Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATMP44-ATMP44, February 1, 2025. Introduction:Understanding factors that contribute to missed diagnoses of acute ischemic stroke (AIS) may improve diagnostic accuracy. Prior studies have focused on the failure of non-neurologists to recognize AIS. The aim of this study was to understand the characteristics of stroke-alerted patients whose symptoms were misattributed to a stroke mimic by the responding vascular neurology team.Methods:A retrospective chart review was conducted on patients seen by the vascular neurology team as a stroke alert at a single Joint-Commission-certified Comprehensive Stroke Center between 1/2021-2/2022. Patients whose symptoms were erroneously attributed to a stroke mimic at the time of assessment but later confirmed by MRI as AIS (“missed stroke”) were compared to 200 consecutive cases of stroke patients who were correctly diagnosed (“accurate stroke”) and 200 who were correctly diagnosed with a stroke mimic (“accurate mimic”). Patient characteristics were compared with univariate analysis, using chi square or Kruskal-Wallis H test as appropriate.Results:1823 stroke alerts were reviewed to identify 40 patients with missed stroke (incidence 2.2%) of which the median age was 66 years (IQR 58-81), median NIHSS was 5 (IQR 1-18), and 40% presented within the 4.5h-treatment window for thrombolysis. Patients with missed strokes were more likely female than those with accurate strokes (57% vs 39%, p

Stroke, Volume 56, Issue Suppl_1, Page ATP323-ATP323, February 1, 2025. Introduction:Hypertension is one of the leading causes of mortality. The direction and strength of the association between death from hypertensive and hypertensive renal disease and stroke mortality during the COVID-19 pandemic among different U.S. ethnic groups is unclear.Hypothesis:Hypertensive and hypertensive renal disease mortality is positively correlated with increased stroke death overtime during the COVID-19 pandemic. We aim to examine the correlation between mortality from Hypertensive and hypertensive renal disease and stroke before and after the COVID-19 pandemic among U.S. Hispanic and non-Hispanic populations.Methods:A database query from the U.S. Centers Disease for Control and Prevention (CDC) Wonder was retrieved. A yearly age-adjusted mortality from hypertension or hypertensive renal disease from 2017 to 2022 was correlated with the mortality from stroke by Pearson’s correlation coefficient. Further analyses were performed by stratified data before and after 2019 as well as among Hispanic and non-Hispanic subgroups.Results:Age-adjusted mortality from hypertension and hypertensive renal disease trended down before the COVID-19 pandemic (from 9 to 8.91 deaths per 100,000 populations) but trended up after the pandemic (from 10.08 to 10.29 deaths per 100,000 populations). A similar trend occurred in age-adjusted mortality from stroke (from 37.59 to 36.59 deaths per 100,000 populations during pre-pandemic and from 38.84 to 39.53 deaths per 100,000 populations during post-pandemic). Those overall cause-specific mortalities are highly correlated with the correlation coefficient of 0.9697 (Figure 1). The correlation remained but slightly attenuated among Hispanics, while more pronounced among non-Hispanics (0.9649 and 0.9680, respectively; Figures 2 and 3). Stratified by time-related to the COVID-19 pandemic, age-adjusted mortality from hypertension and hypertensive renal disease and stroke trended down before the COVID-19 pandemic but trended up after the pandemic. The correlation was 0.9866 before the pandemic and up to 0.9988 during the pandemic (Figures 1, 2, and 3).Conclusions:Hypertensive and hypertensive renal disease mortality as well as stroke mortality have trended up and increased during the COVID-19 pandemic, particularly among the non-Hispanic population. Further investigations are required to mitigate health and ethnic disparities, especially during high demand for limited resources.

