ESOC 2022 Abstract Book

ESOC 2022 – Oral Presentations

O001 / 332

Scientific Communications 1 - Service Organisation / Quality Improvement

EMERGENCY MEDICAL SERVICES ACTIVATION FOLLOWING FACE, ARM, SPEECH, TIME (FAST) PUBLIC AWARENESS CAMPAIGNS IN QUEBEC, CANADA

V. Brissette¹, B. Rioux^2,3,4, T. Choisi⁵, A. Y Poppe ^2,3,4

¹McGill University, Faculty of Medicine, Montreal, Canada, ²Centre Hospitalier de l'Université de Montréal (CHUM), Department of Medicine (Neurology), Montreal, Canada, ³Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada, ⁴University of Montreal, Department of Neurosciences, Faculty of Medicine, Montreal, Canada, ⁵Urgences-Santé Corporation, Montreal, Canada

Background and aims: Face, Arm, Speech, Time (FAST) public awareness campaigns improve stroke recognition in the general population. Whether this translates into improved emergency medical services (EMS) activation remains unclear. We assessed the effect of five consecutive FAST campaigns on EMS calls for suspected strokes in Quebec, Canada.

Methods: We retrospectively assessed data collected between June 2015 and December 2019 by the EMS corporation covering the greater Montreal area in Quebec, Canada. Five FAST campaigns were held over this period (median duration: 53 days). We compared daily EMS call volumes variations before and after FAST campaigns with t-tests. We used single-group, univariate interrupted time-series to measure changes in EMS daily call volumes for suspected strokes following each FAST campaign (all, <5 hours of symptom onset, 3/3 Cincinnati Prehospital Stroke Scale [CPSS]). Calls for acute headaches served as controls.

Results: After five FAST campaigns, mean daily calls increased by 28% (p<0.001) for suspected strokes, compared to 10% for acute headaches (p=0.012; Figure 1). Significant increases in daily stroke call volumes were only observed after three campaigns (highest OR=1.26, 95% CI: 1.11, 1.43; p<0.001). There were no significant changes in calls after individual campaigns for strokes <5 hours of symptom onset or 3/3 CPSS strokes.

Conclusions: Although stroke calls to EMS increased overall following five FAST campaigns, the individual effect of each FAST campaign was inconsistent. A pre-existing easier recognition of severe symptoms may explain the unchanged 3/3 CPSS stroke calls volume. Further refinement of FAST campaigns could improve prompt EMS activation.

Disclosure: No

O002 / 1002

Scientific Communications 1 - Service Organisation / Quality Improvement

IMPLEMENTATION OF ‘F.A.S.T. HEROES’ ON A GLOBAL LEVEL: A SCHOOL-BASED STROKE EDUCATIONAL PROGRAM FOR THE WHOLE FAMILY

K. Tsakpounidou ¹, J. van der Merwe², M.E. Klinke³, C. Webb⁴, S. Martins⁵, H. Proios¹

¹University of Macedonia, Department of Educational and Social Policy, Thessaloniki, Greece, ²Boehringer Ingelheim International GmbH, Healthcare Affairs & Patient Engagement, Ingelheim, Germany, ³University of Iceland, Faculty of Nursing, School of Health Sciences, Reykjavik, Iceland, ⁴Twelve, 3 Liverpool Gardens, Worthing, West Sussex, United Kingdom, ⁵Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil

Background and aims: Transferring knowledge to the general public about stroke symptomatology and the urgency of seeking for help when a stroke occurs is challenging. This work introduces the global implementation of FAST Heroes, a school-based stroke educational campaign for 5-9-year-old children and their extended family. The study aims to evaluate the outcomes hitherto achieved by assessing the transfer of stroke-related knowledge to parents of the enrolled children and to evaluate parents and teachers’ acceptability towards the program.

Methods: The implementation of a 5-week program included face-to-face educational sessions using workbooks, cartoons, digital learning, and other activities. Outcomes were measured before implementation (t1), after implementation (t2), and at six-month follow-up (t3). Parents were divided into 2 groups, as starting dates of differed in each country.

Results: Results of 5 countries, 4,202 parents who joined the program with their children answered surveys at t1 and t2 (group 1). Increase knowledge of three stroke symptoms from 48% to 83% (p<0.001) was observed. All three surveys were completed by 86 parents (group 2), who improved their knowledge on stroke symptomatology, 55% (t1), 79% (t2), and 94% (t3) (p<0.001). Altogether, the educational messages were successfully passed onward.

Conclusions: Outcome evaluations confirm that knowledge about stroke pass on well from children to their families through the FAST Heroes program. Parents and teachers worldwide believe that the program is feasible and worthwhile. Future large-scale studies across more countries can enhance our understanding and continue to raise awareness for educating young children about stroke symptoms.

Disclosure: No

O003 / 405

Scientific Communications 1 - Service Organisation / Quality Improvement

PREHOSPITAL STROKE ASSESSMENT BY PARAMEDICS COMPARED TO IN-HOSPITAL ASSESSMENT BY PHYSICIANS IN A COMPREHENSIVE COHORT OF PATIENTS WITH SUSPECTED STROKE

L. Dekker¹, J.D. Daems ², M.H.C. Duvekot², T. Truc My Nguyen¹, E. Venema³, H.F. Lingsma⁴, A. van der Lugt⁵, A.C.G.M. van Es⁶, A.D. Rozeman⁷, W. Moudrous⁸, F.H. Vermeij⁹, A.S. Plaisier¹⁰, J.-H. Hensen¹¹, D.W.J. Dippel², H. Kerkhoff⁷, I.R. van den Wijngaard¹, J. Bosch¹², E. van Belle¹³, E.W. van Zwet¹⁴, E.L.L.M. de Schryver¹⁵, L.M.H. Kloos¹⁶, K.F. de Laat¹⁷, L.A.M. Aerden¹⁸, S.A. Zylicz¹⁹, M.J.H. Wermer¹, B. Roozenbeek², N.D. Kruyt¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands, ³Erasmus MC University Medical Center, Emergency Medicine, Rotterdam, Netherlands, ⁴Erasmus MC University Medical Center, Public Health, Rotterdam, Netherlands, ⁵Erasmus MC University Medical Center, Radiology & Nuclear Medicine, Rotterdam, Netherlands, ⁶Leiden University Medical Center, Radiology, Leiden, Netherlands, ⁷Albert Schweitzer Hospital, Neurology, Dordrecht, Netherlands, ⁸Maasstad hospital, Neurology, Rotterdam, Netherlands, ⁹Franciscus Gasthuis & Vlietland, Neurology, Rotterdam, Netherlands, ¹⁰IJsseland Hospital, Radiology, Capelle a/d IJssel, Netherlands, ¹¹Maasstad Hospital, Radiology, Rotterdam, Netherlands, ¹²Emergency Medical Services Hollands–Midden, Leiden, Netherlands, ¹³Emergency Medical Services Haaglanden, The Hague, Netherlands, ¹⁴Leiden University Medical Center, Medical Statistics, Leiden, Netherlands, ¹⁵Alrijne Hospital, Neurology, Leiderdorp, Netherlands, ¹⁶Groene Hart Hospital, Neurology, Gouda, Netherlands, ¹⁷Haga Hospital, Neurology, The Hague, Netherlands, ¹⁸Reinier de Graaf Gasthuis Hospital, Neurology, Delft, Netherlands, ¹⁹Langeland Hospital, Neurology, Zoetermeer, Netherlands

Background and aims: Prehospital large-vessel occlusion stroke scales can be used to triage stroke code patients eligible for endovascular thrombectomy for direct transportation to an intervention center. Several items may be difficult to assess for paramedics. We aimed to compare prehospital assessment by paramedics with in-hospital NIHSS assessment by physicians.

Methods: We used data from the PRESTO and LPSS study, two prospective cohort studies in which paramedics included patients suspected of stroke in the ambulance. Patients with transient ischemic attack were excluded from these analyses. Paramedics used a mobile app to score 9-13 clinical items from prehospital stroke scales. Physicians scored the NIHSS on admission at the emergency department. Spearman's Rho was calculated to assess correlation between each prehospital item and its corresponding NIHSS item. Sensitivity and specificity were calculated for each prehospital item with its corresponding NIHSS item as a reference (normal vs. abnormal).

Results: We included 2849 patients (49% female, median age 73 years). Arm and leg motor function correlated strongly with their corresponding NIHSS items, with high sensitivity, but moderately-low specificity(Table1). Answering questions and following commands had moderate sensitivity, but high specificity. Neglect and gaze deviation correlated weakly, with low sensitivity and high specificity, while abnormal speech correlated weakly with high sensitivity and low specificity.

Conclusion: Paramedics can adequately assess most clinical items in a prehospital triage setting. Neglect, abnormal speech and gaze deviation are most difficult to assess, and neglect was missed most frequently. Focused training of paramedics on these items may improve prehospital triage of thrombectomy-eligible patients.

Disclosure: No

O004 / 1149

Scientific Communications 1 - Service Organisation / Quality Improvement

‘DRIVE THE DOCTOR’ FOR ENDOVASCULAR THROMBECTOMY IN A RURAL AREA; A SIMULATION STUDY

W. Maas ^1,2, D.-J. van der Zee³, M. Lahr², E. Buskens^2,3, M. Uyttenboogaart^1,4

¹University Medical Center Groningen, Department of Neurology, Groningen, Netherlands, ²University Medical Center Groningen, Health Technology Assessment, Department of Epidemiology, Groningen, Netherlands, ³University of Groningen, Department of Operations, Faculty of Economics & Business, Groningen, Netherlands, ⁴University Medical Center Groningen, Department of Radiology, Medical Imaging Center, Groningen, Netherlands

Background and aims: 'Drive the doctor' (DD) is an alternative organizational model in which mobile interventionalists (MI’s) are transferred instead of the patient. DD might reduce time to treatment by eliminating interhospital transfer for patients normally routed according to the drip and ship (DS) model. This simulation study aims to estimate potential gain in time and the impact on clinical outcome of DD in a rural region.

Methods: Data from EVT patients in northern Netherlands was prospectively collected in the MR CLEAN Registry. A Monte Carlo simulation model of DS patients served as baseline. To model DD, several design components were taken into account:1) regional spread of thrombectomy capable stroke centers (TSCs), 2) pre-hospital patient routing ‘to the most nearby primary stroke center' or routing based on the RACE scale, 3) MI’s notification moment after LVO confirmation or earlier notification based on the RACE scale, and 4) MI’s transport options including car, ground ambulance or helicopter. Primary outcomes are onset to groin puncture (OTG) and predicted probability of favorable outcome (PPFO) (mRS 0-2) calculated by ordinal regression.

Results: The most optimal and feasible scenario for DD was a combination of 3 TSCs, pre-hospital patient routing based on the RACE scale, MI notification after LVO confirmation and MI’s transport by ground ambulance. OTG would be reduced by 48 minutes and the PPFO would increase by 5.9%.

Conclusions: DD might be a feasible option to implement in the northern Netherland region for acute stroke patients eligible for EVT.

Disclosure: No

O005 / 718

Scientific Communications 1 - Service Organisation / Quality Improvement

SENSITIVITY OF A REGIONAL MODEL OF ACUTE STROKE CARE. STROKE ACTIVATION AND REPERFUSION CEILING IN CATALONIA IN 2019

M. Salvat-Plana ¹, N. Pérez de la Ossa², M. Gallofré³, M. Ayesta³, G. Gallofré⁴, R.M. Vivanco⁵, S. Abilleira⁶, ACICAT-SN Study Group: B. Navarro, M. Molina, E. Gasa, E. Guillamon, L. Queral, P. Margalef, E. Gimeno, H. Barthel, A. Targa, JM. Yepes, J. Muñoz, L. Ortiz, S. Olivet, J. Rodrigo, M. Bagot, C. Casas, A. Cercós, Q. Romero, I. Caballero, N. Clapés, M. Ortega, S. Hidalgo, M. Benítez, M. Prat, C. Munné, A. Gonzalez, R. Baños, I. Fernández, C. Rojo, L. Muñoz, M. Boix, A. Navarro, S. Besalú, L. Palomar, M. Ulloa, G. Perxachs, A. Rios, I. Zamora, G. Dalmases, I. Batuecas, A. Margall, L. Niñerola, H. Oliveira, M. Serrano, E. Pascual, V. Hidalgo, A. Isasi, S. Casanova

¹Catalan Stroke Program, Health Department, Agency for Health Quality and Assessment (AQuAS), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, ²Catalan Stroke Program, Health Department & Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, ³Fundació Ictus, Barcelona, Spain, ⁴Catalan Stroke Program, Health Department, Agency for Health Quality and Assessment (AQuAS), Barcelona, Spain, ⁵Agency for Health Quality and Assessment (AQuAS), Health Department, Barcelona, Spain, ⁶Direcció Assistencial d’Hospitals. Institut Català de la Salut. Departament de Salut, Barcelona, Spain

Aims: To evaluate quality of the Stroke Code (SC) System in Catalonia by quantifying the ceiling effect of SC activations, describing factors associated with lack of SC identification, and estimating loss of reperfusion therapies (RT) opportunities.

Methods: Registry-based study of consecutive stroke patients admitted to the network of acute hospitals of Catalonia during 6 months. SC criteria included acute symptoms suggestive of stroke, prestroke mRS=0-2, within 8h from onset or last known well. Potential candidates for intravenous thrombolysis (IVT) and endovascular treatment (EVT) were estimated according to the criteria: IVT-1: ischemic stroke, prestroke mRS=0-2, onset-arrival<4h; IVT-2: ischemic stroke, prestroke mRS=0-3, onset-arrival<4h; EVT: ischemic stroke, NIHSS>6, prestroke mRS=0-2, onset-arrival<8h. Estimation of SC activation and RT ceiling effect was calculated based on these criteria.

Results: SC was activated in 2246/3822 patients (58%). Among no SC activations, 396 (25%) met SC criteria. Correct SC activations showed higher education level (OR 1.42, IC95%1.11-1.82), and SC missed for activation had more frequently wake-up stroke (OR 0.7, IC95%0.56-0.89), minor stroke (NIHSS<5, OR 0.28, IC95%0.22-0.35) and posterior circulation symptoms (OR 0.7, IC95%0.53-0.92). Identification of all activable SC would have set SC ceiling at 69% of stroke hospitalizations and at 73% if prestroke mRS had been 0-3 (Figure-1). Rate of IVT might have increased from 22.2% to 25.6% (IVT-1) or to 27.5% (IVT-2), and EVT from 16.1% to 23.4% if all SC candidates had been identified (Table-1).

Discussion: Lack of SC activation neglected RT in some stroke patients makingmonitoring of SC system necessary to identify and correct errors.

Disclosure: No

O006 / 504

Scientific Communications 1 - Service Organisation / Quality Improvement

PREHOSPITAL STROKE MIMICS IN THE STOCKHOLM STROKE TRIAGE SYSTEM

M. Sjöö ¹, A. Berglund^1,2, C. Sjöstrand^1,3, E. Eriksson^1,2, M. Mazya^1,2

¹Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden, ²Karolinska University Hospital, Department of Neurology, Stockholm, Sweden, ³Danderyd Hospital, Department of Neurology, Stockholm, Sweden

Background: In 2017, Stockholm implemented a new prehospital Stroke Triage System (SSTS), directing patients with a likely indication for thrombectomy to the regional comprehensive stroke center (CSC), based on symptom severity and teleconsultation with a physician. In Stockholm, 44% of prehospital code-stroke patients are stroke mimics (SM). Inadvertent triage of SM to the CSC could lead to inappropriate resource utilization.

Aims: Compare characteristics and distribution of SM diagnoses between 1) triage positive SM (TP-SM) and stroke (TP-S) and 2) triage negative SM (TN-SM) and stroke (TN-S).

Methods: This prospective observational study collected data during 2017-2018, including 2905 patients with suspected stroke, transported by code-stroke ambulance to a Stockholm Region hospital. Triage positive (TP): directed to CSC. Triage negative (TN): directed to nearest hospital.

Results: TP-SM (n=55) were younger than TN-S (n=268), median 64 [IQR 45-74] vs. 75 [66-82] years; P<0,001, with lower NIHSS, median 7 [3-10] vs. 15 [9-19]; P <0,001. TN-SM (n=1221) were younger than TN-S (n=1361), median 73 [59-83] vs 78 [70-85] years; P<0,001, with lower NIHSS, median 2 [0-6] vs. 4 [2-9]; P<0,001. Functional paralysis was more common in TP-SM than TN-SM, 18/55 (32,7%) vs. 82/1221 (6,7%); P<0,001.

Conclusions: Triage positive and negative SM were younger with less severe symptoms than stroke patients. All TP-SM had a hemiparalysis, yet less severe symptoms versus stroke, albeit more severe than TN-SM triaged to nearest hospital. Over-triage of functional paralysis to the CSC is common. The system correctly triages the vast majority of cases with minor symptoms due to SM.

Disclosure: No

O007 / 1100

Scientific Communications 1 - Service Organisation / Quality Improvement

IMPACT OF ADDITIONAL MOBILE STROKE UNIT DISPATCH ON 3-MONTH FUNCTIONAL OUTCOMES AMONG ALL STROKE AND TIA PATIENTS: RESULTS FROM THE B_PROUD STUDY

J.L. Rohmann ^1,2, M. Piccininni^1,2, M. Ebinger³, M. Wendt⁴, J.E. Weber⁵, E. Schwabauer⁶, F. Geisler⁵, E. Freitag⁵, P. Harmel⁵, I. Lorenz-Meyer⁵, I. Rohrpasser-Napierkowski⁵, C.H. Nolte^1,5,7,8, D.G. Nabavi⁶, I. Schmehl⁴, A. Ekkernkamp⁹, M. Endres^{1,5,7,8,10,11}, H.J. Audebert^1,5

¹Charité - Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany, ²Charité - Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany, ³Medical Park Berlin Humboldtmühle, Klinik für Neurologie, Berlin, Germany, ⁴Unfallkrankenhaus Berlin, Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Berlin, Germany, ⁵Charité - Universtitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany, ⁶Vivantes Klinikum Neukölln, Klinik für Neurologie mit Stroke Unit, Berlin, Germany, ⁷Berlin Institute of Health, Berlin, Germany, ⁸German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany, ⁹Unfallkrankenhaus Berlin, Berlin, Germany, ¹⁰NeuroCure Cluster of Excellence, Berlin, Germany, ¹¹German Center for Neurodegenerative Diseases (DZNE), Partner site Berlin, Berlin, Germany

Background and aims: The Berlin-based B_PROUD study linked mobile stroke unit (MSU) dispatch to better functional outcomes among ischaemic stroke/TIA patients without contraindications to recanalizing therapies. However, possible risks or benefits for patients not eligible for such treatments were not analysed. We aimed to estimate the effect of additional MSU dispatch among the entire stroke/TIA population.

Methods: We used data from B_PROUD (02/2017-05/2019), in which MSUs were dispatched based solely on availability. The primary and coprimary outcomes were the ordinal modified Rankin Scale (mRS) and a 3-tier disability scale at 3-months. Confounders were identified using directed acyclic graphs. We used multiple imputation for missing values and estimated adjusted effects using inverse probability of treatment weighting with corresponding 95% bootstrapped confidence intervals.

Results: MSUs were dispatched to 1,126 eligible stroke/TIA patients (mean age:74y, 46.5% female), while 1,151 had only conventional ambulances dispatched (75y, 49.8% female). After adjustment, MSU dispatch was statistically significantly associated with better 3-month mRS (common OR (cOR)=0.82; 95%CI: 0.70-0.96). No significant association was found with the coprimary outcome (cOR=0.86; 0.72-1.04) or seven-day mortality (OR=1.02; 0.66-1.66). Among patients with cerebral ischaemia (N=2,095), MSU dispatch was associated with better mRS (cOR=0.79; 0.68-0.93) and thrombolysis ⩽60 minutes (OR=4.24; 3.32-5.47). We found no significant association between MSU dispatch and mRS among haemorrhagic stroke patients (N=182; cOR=0.85; 0.51-1.48).

Conclusions: When considering the entire stroke/TIA population, additional dispatch of MSU resulted in better 3-month mRS, without evidence of compromised safety. Our results are relevant since stroke subtype and treatment eligibility are unknown at dispatch.

Disclosure: Yes

O008 / 1303

Scientific Communications 1 - Service Organisation / Quality Improvement

HARMONIZATION OF REGISTRY OF STROKE CARE QUALITY (RES-Q 3.0) DATA COLLECTION FORM FOR MONITORING AND IMPROVING STROKE CARE WORLDWIDE

M. Šrámek¹, R. Sedani ², K. Asif³, S. Martins⁴, S. Middleton⁵, T. Fischer⁶, M. Vařecha², R. Mikulík²

¹Military University Hospital Prague, Prague, Czech Republic, ²St. Anne’s University Hospital Brno, International Clinical Research Center, Brno, Czech Republic, ³University of Illinois, Chicago (UIC), Chicago, United States, ⁴Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ⁵St Vincent’s Hospital Melbourne and Australian Catholic University, Darlinghurst, Australia, ⁶Boehringer Ingelheim International GmbH, Ingelheim/Rhein, Germany

Background and aims: The Registry of Stroke Care Quality (RES-Q) has developed several types of data collection forms since its launch in 2016. Although customized forms address specific needs, they limit cross-country comparability of data. Our aim was to standardize data collection for quality improvement purposes by developing a single form.

Methods: By analyzing feedback received from RES-Q National Coordinators and studying variables included in other national / international registries, RES-Q team along with members from World Stroke Organization, Mission Thrombectomy 2020+, RES-Q Scientific Committee and Quality in Acute Stroke Care and Angels initiative, developed the RES-Q 3.0 version form. The test version of the form was sent to all these stakeholders for final feedback after which it was taken to the development phase.

Results: RES-Q 3.0 version includes all key variables required for improving quality of stroke care at all levels of stroke centers. It captures pragmatic minimal data from pre-admission, diagnosis, treatment, post-acute care, discharge and 3-months follow up. This form will automatically replace all previous form versions. To facilitate harmonization with previously collected data, all records will be pre-processed into a newly developed data model allowing for unified data export and feedback.

Conclusions: A single data collection form will be opened for all countries participating in RES-Q, currently 75 countries in the world, to standardize the quality improvement process, augment accuracy of data collection and enable cross-country comparability of stroke care quality.

Disclosure: No

O009 / 1071

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

INCIDENCE AND OUTCOMES OF CONCORDANCE AND DISCORDANCE ON CT AND CT PERFUSION: A POOLED, PATIENT-LEVEL ANALYSIS OF EXTEND-IA TRIALS AND SELECT

A. Sarraj ^1,2, V. Yogendrakumar³, A.E Hassan⁴, M. Abraham⁵, M. Chen⁶, S. Blackburn⁷, C.W Sitton⁷, S. Ortega-Gutiérrez⁸, N.A Herial⁹, .S. Hussain¹⁰, R.F Budzik¹¹, W.J Hicks¹¹, N. Vora¹¹, T.Y Wu¹², J.P Tsai¹³, T. Kleinig¹⁴, N. Yassi¹⁵, D. Shah¹⁶, H. Dewey¹⁷, V. Thijs¹⁸, F. Ng³, J. Beharry³, D. Pujara², F. Shaker⁷, D. Haussen¹⁹, M.A. Abdulrazzak¹⁰, G. Sharma³, L. Churilov²⁰, M. Ribo²¹, J. Blasco²², J.F Arenillas²³, R. Gupta²⁴, P. Jabbour⁹, P.J Mitchell¹⁵, M. Lansberg²⁵, S. Kasner²⁶, A. Furlan¹, G.A Donnan³, M. Parsons²⁷, J.G Grotta²⁸, S.M Davis³, G.W Albers²⁵, B.CV Campbell³, on behalf of the EXTEND IA, EXTEND-IA TNK and SELECT Investigators

¹Case Western Reserve University, Neurology, Cleveland, United States, ²University Hospitals Cleveland Medical Center, Neurology, Cleveland, United States, ³The Royal Melbourne Hospital, Neurology, Melbourne, Australia, ⁴Valley Baptist Medical Center, Neurology, Harlingen, United States, ⁵University of Kansas Medical Center, Neurology, Kansas City, United States, ⁶Rush University Medical Center, Neurosurgery, Chicago, United States, ⁷University of Texas Health Science Center, Houston, United States, ⁸University of Iowa, Neurology, Iowa City, United States, ⁹Thomas Jefferson University Hospitals, Neurosurgery, Philadelphia, United States, ¹⁰Cleveland Clinic, Cerebrovascular Center, Cleveland, United States, ¹¹OhioHealth - Riverside Methodist Hospital, Columbus, United States, ¹²Christchurch Hospital, Neurology, Christchurch, New Zealand, ¹³Spectrum Health, Neurosurgery, Grand Rapid, United States, ¹⁴Royal Adelaide Hospital, Neurology, Adelaide, Australia, ¹⁵The Royal Melbourne Hospital, Radiology, Melbourne, Australia, ¹⁶Gold Coast Health, Southport, Australia, ¹⁷Monash University Faculty of Medicine, Neurology, Clayton, Australia, ¹⁸Florey Neuroscience Institutes, Parkville, Australia, ¹⁹Emory University, Neurology, Atlanta, United States, ²⁰University of Melbourne, Parkville, Australia, ²¹Hospital Universitario Valle de Hebrón, Neurology, Barcelona, Spain, ²²Hospital Clínic de Barcelona, Barcelona, Spain, ²³Hospital Clínico Universitario de Valladolid, Neurology, Valladolid, Spain, ²⁴Wellstar Health System, Neurology, Marietta, United States, ²⁵Stanford University, Neurology, Stanford, United States, ²⁶University of Pennsylvania, Neurology, Philadelphia, United States, ²⁷Liverpool Hospital - South Western Sydney Clinical School, Neurology, Liverpool, Australia, ²⁸Memorial Hermann Hospital at Texas Medical Center, Neurology, Houston, United States

Background and aims: Estimates of ischemic injury extent and EVT-eligibility may differ between non-contrast CT(NCCT) and CT-perfusion(CTP) imaging. We examined the incidence of discordant imaging profiles, association with time-to-presentation and EVT clinical outcomes.

Methods: From a pooled, patient-level cohort (EXTEND-IA, EXTEND-IA TNK part I/II trials and SELECT prospective cohort), favorable imaging profiles on NCCT(ASPECTS⩾6) and CTP(Ischemic core<50mL) were defined. Associations between imaging profiles, time variables and clinical outcomes were evaluated using trend analysis and between-group comparisons.

Results: Of 885 eligible patients, 684 received EVT; 553/684(81%) demonstrated concordant favorable NCCT/CTP, 28(4%) had unfavorable NCCT/favorable CTP, 80(12%) had favorable NCCT/unfavorable CTP, 23(3%) had concordant unfavorable NCCT/CTP. Favorable NCCT/unfavorable CTP was more frequent <180min after stroke onset(Figure1). Day 90 functional independence occurred in 60% with favorable NCCT/favorable CTP, 54% with unfavorable NCCT/favorable CTP(aOR=0.80, 95%CI: 0.33-1.93,p=0.61 vs concordant favorable), 33% favorable NCCT/unfavorable CTP (aOR=0.33, 95%CI: 0.18-0.60, p<0.001 vs concordant favorable ), and 26% unfavorable NCCT/CTP(aOR=0.29, 95%CI: 0.11-0.80, p=0.017 vs concordant favorable), p-for-trend<0.001. Mortality (p-for-trend<0.001) and symptomatic ICH (p-for-trend=0.004) increased across these categories(Figure2).

Conclusions: Most patients selected for EVT have concordant favorable profiles and high functional independence rates. Early ischemic changes were more likely to be captured on CTP in the first 3 hours. Of the 16% with discordant imaging profiles, functional and safety outcomes in the unfavorable NCCT/favorable CTP did not differ significantly from the concordant favorable group, and were better than those with favorable NCCT/unfavorable CTP, in whom outcomes did not differ significantly from patients with concordant unfavorable profiles.

Disclosure: Yes

O010 / 1041

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

EFFECT OF SUCCESSFUL REPERFUSION IS INDEPENDENT OF CT-PERFUSION ISCHEMIC CORE VOLUME BUT IS MODIFIED BY MISMATCH VOLUME AND MEDIATED THROUGH REDUCED INFARCT GROWTH FROM BASELINE

A. Sarraj ^1,2, D. Pujara², A.E Hassan³, M. Abraham⁴, M. Chen⁵, S. Blackburn⁶, C.W Sitton⁶, S. Ortega-Gutiérrez⁷, N.A Herial⁸, .S. Hussain⁹, R.F Budzik¹⁰, W.J Hicks¹⁰, N. Vora¹⁰, T.Y Wu¹¹, J.P Tsai¹², T. Kleinig¹³, N. Yassi¹⁴, D. Shah¹⁵, H. Dewey¹⁶, V. Thijs¹⁷, F. Ng¹⁴, V. Yogendrakumar¹⁴, F. Shaker⁶, D. Haussen¹⁸, M.A. Abdulrazzak⁹, G. Sharma¹⁴, L. Churilov¹⁹, M. Ribo²⁰, J. Blasco²¹, J.F. Arenillas²², R. Gupta²³, P. Jabbour⁸, P.J Mitchell²⁴, M. Lansberg²⁵, S. Kasner²⁶, A. Furlan¹, G.A Donnan¹⁴, M. Parsons²⁷, J.G Grotta²⁸, S.M Davis¹⁴, G.W Albers²⁵, B.CV Campbell¹⁴, on behalf of EXTEND IA, EXTEND-IA TNK and SELECT Investigators

¹Case Western Reserve University, Neurology, Cleveland, United States, ²University Hospitals Cleveland Medical Center, Neurology, Cleveland, United States, ³Valley Baptist Medical Center, Neurology, Harlingen, United States, ⁴University of Kansas Medical Center, Neurology, Kansas City, United States, ⁵Rush University Medical Center, Neurosurgery, Chicago, United States, ⁶University of Texas Health Science Center, Houston, United States, ⁷University of Iowa, Neurology, Iowa City, United States, ⁸Thomas Jefferson University Hospitals, Neurosurgery, Philadelphia, United States, ⁹Cleveland Clinic, Cerebrovascular Center, Cleveland, United States, ¹⁰OhioHealth - Riverside Methodist Hospital, Columbus, United States, ¹¹Christchurch Hospital, Neurology, Christchurch, New Zealand, ¹²Spectrum Health, Neurosurgery, Grand Rapid, United States, ¹³Royal Adelaide Hospital, Neurology, Adelaide, Australia, ¹⁴The Royal Melbourne Hospital, Neurology, Melbourne, Australia, ¹⁵Gold Coast Health, Southport, Australia, ¹⁶Monash University Faculty of Medicine, Neurology, Clayton, Australia, ¹⁷Florey Neuroscience Institutes, Parkville, Australia, ¹⁸Emory University, Neurology, Atlanta, United States, ¹⁹University of Melbourne, Parkville, Australia, ²⁰Hospital Universitario Valle de Hebrón, Neurology, Barcelona, Spain, ²¹Hospital Clínic de Barcelona, Barcelona, Spain, ²²Hospital Clínico Universitario de Valladolid, Neurology, Valladolid, Spain, ²³Wellstar Health System, Neurology, Marietta, United States, ²⁴The Royal Melbourne Hospital, Radiology, Melbourne, Australia, ²⁵Stanford University, Neurology, Stanford, United States, ²⁶University of Pennsylvania, Neurology, Philadelphia, United States, ²⁷Liverpool Hospital - South Western Sydney Clinical School, Neurology, Liverpool, Australia, ²⁸Memorial Hermann Hospital at Texas Medical Center, Neurology, Houston, United States

Background and aims: The influence of baseline ischemic core or penumbra volumes on endovascular thrombectomy(EVT) effect is uncertain. We evaluated EVT-related reperfusion effect interaction with ischemic core and penumbra volumes and the potential mediation of reperfusion effect through infarct growth.

Methods: In a pooled, patient-level cohort (EXTEND-IA,EXTEND-IA TNK part I/II trials and SELECT prospective cohort), RAPID software estimated CT-perfusion ischemic core(</⩾50mL) and penumbra. The interaction between reperfusion effect and core/penumbra volumes and potential mediation of reperfusion effect through infarct growth (24h follow-up infarct − pre-treatment CT-perfusion ischemic core volume) were examined.

Results: Successful reperfusion(mTICI 2b-3) occurred in 570/678(84%) EVT-treated patients. Functional independence(mRS=0-2) decreased, and mortality and symptomatic ICH rates increased with ischemic core⩾50mL(Figure1). However, reperfusion benefit persisted(ischemic core<50mL: adj-cOR=4.07, 95%CI=2.42-6.83, p<0.001, ischemic core⩾50mL: adj-cOR=4.87, 95%CI=1.11-21.38, p=0.036, p_interaction=0.69). Mismatch volume was not associated with functional independence, but interacted significantly with reperfusion status(p_interaction=0.043).

Successful reperfusion(aOR=2.48, 95%CI=1.50-4.10, p<0.001) was associated with functional independence but became insignificant after including infarct growth(aOR=1.19, 95%CI=0.66-2.16, p=0.56). Infarct growth was independently associated with functional independence(aOR=0.98, 95%CI=0.97-0.98, p<0.001 per mL infarct growth). In mediation analysis, successful reperfusion was associated with 20% total effect on functional independence with infarct growth associated with 17% average causal mediation effect, suggesting 86% of reperfusion benefit was mediated through limiting infarct growth.

Conclusions: Successful reperfusion was associated with better functional outcomes in patients with small and large ischemic core without evidence of effect modification by core size, but was modified by mismatch volume. Reperfusion benefit was predominantly mediated by reduced infarct growth.

Disclosure: Yes

O011 / 607

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

PERSISTENT TISSUE-LEVEL HYPOPERFUSION DESPITE SUCCESSFUL ANGIOGRAPHIC REPERFUSION (NO-REFLOW) NEGATES THE CLINICAL BENEFIT OF THROMBECTOMY ON FUNCTIONAL OUTCOME

F.C. Ng ^1,2, L. Churilov³, N. Yassi⁴, T. Kleinig⁵, V. Thijs²,T. Wu⁶, D. Shah⁷, H. Dewey⁸, P. Desmond⁴, M. Parsons⁹,G. Donnan¹, S. Davis¹, P. Mitchell¹, B. Campbell¹

¹Royal Melbourne Hospital, Department of Neurology, Melbourne, Australia, ²Austin Hospital, Melbourne, Australia, ³University of Melbourne, Melbourne, Australia, ⁴Royal Melbourne Hospital, Melbourne, Australia, ⁵Royal Adelaide Hospital, Adelaide, Australia, ⁶Christchurch Hospital, Christchurch, New Zealand, ⁷Princess Alexandra Hospital, Brisbane, Australia, ⁸Eastern Health, Melbourne, Australia, ⁹University of New South Wales, Sydney, Australia

Background/aims: Tissue-level hypoperfusion persists in 25% of patients with seemingly successful upstream macrovascular angiographic reperfusion at thrombectomy. We investigated the clinical impact of this no-reflow phenomenon by comparing patients with no-reflow versus patients with varying degrees of angiographic success.

Methods: In a pooled analysis of the EXTEND-IA, EXTEND-IA TNK part 1&2 trials, clinical and radiological outcomes were compared between patients with (1) persistent tissue hypoperfusion despite successful thrombectomy, defined as >15% reduction in rCBF or rCBV within the infarct vs contralateral normal brain on 24h-follow-up perfusion-CT/MRI after eTICI 2c-3 angiographic result “eTICI:2c-3 with no-reflow”, (2) eTICI:2c-3 without no-reflow, (3) partial reperfusion “eTICI:2b”, and (4) failed thrombectomy “eTICI:0-2a”.

Results: Among 465 patients, a favorable outcome (3-month mRS 0-2) was observed in 42.4% (n=19/33) of patients with eTICI:2c-3 with no-reflow, 64.4% (n=92/143) of eTICI:2c-3 without no-reflow, 61.5% (n=163/265) of eTICI:2b and 43.5% (n=37/85) of eTICI:0-2a. In multivariable analysis, patients with eTICI:2c-3 with no-reflow had a lower likelihood of favorable outcome compared to those with eTICI:2c-3 without no-reflow (logistic regression aOR=0.31,p=0.016) and eTICI:2b (aOR=0.40,p=0.043), but not eTICI:0-2a (aOR=1.80,p=0.556). Patients with eTICI:2c-3 with no-reflow had similar follow-up infarct volume to eTICI:2c-3 without no-reflow (median regression ß=7.63,p=0.134) and eTICI:2b (ß=3.77,p=0.435), but had smaller infarcts compared to eTICI:0-2a (ß=-13.42,p=0.015).

Conclusions: When no-reflow developed, patients with complete angiographic reperfusion had worse clinical outcome than patients with partial reperfusion, and had similar outcomes with failed thrombectomy, despite achieving apparent angiographic success. The poor clinical outcomes in patients with no-reflow occurred despite reductions in infarct volume.

Disclosure: No

O012 / 1396

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

HEMATOLOGICAL VARIABLES ASSOCIATED WITH DEGREE OF REPERFUSION AFTER INTRA-ARTERIAL THROMBECTOMY DIFFER BETWEEN MEN AND WOMEN

L.M. Overmars ¹, A.D. Uittenboogaard², W.W. Van Solinge¹, L.E. Exalto², S. Haitjema¹

¹University Medical Center Utrecht, Central Diagnostic Laboratory, Utrecht, Netherlands, ²University Medical Center Utrecht, Department of Neurology, Utrecht, Netherlands

Background and aims: The etiology of ischemic stroke likely affects the degree of reperfusion after intra-arterial thrombectomy (IAT). Women more often have cardioembolic stroke, while men more often have atherosclerotic stroke. We aimed to explore differences in hematological variables between men and women associated with degree of reperfusion after IAT that may point to underlying mechanisms.

Methods: We conducted an electronic health record study among patients who underwent IAT at the UMC Utrecht between 2016 and 2020. Radiology reports of IAT procedures and complete full blood counts prior to the IAT, including 75 research-only parameters from blood cell analyzers, were extracted from the Utrecht Patient Oriented Database. Patients were divided into complete reperfusion (TICI 3), partial perfusion (TICI 2a, 2b, 2c), and no/minimal perfusion (TICI 0, 1). We used the Boruta algorithm to identify relevant hematological variables related to degree of reperfusion, which iteratively compares importances of original variables with importances of their shuffled replicates in multiple random forests.

Results: In 283 patients, 43% female, mean age 69 (SD 15), we found no significant sex differences in IAT-success (Figure 1). We identified associations between erythrocyte fluorescence, neutrophil complexity, and monocyte percentage, and the degree of reperfusion (Figure 2). After sex-stratification, monocyte percentage and neutrophil size were associated with degree of reperfusion in men and women respectively (Figure 3),

Conclusions: Although IAT-success rates did not differ between men and women, we identified indications of sex differences in hematological variables that may play a role in the biological mechanisms of IAT success.

Disclosure: No

O013 / 100

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

EFFICACY AND SAFETY OUTCOMES OF MECHANICAL THROMBECTOMY FOR MEDIUM VESSEL OCCLUSION

T. Yoshimoto ¹, K. Tanaka², J. Koge³, M. Shiozawa³, N. Kamogawa³, T. Ohta⁴, T. Satow⁴, M. Inoue^2,3, H. Kataoka⁴, M. Koga³, M. Ihara¹, K. Toyoda³

¹National Cerebral and Cardiovascular Center, Department of Neurology, Suita, Japan, ²National Cerebral and Cardiovascular Center, Division of Stroke Care Unit, Suita, Japan, ³National Cerebral and Cardiovascular Center, Department of Cerebrovascular Medicine, Suita, Japan, ⁴National Cerebral and Cardiovascular Center, Department of Neurosurgery, Suita, Japan

Background: We aim to investigate the efficacy and safety of mechanical thrombectomy (MT) for medium vessel occlusion (MeVO).

Methods: Of the consecutive acute ischemic stroke (AIS) patients admitted to our institute from 2010 to 2021, AIS patients due to MeVO (middle cerebral artery [MCA] M2, M3, anterior cerebral artery A2/A3, or posterior cerebral artery P2/P3 occlusion) within 24 hours of onset were enrolled. Outcomes including the favorable outcome (3-month modified Rankin Scale score of 0–2), symptomatic intracerebral hemorrhage (SICH), and mortality at 3-month were assessed between patients receiving MT and standard medical treatment (SMT).

Results: Of 428 patients (70 women; median age, 78 years; median NIH Stroke Scale score [NIHSS] 15), 347 (81%) patients had MCA M2 occlusion. Patients who received MT (n=105) have a higher median NIHSS score (14 vs. 8, P<0.01), and more intravenous thrombolysis (53.3% vs. 38.7%, P<0.01) than those received SMT (n=323). There were no significant differences in the favorable outcome (52.4% vs. 52.9%, P=1.00) and SICH (3.8% vs. 3.0%, P=1.00) between both groups, but mortality at 3-month (10.5% vs. 2.5%, P<0.01) were more frequent in patients received MT than those received SMT. In patients with NIHSS score ⩾10, favorable outcome was more frequent in patients received MT than those received SMT (adjusted odds ratio [aOR] 2.07, 95% confidence interval [CI] 1.15–3.76), but not in those with NIHSS score <10 (aOR 0.75, 95% CI 0.35–1.62; P for interaction = 0.04).

Conclusions: MT may be more effective than SMT for a part of MeVO.

Disclosure: No

O014 / 1519

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

NATIONAL TRENDS OVER TIME IN PATIENT COMPLEXITY, INTERVENTIONAL TECHNIQUES AND OUTCOMES OF ENDOVASCULAR TREATMENT FOR ACUTE ISCHEMIC STROKE: THE COMPLETED MR CLEAN REGISTRY

W.H Hinsenveld ¹, J. Brouwer², S.J den Hartog³, A. Bruggeman⁴, H.F Lingsma⁵, Y.BWEM Roos², C.BLM Majoie⁶, D.WJ Dippel³, A. van der Lugt⁷, W.H van Zwam⁸, R.J van Oostenbrugge¹, MR CLEAN Registry Investigators

¹Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Neurology, Maastricht, Netherlands, ²Amsterdam University Medical Centers, Neurology, Amsterdam, Netherlands, ³Erasmus University Medical Center, Neurology, Rotterdam, Netherlands, ⁴Amsterdam University Medical Centers, Radiology, Amsterdam, Netherlands, ⁵Erasmus University Medical Center, Public Health, Rotterdam, Netherlands, ⁶Amsterdam University Medical Centers, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁷Erasmus University Medical Center, Radiology, Rotterdam, Netherlands, ⁸Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Radiology, Maastricht, Netherlands

Background and aims: Since the start of the implementation of endovascular treatment (EVT) for stroke in 2015, many changes in workflow and EVT procedures have been introduced and EVT accessibility has been expanded. We aimed to describe trends in patient complexity, EVT procedures and outcomes.

Methods: We analyzed data of the MR CLEAN Registry (2014-2018) including all EVT treated patients in the Netherlands. We described and analyzed trends in patient characteristics over time. ‘Patient complexity’ was summarized as the pre-treatment probability of good outcome based on a validated prediction model. Primary outcome was the modified Rankin Scale (mRS) at 90 days. Secondary outcomes were workflow times, EVT techniques, successful reperfusion (eTICI⩾2b) and complication rates. Time trends were analyzed with multivariable regression models and expressed as adjusted common odds ratios (acOR).

Results: We included 5193 patients. Between 2014 and 2018 the median age increased from 66 to 74 (p<0.001) and pre-stroke dependency increased from 9% to 16% (p<0.001). Patients became more complex; pre-treatment probability of good functional outcome decreased from 40% to 34% (p=0.063). Outcomes improved over time (mRS acOR 1.14, 95%CI:1.09-1.20). The use of local anesthesia increased (aOR 1.15, 95%CI:1.10-1.22) as did use of aspiration techniques (aOR 1.43, 95%CI:1.35-1.53) while the number of reperfusion attempts decreased (aOR 0.93, 95%CI:0.89-0.98). Successful reperfusion increased (aOR 1.32, 95%CI:1.25-1.40). Complications rates did not differ.

Conclusions: Despite treatment of more complex patients, shorter treatment times combined with improved optimization of EVT techniques and low complication rates can result in better functional outcomes after EVT.

Disclosure: No

O015 / 210

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

INCIDENCE AND PREDICTORS OF DELAYED FUNCTIONAL INDEPENDENCE IN THE TREVO RETRIEVER REGISTRY

A. Jadhav¹, S. Desai ², R. Gupta³, B. Baxter⁴, B. Bartolini⁵, A. Krajina⁶, J. English⁷, D. Liebeskind⁸, R. Nogueira⁹, E. Veznedaroglu¹⁰, R. Budzik¹¹

¹Barrow Neurological Institute, Neurosurgery, Phoenix, United States, ²HonorHealth Research Institute, Neurology, Scottsdale, United States, ³Wellstar Hospital, Neurology, Atlanta, United States, ⁴Erlanger Medical Center, Chattanooga, United States, ⁵Lausanne University Hospital, Lausanne, Switzerland, ⁶Charles University Hospital, Radiology, Hradec Kralove, Czech Republic, ⁷California Pacific Medical Center, San Francisco, United States, ⁸University of California Los Angeles, Los Angeles, United States, ⁹Emory University, Neurology, Atlanta, United States, ¹⁰Drexel University, Philadelphia, United States, ¹¹Riverside Methodist Hospital, Columbus, United States

Background: Chronological heterogeneity in the neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is commonly observed in clinical practice. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation. We aim to determine the incidence of early and delayed functional independence and identify associated predictors after EVT.

Methods: Demographic, clinical, radiological, treatment, and procedural information were analyzed from TREVO registry (patients undergoing EVT in the setting of anterior circulation LVO using the Trevo stent-retriever). Incidence and predictors of early functional independence (EFI, modified Rankin Scale (mRS) score 0–2 at discharge) and delayed functional independence (DFI, mRS score 0–2 at 90 days in non-EFI patients) were analyzed.

Results: A total of 1757 patients met study criteria. EFI was observed in 45% (785) of patients. Among non-EFI patients (972), DFI was observed in 34% (332) of patients. Younger age (p<0.001), lower blood glucose (p<0.001), mTICI<=2B (p=0.01), and lower total number of thrombectomy passes (p=0.004) were independent predictors of DFI.

Conclusion: Approximately 45% of patients experience early functional independence. One-third of non-early improvers experience delayed functional independence. Younger age, lower blood glucose, better collateral grade, and lower total number of passes were independent predictors of DFI among non-early improvers. Further studies are required to improve our understanding of DFI.

Disclosure: No

O016 / 1613

Scientific Communications 2 - Neurointervention – Imaging and Reperfusion

COMPARISON OF OPERATOR TECHNIQUES FOR MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE – INSIGHTS FROM THE ASSIST REGISTRY

R. Gupta ¹, S. Miralbés², M. Viles², Á. Calleja², B. Naravetla³, A. Majjhoo³, M. Rayes³, A. Spiotta⁴, C. Loehr⁵, M. Martínez-Galdámez⁶, R. McTaggart⁷, L. Defreyne⁸, P. Vega⁹, O.O. Zaidat¹⁰, D.S. Liebeskind¹¹, A. Rai¹², A. Krajina¹³, M.-N. Psychogios¹⁴, T. Krings¹⁵, W. Yoon¹⁶, A. Sarraj¹⁷, A. Puri¹⁸, M. Möhlenbruch¹⁹

¹WellStar Health System, Department of Neurology, Marietta, United States, ²Hospital Son Espases, Mallorca, Spain, ³McLaren Regional Medical Center, Flint, United States, ⁴Medical University of South Carolina, Charleston, United States, ⁵Klinikum Vest Recklinghausen, Recklinghausen, Germany, ⁶Hospital Clínico Universitario de Valladolid, Valladolid, Spain, ⁷Rhode Island Hospital, Providence, United States, ⁸Ghent University Hospital, Gent, Belgium, ⁹Hospital Universitario Central de Asturias-HUCA, Oviedo, Spain, ¹⁰Bon Secours Mercy Health St. Vincent Medical Center, Neuroscience Department, Toledo, United States, ¹¹David Geffen School of Medicine, University of California, Los Angeles, Department of Neurology and Comprehensive Stroke Center, Los Angeles, United States, ¹²West Virginia University Hospital, Morgantown, United States, ¹³Charles University Hospital, Hradec Kralove, Czech Republic, ¹⁴University Hospital Basel, Basel, Switzerland, ¹⁵Toronto Western Hospital, Toronto, Canada, ¹⁶Chonnam National University Hospital, Gwangju, Korea, Republic of, ¹⁷University Hospital Cleveland Medical Center, Cleveland, United States, ¹⁸University of Massachusetts Medical School, Worcester, United States, ¹⁹Heidelberg University Hospital, Heidelberg, Germany

Background and aims: The ASSIST registry aimed to evaluate clinical and procedural outcomes associated with various operator techniques for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).

Methods: ASSIST is a prospective, global registry of AIS patients with LVO in anterior circulation undergoing treatment with neurointerventional techniques using Stryker Neurovascular devices for the first pass. The patients were grouped in three cohorts: Stent Retriever (SR) Classic [SR + Balloon Guide Catheter (BGC)], SR Combination [SR + Aspiration Catheter (AC) ± Pump + BGC or Long Sheath (LS)] and Direct Aspiration (AC ± Pump + BGC or LS), based on the MT technique. The primary procedural and clinical outcome measure was eTICI ⩾2c (Thrombolysis in Cerebral Infarction) on first pass and good functional outcome (modified Rankin Scale (mRS) 0-2) at 90 days, respectively. The secondary efficacy outcome measures included excellent functional outcomes (90-day mRS ⩽1) and an “early response” at Discharge/Day 5-7 (NIH Stroke Scale (NIHSS) drop of ⩾10 points from baseline or NIHSS score of ⩽1).

Results: Between January 2019 and January 2022 there were 1500 patients [SR Classic (N=250); SR Combination (N=697); Direct Aspiration (N=553)] across 72 sites. Procedural, clinical and safety outcomes will be presented for the 3 techniques.

Conclusions: ASSIST would provide the real-world data on the MT techniques with valuable insights on immediate reperfusion and the long term functional and quality of life outcomes for AIS patients worldwide.

ClinicalTrials.gov ID: NCT03845491

Disclosure: Yes

O017 / 1021

Scientific Communications 3 - Rehab and Recovery

A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF NON-CONVENTIONAL THERAPIES FOR IMPROVING UPPER EXTREMITY MOTOR IMPAIRMENT POST STROKE

M. Saikaley ¹, G. Pauli¹, J. Rodriguez Serra¹, H. Sun¹, J. Iruthayarajah¹, R. Teasell^1,2,3

¹Lawson Health Research Institute, Parkwood Institute Research, London, Canada, ²St. Joseph's Health Care London, Parkwood Institute, London, Canada, ³Western University, Schulich School of Medicine and Dentistry, London, Canada

Background and aims: To present a systematic review and network meta-analysis of the ‘non-conventional’ interventions to improve upper extremity (UE) motor impairment after stroke.

Methods: A literature search was conducted in 5 databases from inception until April 1^st, 2021. RCTs were eligible if: Written in English; 50% or more stroke patients; at least 18 years old; applied interventions for the UE, and/or reported the Fugl-Meyer upper extremity scale (FMUE) as an outcome measure; the intervention had at least 3 RCTs with comparisons against dose-matched ‘conventional care’ groups. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A Bayesian approach was taken to estimate the mean difference (MD) and 95% confidence intervals (95%CI) on the FMUE.

Results: 169 RCTs containing 6,750 participants were included. 20 non-conventional interventions were compared (Figure 1), 11 were significantly better than conventional care as determined by the 95%CI (Figure 2). Modified constraint-induced movement therapy (MD 6.7, 95%CI 4.3-8.9), high-frequency repetitive transcranial magnetic stimulation (MD 5.4, 95%CI 1.9-8.9), mental imagery (MD 5.4, 95%CI 1.8-8.9), bilateral arm training (MD 5.2, 95%CI 2.2-8.1) and intermittent theta-burst stimulation (MD 5.1, 95%CI 0.62-9.5) occupied the top 5 spots according to the surface under the cumulative ranking curve. Meta-regression found no significant influence of sex, laterality, stroke type, age, days post-stroke, baseline FMUE or number of therapeutic sessions.

Conclusions: This analysis highlights where future trial efforts and grant resources could be directed. Further, it guides clinicians in their use of alternative therapeutic interventions.

Figure 1. Figure 2.

Disclosure: No

O018 / 279

Scientific Communications 3 - Rehab and Recovery

COMPUTATIONAL ASSESSMENT OF HAND MOTOR SKILLS IN STROKE PATIENTS

D. López¹, L. Casado², Á. Gutiérrez³, B. Fuentes², R. Sendra-Arranz³, J. Rodríguez-Pardo², R. Rigual², G. Ruiz-Ares², E. de Celis², D. Hernández⁴, E. Abdel-Mutti⁴, E. Díez-Tejedor², M. Alonso de Leciñana ²

¹Hospital La Paz Institute for Health Research (IdiPAZ), Neurology, Stroke Center, University Hospital La Paz, Madrid, Spain, ²Hospital La Paz Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Neurology, Stroke Center, University Hospital La Paz, Madrid, Spain, ³ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain, ⁴Hospital La Paz Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Rehabilitation, University Hospital La Paz, Madrid, Spain

Background and aims: Deficits affecting hand motor skills negatively impact in the functionality and quality of life of stroke patients. In practice, these deficits are assessed with clinical scales that are not sufficiently accurate. It is therefore necessary to develop tools that allow to set an objective assessment to better establish the degree of disability.

Methods: A software application was developed to obtain kinematic data from hand movement tracking by a portable device with two cameras and three infrared sensors (leap motion ®). Four exercises were chosen for analysis:

• (1) wrist flexion-extension

• (2) finger-grip opening-closing

• (3) finger spread

• (4) fist opening-closing.

A validation study comparing data from patients with mild to moderate hand motor deficit was done. Correlations with the FMA-UE (hand items) score were analysed.

Results: Eighty stroke patients and ninety-three controls were recruited. The software allowed identification of significant differences in motor performance between patients’ symptomatic hand and controls and also between patients’ theoretically unaffected side and controls (p< 0,05). Even patients with the maximum score on the FMA-UE scale showed significant differences with controls in certain exercises. Moreover, correlations between kinematic data and FMA-UE score were poor (Pearson’s correlation coefficient: 0,15 to 0,35), which suggests that the application enables measurement of deficits that are not detected by the clinical scales.

Conclusions: A new software for kinematic analysis using optical technology provides a useful tool to objectify hand deficits after a stroke. It may aid in the accurate assessment of disability and in optimization of rehabilitation therapies.

Disclosure: No

O019 / 464

Scientific Communications 3 - Rehab and Recovery

TRUNK CONTROL TEST AS A POTENTIAL PREDICTOR OF STROKE REHABILITATION OUTCOME, ASSESSED BY THE MODIFIED BARTHEL INDEX: RESULTS OF A RETROSPECTIVE ANALYSIS

A. Sodero ^1,2, L. Pellicciari¹, B. Basagni¹, A. Paperini¹, S. Campagnini^1,3, B. Hakiki¹, C. Castagnoli¹, I. Hochleitner¹, L. Avila⁴, M. Barilli¹, L. Landucci Pellegrini¹, E. Romano¹, S. Pancani¹, A. Mannini^1,3, F. Sensoli¹, C. Macchi^1,5, M.C. Carrozza¹, F. Cecchi^1,5, on behalf of the PROMISE@LAB Study Group

¹IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy, ²University of Florence, NEUROFARBA, Florence, Italy, ³Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy, ⁴Fondazione Don Carlo Gnocchi, Marina di Massa, Italy, ⁵University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy

Background: Trunk control plays a crucial role in stroke rehabilitation; the Trunk Control Test (TCT), measured at admission to intensive post-stroke rehabilitation has been reported as a predictor of several discharge functional outcomes. However, although modified Barthel Index (mBI) is one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes, the predictive value of TCT on modified Barthel Index (mBI) has not yet been investigated.

Aims: To verify whether TCT, collected upon admission to intensive inpatient post-stroke rehabilitation, and combined with other variables, potentially affecting rehabilitation outcomes, is independently associated with functional outcome at discharge, measured by mBI.

Methods: Retrospective analysis of data consecutively collected on stroke patients admitted to two intensive inpatient rehabilitation. The primary outcome was mBI at discharge.

Results: 278 post-stroke patients were included. All variables collected to admission and significantly associated with mBI at discharge in the univariate analysis (i.e., TCT, mBI, pre-stroke modified Rankin Scale, mRS, aetiology, gender, age, ambulation, cognitive status, communication ability, Cumulative Illness Rating Scale, bladder catheter, and bedsores) were entered in the multivariate analysis. Three variables independently influencing functional recovery were identified: TCT, mBI, and premorbid disability (mRS) (p<0.001); the model explained 59% of the outcome variance (adjusted R²).

Conclusions: TCT, mBI, and pre-stroke mRS, collected at admission to post-acute intensive inpatient stroke rehabilitation, independently predict mBI at discharge. While TCT is confirmed as a potential predictor of stroke rehabilitation outcome, other variables collected at admission could possibly improve the prediction of stroke rehabilitation global functional outcome.

Disclosure: No

O020 / 758

Scientific Communications 3 - Rehab and Recovery

LONG-TERM PROSPECTIVE MULTI-FACETED FUNCTIONAL RECOVERY IN THE FIRST-EVER STROKE SURVIVORS: THE KOSCO STUDY

S. Shin ¹, Y.-S. Lee¹, W.H. Chang¹, M.K. Sohn², J. Lee³, D.Y. Kim⁴, Y.-I. Shin⁵, G.-J. Oh⁶, Y.-S. Lee⁷, M.C. Joo⁸, S.Y. Lee⁹, M.-K. Song¹⁰, J. Han¹¹, J. Ahn¹², Y.-H. Lee⁷, S.M. Choi¹³, S.K. Lee¹³, Y.-H. Kim^1,14

¹Samsung Medical Center, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Seoul, Korea, Republic of, ²College of Medicine, Chungnam National University, Department of Rehabilitation Medicine, Chungnam, Korea, Republic of, ³Konkuk University School of Medicine, Department of Rehabilitation Medicine, Seoul, Korea, Republic of, ⁴Yonsei University College of Medicine, Department and Research Institute of Rehabilitation Medicine, Seoul, Korea, Republic of, ⁵Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Korea, Republic of, ⁶Wonkwang University, School of Medicine, Department of Preventive Medicine, Iksan, Korea, Republic of, ⁷Kyungpook National University School of Medicine, Department of Rehabilitation Medicine, Daegu, Korea, Republic of, ⁸Wonkwang University, School of Medicine, Department of Rehabilitation Medicine, Iksan, Korea, Republic of, ⁹Jeju National University Hospital, Department of Rehabilitation Medicine, Jeju, Korea, Republic of, ¹⁰Chonnam National University Medical School, Department of Physical and Rehabilitation Medicine, Gwang-ju, Korea, Republic of, ¹¹Hallym University, Department of Statistics, Gang-won, Korea, Republic of, ¹²Ewha Womans University, Department of Health Convergence, Seoul, Korea, Republic of, ¹³Korea Disease Control and Prevention Agency, Division of Chronic Disease Prevention, Cheongju, Korea, Republic of, ¹⁴Sungkyunkwan University, Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Suwon, Korea, Republic of

Background and aims: Improving functional outcome and reducing residual disability are important goals for acute as well as chronic care of the stroke patients. The purpose of this study was to determine the long-term changes of functional status in first-ever stroke patients in Korea.

Methods: This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation designed for 10 years of follow-up of first-ever stroke patients. Out of 10,636 patients screened, 7,858 patients agreed for long-term follow up. Among them, 4,443 patients completed face-to-face functional assessments 10 times from 7 days to 5 years after stroke onset and included for this analysis. We analyzed recovery patterns of six functional domains such as motor, cognition, language, swallowing, and mobility functions and independency in activities of daily living for 5 years after stroke onset. Then, generalized estimating equations (GEE) analysis was done for subgroups according to age, gender, stroke type, and initial stroke severity, respectively.

Results: Overall, functional levels reached to plateau at 12 or 18 months after stroke onset and then slightly declined after 36 months after onset. The GEE analysis showed significant difference in functional recovery pattern between subgroups except gender.

Conclusions: Stroke produces long-term residual disabilities in diverse aspects of human functions. The functional recovery patterns were different according to age, stroke type, and initial stroke severity.

Acknowledgements: Supported by a grant from the Korea Centers for Disease Control and Prevention (2019E-320201) and the National Research Foundation of Korea, funded by the Korean government (NRF-2020R1A2C3010304).

Disclosure: No

O021 / 876

Scientific Communications 3 - Rehab and Recovery

EFFECTIVENESS OF INTERVENTIONS TO SUPPORT THE TRANSITION HOME AFTER ACUTE STROKE: SYSTEMATIC REVIEW AND META-ANALYSIS

G. O’Callaghan ¹, M. Fahy², P. Murphy³, P. Langhorne⁴, R. Galvin⁵, F. Horgan¹

¹Royal College of Surgeons in Ireland, RCSI School of Physiotherapy, Dublin, Ireland, ²Royal College of Surgeons in Ireland, Division of Population Health Sciences, Dublin, Ireland, ³Royal College of Surgeons in Ireland, RCSI Library, Dublin, Ireland, ⁴University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom, ⁵University of Limerick, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, Limerick, Ireland

Background: There are considerable gaps about effective support interventions to manage the transition to home after stroke.

Aim: This systematic review looked at the effectiveness of support interventions at transition from structured stroke services to independent living at home.

Methods: Cochrane Central Register of Controlled Trials, and six databases including MEDLINE and Embase were searched up to June 2021; and extended to trial registries, grey literature, and Google Scholar.

Randomised controlled trials recruiting stroke patients to receive either usual care or any support intervention, were included.

Two authors determined eligibility and extracted data. We performed meta-analyses where possible; and assessed risk of bias (ROB2 tool); and certainty of evidence (GRADE).

Results: Seventeen studies were included in the systematic review, fourteen in meta-analysis. Primary outcome was functional status. Meta-analysis showed support interventions significantly improve functional status, measured by Barthel Index, in the short-term (up to 3-months; MD 7.87 points, 95%CI: 6.84 to 19.16; 620 participants; five studies; I² = 77%); with little or no difference in the medium or long term (between 6-12 months; MD 2.91 points, 95%CI: 0.03 to 5.81; 1207 participants; six studies; I² = 84%).

Support interventions may improve quality of life up to 3-months (p<0.00001), reduce depression (p=0.007) and anxiety (p=0.0005) at 6 -12 months. Effects on other secondary outcomes remain inconclusive.

Conclusions: Incorporating support interventions at hospital-to-home discharge can improve functional status and other outcomes when transitioning home after stroke. However, due to study heterogeneity, the key elements of successful transition of care interventions remain unclear.

Disclosure: No

O022 / 229

Scientific Communications 3 - Rehab and Recovery

WHAT LESSONS CAN WE LEARN FROM RECENT LARGE RANDOMISED CONTROLLED TRIALS IN STROKE REHABILITATION?

V. Fu¹, H. Mcnaughton ¹, K. McPherson², J. Gommans³, M. Harwood⁴

¹Medical Research Institute of New Zealand, Stroke/Rehabilitation research, Wellington, New Zealand, ²AUT University, Rehabilitation, Auckland, New Zealand, ³Hawkes Bay DHB, Medicine, Hastings, New Zealand, ⁴University of Auckland, Medicine and Health Sciences, Auckland, New Zealand

Background and aims: Several large randomised controlled trials (RCTs), involving thousands of stroke rehabilitation participants in total, have been published in the last ten years. However, current practice is informed mainly by experience and shared wisdom based on theoretical principles rather than this evidence. We aimed to reassess the evidence from these trials to see what overall lessons they provide for modern stroke rehabilitation practice.

Methods: We used appropriate search terms to identify RCTs, with more than 300 participants and at least six months of follow up, published in the last 10 years, where the primary focus was stroke rehabilitation interventions. We then mapped each trial to relevant domains of the Biopsychosocial (BPS) model and World Health Organisation International Classification of Function (ICF). We also constructed a series of statements informed by the RCT evidence and compared these to current guidelines.

Results: Eleven studies (12,573 participants) were included in this analysis. Most studies were focussed on the 'biological' or ‘bio/social’ area of the BPS model (8/11) and the Impairment and Activities components of the ICF (8/11). Most trials (9/11) were neutral for their primary endpoint. Exceptions were the A Very Early Rehabilitation Trial after stroke (AVERT) and Taking Charge after Stroke (TaCAS) trials. Aligning rehabilitation practice with published research suggests a need to reconsider current guidelines and research priorities.

Conclusions: Interventions that explicitly target psychological, as well as biologic and social domains, are most promising for delivering positive outcomes for life after stroke.

Disclosure: No

O023 / 594

Scientific Communications 3 - Rehab and Recovery

‘TAKE CHARGE’ IS THE MOST EFFECTIVE STROKE INTERVENTION AVAILABLE: WHAT ARE THE BARRIERS TO IMPLEMENTATION?

H. McNaughton ¹, J. Gommans², K. McPherson³, V. Fu¹, M. Harwood⁴

¹Medical Research Institute of New Zealand, Stroke/Rehabilitation Research, Wellington, New Zealand, ²Hawkes Bay DHB, Medicine, Hastings, New Zealand, ³AUT University, Rehabilitation, Auckland, New Zealand, ⁴University of Auckland, Medicine and Health Sciences, Auckland, New Zealand

Background and aims: Take Charge is a novel self-rehabilitation intervention for people with stroke after hospital discharge. It delivers about 60 more people independent at 9-12 months per 1,000 admitted with stroke, which compares favourably with stroke clot retrieval (about 25) or thrombolysis (about 15) reflecting its low number needed to treat (eight) and large eligible population (50-60% of people admitted). Take Charge is cheap, cost-effective and has been successfully implemented in sites in England, Australia, New Zealand and Ireland. We wished to explore reasons for resistance to implementation.

Methods: Using a best-practice implementation framework, we considered the reasons for non-implementation and strategies that might improve implementation.

Results: The key reasons for non-implementation identified were:

• 1) ‘We don’t believe it’ i.e. how could a simple ‘psychological’ intervention delivered after discharge and weeks after stroke possibly improve independence?

• 2) ‘We are already doing this’ i.e. the belief that our current rehabilitation practice is already completely person-centred.

• 3) ‘This approach will interfere with rehabilitation’ i.e. the clash of the current ‘SMART’ (Specific/Measurable/Achievable/Realistic/Timed) approach to goal setting with Take Charge ‘big goals’.

• 4) ‘Let’s wait for the guidelines’ i.e. keep the status quo until experts advise otherwise.

The presentation will focus on ways of addressing these reasons using evidence from rehabilitation theory, randomised controlled trials, experience from education and sport, and other easily understood analogies.

Conclusions: Implementation of novel therapies that challenge our current approach to rehabilitation can be difficult, but a clear understanding of potential barriers can provide effective solutions.

Disclosure: No

O024 / 1246

Scientific Communications 3 - Rehab and Recovery

THE ROLE OF IPSILESIONAL MOTOR CORTICAL EXCITABILITY AND UPPER LIMB FUNCTION AFTER A STROKE – A TMS-EEG COUPLING STUDY

A. Cadic-Melchior ^1,2, S. Harquel^1,2, T. Morishita^1,2, L. Fleury^1,2, M. Ceroni^1,2, J. Brügger^1,2, S. Avanzi^1,2, N. Meyer³, O. Blanke^3,4, D. van de Ville^5,6, C. Constantin⁷, J. Adolphsen⁸, C. Jagella⁸, V. Alvarez⁹, P. Vuadens¹⁰, J.-A. Ghika⁹, B. Léger¹⁰, J.-L. Turlan¹⁰, A. Mühl¹⁰, D. San Millán Ruíz⁷, C. Bonvin⁹, P. Koch^1,2,11,12, M. Wessel^1,2,13, F.C. Hummel^1,2,14

¹Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Defitech Chair of Clinical Neuroengineering, Geneva, Switzerland, ²Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL Valais), Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Sion, Switzerland, ³Center for Neuroprosthetics & Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Laboratory of Cognitive Neuroscience, Geneva, Switzerland, ⁴University of Geneva, Department of Neurology, Geneva, Switzerland, ⁵Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Medical Image Processing Laboratory, Geneva, Switzerland, ⁶University of Geneva, Department of Radiology and Medical Informatics, Geneva, Switzerland, ⁷Hôpital du Valais, Department of Radiology, Sion, Switzerland, ⁸Berner Klinik Montana, Crans-Montana, Switzerland, ⁹Hôpital du Valais, Department of Neurology, Sion, Switzerland, ¹⁰Clinique Romande de Réadaptation, Sion, Switzerland, ¹¹University of Lübeck, Department of Neurology, Lübeck, Germany, ¹²University of Lübeck, Center of Brain, Behavior and Metabolism (CBBM), Lübeckgermge, Germany, ¹³University Hospital Würzburg, Department of Neurology, Würzburg, Germany, ¹⁴Geneva University Hospitals, Department of Neurology, Geneva, Switzerland

Background and aims: Some of the greatest challenges studying motor cortex function in stroke recovery is the heterogenous motor impairment and the lack of peripheral motor readout (e.g., MEPs). The combination of transcranial magnetic stimulation (TMS) and EEG recording provide the opportunity to circumvent this limitation, allowing to extract neurophysiological markers from the CNS directly (figure 1a). Here, we used TMS-EEG to study motor cortical excitability and its impact on residual motor function longitudinally in a large cohort of stroke patients.

Methods: EEG responses evoked by TMS to the ipsilesional motor cortex were acquired in 76 stroke patients in the acute (1-week), sub-acute (3-weeks) and chronic stage (3-months). Ipsilesional motor cortical excitability was extracted using paired Regression Quality Scores (pRQS) and Local Mean Field Potentials (LMFP). 9-hole peg test (9HP), grip force and upper extremity Fugl-Meyer (FM-UE) were used to quantify residual upper limb function.

Results: An ANCOVA revealed substantial evidence for an effect of pRQS on FM-UE. Lower pRQS values, reflecting lower cortical excitability, were correlated with lower FM-UE scores (figure 1b). LMFP analyses showed a main effect of FM-UE and a positive correlation with performance of the 9HP test, but not with FM-UE (figure 1c).

Conclusions: By using TMS-EEG longitudinally in this cohort of patients, we were able to unveil a relationship between cortical excitability of the ipsilesional motor cortex and residual motor function. However, it is yet to be investigated if this relation evolves along the recovery and can be used as a predictor of this latter.

Disclosure: No

O025 / 243

Scientific Communications 4 - Clinical Practice, Management and Care

EXPLORING STROKE CARE DIFFERENCES BETWEEN HIGH AND MIDDLE INCOME EUROPEAN COUNTRIES FOR FEVER, SUGAR AND SWALLOW MANAGEMENT (THE QASC EUROPE PROJECT)

S. Middleton ¹, S. Dale¹, B. McElduff¹, K. Coughlan², E. McInnes², T. Fischer³, J. Van der Merwe³, R. Havalda⁴, A. Grecu⁵, R. Mikulik⁵, D.A Cadilhac⁶, C. D’Este⁷, C. Levi^8,9, J. Grimshaw¹⁰, C. Quinn¹¹, NW. Cheung¹², W. Pfeilschifter¹³, On behalf of the QASC Europe Steering and Implementation Committees

¹Australian Catholic University, Nursing Research Institute, Sydney, Australia, ²Australian Catholic University, Nursing Research Institute, Melbourne, Australia, ³Angels Initiative, Boehringer Ingelheim International GmbH, Ingelheim, Germany, ⁴Angels Initiative, Boehringer Ingelheim International GmbH, Prague, Czech Republic, ⁵St. Ann's University Hospital and Masaryk University, International Clinical Research Centre, Neurology Department, Brno, Czech Republic, ⁶Monash University, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Clayton, Australia, ⁷Australian National University, National Centre for Epidemiology and Population Health (NCEPH), Canberra, Australia, ⁸John Hunter Health and Innovation Precinct, Hunter New England Local Health District, Newcastle, Australia, ⁹University of Newcastle, Department of Medicine, Newcastle, Australia, ¹⁰University of Ottawa, Ottawa, Canada, ¹¹Prince of Wales Hospital, Speech Pathology Department, Randwick, Australia, ¹²University of Sydney, Centre for Diabetes and Endocrinology Research, Westmead Hospital, Westmead, Australia, ¹³Klinikum Lüneburg, Department of Neurology and Clinical Neurophysiology, Lüneburg, Germany

Background and aim: The QASC Europe project significantly improved nurse-initiated management of fever, hyperglycaemia (sugar) and swallowing (FeSS) in European stroke units with vastly different health care systems. We examined pre-post country management using the 2021-2022 World Bank income classifications.

Methods: This pan-European pre-test/post-test study (2018-2021) collected data at baseline and three months after FeSS protocol implementation. Clinical champions conducted multidisciplinary workshops to feedback baseline audit data, provided education, and identified barriers to protocol implementation. Outcomes were adjusted for age, sex, NIHSS and for clustering by site and country. The interaction between country classification (high income countries [HIC] vs middle income countries [MIC]) and time (pre/post) tested differences in proportions.

Results: Pre-implementation data were analysed from 76 hospitals in 18 countries (eight HIC, ten MIC) (n=3999 patients); and post-implementation from 64 hospitals in 17 countries (seven HIC and the same ten MIC) (3257 patients). Significant pre-to-post improvements were made in both HIC and MIC (Adjusted difference in proportion HIC:(24% (16%,33%), MIC:(25% (15%,34%)). Post-implementation FeSS Protocol adherence were broadly similar between HIC and MIC. There was no difference in post-implementation overall FeSS Protocol adherence between HIC and MIC (p=0.8909).

Conclusions: Our nurse-initiated intervention was highly effective in improving stroke management in all countries irrespective of their income level classification. The clinical significance of these improvements in MIC is noteworthy in that many of these hospitals have limited access to stroke care including acute reperfusion therapies. Upscaling of effective stroke interventions is essential to improving stroke care globally.

Disclosure: Yes

O026 / 1573

Scientific Communications 4 - Clinical Practice, Management and Care

SYSTEM OPTIMISATION IN TIMES OF CRISIS

D. Hargroves ¹, L. Ward¹, M. Farr¹

¹ East Kent Hospitals University Foundation NHS Trust, Stroke Medicine, Canterbury, United Kingdom

Introduction: The benefits of reorganisation (System optimisation) of stroke services to create sustainable, high-quality larger units are well known. This frequently takes many years of planning and public consultation. We report the benefits of co locating two smaller acute stroke units (600 confirmed strokes each per year) onto one non-acute site, planned and delivered to support the wider COVID 19 response in England.

Methods:

Planned and delivered over 10 days in May 2020:

Innovations introduced:

• 1) Prehospital: telemedicine assessment between stroke specialist and ambulance crew; improving sensitivity and specificity of triage to support time critical access to Thrombolysis and Thrombectomy.

• 2) Adherence to a National Optimal Stroke Imaging Pathway (NOSIP): 24/7 access to CTA, CTP with AI support and 12hrs access to MRI.

• 3) Autonomy of stroke bed base

• 4) Inpatient stroke care redesign: to deliver initial acute care (72 hours) and early rehabilitation (post 72 hours) with medical and therapy care delivered routinely 7 days per week.

Monthly evaluation of quality indicators (SSNAP) enabled evaluation, benchmarked against local (pre-pandemic) and national performance. Mortality and length of stay outcomes analysed.

Results: Significant and sustained improvement across all 10 domains of care with increased thrombolysis rates >20%, thrombectomy rates >5%, statistically significant relative mortality risk of 59.6% (65 lives saved) and 38% reduction in length of stay (17 to 11 days).

Conclusions: Sustainable improvements to stroke services may be delivered rapidly, incorporating innovative solutions to deliver sustainable high-quality stroke care, whilst supporting the wider health care response to the COVID pandemic.

Disclosure: No

O027 / 1518

Scientific Communications 4 - Clinical Practice, Management and Care

INTRACEREBRAL HEMORRHAGE CARE BUNDLE: A QUALITY IMPROVEMENT INITIATIVE

A. Gabr ¹, N. Cunningham¹, C. Kennedy², A. Saleh¹, B. Okpaje¹, A. Leahy¹, K. El-Kholy³, E. Loughlin¹, I. Carrol¹, S. Paulose¹, A. Mohamed¹, N. Daly⁴, A. Harnett⁴, E. Buckley⁵, J. McManus⁶, C. Peters¹, C. Quinn¹, E. Shanahan¹, D. O’Keefe⁷, M. Watts⁸, D. Lyons¹, R. Galvin⁹, S. Murphy¹⁰, M. O’Connor¹, A. Antonenko¹

¹University Hospital Limerick, Ageing & Therapeutics, Limerick, Ireland, ²St James Hospital, Clinical Pharmacology & Therapeutics, Dublin, Ireland, ³St James Hospital, Department of Intensive Care Medicine, Limerick, Ireland, ⁴University Hospital Limerick, Pharmacy, Limerick, Ireland, ⁵Mater Hospital, Geriatrics & Stroke medicine, Dubline, Ireland, ⁶University Hospital Limerick, Geriatrics & Stroke medicine, Dubline, Ireland, ⁷University Hospital Limerick, Hematology & Coagulation, Limerick, Ireland, ⁸University Hospital Limerick, Coagulation, Limerick, Ireland, ⁹University of Limerick, School of Allied health, Limerick, Ireland, ¹⁰Mater Hospital, Geriatrics & Stroke medicine, Dublin, Ireland

Background and aims: A third of Intracerebral hemorrhage (ICH) patients die. An ICH care bundle focusing on acute anticoagulation reversal, blood pressure-lowering, and deferring Do-Not-Resuscitate (DNR) was associated with improved survival. The aim was to determine the feasibility and outcomes of the implementation of a bundle of care.

Methods: An ICH care bundle was developed using an iterative process involving expert stakeholder feedback and a review of the evidence-based literature. A pre-and-post quasi-experimental research design was employed. Baseline data were collected from January 2016-June 2018. Implementation took place in a staged manner with multiple PDSA cycles (June 2018 to January 2021).

Results: Systolic blood pressure in the first 24 hours and anticoagulant reversal were significantly better controlled in the post-implementation group (X2 (1, N=91) = 5.34, p=0.02), (X2(N=25)=5.85, p=0.016), respectively. Overall DNR orders were significantly lower post-implementation (X2 (1, N=25) = 5.85, p=0.029). However, DNAR status did not significantly differ when accounting for low GCS as a surrogate measure for poor prognosis (X2 (1, N=34) = 0.00, p=0.966). Modified Rankin Scale on discharge did not differ significantly pre-and-post-implementation (z=-0.075, p=0.94). A greater proportion of patients survived in the post-implementation group; however, this was not statistically significant. The length of stay significantly increased post-implementation.

Conclusion: An ICH care bundle was developed based on expert stakeholder feedback. The feasibility of implementing this bundle of care was demonstrated in a real-world clinical practice setting. A cluster-randomized trial or a large registry study is the next step to evaluate this care bundle.

Disclosure: No

O028 / 386

Scientific Communications 4 - Clinical Practice, Management and Care

ASSOCIATION OF DELIRIUM INCIDENCE WITH VISITATION RESTRICTIONS DUE TO COVID-19 PANDEMIC IN PATIENTS WITH ACUTE CEREBROVASCULAR DISEASE IN A STROKE-UNIT SETTING

M. Hahn ¹, S. Gröschel¹, T. Uphaus¹, K. Gröschel¹

¹ University Medical Center of the Johannes Gutenberg University Mainz, Department of Neurology, Mainz, Germany

Background and aims: Hospitals around the world introduced considerable visitation restrictions to reduce risk of infection during epidemic spread of SARS-CoV2. Understanding of negative impacts of visitation restrictions on subgroups of patients may help to balance and adjust policies accordingly or introduce further measures to mitigate their impact. We aimed to investigate the association of visitation restrictions with delirium incidence in stroke-unit patients.

Methods: Data from 5779 stroke-unit cases with transient ischemic attack or stroke (ischemic/hemorrhagic) admitted between January 2017 and November 2021 were compared between three groups depending on visitation policy implemented at time of admission: pandemic-associated absolute visitation restriction (n=1087), limited visitation policy (n=862) and pre-pandemic visitation policy (n=3830). Univariate comparison and multiple logistic regression analyses were conducted to evaluate association of delirium with visitation restrictions.

Results: We observed delirium incidences of 6.3% during pandemic-associated absolute visitation restriction, 5.8% with limited visitation policy and 5.1% with pre-pandemic visitation policy (p=0.239). In multiple logistic regression analyses adjusting for clinically relevant variables, we found any pandemic-associated visitation restriction (OR:1.353, 95%CI:1.059-1.730, p=0.016) and specifically absolute visitation restriction (OR:1.351, 95%CI:1.005-1.817, p=0.046) independently associated with delirium. Other factors associated with delirium were older age, male sex, stroke versus TIA, acute infection, history of dementia and longer duration of hospitalization.

Conclusion: Pandemic-associated visitation restrictions and specifically absolute visitation restrictions are associated with a higher incidence of delirium among stroke-unit patients with acute cerebrovascular disease. Benefit and harm of visitation restrictions should be carefully weighed and adjusted for patients otherwise at increased risk for delirium.

Disclosure: Yes

O029 / 395

Scientific Communications 4 - Clinical Practice, Management and Care

IMPACT OF THE HEALTHCARE SYSTEM TRANSFORMATIONS SPURRED BY THE COVID-19 PANDEMIC ON STROKE MANAGEMENT: RESULTS FROM A FRENCH REGIONAL STROKE OBSERVATORY

E. Lesaine ^1,2, F. Francis^1,3, S. Domecq^1,2, F. Rouanet⁴, F. Gilbert^1,2, P. Bernady⁵, S. Demales⁶, E. Leca Radu⁷, L. Lucas⁸, I. Sibon^4,9, F. Saillour-Glénisson^1,3, AVICOVID Study Group

¹Bordeaux Population Health, University of Bordeaux, ISPED, Centre INSERM U 1219, Bordeaux, France, ²CHU de Bordeaux, CIC-EC 14-01, Bordeaux, France, ³CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, Bordeaux, France, ⁴Bordeaux University Hospital Neurology, Stroke Unit, Bordeaux, France, ⁵Bayonne Hospital Neurology, Stroke Unit, Bayonne, France, ⁶Pau Hospital Neurology, Stroke Unit, Pau, France, ⁷Agen Hospital Neurology, Stroke Unit, Agen, France, ⁸Arcachon Hospital Neurology, Stroke Unit, Arcachon, France, ⁹University of Bordeaux, INCIA CNRS UMR 5287, Bordeaux, France

Background and aims: The consequences of the COVID-19 pandemic on the management of stroke patients are causing concerns. The objective was to assess the impact of changes in use of care and health reorganizations implementation, spurred by the first wave of the COVID-19 pandemic on acute stroke management time.

Methods: The study was based on a cohort of stroke patients included between January 2019 and August 2020 in a French regional stroke observatory and an ad-hoc collection of hospital reorganizations. The associations between reorganizations, use of care, and emergency unit (EU) admission-to-imaging time were analyzed through multivariate linear regression mixed models. Interaction terms between the use of care variables and the period (pre, per, post-wave) were introduced.

Results: A total of 6,436 stroke patients were included in 14 hospitals. Four main trends were observed during the per-wave period compared to the pre and post-wave periods: 1) more frequent calls to Emergency Dispatch Organization (EDO) (65.5% vs 61.5% and 64.1%, p=0.083), 2) longer median times from symptoms onset- to-call to EDO (139 minutes vs. 121 minutes and 125 minutes, p=0.232), 3) longer median times from EU admission-to-imaging time (91 minutes vs. 83 minutes and 88 minutes, p=0.332), 4) less intravenous thrombolysis (14.6% vs. 19.4% and 16.7%, p=0.011). No association was found between reorganizations and EU admission-to-imaging times.

Conclusions: Hospitals have demonstrated their adaptation ability during the first wave of the COVID-19 by implementing reorganizations without altering stroke pathway structuration.

Acknowledgements: ”Alliance-Tous-unis-contre-le-virus”, “Nouvelle-Aquitaine Regional-Health-Agency”, ObA2 team and healthcare professionals.

Disclosure: No

O030 / 185

WITHDRAWN Scientific Communications 4 - Clinical Practice, Management and Care

GLOBAL IMPACT OF THE COVID-19 PANDEMIC ON STROKE VOLUMES AND CEREBROVASCULAR EVENTS: ONE-YEAR FOLLOW-UP

T.N. Nguyen ¹, M.M. Qureshi², P. Klein¹, H. Yamagami³, R. Mikulik⁴, A. Czlonkowska⁵, M. Abdalkader⁶, P. Sedova⁴, H. Lo⁷, O.Y. Mansour⁸, H.R. Vanguru⁹, E. Lesaine¹⁰, A. Loochtan¹¹, G. Tsivgoulis¹², J. Demeestere¹³, V. Inoa¹⁴, J.E. Siegler¹⁵, D. Aguiar de Sousa¹⁶, J.P. Marto¹⁷, V.P. Lereis¹⁸, S.D. Scollo¹⁹, B.C. Campbell²⁰, A. Ma²¹, J.O. Thomas²², M. Parsons²³, S. Singhal²⁴, L.-A. Slater²⁵, R.T. Martins²⁶, C. Enzinger²⁷, A. Rahman²⁸, T. Bonnet²⁹, S. de Raedt³⁰, R. Lemmens¹³, N. Ligot³¹, F. Vandervorst³², A.B. Conforto³³, D.L. Mora Cuervo³⁴, N. Drenck³⁵, S. Nagel³⁶, K. Asif³⁷, S. Sacco³⁸, M. Acampa³⁹, M. Romoli⁴⁰, E.S. Kristoffersen⁴¹, S. Banerjee⁴², J.M. Coutinho⁴³, U. Fischer⁴⁴, D. Strambo⁴⁵, P. Michel^45,45, R.G. Nogueira⁴⁶, SVIN COVID-19 Global Stroke Registry

¹Boston University School of Medicine, Boston Medical Center, Neurology, Radiology, Boston, United States, ²Boston Medical Center, Radiology, Radiation Oncology, Boston, United States, ³National Hospital Organization, Osaka National Hospital, Stroke Neurology, Osaka, Japan, ⁴International Clinical Research Centre, St Anne’s University Hospital and Faculty of Medicine, Masaryk University, Neurology, Brno, Czech Republic, ⁵Institute of Psychiatry and Neurology, 2nd Department of Neurology, Warsaw, Poland, ⁶Boston Medical Center, Boston University School of Medicine, Radiology, Boston, United States, ⁷Boston University School of Medicine, Boston, United States, ⁸Alexandria University Stroke and Neurointervention Unit, Neurology, Alexandria, Egypt, ⁹Cleveland Clinic, Neurology, Ohio, United States, ¹⁰Centre Hospitalier de l'Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France, ¹¹Ohio Health Riverside Methodist Hospital, Neurology, Riverside, United States, ¹²Attikon University Hospital, National and Kapodistrian University of Athens, Neurology, Athens, Greece, ¹³Leuven University Hospital, Neurology, Leuven, Belgium, ¹⁴University of Tennessee Health Science Center, Neurology, Tennessee, United States, ¹⁵Cooper Neurological Institute, Cooper University Hospital, Neurology, Camden, United States, ¹⁶Hospital de Santa Maria - CHULN, Neurology, Lisbon, Portugal, ¹⁷Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Neurology, Lisbon, Portugal, ¹⁸Institute for Neurological Research, Neurology, Buenos Aires, Argentina, ¹⁹Stroke Unit Ramos Mejia Hospital, Neurology, Buenos Aires, Argentina, ²⁰Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Medicine and Neurology, Melbourne, Australia, ²¹Royal North Shore Hospital, Sydney, Australia, ²²Liverpool Hospital, Neurophysiology, New South Wales, Australia, ²³Liverpool Hospital, Neurology, New South Wales, Australia, ²⁴Monash University, Neurology, Melbourne, Australia, ²⁵Monash University, Melbourne, Australia, ²⁶Mater Hospital, Neurology, Brisbane, Australia, ²⁷Medical University of Graz, Neurology, Graz, Austria, ²⁸Sir Salimullah Medical College, Neurology, Dhaka, Bangladesh, ²⁹Hopital Erasme, Brussels, Belgium, ³⁰Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium, ³¹Hopital Erasme, Neurology, Brussels, Belgium, ³²Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel, Neurology, Brussels, Belgium, ³³Hospital das Clínicas, São Paulo University, São Paulo, Brazil, ³⁴Moinhos de Vento Hospital, Porto Alegre, Brazil, ³⁵Copenhagen University Hospital, Copenhagen, Denmark, ³⁶Heidelberg University Hospital, Neurology, Heidelberg, Germany, ³⁷Amita Health and University of Illinois-Chicago, Chicago, United States, ³⁸University of L'Aquila, Biotechnological and Applied Clinical Sciences, L'Aquila, Italy, ³⁹University of Siena, Siena, Italy, ⁴⁰IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy, ⁴¹Akershus University Hospital, University of Oslo, Neurology, Oslo, Norway, ⁴²Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom, ⁴³Amsterdam University Medical Centers, Neurology, Amsterdam, Netherlands, ⁴⁴Bern University Hospital, University of Bern, Basel University Hospital, University of Basel, Neurology, Basel, Switzerland, ⁴⁵Lausanne University Hospital and University of Lausanne, Neurology, Lausanne, Switzerland, ⁴⁶Emory University School of Medicine, Neurology, Atlanta, United States

Background and aims: Declines in stroke admission, intravenous thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 2020 to February 2021) compared with the preceding year (March 2019 to February 2020).

Methods: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19, ischemic stroke and ICH admissions; IVT treatments, and mechanical thrombectomy procedures. This study is registered NCT04934020.

Results: There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95%CI, -7.1,-6.9). ICH volumes declined 29,585 to 28,156 (-4.8%,[-5.1,-4.6]), and IVT volume from 24,584 to 23,077 (6.1%, [5.8,6.4]). Larger declines were observed at high- compared to low-volume centers (all p<0.0001). There was no change in mechanical thrombectomy volumes (0.7%,[0.6,0.9];p=0.49). Stroke was diagnosed in 1.3% of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% (5,656/195,539) of all stroke hospitalizations.

Conclusion: There was a global decline and shift to lower volume centers of stroke admission, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.

Disclosure: Yes

O031 / 442

Scientific Communications 4 - Clinical Practice, Management and Care

QUALITY OF ACUTE STROKE CARE AND OUTCOMES: THE FIRST TWO WAVES OF THE COVID-19 PANDEMIC IN THE UNITED KINGDOM

S. Ralph ¹, K. Stanley¹, A. Bhalla², C. Wolfe¹, A. Douiri¹, M. James³

¹King’s College London, Population Health Sciences, London, United Kingdom, ²Guys’ and St Thomas’ NHS Foundation Trust, London, United Kingdom, ³Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom

Background: The COVID-19 pandemic has been reported as affecting the quality and outcomes of stroke care around the world. The impact of the first and second waves of the pandemic in the UK are compared.

Methods: Data were extracted from the Sentinel Stroke National Audit Programme database of stroke admissions in England, Wales and Northern Ireland. Care quality and outcomes for 72,698 patients admitted during the first (1 March – 30 June 2020) and second (27 September 2020 – 31 March 2021) pandemic waves were compared.

Results: From the first to second wave, there was an increase in mild strokes admitted (40.3% to 41.3%; p=0.002) and median NIHSS on arrival decreased (5 vs 4, p<0.001).

The second wave was characterised by a decrease in direct stroke unit admission (79.8% to 76.6% ; p<0.001). Time to initial assessment by all specialists increased. Time to stroke consultant assessment increased by 34 minutes (262 vs 296 minutes; p<0.001).

Complications (pneumonia: 8.6% to 9.4%, UTI: 3.3% to 3.9%; both p < 0.001) and in-hospital mortality (10.6% to 12.4%; p<0.001) increased significantly. Moderate and moderately-severe disability were more prevalent at discharge (18.1 to 18.6%, 18.3% to 19.9% respectively; p<0.001). Early supported discharge increased from 39.1% to 44.5% (p>0.001).

Conclusions: Hospital avoidance by patients with mild stroke seen in the first wave was not replicated in the second wave. COVID-19 pressures on hospitals in the second wave appeared to result in fewer direct stroke unit admissions, delays in acute assessment, more complications, and more in-hospital deaths.

Disclosure: No

O032 / 1324

Official Welcome & Large Clinical Trials

ACUTE FEBRILE ILLNESS, INFLUENZA VACCINATION AND THE RISK OF ACUTE STROKE - THE INTERSTROKE STUDY

C.J. Schwarzbach ¹, A.J Grau¹, P. Rao-Melacini², S. Rangarajan², D. Xavier³, H. Zhang⁴, P. Lopez-Jaramillo⁵, A. Damasceno⁶, G.J Hankey⁷, P. Langhorne⁸, A. Rosengren⁹, A.L Dans¹⁰, A. Elsayed¹¹, Á. Avezum¹², C. Mondo¹³, D. Ryglewicz¹⁴, A. Czlonkowska¹⁵, N. Pogosova¹⁶, R. Diaz¹⁷, A. Oguz¹⁸, F. Lanas¹⁹, O.S Ogah²⁰, H.K Iversen²¹, A. Yusufali²², S. Oveisgharan²³, F. Al-Hussain²⁴, C. Judge²⁵, M. O’Donnell²⁵, S. Yusuf²

¹Städtisches Klinikum Ludwigshafen, Department of Neurology, Ludwigshafen am Rhein, Germany, ²McMaster University and Hamilton Health Sciences, Hamilton, Canada, ³St John’s Medical College and Research Institute, Bangalore, India, ⁴Beijing Hypertension League Institute, Beijing, China, ⁵Universidad de Santander / Instituto de Investigaciones MASIRA, Bucaramanga, Colombia, ⁶Eduardo Mondlane University / Faculty of Medicine, Maputo, Mozambique, ⁷University of Western Australia / Faculty of Health and Medical Sciences, Perth, Australia, ⁸University of Glasgow / Glasgow Royal Infirmary, Glasgow, United Kingdom, ⁹University of Gothenburg and Region Västra Götaland / Sahlgrenska University Hospital, Department of Molecular and Clinical Medicine, Gothenburg, Sweden, ¹⁰University of the Philippines / College of Medicine, Manila, Philippines, ¹¹Al Shaab Teaching Hospital, Khartoum, Sudan, ¹²International Research Center / Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, ¹³Uganda Heart Institute / Mulago Hospital, Kampala, Uganda, ¹⁴Military Institute of Aviation Medicine, Warsaw, Poland, ¹⁵Institute of Psychiatry and Neurology, Warsaw, Poland, ¹⁶National Medical Research Center of Cardiology, Moscow, Russian Federation, ¹⁷Estudios Clínicos Latino America (ECLA) / Instituto Cardiovascular de Rosario (ICR), Rosario, Argentina, ¹⁸Istanbul Medeniyet University / Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey, ¹⁹Faculty of Medicine / Universidad de La Frontera, Temuco, Chile, ²⁰University College Hospital, Department of Medicine, Ibadan, Nigeria, ²¹Rigshospitalet / University of Copenhagen, Department of Neurology, Copenhagen, Denmark, ²²Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates, ²³Rush University, Neurology Division, Dept. of Medicine, Chicago, United States, ²⁴College of Medicine / King Saud University, Riyadh, Saudi Arabia, ²⁵HRB-Clinical Research Facility / NUI Galway, Galway, Ireland

Background and aims: Acute febrile illness increases the risk of stroke, while influenza vaccination may be associated with a reduced stroke risk. We studied associations of recent acute febrile illness and influenza vaccination with first-ever stroke around the world.

Methods: INTERSTROKE is a large international case-control study comprising 13,447 cases of acute first stroke and 13,472 community and hospital controls. Recent acute febrile illness and influenza vaccinations were systematically assessed.

Results: Acute febrile illness in the preceding four weeks was more commonly reported by ischemic stroke patients (n=906; 8.7%) than control subjects (n=589; 5.6%; adjusted OR 1.18; 95% CI 1.01-1.39). The association between recent acute febrile illness and ischemic stroke was strong in analyses with community controls (n=183; 3.2%; AOR 2.00; 1.54-2.60) but absent in those with hospital controls (n=406; 8.5%; AOR 0.82; 0.66-1.01). There was no association between acute febrile illness and intracerebral hemorrhage (AOR 0.77; 0.61-0.96) or all stroke (AOR 1.04; 0.90-1.19).

Influenza vaccination was associated with lower odds of all stroke (AOR 0.53; 0.46-0.60), ischemic stroke (AOR 0.57; 0.50-0.67) and intracerebral hemorrhage (AOR 0.34; 0.25-0.46). The odds of stroke were lower among those with five Influenza vaccinations, than one to four vaccinations, within the last five years.

Conclusions: Acute febrile illness is associated with increased odds of ischemic stroke in most parts of the world. Vaccination against influenza is associated with decreased odds of stroke after adjustment for a large number of covariates. Unmeasured residual confounding but also immunostimulation by influenza vaccination may contribute to this result.

Disclosure: Yes

O033 / 1163

Official Welcome & Large Clinical Trials

THE PARAMEDIC NORWEGIAN ACUTE STROKE PREHOSPITAL PROJECT (PARANASPP);DIAGNOSTICS AND TRIAGE OF ACUTE STROKE BY PARAMEDICS USING THE NATIONAL INSTITUTES OF HEALTH STROKE SCALE

M. Guterud ^1,2,3, H.F. Bugge^1,4,3, J. Røislien¹, K.O. Fremstad⁵, K.G Bache^6,7, J. Kramer-Johansen^8,3, M. Toft^9,3, E.C. Sandset^4,1, M.R. Hov^10,4,1

¹Norwegian Air Ambulance Foundation, Department of Research, Oslo, Norway, ²Oslo University Hospital, Division of Prehospital Services, Oslo, Norway, ³University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ⁴Oslo University Hospital, Department of Neurology, Stroke Unit, Oslo, Norway, ⁵Norwegian Air Ambulance Foundation, Department of Development, Oslo, Norway, ⁶Østfold University College, Research and Dissemination, Halden, Norway, ⁷University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway, ⁸Oslo University Hospital, Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Air Ambulance Dept., Division of Prehospital Services, Oslo, Norway, ⁹Oslo University Hospital, Department of Neurology, Oslo, Norway, ¹⁰Oslo Metropolitan University, Department of Health Science, Oslo, Norway

Background: Early prehospital identification of stroke and triage to right level of care may result in more patients receiving acute treatment. Quality of communication between paramedics and the stroke center directly affects prehospital on-scene time, emphasizing this as a key factor to reduce prehospital delay. The aim of Paramedic-Norwegian Acute Stroke Prehospital Project (ParaNASPP) is to assess whether a structured learning program, prehospital NIHSS and a mobile application facilitating communication with the stroke physician may improve triage of acute stroke patients.

Methods: In a stepped wedge cluster randomised controlled trial, paramedics at five ambulance stations enrolled adult patients with suspected stroke within 24 hours of symptom onset,. The intervention was prehospital triage of stroke patients by paramedics specially trained in NIHSS and the ParaNASPP-application which included NIHSS score, age, time of onset, list of anticoagulant medication and vital parameters.

The primary outcome was positive predictive value (PPV) of a final stroke related diagnosis. Secondary outcomes included time variables, prehospital NIHSS quantification, infarction volume and functional outcome at 90 days.

Results: 802 were included, 355 in control and 447 in intervention. Mean age was 71 and 48% were women. 42% suffered an ischaemic stroke/TIA, 5% intracerebral haemorrhage and 53% a stroke mimic condition. Further results will be presented in a late-breaking abstract

Conclusions: Implementation of prehospital NIHSS with the ParaNASPP-application may make paramedics more adept at examining suspected stroke patients, enable more fluent communication with in-hospital services and therefore facilitate more correct triage and transportation to the right level of care.

Disclosure: No

O035 / 928

Official Welcome & Large Clinical Trials

PROCEDURAL SEDATION VERSUS GENERAL ANESTHESIA IN ANTERIOR CIRCULATION LARGE VESSEL OCCLUSION THROMBECTOMY :THE ANESTHESIA MANAGEMENT IN ENDOVASCULAR THERAPY FOR ISCHEMIC STROKE (AMETIS) RANDOMIZED CONTROLLED TRIAL

R. Chabanne ¹, T. Geeraerts², M. Begard¹, B. Balança³, F. Rapido⁴, V. Degos⁵, B. Tavernier⁶, S. Molliex⁷, L. Velly⁸, F. Verdonk⁹, J.-F. Albucher¹⁰, C. Cognard¹¹, A. Guyot¹, R. Moreno¹², A. Ferrier¹³, B. Pereira¹⁴, E. Futier¹⁵, Neurocritical Care and Neuro Anesthesiology French Speaking Society (ANARLF) Network and AMETIS Study Group

¹University Hospital Clermont-Ferrand, Neurocritical Care and Neuroanesthesiology Clinic / Perioperative Medicine Department, Clermont-Ferrand, France, ²University Hospital of Toulouse, Toulouse NeuroImaging Center and University Toulouse 3-Paul Sabatier, Department of Anesthesiology and Critical Care, Toulouse, France, ³Hospices Civils de Lyon and Université Lyon 1, Service d’Anesthésie Réanimation Hôpital Neurologique Pierre Wertheimer, Lyon, France, ⁴CHU de Montpellier, Service d’Anesthésie Réanimation, Pôle Neurosciences Tête et Cou, Hôpital Gui de Chauliac, Montpellier, France, ⁵Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière and Université Pierre et Marie Curie, Anesthésie et Neuro-Réanimation Chirurgicale Babinski, Département d’Anesthésie-Réanimation, Paris, France, ⁶CHRU Lille, Pôle Anesthésie Réanimation, Lille, France, ⁷CHU de St-Etienne and Université Jean Monnet, Service d’Anesthésie Réanimation, Saint-Etienne, France, ⁸Assistance Publique Hôpitaux de Marseille (AP-HM) and Institut des Neurosciences, MeCA, Aix Marseille Université, Service d’Anesthésie Réanimation, Hôpital La Timone, Marseille, France, ⁹Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine and Institut Pasteur, Département d’Anesthésie-Réanimation, Paris, France, ¹⁰University Hospital of Toulouse, Toulouse NeuroImaging Center, University Toulouse 3-Paul Sabatier, INSERM, Department of Neurology, Toulouse, France, ¹¹Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France, ¹²University Hospital Clermont-Ferrand, Department of Neuroradiology, Clermont-Ferrand, France, ¹³University Hospital Clermont-Ferrand, Department of Neurology, Clermont-Ferrand, France, ¹⁴University Hospital Clermont-Ferrand, Biostatistics Unit of the Department of Clinical Research and Innovation (DRCI), Clermont-Ferrand, France, ¹⁵University Hospital Clermont-Ferrand, Department of Perioperative Medicine and Université Clermont Auvergne, GRED, CNRS, Inserm U1103, Clermont-Ferrand, France

General anesthesia (GA) or procedural sedation (PS) for mechanical thrombectomy (MT) could modify outcome of anterior circulation AIS with conflicting results in the literature.

Pragmatic, multicenter, randomized, open label with blinded outcome assessment, controlled trial evaluating GA versus PS for anterior circulation LVO MT (NCT03229148).

Exclusion criteria were coma/altered vigilance and premorbid disability.

Primary composite outcome was functional independence (a score of 0-2 on the mRS) by day90 and absence of major periprocedural complication (intervention-associated arterial perforation/dissection, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema or malignant stroke) occurring by day7. Choice of sedatives and/or analgesics and the thrombectomy technique were at the discretion of the attending physicians. Systolic blood pressure was maintained between 140 and 180mmHg during the procedure.

273 patients were enrolled (135 assigned to GA and 138 to PS). The primary composite outcome occurred in 28.2% in the GA group and in 36.2% in the PS group (RR 1.29; 95% CI, 0.91 to 1.82; P=0.15). At 3 months, 33.3% of patients in the GA group and 39.1% in the PS group were independent (P=0.32). Absence of major periprocedural complication by day 7 was reported in 65.9% of participants in the GA group and 67.4% in the PS group (P=0.80). There was no mortality and reperfusion delay difference between groups. Hypotension occurred in 87.4% of patients in the GA group and in 44.9% in the PS group (P<0.001).

In MT for anterior circulation AIS, GA or PS were not different related to 3 months functional independence and perioperative complications.

Disclosure: Yes

O036 / 990

Official Welcome & Large Clinical Trials

TREATMENT OF INTRACEREBRAL HEMORRHAGE IN PATIENTS ON NON-VITAMIN K ORAL ANTICOAGULANTS WITH TRANEXAMIC ACID (TICH-NOAC)

P. Lyrer ¹, A. Polymeris¹, S. Schaedelin², G. Karwacki³, S. Engelter^1,4, N. Peters^1,4,5, D. Seiffge⁶, on behalf of the TICH-NOAC investigators

¹Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland, ²Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland, ³Department of Neuroradiology, Cantonal Hospital Lucerne, Lucerne, Switzerland, ⁴Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland, ⁵Department of Neurology and Stroke Center, Hirslanden Hospital, Zurich, Switzerland, ⁶Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland

Background and aims: There exists no evidence-based treatment option for intracerebral haemorrhage associated with novel direct oral anticoagulants (NOAC-ICH). Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting secondary hematoma expansion (HE). We aimed to assess the efficacy and safety of TXA compared to placebo for the treatment of NOAC-ICH.

Methods: We conducted a multi-center, double-blind, placebo-controlled, randomized controlled trial at 6 Stroke Centers in Switzerland. We randomized patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake to receive either TXA (2x1g) or placebo. Primary outcome was HE defined as haematoma volume increase of either ⩾33% or ⩾6ml on follow-up imaging 24 hours after admission. Secondary outcomes included modified Rankin Scale score at 3 months, in-hospital mortality, symptomatic HE (defined as HE with neurological deterioration of NIHSS >4 points or GCS >2 points) and major thromboembolic complications. This trial was registered (NCT02866838) and funded by the Swiss National Science Foundation.

Results: The trial was conducted between 1 December 2016 and 30 September 2021. We enrolled 63 (median age 82 years [IQR 76.5-86], 40% female, median National Institutes of Health Stroke Scale score 13 [IQR 6-19]) of 109 planned participants before the trial was stopped due to exhausted funding. We will present the results of the main analysis at ESOC 2022.

Conclusions: The results of this trial will highlight efficacy and safety of TXA in patients with NOAC-ICH.

Disclosure: No

O037 / 1495

Official Welcome & Large Clinical Trials

APIXABAN FOR TREATMENT OF EMBOLIC STROKE OF UNDETERMINED SOURCE - ATTICUS RANDOMIZED TRIAL

S. Poli ¹, C. Meisner², K. Poli¹, A. Mengel¹, H. Bäzner³, M. Wolf³, A. Kraft⁴, F. Hoffmann⁴, F. Hillenbrand⁵, L. Niehaus⁵, C. Hobohm⁶, J. Liman⁷, R. Wachter⁸, H. Kimmig⁹, W. Jung¹⁰, R. Huber¹¹, A. Lindner¹², K. Althaus¹³, J. Meyne¹⁴, M. Schabet¹⁵, G. Petzold¹⁶, J. Brachmann¹⁷, M. Ebinger¹⁸, M. Gawaz¹⁹, U. Ziemann¹, T. Geisler¹⁹, for the ATTICUS investigators

¹University of Tübingen, Department of Neurology & Stroke, Tübingen, Germany, ²University of Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany, ³Klinikum Stuttgart, Department of Neurology, Stuttgart, Germany, ⁴Krankenhaus Martha-Maria Halle-Dölau, Department of Neurology, Halle-Dölau, Germany, ⁵Rems-Murr-Kliniken Winnenden, Department of Neurology, Winnenden, Germany, ⁶Carl-von-Basedow-Clinic Saalekreis, Department of Neurology, Merseburg, Germany, ⁷University of Göttingen, Department of Neurology, Göttingen, Germany, ⁸University of Göttingen, Department of Cardiology, Göttingen, Germany, ⁹Schwarzwald-Baar Hospital, Department of Neurology, Villingen-Schwenningen, Germany, ¹⁰Schwarzwald-Baar Hospital, Department of Cardiology, Villingen-Schwenningen, Germany, ¹¹Medical Campus Lake Constance, Department of Neurology, Friedrichshafen, Germany, ¹²Marien Hospital Stuttgart, Department of Neurology, Stuttgart, Germany, ¹³University of Ulm, Department of Neurology, Ulm, Germany, ¹⁴University of Kiel, Department of Neurology, Kiel, Germany, ¹⁵Klinikum Ludwisburg, Department of Neurology, Ludwigsburg, Germany, ¹⁶University of Bonn, Department of Neurology, Bonn, Germany, ¹⁷Regiomed Kliniken Coburg, Department of Cardiology, Coburg, Germany, ¹⁸Medical Park Berlin Humboldtmühle, Department of Neurology, Berlin, Germany, ¹⁹University of Tübingen, Department of Cardiology, Tübingen, Germany

Background and aims: ATTICUS is the third prospective randomized controlled trial that compared a direct oral anticoagulant vs. acetylsalicylic acid (ASA) for secondary prevention after embolic stroke of undetermined source (ESUS).

Aim of ATTICUS was to determine whether apixaban, initiated within 28 days after ESUS, is superior to ASA in preventing new ischemic lesions on 12-month follow-up MRI (primary endpoint) in subjects with remote cardiac monitoring.

Methods: Multicenter (14 German centers) open-label randomized (1:1) controlled trial with blinded endpoint assessment. ESUS patients with at least one risk factor for atrial fibrillation/cardiac thromboembolism (i.e., left atrium (LA) size > 45 mm, spontaneous echo contrast in LA appendage, LA appendage flow velocity ⩽ 0.2 m/s, atrial high-rate episodes, CHA2DS2-VASc ⩾ 4, patent foramen ovale (PFO)) were enrolled. Study drug was initiated 3 to 28 days after minor/moderate stroke and ⩾ 14 to 28 days after major stroke. ClinicalTrials.gov: NCT02427126. Funding by Bristol Meyers Squibb-Pfizer Alliance (Euro 2,164,650) and Medtronic.

Results: Final results will be presented at the ESO conference; simultaneous publication intended.

Enrollment stopped after interims analysis due to futility. Of 373 patients screened, 178/175 were enrolled into the apixaban/ASA treatment arm.

Conclusions: In contrast to NAVIGATE ESUS and RE-SPECT ESUS, patients enrolled into ATTICUS needed to exhibit AF predicting factors or an PFO. Final analysis of the ATTICUS randomized trial will give insight into the recurrence of silent and manifest ischemic strokes during the 12-month follow-up period and, most importantly, possible association with AF on the basis of the mandatory continuous ECG monitoring.

Disclosure: Yes

O038 / 839

Official Welcome & Large Clinical Trials

THE EFFECTS OF LONG-TERM ORAL ANTICOAGULANT AGENTS FOR ATRIAL FIBRILLATION (AF) AFTER INTRACRANIAL HAEMORRHAGE (ICH): PROSPECTIVE INDIVIDUAL PARTICIPANT DATA META-ANALYSIS (IPDMA) OF RANDOMISED CONTROLLED TRIALS

R. Al-Shahi Salman ¹, R. Pollock², S. Lewis², A. Shoamanesh³, F. Schreuder⁴, B. van der Worp⁵, C.J. Klijn⁴, Collaboration of Controlled Randomised Trials of Oral Antithrombotic Agents after intraCranial Haemorrhage (COCROACH)

¹The University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²The University of Edinburgh, Edinburgh Clinical Trials Unit, Edinburgh, United Kingdom, ³McMaster University / Population Health Research Institute, Department of Medicine (Neurology), Hamilton, Canada, ⁴Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands, ⁵University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center, Utrecht, Netherlands

Background and aims: The safety and efficacy of oral anticoagulants (OAC) for prevention of major vascular events in atrial fibrillation (AF) after intracranial haemorrhage (ICrH) are unclear. We sought to determine the effects of OAC for AF after ICrH in the first iteration of a prospective individual participant data meta-analysis (IPDMA) of randomised controlled trials (RCTs).

Methods: In October 2021, we updated the searches of a Cochrane review (CD012144). RCTs were eligible if they were registered, had completed recruitment and follow-up, and included participants with spontaneous ICrH and AF, allocated at random to long-term use of any OAC or to placebo, open control, another antithrombotic agent, or another intervention for the prevention of major vascular events. The primary outcome is stroke or cardiovascular death. We will assess risk of bias using the Cochrane RoB2 tool and perform two-step IPDMA of included RCTs that share their intention-to-treat datasets, with fixed effects models as the primary analysis. We registered the protocol of this IPDMA on 31 March 2021 (CRD42021246133), and agreed a statistical analysis plan on 2 December 2021.

Results: We identified four eligible RCTs. Three RCTs included participants with ICrH alone: SoSTART (NCT03153150, n=203 participants), APACHE-AF (NCT02565693, n=101), and NASPAF-ICH (NCT02998905, n=30). The ELDERCARE-AF RCT (NCT02801669, n=984) included 80 participants with prior ICrH. RCTs are sharing data, which we are preparing for this iteration of the IPDMA with up to 414 participants, to be analysed by ESOC.

Conclusions: We intend to submit the IPDMA for publication in parallel with this presentation.

Disclosure: No

O041 / 866

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

CARDIOVASCULAR MAGNETIC RESONANCE DETECTS SUBCLINICAL MYOCARDIAL INJURY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

H. Stengl ^1,2,3, E. Blaszczyk^4,5, S. Hellwig^1,3, H. Saad⁴, R. Ganeshan^1,2,3, C.H Nolte^1,3,2,5, J. Fiebach³, J. Kuhnt⁴, J. Gröschel^4,5, M. Endres^1,2,3,5,6,7, J. Schulz-Menger^4,5, J.F Scheitz^1,2,3,5

¹Charité – Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany, ²Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany, ³Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany, ⁴Charité – Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany, ⁵DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany, ⁶Excellence Cluster NeuroCure, Charité – Universitätsmedizin Berlin, Berlin, Germany, ⁷German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany

Background and aims: Patients with acute ischemic stroke (AIS) have a high risk of cardiac events. Until now, incidence and patterns of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) in an AIS population is unknown. This study aims at providing myocardial tissue characterization of AIS patients by using multiparametric CMR.

Methods: We analyzed AIS patients participating in the prospective CORONA-IS study (NCT03892226) between 01/2019 until 09/2020. Patients underwent 3-Tesla CMR including contrast-enhanced imaging for focal changes (late gadolinium enhancement; LGE), parametric T2- and T1-mapping, and feature tracking for myocardial deformation. Main outcome of interest was presence of focal myocardial fibrosis (LGE).

Results: In total, 91 patients were analyzed (mean age 74±10 years, 55% male, NIHSS 2 [0-3], median time from stroke symptom onset to CMR 95h [81-113h]). LGE was detected in 30 of 91 patients (33%), of whom only three had a history of myocardial infarction. Patients with LGE were more often male, had higher rates of diabetes and higher median levels of hs-cardiac troponin-T. Presence of LGE was accompanied by significantly increased T1 native (diffuse fibrosis) and T2-mapping (edema) values in basal, medial, and apical segments, and by impaired global longitudinal strain (-16±2% vs -12±3%, p=0.028).

Conclusions: Approximately one-third of AIS patients had focal myocardial fibrosis on CMR, although the majority had no medical history of myocardial infarction. Focal myocardial fibrosis was linked to diffuse myocardial tissue changes and reduced myocardial deformation suggesting a potentially relevant burden of silent heart disease in AIS patients.

Disclosure: No

O042 / 515

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

EARLY VERSUS LATE INITIATION OF ANTICOAGULATION IN PATIENTS WITH ATRIAL FIBRILLATION AFTER ACUTE STROKE OR TIA – THE PRODAST STUDY

G.M Grosse ¹, C. Weimar¹, N. Kuklik¹, A. Hüsing¹, A. Stang¹, M. Brinkmann¹, H.-C. Diener¹, PRODAST Investigators

¹ University Duisburg-Essen, Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany

Background and aims: The optimal timing for starting anticoagulation after acute ischaemic stroke or transient ischaemic attack (TIA) in patients with atrial fibrillation (AF) is still uncertain. The Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA (PRODAST) study was initiated to provide real-world data on the efficacy and safety of different timing for antithrombotic treatment after acute AF-associated stroke or TIA.

Methods: PRODAST is a prospective, multi-centre, observational post-authorization safety study that recruited 10,000 patients with recent (⩽1 week) stroke or TIA and non-valvular AF at 86 German stroke units. Patients treated with dabigatran, other non-vitamin-K–dependent oral anticoagulants (NOAC), vitamin-K antagonists (VKA), antiplatelet therapy, parenteral anticoagulant therapy or without any antithrombotic treatment were considered. All patients except those treated with NOAC other than dabigatran received a central follow-up interview after three months as well as assessment of vital status one year after the index event. The main objective is to compare the three-months rates of major haemorrhagic events between early (⩽7 days) versus late (>7 days) administration of dabigatran versus treatment with VKA started at any time.

Results: Analyses are ongoing and results will be presented at the conference.

Conclusions: PRODAST will provide highly needed real-world data on safety and efficacy of antithrombotic treatment in the early phase after acute ischaemic stroke or TIA.

Disclosure: Yes

O043 / 1175

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

SINUS RHYTHM RESTORATION AND IMPROVED OUTCOMES IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND PAROXYSMAL ATRIAL FIBRILLATION

D. Sagris ¹, E. Korompoki², G. Ntaios¹, S. Tzeis³, E. Manios², J. Kanakakis⁴, H. Milionis⁵, P. Papanagiotou⁶, G. Andrikopoulos⁷, G.Y.H. Lip⁸, K. Vemmos⁹

¹University of Thessaly, Department of Internal Medicine and Research Laboratory, Larissa, Greece, ²National and Kapodistrian University of Athens, Department of Clinical Therapeutics, Athens, Greece, ³Mitera Hospital, Hygeia Group, Department of Cardiology, Athens, Greece, ⁴National and Kapodistrian University of Athens, Department of Clinical Therapeutics, Section of Interventional Cardiology, Athens, Greece, ⁵University of Ioannina, Department of Internal Medicine, Medical School, Ioannina, Greece, ⁶National and Kapodistrian University of Athens, Department of Radiology, Aretaieion Hospital, Medical School, Athens, Greece, ⁷Henry Dunant Hospital Center, Electrophysiology & Pacing Division, First Cardiac Department, Athens, Greece, ⁸University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom, ⁹Hellenic Cardiovascular Research Society, Athens, Greece

Background and aims: It is unclear whether early cardiac rhythm control is beneficial in patients with acute ischemic stroke and paroxysmal atrial fibrillation (PAF). We sought to investigate whether in-hospital restoration of sinus rhythm (SR) is associated with improved outcome in patients with acute ischemic stroke and PAF, compared to those with sustained AF.

Methods: Consecutive ischemic stroke patients with first-ever acute stroke and confirmed PAF during hospitalization were followed for up to 10 years after the index stroke or until death. We investigated the association of in-hospital SR restoration with 10-year all-cause mortality, stroke recurrence, and major adverse cardiovascular events (MACE). Cox regression analysis was performed to identify independent predictors of each outcome.

Results: Among 313 ischemic stroke patients with PAF, 230 (73.5%) patients had in-hospital SR restoration, whereas SR was not restored in 83 (26.5%) patients. SR restoration was significantly associated with early rhythm control [odds ratio (OR):3.29, 95% confidence intervals (CI):1.90-7.1]. During a mean period of 41.6 ± 40.9 months, there were 12.3 deaths, 4.8 stroke recurrences and 6.7 MACE per 100patient-years in patients with SR restoration and 23.5 deaths, 9.4 stroke recurrences and 15.7 MACE per 100patient-years in those without. On multivariable analysis, SR restoration was associated with a significantly lower risk of death [adjusted hazards ratio (adjHR):0.66; 95% CI:0.43-0.99], stroke recurrence (adjHR:0.54; 95% CI:0.30-0.98) and MACE (adjHR:0.54; 95% CI 0.33-0.88).

Conclusion: Early restoration of sinus rhythm is associated with improved survival and lower risk of stroke recurrence and MACE in patients with acute ischemic stroke and PAF.

Disclosure: No

O044 / 1065

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

LEFT ATRIAL APPENDAGE CLOSURE YIELDS FAVORABLE CARDIO- AND CEREBROVASCULAR OUTCOMES IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION AND PRIOR STROKE

M. Zhao ^1,2, M. Zhao³, C.R. Hou⁴, F. Post⁵, N. Herold⁵, J. Walsleben⁵, Z. Meng^1,6, J. Yu^1,5

¹Helmut-G.-Walther-Klinikum, Department of Cardiology, Lichtenfels, Germany, ²Zhengzhou Ninth People’s Hospital, Heart Center, Zhengzhou, China, ³Beijing Tiantan Hospital, Capital Medical University, Department of Neurology, Beijing, China, ⁴University of Minnesota Medical School, Minneapolis, United States, ⁵Catholic Medical Center, Clinic for General Internal Medicine and Cardiology, Koblenz-Montabaur, Germany, ⁶Kunming Medical University, Department of Cardiology, Kunming, China

Background and aims: Patients with non-valvular atrial fibrillation (NVAF) and previous stroke are at significantly higher risk of stroke recurrence. Data regarding the effect of left atrial appendage closure(LAAC) on these patients is limited. The aim of this study is to investigate the differences of LAAC efficacy on long-term cardio- and cerebrovascular outcomes in NVAF patients with versus without prior stroke.

Methods: 370 consecutive NVAF patients who underwent LAAC were enrolled and divided into stroke and non-stroke groups based on history of previous stroke. Endpoints, such as thromboembolism, major bleeding, and mortality post-LAAC, were followed up among groups.

Results: Patients in the stroke group had higher mean CHA₂DS₂-VASc and HAS-BLED scores compared to the non-stroke group (P < 0.0001). In both groups, LAAC decreased the risk of thromboembolism [RRR 87.5%, P = 0.0335, and 74.6%,P = 0.0035, respectively] and major bleeding (RRR 68.8%and68.6%, P < 0.01, respectively) compared with predicted risk. The extent of RRR in thromboembolism was higher in patients with prior stroke (OR 2.451, 95% CI: 1.200 ~ 5.123, P=0.0155). The risks of cardiovascular death post-LAAC both before (P=0.038) and after adjustment for confounding factors (HR 0.1658, 95% CI: 0.04896 ~ 0.5616, P=0.048) were significantly decreased in the stroke group.

Conclusions: LAAC was associated with significantly lower risks of thromboembolism and major bleeding compared to predicted risks. Despite having a higher CHA₂DS₂-VASc and HAS-BLED scores, patients with prior stroke presented a more favorable long-term outcomes in risk reduction of thromboembolism and cardiovascular death events than those without prior stroke.

Disclosure: No

O045 / 984

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

NATRIURETIC PEPTIDES IMPROVE THE PERFORMANCE OF ATRIAL FIBRILLATION RISK SCORES: DATA FROM THE BIOSIGNAL COHORT

A. Cameron ¹, M. Arnold², H.K. Cheng¹, J. Lin¹, J. Yang¹, J. Schweizer², V. Schütz², T. Pokorny², C. Inauen², L.P. Westphal², M. Arnold³, U. Fischer^3,4, L.H. Bonati⁴, G.M. De Marchis⁴, T. Kahles⁵, K. Nedeltchev⁵, C.W. Cereda⁶, G. Kägi^7,3, A. Bustamante⁸, J. Montaner^8,9, G. Ntaios¹⁰, C. Foerch¹¹, K. Spanaus¹², L. Sahle¹², A. von Eckardstein¹², J. Dawson¹, M. Katan^2,4

¹University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom, ²University of Zurich, Department of Neurology, Zurich, Switzerland, ³Universit Hospital Bern, Department of Neurology, Bern, Switzerland, ⁴University Hospital Basel and University of Basel, Department of Neurology, Basel, Switzerland, ⁵Cantonal Hospital Aarau, Department of Neurology, Aarau, Switzerland, ⁶Regional Hospital of Lugano, Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland, ⁷Cantonal Hospital St. Gallen, Department of Neurology, St. Gallen, Switzerland, ⁸Vall d'Hebron Institute of Research (VHIR), Neurovascular Research Laboratory, Barcelona, Spain, ⁹Hospital Universitario Virgen Macarena, Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Seville, Spain, ¹⁰University of Thessaly, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, Larissa, Greece, ¹¹Goethe University, Department of Neurology, Frankfurt, Germany, ¹²University Hospital of Zurich, Institute of Clinical Chemistry, Zurich, Switzerland

Background: Atrial fibrillation (AF) risk scores may help identify people who benefit most from prolonged cardiac monitoring to search for newly detected AF (NDAF) after ischaemic stroke (IS), but the performance of existing scores is modest. We assessed and compared the effect of adding the blood-based biomarkers midregional proatrial natriuretic peptide (MRproANP) or N-terminal pro B-type natriuretic peptide (NTproBNP) to existing AF risk scores.

Methods: We conducted an analysis of people with IS included in the BIOSIGNAL study (NCT02274727) with no history of AF. Area under the receiver operating characteristic (AUROC) curves were constructed for the outcome of ⩾30 seconds NDAF during 1-year follow-up using MRproANP or NTproANP. AUROC curves were also constructed for NDAF using the AS5F, CHASELESS, CHA₂DS₂-VASc and CHARGE-AF scores ± MRproANP or NTproBNP. AUROCs were compared using De Long’s test.

Results: We included 1430 IS patients without history of AF: 587 (41%) female and mean±SD age 70±14 years. The AUROC (95%CI) for ln-MRproANP was 0.79 (0.76-0.82) and 0.78 (0.75-0.81) for ln-NTproBNP (p=0.17).

AUROC-curves (95%CI) for AF risk scores applied to the dataset are detailed in Table 1. Adding ln-MRproANP or ln-NTproBNP to existing scores improved the performance of all scores (all p<0.001, Table 1).

AF Risk Score	Risk ScoreAUROC (95% CI)	Risk score + ln-MRproANPAUROC (95% CI)	Risk score + ln-NTproBNPAUROC (95% CI)
AS5F	0.70 (0.66-0.73)	0.79 (0.76-0.82)	0.78 (0.75-0.81)
CHASELESS	0.69 (0.65-0.72)	0.79 (0.76-0.82)	0.78 (0.75-0.81)
CHA2DS2-VASc	0.66 (0.62-0.69)	0.81 (0.78-0.84)	0.80 (0.77-0.83)
CHARGE-AF	0.67 (0.63-0.70)	0.79 (0.76-0.82)	0.77 (0.74-0.80)

In direct comparison of AUROC curves, the effect of including ln-MRproANP versus ln-NTproBNP was similar for all scores (all p>0.05).

Conclusions: The natriuretic peptides MRproANP and NTproBNP improve performance of all assessed clinical AF risk-scores and may help identify people most likely to benefit from prolonged cardiac monitoring after IS.

Disclosure: Yes

O046 / 385

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

ATRIAL FIBRILLATION IN CRYPTOGENIC STROKE AND TIA PATIENTS IN THE NORDIC ATRIAL FIBRILLATION AND STROKE (NOR-FIB) STUDY: TOPLINE RESULTS. (CLINICALTRIALS.GOV NONCT02937077)

B. Ratajczak-Tretel ^1,2, A. Tancin Lambert^1,2, R. Al-Ani³, K. Arntzen⁴, G.K Bakkejord⁴, H.M.O. Bekkeseth⁵, G. Eldøen⁶, A. Gulsvik⁷, G.A. Høie³, H. Ihle-Hansen⁸, H. Ihle-Hansen⁹, S. Ingebrigtsen¹⁰, C. Kremer¹¹, S.B Krogseth¹², C. Kruuse¹³, M. Kurz¹⁴, I. Nakstad¹⁵, V. Novotny¹⁶, R. Qazi⁷, M.K Rezaj¹⁴, D.M. Rørholt⁶, L.H. Steffensen¹⁰, J. Sømark⁵, H. Tobro¹⁷, T.C Truelsen¹⁸, L. Wassvik¹⁹, K.L Ægidius¹⁹, D. Atar^2,20, A.H. Aamodt²¹, NOR-FIB Study Group

¹Østfold Hospital Trust, Department of Neurology, Grålum, Norway, ²University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ³Østfold Hospital Trust, Department of Cardiology, Grålum, Norway, ⁴Nordlandssykehuset, Department for Neurology, Bodø, Norway, ⁵Innlandet Hospital Trust, Lillehammer Hospital, Department of Neurology, Lillehammer, Norway, ⁶Molde Hospital, Department of Neurology, Molde, Norway, ⁷Diakonhjemmet Hospital, Department of Internal Medicine, Oslo, Norway, ⁸Oslo University Hospital, Ullevål, Stroke Unit, Oslo, Norway, ⁹Vestre Viken Hospital Trust, Bærum Hospital, Department of Internal Medicine, Gjettum, Norway, ¹⁰University Hospital of North Norway, Department of Neurology, Tromsø, Norway, ¹¹Skåne University Hospital, Department of Neurology, Malmö, Sweden, ¹²Vestfold Hospital, Department of Neurology, Tønsberg, Norway, ¹³Herlev Gentofte Hospital, Department of Neurology, Herlev, Denmark, ¹⁴Stavanger University Hospital, Department of Neurology, Stavanger, Norway, ¹⁵Vestre Viken Hospital Trust, Drammen Hospital, Department of Neurology, Drammen, Norway, ¹⁶Haukeland University Hospital, Department of Neurology, Bergen, Norway, ¹⁷Telemark Hospital, Department of Neurology, Skien, Norway, ¹⁸Rigshospitalet University Hospital, Department of Neurology, Copenhagen, Denmark, ¹⁹Bispebjerg University Hospital, Department of Neurology, Copenhagen, Denmark, ²⁰Oslo University Hospital, Ullevål, Department of Cardiology, Oslo, Norway, ²¹Oslo University Hospital, Rikshospitalet, Department of Neurology, Oslo, Norway

Background and aims: Prolonged cardiac rhythm monitoring to rule out occult atrial fibrillation (AF) in cryptogenic stroke (CS) has been recommended since 2014. However, insertable cardiac monitors (ICMs), most suitable for this purpose, are still not implemented in any stroke guidelines. The aim of the prospective observational multicenter NOR-FIB study was to detect and quantify AF in patients with CS or TIA using an ICM (Reveal LINQ®).

Methods: All patients diagnosed with CS or TIA after protocolled work-up were followed for 12 months. If AF ⩾2 min was detected on ICM they were recommended to switch from antiplatelet therapy to oral anticoagulation (OAC).

Results: After follow-up 74 of 259 patients (28.6 %) were diagnosed with paroxysmal AF, of which 91.9% asymptomatic. AF patients had higher age (72.6 vs 62.2; p<0.001), pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p<0.001), NIHSS (median 2 vs 1; p 0.002) and more often hypertension and dyslipidemia than non-AF patients.

In 86.5% AF was detected within the first months of monitoring (mean 47.7 days ± 52.1). Recurrent AF occurred in 91.9% and 97.3% of the AF patients were switched to OAC. Recurrent strokes occurred in 2 AF patients (2.7 %) and in 9 non-AF patients (4.9 %).

Conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would have gone undiagnosed without ICM. The implantation and use of ICM were fully practicable for stroke physicians in stroke units.

Disclosure: Yes

O047 / 1280

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

ISCHAEMIC STROKES ON ORAL ANTICOAGULANT IN PATIENTS WITH ATRIAL FIBRILLATION: THE NEURO-AFIB STUDY

M.E. Gurol ¹, A.S. Das², N. Daoud¹, A. Abramovitz¹, E. Gokcal¹, E.E. Smith³, S. Yaghi⁴, Neuro-AFib Study Group

¹Massachusetts General Hospital, Neurology, Boston, United States, ²Beth Israel Deaconess Medical Center, Neurology, Boston, United States, ³University of Calgary, Neurology, Calgary, Canada, ⁴Brown University, Neurology, Providence, United States

Background and aims: We aimed to study the causes of ischaemic strokes (IS) in patients with atrial fibrillation (AF) who were using either direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA).

Methods: The Neuro-AFib study is a multicenter effort geared toward elucidating the causes and consequences of strokes in a contemporary AF cohort. Detailed clinical, laboratory and multimodal imaging data from known AF patients consecutively admitted to 22 stroke centers with an IS between 1/2018-12/2019 were used to compare characteristics of IS on vs off oral anticoagulants.

Results: A total of 4898 IS patients had known AF prior to the acute IS. Among these patients, 2204 (45%) were using oral anticoagulants [DOAC (59.3%) or VKA (40.7%)]. Patients who had IS on OAC were younger (76.8±11 vs 78±12, p=0.001), had higher mean CHA₂DS₂-VASc scores (4.17±1.5 vs 3.9±1.5, p<0.0001), and more likely to have a past-history of IS/TIA when compared to non-OAC group (35% vs 23%, p<0.0001). In a multivariable logistic regression model, history of IS/TIA, diabetes, hyperlipidemia, heart failure, prosthetic heart valve, sleep apnea, permanent atrial fibrillation, left atrial dilation and ischemic arterial disease were all independently associated with IS on OAC (all p<0.05). An alternate IS aetiology such as lacunar infarct, extracranial/intracranial large vessel disease or malignancy/hypercoagulable state was found in 33% of patients.

Conclusions: Based on a large multicenter cohort, AF patients who have IS on OAC have multiple vascular risk factors, most don't have a concurrent aetiology and they are more likely to have recurrent ischaemic events.

Disclosure: Yes

O048 / 882

Scientific Communications 5 – Cardioembolism & Heart-Brain Interactions

TROPONIN LEVEL BUT NOT CARDIAC MORPHOLOGY CORRELATES WITH WHITE MATTER LESIONS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE. RESULTS OF THE PROSPECTIVE SICFAIL COHORT STUDY

F.A. Montellano ^1,2,3, K. Ungethüm¹, V. Rücker¹, M.L. Vogt⁴, S. Jans⁴, D. Mackenrodt^1,2,3, S. Wiedmann^1,5, F. Sahiti^3,6, C. Morbach^3,6, S. Frantz^3,6, S. Störk^3,6, M. Pham⁴, C. Kleinschnitz⁷, K.G. Haeusler², P.U. Heuschmann^1,3,8

¹University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany, ²University Hospital Würzburg, Department of Neurology, Würzburg, Germany, ³Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany, ⁴University Hospital Würzburg, Department of Diagnostic and Interventional Neuroradiology, Würzburg, Germany, ⁵Charité – Universitätsmedizin Berlin, Berlin, Germany, ⁶University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany, ⁷University Hospital Essen, Department of Neurology, Essen, Germany, ⁸University Hospital Würzburg, Clinical Trial Centre, Würzburg, Germany

Background and aims: Markers of left ventricular (LV) structure and blood-based cardiac biomarkers have been associated with the extent of magnetic resonance imaging (MRI)-detected white matter hyperintensities (WMH) in the general population or acute ischemic stroke (AIS) patients with limited cardiac diagnostic workup. We investigated cardiac correlates of WMH in AIS patients undergoing detailed cardiac phenotyping.

Methods: Data were collected within the single-center Stroke Induced Cardiac FAILure (SICFAIL) study. We used ordinal regression analysis to investigate the associations of echocardiographic markers of left ventricular (LV) structure and cardiac biomarkers with increasing WMH severity (Fazekas scale) in patients with MRI-confirmed AIS, adjusted for cardiovascular risk factors.

Results: Among 459 patients (median age 71 years (quartiles 61-71); admission NIHSS score 3 points (1.5-5); 64% men; Fazekas score 0/1/2/3 was 24%/24%/39%/13%) high-sensitive troponin T (hs-TnT) at day 3 (2-4) after stroke onset was associated with increasing WMH burden (Fazekas scale) (odds ratio (OR) 2.94 per log unit, 95% confidence interval (CI) 1.55-5.59), but not NT-proBNP, LV end-diastolic diameter, LV septum, LV posterior wall thickness, or LV mass index. Adjustment for markers of LV structure did not attenuate the association of hs-TnT and WMH burden. We identified a significant interaction between arterial hypertension and hs-TnT (p=0.010).

Conclusion: In AIS patients undergoing detailed cardiac phenotyping, hs-TnT was associated with increasing WMH severity, independent of markers of LV structure. Arterial hypertension modified this association, suggesting that hypertension plays a relevant role in the development of both, acute cardiac and chronic brain injury in AIS patients.

Trial registration number: DRKS00011615

Disclosure: No

O049 / 639

Scientific Communications 6 - Intravenous Thrombolysis

INTRAVENOUS THROMBOLYSIS WITH TENECTEPLASE VERSUS ALTEPLASE IN ACUTE ISCHEMIC STROKE PATIENTS WITHIN 4.5 HOURS FROM SYMPTOM ONSET: A PROPENSITY SCORE-MATCHED ANALYSIS FROM THE SITS-ISTR REGISTRY

A. Katsanos ¹, C. Christogiannis², B. Faouzi³, D. Mavridis², A. Dixit⁴, L. Palaiodimou⁵, D. Khurana⁶, M. Petruzzellis⁷, K. Psychogios⁸, M.J. Macleod⁹, N. Ahmed¹⁰, G. Tsivgoulis⁵

¹McMaster University, Hamilton, Canada, ²University of Ioannina, Ioannina, Greece, ³Hassan II University Teaching Hospital, Fez, Morocco, ⁴Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, United Kingdom, ⁵National and Kapodistrian University of Athens, Athens, Greece, ⁶Postgraduate Institute of Medical Education and Research, Chandigarh, India, ⁷University of Bari 'Aldo Moro', Bari, Italy, ⁸Metropolitan Hospital, Piraeus, Greece, ⁹University of Aberdeen, Aberdeen, United Kingdom, ¹⁰Karolinska Institutet, Stockholm, Sweden

Background and aim: Intravenous thrombolysis (IVT) with tenecteplase has been associated with better clinical outcomes in acute ischemic stroke (AIS) patients with confirmed large vessel occlusions compared to IVT with alteplase. However, the utility of tenecteplase for the treatment of all AIS patients eligible for IVT has not been established.

Methods: We compared the safety and efficacy of tenecteplase vs. alteplase in AIS patients by analysing propensity score matched data from 20 centres participating in the SITS-ISTR registry. Patients receiving IVT with tenecteplase were matched with up to three patients receiving alteplase from the same centre. The primary outcome of interest was the distribution of 3-month functional outcomes. Secondary outcomes included the rates of patients with symptomatic intracranial hemorrhage (SICH) in the first 24 hours, favorable functional outcome (FFO; mRS-scores of 0-1), functional independence (FI; mRS-scores of 0-2) and all-cause mortality at 3 months.

Results: A total of 331 tenecteplase-treated AIS patients were matched to 797 patients treated with alteplase [mean age of matched population: 68.2±14.4 years; 43.9% women; median NIHSS-score: 11 (IQR:6-17)]. Patients treated with tenecteplase had more favorable 3-month functional outcomes (common OR=1.35, 95%CI:1.03-1.76) with higher odds of FI (OR=1.58, 95%CI:1.12-2.27) and a lower likelihood of all-cause mortality (OR=0.65, 95%CI:0.43-0.98) at 3 months, compared to alteplase-treated patients. No difference was found in the likelihood of SICH (0.9% vs. 1.25%; OR=0.70, 95%CI:0.18-2.63) and 3-month FFO (OR=1.15, 95%CI:0.79-1.66).

Conclusions: In this study, IVT with tenecteplase was associated with more favorable 3-month clinical outcomes compared to alteplase in AIS patients.

Disclosure: No

O050 / 547

Scientific Communications 6 - Intravenous Thrombolysis

TREATMENT TIMES, FUNCTIONAL OUTCOME AND HEMORRHAGE RATES AFTER SWITCHING TO TENECTEPLASE FOR STROKE THROMBOLYSIS A SUBGROUP STUDY OF THE TETRIS REGISTRY

G. Gerschenfeld ¹, J.-S. Liegey², F.-X. Laborne³, M. Yger¹, V. Lyon², T. Checkouri¹, B. Tricard-Dessagne², G. Marnat⁴, F. Clarençon⁵, N. Chausson⁶, G. Turc⁷, I. Sibon², S. Alamowitch¹, S. Olindo², TETRIS Study Group

¹APHP, Sorbonne Université, Pité-Salpêtrière and Saint-Antoine Hospitals, Urgences Cérébro-Vasculaires, Paris, France, ²CHU de Bordeaux, Neurology department, Bordeaux, France, ³Hôpital Sud Francilien, Unité de Recherche Clinique, Corbeil-Essonnes, France, ⁴CHU de Bordeaux, Neuroradiology department, Bordeaux, France, ⁵APHP, Sorbonne Université, Pité-Salpêtrière Hospital, Neuroradiology department, Paris, France, ⁶Hôpital Sud Francilien, Neurology, Corbeil-Essonnes, France, ⁷GHU Paris Psychiatrie et Neurosciences, Neurology, Paris, France

Background and aims: The non-inferiority of tenecteplase to alteplase in ischemic stroke and its practical advantages motivated our centers to switch from alteplase to tenecteplase. We report its impact on treatment times and clinical outcomes.

Methods: We retrospectively analyzed clinical and procedural data of patients treated with alteplase or tenecteplase in a comprehensive (CSC) and a primary stroke center (PSC), from 09/01/2016 to 12/31/2020. Tenecteplase enabled in-MRI thrombolysis in the CSC. The protocol was unchanged in the PSC. We assessed the association of tenecteplase with 3-month functional independence and PH with multivariable logistic models.

Results: We included 795 patients, 387 (48.7%) received alteplase and 408 (51.3%) tenecteplase. Both groups (tenecteplase vs alteplase) were similar in terms of age (75 vs 76 years), baseline NIHSS score (7 vs 7.5) and proportion of patients treated with mechanical thrombectomy (24.0% vs 27.4%). Tenecteplase patients had a shorter imaging-to-thrombolysis time (27 vs 36 minutes, P<0.0001) mainly driven by patients treated in the CSC (22 vs 38 minutes, P<0.001). In the PSC, tenecteplase patients had shorter thrombolysis-to-puncture times (84 vs 95 minutes, P=0.02), reflecting faster interhospital transfer for MT. Three-month functional independence rate was higher in the tenecteplase group (62.8% vs 53.4%, P<0.01), with no difference in terms of sICH (2.5% vs 3.6%). In the multivariable analysis, tenecteplase was significantly associated with functional independence (OR_a 1.75, _95%CI 1.17-2.60, P<0.01) and not PH (OR_a 0.70, _95%CI 0.42-1.14, P=0.15).

Conclusions: Switch from alteplase to tenecteplase reduces process times and may improve functional outcome, with similar safety profile.

Disclosure: No

O051 / 1236

Scientific Communications 6 - Intravenous Thrombolysis

INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH ISCHAEMIC STROKE TAKING DIRECT ORAL ANTICOAGULANTS – AN INTERNATIONAL COLLABORATION

J.C. Purrucker ¹, D. Wilson^2,3, T. Meinel⁴, H. Gensicke⁵, J.F. Scheitz^6,7, C.H Nolte^6,7, S. Engelter^5,8, P.A. Ringleb¹, T.Y.-H. Wu^2,3, D. Seiffge⁴, on behalf of the international DOAC-IVT and TRISP collaboration. *JP, DW, TM, TW and DS contributed equally.

¹Heidelberg University Hospital, Department of Neurology, Heidelberg, Germany, ²Christchurch Hospital, Department of Neurology, Christchurch, New Zealand, ³New Zealand Brain Research Institute, Christchurch, New Zealand, ⁴Inselspital University Hospital Bern, Department of Neurology, Bern, Switzerland, ⁵University Hospital Basel, Department of Neurology and Stroke Center, Basel, Switzerland, ⁶Charité-Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany, ⁷Charité-Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany, ⁸University of Basel, University Department of Geriatric Medicine Felix Platter, Neurology and Neurorehabilitation, Basel, Switzerland

Background and aims: International guidelines recommend avoiding intravenous thrombolysis (IVT) in patients on direct oral anticoagulant (DOAC) therapy with last intake within 48 hours, thereby restricting this treatment in patients who would otherwise benefit. Different criteria to select patients for IVT have been proposed but they lack comprehensive comparison.

Methods: We identified stroke centres across 5 continents with datasets of patients with DOACs who received IVT and invited centres to join an international, multi-centre collaboration (CRD42021277825). We included patients with ischaemic stroke on prior DOAC therapy (last intake <48h or unknown) who received IVT (with/out thrombectomy). We excluded patients with known last DOAC-intake >48h prior to stroke onset. Main outcome was symptomatic intracerebral haemorrhage (sICH). Patients will be grouped according to selection criteria applied prior to IVT use: a) DOAC-level based, b) IVT-after-reversal agent use, c) time/unspecific coagulation parameter-based and d) no selection criteria (last DOAC-intake unknown prior to IVT). We will conduct subgroup analysis in patients with documented last intake <12h and/or DOAC-levels >30 or 100ng/ml at the time of IVT.

Results: We enrolled patients from >30 centres with more than >300 IVT-treated stroke patients on prior DOAC therapy. We will present the results of the primary analysis at ESOC and provide specific subgroup results according to different selection approaches.

Conclusions: Current guideline recommendations are restrictive regarding the use of IVT in patients with stroke and prior DOAC intake. We will present data from a large multinational observational study on IVT treatment in stroke patients with verified DOAC intake.

Disclosure: Yes

O052 / 1133

Scientific Communications 6 - Intravenous Thrombolysis

INTRAVENOUS THROMBOLYSIS VERSUS DUAL ANTIPLATELET THERAPY IN PATIENTS WITH MILD ISCHEMIC STROKE

M. Sykora ^1,2, S. Krebs², D. Miksova³, I. Badic⁴, J. Ferrari², W. Lang^1,2

¹SFU Vienna, Neurology, Vienna, Austria, ²St. John Hospital, Neurology, Vienna, Austria, ³GOEG, Vienna, Austria, ⁴Sigmund Freud University Vienna, Neurology, Vienna, Austria

Background and aims: It is unclear whether intravenous thrombolysis (IVT) outperforms early dual antiplatelet therapy (DAPT) in the setting of mild ischemic stroke. The aim of this study was to compare safety and efficacy of IVT as compared to DAPT.

Methods: Data of mild non-cardioembolic stroke patients with admission NIHSS <=3 who received IVT or early DAPT in the period 2018-2021 were extracted from a nationwide, prospective stroke unit registry. Study endpoints included symptomatic intracerebral haemorrhage (sICH) according to ECASS3 criteria, early neurological deterioration ³4 NIHSS points (END), NIHSS 0 at discharge and 3-months functional outcome by modified Rankin Score (mRS).

Results: 1707 stroke patients treated with IVT and 420 treated with DAPT were included. Both groups had comparable age (68.3 vs 68.4 years) and pre-stroke mRS (median 0 versus 0). IVT patients had less hypertension (72% versus 80.5%), diabetes (18.5% versus 24%) and history of myocardial infarction (8.5% versus 11.7%) and slightly higher admission NIHSS scores (median 2 versus median 1) as compared to DAPT patients. In the multivariable analysis, IVT was associated with sICH (adjusted OR (aOR) 7.3, CI 0.99-55.6), END (aOR 8.2, CI 2.5-27.5), NIHSS 0 at discharge (aOR 0.81, CI 0.62-1.05) and mRS 0-1 at 3 months (aOR 0.94, CI 0.69-1.41).

Conclusions: This large non-randomized comparison may indicate that IVT is not superior to DAPT in the setting of mild non-cardioembolic stroke and may eventually be associated with harm. Further research focusing acute therapy of mild stroke seems to be highly warranted.

Disclosure: No

O053 / 1001

Scientific Communications 6 - Intravenous Thrombolysis

INTRAVENOUS THROMBOLYSIS BEFORE MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE DUE TO LARGE VESSEL OCCLUSION; SHOULD WE CROSS THAT BRIDGE? A SYSTEMATIC REVIEW AND META-ANALYSIS OF 36,123 PATIENTS

H. Ghaith ¹, A. Negida², M. Diaa³, A. Nawar⁴, M. Sameh⁵, K. Hamam⁵, L. Aboelnasr⁶, E. Elgezery⁷, U. Kanmounye⁸, M. Elfil⁹

¹Al-Azhar University, Faculty of Medicine, Cairo, Egypt, ²Harvard Medical School, Department of Global Health, Boston, Massachusetts, United States, ³South Valley University, Faculty of Medicine, Qina, Egypt, ⁴Zagazig University, Faculty of Medicine, Zagazig, Egypt, ⁵October 6 University, Giza, Egypt, Faculty of Medicine, October, Egypt, ⁶Misr University for Science and Technology, 6th October city, Egypt, Faculty of Medicine, October, Egypt, ⁷Menofia University, Menofia, Egypt, Faculty of Medicine, Menofia, Egypt, ⁸Association of Future African Neurosurgeons, Yaounde, Cameroon, Research department, Yaounde, Cameroon, ⁹University of Nebraska Medical Centre, Omaha, Nebraska, USA, Department of Neurological Sciences, Omaha, Nebraska, United States

Background: The use of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been a question of debate in the field of neuro-interventional surgery. We conducted this systematic review and meta-analysis to synthesize evidence from published studies on the outcomes of bridging therapy (IVT+MT) compared to direct MT alone in patients with AIS-LVO.

Methods: A computer literature search of PubMed, Scopus, Web of Science, and Cochrane CENTRAL was conducted until January 2022 to identify the relevant studies. Data were extracted and pooled in the DerSimonian and Laird random-effects model using the Review Manager software.

Results: Forty-nine studies (4 RCTs and 45 observational studies), with a total of 36,123 patients, were included in this meta-analysis. IVT+MT was significantly superior to MT alone in terms of successful recanalization (RR 1.06, 95% CI 1.03 to 1.09), mortality (RR 0.75, 95% CI 0.68-0.82), favorable functional outcome on the modified Rankin scale (RR 1.21, 95% CI 1.13 to 1.29), and complete recanalization (RR 1.06, 95% CI 1.00 to 1.11). There were no significant differences between the two groups in terms of improvement of the NIHSS score at 24 hours or at discharge (P>0.05). Complications including symptomatic intracranial hemorrhage, symptomatic intracerebral hemorrhage, procedure-related complications were comparable between the two groups (P>0.05).

Conclusion: For patients with AIS-LVO, bridging therapy of IVT+MT is associated with slightly better rates of survival, successful and complete recanalization, and favorable functional outcome as compared with MT alone.

Disclosure: No

O054 / 493

Scientific Communications 6 - Intravenous Thrombolysis

INFLUENCE OF TIME METRICS ON THE EFFECT OF INTRAVENOUS ALTEPLASE PRIOR TO ENDOVASCULAR TREATMENT IN THE MR CLEAN NO-IV TRIAL

L.A. Rinkel ¹, K.M. Treuniet², M. Kappelhof², N.E. LeCouffe¹, A. Bruggeman², D. Nieboer³, W.H. van Zwam⁴, M. Uyttenboogaart^5,6, D.W. Dippel⁷, B.J. Emmer², Y.B. Roos¹, C.B. Majoie², J.M. Coutinho¹, on behalf of the MR CLEAN-NO IV Investigators

¹Amsterdam University Medical Centres, Location AMC, Neurology, Amsterdam, Netherlands, ²Amsterdam University Medical Centres, Location AMC, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ³Erasmus MC University Medical Centre, Public Health, Rotterdam, Netherlands, ⁴Maastricht University Medical Centre, Radiology and Nuclear Medicine, Maastricht, Netherlands, ⁵University Medical Centre Groningen, Neurology, Groningen, Netherlands, ⁶University Medical Centre Groningen, Radiology and Nuclear Medicine, Groningen, Netherlands, ⁷Erasmus MC University Medical Centre, Neurology, Rotterdam, Netherlands

Introduction: We assessed whether the treatment effect of intravenous alteplase (IVT) prior to endovascular treatment (EVT) on functional outcome is modified by time metrics.

Methods: We included data from all patients in MR CLEAN-NO IV, a randomised trial of IVT followed by EVT versus EVT alone in patients who presented directly to EVT capable hospitals. Primary outcome was the modified Rankin scale score at 90 days. We used ordinal regression with a multiplicative interaction term to assess if the effect of IVT is modified by onset-to-randomization (OTR), onset-to-needle (OTN), door-to-groin (DTG) or needle-to-groin (NTG) times. Secondary outcomes included successful reperfusion. Missing data were imputed using multiple imputation. Time intervals were analysed as continuous variables.

Results: In 539 included patients (266 allocated to IVT plus EVT and 273 to EVT alone), median times were: OTR: 93 (IQR 71–145); OTN: 98 (IQR 75–156); DTG: 64 (IQR 51–78), and NTG: 28 (IQR 20–41). There was a significant association between worse outcomes and longer time intervals for all metrics except NTG. We found no interaction between any of the time metrics and IVT for the effect on functional outcome (p-values for interaction: OTR=0.40, OTN=0.39, DTG=0.61, NTG=0.56, figure 1). We also did not observe any significant interaction for successful reperfusion.

Conclusions: In MR CLEAN-NO IV, the effect of IVT prior to EVT was not modified by OTR, OTN, DTG or NTG times. Our results do not support the use of these metrics to guide IVT treatment decisions in eligible patients.

Disclosure: No

O055 / 1130

Scientific Communications 6 - Intravenous Thrombolysis

TRENDS OF FUNCTIONAL OUTCOME IN ACUTE STROKE PATIENTS TREATED WITH INTRAVENOUS THROMBOLYSIS;

M. Marko ¹, D. Miksova², J. Ebner¹, M. Lang¹, W. Serles¹, P. Sommer³, M. Sykora⁴, W. Lang⁴, M. Knoflach⁵, S. Kiechl⁵, S. Greisenegger¹

¹Medical University of Vienna, Department of Neurology, Vienna, Austria, ²Gesundheit Österreich GmbH, Vienna, Austria, ³Krankenanstalt Rudolfstiftung, Department of Neurology, Vienna, Austria, ⁴Krankenhaus Barmherzige Brüder, Department of Neurology, Vienna, Austria, ⁵Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria

Background and aims: Frequencies of rtPA-treatment for acute stroke have been increasing over time. We aimed to investigate trends in frequencies of good functional outcome in rtPA-treated patients and to assess the influence of clinical variables on functional outcome.

Methods: We analyzed patient data in the Austrian Stroke Unit Registry from 2006 to 2019. Frequencies of favorable outcome, defined as modified Rankin Scale (mRS) 0-2, were assessed for the overall population and prespecified subgroups. Logistic regression analysis was performed to evaluate associations of baseline characteristics, including relevant interaction terms, with functional outcome.

Results: Overall, 4865/9409 rtPA-treated patients (51.7%) achieved favorable outcome at 3 months. Frequencies of favorable outcome increased from 45.9% in 2006 to 56.8% in 2019. In logistic regression analysis, year of treatment (OR 1.08, 95%CI 1.01-1.15) was associated with favorable outcome. Stroke severity (NIHSS, OR 0.86, 95%CI 0.85-0.87), age (61-70 years: OR 0.67, 95%CI 0.55-0.80, 71-80 years: OR 0.42, 95%CI 0.35-0.50, >80 years: OR 0.16, 95%CI 0.13-0.20), female sex (OR 0.53, 95%CI 0.89-0.99), and cardiovascular comorbidities were negatively associated. Including interaction terms into the model we observed an association of favorable outcome with interactions between stroke severity and year of treatment (OR 1.01, 95%CI 1.0 – 1.02), and stroke severity and endovascular treatment (EVT, OR 1.02, 95%CI 1.01 – 1.03).

Conclusions: Frequencies of favorable outcome in rtPA-treated patients have been increasing over time, likely driven by improved outcome in more severely affected patients receiving EVT. However, specific subgroups are less likely to achieve functional independency and deserve further attention.

Disclosure: No

O056 / 611

Scientific Communications 6 - Intravenous Thrombolysis

EFFECT OF INTRAVENOUS ALTEPLASE ON PATIENT-REPORTED HEALTH-RELATED QUALITY OF LIFE AFTER STROKE IN THE WAKE-UP TRIAL

M. Jensen ¹, S. Sehner², B. Cheng², E. Schlemm², F. Quandt², E. Barow², F. Boutitie³, M. Ebinger⁴, M. Endres⁴, J.B. Fiebach⁴, V. Thijs⁵, R. Lemmens⁶, K.W. Muir⁷, N. Nighoghossian⁸, S. Pedraza⁹, C.Z. Simonsen¹⁰, G. Thomalla¹¹, C. Gerloff¹¹

¹University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany, ²University Medical Center Hamburg-Eppendorf, Hamburg, Germany, ³Hospices Civils de Lyon, Lyon, France, ⁴Charité - Universitätsmedizin Berlin, Berlin, Germany, ⁵Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, ⁶University Hospitals Leuven, Leuven, Belgium, ⁷University of Glasgow, Glasgow, United Kingdom, ⁸Université Claude Bernard Lyon 1, Lyon, France, ⁹Hospital Dr Josep Trueta, Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain, ¹⁰Aarhus University Hospital, Aarhus, Denmark, ¹¹University Medical Center-Hamburg Eppendorf, Hamburg, Germany

Background and aims: Intravenous alteplase is standard of care for acute ischemic stroke. We aimed to study the effect of intravenous alteplase on self-reported health-related quality of life (HRQoL) after stroke.

Methods: WAKE-UP was a multicenter, randomized, placebo-controlled clinical trial of MRI-guided intravenous alteplase in stroke with unknown onset time. HRQoL was assessed using the EQ-5D questionnaire at 90 days, comprising the EQ-5D utility index and the EQ visual analogue scale (VAS). Functional outcome was assessed by the modified Rankin Scale (mRS). Treatment effect on EQ-5D utility index and EQ VAS was calculated using multiple linear regression models. We also performed mediation analysis to explore the extent to which the effect of alteplase on HRQoL was mediated by functional outcome.

Results: Treatment with alteplase was associated with a higher mean EQ-5D utility index reflecting a better health state as compared to placebo (0.75 vs. 0.67) with an adjusted mean difference of 0.07 (95% CI 0.02-0.13, P=0.007). Mean EQ VAS was also higher with alteplase than with placebo (72.6 vs. 64.9), adjusted mean difference 7.6 (95% CI 3.7-11.5, P<0.001). In mediation analysis, 80% of the total effect of alteplase on the EQ-5D utility index was mediated via the mRS score. In contrast, the treatment effect on the EQ VAS was mainly via the direct pathway (66%), whereas only 34% was mediated by the mRS.

Conclusion: Assessment of patient-reported outcome measures reveals potential beneficial effects of intravenous alteplase on HRQoL beyond improvement of functional outcome.

Disclosure: No

O057 / 850

Scientific Communications 7 - Risk Factors, Primary Prevention

CHILDHOOD DEVELOPMENTAL MILESTONES AND RISK OF ADULT CEREBROVASCULAR DISEASE - THE NORTHERN FINLAND BIRTH COHORT 1966

M. Kivelä ^1,2, I. Rissanen^1,2,3, E. Kajantie^2,4,5,6, M. Ojaniemi^2,4, H. Rusanen^2,7, J. Miettunen^1,2, M. Paananen^1,2

¹University of Oulu, Center for Life Course Health Research, Oulu, Finland, ²University of Oulu, Medical Research Center, Oulu, Finland, ³University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, ⁴University of Oulu, PEDEGO Research Unit, Oulu, Finland, ⁵Finnish Institute for Health and Welfare, Population Health Unit, Helsinki, Finland, ⁶Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Trondheim, Norway, ⁷Oulu University Hospital, Department of Neurology, Oulu, Finland

Background and aims: No previous studies have examined the relationship between childhood developmental milestones and risk of adulthood cerebrovascular disease(CVD). We studied whether the risk of adult CVD is associated with delayed attainment of motor and language milestones.

Methods: 11,991 persons were followed from birth to 52 years of age within the Northern Finland Birth Cohort 1966. CVD diagnoses were extracted from national registers with diagnostic coding based on recommendations of the World Health Organization. Cox proportional hazard models stratified by sex were used to estimate associations of childhood motor development, speech and hearing milestones and adult CVD, i.e., ischemic and haemorrhagic strokes and TIA. Excluded were individuals with a diagnosis of mental retardation. The analyses were adjusted for family socioeconomic status and birth weight for gestational age.

Results: A total of 453(3.8%) CVDs were recorded during follow-up. Among males, later turning from back to tummy was associated with any CVD in adulthood (adjusted hazard ratio 1.16; 95% confidence interval 1.00-1.35), especially ischemic CVD(1.19;1.00-1.41). Later achievement of making sounds was associated with any CVD(2.88;1.40-5.92), especially ischemic CVD(3.71;1.70-8.07). Hearing difficulties at 6 years was associated with risk of any CVD(2.91;1.06-7.93). These associations were not found among females.

Conclusions: The findings suggest that later achievement of specific childhood milestones could be a predictor for development of CVD risk among males. These results point towards a common neurodevelopmental background and could in part explain lifetime CVD risk cumulation. This provides aid in targeting primary preventative measures to individuals with increased risk of CVD.

Disclosure: No

O058 / 599

Scientific Communications 7 - Risk Factors, Primary Prevention

OVERWEIGHT IN ADOLESCENCE AND EARLY ADULTHOOD IN ASSOCIATION WITH EARLY ONSET STROKE – THE NORTHERN FINLAND BIRTH COHORT 1966 STUDY

U. Mikkola ^1,2, I. Rissanen^2,1,3, M. Kivelä^1,2, H. Rusanen^2,4, E. Kajantie^2,5,6,7, M. Paananen^1,2

¹University of Oulu, Center for Life Course Health Research, Oulu, Finland, ²University of Oulu, Medical Research Center, Oulu, Finland, ³University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, ⁴Oulu University Hospital, Department of Neurology, Oulu, Finland, ⁵University of Oulu, PEDEGO Research Unit, Oulu, Finland, ⁶Finnish Institute for Health and Welfare, Population Health Unit, Helsinki, Finland, ⁷Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Trondheim, Finland

Background and aims: Research about individuals’ health throughout their life span in relation to stroke risk later in life is limited. This prospective cohort study aims to determine the effect of body mass index (BMI) and its changes in adolescence and early adulthood on stroke risk.

Methods: Northern Finland Birth Cohort 1966 comprises of 11925 people (6107 males; 5818 females). Height and weight were measured at ages 14 and 31, and BMI was calculated as kg/m². Sex and age specific BMI ranges were used to define overweight and obesity. Information on ischemic and hemorrhagic strokes between ages 14 and 54 were collected from national hospital and death registers. Cox proportional hazard models were used to estimate associations of BMI and stroke, separately for both sexes.

Results: A total of 521 (4.4 %) strokes occurred. Among females, overweight at age 14 (HR=1.80; CI=1.15–2.83) and at age 31 (HR=1.57; CI=1.12–2.20), as well as obesity at age 31 (HR=1.90; CI=1.20–3.02) increased the risk for stroke in later life. So did transitioning from normal weight to overweight (HR=1.48; CI=1.03–2.11) and being overweight at both ages (HR=2.63; CI=1.66–4.17). Similar associations were not found among males. At age 14, the sex-specific risk caused by overweight was 2.04 times higher in females than in males (CI=1.03–4.03).

Conclusion: Among females, overweight in adolescence or early adulthood emerged as a risk factor for stroke. This highlights the importance of preventing overweight already in adolescence in order to decrease the risk of stroke.

Disclosure: No

O059 / 487

Scientific Communications 7 - Risk Factors, Primary Prevention

POLYGENIC RISK, MIDLIFE LIFE’S SIMPLE 7, AND LIFETIME RISK OF STROKE

E.A. Thomas¹, N. Enduru¹, A. Tin², E. Boerwinkle³, M.E. Griswold², T.H. Mosley², R.F. Gottesman⁴, M. Fornage ¹

¹University of Texas Health Science Center at Houston, Institute of Molecular Medicine, Houston, United States, ²University of Mississippi Medical Center, Jackson, United States, ³University of Texas Health Science Center at Houston, Houston, United States, ⁴National Institute of Neurological Disorders and Stroke, Bethesda, United States

Background: Communicating risk is an important component of primary prevention of stroke. Genetic discoveries in stroke provide an opportunity for improving risk prediction. We sought to estimate the lifetime risk of stroke (LTRS) by levels of genetic risk and to investigate whether optimal cardiovascular health can offset the negative impact of high genetic risk on lifetime risk of stroke.

Methods: Study participants were 11,568 middle-aged adults (56% women, 23% African-Americans), who were free of stroke at baseline and were followed up for a median of 28 years. The remaining LTRS was estimated according to levels of genetic risk based on a validated stroke polygenic risk score (PRS), and to levels of cardiovascular health based on the American Heart Association Life’s Simple 7 (LS7) recommendations.

Results: At age 45, individuals with high, intermediate, and low PRS had a remaining LTRS of 23.2% (95% CI: 20.8%-25.5%), 13.8% (95% CI: 11.7%-15.8%), 9.6% (95% CI: 7.3%-11.8%), respectively. Those with both high genetic risk and inadequate LS7 experienced the highest LTRS: 24.8% (95% CI: 22.0%-27.6%). Across all PRS categories, those with an optimal LS7 had a ~30% to 43% lower LTRS than those with an inadequate LS7. This corresponded to up to 6 additional years lived free of stroke.

Conclusions: The LTRS varies substantially by levels of polygenic risk and cardiovascular health. Maintaining an optimal cardiovascular health can partially offset a high genetic risk, illustrating the potential of genetic risk information to motivate lifestyle and vascular health changes for stroke prevention.

Disclosure: No

O060 / 526

Scientific Communications 7 - Risk Factors, Primary Prevention

TYPE 2 DIABETES MELLITUS IN PATIENTS WITH ISCHEMIC STROKE - A NATIONWIDE STUDY

S. Hastrup ¹, J.N. Hedegaard², G. Andersen¹, J. Rungby³, S.P. Johnsen²

¹Aarhus University Hospital, Danish Stroke Center, Department of Neurology, Aarhus N, Denmark, ²Aalborg University, Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg, Denmark, ³Bispebjerg University Hospital, Department of Endocrinology IC, Copenhagen, Denmark

Background and aims: Diabetes 2 is a well-established risk factor for ischemic stroke (IS) and associated with an adverse prognosis. However, the epidemiology of diabetes-related stroke is likely to undergo substantial changes these years due to the evolving diabetes care with introduction of newer antidiabetic drugs and developments in stroke care.

Aims:

• – To determine the prevalence of diabetes 2 among acute IS patients.

• – To explore changes in the risk profile over time among IS patients with diabetes 2.

• – To compare time trends in clinical outcomes including mortality, re-strokes, readmissions and length-of-stay in IS patients with diabetes 2 and no-diabetes.

Methods: Cohort study including all IS events in Denmark in the period 2004-2020 identified from the Danish Stroke Registry (DSR).

The stroke patients with co-morbid diabetes were identified by using information from the Danish Prescription Database, the Danish National Patient Registry and DSR.

Stroke patients with diabetes 2 were compared to stroke patients without diabetes using weighted analyses adjusting for differences in age, sex, stroke severity, living-arrangements, previous stroke, atrial fibrillation, smoking, hypertension, Charlson-Comorbidity-Index, migrant status, income and occupational status.

Results: The study included 147,915 IS events.

Time period	2004-2006	2007-2009	2010-2012	2013-2015	2016-2018,*
Stroke¤ events - total (n)	30614	28955	29322	29066	29958
Prevalence diabetes 2 (%)	12.3 (11.9 - 12.7)	12.4 (12.0 - 12.8)	13.9 (13.4 - 14.3)	15.0 (14.5 - 15.4)	16.7 (16.3 - 17.2)

*

2019-2020 data are pending; ¤Stroke = ischemic stroke

Time period	2004-2006	2007-2009	2010-2012	2013-2015	2016-2018*
30-day mortality rates (% (95%CI))
Strokes with diabetes 2	10.7 (9.7 - 11.7)	10.6 (9.6 - 11.6)	10.1 (9.2 - 11.0)	9.0 (8.2 - 9.9)	8.0 (7.2 - 8.8)
Strokes without diabetes	8.1 (7.8 - 8.4)	7.9 (7.5 - 8.2)	8.0 (7.6 - 8.3)	6.8 (6.5 - 7.1)	5.8 (5.5 - 6.1)
365-day mortality rates (% (95%CI))
Strokes with diabetes 2	25.2 (23.7 - 26.6)	24.1 (22.6 - 25.5)	23.5 (22.1 - 24.8)	21.7 (20.5 - 23.0)	19.9 (18.8 - 21.1)
Strokes without	19.6 (19.1 - 20.1)	19.4 (18.9 - 19.9)	18.5 (18.0 - 19.0)	16.6 (16.1 - 17.1)	14.7 (14.2 - 15.1)

Time period	2004-2006	2007-2009	2010-2012	2013-2015	2016-2018*
30-day mortality risk ratio: Diabetes 2 vs. non-diabetes (95% CI)
Crude	1.325 (1.199 - 1.464)	1.343 (1.211 - 1.490)	1.263 (1.142 - 1.396)	1.324 (1.193 - 1.470)	1.384 (1.245 - 1.539)
Weighted	1.146 (1.014 - 1.296)	1.137 (0.996 - 1.297)	1.236 (1.090 - 1.401)	1.217 (1.071 - 1.383)	1.246 (1.098 - 1.415)
365-day mortality risk ratio: Diabetes 2 vs. non-diabetes (95% CI)
Crude	1.284 (1.209 - 1.364)	1.241 (1.165 - 1.322)	1.268 (1.193 - 1.348)	1.306 (1.227 - 1.391)	1.356 (1.274 - 1.445)
Weighted	1.148 (1.064 - 1.238)	1.043 (0.959 - 1.133)	1.195 (1.107 - 1.290)	1.172 (1.085 - 1.265)	1.198 (1.109 - 1.294)

Conclusions: The prevalence of diabetes 2 among IS patients increased significantly over time. The 30- and 365-day post-stroke mortality rates decreased over time both among patients with- and without diabetes, however the mortality rates were at all times higher in stroke patients with diabetes 2. This highlights the urgent need for further development of strategies to improve the post-stroke prognosis in patients with diabetes.

Disclosure: Yes

O061 / 1549

Scientific Communications 7 - Risk Factors, Primary Prevention

ATRIAL FIBRILLATION SCREENING REDUCES THE RISK OF STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

M. Florentin ¹, P. Tasoudis², I. Kyriakoulis², D. Sagris², D. Koukousaki², E. Korompoki^3,4, H. Milionis¹, G. Ntaios²

¹Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece, Ioannina, Greece, ²Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece, ³Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece, Athens, Greece, ⁴Imperial College London, London, United Kingdom, London, United Kingdom

Background and aims: Atrial fibrillation (AF) is a leading cause of ischaemic stroke. It is unclear whether screening for AF reduces stroke risk. The primary aim of this systematic review and meta-analysis was to assess the impact of AF screening on the risk of stroke.

Methods: We searched PubMed and Scopus until 31/12/2021 for randomised controlled trials comparing AF screening with any modality, to the standard of care in individuals with cardiovascular risk factors. The primary outcome of interest was stroke, and the secondary outcomes of interest were AF detection, anticoagulation initiation and all-cause mortality. Risk estimates in each study were reported as odds ratio (OR) alongside 95% confidence intervals (CI). We employed the random-effect method of DerSimonian Laird estimator and heterogeneity was calculated with I² index.

Results: Among 8 eligible studies including 82,269 patients, 5 studies reported rates of stroke. Screening for AF was associated with a significant reduction of stroke with no heterogeneity (OR 0.84; 95% CI 0.76-0.94, I²:0%). Among 7 studies which reported rates of AF detection and 5 studies which reported rates of anticoagulation initiation, AF screening significantly increased AF detection and anticoagulation initiation (OR 2.48; 95% CI 1.46-4.22, I²: 95.9% and OR 2.38; 95% CI 1.26-4.48, I²: 92.9%, respectively). Among 4 studies which reported all-cause mortality, AF screening was not associated with death (OR 0.71; 95% CI 0.46-1.09, I²: 91.3%).

Conclusions: This systematic review and meta-analysis provides first-time evidence that AF screening reduces the risk of stroke.

Disclosure: No

O062 / 1151

Scientific Communications 7 - Risk Factors, Primary Prevention

CHANGE IN MANAGEMENT AND DECREASE IN MORTALITY OF CEREBRAL VENOUS SINUS THROMBOSIS WITH THROMBOCYTOPENIA AFTER SARS-COV-2 VACCINATION

A. Scutelnic¹, K. Krzywicka ², J. Mbroh³, A. van de Munckhof², M. Sánchez van Kammen², D. Aguiar de Sousa⁴, C. Cordonnier⁵, T. Kleinig⁶, E. Lindgren^7,8, K. Jood^8,7, A. Ciccone⁹, A. Günther¹⁰, S. Middeldorp¹¹, M.M Levi^12,13, M. Wittstock¹⁴, M. Skjelland¹⁵, D. Michalski¹⁶, T.S Field¹⁷, F.J Bode¹⁸, J. Zimmermann¹⁸, A. Elkady¹⁹, A. Devroye²⁰, R. Lemmens²⁰, M. Bandettini di Poggio²¹, M.M. Martin²², D.S Zimatore²³, M. Petruzzellis²⁴, B.L.A. Chew²⁵, C. Garcia Esperon²⁵, S. Schoenenberger²⁶, S. Nagel²⁶, T. Tatlisumak^8,7, J. Brodard²⁷, M. Kruip²⁸, J.A Kremer Hovinga²⁷, J.M Ferro²⁹, J.M Coutinho², M. Arnold³⁰, S. Poli^3,31, M.R Heldner³⁰, Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group

¹Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Department of Neurology, Bern, Switzerland, ²Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ³Eberhard-Karls University, Tuebingen, Department of Neurology & Stroke, Tuebingen, Germany, ⁴Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Department of Neurosciences and Mental Health, Lisbon, Portugal, ⁵University of Lille, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France, ⁶Royal Adelaide Hospital, Department of Neurology, Adelaide, Australia, ⁷Sahlgrenska Academy at University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden, ⁸Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden, ⁹Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Department of Neurology, Mantua, Italy, ¹⁰Jena University Hospital, Department of Neurology, Jena, Germany, ¹¹Radboud University Medical Center, Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Nijmegen, Netherlands, ¹²National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom, ¹³Amsterdam University Medical Centers, University of Amsterdam, Department of Vascular Medicine, Amsterdam, Netherlands, ¹⁴University Hospital Rostock, Department of Neurology, Rostock, Germany, ¹⁵Oslo University Hospital, Department of Neurology, Oslo, Norway, ¹⁶Leipzig University Hospital, Department of Neurology, Leipzig, Germany, ¹⁷University of British Columbia, Vancouver Stroke Program, Division of Neurology, Vancouver, Canada, ¹⁸Universitätsklinikum Bonn, Department of Neurology, Bonn, Germany, ¹⁹Saudi German Hospital, Department of Neurology, Jeddah, Saudi Arabia, ²⁰University Hospital Leuven, Department of Neurology, Leuven, Belgium, ²¹Policlinic San Martino Hospital, Department of Neuroscience, Genoa, Italy, ²²Hospital Complex of Toledo, Department of Neurology, Toledo, Spain, ²³Policlinico di Bari, Department of Neuroradiology, Bari, Italy, ²⁴AOU Consorziale Policlinico di Bari, Department of Neurology, Bari, Italy, ²⁵John Hunter Hospital, Department of Neurology, Newcastle, Australia, ²⁶Heidelberg University Hospital, Department of Neurology, Heidelberg, Germany, ²⁷Inselspital, Bern University Hospital, University of Bern, Department of Hematology, Bern, Switzerland, ²⁸Erasmus University Medical Center, Department of Hematology, Rotterdam, Netherlands, ²⁹Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal, ³⁰Inselspital, Bern University Hospital, University of Bern, Department of Neurology, Bern, Switzerland, ³¹Eberhard-Karls University, Hertie Institute for Clinical Brain Research, Tuebingen, Germany

Background and aims: Cerebral venous sinus thrombosis with thrombocytopenia syndrome (CVST-TTS) is a rare adverse effect of adenovirus-based SARS-CoV-2 vaccines. After the autoimmune pathogenesis of TTS was discovered, treatment recommendations were issued. The aim of this study was to evaluate if adherence to treatment recommendations was associated with lower mortality.

