Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATMP32-ATMP32, February 1, 2025. Introduction:Facilitating evidence-based uptake of new medication regimens for disease prevention is a well-recognized public health challenge. Using data from GWTG-Stroke, researchers previously reported that, after minor ischemic stroke (NIHSS 0-3), the use of aspirin-clopidogrel for stroke prevention is highly variable despite guideline recommendations. We sought to explore potential changes in dual antiplatelet therapy (DAPT) use in patients with moderate ischemic stroke (NIHSS 4-5) after the publication of the THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial in 2020.Methods:We used the GWTG-Stroke registry to describe patterns of DAPT use in the U.S. from 2019 to 2023. All patients with a final diagnosis of ischemic stroke, NIHSS 4-5, hospital arrival within 24 hours, who lacked an indication for anticoagulation (e.g., atrial fibrillation) and were not treated with thrombolysis/thrombectomy were included in our study. Patients with NIHSS 4-5 (moderate stroke) were not included in prior randomized controlled trials of aspirin-clopidogrel for short-term stroke prevention but were included in THALES. We reported basic demographic features of our cohort and used the Cochran-Armitage trend test to report changes in aspirin-ticagrelor use by year.Results:We identified a total of 40,624 acute ischemic stroke patients with NIHSS 4-5 during the study period. The mean age was 68 years and 47% of patients were women. We found that a total of 20,293 (50%) patients were discharged on aspirin-clopidogrel whereas 1,335 (3.5%) were discharged on aspirin-ticagrelor. The use of both DAPT regimens significantly increased over time (Figure 1, p

Stroke, Volume 56, Issue Suppl_1, Page AWP186-AWP186, February 1, 2025. Background and Purpose:Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone leading to the risk of occurrence of acute ischemic stroke (AIS), but the exact prevalence of PA is unknown in patients with AIS. PA induces oxidative stress and inflammation through vascular endothelial cells, which may damage small vessel disease (SVD). We conducted a prospective study to investigate the prevalence of screening and definite diagnosis of PA in patients with AIS. Next, we aimed to reveal whether SVD markers could be associated with PA.Methods:We screened consecutive patients with AIS who participated in our prospective study to investigate the prevalence of PA and followed up for PA evaluation from October 2020 to December 2022. Inclusion criteria were patients with AIS hospitalized and diagnosed with hypertension. Exclusion criteria were patients taking medications affecting renin, aldosterone, and catecholamines. The screening criteria for PA was defined as the aldosterone-to-renin ratio > 200. Final diagnosis of PA was judged by endocrinologist if one of the captopril challenge test, saline infusion test, and furosemide-upright test was positive following discharge. We evaluated total SVD score based on white matter hyperintensities (separately scored by periventricular hyperintensity [PVH] and deep and subcortical white matter hyperintensity), cerebral microbleeds (CMBs; categorized into deep, lobar, and infratentorial lesions), enlarged perivascular spaces (separately scored in basal ganglia and centrum semiovale), and old lacunes on MRI.Results:We included 120 patients with AIS (93 [78%] male, median age 62 years, Figure 1). The screening for PA was positive in 33 (28%) patients and 8 (7%) patients were finally diagnosed with definite PA. In Poisson regression analysis with a robust variance estimator, total SVD score was related to positive PA screening (prevalence ratio [PR] 1.261, 95% CI 1.021-1.556,p= 0.031) and definite PA diagnosis (PR 1.946, 95% CI 1.229-3.082,p= 0.005, Figure 2). In terms of each SVD marker, severe PVH, and deep and lobar CMBs were associated with positive PA screening and definite PA diagnosis (Figure 3).Conclusions:Twenty-eight percent of patients with AIS were positive for PA screening, and then about a quarter of them were confirmed as definite PA. SVD burden, especially PVH, and deep and lobar CMBs, might be associated with positive screening and definite diagnosis of PA.

