Search Results for: Tumore prostata, test della saliva piu’ attendibile del PSA

Stroke, Volume 56, Issue Suppl_1, Page ATP204-ATP204, February 1, 2025. Background:Machine learning and artificial intelligence (ML/AI) are rapidly spreading in clinical medicine. Few data describe the perspectives of patients, proxies (e.g., patients’ spouses), and clinicians. In this mixed-methods study, we qualitatively characterized perspectives regarding ML/AI use and quantitatively explore sentiment towards ML/AI from acute neurology patients, proxies, and clinicians.Methods:We conducted semi-structured interviews with survivors of intracranial hemorrhage, proxies, and clinicians. We analyzed interview transcripts using framework analysis, organizing data within the domains of the Theoretical Framework of Acceptability, adding domains identified with input from all co-authors. We quantitatively analyzed the sentiment scores of responses from positive to negative using a transformer-based model, the same technology that underlies large language models. Sentiment scores were compared with Kruskal-Wallis H, and multiple comparisons adjusted using Dunn’s test.Results:We analyzed 21 interviews (14 patients, 1 proxy, and 6 clinicians), by which point there was thematic saturation. Help with clinical decision-making was cited as the key potential advantage of ML/AI. Participants noted the importance of considering ML/AI as an adjunct to clinical care, not as a replacement for clinicians. Over-reliance on recommendations potentially leading to diminution of clinician skill, incorrect ML/AI recommendations, potential liability, and bias were cited as challenges. Clinician and patient education were noted as potential burdens that impose opportunity costs, but are important for self-efficacy. Median sentiment scores ranged from 0.0 (neutral) to 0.3 (positive). Sentiment varied with question type (P < 0.001). Questions about clinicians’ using ML/AI for patient care had the highest sentiment score.Conclusion:Patients, caregivers, and clinicians expressed mixed views about ML/AI. Concerns related to potential burdens and opportunity costs were noted and should be considered as ML/AI is introduced. Future directions include how best to incorporate ML/AI into education and obviate potential burdens as ML/AI is integrated into clinical care.

Stroke, Volume 56, Issue Suppl_1, Page AWP128-AWP128, February 1, 2025. Introduction:Stroke patients often experience varying degrees of locomotor deficits. Research has shown that physical rehabilitation can help improve these deficits to different extents. Our analysis aims to compare functional outcomes in stroke patients after high-intensity training (HIT) with those achieved through various other exercise intensities.Methods:A comprehensive search of PubMed, Cochrane, Embase, and Scopus databases were performed for studies comparing HIT with low and moderate intensity training (LIT, MIT), or usual activity (UA) in stroke patients. We evaluated changes from baseline in the 6-minute walking test (6MWT), fastest speed, and comfortable speed. Subgroup analyses were performed by exercise intensity and stroke onset, as well as separate analyses according to follow-up periods.Results:12 studies were included, encompassing 1,019 patients, with 54% undergoing HIT. An analysis of ten studies with 860 patients showed that control group had a 49m greater improvement in 6MWT than HIT group (95%CI 21.62-76.38; p

