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

Stroke, Volume 56, Issue Suppl_1, Page AWP211-AWP211, February 1, 2025. Introduction:Physical and occupational therapy are a standard of care for in-hospital stroke patients. The Activity Measure for Post-Acute Care (AMPAC) daily activity and basic mobility scores, a measure of functional ability, are used to assess the need for rehab time while hospitalized. Previous studies demonstrate that AMPAC predicts a patients discharge disposition (DD). This study aims to evaluate whether NIHSS, AMPAC or total rehab duration while hospitalized predicts DD or length of stay (LOS).Methods:Data from adult patients who discharged from two medical centers in Portland, OR in 2019 or between January 2022 and May 2023 were abstracted from electronic medical records. Inclusion criteria was a diagnosis of ischemic stroke or intracerebral hemorrhage (ICH). Patients were excluded from the analysis if they:Had a diagnosis of subarachnoid hemorrhage or traumatic ICH.Died in-hospital or entered hospice within 7 days of arrival.Had concurrent acute disease at arrival that was determined to impact rehab.The primary outcomes were DD and LOS. We dichotomized DD as “good” (home, inpatient rehab) or “poor” (hospice, left against medical advice, acute care facility, intermediate care, and skilled nursing facility). Generalized linear models were used to test if cohort year, arrival NIHSS, 1stAMPAC score, and rehabilitation time associated with DD and LOS. Two-tailed p value of less than 0.05 was considered statistically significant.Results:More rehab minutes were documented for the 2019 cohort [178 (105, 320) vs. 115 (78, 195) Table 1]. We found no differences between NIHSS at arrival or 1stAMPAC score. Our model showed that NIHSS at admit (OR = 0.94, CL: 0.90-0.99, Table 2) and 1stAMPAC score (OR = 1.2, CL: 1.2-1.3, Table 2) were significant predictors of a good DD. 1stAMPAC was also a predictor of shorter LOS (β = -3.8, CL: -5.8 to -1.9, Table 2).Conclusions:AMPAC was the most predictive measure of a good discharge disposition. These findings highlight the continued importance of AMPAC in predicting discharge outcomes and suggest that variations in rehabilitation minutes and hospital stay do not substantially impact discharge disposition.

Stroke, Volume 56, Issue Suppl_1, Page AWP232-AWP232, February 1, 2025. Background:Intracerebral hemorrhage (ICH) is a critical neurological condition with high rates of mortality and morbidity. Accurate prediction of the clinical outcomes in ICH patients is essential for effective clinical management. Intravenous contrast extravasation, also known as spot sign, identified in conventional vascular imaging, has emerged as a significant radiological marker associated with hematoma expansion, potentially influencing mortality and functional outcomes.Aim:We aim to elucidate the predictive value of the spot sign for mortality and poor functional outcomes in patients with ICH.Methods:We searched for studies in PubMed, Embase, and Cochrane Library databases. Our inclusion criteria focused on studies assessing mortality and poor functional outcomes (mRS score 3-6) in adult groups with and without a sign spot in head imaging after ICH. We pooled the odds ratio (OR) for both outcomes using random effects and assessed publication bias through Egger’s test, adjusting while using trim-and-fill analysis. Heterogeneity was measured throughI2. We also conducted bivariate random-effects models using Bayesian Information Criteria (BIC) to determine pooled sensitivity and specificity for both outcomes. Results are presented with a 95% Confidence Interval (CI).Results:We included 29 studies comprising 4,597 patients, with a mortality and poor functional outcomes rates of 21.2% and 47.8%, respectively. Spot sign was consistently identified as a robust predictor of outcomes across multiple studies. For mortality, the pooled specificity was 0.821 (95% CI [0.782-0.855];I2=23.44%) with low sensitivity at 0.468 (95% CI [0.391-0.547];I2=32.3%). For poor functional outcomes, the specificity was 0.876 (95% CI [0.815-0.920];I2=48.5%), and the sensitivity was 0.369 (95% CI [0.295-0.451;I2=32.7%). Spot sign significantly increased the odds of both outcomes. After adjusting for publication bias, the OR for mortality was 3.37 (95% CI: 2.41-4.71;I2=73.2%). For poor functional outcomes, OR was 4.13 (95% CI: 3.15-5.42;I2=33%).Conclusion:Spot sign visualized in conventional vascular imaging is a highly specific radiological biomarker for predicting mortality and poor functional outcomes in patients with ICH. Recognizing this sign should prompt immediate yet targeted interventions to improve patient survival and recovery. However, fully adopting this biomarker for mortality outcome prediction requires further analysis of heterogeneity sources.

