Search Results for: Diagnosi, trattamento e follow-up dei pazienti con vescica iperattiva

Stroke, Volume 56, Issue Suppl_1, Page AWP2-AWP2, February 1, 2025. Introduction:Cathodal transcranial direct current stimulation (C-tDCS) is a potential neuroprotective method in the hyperacute phase of ischemic stroke. In rodent models, C-tDCS reduced final infarct volume and improved functional outcome. Our aim was to assess safety, tolerability, feasibility, and potential efficacy of C-tDCS in stroke patients with salvageable penumbra.Methods:Our study was a single-center, double-blind, randomized, sham-controlled (3 active: 1 sham), 3+3 dose-escalation trial. Inclusion criteria were stroke due to occlusion of the internal carotid or middle cerebral artery, last well-known time within 24 h, evidence of substantial penumbra on baseline CT perfusion, and ineligibility for mechanical thrombectomy. We applied C-tDCS at six dose tiers over the affected primary motor cortex (1 or 2 mA for 20 min in 1 to 3 cycles with 20 min breaks). The primary safety outcome was the symptomatic intracranial hemorrhage (SICH) rate at 24 h post-stimulation. The secondary safety outcomes were the rates of asymptomatic intracranial hemorrhage (AICH), early neurologic deterioration, serious adverse events, and mortality within 90-day follow-up. Tolerability was assessed by the rate of patients completing the entire stimulation period and by structured questionnaires. The success threshold for feasibility was median randomization-to-C-tDCS start time within 10 min in the last ten patients. Exploratory efficacy outcomes included infarct growth at 24 h, and National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale at day 90.Results:A total of 25 patients were enrolled (19 active, 6 sham), mean age (SD) 81 (12) years, 9 males, median NIHSS (Q1–Q3) 8 (6–16) points. Ten active and 4 sham patients were treated with thrombolysis. No SICH and 3 AICH (2 after thrombolysis) occurred in the active arm. We observed no significant difference in serious adverse events. The mortality rate was also comparable (4 active vs 2 sham patients). C-tDCS was well tolerated, all patients completed the stimulation period. Side effects were only mild and transient. C-tDCS was feasible, median randomization-to-C-tDCS start time was 8 (7–9) min. No significant differences in other outcome measures were observed.Conclusions:The application of C-tDCS in hyperacute ischemic stroke was safe, well tolerated, and feasible. Our results support the use of C-tDCS in larger efficacy trials.

Stroke, Volume 56, Issue Suppl_1, Page AWP159-AWP159, February 1, 2025. Introduction:The long-term effects of ischemic stroke on cognition and mental health remain poorly understood, leading to mismatches in perceptions of overall disability despite otherwise qualifying as having ‘good’ or ‘excellent’ outcomes on traditional measures like the modified Rankin Scale (mRS). In our multicenter analysis, we aim to explore the prevalence and factors associated with patient-reported outcomes in patients who underwent reperfusion therapy and otherwise achieved good outcomes as defined by an mRS of 0-2.Methods:Retrospective registries of acute ischemic stroke patients at Cooper University Hospital (2021-2024) and Hospital Vall d’Hebron in Barcelona, Spain (2020-2021) were queried for patients who were treated with reperfusion therapy and achieved 90-day mRS 0-2. These patients were surveyed with the PROMIS Global-10 scale. The PROMIS Global-10 measures two domains: physical health (PROMIS-PH) and mental health (PROMIS-MH). The primary outcome was the rate of fair or poor PROMIS-MH scores (≤11), which was summarized as a frequency. Univariable and multivariable linear regressions for PROMIS-MH scores were performed to identify independently-associated factors.Results:Of 162 patients, 42% reported fair or poor (PROMIS-MH≤11) mental health outcome scores. Clinical factors independently associated with PROMIS-MH scores in a multivariable linear regression include: sex, tobacco use, PROMIS-PH score, and National Institutes of Health Stroke Scale at 3-day follow-up.Conclusions:Despite having mRS 0-2, patients do not necessarily have good long-term mental health outcomes. To better serve our stroke patients, emphasis should extend beyond traditional, limited measures and encompass additional dimensions of evaluation, including patient-reported mental health outcomes.

