Risultati per: Linee Guida per le cure post-parto

Stroke, Volume 53, Issue Suppl_1, Page A2-A2, February 1, 2022. Background:Post stroke cognitive impairment (PSCI) can be as high as 15-70% after stroke depending on the patient population and diagnostic tool. Few studies on PSCI have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI in the current population.Methods:We analyzed Cerner Health Facts® EMR database, which is comprised of de-identified EHR data from over 700 hospitals and clinics in the US from 2000-2018. We evaluated patients ≥40 years of age with a first time acute ischemic stroke (AIS) diagnosis using ICD9/10 codes. PSCI was defined as pts with ICD 9/10 codes for dementia, mild cognitive impairment, or on medications for dementia. Pts with first stroke in the Cerner database and no pre-existing cognitive impairment were included; those with no follow-up visits in the system were excluded. We compared hazard ratios for developing PSCI for patient characteristics.Results:A total of 211,622 AIS pts were evaluated, of which 153,078 had follow-up data in the system and no prior diagnosis of PSCI. Among these, the rate of PSCI was 9.29%. Most pts qualified under PSCI using dementia ICD codes (15,280) compared to mild cognitive impairment codes (4,321) or medication usage (1,032). Median time to PSCI diagnosis was at their first follow-up visit within the first year after stroke. Pts ≥65 years of age at time of stroke (HR 2.95, 95% CI 2.83,3.07) and of African American race (HR 1.37, 95% CI 1.31,1.46) were more likely to develop dementia. There were no disparities for developing PSCI between Hispanic and non-Hispanic pts (HR 0.89, 95% CI 0.69, 1.16). Male pts were less likely to develop PSCI than female counterparts (HR 0.84, 95% CI 0.81,0.87).Conclusion:Our analyses highlight the viability of utilizing large administrative databases to assess trends in PSCI diagnosis. The number of pts with PSCI may be underestimated however, given the importance of EHR records in patient care, this suggests PSCI is under-diagnosed in the community. Previously described racial disparities for black survivors persisted but male patients had less PSCI. Further study into other administrative databases is necessary to assess if these data are consistent in other EHR systems and to evaluate new trends in PSCI diagnosis and treatment.

Stroke, Volume 53, Issue Suppl_1, Page AWP208-AWP208, February 1, 2022. Post-stroke cognitive impairment (PSCI) occurs in 20%-40% of stroke patients and was reported to be a risk factor of recurrent stroke and death. However, to date, no systematic review and meta-analysis exists to precisely estimate the associated risk. The goal of the current study was to conduct a systematic review of published literature on the association between PSCI and risk of recurrent stroke and death. We searched Ovid MEDLINE and Scopus for studies published from 1992 to 2019, combining the following keywords: post-stroke cognitive impairment, risk of stroke recurrence, mortality, post-stroke dementia. Of the 929 references, we identified 23 studies (n=28,305 patients) that met eligibility criteria. The time of PSCI diagnosis ranged from 7 days to 6 months, and 3-month after stroke was the most common time point of neuropsychological testing. The majority (65%, 15/23) of these studies evaluated PSCI mortality endpoint (n = 23,554), while 35% (8/23) looked at combined endpoint of recurrent stroke and death (n= 4,751). In mortality studies, 86% (13/15) showed significantly higher risk of death in PSCI patients compared to those without it (OR/HR/RR range from 1.42 to 7.42). In the two largest studies (n=8,822 and n=6,504), the adjusted HR were 1.42 (1.34-1.50) and RR 2.0 (1.3-3.2) respectively. Only 14% (2/15) of the studies showed negative results. However, one negative study [HR: 1.00 (0.79-1.86)] included a large cohort (n=3,948). In recurrence studies, 75% (6/8) reported higher risk with OR/HR/RR ranging from 1.48 to 4.86. Subgroup analyses in the two largest recurrence clinical trial studies (n=1,528 and n=1,240) reported HR 1.48 (1.04-2.09) and OR 2.32 (1.10-4.89). No association between PSCI and recurrent stroke was found in 25% (2/8) of recurrence studies including those with n=458 [HR 1.74 (0.89-3.39)] and n=202 patients [RR 1.25 (0.47-3.33)].This systematic review revealed about a 0.5 to 7 times increased risk of recurrent stroke and death in patients with PSCI suggesting that PSCI might be a marker predicting recurrent events in secondary stroke prevention. A meta-analysis is warranted to increase the precision and validity of risk estimates of PSCI and study the bases for differences across studies.