Stroke, Volume 56, Issue Suppl_1, Page AWP194-AWP194, February 1, 2025. Introduction:A semi-automated method that compares voxel density with the contra-lateral hemisphere to generate ratio, or relative Non-Contrast CT (rNCCT) maps for identifying hypodensity changes was developed. In addition to being sensitive to stroke related hypodensities, these maps are also sensitive to motion artefacts and naturally occurring asymmetry in densities across hemispheres. We assessed the value of a deep-learning based model to segment and remove these artefacts and for identifying ischemic core of baseline NCCT.Methods:We included data from 268 acute ischemic stroke patients with a large vessel occlusion from the ongoing CT perfusion to Predict Response to Recanalization in Ischemic Stroke Project 2 study. NCCT scans acquired at the primary stroke center were used to create rNCCT maps. These maps detect regions with at least 1% relative hypodensity difference compared to the contralateral region. A trained observer who had insight of arterial occlusion location manually annotated artefacts. We trained ano new UNetusing the NCCT, rNCCT, and flipped NCCT images to detect artefacts from the rNCCT maps. To assess the extent to which our model falsely identified ischemic regions as artefact, we determined the overlap between the automatically segmented artefact on the rNCCT map and the manually segmented ischemic core on diffusion-weighted imaging (DWI) acquired at the comprehensive stroke center before treatment.Results:The best performing model was the ensemble of the five cross-validation folds of 3d low- and high-resolution models based on dice similarity coefficient. Figure 1 provides an example of our model’s artefact segmentation and the processed rNCCT map after artefact removal. For the 54 patients (20% of study population) in our test set, our model achieved a median Dice similarity coefficient of 0.95 (IQR: 0.91-0.97) and a median false positive volume of 6.1 (3.2-11) ml. In the 30 patients with available DWI scans, 30% of patients had any overlap ( >=1 voxel) between the segmented artefact and DWI ischemic core with a median overlap volume of 0.69 (IQR: 0.32-2.3) ml.Conclusion:We demonstrate the use of a deep-learning based model to automatically segment artefacts from rNCCT maps. Our model circumvents time-invasive manual removal of artefacts from the rNCCT map and thereby simplifies segmentation of the ischemic core on baseline NCCT. Validation with external datasets is necessary before use in routine stroke evaluation.

Stroke, Volume 56, Issue Suppl_1, Page ATP319-ATP319, February 1, 2025. Introduction:Residential segregation influences individual health outcomes across the life course. Historic and modern racist lending practices, a form of structural racism, have contributed to residential segregation. Using historic and contemporary measures, we investigated whether longitudinal lending discrimination was associated with stroke prevalence in the U.S.Methods:We used a historic redlining index which linked Home Owners’ Loan Corporation (HOLC) maps to 2010 census tract boundaries to measure the degree of redlining (ranging from best [1] to hazardous [4]). Historic redlining data was combined with current lending discrimination (Home Mortgage Disclosures Act) to assess perceived area lending risk over time. Historic redlining index was dichotomized at the 25thpercentile, and paired with modern lending discrimination measure to create a 4-level categorical measure of lending trajectory: (1) persistent discrimination- high levels of redlining&current discrimination; (2) growing investment- high levels of redlining&no current discrimination; (3) declining investment- low levels of redlining&current discrimination; and (4) no discrimination- low levels of redlining&no current discrimination. Census tract stroke prevalence was estimated using 2021 CDC PLACES data. ANOVA was used to measure the differences between categories of longitudinal lending discrimination.Results:Total of 68172 census tracts had stroke prevalence estimates; of those 10351 were HOLC graded. Nearly half (47%) of graded census tracts had persistent discrimination and tracts with persistent discrimination were younger, less non-Hispanic white, and had higher proportions of diabetes, obesity and hypertension (Table). Stroke prevalence was 1.59% (95% CI:1.50-1.69) higher in tracts with persistent discrimination compared to tracts with no discrimination. Stroke prevalence was also higher in tracts with declining investment (1.40%; 95% CI: 1.18-1.63%) however, tracts that had growing investment had only slightly higher stroke prevalence (0.27%; 95% CI: 0.18-0.37%) compared to tracts with no discrimination. Visual geospatial correlation is shown between stroke and persistent discrimination in New York City (Figure).Conclusions:Areas with persistent lending discrimination for the last 80-90 years are associated with higher stroke prevalence. The influence of the historical and modern social environment in which one resides influences the burden of stroke in a community.

