Risultati per: Stroke

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 ATP309-ATP309, February 1, 2025. Introduction:A nation-wide stroke surveillance system is not available in the US, limiting analyses to identify subgroups at disproportionate risk for ischemic stroke (IS). These data are needed to help inform targeted interventions to improve primary stroke prevention in high-risk populations. We assessed trends in IS hospitalizations and risk factor prevalence by age, sex, and racial/ethnic subgroups using data from GWTG-Stroke.Methods:The sample included patients discharged from GWTG-Stroke participating hospitals in 2010-2021 with a final diagnosis of IS. We conducted a stratified analysis to determine the proportionate composition and temporal trends in IS hospitalizations by race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, or Other), sex (women, men), and age (18-44, 45-64, 65+ y). We then used logistic regression to calculate the unadjusted prevalence odds for 10 stroke risk factors for the different race/ethnic, sex, and age groups.Results:There were 4,229,981 IS hospitalizations (mean age 70.1±14.4 y, 49.8% women) from 2,771 hospitals. The Hispanic and Other groups comprised an increasingly greater proportion of total IS hospitalizations over the study period in both women and men and in all age groups (P for trend

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 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 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 AWMP120-AWMP120, February 1, 2025. Introduction:We previously demonstrated that Mucosal-associated Invariant T (MAIT) cells were involved in acute ischemic stroke by regulating neuroinflammation (JAHA 2021). This study aimed to clarify the dynamics and role of circulating peripheral MAIT cells in acute ischemic stroke patients.Methods:We enrolled patients with acute ischemic stroke who admitted to Jichi Medical University Hospital, classifying them into severe (NIHSS ≥10) and mild (NIHSS

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 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 AWMP104-AWMP104, February 1, 2025. Introduction:Post-Civil War, Richmond emerged as a major center for tobacco cultivation and manufacturing, driven by its exploitation of Black labor. Laborers were often employed in physically demanding positions in unventilated and smoke-filled environments, coupled with forced residence in undesirable neighborhoods due to historic redlining. In response, Black laborers organized strikes leading to lower working hours, increased wages, and improved workplace safety. We investigated whether these changes in social determinants of health (SDOH) may have contributed to the reduction in stroke mortality among Black workers in Richmond in the 20thcentury.Methods:Data was sourced from the Richmond Cemetery Collaboratory (RCC), which digitized Black Death Records in Richmond, Virginia. Death records were ICD-10 coded by ChatGPT. A total of 1,815 death records (1907-1979), were georeferenced based on their proximity to tobacco factories. We conducted hotspot analysis across the study period to assess stroke mortality across time and space. The age distribution of stroke deaths within the period was compared to the 1940 Vital Statistics, which documented stroke mortality for all non-white races.Results:Stroke mortality in RCC data significantly declined following the period of labor activism between 1937 and 1941. Hot spot analysis revealed a geospatial shift in stroke mortality in Richmond, moving from the east side in the early 1900s to the south side in the mid-1900s (Figure 1A). The stroke mortality rate within a 1 km radius of tobacco manufacturing plants was 109.46 per 100,000. The observed K value indicated high levels of stroke death clustering within the sample, likely due to historic redlining (Figure 1B). Additionally, stroke mortality was more common among individuals

Stroke, Volume 56, Issue Suppl_1, Page AWP9-AWP9, February 1, 2025. Background:Acute ischemic stroke can result from extracranial arterial dissection. The effectiveness and safety of intravenous thrombolysis (IVT) for acute ischemic stroke in these cases, particularly those involving large vessel occlusions, are debated. We conducted a systematic review and metanalysis to assess the efficacy and safety of IVT in patients with acute ischemic stroke attributed to extracranial arterial dissection.Methods:This systematic review was registered in PROSPERO (CRD42024499774). We searched MEDLINE (OVID), EMBASE, web of Science, and SCOPUS from inception to 03/03/2024. Search terms included a combination of keywords and controlled vocabulary terms for carotid or vertebral artery dissection and fibrinolysis or alteplase or tenecteplase. We included randomized controlled trials, observational studies, case series that compared IV thrombolysis and standard management with at least 10 patients in each group in patients with cervical or vertebral artery dissection. Where studies were sufficiently similar, we performed metanalyses for benefits (excellent (0-1) and good (0-2) modified Rankin scale at 90 days), safety (symptomatic intracerebral hemorrhage (sICH)), and mortality outcomes, using relative risks (RR). Given the impact of NIHSS on 90-day modified Rankin Scale, we pooled adjusted ORs (adjusting for NIHSS) when exploring 90-day functional outcomes.Results:Our search identified 418 records, we screened 12 studies as potentially eligible. Four studies (all retrospective cohort, 3 studies adjusted for NIHSS variable, one study addressed LVO cohort) met our inclusion criteria. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool. Two studies had serious risk of bias while the other two had a moderate bias risk. When compared no IVT, IVT was associated with comparable risk of sICH (RR, 0.91 [95% CI, 0.11-7.94]) and mortality (RR, 0.63 [95% CI, 0.29-1.37]). However, IVT was associated with a significantly higher odds of good functional outcome at 90-days (aOR, 1.53 [95% CI, 1.14-2.05]) and a non-significantly lower chance of excellent functional outcome at 90-days (aOR 2.16 [95% CI 0.72-6.51]).Conclusion:Our metanalysis suggests that in patients with acute ischemic stroke secondary to extracranial artery dissection, IVT may have improved efficacy but comparable safety and mortality. Our findings should be interpreted with caution until supported by randomized controlled trials.

