Risultati per: Linee Guida per le cure post-parto

Stroke, Volume 53, Issue Suppl_1, Page A98-A98, February 1, 2022. Background and purpose:Post-stroke immunosuppression is associated with increased infection risk and mortality of stroke patients. However, the mechanisms driving post-stroke immunosuppression are not fully elucidated and strategies to prevent this fatal complication are lacking. We investigated the role of programmed death-ligand 1 (PD-L1) on post-stroke lymphocyte deficiency in a murine model of intracerebral hemorrhage (ICH).Methods:ICH was induced by intracerebral injection of autologous blood or collagenase IV to male C57BL/6 (B6) mice. Mice were randomly assigned into two groups to received anti-PD-1 antibody and vehicle respectively via intraperitoneal injection operating at 1 hour after ICH. Neurological function assessment, immunofluorescence, Elisa, flow cytometry, lung colony calculated were analyzed.Results:In a mice model of ICH, we identified that neuron-derived programmed death ligand 1 (PD-L1) are downregulated and released to the blood post ICH. Increased PD-L1 induced T cell and NK cell deficiency via their expressed PD-1, which are associated with increased lung infection post-ICH. Blocking PD-L1 pathway via an anti-PD-1 monoclonal antibody prevented the spleen atrophy of ICH mice, and improved peripheral T and NK cell numbers and function. Anti PD-1 antibody treated mice showed improved clinical outcome and reduced pulmonary bacterial burden.Conclusions:This study identified brain-derived PD-L1 to the periphery as a new pathway that lead to post-stroke immunosuppression, targeting PD-L1 could be a potential treatment strategy to reduce post-stroke infection risk.Key words:Programmed death ligand 1,intracerebral hemorrhage, neuron,immunosuppression, inflammationShort title:PD-L1 and post-stroke immunosuppression

Stroke, Volume 53, Issue Suppl_1, Page AWP218-AWP218, February 1, 2022. Introduction:Midlife hypertension is associated with an increased later-life ischemic stroke risk. However, temporal trends of blood pressure have not been fully explored.Methods:We performed a post hoc analysis of the ARIC study and included participants with four systolic blood pressures (SBP) at Visits 1-4 (1987-1999). Patients who had an ischemic stroke, died, or were lost to follow-up before 1999 were excluded from the analysis. We used group-based trajectory modeling to define six distinct SBP trajectories during Visits 1-4 (Figure 1). We report unadjusted and adjusted hazard ratios from Cox models fit to the primary outcome of ischemic stroke during follow-up from 1999-2017. We confirmed the proportional hazards assumptions of our models.Results:We included 9,689 participants, of which 758 (7.8%) had an ischemic stroke during follow-up. The mean±SD age at Visit 1 was 54±6 years and at Visit 4 was 63±6 years. The adjusted Cox models, Table 1, show the highest risk of ischemic stroke with increasing hypertension or stable severe hypertension. Comparing trajectories with similar baseline hypertension confirmed that increasing hypertension and stable severe hypertension had a higher risk than decreasing trajectories with the same starting point.Conclusion:Midlife blood pressure trajectory is associated with later-life ischemic stroke risk. Patients with hypertension who achieved a midlife reduction in systolic blood pressure were less likely to have a later-life stroke than those who did not.