Stroke, Volume 56, Issue Suppl_1, Page ATMP24-ATMP24, February 1, 2025. Background and Purpose:The Stroke Response Team (SRT) is comprised of a critical care RN with neuro experience and a Neuro ICU APP. The SRT RN acts as a critical link in the care continuum for stroke patients by providing consistent ICU-level care from initial entry into the ED through transitions to procedural areas and the ICU. The SRT resulted from the need to increase patient safety, enhance continuity of care, and improve clinical outcomes. Additional aims are to improve compliance with core measures and standardization of patient care. Data collection is ongoing. Before implementation, charting metrics were at

Stroke, Volume 56, Issue Suppl_1, Page A93-A93, February 1, 2025. Background:Stroke outcomes vary with ethnicity, with immune response markers like interferon-gamma (IFN-γ) playing a significant role in stroke pathophysiology. IFN-γ, a proinflammatory cytokine produced by T cells and natural killer (NK) cells, regulates immune responses by activating macrophages and promoting inflammation. Baseline IFN-γ levels in healthy African Americans are similar to Whites. Ethnic variations in IFN-γhave been noted in diseases like Rheumatoid arthritis and Hepatitis C. Given the worse stroke outcomes experienced by African Americans, we hypothesized that IFN-γ levels may vary with sex and ethnicity post stroke.Methods:Plasma samples were collected from stroke patients admitted to Memorial Hermann Hospital, Houston by UTHealth biobank within 24 hours of admission and analyzed for IFN-γ levels using ELISA. Patients were stratified by sex and ethnicity (Black, Hispanic, White), and statistical analysis was performed using ANOVA, with post-hoc pairwise comparisons. Multilinear regression analysis was conducted to examine the adjusted associations.Results:The mean age of patients was 63.6 years, 35% were women, 88% had hypertension, 47% had diabetes mellitus, and 53% had hyperlipidemia. In men, no significant differences in plasma IFN-γ levels were observed across ethnic groups. However, in women (n=21), IFN-γ levels varied significantly by ethnicity, p=0.04. African American women had the highest IFN-γ levels, 4.0±1.7 pg/mL, followed by Hispanic 2.6±1.6 pg/mL, and White women 1.5±0.8 pg/mL. Pairwise comparisons showed a significant difference between African American and White women (p=0.04), but no difference between Hispanic and White women, p=0.62. This association held true when adjusted for other co-morbidities in the multilinear model.Conclusions:The higher IFN-γ levels observed in African American women likely reflects an exaggerated proinflammatory response to stroke in women. This heightened response may contribute to worse stroke outcomes in this population. The absence of such differences in men suggests a potential sex-specific inflammatory response to stroke. Understanding the up and downstream pathways of IFN-γ in African American women after ischemic stroke can help elucidate the mechanisms behind disparities in stroke and explore potential sex and ethnicity specific therapeutic interventions targeting inflammation.

Stroke, Volume 56, Issue Suppl_1, Page ATP304-ATP304, February 1, 2025. Introduction:Stroke is a common complication of infective endocarditis (IE), affecting 16–25% of cases, and can be the initial or sole manifestation of the condition. This study aims to analyze annual mortality trends and demographic factors related to stroke in IE patients in the U.S. and Texas from 1999 to 2020, to guide public health initiatives and enhance prevention strategies.Methods:The data was analyzed from the CDC’s WONDER database from 1999 to 2020, focusing on stroke and IE-related mortality (ICD-10 Code I64.0 “Stroke”&Code I33.0 “IE”) in adults aged ≥65 years, annual percent changes (APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex, race/ethnicity, age) subgroups was calculated.Results:The AAMR for stroke-related mortality in IE cases reduced in the US from an adjusted rate (AR) 448.7 in 1999 to 171.6 in 2018 (APC: -8.09%; 95% CI: -9.00% to -6.81%) and then it increased to 183.5 in 2020 (APC: 3.07%; 95% CI: 1.22% to 4.69%). In Texas, AAMR for stroke-associated IE-related mortality overall decreased from AR 485.7 in 1999 to 176.2 in 2020 (APC: -5.23%; 95% CI: -5.50% to -4.96%). Males had higher consistently higher AAMRs than females (196.4 vs. 172). The AAMR in the US men decreased from 468.6 in 1999 to 176.7 in 2018(APC: -7.55%; 95% CI: -8.51% to -6.21%), then it increased to 196.4 in 2020(APC: 4.99%; 95% CI: 2.93% to 6.81%). The AAMR in the US women decreased from 431.5 in 1999 to 165.6 in 2018(APC: -8.25%; 95% CI: -9.15% to -6.97%) after which it increased to 172 in 2020(APC: 1.48%; 95% CI: -0.31% to 3.06 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (278.7), followed by the NH White with an AAMR (179) and the NH American Indian or Alaska Native population with an AAMR (165.4). The low-risk populations were the Hispanic or Latino (143.6) and the NH Asian or Pacific Islander (135.2). AAMR also varied by region (overall AAMR: Midwest: 200.8; South: 193.9; Northeast: 166.2; West: 162.8) and non-metropolitan areas had higher AAMR (non-core areas: 233.4; micropolitan areas: 224.5) than metropolitan areas (large fringe metro areas: 170.5; large central metropolitan areas:160.4).Conclusions:The stroke-related mortality in infective endocarditis cases has overall risen in the United States than in Texas over the past two decades, specifically men and (NH) Black or AA, (NH) White and (NH) American Indian or Alaska Native are at high risk.