Stroke, Volume 56, Issue Suppl_1, Page A89-A89, February 1, 2025. Introduction:Platelet glycoprotein (GP) Ibα is a key receptor for thrombosis. Under high shear conditions, GPIbα-VWF interactions are required for initiating platelet adhesion and vessel occlusion. GPIbα is also an important checkpoint for thrombo-inflammation in acute ischemic stroke. It has been considered as a desirable target against ischemic stroke for decades, but no anti-GPIbα drug has been successfully developed.Methods:CA1001 was humanized from our unique mAb crossing different species, and manufactured under GMP-like conditions with 99.9% purity. The efficacy of CA1001 was assessed using variousin vitroplatelet functional assays with blood samples andin vivomodels, including state-of-the-art intravital microscopy thrombosis and transient middle cerebral artery occlusion (tMCAO) models. Pharmacokinetics (PK), pharmacodynamics (PD), and a 14-day regulatory toxicology study were conducted in rats and rhesus monkeys.Results:CA1001 specifically recognized platelet GPIbα from human, monkeys, rats, mice, rabbits and dogs. Using platelets from rhesus monkeys, healthy volunteers, and patients with peripheral artery disease, CA1001 dose-dependently inhibited ristocetin-induced platelet aggregationin vitro. Using laser injury and FeCl3injury intravital microscopy models, CA1001 inhibited thrombosis, prevented vessel occlusion, and importantly, promoted thrombus dissolution (thrombolysis)in vivo. In a 60-min tMCAO models, intravenous injection of CA1001 1 hour after tMCAO significantly reduced the cerebral infarct volume at 24 hours without increasing the risk of intracerebral hemorrhage. The PD studies showed that single bolus injection of CA1001 reached maximal anti-platelet effects within 5 minutes (0.25mg/kg in rats, 4mg/kg in monkeys) which was maintained following intravenous infusion. The extent and duration of the effect were dose-dependent. Plasma concentrations increased linearly with the dose received. In toxicology studies, CA1001 was well tolerated and safe without bleeding nor platelet count reduction. The No Obvious Adverse Event Level in rats and monkeys were 25mg/kg, and 100mg/kg respectively, which are 10 and 25 times the therapeutic targeted doses.Conclusion:The first-in-class humanized anti-GPIbα Fab CA1001 has potent anti-thrombotic effects, consistent PK/PD properties and favorable safety and tolerability profiles warranting further clinical development in healthy volunteers and patients with acute ischemic stroke.

Stroke, Volume 56, Issue Suppl_1, Page AWP7-AWP7, February 1, 2025. Introduction:Blood pressure is a simple physiologic parameter that is always measured, can be modulated, and may affect the outcome. In the hyperacute window, the therapeutic priorities are aimed at preserving penumbral tissue prior to reperfusion with the aim to optimize the chances of improved outcomes.Blood pressure fluctuations early in the stroke can be a predictor of morbidity and mortality, and both high and low systolic blood pressures can negatively affect neurological outcome.Objectives:Investigate the effects of admission systolic blood pressure (aSBP) on outcomes in patients with acute ischemic stroke (AIS), with or without large vessel occlusion (LVO).Methods:This was a retrospective analysis of AIS patient data from a health system’s stroke registry for patients discharged between January 2018 and March 2024.Adult (18+ yo) AIS patients with recorded aSBP to Thrombectomy Capable, Primary Stroke Plus or Comprehensive Stroke Center certified sites were included.Discharge disposition (DD) was dichotomized as poor DD (Hospice, Expired) and favorable DD (Home, SNF/LTC, IRF) while the 90-day modified Rankin Scale (mRS) dichotomized as good outcome (0-2) and unfavorable outcome (3-6).The relationship between the aSsBP , DD and 90-day mRS was analyzed using restricted cubic splines through multivariable mixed-effect models, adjusting for age, sex, race/ethnicity, NIHSS, treatment modalities, and medical history.Results:Data from 21,759 AIS patients were included, 72% aged ≥65 years, 49% female, 68% white, had median aSBP at admission 152 mmHg [interquartile range (IQR) 135, 172]; 3,016 (14%) had LVO.Low aSBP is independently associated with reduced probability of good clinical outcomes (favorable DD and good 90-day mRS) overall and if LVO. (Table 1) The higher probability of good clinical outcome was found from approximately 150 mmHg, when it plateaus, to 180 mmHg.Conclusions:The term permissive hypertension is unique to each patient and needs to be optimized accordingly to achieve the best clinical outcome. This data will be beneficial in educating medical staff and making sure to optimize blood pressure especially during transfer to a certified stroke center.