Stroke, Volume 56, Issue Suppl_1, Page ATP58-ATP58, February 1, 2025. Background:Stroke is a leading cause of disability and death. The use of intravenous (IV) thrombolytics, such as alteplase and tenecteplase (TNKase), for acute ischemic stroke (AIS) is a standard of care. Tenecteplase has been recommended as an alternative agent to alteplase. In November 2020, the use of IV TNKase for AIS at a standard 0.25mg/kg dose was implemented at a small community hospital within a large integrated healthcare system. The use of TNKase without the required infusion may expedite admission to the intensive care unit (ICU).Purpose:The aim of this retrospective comparative review was to ascertain the effects of IV TNKase, compared to IV alteplase, on average length of stay (LOS) in the emergency department (ED) and time of ED to admission to the ICU (ED to floor).Methods:A total of 155 electronic patient charts were reviewed from January 2018 to June 2024. An unpaired t-test was used to determine thepvalue. Thepvalue of < 0.05 was considered statistically significant.Results:There were no significant differences in the age and sex between the alteplase and TNKase patients. The average LOS and ED to floor measure were also not significant between the two groups (3.24 versus 2.87 hours,p= 0.11; 79.7 versus 63.4 minutes,p= 0.20, respectively). When examining the ED to floor measure from a different perspective, there was a significant improvement in the percentage of patients admitted to the ICU within 60 minutes – 54.3% (2018 – 2020) to 72.7% (2021 – 2023) to 85.7% in 2024.Conclusion:There have been numerous trials and studies published on the use of IV TNKase for AIS with promising results. The single bolus IV TNKase dose given over 5 seconds is an attractive nursing workflow. Without the use an infusion, post-TNKase patients may be admitted sooner to ICU. Reducing ED LOS improved throughput in a small often overcrowded ED. Additional in-depth reviews and data analysis would be needed to examine patient characteristics and clinical conditions, variations in workflow, operational needs, staffing, and documentation accuracy contributing to ED LOS and ED to floor measure.

Stroke, Volume 56, Issue Suppl_1, Page AWP263-AWP263, February 1, 2025. Introduction:Despite evidence showing overall improvement of post-stroke outcomes following endovascular therapy (EVT), existing literature on comparative recovery rates of different stroke deficits is limited. We hypothesized that the rate of change in aphasia may vary compared to other neurological deficits in stroke patients post successful EVT.Methods:We performed a retrospective analysis of acute stroke patients at a single comprehensive stroke center who presented with aphasia and underwent EVT from 2022 to 2023 (n=122). Total and itemized NIHSS scores were documented at three separate timepoints: admission, immediately post-EVT, and at discharge; NIHSS scores were normalized by dividing each score by its maximum possible value. We also investigated the NIH Cog-4 and Motor-6 as summative scores representing domain specific cognitive and motor deficits, respectively. We analyzed the effects of TNK and successful reperfusion (TICI 2B to 3 vs 0 to 2A) on the normalized stroke deficit scores with a linear mixed-effect regression model adjusted for measurement timepoint with subjects as a random effect. We extracted each variable’s beta coefficient, representing the variable’s average effect on NIH score (e.g. average change in score from admission to post-EVT). Recovery was represented by percent changes in beta coefficient by successful vs unsuccessful reperfusion. We also evaluated the percent change in beta coefficients with a stratified analysis of ≥ TICI 2B using permutation testing (500 permutations) to test the null hypothesis that there are no change in beta coefficients between subgroups (p