Stroke, Volume 56, Issue Suppl_1, Page AWP6-AWP6, February 1, 2025. Background and Purpose:Whether imaging markers of cerebral small vessel disease on computed tomography (CT-CSVD) relates to early clinical outcomes after intravenous thrombolysis for acute ischemic stroke remains not well understood. This multicenter retrospective study aims to investigate the association between baseline CT-CSVD score and early clinical outcomes in acute ischemic stroke patients who received intravenous thrombolysis.Methods:Individual CT-CSVD imaging markers and total score were assessed based on the following conditions: severe white matter lucencies (grade 2), two or more lacunes, and severe central or cortical atrophy (grade 2), with scores ranging from 0 to 3. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0-2 at discharge. The secondary outcome was early neurological deterioration, defined as a 2-point or greater decline on the NIHSS within the first 24h of admission. Multivariate logistic regression analyses were used to examine the associations between CT-CSVD scores and outcomes.Results:Of 920 eligible patients (median age 68, male 65.8%), 9.9% (91/920) experienced early neurological deterioration, and 62.1% (545/877) achieved functional independence at discharge. Patients with increasing CT-CSVD scores were older (p

Stroke, Volume 56, Issue Suppl_1, Page AWP174-AWP174, February 1, 2025. Introduction:Clinical guidelines have become an essential tool for updating medical professionals. Its use in clinical practice reduces the possibility of medical harm and promotes appropriate medical practices. However, the publication of guidelines in vascular neurology is often inconsistent between medical entities, making access and interpretation of recommendations difficult.Methods:Systematic review of guidelines published by the American, Brazilian, and European Academies of Neurology (AAN, ABN, and EAN), and societies endorsed by such academies (American Heart Association/American Stroke Association – AHA/ASA, European Stroke Organization – ESO), from 2012 to 2023 in the area of vascular neurology, selected through the official websites of the respective institutions. Evaluated the number and proportion of recommendations made.Results:A total of 61 guidelines were analyzed: 5 published by ABN, 34 by EAN/ESO, and 22 by AAN/AHA/ASA. There were 2,547 recommendations, with 261 published by ABN (10,24%), 548 published by EAN/ESO (21,51%) and 1,738 (68,23%) published by AAN/AHA/ASA. There were 430 recommendations with LOE A (16.88%), 1,003 with LOE B (39.37%), and 785 with LOE C (30.82%). Only EAN/ESO adopted the GRADE system in 31 of its 34 publications, with 20 recommendations rated as high (0.78%), 68 as moderate (2.66%), 95 as low (3.72%), and 145 as very low (5.69%). There were 242 recommendations with level of evidence A/Class I (IA), with 178 (73.55%) published by AAN/AHA/ASA. Recommendations classified as high quality of evidence and strong strength of recommendation (high/strong) totaled 17, all published by EAN/ESO. There have been 27 guidelines published in the last 4 years (2020-2023), which were responsible for 709 recommendations (27,83%). The average number of recommendations per guideline in this period was lower when compared to previous years – 26,25 recommendations per guideline versus 54,05.Conclusion:Less than 20% of recommendations in vascular neurology in current guidelines are classified as level A of evidence (LOE A), and less than 1% of the total recommendations receive a high-quality classification in articles that used the GRADE system. New approaches to conducting clinical research are needed to enable the generation of high-quality evidence in a more pragmatic and efficient way.