Stroke, Volume 53, Issue Suppl_1, Page AWP242-AWP242, February 1, 2022. Background:Clinically, ~65% of stroke patients are left with functional impairments after stroke and 15% die shortly after their stroke. Increasing evidence suggests that peripheral inflammatory responses after stroke play an important role in determining neurological outcome. Mast cells (MCs) are one of the most rapid responders to injury. MCs release histamine (HA), a pro-inflammatory transmitter that enhances inflammation. Gut MCs are a major source of HA.Hypothesis:We hypothesize that aged animals stroke will lead to robust gut mucosal MC-activation and HA release, with subsequent gut disruption and inflammation. Stabilizing peripheral MCs will decrease peripheral/central inflammation, MC trafficking, and improve stroke outcomes.Methods:We used a reversible middle cerebral artery occlusion (MCAO) model of ischemic stroke in aged (18mo) wild-type male mice to investigate the MC role in neuroinflammation post-stroke (PS). We stroke the aged animals and treated the animals with 25 mg/kg BW of cromolyn (MC stabilizer), oral gavage. Cromolyn was administered at 3-h, 10-h, 24-h and every other day PS. Positive control group that were stroked but treated only with saline. In total, four groups stroke and sham (surgery control), out of these animals one set received cromolyn and one set received saline. We sacrificed animals at 3-h, 24 –h and 3-days after cromolyn treatment post-stroke.Results:We found that cromolyn administration significantly reduced MC numbers in the brain at 24-hours (P

Stroke, Volume 53, Issue Suppl_1, Page ATP66-ATP66, February 1, 2022. Introduction:Annually, 55,000 more females than males are affected by stroke in the United States. Females also tend to experience more severe strokes with worse functional outcomes, which result in poorer health-related quality of life. Despite the marked differences in long-term recovery between males and females with stroke, little is known about the sex differences in motor performance that may contribute to the differences in recovery and what therapies could be used to optimize recovery, especially for female stroke survivors. In this study, we aimed to determine if sex-related differences in neuromuscular fatigability exist post stroke.Methods:Sixteen chronic stroke survivors (at least 6 months post stroke, 9 females, 58 +/- 14 years) and thirteen neurologically intact controls (7 females, 59 +/- 12 years) performed a submaximal isometric fatiguing knee extension contraction with either the paretic (stroke) or the dominant (control) leg. The submaximal fatiguing contraction torque was equivalent to 30% of the maximal voluntary isometric contraction (MVIC) of the knee extensors. The participants were asked to sustain at the target torque until one of the two criteria for fatigue was met: (1) if the participant’s torque cannot maintain within a 10% window of error for more than 5 seconds; or (2) if there are more than 5 deviations from the 10% error window in a consecutive 10-second time period. Time to task failure (TTF) was measured.Results:Overall, both male and female stroke survivors tended to have lower MVIC than their healthy counterparts (male: 151 +/- 60 Nm vs. 206 +/- 39 Nm; female: 58 +/- 17 Nm vs. 121 +/- 27 Nm). On average, males tended to fatigue similarly between stroke and control groups (259 +/- 164 s vs. 249 +/- 96 s, respectively); while female stroke survivors tended to have a briefer TTF compared to female controls (207 +/- 69 s vs. 311 +/- 129 s).Conclusions:During submaximal isometric knee extension exercise, female stroke survivors had a shorter task duration than female controls, while this stroke-related difference was not observed in males. Our results indicate that, although stroke impairs muscle strength in both sexes, fatigability may be exacerbated to a greater extent in females than in males post stroke.