Stroke, Volume 56, Issue Suppl_1, Page ATMP20-ATMP20, February 1, 2025. Background:Despite the increasing use of intravenous (IV) tenecteplase (TNKase) for acute ischemic stroke (AIS), little is known about the characteristics of patients who suffer intracerebral hemorrhage (ICH) and opportunities to prevent this often-fatal complication.PURPOSE:The aim of this retrospective review was to investigate the characteristics of AIS patients with ICH complication and opportunities in patient management after receiving IV TNKase in the emergency departments (EDs) and to report preliminary results.Methods:Retrospectively, the EHRs that suffered ICH complication after receiving TNKase (0.25 mg/kg) were reviewed from 21 hospitals in a large integrated health system between November 2020 to December 2023. Data collection included demographics, risk factors, blood pressures (BPs), and other variables such as the National Institute of Health Stroke Score (NIHSS), presence and types of large vessel occlusion, and severity of the hemorrhage (symptomatic or asymptomatic).Results:The mean age of the 195 cases was 75.4 (SD = 13.46). There were no sex differences (p=.87). Race breakdown was 50% (n = 98) Whites; 15% (n = 98) Hispanics/Latinos; 20% (n = 39) Asians, and 10% (n = 20) Blacks. Majority of patients (73%) arrived via EMS. History of was present in 75.4% of patients, followed by diabetes (58%), hyperlipidemia (55%), atrial fibrillation (20%), and history of stroke (18%). Anti-coagulants use was 8% (n=17). The initial mean NIHSS in the ED was 11.8 (SD=8.65). On initial presentation, the mean systolic and diastolic BPs was 164 (SD=27.1) and 90 (SD=19.46) respectively. Large vessel occlusions (LVOs) were identified in 35.9% (n=70) of patients. Of the LVO cases (n=70), 68.6% (n=48) of the ICH were asymptomatic.Conclusions:Based on the preliminary results, there were some patient-level risk factors that may have contributed to ICH complications after IV TNKase. Tighter control of BPs with anti-hypertensives before and after IV TNKase may also decrease bleeding risk. There were a few opportunities identified with patient assessment and monitoring. The use of both “full” NIHSS and abbreviated NIHSS varied between facilities, which may have delayed the identification of post-TNKase ICH as the abbreviated NIHSS did not provide a total score to assess for change in patient condition and about 40% of patients did not have an increase in the NIHSS. In-depth data reviews and analysis would be necessary to ascertain clinical significance.

Stroke, Volume 56, Issue Suppl_1, Page ATP320-ATP320, February 1, 2025. Background:The kynurenine (KYN) pathway serves as the primary route for tryptophan (TRP) metabolism and plays a crucial role in the occurrence and development of several nervous diseases. The alterations in this pathway have been confirmed in psychiatric disorders, but their role in stroke remains unclear. This review aims to investigate whether metabolites in the TRP-KYN pathway change in patients with stroke.Methods:We searched PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases for studies that compare the levels of KYN pathway metabolites between stroke and healthy volunteers. The primary outcome of this study was KYN, and the secondary outcome were TRP, kynurenine/tryptophan ratio (KYN/TRP), and kynurenic acid (KYNA). The Stata software was utilized for data synthesis.Results:Seven full-length articles with a total of 1080 participants (767 with stroke and 313 healthy volunteers) were included. The results indicated that compared to the control group, stroke patients had significantly lower levels of TRP (standardized mean difference (SMD)=-1.64; 95% CI [-2.36, -0.93];P