Stroke, Volume 56, Issue Suppl_1, Page ATMP17-ATMP17, February 1, 2025. Background:For optimal care and outcomes, patients must receive treatment from a multidisciplinary team approach at a comprehensive-stroke certified facility with stroke specialist units. The multidisciplinary approach increases bedside RNs engagement. The stroke team frequently performed their rounds on 4N without the bedside RN present. This does not foster trust and communication between RNs and MDs. We sought to improve the bedside RNs engagement by having multidisciplinary rounds including the bedside RN and stroke team during rounds.Smart Aim:Improve the bedside RNs team engagement with an increase of at least 1 point on the Likert scale.Implementation:We began using a simple Likert 5-point questionnaire completed by the nurses on 4N to evaluate their daily experience with stroke team rounds and their engagement with the team. The Likert questions were graded 1-5 from strongly disagree (1) to strongly agree (5). Then from April 2024 to July 2024 the nurses on 4N, joined in collaborative rounds with the stroke team daily. The RN was requested to join collaborative rounding whenever the stroke team was present on the unit. Rounding with the bedside RN included plan of care, overnight events and any issues the bedside RN wanted to inform the stroke team about. After a few months of multidisciplinary/collaborative rounding, the RNS were then asked to complete the same Likert 5-point questionnaire.Results:Looking at the Likert pretest versus the posttest the question “ I feel engaged with the stroke team during their rounds” had a pretest score of 2.7 and a post score of 4.0. Thus demonstrating, the bedside RNs felt more engagement since the implementation of rounding with the stroke team daily.Conclusion:Creating a standardized plan of care with a multidisciplinary team rounding approach for the stroke patients on 4N, increased the nurse’s engagement by at least 1 point on the Likert 5-point questionnaire. The RN felt more engaged and empowered to express patient’s needs, concerns, and felt greater collaboration with stroke team. Demonstrating that multidisciplinary rounding engages the bedside RN. Additionally, we will track&trend this data to include improved patient outcomes for stroke patients.

Stroke, Volume 56, Issue Suppl_1, Page ATMP49-ATMP49, February 1, 2025. Background and Objective:A stable perfusion pattern may guarantee a good clinical outcome in acute stroke patients. This study aimed to explore the differences of perfusion patterns over the acute phase in acute stroke patients with different etiologies.Methods:This study included acute ischemic stroke patients who arrived at Huashan Hospital, Fudan University within 24 hours of last known normal. All patients underwent baseline multimodal CT scan (including CT angiography [CTA] and perfusion imaging), and had confirmed large vessel occlusion or severe stenosis of anterior circulation. Recanalization status was evaluated through follow-up perfusion or angiography imaging. Final infarct volume (FIV) was assessed by follow-up CT or magnetic resonance imaging within 7 days after arrival. Penumbral stability was assessed using the Perfusion-Infarct Index (PFI)，which was defined as 1 – (FIV – baseline infarct core) / baseline penumbra. For patients without recanalization, a stable penumbral pattern was defined PFI > 0.9. Kaplan-Meier survival curve analysis was used to explore the difference of PFI between patients with cardioembolic (CE) and large artery atherosclerotic (LAA) etiology during the acute phase. For patients without recanalization, stepwise logistic regression analysis was conducted to identify independent predictors of a stable penumbral pattern.Results:A total of 250 acute ischemic stroke patients were included, with 160 classified as LAA-related stroke and 90 as CE-related stroke. Kaplan-Meier survival curve analysis revealed that LAA-related stroke patients had a higher PFI value compared to CE-related stroke patients throughout the acute phase (P=0.02). Of the 88 patients who did not achieve recanalization, patients with LAA-related stroke were more likely to have a stable penumbral pattern compared with patients with CE-related stroke (39% vs. 10.3%, P=0.01). Stepwise logistc regression analysis demonstrated that baseline NIHSS ≤8 (OR: 8.8, 95% CI: 2.9 – 26.4, P