Stroke, Volume 53, Issue Suppl_1, Page A115-A115, February 1, 2022. Introduction:Approximately a third of stroke survivors are diagnosed with Post-Stroke Depression (PSD) and half are more likely to commit suicide compared to the general population. The aim of this study was to examine the relationship between demographic and clinical variables and PSD and suicidal ideation among post-stroke survivors.Methods:This was a retrospective review of a clinical registry from a comprehensive stroke center between 10/2018 and 3/2020. Patients were eligible if a Patient Health Questionnaire 9-Item (PHQ-9) was available. Question 9 of the PHQ-9 was screened for suicidal ideation.Results:The study cohort consisted of a total of 194 patients who had an acute (primarily ischemic or intracerebral) stroke who completed a 90-day telephonic PHQ-9. The mean age (years) and NIH Stroke Scale were 64 ± 15 and 7.4 ± 7.3, respectively. The sample was comprised of 56% men, 39% Whites, 31% Blacks, 27% Asians, and 10% Hispanics. The mean PHQ-9 score was 5.9 ± 6.3. Seven percent reported suicidal ideation. Univariate analysis revealed that pre-stroke depression history and 90-day post-dicharge mRS scores were significantly associated with PHQ-9 scores (p=0.005 and p=0.003, respectively). After adjusting for age, stroke type, NIHSS arrival score, pre-morbid mRS score, mRS score at 7 days, and hospital length of stay, multiple linear regression analysis with bootstrap estimates found that pre-stroke depression and 90-day post-dicharge mRS scores remained significant (p

Stroke, Volume 53, Issue Suppl_1, Page AWP102-AWP102, February 1, 2022. Objective:Accurate prognostication of functional outcomes after an acute ischemic stroke (AIS) is essential for the planning of post-stroke treatments. We sought to provide an improved risk score for the prognostication by leveraging an interpretable machine learning and neuroradiologic biomarker.Data:We evaluated 913 patients with available 90-day mRS and admission NIHSS from the MRI-GENIE study. Age, sex, hypertension, atrial fibrillation, diabetes, coronary artery disease, smoking and prior stroke were available. We quantified WMH volume (WMHv) on FLAIR images. We divided patients into development and validation sets from multiple sites, and an external validation set from an individual cohort (Figure (a)).Methods:We measured the unaccounted WMHv (uWMH) by the residual of the log-linear regression model of WMHv regarding the clinical characteristics. Excessive uWMH (eWMH) was defined as present vs. absent based on a uWMH higher than +1 standard deviation. The clinical characteristics, admission NIHSS, and presence of eWMH were used as the inputs of a constrained logistic regression model with variable selection (RiskSLIM) that estimated a risk score for the prediction of post-stroke functional independence (mRS 0-2).Results:Admission NIHSS, age, sex, diabetes, prior stroke, and eWMH were selected with assigned risk scores (Figure (b)). The estimated risk score outperformed the conventional THRIVE and SPAN100 in the development, validation, and external validation sets regarding the area under curve (AUC) and the brier score (Figure (c)).Conclusion:This proposed risk score leveraging the interpretable machine learning and imaging biomarkers improved the prognostication of the post-stroke functional independence. Since the proposed risk score system does not require high computational resources, it is expected to be widely used in daily clinical practices for centers with MR imaging capability.

Stroke, Volume 53, Issue Suppl_1, Page ANS2-ANS2, February 1, 2022. Introduction:Post-stroke depression (PSD) is under-recognized and affects the recovery and rehabilitation of stroke patients. PSD affects one-third of stroke survivors, but there is little known when to screen for depressive symptoms. The purpose of this study is to determine the optimal timing of depression screening at 7 days vs. 30-45 days post discharge.Methods:All stroke patients received a phone call from a stroke certified RN (SCRN) to assess depression within 7 days and within 30-45 days post discharge using the Patient Health Questionnaire Screening Tool (PHQ9). Three call attempts were made. Data were analyzed from 2018 to 2020. Based on the PHQ9 scores, patients were referred to different clinical care pathways. Patients who scored 1-9 received lifestyle modification information, 10-19 were referred to depression care management, 20 and above were referred to psychiatry. The number of patients evaluated and the percentage of those who were referred to specific pathways were assessed. Data were analyzed using a t-test.Results:Stroke subtype were as follows: 17% ICH, 80% ischemic, 2% SAH. 1001 patients were called: 564 at 7 days, 437 at 30-45 days. 421 (75%) at 7 days and 277 (63%) at 30-45 days were reached. 11 (3%) at 7 days, 30 (11%) (p=0.045) at 30-45 days scored ≥10 on the PHQ9. Of those who scored ≥10 on PHQ9, 28 (68%) were female and more than half were over the age of 65. 91% of patients had NIHSS ≤5.Conclusion:A higher percentage of patients with PHQ9 ≥10 was detected within 30-45 days post discharge. The 30-45 day time period is more optimal to detect PSD than the 7-day time period post discharge.