Stroke, Volume 56, Issue Suppl_1, Page AWMP109-AWMP109, February 1, 2025. Introduction:During acute ischemic stroke, energy depletion leads to a rise in creatine (Cr) as a buffer, increased extracellular glutamate from impaired neurotransmitter transport, and a pH drop due to lactic acid buildup. Understanding these changes is crucial for timely intervention, yet no current method captures all these alterations simultaneously. CEST, a novel MRI technique, non-invasively maps metabolites with high sensitivity, providing information on both concentration and pH. Our group recently demonstrated guanidino CEST (GuanCEST) at 3T, reflecting Cr levels, while amine CEST (amineCEST) at 9.4T likely indicates glutamate, and amide CEST (amideCEST) correlates with pH. We aim to use these techniques to investigate metabolic, neurotransmitter, and pH changes in two mouse models of middle cerebral artery occlusion (MCAO).Methods:Ten male C57BL/6 mice (aged 3–6 months) were used for two stroke models: permanent MCAO (pMCAO, n=4) and transient MCAO (tMCAO, n=4). MRI scans were conducted at 9.4T and 3T. Diffusion-weighted imaging identified stroke lesions, followed by T1and T2mapping on the selected slice. CEST scans were performed with a 2s saturation time across B1values ranging from 0.4 to 3.0 μT. We utilized Polynomial and Lorentzian Line-shape Fitting (PLOF) to simultaneously extract GuanCEST, amineCEST, and amideCEST from the CEST spectrum at each pixel, generating corresponding CEST maps. The average CEST values in the lesion and contralateral hemisphere were analyzed.Results:At a B1of 0.4 μT, GuanCEST (Fig. 1, red line) increased by 1.01±0.19% in pMCAO compared to the contralateral hemisphere but decreased by 0.32±0.27% in tMCAO, indicating a greater Cr rise in pMCAO. At higher B1, Cr effects diminished while pH effects increased. When B1exceeded 0.8 μT, amineCEST increased by 3.86±0.42% in tMCAO, nearly four times the rise in pMCAO (1.09±0.26%), possibly reflecting neurotransmitter changes due to cell membrane polarization and energy depletion. At 1.6 μT, amideCEST decreased by 0.53±0.05% in pMCAO but remained stable in tMCAO (0.49±0.48%), suggesting greater tissue acidification in pMCAO. Similar trends were observed at 3T, except amineCEST was undetectable.Conclusion:CEST MRI is a non-invasive technique capable of mapping metabolite, neurotransmitter, and pH changes in the stroke-affected brain, with strong potential for clinical translation.

