Risultati per: Stroke

Stroke, Volume 56, Issue Suppl_1, Page A89-A89, February 1, 2025. Introduction:Platelet glycoprotein (GP) Ibα is a key receptor for thrombosis. Under high shear conditions, GPIbα-VWF interactions are required for initiating platelet adhesion and vessel occlusion. GPIbα is also an important checkpoint for thrombo-inflammation in acute ischemic stroke. It has been considered as a desirable target against ischemic stroke for decades, but no anti-GPIbα drug has been successfully developed.Methods:CA1001 was humanized from our unique mAb crossing different species, and manufactured under GMP-like conditions with 99.9% purity. The efficacy of CA1001 was assessed using variousin vitroplatelet functional assays with blood samples andin vivomodels, including state-of-the-art intravital microscopy thrombosis and transient middle cerebral artery occlusion (tMCAO) models. Pharmacokinetics (PK), pharmacodynamics (PD), and a 14-day regulatory toxicology study were conducted in rats and rhesus monkeys.Results:CA1001 specifically recognized platelet GPIbα from human, monkeys, rats, mice, rabbits and dogs. Using platelets from rhesus monkeys, healthy volunteers, and patients with peripheral artery disease, CA1001 dose-dependently inhibited ristocetin-induced platelet aggregationin vitro. Using laser injury and FeCl3injury intravital microscopy models, CA1001 inhibited thrombosis, prevented vessel occlusion, and importantly, promoted thrombus dissolution (thrombolysis)in vivo. In a 60-min tMCAO models, intravenous injection of CA1001 1 hour after tMCAO significantly reduced the cerebral infarct volume at 24 hours without increasing the risk of intracerebral hemorrhage. The PD studies showed that single bolus injection of CA1001 reached maximal anti-platelet effects within 5 minutes (0.25mg/kg in rats, 4mg/kg in monkeys) which was maintained following intravenous infusion. The extent and duration of the effect were dose-dependent. Plasma concentrations increased linearly with the dose received. In toxicology studies, CA1001 was well tolerated and safe without bleeding nor platelet count reduction. The No Obvious Adverse Event Level in rats and monkeys were 25mg/kg, and 100mg/kg respectively, which are 10 and 25 times the therapeutic targeted doses.Conclusion:The first-in-class humanized anti-GPIbα Fab CA1001 has potent anti-thrombotic effects, consistent PK/PD properties and favorable safety and tolerability profiles warranting further clinical development in healthy volunteers and patients with acute ischemic stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATMP39-ATMP39, February 1, 2025. Obtaining consent for participation in acute stroke trials is particularly challenging due to the time pressure of delivering immediate treatment. As a result, patients are often not able to provide informed consent to participate in clinical trials. Modifications to standard consent practices such asdeferral of consent,surrogate consent,or2-physician consentcan produce problems including violating patient autonomy, disadvantaging patients through their participation and biasing results. Alternatively,advance consent, in which patients at risk of stroke consent to participate in RCTs before they experience a stroke, could address these challenges. In this study, we assessed the acceptability of advance consent to people at risk of stroke.Methods:We approached patients deemed at risk of stroke in the Stroke Prevention Clinic of the Ottawa Hospital, a tertiary care facility in Ontario, Canada. Eligible patients were invited to complete a questionnaire regarding advance consent. Patients who responded positively to questions about advance consent were offered the opportunity to consent in advance to the EASI-TOC and/or FASTEST clinical trials.Results:We screened 1547 patients over a 1-year period (July 2023 – July 2024), of whom 431 (28%) were eligible to participate. Of the 431 eligible participants, 157 (36%) completed the initial questionnaire. Of these, 96% (151/157) either agreed or strongly agreed that inviting stroke patients to provide advance consent to participate in clinical research trials is appropriate. Further, 95% (149/157) of participants either agreed or strongly agreed that they would provide advance consent to specific acute stroke clinical research trials, and 69% (108/157) either agreed or strongly agreed that they would provide advance consent to all acute stroke research trials, whether or not they were given the details of the trial. Ultimately, 123 respondents were eligible to be offered advance consent, of whom 45 (37%) provided advance consent to participate in at least one ongoing trial. One participant (0.8%) specified in advance that they would not want to participate in these trials.Discussion:Preliminary results of this feasibility study show that patients were open to the idea of providing advance consent to participate in acute stroke research and a sizable portion of patients were willing to provide advance consent for ongoing trials.

