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Stroke, Volume 56, Issue Suppl_1, Page AWMP80-AWMP80, February 1, 2025. Introduction:Stroke is a devastating complication of infective endocarditis (IE) and is associated with poor outcomes. The underlying factors contributing to stroke in IE are not yet fully understood, leaving gaps in optimizing disease management and preventive strategies. In this study, we analyzed the radiological characteristics, functional outcomes and predictors of poor outcome in patients who developed acute stroke following a diagnosis of infective endocarditis.Methods:We conducted a retrospective study of patients diagnosed with infective endocarditis at a single tertiary center over a 10-year period from 2014 to 2023. Out of 526 cases, 511 had active infection and were screened for acute stroke associated with IE. We recorded baseline characteristics including age, gender, comorbidities, echocardiographic findings, vegetation location, microbiological profile, stroke type with radiological features, treatment strategies, and functional outcomes assessed by the Modified Rankin Scale (mRS). Descriptive statistical analysis was performed using IBM SPSS v.20, focusing on predictors of poor outcomes from radiological, microbiological, and echocardiographic data.Results:Among 511 patients with active IE, 13.3% (68) developed acute stroke, with 80.88% (55) being male. The mitral valve was the most common site for vegetations (66.12%, 41/62). Most cases were culture-negative (39.7%, 27/68), followed by Streptococci (11.76%, 8/68) and Enterococci (10.29%, 7/68). Ischemic strokes accounted for 77.94% of cases, while hemorrhagic strokes occurred in 22.05% (n=68). The middle cerebral artery (MCA) was most frequently affected (54.72%, 29/53). Hemorrhagic transformation was observed in 20.05% of stroke cases. Among hemorrhagic strokes, subdural hemorrhage occurred in 13.3% (2/15) and subarachnoid hemorrhage in 20% (3/15). A favorable outcome (mRS 0-2) was achieved in 41.17% of patients, while 58.82% had poor outcomes (mRS 3-6). The overall mortality rate was 33.82% (23/68), with 69.56% (16/23) of deceased patients having ischemic strokes, often involving the MCA territory (43.76%, 7/16).Conclusion:Our findings show that patients with ischemic stroke and IE face higher mortality rates. We observed that most strokes occurred in patients with vegetations on native mitral valves. These results emphasize the need for careful monitoring and effective treatment strategies for patients with native valve endocarditis to reduce stroke risk and improve outcomes.

Stroke, Volume 56, Issue Suppl_1, Page AWP118-AWP118, February 1, 2025. Background:Although long-term management following a stroke is crucial, many patients do not adhere to follow-up appointments, which pose a risk to the integrity of clinical trials. This systematic survey aimed to identify factors and potential impacts linked to lost to follow-up (LTFU) in stroke patients participating in long-term management trials, to enhance trial quality. Understanding LTFU is essential for informing patients, clinicians, and researchers for both clinical and research purposes.Methods:An information specialist completed a comprehensive search of available data sources, including studies published up to June 15, 2024. Eligible articles included randomized trials that involved multimodal post-stroke care programs, initiated within one year after the stroke, with specified and assessed follow-up outcomes. We collected data on general trial characteristics and methodological characteristics for each study. Multiple linear regression analyses were conducted to identify factors associated with LTFU. Additionally, we evaluated the relative risk of several assumptions about the outcomes of participants LTFU on the estimate of effect for the significant binary primary outcome.Results:Of the 57 eligible reports identified, 6 (10.5%) did not specify whether LTFU occurred. The duration of follow-up ranged from 1 to 60 months. The median proportion of subjects LTFU was 7.9% (interquartile range, 0–12.9%). Factors of LTFU increase on regression analysis were more study centers (beta=0.003 per center,P=0.017), higher proportion of females (beta=0.027 per percentage of 10,P=0.006), and non-protocol available (beta=-0.06,P=0.021) (Table 1, Fig.1). Patients were also more likely not to be lost if their providers were therapists (beta=-0.14,P=0.016) or rehabilitation team (beta=-0.12,P=0.038) compared to physician alone. In the trials that provided relevant data, results of 14.3% of trials were no longer significant if we assumed no participants LTFU had the event of interest, and 42.9% of trials were no longer significant if we assumed a worst-case scenario (Table 2).Conclusion:Overall, nearly one-tenth of contemporary stroke trials on longer-term patient management still did not report LTFU. Identified modifiable risk factors may provide targets to improve the continuity of stroke management within these trial settings. Neurologists should pay close attention to how the participants are managed which may change the direction of the entire study.