Stroke, Volume 53, Issue Suppl_1, Page ATP64-ATP64, February 1, 2022. Introduction:Stroke is a major cause of balance and walking impairment and is on the rise. The most widely used walking impairment measure is the 10-meter walk test (10-mWT), which provides information about walking speed but does not inform about walking kinematics or neuromuscular control.Objective:Herein, we evaluate single support center of pressure distance (SS CoP Dist), a kinematic measure of dynamic postural control and walking stability, as a complementary measure of walking impairment. We hypothesize that SS CoP Dist will be closely associated with baseline walking speed, and will improve with Backward Locomotor Treadmill Training (BLTT).Methods:Thirty-six chronic stroke survivors with residual walking impairment, based on 10-mWT speed [ mild >0.8 m/s (n =7); moderate 0.4-0.8m/s (n =18); and severe

Stroke, Volume 53, Issue Suppl_1, Page ATP222-ATP222, February 1, 2022. Background:Increased blood pressure variability (BPV) has been associated with stroke risk, but no serum inflammatory markers have been identified associated with increased BPV, despite preclinical data suggesting a role.Methods:This is a post-hoc analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. The study exposure was tertiles of serum level of interleukin-6 (IL-6) at the baseline study visit. The primary outcome was visit-to-visit BPV measured as the residual standard deviation (rSD) of at least 4 subsequent study visits (1999-2018). Two logistic regression models were fit to the top tertile (i.e. most variability) of rSD during follow-up: in Model 1, we adjusted for covariates chosen with restricted Least Absolute Shrinkage and Selection Operator (LASSO) and in Model 2, for all covariates.Results:Our analysis included 5,483 patients, of mean (SD) age 61.4 (10.0) years and with 52.9% female. Mean (SD) of IL-6 was 1.7 (1.2) (pg/mL) in the top tertile BPV rSD and 1.4 (1.1) in the bottom tertiles. The incidence of ischemic stroke and all major adverse cardiovascular event was higher in top tertile of BPV (Table 1). Elevated serum IL-6, but not other serum biomarkers of inflammation and clotting (see comment below), was associated with the highest tertile of BPV, independent of potential confounders (Table 2).Conclusion:Higher levels of serum IL-6 were associated with increased subsequent BPV in a large multiracial cohort. Further investigation is needed to better understand the relationship between chronic inflammation and BPV.Table 1.Baseline demographics, serum biomarkers, and clinical outcomes during follow-up (how long was follow-up on average?) in the full cohort, and stratified by the top versus lower tertiles of BPV.Table 2.Association of serum biomarkers at baseline with the highest tertile of blood pressure variability.*Model 1 adjusted for patient age categories (

Stroke, Volume 53, Issue Suppl_1, Page AWMP46-AWMP46, February 1, 2022. Introduction:Persistent neurovascular uncoupling may be associated with poor outcome in patients with ischemic stroke after successful recanalization. Quantitative electroencephalography (EEG) can be used to assess neuronal function. We assessed relation between degree of recanalization post-endovascular thrombectomy (EVT), quantitative EEG based parameters and severity of neurological deficits.Methods:Patients with acute ischemic stroke with large vessel occlusion in anterior circulation were enrolled. EEG was recorded using a modified Muse headband (InteraXon) before, immediately after and at 24 hours post-EVT. Pairwise-derived brain symmetry index (pdBSI) and delta-to-alpha ratio (DAR) were computed using Fitting Oscillation & one-over F (FOOOF) MATLAB wrapper.Results:A total of six patients with mean age 73.6±11.6 years and baseline median (IQR) NIHSS of 13.5 (11-15) were included. Expanded thrombolysis in cerebral infarction (eTICI) scores were 2b67 in one, 2c in two and 3 in three cases. Baseline EEG was recorded at 75 minutes (60-100) from arrival, second at 255 minutes (90-420) after recanalization and third at 28.5 hours (27-31) after recanalization. Four patients with improvement in NIHSS of >10 had 46.6±31.7% change in pdBSI at 24 h. One patient with NIHSS