Stroke, Volume 56, Issue Suppl_1, Page ATP301-ATP301, February 1, 2025. Background:Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the most common hereditary stroke disorder due to pathogenic variants in the NOTCH3 gene on chromosome 19. Characteristics of CADASIL patients hospitalized with acute ischemic stroke (AIS) have not been widely reported.Methods:We identified all adult hospitalizations in the National Inpatient Sample (NIS) from 2018-2020 with diagnosis codes for acute ischemic stroke (ICD-10 I63) and the newly available code as of October 2018 for CADASIL (I67.850) using weighted sampling. Descriptive statistics evaluated demographic and clinical characteristics among AIS patients with and without CADASIL.Results:Of a total 1,918,920 weighted AIS hospitalizations, there were 300 patients with CADASIL. The prevalence of CADASIL among AIS patients increased from 0.2% in 2018 to 2.8% in 2020. AIS patients with CADASIL were similar in sex and more likely to be younger (55.8 ± 25.2 vs 69.7 ± 31.4 years, p

Stroke, Volume 56, Issue Suppl_1, Page ATMP15-ATMP15, February 1, 2025. Background:After discharge can be a vulnerable time for stroke patients and their caregivers. Nurse navigators have been utilized in other specialties resulting in positive impacts on patient care. Nurse navigators are becoming an important part of Stroke Center teams. Responsibilities vary, including patient education and post-discharge phone calls. A Primary Stroke Center found nurse navigator post-discharge calls improved follow-up and decreased 30-day stroke and all cause readmissions.Purpose:To implement a Stroke Nurse Navigator (SNN) at a Comprehensive Stroke Center (CSC), providing in-person stroke education during the hospitalization and a structured post-discharge phone call protocol with the patient and/or caregiver. The goal is to connect care settings, improve transitions of care, improve secondary stroke prevention medication adherence, and increase Stroke Clinic follow-up.Methods:All patients discharged with stroke, including TIA, AIS, ICH, and SAH receive post-discharge phone calls by the SNN. Additional high risk patients can be added at discretion. Patients discharged home receive a call within 7 post-discharge in which the SNN reviews and verifies the patient’s Stroke Clinic follow-up, outpatient testing, and medications. Stroke symptom recognition and patient concerns are also discussed. All patients regardless of discharge disposition receive calls at various time points post-discharge. The call time points were determined based on predictive recovery curves for stroke subtypes and to anticipate potential vulnerable points after discharge; e.g. AIS patients receive calls at 30, 60, and 90 days post-discharge. For the 30 day call, the SNN reviews the patient’s stroke risk factors and educates on interventions. A Late Complications After Stroke (LCAS) screening tool to identify complications, like depression and headaches is completed at the 60/90 day call. Concerns are communicated to the outpatient stroke clinician to address at follow-up. During the 90/180 day call, a mRS is completed. Calls are completed with the patient or caregiver if the patient is unable to participate for any reason.Discussion:The impact of a structured post-discharge call protocol on secondary stroke prevention medication adherence and Stroke Clinic retention will be evaluated. This initiative aims to prove that it is feasible and beneficial to have a SNN and post-discharge calls as standard of care for stroke patients to improve transitions of care.

Stroke, Volume 56, Issue Suppl_1, Page AWMP105-AWMP105, February 1, 2025. Introduction:Accurate prediction of the risk of ischemic stroke (IS) is vital for prevention and would be aided by multimodal biomarkers integrating genetic, clinical, and functional data. The role of imaging and EKG based atrial measurements, other than atrial fibrillation (AF), in IS prediction is uncertain and many strokes remain cryptogenic despite extensive work-up. As an exploratory step to improve stroke evaluation by including atrial traits, we developed a novel multimodal deep learning model integrating demographic and clinical variables with atrial phenotypic and genotypic data.Methods:We collected individuals from UK Biobank (UKBB) and defined ischemic stroke (IS) by the UKBB Algorithmically Defined Outcome (ADO). We developed a multimodal multi-layer perceptron with late fusion (MMLP-LF) model to predict whether a subject has IS by integrating five data modalities from UKBB: 1) MRI and EKG derived atrial traits, 2) lead genetic variants (P

Stroke, Volume 56, Issue Suppl_1, Page AWMP106-AWMP106, February 1, 2025. Introduction:An elevated urinary albumin-to-creatinine ratio (UACR), a marker of renal dysfunction, has been linked to an increased incidence of stroke. However, the interplay between UACR and demographic factors such as age, obesity, ethnicity, or education remains underexplored.Methods:We conducted a post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, including patients with available data. Time-to-event models were developed to examine the relation between UACR and stroke risk during up to 10 years of follow-up, adjusting for variables such as gender, age, education, and race. Because the exposure of UACR had a right skew, we transformed it into top tertile versus lowest/middle tertile.Results:We included 9,025 ACCORD participants in our analyses. Baseline demographics are seen in Table 1. Those with elevated UACR (top tertile) had a higher incidence of stroke (4.6% vs 3.4%, p