Methods: TTS was defined according to the Brighton criteria. Cases from a prospective international CVT registry with symptom onset within 28 days of adenovirus-based SARS-CoV-2 vaccination were analysed. Treatment recommendations, following the International Society of Thrombosis and Haemostasis, included use of immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusions, unless needed for surgery.

Results: Out of 178 CVT cases from 117 centres in 19 countries reported between March 29 and September 3, 2021, 95 patients fulfilled inclusion criteria. Five of 37 (14%), 13/25 (52%), and 29/33 (88%) of patients diagnosed in March, April, and from May onwards, respectively, were treated according to recommendations. Proportion of patients diagnosed in March, April, and from May onwards who received immunomodulation increased from 19/37 (51%) over 15/25 (60%) to 30/33 (90%), and the percentage of patients who were treated with heparins [26/37 (70%), 4/25 (16%), 1/33 (3%)] and platelet transfusion [15/37 (41%), 4/25 (16%), 7/33 (21%), respectively] decreased accordingly. Mortality of patients treated according to recommendations was 14/47 (30%, 95%CI 19-44%) compared to 28/48 (58%, 95%CI 44-71%) in patients not treated according to recommendations (OR 3.30, 95%CI 1.41-7.71).

Conclusions: Over time, adherence to treatment recommendations improved, and mortality rate of patients with CVST-TTS decreased.

Disclosure: No

O063 / 958

Scientific Communications 7 - Risk Factors, Primary Prevention

ABSOLUTE RISK OF ISCHEMIC AND HEMORRHAGIC STROKE IN DANISH WOMEN USING ORAL CONTRACEPTIVES

T.S. Olsen ¹, K.K. Andersen²

¹Bispebjerg University Hospital, Neurology, Copenhagen, Denmark, ²Danish Cancer Society Research Center, Copenhagen, Denmark

Background and aims: Uncertainty exists for the absolute risk of ischemic and hemorrhagic stroke in users of oral contraceptives (OC). Estimates vary greatly between countries. In Denmark absolute risk of ischemic stroke (IS) is estimated to be 21 per 100,000 person-years. Risk of cerebral hemorrhage (CH) is unknown. Using the Danish Stroke Registry we investigated absolute risk of IS and CH in users of OC.

Methods: For the Danish female population aged 15-49 years during 2003-2011 we obtained information on hospital admission for IS and CH and current use of OC from Danish nation-wide registries. We defined current use of OC as redeeming at least two OC prescriptions within the previous year.

Results: The Danish female population years 2003-2011 consisted mean 1,246,141 women per year. Of these 29.6% were OC-users. In the study period OC users had 291 IS and 14 CH. Absolute risk of IS in OC-users was 8.8 per 100,000 person-years and of CH it was 0.4 per 100,000 person-years.

Conclusions: In OC users' absolute risk of IS was 8.8 per 100,000 person-years. This is more than half that of the risk previously assumed in Denmark. Risk of CH in OC users was very low; 0.4 per 100,000 person-years.

Disclosure: No

O065 / 1196

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

PREVALENCE AND RISK FACTORS OF POST-STROKE COGNITIVE IMPAIRMENT IN ACUTE MILD STROKE

L. Gallucci ¹, A. Hakim², A.U. Monsch³, U. Fischer⁴, R. Umarova¹

¹University Hospital, Department of Neurology, Bern, Switzerland, ²University Hospital, Department of Neuroradiology, Bern, Switzerland, ³Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland, ⁴University Hospital, Department of Neurology, Basel, Switzerland

Background and aims: Thrombolytic therapy leads to reduction of stroke severity with prevailing of mild stroke with reported good outcome. However, cognitive abilities are often outside the scope of these studies and post-stroke cognitive impairment (PSCI) in mild stroke is underinvestigated. We examined the prevalence, the severity and risk factors of PSCI in acute stroke.

Methods: 147 non-aphasic patients (68.8±13.9 years, 46% women) with first-ever ischemic stroke in the MCA-territory and unimpaired pre-stroke cognition underwent a comprehensive neuropsychological assessment 2.0±1.9 days post-stroke. Standardized normative z-score were age-corrected. Logistic regression analysis of risk factors for PSCI in ⩾ 2 domains was performed.

Results: The majority of patients suffered mild stroke (NIHSS24h=2.8±3.5, 82.2% NIHSS ⩽ 5). 83.8% of patients demonstrated cognitive impairment in ⩾ 2 domains (Figure1), with overall more severe deficits in verbal learning (z-score=-1.5±1.4) and episodic memory (z-score=-1.5±1.2). After correcting for age and education effects, the severity of learning and memory deficits was comparable across younger (<55y), middle-aged (55-70y) and older (>70y) stroke patients (p=0.56).

We observed severe deficits in global cognition, episodic memory, executive functions and working memory in ⩾ 25% of patients (Figure2). Lower education (p=0.04), higher stroke severity (p=0.003) and history of TIA (p=0.01) were risk factors for deficits in ⩾ 2 domains.

Figure 1.

Performance in each cognitive domain.

Figure 2.

Prevalence of PSCI.

Conclusion: Despite of mild stroke severity, PSCI in the acute phase is common and might be severe. The awareness of high prevalence of learning and memory deficits is important, as they limit the effectiveness of rehabilitation.

Disclosure: No

O066 / 1457

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

LOW VALUES FOR BLOOD PRESSURE, BMI AND NON-HDL CHOLESTEROL SIGNAL HIGHER LATE-LIFE DEMENTIA RISK

M. den Brok ¹, E. Eggink², M. Hoevenaar-Blom², P. van Gool², E. Moll van Charante², E. Richard¹, J.W. van Dalen¹

¹Radboud University Medical Center, Nijmegen, Netherlands, ²Amsterdam UMC, Amsterdam, Netherlands

Background and aims: Low values of systolic blood pressure, Body Mass Index (BMI) and non-high density lipoproteine (non-HDL) cholesterol in late life have been associated with increased dementia risk. We investigated whether these associations are specific for individuals with multiple low values simultaneously, which could indicate the existence of an overarching dementia-related syndrome involving multiple cardiovascular risk factors.

Methods: We studied 2789 community-dwelling older people (baseline age 70-78 years, 44.9% women) from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial observational extension. Using Cox regression, we assessed the association with dementia for quintiles for each risk factor, and for individuals with lowest quintile values for multiple risk factors simultaneously.

Results: During a median follow-up of 10.3 years (IQR=7.0-10.9), 308 (11.0%) developed dementia and 793 (28.4%) deceased. For all risk factors, the lowest quintile was associated with the highest dementia risk. Individuals with one, two, and three low values had adjusted HRs of 1.18 (95%CI=0.93-1.51), 1.28 (95%CI=0.85-1.93), and 4.02 (95%CI=2.04-7.93) respectively, compared to those without low values. The effects were not attributable to specific risk factor combinations or competing risk of death.

Conclusions: Dementia risk was substantially higher in individuals with low values for all three risk factors than expected based on a dose-response relationship. This suggests these associations may reflect an overarching dementia-related phenomenon involving multiple cardiovascular risk factors simultaneously, rather than independent effects of individual factors. Older people with concomitant low risk factor values may comprise a specific group needing a personalised approach to cardiovascular risk management.

Disclosure: No

O067 / 397

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

THALAMIC VOLUME AND PROCESSING SPEED IN CEREBRAL SMALL VESSEL DISEASE

H. Li ^1,2, M. Cai^1,2, M.A. Jacob^1,2, M. Chamberland³, A. Dewenter⁴, J. Marques³, D. Norris³, M. Duering⁵, F.-E. de Leeuw^1,2, A.M. Tuladhar^1,2

¹Radboud University Medical Centre, Department of Neurology, Nijmegen, Netherlands, ²Donders Center for Medical Neurosciences, Nijmegen, Netherlands, ³Radboud University, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands, ⁴University Hospital, LMU Munich, Institute for Stroke and Dementia Research (ISD), Munich, Germany, ⁵University of Basel, MedicalImage Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, Basel, Switzerland

Background and aims: Thalamus play an important role in cognition, but its relationship with cognitive impairment in cerebral small vessel disease (SVD), independent of thalamic lacunes, is unknown. We aimed to assess whether thalamic volume is associated with cognitive impairment in SVD.

Methods: Patients from 3^rd follow-up of RUN DMC study underwent 3T MRI. We excluded patients with thalamic lacunes. Processing speed was assessed based on Trial Making Test A and B, corrected for age and education using normative data. MRI markers of SVD, including white matter hyperintensity volumes, lacunes, microbleeds, and global brain volumes, and fractional anisotropy (FA), mean diffusivity (MD) within white matter, were assessed. The thalamus was segmented using Freesurfer and manually corrected, and we calculated the volumes. We performed multiple linear regression to assess the association between thalamic volumes and processing speed, followed by mediation.

Results: 207 patients were included (73[10] age years, 117 men). Thalamic volumes were positively associated with processing speed (β=0.155, p=0.025), adjusted for MRI markers of SVD (β= 0.015, p= 0.893), and with FA values (β=0.148, p=0.003) and MD values (β= -0.171, p=0.014) within WM. The association between thalamic volumes and processing speed was partly mediated by FA (Figure 1).

Conclusion: In SVD, thalamic atrophy, independent of thalamic lacunes, is associated with cognitive impairment, which is partly mediated via disruption of white matter integrity. Our findings support that cognitive impairment in SVD may be driven by damage to cortical-subcortical pathways involving the thalamus.

Figure 1.

mediation analysis

Disclosure: No

O068 / 658

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

COGNITIVE IMPAIRMENT AFTER FIRST-EVER TRANSIENT ISCHEMIC ATTACK OR ISCHEMIC STROKE IN YOUNG ADULTS THE ODYSSEY STUDY

M.M.I. Schellekens ¹, E.M. Boot¹, J.I. Verhoeven¹, M.S. Ekker¹, M.E. van Alebeek², P.J.A.M. Brouwers³, R.M. Arntz³, G.W. van Dijk⁴, R.A.R. Gons⁵, I.W.M. van Uden⁵, T. den Heijer⁶, P.L.M. de Kort⁷, K.F. de Laat⁸, A. van Norden², S.E. Vermeer⁹, M.S.G. van Zagten¹⁰, R.J. van Oostenbrugge¹¹, M.J.H. Wermer¹², P.J. Nederkoorn¹³, F.G. van Rooij¹⁴, I.R. van den Wijngaard¹⁵, H.F. de Leeuw¹, R.P.C. Kessels^16,17, A.M. Tuladhar¹

¹Radboud University Medical Centre, Neurology, Nijmegen, Netherlands, ²Amphia Hospital, Neurology, Breda, Netherlands, ³Medisch Spectrum Twente, Neurology, Enschede, Netherlands, ⁴Canisius-Wilhelmina Hospital, Neurology, Nijmegen, Netherlands, ⁵Catharina Hospital, Neurology, Eindhoven, Netherlands, ⁶Franciscus Gasthuis & Vlietland, Neurology, Rotterdam, Netherlands, ⁷Elisabeth-Twee Steden Hospital, Neurology, Tilburg, Netherlands, ⁸Haga Hospital, Neurology, Den Haag, Netherlands, ⁹Rijnstate Hospital, Neurology, Arnhem, Netherlands, ¹⁰Jeroen Bosch Hospital, Neurology, Den Bosch, Netherlands, ¹¹Maastricht University Medical Centre, Neurology, Maastricht, Netherlands, ¹²Leiden University Medical Centre, Neurology, Leiden, Netherlands, ¹³Amsterdam University Medical Centre, Neurology, Amsterdam, Netherlands, ¹⁴Medical Centre Leeuwarden, Neurology, Leeuwarden, Netherlands, ¹⁵Haaglanden Medical Center, Neurology, Den Haag, Netherlands, ¹⁶Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognition, Nijmegen, Netherlands, ¹⁷Vincent van Gogh Institute for Psychiatry, Venray, Netherlands

Background and aims: Post-stroke cognitive impairment is an underrecognized sequelae and data in young stroke patients are scarce. We aimed to investigate the prevalence of cognitive impairment in the subacute phase after stroke and factors that are associated with a vascular cognitive disorder (VCD).

Methods: In this multicenter prospective cohort study, we recruited patients with first-ever TIA and ischemic stroke (IS), aged 18 to 49 years, between 2013 and 2021 for cognitive assessment up to 6 months after index event. We calculated composite Z-scores for 7 cognitive domains using age, education and/or sex-adjusted normative mean or control data. We defined cognitive impairment as a composite Z-score <-1.5. We defined major VCD as a Z-score <-2.0 in one or more cognitive domains.

Results: 53 patients with TIA and 545 with IS completed cognitive assessment with mean time to assessment from index event of 89.7 (SD 40.7) days. Cognitive impairment in episodic memory (21.4%), processing speed (23.3%), visuoconstruction (37.0%), language deficits (18.7%) and attention and working memory (22.8%) were most common, with similar proportion in TIA and IS patients. Patients with major VCD had a lower education level, higher NIHSS scores and more frequent lesions in the left frontotemporal lobe than patients without VCD (p<0,05 FDR corrected).

Conclusions: In the subacute phase after TIA or stroke in young adults, cognitive impairment is prevalent. More attention should be paid to cognitive functioning after stroke in young patients and cognitive assessment may be considered to identify cognitive deficit in more detailed fashion.

Table 1.

Baseline characteristics.

	All participants(n=598)	TIA(n=53)	Ischemic stroke(n=545)
Mean age at index event (years)	41.7 (7.7)	39.3 (9.1)	41.9 (7.5)
Men	310 (51.8%)	25 (47.2%)	285 (52.3%)
Time to assessment (days)	89.7 (40.7)	92.3 (43.4)	89.5 (40.4)
Education	5 (5-6)	5 (5-6)	5 (5-6)
NIHSS score at admission	3 (1-5)	0 (0-1)	3 (1-5)
NIHSS score at discharge	1 (0-2)	0 (0-0)	1 (0-2)
Barthel Index at assessment	98.3 (7.0)	99.7 (1.2)	98.1 (7.4)
Good outcome (BI⩾85)	550 (96.3%)	51 (100%)	499 (96.0%)
mRS at assessment	1 (1-2)	1 (0-1)	1 (1-2)
Good outcome (mRS 0-1)	377 (65.6%)	43 (82.7%)	334 (63.9%)
MMSE	28.0 (26.0-29.0)	28.0 (27.0-29.0)	28.0 (26.0-29.0)
MINI- symptoms of depression present	54 (9.3%)	3 (5.7%)	51 (9.7%)
CIS-20R-fatigue severity	32.9 (11.9)	32.8 (12.8)	32.9 (11.8)
Mild fatigue 27-35	135 (27.7%)	12 (26.1%)	123 (27.8%)
Severe fatigue ⩾ 36	205 (42.0%)	19 (41.3%)	186 (42.1%)
TOAST
Atherothrombotic	25 (4.2%)	0 (0.0%)	25 (4.6%)
Likely atherothrombotic	70 (11.7%)	4 (7.5%)	66 (12.1%)
Small vessel	85 (14.2%)	3 (5.7%)	82 (15.0%)
Cardioembolic	97 (16.2%)	17 (32.1%)	78 (14.7%)
Rare causes	125 (20.9%)	9 (17.0%)	116 (21.3%)
Multiple causes	37 (6.2%)	4 (7.5%)	33 (6.1%)
Cryptogenic	159 (26.6%)	16 (30.2%)	143 (26.2%)

Data were expressed as mean (SD), number (%) or median (Q1-Q3). NIHSS: National Institutes of Health Stroke Scale; mRS: modified Rankin Scale; MMSE: Mini Mental State Examination; MINI: Mini International Neuropsychiatric Interview; CIS-20R: Checklist Individual Strength; TOAST: Trial of ORG 10172 in Acute Stroke Treatment.

Missing data: NIHSS at admission 3 (0.5%); NIHSS at discharge 3 (0.5%); Barthel index 27 (4.5%); mRS 23 (3.8%); MMSE 32 (5.4%); MINI- symptoms of depression 20 (3.3%); CIS-20R-fatigue 110 (18.4%).

Table 2.

Neuropsychological test scores of patients.

Cognitive domain & test	All participants(n=598)	TIA(n=53)	Ischemic stroke(n=545)
Episodic memory
RAVLT trial 1-3	21.3 (6.2)	21.3 (4.5)	21.3 (6.3)
RAVLT delayed recall	6.7 (2.9)	6.7 (2.6)	6.7 (3.0)
Processing speed
SDMT	49.1 (12.5)	55.0 (9.9)	48.5 (12.6)
Stroop part Ia	4.2 (1.0)	4.5 (0.9)	4.1 (1.0)
Stroop part IIa	3.3 (0.8)	3.6 (0.7)	3.3 (0.8)
Visuoconstruction
ROCF copy	29.9 (4.7)	31.7 (3.7)	29.7 (4.8)
Executive functioning
Verbal fluency	19.4 (5.0)	20.6 (4.4)	19.2 (5.0)
Stroop interferencea	0.57 (0.1)	0.59 (0.1)	0.57 (0.1)
Brixton test	12.7 (6.1)	11.0 (4.7)	12.9 (6.2)
Visual neglect
Star Cancellation	53.6 (1.3)	53.9 (0.3)	53.6 (1.4)
Language deficits
Short token test	19.5 (1.9)	19.6 (2.2)	19.5 (1.9)
Attention and working memory
Digit span test	24.6 (5.1)	25.3 (4.8)	24.5 (5.1)

Data were expressed as mean (SD). RAVLT: Rey Auditory Verbal Learning Test; SDMT: Symbol-Digit Modalities Test; ROCF: Rey-Osterrieth Complex Figure. Test not reliable/performed: RAVLT trial 1-3: 9 (1.5%); RAVLT delayed recall 19 (3.2%); SDMT 13 (2.2%); Stroop part I 26 (4.3%); Stroop part II 25 (4.2%); ROCF copy 31 (5.2%); Verbal fluency 13 (2.2%); Stroop interference 29 (4.8%); Brixton test 17 (2.8%); Star Cancellation 14 (2.3%); Short token test 30 (5.0%); Digit span test 28 (4.7%). a) Speed-accuracy composite score. Higher scores indicate better performance on all measures, except for the Brixton test.

Table 3.

Patients with mild and major vascular cognitive disorder and no cognitive disorder.

Characteristics	Without VCD(n=196)	Mild VCD(n=200)	Major VCD(n=202)
Age at index event (years)	42.6 (6.9)	42.3 (7.0)	44.5 (8.8)
Educationa	5 (5-6)	5 (5-6)	5 (5-6)
Ischemic stroke	174 (88.8)	184 (92.0%)	187 (92.6%)
Territorial lesion	144 (73.5%)	150 (75.0%)	151 (74.8%)
Lesion location
Left frontotemporal lobec	36 (18.4%)	38 (19.0%)	58 (28.7%)
Left thalamus	18 (9.2%)	20 (10.0%)	15 (7.4%)
Right parietal lobe	19 (9.7%)	29 (14.5%)	29 (14.4%)
NIHSS score at admissionb	2 (1-5)	2 (1-5)	3 (1-6)
NIHSS score at dischargea	0 (0-2)	1 (0-2)	1 (0-3)
Thrombolysis	52 (26.6%)	52 (26.1%)	47 (23.2%)
Thrombectomy	13 (6.6%)	9 (4.5%)	16 (7.9%)
BI good outcome (⩾85)	185 (96.9%)	187 (97.9%)	178 (94.2%)
mRS Good outcome (0-1)	135 (70.7%)	128 (66.0%)	114 (60.0%)
MINI- symptoms of depression	10 (5.2%)	23 (11.8%)	21 (11.1%)
CIS-20R-fatigue severity	31.4 (11.7)	33.1 (11.8)	33.5 (12.2)
Mild fatigue 27-35	45 (26.5%)	45 (27.4%)	45 (29.2%)
Severe fatigue ⩾ 36	66 (38.8%)	70 (42.7%)	69 (44.8%)
TOAST
Atherothrombotic	7 (3.6%)	6 (3.0%)	12 (5.9%)
Likely atherothrombotic	21 (10.7%)	26 (13.0%)	23 (11.4%)
Small vessel	25 (12.8%)	28 (14.0%)	32 (15.8%)
Cardioembolic	38 (19.4%)	31 (15.5%)	28 (13.9%)
Rare causes	41 (20.9%)	36 (18.0%)	48 (23.8%)
Multiple causes	13 (6.6%)	15 (7.5%)	9 (4.5%)
Cryptogenic	51 (26.0%)	58 (29.0%)	50 (24.8%)

Data were expressed as mean (SD), number (%) or median (Q1-Q3). VCD: vascular cognitive disorder; NIHSS: National Institutes of Health Stroke Scale; BI: Barthel Index; mRS: modified Rankin Scale; MINI: Mini International Neuropsychiatric Interview; CIS-20R: Checklist Individual Strength. Missing data: NIHSS at admission 3 (0.5%); NIHSS at discharge 3 (0.5%); thrombolysis 2 (0.3%); thrombectomy 2 (0.3%); Barthel index 27 (4.5%); mRS 23 (3.8%); MINI- symptoms of depression 20 (3.3%); CIS-20R-fatigue 110 (18.4%). a) Indicating significant difference between without VCD and mild VCD, and without VCD and major VCD after Benjamini-Hochberg correction b) Indicating significant difference between without VCD and major VCD after Benjamini-Hochberg correction. c) Indicating significant difference between without VCD and major VCD, and mild VCD and major VCD after Benjamini-Hochberg correction.

Disclosure: Yes

O069 / 909

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

MULTIVARIATE COGNITIVE PROFILES AFTER STROKE

H. Huygelier ^1,2, A. Odom¹, H. Thielen^1,2, M. Mancuso³, C.R. Gillebert^1,2, N. Demeyere⁴

¹KU Leuven, Brain and Cognition, Leuven, Belgium, ²KU Leuven, Leuven Brain Institute, Leuven, Belgium, ³Tuscany Rehabilitation Clinic, Montevarchi, Italy, ⁴University of Oxford, Department of Experimental Psychology, Oxford, United Kingdom

Background and aims: Although cognitive impairment after stroke is highly prevalent, most research has not investigated patterns of comorbidity. In this study, we aimed to identify separable cognitive profiles after stroke.

Methods: We retrospectively analysed data of 2,172 stroke patients (43% left hemisphere, 50% right hemisphere; 81% ischemic; tested on average 19 days post-stroke) across three countries. All patients completed the Oxford Cognitive Screen in their native language, which screens for impairments in language, memory, number, praxis, executive function and attention. To identify cognitive profiles within this cohort, latent class models were estimated. The best model was selected based on three fit indices, the certainty of class assignments and interpretability of classes.

Results: The best model suggested 13 distinguishable cognitive profiles. The largest group demonstrated no cognitive impairment (30.2%). Five right-lateralized profiles were identified, of which three were characterized by left-sided neglect (neglect without comorbidity, neglect with comorbidity, and neglect with signs of hemianopia). The two other right-lateralized profiles were characterized by non-spatial attention impairments and executive impairment, respectively. Four left-lateralized profiles occurred, of which two were characterized by language impairments (with impaired versus intact praxis and numerical abilities). Four other profiles occurred equally often after left- and right-hemispheric stroke. Age, country, gender and time since stroke did not predict the cognitive profiles.

Conclusions: A simple distinction of right- and left-lateralized cognitive profiles after stroke does not capture the heterogeneity of post-stroke cognitive comorbidities. Our study presents a big step towards an empirically validated taxonomy of post-stroke cognitive profiles.

Disclosure: No

O070 / 1289

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

COGNITION AFTER STROKE, TIA, MI AND HOSPITALISATION: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS OF SIX RANDOMISED CONTROLLED TRIALS

L. Sherlock ¹, S.F. Lee², A. Katsanos^3,2, T. Cukierman-Yaffe⁴, G. Muniz-Terrera⁵, M. Canavan^6,7, R. Joundi^2,3, A. Shoamanesh^2,3, A. Derix⁸, A. Mente^2,9, H. Gerstein², R. Hart^2,3, S. Yusuf^2,10, M. O'Donnell^6,7, J. Bosch^2,11, W. Whiteley^1,12

¹Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom, ²Population Health Research Institute, Hamilton, Canada, ³Department of Medicine (Neurology), McMaster University, Hamilton, Canada, ⁴Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel, ⁵Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ⁶HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland, ⁷Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland, ⁸Global Program Head Thrombosis, Bayer Pharmaceuticals, Leverkusen, Germany, ⁹Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada, ¹⁰Department of Medicine (Cardiology), McMaster University, Hamilton, Canada, ¹¹School of Rehabilitation Science, McMaster University, Hamilton, Canada, ¹²Nuffield Department of Population Health, Oxford, United Kingdom

Background and aims: Studies of cognition after health events rarely account for pre-event cognition. In a large international cohort of participants in vascular RCTs, we measured the years of cognitive ageing due to stroke, TIA, myocardial infarction (MI) and other hospitalisations.

Methods: We used data from trials of vascular risk intervention (NAVIGATE-ESUS, TRANSCEND, ONTARGET, COMPASS, ORIGIN, HOPE-3). We built regression models adjusting for trial, baseline cognitive score, age, sex, education, smoking, BMI and comorbidities to predict country-standardised cognitive z-score after stroke, MI and hospitalisation. Mean difference in z-scores were expressed as years of cognitive ageing.

Results: In 81,777 participants with baseline and follow-up measurements, adjusting for baseline cognition and age, average cognitive ageing was for: any stroke, 12 years (n=2811, 95%CI: 7-17, p < 0.001, between study p_{heterogeneity}<0.01), hospitalisation, 2 years (n=23,436, 95%CI:1-3, p =0.01, p_{heterogeneity}=0.46), and MI, -1 year (n=2124, 95%CI:-2-1, p=0.62, p_{heterogeneity}=0.35). More disabling stroke was associated with greater years of cognitive ageing: disabling stroke, 26 years (95%CI: 24-29, p<0.001), non-disabling stroke, 7 years (95%CI: 4-9, p< 0.001), and TIA, 5 years (95%CI: 2-7, p<0.001), and seemed to account for between study heterogeneity. Haemorrhagic stroke was associated with more cognitive ageing (26 years (95%CI: 20-31, p<0.001) than ischaemic stroke (15 years, 95%CI: 13-17, p <0.001).

Conclusions: Stroke leads to more cognitive ageing than MI or hospitalisation due to other causes, and disabling stroke leads to more cognitive ageing than non-disabling stroke. Reducing stroke incidence is likely to reduce population prevalence of cognitive impairment.

Disclosure: No

O071 / 283

Scientific Communications 8 - Cognition and Vascular Cognitive Impairment

CEREBRAL SMALL VESSEL DISEASE BURDEN AND COGNITIVE AND FUNCTIONAL OUTCOMES AFTER STROKE: A MULTICENTER PROSPECTIVE COHORT STUDY

M. Georgakis ¹, R. Fang¹, M. Düring¹, F. Wollenweber¹, A. Dewenter¹, F. Bode^2,3, S. Stösser^2,3, C. Kindlein^2,3, P. Hermann⁴, T. Liman^5,6, C. Nolte^5,6,7, L. Kerti^8,6, B. Ikenberg⁹, K. Bernkopf⁹, H. Poppert¹⁰, W. Glanz¹¹, D. Janowitz¹, M. Wagner², K. Neumann¹¹, O. Speck^12,11,13,14, L. Dobisch¹¹, E. Duezel¹¹, B. Gesierich¹, K. Waegemann^1,15, M. Görtler^16,11, S. Wunderlich⁹, M. Endres^5,6,8,17, I. Zerr^4,18, G. Petzold^2,3, M. Dichgans^1,15

¹Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany, ²German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany, ³Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany, ⁴University Medical Center Göttingen, Department of Neurology, Göttingen, Germany, ⁵Charité - Univeristätsmedizin Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany, ⁶German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany, ⁷Berlin Institute of Health (BIH), Berlin, Germany, ⁸Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany, ⁹Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Department of Neurology, Munich, Germany, ¹⁰Helios Klinikum München West, Neurology Department, Munich, Germany, ¹¹German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, ¹²Otto von Guericke University, Magdeburg, Germany, ¹³Leibniz Institute for Neurobiology, Magdeburg, Germany, ¹⁴Center for Behavioral Brain Sciences, Magdeburg, Germany, ¹⁵German Center for Neurodegenerative Diseases (DZNE), Munich, Germany, ¹⁶Otto von Guericke University, Department of Neurology, Magdeburg, Germany, ¹⁷German Centre for Cardiovascular Research (DZHK), Berlin, Germany, ¹⁸German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany

Background and aims: Cerebral small vessel disease (SVD) is common in stroke patients and a leading cause of vascular dementia. We explored whether SVD burden assessed at baseline predicts cognitive and functional outcomes one year after stroke.

Methods: In 666 acute stroke patients recruited to a prospective multicenter study in Germany (DEDEMAS-DEMDAS), we quantified individual SVD markers (lacunes, white matter hyperintensities, microbleeds, perivascular spaces) and a global SVD score (range 0-4) on MRI and explored associations with cognitive and functional outcomes at 6- and 12-months. We assessed the predictive performance of SVD markers with calibration, discrimination, and reclassification tools.

Results: The global SVD score at baseline was associated with cognitive impairment (OR per-point increment in score =1.31, 95%CI=1.09-1.58), worse performance in executive function, attention, language, and visuospatial ability, and worse functional outcome across a 12-month follow-up (OR per-point increment for modified Rankin scale (mRS) >1=1.34, 95%CI=1.13-1.60; OR for mRS>2=1.42, 95%CI=1.08-1.86). Adding the global SVD score to demographic, clinical, and other imaging factors did not improve prediction for cognitive or functional impairment. In contrast, individual SVD markers, when assessed across their severity range, showed significant associations with cognitive and functional outcomes and improved prediction of cognitive impairment at 12 months after stroke on top of demographic, clinical, and other imaging factors.

Conclusions: The presence and severity of SVD are associated with worse cognitive and functional outcomes 12 months after stroke. Assessing the severity of individual SVD lesions improves prediction of post-stroke outcomes and may thus aid clinical prognostication for stroke patients.

Disclosure: No

O073 / 970

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

GENETICS OF STROKE OF UNDETERMINED SOURCE: OVERLAP WITH KNOWN STROKE ETIOLOGIES AND ASSOCIATIONS WITH MODIFIABLE RISK FACTORS

M. Georgakis ¹, L. Parodi², S. Frerich³, E. Mayerhofer², G. Tsivgoulis⁴, J. Pirruccello², A. Slowik⁵, T. Rundek⁶, R. Malik³, M. Dichgans³, J. Rosand², C. Anderson⁷

¹Massachusetts General Hospital, Center for Genomic Medicine, Boston, United States, ²Massachusetts General Hospital, Boston, United States, ³Ludwig-Maximilians-University (LMU) Munich, Munich, Germany, ⁴National and Kapodistrian University of Athens, Athens, Greece, ⁵Jagiellonian Uniwersity, Krakow, Poland, ⁶University of Miami, Miami, United States, ⁷Brigham and Women's Hospital, Boston, United States

Background and aims: Ischemic stroke etiology remains undetermined in 30% of cases. We explored the genetic architecture of stroke classified as undetermined to test if mechanisms and risk factors underlying large-artery atherosclerotic (LAAS), cardioembolic (CES), and small-vessel stroke (SVS) contribute to its pathogenesis.

Methods: We analyzed genome-wide data from 16,851 ischemic stroke cases and 32,473 controls. Using polygenic risk scores for LAAS, CES, and SVS we assessed the genetic overlap with stroke of undetermined source and used pairwise GWAS to search for shared loci. We then applied Mendelian randomization (MR) to identify potentially causal risk factors of stroke of undetermined source.

Results: Genetic risk for LAS, CES, and SVS was associated with stroke of undetermined source pointing to overlap in their genetic architecture. Pairwise analyses revealed 19 shared loci with LAAS, 2 with CES, and 5 with SVS that have been implicated in atherosclerosis-related phenotypes. Genetic liability to both carotid atherosclerosis and atrial fibrillation was associated with stroke of undetermined source, but the association with atrial fibrillation was attenuated after excluding cases with incomplete diagnostic workup. MR analyses showed associations of blood pressure, diabetes, waist-to-hip ratio, inflammatory pathways (IL-6 signaling, MCP-1/CCL2 levels), and factor XI levels with stroke of undetermined source.

Conclusion: Stroke of undetermined source shares genetic and vascular risk factors with other stroke subtypes, especially LAAS, pointing to the boundaries of current diagnostic criteria. The potentially causal associations with carotid atherosclerosis and atherosclerotic risk factors might have implications for prevention strategies targeting these mechanisms.

Disclosure: No

O074 / 888

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

DOES INFLAMMATORY PROFILE AFFECT PENUMBRA SALVAGE IN ACUTE ISCHEMIC STROKE?

L. Mechtouff ^1,2, N. Debs³, C. Frindel³, A. Bani-Sadr⁴, T. Bochaton^2,5, A. Paccalet², C. Crola Da Silva², M. Buisson⁶, C. Amaz⁶, Y. Berthezene⁴, O.F. Eker⁴, M. Bouin⁷, C. De Bourguignon⁶, N. Mewton⁶, M. Ovize^6,2, G. Bidaux², N. Nighoghossian^2,1, T.-H. Cho^1,2

¹Hospices Civils de Lyon, Stroke Department, Lyon, France, ²Université Lyon 1, Univ Lyon, CarMeN Laboratory, INSERM, INRA, Lyon, France, ³Université Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1044, Lyon, France, ⁴Hospices Civils de Lyon, Neuroradiology Department, Lyon, France, ⁵Hospices Civils de Lyon, Cardiac Intensive Care Unit, Lyon, France, ⁶Hospices Civils de Lyon, Clinical Investigation Center, INSERM 1407, Lyon, France, ⁷Hospices Civils de Lyon, Cellule Recherche Imagerie, Lyon, France

Background and aims: In acute ischemic stroke (AIS), inflammatory process may adversely affect penumbra salvage. This study aimed to assess the relationship between blood biomarkers of inflammation and the lesion growth within the penumbra in the setting of mechanical thrombectomy (MT).

Methods: HIBISCUS-STROKE cohort enrolled anterior circulation AIS patients treated with MT following MRI. Lesion growth within the penumbra was assessed on day-6 MRI using a voxel-based nonlinear coregistration method. Serum levels of 10 blood biomarkers of inflammation were measured at 4 timepoints within the first 48 hours. A multiple linear regression model was performed to detect any association between area under the curve (AUC) of these biomarkers within the first 48 hours and lesion growth within the penumbra.

Results: 90 patients were included. Median lesion growth within the penumbra was 2.3 [0.7-6.2] mL. On multivariable analysis, a higher soluble form suppression of tumorigenicity 2 (sST2) AUC (β +1.40, 95%CI 0.39-2.41), a younger age (β-1.19, 95%CI 2.33--0.06), a lower Alberta Stroke Program Early CT score (ASPECTS) (β-1.23, 95%CI -2.22--0.23) and lack of successful reperfusion (β-5.69, 95%CI -10.23--1.15) were associated with lesion growth within the penumbra. When restricting analyses to patients with successful reperfusion (n=76 patients with TICI score 2b/2c/3), a higher sST2 AUC (β+1.17, 95%CI 0.14-2.20) and a lower ASPECTS (β-1.83, 95%CI -2.92--0.73) remained associated with lesion growth within the penumbra.

Conclusions: sST2 levels within the first 48 hours seem to affect penumbra salvage in AIS patients.

Acknowledgment: ANR-16-RHUS-0009

Figure.

Index case illustrating the MRI post processing method

Disclosure: No

O075 / 1334

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

EICOSAPENTAENOIC ACID (EPA) MODULATES EXPRESSION OF NEUTROPHIL DEGRANULATION PROTEINS IN BRAIN ENDOTHELIUM FOLLOWING CYTOKINE CHALLENGE

S. Sherratt^1,2, P. Libby³, D. Bhatt³, P. Mason ^3,1

¹Elucida Research LLC, Beverly, United States, ²University of New Hampshire, Durham, United States, ³Brigham and Women's Hospital, Harvard Medical School, Boston, United States

Background and aims: During inflammation, brain vascular endothelial cells (ECs) stimulate neutrophil degranulation, a contributor to atherothrombotic stroke. The omega-3 fatty acid eicosapentaenoic acid (EPA) reduced first and total ischemic strokes each by 36% in patients with elevated cardiovascular risk (REDUCE-IT). We measured the effects of EPA on neutrophil degranulation protein expression in ECs subjected to inflammation.

Methods: Human brain microvascular ECs (HBECs) were first challenged with IL-6 at 12 ng/ml for 2 h and then treated with EPA (40 µM) for 24 h. Global proteomic analysis was performed using LC/MS to measure relative protein expression. Only significant (p<0.05) changes in expression between treatment groups >1-fold were analyzed by differential enrichment analysis of proteomics data (DEP) bioinformatic package in R and included in gene set enrichment analyses (GSEA).

Results: EPA treatment significantly modulated the expression of 504 proteins (212 increased expression, 292 decreased expression) in HBECs compared with IL-6 alone. The GSEA revealed EPA treatment significantly modulated expression of 66 proteins associated with neutrophil degranulation pathway (Gene Ontology ID: 0043312). This included a 1.1-fold decrease in expression of heat shock protein (HSP) 90 (1.1-fold) and HSP 86 (1.1-fold), and increased expression of several thiol proteases, namely cathepsin B (1.1-fold), C (1.1-fold), L (1.4-fold), and Z (1.2-fold).

Conclusions: EPA significantly modulated expression of neutrophil degranulation proteins in brain ECs under conditions of inflammation. These effects of EPA on vascular inflammation have implications for ischemic disease, including stoke, as demonstrated in large outcome trials.

Disclosure: Yes

O076 / 860

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

LONG-TERM OUTCOME OF CEREBRAL VENOUS THROMBOSIS DUE TO SARS-COV-2 VACCINE–INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA

A. van de Munckhof ¹, T. Kleinig², T.S. Field³, C. Cordonnier⁴, K. Krzywicka¹, S. Poli^5,6, M. Sánchez van Kammen¹, A. Scutelnic⁷, E. Lindgren^8,9, R. Lemmens¹⁰, A. Borhani-Haghighi¹¹, A. Ciccone¹², T. Gattringer¹³, M. Wittstock¹⁴, V. Dizonno³, A. Devroye¹⁰, S. Nagel¹⁵, S. Middeldorp¹⁶, M.M. Levi^17,18, J.A. Kremer Hovinga¹⁹, A. Günther²⁰, K. Jood^8,9, T. Tatlisumak^8,9, J. Putaala²¹, M.R. Heldner⁷, M. Arnold⁷, D. Aguiar de Sousa²², J.M. Ferro²³, J.M. Coutinho¹, Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group

¹Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ²Royal Adelaide Hospital, Department of Neurology, Adelaide, Australia, ³University of British Columbia, Vancouver Stroke Program, Division of Neurology, Vancouver, Canada, ⁴Lille University Hospital, Department of Neurosciences and Cognition, Lille, France, ⁵Eberhard-Karls University, Department of Neurology & Stroke, Tuebingen, Germany, ⁶Eberhard-Karls University, Hertie Institute for Clinical Brain Research, Tuebingen, Germany, ⁷Inselspital, Bern University Hospital, University of Bern, Department of Neurology, Bern, Switzerland, ⁸Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden, ⁹Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Department of Clinical Neuroscience, Gothenburg, Sweden, ¹⁰UZ Leuven, Department of Neurology, Leuven, Belgium, ¹¹Shiraz University of Medical Sciences, Department of Neurology, Shiraz, Iran, Islamic Republic of, ¹²Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Department of Neurology, Mantua, Italy, ¹³Medical University of Graz, Department of Neurology, Graz, Austria, ¹⁴University Hospital Rostock, Department of Neurology, Rostock, Germany, ¹⁵Heidelberg University Hospital, Department of Neurology, Heidelberg, Germany, ¹⁶Radboud University Medical Center, Department of Internal Medicine & Radboud Institute of Health Sciences, Nijmegen, Netherlands, ¹⁷National Institute for Health Research, University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom, ¹⁸Amsterdam University Medical Centers, University of Amsterdam, Department of Vascular Medicine, Amsterdam, Netherlands, ¹⁹Inselspital, Bern University Hospital, University of Bern, Department of Hematology, Bern, Switzerland, ²⁰Jena University Hospital, Department of Neurology, Jena, Germany, ²¹Helsinki University Hospital, University of Helsinki, Department of Neurology, Helsinki, Finland, ²²Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Department of Neurosciences and Mental Health, Lisbon, Portugal, ²³Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

Background and aims: Since initiation of COVID-19 vaccination, cases of cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) have been reported. Reported in-hospital mortality varies between 20-50%, but data on long-term outcome of surviving patients with CVT-VITT are not available.

Methods: We report follow-up data of CVT-VITT cases after COVID-19 vaccination from an international registry. VITT was classified according to the Pavord criteria. Outcomes were mortality, functional dependency, relapse of VITT, new thrombosis, and new bleeding events.

Results: Of 62 patients with CVT-VITT who survived initial hospital admission, follow-up data were available for 48/62 (77%) cases (32 (67%) definite VITT, 7 (15%) probable VITT, 9 (19%) possible VITT). Median time from diagnosis to last follow-up was 110 days (IQR 86-174). There were no new venous or arterial thrombotic events reported in any case. Among 35/44 (80%) cases that achieved clinical remission, 0/29 cases had a relapse of VITT. Major bleeding was reported in 1/45 (2%) cases (intracranial bleed). Mortality at follow-up was 1/48 (2%, 95%CI 0-11%). 44/48 (92%) cases had a modified Rankin Scale score of 0-2 at follow-up, compared to 32/46 (70%) at hospital discharge. 16/34 (47%) of cases had returned to work or school.

Conclusions: In patients who survive the acute phase of CVT-VITT, long-term mortality is low and thrombotic and bleeding events are rare. Approximately half of the CVT-VITT patients at follow-up could resume all daily activities.

Disclosure: No

O077 / 341

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

ABSENCE OF SUSCEPTIBILITY VESSEL SIGN IN PATIENTS WITH MALIGNANCY-RELATED ACUTE ISCHEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY

M. Beyeler ¹, N. Belachew², M. Kielkopf¹, E. Aleman³, A.X.L. Betancourt¹, K. Genceviciute¹, C. Kurmann², B. Birner¹, T.R. Meinel¹, A. Scutelnic¹, P. Bücke¹, D. Seiffge¹, T. Dobrocky², H. Mattle¹, M. Arnold¹, U. Fischer⁴, T. Pabst⁵, M. Berger⁵, J. Kaesmacher², S. Jung¹

¹Inselspital, Bern University Hospital, and University of Bern, Department of Neurology, Bern, Switzerland, ²Inselspital, Bern University Hospital, and University of Bern, Institute for Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ³University Hospital of Freiburg, Department of Neuroradiology, Freiburg, Germany, ⁴University Hospital of Basel, University of Basel, Department of Neurology, Basel, Switzerland, ⁵Inselspital, Bern University Hospital, and University of Bern, Department of Oncology, Bern, Switzerland

Background and purpose: Platelet and fibrin-rich composition of retrieved thrombi in patients with acute ischemic stroke (AIS) are associated with the absence of susceptibility vessel sign (SVS) on MRI and the presence of active malignancy. This study analyzed the direct association between SVS status and the presence of active malignancy in AIS patients that underwent mechanical thrombectomy (MT).

Methods: Single-centered, retrospective and cross-sectional study including consecutive patients with admission MRI treated for AIS with MT between January 2010 and December 2018. SVS status was evaluated on susceptibility weighted imaging (SWI). Adjusted OR (aOR) were calculated to determine the association between the absence of SVS and active and occult malignancy presence. The performance of predictive models with and without SVS status were assessed by calculating the areas under the Receiver Operating Characteristics curve (auROC).

Results: Of the 577 AIS patients with assessable SVS status, 40 (6.9%) had a documented active malignancy and 72 patients (12.5%) showed no SVS. The absence of SVS was strongly associated with active malignancy (aOR 4.85, 95% CI 1.94–12.11) and occult malignancy alone (aOR 11.42, 95% CI 2.36–55.20). The auROC of predictive models, including demographics and common malignancy-biomarkers, decreased from 0.85 to 0.82 when SVS status was excluded (Figure 1, P=0.07).

Conclusions: The absence of SVS on baseline MRI is associated with the presence of active and occult malignancy in patients with AIS eligible for MT. Considering SVS status may increase the chances of detecting paraneoplastic coagulation disorders and occult malignancy in patients with AIS.

Disclosure: No

O078 / 710

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

MASS SPECTROMETRY-BASED PROTEOMIC CHARACTERIZATION OF FORMALIN FIXED PARAFFIN-EMBEDDED ACUTE ISCHEMIC STROKE (AIS) BLOOD CLOTS REVEALS POSSIBLE BIOMARKERS FOR STROKE ETIOLOGY

R. Rossi ¹, O.M. Mereuta¹, M. Barbachan e Silva², S. Molina Gil¹, A. Douglas¹, A. Pandit³, M. Gilvarry⁴, R. McCarthy⁴, S. O'Connell², C. Tierney¹, K. Psychogios⁵, G. Tsivgoulis⁶, I. Szikora⁷, T. Tatlisumak⁸, A. Rentzos⁹, J. Thornton¹⁰, P. Ó Broin², K. Doyle¹

¹National University of Ireland Galway, Physiology, Galway, Ireland, ²National University of Ireland Galway, School of Mathematical & Statistical Sciences, Galway, Ireland, ³National University of Ireland Galway, CÚRAM–SFI Research Centre for Medical Devices, Galway, Ireland, ⁴Cerenovus, Galway, Ireland, ⁵Metropolitan Hospital, Stroke Unit, Athens, Greece, ⁶National & Kapodistrian University of Athens, “Attikon” University Hospital, Second department of neurology, Athens, Greece, ⁷National Institute of Clinical Neurosciences, Department of Neurointerventions, Budapest, Hungary, ⁸Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden, ⁹Sahlgrenska University Hospital, 9Department of Interventional and Diagnostic Neuroradiology, Gothenburg, Sweden, ¹⁰Beaumont Hospital, Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland

Background and aims: We developed a shotgun proteomic approach to compare the proteome of formalin-fixed paraffin-embedded (FFPE) cardioembolic (CE) and Large Artery Atherosclerotic (LAA) clots.

Methods: The proteome of 16 CE and 15 LAA clots was extracted from FFPE samples and analysed by label-free quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS). MaxQuant v1.5.2.8 and Perseus v.1.6.15.0 were used for bioinformatic analysis and t-test was used to assess statistical significant difference between the two groups. Protein classes were identified using PANTHER database and STRING database was used to predict protein interactions.

Results: We identified 1581 protein groups as part of the AIS thrombus proteome and 14 were significantly differentially abundant (p<0.05) between the two groups. Four were most abundant in LAA clots and involved in the ubiquitin-proteasome pathway, blood coagulation or plasminogen-activating cascade. Ten were most abundant in CE clots and involved in the ubiquitin proteasome-pathway, cytoskeletal remodeling of platelets, platelet adhesion or blood coagulation (Table).

Proteins most abundant in LAA clots
Protein Name	Uniprot ID	p-value	Fold Change
Ubiquitin-conjugating enzyme E2	P61088	0.007	1.44
Fibrinogen alpha chain	P02671	0.040	1.51
Ubiquitin-conjugating enzyme E2 variant 1	Q13404	0.043	1.38
Ubiquitin-60S ribosomal protein L40	P62987	0.048	1.68
Proteins most abundant in CE clots
Protein Name	Uniprot ID	p-value	Fold Change
Ubiquitin-like modifier-activating enzyme 1	P22314	0.007	1.83
Protein disulphide-isomerase A6	Q15084	0.008	1.43
Coagulation factor XIII A chain	P00488	0.010	1.86
Myosin-9	P35579	0.012	1.47
Ras-related protein Rab-27B	O00194	0.021	1.36
Platelet glycoprotein Ib alpha chain	P07359	0.023	1.61
Coronin-1C	Q9ULV4	0.026	1.72
Actin-related protein 2/3 complex subunit 2	O15144	0.032	1.30
Platelet glycoprotein IX	P14770	0.042	1.44
Valosin-Containing Protein (VCP)	P55072	0.049	1.48

Conclusions: 14 proteins were identified for a proof-of-principle characterization of cardioembolic and LAA FFPE clots advancing the proteome profile of AIS human thrombi and understanding the pathophysiology of ischemic stroke. Ubiquitin-proteasome and blood coagulation pathways were highlighted in clots belonging to both etiologies. In CE clots were also highlighted pathways related to platelet activities.

Funding: Science Foundation Ireland (Grant Number 13/RC/2073_2) and Cerenovus.

Disclosure: No

O079 / 1296

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

GROWTH DIFFERENTIATION FACTOR 15 (GDF-15), A NOVEL PROGNOSTIC MARKER FOR POST STROKE MORTALITY: RESULTS FROM THE BIOSIGNAL STUDY

M. Arnold ¹, J. Schweizer¹, V. Schütz¹, L.P. Westphal¹, C. Inauen¹, T. Pokorny¹, M. Arnold², U. Fischer^2,3, L. Bonati³, G.M. De Marchis³, T. Kahles⁴, K. Nedelchev⁴, C. Cereda⁵, G. Kägi⁶, A. Bustamante⁷, J. Montaner⁷, G. Ntaios⁸, C. Foerch⁹, A. Luft¹, L. Saleh¹⁰, K. Spanaus¹⁰, A. von Eckardstein¹⁰, M. Katan¹

¹University Hospital Zurich, Neurology, Zurich, Switzerland, ²Inselspital, Neurology, Bern, Switzerland, ³University Hospital Basel, Basel, Switzerland, ⁴Cantonal Hospital Aarau, Aarau, Switzerland, ⁵Neurocentro della Svizzera Italiana, Lugano, Switzerland, ⁶Cantonal Hospital St. Gallen, St Gallen, Switzerland, ⁷Vall d`Hebron Institute of Research, Barcelona, Spain, ⁸University of Thessaly, Larissa, Greece, ⁹University Hospital of Frankfurt, Frankfurt, Germany, ¹⁰University Hospital Zurich, Clinical Chemistry, Zurich, Switzerland

Background and aims: Growth differentiation factor 15 (GDF-15) was shown to be a robust blood-biomarker of mortality in patients with cardiovascular-disease and has been linked to various neoplastic disorders. In this study we aimed to evaluate the association of GDF-15 levels with mortality and functional outcome in patients with acute ischemic stroke (AIS). Further, we aimed to evaluate GDF-15 as a predictor of cause-specific death and investigate its association with underlying comorbidities, especially cancer.

Methods: We quantified GDF-15 levels within 24h after symptom-onset in 1759 AIS patients from the multicentre BIOSIGNAL-study (NCT02274727). Primary outcomes were all-cause death and unfavorable functional outcome (mRS 3-5) after one year. Secondary outcomes included cardiovascular-death, non-cardiovascular-death and unclassified-death. The independent prognostic utility of GDF-15 was assessed with multivariable Cox-proportional hazard regression.

Results: Higher GDF-15 levels were associated with a higher risk for all-cause death (adjHR 3.88, 95%-CI 2.58-5.83, p<0.001, per unit log₁₀ increase). Competing risk analysis revealed that GDF-15 levels are associated with both cardiovascular-death (adjHR 3.09, 95%-CI 1.87-5.11, p<0.001) and non-cardiovascular-death (adjusted HR 8.63, 95%-CI 3.54-21.05, p<0.001). In the subgroup of cryptogenic stroke (n=641), the association with non-cardiovascular-death was even more pronounced (adjHR 27.54, p<0.001), in this subgroup GDF-15 was strongly associated with diagnosis of metastatic tumor (n=24) (OR 48.45, p<0.001). GDF-15 was further associated with unfavorable outcome (adjOR 2.76, 95%-CI 1.57-4.83, p<0.001).

Conclusions: GDF-15 is an independent predictor of cardiovascular and non-cardiovascular-death in AIS patients. Further studies need to investigate if GDF-15 may aid in the identification of underlying non-cardiovascular disease, especially cancer.

Disclosure: No

O080 / 803

Scientific Communications 9 - Diagnosis / Investigation of Stroke Etiology and Pathophysiology

LIVER FIBROSIS IS RELATED TO ATRIAL FIBRILLATION AND OUTCOME IN ACUTE ISCHEMIC STROKE

S. Fandler-Höfler ¹, M. Kneihsl¹, R.E Stauber², H. Mangge³, G. Wünsch⁴, M. Haidegger¹, P. Fickert², C. Enzinger¹, T. Gattringer^1,5

¹Medical University of Graz, Department of Neurology, Graz, Austria, ²Medical University of Graz, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Graz, Austria, ³Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria, ⁴Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria, ⁵Medical University of Graz, Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Graz, Austria

Background: Non-alcoholic fatty liver disease and particularly liver fibrosis may indicate an increased risk for atrial fibrillation, but this association has not yet been systematically investigated in a cohort of ischemic stroke patients. Therefore, we aimed to explore whether clinically inapparent liver fibrosis is related to atrial fibrillation and clinical outcome in a cohort of consecutive acute ischemic stroke patients.

Methods: We analyzed data from a prospective single-center study investigating all ischemic stroke patients admitted to our stroke unit over a one-year-period. All patients received thorough etiological work-up including cardiac rhythm monitoring. For evaluation of liver fibrosis, we calculated the FIB-4 index, a well-established non-invasive liver fibrosis test based on simple clinical and laboratory parameters (cut-off ⩾2.67). Laboratory results were analyzed from a uniform blood sample taken within 24 hours of admission.

Results: Of 415 included patients (mean age 70.2 years, 57.7% male), FIB-4 indicated liver fibrosis in 92 (22.2%). Atrial fibrillation as the underlying stroke mechanism was present in 28.0% (large vessel disease: 25.6%, small vessel disease: 11.4%, cryptogenic: 29.2%). Atrial fibrillation was strongly related to liver fibrosis (p<0.001). This association remained significant after correction for age and relevant co-morbidities (Odds Ratio 2.57, 95% confidence interval 1.48-4.47, p=0.001). Additionally, liver fibrosis was associated with worse functional outcome (p<0.001) and higher three-year mortality (p=0.02).

Conclusions: Clinically inapparent liver fibrosis is independently associated with atrial fibrillation and worse outcome in acute ischemic stroke patients. Further studies should evaluate whether adding liver fibrosis to atrial fibrillation risk scores will increase their precision.

Disclosure: No

O082 / 88

Scientific Communications 10 - Prognosis and Outcome After Stroke

DEVELOPING AND VALIDATING A MULTIVARIABLE PREDICTION MODEL FOR FUTILE ACUTE REVASCULARIZATION THERAPIES IN PATIENTS WITH ACUTE ISCHEMIC STROKE

T. Meinel ¹, C. Lerch¹, U. Fischer¹, R. Meier¹, J. Kaesmacher¹

¹ Stroke Research Center Bern, Inselspital, University of Bern, Bern, Switzerland

Objectives: Very poor outcome despite intravenous thrombolysis(IVT) and mechanical thrombectomy(MT) occurs in about 1 of 4 patients with ischemic stroke and is associated with a high logistic and economic burden. We aimed to develop and validate a multivariable prognostic model to identify futile acute revascularizations(FAR) in patients undergoing those therapies.

Materials and methods: Prospectively collected observational registry of a single academic stroke center of patients undergoing MT and/or IVT. Splitting the dataset into a training (1808,80%) and test (453,20%) subgroup, we used gradient boosted decision tree machine-learning models after k-NN imputation of 32 variables available at admission to predict FAR defined as modified Rankin-Scale(mRS) 5-6 at 3 months. We report feature importance, ability for discrimination, calibration and clinical utility.

Results: Of 2261 patients (median age 75 years(64-83), 46%female, median NIHSS 9(4-17)), 539(24%) had FAR. Feature importance identified clinical variables (stroke severity, age, active cancer, prestroke disability), laboratory values (glucose, CRP, dyslipidemia), imaging biomarkers (white matter hyperintensities) and time-to-treatment as the most important predictors. The final model was discriminatory for predicting 3-month FAR (AUC 0.87 95% CI 0.87-0.88) and had good calibration (Brier 0.12). Decision curve analyses suggested higher mean net benefit at lower thresholds of treatment (up to 0.8).

Conclusions: This model for prediction of FAR (mRS 5-6) can help to inform shared decision making and identified the most relevant features for the emergency setting. Whereas its utility might be present in low resource healthcare settings, incorporation of further multifaceted variables is necessary to further increase the predictive performance.

Figure.

Feature-Importance

Disclosure: No

O083 / 1179

Scientific Communications 10 - Prognosis and Outcome After Stroke

TIMING AND CAUSES OF DEATH AFTER ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE ISCHAEMIC STROKE

W.M Sluis ¹, W.H Hinsenveld², R.-J.B Goldhoorn², L.H Potters¹, A.AE Bruggeman³, A. van der Hoorn⁴, J.C. Bot⁵, R.J van Oostenbrugge², H.F Lingsma⁶, J. Hofmeijer⁷, W.H van Zwam⁸, C.BLM Majoie³, HB. van der Worp¹, MR CLEAN REGISTRY Investigators

¹University Medical Center Utrecht, Neurology, Utrecht, Netherlands, ²Maastricht University Medical Center, Neurology, Maastricht, Netherlands, ³Amsterdam University Medical Centers, Location AMC, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁴University Medical Center Groningen, Radiology, Groningen, Netherlands, ⁵Amsterdam University Medical Centers, Location VUmc, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁶Erasmus MC University Medical Center, Public Health, Rotterdam, Netherlands, ⁷Rijnstate Hospital, Neurology, Arnhem, Netherlands, ⁸Maastricht University Medical Center, Radiology, Maastricht, Netherlands

Background and aims: Endovascular treatment (EVT) increases the chance of a good functional outcome after ischaemic stroke due to large vessel occlusion, but the risk of death at 90 days is still considerable. We aim to describe the causes, timing and risk factors of death after EVT to aid future studies aiming to improve outcome after stroke.

Methods: We assessed causes and timing of death in patients included in the MR CLEAN Registry (2014 – 2017), a prospective, multicenter, observational cohort study of EVT in the Netherlands. Causes of death were determined by reviewing serious adverse event forms, discharge letters, and other written clinical information. Risk factors for mortality were determined with multivariate logistic regression.

Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (26.2%), intracranial haemorrhage (16.9%), withdrawal of care due to the initial symptoms (13.4%), and malignant oedema (12.3%). 52% of the deaths occurred in the first seven days, with intracranial haemorrhage as the most frequent cause. The strongest risk factors for death were a higher NIHSS score at 24 to 48 hours after EVT, hyperglycaemia before treatment and functional dependency before the stroke.

Conclusions: Stroke severity after EVT, hyperglycaemia at baseline and pre-stroke functional dependency predict mortality in the first 90 days after EVT. The most common cause of death is pneumonia. About half of the deaths occurred in the first seven days. Strategies to prevent complications after EVT could improve survival.

Disclosure: Yes

O084 / 129

Scientific Communications 10 - Prognosis and Outcome After Stroke

NINETY-DAY STROKE RECURRENCE RATE IN MINOR STROKE: A META-ANALYSIS OF RANDOMIZED TRIALS AND OBSERVATIONAL STUDIES

A. Lim ^1,2, H. Ma^3,1, C. Johnson⁴, S. Singhal^3,1, S. Muthusamy^3,1, Y. Wang^5,6, Y. Pan^5,6, S. Coutts⁷, A. Ois⁸, M.K Kapral⁹, M. Knoflach¹⁰, L.J Woodhouse¹¹, P.M Bath¹¹, T. Phan^1,3

¹Monash University, Department of Medicine, Melbourne, Australia, ²Monash Medical Centre, Department of Emergency Medicine, Melbourne, Australia, ³Monash Medical Centre, Department of Neurology, Melbourne, Australia, ⁴Dell Medical School, The University of Texas at Austin, Austin, United States, ⁵Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ⁶China National Clinical Research Centre for Neurological Diseases, Beijing, China, ⁷Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada, ⁸Servicio de Neurologia, Hospital del Mar, Barcelona, Spain, ⁹Department of Medicine, University of Toronto, Toronto, Canada, ¹⁰Department of Neurology, Innsbruck Medical University, Innsbruck, Austria, ¹¹Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom

Background: Minor ischemic stroke, often defined as National Institutes of Health Stroke Scale Score (NIHSS) ⩽5, is associated with high frequency of stroke recurrence. We plan to evaluate the pooled proportion of 90-day stroke recurrence for minor ischemic stroke.

Methods: Papers published on PubMed up to 1/12/21 and reference lists were searched. Experts in the field were consulted. Studies describing a minor stroke cohort (NIHSS⩽5) with reported 90-day stroke recurrence were selected by two independent reviewers. Three-level random effects meta-analysis (level 3 accounting for between-study heterogeneity – I²_{level 3}, level 2 accounting for within-study heterogeneity – I²_{level 2}) was conducted. Subgroup analysis by study design (RCT experimental, RCT control, observational) and meta-regression were performed.

Results: A total of 20 observations nested into 14 studies were included (6 RCTs and 8 observational studies describing 45462 patients - PRISMA figure 1). The pooled 90-day stroke recurrence was 8.4% (95% CI 6.3%-10.8%; I²_{level 2} = 13.6%, I²_{level 3} = 84.4%) (Figure 2). Subgroup analysis demonstrated significant differences between study designs – 5.5% (95% CI 4.0%-7.2%; I²=91.2%) for experimental arms, 7.7% (95% CI 5.7%-9.9 %; I²=93.6%) for control arms, and 10.4% (95% CI 6.8%-14.6%; I²=98.6%) for observational studies (p<0.0001). Meta-regression demonstrated a significant reduction in the estimate with each subsequent year of publication (β=-0.010; 95% CI -0.020, -0.001; p=0.02), suggesting a reduction in stroke recurrence rate of 0.69% (95% CI 0.71-0.67) per year (Figure 3).

Conclusions: Ischemic stroke recurrence remains high after minor ischemic stroke though rates have declined in recent years.

Disclosure: No

O085 / 1615

Scientific Communications 10 - Prognosis and Outcome After Stroke

PREDICTORS OF POOR OUTCOME IN LARGE VESSEL OCCLUSION STROKE UNDERWENT MECHANICAL THROMBECTOMY WITH SMALL FINAL INFARCT VOLUME

H. Abdelhamid ^1,2, M. Mohammaden¹, D. Haussen¹, A. Al-Bayati¹, L. Viana¹, A. Pinheiro¹, F. Ferreira¹, N. Bhatt¹, B. Liberato¹, M. Frankel¹, R. Nogueira¹

¹Emory University School of Medicine, Grady memorial hospital, Marcus Stroke Center, Neurology department, Atlanta, United States, ²Beni-Suef University, Beni-Suef, Egypt

Background and aims: Final infarct volume (FIV) is a strong predictor of outcome. Despite small FIV is associated with good outcome, a considerable number of patients do not achieve functional independence. We sought to determine predictors of poor outcome in anterior large vessel occlusion stroke (LVOs) with small FIV.

Methods: A prospectively maintained mechanical thrombectomy (MT) database from October 2010 -February 2021 was reviewed. Patients were included if they had intracranial ICA or MCA-M1/2 occlusions, underwent MT, had premorbid modified Rankin Scale (mRS)⩽2, and FIV⩽30 ml on MRI. Uni- and multivariable analyses were performed to identify predictors of poor outcome defined as mRS>2 at 90-days.

Results: Among 2431 thrombectomies, 550 patients were eligible for the analysis (mean age±SD; 71.9±13.4 years, baseline NIHSS score±SD; 17.39±5.9, and 54.2% were females). Patients with poor outcome (n=172) were older and had more frequent atrial fibrillation, hypertension and diabetes mellitus compared to those with good outcome (n=383) (table 1). On multivariable analysis, age (OR1.032, 95%CI [1.012-1.051],P=.001), baseline NIHSS score (OR1.075, 95%CI [1.032-1.119],P<.001), number of passes (OR1.075,95%CI[1.053-1.565],P=.014), history of prior stroke (OR2.512, 95%CI[1.341-4.706],P=.004), long LWK-puncture time (OR1.001,95%CI[1.000-1.002],P.002), low hematocrit value (OR.937, 95%CI[.903-.972],P <.001), CAD (OR1.988, 95%CI[1.039-3.802],P.038) and non-smoking (OR.417, 95%CI[.192-.908],P.028) were independent predictors of poor outcome.

Conclusions: Age, baseline NIHSS, number of passes, history of prior stroke, long LWK-puncture time, low hematocrit value, CAD, and non-smoking were independent predictors of poor outcome in LVOs with small final infarct volume. Future interventions are warranted to improve outcome in those patient population.

Disclosure: No

O086 / 357

Scientific Communications 10 - Prognosis and Outcome After Stroke

COMORBIDITY BURDEN IS A RISK FACTOR FOR WORSE FUNCTIONAL OUTCOME AFTER THROMBECTOMY FOR ACUTE ISCHEMIC STROKE

A.-C. Probst ¹, E. Barow¹, H. Pinnschmidt², M. Heinze¹, M. Jensen¹, D.L. Rimmele¹, F. Flottmann², G. Brooks², J. Fiehler², C. Gerloff¹, G. Thomalla¹

¹University Medical Center Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Hamburg, Germany, ²University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Background and aims: Comorbidities and polypharmacy have been reported as risk and prognostic factors in stroke patients. However, previous results are limited as comorbidities and polypharmacy are mostly studied separately and approaches to assess them vary. We aimed to examine the association of both with functional outcome after thrombectomy for acute ischemic stroke.

Methods: Acute ischemic stroke patients with large vessel occlusion (LVO) undergoing mechanical thrombectomy, enrolled in an observational study between June 2015 and September 2020, were analyzed. Polypharmacy was defined as the intake of ⩾5 medications at time of stroke onset. Relevant comorbidity burden was specified as a Charlson Comorbidity Index (CCI) score ⩾2, modified for stroke patients. Favorable outcome was a score of 0-2 on the Modified Rankin Scale (mRS) at 90 days after stroke.

Results: Of 903 patients enrolled, 703 stroke patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO and available data were studied. Relevant comorbidity burden (CCI ⩾2) was present in 226 (32.1%) patients. 315 (44.8%) patients presented with polypharmacy. Favorable outcome was less frequently achieved in patients with a CCI ⩾2 (47 [20.8%] vs. 172 [36.1%] patients, p<0.001), similar to patients with polypharmacy (69 [21.9%] vs. 150 [38.7%] patients, p<0.001). A CCI ⩾2 was associated with lower odds of favorable outcome (odds ratio 0.52, 95% confidence interval 0.33-0.82, p=0.005), while polypharmacy was not associated with outcome.

Conclusions: Relevant comorbidity burden and polypharmacy are common after thrombectomy for acute ischemic stroke, with comorbidity burden being a risk factor for worse functional outcome.

Disclosure: No

O087 / 1365

Scientific Communications 10 - Prognosis and Outcome After Stroke

THE LEISTAR EYE STUDY: DOES SYMPTOM DURATION AFFECT OUTCOME IN PATIENTS WITH RETINAL ISCHAEMIC EVENTS PRESENTING TO THE UNIVERSITY HOSPITALS OF LEICESTER (UHL) TIA CLINIC?

L. Manning ¹, J. Minhas², L. Beishon², D. Eveson¹, B. Coles³, A. Mistri¹

¹University Hospitals of Leicester NHS Trust, Department of Stroke Medicine, Leicester, United Kingdom, ²University of Leicester, Cardiovascular Sciences, Leicester, United Kingdom, ³University of Leicester, Department of Health Sciences, Leicester, United Kingdom

Background and aims: Retinal ischaemic events (transient monocular blindness (TMB) and retinal artery occlusion (RAO)) confer significant mortality risk, as evidenced by previous research from our group. We investigated the association between symptom duration and mortality following retinal ischaemic events.

Methods: We analysed the Leicester Stroke and TIA Research (LeiSTAR) dataset of prospectively collected data on all patients diagnosed with TIA or stroke at the University Hospitals of Leicester TIA clinic, from 28th Sept 2012 to 13th January 2021. Mortality rate (deaths per 1,000 patient years (PTPY)), and post-appointment survival for those diagnosed with retinal ischaemic events were assessed, and compared between those with symptom duration <24 hours and >24 hours. Survivor function was calculated over full data and evaluated at indicated times.

Results: Among 7131 attendees, 678 were diagnosed with TMB or RAO. 285 women (42%); mean age 72 years (IQR 63-79) and 557 white ethnicity (87%). There were 119 deaths PTPY over 2,633 total years follow up (8 years longest follow-up). Symptom duration data was available for 572: 274 >24-hours duration; 298< 24-hours. Mortality (PTPY) was higher in the >24-hour group: 65.51 (CI 48.75 to 88.03) versus 37.23 (28.71 to 48.71). Yearly post-clinic survival (1 to 8 years) was lower in the >24-hour group: 5-year post appointment survival 81.6% (76.2 to 85.8) versus 71.6% (62.8 to 78.7), p= 0.007.

Conclusions: Mortality following retinal ischaemic events is higher, and survival rates lower, in those with symptom duration > 24 hours. Further research is needed to investigate the reasons for this association.

Disclosure: No

O088 / 847

Scientific Communications 10 - Prognosis and Outcome After Stroke

PRESENTATION AND TREATMENT OUTCOMES OF ACUTE BASILAR ARTERY OCCLUSION: A 13-YEAR RETROSPECTIVE COHORT STUDY

N. Chhabra ¹, C.B. O'Carroll¹, H. Wang², A. Shahid³, A. Ramirez Roggio⁴, Z. Wolcott⁴, A.A. Mbonde¹, R.E. Carlin⁵, O.M. Dumitrascu¹, G. Kumar¹, J. Huang⁴, E.L. Scharf⁶, C.-C. Chiang⁶

¹Mayo Clinic, Neurology, Scottsdale, United States, ²Mayo Clinic, Neurology, Mankato, United States, ³Mayo Clinic, Neurosurgery, Rochester, United States, ⁴Mayo Clinic, Neurology, Jacksonville, United States, ⁵Ceders-Sinai, Neurology, Los Angeles, United States, ⁶Mayo Clinic, Neurology, Rochester, United States

Background and aims: We aim to assess the presentation and treatment outcomes in patients with acute basilar artery occlusion (ABAO) after receiving medical management (MM) (IV tPA, antiplatelet, anticoagulation) and endovascular therapy (EVT) (intra-arterial thrombolysis, stent placement, mechanical thrombectomy).

Methods: This is a retrospective cohort study including all consecutive adult patients treated at Mayo Clinic (Arizona, Florida, Rochester) with ABAO from 2008 to 2021. ICD codes were used to identify patients with ABAO and detailed chart review was conducted. Favorable outcome was defined as modified Rankin score (mRS) ⩽ 3 at discharge.

Results: Final analysis included 182 patients (mean age 65.7, 64.2% male). 95 patients received MM and 87 received EVT. IV tPA was given to 20% of MM and 21.2% of EVT patients. Median NIHSS on presentation was significantly higher in the EVT vs MM group (17 vs 6, p=0.0001). After adjusting for presenting NIHSS and demographic factors, we found no significant difference in favorable outcome between MM and EVT (56.0% vs 35.0%, p=0.285). For patients presenting with NIHSS 0-9, EVT was associated with less favorable outcome compared to MM (OR 0.22, p=0.003 95%, CI 0.08-0.6). However, for those with presenting NIHSS >5, the EVT group had significantly higher odds of having a NIHSS improvement ⩾5 points at discharge compared to MM (OR 3.67 p=0.020 95% CI 1.23-10.61).

Conclusions: We did not find a significant difference in the overall favorable discharge outcome between EVT and MT. However, EVT could potentially provide notable NIHSS improvement in selected, but not all, patients with ABAO.

Disclosure: No

O089 / 1225

Scientific Communications 10 - Prognosis and Outcome After Stroke

CHANGES IN SLEEP-DISORDERED BREATHING FOLLOWING STROKE

L. Lisabeth ¹, G. Zhang¹, X. Shi¹, R. Chervin¹, E. Case¹, M. Smith¹, D. Brown¹

¹ University of Michigan, Ann Arbor, United States

Background and aims: Post-stroke sleep-disordered breathing (SDB) is prevalent and predicts poor outcome. Little data are available on the trajectory of SDB after stroke. The objective was to characterize change in SDB severity and patterns of change in the year following stroke.

Methods: Ischemic stroke cases (n=584) were identified from the population-based BASIC Project (5/12/16-12/30/19) and asked to participate in longitudinal SDB testing (ApneaLink Plus) shortly after stroke and at 3, 6, and 12 months post-stroke. SDB severity was assessed by respiratory event index (REI, sum of apneas and hypopneas/hour of recording); central apnea index and obstructive apnea index were also assessed. Latent class analysis (LCA) was used to identify classes of change in the three SDB severity measures.

Results: Mean age was 62 years (SD=11), 45% female, and 68.5% Mexican American. On average, median AHI decreased from baseline to 3 months, remained stable between 3-6 months and increased between 6-12 months (Figure). Based on LCA, three classes of change in the three outcome variables were identified: stable (26.9%), worsening (49.1%) and improving (24.0%).

Conclusions: The majority of those with stroke have clinically significant SDB and three-quarters experience stable high or worsening SDB severity in the year following stroke. Predicting which patients experience stable or worsening SDB may allow for targeted SDB screening and ongoing treatment to improve outcomes.

Disclosure: No

O090 / 959

Scientific Communications 11 - Neurointervention – Organisation and Outcome

DIFFERENCES BETWEEN CENTER TYPES IN THE PERFORMANCE OF ENDOVASCULAR THROMBECTOMY FOR ACUTE ISCHEMIC STROKE: RESULTS FROM THE MR CLEAN REGISTRY

S. Olthuis ¹, W. Hinsenveld¹, R.-J. Goldhoorn¹, M. Amini², N. van Leeuwen², H. Lingsma², J. Staals¹, T. Schreuder³, W. Schonewille⁴, J.A. Vos⁵, L. Yo⁶, Y. Roos⁷, A. Postma⁸, D. Dippel⁹, W. van Zwam⁸, R. van Oostenbrugge¹, I. de Ridder¹, MR CLEAN Registry investigators

¹Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht, Department of Neurology, Maastricht, Netherlands, ²Erasmus MC, University Medical Center, Department of Public Health, Rotterdam, Netherlands, ³Zuyderland MC, Department of Neurology, Heerlen, Netherlands, ⁴Sint Antonius Hospital, Department of Neurology, Nieuwegein, Netherlands, ⁵Sint Antonius Hospital, Department of Radiology, Nieuwegein, Netherlands, ⁶Catharina Hospital, Department of Radiology, Eindhoven, Netherlands, ⁷Amsterdam University Medical Center, Department of Neurology, Amsterdam, Netherlands, ⁸Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht, Department of Radiology, Maastricht, Netherlands, ⁹Erasmus MC, University Medical Center, Department of Neurology, Rotterdam, Netherlands

Background and aims: It has been argued that endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) should be primarily performed in level 1 centers (centers that provide the full range of neuro(endo)vascular care) or whether EVT could also be safely and effectively performed at level 2 centers (stroke centers that perform EVT for AIS but not for other neurovascular conditions). We aimed to compare clinical and workflow outcomes between these center types.

Methods: We analyzed data from 3,354 patients included in the MR CLEAN Registry (2014-2017). Of these patients, 63% were treated in a level 1 center. Our primary outcome was the functional outcome after 90 days (mRS score). Secondary outcomes were the NIHSS 24-48h post-EVT, door to groin time (DTGT), and procedure times. We used multilevel regression models with center as random intercept and we adjusted for prognostic factors.

Results: We observed no significant differences in level 1 centers compared to level 2 centers in mRS at 90 days (adjusted(a)cOR: 0.82, 95%CI: 0.58 to 1.16), NIHSS 24-48h post-EVT (aβ: 0.22, 95%CI: -0.72 to 1.15), nor procedure duration (aβ: -0.64, 95%CI: -8.27 to 6.99). Level 1 centers had a longer DTGT compared to level 2 centers in univariable analysis (β: 6.56, 95%CI: 3.27 to 9.84), though there was no significant association after adjustment (aβ: 4.69 95%CI: -6.59 to 15.98).

Conclusions: We found no support for the notion that EVT for AIS should be exclusively performed in level 1 centers.

Disclosure: No

O091 / 421

Scientific Communications 11 - Neurointervention – Organisation and Outcome

DRAWBACKS AND POTENTIAL FOR IMPROVEMENT OF THE DRIP-AND-SHIP PARADIGM FOR ISCHEMIC STROKE PATIENTS UNDERGOING ENDOVASCULAR TREATMENT – RESULTS FROM THE GERMAN STROKE REGISTRY

J.H. Schaefer ¹, N. Kurka¹, F. Keil², M. Wagner², H. Steinmetz¹, W. Pfeilschifter^3,1, F.O. Bohmann¹, GSR-ET Study Group

¹University Hospital Frankfurt, Goethe University, Department of Neurology, Frankfurt, Germany, ²University Hospital Frankfurt, Goethe University, Department of Neuroradiology, Frankfurt, Germany, ³Klinikum Lüneburg, Department of Neurology, Lüneburg, Germany

Background and aims: Endovascular therapy (EVT) in acute ischemic stroke has been widely established. Globally, stroke patients are transferred either directly to a thrombectomy center (DC) or a peripheral stroke unit with a “drip-and-ship” (DS) model. We aimed to investigate differences between these paradigms, including influence of time delay on functional outcome after 90 days and effects of secondary imaging before recanalization.

Methods: A retrospective analysis of the prospective German Stroke Registry (GSR) database was performed. Patients receiving EVT were enrolled between June 2015 and December 2019 in 23 German endovascular centers. Baseline characteristics, treatment and modified Ranking Scale (mRS) after 90 days were analyzed according to DC/DS admission.

Results: 2,813 patients were included in the DS and 3,819 in the DC group. After propensity score matching mRS after 90 days was higher in DS than DC admissions (OR 1.26; CI 1.13-1.40; p<0.001). Time from symptom-onset to flow-restoration was shorter in DC than DS (median 199.0 vs. 298.0 min; p<0.001). DS patients undergoing MRI (n=183) before EVT had a lower 90-day mRS than without (n=944) (OR 0.63; CI 0.45-0.88; p=0.006). ASPECTS assessed on MRI correlated with 90-day mRS (ρ= -0.326; p<0.001).

Conclusions: Clinical outcome was worse in the DS setting, even though patients were in a better state of health prior to stroke. A potentially mutable factor was the time delay of 99 min from symptom-onset to successful recanalization. Outcomes were better in the DS group when MRI was performed before EVT and negatively correlated with ASPECTS assessed on MRI.

Disclosure: No

O092 / 302

Scientific Communications 11 - Neurointervention – Organisation and Outcome

SEX DIFFERENCES IN ONSET TO HOSPITAL ARRIVAL TIME, PRESTROKE DISABILITY AND CLINICAL SYMPTOMS IN PATIENTS WITH A LARGE VESSEL OCCLUSION: A MR CLEAN REGISTRY STUDY

M. Ali ¹, A. Van Der Meij², H. Van Os², M. Ali³, E. Van Zwet⁴, F. Spaander⁵, J. Hofmeijer⁶, P. Nederkoorn⁷, I. Van Den Wijngaard^2,8,9, C. Majoie¹⁰, W. Schonewille¹¹, M. Van Walderveen¹², M. Visser¹, N. Kruyt^2,9, M. Wermer^2,9, On behalf of the MR CLEAN Registry Investigators

¹Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam, Netherlands, ²Leiden University Medical Center, Neurology, Leiden, Netherlands, ³Amsterdam UMC, Vrije Universiteit Amsterdam, Surgery, Amsterdam, Netherlands, ⁴Leiden University Medical Center, Biomedical Data Sciences, Leiden, Netherlands, ⁵Zaans Medical Center, Neurology, Zaandam, Netherlands, ⁶Rijnstate Hospital, Neurology, Arnhem, Netherlands, ⁷Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, Netherlands, ⁸Haaglanden Medical Center, Neurology, The Hague, Netherlands, ⁹University Neurovascular Center Leiden-The Hague, Neurology, Leiden, Netherlands, ¹⁰Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ¹¹Sint Antonius Hospital, Neurology, Nieuwegein, Netherlands, ¹²Leiden University Medical Center, Radiology, Leiden, Netherlands

Background and aims: Female sex is associated with worse outcomes after endovascular treatment (EVT). We assessed sex differences at hospital presentation with respect to workflow metrics, prestroke disability, and presenting clinical symptoms to help understand the difference in outcome.

Methods: We included patients from the MR CLEAN Registry (2014-2018) who received EVT for anterior circulation large vessel occlusion (LVO). We assessed sex differences in workflow metrics, prestroke disability (modified Rankin Scale [mRS] score ⩾1), and stroke severity and symptoms according to the NIHSS upon hospital admission with logistic and linear regression and calculated adjusted odds ratios (aOR).

Results: We included 4,872 patients (48% women, median age 72 years). Women less often achieved good functional outcome at 90-days compared with men (mRS⩽2: 35% versus 46%, aOR=0.71;95%CI=0.56-0.88). Mean onset-to-door time was longer in women (2h16min versus 2h7min, adjusted delay 7min;95%CI=2-12). This delay contributed to longer onset-to-groin times (3h26min in women versus 3h13min in men, adjusted delay 12min;95%CI=8-17). Women more often had prestroke disability (mRS⩾1: 41% versus 29%, aOR=1.57;95%CI=1.36-1.82). NIHSS on admission was essentially similar in men and women (mean 15±6 versus 15±6, NIHSS <10 versus ⩾10: aOR=0.91;95%CI=0.78-1.06). There were no sex differences in the occurrence of specific stroke symptoms, except that visual field deficits were less common in women (52% versus 55%, aOR=0.83;95%CI=0.74-0.94).

Conclusions: Women with LVO have longer onset-to-door times and worse prestroke disability than men. Raising awareness of these differences at hospital presentation and investigating underlying causes may help to improve outcome after EVT in women.

Disclosure: No

O093 / 280

Scientific Communications 11 - Neurointervention – Organisation and Outcome

ENDOVASCULAR THROMBECTOMY BEYOND 24 HOURS FROM ISCHAEMIC STROKE ONSET: A PROPENSITY SCORE-MATCHED COHORT STUDY

P.S. Dhillon ^1,2, W. Butt³, A. Podlasek⁴, E. Barrett^5,6, N. McConachie¹, R. Lenthall¹, S. Nair¹, L. Malik¹, M.A James^7,8,9, R.A Dineen^2,4, T.J England^10,11

¹Nottingham University Hospitals NHS Trust, Interventional Neuroradiology, Nottingham, United Kingdom, ²University of Nottingham, Radiological Sciences, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ³University Hospitals Birmingham NHS Trust, Interventional Neuroradiology, Birmingham, United Kingdom, ⁴University of Nottingham, NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom, ⁵Manchester University NHS Foundation Trust, Research and Innovation (Medical Statistics), Manchester, United Kingdom, ⁶University of Manchester, Centre for Biostatistics, Faculty of Biology Medicine and Health, Manchester, United Kingdom, ⁷University of Exeter Medical School, Exeter, United Kingdom, ⁸Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom, ⁹King’s College London, Sentinel Stroke National Audit Programme, London, United Kingdom, ¹⁰University of Nottingham, Stroke, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ¹¹University Hospitals of Derby and Burton NHS Foundation Trust, Stroke, Derby, United Kingdom

Background: The safety and functional outcome of endovascular thrombectomy (EVT) in the very late (VL; >24 hours) time window from ischaemic stroke onset remains undetermined.

Methods: Using data from a national stroke registry, we used propensity-score-matched (PSM) individual level data of patients who underwent EVT between October 2015 and March 2020. Functional and safety outcomes were assessed in both late (6-24 hours) and VL time windows. Subgroup analysis was performed of imaging selection modality in the VL time window.

Results: We included 1150 patients [late window: 1046 (209 after PSM); VL window: 104 (104 after PSM)]. Compared to EVT treatment initiation between 6-24 hours, patients treated in the VL window had similar modified Rankin Scale (mRS) scores at discharge (Ordinal shift; common OR=1.08, 95%CI 0.69-1.47, p=0.70). No significant differences in achieving good functional outcome (mRS⩽2 at discharge; 28.8% (VL) vs 29.2% (late), OR=0.97, 95%CI 0.58-1.64, p=0.93), successful reperfusion (mTICI2b-3) (p=0.77), or safety outcomes of symptomatic intracranial haemorrhage (sICH) (p=0.43) and in-hospital mortality (p=0.23) were demonstrated. In the VL window, there was no significant difference in the functional outcome amongst patients selected with perfusion versus without perfusion imaging (common OR=1.38, 95%CI 0.81-1.76, p=0.18).

Conclusion: In this real-world study, EVT beyond 24 hours from stroke onset or last known well appears feasible with comparable safety and functional outcomes to EVT initiation between 6-24 hours. Randomised trials assessing the efficacy of EVT in the VL window are warranted, but may only be feasible with a large international collaborative approach.

Disclosure: Yes

O094 / 287

Scientific Communications 11 - Neurointervention – Organisation and Outcome

ASSOCIATION BETWEEN TIME TO TREATMENT AND CLINICAL OUTCOMES IN ENDOVASCULAR THROMBECTOMY BEYOND 6 HOURS WITHOUT ADVANCED IMAGING SELECTION

P.S. Dhillon ¹, W. Butt², A. Podlasek³, N. McConachie¹, R. Lenthall¹, S. Nair¹, L. Malik¹, P. Bhogal⁴, H.L.D. Makalanda⁴, O. Spooner⁵, K. Krishnan⁶, N. Sprigg^7,6, A. Mortimer⁸, T.C Booth^9,10, K. Lobotesis¹¹, P. White^12,13, M.A James^14,15,16, P.M Bath^17,6, R.A Dineen^18,3, T.J England^17,19

¹Nottingham University Hospitals NHS Trust, Interventional Neuroradiology, Nottingham, United Kingdom, ²University Hospitals Birmingham NHS Trust, Interventional Neuroradiology, Birmingham, United Kingdom, ³University of Nottingham, NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom, ⁴The Royal London Hospital Barts Health NHS Trust, Interventional Neuroradiology, London, United Kingdom, ⁵The Royal London Hospital Barts Health NHS Trust, Stroke Medicine, London, United Kingdom, ⁶Nottingham University Hospitals NHS Trust, Stroke Medicine, Nottingham, United Kingdom, ⁷University of Nottingham, Stroke Trials Unit, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ⁸North Bristol NHS Trust, Interventional Neuroradiology, Southmead Hospital, Bristol, United Kingdom, ⁹King’s College Hospital NHS Foundation Trust, Neuroradiology, London, United Kingdom, ¹⁰King’s College London, School of Biomedical Engineering & Imaging Sciences, London, United Kingdom, ¹¹Imperial College Healthcare NHS Trust, Interventional Neuroradiology, Charing Cross Hospital, London, United Kingdom, ¹²Newcastle University, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle, United Kingdom, ¹³Newcastle upon Tyne Hospitals NHS Foundation Trust, Interventional Neuroradiology, Newcastle, United Kingdom, ¹⁴Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom, ¹⁵University of Exeter Medical School, Exeter, United Kingdom, ¹⁶King’s College London, Sentinel Stroke National Audit Programme, London, United Kingdom, ¹⁷University of Nottingham, Stroke, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ¹⁸University of Nottingham, Radiological Sciences, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ¹⁹University Hospitals of Derby and Burton NHS Foundation Trust, Stroke, Derby, United Kingdom

Background and aims: The effectiveness and safety of endovascular thrombectomy (EVT) in the late window (6-24 hours) for acute ischemic stroke patients selected without advanced imaging is undetermined. We aimed to assess clinical outcomes and the relationship with time-to-treatment >6 hours from stroke onset without advanced neuroimaging.

Methods: Patients selected with non-contrast CT/CT angiography (without CT perfusion or MR imaging) for EVT between October 2015-March 2020, were included from a national stroke registry. Functional and safety outcomes were assessed in both early (<6 hours) and late windows with time analysed as a continuous variable.

Results: Among 3278 patients, 2610 (79.6%) and 668 (20.4%) patients were included in the early and late windows respectively. In the late window, for every hour delay, there was no significant association with functional outcome (mRS at discharge) (Ordinal shift; adjusted common OR=0.98, 95%CI 0.94-1.01,p=0.27). There was no significant change in predicted functional independence (mRS⩽2) at discharge per-hour delay (24.5% to 23.3% from 6-24 hours; aOR=0.99,95%CI 0.94-1.04,p=0.85). However, predicted functional independence was time sensitive in the early window (5.2% reduction per-hour delay; 49.4% to 23.5% from 1-6 hours,p=0.0001). There were similar rates of symptomatic intracranial haemorrhage (3.4% vs 4.6%,p=0.55) and in-hospital mortality (12.9% vs 14.6%,p=0.33) in the early and late windows respectively without significant association with time.

Conclusion: There was minimal change in functional and safety outcomes within the late window. While confirmatory randomized trials are needed, these findings suggest the effectiveness and safety of EVT is maintained without advanced neuroimaging selection 6-24 hours from stroke onset.

Disclosure: Yes

O095 / 836

Scientific Communications 11 - Neurointervention – Organisation and Outcome

EXACT BASILAR ARTERY OCCLUSION SITE PREDICTS RECANALIZATION RESULT AND STROKE ETIOLOGY IN STROKE PATIENTS ELIGIBLE FOR MECHANICAL THROMBECTOMY

M.A. Mutke¹, A. Potreck¹, N. Schmitt¹, P.A. Ringleb², S. Nagel², M.A. Möhlenbruch¹, M. Bendszus¹, C.S. Weyland ¹

¹University Hospital Heidelberg, Neuroradiology, Heidelberg, Germany, ²University Hospital Heidelberg, Neurology, Heidelberg, Germany

Background and aims: Acute Basilar artery occlusions (BAO) are found in a large minority of patients eligible for endovascular stroke treatment (EST). We aimed to identify the role of the exact BAO location for the EST’s recanalization result and the stroke etiology.

Methods: Retrospective, single-center analysis of patients treated for BAO with EST from 01/2013 until 06/2021 in Heidelberg’s tertiary stroke center. Group classification according to exact location of BAO in I: proximal third, II: middle III: distal third, IV: tip of the basilar artery. Univariate and multivariate analysis to find an association of BAO site with recanalization result, stroke etiology and clinical outcome analysis.

Results: Of 192 patients treated, the occlusion sites Type I-IV were found in 37, 37, 60 and 58 patients, respectively. Occlusion type III/IV were associated with cardiac embolism or ESUS (n=89) compared to type I/II occlusions (n=13) and showed a better recanalization result (OR 3.76 (1.51 - 9.53), p=0.0076). Type I/II were significantly associated with large artery atherosclerosis (n=50). Occlusion type predicts stroke etiology with high accuracy (AUC 0.89, p<0.0001, OR for embolism in type IV: 245). There was no significant difference regarding clinical outcome across all occlusion sites.

Conclusion: The exact basilar artery occlusion site in patients presenting with ischemic stroke predicts the recanalization result and the stroke etiology with proximal occlusions being associated with atherosclerotic disease, while distal occlusions show an association with embolic events and better recanalization results. Clinical outcome was not different for any occlusion site.

Disclosure: No

O096 / 1603

Scientific Communications 11 - Neurointervention – Organisation and Outcome

CHARACTERIZATION OF ENDOVASCULAR INJURY INDUCED BY STENT-RETRIEVER THROMBECTOMY IN SWINE

A. Taha ^1,2, J. Bobi¹, H. Hund^1,3, K. van Noorden¹, M. Stam¹, J. Raben¹, P.J van Doormaal⁴, D.J Duncker¹, D.WJ Dippel², A.CGM van Es⁵, H.MM van Beusekom¹

¹Erasmus MC University Medical Center, Cardiology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands, ³Haaglanden Medical Center, Radiology, The Hague, Netherlands, ⁴Erasmus MC University Medical Center, Radiology, Rotterdam, Netherlands, ⁵Leiden University Medical Center, Radiology, Leiden, Netherlands

Background and aims: Stent-retriever thrombectomy (SR) inflicts vascular injury and could thereby lead to platelet activation and local formation of microthrombi. We aimed to characterize endovascular damage and microthrombus formation following SR in a swine model.

Methods: Aged autologous thrombi, created under flow, were used to occlude swine extracranial arteries for two hours. Injury following SR was assessed acutely (n=8), or at three days follow-up (n=8) using Evans Blue (EB) dye-exclusion-testing. EB-area denotes the extent of injury, expressed as percentage injured area. Scanning electron microscopy (SEM) was used to visualize the nature of vascular injury and presence of microthrombi(<100µm). Data are given as mean±SD or median(min-max).

Results: EB positive area (Fig 1) was 95±10% acutely vs. 77±12% at three days (p<0.01). SEM of acute injury showed microthrombi, endothelial denudation and adhesion of activated platelets and leukocytes. At three days, SEM showed partial re-endothelialization with increased surface folds as a sign of endothelial activation (Fig 2). Acute injury showed 7(5-12), compared to 0(0-1) microthrombi/cm² at three days (p=<0.05).

Conclusions: Stent-retriever-induced endovascular damage yields microthrombi, platelet activation and leukocyte adhesion. After three days, there is significant, but only partial endothelial recovery. Microthrombi are no longer present after three days.

Figure 1.

Luminal surface after Evans Blue perfusion: acute(A) and 3-day follow-up(B) showing intact white and injured blue areas.

Figure 2.

SEM images of acute vascular injury showing a microthrombus(A), leukocytes(B) and activated platelets on denudated endothelium(C). At three days follow-up increased surface folds indicate activated endothelium(D).

Disclosure: No

O097 / 1535

Scientific Communications 11 - Neurointervention – Organisation and Outcome

MIDDLE MENINGEAL ARTERY EMBOLIZATION FOR CHRONIC SUBDURAL HEMATOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS

H. Ghaith ¹, A. Negida², M. Gabra³, K. Albakri⁴, N. Khedr⁵, S. Swed⁶

¹Al-Azhar University, Faculty of Medicine, Cairo, Egypt, ²Harvard Medical School, Department of Global Health, Boston, Massachusetts, United States, ³South Valley University, Faculty of Medicine, Qina, Egypt, ⁴The Hashemite University, Faculty of Medicine, Zarqa, Jordan, ⁵Zagazig University, Faculty of Medicine, Zagazig, Egypt, ⁶Aleppo University, Facutly of medicine, Aleppo, Syrian Arab Republic

Background and aims: Many studies have focused recently on middle meningeal artery (MMA) embolization as an effective invasive method able to modify the vascular supply and prevent continued accumulation and leakage of blood into chronic subdural hematoma (CSDH). This systematic review and meta-analysis aimed to synthesize evidence from published studies on the efficacy and safety of MMA embolization in patients with chronic subdural hematoma in comparison with conventional surgical methods.

Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials until January 2022 for relevant clinical trials and observational studies comparing MMA embolization and conventional treatment. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis using Review Manager (version 5.4).

Results: Seven studies with 1065 patients were included in the meta-analysis. MMA embolization group was superior to conventional treatment group in terms of “recurrence” (RR 0.18, 95% CI 0.09 to 0,36 P<0.00001) and “surgical re-treatment” (RR 0.22, 95% CI 0.12 to 0.42, P<0.00001). No significant difference was found between the two groups in terms of “complications” (RR 0.60, 95% CI 0.30 to 1.18, P=0.14), “mortality” (RR 0.70, 95% CI 0.31 to 1.56, P=0.38), and “length of hospital stay” (MD 0.02, 95% CI -2.83 to 2.83, P=0.99).

Conclusions: Current evidence supports the use of MMA embolization to reduce the incidence of recurrence and surgical re-treatment in CSDH patients. However, there is no significant difference between MMA embolization and conventional treatment in reducing the risk of mortality, complications, and length of hospital stay.

Disclosure: No

O098 / 788

Scientific Communications 12 - Epidemiology

ASSOCIATION OF AIR QUALITY OF BUSHFIRE SMOKE DAYS WITH CEREBROVASCULAR DISEASE-RELATED HOSPITAL ADMISSIONS DURING AUSTRALIA'S 2019-2020 BUSHFIRE SEASON

M. Hasnain ¹, C. Garcia-Esperon^2,1, Y. Tomari¹, R. Walker³, M. Rahman⁴, A. Boyle^2,1, C. Levi^3,1, N. Spratt^2,1

¹University of Newcastle, Newcastle, Australia, ²John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia, ³Hunter New England Local Health District, Newcastle, Australia, ⁴University of Wollongong, Wollongong, Australia

Background and aims: Exposure to ambient air pollution is strongly associated with increased cerebrovascular disease. However, little is known about the effects of short-term air pollution triggered by bushfires. The 2019–2020 bushfire season in Australia burnt 5.4 million hectares of land in NSW alone, with smoke so severe it affected cities in Argentina, 11,000 km away. We compared daily cerebrovascular hospital admissions following smoke events during the 2019-2020 bushfire season with the same period in 2018-19.

Methods: The study was conducted in seven local Government areas of Hunter New England Local Health District (HNE-LHD). Hospitalization data were accessed from the HNE-LHD heart and stroke outcomes database. Bushfire smoke days were defined as days when the 24-hour average concentration of airborne particulate matter, inhalable PM_10, or fine PM_2.5 exceeded the 95^th percentile of the population-weighted daily distribution. We used a time-series design with Poisson regression models to assess the association between smoke events and hospital admissions.

Results: During the bushfire period, a significant association was observed between PM₁₀concentration and daily admissions with ischemic stroke, with the highest cumulative effect across a lag 0-3 days (Risk Ratio, RR: 1.01; 95% Confidence Interval, CI: 1.00-1.02; p-value: 0.014). Similarly, the daily concentration of PM_2.5was also associated with higher daily ischemic stroke admissions across a lag of 0-2 days (RR: 1.01; 95% CI: 1.00-1.03; p-value: 0.030).

Conclusion: Increased particulate matter concentrations during the bushfire period were associated with increased ischemic stroke hospital admissions.

Disclosure: No

O099 / 781

Scientific Communications 12 - Epidemiology

CHANGES IN OVERALL FEATURES OF ISCHEMIC STROKE OR TIA BETWEEN 2011 AND 2020: FINDINGS FROM A NATIONWIDE MUTICENTER REGISTER

H.-J. Bae ¹, T.H. Park ², J. Lee³, B.-C. Lee⁴, CRCS-K Study Group

¹Seoul National University College of Medicine, Seoul National University Bundang Hospital, Neurology, Seongnam-si, Korea, Republic of, ²Seoul Medical Center, Neurology, Seoul, Korea, Republic of, ³Korea University College of Medicine, Biostatistics, Seoul, Korea, Republic of, ⁴Hallym University College of Medicine, Neurology, Anyang, Korea, Republic of

Background and aims: Stroke mortality has decreased despite aging of patients in many countries. Using a multicenter stroke registry, we aimed to estimate changes in ischemic stroke outcomes and related factors over the past decade.

Methods: We analyzed data of 77,662 patients with acute ischemic stroke or transient ischemic attack registered prospectively in the Clinical Research Center for Stroke-Korea, a nationwide multicenter registry between January 2011 and December 2020. Changes in outcomes at 3 months and one year after stroke, and clinical features including demographics, risk factors, severity, etiologies, managements were investigated.

Results: The mean (SD) age was 71.6 (12.8) years in women and 65.6 (12.7) years in men. 45,381 (58.4%) were male. Between 2011 and 2020, the mean age has increased for both men (+2.2 years) and women (+2.4 years). A significant decreasing trend in the cumulative incidence of recurrent stroke or all-cause death within 3 months and one year was observed after adjusting for age, sex, and initial severity. Prevalence of hypertension and smoking decreased significantly (p for trend <0.001), but which of atrial fibrillation did not. Strokes due to large artery atherosclerosis or cardioembolism have declined (p for trend <0.001). The rate of acute recanalization therapy including intravenous thrombolysis and endovascular thrombectomy increased from 13.4% (2011) to 16.5% (2020). Prescription of anticoagulants has increased from 63.6% (2011) to 79.7% (2020) in atrial fibrillation patients.

Conclusions: This study showed improvements in outcomes of ischemic stroke over the past 10 years with changes in the related clinical features.

Disclosure: No

O100 / 1412

Scientific Communications 12 – Epidemiology

WE ARE NOT THE SAME: GEOGRAPHIC DIFFERENCE IN INCIDENCE AND EPIDEMIOLOGY FOR ISCHAEMIC STROKE IN SPAIN. NEUROEPI STUDY.

M. Blanco-Ruiz ¹, L. Amaya Pascasio¹, R. Milán Pinilla¹, J.M. García Torrecillas², A. Arjona Padillo¹, P. Martínez Sánchez¹

¹Torrecardenas University Hospital, Neurology, Almeria, Spain, ²Torrecardenas University Hospital, Emergency, Almeria, Spain

Background and aims: Spain is a country divided geographically and administratively into 17 autonomous communities (ACs) with different socio-cultural and environmental pollution characteristics. Our aim was to identify whether these differences are related to the prevalence of risk factors for ischaemic stroke (IS) and the IS in-hospital incidence and mortality rate.

Methods: Observational study based on hospital database collected by the Spanish National Health Service. Patients older than 18 years with IS (main diagnosis) during 2017 were included. Data about comorbidities, lifestyle and socio-economic factors in each AC were obtained from an European health survey (2014) including 22.842 respondents. Air pollution was obtained from the National inventory of atmospheric emissions. In-hospital incidence and mortality rates were estimated based on the population registered in the National Statistics Institute. A descriptive analysis was performed and factors related to a greater IS were identified for each AC.

Results: Overall, 55919 IS episodes included. There were significant differences in the distribution of vascular risk factors between ACs. Asturias (north) showed the highest in-hospital incidence (228.6/100.000inh.) whereas Galicia (Norwest) had the lowest (60.9/100.000inh.). IS in-hospital incidence was higher in ACs with older age, alcohol consumption, non-qualified workers and sedentary population (p<0.05). In-hospital mortality was higher in ACs with greater rates of non-qualified workers and higher NO2 levels emissions (p<0.05).

Conclusions: The in-hospital incidence, mortality and risk factors of IS differ among the Spanish ACs. Alcohol intake, sedentary lifestyle and non-qualified occupations were related to greater incidence whereas non-qualified workers and higher NO2 levels were related to mortality.

Disclosure: No

O101 / 508

Scientific Communications 12 - Epidemiology

STROKE INCIDENCE AND CASE-FATALITY IN MAINLAND CHINA, HONG KONG, AND MACAO: SYSTEMATIC REVIEW AND META-ANALYSIS

F. He ¹, I. Blackberry², L. Yao³, H. Xie⁴, T. Rasekaba², G. Mnatzaganian⁵

¹La Trobe University, John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, Bendigo, Australia, ²La Trobe University, John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, Albury-Wodonga, Australia, ³The Second Affiliated Hospital of Kunming Medical University, Department of Rehabilitation, Kunming, China, ⁴Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Healthcare, Beijing, China, ⁵La Trobe University, Rural Department of Community Health, La Trobe Rural Health School, Bendigo, Australia

Background and aims: Stroke incidence and case-fatality in China vary by geographic region and are inconsistent. This systematic review and meta-analysis estimated pooled incidence and short-term case-fatality of acute first-ever stroke in mainland China, Hong Kong and Macao.

Methods: Longitudinal studies published in English or Chinese from 1990 were searched in PubMed/MEDLINE, Embase, CINAHL, and Web of Science, SinoMed, and CQVIP. Incidence was expressed as Poisson means estimated as number of events divided by time at risk. Random effect models calculated pooled incidence and case-fatality. Chi-squared trend tests evaluated change in estimates over time.

Results: Seventy-two studies were included. Pooled incidences of total stroke (TS), ischaemic stroke (IS) and haemorrhagic stroke (HS) were 468.9 (95% CI: 163.33-1346.11), 366.79 (95% CI: 129.66-1037.64) and 106.67 (95% CI: 55.96-203.33) per 100,000 person-years, respectively, varying by the four economic regions with the lowest rates detected in the East Coast. Increments in both the incidence of TS and IS were observed over time (p<0.001). One-month and three-to-twelve-month case-fatalities were 0.11 (95% CI: 0.04-0.18) and 0.15 (95% CI: 0.12-0.17), respectively for IS; and 0.36 (95% CI: 0.26-0.45) and 0.25 (95% CI: 0.18-0.32), respectively for HS. One-month case-fatality for both IS and HS decreased over time (p<0.001). Three-to-twelve-month fatalities following IS increased over time (p<0.001). Publication bias was not found.

Conclusions: Highest stroke incidence rates were detected in less-developed regions in mainland China, Hong Kong and Macao. Although 1-month fatality following IS decreased, the increase in 3-12-month fatality suggests potentially inappropriate long-term management following index hospital discharge.

Disclosure: No

O102 / 351

Scientific Communications 12 - Epidemiology

TRENDS IN INCIDENCE OF FIRST-EVER AND RECURRENT ISCHEMIC STROKES IN SWEDEN 2010 - 2019 – A RIKSSTROKE STUDY

C. Drescher ¹, F. Buchwald¹, T. Ullberg¹, M. Pihlsgård², B. Norrving¹, J. Petersson¹

¹Lund University, and Neurology, Skåne University Hospital, Neurology, Department of Clinical Sciences, Malmö, Sweden, ²Lund University, Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences, Malmö, Sweden

Background and aims: To investigate trends in incidence in patients with first-ever and recurrent ischemic stroke (IS) between 2010 and 2019 in Sweden.

Methods: We included patients (⩾18 years) with ischemic stroke registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010 to 2019. The coverage of Riksstroke was consistently high (about 90%) during this period. Data were stratified by first-ever and recurrent ischemic stroke in 3 different time periods (2010-2012, 2013-2016 and 2017-2019) and shown as crude per 100,000 person-years and age-specific incidence rates.

Results: During the study period, 201316 patients with ischemic stroke (IS) were registered in Riksstroke, including 153865 (76,4%) patients with first-ever IS and 46248 (23,0%) with recurrent IS. The crude incidence of all ischemic stroke decreased by 21% from 2010-2012 to 2017-2019, from 290 (95% CI 288-292) to 228 (95% CI 226-230). The crude incidence of first-ever IS decreased by 17% from 216 (95% CI 214-218) to 179 (95% CI 177-181) whereas recurrent IS decreased by 33% from 72 (95% CI 71-73) to 48 (95% CI 47-49). Decreasing trends for IS incidence were seen in all age groups with highest decline in those 75-84 years (1298 (95% CI 1280-1315) to 920 (95% CI 906-933); -29%) and ⩾85 years (2381 (95% CI 2347-2416) to 1722 (95% CI 1693-1751); -28%).

Conclusions: We observed a marked decline in ischemic stroke incidence in Sweden between 2010 and 2019. The highest proportional decreases were seen in recurrent ischemic stroke and in age groups ⩾75 years.

Disclosure: No

O103 / 751

Scientific Communications 12 - Epidemiology

THE INCIDENCE OF STROKE IN THE ABORIGINAL AND NON-ABORIGINAL POPULATIONS OF WESTERN AUSTRALIA, SOUTH AUSTRALIA, AND THE NORTHERN TERRITORY

A.H. Balabanski ^1,2,3, L. Nedkoff⁴, A.G. Thrift¹, T.J. Kleinig^5,6, A. Brown^6,7, O. Pearson^6,7, S. Guthridge⁸, A. Dos Santos^2,3,9, J.M. Katzenellenbogen⁴

¹Monash University, Department of Medicine, Melbourne, Australia, ²Alfred Health, Department of Neurology, Melbourne, Australia, ³University of Melbourne, Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Australia, ⁴University of Western Australia, School of Population and Global Health, Perth, Australia, ⁵Royal Adelaide Hospital, Department of Neurology, Adelaide, Australia, ⁶University of Adelaide, Faculty of Health and Medical Science, Adelaide, Australia, ⁷South Australian Health and Medical Research Institute, Aboriginal Health Equity, Adelaide, Australia, ⁸Charles Darwin University, Menzies School of Health Research, Darwin, Australia, ⁹University of New South Wales, Faculty of Medicine and Health, Kensington, Australia

Background and aims: Most estimates of stroke incidence among Aboriginal and Torres Strait Islander (hereinafter Aboriginal) Australians include limited case numbers and are generally confined to single regions. We aimed to determine stroke incidence in Aboriginal and non-Aboriginal residents of Western Australia, South Australia and the Northern Territory.

Methods: Whole-population multi-jurisdictional person-linked data from hospital and death datasets were used to identify stroke admissions and stroke-related deaths (2001-2015). Fatal (including out-of-hospital deaths) and non-fatal incident (first-ever) strokes in patients aged 20-84 years were identified during the study period (2012-2015), using a 10-year lookback period to identify/exclude non-first-ever stroke events. Incidence rates per 100,000/year were estimated for Aboriginal and non-Aboriginal populations, age-standardised to the World Health Organisation World Standard population.

Results: Between 2012-2015, 11,739 incident strokes (15.6% fatal) occurred in the three states combined, 675 (5.8%) occurring in Aboriginal people (17.0% fatal). Median age at onset in Aboriginal people (54.5 years; 50.1% female) was 16 years younger than in non-Aboriginal people (70.3 years; 44.1% female; p<0.001). Age-standardised stroke incidence was 2.9-fold greater in the Aboriginal population (192/100,000) than the non-Aboriginal population (66/100,000) 20-84 years; fatal incidence was 4.2-fold greater (38 vs 9/100,000; p<0.001). Disparities were particularly apparent at younger ages (20-54 years), where the age-standardised stroke incidence was 4.3-fold greater in the Aboriginal population (90/100,000) than the non-Aboriginal population (21/100,000; p<0.001).

Conclusions: In the largest multi-jurisdictional person-linked dataset to date we found significant disparities in stroke incidence between Aboriginal and non-Aboriginal populations, particularly at younger ages. Results will inform culturally-safe interventions.

Disclosure: No

O104 / 955

Scientific Communications 12 - Epidemiology

SOCIOECONOMIC POSITION BY INCOME RELATED TO AGE AT FIRST STROKE, STROKE SEVERITY AND PREVALENCE OF STROKE RISK FACTORS IN THE DANISH STROKE POPULATION

T.S. Olsen ¹, K.K. Andersen²

¹Bispebjerg University Hospital, Neurology, Copenhagen, Denmark, ²Danish Cancer Society Research Center, Copenhagen, Denmark

Background and aims: Social position is strongly related to risk and to outcome of stroke. We studied age at first stroke, severity of stroke and prevalence of stroke risk factors associated with disposable income in the Danish stroke population.

Methods: We identified all incident cases of first-ever stroke hospitalized in Denmark during the years 2003-2012 in the Danish Stroke Registry with nation-wide coverage (n=60 503; women 28675; men 31828). We obtained information on age, stroke-severity and stroke risk factors. From Statistics Denmark we obtained information of income at person-level categorized into the 20th, 40th, 60th and 80th percentiles of the age and sex-specific income distribution.

Results: Age at first stroke in the lowest income group was 69.4/65.7 years (women/men) and in the highest income group it was 76.2/70.5 (women/men). Stroke severity (Scandinavian Stroke Scale) was the same in the lowest income group ( 42/45 (women/men)) and in the highest income group 5 (42/46 (women/men)). Alcohol overuse, smoking and diabetes were significantly more prevalent in the lowest income group. Diabetes was almost doubled for women, and increased 64% for men in the lowest compared to the highest income group. Prevalence of hypertension and ischemic heart disease was not affected much by income group.

Conclusions: Stroke had occurred 7 (women) and 5 (men) years earlier in the lowest than in the highest income group. Stroke severity was not affected by income. Diabetes was markedly over-represented in the lowest income group.

Disclosure: No

O106 / 727

Scientific Communications 13 - SAH and ICH

SUBARACHNOID HEMORRHAGE DURING PREGNANCY AND PUERPERIUM – A POPULATION-BASED STUDY WITH CHART VALIDATION

A. Korhonen¹, L. Karjalainen², K. Aarnio¹, K. Rantanen¹, A. Saaros¹, H. Laivuori³, M. Gissler⁴, M. Tikkanen⁵, P. Ijäs ¹

¹Helsinki University Hospital and University of Helsinki, Neurology, Helsinki, Finland, ²Helsinki University Hospital and University of Helsinki, Obstetrics and Gynecology, Helsinki, Finland, ³Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Department of Obstetrics and Gynecology, Tampere, Finland, ⁴Finnish Institute for Health and Welfare, Department of Information Services, Helsinki, Finland, ⁵University of Helsinki, Obstetrics and Gynecology, Helsinki, Finland

Background and aims: Pregnancy-related subarachnoid hemorrhage (pSAH) is rare, but it causes high mortality and morbidity. Nevertheless, data on pSAH are limited. The objectives here were to examine the incidence trends, causes, risk factors, and outcomes of pSAH in a nationwide population-based cohort study in Finland covering 30 years.

Methods: We performed a retrospective population-based cohort study and nested case-control study in Finland for the period 1987-2016 (SIPP-FIN). The Medical Birth Register was linked to the Hospital Discharge Register to identify women with incident SAH during pregnancy or puerperium. The temporal connection of SAH to pregnancy and clinical details were verified from patient records.

Results: The incidence of pSAH was 3.21 (95% CI 2.4-3.9) per 100.000 deliveries. No significant increase occurred in the incidence throughout the study period (Figure 1). However, the age of the mother had a significant effect on the incidence. In total, 77% of patients suffered an aneurysmal pSAH, resulting in death in 16.3% of women and with only 67.4% achieving good recovery at the end of follow-up (Figure 2). Patients with non-aneurysmal pSAH all recovered well. The significant risk factors for pSAH were smoking (OR 3.27 (1.56-6.86)), pre-pregnancy hypertension (OR 12.72 (1.39-116.46)), and pre-eclampsia/eclampsia (OR 3.88 (1.00-15.05)).

Conclusions: We found no evidence of an increasing trend of pSAH in Finland. The better prognosis of pSAH may be attributed to a large proportion of non-aneurysmal pSAH since only two-thirds of women with aneurysmal SAH recovered well.

Figure 1. Figure 2.

Disclosure: No

O107 / 883

Scientific Communications 13 - SAH and ICH

INTRACRANIAL ANEURYSM WALL ENHANCEMENT PREDICTS ANEURYSM INSTABILITY DURING FOLLOW-UP: A MULTICENTER COHORT STUDY

L.T. van der Kamp ¹, M. Edjlali², O. Naggara³, T. Matsushige⁴, D.O. Bulters⁵, R. Digpal⁵, D. Saloner⁶, P. Hu⁷, X. Zhai⁷, C. Zhu⁸, M. Mossa-Basha⁸, B. Tian⁹, S. Sakamoto¹⁰, Q. Fu¹¹, H. Zhao¹², H. Chen¹³, G.J.E. Rinkel¹, I.C. van der Schaaf¹⁴, M.D.I. Vergouwen¹⁴

¹UMC Utrecht, Neurology and Neurosurgery, Utrecht, Netherlands, ²Assistance Publique Hôpitaux de Paris, Department of Radiology, Paris, France, ³Université Paris Descartes Sorbonne Paris Cité, Department of Radiology, Paris, France, ⁴Hiroshima City Asa Citizens Hospital, Department of Neurosurgery and Interventional Neuroradiology, Hiroshima, Japan, ⁵University Hospital Southampton, Department of Neurosurgery, Southampton, United Kingdom, ⁶University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, United States, ⁷Capital Medical University Xuanwu Hospital, Department of Neurosurgery, Bejing, China, ⁸University of Washington School of Medicine, Department of Radiology, Seattle, United States, ⁹Changhai Hospital, Department of Radiology, Shanghai, China, ¹⁰Hiroshima University, Department of Neurosurgery and Interventional Neuroradiology, Hiroshima, Japan, ¹¹The First Affiliated Hospital of Zhengzhou University, Department of Magnetic Resonance, Zhengzhou, China, ¹²Renji Hospital, Department of Radiology, Shanghai, China, ¹³Tsinghua University, Department of Biomedical Engineering, Bejing, China, ¹⁴UMC Utrecht, Department of Radiology, Utrecht, Netherlands

Background and aims: In patients with an unruptured intracranial aneurysm, aneurysm wall enhancement after gadolinium may predict future aneurysm growth or rupture. Most previous studies had a cross-sectional design and did not adjust for aneurysm size. We aimed to assess whether aneurysm wall enhancement is a risk factor for aneurysm instability during follow-up independently of aneurysm size.

Methods: Individual patient data were obtained from 12 international cohorts. Inclusion criteria were: 1) 18 years or older; 2) MRI aneurysm wall imaging at baseline of at least one untreated unruptured intracranial aneurysm; and 3) MRA or rupture during follow-up. We calculated hazard ratios (HR) with 95%CI of wall enhancement for growth (⩾1mm increase) or rupture during follow-up and adjusted for aneurysm size. A subgroup analysis was performed for aneurysm size ⩽7mm.

Results: We included 437 patients with 538 aneurysms. After a median follow-up duration of 1.2 (IQR 0.6-2.4) years, growth or rupture had occurred in 13/190 (6.8%) aneurysms with wall enhancement and in 9/348 (2.6%) aneurysms without enhancement (crude HR 3.1[95%CI:1.3-7.4], adjusted HR 1.4[95%CI:0.5-3.9]). In 370 patients with 468 aneurysms ⩽7mm, the crude HR was 3.3(95%CI:1.1-9.9) and the adjusted HR 2.9(95%CI:0.9-9.4).

Conclusions: Gadolinium-enhancement of the aneurysm wall is associated with an increased risk of aneurysm growth or rupture during follow-up, but is not a risk factor independent from aneurysm size. In aneurysms ⩽7mm, larger studies or with a longer follow-up period are needed to assess the predictive value of gadolinium-enhancement of the aneurysm wall for future instability.

Funding: Dutch Heart Foundation

Disclosure: No

O108 / 256

Scientific Communications 13 - SAH and ICH

ANTI-EPILEPTIC DRUG TARGET PERTURBATION AND INTRACRANIAL ANEURYSM RISK: MENDELIAN RANDOMIZATION AND COLOCALIZATION STUDY

M. Bakker ¹, T. van Straten¹, M. Chong², G. Paré², D. Gill³, Y. Ruigrok¹

¹University Medical Center Utrecht, Neurology and Neurosurgery, Utrecht, Netherlands, ²McMaster University, Population Health Research Institute, Thrombosis and Atherosclerosis Research Institute; Department of Pathology and Molecular Medicine, Hamilton, Canada, ³Imperial College London, Department of Epidemiology and Biostatistics, School of Public Health, London, United Kingdom

Background and aims: In a genome-wide association study of intracranial aneurysms (IA), pleiotropy was found between anti-epileptic drug targets, and genes associated with IA. We investigated whether this pleiotropy is driven by shared disease mechanisms between IA and epilepsy and/or indicates that anti-epileptic drug targets play a role in IA.

Methods: Using two-sample Mendelian randomization and colocalization analysis we assessed if epilepsy liability is causally associated with IA, and whether IA-associated genes encode targets of anti-epileptic drugs. Genetically determined gene- and protein expression levels of targets of anti-epileptic drug in blood and arterial tissue were used as exposure, and IA as outcome.

Results: Epilepsy liability does not influence IA risk. Levels of 21 genes and 13 proteins related to anti-epileptic drugs supported a causal effect on IA (p<0.05). Variation in CNNM2 gene expression in arterial tissue and IRF1 in blood were likely driven by a shared causal variant with IA risk (posterior probability > 70%). High CNNM2 levels increased risk with statistical significance (odds ratio=3.02, 95% confidence interval=2.32-3.94, p=3.39×10^-16), while high IRF1 levels reduced risk suggestively (0.43; 0.25-0.75, p=0.0027). CNNM2 is an important blood pressure regulator. Administration of anti-epileptic drugs phenytoin, valproic acid or carbamazepine mimic CNNM2 knockdown and may therefore reduce IA risk.

Conclusions: Variations in gene expression of anti-epileptic drug targets CNNM2 and IRF1 are consistent with a causal effect on IA risk. Levels of CNNM2 can be reduced by three anti-epileptic drugs, making it an important target for further investigations of its role in IA pathogenesis.

Disclosure: No

O109 / 1517

Scientific Communications 13 - SAH and ICH

IS TRANEXAMIC ACID BENEFICIAL FOR PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE? A SYSTEMATIC REVIEW AND META-ANALYSIS OF 2991 PATIENTS

H. Ghaith ¹, A. Negida², M. Gabra³, U. Kanmounye⁴, I. Esene⁵, S. Swed⁶

¹Al-Azhar University, Faculty of Medicine, Cairo, Egypt, ²Harvard Medical School, Department of Global Health, Boston, Massachusetts, United States, ³South Valley University, Faculty of Medicine, Qina, Egypt, ⁴Association of Future African Neurosurgeons, Yaounde, Cameroon, Research department, Yaounde, Cameroon, ⁵Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon, Neurosurgery Department, Bambili, Cameroon, ⁶Aleppo University, Facutly of medicine, Aleppo, Syrian Arab Republic

Objective: We aimed to synthesize evidence from published clinical trials on the efficacy and safety of tranexamic acid (TXA) administration in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: We followed the standard methods of the Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until1 January 2022. We selected observational studies and clinical trials comparing TXA versus no TXA in aSAH patients. Data for all outcomes were pooled as the risk ratio (RR) with the corresponding 95% confidence intervals in the meta-analysis models.

Results: Thirteen studies with a total of 2991 patients were included in the analysis. TXA could significantly cut the risk of rebleeding (RR 0.56, 95% CI 0.44 to 0.72) and mortality from rebleeding (RR 0.60, 95% CI 0.39 to 0.92, P=0.02). However, TXA did not significantly improve the overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus (all P>0.05). In terms of safety, no significant adverse events were reported. No statistical heterogeneity or publication bias was found in all the outcomes.

Conclusion: In patients with aSAH, TXA significantly reduces the incidence of rebleeding and mortality from rebleeding. However, current evidence does not support any benefits in overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus.

Figure 1.

Forest plot of the pooled RR of rebleeding and the corresponding 95% confidence intervals. RR= risk ratio; M-H=Mantel-Haenszel; CI=confidence interval

Disclosure: No

O110 / 908

Scientific Communications 13 - SAH and ICH

LONG-TERM RISK OF RECURRENT STROKE AFTER A FIRST-EVER PRIMARY INTRACEREBRAL HEMORRHAGE : A POPULATION-BASED STUDY FROM THE BREST STROKE REGISTRY

P.-Y. Rousseau ¹, A. Brouazin¹, M. Consigny^1,2, A. Jourdain¹, A. Leblanc¹, I. Viakhireva¹, F.-M. Merrien¹, F. Rouhart¹, P. Goas¹, S. Timsit^1,3

¹CHU Brest, Brest, France, ²INSERM CIC 1412, Brest, France, ³Université de Brest - INSERM, EFS, UMR 1078, Brest, France

Background and aims: Survivors after a primary intracerebral hemorrhage (ICH) are known to be at high risk of vascular events. The aim of our study was to evaluate, after a first-ever primary ICH, the long-term recurrence rate, hemorrhagic or ischemic stroke (IS).

Methods: We collected data from the French population-based Brest Stroke Registry from 2008 to 2017. We included 30-day survivors after ICH. Rate of recurrence was described according to the index ICH location. Patterns of recurrent ICH location, etiological IS subtypes and radiological predictors of recurrence were assessed. Annual rate per 100 patient-year as well as Cox model were used.

Results: 197 (43.5%) had lobar and 256 (56.5%) non-lobar ICH. There were 57 recurrent strokes (32 IS; 25 ICH). Overall rate of first recurrent was 3.1 (95% CI: 2.4-4.1) per 100 patient-years. Annual rate of recurrent ICH was 5.2 times higher after lobar than after non-lobar ICH (p=0.0006). Annual rate of IS was not different according ICH location but it was 3.8 times higher than recurrent ICH after non-lobar ICH (p=0.006). “Lobar – Lobar” was the main pattern of recurrent ICH location. Among IS, cardio-aortic embolisms were the most prevalent. Periventricular white matter hyperintensities was a MRI independent predictor of stroke recurrence (OR=4.61; p=0.0053).

Conclusions: Both location were at high risk of IS. However, non-lobar ICH had higher risk of IS recurrence while lobar had higher risk of ICH recurrence underlying the interest of a better assessment of the risk of recurrence type with MRI biomarkers to guide therapeutic management.

Disclosure: No

O111 / 1171

Scientific Communications 13 - SAH and ICH

CT MARKERS OF CEREBRAL AMYLOID ANGIOPATHY AND HAEMOSTATIC TREATMENT WITH TRANEXAMIC ACID – A SUB-ANALYSIS OF THE TRANEXAMIC ACID IN INTRACEREBRAL HAEMORRHAGE TRIAL (TICH-2)

D. Seiffge ¹, A. Polymeris², Z.K. Law^3,4, K. Krishnan^3,5, A. Zietz², S. Thilemann², D. Werring⁶, R. Al-Shahi Salman⁷, R. Dineen^8,9, S. Engelter^2,10, P. Bath^5,3, P. Lyrer², N. Sprigg^5,3, N. Peters^2,10,11

¹Inselspital University Hospital Bern, Bern, Switzerland, ²University Hospital of Basel, Neurology, Basel, Switzerland, ³University of Nottingham, Stroke Trials Unit, Nottingham, United Kingdom, ⁴National University of Malaysia, Medicine, Bangi, Malaysia, ⁵Nottingham University Hospitals NHS Trust, Stroke, Nottingham, United Kingdom, ⁶Queen Square Institute of Neurology, UCL, London, United Kingdom, ⁷University of Edinburgh, Center for Clinical Brain Sciences, Edinburgh, United Kingdom, ⁸University of Nottingham, Radiological Sciences, Nottingham, United Kingdom, ⁹NIHR Nottingham, Biomedical Research, Nottingham, United Kingdom, ¹⁰University of Basel, Department of Geriatric Medicine Felix Platter Hospital, Basel, Switzerland, ¹¹Hirslanden Hospital Zurich, Stroke Center, Zurich, Switzerland

Background and aims: To determine the association of CT-biomarkers of cerebral amyloid angiopathy (CAA) and different types of intracerebral haemorrhage (ICH) with haematoma expansion (HE), functional outcome and treatment response to tranexamic acid in participants enrolled in the TICH-2 trial (ISRCTN93732214).

Methods: We assessed baseline CT-scans for presence of finger-like projections (FLP) and subarachnoid extension (SAH) and categorized ICH as lobar CAA, lobar non-CAA, and non-lobar. The main outcomes were HE and favourable outcome (mRS of 0-2 at 90 days). We constructed multivariate regression models and assessed treatment effects using interaction terms.

Results: 2298 of 2325 participants were included (98.8%; median age 71years IQR 60-80years; 1014 female [44.1%], ICH-volume 13.2cm³IQR 5.5-32.2cm³; NIHSS 12 IQR 7-19). 194 participants had FLP (8.4%) and 365 had SAH (15.9%); 1637 participants (71.2%) had non-lobar ICH and 661 participants (28.8%) had lobar ICH, of which 173 fulfilled Edinburgh simplified criteria for high probability of CAA (lobar CAA; 7.5%) and 488 did not (lobar non-CAA, 21.2%). There was no association between type of ICH with outcomes. There was a significant interaction between lobar CAA-ICH with time-from-onset-to-randomization (aOR 1.3, 95%CI 1.0-1.6, p_interaction=0.035) and ICH-volume (aOR 0.98 95%CI 0.97-0.99, p_interaction=0003) on HE but no interaction on outcome. Tranexamic acid was associated with reduced odds for HE (aOR 0.7; 95%CI 0.6-1.0, p=0.020) in non-lobar ICH but not in any lobar ICH nor with outcome.

Conclusions: CT biomarkers of CAA were not associated with differences in HE or outcomes. Tanexamic acid reduced haematoma expansion only in non lobar ICH.

Disclosure: No

O112 / 1388

Scientific Communications 13 - SAH and ICH

CEREBROSPINAL FLUID BIOMARKERS FOR CEREBRAL AMYLOID ANGIOPATHY

J.A. Sembill ¹, C. Lusse¹, M. Sprügel¹, A. Mrochen¹, M. Knott², P. Hoelter², T. Engelhorn², M. Schmidt², A. Doerfler², T. Oberstein³, J.M. Maler³, J. Kornhuber³, P. Lewczuk³, V. Rothhammer¹, S. Schwab¹, J.B. Kuramatsu¹

¹University hospital Erlangen, Neurology, Erlangen, Germany, ²University hospital Erlangen, Neuroradiology, Erlangen, Germany, ³University hospital Erlangen, Psychiatry, Erlangen, Germany

Background and aims: Integrating cerebrospinal fluid(CSF)-biomarkers into diagnostic workup of patients with sporadic cerebral amyloid angiopathy(CAA) may support early and correct identification. This study aims to identify and validate clinical- and CSF-biomarkers for in-vivo CAA diagnosis.

Methods: This observational cohort study screened 2,795 consecutive patients admitted for cognitive complaints to the academic departments of neurology and psychiatry over a 10-year period(2009-2018). We finally included 372 patients with available hemosiderin-sensitive imaging and CSF-based neurochemical dementia diagnostics(NDD), i.e. Aβ40, Aβ42, Aβ40/Aβ42-ratio, t-tau, p-tau. We investigated the association of clinical- and CSF-biomarkers with the MRI-based diagnosis of CAA, applying confounder-adjusted modeling and ROC-analyses.

Results: We identified 67 patients with CAA, 76 with Alzheimer’s Disease(AD), 75 with Mild Cognitive Impairment(MCI) due to AD, 76 with MCI with unlikely AD, and 78 Healthy Controls(HC). Patients with CAA showed a specific CSF-pattern: Aß40[13,792pg/ml(10,081-18,063)] was decreased compared to all controls(p<0.05); Aß42[634pg/ml(492-834)] was similar compared to AD and MCI due to AD(p=0.10,p=0.93) but decreased compared to MCI and HC(both p<0.001); p-tau[67.3pg/ml(42.9-91.9)] and t-tau[468pg/ml(275-698)] were decreased compared to AD(p<0.001,p=0.001) and MCI due to AD(p=0.001,p=0.07), but elevated compared to MCI and HC(both p<0.001). Results proved valid among adjusted analyses. Multivariate modeling identified independent association of CAA with older age[Odds-ratio(OR):1.06,95%CI(1.02-1.10),p<0.01], lobar intracerebral hemorrhage[OR:14.00,CI(2.64-74.19),p<0.01], ischemic stroke[OR:3.36,CI(1.58-7.11),p<0.01], transient focal neurologic episodes[OR:4.19,CI(1.06-16.64),p=0.04], gait disturbance[OR:2.82,CI(1.11-7.15),p=0.03], and both lower Aß40[OR:0.9999,CI(0.9998-1.0000),p<0.01] and lower Aß42 levels[OR:0.9989,CI(0.9980-0.9998),p=0.01]. Both CSF parameters showed good discrimination for CAA diagnosis among adjusted ROC-analyses (Aß40,AUROC 0.80,CI(0.73-0.86),p<0.001; Aß42,AUROC 0.81,CI(0.75-0.88),p<0.001).

Conclusions: CAA patients showed a specific CSF-biomarker profile independent of clinical confounders, which may advance diagnostics.

Disclosure: No

O113 / 154

Scientific Communications 13 - SAH and ICH

TRANEXAMIC ACID AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE: POST-HOC ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL

M.R Germans ¹, M. Tjerkstra², R. Post², W.P. Vandertop², D. Verbaan², ULTRA Investigators

¹University Hospital Zurich, Neurosurgery, Zürich, Switzerland, ²Amsterdam University Medical Centers, Location AMC, Neurosurgery, Amsterdam, Netherlands

Background and aims: The ULTRA-trial included all non-traumatic subarachnoid hemorrhage (SAH) patients, so an expected proportion of patients suffered from non-aneurysmal SAH, which generally has a more benign course of disease and lower risk of rebleeding. Our aim was to investigate whether ultra-early and short-term tranexamic acid (TXA) treatment in patients with aneurysmal SAH improves clinical outcome at six months.

Methods: We included 813 ULTRA-trial patients, who presented within 24 hours of symptoms with CT-confirmed SAH and a confirmed intracranial aneurysm. After diagnosis, patients were allocated to either TXA treatment with usual care or usual care only. Patients of the TXA group received a bolus of one gram of TXA intravenously, followed by continuous infusion of one gram every eight hours until the start of aneurysm treatment, or until a maximum of 24 hours.

Primary endpoint was the modified Rankin Scale at six months assessed by a person who was blinded for the intervention, and dichotomized into good (0-3) and poor (4-6) outcome.

Results: Of the 813 patients, 409 (50%) were assigned to the TXA group and 404 (50%) to the control group. In this planned post-hoc analysis, 233 of 405 (58%) patients in the TXA group and 238 of 399 (60%) patients in the control group had a good clinical outcome (adjusted odds ratio 0.92; 95% confidence interval 0.69 to 1.24).

Conclusion: Ultra-early and short-term tranexamic acid treatment did not improve clinical outcome at six months in patients with aneurysmal SAH and therefore, is not recommended.

Disclosure: No

O114 / 1006

Scientific Communications 14 - Genetics, Omics and Biomarkers

A MULTIVARIABLE MENDELIAN RANDOMIZATION ANALYSIS INVESTIGATING CHRONIC KIDNEY DISEASE, HYPERTENSION AND STROKE

D.M. Kelly ¹, M.K. Georgakis^2,3,4, D. Blacker^5,6, A. Viswanathan¹, C.D. Anderson^3,4,7

¹Massachusetts General Hospital, Harvard Medical School, Philip Kistler Stroke Research Center, Department of Neurology, Boston, United States, ²Institute for Stroke and Dementia Research, University Hospital of LMU Munich, Munich, Germany, ³Massachusetts General Hospital, McCance Center for Brain Health, Boston, United States, ⁴Broad Institute, Program in Medical and Population Genetics, Cambridge, United States, ⁵Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston, United States, ⁶Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, United States, ⁷Brigham and Women’s Hospital, Department of Neurology, Boston, United States

Background and aims: Chronic kidney disease (CKD) increases the risk of stroke, but the extent through which this association is mediated by hypertension is unknown. We leveraged large-scale genetic data to explore causal relationships between CKD, hypertension and cerebrovascular disease phenotypes.

Methods: We used data from genome-wide association studies (GWAS) of European ancestry to identify genetic proxies for kidney function (CKD diagnosis, estimated glomerular filtration rate [eGFR], and urinary albumin-to-creatinine ratio [UACR]), systolic blood pressure (SBP), and cerebrovascular disease (ischaemic stroke and its subtypes, and intracerebral haemorrhage [ICH). We then conducted univariable, multivariable and mediation Mendelian randomization (MR) analyses to investigate the effect of kidney function on stroke risk and the proportion of this effect mediated through hypertension.

Results: Univariable MR analysis revealed associations between both lower eGFR (OR per 1-log decrement=2.10; 95% CI, 1.25-3.53) and higher UACR (OR per 1-log increment=2.34, 1.11-4.94) and risk of large artery stroke (LAS), as well as between higher UACR and risk of ICH (OR=5.19, 1.02-26.29). The associations between lower eGFR and LAS (OR=2.51, 1.53-4.13) and between higher UACR and ICH (OR=3.78, 1.39-10.32) remained significant in multivariable MR analysis with only a small proportion of the total effects mediated by SBP (1.8% and 7.8%, respectively). However, a large proportion of the other relationships between renal function and ischaemic subtypes were mediated by SBP.

Conclusions: Our results demonstrate an independent causal effect of impaired kidney function, as assessed by decreased eGFR and increased UACR, on LAS and ICH risk, even when controlled for SBP.

Disclosure: No

O115 / 1347

Scientific Communications 14 - Genetics, Omics and Biomarkers

THE GUT MICROBIOME INFLUENCES THE RISK OF ACUTE ISCHEMIC STROKE: A MENDELIAN RANDOMIZATION STUDY

C.A.F. Rivier ¹, N. Szejko¹, K. Sheth¹, J.N. Acosta¹, G.J. Falcone¹

¹ Yale University, Neurology, New Haven, United States

Background and aims: Recent evidence suggests that gut bacteria influence brain function through microbial compounds, metabolites, and endotoxins. However, the relationship between the gut flora and cerebrovascular disease remains understudied. We conducted a genetic study to assess the relationship between the concentration of gut bacteria and the risk of acute ischemic stroke.

Methods: We performed a two-sample Mendelian Randomization (MR) study using summary statistics from the Flemish Gut Flora Project and the MEGASTROKE consortium. We constructed 95 genetic instruments using single-nucleotide polymorphisms (SNPs) associated with microbial traits in the largest microbiome-wide GWAS. We then conducted summary statistics-based MR to test the association between each of these microbial traits and the risk of ischemic stroke or any of its subtypes: cardioembolic, large artery, and small vessel stroke. We used Bonferroni correction, adjusting for the 95 exposures x 4 traits = 380 tests performed.

Results: Our primary analysis using the inverse-variance weighted MR method identified 20 microbial traits significantly associated with the risk of developing at least one ischemic stroke subtype (Figure). Of these, G_Ruminococcus was associated with all four outcomes. Most of these associations were supported by other more conservative MR methods in secondary analyses.

Conclusions: Genetic analyses show that the gut microbiome influences the risk of developing an ischemic stroke. Further analyses are needed to validate these results and identify the mediating mechanisms. Because the gut microbiota can be easily modified with well-tolerated interventions, this avenue of research offers an appealing opportunity to design novel preventive treatments for stroke.

Disclosure: No

O116 / 1024

Scientific Communications 14 - Genetics, Omics and Biomarkers

GENETICALLY PREDICTED ON-STATIN LDL RESPONSE IS ASSOCIATED WITH HIGHER RISK OF INTRACEREBRAL HEMORRHAGE

E. Mayerhofer ^1,2,3, R. Malik⁴, M. Dichgans⁴, J. Rosand^1,2,3, C.D Anderson^5,3, M.K Georgakis^1,2,3,4

¹Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Boston, United States, ²Massachusetts General Hospital, Center for Genomic Medicine, Boston, United States, ³Broad Institute of Harvard and the Massachusetts Institute of Technology, Program in Medical and Population Genetics, Cambridge, United States, ⁴Ludwig-Maximilians-University, Institute for Stroke and Dementia Research (ISD), Munich, Germany, ⁵Brigham and Women’s Hospital, Department of Neurology, Boston, United States

Background and aims: It remains unclear whether stain-induced LDL lowering influences risk of intracerebral hemorrhage (ICH). We explored whether genetically predicted LDL response to statins is associated with ICH risk.

Methods: Utilizing genomic data from randomized trials, we derived a 35-SNP score of on-statin LDL response and tested it in the population-based UK Biobank (UKB). We extracted statin drug and dose data from primary care data on a subset of UKB participants covering a 29 year period (224,974 individuals). We validated the effects of the genetic score on longitudinal LDL measurements with generalized mixed models and explored associations with incident ICH using Cox regression analysis.

Results: Statins were prescribed at least once to 70,693 (31%) of the cohort (mean 57 years, 55% females). Among statin users, mean LDL decreased by 3.0 mg/dl per year (95% CI: [-3.02, -2.97]) over follow-up. A higher genetic score of statin response (one SD increment) was associated with significant reductions in LDL levels (-0.09 mg/dl per year, [-0.13, -0.05]) and showed concordant effects on other lipid traits as statin use. Over a 14-year follow-up period, a higher genetically predicted statin response among statin users associated with higher ICH risk (HR per one SD increment 1.19, 95% CI [1.06, 1.33]) even after adjusting for statin dose. Among statin non-users, there was no association with ICH risk (p=0.89).

Conclusions: On-statin genetically predicted LDL response is associated with ICH, thus providing further support for the hypothesis that larger LDL declines are causally associated with ICH risk.

Disclosure: No

O117 / 580

Scientific Communications 14 - Genetics, Omics and Biomarkers

POST-STROKE MOTOR RECOVERY GENOME-WIDE ASSOCIATION STUDY: A DOMAIN-SPECIFIC APPROACH

C. Aldridge ¹, K. Keene^2,3, F.-C. Hsu⁴, M. Sale^5,6, B. Worrall^1,6

¹University of Virginia, Department of Neurology, Charlottesville, United States, ²East Carolina University, Department of Biology, Greenville, United States, ³East Carolina University, Center for Health Disparities, Brody School of Medicine, Greenville, United States, ⁴Wake Forest School of Medicine, Department of Biostatistics and Data Science, Division of Public Health Sciences, Winston-Salem, United States, ⁵University of Virginia, Center for Public Health Genomics, Charlottesville, United States, ⁶University of Virginia, Department of Public Health Sciences, Charlottesville, United States

Background and aims: We aim to discover single nucleotide polymorphisms (SNP) associated with motor recovery over two-year follow-up with a Genome-Wide Association Study (GWAS) implementing a novel domain-specific outcome approach.

Methods: The Vitamin Intervention for Stroke Prevention trial genotyped 2,100 participants with non-disabling stroke as a qualifying event, of which 498 (64% men) had motor weakness at enrollment. Genotyped data (~1 million SNPs) underwent a strict quality control process, followed by imputation via TOPMed. The GWAS utilized logistic regression models with generalized estimating equations (GEEs) to leverage repeated measurements of the NIHSS motor score improvement of ⩾1. The GEE model estimated the odds ratio of the primary outcome (i.e., change in motor score ⩾1 vs. <1) of each SNP after adjusting for age, sex, visit, treatment arm, principal components 3 and 5.

Results: No association reached genome-wide significance (p<5x10^-8). However, 116 suggestive associations (p<5x10^-6) were detected. Notably, a cluster of SNPs were detected near PRAG1 and CLDN32 genes. PRAG1 regulates neurite outgrowth and influences modulation of ischemic infract volume, while CLDN32 affects blood-brain barrier, immune cell transmigration, and neurodevelopment. Two association clusters were identified on chromosome 18 (near RTTN and SOCS6 genes) and chromosome 3 (RNU1-43 pseudogene region). RTTN modulates neural tube development, while SOCS6 suppresses inflammatory responses via cytokine signal transduction.

Conclusion: This GWAS showed multiple suggestive associations clustering near genes with plausible mechanisms related to post-stroke motor recovery. Our novel approach with a domain specific outcome and GEEs optimized statistical efficiency. Replication and mechanistic investigation are warranted.

Disclosure: No

O118 / 1460

Scientific Communications 14 - Genetics, Omics and Biomarkers

LVO-CHECK: A RAPID POINT-OF-CARE BLOOD TEST TO DIAGNOSE LVO-PATIENTS AND REFER THEM TO THROMBECTOMY CENTERS ADDS PROGNOSTIC INFORMATION ON THE SUCCESS OF ENDOVASCUSCULAR REPERFUSION THERAPIES

J. Montaner ¹, A. Barragán-Prieto¹, J.A. Cabezas-Rodríguez², R.M. Delgado³, L. Sempere Bordes⁴, A. Zamora⁴, P. Menéndez Valladares¹, I. Muñoz Martínez⁵, M. García Murillo⁵, M.L. Gamero Merino⁵, M. Martín Fernández⁵, J. Sala Cascajo⁵, A. Romero Hidalgo⁶, J.M. Villadiego⁶, E. Casanova Sanz⁶, M.E. Saenz Corbellini⁶, E.M. Sanchez-Ropero⁶, M. Brazo Cubero⁶, A. de Alboniga-Chindurza², E. Zapata², M. Medina-Rodriguez², M. Lamana³, M. Morales⁴, L. Azurmendi Gil⁷, F. Moniche², S. Pérez-Sánchez¹, J.C. Sanchez⁷, A. González-García²

¹Hospital Universitario Virgen Macarena, Seville, Spain, ²Hospital Universitario Virgen del Rocio, Seville, Spain, ³Vall d’Hebron Research Institute (VHIR), Barcelona, Spain, ⁴Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain, ⁵Servicio de Urgencias de Atención Primaria, Seville, Spain, ⁶Empresa Pública de Emergencias Sanitarias, Seville, Spain, ⁷Unviersite de Geneve, Geneve, Switzerland

Background and aims: LVO-check is a rapid (10’) blood test measuring FABP/NT-proBNP that used in the field among stroke suspicion patients identifies those with LVO with precise specificity/sensitivity and might allow referring them to thrombectomy centers or even attempting direct shift to the angio-suite (BIOFAST, NCT04612218). On top of its diagnostic accuracy, we aimed to evaluate the prognostic value of LVO-check among patients with confirmed LVO that receive thrombectomy.

Methods: Consecutive patients with confirmed LVO were tested with the rapid LVO-check test in a blood sample obtained before thrombectomy was performed. Functional outcome at 3 months was the main endpoint (independent=mRS 0-2 vs. dependent=mRS 3-6).

Results: 320 patients were included. After thrombectomy 142 (51.6%) remained independent and 133 (48.4%) were dependent at 3m. Clinical factors significantly associated with poor outcome were age, baseline NIHSS, diabetes and chronic kidney disease. Both FABP and NT-proBNP were elevated among dependent patients (p<0.001). In the logistic regression [OR (2.5%-97.5%)] baseline NIHSS 1.11 per-point (1.07-1.16; p<0.001), FABP 1.17 per-unit (1.05-1.32; p=0.008) and diabetes mellitus 1.65 (0.94-2.89; p=0.079) were the main independent predictors of outcome. Using Panelomix software we identified optimal cutoffs for age, NIHSS score and FABP to predict poor outcome with excellent specificity (specificity=99.30% and sensitivity=21.10%).

Conclusions: Apart from its diagnostic capabilities LVO-check might predict outcome among those patients transferred to thrombectomy centers that get endovascular therapies. This might aid in future decisions about personalizing endovascular therapies and to add neuroprotective strategies in those with predicted poor outcome in spite of successful reperfusion.

Disclosure: No

O119 / 1466

Scientific Communications 14 - Genetics, Omics and Biomarkers

PREVIOUS RETINOGRAPHY FINDINGS IN PATIENTS WITH ACUTE STROKE: A SIMPLE NON-INVASIVE METHOD TO PREDICT COLLATERAL STATUS

A. Barragán-Prieto ¹, A. Zamora², S. Pérez-Sanchez¹, A. de Albóniga-Chindurza³, E. Zapata³, F. Moniche³, J. Moreno², J. Ortega³, E. Mayoral-Sánchez¹, M.A. Martinez-Brocca¹, A. Gonzalez³, J. Montaner¹

¹Hospital Universitario Virgen Macarena, Seville, Spain, ²Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain, ³Hospital Universitario Virgen del Rocio, Seville, Spain

Background and aims: Pial circulation allows the ischemic area to temporary slowdown infarction. There is currently no simple method that precisely predicts collaterals. Due to similarities in brain-eye circulation, we wonder whether microvascular retinal changes might be related to cerebral collateral circulation.

Methods: Patients from a regional prospective mechanical thrombectomy registry (ARTISTA n= 1180 patients) with at least one previous retinography done during routine diabetes retinopathy screening were selected. Collateral status on baseline computed tomography angiography (CTA) was scored from 0-3. Two groups were defined: patients with good collateral status (group A, score 3-2) vs. poor collateral status (group B, score 0-1).

Results: 175 patients with available retinography data were identified. From those 150 patients had good collaterals (Group A = 85.71%); those were younger (75y vs 82y, p<0.01), with more alcohol intake (17% vs 0%, p<0.05), lower median NIHSS score at admission (15 vs 21, p<0.01), lower proportion of SPAN-100-index (20% vs 60%, p<0.01) and more favorable ASPECTS at baseline CTA (63% vs 32%, p<0.01). A trend to altered retinography was identified among those with poor collaterals (retinopathy 8% in group A vs 20% in group B, p=0.07). Regression model adjusted by age, sex and SPAN identified retinopathy as a strong predictor of poor collaterals (OR=4.3123, IC 1.10-15.98, p= 0.029).

Conclusions: Diabetic retinopathy increases 4-fold the risk of poor collaterals among stroke patients. Retinography might be a simple technique to predict brain collateral status. Outcome implications of this finding and applicability to other stroke populations needs further exploration.

Disclosure: No

O120 / 1427

Scientific Communications 14 - Genetics, Omics and Biomarkers

LECTIN COMPLEMENT PATHWAY IN ACUTE ISCHEMIC STROKE PATIENTS TREATED WITH THROMBECTOMY

L. Mechtouff ^1,2, D. Mercurio³, A. Valente³, G. Bidaux², T.-H. Cho^1,2, O.F. Eker⁴, E. Canet-Soulas², N. Nighoghossian^1,2, S. Fumagalli³

¹Hospices Civils de Lyon, Stroke Department, Lyon, France, ²Université Lyon 1, Univ Lyon, CarMeN Laboratory, INSERM, INRA, Lyon, France, ³IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Department of Neuroscience, Milan, Italy, ⁴Hospices Civils de Lyon, Neuroradiology Department, Lyon, France

Background and aims: There is growing evidence that the complement system contributes to the inflammatory response in acute ischemic stroke (AIS) patients. The lectin pathway (LP) activation, depending on initiator molecules and serine proteases, plays especially a key role. In the present study, we aimed to describe their kinetics after AIS according to stroke etiology.

Methods: HIBISCUS-STROKE (CoHort of Patients to Identify Biological and Imaging markerS of CardiovascUlar Outcomes in Stroke) enrolled patients admitted in the Lyon Stroke Center from October 2016 to November 2021 for anterior circulation AIS due to large vessel occlusion treated with mechanical thrombectomy following MRI. Peripheral blood samples were collected from each patient at admission before any reperfusion therapy, 6 hours, 24 hours, 48 hours and 3 months from admission. Plasma levels of ficolin-1, -2, and -3, mannose-binding lectin (MBL) and mannan-binding lectin–associated serine protease 2 (MASP-2) were measured by enzyme linked immunosorbent assay (ELISA).

Results: 245 patients were included. Mean age was 68.3 years (+/-15.6), 106 (42.9%) were women. Median national institute of health stroke scale (NIHSS) score was 15 [9-19]. Etiology was distributed as follows, cardioembolism: 119 (51.5%), large-artery atherosclerosis: 32 (13.9%), other: 20 (8.7%), undetermined: 60 (26.0%). 134 (54.0%) patients were also treated with intravenous thrombolysis. Successful reperfusion (TICI score 2b/2c/3) was obtained in 197 patients (81.1%). 140 (60.6%) patients had a 3-months modified rankin scale (mRS) score ⩽ 2. Final results will be released during the meeting.

Acknowledgments: ANR-16-RHUS-0009; ERA-NET Neuron (project No. neuron-082)

Figure.

Study timeline (mRS: modified rankin scale)

Disclosure: No

O121 / 481

Scientific Communications 14 - Genetics, Omics and Biomarkers

EXTRACELLULAR MATRIX ORGANIZATION, INFLAMMATION, AND SIGNAL TRANSDUCTION PROCESSES RELATE TO LOWER CEREBRAL BLOOD FLOW IN PATIENTS WITH CARDIOVASCULAR DISEASE

L.M. Overmars ¹, S. Kuipers², B. Van Es¹, J. De Bresser³, E.E. Bron⁴, I.E. Hoefer¹, W.W. Van Solinge¹, L.J. Kappelle², M.J. Van Osch³, C.E. Teunissen⁵, G.J. Biessels², S. Haitjema¹, Heart-Brain Connection Consortium

¹University Medical Center Utrecht, Central Diagnostic Laboratory, Utrecht, Netherlands, ²University Medical Center Utrecht, Department of Neurology, Utrecht, Netherlands, ³Leiden University, Department of Radiology, Leiden, Netherlands, ⁴Erasmus Medical Center, Department of Radiology & Nuclear Medicine, Rotterdam, Netherlands, ⁵Amsterdam University Medical Center, Department of Clinical Chemistry, Amsterdam, Netherlands

Background and aims: Patients with cardiovascular disease (CVD) are at risk for structural and functional brain damage, possibly due to cerebral hemodynamic impairment, including a gradual decline in cerebral blood flow (CBF). Biological processes underlying this decreased CBF are largely unknown. We hypothesized that identification of protein biomarker clusters that relate to lower CBF in patients with CVD may provide leads on associated biological processes.

Methods: In 428 participants (mean age 67.2±8.6 years; 37% female; 74% cardiovascular diseases; 26% reference), we assessed the relation between 92 protein biomarkers from the OLINK cardiovascular III panel and partial volume corrected whole-brain normal-appearing gray matter CBF using cluster-based analyses.

Results: CBF was lower in patients with manifest CVD (Figure 1). Nine biomarkers negatively correlated with CBF (r range: -0.10 to -0.19, FDRs <0.05), and formed one cluster, of which we created one Biomarker Compound Score (BCS) (Figure 2). The cluster predominantly reflected inflammation, extracellular matrix organization, and signal transduction processes. BCS was significantly higher in patients with CVD (p < 0.001) and was associated with a ten-year systematic coronary risk evaluation estimate (SCORE) (ρ = 0.42, p < 0.001). Lastly, baseline BCS was a predictor of major adverse cardiovascular events (MACE) within 2-year follow-up (OR 2.05, 95% CI: 1.29-3.32, p < 0.01).

Conclusions: We identified a biomarker cluster, related to lower CBF and MACE within 2 years in patients with CVD, reflecting extracellular matrix organization, inflammation, and signal transduction, suggesting involvement of these processes in the pathophysiology of reduced CBF in CVD.

Disclosure: No

O122 / 258

Presidential Symposium Awards, Studies & Trials

COMPOSITION OF PM 2.5 AND COMORBIDITIES ASSOCIATED WITH HEMORRHAGIC STROKE HOSPITALIZATION IN THAILAND

K. Kongbunkiat ¹, P. Pipat Pattanapipitpaisal², U. Udomlack Peansukwech3³, N. Vorasoot², N. Kasemsap², S. Tiamkao²

¹North-Eastern Stroke Research Group, KhonKaen University, KhonKaen, Thailand, ²KhonKaen University, Internal Medicine, KhonKaen, Thailand, ³KhonKaen University, Chronic Kidney Disease Northeast Thailand (CKDNET), KhonKaen, Thailand

Background and Aims: Particulate matter (PM) 2.5 is associated with increased stroke risk. There are limited studies on the composition of PM 2.5 (black carbon, organic carbon, sulfate, and dust) and comorbidities associated with hemorrhagic stroke hospitalization.

Methods: We gathered data from the MERRA-2 satellite on pollutant concentrations and the Thailand universal health coverage system on hemorrhagic stroke incidence from 1st January 2014 – 31st December 2016. We demonstrated the spatial relationship between PM subspecies using Poisson log-linear model analysis for long-term exposure, which included patient comorbidities and a linear predictor of hemorrhagic stroke incidence rate ratio by PM2.5 subspecies using the INLA approach.

Results: We observed 82,390 patients diagnosed with hemorrhagic stroke on admission (ICD10 I60.X-I62.X). The multivariate analysis revealed that an increase of 1 mcg/m³ in black carbon and dust was associated with an increase in risk of hemorrhagic stroke of 46.3 % and 25.7 %, respectively. Each 1 g/m³ increase in black carbon exposure increases risk of hemorrhagic stroke hospitalization in patients with diabetes or dyslipidemia: RR 1.33 (95 %CI 1.25-1.42) and 1.10 (95 % CI 1.01-1.19, respectively. Each 1 g/m³ increase in dust exposure increases risk of hemorrhagic stroke hospitalization in patients with atrial fibrillation: RR 1.47 (95%CI 1.17-1.85).

Conclusions: Long-term exposure to black carbon and dust increases risk of hemorrhagic stroke hospitalization. Exposure to black carbon leads to an increase in hemorrhagic stroke in patient with diabetes and dyslipidemia. Exposure to dust leads to an increase in hemorrhagic stroke in patient with atrial fibrillation.

Disclosure: No

O123 / 730

Presidential Symposium Awards, Studies & Trials

STROKE GENETICS INFORMS DRUG DISCOVERY AND RISK PREDICTION ACROSS ANCESTRIES

A. Mishra¹, R. Malik², T. Hachiya³, T. Jürgenson⁴, S. Namba⁵, M. Koido⁶, Q. Le Grand¹, F.K. Kamanu⁷, M. Shi⁸, Y. He⁸, M.K. Georgakis², I. Caro⁹, K. Krebs⁴, B.S. Winsvold¹⁰, G. Chauhan¹¹, C. Bordes⁹, M.R. Chong¹², M. Endres¹³, L.E. Ferreira¹⁴, S.J. Kittner¹⁵, P. Lacaze¹⁶, B.D. Mitchell¹⁷, G. Paré¹², I.Y. Millwood¹⁸, H. Adams¹⁹, K. Christensen²⁰, T. Rundek²¹, K.J. Jung²², J. Kõrv²³, P.H. França¹⁴, M. Geerlings²⁴, R. Zand²⁵, K. Prasad¹¹, R. Frikke-Schmidt²⁶, F.-E. de Leeuw²⁷, K.G. Haeusler²⁸, S.S. Rich²⁹, Y.M. Ruigrok³⁰, P.U. Heuschmann³¹, M. Fornage³², W. Longstreth³³, S. Seshadri³⁴, Y. Okada⁵, C.T. Ruff⁷, I. Fernández-Cadenas³⁵, R.G. Walters¹⁸, L. Milani⁴, Y. Kamatani⁸, M. Dichgans³⁶, S. Debette ⁹, on behalf of ISGC Consortium, CHARGE Consortium, and GIGASTROKE Consortium

¹University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France, ²Institute for Stroke and Dementia Research, Munich, Germany, ³Iwate Tohoku Medical Megabank Organization, Morioka, Japan, ⁴Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia, ⁵Osaka University Graduate School of Medicine, Department of Statistical Genetics, Suita, Japan, ⁶Institute of Medical Sciences, The University of Tokyo, Division of Molecular Pathology, Tokyo, Japan, ⁷TIMI Study Group, Boston, United States, ⁸University of Tokyo, Graduate School of Frontier Sciences, Laboratory of Complex Trait Genomics, Tokyo, Japan, ⁹University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France, ¹⁰Oslo University Hospital, Department of Research and Innovation, Division of Clinical Neuroscience, Oslo, Norway, ¹¹Rajendra Institute of Medical Sciences, Rachi, India, ¹²Population Health Research Institute (PHRI), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences, Thrombosis and Atherosclerosis Research Institute, Hamilton, Canada, ¹³Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin, Berlin, Germany, ¹⁴University of the Region of Joinville, Department of Medicine and Joinville Stroke Biobank, Post-Graduation Program on Health and Environment, Joinville, Brazil, ¹⁵University of Maryland School of Medicine, Department of Neurology, Baltimore, United States, ¹⁶Monash University, Melbourne, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Melbourne, Australia, ¹⁷University of Maryland School of Medicine, Department of Medicine, Baltimore, United States, ¹⁸University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom, ¹⁹Department of Clinical Genetics, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands, ²⁰University of Southern Denmark, The Danish Twin Registry, Department of Public Health, Odense, Denmark, ²¹University of Miami, Miller School of Medicine, Miami, United States, ²²Yonsei University, Institute for Health Promotion, Graduate School of Public Health, Seoul, Korea, Republic of, ²³University of Tartu, Department of Neurology and Neurosurgery, Tartu, Estonia, ²⁴University Medical Center Utrecht & Utrecht University, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, ²⁵Geisinger Neuroscience Institute, Geisinger Health System, Danville, United States, ²⁶Copenhagen University Hospital - Rigshospitalet, Department of Clinical Biochemistry, Copenhagen, Denmark, ²⁷Radboud University Medical Center, Department of Neurology, Donders Center for Medical Neuroscience, Nijmegen, Netherlands, ²⁸Universitätsklinikum Würzburg, Department of Neurology, Würzburg, Germany, ²⁹University of Virginia, Center for Public Health Genomics, Charlottesville, United States, ³⁰University Medical Center Utrecht, Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, Netherlands, ³¹University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany, ³²University of Texas Health Science Center at Houston, Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, United States, ³³University of Washington, Department of Neurology, Seattle, United States, ³⁴University of Texas Health Sciences Center, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, United States, ³⁵Biomedical Research Institute Sant Pau (IIB Sant Pau), Stroke Pharmacogenomics and Genetics Laboratory, Barcelona, Spain, ³⁶Institute for Stroke and Dementia Research, University Hospital, Munich, Germany

Background and aims: Previous genome-wide association studies (GWAS) of stroke have been conducted in populations of predominantly European ancestry.

Methods: We undertook cross-ancestry GWAS meta-analyses of stroke and its subtypes in 110,182 stroke patients (33% non-European) and 1,503,898 control individuals of five ancestries from population- and clinic-based studies, nearly doubling the number of cases in previous stroke GWAS.

Results: We identified association signals at 89 independent loci, of which 61 were novel. Effect sizes were overall highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis using a novel machine-learning approach, transcriptome and proteome-wide association analyses revealed putative causal genes and variants. Using a novel three-pronged approach, we provided genetic evidence for putative drug effects, highlighting 5 genes as possible targets, with drugs already under investigation for stroke for 2 of them. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWAS with vascular risk factor GWAS (iPGS) showed strong prediction of ischemic stroke risk in European and, for the first time, East-Asian populations. The iPGS performed better than stroke PGS alone and better than previous best iPGS, in Europeans and East-Asians. Transferability of European-specific iPGS to East-Asians was limited. Stroke genetic risk scores were predictive of ischemic stroke independent of clinical risk factors in 52,600 clinical trial participants with cardiometabolic disease and performed considerably better than previous scores, both in Europeans and East-Asians.

Conclusion: Altogether our results provide critical insight to inform biology, reveal potential drug targets for intervention, and provide genetic risk prediction tools across ancestries for targeted prevention.

Disclosure: No

O124 / 997

Presidential Symposium Awards, Studies & Trials

EPIGENETIC AGE AND STROKE - FINDINGS FROM THE HEALTH AND RETIREMENT STUDY

N. Szejko ^1,2, C. Rivier², J. Acosta², C. Both², K. Sheth², G. Falcone²

¹Medical University of Warsaw, Neurology, Warsaw, Poland, ²Yale University, New Haven, United States

Background and aims: Epigenetic clocks constitute a novel tool to define aging. They are calculated on the basis of DNA methylation and clinical variables relevant for the aging proces. We tested two hypotheses: 1) higher epigenetic age constitutes a risk factor for stroke, and 2) stroke survivors are “epigenetically” older compared to stroke-free persons.

Methods: We evaluated clinical data and epigenetic clocks calculated for the Health and Retirement Study (HRS). Thirteen epigenetic clocks have been constructed using the HRS DNAm data collected in 2016 (n=4,018). Stroke was ascertained via information received from the patient and caregivers. We used logistic regression and Cox proportional models to test for associations.

Results: Out of 42,233 total study participants enrolled in HRS, 4,018 provided DNA samples to assess epigenomic data. Of these, 342 developed stroke over a mean follow up time of 11.53 years. For all but two epigenetic clocks, prevalent stroke increased epigenetic age as compared to stroke-free persons in univariate and multivariate analyses adjusted for age, sex and vascular risk factors (Table 1). When investigating whether increased epigenetic age prior to stroke predisposed to stroke incidence, we found that increased epigenetic age was a risk factor for stroke both in univariate analysis as well as multivariable analysis adjusted for age, sex and vascular risk factors (Table 2).

Conclusions: Epigenic age and stroke are strongly linked. Stroke leads to an acceleration of epigenetic age in stroke survivors. In addition, acceleration of epigenetic age is associated with higher risk of stroke.

Table 1.

The influence of prevalent stroke on epigenetic aging defined by different epigenetic clocks.

	Estimate	Standard error	T value	P value
Horvath clock
Univariate analysis	0.0028121	0.0004558	6.170	7.51e-10
Multivariate analysis with age, sex and vascular factors	0.0019178	0.0005607	3.420	0.000634
Hannum clock
Univariate analysis	0.002855	0.000475	6.011	2.01e-09
Multivariate analysis with age, sex and vascular factors	1.301e-03	6.277e-04	2.073	0.03830
Levine clock
Univariate analysis	0.0030563	0.0004343	7.038	2.28e-12
Multivariate analysis with age, sex and vascular factors	0.0015693	0.0005561	2.822	0.00481
Horvath Skin clock
Univariate analysis	0.0030094	0.0004952	6.077	1.34e-09
Multivariate analysis with age, sex and vascular factors	0.0016740	0.0006733	2.486	0.01296
Lin clock
Univariate analysis	0.0022435	0.0003959	5.667	1.56e-08
Multivariate analysis with age, sex and vascular factors	0.0014398	0.0004856	2.965	0.00305
Weidner clock
Univariate analysis	0.0022435	0.0003959	5.667	1.56e-08
Multivariate analysis with age, sex and vascular factors	0.0014398	0.0004856	2.965	0.00305
Vidalbralo clock
Univariate analysis	0.0039028	0.0007086	5.508	3.86e-08
Multivariate analysis with age, sex and vascular factors	0.0033712	0.0008247	4.088	4.47e-05
Yang clock
Univariate analysis	0.0039028	0.68758	2.932	0.00339
Multivariate analysis with age, sex and vascular factors	0.2323708	0.2456752	0.946	0.3443
Zhang clock
Univariate analysis	0.07923	0.00943	8.402	<2e-16
Multivariate analysis with age, sex and vascular factors	0.0480850	0.0109773	4.380	1.23e-05
Bocklandt clock
Univariate analysis	-0.18917	0.05435	-3.481	0.000506
Multivariate analysis with age, sex and vascular factors	-0.1704521	0.0614834	-2.772	0.0056
Gargnani clock
Univariate analysis	0.25727	0.06076	4.234	2.35e-05
Multivariate analysis with age, sex and vascular factors	0.1041851	0.0734803	1.418	0.15634
DNAMGRIMAGE
Univariate analysis	0.0049064	0.0005044	9.727	< 2e-16
Multivariate analysis with age, sex and vascular factors	0.0041548	0.0007203	5.768	8.88e-09

Table 2.

The influence of epigenetic aging on incident stroke.

	Estimate	Standard error	T value	P value
Horvath clock
Model with age and sex	0.0026201	0.0005608	4.672	3.13e-06
Model with age, sex and vascular factors	0.0019178	0.0005607	3.420	0.000634
Hannum clock
Model with age and sex	0.0023522	0.0006219	3.782	0.000159
Model with age, sex and vascular factors	1.301e-03	6.277e-04	2.073	0.03830
Levine clock
Model with age and sex	0.0025914	0.0005475	4.733	2.32e-06
Model with age, sex and vascular factors	0.0015693	0.0005561	2.822	0.00481
Horvath Skin clock
Model with age and sex	0.0027927	0.0006665	4.190	2.87e-05
Model with age, sex and vascular factors	0.0016740	0.0006733	2.486	0.01296
Lin clock
Model with age and sex	2.026e-03	4.860e-04	4.169	3.15e-05
Model with age, sex and vascular factors	0.0014398	0.0004856	2.965	0.00305
Weidner clock
Model with age and sex	0.0014995	0.0004182	3.586	0.000342
Model with age, sex and vascular factors	0.0011719	0.0004147	2.826	0.00475
Vidalbralo clock
Model with age and sex	4.427e-03	8.244e-04	5.371	8.47e-08
Model with age, sex and vascular factors	0.0033712	0.0008247	4.088	4.47e-05
Yang clock
Model with age and sex	0.3471253	0.2480186	1.400	0.1617
Model with age, sex and vascular factors	0.2323708	0.2456752	0.946	0.3443
Zhang clock
Model with age and sex	0.0653034	0.0108713	6.007	2.13e-09
Model with age, sex and vascular factors	0.0480850	0.0109773	4.380	1.23e-05
Bocklandt clock
Model with age and sex	-0.2001196	0.0622172	-3.216	0.00131
Model with age, sex and vascular factors	-0.1704521	0.0614834	-2.772	0.0056
Gargnani clock
Model with age and sex	0.1943742	0.0736755	2.638	0.00838
Model with age, sex and vascular factors	0.1041851	0.0734803	1.418	0.15634
DNAMGRIMAGE
Model with age and sex	0.0055270	0.0006984	7.914	3.53e-15
Model with age, sex and vascular factors	0.0041548	0.0007203	5.768	8.88e-09

Disclosure: No

O125 / 497

Presidential Symposium Awards, Studies & Trials

OUTCOMES OF PATIENTS WITH ATRIAL FIBRILLATION AND ISCHAEMIC STROKE DESPITE RECEIVING ORAL ANTICOAGULATION

A.P. Benz ¹, J.W. Eikelboom¹, S.H. Hohnloser², A.P. Carnicelli³, R.P. Giugliano⁴, C.B. Granger³, J. Harrington³, Z. Hijazi⁵, D.A. Morrow⁴, M.R. Patel³, A. Shoamanesh¹, L. Wallentin⁵, Q. Yi⁶, S.J. Connolly¹, on behalf of the COMBINE AF Investigators

¹Population Health Research Institute, McMaster University, Hamilton, Canada, ²J. W. Goethe University, Department of Cardiology, Frankfurt, Germany, ³Duke Clinical Research Institute, Duke University, Durham, United States, ⁴Brigham and Women’s Hospital, Harvard Medical School, TIMI Study Group, Boston, United States, ⁵Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden, ⁶School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada

Background and aims: The prognosis of patients with atrial fibrillation (AF) and ischaemic stroke despite receiving oral anticoagulation is poorly understood. We aimed to estimate the incidence of recurrent ischaemic stroke following an index stroke event while on oral anticoagulation.

Methods: Using individual patient data from 5 pivotal randomized trials of direct oral anticoagulants (DOACs) for AF, we evaluated the outcomes of patients with a post-randomization ischaemic stroke while on anticoagulation (DOAC or warfarin) during trial follow-up. Patients with permanent study drug discontinuation prior to the index event were excluded. The primary endpoint was recurrent ischaemic stroke following the index event.

Results: Data from 74,491 patients were available (45,219 [60.7%] and 29,272 [39.3%] randomized to a DOAC and warfarin, respectively). The primary analysis included 1,163 patients with ischaemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrolment; 62.3% on a DOAC, 37.7% on warfarin). During a mean follow-up of 1.1 years, 74 patients had a recurrent ischaemic stroke (incidence at 1 year: 7.0%, 95% confidence interval [CI] 5.2-8.7%) (Figure A). Consistent results were obtained in an analysis starting 2 weeks after the index event, only including patients without permanent study drug discontinuation since then (incidence at 1 year: 6.8%, 95% CI 4.6-8.9%). The mortality rate at 3 months after the index stroke was 12.4% (95% CI 10.5-14.4%) (Figure B).

Conclusions: Patients with AF and ischaemic stroke despite oral anticoagulation are at very high risk of recurrent ischaemic stroke and of death.

Disclosure: No

O126 / 765

Presidential Symposium Awards, Studies & Trials

CIRCULATING INTERLEUKIN-6 PREDICTS CAROTID PLAQUE SEVERITY, VULNERABILITY, AND PROGRESSION IN THE CARDIOVASCULAR HEALTH STUDY

J. Kamtchum Tatuene ¹, L. Saba², M.R. Heldner³, M.H.F. Poorthuis⁴, G.J. de Borst⁵, T. Rundek⁶, S.K. Kakkos⁷, S. Chaturvedi⁸, R. Topakian⁹, J.F. Polak¹⁰, G.C. Jickling¹¹

¹University of Alberta, Neuroscience and Mental Health Institute, Edmonton, Canada, ²University of Cagliari, Department of Radiology, Cagliari, Italy, ³University Hospital Bern, Department of Neurology, Bern, Switzerland, ⁴University Medical Center Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands, ⁵University Medical Center Utrecht, Department of Vascular Surgery, Utrecht, Netherlands, ⁶University of Miami Miller School of Medicine, Department of Neurology, Miami, United States, ⁷University of Patras Medical School, Department of Vascular Surgery, Patras, Greece, ⁸University of Maryland, Department of Neurology, Baltimore, United States, ⁹Academic Teaching Hospital Wels-Grieskirchen, Wels, Australia, ¹⁰Tufts University School of Medicine, Department of Radiology, Boston, United States, ¹¹University of Alberta, Department of Medicine, Edmonton, Canada

Background and aims: Interleukin-6 (IL-6) has important roles in atherosclerosis pathophysiology. To determine if anti-IL-6 therapy warrants evaluation as adjuvant stroke prevention strategy in patients with carotid atherosclerosis, we tested whether circulating IL-6 levels predict plaque severity, vulnerability, and progression in the Cardiovascular Health Study.

Methods: Duplex carotid ultrasound was performed at baseline and 5 years. Plaque severity was scored 0 to 5 based on NASCET grade of stenosis. Plaque vulnerability at baseline was the presence of markedly irregular, ulcerated or echolucent plaques. Plaque progression at 5 years was a ⩾1 point increase in stenosis severity. Relationship of baseline plasma IL-6 with plaque characteristics was modeled using multivariable linear (severity) or logistic (vulnerability, progression) regression. Risk factors of atherosclerosis were included as independent variables. Stepwise backward elimination was used with p>0.05 for variable removal. We performed internal validation with 100 bootstrap samples.

Results: In 4334 participants with complete data (58.9% women, mean age: 72.7 ± 5.1 years), there were 1267 (29.2%) with vulnerable plaque and 1474 (34.0%) with plaque progression. Log IL-6 predicted plaque severity (β = 0.09, p=0.04), vulnerability (OR = 1.22, 95% CI: 1.06-1.40, p=0.006) and progression (OR = 1.44, 95% CI: 1.23-1.69, p<0.001). In participants with >50% predicted probability of progression, mean log IL-6 was 0.54 corresponding to 2.0 pg/mL. Dichotomizing IL-6 levels did not affect the performance of regression models.

Conclusions: Circulating IL-6 predicts carotid plaque severity, vulnerability, and progression. The 2.0 pg/mL cut-off could help select individuals that would benefit from anti-IL-6 drugs for stroke prevention.

Disclosure: No

O127 / 1410

Presidential Symposium Awards, Studies & Trials

STROKE IN THE YOUNG: CANCER IN DISGUISE?

J. Verhoeven ¹, B. Fan², M. Broeders^3,4, C. Driessen⁵, I. Vaartjes⁶, C. Klijn¹, F.-E. de Leeuw¹

¹Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Neurology, Nijmegen, Netherlands, ²Sint Jans Gasthuis, Neurology, Weert, Netherlands, ³Dutch Expert Centre for Screening, Nijmegen, Netherlands, ⁴Radboud Institute for Health Sciences, Nijmegen, Netherlands, ⁵Radboud University Medical Centre, Oncology, Nijmegen, Netherlands, ⁶Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Epidemiology, Utrecht, Netherlands

Background: It is hypothesized that stroke may be a first manifestation of occult cancer or an indicator of an increased cancer-risk in later life. However data, especially in young adults, is limited.

Methods: Patients with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) in the Netherlands, between 1998 and 2018 were included through linking the Dutch Population Registry and national Hospital Discharge Registry, with follow-up until 1-1-2019. Index stroke and malignancies during follow-up were based on administrative codes from the International Classification of Disease (Edition 9/10). Main outcomes were cumulative incidence of first-ever cancer after stroke, stratified by stroke subtype, age and sex, and standardized incidence rates (SIR) compared to matched peers from the general population.

Results: We included 26,616 patients aged 15-49 years (median age 44 [IQR 39-48]; 51.4% women; 89.1% ischemic stroke) and 362,782 patients ⩾50 years old (median age 76 [IQR 67-83]; 50.1% women; 84.8% ischemic stroke). Cumulative incidence of any cancer at ten years was 3.7% (95% CI 3.4-4.0) in the younger and 8.5% (95% CI 8.4-8.6%) in the older age-group. The one-year SIR post-stroke in younger patients was 2.6 (95% CI 2.2-3.1) after ischemic stroke and 5.4 (95% CI 3.8-7.3) after ICH, whereas for older patients this was 1.2 (95% CI 1.2-1.2) after ischemic stroke and 1.2 (95% CI 1.1-1.2) after ICH.