Stroke, Volume 56, Issue Suppl_1, Page AWP377-AWP377, February 1, 2025. Background and Purpose:Aged patients experience more cognitive dysfunction than young patients after stroke. Brain astrocytes and microglia causes excessive removal of synapses at the early stage of stroke. Inhibition of their phagocytosis improved neurobehavioral outcomes. Long-term post-stroke cognitive dysfunction in aged subjects may be associated with increased synapse pruning by astrocytes, as increased reactive astrocytes are present in and around the atrophic region.Hypothesis:Excessive synapse pruning by reactive astrocytes contributes to the long-lasting post-stroke memory dysfunction in aged mice.Methods:pMCAO was induced in young (2-month-old) and aged (15-18-month-old) mice. Memory performance was tested weekly for 8 weeks by Y-maze, and at 8 weeks post-stroke by novel objective recognition (NOR) tests. Brains were collected 8 weeks after pMCAO. Gene expressions were analyzed by RNAseq and western blot. Atrophic volume, CD68+cells, GFAP+cells, and synaptophysin (SYP) were analyzed histologically.Results:In Y-maze test, aged stroke mice made fewer spontaneous alternations from 3 to 8 weeks after pMCAO than young stroke and sham operated aged mice. In NOR test, aged stroke mice spent shorter time on the novel objects than young stroke and sham aged mice. RNAseq data showed up-regulation of inflammation, and down-regulation of axon growth and synaptic transmission pathways in the aged ipsilateral than young ipsilateral cortex and aged contralateral cortex. Glutamatergic and cholinergic synapses were decreased in aged ipsilateral cortex and hippocampus. GABAergic presynapse protein was increased in the aged ipsilateral hippocampus compared to the young mice. All support reduced activity in the cortex and hippocampus of aged stroke mice. Aged mice showed larger atrophic volumes, more CD68+and GFAP+cells in the peri-atrophic and hippocampi regions than young mice. About 10-fold more GFAP+cells were detected in aged peri-atrophic and ipsilateral hippocampi regions than CD68+cells; 57% GFAP+and 37% CD68+cells were SYP+in the ipsilateral hippocampi, 53% GFAP+and 39% CD68+cells were SYP+in the peri atrophic region of aged stroke brain, indicating that reactive astrocytes contributed more than microglia on synapse pruning in aged mice.Conclusions:Reactive astrocytes contribute more than microglia to synapse pruning at the chronic stage of stroke, which is involved in long-lasting post-stroke memory dysfunction in the aged mice.

Stroke, Volume 56, Issue Suppl_1, Page AWP160-AWP160, February 1, 2025. Introduction:Stroke patients with lower socioeconomic status (SES) have been found to experience worse functional outcomes, but few studies have examined the association between SES and quality of poststroke care. The primary aim of this follow-up study was to evaluate the relationship between SES and the poststroke guideline score (PGS) score (Table 1). Secondary aims explored other factors related to overall poststroke quality of care.Methods:We reviewed the electronic medical records of individuals with acute ischemic stroke (AIS) admitted to an urban safety net hospital from July to September 2022. Individuals were given a pass/fail or ineligible for each process. The PGS, calculated per individual, was passes/total number of eligible processes with a possible score of 0 – 1.0. Unknowns were coded as failures as this approach is more likely to reflect actual missed opportunities for care in this population.Results:47 individuals with AIS were eligible for PGS assessment. Mean PGS score was 0.554 (SD 0.245, range 0.111-1.000). Using the independent sample t-test we found no significant difference in PGS based on the presence of financial strain. Individuals with private insurance had a mean PGS of 0.954, compared to those without with a mean PGS of 0.526 (t = 10.30, p < 0.001), however, only three individuals among our cohort had private insurance. Females had significantly higher PGS scores compared to males (t = 4.08, p