Stroke, Volume 56, Issue Suppl_1, Page AWP4-AWP4, February 1, 2025. Introduction:Previous studies have shown the efficacy and safety of time-based intravenous thrombolysis (IVT) in elderly patients with ischemic stroke. However, there are safety concerns about bleeding associated with IVT due to their low body weight, renal dysfunction, and the concomitant use of antithrombotic drugs. Robust evidence on the effect of IVT, particularly in elderly patients with unknown onset stroke, is limited. This study aimed to evaluate the efficacy and safety of imaging-based IVT in this population.Methods:Patients with an unknown onset stroke were evaluated using an individual patient-level database of randomized controlled trials comparing IVT with placebo or standard treatment from the Evaluation of unknown Onset Stroke thrombolysis trials (EOS) collaboration. The primary outcome was favorable outcome, defined as a mRS score of 0-1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22–36 hours and 90-day mortality. The effect of IVT was evaluated in each of patients aged ≥85 and

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 AWP137-AWP137, February 1, 2025. Introduction:Many national initiatives have focused on increasing public awareness of acute ischemic stroke (AIS) symptoms because earlier treatment is associated with improved outcomes. Our purpose was to evaluate the 10-year trends in the last known well to arrival (LKWA) time in AIS patients and assess disparities.Methods:A retrospective study of consecutive AIS patients admitted to a large integrated healthcare system was performed over a 10-year period from 2014-2023. LKWA time was categorized according to treatment eligibility as 0-4.5, >4.5-24, and >24 hours. Demographic and clinical characteristics, treatment utilization, and modified Rankin Score (mRS) at discharge were extracted from the electronic health records. Trend, bivariate, and multivariable logistic regression analyses were conducted.Results:A total of 11,563 AIS patients were included with 53% (6,163) in LKWA0-4.5, 34% (3,988) in LKWA >4.5-24, and 12% (1,412) in LKWA >24 groups. From 2014-2023, there was a downward trend in the early LKWA0-4.5 from 61% to 46% (Figure 1, Table 1). Concurrently, there was an upward trend in the later LKWA >4.5-24 (31% to 42%) and LKWA >24 (8% to 11%) groups.Table 2describes the study cohort characteristics. Compared to LKWA0-4.5, the LKWA >4.5-24 group was less likely to receive endovascular thrombectomy (EVT) and more likely to have worse outcomes (mRS2-5). The AIS patients in the LKWA >4.5 groups were more likely to be older >80 years (Odds Ratio=1.18 [95% Confidence Intervals:1.03-1.32]), males (1.10 [1.03-1.17]), Black (1.20 [1.08-1.33]), Asian (1.20 [1.04-1.39]), Medicaid insurance (1.16 [1.06-1.27]), lower income 4.5-24 group. During the peak of the COVID pandemic (2020), these trends were further exaggerated and did not return to pre-pandemic levels in 2021-2023. The LKWA >4.5 groups were more likely to be older, males, Black or Asian race, Medicaid insurance, lower income, and more comorbidities. Furthermore, the LKWA >4.5-24 group was less likely to receive EVT and more likely to have worse outcomes. These findings highlight the need of implementing targeted efforts towards the late LKWA groups to improve disparities in stroke treatment and outcomes.

