Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATMP37-ATMP37, February 1, 2025. Introduction:Limited studies have examined racial disparities in long-term survival after acute ischemic stroke (AIS) with inconsistent findings. We examined these disparities among Medicare fee-for-service (FFS) beneficiaries in U.S.Methods:We analyzed data on 1,997,487 Medicare FFS beneficiaries aged ≥65 years hospitalized with incident AIS (ICD-10 code I63) and survived >30 days from January 1, 2000 to December 31, 2017, and were followed-up until December 31, 2022. Cox proportional hazard models estimated the adjusted hazard ratio (aHR, 95% CI) and adjusted survival curves by race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), Hispanic and Other). Models were adjusted for age, sex, and comorbidities.Results:The median age at AIS hospitalization was 78 years (IQR 72.0-84.0); 57.0% were women; 81.8%, 10.8%, 4.8% and 2.6% were White, Black, Hispanic and Other, respectively. Over a median follow-up of 4.9-years (IQR 1.7-8.8), there were 1,738,452 all-cause deaths. Adjusted 5-year survival after AIS improved from 2000-2004 to 2015-2017 for White (46.5% (95% CI 46.4-46.6) to 50.9% (50.7-51.1)), and Black (46.0% (45.8-46.3) to 48.9% (48.3-49.2)). For Hispanic and Other, survival remained largely unchanged: 54.4% (54.1-54.8) to 54.2% (53.6-54.8)) for Hispanic and 55.9% (55.4-56.4) to 54.7% (54.0-55.5) for Other. A clear pattern of long-term survival after AIS emerged by race/ethnicity showing similar survival between Hispanic and Other and between White and Black people (Figure). Stroke mortality risk was ~25% higher for White and Black compared to Hispanic and Other (aHR 1.25 (1.24-1.26)). This pattern was consistent across age groups and sex.Conclusions:Long-term survival after AIS has improved for White and Black Medicare FFS beneficiaries over time, while it remained largely unchanged for Hispanic and Other groups. This indicates persistent racial disparities in stroke outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP313-ATP313, February 1, 2025. Background:Lipoprotein(a) (lp(a)) concentrations is an independent risk factor of atherosclerotic cardiovascular disease (ASCVD). The association between lp(a) and prognosis of ischemic stroke patients is uncertain.Hypothesis:The study is aimed to investigate the shape and the association of the risk of short-term and long-term stroke recurrence across the distribution of lp(a) concentrations, and explore whether combining ASCVD risk has an influence on the association.Method:Patients with acute ischemic stroke within 7 days in the Third China National Stroke Registry (CNSR-III) having lp(a) measurements were included in the study. The outcomes were stroke recurrence within one year and two years. ASCVD risk included diabetes mellitus, stroke history and early onset. Based on ASCVD risk and lp(a) concentrations, there were four groups: lp(a)70 mg/dL without ASCVD risk. To display the shape of the relationship between lp(a) and stroke recurrence within two years, lp(a) concentrations were modeled using natural cubic splines with median concentration serving as the reference adjusted by confounders. And the association was assessed using Cox proportional hazards models and Kaplan-Meier curves.Result:Among 9952 included patients with the mean age of 63 years and 69% of male, the median lp(a) concentrations was 18.06 (inter-quartile range, 8.85-35.66) mg/dL. The relationship between lipoprotein(a) and stroke recurrence appeared linear across the distribution. Compared to patients with lp(a)=50 mg/dL was associated with a higher risk of stroke recurrence (adjusted HR for one-year outcome:1.19, 95%CI: 1.01-1.41, p =0.04; adjusted HR for two-year outcome:1.21, 95%CI: 1.04-1.40, p =0.01). Compared to patients with lp(a)70 mg/dL without ASCVD risk (HR:0.90, 95%CI: 0.65-1.26, p =0.55).Conclusion:Lipoprotein(a) concentrations was associated with short-term and long-term prognosis of ischemic stroke, with a linear risk gradient across the distribution. Baseline ASCVD risk may influence the association between lp(a) and stroke recurrence.