Stroke, Volume 56, Issue Suppl_1, Page ADP57-ADP57, February 1, 2025. Introduction:Neonatal Hypoxic-Ischemic Encephalopathy (nHIE) is a leading cause of infant mortality and long-term morbidity, with males experiencing higher mortality rates and poorer neurological outcomes than females. The underlying causes of this sex difference remains unclear but may be due to sex-specific inflammatory responses to acute brain injury.Hypothesis:We hypothesized that the neutrophil response to neonatal brain injury is sexually dimorphic and contributes to outcomes after nHIE.Methods:We conducted a retrospective study at a single academic institution, analyzing data from 2011 to 2021 (n=310). Inclusion criteria were gestational age ≥ 36 weeks, mild to severe HIE by Sarnat staging, CBC reported within the 1st day of life, and exclusion of concomitant infection (eligible group n= 201). In neonatal mice, we utilized the Rice-Vannucci Model of nHIE at postnatal day 9 (PND9) in C57BL/6 pups. Hypoxic-ischemic injury was induced via permanent ligation of the right common carotid artery followed by 50 minutes of hypoxia (n=14), with controls receiving sham surgeries (n=14).Results:Infants diagnosed with nHIE had significantly higher neutrophil counts than control infants admitted to the NICU within 24 hours after birth. Female infants with nHIE exhibited significantly higher neutrophil counts than males (15.2 vs.10.8 k/cm^3 ,p < 0.01), while there was no sex-difference in the control group (n=109). In PND9 mice, 72 hours after nHIE, females had a higher overall neutrophil count in blood and brain (p < 0.02). Male neutrophils produced significantly higher levels of pro-inflammatory cytokines, including IL-1β and TNF-α (p < 0.03,p < 0.01). Female neutrophils exhibited enhanced neuronal phagocytosis (increased intracellular NeuN, p < 0.03) and higher levels of anti-inflammatory/tissue recovery markers such as AHR and MMP9 (p < 0.02). Lastly, consistent with the dimorphic clinical outcomes observed in neonates with nHIE, female mice exhibited enhanced locomotion compared to males (reciprocal social test, p

Stroke, Volume 56, Issue Suppl_1, Page ATP284-ATP284, February 1, 2025. Enrichment is the prospective use of any patient characteristic to select a study population at higher risk in which detection of a drug effect is more likely than it would be in an unselected population. Patients with post-stroke cognitive impairment (PSCI) found to have higher risk of stroke recurrence in a recently completed meta-analysis. The goal of this study is to test whether PSCI based patient selection may represent enrichment strategy for secondary stroke prevention clinical trial. This is a subgroup analysis of Insulin Resistance Intervention after Stroke (IRIS) trial. In IRIS trial, patients were randomized to receive pioglitazone vs. placebo and had a baseline Modified Mini-Mental State Examination (3MS, where 3MS ≤ 88 was indicative of global PSCI. The primary endpoint of the study was recurrent stroke or MI. We estimated the hazard ratio (HR) for the effect of pioglitazone among those with global PSCI. To determine the sample size for a subsequent trial enriched by including only subjects with global PSCI, we make the following assumptions: (1) time to event follows an exponential distribution in both the pioglizone and placebo groups where the hazard rate for the placebo group is assumed to be the same as in the IRIS trial among those with global PSCI; (2) hazards for the pioglitizon and placebo groups are proportional over the course of the study; and (3) subjects are randomized to pioglitazone or placebo in equal proportions.Data on n = 3,338 patients of original cohort of n = 3,876 were analyzed, and n = 473 among them had PSCI at baseline. During 5-years of follow-up, n=246 patients experienced recurrent stroke, and n = 118 had MI. In patients with PSCI HR was 0.56 (95% CI 0.34 – 0.92) suggesting a 44% reduction in the hazard rate for secondary stroke or MI after 5 years of follow-up in the pioglitizone group compared to the placebo. If we conservatively assume that the true HR = 0.56 (closer to the null of HR = 1 than what was observed in the IRIS trial), then a total sample size of n= 967 willl proivde 90% power using a two-sided log-rank test at the 5% significance level. This conservative sample size corresponds to a 75% reduction in the sample size that was required for the IRIS Trial. PSCI screening may represent enrichment strategy for secondary stroke prevention clinical trial potentially reducing sample size by 75%. PSCI screening-based enrichment can be tested in phase 2 secondary stroke prevention trial.

Stroke, Volume 56, Issue Suppl_1, Page ATP222-ATP222, February 1, 2025. Background:Symptomatic intracranial atherosclerotic disease carries a high stroke recurrence rate. Accurate prediction of stroke recurrence is critical for improving patient outcomes through timely and targeted interventions. Prior studies have shown that impaired distal perfusion is a driver of early recurrence. This study aims to validate T max delay and mismatch as predictors of 30-day ischemic stroke recurrence.Methods:This is a single-center study from a comprehensive stroke center including hospitalized patients with symptomatic intracranial arterial stenosis (50-99%) of the intracranial ICA and proximal middle cerebral artery (M1 or proximal M2). The study outcome was recurrent ischemic stroke by day 30. We determined associations of baseline demographics, vascular risk factors, clinical, laboratory variables, imaging variables, and in-hospital treatments with study outcome. Optimal threshold values for perfusion delay volume and perfusion mismatch volume were identified using the Stata module cutpt by the Liu method. Variables with p