Stroke, Volume 56, Issue Suppl_1, Page AWMP110-AWMP110, February 1, 2025. Background:Stroke induced disruption of the blood-brain barrier (BBB) exacerbates neurovascular damage. Emerging data show that deficiency of endothelial β-catenin contributes to stroke-induced BBB disruption and hemorrhagic brain injury. However, whether activation of β-catenin in cerebral endothelial cells (CECs) alleviates stroke induced neurovascular damage is unknown. Using transgenic mice with CEC specific activation of β-catenin, the present study investigated whether enhancement of CEC β-catenin activity reduces neurovascular damage after stroke.Methods:A transgenic mouse line with inducible CEC specific expression of a stable β-catenin mutant (CEC-Ctnnb1 mice) was generated by crossing Slco1c1-CreERT2mouse with Ctnnb1flex3mouse. Tamoxifen (TAM) was injected for 5 days to active Cre recombinase. Western blot was performed to verify β-catenin activation in the adult CEC-Ctnnb1 and their wild-type (WT) littermates (n=6/group) after termination of TAM. Male CEC-Ctnnb1 and WT mice treated with TAM were subjected to permanent middle cerebral artery occlusion (MCAO, n=10/group). Neurological function was evaluated with modified neurological severity score and foot-fault test at 1 and 7 days after MCAO. Brain tissues were processed for evaluations on infarct volume, gross hemorrhage, vascular leakage, and tight junction protein expression.Results:Immunohistochemistry and Western blot analyses revealed nuclear β-catenin expression specifically in the CECs of CEC-Ctnnb1 mice, but not in the WT mice, which was associated with significant elevation of β-catenin regulated the tight junction proteins, claudin 5 and ZO-1 by ~2 fold, compared to the WT mice. The ischemic CEC-Ctnnb1 mice exhibited significantly reduced infarct volume (16±5% vs 25±6% in WT), which was associated with a robust reduction of neurological deficits by 35% and 53% at 1 and 7 days after MCAO, respectively. Compared to the WT ischemic mice, ischemic CEC-Ctnnb1 mice exhibited significant increases of vascular claudin-5 by 45% and ZO-1 by 31%, which were associated with a significant reduction of extravascular fibrin deposition (5±1/mm2vs 8±1/mm2in WT). However, the incidence of gross hemorrhage was not different between the groups.Conclusions:The activation of β-catenin in CECs attenuates ischemic brain damage by alleviating stroke induced cerebrovascular disruption. Thus, targeting endothelial β-catenin signal may be a promising strategy for treatment of acute ischemic stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP304-ATP304, February 1, 2025. Introduction:Stroke is a common complication of infective endocarditis (IE), affecting 16–25% of cases, and can be the initial or sole manifestation of the condition. This study aims to analyze annual mortality trends and demographic factors related to stroke in IE patients in the U.S. and Texas from 1999 to 2020, to guide public health initiatives and enhance prevention strategies.Methods:The data was analyzed from the CDC’s WONDER database from 1999 to 2020, focusing on stroke and IE-related mortality (ICD-10 Code I64.0 “Stroke”&Code I33.0 “IE”) in adults aged ≥65 years, annual percent changes (APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex, race/ethnicity, age) subgroups was calculated.Results:The AAMR for stroke-related mortality in IE cases reduced in the US from an adjusted rate (AR) 448.7 in 1999 to 171.6 in 2018 (APC: -8.09%; 95% CI: -9.00% to -6.81%) and then it increased to 183.5 in 2020 (APC: 3.07%; 95% CI: 1.22% to 4.69%). In Texas, AAMR for stroke-associated IE-related mortality overall decreased from AR 485.7 in 1999 to 176.2 in 2020 (APC: -5.23%; 95% CI: -5.50% to -4.96%). Males had higher consistently higher AAMRs than females (196.4 vs. 172). The AAMR in the US men decreased from 468.6 in 1999 to 176.7 in 2018(APC: -7.55%; 95% CI: -8.51% to -6.21%), then it increased to 196.4 in 2020(APC: 4.99%; 95% CI: 2.93% to 6.81%). The AAMR in the US women decreased from 431.5 in 1999 to 165.6 in 2018(APC: -8.25%; 95% CI: -9.15% to -6.97%) after which it increased to 172 in 2020(APC: 1.48%; 95% CI: -0.31% to 3.06 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (278.7), followed by the NH White with an AAMR (179) and the NH American Indian or Alaska Native population with an AAMR (165.4). The low-risk populations were the Hispanic or Latino (143.6) and the NH Asian or Pacific Islander (135.2). AAMR also varied by region (overall AAMR: Midwest: 200.8; South: 193.9; Northeast: 166.2; West: 162.8) and non-metropolitan areas had higher AAMR (non-core areas: 233.4; micropolitan areas: 224.5) than metropolitan areas (large fringe metro areas: 170.5; large central metropolitan areas:160.4).Conclusions:The stroke-related mortality in infective endocarditis cases has overall risen in the United States than in Texas over the past two decades, specifically men and (NH) Black or AA, (NH) White and (NH) American Indian or Alaska Native are at high risk.

Stroke, Volume 56, Issue Suppl_1, Page AWP175-AWP175, February 1, 2025. Background:Post-stroke cognitive impairment (PSCI) is a condition characterized by cognitive decline that occurs after a stroke. PSCI affects up to 60% of stroke survivors. Early detection of those at high risk for PSCI is essential for timely intervention and personalized care. Electronic health records (EHRs) contain valuable data that can be leveraged by machine learning to predict PSCI, potentially enhancing patient outcomes. This study focuses on developing and validating machine learning models to predict PSCI, aiming to enable earlier diagnosis and improve post-stroke care.Methods:7956 all-type stroke patients (including Ischemic&Hemorrhagic stroke) treated between 2012 and 2021 were extracted from Emory Healthcare system. We employed multiple methods to predict PSCI, using ICD codes and prescribed medications that were available up to the discharge of index strokes. First, we utilized traditional machine learning methods, including Logistic Regression, Support Vector Machine, and Random Forest to develop models. Then, we developed hypergraph models to enhance prediction performance. Unlike traditional graphs that only capture pair-wise relationships between pairs of entities, hypergraphs can model the more complex higher-order relationships among multiple entities, by allowing a hyperedge (encounter) to connect multiple vertices (ICD and medications) simultaneously among patient visits and EHR medical features. Finally, we compared the performance across different methods and selected the best one for the PSCI prediction task. We compared their performance on four metrics: ACC (Accuracy, the proportion of correct predictions), AUC (Area Under the ROC Curve, measuring the model’s ability to distinguish between classes), AUPR (Area Under the Precision-Recall Curve, a comprehensive measure considering both precision and recall), and Macro-F1 (a balanced measure calculated by the harmonic mean of precision and recall).Results:We included 7956 all-type stroke patients (50% female, 56% non-white) in this analysis, where 1797 (23%) had diagnostic codes often used by clinicians at Emory to document PSCI. According to the performance, the hypergraph model was associated with higher ACC, AUC, AUPR, and Macro-F1 than other models.Conclusion:By comparing the results of various machine learning methods, we found that hypergraph model approaches outperform traditional machine learning methods in utilizing EHRs for predicting PSCI after a stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP321-ATP321, February 1, 2025. Introduction:The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.Methods:Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.Results:Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.Conclusion:Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