Stroke, Volume 56, Issue Suppl_1, Page ATMP29-ATMP29, February 1, 2025. Introduction:Mobile Stroke Treatment Units (MSTU) are improving clinical outcomes by significantly shortening the time-to-treatment. On scene, the specialized staff, including a registered nurse and critical care paramedic, are able to rapidly assess the patient for acute stroke symptoms. This rapid treatment algorithm can potentially lead to missed strokes as compared to those patients transported via standard Emergency Medical Services (EMS). Therefore, we evaluated the rate of missed stroke diagnosis through MSTU assessment in the field as compared to the standard EMS-to-Emergency Department (ED) pathway.Methods:A retrospective analysis of patients with potential stroke evaluated by the MSTU crew between 7/25/23 and 5/31/24 was performed. Admission criteria includes age 18 years or older, last known well within 24 hours, one or more cardinal signs of stroke, and exclusions of any other suspected diagnosis outside of stroke or neurological disorders. Our study evaluated patients who were excluded from MSTU admission based on failure to meet said admission criteria. These patients were transported to the hospital by standard EMS. Patient demographics, symptoms, and final hospital diagnoses were extracted to complete univariate and multivariable regression analyses.Results:Our final analysis included 235 patients (mean age 66.3, 56.0% women) evaluated by the MSTU crew, but not admitted due to lower concern for stroke. In our study cohort, 11 had a final diagnosis of stroke that were missed upon initial MSTU evaluation. Patients with missed stroke were significantly older (OR 1.04 (95%CI 1.01 – 1.08), p=0.04) and had a nonsignificant trend towards female sex (OR 0.44 (95%CI 0.14 – 1.45), p=0.17). We did not see any differences among specific MSTU staff performing the evaluation or time of day and day of week. Of the 11 patients with a final stroke diagnosis, none received any acute interventions on arrival to the hospital.Conclusion:Our MSTU admission criteria resulted in an overall low rate of true stroke misses with none of the “missed strokes” receiving an acute intervention at the hospital. Rapid patient evaluation on scene by an expert stroke crew adhering to a standardized admission criterion does not lead to acute stroke interventions being performed upon arrival to the ED. Older patients with stroke-like symptoms evaluated by a Mobile Stroke Treatment Unit are more likely to be misdiagnosed, which deserves further investigation.

Stroke, Volume 56, Issue Suppl_1, Page ATP311-ATP311, February 1, 2025. Introduction:Immune Checkpoint Inhibitors (ICIs) used for treatment of malignancies might promote atherosclerosis and increase the risk of ischemic stroke (IS). We aimed to compare IS characteristics of patients with non-small cell lung cancer (NSCLC) who received ICIs compared to those who did not. We hypothesized that IS associated with atherosclerosis will be more common among those treated with ICIs than other treatments.Methods:A retrospective single center study of patients,18 or older, with NSCLC presenting between 2013 and 2023, treated with either ICIs, chemotherapy, or a combination and had an IS any time following treatment. Patients without vessel imaging were excluded. We collected demographics and stroke characteristics. Two sample Mann-Whitney U and chi-square test were used to compare demographics and stroke etiologies among patients who received chemotherapy and those who received ICIs with or without chemotherapy.Results:A total of 58 patients were identified, 22 received chemotherapy only and 36 received ICIs. The mean age was 68.8, with 50% male (29/58). ICI treated groups had significantly more stage IV diagnoses (chemotherapy only 3.6%, ICI 67%, p=0.04). There was no difference in median time from treatment to stroke onset in days between groups; chemotherapy 90.5 (range 27-386) vs. ICI 337.5 (range 95-665), p= 0.39. The stroke etiology in those treated with chemotherapy alone were as follows: Large artery atherosclerosis (3), cardioembolic (8), small vessel disease (5), ESUS (5), other (1). For those treated with either ICI alone or ICI and chemotherapy: Large artery atherosclerosis (5), cardioembolic (6), small vessel disease (2), ESUS (23), other (0). Stroke etiology consistent with embolic stroke with unknown source (ESUS) was more common in the ICI group (chemotherapy only 2.3%, ICI 64%, p=0.02).Conclusions:Contrary to prior research suggesting atherogenesis with ICI, the most common stroke etiology in the ICI group was ESUS.