Stroke, Volume 53, Issue Suppl_1, Page A14-A14, February 1, 2022. Introduction:We previously demonstrated that the quantitative volumetric assessment of iodinated contrast extravasation (ICE) present on post-intervention imaging was closely associated with the likelihood of an acute ischemic stroke patient having PH-1 or PH-2, and thus ICE may serve as a useful CT biomarker to assess risk of reperfusion injury (hemorrhagic conversion (HC) and blood brain barrier (BBB) disruption). Here we used receiver operator curve (ROC) analysis to compare the efficacy of ICE, infarct volume, and 24hr NIHSS change as a predictor of discharge mRS and HC post-reperfusion therapy.Method:Data on ischemic stroke patients treated with reperfusion therapy were obtained from our Institutional Review Board approved database from January 2017 to November 2019 that had evaluable images within 24 hours of admission. Ischemic volume (IV) was measured on diffusion-weighted imaging. ICE was measured on CT head. A freehand 3D region of interest tool on the Visage Imaging PACS System was used to measure volumes. Susceptibility weighted MRI sequences were used to grade HC. Data analysis was conducted with regression modeling and ROC analysis.Results:Of the 82 patients, median age was 73 (interquartile range (IQR) 61- 77, 49% were women, admission NIHSS was 12 (IQR 7 – 21), 24hr NIHSS change was 4 (IQR 0 -13), IV was 50.6 +/- 7.1 mL, 48% were treated with thrombectomy, 7% had PH-1 or PH-2 identified on MRI, median systolic blood pressure was 154 (IQR 137-175), 56% were MCA territory strokes, and 37% had a discharge mRS of 0-2. ICE volume was 2.6 +/- 1.0 mL. ICE increased the likelihood of PH-1 or PH-2 HC (odds ratio (OR) 14.34, 95% confidence interval (CI) 5.74 – 22.94) and decreased the likelihood of discharge with mRS of 0-2, OR of 0.09 (CI 0.008-0.972). IV was a better predictor of 0-2 mRS (ROC area under the curve (AUC) 0.832) than ICE (AUC 0.640) and 24hr NIHSS change (AUC 0.557), but ICE was a better predictor of PH-1 or PH-2 (AUC 0.942) than IV (AUC 0.667) and 24hr NIHSS change (AUC 0.447).Conclusion:ICE may predict reperfusion injury and functional outcome, but it is a better predictor of hemorrhagic conversion in patients treated with reperfusion therapy.

Stroke, Volume 53, Issue Suppl_1, Page ATMP55-ATMP55, February 1, 2022. Introduction:High blood pressure variability (BPV) after endovascular thrombectomy is associated with post-stroke complications and poor neurological outcomes. However, whether BPV is an epiphenomenon of the stroke itself or causally related to the outcome remains unknown.Objective:In this study we aimed to evaluate if a relationship exists between pre-and post-stroke BPV in patients with large vessel occlusions (LVO).Methods:From our prospective stroke registry, we identified patients who had an anterior circulation LVO, underwent EVT, and had at least three blood pressure measurements recorded in the electronic medical record in the six months prior to their stroke admission. All patients had repeated time-stamped blood pressure data recorded for the first 72 hours after thrombectomy. Using the standard deviation of systolic BP, we calculated BPV for each patient and separated patients into tertiles based on their post-EVT BPV. The relationship between pre-stroke BPV and post-EVT BPV was analyzed using an ordinal logistic regression and Spearman’s rank correlation analysis.Results:Two hundred fifty-two patients were included in our analysis (mean age 70±16.2 years, mean admission NIHSS 15±7, median pre-stroke BP measurements 14.5 (IQR 5.0-55.8)). Pre-stroke BPV gradually increased for patients with higher post-EVT BPV tertiles (tertile 1 = 13.2(±5.2) mmHg, tertile 2 = 15.0(±5.5) mmHg, tertile 3 = 16.7(±7.0) mmHg, p=0.001). A positive correlation was observed between pre-stroke BPV and post-EVT BPV (p