Stroke, Volume 56, Issue Suppl_1, Page A5-A5, February 1, 2025. Introduction:Two randomized trials have evaluated intravenous (IV) Glyburide for the treatment of large hemispheric infarction (LHI) patients at high risk for cerebral edema.Hypothesis:In this meta-analysis of two randomized trials, we aimed to determine whether subjects with a baseline stroke volume ≤125 mL who were treated with IV Glyburide would have better outcomes than those who received placebo.Methods:The source population included all GAMES-RP and CHARM subjects who were enrolled and treated with IV Glyburide or placebo, were ≤70 years of age, and had a baseline stroke volume ≤125 mL (n=138). The outcome of interest was the modified Rankin Scale (mRS) score at 90 days using 5 categories, where 0-1 and 5-6 were each collapsed into a single category. We used mixed-effects ordinal logistic regression models to calculate common odds ratios (cOR) for the primary outcome in the whole population (shift analysis) and in the subgroup with a baseline stroke volume ≤125 mL after adjustment for age, sex, baseline NIHSS, region of world, image modality, thrombolysis and thrombectomy (yes versus no).Results:The cohort included a total of 138 subjects with a mean age 58±10 years, 34% female, baseline NIHSS 18 (15-21), 46% received thrombolysis, baseline stroke volume 97 ml (84-108). The median 90-day mRS was 3 (2-4). Among these patients at 90 days, IV Glyburide was associated with better functional outcome (cOR 2.56, 95% CI 1.28-5.11, p=0.008).Conclusions:Individual patient data meta-analysis of 138 subjects enrolled in the GAMES-RP and CHARM trials show that IV Glyburide was associated with an improvement in functional outcome compared to placebo when the baseline stroke volume was ≤125 mL. This finding requires confirmation in a future clinical trial.

Stroke, Volume 56, Issue Suppl_1, Page AWP143-AWP143, February 1, 2025. Introduction:The majority of patients with cerebral venous thrombosis (CVT) achieve functional independence (modified Rankin Score [mRS] 0-2), although many continue to experience residual symptoms that negatively impact quality of life. Patient-reported outcome measures (PROMs) provides a means to assess these symptoms, capturing aspects of health often missed by clinician-reported assessments. We evaluated differences in PROMs across several health domains between patients with CVT and ischemic stroke.Methods:This observational cohort study included patients hospitalized for ischemic stroke or CVT who had a follow-up visit in a cerebrovascular clinic January 1, 2019 to April 30, 2024 and completed at least one PROM within three months of their last cerebrovascular event. Routinely collected PROMs included Patient Health Questionnaire-9, PROMIS Global Health, NeuroQoL computer adaptive testing (CAT) cognitive function, and the following PROMIS CAT scales: pain interference, physical function, satisfaction with social roles, fatigue, self-efficacy and sleep disturbance. Propensity score matching was used to pair CVT patients with ischemic stroke patients in 1:3 ratio based on demographic characteristics, mRS, Charlson comorbidity index, and time since last cerebrovascular event.Results:Out of 72 CVT and 2,533 ischemic stroke patients who met study criteria, 69 CVT and 196 ischemic stroke patients were matched and analyzed (average age 47.5±17.0 yrs, 62.6% female, 74.7% white race). Evidence of brain tissue injury on MRI was present in 22 (30.6%) of CVT patients. The median mRS of both CVT and ischemic stroke patients was 1 [IQR 0,1]. Except for sleep disturbance, PROMIS scores for both groups were meaningfully worse than the general population mean of 50. Worst scores were seen with physical function followed by fatigue and satisfaction with social roles. Pain interference scores were significantly worse in patients with CVT than those with ischemic stroke (58.0±10.5 vs 53.8±10.4; p=0.008); domain scores were otherwise similar between groups (Table).Conclusion:Despite low rate of brain injury on MRI, CVT patients had worse pain interference and similar severity and pattern of other PROM scores compared to a matched sample of ischemic stroke patients. This suggests that a holistic care approach addressing pain and the broader spectrum of outcomes, in addition to the primary vascular pathology, could be beneficial in the management of patients with CVT.