Stroke, Volume 56, Issue Suppl_1, Page A9-A9, February 1, 2025. Introduction:For patients transferred for EVT considerations, direct-to-angio approach is shown to reduce time to procedure and improve clinical outcomes. We aimed to assess if IV thrombolytics status prior to transfer modifies the association between direct-to-angio approach and improved clinical outcomes in transferred patients who received EVT.Methods:In a secondary analysis of a retrospective cohort of transferred EVT patients from 6 centers across US and Europe, patients were stratified based on IV thrombolytic status. Association of direct-to-angio approach vs repeated imaging approach with functional outcomes was assessed among patients with and without IV thrombolytics using appropriate regression models adjusted for age, stroke severity, time to procedure, occlusion location, serum glucose and successful reperfusion status. Heterogeneity of association was evaluated using multiplicative interaction.Results:Of 1135 patients with documented IV thrombolysis status, 612 (54%) received IVT – with younger age (IVT – 68 (57-78)y, no IVT – 70 (60-79)y, p=0.032) and higher CT ASPECTS (IVT: 8 (7-10) vs no IVT: 8 (7-9), p=0.038), but similar NIHSS (IVT: 17 (13-21) vs no IVT: 17 (12-21), p=0.91). Estimates of association favored direct-to-angio approach among both no IVT (acOR: 2.06, 95% CI: 1.38 to 3.08, p-value

Stroke, Volume 56, Issue Suppl_1, Page A4-A4, February 1, 2025. Introduction:The tenecteplase versus standard of care for minor ischemic stroke with proven occlusion (TEMPO-2) trial showed that patients presenting with minor deficits up to 12 h do not benefit from intravenous thrombolysis. The trial included patients with minor but disabling deficits, mainly beyond 4.5 h, if they were not eligible for standard-of-care thrombolysis. We aimed to determine if intravenous tenecteplase improves outcomes in this subgroup of TEMPO-2 patients with disabling deficits.Methods:This was an exploratory secondary analysis of the TEMPO-2 trial, which randomized patients across 48 hospitals globally with minor acute ischemic stroke (NIHSS score 0-5) and intracranial occlusion or focal perfusion abnormality within 12 h from stroke onset to intravenous tenecteplase (0.25 mg/kg) or non-thrombolytic standard of care. Adopting an available definition for disabling stroke from the TREAT Task Force consensus (Table 1), we compared efficacy and safety outcomes between treatment arms for participants with non-disabling versus disabling syndromes at presentation.Results:Among 886 patients, 786 (88.7%) and 100 (11.3%) were identified to have non-disabling and disabling deficits, respectively. Patients with disabling deficits had higher baseline NIHSS scores (4 vs 2, P

Stroke, Volume 56, Issue Suppl_1, Page AWP388-AWP388, February 1, 2025. Introduction:Eicosanoids (EIC) are lipid mediators that play a systemic role in inflammation and, more specifically, in the brain, contribute to the process of neurovascular coupling. Though EICs have been associated with immediate stroke risk and stroke risk factors, the long-term risk and associations with stroke risk factors have not been previously studied.Methods:Plasma EICs (214) were measured using non-targeted liquid chromatography mass spectrometry in conjunction with chemical networking of spectral fragmentation patterns among participants of the Atherosclerosis Risk in Communities Study at visit 2 (1990-92). Incident stroke (ischemic and hemorrhagic) was ascertained until the end of 2021 with adjudication by an expert panel. Cox regression was used to estimate the hazard ratio (HR) for incident stroke per doubling of EIC levels, and p-values were FDR corrected. Primary model 1 adjusted for age, sex, race/center and additional models adjusted for stroke risk factors (eGFR, BMI, hypertension, diabetes, current smoking status, total cholesterol, prevalent atrial fibrillation, prevalent heart failure, prevalent coronary heart disease, aspirin use, cholesterol-lowering medications, anticoagulation medication use, time-dependent incident atrial fibrillation and incident anticoagulant use).Results:Among the 9,444 participants included, the mean age was 57 (5.7 SD), and 43.2% were men. Over a mean of 22.7 (8.5 SD) years of follow-up, 950 participants had an incident stroke. In model 1, higher levels of 9 EICs were associated with a higher risk of incident stroke (11t LTD4 [HR 1.21, p=7.4E-05], 5S HpEPE [HR 1.21, p=0.005], LXA5 [HR 1.15 p=0.006], 13 HpODE_a [HR 1.17 p=0.009], 17S HpDHA_a [HR 1.16, p=0.018], 15 oxoEDE_a [HR 1.29 p=0.03], 11, 12 di-HETrE_a [HR 1.21 p=0.03], Arachidonic Acid_a [HR 1.17 p=0.03], and 5S HpETE_c [HR 1.18 p=0.04]; and 3 EIC analytes were associated with lower risk of incident stroke (PGF1a_b [HR 0.27 p=0.006], 13, 14 dihydroPGF1a [HR 0.37 p=0.02], 13,14 dihydroPGE1_b [HR 0.5 p=0.03]. Associations did not reach FDR-corrected significance after adjusting for risk factors.Conclusion:Our analysis of this large longitudinal community-based study demonstrates that the risk of incident stroke over decades is associated with alterations in the balance of increasing pro-inflammatory EICs likely interrelated with the presence of stroke risk factors over time and interestingly including an EIC associated with neurovascular coupling.