Stroke, Volume 56, Issue Suppl_1, Page AWMP113-AWMP113, February 1, 2025. Introduction:Post-stroke brain stimulation is a promising neurorestorative approach, yet the molecular mechanisms driving recovery remain unclear. Our previous work demonstrated that post-stroke optogenetic stimulations of the ipsilesional primary motor cortex (iM1) promotes functional recovery. To understand the mechanisms driving post-stroke recovery, we investigated the transcriptome of iM1 in non-stimulated and stimulated mice using RNA sequencing.Methods:C57Bl6 male mice underwent stereotaxic surgery to express Channelrhodopsin in iM1 excitatory neurons, with optical fiber implanted in the same location. After 5-6 weeks, mice underwent transient middle cerebral artery occlusion (30 minutes). Stimulated mice received optogenetic stimulations from post-stroke days (PD) 5–14. Rotating beam test was performed at pre-stroke baseline, PD4, 7 and 14. iM1 from stimulated, non-stimulated stroke mice at PD 7&15, and sham mice were processed for RNA sequencing (n=4-5/group). Expression of cholesterol enzymes such as HMGCS1 was examined using quantitative PCR and immunohistochemistry. Cholesterol levels were visualized using filipin or BODIPY.Results:iM1 stimulations enhanced recovery at PD14, with longer distance traveled and faster speed on the rotating beam test (p

Stroke, Volume 56, Issue Suppl_1, Page AWMP115-AWMP115, February 1, 2025. Intro:Resources for studying stroke are limited to clinical trials with sparse access to physiological and biochemical details, and pre-clinical animal studies with limited relation to humans. A physiologically accurate in silico model would provide a new route for study of the response to an ischemic event. Here we combine a computational model of brain tissue metabolism modified to simulate effects of ischemia (1) with an experimentally-validated approach to model the distribution of nutrients to the extravascular space as provided by a specific cerebral microvasculature network (2,3) to produce simulations of ischemic stroke showing the spatial distribution of damaged and healthy tissue.Methods:Anatomically-accurate models of cortical microvasculature and resulting O2 concentration with consideration of oxygen consumption in tissue were developed and validated against experimental measures of pO2 (2,3, Figure 1). A numerical implementation of a 4-compartment cellular model of brain metabolism (4) was modified to simulate ischemic stroke (1), and further modified to consider effects of the local pO2 and Glucose (GLC) as provided by the vascular network by adjusting local rates of transfer of GLC and O2 into the neuronal compartment of the cell, as shown in Figure 2, bottom. Brain metabolism was simulated for cases with no ischemic event, and after CBF was reduced by 80%.Results:Figure 2 shows timecourse of GLC, ATP, and Sodium in different compartments of the model through time in regions experiencing mild and severe ischemia. Figure 3 shows intraneuronal sodium concentration before and 2 hours after onset of an ischemic event showing failure of sodium pumps during ischemia.Conclusion:Effects of ischemic stroke on cerebral metabolism at the cellular level with consideration of microvasculature and distribution of nutrients within the tissue can be modelled at the capillary and cellular level computationally. Future work will include linking astrocytes to local nutrient concentrations and expansion of the simulated region to include larger region of brain, so an ischemic core and penumbral region surrounded by unaffected tissue can be observed.References1. CM Collins et al. International Stroke Conference, February 7-9 2024, Phoenix2. T Ventimiglia et al. Int J Numer Meth Biomed Engng. 2023;39:e37353. G Hartung et al. PLOS Computational Biology 2020;17(1): e10085844. M Cloutier et al. Journal of computational neuroscience. 2009 Dec 1;27(3):391