Conclusions: Younger patients have a three to five-fold increased risk of cancer after ischemic stroke or ICH compared to their peers, whereas this risk is only slightly elevated in older patients.

Disclosure: No

O129 / 833

Scientific Communications 15 - Atherosclerosis & Stroke

COMPLICATED CAROTID ARTERY PLAQUES AND RISK OF RECURRENT ISCHEMIC STROKE OR TIA

A. Kopczak¹, A. Schindler², D. Sepp³, A. Bayer-Karpinska⁴, R. Malik¹, M.L. Koch⁵, J. Zeller⁶, C. Strecker⁷, D. Janowitz¹, F.A. Wollenweber⁸, J.-M. Hempel⁹, T. Boeckh-Behrens³, C.C. Cyran², A. Helck¹⁰, A. Harloff⁷, U. Ziemann⁶, S. Poli⁶, H. Poppert¹¹, T. Saam¹², M. Dichgans ¹

¹LMU Munich, Institute for Stroke and Dementia Research, Munich, Germany, ²LMU Munich, Department of Radiology, Munich, Germany, ³Technical University of Munich, Department of Neuroradiology, Munich, Germany, ⁴Klinikum Fürstenfeldbruck, Department of Neurology, Fürstenfeldbruck, Germany, ⁵Technical University of Munich, Department of Neurology, Munich, Germany, ⁶University of Tübingen, Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Tübingen, Germany, ⁷University of Freiburg, Department of Neurology and Neurophysiology, Freiburg, Germany, ⁸Helios Dr Horst-Schmidt-Kliniken, Department of Neurology, Wiesbaden, Germany, ⁹University of Tübingen, Department of Diagnostic and Interventional Neuroradiology, Tübingen, Germany, ¹⁰Hirslanden/Klinik im Park, Radiology and Neuroradiology Zurich, Zurich, Switzerland, ¹¹Helios Klinikum München West, Department of Neurology, Munich, Germany, ¹²Radiologisches Zentrum Rosenheim, Rosenheim, Germany

Background and aims: Complicated (AHA-lesion-type-VI) non-stenosing carotid artery plaques (CAP) are an underrecognized cause of stroke. We aimed to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic cerebrovascular events (stroke or TIA).

Methods: The Carotid Plaque Imaging in Acute Stroke (CAPIAS; NCT01284933) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery (Kopczak et al. JACC 2020). Complicated CAP were defined by multi-sequence, contrast-enhanced carotid MRI obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic cerebrovascular events.

Results: Among 196 patients enrolled, 104 patients had cryptogenic stroke and non-stenosing CAP. During a mean follow-up of 30 months, recurrent ischemic cerebrovascular events occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs. 3.61 per 100 patient-years, p=0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years, p=0.003). The results were driven by ipsilateral events. A ruptured fibrous cap and intraplaque hemorrhage were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.

Conclusions: Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with a substantially increased risk of recurrent ischemic cerebrovascular events. Carotid plaque imaging identifies high-risk patients that might be suited for inclusion into future secondary prevention trials.

Disclosure: No

O130 / 242

Scientific Communications 15 - Atherosclerosis & Stroke

MORPHOLOGY OF INTRACRANIAL ATHEROSCLEROTIC PLAQUES IN THE ANTERIOR VERSUS POSTERIOR CIRCULATION: A THREE-DIMENSIONAL ROTATIONAL ANGIOGRAPHY STUDY

X. Leng ¹, L. Wang¹, B.Y. Ip¹, S.H. Ma¹, Y.O. Soo¹, V.H. Ip¹, A.Y. Chan¹, L.W. Au¹, F.S. Fan¹, K. Ma¹, A.Y Lau¹, H. Leung¹, V.C. Mok¹, L.K. Wong¹, S.C. Yu², T.W Leung¹

¹The Chinese University of Hong Kong, Department of Medicine & Therapeutics, Hong Kong, Hong Kong, SAR of China, ²The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, Hong Kong, SAR of China

Background and aims: The morphology of intracranial atherosclerotic plaques in the anterior versus posterior circulation may be different, which was investigated in the current study using three-dimensional rotational angiography (3DRA).

Methods: We prospectively recruited adult patients with acute ischemic stroke or transient ischemic attack attributed to high-grade (60-99%), atherosclerotic intracranial stenosis as confirmed by 3DRA. We assessed the plaque morphology in 3DRA, including the percentage of luminal stenosis, smooth/irregular/ulcerative plaque surface, plaque thickness, length, eccentricity, upstream plaque shoulder angulation, longitudinal distribution of the maximal stenosis, and adjoining branch atheromatous disease (BAD). We compared characteristics of patients with middle cerebral artery-M1 (MCA-M1) and basilar artery (BA) plaques, and the plaque morphology in the two subgroups.

Results: Overall, 152 and 16 patients respectively with MCA-M1 and BA plaques were analyzed, with similar age (medians 59 versus 62 years), sex (male 64.5 versus 56.3%) and history of common vascular risk factors. The percentage of luminal stenosis (medians 76 versus 81%), upstream plaque shoulder angulation (32.7 versus 24.5 ˚), longitudinal distribution of the maximal stenosis, and presence of adjoining BAD (59.8 versus 57.1%) were similar between MCA-M1 and BA plaques. However, BA plaques were thicker (1.6 versus 1.3mm; p=0.02), longer (17.0 versus 8.4mm; p<0.001) and more likely ulcerative (25.0 versus 11.8%; p=0.05), but less likely eccentric (68.8 versus 87.5%; p=0.041).

Conclusions: There were differences in the morphology of symptomatic atherosclerotic plaques in anterior and posterior circulations, independent of demographics and common vascular risk factors. Different artery geometry and the hemodynamics may underlie such differences.

Disclosure: No

O131 / 438

Scientific Communications 15 - Atherosclerosis & Stroke

LIPOPROTEIN (A) IS A NEWLY VALIDATED BIOMARKER FOR LARGE-ARTERY-ATHEROSCLEROSIS STROKE AETIOLOGY

S. Rudin ¹, L. Kriemler^1,2, T. Dittrich¹, A. Zietz¹, J. Schweizer³, M. Arnold³, P. Lyrer^1,4, S. Engelter^1,5, N. Peters⁶, F. Barinka⁶, S. Jung⁷, M. Arnold⁷, U. Fischer^1,4, K. Rentsch⁸, M. Christ-Crain^9,4, M. Katan^1,4, G.M. De Marchis^1,4

¹University Hospital Basel, Neurology, Basel, Switzerland, ²Cantonal Hospital Schaffhausen, Internal Medicine, Schaffhausen, Switzerland, ³University Hospital Zürich, Neurology, Zürich, Switzerland, ⁴University of Basel, Clinical Research, Basel, Switzerland, ⁵University Department of Geriatric Medicine Felix Platter, Neurology and Neurorehabilitation, Basel, Switzerland, ⁶Hirslanden Hospital Zurich, Neurology, Zürich, Switzerland, ⁷Inselspital, University Hospital Bern, Neurology, Bern, Switzerland, ⁸University Hospital Basel, Laboratory Medicine, Basel, Switzerland, ⁹University Hospital Basel, Endocrinology, Basel, Switzerland

Background and aims: Lipoprotein(a) (Lp(a)) serum levels are genetically determined and contribute to atherogenesis. High Lp(a) levels are associated with an increased cardiovascular morbidity. Recently, serum Lp(a) levels have been associated with large artery atherosclerosis stroke (LAAS) aetiology. We aimed to validate this association in an independent cohort.

Methods: We included acute ischemic stroke patients from a prospective cohort study from the University Hospital Bern (Inselspital), Switzerland. Lp(a) serum levels were measured in serum drawn within 24 hours after symptom onset. We assessed the association of Lp(a) with LAAS in univariate and multivariate analysis, adjusting for traditional LAAS risk factors.

Results: Overall, 746 patients were included, of which 105 had a LAA stroke (14%). Lp(a) was higher in patients with LAAS compared to patients with non-LAAS (23.0 nmol/l [IQR:9.8-80.0] versus 16.3 nmol/l [IQR:5.8-57.0], p=0.01). In univariate analysis, patients with LAAS were significantly more often men, suffered more often from dyslipidaemia, arterial hypertension, diabetes and had a higher BMI than patients with non-LAAS (Table 1). In a multivariable logistic regression model, elevated Log₁₀(Lp(a)) was associated with LAAS with a OR of 1.50 (95%CI 1.02-2.21) (Table 2).

Conclusions: Among ischemic stroke patients, we could validate the independent association of higher Lp(a) levels with LAAS aetiology, also after adjusting for traditional cardiovascular risk factors. Independent validation of biomarkers, especially with the aim to guide secondary prevention, is essential. The findings are relevant in view of randomised clinical trials investigating the effect of specific Lp(a) lowering agent in reducing major adverse cardiovascular events.

Table 1.

Baseline and Outcome Characteristics of Patients with an acute ischemic stroke.

	Total (n=746)	LAA Stroke(n=105)	Non-LAA Stroke(n=641)	p-value
Demographic data
Age, y, median (IQR)	71 (61-80)	72 (63-79)	71 (60-80)	0.58
Men, n (%)	467 (62.6)	77 (73.3)	390 (60.84)	0.02
Medical history, n (%)
Dyslipidaemia	427 (58.0)	71 (67.6)	356 (56.4)	0.03
Previous cerebrovascular event	154 (20.7)	29 (27.6)	125 (19.5)	0.07
Arterial hypertension	510 (68.4)	85 (81.0)	425 (66.3)	0.002
Current Smoking	133 (17.8)	26 (24.8)	107 (16.7)	0.05
Former smoking	105 (14.1)	11 (13.9)	94 (17.6)	0.52
Ever Smoker (past and current)	238 (31.9)	37 (35.9)	201 (31.4)	0.43
Coronary heart disease	133 (17.8)	19 (18.1)	114 (17.8)	0.52
Diabetes mellitus	115 (15.4)	25 (23.8)	90 (14.1)	0.01
Positive family history	112 (19.9)	12 (16.0)	100 (20.5)	0.44
Clinical data, median (IQR)
BMI kg/m2	25.7 (13.2-28.3)	26.4 (24.4-29.1)	25.6 (22.9-28.3)	0.02
Stroke severity on admission (NIHSS)	6 (3-12.5)	5 (3-12)	6 (3-13)	0.64
Medication on admission, n (%)
Statins	195 (26.2)	35 (33.7)	160 (25.0)	0.07
Platelet inhibitors	289 (37.6)	53 (49.5)	228 (35.6)	0.009
Antihypertensive drugs	442 (59.5)	76 (73.1)	366 (57.3)	0.002
Laboratory values, median (IQR)
Lipoprotein (a), nmol/L	16.9 (6.1-60)	23.0 (9.8-80)	16.3 (5.8-57)	0.01
LDL-Cholesterol, mmol/L	2.6 (2.0-3.3)	2.6 (2.1-3.4)	2.6 (2.0-3.3)	0.33
Apolipoprotein B, g/L	0.95 (0.8-1.1)	0.94 (0.8-1.1)	0.95 (0.8-1.1)	0.74
Cholesterol, mmol/L	4.7 (4.0-5.5)	4.6 (4.1-5.4)	4.7 (4.0-5.5)	0.74
Triglycerides, mmol/L	1.4 (1.0-2.0),	1.4 (1.1-2.0)	1.4 (1.0-2.0)	0.92
Non-HDL, mmol/l	3.3 (2.7-4.2)	3.3 (2.9-4.2)	3.34 (2.7-4.1)	0.58
HbA1c, %	5.8 (5.6-6.2)	6.0 (5.7-6.3)	5.8 (5.6-6.2)	0.002
TOAST, n (%)
Macroangiopathy	105 (14.1)	105 (100)	N/A	N/A
Cardioembolism	288 (38.6)	N/A	288 (44.9)
Microangiopathy (lacunar)	43 (5.8)	N/A	43 (6.7)
Other aetiologies	28 (3.8)	N/A	28 (4.4)
Undetermined, evaluations complete	117 (15.7)	N/A	117 (18.3)
Undetermined, evaluations incomplete	95 (12.7)	N/A	95 (14.8)
More than 1 possible aetiology	70 (9.4)	N/A	70 (10.9)

Table 2.

Multivariable logistic regression model for the association with large artery atherosclerotic stroke and Lipoprotein (a).

Variable	aOR	95%-CI	p-value
Log10 (Lp (a))	1.50	1.02-2.21	0.04
Arterial hypertension	1.98	1.07-3.68	0.03
Woman	0.59	0.34-1.02	0.06
BMI	1.03	0.98-1.09	0.18
Dyslipidaemia	1.34	0.79-2.29	0.28
Diabetes mellitus	1.72	0.95-3.13	0.76
Platelet inhibitor on admission	1.34	0.82-2.21	0.24

Legend: aOR = adjusted odds ratio, CI = confidence interval, Lp(a) = Lipoprotein (a)

Disclosure: No

O132 / 900

Scientific Communications 15 - Atherosclerosis & Stroke

DISCORDANCE BETWEEN LDL-C AND APOLIPOPROTEIN B IS ASSOCIATED WITH LARGE-ARTERY-ATHEROSCLEROSIS ISCHEMIC STROKE ⩽70 YEARS OF AGE

L. Kriemler ^1,2, S. Rudin¹, J. Gawinecka³, F. Gross⁴, M. Arnold⁵, J. Schweizer⁵, T. Pokorny⁵, T. Dittrich¹, N. Peters⁶, F. Barinka⁶, H. Gensicke^1,7, S. Jung⁸, M. Arnold⁸, L.H Bonati^1,9, U. Fischer^1,9, M. Christ-Crain^10,9, A. Von Eckhardstein³, K. Rentsch¹¹, M. Katan^1,9, G.M. De Marchis^1,9

¹University Hospital Basel, Neurology, Basel, Switzerland, ²Cantonal Hospital Schaffhausen, Internal Medicine, Schaffhausen, Switzerland, ³University Hospital Zürich, Clinical Chemistry, Laboratory Medicine, Zürich, Switzerland, ⁴University Zürich, Zürich, Switzerland, ⁵University Hospital Zürich, Neurology, Zürich, Switzerland, ⁶Hirslanden Hospital Zurich, Neurology, Zürich, Switzerland, ⁷University Department of Geriatric Medicine Felix Platter, Neurology and Neurorehabilitation, Basel, Switzerland, ⁸Inselspital, University Hospital Bern, Neurology, Bern, Switzerland, ⁹University of Basel, Clinical Research, Basel, Switzerland, ¹⁰University Hospital Basel, Endocrinology, Basel, Switzerland, ¹¹University Hospital Basel, Laboratory Medicine, Basel, Switzerland

Background and aims: Dyslipidemia is a risk factor for large artery atherosclerotic (LAA) strokes. LDL and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). For secondary stroke prevention, European guidelines recommend a target low-density-lipoprotein (LDL) cholesterol below 1.4 mmol/l (<55 mg/dl) or apoB<65 mg/dL. The correlation between LDL-C and apoB is usually high, but in some cases LDL-C underestimates apoB levels and thus residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.

Methods: We included patients with an acute ischemic stroke from two prospective cohorts enrolled at the University Hospital Basel and Zurich, Switzerland. LDL-C and apoB were measured on admission. Discordance between LDL-C and apoB was measured with residual analysis. We excluded patients with unknown etiological status.

Results: Overall, we included 1’988 patients, of which 287 had a LAA stroke (14%). Median age was 73 years (IQR 62-81). In the overall cohort, higher-than-expected apoB values were not associated with LAA. However, a strong and significant interaction with age was present. Among the 833 patients ⩽70 years of age, a higher-than-expected apoB was more frequent in patients with LAA- vs. non LAA-stroke (48% versus 36%, p=0.02) (Table 1). In multivariate analysis, a higher-than-expected apoB was associated with LAA stroke (aOR=2.01, 95%-CI 1.11-3.61) (Table 2).

Conclusions: Among patients aged ⩽70 years, a higher-than-expected apoB was independently associated with LAA stroke. In younger patients with LAA-stroke, measuring apoB in addition to LDL-C may help personalize lipid-lowering therapy.

Table 1.

Baseline and Outcome Characteristics of Patients ⩽70 years of age and an acute ischemic stroke.

	Total (n=833)	LAA Stroke(n=121)	Non-LAA Stroke(n=712)	p-value
Demographic data
Age, y, median (IQR)	60 (51-65)	62 (58-65)	58 (50-65)	<0.001
Men, n (%)	560 (67)	89 (74)	471 (66)	0.12
Medical history, n (%)
Dyslipidemia	528 (64)	94 (78)	434 (61)	<0.001
Previous stroke/TIA	134 (16)	29 (24)	105 (15)	0.02
Arterial hypertension	460 (55)	93 (77)	367 (52)	<0.001
Smoking	281 (34)	60 (50)	221 (31)	<0.001
Coronary heart disease	91 (11)	23 (19)	68 (10)	0.004
Diabetes mellitus	102 (12)	27 (22)	75 (11)	0.001
Positive family history	150 (20)	21 (19)	129 (20)	1.00
Clinical data, median (IQR)
BMI kg/m2	26 (23-29)	26 (24-28)	26 (23-29)	0.79
Stroke severity on admission (NIHSS)	4 (2-10)	5 (2-12)	4 (2-10)	0.08
Medication on admission, n (%)
Lipid-lowering therapy	167(20)	42 (35)	125 (18)	<0.001
Platelet inhibitors	210 (25)	48 (40)	162 (23)	<0.001
Antihypertensive drugs	335 (40)	73 (60)	262 (37)	<0.001
Laboratory values, median (IQR)
LDL, mmol/L	2.80 (2.14-3.53)	3.1 (2.1-3.8)	2.8 (2.15-3.50)	0.08
Apolipoprotein B, g/L	0.98 (0.80-1.18)	1.02 (0.86-1.25)	0.98 (0.80-1.17)	0.04
Cholesterol, mmol/L	4.90 (4.18-5.70)	5.10 (4.1-6.0)	4.90 (4.20-5.66)	0.25
Triglycerides, mmol/L	1.44 (0.97-2.07)	1.58 (1.09-2.06)	1.39 (0.96-2.06)	0.11
Non-HDL, mmol/l	3.58 (2.8-4.37)	3.78 (2.89-4.64)	3.55 (2.79-4.33)	0.08
HbA1c, %	5.7 (5.4-6.0)	6.0 (5.6-6.6)	5.7 (5.4-6.0)	<0.001
Discordance LDL/apoB
apoB higher than expected, n (%)	277 (38)	53 (48)	224 (36)	0.02
apoB as expected, n (%)	242 (33)	25 (23)	217 (35)	0.01
apoB lower than expected, n (%)	219 (30)	33 (30)	186 (30)	1.00
TOAST
Macroangiopathy	121 (15)	121 (100)	N/A	N/A
Cardioembolism	236 (29)	N/A	236 (33)
Microangiopathy (lacunar)	93 (11)	N/A	93 (13)
Other etiologies	89 (11)	N/A	89 (13)
Undetermined, evaluations complete	232 (28)	N/A	232 (33)
Undetermined, evaluations incomplete	28 (3)	N/A	28 (4)
More than 1 possible etiology	34 (4)	N/A	34 (5)
Outcome at 3 months, n (%)
Recurrent Ischemic Stroke or TIA	28 (3)	6 (5)	22 (3)	0.08
Death	38 (5)	2 (2)	36 (5)	0.15

Table 2.

Multivariable logistic regression model for the association with large artery atherosclerotic stroke.

Variable	aOR	95%-CI	p-value
Age (per year)	1.03	1.00-1.07	0.13
Woman	1.16	0.62-2.18	0.63
Apolipoprotein B higher than expected	2.01	1.12-3.61	0.02
LDL-C (per 1 mmol/L increase)	1.60	1.18-2.18	0.003
Arterial hypertension	2.07	1.03-4.18	0.04
HbA1c	1.06	0.85-1.33	0.61
Statin on admission	2.40	1.12-6.17	0.002
Smoking	0.93	0.60-1.47	0.73
Previous stroke/TIA	1.51	0.73-3.15	0.27
Coronary artery disease	1.26	0.51-3.09	0.61
Platelet Inhibitors on admission	1.15	0.55-2.45	0.70

Legend: aOR = adjusted odds ratio, CI = confidence interval, LDL-C = Low Density Lipoprotein Cholesterol

Disclosure: No

O133 / 832

Scientific Communications 15 - Atherosclerosis & Stroke

HDL CHOLESTEROL AND MORTALITY IN STROKE PATIENTS WITH OR WITHOUT IMPAIRED KIDNEY FUNCTION – RESULTS OF THE MONDAFIS STUDY

S. Tütüncü ¹, M. Olma¹, C. Kunze¹, P.U. Heuschmann², P. Kirchhof³, U. Laufs⁴, D.G. Nabavi⁵, J. Röther⁶, G. Thomalla⁷, R. Veltkamp⁸, K.G. Haeusler⁹, M. Endres¹⁰

¹Charite Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany, ²University Hospital Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany, ³University Hamburg, University Heart and Vascular Center Hamburg, Hamburg, Germany, ⁴Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany, ⁵Vivantes Klinikum Neukölln, Department of Neurology, Berlin, Germany, ⁶Asklepios Klinik Altona, Department of Neurology, Hamburg, Germany, ⁷University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany, ⁸Alfried Krupp Krankenhaus, Department of Neurology, Essen, Germany, ⁹Universitätsklinikum Würzburg, Department of Neurology, Würzburg, Germany, ¹⁰Charité-Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Berlin, Germany

Background: High HDL cholesterol (HDL-C) serum concentrations are associated with lower mortality in healthy individuals. In patients with chronic kidney disease the beneficial effect of high HDL-C is not observed.

Methods: In the investigator-initiated, prospective, multi-center Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) study 3,465 hospitalized patients with acute ischemic-stroke or transient ischemic attack were randomized 1:1 to standard diagnostic procedures to detect atrial fibrillation or additive Holter-ECG for up to seven days in-hospital. eGFR (estimated using the CKD-epi formula) and HDL-C was assessed at baseline. We categorized HDL-C in ⩽25, 26-33, 34-41, 42-49, ⩾50mg/dl, and eGFR⩾60 and <60ml/min/1.73m². We estimated hazard ratios in confounder adjusted models for all-cause death within 24 months after stroke.

Results: HDL-C and eGFR was available in 1,581 patients (median age 68 years [range 59-77], 38.3% female, median NIHSS score at admission 2 [1-4] points). HDL-C was ⩽25mg/dl in 26 (1.6%) patients, 26-33mg/dl in 165 (10.4%) patients, 34-41mg/dl in 328 (20.7%), 42-49mg/dl in 370 (23.4%), and ⩾50mg/dl in 692 (43.8%). eGFR<60ml/min/1.73m² was present in 314 (19.9%) patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, HDL-C ⩾50mg/dl was significantly associated with lower mortality [HR 0.13, 95%CI 0.03-0.65] in patients with eGFR⩾60ml/min/1.73m², but not in patients with eGFR<60ml/min/1.73m² [HR 0.25, 95%CI 0.05-1.21] at baseline.

Conclusion: A significant association of higher HDL-C with lower mortality was found in stroke patients with normal kidney function but not in those with impaired kidney function.

Disclosure: Yes

O134 / 235

Scientific Communications 15 - Atherosclerosis & Stroke

CLONAL HEMATOPOIESIS IS ENRICHED IN YOUNG ISCHEMIC STROKE PATIENTS AND IS ASSOCIATED WITH ATHEROSCLEROTIC TRAITS

E. Mayerhofer ^1,2,3, C. Strecker¹, H. Becker⁴, M.K Georgakis^2,3,5, M.M Hoffmann⁶, M. Meggendorfer⁷, T. Haferlach⁷, J. Rosand^2,3, C.D Anderson^8,2,3, A. Harloff¹, G. Hoermann⁷

¹University of Freiburg, Department of Neurology and Neurophysiology, Freiburg, Germany, ²Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Boston, United States, ³Broad Institute of Harvard and the Massachusetts Institute of Technology, Program in Medical and Population Genetics, Cambridge, United States, ⁴University of Freiburg, Department of Medicine I, Freiburg, Germany, ⁵Ludwig-Maximilians-University, Institute for Stroke and Dementia Research (ISD), Munich, Germany, ⁶University of Freiburg, Institute of Clinical Chemistry and Laboratory Medicine, Freiburg, Germany, ⁷MLL Munich Leukemia Laboratory, Munich, Germany, ⁸Brigham and Women’s Hospital, Department of Neurology, Boston, United States

Background and aims: Clonal hematopoiesis of indeterminate potential (CHIP) recently emerged as independent risk factor for stroke. We explored the characteristics of CHIP in young stroke patients as a potentially contributing factor to early-onset stroke.

Methods: We prospectively included 248 patients aged 18-60 years (39% females) with acute TIA or stroke. All patients underwent high-sensitive targeted sequencing on 41 genes frequently mutated in hematologic neoplasms. We compared the prevalence of CHIP to age-matched healthy controls from the Nijmegen Biomedical Study and explored the association between CHIP and atherosclerotic traits and stroke etiology.

Results: A total of 51 (20.6%) of the patients had CHIP. After adjusting for method-specific differences, the prevalence was 3-fold higher than among healthy controls (7.7% vs 2.6%, p<0.001). Among patients with CHIP, six (12%) had high-risk mutation features, six (12%) had more than one mutation, and three (6%) also had abnormal blood counts indicative of an unrecognized hematological disease. Patients with CHIP had a higher burden of atherosclerosis, as determined by higher cIMT (median [IQR] 0.68 [0.58-0.71] vs 0.59 [0.51-0.65] mm, p=0.009), higher prevalence of complex aortic atheroma (11.8% vs. 2.0%, p=0.006), coronary artery disease (11.8% vs 4.4%, p=0.012), and any atherosclerotic cardiovascular disease (29.4% vs 16.7%, p=0.04) than patients without CHIP. CHIP prevalence was similar across stroke etiopathological subtypes.

Conclusions: CHIP is significantly enriched among young stroke patients and is associated with a higher atherosclerosis burden. Whether CHIP and other undetected hematologic diseases causally contribute to stroke risk needs to be further explored in future studies.

Disclosure: No

O135 / 213

Scientific Communications 15 - Atherosclerosis & Stroke

RNF213 VARIANT PREDICTS PROGRESSION AND PROGNOSIS OF INTRACRANIAL ARTERY STENOSIS: A 15-YEAR FOLLOW-UP STUDY

S. Okazaki ^1,2, T. Yoshimoto², M. Ohara¹, M. Takagaki³, K. Watanabe¹, Y. Gon¹, K. Todo¹, T. Sasaki¹, T. Yamada⁴, S. Manabe⁵, H. Kishima³, M. Ihara², H. Mochizuki¹, OCR-STROKE Investigators

¹Osaka University Graduate School of Medicine, Neurology, Osaka, Japan, ²National Cerebral and Cardiovascular Center, Neurology, Osaka, Japan, ³Osaka University Graduate School of Medicine, Neurosurgery, Osaka, Japan, ⁴Osaka University Hospital, Data Coordinating Center, Osaka, Japan, ⁵Osaka University Graduate School of Medicine, Department of Medical Informatics, Osaka, Japan

Background and aims: Intracranial artery stenosis is the predominant etiology of ischemic stroke in Asia. We hypothesized that the RNF213 p.R4810K variant, defined as a susceptibility gene for moyamoya disease, may affect the long-term outcome of patients with intracranial artery stenosis.

Methods: Using prospective collected registries, we identified adult patients with intracranial artery stenosis who underwent periodic MRI examinations for more than 5 years. Patients diagnosed with moyamoya disease at the time of initial MRI were excluded. Genotyping of RNF213 p.R4810K was performed at the end of follow-up.

Results: Among 52 patients, 22 (42%) were the RNF213 p.R4810K variant carriers. Median follow-up duration was 10.3 years ranging from 5.3 to 14.8 years. Two patients were newly diagnosed with moyamoya disease during the follow-up period, and both of them were variant carriers. Univariate Cox regression analyses show that the RNF213 p.R4810K variant carrier was significantly associated with the progression of intracranial artery stenosis (hazard ratio (HR) 3.31, 95%CI 1.38 – 7.90, P = 0.007), and the composite endpoint of symptomatic stroke and transient ischemic attack (HR 3.70, 95%CI 1.15 – 11.86, P = 0.028), but not with symptomatic stroke (HR 2.18, 95%CI 0.62 - 7.74, P = 0.23).

Conclusions: The RNF213 p.R4810K variant was a predictor of the progression and prognosis of intracranial artery stenosis.

Disclosure: No

O141 / 119

Scientific Communications 17 - Small Vessel Disease

ASSOCIATION OF CHRONIC COVERT CEREBRAL INFARCTIONS AND WHITE MATTER HYPERINTENSITIES WITH LONG-TERM SURVIVAL IN ISCHEMIC STROKE AND TIA PATIENTS - A COHORT STUDY

M. Schilter¹, A. Epstein¹, J. Vynckier¹, J. Kaesmacher¹, U. Fischer¹, M. Arnold¹, T. Meinel ¹

¹ Stroke Research Center Bern, Inselspital, University of Bern, Bern, Switzerland

Objective: To investigate the association of different phenotypes and locations of chronic covert cerebral infarctions (CBI) with long-term mortality in patients with first-ever manifest AIS and TIA. Additionally, to analyze their potential interaction with white matter hyperintensities (WMH) and incremental predictive value in addition to established mortality scores.

Methods: Single-center cohort study including consecutive patients with ischemic stroke and TIA with available MRI imaging from 01/2015–12/2017. Blinded raters adjudicated CBI phenotypes and WMH (age related white matter changes score) according to established definitions. We compared Cox-Regression models including prespecified established predictors of mortality using Harrell’s C and likelihood ratio tests.

Results: 2236 patients (median (IQR) age 71(59-80) years, 43% female, NIHSS 2(1-6), median follow-up 1436 days, 21% death during follow-up). Increasing WMH (per point ARWMC aHR 1.27,1.13-1.43), but not CBI (aHR 1.21,0.99-1.49) were independently associated with mortality. Neither CBI phenotype nor location were associated with mortality and there was no interaction between CBI and WMH (P>0.1). As compared to patients without CBI or WMH, patients with moderate or severe WMH and additional CBI had the highest hazards of death (aHR 1.59,1.21-2.09). The Cox-regression model including CBI and WMH had a small, but significant increment in Harrell’s C as compared to the model including 14 clinical variables (0.831 vs 0.827,P<0.001).

Conclusions: WMH are a strong surrogate biomarker of long-term mortality in first-ever manifest ischemic stroke and TIA patients. CBI phenotypes and location seem less relevant. Incorporation of CBI and WMH slightly improves predictive capacity of established risk scores.

Disclosure: No

O142 / 202

Scientific Communications 17 - Small Vessel Disease

DETERMINANTS AND TEMPORAL DYNAMICS OF CEREBRAL SMALL VESSEL DISEASE: 14-YEAR FOLLOW-UP

M. Cai ¹, M. Jacob¹, M.R.v. Loenen¹, M. Bergkamp¹, J. Marques¹, D. Norris,¹, M. Duering², A. Tuladhar¹, F.-E. de Leeuw¹

¹Radboud University, Nijmegen, Netherlands, ²University of Basel, Basel, Switzerland

Background and aims: To investigate the effect of vascular risk factors and baseline small vessel disease burden on the temporal dynamics of SVD, with four MRI assessments over 14 years in patients with SVD.

Methods: 503 patients with sporadic SVD (50-85 years) from the ongoing longitudinal Radboud University Nijmegen Diffusion Tensor and Magnetic resonance Cohort (RUN DMC) study with baseline assessment in 2006 and follow-up in 2011, 2015, and 2020.

Results: A total of 382 SVD patients (mean [SD] 64.1 [8.4]; 219 men), who underwent at least two serial brain MRI scans, were included. We found a highly variable temporal course of SVD, with regression alternated with progression, that compensated for regression in all but 4% of all participants (Figure 1). Mean (SD) WMH progression rate was 0.6 (0.74) ml/year (range 0.02-4.73 ml/year) and 13.6% of patients had incident lacunes (1.03%/year) over the 14-year follow-up. Older age was a strong predictor for faster WMH progression and incident lacunes. Patients with mild baseline WMH rarely (2.9%) progressed to severe WMH. In addition, both baseline burden of SVD lesions and vascular risk factors independently and synergistically predicted WMH progression, while only baseline SVD burden predicted incident lacunes over the 14-year follow-up.

Conclusions: SVD shows pronounced progression over time, but mild WMH rarely progression to clinically severe WMH. Regression during 14 years was largely absent and was often compensated by progression during other time intervals.

Figure 1.

WMH temporal dynamics over 14-year follow-up.

Disclosure: No

O143 / 1513

Scientific Communications 17 - Small Vessel Disease

INCIDENT INFARCTS, WMH PROGRESSION, AND DECLINING COGNITION AFTER A STROKE

U. Clancy ¹, C. Arteaga¹, W. Hewins¹, D. Jaime Garcia¹, M.C Valdés-Hernández¹, S. Wiseman¹, M. Stringer¹, M. Thrippleton¹, F.M Chappell¹, O. Hamilton¹, A.C. Jochems¹, Y. Cheng², X. Liu³, J. Zhang⁴, S. Rudilosso⁵, E. Sakka¹, A. Kampaite¹, R. Brown¹, M.E Bastin¹, S. Muñoz Maniega¹, I. Hamilton¹, D. Job¹, I. Marshall¹, F.N Doubal¹, J.M Wardlaw¹

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²Sichuan University, Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Chengdu, China, ³The University of Hong Kong, Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong, SAR of China, ⁴Shanghai Jiao Tong University School of Medicine, Department of Neurology, Shanghai General Hospital, Shanghai, China, ⁵University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Comprehensive Stroke Center, Department of Neuroscience, Barcelona, Spain

Background and aims: The contribution of incident recurrent infarcts to post-stroke cognitive impairment is unclear. We aimed to determine whether both incident infarcts and WMH progression contribute to declining cognition after stroke.

Methods: We recruited patients with non-disabling stroke prospectively. After diagnostic MRI, we repeated MRI and MoCA tests at 3-6 monthly intervals for 12 months, assessing incident infarcts and WMH volume change. We used linear mixed-effects analysis to assess changing MoCA scores during one-year follow-up, adjusting for baseline age, vascular risks, stroke volume, education, premorbid intelligence, and for longitudinal NIHSS, WMH volumes, and incident infarcts.

Results: We recruited 203 participants (mean 66 years; 33% female; 55% lacunar). Median baseline MoCA was 24 (IQR 22-27). MoCA increased between baseline and 12 months (mean +0.73, SD 3.14). In a linear mixed-effects model, MoCA decline was associated with previous stroke/TIA (std.β= -0.49, 95%CI=-0.78– -0.21, p=0.001), lower premorbid intelligence β= -0.46, 95%CI=-0.55– -0.36, p=<0.001), older age (β= -0.24, 95%CI=-0.34– -0.14, p=<0.001), increasing NIHSS during follow-up (β= -0.14, 95%CI=-0.22– -0.06, p=0.001), and longitudinal increase in WMH volumes (β=-0.13, 95%CI=-0.24– -0.02, p=0.024) but not with incident infarcts (β=-0.18, 95%CI=-0.41–0.06, p=0.140), vascular risk factors, index stroke volume, or education. This did not change substantially when repeated with any lacunar incident (rather than any incident) infarct (β=-0.20, p=0.147).

Conclusions: In a population enriched for lacunar stroke, WMH progression, lower premorbid IQ, older age, and increasing NIHSS, but not incident infarcts, predicted declining cognition. This ongoing study highlights individuals who are potentially high-risk for post-stroke cognitive impairment.

Disclosure: No

O144 / 1173

Scientific Communications 17 - Small Vessel Disease

CEREBRAL SMALL VESSEL DISEASE INCREASES THE RISK OF INCIDENT PARKINSONISM

M.A. Jacob ¹, M. Cai¹, M. Bergkamp¹, S.K. Darweesh¹, M. Duering², R.A. Esselink¹, A.M. Tuladhar¹, F.-E. de Leeuw¹

¹Radboud University Medical Centre; Donders Center for Medical Neuroscience, Nijmegen; The Netherlands, Department of Neurology, Nijmegen, Netherlands, ²Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland, Basel, Switzerland

Background: Cerebral small vessel disease (SVD) is associated with prevalent motor impairments and parkinsonian signs, however, there are limited data on whether SVD also increases risk of incident parkinsonism. We investigated the relations of SVD-severity and SVD-progression, with incident parkinsonism over a follow-up period of 14 years.

Methods: This study is embedded within the RUNDMC-study, a longitudinal prospective cohort-study on patients with sporadic SVD. In 2006 and in 2011, patients underwent a standardized MRI-protocol.

Parkinsonism diagnostic work-up was performed until December 2020, and was based on the UK Brain Bank criteria, and stratified into vascular parkinsonism (VP) or idiopathic Parkinson’s Disease. Cox-regression analysis was used to investigate predictors of incident parkinsonism, while considering death as competing risk.

Results: 503 patients (mean age: 65.7 (SD 8.8) years) were included, of whom 51 (10.2%) participants developed parkinsonism, with a mean follow-up time of 13.7 (SD 0.5) years. Higher baseline white matter hyperintensities (WMH) volume (HR=1.46 [95%CI 1.21–1.78] per 1-SD increase), lower white matter microstructural integrity (reflected by higher peak width of skeletonized mean diffusivity (PSMD); HR=1.66 [95%CI 1.34 – 2.05] per 1-SD increase, and presence of lacunes (HR=1.84 [95%CI 0.99-3.42]) were associated with increased risk of incident all-cause parkinsonism. Progression of WMH and lacunes increased risk of all-cause parkinsonism (Figure 1), but only incident lacunes were asociated with incident VP in the multivariable analyses (HR=4.64 [95%CI 1.32-16.32]).

Conclusions: SVD-severity and progression, especially incident lacunes, independently increase risk of all-cause parkinsonism. These data suggest that SVD may be causally related to parkinsonsim.

Disclosure: No

O145 / 583

Scientific Communications 17 - Small Vessel Disease

CLINICAL RELEVANCE OF WHITE MATTER HYPERINTENSITY ‘CAPS’ AND ‘TRACKS’ APPEARING LONG TERM AFTER RECENT SMALL SUBCORTICAL INFARCTS

Y. Cheng ^1,2, C. Arteaga¹, G. Blair¹, M. Stringer¹, M. Thrippleton¹, M. C. Valdés Hernández¹, S. Wiseman¹, F. Chappell¹, U. Clancy¹, K. Shuler¹, I. Hamilton¹, D. Jaime Garcia¹, F. Doubal¹, J. Wardlaw¹, The Edinburgh SVD Research Group

¹Centre for Clinical Brain Sciences, Edinburgh Imaging and the UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom, ²Department of Neurology, West China Hospital, Sichuan University, Chengdu, China

Background and aims: Recent studies reported about half of the recent small subcortical infarcts (RSSIs) developed new white matter hyperintensities (WMH) adjacent to the index infarct, either superior (‘cap’) or inferior (‘track’) during long-term follow-up. However, little is known about their risk factors or clinical relevance. We assessed relationships between WMH ‘caps/tracks’ and vascular risk profile, neuroimaging features, and clinical outcomes.

Methods: We enrolled patients with MRI-confirmed RSSI from three prospective observational stroke studies. At baseline, we recorded risk factors, infarct characteristics and small vessel disease (SVD) score. At 1 year, we repeated MRI and recorded WMH ‘caps/tracks’ blind to other data. We used multivariable logistic regression to identify independent variables associated with WMH ‘caps/tracks’, and 1-year clinical outcomes including favourable functional outcome (modified Rankin scale 0–1), recurrent cerebrovascular events, and cognitive impairment (MOCA<26).

Results: Among 155 RSSI patients (mean age 65.5), 73 (47%) developed WMH ‘caps/tracks’. WMH ‘caps/tracks’ increased with larger RSSI diameter, non-thalamic infarct, and higher SVD score (adjusted odds ratio [aOR] [95%CI] 1.20 [1.10–1.32], 12.5 [3.79–57.61], and 1.56 [1.12–2.22]). Presence of WMH ‘caps/tracks’ was associated with less favourable functional outcome (aOR [95%CI] 0.22 [0.07– 0.61]), but it was not associated with recurrent cerebrovascular events or post-stroke cognitive impairment.

Conclusions: WMH ‘caps/tracks’ were associated with SVD burden and unfavourable functional outcome after lacunar stroke, suggesting they might be a novel marker of vulnerability to progressive vascular brain injury. Reducing secondary white matter damage may offer novel treatment targets to improve outcome after SVD-related stroke.

Disclosure: No

O146 / 1326

Scientific Communications 17 - Small Vessel Disease

CLINICAL ASSOCIATIONS AND PROGNOSTIC SIGNIFICANCE OF ENLARGED PERIVASCULAR SPACES IN PATIENTS WITH PREVIOUS ISCHAEMIC STROKE OR TIA: A POOLED ANALYSIS OF INDIVIDUAL PATIENT DATA

J.G. Best ¹, G. Ambler², D. Wilson^1,3, H. Du^1,4, K.-J. Lee⁵, J.-S. Lim⁶, K.C. Teo⁷, H.K.F. Mak⁸, Y.D. Kim⁹, T.-J. Song¹⁰, D.S. Demirelli¹¹, M. Nishihara¹², M. Yoshikawa¹³, M. Kubacka^14,15, A. Zietz^16,15, R. Al-Shahi Salman¹⁷, H.R. Jäger¹⁸, G.YH Lip^19,20, L.D Panos^21,22, M.B Goeldlin^21,22, L.-A. Slater²³, C. Karayiannis²⁴, T. Phan²⁵, M. Franke²⁶, J. Abrigo²⁷, C. Cheng⁷, T. Leung²⁸, W. Chu²⁷, F. Chappell²⁹, S. Makin³⁰, D.HK van Dam-Nolen³¹, ME. Kooi³², S. Köhler³³, J. Staals³⁴, R. Bordet³⁵, F. Dubost³⁶, J. Wardlaw²⁹, Y. Soo²⁸, F. Fluri²⁶, V. Srikanth²⁴, S. Jung^21,22, N. Peters^14,16,15, H. Hara¹³, Y. Yakushiji^13,37, D.N. Orken³⁸, J.H. Heo⁹, K.K. Lau⁷, H.-J. Bae⁵, D.J Werring¹

¹Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom, ²Department of Statistical Science, University College London, London, United Kingdom, ³New Zealand Brain Research Institute, Christchurch, New Zealand, ⁴Stroke Research Centre, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China, ⁵Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of, ⁶Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of, ⁷Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR of China, ⁸Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, Hong Kong, SAR of China, ⁹Department of Neurology, Yonsei University College of Medicine, Seoul, Korea, Republic of, ¹⁰Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea, Republic of, ¹¹Department of Neurology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey, ¹²Department of Radiology, Saga University Faculty of Medicine, Saga, Japan, ¹³Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan, ¹⁴Stroke Center Klinik Hirslanden Zürich, Zürich, Switzerland, ¹⁵University of Basel, Basel, Switzerland, ¹⁶Department of Neurology and Stroke Center University Hospital, Basel, Switzerland, ¹⁷Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom, ¹⁸Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom, ¹⁹Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, ²⁰Department of Clinical Medicine, Aalborg University, Aalborg, Denmark, ²¹Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland, ²²University of Bern, Bern, Switzerland, ²³Department of Interventional Radiology, Monash Health, Clayton, Australia, ²⁴Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia, ²⁵Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia, ²⁶Department of Neurology, University Hospital of Würzburg, Würzburg, Germany, ²⁷Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR of China, ²⁸Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR of China, ²⁹Centre for Clinical Brain Sciences, Edinburgh Imaging; and UK Dementia Institute at the University of Edinburgh, Edinburgh, United Kingdom, ³⁰Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom, ³¹Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands, ³²Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, Netherlands, ³³Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands, ³⁴Department of Neurology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands, ³⁵University of Lille, Inserm, CHU de Lille. ‘Degenerative and vascular cognitive disorders’ U1171, Lille, France, ³⁶Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands, ³⁷Department of Neurology, Kansai Medical University, Hirakata, Japan, ³⁸Department of Neurology, Istanbul Arel University, Istanbul, Turkey

Background and aims: Enlarged perivascular spaces are an emerging marker of cerebral small vessel disease (CSVD) and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large multicentre analysis.

Methods: We pooled individual patient data from a consortium of prospective observational studies. Participants had recent ischaemic stroke or TIA, underwent baseline MRI, and were followed up for ischaemic stroke and symptomatic intracranial haemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and centrum semiovale (CSOPVS) were rated using a validated visual scale. We investigated clinical and radiological associations cross-sectionally using multinomial logistic regression, and prospective associations with ischaemic stroke and ICH using Cox regression.

Results: We included 7,778 participants from 16 studies. Over a median follow-up of 1.47 years, 80 ICH and 424 ischaemic strokes occurred. BGPVS were associated with increasing age, hypertension, hyperlipidaemia, previous ischaemic stroke, previous ICH, lacunes, cerebral microbleeds (CMBs) and white matter hyperintensities. CSOPVS showed similar but weaker associations. Prospectively, after adjusting for potential confounders including CMBs, BGPVS were associated with ischaemic stroke (11-20 BGPVS: HR 1.20, 95% CI 0.93-1.54; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; overall p = 0.040), but not ICH. CSOPVS were not associated with either outcome.

Conclusions: In patients with ischaemic stroke or TIA, increasing BGPVS burden is associated with more severe CSVD and greater ischaemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH, suggesting that CMBs are a more informative marker for intracranial bleeding risk in this population.

Disclosure: No

O147 / 252

Scientific Communications 17 - Small Vessel Disease

DIFFERENT PATTERN OF SMALL VESSEL DYSFUNCTION ON 7T MRI IN SPORADIC CEREBRAL SMALL VESSEL DISEASE COMPARED WITH CADASIL - THE ZOOM@SVDS STUDY

H. van den Brink ¹, S. Pham¹, T. Arts¹, A. Kopczak², L. Onkenhout¹, J. Siero^1,3, J. Zwanenburg¹, M. Duering^2,4, J. Hendrikse¹, M. Dichgans^2,5,6, G.J. Biessels¹, on behalf of the SVDs@target group

¹UMC Utrecht, Utrecht, Netherlands, ²LMU Munich, Munich, Germany, ³Spinoza Centre for Neuroimaging Amsterdam, Amsterdam, Netherlands, ⁴University of Basel, Basel, Switzerland, ⁵Munich Cluster for Systems Neurology, Munich, Germany, ⁶German Center for Neurodegenerative Disease, Munich, Germany

Background and aims: In patients with CADASIL, we recently showed abnormalities in cerebral small vessel function with 7T MRI, differentially affecting white and grey matter small vessel populations. Here we determine if patients with sporadic small vessel disease (SVD) present with similar patterns of functional small vessel abnormalities.

Methods: 46 sporadic SVD patients (age mean±sd 65±9) and 22 matched controls (63±7) and 23 CADASIL patients (51±10) and 13 matched controls (46±13) participated in the ZOOM@SVDs study. Small vessel measures on 7T MRI included basal ganglia and centrum semiovale perforating artery blood flow velocity and pulsatility, and vascular reactivity in the visual cortex after visual stimulation by estimating the hemodynamic response function (HRF).

Results: Compared with controls, sporadic SVD patients had similar blood flow velocity (mean difference -0.14cm/s, p=.55), but increased pulsatility (mean difference 0.09, p=.01) in basal ganglia perforating arteries, but no abnormalities in centrum semiovale perforating arteries (Table). The HRF to visual stimulation in the visual cortex had a shorter full-width-at-half-maximum in sporadic SVD compared to controls (mean difference 0.62s, p=.003), while amplitude, onset-time and time-to-peak were similar (Table,Figure). In CADASIL, perforating artery flow velocity was more affected than in sporadic SVD, and reactivity to a visual stimulus was altered differently (Table).

Conclusions: Blood flow pulsatility in perforating arteries in the basal ganglia and vascular reactivity in the visual cortex were abnormal in sporadic SVD versus controls. Compared with CADASIL, small vessel function was generally less affected in sporadic SVD with different temporal dynamics in vascular reactivity.

Disclosure: No

O148 / 571

Scientific Communications 17 - Small Vessel Disease

IRON DEPOSITS AND REACTIVE ASTROCYTES COLOCALIZE IN CORTICAL TISSUE WITH CORTICAL SUPERFICIAL SIDEROSIS IN CEREBRAL AMYLOID ANGIOPATHY

C. Auger ¹, M. Kozberg^1,2, V. Perosa^2,3, S. van Veluw^1,2

¹Massachusetts General Hospital, MassGeneral Institute for Neurodegenerative Disease, Charlestown, United States, ²Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston, United States, ³Otto-von-Guericke University, Department of Neurology, Magdeburg, Germany

Background and aims: Cortical superficial siderosis (cSS) has emerged as one of the most important predictors of subsequent symptomatic intracerebral hemorrhage in cerebral amyloid angiopathy (CAA). We hypothesize that this association could be driven by local inflammation. Accordingly, we assessed the distribution of inflammatory markers in relation to cortical iron deposits in post-mortem tissue of CAA cases.

Methods: Serial sections from each lobe of nineteen autopsy cases with CAA were stained with Perls’ Prussian blue (iron) and underwent immunohistochemistry against GFAP (reactive astrocytes). Adjacent sections in select cases underwent double staining for both markers. Sections were digitized and uploaded to the cloud-based Aiforia^TM program, where deep-learning algorithms were utilized to detect tissue, iron, and GFAP-positive cells. In MATLAB, serial sections were coregistered, and local densities of iron deposits and GFAP-positive cells were calculated within 500μm*500μm squares of cortex and within 1000μm-thick consecutive layers in sections with squares of iron density above a predefined threshold.

Results: Within the 500μm*500μm squares, the density of iron deposits was positively correlated with the density of reactive astrocytes (p<0.001, Skillings-Mack test). Both densities were highest in the outermost 1000μm layer and descended inward (p<0.001, Friedman test). Iron deposits were seen within reactive astrocytes on double stains.

Conclusions: Iron deposition resulting from cSS is associated with local inflammation in the form of reactive astrocytes, which may play an important role in secondary tissue injury. Ongoing work focuses on examining the spatial extent of the inflammatory response surrounding iron deposits and assessing similar relationships between iron and activated microglia.

Disclosure: No

O149 / 433

Scientific Communications 18 - Imaging

EARLY POST-THROMBECTOMY CONTRAST EXTRAVASATION ON DUAL-ENERGY CT IS PREDICTIVE OF STROKE OUTCOMES AND COMPLICATIONS: A TEN-YEAR SINGLE-CENTRE EXPERIENCE

F.M.E. Pinckaers ^1,2,3, M.M.G. Mentink¹, H.D. Boogaarts⁴, W.H. van Zwam^1,3, R.J. van Oostenbrugge^2,3, A.A. Postma¹

¹MUMC+, Department of Radiology and Nuclear Medicine, Maastricht, Netherlands, ²MUMC+, Department of Neurology, Maastricht, Netherlands, ³Maastricht University, CARIM, Maastricht, Netherlands, ⁴Radboud UMC, Department of Neurosurgery, Nijmegen, Netherlands

Aims: To determine the relevance of early post-thrombectomy contrast extravasation (CE) on dual-energy CT (DECT) in the prediction of stroke outcomes and complications.

Methods: We analysed 385 patients with DECT within 3h post-thrombectomy (2010-2019). Hyperdense areas on iodine-overlay maps were scored according to the 10 regions of the ASPECTS, thus forming a CE-ASPECTS (a lower score indicates more affected areas). Maximum parenchymal iodine concentration and iodine concentration relative to the torcula were recorded. Follow-up imaging was reviewed for intracerebral haemorrhage (ICH). Clinical data were gathered from prospective records.

Results: CE was found in 303 patients (79%). 31/385 patients (8%) developed ICH. 13 ICHs were symptomatic. Stroke progression occurred in 59/385 patients (15%). Multivariable regression showed a significant association between decreasing CE-ASPECTS and NIHSS at 24-48h (adjusted(a)β: 0.61, 95%CI: 0.33-0.89), mRS at 90 days (acOR: 1.10, 95%CI: 1.02-1.18; Figure 1), stroke progression (aOR: 1.16, 95%CI: 1.04-1.28), and ICH (aOR: 1.18, 95%CI: 1.02-1.36), but not with symptomatic ICH (aOR 1.23, 95%CI: 0.97-1.43). Iodine concentration was significantly associated with NIHSS at 24-48h (aβ: 0.61, 95%CI: 0.21-1.01), mRS at 90 days (acOR: 1.19, 95%CI: 1.06-1.32), ICH (aOR: 1.45, 95%CI: 1.00-2.10), and symptomatic ICH (aOR: 1.23, 95%CI: 1.05-1.43), but not with stroke progression (aOR 1.00, 95%CI: 0.87-1.16). Results of the analyses with relative iodine concentration were similar to those of the absolute analyses, and did not seem to improve overall prediction.

Conclusions: CE-ASPECTS and iodine concentration are both predictive of short- and long term neurological outcomes. CE-ASPECTS is likely a better predictor for stroke progression.

Disclosure: No

O150 / 316

Scientific Communications 18 - Imaging

REVERSIBILITY OF DIFFUSION WEIGHTED IMAGING LESIONS IN ISCHEMIC STROKE PATIENTS IN THE WAKE-UP TRIAL

L. Scheldeman ¹, A. Wouters², J. Bertels³, P. Dupont⁴, F. Boutitie⁵, B. Cheng⁶, M. Ebinger⁷, M. Endres⁷, J. Fiebach⁷, C. Gerloff⁶, K. Muir⁸, N. Nighoghossian⁹, S. Pedraza¹⁰, C. Simonsen¹¹, V. Thijs¹², G. Thomalla⁶, R. Lemmens¹

¹University Hospitals Leuven, Neurology, Leuven, Belgium, ²Amsterdam University Medical Centers, Neurology, Amsterdam, Netherlands, ³KU Leuven, Elektrotechniek (ESAT), Leuven, Belgium, ⁴KU Leuven, Neurosciences, Leuven, Belgium, ⁵Hospices Civils de Lyon, Biostatistique, Lyon, France, ⁶University Medical Center Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Hamburg, Germany, ⁷Universitätsmedizin Berlin, Center for Stroke Research Berlin (CSB), Charité, Berlin, Germany, ⁸University of Glasgow, Institute of Neuroscience & Psychology, Glasgow, United Kingdom, ⁹Hospices Civils de Lyon, Department of Stroke Medicine, Lyon, France, ¹⁰Hospital Dr Josep Trueta, Radiology, Girona, Spain, ¹¹Aarhus University Hospital, Department of Neurology, Aarhus, Denmark, ¹²University of Melbourne, Stroke Theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia

Background and aims: Reversibility of the baseline diffusion-weighted imaging (DWI) lesion implies that not all of the DWI lesion represents permanently injured tissue. We investigated DWI lesion reversibility (DWIR) and association with thrombolysis in patients from the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial.

Methods: A convolutional neural network segmented the DWI lesions (b=1000 s/mm²) at baseline and follow-up (24h). We calculated absolute and relative DWIR in a volumetric (baseline volume - 24h volume > 0) and voxelbased (part of baseline lesion not overlapping with 24h lesion) approach and its association with thrombolysis.

Results: Median DWI volume at baseline and follow-up was 3 (1-10) and 6 (2-20) ml respectively (n=363). Volumetric DWIR was present in 69/363 (19%) with a median absolute and relative reversible volume of 1 ml (0-2) and 29% (14-54). Voxelbased DWIR was present in 358/363 (99%) with a median absolute and relative reversible volume of 1 ml (0-2) and 22% (9-38). Relative voxelbased DWIR was >50% of the baseline lesion in 72/363 (20%). Complete resolution of the baseline lesion was present in 10 (3%) subjects (3 placebo, 7 alteplase). Volumetric DWIR and relative voxelbased DWIR >50% was more frequent in patients treated with alteplase vs placebo (42/176 vs 27/187, OR 1.86, 95%CI 1.09-3.17 and 42/176 vs 25/187, OR 2.03, 95%CI 1.18-3.50).

Conclusions: DWIR was present in a large proportion of randomized patients in the WAKE-UP trial and was more often seen after thrombolysis, although absolute reversible volumes were small.

Disclosure: No

O151 / 557

Scientific Communications 18 - Imaging

SEX-SPECIFIC RELEVANCE OF LESIONS IN RICH CLUB REGIONS FOR FUNCTIONAL OUTCOMES POST-STROKE

A.K. Bonkhoff ¹, M. Schirmer¹, S. Hong¹, M. Bretzner¹, C. Jern², A. Lindgren³, J. Maguire⁴, O. Wu⁵, N. Rost¹, on behalf of the MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium

¹Massachusetts General Hospital/Harvard Medical School, Department of Neurology, Boston, United States, ²University of Gothenburg, Gothenburg, Sweden, ³Lund University, Lund, Sweden, ⁴University of Technology Sydney, Sydney, Australia, ⁵Massachusetts General Hospital/Harvard Medical School, Boston, United States

Background and aims: Lesions in so-called rich club regions have been shown to be linked to a higher symptom load and worse outcomes post-stroke. We here aimed to determine whether the relevance of rich club regions in explaining unfavorable long-term outcomes was sex-specific.

Methods: We relied on acute DWI-derived stroke lesion data and 3-months modified Rankin Scale (mRS) scores from acute ischemic stroke patients enrolled in the multisite MRI-GENIE study. Spatially normalized lesions were parcellated into 108 Harvard-Oxford atlas-defined bilateral cortical and subcortical brain regions. Bayesian logistic regression was employed to model unfavorable outcomes (mRS>2) once across men and women and in sex-specific ways. Effects of individual brain regions were captured as two compound effects for (i) six bilateral rich club regions (Figure 1) and (ii) the rest of bilateral non-rich club regions. In sex-specific analyses, we compared male- and female-specific rich club region effects by integrating an additional hierarchical level in our model structure.

Results: A total of 822 patients were analyzed (age: 64.7(15.0), 39%women, 28% unfavorable outcomes). Rich club regions had a substantial relevance in explaining unfavorable functional outcomes across both men and women (area under the curve: 0.8). Rich club regions were substantially more important in explaining long-term outcomes in women than in men.

Conclusions: Rich club region effects were substantially more pronounced in women compared to men. Our findings motivate further research into the origins of this female-specific effect and elicit the hypothesis that similar female-specific rich club effects may be found for further neuropsychiatric diseases.

Disclosure: No

O152 / 312

Scientific Communications 18 - Imaging

RADIOMICS DERIVED BRAIN AGE PREDICTS FUNCTIONAL OUTCOME AFTER ACUTE ISCHEMIC STROKE

M. Bretzner ^1,2, A. Bonkhoff¹, M. Schirmer¹, S. Hong¹, A. Dalca^1,3, K. Donahue¹, A.-K. Giese¹, M. Etherton¹, P. Rist^1,4, M. Nardin¹, R. Regenhardt¹, X. Leclerc², R. Lopes^2,5, M. Gautherot^2,5, C. Wang^1,3, P. Golland³, G. Kuchcinski², N. Rost¹, on behalf of the MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium

¹Mass General Brigham, Harvard Medical School, Neurology, Boston, United States, ²Université de Lille, Inserm, CHU Lille, U 1172 - LilNCog (JPARC) - Lille Neurosciences & Cognition, Lille, France, ³Massachusetts Institute of Technology, Computer Science and Artificial Intelligence Lab, Cambridge, United States, ⁴Brigham and Women’s Hospital, Division of Preventive Medicine, Department of Medicine, Boston, United States, ⁵CNRS, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France

Background and aims: While chronological age is one of the most influential determinants of post-stroke outcomes, little is known of the impact of neuroimaging-derived biological “brain age”. We hypothesized that T2-FLAIR radiomics will provide brain age estimate, and that advanced brain age of stroke patients will be associated with cardiovascular risk factors and worse functional outcomes.

Methods: We extracted radiomics from T2-FLAIR images acquired during acute stroke clinical evaluation. Brain age was determined from brain parenchyma radiomics using an ElasticNet linear regression model. Subsequently, relative brain age (RBA), which expresses brain age in comparison to chronological age-matched peers, was estimated. Finally, we built a linear regression model of RBA using clinical cardiovascular characteristics as inputs, and a logistic regression model of favorable functional outcome taking RBA as input.

Results: We reviewed 4,163 patients from a large multisite ischemic stroke cohort (mean age=62.8 years, 42.0% females). T2-FLAIR radiomics predicted chronological ages (mean absolute error=6.9 years, r=0.81). After adjustment for covariates, RBA was higher, and therefore described older-appearing brains, in patients with hypertension, diabetes mellitus, history of smoking, and a history of a prior stroke. In multivariate analyses, age, RBA, NIHSS, and a history of prior stroke were all significantly associated with functional outcome (respective adjusted Odds-Ratios: 0.58, 0.76, 0.48, 0.55; all p-values<0.001).

Conclusions: T2-FLAIR radiomics can be used to predict brain age and derive RBA. Older appearing brains, characterized by a higher RBA, reflect cardiovascular risk factor accumulation and are linked to worse outcomes after stroke.

Multivariate regression of the clinical predictors of Relative Brain Age (n=4163)
	Coefficient	95% CI		p-value
		Lower	Upper
Hypertension	0.5615	0.085	1.038	0.021
Diabetes mellitus	0.9098	0.318	1.502	0.003
Atrial Fibrillation	0.4911	-0.133	1.115	0.123
Coronary artery disease	0.1824	-0.387	0.752	0.53
History of Smoking	0.5367	0.07	1.003	0.024
Prior Stroke	3.2134	2.566	3.861	<0.001

Logistic regression of predictors of good functional outcome (n=1871)
	Unstandardized aOR			Standardized aOR
	aOR	95% CI for aOR		aOR	95% CI for aOR		p-value
		Lower	Upper		Lower	Upper
Age	0.96	0.95	0.97	0.58	0.51	0.65	<0.001
NIHSS	0.87	0.85	0.89	0.48	0.43	0.54	<0.001
Prior stroke	0.55	0.41	0.74	0.55	0.41	0.74	<0.001
Relative Brain Age	0.96	0.95	0.98	0.76	0.68	0.86	<0.001

Disclosure: Yes

O153 / 669

Scientific Communications 18 - Imaging

CORTICAL THICKNESS ALTERATIONS ACCOMPANYING METABOLIC SYNDROME PREDICT COGNITIVE FUNCTION

M. Petersen ¹, C. Mayer¹, F.L. Naegele¹, M. Schell¹, C. Gerloff¹, G. Thomalla¹, B. Cheng¹

¹ University Medical Center Hamburg-Eppendorf, Neurology, Hamburg, Germany

Background and aims: Diabetes mellitus, hypertension and obesity are important modifiable cerebrovascular risk factors present in metabolic syndrome (METS) and associated with cognitive decline and dementia. To elucidate the relationship between METS and neurodegeneration and cognitive functions, a structural neuroimaging analysis was performed in a cross-sectional, large-scale population-based cohort.

Methods: MRI data of participants from the Hamburg City Health Study with METS (n=1002) and a matched healthy sample (n=1002) were analysed. Cortical thickness was quantified and averaged across regions of interest (ROIs) defined by the Desikan-Kiliany atlas. Demographic information and risk factors, cognitive and cortical thickness measures were statistically compared between groups. Cortical thickness of ROIs significantly differing between groups served as input for the prediction of cognitive scores using ElasticNet Regression in a 10-fold nested cross-validation setup. Estimations were permuted to assess whether prediction performance significantly differed from chance.

Results: Individuals with METS showed significantly increased cerebrovascular risk factors except for cholesterol levels. Cognitive test performances for the TMT-B, Animal Naming and Word List Recall Test were worse in METS. A differential pattern of lower cortical thickness especially including temporal, parietal and frontal cortical areas accompanied METS (Figure 1). The predictive model successfully achieved above-chance performance for all cognitive scores but the Vocabulary-B-Test (Figure 2).

Conclusion: In our population-based cohort, METS was associated with widespread cortical thickness alterations and reduced performance in multiple cognitive domains. Our findings support the notion of METS as a contributor to neurodegeneration and cognitive impairment.

Table 1

	Controls, median [IQR]	METS, median [IQR]	Statistic (t/χ2)	PBonferroni
	n=1008	n=1002
Age, years	66 [59-71]	67 [61-72]	-2.77	0.112
Sex, % of women	40.2	33.9	8.40	0.075
Years of Education, years	13 [12-16]	13 [12-16]	2.63	0.173
Sys. Blood Pressure, mmHg	137 [126-152]	143.5 [133.5-156]	-6.84	<0.005*
Cholesterol, mg/dL	210 [185 - 235]	202 [169-233]	4.62	<0.005*
LDL, mg/dL	123 [101-146]	116 [86-142]	4.79	<0.005*
Waist-hip-ratio	0.925 [0.87 - 0.97]	0.985 [0.93-1.04]	-16.57	<0.005*
Diabetes mellitus, %	15.9	20.6	180.55	<0.005*
BMI	24.6 [22.6 - 26.9]	28.0 [26.0-30.1]	-21.58	<0.005*
Normalized Brain Volume	1.292 [1.248 - 1.329]	1.283 [1.24-1.32]	3.28	0.021*
TMT-A, seconds	37 [20-46]	39 [31-49]	-2.36	0.368
TMT-B, seconds	81 [64-105]	86 [67-113]	-4.09	<0.005*
Animal Naming Test, n	24 [20-29]	24 [19-28]	3.07	0.043*
Vocabulary B Test, n	32 [30-34]	32 [30-34]	1.55	1
Word List Recall Test, n	8 [7-9]	8 [6-9]	3.67	0.005*
Mini Mental State Exam	28 [27-29]	28 [27-29]	0.36	1

Figure 1 Figure 2

Disclosure: No

O154 / 664

Scientific Communications 18 - Imaging

PREDICTION OF COGNITIVE RECOVERY AFTER STROKE (PROCRAS): THE VALUE OF DIFFUSION-WEIGHTED IMAGING BASED MEASURES OF BRAIN CONNECTIVITY

H.P. Aben ¹, L. de Munter², Y.D Reijmer³, J.M Spikman⁴, J.MA Visser-Meily⁵, G.J. Biessels³, P.LM de Kort¹

¹Elisabeth Tweesteden Hospital Tilburg, Neurology, Tilburg, Netherlands, ²Elisabeth Tweesteden Hospital Tilburg, Trauma TopCare, Tilburg, Netherlands, ³UMC Utrecht Brain Center, Neurology, Utrecht, Netherlands, ⁴University Medical Center Groningen, Clinical Neuropsychology, Groningen, Netherlands, ⁵UMC Utrecht Brain Center, Rehabilitation, Physical Therapy Science & Sports, Utrecht, Netherlands

Background and aims: Prediction of long-term recovery of a post-stroke cognitive disorder (PSCD) is currently inaccurate. We assessed whether diffusion-weighted imaging (DWI) based measures of brain connectivity predict cognitive recovery one year after stroke in patients with PSCD in addition to conventional clinical, neuropsychological, and imaging variables (figure1).

Methods: This prospective mono-center cohort study included 217 consecutive patients with a clinical diagnosis of ischemic stroke, aged⩾50, and Montreal Cognitive Assessment score below 26 during hospitalization. Five weeks after stroke, patients underwent DWI-MRI. Neuropsychological assessment was performed five weeks and one year after stroke, and was used to classify PSCD as absent, modest or marked. Cognitive recovery was operationalized as a shift to a better PSCD category over time. Conventional predictors were demographic characteristics, clinical stroke characteristics, neuropsychological variables and MRI findings (e.g. infarct size). DWI based measures of brain connectivity were mean diffusivity and fractional anisotropy weighted global network efficiency and mean connectivity strength, and were added to a multivariable model to assess additive predictive value.

Results: Of 135 patients (mean age=71 years, 95 men[70%]) with PSCD 5 weeks after ischemic stroke, 41(30%) showed cognitive recovery. 3/4 brain connectivity measures met the pre-defined threshold of P<0.1 in univariable regression analysis. There was no added value of these measures to a multivariable model that included level of education and infarct size as significant predictors of cognitive recovery.

Conclusions: DWI based measures of brain connectivity appear to predict recovery of PSCD, but at present have no added value over conventional predictors.

Disclosure: No

O155 / 270

Scientific Communications 18 - Imaging

IMPAIRMENT OF GLYMPHATIC FUNCTION OF MRI-VISIBLE PERIVASCULAR SPACES IN AGING HUMANS

K. Zhang ¹, Y. Zhou¹, X. Zhang¹, W. Zhang², M. Lou¹

¹Second Affiliated Hospital of Zhejiang University, School of Medicine, Department of Neurology, Hangzhou, China, ²Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China

Objectives: We aimed to evaluate the glymphatic function in MRI-visible perivascular spaces (PVS) in humans, and explore its association with aging, vascular risk factors and cognitive function.

Methods: Patients with indications for lumbar puncture were prospectively enrolled from 2018 to 2021. All patients underwent cognitive assessment and MRI scanning, including T2WI and T2-FLAIR, and 3D-T1 at baseline, 4.5 hours, 15 hours, and 39 hours after intrathecal gadodiamide administration. PVS in the basal ganglia (BG-PVS) and centrum semiovale (CSO-PVS) were evaluated on T2WI, and the mean signal unit ratio (SUR) of PVS were recorded on 3D-T1 at all time points. We defined the glymphatic influx and efflux function as the percentage change of SUR from baseline to 15 hours and 39 hours, respectively.

Results: Finally, 78 patients (mean age = 59.0 ± 1.5 years) were included. After intrathecal administration, signal intensity in both BG-PVS and CSO-PVS changed over time, and different individual PVS had different peak time points of signal intensity in the same patient. Age was negatively related with glymphatic efflux function in CSO-PVS (OR = 1.067, 95% CI: 1.004, 1.135). Patients with history of diabetes showed poorer glymphatic influx function in BG-PVS (OR = 5.726, 95% CI: 1.480, 22.161). The ability of attention and calculation was positively related with glymphatic influx function in BG-PVS (β = 0.343, p = 0.047).

Conclusion: We provide a novel method to assess the glymphatic function of PVS, finding its association with aging, diabetes and cognitive function.

Disclosure: No

O156 / 933

Scientific Communications 18 - Imaging

IMPACT OF CEREBRAL MICROBLEEDS IN STROKE PATIENTS WITH ATRIAL FIBRILLATION TAKING ANTITHROMBOTICS: A SUB-ANALYSIS FROM THE MICROBLEEDS INTERNATIONAL COLLABORATIVE NETWORK (MICON)

Y. Soo ¹, A. Zietz², B. Yiu¹, V. Mok¹, T. Leung¹, W. Chu³, J. Abrigo³, A. Polymeris², D. Seiffge⁴, P. Lyrer², J. Best⁵, D. Werring⁵, S. Engelter², N. Peters², on behalf of the MICON collaborators

¹The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong, SAR of China, ²University Hospital Basel, University of Basel, Department of Neurology and Stroke Centre, Basel, Switzerland, ³The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, Hong Kong, SAR of China, ⁴University of Basel and University of Bern, Department of Neurology and Stroke Centre, Basel, Switzerland, ⁵UCL Queen Square Institute of Neurology, Department of Brain Repair and Rehabilitation, London, United Kingdom

Background and aims: Cerebral microbleeds (CMB) are associated with increased risk of stroke. We aimed to evaluate the risk of intracerebral haemorrhage (ICH) and ischaemic stroke (IS) in patients with atrial fibrillation (AF) and CMB receiving different antithrombotics.

Methods: We performed a sub-analysis of patients from the MICON pooled individual patient data cohort. The association of CMB burden (0, 1, 2-4, 5-10 and ⩾11 CMB) with risks of subsequent ICH and IS in AF patients receiving different antithrombotics were analyzed with multivariable Cox regression.

Results: Among the 7379 patients with AF, 3244 patients received a Vitamin K antagonist (VKA), 1981 a direct oral anticoagulant, 626 an antiplatelet and 1528 a combination of anticoagulant plus antiplatelet (combination therapy). The incidences for both ICH and IS were higher in patients with CMB. The absolute incidence of IS was higher than ICH for most patients, except for the following treatment groups: (i) VKA with 5-10 CMB (25 per 1000 patient-years for ICH vs 23 per 1000 patient-years for IS); (ii) combination therapy with 2-4 CMB (25 per 1000 patient-years for ICH vs 12 per 1000 patient-years for IS); and (iii) combination therapy with ⩾11 CMB (94 per 1000 patient-years for ICH vs 48 per 1000 patient-years for IS).

Conclusions: For patients with AF and high burden of CMB receiving VKA or combination therapy were associated with increased risk of ICH, which approximated that of IS. Further studies are needed to optimize stroke preventive strategies to lower the intracranial bleeding risk in these patients.

Disclosure: No

O157 / 534

Scientific Communications 19 - Experimental / Translational Medicine

PLATELETS REGULATE THE EARLY LOCAL VASCULAR RECRUITMENT OF INFILTRATING NEUTROPHILS DURING MIDDLE CEREBRAL ARTERY OCCLUSION BEFORE RECANALIZATION

M. Bieber ¹, M.K. Schuhmann¹, B. Nieswandt^2,3, M. Pham⁴, G. Stoll¹

¹University Hospital Würzburg, Department of Neurology, Würzburg, Germany, ²University of Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany, ³University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany, ⁴University Hospital Würzburg, Department of Neuroradiology, Würzburg, Germany

Background and aims: In acute ischemic stroke upon a large vessel occlusion (LVO), infarcts rapidly grow from the core into the penumbra before recanalization. We have previously shown that progressive brain infarction during primary occlusion can be delayed by blocking detrimental glycoprotein (GP) receptor Ib-mediated platelet responses. However, the detailed underlying mechanism is still incompletely understood.

Methods: Focal cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) with occlusion times up to 4 hours in young C57Bl/6 mice. Local inflammatory response was compared between control-treated mice and mice in which platelet tethering to the vessel wall by GPIb is blocked. Moreover, Rag1^-/- mice lacking T- and B-cells underwent the same procedures.

Results: Blocking of platelet GPIb reduced Ly6G⁺ neutrophil infiltration into the ischemic core as well as in the penumbral tissue. Moreover 20-25% of neutrophils in control-treated mice were associated with platelets and inhibition of GPIb significantly mitigated the occurrence of platelet-neutrophil complexes, especially in the penumbra. Accordingly, Rag1^-/- mice showed similar results during MCAO as seen with GPIb blockade.

Conclusions: As a principal finding, we show that blocking platelet adhesion or the lack of T cells are important for local vascular neutrophil recruitment. Our data underline the detrimental role of thrombo-inflammation as a driving force of stroke progression into the penumbra under MCA occlusion in mice. These findings suggest that the interplay between platelets and T-cells regulate the early infiltration of neutrophils at the hyper-acute stroke stage under vessel occlusion.

Disclosure: No

O158 / 649

Scientific Communications 19 - Experimental / Translational Medicine

A NOVEL SEVERE CEREBRAL VENOUS THROMBOSIS RAT MODEL BASED ON SEMI-LIGATION COMBINED WITH FERRIC CHLORIDE AND THROMBIN

J. Duan ¹, L. Xiao^1,2, S. Hu¹, X. Ji³

¹Xuanwu Hospital, Capital Medical University, Department of Emergency and Neurology, Beijing, China, ²The People’s Hospital of Qingxian, Department of Neurology, Hebei, China, ³Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China

Background and aims: An applicable cerebral venous sinus thrombosis (CVST) model is imperative for exploring the pathogenesis and pathophysiology of severe CVST, which remains unclear. We established a novel severe CVST model through semi-ligation combined with ferric chloride and thrombin.

Methods: A total of 110 male Sprague-Dawley rats (280-300g) were randomly divided into 2 groups: semi-ligation (n=60) and non-semi-ligation (n=50). Sham group (n=40) was added in this study. A laser speckle meter was used to determine the success of semi-ligation and thrombotic induction. We respectively compared neurological dysfunction, thrombus load, venous infarction volume, blood-brain barrier (BBB) permeability, brain water content, and microglia immunofluorescence staining in brain tissue among the three groups.

Results: The results showed that thrombi involving multiple venous sinuses appeared in all rats on day 1 after surgery in the semi-ligation group rather than non-semi-ligation group. Compared with non-semi-ligation group, the neurological dysfunction was more severe (P<0.01), and thrombus weight, venous infarction volumes, and microglia activation at different time-points were greater (P<0.05), and BBB permeability, brain water content on post-modeling day 2 were significantly higher (P<0.05) in the semi-ligation group.

Conclusions: Semi-ligation combined with ferric chloride and thrombin can produce a severe and stable CVST model with multiple venous sinuses involvement.

Disclosure: No

O159 / 1105

Scientific Communications 19 - Experimental / Translational Medicine

NEUTROPHIL EXTRACELLULAR TRAPS IN CEREBRAL ISCHEMIA AND REPERFUSION INJURY IN ISCHEMIC STROKE

M. De Wilde ¹, S. Staessens¹, L. Desender¹, C. Tersteeg¹, K. Vanhoorelbeke², S.F De Meyer¹

¹KU Leuven Kulak, Cardiovascular Sciences, Kortrijk, Belgium, ²KU Leuven Kulak, Chemistry, Kortrijk, Belgium

Background and aims: Thromboinflammatory processes are involved in cerebral ischemia/reperfusion injury, likely with neutrophil extracellular traps (NETs) as a mediator. In addition, the link between von Willebrand factor (VWF) and neutrophil recruitment in the ischemic brain might play a role in thromboinflammation, possibly by the formation of NETs. Therefore, our aim was to investigate the involvement of NETs in cerebral ischemia/reperfusion injury and to explore the potential regulation of NETosis by VWF and the VWF-cleaving protease ADAMTS13 in cerebral ischemia/reperfusion injury.

Methods: The filament-induced transient middle cerebral artery occlusion model was used to induce 60minutes focal cerebral ischemia in wild-type (WT) and littermate Vwf-knockout (KO) and Adamts13-KO mice after which reperfusion was allowed. At different timepoints post-ischemia, NETs (Ly6G,H3Cit,DNA) were identified in the mouse brains using quantitative immunofluorescence microscopy.

Results: NETs could be identified in the ipsilateral brain hemisphere. Interestingly, quantification of NETs at different timepoints, revealed that NETs start to appear around 6hours, peak around 24hours and start to disappear again 48hours post-ischemia. Remarkably, NETs were predominantly localized within the brain vasculature, suggesting that NETs might play a role in secondary microthrombosis. Strikingly, NET formation was significantly decreased in Vwf-KO mice and significantly increased in Adamts13-KO mice compared to littermate WT mice 24hours post-ischemia.

Conclusions: Our results put forward NETs as a thromboinflammatory mediator and indicate a role for VWF in promoting NETosis in the ischemic brain. Taken together, better understanding of thromboinflammatory processes leading to cerebral ischemia/reperfusion injury could serve as a basis for the development of novel treatment strategies.

Disclosure: No

O160 / 1083

Scientific Communications 19 - Experimental / Translational Medicine

HUMAN ESC-DERIVED IMMUNITY- AND- MATRIX REGULATORY CELLS AMELIORATED VASCULAR COGNITIVE IMPAIRMENT IN RATS SUBJECTED TO CHRONIC CEREBRAL HYPOPERFUSION

Y. Zhao ¹, Y. Wang²

¹Beijing Tiantan Hospital, Beijing, China, ²Beijing Tiantan Hospital, BeiJing, China

Background and aims: This study investigated the ability of immunity- and- matrix regulatory cells (IMRCs) to improve cognitive function in a rat model of vascular cognitive impairment.

Methods: A chronic cerebral hypoperfusion (CCH) model was established in rats via permanent bilateral occlusion of the common carotid arteries (two-vessel occlusion, 2VO). The rats then received intravenous injections of IMRCs or saline. A single injection of different doses of IMRCs (1×10⁶ cells/rat, 2×10⁶ cells/rat, or 4×10⁶ cells/rat) was administered via tail vein 72 h after establishment of the model. To evaluate functional recovery, the rats were subjected to behavioral tests after 30 days of CCH. Imaging, western blotting, immunofluorescence staining, and quantitative real-time PCR were used to analyze neuroinflammation and white matter injury after 14 and 40 days of CCH. RNA sequencing (RNA-seq) was used to profile gene expression changes in copine 1 (CPNE1) in response to IMRCs treatment.

Results: Intravenous injection of 4×10⁶IMRCs alleviated white matter damage and ameliorated cognitive deficits in rats subjected to CCH. Immunofluorescence staining suggested that activation of microglia and astrocytes was reduced, and RNA sequencing showed that CPNE1 expression was significantly elevated following treatment with IMRCs.

Conclusions: Intravenous injection of IMRCs protected against CCH-induced white matter injury and cognitive impairment through polarization of microglia and astrocytes.

Disclosure: No

O161 / 1155

Scientific Communications 19 - Experimental / Translational Medicine

DYNAMIC PROGRESSION OF NEURO-INFLAMMATION IN A NON-HUMAN PRIMATE MODEL OF STROKE

G. Becker ¹, J. Debatisse¹, M. Rivière¹, C. Crola Da Silva¹, M. Beaudoin-Gobert², O. Eker^3,4, T.H. Cho^1,4, C. Bonaz³, O. Wateau⁵, M. Wiart¹, N. Costes⁶, I. Mérida⁶, C. Léon¹, J.-B. Langlois⁶, D. Le Bars^4,6, S. Lancelot^4,6, F. Lux⁷, N. Nighoghossian^4,1, L. Mechtouff^4,1, E. Canet-Soulas¹

¹University Claude Bernard Lyon 1, CarMeN Laboratory, Lyon, France, ²University Claude Bernard Lyon 1, Cognitive Neuroscience Center, Lyon, France, ³University Claude Bernard Lyon 1, CREATIS, Lyon, France, ⁴Hospices Civils de Lyon, Lyon, France, ⁵Cynbiose, Lyon, France, ⁶CERMEP - Imagerie du vivant, Lyon, France, ⁷University Claude Bernard Lyon 1, Institut Lumière Matière, Lyon, France

Background and aims: Stroke triggers neuroinflammation that is considered as a global and long-lasting phenomenon. We evaluated neuroinflammation in a preclinical non-human primate (NHP) stroke model mimicking mechanical thrombectomy using simultaneous PET/MR imaging.

Methods: Endovascular 110-minutes middle cerebral artery occlusion was induced in mature male Fascicularis Macaca. We used the 11C-PK1195 radiotracer and PET/MR imaging to assess microglial activation. Imaging sessions were performed before intervention and after 7 and 30 days. Data were analyzed in atlas-based ROI as well as in tissue compartments defined on the FLAIR MRI. A baseline scans database was developed for individual voxel-based analyses at day 7 and day 30.

Results: Illustrative maps of 11C-PK11195 binding show a clear microglial activation in the vicinity of the infarct core ipsilateral to the lesion side at day 7. The inflammatory process also involved the contralateral hemisphere, and extended to the global brain (Figure 1). 11C-PK11195 binding was clearly increased in the thalamic region at day 7 compared to baseline, although this region was not affected by ischemic lesion. Day 30 voxel-wise comparison revealed clusters of voxels statistically different from the baseline lying in the region of FLAIR MRI hyperintensity (Figure 2).

Conclusions: Our NHP model of stroke reproduced global inflammation observed in patients. This translational pipeline may help to assess further approaches targeting brain inflammation in stroke.

Fig 1.

Illustrative maps of ¹¹C-PK11195 binding at day 7 and day 30.

Fig 2.

Individual voxel-wise analyses of two NHP at day 30.

Acknowledgment

ANR-15-CE17-0020-01

ANR-16-RHUS-0009

Disclosure: No

O162 / 595

Scientific Communications 19 - Experimental / Translational Medicine

CHARACTERISTICS OF THE NO-REFLOW AREA AFTER MECHANICAL RECANALIZATION IN ISCHEMIC STROKE

J. Debatisse¹, O.F. Eker², T.-H. Cho³, C. Bonaz⁴, G. Becker³, O. Wateau⁵, M. Wiart¹, N. Costes⁶, I. Merida⁶, C. Léon¹, J.-B. Langlois⁶, D. Le Bars⁶, S. Lancelot⁶, F. Lux⁷, L. Chalet¹, T. Boutelier⁸, N. Nighoghossian³, L. Mechtouff³, E. Canet Soulas ¹

¹Université Lyon, CarMeN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, Bron, France, ²Hospices Civils de Lyon, Université Lyon, Interventional Neuroradiology, Bron, France, ³Hospices Civils de Lyon, Université Lyon, CarMeN Lab., INSERM, INRAE, Neurology Department, Bron, France, ⁴Hospices Civils de Lyon, Université Lyon, Neuroradiology, Bron, France, ⁵Cynbiose SAS, Lyon, France, ⁶Cermep Imagerie du Vivant, Bron, France, ⁷Université Lyon, Institut Lumière Matière ILM, CNRS, Université Claude Bernard Lyon 1, Villeurbanne, France, ⁸Olea Medical, La Ciotat, France

Background and aims: The participation of the no-reflow phenomenon is still debated in reperfusion damage after revascularization. We evaluated no-reflow in a preclinical non-human primate (NHP) stroke model mimicking endovascular mechanical thrombectomy (MT). We used positron emission tomography-magnetic resonance imaging (PET-MRI) perfusion and PET oxygen metabolism imaging during occlusion and after revascularization.

Methods: Endovascular 110-minutes middle cerebral artery occlusion was induced in mature male fascicularis Macaca. MR angiography confirmed recanalization. PET-MRI imaging included clinical stroke MRI sequences, perfusion PET ([¹⁵O]-water cerebral blood blow, CBF, mL/min/g),perfusion MRI (T_max, sec), [¹⁵O]-oxygen for oxygen consumption (CMRO₂, mL O₂/min/100g) and extraction fraction (OEF, %). Neuroscore was evaluated daily (persistent score>6 was considered as poor outcome). No-reflow was defined as CBF<0.2 mL/min/g.

Results: We observed no-reflow in 57% of NHPs (12/21 on perfusion PET, 35 [30-40] minutes post-revascularization). The no-reflow co-localized with hemorrhage (post-contrast T1 MRI, 57% cases) (Figure 1) and more frequent in poor outcome cases (PO, neuroscore>6 at day 7) (50% in PO and 22% in good outcome (GO) NHPs). The no-reflow area was more ischemic and more metabolically compromised (decreased CMRO₂) in PO compared to GO (Figure 2).

Conclusions: The no-reflow was common and characterized by frequent hemorrhage. Perfusion and metabolic measures may help to predict outcome after MT.

Fig 1.

MRI no-reflow (left) with hemorrhage on post-gadolinium T1 (right).

Fig 2.

Poor outcome (PO) NHPs had more severe ischemic no-reflow with compromised O₂ consumption (CMRO₂ low despite high OEF, arrow) than good outcome (GO).

Acknowledgment:

ANR-15-CE17-0020-01

ANR-16-RHUS-0009

Disclosure: No

O163 / 575

Scientific Communications 19 - Experimental / Translational Medicine

HEAD DOWN TILT 15° INCREASES COLLATERAL BLOOD FLOW IN ACUTE ISCHEMIC STROKE DUE TO LARGE VESSEL OCCLUSION: A PERFUSION MRI STUDY IN RATS

S. Beretta ¹, D. Carone², T.-H. Cho³, M. Viganò¹, S. Diamanti¹, J. Mariani¹, F. Pedrazzini¹, C. Pini¹, R. Bolbos³, M. Wiart³, C. Ferrarese¹, F. Chauveau³

¹University of Milano Bicocca, Department of Medicine and Surgery, Monza, Italy, ²University of Oxford, Radcliffe Department of Medicine, Oxford, United Kingdom, ³Université Claude Bernard Lyon 1, Lyon, France

Cerebral collaterals are recruited after large vessel occlusion (LVO) and highly affect tissue outcome in acute ischemic stroke. We investigated head down tilt 15° (HDT15) as a treatment for increasing collateral blood flow in a rat model of LVO ischemic stroke. Endovascular occlusion of the proximal middle cerebral artery was induced for 90 minutes in Wistar rats (n = 22), followed by reperfusion. Rats were randomly assigned to HDT15 or flat position for 60 minutes, starting 30 minutes after arterial occlusion. Brain MRI sequences including MRI angiography, dynamic susceptibility contrast perfusion imaging, apparent diffusion coefficient and T2 structural imaging were acquired before treatment, 60 minutes after treatment and 24 hours after reperfusion. The primary outcome was change in cerebral perfusion in the ischemic hemisphere after treatment. Secondary outcomes were hemodynamic rescue of severely ischemic tissue with relative cerebral blood flow < 40% and infarct growth in the first 24 hours. Application of HDT15 improved cerebral perfusion, decreasing time-to-peak (TTP) values in the ischemic hemisphere (-26.25% versus -2.87%, p = 0.034), and was associated with a smaller infarct growth (45 mm3 versus 158 mm3; p = 0.035), compared to flat position. The median volume of severely ischemic tissue rescued by HDT15 was 16% (interquartile range -5% to 39%; p = 0.038). Our findings suggest that HDT15 acutely increases collateral blood flow in acute ischemic stroke due to LVO and provides a tissue-saving effect. Further research is needed to develop HDT15 as a pre-hospital emergency therapy for acute ischemic stroke.

Disclosure: No

O164 / 175

Scientific Communications 19 - Experimental / Translational Medicine

ZEBRAFISH DRUG SCREENING IDENTIFIES CANDIDATE THERAPIES FOR NEUROPROTECTION AFTER SPONTANEOUS INTRACEREBRAL HAEMORRHAGE

S. Crilly¹, A. Parry-Jones¹, X. Wang², J. Selley¹, J. Cook¹, V. Tapia¹, C. Anderson², S. Allan¹, P. Kasher ¹

¹The University of Manchester, Manchester, United Kingdom, ²University of New South Wales, Sydney, Australia

Background: Development of alternative pre-clinical models of spontaneous intracerebral haemorrhage (ICH) is urgently required to help address the ongoing failure to translate specific medications to patients. Our previous work indicates that spontaneous ICH in zebrafish larvae induces brain injury, locomotor deficits and neuroinflammation. Due to their high fecundity, small size and translucency, zebrafish larvae offer a unique system to visualise disease biology within the brain in real-time and allow for large-scale drug screening.

Aim: The aim of this study was to use zebrafish drug screening to identify compounds that offer neuroprotection after ICH

Methods: Using a transgenic cell death reporter strain and live imaging, we applied the Spectrum Library compounds (n=2000 drugs; 25μM) to zebrafish larvae acutely after ICH to screen for neuroprotective agents. Sub-analysis of the INTERACT2 clinical trial dataset was performed to assess effects of angiotensin converting enzyme inhibitors (ACE-I) when administered to ICH patients acutely.

Results: We identified 150 compounds that were capable of inhibiting brain cell death after ICH in the zebrafish larval model, including two ACE-I. Ramipril and quinapril were further assessed to confirm a significant 55% reduction in brain cell death. Proteomic analysis revealed potential mechanisms of neuroprotection, including targeting of mitochondria. Sub-analysis of INTERACT2 clinical trial data revealed a significant association (P=0.009) between ACE-I use after ICH and a good outcome (mRS 0-2) at 90 days.

Conclusions: Zebrafish can be used as a reliable drug screening platform for ICH, and we have identified compounds which may offer neuroprotection following acute ICH, including ACE-I.

Disclosure: No

O165 / 1174

Scientific Communications 20 - Intracerebral Haemorrhage

INTRAVENTRICULAR HAEMORRHAGE: CLINICAL CHARACTERISTICS AND RELATIONSHIPS WITH OUTCOMES

K. Krishnan ^1,2, L.J Woodhouse², Z. Law³, J.P Appleton^4,5, R. Dineen⁶, J. Wardlaw⁷, P.M Bath^2,1, N. Sprigg^2,1

¹Nottingham University Hospitals NHS Trust, Stroke, Department of Acute Medicine, Nottingham, United Kingdom, ²University of Nottingham, Stroke Trials Unit, Nottingham, United Kingdom, ³National University of Malaysia, Department of Medicine, Kuala Lumpur, Malaysia, ⁴University Hospitals Birmingham NHS Foundation Trust, Stroke, Department of Medicine, Birmingham, United Kingdom, ⁵University of Birmingham, Institute of Applied Health Research, College of Dental and Medical Sciences, Birmingham, United Kingdom, ⁶Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom, ⁷University of Edinburgh, Centre for Clinical Brain Sciences, UK Dementia Research Centre, Edinburgh, United Kingdom

Background and aims: Intraventricular haemorrhage (IVH) in acute intracerebral haemorrhage (ICH) is common but little is known on the baseline clinical characteristics of patients and effect on early and late functional outcomes.

Methods: Data from ICH participants recruited within 6 hours of symptom onset and randomised to control arms in the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT-2) and Tranexamic acid for hyperacute intracerebral haemorrhage (TICH-2) trials were retrospectively analysed. Functional outcome was assessed using the modified Rankin scale (mRS) at day 90. Binary logistic regression was used to assess the effect of baseline IVH on early neurological deterioration, death at day 7, day 90 and mRS.

Results: Of the 1063 participants, IVH was present in 328 (31%) participants at baseline. Patients with IVH were older (71 vs 68 years), had lower level of consciousness (Glasgow Coma Scale 14 vs 15) with larger haemorrhages (35 vs 19 cm³) compared to those without (all, p<0.001). 283 (87%) participants with IVH at baseline had poor functional outcome (mRS>2) at day 90. After adjusting for baseline variables (age, baseline GCS, stroke location, time to CT, ICH volume, midline shift), IVH at baseline was independently associated with early neurological deterioration (OR 1.83, 95% CI 1.31-2.54), death at day 7 (OR 1.75, 95% CI 1.15-2.68) and day 90 (OR 1.77, 95% CI 1.20-2.61) and poor mRS (OR 1.61, 95% CI 1.23-2.11).

Conclusions: IVH is independently associated with poor outcomes but the thresholds need further exploration.

Disclosure: No

O166 / 602

Scientific Communications 20 - Intracerebral Haemorrhage

ASSOCIATION BETWEEN STEREOTACTIC THROMBOLYSIS WITH ALTEPLASE FOR INTRACEREBRAL HEMORRHAGE AND INTRAVENTRICULAR HEMATOMA VOLUME: A SECONDARY ANALYSIS OF THE MISTIE-III TRIAL

P. Sun ¹, R. Avadhani², I. Awad³, D. Hanley², S. Murthy⁴, W. Ziai^1,2

¹Johns Hopkins University School of Medicine, Division of Neurosciences Critical Care, Department of Neurology, Baltimore, United States, ²Johns Hopkins University School of Medicine, Brain Injury Outcomes Division, Baltimore, United States, ³University of Chicago School of Medicine, Department of Neurological Surgery, Chicago, United States, ⁴Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, Clinical and Translational Neuroscience Unit and Department of Neurology, New York, United States

Background: Stereotactic thrombolysis reduces parenchymal hemorrhage volume in patients with spontaneous intracerebral hemorrhage (ICH). Whether intrahematomal alteplase administration is associated with a change in intraventricular hemorrhage volume (deltaIVH) and functional outcomes is unclear.

Methods: Post-hoc analysis of MISTIE-III trial which evaluated minimally invasive surgery+alteplase in ICH >30mL. Exposure was MIS+alteplase. Primary outcome was deltaIVH between hematoma-stability and end-of-treatment (EOT) CT scans. Secondary outcomes were mRS>3 and mortality at 12 months. The relationship between alteplase and deltaIVH was assessed using multiple linear regression, and between deltaIVH and 12-month outcomes using multiple logistic regression.

Results: Of the 499 patients in MISTIE-III, 310 (62.1%) had IVH on hematoma-stability scans, with mean age of 61±12 years. A total of 146 (47.1%) received MIS+alteplase and 164 (52.9%) medical management only. The mean IVH volumes on stability-CT in MIS+altepase and the medical groups were 4.7±7.8mL and 4.0±5.5mL, respectively, lowered to 2.5±4.6mL and 2.9±4.4mL on EOT scans, respectively. MIS+alteplase group had greater IVH volume reduction compared to medical group (mean, 2.3mL versus 1.1mL, p=0.02). MIS+alteplase was associated with deltaIVH in multivariable linear regression analysis adjusted for demographics, stability ICH and IVH volumes, EVD use, and time from ictus to EOT CT (per 1mL change; beta, 0.87; 95%CI, 0.27-1.47; p=0.005). Secondary analyses did not show association between deltaIVH and poor outcome or mortality.

Conclusions: MIS+alteplase in patients with large ICH and IVH was associated with reduction in IVH volume, but this did not translate into a significant benefit in mortality or functional outcomes.

Disclosure: Yes

O167 / 680

Scientific Communications 20 - Intracerebral Haemorrhage

THE ROLE OF HYPERGLYCEMIA IN THE OUTCOME OF INTRACEREBRAL HEMORRHAGE: A CAUSATIVE ANALYSIS

J.-Y. Wang ¹, A. Andreev¹, M. Wilson¹, M. Selim¹, V. Lioutas¹

¹ Harvard University / Beth Israel Deaconess Medical Center, Neurology, Boston, United States

Background: The role of hyperglycemia in the acute phase of intracerebral hemorrhage (ICH) is incompletely understood. Interventions aimed at lowering glucose in the acute phase of ICH have yielded neutral or negative results. We used path analysis to attempt an explanation of the causal role of hyperglycemia in ΙCH outcome.

Methods: Consecutive primary ICH patients admitted to tertiary hospital between 2007-2018. Hematoma volume (HV) on presentation, mean 72-hour glucose and age were recorded as continuous variables. Intraventricular extension (IVE), infratentorial location, the presence of diabetes and relative hematoma expansion >33% (HE) were recorded as dichotomous variables. 90-day functional outcome was dichotomized as favorable vs unfavorable (modified Rankin Scale of ⩽2 vs >2). We used generalized structural equation modelling for model estimation.

Results: 405 patients (70.4±13.8years, 43% female) met inclusion criteria. Mean 72-hour glucose was 137.5±33.4mg/dl. 102 (25%) patients were diabetic. Median HV was 20.7cm³. IVE was present in 170 (42%) patients and 48 hemorrhages (12%) were infratentorial. 104 (26%) patients had favorable functional outcome. On bivariate analysis, mean 72-hour glucose levels were negatively correlated with favorable outcome (Standardized beta -0.36, p<0.0001) but this effect was significantly attenuated when introducing other variables in our model (figure). Serum glucose levels were driven by HV (p<0.0001), diabetes (p<0.0001), IVE (p=0.003) and HE (p=0.04).

Conclusion: Hyperglycemia in ICH appears to be mainly influenced by markers of ICH severity, a possible explanation for the lack of response to intensive glucose lowering interventions. Its direct effect on functional outcome in ICH merits further investigation.

Disclosure: No

O168 / 467

Scientific Communications 20 - Intracerebral Haemorrhage

RISK OF MAJOR VASCULAR EVENTS IN PEOPLE WITH AND WITHOUT HISTORY OF INTRACEREBRAL HAEMORRHAGE: A DANISH NATIONWIDE COHORT STUDY

D. Gaist ¹, S.M. Hald¹, L.A. García Rodríguez², A. Clausen³, S. Möller³, J. Hallas⁴, R. Al-Shahi Salman⁵

¹Odense University Hospital, University of Southern Denmark, Research Unit for Neurology, Odense, Denmark, ²Centro Español Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain, ³Odense University Hospital, University of Southern Denmark, Open Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense, Denmark, ⁴University of Southern Denmark, Department Of Clinical Pharmacology & Pharmacy, Odense, Denmark, ⁵University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom

Background and aims: Survivors of stroke due to non-traumatic (spontaneous) intracerebral haemorrhage (ICH) often harbour vascular risk factors and co-morbidities, but it is unclear which major vascular events affect ICH survivors more frequently than the general population.

Methods: We identified patients with a first-ever ICH in the Danish Stroke Registry in 2005-2018 who were aged ⩾45 years and survived ⩾30 days after ICH. We matched these ICH patients (1:40) on age, sex, and ICH onset-date to people from the general population with no history of ICH (population controls). Both cohorts were followed-up until the end of 2018 for ICH, ischaemic stroke (IS), myocardial infarction (MI), and other major vascular events (composite of stroke [IS, ICH, or ‘unspecified stroke’], MI, systemic embolism or vascular death) using registry data. We calculated crude absolute vascular event rates per 100 person-years [95% CIs] and adjusted hazard ratios (aHR) [95%CIs].

Results: The ICH cohort of 8,991 patients (53.5% men, mean age 70.7 years) had higher event rates (per 100 person-years) compared with 359,185 population controls for all major vascular events (4.09 [3.89-4.30] vs 1.32 [1.30-1.33]; aHR 3.14 [2.98-3.31]), IS (1.52 [1.40-1.65] vs 0.56 [0.55-0.57]; aHR 2.64 [2.43-2.88]) and ICH (1.44 [1.32-1.56] vs 0.06 [0.06-0.07]; aHR 23.49 [21.12-26.13]), but not MI (0.52 [0.45-0.60] vs 0.48 [0.47-0.49]; aHR 1.12 [0.97-1.29]).

Conclusion: Danish ICH survivors are at higher risk of all major vascular events (except MI) than the general population, mandating attention to optimal secondary prevention with BP-lowering, antithrombotic and statin therapies in clinical research and practice.

Disclosure: Yes

O169 / 324

Scientific Communications 20 - Intracerebral Haemorrhage

PREVENTION OF EPILEPTIC SEIZURES IN ACUTE INTRACEREBRAL HAEMORRHAGE (PEACH): A DOUBLE-BLIND RANDOMISED PLACEBO-CONTROLLED TRIAL

L. Peter-Derex¹, F. Philippeau², P. Garnier³, N. Andre-Obadia¹, S. Boulogne¹, H. Catenoix¹, P. Convers³, L. Mazzola³, M. Gouttard², M. Esteban¹, J. Fontaine¹, L. Mechtouff¹, E. Ong¹, N. Perreton⁴, A. Termoz⁴, J. Haesebaert⁴, A.-M. Schott⁴, M. Rabilloud⁵, C. Pivot⁶, C. Dhelens⁶, A. Filip⁷, Y. Berthezene⁷, S. Rheims¹, F. Boutitie⁵, L. Derex ¹

¹Hospices Civils de Lyon, Neurology, Lyon, France, ²Centre Hospitalier de Bourg-en-Bresse, Neurology, Bourg-en-Bresse, France, ³CHU de Saint-Etienne, Neurology, Saint-Etienne, France, ⁴Hospices Civils de Lyon, Public Health, Lyon, France, ⁵Hospices Civils de Lyon, Biostatistics, Lyon, France, ⁶Hospices Civils de Lyon, Pharmacy, Lyon, France, ⁷Hospices Civils de Lyon, Neuroradiology, Lyon, France

Background and aims: Acute epileptic seizures are common in intracerebral haemorrhage (ICH), especially if continuous EEG is recorded to diagnose subclinical seizures, and may be associated with worse outcome. We did a double-blind randomised placebo-controlled trial to assess whether levetiracetam would reduce the risk of acute seizures in ICH (ClinicalTrials.gov registration number: NCT02631759).

Methods: Patients who presented with a non-traumatic ICH within 24h after onset were randomly assigned to placebo or levetiracetam (1000 mg/day). Treatment was continued for 6 weeks. Continuous EEG was started within 24h after inclusion and recorded over 48h. The primary endpoint was the occurence of a clinical and/or electrographic seizure within the first 72h following inclusion.

Results: Fifty patients were included between June 2017 and April 2020, 24 assigned to levetiracetam and 26 to placebo. During the first 72h, a clinical and/or electrographic seizure was observed in 3 (15.8%) patients in the levetiracetam group versus 10 (43.5%) patients in the placebo group (Odds Ratio 0.164, 95% CI [0.03;0.94], p=0.043). Seizures were electrographic seizures only in all but one patient. The number of epileptic discharges during EEG recording was significantly lower in the levetiracetam group (6) than in the placebo group (158) (Rate Ratio 0.07, 95% CI [0.01;0.38], p=0.002), as was the total seizure duration in the 3+10 patients with seizures (67 s [46,300] versus 780 s [380,1980], p=0.028).

Conclusions: Levetiracetam is effective in preventing acute seizures in ICH. An adequately powered randomized-controlled trial is needed to answer whether seizure prophylaxis improves functional outcome in this setting.

Disclosure: No

O170 / 1168

Scientific Communications 20 - Intracerebral Haemorrhage

IATROGENIC CEREBRAL AMYLOID ANGIOPATHY AFTER NEUROSURGERY; FREQUENCY, FEATURES, AND OUTCOME

K. Kaushik ¹, E.S. van Etten¹, B. Siegerink², L.J. Kapelle³, F.H.B.M. Schreuder⁴, C.J. Klijn⁴, G.M. Terwindt¹, W.C. Peul⁵, M.A.A. van Walderveen⁶, M.J.H. Wermer¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Leiden University Medical Center, Clinical Epidemiology, Leiden, Netherlands, ³University Medical Center Utrecht, Neurology, Utrecht, Netherlands, ⁴Radboud University Medical Center, Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands, ⁵Leiden University Medical Center, Neurosurgery, Leiden, Netherlands, ⁶Leiden University Medical Center, Radiology, Leiden, Netherlands

Background and aims: Prion-like transmission of amyloid-ß through cadaveric dura, decades after neurosurgical procedures, has been hypothesized as an iatrogenic cause of Cerebral Amyloid Angiopathy(CAA). We investigated new and previously described cases to assess frequency, features and outcome of this presumed iatrogenic form of CAA(iaCAA).

Methods: From our prospective hospital CAA-database with patients from 1994-2021 we selected patients with a history of neurosurgery in the period of cadaveric dura use (1968-1990), who met the Boston-criteria except for age and strict lobar hemorrhage location. Additionally, we identified iaCAA-cases from other hospitals and performed a systematic literature-search for previously described iaCAA-cases. We checked neurosurgical reports, assessed the frequency of probable or possible iaCAA based on respectively confirmed/likely or unclear use of cadaveric dura and evaluated disease features and intracerebral haemorrhage (ICH)-recurrence.

Results: Thirty-seven patients with suspected iaCAA were included (73% men, mean age at presentation 44 years (range 29-84)): 12 of the 236 CAA-database patients (5.1%; 95%CI:2.8–8.5%; 35.3% of patients <55 years), three from other hospitals and 22 from the literature. We classified 23/37 (62.2%) as probable and 14/37 (37.8%) as possible iaCAA. iaCAA presented with lobar ICH (59.5%), transient focal neurological episodes (8.1%) or cognitive decline (5.4%). Deep ICH or microbleeds were present in 21.6%. ICH-recurrence rate was 55/100 person-years (95%CI:42-71, median follow-up 18 months) and highest in patients <55 years.

Conclusions: iaCAA should be considered in patients who underwent neurosurgery between 1968-1990. The variety of presentations is similar to sporadic CAA. Prognosis seems to be poor with high ICH-recurrence rates.

Disclosure: No

O171 / 996

Scientific Communications 20 - Intracerebral Haemorrhage

SUBGROUP ANALYSES FROM TICH-NOAC (TREATMENT OF INTRACEREBRAL HEMORRHAGE IN PATIENTS ON NOAC WITH TRANEXAMIC ACID): EFFECTS OF PROTHROMBIN COMPLEX CONCENTRATE, CLINICAL AND IMAGING CHARACTERISTICS

A. Polymeris¹, D. Seiffge², S. Schaedelin³, G. Karwacki⁴, S. Engelter^1,5, P. Lyrer¹, N. Peters ^1,5,6, on behalf of the TICH-NOAC Investigators

¹Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland, ²Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland, ³Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland, ⁴Department of Neuroradiology, Cantonal Hospital Lucerne, Lucerne, Switzerland, ⁵Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland, ⁶Department of Neurology and Stroke Center, Hirslanden Hospital, Zurich, Switzerland

Background and aims: Evidence-based treatment options for intracerebral haemorrhage associated with novel direct oral anticoagulants (NOAC-ICH) are lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting secondary haematoma expansion (HE). Treatment effects of TXA in patients with NOAC-ICH may differ according to certain co-variates, indicating the importance of subgroup analyses presented here.

Methods: We conducted a multi-center, double-blind, placebo-controlled, randomized controlled trial at 6 Stroke Centers in Switzerland. We randomized patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake to receive either TXA (2x1g) or placebo. Primary outcome was HE defined as haematoma volume increase of either ⩾33% or ⩾6ml on follow-up imaging 24 hours after admission. Secondary outcomes included modified Rankin Scale score at 3 months and major thromboembolic complications. This trial was registered (NCT02866838) and funded by the Swiss National Science Foundation. We performed pre-specified subgroup analyses according to certain clinically important co-variates.

Results: In addition to the main results of this trial presented at ESOC 2022, we will present the results of pre-defined subgroups, including patients with vs. without concomitant treatment with prothrombin complex concentrate, age (⩽80 vs. >80 years), Glascow Coma Scale (>12 vs. 8-12), baseline hematoma volume (⩽30 vs. >30 ml), anatomical location (lobar vs. non-lobar hematoma), and intraventricular hemorrhage (present vs. absent).

Conclusions: The results of these subgroup analyses will allow a refined understanding of the results of the TICH-NOAC trial.

Disclosure: No

O172 / 666

Scientific Communications 20 - Intracerebral Haemorrhage

AN MRI-BASED SMALL VESSEL DISEASE-PHAENOTYPE CLASSIFICATION OF INTRACEREBRAL HAEMORRHAGE SUBTYPES AND RISK OF RECURRENT CEREBROVASCULAR EVENTS

M. Goeldlin ^1,2, M. Mueller^1,2, B.M Siepen^1,2, W. Valenzuela Pinilla³, P. Radojewski³, A. Hakim³, T.R Meinel^1,2, L. Clénin¹, D. Strambo⁴, T. Fischer⁵, F. Medlin⁶, N. Peters⁷, E. Carrera⁸, E. Dirren⁸, G. Karwacki⁹, C.W Cereda¹⁰, J. Niederhaeuser¹¹, M.-L. Mono¹², A. Mueller¹³, S. Wegener¹³, S. Sartoretti-Schefer¹⁴, A.A Polymeris¹⁵, R. Sturzenegger¹⁶, M. Psychogios¹⁷, M. Schaerer¹⁸, W. Z’Graggen^1,19, D. Bervini¹⁹, L. Bonati¹⁵, M. Arnold¹, U. Fischer^17,1, D.J Seiffge¹, Swiss Stroke Registry Investigators

¹Inselspital Bern University Hospital and University of Bern, Department of Neurology, Bern, Switzerland, ²University of Bern, Graduate School for Health Sciences, Bern, Switzerland, ³Inselspital Bern University Hospital and University of Bern, University Institute for Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ⁴Lausanne University Hospital and University of Lausanne, Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland, ⁵Cantonal Hospital St. Gallen, Department of Radiology, St. Gallen, Switzerland, ⁶HFR Fribourg – Cantonal Hospital, Stroke Unit and Division of Neurology, Fribourg, Switzerland, ⁷Klinik Hirslanden Zurich, Stroke Center Hirslanden, Zurich, Switzerland, ⁸University Hospital and Faculty of Medicine Geneva, Stroke Research Group, Department of Clinical Neurosciences, Geneva, Switzerland, ⁹Luzerner Kantonsspital, Department of Radiology and Nuclear Medicine, Lucerne, Switzerland, ¹⁰Neurocenter of Southern Switzerland, Lugano, Stroke Center EOC, Lugano, Switzerland, ¹¹Hôpital de zone de Nyon, Stroke unit, GHOL, Nyon, Switzerland, ¹²Stadtspitäler Triemli und Waid, Zurich, Switzerland, ¹³University Hospital and University of Zurich, Department of Neurology, Zurich, Switzerland, ¹⁴Kantonsspital Winterthur, Department of Radiology and Nuclear Medicine, Winterthur, Switzerland, ¹⁵University Hospital Basel, Department of Neurology, Basel, Switzerland, ¹⁶Kantonsspital Graubünden, Department of Neurology, Chur, Switzerland, ¹⁷University Hospital Basel, Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, Basel, Switzerland, ¹⁸Buergerspital Solothurn, Department of Neurology, Solothurn, Switzerland, ¹⁹Inselspital Bern University Hospital and University of Bern, Department of Neurosurgery, Bern, Switzerland

Background and aims: We present a novel MRI-based small vessel disease (SVD)-phaenotype classification of intracerebral haemorrhage (ICH) and investigate associations with outcomes.

Methods: We included all consecutive patients with non-traumatic, small vessel disease-related ICH from the multi-center, prospective Swiss Stroke Registry who underwent MRI. Patients were classified according to a novel MRI-based classification using haemorrhagic (microbleeds, cortical siderosis) and non-haemorrhagic (white matter hyperintensities, lacunes) markers and haematoma location as cerebral amyloid angiopathy (CAA), deep perforator arteriopathy (DPA), mixed SVD or undetermined SVD. Primary outcome was recurrent ICH or ischaemic strokes within 3 months.

Results: We enrolled 858 patients (median age 73 years, IQR 62-79; 44.4% female, admission NIHSS 8). The distribution of MRI-phaenotypes was 22.6% DPA (194 patients), 10.8% CAA (93 patients), 51.0% mixed SVD (438 patients) and 15.5% undetermined SVD (133 patients). During follow-up, 8.4% (58 patients) suffered ⩾1 recurrent event (27 ischaemic strokes, 32 ICH). Rates of recurrent ICH and ischaemic stroke were 3.1%/3.1% respectively in patients with DPA, 3.9%/0% in CAA, 4.6%/6.1% in mixed SVD and 7.9%/1.0% in patients with undetermined SVD. After adjusting for confounders (including atrial fibrillation for ischaemic stroke and history of ICH for recurrent ICH), we did not observe a significant association of events with MRI phaenotype.

Conclusion: This new MRI-based SVD-ICH phaenotype classification is feasible and reproducible. Larger studies with longer follow-up are needed to determine distinct risk profiles for recurrent ICH and ischaemic stroke beyond established risk factors.

Disclosure: Yes

O173 / 436

Scientific Communications 21 - Rare Causes, Stroke in the Young

ACUTE ISCHEMIC STROKE IN PATIENTS WITH NEWLY DIAGNOSED VERSUS KNOWN ACTIVE CANCER: CHARACTERISTICS, MECHANISMS, AND RECURRENCES

G. Costamagna ¹, A. Hottinger¹, H. Milionis², A. Salerno¹, D. Strambo¹, B. Navi³, P. Michel¹

¹Lausanne University Hospital and University of Lausanne, Department of Clinical Neurosciences, Lausanne, Switzerland, ²University of Ioannina, Ioannina, Greece, ³Weill Cornell Medicine, Feil Brain and Mind Research Institute and Department of Neurology, New York, United States

Background:  Acute ischemic stroke (AIS) and cancer are important causes of disability and death among adults. We aimed to estimate the rate of newly-diagnosed cancer (NDC) and active cancer (AC) in AIS patients, and to compare demographic, clinical, and long-term outcome data between groups.

Methods: We retrospectively analyzed data from ASTRAL (Acute-STroke-Registry-and-Analysis-of-Lausanne) between 1/2003-10/2021, a consecutive single-center registry in Switzerland. We defined NDC as cancer diagnosed <12 months since the index stroke. AC was defined following standard definition (Khorana, J.Thromb.Haemost, 2018). We compared both groups regarding patients’ characteristics, stroke mechanisms, long-term functional outcome, mortality, and recurrences. Univariate analysis is provided; other logistic regression analyses are ongoing and will be presented at the congress.

Results: Among 6686 AIS patients, 38.9% were women and the median age was 74.3 years (IQR 16.7). Eighty six (1.3%) patients had NDC and 310 (4.6%) had AC. The table indicates no difference in risk factors and stroke mechanisms between NDC and AC patients, except that NDC patients had a lower pre-stroke modified Rankin Scale (mRS). Unadjusted analysis indicates no difference in short- or long-term mortality nor 3-month disability (mRS>2). The 3-month stroke recurrence rate was 16.2% with NDC vs 9.7% with AC (OR 1.80, 95% CI 0.91-3.58).

Conclusions: In the year after AIS, 1.3% of patients were newly diagnosed with cancer. Patients with NDC and AC seem to be similar in most aspects, except that NDC patients seem to have less pre-stroke disability and a trend towards more stroke recurrence.

Table.

Patient characteristics and results.

Variable	Study cohort(N=396)	Newly diagnosed cancer (NDC)(N = 86)	Active cancer (AC)(N = 310)	OR (95% CI)	p-value
Age	74.3 (16.7)	74.8 (15.4)	74.3 (17.2)	0.87 (0.98-1.02)	0.87
Female sex	154/396(38.9%)	35/86 (40.7%)	119/310 (38.4%)	0.91 (0.56 - 1.48)	0.7
mRS pre-stroke	1 (2)	1(2)	1(2)		0.026
Vascular risk factors
Hypertension	288/396 (72.9%)	67/86 (77.9%)	221/309 (71.5%)	1.4 (0.8-2.47)	0.24
Atrial fibrillation	106/396 (27%)	24/86 (27.9%)	82/307(26.7%)	1.06 (0.62-1.81)	0.83
Diabetes	80/396 (20.3%)	14/86 (16.3%)	66/309 (21.4%)	0.72 (0.38-1.35)	0.3
Dyslipidaemia	274/396 (69.7%)	63/86 (73.3%)	211/307 (68.7%)	1.25 (0.73-2.13)	0.42
Smoking	105/396 (27%)	28/85 (32.9%)	77/304 (25.3%)	1.5 (0.86-2.44)	0.16
Coronary disease	79/396 (20.2%)	18/85 (21.2%)	61/306 (19.9%)	1.08 (0.6-1.95)	0.8
Prosthetic valve	7/396 (1.8%)	2/86 (2.3%)	5/308 (1.6%)	1.44 (0.28-7.57)	0.66
Eject. fraction <35%	18/396 (4.5%)	7/86 (8.1%)	11/310 (3.5%)	2.41 (0.9-6.4)	0.071
Stroke etiologies
Atherosclerosis	49/370 (13.2%)	11/86 (12.8%)	38/284 (13.4%)	0.95 (0.46-1.95)	0.89
Cardioembolism	86/370 (23.2%)	22/86 (25.6%)	64/284 (22.5%)	1.48 (0.84-2.61)	0.117
Lacunar	26/370 (7%)	6/86 (7%)	20/284 (7%)	1.17(0.45-3.03)	0.74
Dissection	3/370 (0.8%)	1/86 (1.2%)	2/284 (0.7%)	1.95 (0.17-21.8)	0.58
PFO-related	3/370 (0.8%)	1/86 (1.2%)	2/284 (0.7%)	1.92 (0.17-21.5)	0.59
Rare and/or cancer-related	94/370 (25.4%)	23/86 (26.7%)	71/284 (25%)	1.28 (0.74-2.23)	0.37
Multiple mechanism	48/370 (13%)	10/86 (11.6%)	38/284 (13.38%)	0.98 (0.47-2.1)	0.97
Embolic stroke of undet. source	37/370 (10%)	10/86 (11.6%)	27/284 (9.51%)	1.5 (0.69-3.25)	0.3
Undetermined, and/or incomplete work-up	24/370 (6.5%)	2/86 (2.3%)	22/284 (7.75%)	0.33 (0.07-1.45)	0.13
Recurrence 3 months	44/394 (11.2%)	14/86 (16.2%)	30/308 (9.7%)	1.8 (0.91-3.58)	0.089
Mortality 7 days	42/396 (10.6%)	6/86 (7.0%)	36/310 (11.6%)	0.57 (0.23-1.4)	0.22
Mortality 3 months	110/349 (31.5%)	23/82 (28%)	87/267 (32.6%)	0.81 (0.47-1.4)	0.44
Mortality 12 months	165/305 (54%)	41/71 (57.7%)	124/234 (53.0%)	1.21 (0.71-2.07)	0.48
mRS>2 at 3 months	194/350 (55.4%)	42/82 (51.2%)	152/268 (56.7%)	0.8 (0.49-1.32)	0.38
mRS 3 months	3 (5)	3(4)	3 (5)		0.71

Continuous and ordinal variables are expressed as medians (with interquartile range, IQR), and categorical variables as absolute counts (with percentage). Results from the univariate analysis in the “NDC” and “AC” groups are reported as odds ratio (OR) and 95% confidence interval (CI). PFO: patent foramen ovale; mRS: modified Rankin Scale.

Disclosure: No

O174 / 671

Scientific Communications 21 - Rare Causes, Stroke in the Young

TRIGGER FACTORS FOR STROKE IN YOUNG ADULTS: A CASE-CROSSOVER STUDY

M.S. Ekker ¹, J.I. Verhoeven¹, K.M.L. Rensink¹, M.M.I. Schellekens¹, E.M Boot¹, M.E van Alebeek², P.J.A.M. Brouwers³, R.M Arntz³, G.W. van Dijk⁴, R.A.R. Gons⁵, I.W.M. van Uden⁵, T. den Heijer⁶, P.L.M. de Kort⁷, K.F. de Laat⁸, A. van Norden², S.E. Vermeer⁹, M.S.G. van Zagten¹⁰, R.J. van Oostenbrugge¹¹, M.J.H. Wermer¹², P.J. Nederkoorn¹³, H. Kerkhoff¹⁴, F.A. Rooyer¹⁵, F.G. van Rooij¹⁶, I.R. van den Wijngaard¹⁷, C.J.M. Klijn¹, A.M Tuladhar¹, F.-E. de Leeuw¹

¹Radboudumc, Neurology, Nijmegen, Netherlands, ²Amphia Ziekenhuis, Breda, Netherlands, ³Medisch Spectum Twente, Enschede, Netherlands, ⁴Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands, ⁵Catharina Ziekenhuis, Eindhoven, Netherlands, ⁶Sint Franciscus Gasthuis, Rotterdam, Netherlands, ⁷Elisabeth Tweesteden Ziekenhuis, Tilburg, Netherlands, ⁸Haga Ziekenhuis, Den Haag, Netherlands, ⁹Rijnstate Ziekenhuis, Arnhem, Netherlands, ¹⁰Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands, ¹¹MUMC+, Maastricht, Netherlands, ¹²LUMC, Leiden, Netherlands, ¹³Amsterdam UMC, Amsterdam, Netherlands, ¹⁴Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands, ¹⁵Zuyderland Ziekenhuis, Sittard-Geleen, Netherlands, ¹⁶Medisch Centrum Leeuwarden, Leeuwarden, Netherlands, ¹⁷Haaglanden Medisch Centrum, Den Haag, Netherlands

Background and aims: In order to gain more insight in the etiology of (cryptogenic) stroke in the young, we investigated whether trigger factors may play a role.

Methods: Patients aged 18-49 years with a first-ever TIA, ischemic stroke or intracerebral hemorrhage (ICH) in 17 participating centers in the Netherlands completed a questionnaire about exposure to nine potential trigger factors in hazard periods and on a regular yearly basis. A case-crossover design was used to assess Relative Risks (RR) with 95% confidence intervals (95% CI) by Mantel-Haenszel method and conditional logistic regression.

Results: 1146 patients completed the questionnaire (80 with a TIA, 963 with ischemic stroke, 103 with ICH, median age 44.0 years, 52.6% men). For any stroke (TIA, ischemic stroke and ICH combined), an increased risk emerged within one hour of cola consumption (RR 2.0, 95% CI 1.5-2.8) and vigorous physical exercise (RR 2.6, 95% CI 2.2-3.0), within two hours after sexual activity (RR 2.4, 95% CI 1.6-3.5), within 4 hours after illicit drug use (RR 2.8, 95% CI 1.7-4.9) and within 24 hours after fever or flu-like disease (RR 14.1, 95% CI 10.5-31.2; RR 13.9, 95% CI 8.9-21.9). Illicit drug use, fever and flu-like disease showed no increased risk for ICH alone. The most (seven) trigger factors were found for other determined and cryptogenic stroke.

Conclusions: These findings might help in better understanding the pathophysiological mechanisms of (cryptogenic) stroke in the young.

Disclosure: No

O175 / 1233

Scientific Communications 21 - Rare Causes, Stroke in the Young

LONG-TERM CLINICAL OUTCOME OF DISSECTING PSEUDOANEURYSM IN CERVICAL INTERNAL CAROTID ARTERY TREATED WITH MEDICAL THERAPY

Z. Keser ¹, A.I. Casanegra², G. Lanzino³

¹Mayo Clinic, Neurology, Rochester, United States, ²Mayo Clinic, Division of Vascular Medicine, Department of Cardiology, Rochester, United States, ³Mayo Clinic, Neurosurgery, Rochester, United States

Background and aims: The short-term clinical outcome of patients with cervical internal carotid artery (cICA) dissections is well defined, the long-term clinical outcome of those patients with a cervical carotid dissecting pseudoaneurysm (PSA) after dissection is not well described. Many patients with cICA PSA are referred for possible intervention as endovascular therapies advance and expand, but the long-term clinical outcome of patients with cICA PSA with medical therapy alone is unknown.

Methods: A prospective registry of patients with cICA PSA (December 2016 – December 2021) referred for an opinion on intervention was evaluated by a Neurosurgeon (GL) with dual training in endovascular and open cerebrovascular surgery at the Mayo Clinic in Rochester, Minnesota. Patients managed medically, with intervention considered only if they presented recurrent symptoms or PSA progression at follow-up.

Results: We enrolled   sixty-one patients with mean age of 54.5±13.5 (34F). All patients were managed with an antithrombotic regimen (mostly on aspirin). Over a mean follow-up of 20 months, no PSA ruptured, and one patient suffered an ipsilateral stroke from in-situ thrombus formation in PSA requiring stent placement. Only two patients with PSA had an interval growth detected at the first three months follow-up study.

Conclusions: Most patients with cICA PSA have a benign prognosis with medical therapy alone. These PSA do not rupture, and progression after the first three months is an exceptional event. The growing practice of routine endovascular repair should be discouraged.

Disclosure: No

O176 / 120

Scientific Communications 21 - Rare Causes, Stroke in the Young

NEUROIMAGING FEATURES OF ANTIPHOSPHOLIPID ANTIBODY-RELATED STROKE COMPARED TO ATRIAL FIBRILLATION-RELATED STROKE

W. Yang ¹, D.-W. Kang¹, S.Y. Ha¹, J. Bae¹, E.-J. Lee¹, H.-Y. Jeong¹, J.-M. Kim¹, K.-H. Jung¹, S.-H. Lee¹

¹ Seoul National University Hospital, Neurology, Seoul, Korea, Republic of

Background: Recognizing the lesion pattern of antiphospholipid antibody-related stroke (aPL-stroke) may contribute to establishing the cause in patients with cryptogenic stroke. We aimed to describe the neuroimaging features of aPL-stroke compared with atrial fibrillation-related stroke (AF-stroke), a major hidden cause of cryptogenic stroke.

Methods: Among consecutive patients admitted with acute stroke, aPL- and AF-stroke patients without other potential causes of stroke were reviewed. Neuroimaging features based on diffusion-weighted imaging and angiographic findings at admission were compared.

Results: A total of 56 and 333 patients were included in the aPL- and AF-stroke groups, respectively. aPL-stroke patients more often presented with single small lesions (aPL-stroke, 30.4% vs. AF-stroke, 7.5%, p<0.001), while the predominant pattern in AF-stroke patients was large territorial lesions (26.8% vs. 56.5%, p<0.001). aPL-stroke patients had smaller infarct volume (1.58 mL [0.45; 9.41] vs. 11.32 mL [2.82; 33.08], p<0.001) and less experience of relevant artery occlusion (17.9% vs. 54.7%, p<0.001). The proportion of multi-territory lesions, an embolic pattern, was similar between the two groups (28.6% vs. 22.8%, p=0.44). In comparison only including patients with multi-territory lesions as well, aPL-stroke patients showed small lesion dominance and smaller infarct volume. Multivariate analyses showed independent associations between mild neuroimaging features (small lesion prevalence, smaller infarct volume, and absence of relevant artery occlusion) and aPL-stroke.

Conclusions: Patterns of small lesion prevalence, small infarct volume, and absence of relevant artery occlusion were suggestive of aPL-stroke rather than AF-stroke. Cryptogenic stroke patients with such neuroimaging features may benefit from aPL testing for a precise diagnosis.

Disclosure: No

O177 / 223

Scientific Communications 21 - Rare Causes, Stroke in the Young

CLINICAL AND RADIOLOGICAL COMPLICATIONS OF REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME IN RELATION TO AGE

K.S. Lange* ^1,2, G. Tuloup*^3,4, C. Burcin⁴, L. Corti², C. Duflos⁵, C. Roos⁴, J. Mawet*⁴, A. Ducros*^2,6

¹Charité - University Hospital Berlin, Department for Neurology, Center for Stroke Research Berlin (CSB), Berlin, Germany, ²University Hospital Montpellier, Department of Neurology, Montpellier, France, ³University Hospital of Caen, Department of Neurology, Caen, France, ⁴Lariboisière Hospital, Emergency Headache Center, Department of Neurology, Paris, France, ⁵University Hospital of Montpellier, Clinical Research and Epidemiology Unit, Department of Medical Information, Montpellier, France, ⁶University Hospital of Montpellier, Charles Coulomb Laboratory, CNRS UMR 5221, Montpellier, France

Background and aims: Reversible cerebral vasoconstriction syndrome (RCVS) has a heterogenous clinical and radiological presentation. We investigated whether clinico-radiological complications of RCVS vary according to age.

Methods: In a pooled cohort of 345 French patients with RCVS, we compared 1) rates of clinical and radiological complications, and 2) the functional outcome at 3 months across different age groups (⩽19, 20 to 29, 30 to 39, 40 to 49, 50 to 59, ⩾60 years; P value from linear regression) and between young patients aged ⩽49 years versus those aged ⩾50 years.

Results: The risk for any focal deficit and for any brain lesion were independently associated with increasing age (OR 1.4, 95% CI 1.1-1.8; p=0.017, and OR 1.6, 95% CI 1.2-2.1; p<0.001, respectively). Subtypes of brain lesions independently associated with increasing age were subarachnoid haemorrhage (OR 1.8, 95% CI 1.3-2.4; p<0.001) and intracerebral haemorrhage (OR 1.5, 95% CI 1.1-2.2; p=0.023). Frequency of cervical artery dissections peaked at age 30-39, and young age was independently associated with cervical artery dissections (OR 13.6, 95% CI 2.4-76.6; p=0.003). The functional outcome was excellent regardless of age, with a modified Rankin scale score of 0-1 in >96% of patients.

Conclusions: Age seems to influence rates and types of complications of RCVS, with young age being associated with cervical artery dissections, and increasing age with haemorrhagic complications. If confirmed in larger prospective studies, recognition of age-specific patterns might help to guide clinical management and to identify complications in the setting of RCVS and vice versa.

Disclosure: No

O178 / 439

Scientific Communications 21 - Rare Causes, Stroke in the Young

FACTORS ASSOCIATED WITH ADVERSE OUTCOMES FOLLOWING CVT: ANALYSIS OF ACTION-CVT

P. Klein ¹, L. Shu², T.N. Nguyen¹, J.E. Siegler³, S. Salehi Omran⁴, A. Simpkins⁵, M. Heldner⁶, A. de Havenon⁷, H. Aparicio¹, M. Abdalkader¹, M. Psychogios⁸, M.C. Vedovati⁹, M. Paciaroni¹⁰, D.S. Liebeskind¹¹, D.A. de Sousa¹², J.M. Coutinho¹³, S. Yaghi², ACTION-CVT Study Group

¹Boston Medical Center, Boston University School of Medicine, Department of Neurology, Boston, United States, ²Brown University, Department of Neurology, Providence, United States, ³Cooper Neurological Institute, Cooper University Hospital, Department of Neurology, Camden, United States, ⁴University of Colorado School of Medicine, Department of Neurology, Aurora, United States, ⁵University of Florida, Department of Neurology, Gainesville, United States, ⁶Inselspital, University Hospital Bern, University of Bern, Department of Neurology, Bern, Switzerland, ⁷Yale University, Department of Neurology, New Haven, United States, ⁸University Hospital Basel, Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, Basel, Switzerland, ⁹University of Perugia, Department of Medicine and Surgery, Perugia, Italy, ¹⁰IRCCS MultiMedica, Neurology – Stroke Unit, Milan, Italy, ¹¹University of California at Los Angeles, Department of Neurology, Los Angeles, United States, ¹²Hospital de Santa Maria/CHULN, University of Lisbon, Department of Neurosciences and Mental Health, Neurology Service, Lisbon, Portugal, ¹³Amsterdam University Medical Center, Location AMC, Department of Neurology, Amsterdam, Netherlands

Background and aims:Limited data are available to predict neurological outcome following cerebral venous thrombosis (CVT). We sought to identify risk factors and to derive a prognostic score model for poor neurologic outcome and death following CVT.

Methods: We conducted an international multicenter retrospective study including consecutive patients with a confirmed diagnosis of CVT from January 2015 to December 2020. Univariable and multivariable logistic regressions were utilized to determine risk factors for poor outcome, defined as mRS 3-6. A prognostic score model was derived and internally validated via bootstrap analysis.

Results: A total of 1,025 patients across 27 centers were available for analysis with median 375 (IQR 180-747) days of follow-up. The median age was 44 (IQR 32-58) and 62.4% were female. Multivariable analysis revealed the following factors were associated with poor outcome at 90-day follow-up: active cancer (OR: 10.96 [95% CI: 4.26-28.19]; p<0.001), Black race (OR: 2.37 [1.13-4.99]; p=0.023), encephalopathy or coma on presentation (OR: 2.38 [1.13-5.02]; p=0.022), and increased NIHSS on presentation (OR: 1.07 [1.02-1.12]; p=0.005). Increased hemoglobin (OR: 0.86 [0.76-0.9]; p=0.030) was inversely associated with poor outcome at 90-day follow-up. The derived model IN-REVASC (AUC: 0.831 [0.788-0.873]) outperformed ISCVT-RS (AUC: 0.712 [0.659-0.764]) for the prediction of poor outcome at 90-day follow-up (Figure 1).

Conclusions: Active cancer, Black race, encephalopathy or coma on presentation, and increased NIHSS on presentation were associated with poor outcome following CVT. The IN-REVASC model offers increased accuracy for CVT outcomes compared to ISCVT-RS.

Figure 1.

Disclosure: No

O179 / 1234

Scientific Communications 21 - Rare Causes, Stroke in the Young

PREVALENCE OF FABRY DISEASE IN YOUNG-ADULT PATIENTS HOSPITALIZED FOR TIA, ISCHEMIC STROKE, OR INTRACEREBRAL HEMORRHAGE. FIRST REPORT FROM THE FABRY-STROKE ITALIAN REGISTRY (FSIR)

I. Romani ¹, C. Sarti¹, P. Nencini¹, G. Pracucci¹, S. Biagini¹, D. Accavone¹, M. Zedde², A. Nucera³, V. Cianci⁴, J. Moller⁵, D. Toni⁶, D. Orsucci⁷, C. Casella⁸, V. Pinto⁹, P. Palumbo¹⁰, L. Barbarini¹¹, R. Bella¹², M. Ragno¹³, U. Scoditti¹⁴, D.M. Mezzapesa¹⁵, R. Tassi¹⁶, M. Diomedi¹⁷, A. Cavallini¹⁸, G. Volpi¹⁹, A. Chiti²⁰, G. Bigliardi²¹, S. Sacco²², G. Linoli²³, S. Ricci²⁴, A. Giordano²⁵, B. Bonetti²⁶, M. Rasura²⁷, E. Cecconi²⁸, L. Princiotta Cariddi²⁹, R. Currò Dossi³⁰, M. Melis³¹, U. Aguglia⁴, M. Melis⁵, E. Sbardella⁶, M. Vista⁷, R.F. Musolino⁸, B. Passarella⁹, R. Valenti¹⁰, V. Direnzo¹¹, G. Pennisi¹², F. Di Marzio¹³, A. Genovese¹⁴, M. Acampa¹⁶, S. Nannucci¹⁹, D. Inzitari¹, FSIR Study Group

¹University of Florence, NEUROFARBA, Firenze, Italy, ²Santa Maria Nuova Hospital, Reggio Emilia, Italy, ³Spaziani Hospital, Frosinone, Italy, ⁴Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy, ⁵Brotzu Hospital, Cagliari, Italy, ⁶Sapienza University of Rome, Rome, Italy, ⁷Lucca Hospital, Lucca, Italy, ⁸AOU Policlinico G. Martino, University of Messina, Messina, Italy, ⁹Di Summa - Perrino Hospital, Brindisi, Italy, ¹⁰Santo Stefano Hospital, Prato, Italy, ¹¹Fazzi Hospital, Lecce, Italy, ¹²Vittorio Emanuele University Hospital, Catania, Italy, ¹³C. E G. Mazzoni Hospital and Madonna del Soccorso Hospital, Ascoli Piceno, Italy, ¹⁴Parma University Hospital, Parma, Italy, ¹⁵Bari Polyclinic Hospital, Bari, Italy, ¹⁶Siena University Hospital, Siena, Italy, ¹⁷Tor Vergata Polyclinic Hospital, Rome, Italy, ¹⁸C. Mondino Foundation, Pavia, Italy, ¹⁹San Iacopo Hospital, Pistoia, Italy, ²⁰Apuane Hospital, Massa, Italy, ²¹Sant’Agostino Estense New Hospital, Modena, Italy, ²²SS Filippo E Nicola Hospital, Avezzano, Italy, ²³San Donato Hospital, Arezzo, Italy, ²⁴Città Di Castello Hospital and Gubbio-Gualdo Tadino Hospital, Città di Castello, Italy, ²⁵Guzzardi Hospital, Ragusa, Italy, ²⁶Verona University Hospital, Verona, Italy, ²⁷Sant’Andrea Hospital, Rome, Italy, ²⁸Belcolle Hospital, Viterbo, Italy, ²⁹Circolo University Hospital, Varese, Italy, ³⁰Bolzano Hospital, Bolzano, Italy, ³¹Monserrato University Hospital, Cagliari, Italy

Background and aims: Fabry disease (FD) is a rare cause of stroke. There are no guidelines to help neurologists in selecting patients for FD screening. Data on Fabry-related stroke are evolving. We initiated the nationwide longitudinal Fabry-Stroke Italian Registry (FSIR) to screen a cohort of cerebrovascular patients and collect information on these purposes.

Methods: Overall, 1906 patients aged 18-60 years and admitted for TIA (246) ischemic stroke (1487), or intracerebral hemorrhage (173), were screened for FD among 33 stroke units. We recorded information on stroke severity, pathogenesis, and early FD symptoms.

Results: Males [median age 51 (IQR:45-56) years] represented the 67% of our cohort. Fifteen patients had a GLA gene mutation which based on genetic counseling was classified as: 6 (0.31%) polymorphic (c.937G>T x5, c.196G>C), 6 (0.31%) of uncertain significance (c.376A>G x3, c.427G>A, c.427G>A+c.1181T>C, c.856C>G), and 3 (0.16%) pathogenic for FD (c.1139C>T, c.337T>C, c.801+1G>T). No mutation was found in patients enrolled for intracerebral hemorrhage. Possible FD predictors (propensity score method) were: lower NIHSS (p=0.030), stroke recurrence (p=0.023), previous TIA (p<0.001), acroparesthesia (p=0.020), and hearing loss (p=0.003). Trends towards higher prevalence of small artery occlusion and absence of supra-aortic large artery atherosclerosis were observed in FD.

Conclusions: This study confirms FD as a rare diagnosis in Italian young adults with ischemic stroke. Despite the small number of FD cases compared to the much wider screened population, we observed trends for TIAs-strokes recurrence and small artery occlusion among FD patients, confirming the importance of continuing to study FD characteristics in the young stroke population.

Disclosure: No

O180 / 1362

Scientific Communications 21 - Rare Causes, Stroke in the Young

MECHANICAL TROMBECTOMY IN YOUNG ADULTS WITH ACUTE ISCHEMIC STROKE FROM LARGE VESSELS OCCLUSION: DATA FROM THE ITALIAN REGISTRY OF ENDOVASCULAR TREATMENT IN ACUTE STROKE

E. Nicolini ¹, V. Saia², G. Pracucci³, S. Mangiafico³, D. Toni⁴

¹Policlinico Umberto I - Sapienza University of Rome, Stroke Unit, Rome, Italy, ²Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy, ³NEUROFARBA Department, University of Florence, Florence, Italy, ⁴Sapienza University of Rome, Department of Human Neurosciences, Rome, Italy

Background: The weight of outcome predictors which are relevant in patients older than 60 years is not necessarily mirrored in the younger population, posing the question that outcome determinants specific for the latter might vary. Very few data are available specifically focusing on outcome and predictors of outcome of young AIS patients receiving endovascular treatment (EVT).

Methods: We analyzed data from the Italian registry of endovascular treatment in acute ischemic stroke (IRETAS), of 155 patients aged between 16 and 35 y.o. and 1382 between 36 and 55 y.o, and tested differences in term of functional outcome Secondarily, we looked for predictors of good outcome in this population.

Results: 935 (61.9%) patients aged 36-55 and 120 (74.1%) under 36 reached functional independence (mRS 0-2) at 90 days. Predictors of poor outcome in the first group were Age (aOR 1.043, 95%CI 1.006-1.081, p=0.022), diabetes (aOR 2.155, 95%CI 1.124–4.133, p=0..21) groin-to-recanalization (GtR) time (aOR 1.004, 95%CI 1.001-1.007, p=0.007), baseline NIHSS (aOR 1.113, 95%CI 10.082-1.145, p<0,001), symptomatic intracranial haemorrhage (aOR 6.533 95%CI 3.023-14.120, p<0,001) and successful recanalization (aOR 0.175, 95%CI 0.116-0.263, p<0.001). Predictors of poor outcome in under-36 were GtR (aOR 1.021 95%CI 1.004-1.039, p=0.018), arterial hypertension (aOR 14.944 95%CI 1.186-188.255, p=0.036) and successful recanalization (aOR 0.081, 95% CI 0.014-0.471, 0.005).

Conclusion: Studies evaluating EVT efficacy in young adults are scarce. Our real-life study suggests that procedural variables rather than common risk factors seem to have a major role in determining clinical outcome.

	Logistic regression model for 90-day mRS 3-6 in patients 36-55
	aOR	p	95% C.I.
Age	1.043	0.022	1.006 - 1.081
Sex	1.017	0.926	0.718 - 1.439
Baseline NIHSS	1.113	<0.001	10.082 -1.145
Arterial Hypertension	1.233	0.285	0.840 - 1.811
diabetes	2.155	0.021	1.124 - 4.133
Site of occlusion		0.980
Extracranial ICA	0.840	0.804	0.213 - 3.315
Carotid T	0.637	0.512	0.165 - 2.458
M1	0.699	0.590	0.189 - 2.577
M2	0.627	0.508	0.158 - 2.494
Tandem occlusion	0.762	0.700	0.191 - 3.036
Posterior circulation	0.823	0.783	0.207 -3.277
Direct MT	1.350	0.085	0.960 - 1.900
Groin to recanalization time	1.004	0.007	1.001 -1.007
TICI 2b-3	0.175	<0.001	0.116 -0.263
ASPECTS<6	1.371	0.468	0.584 - 3.219
sICH	6.533	<0.001	3.023 -14.120
	Logistic regression model for 90-day mRS 3-6 in patients Under 36
	aOR	p	95% C.I.
Age	0.916	0.208	0.800 - 1.050
Sex	3.094	0.206	0.538 - 17.786
Baseline NIHSS	1.099	0.055	0.998 1.210
Arterial Hypertension	14.944	0.036	1.186 - 188.255
Atrial fibrillation	0.497	0.728	0.010 - 25.464
Heart failure	10.110	0.211	0.270 - 378.434
ASPECTS < 6	7.639	0.248	0.243 - 240.419
Site of occlusion		0.388
Extracranial ICA	54056716.568	0.999	0
Carotid T	1415398.947	1.000	0
M1	4367916.409	1.000	0
M2	3271760.514	1.000	0
Tandem occlusion	143191791.932	0.999	0
Groin to recanalization time	1.021	0.018	1.004 - 1.039
TICI 2b-3	0.081	0.005	0.014 - 0.471

Disclosure: No

O181 / 228

Scientific Communications 22 - Stroke Complications & Outcome

SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR THE PREVENTION OF POST-STROKE DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

D. Richter ¹, J. Charles James¹, A. Ebert², A.H. Katsanos³, L. Mazul-Wach⁴, Q. Ruland⁴, R. Gold¹, G. Juckel², C. Krogias¹

¹Ruhr-University Bochum, Neurology, St. Josef-Hospital, Bochum, Germany, ²Ruhr-University Bochum, Psychiatry, LWL-Klinik, Bochum, Germany, ³McMaster University and Population Health Research Institute, Neurology, Hamilton, Canada, ⁴Ruhr-University Bochum, Bochum, Germany

Background and aims: The consequences of a stroke are often severe and affect both motor and non-motor aspects, including post-stroke depression (PSD) as the most common and distressing complication. There is controversial data on the efficacy of selective serotonin reuptake inhibitors (SSRIs) to prevent PSD. We aimed to perform a systematic meta-analysis to analyze the efficacy and the safety profile of early SSRI therapy for preventing PSD in patients after acute stroke.

Methods: We performed a systematic search to identify randomized controlled trials investigating early SSRI therapy (initiated <1 month after stroke) in post-stroke patients which reported PSD as primary or secondary outcome parameter. We extracted the data on PSD occurrence for each treatment arm (SSRI versus placebo), as reported by each study. A Random-effects model was used to calculate the pooled relative risk estimates. Information on adverse events were extracted for safety analysis. Missing outcome data bias was addressed by post-hoc sensitivity analysis.

Results: We included six studies with 6560 participants. Early SSRI therapy reduces the incidence of PSD compared to placebo (10.4% versus 13.8%; relative risk: 0.75 [95% CI, 0.66–0.86]; absolute risk reduction: 3.4%;). This finding was stable in sensitivity analysis. Early SSRI therapy increases the risk of bone fracture (RR 2.28 [95% CI, 1.58–3.30]) and nausea (RR 2.05 [95% CI, 1.10–3.82]).

Conclusions: As PSD is a substantial non-motor complication after stroke, future research should identify high-risk patients for PSD to improve the risk-benefit consideration of early SSRI therapy in the post-stroke population.

Disclosure: No

O182 / 631

Scientific Communications 22 - Stroke Complications & Outcome

REMOTE INTRACRANIAL HEMORRHAGE IN ACUTE ISCHEMIC STROKE: IMPACT OF INTRAVENOUS THROMBOLYSIS AND RISK FACTORS

L. Rascle ¹, A. Mattar¹, N. Nighoghossian¹, Y. Berthezene², T.B. Braemswig³, L. Derex¹, J. Fontaine¹, O.F Eker², M. Endres³, M. Jensen⁴, L. Mechtouff¹, R. Lemmens⁵, K. Muir⁶, C.H Nolte³, E. Ong¹, S. Pedraza⁷, L. Schlemm³, C.Z Simonsen⁸, C. Gerloff⁴, G. Thomalla⁴, T.-H. Cho¹

¹Hospices Civils de Lyon, Stroke Unit, Lyon, France, ²Hospices Civils de Lyon, Neuroradiology Department, Lyon, France, ³Charité – Universitätsmedizin, Department of Neurology, Berlin, Germany, ⁴Universitätsklinikum Hamburg–Eppendorf, Klinik und Poliklinik für Neurologie, Hamburg, Germany, ⁵University of Leuven, Department of Neurosciences, Leuven, Belgium, ⁶University of Glasgow, Institute of Neurosciences and Psychology, Glasgow, United Kingdom, ⁷Hospital Universitari Doctor Josep Trueta, Girona, Spain, ⁸Aarhus University Hospital, Danish stroke Center, Aarhus, Denmark

Background and aims: Remote intracranial hemorrhage (rICH: bleeding outside infarcted areas) is observed in 1.3-3.7% of acute ischemic stroke (AIS) patients treated by intravenous thrombolysis (IVT). The pathophysiology of rICH remains poorly understood. We aimed to: (1) assess the role of IVT in the occurrence of rICH; (2) identify other risk factors of rICH.

Methods: Patients from the WAKE-UP trial and RELATE (monocentric registry of AIS patients treated by IVT and/or thrombectomy), all of whom had a day-0 MRI, were assessed for rICH on day-1. The occurrence of rICH was compared between patients treated with or without IVT. Uni/multivariable logistic regressions identified the predictors of rICH among RELATE patients.

Results: IVT was associated with rICH in both WAKE-UP (N=503; 2.4% versus 0% in IVT and placebo-treated patients, respectively; p=0.03) and RELATE patients (N=1761; 3.2% versus 0% in IVT with/without thrombectomy and thrombectomy-only patients, respectively; p<0.0001). The table shows the variables associated with rICH in univariable analyses.

	OR	95% CI	P-value
Age (/year)	1.06	1.03-1.09	<0.001
Gender (male)	0.52	0.27-0.98	0.042
Current smoking	0.22	0.04-0.72	0.009
Total number of microbleeds	1.05	1.01-1.12	0.022
Probable cerebral amyloid angiopathy (CAA, modified Boston criteria)	10.65	4.01-25.40	<0.001
Total SVD (small vessel disease) score ⩾2	3.98	2.08-7.63	<0.001
Total Fazekas score ⩾3	3.74	1.88-7.94	<0.001

The best model in bidirectional stepwise multivariable regression incorporated age, probable CAA and total Fazekas score ⩾3 (AIC=290.6; p<0.0001).

Conclusions: IVT, increasing age and baseline MRI features indicating probable CAA and moderate to severe microangiopathy were associated with subsequent rICH.

Disclosure: No

O183 / 343

Scientific Communications 22 - Stroke Complications & Outcome

SAFETY AND OUTCOME OF REVASCULARIZATION TREATMENTS IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND COVID-19: RESULTS OF THE GLOBAL COVID-19 STROKE REGISTRY

J.P. Marto ¹, D. Strambo², G. Ntaios³, T.N. Nguyen⁴, R. Herzig⁵, A. Członkowksa⁶, J. Demeestere⁷, O.Y. Mansour⁸, G. Georgiopoulos^9,10, R. Nogueira¹¹, P. Michel², GLOBAL COVID-19 STROKE REGISTRY

¹Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Neurology, Lisbon, Portugal, ²Lausanne University Hospital, Stroke Center, Neurology Service, Department of Neurological Sciences, Lausanne, Switzerland, ³Faculty of Medicine, School of Health Sciences, University of Thessaly, Internal Medicine, Larissa, Greece, ⁴Boston Medical Center, Boston University School of Medicine, Neurology and Radiology, Boston, United States, ⁵Charles University Faculty of Medicine and University Hospital, Neurology, Comprehensive Stroke Center, Hradec Králové, Czech Republic, ⁶Institute of Psychiatry and Neurology, 2nd Department of Neurology, Warsaw, Poland, ⁷Leuven University Hospital, Neurology, Leuven, Belgium, ⁸Alexandria University Hospitals and Affiliated Stroke Network, Alexandria, Egypt, ⁹School of Biomedical Engineering and Imaging Sciences, St Thomas Hospital, King’s College London, London, United Kingdom, ¹⁰National and Kapodistrian University of Athens, Clinical Therapeutics, Athens, Greece, ¹¹Grady Memorial Hospital, Radiology, Neurology and Neurosurgery, Atlanta, United States

Background and aims: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with ischemic stroke (IS). We aimed to evaluate the safety and disability outcomes of revascularization treatments in patients with IS and COVID-19.

Methods: Retrospective multicenter cohort study of consecutive IS patients receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March-2020 and June-2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Study protocol was registered in ClinicalTrials.gov (NCT04895462).

Results: Among 15128 revascularized patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT only, and 9280 (61.3%) EVT (+/- IVT). As shown in the Figure, treated patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH), symptomatic subarachnoid hemorrhage (sSAH), the combination thereof, higher mortality at 24 hours and 3 months, and worse 3-month modified Rankin score (mRS). Results for treatment subgroups were similar, except that in the IVT-only group only SICH, 3-month mRS and mortality were significantly increased.

Conclusion: Ischemic stroke patients with COVID-19 showed higher rates of bleeding complications and worse clinical outcomes after acute revascularization treatments than contemporaneous non-COVID-19 treated patients.

Disclosure: No

O184 / 559

Scientific Communications 22 - Stroke Complications & Outcome

THE TIMING OF STROKE CARE PROCESSES AND DEVELOPMENT OF STROKE ASSOCIATED PNEUMONIA: A NATIONAL REGISTRY COHORT STUDY

M. Lobo Chaves¹, M. Gittins², B. Bray³, A. Vail², C. Smith ¹

¹University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom, ²University of Manchester, Centre for Biostatistics, Manchester, United Kingdom, ³King’s College London, School of Population Health and Environmental Sciences, London, United Kingdom

Background and aims: Little is known about how stroke care processes relate to complications such as the development of stroke associated pneumonia (SAP). Here we investigated associations between stroke care processes, their timing and development of SAP.

Methods: We obtained patient-level data from the Sentinel Stroke National Audit Programme for all confirmed strokes between 1st April 2013 and 31st December 2018. SAP was identified if new antibiotic initiation for pneumonia occurred within the first 7 days of admission. Time to key stroke care processes in the pre-hospital, hyperacute and acute phase were investigated. A mixed effects logistic regression model estimated the association between SAP (Odds ratios [OR] with 95% CI) and each process of care after controlling for pre-determined confounders such as age, stroke severity and comorbidities.

Results: SAP was identified in 8.5% of 413,133 patients in 169 stroke units. A longer time to arrival at a stroke unit after symptom onset or time last seen well [OR (95% CI) = [1.29 (1.23 to 1.35)], from admission to assessment by a stroke specialist [1.10 (1.06 to 1.14)] and from admission to assessment by a physiotherapist [1.16 (1.12 to 1.21)] were all independently associated with SAP. Shorter door to needle times for thrombolysis were associated with lower odds of SAP [0.90 (0.83 to 0.97)].

Conclusions: Times from stroke onset and admission to certain key stroke care processes were associated with SAP. Better understanding these relationships may enable development of preventive interventions to reduce antibiotic use and improve clinical outcomes.

Disclosure: No

O185 / 638

Scientific Communications 22 - Stroke Complications & Outcome

SEX DIFFERENCES IN INTENSITY OF CARE AND OUTCOMES AFTER ACUTE ISCHEMIC STROKE ACROSS THE LIFESPAN

A. Yu ¹, P.C Austin², M. Rashid², J. Fang², J. Porter², M.V Vyas¹, E.E Smith³, R. Joundi⁴, J.D Edwards⁵, M. Reeves⁶, M.K Kapral¹

¹University of Toronto, Toronto, Canada, ²ICES, Toronto, Canada, ³University of Calgary, Calgary, Canada, ⁴McMaster University, Hamilton, Canada, ⁵University of Ottawa, Ottawa, Canada, ⁶Michigan State University, East Lansing, United States

Background and aims: Sex differences in stroke care and outcomes have been previously reported, but it is not known if this association is modified by age. We evaluated whether the magnitude of female-male differences varied across the lifespan.

Methods: In a population-based cohort study, we used linked administrative data to identify patients hospitalized with ischemic stroke between 2012-2019 and followed through 2020 in Ontario, Canada. We used logistic regression to evaluate the association between age, sex, and care measures (intensive care unit, mechanical ventilation, gastrostomy tube, comprehensive stroke centre, stroke unit, revascularization treatments). We used Cox proportional hazard models for 90-day mortality. Models were adjusted for covariates and included an interaction between age and sex, where the relationship between outcomes and age was modeled using restricted cubic splines.

Result: Among 68,759 patients (45.8% women, median age 74 years [63,83]), women had lower odds of having a gastrostomy tube in the ages of 40-70 years compared to men (most extreme odds ratio (OR) and 95% confidence intervals (CI) 0.68 [0.48,0.86]) or >90 years (0.36 [0.16,0.72]), and higher odds of receiving endovascular thrombectomy between 54-66 years (most extreme OR 95% CI 1.40 [1.10,2.00]) and 80-90 years (1.70 [1.20,2.10]). Women had higher hazard of 90-day death than men between 50-70 years (most extreme hazard ratio 95% CI 1.22 [1.08,1.44], Figure 1).

Conclusion: Sex differences in stroke care and outcomes varied with age, highlighting that sex effects in stroke should be examined and interpreted in light of their interactions with age.

Disclosure: No

O186 / 654

Scientific Communications 22 - Stroke Complications & Outcome

COEXISTENT CEREBRAL SMALL VESSEL DISEASE AND MULTIPLE INFARCTIONS PREDICT RECURRENC IN PATIENTS WITH ACUTE MINOR STROKE OR TRANSIENT ISCHAEMIC ATTACK

Y. Tian ^1,2,3,4,5, Y. Pan^1,2,3,4,5, W. Wang^1,2,3,4,5, Y. Wang^1,2,3,4,5

¹Beijing Tiantan Hospital of Capital Medical University, Neurology, Beijing, China, ²Chinese Institute for Brain Research, Beijing, China, ³China National Clinical Research Center for Neurological Diseases, Beijing, China, ⁴Advanced Innovation Center for Human Brain Protection of Capital Medical University, Beijing, China, ⁵Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China

Background and purpose: To investigate the association of different status of cerebral small vessel disease (CSVD) and infarction number with recurrence after acute minor stroke and transient ischaemic attack (TIA).

Methods: This study was a post hoc analysis of the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, and includes 886 patients with acute minor stroke and TIA. The status of CSVD and infarction number was recorded for each individual. Infarction number were classified as multiple acute infarctions (MAIs,⩾2), single acute infarction(SAI, =1) and non-acute infarction (NAI, =0). The CSVD burden were grouped into non-CSVD (0 score) and CSVD (1-4 score). The primary outcome was a recurrent stroke at the 1-year follow-up. The secondary outcomes were recurrent ischaemic stroke, composite vascular event (CVE), and TIA. We analyzed the relationships between different status of CSVD burden and infarction pattern with the risk of outcomes using multivariable Cox regression models.

Results: Among all 886 patients included in present analysis, recurrent stroke was occurred in 93 (10.5%) patients during 1-year follow-up. After adjusted for all potential covariates, compared with patients with non-CSVD and NAI, patients with CSVD and MAIs were associated with approximately 9.5-fold increased risk of recurrent stroke at 1 year (HR 9.560, 95% CI 1.273–71.787, p=0.028). Similar results observed in ischaemic stroke and CVE.

Conclusion: The status of CSVD and infarction number predicted recurrent stroke in patients with acute minor stroke and TIA, especially for those with coexistent CSVD and MAIs.

Table.

Risk of outcomes by CSVD and infarction number in patients with minor ischaemic stroke or TIA at 1-year follow-up.

Outcomes	No.	Event, n(%)	Model 1		Model 2
			Adjusted HR(95%CI)	P value	Adjusted HR(95%CI)	P value
Stroke
No CSVD with NAI	58	1(1.7)	Ref.		Ref.
CSVD with NAI	225	7(3.1)	1.78(0.22-14.59)	0.59	1.73(0.21-14.33)	0.61
No CSVD with SAI	86	11(12.8)	8.03(1.04-62.20)	0.05	7.86(1.00-61.50)	0.05
CSVD with SAI	312	40(12.8)	7.88(1.08-57.55)	0.04	7.27(0.98-54.09)	0.05
No CSVD with MAIs	50	7(14.0)	9.10(1.12-74.04)	0.04	8.86(1.08-72.69)	0.04
CSVD with MAIs	155	27(17.4)	10.66(1.44-78.98)	0.02	9.56(1.27-71.79)	0.03
Ischaemic Stroke
No CSVD with NAI	58	1(1.7)	Ref.		Ref.
CSVD with NAI	225	7(3.1)	1.78(0.22-14.59)	0.59	1.73(0.21-14.33)	0.61
No CSVD with SAI	86	11(12.8)	8.03(1.04-62.20)	0.05	7.86(1.00-61.50)	0.05
CSVD with SAI	312	40(12.8)	7.88(1.08-57.55)	0.04	7.27(0.98-54.09)	0.05
No CSVD with MAIs	50	7(14.0)	9.10(1.12-74.04)	0.04	8.86(1.08-72.69)	0.04
CSVD with MAIs	155	27(17.4)	10.66(1.44-78.98)	0.02	9.56(1.27-71.79)	0.03
CVE
No CSVD with NAI	58	1(1.7)	Ref.		Ref.
CSVD with NAI	225	7(3.1)	1.76(0.22-14.44)	0.60	1.70(0.21-14.06)	0.62
No CSVD with SAI	86	11(12.8)	8.03(1.04-62.17)	0.05	8.00(1.02-62.63)	0.05
CSVD with SAI	312	40(12.8)	7.82(1.07-57.15)	0.04	7.32(0.99-54.42)	0.05
No CSVD with MAIs	50	7(14.0)	9.08(1.12-73.85)	0.04	9.02(1.10-73.93)	0.04
CSVD with MAIs	155	30(19.4)	11.81(1.60-87.17)	0.02	10.84(1.45-81.04)	0.02
TIA
No CSVD with NAI	58	5(8.6)	Ref.		Ref.
CSVD with NAI	225	7(3.1)	0.32(0.10-1.07)	0.06	0.36(0.10-1.28)	0.11
No CSVD with SAI	86	1(1.2)	0.13(0.02-1.15)	0.07	0.18(0.02-1.64)	0.18
CSVD with SAI	312	4(1.3)	0.14(0.04-0.53)	0.004	0.24(0.06-1.01)	0.05
No CSVD with MAIs	50	1(2.0)	0.22(0.03-1.93)	0.17	0.30(0.03-2.64)	0.28
CSVD with MAIs	155	6(3.9)	0.40(0.12-1.39)	0.15	0.63(0.17-2.40)	0.50

CVE, composite vascular event; TIA, transient ischaemic attack; CSVD, cerebral small vessel disease; NAI, non-acute infarction; SAI, single acute infarction; MAIs, multiple acute infarctions; N.A., not available; Ref, reference.

Model 1: adjusted for age and sex.

Model 2: adjusted for age, gender, body mass index, history of ischaemic stroke, TIA, coronary artery disease, atrial fibrillation, hypertension, diabetes, hypercholesterolaemia, smoking status, time to randomization, qualifying event, NIHSS score on admission, and antiplatelet therapy.

Disclosure: Yes

O187 / 726

Scientific Communications 22 - Stroke Complications & Outcome

COMPARISON OF OUTCOMES BETWEEN IN-PERSON AND VIRTUAL TIA CLINIC VISITS

S. Fridman ^1,2, L. Mai^1,2, J.L. Mandzia^1,2, A.V. Khaw^2,3,1, D. Ayan², L.A. Sposato^1,2,3

¹Western University / London Health Science Centre, Clinical Neurological Sciences, London, Canada, ²Lawson Research Institute, London, ON, Canada, London, Canada, ³Robarts Research Institute, London, Canada

Background and aims: During the COVID-19 pandemic, outpatient services transitioned mostly to virtual care. It is unknown if virtual Urgent TIA Clinic care outcomes are comparable to those of in-person visits. We, therefore, compared the risk of major adverse cardiovascular events (MACE) at 12 months between first virtual and in-person Urgent TIA Clinic visits.

Methods: A virtual TIA Clinic was implemented in March 2020 in a Regional Stroke Center as an urgent response to the COVID-19 pandemic. We conducted a retrospective observational study by interrogating prospectively collected data from the London Ontario Stroke Registry. We used 26 epidemiological weeks from 2019 (in-person, pre-pandemic) and 2020 (virtual, pandemic). We included patients with and without a final diagnosis of stroke or TIA. The primary outcome was MACE (stroke, acute coronary syndromes, heart failure hospitalizations, and cardiovascular death) at 12 months. We applied propensity score weighted Cox regression analyses to control for risk factors, vascular comorbidities, presenting symptoms, diagnostic investigations, and secondary prevention therapies (see table for a comprehensive list), further adjusted for the final diagnosis (cerebrovascular vs. non-cerebrovascular event).

Results: We included1153 patients, 700 assessed in-person and 453 virtually. The median age was 70 years, and 53% were females. MACE occurred in 27 (3.9%) in-person and 14 (3.1%) virtual care patients at 12 months, a statistically non-significant difference (adjusted HR 0.95, 95%CI 0.46 to 1.99; P=0.90).

Conclusions: We found no differences in MACE at 12 months between in-person and virtual care visits in an Urgent TIA Clinic.

Variables	Missing(%)	Overall,N = 1,153	In person,N = 700	Virtual,N = 453	SMD
Age at encounter, Median (IQR)	<0.1	70 (58 – 79)	71 (59 – 79)	67 (57 – 78)	0.060
Female, n (%)	<0.1	615 (53)	388 (56)	227 (50)	0.120
BMI, Median (IQR)	17	27.0 (23.9 – 31.2)	26.9 (23.9 – 31.2)	27.4 (23.9 – 31.1)	0.017
First event, n (%)	0	1,045 (91)	628 (90)	417 (92)	0.082
Days from event to encounter,Median (IQR)	9.8	7 (4 – 14)	7 (4 – 15)	5 (3 – 11)	0.045
During COVID-19 pandemic	0	576 (50%)	123(18%)	453 (100%)	3.063
Past Medical History
History of migraine, n (%)	0.3				0.114
With aura		106 (9.2)	71 (10)	35 (7.7)
Without aura		52 (4.5)	30 (4.3)	22 (4.9)
Aura not known		67 (5.8)	45 (6.4)	22 (4.9)
Prior ischemic stroke, n (%)	<0.1	124 (11)	80 (11)	44 (9.7)	0.056
Prior TIA, n (%)	0.3	82 (7.1)	51 (7.3)	31 (6.9)	0.017
Prior cerebral amyloid angiopathy, n (%)	0.2	5 (0.4)	5 (0.7)	0 (0)	0.120
Hypertension, n (%)	<0.1	680 (59)	425 (61)	255 (56)	0.090
Diabetes, n (%)	0.3	275 (24)	177 (25)	98 (22)	0.085
Dyslipidemia, n (%)	<0.1	552 (48)	329 (47)	223 (49)	0.045
Chronic kidney disease, n (%)	0.3	44 (3.8)	28 (4.0)	16 (3.5)	0.024
Coronary artery disease, n (%)	0	130 (11)	76 (11)	54 (12)	0.033
Atrial Fibrillation, n (%)	0.2	135 (12)	89 (13)	46 (10)	0.081
Prior myocardial infarction, n (%)	0.2	89 (7.7)	55 (7.9)	34 (7.5)	0.014
Peripheral artery disease, n (%)	0.4	29 (2.5)	24 (3.4)	5 (1.1)	0.157
Congestive heart failure, n (%)	0.3	31 (2.7)	22 (3.2)	9 (2.0)	0.074
Deep venous thrombosis, n (%)	0.2	37 (3.2)	20 (2.9)	17 (3.8)	0.051
Pulmonary embolism, n (%)	0.5	19 (1.7)	15 (2.1)	4 (0.9)	0.103
Current smoker, n (%)	1.1	208 (18)	125 (18)	83 (19)	0.014
Alcohol intake, n (%)	6.0				0.158
No alcohol intake		517 (45)	334 (48)	183 (41)
2 or more SD/day		116 (10)	70 (10)	46 (10)
less than 2 SD/day		452 (40)	266 (38)	186 (42)
Recreational drugs, n (%)	10	117 (10)	67 (9.6)	50 (11)	0.067
Physically active, n (%)	<0.1	355 (31)	235 (34)	120 (26)	0.196
Not applicable		303 (26)	163 (23)	140 (31)
Clinical Presentation
Weakness, n (%)	18	292 (31)	175 (29)	117 (35)	0.139
Numbness, n (%)	18	365 (38)	220 (36)	145 (42)	0.113
Dysmetria, n (%)	23	38 (4.3)	28 (4.8)	10 (3.3)	0.078
Vertigo, n (%)	22	110 (12)	71 (12)	39 (13)	0.012
Neglect, n (%)	24	4 (0.5)	2 (0.3)	2 (0.7)	0.044
Dizziness, n (%)	22	129 (14)	87 (15)	42 (13)	0.048
Dysarthria, n (%)	20	177 (19)	115 (19)	62 (19)	0.021
Aphasia, n (%)	19	151 (16)	97 (16)	54 (16)	0.018
Dysphagia, n (%)	24	9 (1.0)	4 (0.7)	5 (1.7)	0.089
Agnosia, n (%)	24	4 (0.5)	3 (0.5)	1 (0.3)	0.030
Apraxia, n (%)	28	5 (0.6)	5 (0.9)	0 (0)	0.137
Transient global amnesia, n (%)	27	21 (2.5)	14 (2.6)	7 (2.4)	0.012
Alexia/Agraphia/Dystypia, n (%)	24	14 (1.6)	10 (1.7)	4 (1.3)	0.034
Transient monocular blindness, n (%)	23	61 (6.9)	36 (6.2)	25 (8.1)	0.075
Diplopia, n (%)	23	59 (6.6)	32 (5.5)	27 (8.7)	0.123
Hemianopia, n (%)	24	35 (4.0)	20 (3.5)	15 (4.9)	0.073
Visual spacial disturbances, n (%)	20	163 (18)	98 (17)	65 (20)	0.081
Visual aura, n (%)	23	74 (8.3)	49 (8.5)	25 (8.0)	0.017
Loss of consciousness, n (%)	24	34 (3.9)	24 (4.2)	10 (3.3)	0.047
Headache, n (%)	18	292 (31)	173 (29)	119 (34)	0.109
Abnormal movements or Limb shacking, n (%)	24	35 (4.0)	21 (3.7)	14 (4.6)	0.049
Duration of symptoms, n (%)	26				0.076
Less or equal to 10min		194 (23)	110 (23)	84 (23)
Between 11 to 60min		211 (25)	112 (23)	99 (27)
More than 60 min		252 (30)	147 (30)	105 (29)
Persistent		193 (23)	116 (24)	77 (21)
Baseline treatments and investigations
Any prescribed medication, n (%)	0.2	1,047 (91)	640 (92)	407 (90)	0.052
Antiplatelets, n (%)	9.4	430 (41)	253 (40)	177 (44)	0.083
Oral anticoagulants, n (%)	9.5	139 (13)	93 (15)	46 (11)	0.095
Lipid-lowering agents, n (%)	9.4	504 (48)	303 (47)	201 (49)	0.039
Anti-hypertensives, n (%)	9.5	537 (51)	343 (54)	194 (48)	0.120
Beta-blockers, n (%)	9.6	223 (21)	147 (23)	76 (19)	0.107
Diabetes medications, n (%)	0.3	173 (15)	116 (17)	57 (13)	0.117
CT Head, n (%)	0	158 (14)	96 (14)	62 (14)	0.009
CT Angiography, n (%)	0	336 (29)	203 (29)	133 (29)	0.010
ECG, n (%)	0	409 (35)	237 (34)	172 (38)	0.084
Blood work, n (%)	0	555 (48)	309 (44)	246 (54)	0.202
MR Head, n (%)		40 (3.5)	28 (4.0)	12 (2.6)	0.055
MR Angiography, n (%)		24 (2.1)	12 (1.7)	12 (2.6)	0.064
Echocardiogram, n (%)		63 (5.5)	42 (6.0)	21 (4.6)	0.051

Disclosure: No

O188 / 1112

Scientific Communications 22 - Stroke Complications & Outcome

PRESTROKE PHYSICAL INACTIVITY PREDICTS MODERATE TO SEVERE STROKE IN MALE AND FEMALE PATIENTS

P. Salmantabar ¹, T. Abzhandadze^1,2, A. Viktorisson¹, M. Reinholdsson^1,2, K. S. Sunnerhagen¹

¹University of Gothenburg, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine, Gothenburg, Sweden, ²Sahlgrenska University Hospital, Department of Occupational Therapy and Physiotherapy, Gothenburg, Sweden

Background and aims: Studies have reported associations between pre-stroke physical activity and stroke severity. However, it is unclear if this association differs between males and females. Therefore, we aimed to explore the association between pre-stroke physical inactivity and stroke severity in male and female patients with ischemic stroke.

Methods: This was a retrospective, registry-based study. The data were retrieved from two stroke registries. The primary explanatory variable was physical inactivity prior to stroke, assessed using the Saltin-Grimby Physical Activity Level Scale (range 1-4, 1 indicated physical inactivity). The outcome was moderate to severe stroke at hospital admission, assessed using the National Institutes of Health Stroke Scale (NIHSS, ⩾ 6 indicated moderate to severe stroke). Binary logistic regression analyses were performed.

Results: In total 4535 patients with ischemic stroke were included. Female patients (n = 2145) had a mean age of 76 years, 35 % had moderate to severe stroke, and 64% were physically inactive pre-stroke. Male patients (n = 2390) had a mean age of 72 years, 26 % had moderate to severe stroke, and 49% were physically inactive pre-stroke. Physical inactivity was associated with higher odds of experiencing moderate to severe stroke in both sexes (females’ odds ratio [OR], 2.7, 95% confidence interval [CI] 2.2–3.3, p < 0.001 and males’ OR, 2.06, 95% CI 1.7–2.49, p <0.001).

Conclusions: Physically inactive females and males had higher odds of experiencing a moderate to severe stroke. However, the OR of female patients was somewhat higher than that of male patients.

Disclosure: No

O189 / 1063

Scientific Communications 23 - Secondary Prevention

MULTIMORBIDITY AND RISK OF MAJOR BLEEDING ON ANTIPLATLET TREATMENT AFTER TIA OR STROKE: A POPULATION BASED STUDY

M. Downer ¹, L. Li¹, P. Rothwell¹, Oxford Vascular Study

¹ University of Oxford, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom

Background and aims: Bleeding on antiplatelet treatment is a major concern following transient ischaemic attack (TIA) or ischaemic stroke. Recent predictive models have included individual comorbidities, but not multimorbidity.

Methods: We studied all patients with a first-in-study TIA or ischaemic stroke from 2002-2012 ascertained in a population-based study (Oxford Vascular Study) who were subsequently treated with antiplatelet drugs. We identified all bleeding events requiring medical attention by 10-year face-to-face follow-up and from multiple other sources. Multimorbidity at baseline was quantified using the Charlson Comorbidity Index (CCI). Cox regression adjusted for age and C-statistics were used to quantify the association of multimorbidity with risk of bleeding.

Results: Of 2071 patients (mean/SD age=72.9/13.4), 524 (25.3%) had 1 CCI comorbidity, 390 (18.8%) had 2, and 348 (16.8%) had ⩾3. After adjustment for age, CCI predicted any bleeding (HR per CCI comorbidity=1.32, 95%CI 1.22-1.43), major bleeding (1.41, 1.26-1.58), and disabling or fatal bleeding (1.36,1.17-1.59). CCI also predicted upper GI bleeding (1.37, 1.21-1.54), all major GI bleeding (1.36, 1.22-1.52) and non-GI bleeding (1.18 95%CI 1.01-1.37), but not intracranial bleeding (1.14, 0.93-1.39, p=0.21). The C-statistic for CCI alone was 0.60 (95%CI 0.56-0.64) for any bleeding, 0.64 (0.59-0.69) for major bleeding, and 0.63 (0.55-0.71) for disabling or fatal bleeding.

Conclusions: Multimorbidity was independently predictive of major bleeding on antiplatelet treatment after TIA and ischaemic stroke and might improve the performance of predictive models.