Stroke, Volume 56, Issue Suppl_1, Page ATP202-ATP202, February 1, 2025. Introduction:Early interventions limit morbidity and mortality in ICH patients. Recognizing epidemiological risk factors in local communities helps target specific populations through community education and implement appropriate healthcare delivery measures. We investigated ICH patients presenting and referred to a large “hub and spoke” model comprehensive stroke center in North Texas.Methods:Patients admitted directly to the “hub” hospital (via emergency medical services, EMS or private transportation, PT) and transferred from a “spoke” hospital (ST) were investigated. Door-in-door-out (DIDO) time was used to estimate delay at the referring hospital. ICH score estimated disease severity and modified Rankin score (mRS) at discharge defined patient outcome. Comparison between race/ethnicity [i.e., non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanics (HP)] and mode of presentation [i.e., EMS, PT, ST] were performed using Chi-square test and one-way ANOVA.Results:Of the 448 ICH patients admitted over 2.5 years, 170 (37.9%) were NHW, 146 (32.6%) were NHB, and 106 (23.7%) were HP. HP patients were younger compared to other racial cohorts [NHW vs. NHB vs. HP – 69.5 (IQR, 58.5, 79.0) vs. 58.0 (50.5, 67.5) vs. 56.0 (47.0, 67.0), p

Stroke, Volume 56, Issue Suppl_1, Page AWP298-AWP298, February 1, 2025. Introduction:Oral carriage ofStreptococcus mutans(the main pathogen of dental caries), positive forcnmthat encodes the collagen-binding protein Cnm, is associated with the development of hypertensive intracerebral hemorrhage and increase of cerebral microbleeds (CMBs) in our retrospective observational studies. Herein, we prospectively investigated a relationship between Cnm-expressingS. mutansand increase in CMBs in a longitudinal multicenter cohort study.Methods:We initiated a multicenter, prospective cohort study (RAMESSES:Riskassessment of Cnm-positiveS. mutansinstrokesurvivors; UMIN Clinical Trials Registry: UMIN000045559) in November 2018 with 14 domestic institutions. We included patients who experienced stroke or transient ischemic attack that developed within the past year, and had deep intracerebral hemorrhage or at least one deep CMBs on T2* weighted brain magnetic resonance imaging. The observation period was 2 years. The primary outcome was the number of newly developed deep CMBs between patients with Cnm-positiveS. mutansand those without. The newly developed CMBs were compared by Mann-WhitneyUtest, and the frequency of patients who newly developed CMBs was compared by chi-square test.Results:Out of 227 patients (138 patients with ischemic stroke, 60 patients with hemorrhagic stroke, 23 patients with ischemic and hemorrhagic stroke, 7 patients with TIA, and 2 patients with hemorrhagic stroke and TIA during the past year), the median age was 70 (interquartile range [IQR]: 62–79) years, and the number of women was 63 (27.8%). The number of patients with Cnm-positiveS. mutanswas 34 (15.0%), and that without was 133 (85.0%). Patients with Cnm-positiveS. mutanshad significantly larger number of newly developed deep CMBs over 2 years than those without (0 [IQR, 0–1] vs. 0 [0–0];p= 0.030), and the frequency of patients who had newly developed deep CMBs tended to be higher in patients with Cnm-positiveS. mutansthan in those without (13 [41.9%] vs. 41 [24.7%];p= 0.079). Regarding lobar CMBs, the number (p= 0.22) and frequency (p= 0.22) were comparable between the two groups.Discussion:The 2-year longitudinal prospective cohort study unveiled that Cnm-positiveS. mutanswas significantly associated with increase in CMBs, which validated our previous retrospective studies. These findings may provide guidance for novel prophylactic strategies against Cnm-positiveS. mutans-induced CMBs and intracerebral hemorrhage.