Stroke, Volume 53, Issue Suppl_1, Page A108-A108, February 1, 2022. Introduction:Hypertension is the most important modifiable risk factor for recurrent stroke. However, it remains poorly controlled after stroke, especially among Black and Hispanic patients. Black and Hispanics have a higher prevalence of uncontrolled BP and limited access to care. Interventions that promote equitable access are needed to improve outcomes.Aim:We tested whether a randomized trial of post-acute stroke care that integrates nurse-supported home BP telemonitoring, tailored infographics, and video visits with a multidisciplinary team including pharmacy (Telehealth After Stroke Care (TASC intervention) was feasible.Methods:Acute stroke patients with hypertension were randomized prior to discharge to usual care or TASC. Usual care patients received a video visit with primary care at 1-2 weeks and stroke specialist at 6 and 12 weeks after discharge. TASC patients received a tablet that wirelessly transmits BP data to the electronic health record, supported by remote telehealth nurse monitoring along with BP infographics, developed through community participatory design, at first visit and pharmacist visits. Outcomes included recruitment feasibility, visit adherence, and retention. Generalized linear modeling was used to evaluate within-patient home BP change.Results:Of 67 eligible patients, 6 were discharged before recruitment, 8 refused and 3 engaged in other studies. Fifty enrolled patients included 44% Hispanic, 32% Black and 36% women with mean age 64.3 (±14.0) yrs. About half had ≤ a high school education and 30% had commercial insurance. Baseline SBP was similar in TASC (140 ± 19 mmHg) vs. usual care (142 ± 19 mmHg). Retention rate was higher in TASC vs. usual care (84% vs 64%, p=0.11). Adherence to video visits was also higher in TASC (91% vs 75%, p=0.14). SBP control was better in TASC (76% vs. 25%, p

Stroke, Volume 53, Issue Suppl_1, Page A56-A56, February 1, 2022. Objective:We aimed to evaluate which factors contributed to acute ischemic stroke (AIS) following up in stroke clinic post hospitalization.Methods:Single center retrospective analysis of AIS patients from January 2016 to April 2021. Patients were excluded if: died during index hospitalization, discharged to hospice or had incomplete data. We evaluated our primary outcome: factors contributing to patients attending post-discharge appointments and secondary outcome: factors contributing to patients scheduling post-discharge appointments utilizing binomial stepwise logistic regression models. Subgroup analysis compared latency to be seen in follow-up clinic between patients who had an appointment scheduled at discharge compared to those who did not using a Mann-Whitney test.Results:Out of 7960 AIS patients, 2734 were included in this study, 2130 (77.9%) of those patients scheduled an appointment post-discharge, whereas 1649 (60.3%) attended an appointment post-discharge. Patients were more likely to attend a follow-up appointment if scheduled while hospitalized, OR=3.48 [95%CI, 2.94-4.14], p

Stroke, Volume 53, Issue Suppl_1, Page AWMP3-AWMP3, February 1, 2022. Background and Purpose:Hyperglycemia has been associated with higher rates of death or disability in acute ischemic stroke patients undergoing endovascular treatment. However, it remains unclear whether intensive serum glucose reduction can reduce the rates of death or disability in patients undergoing endovascular treatment.Methods:We analyzed the effect of intensive (serum glucose

Stroke, Volume 53, Issue Suppl_1, Page AWP258-AWP258, February 1, 2022. Introduction:The spatiotemporal pattern of microvascular reperfusion in vivo after large vessel recanalization is poorly understood. Combining chronic cranial window with embedded microprism (CCW-MP) and visible-light optical coherence tomography angiography (Vis-OCTA) enables the study of mouse cortical cerebrovasculature up to 60 days post-stroke. Vis-OCTA/CCW-MP can identify the presence or absence of microvascular flow, without labelling, up to 1 mm in cortical depth of the mouse brain at 1.3 micron resolution. We sought to build on these findings to understand the pattern of microvascular no-reflow in a mouse model of stroke that simulates large vessel occlusion and reperfusion.Hypothesis:Different regions of the cortex have striking variation in flow characteristics after macrovascular reperfusion.Methods:All mice studied were 3-4 mo old, C57/Bl6 background, and subject to IMPROVE guideline. Control mice (n=3) were studied to confirm absence of cortical or vascular changes induced by CCW-MP surgery. Test mice (n =6) underwent CCW-MP as previously published. After 2 weeks to allow for healing post-surgery, mice were subject to transient middle cerebral artery occlusion (tMCAO) to model large vessel occlusion and reperfusion. Vis-OCTA measured cortical flow at baseline, 24 hours post-stroke, and 72 hours post-stroke. Cortical mouse vascular regions were divided into layers 1-3: layer 4 : layer 5-6 from top to bottom.Results:Control mice showed no neuronal death, astrogliosis, microgliosis, or neutrophil recruitment induced by CCW-MP implantation. There was no significant difference between vascular density for prism-adjacent cortex and prism-remote cortex. We also determined that the CCW-MP images cortical vascular territory supplied by the middle cerebral artery. For the test mice, all six mice survived combined surgery. Vis-OCTA showed four of six mice had reduction of microvascular flow > 20% from baseline by 72h post-stroke at layer 5-6.Conclusions:Microvascular reperfusion post large vessel recanalization can be incomplete up to 72 hours post-stroke, especially at deeper cortical levels. Further studies should define associated changes in inflammatory cells as well as oxygenation of vessels.