Disclosure: No

O190 / 260

Scientific Communications 23 - Secondary Prevention

CEREBROVASCULAR EVENTS AND INFLUENCE OF ANTITHROMBOTIC THERAPY DURING FOLLOW-UP OF PATIENTS WITH ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACKS AND CORTICAL SUPERFICIAL SIDEROSIS

J. Martí-Fàbregas ¹, L. Prats-Sánchez¹, J. Best², P. Camps-Renom¹, A. Ramos-Pachón¹, A. Martínez-Domeño¹, M. Guasch-Jiménez¹, D. Guisado-Alonso¹, D. Werring², on behalf of the MICON Collaborators

¹Hospital de la Santa Creu i Sant Pau, Biomedical Research institute Sant Pau, Neurology, Barcelona, Spain, ²Stroke Research Centre, UCL Queen Square Institute of Neurology, Brain Repair and Rehabilitation, London, United Kingdom

Background and aims: Patients with cortical superficial siderosis (cSS) have an increased risk of intracranial haemorrhage (ICHr) during follow-up. However, the risk of future ischemic stroke (IS) and death, and the effects of antithrombotic agents are undefined.

Methods: We retrospectively analysed the MICON database, which includes pooled individual patient-data. We selected patients from 21 prospective cohorts who had an IS or transient ischemic attack, MR-assessment of cSS, available information on antithrombotic treatments as well as cerebrovascular events and mortality during follow-up. We performed Cox regression analyses.

Results: We studied 12,669 patients (mean age 70.4±12.3 years, 57.3% were men). cSS was detected in 273 (2.2%) patients and mean follow-up was 24±17 months. In univariable analysis, cSS was associated with the occurrence of ICHr, IS, any stroke (ICHr or IS), and death. However, after multivariable analysis, only the risk of any stroke was significantly increased (aHR 1.62, 95%CI 1.14-2.28, p=0.006, incidence cSS group/non-cSS group: 83 versus 42/1000 patient-years, p=0.0002). In patients receiving antiplatelets, the adjusted incidence of ICHr (aHR 2.89, 95%CI 1.15-7.25, p=0.024), any stroke (aHR 1.74, 95%CI 1.17-2.59, p=0.006) and death (aHR 1.54, HR 1.54, 95%CI 1.03-2.31, p=0.033) was increased in patients with cSS compared to non-cSS. However, cSS was not significantly associated with outcomes in patients treated with oral anticoagulants.

Conclusions: Patients with IS and CSS are at an increased risk of any stroke during follow-up. Moreover, the subgroup of patients with cSS who receive antiplatelets have an increased incidence of ICHr, any stroke and death during follow-up.

Disclosure: No

O191 / 1247

Scientific Communications 23 - Secondary Prevention

APPLICATION OF NEUROIMAGING PREDICTORS FOR STROKE RECURRENCE IN PATIENTS WITH ATRIAL FIBRILLATION

D.Y. Kim ¹, S.-G. Han¹, H.-G. Jeong¹, K.-J. Lee¹, B.J. Kim¹, M.-K. Han¹, K.-H. Choi², J.-T. Kim², D.-I. Shin³, J.-K. Cha⁴, D.-H. Kim⁴, D.-E. Kim⁵, W.-S. Ryu⁵, J.-M. Park⁶, K. Kang⁷, J.G. Kim⁸, S.J. Lee⁸, M.-S. Oh⁹, K.-H. Yu⁹, B.-C. Lee⁹, H.-K. Park¹⁰, K.-S. Hong¹⁰, Y.-J. Cho¹⁰, J.C. Choi¹¹, S.I. Sohn¹², J.-H. Hong¹², T.H. Park¹³, K.B. Lee¹⁴, J.-H. Kwon¹⁵, W.-J. Kim¹⁵, J. Lee¹⁶, J.S. Lee¹⁷, J. Lee¹⁸, H.-J. Bae¹, EAST-AF Study Group

¹Seoul National University Bundang Hospital, Seoul National University College of Medicine, Department of Neurology and Cerebrovascular Center, Seongnam, Korea, Republic of, ²Chonnam National University Hospital, Department of Neurology, Gwangju, Korea, Republic of, ³Chungbuk National University Hospital, Department of Neurology, Cheongju, Korea, Republic of, ⁴Dong-A University Hospital, Dong-A University College of Medicine, Department of Neurology, Busan, Korea, Republic of, ⁵Dongguk University Ilsan Hospital, Department of Neurology, Goyang, Korea, Republic of, ⁶Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Department of Neurology, Uijeongbu, Korea, Republic of, ⁷Nowon Eulji Medical Center, Eulji University School of Medicine, Department of Neurology, Seoul, Korea, Republic of, ⁸Daejeon Eulji Medical Center, Eulji University School of Medicine, Department of Neurology, Daejeon, Korea, Republic of, ⁹Hallym University Sacred Heart Hospital, Department of Neurology, Anyang, Korea, Republic of, ¹⁰Inje University Ilsan Paik Hospital, Inje University College of Medicine, Department of Neurology, Goyang, Korea, Republic of, ¹¹Jeju National University Hospital, Jeju National University School of Medicine, Department of Neurology, Jeju, Korea, Republic of, ¹²Keimyung University Dongsan Medical Center, Department of Neurology, Daegu, Korea, Republic of, ¹³Seoul Medical Center, Department of Neurology, Seoul, Korea, Republic of, ¹⁴Soonchunhyang University Hospital, College of Medicine, Department of Neurology, Seoul, Korea, Republic of, ¹⁵Ulsan University Hospital, Ulsan University College of Medicine, Department of Neurology, Ulsan, Korea, Republic of, ¹⁶Yeungnam University Hospital, Department of Neurology, Daegu, Korea, Republic of, ¹⁷Asan Medical Center, Clinical Research Center, Seoul, Korea, Republic of, ¹⁸Korea University College of Medicine, Department of Biostatistics, Seoul, Korea, Republic of

Background and aims: The usefulness of the existing risk stratification tool, CHA₂DS₂-VASc score for atrial fibrillation (AF) is limited in predicting stroke recurrence in patients with acute ischemic stroke (AIS). Neuroimaging parameters obtained from diagnostic work-up of AIS could offer more elaborate prediction.

Methods: A multicenter prospective cohort of AIS patients with AF recruited from 14 university hospitals or regional stroke centers were followed up for recurrent ischemic stroke (RIS) and a composite of all stroke and TIA. Neuroimaging parameters collected acute infarction and chronic infarction patterns and small vessel disease markers including chronic infarction, lacunes, cerebral microbleeds, and white matter hyperintensities. Cumulative incidence according to each neuroimaging parameter was estimated and compared multivariable cause-specific hazard models with non-stroke death as a competing risk.

We defined CHA₂DS₂-VASc-NIP score as a sum of CHA₂DS₂-VASc score and scores from each neuroimaging parameters of P-value <0.05 in the multivariable model.

Results: A total of 2,270 patients were followed up for 431 days (IQR, 365-735), during which 111 RISs and 130 composite outcomes occurred. The adjusted HRs of acute infarction multiplicity, chronic infarction and lacunes were 1.51 (95% CI, 1.04-2.21), 1.64 (1.12-2.38) and 1.91 (1.29-2.85) for RIS, respectively. Similar findings were obtained for the composite outcome. With addition of these three parameters, CHA₂DS₂-VASc-NIP score were defined. CHA₂DS₂-VASc-NIP score showed three-year event rates from 1.7% (0.0-4.0) for 3 points to 20.8% (5.8-33.4) for 10 points with a linear trend.

Conclusions: Several neuroimaging markers could be applied in the prediction of RIS in AIS with AF.

	Unadjusted model		Adjusted model *
Neuroimaging parameters	HR (95% CI)	P-value	HR (95% CI)	P-value
Multiple acute infarction(vs. single acute infarction)	1.52(1.04-2.21)	0.030	1.51(1.04-2.21)	0.033
Presence of chronic infarction	1.67(1.15-2.42)	0.007	1.64(1.12-2.38)	0.010
Presence of lacunes	1.96(1.3-2.89)	0.0007	1.91(1.29-2.85)	0.001
Presence ofcerebral microbleeds	1.34(0.91-1.97)	0.14	1.30(0.88-1.92)	0.18
White matter hyperintensities (Fazekas 2-3) vs.(Fazekas 0-1)	1.38(0.95-2.01)	0.09	1.36(0.90-2.04)	0.14

*

Variables adjusted are age, sex, history of stroke/TIA, hypertension, diabetes mellitus, heart failure, history of coronary artery disease, symptomatic steno-occlusive lesion, discharge antithrombotics, discharge statin treatment

Disclosure: No

O192 / 1206

Scientific Communications 23 - Secondary Prevention

NOT USING OF STATIN THERAPY AND OUTCOMES AFTER ISCHEMIC STROKE

J. Åivo¹, J. Ruuskanen ¹, A. Tornio², P. Rautava³, V. Kytö^4,5,6

¹University of Turku, Neurocenter, Turku University Hospital and Clinical neurosciences, Turku, Finland, ²Institute of Biomedicine University of Turku, Clinical Pharmacology, Turku University Hospital and Integrative Physiology and Pharmacology, Turku, Finland, ³University of Turku, Turku, Clinical Research Center, Turku University Hospital and Department of Public Health, Turku, Finland, ⁴University of Turku, Heart Center, Turku University Hospital and Clinical Research Centre of Applied and Preventive Cardiovascular Medicine, Turku, Finland, ⁵University of Turku, Center for Population Health Research, Turku University Hospital, Turku, Finland, ⁶University of Helsinki, Department of Public Health, Helsinki, Finland

Background and aims: Statin treatment is effective in preventing recurrent stroke and other vascular events after ischemic stroke (IS). However, a number of patients do not use statins. We studied the influence of not using statins after IS on adverse outcomes.

Methods: Data from all IS patients admitted to 20 Finnish hospitals between Jan 1^st 2005 – Dec 31 2017 were combined from national registries on hospital admissions, mortality and causes of death and prescription medication purchases. Usage of prescription medicines after IS was defined as drug purchase within 90 days after hospital discharge. Differences in baseline features, comorbidities, revascularisation and other evidence-based medications were balanced with inverse probability of treatment weighting.

Results: 59,588 patients were identified. Statin was not used by 27.1% early after discharge. Patients not using statins had higher all-cause mortality in 1-year (7.5% vs 4.4%; p<0.0001) and 12-year follow up (56.8% vs 48.6%; HR 1.37; CI 1.33-1.41; p<0.0001). The number needed to harm by not using statins was 31.9 at 1 years and 8.9 at 12 years. New IS, myocardial infarction, and cardiovascular death were more frequent without early statin use, and cumulative incidence of a major adverse cerebrovascular or cardiovascular event was higher at 1-year (p<0.0001) and 12 years (sub distribution HR 1.21; p<0.0001). Probability of haemorrhagic stroke was not increased by statin use (p=0.094)

Conclusions: Not using statins after IS is associated with increase in mortality and adverse ischemic outcomes. Measures to improve statin use early after IS are needed.

Disclosure: No

O193 / 1492

Scientific Communications 23 - Secondary Prevention

CHARACTERISTICS ASSOCIATED WITH SELF-MONITORING OF BLOOD PRESSURE (BP) 90 DAYS AFTER DISCHARGE IN PATIENTS WITH STROKE OR TIA: THE COMPREHENSIVE POST-ACUTE STROKE SERVICES (COMPASS) STUDY

C.D. Bushnell ¹, S.B. Jones², W.D. Rosamond², M.A. Psioda², J.R. Halladay², D.M. Cummings³, A.M. Johnson², B.J. Lutz⁴, S.B. Gesell⁵, J. Prvu-Bettger⁶, A.M. Pastva⁶, A.M. Kucharska-Newton⁷, M.E. Sissine⁵, P.W. Duncan⁵

¹Wake Forest School of Medicine, Neurology, Winston Salem, United States, ²University of North Carolina at Chapel Hill, Chapel Hill, United States, ³East Carolina University, Greenville, United States, ⁴University of North Carolina at Wilmington, Wilmington, United States, ⁵Wake Forest School of Medicine, Winston Salem, United States, ⁶Duke University, Durham, United States, ⁷University of Kentucky, Lexington, United States

Background and aims: The COMPASS transitional care (COMPASS-TC) intervention was associated with improved 90-day BP self-monitoring in patients with stroke or TIA. Here we evaluated clinical and demographic characteristics of COMPASS-TC patients who did not self-monitor BP.

Methods: COMPASS was a cluster-randomized pragmatic trial comparing COMPASS-TC to usual care at 40 hospitals in North Carolina, United States. COMPASS-TC included a BP log at discharge, 2-day post-discharge phone call, and clinic visit within 14 days during which a nurse conducted a functional assessment to determine social, medical, and physical health determinants, provided a tailored care plan, and encouraged BP self-management. We evaluated covariates associated with lack of self-reported regular BP monitoring at 90 days. The population included 1,919 patients in the intervention arm who attended the clinic visit and completed the survey. Statistical analysis utilized chi-square tests (categorical variables) and t-tests (continuous variables).

Results: At 90 days, 25% of participants were not self-monitoring their BP. Factors significantly associated with not self-monitoring included lack of insurance, black race, younger age, Hispanic ethnicity, smoking, history of depression, no history of hypertension, and cardiovascular comorbidities. In addition, not knowing BP is a stroke risk factor, not having a caregiver, and systolic BP<140 mm Hg at the visit were associated with absence of BP self-monitoring.

Conclusions: A quarter of patients who received COMPASS-TC were not self-monitoring BP 90 days post-stroke/TIA. Those not self-monitoring represent a group in whom targeted education and awareness may lead to better self-management of BP.

Disclosure: No

O194 / 838

Scientific Communications 23 - Secondary Prevention

PLASMA FIBRINOGEN AND RISK OF VASCULAR RECURRENCE AFTER ISCHAEMIC STROKE: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS OF PROSPECTIVE COHORT STUDIES

J.J. McCabe ^1,2,3, C. Walsh^4,1, S. Gorey^1,3,2, P. Hervella⁵, K. Harris⁶, R. Iglesias-Rey⁵, C. Jern^7,8, L. Li⁹, N. Miyamoto¹⁰, J. Montaner^11,12,13,14, F. Purroy^15,16, A. Pedersen⁸, P. Rothwell⁹, C. Sudlow^17,18, Y. Ueno¹⁰, M. Vicente-Pascual^16,15, W. Whiteley^18,19, M. Woodward^20,6,21, P.J Kelly^2,1,3, Blood Inflammatory markers in Stroke Collaboration (BISC)

¹Stroke Clinical Trials Network Ireland, Dublin, Ireland, ²Mater Misericordiae University Hospital, Dublin, Ireland, ³University College Dublin, School of Medicine, Dublin, Ireland, ⁴University of Limerick, Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI), Department of Mathematics and Statistics, Limerick, Ireland, ⁵Health Research Institute of Santiago de Compostela, Clinical Neuroscience Research Laboratory, Santiago de Compostela, Spain, ⁶The George Institute for Global Health, University of New South Wales, Sydney, Australia, ⁷Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Department of Laboratory Medicine, Gothenburg, Sweden, ⁸Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden, ⁹Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom, ¹⁰Juntendo University School of Medicine, Department of Neurology, Tokyo, Japan, ¹¹Hospital Universitari Vall d’Hebron, Department of Neurology, Barcelona, Spain, ¹²Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain, ¹³Virgen Macarena Hospital, Department of Neurology, Sevilla, Spain, ¹⁴Vall d’Hebron Institute of Research, Universitat Autònoma de Barcelona, Neurovascular Research Laboratory, Barcelona, Spain, ¹⁵Hospital Universitari Arnau de Vilanova, Department of Neurology, Lleida, Spain, ¹⁶Institut Reserca Biomèdica Lleida, Department of Clinical Neurosciences, Lleida, Spain, ¹⁷Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Centre for Medical Informatics, Edinburgh, United Kingdom, ¹⁸University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ¹⁹University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom, ²⁰George Institute for Global Health, Imperial College London, London, United Kingdom, ²¹Johns Hopkins University, Department of Epidemiology, Baltimore, United States

Background: Anti-inflammatory therapies reduce the risk of stroke in coronary disease and randomised trials in patients with stroke are ongoing. Validation of inflammatory markers to select patients most likely to benefit from anti-inflammatory treatment after stroke is needed. Fibrinogen is an acute-phase reactant expressed in response to hepatic interleukin-6 stimulation. Existing studies report conflicting findings for the association of plasma fibrinogen with vascular recurrence after stroke.

Methods: We investigated the association between plasma fibrinogen and risk of recurrent stroke/major adverse cardiovascular events (MACE) in individual-participant data from 6,784 patients with ischaemic stroke/TIA from seven prospective cohort studies. We did within-study multivariate regression and combined adjusted relative risks (RR) by random-effects meta-analysis.

Results: 1,231 (18.1%) patients had at least one MACE and 1,049 (15.5%) recurrent strokes. After adjustment for age, sex, vascular risk factors, and medication use, fibrinogen was not associated with recurrent stroke (RR per g/l increase 0.99, 95% CI 0.91-1.09) or MACE (RR 1.04, 95% CI 0.96-1.13). On ‘leave-one-out’ sensitivity analysis, results were heavily-influenced by a single study. The adjusted RR for MACE after exclusion of this study was 1.09 (95% CI 1.0-1.18).

Conclusion: These data suggest that fibrinogen is not independently associated with vascular recurrence after stroke, possibly related to between-study differences in acute fibrinogen sampling or stroke severity. C-reactive protein or interleukin-6 may represent better markers of residual inflammatory vascular risk in patients with stroke.

Disclosure: No

O195 / 477

Scientific Communications 23 - Secondary Prevention

REANALYSIS OF VASCULAR EVENT OUTCOMES IN PREVENTION TRIALS USING GLOBAL ANALYSIS METHODS

L.J. Woodhouse ¹, A.A Montgomery², P.M Bath¹, OA-Prevention Collaboration

¹University of Nottingham, Stroke Trials Unit, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom, ²University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom

Background: Ordinal vascular outcomes that incorporate severity are more efficient statistically and provide more clinical information than binary versions. We studied whether global ordinal analysis of multiple ordinal vascular outcomes was also more efficient than binary equivalents.

Methods: Lead researchers of vascular prevention trials shared individual participant data with this pooling project. Binary and ordinal outcomes were created for stroke, myocardial infarction, bleeding events as well as composite outcomes. Assessments were made using binary logistic regression and Chi-Square test for binary outcomes and ordinal logistic regression and Mann-Whitney U test for ordinal outcomes. Global analysis techniques included the Hotellings T², Wei-Lachin and Wald tests. Results were ranked, with the result with the smallest p-value given the smallest rank; Friedman and Duncan’s multiple range tests were then performed to assess differences between tests by comparing the average ranks for each statistical test.

Results: Of the 35 trials shared, 24 (158,901 patients) had outcome data for each of the vascular event outcomes; mean age 64.0 (9.9), 52.6% female. From these, 35 comparisons were created since five trials had multiple intervention arms. Based on four- or five-level stroke with three-level myocardial infarction, the Wei-Lachin global analysis technique had the smallest average ranks, 2.95 and 2.64 respectively, and therefore appeared to be more efficient statistically than those that analysed the composite outcomes (p<0.0001).

Conclusion: Global analysis techniques such as Wei-Lachin can incorporate multiple ordinal outcomes, provide summary information on overall treatment effects and are statistically more efficient.

Disclosure: No

O197 / 545

Scientific Communications 24 - Hyperacute Management

ANALYSIS AND MODELLING OF MISTRIAGE IN THE STOCKHOLM STROKE TRIAGE SYSTEM

B. Keselman ^1,2, A. Berglund^1,2, N. Ahmed^1,2, D. Grannas³, M. von Euler^4,5, S. Holmin^1,6, A.-C. Laska⁷, J.M. Mathé⁸, C. Sjöstrand¹, E.E. Eriksson^1,2, M.V. Mazya^1,2

¹Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden, ²Karolinska University Hospital, Department of Neurology, Stockholm, Sweden, ³Karolinska Institutet, Unit of Biostatistics, Stockholm, Sweden, ⁴Karolinska Institutet, Stroke Research Network at Södersjukhuset, Department of Clinical Science and Education, Stockholm, Sweden, ⁵Örebro University, School of Medicine, Örebro, Sweden, ⁶Karolinska University Hospital, Department of Neuroradiology, Stockholm, Sweden, ⁷Karolinska Institutet, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden, ⁸Capio S:t Görans Hospital, Department of Neurology, Stockholm, Sweden

Background and aims: The Stockholm Stroke Triage System (SSTS), is a prehospital triage system for detection of patients eligible for endovascular thrombectomy (EVT). Assessment of hemiparesis combined with ambulance-hospital teleconsultation is used to route patients directly to the thrombectomy centre. Some patients are not identified and require secondary transport for EVT (undertriage) while others taken to the thrombectomy centre do not undergo EVT (overtriage). The aims of this study were to characterize mistriaged patients, model for and evaluate alternative triage algorithms.

Methods: Patients with suspected stroke transported by priority 1 ground ambulance between October 2017-October 2018 (n=2905) were included. Three triage algorithms were modelled using prehospital data. Decision curve analysis was performed to calculate net benefit (correctly routing patients without increasing mistriage) of alternative models vs SSTS.

Results: Undertriage for EVT occurred in n=35/2582 (1.4%) and overtriage in n=239/323 (74.0%). Compared to correct thrombectomy triages, undertriaged patients were younger and had lower median NIHSS (10 vs 18), despite 62.9% with an M1 occlusion. In overtriaged patients, 77.0% had a stroke diagnosis (29.7% haemorrhagic). Hemiparesis and FAST items face and speech were included in all models. Decision curve analysis showed highest net benefit for SSTS for EVT, but lower for large artery occlusion (LAO) stroke.

Conclusion: Undertriaged patients had lower NIHSS, likely due to better compensated proximal occlusions. SSTS was superior to other models for identifying EVT candidates, but lacked information allowing comparison to other prehospital scales. Using prehospital data, alternative models did not outperform the SSTS in finding EVT candidates.

Disclosure: No

O198 / 1167

Scientific Communications 24 - Hyperacute Management

STROKE MIMICS: FINDINGS FROM THE FIRST NATIONWIDE AUDIT OF MIMIC ACTIVITY IN THE UK

E. Käld ¹, E. McMullen¹, S. Ralph¹, K. Stanley¹, A. Bhalla², A. Douiri¹, C. Wolfe¹, M. James³

¹King’s College London, Department of Population Health Sciences, London, United Kingdom, ²Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, ³Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom

Background and aims: Patients with a range of diagnoses can present with stroke-like symptoms and are known as stroke mimics. Little is known about resource use for this group of patients.

Methods: Data for patients admitted with suspected stroke during September 2021 in England and Wales were extracted from the Sentinel Stroke National Audit Programme, a nationwide quality improvement registry. Pathway timings and care processes were compared between patients finally diagnosed with stroke versus mimics. Cohorts were compared using Mann-Whitney U and Chi²tests.

Results: 107 teams entered 11,957 admissions, with 53.1% (6350) ultimately diagnosed as mimics. Mimics were more often female (55.2% v 46.2%, p<0.001), and were younger (median 70 v 76, p<0.001). Stroke unit admission rates were 35.8% and 94.1% respectively (p<0.001), with two days difference in length of stay (2 v 4 days, p<0.001). 33.3% of mimics were discharged same day as admission (v 2.1%, p<0.001); 42.3% were discharged after more than two days (v 83.3%, p<0.001). Consultant assessment in person was more common in mimics (93% v 79.3%, p<0.001). Thrombolysis rates were mimics: 0.7% and all strokes: 10.1% (p<0.001); median age for thrombolysed mimics was lower (58 v 74 years, p<0.001).

Conclusions: In this first-ever nationwide audit of mimic activity, over half of acute assessments by stroke teams were mimics, representing 30% of stroke unit admissions. One in thirteen patients thrombolysed was a mimic. Although mimics spend less time on a stroke unit, services must be adequately resourced to diagnose and manage patients with stroke-like presentations.

Disclosure: No

O199 / 950

Scientific Communications 24 - Hyperacute Management

GOLDEN HOUR TREATMENT WITH TISSUE PLASMINOGEN ACTIVATOR IN THE BEST-MSU STUDY

J. Mackey ¹, J.-M. Yamal², S.A. Parker³, K. Silnes¹, S.S. Rajan², A.P. Jacob², M. Wang², N. Singh², W.J. Jones⁴, I. Spokoyny⁵, J.L. Saver⁶, J.C. Grotta⁷, for the BEST-MSU Study group

¹Indiana University School of Medicine, Indianapolis, United States, ²University of Texas School of Public Health, Houston, United States, ³University of Texas McGovern Medical School, Houston, United States, ⁴University of Colorado, Aurora, United States, ⁵Mills Peninsula Medical Center, Burlingame, United States, ⁶Ronald Reagan UCLA Medical Center, Los Angeles, United States, ⁷Memorial Hermann Hospital-Texas Medical Center, Houston, United States

Background and aims: Treatment of patients with acute ischemic stroke on mobile stroke units (MSUs) improves outcomes compared to management by Emergency Medical Services and is associated with more patients treated in the first “golden hour” after last known normal (LKN). We explored the predictors and outcomes of first hour treatment (FHT) compared with later treatment.

Methods: We analyzed all patients treated with intravenous tissue plasminogen activator (tPA) combining both arms of the Benefits of Stroke Treatment Delivered by a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services (BEST-MSU) Study. After stratifying by treatment timeframe, we identified factors associated with FHT. We performed adjusted analyses of the association between FHT and clinical outcome and modeled the shape of the relationship between LKN-to-treatment time and excellent outcome.

Results: We identified 941 tPA-treated patients. Older age, faster arrival on-scene and imaging, absence of heart failure or pre-treatment antihypertensive treatment, higher weight, more severe stroke, and LKN during waking hours were associated with FHT. Compared with later treatment, FHT was associated with higher adjusted OR for 90-day mRS 0-1 (OR 1.87 [95% CI 1.25, 2.84], p<0.001). 68% of FHT patients achieved a 90-day mRS of 0 or 1 or returned to their baseline status. FHT was not associated with higher risk of misdiagnosis or hemorrhage.

Conclusions: FHT on an MSU almost doubles the odds of excellent clinical outcome without increased risk compared with later treatment.

Disclosure: Yes

O200 / 460

Scientific Communications 24 - Hyperacute Management

GLYCERYL TRINITRATE IN PATIENTS WITH ACUTE ISCHEMIC STROKE TREATED WITH INTRAVENOUS THROMBOLYSIS OR ENDOVASCULAR THROMBECTOMY – RESULTS FROM THE MR ASAP TRIAL

S.M. Uniken Venema ¹, S.A. Van den Berg², P.M. van der Sluijs³, L. Wolff³, S.D. Roosendaal⁴, M. Krietemeijer⁵, B.J. Emmer⁴, J. Hofmeijer⁶, P.J. Nederkoorn², H.B. van der Worp¹, MR ASAP Investigators

¹UMC Utrecht, Neurology and Neurosurgery, Utrecht, Netherlands, ²Amsterdam UMC, Neurology, Amsterdam, Netherlands, ³Erasmus MC, Radiology & Nuclear Medicine, Rotterdam, Netherlands, ⁴Amsterdam UMC, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁵Catharina Hospital, Radiology, Eindhoven, Netherlands, ⁶Rijnstate, Neurology, Arnhem, Netherlands

Background and aims: Glyceryl trinitrate (GTN) did not improve outcomes in broad populations of patients with acute ischemic stroke in randomized trials but could be beneficial in those receiving intravenous thrombolysis (IVT) or endovascular treatment (EVT).

Methods: We assessed patients with ischemic stroke or TIA included in MR ASAP, an ambulance-based randomized trial of transdermal GTN versus no GTN within three hours of symptom onset in patients with presumed stroke. The NIHSS at 24h was the primary outcome of this substudy and the 90-day mRS a secondary outcome, both analyzed with multivariable regression. We also assessed radiological and safety outcomes. Subgroup analyses were performed for patients treated with IVT or EVT. Registration: ISRCTN99503308.

Results: MR ASAP was stopped for futility after 325 patients. Of 235 patients with ischemic stroke or TIA, 139 (59%) received IVT and 54 (23%) EVT. Compared with no GTN, GTN was associated with a 23% lower NIHSS at 24h (95%CI -41% to 1%) in patients without IVT, but not in those with IVT (27% higher; 95%CI: -6% to 73%), p_interaction=0.06. GTN was associated with worse functional outcome (acOR 0.51; 95%CI 0.60-1.00) in those treated with IVT. There was no heterogeneity of GTN effect by EVT on any outcome. GTN was not associated with safety outcomes in any subgroup. Radiological outcomes will be presented at the conference.

Conclusions: Patients treated with IVT may fare worse with GTN than those without IVT. Given the early trial termination and overall neutral results, this finding should be interpreted with caution.

Disclosure: Yes

O201 / 711

Scientific Communications 24 - Hyperacute Management

CLINICAL OUTCOME OF POPULATION INCLUDED IN RACECAT TRIAL COMPARED TO PATIENTS LIVING IN URBAN AREAS INITIALLY ATTENDED IN THROMBECTOMY CENTERS

N. Pérez de la Ossa ¹, M. Ribó², S. Abilleira³, Á. Garcia-Tornel², A. Valls¹, X. Jiménez-Fàbrega⁴, X. Urra⁵, P. Cardona⁶, D. Cocho⁷, F. Purroy⁸, J. Serena⁹, Á. Chamorro⁵, C. Molina², L. San Roman⁵, M. Salvat-Plana³, M. Gallofré³, E. Cobo¹⁰, A. Dávalos¹, T. Jovin¹¹, M. Millán¹

¹Hospital Universitari Germans Trias i Pujol, Neurology, Stroke Unit, Badalona, Spain, ²Hospital Vall d’Hebrón, Neurology, Stroke Unit, Barcelona, Spain, ³Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain, ⁴Emergency Medical Services (SEM) of Catalonia, Barcelona, Spain, ⁵Hospital Clínic, Barcelona, Spain, ⁶Hospital Bellvitge, Barcelona, Spain, ⁷Hospital de Granollers, Granollers, Spain, ⁸Hospital Arnau de Vilanova, Lleida, Spain, ⁹Hospital Josep Trueta, Girona, Spain, ¹⁰Universitat Politècnica de Catalunya, Statistics and Operational Research, Barcelona, Spain, ¹¹Neurological Institute, Cooper University Hospital, Camden, New Jersey, United States

Background and aims: RACECAT trial showed no clinical differences between direct transportation to a thrombectomy-capable center (TM-center) vs. a local stroke center in patients with acute stroke with suspicion of large vessel occlusion (RACE>4) from non-urban areas in Catalonia. We aim to compare the outcome of population enrolled in RACECAT to patients located in urban areas initially attended at TM-centers.

Methods: CICAT is a mandatory regional registry of all stroke code patients in Catalonia. We selected patients located in areas primarily covered by TM-centers, who met the RACECAT inclusion criteria (RACE>4, time form onset<8h, functional independence), during the study period (March-2017 to June-2020). Disability was centrally assessed at 90 days by the same blinded evaluators of RACECAT patients. Primary outcome was functional independence at 90 days (mRS 0-2) in ischemic stroke patients.

Results: A total of 1833 patients from urban areas were compared to 1369 RACECAT patients. Baseline characteristics and final diagnostic were similar between groups (Table 1). Endovascular treatment (EVT) was more often and earlier offered to urban patients (EVT: 62.3% vs. 44.8% of patients with ischemic stroke, p<0.001; onset to EVT time 150 [115-225] vs. 233 [195-332] min, p<0.001]. Patients from urban areas had higher odds of good outcome compared to RACECAT patients (mRS 0-2 41% vs. 33%; aOR 1.63, IC95%[1.32-2.00] adjusted by age, sex, pre-stroke mRS and baseline NIHSS).

Conclusions: Suspected large vessel occlusion stroke patients attended in non-urban areas are less likely to receive thrombectomy and to recover as compared to patients located in urban areas.

	Patients living in urban areas(N=1833)	RACECAT population(N=1369)
Age, median (IQR)- yrs	72 (14)	73 (13)
Female Sex - n (%)	836 (45.6)	601 (43.9)
NIHSS score - median (IQR)	18 (14, 21)	17 (11, 21)
RACE score - median (IQR)	7 (6, 8)	7 (6, 8)
Wake-up or unknown time from onset - n (%)	435 (23.8%)	337 (24.6%)
Clinical diagnosis
Ischemic - n (%)	1176 (62.2%)	907 (66.3%)
TIA - n (%)	21 (1.1%)	29 (2.1%)
Hemorrhagic stroke - n (%)	458 (25.0%)	318 (23.2%)
Mimic stroke - n (%)	178 (9.7%)	115 (8.4%)
Large vessel occlusion - n (%)	873 (47.6%)	636 (46.5%)
Median time from stroke onsetto first hospital arrival (IQR) - min	69 (47, 136)	114 (77, 186)
Reperfusion therapy
iv-tPA alone - n (%)	208 (11.3%)	261 (19.1%)
EVT (with iv-tPA) - n (%)	387 (21.1%)	249 (18.2%)
EVT (no iv-tPA) - n (%)	359 (19.6%)	170 (12.4%)
No reperfusion therapy - n (%)	879 (48.0%)	689 (50.3%)
Median time from onset to groin puncture (IQR) – min	150 (115, 225)	233 (195, 332)
Final mTICI 2b-3 (%)	87.1%	85.2%

Disclosure: No

O202 / 576

Scientific Communications 24 - Hyperacute Management

SAFETY AND EFFICACY OF ENDOVASCULAR THROMBECTOMY PLUS INTRAVENOUS THROMBOLYSIS VS. INTRAVENOUS THROMBOLYSIS ALONE IN MILD SYMPTOMS STROKES WITH LARGE VESSEL OCCLUSION: PROPENSITY SCORE MATCHED ANALYSIS

G. Schwarz ^1,2, S. Bonato¹, S. Lanfranconi¹, M. Matusevicius^3,4, I. Ghione¹, G. Valcamonica¹, G. Tsivgoulis⁵, A. Paiva Nunes⁶, M. Mancuso⁷, A. Zini⁸, P. Candelaresi⁹, V.M. Rand¹⁰, G.P Comi¹, M.V Mazya^3,4, N. Ahmed^3,4

¹Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Stroke Unit, Milan, Italy, ²Stroke Research Centre, University College London, Institute of Neurology, London, United Kingdom, ³Karolinska University Hospital, Department of Neurology, Stockholm, Sweden, ⁴Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden, ⁵Attikon University Hospital, National & Kapodistrian University of Athens, School of Medicine, Second Department of Neurology, Athens, Greece, ⁶Stroke Unit, Saint Joseph’s Hospital, Central Lisbon University Hospital Centre, Lisbon, Portugal, ⁷Neurological Clinic, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, Pisa, Italy, ⁸IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy, ⁹Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy, ¹⁰North Estonia Medical Centre Foundation, Department of Neurology, Tallinn, Estonia

Background and aims: The best reperfusion treatment for patients with mild (NIHSS score ⩽5) acute ischemic stroke (AIS) harboring anterior circulation large vessel occlusion (LVO) is unknown. We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) plus endovascular thrombectomy (EVT) vs IVT alone in mild LVO patients.

Methods: From the SITS-International Stroke Thrombolysis and Thrombectomy Register (SITS-ISTR), we included consecutive treated AIS patients presenting within 4.5h, with NIHSS score ⩽5 and intracranial ICA, M1 or T occlusion. We compared outcomes in patients treated with IVT+EVT and IVT alone, after propensity score matching (PSM).

Results: 1037 patients were included. In PSM analysis (n=312 per group), IVT+EVT group vs. IVT alone showed an odds ratio (OR) 1.49 (95% CI 1.04–2.12; p=0.03) for a shift in the 3-month modified Rankin scale (mRS) score, with lower rates of mRS 0-1 (68.8% vs 78.9% [p=0.019]) and mRS 0-2 (57.5% vs 72.4% [p=0.001]), higher median NIHSS score at 24 hours (score 2 [IQR 0-7] vs score 1 [IQR 0-3]; p<0.001), higher rate of non-haemorrhagic early neurological deterioration (nhEND; 27.0% vs 12.5%; p<0.001), higher rate of any haemorrhagic transformation (17.6% vs 7.3%; p<0.001) and subarachnoid hemorrhage (SAH; 7.9% vs 1.5%; p=0.002). Symptomatic haemorrhagic transformation rate was also numerically higher (3.3% vs 1.1%; p=0.082) in IVT+EVT group.

Conclusion: IVT+EVT was associated with worse 3-month functional outcomes and higher rates of nhEND, any haemorrhagic transformation and SAH compared to IVT alone. Advanced imaging criteria to select profiting patients and randomized-controlled clinical trials are needed.

Disclosure: No

O203 / 1198

Scientific Communications 24 - Hyperacute Management

MULTIMODAL IMAGING IN THE SELECTION OF PATIENTS WITH ACUTE STROKE UNDERGOING ENDOVASCULAR TREATMENT (EVT).THE IMAGECAT CLINICAL TRIAL (CLINICALTRIALS.GOV IDENTIFIER: NCT03745391)

M. Millan ¹, M. Hernández-Pérez¹, A. Valls¹, N. Pérez de la Ossa¹, A. Bustamante¹, L. Dorado¹, M. Gomis¹, S. Remollo¹, P. Cuadras², P. Puyalto², S. Domenech², L. Muñoz¹, I. Puig¹, G. Ezcurra¹, M. Hernández¹, A. Dávalos¹

¹Germans Trias Pujol Hospital, Neurosciences, Badalona, Spain, ²Germans Trias Pujol Hospital, Radiology, Badalona, Spain

Background and Aims: The optimal multimodal imaging to select patients for endovascular therapy (EVT) remains uncertain. We aimed to compare the rate of EVT, in-hospital metrics, safety and functional outcome between patients with acute stroke selected by MR or CT perfusion (CTP).

Methods: Stroke patients (<24h from onset, NIHSS⩾6, mRS⩽2) were randomly assigned to CTP or MR. RAPID software was used to evaluate ischemic core and perfusion volumes. Criteria for EVT were ASPECTS >5, large vessel occlusion and infarct core volume <70 cc.

Results: 168 patients were assigned to CTP and 161 to MR from whom 9 (5.5%) finally underwent CTP due to MR movement artifacts. Baseline variables, rate of acute ischemic stroke (AIS) (69 vs 70%), ICH (23 vs 21%) and stroke mimic (8 vs 9%) were similar between groups. Tables 1 & 2 show baseline variables, metrics and outcome variables in patients with AIS and in patients undergoing EVT by image groups. Rate of EVT was not diiferent between groups (Table 1). Eligibility by MR compared to CTP was associated with a higher frequency of sICH and mortality at 90 days, although differences disappeared after adjusting for age, NIHSS score, time to final image and core volumen (adjusted OR 95%CI 3.61 [0.63-20.50]; adjusted OR 95%CI 0.92 [0.36-2.34], respectively).

Conclusion: Eligibility for EVT is similar by using both image technics and lead to comparable functional outcome (Figure). MR is associated with longer in-hospital times and technical failures, being less feasible in the setting of AIS.

Table 1.

Baseline and outcome characteristics by group in patients with acute ischemic stroke.

Study variables	CTPN= 122	MRN=107	P value
Age, y	70(12)	74(11)	0.043
NIHSS score	14[9,19]	17[10,21]	0.230
Onset to Door time, min	118[63,271]	126[62,325]	0.677
Door to final image sequence time, min	35[26,46]	45[40,55]	<0.001
ASPECT score	10[8,10]	8[6,9]	<0.001
Infarct Core volume, cc	4[0,16]	12[0,67]	0.016
Reperfusion therapy			0.118
No	26(21)	32(30)
IV tPA alone	31(25)	23(21)
Mechanical thrombectomy	65(53)	52(49)
Door to needle time, min	30[24,40]	36[29,45]	0.025
Door to groin time, min	91[70,107]	89[60,116]	0.974
Symptomatic ICH	5(5)	11(13)	0.049
Mortality at day 7	5(4)	12(11)	0.042
Mortality at day 90	16/120(13)	25/105(24)	0.043
mRS ⩽ 2 at day 90	58/120 (48)	43/105 (41)	0.265

Values are expressed as mean (SD), number (%) and median [quartiles].

Table 2.

Baseline and outcome characteristics by group in patients who underwent endovascular treatment.

Study variables	CTPN=65	MRN=52	P value
Age, y	68(13)	74(11)	0.014
NIHSS score	18[12,22]	17[15,22]	0.965
Onset to Door time, min	103[52,231]	117[61,326]	0.256
Door to final image sequence time, min	32[23,42]	44[38,53]	<0.001
ASPECT score	9[7,10]	8[6,9]	0.158
Infract Core volume, cc	10[0,29]	14[0,39]	0.273
Reperfusion therapy			0.057
EVT alone	26(40)	30(58)
IVT + EVT	39(60)	22(42)
Door to groin time, min	91[70,107]	89[60,116]	0.974
TICI ⩾2b	53(83)	47(90)	0.240
Symptomatic ICH	4(7)	7(14)	0.192
Mortality at day 7	4(6)	6(12)	0.285
Mortality at day 90	9/64 (14)	13/51 (25)	0.122
mRS ⩽ 2 at day 90	29/64 (45)	24/51 (47)	0.852

Values are expressed as mean (SD), number (%) and median [quartiles].

Disclosure: No

O204 / 92

WITHDARWN Scientific Communications 24 - Hyperacute Management

INTRACRANIAL PRESSURE MONITORING IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE. INSIGHTS FROM THE SYNAPSE-ICU STUDY

S. Dallagiacoma ¹, C. Robba², F. Graziano³, P. Rebora³, J.C. Hemphill⁴, S. Galimberti³, G. Citerio⁵

¹University of Milano Bicocca, Neurointensive Care Unit, Department Neuroscience, San Gerardo Hospital, Monza, Milano, Italy, ²Policlinico San Martino IRCCS for Oncology and Neuroscience, Department of Anaesthesia and Intensive Care, Genova, Italy, ³University of Milano Bicocca, Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Milano, Italy, ⁴University of California, San Francisco, Department of Neurology, San Francisco, United States, ⁵University of Milano Bicocca, Neurointensive Care Unit, Department Neuroscience, San Gerardo Hospital, Milano, Italy

Background and aims: Uncertainties remain regarding the indications, management, and effect of intracranial pressure (ICP) monitoring and treatment on outcome in spontaneous intracranial hemorrhage (ICH) patients. The aims of this study were to describe the clinical practice of ICP monitoring, the occurrence of intracranial hypertension (IHT) and its therapeutic management in a large cohort of ICH patients admitted in intensive care unit. We assessed in-hospital and 6-months mortality and outcome of ICP monitoring.

Methods: Analysis of spontaneous ICH patients enrolled in the SYNAPSE-ICU study, an international prospective observational study on use of ICP monitoring.

Results: Of 587 ICH patients 281 (47.9%) received ICP monitoring. ICP-monitored patients, compared to non-monitored, were younger (61 vs 67 years, p<0.001), had more frequently both reactive pupils (67.2%, vs 55.2%, p=0.008), with better neurological status at admission (GCS⩽ 8, 82.3% vs 88.8%, p=0.038) and received higher therapy intensity level. 46.6 % of monitored patients had at least one episode of ICP ⩾ 20 mmHg during the first week. An intraventricular device was the most frequently used and had fewer episodes of IHT. ICP monitoring showed a significant reduction of 6-month mortality (Hazard Ratio, HR= 0.49, 95% CI=0.35-0.71, p=0.001), but not with better neurological outcome (OR=0.83, 95% CI= 0.41-1.68, p=0.6077).

Conclusions: ICP monitoring in ICH was utilized mainly in moderate-severe cases. It was associated with a reduction of in-hospital and 6-month mortality but not improved 6-month functional outcome. Further randomized controlled trials to support guidelines regarding ICP use and treatment in patients with ICH are needed.

Disclosure: No

O205 / 874

Closing Ceremony & Large Clinical Trials 2

DRIP-AND-SHIP VS MOTHERSHIP TRANSFER PROTOCOLS IN PATIENTS WITH INTRACRANIAL HEMORRHAGE: SECONDARY ANALYSIS OF RACECAT TRIAL

A. Ramos-Pachón ¹, D. Rodriguez-Luna², J. Martí-Fàbregas³, M. Millán¹, A. Bustamante¹, M. Hernández-Pérez¹, J. Serena⁴, M. Terceño⁴, C. Vera⁴, O. Pancorbo², N. Rodriguez-Villatoro², L. Prats-Sánchez³, M. Escudero Campillo⁵, M. Ribó², S. Abilleira⁶, N. Perez de la Ossa¹, Y. Silva⁴

¹Hospital Universitari Germans Trias i Pujol, Stroke Unit, Neurology, Badalona, Spain, ²Hospital Universitari Vall d’Hebrón, Stroke Unit, Neurology, Barcelona, Spain, ³Hospital de la Santa Creu i Sant Pau, Stroke Unit, Neurology, Barcelona, Spain, ⁴Hospital Universitari Dr Josep Trueta, Stroke Unit, Neurology, Girona, Spain, ⁵Sistema d’Emergències Mèdiques, Barcelona, Spain, ⁶Departament de Salut, Barcelona, Spain

Background and purpose: RACECAT trial have recently shown no differences on clinical outcomes between drip-and-ship and mothership transfer protocols for acute stroke patients suspected to harbor a large vessel occlusion (LVO). We aimed to perform a predefined secondary analysis of RACECAT trial to assess the effect of pre-hospital transfer strategies in patients with spontaneous intracranial hemorrhage (ICrH).

Methods: RACECAT trial was a population-based, multicenter, cluster-randomized controlled trial that included suspected LVO patients at the pre-hospital setting with a RACE scale ⩾5. For the present study, inclusion criteria were consecutive RACECAT patients with final diagnosis of spontaneous ICrH. Primary outcome was disability, evaluated by shift analysis of 90-day modified Rankin scale (mRS) score, and secondary outcome 90-day mortality. We performed a multivariate logistic regression analysis adjusted by age and baseline NIHSS score.

Results: Among 1401 RACECAT patients, 314 (22.4%) suffered an ICrH (mean age 71.3±12.8 years, 66.9% men). 173 (55.1%) patients were assigned to drip-and-ship protocol. Baseline demographic characteristics were similar between study arms. Median time from symptom onset to first hospital arrival was 95 (68–168) minutes in drip-and-ship and 135 (97–183) minutes in mothership protocol. Among mothership group, we detected higher transfer complications (6.4% vs. 23.4%, p<0.001) and in-hospital pneumonia (19.7% vs. 35.5%, p=0.002). 90-day mRS score distribution (adjusted common odds ratio 0.76 [95% CI, 0.48-1.20]) and 90-day mortality (adjusted Hazard Ratio 1.22 [95%CI: 0.86-1.71]) were similar in both groups.

Conclusions: Mothership transfer protocol resulted in similar 90-day functional outcome and mortality in patients with intracranial hemorrhage.

Disclosure: Yes

O207 / 505

Closing Ceremony & Large Clinical Trials 2

EFFECTS OF INTENSIVE BLOOD PRESSURE LOWERING ON CEREBRAL ISCHAEMIA: INSIGHTS FROM THE ENCHANTED TRIAL

C. Chen ^1,2,3, M. Ouyang^2,3, S. Ong^4,2, L. Zhang⁴, G. Zhang³, C. Delcourt^2,5, L. Liu², Z. Zhou², L. Billot^2,6, X. Chen², L. Song^2,3, G. Li¹, R.I Lindley^2,7, M. Parsons⁸, C.S Anderson^2,3

¹Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China, ²The George Institute for Global Health, University of New South Wales, Sydney, Australia, ³The George Institute China at Peking University Health Sciences Center, Beijing, China, ⁴Hospital Queen Elizabeth, Sabah, Malaysia, ⁵Macquarie University, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Sydney, Australia, ⁶University of Bordeaux, Bordeaux, France, ⁷Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Sydney, Australia, ⁸Ingham Institute for Applied Medical Research, Liverpool Hospital, University of New South Wales, Sydney, Australia

Background and aims: ENCHANTED was an international, multicentre, 2x2 factorial, open, blinded endpoint, active-comparator randomised trial (ClinicalTrials.gov NCT01422616) which showed no benefit on functional recovery for intensive (target systolic blood pressure [SBP] <140mmHg) versus standard (SBP <180mmHg) management in 2227 thrombolysis-treated patients with acute ischaemic stroke (AIS). However, intensive BP lowering significantly reduced intracerebral haemorrhage (ICH), including on fatal and parenchymal haematomas. Thus, questions persist about potential interactions in the effects of intensive BP lowering on cerebral ischaemia and ICH to explain the neutral primary outcome. We aimed to determine whether intensive BP lowering

• (i) increased the size of cerebral ischaemia and

• (ii) this modified the effects of BP lowering on functional recovery.

Methods: Among ENCHANTED BP-control arm participants, available brain images (baseline+follow-up, mainly CT scans) were analysed centrally with standardised techniques by expert readers blind to clinical details, using computer-assisted multi-slice morphometric and voxel threshold techniques (Apollo MIStar software) to record the extent of cerebral infarction, associated cerebral abnormalities, and ICH by the Heidelberg classification system. Multilevel logistic models were used to determine effects of intensive BP lowering on cerebral infarction, with adjustment for confounders and interactions. Sequential mediation analysis was used to quantify effects of bleeding and infarct size on 90-day functional outcome.

Results: Brain CT scans from 1463 (65.7%) patient participants were included, 802 from the BP-control arm and 661 in combination with the alteplase-dose arm. The results will be presented at the conference.

Conclusions: ENCHANTED should resolve uncertainties over effects of BP lowering in AIS

Disclosure: Yes

O209 / 924

Closing Ceremony & Large Clinical Trials 2

ASSOCIATION OF INTRAVENTRICULAR FIBRINOLYSIS WITH CLINICAL OUTCOMES IN PATIENTS WITH INTRACEREBRAL HEMORRHAGE: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS

J.B. Kuramatsu ¹, S.T. Gerner², W. Ziai³, a.o.c.-a. will be stated at presentation², S. Schwab², D. Hanley³, H.B. Huttner²

¹University Hospital Erlangen, Neurology, Erlangen, Germany, ²University Hospital Erlangen, Erlangen, Germany, ³Johns Hopkins, Baltimore, United States

Background and aims: In patients with intracerebral hemorrhage (ICH) the presence of intraventricular hemorrhage (IVH) constitutes an important therapeutic target. Intraventricular fibrinolysis (IVF) reduces mortality, yet impact on functional disability remains unclear. Thus, we aimed to determine the influence of IVF on functional outcomes.

Methods: This individual participant data(IPD) meta-analysis pooled 1,501 patients from two randomized trials and seven observational studies enrolled during 2004 to 2015. We compared IVF vs standard of care(SoC, including placebo) in patients treated with external ventricular drainage due to acute hydrocephalus caused by ICH and/or IVH. The primary outcome was functional disability evaluated by the modified Rankin Scale at 6 months, dichotomized into mRS:0-3 vs mRS:4-6. Secondary outcomes included ordinal-shift analysis, all-cause mortality, and intracranial adverse events. Confounding and bias were adjusted by random-effects- and doubly-robust-models to calculate odds-ratios(OR) and absolute treatment-effects(ATE).

Results: Comparing treatment of 596 with IVF to 905 with SoC resulted in an ATE to achieve the primary outcome of 9.3%[95%CI4.4-14.1]. IVF treatment showed a significant shift towards improved outcome across the entire range of mRS estimates, common-OR:1.75[95%CI1.39-2.17], reduced mortality, OR:0.47[95%CI 0.35-0.64], without increased adverse events, absolute difference:1.0%[95%CI-2.7-4.8]. Exploratory analyses provided that early IVF-treatment (⩽48 hours) after symptom onset was associated with an ATE:15.2%[95%CI8.6-21.8] to achieve the primary outcome.

Conclusions: As compared to SoC, the administration of IVF in patients with acute hydrocephalus caused by intracerebral and intraventricular hemorrhage significantly improved functional outcome at 6 months. The treatment effect was linked to an early time-window<48h, specifying a target population for future trials.

Disclosure: No

ESOC 2022 – E-PosterACUTE MANAGEMENT – NEITHER THROMBOLYSIS NOR THROMBECTOMY

P0001 / 889

RELIABILITY OF BLINK REFLEX (BR), MEP AND BAEP IN POSTERIOR CIRCULATION ISCHEMIC STROKE

Š. Brušáková ¹, J. Ceé¹, D. Ospalík¹, D. Adámek²

¹Masaryk Hospital, Krajska Zdravotni a.s., Department of Neurology, Ústí nad Labem, Czech Republic, ²Faculty of Health Studies UJEP, Radiological Department, Ústí nad Labem, Czech Republic

Background: CT examination of posterior circulation strokes is often inconclusive. The aim of study was to determine how posterior circulation stroke affects evoked potentials.

Methods: Our group includes 38 patients with acute clinical signs of posterior circulation stroke and negative CT scan. Motor evoked potentials (MEP) of upper extremities, blink reflex (BR), brainstem auditory potentials (BAEP) and DWI MR scans were recorded in the first week after stroke. Results of these tests were statistically correlated. All patients without acute ischemic lesion in DWI were excluded. Pearson’s χ2 test and Fisher’s exact test was performed for valuables to compare reliability of electrofysiologic tests with MR scan (localisation and side of stroke).

Results: Variable „MR localisation of ischemia” can be distinguished by BR, especially in medulla oblongata (p = 0.00563), but variable „MR side” is independent to BR. Variable „MR localisation of ischemia” can be distinguished by MEPs, especially in pontomesencefalic and cerebellar regions (p = 0.04420), but variable “MR side” is independent to MEP. Variable „MR localisation of ischemia” and “side of ischemia” is independent to BAEP.

Conclusions: Neurophysiological methods can be used as useful additional test with imaging methods in acute phase of posterior circulation stroke. As sensitive tests were determined MEP and BR. BAEP is less sensitive test. Abnormal electrophysiological tests can help to indicate patients with posterior stroke clinical suspition to DW MR. Our results can be limited by the error of small numbers.

Disclosure: No

P0002 / 801

RESULTS OF AN OPEN-LABEL, MULTICENTER, CASE-CONTROL STUDY OF THE EFFECTS OF CONCOMITANT THERAPY WITH “KSAVRON” ON THE CONSEQUENCES OF ISCHEMIC STROKE IN CLINICAL PRACTICE SETTING

O. Kirichenko¹, S. Moskovko ¹, H. Rudenko¹, STIKs Study Group

¹ National Pirogov Memorial Medical University, Vinnytsya, Neurology, Vinnytsya, Ukraine

Background: Blocking of active oxygen radicals in the hyperacute period of stroke may increase the potential for recovery in the future.

Aim: Assess the impact of radical scavenger use on the stroke consequences.

Material and methods: The study covered 53 stroke departments in Ukraine. 570 patients with ischemic stroke received additional therapy with “Ksavron” (edaravon, Yuria-Pharm, Ukraine) - 30 mg twice daily, starting 1 hour after admission (active treatment group, ATG). 430 patients received conventional treatment (control group, CG). The average score on NIHSS in the ATG was 11.67±0.26 and 10.93±0.29 in CG. The number of thrombolysis procedures was 25 (4.4%) in ATG and 30 (6.98%) in CG.

Results: At the discharge, the NIHSS score was 6.34±0,22 in ATG versus 7.46±0.27 in CG, p=0,001. The mean mRS score was the same (2.66±0.06 in ATG and 2.77±0.22 in CG). After 3 months, the score of mRS in ATG was lower - 1.87±1.36 against 2.56±1.49, p <0.01. Dichotomous comparison of mRS 0-1 vs. 2-6: 42.47% in ATG vs. 32.74% in CG, p = 0.0018. For mRS 0-2 / 3-6: 65.4% in ATG and 56.1% in CG, p = 0.0029. mRS “-1 point” was observed in 62.6% of ATG against 34.8% in CG: OR = 2.42 (95% CI - 2.42 - 4.17). Hemorrhagic transformation was observed in 9 (1.84%) ATG and 22 (5.67%) CG, p = 0.0012.

Conclusions: Additional therapy with free radical scavengers is perspective approach to strengthening the restorative potential after stroke.

Disclosure: No

P0003 / 1327

HIGH DOSE METHYLPREDNISOLONE FOR PREVENTION OF MALIGNANT ANTERIOR CIRCULATION STROKE IN THROMBOLYSED PATIENTS, A PILOT STUDY.

A. Elkady ¹, A. Sharawy¹, A. Anany¹, M. Madkour¹, M. Bakheet¹

¹ Saudi German Hospital, Neurology Department, Jeddah, Saudi Arabia

Background and aims: High mortality related to stroke increases due to worsening brain dysfunction, elevated intracranial pressure (ICP). Post-stroke inflammation has largely been thought to exacerbate ischemic injury and related to massive cytotoxic edema. We aimed to investigate the safety and efficacy of one dose of pulse methylprednisolone for patients with anterior circulation stroke (ACS) who received tissue plasminogen activator (tPA).

Methods: In this pilot single-arm pilot study, patients with large ACS who receive tPA will receive pulse methylprednisolone (1000 mg) slowly over 2 hours once, not later than 8 hours of onset. Patients who are known to be uncontrolled DM or have any contraindication for steroid were excluded. The primary outcome was malignant ACS within 5 days of admission with early neurological deterioration (END) (GCS dropped > 2; NIHSS increased > 3), related to massive edema on follow-up CT brain with midline shift > 4 mm.

Results: Between January and June 2020, 17 patients were enrolled (ages 33–67 years, eight male). END happened in one patient and required mechanically ventilation and treated with hemicraniotomy. Four patients showed mild deterioration with no need for any intervention. 12 patients showed a stationary course with improvement on discharge. Two patients had high glucose after admission and required transient insulin drip for 12 hours.

Conclusions: The efficacy of methylprednisolone with tPA for the prevention of malignant ACS is feasible, and no major complications were observed. We propose further randomized control studies are needed to confirm these results.

Disclosure: No

P0004 / 678

ASSESSMENT OF 3 MR PERFUSION SOFTWARE PACKAGES IN PREDICTING FINAL INFARCT VOLUME AFTER MECHANICAL THROMBECTOMY

A. Bani-Sadr ¹, T.-H. Cho², M. Cappucci¹, M. Hermier¹, R. Ameli¹, R. Riva¹, L. Derex², C. De Bourguignon³, L. Mechtouff², O. Eker¹, N. Nighoghossian², Y. Berthezene¹

¹Hospices Civils de Lyon, Neuroradiology, Bron, France, ²Hospices Civils de Lyon, Stroke, Bron, France, ³Hospices Civils de Lyon, Clinical Investigations Center, Bron, France

Background and aims: To evaluate the performance of 3 MR perfusion software packages (A: RAPID®; B: OleaSphere®; C: Philips ®) in predicting final infarct volume (FIV).

Methods: This cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were postprocessed 3 three packages to quantify ischemic core and perfusion deficit (PDV). Automatic package outputs (uncorrected volumes) were collected, and corrected by an expert. Successful revascularization was defined as a modified thrombolysis in cerebral infarction (mTICI) score ⩾ 2B. Uncorrected and corrected volumes were compared between each package and, to FIV according to mTICI score.

Results: Ninety-four patients were included, of whom 67 (71.28%) had mTICI score ⩾ 2B.

In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (P>0.15). Conversely, assessment of PDV revealed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference: -40.9mL) and B (median absolute difference: -67.0mL) overestimated FIV to a lesser degree compared with package C (median absolute difference: -118.7mL, P=0.03 and P=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (P⩾0.99).

Conclusions: Automated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same data set. This highlights the need for routine expert evaluation, and correction of automated package outputs data for appropriate patient management.

Disclosure: No

P0005 / 1569

VALIDATION OF THE PERFORMANCE OF ICH SCORE FOR PREDICTING MORTALITY IN CERBRAL HEMORRHAGE IN THE EMERGENCY DEPARTEMENT

S. Saad ¹, H. Touj², A. Cherni², E. Hajouni¹, I. Sedghiani³, B. Bahri², N. Falfoul Borsali³

¹Habib thameur hospital, Emergency, Tunis, Tunisia, ²Habib thameur hospital, Emergency departement, Tunis, Tunisia, ³Habib thameur hospital, Intensive care Unit, Tunis, Tunisia

Background and aims: Intracerebral hemorrhage is related to a high risk of mortality. Our study aims to validate ICH score in our population.

Methods: Prospective, monocentric, observational study during 12 months (January-December 2021). Inclusion of patients over the age of 16 years admitted on the emergency department (ED) for intracerebral hemorrhage confirmed by brain computed tomography.

Results: Inclusion of 42 patients. The mean age was 64±15 years, and 27 (64 %) were men. Mainly comorbidities were hypertension (64%), Diabetes (31%), dyslipidemia (19 %), atrial fibrillation (19%) and ischemic stroke (14%). Patients on anticoagulant therapy represented 16.7%. The mean delay of consultation at ED was 16±8 hours. At presentation, the most symptoms found were n(%): Altered level of consciousness 26(66.7), hemiplegia 15(35.7), hemiparesis 8(19). The mean of systolic blood pressure pas 170±50 mmHg, 23(54.8%) patients had GCS<13. Mortality at 30 days was 50 %.

Patients were divided into 5 groups according to the ICH score n(%): 0 (23.8), 1(23.8), 2(21.4), 3(23.8), 4(7.1). Threshold value of the ICH score for predicting 30-day mortality determined by the ROC curve was 3. The AUC was 0.76; with IC 95% [0.61-0.91] ans p=0.001. Sensitivity and specificity were respectively 57.2% and 95.2%; Positive Predictive Value =92.3% and Negative Predictive Value =69%.

Conclusions: Our study validates the use of ICH score for the mortality risk stratification in patients admitted at the ED for intracerebral hemorrhage.

Disclosure: No

P0006 / 205

DELIRIUM IN A NORWEGIAN STROKE UNIT

H. Ihle-Hansen ¹, M.M Walle-Hansen², I. Landgraff¹, N.T Jonsen¹, T. Jankowiak¹, G. Høvik¹, E. Graven¹, G. Hagberg², M. Myrstad¹

¹Bærum Hospital, Vestre Viken Hospital Trust, Department of Medicine, Drammen, Norway, ²Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway

Background and aims: Delirium is common in hospitalized patients. The incidence of delirium is scarcely investigated in acute stroke populations. Hence, we aimed to assess incident delirium among patients admitted to a Norwegian stroke unit and the feasibility of delirium screening conducted by nurses.

Methods: Patients admitted to the stroke unit at Bærum Hospital, Norway, from March-October 2020, with stroke, were consecutively invited to participate. Delirium screening was performed by nurses using the 4’A’-test (4AT) on day one after admission and repeated if the patient presented new symptoms of cognitive impairment. In patients with 4AT⩾4, indicating delirium, the diagnosis was validated by a geriatrician.

Results: In all, 62 patients with confirmed stroke were included, mean age 73.3, and 92% had an ischemic stroke. Median National Institutes of Health Stroke Scale (NIHSS) at admission was two (range 0-15) and 74% had a minor stroke (NIHSS 0-5). Two patients had 4AT⩾4, indicating delirium, on day one after admission. In total, five patients (8%) were diagnosed with delirium during the hospital stay. Mean NIHSS among patients with delirium was 9.0 (SD 4.8) and four out of the five patients with delirium had moderate to severe stroke (NIHSS>5). NIHSS>5 was a predictor of delirium (OR 15, 95% CI 1.5-146.9, p=0.02), even after adjusting for sex, age, and pre-stroke cognitive function.

Conclusions: While delirium was rare among patients with minor stroke, moderate to severe stroke was an independent risk factor. Delirium screening with 4AT performed by stroke unit nurses seems feasible.

Disclosure: No

P0007 / 1114

THE BLOOD BRAIN BARRIER PERMEABILITY IN PATIENTS WITH ASYMPTOMATIC CAROTID ARTERY STENOSIS

B. Chen ¹, X. Yin¹, J. Hang¹, H. Yu¹

¹ Clinical Medical College of Yangzhou University, Yangzhou, China

Background and aims: It is not known whether blood brain barrier permeability (BBBP) has changed in patients with asymptomatic carotid artery stenosis (ACAS). The study aimed to evaluate the cerebral brain perfusion, BBBP and the volume of gray matter in patients with ACAS by arterial spin labeling (ASL) MRI, dynamic contrast-enhanced (DCE) MRI and artificial intelligence (AI).

Methods: ASL-MRI, DCE-MRI and three-dimension brain volume (3D-BRAVO) imaging were performed respectively to obtain cerebral blood perfusion, BBBP which was expressed by volume transport constant K^trans and gray matter volume of both hemispheres.

Results: Total of 30 patients with ACAS were enrolled. Compared with the cerebral hemisphere without carotid artery stenosis, the hemisphere with stenosis had a significant decrease in cerebral brain perfusion (41.9757 vs 45.3932, P < 0.001). The K^trans of the cerebral hemisphere with stenosis was higher than another hemisphere (0.0050 vs 0.0046, P = 0.012). The area with increased K^trans was consistent with the area of hypo-perfusion. The volume of gray matter of cerebral hemisphere with stenosis was significantly smaller than another one (190.7437 vs 196.7959, P <0.001). There were significant differences between bilateral temporal lobe (P = 0.013), frontal lobe (P = 0.033), parietal lobe (P = 0.006) and insular lobe (P = 0.032). But there were not significant differences between sub-cortical gray matter (P = 0.237).

Conclusion: In patients with ACAS, there was increase in BBBP, which may be associated with chronic hypo-perfusion caused by CAS. And there was brain atrophy in the area with increased BBBP.

Disclosure: Yes

P0008 / 254

QUALITY IN ACUTE STROKE CARE (QASC) EUROPE - FACTORS INFLUENCING INTERNATIONAL UPSCALE OF NURSE-LED STROKE PROTOCOLS IN 64 EUROPEAN HOSPITALS: A QUALITATIVE STUDY

E. McInnes ¹, S. Dale², K. Bagot¹, K. Coughlan¹, J.M Grimshaw³, W. Pfeilschifter⁴, D.A Cadilhac⁵, S. Middleton², on behalf of the QASC Europe Steering and Implementation Committees

¹Australian Catholic University, Nursing Research Institute, Melbourne, Australia, ²Australian Catholic University, Nursing Research Institute, Sydney, Australia, ³University of Ottawa, Ottawa, Canada, ⁴Klinikum Lüneburg, Department of Neurology and Clinical Neurophysiology, Lüneburg, Germany, ⁵Monash University, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Clayton, Australia

Background and aims: QASC Europe was a collaboration between academics, the European Stroke Organisation and the Angels Initiative. A before-after study evaluated the effect of nurse-led implementation of evidence-based stroke protocols on patient care in 64 European hospitals from 17 countries. A qualitative process evaluation sought to identify factors that influenced protocol implementation from multiple stakeholders’ perspectives.

Methods: Focus groups and individual face-to-face videoconference interviews using a semi-structured interview guide. Purposive sampling to recruit interviewees from four stakeholder groups: 1) high-level project governance (senior project team and steering committee members); 2) Angels team leaders; 3) Angels consultants and 4) Stroke Nurse Country Co-ordinators. Interview transcripts were thematically analysed.

Results: All 22 approached, consented and participated. Participant numbers: n=13 interviews (groups 1 and 2); n=9 across three focus groups (groups 3 and 4). Four themes represent factors that influenced protocol implementation: 1) negotiating expectations; 2) role clarity; 3) optimal communication and 4) ability to tailor and adapt processes. These themes underpin a cascading facilitation model that reflects the sequence of processes and support required for multi-country nurse-led protocol implementation. Stakeholders reported the following benefits: expanded skillsets in implementation science and clinical quality monitoring; nurse leadership in evidence translation; and progressing of national stroke nurse networks.

Conclusions: A multi-layered collaborative partnership model of cascading facilitation enabled European stroke nurses to develop capability in leading and negotiating practice change at the hospital level. This model has potential for future international scale-up of other evidence translation initiatives.

Disclosure: Yes

P0009 / 491

EFFECTS OF EDARAVONE DEXBORNEOL ON NEUROLOGICAL FUNCTION AND SERUM INFLAMMATORY FACTORS IN PATIENTS WITH ACUTE ISCHEMIC STROKE

L. Qu ¹, H. Ge¹, W. Wei¹, C. Li¹

¹ Dezhou People’s Hospital, Department of Neurology, Dezhou, China

Background and aims: To investigate the therapeutic effects of edaravone dexborneol on neurological function and serum inflammatory factors in patients with acute ischemic stroke (AIS).

Methods: The cases of AIS treated from September 2020 to April 2021 were analyzed retrospectively. Patients enrolled were divided into 4 groups: edaravone dexborneol group (n = 65), routine treatment group (n = 68), edaravone dexborneol combined with alteplase thrombolytic group (n = 29) and alteplase thrombolytic group (n = 35). The changes of NIHSS score, hs-CRP, IL-6 and TNF- α before and after treatment were compared between groups.

Results: There were no significant differences in baseline characteristics between four groups. After treatment, the NIHSS score, hs-CRP, TNF-α, and IL-6 levels significantly decreased in both four groups compared before treatment. The decrease of NIHSS score, hs-CRP,TNF-α,and IL-6 in the combination treatment group reached -5.85 (95%CI:-6.70,-5.00) score,-21.17(95%CI:-21.95,-20.38) mg/L,-43.13(95%CI:-43.69,-42.57) pg/mL, -54.92 (95%CI:-55.49,-54.36) pg/mL, and in the edaravone dexborneol group reached -4.24 (95%CI:-4.81,-3.67) score,-16.54(95%CI:-17.07,-16.02) mg/L,-30.65(95%CI:-31.03,-30.28) pg/mL, -47.78 (95%CI:-48.16,-47.41) pg/mL, separately. After a pairwise comparison, the changes of the NIHSS score, hs-CRP, TNF-α, and IL-6 in the combination treatment group decreased more than other three groups (P<0.05). Patients in both the edaravone dexborneol group and alteplase thrombolytic group had higher decrease in both NIHSS score, hs-CRP, TNF-α, and IL-6 than the routine treatment group (P<0.05).

Conclusions: The application of edaravone dexborneol can significantly reduce the level of inflammatory factors and improve the neurological function in patients with AIS, either received or not received alteplase thrombolytic therapy.

Disclosure: No

P0010 / 699

BRUSH SIGN AND COLLATERAL SUPPLY AS POTENTIAL MARKERS OF INFARCT GROWTH AFTER SUCCESSFUL THROMBECTOMY

A. Bani-Sadr ¹, D. Pavie¹, L. Mechtouff², M. Cappucci¹, M. Hermier¹, R. Ameli¹, L. Derex², C. De Bourguignon³, T.-H. Cho², O. Eker¹, N. Nighoghossian¹, Y. Berthezene¹

¹Hospices Civils de Lyon, Neuroradiology, Bron, France, ²Hospices Civils de Lyon, Stroke, Bron, France, ³Hospices Civils de Lyon, Clinical Investigations Center, Bron, France

Background and aims: To investigate the impact of brush sign and cerebral collateral status on infarct growth after successful thrombectomy.

Methods: The HIBISCUS-STROKE cohort includes patients with acute ischemic stroke treated with thrombectomy after MRI triage and, undergoing a MRI at day-6 including FLAIR images to quantify final infarct volume (FIV). Successful revascularization was defined as mTICI score ⩾ 2B. Infarct growth was calculated by subtracting day-6 FLAIR images from the admission DWI images and, considered significant (SIG) when > 11.6mL. Cerebral collateral status was assessed using the hypoperfusion intensity ratio (volume of Tmax ⩾ 10s divided by the volume of Tmax ⩾ 6s). Good collaterals were defined by a hypoperfusion intensity ratio < 0.4.

Results: Eighty-eight patients were included, of whom 30 (34.1%) had a brush sign and, 42 (47.7%) had good collaterals. The brush sign was associated with higher rCBV (p=0.05), larger penumbra (p<0.001), greater infarct growth (p=0.01) and, larger FIV (p=0.02). Patients with good collaterals had a smaller baseline ischemic core (p<0.001), larger penumbra (p=0.05) and, lower FIV (p<0.001). Collateral status was not associated with brush sign (p=0.18) or with infarct growth (p=0.72). Nineteen (21.6%) patients experienced SIG. Univariate regressions indicated that brush sign (OR: 4.86, 95% CI: [1.69; 14.93], p=0.004) and hemorrhagic transformation (OR: 1.61; 95% CI: [1.05; 2.65], p=0.04) were predictive of SIG. In multivariate regression, only the brush sign remained predictive of SIG (OR: 5.21, 95% CI: [1.61-18.78], p=0.007).

Conclusions: Brush sign is a predictor of infarct growth after successful thrombectomy whereas cerebral collateral status is not.

Disclosure: No

P0011 / 686

CLINICAL CHARACTERISTICS OF PATIENTS WITH ACUTE ISCHEMIC STROKE: A REPORT FROM THE ACUTE STROKE DATABASE INCLUDING NEUROSONOLOGY LAB

J.H. Lee ¹

¹ National Health Insurance Service Ilsan Hospital, Neurology, Goyang-si, Korea, Republic of

Background and aims: The aim of this study was to establish clinical characteristics of patients after acute ischemic stroke (AIS).

Methods: In total, 972 consecutive patients with AIS were included from 2006 to 2012. We analyzed database after acute ischemic stroke from the database and medical records including neurosonology lab.

Results: Among the risk factors, hypertension was observed in 684 patients(70.4%), diabetes mellitus in 326 patients(33.5%), hyperlipidemia in 284 patients(29.2%), previous stroke history in 170 patients(17.5%), coronary heart disease in 72 patients (7.4%), atrial fibrillation in 169 patients(17.4%) and a history of smoking in 378 patients(38.9%). Regarding the types of stroke, ischemic stroke was observed in 886 patients(91.1%), AIS with hemorrhagic transformation was seen in 18 patients (1.9%) and transient ischemic attack in 68 patients(7.0%). By TOAST classification with neurosonology lab., large artery atherosclerosis was observed in 339 patients(34.9%), small vessel occlusion in 235 patients(24.2%), cardioembolism in 181 patients(18.6%), other determined causes in 25 patients(2.6%) and undetermined causes in 192 patients(19.7%). Mildly severe strokes were observed in 694 patients(71.4%), moderatelysevere strokes, in 174 patients(17.9%), and severe strokes in 104 patients(10.7%). Recanalization treatment was performed in 135 patients(13.9%), IV thrombolysis in 67.5%, endovascular treatment in 16%, and combined IV thrombolysis and endovascular treatment in 16.5%.

Conclusions: Our findings suggest that stroke mechanisms were similar to those reported by previous studies; however, the mechanism of large artery atherosclerosis seems more prevalent than in other studies. Only 13.9% patients underwent recanalization treatment, so a better system for treating patients with acute stroke seems necessary.

Disclosure: No

P0012 / 387

COMPARISON OF FUNCTIONAL NEUROLOGICAL OUTCOME WITH PROPOFOL TOTAL INTRAVENOUS ANAESTHESIA AND SEVOFLURANE BASED BALANCED ANAESTHESIA IN PATIENTS UNDERGOING DECOMPRESSIVE CRANIECTOMY FOR SUPRATENTORIAL ACUTE ISCHAEMIC STROKE

P.B. Sharma ¹, R.S. Chouhan¹, N. Sokhal¹, R. Bhatia², M. Singh³, B. Khaklari¹

¹All India Institute of Medical Sciences, Department of Neuroanaesthesiology and Critical Care, Neurosciences Center, New Delhi, India, ²All India Institute of Medical Sciences, Department of Neurology, Neurosciences Center, New Delhi, India, ³All India Institute of Medical Sciences, Department of Neurosurgery, Neurosciences Center, New Delhi, India

Background and aims: Malignant acute ischaemic stroke (AIS) often requires decompressive craniectomy (DC). There is trend towards propofol total intravenous anaesthesia (TIVA) in patients with raised intracranial pressure (ICP) which may provide better intraoperative brain condition and neurological outcomes. Studies comparing propofol TIVA and sevoflurane based balanced anaesthesia (SBBA) in other neurosurgical procedures have provided equivocal results and have not yet been studied in these patients. Our primary objective was to compare functional neurological outcomes in patients undergoing DC for supratentorial AIS using propofol TIVA or SBBA.

Methods: Total 23 adults aged upto 60 years having supratentorial AIS for DC were randomized into propofol TIVA (14) and SBBA group (09). Anaesthetic induction with propofol and fentanyl in both groups was followed by propofol infusion (100 mcg/kg/min) or 0.8-1.2 minimum alveolar concentration of sevoflurane for maintenance based on group allocation. Adequate blood-pressure, euthermia, euglycaemia were maintained. ICP was measured at first burr hole and brain relaxation was recorded. Neurological outcomes were assessed using modified Rankin scale (mRS) at discharge and 3 months after ictus.

Results: TIVA group had more patients with higher baseline NIHSS score. At 3 months from stroke onset, SBBA group (66.67%Vs21.41%) had significantly increased incidence of favorable functional neurological outcomes (mRS⩽3) than TIVA. All-cause mortality rate was higher with TIVA (50% Vs 22.2%). Both modalities had similar incidence of hypotension, perioperative vasopressor requirements, intraoperative brain relaxation.

Conclusions: Neurological outcomes were better with SBBA technique in patients undergoing DC for supratentorial AIS at 3 months after stroke.

Disclosure: No

P0013 / 381

THE EFFECTS OF BUTYLPHTHALIDE IN PATIENTS WITH LARGE HEMISPHERIC INFARCTION: A MULTICENTRE, INTERVENTIONAL STUDY

X. Li ¹, J. Xia¹, X. Zhang¹

¹ The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Background: To evaluate the clinical effect of Butylphthalide in patients with large hemispheric infarction.

Methods: A multi-center, interventional study was conducted at 27 centers in 16 provinces in China. 485 participants with large hemispheric infarction (baseline infarction area involving at least 2 lobes or diameter of infarction larger than 4.0 cm) were enrolled within 72 hours of symptom onset and divided into Butylphthalide treatment (n=327) and control groups (n=158) from July 2014, through March 2017. The primary efficacy outcome was favourable outcome among the treatment and control groups as measure by the proportion of patients who achieved a modified Rankin Scale (MRS) of 0-2 at 90 days.

Results: In total, 148 and 51 patients in the Butylphthalide treatment and control groups, respectively, had a MRS score of 0–2 at 90 days (54.6% vs 35.4%, adjusted OR=1.79, 95% CI:[1.054–3.04]; P=0.031). The butylphthalide treatment group exhibited lower mortality at all time points during the observation period ( χ²=23.71, P<0.001). The adjusted logistic regression model showed that changes in the National Institutes of Health Stroke Scale (OR=−1.34, 95% CI: [−2.48 to −0.2], P=0.021) and MRS scores (OR=−0.36, 95% CI: [−0.61 to −0.12], P=0.004) were significantly different between the butylphthalide treatment and control groups at 90 days.

Conclusions: Favourable outcomes and decrease mortality were observed in patients with large hemispheric infarction who treated with butylphthalide. These findings suggest a greater benefit of butylphthalide in patients with large hemispheric infarction.

Disclosure: No

P0014 / 1110

RISK OF CEREBRAL VASCULAR ACCIDENT IN CHILDREN WITH CONGENITAL CEREBRAL MALFORMATIONS

O. Tihai ¹, S. Hadjiu², M. Sprincean³, C. Calcii², N. Lupusor², C. Griu², L. Fegiu², N. Revenco²

¹IMSPSCMC V. Ignatenco, Pediatria, Chisinau, Moldova, Republic of, ²State University N. Testimitanu, Pediatria, Chisinau, Moldova, Republic of, ³State University N. Testimitanu, Pediatria, Chisinau, Micronesia, Federated States of

Introduction: Congenital cerebral malformations (CKD) are often a risk factor for ischemic stroke (stroke) in children.

Purpose: To investigate the causes of stroke in children by imaging examination to identify MCC.

Materials and methods: In 2010-2020, a retro- and prospective study was conducted in the Republic of Moldova on a sample of 510 children with stroke with a newborn age up to 18 years, of which 44 children were confirmed by MCC brain imaging. Results. Among the MCCs diagnosed in children with stroke can be listed agenesis 4 (9%) or hypogenesis of the body calozum - 9 (20.5%) cases, Dandy-Walker syndrome - 6 (13.6%) cases, malformation Arnold Chiari - 7 ( 16%) cases, congenital microcephaly - 3 (6.8%) cases, malformations of the cerebellum - 4 (9%) cases, expressed by simple hypogenesis of the worm - 2 (50%) cases or hypogenesis of the cerebellar hemispheres in 2 (50% ) cases, congenital hydrocephalus - 2 (4.6%) cases, intrauterine dilation of the ventricular system - 9 (20.5%) cases. MCC can often be responsible for the development of stroke, among those found in children in our study we cite Dandy-Walker syndrome, Arnold Chiari malformation, congenital hydrocephalus. In some newborns with stroke, brain conditions have been identified that have occurred in the fetal or neonatal period, suggestive of perinatal stroke, including cerebral cyst in 24 (4.7%;) EI cases.

Conclusions: One of the causes of stroke in children is determined by MCC which represents 8.6%.in the case of our study.

Keywords: congenital brain malformations, stroke, ischemic.

Disclosure: No

P0015 / 130

HEALTHCARE PROFESSIONAL’S VIEWS ON THE BARRIERS AND ENABLERS OF THROMBOLYSIS IN ACUTE ISCHAEMIC STROKE PATIENTS: A MIXED - METHOD SYSTEMATIC REVIEW

B. Ettimoottil Varghese ^1,2, L. Philpott³

¹Tipperary University Hospital, Stroke Unit, Clonmel, Ireland, ²University College, Cork, Catherine McAuley of School of Nursing and Midwifery, Cork, Ireland, ³University Colege, Cork, Catherine McAuley of School of Nursing and Midwifery, Cork, Ireland

Background: Administration of intravenous tissue Plasminogen Activator (t-PA) within 4.5 hours from the time of onset of stroke symptoms is the only proven effective treatment for Acute Ischaemic Stroke (AIS). However, despite its effectiveness, its current utilisation is very low. There are various factors affecting the use of t-PA for patients with AIS.

Purpose: The purpose of this systematic review is to explore healthcare professional’s views on the barriers and enablers of thrombolysis in acute ischaemic stroke patients.

Methodology: A mixed- method systematic review protocol was developed and registered with PROSPERO (Reference number: CRD193556).The review was guided by the PRISMA reporting process. A systematic search of databases was conducted using CINAHL, MEDLINE and Cochrane Library. Papers published in English and database from 2009 to 2019 was searched and included in the review.

Results: A total of 485 hits were identified from the databases and 5 additional studies found from other resources. Nine studies met the inclusion criteria out of a total of 490 search results. The main barriers and enablers identified are comprised in four domains. The key identified barriers are delayed hospital presentation of the patients from time of onset of stroke symptoms, healthcare professional’s limited skills or competence to use the thrombolytic therapy, unavailability of acute stroke protocols and guidelines in ED.

Conclusion: Despite the considerable evidence of effective use of thrombolysis, it is due to barriers across patients, HCPs, organizational and guideline domains. Evidence of enablers and recommendations are reported to improve thrombolysis rate.

Disclosure: No

P0016 / 966

CORRELATION OF COLLATERAL SCORES DERIVED FROM WHOLE BRAIN TIME-RESOLVED FLAT PANEL DETECTOR IMAGING IN ACUTE ISCHEMIC STROKE

C. Kurmann ¹, J. Kaesmacher¹, S. Pilgram-Pastor¹, E. Piechowiak¹, A. Scutelnic², M. Heldner², T. Dobrocky¹, J. Gralla¹, P. Mordasini¹

¹University Hospital Bern, Inselspital, Department of Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ²University Hospital Bern, Inselspital, Institute of Neurology, Bern, Switzerland

Background and aims: Collaterals can be assessed on multiphase angiography, perfusion imaging or conventional angiography. Flat panel detector CT perfusion (FD-CTP) imaging offers the unique possibility to assess all different measures of collateral status and compare it to gold-standard conventional digital subtraction angiography (DSA) at almost the same time. We aimed to validate multiphase flat panel detector CT angiography (mFDCTA) and hypoperfusion intensity ratio (HIR) derived from FD-CTP as reliable collateral scores.

Methods: Retrospective analysis of patients with the first or second segment middle cerebral artery occlusion undergoing pre-interventional FD-CTP imaging. Interrater-reliability was calculated for the Calgary/Menon for mFDCTA and the ASITN/SIR for DSA collateral scores using Intraclass Correlation Coefficients. Spearman correlation was determined between HIR/mFDCTA score and ASITN/SIR score.

Results: We included 30 patients from November 2019 to February 2021. Interrater-reliability was moderate for the ASITN/SIR DSA score (0.68, 95%-CI 0.50-0.82) and for the Calgary/Menon mFDCTA score (0.53, 95%-CI 0.29-0.72). Correlation was strong between ASITN/SIR DSA and Calgary/Menon mFDCTA score (ρ=0.54, p=0.002) and between the HIR and Calgary/Menon mFDCTA score (ρ=-0.57, p<0.001), and moderate between HIR and ASITN/SIR DSA score (ρ=-0.49, p=0.006). Correlation with infarct core was moderate for the ASITN/SIR DSA (ρ=-0.46, p = 0.01), and strong for the Calgary/Menon mFDCTA (ρ=-0.66, p<0.001) and the HIR (ρ=0.76, p<0.001).

Conclusions: The Calgary/Menon mFDCTA collateral score and HIR derived from FD-CTP have good correlation with the ASITN/SIR DSA collateral score as gold-standard and between each other. Our findings show that collateral scoring derived from FD-CTP is clinically reliable.

Disclosure: No

P0017 / 935

ASSOCIATION BETWEEN HYDRATION STATUS AND CLINICAL OUTCOME IN ACUTE ISCHEMIC STROKE PATIENTS WITH LARGE VESSEL OCCLUSION RECEIVING MECHANICAL THROMBECTOMY

A. Labedi¹, J. Charles James ¹, D. Richter¹, C. Schroeder¹, K. Vohl¹, A.-M. Aloizou¹, J. Motte¹, F. Kämmerer¹, C. Lukas¹, R. Gold¹, C. Krogias¹

¹ Ruhr University Bochum, Bochum, Germany

Background and aims: Dehydration was found to be a marker of poor prognosis in patients with acute ischemic stroke (AIS), including patients receiving intravenous thrombolysis. It is unclear whether dehydration status before onset is related with short-term outcome of AIS patients with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).

Methods: In this monocentric retrospective study, consecutive AIS patients presenting with LVO undergoing MT in our comprehensive stroke center were included.

An elevated Blood Urea Nitrogen / Creatinin ratio (BUN/Cr) ⩾ 15 was chosen as the dehydration

Marker, and patients were categorized in two groups (A=dehydrated vs. B=non dehydrated). Clinical and procedural data were analyzed between two groups.

Results: 95 eligible patients were included (mean age= 76.6±14.3y; 57.9% female; NIHSS score at admission= 10±6.5). Dehydration status was documented in 65 patients (68.5%). Baseline characteristics including NIHSS and ASPECTS score did not differ between the two groups. Additionally, no significant difference was documented regarding clinical and procedural outcomes (Group A vs. group B: NIHSS at discharge= 2.5±3.5 vs. 3.0±5.0 (p=0.790), mRS at discharge=2.5±2.0 vs. 3.0±2.0 (p=0.615), successful recanalization=80.0%. vs. 81.5% (p=0.655), inhospital mortality=13.3% vs. 16.9% (0.656).

Conclusions: The present findings suggest that in AIS patients with LVO undergoing mechanical thrombectomy, the BUN/Cr ⩾ 15 as a marker of dehydration status is not associated with the clinical outcome. However, the high proportion of dehydrated patients in LVO patients warrants further investigation.

Disclosure: No

P0018 / 1527

THROMBUS PERVIOUSNESS IN LARGE VESSEL STROKE AS A PREDICTOR OF OUTCOME TO TENECTEPLASE

D. Ferreira ^1,2, A.I. Almeida³, R. Soares-dos-Reis^1,2,4, L. Albuquerque³, L. Fonseca⁵, E. Azevedo^1,2,6, P. Castro^1,2,6

¹Centro Hospitalar Universitário de São João, Department of Neurology, Porto, Portugal, ²Faculty of Medicine of University of Porto, Department of Clinical Neurosciences and Mental Health, Porto, Portugal, ³Centro Hospitalar Universitário de São João, Department of Neuroradiology, Porto, Portugal, ⁴I3S – Institute for Research and Innovation in Health, Porto, Portugal, ⁵Centro Hospitalar Universitário de São João, Department of Internal Medicine, Porto, Portugal, ⁶Faculty of Medicine of University of Porto, Cardiovascular R&D Unit, Porto, Portugal

Background and aims: Thrombus perviousness is associated with better outcomes in stroke. Histological data suggest greater fibrin composition in more permeable thrombi. Tenecteplase (TNK) has 15-fold higher affinity for fibrin than Alteplase (ALT). We aimed to evaluate imaging characteristics of thrombi that predict the efficacy of tenecteplase vs. alteplase in patients with ischemic stroke.

Methods: Retrospective study in patients submitted to thrombolysis between Mar/2020-Aug/2021, matched for sex, age, and site of occlusion. Sociodemographic, clinical, and imaging data were collected, specifically the Thrombus Attenuation Increase on CTA (TAI), and onset-to-recanalization time (OTR). Main outcomes were primary recanalization (before angiography or initial TICI 2b/3), secondary recanalization (final TICI 2b/3) and clinical improvement. Permeable vs. non-permeable thrombi were classified by TAI (cut-off=10) after selecting occlusions in M1±TICA segments.

Results: 47 patients were selected (TNK n=15; ALT n=32). Analysis regarding the total number of patients revealed a trend towards greater primary recanalization (TNK: 20% vs. ALT: 9%; p=0.283) and significantly lower OTR in TNK group (TNK: 309min vs. ALT: 371min; p=0.010). Regarding permeable thrombi (n=20), patients undergoing TNK had a greater recovery in NIHSS at 24 hours (TNK: 12 ± 6 vs. ALT: 4 ± 9; p<0.002). No differences were noted in the primary or secondary recanalization nor in the non-permeable thrombi.

Conclusions: Our results raise the hypothesis that a greater clinical improvement might occur with TNK in patients with more permeable fibrin-rich thrombi. These findings may be relevant for therapeutic decisions. Nevertheless, validation in a larger cohort is necessary.

Disclosure: No

P0019 / 1004

SEX-SPECIFIC DIFFERENCES IN OCTAGENARIAN STROKE PATIENTS RECEIVING THROMBOLYSIS

M. Schäbitz ^1,2, N. Klein^1,3, L. Wulff¹, A. Kitsiou¹, R. Klingebiel⁴, A. Friedrich⁵, F. Zuhorn¹, A. Rogalewski¹

¹Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Department of Neurology, Bielefeld, Germany, ²University of Marburg, Medical School, Marburg, Germany, ³University of Aachen, Medical School, Aachen, Germany, ⁴Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Department of Neuroradiology, Bielefeld, Germany, ⁵Bielefeld University, Department of Psychology, Bielefeld, Germany

Background and aims: In recent years, there has been increasing recognition of the importance of sex for care and management of stroke patients. Females have, for example, a higher stroke incidence due to their higher life expectancy, receive a lower quality of care and less frequently guideline-based medications including thrombolysis. The goal of the present study was to extend such sex specific analysis to intra-hospital process and treatment parameters and long-term outcome.

Methods: We retrospectively analysed demographic data, clinical treatment parameters, imaging data including infarct volume, location, extent of microangiopathy and assessed quality parameters of all patients treated with thrombolysis (N=815; 47.6% females) in a large comprehensive stroke center between 01/2017 and 06/2020. Long-term outcome was analysed by assessing the modified Ranking Scale and the EQ-5D-5L-Index.

Results: In patients aged between 79 and 86 years without any difference between the sex groups, females showed a significantly higher proportion of cryptogenic strokes, had longer door-to-needle times, more severe strokes when admitted to hospital, had less frequently diabetes mellitus, showed different degrees of cerebral microangiopathy and most importantly, exhibited a worse long-term outcome with regard to quality of life.

Conclusions: Unexpectedly, this study shows that octogenarian females have a worse long-term outcome after intravenous thrombolysis than males. Interestingly, differences between groups can be observed in process parameters of the acute phase such as time of initiation of thrombolytic therapy and correlate to long-term outcome. These data are of great relevance to enable females to receive equivalent quality of treatment.

Disclosure: No

P0021 / 383

ADDITIONAL INTRAVENOUS THROMBOLYSIS WITH TENECTEPLASE FOR ACUTE ALTEPLASE-RESISTANT MEDIUM VESSEL OCCLUSION STROKES

N. Chausson ¹, S. Olindo², M. Aghasaryan³, F.-X. Laborne⁴, P. Renou², D. Soumah³, S. Debruxelles², T. Altarcha³, M. Poli², Y. L’Hermitte³, S. Sagnier², C. Alecu³, C. Imbernon³, L. Smadja¹, G. Ouanounou³, M. Toudou-Daouda³, N.R. Aminou-Tassiou³, F. Rouanet², I. Sibon², D. Smadja¹

¹Université Paris-Saclay/Centre Hospitalier Sud-Francilien, Neurology, Corbeil-Essonnes, France, ²CHU Bordeaux, Neurology, Bordeaux, France, ³Centre Hospitalier Sud-Francilien, Neurology, Corbeil-Essonnes, France, ⁴Centre Hospitalier Sud-Francilien, Biostatistic, Corbeil-Essonnes, France

Background and aims: Intracranial medium-vessel-occlusion (MeVO) strokes can cause major disabilities. Intravenous thrombolysis (IVT) and endovascular treatment of MeVOs are, respectively, inconstantly effective or still unproven. We assessed a new therapeutic strategy: a second IVT with tenecteplase for patients without early recanalization.

Methods: Consecutive pre-selected patients with MeVO strokes eligible for alteplase, 0.9 mg/kg (IVT1) and low bleeding risk underwent systematic 1-hour post-IVT brain magnetic resonance imaging (dual-IVT strategy (DIS) cohort). DIS patients with persistent occlusion (arterial occlusive lesion [AOL] scale grade 0–1) 1-hour post-IVT-1 received tenecteplase (0.25 mg/kg, IVT-2). Primary efficacy and safety endpoints were recanalization (AOL grade 2–3) at 24–36 hours and severe bleeding. They were compared to MeVO-stroke patients from another stroke unit managed with single-IVT strategy (SIS cohort).

Results: Among 148 DIS-cohort patients, 97 received tenecteplase IVT-2. At 24–36 hours, 124/148 (84%) DIS vs. 57/89 (64%) SIS patients’ lesions were recanalized (P<0.01). Three DIS and one SIS patients had symptomatic intracerebral hemorrhage (P=1). DIS was independently associated with recanalization at 24–36 hours (OR, 2.5 [95% CI, 1.29–4.89]; P<0.01). Good outcomes (modified Rankin scale 0–2) at 3 months were more frequent for DIS than SIS patients (79% vs. 63%, P<0.01).

Conclusions: For patients with IV alteplase-treated MeVO strokes without early recanalization, an additional-dose of tenecteplase appears safe, more effective than alteplase alone and an easy-to-implement therapeutic option for carefully selected cases. Further controlled studies are needed to confirm these promising findings.

Disclosure: No

P0022 / 219

ACUTE REPERFUSION TREATMENT DURING THE COVID-19 PANDEMIC: FINDINGS FROM SHANGHAI STROKE SERVICE SYSTEM

Y. Dong ¹, J. Xu¹, Y. Xie¹, K. Fang¹, Q. Dong¹

¹ Huashan Hospital, Fudan University, Shanghai, China, Department of Neurology, Shanghai, China

Background and aims: COVID-19 pandemic is affecting triage of strokes in emergency. We aimed to find whether COVID-19 delayed the reperfusion treatment in acute ischemic stroke (AIS) patients.

Methods: The Shanghai Stroke Service System (4S) is a regional network that prospectively registries AIS patients within 7 days. Data with COVID-19 negetive was extracted from January 2018 to December 2020. Compared to quality measures in 2018-2019, the performance during COVID-19 outbreak (mainly during 1st quarter of 2020) and post were analyzed. The primary outcome was door to needle time (DTN). The secondary outcomes included the rate of reperfusion treatment and hospitalization cost.

Results: Our study included 69,258 patients from 64 stroke centers. During 1^st quarter 2018 to 4^th quarter 2019, there was an overall downward trend of DTN (P trend=0.006). However, during 1^st and 2^nd quarters 2020, there was a significant delay of DTN. After outbreak in China, the average DTN plus mandatory COVID-19 PCR test dropped back to <60 minutes. The drop of reperfusion rate was also associated to COVID-19 outbreak (57.92% pre vs 51.74% during, P<0.001), while improved after, compared to those of previous(57.92% pre vs 62.32% post, P<0.001). The cost was slightly declined in 1^st quarter 2020 (-$125 USD), which reflected changes in reperfusion rates.

Conclusions: In 2020, COVID-19 pandemic prolonged the DTN during COVID-19 outbreak but improved after in Shanghai. Although the prevention protocol and PCR test are still in place, acute stroke care in Shanghai has back to normal post pandemic.

Disclosure: No

P0023 / 226

DIRECT BYPASS TO ENDOVASCULAR CAPABLE STROKE CENTER COMPARED TO SECONDARY TRANSFER FROM PRIMARY STROKE CENTRES

J.B. Hong ^1,2, W. Diprose^1,2, M.T.M. Wang², J. Meyer², D. Kilfoyle¹, P.A. Barber^1,2

¹Auckland District Health Board, Neurology, Auckland, New Zealand, ²University of Auckland, Faculty of Health and Medical Sciences, Auckland, New Zealand

Background and aims: Our stroke network operates a hybrid organizational structure with potential large vessel occlusion (LVO) patients taken to the local primary stroke centre (PSC) during office-hours, and directly bypassed to the endovascular thrombectomy stroke center (EVT-SC) after-hours. We aimed to compare the two methods of transfer.

Methods: Consecutive anterior LVO patients treated with EVT within 6 hours of last-known-normal between August 2017 and February 2021 were identified. Patients were grouped into method of presentation: direct bypass to EVT-SC (‘EVT-SC direct’), or taken to local PSC with secondary transfer to EVT-SC (‘PSC-transfer’). The primary outcome was 3-month functional independence (modified Rankin Scale score 0-2). Secondary outcomes included mortality at 7-days and at 3-months.

Results: 259 patients (109 women; mean±SD age 66.8±15.2 years) were included; 91 (35.1%) EVT-SC direct and 168 (64.9%) PSC-transfer patients. The EVT-SC direct patients had shorter median times from last-known-normal to thrombolysis (120 vs 147 minutes, P=0.004) and puncture (190 vs 230 minutes, P<0.001). Multivariable logistic regression analysis found that EVT-SC direct patients had greater 3-month functional independence (OR=2.04, [95%CI, 1.12-3.73]; P=0.02), and lower 3-month mortality (OR=0.33, [95%CI, 0.12-0.91]; P=0.03). For every 100 patients directly bypassed to EVT-SC, there were 14 more patients functionally independent and 9 fewer who had died, at 3-months.

Conclusions: In this comparison of two organizational paradigms in patients with a PSC as the closest stroke center, direct bypass to EVT-SC resulted in significantly better process times and clinical outcomes compared to secondary transfers from PSCs.

Disclosure: No

P0024 / 525

DIAGNOSTIC IMPACT OF FUTILE RECANALIZATION ON PARENCHYMAL BLOOD VOLUME AFTER REPERFUSION FOR ACUTE ISCHEMIC STROKE

I. Nakagawa ¹, M. Kotsugi¹, S. Yokoyama¹, H. Park¹, R. Maeoka¹, T. Furuta¹, H. Sasaki¹, S. Yamada¹, H. Nakase¹

¹ Nara Medical University, Neurosurgery, Kashihara, Nara, Japan

Purpose: In recent years, the efficacy of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) has been established even beyond 6 hours of onset with diffusion-perfusion mismatch patients. However, it is difficult to predict clinical outcome just after reperfusion by MT. In this study, we evaluated whether parenchymal blood volume (PBV) after MT can predict futile recanalization in AIS patients.

Methods: Patients who underwent MT for AIS at our institution from 2018 to 2021, had a reperfusion of TICI 2b or higher, and could be evaluated by PBV before and after treatment were included in the study. Whole brain imaging was performed. ROIs for each reflux region, ischemic core and non-core penumbral region, were set from the obtained cerebral blood volume (CBV) map, and the obtained CBV values were averaged for evaluation (syngo XWP VD 10E). Patients were divided into two groups based on clinical outcome. Good prognosis is defined as modified Rankin Scale 0-2 three months after reperfusion.

Results: Seventy-one patients (38 males, mean age 76 years) were retrospectively enrolled in this study. Good prognosis group showed significant increase of non-core PBV and highly collateral score (p<0.001 in both), however, poor prognosis group demonstrated no improvement of non-core PBV even after reperfusion. Logistic regression analysis indicates that increase of non-core PBV and high collateral score were significantly related to good clinical outcomes (p=0.04, 0.007, respectively).

Conclusions: No-improvement of parenchymal blood volume after reperfusion predicts poor prognosis with futile recanalization in acute ischemic stroke patients.

Disclosure: Yes

P0025 / 225

FULLY AUTOMATIC SCORING OF COLLATERAL STATUS ON MULTIPHASE CTA AND ITS CLINICAL VALUE IN PREDICTING PROGNOSIS OF PATIENTS WITH ACUTE ISCHEMIC STROKE

X. Wang¹, J. Ma ¹, X. Chen¹, Y. Li², L. Fu²

¹Soochow University, Department of Radiology, Institute of Medical Imaging, Suzhou, China, ²Neufost Medical System, Shanghai, China

Background and aims: Multiphase CTA(mCTA) with time resolution, which can accurately assess the status of cerebral collateral in patients with acute ischemic stroke. A mCTA based collateral grading scale, 6-scale, is widely used by ESCAPE and other studies. The purpose of this study is to obtain 6-scale score automatically and verify the accuracy and clinical value of the score.

Methods: Gray threshold, active contour model and connected component analysis were used to segment brain tissue, after image enhancement and other conventional preprocessing steps. Finally, the collateral vessels were scored according to 6-scale by calculating reduced extent and delay time of the diseased side compared to the normal side. The agreement between automated collateral scores and neuroradiologists was estimated by calculating the spearman correlation coefficient. Area under the curve(AUC) was calculated by building Multivariable logistic regression model to predict prognosis.

Results: 58 patients with unilateral anterior circulation large vessels occlusion were included (mean age=64 years;38% male; 29% diabetes; median baseline NIHSS=9(3-13); median baseline ASPECTS=9(8-9)). For automatic and manual score, the spearman correlation coefficient was 0.493 (p<0.01). Automated collateral score was predictive of prognosis (AUC=0.603; 95%CI, 0.454, 0.752). Automated collateral score combined with three baseline affecting factors of NIHSS, ASPECTS and diabetes were entered into the multivariate logistic regression model which predicted prognosis well (AUC=0.822, 95%CI, 0.709, 0.935).

Conclusions: The accuracy of the automatic collateral score is good, while avoiding the disadvantages of time-consuming, large differences between evaluators, and strong experience dependence. In addition, automatic collateral score combined with patient clinical information can accurately predict good prognosis.

Disclosure: No

PREVENTION

P0026 / 475

OPTIMISING THE ANALYSIS OF VASCULAR PREVENTION TRIALS: RE-ASSESSMENT OF THE TARDIS TRIAL, THE FIRST PREVENTION TRIAL TO ADOPT AN ORDINAL PRIMARY OUTCOME MEASURE

L.J. Woodhouse ¹, A.A Montgomery², S. Pocock³, M. James², A. Ranta⁴, P.M Bath¹, TARDIS Investigators

¹University of Nottingham, Stroke Trials Unit, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom, ²University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom, ³London School of Hygiene & Tropical Medicine, London, United Kingdom, ⁴University of Otago Wellington, Department of Medicine, Wellington, New Zealand

Background: Ordinalised vascular outcomes incorporating event severity rather than just event numbers are more informative and efficient statistically. The TARDIS trial was the first vascular prevention study to use an ordinalised vascular outcome as its primary efficacy and safety measures and also collected severity information for other vascular events.

Methods: TARDIS was an international prospective randomised open-label blinded-endpoint trial assessing one month of intensive versus guideline antiplatelet therapy in patients with acute non-cardioembolic stroke or TIA. Vascular events and their severity were recorded up to final follow-up at 90 days post randomisation. For each outcome, statistical techniques compared ordinal (10 models) and dichotomous (5 models) analyses; results were then ranked with the smallest p-value being given the smallest rank. Outcomes were also assessed within the pre-defined subgroup of participants with mild stroke (NIHSS⩽3) or TIA recruited within 24 hours.

Results: Ordinal versions of vascular event outcomes were created in 3096 participants for stroke, myocardial infarction, major cardiac events, bleeding events, serious adverse events and venous thromboembolism (VTE), with 32 outcomes being created overall (29 in the subgroup population due to the absence of VTE events). Overall, tests run on ordinal outcomes appeared more efficient for 20/32 (63%) of analyses in comparison with binary tests. 764 (24.7%) participants were recruited within 24 hours of a mild stroke/TIA; again, tests run on ordinal outcome were superior in 27/29 (93%) of the comparisons.

Conclusions: In TARDIS, tests performed on ordinal vascular outcomes were more efficient statistically than those using binary data.

Disclosure: No

P0027 / 1342

PATENT FORAMEN OVALE IN CRYPTOGENIC STROKE: TO CLOSE OR NOT TO CLOSE

M. Immens ¹, V. van den Hoeven¹, R. van Lith¹, T. ten Cate², F.E. de Leeuw¹

¹Radboud university medical centre, Neurology, Nijmegen, Netherlands, ²Radboud university medical centre, Cardiology, Nijmegen, Netherlands

Bckground and aims: Patent foramen ovale (PFO) closure is proven beneficial in preventing recurrent ischemic stroke in highly selected trial patients with a demonstrated relation between PFO and stroke. These trial results tend to be generalized to daily practice, without adhering to the original trial criteria. This may result in unnecessary closure without benefits, but with risk of complications.

We therefore wanted to investigate the relation between PFO and stroke among referrals to one of four congenital cardiac centers in the Netherlands.

Methods: 173 consecutive stroke patients referred to the Radboudumc for PFO closure. PFO was defined as a right-to-left shunt within 5 heart beats on contrast-enhanced echocardiography. All patients underwent a standardized work-up to demonstrate the ischemic event and to evaluate arteriopathy, cardiac embolism and prothrombosis.

Results: 173 Patients were referred for PFO closure on the basis of cryptogenic stroke with PFO. After assessment, 77 patients (45%) were rejected for PFO closure. Standardized work-up showed a different etiology for stroke (34%), discordant clinical presentation and imaging (20%) and presence of multiple cardiovascular risk factors (21%).

Conclusion: Among 45% of neurological referrals for PFO closure, a relation between PFO and stroke could not be demonstrated and did not underwent an invasive, high risk PFO closure. This stresses the need of a complete work-up, multidisciplinary assessment and of careful extrapolation of trial data to daily clinical practice.

Disclosure: No

P0028 / 1086

PERSISTENCE TO ORAL ANTICOAGULATION AND HEALTH-RELATED QUALITY OF LIFE IN STROKE SURVIVORS WITH ATRIAL FIBRILLATION – THE BERLIN ATRIAL FIBRILLATION REGISTRY

M.C Olma*^1,2, S. Tütüncü*¹, L. Steindorf-Sabath¹, A. Schneider³, C. Fiessler⁴, C. Kunze¹, M. Krämer¹, P.U Heuschmann⁴, M. Endres*^2,1,5,6,7,8, K.G Haeusler* ⁹

¹Charité - Universitätsmedizin Berlin, Center for stroke research, Berlin, Germany, ²Charité - Universitätsmedizin Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany, ³Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany, ⁴University Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany, ⁵Berlin Institute of Health (BIH), Berlin, Germany, ⁶Excellence Cluster NeuroCure, Berlin, Germany, ⁷German Center for Cardiovascular Research, Partner Site Berlin, Germany, ⁸German Center for Neurodegenerative Diseases, Partner Site Berlin, Germany, ⁹University Hospital Würzburg, Department of Neurology, Würzburg, Germany

Background and aims: Persistence to oral anticoagulation (OAC) is key in stroke survivors with atrial fibrillation (AF). Besides persistence rates, we prospectively evaluated health-related quality of life (HR-QoL).

Methods: The investigator-initiated prospective multi-centre Berlin Atrial Fibrillation Registry enrolled 1,080 patients with AF and acute ischemic stroke or transient ischemic attack (TIA). Primary outcome measure was patient-reported persistence to OAC (using non-vitamin K-dependent oral anticoagulant (NOAC) or vitamin K antagonist (VKA)) at 12 months after the index stroke/TIA. Patient-reported HR-QoL (EQ-5D including EQ-index and EQ-VAS) in anticoagulated patients was a pre-defined secondary outcome.

Results: OAC status was available in 844 registry patients at 12 months after stroke/TIA. Of those, 800 (94.8%) patients were on OAC and 745/819 (91.0%) patients were persistent to OAC therapy (re-)started after stroke/TIA. Specifically, 630/723 (87.1%) patients were persistent to (re-)started NOAC therapy vs. 112/165 (67.9%) patients (re-)started on VKA (p<0.001). In patients using OAC, median EQ-index was 0.89/0.89 and median EQ-VAS was 65/68 at 3 or 12 months follow-up, respectively. There was no difference in HR-QoL between patients on NOAC or VKA at these time-points. Multivariable linear regression-analysis showed that non-persistence to OAC (vs. OAC-persistence) was associated with lower EQ-VAS at 12 months (p=0.005).

Conclusions: Persistence to OAC in registry patients with AF was high within one-year after stroke/TIA. Of note, persistence rate in NOAC treated patients was higher than in VKA treated patients. Type of OAC was not associated with HR-QoL, but non-persistence to OAC was associated with lower HR-QoL at 12 months after stroke/TIA.

Disclosure: Yes

P0029 / 934

SMOKERS WITH ELEVATED GLYCATED ALBUMIN COULD NOT BENEFIT FROM DUAL ANTIPLATELET THERAPY AFTER MINOR STROKE OR TRANSIENT ISCHEMIC ATTACK

H. Zhou ¹, Y. Pan¹, W. Chen¹, Y. Suo¹, X. Meng¹, Y. Wang¹

¹ Beijing Tiantan Hospital, Capital Medical University, Neurology, Beijing, China

Background and aims: The previous study found that smokers treated with dual antiplatelet therapy had a lower recurrence of stroke compared with nonsmokers, which may be attributed to the increase in cytochrome P450 1A2 activity by smoking. Patients with diabetes mellitus have impaired responsiveness to clopidogrel. We aimed to investigate the impact of smoking on dual antiplatelet therapy in patients with minor stroke (MS) or transient ischemic attack (TIA) under different glycated albumin (GA) levels.

Methods: We analyzed data from the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events trial (CHANCE). Patients were categorized by smoking status and GA levels. The primary efficacy outcome was a new stroke within 90 days. The interaction of smoking status with antiplatelet therapy was calculated by Cox proportional hazards regression model.

Results: A total of 3044 patients were included. During the 3-mo follow-up period, 299 (9.9%) patients had a new stroke occurrence. In the elevated GA group, both smokers and nonsmokers could not benefit from dual antiplatelet therapy (smokers: adjusted HR 0.68, 95%CI 0.42-1.10; nonsmokers: adjusted HR 0.82, 95%CI 0.58-1.17). In the normal GA group, dual antiplatelet therapy reduced the risk of recurrence stroke in smokers by 69% (adjusted HR 0.31, 95%CI 0.17-0.59), and in nonsmokers by 48% (adjusted HR 0.52, 95%CI 0.30-0.93). However, there was no significant interaction between smoking status and antiplatelet therapy in the normal GA group.

Conclusions: Smokers with elevated GA could not benefit from dual antiplatelet therapy after MS or TIA.

Disclosure: No

P0030 / 1266

VALIDATION OF A PREHOSPITAL TRIAGE SYSTEM FOR STROKE IN OSAKA

T. Noda ¹, Y. Katayama², T. Nishimura¹, Y. Mizobata¹

¹Osaka City University, Trauma and Critical Care Medicine, Osaka, Japan, ²Osaka University, Traumatology and Acute Critical Medicine, Osaka, Japan

Background and aims: In Osaka, the Emergency Medical Service (EMS) uses a triage system to ensure that stroke patients are transported quickly and appropriately. However, the validity of this triage hasn’t yet been evaluated. The purpose of this research is to verify the validity of the implementation criteria of the stroke triage system using the data collected by the Osaka Emergency Information Research Intelligent Operation Network system (ORION).

Methods: The research period was 60 months, from January 2016 to December 2020, and included patients registered in the ORION data who were transported to the emergency room as sick, excluding those with trauma, external causes, 19 years old or younger, or incomplete data.

Results: There were 277,501 patients in the EMS-Stroke group who were suspected of having had a stroke using EMS criteria and 562,354 patients in the EMS-Non stroke group who weren’t suspected of having had a stroke using EMS criteria. The final diagnoses of stroke in each group were 35,496 and 10,208, respectively.

The EMS-Stroke group was found to be significantly more likely to have a stroke with p<0.001 (x2 test).

In stroke, there are many symptoms of acute onset, and “convulsions” are inappropriate items to suspect stroke among the items suspected of stroke by EMS used in ORION.

Conclusions: In conclusion, we have shown that the triage system of Osaka is useful for the triage of strokes. Furthermore, the results of this study can be used to improve the system by adjusting the triage items.

Disclosure: No

P0031 / 1165

TIME INTERVAL BETWEEN NOAC LAST INTAKE AND ISCHEMIC STROKE RECURRENCE - DATA FROM THE RENO-EXTEND DATABASE

L. Petraglia ¹, A. Falcou¹, L. Gentile², A. Risitano¹, M. Paciaroni³, D. Toni⁴

¹Policlinico Umberto I, Emergency Department - Stroke Unit, Roma, Italy, ²IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana Ospedale Maggiore, Bologna, Italy, ³University of Perugia, Stroke Unit and Division of Cardiovascular Medicine, Perugia, Italy, ⁴La Sapienza Università di Roma, Dipartimento di Neuroscienze Umane, Roma, Italy

Background and aims: Direct Oral Anticoagulants (DOAC) are the gold standard for Ischemic Stroke (IS) prevention in patients with Atrial Fibrillation (AF). Four molecules are available: Dabigatran and Apixaban, administered twice daily (BID); Edoxaban and Rivaroxaban, administered once daily (QD), despite similar Time to Peak and Halflife. We evaluated the delay between the last drug intake and the onset of IS in order to understand the potential influence of daily frequency administration on IS recurrence.

Methods: The RENO-EXTEND is a prospective multicenter observational database which collected consecutive IS in stroke patients with AF receiving DOAC. The time elapsed between the last intake of the drug and the onset of stroke was available in 467 patients. We analyzed data according to 2 groups: patients on BID-DOAC vs patients on QD-DOAC.

Results: In the BID-NOAC group, the mean time between last DOAC intake and recurrent IS was of 11.18 hours (± 15.92 SD, median 11, IQR 5-18). In the QD-DOAC group, the mean time was of 14.34 hour (± 17.98 SD, median 8, IQR 4-12). The delay between last intake of BID-DOAC and IS onset was about 11 hours, that is close to the next drug intake, corresponding to the lowest serum drug level. In the QD-DOAC group, IS was mainly experienced about 14 hours after last drug intake, far from the next intake but corresponding to the Halflife time (10-13 hours for QD-DOAC).

Conclusions: Our results suggest a possible relationship between IS occurence and DOAC Halflife, irrispective of drug posology.

Disclosure: No

P0032 / 251

PREVALENCE AND RISK FACTORS OF OBSTRUCTIVE SLEEP APNEA IN ACUTE ISCHEMIC STROKE PATIENTS USING OVERNIGHT PULSE OXIMETRY

S. Roongruang ¹, A. Chutinet², N. Chirakalwasan²

¹Chulalongkorn University, Medicine, Bangkok, Thailand, ²Chulalongkorn University, Bangkok, Thailand

Background and aims: OSA is linked with ischemic strokes and TIAs, but it remains underdiagnosed because of inconvenience and costs of in-laboratory polysomnography.

The objective of this study was to investigate the prevalence of OSA in patients with acute ischemic stroke, to find out variable risk factors of OSA in these patients, and to generate the predictive mathematic equation for OSA in stroke patients.

Methods: This cross sectional study was conducted between April 2021 and November 2021 in the Stroke Unit, KCMH.

We consecutively recruited stroke patients aged > 18 years with the diagnosis of stroke/TIA. All patients were assessed using NONIN PureSAT Model 3150 (WristOx2 3150).

This consisted of three parts:

a) Data collection of baseline characteristics of stroke patients.

b) The Berlin’s and STOPBANG questionnaire for evaluation of OSA risk together with the evaluation of daytime sleepiness using the Epworth Sleepiness Scale, and

c) Using overnight pulse oximetry and data collection.

Results: 83 patients (mean age 65 +/- 15 SD [year]) with a diagnosis of stroke/TIA ( 51 men and 32 women), the overall prevalence of OSA was 72.28%.

Conclusions: We found a high prevalence of OSA among Stroke patients, particularly in those with higher BMI, increased neck and waist circumference, high score of STOPBANG and Berlin’s questionnaire and higher score in Epworth Sleepiness Scale. The result can be use to make a predictive equation of OSA in stroke.

Early detection of OSA may play an important role in enhancing quality of life of these individuals.

Disclosure: No

P0033 / 265

DIAGNOSTIC UTILITY OF BRAIN MRI IN PATIENTS WITH SPONTANEOUS INTRACEREBRAL HEMORRHAGE

M. Wilson ¹, J.-Y. Wang¹, A. Andreev¹, M. Selim¹, V.-A. Lioutas¹

¹ Beth Israel Deaconess Medical Center/Harvard Medical School, Neurology, Boston, United States

Background and aims: MRI is often performed to evaluate the underlying etiology of spontaneous intracerebral hemorrhage (ICH). However, the diagnostic yield of MRI in ICH is unclear. We examined the prevalence of secondary lesions on baseline and follow-up MRI.

Methods: We examined a cohort of 856 consecutive patients with spontaneous ICH identified on head CT admitted to a tertiary center from 2008-2018. Brain MRI scans at baseline and follow-up were reviewed by trained investigators for secondary lesions. We also examined clinical and CT radiographic variables associated with secondary lesions in univariable analyses.

Results: Our cohort comprised 856 spontaneous ICH patients;186 suffered in-hospital mortality. Among the 670 survivors [70±15 years, 379(57% male)], 449(67%) had at least one MRI: 430(64%) at baseline, 154(23%) on follow-up and 136(20%) on both. 30/430(7%) of baseline MRIs revealed a secondary lesion. 4/154(3%) of follow-up MRIs revealed a lesion that was not previously identified on baseline MRI: (3 mass, 1 vascular malformation). 127/136 patients with baseline and follow-up MRIs had a negative admission MRI; 4/127 (3%) patients with a negative MRI at baseline had a lesion identified on follow-up MRI. For the 449 patients who underwent MRI, no clinical or radiographic variables were associated with the presence of secondary lesion on MRI.

Conclusions: Follow-up MRI for patients with spontaneous ICH had a relatively low diagnostic yield for secondary lesions in this cohort. Larger cohort studies with cost-benefit analysis are required to better understand the utility of MRI in these patients.

Disclosure: No

P0034 / 1243

UNDERTREATMENT OF ANTICOAGULANT THERAPY IN HOSPITALIZED ACUTE ISCHEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATION

X. Gong ¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, School of Medicine, Neurology, Hangzhou, China

Background: This study aimed to investigate the prevalence and factors associated with the initiation of anticoagulation among acute ischemic stroke (AIS) patients with atrial fibrillation (AF) at discharge in China.

Methods: We continuously included hospitalized AIS patients with AF diagnosis registered in the CASE II from 2016 to 2020 and divided them into anticoagulant and non-anticoagulant group according to the medications at discharge.

Results: A total of 16,162 patients were enrolled, mean age was 77±9 years, 8596 (53.2%) were males; median baseline NIHSS score was 5(2-12). Of the 14838 patients without contraindications of antithrombotic therapy, 6335 (42.7%) patients initiated anticoagulation at discharge. Prior history of hemorrhagic stroke (OR 0.646, P<0.001) and gastrointestinal bleeding (OR 0.607, P=0.002) were associated with lower rate of anticoagulation at discharge. Patients with any intracranial hemorrhage (OR 0.268, P<0.001) or pneumonia during hospitalization (OR 0.601, P<0.001) were less likely to receive anticoagulants at discharge. Among 7807 patients with previously diagnosed AF and high risk of stroke (CHA₂DS₂-VASc⩾2), only 1585 (20.3%) patients had been receiving anticoagulation prior to the onset of stroke. However, the mean INR was 1.5 on the first test during hospitalization in these patients receiving warfarin.

Conclusions: Less than half of AIS patients with AF initiated guideline recommended anticoagulation at discharge, while only 20% previously diagnosed AF patients with high risk of stroke had been using anticoagulants prior to the onset of stroke, which highlights a large care gap in hospitalized stroke patients and the importance of AF management.

Disclosure: No

P0035 / 1377

THE EFFECT OF ALLOPURINOL ON VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY FOLLOWING ISCHAEMIC STROKE AND TRANSIENT ISCHAEMIC ATTACK – AN EXPLORATORY ANALYSIS OF THE XILO-FIST STUDY

A. MacDonald ¹, M. Robertson², N. Broomfield^3,4, K. Dani⁵, D.A. Dickie^3,6, A. Doney⁷, K. Forbes⁵, G. Houston⁸, S. Kean², A. McConnachie², T. Quinn³, A. Struthers⁸, M. Walters³, P. Bath⁹, J. Dawson³

¹University of Glasgow, Glasgow, United Kingdom, ²Robertson Centre for Biostatistics, Institute of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom, ³Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom, ⁴Stroke Psychology, West Glasgow Ambulatory Care Hospital, Glasgow, United Kingdom, ⁵Department of Neurology, Institute of Neurological Sciences Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom, ⁶DD Analytics Cubed Ltd, Bishopton, United Kingdom, ⁷Medicine Monitoring Unit (MEMO), School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom, ⁸Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, Dundee, United Kingdom, ⁹Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom

Background and Aims: Xanthine oxidase inhibition with allopurinol lowered systolic blood pressure in people with ischaemic stroke and transient ischaemic attack (TIA) in a recent randomised trial. This study aimed to investigate the effect of allopurinol treatment on visit-to-visit blood pressure variability (BPV).

Methods: We did an exploratory analysis of data from the XILO-FIST trial. XILO-FIST was a multicentre, randomised, double-blind trial of allopurinol versus placebo after stroke in 464 participants. Brachial blood pressure (BP) was measured at clinic visits across the two-year treatment period and participants with five valid clinic BP measurements were included in this analysis. Using the systolic BP data, visit-to-visit BPV was expressed by five measures. Between group comparisons of BPV were assessed using Wilcoxon-Mann-Whitney tests.

Results: Among the 356 participants (178 per group) with five valid BP measurements, there were no significant differences observed between placebo and allopurinol groups for any measure of BPV: Range [between group difference = 0.5 mmHg (95% Confidence Interval (CI) = -2.0 to 3.0, p = 0.79)]; Standard Deviation [0.15 mmHg (95% CI -0.92 to 1.19, p = 0.77)]; Coefficient of Variation [-0.04% (95% CI -0.78 to 0.69, p = 0.90)]; Average Real Variability: -0.13 mmHg (95% CI -1.38 to 1.13, p = 0.85)]; and Variation Independent of Mean [-0.22 U (95% CI -1.21 to 0.77, p = 0.64)].

Conclusions: Allopurinol did not affect visit-to-visit BPV in people with recent ischaemic stroke or TIA. Further research should aim to identify whether allopurinol influences short-term BPV after stroke.

Disclosure: Yes

P0036 / 962

REMOTE ISCHAEMIC CONDITIONING FOR SECONDARY STROKE PREVENTION (RIC-PREVENT) – A PILOT RANDOMISED CONTROLLED TRIAL

S. Baig^1,2, S. Pamma², R. Jessica^1,3, M. Arshad^2,3, A. Ali ^4,3

¹Sheffield Teaching Hospitals, Neuroscience, Sheffield, United Kingdom, ²University of Sheffield, Neuroscience, Sheffield, United Kingdom, ³Biomedical Research Centre, Sheffield, United Kingdom, ⁴Sheffield Teaching Hospitals, Geriatrics and Stroke Medicine, Sheffield, United Kingdom

Background and aims: There is a great need to enhance secondary prevention after stroke. Remote ischaemic conditioning (RIC) involves brief periods of non-lethal limb ischemia, interspersed with reperfusion, and may improve tissue perfusion, inflammatory mediator profile and thus secondary vascular risk. We undertook a pilot randomised controlled trial to evaluate the feasibility of undertaking RIC to reduce secondary stroke

Methods: 18 patients within a week of suffering a TIA or minor stroke (non-cardioembolic) were randomised (1:1) to either RIC (BP cuff inflation around the upper arm at 200 mmHg for 5 minutes followed by 5 minutes of deflation), or sham (inflation pressure 20 mmHg), repeated 4 times, daily for 8 weeks. Primary outcomes: Safety, tolerability and compliance. Secondary outcomes: blood pressure (BP), EQ-5D and vascular events at baseline, 8 weeks, 6 months.

Results: RIC was safe (no serious adverse events related to RIC), well tolerated (discomfort scores only mild to mod) and compliance to treatment was excellent (98% all sessions completed). Median (IQR) systolic (SBP) and diastolic (DBP) blood pressures appeared lower in the RIC group compared to sham at 8 weeks although this was not statistically significant (-15 mmHg (9.5) vs + 2.5 mmHg (8); p= 0.257). Only 1 participant experienced a recurrent minor ischaemic stroke within the first 6 months (sham group). No changes to EQ-5D were noted.

Conclusion: RIC appears a safe and an acceptable treatment for secondary stroke risk reduction, and may result in beneficial effects to BP. Further study evaluating its clinical effectiveness are warranted.

Disclosure: No

REHABILITATION & RECOVERY

P0037 / 239

WITHDRAWN VALIDITY OF THE MODIFIED RANKIN SCALE IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE

E. Nobels-Janssen ¹, E. Postma², I. Abma³, M. van Dijk⁴, I. de Ridder⁵, H. Schenck⁵, W. Moojen⁶, H. den Hertog⁷, D. Nanda⁷, A. Potgieser⁴, B. Coert², W. Verhagen⁸, R. Bartels⁹, P. van der Wees³, D. Verbaan², J. Boogaarts⁹

¹Radboud University Medical Center, Neurosurgery, Nijmegen, Netherlands, ²Amsterdam UMC, Amsterdam, Netherlands, ³Radboud University Medical Center, IQ healthcare, Nijmegen, Netherlands, ⁴University Medical Center Groningen, Groningen, Netherlands, ⁵Maastricht University Medical Center, Maastricht, Netherlands, ⁶Haaglanden Medical Center, The Hague, Netherlands, ⁷Isala Hospital, Zwolle, Netherlands, ⁸Canisius Wilhelmina Hospital, Nijmegen, Netherlands, ⁹Radboud University Medical Center, Nijmegen, Netherlands

Background and purpose: The modified Rankin Scale (mRS), a clinician-reported outcome measure of global disability, has never been validated in patients with aneurysmal subarachnoid hemorrhage (aSAH). The aims of this study are to assess:

1) convergent validity of the mRS;

2) responsiveness of the mRS; and

3) the distribution of mRS scores across patient reported outcome measures (PROMs).

Methods: This is a prospective, randomized, multicenter study. The mRS was scored by a physician, and by structured interview or self-assessment. All patients completed EuroQoL 5D-5L, RAND-36, Stroke Specific Quality of Life scale (SS-QoL) and Global Perceived Effect (GPE). Convergent validity and responsiveness were assessed by testing hypotheses.

Results: The correlation of the mRS with EQ-5D-5L was r = -0.546, with RAND-36 physical and mental component score being r = -0.439 resp. r = -0.574, and with SS-QoL r = -0.671. Three out of four hypotheses for convergent validity were met. The mRS assessed through structured interview has higher correlation with the mental component score than with the physical component score of RAND-36. Improvement on GPE was indicated by 83% of patients; the mean change score of these patients on the mRS was -0.08 (SD 0.915). None of the hypotheses for responsiveness were met.

Conclusion: The results show that the mRS generally correlates with other instruments as expected, but it lacks responsiveness. A structured interview of the mRS is best for detecting disabling neuropsychological complaints.

Registration: URL: www.trialregister.nl; Unique identifier: NL7859

Disclosure: No

P0038 / 261

MAK EXOSKELETON FOR REHABILITATION IN STROKE PATIENTS: A NEW DEVICE FOCUSED ON THERAPY AND FUNCTIONAL TASKS

G. Puyuelo-Quintana ^1,2, C. Cumplido-Trasmonte^3,2, E. Barquín-Santos², M.A. Destarac-Eguizabal², A. Plaza-Flores^4,2, M. Hernández-Melero³, A. Gutiérrez-Ayala³, E. Garcés-Castellote^5,2, E. Delgado-Castillejo³, R. Cano-de-la-Cuerda⁶, A.L. López-Morón⁷, E. García-Armada³

¹King Juan Carlos University, International Doctoral School, Madrid, Spain, ²Marsi Bionics S.L., Madrid, Spain, ³Spanish National Research Council (CSIC-UPM), Centre for Automation and Robotics, Madrid, Spain, ⁴Polytechnic University of Madrid, Madrid, Spain, ⁵Alcalá de Henares University, Doctoral Program in Health Sciences, Madrid, Spain, ⁶Rey Juan Carlos University, Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Madrid, Spain, ⁷La Zarzuela University Hospital, Rehabilitation, Madrid, Spain

Background and objective: Given the population affected by stroke, and the movement/participation alteration caused by this pathology, a newly developed exoskeleton (MAK) was designed. This device is oriented to provide movements typically applied in therapy and to assist functional tasks. The MAK exoskeleton is a one degree of freedom device which is attached to patient’s affected lower limb (Figure 1).

Figure 1.

MAK exoskeleton attached to user’s lower limb.

The objective of this trial was to assess if the device could assist during the proposed functional tasks.

Method: 6 participants diagnosed with stroke were recruited. The training program consisted of 9 sessions of 1.5 hours each, twice a week where the device was used (NCT04837144). Data related to exercise performance was collected and analysed. The exoskeleton-assisted exercises proposed were: sit to stand, gait, weight transfer and stair climbing.

Results: All participants completed the trial. All the proposed exoskeleton-assisted exercise were performed. As some exercise required more functional ability than others, the participants were able to perform the therapy program according to their functional ability (Figure 2).

Figure 2.

Number of sessions where each exercise was performed.

Conclusions: The present study confirms that the device is able to assist in the performance of different types of functional and therapy focused exercises. Further trials with more participants, exposure time and efficacy-based studies are needed to assess the application of the MAK in stroke population.

Disclosure: Yes

P0039 / 1509

STROKE MECHANISMS AND SEVERITY IN ISCHEMIC STROKE PATIENTS WITH APHASIA

A. Grönberg ¹, I. Henriksson², A.G Lindgren¹

¹Department of Clinical Sciences Lund, Neurology, Lund University, Department of Neurology, Skåne University Hospital, Lund, Sweden, ²Division of Speech and Language Pathology, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden

Background: Aphasia is a devastating stroke symptom, affecting approximately 30% of patients with first-ever ischemic stroke (IS). The relationships between pathogenetic stroke mechanisms, stroke severity and aphasia need further study.

Methods: Consecutive patients hospitalized with first-ever acute IS between March 1, 2017 and February 28, 2018 were examined. Patients were assessed with NIHSS at hospital admission and presence of aphasia was evaluated with the language item of NIHSS (item 9). We registered pathogenetic stroke mechanisms according to TOAST, and clinical stroke syndromes according to The Oxfordshire Community Stroke Project (OCSP). Lacunar mechanisms usually preclude aphasia. We also collected data regarding length of hospital stay, discharge location and in-hospital death.

Results: Among 308 IS patients, 30% (n=91) had aphasia. The pathogenetic stroke mechanism cardioembolism was significantly more common for patients with aphasia compared to those without aphasia (P=0.02,Table 1). Patients with aphasia more often presented with the OCSP syndrome total anterior circulation stroke compared to patients without aphasia (36% vs 8%,P<0.001). Patients with aphasia had significantly more severe strokes (also when excluding the aphasia item on NIHSS,P<0.001), had longer hospital stays (median 8 days vs 4 days, P<0.001), were more frequently discharged to a short-term care facility (35% vs 13%, P=0.01), and had higher overall in-hospital mortality (18%) in comparison to those without aphasia (2%, P<0.001).

Conclusions: Cardioembolism is an important stroke mechanism associated with aphasia after IS. Persons with aphasia have numerous factors negatively influencing outcome and mortality. Further research within intervention is warranted to understand the effects of aphasia.

TOAST classification, n (%)	Patients without aphasia n=217	Patients with aphasia n=91	P-value
Cardioembolism	52 (24%)	33 (36%)	0.02
Large artery atherosclerosis	22 (10%)	16 (18%)	0.06
Small artery occlusion	33 (15%)	2 (2%)	0.001
Other determined etiology	6 (3%)	0	-
Undetermined etiology	104 (48%)	40 (44%)	0.31

Disclosure: No

P0040 / 1242

EFFECT OF TELEREHABILITATION IN FACILITATING UPPER EXTREMITY HOME PROGRAMS AND ASSOCIATED FUNCTIONAL REGAIN AMONG CHRONIC STROKE SURVIVORS: A PILOT STUDY

H. Maina Ali ¹, U. Muhammad Bello², A. Salisu Muhammad¹, F. Mahmud Ado³, H. Jalo abubakar⁴, S. Kamilu Sulaiman⁵, A. Muhammad Usman⁶, B. Ismail Muhammad⁷

¹Yobe State University Teaching Hospital, physiotherapy, Damaturu, Nigeria, ²Hong Kong Polytechnic University, Hong Kong, SAR, China, Rehabilitation Sciences, Hong Kong, China, ³Yobe State Specialist Hospital, physiotherapy, Damaturu, Nigeria, ⁴Yobe State Specialist Hospital, paediatrics, Damaturu, Nigeria, ⁵Bayero University Kano, physiotherapy, Kano, Nigeria, ⁶University of Maiduguri, medical Rehabilitation, Maiduguri, Nigeria, ⁷Ahmadu Bello University, physiotherapy, Zaria, Nigeria

Background: Stroke is a leading cause of disability in adults, requiring regular patient-therapist contacts to achieve greater functional regain of the affected extremities. Factors such as the recent Covid-19 pandemic have limited access to Rehabilitation services across several communities globally. A proliferation of telerehabilitation to ameliorate these healthcare challenges has been palpable in the recent years across the globe.

Purpose: To assess the effect of telerehabilitation in facilitating upper extremity home program and associated functional regain among chronic stroke survivors.

Methods: Two groups pretest-posttest study design was employed. Participants were instructed to perform upper extremity home programs three times a week for four weeks. A task-oriented, individually tailored, and intensive home-based telerehabilitation program was administered to the participants using audio calls. Upper extremity functional status was assessed using Fugl-Meyer Motor Assessment, and Wolf Motor Function Test. The Barthel Index was used to assess the extent of activities of daily living.

Results: A total number of 14 people were recruited (experimental n=7 age, 58 ± 5.83; control n=7, age 50.71 ± 8.62). Participants showed significant improvement for Fugl-Meyer Motor Assessment changed from 17.57 to 25.86 (p=0.02), whereas Wolf Motor Function Test changed from 28.14 to 43.71 (p=0.03).

Conclusions: Amidst situations restricting regular hospital visit among stroke survivors; telerehabilitation could serve as an adjunct therapeutic option for upper extremity rehabilitation. Future studies should employ a randomized controlled trial design with a larger sample size to confirm the utility of telerehabilitation.

Disclosure: No

P0041 / 884

LOWER BLOOD NUTRIENT LEVELS, HIGHLY PREVALENT MALNUTRITION, AND LOWER NUTRITIONAL INTAKE IN SUB-ACUTE STROKE PATIENTS WITH OR WITHOUT DYSPHAGIA

M. Siebler ^1,2, N. van Wijk³, B. Studer^4,5, C. van den Berg³, M. Lansink³, T. Schmidt-Wilcke^4,6

¹Fachklinik Rhein Ruhr, Neurologie und Neurorehabilitation, Essen, Germany, ²University of Düsseldorf, Neurology Department, Düsseldorf, Germany, ³Danone Nutricia Research, Utrecht, Netherlands, ⁴Formerly at St. Mauritius Therapieklinik, Meerbusch, Germany, ⁵University of Düsseldorf, Institute for Clinical Neuroscience, Medical Faculty, Düsseldorf, Germany, ⁶Neurologisches Zentrum, Mainkofen, Germany

Background and aims: Deterioration in nutritional status is highly prevalent after stroke, particularly if post-stroke oropharyngeal dysphagia (OD) reduces nutritional intake. Stroke complications are not limited to protein-energy malnutrition, but can also encompass micronutrient insufficiencies. We performed comprehensive nutritional assessments in sub-acute ischaemic stroke patients with or without OD to further comprehend stroke-related malnutrition.

Methods: This exploratory, cross-sectional study in rehabilitation centres included moderate ischaemic stroke patients with (N=36) or without (N=49) OD between 2-12w after stroke (www.trialregister.nl:NL6625). Patients were age- and sex-matched to healthy reference (HR) subjects. Blood nutrient concentrations, presence of (risk of) malnutrition, nutritional intake, quality of life (QoL), and activities of daily living (ADL) were assessed.

Results: Fasted blood concentration of several vitamins, minerals, fatty acids, and nutritional metabolites were significantly lower in stroke patients (-5 to -60%) vs. their matched HR subjects, irrespective of OD status. More than half of the stroke patients had (risk of) malnutrition, with more prevalence in OD vs. non-OD patients. Reported energy and macronutrient intake was lower in stroke patients vs. HR. Additionally, QoL and ADL were lower in stroke patients vs. HR, with OD scoring worse than non-OD patients.

Conclusions: We report a highly impaired nutritional status in sub-acute moderate stroke rehabilitation patients. Even though OD patients more often had malnutrition and reported lower QoL and ADL, blood nutrient levels were similarly lower in both OD and non-OD stroke patients vs. HR. These findings stress the importance of nutritional management in stroke patients with and without OD during rehabilitation.

Disclosure: Yes

P0042 / 840

CCR5-Δ32 POLYMORPHISM - A POSSIBLE PROTECTIVE FACTOR FOR POST-STROKE GAIT FUNCTION

J. Molad ¹, H. Hallevi¹, E. Seyman¹, O. Rotschild¹, N.M. Bornstein², O. Tene³, N. Giladi³, J.M. Hausdorff¹, E. Ben Assayag¹

¹Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, ²Shaare Zedek Medical Center, Jerusalem, Israel, ³Tel Aviv Sourasky Medical Center, Tel aviv, Israel

Background and aims: Stroke and small vessel disease are main causes of gait disturbances and falls. The naturally occurring loss-of-function mutation (LOFM) in the C-C Chemokine receptor 5 gene (CCR5-Δ32) has recently been reported as a protective factor in post-stroke motor and cognitive recovery. We sought to examine whether it also influences gait and balance measures up to two years after stroke.

Methods: Participants were survivors of first-ever, mild-moderate ischemic stroke or transient ischemic attack from the TABASCO prospective study, who underwent a 3T MRI at baseline, and were examined by a multi-professional team 6, 12 and 24 months after the event, using genetic, neurological, neuropsychological, and mobility examinations. We used force-sensitive insoles to assess gait rhythm and the timing of the gait cycle. CCR5-Δ32 status and gait measures were available for 335 patients.

Results: CCR5-Δ32 carriers (16.1%) had decreased (better) stride and swing time variability 6 and 12 months after the index event compared to non-carriers (p<0.01 for all). The association remained significant, after adjustment for age, gender, education, ethnicity, and the existence of lesion in neuroimaging.

Conclusions: CCR5-Δ32 LOFM has a significant association with better gait measures among stroke survivors. This is the first study showing that genetic factors may predict long-term gait and motor recovery after ischemic stroke.

Disclosure: No

P0043 / 916

HEMIPLEGIC SHOULDER PAIN AND SUBLUXATION: CAN WE OFFER MORE THAN A PILLOW? A COLLABORATION

S. Coleman ^1,2, H. Kavanagh^1,2, C. Soraghan³, C. Keady⁴, N. Clarke⁵, J. Halpin⁵, J. Harbison²

¹St James’s Hospital, Physiotherapy, Dublin, Ireland, ²St James’s Hospital, Mercer’s Institute for Successful Ageing, Dublin, Ireland, ³St James’s Hospital, Medical Physics and Bioengineering, Dublin, Ireland, ⁴St James’s Hospital, Occupational Therapy, Dublin, Ireland, ⁵National College of Art and Design, Dublin, Ireland

Introduction: Hemiplegic shoulder pain (HSP) and glenohumeral subluxation (GHS) are common complications after stroke. The stroke team in a large Dublin teaching hospital identified a need for an alternative way to prevent and manage HSP and GHS. The aim was to explore a novel approach to this ongoing clinical need.

Methods: Members of the stroke team submitted an application to a local innovation competition in 2019. This was shortlisted for a design sprint which was presented to a panel of judges and was deemed the best design. Funding was awarded to further develop the design in-house. A collaborative team was developed and included expertise from Physiotherapy, Occupational Therapist, Bioengineering and external designers.

Results: The team met and iteratively developed the design over 6 months in 2019 resulting in the creation of a final prototype. The design allows the upper limb to be cradled in a position which supports the shoulder, elbow, wrist and hand in both lying and sitting positions. An ethics application was submitted for a trial to commence in 2020. The initial study will look at the suitability and acceptability of this device for patients and staff.

Conclusions: A lack of effective options for the management of HSP and GHS was the motivation behind this project. This novel grass roots development was identified and driven by frontline specialist staff and the invaluable input from design students brought a diverse perspective to the project. It is hoped that the study will show improved patient comfort and management of GHS.

Disclosure: No

P0044 / 215

WITHDRAWN ONLINE MINDFULNESS FOR ANXIETY AND DEPRESSION SYMPTOMS AFTER STROKE: A MIXED METHODS STUDY

B. Parkinson ¹, M. Lawrence¹, E. McElhinney¹, J. Booth¹

¹ Glasgow Caledonian University, Department of Nursing and Community Health, Glasgow, United Kingdom

Background and aims: Mindfulness-based interventions (MBIs) can improve symptoms of anxiety/depression. Learning mindfulness in a stroke survivor-caregiver partnership (e.g. spouses) might help improve mood and be preferable for some people. Be Mindful is an online MBI, not previously evaluated with stroke survivor-caregiver partnerships. The aim was to evaluate the experience and outcomes for stroke survivor-caregiver partnerships using Be Mindful together.

Methods: Mixed methods case study research with an explanatory sequential design. Ethically approved and prospectively registered (NCT03473054). Stroke survivor-caregiver partnerships experiencing anxiety/depression symptoms were purposively recruited from the UK in 2019. Participants were enrolled onto Be Mindful, an asynchronous, 4-week, online mindfulness course. Data collection at weeks 0, 4, and 8 included the Hospital Anxiety and Depression Scale, Mutuality Scale, and the Mindful Attention Awareness Scale. Post-intervention interviews were completed. Effectiveness was evaluated using minimal clinically important difference (MCID). Interpretative Phenomenological Analysis was used to explain the meaningfulness of mindfulness and contextualise findings.

Results: 5 stroke survivor-caregiver partnerships (n=10 participants) participated. Be Mindful engagement varied between 0%-100%. Modal engagement was 75% at week 4 and 100% by week 8. Participants reported improvement in mutuality (n=3) and mindfulness (n=8). MCID was achieved for anxiety (n=5) and depression (n=2) symptoms. IPA analysis identified dialectical tension as a means of articulating the themes: curiosity, usage, togetherness, and change.

Conclusion: Stroke survivor-caregiver partnerships experience some improvement in mutuality, mindfulness, and anxiety/depression symptoms after using Be Mindful. Engagement and experiences varied. The findings are complex and preliminary; more research is needed before making firm recommendations.

Disclosure: No

P0045 / 337

SELF-ASSESSED HEALTH OF PATIENTS WITH ACUTE RETINAL ISCHEMIA

D.L. Rimmele ¹, L. Lebherz², L. Kriston³, H. Appelbohm¹, C. Gerloff¹, M. Härter², G. Thomalla¹

¹University Medical Center Hamburg-Eppendorf, Neurology, Hamburg, Germany, ²University Medical Center Hamburg-Eppendorf, Medical Psychology, Hamburg, Germany, ³University Medical Center Hamburg Eppendorf, Medical Psychology, Hamburg, Germany

Background: The value of patient reported outcomes measures (PROMs) to evaluate acute retinal ischemia is not known. We aimed to use PROMs of a standard set for stroke amended by a behavioral questionnaire to assess acute retinal ischemia.

Methods: In a prospective study patients with acute retinal ischemia were recruited over a period of 15 months during treatment on stroke unit. Baseline characteristics were collected from medical record and interview. PROM Information System 10-Question Short-Form (PROMIS-10) and the Patient-Health-Questionnaire-4 (PHQ-4) were assessed at follow up three and twelve months after admission postal and via phone. The study is registered at ClinicalTrials.gov, NCT03795948.

Results: 56 patients with RAO on fundoscopy and 25 with transient monocular vision loss (TVL) were included. Patients with RAO had a mean age of 72.3 years, 45.6% were female and 54.4% of them had hypertension. Patients with TVL were in mean 69.6 years of age, 36% were female, and 68% had hypertension. At three months the T-scores of PROMIS physical and mental were 47.1 ±8.85 and 46.7 ±8.80 for patients with RAO, 49.4 ±8.82 and 46.9 ±8.01 for TVL, compared to 50 ±10 in healthy populations. On the PHQ-4 25% of patients with RAO, 23% with TVL scored indicative for anxiety or depressive symptoms at three months. All values showed a slight increase at 12 months.

Conclusion: RAO and TSL led only to a slight impairment of outcomes determined by behavioral and stroke associated PROMs.

Disclosure: No

P0046 / 754

TASK-RELATED HEMODYNAMIC CHANGES BY HIGH-DEFINITION TRANSCRANIAL DIRECT CURRENT STIMULATION IN CHRONIC STROKE PATIENTS: AN FNIRS STUDY

H. Kim ^1,2, J. Kim^1,2, J. Lee¹, G. Lee¹, Y.-H. Kim^1,2,3

¹Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Seoul, Korea, Republic of, ²SAIHST, Sungkyunkwan University, Department of Health Sciences and Technology, Seoul, Korea, Republic of, ³SAIHST, Sungkyunkwan University, Department of Medical Device Management & Research, Seoul, Korea, Republic of

Background and aims: This study investigated the task-related hemodynamic changes caused by high-definition transcranial direct current stimulation (HD-tDCS) over the ipsilesional motor cortical area in chronic stroke patients.

Methods: Twenty-six chronic stroke patients participated in this study. HD-tDCS (1 mA for 20 minutes, 4 1) was administered to the ipsilesional C3 or C4 using the Starstim 8 (Neuroelectrics®, Spain) for four consecutive days. The cortical activity was measured using the NIRScout^® functional near-infrared spectroscopy (fNIRS) system (NIRx Medical Technologies, Germany) during the finger tapping task (FTT) with affected hand before and after stimulation. fNIRS data were analyzed using both NIRS-statistical parametric mapping (NIRS-SPM) software (KAIST, Korea) and nirsLAB® software (NIRx Medical Technologies, USA).

Results: Oxyhemoglobin (oxyHb) concentration was increased during FTT in bilateral hemispheres before HD-tDCS. After HD-tDCS, overall oxyHb concentration was decreased but lateralized to the affected hemisphere. In the time-series analysis, mean and integral values of oxyHb concentration during FTT showed a noticeable decrease in the channel closest to hand motor hotspot (hMHS) in affected hemisphere after HD-tDCS.

Conclusions: This study implies that HD-tDCS rebalances interhemispheric cortical activities and reduces oxyHb concentration of affected hemisphere during motor task. Noticeable changes in the area adjacent to the affected hMHS indicate that personalized HD-tDCS electrode placement is needed according to individual hMHS location.

Acknowledgements: This study was supported by an NRF grant funded by Korean government (NRF-2020R1A2C3010304) and Korean Health Technology R&D Project through the KHIDI, funded by the Ministry of Health & Welfare, Republic of Korea (HI17C1501).

Disclosure: No

P0047 / 952

CAN VISUAL FIELD RECOVERY AFTER STROKE BE ENHANCED BY ORCHESTRATED MULTIFOCAL CROSS-FREQUENCY TACS?

E. Raffin ^1,2,3, R.F. Salamanca-Giron^1,2,3, M. Bevilacqua^1,2,3, S.B. Zandvliet^1,2,3, F. Windel^1,2,3, P. Menoud^1,2,3, L. Draaisma^1,2,3, L. Fleury^1,2,3, P. Vuilleumier⁴, A. Guggisberg⁴, J. Gihka⁵, C. Bonvin⁵, P. Vuadens³, F.C. Hummel^1,2,3,4

¹Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland, ²Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland, ³Clinique Romande de Réadaptation, Sion, Switzerland, ⁴University of Geneva, Geneva, Switzerland, ⁵Hôpital du Valais, Sion, Switzerland

Background and aims: Visual field loss manifests in about one-third of stroke patients. Yet, there is currently no efficient rehabilitation strategy. Phase synchronization of cross-frequency oscillations in the α and γ bands is a key communication feature of the visuo-attentional network and can be modulated with transcranial alternating current stimulation (tACS). We applied a multifocal cross-frequency tACS protocol, applied on two key visual areas (V1 and V5) to promote residual visual communication and enhance visual field recovery in chronic stroke patients.

Methods: One stroke patient, 65 years, 1-year post stroke underwent two visual retraining blocks of 10 sessions with simultaneously applied tACS. Individual α and γ peak frequencies were used to apply tACS via two center-surround electrodes on V1 and V5 of the lesioned hemisphere. During the second training block, the combination stimulation frequency/electrode was reversed.

Results: The chronic, previously clinically stable patient significantly improved at the training task, with the largest improvement after the first block, associated with an increase in θ power and a decrease in α power. In line with the self-reported daily living benefit, the volume of the visual defect decreased after block 1, but not after block 2. Task related BOLD activity increased in the visuo-attentional network after the first training block.

Conclusions: A consistent pattern of changes was associated with visual field improvements. Recruitment is ongoing with 15 patients expected to be included in September 2022 at which time point de-blinding in regard of the interventional conditions can take place.

Disclosure: No

P0048 / 231

IMPROVING SLEEP IN REHABILITATION AFTER STROKE (INSPIRES)

M.K Fleming ¹, T. Smejka¹, E. Macey¹, S.D Kyle², A.L Henry^2,3, R. Luengo-Fernandez⁴, C.A Espie^2,3, H. Johansen-Berg¹

¹University of Oxford, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom, ²University of Oxford, Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom, ³Big Health Ltd., London, United Kingdom, ⁴University of Oxford, Health Economics Research Centre, Nuffield Department of Population Health, Oxford, United Kingdom

Background and aims: Stroke is frequently accompanied by sleep disruption, which persists long term throughout recovery. This study aims to assess the efficacy of an online cognitive behavioural therapy for insomnia (CBT-I) programme, Sleepio.

Methods: 84 community dwelling stroke survivors (39 female, mean 5.5 years post-stroke, mean 59 years of age) were randomised to Sleepio or control (sleep hygiene brochure). The primary outcome was self-reported insomnia (Sleep Condition Indicator; SCI-8) post-intervention. Secondary outcomes included mood (depression and anxiety), self-efficacy, quality of life and heath economics.

Results: For the primary outcome, intention-to-treat analysis revealed SCI-8 was significantly better post-intervention for the Sleepio group than control (analysis of covariance, baseline and sex as covariates, 5 imputed datasets, effect of group p=0.002–0.020, η²=0.066–0.114; intermediate effect size). Analysis of complete cases (Sleepio n=35, control n=33) showed a greater proportion of the Sleepio group experienced a clinically relevant improvement post-intervention (⩾7-points, 48.6% vs 21.2%, p=0.018). Secondary outcome analysis (complete cases, Sleepio n=34, control n=33) found less depression and anxiety for the Sleepio group across post-intervention and 8 week follow-up assessments (mixed repeated-measures analysis of covariance, baseline as covariate, effect of group p<0.05) and a tendency towards higher self-efficacy (p=0.05), but no difference for the stroke impact scale (p=0.72).

Conclusions: Online CBT-I (Sleepio) is effective at improving sleep condition and mood in chronic stroke survivors. CBT-I is recommended for treatment of sleep problems in European guidelines and should be considered as part of the multidisciplinary care pathway after stroke.

Clinical trial registration: NCT04272892

Disclosure: Yes

P0049 / 427

HIGH-INTENSITY INTERVAL TRAINING AFTER STROKE (THE HIIT STROKE STUDY) - EFFECTS ON COGNITIVE FUNCTION

T.I. Gjellesvik ¹, F. Becker², A.E. Tjønna³, B. Indredavik¹, E. Lundgaard⁴, H.R. Solbakken⁵, B. Brurok¹, T. Tørhaug¹, S. Lydersen⁶, T. Askim¹

¹Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, Trondheim, Norway, ²University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ³Norwegian University of Science and Technology, NeXt Move, Trondheim, Norway, ⁴Sunnaas Rehabilitation Hospital, Department of Research, Oslo, Norway, ⁵Ålesund Hospital, Department of Physical Medicine and Rehabilitation, Ålesund, Norway, ⁶Norwegian University of Science and Technology, Regional Centre for Child and Youth Mental Health and Child Welfare, Trondheim, Norway

Background and aims: There is significant evidence that exercise and repetitive task training improve fitness, balance, and walking capacity after a stroke. Despite being a key outcome, the benefit of exercise on post-stroke cognitive function remains under-investigated. High-intensity interval training (HIIT) has emerged as a popular and potent exercise modality. This intervention is safe and feasible for use in the troke population wsith promising findings on both peak oxygen uptake and mobility.

Methods: These are secondary results from The HIIT Stroke study, a multicenter, single-blinded, parallel-group, randomized controlled trial. Participants 3 months to 5 years after the first-ever stroke were included. The HIIT intervention consisted of 4x4 minutes of high-intensity interval treadmill training at 85-95% of peak heart rate (HRpeak) interspersed with 3 minutes of low-intensity walking at 50-70% of HRpeak, three times a week for eight weeks. The outcomes were the Montreal Cognitive Assessment (MoCA), Trail Making Test Part A (TMT-A) and TMT-B assessed immediately after the intervention (post-test) and, at 12 months follow-up.

Results: Participants were randomly assigned to intervention (n=36) or control group (n=34), mean (SD) age was 57.6(9.3) years, 26.4(14.5) months post-stroke. The intervention group showed a significant treatment effect (95% CI) from baseline to post-test on TMT-B (-24.16 [-46.35 to -1.98] seconds, p=0.033). There were no significant differences between groups on the TMT-A or MoCA either at post-test or at the 12 months follow-up.

Conclusions: Our data suggest that supervised HIIT improves parts of cognitive function in the short and long term after stroke.

Disclosure: No

P0050 / 1497

ASSESSING THE BENEFIT, ACCEPTABILITY AND FEASIBILITY OF A STROKE-SPECIFIC PSYCHOLOGICAL SELF-MANAGEMENT INTERVENTION, HEADS:UP

B. Davis ¹, M. Lawrence¹, N. Clark¹

¹ Glasgow Caledonian University, School of Health & Life Science, Glasgow, United Kingdom

Introduction: Mood disorder is a significant problem following stroke, affecting survivors (approximately 33%) up to 5 years post-stroke. Mindfulness Based Stress Reduction (MBSR) group-based courses are effective in helping people self-manage symptoms of anxiety and depression. In earlier co-creation work we developed HEADS: UP (Helping Ease Anxiety and Depression after Stroke), a 9-week stroke-specific MBSR course designed to mitigate effects of stroke which make mastery of MBSR skills challenging.

Methods: In two non-randomised mixed-methods feasibility studies we further adapted HEADS: UP: face-to-face (study 1); online, in response to COVID-19 restrictions (study 2). We used community networks and social media to recruit stroke survivors (SS) with self-reported anxiety and depression. Quantitative and qualitative data were collected pre-/post-intervention. Both studies received ethical approval.

Results: We enrolled 21 community-dwelling participants. Study 1: 13 SS (female n=4, 30.8%; mean age 63.3 years). Study 2: 9 SS (female n=5, 55.6%; mean age 54.2 years).

Pooled results showed positive trends toward improvement in symptoms of mood disorder (Table 1):

Table 1.

Results Time 0/1 - Becks Anxiety & Depression Indices (example of outcomes measures used).

	STUDY ONE		STUDY TWO
	T0 (n=9)Mean (SD)	T1 (n=5)Mean (SD)	T0 (n=5)Mean (SD)	T1 (n=5)Mean (SD)
BAI	9.89 (8.6)	7.20 (5.2)	22.8 (11.8)	5.4 (5.3)
BDI	20.67 (11.0)	9.8 (7.7)	19.4 (8.2)	3.2 (3.3)

Qualitative data informed changes to research processes and HEADS: UP course materials. Participants found the course accessible and beneficial, “It’s helped dramatically; I can’t explain how much.”

Conclusions: Stroke survivors found a stroke-specific psychological self-management intervention, HEADS: UP (face-to-face, online) acceptable, feasible and beneficial.

Disclosure: No

P0051 / 693

EVALUATION OF THE DIGITAL TOOL ‘STROKEHÄLSA’- A SUPPORT TO PREPARE FOR A CLINICAL VISIT AND TO ADDRESS UNMET NEEDS

E.K Kjörk ¹, K. Klerfors¹, K.S. Sunnerhagen¹

¹ University of Gothenburg, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden

Background and aims: With intent of enabling structured follow-up visits and enhanced patient preparedness, the digital tool Strokehälsa was created. Strokehälsa is an adaptation of the 11-item post-stroke checklist combined with health information and has recently been incorporated in a national healthcare platform. The aim was to evaluate the digital tool Strokehälsa in regards of perceived benefits, usefulness, and the ability to capture health problems by people with stroke prior to a clinical visit.

Methods: People having their follow-up visit after stroke were consecutively recruited at three hospitals in Sweden. Data consisted of two parts, perceived health problems gathered by Strokehälsa and a following survey regarding demographic data and user experiences. Data were analysed with descriptive statistics and free text answers with thematic analysis.

Results: Of the 171 individuals receiving the tool Strokehälsa, 80 responded (median of 67 years, 56% men) and of these 58 answered the survey. The survey showed high satisfaction with the tool. Every question had a large majority (minimum 84.5%) that stated to be satisfied or very satisfied. None of respondents said to be very dissatisfied. Almost everyone, 96.6%, was confident with Strokehälsa capturing their health problems. Analyze of text-answers showed the tool was perceived to provide a structured follow-up and enhanced patient involvement. Improvement suggestions were wider answering options, ability to explain one’s answers and amended explanatory texts.

Conclusion: Strokehälsa is a user-friendly and useful tool to enable preparation and identification of health problems prior to a care-visit among people with stroke.

Disclosure: No

P0052 / 153

ASSOCIATION OF NEUROPHYSIOLOGICAL PARAMETERS AND NEUROLOGICAL DEFICIENCY IN ATHEROSCLEROTIC CAROTID ARTERY DISEASE

N. Solianik ¹, R. Kalinin², I. Suchkov², A. Pshennikov², R. Zorin², A. Egorov²

¹Ryazan State Medical University, Vascular Surgery, Ryazan, Russian Federation, ²Ryazan State Medical University, Ryazan, Russian Federation

Background and aims: Carotid atherosclerosis is the main reason about 20–30 % of strokes. One-fifth of ischemic strokes affect the vertebrobasilar area. The aim of the study was to assess the relationship of neurological deficit and changes of neurophysiological parameters of the brain in carotid atherosclerosis.

Methods: This retrospective, single-center study enrolled patients with carotid atherosclerosis. Thirty-five patients divided into groups based on severity of cognitive performance and the degree of stenosis. The patients had spectral analysis and analysis of the coherence function of the electroencephalogram, cognitive evoked potentials P300, and heart rate variability. For determination of association between signs and severity of the disease carried out using neural networks.

Results: The patients divided on 2 groups by use cluster analysis based on parameters of neurological status and degree of stenosis in the selected patients. For assessment of significance of indicators, it ranked in descending order of their importance. In the group of indicators with high prognostic significance, the characteristics of the cognitive evoked potential has a prevalence in 40%, the second place was taken by the indicators of the cross-correlation function of the EEG (30%), then the spectral characteristics of the EEG (20%) and HRV (10%).

Conclusion: Search of predisposing factors for development of neurological disorders is important for patient’s treatment and changing quality of life, social adaptation. This allows us to single out the most significant neurophysiological parameters of neurological functions insufficiency, which primarily include the indicators of the P300 cognitive evoked potential.

Disclosure: No

P0053 / 646

ESTIMATION OF IMPACT OF STROKE ON SELF-RATED HEALTH: A CROSS-SECTIONAL STUDY IN SLOVENIA

M. Zaletel ¹, B. Žvan¹

¹ University Clinical Centre of Ljubljana, Vascular Neurology, Ljubljana, Slovenia

Background and aims: Self-rated health (SRH) became indicator in obtaining assessment of health. The aim of the study was to provide evidence for public health action as well as more individualized clinical treatment of stroke in Slovenia, the objective of our study was to assess the association between poor self-rated health (PSRH) and stroke, adjusted for selected comorbidity and socioeconomic factors.

Methods: The survey, conducted 2019, included 9900 adults. Logistic regression was used in univariate as well as in multivariate analysis. Three multivariate models were defined - MODEL 1 consisted of stroke and comorbidities related to physical dimension, MODEL 2 consisted additionally of comorbidities related to mental dimension, while MODEL 3 consisted additionally of socioeconomic factors.

Results: In univariate as well as in all three multivariate models the odds of PSRH were statistically significantly higher in stroke sufferers in comparison to non-sufferers (univariate model: OR stroke e=yes vs. stroke=no=6.98 (p<0.001); MODEL 1: OR stroke =yes vs. stroke=no=3.34 (p<0.001); MODEL 2: OR stroke=yes vs. stroke=no=3.08 (p<0.001); MODEL 3: OR stroke=yes vs. stroke=no=3.07 (p<0.001).

Conclusions: Stroke is important related to PSRH. Comorbidities related to the physical states reduce the power of stroke association with PRSH, while comorbidities related to the mental dimension do not reduce the power of stroke and other health conditions. Power of stroke’s association with PRSH is also independent of socioeconomic factors. We can conclude that stroke is a condition which is in bidirectional relationships with physical states expressing influence on PSRH and itself represent a stressor.

Disclosure: No

P0054 / 1011

INTRAVENOUS FRESH ALLOGENIC ADIPOSE-DERIVED MESENCHYMAL STEM CELLS AFTER STROKE: A PHASE 1A, SAFETY TRIAL (RESSTORE)

O. Detante ^1,2, A. Moisan³, M. Hommel^4,5, I. Favre-Wiki^1,2, A. Thuriot¹, J. Soulard^1,4, B. Naegele^1,2, L. Lamalle⁶, F. Boucher⁷, S. Grand^2,6,8, A. Jaillard^4,5,6, RESSTORE Study Group

¹CHU Grenoble Alpes, Neurology, Grenoble, France, ²Univ. Grenoble Alpes UGA, Grenoble Institute of Neurosciences, Inserm U 1216, Grenoble, France, ³EFS Auvergne Rhône Alpes, Cell Therapy and Engineering Unit, St ISMIER, France, ⁴Univ. Grenoble Alpes UGA, AGEIS EA 7407, Grenoble, France, ⁵CHU Grenoble Alpes, Research Department, Grenoble, France, ⁶CHU Grenoble Alpes, IRMaGe, Inserm US17 CNRS UMS 3552-UGA, Grenoble, France, ⁷HCL La Croix Rousse, Plastic Surgery, Lyon, France, ⁸CHU Grenoble Alpes, Neuroradiology - MRI, Grenoble, France

Background: Despite spontaneous recovery, 60% of stroke patients have residual impairment. Thawed allogenic adipose-derived mesenchymal stem cells (ADSCs) were used in cell therapy studies with promising results. However, fresh allogenic ADSCs, obtained after a short (one-week) culture from a frozen cell stock, have a better viability and functionality. We assessed feasibility and safety of intravenous (IV) injection of fresh ADSCs in subacute ischemic stroke.

Methods: RESSTORE 1a is a first-in-human, open, dose-escalation toxicity 3+3 trial. Four doses of ADSCs were assessed: 1, 1.5, 2 or 3 million/kg injected <10 days after stroke onset. Dose-limiting toxicity (DLT) events were predefined: recurrent stroke, myocardial infarction, pulmonary embolism, life-threatening event within one week after treatment.

Results: 17 patients were included (mean age +/-SD = 57 +/-18 years; inclusion NIHSS = 14.5 +/-3.5). As 2 patients were not treated (non conformity of ADSC culture and technical problem during infusion), 2 additional patients were included. A DLT event (recurrent minor stroke) occurred in the 2-million/kg group. Among the 15 treated patients, 3 patients received 1, 1.5 or 3 million ADSCs /kg, and 6 patients 2 million ADSCs /kg. A lung carcinoma was diagnosed in an active smoker (1.5 year after treatment) and a patient died after Covid-19 pneumopathy (1 year after treatment). No dose effect on safety was noted.

Conclusions: IV injection of fresh allogenic ADSC seems safe in subacute stroke. A multicenter randomized trial is planned.

Acknowledgements: EC Horizon2020; Pr Mojallal (Plastic Surgery, Croix Rousse, Lyon, France); ECell France (PIA/ANR-11-INSB-005)

Disclosure: No

P0055 / 1607

HASHTAG RESEARCH: UTILISING SOCIAL MEDIA FOR RECRUITMENT OF STROKE SURVIVORS TO THE HEADS: UP ONLINE RANDOMISED CONTROLLED TRIAL, A STROKE-SPECIFIC PSYCHOLOGICAL SELF-MANAGEMENT INTERVENTION

N. Clark ¹, M. Lawrence¹, B. Davis¹

¹ Glasgow Caledonian University, Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow, United Kingdom

Background: Social media can be a useful tool in clinical trial recruitment strategy and could become increasingly important as established recruitment methods may be impaired by the COVID-19 pandemic, i.e. flyers, posters. The HEADS: UP randomized control trial utilised multiple social media platforms to access and recruit stroke survivors alongside additional, non-social media routes in response to COVID-19 pandemic restrictions.

Aim: To assess the effectiveness of recruitment to the HEADS: UP clinical trial through social media.

Methods: We recruited community-dwelling stroke survivors (SS) with self-reported anxiety and depression using community networks and social media. Social media recruitment allowed for direct communication with potential participants through the development of Twitter (@HeadsUpStroke), YouTube and Reddit accounts. Facebook posts were shared on the researchers’ personal accounts and UK-based stroke organization Facebook pages and groups.

Results: Recruitment lasted 16 weeks and resulted in 120 leads (7.5/week). Where recruitment source was known, social media contributed 36 leads (2.3/week). We enrolled 64 participants (female n=36, mean age 56.3 years) of which 28 were recruited through social media (43.8%; female n=15; mean age 53.0 years). Facebook was the most effective route (n=21, 75%). The least effective route was Reddit. One lead contacted the primary investigator using LinkedIn, a platform we had not included in our strategy. Costs totaled £50 (£1.79/enrolled social media participant).

Conclusions: The use of social media for recruitment of stroke survivors to a psychological self-management intervention trial was both effective and low-cost, significantly contributing to overall recruitment and supplementing established research methods.

Disclosure: No

P0056 / 807

MOVING BEYOND PATIENT FACTORS IN THE DESIGN OF STROKE CARE ENVIRONMENTS: A VIRTUAL REALITY EXPLORATION OF THE IMPACT OF HOSPITAL PATIENT ROOM DESIGN

M. Shannon ¹, J. Olver², M. White³, T. Yang³, M. Elf⁴, J. Bernhardt¹

¹The Florey Institute of Neuroscience and Mental Health, Stroke Theme, Heidelberg, Australia, ²Monash University, Rehabilitation Medicine, Melbourne, Australia, ³Swinburne University, Centre for Design Innovation, Melbourne, Australia, ⁴Dalarna University, Falun, Sweden

Background and aims: Stroke patient’s social and physical activity is observed to change as physical design changes. We explored how physical design factors in the hospital patient room impact affect, and choice-preference, in people with stroke.

Methods: A cross-sectional, factorial experiment explored stroke participants’ responses to 16 virtual reality (VR) scenarios (day, night) varying by one factor per scenario: spaciousness, greenery outlook, night-time noise, social connectivity in multi-patient (MPR) and in single rooms (SPR). Recorded after each exposure

(i) Pick-a-Mood Scale (affect) and

(ii) Visual Analogue Scale (choice-preference). Interactions between factors were explored using regression analyses.

Results: Community-dwelling stroke participants (n=44) completed the study, between April 1^st 2019-March 13^th 2020: 54.5% >65 years old, 61.4% male. Regression analysis showed variation in affective responses with a single physical design factor change. Participants were more likely to be irritated (low valence state) with MPR (OR 3.4, 95% CI 1.6-7.1), and with social connectivity present (OR 3.3, 95% CI 1.6-7.1), with a reduction (OR 0.4, 95% CI 0.2-0.8) in irritation when exposed to a greenery outlook, compared to the alternatives. No motion-sensitivity was reported. Higher choice-preference for SPR was shown in both day ((mean=74.8mm (SD 22.7), vs mean=55.3mm (SD 26.3)), and night ((mean=70.6mm (SD 24.4) vs mean=53.4mm (SD 27.5)) conditions.

Conclusions: VR technology can feasibly and safely be utilised to explore how different physical design factors (and room occupancy) can influence hospital experience after stroke. Building design matters and occupancy alone may not determine stroke hospital experience and outcomes.

Disclosure: No

P0057 / 746

REMOTE ISCHAEMIC CONDITIONING FOR FATIGUE AFTER STROKE: A PILOT RANDOMISED CONTROLLED TRIAL (RICFAST)

B. Moyle ^1,2, N. Kudierski³, S. Nichols¹, N. Totten¹, J. Redgrave^4,1, A. Majid^1,2, A. Ali^5,2

¹University of Sheffield, Neuroscience, Sheffield, United Kingdom, ²Biomedical Research Centre, Sheffield, United Kingdom, ³Sheffield Hallam University, Sheffield, United Kingdom, ⁴Sheffield Teaching Hospitals, Neuroscience, Sheffield, United Kingdom, ⁵Sheffield Teaching Hospitals, Geriatrics and Stroke Medicine, Sheffield, United Kingdom

Background: Post stroke fatigue (PSF) affects 50% of stroke survivors, half of whom report it as one of their worst symptoms. Remote Ischaemic Conditioning (RIC), can result in preservation of mitochondrial function , anti-inflammatory changes to cytokines and improved organ perfusion . We undertook a pilot randomised controlled trial to evaluate the feasibility of using RIC for PSF.

Methods: 24 People with debilitating PSF (Fatigue severity score (FSS) > 4) were randomised (1:1) to either RIC (BP cuff inflation around the upper arm at 200 mmHg for 5 minutes followed by 5 minutes of deflation), or sham (inflation pressure 20 mmHg), repeated 4 times, 3 times per week for 6 weeks. Primary outcomes: feasibility of recruitment and study procedures, safety and tolerability. Secondary outcomes: FSS (baseline, 6 and 12 weeks) and cardiopulmonary exercise testing (CPET) (baseline and 6 weeks).

Results: RIC was safe, well tolerated, adherence was excellent (91% sessions completed) and recruitment was feasible. There was a strong (but non-significant) trend towards lower FSS scores with RIC compared to sham (mean (SD) reduction -1.8 (1.5) vs -0.9 (1.0) at 6 weeks; -2.1 (1.1) vs -1.1 (1.1) at 12 weeks). CPET demonstrated increased ventilatory anaerobic thresholds in the RIC group (10% vs 0%), indicating increased capacity to produce ATP aerobically. This was accompanied by increased 6 minute walking test distances with RIC group

(median 17.8m, IQR 71) compared to sham (-7.3m, IQR 85).

Discussion: RIC is safe, acceptable and feasible for PSF and appears to result in clinically meaningful improvements in fatigue.

Disclosure: No

P0058 / 796

IS AGE AN IMPORTANT FACTOR FOR SPONTANEOUS MOTOR RECOVERY OF THE UPPER PARETC LIMB AFTER STROKE?

V. Zonjee ¹, G. Kwakkel^2,3,4, J. Vanhommerig⁵, R. Selles^6,7, L. Roorda⁸, R. Nijland², C. Meskers^3,4, S. van Schaik¹, R. Van den Berg-Vos^1,9

¹OLVG, Neurology, Amsterdam, Netherlands, ²Amsterdam Rehabilitation Research Centre Reade, Neurorehabilitation, Amsterdam, Netherlands, ³Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands, ⁴Feinberg School of Medicine, Northwestern University, Physical Therapy and Human Movement Sciences, Chicago, United States, ⁵OLVG, Research and Epidemiology, Amsterdam, Netherlands, ⁶Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands, ⁷Erasmus MC, Plastic and Reconstructive Surgery, Rotterdam, Netherlands, ⁸Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands, ⁹Amsterdam UMC, Location AMC, Neurology, Amsterdam, Netherlands

Background and aims: It is unclear if age is an important factor that may influence spontaneous motor recovery of the upper paretic limb in the first 6 months post stroke. A recent study showed that the amount of spontaneous motor recovery may range between less than 10% to more than 90%, and that this recovery occurs within the first 10 weeks after onset. The aim of the present study is to determine if age is an important, independent covariate for spontaneous motor recovery of the upper paretic limb in the first 6 months post stroke.

Methods: A linear mixed model (LMM) was employed in an inception cohort of 461 patients with a first-ever ischemic, hemispheric stroke with repeated measurements of the Fugl Meyer Upper Extremity (FM-UE). Spontaneous motor recovery was defined as progress of time on the measured improvement following the FM-UE. We used time-dependent biweekly change (Δ) in FM-UE scores as dependent variable in the LMM. Baseline FM-UE score (random), demographic (fixed) and disease characteristics (fixed) were added to the model. Subsequently, we added age as a covariate to the LMM in order to detect its influence on biweekly improvements (time). Changes beyond the 10% of the regression coefficient (time) were defined as significant.

Results: In total, 1380 ΔFM-UE scores were available. Preliminary results show that age does not significantly influence the regression coefficient of biweekly improvements.

Conclusions: Our preliminary results suggest that age does not significantly interact with spontaneous motor recovery of the most affected upper-limb after stroke.

Disclosure: No

P0059 / 548

QUALITY OF SLEEP IN PATIENTS WITH ACUTE ISCHEMIC STROKE ASSOCIATED WITH COVID-19

A. Stojanov ¹, J. Stojanov², R. Damjanovic¹

¹University Clinical Center Nis, Nis, Serbia, ²Special Psychiatric Hospital Gornja Toponica Nis, Nis, Serbia

Background and aims: The coronavirus disease 2019 (COVID-19) is the largest pandemic of our times. Sleep disturbances are underestimated symptoms in patients after acute ischemic stroke (AIS). We wanted to assess levels of sleep disturbance after AIS in patients with associated COVID-19 infection and to verify potential predictors of poor sleep quality (QoS).

Methods: The study included 47 patients with AIS who were diagnosed with COVID-19 concomitantly or up to 2 weeks before the onset of AIS. Patients with severe COVID-19 clinical picture (who were hospitalized due to COVID-19) and aphasia were excluded. We collected sociodemographic and clinical data, and also used Pittsburgh sleep quality index (PSQI) for assessing QoS. The actual severity of the AIS was estimated using NIH Stroke Scale (NIHSS). We assessed patients at disease onset (to estimate QoS within 1 month before the stroke), and 3 months after AIS.