Stroke, Volume 56, Issue Suppl_1, Page ADP56-ADP56, February 1, 2025. Introduction:We discovered a marked upregulation of MMP-12 levels in the brain following an ischemic stroke and demonstrated that reducing MMP-12 levels in otherwise healthy rodents decreases brain damage and facilitates functional recovery. This study aimed to assess the effectiveness of MMP-12 gene silencing in improving sensorimotor function recovery in aged mice and hypertensive rats.Methods:Both male and female C57BL/6 mice (≥16 months old) and male spontaneously hypertensive rats (SHRs) (2-3 months old) were subjected to 35-min and 1-h transient right middle cerebral artery occlusion (MCAO), respectively. Appropriate cohorts of animals (25 mice/group; 18 rats/group) received either control shRNA or MMP-12 shRNA plasmids (1 mg/kg) formulated as nanoparticles that were administered intravenously via tail vein 2 h after reperfusion. In mice, stroke symptoms were evaluated using the neurological deficit score at 2-4 hours and 1 day after reperfusion, while the modified neurological severity score was used in rats. Sensorimotor functions were assessed using the sticky tape test, pole test, and rotarod test at baseline (before MCAO) and at regular intervals post-MCAO (days 3, 5, and 7 in mice, and days 1, 3, 5, 7, and 14 in rats).Results:MMP-12 expression in the ischemic brain was significantly increased by 35-min MCAO in aged mice and 1-h MCAO in SHRs, as was previously observed in healthy young mice and rats that were subjected to 1-h and 2-h MCAO, respectively. In comparison to the control shRNA treatment, MMP-12 shRNA treatment facilitated a greater mean recovery of somatosensory function in aged mice (sticky tape latency was significant on day 3 and day 5; sticky tape interaction was significant on day 5) and in SHRs (sticky tape ratio was significant on day 14). Furthermore, MMP-12 shRNA treatment resulted in a greater mean recovery of motor function across all tested time points in aged mice (pole descent score was significant on day 7; rotarod latency was significant on day 7) and in SHRs (rotarod latency was significant on day 5 and day 14).Conclusions:Reducing MMP-12 expression in the ischemic brain facilitates the recovery of both somatosensory and motor function in aged mice and hypertensive rats after transient focal cerebral ischemia. Our findings further reinforce the potential benefits of MMP-12 gene silencing as a therapeutic approach for improving recovery outcomes in stroke patients.

Stroke, Volume 56, Issue Suppl_1, Page ATP5-ATP5, February 1, 2025. Introduction:Successful clinical trials demonstrate that new treatments are safe and efficacious. Adequate representation of underrepresented groups within clinical trials is important to build trust in research institutions and promote fairness in research. We sought to investigate whether participants in recently completed NIH StrokeNet trials were representative by race and sex compared to the expected trial population estimated from a population-based stroke study.Methods:Since 2014, in collaboration with NIH StrokeNet, we have prepared feasibility analyses for proposed clinical trials. Thus far, 3 trials have been completed: ARCADIA, DEFUSE 3, and MOST. Our analyses used data from the 2010 epoch of the Greater-Cincinnati/Northern Kentucky Stroke Study (GCNKSS). DEFUSE 3 and MOST investigated acute treatments for ischemic stroke while ARCADIA investigated secondary stroke prevention therapies. Each study’s inclusion and exclusion criteria were applied to the GCNKSS population and a percentage of eligible patients was generated. Retrospectively, we calculated the proportion of those eligible patients by race and sex and compared that to the observed proportion from each trial using Chi-square test.Results:In 2010, there were 2265 ischemic strokes, of which 248, 74, and 135 were predicted to be eligible for ARCADIA, DEFUSE 3, and MOST, respectively. The application of the I/E criteria for each trial was limited by data available in GCNKSS, and all proposed exclusions were not able to be accounted for (namely, imaging data for DEFUSE 3 and EKG/TTE findings for ARCADIA). All 3 trials enrolled an expected number of females but DEFUSE 3 enrolled less Black participants than would have been expected (O:E ratio 0.3, p-value

