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Stroke, Volume 56, Issue Suppl_1, Page ATP129-ATP129, February 1, 2025. Introduction:An equitable health system requires access to clinical advances across society. In stroke, mechanical thrombectomy (MT) has revolutionized the field by providing an acute therapy with unprecedented reduction in morbidity and mortality. Its benefit depends heavily on the duration between stroke onset and cerebral reperfusion. As such, patient factors associated with delays in care can influence outcomes after MT and lead to health inequities. Communication is paramount to a neurological evaluation. In a predominantly English-speaking medical system, we hypothesized that patients with a primary language other than English who presented to the hospital with large-vessel occlusion ischemic stroke (LVO) might experience delays in care resulting in longer times to MT.Methods:We conducted a single-center retrospective cohort study to investigate the impact of primary language on door-to-puncture time (DTP) among patients with LVO who presented to a single comprehensive stroke center between 01/2020 and 05/2024 and underwent MT. We employed non-parametric statistics to compare patient demographics and clinical outcomes and a LASSO approach to identify independent predictors of DTP.Results:Of the 413 patients who underwent MT, 52 (13%) were non-English-speaking (Table 1). In the overall cohort, patients were on average 71 years of age and majority male (57%). They presented to the hospital 8.1 hours after last known well with a mean NIHSS of 19. Compared with the English-speaking cohort, non-English-speaking patients presented earlier to the hospital after last known well (6.1 hours versus 8.1 hours, p = 0.110), were more likely to receive thrombolysis (33% versus 14%, p < 0.001), and had higher rates of hypertension (63% versus 44%, p < 0.008) and lower rates of congestive heart failure (12% versus 30%, p = 0.005). Neither DTP (60 minutes versus 60 minutes, p = 0.900) nor door to needle time (time to administration of thrombolytic, 43 minutes versus 47 minutes, p = 0.600) differed between non-English and English-speaking patients. Regression analysis identified a history of dyslipidemia (decreased DTP 8 min, 95% CI 2-14 min) and having received IV thrombolysis (increased DTP 13 min, 95% CI 5-21 min), but not primary language, as independent predictors of DTP.Conclusions:Our comprehensive stroke center promotes an equitable health system by providing a timely opportunity for MT after LVO irrespective of patient language.

Stroke, Volume 56, Issue Suppl_1, Page ATP120-ATP120, February 1, 2025. Introduction:AI-based Stroke Care Coordination Platforms (AI-SCCP) have been shown to improve patient transfer decisions and provide access to the highest quality standards of care for all patients. Since strokes happen everywhere and anytime, we examine the economic benefits of implementing AI-SCCPs for two different hospital types: CSC – a comprehensive 24/7 stroke program inclusive of endovascular surgical care and PSC – “Acute Stroke Ready” facilities with radiological imaging and thrombolytic medication treatment capacities but no endovascular surgical care and patients/families.Methods:Using 2021 Medicare MS-DRG payment averages, we calculate the AI-SCCP’s PSC break-even point, its effects on CSC finances, and the reduced transfers’ economic benefits for the patient and family.Results:Avoided transfers enable the PSC to continue caring for the patient locally, increasing patient volume and resulting in increases in total contribution margin and net revenues beyond the costs of the AI-SCCP. While these retained patients decrease the CSC patient transfer volume, the CSCs will still provide care to all PSC patients needing surgical interventions and patients with MS-DRGs 61-66 who arrive at their locations via initial presentation in their emergency departments. Only 1.7% of all non-surgical stroke discharges were from PCS rural/small-town community hospitals (15% of all US hospitals), illustrating that there is room to avoid more futile transfers. Futile transfers have financial costs for family members, such as hotels, transportation, meals, and lost wages during the patient’s care and increased negative impacts on the patient’s health. Futile transfers increase the episode of care costs to the healthcare system through added ambulance transfers and physician and facility bills, adding out-of-pocket patient costs without adding health outcomes or value.Conclusions:AI-SCCPs offer financial benefits to the PSC and CSC by ensuring patients are at the facility, which provides the best possible benefits for them, a triple “win” for the PCS, CSC, and patients/families. For financially strained PCSs, the retained revenue is critical. Using AI-SCCPs ensures that local hospital/emergency departments can provide timely, expert stroke care for patients and their families in situ. In cases of necessary transfer, the receiving CSC team is prepared and ready to treat these patients, saving valuable time and brain immediately.