Stroke, Volume 56, Issue Suppl_1, Page AWMP91-AWMP91, February 1, 2025. Background and Objective:Carotid artery stenting (CAS) is a procedure that has been established as a safe and effective alternative to carotid endarterectomy in high surgical risk patients. There are procedural questions that remain unanswered, specifically, the safety of pre-stent balloon angioplasty versus post-stent versus both. The objective of our study is to understand the risk and safety of these procedural techniques.Methods:Multicenter retrospective data related to angioplasty balloons, stents, complications due to pre and post-stent angioplasty along with the modified Rankin score (mRS) before and after the procedure were collected from January of 2015 until December of 2022. Statistical analysis was performed to correlate this data with risks of complications and clinical outcomes.Results:A total of 1355 patients were enrolled. We found that patients who underwent pre-stent angioplasty, or both (pre and post-stent angioplasty) had a higher risk of complications compared to those who only had post-stent angioplasty. There were more complications in patients who did not undergo post-stent angioplasty as compared to those who did undergo angioplasty (p=0.018, OR=0.513). Follow-up MRS at 30-90 days was higher if the balloons in both pre-stent angioplasty (p=0.016) and post-stent angioplasty (p=0.020) stent angioplasty were not inflated to nominal pressure. Follow up MRS was statistically higher (p=0.01) in patients with open-cell stents than closed-cell stents. Open-cell stents were more likely to undergo post-stent angioplasty (p

Stroke, Volume 56, Issue Suppl_1, Page AWMP96-AWMP96, February 1, 2025. Introduction:Patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and small ischemic cores have the most favorable outcomes after thrombectomy. Core growth and growth rate during transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) may hinder outcomes. The effect of the CCC’s combined arterial, tissue, and venous outflow on core growth remains unclear. We determined if poor CCC profiles before transfer to a CSC predict ischemic core growth in AIS-LVO.Methods:AIS-LVO patients in the prospective CRISP2 study with a CT angiogram (CTA) and CT perfusion (CTP) at a PSC and a follow-up CTP or Diffusion-weighted imaging(DWI) after transfer to the CSC were screened for enrollment. CCC was determined on CTA collaterals using the TAN scale(favorable: Tan 2-3), tissue level collaterals on CTP using the hypoperfusion intensity ratio (HIR [Tmax >10s/Tmax >6s volume]; favorable HIR≤0.5), and venous outflow on CTA (favorable cortical venous opacification score 3-6). Patients were grouped into favorable CCC (CCC+; favorable scores at all three levels), unfavorable CCC (CCC-; unfavorable scores at all three levels), or CCCmixed(mixed scores at the levels). Ischemic core was determined on CTP at the PSC and pre-thrombectomy DWI-MRI or CTP at the CSC. Ischemic core growth was assessed using a voxel-based method following co-registration between the PSC and CSC images. The primary outcomes were ischemic core growth volume and rate.Results:The study included 175 patients; 24.6% were CCC+, 8% were CCC-, and 67.4% were CCCmixed. No differences in baseline demographic or clinical characteristics were found between the groups. CCC- patients had larger baseline ischemic core volumes (median 17.1 ml [IQR: 10.5-56.3]; P