Stroke, Volume 53, Issue Suppl_1, Page ATP149-ATP149, February 1, 2022. Introduction:Higher blood pressure (BP) most post mechanical thrombectomy (MT) can influence perfusion in the ischemic brain tissue depending on collateral status. We aim to determine the association of 24 hour post MT BP parameters with the functional outcome depending on the pre MT collateral status.Methods:We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into two groups (good versus bad) depending on collateral status. A board certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Mass ≥3 and modified-Tan >50% to designate good collaterals on the pre MT CT Angiogram. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, time to thrombectomy, LDL, Hemoglobin A1C, intravenous alteplase, with the 24 hour post MT BP parameters as the predictors. The outcomes were good functional outcome (90 day mRS≤2) and mortality.Results:220 patients met the inclusion criteria. Lower 24 hour BP parameters of standard deviation (SD) SBP (OR,1.16; 95% CI,1.01-1.33; P 0.047) and maximum DBP (OR,1.05; 95% CI,1.01-1.09; P 0.036) were associated with good functional outcome, while higher values of SD SBP (OR,1.15; 95% CI,1.01-1.31; P 0.045), coefficient variation (CV) SBP (OR,1.19; 95% CI,1.01-1.41; P 0.043), SBP range (OR,1.04; 95% CI,1.01-1.07; P 0.046), maximum DBP (OR,0.95; 95% CI,0.91-0.99; P 0.016), pulse pressure (OR,1.09; 95% CI,1.02-1.16; P 0.022) and SBP≥140 (OR,5.85; 95% CI,1.11-30.85; P 0.038) were associated with mortality in patients with good collaterals according to Mass grading. Higher values of BP parameters of SD SBP (OR,1.13; 95% CI,1.04-1.24; P 0.007), CV SBP (OR,1.18; 95% CI,1.05-1.32; P 0.006), SBP range (OR,1.04; 95% CI,1.01-1.06; P 0.008) and maximum DBP (OR,0.97; 95% CI,0.94-1; P 0.02) were associated with mortality in patients with good collaterals according to modified-Tan grading. There was no such association in patients with bad collaterals.Conclusion:Various higher 24 hour BP parameters post MT are associated with a bad functional outcome or mortality in patients with good collaterals, unlike in patients with bad collaterals.