Results:  We noticed a statistically significant difference between the results at these two-time points in PSQI scores (p<0.01), which was worse 3 months after AIS. Patients with higher scores on NIHSS (p<0.01), patients with diabetes mellitus, and unemployed patients had higher scores on PSQI (p<0.05). Higher scores on NIHSS were an independent predictor of the worse PSQI scores 3 months after AIS.

Conclusion: Lower levels of QoS correlate with worse disease severity, some clinical and socio-demographic variables in AIS patients.

Disclosure: No

P0061 / 445

COGNITION AS A MEDIATOR OF CHANGES IN ACTIVITY LEVELS AND DEPRESSION IN CHRONIC STROKE

A. Kusec ¹, G. Chiu¹, C. Carrick¹, P. Watson¹, B. Drozdowska¹, N. Demeyere¹

¹ University of Oxford, Department of Experimental Psychology, Oxford, United Kingdom

Background and aims: Depression is a common consequence of stroke. Previous research has demonstrated that decreases in activity levels are associated with increased depression severity. However, it is unclear to what extent this holds true in chronic stroke, and to what degree this relationship is modified by post-stroke cognitive impairment. The purpose of this study is to evaluate whether depression severity is mediated by degree of cognitive impairment across domains of language, executive function, spatial attention, number processing, and memory.

Methods: This study uses data collected as part of OX-CHRONIC, a longitudinal stroke cohort. A cross-sectional multiple mediation will be used to determine direct pathways of activity levels (as measured by the Nottingham Extended Activities of Daily Living Questionnaire) to depression severity (Hospital Anxiety and Depression Scale - Depression subscale). Potential confounding mediators of this relationship will include both age and stroke severity as measured by the Stroke Impact Scale, with cognitive mediators assessed using the Oxford Cognitive Screen.

Results: N = 105 adults with a stroke between 2 and 9 years stroke are included in this study. Analysis will be completed by time of presentation.

Conclusions: The results of this study will extend the application of the relationship between activity levels and depression beyond an acute population. Delineating whether cognitive mediators account for the relationship between activity levels and depression will provide novel information on which factors may be secondary targets of depression intervention in chronic stroke.

Disclosure: No

ONGOING TRIALS

P0062 / 502

THE LINK BETWEEN MRI-CEREBRAL SMALL VESSEL DISEASE FEATURES AND BLOOD PRESSURE VARIABILITY

R. Bartiuk ¹

¹ National Pirogov Memorial Medical University, Neurology, Vinnytsya, Ukraine

Background and aims: Cerebral small vessel disease (CSVD) contributes up to about 25% of strokes and is the second most common cause of dementia and cognitive decline. Hypertensive arteriolosclerosis is the leading cause of CSVD, hence understanding its relationships with blood pressure (BP) changes, including blood pressure variability (BPV), is crucial.

The aim of our study was to find out relationships between BP parameters and MRI-features of CSVD (white matter hyperintensity (WMH), lacunes, enlarged perivascular spaces (EPVS), brain atrophy) in acute-stroke patients during hospitalization time.

Methods: 160 participants enrolled in our study (56,3% male, age – 61,05±10,95, hospitalization time – 10 days). We measured such BP parameters as mean systolic BP, mean diastolic BP, standard deviation and coefficient of variability.

Results: A moderate positive correlation was found between systolic BPV and WMH severity (r> 0.3, p = 0.03), mean systolic BP and WMH severity (r> 0.3, p <0.005), mean systolic BP and EPVS at the basal ganglia level (r> 0.3, p <0.01), mean systolic BP and total CSVD burden (r> 0.3, p <0.005). There was also a tendency for association between systolic BPV and EPVS at the basal ganglia level, but it was not significant (p = 0.09).

Conclusions: Systolic BP and its variability are associated with WMH and EPVS, which may provide valuable diagnostic and prognostic data about subtypes of CSVD and the consequences of vascular damage to the brain. Systolic BP variability targeting might be beneficial for prevention of CSVD progression.

Disclosure: No

P0063 / 1290

THE BENEFIT OF EXTENDING ORAL ANTICOAGULANT TREATMENT AFTER ACUTE CEREBRAL VEIN THROMBOSIS (EXCOA-CVT): A CLUSTER OBSERVATIONAL STUDY

B. Miranda¹, D. Aguiar de Sousa ², S. Aaron³, A. Arauz⁴, F. Barinagarrementeria⁵, A. Borhani-Haghighi⁶, M. Carvalho⁷, A.B Conforto⁸, J.M Coutinho⁹, J. Stam⁹, P. Canhão², J.M Ferro²

¹Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal, ²Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Neurology, Lisboa, Portugal, Lisbon, Portugal, ³Christian Medical College and Hospital, Department of Neurological Sciences, Vellore, India, ⁴Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suarez, Department of Neurology, Mexico City, Mexico, ⁵Hospital H+, Department of Neurology, Queretáro, Mexico, ⁶Shiraz University of Medical Sciences, Clinical Neurology Research Center, Shiraz, Iran, Islamic Republic of, ⁷Hospital de São João - Centro Hospitalar São João, Neurology Department, Porto, Portugal, ⁸Hospital das Clínicas - São Paulo University, Neurology Clinical Division, São Paulo, Brazil, ⁹Academic Medical Center, Department of Neurology, Amsterdam, Netherlands

Background and Aims: After cerebral vein thrombosis (CVT) there is an increased risk of further venous thromboembolic events (VTEs). Guidelines suggest oral anticoagulation (OAC) for 3 to 12 months after a first CVT, depending on event-related and thrombophilic characteristics. Recommendations are extrapolated from extracerebral VTE, which may be inaccurate as the risk of recurrence is different.

EXCOA-CVT is a prospective study with a cluster-randomised allocation design that aims to compare a policy of standard (3-6 months) versus extended (12 months) OAC in the prevention of VTEs after CVT.

Methods: Participating centres are asked whether they have preference for any of the policy treatment options. Centres with no preference are randomly allocated for one of the two options. Adult subjects with confirmed CVT will be treated according to the approach allocated to their centre once their acute clinical situation is stable and not more than 1 month after CVT diagnosis. Those with conditions judged by the investigator to be absolute indication for prolonged OAC will be excluded. Follow-up will be performed at 6, 12, 18 (telephone-interview) and 24 months. Primary efficacy outcome is any symptomatic and confirmed VTE (recurrent CVT or other VTE) or death associated with VTE. Primary safety endpoints include bleeding events (major/minor; according to the site), and death from any cause.

Results: At present, a total of 1038 subjects with CVT have been included from 38 active centres (in 20 countries).

Conclusion: The results of this study will provide crucial evidence regarding optimal duration of OAC after CVT.

Disclosure: No

P0064 / 1582

THE METOCLOPRAMIDE FOR AVOIDING PNEUMONIA AFTER STROKE (MAPS-2) TRIAL: A SINGLE-BLIND RCT OF METOCLOPRAMIDE FOR THE PREVENTION OF PNEUMONIA IN PATIENTS WITH DYSPHAGIA AFTER STROKE

A. Warusevitane¹, C. Smith², A. Dixit³, N. Sprigg⁴, B. Helliwell⁵, N. Phillips⁶, J. Sim⁷, S. Jowett⁸, R. Ogollah⁴, P. Bath⁴, C. Roffe ^9,10

¹Royal Stroke University Hospital, Stoke-on-Trent, United Kingdom, ²University of Manchester, Salford, United Kingdom, ³Freeman Hospital, Newcastle upon Tyne, United Kingdom, ⁴University of Nottingham, Nottingham, United Kingdom, ⁵Patient and Public Involvement Representative, Birmingham, United Kingdom, ⁶Patient and Public Involvement Representative, Coventry, United Kingdom, ⁷Keele University, Newcastle under Lyme, United Kingdom, ⁸University of Birmingham, Birmingham, United Kingdom, ⁹Royal Stoke University Hospital, Neurosciences, Stoke-on-Trent, United Kingdom, ¹⁰Keele University, School of Medicine, Newcastle under Lyme, United Kingdom

Background: Pneumonia causes more deaths after stroke than the neurological damage. Stroke-associated pneumonia is caused by aspiration of vomited and regurgitated gastric content. Metoclopramide, an antiemetic with both central and peripheral actions, was associated with less pneumonia and a trend to fewer deaths in our pilot study. The aim of this study is to determine whether metoclopramide, given early after stroke onset and continued for 14 days, prevents pneumonia and reduces mortality.

Methods:

Design: Single blind randomized controlled trial

Intervention: Metoclopramide 10 mg tds iv or via nasogastric tube for 14 days.

Control: Normal saline (sham control) 2 ml tds iv or via nasogastric tube for 14 days.

Inclusion criteria:

1. Adults admitted to hospital with a diagnosis of acute stroke and

2. Within 9 hours of symptom onset and

3. Moderate to severe neurological impairment (NIHSS 10 or greater) and

4. Dysphagia (assessed by bedside clinical screen)

Exclusion criteria: Probable or definite pneumonia at screening, contraindications to metoclopramide, pregnancy, life-limiting comorbidities.

Follow-up: At 14 days (in person) and 6 months (by telephone)

Primary outcome: All-cause mortality by 6 months

Secondary outcomes at 14 days: 1. Pneumonia (clinician diagnosis), 2. Pneumonia (criteria-based), 3. No of days of antibiotic treatment, 4. Recovery of swallow, 5. Neurological recovery, quality of life

Secondary outcomes at 180 days: 1. modified Rankin Scale, 2. Recovery of swallow, 3. Frailty, 3. Home time, 4. quality of life 2100 participants will be recruited from 60 or more UK hospitals.

Disclosure: No

P0065 / 1642

RANDOMIZATION TO EXTEND STROKE INTRAVENOUS THROMBOLYSIS IN EVOLVING NON-LARGE VESSEL OCCLUSION WITH TNK (RESILIENT- EXTEND-IV)

G. Silva ¹, R. Nogueira², O. Pontes-Neto³, L. Carbonera⁴, F.B. Barros⁵, M. Miranda Alves⁵, F. Lima⁶, J. Oliveira-Filho,⁷, E. Rocha⁵, L. Rebello⁸, A.C. de Souza⁴, J.B. de Andrade⁵, F.J. Montalverne⁶, S.C.O. Martins⁹

¹HIAE/UNIFESP, Academic Research Organization ( AR0)-HIAE/ Neurology Departament, São Paulo, Brazil, ²Emory University, Neurology, Atlanta, United States, ³FMUSP, Neurology, São Paulo, Brazil, ⁴Hosp Moinhos de Vento, Porto Alegre, Brazil, ⁵UNIFESP, Neurology Departament, São Paulo, Brazil, ⁶Hospital Geral de Fortaleza, Neurology, Fortaleza, Brazil, ⁷Universidade Federal da Bahia, Neurology, Salvador, Brazil, ⁸Hospital de Base, Neurology, Brasilia, Brazil, ⁹Hospital de Clínicas de Porto Alegre, Neurology, Porto Alegre, Brazil

Prospective, multi-center, randomized, controlled, double-blinded trial with an adaptive design andpopulation enrichment. The randomization employs a 1:1 ratio of intravenous thrombolysis withtenecteplase (TNK) versus placebo in patients who suffer a non-large vessel occlusion ischemic strokebetween 4.5 and 12 hours from time last seen well (TLSW) and have evidence of salvageable brain tissue onperfusion imaging. Randomization will be done under a minimization process using age, baseline NIHSS,baseline infarct volume, baseline perfusion mismatch volume, therapeutic window (4.5-9 or 9-12 hoursafter TLKW), and clinical site. The candidate enriched populations that the trial considers are based on timelast known well (TLKW) to randomization (4.5-9 vs. 9-12 hours) and mismatch volumes as measured usinge-Mismatch MR-DWI or CTP-rCBF maps. For the primary Endpoint,subjects will be followed for 90 days post-randomization. Study Objective: To evaluate the hypothesis thatintravenous thrombolysis with Tenecteplase (TNK) ata dose of 0.25 mg/Kg is superior to standard medicalmanagement in achieving more favorable outcomes according to the modified Rankin Scale scores at 90days in subjects presenting with acute ischemic stroke not related to a large vessel occlusion within 4.5-12hours from symptom onset. Primary endpoint Distribution of themodified Rankin Scale scores at 90 days (shift analysis) as evaluated by two separate assessors at the centralcore lab) who are blinded to treatment. Primary Endpoint will only consider central core lab readings (videointerview with RFA method) with local reading as a backup mechanism. Interim Analyses Conducted: when the first 386 patients enrolled have completed their study involvement. Sample size: 642 patients.

Disclosure: Yes

P0066 / 188

TIROFIBAN VERSUS INTRAVENOUS ASPIRIN IN PATIENTS WITH ACUTE ISCHEMIC STROKE SECONDARY TO TANDEM LESION TREATED WITH MECHANICAL THROMBECTOMY(ATILA-TRIAL): A PHASE IV, RANDOMIZED, CONTROLLED MULTICENTER TRIAL

E. Zapata-Arriaza ^1,2, M. Medina Rodríguez³, F. Moniche Álvarez³, F. Delgado Acosta⁴, E. Jimenez⁴, E. Gonzalez Diaz⁵, M.d.M. Freijo Guerrero⁶, I. Escudero-Martínez⁷, L. Morales Caba⁷, M.d.M. Castellanos⁸, S. Mosteiro⁹, L. Amaya Pascasio¹⁰, C. Hidalgo¹¹, J.M. Ramirez Moreno¹², L. Fernandez Prudencio¹³, P. Baena Palomino¹⁴, G. Sanz¹⁴, M.A. Gamero Garcia¹⁵, J. Díaz Pérez¹⁶, J. Ortega Quintanilla², A. De Albóniga-Chindurza², A. Zamora¹, I. Bravo Rey⁴, R. Oteros⁴, B. Pardo-Galiana³, L. Ainz Gomez³, L. Lebrato Hernandez³, A. González Garcia²

¹Instituto de Investigación Biomédica de Sevilla, Neurovascular Laboratory Research, Seville, Spain, ²Hopital Universitario Virgen del Rocio, Interventional Neurorradiology, Sevilla, Spain, ³Hospital Universitario Virgen del Rocio, Stroke neurology, Seville, Spain, ⁴Hospital Universitario Reina Sofía, Interventional Neurorradiology, Cordoba, Spain, ⁵Hospital Universitario Cruces, Interventional Neurorradiology, Bilbao, Spain, ⁶Hospital Universitario Cruces, Stroke Neurology, Bilbao, Spain, ⁷Hospital Universitari i Politècnic La Fe, Stroke Neurology, Valencia, Spain, ⁸Complejo Hospitalario Universitario A Coruña, Stroke Neurology, A Coruña, Spain, ⁹Complejo Hospitalario Universitario A Coruña, Interventional Neurorradiology, A Coruña, Spain, ¹⁰Hospital Universitario Torrecardenas, Neurology, Almeria, Spain, ¹¹Hospital Universitario Torrecardenas, Interventional Neurorradiology, Almeria, Spain, ¹²Hospital Universitario de Badajoz, Neurology, Badajoz, Spain, ¹³Hospital Universitario de Badajoz, Interventional Neurorradiology, Badajoz, Spain, ¹⁴Hospital Juan Ramon Jimémez, Stroke Neurology, Huelva, Spain, ¹⁵Hospital Universitario Virgen Macarena, Stroke Neurology, Sevilla, Spain, ¹⁶Hospital Clínico Universitario Virgen de la Arrixaca, Interventional Neurorradiology, Murcia, Spain

Background: Acute Ischemic stroke (AIS) due to tandem lesions (TL) presents a controversial management related to stent placement and antithrombotic medication during mechanical thrombectomy(MT). In order to define best safety and efficacy protocol for mono-antiplatelet therapy in the acute phase of TL, we propose to carry out a prospective multicenter randomized clinical trial.

Methods: A multicenter prospective phase IV, randomized, controlled, assessor-blinded, clinical trial of intravenous (iv) tirofiban versus aspirin (ASA) in patients with AIS due to TL. Inclusion criteria: all patients with AIS secondary to TL in the anterior circulation who are candidates for mechanical thrombectomy will be included. Included patients will undergo a cervical stent placement in the acute phase, being randomized to two groups: 500 mg of iv ASA (control) vs Low regimen Tirofiban (intervention) dose iv.

Results: Two hundred and forty will be included in the trial, that provides an 80% power to detect an estimated difference between two proportions of 22% (ASA) and 10% (for tirofiban) in reocclusion rated, based on sample calculation from a previous local study. Recruitment will begin on January 1, 2022. The primary efficacy and safety outcomes are carotid reocclusion and symptomatic intracranial hemorrhage rates at 24 hours after MT. Secondary outcome is the proportion of patients with modified Rankin Scale scores of 0–2 at 90 days.

Conclusion: This is the first trial to explore efficacy and safety of two mono-antiplatelet protocols in acute ischemic stroke patients secondary to TL. The trial is registered as NCT2021-003874-30.

Disclosure: No

P0067 / 1274

STUDY OF ANTITHROMBOTIC TREATMENT AFTER INTRACEREBRAL HAEMORRHAGE (STATICH)

H. Eilertsen ¹, K. Tveitan Larsen^2,3, E. Forfang², J. Pennlert⁴, E.-L. Glader⁴, C. Kruuse⁵, P. Wester⁴, H. Ihle-Hansen¹, M. Carlsson^6,7, E.C. Sandset¹, R. Al-Shahi Salman⁸, T. Bruun Wyller^2,1, O.M. Rønning^2,3

¹Oslo University Hospital, Oslo, Norway, ²University of Oslo, Oslo, Norway, ³Akershus University Hospital, Lørenskog, Norway, ⁴Norrlands Universitetssjukhus, Umeå, Sweden, ⁵Herlev and Gentofte Hospital, Copenhagen, Denmark, ⁶University of Tromsø, Tromsø, Norway, ⁷Nordlandssykehuset HF Bodø, Bodø, Norway, ⁸University of Edinburgh, Edinburgh, United Kingdom

Background and aims: Patients with prior intracerebral haemorrhage (ICH) often have indications for antithrombotic treatment for prevention of ischaemic events, but it is uncertain whether such treatment is beneficial after ICH. STATICH will assess the effects of long-term antithrombotic treatment on the risk of ischaemic and haemorrhagic events after ICH.

Methods: STATICH is a Scandinavian, multicentre, randomised controlled, open trial of starting vs. avoiding antithrombotic treatment in patients who have had a primary ICH and who have an indication for antithrombotic treatment. Participants with vascular disease as an indication for antiplatelet treatment are randomly allocated to antiplatelet treatment or no antithrombotic treatment. Participants with atrial fibrillation as an indication for anticoagulant treatment are randomly allocated to anticoagulant or no anticoagulant treatment. Cerebral CT or MRI is performed before randomisation and MRI is repeated at two years. Assessment of clinical outcomes is performed blinded to treatment allocation. The primary outcome is recurrent ICH. Secondary outcomes include ischaemic events and death. Target recruitment is 500 participants, and duration of follow-up is at least two years.

Status: Recruitment of participants is on-going, with 103 participants recruited per January 2022. The primary analysis will assess the effects of antithrombotic treatment on clinical events. Secondary analyses will examine whether imaging findings, like cerebral microbleeds, modify the effects of antithrombotic treatment on the risk of recurrent ICH.

Conclusions: Randomised controlled trials like STATICH are needed to evaluate the net effects of antithrombotic treatment after ICH. An individual patient data meta-analysis is planned with similar randomised trials.

Disclosure: No

P0068 / 1055

EFFICACY OF NITRIC OXIDE IN STRIKE-2 (ENOS-2): RATIONALE AND DESIGN OF A PHASE IIB SINGLE BLIND RANDOMISED CONTROLLED SINGLE-CENTRE TRIAL

N. Sprigg¹, L.J Woodhouse¹, D.K. Krishnan², A. Buck³, J. Craig¹, T.J England⁴, D. Havard¹, C. Kirkland³, E. Stanyard¹, L. Haywood¹, I.I Mhlanga¹, P.M Bath ²

¹University of Nottingham, Stroke Trials Unit, Mental Health and Clinical Neurosciences, Nottingham, United Kingdom, ²Nottingham University Hospitals NHS Trust, Clinical Stroke Trial Unit, Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, Nottingham, United Kingdom, ³University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom, ⁴University of Nottingham, Cinical Stroke Trial Unit, Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, Derby, United Kingdom

Background: High blood pressure is common in stroke and is associated independently with increased recurrence and dependency or late death. Nitric oxide (NO) donors such as glyceryl trinitrate (GTN) are candidate treatments for acute stroke. Whether GTN improves outcome through reducing expansion and recurrence, or worsens it through reducing cerebral blood flow remains unclear.

Objectives: We aim to assess the feasibility of recruitment and safety GTN against sham to inform the design of a definitive trial for a period of 24 months.

Design: 120 adult stroke patients (100 ischaemic stroke, 20 intracerebral haemorrhage), with systolic BP >120mmHg and compatible CT/MR scans, will be recruited within 3-5 hours of onset. Exclusion criteria include; seizure, mRS⩾4, glucose <3mmol/l, GCS<8, known stroke mimic, life expectancy <6months, known sensitivity to Duoderm and contraindications to GTN.

Patients will be randomised (1:1) to receive 5mg GTN or matching comparator Duoderm patch placed on back or shoulders applied for 2 days. Patients, relatives, researchers and outcome assessors will be masked to treatment allocation.

Feasibility outcomes include recruitment of 100 is patients and 20 ICH patients, rate of recruitment, proportion of patients approached being randomised, adherence to treatment and follow up. Secondary outcomes include BP and heart rate over the first 2 days, discharge destination, serious adverse events up to day 2 and fatal SAEs up to day 90 and mortality, disability, cognition, mood and quality of life at day 90.

Funding: This study is funded by NUH Charity, grant code CRF-BATH-NOV 2019 (fund number Q7010).

Disclosure: No

P0069 / 779

SWISS TRIAL OF INITIAL DECOMPRESSIVE CRANIECTOMY VERSUS BEST MEDICAL TREATMENT OF SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE: A RANDOMIZED TRIAL (SWITCH)

J. Beck¹, C. Fung¹, D. Strbian², F. Ringel³, S. Beyeler⁴, A. Raabe⁴, U. Fischer ^4,5

¹Medical Center - University of Freiburg, Freiburg, Germany, ²Helsinki University Central Hospital, Helsinki, Finland, ³Johannes Gutenberg University Mainz, Mainz, Germany, ⁴Bern University Hospital and University of Bern, Bern, Switzerland, ⁵University Hospital Basel, Basel, Switzerland

Background and aims: Decompressive craniectomy (DC) is beneficial in patients with various diseases including malignant middle cerebral artery infarction. In intracerebral hemorrhage (ICH), DC without hematoma evacuation has only been evaluated in small retrospective studies with a trend towards reduced mortality. However, no randomized trial has ever assessed whether DC is beneficial in patients with ICH. Therefore, the SWITCH trial evaluates whether DC and best medical treatment (BMT) in patients with spontaneous supratentorial ICH will improve outcome compared to BMT alone.

Methods: SWITCH is an international multicenter randomized trial. 300 patients will be randomized (1:1) into either DC and BMT or BMT alone. Main inclusion criteria are spontaneous supratentorial ICH of deep origin, NIHSS⩾10 and ⩽30, GCS>7 and <14 and ICH volume ⩾30 and ⩽100. The primary endpoint is severe disability and mortality, measured with the modified Rankin score 6 months after ictus.

Results: 178 patients have been randomized into the trial in 35 sites (Switzerland, Germany, The Netherlands, Spain, Finland, Austria, France, and Belgium). The Data Safety Monitoring Board reviewed data of the first 150 patients and recommended continuing recruitment with the current protocol. The next interim analysis will take place after randomization of 200 patients.

Conclusions: Currently, 178 patients have been randomized into the SWITCH trial and SWITCH has become the largest trial on DC in stroke ever. Further centers are still highly welcome to help us to answer the clinically relevant question, whether DC improves outcome in patients with supratentorial ICH.

Disclosure: No

P0070 / 1610

A RCT OF INTERMITTENT SURFACE NEUROMUSCULAR STIMULATION USING THE GEKO™ DEVICE COMPARED WITH INTERMITTENT PNEUMATIC COMPRESSION TO PREVENT VENOUS THROMBOEMBOLISM IN IMMOBILE ACUTE STROKE PATIENTS

P. Ferdinand^1,2, D. Wells³, A. Pandyan⁴, A. Amin⁵, M. Lewis², B. Helliwell⁶, B. Ross⁷, C. Roffe ^3,2

¹Royal Stoke University Hospital, Neurosciences, Stoke-on-Trent, United Kingdom, ²Keele University, Newcastle under Lyme, United Kingdom, ³Royal Stroke University Hospital, Stoke-on-Trent, United Kingdom, ⁴Bournemouth University, Bournemouth, United Kingdom, ⁵University of California, Irvine, United States, ⁶Patient and Public Involvement Representative, Birmingham, United Kingdom, ⁷Firstkind Ltd, High Wycombe, United Kingdom

Background: Venous thromboembolism (VTE) is a disabling and potentially fatal complication of stroke. Intermittent pneumatic compression (IPC) sleeves are recommended as the primary method of VTE prevention in the UK. Surface neuromuscular stimulation of the peroneal nerve using the geko™ is an alternative form of mechanical VTE prevention. The aim of this study is to assess whether the geko™ is more effective for prevention of VTE than IPC.

Methods:

Design: Single blind randomized controlled trial

Intervention: Surface electrical muscle stimulation using the geko™ device for 30d

Control: Intermittent pneumatic compression for 30d

Inclusion criteria:

1. Adults admitted to hospital with a diagnosis of acute stroke and

2. Within 36h of symptom onset and

3. unable to get up from a chair/bed and walk to the toilet without help

Exclusion criteria:

1. Unwitnessed onset with a long lie on the floor

2. Clinically apparent deep vein thrombosis at screening

3. Expected to require palliative care within 14d

4. Contraindications to IPC or geko™

Follow-up: at 7, 14, 30 days (in person) and 6 months by telephone

Primary outcome: Any symptomatic or asymptomatic deep vein thrombosis (DVT) in the calf, popliteal or femoral veins or any confirmed fatal or non-fatal pulmonary embolism (PE) within 30 days

Secondary outcomes at 30 days: Device tolerability, adherence to treatment, VTE, deaths, stroke recovery at 30 days

Leg pain and swelling, VTE, disability (mRS), quality of life, length of stay, discharge destination, home time at 90 days

1200 participants will be recruited from 10-20 UK hospitals.

Disclosure: Yes

P0071 / 1042

INTENSIVE AMBULANCE-DELIVERED BLOOD PRESSURE REDUCTION IN HYPER-ACUTE STROKE TRIAL (INTERACT4): PROGRESS UPDATE

L. Song ^1,2, C. Chen^1,2,3, X. Chen², Z. Yang¹, F. Liu³, Y. Lin⁴, Y. Guo⁴, K. Liao⁵, H. Arima^2,6, G. Li³, J. Yang⁵, C.S Anderson^1,2,7

¹The George Institute China at Peking University Health Sciences Center, Beijing, China, ²The George Institute for Global Health, University of New South Wales, Sydney, Australia, ³Department of Neurology, Shanghai Eastern Hospital, Tongji University, Shanghai, China, ⁴Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China, ⁵Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Sichuan, China, ⁶Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan, ⁷Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia

Background and Aims: Early pre-hospital initiation of blood pressure (BP) lowering could improve outcomes for patients with acute stroke, by reducing haematoma expansion in intracerebral haemorrhage (ICH), and time-to-reperfusion and ICH risk in acute ischaemic stroke. INTERACT4 aims to determine the effectiveness and safety of hyperacute BP lowering for patients with suspected acute stroke in China.

Methods: A multicentre, prospective, open, randomised, blinded endpoint trial of pre-hospital BP lowering in 3116 hypertensive presumed acute stroke patients at 50+ sites in China. Patients are randomised through a mobile phone digital system to intensive BP lowering (target systolic BP <140 mmHg within 30 minutes) or guideline-recommended BP management according to local protocols. Ambulance and in-hospital data are collected over 7-days. Primary outcome is a shift (improvement) in mRS scores at 90 days, analysed as an ordinal outcome.

Results: Waver or brief consent in ambulance plus formal written consent post-admission has been approved by ethics committees, with enrolment commenced in March 2020 and 49 sites activated to date. 938 patients (~30% ICH, ~4% stroke mimics) enrolled at 31 December 2021. The planned sample size should be achieved by December 2023.

Conclusion: INTERACT4 study is a pragmatic clinical trial to provide reliable evidence on the effectiveness and safety of ambulance-delivered intensive BP lowering in patients with presumed acute stroke.

Disclosure: Yes

P0072 / 200

COMPARISION OF DIFFERENT ROBOTIC-ASISTED GAIT TRAINING DEVICES FOR GAIT REHABILITATION IN PEOPLE WITH STROKE

A. Lerín Calvo ¹, A. Hernando Jorge¹, D. Rodríguez Martínez¹, E. Escribano Gómez¹, Á. Entrena Casas¹, J. Esteban Fernández¹, A. Casado Fernández¹, S. Lerma Lara²

¹Neuron, Physical Therapy, Madrid, Spain, ²La Salle Centro Universitario, Physical Therapy, Madrid, Spain

One of the main goals of stroke patients is gait recovery, however one third of patients remain wheelchair bound for the first 3 months. In recent years, gait rehabilitation has changed greatly due to the appearance of new robotic devices that facilitate and enhance recovery, such as exoskeletons or body-weight-supported systems with augmented reality. Nevertheless, the dose of treatment that should be applied in each case and the type of device that is most beneficial for each patient is still unknown. Therefore, the aim of this study is to test the effectiveness of the C-Mill (a body-weight-supported treadmill system with augmented reality) in comparison to the Ekso exoskeleton and a body-weight-supported treadmill system without augmented reality in the recovery of walking in stroke patients. Patients will therefore be divided into 3 groups, who will receive 2 to 5 sessions with one of the walking devices for 30-50 minutes during 4 weeks. After reassessment, 2 weeks will be left as a washout period to test the effects of the robot-assisted gait treatment in comparison to the conventional treatment based on task-oriented training and strength exercise. After the last re-evaluation, the same assessment tests as realized at baseline will be performed after this period. The results of the study will be exposed to assess the effectiveness of each device and a subgroup analysis will be done to identify which aspects of gait shows the greatest improvement with each of the devices.

Disclosure: No

P0073 / 486

RATIONALE AND DESIGN OF THE STATISTICAL ANALYSIS TECHNIQUES VERSUS ARTIFICIAL NEURAL NETWORKS FOR DIAGNOSIS AND OUTCOME PREDICTION AFTER ACUTE STROKE (SAVANNAS) COLLABORATION STUDY

L.J. Woodhouse ¹, X. Chen², J. Garibaldi², D. Havard¹, A.A Montgomery³, T. Quinn⁴, N. Sprigg¹, P.M Bath¹, SAVANNAS Collaboration

¹University of Nottingham, Stroke Trials Unit, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom, ²University of Nottingham, School of Computer Science, Nottingham, United Kingdom, ³University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom, ⁴University of Glasgow, Cardiovascular & Medical Sciences, Glasgow, United Kingdom

Background: Stroke is common, may be mimicked by other conditions, and often has a poor outcome.

Objectives: We will assess and compare the accuracy of state-of-the-art machine learning models and statistical regression techniques for event diagnosis and predicting post-stroke outcomes.

Design: High-fidelity data on ~90,000 patients with acute stroke is being sought from chief investigators of published trials (which include patients with a final diagnosis of either stroke, TIA or mimics). Data include trial characteristics, patient demographics, baseline clinical and imaging data, final diagnosis and outcome measures. We will use artificial neural network (ANN) models, including deep neural networks (DNN) and conventional statistical regression models (binary, Cox, ordinal and linear regression). These modelling methods will be compared for the diagnosis of stroke versus mimics, and prediction of early complications (deterioration, stroke recurrence and re-bleeding) and late outcomes (functional outcome, cognition, mood, quality of life, disposition, death) after stroke.

Discussion: As of 6^th January 2022, the SAVANNAS collaboration has received individual participant data for 13 trials; including 30,991 patients records. If diagnostic and prediction models are accurate then their use could be rapidly introduced into clinical care to improve patient management, for example through the use of apps on phones/tablets/computers.

Disclosure: No

P0074 / 897

SCREENING AND PATIENT-TAILORED CARE FOR EMOTIONAL AND COGNITIVE PROBLEMS IN PATIENTS DISCHARGED HOME AFTER ISCHEMIC STROKE (ECO-STROKE TRIAL)

J. Slenders¹, R. Van den Berg-Vos¹, C. van Heugten², J. Visser-Meily³, V. Kwa ¹

¹OLVG, Neurology, Amsterdam, Netherlands, ²Maastricht University, School for Mental Health & Neuroscience, Maastricht, Netherlands, ³UMC Utrecht, Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands

Background and aim: Patients diagnosed with minor ischemic stroke are likely to be discharged home. At home, many patients experience cognitive and emotional complaints, resulting in decreased societal participation. Therefore, this study examines the effect of screening and patient-tailored care for cognitive and emotional problems in patients discharged home after ischemic stroke.

Methods: In a multicenter, single blinded, cluster randomized controlled trial, 12 hospitals will be randomized (1:1) to the intervention group or the usual care group. Patients discharged home after ischemic stroke without rehabilitation care will be included. The intervention encompasses one consultation of 60 minutes executed by a specialized nurse at the outpatient clinics six weeks after the diagnosis. This consultation includes 1) screening for emotional and cognitive problems using sensitive instruments, 2) active information provision and decision making according to the principles of self-management support and 3) a protocol for referral to specialized care if needed.

Results: The primary outcome will be the level of participation measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation at one year. Secondary outcomes will be the level of cognitive complaints, depression and anxiety, quality of life, patient-reported global health and physical disability at one year. Additionally, a cost-analysis will be performed. Finally, a mixed-methods study will assess the feasibility of the intervention.

Conclusions: This study will analyze the clinical effectiveness, cost-effectiveness and feasibility of screening and care for emotional and cognitive complaints compared to care as usual in patients discharged home after ischemic stroke.

Disclosure: No

P0075 / 259

AN INTERVIEW STUDY OF THE REASONS’ PATIENTS HAVE TO CONSENT IN A RANDOMISED CONTROLLED TRIAL

E. Isaksson ¹, M. Flinck², S. Lindblom², A.-C. Laska³, P. Mazzocato⁴, E. Lundström⁵

¹Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden, ²Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Huddinge, Sweden, ³Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden, ⁴Karolinska Institutet, Department of Learning Informatics Management and Ethics, Solna, Sweden, ⁵Uppsala University, Department of Neurosciences, Uppsala, Sweden

Background and aims: Randomised controlled trials are the gold standard for evaluation treatments. Nevertheless, recruitment into trials is still challenging and many trials fail to meet their recruitment goals within the predetermined time. One possible explanation for the recruitment problem is that people do not want to be part of a study. We carried out this qualitative study with semi-structured interviews embedded in Efficacy oF Fluoxetine - a randomisEd Controlled Trial in Stroke (EFFECTS), an investigator led Swedish-based, multicentre, parallel group, double blind placebo-controlled trial. We did this qualitative study by interviewing patients in two groups; one that has consented to participate in EFFECTS and one with patients that have said no to being in the trial. The aim was to identify and describe factors contributing to acceptance or denial to participation in a randomised controlled trial.

Methods and design: We conducted a qualitative descriptive study with individual interviews and will do content analysis by Graneheim and Lundman.

Results: The result could be useful in clinical settings outside the field of stroke, and could add knowledge about the management of RCT.

Conclusions: Research about management of clinical trials and how to enhance recruitment to clinical trials is very important and this study can help identify barriers and find solutions to why patients say no to participate in RCT.

Trial Registration: Ethical approval 9 August 2017, 2017/1286-31/1

The protocol is registered at the Northern Ireland Hub for trials methodology research.

Disclosure: No

P0076 / 253

SHARED DECISION-MAKING SUPPORTED BY OUTCOME INFORMATION AMONG PATIENTS WITH STROKE

J. Prick ^1,2, S. van Schaik¹, I. Deijle³, R. Dahmen⁴, P. Brouwers⁵, B. van der Star⁵, P. Hilkens⁶, M. Garvelink⁷, M. Verschueren⁸, R. Saxena⁹, R. Gons¹⁰, E. Schut¹¹, G. van Dijk¹², S. Keus³, N. Engels², J. Ankersmid², M. Hackert², C. van Uden-Kraan², P. van der Wees¹³, R. Van den Berg-Vos^1,14

¹OLVG, Neurology, Amsterdam, Netherlands, ²Santeon, Utrecht, Netherlands, ³OLVG, Quality and Improvement, Amsterdam, Netherlands, ⁴Amsterdam Rehabilitation Research Centre Reade, Amsterdam, Netherlands, ⁵Medisch Spectrum Twente, Neurology, Enschede, Netherlands, ⁶St. Antonius Hospital, Neurology, Nieuwegein, Netherlands, ⁷St. Antonius Hospital, Value Based Healthcare, Nieuwegein, Netherlands, ⁸St. Antonius Hospital, Clinical Pharmacy, Nieuwegein, Netherlands, ⁹Maasstad Hospital, Neurology, Rotterdam, Netherlands, ¹⁰Catharina Hospital, Neurology, Eindhoven, Netherlands, ¹¹Martini Hospital, Neurology, Groningen, Netherlands, ¹²CWZ, Neurology, Nijmegen, Netherlands, ¹³Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands, ¹⁴Amsterdam UMC, Location AMC, Neurology, Amsterdam, Netherlands

Background and aims: Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making (SDM). This study aims to develop and evaluate a multicomponent intervention consisting of the implementation of a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke and a training on SDM for healthcare professionals. The PtDA consists of a printed consultation sheet to introduce the options for discharge destinations, an online information and deliberation tool to support patient education and clarification of patient values, and a summary sheet to support actual decision-making.

Methods: A multiple interrupted time series design is used to stepwise implement the intervention. In total, 630 hospitalized patients with acute stroke will be included. The primary outcome is the patients’ perceived level of involvement in decision-making. Secondary outcomes include patients’ decisional conflict, role in decision-making, preferences in decision-making, quality of life, participation, and satisfaction with the intervention. Measurements will be performed at baseline and 3 months. Segmented regression will be employed, with the period before and after the introduction of the intervention as segments. In each segment, linear regression will be fitted to the data, allowing each segment of the time series to exhibit different levels and trends.

Results: Results will be expected mid-2022.

Conclusions: This study might identify an effective approach for providing personalized stroke care and enhancing SDM, based on the needs and preferences of patients with stroke.

Disclosure: No

P0077 / 920

GAPLESS ECG-MONITORING IN STROKE AT HIGH RISK OF ATRIAL FIBRILLATION - GEMS AF PRELIMINARY RESULTS

A.L. Burger ^1,2, P. Sommer³, E. Fertl³, W.-B. Winkler⁴, F. Weidinger⁴, C. Roesler⁵, U. Leitner⁵, S. Mutzenbach⁵, E. Trinka⁵, C. Hengstenberg², T. Berger¹, T. Pezawas², S. Greisenegger¹

¹Medical University of Vienna, Department of Neurology, Vienna, Austria, ²Medical University of Vienna, Department of Medicine II, Division of Cardiology, Vienna, Austria, ³Clinic Landstrasse (Rudolfstiftung Hospital), Department of Neurology, Vienna, Austria, ⁴Clinic Landstrasse (Rudolfstiftung Hospital), Department of Cardiology, Vienna, Austria, ⁵Medical University of Salzburg, Department of Neurology, Salzburg, Austria

Background: Atrial fibrillation (AF) is a major risk factor for ischemic stroke. Gapless electrocardiogram (ECG) monitoring without any interruption of monitoring time via an implantable loop recorder (ILR) might increase the detection rates of AF after ischemic stroke.

Methods: Patients with acute ischemic stroke or transient ischemic attack without known AF were included in this prospective multicenter study. Participants received gapless ECG monitoring via telemetry followed by implantation of an ILR during stroke-unit admission, avoiding any interruption in monitoring time. Patients acted as their own controls and also received standard Holter ECG-monitoring. The primary outcome parameter was new-onset AF within six months of follow-up.

Results: A total of 80 patients were included. Of these, 65 (81.3%) patients had an embolic stroke of unknown source, 6 (9.2%) patients were included with large-artery disease and 9 (11.3%) participants had small-vessel disease. AF was newly detected in 15 (18.8%) patients via ILR monitoring compared to one patient (1.3%) via Holter-ECG monitoring (p=0.001). The median time to the first AF episode was 19 days [Interquartile range (IQR): 9-43] with a median duration of the detected AF episodes of 3.1 [IQR: 0.25-4.78] hours. Patients with a CHA₂DS₂-VASc Score⩾5 had a significantly higher risk of new onset AF compared to patients with a CHA₂DS₂-VASc Score<5 (Figure 1, p=0.008) . Oral anticoagulation was established in all patients with new-onset AF.

Conclusion: Gapless ECG monitoring with an ILR is a feasible and highly effective approach to significantly increase the detection rates of AF after acute ischemic stroke.

Disclosure: Yes

P0078 / 271

USING ARTIFICIAL INTELLIGENCE (AI) NETWORKS TO DETECT ATRIAL FIBRILLATION (AF) AFTER STROKE - AIAF PILOT STUDY

S. Roman ¹, A. Ali²

¹Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom, ²Stroke Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom

Background and aims: Atrial fibrillation (AF) is a frequent tachyarrhythmia that increases ischaemic stroke risk. Conventional electrocardiography and Holter monitoring enable short-term AF detection. However, they are obstructive and time-consuming to analyse. This research examined the feasibility of collecting heart rate data for a deep learning system (DLS), a type of artificial intelligence that automatically analyses heart rhythm. We validated DLS and Holter monitor agreement in accurately detecting patients at high and low (present and absent) AF risk.

Methods: A cross-sectional longitudinal observation study of patients with ischaemic stroke and transient ischaemic attack with and without known AF. Participants were continuously monitored for AF with the Holter monitor and Lifetouch sensor (with DLS analysis) for 24 hours. Agreement criteria for AF detection were compared.

Results: Nine patients had complete Holter and DLS data for analysis. There were zero adverse events. Device preference was Lifetouch technology (80% of patients). Compliance for Holter and Lifetouch monitoring durations were equal (M = 22.6 hours). AF risk prediction scores were produced for all patients using both devices. DLS diagnosis of AF indicated 75% and 40% agreement with the Holter monitor in the AF and non-AF cohort respectively. The DLS identified AF with greater frequency than Holter monitoring in both groups.

Conclusions: Lifetouch technology with DLS analysis is tolerated and safe for capturing AF. The DLS did not reach the intended threshold of >90% agreement with Holter monitoring. Future research should examine acceptability with larger samples and assess technological refinements to improve DLS detection accuracy.

Disclosure: No

P0079 / 1238

PERFORMANCE OF THE CPSSS IN PRE-HOSPITAL CARE TO DETECT CEREBRAL INFARCTION RELATED TO PROXIMAL ARTERIAL OCCLUSION

T. Bony¹, F. Got¹, L. Derex^2,3, F. Maziere¹, A. Maurin ⁴, A. Termoz^4,3, P.-Y. Gueugniaud¹, J. Haesebaert^4,3

¹Hospices Civils de Lyon, SAMU, Lyon, France, ²Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Service Neuro-vasculaire, Lyon, France, ³Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France, ⁴Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France

Background and aims: The prehospital management of acute stroke suspicions represents a major issue, due to time-dependent efficiency of reperfusion treatments (thrombolysis and Endovascular thrombectomy (EVT) which can only be performed in an EVT-center). The main pre-hospital stroke management challenge is to adequately orient patients to EVT or non-EVT-centers in order to avoid a loss of chance. Our main objective was to evaluate the performances of the CPSSS to identify strokes eligible for thrombectomy.

Methods: We conducted a prospective diagnostic study, including consecutive patients with a suspicion of stroke in the acute phase during the pre-hospital contact, by telephone with a medical regulator in a French emergency call center. The CPSSS was rated by the medical regulator by telephone with the firefighters or paramedics who were on-site with the patient. The score includes 3 items (eye deviation, awareness, motor skills). The gold standard for confirming proximal occlusion was brain imaging.

Results: This intermediate analysis was conducted on the first 490 included patients, out of 1220 expected. This sample included 247 confirmed ischemic strokes (IS). Among patients with IS, 107 (43.3%) presented proximal occlusion. The sensitivity of the CPSSS was 0.61 95%CI [0.51-0.70], the specificity was 0.78 95%CI [0.73-0.82].

Conclusions: Based on these preliminary results, the CPSSS appears to have limitations for predicting proximal occlusion, but data collection is ended and we will be able to present consolidated final results at the congress. Other scores (3I-SS, PASS, LAMS and G-FAST) may also be tested.

Disclosure: No

P0080 / 431

DUAL THROMBOLYTIC THERAPY WITH MUTANT PRO-UROKINASE AND LOW DOSE ALTEPLASE FOR ISCHEMIC STROKE (DUMAS)

N.A. van der Ende ^1,2, B. Roozenbeek^1,2, L.A. Aerden³, P. Kraayeveld⁴, I.R. van den Wijngaard^5,6, G.J. Lycklama à Nijeholt⁶, H.M. den Hertog⁷, H.Z. Flach⁸, L. Smagge², H.F. Lingsma⁹, A. van der Lugt², D.W. Dippel¹, DUMAS investigators

¹Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Radiology & Nuclear Medicine, Rotterdam, Netherlands, ³Reinier de Graaf, Neurology, Delft, Netherlands, ⁴Reinier de Graaf, Radiology & Nuclear Medicine, Delft, Netherlands, ⁵Haaglanden Medical Center, Neurology, The Hague, Netherlands, ⁶Haaglanden Medical Center, Radiology & Nuclear Medicine, The Hague, Netherlands, ⁷Isala Klinieken, Neurology, Zwolle, Netherlands, ⁸Isala Klinieken, Radiology & Nuclear Medicine, Zwolle, Netherlands, ⁹Erasmus MC University Medical Center, Public Health, Rotterdam, Netherlands

Background and aims: The effectiveness of alteplase for ischemic stroke treatment is limited and the occurrence of intracranial and extracranial hemorrhage is a major limitation. Mutant pro-urokinase (m-pro-urokinase) does not deplete fibrinogen and lyses fibrin only after induction with alteplase. Our aim is to test the safety and efficacy of dual thrombolytic treatment consisting of a bolus alteplase followed by m-pro-urokinase compared with usual treatment with alteplase in patients with ischemic stroke.

Methods: DUMAS is a multicenter, phase II, randomized clinical trial with open-label treatment, adaptive design for dose optimization, and blinded outcome assessment. Patients with ischemic stroke, who meet the criteria for treatment with intravenous (IV) alteplase can be included. Patients eligible for endovascular thrombectomy are excluded. Patients will be randomly assigned (1:1) to receive a bolus of IV alteplase (5mg) followed by continuous IV infusion of m-pro-urokinase (40mg/hr during 60 minutes) or usual care with alteplase (0.9mg/kg). We aim to include 200 patients with a discharge diagnosis of ischemic stroke. The primary outcome is any post-intervention intracranial hemorrhage (ICH) on MRI according to the Heidelberg Bleeding Classification. Secondary outcomes include symptomatic ICH, NIHSS scores at 24 hours and 5-7 days, and mRS score at 30 days.

Results: First patient was included August 10^th, 2019. Currently, 172 patients have been included as of January 3, 2022.

Conclusions: The trial is well underway. It will test the hypothesis that dual thrombolytic therapy with a bolus alteplase and m-pro-urokinase reduces the occurrence of ICH in ischemic stroke patients compared to patients treated with alteplase alone.

Disclosure: Yes

P0081 / 987

TRANEXAMIC ACID FOR INTRACEREBRAL HAEMORRHAGE 3 (TICH-3): RATIONALE AND DESIGN OF A PHASE III DOUBLE BLIND RANDOMISED CONTROLLED MULTI-CENTRED SUPERIORITY TRIAL

N. Sprigg ¹, P.M Bath², D.R. Dineen², P.R. Al-Shahi Salman³, P.C. Roffe⁴, P.D. Werring⁵, C.A.P.T. England⁶, P.T. Coats⁷, P.M. James⁸, A.P.C. Rick⁹, P.T.G Robinson¹⁰, T. Hepburn², P.I. Roberts¹¹, P.A. Montgomery¹²

¹University of Nottingham, Stroke Trials Unit, Mental Health and Clinical Neurosciences, NG7 2UH, United Kingdom, ²University of Nottingham, Cinical Stroke Trial Unit, Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, Nottingham, United Kingdom, ³University of Edinburgh, Professor of Clinical Neurology, Edinburgh, United Kingdom, ⁴University Hospitals of North Midlands NHS Trust, Consultant Stroke Physician, Stoke, United Kingdom, ⁵UCL Institute of Neurology, Professor of Clinical Neurology, London, United Kingdom, ⁶University of Nottingham, Cinical Stroke Trial Unit, Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, Derby, United Kingdom, ⁷University of Leicester, Professor of Emergency Medicine, Leicester, United Kingdom, ⁸University of Nottingham, Professor of Health Economics, Nottingham, United Kingdom, ⁹University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom, ¹⁰University of Leicester, Professor of Stroke Medicine, Liecester, United Kingdom, ¹¹London School of Hygiene & Tropical Medicine, London, United Kingdom, ¹²University of Nottingham, Clinical Trials Unit, Nottingham, United Kingdom

Background: Intracerebral haemorrhage (ICH) is a medical emergency and causes more than 1.7 million strokes worldwide per year with a mortality of over 40%. Tranexamic acid (TXA) when given early reduces mortality and haematoma expansion in spontaneous ICH. The haemostatic effect of TXA was demonstrated in prior pilot studies which could change clinical practice globally.

Objectives: We aim to assess the clinical effectiveness of TXA after ICH and determine whether TXA should be used in clinical practice.

Design: TICH-3 is a pragmatic phase III prospective blinded randomised placebo-controlled trial. 5500 adult patients with ICH will be recruited within 4.5 hours of onset across UK and International sites. Exclusion criteria include known indication for TXA, contraindication for TXA, known to be on anticoagulation, massive ICH (>60ml), severe coma (GCS<5) and end of life care.

Rapid emergency consent will take place and patients will be randomised (1:1) by simple randomisation to receive intravenous TXA 2g; 1g bolus loading dose given as 100ml infused over 10 minutes, followed by another 1g in 250ml infused over 8hrs or matching placebo. Patients, relatives, researchers and outcome assessors will be masked to treatment allocation.

The primary outcome is mortality by day 7. Secondary outcomes include dependency (using the modified Rankin Scale) and Quality of Life (including health economics outcomes) at day 180, serious adverse events (SAE) up to 7 days and fatal SAEs up to day 180.

Funding: TICH-3 is funded by the National Institute for Health Research Health Technology Assessment Programme (NIHR129917).

Disclosure: No

P0082 / 1559

CEREBROLYSIN IN PATIENTS WITH SUBARACHNOIDAL HAEMORRHAGE AND HIGH INITIAL HUNT-HESS GRADE

Z. Poljakovic ¹, S. Supe², J. Ljevak², I. Peric², A. Bazina Martinovic², N. Blazevic²

¹Medical Faculty Zagreb, University Hospital Zagreb, Neurology, Zagreb, Croatia, ²University Hospital Zagreb, Neurology, Zagreb, Croatia

Background and aims: Outcome after aneurysmal subarachnoidal haemorrhage (SAH) varies strongly depending mostly on initial clinical state. Mortality of patients with HH 3 is up to 20%, 42% if HH grade is 4, and more than 70% if initial HH score is 5. On the other hand, percentage of good outcomes declines respectively with higher HH score. Only 25-30% of patients have good functional outcome if initial HH is 4 or 5. Neuroprotective agents as add-on therapy for patients with HH 3 and higher seem to be a promising approach in the standard treatment of SAH. Aim of our study is to investigate efficacy and safety of Cerebrolysin as add-on therapy for patients with HH 3 and higher.

Methods: Patients with aneurysmal SAH and initial HH of 3 and higher, who meet the inclusion criteria, are treated according to standard protocol and Cerebrolysin systemic infusion as add-on therapy. Primary outcome of the study is measured with functional outcome (mRS day 90) and death.

Results: We present the results of first 10 patients included in the study who finished the study and full follow-up period untill 1. jan 2022. By the end of the follow-up period 3 patients died and 3 had 90-days mRS of 4. Four patients reached mRS of 3. No AE due to Cerebrolysin were observed.

Conclusion: Our initial results confirmed safety of the drug. Considering efficacy, 40% of our patients had good functional outcome and 30% died. Final results of the study are expected within 2 years.

Disclosure: No

P0083 / 291

STROKE IN PATIENTS WITH LARGE ISCHAEMIC CORE: ASSESSMENT OF REPERFUSION THERAPY IMPACT ON OUTCOME (SICARIO) TRIAL

C. Garcia-Esperon ¹, M. Parsons², A. Bivard³, F. Miteff¹, L. Churilov⁴, N. Spratt¹, K. Butcher⁵, E. Holliday⁶, C. Bladin⁷, B. Yan³, L. Gao⁸, A. Cheung⁵, D. Easton³, M. Russell¹, C. Levi¹

¹John Hunter Hospital, Neurology, New Lambton Heights, Australia, ²University of New South Wales South Western Sydney Clinical School, Sydney, Australia, ³Royal Melbourne Hospital, Melbourne, Australia, ⁴University of Melbourne, Melbourne, Australia, ⁵Prince of Wales hospital, Sydney, Australia, ⁶University of Newcastle, Newcastle, Australia, ⁷The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, ⁸Deakin University, Geelong, Australia

Background: Endovascular thrombectomy (EVT) is effective for large vessel occlusion (LVO) stroke patients with small volumes of computed tomography perfusion (CTP)-defined ischemic core infarction within 24 hours from onset. There is little data available regarding EVT for patients with large cores. Observational studies suggest large benefits with core 50-70 mL. For those with core 70-100 mL there is strong suggestion of benefit, with the caveat of all non-radomised data. For core >100 mL there is insufficient data regarding benefits, or even potential harm, to justify a randomised trial. We propose a randomised controlled trial, using volumetric measures of large core (>70 mL).

Methods: Design: SICARIO is a basket trial designed to test the effect of EVT versus standard of care on 3-month mRS in two different populations.

Sub-study 1 (CTP core 70-100mL) is a prospective, randomized, open-label, blinded endpoint, international, parallel 2-arm Bayesian Optimal Phase 2 (BOP2) design trial (Sample size: 150 patients).

Sub-study 2 (CTP core >100mL) is a prospective, single arm, international, BOP2 design trial (Sample size: 180 patients).

Population: Ischaemic stroke patients with anterior LVO within 24 hours of onset with an ischemic core of >70mL and a premorbid mRS<3.

Primary Outcome: Substudy 1: Proportion of mRS 0-2 at 3 months.

Substudy 2: Proportion of mRS 0-4 at 3 months.

Conclusions: SICARIO trial will start recruitment in Australia in February 2022 and internationally in June 2022.

Disclosure: No

P0084 / 1153

DOES PHARYNGEAL ELECTRICAL STIMULATION IMPROVE SWALLOWING IN ACUTE STROKE DYSPHAGIA? THE PHEAST TRIAL

L.J. Woodhouse¹, T. England¹, L. Everton¹, S. Hamdy², T. Hamilton¹, D. Havard¹, M. James³, L. Kurlak¹, A.A Montgomery³, C. Smith⁴, G. Squires¹, G. Wilkinson¹, N. Sprigg¹, P.M Bath ¹, PhEAST Trial Investigators

¹University of Nottingham, Stroke Trials Unit, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom, ²University of Manchester, Division of Diabetes, Endocrinology & Gastroenterology, Manchester, United Kingdom, ³University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom, ⁴University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom

Background: Dysphagia (swallowing difficulties) is common post stroke and an independent predictor of poor outcome, but there are no standardised treatment guidelines. Pharyngeal electrical stimulation (PES) is licensed for use in the UK and Europe but lacks a definitive evidence-base and so is not widely used. We aim to assess whether PES is safe and effective at improving post-stroke dysphagia.

Methods: PhEAST is an international prospective, randomised, open-label, blinded-endpoint (PROBE) trial. 800 adults with recent (4-21 days) ischaemic or haemorrhagic anterior or posterior circulation stroke, and clinical dysphagia with a reliance on non-oral nutrition will be recruited.

Patients will be randomised (1:1), with stratification on country and minimisation on age, sex, dysphagia severity rating scale (DSRS), impairment, stroke type, circulation and time to randomisation, to receive either PES or No PES. The PES group will receive six, once daily (10 minute) treatments of PES. Both groups will receive standard dysphagia rehabilitation.

The primary outcome is dysphagia status, assessed using the Dysphagia Severity Rating Scale (DSRS) at day 14. Secondary outcomes include PES threshold and tolerability at day 7, dysphagia status, dependency, disability, quality of life, cognition, mood and disposition at 90 and all-cause mortality at day 365.

Conclusions: PhEAST will provide definitive evidence for the use of PES in acute stroke. The results may directly inform clinical decision making and support decisions on guidelines for standardised practice in dysphagia treatment.

Disclosure: No

P0085 / 204

COMPUTER-ASSISTED SELF-TRAINING TO IMPROVE EXECUTIVE FUNCTION VERSUS UNSPECIFIC TRAINING IN PATIENTS AFTER STROKE, CARDIAC ARREST OR IN PARKINSON’S DISEASE: A RANDOMIZED CONTROLLED TRIAL: THE COMPEX-TRIAL

K. Sværke Schiøler ¹, L. Marguerite Christensen², A. Løkkegaard², H. Christensen²

¹Bispebjerg Hospital, University of Copenhagen, Neurology, Copenhagen NV, Denmark, ²Bispebjerg Hospital, Neurology, Copenhagen NV, Denmark

Background and aims: Patients with stroke and other conditions affecting the brain often experience impairments with working memory (WM), which can be devastating for the individual’s ability to lead a normal life. Gold-standard for treatment is 1:1 sessions with neuropsychologist, but this approach is expensive and the majority of patients don’t receive cognitive rehabilitation. Computer-Based Cognitive Rehabilitation (CBCR) is a promising method to increase availability and flexibility of cognitive rehabilitation while minimizing costs. CBCR consists of exercises targeted at specific cognitive functions and is carried out on the patient’s computer at home. The current evidence for the efficacy of CBCR is sparse and there is especially a lack of studies comparing CBCR with active control conditions and measuring improvement with far-transfer ADL-function measures instead of near-transfer neuropsychological measures.

Methods: 600 patients with different brain-related conditions affecting WM will be included from various European sites: 400 with stroke (focal brain injury), 100 after heart attack (anoxic brain injury) and 100 with Parkinson’s disease (neurodegenerative disease). Patients will be randomly allocated in a 1:1 ratio to specific CBCR-training targeting WM and general stimulating activities such as solitaire, puzzles etc. Both groups are to train five hours a week for eight weeks. The primary endpoint is the iADL-measure from MDS-HC at three months after the end of the intervention to assess any lasting effects of training. Secondary endpoints include neuropsychological tests and questionnaires concerning anxiety, depression, and quality of life.

Results: Main results expected to be presented primo 2024.

Disclosure: No

P0086 / 370

TOWARDS INDIVIDUALIZED MEDICINE IN STROKE - THE TIMES PROJECT: A LONGITUDINAL, MULTI-DOMAIN, MULTI-MODAL STUDY OF STROKE PATIENTS DURING THE FIRST YEAR AFTER THE ICTAL EVENT

L. Fleury ¹, P.J Koch^2,1, M.J Wessel^2,1, C. Bonvin³, D. San Millan³, C. Constantin³, J.-A. Ghika³, P. Vuadens⁴, J. Adolphsen⁵, C. Jagella⁵, A. Cadic-Melchior¹, J. Brügger¹, E. Beanato^1,2, M. Ceroni¹, P. Menoud¹, D. de Leon Rodriguez¹, V. Zufferey², S. Avanzi^1,2, T. Popa¹, E. Raffin², V. Alvarez³, J.-L. Turlan⁴, A. Mühl⁴, B. Léger⁴, T. Morishita^2,1, S. Micera², O. Blanke², D. Van de Ville², F.C Hummel^1,2,6

¹Swiss Federal Institute of Technology (EPFL), Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, Sion, Switzerland, ²Swiss Federal Institute of Technology (EPFL), Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, Geneva, Switzerland, ³Hôpital du Valais (HVS), Hôpital de Sion, Sion, Switzerland, ⁴Clinique Romande de Réadaptation, Sion, Switzerland, ⁵Berner Klinik Montana, Crans-Montana, Switzerland, ⁶University of Geneva Medical School, Clinical Neuroscience, Geneva, Switzerland

Despite recent improvements, complete motor recovery occurs in less than 15% of patients. To improve the therapeutic outcomes, there is a strong need to tailor treatments to each individual patient. However, there is a lack of knowledge concerning the precise neuronal mechanisms underlying motor recovery. The TiMeS project is an ongoing longitudinal exploratory study aiming at characterizing stroke phenotypes of a large, representative stroke cohort through an extensive, multi-modal evaluation. The ultimate goal of the study is to identify biomarkers allowing to predict the individual course of motor recovery and paving the way for treatment stratification of individual patients.

A total of up to 100 patients will be assessed at 4 timepoints over the first year after the stroke: during the first (T1) and third (T2) week, then three (T3) and twelve (T4) months after stroke onset. To assess underlying mechanisms of recovery with a focus on brain connectivity, we will apply synergistic state-of-the-art systems neuroscience methods: functional and structural magnetic resonance imaging (MRI), and electrophysiological recordings including transcranial magnetic stimulation (TMS) coupled with electroencephalography (EEG) and electromyography (EMG). In addition, an extensive, multi-domain neuropsychological evaluation will be performed at each timepoint, covering all sensorimotor and cognitive domains according to the DSM-V.

Ending in December 2022, this project will provide a multi-dimensional dataset serving as a basis to develop biomarkers that will help to predict outcomes and promote personalized stratification towards individually tailored treatment concepts using neuro-technologies. This will pave the way towards personalized precision medicine approaches in stroke rehabilitation.

Disclosure: No

P0087 / 355

AURORA: DUTCH-TYPE HEREDITARY CEREBRAL AMYLOID ANGIOPATHY NATURAL HISTORY STUDY

R. van Dort ¹, I. Rasing¹, S. Voigt¹, E.A. Koemans¹, K. Kaushik¹, R. van der Zwet¹, M. Schipper², T. van Harten², E. van Etten¹, M. Verbeek³, M. van Buchem², S. van Rooden², J. van der Grond², E. van Zwet⁴, M. van Walderveen², M. van Osch², G. Terwindt¹, M. Wermer¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Leiden University Medical Center, Radiology, Leiden, Netherlands, ³Radboud University Medical Center, Neurology, Nijmegen, Netherlands, ⁴Leiden University Medical Center, Biomedical Data Sciences, Leiden, Netherlands

Background and aims: Dutch-type hereditary cerebral amyloid angiopathy (D-CAA, also known as HCHWA-D), is an autosomal dominant form of cerebral amyloid angiopathy (CAA) caused by a mutation in the amyloid-beta (Aβ) precursor protein gene. Because of pathological and biochemical similarities, D-CAA is considered to be a monogenic model for sporadic CAA (sCAA). Though the disease course varies widely, disease onset is approximately 20 years earlier in D-CAA than in sCAA patients. This wide variation in phenotype suggests that additional systemic factors may interact with amyloid in triggering ICH. The aim of this prospective follow-up study is to investigate the (pre)symptomatic disease course and to assess clinical risk factors and biomarkers of disease progression.

Methods: In all patients, 3T-MRI and 7T-MRI at baseline and follow-up (alternating years) will be performed over a period of 6 years. The standardized annual study protocol consists of an interview (general health and vascular risk factors), neurological examination, cognitive screening and blood withdrawal. Participants will be asked for a lumbar puncture each study visit. Blood and cerebrospinal fluid will be stored for future biomarker analysis. Electroencephalography and home blood pressure monitoring will be performed once during follow-up.

Main study parameters: CAA markers on 3T-MRI and 7T-MRI, changes in CSF and plasma, ICH recurrence rate and clinical outcome. We will investigate disease progression in 150 (pre)symptomatic mutation carriers and compare D-CAA patients with the sCAA population (FOCAS study, analogous protocol).

Current status: AURORA started in May 2018, until now 89 patients have been included.

Disclosure: No

P0088 / 454

TRIPLE THERAPY PREVENTION OF RECURRENT INTRACEREBRAL DISEASE EVENTS TRIAL (TRIDENT): PROGRESS REPORT

R. Freed ¹, C. Anderson¹, A. Rodgers¹, A. De Silva^2,3, S. Ouriques Martins^4,5, C.J. Klijn⁶, B. Senanayake⁷, L. Billot^1,8,9, Q. Li¹, H. Arima¹⁰, N. Huy Thang¹¹, W.A.W. Zaidi¹², T. Kherkheulidze¹³, K. Wahab¹⁴, U. Fischer^15,16, T.-H. Lee^17,18, C. Chen¹⁹, O. Pontes-Neto²⁰, T. Robinson²¹, J. Wang²², F.H Schreuder⁶, R.I Lindley^23,1, M. Woodward^1,8, S. MacMahon^8,1, R.A.-S. Salman²⁴, C.K Chow^23,1, J. Chalmers¹

¹The George Institute for Global Health, University of New South Wales, Sydney, Australia, ²Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka, ³Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka, ⁴Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto, Alegre, Brazil, ⁵Neurology Service Hospital Moinhos de Vento, Porto Alegre, Brazil, ⁶Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands, ⁷Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka, ⁸The George Institute for Global Health, School of Public Health, Imperial College, London, United Kingdom, ⁹University of Bordeaux, Bordeaux, France, ¹⁰Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan, ¹¹Stroke Unit, 115 Hospital, Ho Chi Minh City, Vietnam, ¹²Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia, ¹³Urgent Neurological Clinic Neurology, Tbilisi State Medical University, Tbilisi, Georgia, ¹⁴Department of Medicine, University of Ilorin, Ilorin, Nigeria, ¹⁵Department of Neurology University Hospital Bern and University of Bern, Bern, Switzerland, ¹⁶Department of Neurology, University Hospital Basel, Basel, Switzerland, ¹⁷Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, Province of China, ¹⁸College of Medicine, Chang Gung University, Taoyuan, Taiwan, Province of China, ¹⁹Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, ²⁰Department of Neurosciences and Behavioural Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil, ²¹College of Life Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, United Kingdom, ²²Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China, ²³Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Sydney, Australia, ²⁴Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom

Background and aims: Patients who suffer intracerebral haemorrhage (ICH) are at very high-risk of recurrent ICH and other serious cardiovascular events. A single-pill combination (SPC) of blood pressure (BP) lowering drugs offers a potentially powerful but simple strategy to optimise secondary prevention. TRIDENT aims to determine the effects of a novel SPC ‘Triple Pill’, three generic antihypertensive drugs with demonstrated efficacy and complementary mechanisms of action at half standard dose (telmisartan 20mg, amlodipine 2.5mg, indapamide 1.25mg), with placebo, for the prevention of recurrent stroke, cardiovascular events, and cognitive impairment after ICH.

Methods: An international, double-blind, placebo-controlled, randomised trial in adults with ICH and mild-moderate hypertension (systolic BP 130-160mmHg), who are not taking any Triple Pill component drug or equivalent at greater than half-dose. 1500 randomised patients will provide 90% power to detect a hazard ratio of 0.5, over an average follow-up of 3 years, according to a total primary event rate (any stroke) of 12% in the control arm and other assumptions. Secondary outcomes include recurrent ICH, cardiovascular events, disability, cognitive impairment/dementia, and safety.

Results: Recruitment started 28 September 2017. Up to 31 December 2021, 849 patients have been randomised at 55 active sites in 10 countries. Triple pill adherence after 30 months is 86%. The required sample size should be achieved by 2024.

Conclusions: Low-dose Triple Pill BP lowering could improve long-term outcome from ICH.

Trial registration: ClinicalTrials.gov (NCT02699645)

Disclosure: No

P0089 / 1037

INTENSIVE CARE BUNDLE WITH BLOOD PRESSURE REDUCTION IN ACUTE CEREBRAL HAEMORRHAGE TRIAL (INTERACT3): PROGRESS REPORT

L. Song ^1,2, L. Ma³, M. Ouyang¹, C. Zhang¹, X. Li³, L. Billot², Q. Li², C. You³, C.S Anderson^1,4,5

¹The George Institute China at Peking University Health Sciences Center, Beijing, China, ²The George Institute for Global Health, University of New South Wales, Sydney, Australia, ³West China Hospital, Sichuan University, Department of Neurosurgery, Chengdu, China, ⁴Royal Prince Alfred Hospital, Neurology Department, Sydney, Australia, ⁵Sydney Medical School, University of Sydney, Sydney, Australia

Background and aims: Early intensive blood pressure (BP) lowering is a potentially beneficial treatment for acute intracerebral haemorrhage (ICH), despite discordant results between trials and heterogeneity in effects by approach. INTERACT3 aims to determine the effectiveness of a goal-directed care bundle of early intensive BP lowering, glycaemic control, treatment of pyrexia, and reversal of anticoagulation, in patients with ICH.

Methods: An international, multicentre, stepped-wedge (4 phases/3 steps, average 29 patients/phase), cluster randomised trial to assess the effectiveness of a multifaceted care package in 8621 patients across 110+ sites in 10 countries. After a ‘usual care’ control period, hospitals are randomised for immediate implementation of the intervention (systolic BP target <140mmHg; glucose control target 6.1-7.8/7.8-10.0 mmol/L; temperature ⩽37.5 °C; anticoagulation reversal, INR <1.5). Primary outcome is modified Rankin scale (mRS) scores at 6 months, analysed by ordinal logistic regression. Sample size provides 90% power (α 0.05) to detect a 5.6% absolute improvement (shift) in primary outcome, with various assumptions.

Results: Since activation late 2017, 7057 patients have been enrolled in China, Chile, Peru, Pakistan, Brazil, Mexico, Vietnam, Sri Lanka, India, and Nigeria at 31 December 2021. After completion of patient follow-up and close-out activities (late-2022), results are to be presented early 2023.

Conclusion: INTERACT3, the largest ICH trial to date, will provide a reliable assessment of a widely applicable goal-directed care bundle intervention.

Disclosure: Yes

P0090 / 1109

SAFETY AND TOLERABILITY OF AZD6482 IN REPERFUSION FOR STROKE (STARS)

C. Delcourt ^1,2, M. Ellis³, S. Schoenwaelder³, J. Maclean³, C. Levi⁴, S. Jackson³

¹Macquarie University, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Sydney, Australia, ²The George Institute, Sydney, Australia, ³Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia, ⁴Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia

Background: Current acute stroke therapies have limitations in terms of eligibility and efficacy. About 20% and 10% of patients with acute ischaemic stroke are eligible for thrombolysis and endovascular thrombectomy respectively. Following the former 50% will not recanalize and 20% experience re-occlusion. With the later, ~10% will not recanalize. There is an urgent need for more effective therapies in acute ischaemic stroke.

Aims: We are conducting the STARS trial (Safety and Tolerability of AZD6482 in Reperfusion for Stroke), a phase IIa, dose escalation study to evaluate the safety and tolerability of the anti-platelet drug AZD6482 in adult patients with acute ischaemic stroke.

The new drug is an enzyme PI 3-kinase (PI3K) inhibitor Type Ia p110β isoform which is a safe and effective way to inhibit pathological thrombus formation without causing bleeding based on robust animal and healthy volunteers’ trials.

Methods: We will include ~42 patients with acute ischaemic stroke receiving thrombolysis with or without thrombectomy. AZD6482 will be given as a bolus and 3-hour infusion in addition and concomitantly to acute stroke management. Patients will be included according to the continual reassessment method. The primary outcome will be intracerebral haemorrhage. Secondary outcomes will include imaging and clinical outcomes. The trial will start recruiting in Australia in July 2022.

Conclusions: If the trial shows safety of the AZD6482, further trials will be conducted to assess its efficacy.

Disclosure: No

P0091 / 1467

ALAMEDA - A SYSTEM DESIGNED TO OPEN NEW AVENUES IN PATIENTS’ REHABILITATION AFTER STROKE

D. Dumitrascu ¹, P. Ioan², R. Badea², A. Ribigan², F. Antochi²

¹University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, ²University Emergency Hospital Bucharest, Bucharest, Romania

Background and aims: Stroke is the leading cause of adult disability worldwide.

ALAMEDA is an international research project that involves 15 partners and organizes three pilot studies in 3 sites, one for each disease (Greece for Parkinson, Italy for Multiple Sclerosis, Romania for Stroke).

The aim of our project is to help predict episodes of worsening of the disease and to design the most appropriate treatment and rehabilitation path in the case of stroke patients.

Methods: Three focus groups (8 members from Greece, 12 from Italy, 10 from Romania-represented by patients, caregivers and clinicians) were established in order to provide feedback on the proposed usage scenarios using questionnaires, interviews and co-creation meetings.

Results: The main topics addressed through questionnaires were regarding preferences for:

• - wearing the devices

• - filling out Patient Reported Outcomes

• - the Conversational Agent

• - the Disease Self-Management Module

By monitoring patients using smart devices (Smart watch, Smart bracelet, Shoe pressure sensors, Belt sensors, Sleep Monitoring Mattress, Smartphone/Tablet Camera), we attempt to open new means to amplify gains in recovery after stroke and to anticipate an eventual aggravation of the deficits.

Conclusions: We choose to present this project in order to increase the awareness regarding the need for a high level of care in the case of patients who had suffered a stroke for a personalized rehabilitation treatment assessment.

Disclosure: No

P0092 / 501

MEASURING CHANGES IN BLOOD BIOMARKERS AFTER A NEUROPROTECTIVE INTERVENTION (REMOTE ISCHEMIC CONDITIONING) IN A PREHOSPITAL STROKE TRIAL

R. Blauenfeldt ¹, D.C. Hess², M.F. Gude³, A.-M. Hvas⁴, G. Andersen¹, K.R. Drasbek⁵

¹Aarhus University Hospital, Department of Neurology & Danish Stroke Center, Aarhus, Denmark, ²Medical College of Georgia, Augusta University, Department of Neurology, Augusta, United States, ³Prehospital Emergency Medical Services, Central Denmark Region, Department of Research and Development, Aarhus, Denmark, ⁴Aarhus University Hospital, Department of Clinical Biochemistry, Aarhus, Denmark, ⁵Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus, Denmark

Background and aims: In neuroprotective trials, a critical barrier is the lack of biomarkers predicting and monitoring the response to therapy. Remote ischemic conditioning (RIC) is a potent activator of endogenous neuroprotective mechanisms against ischemic injury. Here, we discuss the methodological considerations behind investigating the effect of RIC on hemostasis and endogenous fibrinolysis, rheo-erythrocrine function in red blood cells and extracellular vesicle release in an ongoing clinical trial, RESIST (REmote iSchemic conditioning In patients with acute STroke).

Methods: RESIST is a multicenter, prospective, randomized, patient-assessor blinded, sham-controlled study. The entire implementation process of blood-sampling (prehospital and in-hospital) was done gradually according to the plan-do-study-act principle. Blood-sampling were drawn in the hyperacute prehospital phase immediately following randomization, upon stroke center admission, and again after two and 24 hours. Measurement of hemostasis and endogenous fibrinolysis will be performed using functional and immunologic plasma assays, and the rheo-erythrocrine function of red blood cells using analytical flowcytometry (nitric oxide content), chemiluminescence (nitrite), and laser based ektacytometry (red blood cell deformability). Finally, proteins and miRNAs in isolated plasma extracellular vesicles (EV) will be analyzed.

Results: From October 7, 2019 through January 6, 2021, 330 patients had blood-samples taken. Demographics, time metrics and quality control data will be presented.

Conclusion: Measuring changes in prehospital blood biomarkers in an acute neuroprotective stroke trial is feasible. However, prehospital blood-sampling is associated with higher error rates compared to in-hospital sampling. Identifying biomarker responders to a neuroprotective treatment may be a key step towards a successful translation to the clinic.

Disclosure: No

P0093 / 269

TELEMEDICINE EFFICACY IN MEDICATION ADHERENCE IN POST-ISCHEMIC STROKE PATIENTS: ONGOING CLINICAL TRIAL

J. Garzón ^1,2,3, I. Freire⁴, A. Díaz¹, F. Silva^1,2,3

¹Hospital Internacional de Colombia, Instituto Neurológico, Piedecuesta, Colombia, ²Fundación Cardiovascular de Colombia, Grupo de Ciencias Neurovasculares, Floridablanca, Colombia, ³Universidad Industrial de Santander, Bucaramanga, Colombia, ⁴Universidad de La Sabana, Bogotá D.C, Colombia

Background and aims:

Several studies have demonstrated that stroke patients benefit with the implementation of telemedicine by providing timely and appropriate neurological consultation, diminishing accessible barriers, improving medication adherence for secondary prevention, and facilitating linkages between patient and physician. We aim to determine the efficacy of telemedicine on preventive medication adherence in Stroke survivors.

Methods: We estimate to recruit eighty-four adults survivors of their first Stroke. Subjects will be randomly allocated to either an intervention or control group. Intervention participants received a brief phone call on days 12-14 post-discharge, aimed at increasing adherence by using strategies that help establish better medication-taking routines. Both groups will receive neurology consultation follow up at 1, 3, and 6-months post-discharge. This follow up consults for the intervention group will be completely via telemedicine while the control group will have in-person sessions at the hospital with a physician. Primary outcome will be self-reported attachment to secondary stroke prevention medicine at 1, 3, and 6-months by Morisky-Green questionnaire. On the other hand, our secondary outcome includes the self-reported adherence to healthy lifestyles by Fantastic Instrument and the caregiver burden using the Zarit burden instrument.

Results: During the first 6 months, we recruited 45 patients, who are currently under follow-up.

Conclusions: The results from the trial will provide evidence on the impact of telemedicine by showing the benefits of adherence to preventive medication in Stroke survivors, especially for those in neurologically underserved areas.

Trial registration: NCT04877171.

This work is supported by Minciencias (No. 80740-043-2021).

Disclosure: No

P0094 / 523

CHLORHEXIDINE OR TOOTHPASTE, MANUAL OR POWERED BRUSHING TO PREVENT PNEUMONIA COMPLICATING STROKE (CHOSEN): A 2X2 FACTORIAL RANDOMISED CONTROLLED FEASIBILITY TRIAL

C. Smith ¹, C. Lightbody², F. Sandom³, I. Clements⁴, M. Brady⁵, G. McCracken⁶, P. Langhorne⁷, Z. Hoare³, C. Watkins², P. Brocklehurst³

¹University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom, ²University of Central Lancashire, School of Nursing, Preston, United Kingdom, ³Bangor University, School of Medical and Health Sciences, Bangor, United Kingdom, ⁴Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom, ⁵Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, United Kingdom, ⁶Newcastle University, School of Dental Sciences, Newcastle, United Kingdom, ⁷University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom

Background and aims: Increasing evidence links poor oral health status, dysphagia and development of stroke-associated pneumonia (SAP). The aim of this study is to determine whether a phase 3, randomised controlled trial of oral healthcare (OHC) to prevent SAP in dysphagic acute stroke patients is feasible.

Methods: This is a randomised feasibility trial with parallel process evaluation. Using a factorial design, we will randomise 120 patients with acute stroke and dysphagia within 24 h of admission to either non-foaming toothpaste v 1% chlorhexidine gel and to either manual v powered brushing. Stroke unit nursing staff will receive standardised training to deliver the OHC treatments. Assessment of feasibility will include recruitment and set-up of sites, recruitment and retention of participants, adherence to allocated OHC treatment, acceptability and tolerability. We will also record incident SAP, antibiotic doses received, length of stay and modified Rankin score at 3 months. In the process evaluation we will focus on implementation of, and fidelity to, the OHC by undertaking focus groups at each site and employing behaviour change techniques to establish an implementation package.

Results: The standardised staff training commenced on 31^st August 2021 at 4 UK North West hospitals and participant recruitment will commence in January 2022. Final 3 month follow-up is planned at the end of March 2023.

Conclusions: We will establish whether feasibility progression criteria are met for a phase 3 trial, and whether further piloting is required.

ISRCTN52421361

Disclosure: No

P0095 / 483

DESMOPRESSIN FOR REVERSAL OF ANTIPLATELET DRUGS IN STROKE DUE TO HAEMORRHAGE (DASH): RATIONALE AND DESIGN OF A PHASE II DOUBLE BLIND RANDOMISED CONTROLLED TRIAL

N. Sprigg ¹, M. Desborough², R.A.-S. Salman³, S. Stanworth⁴, D. Havard¹, P.M Brennan³, R. Dineen⁵, T. Coats⁶, P. Johnson⁷, T. Hepburn⁸, L.J. Woodhouse¹, P.M Bath¹, DASH Trial Investigators

¹University of Nottingham, Stroke Trials Unit, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom, ²Oxford University Hospitals, Oxford, United Kingdom, ³University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ⁴NHS Blood and Transplant, Oxford, United Kingdom, ⁵University of Nottingham, Radiological Sciences, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom, ⁶University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom, ⁷Patient Representative, Nottingham, United Kingdom, ⁸University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, United Kingdom

Rationale: Prior antiplatelet therapy is an independent risk factor for haematoma expansion, death and poor functional outcome in spontaneous intracerebral haemorrhage. Reversal of antiplatelet effect with desmopressin was shown to be a promising therapeutic target in pilot studies.

Objectives: We aim to assess the feasibility of screening, checking the eligibility, approaching, randomising, administering the intervention, and completing follow-up for patients treated with desmopressin or placebo.

Design: 50 patients with spontaneous intracerebral haemorrhage, who were taking oral antiplatelet agents in the preceding seven days, within 24 hours of onset will be recruited. Exclusion criteria are secondary intracerebral haemorrhage and contraindications to desmopressin.

Patients will be randomised (1:1) to receive intravenous desmopressin 20μg in 50 mls Sodium Chloride 0.9% infused over 20 minutes or matching placebo. Randomisation will involve minimisation on key prognostic factors: age; sex; time since onset; systolic blood pressure; and presence of intraventricular haemorrhage. Patients, relatives, researchers and outcome assessors will be masked to treatment allocation.

Feasibility outcomes include number of patients receiving allocated treatment, rate of recruitment, proportion of patients approached being randomised, adherence to treatment and follow up. Secondary outcomes include hyponatremia at 24 hour, death within 7 days, serious adverse events up to 90 days and haematoma growth at 24 hours.

Discussion: As of 6^th January 2022, 51 participants have been recruited to this trial. This is a feasibility trial which will inform the design of a definitive trial.

Disclosure: No

P0096 / 1244

AUTOMATIC PREDICTION OF EDEMA AFTER STROKE (APICES)

K. Poli ¹, M. Wenzel², S. Diekmann², J.-M. Hempel³, H. Strohm², F. Thielke², K. Althaus⁴, H. Bäzner⁵, M. Bendszus⁶, G. Bohner⁷, K. Dimitriadis⁸, M. Endres⁹, U. Ernemann³, J. Fiehler¹⁰, M. Gliem¹¹, G. Höglinger¹², T. Liebig¹³, J. Liman¹⁴, S. Meuth¹⁵, D. Michalski¹⁶, J. Minnerup¹⁷, H. Neugebauer¹¹, G. Petzold¹⁸, P. Ringleb¹⁹, F. Schlachetzki²⁰, A. Seiler²¹, G. Thomalla²², K. Weißenborn¹², S. Wunderlich²³, U. Ziemann¹, S. Poli¹, for the APICES investigators

¹University of Tübingen, Department of Neurology & Stroke, Tübingen, Germany, ²Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany, ³University of Tübingen, Department of Diagnostic and Interventional Neuroradiology, Tübingen, Germany, ⁴University of Ulm, Department of Neurology, Ulm, Germany, ⁵Klinikum Stuttgart, Department of Neurology, Stuttgart, Germany, ⁶University of Heidelberg, Department of Neuroradiology, Heidelberg, Germany, ⁷Charité-Universitätsmedizin Berlin, Department of Neuroradiology, Berlin, Germany, ⁸Ludwig-Maximilian University of Munich, Department of Neurology, Munich, Germany, ⁹Charité-Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany, ¹⁰University of Hamburg-Eppendorf, Department of Neuroradiology, Hamburg, Germany, ¹¹University of Würzburg, Department of Neurology, Würzburg, Germany, ¹²University of Hannover, Department of Neurology, Hannover, Germany, ¹³Ludwig-Maximilian University of Munich, Department of Neuroradiology, Munich, Germany, ¹⁴University of Göttingen, Department of Neurology, Göttingen, Germany, ¹⁵University of Düsseldorf, Department of Neurology, Düsseldorf, Germany, ¹⁶University of Leipzig, Department of Neurology, Leipzig, Germany, ¹⁷University of Münster, Department of Neurology, Münster, Germany, ¹⁸University of Bonn, Department of Neurology, Bonn, Germany, ¹⁹University of Heidelberg, Department of Neurology, Heidelberg, Germany, ²⁰University of Regensburg, Department of Neurology, Regensburg, Germany, ²¹University of Frankfurt, Department of Neurology, Frankfurt, Germany, ²²University of Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany, ²³Technical University of Munich, Department of Neurology, Munich, Germany

Background and aims: In space-occupying hemispheric infarction, decompressive craniectomy within 48h of stroke onset reduces mortality and improves functional outcome of survivors. Due to significant inter-individual variation in infarct swelling, with some patients suffering from herniation within few hours but others never, ultra-early craniectomy in all large hemispheric infarctions is no option. Despite clinical, laboratory, and radiological edema predictors have been identified, clinicians still face the dilemma of whether and when to perform surgical decompression.

Methods: Multicenter (16 German, 1 Austrian, Fraunhofer MEVIS/Germany) project for deep learning-based analysis of sequential CT/-angiography/-perfusion scans and clinical data from 1,500 patients with large hemispheric infarction (www.apices-trial.de; ClinicalTrials.gov: NCT04057690); funded by Federal Joint Committee Innovation Fund (01VSF18055; Euro 1,102,360); duration until March 31, 2023. Brainomix/UK supports image analysis. APICES aims at timely prediction of malignant infarct swelling and comprises three phases: first, problem-oriented assessment of clinical course data on edema/herniation including known predictors (white box). Second, deep learning alogrithm training with 1,400 sets of clinical/imaging data (black box). Computer-aided diagnosis system avoids bias due to inaccurate image processing and improves automatic image analysis. Effects of clinical and imaging parameters on predictive performance will be tested (grey box). Deep neural network methods will help in determining whether additional brain scans may improve prediction. Third, model validation with 100 independent datasets.

Conclusions: APICES trainable algorithms will help clinicians to guide indication and timing of decompression surgery, and if additional brain scans are required for treatment decision. An integrated feedback-loop will permit continuous refinement of the algorithm.

Disclosure: Yes

P0097 / 480

AN APP TO MEASURE OBJECTIVE MOTIVATION IN STROKE PATIENTS UNDERGOING REHABILITATION

L. Almedom ¹, A. Yurkewich², E. Burdet², P. Bentley¹

¹Imperial College London, Brain Sciences, London, United Kingdom, ²Imperial College London, Bioengineering, London, United Kingdom

Background and aims: Motivation is a key factor for engagement with rehabilitation, particularly when exercises are intended to be self-directed. Subjective measures of motivation are unreliable and imprecise, and confounded by language or cognitive impairment. An alternative strategy is to probe objective motivation using a task that measures subjects’ decisions to expend variable effort, for variable rewards. We developed a mobile App that assesses such “reward sensitivity” during a simple motor control task and assessed its feasibility and validity in stroke patients undergoing inpatient rehabilitation.

Methods: Cross-sectional observation study of stroke patients with upper limb weakness (Median Age: 50; Mean UEFM score: 51/66; MoCA score: 28/30). Subjects were provided with a mobile tablet & hand-grip device and asked to complete gaming apps, using their affected and unaffected hands. Effort was varied by presenting different grip force, while reward was manipulated by varying height and value. Subjects were also provided with questionnaires assessing cognition, fatigue, upper limb extremity, mood and apathy.

Results: Game app was completed by 25 patients during two sessions of game play. The App measure of reward sensitivity significantly correlated with the Lille Apathy Rating scale questionnaire (p=0.025, r =0.44). Performance in the unaffected was related/not related to that in the affected arm.

Conclusions: We demonstrate a convenient method for bedside testing of objective motivation that is associated with subjective apathy ratings. Further testing is under way to assess relationships between reward sensitivity using the App and exercise engagement during both supervised and unsupervised periods of stroke rehabilitation.

Disclosure: No

P0098 / 503

A RANDOMIZED TRIAL ON HEMODYNAMIC OPTIMIZATION OF CEREBRAL PERFUSION AFTER ENDOVASCULAR THERAPY IN PATIENTS WITH ACUTE ISCHEMIC STROKE (HOPE STUDY)

J. Martí-Fàbregas ¹, L. Prats-Sánchez¹, A. Martínez-Domeño¹, A. Ramos-Pachón¹, R. Marín¹, M. Guasch-Jiménez¹, D. Guisado-Alonso¹, B. Pardo-Galiana², F. Moniche², J. Serena³, J. Álvarez-Cienfuegos³, D. Fernández Couto⁴, M. Castellanos⁴, E. López-Cancio⁵, M. Castañón⁵, A. Luna⁶, M. Freijo⁶, J. Tembl⁷, A. Rodríguez-Campello⁸, E. Giralt-Steinhauer⁸, M. Rodríguez-Yáñez⁹, S. Arias-Rivas⁹, P. Camps-Renom¹

¹Hospital de la Santa Creu i Sant Pau, Biomedical Research institute Sant Pau, Neurology, Barcelona, Spain, ²Hospital Universitario Virgen del Rocío, Sevilla, Spain, ³Hospital Universitari Dr Josep Trueta, Girona, Spain, ⁴Hospital Universitario de A Coruña, La Coruña, Spain, ⁵Hospital Universitario Central de Asturias, Oviedo, Spain, ⁶Hospital Universitario de Cruces, Baracaldo, Spain, ⁷Hospital Universitario y Politécnico La Fe, Valencia, Spain, ⁸Hospital del Mar, Barcelona, Spain, ⁹Hospital Clínico Universitario de Santiago CHUS, Santiago de Compostela, Spain

Background and aims: After mechanical thrombectomy (MT) less than half of the patients with large vessel intracranial occlusion (LVO) achieve functional independence. Optimization of blood pressure (BP) after MT could improve clinical outcomes by improving cerebral perfusion and preventing cerebral bleeding and edema.

Methods: ClinicalTrials.gov Identifier: NCT04892511. Standard BP management will be compared with BP targets according to the degree of recanalization, as measured by the TICI (Thrombolysis in Cerebral Infarction) scale after successful MT (TICI 2b, 2c or 3). The study design corresponds to a multicenter Prospective Randomized Open, Blinded End-point (PROBE) study. A total of 814 patients with LVO will be allocated to either receive standard treatment (routine local BP management) or hemodynamic optimization, which includes: 1) BP lowering during the 72 hours following MT with different targets according to the TICI score: Intensive (100-140 mmHg systolic BP) after TICI 2c/3; or moderate (140-159mmHg systolic BP) after TICI 2b; 2) Induced hypertension (with isotonic saline serum and intravenous phenylephrine) to reach the desired target if needed.

Primary end-point: Functional outcome assessed by the Rankin scale score at 3 months by a blinded investigator. We will perform a shift analysis to demonstrate differences on the mRS score distribution between both groups. We will compare also the common odds ratio of worsening 1 point on the mRS score between groups using ordinal logistic regression.

Results: We expect to have them in 2024

Conclusions: Protocolised management of BP after MT may improve clinical outcomes.

Disclosure: No

P0099 / 479

EFFICACY OF CEREBROLYSIN TREATMENT AS AN ADD-ON THERAPY TO MECHANICAL THROMBECTOMY – PRELIMINARY RESULTS OF WIM-CEREBROLYSIN STUDY

J. Staszewski ¹, P. Piasecki², A. Maliborski², R. Piusinska-Macoch¹, A. Dębiec¹, K. Gniadek-Olejniczak³, J. Mróz³, A. Stępień¹

¹Military Institute of Medicine, Clinic of Neurology, Warsaw, Poland, ²Military Institute of Medicine, Radiology Department, Warsaw, Poland, ³Military Institute of Medicine, Neurorehabilitation Department, Warsaw, Poland

Background and aims: We hypothesized that adding Cerebrolysin (30 ml iv od within 8h of onset and followed until day 21) in consecutive 50 acute ischemic stroke (AIS) patients (with baseline small ischemic core, good collateral status, effective reperfusion, symptoms of cortical damage) may increase the effectiveness and safety of mechanical thrombectomy (MT) in the early recovery phase (90 days) comparing to 50 historical control group (CG) matched for age and sex fulfilling the same inclusion criteria by initiating cytoprotective effects and preventing reperfusion injury and delayed cell death.

Methods: The primary outcome measure is overall proportion of subjects experiencing a favorable functional outcome (mRS 0-2), the secondary objectives are risk of sICH, neurological outcome (NIHSS) and mortality rates during hospitalization and at the 90-day and 12 months study period.

Results: The study is currently recruiting patients. 12/50 (24%) patients have already been enrolled and followed for 30 days. The first interim analysis revealed the decrease of the risk of postthrombectomy ICH and 30 day mortality rate in patients receiving Cerebrolysin. Update on trial progression will be presented at the time of the conference.

Conclusions: To be determined.

Trial Registration Number: NCT04904341; Ethics Committe Approval: 53/WIM/20 Komisja Bioetyczna przy Wojskowym Uniwerystecie Medycznym.

Disclosure: No

P0100 / 1372

VASCULAR RISK FACTORS: CEREBRAL COLLATERAL EFFICIENCY AND BURDEN OF SMALL VESSEL DISEASE IN ANTERIOR CIRCULATION LARGE VESSEL OCCLUSION STROKE

N. McMillan ¹, F. Carvalho², S. Marchina², S. Cole¹, M. Selim¹, V.-A. Lioutas¹

¹Beth Israel Deaconess Medical Center, Neurology, Boston, United States, ²Beth Israel Deaconess Medical Center, Boston, United States

Background: Subclinical ischemia is thought to play a central role in Cerebral small vessel disease (CSVD) pathogenesis. We undertook this analysis to explore the association between cerebral collateral circulation status and CSVD burden.

Methods: Retrospective single-center cohort of consecutive patients with anterior circulation large vessel occlusions with available MRI and CT angiography. We identified the burden of individual CSVD markers (white matter hyperintensities(WMH), cerebral microbleeds(CMB), lacunes, and enlarged perivascular spaces (EPVS)) and computed the global CSVD burden on MRI obtained in the acute stroke. We used the Tan Collateral score (CS) on CT angiogram to grade collaterals (0-3; 0=absent supply, 3=100% collateral supply). We performed univariable and multivariable adjusted analyses to explore the association between CS and CSVD.

Results: 154 patients (64.6±17.1 years), 78(51%) female were included. Mean CS was 1.8(±0.73). WMH (80%) and basal ganglia EPVS (61%) were the most prevalent markers. Older age(beta=0.12,p<0.0001) and hypertension(beta=0.27,p=0.01) had the most potent association with individual CSVD markers and higher global CSVD burden. Older age(beta=-0.008,p=0.02) and presence of hypertension(beta=-0.28,p=0.03) were associated with lower CS. Although a trend was detected between lower CS score and higher WMH burden, it did not reach statistical significance after adjusting for confounders (beta=-0.18,p=0.3).

Conclusion: In this cohort of large vessel occlusion patients, we found that older age and presence of cardiovascular risk factors, mainly hypertension, are associated with higher individual CSVD marker and global CSVD burden and poor collateral status. We did not find an overt association between CS and WMH or global CSVD burden.

Disclosure: No

P0101 / 1310

EFFICACY AND SAFETY OF INJECTION TENECTEPLASE IN 4.5 TO 24 HOURS IMAGING ELIGIBLE WINDOW PATIENTS WITH ACUTE ISCHEMIC STROKE

A.K. Pandit ¹, A. Srivastava¹, M.P. Srivastava¹, V. VY¹, A. Garg², L. Joseph², S. Gaikwad², R. Bhatia¹, R.K. Singh¹, D. Vibha¹

¹All India Institute of Medical Sciences, Neurology, New Delhi, India, ²All India Institute of Medical Sciences, Neuroradiology, New Delhi, India

Background and aims: Acute Ischemic stroke presenting upto 4.5 hours have scope of receiving intravenous thrombolysis and upto 24 hours gets treatment with mechanical thrombectomy (only those with large vessel occlusion). Understanding the safety and efficacy in small study and with its biological plausibility, the idea is planned to be tested in a randomized controlled trial to determine injection tenecteplase in acute ischemic stroke patients (with or without large vessel occlusion) presenting between 4.5 to 24 and having imaging eligibility with perfusion lesion-ischemic core mismatch greater than 1.8 between the volume of hypoperfusion and volume of the ischemic core, an absolute difference in volume greater than 10 ml, and an ischemic-core volume of less than 70 ml.

Methods: The study is prospective, randomised, open-label, blinded end-point (PROBE) design. Eligible patients will be included with age >18 years with acute ischemic stroke within window period of 4.5to24 hours with NIHSS>5 and having pre-stroke mRS 2 or less. Patients will be enrolled based on advanced imaging results. A total of 100 eligible patients will be randomized 1:1 to Tenecteplase (0.25 mg/kg; maximum 25mg) or placebo administered as a single bolus injection (cases 50 and 50 controls). An independent data safety and monitoring board (DSMB) will share responsibility for regular oversight of patient safety in study.

Conclusion: Efficacy and safety of tenecteplase using the modified Ranking scale (mRS) score at Day 90 will be determined.

Disclosure: No

P0102 / 1458

ASSOCIATION OF PHYSICAL ACTIVITY INTENSITY LEVELS AT 3 MONTHS AND MAJOR VASCULAR EVENTS FOLLOWING FIRST-EVER ISCHEMIC STROKE AT 1 – YEAR. THE MIDNOR STROKE STUDY

A. Phan ¹, T. Askim¹, B. Indredavik¹, T. Wethal¹

¹ Norwegian University of Science and Technology, Medicine and Health Sciences, Trondheim, Norway

Background and aims: Stroke survivors are at increased risk of vascular morbidity and mortality. Physical inactivity is a well-established risk factor for vascular disease and all-cause mortality. The beneficial effects of physical activity in both primary and secondary prevention on cardiovascular disease is well-known. It remains unclear how major vascular events vary with the intensity of physical activity performed after stroke and how this association is modified by other factors, such as stroke severity, comorbidity burden and function.

This study aims to evaluate the association between physical activity intensity measured 3 months after stroke and major vascular events registered 1 year after stroke, and to assess how function, stroke severity and comorbidity burden modify this association.

Methods: MIDNOR-STROKE is a multicenter prospective longitudinal cohort study including patients with first-ever ischemic stroke admitted to 8 stroke units during 2015-2017 in Central - Norway. Data on risk factors, comorbidities, physical functioning, PA and stroke characteristics were collected during hospital stay, and follow-up at 3 and 12 months. PA was measured using ActivPal attached to the unaffected thigh for at least 4 consecutive days. PA data included intensity measured in METs, time spent walking, standing and sedentary. Occurrences of death and major vascular events were retrieved from national health registries.

Multivariate regression models will be used to investigate the association between PA levels, all-cause mortality, and major vascular events.

Disclosure: No

P0103 / 665

A DUBBING PROCEDURE TO IMPROVE COMMUNICATION IN POST-STROKE APHASIA: THE DUBBING LANGUAGE-THERAPY CINEMA-BASED IN APHASIA POST-STROKE (DULCINEA) TRIAL

B. Fuentes ¹, L. de la Fuente-Gómez², C. Sempere-Iborra², C. Delgado-Fernández², A. Tarifa-Rodríguez³, M. Provencio⁴, M. Alonso de Leciñana¹, E. de Celis-Ruiz¹, J. López-Táppero⁵, M. Martín-Alonso⁶, R. Rigual¹, G. Ruiz-Ares¹, J. Rodríguez-Pardo¹, J. Virués-Ortega⁷, A.M. Borobia⁸, P. Blanco⁹, N. Bueno-Guerra⁴

¹La Paz University Hospital, Universidad Autónoma de Madrid, IdiPAZ Health Research Institute, Neurology, Madrid, Spain, ²IdiPAZ Health Research Institute, Neurosciences Area, Madrid, Spain, ³Universidad Autónoma de Madrid, Psychology, Madrid, Spain, ⁴Universidad Pontificia Comillas, Psychology, Madrid, Spain, ⁵La Paz University Hospital and Universidad Complutense de Madrid, Department of Rehabilitation. Speech and Language Unit, Madrid, Spain, ⁶La Paz University Hospital, Department of Rehabilitation, Speech and Language Unit, Madrid, Spain, ⁷Universidad Autónoma de Madrid and the University of Auckland, Psychology, Madrid, Spain, ⁸La Paz University Hospital, Universidad Autónoma de Madrid, IdiPAZ Health Research Institute, Clinical Pharmacology, Clinical Trials Unit, Madrid, Spain, ⁹Asociación Afasia Activa, Madrid, Spain

Background and aims: Evidence-based strategies to help people recover from poststroke aphasia are a research priority. Our aim is to validate a new software integrating a dubbing procedure aimed at improving functional communication.

Methods: We designed a randomized, crossover, pilot trial. A total of 54 patients with poststroke non-fluent aphasia will be recruited. Two research assistants (a speech therapist and an actor) will select the clips and words to be dubbed according to the patient’s and their relatives’ preferences from a list of words considered to be functionally meaningful. Patients will be treated individually in 40-minute sessions twice per week for 8 weeks. Primary outcomes will be significant differences in scores in the Communicative Activity Log (CAL) questionnaire and Boston Diagnostic Aphasia Examination (BDAE) administered by a psychologist blinded to the patients’ characteristics. Secondary outcomes: General Health Questionnaire (GHQ)-12, Stroke Aphasia Quality of Life Scale (SAQOL-39), Western Aphasia Battery Revised (WAB-R) and the Stroke Aphasic Depression Questionnaire (SADQ10). The trial includes an ancillary study with 10 randomly selected patients undergoing a multiple-baseline design to evaluate idiosyncratic and generalization effects.

Results: Recruitment and data collection started on December 2020 and it is expected to continue until March 2023. We will present a summary of the recruitment progress, and baseline performance of participants.

Discussion: This pilot clinical trial explores the efficacy of a new software to improve poststroke aphasia based on dubbing techniques and computer technology to improve functional communication, with standardized test assessments.

Trial registration: NCT04289493, Registered 28 February 2020.

Disclosure: Yes

P0104 / 905

EARLY VERSUS LATE INITIATION OF DIRECT ORAL ANTICOAGULANTS IN POST-ISCHAEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATION (ELAN): AN INTERNATIONAL, MULTICENTRE, RANDOMISED-CONTROLLED, TWO-ARM, ASSESSOR-BLINDED TRIAL

U. Fischer ^1,2, D. Strbian³, M. Paciaroni⁴, G. Thomalla⁵, G. Ntaios⁶, L. Bonati², P. Michel⁷, K. Nedeltchev⁸, S. Trelle⁹, T. Gattringer¹⁰, E. Sandset¹¹, C. Ferrari¹, S. Sterchi¹, S. Beyeler¹, S. Abend¹, R. Lemmens¹², M. Koga¹³, S. P. N¹⁴, D. Aguiar de Sousa¹⁵, J. Dawson¹⁶

¹Bern University Hospital, Inselspital, Department of Neurology, Bern, Switzerland, ²University Hospital Basel, Department of Neurology, Basel, Switzerland, ³University Hospital Helsinki, Department of Neurology, Helsinki, Finland, ⁴University Hospital Perugia, Department of Internal Medicine, Perugia, Italy, ⁵University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany, ⁶University of Thessaly, Department of Internal Medicine, Larissa, Greece, ⁷University Hospital Lausanne, Department of Neurology, Lausanne, Switzerland, ⁸Cantonal Hospital Aarau, Department of Neurology, Aarau, Switzerland, ⁹University Hospital and University of Bern, Clinical Trial Unit, Bern, Switzerland, ¹⁰Medical University of Graz, Department of Neurology, Graz, Austria, ¹¹Oslo University Hospital, Department of Neurology, Oslo, Norway, ¹²University Hospitals Leuven, Department of Neurology, Leuven, Belgium, ¹³National Cerebral and Cardiovascular Center Osaka, Department of Cerebrovascular Medicine, Osaka, Japan, ¹⁴Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Neurology, Kerala, India, ¹⁵Hospital de Santa Maria, Department of Neurology, Lisbon, Portugal, ¹⁶University of Glasgow, Department of Neurology, Glasgow, United Kingdom

Background and aims: When to start oral anticoagulation in patients with ischaemic stroke with atrial fibrillation (AF) is an unanswered clinical dilemma. The ELAN trial will determine the net benefit of early versus late initiation of DOACs in patients with acute ischaemic stroke related to AF with respect to infarct size.

Methods: ELAN is an international, multicentre, randomised (1:1) controlled, two-arm, assessor-blinded, trial comparing early versus late initiation of anticoagulation with DOACs in post-ischaemic stroke patients with AF. In ELAN 2000 patients will be randomly assigned to either the control (late treatment) or the experimental arm (early treatment) in a 1:1 ratio. The time-point of initiation of DOAC therapy depends on the size of the ischaemic stroke (i.e. early treatment: within 48 hours in minor and moderate, or at day 6+1 in major stroke; late treatment: minor stroke after day 3+1, moderate stroke after day 6+1 and major stroke after day 12+2).

Results: 1500 patients (10.01.2022) have been randomised into the trial in 90 sites in Europe, the Middle-East and Asia. Up to 100 sites in 15 countries will eventually be recruiting patients.

Conclusions: The ELAN trial will provide evidence as to whether patients with an acute ischaemic stroke due to AF will have a net benefit if anticoagulation therapy with DOACs is started early compared to late treatment initiation. The ELAN trial has the potential to resolve a major clinical dilemma for many stroke physicians worldwide and to change future stroke guidelines to the benefit of the patients.

Disclosure: No

P0105 / 713

RATIONALE AND DESIGN FOR A CLINICAL TRIAL OF SELECTIVE BRAIN HYPOTHERMIA IN LVO ACUTE ISCHEMIC STROKE: HYBERNIA POST-MECHANICAL THROMBECTOMY- ENDOVASCULAR CEREBRAL HYPOTHERMIA TRIAL (POST-MTECH TRIAL)

J. Saver¹, R. Nogueira², S. Poli ³, T. Nguyen⁴, M. Chen⁵, C. Matouk⁶, J. Pile-Spellman⁷, J. Choi⁷

¹University of California Los Angeles, Stroke Center, Los Angeles, United States, ²University of Pittsburgh Medical Center, Stroke Center, Pittsburgh, United States, ³University of Tuebingen, Neurology, Tuebingen, Germany, ⁴University of Boston Medical Center, Stroke Center, Boston, United States, ⁵Rush University Medical Center, Neurosurgery, Chicago, United States, ⁶Yale New Haven Medical Center, Neurosurgery, New Haven, United States, ⁷NSPC Brain & Spine Surgery, Neurovascular Center, Lake Success, United States

Background and aims: Although significant clinical improvement is achieved with mechanical thrombectomy (MT) in large vessel occlusion (LVO) stroke patients, < 1/5 patients have outcomes comparable to their pre-stroke conditions. Therapeutic hypothermia is a promising method for acute neuroprotection for which a reduction of brain temperature by several °C is required. Systemic hypothermia has been difficult to implement in stroke patients due to the long delay to reach target temperature and associated systemic complications and adverse events. In contrast, targeted brain cooling may provide effective hypothermic neuroprotection, because 1) of more rapid brain cooling (minutes) and 2) it is safer (avoids systemic cooling).

Methods: This is a multicenter, prospective, randomized, open, blinded endpoint, pivotal clinical trial with an investigational device, a novel endovascular system for selective intra-arterial brain hypothermia, developed by Hybernia Medical, LLC. Eligible patients are LVO stroke patients who undergo acute MT. Main objective is to determine whether selective brain cooling with Hybernia’s device following routine MT in LVO patients results in improved functional outcome (as measured with the modified Rankin Scale) compared to routine MT alone. For this sequential adaptive design clinical trial, up to 1,000 LVO stroke patients will be recruited from 40-60 international sites.

Results: Regulatory protocol approval is pending. Trial description will be uploaded to clinicaltrials.gov in due time. Please contact the authors for more information.

Conclusion: To determine whether selective brain cooling with Hybernia’s device following routine MT in LVO patients results in improved functional outcome compared to routine MT alone.

Disclosure: Yes

P0106 / 1129

AMASCIS-02: ALLOGENEIC ADIPOSE TISSUE-DERIVED MESENCHYMAL STEM CELLS IN ISCHAEMIC STROKE. A PHASE IIB, MULTICENTRE, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL

E. de Celis Ruiz ¹, B. Fuentes¹, F. Moniche², J. Montaner³, A.M Borobia⁴, M. Gutiérrez Fernández¹, E. Díez Tejedor¹

¹Department of Neurology and Stroke Center, Neurological Sciences and Cerebrovascular Research Laboratory, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain, ²Department of Neurology and Stroke Research Program, Hospital Universitario Virgen del Rocío.Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain, ³Department of Neurology and Stroke Research Program, Hospital Universitario Virgen Macarena,Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain, ⁴Department of Clinical Pharmacology, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain

Background and aims: Stroke is a serious public health problem, given it is a major cause of disability despite wide use of recanalization therapies. Stem cell administration is a promising therapy that may reduce sequelae by enhancing brain plasticity.

Methods: Phase IIb, multicentre, randomized, double-blind, placebo-controlled clinical trial to evaluate the safety and efficacy of intravenous administration of allogeneic adipose tissue-derived mesenchymal stem cells (AD-MSCs) in patients with acute ischaemic stroke, concurrently with conventional stroke treatment. Thirty patients will be randomized on a 1:1 basis to receive either intravenous placebo or AD-MSCs (at a dose of 1 million cells per kg) within the first 4 days from stroke symptom onset. Patients will be followed up to 24 months with nine study visits performed in this period. Primary objective is the safety assessment of intravenous AD-MSC administration by reporting all adverse events and neurological or systemic complications. Secondary objectives assess efficacy of early intravenous AD-MSC treatment by evaluating changes in the modified Rankin Scale and the National Institutes of Health Stroke Scale throughout the follow-up period. In addition, brain repair biomarkers will be measured at various visits.

Trial registration: Eudra CT 2019-001724-35; NCT04280003.

Results: Recruitment began on January 2021, with 9 patients randomized and 8 treated (one excluded because of recurrent stroke) by December 2021. No treatment related serious adverse events have occurred so far.

Conclusions: This clinical trial will assess the safety and efficacy of early intravenous administration of AD-MSCs in reducing ischemic stroke sequelae.

Disclosure: No

P0107 / 1132

RATES, RISKS AND ROUTES TO REDUCE VASCULAR DEMENTIA (R4VAD)

E.V Backhouse ¹

¹ University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom

Background and aims: R4VAD is a multi-site longitudinal, inclusive observational study of patients presenting with stroke to UK stroke centres aiming to determine rates of, and risk factors for, cognitive and related impairments after stroke, assess mechanisms and improve prediction models.

Methods: R4VaD is recruiting patients within six weeks of stroke and collecting clinical, socioeconomic, lifestyle, cognitive, mood and informant data using clinical trial methods. Detailed assessments are obtained at 6+/-2 weeks post baseline assessment, with annual follow-up by phone and post to at least 2 years plus data linkage for 10 years. Diagnostic neuroimaging is assessed in all, and inflammatory blood markers and genetic analysis in as many patients as possible. Recruitment opened in September 2018, paused briefly in March 2020 and reopened in April 2020 with a COVID-19 substudy.

Results: To date, we have recruited 2371 participants (initial target 2000) in 53 centres across the UK (mean age=68.3 years, SD=13.6; 40.1% female). So far, 85% of participants have ischaemic stroke; 8% ICH; 6%; mean NIHSS=2.9 (SD=3.4); 6% lack capacity; 29% have an informant. Prevalent vascular risk factors include: hypertension (63%);hyperlipidaemia (46%);current/ex-smoker (59%); previous stroke/TIA (28%). At baseline, mean scores were: MOCA=23.2/30, SD=4.2; Zung depression=46.0/80, SD=13.3 (⩾50 suggests depression) and anxiety (GAD-7)=3.9/21, SD=4.8 (⩾5 suggests anxiety).

Conclusions: R4VAD will provide reliable data on cognitive and neuropsychiatric consequences long-term after stroke; improve understanding of clinical, demographic, laboratory, neuroimaging and social predictors of post-stroke cognitive impairment and dementia and provide objective data on the impacts of COVID-19 on stroke.

Disclosure: No

P0108 / 549

CEREBRAL HEMODYNAMICS DURING EARLY VERTICALIZATION AFTER SUCCESSFUL THROMBECTOMY POSTSTROKE (CHEST-STUDY)

A. Schwarz ¹, J. Deseoe¹, T. Pipping¹, S. Wegener^1,2, A.R. Luft^1,3, J.P. Held^1,4

¹University Hospital Zurich and University of Zurich, Department of Neurology, Zurich, Switzerland, ²University of Zurich, Clinical Neuroscience Center, Zurich, Switzerland, ³cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland, ⁴Valens Clinics, Rehabilitation Center Triemli Zurich, Zurich, Switzerland

Background and aims: The immediate reestablishment of cerebral perfusion is one of the most contributing factors for cerebrovascular recovery after ischemic stroke. Mechanical thrombectomy is an effective acute intervention, but has been associated with cerebral hyperperfusion syndrome. Early verticalization can have a positive influence on rehabilitation outcome, but it is unknown if it alters cerebral blood flow (CBF) in the affected territory, potentially inducing hyperperfusion after thrombectomy. The aim of this study was to determine the association between verticalization and CBF in healthy subjects and in acute ischemic stroke patients within the 24 hours after thrombectomy.

Methods: Twenty healthy subjects and four stroke patients after successful thrombectomy were included and assessed during verticalization. The study protocol included a stepwise verticalization in supine position on a tilt table device and continuous transcranial Doppler ultrasound of the medial cerebral artery (MCA) velocity besides vital parameter monitoring.

Results: All participants completed the protocol. A mean decline in MCA velocity of 4.84 ±1.2 cm/s in healthy subjects and 8.98 ±6.16 cm/s in stroke patients was shown between lying supine and a 70° verticalized position. The stroke subjects were included at a mean of 16.2 ±5.4 hours after thrombectomy and showed higher MCA velocities at lying supine when compared to the healthy subjects.

Conclusions: These preliminary data support the idea that verticalization is an effective and safe conservative intervention, decreasing critical CBF and the therefore potentially reducing the risk of hyperperfusion after successful thrombectomy. The presented results will be proven for the complete study sample.

Disclosure: No

P0109 / 1203

OPTIMAL BLOOD PRESSURE FOR THE PREVENTION OF MAJOR VASCULAR EVENTS IN STROKE PATIENTS (OPTIMAL- STROKE)

G. Silva ¹, O. Berwanger², K. Santo², R. Furtado², O. Pontes-Neto³, S.C. Ouriques Martins⁴, A. Conforto³, F. Fuchs⁵, J. Machline Carrion²

¹HIAE/UNIFESP, Academic Research Organization ( AR0)/ HIAE, São Paulo, Brazil, ²HIAE, Academic Research Organization ( AR0)/ HIAE, São Paulo, Brazil, ³FMUSP, Neurology, São Paulo, Brazil, ⁴Hospital de Clínicas de Porto Alegre, Neurology, Porto Alegre, Brazil, ⁵Hospital de Clínicas de Porto Alegre, Cardiology, Porto Alegre, Brazil

Background and aims: Despite the evidence suggesting the use of antihypertensives in patients with ischemic stroke (IS), the heterogeneity of the clinical trials included in guidelines compromises the recommendation of a blood pressure (BP) target and the intensity of the BP reduction required. The primary objective of the OPTIMAL-Stroke trial is to determine if a more intensive BP control target compared to the standard BP target in a population of patients with previous IS has an impact on the reduction of major cardiovascular events.

Methods: OPTIMAL-Stroke is a randomized, controlled, 1:1 open-label clinical trial with blind assessment of clinical outcomes.

Population: Patients are eligible to the study if they are over 18 years, and have a history of IS or transient ischemic attack, clinically stable for at least 48 hours prior to study inclusion; have a systolic blood pressure of 130- 180 mmHg.

Sample Size: 7104 patients

Intervention: Patients are being randomized to either an intensive BP control group targeting SBP <120 mmHg or to a control group, targeting SBP <140 mmHg.

Outcome: The primary outcome is the first occurrence of a composite outcome of major cardiovascular events (cardiovascular death, non-fatal myocardial infarction (MI), non-fatal stroke, hospitalization for unstable angina or hospitalization for heart failure).

Trial Status: Enrollment is ongoing at 28 sites. As of January 10th, 2022, 3125 subjects have been enrolled.

Disclosure: No

P0110 / 656

ENDOVASCULAR THERAPY PLUS BEST MEDICAL TREATMENT (BMT) VERSUS BMT ALONE FOR MEDIUM VESSEL OCCLUSION STROKE - A PRAGMATIC, INTERNATIONAL, MULTICENTRE, RANDOMIZED TRIAL (DISTAL)

M.-N. Psychogios ¹, A. Brehm¹, J. Fiehler², G. Thomalla², I. Fragata³, J. Gralla⁴, R. Leker⁵, P. Machi⁶, M. Ribo⁷, J.L Saver⁸, D. Strbian⁹, C. Zimmer¹⁰, U. Fischer¹, on behalf of the DISTAL Investigators

¹University of Basel, Basel, Switzerland, ²University Hospital Hamburg Eppendorf, Hamburg, Germany, ³Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal, ⁴Inselspital Bern, Bern, Switzerland, ⁵Hadassa Medical Centers the Hebrew University Jerusalem, Jerusalem, Israel, ⁶Hôpitaux Universitaires de Genève, Geneve, Switzerland, ⁷Hospital Vall d’Hebron, Barcelona, Spain, ⁸University of California, Los Angeles, United States, ⁹HUS, Neurocenter, Helsinki, Finland, ¹⁰TU München, München, Germany

Background and aims: Whether mechanical thrombectomy (MT) in addition to best medical treatment (BMT) in acute ischemic stroke (AIS) patients with distal, medium vessel occlusion (dMEVO, defined as an occlusion of the co- or non-dominant M2, M3 or M4, A1, A2 or A3, P1 or P2) is beneficial is unknown. Prior randomized-controlled trials assessing the efficacy of MT have not included patients with dMEVO. As they represent up to 40% of AIS patients, randomized-controlled evidence is warranted. DISTAL aims to assess, whether MT in patients with dMEVO in addition to BMT is superior to BMT alone.

Methods: The trial will be conducted at 40–50 academic tertiary care centres in Europe and North America. The main hypothesis is that additional MT leads to superior long-term outcome in AIS patients due to a dMEVO. Five hundred twenty-six patients with dMEVO will be randomly assigned in a 1:1 ratio to undergo MT plus BMT versus BMT alone. The primary objective is to determine whether patients experiencing an AIS due to an isolated dMEVO have superior functional outcome (measured with the modified Rankin Scale at 90 days) when treated with EVT plus BMT compared to patients treated with BMT alone. Secondary objectives are to study causes of mortality, dependency, and quality of life.

Results: DISTAL started recruitment in December 2021 and until now x patients have been recruited. We estimate to finish recruitment by December 2024.

Conclusions: DISTAL will provide evidence for the effects of MT in dMVO stroke patients.

ClinicalTrials.gov Identifier: NCT05029414

Disclosure: No

P0111 / 488

REMOTE ISCHAEMIC CONDITIONING AFTER STROKE 3 (RECAST-3): A MULTICENTRE RANDOMISED CONTROLLED TRIAL

T.J England ¹, D. Havard², L. Haywood², E. Stanyard², J. Craig³, T. Morgan², L.J Woodhouse², I.I Mhlanga², N. Sprigg², P.M Bath²

¹University of Nottingham, Cinical Stroke Trial Unit, Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, Derby, United Kingdom, ²University of Nottingham, Stroke Trials Unit, Mental Health and Clinical Neurosciences, Nottingham, United Kingdom, ³University of Nottingham, Cinical Stroke Trial Unit, Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, Nottingham, United Kingdom

Background: Remote ischaemic per-conditioning (RIC) in experimental ischaemic stroke is neuroprotective and may reduce ischaemic reperfusion injury. It is simply achieved by repeated transient occlusion of the blood supply to a limb using a blood pressure cuff.

Objective: To perform a multicentre randomised controlled trial assessing RIC in patients with hyperacute ischaemic stroke

Design: RECAST-3 is a prospective, randomised, controlled, blinded-endpoint, parallel-group, multicentre trial. The aim is to recruit 1300 adults with hyperacute ischaemic stroke (<6 hours post onset, NIHSS ⩾4) presenting in Emergency Departments and Stroke Units in the UK. Exclusion criteria include: pre-morbid dependency; spontaneous intracerebral haemorrhage; dementia; coma; malignancy; significant co-morbidity; BM <3.0mmol/L; seizure on presentation unless brain imaging identifies significant brain ischaemia; long term nitrate therapy; on treatment for diabetes. Participants will be randomised (1:1) to receive either RIC (4 cycles alternating between 5 minutes inflation to 20mmHg above systolic BP and 5 minutes deflation) or Sham (4 cycles alternating between 5 minutes inflation to 20mmHg and 5 minutes deflation). The first dose is given after randomisation and then a second dose 1-2 hours later. Two further doses are given on the following day. The primary outcome is death or dependency (modified Rankin Scale) at day 90 recorded using central blinded telephone follow-up. Secondary outcomes include cerebrovascular events, major adverse cardiac and cerebral events, acute kidney injury, disability, cognition, mood, frailty, quality of life, and safety.

Funding: NIHR Efficacy and Mechanism Evaluation.

Disclosure: No

P0112 / 1344

STELO: A NEW EXOSKELETON CONCEPT FOR PEOPLE WITH STROKE. AN ON-GOING TRIAL

C. Cumplido Trasmonte ^1,2, E. Barquín Santos³, G. Puyuelo Quintana^3,2, M. Destarac Eguizabal³, A. Plaza Flores^3,4, M. Hernández Melero¹, A. Gutiérrez Ayala¹, E. Delgado Castillejo¹, E. Garcés Castellote^3,5, E. García Armada¹

¹Centre for Automation and Robotics (Spanish National Research Council), Madrid, Spain, ²International Doctorate School of the Rey Juan Carlos University, Madrid, Spain, ³Marsi Bionics, Madrid, Spain, ⁴Technical University of Madrid, Madrid, Spain, ⁵Doctorate Programme in Health Sciences, University of Alcalá, Madrid, Spain

Background and objective: Gait impairment in people with stroke can be very heterogeneous. For this reason, STELO has been developed: a new concept of exoskeleton based on modular technology for gait assistance. It allows a personalised configuration according to the functional capacity of each patient, as the therapist can choose which robotic joints to use depending on the therapeutic goal and on the patient recovery phase. The objective is to analyse the usability of the STELO modular exoskeleton in stroke population.

Method: It will be carried out in the private outpatient clinic Centro Lescer (Madrid) and the public Spanish Reference Centre for the Care of People with Acquired Brain Injury (Madrid). The protocol consists of 9 sessions of exoskeleton use, in which safety of participants and therapists with this device will be assessed. Different STELO configurations will be tested: complete exoskeleton (to try with all participants regardless lower limb motor score); hemiplegic modularity (participants with affected hip and knee motor scores equal or below 3/5); just-one-knee (participants with affected-hip motor score over 3/5 but affected-knee motor score equal or below 3/5); just-one-hip (participants with affected-hip motor score equal or below 3/5). After the completion of the study, results in the usability of the device and its configurations will be shown. Also, conclusions about the new exoskeleton concept will be drawn. This study has been registered in clinicaltrials.gov.

Results: The first results of the study will be available in April 2022.

Figure 1.

Main configurations of STELO modular exoskeleton.

Disclosure: Yes

P0113 / 297

NON-INVASIVE VAGUS NERVE STIMULATION IN ACUTE ISCHEMIC STROKE (NOVIS)

A. van der Meij ¹, M.A. van Walderveen², N.D. Kruyt¹, E.W. van Zwet³, E.J. Liebler⁴, M.D. Ferrari¹, M.J. Wermer¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Leiden University Medical Center, Radiology, Leiden, Netherlands, ³Leiden University Medical Center, Medical Statistics, Leiden, Netherlands, ⁴electroCore, Inc., Rockaway, United States

Background and aims: Secondary damage due to neurochemical and inflammatory changes in the penumbra in the first days after ischemic stroke contributes substantially to poor clinical outcome. Non-invasive Vagus Nerve stimulation (nVNS) may improve stroke outcome by preventing secondary damage of the penumbra through inhibiting peri-infarct spreading depolarizations (SDs) and reducing inflammation. The aim of this trial is to assess the efficacy and safety of nVNS in addition to current standard treatment to minimize final infarct size in patients with an acute ischemic stroke.

Methods: NOVIS is a single center prospective randomized clinical trial with blinded outcome assessment. 150 patients admitted with an ischemic stroke and a perfusion deficit, in which the penumbra comprises at least 1/3 of the total ischemic area (ischemic core and penumbra), will be randomly allocated (1:1) within 12 hours from symptom onset to nVNS for five days with the gammaCore Sapphire^TM device (Figure) in addition to standard treatment versus standard treatment alone. The perfusion deficit is measured using automated software (RAPID, iSchemaView). The primary endpoint is the infarct volume on day five as assessed with MRI.

Results: The first patient was enrolled in October 2019. At the time of submission 78 patients were randomized. The trial is registered on www.clinicaltrials.gov (NCT04050501).

Conclusions: We hypothesize that nVNS will reduce penumbral recruitment and infarct size as compared to standard treatment.

Disclosure: No

P0114 / 177

FIBRINOGEN REPLACEMENT TO PREVENT INTRACRANIAL HAEMORRHAGE IN ISCHAEMIC STROKE PATIENTS AFTER THROMBOLYSIS: A PILOT PROBE RANDOMIZED CONTROLLED TRIAL

S. Forlivesi ¹, M. Gentile¹, G. Bigliardi², L. Vandelli², M.L. Dell’Acqua², M. Romoli³, S. Cevoli¹, F. Sacchetti², L. Simonetti¹, F. Nonino¹, A. Zini¹

¹IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy, ²Azienda Ospedaliero-Universitaria di Modena, Modena, Italy, ³“M. Bufalini” Hospital, AUSL Romagna, Cesena, Italy

Background and aims: Intracranial haemorrhage (ICH) can be a fatal complication of thrombolytic treatment with intravenous recombinant tissue plasminogen activator (rtPA) for ischaemic stroke. Fibrinogen depletion after rtPA infusion has been associated with early ICH. We aim to evaluate efficacy and safety of fibrinogen replacement in stroke patients with post-rtPA hypofibrinogenemia to reduce the risk of ICH and improve clinical outcome.

Methods: Pilot, phase 3, prospective randomized open-label blinded endpoint (PROBE) controlled trial that will collect data from 200 ischaemic stroke patients consecutively enrolled in two Italian Comprehensive Stroke Centres during 3 years. Patients who develop post-rtPA hypofibrinogenemia (fibrinogen <2 g/L or decrease rate >50% after 2 or 6 hours from rtPA infusion compared to baseline values) will be randomized in a 1:1 ratio to receive an intravenous infusion of 2 grams of purified fibrinogen concentrate (treatment arm) or not (control group).

Results: The primary outcome measure will be combined rate of parenchymal haematomas within the infarct area (PH1, PH2) or remote from the actual infarct (rPH1, rPH2) documented on brain computed tomography scan after 24 hours and 7 days from rtPA infusion. Secondary outcomes will be symptomatic ICH, National Institutes of Health Stroke Scale at 7 days, and modified Rankin Scale at 3 months. Safety endpoints will be serious thromboembolic adverse events at 7 days, including deep vein thrombosis, pulmonary embolism, myocardial infarct, and stroke recurrence.

Conclusions: Early identification of patients at risk of ICH after intravenous thrombolysis could allow to treat these patients in order to prevent ICH.

Disclosure: No

P0115 / 286

EFFECT OF PROXIMAL BLOOD FLOW ARREST DURING ENDOVASCULAR THROMBECTOMY (PROFATE) - PROTOCOL FOR A RANDOMISED CONTROLLED TRIAL

P.S. Dhillon ^1,2, W. Butt³, A. Podlasek⁴, N. McConachie¹, R. Lenthall¹, S. Nair¹, L. Malik¹, P. Bhogal⁵, R.A. Dineen^6,4, T.J England^7,8

¹Nottingham University Hospitals NHS Trust, Interventional Neuroradiology, Nottingham, United Kingdom, ²University of Nottingham, Radiological Sciences, Nottingham, United Kingdom, ³University Hospitals Birmingham NHS Trust, Interventional Neuroradiology, Birmingham, United Kingdom, ⁴University of Nottingham, NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom, ⁵The Royal London Hospital Barts Health NHS Trust, Interventional Neuroradiology, London, United Kingdom, ⁶University of Nottingham, Radiological Sciences, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ⁷University of Nottingham, Stroke, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ⁸University Hospitals of Derby and Burton NHS Foundation Trust, Stroke, Derby, United Kingdom

Background: Non-randomised clinical studies have demonstrated that the adjunctive use of a balloon guide catheter (BGC) for proximal blood flow arrest, with a stent-retriever (SR)-only technique during endovascular thrombectomy (EVT) is associated with higher successful recanalisation rates and better clinical outcomes. However, more advanced EVT techniques (combining SR and contact-aspiration (CA)) or CA-only are now increasingly used, achieving high recanalisation rates. It remains unclear whether BGC use influences successful vessel recanalisation and functional outcome of patients undergoing EVT, particularly when a combined technique (SR and CA) or CA-only is used.

Aim: We will test the effectiveness and safety of proximal flow arrest using BGC during EVT for anterior circulation large vessel occlusion.

Methods: The ProFATE trial is a prospective, randomised, multi-centre, outcome-blinded, phase IIb trial. We will recruit 124 participants with anterior circulation ischaemic stroke eligible for EVT with the intention to treat using first-line combined use of CA and SR or CA-alone, randomised 1:1 by minimization to receive balloon inflation or no inflation in the internal carotid artery during EVT. 124 participants will have 80% power to detect a 25% proportional difference of successful vessel recanalisation (primary outcome; extended Thrombolysis In Cerebral Infarction (eTICI)2c-3). Secondary outcomes include successful recanalisation after the first pass, new/distal vascular territory embolisation, procedure-related complications, symptomatic intracranial haemorrhage at 24 hours, modified Rankin Scale score at 90 days and mortality.

Discussion: This is the first randomised trial to directly compare the effectiveness of proximal blood flow arrest versus no flow arrest during EVT.

Disclosure: Yes

P0116 / 1026

CHINESE HERBAL MEDICINE IN ACUTE INTRACEREBRAL HAEMORRHAGE (CHAIN) RANDOMISED TRIAL: STUDY PROGRESS

L. Song ^1,2, J. Guo³, Y. Li¹, Y. Chen¹, C.S Anderson^1,2,4

¹The George Institute China at Peking University Health Sciences Center, Beijing, China, ²The George Institute for Global Health, University of New South Wales, Sydney, Australia, ³Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China, ⁴Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia

Background and aims: Traditional Chinese medicine (TCM) with herbs are popular therapies for a range of conditions including stroke, where anti-inflammatory and neuroprotective properties could reduce cerebral oedema and secondary injury after intracerebral haemorrhage (ICH). We aim to determine the effectiveness and safety of TCM FYTF-919 in patients with ICH.

Methods: A multicentre, prospective, double-blind, placebo-controlled, randomised trial of FYTF-919 in patients with moderate-severe (NIHSS ⩾8, or GCS 7-14) ICH within 48 hours of onset to be recruited from 20+ sites in China. Patients are centrally randomised to FYTF-919 or placebo, (oral liquid 100 mL/d) over 28 days. Data are collected at baseline, and 1, 7, 90 and 180 days. Primary outcome is utility-weighted modified Rankin scale (UW-mRS) scores at 90 days. Sample of 1504 patients provides 90% power to detect a 20% difference in average scores UW-mRS scores between groups.

Results: Approvals have been obtained from all relevant ethics committees and regulatory bodies at country, local and hospital levels in China. Patient enrolment commenced in November 2021. Up to 31 December 2021, 62 patients have been enrolled at 18 sites. The planned sample size should be achieved by December 2023.

Conclusions: CHAIN aims to provide reliable evidence on the effectiveness and safety of using TCM in patients with acute ICH.

Disclosure: Yes

P0117 / 790

ACTION: ANAKINRA IN CEREBRAL HAEMORRHAGE TO TARGET SECONDARY INJURY RESULTING FROM NEUROINFLAMMATION – A PHASE II CLINICAL TRIAL

M. Cliteur ¹, J. Hofmeijer², W. Jolink³, C. Klijn¹, F. Schreuder¹

¹Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Neurology, Nijmegen, Netherlands, ²Rijnstate Hospital, Department of Neurology, Arnhem, Netherlands, ³Isala Hospital, Department of Neurology, Zwolle, Netherlands

Background: Inflammation plays a vital role in the development of secondary brain injury after spontaneous intracerebral haemorrhage (ICH). Interleukin-1 beta is an early pro-inflammatory cytokine, and is a potential therapeutic target.

Objectives: To determine the safety and efficacy of treatment with recombinant human interleukin-1 receptor antagonist anakinra compared to standard medical management, and whether its effects are dose-dependent.

Study design: Phase-II, prospective, randomized, three-armed (1:1:1) trial with open-label treatment and blinded end-point assessment at 3 hospitals in the Netherlands.

Study population: 75 patients with supratentorial spontaneous ICH admitted within 8 hours after symptom onset.

Intervention: Participants will receive anakinra in a high dose (loading dose 500mg intravenously, followed by infusion with 2mg/kg/h over 3 days; n=25) or in a low dose (loading dose 100mg subcutaneously, followed by subcutaneous administration of 100mg twice daily for 3 days; n=25). The control group (n=25) will receive standard medical management.

Primary outcome: Subacute perihaematomal oedema after ICH, measured as oedema extension distance (OED) on MRI at day 7±1.

Secondary outcomes: 1) Safety of anakinra in ICH patients; 2) Effect on serum inflammation markers and MRI measures of blood brain barrier integrity; 3) Estimate an effect on functional outcome at 90±7 days.

Sample size: A sample size of 25 participants per group allows to detect a reduction in OED from 0.6 (SD 0.25) in the control group to 0.4 in anakinra treated subjects (alpha 0.05, power 0.80), allowing 25% drop-out.

Funding: Dutch Heart Foundation (grant 2019T060).

Status: Inclusion will start in early 2022.

Disclosure: No

P0118 / 793

STROKE ASSOCIATED IMMUNE MEDIATED PATHWAYS AND COGNITIVE TRAJECTORY (STROKE-IMPACT)

M. Younas ¹, A. Bradley², M. Musabbir³, C. Quigley², J. Anrather⁴, K. Becker⁵, B. McColl⁶, K. Doyle⁷, A. Meisel⁸, M.A Moro⁹, M.S Elkind¹⁰, J. Grainger², M.G Lansberg³, S.M. Allan², C.J. Smith², M.S. Buckwalter³

¹University of Manchester, Neurosciences and experimental psychology, Manchester, United Kingdom, ²University of Manchester, Manchester, United Kingdom, ³Stanford University, California, United States, ⁴Weill Cornell Medical College, New York, United States, ⁵University of Washington, Washington, United States, ⁶University of Edinburgh, Edinburgh, United Kingdom, ⁷University of Arizona, Arizona, United States, ⁸University of Berlin, Berlin, Germany, ⁹University of Madrid, Madrid, Spain, ¹⁰Columbia University College of Physicians and Surgeons, New york, United States

Background and aims: Post-stroke cognitive decline (PSCD) is a devastating complication with limited preventive or treatment strategies. Our aim is to prospectively investigate the relationships between altered peripheral blood immune and inflammatory status in acute ischaemic stroke and longer-term PSCD.

Methods: This is an ongoing, multicentre cohort study in Manchester (UK) and Stanford (USA) recruiting patients (⩾45y old, without significant dysphasia, living independently) with ischaemic stroke ⩽72h of symptom onset confirmed on brain imaging. Blood is drawn for comprehensive immunophenotyping and functional assessment of immune cell populations, using high-dimensional multicolour flow-cytometry. Follow-up at 6, 18 and 30 months will include a detailed cognitive battery and repeat blood draw. Accounting for attrition, we anticipate recruiting a minimum of 200 patients, giving us 95% power, a=5% to detect a difference in plasmacytoid dendritic cell STAT3 signaling between patients with and without a decline on the MoCA between 6 and 18 months based on previous pilot data.

Results: To date (December 31^st 2021), 106 patients (n=70 Stanford, n=36 Manchester; median [IQR] age of 70.5 y [19.5]; median [IQR] baseline NIHSS score of 3 [7]) have been enrolled. We expect to complete recruitment and follow-up by March 2025.

Discussion: Stroke-IMPaCT will provide novel insights into how reprogramming of specific peripheral immune cell populations during the acute phase of ischaemic stroke relate to subsequent cognitive trajectory. We will also create a dedicated biobank and seek funding for MR brain imaging substudies.

Funder: Leducq Foundation Transatlantic Network of Excellence (Ref: 19CVD01)

Disclosure: No

P0119 / 764

INTRA- AND INTER-HEMISPHERIC CONNECTIVITY DURING HD-TDCS IN CHRONIC STROKE: AN FNIRS STUDY

G. Lee ^1,2, J. Lee¹, J. Kim^1,2, H. Kim^1,2, S. Shin¹, Y.-H. Kim^1,2,3

¹Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Seoul, Korea, Republic of, ²Sungkyunkwan University, Department of Health Sciences and Technology, SAIHST, Seoul, Korea, Republic of, ³Sungkyunkwan University, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Seoul, Korea, Republic of

Background and aims: In spite of many studies on the effects of transcranial direct current stimulation (tDCS) using brain activation analysis, studies using the analysis of the hemodynamic connectivity changes are lacking. This study investigated the effects of high definition (HD)-tDCS over the ipsilesional primary motor cortex (M1) in chronic stroke patients using analysis of the intra- and inter-hemispheric connectivity during the stimulation time.

Methods: Twenty-six patients with chronic stroke participated in this study. HD-tDCS was administered to the ipsilesional M1 using the Starstim 8 (Neuroelectrics^®, Spain) for 20 minutes at 1 mA. The fNIRS data were recorded by NIRScout^® system (NIRx Medical Technologies, Germany). Measured fNIRS data were analyzed using OptoNet II^® toolbox during tDCS for 20 minutes. Intra- and inter-hemispheric connectivity were analyzed for all functional brain regions using phase-locking value.

Results: Most of the connections were strongly synchronized for 7.5 minutes after the start of tDCS, and the intra-connectivity of the affected side, which was the stimulated side, showed higher values. And the synchronization of the connection shows sharp decreases and then continuous rises until the end of tDCS. The intra-connectivity of the affected side showed a higher increase than the unaffected.

Conclusions: This study implies that applying HD-tDCS demonstrated modulation of the connectivity within and between hemispheres, and HD-tDCS over 10 minutes bring a beneficial effect on ipsilesional M1 connectivity in chronic stroke patients.

Acknowledgements: This study was supported by National Research Foundation of Korea (NRF) grant funded by the Korean government (NRF- 2020R1A2C3010304, NRF-2019R1I1A1A01060660).

Disclosure: No

P0120 / 895

EVALUATION OF MICROVASCULAR RAREFACTION IN VASCULAR COGNTIVE IMPAIRMENT AND HEART FAILURE: CRUCIAL-VCI

M. van Dinther ¹, P.H. Voorter², G.D. Thornton³, T.A. Treibel³, G. Bastarrika⁴, A. González⁵, E.A. Jones⁶, W.H. Backes⁷, J. Staals¹, R.J. van Oostenbrugge¹

¹Maastricht University Medical Center+, Neurology, Maastricht, Netherlands, ²Maastricht University Medical Center +, Radiology and Nuclear Medicine, Maastricht, Netherlands, ³University College London, Cardiovascular Science, London, United Kingdom, ⁴Clínica Universidad de Navarra, Radiology, Pamplona, Spain, ⁵CIMA Universidad de Navarra, Cardiovascular Diseases, Pamplona, Spain, ⁶KU Leuven, Cardiovascular Sciences, Leuven, Belgium, ⁷Maastricht University Medical Center+, Radiology and Nuclear Medicine, Maastricht, Netherlands

Background: Microvascular rarefaction (reduction of microvascular density) is thought to be an important mechanism in the pathophysiology of small vessel diseases such as vascular cognitive impairment (VCI) and heart failure with preserved ejection fraction (HFpEF). VCI and HFpEF often present together, and share identical cardiovascular risk factors. The international CRUCIAL consortium set out to develop novel non-invasive tools to determine microvascular health in both heart and brain using perfusion MRI, as well as easier and faster surrogate biomarkers of cerebral and/or cardiac rarefaction by investigating sublingual capillary health, vascular density of the retina, and mRNA sequencing of circulating endothelial-derived extracellular vesicles.

Methods: The clinical research program of CRUCIAL consists of several concurrent observational cohort studies in VCI patients, HFpEF patients and elderly controls. In CRUCIAL-VCI we aim to recruit 75 VCI patients and 40 controls. Main study endpoints are advanced brain and heart MRI markers for microvascular hypoperfusion and dysfunction, structural vascular brain MRI markers, cognitive function, and diastolic heart function. Regression analysis will be performed to investigate independent associations between perfusion measures in heart and brain, and measures of disease severity. Secondary study endpoints include sublingual flow-related capillary density, retinal vascular density on OCT angiography and microvesicles.

Results: Study protocol and patient information leaflet have been developed and ethical approval has been secured. Recruitment has been ongoing since December 2020. Currently we have recruited 19 VCI patients and 8 aged matched controls.

Acknowledgements: Supported by European Union’s Horizon 2020 research and innovation programme (No 848109: CRUCIAL)

Disclosure: No

P0121 / 1199

CONVINCE: COLCHICINE FOR THE PREVENTION OF VASCULAR INFLAMMATION IN NON-CARDIOEMBOLIC STROKE - A RANDOMISED CONTROLLED TRIAL

S. Gorey ¹, C. Price², R. Lemmens³, C. Weimar^4,5, F. Purroy⁶, A. Aziz⁷, A. Czlonkowska⁸, A. Devroye³, U. Fischer⁹, D. Forshaw⁷, A.C. Fonseca¹⁰, M.D Hill¹¹, G. Horgan¹, D. Jatuzis¹², J. Kõrv¹³, C. Kruuse¹⁴, C. Lynch¹, R. Mikulik¹⁵, S. Murphy^1,16,17, P.J Nederkoorn¹⁸, B. Schröder⁴, K. Tobin¹, P.J Kelly^1,16

¹University College Dublin, Stroke Clinical Trials Network Ireland, Dublin, Ireland, ²Newcastle University, Stroke Research Group, Newcastle-Upon-Tyne, United Kingdom, ³UZ Leuven, Department of Neurology, Leuven, Belgium, ⁴University Duisburg-Essen, Faculty of Medicine, Essen, Germany, ⁵BDH Clinic, Elzach, Germany, ⁶Universitat de Lleida- Hospital Universitario Arnau de Vilanova de Lleida, Department of Neurology, Lleida, Spain, ⁷University Of Central Lancashire, Lancashire Clinical Trials Unit, Preston, United Kingdom, ⁸Institute of Psychiatry and Neurology, 2nd Department of Neurology, Warsaw, Poland, ⁹University Hospital Inselspital, Acute Neurology and Stroke, Bern, Switzerland, ¹⁰Hospital de Santa Maria, Department of Neurology, Lisbon, Portugal, ¹¹University of Calgary, Department of Clinical Neurosciences, Calgary, Canada, ¹²Vilnius University Clinic of Neurology and Neurosurgery Republic Vilnius University Hospital, Department of Neurology, Vilnius, Lithuania, ¹³University of Tartu, Department of Neurology and Neurosurgery, Tartu, Estonia, ¹⁴Copenhagen University Hospital-Herlev Gentofte Hospital, Department of Neurology, Copenhagen, Denmark, ¹⁵St Anne’s University Hospital, Neurology Department, Brno, Czech Republic, ¹⁶Mater Misericordiae University Hospital, Acute Stroke Service, Dublin, Ireland, ¹⁷RCSI University of Medicine and Health Sciences, School of Medicine, Dublin, Ireland, ¹⁸Academic Medical Center, Department of Neurology, Amsterdam, Netherlands

Background and aims: Stroke is a leading cause of death, disability, and dementia. Recurrent stroke and vascular events occur in about 30% of patients at 5 years, despite advances in medical therapies. Inflammation is an important contributor to residual risk, and randomised trials have shown benefit of anti-inflammatory agents in coronary disease. CONVINCE is investigating if the pleiotropic anti-inflammatory agent colchicine prevents recurrent vascular events after stroke.

Methods: CONVINCE is a prospective open-label blinded endpoint-assessed randomised clinical trial, randomising patients with non-severe non-cardioembolic stroke or high-risk TIA to guideline-based usual care or colchicine 0.5mcg once-daily in addition to usual care. Participants are followed for a median of 36 months. The primary outcome is a composite of non-fatal recurrent ischaemic stroke, myocardial infarction, non-fatal cardiac arrest, hospitalisation for unstable angina or vascular death.

Results: CONVINCE began recruiting in December 2016 and 2,575 participants have been recruited across 152 sites in 14 countries in Europe and Canada. The target sample size is 3,154, based on a 26% effect size, corresponding to an absolute event rate reduction from 13.5% to 9.99% (80% power, alpha 0.05). Recruitment will complete in mid-2022 and follow-up in December 2023. No excess Serious Adverse Events attributable to colchicine has been observed. Interim clinical characteristics of trial participants, pooled by treatment allocation, will be presented.

Conclusions: CONVINCE will provide high-quality randomised evidence about the benefit and safety of addition of low-dose colchicine to guideline-based usual care to prevent recurrent stroke and major vascular events after non-severe, non-cardioembolic ischaemic stroke.

Disclosure: No

P0122 / 792

ALTEPLASE-TENECTEPLASE TRIAL EVALUATION FOR STROKE THROMBOLYSIS (ATTEST 2)

K. Muir ¹, S. Mitchell¹, I. Ford², J. Wardlow³, G. Ford⁴

¹University of Glasgow, School of Psychology and Neuroscience, Glasgow, United Kingdom, ²University of Glasgow, Robertson Centre of Biostatistics, Glasgow, United Kingdom, ³University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ⁴Oxford University Hospitals NHS Foundation Trust, Geriatric Medicine, Oxford, United Kingdom

Background: The modified tissue plasminogen activator tenecteplase has greater fibrin specificity and longer half-life than alteplase. Evidence for tenecteplase 0.25mg/kg as an alternative to alteplase is considered low by American and European guidelines. Significantly greater rates of early recanalization in selected large vessel occlusion patients pre-thrombectomy were found in the EXTEND-IA TNK trial.

This pragmatic trial compares tenecteplase 0.25mg/kg to alteplase 0.9mg/kg using simple and universally available clinical and imaging criteria for patient selection.  Non-inferior safety and efficacy compared to alteplase would potentially modify clinical practice as tenecteplase is significantly easier to administer than alteplase.

Objectives & Methods: ATTEST-2 will establish whether tenecteplase is non-inferior (and if non-inferior, superior) to alteplase by undertaking a prospective randomized, open-label, blinded endpoint (PROBE) trial in patients eligible for IV thrombolysis based on non-contrast CT imaging. Up to 60 UK centres will recruit 1870 patients.

Study Status: Study recruitment is ongoing and will continue until at least April 2022.

Outcome: Primary outcome is the distribution of modified Rankin Scale (mRS) outcomes at day 90, determined by the Rankin Focused Assessment method, analysed by ordinal distribution analysis of scores in intervention and control groups. Secondary outcomes include dichotomous mRS outcomes, SICH and mortality.

Conclusion: Superiority or non-inferiority of tenecteplase compared to alteplase would potentially extend thrombolytic treatment to a greater proportion of patients, simplify drug administration and reduce the need for mechanical thrombectomy. This trial will contribute to the optimisation of reperfusion strategies.

Disclosure: No

P0123 / 802

EEG CONTROLLED TRIAGE IN THE AMBULANCE FOR ACUTE ISCHEMIC STROKE TRIAL (ELECTRA-STROKE)

A.A. van de Munckhof ¹, M.N. van Stigt¹, L.C. van Meenen¹, M. Theunissen², G. Franschman², M.D. Smeekes³, J.A. van Grondelle⁴, G. Geuzebroek⁴, A. Siegers⁴, H.A. Marquering^5,6, C.B. Majoie⁶, Y.B. Roos¹, J.H. Koelman¹, W.V. Potters¹, J.M. Coutinho¹

¹Amsterdam University Medical Centers, University of Amsterdam, Neurology, Amsterdam, Netherlands, ²Witte Kruis Ambulance Care Alkmaar, Alkmaar, Netherlands, ³Ambulancezorg Nederland, Zwolle, Netherlands, ⁴Ambulance Amsterdam, Amsterdam, Netherlands, ⁵Amsterdam University Medical Centers, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, Netherlands, ⁶Amsterdam University Medical Centers, University of Amsterdam, Radiology and Nuclear Medicine, Amsterdam, Netherlands

Background and aims: Endovascular thrombectomy (EVT) is the standard treatment for patients with a large vessel occlusion (LVO) stroke. Approximately half of EVT eligible patients are initially admitted to a hospital that does not provide this therapy. Inter-hospital transfer substantially delays onset-to-treatment time, which decreases the chance of recovery. Therefore, a reliable prehospital triage method is necessary to identify patients with an LVO stroke. Previous electroencephalography (EEG) studies have shown that hemispheric hypoxia quickly results in EEG-slowing.The aim of the ELECTRA-STROKE study is to develop and validate an algorithm based on dry electrode cap EEG data that accurately determines the likelihood of an LVO stroke in the prehospital setting.

Methods: The ELECTRA-STROKE study consists of four phases. In the first three phases, the technical and logistical feasibility of performing dry electrode EEGs were tested in various in-hospital settings: the outpatient clinic, Neurology ward, and emergency room, respectively. In phase 4, ambulance paramedics perform dry electrode cap EEGs in suspected stroke patients in the prehospital setting.

Results: Phases 1 and 2 have been successfully completed. Phase 3 started in December 2018, and 240/250 patients have currently been included. Phase 4 started in August 2020 and 303/386 patients have currently been included in this phase.

Conclusions: ELECTRA-STROKE is an ongoing clinical study. The primary endpoint of the study is the specificity of a dry electrode EEG-based algorithm for the diagnosis of LVO stroke in the ambulance.

Disclosure: No

P0124 / 1125

TENECTEPLASE IN CENTRAL RETINAL ARTERY OCCLUSION STUDY - TENCRAOS: A PROSPECTIVE, RANDOMISED-CONTROLLED, DOUBLE-DUMMY, DOUBLE-BLIND PHASE 3 MULTI-CENTRE TRIAL NCT04526951)

S.J. Ryan ¹, Ø.K. Jørstad², M. Skjelland¹, P. Ijäs³, I. Nakstad⁴, K. Jenssen⁵, T. Truelsen⁶, J. Valaikienė⁷, M. Mazya⁸, S. Murph⁹, P. Ylikotila¹⁰, P. Vanacker¹¹, I. Slautaite¹², V. Matijosaitis¹³, G. Pope¹⁴, M.f O`Connor¹⁵, R. Soares dos Reis¹⁶, D. Strbian¹⁷, C.Z. Simonsen¹⁸, K. Devik¹⁹, S.-H. Johnsen²⁰, H. Ellekjær²¹, A. Khanevski²², M. Kurz²³, A. Tveiten²⁴, V. Malmberg²⁵, Å.H. Morsund²⁶, A.H. Farmen²⁷, E. Rødahl²², J. Krohn²², T. Bek¹⁸, K.L. Kraglund¹, O.M. Rønning²⁸, A. Roy¹, C. Kefaloykos¹, M.C. Moe¹, A.H. Aamodt¹

¹Oslo University Hospital, Neurology, Oslo, Norway, ²Oslo University Hospital, Ophthalmology, Oslo, Norway, ³Helsinki, Helsinki, Finland, ⁴Drammen Hospital, Drammen, Norway, ⁵Tønsberg Hospital, Tønsberg, Norway, ⁶Rigshospitalet Copenhagen, Copenhagen, Denmark, ⁷Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania, ⁸Karolinska University Hospital, Stockholm, Sweden, ⁹Mater Misericordiae University Hospital, Dublin, Ireland, ¹⁰Turku University Hospital, Turku, Finland, ¹¹University Hospital Antwerp, Antwerp, Belgium, ¹²Respublican Vilnius University Hospital, Vilnius, Lithuania, ¹³Hospital of Lithuanian University of Health Sciences, Kauno klinikos, Kaunas, Lithuania, ¹⁴University Hospital Waterford, Waterford, Ireland, ¹⁵University Hospital Limerick, Limerick, Ireland, ¹⁶Centro Hospitalar Universitário de São João, Porto, Portugal, ¹⁷Helsinki University Hospital, Helsinki, Finland, ¹⁸Aarhus University Hospital, Aarhus, Denmark, ¹⁹Helse Nord Trøndelag Trust, Namsos, Namsos, Norway, ²⁰University Hospital of North Norway, Tromsø, Tromsø, Norway, ²¹St. Olav University Hospital, Trondheim, Norway, ²²Haukeland University Hospital, Bergen, Norway, ²³Stavanger University Hospital, Stavanger, Norway, ²⁴Sørlandet Hospital Trust, Kristiansand, Norway, ²⁵Telemark Hospital Trust, Skien, Norway, ²⁶Nordmøre and Romsdal Regional Hospital, Molde, Norway, ²⁷Innlandet Hospital Trust, Lillehammer, Norway, ²⁸Akershus University Hospital, Lørenskog, Norway

Background and aims: Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt reperfusion, bears high risk of permanent blindness. No evidence-based treatment is currently available. Whether prompt reperfusion with thrombolytic agents can improve the outcome in CRAO, as proved in ischemic stroke, remains unanswered. The main aim is to assess the effect of systemic tenecteplase within 4.5 hours of onset of central retinal artery occlusion

Methods: The trial is an ongoing prospective, randomised-controlled, double-dummy, double-blind phase 3 multi-centre trial of TNK 0.25 mg/kg + placebo vs. ASA + placebo (2 arms with 1:1 block randomisation).

Patients are recruited after an ophthalmologist has confirmed CRAO and they can be treated within 4.5hrs. After observation in the stroke unit, patients will be re-examined by an ophthalmologist and a neurologist as an out-patient at 30 and 90-day follow-up.

The primary outcome is the proportion of patients with ⩽ 0.7 logMAR best-corrected visual acuity (BCVA) in the affected eye at 30 days after treatment, representing an improvement in BCVA of at least 0.3 logMAR.

Results: 9 countries are participating with more than 30 centres. Currently there are 6 countries activated for recruitment. We have recruited 8 patients so far, 6 in Norway and 2 in Finland. Updated figures will be presented.

Discussions: Inclusion will continue until 78 patients have been randomized. All patients have been included within the strict parameters of the study without any serious adverse events.

Disclosure: Yes

P0125 / 921

ENHANCEMENT OF STROKE REHABILITATION WITH LEVODOPA (ESTREL-STUDY) - DESIGN AND PROGRESS OF THE ONGOING MULTICENTER PLACEBO-CONTROLLED RANDOMIZED TRIAL

S.T Engelter ^1,2, A. Zietz^3,1, A. Polymeris^3,1, K. Wiesner¹, N.S Avramiotis^2,1, M. Lucht^2,1, V. Altersberger^2,1, J. Kaufmann^2,1, S. Schaedelin⁴, R. Müri⁵, L.G Hemkens^6,7,8, P. Michel⁹, P.A Lyrer², J.P Held^10,11, G.A Ford¹², A.R Luft¹³, C. Traenka^6,1

¹University of Basel, Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland, ²University Hospital Basel and University of Basel, Department of Neurology and Stroke Center, Basel, Switzerland, ³University Hospital Basel and University of Basel, Basel, Switzerland, ⁴University Hospital Basel and University of Basel, Clinical Trial Unit, Department of Clinical Research, Basel, Switzerland, ⁵Inselspital, Department of Neurology and Cognitive and Restorative Neurology, Bern, Switzerland, ⁶University Hospital Basel and University of Basel, Switzerland, Department of Clinical Research, Basel, Switzerland, ⁷Stanford University, Meta-Research Innovation Center at Stanford (METRICS), Stanford (California), United States, ⁸Berlin Institute of Health, Meta-Research Innovation Center Berlin (METRIC-B), Berlin, Switzerland, ⁹University Hospital Lausanne, Stroke Center Lausanne, Lausanne, Switzerland, ¹⁰University Hospital Zurich, Vascular Neurology and Neurorehabilitation, Stroke Center, Zürich, Switzerland, ¹¹Valens Clinics, Rehabilitation Triemli Zurich, Zürich, Switzerland, ¹²University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, ¹³Center for Neurology and Rehabilitation, cereneo, Vitznau, Switzerland

Background: In this multicenter, randomized, placebo-controlled trial we study whether Levodopa given in addition to usual rehabilitative therapies is associated with a patient-relevant enhancement of motor recovery after acute stroke.

Methods: ESTREL ( E nhancement of S troke RE habilitation with L evodopa) is a multicenter, placebo-controlled randomized superiority trial. Patients with an acute ischemic or hemorrhagic stroke ⩽7 days leading to a clinically meaningful hemiparesis in need of in-hospital rehabilitation are enrolled in stroke units and later transferred to experienced neurorehabilitation centers. Participants receive Levodopa 100mg/Carbidopa 25mg three times daily or matching placebo for 5 weeks in addition to standardized rehabilitative therapy. The primary outcome is the Fugl-Meyer-Motor Assessment score 3 months after randomization.  We present the characteristics of the first 200 of 610 patients to be enrolled.

Results: 13 certified stroke units and 13 neurorehabilitation centers are involved (“stroke-pathway-trial”). The first 200 participants had a median age of 73 [IQR 64-82] years and 43.5 % were female. 169 patients (84.5%) had ischemic stroke. At baseline, the median NIH-Stroke scale score was 8 [5-10]. Successful 3-month assessment was performed in 183 patients (91.5%); 11 (5%) died, 5 (2.5%) withdrew from the study and 1 patient missed the clinical 3 months-visit due to the COVID-19 pandemic.

Conclusions: The ESTREL study will provide evidence whether the additional use of Levodopa in the rehabilitation process of stroke patients is safe and effective. The ESTREL-study started successfully due to the good cooperation between acute stroke units and rehabilitation centers, as well as the high acceptance rate among patients

Disclosure: No

P0126 / 1069

RANDOMIZATION TO ENDOVASCULAR TREATMENT ALONE OR PRECEDED BY SYSTEMIC THROMBOLYSIS WITH TENECTEPLASE IN ACUTE ISCHEMIC STROKE DUE TO LARGE INTRACRANIAL VESSEL OCCLUSION TRIAL -RESILIENT DIRECT-TNK

O. Pontes-Neto ¹, S. Martins², G. Sampaio Silva³, L. Carbonera⁴, A.C. Souza⁴, D. Abud⁵, D. Bezerra⁶, M. Camilo¹, J. Oliveira-Filho⁷, F. Oliveira Lima⁸, F.J. Mont'Alverne⁸, L. Rebello⁹, M. Wagner¹⁰, R. Nogueira¹¹

¹Ribeirão Preto Medical School - University of São Paulo, Neuroscience and Behavioral Sciences, Ribeirão Preto, Brazil, ²Federal University of Rio Grande do Sul and Hospital Moinhos de Vento, Porto Alegre, Brazil, ³Federal University of São Paulo and Hospital Israelita Albert Einstein, São Paulo, Brazil, ⁴Hospital Moinhos de Vento, Porto Alegre, Brazil, ⁵Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil, ⁶Pro Cardiaco Hospital, Rio de Janeiro, Brazil, ⁷Federal university of Bahia, Salvador, Brazil, ⁸Hospital Geral de Fortaleza, Ribeirão Preto, Brazil, ⁹Hospital de Base de Brasilia, Brasilia, Brazil, ¹⁰Federal University of Rio Grande do Sul, Porto Alegre, Brazil, ¹¹Emory University, Atlanta, United States

Background and aims: Recently completed studies have suggested that direct endovascular treatment (without previous administration of alteplase) may be a non-inferior alternative to the combination of tPA and thrombectomy for patients with anterior proximal large vessel occlusion. Studies have also suggested that Tenecteplase (TNK) prior to mechanical thrombectomy results in higher recanalization rates and better clinical outcomes than bridging therapy with IV tPA. Our objective is to compare direct thrombectomy versus thrombectomy preceded by TNK for patient with AIS due to LVO of the anterior circulation.

Methods: RESILIENT DIRECT TNK is a randomized, prospective, multicenter, placebo controlled clinical trial in patient with AIS due to LVO of the anterior circulation. Randomization will be 1:1 according to reperfusion treatment modalities: (A) direct mechanical thrombectomy (placebo controlled) vs. (B) Intravenous thrombolysis with TNK (0.25 mg/kg) plus mechanical thrombectomy. Subjects will be followed up within 90 days after randomization. The primary outcome will be the ordinal distribution from the modified Rankin scale score (mRS).

Results: The sample size is projected to be 530 patients in both arms (statistical power of 90%), including two pre-planned interim analysis regarding 50% and 75% of recruitment.

Conclusions: Study will test the hypothesis that acute ischemic stroke treatment with anterior LVO < 4.5 hours from the onset of symptoms, the mechanical thrombectomy strategy preceded by TNK is superior to mechanical thrombectomy alone to achieve more favorable outcomes measuring by mRS scores at 90 days.

Disclosure: Yes

P0127 / 948

FEASIBILITY AND SAFETY STUDY TO EVALUATE THE NEUROPROTECTIVE EFFECT OF HEMODIALYSIS IN ACUTE ISCHEMIC STROKE (DIAGLUICTUS2)

Á. Ximénez-Carrillo ¹, M. Sobrado¹, M. Giorgi², E. De la Fuente¹, C. Ramos¹, S. Trillo¹, F. Nombela¹, G. Reig¹, G. Zapata-Wainberg¹, C. Aguirre¹, A. Cano-Manchón³, M.Á. Moral⁴, A. Barbosa⁵, J.L. Caniego⁶, M. Torres⁷, J. Sánchez-Prieto⁷, J.M Pradillo⁸, M.Á. Moro⁸, I. Lizasoain⁸, G. Barril², J. Vivancos¹

¹Stroke Center, Neurology Department, La Princesa Health Research Institute, Hospital Universitario de la Princesa, Madrid, Spain, ²Nephrology Department, La Princesa Health Research Institute, Hospital Universitario de la Princesa, Madrid, Spain, ³Neurology Nursing. La Princesa Health Research Institute, Hospital Universitario de la Princesa, Madrid, Spain, ⁴Nephrology Nursing. La Princesa Health Research Institute, Hospital Universitario de la Princesa, Madrid, Spain, ⁵Neuroradiology. La Princesa Health Research Institute, Hospital Universitario de la Princesa, Madrid, Spain, ⁶Interventional Neuroradiology. La Princesa Health Research Institute, Hospital Universitario de la Princesa, Madrid, Spain, ⁷Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Complutense University, Madrid, Spain, ⁸Department of Pharmacology and Toxicology, Faculty of Medicine, Complutense University, Madrid, Spain

Background and aims: Our work is based on published results in experimental animal models of stroke where our research group has shown that peritoneal dialysis is an effective technique to reduce plasma glutamate levels and reduce infarct volume. The objective of this study is to evaluate the viability, safety and efficacy of hemodialysis in patients with acute ischemic stroke (AIS), proposing that it may have a potential neuroprotective effect by reducing the excitotoxic levels of glutamate and proinflammatory cytokines.

Methods: We conduct a single-center, randomized, open-label, controlled study. The active group will include 10 patients with AIS treated with mechanical thrombectomy (MT) who, in addition to conventional treatment, will undergo two hemodialysis sessions in the acute phase of stroke. In the control group, 10 patients with similar characteristics will receive only conventional medical treatment after MT. The primary endpoints are safety (mortality, serious adverse events, early neurological impairment, symptomatic bleeding transformation) and feasibility of hemodialysis procedure. Secondary endpoints include efficacy in reduction of excitotoxic substances, reduction of infarct volume and modified Rankin scale assessed 90 days after stroke onset. The identity of the treatment will remain masked for the analysis of clinical and laboratory data. Neuroimaging will be evaluated by a single neuroradiologist blind to the clinical and biological variables of the patients.

Results: The study is currently in the recruitment phase and the estimated Study Completion Date is December 2022.

Conclusions: We present the design and methodology of our study. The trial is registered at clinicaltrials.gov NCT04297345.

Disclosure: No

P0128 / 441

THE DUTCH INTRACEREBRAL HAEMORRHAGE SURGERY TRIAL (DIST); MINIMALLY-INVASIVE ENDOSCOPY-GUIDED SURGERY IN PATIENTS WITH SPONTANEOUS, SUPRATENTORIAL INTRACEREBRAL HAEMORRHAGE

F.N.H. Wilting ¹, R. Dammers², C.JM Klijn¹, on behalf of the Dutch ICH Surgery Study Group, Part of the CONTRAST Consortium

¹Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands, ²Erasmus Medical Center, Erasmus MC Stroke Center, Department of Neurosurgery, Rotterdam, Netherlands

Background and aims: Intracerebral haemorrhage (ICH) accounts for 16-19% of all strokes in Western Europe and contributes profoundly to mortality and disability. Except for stroke unit care and early blood pressure lowering, which may be beneficial, there is currently no treatment of proven benefit. Increasing evidence suggests that surgical treatment may be beneficial, in particular with minimally-invasive procedures and when performed early. The aim of the Dutch Intracerebral haemorrhage surgery trial (DIST) is to assess whether minimally-invasive endoscopy-guided surgery within 8 hours of symptom onset in addition to standard medical management, improves functional outcome after spontaneous supratentorial ICH when compared to standard medical management alone.

Methods: DIST is a multicentre, prospective, randomised, open clinical trial with blinded outcome assessment. We will include 600 adults (⩾18 years) with a spontaneous supratentorial ICH with a haematoma volume ⩾ 10 mL and NIHSS ⩾ 2. Patients with an aneurysm, cerebrovascular malformation, or cerebral venous sinus thrombosis, or a known tumour as the cause of their ICH, will be excluded. Patients will be randomised (1:1) to minimally-invasive endoscopy-guided surgery performed within 8 hours of symptom onset in addition to standard medical management or to standard medical management alone.

Results: Primary outcome will be the modified Rankin scale score at 180 days. The treatment effect estimate will be adjusted for known prognostic variables.

Conclusions: Patient recruitment is expected to start in Q2 2022, with a predicted 3-year inclusion period. Results of this trial will be available after the 365-day assessment of the last enrolled participant.

Disclosure: Yes

P0129 / 294

THE AVANCER CLINICAL TRIAL PROTOCOL: DOSE-PERSONALIZATION AND COMBINATION OF NEUROTECHNOLOGIES FOR UPPER-LIMB REHABILITATION IN SEVERELY IMPAIRED CHRONIC STROKE PATIENTS

C. Bigoni ^1,2, S.B. Zandvliet^1,2, E. Beanato^1,2, A. Crema^3,4, M. Coscia⁵, A. Espinosa⁶, T. Henneken^1,2, J. Hervé^1,2, M. Oflar^1,2, S. Harquel^1,2, G.G. Evangelista^1,2, T. Morishita^1,2, M. Wessel^7,1,3, C. Bonvin⁸, J.-L. Turlan⁹, N. Birbaumer¹⁰, F.C. Hummel^1,2,11

¹École Polytechnique Fédérale de Lausanne, Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Geneva, Switzerland, ²École Polytechnique Fédérale de Lausanne, Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, Sion, Switzerland, ³École Polytechnique Fédérale de Lausanne, Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Geneva, Switzerland, ⁴AGO Neurotechnologies, sàrl, Geneva, Switzerland, ⁵confinis AG, Sursee, Switzerland, ⁶Wyss Center for Bio and Neuroengineering, Geneva, Switzerland, ⁷University Hospital Würzburg, Department of Neurology, Würzburg, Germany, ⁸Wallis Hospital, Division of Neurology, Sion, Switzerland, ⁹Neurological Rehabilitation Department of Clinique Romande de Réadaptation SUVA, Sion, Switzerland, ¹⁰University of Tuebingen, Department of Medical Psychology and Behavioral Neurobiology, Tuebingen, Germany, ¹¹University of Geneva Medical School, Clinical Neuroscience, Geneva, Switzerland

Background and aim: Effective treatments to restore upper-limb motor function in severely impaired chronic stroke patients are still missing. The AVANCER proof-of-concept clinical trial (clinicaltrials.gov NCT04448483) aims at maximizing upper-extremity recovery with a neurotechnologies-based intervention provided in a sequential patient-tailored manner.

Methods: AVANCER is a 2:1 individual-based cumulative longitudinal interventional trail. Thirty chronic stroke patients with FM-UE <20 will be recruited at two centers and randomized into a waiting (n=10) and starting (n=20) group. All patients undergo the same treatment, with the waiting group doing a three-month observational period prior to therapy to confirm motor stability of the targeted population. The two sequential interventions use a non-invasive BCI to trigger a variety of patient-tailored movements supported by multi-channel FES and an exoskeleton. The second phase adds anodal ipsilesional tDCS. Each phase lasts minimum 11 sessions and is extended until patients reach a plateau according to a quantitative-threshold based on the continuous monitoring of a 54-point FM-UE evaluation. Clinical and multimodal (MRI-, EEG-, TMS-based) assessments are acquired before (T0), between (T1) and at the end of the two interventions (T2).

Study outcome: The primary outcome is met with an improvement in the FM-UE between T0 and T2 of at least four points. Clinical and system neuroscience assessments are evaluated as secondary outcomes measures to determine recovery’s underlying mechanisms and to provide possible predictive outcome factors.

Conclusion: AVANCER aims at providing evidence for an effective, safe, and lasting treatment strategy to enhance upper-extremity functions in severe chronic stroke patients.

Disclosure: No

P0130 / 1106

ATRIAL FIBRILLATION AND ATRIAL FLUTTER IN PATIENTS WITH ARTERIAL HYPERTENSION ACCORDING TO SYSTEMIC INFLAMMATION AND IMMUNE STATUS

O. Ilchyshyna ¹

¹ National Scientific Center "M. Strazhesko Institute of Cardiology" of the National Academy of Sciences of Ukraine, Department of Clinical Arrhythmology and Electrophysiology, Kyiv, Ukraine

Background and aims: The most common reason of stroke is arterial hypertension and cardioembolism. Still there is no concrete reason for their occurrance, but the inflammative theory of arrhythmogenesis is interesting, so the aim of our work is to compare the immune status and systemic inflammation activity of patients with atrial fibrillation and flutter with arterial hypertension.

Methods: The study involved 103 patients (pts) who were divided into three main groups: 1 - with paroxysmal atrial fibrillation (AF), 2 - with persistent form of AF, 3 - with persistent form of atrial flutter (AFl). Also 2 control groups were formed: group 4 - pts with hypertension, but without arrhythmias and group 5 - almost healthy people. Monocytes (Mc), lymphocytes subpopulations and T-regulatory cells (T-reg) level in serum using flow cytometry and highly specific C-reactive protein (CRP) were assessed.

Results: The number of CD14++CD16- and CD14++CD16+ Mc was higher and CD14+CD16++ Mc lower in pts with persistent AF and AFl comparing to pts without arrhythmias (p<0.005). The count of T cells with natural killer (TNK) activity was higher but T-reg cells were decreased (p <0.005). In a 2 group pts had higher CRP level (exceeded norma by 6.7 times (8.31 ± 0.42 vs 1.25 ± 0.01) mg per l (p <0.001).

Conclusions: Pts with AF and AFl on hypertension background have a higher intensity of systemic inflammation, increased activity of proinflammatory Mc subpopulation, higher amount of T-cells with natural killer activity and reduced T-regulatory cells, whose main function is to control the immune response.

Disclosure: No

P0131 / 1035

SECOND, ENHANCED CONTROL OF HYPERTENSION AND THROMBECTOMY STROKE STUDY (ENCHANTED-MT): PROGRESS REPORT

L. Song ^1,2, P. Yang³, Y. Zhang³, X. Zhang³, Y. Li¹, Y. Wang¹, X. Chen¹, J. Liu³, C.S Anderson^1,2,4

¹The George Institute China at Peking University Health Sciences Center, Beijing, China, ²The George Institute for Global Health, University of New South Wales, Sydney, Australia, ³Changhai Hospital, Second Military Medical University, Shanghai, China, ⁴Royal Prince Alfred Hospital, Neurology Department, Sydney, Australia

Background and aims: Uncertainty persists over the optimal level of blood pressure (BP) control after mechanical thrombectomy (MT) in patients with acute ischaemic stroke (AIS). ENCHANTED2 aims to determine the effectiveness and safety of intensive BP lowering following successful MT recanalisation of an AIS due to large vessel occlusion (LVO).

Methods: An investigator-initiated, multicentre, prospective, randomised, open, blinded-endpoint (PROBE) trial of intensive BP control in ‘hypertensive’ successfully (TICI 2b/3) recanalised LVO-AIS patients at 60+ sites in China. Eligible patients are centrally randomly allocated to intensive BP (target SBP <120 mmHg within 1 hour) or standard BP (target SBP 140-180mmHg), to be maintained for ⩾72 hours). Primary outcome is an ordinal shift analysis in modified Rankin scale scores at 90 days. Data are collected in-hospital over 7-days, and at 90-days, via telephone or face-to-face follow-up. Sample size of 2257 patients provides 90% power to detect a relative reduction of 0.77 in poor outcome from intensive treatment using ordinal logistic regression.

Results: Central and site ethics committees and regulatory bodies approvals obtained at country-level in China. Recruitment commenced in June 2020. Up to 31 December 2021, 658 patients have been enrolled at 44 sites. Mean achieved SBP at 1-hour post-randomisation are 123 mmHg and 144 mmHg in intensive and standard groups, respectively. The sample size should be achieved by the end of 2023.

Conclusion: ENCHANTED2 aims provide reliable evidence on role of intensive BP lowering after recanalisation of MT-treated AIS patients.

Disclosure: No

P0132 / 246

IMAGING, COGNITION, AND NEUROPSYCHOLOGICAL OUTCOMES AFTER SUBARACHNOID HAEMORRHAGE (ICONS): PROTOCOL OF A LONGITUDINAL, PROSPECTIVE, COHORT STUDY TO INVESTIGATE RECOVERY AFTER SUBARACHNOID HAEMORRHAGE

S. Khosdelazad ¹, L.S. Jorna¹, A.M. Buunk¹, S.E. Rakers¹, M.E. Timmerman², R.J. Borra³, A. van der Hoorn³, R.J. Groen⁴, J.M. Spikman¹

¹University Medical Centre Groningen, Neurology, unit Neuropsychology, Groningen, Netherlands, ²University of Groningen, Psychometrics and Statistics, Groningen, Netherlands, ³University Medical Centre Groningen, Radiology, Groningen, Netherlands, ⁴University Medical Centre Groningen, Neurosurgery, Groningen, Netherlands

Background and aims: The Imaging, Cognition and Outcome of Neuropsychological functioning after Subarachnoid haemorrhage (ICONS) study aims to measure cognitive, emotional, and behavioural deficits and brain damage in the subacute stage after SAH, in relation to long-term recovery. Recovery is defined as functioning at societal participation level, with a focus on resumption of work, leisure activities, and social relationships.