Stroke, Volume 56, Issue Suppl_1, Page ATMP38-ATMP38, February 1, 2025. Background:Randomized clinical trials have demonstrated that IV thrombolysis (IVT) can be administered safely in wake-up stroke (WUS) after MRI- or CT-based imaging selection to improve clinical outcomes. The objective of this study was to evaluate the utilization of IVT to treat WUS using a standardized WUS protocol across a healthcare system.Methods:A WUS protocol using MRI-based imaging selection was implemented across an academic healthcare system with 6 acute care hospitals in the state of Georgia. We prospectively identified all WUS patients who underwent the WUS protocol over a 12 month period through August 15, 2024. Patients were eligible for the WUS protocol if they presented with disabling symptoms identified on awakening, had a CT head without contrast showing no hypodensity to explain clinical symptoms and had CT angiography of the head and neck demonstrating no large vessel occlusion as a cause of symptoms. All patients underwent expedited brain MRI sequences (DWI, T2w FLAIR, GRE) without contrast and IVT was administered at the discretion of the treating neurologist.Results:During the study period, the WUS protocol was activated for 27 patients of which 6 (22%) received IVT (median NIHSS 10, IQR 5-15). Reasons for not receiving IVT included lack of DWI-FLAIR mismatch on MRI (n=11), DWI negative MRI (n=8), IVT declined by patient (n=1) and IVT contraindication (n=1). A modified Rankin scale of 0-1 at 90 days was achieved in 67% of WUS patients treated with IVT and no symptomatic intracerebral hemorrhages. Door-to-needle time within 60 minutes was significantly less likely in WUS compared with non-WUS cases (0% vs 69%, p=0.001). IVT administration in WUS patients made up 2% of all acute ischemic stroke patients receiving IVT.Conclusions:An MRI-based WUS protocol was able to identify a small subset of acute ischemic stroke patients who met eligibility criteria for IVT outside of the 4.5 hour time window. IVT was associated with good clinical outcomes and not associated with any complications.

Stroke, Volume 56, Issue Suppl_1, Page ATP308-ATP308, February 1, 2025. Introduction:The social environment plays an essential role in a patient’s arrival time to the hospital when experiencing medical emergencies. For stroke events an understanding of these socio-ecological factors may provide insight on eligibility for time-based interventions. This study aimed to assess the relationship between the first person made aware during a stroke and the impact on a patient’s hospital arrival timeliness.Methods:Time is Brain is a multi-center observational study assessing the role of social network mechanisms involved in delays to the hospital. As part of this study, we enrolled patients who had an acute stroke syndrome within the past seven days and received hospital care at either Mass General Brigham or Yale New Haven Hospital. We collected data on the social circumstances and the decision-making during the acute stroke in the community. We asked participants: 1. Did you tell anyone about your symptoms? 2. If yes, who did you tell about these symptoms? 3. Did anyone other than yourself notice symptoms? 4. If yes, who noticed your symptoms? We combined the responses for these questions into the first person aware of symptoms. The categories for people first aware were family members, spouse, co-worker/friend/stranger, and no one made aware. Here, we describe the median last known well to hospital arrival time and the median symptom onset to hospital arrival for each of these categories.Results:In 181 patients, we found that 72 (39.6%) individuals identified a spouse, 51 (28.2%) identified a family member, 33 (18.2%) identified a co-worker, friend, or stranger, and 25 (13.8%) did identified no one. Patients who reached out to friends, co-workers, or strangers had a median last known well to hospital arrival time of 180 minutes and a median symptom onset to hospital arrival time of 92 minutes. In contrast, arrival times were longest for those who contacted family with a median last known well to hospital arrival time of 615 minutes and median symptom onset to hospital arrival time of 120 minutes.Conclusion:The decision to seek care during stroke usually includes family or lay others. This preliminary analysis suggests that who is involved may influence the time to arrival to the hospital and ultimately improve individual stroke recovery. When considering how to improve arrival times, this multi-person decision-making process should be a factor in intervention development.

