Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATP324-ATP324, February 1, 2025. Background and Purpose:Antiphospholipid antibody syndrome (APS) is a rare cause of cerebral infarction, but the effect of antiphospholipid antibodies (aPL) on the acute phase of ischemic stroke in each stroke subtypes is still unclear, especially in the elderly patients. To clarify this, we compared antiphospholipid antibody levels in patients with acute cerebral infarction with or without recurrence, expansion, or hemorrhagic transformation of infarct in each stroke subtype.Methods:Consecutive ischemic stroke patients in a comprehensive stroke center were screened between April 2013 and April 2024. Inclusion criteria were: 1) admitted 24 hours from the onset, 2) more than 60 years-old on the admission, 3) who had follow-up MRI/CT around one week from the onset, and 4) whose aPL (anti-cardiolipin-beta2-glycoprotein I complex antibody [β2-GPI], anti-cardiolipin antibody [aCL] and lupus anticoagulant [LAC]) measured during the admission for suspected APS. Then, we dichotomized the patients with and without recurrence (R), expansion (E), or hemorrhagic transformation (HT) of infarct upon follow-up MRI/CT findings. We compared clinical features including aPL between the groups by each stroke subtypes based on TOAST classification. Sensitivity and specificity were calculated from receiver operating characteristic (ROC) curve of aPL for predicting R, E, and HT.Results:We screened 2,528 consecutive ischemic stroke patients and 271 patients met the inclusion criteria (60 [22%] cardioembolism (CE), 43 [16%] large-artery atherosclerosis, 29 [11%] small-vessel occlusion and 139 [51%] others). In enrolled patients, 30 (11%) patients showed R, 43 (16%) patients for E and 65 (24%) patients for HT. In CE, CL aCL and LAC were higher in patients with R compared without R (aCL 9.5 vs. 8.0 U/mL,p=0.047; LAC 1.15 vs. 1.01,p=0.006) while aPL were not significantly different in other stroke subtypes. Also, aPL were not significantly different between the patients with and without E or HT. In CE, R increased as LAC became higher (1st tertile vs. 2nd tertile vs. 3rd tertile of LAC: 0 (0%) vs. 1 (6%) vs. 6 (33%),p=0.004). In ROC analysis, the optimal cutoff of LAC for predicting R in CE was 1.12 (area under curve 0.83 [95% confidence interval 0.71-0.94],p=0.006; sensitivity 0.86, specificity 0.82).Conclusions:In CE, LAC was associated with acute recurrence of infarct. LAC should be measured in cardioembolic stroke with recurrence in acute phase.

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 ATMP31-ATMP31, February 1, 2025. Background:A prehospital, paramedic-administered scale to distinguish intracerebral hemorrhage (ICH) from acute cerebral ischemia (ACI) could improve routing to appropriate centers, enrich field randomized trials with targeted subtype patients, and potentially guide prehospital clinical treatment such as hyperacute blood pressure (BP) lowering. We aimed to create a quickly administered prehospital scale from prospectively performed field assessments.Methods:Two scales were created from NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) trial data, using logistic regression model with backward stepwise variable selection and retention criterion of p

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 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 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 ATMP36-ATMP36, February 1, 2025. This study compares the accuracy of manual stroke scale calculations against electronically calculated scores using the Ultimate Stroke Scale (USS), a new software designed to automate large vessel occlusion (LVO) screening scales from a modified National Institute of Health Stroke Scale (NIHSS). The USS has the potential to streamline LVO screening with enhanced accuracy using multiple validated stroke scales simultaneously.We prospectively applied eight stroke screening scales (NIHSS, BE-FAST, VAN, LAMS, FAST-ED, EMS RACE, 3-ISS, and PASS) to 199 stroke activations between January 2021 to December 2023. These values were recalculated with the USS calculator which incorporates inputs from a modified NIHSS score, including up to two additional points for hand grip strength. A Bland-Altman analysis was conducted to assess agreement between manual and USS-calculated scores.The NIHSS showed a percentage error of -8.24% and a mean difference of -0.97 (LoA: -3.88 to 1.93). The BE-FAST scale exhibited a percentage error of -14.72% and a mean difference of -0.12 (LoA: -0.85 to 0.60). The VAN scale had a percentage error of -21.76% and a mean difference of -0.11 (LoA: -0.83 to 0.62). The LAMS scale had a percentage error of 6.59% and a mean difference of 0.15 (LoA: -1.20 to 1.50). The FAST-ED scale had a percentage error of -4.82% and a mean difference of -0.15 (LoA: -2.10 to 1.80). The EMS-RACE scale had a percentage error of -9.99% and a mean difference of -0.39 (LoA: -3.20 to 2.42). The 3-ISS scale exhibited the highest percentage error of -29.36% and a mean difference of -0.54 (LoA: -2.47 to 1.39). The PASS scale had the lowest percentage error at -2.86% and a mean difference of -0.04 (LoA: -0.66 to 0.58). The combined percentage error for all scales was -8.44%, increasing slightly to -8.61% when excluding the NIHSS score. Excluding both NIHSS and 3-ISS reduced the combined error to -5.44%.Our findings demonstrate a general agreement between the manual and USS-calculated scores, with the strongest concordance observed in PASS, FAST-ED, and LAMS. Although some scales exhibited larger discrepancies, the moderate overall combined percentage error suggests that USS-calculated scores are generally consistent with manual calculations. These findings support the potential of the USS software to streamline LVO stroke screening, although further validation is necessary.