Stroke, Volume 53, Issue Suppl_1, Page ATP67-ATP67, February 1, 2022. Background and Purpose:Stroke is among the leading causes of death and disability worldwide. Despite the prevalence of cognitive impairment post-stroke, there is uncertainty regarding the optimal type of rehabilitation intervention to improve cognitive functioning in people post-stroke. This systematic review and meta-analysis evaluates the effectiveness of rehabilitation interventions across multiple domains of cognitive function, namely, memory, attention, executive function, perception, apraxia and neglect, as well as general cognitive functioning.Methods:Five databases were searched from inception to August 2019. Eligible studies included randomised controlled trials (RCTs) of rehabilitation interventions for people with stroke when compared to other active interventions or standard care where cognitive function was an outcome.Results:Sixty-four RCTs (n= 4,005 participants) were included. Multiple component interventions improved general cognitive functioning (MD:1.56, 95% CI 0.69 to 2.43) and memory (SMD:0.49, 95% CI 0.27 to 0.72) compared to standard care. Physical activity interventions improved neglect (MD:13.99, 95% CI 12.67 to 15.32) and balance (MD:2.97 to 95% CI 0.71, 5.23) compared to active controls. Non-invasive brain stimulation (NIBS) impacted neglect (MD:20.79, 95% CI 14.53 to 27.04) and function (MD:14.02, 95% CI 8.41 to 19.62) compared to active controls. Neither cognitive rehabilitation (MD:0.37, 95% CI -0.94 to 1.69) or occupational-based interventions (MD:0.45, 95% CI -1.33 to 2.23) had a significant effect on cognitive function compared to standard care.Conclusion:The evidence regarding the effects of rehabilitation interventions for improving cognitive deficits post-stroke is uncertain. Finings must be considered in the context of moderate and high risk of bias across various methodological domains. There is some evidence to support multiple component interventions, physical activity interventions and NIBS protocols. However, findings must be interpreted with caution given the heterogeneity of interventions and outcome measures used across studies.

Stroke, Volume 53, Issue Suppl_1, Page AWP246-AWP246, February 1, 2022. Enhancing an endogenous stem cell response is a promising approach to improve stroke recovery. We have previously shown that a conductive polymer cannula system for human stem cell delivery and electrical stimulation of the post-stroke environment increases endogenous stem cell production and improves functional recovery in a rodent model of distal middle cerebral artery occlusion (dMCAO). Transcriptomic analyses coupled with lentiviral manipulation identified stanniocalcin 2 (STC-2) as one key mediator of this functional improvement. To further investigate the role of STC-2, we intraventricularly administered recombinant STC-2 one week post-dMCAO and assessed functional recovery via vibrissae-forepaw (WP) test at 5 weeks. Our results indicate that intraventricular injection of STC-2 alone post-stroke improves functional recovery in comparison to a control and intraventricular saline group (n=10 per group, p=