Stroke, Volume 56, Issue Suppl_1, Page AWP94-AWP94, February 1, 2025. Background:The transition period after hospitalization for stroke is a vulnerable time for patients as all adapt to new physical, cognitive, or emotional changes and destabilized comorbid conditions. Transitional care programs designed for post-stroke care carry the promise of improved outcomes and reduced hospital readmission rates, however attendance rates to these scheduled visits in other stroke early supported discharge programs are reported as low as 35%. In addition to patient specific consequences, missed stroke clinic visits impact system efficiency and workflow which carry broad regional consequences. We sought to understand the impact of our early supported discharge program on hospital length of stay and clinic attendance patterns to prepare for ongoing iteration of this program.Methods:All hospitalized stroke patients who are discharged to home are enrolled in the Joint Stroke Transitional Technology-Enhanced Program (JSTTEP) and seen by a stroke specialist using telemedicine platform within the first 2 weeks of hospital discharge. Following JSTTEP, patients receive usual care which includes a stroke clinic visit 2-3 months after discharge, either by telemedicine or in-person based on patient preference and clinical needs.Results:There has been no change in demographics since the inception of JSTTEP in 2020 with the average age of patients 61 years, 40% female, and nearly 50% black. In calendar year 2023, 309 patients were enrolled in the JSTTEP following hospitalization for acute stroke. Of those, 277 (90%) completed the first JSTTEP telemedicine visit. The mean time from hospital discharge to the first JSTTEP visit was 7.6 days. Hospital length of stay has decreased from 4.5 days prior to JSTTEP to 4.0 days in 2023. Modified Rankin Scale scores at 90 days decreased from 2.2 to 1.1 in a subset of patients with available scores.Conclusion:Since the implementation of JSTTEP, hospital length of stay has decreased for stroke patients who are discharged to home. We note a high show rate to this clinic and suspect that there are a variety of contributors to these successes including close proximity to hospitalization, rapid attention to evolving post-discharge needs, interaction with stroke specialists, and use of telemedicine to facilitate access during a time period where driving is prohibited. The intentional design of the JSTTEP resulting in high level of engagement is likely a strong factor in the early success of the JSTTEP program.

Stroke, Volume 56, Issue Suppl_1, Page ATP151-ATP151, February 1, 2025. Background:Efficient management of acute ischemic stroke is critical to reducing disability and mortality. The hub-and-spoke telestroke model has been developed to extend specialized stroke care to regions with limited resources, ensuring timely diagnosis and treatment.Objective:To evaluate the effectiveness of a large-scale hub-and-spoke telestroke network in delivering acute stroke care, focusing on the rates of thrombolysis and mechanical thrombectomy, treatment timelines, and patient outcomes.Methods:We conducted a retrospective analysis of 9,702 patients treated within a 38-hospital telestroke network from December 2014 to January 2018. Data collected included patient demographics, stroke characteristics, treatment interventions, and outcomes. Key measures included the proportion of patients receiving intravenous tissue plasminogen activator (IV tPA), mechanical thrombectomy, time from stroke onset to treatment, and rates of complications and discharge outcomes.Results:Of the 9,702 patients included, 83.1% were diagnosed with a true stroke, and the mean NIHSS score on admission was 6.2. IV tPA was recommended for 16.3% of patients, with 61.7% receiving the treatment. Mechanical thrombectomy was performed in 2.3% of cases, with an average procedure duration of 46.2 minutes. The median time from stroke onset to IV tPA administration was 114.2 minutes. Hemorrhagic transformation occurred in 19.4% of patients who received thrombolysis, and the overall mortality rate was 17.4%. The average NIHSS score at discharge improved to 4.4, with 54.9% of patients discharged home.Conclusion:The hub-and-spoke telestroke network demonstrated significant efficacy in delivering timely, specialized stroke care across a large and diverse patient cohort. By reducing treatment delays and optimizing access to advanced interventions, this model has the potential to transform stroke care in underserved regions, reducing both mortality and long-term disability.