Stroke, Volume 56, Issue Suppl_1, Page ATP284-ATP284, February 1, 2025. Enrichment is the prospective use of any patient characteristic to select a study population at higher risk in which detection of a drug effect is more likely than it would be in an unselected population. Patients with post-stroke cognitive impairment (PSCI) found to have higher risk of stroke recurrence in a recently completed meta-analysis. The goal of this study is to test whether PSCI based patient selection may represent enrichment strategy for secondary stroke prevention clinical trial. This is a subgroup analysis of Insulin Resistance Intervention after Stroke (IRIS) trial. In IRIS trial, patients were randomized to receive pioglitazone vs. placebo and had a baseline Modified Mini-Mental State Examination (3MS, where 3MS ≤ 88 was indicative of global PSCI. The primary endpoint of the study was recurrent stroke or MI. We estimated the hazard ratio (HR) for the effect of pioglitazone among those with global PSCI. To determine the sample size for a subsequent trial enriched by including only subjects with global PSCI, we make the following assumptions: (1) time to event follows an exponential distribution in both the pioglizone and placebo groups where the hazard rate for the placebo group is assumed to be the same as in the IRIS trial among those with global PSCI; (2) hazards for the pioglitizon and placebo groups are proportional over the course of the study; and (3) subjects are randomized to pioglitazone or placebo in equal proportions.Data on n = 3,338 patients of original cohort of n = 3,876 were analyzed, and n = 473 among them had PSCI at baseline. During 5-years of follow-up, n=246 patients experienced recurrent stroke, and n = 118 had MI. In patients with PSCI HR was 0.56 (95% CI 0.34 – 0.92) suggesting a 44% reduction in the hazard rate for secondary stroke or MI after 5 years of follow-up in the pioglitizone group compared to the placebo. If we conservatively assume that the true HR = 0.56 (closer to the null of HR = 1 than what was observed in the IRIS trial), then a total sample size of n= 967 willl proivde 90% power using a two-sided log-rank test at the 5% significance level. This conservative sample size corresponds to a 75% reduction in the sample size that was required for the IRIS Trial. PSCI screening may represent enrichment strategy for secondary stroke prevention clinical trial potentially reducing sample size by 75%. PSCI screening-based enrichment can be tested in phase 2 secondary stroke prevention trial.

Stroke, Volume 56, Issue Suppl_1, Page ATP259-ATP259, February 1, 2025. Background:Endovascular treatment (EVT) is an effective treatment for acute ischemic stroke in anterior large vessel occlusions. Despite successful reperfusion, many patients still have unfavorable outcomes even in the presence of favorable arterial collaterals. We determined patient characteristics, treatment details and imaging characteristics associated with favorable outcome in patients with good collaterals who had successful EVT.Methods:In a post hoc analysis of the prospective CRISP 2 study, we identified patients with successful reperfusion following EVT (TICI 2b-3) and good collaterals (Tan ≥2). These patients were dichotomized into favorable (mRS 0-2) and unfavorable outcome (mRS 3-6) groups. Multivariate analyses were performed to identify clinical, imaging, and treatment predictors of favorable outcome.Results:92 patients were included, and 31 patients (33.7%) had favorable outcomes. There were no differences in the number of females (16 patients [52%] versus 33 patients [54%]; p=0.821) or age (71 years, [IQR 56-79] versus 68 years [IQR 57-79]; p=0.859) in favorable versus unfavorable groups, respectively. Favorable outcome patients had lower pre-treatment mRS (p

Stroke, Volume 56, Issue Suppl_1, Page ADP44-ADP44, February 1, 2025. Introduction:Patient reported outcomes post-stroke may be more sensitive to meaningful differences than the modified Rankin Scale (mRS). We aimed to compare patient reported outcomes (PROMs) in Mexican Americans (MAs) and non-Hispanic Whites (NHWs) in a community-based study. We also explored the correlation of PROMs with the mRS at 3 months post-stroke.Methods:All patients with ischemic and hemorrhagic stroke (ICH) from mid 2019-2023 in the Brain Attack Surveillance in Corpus Christi (BASIC) project were enrolled. PROMs and mRS were assessed at 3 months post-stroke. PROMs were assessed by the Patient-Reported Outcomes Measurement Information System, (PROMIS), Work and Social Adjustment Scale (WSAS), Economic Quality of Life Survey (EQOL) and ability to return to work and driving.For unadjusted analyses, medians and IQRs were reported for continuous and ordinal variables, with t-test p-values. Chi-squared tests were used for binary variables. For adjusted models, logistic, multinomial, or proportional-odds cumulative logit models were used as appropriate. Multitier inverse probability weighting (IPW) addressed sample attrition, and covariates included age, sex, initial NIHSS, comorbidity count, ischemic vs ICH, and previous stroke.Results:A total of 913 patients were included. Table 1 provides the main results. In the adjusted analysis, MA had significantly lower (worse) PROMIS Global Mental Health score (mean ethnic difference: -2.24, 99% CI: -3.93 to -0.54, p

