Risultati per: Stroke

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 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 A94-A94, February 1, 2025. Introduction:Ischemic stroke is a leading cause of death and disability worldwide, but there has been limited success in translating putative treatments from preclinical trials to patients. The Stroke Preclinical Assessment Network (SPAN) is a large-scale multicenter trial (six sites plus a coordinating center).Methods:SPAN implemented a multiparametric MRI protocol with minimal human input to assess tissue outcomes after mouse endovascular middle cerebral artery occlusion (MCAO). Imaging from 1766 mice was used in this study. The sample size includes three comorbidity models (Young mice, Aging mice, and diet-induced hyperglycemia/ obesity mice.Results:Infarct volumes were variable across the network but right-skewed at all sites. Striatal and cortical infarcts were more common than thalamic and hippocampal infarcts (present in 75%, 65%, 20%, and 22% of mice, respectively). Total lesion was more associated with striatal and cortical infarct volumes (R=0.94 and 0.97). Infarct volumes were strongly associated with midline shift on days 2 (R=0.74) and 30 (R=-0.80), reflecting ischemic swelling and encephalomalacia, respectively. Factor analysis identified the underpinnings of the covariance among MRI variables (Figure 1). We found 13 MRI readouts linked to the injury severity after MCAO. These included the total, striatal, and cortical infarct volumes, indices of ischemic edema on day 2, and indices of tissue loss on day 30. Five variables were linked to infarction involving the posterior cerebral artery. Another set of five variables was linked to ventricular volume, suggesting an independent contributing factor, such as age. Average R2ratein the contralateral tissue was lower in diet-induced obesity and aged mice compared with normal young mice, suggesting higher brain water content. Within the infarct, the R2ratewas significantly lower only in diet-induced obese mice versus the other groups.Conclusion:Our data revealed critical insight into the stroke model regarding lesion distribution, swelling, and atrophy. Our findings also shed light on previously underappreciated biological associations among these variables.

Stroke, Volume 56, Issue Suppl_1, Page ATMP27-ATMP27, February 1, 2025. Background:In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years.Methods:This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic’s height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels.Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75.MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p

Stroke, Volume 56, Issue Suppl_1, Page AWP179-AWP179, February 1, 2025. Background:In reperfusion treatment, advanced neuroimaging can be used to indicate treatment or forecasting outcomes, however immediate access is not widely available. This study aims to explore the assessment of initial core volume (ICV) measured on NCCT by a machine learning-based algorithm on outcomes in overall and according to ASPECTS and stroke elapsed time.Methods:Consecutive patients who received reperfusion treatment were studied in two stroke-centers (Jan-2021 to Dec-2023). On admission, ICV was defined on NCCT (aICV) by an algorithm trained using UNet architecture with ResNet 34 encoder. Favorable ASPECTS was defined as score 9-10. Elapsed time from symptoms onset to admission was stratified as early (240 min) temporal window. Good clinical outcome was defined as mRS 0-2 at 90 days. A statistical analysis was performed to evaluate the relation between aICV and clinical outcome in overall and pre-defined groups.Results:Among 595 consecutive patients included, mean age was 73.5(SD±14.4) and median baseline NIHSS 13(IQR:7-19). Mean aICV presented an inverse (r=-0.580, 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 AWMP119-AWMP119, February 1, 2025. Introduction:About 65% of women in their reproductive years use contraception, with combined oral contraceptives (OC) being among the most popular. OC, which contain estrogen and progestin, are linked to a higher risk of stroke, particularly in the first year of use. This study aims to explore the mechanisms and effects of OC exposure on stroke outcomes.Methods:Adult female Sprague-Dawley rats (n= 6-8/group) were randomly assigned to receive either a placebo or OC by oral gavage for 12-14 estrous cycles. The animals were divided into two cohorts following treatment. In the first cohort, brain tissue was harvested to obtain an unbiased global metabolomic profile (Metabolon Inc.) This metabolomic analysis was supplemented with western blotting and enzyme activity measurements of key altered pathways. The second cohort underwent either transient middle cerebral artery occlusion (tMCAO; 90 min) or sham surgery and was observed for 21 days. During this post-tMCAO/sham period, cognition was assessed using the Morris water maze, followed by brain collection for histopathological and immunohistochemical analysis.Results:OC exposure significantly increased infarct volume and impaired cognition in rats compared to the placebo group. Metabolomic analysis revealed significant alterations in sphingolipid metabolism, particularly an increase in sphingosine 1-phosphate (S1P) levels (p

Stroke, Volume 56, Issue Suppl_1, Page AWMP115-AWMP115, February 1, 2025. Intro:Resources for studying stroke are limited to clinical trials with sparse access to physiological and biochemical details, and pre-clinical animal studies with limited relation to humans. A physiologically accurate in silico model would provide a new route for study of the response to an ischemic event. Here we combine a computational model of brain tissue metabolism modified to simulate effects of ischemia (1) with an experimentally-validated approach to model the distribution of nutrients to the extravascular space as provided by a specific cerebral microvasculature network (2,3) to produce simulations of ischemic stroke showing the spatial distribution of damaged and healthy tissue.Methods:Anatomically-accurate models of cortical microvasculature and resulting O2 concentration with consideration of oxygen consumption in tissue were developed and validated against experimental measures of pO2 (2,3, Figure 1). A numerical implementation of a 4-compartment cellular model of brain metabolism (4) was modified to simulate ischemic stroke (1), and further modified to consider effects of the local pO2 and Glucose (GLC) as provided by the vascular network by adjusting local rates of transfer of GLC and O2 into the neuronal compartment of the cell, as shown in Figure 2, bottom. Brain metabolism was simulated for cases with no ischemic event, and after CBF was reduced by 80%.Results:Figure 2 shows timecourse of GLC, ATP, and Sodium in different compartments of the model through time in regions experiencing mild and severe ischemia. Figure 3 shows intraneuronal sodium concentration before and 2 hours after onset of an ischemic event showing failure of sodium pumps during ischemia.Conclusion:Effects of ischemic stroke on cerebral metabolism at the cellular level with consideration of microvasculature and distribution of nutrients within the tissue can be modelled at the capillary and cellular level computationally. Future work will include linking astrocytes to local nutrient concentrations and expansion of the simulated region to include larger region of brain, so an ischemic core and penumbral region surrounded by unaffected tissue can be observed.References1. CM Collins et al. International Stroke Conference, February 7-9 2024, Phoenix2. T Ventimiglia et al. Int J Numer Meth Biomed Engng. 2023;39:e37353. G Hartung et al. PLOS Computational Biology 2020;17(1): e10085844. M Cloutier et al. Journal of computational neuroscience. 2009 Dec 1;27(3):391