Stroke, Volume 53, Issue Suppl_1, Page A19-A19, February 1, 2022. Background and Purpose:Stroke can cause memory dysfunction. Long-term memory dysfunction of mice with tibia fracture (BF)+stroke is associated with accumulation of CD68+cells in the hippocampus, which can be alleviated by activation of alpha-7 nicotinic acetylcholine receptor (α-7 nAchR). Microglia maintain normal memory via removing excessive synapses. We hypothesize that aged mice would develop long-lasting memory dysfunction after stroke, which is associated with increased CD68+cells and synapses removing in the hippocampi.Methods:Permanent distal middle cerebral artery occlusion (pMCAO) was performed in young (2-month-old) and aging (15-18-month-old) mice, or 6 hours before pMCAO in young mice. The memory functions were analyzed weekly for 8 weeks by Y-maze and at 8 weeks post pMCAO by NOR tests. Atrophic volumes, CD68+cells and microglial phagocytosis of synapses were quantified at 8 weeks after pMCAO.Results:Aged mice had larger atrophic volumes, more CD68+cells in the hippocampi ipsilateral to stroke side than young mice, and also had more CD68+cells in the ipsilateral hippocampus than the contralateral. In Y-maze test, the aged stroke mice made fewer spontaneous alternations from 3 to 8 weeks after pMCAO than the young stroke mice and sham aged mice. In NOR test, aged stroke mice spent less time on the novel object than young stroke mice and sham aged mice. α-7 nAchR agonist treatment reduced the number of CD68+cells in the hippocampi in the BF+stroke mice. Almost all CD68+cells were synaptophysin positive. Therefore, increased CD68+cells in the ipsilateral hippocampus will increase synaptic removal. Reduction of neuroinflammation could reduce synaptic loss and improve post-stroke memory function.Conclusions:Increased CD68+cells in the hippocampus is associated with long-lasting post-stroke memory dysfunction in aged mice, and reduced neuroinflammation could improve post-stroke memory function.

Stroke, Volume 53, Issue Suppl_1, Page AWP199-AWP199, February 1, 2022. Introduction:Stroke patients with a pre-existing disability are less likely to receive acute stroke treatments compared to those without a pre-existing disability. Using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study, we aimed to understand the disparities in inpatient and outpatient continuum of stroke care according to the patients’ pre-stroke functional status.Methods:We ascertained all hospitalized stroke patients ≥18 years old in year 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 within GCNK population; all cases were physician-reviewed. Per-stroke functional status was ascertained by trained research nurses during medical record review. We compared rates of in-hospital rehabilitative therapies, initiation of stroke prevention treatments, inpatient stroke workup (cardiac/vessel imaging), in-hospital and post-discharge rehabilitative therapies between ischemic stroke patients with pre-stroke modified Rankin score (mRS) 0-1 vs ≥2. Logistic regression was used to evaluate the association between pre-stroke mRS and these outcomes adjusting for age, presenting NIHSS, and insurance status.Results:Of 2476 patients with ischemic stroke in the GCNK population during 2015, 1326 (53%) had a pre-stroke mRS ≥2. Compared to those with pre-stroke mRS 0-1, these patients were less likely to receive complete stroke workup (aOR 0.86 [0.71-1.04]) and certain stroke prevention treatments (aOR 0.46[0.26-0.81], p

Stroke, Volume 53, Issue Suppl_1, Page AWP81-AWP81, February 1, 2022. Introduction:Beliefs regarding ones’ control over their health can lie internally, influenced by their own actions, or externally, controlled by others or due to chance.Objective:To examine the association between health-related locus of control (HRLC) type and post-stroke disability, quality of life, and depression.Methods:This study utilized data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial (n=552). Participants were categorized into three groups based on their highest Multidimensional Health Locus of Control (MHLC) score. The Stroke Impact Scale (SIS) was used to assess post-stroke disability and quality of life. Linear regression was used to identify differences in each SIS domain score between the three groups while adjusting for the intervention. Depression was defined as a Center for Epidemiological Studies Depression (CESD) score ≥16. Logistic regression was used to examine differences in depression between the three groups while adjusting for the intervention.Results:Of the 529 participants who completed the MHLC questionnaire at baseline, 179 (33.3%) were categorized into theinternalgroup,163 (30.8%) into thepowerful othersgroup, and 190 (35.9%) into thechancegroup. Of the 297 participants who completed the CESD questionnaires at 12 months, 163 (54.8%) scored ≥ 16. Participant’s mean scores for each SIS domain are reported in Table 1. For the SIS communication domain, thechancegroup’s mean score was 3.03 points lower than thepowerful othersgroup’s score (SE=1.39, p=.029). There were no statistically significant differences in scores for the other seven SIS domains or for depression between groups (Table 1).Discussion:External HRLC based on chance may be a predictor of communication difficulties in patients post-stroke. However, mean communication scores are skewed. Control beliefs are important in post-stroke recovery. More research is needed to validate these findings.