Stroke, Volume 56, Issue Suppl_1, Page ATP270-ATP270, February 1, 2025. Introduction:Syphilis is associated with increased risk of cerebrovascular disease and acute stroke; stroke may even be the initial clinical manifestation of syphilis (Images 1 and 2). In the United States, syphilis rates have been increasing at an alarming rate since 2000, and between 2018-2022 cases increased by nearly 80%. Knowing the infectious status of a patient changes acute and secondary stroke management strategies, and widespread screening is imperative toward national eradication efforts. This study aims to explore syphilis laboratory screening trends in hospitalized stroke patients, whether rates of screening have risen with increases in national cases, and which demographic factors predict screening.Hypothesis:We hypothesized that 1) overall screening for syphilis in acute stroke is low, especially in comparison to screening for diabetes and hyperlipidemia, 2) screening rates increase annually from 2016-2020, and 3) screening for syphilis occurs more often in younger and minority patients.Methods:We reviewed all stroke admissions from a US comprehensive stroke center between 2016-2020 and collected syphilis laboratory data and patient demographics. Of patients without known history of syphilis, we evaluated screening rates of syphilis and compared to that of Hemoglobin A1c (HbA1c) or Low-Density Lipoprotein (LDL) for this period with Student’s t-test. We used logistic regression to determine the relationship between screening rates of syphilis and patient age and race.Results:Between 2016-2020, there were 5,653 stroke admissions without established infection. The average annual screening rate of syphilis (1.19%) was significantly lower than that of HbA1c (58%; p=0.002) and LDL (69.0%; p

Stroke, Volume 56, Issue Suppl_1, Page ATP272-ATP272, February 1, 2025. Background:Certain findings on transthoracic echocardiography (TTE) are associated with a recognized cardioembolic stroke mechanism but less is known about the prevalence of those findings in other subtypes, especially cryptogenic stroke patients. We sought to describe the prevalence of these abnormalities reported on TTE in stroke patients in a large, population-based stroke study and compare the findings specifically of cryptogenic stroke patients to those with the other identified subtypes.Methods:In 2015, the Greater Cincinnati/Northern Kentucky Stroke Study identified all stroke cases in the 5-county area surrounding Cincinnati by ICD 9/10 codes. Potential cases were abstracted by trained study nurses and physician adjudicated, which included assigning ischemic stroke etiology based on our epidemiologic criteria. TTE reports were reviewed. Demographic information, medical history, stroke subtype and prespecified TTE features were collected for each patient and compared across stroke subtype groups. We performed a pair-wise post hoc comparison to the cryptogenic group if a difference was found amongst the groups based on the omnibus test.Results:In 2015, there were 2481 ischemic strokes among patients 18 years or older in our 5-county area. Of these, 677 (27%) were cardioembolic, 312 (13%) large artery atherosclerotic (LAA), 419 (17%) small vessel, 154 (6%) other etiology and 919 (37%) cryptogenic. Of these ischemic stroke events, there were 1503 (61%) with TTE reports available. The severity for diastolic dysfunction, left atrial (LA) dilation, left ventricular hypertrophy and valvular abnormalities were not included in the data analysis. Cardioembolic strokes had significantly higher proportions of LA dilation, mitral and aortic regurgitation, greater LA size and area, and lower left ventricular ejection fraction (LVEF) compared to cryptogenic patients. LAA patients had a higher LA size and lower LVEF compared to cryptogenic patients. The only difference found between cryptogenic and small vessel patients was higher LA size in the latter group.Conclusion:In a large population-based study, TTE findings in cryptogenic stroke patients were less similar to cardioembolic stroke and more similar to other subtypes. While our findings suggest it is less likely to have echocardiographic findings concerning for cardioembolic stroke in the cryptogenic population, further studies on novel and comprehensive cardiac markers are needed to confirm this.