Stroke, Volume 56, Issue Suppl_1, Page AWP149-AWP149, February 1, 2025. Introduction:Stroke imposes a significant burden on individuals, families, and healthcare systems, with high readmission rates and healthcare utilization. It disproportionately affects racial/ethnic minorities, exacerbating healthcare disparities. There is a critical need for tailored, patient-centered interventions, particularly for minority populations.Objectives:This research identifies key themes in stroke survivors’ and care partners’ perspectives post-stroke, and examines the demographic and social determinants of health impacting outcomes. The study focuses on how these factors influence survivors’ experiences with a digital health platform offering personalized support through remote clinical guidance and curated educational content.Methods:A mixed-methods, exploratory design was employed with 50 participants, including 36 unique stroke survivors (52.7% female, 47.2% male) and 13 care partners (84.6% female, 15.3% male), followed for 90 days for comprehensive post-stroke care via Principal Illness Navigation (PIN). The average age of participants was 59 years, with close to 60% being non-white. Participants provided feedback through focus groups conducted via video-conferencing between December 2022 and March 2024. These sessions included up to 3 participants, a facilitator, a Kandu representative, and lasted no more than 60 minutes.Results:Participants were highly engaged, with an average of 12 navigator touchpoints over 12 weeks, totaling 7.65 hours of one-on-one navigator time. The cohort identified an average of 3.1 social determinants of health (SDOH) needs, with mental health (43.9%), financial strain (34.1%), and family/community support (31.7%) being the most common. Focus group themes included: (1) Multi-faceted Therapeutic Support, (2) Educational Content&Services, (3) Triaging/Clinical Care Guidance, (4) Behavioral Health Support, (5) Connectivity/Community, (6) Programmatic Value, and (7) Constructive Feedback/Future Opportunities.Conclusion:This study offers insights into the effectiveness of a digital health and clinical navigation platform in enhancing stroke recovery and person-centered care. The program addressed core themes impacting patient and care partner experiences, such as access to educational resources, real-time clinical guidance, intervention compliance, and behavioral health needs. These findings can inform future interventions aimed at providing post-acute stroke navigation and reducing healthcare disparities.

Stroke, Volume 56, Issue Suppl_1, Page AWMP93-AWMP93, February 1, 2025. Background:Chronic total internal carotid artery occlusion (CTO) can be associated with a high (22-25%) annual risk of stroke with limited therapeutic options. Total endovascular reconstruction (TER) is increasingly feasible but mid-term and long-term outcomes have not been reported.Methods:Data from all patients treated with carotid CTO treated with TER over the past 18years were collected in a database. Patients were selected based on the presence of angiographically proven symptomatic carotid occlusion, adequate landing zone and concurrent impairment of cerebrovascular reserve or recurrent ischemia despite maximal medical therapy. They were treated via a femoral approach using conventional CTO techniques with balloon expandable and/or self-expanding stents. Neurological evaluation of NIHSS, mRankin and carotid U/S were performed at discharge, 30days, and all subsequent follow-up. All TIA, stroke, death, and MI were recorded during follow-up. Angiographic follow-up was performed between 6-12months when possible.Results:Twenty-six symptomatic patients with a mean age of 65±7.8years were treated. Technical success was achieved in 22/26 (85%) on first attempt and in 3/4 on second attempt for total success rate of 25/26(96%). Total 30-day stroke/death/MI was 6.9% (2 ICH, both in first 3 years of experience). There were no recurrent events during 15.2±9.8months (median 12) of follow-up. Restenosis was found in 5/26 (19.2%) of patients; 2/5 were in unstented segments of the ICA. There was one case of asymptomatic carotid occlusion at 7months. The median mRS dropped from 2 to 1 at follow-up.Conclusion:TER is feasible in most patients with carotid CTO and is associated with a 30-day event rate lower than reported for STA-MCA bypass surgery. It is associated with good long-term stroke reduction despite a 19.2% risk of restenosis. Carotid re-occlusion is rare. Randomized trials are needed to validate this approach.