Stroke, Volume 53, Issue Suppl_1, Page ATP231-ATP231, February 1, 2022. Significance:Low frequency whole body vibration (LFV) at 40 Hz, a low impact form of exercise, for a month following mild transient middle-cerebral artery occlusion (tMCAO) reduces infarct volume and improves motor function in reproductively senescent, middle-aged female rats (1). In humans, LFV was shown to increase circulating levels of irisin, a skeletal muscle-derived hormone. Irisin has also been shown to play a crucial role in preserving mitochondrial function, preventing oxidative stress, and elevating expression of BDNF, among other neuroprotective measures. The current study aims to investigate the efficacy of LFV in ameliorating post-tMCAO cognitive deficits and to determine the putative role of irisin in conferring the benefits of LFV in middle-aged rats.Methods:Middle-aged rats of both sexes (5-8) were randomly assigned to tMCAO (90 min), or sham surgery followed by exposure to either LFV (twice a day for 15 min each for 5 days a week over a month) or no LFV treatment groups. Following the last LFV treatment, rats were tested for hippocampus-dependent learning and memory using a water maze followed harvesting brain and blood samples for histopathological and inflammatory marker analyses, respectively. In a parallel experiment in the absence of LFV, middle-aged female rats were randomly assigned to either saline or irisin treatment following tMCAO. Recombinant irisin was purchased from PeproTech (Rocky Hill, NJ). Rats were treated with irisin (0.2 μg/g BW; IP) or saline for a month followed by their brains were assessed by histopathology.Results:Post-tMCAO LFV significantly lessens cognitive deficits in rats of both sexes. It also significantly decreased circulating pro-inflammatory cytokines and increased serum levels of native irisin. Quantification of infarct volume irisin-treated rats demonstrated that, compared to saline, infarct volume was significantly reduced. Saline treatment resulted in 234 ± 30 mm3, while irisin treatment yielded 128 ± 34 mm3(p

Stroke, Volume 53, Issue Suppl_1, Page AWP173-AWP173, February 1, 2022. Introduction:Approximately 2/3 of children face neurological deficits following arterial ischemic stroke (AIS). In neurotypical development, bilingualism is thought to confer certain linguistic and cognitive advantages. However, research on whether this may affect development in bilingual pediatric stroke patients is scarce.Objectives:To evaluate the effects of bilingual vs. monolingual exposure on language and cognitive outcomes in children following arterial ischemic stroke across two studies: (1) large-scale group analysis using the Pediatric Stroke Outcome Measure (PSOM); (2) exploratory case studies using neuropsychological measures.Methods:An institutional stroke registry and chart review were used to gather patient and stroke data, including the Pediatric Stroke Outcome Measure (PSOM) and standardized neuropsychological measures performed at several timepoints post-stroke in children with AIS. In Study 1, growth curve modeling based on PSOM subscales, predicted by age at stroke groups, language groups and their interactions was used. In Study 2, comparative case studies were conducted with a monolingual-bilingual pair, aged 7 and 8 at stroke onset.Results:In Study 1, 237 patients were identified (44%, bilingual patients). Patients were stratified based on age at stroke onset i.e. neonatal (

Stroke, Volume 53, Issue Suppl_1, Page ATP16-ATP16, February 1, 2022. Introduction:Endothelin (ET) system contributes to cerebrovascular dysfunction and acute neurovascular injury after ischemic stroke. While some clinical and preclinical studies suggests, dual inhibition of ET receptors prevent poststroke cognitive impairment (PSCI), also recent advances suggests systemic ETB receptor agonism improves PSCI. Current, study aimed to investigate the role of ETB receptors in post stroke recovery by selectively silencing cerebral ETB receptors in rats. We hypothesized that ETB receptors are protective, and inhibition of ETB receptors will worsen PSCI.Methods:ETB receptors were knocked down by intra-cerebroventricular injections of GFP tagged lentiviral vectors with ETB-shRNA particles (ETBR-KD) or scrambled (sc-shRNA) in male Wistar rats. Middle cerebral artery occlusion (MCAO; 30 minutes) was performed 10 days post lentiviral transfection. Animals were monitored for motor functions with adhesive removal time (ART) and composite score. Cognitive functions were measured at baseline and 28 days post MCAO with novel object recognition (NOR), novel object placement recognition (NOP), 2-trial Y-maze and open field (OF).Results:Animals of both the groups had significant deficits in ART and composite score, indicating consistent ischemic injury (table 1). By day 28, NOR-RI and NOR-d2 in sc-shRNA group (n=3) was significantly lower than the ETBR-KD group (n=5). There was a trend for lower NOP-d2 in the ETBR-KD group. Number of alterations and forced alternation scores (Y maze) were lower in ETBR-KD group at baseline and were significantly different between groups at day 28. Animals of both the groups moved around the same amount in OF.Conclusions:NOR scores suggest ETBR silencing improves working memory but worsens spatial memory. Y-maze scores also suggest that ETBR-KD worsen deficits. Longer monitoring of animal will provide more definitive answers with respect to the role of ETB receptors in stroke recovery and PSCI.