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.

Stroke, Volume 56, Issue Suppl_1, Page ATMP39-ATMP39, February 1, 2025. Obtaining consent for participation in acute stroke trials is particularly challenging due to the time pressure of delivering immediate treatment. As a result, patients are often not able to provide informed consent to participate in clinical trials. Modifications to standard consent practices such asdeferral of consent,surrogate consent,or2-physician consentcan produce problems including violating patient autonomy, disadvantaging patients through their participation and biasing results. Alternatively,advance consent, in which patients at risk of stroke consent to participate in RCTs before they experience a stroke, could address these challenges. In this study, we assessed the acceptability of advance consent to people at risk of stroke.Methods:We approached patients deemed at risk of stroke in the Stroke Prevention Clinic of the Ottawa Hospital, a tertiary care facility in Ontario, Canada. Eligible patients were invited to complete a questionnaire regarding advance consent. Patients who responded positively to questions about advance consent were offered the opportunity to consent in advance to the EASI-TOC and/or FASTEST clinical trials.Results:We screened 1547 patients over a 1-year period (July 2023 – July 2024), of whom 431 (28%) were eligible to participate. Of the 431 eligible participants, 157 (36%) completed the initial questionnaire. Of these, 96% (151/157) either agreed or strongly agreed that inviting stroke patients to provide advance consent to participate in clinical research trials is appropriate. Further, 95% (149/157) of participants either agreed or strongly agreed that they would provide advance consent to specific acute stroke clinical research trials, and 69% (108/157) either agreed or strongly agreed that they would provide advance consent to all acute stroke research trials, whether or not they were given the details of the trial. Ultimately, 123 respondents were eligible to be offered advance consent, of whom 45 (37%) provided advance consent to participate in at least one ongoing trial. One participant (0.8%) specified in advance that they would not want to participate in these trials.Discussion:Preliminary results of this feasibility study show that patients were open to the idea of providing advance consent to participate in acute stroke research and a sizable portion of patients were willing to provide advance consent for ongoing trials.

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 AWMP118-AWMP118, February 1, 2025. Background and Purpose:Thrombolysis can improve outcome in patients with acute ischemic stroke. However, recanalization is not always complete with persisting cerebral vascular occlusion in >50% of patients despite treatment. Properties of the formed thrombus may influence thrombolysis efficiency and impede recanalization success. Here we examine whether differences thrombin generation are associated with unfavourable outcome in thrombolysis treated patients with acute ischemic stroke.Methods:Two cohorts of patients with acute ischemic stroke treated with thrombolysis were recruited (cohort 1 n=36 patients, cohort 2 n= 42). Thrombin generation was determined by thrombin generation assay and related to stroke outcome at 90-days determined by modified Rankin Scale (mRS). The relationship of thrombin concentration to clot lysis rate was examinedin vitro.Inflammatory factors associated with increased thrombin generation were also identified.Results:An increase in peak thrombin was associated with unfavourable 90-day outcome in patients with acute ischemic stroke treated with thrombolysis. In cohort 1, patients with mRS£2 had a mean peak thrombin of 208.4nM compared to 255.5nM in those with mRS >2 (p=0.019). In cohort 2, patients with mRS£2 had a mean peak thrombin of 211.1nM compared to 251.6nM in those with mRS >2 (p=0.019).In vitro, an increase in thrombin concentration slowed the rate of clot lysis by tPA. In patients with stroke, an increase in peak thrombin was associated with increased plasma interleukin (IL)-6, interleukin-8 and a decrease in a2-macroglobulin.In vitro, IL-6 can was found to increase thrombin generation via monocyte tissue factor.Conclusions:Increased thrombin generation on admission is associated with unfavourable outcome at 90 days in thrombolysis treated stroke patients. Higher thrombin generation may influence thrombus properties, reducing effectiveness of thrombolysis, and impairing recanalization. Further understanding regarding the relationship of thrombin generation to thrombolysis is necessary to enhance recanalization and further improve outcomes in stroke.