Stroke, Volume 56, Issue Suppl_1, Page ATP102-ATP102, February 1, 2025. The recovery process for stroke patients requires ongoing reinforcement of critical health information. Traditional education methods of written handouts often fail to adequately meet patient needs, particularly for those with limited literacy, or busy lifestyles. Podcasts are emerging as a powerful tool in patient education, offering a flexible, accessible, and engaging format that can be accessed anytime, anywhere.The hypothesis was that by prescribing podcasts, we could ensure patients have continuous access to vital information, allowing for repeated exposure and improved retention of key concepts. Studies have shown that podcasts can significantly enhance knowledge retention and listener engagement, even when listeners are engaged in other activities, as verified by EEG. This makes podcasts a practical solution for reinforcing key health messages and catering to diverse learning preferences, offering an alternative for patients who may struggle with written materials. Since neurological patients struggle to retain complex medical information provided during brief consultations, this can lead to gaps in understanding, and consequently suboptimal outcomes.Putting this hypothesis to the test, our method was to create a podcast with episode topics selected by a multidisciplinary stroke team, focusing on the frequently asked questions posed by stroke survivors and caregivers. Each podcast episode features interviews with expert guests or stroke survivors who discuss strategies and resources relevant to the topic. To enhance accessibility, links to printable information and specialist directories are provided in the show notes of each episode.The results demonstrate global demand for access to such specialized information, with regular listeners in 56 countries, all 50 of the United States and over 1600 downloads in outlying US territories. Each new episode consistently averages 300 audio downloads or video views in the first week they are released.In conclusion, neurology providers are encouraged to incorporate podcasts as a standard component of their stroke patient education strategy. Also, future research should focus on developing specialized neurological podcasts tailored to community needs, providing insight into how to aid them to better understand and manage their conditions, ultimately contributing to improved adherence to treatment plans and better quality of life.

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

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

Stroke, Volume 56, Issue Suppl_1, Page ATP156-ATP156, February 1, 2025. Introduction:Early recognition of acute stroke and activation of emergency medical services (EMS) is a critical first step in the stroke care continuum. Failure to call 9-1-1 and other delays in seeking care contribute to prolonged prehospital delays, often limiting access to time-sensitive treatment. To identify challenges in early initiation of EMS, we sought to understand stroke survivor and caregiver perspectives on seeking acute stroke care.Methods:We conducted individual, semi-structured interviews with a convenience sample of adult stroke survivors and caregivers for patients with acute stroke that occurred in central North Carolina. In virtual interviews, participants were asked about stroke signs and symptoms experienced, their response, and care received from EMS and in the ED and hospital. Interviews were recorded, transcribed, and analyzed by two individual coders. Deductive coding and rapid thematic analysis focused on care-seeking behaviors and perspectives.Results:Of 16 interviews conducted thus far, 10 were with stroke survivors and 6 were with accompanying caregivers (14 Non-Hispanic White; 13 used EMS). Stroke onset was promptly recognized when the patient/caregiver had prior experience with stroke, exposure to stroke education, or access to healthcare professionals among their personal circles. Early stroke recognition prompted over half of the caregivers or other bystanders (spouses, adult children, or neighbors) to call 9-1-1 right away. Symptoms perceived by the patient/caregiver as a non-stroke issue (e.g., migraine, seizure) or not severe enough led a third of the participants/caregivers to delay or fail to call 9-1-1. Some participants reported being aware of EMS costs; however, none reported delaying care-seeking due to these concerns. Other concerns with calling 9-1-1 included general apprehension of medical professionals and fear of being perceived as “the boy who cried wolf.”Conclusion:Stroke survivors’ and caregivers’ perspectives highlighted accurate and early stroke recognition as a facilitator of prompt EMS initiation. Conversely, symptoms associated with other neurologic conditions or perceived as mild created delays in seeking care. Further recruitment is in progress until reaching at least 30 participants, focusing on racial and ethnic minority groups and underserved rural populations. Study findings will be used to develop effective solutions to challenges in seeking acute stroke care.