Stroke, Volume 56, Issue Suppl_1, Page AWP136-AWP136, February 1, 2025. Introduction:Intracerebral hemorrhage (ICH) leads to the highest mortality among stroke patients. ICH expansion causes worse outcomes, especially with anticoagulant-associated ICH. Rapid management of ICH has been shown to improve patient mortality.Hypothesis:A standardized timeout procedure will improve timely treatment and functional outcomes in patients with ICH.Methods:A checklist was created to be filled out by the nurse, pharmacist, and neurology resident during a timeout procedure for patients with ICH presenting to the emergency department at a large academic medical center. The checklist tracks blood pressure (BP) management and calling a neurosurgery consult. Additionally, the checklist includes verification of antiplatelet and/or anticoagulant (AP/AC) usage with subsequent guidance regarding reversal, including agent used, dose used, and time administered. Training sessions and online modules on this process were required for staff members to complete prior to implementation. Data analysis involves comparing initiation times of steps on the checklist as well as difference in admission and discharge National Institutes of Health Stroke Scale (NIHSS) score pre- and post-intervention.Results:Data prior to intervention was compiled from January 2021 up to workflow implementation on August 12th, 2024. Post-intervention data is currently being collected from the implementation date onwards. Data analysis thus far has demonstrated significant improvements in patient management. Average time to BP medication initiation improved from 188 minutes pre- to 55 minutes post-intervention. Average time to AP/AC reversal improved from 238 minutes pre- to 50 minutes post-intervention. Time to neurosurgical intervention did not show improvement post intervention. In terms of functional outcome, the average improvement in discharge NIHSS score increased by 1.33 points post-intervention.Conclusions:This study demonstrates that a standardized timeout procedure for ICH can increase efficiency in patient management. Reducing delays to treatment has been shown to improve morbidity and mortality associated with ICH, and while data collection is still ongoing, this study already shows improvement in patient outcome.

Stroke, Volume 56, Issue Suppl_1, Page AWP128-AWP128, February 1, 2025. Introduction:Stroke patients often experience varying degrees of locomotor deficits. Research has shown that physical rehabilitation can help improve these deficits to different extents. Our analysis aims to compare functional outcomes in stroke patients after high-intensity training (HIT) with those achieved through various other exercise intensities.Methods:A comprehensive search of PubMed, Cochrane, Embase, and Scopus databases were performed for studies comparing HIT with low and moderate intensity training (LIT, MIT), or usual activity (UA) in stroke patients. We evaluated changes from baseline in the 6-minute walking test (6MWT), fastest speed, and comfortable speed. Subgroup analyses were performed by exercise intensity and stroke onset, as well as separate analyses according to follow-up periods.Results:12 studies were included, encompassing 1,019 patients, with 54% undergoing HIT. An analysis of ten studies with 860 patients showed that control group had a 49m greater improvement in 6MWT than HIT group (95%CI 21.62-76.38; p

Stroke, Volume 56, Issue Suppl_1, Page AWP157-AWP157, February 1, 2025. Background:e-consults for outpatient stroke/TIA care can improve timeliness of neurologic care, however it is unknown whether active implementation of an e-consult impacts the overall volume of outpatient stroke care provided in one healthcare system vs another.Methods:We studied the implementation of an e-consult for outpatient stroke/TIA care in a stepped-wedge trial in 10 VA facilities in the VA National TeleNeurology Program (NTNP). Sites were randomized to one of three sequential 6-month active implementation waves (after 2 months of usual care where the e-consult was available) that included a stroke prevention lecture for primary care (PC) providers, as well as participation in monthly PC meetings to review cases and utilization of the consult. After the 6-month active implementation (sustainability period), no data were presented to PC teams. The primary outcome was whether a consult was placed in the VA versus community care neurology (CCN) for outpatient stroke/TIA care. A generalized linear mixed model (GLMM) with binomial distribution and log link fit to the primary outcome was used to estimate the effect of active implementation with baseline serving as the reference. Other effects in the model includeda prioriselected variables: demographics, site data (stroke volume, median consult wait time, rurality, availability of local neurology, indicator for sustainability), time block (as categorical 2-month blocks) and random site effect. A similar model was fit including 4 control sites, with an added site-level indicator for intervention vs control site.Results:Of the 1545 consults placed for stroke/TIA, 21% (322/1545) were NTNP (within VA). The GLMM model demonstrated that the odds of a stroke/TIA consult being placed within the VA increased during active implementation: OR 1.92 (1.17-3.16, p = 0.01, Table). Adding data from 4 NTNP control sites who had access to the e-consult but did not receive the active implementation showed no trend in consult location over time but added additional variability to the model, resulting in a decrease in the effect (N = 1680, OR 1.48, 95% CI 0.96-2.28, p = 0.07).Conclusion:Active implementation of a stroke/TIA e-consult may increase the likelihood of further outpatient care being provided in that healthcare system. This may be relevant to healthcare systems seeking to improve continuity of care for post-acute stroke follow-up through innovative care models and use of asynchronous telehealth modalities.