Stroke, Volume 56, Issue Suppl_1, Page ATP401-ATP401, February 1, 2025. Background and Purpose:In the current era, where mechanical thrombectomy (MT) has become the gold standard for treating large vessel occlusions in acute ischemic stroke, the role of intravenous tissue plasminogen activator (tPA) remains pivotal. It is well-established that pre-thrombectomy administration of tPA can enhance recanalization rates and excellent outcomes, leading to an increased adoption of this combined treatment approach. Understanding how tPA alters clots occluding large vessels is of crucial clinical importance for improving outcomes in thrombectomy when tPA is combined. This study seeks to elucidate the temporal changes in clots characteristics post-tPA administration, providing insights that could optimize the timing and strategy of subsequent mechanical intervention.Methods:We utilized a modified Chandler loop technique to generate RBC-rich clots from ovine blood for simulating clot analogs. The clots were treated with 10 μg/ml concentration of Alteplase to evaluate clot dissolution. An in-vitro MCA occlusion model, replicating human neurovascular anatomy, was used to assess the impact of clot treatment under dynamic flow conditions. Clots were analyzed for weight changes before and after treatment, and detailed pathological analyses were conducted using advanced imaging techniques. Statistical significance was determined using Student t test and 2-way repeated-measures ANOVA, with p-values

Stroke, Volume 56, Issue Suppl_1, Page AWP213-AWP213, February 1, 2025. Intracerebral Hemorrhagic (ICH) stroke is the second most common type of stroke and its aftermath is often more severe than ischemia. Recent population data has shown increasing trends of ICH in middle aged people, contributing to the economic burden of society. In order to improve post ICH outcome, immediate therapeutic interventions should be administered. Hence, our research is looking into the effects of electrical stimulation of the perihematomal cortex in the hyperacute/acute phase post ICH. The end goal is to test improvement in outcomes of subjects post the administration of such a stimulation paradigm by using the observations in experimental data to validate the theoretical model and hence design a closed loop stimulation paradigm. The two approaches in the work:Experimental:Hemorrhagic stroke is induced in minipigs by injecting 2cc of blood into the ventricular space beneath sensorimotor cortex to simulate an ICH. We insert ultra flexible microelectrodes in this region to record cortical neuronal activity and administer stimulation. Neural activity (Electrophysiological) data is collected pre/post stroke and during stimulation. The data collected is analyzed to understand changes in neural activity at different points in time. Through preliminary data analysis, we could clearly see the changes in the statistics of neural activity (pre/post ICH InterSpike Interval (ISI) histogram and firing frequency histogram). Local connectivity changes were observed in the data. Further removal of stimulation artifacts and analysis of neural data before, during and after stimulation shall be performed to understand the changes that occur during stimulation.Theoretical:We have mathematically modeled a neuron-astrocyte-vascular system in the cortical perihematoma by extending Hodgkin-Huxley biophysics to simulate pre/post acute ICH and electrical stimulation paradigms in such conditions. The results obtained help us understand the changes in the system dynamics post ICH with bifurcation analysis giving unique outlook of the complex system. The simulated data shows increase in excitability of perihematomal tissue during acute phase. Further, the model also showcases calcium ion dyshomeostasis and problems in ATP production and consumption. Normal stimulation paradigms are shown to not work in such settings. Further exploration of the intricacies of the system is at focus to better understand electrical stimulation in such cerebrovascular conditions.

Stroke, Volume 56, Issue Suppl_1, Page ATP45-ATP45, February 1, 2025. Introduction:Standardized cognitive assessments such as the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) are generally administered using paper-and-pencil methods. Technological advancements have digitized these exams and expanded cognitive testing capabilities in the post-stroke population.Methods:Studies from 2010-2022 were identified from PubMed, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar to include digital cognitive assessments utilized for acute and chronic ischemic and hemorrhagic stroke patients. The research questions aim to evaluate technical aspects of digital tests, digital tool effectiveness, cognitive domains assessed, study population characteristics, patient usability, and exam feasibility. The methodological framework for this review included research question identification, relevant study collection, final study selection, data extraction, analysis, and summary. Covidence was used to compile relevant studies.Results:72 articles were included for final analysis. 8 different digital methods (e.g., tablet, computer, virtual reality) were used to assess cognition, with 26 studies creating a new cognitive test and 24 creating a cognitive test based on a standardized exam. Participants were tested in both acute and chronic phases (5 strictly in acute, 55 strictly in subacute/chronic, and 11 in both). 58% of articles assessed ischemic and hemorrhagic stroke participants, and 9 studies only tested aphasia patients. Exams consisted of a variety of cognitive domains, with the majority of studies testing multiple domains (e.g., executive functioning, attention, and visuospatial processing), and some studies testing only one cognitive domain. The average rate of digital test completion was 95%. Validation of the digital tool was compared with a standardized, paper-and-pencil test (e.g., MOCA, MMSE) in 48 articles (67%). An overall positive satisfaction with the digital test was seen in 8 articles that incorporated patient questionnaires.Conclusion:This review suggests that post-stroke digital cognitive assessments are feasible in the acute and post-acute settings across multiple domains similar to the MOCA and MMSE. Enhancements in these tools will expand access to testing and allow for increased identification of post-stroke cognitive impairment.

