severity.Methods:Data was collected from the TriNetX US Collaborative Network, which allowed access to de-identified retrospective electronic medical records. Patients treated with TNK or ALT for AIS after January 1, 2019 were divided into subgroups by stroke severity using the National Institutes of Health Stroke Scale (NIHSS). Patients who underwent acute mechanical thrombectomy were excluded. Propensity score matching for baseline characteristics was performed (Figure 1). Outcomes including any (asymptomatic or symptomatic) nontraumatic intracerebral hemorrhage (ICH), mortality, non-intracerebral hemorrhage, and changes in NIHSS score were assessed over 7 days from the index event. Statistical analysis was completed on the TriNetX platform.Results:Patients with mild AIS (NIHSS 1-4) who received TNK (n=1,639) versus ALT (n=1,639) had greater risk for developing ICH (10.3% vs 7.4%, p=0.004) and worsened NIHSS score (15.8% vs 9%, p

Stroke, Volume 56, Issue Suppl_1, Page AWP120-AWP120, February 1, 2025. Objective:Despite guidelines recommending intensive rehabilitation for walking recovery after stroke, its implementation remains challenging. Our understanding of barriers and facilitators in real-world settings remains minimal. We aimed to understand the implementation factors for intensive rehabilitation within real-world inpatient rehabilitation settings.Methods:A cross-sectional online survey design was used. We invited 85 therapy staff (physiotherapists + therapy assistants) who delivered the structured, progressive intensive rehabilitation protocol ( >2000 steps, 40-60% heart rate reserve, >30 minutes/session) as usual care from 12 sites (7 Canadian provinces) within the Walk ’n Watch implementation trial (NCT04238260). Fitbit step counters and Garmin heart rate monitors were provided. The survey was developed by a multidisciplinary team (clinicians, scientists, and a stroke patient), including close-ended (Likert agreement scale) and open-ended questions regarding protocol practicalities, workplace structure, and support. Close-ended responses were descriptively summarized. Open-ended responses were thematically analyzed using the Consolidated Framework for Implementation Research (CFIR).Results:Forty-seven therapy staff (85% female; mean 13 ± 10 years clinical experience) completed the survey. Most therapy staff agreed that they delivered the protocol safely and successfully (87%) and that the step and heart rate targets were helpful (72%). However, only about one-third agreed that they had enough time to deliver the protocol (36%); 26% and 47% agreed that they achieved the prescribed step count and heart rate targets, respectively. The major time-related factor was insufficient therapy time to accommodate the 30-minute protocol, besides other required therapy activities (CFIR Work Infrastructure). For example, discharge planning often took priority near the end of the stay. Most agreed to future use of the protocol (87%). However, only about half agreed to future use of the trial-assigned devices (49% step counters, 64% heart rate monitors), likely due to perceptions of device inaccuracies (CFIR Materials&Equipment).Conclusions:Therapy staff reported successfully delivering an intensive rehabilitation protocol as usual care under real-world conditions. Strategies identified to facilitate implementation included building in discharge planning considerations within the protocol and acquiring more accurate step counters and heart rate monitors.

Stroke, Volume 56, Issue Suppl_1, Page ATP205-ATP205, February 1, 2025. Introduction:Alzheimer’s Disease (AD), characterized by extracellular deposition of amyloid beta (Aβ) plaques in brain tissue, is often comorbid with cerebral amyloid angiopathy, which carries an elevated risk of intracranial hemorrhage. Furthermore, severe hemorrhagic complications have been observed following the use of new Aβ-targeted immunotherapies for AD. However, there are limited population-based data regarding the risk of intracranial hemorrhage associated with AD.Methods:We performed a retrospective cohort study using inpatient and outpatient claims between 2008-2018 from a nationally representative 5% sample of Medicare beneficiaries ≥65 years of age. The exposure variable was AD, defined byICD-9-CMcode 331.0 andICD-10-CMcode G30.x. The primary outcome was non-traumatic intracranial hemorrhage, defined as a composite of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH) using validatedICD-9-CMandICD-10-CMdiagnosis codes. Secondary outcomes were ICH, SAH, and SDH assessed separately. Cox proportional hazards models were used to determine the associations between AD and outcomes after adjustment for demographics, vascular risk factors, and Charlson comorbidities.Results:Of 2,107,151 patients included, 87,751 (4.1%) had a diagnosis of AD. A total of 14,400 (0.7%) patients were diagnosed with ICH, 6,003 with SAH (0.3%), and 6,650 (0.3%) with SDH. In multivariable Cox proportional hazards analysis, AD was associated with an increased risk of intracranial hemorrhage (adjusted hazard ratio [aHR], 1.54, 95% confidence interval [CI], 1.44-1.65). In adjusted analyses of secondary outcomes, AD was associated with an increased risk of ICH (aHR, 1.35; 95% CI, 1.23-1.48), SAH (aHR, 2.59; 95% CI, 2.26-2.97), and SDH (aHR, 2.05; 95% CI, 1.83-2.30).Conclusions:In a nationally representative cohort of Medicare beneficiaries, AD was associated with an increased risk of spontaneous intracranial hemorrhage. This increased risk was also present for ICH, SAH, and SDH when examined separately.