Stroke, Volume 56, Issue Suppl_1, Page ADP29-ADP29, February 1, 2025. Introduction:The potential role of tRNA derived fragment (tRF&tiRNA) in ischemic stroke remains largely unknown. Here, our study discovered the profile of tRFs and tiRNAs in cerebral cortex and clarified the role of candidate tRF, tRF-Gly-GCC, after ischemic stroke.Hypothesis:tRF-Gly-GCC contributes to ischemia injury.Methods:Cerebral ischemia was induced in male young (2-3 months old) and aged (18 months old) C57BL/6 mice using permanent distal middle cerebral artery occlusion (dMCAO). Small RNA sequencing analyses were conducted to explore the differentially expressed tRNA derived fragments. Real-time PCR was performed to confirm relative expression of candidate tRFs and tiRNAs. Regional cerebral blood flow was monitored before and after dMCAO. The infarct volume was verified by magnetic resonance imaging, and neurological functions were assessed using the modified Garcia test. RNA pull-down assays followed by liquid chromatography-tandem mass spectrometry were conducted to analyze the proteins that interact with tRF-Gly-GCC. To determine the role of tRF-Gly-GCC, tRF-Gly-GCC antisense inhibitors (antagomirs) were injected intracerebroventricularly.Results:tRF-Gly-GCC levels were significantly elevated in cerebral cortex after ischemia in both young and aged mice. Administration of synthetic tRF-Gly-GCC antagomirs into the right ventricle significantly reduced the infarct volume in both young and aged mice compared to control antagomir-treated groups. Additionally, tRF-Gly-GCC antagomir improved relative apparent diffusion coefficient values in the peri-infarct region of ipsilateral cortex. Neurological assessments were significantly improved in tRF-Gly-GCC antagomir treated young/aged mice compared to control antagomir-treated groups. To mimic ischemia in vitro, primary astrocytes were exposed to conditioned medium from oxygen-glucose deprivation-treated primary neurons, resulting in increased tRF-Gly-GCC expression in the astrocytes. As a candidate RNA binding protein, PARP9 relative expression was evaluated after ischemia, but not other candidate RNA binding proteins, such as Ykt6, hnRNPA1 and Tardp. Moreover, PARP9 expression was decreased in tRF-Gly-GCC antagomir treated group compared to control group.Conclusions:In conclusion, tRF-Gly-GCC aggravated ischemic injury, suggesting that it may serve as a potential therapeutic target for cerebral ischemia.

Stroke, Volume 56, Issue Suppl_1, Page ATP216-ATP216, February 1, 2025. Introduction:Patients with atherosclerotic carotid artery disease are at high risk of mortality in the long-term follow-up after carotid endarterectomy (CEA), partly due to dysrhythmia. Atrial fibrillation (AF) is a common cardiac dysrhythmia linked to stroke and cardiovascular events. An artificial intelligence-based electrocardiogram (ECG) AF algorithm (AI-AF) can effectively identify silent AF. We aimed to assess the effectiveness of AI-AF in predicting mortality in patients with carotid artery disease undergoing CEA.Methods:Patients with carotid artery disease undergoing CEA at Mayo Clinic from 2002-2023 were included if they had >30 days follow-up and an ECG within one year before CEA. The ECG closest to the CEA date was used to calculate AI-AF (probability of AF ranging from 0 to 1). All-cause mortality rates after CEA were obtained from clinical records. The optimal AI-AF cut-off value for predicting mortality was calculated using a receiver operating characteristic curve and the Youden index. Long-term survival after CEA was depicted with a Kaplan Meier plot and compared with the Log-rank test. Univariate and multivariate Cox Regression models were used to assess the predictive value of AI-AF for mortality, adjusting for age, sex, body mass index, diabetes mellitus, hypertension, and hyperlipidemia.Results:A total of 636 patients with a median age of 72 [IQR: 66, 78] years and 414 (65.1%) males were included. The median AI-AF was 0.056 [IQR:

Stroke, Volume 56, Issue Suppl_1, Page ATP4-ATP4, February 1, 2025. Introduction:Current guidelines exclude patients with recent NOAC use from thrombolysis, even if they present during the 4.5hr timeframe. Emerging data suggest there may not be an increased risk of hemorrhagic conversion for patients who receive thrombolysis despite recent NOAC use. At a large urban Joint Commission certified comprehensive stroke center, a retrospective analysis was conducted to identify characteristics of patients excluded from thrombolytic due to NOAC use.Methods:The GWTG database was queried for patients with acute ischemic stroke presenting (time frame) within 4.5 of last known well. A total of 1,933 AIS patients were identified). A total of 5.0 % (n=96) of these patients were excluded due to recent NOAC use. A chi-squared analysis was performed to determine if there was a significant difference based on sex, race, age, history of heart disease and statin use. A pooled T-test analysis was also performed to determine if a significant difference exists between the mRS and NIHSS at baseline and at discharge within the excluded patients group.Results:Patients excluded from IVT due to recent NOAC use were more likely to take cholesterol reducer (67.1% vs 45.6%). The NOAC exclusion group were more likely to have medical co-morbidities including Afib/Aflutter, prosthetic heart valves, CAD/prior MI, heart failure, prior DVT/PE and sleep apnea (Table 1). Both groups had an equal probability of having a history of a previous stroke. There was no statistically significant difference in patient demographics (race, sex,etc.) between the two groups.Among the patients excluded from IVT due to recent NOAC use: 54.2% (n=52) had a normal EF, 10.8 % (n=10) had a thrombus visualized on TTE, 49.0 % (n=47) had a L.MCA stroke. 80.2% (n=77) had plans to restart their AC on discharge: Apixaban 45.8% (n=44), Rivaroxaban 11.5% (n=11) and Dabigatran 2.1 % (n=11). The median mRS at baseline was 1 and at discharge was 4.Conclusion:Patients excluded from IVT due to recent NOAC use were more likely to have cardiovascular co-morbidities. If NOAC exclusion is removed in the future, 1 in 20 patients could potentially become eligible for IVT, and MRS worsening due to stroke can potentially be avoided.

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 ATP263-ATP263, February 1, 2025. Introduction:Children with arteriopathy are at an increased risk to develop ischemic stroke that can lead to lifelong neurological deficits. Blood pressure is an important modifiable factor associated with poor neurological outcomes. However, there is a lack of sufficient evidence to provide patient specific blood pressure guidelines post pediatric ischemic stroke.Objective:We aimed to evaluate blood pressure averages and changes in pediatric patients with arteriopathy within the first 48 hours in intensive care after an arterial ischemic stroke.Method:We conducted a retrospective study of children diagnosed with acute arterial ischemic stroke admitted to the pediatric intensive care unit (PICU). We reviewed data on demographics, clinical outcome, radiologic, hemodynamic signs, and medication within PICU. Ischemic lesion volume size was obtained from Diffusion-Weighted Imaging by a full-trained neuroradiologist. Blood pressure percentile was obtained based on age, sex, and the 50thheight rang. We also contrasted blood pressures of stroke patients with age and admission year matched controls without a history of stroke. We used linear regression to model blood pressure trends, t-test to compare continuous data, and chi square analyses to compare discrete data points.Results:Forty-five patients (49% female, median age 7.8 years, range age 17 years) were included. Arteriopathy disease included Dissection, Moyamoya, Focal Cerebral Arteriopathy and Vasculitis. Despite only a minority of patients being on vasoactive medications, patients with arteriopathy had higher blood pressures compared to age-matched control PICU patients in the first 48 hours. In addition, 31% of arteriopathy patients had an average systolic blood pressure greater than the 95thpercentile for the first two days after an acute arterial ischemic stroke, versus only 14% of their control (p-value < 0.05). Neurological deficits and increased brain ischemic lesion volume were associated with higher blood pressures.Conclusion:Understanding blood pressure trends and outcomes after an ischemic stroke in children at risk is crucial to guide the management of this modifiable factor. Blood pressure in children with arteriopathy is increased after an ischemic stroke compared to controls admitted to PICU. Further research into the etiology of differences observed here and blood pressure management is crucial to reducing the burden of pediatric ischemic stroke on this at risk population.