Methods: The ICONS study is an observational, prospective, single-centre cohort study conducted in the University Medical Centre Groningen, the Netherlands. A total of 150 SAH patients will be included. Inclusion criteria are an aneurysmal SAH (aSAH) or angiographically negative SAH (anSAH) diagnosis, sufficient mastery of the Dutch language and age older than 18 years. Patients will undergo neuropsychological assessment to assess a broad range of cognitive domains (e.g. memory, attention, executive functioning) and 3Tesla-magnetic resonance imaging (3T-MRI) 6 months after SAH. New, and advanced MRI-techniques, that are considered more sensitive as compared to conventional MRI, are applied to measure brain damage. Furthermore, patients will fill in questionnaires about various psychosocial topics (e.g. anxiety, depression, fatigue) 6 months, 1-year, and 2-years after SAH. The primary outcome measure is recovery 1-year post-SAH, measured with the Impact on Participation and Autonomy questionnaire.

Results: Thus far, 52 patients and 58 healthy controls have been included. First results are expected late 2022.

Conclusions: This study is the first to collect and combine data in a variety of domains (cognition, emotion and behaviour, brain damage), which allows for a broad investigation of recovery after SAH.

Disclosure: No

P0133 / 881

PRE-STROKE PHYSICAL ACTIVITY AND ASSOCIATIONS WITH HEALTH-RELATED QUALITY OF LIFE THREE MONTHS AFTER STROKE – A REGISTER-BASED STUDY

M. Reinholdsson ¹, A. Palstam¹, K. Jood¹, K. S Sunnerhagen¹

¹ University of Gothenburg, Department of Clinical Neuroscience, Göteborg, Sweden

Background and aims: Pre-stroke physical activity may have beneficial associations with stroke outcomes, although health-related quality of life remains to be investigated. The aim is to explore associations between pre-stroke physical activity and health-related quality of life 3 months after stroke.

Methods: The study design is retrospective with consecutively collected data from two Swedish stroke registries. Adult patients with first-ever stroke 2014-2018 were included in the study. Patients without registered information on pre-stroke physical activity (assessed with Saltin-Grimby Physical Activity Scale) and health-related quality of life (assessed with EQ-5D-5L) were excluded. Multivariable binary logistic regression analysis will be performed performed with the independent variables; pre-stroke physical activity, living arrangements, education sex, age, stroke severity, aphasia, cognition, length of hospital stay, function at discharge, discharge destination, and stroke symptoms after 3 months to predict the dependent variable EQ-5D-5L.

Results: In total 2098 patients were included, 88% with cerebral infarct, 46% females, mean age 73 years (19-100 years), and 79% with mild stroke (NIH Stroke Scale 0-5). Patients reported problems with mobility (50%), self-care (30%), usual activities (59%), pain/discomfort (56%), anxiety/depression (58%) according to EQ-5D-5L, leaving many with persistent health problems after three months. The patients who were pre-stroke physically active had less problems compared to the physically inactive.

Conclusions: The preliminary results indicate that pre-stroke physical activity levels have influence on functioning and health-related quality of life 3 months post-stroke. The results and conclusion are not definite but will be ready for presentation later this spring.

Disclosure: No

THROMBOLYSIS – EXCLUDING CLINICAL TRIAL RESULTS

P0134 / 887

DOES INTRAVENOUS THROMBOLYSIS PROMOTE DELAYED REPERFUSION AFTER INCOMPLETE MECHANICAL THROMBECTOMY?

A. Mujanovic ¹, C. Kammer¹, C.C Kurmann¹, L. Grunder², M. Beyeler³, M.F Lang¹, E.I Piechowiak¹, T.R Meinel³, S. Jung³, A. Hoffmann¹, D.J Seiffge³, M.R Heldner³, T. Dobrocky¹, P. Mordasini¹, M. Arnold³, J. Gralla¹, U. Fischer³, J. Kaesmacher¹

¹University Hospital Bern Inselspital, University Institute of Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ²University Hospital Bern Inselspital, University Institute of Diagnostic, Interventional and Pediatric Radiology, Bern, Switzerland, ³University Hospital Bern Inselspital, Department of Neurology, Bern, Switzerland

Background and aims: Indication and treatment of distal vessel occlusions causing incomplete reperfusion after mechanical thrombectomy (MT) is debated. We hypothesized that pre-treatment with intravenous thrombolysis (IVT) may facilitate delayed reperfusion (DR) of distal vessel occlusion causing incomplete reperfusion after MT.

Methods: Retrospective analysis of patients with incomplete reperfusion after MT (defined as TICI 2a - 2c) and available perfusion follow-up imaging. DR was defined as absence of any perfusion deficit on time-sensitive perfusion maps. The association of IVT was evaluated using logistic regression analysis with dichotomized populations (IVT vs non-IVT), and population splits based on IVT timings (time between IVT start and the occurrence incomplete reperfusion following MT).

Results: In 371 included patients (median age 73.7, 49.1% female), DR occurred in 226 (60.9 %). Atrial fibrillation, TICI, and longer intervention-to-follow-up time were associated with DR. Dichotomized, IVT did not show an association with the occurrence of DR (aOR 0.75 [95% CI 0.42 – 1.34]). However, time-sensitive analysis suggested a potentially beneficial role of IVT, when incomplete reperfusion occurred within a short time frame after IVT start (OR 2.45 [95% CI 1.08 – 6.92, and OR 2.17 [95% 1.09 – 4.62], for occurrence of incomplete MT within 80 and 100 minutes after IVT start, respectively).

Conclusions: DR occurs in 60% of patients with incomplete MT at ⁓24h, with no evidence for an overall effect of pretreatment with IVT. However, subgroup analysis suggested a potential association of IVT with DR when incomplete reperfusion occurs within a shorter time frame.

Disclosure: No

P0135 / 1606

RECANALIZATION THERAPIES IN ACUTE ISCHEMIC STROKE: THE EXPERIENCE OF A BRAZILIAN UNIVERSITY HOSPITAL

K.S. Ferreira¹, M.R. Camilo¹, P.T. Cougo Pinto¹, F.A. Dias¹, R.K.d.V. Martins Filho¹, L.H.d. Castro-Afonso¹, D.G. Abud¹, O. Pontes-Neto ¹

¹ Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirao Preto, Brazil

Background and aims: Stroke is the second leading cause of death and functional disability in the world. Ischemic stroke (IS) accounts for 85% of cases and its treatment reduces sequalae and mortality. However, recanalization therapies are still underutilized in Brazil.

Objective: To evaluate the clinical characteristics of patients undergoing recanalization therapy treated at a public University Hospital in Brazil and to identify predictors of in-hospital mortality, symptomatic hemorrhagic transformation (SHT) and good functional outcome by Modified Rankin Scale (mRs) 0-2 in 90 days.

Methods: Medical records review of patients with acute IS who underwent thrombolysis and/or endovascular treatment between 2001 to 2017.

Results: There were 869 treated patients, mostly male (57%), mean age 66.5±13.1 years, median NIHSS 15 and 65.7% with proximal occlusion. The rate of endovenous thrombolysis was 87.5% and of endovascular treatment, 28.7%. The mean admission-needle time was 57 minutes [35-70] and ictus-needle time was 204 minutes [150-248]. SHT occurred in 5.9% of patients, in-hospital death was 16.8% and the median mRs after 90 days was 3. The predictors of good functional outcome (0-2) were age and NIHSS; for in-hospital mortality, in addition to these, diabetes mellitus, proximal occlusion and SHT; for SHT, NIHSS, proximal occlusion, and blood glucose.

Conclusions: Acute stroke patients treated with recanalization therapies were predominantly male, elderly, with high blood pressure and high glucose levels at admission and with severe stroke symptoms. Recanalization therapies proved to be safe, with 5.9% of SHT, similarly to other studies, and 40% of patients with a good functional outcome.

Disclosure: No

P0136 / 506

FIBRINOLYTIC CAPACITY AND THE IN VIVO RESPONSE TO TPA VARIES OVER 100-FOLD IN PATIENTS WITH ACUTE ISCHAEMIC STROKE

R. Medcalf ¹, T. Lillicrap², Z. Liu¹, S. Harman¹, J. Chan¹, T. Akmal¹, C. Keragala¹, H. Ho¹, F. McCutcheon¹, A. Pillai¹, D. Draxler¹, G. Cloud³, V. Stanislaus³, E. Holliday⁴, C. Garcia-Esperon⁵, N. Spratt⁵, J. Attia⁵, B. Campbell⁶, P. Choi⁷, T. Kleinig⁸, S. Koblar⁹, A. Hamilton-Bruce⁸, J. Montaner¹⁰, I. Fernandez-Cadenas¹⁰, A. Bustamante¹⁰, Z. Bagoly¹¹, C. Levi⁵

¹Monash University, Australian Centre for Blood Diseases, Melbourne, Australia, ²University of Newcastle, Newcastle, Australia, ³Monash University, Clinical Neuroscience, Melbourne, Australia, ⁴University of Newcastle, School of Medicine and Public Health, Newcastle, Australia, ⁵Hunter Medical Research Institute, Newcastle, Australia, ⁶University of Melbourne, Department of Neurology, Melbourne, Australia, ⁷Monash University, Eastern Health Clinical School, Box Hill, Australia, ⁸Royal Adelaide Hospital, Department of Neurology, Adelaide, Australia, ⁹University of Adelaide, Department of Neurology, Adelaide, Australia, ¹⁰Vall d'Hebron Institute of Research, Barcelona, Spain, ¹¹University of Debrecen, Department of Laboratory Medicine, Debrecen, Hungary

Background and aims: t-PA thrombolysis for patients with acute ischaemic stroke (AIS) is without clinical benefit in the majority of patients. We evaluated the inherent variation in fibrinolytic capacity using pre-thrombolysis plasma from AIS patients from Australia (n=148), Hungary (n=84) and Spain (n=139). Matching plasma was obtained where practical at 1h and 24h post-thrombolysis. Pre- and post-thrombolysis plasma was also obtained from 6 patients administered tenecteplase (TNK).

Methods: Pre-thrombolysis plasma was treated with vehicle or t-PA for 10min in the presence of a fibrin cofactor. Plasmin-antiplasmin complex (PAP) levels were evaluated by ELISA to reflect plasmin formation. Post-t-PA or TNK thrombolysis plasma was evaluated for PAP, fibrinogen (by western blotting), and matrix metalloproteinase (MMP) activity by gelatin zymography.

Results: t-PA-induced PAP formation ex-vivo increased 71.91-fold (median 42.78 [IQR:16.6-77.8]; n=345). The ex-vivo PAP induction strongly correlated with the in-vivo PAP formation in patient plasma 1h-post thrombolysis (r2=0.93, n=81; p<0.0001; in-vivo range 8-129-fold). MMP-9 activity was consistently increased. Fibrinogen consumption was variable but observed in all patients 1h post-thrombolysis (n=16). TNK caused ~50% less systemic plasminogen activation than tPA and did not consume fibrinogen consistent with its cofactor preference for fibrin over fibrinogen. However, TNK still increased systemic MMP-9 activation (n=6).

Conclusions: The ability of t-PA to activate plasminogen ex-vivo correlates with the in-vivo response yet there is marked variation. The basis for this variation in plasmin generating capacity is unclear but may partly explain the clinical variation in tPA thrombolysis. TNK administration produces less systemic plasminogen activation and preserves fibrinogen.

Disclosure: No

P0137 / 945

THE COMPARISON OF REVASCULARIZATION RATE IN STROKE WITH LARGE VESSEL OCLUSSION USING TENECTAPLASE VS ALTEPLASE

J. Vetra ^1,2, A. Teivane³, K. Jurjans^1,2, K. Kupcs⁴, E. Miglane^1,2

¹Riga Stradins University, Neurology and Neurosurgery, Riga, Latvia, ²Pauls Stradiņš Clinical University Hospital, Neurology, Riga, Latvia, ³Riga Stradins University, Faculty of Residency, Riga, Latvia, ⁴Riga Stradins University, Radiology, Riga, Latvia

Background and aims: Our aim was to investigate the efficacy of intravenous thrombolysis with tenectaplase prior to thrombectomy for ischemic stroke patients compared with previous results using alteplase. Clinical trials for tenectaplase so far have indicated increased incidence of vascular reperfusion.

Methods: In this retrospective descriptive study we analysed directly admitted patients with ischemic stroke who had occlusion of the internal carotid, middle cerebral or basilar artery and who underwent thrombectomy, and the recanalization rate at the first angiographic assessment (revised Treatment in Cerebral Ischemia score 2b–3). We compared recanalization rate between patients who received tenectaplase with patients who received alteplase.

Results: We included 130 patients (median age 73 years [interquartile range (IQR) 63–80]; 64 women [49.2 %]; median NIH Stroke Scale score 15 [IQR 10–18]). During Apr-Dec 2021 there were 45 patients who received tenectaplase (at a dose of 0.25 mg/kg; maximum dose, 25 mg) and during Apr-Dec 2020 - 85 patients who received alteplase (at a dose of 0.9 mg/kg; maximum dose, 90 mg) within 4.5 hours after symptom onset. Recanalization at the first angiographic assessment occurred in 8.2% of the patients treated with alteplase versus 22.2% of patients treated with tenectaplase (incidence difference, 14 percentage points).

Conclusions: Tenecteplase prior to thrombectomy is effective and achieves a high rate of recanalization in clinical practice in acute ischemic stroke patients with large-vessel occlusion. Our findings are in line with other published results.

Disclosure: No

P0138 / 541

AN IMMUNOTHERAPY PREVENTING THE DELETERIOUS EFFECTS OF BOTH ENDOGENOUS AND RECOMBINANT TPA REDUCES DAMAGES AFTER ISCHEMIC STROKE: GLUNOMAB, A NEW HOPE FOR PATIENTS?

F. Lebrun*^1,2, E. Lemarchand*¹, F. Potzeha*^1,3, P. Prunotto¹, Y. Hommet¹, L. Lebouvier¹, C. Ali¹, N. Violle², R. Macrez^1,3,4, M. Blanc³, V. Agin¹, C. Orset¹, F. Lesept ³, D. Vivien^1,3,5

¹INSERM UMRS U 1237 PhIND, Caen, France, ²Pôle de Recherche et Innovation en Santé, Caen, France, ³Lys Therapeutics, Caen & Lyon, France, ⁴Caen-Normandie University Hospital, CHU, Department of Urgency, Caen, France, ⁵Caen-Normandie University Hospital, CHU, Department of Clinical Research, Caen, France

Background and purpose: Recombinant tissue-type plasminogen activator (rtPA, Alteplase/Actilyse®) is the only drug approved for the acute treatment of ischemic stroke, alone or combined with thrombectomy. Despite its beneficial fibrinolytic activity, tPA was also reported to display damaging effects on neurovascular units and brain parenchyma by increasing the activity of endothelial and neuronal N-methyl-D-aspartate receptors (NMDAR). To counteract this, we developed a novel strategy relying on a monoclonal antibody, Glunomab, targeting the deleterious effects of both endogenous and recombinant tPA.

Methods: Glunomab was designed to prevent tPA from interacting with the GluN1 subunit of NMDAR. We then evaluated its efficacy in different animal models of thromboembolic stroke (fibrin and platelets rich clots) alone or with early or late recombinant tPA-driven thrombolysis, including comorbidity studies. Magnetic Resonance Imaging (MRI), laser speckle flowmetry, behavioral tasks and/or immunohistochemistry were used to evaluate treatment efficacy.

Results: After a single i.v. administration either in standalone or combined with rtPA-induced thrombolysis, Glunomab reduced brain lesion volumes along with hemorrhagic transformations, translating in improved long-term neurological outcomes.

Conclusions: Glunomab drastically limits ischemic damages induced by both endogenous and recombinant tPA. A humanized form of Glunomab is currently under development as a potential game-changer treatment for stroke patients.

Disclosure: Yes

P0139 / 1137

CHARACTERISATION OF THE THROMBIN MODEL OF STROKE AND REPERFUSION IN RATS

W.A. Middleham ^1,2, N.F Binder^1,2, M.T Wyss^1,3, A.R Luft^1,2, B. Weber^1,3, M. El Amki^1,2, S. Wegener^1,2

¹University of Zürich, Neuroscience Centre Zürich, Zürich, Switzerland, ²University Hospital Zürich, Department of Neurology, Zürich, Switzerland, ³Institute of Pharmacology and Toxicology, Experimental Imaging and Neuroenergetics, University of Zürich, Zürich, Switzerland

Background and aims:

Animal models are an essential part of preclinical research. However, there is still an urgent need for animal models of stroke that are clinically relevant and therefore provide more translational research. The thrombin model of stroke, which is well described in mice, offers the possibility of thrombolysis and recanalization of the occluded vessel using recombinant tissue plasminogen activator (rt-PA). So far, there is little data from this model in rats. Our aim is to characterise and establish the thrombin model of stroke and rt-PA treatment in rats.

Methods: Induction of ischemia was achieved by injecting thrombin into the exposed left middle cerebral artery (MCA) of Sprague Dawley rats. After 30 minutes, saline was given intravenously, as a control, or thrombolysis was achieved through a bolus and subsequent infusion of rt-PA. Laser speckle imaging was used to monitor CBF changes during stroke and reperfusion. Furthermore, MRI was performed on days 1 and 7, post-stroke, to assess the stroke lesion evolution. On day 7, the rats were perfused, and their brains harvested for histological analysis.

Results/Conclusions: A reliable stroke was achieved when CBF dropped to around 20-25% of baseline values and remained under 50% for 30 minutes. First results show that CBF in rats treated with rt-PA recovered to around 70-80% of baseline, compared to only 50% when saline was given. A reduction of infarct size for the rats administered with rt-PA was observed on both days 1 and 7. Further experiments are currently being performed to investigate microvascular failure.

Disclosure: No

P0140 / 558

HOW THE REGISTRY OF STROKE CARE QUALITY (RES-Q) HELPS TO sIDENTIFY BARRIERS TO SYSTEMIC THROMBOLYTIC THERAPY IN ACUTE ISCHEMIC STROKE

S. Moskovko ^1,2, Y. Flomin^3,4,2, D. Fix⁵, M. Guliaieva^3,6,2

¹Pirogov National Medical University, Neurology, Vinnytsya, Ukraine, ²ESO EAST/ANGELS Steering Committee for Ukraine, Kyiv, Ukraine, ³Bogomolets National Medical University, Kyiv, Ukraine, ⁴Medical Center 'Universal Clinic 'Oberig', Stroke Center, Kyiv, Ukraine, ⁵Pirogov National Medical University, Vinnytsya, Ukraine, ⁶Medical Center 'Universal Clinuic 'Oberig', Stroke Center, Kyiv, Ukraine

Background: Thrombolytic therapy (TLT) is underused in routine clinical practice but reasons are frequently unclear.

Aim: Using the RES-Q registry, barriers to systemic TLT in acute stroke (AS) were identified.

Methods: Data of all AS patients consecutively admitted to two hospitals in Vinnytsya region from 2017 to 2019 were collected using the RES-Q and compared. Both hospitals provided similar level of stroke care with one being the regional hospital (H1) and the other – a city hospital (H2).

Results: The study enrolled 3,124 patients (44.1% women, mean age 66.2 ± 0.63 years, 88.5% ischemic strokes), including 1,286 from H1 and 1,477 from H2. Mean onset to admission time at H1 was 11.54 hours compared with 15.01 hours at H2. Overall, 99% of patients at H1 and 96% patients at H2 underwent head CT. However, within 1 hour of admission head CT was performed in 96% patients at H1 and only in 33% patients at H2. At H1, prenotification was performed in all cases, whereas at H2 pre-notification was very rare. 262 AS patients (thrombolytic rate 22,3%) received TLT at H1 and just one AS patient at H2 (thrombolytic rate 0,08%,).

Conclusions: RES-Q data allowed to benchmark hospitals and identify several organizational barriers to TLT in AS, including late arrival (at both hospitals), lack of pre-notation and a much lower rate of neuroimaging within 60 minutes after admission at H2. These data allow to plan steps aimed at improving quality of AS care.

Disclosure: No

P0141 / 1136

LEPTOMENINGEAL COLLATERALS REGULATE BLOOD FLOW RECOVERY IN STROKE AND RESCUE THE BRAIN FROM REPERFUSION INJURY

N.F. Binder ¹, A. Bertolo², M. El Amki¹, W.A. Middleham¹, M. Wyss³, T. Deffieux², C. Orset⁴, M. Tanter², D. Vivien⁴, B. Weber³, S. Wegener¹

¹University Hospital Zurich and University of Zurich, Department of Neurology, Zurich, Switzerland, ²Physics for Medicine, PSL Research University, INSERM U1273, ESPCI Paris, CNRS UMR 8063, Paris, France, ³University of Zurich, Institute of Pharmacology and Toxicology, Experimental Imaging and Neuroenergetics, Zurich, Switzerland, ⁴Normandie University, UNICAEN, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, France

Background and aims: Leptomeningeal collaterals (LMC) are important determinants of ischemic stroke severity. However, the underlying mechanism of protection is still unknown. Here, we propose that LMCs lead to a controlled gradual reperfusion after thrombolytic treatment preventing reperfusion injury.

Methods: We compared three mouse strains with differences in their collateral network (Balb-C, C57BL/6, Rabep2-/-). Stroke was induced by injecting thrombin into the M2 bifurcation of the right middle cerebral artery (MCA). Thirty minutes later, thrombolysis was initiated through recombinant tissue plasminogen activator (rt-PA). CBV was monitored using laser speckle imaging and ultrafast ultrasound for 2 hours during stroke and reperfusion. In a subset of animals, functional deficits were assessed during the chronic phase and on day 7, infarct volumes were quantified using Triphenyl-tetrazolium chloride (TTC).

Results: In mice with no (Balb-C) and poor (Rabep2-/-) LMCs, rt-PA led to a significant reperfusion in the area supplied by the MCA-M4 segment. In mice with rich (C57BL/6) LMCs, irrespective of rt-PA administration, CBV did not recover in this area. However, regions more proximal (MCA-M3) showed considerable reperfusion in all three strains. While C57BL/6 displayed a gradual reperfusion reaching 100% of baseline, Balb-C and Rabep2-/- showed steep reperfusion resulting in an uncontrolled hyperemic response. In the chronic phase after stroke (7d), only mice with no and poor LMCs suffered hemorrhages and mortality. In addition, these animals had more extensive lesions than mice with rich LMCs.

Conclusions: Our findings suggests that LMC allow a controlled, gradual reperfusion after thrombolysis.

Disclosure: No

P0142 / 1191

FIBRINOGEN DEPLETION COAGULOPATHY AND SYMPTOMATIC INTRACEREBRAL HEMORRHAGE AFTER THROMBOLYSIS: A MULTICENTER PROSPECTIVE STUDY

M. Romoli ¹, L. Vandelli², G. Bigliardi², M. Naccarato³, J. Moller⁴, M. Balestrino⁵, F. Giammello⁶, M. Gentile⁷, M.L. Dell'Acqua², P. Manganotti³, S. Forlivesi⁷, M. Melis⁴, L. Picchetto², F. Rosafio², G. Furlanis³, S. Testoni⁷, V. Piras⁴, L. Malfatto⁵, R.F. Musolino⁶, I. Scali³, S. Maffei², L. Migliaccio⁷, T. Trenti⁸, R. Mancini⁹, M. Marietta⁸, V. Randi¹⁰, S. Meletti¹¹, A. Zini⁷

¹Neurologia, Neuroscience, Cesena, Italy, ²Stroke Unit, Modena, Italy, ³Clinical Unit of Neurology, Trieste, Italy, ⁴Neurology and Stroke Unit, Cagliari, Italy, ⁵IRCCS San Martino, Genova, Italy, ⁶Policlinico Martino, Messina, Italy, ⁷IRCCS IStituto delle Scienze Neurologiche di Bologna, Bologna, Italy, ⁸Medicina di Laboratorio e Anatomia Patologica AOU Modena, Modena, Italy, ⁹Laboratorio Unico Metropolitano, Bologna, Italy, ¹⁰Regional Blood Center, Bologna, Italy, ¹¹Dept of Biomedical, Metabolic and Neural Science, Modena, Italy

Background and aims: Fibrinogen depletion by recombinant tissue plasminogen activator can increase the risk of thrombolysis-related bleeding complications. In this multicenter prospective study we investigated the risk of symptomatic intracerebral hemorrhage (sICH) with fibrinogen depletion after thrombolysis.

Methods: We included consecutive stroke patients receiving thrombolysis for acute ischemic stroke, undergoing repeated assessment of fibrinogen levels before, 2 and 6 hours after thrombolysis. Symptomatic intracranial hemorrhages were adjudicated according to National Institute of Neurological Disorders and Stroke criteria.

Results: Overall, among 1678 patients, 115 (6.9%) had sICH. sICH was associated with older age, higher NIHSS at admission, lower platelet count, higher creatinine, higher blood glucose and fibrinogen depletion. Fibrinogen depletion carried, alone, a 5-fold increase in sICH risk.

Conclusions: Fibrinogen depletion significantly increases the risk of ICH after IVT for acute ischemic stroke. Routine fibrinogen assessment and studies on fibrinogen repletion are needed.

Logistic regression analysis
Factor	OR	p-value
Age	2.8 (2.7-2.8)	0.020
NIHSS ingresso	3 (2.9-3)	0.000
PLT (x10e 9/l)	2.7 (2.7-2.7)	0.012
Creatinina (mg/dl)	12.5 (4.8-57.9)	0.000
Fibrinogen<201 mg/dl or <49% (2h)	4.9 (2.9-10.8)	0.024

Disclosure: No

P0143 / 1552

INTRAVENOUS THROMBOLYSIS WITH RT-PA FOR ACUTE ISCHEMIC STROKE: CLINICAL EXPERIENCE ABOUT 120 PATIENTS

S. Daoudi¹, M. Lounis ¹, F. Miloudi¹, N. Mesbahi¹, M. Boutouche¹, N. Ababou¹, H. Si Ahmed¹

¹ Nedir Mohammed Teaching Hospital, Tizi-Ouzou, Algeria

Introduction: Thrombolytic therapy are the most important advance in the management of acute ischemic stroke (AIS) these last years and has been evaluated in several randomised trials. We report a case series of 120 patients treated with rt-PA for AIS in a north Algerian stroke unit.

Methods: This a retrospective study that included a total of 120 AIS patients aged between 18 and 80 years old, treated with rt-PA within 4.5 hours from onset at Nedir Mohammed Teaching Hospital stroke unit located in north Algeria. This study was conducted between 2015 and 2019. we used the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) to assess the patients at baseline and 3 months later.

Results: The mean age was 68 years with a sex ratio Male / Female of 1,4. With 65%, Hypertension was the most common vascular risk factor. 70,8% of patients were treated by rt-PA within a 2 hours30. Mean door-to-needle time was 54 min. Median NIHS score was 14 at admission with a median change 24 hours later of -4. Intracerebral hemorrhage was reported in 10% of cases. At 3-month follow-up, 53% of patients had a modified Rankin Scale (mRS) ⩽2.

Cconclusion:The fate of ischemic stroke changed with thrombolysis, and rtPA therapy would appear to improve functional prognosis and consequently the quality of life after an ischemic stroke.

Disclosure: No

P0144 / 1054

COVID IMPACT ON DOOR-TO-NEEDLE TIME

C. Brown ¹, K. Muir¹

¹ University of Glasgow, Imaging Centre of Excellence, Glasgow, United Kingdom

Background and aims:

Hospital responses to COVID-19 included re-organisation of services to limit infection spread, restricted access for family members, and redeployment of staff and other resources, which may be reflected in door-to-needle time (DNT) for thrombolysis.   We reviewed routinely collected data on DNT over the course of the pandemic.

Methods: Routinely collected performance data on thrombolysis for acute ischaemic stroke at a large academic centre from 01/01/2018 - 31/01/2021 were collated.  Data are presented as mean (95%CI). Non-parametric data were normalised with logarithmic transformation.  Single and multiple comparisons were calculated using independent t-test and one-way ANOVA with post-hoc Tukey HSD test respectively. P-values of <0.05 were considered significant. Significant factors were used to create a binary logistic regression model to predict DTN time <60mins.

Results: Mean DNT was 49mins (44.4-53.4) in 2018 (n=205), 40mins (36.8-44.1) in 2019 (n=203), 61min (55.8-66.1) in 2020-21 (n=154). Trends in DNT, DTCT and CTTN are presented (Figure).  DNT was significantly prolonged comparing pre-COVID 44mins (42.1-47.6) and post-COVID 63.1mins (58.1-69.1) periods (t(560)=6.177,p<0.01), mean difference 18.9mins (12.9-25.0).

Regression analysis revealed the odds of DNT <60mins were reduced by 94% during the post-COVID period (CI=0.009-0.379,p<0.01), adjusted for NIHSS, year of presentation, anticoagulation at onset and hospital transfer status. The model displayed significant predictive power, AUROC 0.771 (0.712-0.830,p<0.01).

Conclusion: COVID-19 has adversely impacted impact on our DNT and was associated with increase of 18mins compared with pre-pandemic and decreased odds of DNT <60mins. Limited data on specific factors modified in response to the pandemic limit conclusions.

Disclosure: No

P0145 / 1415

CEREBRAL SMALL VESSEL DISEASE MARKERS ARE ASSOCIATED WITH LESS SALVAGEABLE TISSUE IN ACUTE ISCHEMIC STROKE TREATED WITH INTRAVENOUS THROMBOLYSIS

F. Arba ¹, R. Leigh², A. Fara², S. Warach³, M. Luby⁴, K. Lees⁵, J. Dawson⁶, STIR/VISTA Imaging Collaboration

¹Careggi University Hospital, Stroke Unit, Emergency Department, Firenze, Italy, ²Johns Hopkins Institute, Department of Neurology, Baltimore, United States, ³University of Texas, Department of Neurology, Austin, United States, ⁴National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, United States, ⁵University of Glasgow, School of Medicine, Dentistry, and Nursing, Glasgow, United Kingdom, ⁶University of Glasgow, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, Glasgow, United Kingdom

Background and aims: Cerebral Small Vessel Disease (SVD) causes structural changes within the brain but the consequences on acute ischemic stroke are unclear. We investigated the associations between markers of SVD and the evolution of the ischemic brain tissue, from ischemic core to final infarct, in people treated with intravenous thrombolysis.

Methods: On pre-treatment Magnetic Resonance scans of patients from an international anonymised dataset we rated single SVD markers (number of pre-existing lacunes, white matter changes [WMCs], brain atrophy) and global SVD burden. Two operators independently measured ischemic core and final infarct volumes. We investigated the associations between SVD markers and ischemic core, final infarct, infarct growth (IG) (final infarct-ischemic core) and relative tissue loss (rTL) [(final infarct-ischemic core)/ischemic core]. We used linear regression adjusted for main confounders to investigate independent associations.

Results: We included 165 patients, mean (±SD) age 69.5(±15.7) years, 74(45%) males. Mean (±SD) ischemic core was 25.48(±42.22) ml, infarct volume 52.06(±72.88) ml, rTL 7.22(±38.12). Ischemic core was higher but not statistically significant in patients with SVD, whereas final infarct was similar between patients with or without SVD. In linear regression analysis WMCs and brain atrophy were associated with rTL (β=-0.30;p=0.004; β=-0.31;p<0.001, respectively); lacunes and brain atrophy with IG (β=-0.17;p=0.024; β=-0.27;p=0.004, respectively). We did not find associations with global SVD burden.

Conclusions: Single SVD features were associated with smaller loss of ischemic tissue and infarct growth despite similar final infarct volumes, suggesting less salvageable tissue at time of administration of reperfusion therapy.

Disclosure: No

P0146 / 822

INTRAVENOUS THROMBOLYSIS BEFORE THROMBECTOMY UP TO 9 HOURS OF ONSET IN STROKES PATIENTS SELECTED BY PERFUSION IMAGING

J.B. Escribano Paredes ¹, E. Dirren¹, J. Klug¹, N. Sanda¹, A. Rosi², G. Bernava², M. Vargas², P. Machi², E. Carrera¹

¹University Hospital, Geneva, Neurology, Geneva, Switzerland, ²University Hospital, Geneva, Neuroradiology, Geneva, Switzerland

Background and aims: Recent studies demonstrated the benefit of IVT up to 9 hours of stroke onset, in patients without large vessel occlusion (LVO) selected by perfusion imaging. In patients with LVO, it is unknown whether extending IVT to 4.5 and 9 hours of onset improves outcome compared to endovascular therapy (EVT) alone.

Methods: We retrospectively analyzed 63 consecutive patients treated with EVT in the Geneva University Hospital with the following criteria i) anterior circulation occlusion, ii) favorable CT-perfusion mismatch (EXTEND criteria), iii) treatment initiation between 4.5 and 9 hours of onset or wake-up strokes. Patients were treated with IVT before EVT (bridging) or EVT alone when IVT was contraindicated. Outcomes were compared between treatment groups using propensity score weighting.

Results: We included 29 patient in the bridging and 34 in the EVT alone groups. Between groups, there was no difference regarding age, stroke severity, occlusion location, nor hypoperfused volumes.  A favorable outcome (mRS 0-2) at 90 days was reached in 52% in the bridging and 29% in the EVT alone groups (p=0.283). Bridging was not associated with an increased risk of symptomatic intracranial hemorrhage (3 vs 0%:p=0.297)).

Conclusions: Between 4.5 and 9 hours after onset, bridging therapy was associated with similar functional outcomes compared to EVT alone in patients selected using perfusion imaging. These preliminary results echo observations from recent randomized trials in the early window (0-4.5 hours), giving the clinicians two options of treatment, depending on perceived risks, benefits and local situations.

Disclosure: No

P0147 / 772

D-DIMER AFTER ENDOVASCULAR TREATMENT CAN PREDICT OUTCOME IN ACUTE ISCHAEMIC STROKE

H.S. Nam ¹, Y.D. Kim¹, J. Yoo², H. Park³, B.M. Kim⁴, O.Y. Bang⁵, H.C. Kim⁶, E. Han⁷, D.J. Kim⁴, I.H. Lee¹, J. Heo¹, H. Lee¹, J.K. Choi¹, K.-Y. Lee⁸, H.S. Lee⁹, D.H. Shin¹⁰, H.-Y. Choi¹¹, S.-I. Sohn³, J.-H. Hong³, J.Y. Lee¹², J.-H. Baek¹³, G.S. Kim¹⁴, W.-K. Seo⁵, J.-W. Chung⁵, S.H. Kim¹⁵, T.-J. Song¹⁶, S.W. Han¹⁷, J.H. Park¹⁷, J. Kim², Y.H. Jung⁸, H.-J. Cho¹⁸, S.H. Ahn¹⁹, S.I. Lee²⁰, K.-D. Seo¹⁴

¹Yonsei University College of Medicine, Department of Neurology, Seoul, Korea, Republic of, ²Yongin Severance Hospital, Department of Neurology, Yongin, Korea, Republic of, ³Brain Research Institute, Keimyung University School of Medicine, Department of Neurology, Daegu, Korea, Republic of, ⁴Yonsei University College of Medicine, Department of Radiology, Seoul, Korea, Republic of, ⁵Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Neurology, Seoul, Korea, Republic of, ⁶Yonsei University College of Medicine, Department of Preventive Medicine, Seoul, Korea, Republic of, ⁷Yonsei Institute for Pharmaceutical Research, Yonsei University, College of Pharmacy, Incheon, Korea, Republic of, ⁸Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Department of Neurology, Seoul, Korea, Republic of, ⁹Biostatistics Collaboration Unit, Yonsei University College of Medicine, Department of Research Affairs, Seoul, Korea, Republic of, ¹⁰Gachon University Gil Medical Center, Department of Neurology, Incheon, Korea, Republic of, ¹¹Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Department of Neurology, Seoul, Korea, Republic of, ¹²National Medical Center, Department of Neurology, Seoul, Korea, Republic of, ¹³Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Department of Neurology, Seoul, Korea, Republic of, ¹⁴National Health Insurance Service Ilsan Hospital, Department of Neurology, Goyang, Korea, Republic of, ¹⁵Yonsei University Wonju College of Medicine, Department of Neurology, Wonju, Korea, Republic of, ¹⁶College of Medicine, Ewha Woman’s University, Department of Neurology, Seoul, Korea, Republic of, ¹⁷Sanggye Paik Hospital, Inje University College of Medicine, Department of Neurology, Seoul, Korea, Republic of, ¹⁸Pusan National University School of Medicine, Department of Neurology, Busan, Korea, Republic of, ¹⁹Chosun University School of Medicine, Department of Neurology, Gwangju, Korea, Republic of, ²⁰Sanbon Hospital, Wonkwang University School of Medicine, Department of Neurology, Sanbon, Korea, Republic of

Background and aims: D-dimer level is a marker of hypercoagulable states and it is associated with thrombus formation and resolution. This study investigated the value of D-dimer levels after endovascular treatment (EVT) for predicting outcomes in acute ischaemic stroke patients.

Methods: We analyzed data from the SElection CRiteria in Endovascular thrombectomy and Thrombolytic therapy (SECRET) registry. Patients who received only EVT were included to eliminate the effect of tissue plasminogen activator on D-dimer level.

Results: A total of 170 patients were included. The median age was 73 (IQR, 66 - 80) years, and 96 patients (56.5%) were men. The median D-dimer level was 477 (IQR, 249 – 988). The mean National Institutes of Health Stroke Scale score was 14.7 ± 6.7. Poor outcome (modified Rankin scale = 3 to 6) at 3 months were more frequent in patients with high tertiles (T1, 26.3%, T2, 57.1%, and T3, 76.4%). Multivariate analysis showed that D-dimer level was an independent predictor of poor outcome at 3 months. Comparing the lowest tertiles the highest tertiles showed independently associated with poor outcome at 3 months (OR 4.399, 95% CI 1.594-12.135). No evidence of heterogeneity of the D-dimer effect across the subgroups was noted. The direction of effect unfavoured the high tertiles group across all strata.

Conclusions: We found that D-dimer after EVT can predict the poor outcome at 3 months. Early surrogate marker after EVT might be helpful both in clinical practice and clinical trials.

Disclosure: No

P0148 / 358

ASSOCIATION OF WHITE BLOOD CELL COUNT WITH CLINICAL OUTCOME INDEPENDENT OF TREATMENT WITH ALTEPLASE IN ACUTE ISCHEMIC STROKE

E. Barow ¹, F. Quandt¹, B. Cheng¹, M. Gelderblom¹, M. Jensen¹, A. Königsberg¹, F. Boutitie², N. Nighoghossian², M. Ebinger³, M. Endres³, J.B. Fiebach³, V. Thijs⁴, R. Lemmens⁵, K.W. Muir⁶, S. Pedraza⁷, C.Z. Simonsen⁸, C. Gerloff¹, G. Thomalla¹

¹University Medical Center Hamburg-Eppendorf, Hamburg, Germany, ²Hospices Civils de Lyon, Lyon, France, ³Charité – Universitätsmedizin Berlin, Berlin, Germany, ⁴University of Melbourne, Melbourne, Australia, ⁵University Hospitals Leuven, Leuven, Belgium, ⁶University of Glasgow, Glasgow, United Kingdom, ⁷Institut de Diagnostic per la Image, Girona, Spain, ⁸Aarhus University Hospital, Aarhus, Denmark

Background and aims: To assess the association between white blood cell (WBC) count and treatment effect of intravenous alteplase on functional outcome in acute ischemic stroke.

Methods: WAKE-UP was a randomized controlled trial of efficacy and safety of MRI-based thrombolysis in unknown onset stroke. WBC count was measured on admission and 22-36 hours after randomization to treatment. Favorable outcome was the score of 0-1 on the modified Rankin Scale (mRS) at 90 days after stroke. Further outcomes were stroke volume and any hemorrhagic transformation (HT).

Results: Of 503 randomized patients, WBC count and baseline parameters were available in 437 patients on admission and 355 patients on follow-up. Median WBC count on admission was 7.6 x 10⁹ g/l (interquartile range, IQR, 6.1 – 9.4 x 10⁹ g/l) and 8.2 x 10⁹ g/l (IQR, 6.7 – 9.7 x 10⁹ g/l) on follow-up. Higher WBC count on admission and follow-up adjusted for age, National Institutes of Health Stroke Scale score, temperature and treatment (alteplase vs. placebo) were both associated with lower odds of favorable outcome (adjusted OR of 0.85, 95% confidence interval [CI)] 0.78-0.94 and aOR 0.88, 95% CI 0.79-0.97). No interaction of WBC count and treatment was observed. Furthermore, WBC count on admission was significantly associated with HT (aOR 1.14, 95%CI 1.05-1.24), whereas WBC on follow up was associated with larger stroke volume (p=0.03).

Conclusions: Higher WBC count is associated with unfavorable outcome, independent of treatment with alteplase. Elevated WBC count is related to an increased risk of HT.

ClinicalTrials.gov identifier NCT01525290.

Disclosure: No

P0149 / 1399

INTRAVENOUS THROMBOLYSIS IN ACUTE ISCHAEMIC STROKE AFTER REVERSAL OF UNFRACTIONATED HEPARIN WITH PROTAMINE: CASE SERIES ANS SYSTEMATIC REVIEW OF LITERATURE

K. Berger ¹

¹ University of Tübingen, Department of Neurology, Tübingen, Germany

Background and aims: Intravenous thrombolysis (VT) is the gold standard for acute ischemic stroke (AIS).10% of AIS-patients cannot be treated with IVT due to limiting contraindications,including heparin usage within the past 48 hours.Protamine is a potent antidote to heparin forming an inactive metabolite. There is limited data on IVT following antagonization of heparin using protamine. Herewith, we report a case series of IVT-treated patients after antagonization of heparin using protamine and provide a systematic review to evaluate the outcome of such treatment algorithm.

Methods: Patients receiving IVT after heparin reversal with protamine between 01/2015 and 09/2021 in our stroke centre were analysed regarding clinical data including, stroke severity using National Institutes of Health Stroke Scale (NIHSS), treatment course and outcome. Safety data was obtained for mortality and symptomatic intracerebral hemorrhage (sICH).Follow-up was assessed using the modified Rankin Scale (mRS).Good outcome was defined as mRS 0-2,excellent outcome as mRS 0-1.We searched PubMed and Scopus for all published cases of IVT after reversal with protamine in AIS-patients.

Results: We included 5 patients (56.2±16 years, 20% female, median pmRS 1 (2,5)) treated with IVT after heparin reversal using protamine. Median NIHSS change was 3,4 patients improved clinically. On follow-up, 60% had excellent, 20% good outcome. Literature review included the analysis of 11 patients (68.2± 8.5 years, 46% female,median pmRS 2(2,5)). Good clinical outcome was observed in 46%, excellent outcome in 18%, in 27% no benefit was observed. No adverse reactions by protamine were reported, no sICH occurred.

Conclusion: IVT in heparin anticoagulated patients treated with protamine seems to be safe and prospectively may extend the number of AIS-patients who can benefit from reperfusion treatment using IVT. Further prospective registry trials are needed.

Disclosure: No

P0150 / 1555

COMPUTERIZED CLINICAL DECISION SUPPORT SYSTEM IMPROVES DOOR-TO-NEEDLE TIME FOR ACUTE ISCHEMIC STROKE

C. Venkatasubba Rao ^1,2, E. Villatoro², V. Nguyen², K. Siddiqui³, A. Ahmad³, M. McGlennon³, M. Hirzallah¹, K. Ressler³, U. Hafeez³, R. Damani¹, H. Radhakrishnan⁴, J. Holcomb⁴, B. Shresta⁴, E. Bershad¹

¹Baylor College of Medicine, Neurology, Neurosurgery and Center for Space Medicine, Houston, United States, ²Baylor St Luke's Medical Center, Neurosciences, Houston, United States, ³Baylor College of Medicine, Neurology, Houston, United States, ⁴DECISIOInsight, Houston, United States

Background and aims: Administration of thrombolytics (tPA) within the first 60 minutes of presentation for acute Ischemic Stroke is recommended. We utilized a computerized clinical decision support (CCDS) software to identify such patients and created timely alerts to coordinate teams and optimize workflow through a plan-do-study-act (PDSA) based approach.

Methods: We reviewed all patients who received thrombolytics for Ischemic Stroke after prospectively implementing the DECISIOInsight software which digitized our institutional stroke protocol in acute Ischemic Stroke patients. The software displayed a countdown door-to-needle (DTN) timer at bedside while sending out automated alerts via TigerConnect (a HIPAA compliant communication tool) every 15 minutes to key patient care providers. We performed PDSA cycles to address systemic issues affecting the delay of care in real time using this CCDS software and workflow modification tool. The primary outcome was DTN time. The secondary outcome was DTN <30 or <45 minutes.

Results: 76 patients (46% females, 50% African American, average age of 67 years, median NIHSS of 7.5 and ASPECTS score of 10) received tPA between January 2020 and November 2021. The average time to tPA decreased from 84 minutes (1st Quarter 2020) to 39 minutes (3rd Quarter 2021) (p for trend =0.01). Similarly, the proportion of patients receiving tPA within 45 minutes and within 30 minutes improved from 27.3% to 83.3% (p for trend =0.01) and 0.0% to 41.7% (p for trend =0.006), respectively.

Conclusions: Despite the COVID-19 pandemic, the CCDS-based stroke identification and alerting system significantly improved DTN time in ischemic stroke patients.

Disclosure: No

P0151 / 1374

VALIDATION OF ISCHEMIC STROKE MODELS FOR USE IN TRANSLATIONAL RESEARCH:IN VITRO FLOW AND IN VIVO RAT MODELS

S. Thalerová ^1,2,3, P. Scheer^1,4, J. Hložková^1,4, E. Brhelová¹, P. Kittová^2,3, M. Pešková^2,3, J. Víteček^2,5, L. Kubala^2,5, R. Mikulík¹

¹St. Anne's University Hospital Brno, International Clinical Research Center, Brno, Czech Republic, ²Institute of Biophysics AS CR, Department of Biophysics of Immune System, Brno, Czech Republic, ³Masaryk University, Faculty of Science, Department of Biochemistry, Brno, Czech Republic, ⁴Masaryk University, Faculty of Pharmacy, Department of Pharmacology and Toxicology, Brno, Czech Republic, ⁵St. Anne's University Hospital Brno, International Clinical Research Center, Center of Biomolecular and Cell Engineering, Brno, Czech Republic

Background and aims: The development of more effective recanalization treatments, e.g., new thrombolytics, for acute ischemic stroke treatment will be facilitated if high-throughput screening and clinically relevant models are available. We present cross-validation of two thrombolytic models, in vitro and small animal in vivo model, using alteplase and tenecteplase.

Methods: In vitro flow model with semi-synthetic clots and in vivo systemic embolization rat model with synthetic clots were used to evaluate efficacy of alteplase and tenecteplase. Thrombolytics were applied at a dose or concentration clinically relevant to alteplase for treatment of ischemic stroke. In both models, efficacy was determined by real-time measuring the clot size change during 60-minute incubation/thrombolytic infusion.

Results: In in vitro (n=36 – alteplase, n=10 – tenecteplase) and in vivo (n=28 – alteplase, n=4 – tenecteplase) experiments, alteplase-treated clots showed relative clot reduction in vitro 54±41% vs in vivo 52±29% (difference 1.8%, 95%CI -17-20%). Tenecteplase-treated clots showed relative clot reduction in vitro 52±43% vs in vivo 82±15% (difference 30%, 95%CI -19-79%). In vitro, alteplase vs tenecteplase showed the same relative clot reduction (difference 2%, 95%CI -28-32%); in vivo, tenecteplase had better efficacy compared to alteplase (difference 30%, 95%CI 0-60%).

Conclusions: Clot reduction due to alteplase was similar in both models and compared well with clinical data (clot size reduction 41% (Kim YD et al., 2015)). Higher clot reduction of tenecteplase vs alteplase in the in vivo model is due to prolonged half-life of tenecteplase in vivo. Our models could be suitable to predict thrombolytic efficacy in patients.

Disclosure: No

P0152 / 1587

EIGHT-YEAR EVOLUTION OF TEMPORAL TRENDS IN REPERFUSION THERAPY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

C. El Khoury ¹, C. Aboa-Eboulé², L. Fraticelli³, O. Guerrier⁴, J. Freyssenge^1,5, E. Moderni¹, M. Bischoff¹, M. Buisson⁶, S. Cakmak⁷, F. Philippeau⁸, P. Serre¹, K. Blanc-Lassere⁹, A.-E. Vallet¹⁰, N. Nighoghossian⁴, T.H. Cho⁴, L. Mechtouff⁴, E. Ong⁴, L. Derex^4,5

¹RESUVal, ARS Auvergne Rhône-Alpes, Vienne, France, ²Louis Pradel Hospital, Hospices Civils de Lyon (HCL), Department of ambulatory cardiology, Bron, France, ³University of Lyon, Laboratory Systemic Health Care, EA4129, Lyon, France, ⁴Hôpital Neurologique, Hospices Civils de Lyon (HCL), Department of stroke medicine, Bron, France, ⁵Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France, ⁶Hospices Civils de Lyon, Clinical Investigation Center, Lyon, France, ⁷Hôpital de Villefranche sur Saône, Department of Stroke Medicine, Villefranche sur Saône, France, ⁸Hôpital de Bourg en Bresse, Department of Stroke Medicine, Bourg en Bresse, France, ⁹Hôpital de Valence, Department of Stroke Medicine, Valence, France, ¹⁰Hôpital de Vienne, Department of Stroke Medicine, Vienne, France

Background and aims: The RESUVal registry was funded to organize emergency care pathways and improve clinical practices throughout its territory in the Auvergne Rhône-Alpes region (France). This study aimed to analyze the temporal trends in thrombolysis rates for acute ischemic stroke (AIS) after implementation of the RESUVal network.

Methods: A retrospective study based on a prospective multi-center observational registry was conducted from 2010 to 2018, covering a population of 3 million inhabitants. The AIS treated with reperfusion therapy were included in one of the five primary stroke units or one comprehensive stroke center and 37 emergency departments by using a standardized case report form. Analysis on delays and temporal linear trends in thrombolysis rates were assessed.

Results: A total of 32,319 AIS were reported in the regional hospitalization database of which 2,215 thrombolyzed AIS patients were included in the registry. Throughout the study period, the annual incidence rate of thrombolysis continuously and significantly increased from 10.2 to 17.3% (p-trend=0.0013). The median Rankin scale score was 2 (IQR 0-4) and remained stable, as did the percentage of patients with a good recovery (mRS ⩽1) (33.3%). The follow-up of the onset-to-door and the door-to-needle delays showed stable rates, and so the 3-month all-cause mortality rate (13.2%).

Conclusions: Although access to stroke thrombolysis has increased linearly since 2010, the 3-month functional outcome has not evolved as favorably. One of the goals of the RESUVal network will be to focus on reducing hospital delays.

Disclosure: No

P0153 / 106

EVALUATION OF STROKE PROGNOSTICATION USING AGE AND NIH STROKE SCALE INDEX (SPAN-100 INDEX) IN DELAYED INTRAVENOUS THROMBOLYSIS PATIENTS (BEYOND 4.5 HOURS)

N. Elsaid ^1,2, A. Saied^1,2, M.L. Dell’Acqua², L. Vandelli², L. Ciolli², L. Picchetto², G. Borzi², R. Ricceri², R. Pentore², S. Vallone³, S. Meletti², G. Bigliardi²

¹Faculty of Medicine, Mansoura University, Neurology Department, Mansoura, Egypt, ²Ospedale Civile di Baggiovara, AOU di Modena, Stroke Unit – Neurology Clinic, Department of Neuroscience, Modena, Italy, ³Ospedale Civile di Baggiovara, AOU di Modena, Stroke Unit – Neurology Clinic, Department of Radiology, Modena, Italy

Introduction: The efficacy of delayed intravenous tissue plasminogen activator (tPA), beyond the 4.5 hours window, is evolving. Advanced age and high admission National Institutes of Health Stroke Scale (NIHSS) score are proposed to adversely affect the outcome of delayed thrombolysis and limit the inclusion criteria. The summation of patient age and admission NIHSS score was introduced as the SPAN-100 index as a tool of prediction of the clinical outcome after acute ischemic stroke (AIS). We aimed to assess the SPAN-100 index in AIS thrombolysed patients after 4.5 hours.

Methods: The SPAN-100 index was applied to AIS patients receiving delayed IV thrombolysis (IVT) after 4.5 hours. Patients demographics, risk factors, clinical, laboratory and radiological data, mismatch evidence, treatment onset and modality, NIHSS score at baseline and at discharge, and 3 months follow-up modified Rankin Scale (mRS) were reviewed. SPAN-100 score ⩾ 100 is classified as SPAN-100 positive while score < 100 is SPAN-100 negative. Clinical outcomes, death, and intracerebral hemorrhage (ICH) incidences were compared between SPAN-100 positive and negative groups.

Results: SPAN-100-positive delayed IVT-patients (11/136) had a 6-fold increased risk for unfavorable outcome compared to SPAN-negative patients (OR 6.34; 95% CI 1.59–25.24 p=0.004), however, there was no relation between the SPAN-100 positivity and mortality or ICH.

Conclusion: the SPAN-100 index may be used to predict the clinical outcome of delayed IVT patients. However, it is not predictive of ICH or death, thus the feared risk of ICH or death shouldn’t withhold the SPAN-100 positive patients from delayed IVT.

Disclosure: No

P0154 / 333

INTRAVENOUS THROMBOLYSIS AND ENDOVASCULAR THROMBECTOMY FOR ACUTE ISCHAEMIC STROKE IN MOYAMOYA DISEASE PATIENTS - A SYSTEMATIC REVIEW OF CASE REPORTS

M.-Y. Koh ¹, K.Z.-X. Toh¹, B.Y.-Q. Tan², J.S.-Y. Ho³

¹Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, ²Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore, ³Royal Free London NHS Foundation Trust, London, United Kingdom

Background and aims: Moyamoya disease (MMD) can present with ischaemic or haemorrhagic stroke. Medical management of MMD currently recommends antiplatelet therapy, however, evidence is lacking for other acute interventions like intravenous thrombolysis (IVT) and endovascular thrombectomy (ET) in MMD-associated acute ischaemic stroke (AIS). Given moyamoya vessels’ friability, these acute interventions have been considered unsafe. This study aimed to perform a systematic review of literature to evaluate the safety and efficacy of IVT or ET in managing MMD-associated AIS patients.

Methods: Using a suitable search strategy, a systematic search was performed manually and from four electronic databases: PubMed, Cochrane Library, EMBASE and Scopus. Twelve case reports detailing 12 MMD patients presenting with AIS and undergoing IVT or ET, or both, were included in the analysis.

Results: The median National Institute of Health Stroke Scale score at presentation was 10 (IQR 6–14). IVT alone was instituted in 7 patients (58.3%), primary ET was attempted in 3 (25%), and 2 (16.7%) had received bridging IVT with ET. Of the 5 patients who underwent ET, 2 (40%) achieved successful reperfusion (mTICI>2b). In terms of functional outcomes, 2 patients (16.7%) achieved complete recovery (modified Rankin Scale 0), 5 (41.7%) attained improvement in neurological status, and 4 (33.3%) had no improvement, whilst functional outcome was unreported in 1 patient. No patient experienced symptomatic intracranial haemorrhage.

Demographics, presentation, treatment and outcomes of patients
No.	Author	Year	Age	Gender	NIHSS at presentation	Imaging - Parenchymal	Imaging - Vascular (CTA/MRA)	Cerebral angiography	Thrombolysis Type	Endovascular Thrombectomy	Immediate Complications	Functional Outcome
1	Lee et al.	2012	37	F	11	MRI-DWI: L MCA and L ACA territories ischaemic infarct	MRA: Bilateral supraclinoid ICA occlusion	R terminal ICA, L supraclinoid ICA occlusion. Abnormal network of fine vessels at the base of the brain.	IV Alteplase, IA at left ICA	Not performed	None	NIHSS 8 post-treatment; NIHSS 1 and mRS 1 at 1-month
2	Ahmad et al.	2018	54	F	4	CTB: No acute abnormalitiesMRI: R MCA territory ischaemic infarcts, chronic bilateral cortical and subcortical infarcts.	MRA: L MCA occlusion. R MCA and bilateral ACA stenosis.CTA: Bilateral supraclinoid ICA and proximal MCA stenosis. L M1 occlusion. Prominent lenticulostriate vessels	Bilateral stenosis of the supraclinoid ICA and proximal MCA. L M1 occlusion. Prominent lenticulostriate vessels consistent with moyamoya (R>L).	IV Alteplase	Not performed	None	Not reported
3	Almeida et al.	2019	36	F	6	CTB: No acute abnormalities	CTA/Transcranial Doppler US: Distal L ICA occlusion	Bilateral ICA occlusion, bilateral moyamoya	Not given	Attempted, but unsuccessful as guidewire could not go through L ICA	None	Symptoms improved, NIHSS 3 post-treatment
4	Argetsinger et al.	2015	55	F	22	CTB: ASPECTS = 9, "dense vessel sign" in L MCA.	CTA: L distal intracranial ICA and L M1 near occlusion	Supraclinoid L ICA stenosis, L MCA occlusion, collateralisation to lenticulostriate branches	IV Alteplase	Stent retriever (TICI 0 to 2B). Wingspan stent (TICI 2B) post reocclusion.	None	mRS 3 at 90 days
5	Elkady et al.	2020	56	F	12	CTB: L CSAHDWI-MRI: L MCA territory ischaemic infarct	MRA: L proximal MCA occlusion.CTA: M1 of L MCA near occlusion.	NR	Not given	Unsuccessful as failed to remove the thrombus fully.	None	Symptoms improved
6	Tabuchi et al.	2013	33	M	20	CTB: No acute abnormalitiesMRI: L basal ganglia to corona radiata ischaemic infarctsPerfusion MRI: Prolongation of MTT in left MCA territory	MRA: Bilateral terminal ICA stenosis and occlusion at the origin of L MCA	Mild stenosis of R terminal ICA, severe stenosis A1 of R ACA, severe stenosis L terminal ICA and M1 of L MCA.	IV Alteplase	Not performed	Progression of symptoms. Emergency STA-MCA bypass performed.	Resumed full-time employment at 4-months
7	Valluri et al.	2018	54	F	9	CTB: No acute abnormalities	MRA: Possible chronic watershed infarctions within the left hemisphere	Chronic occlusion of M1 of L MCA. Tangle small collaterals in L temporal region. Large L ACA collaterals.	IV Alteplase	Not performed	None	mRS 0 immediately post-treatment
8	Wasserman et al.	2021	29	F	Not reported. Left hemiparesis and hemisensory paraesthesia and bilateral temporal scotomas.	CTB: No acute abnormalities	CTA: R MCA occlusionMRA: Replacement of R MCA with multiple small tortuous vessels	R ICA stenosis	IV Alteplase	Not performed	None	mRS 0 immediately post-treatment
9	Yokoyama et al.	2013	38	M	13	MRI: No acute abnormalities	MRA: L terminal ICA, bilateral ACA, R vertebral artery stenosis.	L terminal ICA stenosis, collateral circulation from the ECA. Vascular network at base of the brain (L>R).	IV Alteplase	Not performed	None	NIHSS 3, mRS 1 at 12 days
10	Jehangir et al.	2015	26	F	Not reported. Right arm paraesthesia, right arm weakness, right facial droop, slurred speech.	CTB: No acute abnormalities	MRA: Bilateral intracranial ICA, PCA, SCA, AICA stenosis. L PICA and cervical L ICA stenosis.	NR	IV Alteplase	Not performed	None	Symptoms improved
11	Ogawa et al.	2021	51	F	Not reported. Consciousness disturbance, right conjugate deviation, left hemiparesis.	MRI: R frontal lobe, insular cortex, caudate nucleus, and internal capsule ischaemic infarcts, ASPECTS + W = 3 .	MRA: Bilateral MCA occlusion	Bilateral terminal ICA stenosis. Extremely delayed flow in R terminal ICA.	Not given	Aspiration catheter (TICI 2C)	None	mRS 2 at 90-days
12	Sogabe et al.	2020	73	F	6	MRI DWI: Mild high-intensity foci in L caudate nucleus, putamen, corona radiata.	MRA: L terminal ICA occlusion	Bilateral terminal ICA to proximal MCA stenosis. R MCA occlusion. Moyamoya vessels in the basal ganglia region.	IV Alteplase	Stent retriever, balloon angioplasty (TICI 3)	Acute thrombus in left ICA post thrombolysis. Persistent stenosis post MT.	mRS 1 at discharge

Conclusions: In this systematic review of case reports, the utility of IVT and ET in MMD-associated AIS appears feasible. Further larger cohort studies are required to evaluate these treatment approaches.

Disclosure: No

P0155 / 692

AGE-RELATED FEATURES OF THROMBOLYSIS IN ISCHEMIC STROKE

S. Kotov ¹, S. Belkina¹, E. Isakova¹, A. Kotov¹

¹ M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Department of Neurology, Moscow, Russian Federation

Background and aims: Frequency of ischemic strokes (IS) increases with age. Systemic thrombolysis (STL) with tPA is an efficacious treatment for stroke and leads to improved outcomes. The aim of the study was to evaluate the effectiveness of STL in elderly and senile people.

Methods: 205 patients were examined (64.6±11.7 years) in acute IS in the middle cerebral artery, 104 were 60-74 years old (group 1), 41 - 75 and older (group 2). Period from appearance of first signs of IS to beginning of STL was 158.7 ± 47.4 minutes. Atrial fibrillation was detected in 38.1 patients of group 1 and 65.9 - 2, type 2 diabetes mellitus - in 29.8 and 43.9, atherothrombotic subtype IS – in 43.3 and 31.7, cardioembolic (CEIS) - in 28.9 and 48.8%, respectively.

Results: NIHSS score at admission was 10.0 [8.0, 14.0] in group 1, 14.0 [10.0, 17.0] in 2 (p=0.014). Frequency of symptomatic hemorrhagic transformation (SHT) was 10.6% in group 1, 36.6% in 2. Mortality in the acute period was 11.5% in group 1, 34.1% in 2 (p=0.0053). NIHSS in survivors on day 28 was 3.0 [1.0, 5.25] in group 1, 3, 0 [2.0, 8.5] in 2 (p=0.236).

Conclusion: CEIS and type 2 diabetes mellitus were more often detected in the elderly, which caused a greater severity, probably contributed to a greater frequency of SHT compared with middle-aged and elderly patients. Despite this, on 28th day, survivors in all age categories showed the same regression of neurological disorders.

Disclosure: No

P0156 / 1591

A SINGLE-CENTER EXPERIENCE OF INTRAVENOUS THROMBOLYSIS AND MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE IN UKRAINE

O. Tsurkalenko ¹, Y. Cherednychenko², L. Dziak¹, T. Vikhrova², M. Dibrova²

¹Dnipro State Medical University, Dnipro, Ukraine, ²Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnykov, Dnipro, Ukraine

Objective: Intravenous thrombolysis (IVT) Mechanical thrombectomy (MT) are the reference pharmacological treatment in acute ischemic stroke (AIS). We aimed to present a single center experience of IVT and MT in Dnipro, Ukraine.

Materials and methods: This is a single center prospective observational study of patients receiving thrombolysis between January 2020 and December 2021.

Results: A total 151 patients were included: 79 received thrombolysis alone, 18 - MT alone, 54 - bridging therapy (IVT followed by MT). Since January 2021, the neurological department has been reorganized into stroke unit with trained stuff. The rate of IVT increased from 1% (n=11) in 2020 to 11,1% in 2021 (n=122). The median of the start-to-door time was 101±45 minutes. The median door-to-needle time (DNT) was 81±33 minutes, showing significant improvement between 2020 (134 minutes) and 2021 (81 minutes) (p<0.001). Likewise, there was a constant decrease in DNT. The median of the NIHSS score at discharge was 6 points, with a prethrombolysis score of 12 points. The mortality rate was 12.7% (n=19) : 10 due to AIS, 6 due to hemorrhagic transformation 2 due to severe pneumonia, and 1 due to cancer. IVT + MT was associated with better functional outcome (OR 1.51; 95%) and lower mortality (OR 0.61; 95%).

Conclusions: The presence of stroke unit with trained stuff has allowed us to increase the quantity and quality of IVT and MT in our hospital. The number of patients treated per year was increased in 10 times. The mean door-to-needle time significantly improved.

Disclosure: No

P0157 / 1187

IS BRIDGING THERAPY ADVANTAGEOUS IN PATIENTS WITH FINAL TICI 2B?

C. Bernardes ¹, J.A. Sousa¹, R. Pires², R. Ramalho³, C. Maia², A. Henriques³, A.I. Rodrigues⁴, A.I. Martins¹, A. Brás¹, L. Almendra¹, C. Cecília¹, C. Machado¹, B. Rodrigues¹, C. Nunes², R. Veiga², G. Santo¹, F. Silva¹, E. Machado², J. Sargento-Freitas^1,5

¹Coimbra University Hospital Centre, Neurology, Coimbra, Portugal, ²Coimbra University Hospital Centre, Neuroradiology, Coimbra, Portugal, ³Coimbra University Hospital Centre, Internal Medicine, Coimbra, Portugal, ⁴Leiria Hospital Centre, Internal Medicine, Leiria, Portugal, ⁵Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Background and aims: It is controversial whether endovascular treatment alone (EVT) is non-inferior to intravenous thrombolysis plus endovascular treatment (IVT+EVT) for large vessel occlusion acute ischemic strokes (LVO-AIS), particularly in specific subgroups of patients. Due to its ability in promoting the dissolution of more distal emboli, IVT+EVT might increase the odds of good outcomes in TICI 2b patients

The aim of this work is to investigate whether IVT+EVT is superior to EVT alone in TICI 2b patients.

Methods: Retrospective analysis of consecutive patients admitted to a comprehensive stroke centre with anterior circulation LVO-AIS and submitted to EVT with final TICI 2b. Functional independence at 90 days (defined as modified Rankin Scale ⩽2 or equal to premorbid), 90-day mortality and haemorrhagic transformation were compared between patients submitted to EVT and IV+EVT.

Results: We identified 154 patients submitted to EVT with final TICI 2b, mean age 78.2 (SD 11.5) years and 52.6% female. Of those, 39.6% had bridging therapy with IVT. 90-day functional independence (43.8% vs 51.9%, p=0.5) and 90-day mortality (12.4% vs 15.1%, p=0.643) did not differ between groups. Haemorrhagic transformation was increased in patients submitted to IVT+EVT (23.7% vs 47.2%, p=0.034), but symptomatic haemorrhagic transformation was similar (2.4% vs 1.9%, p=0.827).

Conclusions: Among patients with anterior circulation LVO-AISC submitted to EVT and final TICI 2b, our results suggest that bridging therapy does not appear to be superior to EVT alone.

Disclosure: No

P0158 / 1120

WITHDRAWN HOSPITAL DISPARITIES IN REPERFUSION THERAPY FOR PATIENTS WITH ACUTE ISCHEMIC STROKE

J.-M. Park ¹, H.-K. Park², S.-E. Kim³, Y.-J. Cho², J.Y. Kim³, H. Oh³, B.J. Kim³, K.-Y. Park⁴, K.B. Lee⁵, S.J. Lee⁶, J.S. Lee⁷, J. Lee⁸, H.-J. Bae³

¹Uijeongbu Eulji Medical Center, Eulji University, Neurology, Uijeongbu, Korea, Republic of, ²Inje University Ilsan Paik Hospital, Goyang, Korea, Republic of, ³Seoul National University Bundang Hospital, Seongnam, Korea, Republic of, ⁴Chung-Ang University Hospital, Seoul, Korea, Republic of, ⁵Soonchunhyang University Hospital, Seoul, Korea, Republic of, ⁶Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea, Republic of, ⁷Asan Medical Center, Clinical Research Center, Seoul, Korea, Republic of, ⁸Korea University College of Medicine, Seoul, Korea, Republic of

Background and aims: Health care disparities are widespread, including in stroke care. Reperfusion therapy is a standard treatment for acute ischemic stroke, but there may be disparities in relation to its utilization across hospitals.

Methods: Data from 75,870 patients admitted to 247 acute stroke care hospitals covering the entire country of South Korea were obtained from the Acute Stroke Quality Assessment Program of 2013-2018 held by the Health Insurance Review and Assessment Service. The primary outcome measure was the hospital reperfusion therapy rate (RTR) defined as the proportion of intravenous tissue plasminogen activator (IVT) and/or endovascular thrombectomy (EVT) cases in patients potentially eligible for reperfusion therapy (onset-to-arrival time ⩽ 6 hours, initial NIHSS score ⩾ 4). Hospital RTRs, adjusted for age, sex, onset-to-arrival time, and initial stroke severity, were correlated with hospital characteristics.

Results: During the study period, 10,513 stroke patients potentially eligible for reperfusion therapy were admitted to 247 acute care hospitals. The overall RTR was 52.9%. The average hospital RTR was 52.9% (range 0–100%). A higher number of beds and average stroke admission per month were associated with higher adjusted RTR. RTR was inversely correlated with 1-year crude mortality within the hospital level. Multivariable analysis revealed the average stroke admission per month, presence of stroke unit, the average IVT per month, and the average EVT per month were the independent determinants for adjusted RTR.

Conclusions: Hospital RTRs vary widely and higher hospital RTRs are associated with better outcomes. Higher hospital patient volume is associated with higher hospital RTRs.

Disclosure: No

P0159 / 1422

HIGHER EFFICACY OF THROMBOLYSIS IN CARDIOEMBOLIC STROKE

A. Sanna ¹, F. Cabigiosu¹, B. Zanda¹, L. Saderi², R. Boccaletti¹, G. Sotgiu²

¹Azienda Ospedaliera Universitaria di Sassari, Stroke Unit, Sassari, Italy, ²Azienda Ospedaliera Universitaria di Sassari, Clinical Epidemiology and Medical Statistics Unit, Sassari, Italy

Background and aims: Ischemic stroke is the third leading cause of death and the first cause of disability in high income countries. Intravenous thrombolysis, mostly performed administering recombinant tissue-type plasminogen activator (r-tPA), is recommended for ischemic stroke. TOAST classification divides ischemic stroke into five categories based on their pathophysiology. Atherothrombotic, cardioembolic, and lacunar strokes are the more frequent subtypes. Aim of the present study is to assess the effectiveness of r-tPA in ischemic stroke subtypes.

Methods: Italian patients undergoing thrombolysis from 1^st January 2014 to 31^st December 2017 were consecutively enrolled in our Stroke Unit (287 patients). NIHSS was assessed before treatment and after 2 and 24 hours, and after seen days. Three subgroups were selected:, atherothrombotic (1) cardioembolic (2), and lacunar stroke (3).

Results: Patients with an atherothrombotic stroke showed a higher baseline NIHSS (1)14vs(2)12vs(3)5, which was confirmed during the selected time points: after 2 hours (1) 11,5vs(2)8vs(3)3, after 24 hours (1) 9.5vs(2)6vs(3)2, after 7days (1) 6vs2,5(2),vs(3)1. A lower response to r-tPA in the group of atherothrombotic stroke was found (p<0.0001). STATA 18 was used for statistical analysis

Conclusions: The different response might depend on the thrombus composition; thrombotic material in the cardioembolic and lacunar subgroups might be more susceptible to r-tPA. Tailored therapies would be needed based on the stroke subtype characteristics.

Disclosure: No

P0160 / 1361

A STUDY OF OUTCOME OF STANDARD VERSUS LOW DOSE THROMBOLYSIS IN ACUTE ISCHEMIC STROKE

A. Goswami ¹, P.N. Renjen¹, K.K. Jindal², D. Chaudhari¹

¹Indraprastha Apollo Hospital, Department of neurosciences, New Delhi, India, ²Max Super Speciality Hospital, Department of Neurology, New Delhi, India

Background and aims: To study the outcome of thrombolysis in acute ischemic stroke with standard dose of alteplase (rtPA) and low dose alteplase (rtPA).

Methods: A total of 60 acute ischemic stroke patients reporting within 4.5 hours of onset of symptoms were enrolled from August, 2019 to June, 2021. Patients were evaluated, urgent NCCT head was performed, NIHSS and MRS score was calculated. Patients fulfilling AHA/ASA guidelines (2019 update) for thrombolysis were randomly assigned to receive low dose (0.6mg/kg;15% as bolus and 85% as infusion over one hour) or standard dose (0.9mg/kg;10% as bolus and 90% as infusion over one hour) alteplase with a maximal dose limit of 90mg. After thrombolysis, all patients were monitored in Intensive care unit at least for 24 hours and blood pressure was strictly monitored as per AHA/ASA guideline.

Results: According to TOAST classification most patients were large artery stroke followed by small vessel disease, cardioembolic, undetermined etiology and other determined etiology. Mean NIHSS and MRS of study patients were 12.72 (SD=4.95) and 4.19 (SD=0.89). Functional outcome of 0-2 (independent) on MRS scale was achieved by 58.33% patients in standard dose group and 54.17% in low dose group at 3 months.

Conclusions: Lower dose of alteplase was found to be non-inferior to standard dose of alteplase in terms of efficacy for thrombolysis in acute ischemic stroke. Symptomatic ICH is more common in thrombolysis with standard dose of alteplase and significantly less with low dose of alteplase.

Disclosure: No

P0161 / 1087

ANTIPLATELET VS. ANTICOAGULATION IN CERVICAL ARTERY DISSECTION

X. Zhang ¹, S. Liu², X. Bai¹, Y. Yang³, T. Wang¹, X. Xu¹, R. Xu¹, L. Li¹, Y. Feng¹, K. Yang¹, X. Wang¹, Y. Ma¹, L. Jiao¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Peking Union Medical College, Department of Clinical Medicine, Beijing, China, ³Imperial College London, National Heart & Lung Institute, London, United Kingdom

Background and aims: The optimal management for cervical artery dissection (CAD) is uncertain. This study aimed to summarize the current randomized controlled trials (RCTs) to compare the efficacy and safety of antiplatelet and anticoagulation therapies for CAD.

Methods: A literature search was conducted in the major databases. Only the RCTs comparing the antiplatelet and anticoagulation therapies for the patients with CAD were included. Combined estimates of the relative risk (RR) of antiplatelet vs. anticoagulation were analyzed. The analyses were performed in the intention-to-treat (ITT) and per-protocol (PP) population, respectively.

Results: Two RCTs involving 444 patients in the ITT population and 370 patients in the PP population were included. The quality of studies was high overall. In the ITT population, compared with the patients in the anticoagulation group, the patients in the antiplatelet group showed a higher rate of ischemic stroke within 3 months (RR = 6.73, P = 0.029). No difference between these two treatment groups was found for the outcomes of transient ischemic attack, intracranial hemorrhage, or the composite of these outcomes within 3 months. For the PP population, the results of the meta-analysis of outcomes between the antiplatelet and anticoagulation groups were consistent with the ITT population.

Conclusions: Compared with the antiplatelet group, the anticoagulation group has a lower risk of ischemic stroke without increasing bleeding risk when treating CAD. Anticoagulation seems to be superior over the antiplatelet in treating CAD but needs to be further tested by specifying several issues, such as location, and initial symptom types.

Disclosure: No

P0162 / 771

CLINICAL FEATURES AND THROMBOLYSIS TREATMENT RESULT OF ISCHEMIC STROKE PATIENTS BEYOND 4.5 HOURS

T. Pham-Quang ¹, V.-P. Dao¹, H. Nguyen-Thi², D. Nguyen-Tien¹, Q. Phan-Ha¹, T. Vuong-Xuan¹, A. Nguyen-Minh¹, V. Bui-Quoc¹, H. Dinh-Trung¹, T. Phung-Dinh¹, T. Tran-Anh³, T. Mai-Duy¹

¹Bachmai Hospital, Stroke Center, Hanoi, Vietnam, ²Thanhnhan General Hospital, Intensive Care Department, Hanoi, Vietnam, ³Bachmai Hospital, Radiology Center, Hanoi, Vietnam

Background and aims: Ischemic stroke is the leading cause of death and disability worldwide. However, only a small number of patients who present within 4.5 hours from onset meet the criteria for thrombolysis therapy. This study is to identify the efficiency of thrombolysis treatment among ischemic stroke patients beyond 4.5 hours.

Methods: A prospective descriptive study was conducted at Bachmai hospital on a group of wake-up ischemic stroke patients and those with unknown times of onset. The selected patients had visible lesions on MRI DWI but no changes on FLAIR and were not planned for thrombectomy therapy. Thrombolysis was started within 4.5 hours from symptoms recognition. The primary outcomes were the rate of favorable outcome (mRS 0-2), and the rate of mortality at 90 days.

Results: Among 40 patients recruited, the interval between last-seen-well time and treatment initiation was 7.75 ± 2.13 hours; median time from symptoms recognition to treatment initiation was 3.1 ± 0.82 hours. The median admission NIHSS was 6 (4-15). A favorable outcome (mRS 0-2) at 90 days was seen in 72.5% of patients. 2 (5%) patients had symptomatic intracranial hemorrhage and 1 (2.5%) patient died.

Conclusions: These data suggested the effectiveness of thrombolysis treatment on ischemic stroke patients whose times of onset were beyond 4.5 hours at Bachmai hospital. A high rate of good recovery (72.5%) was seen in this study.

Disclosure: No

P0163 / 122

STROKE THROMBOLYSIS DURING THE COVID PANDEMIC IN INDIA - A TALE OF TWO WAVES & LESSONS LEARNT

S. Murali ¹, A. Agarwal¹, V. Venugopalan Y¹, R. Bhatia¹, D. Vibha¹, A.K. Pandit¹, R.K. Singh¹, P. Srivastava¹

¹ All India Institute of Medical Sciences, Neurology, New Delhi, India

Background: The world was witness to a pandemic never experienced by this generation. The call to arms was answered by each branch of medicine, each fighting separate wars. The war, we as neurologists faced was the “Battle for the Vessels”. Health care workers are a precious resource in Low-Middle-Income-Countries. Hence, exposure to a covid-positive patient for a “full hour” during thrombolysis, isn’t warranted. Hence Tenecteplase use which fits the bill “ideally” and “literally” was analysed in this study against Alteplase in strokes with covid-positivity. We analyse the factors which affect their action and the role covid had, in each scenario.

Methods: This is an ambi-spective observational study of 37 patients in an apex tertiary-care centre in India. Routine stroke variables were assessed including follow-up imaging, functional outcomes at 3 months. The results were also analysed with the thrombolysis data from covid-negative individuals too in the same period.

Results: Among the covid-positive patients 62.16% patients received tenecteplase while 37.83% received alteplase. Although the baseline characteristics were similar, the time-metrics for thrombolysis were significantly favourable in the tenecteplase arm. The median-hospital stay was shorter in the tenecteplase group as was the in-hospital mortality. On follow-up at 3 months, the median mRS-score was significantly favourable in the tenecteplase group.

Conclusions: Thrombolysis during the pandemic has been a challenge in many ways especially in resource limited settings. This study shows that there needs to be a conscious and judicial transition towards tenecteplase during the pandemic, where healthcare workers are a precious resource too.

Disclosure: No

P0164 / 105

THROMBOTIC EVENTS IN CHILDREN AND ADOLESCENT PATIENTS WITH SARS-COV-2 INFECTION: A SYSTEMATIC REVIEW WITH METANALYSIS ON INCIDENCE AND MANAGEMENT

G. Vitaliti ^1,1, V. Giacchi², M. Sciacca², R. Falsaperla²

¹University of Ferrara, Ferrara, Italy, ²University of Catania, Catania, Italy

Background and aims: Herein authors present a systematic review and metanalysis on the incidence of thrombotic events in pediatric and adolescent Sars-Cov-2 infection and the use of anticoagulant therapy in this age group.

Methods: N 244 titles were screened using the elected MESH words, n 188 abstracts and n 120 full text were read, n 12 articles were included, and among these last, four were included for metanalysis.

Results: Over 1128 COVID-19 positive patients, nearly half of them developed inflammatory sequelae, and 7.35% developed thrombotic events.

Less than half patients who developed inflammatory disease were under anticoagulant prophylactic treatment, and dosages of therapeutic anticoagulant protocols vary from different centres. Thrombotic events solved after the onset of unfractioned heprin (UFH) therapy in the majority of cases, even if 1.06% died. Two of these deaths had peripheral severe gangrene.

No difference in the incidence of thrombotic events between patients under prophylactic low molecular weight heparin (LMWH) and without was found in metanalysis.

Conclusions: Little is known on the incidence and management of hypercoagulopathy in pediatric COVID-19 infection; prophylactic doses of LMWH seem to be inefficient in preventing thrombotic events. Therapeutic dosed of UFH seem more efficient. Protocols on dosages have to be discussed.

Disclosure: No

P0165 / 917

BRIDGING INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH ATRIAL FIBRILLATION

A. Mujanovic ¹, C.C Kurmann¹, T. Dobrocky¹, M. Olive-Gadea², C. Maegerlein³, L. Pierot⁴, V.M. Pereira⁵, V. Costalat⁶, M. Beyeler⁷, E.I Piechowiak¹, D.J Seiffge⁷, P. Mordasini¹, M. Arnold⁷, J. Gralla¹, U. Fischer⁷, J. Kaesmacher¹, T.R Meinel⁷

¹University Hospital Bern Inselspital, University Institute of Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ²University Hospital Vall d’Hebron, Department of Neurology, Barcelona, Spain, ³Klinikum rechts der Isar der Technischen Universität München, Department of Diagnostic and Interventional Neuroradiology, München, Germany, ⁴Centre Hospitalier Universitaire Reims, Department of Neuroradiology, Reims, France, ⁵Toronto Western Hospital, Joint Department of Medical Imaging, Ontario, Canada, ⁶Hospital Center University De Montpellier, Department of Neuroradiology, Montpellier, France, ⁷University Hospital Bern Inselspital, Department of Neurology, Bern, Switzerland

Background and aims: Atrial fibrilation (AF) causes about 40% of ischemic strokes treated by mechanical thrombectomy (MT). The role of bridging thrombolysis (MT + intravenous thrombolysis (IVT)) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) or AF and bridging thrombolysis, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome.

Methods: Observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT at nine high-volume centers worldwide between 2010-2018 (n=2941). Multiple logistic regression models were adjusted for prespecified baseline and plausible pathophysiologically covariates identified on a univariate analysis to assess the association of AF and OAC with sICH and favorable functional outcome (modified Rankin Scale 0-2 at 90-day).

Results: In the total cohort (median age 74, 50.6% female), 1347 (45.8%) patients had AF. Higher National Institutes of Health Stroke Scale(NIHSS) score on admission (aOR 1.04 [95% 1.02 – 1.06], per point of increase), and using Vitamin K antagonists (aOR 2.19 [95% 1.27 – 3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41 – 1.24]), nor bridging thrombolysis (aOR 1.08 [0.67 – 1.75]) were significantly associated with increased risk of sICH. Receiving bridging therapy (aOR 1.61 [95% 1.24 – 2.11]) was found to be associated with achieving favorable functional 90-day outcome without an interaction of AF and IVT (p=0.92).

Conclusions: In AF patients undergoing MT, bridging approach appears to be a reasonable clinical option in selected patients admitted to experienced, high-volume thrombectomy centers.

Disclosure: No

P0166 / 201

EARLY EFFECT OF THROMBOLYSIS ON STRUCTURAL BRAIN NETWORK ORGANISATION AFTER ANTERIOR-CIRCULATION STROKE

E. Schlemm ¹, M. Jensen¹, C. Gerloff¹, G. Thomalla¹, B. Cheng¹

¹ University Medical Center Hamburg Eppendorf, Neurology, Hamburg, Germany

Background and aims: The symptoms of stroke can be attributed to disruption of the brain network architecture resulting from damage of grey matter and interconnecting fibre tracts. Systemic thrombolysis is an effective treatment that preserves structural connectivity. Its effect on the evolution of global network organisation is, however, not well understood.

Methods: This is a secondary analysis of 269 patients with anterior circulation stroke from the WAKE-UP trial, a randomized trial of the efficacy of of thrombolysis in imaging-selected patients with unknown time of stroke-onset (NCT01525290). We used indirect network mapping to quantify the impact of ischemic lesions on structural brain network organisation in terms of both global parameters of segregation and integration, and local disruption of individual connections. We compared network evolution between alteplase and placebo groups and characterized the spatial embedding of the brain connectome as a mediator of the topological effects of a focal lesion.

Results: We found that over 22 to 36 hours after stroke, the evolution of brain network organisation was characterized by a loss in integration and gain in segregation, which was attenuated by alteplase. Preserved networks were associated with excellent functional outcome. Furthermore, the protective effect of alteplase was spatio-topologically non-uniform, concentrating on a network of high centrality supported in the salvageable white matter surrounding the infarcts analysed in this study.

Conclusions: The interplay between the location of an ischemic lesion and the spatial embedding of the brain network explains the observed potential of thrombolysis to attenuate topological network damage early after stroke.

Disclosure: No

NEUROINTERVENTION – EXCLUDING CLINICAL TRIAL RESULTS

P0167 / 617

ENDOVASCULAR TREATMENT OF ISCHEMIC STROKE DUE TO ISOLATED INTERNAL CAROTID ARTERY OCCLUSION: ETIS REGISTRY DATA ANALYSIS

A. ter Schiphorst ¹, R. Peres², C. Dargazanli³, R. Blanc⁴, B. Gory⁵, S. Richard⁶, G. Marnat⁷, I. Sibon⁸, B. Guillon⁹, R. Bourcier¹⁰, C. Denier¹¹, L. Spelle¹², J. Labreuche¹³, A. Consoli¹⁴, B. Lapergue¹⁵, M. Obadia², V. Costalat³, C. Arquizan¹

¹CHU Gui de Chauliac, CHU Montpellier, Neurology, Montpellier, France, ²Fondation Rothschild Hospital, Neurology, Paris, France, ³CHU Gui de Chauliac, CHU Montpellier, Neuroradiology, Montpellier, France, ⁴Fondation Rothschild Hospital, Neuroradiology, Paris, France, ⁵CHRU Nancy, Neuroradiology, Nancy, France, ⁶CHRU Nancy, Neurology, Nancy, France, ⁷University Hospital of Bordeaux, Neuroradiology, Bordeaux, France, ⁸University Hospital of Bordeaux, Neurology, Bordeaux, France, ⁹University Hospital of Nantes, Neurology, Nantes, France, ¹⁰University Hospital of Nantes, Neuroradiology, Nantes, France, ¹¹CHU Bicêtre, Neurology, Le Kremlin Bicêtre, France, ¹²CHU Bicêtre, Neuroradiology, Le Kremlin Bicêtre, France, ¹³CHU Lille, Univ Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France, ¹⁴Foch Hospital, Neuroradiology, Suresnes, France, ¹⁵Foch Hospital, Neurology, Suresnes, France

Background and aims: The best treatment for AIS due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO.

Methods: We analysed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, 24 hours NIHSS and 3-month favorable outcome (modified Rankin Scale, mRS⩽2 or equal to the pre-stroke value).

Results: Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ⩾4 points). The rate of procedural complications was 36%, including stent thrombosis (n=7), intracranial embolism (n=7), symptomatic intracranial hemorrhage (n=1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead.

Conclusion: EVT led to high rate of recanalization at Day 1, and a 40% rate of favorable outcome at 3 months in our study of patients with initial severe deficit on CICAO, with a high rate of procedural complications. Randomized controlled trials are needed.

Disclosure: No

P0168 / 1181

HIGH PROPORTION OF GRANULOCYTES FROM INTRACRANIAL THROMBUS PREDICTS FAILURE OF CONVENTIONAL MECHANICAL THROMBECTOMY

J. Juega ¹, C. Palacio², M. Ribó¹, M. Rodriguez¹, D. Rodriguez-Luna¹, M. Requena¹, Á. Garcia-Tornel¹, N. Rodriguez-Villatoro¹, M. Rubiera¹, S. Boned¹, M. Muchada¹, M. Olivé-Gadea¹, P. Lozano¹, C. Piñana¹, D. Hernandez¹, P. Coscojuela¹, M. Dios-Lascuevas¹, J.L. Cuevas¹, J. Li¹, E. Sanjuan¹, M. Hernandez-Perez¹, L. Dorado¹, H. Quesada¹, P. Cardona¹, C. DelaTorre¹, L. Gallur², M. Sanchez², S. Gonzalez-Rubio², J. Camacho², S. Ramon-y-Cajal², A. Tomasello², J. Álvarez-Sabin², C. Molina¹, J. Pagola¹

¹Vall d’Hebron University Hospital ; Vall d ’Hebron Research Institute, Stroke Unit, Department of Neurology, Barcelona, Spain, ²Vall d Hebron University Hospital, Barcelona, Spain

Background and aims: We aim to identify by flow cytometry (FC) a profile of intracranial thrombus resistant to recanalization that may predict failure of conventional mechanical thrombectomy (MT).

Methods: First extracted clot of each MT were analyzed by FC obtaining main leukocyte populations:  granulocytes, monocytes and lymphocytes. Failure of conventional MT was defined as final modified Thrombolysis in Cerebral Infarction (mTICI) score IIa or lower and /or need of permanent intracranial stenting (PIS) as rescue therapy after MT. Baseline characteristics, stroke etiology, acute reperfusion strategy and clot analysis were included in a multivariate model to predict MT failure.

Results: Two hundred twenty five patients were included, 13 % of cases were failure of conventional MT (20 final mTICI ⩽ 2a and 10 PIS). MT failure was significantly associated to Large Arterial Atherosclerosis etiology (33.3% vs. 15.9% ; p 0.021), more passes ( 3 vs. 2; p <0.001), higher proportion of clot granulocytes (82.46% vs. 68.90%; p <0.001) and lower proportion of clot monocytes ( 9.18% vs.17.34%; p<0.001). Among MT with multiples passes, clot granulocytes cut-off point of 74.40% yielded sensitivity of 73, 33%, specificity of 69.16% and negative predictive value of 90.24% for MT failure. Clot granulocytes > 74.40% (aOR: 7.00, CI 95%: 2.63-18.59, p <0.001) predicted MT failure after adjustment for significant characteristics of univariate analysis.

Conclusions: Clot analysis by FC was useful to identify thrombectomy-resistant thrombus. High proportion of granulocytes in extracted first clot was independently associated with failure of conventional MT.

Disclosure: No

P0169 / 288

PERFUSION IMAGING FOR ENDOVASCULAR THROMBECTOMY IN ACUTE ISCHAEMIC STROKE IS ASSOCIATED WITH IMPROVED FUNCTIONAL OUTCOMES IN THE EARLY AND LATE TIME WINDOWS

P.S. Dhillon ^1,2,3, W. Butt⁴, A. Podlasek³, N. McConachie¹, R. Lenthall¹, S. Nair¹, L. Malik¹, T.C Booth^5,6, P. Bhogal⁷, H.L.D. Makalanda⁷, O. Spooner⁸, A. Mortimer⁹, S. Lamin⁴, S. Chavda⁴, H.S. Chew⁴, K. Nader⁴, S. Al-Ali⁴, B. Butler⁴, D. Rajapakse⁴, J.P Appleton^10,11, K. Krishnan¹², N. Sprigg^12,13, A. Smith¹⁴, K. Lobotesis¹⁵, P. White^16,17, M.A James^18,19,20, P.M Bath^13,12, R.A Dineen^2,3, T.J England^21,22

¹Nottingham University Hospitals NHS Trust, Interventional Neuroradiology, Nottingham, United Kingdom, ²University of Nottingham, Radiological Sciences, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ³University of Nottingham, NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom, ⁴University Hospitals Birmingham NHS Trust, Interventional Neuroradiology, Birmingham, United Kingdom, ⁵King’s College Hospital NHS Foundation Trust, Neuroradiology, London, United Kingdom, ⁶King’s College London, School of Biomedical Engineering & Imaging Sciences, London, United Kingdom, ⁷The Royal London Hospital Barts Health NHS Trust, Interventional Neuroradiology, London, United Kingdom, ⁸The Royal London Hospital Barts Health NHS Trust, Stroke Medicine, London, United Kingdom, ⁹North Bristol NHS Trust, Interventional Neuroradiology, Southmead Hospital, Bristol, United Kingdom, ¹⁰University of Birmingham, Institute of Applied Health Research, College of Dental and Medical Sciences, Birmingham, United Kingdom, ¹¹University Hospitals Birmingham NHS Trust, Stroke, Birmingham, United Kingdom, ¹²Nottingham University Hospitals NHS Trust, Stroke Medicine, Nottingham, United Kingdom, ¹³University of Nottingham, Stroke Trials Unit, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ¹⁴Hull and East Yorkshire Hospitals NHS Trust, Interventional Neuroradiology, Hull Royal Infirmary, Hull, United Kingdom, ¹⁵Imperial College Healthcare NHS Trust, Interventional Neuroradiology, Charing Cross Hospital, London, United Kingdom, ¹⁶Newcastle University, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle, United Kingdom, ¹⁷Newcastle upon Tyne Hospitals NHS Foundation Trust, Interventional Neuroradiology, Newcastle, United Kingdom, ¹⁸Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom, ¹⁹University of Exeter Medical School, Exeter, United Kingdom, ²⁰King’s College London, Sentinel Stroke National Audit Programme, London, United Kingdom, ²¹University of Nottingham, Stroke, Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ²²University Hospitals of Derby and Burton NHS Foundation Trust, Stroke, Derby, United Kingdom

Background and aims: The impact on clinical outcomes of patient selection using perfusion imaging for endovascular thrombectomy (EVT) in acute ischaemic stroke patients presenting beyond 6 hours from onset remains undetermined in routine clinical practice.

Methods: Patients from a national stroke registry that underwent EVT selected with or without perfusion imaging (non-contrast CT/CT angiography) in the early (<6 hours) and late (6-24 hours) time windows, between October 2015 and March 2020, were compared.

Results: We included 4249 patients, 3203 in the early window (593 with perfusion vs 2610 without) and 1046 in the late window (378 with perfusion vs 668 without). Within the late window, patients with perfusion imaging had better functional outcome (modified Rankin Scale) at hospital discharge compared to those without perfusion imaging (adjusted common odds ratio(acOR)=1.45, 95%CI 1.16-1.83,p=0.001). There was no significant difference in functional independence (mRS⩽2; 29.3% with perfusion vs 24.8% without,p=0.210), symptomatic intracerebral haemorrhage (p=0.53) and in-hospital mortality (10.6% with perfusion vs 14.3% without,p=0.053). In the early window, patients with perfusion imaging had improved odds of functional outcome (acOR=1.51, 95%CI 1.28-1.78,p=0.0001) and functional independence (41.6% vs 33.6%, aOR=1.31, 95%CI 1.08-1.59,p=0.006). Perfusion imaging was associated with lower odds of futile recanalisation in both time windows (late: aOR=0.70, 95%CI 0.53-0.92,p=0.01; early: aOR=0.72,95%CI 0.59-0.87,p=0.001).

Conclusions: In this real-world study, acquisition of perfusion imaging for EVT was associated with improvement in functional disability in the early and late time windows compared to non-perfusion neuroimaging. These indirect comparisons should be interpreted with caution whilst awaiting confirmatory data from prospective randomised trials.

Disclosure: Yes

P0170 / 1254

ENDOVASCULAR THROMBECTOMY FOR ANTERIOR CIRCULATION STROKE BEYOND 6 HOURS OF ONSET IN SWEDEN 2015 TO 2020 – RATES AND OUTCOMES IN A NATIONWIDE REGISTER-BASED STUDY

T. Ullberg ¹, M. von Euler², P. Wester³, F. Arnberg⁴, B. Norrving¹, T. Andersson⁵, J. Wassélius¹

¹Lund University, Institution of Clinical Sciences, Neurology, Dept. of neurology, Dept. of medical imaging, Lund, Sweden, ²Örebro University, School of Medicine, Neurology, Örebro, Sweden, ³Umeå Univeristy, Department of Public Health and Clinical Science, Neurology, Umeå, Sweden, ⁴Department of Clinical Neuroscience, Karolinska Institute, Department of Neuroradiology, Stcokholm, Sweden, ⁵Department of Clinical Neuroscience, Karolinska Institute, Department of Neuroradiology, Stockholm, Sweden

Background: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden.

Methods: We included all anterior circulation ISs caused by occlusion of the intracranial carotid artery, the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015–2020. Three groups were defined from onset-to-groin-puncture OTG time: early window (<6h), late window (6–24h) known onset, late window last seen well (LSW). Favorable outcome (mRS 0–2) and all-cause mortality at 90 days were main outcomes, and symptomatic intracerebral hemorrhage (sICH) the safety outcome.

Results: Late window EVT increased from 0.3% of all IS in 2015 to 1.8% in 2020, and from 17.4% of all anterior circulation EVTs in 2015 to 32.9% in 2020. Of 2199 patients, 76.9% (n=1690) were early window EVTs and 23.1% late window EVTs (n=509;148 known onset, 368 LSW). Median age was 73 years, 46.2% were female, with no differences between groups. Favorable outcome did not differ between groups (early window: 42.4%, late window known onset: 38.9%, late window LSW 37.5% (p=0.737)) and remained similar when adjusted for baseline differences. sICH rates did not differ (early window: 4.0%, late window known onset: 2.1%, late window LSW 4.9% (p=0.413)).

Conclusion: Late window EVTs increased substantially over time, and currently accounts for one third of anterior circulation treatments. Early and late window patients had similar outcomes.

Disclosure: No

P0171 / 1060

CEREBRAL SMALL VESSEL DISEASE BURDEN AND FUTILE REPERFUSION AFTER ENDOVASCULAR THROMBECTOMY FOR ACUTE ISCHEMIC STROKE PATIENTS

M. Lee ¹, Y. Kim², H.J. Mo³, M.U. Jang³, K.-H. Yu¹, B.-C. Lee¹, C.-H. Kim⁴, S.-H. Lee⁴

¹Hallym University Sacred Heart Hospital, Department of Neurology, Anyang, Korea, Republic of, ²Kangdong Sacred Heart Hospital, Department of Neurology, Seoul, Korea, Republic of, ³Dongtan Sacred Heart Hospital, Department of Neurology, Hwa seong, Korea, Republic of, ⁴Chunchon Sacred Heart Hospital, Department of Neurology, Chunchon, Korea, Republic of

Background and aims: We aimed to investigate the impact of cerebral small vessel disease(cSVD) burden on long-term clinical outcome in patients with acute ischemic stroke who received endovascular treatment (EVT), and more specifically, whether cSVD is associated with futile reperfusion (FR; poor functional status despite successful reperfusion)

Methods: Based on a prospective multicenter stroke registry, we studied consecutive acute ischemic stroke patients with either intracranial and/or extracranial large artery occlusion at anterior circulation, treated with EVT achieving successful arterial reperfusion (Thrombolysis in Cerebral Infarction grade 2b–3). The cSVD burden was evaluated on Brain MRI T2 FLAIR using modified Fazekas Score(mFS). The main outcome variable was FR, defined as poor functional outcomes (modified Rankin scale [mRS] 3–6) at 3 months.

Results: Among 10,890 patients with acute stroke, 577 (5.3%) received EVT within 12 h of onset, including 354 who met study eligibility criteria. FR was observed in 191 patients (54.0%) and was positively associated with cSVD burden: mFS 1; 40.9% mFS 2; 60.3% and mFS3; 82.5%. After adjustment of covariates including age, sex, stroke etiology, initial stroke severity, collateral status, ASPECTS, initial glucose, systemic blood pressure and vascular risk factors, mFS grade 3 was significantly associated with FR(odds ratio 3.93[95% Confidence interval 1.602-9.619], p=0.003)

Conclusions: A higher burden of cSVD is associated with futile reperfusion after anterior circulation acute ischemic stroke. Further studies with prospective designs with a large sample are needed to confirm the clinical applicability of cSVD evaluation for the selection of patients with acute ischemic stroke for EVT.

Disclosure: No

P0172 / 1078

GENERAL ANESTHESIA VERSUS CONSCIOUS SEDATION FOR ENDOVASCULAR THERAPY IN ACUTE ISCHEMIC STROKE

X. Zhang ¹, X. Bai¹, T. Wang¹, Y. Feng¹, Y. Wang², K. Yang¹, X. Wang³, H. Song⁴, Q. Ma⁴, Y. Ma¹, L. Jiao⁴

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²China Medical University, Shenyang, China, ³Xuanwu Hospital, Capital Medical University, Medical Library, Beijing, China, ⁴Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China

Background and aims: Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this study is aimed to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT.

Methods: Literature search was conducted in following databases, EMBASE, MEDLINE, Web of Science, and the Cochrane Library, for relevant randomized controlled trials (RCTs) comparing general anesthesia (GA) and conscious sedation (CS) for AIS patients during EVT. We used the Cochrane Collaboration criteria for assessment of risk bias of included studies.

Results: 5 RCTs with 498 patients were included. GA was conducted in 251 patients and CS in 247 patients. EVT under GA in AIS patients had higher rates of successful recanalization (RR: 1.13, 95% CI: 1.04-1.23; P = 0.004; I² = 40.6%) and functional independence at 3 months (RR: 1.28, 95% CI: 1.05-1.55; P = 0.013; I² = 18.2%) than CS. However, GA was associated with higher risk of mean arterial pressure (MAP) drop (RR: 1.71, 95% CI: 1.19-2.47; P <0.01; I² = 80%) and pneumonia (RR: 2.32, 95% CI: 1.23-4.37; P = 0.009; I² = 33.5%). There was no difference between GA and CS groups in mortality at 3 months, interventional complications, intracerebral hemorrhage and cerebral infarction after 30 days.

Conclusions: GA was superior over CS in successful recanalization and functional independence at 3 months when performing EVT in AIS patients. However, GA was associated with higher risk of MAP drop and pneumonia.

Disclosure: No

P0173 / 179

MENISCUS SIGN IN PATIENTS WITH ANTERIOR CIRCULATION LARGE VESSEL OCCLUSION STROKE

A. Miranda¹, R. Abdelnaby², A. Araújo¹, M. Rodrigues¹, S. Castro¹, M. Wiesmann³, J.B Schulz², O. Nikoubashman³, A. Reich², M. Ribeiro¹, J. Pinho ²

¹Centro Hospitalar Vila Nova de Gaia/Espinho, Imagiology Department, Neuroradiology Unit, Vila Nova de Gaia, Portugal, ²University Hospital RWTH Aachen, Department of Neurology, Aachen, Germany, ³University Hospital RWTH Aachen, Department of Diagnostic and Interventional Neuroradiology, Aachen, Germany

Background and aims: The angiographic appearance of the occlusion site was suggested to influence reperfusion rates and clinical outcomes of patients with stroke undergoing endovascular treatment (EVT). We aimed to study the impact of the meniscus sign on angiographic and clinical outcomes in stroke patients with anterior circulation large vessel occlusion (LVO) undergoing EVT.

Methods: Multicentric retrospective study of consecutive acute ischemic stroke patients with carotid-T, M1- or M2-occlusion who underwent EVT during a period of 3 years. The angiographic meniscus sign was assessed by two independent observers blinded to angiographic and clinical outcomes. The groups of patients with and without meniscus sign were compared.

Results: We included 903 patients, median age 78 years, 59.8% were male, baseline NIHSS 14, 39.5% received intravenous thrombolysis. The meniscus sign was present 18.8% of patients, interobserver agreement was substantial (κ=0.76). Patients with meniscus sign were more frequently female, presented with higher NIHSS scores, more frequently had been treated with intravenous thrombolysis and more frequently presented a cardioembolic etiology. Successful reperfusion, number of passes, first pass effect, procedural time, symptomatic intracerebral hemorrhage, in-hospital mortality and favourable 3-month functional outcome were similar in the groups of patients with and without meniscus sign. In the multivariable analyses, meniscus sign was not associated with successful reperfusion (OR=1.08, 95%CI=0.76-1.55), first pass effect (OR=0.96, 95%CI=0.48-1.92) or favourable 3-month outcome (OR=1.40, 95%CI=0.88-2.24).

Discussion: The presence of meniscus sign in acute ischemic stroke patients with anterior circulation LVO undergoing EVT does not appear to influence angiographic or clinical outcomes.

Disclosure: No

P0174 / 553

AUTOTICI: AUTOMATED TICI SCORING IN ISCHEMIC STROKE PATIENTS

M. van der Sluijs ¹, R. Su¹, S. Cornelissen¹, T. van Walsum¹, A. van der Lugt¹

¹ ErasmusMC, Radiology & Nuclear Medicine, Rotterdam, Netherlands

Background and aims: Thrombolysis in Cerebral Infarction (eTICI) score is used to quantify reperfusion grade on Digital Subtraction Angiography in endovascularly treated (EVT) ischemic stroke patients. Automatic TICI score could improve clinical outcome prediction in patients treated with EVT. We aim to study the performance of AutoTICI in a large sample size.

Methods: Patients in the MR CLEAN Registry with an ICA, M1 and M2 occlusion were selected if both AP and lateral views were present in pre- and post-EVT DSAs with more than 6 frames. AutoTICI was assessed with a custom made algorithm. AUC of AutoTICI and eTICI for predicting dichotomized mRS at 90 days using univariable and multivariable logistic regression models was calculated. The following prognostic factors were included in the multivariable model: age, sex, NIHSS baseline, pre-stroke mRS, collateral status, occlusion location, IVT, and time from onset to groin puncture.

Results: In total 503 of 3180 patients were included concerning, 92 ICA, 267 M1 and 144 M2 occlusions. AutoTICI had equal predictability of dichotomized mRS compared to eTICI (AUC 0.57 vs 0.63; p = 0.053). AUC of the multivariable model with AutoTICI was comparable to the model with eTICI (0.78 vs 0.80; p = 0.28). Remodeling of AutoTICI by excluding retrograde contrast flow, which now counts as area not at risk, is thought to improve good outcome prediction of AutoTICI.

Conclusion: AutoTICI proves to have similar predictable applications as eTICI in both univariable and multivariable prediction models.

Disclosure: No

P0175 / 1449

ENDOVASCULAR TREATMENT IN MCA STROKE BEYOND THERAPEUTIC WINDOW: A MULTICENTRIC STUDY IN THE REGION OF MADRID.

S. Trillo ¹, C. Gómez-Escalonilla², A. Cruz-Culebras³, P. Calleja⁴, A. García-Pastor⁵, M. Guillán⁶, E. de la Fuente¹, P. Simal², F. Rodríguez-Jorge³, F. Ostos⁴, A. Iglesias-Mohedano⁵, C. Rodríguez-Fernández⁷, C. Ramos¹, J. Masjuán³, P. Rábano⁴, M. Vales-Montero⁵, J. Fernández-Ferro⁶, Á. Ximénez-Carrillo¹, J. Egido², F. Ballenilla⁸, A. Gil⁵, M. Moreu⁹, A. Fernández-Revuelta⁵, J.L. Caniego¹⁰

¹Hospital Universitario La Princesa, Neurology, Madrid, Spain, ²Hospital Clínico San Carlos, Neurology, Madrid, Spain, ³Hospital Universitario Ramón y Cajal, Neurology, Madrid, Spain, ⁴Hospital Universitario 12 de Octubre, Neurology, Madrid, Spain, ⁵Hospital Universitario Gregorio Marañón, Neurology, Madrid, Spain, ⁶Hospital Universitario Rey Juan Carlos, Neurology, Madrid, Spain, ⁷Hospital Universitario Rey Juan Carlos, Radiology, Madrid, Spain, ⁸Hospital Universitario 12 de Octubre, Radiology, Madrid, Spain, ⁹Hospital Clínico San Carlos, Radiology, Madrid, Spain, ¹⁰Hospital Universitario La Princesa, Radiology, Madrid, Spain

Background and Aims: Endovascular treatment (EVT) beyond 24 hours in MCA stroke provides an unclear benefit. The aim of our study is to present the joint experience of patients with MCA stroke who underwent EVT beyond therapeutic window in the region of Madrid.

Methods: Retrospective and multicentric (6 centers) study of patients who received EVT for MCA stroke with time from symptom onset >24 hours. For cases with unknown onset, last-seen-well was considered as onset time. Characteristics of cases and outcomes were evaluated.

Results: N=32. Women 75%, mean age 65,8(DE 15,9). Reason for treatment beyond 24h: diagnostic delay in 16 cases(50%), worsening in 9(28,1%), reevaluation in 4(12,5%) and other reasons in 3(9,4%). Recanalization was achieved in 27 cases(84,4%) with a median onset-to-recanalization time of 28,9 hours[26-50,4]. 8 cases(25%) received treatment beyond 48 hours. There were procedure-related complications in 7 cases (21,8%), being the distal migration of thrombus the most frequent one (4 cases). There were no cases of symptomatic hemorrhagic transformation. At three months, 58.1% had mRS<3 and 2 patients (6,5%) died. No significant association was found with prognostic factors, such as age or time from onset.

Conclusions: According to the experience at the stroke centers of our region, EVT beyond 24 hours seems to show a favorable efficacy and safety profile. This suggests that a dichotomous time limit shouldn’t exclude treatment in selected cases.

Disclosure: No

P0176 / 1058

UNDERSTANDING NEUROLOGISTS’ AND NEUROINTERVENTIONALISTS’ DECISION-MAKING AROUND ENDOVASCULAR THERAPY IN ACUTE STROKE: A PILOT STUDY ON INTERDISCIPLINARY COLLABORATION USING THE THEORETICAL DOMAINS FRAMEWORK

H. Yim ¹, B. Dewar², S. Kitto³, A. Poppe⁴, M. Shamy¹

¹The Ottawa Hospital, University of Ottawa, Neurology, Ottawa, Canada, ²The Ottawa Research Institute, Neurology, Ottawa, Canada, ³University of Ottawa, Department of Innovation in Medical Education, Ottawa, Canada, ⁴Université de Montréal, Neurosciences, Montreal, Canada

Background and aims: How stroke neurologists and neurointerventionalists determine patient candidacy for endovascular thrombectomy (EVT) in the real-world remains underexplored, though differences may affect the interdisciplinary collaboration. We piloted the use of the Theoretical Domains Framework (TDF) to compare decision-making and collaboration surrounding EVT between both groups.

Methods: All stroke neurologists and neurointerventionalists at a Canadian comprehensive stroke centre were invited to complete a semi-structured interview on decision-making and collaboration around EVT from April-June 2019. One interviewer conducted and transcribed all interviews, and used the TDF for analysis.

Results: Five stroke neurologists (100% response rate) and two neurointerventionalists (40% response rate) completed the interviews which averaged 26 minutes 45 seconds. One respondent did not answer 1/10 questions. All respondents identified favourable neuroimaging to support treatment with EVT. All neurologists identified the severity of patient’s deficits as an important factor, whereas all neurointerventionalists identified procedural technicalities as being important. These factors mapped onto domains of “knowledge”, “skills”, and “motivation and goals” in the TDF. Respondents suggested enhancing collaboration by increasing availability of neurologists and neurointerventionalists, restructuring on-call communication, and providing regular and mutual feedback. These suggestions mapped onto domains of “environmental context and resources” and “behavioural regulation” in the TDF.

Conclusions: It is feasible to examine decision-making and collaboration surrounding EVT at a tertiary stroke centre using interviews and the TDF. While respondents identified patient-level factors for decision-making, they also described organizational strategies to improve collaboration. This pilot study supports the use of TDF to enhance interdisciplinary collaboration.

Disclosure: No

P0177 / 819

OUTCOME IN PATIENTS WITH CAROTID ARTERY DISSECTION TREATED WITH ENDOVASCULAR TREATMENT

R. Puggaard ¹, N.G. Laugesen¹, J. Højgaard¹, T. Stavngaard², K. Hansen^1,3, T. Truelsen^1,3

¹Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark, ²Rigshospitalet, Copenhagen University Hospital, Department of Radiology, Copenhagen, Denmark, ³University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark

Aim and background: Functional outcome after endovascular thrombectomy (EVT) in patients with large vessel occlusion due to carotid artery dissection (CAD) have not been sufficiently studied. We compared the functional outcome in CAD and non-CAD patients with occlusion of the internal carotid artery (ICA).

Methods: A prospective, single-center, consecutive, observational study of patients treated with EVT in 2017-2019. Functional outcome, using the modified Rankin Scale (mRS) at 90 days, was defined as either favorable (mRS 0-2) or non-favorable (mRS>2). Logistic regression analyses included age (years), sex, National Institute of Health Stroke Scale (NIHSS), reperfusion, pre-treatment with intra-venous alteplase (IVT), time from groin puncture to reperfusion, and use of ICA-stent.

Results: Of 208 patients treated with EVT of the ICA, 32 patients (15.4%) had CAD. Patients with CAD compared to non-CAD patients were significantly younger, 56 (IQR:49-64) vs. 73 (IQR:65-79), p<0.01, were predominantly male, 26 (81.3%) vs. 99 (56.3%), p=0.01, and a higher proportion had known time of onset, 29 (90.6%) vs. 107 (60.8%), p<0.01. Baseline NIHSS did not differ, 18 (IQR:13-20) vs. 18 (IQR:14-22), p=0.35, but CAD patients had lower NIHSS at 24 hours post-EVT, 9 (IQR:2-13) vs. 14 (IQR:5-21), p<0.01. CAD patients had significantly more favorable outcome, 68.8% vs. 33.0 %, p<0.01. Increasing age was associated with non-favorable outcome, Odds Ratio (OR), 1.13 (95% CI:1.00-1.29), p=0.049, whereas pre-treatment with IVT was associated with favorable outcome, OR=9.00 (95% CI:1.20-67.42), p=0.03).

Conclusion: CAD patients had a better functional outcome than non-CAD patients. Age and IVT were significantly associated with functional outcome.

Disclosure: No

P0178 / 867

A NATIONWIDE ANALYSIS OF THE DECLINE IN MECHANICAL THROMBECTOMY DURING THE COVID-19 EPIDEMIC IN HUNGARY

P.P. Böjti ^1,2,3, G. Szilágyi^4,3, B. Dobi^5,6, R. Stang^2,3, T.T. Takács², L. Both², E. Merose², I. Szikora^1,3,7, C. Óváry¹, L. Erőss^1,3,7, P. Banczerowski^1,3,7, D. Bereczki^2,3,8,6

¹National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary, ²Semmelweis University, Department of Neurology, Budapest, Hungary, ³Semmelweis University, János Szentágothai Doctoral School of Neurosciences, Budapest, Hungary, ⁴Medical Centre, Hungarian Defence Forces, Department of Neurology, Budapest, Hungary, ⁵Eötvös Loránd University, Department of Probability Theory and Statistics, Budapest, Hungary, ⁶MTA-SE, Neuroepidemiology Research Group ELKH, Budapest, Hungary, ⁷Semmelweis University, Department of Neurosurgery, Budapest, Hungary, ⁸European Academy of Neurology, EANcore COVID-19 Task Force, Vienna, Austria

Background and aims: Our previous study demonstrated a significant disruption in ischemic stroke care during the COVID-19 outbreak in Hungary, with a significant decline in mechanical thrombectomy (MT). We aimed to assess the differences between thrombectomy centres.

Methods: In our nationwide retrospective study, we assessed the number of MTs between 2/01/2017-31/12/2020 in Hungary. Thrombectomy centres were categorized as high- or low-volume (weekly median EVT ⩾5 or <5) centres, which data then were pooled into high- and low-volume groups. COVID-19’s impact on pooled MT volumes was analyzed during the first two epidemic waves, comparing weekly medians of raw and standardized (z-scores) MT numbers to the identical period of the previous year.

Results: Although during the first epidemic wave, the raw MT numbers did not change considerably either in the high- or low-volume groups (10.00 vs 9.00, p=0.875; 11.96 vs 12.93, p=1, respectively), the analysis of z-scores showed a significant decline in the low-volume cohort, but not in the high-volume group (-0.19 vs -0.93, p=0.015; 0.60 vs -0.47, p=0.057). During the second epidemic wave, raw and standardized MT numbers decreased significantly in the low-volume but not in the high-volume group (raw numbers: 14.93 vs 12.96, p=0.035; 8.00 vs 9.00, p=0.836; respectively. z-scores: 0.39 vs -1.69, p<0.001; -0.40 vs -0.74, p=0.243, respectively).

Conclusions: Our study demonstrated a remarkable decline in MT numbers in the low-volume but not in the high-volume group of thrombectomy centres. One of the reasons may be the different institutional settings and involvement in the action against COVID-19.

Disclosure: No

P0179 / 702

MECHANICAL THROMBECTOMY IN ACUTE STROKE PATIENTS WITH MODERATE TO SEVERE PRE-STROKE DISABILITY

M. Sykora ^1,2, P. Michel³, D. Strambo³, S. Krebs², J. Ferrari², A. Posekany⁴, D. Miksova⁵, K. Hermann⁶, T. Gattringer⁷, E. Gizewski⁸, H. Deutschmann⁹, C. Neumann¹⁰, W. Lang^1,2

¹Sigmund Freud University Vienna, Neurology, Vienna, Austria, ²St. John Hospital, Neurology, Vienna, Austria, ³University Lausanne, Neurology, Lausanne, Switzerland, ⁴University of Technology, Vienna, Austria, ⁵GOEG, Vienna, Austria, ⁶SFU Vienna, Neurology, Vienna, Austria, ⁷University Graz, Neurology, Graz, Austria, ⁸University Innsbruck, Neuroradiology, Innsbruck, Austria, ⁹University Graz, Neuroradiology, Graz, Austria, ¹⁰St. John Hospital, Radiology, Vienna, Austria

Background and aims: There are limited data on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with preexisting disability. We aimed to compare functional and safety outcomes of AIS patients with pre-stroke disability treated with MT compared to those receiving best medical treatment.

Methods: From the Austrian Stroke Unit registry and the ASTRAL registry, we included all consecutive acute ischemic stroke patients with pre-stroke disability, defined as modified Rankin Score (mRS) ⩾3, and acute intracranial large vessel occlusion (LVO). Patients undergoing MT were compared to those receiving best medical treatment (BMT) by means of univariate and multivariate logistic regression analysis.

Results: We included in the study 462 AIS patients with pre-stroke mRS ⩾3 and LVO. Among them, 175 underwent MT and 287 received BMT. Patients with MT were younger, had more severe strokes and lower pre-stroke mRS, but similar proportion of treatment with intravenous thrombolysis. On multivariate analysis, MT was associated with a higher probability of returning to baseline mRS at 3 months (aOR 2.5, CI 1.4-4.5) and neurological improvement ⩾8 NIHSS points (aOR 2.6, CI 1.4-4.9), as well as to a lower probability of 3-month poor outcome (aOR 0.4, CI 0.2-0.7) and mortality (aOR 0.3, CI 0.2-0.5).

Conclusions: Patients with pre-stroke mRS ⩾3 treated with mechanical thrombectomy had better short-term and 3-month outcomes. This suggests that pre-stroke disability alone should not be a reason to withhold MT, but that individual case-by-case decisions may be more appropriate.

Disclosure: No

P0180 / 1156

INCREASED NUMBER OF PASSES AND DOUBLE STENT RETRIEVER TECHNIQUE INDUCES CUMULATIVE INJURY ON ARTERIAL WALL AFTER MECHANICAL THROMBECTOMY IN A SWINE MODEL

J.L. Cuevas ¹, D. Hernandez², L.L. Gragmegna², M. Requena², C. Piñana², M. De Dios², P. Coscojuela², M. Estevez², J. Li², A. Gil³, M. Ribo², A. Tomasello²

¹Hospital de Puerto Montt, Neurosurgery and Interventional Neuroradiology, Puerto Montt, Chile, ²Hospital Vall d Hebron, Interventional Neuroradiology, Barcelona, Spain, ³Hospital Universitario Marques de Valdecilla, Interventional Neuroradiology, Santander, Spain

Background: The number of stentriever passes during endovascular thrombectomy impacts clinical outcomes in acute ischemic stroke. Previous studies suggest that simultaneous double stent retriever technique (DSRT) could improve the efficacy and reduce the number of passes. We aim to analyze the degree of vessel wall injury according to the number of passes and technique (single vs. simultaneous devices).

Methods: Histological changes were evaluated in renal arteries (RA) of swine models after thrombectomy (1, 2, or 3 passes) with single (SSRT) and DSRT. Thrombectomy passes were performed in 12 RA: 3 samples from each artery were studied by optical microscopy to assess a vascular damage score.

Results: All samples showed endothelial denudation and different degrees of damage in the deepest layers of the arterial wall; however, all arteries remained patent by the time of assessment. In all cases, the degree of vascular injury increased with the number of passes. Compared with a SSRT, DSRT showed a higher severity of histological damage corresponding to the damage caused by 1.4 SSRT passes. However, in distal arteries, vascular damage was relatively similar when comparing SSRT with multiple passes and DSRT with one pass.  

Conclusions: The degree of vessel injury increases with the number of passes. Even though histological damage per pass was 1.4 higher with DSRT than SSRT, short-term vessel patency was not compromised after up to 3 DSRT passes. Further studies are needed to characterize the risk-benefit ratio of the DSRT in routine clinical practice.

Disclosure: No

P0181 / 1538

DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH CAROTID WEB: EXPERIENCE OF A COMPREHENSIVE STROKE CENTRE

F. Gallo Pineda ¹, M. Fernandez Gomez¹, A. Arjona Padillo², L. Amaya Pascasio², P. Martinez Sanchez²

¹Torrecardenas University Hospital, Radiology department, Almeria, Spain, ²Torrecardenas University Hospital, Stroke Centre. Department of Neurology, Almeria, Spain

Background and aims: Carotid webs (CaWs) are responsible up to 35% of strokes with cryptogenic origin, especially in young patients. Computerized tomography angiography (CTA), Digital subtraction angiography (DSA) and ultrasound (US). It can be treated conservatively or with surgical management, having two modalities: carotid stenting (CAS) and endarterectomy (CEA).

Methods: Retrospective analysis of consecutive symptomatic CaW patients attended in a Comprehensive Stroke centre, serving a population of 727.945 inhabitants, during 2021. All patients underwent CTA, DSA and US. CaW was defined as the presence of a shelf-like linear filling defect in the posterior aspect of the carotid bulb on DSA. Variables analyzed: age, sex, side (unilateral or bilateral), stroke severity, treatment (conservative, CAS, CEA) and outcome (recurrent ischemic stroke).

Results: Five patients were identified, median age (range) 40 (30-70) years; 3 women. Four presented a CaW on the right side and one on the left. One patient had two webs (carotid and vertebral). Two patients were treated with CAS, two with CEA and one with medical management. No treatment complications were observed. Two patients had more than one stroke episode before definitive treatment. No stroke recurrence was observed after CAS or CEA.

Conclusions: CaWs can be found in both young and older patients. They may occur in more than one artery in the same patient. In our series CAS and CEA were safe treatment options.

Disclosure: No

P0182 / 677

SAFETY AND EFFICACY OF ENDOVASCULAR THROMBECTOMY IN PATIENTS WITH SEVERE CEREBRAL VENOUS THROMBOSIS: A META-ANALYSIS

G. Nepal ¹

¹ Tribhuvan University Institute of Medicine, Internal Medicine, Kathmandu, Nepal

Background and aims: Cerebral venous thrombosis (CVT) is a rare thrombotic condition that is traditionally treated by anticoagulation therapy. The subset of patients with severe CVT has been treated with endovascular thrombectomy (EVT). We studied the safety and efficacy of EVT in this subset of patients, given the lack of robust evidence.

Methods: We performed this systematic review and meta-analysis according to PRISMA guideline. Electronic databases were searched for potentially eligible studies published from January 2007 to April 2021. A meta-analysis of the proportion was performed for various outcomes and expressed as a pooled proportion with a 95% confidence interval (CI).

Results: A total of 33 studies comprising 610 patients treated with EVT were included for analysis which comprised one randomized control trial, one prospective study, and 31 retrospective studies. All the patients included in our study were treated with adjunctive anticoagulation prior to EVT. The indication of EVT varied across the studies, however, common indications were an anticoagulation failure, worsening neurological symptoms, coma, intracerebral hemorrhage, and cerebral edema, and raised intracranial pressure. Devices used varied among different studies which included rheolytic thrombectomy, balloon angioplasty, aspiration thrombectomy, coil thrombectomy, catheter fragmentation, and stent retriever thrombectomy. Based on pooled data, 85% of patients had good functional outcomes, 62% had complete recanalization, 5% had all-cause mortality, and 3% had catheter-related complications.

Conclusions: EVT represents a safe and efficacious salvage therapy for patients with severe CVT.

Disclosure: No

P0183 / 907

ASSOCIATION BETWEEN THROMBOEMBOLUS COMPOSITION AND FIRST PASS RECANALISATION AFTER THROMBECTOMY

S. Staessens¹, S. Vandelanotte ¹, O. François², L. Desender¹, T. Dewaele², C. Tersteeg¹, K. Vanhoorelbeke¹, P. Vanacker^3,4,5, T. Andersson^2,6, S.F. De Meyer¹

¹KU Leuven, Campus Kulak Kortrijk, Laboratory for Thrombosis Research, Kortrijk, Belgium, ²AZ Groeninge, Department of Medical Imaging, Kortrijk, Belgium, ³AZ Groeninge, Department of Neurology, Kortrijk, Belgium, ⁴University Hospitals Antwerp, Department of Neurology, Antwerp, Belgium, ⁵University of Antwerp, Department of Translational Neuroscience, Antwerp, Belgium, ⁶Karolinska University Hospital, and Clinical Neuroscience, Karolinska Institutet, Departments of Neuroradiology, Stockholm, Sweden

Background and aims: Achieving good recanalization in the first pass (first pass effect, FPE) is associated with a good clinical outcome and has become the aim of thrombectomy. The reasons why multiple attempts are sometimes needed are not fully understood, but the composition of the thromboembolus is considered an important factor. The aim of this study was to investigate the link between thromboembolus composition and FPE.

Methods: In total, 263 stroke thromboemboli from the AZ Groeninge hospital (Kortrijk, Belgium)  were analysed histologically for 7 thromboembolus components: red blood cells (RBC), fibrin, von Willebrand factor, platelets, leukocytes, citrullinated histone 3 (marker for neutrophil extracellular traps) and DNA (intra- and extracellular). FPE was defined as obtaining a modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2c/3 after the first pass. Thromboembolus histology was compared between FPE cases and cases in which a mTICI score of 2c/3 was achieved after multiple passes.

Results: Good recanalization (mTICI 2c/3) was obtained in 180 patients, of which a FPE was achieved in 126. In 54 patients, multiple attempts were needed to achieve good recanalization. Patients in which no good recanalization was obtained (n= 83) were excluded. Interestingly, thromboemboli from FPE cases contained more RBC (median (IQR): 44.86% (29.74%-59.66%) versus 36.58% (24.59%-52.86%), p=0.03) and less fibrin (median (IQR): 27.97% (20.15%-39.48%) versus 35.80% (22.57%-56.19%), p=0.02) compared with patients in which multiple passes were needed.

Conclusions: Achieving a FPE is more likely in RBC-richer thromboemboli. Future research and technical improvement are needed to improve FPE-rates for fibrin-richer thromboemboli.

Disclosure: No

P0184 / 612

SAFETY AND OUTCOME OF REVASCULARIZATION TREATMENTS IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND ACTIVE CANCER

A. Avanzo¹, C. Gonçalves¹, M. Magriço¹, M. Serôdio¹, R. Ventura¹, A. Sobral-Pinho¹, J.N. Ramos², J.P. Marto ¹, M. Viana-Baptista¹

¹Hospital Egas Moniz, Neurology, Lisbon, Portugal, ²Hospital Egas Moniz, Neuroradiology, Lisbon, Portugal

Background and aims: There is limited and conflicting evidence on safety and efficacy of revascularization treatments of patients with acute ischemic stroke (AIS) and active cancer. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and active cancer.

Methods: Retrospective cohort study of patients with AIS who underwent intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) from January-20016 to August-2021. Patients with active cancer were identified and the following outcomes were compared with patients without active cancer using univariate analysis: symptomatic intracerebral hemorrhage, any intracerebral hemorrhage, in-hospital death, 3 -month mortality and unfavorable prognosis [modified Rankin Scale (mRS) >2 or higher than pre-stroke if pre-stroke mRS >2). In patients undergoing EVT, we compared the achievement of successful recanalization and the number of passages during the procedure.

Results: We included 798 patients, 59 (7.4%) with active cancer, 17 (28.8%) of whom with active metastasis. Active cancer was not associated with symptomatic intracerebral hemorrhage (5.1% vs 6.2%; p=0.962), any intracerebral hemorrhage (23.7% vs 26.6%; p=0.738) in-hospital mortality (16.9% vs 14.7%; p=0.787), 3-month mortality (24.1% vs 20.7%; p=0.647) and 3-month unfavorable outcome (58.6% vs 51.3%; p=0.351). In EVT patients, active cancer was not associated with successful recanalization (80.6% vs 80.6%; p=1.000) or number of passages [median 1 (IQR 1–3) vs 2 (IQR 1–2; p=0.348].

Conclusions: In our study the presence of active cancer was not associated with a higher risk of cerebral bleeding or worse functional prognosis in patients with AIS undergoing revascularization treatments.

Disclosure: No

P0185 / 696

CLINICAL FRAILTY AND OUTCOME AFTER MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE IN PATIENTS AGED ⩾ 80 YEARS

M. Tiainen ¹, N. Martinez-Majander¹, P. Virtanen², S. Räty¹, D. Strbian¹

¹Helsinki University Hospital and University of Helsinki, Department of Neurology, Helsinki, Finland, ²Helsinki University Hospital and University of Helsinki, Department of Radiology, Helsinki, Finland

Background and aims: Data concerning the results of endovascular thrombectomy (EVT) in old patients are still limited. We aimed to investigate the outcomes in thrombectomy-treated ischemic stroke patients aged ⩾ 80 years, focusing on frailty as a contributing factor.

Methods: We performed a single-centre retrospective cohort study with 159 consecutive patients aged ⩾80 and treated with EVT for acute ischemic stroke between January 1^st 2016 and December 31^st 2019. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS). Patients with CFS⩾5 were defined as frail. The main outcome was very poor outcome defined as mRS 4-6 at three months after EVT. Secondary outcomes were recanalization status, symptomatic intracerebral haemorrhage (sICH), and one-year survival. Finally, we recorded if the patient returned home within 12 months.

Results: Very poor outcome was observed in 57.9% of all patients (52.4% in non-frail and 79.4% in frail patients). Rates of recanalization and sICH were comparable in frail and non-frail patients. Of all patients, 46.5% were able to live at home within 1 year after stroke. One-year survival was 59.1% (65.6% in non-frail and 35.3% in frail patients). In logistic regression analysis higher admission NIHSS, not performing thrombolysis, lack of recanalization and higher frailty status were all independently associated with very poor three-month outcome. Factors associated with one-year mortality were male gender, not performing thrombolysis, sICH, and higher frailty status.

Conclusions: Almost 60% of studied patients had very poor outcome. Frailty significantly increases the likelihood of very poor outcome and death after EVT-treated stroke.

Disclosure: No

P0186 / 640

SIDE MATTERS: DIFFERENCES IN FUNCTIONAL OUTCOME AND QUALITY OF LIFE AFTER THROMBECTOMY IN LEFT AND RIGHT HEMISPHERIC STROKE

M. Deb-Chatterji ¹, F. Flottmann², L. Meyer², C. Brekenfeld², J. Fiehler², C. Gerloff¹, G. Thomalla¹, on behalf of the GSR-ET-Investigators

¹University Medical Center Hamburg Eppendorf, Neurology, Hamburg, Germany, ²University Medical Center Hamburg Eppendorf, Neuroradiology, Hamburg, Germany

Background and aims: To evaluate the impact of stroke laterality on functional outcome and patient-reported health-related quality of life (HRQoL) after endovascular thrombectomy (EVT).

Methods: Consecutive stroke thrombectomy patients, derived from a multi-center, prospective registry (German Stroke Registry) between June 2015 and December 2019, were included in this study. At 90 days, outcome after EVT was assessed by the modified Rankin scale (mRS) and HRQoL using the European QoL-five dimensions questionnaire utility-index (EQ-5D-I; higher values indicate better HRQoL) in patients with left (LHS) and right hemispheric stroke (RHS). Adjusted regression analysis was applied to evaluate the influence of stroke laterality on outcome after EVT.

Results: In total, 5683 patients were analyzed. Of these, 2953 patients (52.8%) had LHS and 2637 (47.2%) RHS. LHS patients had a higher baseline NIHSS (16 vs 13, p<0.001) and a higher ASPECTS (9 vs. 8, p<0.001) compared to RHS patients. Among survivors, patients with LHS less frequently had a self-reported affected mobility (p=0.037), suffered less often from pain (p=0.04) and anxiety/depression (p=0.032) three months after EVT. After adjusting for confounders (age, sex, baseline NIHSS), LHS was associated with a better HRQoL (OR 1.041, CI 95% 1.017 – 1.065; p=0.001), and better functional outcome assessed by lower values on the mRS (OR 0.897, CI 95% 0.805 – 1.000; p=0.049).

Conclusions: Ninety days after EVT, LHS patients have a better functional outcome and HRQoL. Patients with RHS should be actively assessed and treated for pain, anxiety and depression to improve their HRQoL after EVT.

Disclosure: No

P0187 / 520

CLINICAL AND TECHNICAL OUTCOMES AFTER DIRECT ASPIRATION THROMBECTOMY VS STENT RETRIEVER THROMBECTOMY IN BASILAR-ARTERY OCCLUSIONS: A BASICS TRIAL SUB-STUDY

R.R.M.M. Knapen ¹, M.L.E Bernsen², L.CM Langezaal³, S.GH Olthuis⁴, P. Michel⁵, J. Hofmeijer⁶, J.A Vos³, S. van Kuijk⁷, C.B. Majoie⁸, B.J Emmer⁸, G.J Lycklama a Nijeholt⁹, J. Boiten¹⁰, V. Puetz¹¹, J. Gerber¹², M. Mazighi¹³, O.M Pontes-Neto¹⁴, F.J Mont'Alverne¹⁵, A.J Yoo¹⁶, C. Van der Leij¹, R. Van Oostenbrugge⁴, W.H Van Zwam¹, W.J Schonewille¹⁷

¹Maastricht University Medical Center +, Radiology, Maastricht, Netherlands, ²Rijnstate, Radiology, Arnhem, Netherlands, ³St. Antonius Ziekenhuis, Radiology, Nieuwegein, Netherlands, ⁴Maastricht University Medical Center +, Neurology, Maastricht, Netherlands, ⁵Centre Hospitalier Universitaire Vaudois, Neurology, Lausanne, Switzerland, ⁶Rijnstate, Neurology, Arnhem, Netherlands, ⁷Maastricht University Medical Center +, Clinical Epidemiology, Maastricht, Netherlands, ⁸Amsterdam University Medical Center, Radiology, Amsterdam, Netherlands, ⁹Haaglanden Medical Center, Radiology, Den Haag, Netherlands, ¹⁰Haaglanden Medical Center, Neurology, Den Haag, Netherlands, ¹¹Technical University Dresden, Neurology, Dresden, Germany, ¹²Technical University Dresden, Radiology, Dresden, Germany, ¹³Hospital Foundation Adolphe de Rothschild, Radiology, Paris, France, ¹⁴Hospital das Clinicas de Ribeirao Preto, Neurology, Sao Paulo, Brazil, ¹⁵Fortaleza General Hospital, Radiology, Fortaleza, Brazil, ¹⁶Texas Stroke Institute, Radiology, Fort Worth, United States, ¹⁷St. Antonius Ziekenhuis, Neurology, Nieuwegein, Netherlands

Background and aims: Both stent retriever and aspiration thrombectomy are safe and effective in patients with an anterior circulation large vessel occlusion. Little is known about endovascular treatment (EVT) technique in patients with a basilar-artery occlusion (BAO). The aim of this study was to compare clinical and technical outcomes between stent retriever and aspiration thrombectomy as first-choice treatment for BAO’s.

Methods: For this sub-study of the BASilar artery International Cooperation Study (BASICS) trial, 137 patients with a BAO treated with EVT were analyzed. The primary outcome was favorable functional outcome, defined as a modified Ranking Scale (mRS) score of 0-3 at 90 days follow-up. Secondary outcomes were: shift on the mRS, procedure time, mortality at 90 days, and successful recanalization (mTICI⩾2B). Univariate and multivariate regression analyses are performed.

Results: Stent retriever thrombectomy was the first treatment choice in 70 patients, aspiration in 62 patients, and in 5 cases the technique was unknown. We observed no significant difference in favorable functional outcome between patients treated with first-choice aspiration compared to stent retriever (adjusted(a)OR:1.19; 95%CI 0.50 to 2.82). A shift for a 1-point improvement on the mRS (acOR:0.79; 95%CI 0.39 to 1.58), procedure time (aβ:-11.32; 95%CI -25.78 to 3.14), mortality at 90 days (aOR:0.51; 95%CI 0.21 to 1.25)) and recanalization rates (aOR:1.57; 95%CI 0.52 to 4.73) showed also no significant differences between both techniques.

Conclusions: Stent retriever and aspiration thrombectomy as first-choice treatment show similar clinical and technical outcomes in this population of patients with a BAO.

Disclosure: No

P0188 / 1212

PREDICTING FACTORS OF PROLONGED MECHANICAL VENTILATION AFTER ENDOVASCULAR TREATMENT IN LARGE VESSEL OCCLUSION STROKE

E. de la Fuente Sanz ¹, C. Romero¹, S. Trillo¹, C. Ramos¹, C. Aguirre¹, J. Vega², J.L. Caniego², A. Canabal³, Á. Ximénez-Carrillo¹, J. Vivancos¹

¹La Princesa Health Research Institute, Hospital Universitario de la Princesa, Stroke Center. Neurology department, Madrid, Spain, ²La Princesa Health Research Institute, Hospital Universitario de la Princesa, Radiology department, Madrid, Spain, ³La Princesa Health Research Institute, Hospital Universitario de la Princesa, Intensive Care Unit, Madrid, Spain

Background and aims: Intensive Care Units(ICUs) are a necessary resource for many patients with large vessel occlusion stroke(LVOS) after endovascular treatment(EVT). However, ICUs have a limited availability of beds and ventilators, situation that has been worsened by the current Covid-19 pandemic. We analyze predicting factors for prolonged mechanical ventilation(PMV) after EVT in patients with LVOS.

Methods: Retrospective study of patients admitted to our stroke center from 2012-2019 for LVOS who were treated with EVT. We identified patients that required PMV(defined as >24h intubation with admission in ICU) after EVT, and evaluated the association with clinical and radiological factors on admission.

Results: N=438. 236(53.9%) women. Mean age 69(DE 14.6). 411(93.8%) anterior circulation stroke, 27(6.2%) posterior. 82(19%) required general anesthesia and intraprocedural intubation, and 47 of them(10.7%) required PMV. Median length of stay(LOS) in ICU: 3 days(1-7). 12/47(25.5%) had prolonged LOS for another reason (6 neurological worsening, 4 hemodynamic instability, 1 respiratory infection, 1 no available beds at Stroke Unit). 19/47(44%) died and 22/47(52.4%) were functionally dependent at three months.

Factors associated to a higher risk of PMV after EVT were: basilar occlusion (OR=12.3, IC95%[5.3-28.4],p<0,001); ASPECTS ⩽7 (OR=3, IC95%[1.4-6.1],p=0,003) and NIHSS ⩾18 (OR=2.8, IC95%[1.3-5.8],p=0,006). Patients with PMV had a higher risk of mortality (OR=6.5, IC95%[3.3-12.8],p<0,001) and functional dependence (OR=5.1, IC95%[2.4-1],p<0,001) at three months.

Conclusions: In our study, patients with basilar occlusion, high NIHSS and lower ASPECTS had higher probability of requiring PMV after EVT, which also led to worse outcome. These are aspects to consider in scenarios with limited availability of ICU beds.

Disclosure: No

P0189 / 892

ENDOVASCULAR RECANALISATION THERAPY BEYOND 24 HOURS IN ACUTE STROKE OF THE ANTERIOR AND POSTERIOR CIRCULATION

J.C. Purrucker ¹, P.A. Ringleb¹, A. Berberich¹, F. Seker², A. Potreck², M. Möhlenbruch², C. Weyland²

¹Heidelberg University Hospital, Department of Neurology, Heidelberg, Germany, ²Heidelberg University Hospital, Department of Neuroradiology, Heidelberg, Germany

Background and aims: There is little evidence of endovascular therapy (EVT) performed in acute ischaemic stroke beyond 24 hours, and evidence is limited to anterior circulation stroke. The aim is to extent evidence of efficacy and safety of EVT>24 hours in both anterior and posterior circulation stroke.

Methods: Local prospectively collected registries were screened for patients with acute ischemic stroke and large-vessel occlusion, who had received either EVT>24 hours after last-seen-well but <24 hours after definitive symptom recognition (EVT>24LSW) or endovascular therapy >24 hours since definitive symptom recognition (EVT>24DEF). Patients treated < 24 hours served as a comparator group. Favourable outcome was defined as mRS 0–2 or return to pre-stroke mRS at 3-months.

Results: Between 01/2014 and 08/2021, N=2352 were treated with EVT, of whom n=43 met inclusion criteria (EVT>24LSW n=16, EVT>24DEF, n=27). EVT>24LSW patients were treated at a median of 28,7h (IQR 27,3—32,8) after last-seen-well, and 7,3h (IQR 2.8–14.3) after symptom recognition; EVT>24DEF patients were treated 52.5h (IQR 26.5—94.2) after definite symptom recognition. Posterior circulation stroke was more frequent in the EVT>24 group (n=12/43, 27.9% vs. EVT<24, n=256/2309, 11.1%, p=0.002). Favourable outcome was achieved by 23.3% in the EVT>24 compared to 38.9% in the EVT<24 group (p=0.04). Bleeding rates were similar across groups. Mortality rates were also similar (EVT>24, 27.9% vs. EVT<24, n=584/2269, 25.7%, p=0.727; posterior circulation EVT>24, n=5/12, 41.7% vs. EVT<24, n=92/252, 36.5%, p=0.764).

Conclusions: In selected patients, EVT seems effective and safe beyond 24 hours in both anterior and posterior circulation stroke.

Disclosure: Yes

P0190 / 776

DEFICIENCY IN NEUROSERPIN EXACERBATES COCL₂ INDUCED HYPOXIC INJURY IN ZEBRAFISH MODEL BY INCREASED OXIDATIVE STRESS

S. Han ¹, L. Wang¹

¹ Huashan Hospital, Fudan University, Department of Neurology, Shanghai, China

Background and aims: Protective strategy against hypoxic-ischemic (H/I) induced injury has been intensively discussed. Neuroserpin, an inhibitor for tissue plasminogen activator (tPA), has been proved a vital neuroprotective agent in cerebral ischemia mouse model and oxygen-glucose deprivation and reoxygenation (OGD/R) cell model. Neuroserpin is a promising therapeutic hint for neonatal hypoxic-ischemia injury. We established a neuroserpin deficient zebrafish to study its role in CoCl2 chemically induced hypoxic injury.

Methods: CoCl₂ exposure was beginning at the embryonic stage. Development defects, neuronal loss, and vascular malformation were assessed by imaging microscopy in WT and serpini1^-/-under CoCl2 induced hypoxic injury. AO staining was used to identify the apoptotic cells. Oxidative stress levels were assessed by measuring the level of lipid peroxidation, glutathione peroxidase, catalase, and superoxide dismutase.

Results: Neuroserpin deficient zebrafish showed more development defects, neuronal loss and vascular malformation compared to wide-type. Apoptosis and oxidative stress were evaluated to further identify the possible mechanisms.

Conclusions: These findings indicate that neuroserpin could be protective against CoCl2 induced hypoxic injury by alleviating oxidative stress.

Disclosure: No

P0191 / 1536

ENDOVASCULAR TREATMENT IN TANDEM OCCLUSIONS

B. Enriquez ¹, T. Nome², C. Nome³, B. Tennøe², C.G. Lund¹, M. Skjelland^1,4, A.H. Aamodt¹

¹Oslo University Hospital, Neurology, Oslo, Norway, ²Oslo University Hospital, Neuroradiology, Oslo, Norway, ³University of Oslo, Molecular Medicine, Oslo, Norway, ⁴University of Oslo, Institute of Clnical Medicine, Oslo, Norway

Background and aims:

Tandem occlusions (TO) occur in approximately 15% of stroke patients with medium (MeVO) and large vessel occlusions (LVO). Optimal management in patients with TO remains uncertain as no RCTs focused on TO have been completed. The aim of this study is to assess factors that may be associated to efficacy and safety in the management of TO.

Methods: In this single center prospective observational study of consecutive MeVO and LVO anterior circulations stroke patients with TO were compared to patients with single occlusions during a 34-month period. Pertinent clinical data, radiological and interventional variables were analyzed to identify factors which may be associated to symptomatic intracranial hemorrhage (sICH) and functional outcome

Results: 90 (%) of 662 anterior circulation stroke patients with MeVO and LVO stroke had TO. Stenting was used in 73 (81%) patients. Successful reperfusion with TICI ⩾2b was achieved in 82 (91%). 1 in 10 patients had sICH. At 90-day follow up, 58% had good outcome (modified Rankin scale ⩽ 2) in the TO group and 59% in the SO group. The strongest predictors for SICH in TO were diabetes mellitus and number of stent retriever passes ⩾ 3. The risk of unfavourable outcome increased with time to recanalization, diffusion weighted imaging volume, age, and smoking history.

Conclusions: Outcome of patients with TO was comparable to patients with SO. 1 in 10 patients with TO had sICH, with diabetes mellitus and number of stent-retriever passes as predictors.

Disclosure: No

P0192 / 763

PREVALENCE AND PREDICTORS OF UNFAVORABLE OUTCOME IN STROKE PATIENTS SUCCESSFULLY TREATED WITH EVT IN THE LATE TIME WINDOW

F. Bala ¹, I. Casetta², S. Nannoni³, M. Goyal¹, E. Fainardi⁴, P. Michel³, J. Thornton⁵, S. Power⁵, V. Saia⁶, A. Demchuk¹, S. Mangiafico⁷, K. Boyle⁵, M. Hill¹, D. Toni⁸, S. Murphy⁹, A. Ademola¹, B.J. Kim¹⁰, B. Menon¹, M. Almekhlafi¹

¹University of Calgary, Calgary, Canada, ²University of Ferrara, Ferrara, Italy, ³University of Lausanne, Lausanne, Switzerland, ⁴University of Florence, Florence, Italy, ⁵Beaumont Hospital, Dublin, Ireland, ⁶Santa Corona Hospital, Pietra Ligure, Italy, ⁷Interventional Neuroradiology Unit, Pozzilli, Italy, ⁸Sapienza University Hospital, Rome, Italy, ⁹University College Dublin, Dublin, Ireland, ¹⁰Seoul National University Bundang Hospital, Seoul, Korea, Republic of

Background: Over half of the patients treated with endovascular thrombectomy (EVT) in the late time window trials achieved unfavorable functional outcomes. We studied the factors associated with unfavorable outcome despite successful reperfusion in a pooled, late time window cohort.

Methods: We pooled individual patients' data from 7 international trials and registries that enrolled acute ischemic stroke patients treated with EVT between 6-24 hours after onset in patients with successful reperfusion (mTICI 2b/3). The primary outcome was 90-day modified Rankin Score (mRS) of 3-6. A logistic regression model was used to identify factors associated with unfavorable outcome despite successful reperfusion.

Results: Of 474 patients with successful reperfusion, 235 (49.6%) had unfavorable outcome. Among those patients, 69 (14.6%) had mRS 3, 58 (12.2%) mRS 4, and 108 (22.8) mRS 5-6. Patients with unfavorable outcome were older (median 75 vs. 65 years), had higher median NIHSS (17 vs. 13), lower proportions of favorable collateral profile (86.8% vs. 93.3%) and higher proportions of terminal ICA occlusions (29.7% vs. 17.1%) compared to patients with favorable outcome. The proportion of unfavorable outcome was similar between patients selected using collateral imaging vs. perfusion imaging (51.6% vs 48.3%). In the multivariable analysis, age (aOR per 10-year 1.71 [95%CI:1.36-2.15]), NIHSS (aOR 1.11 [95%CI:1.10-1.12]), ASPECTS (aOR 0.84 [95%CI:0.72-0.98]), and terminal ICA occlusions (aOR 2.02 [95%CI:1.36-2.98]) were associated with unfavorable outcome.

Conclusion:  Unfavorable functional outcome occurred in half of successfully treated reperfused EVT patients in the late time window and was associated with older age, severe stroke and terminal carotid occlusion.

Disclosure: No

P0193 / 708

MECHANICAL THROMBECTOMY VERSUS MEDICAL TREATMENT FOR LARGE VESSEL OCCLUSION BETWEEN 6 AND 24 HOURS AFTER STROKE ONSET IN PATIENTS NOT FULFILLING DEFUSE-3 AND DAWN CRITERIA

T. Dittrich ¹, L. Kriemler², S. Rudin¹, A. Zietz¹, A. Polymeris¹, C. Tränka¹, S. Thilemann¹, B. Wagner¹, V. Altersberger¹, I. Piot¹, N. Peters³, F. Barinka⁴, M. Hänsel⁵, Z. Kulcsár⁶, S. Müller⁶, M. Pileggi⁷, C. Cereda⁸, G. Karwacki⁹, A. Brehm¹⁰, P. Sporns¹⁰, H. Gensicke¹, S. Engelter¹, P. Lyrer¹, U. Fischer¹, L. Bonati¹, M. Katan¹, S. Wegener⁵, M. Psychogios¹⁰, R. Sutter¹¹, G.M. De Marchis¹

¹University Hospital Basel and University of Basel, Department of Neurology, Basel, Switzerland, ²Cantonal Hospital Schaffhausen, Department of Internal Medicine, Schaffhausen, Switzerland, ³Hirslanden Hospital Zurich, Department of Neurology and Stroke Center, Basel, Switzerland, ⁴Hirslanden Hospital Zurich, Department of Neurology and Stroke Center, Zurich, Switzerland, ⁵University Hospital Zurich, Department of Neurology, Zurich, Switzerland, ⁶University Hospital Zurich, Department of Neuroradiology, Zurich, Switzerland, ⁷EOC Neurocenter of Southern Switzerland, Department of Neuroradiology, Lugano, Switzerland, ⁸EOC Neurocenter of Southern Switzerland, Department of Neurology and Stroke Center, Lugano, Switzerland, ⁹Cantonal Hospital of Lucerne, Department of Radiology and Nuclear Medicine, Lucerne, Switzerland, ¹⁰University Hospital Basel, Department of Neuroradiology, Basel, Switzerland, ¹¹University Hospital Basel, Department of Intensive Care Medicine, Basel, Switzerland

Background and aims: To assess the efficacy and safety of mechanical thrombectomy (MT) in stroke patients with anterior circulation large vessel occlusion (LVO-ant) presenting in the late time window not fulfilling the DEFUSE-3 and DAWN (D3D) inclusion criteria.  

Methods: Retrospective analysis of adult patients with LVO-ant admitted between 6 and 24 hours of last-seen-well at five participating Swiss Stroke Centers between 2014 and 2020. Mismatch was re-assessed by CT or MRI perfusion with automated software (RAPID or OLEA). We excluded patients satisfying the D3D inclusion criteria and compared patients undergoing MT versus best medical treatment (BMT).

Results: Among 250 patients presenting with LVO-ant in the late window, 160 (64%) did not meet the D3D inclusion criteria and thus were included in the analyses (Figure 1). Of those, 76 (48%) received MT. In propensity score analysis MT patients had a numerically higher chance of functional independence (modified Rankin Scale [mRS] 0-2) at 90 days compared to the BMT group (risk difference: 13.1%, 95%CI: -6.6% to 32.9%; Figure 2). There were no significant differences in symptomatic intracranial hemorrhage (sICH) (MT vs BMT: 3.2% vs 1.6%, p=0.99) or death within 90 days (26.4% vs 30.9%, p=0.67).

Conclusions: Two out of three patients with LVO-ant presenting in the late window do not meet the D3D inclusion criteria. In those patients, MT might be associated with a better neurofunctional outcome compared to BMT, without excess in sICH. Broader inclusion criteria for MT in the late window are presently studied in ongoing trials.

Table 1.

Admission Characteristics of Patients admitted 6 to 24 Hours after Symptom Onset.

	All patients (N=250)	Non-DEFUSE-Non-DAWN patients (N=160)
		MT1 (N=76)	BMT2 (N=84)	P value
Clinical characteristics
Age (yr) – median (IQR3)	77 (69, 84)	79 (68, 85)	75 (69, 83)	0.490
Age ⩾ 80 (yr) – no. (%)	106 (42)	30 (40)	39 (46)	0.467
Male sex – no. (%)	109 (44)	44 (58)	42 (50)	0.400
Atrial fibrillation – no. (%)	93 (37)	28 (37)	34 (41)	0.758
Diabetes mellitus – no. (%)	45 (18)	9 (12)	20 (24)	0.079
Hypertension – no. (%)	173 (69)	53 (70)	59 (70)	1.000
Previous ischemic stroke or transient ischemic attack – no. (%)	48 (19)	16 (21)	17 (20)	0.313
Premorbid mRS4 0 – no. (%)	159 (66)	39 (55)	43 (54)	1.000
NIHSS5 score at admission – median (IQR)	13 (6, 19)	11 (5, 18)	12 (5, 18)	0.800
Stroke onset known – no. (%)
Yes	34 (13.6)	7 (9.2)	18 (21.4)	0.056
No
On awakening	112 (44.8)	38 (50.0)	29 (34.5)
Unwitnessed during wakefulness	104 (41.6)	31 (40.8)	37 (44.0)
Imaging characteristics 6
Infarct volume (ml) – median (IQR)	8.0 (0, 24.0)	7.0 (0, 19.5)	9.5 (0, 40.0)	0.441
Perfusion lesion volume (ml) – median (IQR)	78.0 (39.0, 125.8)	81.5 (51.5, 127.3)	51.0 (23.8, 111.8)	0.008
Mismatch volume (ml) – median (IQR)	57.0 (27.0, 98.0)	73.5 (39.0, 101.0)	28.5 (12.0, 51.3)	<0.001
Occlusion site – no. (%)7
Internal carotid artery	69 (28)	18 (24)	21 (25)	0.993
M1	144 (58)	38 (50)	35 (42)	0.369
M2	65 (26)	26 (34)	37 (44)	0.267
A1	6 (2)	0	0
Treatment characteristics
Treatment with intravenous tPA – no. (%)8	47 (19)	17 (22)	18 (21)	1.000
mTICI scores 2b or 39	116 (82)10	61 (80)	NA	NA

1: Mechanical thrombectomy

2: Best medical treatment

3: Interquartile range

4: Modified Rankin Scale (mRS), 0 to 6 points, with higher scores indicating more severe neurological disability

5: National Institutes of Health Stroke Skale (NIHSS), 0 to 42 points, with higher scores indicating more severe deficits

6: Automated assessment with RAPID or OLEA

7: Not mutually exclusive

8: Tissue-type plasminogen activator

9: Modified scale for thrombolysis in cerebral infarction (mTICI), range from 0 to 3, successful recanalization with grade 2b or higher

10: Referring to the MT group (N=142); four missing mTICI values

Disclosure: No

P0194 / 818

ENDOVASCULAR STROKE THERAPY OUTSIDE REGULAR WORKING HOURS IN A NATIONWIDE STROKE SYSTEM

S. Fandler-Höfler ¹, D. Miksova², H. Deutschmann³, E.R Gizewski⁴, M. Sykora⁵, M. Knoflach⁶, S. Kiechl⁶, S. Mutzenbach⁷, W. Lang⁵, C. Enzinger¹, T. Gattringer^1,3

¹Medical University of Graz, Department of Neurology, Graz, Austria, ²Austrian National Public Health Institute, Vienna, Austria, ³Medical University of Graz, Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Graz, Austria, ⁴Medical University of Innsbruck, Department of Neuroradiology, Innsbruck, Austria, ⁵St John's Hospital, Department of Neurology, Vienna, Austria, ⁶Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria, ⁷Christian Doppler Medical Center, Paracelsus Medical University, Department of Neurology, Salzburg, Austria

Background: Endovascular therapy (EVT) has been established as a major component in the acute treatment of large vessel occlusion stroke. In Austria, nationwide coverage of EVT (including mandatory electronic documentation) was established in 2013. However, it is unclear whether outcome and other treatment-related factors differ if patients are treated within or outside regular working hours.

Methods: We analyzed data from the prospective nationwide Austrian stroke registry capturing all consecutive stroke patients treated with EVT between 2016-2019. Patients were trichotomized according to time of groin puncture into treatment within regular work hours (7:00-14:00), afternoon/evening (14:00-21:00) and night-time (21:00-07:00). Moreover, we analyzed 12 similarly-sized EVT treatment windows. Outcome parameters included favorable outcome (modified Rankin Scale scores of 0-2) three months post-stroke and procedural success.

Results: 2911 patients were included in this study (median age 74 years, 50.7% female). Patients treated within regular working hours more frequently had favorable outcome three months post-stroke (42.7% compared to 35.8% treated in the afternoon/evening and 35.6% treated at night-time, p=0.004). Lowest and highest rates of favorable outcome were found in the time windows of 0:41-6:59 (32.4%) and 7:00-9:30 (48.2%). While NIHSS at admission and onset-to-door time was not different between groups, door-to-groin time was considerably longer outside of regular working hours, especially at night-time (p<0.001). There was no difference regarding number of passes, recanalization success and treatment-related complications.

Conclusions: EVT workflows outside of regular working hours need to be improved in order to reach similar treatment speed and functional outcome as within regular working hours.

Disclosure: No

P0195 / 1309

SEIMLESS TECHNIQUE FOR THE TREATMENT OF TANDEM OCCUSIONS IN ACUTE STROKE. SINGLE CENTER EXPERIENCE.

L. Morales Caba ¹, V. Vazquez-Añon Pérez², I. Escudero Martinez¹, I. Vielba Gomez¹, G. Fortea Cabo¹, J.I. Tembl Ferrairo¹, F. Aparici Robles²

¹Hospital Universitari i Politècnic La Fe, Neuroradiology - Stroke Unit, Valencia, Spain, ²Hospital Universitari i Politècnic La Fe, Neuroradiology, Valencia, Spain

Background and aims: SEIMLESS has been recently described as a novel approach for the treatment of tandem occlusions in acute stroke. We analyze the preliminary experience with this technique in our center and compare it with the patients treated with classic anterograde revascularization technique (ART).

Methods: Observational study of patients admitted in 2021 for endovascular treatment with anterior circulation tandem stroke, defined as bulbar occlusion or stenosis > 70% plus intracranial stop. We describe for both SEIMLESS and ART: admission NIHSS, groin-to-recanalization time (GRT), rate of TICI2b-3 result, fluoroscopy time and radiation dose, complication rate, and discharge NIHSS and mRS.

Results: 13 patients treated; 7 with SEIMLESS. Patients in the SEIMLESS group were younger (average age 64 vs 70), GRT was shorter (average 37 vs 61 minutes), fluoroscopy times were longer (1223 vs 872 seconds), dose was higher (103.16 vs 60.74 Gy·cm2), TICI2b-3 rate was higher (100% vs 50%), discharge NIHSS was lower (6 vs 10), although admission NIHSS (15 vs 15) and discharge mRS (3 vs 3) were the same. No intraprocedural complications were observed in either group.

Conclusions: SEIMLESS technique application in our center was observed to correlate with a trend in shorter reperfusion times and, but a longer fluoroscopy time and higher dose. No difference in mRS at discharge was observed. Further studies with larger samples are needed to validate this data and explore clinical.

Disclosure: No

P0196 / 532

INFLUENCE OF REPERFUSION STATUS AFTER ENDOVASCULAR STROKE TREATMENT ON THE EFFECT OF PERIPROCEDURAL UNFRACTIONATED HEPARIN AND ACETYLSALICYLIC ACID

W. van der Steen ^1,2, P.M. van der Sluijs², R.A. van de Graaf^1,2, R. Su², L. Wolff², H. van Voorst^3,4, H.M. den Hertog⁵, P.J. van Doormaal², A.C. van Es⁶, J. Staals⁷, W. van Zwam⁸, H.F. Lingsma⁹, C.B. Majoie³, A. van der Lugt², D.W. Dippel¹, B. Roozenbeek^1,2, on behalf of the MR CLEAN-MED Investigators

¹Erasmus MC University Medical Center, Department of Neurology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands, ³Amsterdam University Medical Center, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁴Amsterdam University Medical Center, University of Amsterdam, Department of Biomedical Engineering & Physics, Amsterdam, Netherlands, ⁵Isala, Department of Neurology, Zwolle, Netherlands, ⁶Leiden University Medical Center, Department of Radiology, Leiden, Netherlands, ⁷Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Department of Neurology, Maastricht, Netherlands, ⁸Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Department of Radiology and Nuclear Medicine, Maastricht, Netherlands, ⁹Erasmus MC University Medical Center, Department of Public Health, Rotterdam, Netherlands

Background: Observational studies suggest that periprocedural antithrombotic treatment during endovascular therapy (EVT) for ischemic stroke is more effective in patients with successful reperfusion. We aimed to assess whether the effect and safety of periprocedural unfractionated heparin and acetylsalicylic acid is influenced by the reperfusion status after EVT in randomized data.

Methods: We performed a post-hoc analysis of the MR CLEAN-MED trial, which included adult patients with a large vessel occlusion in the anterior circulation who underwent EVT within 6 hours of stroke onset. In this trial, patients were randomized to periprocedural unfractionated heparin or no unfractionated heparin, and to periprocedural acetylsalicylic acid or no acetylsalicylic acid. We tested for an interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and periprocedural treatment with multivariable regression analyses. Primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes were intracranial hemorrhage (ICH), symptomatic ICH, and final infarct volume.

Results: Of 591 included patients, 69 (12%) had a post-EVT eTICI score of 0-2a, 127 (21%) a score of 2b, 131 (22%) a score of 2c, and 264 (45%) a score of 3. For both unfractionated heparin and acetylsalicylic acid, we found no interaction between post-EVT eTICI score and treatment for mRS (p=0.42, and p=0.25, respectively), ICH (p=0.56, and p=0.85), symptomatic ICH (p=0.49, and p=0.94), and final infarct volume (p=0.56, and p=0.37).

Conclusion: The efficacy and safety of periprocedural unfractionated heparin and acetylsalicylic acid during endovascular stroke treatment is not influenced by reperfusion status after the procedure.

Disclosure: Yes

P0197 / 414

ASPIRATION THROMBECTOMY FOR ACUTE ISCHEMIC STROKE PATIENTS PRESENTING AFTER 6 HOURS

A. Hassan ¹, J. Fifi², O. Zaidat³

¹University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, United States, ²Icahn School of Medicine at Mount Sinai, New York, United States, ³Mercy Health St. Vincent Medical Center, Toledo, United States

Background and aims: The purpose of this analysis was to evaluate the safety and performance of aspiration thrombectomy in patients with late onset to treatment (> 6 hours) acute ischemic stroke (AIS) in a real-world setting.

Methods: This is a subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with large vessel occlusion AIS with mRS of 0-1 who underwent aspiration thrombectomy with the Penumbra System. Data are presented for all patients with late presentation (> 6 hours onset to puncture) anterior circulation LVO and ASPECTS ⩾ 6. Primary endpoints were successful revascularization (mTICI score 2b-3) post-procedure, good functional outcome at 90 days (mRS 0-2), and all-cause mortality at 90 days.

Results: Of 650 patients enrolled across 42 centers (29 in the United States and 13 in Europe), 167 patients (mean age 68.4, 56.3% female) with late presentation were included in this analysis. Median NIHSS was 12 (IQR 7, 17) and median ASPECT Score was 8 (IQR 7, 9). Post-procedure successful revascularization rate was 83.2% (139/167), 90-day good functional outcome rate was 55.4% (87/157), and 90-day all-cause mortality rate was 14.4% (24/167). Symptomatic ICH occurred in 4.2% (7/167) of patients, procedure-related SAEs in 5.4% (9/167) of patients, and no device-related SAE were observed.

Conclusions: These findings suggest that for patients with late presentation stroke, aspiration thrombectomy with the Penumbra System is safe and effective. Rates of good functional outcome and all-cause mortality compare favorably to the DAWN and DEFUSE-3 medical management arms.

Baseline Characteristics	COMPLETE(N=167)	DAWN control arm (n=99)	DEFUSE-3 control arm (n=90)
Age in years, mean (SD) (*median [IQR])	68.4 (13.9)	70.7 (13.2)	71 [59, 80]*
Female, % (n/N)	56.3% (94/167)	48% (48/99)	51% (46/90)
NIHSS, median [IQR]	12 [7, 17]	17 [14, 21]	16 [12, 21]
ASPECT Score, median [IQR]	8 [7, 9]	N/A	8 [7, 9]
IV tPA pre-procedure, % (n/N)	21.6% (36/167)	13% (13/99)	9% (8/90)
Time from stroke onset to puncture (*or randomization), hours, median [IQR]	10.5 [7.6, 14.8]	5.6 [3.6, 7.8]*	10.7 [8.7, 13.1]*

Endpoints, % (n/N)	COMPLETE(N=167)	DAWN control arm (n=99)	DEFUSE-3 control arm (n=90)
90-day mRS 0-2	55.4% (87/157)	13% (13/99)	17% (15/90)
90-day all-cause mortality	14.4% (24/167)	18% (18/99)	26% (23/90)
Symptomatic ICH, ⩽ 24 hrs	4.2% (7/167)	3% (3/99)	4% (4/90)
Procedural Outcomes, % (n/N)
Aspiration only as frontline treatment, % (n/N)	59.9% (100/167)	N/A	N/A
Aspiration with 3D as frontline treatment, % (n/N)	40.1% (67/167)	N/A	N/A
mTICI 2b-3 post-procedure	83.2% (139/167)	N/A	N/A
mTICI 2b-3 post-first pass	49.1% (81/165)	N/A	N/A
Device-related SAE, ⩽ 24 hrs	0.0% (0/167)	N/A	N/A
Procedure-related SAE, ⩽ 24 hrs	5.4% (9/167)	N/A	N/A
ENT, at end of procedure	2.4% (4/167)	N/A	N/A
Vessel Perforation	0.0% (0/167)	N/A	N/A
Vessel Dissection	0.6% (1/167)	N/A	N/A

Disclosure: Yes

P0198 / 1515

MANAGEMENT OF ACUTE ISCHEMIC STROKE PATIENTS WITH TANDEM LESIONS: ANALYSIS FROM THE PROXIMAL INTERNAL CAROTID ARTERY ACUTE STROKE SECONDARY TO TANDEM OCCLUSION (PICASSO) REGISTRY

A. Divani ¹, M. Farooqui², D. Quispe-Orozco², A. Ikram¹, H. Anwar¹, A. Castonguay³, S. Zaidi³, M. Ribo⁴, M. Abraham⁵, J. Fifi⁶, N. Petersen⁷, M. Requena⁴, M. Patterson⁸, M. Gadea⁴, S. Matsoukas⁶, S. Matsoukas⁶, J. Kobsa⁷, A. Prasad⁷, A. Malik⁹, V. Saini⁹, W. Guerrero¹⁰, A. Rana¹¹, A. Kaliaev¹², M. AbdalKader¹², V. Lopez Rivera¹³, M. Oliver³, S. Salazar Marioni¹³, C. Cajavilca¹⁴, J. Soomro¹⁴, C. Zevallos², M. Galecio-Castillo², J. Vivanco-Suarez², A. Dajles², N. Janjua¹⁵, A. Yoo¹⁴, R. Edgell¹⁶, G. Linares¹⁶, S. Sheth¹³, T. Nguyen¹², J. Sigler¹¹, T. Jovin¹¹, M. Mokin¹⁰, D. Yavagal⁹, M. Jumaa³, A. Hassan¹⁷, O. Zaidat⁸, S. Ortega-Gutierrez², PICASSO Study Group

¹University of New Mexico, Albuquerque, United States, ²University of Iowa Hospitals and Clinics, Iowa City, United States, ³University of Toledo, Toledo, United States, ⁴Vall De Hebron, Barcelona, Spain, ⁵University of Kansas Medical Center, Kansas City, United States, ⁶Mount Sinai, New York City, United States, ⁷Yale School of Medicine, New Haven, United States, ⁸Mercy Health St. Vincent Hospital, Toledo, United States, ⁹University of Miami, Miami, United States, ¹⁰University of South Florida, Tampa, United States, ¹¹Cooper University Hospital, Camden, United States, ¹²Boston University, Boston, United States, ¹³University of Texas health Sciences Center, Houston, United States, ¹⁴Texas Stroke Center, Dallas, United States, ¹⁵Pomona Medical Center, Pomona, United States, ¹⁶Saint Louis University, Saint Louis, United States, ¹⁷Valley Baptist Medical Center, Harlingen, United States

Background and aims: Tandem lesions (TL) constitute 10-20% of all strokes and involve concomitant cervical internal carotid artery (ICA) occlusion/stenosis along with intracranial large vessel occlusion. Mechanical thrombectomy (MT) has become the standard of care in acute stroke patients with TLs. In this multicenter study, we aimed to determine the safety and efficacy of acute stenting of the cervical ICA lesion.

Methods: Patient data from 15 centers were divided into stenting and non-stenting groups based on the treatment of TL. Multivariate analyses were used to assess the association of primary outcomes defined as modified Rankin Score (mRS) 0-2 at 90 days, and symptomatic intracranial hemorrhage (sICH), and secondary outcomes defined as successful reperfusion (mTICI score ⩾2b) and mortality.

Results: Of the 686 patients, 589 were included in the final analysis with 363 and 225 in the stenting and non-stenting groups, respectively. There were fewer patients with atrial fibrillation, lower median NIHSS, and higher median ASPECTS at admission in the stenting group. The odds of good functional outcome were significantly higher for the stenting group (OR: 1.7; CI: 1.1-2.5; p=0.02) at 90 days, as well as the odds of successful reperfusion (OR:1.9; CI: 1.13-3.22; p=0.016) and lower mortality rates (16.2% vs 22.5%, p=0.07), while the two groups were similar for sICH (5.2% vs 5.4%, p=0.96).

Conclusions: Acute stenting of the cervical lesion in conjunction with MT is associated with increased odds of a favorable outcome and successful revascularization without significant risk of symptomatic hemorrhage in acute ischemic stroke patients with TL.

Disclosure: No

P0199 / 1650

THE POSSIBILITY OF ENDOVASCULAR EMBOLIZATION AS MONOTHERAPY FOR THE TREATMENT OF CEREBRAL ARTERIOVENOUS MALFORMATIONS

O. Tsurkalenko ¹, L. Dziak¹, Y. Cherednychenko²

¹Dnipro State Medical University, Dnipro, Ukraine, ²Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnykov, Dnipro, Ukraine

Background and aims: Arteriovenous malformations of the brain ()AVM are a common problem that can lead to disability in the event of bleeding. Our work presents the experience of using endovascular interventions in the management of patients with AVM. The aim - to assess possibility of using endovascular embolization as monotherapy for the treatment of cerebral AVM.

Methods: Examination and gradual endovascular treatment with non-adhesive liquid embolic agents of 64 patients (120 sessions) were performed.

Results: The average decrease in volume after embolization was 79.5 % (up to 50 % – in 7 cases, 50–75 % – in 14, 75–99 % – in 29). Complete exclusion of AVM was achieved in 14 (22 %) patients. On average, 2–3 feeders were embolized on the AVM to achieve such results. Malformations of small size (up to 3 cm) often managed to close in one session. Clinically significant deficiency (2 on the modified Rankin scale) after embolization was found in 2 (3 %) patients. The deficit regressed within 7 days. The angiographic frequency of complete obliteration of AVM at the end of all embolization procedures was 22 % (14 AVM).

Conclusions: Knowledge of the angioarchitectural characteristics of AVM, which are suitable for the treatment with liquid embolic agents, and their careful selection allow to achieve a high frequency of occlusion with a low frequency of complications. The use of superselective intranidal or perinidal positions of the catheter, slow controlled injections that protect the draining veins, the gradual embolization make the therapy safer.

Disclosure: No

P0200 / 292

OUTCOME IN ELDERLY PATIENTS WITH ACUTE ISCHEMIC STROKE TREATED WITH THROMBECTOMY - REAL WORLD ANALYSIS

C. Beuker ¹, J. Köppe¹, H. Wiendl¹, H. Reinecke¹, J. Minnerup¹

¹ University of Münster, Münster, Germany

Background and aims: Randomized clinical trials demonstrated benefit of mechanical thrombectomy for large vessel occlusion in acute ischemic stroke. However, whether this is true for elderly patients remains uncertain. We therefore analyzed the outcome in patients aged > 80 years with acute ischemic stroke treated with thrombectomy.

Methods: From the largest public German health insurance, anonymized data of all patients with acute ischemic stroke and mechanical thrombectomy between 2010 and 2018 were analyzed and followed-up for one year after stroke.

Results: Of 18,506 ischemic stroke patients treated with thrombectomy, 6,729 were aged > 80 years and 11,777 were aged < 80 years. Thirty-day mortality was 35.0% in patients aged > 80 years compared to 24.4% in the entire cohort. These increased mortality rates in elderly patients did not change over time (period of 5 years). Multivariable Cox regression for long-term mortality found ventilation > 48 hours (HR 2.63), chronic limb-threatening ischemia (HR 1.67) and diabetes mellitus (HR 1.38) to have the strongest impact (all p<0.001). Furthermore, elderly patients had an increased risk to be newly dependent on nursing care 3 months after ischemic stroke (37.5% vs. 27.2%).

Conclusions: In this large ‘real world’ data, prognosis after mechanical thrombectomy was markedly reduced in elderly patients. In particular, if certain comorbidities, such as diabetes mellitus or chronic limb-threatening ischemia, or ventilation > 48 hours existed.

Disclosure: No

P0201 / 326

A COMPARIONS OF DIFFERENT ENDOVASCULAR TREATMENT FOR VERTEBRAL ARTERY ORIGIN STENOSIS

Z. Wang ¹, W. Cao¹

¹ Huashan Hospital, Fudan University, Department of Neurology and Institute of Neurology, Shanghai, China

Background and aims: Endovascular treatment for vertebral artery origin stenosis (VAOS) includes stenting with bare mental stent (BMS), stenting with drug-eluting stent (DES), and angioplasty alone with drug-coated balloon (DCB). We aimed to compare the safety and efficacy of these three endovascular treatment modalities in patients with symptomatic VAOS.

Methods: Patients with VAOS who received endovascular treatment from December 2018 to June 2021 in our institution were retrospectively evaluated. Baseline demographics and angiographic features were reported. The main outcomes compared were technical success, perioperative complications, recurrence of ischemic events, progression of stenosis, and in-stent restenosis (ISR)/ restenosis rate.    

Results: A total of 39 patients were analyzed, including 11 with BMS placement, 23 with DES placement, and 5 with DCB angioplasty alone. Technical success was achieved in 100%, 100%, and 60%, respectively (p < 0.001). Perioperative complication occurred in one case in the DES group. The mean follow-up period was 5.8 months, 3.5 months, and 3.2 months, respectively (p = 0.06 ). Recurrent ischemic events were observed in one in the BMS group, two in the DES group, and none in the DES group (p = 1.00). Progression of stenosis rate was 37.2%, 8.0%, and -8.0%, respectively (p < 0.001). ISR/restenosis rate was 63.6%, 4.3%, and 20.0%, respectively (p = 0.001). BMS was independently associated with ISR/restenosis (aOR, 25.11[95% CI, 1.56 to 403.97], p = 0.02).    

Conclusion: DES is a promising therapeutic strategy for VAOS. BMS is independently associated with ISR/restenosis. DCB exhibits a persistent potential in ameliorating stenosis.