Stroke, Volume 56, Issue Suppl_1, Page AWMP106-AWMP106, February 1, 2025. Introduction:An elevated urinary albumin-to-creatinine ratio (UACR), a marker of renal dysfunction, has been linked to an increased incidence of stroke. However, the interplay between UACR and demographic factors such as age, obesity, ethnicity, or education remains underexplored.Methods:We conducted a post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, including patients with available data. Time-to-event models were developed to examine the relation between UACR and stroke risk during up to 10 years of follow-up, adjusting for variables such as gender, age, education, and race. Because the exposure of UACR had a right skew, we transformed it into top tertile versus lowest/middle tertile.Results:We included 9,025 ACCORD participants in our analyses. Baseline demographics are seen in Table 1. Those with elevated UACR (top tertile) had a higher incidence of stroke (4.6% vs 3.4%, p

Stroke, Volume 56, Issue Suppl_1, Page A97-A97, February 1, 2025. Objective:To evaluate a potential relationship between post-stroke cognitive impairment (PSCI) and a radiographic measure of glymphatic function after intracerebral hemorrhage (ICH).Introduction:PSCI has been less studied in patients with ICH. Here we aim to evaluate the role of glymphatic function after ICH and its association with PSCI. Glymphatic cleanup occurs in the perivascular space (PVS) formed by astroglial end-feet loosely surrounding small arteries and veins. Here we applied non-invasive diffusion tensor imaging (DTI) to measure changes in brain diffusion due to dynamics changes of interstitial fluid (ISF) and CSF along the PVS. The application of DTI-along the perivascular space index (DTI-ALPSI) has been validated to evaluate glymphatic function. It computes the diffusivity ratio between projection and association fibers oriented orthogonally with the medullary veins at the level of the lateral ventricle body (Fig-1A).Methods:We serially imaged 18 patients with deep ICH at 9.3±9.1 (V1) and 109±28 (V2) days of onset on a 3T MRI system. Cognitive assessment was obtained via MoCA scores. Fractional anisotropy (FA) and mean diffusivity (MD) maps were registered to the T1W and SWI images. Three regions of interest (ROI), remote from a lesion, in the association and projection fibers, orthogonal to the medullary veins at PVS were used to compute diffusivity (Fig-1C). Using the equation shown, the DTI-ALPSI was calculated. DTI-ALPSI = Mean (Dx proj, Dx assoc) / Mean (Dy proj, Dz assoc)Using 3D-Flair images, hematoma (HV) and edema (EV) volumes were segmented. The ipsilesional DTI-ALPSI was correlated with MoCA, HV, and NIHSS. Contralesional DTI-ALPSI was used as a control. A non-linear regression model was used for statistical analysis.Results:We enrolled 12M/6F with an average age of 49.3±13.3y. Compared to the control, the ipsilesional DTI-ALPSI was significantly decreased (p=0.036) at V2. Temporally the MoCA scores were significantly increased (19±8.5 to 23±6.0, p

Stroke, Volume 56, Issue Suppl_1, Page ATP305-ATP305, February 1, 2025. Introduction:Acute ischemic stroke (AIS) may be associated with feelings of anxiety and/or depression (A/D) in subsequent months. The purpose of this study was to determine the frequency of feelings of A/D after AIS longitudinally and to identify risk factors that may predict post-stroke feelings of A/D.Methods:Data were collected from patients with AIS at a stroke center from 2016-2022. Patients were excluded if