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.

Stroke, Volume 56, Issue Suppl_1, Page A58-A58, February 1, 2025. Background:Acute ischemic stroke (AIS) is a leading cause of disability worldwide. While intravenous thrombolysis is recommended within 4.5 hours of symptom onset, many patients present beyond this window. Tenecteplase (TNK) has shown to be non-inferior to tissue plasminogen activator (tPA) in early treatment window. However, its efficacy and safety in the extended 4.5 to 24-hour window remain unclear.Methods:We conducted a systematic review and meta-analysis of published clinical trials investigating TNK administration in AIS patients between 4.5 to 24 hours of symptom onset. PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov were searched from inception through June 23rd, 2024. Inclusion criteria were: (1) clinical trials, (2) published in English, (3) full-text available, and (4) TNK administration in AIS or transient ischemic attack patients within 4.5-24 hours of onset. Primary outcomes assessed were functional independence at 90 days (defined as a modified Rankin Scale [mRS] score of 0-2) and ordinal shift in the mRS. Safety outcomes included symptomatic intracranial hemorrhage (sICH). Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).Results:Five clinical trials met inclusion criteria with a total of 1,197 patients (599 TNK, 598 best medical therapy). Mean age was 71 years, with 61.7% males and a median baseline NIHSS of 10. Studies varied in imaging selection criteria, using either MRI DWI/FLAIR mismatch or CTP imaging with different perfusion cut-off values. Additionally, the proportion of patients receiving EVT post-randomization varied among studies. TNK treatment was associated with increased functional independence at 90 days (OR 1.33, 95% CI 1.04-1.70, p=0.02), but no significant difference in overall mRS (standardized mean difference: 0.01, 95% CI -0.37 to 0.39, p=0.969). A trend towards increased sICH with TNK was observed, though not statistically significant (OR 2.16, 95% CI 0.96-5.05, p=0.06).Conclusion:This meta-analysis suggests that TNK might be safe and effective for AIS patients in the 4.5 to 24-hour time window, potentially offering improved functional outcomes without significant increase in sICH. Future research should focus on conducting large, multicenter randomized controlled trials with refined patient selection criteria and standardized imaging protocols, to more precisely access the risk-benefit profile of TNK in extended time window.