Disclosure: No

P0202 / 1170

RECURRENT STROKE AFTER ENDOVASCULAR TREATMENT FOR SYMPTOMATIC INTRACRANIAL ARTERY ATHEROMATOUS STENOSIS: A RETROSPECTIVE COHORT STUDY

E. Panicucci ¹, M. Jamjoom², C. Bruno¹, A. La Porta¹, M.H. Mahagne¹, P. Arnoffi², Y. Chau², J. Sedat², B. Casolla¹

¹Hôpital Pasteur 2, Neurovascular Unit, Nice, France, ²Hôpital Pasteur 2, Neurointerventional Unit, Nice, France

Background and aims: The clinical benefit of endovascular treatment (EVT) in patients with intracranial stenosis is uncertain. This study aimed at identifying the incidence of ischemic stroke (IS) recurrences and their associated factors in patients treated by angioplasty with/without stenting for symptomatic intracranial arterial stenosis.

Methods: We included consecutive patients who underwent EVT for symptomatic intracranial atheromatous arterial stenosis (defined as a stenosis degree >70% on digital angiography), from 1^st Jan 2006 to 31^st Dec 2019 at Nice University Hospital. We studied IS recurrence in the vascular territory of the treated artery during follow-up and identified associated factors by performing bivariate analyses. We analyzed clinical and radiological outcomes, including death and favorable functional outcome at 3 months, post procedure residual stenosis and re-stenosis during follow-up.

Results: We included 70 patients (75,95% men, median age 67 [58-73]) who underwent 79 EVT. Fifty-seven (72,15%) patients were treated with angioplasty with stenting. Fifteen patients presented an IS recurrence during follow-up (7 per-procedural, 10 within 30 days, 4 between 30 days and 1 year, 5 after 1 year). Patients with history of IS, previous to the index event, and delayed restenosis were more likely to suffer an IS recurrence (OR= 3.86 CI[1.23-12.14], p=0.022; OR= 5.46 CI[1.69-17.62], p=0.009). IS recurrences did not significantly impact mortality and functional outcome (OR= 2.86 CI[0.44-18.75], p=0.265; OR= 0.29 CI[0.059-1.47], p=0.143).

Conclusion: Incidence of IS recurrence after EVT is high, reaching one out of five patients during follow-up. Further research is needed to evaluate their impact on long-term mortality and functional outcome.

Disclosure: No

P0203 / 1081

INFLUENCE OF FIRST-PASS EFFECT ON RECANALIZATION OUTCOMES IN THE ERA OF MECHANICAL THROMBECTOMY

X. Zhang ¹, X. Bai¹, W. Yang², Y. Zhang¹, T. Wang¹, R. Xu¹, Y. Wang³, L. Li¹, Y. Feng¹, K. Yang⁴, X. Wang⁵, H. Song⁶, Q. Ma⁶, L. Jiao¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, United States, ³China Medical University, Shenyang, China, ⁴Xuanwu Hospital, Capital Medical University, Department of Evidence-Based Medicine, Beijing, China, ⁵Xuanwu Hospital, Capital Medical University, Medical Library, Beijing, China, ⁶Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China

Background and aims: This study summarized the current literature to compare the safety and efficacy between first-pass effect (FPE) and multiple-pass effect (MPE) for thrombectomy in treatment of acute ischemic stroke (AIS)

Methods: Major databases were searched for studies which reported clinical outcomes regarding successful or complete recanalization after first pass of mechanical thrombectomy in AIS. The assessment of bias was performed using different scales.

Results: A total of 9 studies were eligible for final analysis. For successful recanalization (mTICI 2b-3), favorable outcomes were seen in 49.7% (95% confidence interval (CI): 40.5-58.9%) and 34.7% (95% CI: 26.8-42.7%) of FPE and MPE patients, respectively. Mortality at 3 months was 13.8% (95% CI: 10.8-16.9%) and 26.0% (95% CI: 17.7-34.2%), respectively. For complete recanalization (mTICI 2c-3), proportion of favorable outcomes were 62.7% (95% CI: 51.2-74.2%) and 47.7% (95% CI: 37.4-58.0%) in FPE and MPE; mortality was seen in 11.5% (95% CI: 4.9-18.2%) and 17.0% (95% CI: 5.2-28.7%), respectively. For AIS with successful recanalization, FPE had more favorable outcome (odds ratio (OR): 1.85, 95% CI: 1.48-2.30; p < 0.01; I2 = 0%) and lower mortality than MPE (OR: 0.58, 95% CI: 0.42-0.79; p = 0.001; I2 = 61.9%). Similar results were seen in a subgroup analysis of patients with complete recanalization, with FPE having better outcome (OR: 1.79, 95% CI: 1.40-2.28; p < 0.01) and lower mortality risk (OR: 0.61, 95% CI: 0.44-0.86; p = 0.005) compared to MPE.

Conclusion: FPE is associated with better outcomes than MPE after achieving successful or complete recanalization.

Disclosure: No

P0204 / 1245

EFFECT OF AGE ON THE EFFICACY AND SAFETY OF INTRAVENOUS THROMBOLYSIS BEFORE MECHANICAL THROMBECTOMY

A. Honig¹, R. Leker¹, H. Hallevi², N. Simaan¹, A. Filioglo¹, E. Seyman², E. Ben-Assayag², O. Rotschild², J. Molad ²

¹Hadassah-Hebrew University Medical Center, Department of Neurology, Jerusalem, Israel, ²Tel-Aviv Sourasky Medical Center, Departement of Neurology & Stroke, Tel-Aviv, Israel

Background and aims: Current guidelines advocate intravenous thrombolysis (IVT) treatment to all acute ischemic stroke patients due to large vessel occlusion prior to endovascular thrombectomy (EVT), however recent studies have shown conflicting results.

Methods: Data from an ongoing prospective database of consecutive EVT patients of two academic centers was obtained. Institutional protocols allow patients presenting within 4 hours of symptoms onset to undergo direct EVT without preceding IVT if the interventional team is at the hospital. To assess the comparative efficacy of pretreatment with IVT, the two cohorts were retrospectively analyzed.

Results: 312 patients were included in this cohort, among them 101 patients were older than 80-year-old (85.8±4.5, 27% males). Baseline characteristics and stroke severity were similar between Direct-EVT (n=50) and IVT-EVT (n=51) groups apart from higher rates of malignancy (12% vs 2%, p=0.047) and previous anti-platelet treatment (46% vs 22%, p=0.016) in the Direct-EVT group. Carotid stent was more frequently deployed in the Direct-EVT group (12% vs 2%, p=0.04). No difference was found in the rates of recanalization, favorable outcome (30% vs 26%, p=0.558) and mortality (22% vs 22%, p=0.958). Patients underwent direct EVT had higher rates of PH2 (6% vs 0%, p=0.045) and trend for higher rates of symptomatic HT (4% vs 0%, p=0.162). Sub-analysis including patients older than 85 (n=51) demonstrated similar results.

Conclusions: In this study, pretreatment with IVT among patients above 80 demonstrated similar efficacy and better safety compared to EVT alone. According to our results, age should not withhold IVT administration among EVT eligible patients.

Disclosure: No

P0205 / 1566

ASSOCIATION OF INTRACRANIAL HEMORRHAGE AFTER ENDOVASCULAR STROKE TREATMENT WITH FUNCTIONAL OUTCOME

W. van der Steen ^1,2, N. van der Ende^1,2, S. Luijten², L. Rinkel³, K.R. van Kranendonk⁴, H. van Voorst^4,5, S.D. Roosendaal⁴, L.F. Beenen⁴, J.M. Coutinho³, B.J. Emmer⁴, R.J. van Oostenbrugge⁶, Y.B. Roos³, C.B. Majoie⁴, H.F. Lingsma⁷, A. van der Lugt², D.W. Dippel¹, B. Roozenbeek^1,2, on behalf of the MR CLEAN-NOIV and MR CLEAN-MED investigators

¹Erasmus MC University Medical Center, Department of Neurology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands, ³Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ⁴Amsterdam University Medical Center, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁵Amsterdam University Medical Center, University of Amsterdam, Department of Biomedical Engineering & Physics, Amsterdam, Netherlands, ⁶Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Department of Neurology, Maastricht, Netherlands, ⁷Erasmus MC University Medical Center, Department of Public Health, Rotterdam, Netherlands

Background: We aimed to assess the association of various classifications of intracranial hemorrhage (ICH) after endovascular stroke treatment with functional outcome.

Methods: We analyzed data from the MR CLEAN-NOIV and MR CLEAN-MED trials. Both trials included adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular therapy. We selected patients with available follow-up imaging. ICH was classified i) as asymptomatic or symptomatic (concomitant neurological deterioration of ⩾ 4 points on the NIHSS, or ⩾ 2 points on 1 NIHSS item), and ii) according to the anatomic description based on the Heidelberg Bleeding Classification. We used multivariable ordinal logistic regression analyses to assess the association of the various classifications of ICH with the modified Rankin Scale score at 90 days.

Results: Of 1038 included patients, 334 (32%) had an asymptomatic ICH, and 93 (9%) had a symptomatic ICH. Compared to no ICH, both asymptomatic (adjusted common odds ratio [acOR] 0.75; 95% CI 0.57-0.97) and symptomatic (acOR 0.07; 95% CI 0.04-0.13) ICH were associated with worse functional outcome. In particular, parenchymal hematoma type 2 (acOR 0.34; 95% CI 0.18-0.64), remote parenchymal hematoma (acOR 0.35; 95% CI 0.15-0.79), and intraventricular hemorrhage (acOR 0.25; 95% CI 0.11-0.56) were associated with worse functional outcome compared to no ICH.

Conclusion: Both symptomatic and asymptomatic ICH after endovascular stroke treatment are associated with worse functional outcomes compared to no ICH. The strength of the association depends on the presence of symptoms and on the anatomic description of the ICH.

Disclosure: Yes

P0206 / 1520

CLINICAL AND RADIOLOGICAL FEATURES OF TREATED PATIENTS WITH ACUTE ISCHEMIC STROKE DUE TO MEDIUM-VESSEL OCCLUSIONS

F. Rizzo ¹, M. Romoli², M. Petruzzellis³, M. Gentile⁴, S. Forlivesi⁴, L. Piccolo⁴, F. Naldi⁴, A. Zaniboni⁴, S. Testoni⁴, S. Galluzzo⁵, L. Cirillo⁵, F. Taglialatela⁵, L. Simonetti⁵, A. Zini⁴

¹University of Bari, Neurology Department and Stroke Unit, Bari, Italy, ²Cesena "M.Bufalini" Hospital- AUSL Romagna, Neurology Department and Stroke Unit, Cesena, Italy, ³AOU Consorziale Policlinico, Neurology Department and Stroke Unit, Bari, Italy, ⁴IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore, Department of Neurology and Stroke Center, Bologna, Italy, ⁵IRCCS Istituto di Scienze Neurologiche di Bologna, Ospedale Maggiore, Neuroradiology Unit, Bologna, Italy

Background and aims: MeVOs account for 25–40% of all AIS. There is limited but promising evidence for the safety and efficacy of EVT in MeVOs. Our study aims to collect clinical and radiological features of MeVOs AIS patients admitted to our CSC treated with IVT, EVT, or both and to compare their clinical outcomes.

Methods: We retrospective collected clinical and radiological data of patients with MeVOs AIS admitted at our CSC between January 2019 and July 2021. The primary outcome was mRS⩽2 at three months. To identify potential predictors for mRS⩽2, we performed univariate analysis, including demographic, clinical, and treatment-related variables. All candidate variables were entered into binary logistic regression analysis, with a backward stepwise elimination approach set to simplify the model.

Results: We identified 180 patients with MeVOs (IVT=59, EVT=38, IVT+EVT=83). mRS score⩽2 at 3 months was obtained for 61% of patients in the IVT, 31.6% in the EVT group and 63.9% in the IVT+EVT group. Overall rate of sICH was very low (1.1%). Procedural complications were vasospasm (4.2%) and subarachnoid haemorrhage (1.7%), no neurological deterioration due to the complications was reported. In the backward stepwise multivariable logistic regression IVT+EVT was found to positively and significantly impact the primary outcome (OR 2.33; CI 95% 0.88-6.14; p=0.05).

Conclusions: The combination of IVT+EVT was found to increase the possibility of functional independence at 3 months by 2.33 times. EVT in MeVOs AIS seems feasible and safe. To establish the efficacy and safety of EVT RCTs are warranted.

Disclosure: No

P0207 / 189

OUTCOME AFTER ENDOVASCULAR THROMBECTOMY FOR ACUTE ISCHEMIC STROKE IN PATIENTS AGED 80 YEARS OR OLDER

N.G. Laugesen ¹, T. Stavngaard², J. Højgaard¹, K. Hansen^1,3, T.C. Truelsen^1,3

¹Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark, ²Rigshospitalet, Copenhagen University Hospital, Department of Radiology, Copenhagen, Denmark, ³University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark

Background and aims: Patients ⩾80 years constituted only 15% of the large endovascular thrombectomy (EVT) trials but a considerable proportion in daily clinical routine. Our aim was to study predictors of functional outcome in patients aged ⩾80 compared with patients aged <80 years following EVT.

Methods: A prospective single-center observational study of consecutive EVT patients during the 3-year period 2017-2019. Outcome at 90 days, using the modified Rankin Scale (mRS), was categorized as fair outcome (mRS 0-3), disability (mRS 4-5), and death. Predictors of functional outcome in ⩾80 patients were examined using multivariate ordinal logistic regression including age, sex, treatment with alteplase, pre-stroke mRS, successful reperfusion (modified Treatment in Cerebral Ischemia 2b+3), time to reperfusion, site of vessel occlusion, National Institute of Health Stroke Scale (NIHSS) at admission, and Alberta Stroke Programme Early CT (ASPECT). Significance was defined at the P<0.05 level.

Results: A total of 686 patients had EVT of which 167 patients (24.3%) were ⩾80 years. In patients ⩾80, 73/167 (43.7%) fair outcome, vs. 313/519 (60.3%) in patients aged <80 years, p<0.01, and mortality was twice as high, 62/167 (37.1%) vs. 95/519 (18.3%), p<0.01, respectively. Disability did not differ, 25/167 (14.4%) vs. 88/519 (17.0%), p=0.43. Predictors significantly associated with better functional outcome were: age, OR=0.89 (95%CI 0.81-0.97); pre-stroke mRS, OR=0.56 (95%CI 0.40-0.81); successful reperfusion, OR=3.18 (95%CI 1.11-9.13); NIHSS, OR=0.92 (95%CI 0.86-0.98); ASPECT, OR=1.38 (95%CI 1.07-1.78).

Conclusion: In patients ⩾80 years, 2-of-5 patients achieved fair outcome but the mortality was twice as high as in patients aged <80 years.

Disclosure: No

P0208 / 209

ULTRA-EARLY FUNCTIONAL IMPROVEMENT AFTER STROKE THROMBECTOMY – PREDICTORS AND IMPLICATIONS

S. Desai ¹, J. Catapano², D. Tonetti³, G. Nayar³, K. Shah³, A. Morrison⁴, R. Jha⁵, T. Jovin⁶, A. Jadhav²

¹HonorHealth Research Institute, Neurology, Scottsdale, United States, ²Barrow Neurological Institute, Neurosurgery, Phoenix, United States, ³University of Pittsburgh, Neurosurgery, Pittsburgh, United States, ⁴University of Pittsburgh School of Medicine, Neurology, Pittsburgh, United States, ⁵Barrow Neurological Institute, Neurology, Phoenix, United States, ⁶Cooper University, Neurology, Camden, United States

Background/aims: Neurocritical care is consistently provided to patients post endovascular thrombectomy (EVT) for anterior large vessel occlusion (LVO) strokes. We aim to study the relationship between immediate improvement in NIHSS score on outcomes post-EVT and potential implications for post-procedural care.

Methods: A retrospective review of anterior circulation LVO (internal carotid/proximal middle cerebral artery) patients undergoing EVT. Demographic, clinical, and imaging information was analyzed. Ultra-early functional improvement (UEFI) was defined as NIHSS score <6 within 30-minutes of successful recanalization. We analyzed the incidence and predictors of UEFI.

Results: Of the 343 anterior LVO patients undergoing EVT, mean age was 71±15 and 46% were males. Mean NIHSS was 17±6 and time to arrival was 9±11 hours. UEFI was observed in 23% of patients. Independent predictors of UEFI included lower NIHSS, favorable ASPECTS, and lower admission systolic blood pressure. Rates of 90-day-modified Rankin scale 0-2 were higher (71% vs 33%,p< 0.01) and the rate of mortality (8% vs 28%,p< 0.01) was lower in the UEFI group compared to the non-UEFI group. Amongst patients with UEFI, 1.3% experienced increase in NIHSS (⩾4) within 24-hours of EVT. None of the UEFI patients required continuous antihypertensive infusions.

Conclusion: Approximately 1-in-4 of anterior LVO stroke patients undergoing EVT have an NIHSS score of <6 within 30 minutes of successful recanalization. Only 1% of them experience significant decline in neurological status within 24 hours of the procedure with the majority achieving functional independence at 90 days. The need for advanced neurocritical care should be re-evaluated in these patients.

Disclosure: No

P0209 / 1500

INTRAOPERATIVE MONITORING MIGHT IMPROVE THE CLINICAL OUTCOME OF SURGICAL EXTRACRANIAL INTERNAL CAROTID ARTERY RECANALIZATION

S. Ostrý ^1,2, M. Nevšímal³, M. Reiser¹, R. Voldřich², O. Krtička¹, J. Kubále⁴, M. Nevšímalová¹, J. Fiedler^3,5

¹Hospital České Budějovice a.s., Department of Neurology, České Budějovice - Budweis, Czech Republic, ²First Faculty of Medicine Charles University in Prague and Military University Hospital Prague, Department of Neurosurgery and Neurooncology, Prague, Czech Republic, ³Hospital České Budějovice a.s., Department of Neurosurgery, České Budějovice - Budweis, Czech Republic, ⁴Hospital České Budějovice a.s., Department of Radiology, České Budějovice - Budweis, Czech Republic, ⁵Faculty of Medicine in Plzeň, Charles University in Prague, Department of Neurosurgery, Pilsen, Czech Republic

Background: Favorable clinical outcome after intravenous, endovascular, and surgical extracranial internal carotid artery (eICA) recanalization is about 30%, 50%, and 62% respectively. Median nerve somatosensory evoked potentials (SEP) amplitude is a direct marker of cortical neuronal activity in the rolandic area and correlates well with cortical regional cerebral blood flow (rCBF). Intraoperative carotid artery cross-clamp might lead to additional lowering of rCBF in the area of hypoperfusion and ultimately to the development of definitive ischemia.

Aims: Evaluate functional clinical outcome after urgent surgical eICA recanalization with intraoperative SEP monitoring.

Methods: Prospective enrollment. Inclusion criteria: Acute ischemic stroke with eICA occlusion within 24hours eligible for intravenous and/or endovascular recanalization.

Exclusion criteria: pre-stroke disability – modified Rankin score (mRS) > 2.

Parameters measured: proportion of intraoperative ipsilateral significant SEP amplitude decrease < 50% of baseline,  3-month functional outcome according to mRS.

Results: Cohort: 33 patients, 30 males (90.1%), average age of 70.4 ± 8.9 years.

Ipsilateral SEP amplitude significantly decreased in 6 (18.2%). Sufficient for recovery was mean arterial pressure increase > 100 mmHg, rapid eICA blood flow restoration, and intraluminal shunt insertion in 3, 1, and 2 respectively.

3-months after surgery favorable outcome (mRS 0-2) was reached in 28 (84.8%), severe disability (mRS 4-5) in 2 (6.1%), three patients (9.1%) died.

Conclusion: Intraoperative SEP during urgent eICA recanalization seems to be beneficial in the prevention of intraoperative ischemia development. Thanks to intraoperative SEP monitoring, the clinical outcome after eICA recanalization could be positively affected.

Supported by NV19-09-00199, NV19-04-00270.

Disclosure: No

P0210 / 208

DURATION OF ISCHEMIA IMPACTS POST-REPERFUSION CLINICAL OUTCOMES INDEPENDENT OF FOLLOW-UP INFARCT VOLUME

S. Desai ¹, A. Aghaebrahim², J. Siegler³, A. Monteiro², R. Jha⁴, A. Jadhav⁵, T. Jovin⁶

¹HonorHealth Research Institute, Neurology, Scottsdale, United States, ²Baptist Health, Neurosurgery, Jacksonville, United States, ³Cooper Univeristy, Neurology, Camden, United States, ⁴Barrow Neurological Institute, Neurology, Phoenix, United States, ⁵Barrow Neurological Institute, Neurosurgery, Phoenix, United States, ⁶Cooper University, Neurology, Camden, United States

Background and aims: Time to reperfusion is believed to influence clinical outcomes post-thrombectomy mainly through reduction of infarct growth. We aim to understand whether clinical outcomes can be influenced by ischemia duration (penumbral time) independent of post-intervention infarct volume by comparing outcomes post-thrombectomy in patients with similar (and small) follow-up infarct volumes.

Methods: A retrospective analysis across 3 US Centers. Demographic, radiological, and outcomes data of patients with anterior circulation LVO [large vessel occlusion] stroke who had witnessed-onset stroke, achieved successful reperfusion, and a follow-up infarct volume of <20 ml were analyzed.

Results: A total of 233 patients (Center A-25;Center B-33;Center C-175) were included. Mean age was 71±16 and median NIHSS was 15(10-20). Median penumbral time was 4.7(2.9-10) hours and follow-up infarct volume was 4.7(0.2-9.4) ml. Despite comparable baseline characteristics and 24-hour infarct volumes, patients reperfused in the 0-6 hour window had significantly higher rates of mRS-0-2 (61% vs 40%, p=0.002) and numerically lower rates of mortality (11% vs 17%, p=0.16) when compared to patients reperfused in the 6-24 hour window. Duration of ischemia is an independent predictor of mRS-0-2 [OR-0.91 (0.80-0.99), p=0.012]. In multivariable analysis accounting for age and NIHSS, the association between penumbral time and mRS-0-2 remained significant (absolute risk difference: -1.2% [(95% CI -1.9, -0.4)]/hour delay)(Figure 1).

Conclusion: Longer penumbral duration is associated with a lower likelihood of functional independence amongst LVO strokes with small and comparable 24-hour follow-up infarct volume. Our findings indicate that delays in time to reperfusion affect clinical outcomes through mechanisms not solely limited to infarct reduction.

Figure 1

Disclosure: No

P0211 / 1502

PRE-TREATMENT THROMBUS MIGRATION IN THE POSTERIOR CIRCULATION: PREVALENCE AND ASSOCIATION WITH CLINICAL AND TECHNICAL OUTCOMES

C. Riegler ¹, E. Siebert², J.F Kleine², C.H Nolte¹

¹Charité Universitätsmedizin Berlin, Department of Neurology and Center for Stroke Research, Berlin, Germany, ²Charité Universitätsmedizin Berlin, Institute of Neuroradiology, Berlin, Germany

Background and aims: Pre-Treatment thrombus migration (TM) is common in large vessel occlusion (LVO) of the anterior circulation. It is associated with better clinical outcome, yet a lower probability of successful reperfusion. To our knowledge, no data on TM in the posterior circulation (PC) has been published. We assessed TM in the PC regarding technical and clinical outcomes.

Methods: Local registries were searched for patients with LVO in the PC undergoing thrombectomy between 10/2015 and 12/2020. CTA/MRA and DSA were assessed by a trained neurologist (CR) regarding LVO location and TM. A senior neuroradiologist (JFK) reassessed borderline cases. Outcomes were defined as follows: early neurological improvement (ENI): improvement by eight or more points on the NIHSS at 24hrs. Successful reperfusion: mTICI 2b/3. Functional outcome: mRS at d90.

Results: We identified 58 patients (8 VA, 43 BA and 7 PCA occlusions), 15 demonstrated TM. Age (median[IQR]: 79[72 – 81] vs. 75[66 – 83] years), female sex (60% vs. 51%) and NIHSS at admission (median[IQR]: 13[9 – 31] vs. 13[6 – 25]) did not differ significantly between groups. TM-patients had received IVT more often (67% vs. 26%,p<.01), more often had first imaging with MRA (33% vs. 5%,p<.01) and tended to have a worse functional status pre-stroke (mRS⩽2: 67% vs. 88 %,p=.06). TM tended to be associated with ENI (54% vs. 25%,p=.05), and better clinical (mRSd90⩽3: 60% vs. 38%,p=.13) as well as technical outcome (mTICI2b/3: 100% vs. 83%,p=.09).

Conclusions: TM in the PC may influence outcome favorably. Larger studies are needed to assess its effects.

Disclosure: No

P0212 / 1140

PREDICTORS OF OUTCOMES AFTER ENDOVASCULAR TREATMENT IN ACUTE BASILAR ARTERY OCCLUSION: A NATIONAL MULTICENTER STUDY

C. Ramos ¹, A. De Albóniga-Chindurza², P. Zunzunegui Arroyo³, R. Vera Lechuga⁴, C. Gómez-Escalonilla⁵, J. Membrilla López⁶, P. Calleja Castaño⁷, H. Tejada-Meza⁸, J. Vega¹, J. Ortega- Quintanilla², L. Benavente Fernández³, R. Sainz-Amo⁴, A. López-Frías⁵, B. Marín Aguilera⁶, F. Ostos⁷, M. Serrano-Ponz⁸, L. Martínez-Vicente¹, E. Zapata-Arriaza², S. Calleja Puerta³, A. Cruz Culebras⁴, J. Egido⁵, B. Fuentes⁶, F. Ballenilla⁷, J. Marta-Moreno⁸, S. Trillo¹

¹Hospital Universitario de La Princesa, Madrid, Spain, ²Hospital Universitario Virgen del Rocío, Sevilla, Spain, ³Hospital Universitario Centras de Asturias, Oviedo, Spain, ⁴Hospital Universitario Ramón y Cajal, Madrid, Spain, ⁵Hospital Clínico San Carlos, Madrid, Spain, ⁶Hospital Universitario La Paz, Madrid, Spain, ⁷Hospital Universitario 12 de Octubre, Madrid, Spain, ⁸Hospital Universitario Miguel Servet, Zaragoza, Spain

Background and aims: Acute basilar artery occlusion (ABAO) associate the highest morbimortality in acute stroke. Therefore, the benefit of endovascular treatment (EVT) in this entity is not clearly established. We conducted a national study to predict factors for response to EVT in patients with ABAO.

Methods: Retrospective multicenter study of consecutive patients with acute BAO who underwent EVT in eight comprehensive stroke centers from January-2012 to May-2019. We prospectively collected demographic, clinical and procedure-related variables and evaluated the association with modified Rankin scale at three months (mRS-3m) and mortality.

Results: N=282. Women 112 (39.7%). 79 patients (28.1%) received intravenous thrombolysis. Among all patients, 102 cases (37.5%) were treated with aspiration technique alone and successful recanalization was achieved in 227 patients (83.8%). There were procedure-related complications in 28 cases (10%), with distal embolisms being the most frequent (11 cases; 3.9%). Median mRS-3m was 3[IQR 5]. The embolic etiology was an independent predictor for complete recanalization (OR, 2.860[95%CI, 1.432-5.711]; p<0.001). Functional independence was independently associated with baseline Glasgow Coma Scale score (OR, 1.118[95%CI, 1.013-1.377]; p=0.034), baseline NIHSS score (OR, 0.917[95%CI, 0.859-0.979]; p<0.001), admission glycaemia (OR, 0.987[95%CI, 0.978-0.996]; p<0.001) and successful recanalization (OR, 4.016[95%CI, 1.098-14.690]; p=0.036). Patients with non-embolic etiologies, symptomatic hemorrhagic transformation and incomplete reperfusion had statistically significant higher intrahospital mortality rates.

Conclusions: In basilar artery occlusion stroke, clinical severity, hyperglycaemia and absence of recanalization, were independent factors associated with worse clinical outcome. Non-cardioembolic etiology might predict poor outcome as well. Potential prognostic neuroimaging factors of outcome are being studied.

Disclosure: No

P0213 / 1612

DAYTIME TELEVISION DECREASES DELIRIUM PREVALENCE IN A CEREBROVASCULAR DISEASE WARD

I. Rovisco Monteiro ¹, C. Bernardes¹, J. Peixoto², D. Ferreira³, R. Sousa⁴, A.I. Martins¹, A.C. Brás¹, L. Almendra¹, C. Nunes¹, C. Machado¹, B. Rodrigues¹, F. Silva¹, J. Sargento Freitas¹

¹Coimbra University Hospital Centre, Neurology, Coimbra, Portugal, ²Coimbra University Hospital Centre, Internal Medicine, Coimbra, Portugal, ³Meio Tejo Hospital Centre, Internal Medicine, Abrantes, Portugal, ⁴Tâmega e Sousa Hospital Centre, Physics and Reabilitation Medicine, Penafiel, Portugal

Background and aims: Delirium has a significant impact on health systems, particular in neurological wards. It is estimated that multimodal sensorial stimulation may prevent up to 40% of cases, but these strategies are very time consuming. We aim to assess the influence of visual-auditory stimulation with television during daytime on the prevalence of delirium in a neurology ward.

Methods: Case-control study including patients admitted in a neurology ward of a tertiary hospital with acute ischemic or haemorrhagic cerebrovascular disease. Patients admitted during the six months before the installation of televisions were compared to patients who were admitted in the six months after. We registered the prevalence of delirium, the need of benzodiazepines and neuroleptics. Televisions were turned on between 8:00 am and 8:00 pm. Diagnosis of delirium was determined by the assistant clinician. We performed univariate analysis comparing groups. Considering no confounders were identified, the primary endpoints were also assessed in univariate analysis. Statistical significance was set for p<0.05.

Results: A total of 422 patients were included, mean age 73.7 years (SD 15,2) and 50.5% female. 19,5% had a psychiatric background and 6,7% dementia. 49.8% were exposed to a television during hospital stay. Delirium was less frequent in the exposed group (26,5%vs6,7%, p<0,001), however prescription of benzodiazepines and neuroleptics were similar between the two groups (55.9% vs 59.3%, p=0.48).

Conclusions: This work suggests that exposure to a visuo-auditory stimulus of a television during hospital stay may reduce the prevalence of delirium in patients admitted for a cerebrovascular disease.

Disclosure: No

SECONDARY PREVENTION – EXCLUDING CLINICAL TRIAL RESULTS

P0214 / 273

APPLICATION OF THE VASCULAR RISK CATEGORIES OF THE 2019 ESC/EAS DYSLIPIDEMIA GUIDELINE TO PATIENTS WITH STROKE. HOW DO WE OPTIMIZE THE TARGETING THERAPY FOR CHOLESTEROL?

B. Rebollo ¹, P. Macias Sedas¹, N. Valverde Mata¹, A. Parejo Olivera¹, J.M Ramirez-Moreno^1,2

¹Badajoz University Hospital, Stroke Center, Neurology, Badajoz, Spain, ²Extremadura University, Faculty of Medicine and Health Sciences, Biomedical Sciences, Badajoz, Spain

Background and aims: Recent data conclusively demonstrate the inverse epidemiological relationship of LDL cholesterol with stroke and the efficacy of different strategies to achieve its reduction. Current international lipid guidelines strongly recommend lipid-lowering therapy for prevention in patients with atherosclerotic disease, including stroke, based on their risk category. Our objective is to categorize the vascular risk of patients with a first stroke.

Methods: Patients who had been admitted with a first stroke to a single Stroke Center were included. Following the proposal of the guide, we established four categories of cardiovascular risk: very high risk, high risk, moderate risk and low risk. We reviewed the documented presence of atherosclerotic disease, diabetes with target organ damage, major vascular risk factors, Systematic Coronary Risk Estimation, blood pressure, glomerular filtration rate, familial hypercholesterolemia and lipid levels.

Results: We included 413 patients, admitted between June, 2019 and December, 2020. The mean age(SD) was 69.9(13.3) years, 40.9% were women. 85(20.6%) patients were classified in the LAA group, 107(25.9%) in the cardioembolic, 71(17.2%) in the small artery occlusion, 142(34.4%) in the indeterminate and 8(1.9%) in the group of other causes. The mean(SD) level of total cholesterol and LDL-C was 154.0(41.9) and 90.1(34.0) mg/dL, respectively. 40.9% were classified as very high risk, 23.5% as high, 33.2% as moderate and 2.4% as low risk.

Conclusions: Despite the etiological heterogeneity of stroke, most stroke patients have a very high or high cardiovascular risk. Risk categorization is necessary to mark the more or less aggressive approach to lowering LDL cholesterol.

Disclosure: No

P0215 / 960

INITIATION OF DIRECT ORAL ANTICOAGULATION AFTER REPERFUSION THERAPY IN ISCHEMIC STROKE IN CLINICAL PRACTICE: RESULTS FROM SITS-INTERNATIONAL STROKE REGISTRY

M. Säflund ^1,2, M. Matusevicius^1,2, J.A Egido³, J.M Ferro⁴, J. Kõrv⁵, M. Melis⁶, A. Peeters⁷, M. Petruzzellis⁸, V.-M. Rand⁹, A. Vilionskis¹⁰, M.V Mazya^1,2, T. Moreira^1,2, N. Ahmed^1,2

¹Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden, ²Karolinska University Hospital, Department of Neurology, Stockholm, Sweden, ³Hospital Clinico Universitario San Carlos, Department of Neurology, Madrid, Spain, ⁴Universidade de Lisboa, Department of Neurosciences, Faculdade de Medicina, Lisboa, Portugal, ⁵University of Tartu, Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Tartu, Estonia, ⁶Azienda Ospedaliera G.Brotzu, SC Neurologia e Stroke Unit, Cagliari, Italy, ⁷Cliniques Universitaires Saint-Luc, Department of Neurology, Bruxelles, Belgium, ⁸University of Bari, Stroke Unit, AOU Consorziale Policlinico, Bari, Italy, ⁹North Estonia Medical Centre, Department of Neurology, Tallin, Estonia, ¹⁰Vilnius University, Stroke Center, Clinic of Neurology and Neurosurgery, Vilnius, Lithuania

Background and aims: There are no robust data on safety of early initiation of direct oral anticoagulation (DOAC) treatment after acute ischemic stroke (AIS) in patients with atrial fibrillation (AF). We investigated the timing of DOAC initiation in clinical practice and evaluated the safety and outcomes.

Methods: We collected AIS patients receiving reperfusion therapy with AF diagnosis (prevalent or new) registered in the SITS-International Stroke Thrombolysis and or thrombectomy Registry during 2014-2020. Primary outcome was time of DOAC initiation. Safety outcomes were haemorrhage and death. Other outcomes were recurrent AIS, any embolism and functional independence (mRS 0-2) at 3-months. We performed descriptive statistics and multivariate analysis to identify factors associated with DOAC initiation time.

Results: 10625 patients had DOAC initiation time (apixaban=4754, dabigatran=3092, rivaroxaban=2069 and edoxaban=711). Median stroke onset to DOAC initiation time was 8 (IQR 4-14) days, baseline NIHSS score was 11 (6-17) and age was 78 (70-83) years. 6506 patients had new event data by 3-month: 8 (0.1%) intracranial haemorrhage, 22 (0.3%) major extracranial haemorrhage, 71 (1.1%) recurrent ischemic stroke, and 43 (0.7%) other emboli. At 3-months 4.5% (339/7503) patients had died, and functional independence was achieved in 62.5% (4574/7313). Higher baseline NIHSS score and history of hyperlipidaemia was associated with delayed DOAC initiation, while higher baseline mRS and heart failure with earlier DOAC initiation.

Conclusions: Median DOAC initiation was 8 days in reperfusion treated AIS patients. Severe stroke was associated with delayed DOAC initiation. Lower incidence of safety outcomes in this study should be interpreted with caution due to missing data.

Disclosure: No

P0216 / 943

ANALYSIS OF COMPLIANCE WITH ANTICOAGULANT THERAPY IN PATIENTS WITH ISCHEMIC STROKE AND ATRIAL FIBRILLATION

O. Kyrychenko ¹

¹ National Pirogov Memorial Medical University, Vinnytsya,Ukraine, neurology, Vinnytsya, Ukraine

Background and aims: Ischemic strokes in patients with atrial fibrillation (AF) are usually severe, prone to early recurrence and to hemorrhagic transformation. Oral anticoagulant therapy can significantly reduce the risk of cardioembolic stroke.

The aim of the study was to evaluate the adherence to oral anticoagulants for stroke prevention among patients with IS and AF.

Methods: The analysis included data of 153 patients admitted to the stroke unit during 2020-2021 years.

Results: Among 153 enrolled patients with confirmed acute IS 48 (31.37%) patients had anamnesis of AF. There were 23 women (47.9%) and 25 men (52.1%), mean age was 70,38±1,2 years, median - 70 years. Permanent form of AF was diagnosed in 36 patients (75%), persistent in five patients (10.4%), and paroxysmal form had seven (14.6%) subjects. Only seven patients (14.6%) took oral anticoagulants, five of them (10.4%) took medications constantly, and two (4.2%) subjects noted irregular medication intake. 41 patients (85.4%) did not follow prophylactic therapy. History of IS or transient ischemic attack (TIA) had 14 patients (29.2%) with AF and only one of them (7.4%) took oral anticoagulants, while 13 (92.86%) did not follow any treatment.

Conclusions: Obviously, poor compliance of patients can affect primary and secondary stroke prophylaxis in patients with AF. Awareness of patients about the role of stroke prevention is a key issue.

Disclosure: No

P0217 / 348

EFFICACY AND SAFETY OF EARLY ANTICOAGULATION IN PATIENTS WITH ACUTE ISCHEMIC STROKE DUE TO ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

L. Palaiodimou ¹, M.-I. Stefanou¹, A. Katsanos², M. Paciaroni³, S. Sacco⁴, G.M. De Marchis⁵, A. Shoamanesh², K. Malhotra⁶, D.A. de Sousa⁷, V. Lambadiari⁸, M. Kantzanou⁸, S. Vassilopoulou⁸, K. Toutouzas⁸, D. Filippou⁸, D. Seiffge^5,9, G. Tsivgoulis¹

¹National and Kapodistrian University of Athens, Second Department of Neurology, Athens, Greece, ²Population Health Research Institute, McMaster University, Hamilton, Canada, ³University of Perugia, Perugia, Italy, ⁴University of L'Aquila, L'Aquila, Italy, ⁵University Hospital of Basel, Basel, Switzerland, ⁶Allegheny Health Network, Pittsburgh, United States, ⁷University of Lisbon, Lisbon, Portugal, ⁸National and Kapodistrian University of Athens, Athens, Greece, ⁹University Hospital Bern, Bern, Switzerland

Background and aims: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF).

Methods: We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral hemorrhage (sICH) and any ICH.

Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5,616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p=0.18; p=0.90; and p=0.82 accordingly). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality.

Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs.

Disclosure: No

P0218 / 466

A REAL-LIFE STUDY ON SHORT-TERM DUAL ANTIPLATELET TREATMENT IN PATIENTS WITH ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK (READAPT): PRELIMINARY EFFICACY AND SAFETY DATA

E. De Matteis ¹, R. Ornello¹, F. De Santis¹, B. Censori², P. Di Viesti³, T. Tassinari⁴, V. Saia⁴, S. Cenciarelli⁵, C. Bedetti⁵, M. Petruzzellis⁶, D.M. Mezzapesa⁶, M. Paciaroni^7,8, M.G. Mosconi⁷, F. Muscia⁹, S. Gallo Cassarino⁹, M. Diomedi¹⁰, M.R. Bagnato¹⁰, C. Palmieri¹¹, E.A. Caggia¹², S. La Spada¹³, L.M. Cupini¹⁴, P. Cardinali¹⁵, U. Scoditti¹⁶, A. Cavallini¹⁷, G. Rinaldi¹⁸, G. Ruzza¹⁹, C. Paci²⁰, L. Dambrosio²¹, F. Pistoia²², G. Volpi²³, A. De Boni²⁴, G. Viticchi²⁵, P. Invernizzi²⁶, F. Di Blasio²⁷, C. Roberti²⁸, G. Manobianca²⁹, R. Tarletti³⁰, F. Passarelli³¹, G. Frisullo³², E. Sanzaro³³, M.V. De Angelis³⁴, A. Fortini³⁵, M.R. Bongioanni³⁶, A. Tonon³⁷, S. Ricci³⁸, D. Toni³⁹, S. Sacco¹, READAPT Study Group

¹University of L'Aquila, Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, L'Aquila, Italy, ²ASST Cremona, Department of Neurology, Cremona, Italy, ³Casa Sollievo della Sofferenza, Department of Neurology, San Giovanni Rotondo, Italy, ⁴Santa Corona Hospital, Department of Neurology, Pietra Ligure, Italy, ⁵Città di Castello Hospital, Department of Neurology, Città di Castello, Italy, ⁶AOU Consorziate Policlinico, Stroke Unit, Bari, Italy, ⁷University Hospital of Perugia, Stroke Unit, Perugia, Italy, ⁸San Giuseppe Hospital, IRCCS MultiMedica, Department of Neurology and Stroke Unit, Milan, Italy, ⁹ASST Ovest Milanese, Department of Neurology, Legnano, Italy, ¹⁰University Hospital of Tor Vergata, Department of Neurology and Stroke Unit, Rome, Italy, ¹¹E. Agnelli Hospital Pinerolo, Department of Neurology and Stroke Unit, Pinerolo, Italy, ¹²Giovanni Paolo II Hospital, Neuro-Cardio-Vascular Department, Ragusa, Italy, ¹³A. Perrino Hospital, Department of Neurology, Brindisi, Italy, ¹⁴S. Eugenio Hospital, Department of Neurology and Stroke Unit, Rome, Italy, ¹⁵"A. Murri" Hospital Fermo, Department of Neurology, Fermo, Italy, ¹⁶Azienda Ospedaliero-Universitaria di Parma, Department of Emergency, Parma, Italy, ¹⁷IRCCS Istituto Neurologico Mondino, Department of Cerebrovascular disease and Stroke Unit, Pavia, Italy, ¹⁸Di Venere Hospital ASL Bari, Neurosensorial Department, Bari, Italy, ¹⁹Cittadella Hospital, Department of Neurology, Cittadella, Italy, ²⁰Madonna del Soccorso Hospital, Department of Neurology and Stroke Unit, San Bendetto del Tronto, Italy, ²¹Arzignano Hospital, Department of Neurology and Stroke Unit, Arzignano, Italy, ²²San Salvatore Hospital, University of L'Aquila, Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, L'Aquila, Italy, ²³San Jacopo Hospital, Department of Neurology, Pistoia, Italy, ²⁴S. Bortolo Hospital AULSS8 Vicenza, Department of Neurology, Vicenza, Italy, ²⁵Marche Polytechnic University, Neurological Clinic, Ancona, Italy, ²⁶Istituto Ospedaliero Fondazione Poliambulanza, Department of Head and Neck diseases, Brescia, Italy, ²⁷S.Spirito Hospital of Pescara, Department of Neurology, Pescara, Italy, ²⁸San Filippo Neri Hospital, Department of Neurology, Rome, Italy, ²⁹Ente Ecclesiastico Ospedale Generale Regionale Miulli, Department of Neurology, Acquaviva delle Fonti, Italy, ³⁰Azienda Ospedaliero-Universitaria "Maggiore della Carità”, Department of Neurology and Stroke Unit, Novara, Italy, ³¹Fatebenefratelli Hospital, Department of Neurology, Rome, Italy, ³²Policlinico Gemelli Hospital, Department of Neurology, Rome, Italy, ³³Umberto I Hospital, Department of Neurology, Siracusa, Italy, ³⁴SS Annunziata Hospital, Department of Neurology and Stroke Unit, Chieti, Italy, ³⁵San Giovanni di Dio Hospital, Department of Neurology, Firenze, Italy, ³⁶SS. Annunziata Hospital, Department of Neurology, Savigliano, Italy, ³⁷SS. Giovanni e Paolo Hospital, Department of Neurology, Venezia, Italy, ³⁸USL Umbria 1, Gubbio and Città di Castello Hospital, Department of Neurology and Stroke Unit, Perugia, Italy, ³⁹Sapienza University of Rome, Department of Human Neurosciences, Rome, Italy

Background and aims: Following the results of randomized controlled trials (RCTs), several guidelines recommend short-term (21-90 days) dual antiplatelet treatment (DAPT) for secondary prevention of minor ischemic stroke (NIHSS score ⩽5) or high risk-TIA (ABCD₂ score ⩾3). We aim at evaluating DAPT benefits and risks in a real-life setting focusing on peculiar subgroups of patients.

Methods: The REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack (READAPT) is a prospective, multicenter, observational study including, since February 2021, patients with non-cardioembolic minor-to-moderate ischemic stroke or high-risk TIA receiving short-term DAPT. Patients are followed-up to 90 days.

Results: Overall, 484 patients from 37 centers were included up to 31^st December 2021; 154 (31.8%) completed the follow-up. Most patients were male (307, 63.4%); mean age was 70.4±12.7 years; 156 (33%) received DAPT after TIA and 325 (67%) after stroke; 46 (14%) patients had NIHSS score ⩾5, 31 (19%) ABCD₂ score ⩽3. Among patients with stroke, 49 (15.9%) underwent intravenous thrombolysis. During the follow-up, 19 (12%) patients had a recurrent ischemic event (8 TIAs and 11 strokes); 2 (1.3%) had intracerebral hemorrhages:1 lobar occurred in a patient treated with intravenous thrombolysis.

Conclusions: Patients with minor stroke or high-risk TIA treated with short-term DAPT may have a higher proportion of ischemic recurrence and lower proportion of hemorrhagic events in real-life than in RCTs. Real-life data will address the benefit/risk profile of DAPT in patients excluded from RCTs, including those undergoing intravenous thrombolysis and with higher NIHSS scores.

Disclosure: No

P0219 / 320

SECONDARY PREVENTIVE EFFECTS OF NON-VITAMIN K ORAL ANTICOAGULANTS IN ISCHEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATION: KOREAN REAL-WORLD DATA

K.-W. Nam ¹, H.-M. Kwon¹, Y.-S. Lee¹

¹ Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Neurology, Seoul, Korea, Republic of

Background and aims: Recently, non-vitamin K oral anticoagulants (NOACs) have been widely used in ischemic stroke patients with atrial fibrillation (AF). However, real-world data on their efficacy in secondary prevention of ischemic stroke and safety are still lacking. This study compared the effectiveness and safety of NOACs with those of warfarin in ischemic stroke patients with AF.

Methods: Based on the Korean National Health Insurance Service database, we included new users of NOACs and warfarin in ischemic stroke patients with AF from July 2015 to December 2019. We analyzed the risk of ischemic stroke, intracranial hemorrhage (ICH), major bleeding, and all-cause death. The propensity score matching method was used to balance covariates across NOACs and warfarin users.

Results: We compared a 1:4 propensity score-matched cohort of ischemic stroke patients with AF who were new users of NOACs and warfarin (n = 18,804 and n = 4,076, respectively). NOACs users had a significantly lower risk of ischemic stroke (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.80-0.97), ischemic stroke + systemic embolism (HR: 0.85; 95% CI: 0.77-0.93), major bleeding (HR: 0.54; 95% CI: 0.46-0.63), ICH (HR: 0.52; 95% CI: 0.37-0.75), and all-cause death (HR: 0.86; 95% CI: 0.81-0.93) than warfarin users.

Conclusions: In this real-world data of the Korean ischemic stroke population with AF, NOACs showed a lower risk of both efficacy outcomes and safety outcomes compared with warfarin. This may mean that NOACs are sufficiently effective and safe to use as a replacement for warfarin in clinical fields.

Disclosure: No

P0220 / 800

PROTOCOL OF PROCESS EVALUATION OF SECONDARY PREVENTION BY STRUCTURED SEMI-INTERACTIVE STROKE PREVENTION PACKAGE IN INDIA (SPRINT INDIA) STUDY

S.J. Verma ¹, P. Gulati², J.D. Pandian¹, D. Arora¹, H. Khatter¹, A. Dhasan³, M. Sharma⁴, P.N. Sylaja³

¹Christian Medical College and Hospital, Neurology, Ludhiana, India, ²Desh Bhagat University, School of Pharmacy, Mandi Gobindgarh, India, ³Sri Chitra Tirunal Institute of Medical Sciences and Technology, Neurology, Thiruvananthapuram, India, ⁴Indian Council of Medical Research, Non-Communicable Diseases Section, New Delhi, India

Background and aims: Secondary Prevention By Structured Semi-Interactive Stroke Prevention Package in India (SPRINT India) is a complex intervention delivered across 30 centres, in 12 languages in form of workbook, videos and Short messaging service (SMS) for one year. The objectives of process evaluation (PE) are to assess whether trial was implemented as planned (fidelity, dose); whether, how, and why intervention is effective by looking at stakeholders experiences (effectiveness); to assess reach of intervention in population (reach); how intervention fits into treatment plan to cause behavioural change when adopted (adoption);  usefulness for target population and bring behaviour change (maintenance).

Methods: The study is a prospective, multicentre trial conducted with mixed methods approach. Qualitative data will comprise of interviews of patients, care givers and health professionals at 11 centres by using semi structured interview guide. The quantitative data will comprise of all randomized patients. SPRINT India PE framework is based on the Realist and RE-AIM evaluation models presented according to the Medical Research Council's guidance. The four sections of the framework are context, trial implementation, mechanisms of impact and trial outcomes.

Results: Maximum variance purposive sampling strategy will select sample size. Interviews for approximately 100 stakeholders and focus group interview of health professionals will be conducted. Triangulation methodology will incorporate use of different- quantitative/qualitative data, data collection techniques, data sources, theoretical frameworks, stakeholders and researchers.

Conclusions: PE of the trial will identify factors efficacious in intervention package and consolidate stroke secondary prevention awareness into practice and policy to prevent recurrent stroke.

Disclosure: No

P0221 / 1250

ANTITHROMBOTIC PRESCRIBING AFTER ISCHAEMIC STROKE AND SURVIVAL TO ONE YEAR IN SCOTLAND: A NATIONAL DATABASE STUDY

K.-A. Sterling ¹, M. Turner¹, M. Barber², P. Langhorne³, M.J. Macleod¹

¹University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, ²NHS Lanarkshire/Chair Scottish Stroke Care Audit, University Hospital Monklands, Airdrie, North Lanarkshire, United Kingdom, ³University of Glasgow, Institute of Cardiovascular & Medical Sciences, Glasgow, United Kingdom

Introduction: Secondary prevention after ischaemic stroke (IS) often include antithrombotics to help prevent recurrent strokes and death.

Aim: To examine the prescribing patterns of antithrombotic medications after an incident ischaemic stroke and the effect on all-cause mortality at one year in a Scottish stroke cohort.

Methods: Data for stroke cases, hospital admissions, prescriptions dispensed within the community and mortality outcomes from 2010 to 2015 contained within national datasets were analysed. Therapy was defined as at least one prescription for an antithrombotic medication within six months after IS in patients who were discharged to home within ninety days and then went on to survive to six months. Hazard ratios were adjusted for age, gender, stroke severity, Charlson comorbidity index, levels of deprivation and atrial fibrillation.

Results: Among the 31 358 patients, 2340 (7.5%) were on no antithrombotic therapy, 3762 (12.0%) were on oral anticoagulant (OAC) only, 23 311 (74.3%) were on antiplatelet only, while 1945 (6.2%) received a prescription for both. All three medication categories were associated with a decreased risk of all-cause mortality within one-year post-stroke compared with no antithrombotic therapy. After adjustments, OAC only (adjusted Hazard Ratios (aHR) 0.303, (95% Confidence Interval (CI): 0.235 – 0.391) appeared to be the most impactful on mortality compared with antiplatelet only (aHR 0.527, 95% CI: 0.441 – 0.630) and antiplatelet and OAC therapy (aHR 0.469, 95% CI: 0.353 – 0.624) respectively.

Conclusions: This study provides reassuring evidence of the significant benefit of antithrombotic therapy in decreasing all-cause mortality within one year after an ischaemic stroke.

Disclosure: No

P0222 / 1423

PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION DATA FROM MATER DEI HOSPITAL; MALTA

M. Bonello ¹, K. Cilia¹, J. Bonello²

¹Mater Dei Hospital, Department of Neurosciences, Msida, Malta, ²Mater Dei Hospital, Department of Cardiology, Msida, Malta

Background and aims: Left atrial appendage occlusion (LAAO) may be considered in patient with atrial fibrillation where long-term anti-coagulation is contra-indicated. LAA closure has been introduced locally in 2014. Our aim is to retrospectively analyse thromboembolic events, bleeding and death in patients who underwent LAAO locally,  compared to patients receiving direct oral anticoagulation.

Methods: Data was collected retrospectively from national registries and discharge electronic summaries and data was anonymised. Data collected included patient demographics, CHA2DS2VASc and HAS-BLED scores, occlusion device details, post-operative complications, cardiovascular and adverse events. Index patients were matched with controls who had the same CHA2DS2VASc   but did not undergo LAAAO.

Results: A total of 30 atrial fibrillation patients underwent LAAO locally from 2014 to 2021. The vast majority of patients were male (20 males, 71.4 ±8.0 years old). Mean CHA2DS2VASc score was 3.9±1.3 and mean HASBLED score was 3.7±1.3. The majority of patients (24 patients) received antiplatelet therapy post-procedure; out of which 11 patients required dual anti-platelets agents for at least 3 months. 6 patients were prescribed anticoagulants, 2  of which were lifelong. 3 patients suffered an ischemic event post-procedure and 1 patient had embolization of the LAAO device. None of the patients had passed away at the time of data collection.

Conclusions: Despite numbers being small, long-term outcomes were very encouraging. Very few patients suffered from ischemic events post procedure. This study further confirms that LAAO is associated with a reduced risk of stroke and systemic thromboembolic events.

Disclosure: No

P0223 / 566

HYPERTRIGLYCERIDEMIA AS A NOVEL TREATMENT TARGET FOR STROKE PREVENTION

S. Chaturvedi ¹, A. Klein¹, J. Solomonow¹, P. Mehndiratta¹, K. Yarbrough¹, C. Cronin¹, J. Nunez¹, M. Phipps¹, M. Wozniak¹, J. Cole¹, S. Kittner¹

¹ University of Maryland, Neurology, Baltimore, United States

Background and aims: Hypertriglyceridemia (HTG) can result in accelerated atherosclerosis, a major stroke risk factor. Icosapent ethyl (IPE) is approved as a novel treatment for HTG in patients older than 45. We evaluated patient eligibility for IPE with regard to risk factors, demographics, and stroke subtypes.

Methods: A total of 743 patients admitted with acute ischemic stroke (AIS) between Jan 2018 – Dec 2020 were identified.  Those on a statin at admission were categorized into eligible for IPE (LDL 41-100 and Triglyceride 150-499) vs. not eligible. Chi squared tests were performed to evaluate differences in demographics, risk factors, and stroke subtype.

Results: We found that 365/743 (49%) were on a statin at the time of stroke. Of these, 39 (11%) were eligible for IPE by LDL and TG criteria. Mean age of eligible patients was 68.5 (51% women). Candidates for IPE were more likely to be white (67% vs. 44%, p=0.006), diabetic (67% vs. 47%, p=0.018), and hypertensive (97% vs. 86%, p=0.042), as well as a trend for prior MI or CAD (46% vs. 33%, p=0.09). The most common stroke subtype in those eligible was cardioembolic (CE) (33%, p=.015).

Conclusion: A large proportion of our population was not on a statin on admission underscoring the need for better primary prevention. About 11% of patients on a statin qualified for IPE. This population was more likely to have DM, HTN and CAD. These findings can help clinicians identify patients with elevated triglyceride levels who could benefit from pharmacologic treatment.

Disclosure: No

P0224 / 1251

ANTITHROMBOTIC TREATMENT AND OUTCOME AFTER ENDOVASCULAR THROMBECTOMY AND STENTING IN STROKE PATIENTS WITH ATRIAL FIBRILLATION: ANTICOAGULATION REDUCES MORTALITY

J. Weller ¹, F. Dorn², G.C Petzold^1,3, F.J Bode¹, GSR-ET investigators

¹University Hospital Bonn, Department of Neurology, Bonn, Germany, ²University Hospital Bonn, Department of Neuroradiology, Bonn, Germany, ³German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany

Background and aims: The mainstay of secondary prophylaxis in stroke patients with atrial fibrillation (AF) is oral anticoagulation (OAC). In AF patients treated by endovascular thrombectomy and emergency carotid stenting, there is uncertainty regarding the optimal antithrombotic medication.

Methods: This is a subgroup analysis of the German Stroke Registry – Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with acute ischemic stroke who unterwent endovascular treatment (ET). Patients with AF and acute ischemic stroke due to large artery occlusion treated with ET and acute ICA stenting were included. We describe baseline and periprocedural characteristics, antithrombotic strategies and functional outcome after 90 days.

Results: A total of 84 patients were included. Periprocedural, postprocedural and discharge antithrombotic medication was highly variable. Among discharged patients (n=68), most frequent antithrombotic regimes were DAPT (38%), DAPT+OAC (26%) and single APT+OAC (20%). Comparing DAPT to DAPT+OAC, baseline, periprocedural and clinical characteristics as well as outcome upon discharge (median NIHSS 7 [interquartile range, 3-10] vs 7 [3-8], p=0.52) were similar (all p>0.05), but 90-day mortality was higher without OAC (35 vs 0%, p=0.018).

Conclusion: In AF patients with tandem occlusions who underwent ET and stenting, 90-day mortality was higher without OAC. Therefore, the combination of APT and OAC seems beneficial. However, the optimal regime has to be defined.

Disclosure: No

P0225 / 307

STROKE ILR SERVICE - SOUTHEND UNIVERSITY HOSPITAL

N. Menon ¹, P. Guyler¹, I. Vlahovic¹, A. Gul²

¹Southend University Hospital, Stroke Medicine, Southend-on-Sea, United Kingdom, ²Southend University Hospital, Cardiology, Southend-on-Sea, United Kingdom

More recently there has now been Positive NICE Guidance recommending Reveal LINQ (ILR) for the long-term monitoring of this Stroke patient sub-group, this guidance further supports the service and its expansion across the MSE.

Currently the service has over 300 ILR patients in active follow up, and in recent years the service has seen a steady increase in the Cryptogenic Stroke referrals for the purpose of identifying Paroxysmal AF with an aim to improve secondary stroke prevention.

Outcomes from the 2020* Fast Track Stroke ILR Implants:

StrokeIndicationImplants	AFdiagnosiswithin first12 months	Pacemaker	Non atrial driven arrhythmia	Nothing significant (still being reviewed)
22	5 (22%)	2*	0	17

Key Data points

Year of Implant	Total Number of Procedures	Implant Indication
		Syncope	Arrhythmia	Stroke	Explant
2019	167	98	16	23	30
2020*	141	64	17	22	38
2021	40	23	5	2	10

Info below taken from data reviewed for implants 2015-2019

Patient Age	47year old – Average age
PFO found via TOE	23
RoPE Score	Average score = 6
% chance that stroke is due to PFO	57%
% risk of 2 year recurrence of stroke/TIA.	8%

Conclusion:

Southend University Hospital has been running a Non-Medic led ILR implant service since 2015 with a growing patient indication pool and over 690 procedures performed. 

Disclosure: No

P0226 / 598

DUAL ANTIPLATELET THERAPY IN PATIENTS WITH MINOR STROKE RECEIVING INTRAVENOUS THROMBOLYSIS

Z. Xu ¹, Q. Deng¹, T. Jiang¹, Y. Zhang¹

¹ Nanjing First Hospital, Nanjing Medical University, Department of Neurology, Nanjing, China

Background and aims: Concern over the  bleeding risk of dual antiplatelet therapy for minor stroke patients after intravenous thrombolysis leads to different antiplatelet strategies in the secondary prevention of stroke. Our aim was to investigate the effect of dual antiplatelet therapy on minor ischemic stroke patients receiving intravenous thrombolysis.

Methods: From November 2016 to April 2021, a total of 855 consecutive patients who received intravenous thrombolysis were observed. We collected and analysed demographic characteristics, medical history, clinical information and important time metrics of patients with minor ischemic stroke. Comparative and multivariate logistic regression analyses were used. Propensity score matching analyses (1:1 matching including patients' baseline characteristics) was also performed.

Results: A total of 245 patients were enrolled in the study (118 patients in single antiplatelet therapy group and 127 patients in dual antiplatelet group). No significant difference was found in baseline characteristics except stroke aetiology (p<0.001) for minor stroke patients. The dual antiplatelet group showed a higher proportion of 90-day mRS (0-1) than the single antiplatelet group (p=0.030). Furthermore, patients receiving dual antiplatelet therapy had excellent outcomes (90-day mRS 0-1) after adjustment (odds ratio 2.76, 95% confidence interval 1.27-6.01, p=0.010). Other secondary outcomes (recurrent stroke within 90 days, symptomatic intracerebral haemorrhage and early neurological deterioration) were not significantly different between the two groups. These findings were generally consistent in propensity score analyses.

Conclusions: Dual antiplatelet therapy may be a potential therapeutic approach in minor stroke patients receiving intravenous thrombolysis. Further randomized controlled trials are required to confirm this finding.

Disclosure: No

P0227 / 1545

EXERCISE AND EXERCISE-BASED SUPPORT PREFERENCES OF PEOPLE WITH TRANSIENT ISCHAEMIC ATTACK OR MILD STROKE: A SYSTEMATIC REVIEW

E. Hibbert¹, C. Pearce¹, I. Wellwood ¹, B. Bilney¹

¹ Australian Catholic University, Physiotherapy, School of Allied Health, Ballarat, Australia

Background and aims: Exercise is recommended for secondary stroke prevention, yet patient adherence is limited. We aimed to synthesise qualitative research on the preferences of people with transient ischaemic attack (TIA) or mild stroke for exercise and exercise-based support.

Methods: Systematic review, guided by Joanna Briggs Institute methods, of English-language, qualitative and mixed-methods studies of adults with TIA / mild stroke (NHISS ⩽4 or MRS ⩽ 2) - presenting views and preferences on exercise programs, physical activity and / or preferences for exercise-based support including: counselling, delivery of information. MEDLINE, CINAHL, PEDro, Embase, PsychINFO, Cochrane and ERIC databases were searched (inception to Dec 2021). Methodological quality was assessed by Critical Appraisal Skills Programme qualitative checklist. Data were extracted and analysed with three-stage thematic synthesis.

Results: We screened 790 records, of which 15 were included. Most were considered good quality. Thematic synthesis identified six analytical themes relating to exercise and support preferences; (1) expressed need for more information, (2) appropriate education delivery, (3) proximity to home, (4) importance of support and company, (5) previous and current preferences, (6) attitudes toward exercise programs.

Conclusions: Preferences for increased quantity and improved delivery of exercise education and support were identified. Support to change and maintain exercise behaviour, and company during exercise were valued. Positive attitudes were expressed towards group exercise and education programs. Future research should investigate the acceptability and preferences for exercise-based rehabilitative programs targeting people with TIA or mild stroke, with the aim of increasing exercise participation.

Unfunded, registered PROSPERO 2020 CRD42020184479

Disclosure: No

P0228 / 823

PROTOCOL FOR MULTIMORBIDITY IN STROKE IN SPRINT INDIA TRIAL

D. Arora ¹, P. Gulati², J.D Pandian¹, S.J. Verma¹, H. Khatter¹, A. Dasan³, P. Sylaja³

¹Christian Medical College and Hospital, Neurology, Ludhiana, India, ²Desh Bhagat University, Pharmacology, Mandi Gobindgarh, India, ³Sree Chitra Tirunal Institute for Medical Sciences & Technology, Neurology, Thiruvananthapuram, India

Background and aims: World Health Organization (WHO) defined “Multimorbidity” as the coexistence of two or more chronic conditions in the same individual. Multimorbidity contributes to poorer health status, high risk of mortality, increased hospital visits and polypharmacy. India's data is inadequate for the concepts and trends of multimorbidity in stroke. The aim is to determine the prevalence of multimorbidity in stroke patients in India, and its correlation with mortality and health outcomes, sociodemographic, behavioural factors, polypharmacy and increased hospital visits.

Methods: The data will be collected from 30 centres for 2200 patients, aged 18 years and above, both men and women, with the imaging confirmed stroke (both ischemic and haemorrhagic) from the SPRINT India Trial cohort (Secondary Prevention By Structured Semi-Interactive Stroke Prevention Package in INDIA). A total of thirteen comorbid conditions will be studied with stroke. All the patients will be followed up for a period of one year to assess the events and mortality. The data will be collected both retrospectively (from April 2018) and prospectively (till March 2022).

Results: All the stroke patients from SPRINT India will be screened and randomized using simple random sampling for our study’s sample size. The prevalence will be calculated from the patients with comorbid conditions. The patients with the presence of stroke multimorbidity then will further associate with baseline characteristics and health outcomes.

Conclusion: The study will highlight several implications for future research on stroke multimorbidity in India, and its relationship with functional outcome, mortality, sociodemographic and lifestyle factors.

Disclosure: No

P0229 / 1200

ANTITHROMBOTIC MANAGEMENT OF ACUTE NON-DISABLING ISCHAEMIC STROKE AND TIA: A SURVEY OF BRITISH AND IRISH STROKE PHYSICIANS

J.P Appleton ^1,2, Z.K. Law³, J.S Minhas⁴, T.J England^5,6, K. Krishnan⁷

¹University Hospitals Birmingham NHS Foundation Trust, Stroke, Birmingham, United Kingdom, ²University of Birmingham, Institute of Applied Health Research, College of Dental and Medical Sciences, Birmingham, United Kingdom, ³National University of Malaysia, Department of Medicine, Kuala Lumpur, Malaysia, ⁴University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom, ⁵University of Nottingham, Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, Nottingham, United Kingdom, ⁶University Hospitals of Derby and Burton NHS Foundation Trust, Stroke, Royal Derby Hospital, Derby, United Kingdom, ⁷Nottingham University Hospitals NHS Trust, Stroke, Department of Acute Medicine, Nottingham, United Kingdom

Background and aims: Antithrombotic management for acute non-disabling ischaemic stroke and transient ischaemic attack (TIA) is rapidly evolving and yet anecdotally clinical practice varies considerably. We sought to assess this using a questionnaire sent to members of the British and Irish Association of Stroke Physicians (BIASP).

Methods: BIASP members were invited to complete an online questionnaire comprising six cases covering acute non-disabling ischaemic stroke (NIHSS ⩽4) and TIA patients with a variety of potential antithrombotic management options. In addition, respondents were asked about availability of platelet function or genetic testing for antiplatelet resistance in their institution and use of such testing.

Results: 107 members completed the questionnaire by 10/01/2022. Responses varied considerably: for a patient with acute minor ischaemic stroke within 4 hours of symptom onset 50.5% of respondents would give aspirin only and 35.2% suggested dual antiplatelet therapy with aspirin and clopidogrel. The next day, 71.4% of respondents would recommend dual antiplatelet therapy with aspirin and clopidogrel for 21 days, whilst 22.9% would give aspirin 300mg for 2 weeks, then clopidogrel 75mg to continue. Only 17.3% of respondents have access to platelet function testing in their institution, and only 8.5% use this occasionally in their clinical practice.

Conclusions: Antithrombotic management in acute non-disabling ischaemic stroke and TIA varies considerably across a large body of stroke physicians and neurologists in Britain and Ireland. Testing for antiplatelet resistance is not routinely available or used in clinical practice. Further research is needed to help guide antithrombotic management in this patient population.

Disclosure: No

P0230 / 721

WHEN TO PERFORM CAROTID ENDARTERECTOMY AFTER INTRAVENOUS THROMBOLYSIS FOR ACUTE STROKE?

N.D. Loizzo ¹, C. Desantis², F. Rizzo¹, M. Parisi¹, D. Galotto¹, M. Caccamo¹, D. Angiletta², D.M. Mezzapesa¹, M. Petruzzellis¹

¹University of Bari Aldo Moro, Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy, ²University of Bari Aldo Moro, Department of Emergency and Organ Transplantation, Vascular and Endovascular Surgery Unit, Bari, Italy

Background and aims: European Society for Vascular Surgery suggests considering CEA within 14 days after IVT in selected patients. The systemic fibrinolytic effects persisting up to 72 hours worry for surgical complications. Only small case series mainly by vascular surgery registries are available. We report our data collected with the vascular surgery team from a neurological point of view.

Methods and results: Between 2020 and 2021, 11 patients with ischemic stroke due to ipsilateral extracranial internal carotid stenosis upper than 60% underwent to CEA after IVT: 5 within 14 days (median 5, range 1-14) and 6 after 14 days (median 58, range 19-180). Median age was similar (69 vs 70 years). Cardiovascular risks factor were similar except for higher prevalence of dyslipidemia in the “early CEA” group and diabetes in the latter one. Only three patients in the “late CEA” group had pre-existing mild disability (mRS=1). Patients treated within 14 days had milder symptoms at onset (median NIHSS 3 vs 10) and smaller ischemic lesion volume (median cm³10 vs 24).  No hemorrhagic complication neither stroke recurrence at 30 days occurred. All the patients treated within 14 days but only 4 of the “late CEA” group reached excellent outcome (mRS⩽1) at 90 days.

Conclusions: According to literature, our data confirm the good safety of CEA performed within 14 days after IVT. Little is known about long term disability but our experience suggests that early CEA might help in reaching good outcome in accurately selected patients.

Disclosure: No

P0231 / 709

ASSOCIATION OF ABCD2 SCORE AND RISK LEVEL WITH STROKE EVENT AFTER TRANSIENT ISCHEMIC ATTACK: A LONG-TERM 12-MONTHS FOLLOW-UP

C. Mayurapak ¹, J. Suwanno¹

¹ Walailak University, School of Nursing, Thasala, Thailand

Background and aims: We assessed risk, incident and prevalence of stroke during the 12-months period after TIA. Furthermore, we examined whether the ABCD2 score and risk level associated with stroke event.

Methods: We used retrospective data from TIA Registry, of the total 157 TIA patients who were admitted to a stroke care unit of the 750-bed tertiary care hospital, between December 2011 and September 2015. Data were analyzed using descriptive statistic, Chi-square and odds ratio.

Results: Using ABCD2 to stratify risk level revealed nearly a haft had low risk (47.8%), two-fifth in moderate risk (43.9%), and 8.3% in high risk groups. None of them develop stroke in the immediate phase during 24-48 hours after TIA and during hospitalization. Short-term incidence during 2-week, 4-week, and 3-month were 0%, 3.2%, and 3.2%. Long-term incidence during 12-month was 6.4%. Stroke prevalence after TIA at 3 and 12-month were 6.4% and 11.8%. The higher the score and the higher risk level on ABCD2 were significantly associated with the higher incident and prevalence of stroke in short-term, but not the long-term cohort.

Conclusions: Patients with ABCD2 score of 6 and 7 as well as those in moderate-, and high-risk groups had an increment odds ratio with a significantly associated with the prevalence of stroke at 3 and 12-month. ABCD2 score should be added into routine assessment for patients with TIA to stratify, monitoring, and judgment for any appropriate treatment protocol.

Disclosure: No

P0232 / 1235

STATIN TREATMENT USE IN THE SETTING OF SECONDARY PREVENTION OF STROKE: AN OBSERVATIONAL RETROSPECTIVE ANALYSIS

B. Cășaru ¹, E.O. Terecoasă¹, A. Negrilă¹, A. Tănăsescu¹, R. Radu², C. Tiu¹

¹University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, ²University Emergency Hospital Bucharest, Interventional Radiology, Bucharest, Romania

Background and aims: Lipid-lowering therapy has proven its significant role in the prevention of ischemic stroke. There is still a gap between the overwhelming evidence supporting the benefits of this class of drugs and its rate of prescription. The aim of this study was to assess the rate of statin use in a population of patients with acute ischemic stroke from Romania.

Methods: Between January 2018 and July 2018, 770 patients with acute ischemic stroke were admitted to the Department of Neurology of the University Emergency Hospital Bucharest. 509 patients of the initial cohort were considered eligible to be included in this observational retrospective analysis.

Results: 41.9% of the patients with a previous history of cerebrovascular events didn’t take any cholesterol-lowering therapy at home. Only 21.9% had an LDL-cholesterol value < 70 mg/dL at admission in our department. At discharge from hospital, 276 patients (54.2%) were recommended moderate-intensity statin therapy, 1 (0.2%) low-intensity, 54 (10.6%) didn’t receive any lipid-lowering therapy and only 178 (35%), received high-intensity statins. We found a significant association between age and statin-intensity treatment at discharge. The majority of patients (66.4%) aged 80 or more were recommended moderate-intensity statin therapy and only 16.8% received high-intensity statin, vs 41.9% and 44.4% in the group of patients younger than 60 years old (p=0.0002).

Conclusions: A significant percentage of stroke patients from Romania do not receive statin therapy in accordance with their cardio – vascular risk and therefore they don’t reach the LDL-cholesterol target established by the guidelines.

Disclosure: No

P0233 / 738

PREDICTORS OF CORRECT ANTIPLATELET RESPONSE IN STROKE PREVENTION MEASURED WITH ELECTRICAL IMPEDENCE AGGREGOMETRY

A. Reia ^1,2, L. Ciolli^1,3, T. Pirotti⁴, N. Lelli⁴, L. Vandelli¹, F. Rosafio¹, L. Picchetto¹, G.M. Borzì¹, R. Ricceri¹, M.L. Dell'Acqua¹, R. Pentore¹, G. Vandelli^1,3, L. Giacobazzi^1,3, S. Maffei¹, S. Meletti³, S. Vallone⁵, G. Bigliardi¹

¹Stroke Unit, Neurology Unit, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Department of Neuroscience, Modena, Italy, ²Federico II University, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Napoli, Italy, ³University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy, ⁴Laboratory of Clinical Pathology and Toxicology, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Department of Laboratory Medicine, Modena, Italy, ⁵Neuroradiology Unit, Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Department of Neuroscience, Modena, Italy

Background and aims: Platelet function tests could allow a guided selection of the appropriate treatment in secondary stroke prevention. We aimed to detect clinical and laboratory factors influencing the platelet inhibition in patient on antiplatelet therapy.

Methods: We retrospectively enrolled 300 patients hospitalized for acute cerebrovascular disease from 2017 to 2021, taking antiplatelet therapy and undergoing electrical impedance aggregometry. Demographic, clinical and laboratory data were collected and analyzed to detect predictors of high on-treatment platelet reactivity (HPR) Four parameters were analyzed: ASPI or ASPI/TRAP for aspirin and ADP or ADP/TRAP for P2Y₁₂ inhibitors.

Results: Platelet count was an independent predictor of HPR with ASPI (OR 0.990, 95% CI 0.982–0.998, p = 0.01), ADP (OR 0.98, 95% CI 0.97-0.99, p=0.001) and ADP/TRAP (OR 0.993, 95% CI 0.988-0.999, p =0.02) tests; PTT was a predictor of correct response to aspirin measured by ASPI test (OR 1.06, 95% CI 1.01-1.11, p =0.02); glomerular filtration rate was an independent factor of HPR with ADP test (OR 0.97, 95% CI 0.95-0.99, p =0.02); as to ADP/TRAP ratio, smoking was an independent predictor of HPR (OR 0.23, 95% CI 0.06-0.91, p =0.04), while dyslipidaemia was associated with an effective antiplatelet response (OR 3.98, 95% CI 1.04-15.24, p =0.04).

Conclusions: We found some clinical and laboratory variables affecting the antiplatelet response measured by aggregometry.  If confirmed, our findings can help to better tailorize the antiplatelet therapy in secondary stroke prevention.

Disclosure: No

P0234 / 1637

BARRIERS AND ENABLERS TO PHYSICAL ACTIVITY FOLLOWING TRANSIENT ISCHAEMIC ATTACK AND MILD STROKE: A SYSTEMATIC REVIEW

C. Pearce¹, E. Hibbert¹, I. Wellwood ¹, B. Bilney¹

¹ Australian Catholic University, Physiotherapy, School of Allied Health, Ballarat, Australia

Background and aims: Low physical activity (PA) is a modifiable risk factor for secondary prevention of stroke. We aimed to identify barriers and enablers to physical activity specifically in people after transient ischaemic attack (TIA) or mild stroke.

Methods: We conducted a systematic review, guided by Joanna Briggs Institute methodology to search Cochrane, MEDLINE, CINAHL, Embase, PEDro and PsychINFO databases from inception to end December 2021. Inclusion criteria were English language studies of adults with TIA / mild stroke (NHISS <4 or MRS < 2) which investigated patient-reported barriers and enablers to physical activity. Independent reviewers screened studies for eligibility and conducted quality appraisal using the Critical Appraisal Skills Programme Qualitative Checklist. Data on barriers and enablers were extracted, tabulated and summarised using narrative synthesis informed by the Theoretical Domains Framework.

Results: We identified 980 titles, of which 4 met inclusion criteria. The most commonly reported enablers to physical activity were found in the Knowledge, Intentions and Social Influences domains and included: education, the desire to prevent a second stroke and social support. The domains of Environmental Context and Resources and Social Influences held the most barriers. The barriers and enablers to PA in this patient group may differ from those in the more disabled stroke population.

Conclusions: Healthcare providers should be aware of barriers and enablers when designing and tailoring interventions targeting physical activity. There is a need for more qualitative studies that are specific to people with TIA.

Unfunded study. Registered on PROSPERO (CRD42020184476).

Disclosure: No

P0235 / 715

IMPROVED ATRIAL FIBRILLATION (AF) DETECTION DURING THE COVID-19 PANDEMIC USING HOME DELIVERED AND PATIENT ADMINISTERED AMBULATORY ECG MONITORS

L. Finnen ¹, I. Janmohamed¹, S. Mahmood¹, E. Lawrence¹, YK Kee¹

¹ Croydon University Hospital, Stroke Department, London, United Kingdom

Ischaemic strokes secondary to atrial fibrillation (AF) have a high morbidity and mortality thus, detection of AF post stroke is crucial for secondary prevention. Cardiology services were already struggling to provide timely Holter monitoring and the COVID-19 pandemic resulted in further delays. We collaborated with an external company to deliver adhesive ambulatory electrocardiographic monitors (AECG) to patient’s homes which ensured compliance with infection control measures to reduce investigation wait times. We conducted a retrospective study looking at AF detection rates when changing from a traditional 24-hour Holter monitor to a 7-day AECG which was delivered and collected from patients’ homes during the pandemic.

78 patients were included in this study. 37 patients had a 24-hour Holter monitor applied and removed by a health care professional in an outpatient setting. 41 patients had a 7-day AECG posted to their home where it was self-administered, removed and collected by a courier.

AF was detected in a total of 7 patients. 1 out of 37 (1.2%) patients were found to have AF in the 24-hour Holter monitor group.  6 out of 41 patients (7.7%) were found to have AF when using AECG monitors.

We conclude that 7-day AECG monitoring is more effective at detecting AF than 24-hour Holter monitoring. The model of a self-administered monitoring device with a longer observation period helps to reduce wait times for ambulatory monitoring whilst improve the detection rate of AF when used during the COVID-19 pandemic and may be beneficial for use in the future.

Disclosure: No

P0236 / 778

IMPLEMENTATION OF ONLINE TOOLS FOR PERIOPERATIVE ANTICOAGULANT MANAGEMENT: IMPACT ON CEREBROVASCULAR EVENTS

F. Duchi¹, L. Vandewalle ², J. Van den Broucke¹, A. Verhaeghe¹, P. Vanacker^2,3,2,3

¹AZ Groeninge, Department of Clinical Pharmacy, Kortrijk, Belgium, ²AZ Groeninge, Department of Neurology, Kortrijk, Belgium, ³Antwerp University Hospital, Neurovascular Reference Center, Department of Neurology, Antwerp, Belgium

Background: Previous study showed discrepancies on perioperative anticoagulants and anti-thrombotic use between regional management and EHRA guideline. In response, online bridging tool was developed within our hospital-network. Impact was assessed on the occurrence of peri-operative cerebrovascular events.

Methods: Data from all patients with an ischemic cerebrovascular accident previously treated with antiaggregant/anticoagulant were collected. Patients were included if they had an ischemic cerebrovascular accident in the peri-operative period (-5d till 14d). Following data were extracted from the electronic patient records: aetiology, previous stroke, antiaggregant or anticoagulant, renal function, age, surgery and preoperative advice based on bridging link. Compliance of perioperative anticoagulation management with the new bridging link and EHRA guidelines was assessed by clinical pharmacist.

Results: A total of 64 patients were included. Only three patients (2,9%) were scheduled to undergo surgery. In one patient ischemic stroke occurred before surgery and in two patients it occurred after surgery. First, the classification based on bleeding risk of surgery was compared between the EHRA guidelines and our new bridging link. In all cases, classification in both sources was compliant. In only one patient, recommendation given on whether or not to stop anticoagulation pre-operatively was conform to the bridging link. In two patients, that recommendation did not match. In one, recommendation was correctly stated in patientrecord but was not correctly implemented. The other stopped aspirin incorrectly preoperatively, resulting in ischemic stroke postoperatively.

Conclusion: The new-developed, bridging application is well used in clinical practice. Patients non-adherence to the preoperative advice is point of attention.

Disclosure: No

REHABILITATION – EXCLUDING CLINICAL TRIAL RESULTS

P0237 / 1418

THE EFFECT OF GAMIFIED ROBOT-ENHANCED TRAINING ON MOTOR PERFORMANCE IN CHRONIC STROKE SURVIVORS

M.J. Wessel ¹, A. Guneysu Ozgur², J.K. Olsen³, A. Cadic-Melchior⁴, V. Zufferey⁴, W. Johal⁵, G. Dominijanni⁶, B. Bruno², J.-L. Turlan⁷, A. Mühl⁷, P. Vuadens⁷, P. Dillenbourg², F.C. Hummel¹

¹Swiss Federal Institute of Technology Lausanne (EPFL), Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Geneva, Switzerland, ²Swiss Federal Institute of Technology (EPFL), Computer Human Interaction in Learning and Instruction (CHILI), Lausanne, Switzerland, ³University of San Diego, San Diego, United States, ⁴Swiss Federal Institute of Technology Lausanne (EPFL), Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Sion, Switzerland, ⁵University of New South Wales Sydney, Sydney, Australia, ⁶Swiss Federal Institute of Technology (EPFL), Center for Neuroprosthetics and School of Engineering, Lausanne, Switzerland, ⁷Clinique Romande de Réadaptation (SUVA), Sion, Switzerland

Background and aims: Task-specific training is a key element for evidence-based rehabilitation strategies targeted at improving upper extremity activity after stroke. Pairing it with additional practice strategies and neurotechnology-based solutions could further improve patient outcomes.

Methods: N = 10 chronic stroke survivors were recruited for the study. The effect of gamified robot-assisted (Cellulo system) upper limb motor training on motor performance, skill learning, and transfer was evaluated in two training sessions scheduled on two consecutive days and compared to a non-gamified control condition in a single-blind, randomized design.

Results: Gamified training resulted in a higher overall and more controlled motor performance during the training phase, which was characterized by a higher accuracy (lower deviance), higher smoothness (lower jerk), but lower speed. The responder analyses indicated that mildly impaired patients benefited most from the gamification approach.

Conclusions: Gamified robot-assisted motor training constitutes a promising investigational strategy for tuning performance during motor practice after stroke. The approach allows for personalized and potentially home-based application, which have to be investigated in detail in future studies.

Disclosure: No

P0238 / 249

A QUALITATIVE STUDY EXPLORING HOW PATIENTS' EXPECTATIONS AND UNDERSTANDING OF STROKE EARLY SUPPORTED DISCHARGE SHAPED THEIR EXPERIENCE AND ENGAGEMENT WITH THE SERVICE

T. Cameron ¹, A. Byrne¹, K. Koller¹, N. Chouliara¹, T. Robinson², P. Langhorne³, M. Walker¹, R. Fisher¹

¹University of Nottingham, School of Medicine ARU1 Mental Health and Clinical Neurosciences, Nottingham, United Kingdom, ²University of Leicester, College of Life Sciences, Leicester, United Kingdom, ³University of Glasgow, Institute of Cardiovascular & Medical Science, Glasgow, United Kingdom

Background and aims: Early supported discharge (ESD) is recommended as part of the National stroke service model in England. Medically stable patients are discharged home from hospital to receive intensive, home-based rehabilitation from a specialist stroke multi-disciplinary team. There are 1.3m stroke survivors in the UK and two thirds leave hospital with a disability. Understanding how to optimise recovery through ESD is vital. This study explored patients’ experiences of ESD services, how their understanding and expectations shaped their engagement with the clinicians and services and potentially enhanced their recovery.

Methods: This research was conducted as part of ‘What is the Impact of Stroke Early Supported Discharge?’ WISE study. Semi-structured interviews were conducted with five stroke survivors from six purposively selected sites (n=30) in England. Interview transcripts were analysed using reflexive thematic analysis.

Results: Three overarching themes were identified:

• 1) ESD as a post-stroke recovery tool,

• 2) desire to recover quickly,

• 3) psychosocial impact and support.

Stroke survivors were uncertain about what to expect from the service, however, their experience of ESD exceeded their expectations. Patients valued the team’s goal-oriented approach which motivated, engaged and encouraged extension of therapy practice outside of formal sessions. Rehabilitation at home was perceived as positive and practical, encouraging independence within real-life contexts. Psycho-social support played an important role in the patients’ rehabilitation.

Conclusions: Increasing patient understanding and expectations of ESD prior to admission to the service could potentially increase engagement with clinicians and enhance patient experience.

Disclosure: No

P0239 / 1620

THE EFFECTIVENESS OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON HAND DEXTERITY IN STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

L. Alabdulaali ^1,2, L. Hickman³, T. Punt⁴, N. Jenkinson⁴

¹University of Birmingham, Birmingham, United Kingdom, ²Imam Abdulrahman Bin Faisal University, Physical Therapy, Dammam, Saudi Arabia, ³University of Birmingham, School of Psychology, Birmingham, United Kingdom, ⁴University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom

Background and aims: Hand dexterity is commonly impaired post-stroke resulting in an inability to perform the skilful movement. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique. It has gained popularity in improving upper limb function. However, the effect of tDCS has been varied between studies. Therefore, we aim to investigate the difference in recovery between fine and gross hand dexterity through testing our hypothesis that stimulating the primary motor cortex will facilitate fine dexterity more than gross dexterity.

Methods: This is a systematic review and meta-analysis conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. CENTRAL, SCOPUS, MEDLINE, EMBASE, CINAHL and Web of Science databases were searched for randomised controlled trials examining the effect of tDCS in improving hand dexterity of stroke patients. The outcomes of interest were fine and gross hand dexterity measures.

Results: Sixteen studies met the inclusion criteria, six had an excellent quality, and ten had a good quality according to Physiotherapy Evidence Database(PEDro) scale. Meta-analysis of fine dexterity studies found a small Standard Mean Difference (SMD), and meta-analysis of gross dexterity studies found a very small SMD.

Conclusions: It appears that tDCS has a small effect in improving dexterity. We need to carry out experiments studying the effect of tDCS alone with no combination with motor rehabilitation to get a more accurate assessment of the effect of tDCS. Because it seems that motor rehabilitation improves the performance of both experimental and control groups.

Disclosure: No

P0240 / 1560

ADAPTING THE STROKE RECOVERY IN MOTION (SRIM) PLANNER TO SUPPORT CULTURALLY RELEVANT POST STROKE COMMUNITY-BASED EXERCISE PROGRAMS IN ETHNICALLY DIVERSE COMMUNITIES

T. Nguyen ¹, H. Singh², J. Fulton¹, S. Mirzazada³, M. Nelson⁴, S. Team⁵

¹March of Dimes Canada, Toronto, Canada, ²University of Toronto, Toronto, Canada, ³Bridgepoint Collaboratory for Research and Innovation, Toronto, Canada, ⁴Lunenfeld-Tanenbaum Research Institute Sinai Health, Toronto, Canada, ⁵SRIM Team, Toronto, Canada

Background and aims: Stroke is the leading cause of adult disability (affecting 1.1 million citizens) and among the leading cause of death (440,000 annual deaths) in the European Union. The Stroke Recovery in Motion (SRiM) Planner is an evidence-informed guide designed to assist program planners in the planning and implementation of community-based exercise programs for people living with stroke. This presentation aims to describe a protocol for adapting the SRiM Planner to support the development of culturally relevant post-stroke community-based exercise programs to improve physical activity in ethnic communities.

Methods: A qualitative approach will be used to learn directly from program planners, community developers, and health professionals with lived experience about the value of culturally relevant community-based exercise programs in facilitating post-stroke rehabilitation.  A purposeful, multisectoral approach will be used to recruit 20-30 participants with varying experience and expertise in program planning and implementation. Semi-structured interviews will be conducted via Zoom or by phone, audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

Results: Outcomes of this work will assist in building foundational knowledge around the concept of cultural relevance, addressing health inequities, and the process and skills needed to adapt the SRiM Planner to develop culturally relevant community-based exercise programs to improve physical activity in ethnically diverse populations.

Conclusions: Culturally relevant programs are essential in promoting health equity, diversity and inclusion. Our approach to adapting the SRiM Planner could also provide a model approach for researchers, clinician-scientists, and trainees to promote culturally relevant stroke programs and research.

Disclosure: No

P0241 / 1443

AWARENESS AND USE OF STROKE REHABILITATION INTERVENTIONS IN CLINICAL PRACTICE AMONG OCCUPATIONAL THERAPISTS (OT) AND OT ASSISTANTS

A. McIntyre ¹, R. Viana^1,2,3, P. Cao¹, M. Longvaal¹, K. Kang¹, E. Lin³, A. Harnett¹, R. Teasell^1,2,3

¹Parkwood Institute, London, Canada, ²St. Josephs Health Care London, London, Canada, ³University of Western Ontario, London, Canada

Background and Aims: To examine occupational therapists (OT) and OT assistants (OTA) awareness and use of stroke rehabilitation interventions, as well as the factors associated with intervention use and non-use in real world clinical practice.

Methods: Participants were recruited from medical centres providing stroke rehabilitation to stroke patients in each of the ten provinces across Canada. OT/OTAs meeting the following inclusion criteria completed a bilingual survey: 1) provide direct stroke rehabilitative care to individuals after a stroke; 2) 18+ years old; and 3) read and write in English or French. The survey asked questions about therapists’ work setting, patient demographic, and how they stay up-to-date. Therapists were also asked about their awareness and use of OT stroke rehabilitation interventions. Surveys were completed January-July 2021.

Results: 127 OT/OTAs (female=89.8%), mainly from Ontario or Quebec (62.2%) were included; most worked full-time (80.3%) in moderate-large (86.1%) cities. The highest awareness and use of interventions were those applied to the body peripherally, without a technological component. Few individuals were aware of interventions applied to the brain (priming or stimulating) with a technological component, and they were rarely, if ever, used. Greatest barriers to using adjunct therapies appear to be cost, access, time, and the perception that they are outside therapists’ role or scope of practice.

Conclusions: Investigating therapists’ perspectives on OT stroke rehabilitation interventions, as well as the barriers and facilitators to therapy use, have the potential to inform future guidelines, enhance OT service provision, and provide strategic direction to future research initiatives.

Disclosure: No

P0242 / 554

PREDICTORS OF INDEPENDENT AMBULATION IN STROKE PATIENTS

Y. Flomin ^1,2

¹Bogomolets National Medical University, Physical and Rehabilitation Medicine, Kyiv, Ukraine, ²Medical Center 'Universal Clinic 'Oberig', Stroke Center, Kyiv, Ukraine

Background and aims: Unassisted walking is a crucial goal in stroke rehabilitation. We aimed to determine the predictors of independent ambulation at Comprehensive Stroke Unit discharge.

Methods: Uni– and multivariable regression models were built based on demographic, clinical and laboratory data of 442 study participants (median age: 65.8 years, 43% female, 84% ischemic strokes, median baseline NIHSS score: 10).

Results: In univariable analysis, 28 variables were significantly (p<0.05) associated with inability to walk unassisted, including stroke subtype, patient’s age and sex, atrial fibrillation, initial severity of stroke, disability, motor and cognitive impairments as well as increased levels of inflammation markers on admission. Multivariate analysis revealed only four independent predictors that were significantly (p<0.05) associated with lack of independent abulation: age (OR= 1.07; 95% CI 1.03-1.10, on average, for each additional year, p<0.001), baseline NIHSS score (OR= 1.15; 95% CI 1.08-1.22, on average, with a 1-point increase in the total score, p<0.001), initial Functional Ambulation Classification score (OR= 0.40; 95% CI 0.31–0.52, on average, with a 1-point decrease in the score, p<0.001), and very long dalay from stroke onset Comprehensive Stroke Unit admission (over 180 days; OR= 5.7; 95% CI 1.9–17.1, p=0.002).

Conclusions: Four admission variables may be independently associated with independent ambulation at discharge from a Comprehensive Stroke Unit. If the validity of the prognostic model is confirmed in independent studies, its use can contribute to improving stroke outcomes and mitigating risk of inability to ambulate without assistance.

Disclosure: No

P0243 / 266

MINDFULNESS FOR ALLEVIATING FATIGUE AFTER STROKE

B. Johansson ¹

¹ Gothenburg University, Neuroscience and Physiology, Göteborg, Sweden

Background: In chronic phase after stroke, about 50% report fatigue an unmet need. Fatigue reduce the ability to participate in ordinary living with work and social activities. Many suffer from isolation, frustration and emotional problems.

Mindfulness, with the program Mindfulness Stress Reduction (MBSR) is promising for many illnesses, including stroke. MBSR includes meditation, group discussions with specific teams including insight of unhealthy reactions and with increase the awareness of healthy responses and meeting life on its own terms, with compassion.

Methods: We have evaluated the MBSR program with; in-person group meetings, live online group meetings, individually guided Internet MBSR with pre-recordings and a qualitative evaluation of in-person group meetings.

Results: We have shown reduced fatigue, depression and anxiety symptoms, and improved cognitive function for chronic stroke participants. Sharing experiences are highly appreciated with gain of awareness of the condition. This in turn implied new perspectives on how to relate to and address these. Individual Internet MBSR shown feasible and gives people the opportunity to get access to the program when group meetings are not possible. For some the MBSR program need modifications, with a slower pace and more repetitions.

Conclusions: MBSR have the potential to alleviate fatigue after stroke, reduce emotional responses and improve cognitive function. MBSR can improve well-being and help people managing life with more of ease and with acceptance, but in new ways.

Disclosure: No

P0244 / 521

ASSESSING THE RELIABILITY AND VALIDITY OF 4-METER AND 10-METER WALKING TEST FOR MEASUREMENTS OF GAIT SPEED IN CHRONIC STROKE SURVIVORS

R. Cabanas-Valdés ¹, C. López-de-Celis^1,2, L. Garcia-Rueda¹, A. Pérez-Bellmunt³, C. Paucirerol i Fabregat¹, C. Salgueiro^1,4

¹Universitat Internacional de Catalunya, Physical Therapy, Barcelona, Spain, ²Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Physical Therapy, Barcelona, Spain, ³Universitat Internacional de Catalunya, Basic Sciences Department, Actium Functional Anatomy Research Group, Barcelona, Spain, ⁴Neurorehabilitación Clinic, Physical Therapy, Barcelona, Spain

Background and aims: Walking speed is an important temporal-distance parameter of gait. The 10-Meter walk test is a measure demonstrating excellent reliability and validity but its correlation with the 4-Meter walk test in stroke survivors has not been studied. The study aim was to examine the reliability and validity of 4-Meter walk test compared to 10-Meter walk test as a measurement of gait speed in chronic stroke survivors.

Methods: A cross-sectional observational study design was used with comparisons of gait speed between two different walking tests. The sample size calculation was 20 individuals. They performed two 4-Meter and 10-Meter walk test same day. One investigator performed all measurements.

Results: Characteristics of participants are summarized in Table-1. Gait speed measurements were shown to have excellent test-retest reliability Table-2. The Bland-Altman plot for the gait speed differences between the two tests is shown Figure-1. There is no statistically significant difference in the comparison of the mean of both gait tests (p<0.091), using the paired t-test. There is a strong positive correlation (r=0.867, p<0.001) between the 4-Meter and the 10-Meter walk test Figure-2.

Conclusions: This study indicates excellent validity and reliability agreement between 4-meter and 10-meter walk test gait speed measurements in chronic stroke survivors. The use of these two tests as complementary outcome measures for functional evaluation in these individuals are recommended. They require little space, and the health professional does not require any specialist training. Both tests could be used in clinical or home environments during outpatient stroke rehabilitation.

Table 1.

Sample characteristics of participants n=20.

Age (Years) Mean ± SD	57.30 ± 12.42
Gender n (%)
Men	11 (55%)
Women	9 (45%)
Weight (Kilograms) Mean ± SD	76.16 ± 17.21
Height (meters) Mean ± SD	1.70 ± 0.09
BMI Mean ± SD	26.19 ± 4.64
Time onset of stroke (years)	8.50 ± 7.79
Type of Ictus n (%)
Haemorrhagic	5 (25%)
Ischemic	15 (75%)
Paretic side (n and %)
Right	9 (45%)
Left	11 (55%)
Using walking assistive device n (%)
None	7 (35%)
Cane	2 (10%)
AFO	9 (45%)
Cane + AFO	2 (10%)
Modified Ashworth scale (MAS) n (%)
MAS 0	3 (15%)
MAS 1-1+	6 (30%)
MAS 2	11 (55%)
Fulg-Meyer scale standing knee flexion n (%)
<90º	4 (20%)
90º	11 (55%)
>90º	5 (25%)
Lunge test Mean ± SD	29.85 ± 14.67

AFO: ankle-foot orthosis, BMI: body mass index, MAS: SD: standard deviation.

Table 2.

Test-Retest Reliability Coefficients, Standard error measurement and Minimal detectable change between the 4-Meter Walk test and the 10-Meter Walk test.

	ICC (95% CI)	SEM	MDC 95%
4-Meter Walk test (m/s)	0.992 (0.980; 0.997)	0.031	0.085
10-Meter Walk test (m/s)	0.996 (0.989; 0.998)	0.028	0.077
Comparison between 4-Meter /10-Meter Walk test (m/s)	0.906 (0.758; 0.963)	0.068	0.188

ICC: Intraclass correlation coefficients, CI: Confidence interval, MDC: Minimal detectable change, m/s: meters second, SEM: standard error measurements

Figure-1 Figure-2

Disclosure: No

P0245 / 1596

HOW MANY MUSCLES SHOULD WE PROBE TO ELICIT MOTOR EVOKED POTENTIALS IN STROKE PATIENTS?

M. Nazarova ^1,2, V. Tsivileva¹, T. Ivanov¹, U. Voronkova¹, T. Abramova¹, E. Kovrazhkina¹, S. Gulyaev¹, A. Trofimova¹, I. Gubskii¹, T. Rostovceva¹, A. Nikogosova¹, M. Bulatova¹, B. Polyaev¹, A. Dolova¹, P. Novikov², V. Nikulin^2,3, V. Lelyuk¹, G. Ivanova¹

¹Federal State Budgetary Institution «Federal Center of Brain Research and Neurotechnologies» of the Federal Medical Biological Agency, Moscow, Russia, Moscow, Russian Federation, ²Center for Cognition and Decision Making, National Research University Higher School of Economics, Moscow, Russia, Moscow, Russian Federation, ³MPI for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany

Background and aims: The possibility to obtain motor evoked potentials (MEPs) using transcranial magnetic stimulation (TMS) is considered an important feature for motor recovery prediction after stroke. We aimed to probe how many and which upper limb muscles are preferable to probe in stroke patients to obtain MEPs in a maximal fraction of patients.

Methods: We enrolled 52 patients with supratentorial ischemic stroke (21 females, mean age 55 [21–83] y.o., meantime after stroke 4 [1–11] months) with upper limb weakness, assessed by Fugl-Meyer Upper Extremity Scale (FMUE). We probed MEPs in three upper limb muscles: abductor pollicis brevis (APB), extensor digitorum communis (EDC), and abductor digiti minimi (ADM). Then we assigned each muscle a score: MEPs without facilitation - MEP+ (1 point), MEPs only with facilitation - MEP+ (0.5 points), no MEPs from that muscle - MEP- (0 points).

Results: We showed that MEPs in at least one of three muscles were obtained in 33 of 52 patients (63.5%), while MEPs in all three muscles - only in 17 of 52 patients (32.7%). Most often MEPs were found in ADM muscle (88% of all MEP+ patients), while the best combination of two muscles was APB-ADM (97% of all MEP+ patients) (Figure 1a). A moderate correlation was shown between the FMA-UE and MEP scores (Spearman's test, r=0.48, p<0.001) (Figure 1b).

Conclusions: We showed that the investigation of multiple muscles can increase the chance to obtain MEPs in stroke patients by 21%, which may be important for rehabilitation trials` recruitment.

Disclosure: No

P0246 / 994

STROKE IN YOUNG ADULTS: THE FEASIBILITY OF AN OUTDOOR REHABILITATION PROGRAMME INVESTIGATING WALKING PERFORMANCE AND QUALITY OF LIFE s

R. Clarke ¹, N. Reeves¹, K. Tzoulas², G. Cavan², A. Griffiths³, L. Walker⁴, N. Rees⁴, K. Jackson⁵, H. Jarvis¹

¹Manchester Metropolitan University, Life Sciences, Manchester, United Kingdom, ²Manchester Metropolitan University, Environmental Sciences, Manchester, United Kingdom, ³NHS Wales, Aneurin Bevan University Health Board, NP20 4SZ, United Kingdom, ⁴NHS Wales, Cwm Taf University Health Board, CF45 4SN, United Kingdom, ⁵NHS Wales, Betsi Cadwaladr University Health Board, LL57 2PW, United Kingdom

Background and aims: Exercising in natural outdoor natural environments have been associated with better physical and mental health. No rehabilitation programmes exist for young adults who have had a stroke using “outdoor natural environments” to improve health and wellbeing. The aim of this study was to determine the feasibility of conducting a case controlled study testing the effectiveness of an outdoor rehabilitation programme for young adults who have had a stroke.

Methods: Participants who have had a stroke (n=4) were recruited to participate in a 3-week outdoor-based rehabilitation programme, involving walking, archery and canoeing. Participant and outdoor instructor feedback (enjoyment, delivery and improvements) was captured pre, weekly and post rehabilitation programme using guidelines. Feedback was investigated using thematic analysis by inductive coding. Quality of life was assessed using EuroQol.

Results: Participant feedback (Figure1) suggested that the outdoor rehabilitation programme was enjoyable and motivational due to participating in a stroke specific group with similar impairments. Feedback of the home-based exercises suggested that they disliked completing the planned exercises at home, as it was not group based. Quality of life improved from 70 to 87.5 (EQ-VAS). Instructor feedback suggested archery and canoeing were not feasible to deliver routinely for a larger cohort.

Conclusion: The activities as part of this feasibility study seemed to be well-tolerated and were feasible to deliver with participants who had mild-moderate motor impairments caused by stroke. The group-based design of the intervention was well received.

Figure 1.

Key themes identified from participant feedback of feasibility study

Disclosure: No

P0247 / 118

INTRODUCING A MINDFULNESS-BASED PROTOCOL FOR RECOVERY FROM STROKE (MBRFS)

L. Gray ¹

¹ Western Michigan University, Integrative Holistic Health and Wellness, Kalamazoo, United States

Background and aims: Decades of research suggest that Mindfulness-Based Stress Reduction (MBSR) training supports a greater capacity to live with chronic medical conditions. This paper introduces a model for a Mindfulness-Based Recovery from Stroke (MBRfS) for promoting stroke recovery, informed by the lived experience of the author (a stroke survivor and certified MBSR instructor), and the specific challenges of stroke recovery.

Methods: A literature search was conducted to explore possible research and publications adapting M.B.S.R. to medical populations, including stroke survivors. There is limited research in this area. A summary will be presented of similar protocols, such as applying M.B.S.R. in programs for cancer survivors and chronic pain patients. An autoethnography was developed as a methodology to support the model. A theoretical case is made for the value and need for the development of a mindfulness-based program for those who have experienced and are recovering from a stroke.

Results: The proposed mindfulness-based stroke recovery intervention (MBRfS) is outlined in detail.  Case vignettes are offered in the autoethnography that emerged, drawing on the author's experiences as a stroke survivor and MBSR certified teacher. A four-component MBRfS model is offered, which consists of integration amongst a modified MBSR framework, emergent attitudinal themes, and insights from the autoethnographic vignettes.

Conclusions: The MBRfS model offers a path for providing participants with a supportive experience within stroke recovery. Recommendations and suggestions for future studies are offered to support the development of MBRfS for stroke survivors and their caregivers, as well as contributing to healthcare providers.

Disclosure: No

P0248 / 1262

INTERVENTIONS FOR IMPROVING PSYCHOSOCIAL WELL-BEING AFTER STROKE

D. van Nimwegen ¹, E. Hjelle², M. Kirkevold², U. Sveen^3,4, L. Schoonhoven⁵, A. Visser-Meily⁶, L. Bragstad^7,8, J. de Man-van Ginkel⁵

¹University of Applied Sciences Utrecht, Research Group Proactive Care for Elderly People Living at Home, Utrecht, Netherlands, ²University of Oslo, Oslo, Norway, ³Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway, ⁴Oslo University Hospital, Department of Physical Medicine and Rehabilitation, Oslo, Norway, ⁵University Medical Center Utrecht, Department of Nursing Science Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, ⁶University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, Utrecht, Netherlands, ⁷University of Oslo, Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Oslo, Norway, ⁸Oslo Metropolitan University, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Norway

Background and aims: Many stroke survivors suffer from psychosocial problems, which can lead to suboptimal rehabilitation and reduced participation in daily life and social activities. Although in the last decades a large number of studies have been conducted on the identification, prevention and treatment of psychosocial disorders, the prevalence after stroke has not decreased. Most of these studies have in common a sole focus on one particular psychosocial disorder. However, practice as well as research suggest clustered occurrences of psychosocial problems. Therefore, the aim of our review is to identify effective interventions – or intervention components – for clusters of psychosocial problems to improve patients’ psychosocial well-being after stroke.

Methods: We conducted a systematic review of randomized controlled trials and quasi experimental studies, using the Joanna Briggs Institute methodology of systematic reviewing and PRISMA-P guidelines.

Results: We identified 23 interventions that showed positive effects on one or more of the following psychosocial outcomes: depression, anxiety, fatigue, (health related) quality of life, hope, and (societal) participation. Interventions shown to be effective on one or more of these outcomes focused at least on the components: prevention of risk factors, self-management, recovery, coping, and mood, and included active information provision and physical activity.

Conclusions: To effectively improve psychosocial well-being after stroke, this review confirms the value of a multicomponent intervention that focusses not only on clustered psychosocial consequences but also on stroke related problems. Such a  multicomponent intervention requires  further refinement / development and evaluation within the entire stroke care pathway.

Disclosure: No

P0249 / 1378

HEADS: UP APHASIA: CO-CREATING A MINDFULNESS-BASED COURSE FOR STROKE SURVIVORS WITH APHASIA. FINDINGS FROM A PROFESSIONAL STAKEHOLDER SURVEY

M. Pieri ¹, M. Grealy², M. Lawrence¹, A. Lowit², G. Pearl³

¹Glasgow Caledonian University, Nursing and Community Health Department, Glasgow, United Kingdom, ²University of Strathclyde, School of Psychological Sciences & Health, Glasgow, United Kingdom, ³Speakeasy, Bury, United Kingdom

Background and aims: One third of stroke survivors lives with aphasia. Although anxiety and depression are common among people with aphasia (pwa), due to their complex communication needs these individuals are frequently excluded from therapeutic interventions with negative consequences on their mental health.  HEADS: UP Aphasia is a Stroke Association-funded PHD research study which aims to co-create an aphasia-friendly version of HEADS: UP (Helping Ease Anxiety and Depression following Stroke; https://bit.ly/2QbB0cV), a stroke-specific adaptation of Kabat-Zinn’s Mindfulness-based Stress Reduction (MBSR) course.

Methods: The study was conducted online. In stage 3 of the research a social media strategy was used to recruit health professionals (HPs). Participants were invited to complete a 10-min bespoke questionnaire structured around the TIDieR checklist (Hoffmann et al., 2014) and delivered via RedCap. Questions focused on potential adjustments to be considered during subsequent co-creation/adaptation work. Closed questions were supplement by the option to ‘comment’. Quantitative questionnaire data were analysed using descriptive statistics e.g. distribution and frequency; qualitative data using thematic analysis.

Results: Twenty-eight HPs were recruited; n=25 professionals completed the survey (n=3 not completed). Key findings: delivery mode: 48% (n=12) ‘blended’; setting: 68% (n=17) ‘mix of 1:1 and group sessions’; session frequency: 44.4% (n=12) ‘once weekly’. Explanatory comments helped identify potential facilitators and barriers e.g. group for peer support.

Conclusions: The results offer a professional perspective of pwa’s needs and priorities in the context of a complex psychosocial self-management intervention, and will guide the decision-making during subsequent HEADS: UP Aphasia co-development processes.

Disclosure: No

P0250 / 1184

STROKE IN YOUNG ADULTS: THE INFLUENCE OF AN OUTDOOR-WALKING REHABILITATION PROGRAMME ON WALKING SPEED, ENERGY COST AND QUALITY OF LIFE

R. Clarke ¹, N. Reeves¹, K. Tzoulas², G. Cavan², A. Griffiths³, L. Walker⁴, N. Rees⁴, S. Rowland⁵, K. Jackson⁶, H. Jarvis¹

¹Manchester Metropolitan University, Life Sciences, Manchester, United Kingdom, ²Manchester Metropolitan University, Environmental Sciences, Manchester, United Kingdom, ³NHS Wales, Aneurin Bevan University Health Board, NP20 4SZ, United Kingdom, ⁴NHS Wales, Cwm Taf University Health Board, CF45 4SN, United Kingdom, ⁵NHS Wales, Swansea Bay University Health Board, SA12 7BR, United Kingdom, ⁶NHS Wales, Betsi Cadwaladr University Health Board, LL57 2PW, United Kingdom

Background and aims: Twenty-six percent of adults who have had a stroke in the United Kingdom are under 65years of age (defined as young adults). Most are unable to return to employment or participate in social/leisure activities due to difficulties walking. No rehabilitation programmes exist using “outdoor natural environments” for young stroke survivors. Previous research reported exercising outdoors improves physical function for other health conditions. The aim of this study is to investigate if an outdoor-walking rehabilitation programme can improve walking speed and energy cost of young adults who have had a stroke.

Methods: Participants who had experienced a stroke (18-65years: n=12) were recruited from three health boards in Wales, UK to participate in a ten-week outdoor-walking and home exercise rehabilitation programme. Walking speed and energy cost (using the physiological cost index) was measured during three minutes of walking in indoor and outdoor environments at baseline and post-rehabilitation. Quality of life was assessed using SAQOL.

Results: Stroke participants walked quicker indoors (pre: 0.82m/s, post: 0.91m/s post-intervention (p=0.01)), outdoors (pre: 0.79m/s, post: 0.89m/s (p=0.005)) and more efficiently (indoor, pre: 0.75 beats/m, post: 0.57 beats/m (p=0.56), outdoor, pre: 0.83 beats/m, post: 0.60 beats/m (p=0.168)). Overall quality of life improved from 2.76 to 3.21 (p=0.024).

Conclusion: This study highlights the positive role of exercising in outdoor natural environments to promote recovery, improve walking ability and quality of life, following stroke in young adults and the need for natural outdoor environments to be used as settings for an alternative form of rehabilitation.

Disclosure: No

P0251 / 241

INDIVIDUAL PEER SUPPORT FOR STROKE SURVIVORS: REPRESENTATIONS OF STROKE REHABILITATION TEAM MEMBERS

S. Corbin¹, E. Damiolini², A. Termoz^2,1, L. Huchon³, G. Rode³, A.-M. Schott^1,2, J. Haesebaert ^1,2

¹Université Lyon 1, RESHAPE Inserm U 1290 Laboratory, Lyon, France, ²Hospices Civils de Lyon, Service de Recherche et d'Épidémiologie Cliniques, Lyon, France, ³Hospices Civils de Lyon, Service de Rééducation Post-AVC Hôpital Henry Gabrielle, Saint Genis Laval, France

Background and aims: When discharged home after a stroke, patients and caregivers express needs for information and psychosocial support, that individual peer support could meet. We aimed to explore stroke rehabilitation professionals’ representations of peer support; the benefits they anticipated for patients; and the levers and barriers they perceive to implement the intervention in their practice.

Methods: Qualitative study composed of four focus groups and four semi-structured interviews held with 25 rehabilitation professionals from a French hospital. The interview guide targeted representations on peer support, needs of patients and tasks that a peer-supporter could fulfill, practical organization, brakes and levers to the implementation of a peer-support intervention. We conducted a thematic content analysis of transcribed verbatim.

Results: Rehabilitation professionals had low formal knowledge on peer support. However, they acknowledged many unmet needs of stroke survivors that peer support could meet, such as social, emotional and informational support. They were favorable to the integration of peer-supporters in stroke survivor pathway, but raised some barriers such as the lack of human and financial resources to dedicate staff to supervise the peer supporter, the lack of coordination between hospital and community professionals, and the fear that peer support might give false hope to survivors or lead to undesired effects.

Conclusions: Peer-support for stroke survivors might be beneficial for stroke patients, but the peer-support intervention has to be clearly defined and the teams have to be prepared. Our study provides insights into developing effective implementation strategies to enhance the success of the intervention.

Disclosure: No

P0252 / 1013

A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIAL CHARACTERISTICS FOR INTERVENTIONS TO IMPROVE UPPER EXTREMITY MOTOR RECOVERY POST STROKE

M. Saikaley ¹, A. McIntyre¹, G. Pauli¹, R. Teasell^1,2,3

¹Lawson Health Research Institute, Parkwood Institute Research, London, Canada, ²St. Joseph's Health Care London, Parkwood Institute, London, Canada, ³Western University, Schulich School of Medicine and Dentistry, London, Canada

Background and aims: A large proportion of stroke rehabilitation interventions are directed towards motor recovery. Understanding the characteristics of this literature base can aid in the interpretation of evidence and help guide future research directions. Therefore, this study aims to present an overview of the methodological characteristics of the randomized controlled trials (RCTs) designed to facilitate upper extremity motor recovery post-stroke.

Methods: This review was conducted following PRISMA guidelines. A literature search was run in 5 established databases. English articles reporting on RCTs were eligible if they were published before April 1st, 2021 and applied an intervention to the hemiparetic upper extremity of individuals post-stroke as the primary objective of the study, or recorded at least one upper extremity related outcome measure.

Results: 5,408 records were identified from databases. After screening and review, 1,307 articles were included. The number of RCTs is growing exponentially (Figure 1.) The mean sample size (start/finish) was 45.8 (SD 55.4)/41.8 (SD 49.7). The median sample size (start/finish) was 30 (IQR 20-48)/29 (IQR 19-44). The mean Physiotherapy Evidence Database (PEDro) score was 6.12 (SD 1.55). 251 RCTs (19%) were multi-centered trials. Key methodological measures of quality are low, including the blinding of assessors (59%), intention to treat analyses (42%) and concealed allocation (37%). More than 60 different interventions were identified.

Conclusions: These findings are useful in identifying areas of improvement when designing future trials, helping with the overall interpretation of the evidence within this literature base, and highlighting areas for evidence synthesis and meta-analysis.

Figure 1.

Disclosure: No

P0253 / 1103

IMPACT OF THE COVID-19 PANDEMIC ON QUALITY OF LIFE IN A NORWEGIAN STROKE COHORT

A. Hokstad ¹, B. Thommessen², H. Ihle-Hansen³, B. Indredavik¹, T. Askim¹

¹Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science (INB), Trondheim, Norway, ²Akershus University Hospital, Department of Neurology, Nordbyhagen, Norway, ³Bærum Hospital, Vestre Viken Hospital Trust, Department of Internal Medicine, Gjettum, Norway

Background and aims: The implementation of interventions like closing exercise facilities and restrictions in social activities in order to minimize spreading of the SARS-CoV-2 virus, may have affected quality of life (QOL) among stroke survivors.

The study aimed to assess how changes in physical activity levels, mental health, and feeling of loneliness were associated with QOL during the pandemic.

Methods: A survey was conducted between March and July 2021 among the 150 first stroke patients included in an ongoing randomized controlled trial (RCT) on long-term follow-up after stroke (The LAST-LONG Trial ClincalTrials.gov Identifier: NCT03859063) recruiting patients from three Norwegian hospitals at 3 months poststroke. Patients were asked to complete a questionnaire about self-reported health at inclusion or during follow-up. Univariate and multivariate binomial regression analyses were used to explore the association between physical activity, loneliness, mental health, and QOL.

Results: In all, 116 (77%) patients completed the questionnaire. Median age was 74 (range 35-93) years, and 48 (41%) were female. A total of 79 (68%) reported less physical activity, 36 (31%) felt lonelier, and 43 (37%) reported worse mental health, while 49 (42%) reported reduced quality of life during the lock-down. In the univariate analyses less physical activity, feeling lonelier and changes in mental health were associated with reduced QOL. In the multivariate analysis only less physical activity OR=3.18 (95% CI 1.10-9.17, p=0.032) was significantly associated with reduced QOL.

Conclusion: In this group of stroke survivors, less physical activity during the Covid-19 pandemic was strongly associated with reduced QOL.

Disclosure: No

P0254 / 841

AGE FEATURES OF REHABILITATION OF PATIENTS WITH POST-STROKE DISTURBANCES OF THE MOTION FUNCTIONS

S. Kotov ¹, L. Kodzokova¹, E. Isakova¹, A. Kotov¹

¹ M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Department of Neurology, Moscow, Russian Federation

Background and aim: There are dangers associated with comorbidities and physical activity in stroke rehabilitation. The aim of the work was to evaluate the effectiveness of motor rehabilitation in elderly, elderly and senile patients with post-stroke hemiparesis.

Methods: 80 patients were treated, mean age 65.5 ± 9.8 years in the early recovery period of ischemic stroke. For three weeks, physical therapy, mechanotherapy, classes with a speech therapist and a neuropsychologist were carried out in the hospital. To assess the state, a six-point scale for assessing muscle strength, Ashworth's scale, Berg's scale, Hauser's scale, Rankin's scale, Bartel's index were used.

Results: An increase in muscle strength was observed in middle-aged and elderly patients; in persons of 75 years and older, only a tendency toward an increase in strength was noted. However, in patients 75 years of age and older, there was a decrease in spastic tone in the paretic limbs, and in those under 60 years of age, no. As a result, all patients showed improvements in balance, quality and walking speed. In patients 75 years and older, despite a slight increase in strength, there was an increase in the quality and speed of walking, which also led to an increase in the Bartel and Rankine index.

Conclusion: As a result of the treatment of patients with post-stroke hemiparesis, efficacy was noted in patients of middle, elderly and senile age. Positive changes included indicators of stability and gait, improvement in functional status.

Disclosure: No

P0255 / 1253

EVALUATION OF THE EFFECTIVENESS OF REHABILITATION IN THE RECOVERY PERIOD OF ISCHEMIC STROKE BASED ON CHANGES IN THE DEGREE OF MUSCLE SPASTICITY

V. Mishchenko ¹, K. Kharina¹, T. Mishchenko¹, H. Linska¹, V. Bokatuieva¹

¹ SI Institute of Neurology,Psychiatry and Narcology of NAMS of Ukraine, Department of Vascular pathology of the brain and neurorehabilitation, Kharkiv, Ukraine

Background and aims: Post-stroke muscle spasticity is manifested by increased muscle rigidity. Real-time shear wave elastography (SW) can be used to evaluate it by comparing the Young's modulus. This parameter is important for choosing rehabilitation tactics and evaluating its effectiveness. To assess the degree of changes in muscle spasticity before and after rehabilitation by comparing the stiffness of normal and spastic biceps in patients in the recovery period of ischemic stroke.

Methods: The stiffness of the biceps muscle was assessed by estimation the mean value of the Young's modulus before and after rehabilitation on the affected side and on the intact side using an ultrasonic scanner Soneus P7.

Results: We examined 27 patients aged 61.42 (52 - 68) years in the recovery period of ischemic stroke with spasticity in the upper extremity.

High stiffness of the biceps on the spastic side was found - the average value of the Young's modulus was 105.31 kPa; on the unaffected side, this figure was 32.18 kPa [Figure 1]. After rehabilitation muscle stiffness on the intact side, did not change (34.31 kPa), byt on the spastic side significantly decreased to 64.79 kP.

Conclusions: Analysis of changes in muscle spasticity based on the use of shear wave elastography is a reliable means of assessing the effectiveness of treatmentand rehabilitation; it can be used to quantify the effectiveness of rehabilitation in patients in the recovery period of ischemic stroke

Disclosure: No

P0256 / 1593

REHABILITATION SERVICE ACCESS WITHIN THE REGIONAL STROKE NETWORK OF LAZIO REGION - PRELIMINARY RESULTS

F.R. Pezzella ¹, S. Ribaldi², A. Polo², A. Urso²

¹San Camillo Forlanini Hospital, Neuroscience, Rome, Italy, ²Lazio Regional Governament, Health Department, Rome, Italy

Background and aims: Continuity of care, between the acute hospital phase and the various post-acute phases, is  critical to ensure the best recovery of the person with stroke sequaele. In October 2020 the Health Dept. of the Regional Government of Lazio approved a new Stroke Network Plan aiming at updating the previous care pathway, here we present a preliminary analysis of the first year of activity.

Methods: the stroke clinical pathway has augmented and empowered early rehabilitation services within acute stroke wards.  According to the plan patients should be sent to hospital rehabilitation departments when having complex impairments and disabilities with recovery potential, and if their clinical conditions and medical/surgical comorbidities are compatible with the patient's participation in rehabilitation programs. Transition to local treatment services is indicated when no further modifications of the functional clinical picture are expected. A defined set of rehabilitation scales and scores has been identified to establish access to treatment thresholds together with social evaluation and patients/family preference.

Results: Patients’ discharge from Regional Health Services, with age at admission >= 18, with ICD-9-CM codes used for the definition of the stroke cohort researched in: pathology object of the rehabilitation intervention, main diagnosis and all secondary diagnoses (diase1-diase8):

YEAR	Stroke* discharges	Stroke* discharges from acute care wards	%
2017	3,876	3,236	83.5%
2018	3,468	2,944	84.9%
2019	3,357	2,806	83.6%
2020	2,862	2,487	86.9%

(*) Codes 431.XX, 430.XX and 432.XX (with the exclusion of traumas 800 to 904 and 910 to 959), 43301, 43311, 43321, 43331, 43381, 43391, 43401, 43411, 43491, 436.XX

Conclusions: Early rehabilitation of stroke patients, starting in the acute phase, is important to prevent secondary complications due to immobility, to improve the patient's outcomes and to restore the highest degree of personal autonomy, and, in our Region, has increased the percentage of patients discharged home and to outpatient rehabilitation services.

Disclosure: No

P0257 / 1312

THE EFFECT OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON UPPER LIMB FUNCTION: SECONDARY RESEARCH

L. Alabdulaali ^1,2, T.D. Punt³, N. Jenkinson³

¹University of Birmingham, Birmingham, United Kingdom, ²Imam Abdulrahman Bin Faisal University, Physical Therapy, Dammam, Saudi Arabia, ³University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom

Background and aims: Upper limb motor function is commonly impaired post-stroke resulting in disability and consequently deterioration in the quality of life. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation. It has shown promise as an intervention in recovering motor dysfunction post-stroke when applied in combination with motor rehabilitation. However, its utility needs further exploration. Therefore, we aimed to enhance the understanding of the effect of tDCS through testing our hypothesis that stimulating the primary motor cortex will facilitate improvement in fine hand movement more than gross hand and arm movement.

Methods: Study design: Secondary research using a quantitative data set ofAllman,Amadi, Winkler et al., 2016.

Study participants: 24 chronic stroke patients were suffering from upper limb hemiparesis randomised into two groups: anodal and sham. The anodal group included 11 participants who received anodal tDCS and motor training. The sham group included 13 participants who received sham tDCS and motor training.

Study procedures: Reanalyse the data of the outcome measures: Action Research Arm Test (ARAT), Fugl Meyer Test (FMT) and Wolf Motor Function Test (WMFT) after separating the outcome measure items into those that preferentially measured hand and arm function.

Results: We observed improvement in performing both hand and arm tests in both groups. The hand test performance of the anodal group showed the greatest improvement.

Conclusion: The tDCS seems to have a superior effect in improving fine hand movement more than gross hand and arm movement. However, these findings need more exploration.

Disclosure: No

P0258 / 1406

UNDERSTANDING THE LANDSCAPE OF PHYSICAL ACTIVITY AND EXERCISE IN STROKE REHABILITATION FOR OLDER ADULTS: A SCOPING REVIEW

G. Clay ¹, A.B. Evans², J. Allen-Collinson¹, H. Henderson¹

¹University of Lincoln, School of Sport and Exercise Science, Lincoln, United Kingdom, ²University of Copenhagen, Department of Nutrition, Exercise and Sports, Copenhagen, Denmark

Background and aims: Older adults are at higher risk of stroke and are more likely to be insufficiently active. Despite demonstrated benefits of physical activity post-stroke, there is limited evidence of consistent support offered specifically for older adults. It is therefore timely and important to consider the policy and practice domains of physical activity within community stroke rehabilitation.

Methods: A scoping review was conducted. A total of 8 electronic databases, appropriate international stroke policy guidance documents and websites were searched. Initially, authors reviewed 25 titles, abstracts and policy aims independently to assesses appropriateness to the inclusion criteria and research questions.

Results: After removing duplicates, a total of 800 research articles were screened, as well as relevant international policy documents and clinical guidance. Preliminary findings indicate that stroke policy and guidance is becoming more activity-inclusive, however recommendations for being active are often made within the context of generalised guidelines and focus predominantly on structured activity via rehabilitation in acute settings. Within the research, many RCTs demonstrate great potential for post-stroke exercise-based programmes in adults/older adults, yet there is limited evidence of integration of such interventions in everyday community rehabilitation practice.

Conclusions: A comprehensive map of policy, research and practice is being created to demonstrate the current landscape of the integration of physical activity and exercise for older adult stroke survivors. There appears to be some contestation, however, between recommendations in stroke policy and guidance, and further insight into the impact of this, on both services and stroke survivors, is urgently required.

Disclosure: No

P0259 / 1216

HEADS: UP MIXED METHODS DEVELOPMENT STUDY: WORKING WITH STAKEHOLDERS TO ADAPT A MINDFULNESS BASED STRESS REDUCTION COURSE FOR STROKE SURVIVORS WITH MOOD DISORDER

M. Lawrence ¹, B. Davis¹, L. De Amicis¹

¹ Glasgow Caledonian University, Nursing and Community Health, Glasgow, United Kingdom

Background: Anxiety and depression are common post-stroke, but people do not always have skills to cope with symptoms. Mindfulness Based Stress Reduction (MBSR) is an 8-week course that teaches people skills like meditation and mindfulness breathing to help them self-manage symptoms of mood disorder. Mastery of MBSR skills corelates with positive outcomes. However, although many people find MBSR helpful, systematic review evidence indicates stroke-related impairments impact capacity to follow a course/commit to practice.

Aim: to co-create a stroke-specific adaptation of an MBSR course for people with post-stroke anxiety and/or depression.

Methods: Stroke survivors (SS) and family members (FMs) participated in iterative MBSR taster sessions and focus groups. Theoretically-informed course adaptations incorporating behaviour change techniques (BCTs) were discussed with a panel of experts (clinicians; SS; stroke charity representatives), implemented and tested in subsequent taster sessions. A modelling matrix based on the Template for Intervention Description and Replication aided evidence-based data-driven decision-making.

Results: The community-dwelling participants: SS n=23 (76.7%); FMs n=7 (23.3%). SS were female (14, 60.9%), aged 61 years (median, IQR 56.5-69.5), educated to college level/above (17, 73.9%), 46 months post-stroke (median, IQR 12.5-127 months). SS self-reported mood disorder was high: ‘anxiety’ n=17 (73.9%); ‘depression’ n=13 (56.5%). This was not supported by results from standardised measures. FM data was similarly patterned. Adaptions identified from focus group data were categorised as: stroke-specific, generic, BCTs. A bespoke complementary Train the Trainer package was developed concurrently.

Conclusions: We co-created HEADS: UP, a 9-week MBSR course incorporating BCTs for testing in subsequent feasibility pilot work.

Disclosure: No

P0260 / 592

TIME TO MOVE ON: WE NEED TO BROADEN OUR APPROACH TO STROKE REHABILITATION

K. McPherson¹, M. Harwood², V. Fu³, J. Gommans⁴, H. Mcnaughton ³

¹AUT University, Rehabilitation, Auckland, New Zealand, ²University of Auckland, Medicine and Health Sciences, Auckland, New Zealand, ³Medical Research Institute of New Zealand, Stroke/Rehabilitation research, Wellington, New Zealand, ⁴Hawkes Bay DHB, Medicine, Hastings, New Zealand

Background and aims: The dominant stroke rehabilitation approach in current clinical practice relies heavily on so-called ‘SMART’ (Specific/Measurable/Achievable/Realistic/Timed) goal-setting, repetitive exercises and amelioration of environmental barriers. Evidence from recent large randomised controlled trials (RCTs) does not support this narrow ‘biological’ approach.

Methods: Following a review of large RCTs in stroke rehabilitation we developed a series of evidence statements of stroke rehabilitation effectiveness and aligned these with current guidelines. We then explored the cognitive dissonance that exists where current rehabilitation guidelines and practice are not supported by adequate evidence or where evidence for ineffectiveness exists. We used established theoretical principles, primarily the Biopsychosocial model of health and the World Health Organisation International Classification of Functioning, plus our evidence statements, to formulate a broader approach to stroke rehabilitation that would be more likely to be associated with improved outcomes.

Results: Our model recognises intrinsic motivation and social connectedness as necessary conditions for successful rehabilitation. Task-oriented repetitive practice as determined by the person with stroke is more likely to be helpful when these necessary conditions are met.  This fully person-centred approach requires a change in focus from clinicians, acknowledging that the person with stroke and not the professionals working with them should be in the ‘driving seat’ of their rehabilitation plan.  The main barrier to implementation is the need to acknowledge that change is required.

Conclusions: Evidence from large RCTs and rehabilitation theory require a broadening of current rehabilitation practice and guidelines with more emphasis on motivational and social factors.

Disclosure: No

P0261 / 539

SUPPORTED SELF-MANAGEMENT: WHAT MAKES IT WORK IN COMMUNITY STROKE REHABILITATION? A REALIST EVALUATION (THE IMPETUS STUDY)

L. Kidd ¹, J. Duncan Millar², H. Mason³, T. Quinn², K. Gallacher⁴, F. Jones⁵, R. Fisher⁶, T. Lebedis⁷, M. Barber⁸, K. Brennan⁹, M. Smith¹⁰

¹University of Glasgow, School of Medicine, Dentistry & Nursing, Glasgow, United Kingdom, ²University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom, ³Glasgow Caledonian University, Yunis Centre for Social Business and Health, Glasgow, United Kingdom, ⁴University of Glasgow, Institute of Health and Wellbeing, General Practice and Primary Care, Glasgow, United Kingdom, ⁵St Georges University of London/Kingston University, Centre for Health and Social Care Research, London, United Kingdom, ⁶University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom, ⁷NHS Grampian/Scottish Government Stroke Improvement Programme, Woodend Hospital, Aberdeen, United Kingdom, ⁸NHS Lanarkshire/Scottish Government Stroke Improvement Programme, University Hospital Monklands, Airdrie, United Kingdom, ⁹NHS Lanarkshire/Scottish Government Stroke Improvement Programme, Coatbridge, United Kingdom, ¹⁰NHS Lothian/Scottish Government Stroke Improvement Programme, Edinburgh, United Kingdom

Background and aims: Supported self-management is a core component of long-term stroke rehabilitation and recovery yet it is a poorly understood concept and its provision in community stroke care is inconsistent.

Methods: This study was a realist evaluation to understand how, why and for whom supported self-management works in community stroke rehabilitation, comprising multiple workpackages (WP). We conducted a realist review and Q-methodology study (WP1) to develop initial theories about how supported self-management in stroke works (identifying relevant contexts, mechanisms and outcomes). We tested theories for relevance and meaningfulness through qualitative interviews and focus groups with stroke survivors, community-based practitioners and team managers (n=48) from four Scottish healthboards (WP2).

Results: We identified relationships between contexts, mechanisms and outcomes for ‘good’ supported self-management in practice.  Compassionate and relational leaders, repeated opportunities for training, and a network of peer support help to reinforce a message that supported self-management is valued and supported within organisations and teams. Meaningful conversations between stroke survivors and practitioners help to build trusting and supportive relationships, provide time and space to listen to and get to know stroke survivors in their social context, and offer an opportunity to discuss expectations for self-management and how support can be tailored towards people’s priorities.

Conclusion: The findings from this study have deepened our understanding of the contexts and mechanisms that contribute to the successful implementation of supported self-management in practice and identify what is needed to make it work well in community stroke care for stroke survivors and practitioners.

Disclosure: No

P0262 / 1454

PHYSIOTHERAPISTS’ (PT) AND PT ASSISTANTS’ (PTA) AWARENESS AND USE OF STROKE REHABILITATION INTERVENTIONS IN CLINICAL PRACTICE

A. McIntyre ¹, M. Saikaley¹, S. Janzen¹, P. Cao¹, M. Longvaal¹, R. Teasell^1,2,3, R. Viana^1,2,3

¹Parkwood Institute, London, Canada, ²St. Josephs Health Care London, London, Canada, ³University of Western Ontario, London, Canada

Background and aims: This study examined physiotherapists’ (PT) and PT assistants’ (PTA) awareness and use of stroke rehabilitation interventions, as well as the factors associated with intervention use and non-use in real world clinical practice.

Methods: Participants were recruited from medical centres providing stroke rehabilitation to patients in each of the ten provinces across Canada. PT/PTAs meeting the following inclusion criteria completed a bilingual survey: 1) provide direct rehabilitative care to individuals after a stroke; 2) 18+ years old; and 3) read and write in English or French. The survey asked questions about therapists’ work setting, patient demographic, how they stay up-to-date, and their awareness and use of PT stroke rehabilitation interventions. Surveys were completed January-July 2021.

Results: 175 PT/PTAs (female=82.9%), mainly from Ontario and Alberta (57.7%) were included; most worked full-time (76.6%) in moderate-large (84.0%) cities. PT/PTAs were highly aware of interventions applied to patients at the peripheral level; they were also used the most frequently (e.g., task-specific training, overground walking); these conventional therapies had low/no technological component. With the exception of mirror therapy and bilateral arm training, PT/PTAs had low/no awareness or use of brain primers/stimulators with or without a technological component.

Conclusions: Interventions outside of standard PT/PTA education have low awareness and use. Low application of adjunct therapies primarily related to lack of cost, time, and access, or the perception it was outside of therapists’ scope of practice. Strategies are required to increase therapist knowledge, promote use of interventions with strong evidence, and address access barriers.

Disclosure: No

P0263 / 940

GAIT SPEED RECOVERY IN PATIENTS WITH ISCHEMIC STROKE IN ANTERIOR CIRCULATION

B. Kolarova¹, D. Sanak ², P. Kolar¹, H. Haltmar¹

¹University Hospital Olomouc, Department of Rehabilitation, Olomouc, Czech Republic, ²University Hospital Olomouc, Comprehensive Stroke Center, Dept. of Neurology, Olomouc, Czech Republic

Background and aims: Majority of ischemic stroke (IS) patients have some walking disability, which limits their independence in everyday activities. Rehabilitation to restore gait in stroke patients Gait speed (GS) has been identified as a determinant of gait independency. We aimed to assess a change of GS after intensive rehabilitation (RHB) in the first ever IS patients.

Methods: Consecutive middle cerebral artery (MCA) IS patients enrolled in the prospective GAITFAST trial (NCT04824482) were included in the pilot analysis. Walking disability was classified according to Functional Ambulatory Category (FAC), GS was assessed using 10 meters-walking test (10MWT) and neurological deficit using NIHSS. GS, NIHSS and FAC were assessed at the beginning and at the end of intensive two-week inpatient RHB, which consisted of individual physical therapy, occupational therapy and 10-day treadmill gait training for up to 150 minutes.

Results: Thirty-one IS patients (15 males, mean age 64 ± 11 years) with median of NIHSS 4 (2-6) and FAC score 4 (2-4) were analyzed. RHB started 11 ± 4 days after IS onset. Mean GS increased after RHB from 0.89 ± 0.34 m/s to 1.13 ± 0.39 m/s (p<0.001) and median of FAC score improved from 4 (2–4) to 5 (4–5) (p<0.001). Median NIHSS decreased to 1 (0-3) (p<0.001).

Conclusions: This pilot analysis showed, that GS and gait dependency improved significantly in MCA IS patients after intensive 2-week RHB including treadmill training. Further larger analysis confirming this promising preliminary data is needed.  Acknowledgement: The study supported by Ministry of Health, Czech Republic (FNOl, 0098892).

Disclosure: No

P0264 / 1462

AN ASSESSMENT OF SPEECH LANGUAGE PATHOLOGISTS (SLP) AWARENESS AND USE OF STROKE REHABILITATION INTERVENTIONS IN CLINICAL PRACTICE

A. McIntyre ¹, S. Janzen¹, A. Harnett¹, M. Saikaley¹, M. Longval¹, R. Viana^1,2,3, R. Teasell^1,2,3

¹Parkwood Institute, London, Canada, ²St. Josephs Health Care London, London, Canada, ³University of Western Ontario, London, Canada

Background and aims: To examine speech language pathologists’ (SLPs) awareness and use of stroke rehabilitation interventions, as well as the factors associated with intervention use and non-use in real world clinical practice.

Methods: Participants were recruited from medical centres providing stroke rehabilitation to stroke patients in each of the ten provinces across Canada. SLPs meeting the following inclusion criteria completed a bilingual survey: 1) provide direct stroke rehabilitative care to individuals after a stroke; 2) 18+ years old; and 3) read and write in English or French. The survey asked questions about therapists’ work setting, patient demographic, and how they stay up-to-date. Therapists were also asked about their awareness and use of SLP stroke rehabilitation interventions. Surveys were completed January-July 2021.

Results: 61 SLPs (female=90.2%) were included; most were from Ontario or Newfoundland (50.8%) and worked full-time (70.5%) for more than ten years (63.9%). With the exception of dietary modification, SLPs had very limited awareness and use of most adjunct therapies to address swallowing dysfunction. Regarding cognition and communication, SLPs were moderately-highly aware of most interventions; however, use was dependent on whether it contained a technological component. With the exception of thermal stimulation, priming or stimulating therapies were unused among SLPs.

Conclusions: Few SLP rehabilitation interventions studied in the scientific literature which are meant to remediate swallowing, cognition, and communication post stroke have a role in current clinical practice. Strategies are needed to improve SLPs’ knowledge of these interventions and address barriers including cost, time, and access.

Disclosure: No

EPIDEMIOLOGY & RISK FACTORS

P0265 / 834

RESULTS OF RES-Q REGISTRY IN UKRAINE

T. Mishchenko ¹, N. Chemer², Y. Flomin³

¹V.N. Karazin KharkivNational University, Department of Neurology, Psychiatry, Narcology and Medical Psychology, Kharkiv, Ukraine, ²Kiev Regional Clinical Hospital, Kiev, Ukraine, ³Universal Clinic “Oberig”, Kiev, Ukraine

Background and aims: These studies are dedicated to REgistry of Stroke Care Quality (RES.Q) data as the quality-of-care indicators within the new model of medical services for patients with stroke in Ukraine.

Methods: Analysis of 15 annual stroke care quality markers from the RES.Q for last 5 years was performed.

Results: Information on 5,549 patients from 22 hospitals in Ukraine was included in the RES.Q register in 2020-2021. The average age of patients was 68.8 years. The prevalence of patients with ischemic stroke and transient ischemic attack increased (2.49% and 2.39%, respectively), intracerebral haemorrhage and subarachnoid haemorrhage decreased (4.00% and 0.88%, respectively) [Figure 1]. In 2021, 1.97% more patients were treated in stroke units than in 2020. Neuroimaging in 2021 was performed in 99.2% of patients. In 2021, the severity of stroke was estimated using the NIHSS in 98.8% of patients, which is 2.18% more than in 2020. The test for dysphagia was performed in 2021 by 99.01% of patients. In 2021, RP were performed in 11.73% of patients, and hemicraniectomy was performed in 0.27% of patients. In 2021, the prevalence of atrial fibrillation in patients with stroke decreased by 7.38% compared to 2020 and amounted to 34.53%. In 2021, 91.71% of patients received RC, which is 10.61% more than in 2020.

Conclusions: According to RES.Q data, the new model of medical services has improved the quality of medical care, including screening for dysphagia, stroke severity assessment, neuroimaging, RP and RC rates, compared to 2017-2019.

Disclosure: No

P0266 / 1465

NEUROVASCULAR DISEASE IN CHILDREN UNDER 18 YEARS OF AGE IN SPAIN: NATIONWIDE EPIDEMIOLOGICAL STUDY

L. Andrade Zumárraga ¹, L. Amaya Pascasio¹, C. Del Toro Perez¹, J.M. García Torrecilla¹, P. Martinez Sanchez¹

¹ Torrecardenas General Hospital, Almeria, Spain

Background and aims: Reported incidence rates of neurovascular disease (NVD) in children and young adults range widely. This study aims to estimate the in-hospital incidence and describe the main characteristics of NVD in patients under 18 years of age as well as the main comorbidities in Spain.

Methods: Observational study based on the Hospital Episode Database collected by the Spanish Health Service. Patients <18 years with any NVD as main diagnosis in the period 2016-2018 were included. A descriptive analysis was performed and in-hospital incidence was estimated based on the population registered in the National Statistics Institute.

Results: Overall, 362 patients included, median age 10 years, 52.2 % were female. Fifty percent were hospitalized for ischemic stroke (IS), 30.9% for intracranial hemorrhage and 8.6% for cerebral venous sinus thrombosis (VST). The estimated incidence for IS, hemorrhage and VST were 0.74, 0.47 and 0.12 per 100,000 inhabitants, respectively. Among IS patients, 2.5% had congenital heart disease, 2.7% moya moya syndrome, 1.7% thrombophilia and 5.3% presented with seizures.  Seventy percent of IS occurred in children under 14 years of age, who presented a higher rate of seizures (6.3% vs 1.8%, p N.S.) and lower rate of interatrial comunication (7.9% vs 18.2%, p0.04).

Conclusions: Among patients under 18 years of age, NVD was infrequent, presenting specific clinical characteristics. IS was the pathology with the highest incidence.

Disclosure: No

P0267 / 163

STROKE DEATH BURDEN IN COLOMBIA:1995-2020

C. Romero ¹

¹ Fundacion Cardioinfantil, Neurology, Bogota, Colombia

Background: Stroke is a main cause of adult death in Colombia, with an early stroke-case fatality rate of 30%. 67-80% being ischemic strokes, 6-20% intracerebral hemorrhages and 1-7% subarachnoid hemorrhages (SAH). Four interventions have decreased early stroke mortality: Intravenous Thrombolysis (IT) (1996), Decompressive Craniectomy DC (2006), Mechanical Thrombectomy MT (2010) and the creation of Stroke units (4 in Colombia). (1,2,3)

Aim: To describe stroke mortality epidemiology in Colombia from 1995-2020 and since the introduction of IT, DC, MT.

Methods: Stroke deaths and population data were extracted from the Administrative Deparment of National Statistics (DANE1995-2020)(4). Age (20-49 ,50-74 and >75 years) and gender ajusted mortality rates were calculated using  a direct method.

Results: With increased mortality, stroke became the second cause for adult deaths (1995-2019), mainly driven by the increase of mortality amongst the older age group (>75 years) (Figure 1). Global stroke death rates have remained stable, between 0,36 x 1000 inhabitants (2000) to 0,30 x 1000 inhabitants (2020). Age-adjusted stroke mortality rate has increased in men and decreased in women in the studied period. (Figure 2).

Conclusions: The introduction of intravenous thrombolysis (IT), mechanical thrombectomy (MT) and decompressive craniectomy (DC) for stroke patients in Colombia has not had an impact in stroke death rates. Gender gaps, limited access to interventions (IT, DC, MT), time windows, a ceiling effect and stroke unit  availability in Colombia could explain this phenomenon.Further studies on the Colombian population are needed to understand the epidemiology of stroke mortality.

Disclosure: No

P0268 / 1258

INFLUENCE OF METEOROLOGICAL FACTORS ON THE OCCURENCE OF INTRACEREBRAL HEMORRHAGE

B. Cășaru ¹, M.-V. Bîrsan², C. Ghiță¹, R. Radu³, E.O. Terecoasă¹, C. Tiu¹

¹University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, ²National Administration for Meteorology, Bucharest, Romania, ³University Emergency Hospital Bucharest, Interventional Radiology, Bucharest, Romania

Background and aims: The relationship between weather and hemorrhagic stroke (HS) has been studied extensively, having reported inconclusive results. Apart from the higher number of admissions due to the spontaneous intracerebral hemorrhage observed during the cold months, there has been scarce association found with daily meteorological factors.

Methods: We have conducted a retrospective observational analysis on all patients admitted in the Department of Neurology of the University Emergency Hospital Bucharest for hemorrhagic stroke between January 2018 and December 2020. All daily meteorological data, including mean, maximum, minimum temperature, atmospheric pressure, wind speed, precipitation amount and relative humidity were provided by the National Administration for Meteorology from a local measurement center.

Results: During the studied period, 700 patients with HS (372 men, 328 female) were admitted in our department. The median age was 69 years. Changes in mean temperatures and atmospheric pressure were calculated as the difference between the date of and the day before the onset of the HS. Spearman’s Rho coefficient did not show any correlation between the atmospheric pressure gradient and the number of daily admissions of intracerebral hemorrhage (rho=0.004, p=0.8, 95% CI 0.05-0.06). We also found no correlation between the mean temperature change and the daily number of HS (rho=0.018, p=0.5, 95% CI- 0.04 to 0.07).  

Conclusions: Our data did not show an influence of meteorological factors on the occurrence of intracerebral hemorrhage, however further multi-center studies are needed to establish which role does the weather play in the mechanism of this pathology.

Disclosure: No

P0269 / 1489

CHANGES IN STROKE CARE DURING THE FIRST WAVE OF COVID-19 PANDEMIC IN A HOSPITAL IN SWEDEN, A REGISTERED-BASED STUDY

M. Rydell ¹, A.-C. Laska¹, A.-S. Rudberg¹

¹ Karolinska Institute, Stockholm, Sweden

Background and aims: Clinicians and researchers have addressed concerns about the negative impact of COVID-19 outbreaks on the ability of health care systems to provide timely assessment and acute therapies to patients with stroke. The aims of this study are to describe stroke care during the first wave of the COVID-19 pandemic compared to the same period the year before at a large acute care hospital in Sweden.

Methods: In this cohort study data were collected from March 1^st to August 31^st in 2019 and 2020 on all patients diagnosed with stroke and TIA and registered at Danderyd Hospital in the national quality registry (Riksstroke). Data were completed with information from the medical record. Sweden had no lockdown during 2020. The number of patients with COVID-19 the same period 2020 treated at Danderyd Hospital were collected.

Results: In year 2019 there were 472 registered stroke patients at Danderyd Hospital, compared to 481 registered stroke patients the same period during 2020. The number of minor stroke and TIA during the period in 2019 compared to 2020 were 424 versus 410 respectively (-3.3%).

During the study period 2020 1428 patients with a COVID-19 diagnosis were treated.

There was an increased delay from onset to arrival to the ED and door-to needle time. The rate of admission to Stroke Unit care and the rate of thrombolysis was maintained.

Conclusions: There were no difference in the number of patients diagnosed with stroke and TIA during the first wave of the COVID-19 pandemic.

Disclosure: No

P0270 / 1077

EPIDEMIOLOGY OF STROKE AT ORAN UNIVERSITY HOSPITAL (ALGERIA)

M. Goulmane ¹

¹ Faculty of Medicine of Oran, Medecine, Oran, Algeria

Introduction: Ischemic Stroke is a medical emergency where optimal management is required in appropriate health facilities, which are almost non-existent in developing countries. Objective To assess the short-term prognostic factors of ischemic stroke in a hospital population in ALGERIA.

Methods: We carried out a descriptive retrospective study lasting 2 years from January 1, 2020 to December 31, 2021. In our study, all the files of patients hospitalized for a ischemic stroke confirmed by cerebral CT and having undergone an etiological assessment were included. The clinical, paraclinical and prognostic data were collected. The data was analyzed using SPSS software version 21.0. Any value of P < 0.05 was considered statistically significant.

Results: 1185 cases of stroke were hospitalized, among which 879 patients had cerebral ischemia (74.2%). The mean age of the patients was 66.32 ± 16,01 years, with a predominance of women (sex ratio F/M = 1.11). A non-medical mode of transport was used for 83% or 984 cases. The mean time to consultation was 9.4 ± 7 hours. The overall mortality was 14,9%.

The predictive factors of poor prognosis were:the age which multiplies the risk of death by 2,86 (HZa=2,86;(1,8-4,34),the number of co-morbid factors that multiply the risk of death by 2,25(HZa=2,25;(1,33-3,80)),

Conclusion: These results should be taken into account in the national stroke control plan. Better management of arterial hypertension and complications of decubitus, and the establishment of an emergency medical assistance service could significantly reduce morbidity and mortality.

Disclosure: No

P0271 / 207

COMMUNITY AWARENESS OF STROKE RISK FACTORS, WARNING SIGNS, AND THERAPEUTIC OPTIONS AMONG GENERAL POPULATION IN EASTERN BULGARIA: PILOT STUDY

M. Tsalta-Mladenov ^1,2, D. Rosenova^2,3, V. Atanasova⁴, D. Georgieva^1,2, K. Dokova⁴, K. Bliznakova⁵, S. Andonova^1,2

¹Medical University 'Prof. Paraskev Stoyanov', Department of Neurology and Neuroscience, Varna, Bulgaria, ²University Hospital 'St. Marina', Second Clinic of Neurology with ICU and Stroke Unit, Varna, Bulgaria, ³Medical University 'Prof. Paraskev Stoyanov', Department of Physiotherapy, Rehabilitation, Thalassotherapy and Occupational Diseases, Varna, Bulgaria, ⁴Medical University 'Prof. Paraskev Stoyanov', Department of Social Medicine and Health Care Organization, Varna, Bulgaria, ⁵Medical University 'Prof. Paraskev Stoyanov', Department of Medical Equipment, Electronic and Information Technologies in Healthcare, Varna, Bulgaria

Background and aims: Public awareness of stroke risk factors (RFs), symptoms, therapeutic options are important factors for a favorable outcome of acute stroke. This study aims to evaluate stroke awareness among Bulgarian population.

Methods: An online questionnaire was designed to assess public knowledge about risk factors, signs, appropriate behavior in case of stroke. It was distributed through email and social media during the World Stroke Day– 29^th October 2021.

Results: Out of 319 respondents, 94.7% had partial or detailed information about acute stroke. A quarter (26.1%) of the respondents were related to the field of healthcare through work or studies. Awareness that stroke is an emergency is high- 80.5% would call an ambulance, 6.6% would go directly to a hospital. The most commonly reported modifiable RFs were hypertension 89.0%), dyslipidemia(51.4%) diabetes mellitus(54.5%) stress(72.1%), and smoking(62.4%).

The most familiar stroke signs were facial asymmetry/weakness (87.4%), limb paralysis/weakness (86.8%), speech disorders (85.2%), and dizziness/vertigo (67.6%).

Half (56.3%) of the participants were informed for intravenous thrombolysis and (42.8%) were aware of the 4.5h therapeutic-window, while (44.3%) were informed about endovascular treatment and only (29.9%) were aware of the 6h therapeutic-window.

Conclusions: Satisfying levels of awareness for stroke signs and risk factors were established among the respondents in the study. The majority of the people would take prompt actions in a case of acute stroke, but there is a lack of awareness of the therapeutic options. A focused informational campaign on acute stroke treatment would be beneficial to facilitate decision-making in the acute stage.

Disclosure: No

P0272 / 1148

PREDICTORS OF POOR OUTCOME AFTER A FIRST EVER STROKE IN A POPULATION-BASED STUDY IN BRAZIL

C. Minelli ¹, M. Rodrigues Camilo¹, G.C. dos Reis¹, O.M. Pontes-Neto¹

¹ Ribeirão Preto Medical School, University of São Paulo, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto, Brazil

Background and aims: The purpose of this study was to identify the risk factors and clinical characteristics at admission associated with poor outcome after a first ever stroke (FES) in a population-based study in Matão, Brazil.

Methods: We have prospectively investigated the characteristics of 373 consecutively admitted subjects at admission of FES from MAPS study, a prospective, population-based stroke registry study conducted in the city of Matão, Brazil (NCT03391102). Poor outcome was defined as the modified Rankin scale (mRS) score of 3 to 6, assessed at 3-month and one year of follow-up. Association between the relevant risk factors to poor outcome were analyzed using logistic regression analysis.

Results: The independent risk factors at admission for poor prognosis at 3 months and one year were, respectively, each year of age (odds ratio [OR]: 1.04; 95% confidence interval [CI] 1.02-1.06 and OR: 1.04; 95% CI 1.01-1.06), female gender (OR: 2.10; 95% CI 1.20-3.65 and OR: 1.94; 95% CI 1.08-3.50), heart failure (OR: 12.03; 95% CI 1.07-135,43 and OR: 25.09; 95% CI 1.83-343.84), hemiplegia (OR: 4,39; 95% CI 1.74-11.11 and OR: 3.80; 95% CI 1.49-9.74), severe aphasia or mute (OR: 5.35; 95% CI 2.31-12.43 and OR: 6.91; 95% CI 2.96-16.09) and conjugated eyes deviation (OR: 13.04; 95% CI 3.91-43.52 and OR: 7.56 ; 95% CI 2.60-21.97).

Conclusions: Age, female gender, heart failure, hemiplegia, severe disorders of language and conjugate eye deviation at admission were independent risk factors associated with poor outcome of FES in a population-based study in Matão, Brazil.

Disclosure: No

P0273 / 695

RISK FOR RECURRENT ISCHEMIC STROKE IN SUBJECTS NEWLY DIAGNOSED WITH CANCER VARIES SIGNIFICANTLY ACCORDING TO PREVIOUS HISTORY OF STROKE

R. Lun ^1,2, J. Cerasuolo³, M. Carrier^4,5, P.L. Gross³, M.K. Kapral⁶, M. Shamy^1,5, R. Sutradhar⁷, D.M. Siegal^4,5

¹The Ottawa Hospital, Department of Medicine: Division of Neurology, Stroke Program, Ottawa, Canada, ²University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada, ³McMaster University, Hamilton, Canada, ⁴The Ottawa Hospital, Department of Medicine: Division of Hematology, Thrombosis Program, Ottawa, Canada, ⁵Ottawa Hospital Research Institute, Ottawa, Canada, ⁶University of Toronto, Department of Medicine, Toronto, Canada, ⁷University of Toronto, Dalla Lana School of Public Health, Toronto, Canada

Background and aims: We sought to examine the relationship between previous ischemic stroke and risk for future stroke in individuals newly diagnosed with cancer.

Methods: We conducted a population-based matched cohort study using a provincial administrative database. Individuals with a new diagnosis of cancer and history of ischemic stroke were matched (1:4) by age, sex, cancer stage/site, and year of diagnosis to cancer patients without prior stroke. The cohort was followed until stroke, death, or March 31, 2021. CIF curves were created for the incidence of stroke (primary outcome), with the date of cancer diagnosis as the index date. Sub-distribution adjusted hazard ratios (aHR) and 95%CI were calculated, with death treated as a competing event. Those with a history of stroke were further stratified by its temporal relation to the index date. Regression analyses were adjusted for baseline characteristics.

Results: We examined 65,525 individuals with cancer, including 13,105 with a history of stroke and 52,420 without. Individuals with a prior history of ischemic stroke had an increased risk for stroke after cancer diagnosis compared to those without prior stroke (aHR 2.68 95%CI [2.41-2.98]). The highest risk of stroke was seen among individuals who suffered a stroke <1 year before their cancer diagnosis (aHR 3.68, 95%CI 3.22-4.22).

Conclusion: Cancer patients with a history of ischemic stroke were more likely to suffer stroke after their cancer diagnosis, especially if the previous stroke occurred within the year preceding cancer diagnosis. This has important implications for prevention strategies in a highly susceptible population.

Disclosure: No

P0274 / 131

STROKE UNIT TREATMENT AND RISK FACTOR CONTROL REDUCE RECURRENT STROKE RISK

S. Shani ¹, R.P. Varma², P.S. Sarma³, R. Sreelakshmi⁴, P. Harikrishnan¹, P. Sylaja⁵, V.R. Kutty⁶

¹SCTIMST, Neurology, Trivandrum, India, ²AMCHSS, SCTIMST, Epidemiology, Trivandrum, India, ³AMCHSS, SCTIMST, Statistics, Trivandrum, India, ⁴SCTIMST, Social Work, Trivandrum, India, ⁵SCTIMST, Neurolgy, Trivandrum, India, ⁶Amala Institute of Health Sciences, Research, Trissur, India

Introduction: The risk factor control is an important predictor of risk of stroke recurrence. The attributable fraction which estimates the excess risk among the exposed stroke survivors has not been studied previously. We studied the attributable fraction for stroke recurrence in consecutive incident cases of recurrent stroke.

Methods: A case control study with incident cases of recurrent stroke and controls matched for age and post stroke period was done. Structured interview was done to collect data on sociodemographic variables, lifestyle and medication adherence. The risk factors, treatment of index stroke and outcome were collected. Logistic regression analysis was done to find out the factors associated with stroke recurrence. Attributable fraction and average attributable fraction were calculated.

Results: Among the 103 matched pairs, more than 70% were rural residents. Male gender (OR 2.59; 95% CI 1.05-6.42), presence of depression (OR 8.67 95% CI 2.80- 26.84), memory problem (OR 10.12 95% CI 2.48- 41.34), uncontrolled diabetes (OR 3.19 95% CI 1.42- 7.19), cardioembolic stroke (OR 4.45 95% CI 1.12- 17.62) and index stroke not being treated in stroke unit (OR 6.60 95% CI 2.86- 15.23) were associated with increased risk of stroke recurrence.  The maximum average attributable fraction for stroke recurrence risk was attributed to index stroke not being treated in stroke unit and uncontrolled diabetes.

Conclusion: The index stroke treated in a comprehensive stroke care unit and risk factor control can reduce recurrent stroke risk among stroke survivors. This population attributable risk is important in planning secondary stroke prevention strategies.

Disclosure: No

P0275 / 1451

ANALYSIS OF CAUSES AND CLINICAL REPERCUSSION IN SMOKERS AFTER MECHANICAL THROMBECTOMY (MT) IN PACIENTS WITH ACUTE ISCHEMIC STROKE (AIS)

C. Hernández Javier ¹, M.J. Hernández García², D.A. Padilla León², G.R. González Toledo², M. Crespo Rodríguez², M. Lobato González², A. Bartolomé Yumar³, F. Carrillo Padilla²

¹Hospital Universitario de Canarias, Neurology, San Cristóbal de la Laguna, Spain, ²Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain, ³Hospital Universitario de Canarias, San Cristóbal de la Laguna, Spain

Background and aims: Smoking is a known risk factor for AIS. Although interaction between smoking and thrombolysis in AIS has been described, we need more studies about tobacco and MT.

We propose to investigate tobacco influence in patients with AIS treated with MT.

Methods: We retrospectively reviewed all the AIS patients with indication of MT that were evaluated in our hospital in 3 years.

We classified patients in three groups: smokers (S), non-smokers (NS) and previous-smokers (PS) and we analyzed aetiology of the stroke, treatment effectivity (NIHSS at discharge), presence of Intracranial Hemorrhage (ICH) and functional prognosis at discharge.

Results: 96/100 patients were treated with MT (S 22%, PS 18% and NS 60%). The mean age was 68 years, 54% male. Most common etiology was cryptogenic in S (36.3%) and cardioembolism in NS (46.6%) and PS (61%). A close statistically significant relationship between smoking and carotid dissection was found.

While we didn’t find differences in clinical severity (NIHSS at admission) or the risk of ICH after treatment, we found that clinical improvement was higher in NS (7.4 points NIHSS).

At discharge, 54.1% showed functional independence (mRS 0-2), with a better functional prognosis in NS patients with a higher rate of patients with mRS 0-1 (minimal symptoms).

Conclusions: Although we are limited by the size of our sample, we found favorable results regarding functional recovery in NS patients.  In relation with their aetiology, a close statistical relationship between smoking and carotid dissection was found. No other significant differences were found.

Disclosure: No

P0276 / 600

CLINICAL PHENOTYPE OF PATIENTS WITH DISTURBED GLUCOSE METABOLISM AFTER ISCHEMIC STROKE OR TIA

J. Kobben ¹, J. Koffijberg², S. Fonville³, P. Koudstaal⁴, W. de Herder¹, H. den Hertog², A. Zandbergen¹

¹Erasmus MC, Internal Medicine, Rotterdam, Netherlands, ²Isala Hospital, Neurology, Zwolle, Netherlands, ³Spaarne Gasthuis, Neurology, Haarlem, Netherlands, ⁴Erasmus MC, Neurology, Rotterdam, Netherlands

Background and aims: We studied the clinical phenotype of patients with ischemic stroke or transient ischemic attack (TIA) and disturbed glucose metabolism, either diabetes or prediabetes, as detected by fasting plasma glucose, oral glucose tolerance test (OGTT) and glycosylated hemoglobin (HbA1c).

Methods: We derived 1,532 patients from the Erasmus Stroke Study, a single-center prospective registry, who were included between 2005 and 2012 with ischemic stroke or TIA and had undergone acute phase glucose measurements.

Results: Nine hundred and twenty five of 1301 patients (71%) had newly disturbed glucose metabolism. The prevalence of disturbed glucose metabolism in the 1301 patients without known diabetes mellitus was 471/1278 (36.9%), 668/1196 (55.9%) and 500/1083 (46.2%) when tested with FPG, OGTT and HbA1c, respectively. 267/297 (90%) patients in the diabetic range were detected by OGTT. Patients with three elevated glucose tests compared with one isolated elevated glucose test more frequently had additional vascular risk factors. Elevated glucose levels detected by OGTT only was more common among women (56.7%), while disturbed glucose metabolism detected by FPG or HbA1c was more common among men (66.2% and 63.5%).

Conclusions: Disturbed glucose metabolism is highly prevalent in patients after ischemic stroke or TIA, especially when multiple vascular risk factors are present. There is limited concordance between the three diagnostic glucose tests, which highlights the importance of using multiple tests. Distinct phenotypes are related to glucose testing with disturbed OGTT being more prevalent in women, and abnormal FPG and HbA1c more common in men.

Disclosure: No

P0277 / 606

HIGH-DENSITY LIPOPROTEIN CHOLESTEROL PREDICTS ADVERSE OUTCOMES IN ACUTE ISCHEMIC STROKE WITH DIABETES MELLITUS

G. Hu ¹, Y. Pan², M. Wang², X. Meng², Y. Jiang², Z. Li², H. Li², Y. Wang¹, Y. Wang¹

¹Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ²China National Clinical Research Center for Neurological Diseases, Beijing, China

Background and aims: Experimental studies have found that the functionality of high-density lipoprotein cholesterol (HDL-C) may be reduced in the presence of diabetes mellitus. Results on the relationship between HDL-C and adverse outcomes in diabetic status remain controversial in previous observational studies. We aimed to assess the relationship between HDL-C and adverse outcomes among acute ischemic stroke (AIS) patients with diabetes mellitus.

Methods: Data were obtained from the Third China National Stroke Registry. Low HDL-C was defined as serum HDL-C < 1.0 mmol/L (40 mg/dL). Outcomes investigated in this study included recurrent stroke and composite endpoint within 1 year. Composite endpoint comprised cardiovascular death, non-fatal stroke, and non-fatal myocardial infarction. Multivariable Cox regression was used to evaluate the association of HDL-C with recurrent stroke and composite endpoint at 6 months and 1 year.

Results: A total of 3,824 AIS patients with diabetes mellitus were enrolled. Compared with patients with normal HDL-C (⩾1 mmol/L), the adjusted hazard ratio (95% confidence intervals) of the low HDL-C (<1 mmol/L) was 1.40 (1.07–1.82) for recurrent stroke at 6 months, and 1.47 (1.16–1.87) for recurrent stroke at 1 year, and 1.45 (1.12–1.88) for composite endpoint at 6 months, and 1.47 (1.17–1.86) for composite endpoint at 1 year. There were linear associations between HDL-C and the risks of both recurrent stroke and composite endpoint.

Conclusions: Low HDL-C was associated with increased risks of recurrent stroke and composite endpoint within 1 year in AIS patients with diabetes mellitus.

Disclosure: No

P0278 / 902

THE LEISTAR EYE STUDY: CAROTID DISEASE IN PATIENTS WITH RETINAL ISCHAEMIC EVENTS PRESENTING TO THE UNIVERSITY HOSPITALS OF LEICESTER TIA CLINIC

A.K Mistri ¹, J.S Minhas², L.C Beishon³, B. Coles³, D.J Eveson⁴, L.S Manning⁴

¹University Hospitals of Leicester NHS Trust, Stroke Medicine, Leicester, United Kingdom, ²University of Leicester, Cardiovascular Sciences, Leicester, United Kingdom, ³University of Leicester, Leicester, United Kingdom, ⁴University Hospitals of Leicester, Stroke Medicine, Leicester, United Kingdom

Background and aims: Retinal ischaemic events, including transient monocular blindness (TMB) and retinal artery occlusion (RAO) are commonly considered to be secondary to carotid artery disease.  We explored the association of carotid disease with mortality, ethnicity and symptom duration.

Methods: We analysed the Leicester Stroke and TIA Research (LeiSTAR) dataset of prospectively collected data on all patients diagnosed with ischaemic retinal events, at the University Hospitals of Leicester TIA clinic, from 28^th Sept 2012 to 13^th January 2021. Ethnicity, symptom duration, mortality rates (deaths per 1,000 patient Years: PTPY), and survival following retinal ischaemic events was explored.

Results: 678 (9.5%) of 7131 attendees were diagnosed with TMB/RAO, including:  285 women (42%); median age 72 years (IQR 63-79), and predominantly White European (557,87%). Symptom duration was <10mins-41%, 10-59mins-19%, 1-24hours-9%, >24hours-30%. Pre-existing conditions included: hypertension (45%), hypercholesterolaemia (24%), diabetes (19%) and atrial fibrillation (4.7%).  Overall mortality was 119 PTPY over 2,633 years follow up (8 years longest follow-up).

Carotid Doppler was undertaken in 87% (590), 117 (19.2%) had ipsilateral carotid stenosis (CS, NASCET >50%). CS was associated with significantly reduced survival at end of follow up 58.9% (versus 74.2%), tended to be more frequent in White Europeans than South Asians (18.7% vs 13.9%, p=0.28), and symptom duration was similar between groups (p=0.66).

Conclusions: Following retinal ischaemic events, CS was associated with reduced survival, but not significantly associated with ethnicity or symptom duration. The association with subsequent management requires further study, and the current strategy of intensive medical and surgical intervention seems appropriate.

Disclosure: No

P0279 / 339

ANALYSIS OF THE POTENTIAL ROLE OF PATENT FORAMEN OVALE IN THE HIGH CEREBROVASCULAR RISK OF OBSTRUCTIVE SLEEP APNEA SYNDROME

L. Both¹, P. Daróczi¹, I. Palásti², Z. Szakács³, E.-N. Bartha³, G. Szilágyi^4,3, P.P. Böjti ^4,5,1

¹Semmelweis University, Department of Neurology, Budapest, Hungary, ²Medical Centre, Hungarian Defence Forces, Department of Cardiology, Budapest, Hungary, ³Medical Centre, Hungarian Defence Forces, Department of Neurology, Budapest, Hungary, ⁴Semmelweis University, János Szentágothai Doctoral School of Neurosciences, Budapest, Hungary, ⁵National Institute of Mental Health, Neurology and Neurosurgery, Department of Neurointervention, Budapest, Hungary

Background and aims: During an apnea, intracardiac pressure changes may open a normally functionally closed patent foramen ovale (PFO), thus creating a right-to-left shunt (RLS) that allows paradoxical embolization. Hence PFO may play a role in the high cerebrovascular risk of obstructive sleep apnea syndrome (OSAS). Previous case-control studies mainly reported higher PFO prevalence in patients with OSAS (27-72%). However, several methodological biases can be raised regarding case definitions and diagnosis of PFO. We sought to determine the prevalence of PFO in patients with OSAS compared to a control group, excluding the methodological biases.

Methods: We prospectively included patients who underwent polysomnography at the Medical Centre-Hungarian Defence Forces between 01/01/2019 and 31/03/2019. Patients were classified into OSAS and control group based on the apnea-hypopnea index. For PFO detection, patients were screened for RLS with a transcranial Doppler bubble test, followed by contrast-enhanced transesophageal echocardiography in case of positivity.

Results: 24 patients (5 female, 19 male) were included. Based on polysomnography, 16 patients (1 female, 15 male; mean age: 57±12 years) were diagnosed with OSAS (4 mild, 2 moderate, 10 severe), and 8 patients were classified into control group (4 female, 4 male; mean age: 57±7 years). Among OSAS patients, we found 2 patients with PFO (2/24, 12.5%), while in the control group, we could diagnose PFO in 1 case (1/4, 12.5%).

Conclusions: The prevalence of PFO was identical in the OSAS and control groups, which do not support the role of PFO in OSAS patients’ high stroke risk.

Disclosure: No

P0280 / 1096

INFLAMMATORY BIOMARKERS IN ACUTE ISCHEMIC STROKE PATIENTS WITH DEMENTIA

K. Abdurakhmonova ¹, G. Rakhimbaeva¹

¹ Tashkent Medical Academy, Tashkent, Uzbekistan

Background and aims: We carried out a study to find evidence supporting the thought, specifically asking whether the blood-brain-barrier (BBB) breakdown invariably associated with acute ischemic stroke(AIS) was associated with increased plasma levels of the classic inflammatory biomarkers interleukin-6 (IL-6) and C-reactive protein (CRP) in patients carrying a clinical diagnosis of dementia(D).

Methods: 56 patients with acute ischemic stroke were enrolled in the study. 11 of them were diagnosed acute ischemic stroke and progressive neurodegenerative dementia (AIS + D) and 45 had only AIS without dementia. Blood was taken within 24 h of stroke symptom onset, and serum levels IL-6 and CRP were measured, with levels of S100B protein.

Results:  IL-6 levels observed in the AIS + D group  (median 12.5 pg/mL with IQR 7.9) were higher than patients with acute stroke alone (median 3.1 pg/mL, IQR 3.4, on admission), and similarly, the CRP values observed in the AIS + D (median 20.1 mg/L with IQR 29.2) were higher than patients with only AIS. There was a trend towards higher serum S100B levels as well in the AIS + D group compared to the AIS group, but this difference did not reach statistical significance.

Conclusions: Patients with neurodegenerative dementia and acute ischemic stroke (AIS + D) had higher levels of serum IL-6 and CRP than patients with acute ischemic stroke alone (AIS). This study supports the possibility that opening of the blood-brain barrier may enhance the blood appearance of brain tissue markers of inflammation associated with neurodegenerative dementia.

Disclosure: No

P0281 / 353

A NOVEL TECHNOLOGY TO MEASURE MULTIPLE-PULSE WAVE VELOCITY FOR MEASUREMENT OF CEREBROVASCULAR STIFFNESS USING MRI

Y. Lee ¹, Y.-J. Kim¹, J.-Y. Jung², C.-K. Kang³

¹Gil Medical Center, Gachon University College of Medicine, Neurology, Incheon, Korea, Republic of, ²Gachon University Graduate School, Health Science, Incheon, Korea, Republic of, ³College of Health Science, Gachon University, Radiological Science, Incheon, Korea, Republic of

Background and aims: The existing pulse wave velocity (PWV) techniques using magnetic resonance imaging (MRI)  have various technical and clinical shortcomings for cerebrovascular PWV such as long scan time and complicated procedure. Therefore, this study aimed to propose a new PWV technique to determine cerebral vascular stiffness.

Methods: A new measuring method was developed by combining a simultaneous multi-slice (SMS) excitation pulse sequence, and keyhole acquisition and reconstruction (SMS-K). The feasibility of the developed method was evaluated using 3T MRI. A common and internal carotid artery vascular phantom and human experiment were conducted to evaluate the technical and procedural feasibility of the proposed SMS-K technique.

Results: A single vascular point was obtained in 48 msec and 500 points in the scan time of about 24 sec were acquired, which could generate 26 cardiac pulses (Figure 1A). Most importantly, there was no temporal difference during acquisition for the signals of two target arteries in SMS-K method even if the two target arteries were far apart from each other. Furthermore, we could obtain multi PWVs in the cerebral vessels with spline interpolated and 5-point averaged peak values (Figure 1B). And the mean transit time between the target vessels was 25.23±6.57 ms and the PWV was 2.38 m/s.

Conclusion: The SMS-K technique can provide multiple PWVs information with a simplified procedure within a short period of time (within 30 s). Therefore, the procedural convenience and technical advantages of PWV using the SMS-K will be helpful in clinical applications in the future.

Disclosure: No

P0282 / 524

ASSOCIATIONS FOR PROGRESSION OF CEREBRAL SMALL VESSEL BURDEN IN HEALTHY ADULTS: THE KASHIMA SCAN STUDY

T. Ide ¹, Y. Yakushiji², K. Suzuyama¹, A. Ogata³, M. Nishihara⁴, M. Eriguchi¹, A. Matsumoto⁵, H. Hara¹

¹Saga University, Faculty of Medicine, Division of Neurology, Department of Internal Medicine, Saga, Japan, ²Kansai Medical University, Department of Neurology, Hirakata, Japan, ³Saga University Faculty of Medicine, Department of Neurosurgery, Saga, Japan, ⁴Saga University Faculty of Medicine, Department of Radiology, Saga, Japan, ⁵Saga University Faculty of Medicine, Department of Social Medicine, Saga, Japan

Background and aims: We investigated the association between vascular risk factors and progression of cerebral small vessel burden measured on brain magnetic resonance imaging (MRI) in the healthy Japanese population.

Methods: The presence of small vessel disease (SVD) features including lacunes, cerebral microbleeds, white matter changes, and basal ganglia perivascular spaces on MRI, was summed to obtain a “total SVD score” (range 0-4). In this study, we included subjects who had follow-up MRI more than 1 year after the baseline MRI. The progression of SVD was defined as an increase of one or more points in the total SVD score at follow-up compared with baseline (i.e. the SVD worsening group). Multivariate logistic regression analyses were performed to investigate the association of the SVD worsening group with vascular risk factors.

Results: We included 674 neurologically healthy adults (mean age, 57.8 years; 49% male). 154 subjects (22.8%) were classified as the SVD worsening group. Multivariate logistic regression analyses showed that the SVD worsening group was associated with aging (per 10-years increase, odds ratio [OR] 1.88, 95% confidence internal [CI] 1.48-2.39); hypertension (OR 1.51, 95% CI 1.03-2.21); systolic blood pressure (per standard deviation [SD] increase, OR 1.26, 95%CI 1.04-1.53) and mean arterial pressure (per SD, OR 1.24, 95%CI1.02-1.51).

Conclusions: Aging and hypertension play a key role in the progression of cerebral small vessel burden in the healthy population.