Stroke, Volume 56, Issue Suppl_1, Page AWMP118-AWMP118, February 1, 2025. Background and Purpose:Thrombolysis can improve outcome in patients with acute ischemic stroke. However, recanalization is not always complete with persisting cerebral vascular occlusion in >50% of patients despite treatment. Properties of the formed thrombus may influence thrombolysis efficiency and impede recanalization success. Here we examine whether differences thrombin generation are associated with unfavourable outcome in thrombolysis treated patients with acute ischemic stroke.Methods:Two cohorts of patients with acute ischemic stroke treated with thrombolysis were recruited (cohort 1 n=36 patients, cohort 2 n= 42). Thrombin generation was determined by thrombin generation assay and related to stroke outcome at 90-days determined by modified Rankin Scale (mRS). The relationship of thrombin concentration to clot lysis rate was examinedin vitro.Inflammatory factors associated with increased thrombin generation were also identified.Results:An increase in peak thrombin was associated with unfavourable 90-day outcome in patients with acute ischemic stroke treated with thrombolysis. In cohort 1, patients with mRS£2 had a mean peak thrombin of 208.4nM compared to 255.5nM in those with mRS >2 (p=0.019). In cohort 2, patients with mRS£2 had a mean peak thrombin of 211.1nM compared to 251.6nM in those with mRS >2 (p=0.019).In vitro, an increase in thrombin concentration slowed the rate of clot lysis by tPA. In patients with stroke, an increase in peak thrombin was associated with increased plasma interleukin (IL)-6, interleukin-8 and a decrease in a2-macroglobulin.In vitro, IL-6 can was found to increase thrombin generation via monocyte tissue factor.Conclusions:Increased thrombin generation on admission is associated with unfavourable outcome at 90 days in thrombolysis treated stroke patients. Higher thrombin generation may influence thrombus properties, reducing effectiveness of thrombolysis, and impairing recanalization. Further understanding regarding the relationship of thrombin generation to thrombolysis is necessary to enhance recanalization and further improve outcomes in stroke.

Stroke, Volume 56, Issue Suppl_1, Page AWMP103-AWMP103, February 1, 2025. Introduction:Ambient air pollution (particulate matter (PM) 2.5, defined as particles

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 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 AWMP109-AWMP109, February 1, 2025. Introduction:During acute ischemic stroke, energy depletion leads to a rise in creatine (Cr) as a buffer, increased extracellular glutamate from impaired neurotransmitter transport, and a pH drop due to lactic acid buildup. Understanding these changes is crucial for timely intervention, yet no current method captures all these alterations simultaneously. CEST, a novel MRI technique, non-invasively maps metabolites with high sensitivity, providing information on both concentration and pH. Our group recently demonstrated guanidino CEST (GuanCEST) at 3T, reflecting Cr levels, while amine CEST (amineCEST) at 9.4T likely indicates glutamate, and amide CEST (amideCEST) correlates with pH. We aim to use these techniques to investigate metabolic, neurotransmitter, and pH changes in two mouse models of middle cerebral artery occlusion (MCAO).Methods:Ten male C57BL/6 mice (aged 3–6 months) were used for two stroke models: permanent MCAO (pMCAO, n=4) and transient MCAO (tMCAO, n=4). MRI scans were conducted at 9.4T and 3T. Diffusion-weighted imaging identified stroke lesions, followed by T1and T2mapping on the selected slice. CEST scans were performed with a 2s saturation time across B1values ranging from 0.4 to 3.0 μT. We utilized Polynomial and Lorentzian Line-shape Fitting (PLOF) to simultaneously extract GuanCEST, amineCEST, and amideCEST from the CEST spectrum at each pixel, generating corresponding CEST maps. The average CEST values in the lesion and contralateral hemisphere were analyzed.Results:At a B1of 0.4 μT, GuanCEST (Fig. 1, red line) increased by 1.01±0.19% in pMCAO compared to the contralateral hemisphere but decreased by 0.32±0.27% in tMCAO, indicating a greater Cr rise in pMCAO. At higher B1, Cr effects diminished while pH effects increased. When B1exceeded 0.8 μT, amineCEST increased by 3.86±0.42% in tMCAO, nearly four times the rise in pMCAO (1.09±0.26%), possibly reflecting neurotransmitter changes due to cell membrane polarization and energy depletion. At 1.6 μT, amideCEST decreased by 0.53±0.05% in pMCAO but remained stable in tMCAO (0.49±0.48%), suggesting greater tissue acidification in pMCAO. Similar trends were observed at 3T, except amineCEST was undetectable.Conclusion:CEST MRI is a non-invasive technique capable of mapping metabolite, neurotransmitter, and pH changes in the stroke-affected brain, with strong potential for clinical translation.

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 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 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