Stroke, Volume 56, Issue Suppl_1, Page ATMP100-ATMP100, February 1, 2025. Introduction:Food insecurity, defined as limited access to nutritious food due to financial challenges, has grown substantially over the past two decades in the United States. Stroke survivors are more likely to experience food insecurity compared to the general population. However, the impact of food insecurity on long-term survival post-stroke remains unclear. Hence, we aimed to determine associations between food insecurity post-stroke and all-cause mortality.Methods:The National Health and Nutrition Examination Survey (NHANES) is an iterative cross-sectional study representative of the US population. Using data from 1999-2018, we assessed associations between food insecurity and all-cause mortality among stroke survivors and the general NHANES population, using linkage to death certificates from the National Death Index. Food security was assessed using ten NHANES questions and dichotomized into food security and food insecurity. A Cox proportional hazards model was used to evaluate associations between food insecurity and mortality adjusting for NHANES weighting, sex, age, race/ethnicity, education, marital status, poverty income ratio, BMI, diabetes, stroke, myocardial infarction, and cancer.Results:Among 101,316 NHANES participants, 2,197 (2.2%) self-reported as stroke survivors (mean age 67.6y, 50.8% female). Stroke survivors were more often food insecure compared to the general NHANES population (17.6% [SE:1.3%] vs. 14.3% [SE:0.4%], p=0.0038). Among 1,754 (78.9%) stroke survivors with linked death records, 801 died during a median follow-up of 105 months (IQR 56-159). The 10-year all-cause mortality rate among stroke survivors was 36.2% (SE: 3.0%) for the food secure and 48.4% (SE: 1.8%) for the food insecure group. In the general NHANES population, the corresponding rates were 10.9% (SE: 0.2%) and 14.2% (SE: 0.4%), respectively (Fig 1). Regression analysis showed that food insecurity was associated with a 31% increased risk of mortality in stroke survivors (HR: 1.31, 95%CI:1.00-1.73, P=0.049) and a 40% increase in the general NHANES population (HR: 1.40, 95%CI:1.25-1.57, P

Stroke, Volume 56, Issue Suppl_1, Page ATP134-ATP134, February 1, 2025. Background:Considerations of equity in funding and conduct of medical research are receiving greater attention. However, perspectives of diverse stakeholder groups on this topic are poorly characterized. Our study aimed to further understand various stakeholder perspectives and associated priorities regarding perceived inequities in medical research, with a particular interest in the field of stroke.Methods:We employed a qualitative descriptive methodology embedded in an interpretive grounded theory framework. This approach involved in-depth, semi-structured interviews with researchers, funders, patients, and members of the public. Participants were asked to discuss their perspectives on the current state of equity in stroke and medical research funding. Collected data were analyzed using constant comparison, open-coding, and theme identification to generate a substantive theory.Results:We conducted 41 interviews involving 11 researchers, 10 funders, 10 patients, and 10 members of the public. Participants perceived several inequities in research participation, funding opportunities, topic prioritization, and lack of international collaborations inclusive of low- and middle-income countries (LMICs). Potential strategies to address these inequities were also identified. Through participants’ perspectives, we developed a central theory that addressing inequities in medical research and funding can promote collaborative spaces and produce greater research impact for society, regardless of demographics, socioeconomic status, and geographical residence.Conclusion:Participants perceived various inequities in the funding and conduct of medical research. However, based on the insights into potential solutions that we gained from their diverse perspectives, we are optimistic that addressing these inequities will help broaden the societal impact of stroke research and that these solutions will also result in more equitable outcomes and impact, inclusive of LMICs.

Stroke, Volume 56, Issue Suppl_1, Page A61-A61, February 1, 2025. Introduction:Patent Foramen Ovale (PFO) contributes to a quarter of Embolic strokes of Undetermined Source (ESUS). Although benefit of PFO closure in selected patients has been demonstrated, our workflow resulted in a low rate of PFO evaluation for closure. The aim of the PFO-ACCESS program (which included implementation of the Viz.ai PFO-specific communications module) was to determine any change in PFO management due to improved communication between stroke and interventional cardiology (IC) teams.Methods:In this Quality Improvement (QI) project, we compared pre-PFO ACCESS (12/22-11/23) to post- periods (11/23-6/24) for PFO referrals. The Viz.ai PFO module was deployed to the stroke team and IC team members. No other workflow changes were introduced. Key performance indicators (KPIs) included referral frequency, PFO closure rates, and referral- related time intervals. Statistical comparisons utilized Mann-Whitney U tests.Results:The post-implementation period noted a 492% PFO referral increase (11,65(annualized);p