Stroke, Volume 56, Issue Suppl_1, Page ATP315-ATP315, February 1, 2025. Introduction:While Asian populations appear healthier than non-Hispanic Whites overall, recent studies have highlighted significant health disparities within Asian subgroups in the US. However, most US health databases aggregate Asians into broader categories, limiting understanding of subgroup-specific risks. This study aims to investigate the disparity in stroke risk among Asian subgroups in California – a state where nearly 30% of U.S. Asians live.Methods:We analyzed 2013-2019 Behavioral Risk Factor Surveillance System (BRFSS) data from California. Stroke prevalence was determined by self-reported diagnosis. Asian subgroups were categorized as East Asian (Chinese, Japanese, Korean), South Asian (Indian, Pakistani), Southeast Asian (Filipino, Vietnamese, Cambodian), and Other Asian. Logistic regression models examined odds of stroke prevalence by Asian broadly and detailed categorized subgroups using non-Hispanic Whites as the reference and adjusting for age and sex.Results:Among 1,768 Asian participants, females comprised 47% overall, ranging from 37% (South Asians) to 52% (Southeast Asians). The mean age for all Asians is about 42 years, and the subgroups show similar results. Detailed subgroups showed Filipinos had the highest female proportion (54%) and Indians the lowest (36%). Age distribution showed Japanese were oldest (52 years) and Cambodians youngest (37 years). After adjusting for age and sex, East Asians demonstrated significantly lower odds of stroke prevalence (OR=0.43; 95% CI: 0.24-0.77) compared to non-Hispanic Whites. Southeast Asians had increased stroke risk (OR=1.17), although non-significant. In detailed subgroup analysis, Chinese showed lower stroke prevalence (OR=0.39; 95% CI: 0.17-0.87), while Cambodians had significantly higher prevalence (OR=4.43; 95% CI: 1.02-19.23).Conclusions:Our findings reveal significant heterogeneity in stroke prevalence among Asian American subgroups in California. The fluctuation in results underscores the importance of disaggregated analyses in stroke research, and future research should expand upon these findings to uncover the underlying causes in the variance. This study is the beginning of an important roadmap to mitigating stroke disparities in Asian populations by tailoring stroke prevention and treatment methods to specific Asian subgroups, rather than integrating all subgroups into a singular broad category.

Stroke, Volume 56, Issue Suppl_1, Page ATMP35-ATMP35, February 1, 2025. Introduction:Studies have suggested efficacy of glycoprotein IIb/IIIa antagonists such as tirofiban for patients with acute ischemic stroke (AIS). However, neurological deterioration is still common in many of the recommended antiplatelet regimens. We aimed to evaluate the efficacy and safety of tirofiban versus dual antiplatelet therapy (DAPT) or aspirin in patients with AIS.Methods:Following PRISMA guidelines, we searched Pubmed, Embase, Scopus and Cochrane databases for studies comparing effects of tirofiban versus DAPT or aspirin alone in patients with AIS. Main outcomes were increase in NIHSS score, Modified Rankin Scale (mRS) scores at 90 days (0 to 2), intracranial hemorrhage (ICH) and mortality. Statistics analysis was performed using Review Manager 5.4.1 software. Heterogeneity was assessed with I2statistics.Results:We included 5 RCT and 5 non-RCT studies covering 1,857 patients, of whom 926 were treated with Tirofiban. Neurological deterioration, assessed by changes in NIHSS scores from baseline across four studies, was less pronounced in the Tirofiban group (MD -0.32; 9% CI -0.83-0.19; p

Stroke, Volume 56, Issue Suppl_1, Page ATMP34-ATMP34, February 1, 2025. Introduction:Stroke misdiagnosis is not uncommon and Black people have a higher odds of stroke misdiagnosis than White people. Little is known about the reasons for misdiagnosis or how diagnostic pathways lead to error.Hypotheses:To explore possible explanations for race differences in stroke diagnosis, we examine two hypotheses. First, to understand where diagnostic pathways may err we quantified, whether race predicted whether receipt of initial imaging (ie. CT/MRI), hypothesizing that black people receive less imaging. Second, amongst individual that receive imaging, we hypothesized that Black people will be less likely to receive stroke diagnoses or be admitted to the hospital.Methods:We used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2011-2021. Our primary study population was adults with any neurologic chief complaint, defined using reason for visit (RFV) data. Our primary exposure was Black race. For each outcome, we built unadjusted, minimally adjusted, and fully adjusted survey-weighted logistic regression models to predict outcomes: receipt of imaging, stroke diagnoses and hospital admission. The minimally adjusted model added age, sex, and insurance to race/ethnicity. The fully adjusted model added vital signs, arrival by ambulance, triage level, episode of care, vascular risk factors, prior vascular disease and RFV-based characterization of stroke probability.Results:The mean age was across the ~146,000 emergency room visits 47.8 ± 19.7 and black people comprised 24.9% of the sample. Amongst individuals with a neurologic RFV, black people were less likely to get a CT (OR 0.79, 95% CI 0.72-0.88), MRI (OR 0.64, 95% CI 0.47-0.89), or any imaging (OR 0.78, 95% CI 0.71-0.86 ) in the unadjusted model. These effects persisted or were strengthened in the fully adjusted model: Black race-imaging association (OR 0.67, 95% CI 0.45-0.99). Conditioned on receiving imaging after full adjustment, there was no association between Black race and stroke diagnoses (OR 1.1, 95% CI 0.63-1.9) or hospital admission for stroke (OR 1.19, 95% CI 0.46-3.08).Conclusion:We found that Black people were less likely to receive imaging when presenting with neurologic reasons for visit, but that conditioned on receiving imaging, there were no differences in stroke diagnosis or hospitalization. This suggests that race differences in stroke diagnosis likely occur at or prior to the time of initial imaging selection.