Stroke, Volume 56, Issue Suppl_1, Page AWP162-AWP162, February 1, 2025. Introduction:Outpatient follow-up within thirty days of discharge home after an ischemic stroke is associated with reduced readmission rates. Current guidelines emphasize a primary care-based approach to follow-up care but provide little information regarding neurology-specific follow-up. This study aims to examine the rates of follow-up with non-neurology care providers and neurologists, and their association with patient outcomes.Methods:We conducted a retrospective cohort study using electronic health records collected of patients discharged home after admission on the neurovascular service from a tertiary care hospital from October 2020 to October 2023 who were then subsequently contacted via guideline-recommended seven-day phone call. Clinical demographics, follow-up with either a non-neurology care provider (e.g., primary care provider, cardiologist, endocrinologist) or neurologist, emergency department (ED) presentations, and mortality were analyzed using a Chi-square analysis.Results:We identified a total of 246 patients for this review, 232 (94.3%) of whom attended follow-up with a non-neurologist compared to 182 (74.0%) with a neurologist an average of 33.9 days and 77.5 days from hospital discharge, respectively. A total of 127 (51.6%) patients presented to the ED within the follow-up timeframe, with 31 (12.6%) patients presenting prior to any follow-up appointment. There was a noted difference in the ED presentation rate between patients who did not attend a neurology appointment (36/62, 58.1%) compared to those that did attend (91/182, 41.9%), however this was not statistically significantly different. Of the 16 (6.9%) deaths in the cohort, they occurred significantly disproportionately in the patients without a neurology follow-up appointment (8/62, 12.9%; p = 0.02).Conclusion:Our findings suggest that patients who do not attend a neurology-specific follow-up appointment after stroke may have worse outcomes, including higher mortality rates. Further research is needed to develop interventions that improve neurology follow-up rates, with the goal of reducing ED visits, hospital readmissions, and mortality in patients with stroke.

Stroke, Volume 56, Issue Suppl_1, Page AWP374-AWP374, February 1, 2025. Introduction:The human microbiome has been studied in various diseases, including inflammatory bowel disease, diabetes, obesity, and cardiovascular diseases. However, its role in acute ischemic stroke (AIS) remains underexplored. This study aims to investigate the microbiome profiles in stool and saliva samples from AIS patients compared to control groups to identify distinct microbial patterns associated with ischemic stroke.Methods:We enrolled 54 AIS patients, collecting stool and saliva samples within one week of admission. Saliva was either self-expectorated (n=44) or obtained via oral swab (n=10) for those unable to spit. The 40 control group was defined as those without cerebrovascular disease, in whom no abnormalities were found on brain MRI/A taken for health check-up purposes within the past year. DNA extraction and 16S rRNA gene sequencing were performed, and data were analyzed using QIIME 2 for diversity and taxonomy, with Linear discriminant analysis Effect Size (LEfSe) for differential abundance and functional predictions.Results:AIS patients demonstrated significantly higher alpha diversity in stool samples compared to controls (p=0.001), indicating increased microbial richness. Saliva samples, however, showed decreased microbial richness in AIS patients (p=0.024). Beta diversity analysis revealed distinct microbial community structures between AIS patients and controls, especially at the genus level in stool samples (p=0.001). LEfSe analysis identified several bacterial taxa enriched in AIS patients’ stool, while saliva samples from AIS patients exhibited a higher number of depleted taxa compared to controls. Notably, the AIS microbiome showed reduced functional capabilities related to beneficial metabolic processes includingProteobacteria, Gammaproteobacteria, Enterobacteriaceae, andShigella, etc.These findings highlight a potential link between microbiome dysbiosis and the pathophysiology of AIS.Conclusions:This study identifies significant microbiome dysbiosis in AIS patients, characterized by altered diversity and bacterial composition in stool and saliva samples. The findings suggest that gut and oral microbiomes may contribute to the pathophysiology of cerebral infarction, warranting further investigation into their roles as potential biomarkers or therapeutic targets.