Stroke, Volume 56, Issue Suppl_1, Page A91-A91, February 1, 2025. The acute phase of ischemic stroke triggers a complex cascade of cellular responses in the brain and the immune system. Previous studies show that ischemic stroke induces microglial lipid accumulation from 3d to 7d after stroke, linked to pro-inflammatory activation. However, little is known about cellular lipid alterations in peripheral immunity acutely after stroke. We hypothesized that acute ischemic stroke would increase neutral lipid content (lipid droplets) in peripheral myeloid cells and promote immunosuppression phenotypes.To assess neutral lipid levels during the first week of stroke, we used the BODIPY493/503 dye probe and performed flow cytometry on human PBMCs of healthy volunteers (N=31), and ischemic stroke patients at 3d (N=43) and 7d (N=52). In time course experiments on C57BL/6 mice (1d, 3d and 7d post-MCAO), the same technique was performed using Staph A pHrodo bioparticles, BODIPY, LipiM and Bodipy-cholesterol probes to explore changes in neutral lipid level, lipid uptake, and phagocytic activity of leukocytes. We collected white adipose tissue (WAT)-conditioned PBS from sham and 1d post-MCAO mice to stimulate naive spleen cells and examine whether factors released from WAT alter lipid content and phagocytosis.In human PBMCs, we found a significant increase in neutral lipids across innate and adaptive cells for up to 7d post-stroke (p

Stroke, Volume 56, Issue Suppl_1, Page ATMP20-ATMP20, February 1, 2025. Background:Despite the increasing use of intravenous (IV) tenecteplase (TNKase) for acute ischemic stroke (AIS), little is known about the characteristics of patients who suffer intracerebral hemorrhage (ICH) and opportunities to prevent this often-fatal complication.PURPOSE:The aim of this retrospective review was to investigate the characteristics of AIS patients with ICH complication and opportunities in patient management after receiving IV TNKase in the emergency departments (EDs) and to report preliminary results.Methods:Retrospectively, the EHRs that suffered ICH complication after receiving TNKase (0.25 mg/kg) were reviewed from 21 hospitals in a large integrated health system between November 2020 to December 2023. Data collection included demographics, risk factors, blood pressures (BPs), and other variables such as the National Institute of Health Stroke Score (NIHSS), presence and types of large vessel occlusion, and severity of the hemorrhage (symptomatic or asymptomatic).Results:The mean age of the 195 cases was 75.4 (SD = 13.46). There were no sex differences (p=.87). Race breakdown was 50% (n = 98) Whites; 15% (n = 98) Hispanics/Latinos; 20% (n = 39) Asians, and 10% (n = 20) Blacks. Majority of patients (73%) arrived via EMS. History of was present in 75.4% of patients, followed by diabetes (58%), hyperlipidemia (55%), atrial fibrillation (20%), and history of stroke (18%). Anti-coagulants use was 8% (n=17). The initial mean NIHSS in the ED was 11.8 (SD=8.65). On initial presentation, the mean systolic and diastolic BPs was 164 (SD=27.1) and 90 (SD=19.46) respectively. Large vessel occlusions (LVOs) were identified in 35.9% (n=70) of patients. Of the LVO cases (n=70), 68.6% (n=48) of the ICH were asymptomatic.Conclusions:Based on the preliminary results, there were some patient-level risk factors that may have contributed to ICH complications after IV TNKase. Tighter control of BPs with anti-hypertensives before and after IV TNKase may also decrease bleeding risk. There were a few opportunities identified with patient assessment and monitoring. The use of both “full” NIHSS and abbreviated NIHSS varied between facilities, which may have delayed the identification of post-TNKase ICH as the abbreviated NIHSS did not provide a total score to assess for change in patient condition and about 40% of patients did not have an increase in the NIHSS. In-depth data reviews and analysis would be necessary to ascertain clinical significance.

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.