Stroke, Volume 53, Issue Suppl_1, Page A26-A26, February 1, 2022. Introduction:Current recommendations for regional stroke destination suggest that patients with an acute severe stroke should be triaged based on estimated time to arrival to a thrombectomy-capable center. We aimed to evaluate which time period available at the time that patient is triaged is able to discriminate which transfer modality should be chosen.Methods:We built and ordered logistic regression model adjusted for multiple comparisons with the RACECAT trial population using time periods available during triage: time from onset to emergency medical services (EMS) evaluation, estimated time of arrival to the thrombectomy-capable center and between centers distance. Estimated times were computed using a distance matrix API. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin score.Results:Of the 1369 patients evaluated, median time from onset to EMS evaluation, estimated time to arrival to the thrombectomy-capable center and between centers distances were 65 minutes (interquartile ratio (IQR) 43 to 138), 61 minutes (IQR 36 to 80) and 62 minutes (IQR 36 to 73), respectively. In patients transferred to local stroke centers, delay in EMS evaluation was associated with higher degrees of disability (for each 30 minutes delay, adjusted common odds ratio (acOR) 1.035, 97.5% confidence interval (CI) 1.005 to 1.066), with no influence in patients directly transferred to thrombectomy-capable centers (for each 30 minutes delay, acOR 0.999, 97.5% CI 0.981 to 1.018) (pinteraction=0.048). In patients evaluated by EMS above 120 minutes after stroke onset, direct transfer to a thrombectomy-capable center was associated with lower degrees of disability (acOR 1.494, 95% CI 1.026 to 2.174).Conclusion:In the RACECAT trial, delay in EMS evaluation was associated with higher degrees of disability in patients transferred to local stroke centers and may serve as a potential biomarker for prehospital triage optimization.

Stroke, Volume 53, Issue Suppl_1, Page AWP69-AWP69, February 1, 2022. Introduction:Treatments for stroke developed in the last decade, such as thrombectomy, have improved patient outcomes. However, these treatments do not guarantee stroke recovery and many patients still need additional treatment to recover. Identifying the expected degree of recovery would help inform patient planning and improve personalized care.Methods:Retrospective patient information from 54 emergent thrombectomy patients, including hemorrhagic infarction, and diffusion parameters from their clinical diffusion MRI scan (1.5T, 20 directions, b=2000, NEX=2) were analysed in a multivariable logistic regression with the outcome of identifying favorable outcomes, score 0-2, of their modified Rankin Score (mRS) at 90 days. Models using patient information and imaging data were generated and compared.Results:Using stepwise regression, gender and a 24 hour NIHSS score were identified as the best patient information for indicating mRS at 90 days, while mean difference of the ipsilesional and contralesional motor track regions for fractional anisotropy (FA), mean diffusivity (MD), and orientation dispersion index (ODI) were the best imaging indicators for mRS at 90 days. The model from a multivariable logistic regression analysis of patient information gave a predictive model with an area under the curve (AUC) of 0.83 and confidence interval (CI) of 0.69 to 0.93 whereas a model using patient imaging data had an AUC of 0.93 and CI of 0.83 to 0.98. Combining both patient information and imaging data produced a model with an AUC of 0.95 and CI of 0.86 to 0.98.Conclusions:Patient information, imaging data, and combined create models for a post-thrombectomy cohort with good AUCs ranging from 0.83 to 0.95 for prediction of 90 day mRS . This initial study shows promising results that these models can be predictive in a heterogeneous post thrombectomy population.

Stroke, Volume 53, Issue Suppl_1, Page AWP117-AWP117, February 1, 2022. Introduction:Hyperfibrinolysis is associated with intracerebral hemorrhage (ICH) after the use of tPA for acute ischemic stroke (AIS). Point-of-care Rotational ThromboElastoMetry (ROTEM) testing may rapidly detect hyperfibrinolysis and identify AIS patients at high risk for hemorrhage.Hypothesis:Evidence of fibrinogen depletion on ROTEM will accurately predict bleeding following revascularization therapy for AIS.Methods:We reviewed medical records of AIS patients who underwent revascularization therapy between 2019-2020. All patients underwent ROTEM testing post-procedure to facilitate targeted blood product transfusion should hemorrhage occur. However, transfusion was not performed prophylactically. Repeat imaging with dual-energy CT was performed within 24 hours. A quality control registry of all AIS patients who undergo revascularization is maintained for purposes of Joint Commission certification. All variables, including ROTEM values and occurrence of intra- and extracranial hemorrhage, were entered prospectively. We examined the predictive value of a FIBTEM-A10