Stroke, Volume 56, Issue Suppl_1, Page ATP42-ATP42, February 1, 2025. Introduction:Aging and chronic cerebral hypoperfusion (CCH) are major risk factors for Vascular contribution to cognitive impairment and dementia (VCID), which is a heterogeneous group of disorders characterized by cognitive deficits secondary to cerebrovascular pathology. Importantly, patients with CCH show enhanced brain iron deposition and iron metabolism dysregulation, which have been associated with different types of dementia and neurodegenerative disorders, such as Alzheimer’s disease, Huntington’s disease, VCID, etc. Recent studies have proposed different mechanisms involved in VCID induced by CCH in young small rodents. However, no study has elucidated the molecular changes that occur in CCH models using aged animals. Thus, we hypothesize that brain iron metabolism is dysregulated in an aged mouse model of VCID.Methodology:We induced CCH through bilateral carotid artery stenosis (BCAS) by ligating carotid arteries with 0.18 mm diameter coils in 17-18 months C57BL/6 mice of both sexes. Sham mice underwent the same surgery without coil ligation. After surgery, mice were maintained for 5 months; then, they were tested for open field, elevated plus maze, and fear conditioning. After behavior tests, their brains were analyzed for histochemistry analysis and qPCR.Results:We observed that BCAS mice showed increased velocity (p=0.016) and distance moved (p=0.009) in the open field test, and they showed a higher number of visits to open arms (p=0.026) in the elevated plus maze, compared with sham mice. Furthermore, the percentage of freezing time in the fear conditioning test was significantly reduced in BCAS mice (p=0.037), compared with sham mice. We also found that the number (p=0.039) and size (p=0.003) of iron deposits increased in the striatum of BCAS mice, compared with sham mice. Interestingly, the relative expression of genes involved in iron metabolism such asNcoa4(codes mediator of ferritinophagy) andFtl1(coding for iron storage protein ferritin light-chain), were significantly reduced (p=0.007, p=0.001, respectively) in the striatum, but not in the cortex, of BCAS mice, compared with sham mice.Conclusion:Our data indicates that BCAS mice showed enhanced anxiety-like behavior and impaired conditioning memory, increased iron deposition, and impaired iron metabolism in their striatum, compared with sham mice. Next, we will determine if restoring brain iron metabolism in BCAS mice can mitigate CCH-induced phenotype.

Stroke, Volume 56, Issue Suppl_1, Page ATMP9-ATMP9, February 1, 2025. Background:Intracranial Atherosclerosis carries a high recurrence rate. Single center studies have shown that impaired distal perfusion is a driver of early recurrence. In this study, we aim to identify predictors of 30-day ischemic stroke recurrence in a multicenter cohort.Methods:This is a pooled analysis of individual patient data from four comprehensive stroke centers of 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 compared baseline demographics (age, sex, race, ethnicity), vascular risk factors (hypertension, hyperlipidemia, diabetes, atrial fibrillation), NIHSS score, last known well to arrival, home medications (aspirin, anticoagulation), imaging variables (prior infarct in territory, degree of stenosis, perfusion delay volume, borderzone infarct pattern), and in-hospital treatments (thrombolysis, dual antiplatelet therapy, statin, permissive hypertension). Variables with p