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 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 ATP314-ATP314, February 1, 2025. Introduction:Blood pressure (BP) control after a stroke is crucial in lowering the risk of stroke recurrence. Our prior work found that over 60% of patients recently discharged from a regional health system with stroke did not achieve BP control according to current guidelines. Less is known about the impact of insurance type and co-morbidities on post-stroke BP control.Objective:To analyze the relationship between insurance type, comorbidities and post-stroke BP control among patients within a regional health system.Methods:This report is an observational cohort study. Patients were admitted between 2013-2021 for ischemic and hemorrhagic stroke and had seen a PCP/PCAPP (primary care physician/primary care advance practice provider) in a regional health system or affiliated outpatient clinics using the EPIC electronic health record. We excluded patients who died during hospitalization, were lost to follow-up, or were on dialysis.Results:The analysis included 2,750 patients. Six months after hospital discharge, the insurance coverage among stroke survivors with uncontrolled BP ( >130/80 mm Hg) was 61.1% for public, 35.8% for private, 1.9% for other/unknown, and 1.3% for self-pay. In comparison, among those with controlled BP (

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 ATMP33-ATMP33, February 1, 2025. Introduction:Acute ischemic stroke (AIS) with large vessel occlusion (LVO) benefits from mechanical thrombectomy (MT), but the majority of Americans require interhospital transfer for MT. Thrombolysis at the spoke hospital with the patient transferred to the hub for MT is a model known as “drip-and-ship.” In contrast, “mothership” patients present directly to MT capable centers and have immediate access to MT. We sought to evaluate the effects of thrombolysis dwell time (time for the drug to work) and drip-and-ship versus mothership status on recanalization rates.Methods:Among 385 patients who received thrombolysis for AIS at our academic comprehensive stroke center from January 1, 2023 to June 30 2024, 76 patients had LVO and repeat vessel imaging available to evaluate for recanalization status. Thrombolysis dwell time was defined as the timefrom administration of thrombolysis to repeat vascular imaging. Recanalization was defined as complete resolution of the occlusion. Partial recanalization was defined as some recanalization (i.e. M1 transformed into M2). Patients without vascular imaging or without repeat vessel imaging were excluded. Data was collected on demographics, last known normal time (LKN), National Institutes of Health Stroke Scale (NIHSS), thrombolysis administration time, and repeat vascular imaging results.Results:Among 76 AIS LVO patients, the mean age was 68.8 years (range, 25.1 to 96.8), and 40 (52.6%) were women. The mean initial NIHSS was 14.7 (range, 0 to 34). Twenty-three (30%) were mothership and 53 (69.7%) were drip-and-ship. The mean time from LKN to thrombolysis was 2.2 hours (range, 0 to 4.9). The site of LVO occlusion was as follows: 56 (76.7%) M1, 8 (10.5%) M2s occlusions, 5 (6.6%) carotid terminus, 5 (6.6%) basilar, and 2 (2.6%) PCA occlusions. In 69 (90.8%), repeat vascular imaging was cerebral angiogram. There were 7 (9.2%) complete recanalization, and 20 (26.2%) partial recanalization. Mothership status was associated with lower rates of partial recanalization (8.7% vs 34%, p 0.016) and shorter mean thrombolysis dwell time (0.9 hours vs 2.7 hours, p < 0.0001) compared to drip-and-ship status.Conclusions:In LVO AIS patients who receive thrombolysis, drip-and ship status is associated with higher partial recanalization rates and longer thrombolysis drug dwell time compared to mothership status. This may impact strategy for recruitment of sites in clinical trials.