Stroke, Volume 56, Issue Suppl_1, Page ATP144-ATP144, February 1, 2025. Introduction:Limiting the rate of unplanned emergency department (ED) revisits for patients with acute ischemic stroke is an important aspect of secondary stroke prevention. This is influenced by patients’ demographics, comorbidities, stroke severity, disposition destination, and may be impacted by early outpatient follow-up where stroke risk factors and etiology continue to be evaluated.Methods:We retrospectively identified all acute ischemic stroke patients discharged from an 11-hospital network, 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 ED visits within 30- and 90-days after discharge.Results:Of 2,191 patients, 143 (6.5%) had ED visits within 30 days and 296 (13.5%) within 90 days. The median age was 68 [IQR 57, 77]. History of heart failure (HF), atrial fibrillation (AF), chronic kidney disease and end stage renal disease each increased the likelihood of an ED re-visit within 30 and 90 days whereas diabetes mellitus increased the likelihood of an ED re-visit at 90 days only. In multiple logistic regression analyses, factors independently associated with 30-day ED visit was a history of HF (OR 1.57, 95% CI 1.07-2.28; p=0.02) and AF (OR 1.49, 95% CI 1.00-2.19; p=0.04); at 90 days, only an increased Charlson Comorbidity Index score was associated with ED visit (OR 1.09, 95% CI 1.02-1.16; p=0.01). There were 501 (23%) patients who completed an outpatient neurology clinic follow-up within 30 days of discharge, including 81 patients (4%) who completed a telemedicine outpatient visit; patients completing a telemedicine visit were less likely to have a 30-day ED visit than those who had an in-person visit (OR= 0.13, 95% CI 0.01-0.62; p=0.05).Conclusion:ED revisits after hospitalization for acute ischemic stroke are relatively common and associated with patients who have comorbid conditions including HF and AF. Our study suggests that telemedicine-based follow-ups were associated with lower rates of unplanned ED revisits within 30 days. Efforts to increase outpatient neurology clinic access through telemedicine may reduce ED visits after discharge for acute ischemic stroke patients.

Stroke, Volume 56, Issue Suppl_1, Page AWMP2-AWMP2, February 1, 2025. The treatment strategy for acute ischemic stroke (AIS) is reperfusion. In addition, neuroprotective measures have influenced outcomes in mortality, morbidity, and disability. Remote ischemic conditioning (RIC) is a neuroprotective measure that minimizes ischemic reperfusion injury to the target organ. Previous trials have showed its safety and efficacy, but its impact to vascular cognitive impairment and quality of life is undermined. This study aimed to demonstrate its efficacy and impact in terms of disability, cognitive impairment, and quality of life.This is a single center, open-label trial conducted in a tertiary center in the Philippines which included 104 patients randomized to RIC (n=52) and control (n=52) groups. One dose of RIC comprised of 4 cycles of BP cuff inflation 20mmHg above baseline systolic blood pressure (ceiling of 180mmHg) for 5 minutes followed by 5 minutes of cuff deflation; a total of 8 doses of RIC were given over four days with 12 hour intervals. The control arm did not receive cuff inflations; both groups received guideline-based standard stroke care.Out of 104 patients, 10 (9.6%) were excluded from full analysis; 6 patients were excluded due to mortality, while 4 patients failed to undergo MOCA-P and HRQoL testing due to severe aphasia. RIC procedure was completed according to the study protocol in all enrolled 52 patients.Both groups had similar baseline clinical and radiologic findings. NIHSS scores across admission, 24 hours, and discharge timepoints show significant change in the RIC group, while the control group only showed significant NIHSS change between the admission and 24 hour timepoints. The mean MOCA-P scores are 26.5 for RIC group vs control group (25.9). Subgroup analysis for MOCA-P classification showed that RIC group had more normal scores (70.8%) vs control group (65.2%). The control group also had more patients under moderate/severe scores (6.4%). The mean HRQoL score at 90 days for RIC group was 90.6 vs 84.7 for control group. Subgroup analysis showed that the RIC group had a mean pain score of 92.5 vs control group 78.7, which was statistically significant (p

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