Stroke, Volume 56, Issue Suppl_1, Page A101-A101, February 1, 2025. Introduction:Previous studies have shown an association between vascular disease and Alzheimer’s disease, but there are few studies have considered a relationship between brain arterial remodeling and biomarkers of Alzheimer’s disease. Our study aims to find the association between specific arterial characteristics in brain arterial remodeling and Alzheimer’s pathology.Method:We analyzed 132 brain autopsy cases from the Brain Arterial Remodeling Study (BARS), a collection of brains from multiple brain banks in the United States and abroad. Brain sections were obtained systematically by each brain bank, and the anatomical location was harmonized across the banks. The brain slides were stained with LH&E to measure the lumen and wall thickness of the pial, CSF-floating small arteries, parenchymal arteries, and arterioles. Then lumen area, wall thickness, lumen-to-wall ratio (LWR), and wall proportion (which serves as a measure of vessel stenosis) were calculated. We used immunohistochemistry to stain for beta-amyloid, phospho-tau, and Iba1, a measure of microglia. Each stained slide was processed automatically using Visiopharm (version 2021.12) by color thresholding and pattern detection to quantify the number of amyloid plaques and microglial (Iba1+ cells) per 100 µm2and the percentage of tissue area stained positive by phospho-tau, and the number of microglial cells per 100 µm2.Results:Overall, a thicker arterial wall was associated with a greater area of tau staining and a lower lumen-to-wall ratio (suggestive of inward remodeling) was associated with a higher number of microglial cells (table 1). There was a statistical interaction between measures of arterial remodeling by anatomical location (pial vs. parenchymal, P

Stroke, Volume 56, Issue Suppl_1, Page A138-A138, February 1, 2025. Introduction:Echocardiography, the current gold standard for evaluating cardioembolic sources of acute ischemic stroke (AIS), is relatively low yield, not readily available at all hospitals, and may delay treatment and disposition. Cardiac CT angiography (CCTA) can also be used to identify cardioembolic sources of stroke. Many prior studies of CCTA in AIS have been enriched with a patient population most likely to have embolic stroke and/or large vessel occlusion. We report the preliminary results of a pilot study assessing the utility of CCTA in the routine evaluation of all AIS and TIA stroke patients.Methods:In 2024, we integrated CCTA into the standard of care diagnostic evaluation of patients with AIS and TIA in addition to routine echocardiography (TTE or TEE). CCTA was obtained for all AIS patients when possible, but limitations included scanner availability, cardiology availability, and CT tech training. CCTA could be integrated directly into the stroke code imaging (i.e. combined with CT Angiograms of the Head/Neck utilizing a single contrast bolus) or obtained as a standalone study. The patient’s demographics, stroke characteristics, and type of CCTA obtained (integrated vs standalone) were reported using descriptive statistics. To assess the diagnostic yield of CCTA we analyzed: 1) the number of times echocardiography changed the stroke etiology and 2) the number of times CCTA changed the stroke etiology (by TOAST criteria). In addition, we studied how often echocardiography or CCTA findings changed management. We tested statistical significance using McNemar’s mid P-test.Results:Our study population consisted of 88 patients with the final diagnosis of AIS or TIA. The median age was 70 IQR: 65-80, female 48.9%, median NIHSS: 2.5, IQR: 0-9, AIS 70 (79.5%). (Table 1). Echocardiography changed the diagnosed stroke etiology in 1 (1.1%) of patients, CCTA changed the diagnosed stroke etiology in 6 (6.8%) of patients (p=0.07). Echocardiography changed management in 1 (1.1%) of patients, whereas CCTA changed management in 10 (11.4%) of patients (p

Stroke, Volume 56, Issue Suppl_1, Page A147-A147, February 1, 2025. Background:Telestroke has proven efficacy in improving clinical outcomes by providing rapid access to specialized stroke care, particularly in remote areas. However, the global implementation of telestroke networks remains uneven, with limited data on their structure and coverage outside of high-income countries (HICs).Objective:This study aimed to provide a comprehensive overview of the global landscape of telestroke networks, highlighting disparities and underscoring the need for universal guidelines. We aimed to map the global telestroke landscape, characterize existing networks, and identify disparities in access, technological adoption, and quality monitoring practices across different regions.Methods:We conducted a three-tiered identification process involving engagement with national stroke experts, stroke societies, and international authorities, supplemented by extensive literature and internet searches to identify providers involved in telestroke networks worldwide. A detailed 39-question survey was distributed to the leaders of identified telestroke networks, assessing their structural characteristics, operational processes, and quality monitoring practices.Results:A total of 254 telestroke networks were identified across 67 countries (Figure 1), with 69% located in HICs. The response rate to our survey was 34%, with 88 networks from 31 countries providing detailed data. Our findings reveal significant disparities in the establishment and operation of telestroke networks. HICs predominantly host large, well-established networks, with robust technological infrastructures and comprehensive quality monitoring. In contrast, networks in low- and middle-income countries (LMICs) are fewer, smaller, and often lack advanced technology and standardized quality assurance measures. Notably, 87% of networks established within the last three years are located in non-HIC regions, signaling a shift toward broader global implementation.Conclusion:This study provides one of the most comprehensive global mappings of telestroke networks to date, uncovering significant disparities in access, resources availability (Figure 2) and quality monitoring practices. While telestroke networks are expanding into LMICs, there remains a critical need for universally applicable guidelines that can be adapted to diverse resource settings.