Stroke, Volume 56, Issue Suppl_1, Page ATP46-ATP46, February 1, 2025. Background:Modifiable lifestyle factors such as diet and genetic predisposition influence cognitive aging. The Mediterranean diet (MeDi) is associated with healthy brain aging while the Western diet (WD) is associated with cognitive impairment. Genetics may interact with dietary patterns to further impact cognitive function through the gut-brain axis. The objective of this study was to determine the effect of the MeDi on cognition and fecal metabolites relative to the WD as animals age in genetically distinct wild-type strains.Methods:Ten-week-old Male Fischer344 (F344; in-bred) and Sprague Dawley (SD; out-bred) rats were randomized to a MeDi or WD (n=8/group/strain). Y-maze and Morris water maze (MWM) were completed at 3.5, 9.5, and 15.5 months of diet to test spatial reference memory. Fecal samples for metabolomics were collected prior to behavioral assessment at 3.5 and 15.5 months. Data were analyzed using a Student’s t-test with false discovery rate of 0.1 or Two-Way Repeated Measures ANOVA, where appropriate.Results:There was no difference for Y-maze by Diet for F344 or SD rats. For MWM, there was no difference in latency to reach the platform by Diet for either strain at 3.5 or 9.5 months. However, at 15.5 months of diet, the F344 MeDi rats had a shorter latency compared to the F344 WD rats. Latency for SD rats did not differ by Diet. At 3.5 months, fecal metabolomics demonstrated 6 and 5 differing metabolites by Diet for F344 or SD rats, respectively. This increased to 202 and 139 at 15.5 months by diet for F344 or SD rats, respectively. There were 99 metabolites that overlapped by strain including an increase in deconjugated bile acids with the MeDi relative to the WD. Interestingly, the F344 had an additional 103 metabolites that were different between diets, including pathways related to glycolysis, tryptophan metabolism, and hormone production such as lower cortisol with the MeDi relative to the WD.Conclusion:Duration of diet and strain is an important factor in cognitive function and fecal metabolomics. The effect of diet on cognition was only evident at 15.5 months with the MeDi demonstrating better cognitive function relative to a WD within the F344 strain. Fecal metabolite differences increased with diet duration with greater differences found by diet in the F344 rats at 15.5 months. These metabolic and inflammatory pathway differences may be an indicator of related mechanisms contributing to the cognitive differences in F344 rats.

Stroke, Volume 56, Issue Suppl_1, Page ATP48-ATP48, February 1, 2025. Introduction:Vascular cognitive impairment and vascular dementia are diagnosed based on brain vascular changes related to strokes. However, the change in cognitive function in the same individual before and after strokes is not well-documented especially among Hispanics. We examined the intra-individual cognitive performance before and after an incident stroke in a longitudinal cohort of Hispanics (Cameron County Hispanic Cohort (CCHC)). CCHC participants were recruited randomly for reasons other than strokes and were followed every 5 years for up to 20 years.Methods:We conducted a prospective study to measure cognitive function changes among those presented with incident stroke. Strokes were self-reported and we used mini-mental score test (MMSE) to asses for cognitive impairment at each visit. Incident strokes were identified after excluding all those who reported the presence of a stroke at their first visit. We measured intra-individual cognitive performance via paired student t-test by comparing MMSE scores before and after incident stroke in the same individual. We conducted a prospective longitudinal study using mixed linear models adjusted for age and education to assess for associations of MMSE scores with several cardiometabolic indicators among those who had an incident stroke. All analyses were preformed using R software.Results:We identified 87 incident strokes (total N=4692) in the CCHC. Subjects with strokes had a mean (sd) age of 61.4 (13.9) and a mean (sd) MMSE score of 26.7 (4.47). Over half of the subjects with strokes were females (55 (63.2%)), diabetic (44 (50.6%)), hypertensive (58 (66.7%)), and had metabolic syndrome (44 (50.6%)). Although the mean (median) MMSE scores for after strokes (25.50(27.00)) were lower compared to pre strokes (26.16(28.00); there were no statistically significant changes in the intra-individual MMSE scores before and after strokes (p value >.05). Mixed linear models adjusted for age and education showed that diabetes (Beta: -1.4, 95%CI: – 0.14 – -2.73) to be significantly associated with a lower cognition function in those with strokes.Conclusions:Although there were no significant changes in intra-individual MMSE scores before and after a stroke; our adjusted models showed that diabetes was significantly associated with a lower cognitive function among our stroke cohort. The use of self-reported strokes, and our small sample size might bias our results towards the null.