Stroke, Volume 56, Issue Suppl_1, Page ATP326-ATP326, February 1, 2025. Background:In patients with ischemic stroke who receive insertable cardiac monitors, the CRYSTAL-AF and STROKE-AF randomized trials showed similar (~12%) AF detection rates at one year among patients with cryptogenic stroke and stroke from large vessel disease and small vessel disease, respectively. This finding may suggest that AF detected on an insertable cardiac monitor in cryptogenic stroke is often not pathogenic. In this study, we aim to compare AF detection rates on ZIOPATCH in ESUS vs. non-cardioembolic ischemic stroke.Methods:From a comprehensive stroke center registry, we identified patients with a diagnosis of ischemic stroke who underwent a ZIOPATCH to look for AF. The primary predictor was stroke subtype (ESUS vs. non-cardioembolic). Non-cardioembolic stroke was defined as stroke from large artery atherosclerosis, small vessel disease, or other known mechanism. ESUS was defined using the ESUS consensus criteria. The study outcome was AF detected on ZIOPATCH. We compared baseline characteristics and risk factors between patients with vs. without AF detected. Univariate and multivariate regression models were used to determine odds ratios (OR).Results:We identified 478 patients who had a ZIOPATCH placed; 410 had the ZIOPATCH completed (217 ESUS, 71 small vessel disease, 100 large vessel disease, and 22 had another defined mechanism). The mean age was 69 years and 51% were men. The mean duration of ZIOPATCH monitoring was 12 days and 17 (4.1%) had AF. Patients with AF were more likely to be older (82 years vs. 68 years, p

Stroke, Volume 56, Issue Suppl_1, Page ATP316-ATP316, February 1, 2025. Background:Despite improvements in the safety of transcatheter aortic valve replacement (TAVR), ~4% of patients experience a procedure-related stroke. TAVR seems to be preferred in patients with cancer; however, related research on the clinical efficacy and stroke outcomes of TAVR in patients with cancer is limited. This study aimed to evaluate the association of TAVR-related stroke in patients with cancer and without cancer.Methods:This retrospective cohort study identified 14,046 patients with aortic valve stenosis that underwent TAVR. Patients were stratified into two groups: cancer patients 13583 (96.7%) and non-cancer patients 463 (3.3%). We assessed if there was a difference in stroke events between cancer and non-cancer patients. Binary logistic regression models were used to measure the stroke association.Results:Among 14,046 TAVR patients, 214 (1.5%) had a procedure-related stroke. These patients were more likely to be female (p=0.0007, 95% CI: 1.219-2.102), older (p

Stroke, Volume 56, Issue Suppl_1, Page ATMP41-ATMP41, February 1, 2025. Background:Stroke remains a leading cause of mortality and morbidity, with treatment and outcomes differing across ethnic groups. Tele-stroke networks have expanded access to stroke care, particularly in underserved areas, but the impact of ethnicity on these outcomes is still being explored. This study aims to compare stroke treatment outcomes among White/Caucasian, African-American, and Other ethnic groups within a tele-stroke network.Methods:We conducted a retrospective analysis of 4,256 stroke patients treated within a tele-stroke network spanning 38 hospitals. Patients were categorized into three ethnic groups: White/Caucasian (n = 2,925), African-American (n = 1,122), and other (n = 209). Data on baseline characteristics, treatment interventions, and discharge outcomes were analyzed using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables.Results:The median age was highest in White/Caucasian patients (70 years, IQR 57-81) and lowest in the other group (61 years, IQR 49-72) (p < 0.001). True strokes occurred in 82.3% of White/Caucasian patients, 79.3% of African-American patients, and 89.9% of the other group (p = 0.001). tPA was administered to 19.4% of White/Caucasian patients, 16.7% of African-American patients, and 15.2% of the other group (p = 0.12). Mechanical thrombectomy rates were similar across all groups (p = 0.07). Discharge to home was most common in the other group (58.4%), followed by African-American (50.3%) and White/Caucasian patients (44.9%) (p = 0.01).Conclusion:This study identified important ethnic differences in stroke treatment and outcomes within a tele-stroke network. While there were no significant disparities in the administration of key treatments such as tPA and mechanical thrombectomy, differences in age, gender distribution, stroke severity, and true stroke rates highlight the need for tailored approaches in stroke management to address the unique needs of different racial/ethnic groups.