Stroke, Volume 56, Issue Suppl_1, Page ATP77-ATP77, February 1, 2025. Background and Issues:Timely diagnosis and treatment are essential for optimal outcomes in acute stroke care. The lack of EMS integration into the stroke system of care is leading to delays in treatment resulting in poor outcomes. The absence of centralized resources at the Comprehensive Stroke Center (CSC) results in delayed patient care and worsened outcomes.Purpose:This project aimed to enhance EMS stroke recognition and improve triage to appropriate stroke centers, thereby reducing treatment times. The successful integration of EMS with an optimized CSC triage protocol seeks to reduce hospital stays, mortality rates, direct costs, and long term disability.Method:Effective integration of EMS into the stroke system of care was achieved by developing triage protocols with local EMS leaders. Adoption of a standardized stroke triage assessment tool was implemented. Centralizing resources at the CSC was a multidisciplinary approach to streamline the identification and treatment of stroke patients in a definitive location near CT scan. Stroke triage education and mock drills were provided to local EMS agencies and the acute stroke team. Outcomes were measured using pre and post intervention data for TNK administrations and endovascular therapy.Results:Outcomes were measured in two groups of acute stroke patients who received TNK, mechanical thrombectomy, or both. 115 patients from 2022 prior to project initiation and 131 patients from 2023 after its initiation. TNK door-to-needle time decreased from 37 to 32 minutes. Thrombectomy door-to-revascularization time dropped from 118 to 85 minutes. Average hospital stay reduced from 8 to 7 days. Mortality rates fell from 13.04% to 3.94%. Direct costs decreased from $27,989 to $24,109. Thrombectomy mortality decreased from 17.14% to 6.06%. 90-day modified Rankin score 2 or less improved from 45% to 49%. Average EMS first contact to revascularization went from 152 minutes to 120 minutes. Average EMS first contact to TNK administration went from 70 minutes to 67 minutes.Conclusion:The implementation of standardized EMS triage protocols and centralized resources at the CSC led to significant improvements in acute stroke care. The interventions resulted in faster treatment times, reduced hospital days, lower mortality rates, decrease in direct costs, and improved long-term functional outcomes. These findings highlight the significance of EMS integration and resource centralization to improve patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP65-ATP65, February 1, 2025. Background and Purpose:In 2023, High Point Medical Center implemented a quality improvement initiative to enhance outcomes for hospitalized patients experiencing strokes. This initiative was created after review of cases entered in a patient event reporting system. Root cause analyses of the reported events identified multiple opportunities for improvement. An interdisciplinary initiative was launched that engaged stakeholders from patient safety, the stroke team, and nursing education. The project team concentrated on implementing hospital-wide strategies aimed at preventing harm by enhancing stroke symptom recognition, stroke alert activations, and the execution of the code stroke protocol for inpatient stroke alerts. The purpose of this quality improvement initiative was to increase the quantity and quality of code stroke activations among hospitalized patients.Methods:Patient volumes from 2022 and 2023 were trended in Get with The Guidelines and compared to the Stroke Data Bank. Our intervention consisted of comprehensive education for all clinical staff including symptom recognition, stroke simulations, and empowering nurses to activate stroke alerts immediately upon suspicion of stroke. Interventions were initiated in quarter two of 2023 and continued throughout the year.Results:Initial analysis of patient volumes determined that our hospital had fewer recognized inpatient strokes than anticipated for our size. Reported safety events concluded that stroke events were not consistently recognized or implemented in a timely manner. After the intervention, surveys indicated that staff experienced a heightened awareness of signs of stroke and knowledge of their roles in the code stroke process. Inpatient code stroke activations tripled from quarter one to quarter four after the interventions. The number of patients receiving intervention quadrupled by the end of quarter four. Nurses identified stroke symptoms and had gained the confidence to independently activate a code stroke. A culture of stroke advocacy and reporting of events was formed.Conclusions:Increasing stroke symptom awareness through symptom recognition, stroke simulation, and empowering nurses to activate stroke alerts improved patient care and outcomes for those who experienced a stroke while hospitalized. Staff recognition of stroke symptoms increased, resulting in more inpatient stroke alerts, thrombolytic administrations, and thrombectomies for acute ischemic strokes.