Stroke, Volume 53, Issue Suppl_1, Page AWP3-AWP3, February 1, 2022. Objective:To investigate the effect of early hyperchloremia on 90-day outcomes in acute ischemic strokeMethods:We analyzed data from Albumin in Acute Ischemic Stroke (ALIAS) Part 1 and 2 trials which recruited patients with acute ischemic stroke within 5 hours of onset. Patients with hyperchloremia (defined as 110 mmol/L or greater) at baseline, 24, or 48 hours after randomization were identified. We trichotomized patients into 3 groups; no instances, one instance, and two or more instances of measured hyperchloremia within the first 48 hours. Serum creatinine levels at baseline, 24, and 48 hours were used to identify acute kidney injury (AKI) via the Acute Kidney Injury Network (AKIN) classification. Logistic regressions were performed to determine the effects of hyperchloremia on outcomes defined by modified Rankin scales or National Institutes of Health Stroke Scale scores at 90 days and mortality at 90 days.Results:Among the total of 1275 patients analyzed, zero, one and two or more occurrence of hyperchloremia within 48 hours were observed in 976, 191 and 108 patients respectively. Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia at significantly higher odds of non-favorable outcomes within 90 days after adjustment for age, NIHSS score, initial systolic blood pressure, and ALIAS treatment group (albumin or placebo) (OR 3.0, 95%, CI 1.8-5.0). Patients with two or more occurrences of hyperchloremia also presented higher odds of death within 90 days vs the non-hyperchloremia group. Patients with one occurrence of hyperchloremia were not at higher odds for non-favorable outcomes at 90 days. There was no association between occurrence of two or more occurrence of hyperchloremia and AKI (OR 0.8, 95% CI 0.3-1.9).Conclusions:The independent association between sustained hyperchloremia and non-favorable outcomes at 90 days suggest that avoidance of hyperchloremia may increase the rate of favorable outcomes in patients with acute ischemic stroke.

Stroke, Volume 53, Issue Suppl_1, Page AWMP17-AWMP17, February 1, 2022. Introduction:Associations between post-stroke vascular risk factors levels with post-stroke cognitive decline are uncertain. We determined associations between systolic blood pressure (BP), glucose, and low-density lipoprotein (LDL) cholesterol levels with post-stroke cognitive decline.Hypothesis:Higher post-stroke systolic BP, glucose, and LDL cholesterol levels are associated with faster post-stroke cognitive decline.Methods:This cohort study pooled data from 832 participants 18 and older with incident stroke and free of dementia before stroke (50% women and 32% Black) from 4 cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Offspring Study, and REasons for Geographic and Racial Differences in Stroke Study. Linear mixed-effects models were used to estimate longitudinal changes in cognition after incident stroke. The primary outcome was change in global cognition. Global cognition was harmonized across studies and standardized as T-scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition. Median (IQR) follow-up was 5.5 (3.3-8.3) years.Results:In separate models, higher post-stroke glucose and LDL levels, but not systolic BP, were associated with faster declines in global cognition (Models M1a, M1b, and M1c, Table 1). In a model with all three vascular risk factors, higher post-stroke mean glucose and LDL levels were associated with faster global cognition decline, though not to traditional levels of statistical significance; however, post-stroke mean systolic BP was not associated with global cognition decline (Model M2, Table 1). Older age was associated with faster cognitive decline in all models.Conclusions:Our results suggest that higher post-stroke glucose and LDL levels are associated with faster post-stroke cognitive decline. We found no evidence that post-stroke BP levels are associated with post-stroke cognitive decline.