Stroke, Volume 56, Issue Suppl_1, Page AWP181-AWP181, February 1, 2025. Background:Timely intervention is crucial for patients with acute ischemic stroke. The RapidAI imaging system (RAPID) was implemented to enhance the speed and efficiency of care delivery. We evaluated the impact of RAPID on various metrics in the patient care pathway.Methods:In this retrospective observational study, we analyzed consecutive patients who presented to our hospital ER with acute ischemic stroke and who were treated with Intravenous Thrombolysis (IVT) or mechanical thrombectomy between December 20, 2014, and April 20, 2024. Patients were divided into pre-RAPID (n =186) and post-RAPID (n =264) groups based on the implementation date of the RAPID system (September 1, 2019). We compared Door to Non-contrast CT (NCCT), Door to CT Angiography (CTA) / Perfusion Imaging, Door to IVT, and Door to Puncture / first pass for thrombectomy, between the two groups using Fisher’s exact test.Results:For Door to CT, no significant difference was observed between pre-RAPID and post-RAPID groups; 74% of patients in the post-RAPID group and 71% in the pre-RAPID group received NCCT within 45 minutes (p= 0.44). Significant improvements were observed in Door to CTA/Perfusion times; 90% of patients received vessel or perfusion imaging within 150 minutes post-RAPID compared to 70% pre-RAPID (p= 0.01), and 87% received imaging within 120 minutes post-RAPID compared to 70% pre-RAPID (p= 0.031). For Door to IVT, 96% of patients received treatment within 120 minutes post-RAPID compared to 82% pre-RAPID (p= 0.015). For thrombectomy, there was a trend toward faster door to puncture post-RAPID; 70% of patients were treated within 150 minutes post-RAPID compared to 62% pre-RAPID (p= 0.36), and 90% were treated within 210 minutes post-RAPID compared to 81% pre-RAPID (p= 0.12). Similarly, a trend toward faster Door to First Pass times was observed post-RAPID, with 88% treated within 240 minutes compared to 80% pre-RAPID (p= 0.20).Conclusions:RapidAI Implementation was associated with significant improvements in key workflow metrics, notably in Door to Vessel/Perfusion Imaging and Door to IVT. These findings suggest that RAPID enhances the efficiency of patient care delivery in acute ischemic stroke. Further studies with larger sample sizes are warranted.

Stroke, Volume 56, Issue Suppl_1, Page ATMP30-ATMP30, February 1, 2025. Background:The prehospital scales have been developed to identify stroke patients with large vessel occlusion (LVO) to facilitate rapid transport to appropriate stroke centres. In practice, these stroke scales have moderate accuracy. There is a pressing need for adjunct easy-to-use and interpret diagnostic devices to improve prehospital stroke diagnosis and LVO detection. We aim to determine whether a machine learning algorithm using adjunct electroencephalography (EEG) Spectra can improve the accuracy of LVO detectionMethods:Adult patients with suspected acute stroke were prospectively enrolled as soon as possible on arrival at the emergency department. A wearable MuseTMheadband (InteraXon Inc, Canada) with an embedded 4-channel EEG was used for a resting 3-minute recording. EEG Spectra including relative alpha, beta, theta and delta spectral powers, delta-alpha ratio (DAR) and pairwise-derived brain symmetry indices (pdBSI) were calculated. These indices were compared between patients with LVO and non-LVO groups. The accuracy of LVO detection was tested with the aid of supervised machine learning(ML) algorithms including EEG Spectra, Los Angeles Motor Stroke Scale (LAMS), sex and side of stroke.Results:A total of 142 patients were included in the analysis with a mean age of 69.6±13.7 years, 60(42.2%) females, (Stroke Subtype:113[79.6%] were ischemic stroke, 22[15.5%] stroke mimics, 7[4.9%] intracerebral hemorrhage) and median NIHSS 5(2-11). Thirty-seven(26.1%) patients had LVO and EEG was acquired at a median of 6h 45m (3h 29m – 14h 15m) after symptom onset. Relative alpha spectral power was lower in both affected (p