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 AWP192-AWP192, February 1, 2025. Background:Mechanical Thrombectomy (MT) treats Acute Ischemic Stroke (AIS) removing the thrombus, and improves clinical outcome. However, it uses high quantities of contrast, with risk of Contrast Extravasation (CE), but also Hemorrhagic Transformation (HT), both detected by cranial Computed Tomography (CT). However, to differentiate between them, it is necessary to perform a control CT 72 hours after MT.Aims:This study aims to develop a tool capable of differentiating HT from EC in cranial CT.Methodology:398 CTs were classified into four classes: TH, CE HT with CE, and without HT nor CE. We selected 111 CT performed until 72 hours after angiotomography+MT and segmented the images with 3DSlicer. Then, we had 2 approaches: 1) Three classification models were developed based on phenotypic characteristics: Support Vector Machines (SVM), Random Forest (RF) and Logistic Regression (LR); 2) The U-Net, a Convolutional Neural Networks (CNN) model for biomedical image segmentation.Results:SVM and RF had ROC AUC above 92% for the three classes. Cross-validation demonstrated good accuracy (SVM=0.947±0.064; RF=0.893±0.076; LR=0.956±0.048) and macro-precision (SVM=0.947 ± 0.066. RF=0.901±0.075, LR=0.956±0.049). The U-Net also presented good predictive performance after cross-validation: ROC AUC above 98% for the three classes, accuracy=0.956±0.072 and macro-precision=0.965±0.055.Conclusion:In this study, we developed a tool with high performance to distinguish between CE and HT with two different approaches, which could help in clinical decision-making, such as introduction of anticoagulants and antiaggregants.

Stroke, Volume 56, Issue Suppl_1, Page ATMP26-ATMP26, February 1, 2025. Introduction:Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. Yet few studies have compared acute stroke treatment metrics and outcomes in patients treated using telestroke versus standard in-person stroke evaluation.Methods:This was a retrospective cohort study of acute ischemic stroke patients age ≥18 presenting to 53 Paul Coverdell Michigan hospitals between 2022 and 2023 who were potentially eligible for thrombolysis (i.e., presented ≤ 4 hours of last known well, no contraindications to thrombolysis). The primary exposure was telestroke (vs non-telestroke), and primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time. Secondary outcomes included discharge ambulatory status and door-in-door-out (DIDO) time in transferred patients. Multivariable hierarchical models evaluated associations between the telestroke (vs. non-telestroke) activation and outcomes, sequentially adjusted for demographics, medical history, presenting/arrival, and hospital characteristics.Results:Among the 4974 stroke patients potentially eligible for thrombolysis (mean age 69.2 [SD: 14.6], 48.3% female), 1078 (21.7%) were evaluated using telestroke and 3896 (78.3%) without telestroke. Telestroke patients were more commonly at primary stroke centers (71.1% vs 39.0%) and less at comprehensive stroke centers (13.3% vs 53.9%; P

Stroke, Volume 56, Issue Suppl_1, Page ATP321-ATP321, February 1, 2025. Introduction:The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.Methods:Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.Results:Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.Conclusion:Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

Stroke, Volume 56, Issue Suppl_1, Page AWP176-AWP176, February 1, 2025. Introduction:Informed consent for clinical trials in the acute stroke setting is challenging. There is a need for context-appropriate approaches to consent, but few data exist regarding implementation of innovative approaches. In the Multi-Arm Optimization of Stroke Thrombolysis (MOST) trial (NCT03735979), a consent process was designed in collaboration with patient advisors that included a short consent form and a companion information sheet. This approach was implemented at all study sites, and participants’ experiences were assessed using a post-enrollment survey.Methods:All participants enrolled in MOST were eligible for the survey. The person who provided consent for enrollment (patient or surrogate) was asked to fill out the survey. The survey was adapted from a prior survey of patients’ and surrogates’ experiences with consent in acute care research and was cognitively pre-tested. Descriptive statistics were tabulated. Likert scale responses on a scale of 1-5 with 1 being strongly agree and 5 being strongly disagree and on a scale of 1-5 with 1 being extremely helpful and 5 being not helpful at all were collapsed into agree (1-2)/not agree (3-5) and helpful (1-2)/not helpful (3-5), respectively.Results:There were 195 completed surveys out of 514 enrollments in the MOST trial (overall capture rate 37.9%). Seventeen surveys were excluded due to mismatch between who consented to MOST and who completed the survey (total n=178 analyzable surveys). Patients completing the survey (or for whom a surrogate completed the survey) were similar to the overall enrolled population in terms of age, sex, race, and stroke severity (Table 1). The average age of survey respondents was 60.1 years, with 42.1% being male and 61.8% being surrogates (Table 2). Overall patients’ and surrogates’ experiences were positive. Post-enrollment communication and consent materials were viewed favorably (Table 3). Open-ended feedback was positive; participants acknowledged that time stress was intrinsic to the situation, encouraged simplicity, and offered few suggestions for improvement.Conclusions:A patient-centered consent process in an acute stroke trial was positively viewed by both patients and surrogates. Embedding assessments of patients’ and surrogates’ experiences within clinical trials offers an important opportunity for understanding the impact of innovation regarding consent.