Stroke, Volume 56, Issue Suppl_1, Page ATMP45-ATMP45, February 1, 2025. Background:Prior studies reported only half of stroke patients arrived at emergency departments (ED) via emergency medical services (EMS). Some studies found EMS arrival to be associated with more rapid evaluation and treatment which have been shown to be associated with better outcomes. We sought to explore ED modes of arrival for potential acute stroke patients in two large racial-ethnically diverse regional cohorts in California.Methods:Kaiser Permanente Northern California (KPNC) consists of 21 certified stroke centers, and Kaiser Permanente Southern California (KPSC) have 15 certified centers. Both regions have standardized Telestroke programs for all stroke centers to include video evaluation by a teleneurologist. From 1/1/2016 to 12/31/2022, the KPNC study cohort included all non-cancelled stroke alerts who were potential candidates for further workup for acute ischemic stroke treatment. Non-cancelled group was approximately 45% of the total stroke alert volume in the KPNC region. During the same period, KPSC study cohort included all stroke alerts who were evaluated by Telestroke for possible acute stroke. KPSC did not use a cancel-versus-non-cancel system. Assessment included demographics, ED mode of arrival, and neighborhood deprivation index (NDI).Results:During the study period, there were 17,437 patients from KPNC and 41,466 patients from KPSC yielding a combined total of 58,903 adults evaluated by Telestroke neurologists for possible acute stroke at 36 stroke centers in California. Overall, 31,533 (53.5%) arrived via walk-in rather than EMS. However, in Southern CA, patients were more likely on average, to arrive as walk-in (67.7%) compared to Northern CA (19.8%). Range of walk-in for KPNC facilities was 11% to 38.5%, and 34% to 86.1% for KPSC centers [Figure]. Patients who presented as walk-in tended to be younger and more Hispanic. Those from more impoverished communities presented via EMS more often than via walk-in [Table].Conclusions:In our combined cohort, there were several differences between walk-in patients and those who arrived via EMS. There was notable variation in ED arrival mode by facility and stark contrast between the two regions in California. Further research is needed to understand these differences and whether they are associated with outcomes, and to identify potential targets for future interventions to improve acute stroke care delivery for walk-in patients.

Stroke, Volume 56, Issue Suppl_1, Page AWP8-AWP8, February 1, 2025. Introduction:Current guidelines recommend 24-hours of high-intensity monitoring (HIM) for acute ischemic stroke patients post-intravenous thrombolysis (IVT) due to risk of bleeding complications including symptomatic intracranial hemorrhage (sICH). We report the outcomes of a 12-hour targeted-intensity monitoring (TIM) pathway for low-risk post-IVT patients.Methods:Post-IVT patients were considered low-risk if their NIHSS < 10, blood pressure < 180/105 without medical intervention, level of consciousness was preserved, and no high-risk vessel stenosis/occlusion was present. All patients meeting these criteria between Oct 2020-April 2024 were included in our study; those who presented prior to March 2022 utilized the conventional HIM pathway and those presented afterwards utilized the TIM pathway. In the TIM pathway neurological exams and vital sign assessments were conducted every 15 minutes for the first hour, every 1 hour for the next 3 hours, every 2 hours for the next 8 hours, and every 4 hours for the next 12 hours (14 total neurochecks/vital sign assessments over 24 hours compared to 36 neurochecks/vital sign assessments with HIM). Patients utilizing the TIM pathway were admitted to an intermediate care unit bypassing the ICU.We examined the number of TIM patients who required transfer from IMC to the ICU and the duration of time in the ICU for HIM patients. Additionally, we compared the length of hospital admission, rate of sICH, 24-hour NIHSS scores, and 90-day mRS scores in matched post-IVT HIM and TIM patients.Results:A total of 95 patients were included in the study: 47 HIM (median age 71 [IQR 56-75.5], median NIHSS 4) and 48 TIM (median age 65, [IQR 60-81.25], median NIHSS 4). There were no significant differences in age, presenting blood pressure, or NIHSS between the two groups. The mean length of ICU-stay for the HIM group was 32.8 hours. No patient in the TIM pathway required transfer to the ICU for a higher level of care. The median length of hospital stay for the HIM group was 49.8 hours [IQR: 43.8-83.3] and 49.6 hours [IQR: 32.6-99.7] for the TIM group (p=0.716). No sICH was noted in either group. Median discharge NIHSS = 1 for both groups (p=0.125) and 90-day mRS = 2 for both groups (p=0.599)Conclusion:In our study, post-IVT TIM was feasible without safety concerns. Post-IVT TIM pathways may conserve healthcare resources and increase ICU bed availability. Further studies defining the optimal post-IVT TIM criteria are indicated.