Stroke, Volume 56, Issue Suppl_1, Page ATP61-ATP61, February 1, 2025. Background:Intracerebral hemorrhage (ICH) constitutes 10% of all strokes and is the most fatal and debilitating subtype. Unlike ischemic stroke, treatment strategies for ICH have not advanced as rapidly, resulting in limited adoption of specialized care metrics. Translating current guidelines into actionable performance measures is central to enhancing care delivery and improving ICH patient outcomes.Objective:Establish a three-year national initiative focused on promoting ICH data collection and analysis with specific ICH education, model share events, and protocol contribution which is built on existing hospital quality improvement work.Methods:In February 2023, expanded data elements and sixteen measures for ICH care adopted from theClinical Performance Measures for Adults Hospitalized with Intracerebral Hemorrhagewere added to the American Heart Association’s Get With The Guidelines® (GWTG)-Stroke registries. This allowed hospitals to identify gaps and barriers in care with support from AHA staff through training, model sharing, and resource development.Findings:The initiative led to a significant increase in data collection entered into GWTG-Stroke registry during 2023. It also identified gaps in care, particularly inLast Known Well, Baseline Severity Scoredocumentationand Time to Anticoagulation Reversal.Conclusions:This national initiative allows for hospitals to analyze data, exchange challenges, develop strategies and resources, all aimed at fostering continuous quality improvement in ICH guideline adherence. Enhanced data collection established during the initiative timeframe will prove to strengthen insights into ICH care for years to come.

Stroke, Volume 56, Issue Suppl_1, Page ATP89-ATP89, February 1, 2025. Introduction:Pulsara and Viz.ai are advanced technologies designed to streamline acute stroke care. Pulsara facilitates real-time communication and dynamic team building for stroke management, ensuring rapid connection with neurologists and interventionalists. Viz.ai uses AI-powered algorithms to accelerate diagnosis and optimize care pathways, improving outcomes by enhancing coordination between neurology and interventionalist teams. This study evaluates whether these innovations have led to significant reductions in treatment times and length of stay (LOS) in a single center.Methods:We conducted a single-center, retrospective analysis comparing acute ischemic stroke and TIA patients across three periods: pre-Pulsara (January 1, 2013–July 31, 2018; n=96), post-Pulsara/pre-Viz (August 1, 2018–April 30, 2022; n=71), and post-Viz (May 1, 2022–December 31, 2023; n=28). We analyzed door-to-CT, door-to-needle, and door-to-puncture times using the Kruskal-Wallis test, followed by pairwise Wilcoxon tests with Bonferroni correction for post-hoc comparisons.Results:Significant reductions in treatment times were observed across the three periods. Median door-to-needle time decreased significantly from 59.05 minutes pre-Pulsara to 29.78 minutes post-Viz (p < 0.001). Median door-to-CT time improved from 16.75 minutes pre-Pulsara to 9.54 minutes post-Viz (p < 0.01). Median door-to-puncture time showed substantial reduction from 131.42 minutes pre-Pulsara to 61.69 minutes post-Viz (p < 0.01). However, no significant differences were observed in LOS between the groups.Conclusion:The integration of Pulsara and Viz.ai into stroke care significantly reduced critical treatment times, particularly in door-to-needle and door-to-puncture metrics, underscoring the effectiveness of these technologies in enhancing the speed and coordination of acute stroke management. However, no significant impact on length of stay was observed, suggesting that further factors may influence this outcome.

Stroke, Volume 56, Issue Suppl_1, Page AWP268-AWP268, February 1, 2025. Introduction:The overall composition of stroke subtype is typically stable within biogeographical groups. Whether the COVID-19 pandemic impacted stroke etiology is still being investigated, but most studies have been performed outside the United States. This study sought to determine the composition of acute ischemic strokes (AIS) before and during the pandemic.Methods:This retrospective cohort study was conducted at a comprehensive stroke center in Colorado (USA). Adults (≥18) with AIS were compared based on admission date: Pre-COVID period (1/1/2019 – 12/31/2019) vs. COVID period (3/1/2020 – 3/1/2021). Stroke subtype was examined using TOAST classification: 1) large artery atherosclerosis; 2) cardioembolic; 3) small vessel occlusion; 4) other known etiology (e.g., hematologic disorders or arterial dissection); 5) cryptogenic stroke. Comparisons were made with Pearson chi-square tests.Results:There were 2,130 patients with AIS during the study period: Pre-COVID (n=1,034) and COVID (n=1,096). There were significant differences in stroke subtype by time period (Table 1). Compared to the pre-COVID period, the COVID period had a lower proportion of strokes from large artery atherosclerosis (17.6% vs. 12.1%, p

Isa-Aii, con Stroke Action Plan for Italy obiettivo 90% nel 2030