Stroke, Volume 56, Issue Suppl_1, Page AWP262-AWP262, February 1, 2025. Introduction:Early prediction of final infarct volume is a vital component of clinical recovery. Ischemic infarct volume is an independent predictor of stroke prognosis with larger volumes nonlinearly correlating to worse outcomes. Virtual non contrast imaging (VNC) is a dual-energy computed tomography head (CTH) utilized in differentiating post-thrombectomy contrast staining from hemorrhage due to reperfusion injury. Studies show VNC improves visualization of early infarcts and can be a reliable predictor of final infarct volume. This study investigates difference between initial VNC infarct and final CTH infarct volumes as well as association with modified Rankin Scale (mRS).Methods:This is a retrospective, observational, single-center study of 14 patients who underwent mechanical thrombectomy for acute ischemic stroke between January 2023 and August 2024. Inclusion and exclusion criteria and exclusion flowchart are listed in Figure 1 and 2, respectively. Demographics, National Institute of Health Stroke Scale (NIHSS) and mRS data were extracted from the electronic medical record. Infarct volumes on initial VNC and final CTH were measured using the ABC/2 or ABC/3 formula for ellipsoid or irregular infarcts, respectively. Statistical analysis was conducted with a paired t-test (p-value

Stroke, Volume 56, Issue Suppl_1, Page AWP287-AWP287, February 1, 2025. Introduction:Effective blood pressure (BP) control post-stroke is a critical secondary prevention strategy. Research shows that social determinants of health (SDOH) may influence this process by addressing underlying factors contributing to health disparities. We conducted a secondary analysis using data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study to investigate the cumulative effect of multiple SDOH domains on BP reduction in stroke survivors, with a particular focus on sex-specific outcomes.Methods:We applied the Healthy People 2020 framework to identify SDOH across the following domains: economic factors, education, social context, healthcare access, and neighborhood characteristics. Stroke survivors in the DESERVE skill-based intervention study completed a 6-month follow-up (n=361) and were classified into two groups based on the number of negative factors:

Stroke, Volume 56, Issue Suppl_1, Page AWP281-AWP281, February 1, 2025. Introduction:Determining ischemic stroke etiology using transthoracic echocardiography (TTE) is often considered to be a standard part of routine stroke care and secondary prevention of stroke. However, TTE’s are not always readily available, can delay hospital discharge, and increase the cost of each hospitalization. Identifying which patients specifically benefit from TTE’s could optimize resource allocation. The aim of the study is to develop a model using machine learning methods to confidently identify patients unlikely to have an actionable finding with enough statistical certainty to defer an inpatient TTE.Methods:The model was developed using 874 patients admitted for stroke/TIA from 2017-2018 and was validated on another data set of 200 patients randomly selected from 2017-2018 from a different institution. 23 variables were considered as potential inputs for the model, which was developed using logistic regression. All variables except six were truncated from the model based on coefficient magnitude and adjusted to be the same low-term improper fraction for simplicity. This model was internally validated using a 5-fold cross-validation and was then tested on an external validation data set with performance being compared to other standard machine learning models.Results:The training/test data consisted of 874 patients (52.9% male; median age 64 years). Validation data set consisted of 200 patients (53.5% male; median age, 63 years). For the final model, termed ALO2HA, mean AUC on the training/test data across five-fold cross validation was 0.79 (95% CI, 0.74 – 0.84). The model consisted of six variables, and one point was awarded for each: atrial fibrillation, large artery atherosclerosis, large vessel occlusion, obesity, prior anti-hypertensive medication usage and if patient’s age was 18-39 or > 69. Risk of positive findings was 6.2% for score of 0, 26.1% for score of 1, 65.0% for score of 2, 90.7% for score of 3, 98% for score of 4, and 99.7% for score of 5 or greater. When tested on the external validation data set, AUC was determined to not be significantly different than the AUC for the training/test data.Conclusion:The ALO2HA model is a clinical tool which can stratify which patients admitted for acute ischemic stroke/TIA are more likely to benefit from inpatient TTE’s.