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 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 ATP306-ATP306, February 1, 2025. Background:Cancer is a leading cause of mortality and a well-known risk factor for ischemic stroke. However, the relationship between cancer and stroke is not well studied. Previous research in this area suggests presence of right-to-left shunt as a possible underlying mechanism of paradoxical embolism in patients with cancer diagnosis within one year of the stroke. Thus, our study seeks to further investigate the potential role of right-to-left shunting in stroke occurrence among cancer patients.Methods:This is a retrospective cohort study with our population consisting of patients presenting to the Ottawa Hospital with ischemic stroke between January 01, 2020, and December 31, 2022, who have undergone transthoracic echocardiography. Presence of right-to-left shunting is identified on echocardiography in patients without cancer and those with cancer diagnosis one year before and one year after the ischemic stroke. The prevalence of shunt is assessed using 95% confidence intervals (CI).Results:Among 495 patients (37% female, median age 53 years) presenting with ischemic stroke, 47 (9.5%) had cancer diagnosis within one year of stroke, with 12 patients (25.5%, 95% CI 14 – 40) diagnosed with a shunt. In contrast, among 448 patients (90.5%) that did not have a cancer diagnosis within one year of their stroke, 133 patients (30%, 95% CI 25 – 34) were identified to have a shunt.Conclusion:The prevalence of right-to-left shunting tends to be lower in patients presenting with ischemic stroke and active cancer diagnosis. This result is consistent with a recent study in this area indicating a higher rate of shunt among patients without cancer than those with cancer. Our finding does not support the hypothesis that cancer-associated stroke is related to right-to-left shunting.

Stroke, Volume 56, Issue Suppl_1, Page AWP187-AWP187, February 1, 2025. Introduction:3 to 5% of patients undergoing endovascular thrombectomy present impossible catheter access to the occlusion site from transfemoral access (TFA), largely attributed to complex arterial anatomy. Radial access can be an effective bailout strategy, but intraprocedural delays may negatively impact outcomes. Novel image processing algorithms allow for advanced characterization of vascular pathways from baseline neuroimaging, enabling the exploration of predictive models of impossible TFA before arterial puncture.Methods:A retrospective cohort of patients with an anterior large vessel occlusion who received thrombectomy from TFA between 2017 and 2023 were included in this study. A previously described automatic vascular analysis software was used to generate centerline graphs from the aorta to the intracranial occlusion site from baseline CTA. ArterialGNet, a graph neural network based on graph attention designed to integrate descriptors of centerline pathways extracted at three different distance scales, was trained for impossible TFA prediction. Five-fold cross validation was used for model derivation. The method was compared to a previously introduced random forest ensemble model with extreme gradient boosting (XGBRF) based on six vascular tortuosity descriptors of the aortic and supra-aortic regions.Results:A total of 745 patients (aged 78 years IQR 68-85, 56% women) were included in this study. Patients treated between 2017 to 2022 (n=568, 3.2% with impossible TFA) were used for model training and validation. Patients treated in 2023 (n=177, 3.4% with impossible TFA) were held out for testing. In validation, the best-performing configuration of ArterialGNet achieved a C-statistic of 0.82 (95%CI 0.74-0.90), similar to the baseline model (0.82, 95%CI 0.77-0.88). Comparable outcomes were observed in the final testing for ArterialGNet (0.84, 95%CI: 0.82–0.86). In contrast, the XGBRF model exhibited signs of overfitting (0.65, 95% CI: 0.53–0.78). In final testing, ArterialGNet predicted impossible TFA with a sensitivity of 0.80 (95%CI 0.66-0.94) and a specificity of 0.84 (95%CI 0.76-0.91). Median processing time for ArterialGNet was below 4 min.Conclusions:A novel model for impossible TFA prediction was validated with a large dataset. Impossible TFA prediction before arterial puncture may assist in decision support for initial access selection in thrombectomy, reducing intraprocedural delays and potentially improving clinical outcomes.