Stroke, Volume 56, Issue Suppl_1, Page ATP307-ATP307, February 1, 2025. Introduction:In this study, we investigated peripheral blood mononuclear cells (PBMCs) transcriptomics of patients who had a stroke using single-cell RNA sequencing (scRNA-seq) to understand peripheral immune response after Early neurological deterioration (END) based on the gene expression in an unbiased way.Methods:Transcriptomes of PBMCs from 5 patients who had END within 24 hours after stroke onset were compared with 5 race-matched/age- matched/gender-matched controls. Based on whether the patient experienced END and the timing before and after the occurrence of END, the samples were divided into four groups: END_T0, END_T1, Non-END_T0, and Non-END_T1.Results:A total of 20 peripheral blood PBMC samples were collected from patients with acute ischemic stroke before and after the occurrence of END. Compared with Non-END, the proportion of mononuclear macrophages in the peripheral blood of patients with END and the number of differential genes have significantly increased (P< 0.05). Further heterogeneity analysis of mononuclear macrophages revealed a cell subset C1Q+Mono that highly expresses C1QA. The proportion of this subset significantly increased before and after the occurrence of END (P< 0.05). Pseudotime analysis showed that its differentiation trajectory is different from that of classical mononuclear macrophages, and functional enrichment suggests it is related to the activation of inflammatory cells and the coagulation system.Conclusion:For the first time, our study constructed a peripheral blood immune landscape of acute ischemic stroke before and after the occurrence of END, as well as in Non-END cases, based on scRNA-seq. our study also identified a novel monocyte subpopulation, providing new insights into the immune regulation of END

Stroke, Volume 56, Issue Suppl_1, Page ATMP47-ATMP47, February 1, 2025. Background:Life’s Essential 8 (LE8) is a cardiovascular health (CVH) metric proposed by the American Heart Association (AHA) that includes blood glucose, blood pressure, lipid levels, diet, physical activity, nicotine exposure, body mass index, and sleep duration. LE8 is used as a tool to assess and improve CVH outcomes. Little is known about the association between LE8 and mortality after stroke.Methods:We included data from participants aged 20 and older with self-reported stroke who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Data was linked with National Death Index mortality data through 2019. The association between poor and ideal LE8 scores and all-cause mortality and CV mortality rates after stroke were determined in 3 models: (1) unadjusted; (2) adjusted for sociodemographic factors (age, sex, race/ethnicity, poverty income ratio (PIR)) and (3) further adjusted for comorbidities (Charlson Comorbidity Index).Results:During the study period, 1,019 out of 26,670 individuals reported a prior stroke. When assessing mortality in those with poor CVH, although the direction of the hazard ratios (HR) suggested an increased risk of CV mortality with higher numbers of poor LS8 metrics, the associations were not significant in any of the models. However, for all-cause mortality, the risk increased with a higher number of poor CVH metrics. Possessing at least 4 poor CVH metrics was associated with a higher risk of all-cause mortality (Model 1 HR 1.69, 95%CI 1.13-2.52; Model 2 HR 2.25, 1.51-3.35; Model 3 HR 2.10, 1.39-3.20). Conversely, possessing at least 4 ideal metrics was associated with lower CV mortality in the unadjusted model, (HR 0.35, 0.15-0.85) but this association was no longer significant in Models 2 and 3. Possessing at least 4 ideal CVH characteristics was associated with lower all-cause mortality in all 3 models (Model 1 HR 0.50, 0.29-0.85; Model 2 HR 0.54, 0.31-0.92; Model 3 HR 0.56, 0.33-0.96). Higher LE8 scores were associated with lower CV mortality in Model 2 (HR per point LE8 score 0.98, 0.96-0.99) and Model 3 (0.98, 0.96-0.99) and all-cause mortality in Model 2 (0.98, 0.97-0.99) and Model 3 (0.98, 0.97-0.99).Conclusion:A higher LE8 score correlates with an increased risk of both CV and all-cause mortality in stroke survivors. Possession of at least 4 ideal CVH metrics is associated with a nearly two-thirds risk reduction in CV mortality and 50% risk reduction in all-cause mortality.