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 ATP327-ATP327, February 1, 2025. Self-reported stroke prevalence has increased among US adults aged 18-64 over the past decade and is projected to rise. As younger stroke survivors live longer, access to healthcare is essential for the detection, treatment, and monitoring of cardiovascular disease (CVD) risk factors to prevent recurrent stroke or other acute CVD events. Adults aged 1 personal healthcare provider, the ability to afford to see a doctor in the past year, and a routine checkup within the past year).Most stroke survivors reported healthcare access: 86.3% (95% CI 85.7 – 86.8 had insurance coverage and >1 personal healthcare provider); 26.6% (95% CI 25.9 – 27.3) couldn’t afford a doctor in the past year; and 81.2% (95% CI 80.6 – 81.1) had a routine checkup in the past year. Statistically significant differences (p < 0.05) were found across all sociodemographic groups. Younger adults (aged 18-29 and 30-44), men, and those with lower education reported less healthcare access. Varying measures of access were reported across racial/ethnic groups.Overall, most stroke survivors reported access to healthcare, although opportunities exist to improve access for younger adults, men, different racial/ethnic minorities, and those with lower education. Prior access to healthcare might have contributed to stroke survival for some individuals. Continued and improved healthcare access could help prevent recurrent stroke or other acute CVD event among stroke survivors.

Stroke, Volume 56, Issue Suppl_1, Page ATMP42-ATMP42, February 1, 2025. Background:Ischemic strokes occur due to a blood supply blockage in one of the brain’s blood vessels, and Hemorrhagic strokes occur when one of the brain’s blood vessels ruptures. The American Stroke Association cites strokes as the fifth leading cause of death in the United States. This study aimed to determine the average minutes needed for patients to achieve their Medicare-calculate goals at our inpatient rehabilitation program.Methods:A retrospective study of 393 patients with stroke (age >18: 209 men, 184 women) that received either 3 hours of therapy 5 days per week or 2 hours and 20 minutes of therapy 7 days a week for the length of their stay in our program from January 2021-December 2023.Results:Main outcome measures were the Medicare calculated self-care and mobility scores on admission and on discharge. 283 patients met at least one of their Medicare calculated discharge goals. Those that met their self-care goals needed less PT, OT, and ST minutes. They also had a higher AMS than those that did not meet their self-care goals. Those that met their mobility goals required more PT, OT, and ST minutes, and had a higher AMS than those that did not meet their mobility goals. Those that met both their self-care and mobility goals required more PT and OT minutes, less ST minutes, and had a higher AMS.Discussion:ST minutes were an independent predictor of whether people would meet their self-care goal. Patients with higher BMIs were not likely to meet their mobility goal. Patients with a higher AMS were more likely to meet their mobility goal. BMI and AMS were independent predictors of whether people met their mobility goal. There were no independent predictors as to whether patients would meet both their self-care and mobility goals. Those achieving theirself-care goalneeded an average of 831.5 minutes (PT), 826.8 minutes (OT), and 397.2 minutes (ST). Those achieving theirmobility goalneeded an average of 845.8 minutes (PT), 833.7 minutes (OT), and 403.8 minutes (ST). Those achieving both theirself-care and mobility goalsneeded an average of 835.5 minutes (PT), 830.3 minutes (OT), and 417.1 minutes (ST).Conclusion:Stroke patients are more likely to meet their Medicare-required self-care goals if they require less ST minutes. Patients with a higher BMI and lower AMS score are less likely to meet their Medicare-required mobility goals. There was not an independent predictor for patients that met both their self-care and mobility goals.

Stroke, Volume 56, Issue Suppl_1, Page ATP305-ATP305, February 1, 2025. Introduction:Acute ischemic stroke (AIS) may be associated with feelings of anxiety and/or depression (A/D) in subsequent months. The purpose of this study was to determine the frequency of feelings of A/D after AIS longitudinally and to identify risk factors that may predict post-stroke feelings of A/D.Methods:Data were collected from patients with AIS at a stroke center from 2016-2022. Patients were excluded if

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.