Stroke, Volume 56, Issue Suppl_1, Page AWP251-AWP251, February 1, 2025. Chronic subdural hematoma (cSDH) represents a relatively treatment-resistant pathologic process with a large impact on quality-adjusted life years. This risk is increased in the elderly, and the prevalence is expected to rise as the population ages. Expectant management and classical surgical treatment are associated with increased recurrence rate as well as complications. Middle meningeal artery (MMA) embolization is being utilized more frequently as adjunctive and primary treatment. It has demonstrated beneficial effects on recurrence and progression of cSDH. Here, we present the outcomes of this technique with different embolic agents in our patient population.IRB approval was obtained for this study. Retrospectively, all patients at a single institution who underwent endovascular MMA embolization with or without open surgical intervention for cSDH were included. Vulnerable populations were excluded. Demographic and medical data were collected at initial, 1-month, and 3-month time points if available and analyzed for differences with unpaired T-test, paired-T test, and chi-square test.Between 2020 and 2024, a total of 50 patients were treated with MMA embolization for cSDH. Mean age was 73 years. Majority were male. Most were on antithrombotic therapy. Of these, 34 had history of prior SDH, and 38 had history of head trauma. Of the 50 patients, 29 patients underwent combined open surgery and MMA embolization, while 21 underwent MMA embolization alone. The cSDH was bilateral in 23 patients and unilateral in 27 (13 right, 14 left) for a total of 73 cSDHs. Surgical evacuation was performed in 44 cSDHs. Liquid embolic agent (Onyx) was utilized for 32 patients, while particulate embolic agents (250-500 um) were utilized for 18 patients. Of the patients who had follow-up CTs at 1 month, there were 21 cSDHs treated with particles and 39 with Onyx. There was no significant difference in the proportions of patients undergoing surgery in addition to MMA embolization between the groups treated with Onyx and those treated with particle embolization. Additionally, there was no significant difference in the proportions of treated hemispheres with ≥ 50% reduction or ≥ 75% reduction between those treated with Onyx and those treated with particles.At our institution, there was no difference in reduction of cSDH with Onyx as compared to particle embolization. MMA embolization was associated with no recurrence or progression of cSDH at 3 months.

Stroke, Volume 56, Issue Suppl_1, Page ATP41-ATP41, February 1, 2025. Background:Our studies show that intracerebroventricular (ICV) infusion of IGF1 is neuroprotective in the acute phase of stroke but does not reduce peripheral inflammation or improve cognitive function in the chronic phase. In contrast, intraperitoneal (IP) injection of IGF1 did not improve acute phase recovery, but reduced stroke-induced elevation of plasma inflammatory cytokines, repaired the gut epithelium and attenuated stroke-induced cognitive impairment. Here we evaluated the extent of chronic neurodegeneration after stroke and the impact of IP versus ICV treatment with IGF-1.Method:Middle-aged female rats were subject to MCAo and treated with either ICV-IGF1 or IP-IGF1 4h after stroke. Animals were tested for cognitive impairment using the Barnes Maze test 30 days later and terminated thereafter. Brains were collected and processed for block embedding and sectioning. One set of sections was stained for Weil myelin and imaged using an Olympus VS120 Slide Scanner. For each section between bregma 2.52 and -5.88, the left and right hemisphere was manually outlined and measured (QuPath 0.4.3) to obtain hemisphere volume (μm 3 ). Lateral ventricle in each hemisphere was calculated using slices between bregma 1.56 and -5.88. For callosal thickness, the average dorsal to ventral margin was measured at the midline in 5 sections of the corpus callosum (0.6 mm apart; bregma 0.3 mm to −0.9 mm).Results:Histological analysis showed significant reductions in the volume of the ischemic hemisphere compared to the non-ischemic hemisphere in the ICV-Veh and ICV-IGF1 groups. Similarly, both groups had enlarged ventricles in the ischemic hemisphere. Sham (no stroke) animals did not show any left-right differences in hemisphere or ventricular volume. Corpus callosum width was similar in all groups. In contrast, in the IP-study the volume of the ischemic hemisphere as compared to the non-ischemic hemisphere were similar in all groups, however, ventricular enlargement was seen in the ischemic hemisphere of the IP-vehicle group, but not in the IP-IGF1 or sham groups. Moreover, the midline width of the corpus callosum was significantly reduced in the IP-Veh group, but not the IP-IGF1 group.Conclusions:These data suggest that improved cognition in the IP-IGF1 is associated with preservation of the gray and white matter structures. These data also indicate that targeting peripheral organs such as the gut presents a fresh approach to enhancing brain health in aging females.