Disclosure: No

P0283 / 1625

INCIDENCE OF TRANSIENT INSCHEMIC ATTACK (TIA): A NEW POPULATION-BASED COHORT AND META-ANALYSIS

R. Schneckenburger ¹, M. Watrin², G. Le Du², E. Touzé¹

¹Caen University Hospital, Neurology, Caen, France, ²INSERM, Caen, France

Background and aims: The incidence of  TIA and its temporal evolution remains poorly known. We report the incidence of TIA in the Caen Normandy Stroke Registry and a meta-analysis.

Methods: The Normandy Stroke study is a population study aiming at the exhaustive identification of strokes and TIAs through multiple overlapping sources in the Caen La Mer area. TIAs (WHO definition) occurring between May 2017 and May 2020 were included. Then we performed a systematic review of the literature between 1980 and 2020 to identify population-based studies using methods similar to the Caen registry and having reported the incidence of TIA. Finally, we performed a meta-analysis including the Caen data and a meta-regression analysis to try to explain the heterogeneity of incidence data.

Results: In the study period, 292 incident TIA cases were identified, representing a crude incidence of 36.4/100 000 person-years (95% CI: 32.4-40.8) and 38.5 after standardisation to the 2013 European population (95% CI: 38.5, 43.2). Twenty-four cohorts were included in the meta-analysis and the combined crude incidence was 31.1/100,000 person-years (95% CI: 23.8 - 40.7). There was considerable heterogeneity (i²: 98%). The methodological factors on which the meta-regressions were performed did not explain the heterogeneity, nor did the year of publication or the geographical area studied. However, the meta-regression on stroke rate over equivalent time periods and geographical areas was significant (p = 0.01).

Conclusions: The incidence rate of TIA is highly variable between studies. These variations in TIA incidence are associated with the overall epidemiology of stroke.

Disclosure: No

P0284 / 1189

ASSOCIATION OF HIGH LIPOPROTEIN(A) WITH STROKE IN A NATIONALLY REPRESENTATIVE CROSS-SECTIONAL GERMAN POPULATION – RESULTS FROM THE GERMAN NATIONAL HEALTH INTERVIEW AND EXAMINATION SURVEY 1998 (GNHIES98)

G.G. Gelfert ^1,2, U. Grittner^3,4, M. Endres^1,2,5,4,6, H. Neuhauser⁷, C. Scheidt-Nave⁷, M.A. Busch⁷, A.H. Nave^1,2,8,4

¹Charité - Universitätsmedizin Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany, ²Charité - Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany, ³Charité - Universitätsmedizin Berlin, Institut für Biometrie und Klinische Epidemiologie, Berlin, Germany, ⁴Berlin Institute of Health (BIH), Berlin, Germany, ⁵Charité - Universitätsmedizin Berlin, NeuroCure Clinical Research Center, Berlin, Germany, ⁶German Center for Neurodegenerative Disease, Partner Site Berlin, Berlin, Germany, ⁷Robert Koch Institute, Berlin, Germany, ⁸German Center for Cardiovascular Disease (DHZK), Berlin, Germany

Background and aims: Elevated Lipoprotein(a) [Lp(a)] is associated with an increased risk of cardiovascular events, in particular myocardial infarction and stroke. Evidence regarding venous thrombosis has been heterogonous. Representative epidemiological data for the German population are lacking.The aim of this study was to investigate the age and sex-dependent distribution of Lp(a) in a representative German cohort and its association with cardiovascular risk factors and events.

Methods: Cross-sectional data from the GNHIES98, a representative study of the German adult population’s health status, were analyzed (n=6657). Lp(a) levels were compared across demographics. Associations between Lp(a), as a continuous and dichotomous variable, and patient-reported history of nonfatal myocardial infarction (MI), stroke and venous thrombosis were tested using multiple logistic regression. Increased Lp(a) levels were defined at a cut-off of ⩾50 mg/dL.

Results: In the GNIEHS98 study population, median Lp(a) was 15.3 mg/dL (IQR: 5.6, 43.1) (n=6657) and 21.6% (n=1.434) had Lp(a) ⩾50 mg/dL. Men had a higher median Lp(a) than women (22.1 mg/dL [IQR: 20.7, 23.4] vs. 10.3 [(IQR: 9.5, 11.1], P <0.001). In multiple logistic regression analysis, Lp(a) (⩾50 mg/dL) was positively associated with the probability of stroke (1.76 [1.00-3.09], P=0.050), but not MI (0.90 [0.54-1.51], P=0.695). Lp(a) was not associated with venous thrombosis.

Conclusions: Lp(a) levels ⩾50 mg/dL were associated with stroke, but not myocardial infarction or venous thrombosis.Prospective data and updated health surveys are needed to gain Lp(a) estimations for the current German population.

Disclosure: No

P0285 / 1530

SHORT-TERM EFFECT OF AIR POLLUTION ON STROKE INCIDENCE

Ł. Kuźma¹, S. Roszkowska², M. Święczkowski ¹, E.J. Dąbrowski¹, A. Kurasz¹, W. Wańha³, H. Bachórzewska-Gajewska^1,4, S. Dobrzycki¹

¹Medical University of Bialystok, Department of Invasive Cardiology, Białystok, Poland, ²University of Lodz, Faculty of Economics and Sociology, Łódź, Poland, ³Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland, ⁴Medical University of Bialystok, Department of Clinical Medicine, Białystok, Poland

Background and aims: Ambient air pollution is a well-known risk factor for cardiovascular disease, but data on its impact on stroke incidence and mortality are limited. We aimed to investigate the association between short-term exposure to major air pollutants and incidences of stroke in north-eastern Poland.

Methods: Patients hospitalized for stroke in 2011-2020 were analyzed. Incidence data were obtained from the National Health Fund. Data on air pollution and weather conditions were obtained from the Provincial Inspectorate of Environmental Protection and the Institute of Meteorology and Water Management. We used time-series ordered logistic regression models with a distributed lag of up to 7 days.

Results: We analyzed 4838 patients, 45.6% of which were male, average age was 74.3 years old. Mean PM_2.5 concentrations were 19.09 µg/m³, PM₁₀ 26.66 µg/m³, CO 0.35 µg/m³. Increase in 10 µg/m³ of PM_2.5 and PM₁₀ was related with increase in stroke frequency on the day of the exposure (OR=1.075, 95% CI 0.999-1.157, p=0.053; OR=1.056, 95% CI 1.004-1.110, p=0.035) and the impact on the stroke occurrence even a few times higher (PM_2.5: OR=1.120, 95% CI 1.013-1.237, p=0.026; PM₁₀: OR=1.103, 95% CI 1.028-1.182, p=0.006). On the other hand, increase in 1ug/m³ of CO was related with lower stroke occurrence on LAG 2 (OR=0.976, 95% CI 0.953-0.998, p=0.037) and higher on LAG 3 (OR=1.026, 95% CI 1.004-1.049, p=0.022).

Conclusions: In the studied region besides PMs, the short-term influence of CO on stroke occurrence was observed. The effect was noted up to 3 days after exposure.

Disclosure: No

P0286 / 284

INCIDENCE AND MORTALITY RATES OF STROKES IN KAZAKHSTAN

G. Zhakhina ¹, B. Zhalmagambetov¹, A. Gusmanov¹, Y. Sakko¹, S. Yerdessov¹, E. Matmusaeva¹, A. Imanova², B. Crape¹, A. Sarria-Santamera¹, A. Gaipov¹

¹Nazarbayev University, Department of Medicine, Nur-Sultan, Kazakhstan, ²Multidisciplinary City Hospital #2, Department of Neurology, Nur-Sultan, Kazakhstan

Background and aims: There is a lack of information on epidemiology of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in developing countries. This research presents the incidence and mortality rate of stroke patients based on hospital admission and discharge status in Kazakhstan.

Methods: The registry data of 177,947 patients admitted to the hospital with the diagnosis of stroke between 2014 and 2019 were extracted from the Unified National Electronic Health System. We provide descriptive statistics of socio-demographic and medical characteristics. Survival analysis using Kaplan-Meier estimation and Cox regression is performed.

Results: Among all patients, who had at least one episode of stroke, 84,255 (47%) were females. Majority of patients had an acute ischemic stroke (n=138542, 78%), while the admission of intracerebral and subarachnoid hemorrhage patients was notably lower (34262 (19%) and 5143 (3%) respectively). The incidence and mortality rates based on admission and discharge status in 2014 were 1,905 and 240 per million population (PMP), respectively, which were different in 2019 (1,884 and 271 PMP, respectively). In 5 years of follow-up period, AIS patients had better outcome than SAH and ICH patients (64.7%, 63.1%, and 57.3% respectively) (Figure 1).

Conclusions: We describe for the first time in Kazakhstan an increase in the all-cause mortality rates based on discharge status of stroke patients, while the incidence rate decreased. We observed a statistically significant lower survival probability in ICH patients compared to ones who had an episode of AIS or SAH.

Figure 1.

Survival rates of stroke patients

Disclosure: No

P0287 / 936

LONG TERM USE OF ANTICOAGULATION IN CVT IN A TERTIARY HOSPITAL

L.C. Reyes-Sosa ¹, V.A. Carrasco-Wall¹, E.F. Gutiérrez-Guzmán¹, A. Vallejo-Calderón¹, M. Martínez-Marino¹

¹ Universidad Nacional Autonoma de Mexico / Instituto Mexicano del Seguro Social, Neurology Department, Hospital de Especialidades Centro Médico Nacional Siglo XXI IMSS, Mexico City, Mexico

Background and aims: Anticoagulation use on CVT is followed until 6 to 12 months according to guidelines. Longer periods of treatment are used in patients with high thrombotic risk. We describe the duration of treatment with OAC and what risk factors are related to longer treatment.

Methods: We conducted a retrospective single centre study in a tertiary hospital in México City. Electronic medical files of consecutive patients with CVT were reviewed from January 2018 to June 2020. Clinical, radiological and laboratory variables were obtained. Patients were allocated according to the time of use of OAC (less or more than a year).

Results: We collected data from 20 patients. 14 (70%) were female, with a mean age of 33.5 (26-50). 40% (n=8) were smokers, 20% (n=4) used hormonal contraceptives, 15% (n=3) were pregnant or in puerperium and 10% (n=2) referred vaccination for SARS-CoV-2. Superior sagittal sinus was the most frequently affected (65%). The median time of AOC treatment was 13 months (6.7-16.7). In the bivariate analysis, the existence of a chronic cause (OR 14; IC95%, 1.25 - 156; p= 0.028), and prolonged hospitalization (OR 15.7; IC95% 1.7 – 141.4 p= 0.22) were associated with AOC treatment over a year.  Initial NIHSS, mRS at discharge, D-dimer values, or seizures at presentation showed no correlation.

Conclusions: Use of OAC in a tertiary centre is related to chronic conditions with high thrombotic risk and with long hospital stay, according to the guideline’s recommendations.

Table 1.

Comparison of baseline features in the groups treated with OAC within and over 12 months.

Variable	< 12 months with OACn=11	> 12 months with OACn=9	p value
Sex Women, n (%)	9 (82)	5 (56)	0.33
Age, years, md (IQR)	36 (25-52)	29 (23-43.5)	0.49
Smoking, n (%)	2 (18)	6 (67)	0.065
Special risk factors, n (%)	7 (64)	2 (22)	0.092

OAC. Oral anticoagulation

Table 2.

Factors related to chronic use of OAC.

Variable	< 12 months with OACn=11	> 12 months with OACn=9	p value
NIHSS >5, n (%)	2 (22)	5 (45)	0.37
Chronic etiology, n (%)	1 (11)	7 (64)	0.028
Long stay >7d, n (%)	2 (22)	9 (82)	0.022
Disability at discharge (mRS ≥2), n (%)	4 (44)	7 (64)	0.65
Seizures, n (%)	5 (56)	7 (64)	1.0
D-dimer >1µg/ml, n (%)	4 (44)	8 (73)	0.36
Fibrinogen >350mg/d, n (%)	4 (44)	7 (64)	0.65

Chronic etiology: thrombophilia (n=4), malignancy (n=2), autoimmune disorders (n=2)

Disclosure: No

P0288 / 655

PREVALENCE OF LARGE VESSEL OCCLUSIONS IN AN UNSELECTED HOSPITAL-BASED STROKE COHORT

M. Roland ¹, I. Markaki^1,2, F. Arnberg¹, S. Klironomos¹, C. Sjöstrand¹

¹Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden, ²Academic Specialist Center, Center of Neurology, Stockholm, Sweden

Background and aims: Patients with large vessel occlusions (LVO) may be effectively treated with mechanical thrombectomy. LVO prevalence in stroke patients is hard to estimate due to the variety of inclusion criteria and selection bias. In this study we determine the LVO prevalence in an unselected hospital-based stroke cohort.

Methods: Unselected patients treated for stroke at Karolinska University Hospital Huddinge were consecutively collected in a database during the years 2008 through 2015. Patients were identified by the ischemic stroke ICD-10 diagnosis (I63). Patients with LVO were identified by retrieving radiology reports indicating LVO. Eventually 895 radiology reports were manually evaluated for the presence of LVO. LVO was defined as occlusion of any of the following arterial segments: internal carotid artery, the first two segments of middle cerebral artery (M1, M2), anterior cerebral artery (A1, A2), the vertebral arteries, the basilar artery and the first two segments of posterior cerebral artery (P1, P2).

Results: A total of 3152 consecutive ischemic stroke events and 356 LVO events were identified. This resulted in a 11.3% LVO prevalence. Seventy-six percent of occlusions were located in the anterior circulation and 24% in the posterior circulation. The most frequent occlusion location was the M1 segment (n=166, 39%).

Conclusions: In this study of consecutively collected ischemic stroke patients the prevalence of LVO was low which might be related to the unselected stroke cohort. These results add important information on the presence of LVOs in patients admitted and treated for stroke, stroke care planning and health economics.

Disclosure: No

P0289 / 531

COGNITIVE FUNCTION EARLY AFTER ISCHAEMIC STROKE AND TRANSIENT ISCHAEMIC ATTACK – AN ANALYSIS OF DATA FROM THE XILO-FIST TRIAL

W. Yan ^1,2, M. Robertson², N. Broomfield², K. Dani³, D.A. Dickie^2,3,4, A. Doney^5,6, K. Forbes³, G. Houston⁶, A. McConnachie², T. Quinn^2,7, A. Struthers⁵, M. Walters^2,3, P. Bath⁸, J. Dawson^2,3

¹The First Affiliated Hospital of Harbin Medical University, Harbin, China, ²University of Glasgow, Glasgow, United Kingdom, ³Queen Elizabeth University Hospital, Glasgow, United Kingdom, ⁴Analytics Cubed Ltd, Bishopton, United Kingdom, ⁵University of Dundee, Dundee, United Kingdom, ⁶Ninewells Hospital, Dundee, United Kingdom, ⁷Glasgow Royal Infirmary, Glasgow, United Kingdom, ⁸University of Nottingham, Nottingham, United Kingdom

Background and aims: Post-stroke cognitive impairment has been associated with both clinical and imaging variables but studies have often been limited by a lack of detailed phenotyping. We explored associations with cognitive function early after stroke using data from a randomised controlled clinical trial of 464 people with recent ischaemic stroke or TIA.

Methods: The XILO-FIST study enrolled people within recent ischaemic stroke or TIA and randomised them on a 1:1 basis to 2-years treatment with allopurinol 300mg twice daily or placebo. All participants underwent MRI brain imaging and cognitive assessment. We performed a cross-sectional analysis of baseline cognitive function (assessed using the MoCA score) and its relationship with other baseline measures. We performed simple linear regression, with separate models adjusting for

1) age, gender and education year, and

2) these factors plus stroke subtype and NIHSS score.

Results: A total of 376 participants completed cognitive assessment were included. The baseline MoCA score was 26.5 (SD 2.75). In unadjusted analysis, MoCA score was inversely associated with age, previous stroke, Fazeka score, Scheltens score, white matter hyperintensity volume and CSF volume. It was directly associated with alcohol consumption, haemoglobin level, and brain volume. In both adjustment models only previous stroke and CSF volume remained associated with MoCA score.

Conclusions: In this analysis of people with recent ischaemic stroke or TIA previous stroke and higher CSF volume were associated with lower MoCA score. These data raise the hypothesis that prevention of recurrent stroke may help maintain cognitive function in stroke survivors.

Disclosure: No

P0290 / 1345

LOGISTIC REGRESSION MODELS TO EXAMINE THE NON-PROPORTIONALITY OF STROKE RISK FACTORS BY AGE

E. Hunter ¹, J.D. Kelleher¹

¹ Technological University Dublin, Dublin, Ireland

Background and aims: Models to predict stroke risk typically assume that risk factors for stroke are proportional by age.  If risk factors are non-proportional by age this could lead to over or under-prediction of risk. We examine if evidence of non-proportionality by age exists in stroke risk factors.

Methods: We fit single variable logistic regression models for four different age groups (under 50, 50-59, 60-69, 70+) and four different variables (systolic blood pressure, diastolic blood pressure, total cholesterol, and BMI) using Framingham Heart Study data from the NHLBI to predict risk of stroke within a five-year window and examine model coefficients. If the contribution of a risk factor varies by age, we should see differences in the observed coefficients across the age models for that factor.

Results: Results show that the coefficients for systolic blood pressure decreases with age with the highest coefficient in the under 50s model and the lowest in the 70+ model.  The coefficients for diastolic blood pressure are stable between the under 50s and 50 to 59s, and then decreases for older age groups. The coefficients for total cholesterol decreases with age from 0.36 in the under 50s to 0.07. For BMI, the coefficients remain the same for the under 50s and 50 to 59s and drop in magnitude and then remain stable between the 60 to 69s and 70+.

Conclusions: The changes in the coefficients across age groups show that the contribution of each risk factor to an individual's risk may not be proportional across ages.

Disclosure: No

P0291 / 986

RISK FACTORS FOR BLEEDING IN THE PREVENTION OF STROKE IN PATIENTS WITH ATRIAL FIBRILLATION ON THE HAS-BLED SCALE DEPENDING ON THE PREVIOUS INFECTION WITH COVID-19

O. Stasyshena ¹

¹ National Scientific Center 'M. Strazhesko Institute of Cardiology' of the National Academy of Sciences of Ukraine, Department of Clinical Arrhythmology and Electrophysiology, Kyiv, Ukraine

Introduction: Bleeding is the main complication of anticoagulant therapy necessary for the prevention of cerebral strokes and other thromboembolisms in atrial fibrillation (AF). The aim: to assess the risk factors for bleeding on the HAS-BLED scale in patients (pts) with AF, depending on the previous COVID-19 infection.

Methods: 167 pts aged 62.5 + 0.09 years with AF. 118 pts had a history of an average of 6.2 + 0.5 months ago COVID-19 infection - the 1st group. 49 pts did not have a history of this infection - the 2nd group (control group). The HAS-BLED scale was used to assess the risk of bleeding.

Results: The pts of the 1st group compared with the pts of the 2nd group, had a higher average HAS-BLED score (1.53 + 0.03 compared to 1.07 + 0.04, p <0.001). The 2nd group there were fewer pts who had 0 and 1 points on this scale, which indicates a low risk of bleeding (56.8% and 71.4%, p <0.001) and more pat. Pts of the 1st group were also divided into two subgroups:

"A" - who had AF before COVID-19 (72 pts (61%), and "B" who did not have this arrhythmia before infection (46 pts (39 %). As a result, the fact was established that the pts of subgroup, "B" had higher values of the HAS-BLED scale compared to the subjects of group "A" (1.82 + 0.02 and 1.33 + 0.03, p <0.001).

Conclusion: Pts with AF who have had coronavirus infection have an increased risk of bleeding.

Disclosure: No

P0292 / 1557

THE CLINICAL AND PROGRESSIVE ASPECTS OF CEREBRAL VENOUS THROMBOSES AT THE ORAN HOSPITAL AND UNIVERSITY CENTER

M. Goulmane ¹

¹ Oran Faculty of Medicine, Medecine, Oran, Algeria

Background and aims: Cerebral venous thrombosis (CVT) is a rare but very serious disease with various clinical and etiological aspects. Unlike ischemic arterial accidents, epidemiological studies are limited. The aim of our work is to study the clinical, etiological and evolutionary features of TVC in the Algerian population from a sample of 28 patients.

Methods: This is a retrospective observational study conducted in the neurology department of the Oran hospital and university center between January 2020 and December 2021. In a clinical context suggestive of CVT, the diagnosis of certainty was provided by brain MRI coupled with MRA. . All subjects benefited from a complete etiological assessment. The anticoagulant treatment was based on the low molecular weight heparin relayed by the anti-vitamin K. The duration of the follow-up was 12 months.

Results: The mean age was 38.26 ± 13.59 years, the sex ratio was 6 (24F / 4H), the onset was subacute in 55% of cases. The main early signs were headache (88.8%), visual disturbances (50%), epileptic seizures (44.4%) and motor deficit (44.4%). Thrombosis predominated in the upper sagittal sinus and lateral sinuses; Parenchymal lesions were associated in 2/3 of the cases. Gynecologic obstetric causes were by far the most frequent. The evolution was favorable in 83,3% of the cases.

Conclusions: The characteristics of CVT in the Algerian population are distinguished by a high frequency of gynecological obstetric causes. Awareness campaigns for women of childbearing age are useful.

Disclosure: No

P0293 / 1561

HYPONATREMIA ADVERSELY AFFECTS MORTALITY IN PATIENTS WITH ACUTE STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

F. Barkas ^1,2, G. Liamis¹, M.S Kostapanos³, A.-D. Koutsogianni¹, D. Sagris⁴, G. Ntaios⁴, H. Milionis¹

¹University of Ioannina, School of Medicine, Department of Internal Medicine, Ioannina, Greece, ²University of Ioannina, School of Medicine, Department of of Hygiene and Epidemiology, Ioannina, Greece, ³Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Acute and General Internal Medicine, Cambridge, United Kingdom, ⁴University of Thessaly, School of Medicine, Department of Internal Medicine, Larisa, Greece

Background and aims: Hyponatremia is a relatively common electrolyte disorder which is associated with increased mortality both in hospitalized patients and the community. Although frequently noted in patients with acute stroke, it is still debatable whether it affects their prognosis. We assessed available data from observational studies investigating mortality risk associated with hyponatremia in patients with acute stroke.

Methods: The databases of MEDLINE, Scopus and EMBASE were searched until 18 December 2021 for retrospective or prospective studies examining the association between hyponatremia and mortality in patients with acute ischemic stroke or intracerebral hemorrhage. Three reviewers abstracted independently data and appraised risks of bias and a random-effects model was applied. Mortality in-hospital of after discharge was considered as the primary outcome of interest. Odds ratios (OR) and mean differences with 95% confidence intervals (95% CI) were calculated.

Results: Fifteen eligible cohorts (n=24,537) were included. The pooled analysis showed that hyponatremia doubled the risk of death in patients with any stroke (OR: 2.34, 95% CI: 1.81-3.02, p<0.001; I²=78%, p <0.001; Figure 1A). Sensitivity analyses showed that this was true for both ischemic stroke (OR: 2.50, 95% CI: 1.60-3.3.92, p<0.001; I²=69%, p <0.001; Figure 1B) and intracerebral hemorrhage (OR: 2.28, 95% CI: 1.30-4.00, p<0.05; I²=77%, p <0.001; Figure 1C).

Conclusions: Available evidence indicates that hyponatremia is associated with an increased mortality risk in patients with acute ischemic stroke or intracerebral hemorrhage and may serve as negative prognostic marker in these settings.

Figure 1.

Hyponatremia and stroke mortality

Disclosure: No

P0294 / 719

THE PECULIARITIES OF THE ASSOCIATION BETWEEN STROKE AND DIFFERENT TYPES OF CIRRHOSIS

A. Antonenko ¹, K. Antonenko², Z. Dubovenko¹

¹Bogomolets National Medical University, Department of Internal Medicine 3, Kyiv, Ukraine, ²Bogomolets National Medical University, Neurology Department, Kyiv, Ukraine

Background and aims: Liver cirrhosis is often associated with such complications as gastrointestinal bleeding and venous thromboembolism that can lead to the stroke. The aim of study was to assess stroke risk factors in patients withcirrhosis, to compare the peculiarities of different types of stroke in patients with alcohol-related and non-alcohol-related cirrhosis.

Methods: We performed a retrospective cohort study of 93 patients with cirrhosis: 58 patients – alcohol-related cirrhosis, 17 – due to viral hepatits, 4 – cryptogenic, 14 – due to nonalcoholic fatty liver disease. The incidence of stroke development was observed in 35 patients. Patient’s baseline characteristics were compared using the chi-squared test, unpaired t test.

Results: Patients with stroke were more frequently male, they were suffered from diabetes, atrial fibrillation, chronic kidney disease, COPD and coronary heart disease. Tobacco use and age were also among stroke risk factors (p<0.001). Valvular disease, peripheral vascular disease and hypertension were not associated with the development of stroke. The degree of association between intracerebral hemorrhage and liver cirrhosis was statistically higher in patients with alcohol-related liver cirrhosis, compared to non-alchohol-related cirrhosis: HR, 1.6; 95%CI, 1.5-3.7 (p<0.05). Ischemic stroke and subarachnoid hemorrhage were not statistically significant: HR, 1.1; 95% CI, 0.7-2.3 (p<0.05); HR, 1.4; 95% CI, 0.7-3.2 (p<0.05), accordingly. In patients with non-alcohol-related cirrhosis the significant difference of various types of strokes was not observed.

Conclusion: Cirrhosis is characterized by the imbalance of prothrombotic and prohemorrhagic derangements. The risk of stroke is higher in elderly patients with decompensated alcohol-related liver cirrhosis and vascular risk factors.

Disclosure: No

P0295 / 723

STROKE SUBTYPE PRESENTATION DURING THE FIRST WAVE OF THE COVID-19 PANDEMIC

K.M Sawicka ¹, L. Catanese², J. Williams³, L. Crellin³, T. Francis⁴, A. Katsanos², A. Shoamanesh², H. Michael⁵, J. Chen⁵, A. Pikula*³, J.D Schaafsma*³

¹University of Toronto, Medicine, Division of Neurology, Toronto, Canada, ²Hamilton Health Sciences, McMaster University, Medicine (Neurology), Hamilton, Canada, ³University Health Network, Toronto Western Hospital, University of Toronto, Division of Neurology, Toronto, Canada, ⁴University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada, ⁵McMaster University, Hamilton, Canada

Background and aims: It is unknown whether the covid-19 pandemic and public health measures impact stroke subtypes. We aimed to evaluate if the distribution of stroke subtypes during the pandemic’s first wave was different from pre-pandemic.

Methods: For this retrospective cohort study, patients with ischemic or hemorrhagic stroke presenting at two comprehensive stroke-centers between March–May 2019 (pre-pandemic cohort) and March–May 2020 (pandemic cohort) were included. All patients had vascular and brain parenchymal imaging. We compared stroke subtypes and etiologies between cohorts.

Results: The pre-pandemic cohort consisted of 234 patients and the pandemic cohort of 207 patients. There were no differences in age, sex, stroke severity, nor vascular risk factor profiles between cohorts. Proportions of patients presenting with ischemic versus hemorrhagic stroke were similar in both cohorts (77% vs 75% ischemic stroke,  12% vs 14% intraparenchymal hemorrhage, 11% vs 10% subarachnoid hemorrhage; p>0.6). There were no differences in ischemic or hemorrhagic stroke etiologies, except for a decreased proportion of ischemic stroke patients with large artery atherosclerosis in the pandemic cohort (15% vs 26%; OR: 0.5; 95%CI: 0.3-0.9). Notably, during the pandemic, ischemic stroke etiology was more often unknown due to incomplete work-up (28% vs 13%; OR: 2.6; 95%CI: 1.5-4.5).

Conclusions: Stay-at-home orders and the pandemic’s first wave seemed not to have largely influenced stroke triggers and subsequently stroke subtypes. However, a lower incidence of large artery atherosclerosis during the pandemic may suggest a higher incidence of ischemic strokes caused by an undetected cardio-embolic source or hypercoagulable state due to incomplete work-up.

Disclosure: No

P0296 / 1575

ISCHEMIC STROKE MANAGED IN EMERGENCY DEPARTMENTS BETWEEN 2016 AND 2019

J. Freyssenge ^1,2,3, A. Redjaline^2,4, C. Vallot⁵, J. Duchenne⁶, M. Martinez⁴, C. El Khoury¹

¹RESUVal, ARS Auvergne Rhône-Alpes, Vienne, France, ²Observatoire Régional des Urgences (ORU), Agence Régionale de Santé Auvergne Rhône-Alpes, Lyon, France, ³Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France, ⁴REULIAN Network, ARS Auvergne Rhône-Alpes, Firminy, France, ⁵RENAU Network, ARS Auvergne Rhone-Alpes, Annecy, France, ⁶RAMU Network, ARS Auvergne Rhône-Alpes, Aurillac, France

Background and aims: Patient data records (Résumés de Passages aux Urgences, RPU) are collections of medical data, daily transmitted by institutions with emergency departments (ED) since 2013. This study aims to describe the evolution of ischemic strokes (IS) pathway in ED between 2016 and 2019 in the Auvergne Rhône-Alpes region (France) through RPU.

Methods: A retrospective multicenter analysis was conducted on regional RPU, covering a population of 8 million inhabitants. The data analyzed were: patient characteristics, mode of transport on admission, severity, referral, mode of discharge and average length of stay in the ED.

Results: For all variables, a stability of the data was observed over the time. Between 2016 and 2019, O.4% (around 10,000) of RPU were IS; 49% of patients were >75 years old; between 6% and 7% of diagnosed patients are classified as high severity and between 6% and 8% of patients were hospitalized in intensive care. More than 75% of patients are transferred in other department and a quarter go back (home or institution). With, 7.5 hours on average, the length of stay is stable over time.

Conclusions: The use of RPU provides a relevant description of the patient’s pathway through the ED for IS. With data stability over time, RPU are reliable for analyzing patient pathways, particularly on the scale of a large region because of the uniformity of the data throughout the country. This reliability needs to be evaluated over time.

Disclosure: No

P0297 / 1014

PREVALENCE OF FABRY DISEASE IN STROKE PATIENTS: META-ANALYSIS

T. Phan ¹, J. Vuong¹, Y. Lie¹, S. Singhal¹, H. Ma¹

¹ Monash Health and Monash University, Neurology, Clayton, Australia

Background and aims: Fabry disease, a rare X-linked inherited lysosomal storage disorder caused by mutation in the alpha-galactosidase (alpha-GAL) A gene, has been suggested to occur in 1 – 4% of strokes. This study aims to estimate the prevalence of Fabry disease among adults presenting with stroke.

Methods: PubMed, Embase, conference proceedings and reference lists of relevant papers were searched for studies in English published up to 31^st October 2021, reporting “stroke” and “Fabry”.  We performed a meta-analysis of published studies (n=31, size=17430 patients) on prevalence of Fabry disease among patients presenting with stroke.

Results: The meta-analysis found that the proportion stroke patients with Fabry disease was 0.00051 (95% CI 0.0000-0.00177, approximately 51 cases per 100000 stroke, I²= 52.2%, see Forest plot ordered by estimate of proportion of Fabry disease) and increase to 0.00477 (95% CI 0.00183-0.00898, 489 cases per 100000, I2= 83.3%) when variants (D313Y, A143T, S126G) are included in the analysis. Meta-regression shows that geographical regions of the studies increase the prevalence (β=0.1255, 95% CI 0.0512-0.1998, p=0.0009). When variants are included, meta-regression shows additionally that variants increase estimate for each additional patient with variant added (β=0.0028, 95% CI 0.00008 - 0.0048, p=0.0068), but not year of publication, age, sample size or study restricted to lacunar stroke or mechanism.

Conclusion: Our study demonstrates that stroke is a rare presentation of Fabry disease if the diagnosis does not include variants. Meta-regression did not identify other criteria to help narrow the search for Fabry disease beyond geographical region and inclusion of variants.

Disclosure: No

P0298 / 1335

ADMISSION TIME DELAY IN STROKE AFFECTS DOOR TO CT SCAN TIME

E.F. Gutierrez Guzman ¹, M. Martinez Marino², V. Carrasco Wall¹, A. Calderon Vallejo³, T. Colin Martinez⁴

¹Universidad Nacional Autonoma de Mexico/ IMSS, Neurology, Mexico city, Mexico, ²Universidad Nacional Autonoma de Mexico/ IMSS, Stroke clinic / Neurology department. Hospital de especialidades Centro Médico Nacional Siglo XXI IMSS, Mexico city, Mexico, ³Universidad Nacional Autonoma de Mexico/ IMSS, Neurology department. Hospital de especialidades Centro Médico Nacional Siglo XXI IMSS, Mexico city, Mexico, ⁴Universidad Nacional Autonoma de Mexico/ IMSS, Emergency medicine Department. Hospital de especialidades Centro Médico Nacional Siglo XXI IMSS, Mexico city, Mexico

Background and aims: Delay in hospital admission after stroke is the first obstacle to develop correctly care and acute therapy, The aim of this study was to describe de delay in hospital admission of patients with stroke subtypes and association with door to computed tomography (CT) scan time.

Methods: We conducted a retrospective, single-center study in México City. We included electronic medical files of patients with stroke admitted to ER from January 2019 to October 2021. Patients were allocated in 2 groups: early arrival time and late arrival time (more or less than 3 hours). Demographic, radiological, and clinical variables were obtained.

Results: We enrolled 410 patients with baseline characteristics described in Table 1. The median admission delay was 283 minutes (140- 506). Three hundred eighty-three (93.4%) patients were admitted within 24 h. CVT was the stroke subtype with more time delayed. Statistical analysis showed that delay in hospital admission >3 hours increase the risk (OR 2.1, CI 95% 1.37 – 3.3) of delay in door to CT scan time (p = 0.001). There was not association with other variables (Table 2).

Conclusions: There was association between admission delay in stroke patients and door to CT scan time delay. There is a considerable admission delay in CVT in comparison with arterial stroke subtypes.

Table 1.

Baseline characteristics of 410 patients included in this study.

Variable	No cases	%
Mean age (SD) 63.3 (16.7)
Female	217	52.9
Diabetes	140	34.1
Hypertension	233	56.8
Dyslipidemia	24	5.9
AF	36	8.8
Smoking	57	13.9
Stroke subtype
TIA	49	12
IS	154	37.6
ICH	56	13.7
SAH	130	31.7
CVT	21	5.1
Recurrent stroke	38	9.3

Table 2.

Clinical patterns and stroke subtypes of 410 included in this study.

Variable	Arrival time ⩽ 3 hn= 138	Arrival time > 3 hn= 272	p value
Years, mean (SD)	64.8 (16.6)	62.6 (16.7)	0.21**
Sex, female (%)	80 (58)	137 (50)	0.14*
NIHSS >10, n (%)	57 (41)	110 (40)	0.86*
Stroke subtype
TIA, n (%)	22 (16)	27 (10)	0.076*
IS, n (%).	51 (37)	103 (38)	0.85*
ICH, n (%)	16 (11)	40 (15)	0.38*
SAH, n (%)	7 (58)	5 (63)	1.0*
CVT, n (%)	2 (1)	19 (7)	0.016*
Stroke onset	4 (33)	5 (63)	0.43*
Morning, n (%)	39 (28)	71 (26)
Afternoon, n (%)	61 (44)	109 (40)
Night, n (%)	38 (28)	92 (34)

*

Chi square test

**

t student test

Disclosure: No

P0299 / 447

DELAYED CEREBRAL ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE IN YOUNG PATIENTS WITH A HISTORY OF MIGRAINE

H.J.A. van Os ¹, D. Verbaan², Y.M. Ruigrok³, P. Dennesen⁴, M.C.A. Muller⁵, B. Coert², M.D.I. Vergouwen³, M.J.H. Wermer¹

¹Leiden University Medical Center, Department of Neurology, Leiden, Netherlands, ²Amsterdam UMC, Department of Neurosurgery and Neuroscience, Amsterdam, Netherlands, ³University Medical Center Utrecht and Utrecht University, Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, Netherlands, ⁴Haaglanden Medical Center, Department of intensive Care, Den Haag, Netherlands, ⁵University of Amsterdam, Department of Intensive Care, Amsterdam UMC, Amsterdam, Netherlands

Background and purpose: Young patients with aneurysmal subarachnoid hemorrhage (aSAH) and a history of migraine may have an increased risk of delayed cerebral ischemia (DCI). We investigated this potential association in a prospective cohort of aSAH patients under 50 years of age.

Methods: We included patients with aSAH under 50 years from three hospitals in the Netherlands. We assessed life-time migraine history with a short screener. DCI was defined as neurological deterioration lasting >1 hour not attributable to other causes by diagnostic work-up. Adjustments were made for possible confounders in multivariable Cox regression analyses and adjusted hazard ratios (aHR) were calculated.

Results: We included 236 young aSAH patients (mean age 41 years, 64% women) of whom 44 (19%) had a history of migraine (16 with aura). Patients with aSAH and a history of migraine were not at increased risk of developing DCI compared with patients without migraine (25% versus 20%, aHR:1.16;95%CI:0.57–2.35). Additionally, no increased risk was found in migraine patients with aura (aHR:0.85;95%CI:0.30–2.44) or in women (aHR:1.24;95%CI:0.58–2.68).

Conclusions: Patients with aSAH under the age of 50 years with a history of migraine are not at increased risk of DCI.

Disclosure: No

P0300 / 1540

CHRONOBIOLOGY AND THE EFFECT OF PMS ON STROKE INCIDENCE

M. Święczkowski ¹, Ł. Kuźma¹, S. Roszkowska², A. Kurasz¹, E.J. Dąbrowski¹, H. Bachórzewska-Gajewska^1,3, S. Dobrzycki¹

¹Medical University of Bialystok, Department of Invasive Cardiology, Białystok, Poland, ²University of Lodz, Faculty of Economics and Sociology, Łódź, Poland, ³Medical University of Bialystok, Department of Clinical Medicine, Białystok, Poland

Background and aims: Evidence on a temporal variation on strokes is inconsistent and limited. Our purpose was to assess the association between incidence and mortality of stroke and the seasons, months, days of the week, and its correlation with particulate matters (PMs) concentrations.

Methods: We analyzed patients hospitalized for stroke in 2011-2020. Data on morbidity and mortality were obtained from National Health Fund. The PMs data were obtained from Voivodeship Inspectorate for Environmental Protection.

Results: Of the 4838 patients with stroke, 54.4% were women with a median age of 74 years (IQR=16). In-hospital deaths accounted for 16.8% (N=813). The limit of daily mean given by the WHO guidelines for PM_2.5 was exceeded on 47.9% days and 11.2% days for PM₁₀. The highest number of strokes was observed in the winter season comparing to other seasons (p<0.01). The months with the highest stroke percentage were January 1.5/day (N=479) and February 1.49/day (N=419). Additionally, the daily distribution of stroke admissions was observed with the highest frequency on Mondays and Wednesdays in opposition to the weekend (p<0.01). On days with exceeded PM_2.5 norms (1.37/day, N=2282 vs. 1.26/day, N=2301; p<0.01) and PM₁₀ concentration significantly more strokes were noted 1.45/day (N=571) vs. 1.30 (N=4065; p<0.03) and higher in-hospital mortality.

Conclusions: The stroke occurrence and mortality rate were significantly greater in the winter season. The highest and the lowest frequencies of stroke incidence occurred at the beginning of the week and weekends, respectively. Exceeded daily PMs concentration norms were associated with more admissions and worse prognosis.

Disclosure: No

P0301 / 829

LOWER EXTREMITY PERIPHERAL ARTERY DISEASE IS COMMON AMONG PATIENTS WITH ISCHEMIC STROKE AND TIA

L. Ziegler ¹, E. Rooth¹, P. Becker², P. Wester³, A.C. Laska¹

¹Karolinska Institutet, Dept of Clinical Sciences Danderyd Hospital, Stockholm, Sweden, ²Karolinska Institutet, Dept of Neurology, Danderyd Hospital, Stockholm, Sweden, ³Umeå University, Dept of Public Health & Clinical Medicine, Umeå, Sweden

Background and aims: Peripheral artery disease (PAD) of the lower extremities entails atherosclerosis-driven hypoperfusion of the legs. The risk of non-fatal and fatal atherothrombotic events is higher in patients with both cerebrovascular disease and PAD compared to either of the conditions alone. Therefore, we aimed at examining the prevalence of PAD in a cerebrovascular disease population.

Methods: Planning a prospective cohort study investigating pathogenesis and vascular risk in patients with ischemic stroke or transitory ischemic attack (TIA), we performed a pilot study on 43 consecutive patients able to perform the investigation at our Stroke Unit outpatient clinic. The ankle brachial index (ABI), a validated marker of PAD when ABI ⩽0.9, was assessed in each patient with Dopplex®ABIlity, DA100PB; Huntleigh Healthcare, Cardiff, UK, an automated device using volume plethysmography to quantify perfusion.

Results: Nearly half of the patients (49%) were women, and the median age was 78 years (interquartile range 71-82). Eight (18,6%) patients had an ABI⩽ 0.9 diagnostic for PAD and merely one had previous knowledge thereof. The proportion women and median age did not differ significantly between patients with normal and low ABI. In the group with PAD, the median ABI (both legs) was 0.85 (interquartile range of 0.74-0.91).

Conclusions: In this pilot ischemic stroke/TIA cohort, nearly a fifth of patients had ABI⩽0.9 indicating PAD which implicates an increased atherothrombotic risk. Moreover, the majority were unaware of their decreased limb circulation.

Disclosure: No

P0302 / 630

PRE-STROKE MULTIMORBIDITY AND MORTALITY AFTER STROKE: A POPULATION BASED STUDY

M. Downer ¹, L. Li¹, R. Luengo-Fernandez¹, P. Rothwell¹, Oxford Vascular Study

¹ University of Oxford, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom

Background and aims: Pre-stroke multimorbidity is associated with increased mortality after stroke, but few studies have investigated potential confounders of this association.

Methods: We studied patients with a first-in-study stroke in a population-based study (Oxford Vascular Study/2002-2018) with follow-up until 2020. Multimorbidity prior to stroke onset was quantified using the Charlson Comorbidity Index (CCI). Logistic regression was used to examine the association of CCI with stroke severity (NIH Stroke Scale; NIHSS) and with possible confounders, including premorbid disability (modified Rankin Scale; mRS), smoking, deprivation (Index of Multiple Deprivation; IMD) and stroke subtypes (TOAST). Cox proportional hazard models were used to examine associations between CCI and all-cause mortality.

Results: Among 2378 patients (mean/SD age=73.6/14.1), 1517 (63.8%) had at least one CCI comorbidity. After adjustment for age/sex, CCI was associated with greater premorbid disability (mRS>2: aOR per CCI comorbidity=2.16 95%CI 1.71-2.73), current smoking (1.20, 1.01-1.43), greater deprivation (IMD tertile 1 vs 3: 1.31, 1.08-1.62), but not stroke severity (NIHSS 4-9: 1.14, 0.92-1.41, NIHSS 10+: 1.11, 0.90-1.39). Compared to cryptogenic stroke, CCI was associated with Cardioembolic (1.56, 1.22-1.99), Multiple aetiologies (1.98,1.22-3.33), and Other aetiological subtypes (1.93,1.07-3.48). After adjustment for age, sex, mRS, smoking, IMD, and NIHSS, CCI remained predictive of 90-day (CCI 2+: aHR=1.28, 95%CI 1.11-1.47), 1-year (1.36, 1.19-1.56) and 5-year (1.51, 1.32-1.73) mortality.

Conclusions: Pre-stroke multimorbidity was associated with premorbid disability, smoking, deprivation, and certain aetiological subtypes of stroke, but remained independently predictive of all-cause mortality.

Disclosure: No

P0303 / 1429

SOCIOECONOMIC RISK FACTORS IN EARLY FAMILY AND RISK FOR STROKE UNTIL MIDLIFE – NORTHERN FINLAND BIRTH COHORT 1966

V. Hyytiäinen ^1,2, L. Ala-Mursula^1,2, P. Oura^1,2, M. Paananen^1,2, H. Rusanen^2,3, M.I. Geerlings⁴, J. Miettunen^1,2, I. Rissanen^1,2,4

¹University of Oulu, Center for Life Course Health Research, Oulu, Finland, ²University of Oulu, Medical Research Center, Oulu, Finland, ³Oulu University Hospital, Department of Neurology, Oulu, Finland, ⁴University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands

Background and aims: Low socioeconomic status (SES) is a known risk factor for stroke. However, SES is multidimensional and cannot be fully described with single variables. Moreover, the relevance of being born to low SES is poorly understood. Therefore, we illustrate early life SES as broadly as possible using clusters. We are among the first studies to study if low SES in early family associates with increased risk for stroke in later life.

Methods: In the Northern Finland birth cohort 1966, covering 96% of all births in the region in 1966, 11 925 individuals were followed from mid-pregnancy for 54 years. We used previously published family SES clusters, based on latent class analysis of a wide set of prenatally collected variables, including mother’s marital status, education and occupation; father’s occupation; number of family members; location of residence, room count, utilities; and family’s wealth. The information of strokes was obtained from national registers. The associations of the five distinct family SES clusters with offspring’s stroke risk were analysed by Cox regression adjusted for sex.

Results: By 2020 521 strokes were recorded. Compared to highest status families, the hazard ratios and 95% confidence intervals for stroke were: in small families (1.21, 0.90-1.61), larger families (1.30, 0.95-1.77), average wealth families (1.15, 0.86-1.54), and rural families (1.03, 0.77-1.38).

Conclusions: Early family SES seems not to be a risk factor for stroke until midlife in Finnish population. The generalizability of this finding needs to be confirmed in other sociocultural contexts.

Disclosure: No

P0304 / 724

SILENT ISCHEMIC STROKE IN PATIENTS WITH ACUTE CARDIOEMBOLIC STROKE

I. Najmi ¹, S. Benmaamar², S. Zejli¹, S. Bouchal¹, K. El Ghazi², M.F. Belahsen¹

¹Hassan II University Hospital Center, Neurology, Fez, Morocco, ²Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco

Background and Aims: The common cardiovascular risk factors for silent ischemic stroke (SIS) have been identified including atrial fibrillation (AF) which is often the major cause of cardioembolic stroke. We aim to determinate the prevalence of SIS associated to cardiovascular risk factors in patients presented with acute cardioembolic stroke.

Methods: It’s a retrospective study of 267 patients with acute cardioembolic stroke admitted to the emergency and / or the neurology departments of the University Hospital Center Hassan II in Fez, Morocco from January 2019 to July 2021. The clinical, biological, echocardiographic and radiological features of patients were recorded.

Results: The prevalence of SIS was 46%. Two groups were identified. A group of 64 patients with valvular disease and a group of 203 patients without valvular disease.

For valvular patients, the prevalence of SIS was 48%. Moderate or severe mitral stenosis and the enlarged left atrium (LA) were significantly associated to the occurrence of SIS (P=0.02, P=0.002 respectively).

For non-valvular patients, the prevalence of SIS was 45%. Enlarged LA, labile international normalized ratio (INR), the association of AF to the enlarged LA, a history of previous symptomatic stroke and a CHA2DS2-VASc ⩾ 4 were significantly associated to the occurrence of SIS ((P=0.0001, P=0.06, P=0.01, P=0.013 and P=0.032 respectively).

For the 2 groups, there was no significant difference between permanent and paroxysmal AF.

Conclusions: SIS are frequently discovered in acute cardioembolic stroke. Their identification is a supplemental indicator for early management of the intercurrent cardiovascular risk factors.

Disclosure: No

P0305 / 176

THROMBUS LOCATION AND VOLUME ARE THE MAIN RISK FACTORS FOR THE DEVELOPMENT OF SECONDARY INTRACRANIAL HYPERTENSION IN ACUTE CEREBRAL VENOUS THROMBOSIS

F. Schuchardt ¹, T. Demerath², N. Lützen², W.A. Lagrèze³, M. Reich³, H. Urbach², A. Harloff¹, S. Meckel⁴

¹University Hospital Freiburg, Neurology and Neurophysiology, Freiburg, Germany, ²University Hospital Freiburg, Neuroradiology, Freiburg, Germany, ³University Hospital Freiburg, Neuroophthalmology, Freiburg, Germany, ⁴Klinikum Ludwigsburg, Institute of Diagnostic and Interventional Neuroradiology, Ludwigsburg, Germany

Background: Secondary intracranial hypertension (IH) is a potential complication of cerebral venous sinus thrombosis (CVT) and may cause permanent visual loss. Current knowledge of risk factors for the development of IH following CVT is scarce. We hypothesized that thrombus location, the number of thrombosed segments, and thrombus volume are predictors of IH in acute CVT.

Methods: Between 2011 and 2019, we prospectively screened 70 patients with acute CVT and included 28 into this study. Patients with elevated cerebrospinal fluid pressure in lumbar puncture or imaging surrogates with high specificity for intracranial hypertension (i.e., optic nerve sheath diameter >5.8mm, flattening of the eyeball, papilledema) were compared with patients without these indicators. Using high-resolution contrast-enhanced 3D MRI, we determined thrombosis location, number of thrombosed segments, and thrombus volume and their association with IH.

Results: Patients in our cohort showed a high IH frequency (71.4%), objectified by lumbar puncture in 60% and by imaging surrogates in 40% (2.3±0.9 (95%CI 1.5-3) pathological neuroimaging criteria). Thrombosis of the dorsal superior sagittal sinus (SSS), extensive involvement of the entire SSS, and higher thrombus volume were significantly associated with IH (p=0.044, p=0.041, and p=0.015). However, the number of thrombosed segments and frequency of transverse sinus thrombosis were comparable between groups.

Conclusions: The incidence of IH following acute CVT was high. Dorsal thrombosis, extensive thrombosis of the SSS, and larger thrombus volume appear to increase the risk of IH. Thus, patients showing these features should be particularly screened for IH and treated early and appropriately if needed.

Disclosure: No

P0306 / 1461

SEX DIFFERENCES IN RISK FACTORS FOR STROKE INCIDENCE AND RECURRENCE – THE UCC-SMART STUDY

I. Rissanen ¹, M. Basten¹, L.G. Exalto², S.A. Peters^1,3,4, F.L. Visseren⁵, M.I. Geerlings¹, UCC-SMART-Study Group

¹University Medical Center Utrecht and Utrecht University, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, ²University Medical Center Utrecht and Utrecht University, Department of Neurology, Utrecht, Netherlands, ³Imperial College London, The George Institute for Global Health, School of Public Health, London, United Kingdom, ⁴University of New South Wales, The George Institute for Global Health, Sydney, Australia, ⁵University Medical Center Utrecht and Utrecht University, Department of Vascular Medicine, Utrecht, Netherlands

Background and aims: Stroke incidence, recurrence, and risk factors differ between men and women. However, it is not known if this applies to high-risk populations. We investigated if sex modified the relation between risk factors and stroke incidence and recurrence in patients with atherosclerotic disease.

Methods: Within the prospective UCC-SMART study 13,898 (35% women) patients with symptomatic or asymptomatic atherosclerotic disease were followed up to 23 years for stroke incidence or recurrence. At baseline, hypertension, smoking, diabetes, overweight, hypercholesterolemia, alcohol use, and physical activity were assessed. Sex modification of the relation between risk factors and stroke was studied using Cox proportional hazard models and women-to-men relative hazard ratios (RHR) for each risk factor were estimated. Left-truncated age was used as timescale. Analyses were done separately for stroke incidence and recurrence.

Results: Stroke incidence rate was lower in women than men (3.5 vs 4.2 per 1000 person-years), as well as stroke recurrence rate (8.2 vs 11.7). Hazard for stroke incidence per 1mmol/l increase in HDL cholesterol was 0.51 (95%confidence interval 0.32-0.81) in women and 1.03 (0.72-1.48) in men, resulting the women-to-men RHR to be 0.49 (0.27-0.88). Hazard for stroke recurrence associated with overweight was 0.48 (0.28-0.82) in women and 1.20 (0.86-1.68) in men, resulting the RHR to be 0.42 (0.23-0.80). Effects of other risk factors were not modified by sex.

Conclusion: In women, increasing HDL cholesterol lowers the risk for stroke incidence and overweight lowers the risk for stroke recurrence. Clinicians should consider the sex differences when treating high risk patients.

Disclosure: No

P0307 / 856

FKBP5 RISK HAPLOTYPE AND CLINICAL OUTCOME AFTER FIRST ISCHEMIC STROKE: THE PROSPECTIVE COHORT WITH INCIDENT STROKE STUDY BERLIN (PROSCIS-B)

T. Liman ¹, K. Gertz¹, D. Czamara², E. Binder², M. Endres¹

¹Charité, Neurology, Berlin, Germany, ²Max Planck Institute of Psychiatry, Translational Research in Psychiatry, Munich, Germany

Background: FK506-binding protein 51 (FKBP5), a co-chaperone of the glucocorticoid receptor, has been introduced as a potential mediator between stress, vascular morbidity and neuropsychiatric sequelae. Here, we aimed to assess whether the FKBP5 risk haplotype is associated with functional outcome and depression after first-ever, mild-to-moderate ischemic stroke.

Methods: Data were used from the Prospective Cohort with Incident Stroke Berlin (PROSCIS-B; NCT01363856). Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CESD) during a three-year follow-up. Depression was defined as CESD ⩾16. Poor functional outcome was defined as modified Rankin Scale 0-1 vs 2-6 at one year after stroke. Risk allele ACT (dominant or recessive) versus non-ACT from a predefined FKBP5 haplotype (SNPs combination rs9296158, rs3800373, rs1360780) was used as exposure variable. Logistic regression analyses were performed adjusted for potential confounders (e.g. demographics, vascular risk factors, stroke severity).

Results: We included 530 patients with ischemic stroke and data on genetics. Median age was 69 (IQR59-76), 39% were female, median NIHSS was 2 (IQR1-4). Depression rates were 24 % at year 1, 26 % at year 2, and 23 % at year 3, respectively. ACT was associated with higher prevalence of CEDS⩾16 over 3 years (adjusted OR 1.5; 95%CI 1.02-2.40) as well as poor functional outcome defined as mRS 2-6 at one year (adjusted OR 1.6; 95%CI 1.07-2.43).

Conclusion: In our cohort with mild-to-moderate first-ever ischemic stroke, FKBP5 risk haplotype ACT was associated with poor functional outcome and a higher prevalence of depression after first ischemic stroke.

Disclosure: No

P0308 / 830

COVID-19 DID NOT RESULT IN INCREASED HOSPITALIZATION FOR STROKE AND TRANSIENT ISCHEMIC ATTACK: A NATIONWIDE STUDY

C.Z. Simonsen ¹, R.A. Blauenfeldt¹, J.N. Hedegaard², C. Kruuse³, D. Gaist⁴, T. Wienecke⁵, B. Modrau⁶, S.P. Johnsen², G. Andersen¹

¹Aarhus University Hospital, Neurology, Aarhus, Denmark, ²Aalborg University, Department of Clinical Medicine, Aalborg, Denmark, ³Copenhagen University Hospital-Herlev Gentofte, Neurology, Copenhagen, Denmark, ⁴Odense University Hospital, Neurology, Odense, Denmark, ⁵Zealand University Hospital, Neurology, Roskilde, Denmark, ⁶Aalborg University Hospital, Neurology, Aalborg, Denmark

Background: The risk of thrombosis increases in infectious diseases, yet observational studies from single centers have shown a decrease in admission of acute ischemic stroke patients during the COVID-19 pandemic. To investigate unselected stroke admission rates, we performed a nationwide study in Denmark.

Methods: We extracted information from Danish national health registries. The following mutually exclusive time periods were compared to the year before the lockdown: 1) 1^st national lockdown, 2) gradual reopening, 3) few restrictions, 4) regional lockdown, 5) 2^nd national lockdown.

Results: Generally, admission rates were unchanged during the pandemic. In the unadjusted data, we observed a small decrease in the admission rate for all strokes under the first lockdown (incidence rate ratio: 0.93, confidence interval [CI]: 0.87-0.99) and a slight increase during the periods with gradual reopening, few restrictions, and the regional lockdown driven by ischemic strokes. We found no change in the rate of severe strokes, mild strokes, or 30-day mortality. An exception was the higher mortality for all stroke during the 1^st lockdown (risk ratio: crude 1.30 [CI: 1.03-1.59]; adjusted 1.17 [CI: 0.93-1.47]). The quality of care remained unchanged.

Discussion: In Denmark, stroke admission rates remained largely unchanged during the pandemic. The increased short-term mortality rate in patients admitted with stroke observed during the 1^st lockdown probably reflects that the frailest patients were more prone to die in the beginning of the pandemic. It seems unlikely that patients avoided admission, since admission rates for mild strokes and transient ischemic attacks were unchanged.

Disclosure: Yes

P0309 / 1407

LIPID LEVELS AND OUTCOME AFTER ENDOVASCULAR THERAPY IN ACUTE ISCHAEMIC STROKE WITH LARGE VESSEL OCCLUSION

M. Krasteva ^1,2, M. Peitcheva^1,3, G. Padlina¹, P. Radojewski⁴, M.D Müller⁵, D. Bervini⁵, P. Mordasini⁴, L. Bally⁶, C. Gräni⁷, H. Sarikaya¹, J. Gralla⁴, M. Arnold¹, M.R Heldner¹

¹Inselspital, University Hospital and University of Bern, Department of Neurology, Bern, Switzerland, ²Queen Giovanna University Hospital, Department of Neurology, Sofia, Bulgaria, ³Medical University of Plovdiv, Department of Neurology, Plovdiv, Bulgaria, ⁴Inselspital, University Hospital and University of Bern, Institute of Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ⁵Inselspital, University Hospital and University of Bern, Department of Neurosurgery, Bern, Switzerland, ⁶Inselspital, University Hospital and University of Bern, Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Bern, Switzerland, ⁷Inselspital, University Hospital and University of Bern, Department of Cardiology, Bern, Switzerland

Aim: Our aim was to compare lipid levels and outcome in stroke patients due to a large vessel occlusion, treated by endovascular therapy (EVT) at a tertiary care center.

Methods: Consecutive EVT eligible patients admitted to our stroke center from 02/2015 were included in this observational cohort study. Baseline characteristics, outcome and predictors for poor outcome were analyzed for patients with an admission LDL <1.8 vs. ⩾1.8 mmol/l.

Results: We included 821 patients (50.9% women, median age 76 years), of which 188 (77.1%) had an admission LDL <1.8 mmol/l. Patients with an admission LDL <1.8 vs. ⩾1.8 mmol/l less frequently had a history of arterial hypertension (76.5% vs. 83.5%;p=0.040), of diabetes mellitus (19.7% vs. 27.1%;p=0.030), of coronary heart disease (22.7% vs. 37.8%;p<0.0001), of peripheral artery disease (5.8% vs. 11.2%;p=0.012), of pre-stroke intake of antithrombotics (41.9% vs. 63.8%;p<0.0001), of antihypertensives (63.8% vs. 73.4%;p=0.014) and of antilipids (18.6% vs. 52.7%;p<0.0001). Patients with an admission LDL <1.8 vs. ⩾1.8 mmol/l had a similar rate of successful reperfusion (85.6% vs. 85%;p=0.827), recurrent in-hospital ischaemic stroke (8.1% vs. 6.8%;p=0.556), symptomatic intracranial haemorrhage (7.1% vs. 6.5%;p=0.789), 3-months mortality (27.3% vs. 28.8%;p=0.692) and favourable outcome (41.6% vs. 43.9%;p=0.576). In a multivariable analysis, history of arterial hypertension (p=0.030), diabetes mellitus (p=0.007), peripheral artery disease (p=0.004) and pre-stroke intake of antithrombotics (p=0.003) were independent predictors of poor outcome, but not admission LDL ⩾1.8 mmol/l (p=0.635).

Conclusions: Our data found differences in baseline characteristics but not in outcome of patients admitted to our stroke center with an admission LDL <1.8 vs. ⩾1.8 mmol/l.

Disclosure: No

P0310 / 783

TRENDS OF RECANALIZATION THERAPIES AND STATE OF ART FOR ISCHAEMIC STROKE TREATMENT IN CAMPANIA REGION, ITALY IN 2019 AND 2020

E. Spina ¹, P. Candelaresi¹, R. Napoletano², V. Andreone¹

¹AORN "A. Cardarelli", Naples, Italy, ²University of Salerno "San Giovanni di Dio e Ruggi d'Aragona", Neurology and Stroke Unit, Salerno, Italy

Background and aims: According to the last Italian report by the Ministry of Health in 2018, the estimated number of acute ischemic stroke (AIS) every year in Campania is around 10.000, with an expected number of treatments of 1390 intravenous thrombolysis (IVT) and 694 mechanical thrombectomy (MT). In 2017, only 1.5% of expected patients received IVT and 0.2% MT. This work aims to evaluate the trend of IVT and MT in 2019 and 2020 and the state of art of Stroke Care in Campania Region.

Methods: We obtained from the Regional health task force the hospital discharge forms from all Campanian health facilities, then we selected patients with a principal diagnosis of AIS and measured the rate of patients admitted in Neurology Units and of IVT, MT and IVT+MT for both 2019 and 2020.

Results: In 2019 we observed 4817 admissions for AIS of whom 2858 in Neurology Units (59.3%). Of these patients, 192 received IVT, 165 MT only and 131 IVT+MT (488 single patients treated; 10.1%). In 2020 we observed 4129 admissions of whom 2502 in Neurology Units (62.7%). Of these patients, 198 received IVT, 250 MT only and 180 IVT+MT (628 single patients treated, 15.2% of total).

Conclusion: These results showed that despite a reduction of admissions for AIS in 2020, relative and absolute rate of recanalization treatments increased. However, the number of patients not admitted to Neurology Units and not treated remains dramatically high; furthermore, level of Stroke care still needs significative efforts to achieve an adequate level of assistance.

Disclosure: No

P0311 / 770

CLINICAL CHARACTERISTICS AND TREATMENT RESULT OF ACUTE ISCHEMIC STROKE PATIENTS UNDER 45 YEARS OLD IN VIETNAM

T. Pham-Quang ¹, V.-P. Dao¹, T. Hoang-Trong², D. Nguyen-Tien¹, Q. Phan-Ha¹, T. Vuong-Xuan¹, A. Nguyen-Minh¹, V. Bui-Quoc¹, H. Dinh-Trung¹, T. Phung-Dinh¹, T. Nguyen-Anh³, T. Mai-Duy¹

¹Bachmai Hospital, Stroke Center, Hanoi, Vietnam, ²Hadong Hospital, Hanoi, Vietnam, ³Bachmai Hospital, Emergency Center, Hanoi, Vietnam

Background and aims: Ischemic stroke is the leading cause of death and disability worldwide, affects not only the elderly but also younger patients. The burden of stroke in patients under the age of 45 is increasing. Clinical characteristics, causes, risk factors, and treatment outcomes have been being studied.

This study aimed to identify the clinical features, some risk factors, and treatment results of cerebral infarction patients under 45 years old at Bachmai hospital, Vietnam.

Methods: A retrospective descriptive study was conducted at Bachmai hospital on a group of ischemic stroke patients under 45 years of age. The primary outcome was the rate of favorable outcome (mRS 0-2), and the rate of mortality at 90 days.

Results: Among 91 patients recruited, 69.2% were male and the mean age was 37.62 ± 5.83 years old. 30 patients received recanalization therapies (either thrombolysis or thrombectomy or both). The rate of popular stroke risk factors such as hypertension, diabetes, atrial fibrillation, and dyslipidemia was 19.8%; 3.3%; 11% and 24.2%, respectively. According to TOAST classification, large-artery atherosclerosis (31.9%) was the highest-rank etiology, followed by small-vessel (23.1%), and cardio embolism (14,3%). Stroke of other determined etiology accounted for 10.9% (for example, hypercoagulation stage due to shortage of protein C, S, or autoimmune disease. . .). After 90 days, 85.7% patients well recovered (mRS 0-2), and mortality rate was 5.5%.

Conclusions: These data suggested some different features of under-45-year-old ischemic stroke patients admitted to Bachmai hospital. A high rate of good recovery (85.7%) was seen in this study.

Disclosure: No

P0312 / 1352

STROKE AFTER COVID-19 ERA: IS THERE A “STROKE WAVE” RESULTING FROM THE PANDEMIC?

A. Franco Salinas ¹, S. Pérez-Sánchez¹, R. De Torres Chacon¹, A. Fuerte Hormigón¹, M.Á. Gamero García¹, A. Domínguez Mayoral¹, A. Barragan Prieto¹, J. Loscertales Castaños¹, S. Banda Ramírez¹, A. Torres Moral¹, E. Montero Ramírez¹, L. Ruíz Bayo¹, J. Montaner Villalonga¹

¹ Hospital Universitario Virgen Macarena, Neurology, Sevilla, Spain

Background and aims: The pandemic caused by SARS-COV2 is responsible for a considerable impact on stroke care. During this time many other non-COVID diseases have been neglected. Primary health care centers collapsed in some regions and the control and monitoring of vascular risk factors has been difficult. On the other hand, it is also known that covid infection leads to a certain prothrombotic state that could result in subsequent strokes.

Our objective is to evaluate the effect of the SARS-CoV-2 pandemic on stroke unit admission rates.

Methods: Temporal admission rates in the stroke unit of a regional hospital were analyzed from 2019, 2020 and 2021. The type of stroke, baseline characteristics and treatments received were recorded.

Results: Stroke unit admission rates were similar between 2019 and 2020: 397 and 408 patients respectively. However, in 2021 the number of stroke admission, Ischemic or hemorrhagic, has incremented by more than 30% (p-value 0,005), with 589 attended patients. Hemorrhagic stroke rates were 15.62%, 10.70% and 16.98% in the three years respectively.

Conclusions: During the first year of SARS-CoV-2 pandemic the use of health services for neurological emergencies was reduced, included the number of admissions at the stroke unit. However, we are experiencing a significant increase in the number of strokes, which now far exceeds pre-pandemic levels. It remains to be determined whether the cause of this huge increase in stroke cases is related to suboptimal vascular risks factor control, to COVID-related factors or to optimal population response following stroke campaigns in the region.

Disclosure: No

P0313 / 407

THE ASSOCIATION BETWEEN ISCHEMIC STROKE SUBTYPE AND STROKE SEVERITY: THE ARIC STUDY

M.C. Johansen ¹, J. Chen², D.S. Knopman³, A.L.C. Schneider⁴, J. Carlson⁵, T. Haight⁶, K. Lakshminarayan⁷, S. Patole⁸, R.F. Gottesman⁹, J. Coresh², S. Koton¹⁰

¹The Johns Hopkins University School of Medicine, Cerebrovascular Neurology, Baltimore, United States, ²The Johns Hopkins University School of Public Health, Epidemiology and Biostatistics, Baltimore, United States, ³University of North Carolina, Chapel Hill, United States, ⁴University of Pennsylvania, Philadelphia, United States, ⁵Massachusetts General Hospital, Boston, United States, ⁶Virginia Commonwealth University, Richmond, United States, ⁷University of Minnesota, Minneapolis, United States, ⁸The Johns Hopkins University School of Public Health, Baltimore, United States, ⁹National Institutes of Neurological Disorders and Stroke Intramural Program, Bethesda, United States, ¹⁰Stanley Steyer School of Health Professions, Tel Aviv, Israel

Background and aims: Disability occurs across ischemic stroke subtypes, but if specific mechanisms (embolic versus thrombotic) are associated with more severe deficits, or mortality, independent of underlying risk factors, is unknown.

Methods: 928 Atherosclerosis Risk in Communities (ARIC) study participants with incident adjudicated ischemic stroke, severity/mortality data and complete covariates were included. Ordinal and multinomial logistic regression models determined the association between admission NIHSS category [minor (⩽5), mild (6-10), moderate (11-15), severe (16-20), very severe (>20)] and stroke subtype (embolic versus thrombotic) adjusted for covariates proximal to stroke, with interaction terms for race and sex. Adjusted Cox proportional hazard models estimated the association between stroke subtype and mortality (March 1989-December 2019).

Results: Participants were mean age 71years [SD=9] at incident stroke, 51% female and 49% Black. Using ordinal regression, the odds of being in a worse NIHSS category was doubled among embolic versus thrombotic stroke patients (OR 1.99 95%CI 1.43-2.73). Furthermore, the risk of having a more severe stroke was higher among embolic stroke patients, with a step-wise increase when moving from mild to very severe strokes (Table 1). Sex modified the association between stroke subtype and severity (females OR 2.68 for embolic vs thrombotic strokes, 95%CI 1.79-4.04; males OR 1.50 95%CI 0.94-2.37;p-interaction=0.019). Risk of death (median follow-up 5years, IQR 1-12) was increased for embolic stroke patients (HR 1.41, 95%CI 1.18-1.71; Figure 1).

Conclusions:  In this study, an embolic stroke was associated with stroke severity and higher risks of death compared to thrombotic stroke patients, independent of patient-level differences.

Disclosure: No

P0314 / 992

STROKE ILLITERACY IN SOUTHWEST PORTUGAL

C. Rodrigues ¹, A. Oliveira², K. Sica¹, F. Ferreira², K. Rabcheva¹, M. Silva³, I. Taveira⁴

¹Unidade Local de Saúde do Litoral Alentejano, UCSP Sines, Sines, Portugal, ²Unidade Local de Saúde do Litoral Alentejano, UCSP Alcácer do Sal, Alcácer do Sal, Portugal, ³Universidade do Algarve, Faro, Portugal, ⁴Centro Hospitalar Universitário do Algarve - Portimão, Portimão, Portugal

Background and aims: Stroke recognition constitutes the 1st link of the survival chain, which makes it essential to improve prognosis and reduce both morbidity and mortality. Therefore, the purpose of this study was to characterize the population knowledge regarding stroke, in the Southwest region of Portugal.

Methods: An observational study was carried out using an anonymous survey, distributed in primary care units’ waiting rooms. The surveys were filled in by voluntary adult users. The study took place in the second semester of 2021. Statistical analysis was performed using the SPSS v26 program.

Results: 2004 surveys were obtained, with a median age of 47 years and a similar distribution between genders, of which 2.9% had already had a stroke. 70% of the sample identified stroke as a “brain problem”, with 21% considering it as a “heart problem”. There was no statistical significance between stroke knowledge and age, except for people over 75. Regarding warning signs, 37.3% identified “chest pain” and 15% “shortness of breath” as stroke symptoms. However, “half-body paralysis”, and “loss of strength in a body area” were recognized by 54%, and 58.5%, respectively. When asked what they would do if they suspected they were having a stroke, 58% of the sample would contact 112 (national emergency number).

Conclusions: This study demonstrates a significant populational lack of knowledge regarding stroke. Health illiteracy is a silent epidemic that must be fought. This study is the first step of a regional health community project that will hopefully improve health literacy.

Disclosure: No

P0315 / 1018

INSTANTANEOUS STROKE RISK ASSESSMENT OF ADULTS IN ENUGU, SOUTH EAST NIGERIA – RESULTS FROM A RANDOM POINT SURVEY

I. Ndionuka ¹, I. Onwuekwe¹, O. Ekenze¹, C. Okereke¹, C. Orah¹, B. Ezeala-Adikaibe¹, V. Madu¹

¹ University of Nigeria Teaching Hospital, Department of Medicine, Enugu, Nigeria

Background: Stroke remains a major cause of morbidity, death and disability around the world and most especially in black Africans. Understanding the magnitude and appreciation of stroke risk in susceptible populations remains a key strategy in reducing stroke burden.

Aim: This survey examined and compared 5 –year stroke risk in an adult population in Enugu, the regional capital in South East Nigeria.

Method:  A point cross-sectional survey assessing stroke risk in adults was done in October 2019 in the city of Enugu as part of the World Stroke Day commemoration using the Stroke Riskometer app and the data was analysed.

Results: The total number of participants in this survey was 117 traders in a market in Enugu metropolis. More males 63% than females 37% participated in this survey. The total mean age was 47.50 years with a total mean 5 year stroke risk of 3.93. Stroke risk was higher in females 4.56 than in males 3.56. Elevated blood pressure was present in 35% and elevated blood glucose was seen in 5% of the total population.

Conclusion: The World Stroke Organization stroke riskometer app is a valuable tool in assessing stroke risks especially in resource poor settings. This app also serves as a cost effective method of conducting epidemiological research in stroke globally. Hypertension remains the most common risk factor for stroke globally. Higher stroke risk in females likely associated with higher mean age.

Keywords: Stroke risk, adults, Enugu, South East Nigeria.

Disclosure: No

P0316 / 476

EQUAL RISK FOR SICK LEAVE IN PATIENTS WITH TRANSIENT ISCHEMIC ATTACK AND STROKE

B. Hede Ebbesen ^1,2, S. Grøntved^3,4, M. Rathleff^5,2,6, B. Modrau⁷, J. Andreasen^8,2,5, S. Paaske Johnsen⁴

¹Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark, ²Aalborg University, Department of Health Science and Technology, Aalborg, Denmark, ³Region North Psychiatry, Aalborg, Denmark, ⁴Aalborg University, Danish Center for Clinical Health Services Research, Aalborg, Denmark, ⁵Aalborg University Hospital, Department of Physiotherapy and Occupational therapy, Aalborg, Denmark, ⁶Aalborg University, Center for General Practice, Aalborg, Denmark, ⁷Aalborg University Hospital, Department of Neurology, Aalborg, Denmark, ⁸Aalborg Municipality, Aalborg Center of Health and Rehabilitation, Aalborg, Denmark

Background: In contrast to stroke, neurological symptoms are fully recovered within 24 hours in patients with Transient Ischemic Attack (TIA). However, evidence indicates lasting symptoms of fatigue, depression, anxiety and cognitive difficulties, which may be severe enough to affect patients’ ability to return to work.

Aim: To investigate the risk of sick leave following TIA.

Methods: The Danish Stroke Registry was used to identify patients with TIA and stroke nation-wide in the years 2014-2018. Information on work attachment and public services as sick leave benefits were added from the Danish Registry for Evaluation of Marginalization. Finally, the cumulative risk of sick leave following TIA was compared to that of stroke.

Results: A total of 21043 TIA events (mean age 69.6, SD 13.1) and 49323 stroke events (mean age 71.6, SD 10.6) were registered. In TIA events, 4711 (22.4%) paid labor market contributions prior to their TIA and 194 (4.1%) received sick leave benefits between 5 and 12 weeks after TIA. In stroke events, 8838 (17.9%) paid labor market contributions prior to their stroke and 288 (3.3%) received sick leave benefits between 5 and 12 weeks after stroke. The median length of continuous sick leave was 17 weeks (IQR 7-30) in TIA and 30 weeks (IQR 16-50) in stroke.

Conclusion: The cumulative risk of sick leave among patients with TIA was at least as high as the risk among patients with stroke, which underpins the need for further awareness for lasting symptoms in these patients.

Disclosure: No

P0317 / 1618

STROKE ETIOLOGY OF LARGE VESSEL OCCLUSION ACUTE ISCHEMIC STROKE (LVO-AIS) & THROMBECTOMY OUTCOMES IN MULTI-ETHNIC YOUNG ADULTS (AGE 18-49)

R. Chandra ¹, G.A. Kharal¹, A. Mahapatra¹, D. Baker¹, A. Zhang¹, T. Patterson¹, G. Toth¹, M.S. Hussain¹

¹ Cleveland Clinic Foundation, Cerebrovascular Center, Cleveland, United States

Background and aims: Large vessel occlusion acute ischemic stroke (LVO-AIS) is considerably uncommon in young adults. Younger patients have distinctively different stroke mechanisms compared to older patients. We sought to assess the proportion of LVO-AIS in young adults presenting to our racially diverse comprehensive stroke center to identify underlying stroke etiologies and mechanical thrombectomy (MT) related outcomes.

Methods: We retrospectively analyzed all patients with LVO-AIS from Jan 2017- June 2021 who underwent MT at the Cleveland Clinic Cerebrovascular Center.  We assessed demographics, underlying risk factors, stroke etiology and modified Rankin score (mRS) at 90 days after stroke in young adult patients defined as age 18-49.  

Results: Out of 496 patients who underwent MT, 48 (9.7%) were young adults (64.6% male, 48% white). Median age (IQR 0.25-0.75) was 41(18, 46). Median NIHSS was 13 (7.75, 19.25). Most prevalent risk factors were Hypertension (39.6%), Diabetes (16.6%), Hyperlipidemia (35.4%) and smoking (43.7%). Most common stroke etiology was Cryptogenic (33.3%) followed by Cardiomyopathy (18.7%), Large artery atherosclerosis (12.5%), Atrial Fibrillation (12.5%), Dissection (6.25%), Hypercoagulable state (4.2%), Paradoxical embolism (4.2%), Surgical Complication (4.2%), Endocarditis (2.1%) and Embolic Stroke of Unknown Source (2.1%). Functional independence [mRS 0-2] at 90 days was achieved in 35 (72.9%); with only 4.2% mortality.

Conclusions: In our racially diverse cohort, a high proportion of patients were functionally independent after MT. However, stroke etiology in the majority of young adults remained cryptogenic and was not explained by known risk factors. Further studies are needed to better inform LVO-AIS etiology in young adults.

Disclosure: No

P0318 / 1282

HOW STROKE MIMICS MANAGEMENT EVOLVES WITH IMPROVEMENT OF ACCESS TO REPERFUSION THERAPY? THE STROKE69 COHORT STUDY

Y. Xue^1,2, A. Denis³, T. Bony³, J. Haesebaert^2,1, A. Termoz^2,1, K. Tazarourte^4,1, L. Derex^5,1, A.-M. Schott ^2,1

¹Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France, ²Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France, ³Hospices Civils de Lyon, Hôpital Lyon Sud, Service des Urgences, Pierre-Bénite, France, ⁴Hospices Civils de Lyon, Hôpital Edouard Herriot, Service des Urgences, Lyon, France, ⁵Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Service Neuro-vasculaire, Lyon, France

Background: How Stroke mimics management evolves in parallel with the improved awareness of the public and effectiveness of pre- and intra-hospital management of ischemic stroke patients is not clear.

Methods: We used two similar population-based cohort studies, AVC69 and STROKE69, conducted respectively in 2007 and 2016, which included all patients with a suspicion of acute stroke in the Rhône County. Several actions for improving acute stroke management, including public awareness campaigns, were implemented between the two studies.

Results: Respectively 1166 and 1750 patients were included in AVC69 and STROKE69. Patients calling #15 (regional emergency call center) increased from 33.9% to 59.7% (OR: 2.89 [95%CI, 2.47-3.39]), and those having a reperfusion therapy (either IVT and/or EVT) from 9 to 23% (OR: 3.22 [95%CI, 2.33-4.49]). Among all patients with a suspicion of stroke, the proportion of stroke mimics increased significantly from 9.6% to 17.8% (OR: 2.04 [95%CI, 1.61-2.60]), and that of patients inappropriately hospitalized in a stroke unit with a SM increased significantly from 2.3% to 4.8% (OR: 2.10 [95%CI, 1.37 -3.32]). The probability of being admitted in stroke unit for SM patients remained higher during the second period after adjustment for age, sex, and realization of brain imaging (OR: 1.66 [95%CI, 1.06-2.65]).

Conclusions: Whether these results correspond to a real increase of the proportion of SM patients or rather to an improved imaging diagnosis leading to decrease overestimation of ischemic stokes has to be investigated. Nevertheless, reducing the rate of SM patients admitted in stroke units remains a challenge.

Disclosure: No

P0319 / 403

STATIN THERAPY FOR PREVENTING RECURRENT STROKE IN PATIENTS WITH ISCHAEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS AND OBSERVATIONAL COHORT STUDIES

Y. Yin¹, L. Zhang ¹, Y. Wang¹

¹ King's College London, Population Health Sciences, London, United Kingdom

Background and aims: Almost 30% of strokes are recurrent events that are more likely to result in disability or death. This review aims to assess the efficacy of statin treatment for stroke recurrence in patients with ischaemic stroke.

Methods: Four electronic databases were searched to identify published Randomised Controlled Trials (RCTs) and observational cohort studies following PRISMA guidelines. The primary outcome of this study was a recurrent stroke of any type, and the secondary outcome was divided into recurrent ischaemic stroke and recurrent haemorrhagic stroke. Odds ratio (OR) was used to assess the effect of statin therapy. Meta-analysis was conducted under RevMan 5.4 software.

Results: The initial searches identified 559 papers, of which 11 randomised controlled trials and 12 observational cohort studies were included. For primary outcome, 11 RCTs (odds ratio 0.87, 95% CI [0.77,0.97]; P=0.02) and 12 cohort studies (odds ratio 0.80; 95% CI [0.66, 0.96]; P=0.02) showed similar results that statin therapy exerted beneficial impact on preventing recurrent stroke of any type in ischaemic stroke survivors. For secondary outcome, analysis of 6 RCTs (odds ratio 0.81; 95% CI [0.70, 0.93]; P=0.002) and 3 observational studies (odds ratio 0.67; 95% CI [0.61, 0.75]; P<0.00001) both displayed that statin therapy exerted positive impact on secondary prevention of ischaemic stroke.

Conclusions: Statin therapy has a positive effect on reducing the risk of recurrent stroke (any type)  and recurrent ischaemic stroke for ischaemic stroke survivors; however, no strong evidence can prove statin reduces the risk of recurrent haemorrhagic stroke.

Disclosure: No

P0320 / 1092

CEREBROVASCULAR DISEASE INCIDENCE AND MORTALITY CORRELATED WITH AIR TEMPERATURE AMONG NUR-SULTAN ADULT POPULATION

B. Assel ¹, S. Karlygash¹

¹ Astana Medical University, Nur-Sultan, Kazakhstan

Summary: Climate of Nur-Sultan is sharply continental. Average annual temperature is 3.2 - 3.5°C. Nur-Sultan is the second coldest capital in the world.

Goal: Determine seasonal dependence of mortality.

Methods: Retrospective analysis of CVD daily mortality with daily temperature data.

Results: Analysis of cerebrovascular mortality among Nur-Sultan adults for 2013-2021 by seasons (Table 1) showed that the highest CVD mortality is observed in autumn and winter, then spring and summer.

Table 1.

Age/season	spring		summer		autumn		winter		Total
	female	male	female	male	female	male	female	male	female	male
18-44	15	26	17	29	8	25	14	26	54	106
45-59	55	88	44	66	40	81	70	110	209	345
60-74	120	115	115	135	145	139	122	119	502	508
75 and above	222	105	204	88	234	126	215	103	875	422
Subtotal	412	334	380	318	427	371	421	358	1640	1381
Seasons total	746		698		798		779		3021

Month, season, period, sex and age groups -based analysis of materials was conducted: young, middle, elderly and senile with determination of Spearman and Pearson correlation coefficient. Age group distribution of patients: 117 (5.2%), 441 (19.4%), 853 (37.5%) and 861 (37.9%), respectively. Moreover, in first 2 age groups, mortality prevailed among men, especially young age, in senility among women - 589. Autumn -583 died, winter -582, slightly less in spring -575 and summer -532. Relationship between mortality and temperatures by seasons was mostly weak (r = up to 0.300).

Conclusion: CVD mortality is slightly higher in autumn and winter, lowest mortality is in summer.

Disclosure: No

P0321 / 647

INCIDENCE RATES AND RISK FACTORS FOR MAJOR GASTROINTESTINAL BLEEDING AFTER ISCHEMIC STROKE

J.Y. Kim ¹, K.-J. Lee¹, B.J. Kim¹, J. Kang¹, M.-K. Han¹, S.-E. Kim¹, J.-M. Park², K. Kang³, S.J. Lee⁴, J.G. Kim⁴, J.-K. Cha⁵, D.-H. Kim⁵, T.H. Park⁶, K.B. Lee⁷, H.-K. Park⁸, Y.-J. Cho⁸, K.-S. Hong⁸, K.-H. Choi⁹, J.-T. Kim⁹, D.-E. Kim¹⁰, W.-S. Ryu¹⁰, J.C. Choi¹¹, M.-S. Oh¹², K.-H. Yu¹², B.-C. Lee¹², K.-Y. Park¹³, J.S. Lee¹⁴, J. Lee¹⁵, H.-J. Bae¹

¹Seoul National University Bundang Hospital, Seoul National University College of Medicine, Neurology, Seongnam, Korea, Republic of, ²Uijeonbu Eulji Medical Center, Eulji University, Neurology, Uijeongbu, Korea, Republic of, ³Nowon Eulji Medical Center, Eulji University, Neurology, Seoul, Korea, Republic of, ⁴Eulji University Hospital, Eulji University College of Medicine, Neurology, Daejeon, Korea, Republic of, ⁵Dong-A University Hospital, Dong-A University College of Medicine, Neurology, Busan, Korea, Republic of, ⁶Seoul Medical Center, Neurology, Seoul, Korea, Republic of, ⁷Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Neurology, Seoul, Korea, Republic of, ⁸Inje University Ilsan Paik Hospital, Neurology, Goyang, Korea, Republic of, ⁹Chonnam National University Hospital, Chonnam National University College of Medicine, Neurology, Gwangju, Korea, Republic of, ¹⁰Dongguk University Ilsan Hospital, Neurology, Goyang, Korea, Republic of, ¹¹Jeju National University Hospital, Jeju National University School of Medicine, Neurology, Jeju, Korea, Republic of, ¹²Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Neurology, Anyang, Korea, Republic of, ¹³Chung-Ang University Hospital, Chung-Ang University College of Medicine, Neurology, Seoul, Korea, Republic of, ¹⁴Asan Institute for Life Sciences, Asan Medical Center, Clinical Research Center, Seoul, Korea, Republic of, ¹⁵Korea University College of Medicine, Biostatistics, Seoul, Korea, Republic of

Background and aims: Incidence of major gastrointestinal bleeding (GIB) required blood transfusion after acute ischemic stroke (AIS) was reported as 0.5% during hospitalization. However, it is not known about the long-term incidence rates by period after AIS.

Methods: AIS patients who were admitted to the 14 hospitals between 2011 and 2013 were identified using a nationwide multicenter prospective stroke registry database. GIB was captured with diagnosis codes through linkage between registry and claims data. GIB requiring at least 2 packs of blood transfusion was defined as major GIB. Incidence rates were calculated for each epoch; 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3years, after 3 years.

Results: Of 10,818 AIS patients (male, 59%; age, 68±13 years), 947 patients (8.8%) had 1,224 episodes of major GIB during median follow-up of 3.1 years. Twenty percent of these 947 had ⩾2 bleeding episodes. The second bleeding occurred mostly within a month of the first. The incidence rates were highest in the first month with 19.21 per 100 person-years, and gradually decreased to about 1/6 at the first year, and then showed plateau above 3 years. In the multivariable recurrent event analysis, anemia at admission, lower eGFR below 60, and 3-month mRS ⩾4 were independently associated with higher risk of major GIB during the observation periods.

Conclusions: Major GI bleeding occur frequently after AIS in the first month, and the risk was gradually decreased. The efforts are needed to prevent it, especially in patients with anemia and decreased renal function.

Disclosure: No

P0322 / 1016

ISCHEMIC STROKE IN YOUNG ADULTS IN SPAIN: CHANGE IN STROKE TRENDS FROM 2000 TO 2018

L. Amaya Pascasio ¹, M. Blanco Ruiz¹, J. Fernández Pérez¹, J.M. García Torrecillas², R. Milán Pinilla¹, P. Martínez Sánchez^3,1, NeuroEPi Study Group

¹Torrecardenas University Hospital, Neurology, Almeria, Spain, ²Torrecardenas University Hospital, Emergency, Almería, Spain, ³University of Almeria, Health Sciences, Almeria, Spain

Background and aims:  Recent studies warn about a greater incidence of ischemic stroke (IS) and cardiovascular risk factors in young adults. This study aims to analyse the in-hospital epidemiology of IS and prevalence of risk factors in young adults in Spain during 2000-2018.

Methods: Observational study based on the hospital episode database collected by the Spanish Health Service. Patients between 18-50 years with IS as main diagnosis at discharge during 2000-2018 were included. The incidence was estimated with the population registered in the National Statistics Institute. The correlation between in-hospital mortality and reperfusion therapies was analyzed with Spearman’s non-parametric test.

Results: Overall, 50.861 IS episodes were registered, 65,4% were males, median age 45 (IQR 40-48). The estimated IS in-hospital incidence increased from 8.5/100.000 in 2000 to 13.7/100,000 in 2018. The in-hospital IS mortality decreased from 4.3% to 2.4% and the rate of thrombolysis and mechanical thrombectomy increased from 0,4% and 0% to 10.9% and 7.8%. A negative correlation was found between reperfusion treatment and IS in-hospital mortality (p<0.001). The rate of hypertension varied between 31%-35.5% and of diabetes between 12.5%-15.2%. The rates of smoking, dyslipemia and obesity increased over the years, from 36.9% to 54.9%; 21% to 30.1% and 5.3% to 12.9%, respectively.

Conclusions: The incidence of IS has increased among young adults in Spain during the last decade, with an increase in the rate of reperfusion treatment and a decrease in the in-hospital mortality. Likewise, there has been an increasing trend in the prevalence of smoking, dyslipidemia and obesity.

Disclosure: No

P0324 / 1389

EFFECT OF PRECONDIOTIONING INDUCED BY PREVIOUS TRANSIENT ISCHEMIC ATTACK PHENOMENA IN THE OUTCOME OF ACUTE ISCHEMIC PATIENTS, A META-ANALYSIS UPDATE

F. Purroy ^1,2,3, M. Baraldés⁴, D. Vazquez-Justes¹, G. Mauri¹

¹Hospital Universitari Arnau de Vilanova de Lleida, Stroke Unit, Lleida, Spain, ²IRBLleida, Lleida, Spain, ³UdL, Lleida, Spain, ⁴Hospital Universitari Arnau de Vilanova de Lleia, Stroke Unit, Lleida, Spain

Background and aims: Transient ischemic attacks (TIAs) before an acute ischemic stroke (AIS) could induce ischemic tolerance phenomena (IT). Existing studies report conflicting findings for the association of previous TIA (pTIA) with clinical and neuroimaging outcomes. Our aim was to systematically determine the clinical effect of pTIA and to define the characteristics related to a better outcome.

Methods: We searched for studies from January 1999 to June 2021 according to PRISMA guidelines. We included AIS studies which reported pTIA and clinical outcomes. We performed both fixed and random effects meta-analyses to determine clinical outcomes and to assess sources of heterogeneity.

Results: A systematic search yielded 14 articles that included a total of 26,897 patients. 5,427 (20.2%) had pTIA. Although clinical endpoints variated significantly in 12 up to 14 studies, we observed a beneficial effect of pTIA. Globally, pTIA was related to a better outcome: odds ratio (OR) 1.80 (1.41-2.30). The effect was greater when we considered a clinical outcome of mRS<=1 at 90 days: OR 2.26 (1.61-3.17) and when we considered pTIA within the first week before AIS: OR 7.34 (3.64-14.82). pTIA was significantly related to large-artery atherosclerosis: OR 1.88 (1.56-2.27).

Conclusions: Recent previous TIA was associated with better clinical outcome. This fact encourages the study of the IT in these patients to identify biomarkers related to neuroprotection and neurorepair phenomena that should be adjusted for etiology.

Disclosure: No

P0325 / 804

PRE-STROKE PHYSICAL ACTIVITY IS ASSOCIATED WITH SMALLER HEMATOMA VOLUMES IN PATIENTS WITH PRIMARY INTRACEREBRAL HEMORRHAGE, A RETROSPECTIVE REGISTRY-BASED STUDY IN SWEDEN

A. Viktorisson ¹, D. Buvarp¹, T. Skoglund¹, K. Stibrant Sunnerhagen¹

¹ University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden

Background and aims: Hematoma volume is the most dominant predictor of mortality following intracerebral haemorrhage (ICH). However, modifiable determinants of hematoma volume in ICH are scarce. Physical activity (PA) may improve outcomes after stroke, but the relationship between pre-stroke PA and the volume of ICH has not been previously studied.

Methods: All patients with a radiologically verified primary ICH admitted to three stroke units in Gothenburg, Sweden, between 1 November 2014 and 30 June 2019 were included. We reviewed admission brain imaging to asses hematoma volume using the ABC/2 formula for approximation of an ellipsoid. Pre-stroke PA was defined as regular light PA for ⩾4 hours/week. Multivariable linear regression models were used to estimate adjusted associations of pre-stroke PA in deep, lobar and infratentorial ICH.

Results: We included 686 patients with primary ICH, of which 255 (37%) were physically active. There were 349 (51%) cases of deep, 240 (35%) cases of lobar, and 97(14%) cases of infratentorial ICH. Among infratentorial cases, 65 (67%) were cerebellar and 32 (33%) in the brain stem. Pre-stroke PA was associated a 36% mean decrease in deep ICH volumes (β=0.36, 95% confidence interval [CI] 0.52-0.19), a 25% decrease in lobar ICH volumes (β=0.25, 95% CI 0.45-0.05), and a 39% decrease in infratentorial ICH volumes (β=0.39, 95% CI 0.68-0.09). Intraventricular breakthrough occurred less often in physically active patients (24% vs 39%, χ2=16.3, p<0.001).

Conclusions: Our results suggest that regular light PA prior to a primary ICH is associated with smaller intraparenchymal hematoma volumes.

Disclosure: No

P0326 / 416

CONCERNINGLY HIGH INCIDENCE AND POOR OUTCOME FOR STROKE IN MONGOLIA: A PROSPECTIVE POPULATION-BASED STUDY IN ULAANBAATAR DURING 2019-2021

C. Banzrai ¹, O. Bosookhuu², E. Yadamsuren², B. Dambasuren², S. Turbat², T. Erdenedalai², M. Myagmarsuren², U. Munkhtur², K. Baatar², P. Boldbaatar², T. Avirmed³, B. Badrakh⁴, M. Ouyang⁵, X. Chen⁵, X. Wang⁵, C. Anderson⁵

¹Department of Neurology, Institute of Medical Sciences, National University of Medical Sciences, Ulaanbaatar, Mongolia, ²Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia, ³School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia, ⁴Ach Medical University, Ulaanbaatar, Mongolia, ⁵The George Institute for Global Health, University of New South Wales, Sydney, Australia

Background and aims: A prospective population-based study was undertaken to determine the incidence and outcome of stroke in Ulaanbaatar, Mongolia.

Methods: All stroke cases were identified through hot and cold surveillance methods via multiple overlapping sources using standardised criteria in the resident (age ⩾15 years) population (N=991504) of Ulaanbaatar, Mongolia between 1 January 2019 and 31 December 2020, and followed up over 12 months. Crude and standardised incidence of first-ever stroke and subtypes, and 28-day case fatality and 90-day functional outcome, reported with 95%CI.

Results: 3803 strokes in 3738 patients were identified, with 2962 first-ever incident cases (mean age 59 [SD 13] years; 39.2% female). Crude annual incidence of first-ever stroke (per 100,000) was 149.4 (95%CI 141.8-157.0) and age adjusted to Mongolian and World populations of 175.5 (95%CI 160.9-190.0) and 143.6 (95%CI 139.8-147.4).  World-adjusted incidence rates were 68.4 (95%CI 66.5-70.2), 55.8 (95%CI 54.1-57.4) and 19.0 (95%CI 18.6-19.4) for ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage; the latter being several-fold higher than elsewhere. 28-day case-fatality and functional outcomes were poor.

Conclusions: The low resource population of Mongolia has a very high incidence of hypertension-related intracerebral haemorrhage and subarachnoid haemorrhage, from which over two thirds are either dead or dependent at 90 days. These reliable epidemiological data can inform the implementation of future programs and scale-up activities for the primary and secondary prevention of stroke.

Funding: Science and Technology Foundation of the Ministry of Education, Culture and Science of Mongolia (SHuUz-2018/32) and The George Institute for Global Health.

Disclosure: No

P0327 / 308

INCIDENCE, AETIOLOGY AND 30-DAY-MORTALITY RATE OF INTRACEREBRAL HAEMORRHAGE: A POPULATION-BASED STUDY

M. Hay¹, M. Watrin¹, R. Schneckenburger², L. Guittet³, E. Touzé², M. Boulanger ²

¹University of Caen Normandie, Caen, France, ²University of Caen Normandie-INSERM U 1237, Neurology, Caen, France, ³University Caen Normandie-INSERM U 1086 ANTICIPE, Caen, France

Background and aims: Up-to-date information on intracerebral haemorrhage (ICH) epidemiology is important for care planning and resource allocation.

Methods: In a population-based cohort of stroke patients in Normandy, France, we calculated the age-standardized incidence rate (ASR) of spontaneous (non-traumatic) ICH, using the 2013 European Standard Population, and the 30-day mortality rate for 2017-2020. ICH location was defined as lobar (cerebral or cerebellar cortex) and non-lobar (basal ganglia, thalami, brainstem or deep cerebellum). The use of brain MRI was required to conclude on primary ICH aetiology. The diagnosis of cerebral amyloid angiopathy (CAA) was based on the Boston criteria and of hypertensive microangiopathy on the presence of at least one small vessel disease biomarker, chronic hypertension and no other cause.

Results: There were 204 first-ever ICH (mean age=75 years, 49% lobar ICH). ICH aetiologies were: 35.3% hypertensive microangiopathy; 15.2% CAA; 6.4% vascular malformations; 4.4% coagulopathies; 4.4% tumour; 3.9% cryptogenic, 22.1% were suspected of having hypertensive microangiopathy and 4.4% of CAA but no MRI was performed, and 3.9% undetermined due to incomplete workup. The ASRs were 25.2 per 100,000 person-years (95%CI 21.7-28.6) overall, 25.8 (20.2-31.3) and 23.7 (19.4-28.0) per 1000,000 person-years in men and women respectively. The ASR were 8.3 per 100,000 person-years (6.3–10.3) for MRI diagnosed hypertensive microangiopathy and 3.7 per 100,000 person-years (2.4–5.0) for CAA. The overall 30-day mortality rate was 40.7% (33.9–47.4)

Conclusions: The main cause of ICH is hypertensive microangiopathy. The current early mortality rate after ICH remains high, even in high-income countries.

Disclosure: No

P0328 / 586

PREVALENCE OF DIABETES AND ITS EFFECTS ON IN-HOSPITAL OUTCOMES AMONG PATIENTS WITH ACUTE ISCHEMIC STROKE ACROSS CHINA

G. Hu ¹, H. Gu², Y. Jiang², X. Yang², C. Wang², Y. Jiang², Z. Li¹, Y. Wang¹, Y. Wang¹

¹Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ²China National Clinical Research Center for Neurological Diseases, Beijing, China

Background and aims: Guidelines have classified patients with acute ischemic stroke (AIS) and diabetes as a special population for management considering their extremely high risk. However, in China the updated information of the burden of diabetes in AIS patients is lacking and the impact of diabetes on in-hospital outcomes of these patients is unclear. This study aims to provide updated estimation for the burden of diabetes in AIS patients in China and to evaluate the relationship between diabetes and in-hospital outcomes after AIS.

Methods: The Chinese Stroke Centre Alliance was launched in 2015 to monitor and improve care quality and outcomes for AIS patients. A total of 838,229 AIS inpatients were included from 1,476 hospitals in China. Multivariate logistic regression was performed to examine the association between diabetes and in-hospital outcomes.

Results: Of these patients, 280,234 (33.4%) had diabetes. The prevalence of diabetes was higher in women than in men (36.8% versus 31.4%). Even in patients younger than 45 years, 23.7% had diabetes. Patients with history of cerebrovascular diseases had higher rate of diabetes than those without (37.5% versus 31.6%). Multivariable analysis showed that diabetes was associated with higher risk of all-cause mortality (odds ratio (OR)=1.44, 95% confidence interval (CI): 1.33-1.55) and recurrent ischemic stroke (OR=1.14, 95% CI: 1.12-1.17) in AIS patients.

Conclusions: Diabetes was highly prevalent and associated with increased risk of all-cause mortality and recurrent ischemic stroke among AIS patients in China. Implementing appropriate management of diabetes for AIS patients should be considered a priority for clinical practice.

Disclosure: No

P0329 / 390

RISK FACTORS IN STROKE PATIENTS IN THE REPUBLIC OF MOLDOVA: ANALYSIS OF FIRST DATA FROM THE RES-Q REGISTRY

S. Groppa ^1,2, E. Manole³, N. Ciobanu¹, S. Plotnicu^1,2, I. Crivorucica², O. Odainic⁴

¹Nicolae Testemitanu State University of Medicine and Pharmacy, Neurology Department 2, Chisinau, Moldova, Republic of, ²Institute of Emergency Medicine, Chisinau, Moldova, Republic of, ³Nicolae Testemitanu State University of Medicine and Pharmacy, Neurology Department 1, Chisinau, Moldova, Republic of, ⁴Diomid Gherman Institute of Neurology and Neurosurgery, Chisinau, Moldova, Republic of

Background: There is no national registry of stroke patients in the Republic of Moldova. The National Bureau of Statistics focuses mostly on the demographics of patients with stroke. Dyslipidemia, obesity, hypertension, smoking, and diabetes are the main risk factors in the general population of Moldova. The Registry of Stroke Care Quality (RES-Q), which has been used by hospitals in the Republic of Moldova since 2017, has launched a new form (Comprehensive RES-Q), which contains information on stroke risk factors.

The aim of our study was to analyse risk factors in stroke patients based on the RES-Q registry.

Methods: A descriptive analysis of stroke patients from 11 hospitals in the Republic of Moldova was performed. The data were collected for 1 month in 2021. Each hospital registered at least 30 consecutive patients with acute stroke and completed the information on the online RES-Q platform. Statistical analysis was performed by the RES-Q team.

Results: 430 patients were collected, median age 68 y, 55% male. The main modifiable risk factors included: hypertension (78%), atrial fibrillation (AF) (28%), congestive heart failure (25.5%), hyperlipidemia (23%), diabetes (21%). There were 23% of patients with recurrent stroke and 11% were smokers. At discharge 93.5 % of all patients were prescribed antiplatelets and 95.6% - antihypertensives. 61% of patients with IS and AF were recommended anticoagulants and 15.5% from smokers were discouraged to smoke.

Conclusions: There is a need for continuous monitoring of risk factors in order to improve stroke prevention strategies in the Republic of Moldova.

Disclosure: No

P0330 / 1229

LOGISTIC FACTORS INFLUENSING IN-HOSPITAL OUTCOME AND MORTALITY IN PATIENTS WITH INTRACEREBRAL HEMORRHAGE (DATA FROM POMERANIAN STROKE REGISTER)

E. Brelak ¹, P. Sobolewski², J. Antecki¹, W. Szczuchniak³, G. Kozera⁴

¹Regional Hospital in Kielce, Department of Neurology and Stroke Unit, Kielce, Poland, ²Collegium Medicum of Jan Kochanowski University, Department of Neurology and Storke Unit in Sandomierz, Sandomierz, Poland, ³Jan Kochanowski University, Kielce, Department of Neurology and Storke Unit in Sandomierz, Sandomierz, Poland, ⁴Medical University of Gdańsk, Medical Simulation Center, Gdańsk, Poland

Background and aims: Intracerebral hemorrhage (ICH) is a critical disease usually leading to severe disability or death. The management of patients with ICH is still a serious challenge for medical services. The aim of the study was to identify factors influencing in-hospital outcome and mortality.

Methods: An observational, retrospective study included 8.790 patients with acute ischemic stroke (AIS) including 813 patients with ICH, who had been hospitalized in the stroke units and consequently reported to the Pomeranian Stroke Register (PRUM) in the period of 2009-2013.

Results: Factors that negatively affected the functional condition of patients with ICH were: unknown time of the ICH onset (p=0.019); living in a rural area (p=0.019); motor deficiency(p<0.001); high rate in the NIHSS upon admission to hospital (p<0.001) whereas factors that caused higher in-hospital mortality were: unknown time of the ICH onset (p=0.001); living in a rural area (p=0.023); age over 80 (p=0.029); atrial fibrillation (p=0.006); disturbance of consciousness (p<0.001); severe neurological state upon admission to hospital according to the NIHSS (p<0.001). Professional activity (p=0.01) had a favorable impact on the functional condition according to mRS 3-5, and dyslipidemia (p=0.001) and preliminary diagnosis of cerebral stroke (p=0.037) were factors that decreased the in-hospital mortality rate.

Conclusions: Unknown time of the stroke onset and living in a rural area were logistic factors influencing in-hospital outcome and mortality among patients suffering from ICH.

Disclosure: No

P0331 / 305

OUTCOMES AND COMPLICATIONS IN ACUTE STROKE WITH AND WITHOUT THALASSEMIA IN THAILAND

M. Phasuknit¹, S. Tiamkao¹, K. Thepsuthammarat², K. Kongbunkiat ³

¹Khon Kaen University, Internal Medicine, Khon Kaen, Thailand, ²Khon Kaen University, Khon Kaen, Thailand, ³Khon Kaen University, North-Eastern Stroke Research Group, Khon Kaen, Thailand

Background and aims: Thalassemia is a common hereditary illness that affects people in many areas, including Southeast Asia. There are currently limited studies examining the complications and outcomes of acute stroke patients with thalassemia. Our objective is to study outcome and complications in acute stroke (ischemic and hemorrhagic stroke) with and without thalassemia in Thailand.

Methods: A retrospective analytic study from Universal Coverage Health Security Insurance Scheme Database in Thailand, 1 October 2007- 30 September 2017. Compare the incidence of complications among acute stroke patients with and without thalassemia.

Results: 399,813 ischemic stroke patients had thalassemia 25,285 representing 6.32%. Ischemic stroke with thalassemia had more incidence of complications than without thalassemia: pneumonia (Adjusted OR 1.73,  95%CI 1.66-1.81), urinary tract infection (1.89, 95%CI 1.81-1.98), sepsis (1.55, 95%CI 1.47-1.64), gastrointestinal bleeding (4.03, 95%CI 3.79-4.28), acute renal failure (2.19, 95%CI 2.09-2.30), respiratory failure (1.37, 95%CI 1.31-1.44). 150,559 hemorrhagic stroke patients had thalassemia 18,873 representing 12.54%. Hemorrhagic stroke with thalassemia had more incidence of complications than without thalassemia: pneumonia (Adjusted OR 2.31, 95%CI 2.22-2.41), urinary tract infection (1.57, 95%CI 1.49-1.66), sepsis (1.50, 95%CI 1.41-1.59), gastrointestinal bleeding (2.52, 95%CI 2.31-2.75), acute renal failure (2.07, 95%CI 1.94-2.21), respiratory failure (1.76, 95%CI 1.69-1.82) and mortality at discharge (1.03, 95%CI 1.02. -1.08).

Conclusions: Ischemic stroke and hemorrhagic stroke in patients with thalassemia had a higher rate of complications than without thalassemia.

Disclosure: No

P0332 / 1180

RISK FACTORS FOR ISCHAEMIC STROKE IN RURAL AND URBAN RESIDENTS - A COMPARATIVE ANALYSIS OF DATA FROM POMERANIAN STROKE REGISTER

J. Antecki ¹, E. Brelak¹, W. Szczuchniak², P. Sobolewski³, G. Kozera⁴

¹Regional Hospital, Department of Neurology and Stroke Unit, Kielce, Poland, ²Jan Kochanowski University, Department of Neurology and Stroke Unit in Sandomierz, Sandomierz, Poland, ³Collegium Medicum of Jan Kochanowski University, Department of Neurology and Stroke Unit in Sandomierz, Kielce, Poland, ⁴Medical University of Gdańsk, Medical Simulation Center, Gdansk, Poland

Background and aims: Stroke is the most common acute neurological disease and reason for adult disability. Stroke care quality may differ between rural and urban areas, however associations between its risk factors profile and patients’ residence has not been analyzed in Poland yet.

Methods: An observational, retrospective study on 7977 patients with acute ischaemic stroke, including 64% rural residents, hospitalized in the Polish Stroke Units and consequently reported to the Pomeranian Stroke Register from 2009-2013.

Results: Patients living in rural areas were characterized by a higher presence of males (50,0 vs. 47 %, p<0,01), subjects aged < 55 years (8,8 vs. 7,1 %, p=0,01) and a lower presence of living alone (11,7 vs. 17,9 %, p<0,01) and those with a higher education (5,7 vs 15,1 %, p<0,01).  The proportion of overweight and/or obesity was higher in rural than in urban residents (83,4 vs. 63,8 %, p<0,01), a lower presence of arterial hypertension (71,4 vs. 76,8 %, p<0,01) diabetes mellitus (26,7 vs. 30,2 %, p<0,01), hyperlipidemia (41,5 vs 46,2 %, p<0,01), coronary heart disease (28,9 vs. 34,0 %, p<0,01) and smoking habit (29,8 vs 34,0, p<0,01) characterized rural residents.  Rural residence independently impacted presence of obesity (OR 1,41), coronary disease (OR 0,78); pre-stroke detection of atrial fibrillation (OR 0,74) and antiplatelets use after discharge (OR 0,73).

Conclusions: Risk profile differs between stroke patients from rural and urban areas.  Rural residence has an impact of some risk factors presence, its recognition and secondary prevention.

Disclosure: No

P0333 / 543

PREVALENCE AND DISTRIBUTION OF LACUNAR INFARCTION IN CHINA: RESULTS FROM THE NESS-CHINA STUDY

S. Han ¹, D. Sun², B. Jiang², H. Sun², X. Ru², A. Jin¹, Y. Wang¹, W. Wang²

¹Beijing Tiantan Hospital, Neurology, Beijing, China, ²Beijing Neurosurgical Institute, Beijing, China

Abstract

Background and aims: Lacunar infarction is of increasing interest in China. However, the prevalence and distribution of lacunar infarction across the country have not yet been reported. This study aims to report the real-world prevalence and distribution of lacunar infarction in different regions of China, as well as the demographical characteristics of symptomatic and asymptomatic lacunar infarction.

Methods: Data was collected from the NESS-China study, a national representative cross-sectional population-based study conducted in 2013. Diagnosis of lacunar infarction was defined by neurologists, and data was collected through a door-to-door survey.

Results: A total of 458,833 participants aged ⩾20 years were enrolled in this study, 7,520 (1.63%) of whom have been diagnosed with lacunar infarction. The peak rate of diagnosis was at the age of 70–79 years in both males and females. Geographically, the age- and sex-standardized prevalence was the highest in Northeast China (2,495.3/100,000 persons) and lowest in Southeast China (599.7/100,000 persons), showing a geographic disparity. Over 90% of patients with lacunar infarction were diagnosed in secondary or tertiary hospitals. Patients who were diagnosed with symptoms had significantly different demographic characteristics in age and geographic regions compared to those who were diagnosed without symptoms.

Conclusions: In this study, the prevalence and distribution of lacunar infarction were reported on a population level across China. Special attention and prevention should be given to the age, sex, and geographic groups that are vulnerable to lacunar infarction.

Disclosure: No

IMAGING – HYPERACUTE

P0334 / 1178

ISCHEMIC LESION EVOLUTION IN PATIENTS WITH ACUTE ISCHEMIC STROKE TREATED WITH INTRAVENOUS ALTEPLASE FOLLOWED BY ENDOVASCULAR TREATMENT VERSUS ENDOVASCULAR TREATMENT ALONE

J.W. Hoving ¹, M. Kappelhof¹, K.M. Treurniet¹, N.E. LeCouffe², H. van Voorst³, P.R. Konduri⁴, F. Cavalcante³, I. van den Wijngaard⁵, H.F. Lingsma⁶, J.M. Coutinho², Y.B. Roos², B.J. Emmer¹, C.B. Majoie¹, MR CLEAN-NO IV Investigators

¹Amsterdam University Medical Centers, University of Amsterdam, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ²Amsterdam University Medical Centers, University of Amsterdam, Neurology, Amsterdam, Netherlands, ³Amsterdam University Medical Centers, University of Amsterdam, Biomedical Engineering and Physics; Radiology and Nuclear Medicine, Amsterdam, Netherlands, ⁴Amsterdam University Medical Centers, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, Netherlands, ⁵Haaglanden Medical Center, Neurology, The Hague, Netherlands, ⁶Erasmus University Medical Center, Public Health, Rotterdam, Netherlands

Background and aims: Ischemic lesion evolution after endovascular treatment (EVT) is associated with clinical outcome after acute ischemic stroke (AIS). We aim to assess whether ischemic lesion evolution after EVT is affected by administering intravenous alteplase (IVT).

Methods: We included patients with baseline CT perfusion (CTP) and follow-up diffusion-weighted imaging (DWI) or non-contrast CT (NCCT) from the MR CLEAN-NO IV trial. CTP data were processed using syngo.via (version VB40). Follow-up lesion size was semi-automatically segmented on either 24h follow-up DWI or NCCT. Ischemic lesion evolution was defined as the difference between follow-up lesion volume and baseline CTP core volume divided by the hours between baseline and follow-up imaging. A Mann-Whitney U test was performed to determine whether infarct growth rates were different between patients who received IVT followed by EVT versus EVT alone.

Results: In 104 included patients, the median CTP core volume was 12 (IQR 4-34) mL. Any infarct growth occurred in 22/51 (43%) patients treated with IVT followed by EVT (median growth 0.7 [IQR 0.1-4.1] mL/h), versus 27/53 (51%) patients treated with direct EVT (median 1.1 [IQR 0.9-2.5] mL/h). Infarct growth >10 mL occurred in 13/51 (26%) patients treated with IVT followed by EVT versus 19/53 (36%) patients treated with EVT alone (p=0.6).

Conclusions: Ischemic lesion evolution is not different between patients who received IVT followed by EVT versus patients who received EVT alone. Administering or withholding IVT prior to EVT does not seem to affect ischemic lesion evolution after EVT.

Disclosure: No

P0335 / 1249

MULTIPHASE CT ANGIOGRAPHY PERFUSION PREDICTS FOLLOW-UP INFARCTION AS WELL AS CT PERFUSION

L.A. Souto Maior Neto ¹, H. El-Hariri¹, R. Golan¹, S.H. Mousavi¹, M.U. Sadiq¹, I. Olajumoke Elebute¹, C. Duszynski¹, A. Sojoudi¹, W. Qiu², B.K Menon²

¹Circle Neurovascular Imaging, Calgary, Canada, ²University of Calgary, Calgary, Canada

Background and aims: In patients with acute ischemic stroke, baseline CT Perfusion (CTP) is often used for brain tissue fate prediction. However, CTP is affected by patient motion and is not widely available outside of tertiary hospitals. Multiphase CT Angiography (mCTA) is a simple addition of low-radiation dose scans to the typical CT Angiography workflow. Here, we evaluate StrokeSENS mCTA Perfusion, which predicts brain blood flow information and tissue fate, and compare it to CTP.

Methods: 551 subjects with baseline non-contrast CT (NCCT), mCTA, CTP, and 24-48h-follow-up DWI/NCCT were included. 480 were used for the development of StrokeSENS mCTA Perfusion, while 71 were used for validation. Two expert neuroradiologists annotated follow-up infarction on DWI/NCCT. We compared time-to-maximum (Tmax) and cerebral blood flow (CBF) perfusion maps from a) StrokeSENS mCTA Perfusion (mCTAp) and b) GE Perfusion 4D (CTP) in their ability to predict, at baseline, follow-up infarction at a voxel-level. AUC-ROC are reported and stratified by imaging-to-reperfusion time. Two-sided p-values > 0.05 were considered as non-statistically significant differences.

Results: For Tmax, mCTAp and CTP had mean AUC-ROC of 73.2% (95%C.I.:[69%,77%]) and 74.8% (95%C.I.:[69%,80%]), p=0.6268. respectively. For CBF, mCTAp and CTP had mean AUC-ROC of 63.5% (95%C.I.:[59%,68%]) and 66.7% (95%C.I.:[62%,71%]), p=0.2952. respectively. CTP and mCTAp AUC-ROCs overlapped significantly across reperfusion timings, except for <90minutes for Tmax (Figure), with mCTAp higher than CTP for reperfusion within 90-to-180 minutes.

Conclusions: In patients with acute ischemic stroke, StrokeSENS mCTA Perfusion performed as well as CTP at baseline in ability to predict follow-up infarction.

Disclosure: Yes

P0336 / 1315

HYPERACUTE DWI POSITIVE MRI LESIONS IN PATIENTS WITH TIA: CLINICAL PREDICTORS AND OUTCOME RELATIONSHIP

M.R. de Torres Chacón ¹, S. Perez Sanchez¹, T. Busquier Cerdan², M.A. Gamero Garcia¹, I. Morales Barroso³, N. Perez Sanchez², A. Fuerte Hortigon¹, J.M. Garrido Castillo³, M. Garcia Marin², C. Navarro Bustos³, J. Montaner¹, RUN-AIT Study Group

¹Hospital Virgen Macarena, Neurology, Seville, Spain, ²Hospital Virgen Macarena, Radiology, Seville, Spain, ³Hospital Virgen Macarena, Emergency, Seville, Spain

Background and aims: Transient ischemic attack (TIA) is clinically described as the presence of neurological symptoms lasting less than 24 hours. We explored the neuroimaging data of RUN-TIA Study searching for clinical factors related to the presence of acute lesions and the role of those lesions in TIA outcome.

Methods: We included patients with clinical diagnosis of TIA during 2021. Patients were evaluated by a neurologist and undergo cranial MRI with DWI sequences in the first 24 hours of TIA onset. We collect baseline and neuroimaging characteristics, looking for differences between patients who present acute lesion in neuroimaging and those who do not.

Results: 73 patients included. 44.4% (32) were women, mean age 68.5 years. 67.1% (49) had hypertension, 39.7% (29) diabetes and17.8% (13) atrial fibrillation. Median ABCD2 score was 4 (1-7). Mean symptoms duration was 59.8 minutes. 39.7% (29) had DWI positive lesions. DWI-positive patients had higher ABCD2 score (median 5 vs 4; p=0.034), had symptoms that lasted more than 60 minutes (48.3% vs 18.6%; p=0.027) and motor impairment (62.1% vs 34.9%; p=0.071).

DWI positive patients had a higher rate of recurrence in the first month (11.5% vs 0%; p=0.023).

Conclusions: MRI plays an important role in patient management since a negative result means that patients are discharged safely and with a very low risk of recurrence. Nevertheless, we encourage intensified vigilance and diagnostic workup of patients with these characteristics, even when there is no possibility of performing an MRI to confirm the presence of acute lesions.

Disclosure: No

P0337 / 1284

GLYMPHATICS COUNT: INCORPORATING INFORMATION ON GLYMPHATICS USING BOLD-MRI IMPROVES PREDICTION OF CEREBRAL EDEMA

D. Carone ¹, J. Garrard¹, F. De Angeli², A. Sodero³, P. Jezzard⁴, J. Kennedy¹

¹University of Oxford, Acute Vascular Imaging Centre, Radcliffe Department of Medicine, Oxford, United Kingdom, ²Niguarda Hospital, S.C. Neurologia e Stroke Unit, Milan, Italy, ³University of Florence, NEUROFARBA Department, Neuroscience Section, Florence, Italy, ⁴University of Oxford, FMRIB, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom

Background and aims: Neurovascular-unit dysfunction and hyperaemia are key mechanisms in the development of cerebral edema. It has been suggested that the glymphatic system adds an important contribution to edema formation through the influx of cerebrospinal-fluid via the glymphatic pathway secondary to vessel diameter reduction. This work investigates the relationship between microvasculature status and edema in acute stroke patients using BOLD-MRI.

Methods: Consecutive patients enrolled in an observational MRI study underwent BOLD imaging alongside DWI and ASL-perfusion within 24 hours of onset, and a T2-FLAIR at 1-week. Edema was measured by quantifying anatomical distortion relative to infarct size (rAD) at both timepoints. Vessel diameter at presentation was measured using the BOLD signal amplitude relative to the contralateral hemisphere. The relationship between BOLD-amplitude at presentation and rAD was explored using polynomial models.

Results: 41 patients were enrolled (Female: n=13; Age-Range:26-89years). Median rAD was 6% (IQR:1%-15%) at presentation and 17% (IQR:5%-40%) at 1-week. There was a quadratic relationship between BOLD-amplitude at presentation and rAD at both timepoints. The square of BOLD-amplitude remained an independent predictor of rAD at presentation (p-value <0.001) and at 1-week (p-value <0.001) in multivariate analyses, and improved model accuracy (R²: from 0.59 to 0.71-p<0.001 at presentation; from 0.56 to 0.82-p<0.001 at 1-week)

Conclusions: The results presented support the suggested role that the glymphatic system plays in edema formation following acute ischemic stroke, in addition to accepted roles of neurovascular-unit dysfunction and hyperaemia. Further work is required to guide the use of BOLD-MRI for patient stratification and personalization of patient care.

Disclosure: No

P0338 / 1341

COLLATERAL FLOW ASSESSMENT IN PATIENTS WITH RECURRENT STROKE UNDERGOING MECHANICAL THROMBECTOMY

M. Medina-Rodriguez ^1,2, J. Ortega-Quintanilla^3,2, B. Pardo-Galiana^1,2, E. Zapata-Arriaza^3,2, L. Ainz-Gomez^1,2, J.A. Cabezas-Rodriguez^1,2, A. de Alboniga-Chindurza^3,2, A. Gonzalez^3,2, F. Moniche^1,2

¹University Hospital Virgen del Rocio, Stroke Unit, Sevilla, Spain, ²Instituto de Biomedicina de Sevilla, Sevilla, Spain, ³University Hospital Virgen del Rocio, Interventional Neuroradiology Unit, Sevilla, Spain

Background and aims: Collateral flow (CF) is related to functional outcomes in stroke, but how to improve it remains uncertain. Our aim is to analyze modifiable factors related to CF in patients with recurrent stroke.

Methods: A retrospective observational study including patients with recurrent stroke involving anterior circulation undergoing mechanical thrombectomy (MT) was designed. Glycemia, blood systolic pressure (BSP), onset-to-CT and onset-to-groin time were compared at first stroke (FS) and recurrence. Good CF (GCF) was defined by CT-angiography (CTA) as a score of 2-3 in Tan Scale and by digital subtraction angiography (DSA) as 3-4 in ASITN/SIR scale.

Results: From 1932 MT performed between 2016-2020, 25 patients (women=11) with recurrent stroke were included. Mean age was 70.4 years. Recurrence occurred 204(IQ=4-213) days later. Onset-to-CT time was 215(IQ=120-557) vs 215 min(IQ=95-432.5)(p=0.35) and onset-to-groin time 335(IQ=177.5-515) vs 307 min(IQ=131.2-583.7)(p=0.45). By CTA, 67.7% had GCF at FS vs 58.1%(p=0.25), whereas 58.1% vs 51.6% had GCF by DSA(p=0.58). At FS, patients with GCF by CTA had similar glycemia[122(IQ=99-142) vs 106 mg/dl(105-110),p=0.78] and BSP(153±19.9 vs 134±24 mmHg,p=0.135) to patients with suboptimal CF. At recurrence, patients with GCF by CTA had similar glycemia[120(IQ=109-154) vs 124 mg/dl(IQ=104-173.5),p=0.89] and BSP(156±17.7 vs 151±31 mmHg,p=0.65). Similar results were obtained by DSA. FS-to-recurrence time did not correlate to CF. Sixteen patients (64%) had GCF at FS and recurrence.

Conclusions: In our cohort, modifiable factors did not predict a change in CF in patients with stroke recurrence. Other non-modifiable factors might be also related to GCF in stroke.

Disclosure: No

P0339 / 1288

RAPID AUTOMATED SOFTWARE UTILITY FOR ESTIMATING THE CONSERVED COLLATERAL CIRCULATION INDEX: A PRECISION TOOL

E. Valiente ¹, S. Trillo¹, C. Ramos¹, J. Vega², P. García-García², C. Alonso², E. de la Fuente¹, M. Domínguez Gallego¹, J. Alonso¹, Á. Ximénez-Carrillo¹, J.L. Caniego², J. Vivancos¹

¹Hospital Universitario La Princesa, Neurology, Madrid, Spain, ²Hospital Universitario La Princesa, Radiology, Madrid, Spain

Background and aims: Perfusion computed tomography(PCT) softwares allow to obtain parameters which indicate the degree of LCC in a fast, precise and reproducible way. Our objective is to study leptomeningeal collateral circulation(LCC) using RAPID software and some factors associated.

Methods: Retrospective study of patients with MCA stroke due to M1/T-carotid occlusion from August 2020-May 2021, with a study of PCT processed using RAPID. The degree of LCC was evaluated by 10 parameters obtained automatically. The best LCC estimator was determined by its association with LCC scales:PATHS, Tan and Hypoperfusion Index(HHI). The relationship between the degree of LCC was studied with 65 variables.

Results: N = 71. Average age 74.87(SD 14.53) Women 66.2%. Occlusion M1 54(76.1%). Endovascular treatment 56(78.9%). The best estimator of LCC was the relative flow reduction <34%(CBFr<34%), PATHS correlation(rho = 0.88; p <0.001), Tan(rho = 0.59;p <0.001) and HHI(rho = 0.86;p <0.001). CBFr<34% was transformed into a percentage index of conserved LCC and was called BIRDIE(BraIn collateRals rapiD IndEx). BIRDIE mean 0.7(SD 0.33). A higher BIRDIE was associated with mRS 0/1(p = 0.026) and overweight(BMI> 25;p = 0.036). A lower BIRDIE was associated with T-carotid occlusion(p = 0.004), lower ASPECTs(p <0.01), higher NIHSS(p <0.001), diastolic blood preassure> 100mmHg(p = 0.048) or sistolic blood preassure> 200mmHg(p = 0.003),cerebral small vessel disease(p = 0.022), systemic vascular disease(p = 0.045) and chronic kidney disease(p = 0.008).

Conclusions: In our study, RAPID is shown as an adequate estimator of LCC, especially using BIRDIE. LCC was fundamentally associated with vascular disease and, paradoxically, overweight.

Disclosure: No

P0340 / 123

ATYPICAL CLINICAL PRESENTATIONS OF SUSPECTED TIA AND MINOR ISCHAEMIC STROKE ARE COMMON IN PATIENTS WITH DWI-MRI CONFIRMED CEREBRAL ISCHAEMIA

P. Gallogly ¹, A. Chandratheva¹, J. Best¹, D. Werring¹, J. Hassan², C. Lee², J. Cousins¹, R. Jagar¹

¹The National Hospital for Neurology and Neurosurgery, Stroke, London, United Kingdom, ²University College London, Medical School, London, United Kingdom

Background and aims: Current diagnostic criteria for TIA/minor stroke disqualify several atypical clinical presentations, but pre-dated DWI-MRI use. DWI positive ischaemic lesions provide a definite diagnosis of cerebral ischaemia and are associated with increased stroke recurrence. We aimed to: (1) ascertain the proportion of DWI-positive patients with atypical presentations; and (2) identify clinical factors predicting DWI positivity.

Methods: We retrospectively reviewed consecutive patients with suspected TIA/minor stroke undergoing MRI at our comprehensive stroke centre from March 2020-February 2021. We identified clinical factors predicting DWI positivity using multivariable logistic regression.

Results: We included 1615 patients. Of the 442 who were DWI-positive, 38.5% had atypical presentations including 20% with progressive symptom onset. Atypical symptoms common in DWI-positive patients included headache (present in 17%), unsteadiness (15%), positive sensory symptoms (11%), presyncope (10%), confusion (9%) and vertigo (8%). Symptoms independently associated with DWI-positivity included weakness (OR 1.299, 95% CI 1.008-1.673), dysarthria (OR 2.056, CI 1.564-2.702), and ataxia (OR 3.750, CI 2.269-6.198). Fluctuating symptoms (present in 21.5%) predicted DWI positivity (OR 1.373, CI 1.004-1.806), but sudden onset (80.1%) did not (OR 1.051, CI 0.800-1.381). Risk factors associated with DWI positivity included increasing age (OR 1.014/year, CI 1.006-1.022), hypertension (OR 1.696, CI 1.297-2.218), diabetes (OR 1.435, CI 1.066-1.932), and smoking (OR 1.682, CI 1.186-2.386). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p=<0.001).

Conclusions: Over one-third of people with DWI-confirmed TIA/minor stroke present atypically. The value of atypical symptoms in excluding ischaemia, particularly in patients with vascular risk factors, appears to be limited.

Disclosure: No

P0341 / 167

A PRELIMINARY REPORT ON ONE-STOP MULTIMODAL-MRI WORKFLOW IN THE IMAGING PROCESS OF PATIENTS WITH ACUTE ISCHEMIC STROKE RECEIVING INTRAVENOUS THROMBOLYSIS

Z. Xu ¹, Q. Deng¹, T. Jiang¹, Y. Zhang¹

¹ Nanjing First Hospital, Nanjing Medical University, Department of Neurology, Nanjing, China

Background: Multiple imaging workflows are derived in evaluations and clinical decisions of acute ischemic stroke (AIS) patients in the acute-stage treatment and our center introduced the one-stop multimodal-magnetic resonance imaging (one-stop MRI). This study aimed to investigate the clinical significance of one-stop multimodal-MRI in AIS patients receiving intravenous thrombolysis (IVT).

Methods: From September 2020 to June 2021, we observed 160 patients in an observational acute stroke cohort: the AISRNA study. We collected and analyzed AIS patients’ demographic characteristics, medical history, clinical information and important time metrics. Comparative and multivariate logistic regression analysis were used.

Results: A total of 73 patients (51 patients in the CT-MRI group and 22 patients in the One-stop MRI group) were enrolled. There were no significant differences in the patients’ age, sex, cause of stroke, initial mRS and NIHSS score, except more patients in one-stop MRI group has history of hypertension (p=0.031). In one-stop MRI group, median door-to-needle (DTN) time was prolonged (p=0.007), but the time from admission to imaging completed significantly decreased (p=0.001). No differences were found in clinical outcomes including 90-Day mRS score and early neurological improvement. After adjustment, these results indicated the one-stop MRI group did not prolong DTN time compared with the CT-MRI group (p=0.388).

Conclusions: The workflow of one-stop multimodal-MRI might increase DTN time but has no significant effect on outcomes. Besides, the minimization of the time used in imaging may bring better prognosis for AIS patients with suspected large vessel occlusion.

Trial registration: ClinicalTrials.gov NCT04175691. Registered November 21, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04175691.

Disclosure: No

P0342 / 371

LESION-DEFICIT MAPPING AND FUNCTIONAL RELEVANCE OF A NOVEL DEFICIT DIMENSION STRUCTURE OF THE NIHSS

B. Cheng ¹, J. Chen², A. Königsberg¹, C. Mayer¹, L. Rimmele¹, K.R. Patil³, C. Gerloff¹, G. Thomalla¹, S.B. Eickhoff³

¹University Medical Center Hamburg Eppendorf, Department of Neurology, Hamburg, Germany, ²Zhejiang University, Department of Psychology and Behavioral Sciences, Hangzhou, China, ³Research Centre Jülich, Institute of Neuroscience and Medicine, Brain &Behaviour (INM-7), Jülich, Germany

Background and aims: The NIHSS is the most frequently applied clinical stroke rating scale. Previous investigations of its dimensional structure yielded inconsistent results, and neuroanatomical substrates of principal deficit dimensions remain unclear. We employ advanced machine learning to identify an optimal dimensional representation of the NIHSS across independent datasets. We identify associated lesion locations and characterize these based on a-priori task activation meta-data analysis.

Methods: NIHSS ratings from a large stroke trial (N=503) were factorized by an orthonormal projective nonnegative factorization. An independent dataset (N=690) was collected to facilitate a systematic evaluation procedure for deriving the optimal dimensional structure. We applied Lesion-deficit mapping (LDM) of stroke lesions from MRI to identify associated neuroanatomical locations characterized through a database of task-evoked functional MRI experiments profiling.

Results: A five-factor structure of the NIHSS was identified as the optimal representation of the deficit dimensions across study populations, comprising items for

• (1) left and

• (2) right motor deficits,

• (3) dysarthria/ facial palsy,

• (4) language, and

• (5) neglect.

LDM related deficit dimensions to differential brain regions, including the internal capsules, left precentral cortex, frontal and temporal cortex, and right subcortical and temporal cortical cortex. Functional characterization of LDM results aligned with the detected deficit dimensions.

Conclusion: We identified a novel five-dimensional representation of stroke deficits based on the NIHSS, with one dimension specifically capturing non-lateralized deficits (dysarthria, facial palsy). We reveal the overarching structure of stroke deficits as captured by the NIHSS. Our work informs the application of the NIHSS in research and clinical practice.

Disclosure: No

P0343 / 379

DIAGNOSTIC ACCURACY OF 0.5T VERSUS 1.5T MRI IN SUSPECTED ACUTE STROKE

K. Wagner ¹, D. Volders², A. Patterson³, J. Rioux⁴, C. Bowen⁴, S. Phillips⁵, S. Beyea⁴, E.A. Cora²

¹Dalhousie University, Halifax, Canada, ²QEII Health Sciences Centre, Neuroradiology, Halifax, Canada, ³QEII Health Sciences Centre, Radiology, Halifax, Canada, ⁴BIOTIC, Halifax, Canada, ⁵QEII Health Sciences Centre, Neurology, Halifax, Canada

Background and aims: Accurate, rapid imaging is required for timely management of suspected stroke. CT is often first-line, but negative scans with persistent symptoms require further imaging. MRI is preferred, though not always readily available. Synaptive’s new 0.5T MRI can increase imaging throughput via its low field, head-only design. This study assesses diagnostic accuracy of this system’s images compared to clinical 1.5T images.

Methods: Evry™ is a 0.5T, small footprint, cryogen-free system for point-of-care use. It has high slew rate (400 T/m/s) high strength (100 mT/m) gradients and a 16 channel patient conformable head coil. Our stroke protocol contains the following sequences: DWI, T2 FSE, FLAIR, SWI total of 11:19 minutes with optional TOF MRA 7:38 min. We scanned and anonymized 24 consecutive patients with stroke symptoms and clinical MRI indicated. A blinded neuroradiologist assessed the 0.5T images for acute stroke or other significant pathology using confidence levels on a Likert scale (1=very poor to 5=excellent).

Results: 24 patients, median age 66, 62.5% male, were enrolled. CT scans showed no significant pathology in 95.8% of cases. Scan findings from 0.5T versus 1.5T MRI were 100% congruent: 75.0% stroke, 25.0% another or no significant pathology. The 0.5T confidence rating was excellent in 91.7%, good in 4.2%, and adequate in 4.2%.

Conclusions: 0.5T MRI demonstrates adequate to excellent visualization of strokes and other pathologies and is comparable to clinical 1.5T imaging. This system could expedite MR imaging, allowing for earlier stroke diagnosis and treatment while reducing burden on hospital resources.

Disclosure: Yes

P0344 / 402

CT HYPOPERFUSION-HYPODENSITY MISMATCH TO IDENTIFY PATIENTS WITH ACUTE ISCHEMIC STROKE WITHIN 4.5 HOURS OF SYMPTOM ONSET

J. Minnerup¹, M. Psychogios², P. Sporns ²

¹University of Muenster, Department of Neurology, Münster, Germany, ²University of Basel, Department of Neuroradiology, Basel, Switzerland

Background and aims: To test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset.

Methods: We therefore performed the Retrospective Multicenter Hypoperfusion-Hypodensity Mismatch for The identification of Patients With Stroke Within 4.5 Hours study of patients with acute ischemic stroke and known time of symptom onset. The predictive values of hypoperfusion-hypodensity mismatch for the identification of patients with symptom onset within 4.5 hours were the main outcome measure.

Results: Of 666 patients, 548 (82.3%) had multimodal CT within 4.5 hours and 118 (17.7%) beyond 4.5 hours. Hypoperfusion-hypodensity mismatch was visible in 516 (94.2%) patients with symptom onset within and in 30 (25.4%) patients beyond 4.5 hours. CT hypoperfusion-hypodensity mismatch identified patients within 4.5 hours of stroke onset with 94.2% (95% confidence interval [CI] 91.9%–95.8%) sensitivity, 74.6% (95% CI 66.0%–81.6%) specificity, 94.5% (95% CI 92.3%–96.1%) positive predictive value, and 73.3% (95% CI 64.8%–80.4%) negative predictive value. Interobserver agreement for hypoperfusion-hypodensity mismatch was substantial (κ = 0.61, 95% CI 0.53–0.69).

Conclusions: Patients with acute ischemic stroke with absence of a hypodensity on native CT (NCCT) within the hypoperfused core lesion on perfusion CT (hypoperfusion-hypodensity mismatch) are likely to be within the time window of thrombolysis. Applying this method may guide the decision to use thrombolysis in patients with unknown time of stroke onset.

Disclosure: No

P0345 / 396

YIELD OF COMPUTED TOMOGRAPHY PERFUSION IN STROKE MANAGEMENT

M. Cviková ¹, I. Fojtová², M. Haršány^1,1, R. Mikulík^1,2

¹St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czech Republic, Department of Neurology, Brno, Czech Republic, ²International Clinical Research Centre, St. Anne’s University Hospital in Brno, Brno, Czech Republic, Brno, Czech Republic

Background and aims: False-positive and false-negative diagnoses of acute ischemic stroke can lead to unnecessary treatment with intravenous thrombolysis (IVT) in patients without stroke or withdrawal of IVT in patients with stroke. The purpose of this study was to define a yield of CT-perfusion (CTP) in diagnoses of false positive and negative cases with acute ischemic stroke.

Methods: All consecutive patients with acute onset of neurological impairment within a 24-hour window had CTP as part of routine scanning protocol. The diagnostic value of CTP was calculated against both radiological and clinical diagnoses of stroke. CTP was considered positive when core or penumbra was diagnosed by RAPID software. Radiological diagnosis was established as new hypodensity/DWI positivity on follow-up CT/MRI or intracranial occlusion on baseline CT angiography. Clinical diagnosis of stroke was established as discharge diagnosis.

Results: Five hundred patients with multimodal CT imaging of the brain were scanned between Nov/2018 and Nov/2019: 185 (37%) had positive CTP, 153 (31%) had a radiological diagnosis of stroke, and 122 (24%) had a clinical diagnosis of stroke. When CTP was positive, all patients had a clinical/radiological diagnoses of stroke (positive predictive value and specificity 100%). Patients with negative CTP with stroke mimics were younger (68 vs. 73, p=0.001) and with lower NIHSS (0 vs. 4, p<0.001) compared to patients with CT negative stroke.

Conclusions: Positive CTP is confirmative of stroke. Negative CTP should raise suspicion to stroke mimics, especially in younger patients with less severe stroke symptoms.

Disclosure: No

P0346 / 398

POTENTIAL OF STROKE-IMAGING USING A NEW PROTOTYPE OF LOW-FIELD MRI: A PROSPECTIVE DIRECT 0.55T-1.5T-SCANNER COMPARISON

T. Rusche¹, G.M. De Marchis², M. Psychogios¹, P. Sporns ¹

¹University of Basel, Department of Neuroradiology, Basel, Switzerland, ²University of Basel, Department of Neurology, Basel, Switzerland

Background: Imaging of choice for hyperacute stroke detection is computed-tomographic (CT) or magnetic resonance-imaging (MRI), especially diffusion-weighted (DW)-sequences. However, MR-imaging is associated with high costs and therefore has a limited availability leading to low-field-MRI techniques increasingly coming into focus. The aim of our study was to assess the potential of stroke-imaging with low-field-MRI.

Methods: A prospective scanner-comparison was performed including 27 patients (17 stroke-cohort, 10 control-group). For each patient, a brain-scan was performed first with a 1.5T-scanner and afterwards with a 0.55T-scanner. Data-analysis was performed in three steps: All DWI/ADC (apparent diffusion-coefficient)- and FLAIR (fluid attenuated inversion-recovery)-sequences underwent Likert-rating with respect to image-impression, resolution, noise, contrast, and diagnostic quality and were evaluated by two neuroradiologists regarding number and localization of DWI/FLAIR-lesions in a blinded fashion. Then segmentation of lesion volumes was performed.

Results: DWI/ADC-lesions could be diagnosed with the same reliability by the most experienced reader in the 0.55T- and 1.5T-sequences (specificity 100% and sensitivity 92.9%, respectively).

False-positive findings did not occur. Detection of number/location of FLAIR-lesions was mostly equivalent between 0.55T-/1.5T-sequences. No significant difference (p=0.789-0.104) for FLAIR-resolution and -contrast was observed regarding Likert-scaling. For DWI/ADC-noise the 0.55T-sequences were significantly superior (p < 0.026). Otherwise, the 1.5T-sequences were significantly superior (p < 0.029). There was no significant difference in infarct-volume and volume of infarct-demarcation between the 0.55T- and 1.5T-sequences, when detectable.

Conclusions: Low-field MRI stroke-imaging at 0.55T is non-inferior to scanners with higher field-strengths and thus has great potential as a low-cost alternative in future stroke-diagnostics.

Disclosure: No

P0347 / 474

BOLD-MRI DETECTS MICROVASCULAR PERFUSION FAILURE AT A TISSSUE LEVEL

D. Carone ¹, J. Garrard¹, F. De Angeli², A. Sodero³, P. Jezzard⁴, J. Kennedy¹

¹University of Oxford, Acute Vascular Imaging Centre, Radcliffe Department of Medicine, Oxford, United Kingdom, ²Niguarda Hospital, S.C. Neurologia e Stroke Unit, Milan, Italy, ³University of Florence, NEUROFARBA Department, Neuroscience Section, Florence, Italy, ⁴University of Oxford, FMRIB, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom

Background: Reperfusion failure at the microvascular level, whether due to mechanisms such as microthrombosis or pericyte constriction, significantly attenuates the beneficial effect of recanalization therapy. Transcranial doppler ultrasound can only be used to indirectly infer microvascular failure. This work explores the ability of a novel BOLD-MRI approach to directly investigate microvascular failure at a tissue level and its relationship with infarct growth.

Methods: Consecutive patients were enrolled in an observational multimodal MRI study with BOLD imaging obtained alongside DWI and ASL perfusion within 24 hours of onset. The cardiac signal was isolated from the BOLD signal using a novel hyper-sampling approach, and used to generate the Resistive-Index. Infarct growth was measured at 1-week using T2-FLAIR, relative to the infarct seen on DWI at presentation. The relationship between Resistive-Index at presentation and infarct growth by 1-week was explored via multivariate-analysis.

Results: 41 patients were enrolled (Female: n=13(32%); Age Range:26-89 years). Infarct growth represented 35% (median; IQR:5-50%) of the final infarct. In multivariate analysis, age, increasing CBF and the use of alteplase were associated with reduced relative infarct growth (p-value <0.001). A higher Resistive-Index was associated with increased relative infarct growth regardless of CBF (p-value <0.001). Including Resistive-Index significantly improved the model accuracy (R² from 0.40 to 0.54-pvalue<0.01)

Conclusions: BOLD-MRI allows the direct detection of acute changes in vascular resistance at a tissue-level that are associated with infarct growth independently from perfusion status. Further work is needed to confirm this finding and possible role in patient stratification for appropriate adjuvant therapy.

Disclosure: No

P0348 / 1554

ALTERED PATTERN IN PERFUSION CT OF PATIENTS WITH SUSPECTED POSTERIOR REVERSIBLE ENCEPHALOPATHY

C. Hervas Testal ¹, S. Trillo¹, F. Gilo-Arroyo¹, E. De la Fuente¹, C. Ramos¹, A. González¹, A. Aizpun¹, J. Vega², A. Xímenez-Carrillo¹, J. Vivancos Mora¹

¹Hospital Universitario de La Princesa, Neurology, Madrid, Spain, ²Hospital Universitario de La Princesa, Radiology, Madrid, Spain

Background: Posterior reversible encephalopathy syndrome (PRES) is an entity with defined clinical-radiological findings. Its definition could be too restrictive by excluding patients without a neuroimaging study with classic findings. The objective of our study is to present altered patterns in perfusion CT (PCT) in a series of patients with suspected PRES.

Methods: Retrospective study with prospective data collection of patients treated in our hospital between 2011-202 and suspected of PRES, with a study of TCP. We present clinical characteristics, altered pattern in PCT and iconography.

Results: 29 cases with a possible diagnosis of PRES, 17 with a TCP study(58.6%), 14(83.2%) with alterations. Average age 80.1(SD 8.4), women 10(71.4%). Acute neurological symptoms in 14(100%): encephalopathy 8(57.1%), low level of consciousness 6(42.9%), neurological deficit 12(85.7%), seizures 11(78.6%); initial median NIHSS 11, final median NIHSS 0. BP> 180 / 110mmHg 8(51.1%), TAS 205.1mmHg(SD30.7), TAD 113.1mmHg(SD18.6). Classic triggers 5(35.7%). Control CT in 8 cases, 4 presented characteristic alteration(50%), control MRI in 10 cases, 4 with alteration(40%).

TCP alterations were mostly identified in time maps, 13(92.9%), and bihemispheric 8(57.1%), altering flow maps in 7(50%) and volume maps in 2(14.3%). Corresponding mainly to posterior parieto-occipital territories 11(84.6%), observing bihemispheric involvement in 8(72.7%) and focal non-vascular unilateral in 3(27.3%).

Conclusions: PCT altered patterns in patients with suspected PRES are frequent, being the most typical pattern non-vascular distribution with parieto-occipital bihemispheric involvement. Larger future studies are needed to define whether this pattern can be specific enough to aid in the diagnosis of some cases.

Disclosure: No

P0349 / 1416

AUTOMATED SCORING OF COLLATERALS, BLOOD PRESSURE AND CLINICAL OUTCOME AFTER ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND LARGE-VESSEL OCCLUSION

D. Guisado-Alonso ¹, P. Camps-Renom¹, R. Delgado-Mederos¹, E. Granell², A. Martínez-Domeño¹, L. Prats-Sánchez¹, M. Guasch-Jiménez¹, M.V. Acosta¹, A. Ramos-Pachón¹, J. Martí-Fàbregas¹

¹Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Stroke Unit, Department of Neurology, Barcelona, Spain, ²UDIAT Corporació Sanitària Parc Taulí, Department of Radiology, Sabadell, Spain

Background and aims: We aimed to determine whether admission Blood Pressure (BP) values are associated with the degree of Collateral Circulation in acute ischemic stroke (AIS) patients treated with endovascular treatment(EVT), and to determine its prognostic value.

Methods: We evaluated patients with M1 or proximal M2 segment of middle cerebral artery (MCA) or terminal internal carotid artery occlusion treated with EVT in a single-centre prospective registry. Automated and validated software (Brainomix Ltd., Oxford, UK) was used to generate the Collateral Score (CS) from the baseline single-phased CT angiography, that was graded: CS=0, ⩽10% of the occluded MCA territory; CS=1, 11-50%; CS=2, 51-90%; CS=3, >90%. We dichotomized CS as good (2-3) or poor (0-1). The outcome was considered favourable when the Rankin scale score at 3 months was 0-2.

Results: We included 101 patients, mean age 72.1± 13.1 year, 56.4% were women. We classified patients according to the CS: CS=0 in 7 patients (6.9%), CS=1 in 15 (14.9%), CS=2 in 43 (42.6%) and CS=3 in 36 (35.6%). Admission systolic BP (aOR for 10 mmHg increase 0.79 [95% CI 0.68-0.92]) and higher baseline NIHSS (aOR  0.90, 95% CI 0.84-0.96) were associated with a worse CS. Dichotomized CS showed that good CS was associated independently with a favourable functional outcome (OR 0.25, 95% CI 0.06-0.99).

Conclusions: In AIS patients with anterior large vessel occlusion treated with EVT, admission systolic BP was inversely associated with the degree of CS on baseline CT angiography. Moreover, a good CS was associated with a favourable functional outcome.

Disclosure: Yes

P0350 / 1202

PREVALENCE OF "TARGET MISMATCH" WITHIN 24 HOURS AFTER STROKE ONSET

V. Biswas ¹, K. Muir¹

¹ University of Glasgow, Glasgow, United Kingdom

Background and aims: We undertook a prospective observational single centre study to investigate penumbra survival in the first 24 hours after acute ischaemic stroke [AIS] in order to identify the proportion of patients with salvageable brain tissue meeting treatment criteria in late time windows.

Methods: We analysed CT Perfusion [CTP] scans from patients imaged <24 hours after symptom onset using RAPID.

Penumbra was defined as Tmax>6 seconds and ischaemic core as Tmax>6 seconds and relative cerebral blood flow [CBF]<30%. “Target mismatch” was defined as core<70ml, penumbra⩾15ml. The proportion of patients with target mismatch ⩽6 hours and 6 to ⩽24 hours after symptom onset were identified. This was also explored using the ⩽4.5 hours, 4.5 – ⩽12 hours, 12 – ⩽24 hours time windows.

Results: 185 patients were recruited of which 168 (91%) had a final diagnosis of AIS. Of these, 3 patients did not have a CTP and 3 scans were not evaluable by the software. In 162 patients, median core volume was 0ml (IQR 0-8) and median penumbra volume 17ml (IQR 0-80).

51% of patients within the 4.5 to 12 hour window met target mismatch criteria and 10% of patients met criteria >12 hours (Table 1). Volumes of core and penumbra did not differ by time window among target mismatch cases (Kruskal-Wallis test, p=0.585 and p=0.418 respectively).

Table 1.

Number meeting mismatch within time windows.

		⩽4.5 hours	4.5 to ⩽12 hours	>12 hours	Overall
Number meeting mismatch (%)		52 (60)	15 (51)	16 (10)	83 (51)
Median core volume (IQR) (ml)	Meets Target Mismatch	5 (0-13)	0 (0-12)	0 (0-9)	0 (0-13)
	Does not Meet Target Mismatch	0 (0-0)	0 (0-0)	0 (0-0)	0 (0-0)
Median penumbra volume (IQR) (ml)	Meets Target Mismatch	66 (34- 116)	87 (58-129)	65 (18-97)	68 (34-125)
	Does not Meet Target Mismatch	0 (0-10)	0 (0-5)	0 (0-1)	0 (0-7)
Median NIHSS (IQR)	Meets Target Mismatch	9 (5-13)	8 (3-17)	9 (5-12)	5 (1-10)
	Does not Meet Target Mismatch	5 (3-11)	6 (4-8)	4 (2-7)	5 (3-8)

Table 2.

Baseline Clinical and Demographic Data for Subjects Suitable for Analysis n=162.

Demographic Data	Gender
	Male (n, %)	96 (59)
	Age
	Overall (mean, SD)	67 (14)
	<70 years (n, %)	88 (54)
	<70 years (mean, SD)	57 (11)
	⩾70 years (mean, SD)	78 (6)
CTP Imaging	Onset to CTP (median, IQR) (minutes)	246 (158-789)
	Onset to CTP ⩽4.5 hours (n, %)	86 (53)
	Onset to CTP ⩽4.5 hours (median, IQR) (minutes)	163 (113-210)
	Onset to CTP 4.5 hours to ⩽12 hours (n, %)	29 (18)
	Onset to CTP 4.5 hours to ⩽12 hours (median, IQR) (minutes)	441 (335-615)
	Onset to CTP >12 hours (n, %)	47 (29)
	Onset to CTP >12 hours (median, IQR) (minutes)	984 (815-1162)
	Onset to CTP ⩽6 hours (n, %)	98 (60)
	Onset to CTP ⩽6 hours (median, IQR) (minutes)	183 (118-229)
	Onset to CTP >6 hours (n, %)	64 (40)
	Onset to CTP >6 hours (median, IQR) (minutes)	871 (715-1052)
Thombolysis	Number treated with IV rTPA (n, %)	82 (51)
NIHSS	Admission (median, IQR)	6 (4-11)

Conclusions: A higher proportion of patients presenting 4.5-12h have salvageable penumbra than beyond 12 hours. Volumes of core and penumbra in patients meeting target mismatch did not differ by time window.

Disclosure: No

P0351 / 1584

EFFECT OF ONSET-TO-IMAGING TIME AND QUANTITATIVE COLLATERAL SCORE ON CT PERFUSION ISCHEMIC CORE VOLUMES IN ACUTE ISCHEMIC STROKE

A. Vos ¹, J.W. Hoving¹, N. Arrarte Terreros^1,2, M.S. Koopman¹, A. Wouters¹, J.M. Coutinho³, E. van Bavel², H.A. Marquering^1,2, B.J. Emmer¹, C.B. Majoie¹

¹Amsterdam UMC, location AMC, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands, ²Amsterdam UMC, location AMC, Department of Biomedical Engineering and Physics, Amsterdam, Netherlands, ³Amsterdam UMC, location AMC, Department of Neurology, Amsterdam, Netherlands

Background and aims: CT perfusion (CTP)-estimated ischemic core is a dynamic phenomenon and might be dependent on various pathophysiological factors. We aim to determine whether the CTP core volume is affected by onset-to-imaging (OTI) time in combination with a quantitative collateral score (qCS).

Methods: EVT-treated patients with M1 occlusion from the MR CLEAN Registry (November 2017-December 2018) and our local cohort (January 2019-December 2020) with available baseline non-contrast CT, CTP, and CT-angiography were included. CTP data was post-processed using syngo.via (version VB40). Automated qCS, defined as the percentage of contrast filling distal to the occlusion (compared to the non-occluded side) was determined on CT-angiography with Nicolab’s software. Linear regression analysis was used to assess the association of OTI time and qCS with CTP core volumes.

Results: In 49 included patients, median CTP core volume was 18 (IQR 9-34) mL, median qCS was 42 (IQR 23-57) % and median OTI was 216 (IQR 110-427) min. qCS was significantly associated with CTP core volumes (β = -0.54 [95% CI -0.95; -0.13] p = 0.01). OTI time was not significantly associated with CTP core volumes (β = -0.01 [95% CI -0.04; -0.02] p = 0.41).

Conclusions: In our study population a higher quantitative collateral score was associated with smaller CTP core volumes. The introduction of qCS can lead to a rapid, accurate and observer-independent assessment of distal tissue perfusion state.

Disclosure: No

P0352 / 145

THE ROLE OF AUTOMATED COMPUTED TOPOGRAPHY PERFUSION IN PREDICTION OF HEMORRHAGIC TRANSFORMATION AFTER ACUTE ISCHEMIC STROKE

A. Saied ^1,2, G. Bigliardi², M.L. Dell’Acqua², L. Vandelli², L. Ciolli², L. Picchetto², G. Borzi², R. Ricceri², R. Pentore², S. Vallone³, S. Meletti², N. Elsaid^1,2

¹Mansoura University, Faculty of medicine, Neurology, Mansoura, Egypt, ²Ospedale Civile di Baggiovara, AOU di Modena, Stroke Unit – Neurology Clinic, Department of Neuroscience, Modena, Italy, ³Ospedale Civile di Baggiovara, AOU di Modena, Stroke Unit – Neurology Clinic, Department of Neuroradiology, Modena, Italy

Introduction: The role of computed tomography perfusion (CTP) in prediction of hemorrhagic transformation (HT) has been evolving. We aimed to study the role of automated perfusion post-processing software in prediction of HT using the commercially available RAPID software.

Methods: 282 patients with anterior circulation ischemic stroke, who underwent CTP with RAPID automated post-processing, were retrospectively enrolled and divided into HT (n=91) and non-HT groups (n=191). The automated RAPID-generated perfusion maps were reviewed. Mismatch volume and ratio, time to maximum (Tmax) >10s-4s volumes, hypoperfusion index, cerebral blood flow (CBF) <20-38% volumes, cerebral blood volume (CBV) <34%-42% volumes, and CBV index were recorded and analyzed.

Results: The volumes of brain tissues suffering from reduction of cerebral blood flow (CBF<20%-38%), reduction in cerebral blood volumes (CBV<34-42%), and delayed contrast arrival times (Tmax>4-10s) were significantly higher in the HT group. The mismatch volumes were also higher in the HT group (P=0.001). Among these parameters, the Tmax>6s volume was the most reliable and sensitive predictor of HT (p=0.001, AUC=.667). However, the combination of the perfusion parameters can slightly improve the diagnostic efficiency (AUC=0.703). There was no statistically significant difference between the non-HT group and either the parenchymal or the symptomatic subtypes.

Conclusion: The RAPID automated CTP parameters can provide a reliable predictor of HT overall but not the parenchymal or the symptomatic subtypes. The infarct area involving the penumbra and core represented by the Tmax >6s threshold is the most sensitive predictor; however, the combination of the perfusion parameters can slightly improve the diagnostic efficiency.

Disclosure: No

P0353 / 400

CEREBROVASCULAR COLLATERAL INTEGRITY IN PEDIATRIC LARGE VESSEL OCCLUSION: ANALYSIS OF THE SAVE CHILDS STUDY

S. Lee¹, M. Psychogios², P. Sporns ²

¹Stanford Stroke Center, Department of Neurology & Neurological Sciences, Stanford, United States, ²University of Basel, Department of Neuroradiology, Basel, Switzerland

Background: Robust cerebrovascular collaterals in adult stroke patients have been associated with longer treatment windows, better recanalization rates, and improved outcomes. No studies have investigated the role of collaterals in pediatric stroke. The primary aim was to determine whether favorable collaterals correlated with better radiographic and clinical outcomes in children with ischemic stroke who underwent thrombectomy.

Methods: This study analyzed children who underwent thrombectomy between 2000-2018 at 27 US and European centers. Patients had baseline angiographic imaging and follow-up modified Rankin Scale scores available for review. Collaterals were graded on neuroimaging by 2 blinded neuroradiologists according to the Tan collateral score. Collateral status was correlated with clinical and neuroimaging characteristics and outcomes.

Results: Thirty-three children (mean age 10.9 [SD±4.9]) years were included; 14 (42.4%) had favorable collaterals. Median final stroke volume as a percent of total brain volume (TBV) was significantly lower in patients with favorable collaterals (1.35% [IQR 1.14-3.76] versus 7.86% [1.54-11.07], p=0.049). Collateral status did not correlate with clinical outcome, infarct growth or final ASPECTS in our cohort. Patients with favorable collaterals had higher baseline ASPECTS (7 [IQR 6-8] versus 5.5 [4-6], p=0.006), smaller baseline ischemic volume (1.57% TBV [IQR 1.09-2.29] versus 3.42% TBV [IQR 1.26-5.33], p=0.035) and slower early infarct growth rate (2.4 mL/hr [IQR 1.5-5.1] versus 10.4 mL/hr [IQR 3.0-30.7], p=0.028).

Conclusions: Favorable collaterals were associated with smaller final stroke burden and slower early infarct growth rate, but not with better clinical outcome in our study.

Disclosure: No

P0354 / 593

EARLY VEIN FILLING, MORE BLEEDING: A NEW ANGIOGRAPHIC SIGN TO PREDICT INTRACEREBRAL HEMORRHAGE?

G. Charbonnier ^1,2, M. Dillmann¹, L. Bonnet¹, F. Vuillier¹, A. Biondi², T. Moulin¹

¹Besançon University Hospital, Neurology, Besançon, France, ²Besançon University Hospital, Interventional Neuroradiology, Besançon, France

Background and aims: Prediction of intracerebral hemorrhage (ICH) following revascularization of acute ischemic stroke (AIS) is crucial to its understanding and management. Several studies have investigated the utility of angiographic signs appearing during endovascular treatment (EVT). We describe a simple new angiographic sign and evaluate its role in ICH prediction.

Methods: We retrospectively reviewed a monocentric cohort of patients with AIS undergoing EVT. We tested predictive factors of symptomatic and asymptomatic intracerebral hemorrhage (sICH, aICH). Among them, we counted the number of angiogram images during the final angiography run of EVT. The number of images between the first appearance of dye and the first vein visualization was named venous filling (VF).

Results: We reviewed 379 patients who underwent EVT between January 2015 and March 2020. Mean age was 70 years, 51% of patients were female, median ASPECTS was 7, mean DWI infarct at baseline was 49 cc, median NIHSS was 18. Sixty-six percent of patients were also treated by intravenous thrombolysis. Forty-one percent of patients had an mRS of 0–2 at 3 months. Regarding hemorrhage, 16 patients experienced sICH and 166 experienced aICH. The only predictor of sICH was VF (median 7 in sICH group vs. 6.50 in aICH group, p=0.013). The predictors of aICH were ASPECTS score and anterior circulation infarct.

Conclusions: VF is a potential tool in predicting sICH following EVT for large vessel occlusion and could be a target for prevention therapies such as drastic blood pressure reduction.

Disclosure: No

P0355 / 109

OPTIMAL THRESHOLDS OF DIFFUSION SIGNAL AND APPARENT DIFFUSION COEFFICIENT FOR AUTOMATED SEGMENTATION OF INFARCT CORE

B. Takahashi ¹, K. Kudo², R. Shimura³, T. Osanai⁴, S. Kobayashi⁴, K. Maruiti⁵, S. Ushikoshi⁶, M. Fujimura⁴

¹Hokkaido University, Department of Diagnostic Imaging, Graduate School of Medicine, Sapporo City, Japan, ²Hokkaido University, Department of Diagnostic Imaging, Faculty of Medicine and Global Center for Biomedical Science and Engineering, Faculty of Medicine, Sapporo City, Japan, ³Hokkaido University, Department of Diagnostic Imaging, Faculty of Medicine, Sapporo City, Japan, ⁴Hokkaido University, Department of Neurosurgery, Faculty of Medicine and Graduate School, Sapporo City, Japan, ⁵Kashiwaba Neurosurgical Hospital, Department of Neurosurgery, Sapporo City, Japan, ⁶Hokkaido Medical Center, Department of Neurosurgery, Sapporo City, Japan

Background: Apparent diffusion coefficient (ADC) has been used for the threshold of automated segmentation of infarct core in most of automated software including RAPID; however, diffusion signal could be also utilized. The purpose of this study was to evaluate the optimal threshold of diffusion signal and ADC for the core segmentation using PMA software, comparing with RAPID.

Methods: We included 647 patients in the RELAXED study and the other 65 patients in a multicenter, retrospective, observational study. The inclusion criteria was within 24 hours from acute stroke onset.

The infarct core in patients with RELAXED study was manually segmented on DWI by four neuroradiologists, which was used for gold standard of core volume. The same DWI data was analyzed by RAPID and PMA software, and their correlation coefficients were evaluated. In the PMA analysis, the thresholds of ADC values and DWI signals were varied to perform a comprehensive analysis to determine the optimal threshold.

Results: The better correlation between PMA and RAPID, and between PMA and manual segmentation were noted with higher threshold values of DWI signal and lower ADC values in PMA; however, those settings underestimated the core volume in PMA.

In the external validation, the optimal settings in PMA were achieved with DWI signal of mean +0.8SD and ADC of 660, to predict the core volume of 70mL in RAPID (PPV of 0.84 and NPV of 1.0).

Conclusion: Optimal thresholds of ADC values and DWI signals could be determined using large data sets of DWI with manual analysis.

Disclosure: No

P0356 / 1185

FEASIBILITY OF USING CEREBRAL ATTENUATION CHANGES ON NON-ENHANCED CT BRAIN TO PREDICT TISSUE FATE AT FOLLOW-UP AFTER ACUTE ISCHAEMIC STROKE

A. Alzahrani ^1,2, X. Zhang³, J.M Wardlaw⁴, G. Mair⁴, The IST-3 Collaborative Group

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²King Abdulaziz University, Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, Jeddah, Saudi Arabia, ³University of Dundee, Medical School, Dundee, United Kingdom, ⁴University of Edinburgh, Edinburgh Imaging, and UK Dementia Research Institute at the University of Edinburgh and Centre for Clinical Brain Sciences, Edinburgh, United Kingdom

Background and aims: CT imaging can detect brain tissue oedema as a reduction in attenuation. We aimed to assess whether the CT attenuation of ischaemic lesions measured on baseline non-enhanced CT (NECT) can predict brain tissue fate at follow-up after stroke.

Methods: The Third International Stroke Trial (IST-3) was a multicenter randomized-controlled trial of intravenous alteplase given within six-hours of ischaemic stroke. In a subgroup of 255 IST-3 patients with visible ischaemic lesions on baseline NECT that shrank or disappeared on 24-48 hour follow-up NECT, a single reader, masked to clinical data, measured the attenuation of ischaemic lesions and contralateral normal brain to derive attenuation ratios (ischaemic/normal) for each scan. Per patient, we visually classified follow-up scans with and without completely reversible lesions. We used multivariable logistic regression to predict tissue fate at follow-up (dependent variable: lesion reversibility) controlled for age, sex, time from stroke onset to baseline scan, and NIHSS (National Institutes of Health Stroke Scale). Discriminative ability of the predictive model was tested using receiver operating characteristics (ROC) curve.

Results: Of 255 patients, 114 had completely reversible lesions and 141 had non-reversible lesions. Patients with non-reversible lesions were older (median 82 versus 78 years, p<0.001). Baseline attenuation ratio was 0.89 in reversible, versus 0.86 in non-reversible lesions (p<0.001). Greater baseline attenuation ratio (odds ratio (OR)=3.16,[95%confidence interval, 95%CI=1.56-6.41], p<0.001) and lower NIHSS (OR=0.84,[0.79-0.88],p<0.001) were independently associated with ischaemic lesion reversibility: area under ROC curve 0.823.

Conclusion: The fate of ischaemic brain lesions can be predicted using simple attenuation measurement.

Disclosure: No

P0357 / 329

THROMBUS IMAGING CHARACTERISTICS TO PREDICT EARLY RECANALIZATION IN TRANSFERRED PATIENTS WITH LARGE VESSEL OCCLUSION STROKE

N. Arrarte Terreros ^1,2, J. Stolp³, A.A. Bruggeman², I.S. Swijnenburg^1,2, L.C. van Meenen³, A.E. Groot³, J.M. Coutinho³, Y.B. Roos³, B.J. Emmer², L.F. Beenen², E. van Bavel¹, H.A. Marquering^1,2, C.B. Majoie²

¹Amsterdam UMC, location AMC, Department of Biomedical Engineering and Physics, Amsterdam, Netherlands, ²Amsterdam UMC, location AMC, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands, ³Amsterdam UMC, location AMC, Department of Neurology, Amsterdam, Netherlands

Background and aims: Early recanalization in large vessel occlusion (LVO) stroke patients transferred from a primary stroke centre (PSC) results in refrainment from endovascular treatment (EVT). We aim to predict early recanalization based on both clinical-patient and thrombus-imaging characteristics identifiable at PSC admission.

Methods: We included anterior circulation LVO patients that were consecutively presented to a PSC between January 2016 and January 2021, were subsequently referred to our hospital for EVT, and underwent repeated-CT imaging on arrival to assess early recanalization. Early recanalization was defined as the resolution of the LVO or the migration to a distal location not reachable with EVT. We measured distance from the ICA-T to the thrombus (DT), thrombus length, density, and perviousness on baseline CT images. We built a multivariable logistic regression model to predict early recanalization using backward elimination. We validated the predictive ability of the model-variables by computing the median of the area under the curve (AUC) of the receiver operating characteristics curve for 100-times 5-fold cross validations. Patients with missing data were excluded.

Results: We included 253 patients. Early recanalization occurred in 32% of patients. Early recanalization was associated with IVT administration (OR 3.7, 95%CI 1.2-11.7, p=0.03), DT (OR 1.02, 95%CI 1.00-1.05 per mm, p=0.02), and thrombus length (OR 0.96, 95%CI 0.93-0.98 per mm, p<0.01). The median AUC was 0.72 (IQR 0.66-0.77).

Conclusions: IVT, and smaller and more distal thrombi increase the chance of early recanalization. These characteristics can be used to predict early recanalization at PSC admission with moderate discriminative ability.

Disclosure: Yes

P0358 / 937

DETECTION OF THE INFARCT CORE AND PENUMBRAL TISSUE ON NON-ENHANCED CT AND CT PERFUSION IN ACUTE ISCHAEMIC STROKE

A. Alzahrani ^1,2, X. Zhang³, A. Albukhari⁴, J.M Wardlaw⁵, G. Mair⁵

¹King Abdulaziz University, Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, Jeddah, Saudi Arabia, ²University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ³University of Dundee, Medical School, Dundee, United Kingdom, ⁴King Abdulaziz University Hospital, Department of Radiology, Jeddah, Saudi Arabia, ⁵University of Edinburgh, Edinburgh Imaging, and UK Dementia Research Institute at the University of Edinburgh and Centre for Clinical Brain Sciences, Edinburgh, United Kingdom

Background and aims: Early ischaemic features on non-enhanced CT (NECT) may indicate different pathophysiological subtypes of brain tissue injury after stroke. We aimed to correlate appreciable early ischaemic features on NECT with concurrent CT perfusion (CTP) changes indicative of penumbra or infarct core.

Methods: We retrospectively assessed all consecutive patients presenting to King Abdulaziz university hospital with acute ischaemic stroke (<24 hours duration). All patients underwent NECT and CTP. Two raters independently scored all CT blind to clinical data. Major arterial territories of brain were scored individually: on NECT as normal, parenchymal hypoattenuation, or isolated tissue swelling; and on CTP as normal, increased or decreased perfusion for mean transit time(MTT), cerebral blood volume(CBV), and cerebral blood flow(CBF). Rater disagreement was decided by consensus. We sought associations between swelling and penumbra and between hypoattenuation and core using Fisher’s exact test.

Results: We included 122 patients (976 regions). Median time from symptom onset to NECT was 261 minutes. Of 255 regions assessed as penumbra (increased/normal CBV, decreased CBF, increased MTT) on CTP, 70 were isolated tissue swelling, 109 were parenchymal hypoattenuation on NECT. Of 155 regions assessed as core (decreased CBV, CBF, increased MTT) on CTP, 141 were parenchymal hypoattenuation on NECT. Isolated tissue swelling was associated with penumbra (p<0.001) while hypoattenuation was associated with infarct core (p<0.001).

Conclusions: In acute ischaemic stroke, NECT may provide information on brain tissue viability. While hypoattenuating regions on NECT are commonly associated with infarct core we found 42% were still viable according to CTP.

Disclosure: No

P0359 / 306

MONOENERGETIC CONE-BEAM CT ANGIOGRAPHY IS NON-INFERIOR TO STANDARD CT ANGIOGRAPHY – A PROSPECTIVE OPEN LABEL TRIAL IN STROKE PATIENTS

F. Ståhl ^1,2, H. Almqvist^1,2, J. Kolloch², V. Gontu^1,2, M. van Vlimmeren³, Å. Holmberg², M. Mazya^1,4, M. Söderman^1,2, A. Falk Delgado^1,2

¹Karolinska Institutet, Clinical Neuroscience, Solna, Sweden, ²Karolinska University Hospital, Neuroradiology, Solna, Sweden, ³Philips, Image-Guided Therapy Systems, Best, Netherlands, ⁴Karolinska University Hospital, Neurology, Solna, Sweden

Background: In stroke patients, cone-beam CT (CBCT) intravenous angiography in the angiography suite could be an alternative to CT angiography (CTA) to shorten door to thrombectomy time. However, image quality in CBCT is typically limited by artifacts. We aimed to evaluate intravenous angiography using a prototype dual-layer detector CBCT versus CTA in stroke patients.

Methods: A prospective open label single centre clinical trial (NCT04571099) enrolled consecutive patients, 50 years or older, with ischemic or hemorrhagic stroke on initial CT. Sixteen intracranial arterial segments were evaluated by two neuroradiologists on 70 keV monoenergetic images, regarding vessel conspicuity and artifact presence on 5-point Likert scales (5: highest vessel conspicuity or fewest artifacts). Twelve subjects were necessary to show non-inferiority of CBCT angiography compared to CTA, given a predetermined selection of eleven vessel segments evaluated in each subject. Bonferroni corrected Wilcoxon matched-pairs signed-rank test determined significance (p<0.05).

Results: Of 28 enrolled subjects, 21 had complete matched image sets. Median conspicuity of CBCT and CTA vessel segments was identical, 4 (IQR 3–5) versus 4 (IQR 3–5), p=0.21. Median artifact rating for CBCT and CTA were 4 (IQR 3.67–4.50) versus 5 (IQR 4–5), p<0.01, with more artifacts on CBCT. For all sixteen arterial vessel segments combined, CBCT had superior vessel conspicuity (p=0.004). For individual regions, CBCT showed superior conspicuity in the M4 segment (p=0.03).

Conclusions: Monoenergetic CBCT 70 keV images showed non-inferior vessel conspicuity to CT angiography in stroke patients, despite more artifacts. Some small arteries had better conspicuity on CBCT.

Disclosure: No

P0360 / 1228

ACUTE ISCHEMIC STROKE CORE ESTIMATION IS IMPROVED BY ONSET TIME-DEPENDENT RELATIVE CEREBRAL BLOOD FLOW THRESHOLDS

J. Bertels ¹, L. Scheldeman², J. Lambert³, J. Demeestere², E. Heylen¹, F. Ståhl⁴, Å. Holmberg⁴, G. Albers⁵, M. Lansberg⁶, D. Robben¹, D. Vandermeulen¹, R. Lemmens²

¹KU Leuven, Electrical Engineering, Leuven, Belgium, ²University Hospitals Leuven, Neurology, Leuven, Belgium, ³University Hospitals Leuven, Radiology, Leuven, Belgium, ⁴Karolinska University Hospital, Neuroradiology and Clinical Neuroscience, Stockholm, Sweden, ⁵Stanford University, Stanford Stroke Center, Stanford, United States, ⁶Stanford University, Stanford Stroke Center, Stanford, United States

Background and aims: CT perfusion-based mismatch criteria predominantly rely on fixed thresholding of the reduction in relative cerebral blood flow (rCBF<0.30) to determine the ischemic core. This decrease to assess irreversibly damaged tissue is time-dependent. There is limited empirical evidence on how to alter the rCBF threshold based on the time since onset (TsO), i.e. the time from (estimated) stroke onset to acute imaging.

Methods: We used a combination of two retrospective datasets, curated based on the quality and availability of the required imaging and procedural data: CRISP (N=50) and an in-house dataset (N=224). We included patients in whom reperfusion (TICI⩾2b) was achieved within a reasonable time from acute imaging (<120 min). We used bootstrapping to assess the correlation between TsO and optimal rCBF threshold. Core volumes were approximated by final infarct volumes assessed on ±24 h FLAIR or non-contrast CT imaging.

Results: The rCBF threshold correlated positively with TsO, reaching a Pearson correlation of 0.91±0.10 (p<0.001) at a group size of ±80. Following these settings, we categorised patients based on TsO<150 (early), <240 (intermediate) and ⩾240 (late) min, subjected to rCBF thresholds of 0.26, 0.32 and 0.36, respectively. The volumetric over- and underestimation decreased for cases presenting early and late, respectively from 9.76[-5.58-28.59] (p<0.01) to -0.94[-9.73-17.52] ml and from -11.48[-26.16-12.05] (p<0.01) to 1.21[-16.22-25.13] ml. The absolute volume error across all categories remained similar.

Conclusions: There is a correlation between rCBF and TsO, which could be harvested to improve core volume estimation by TsO-dependent rCBF thresholds.

Disclosure: No

P0361 / 760

CORRELATION OF THE AUTOMATICALLY-DERIVED CT PERFUSION VOLUMES AND THE MULTIPHASE CTA COLLATERAL SCORE

P. Cimflova ^1,2,3, K. Holikova², B.J. Kim⁴, T. Krivka², O. Volny^5,6, A. Krajina⁷, R. Mikulik^8,6, J. Vanicek²

¹University of Calgary, Department of Radiology, Calgary, Canada, ²St. Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno, Department of Medical Imaging, Brno, Czech Republic, ³Charles University in Prague, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic, ⁴Seoul National University Bundang Hospital, Department of Neurology and Cerebrovascular Center, Seoul, Korea, Republic of, ⁵University Hospital in Ostrava, Department of Neurology, Ostrava, Czech Republic, ⁶St. Anne's University Hospital Brno, International Clinical Research Centre, Stroke Research Program, Brno, Czech Republic, ⁷University Hospital Hradec Kralove and Faculty of Medicine Charles University, Department of Radiology, Hradec Kralove, Czech Republic, ⁸St. Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno, Department of Neurology, Brno, Czech Republic

Background: The aim of the study was to evaluate the automatically derived CT perfusion (CTP) volumes with collateral score using multiphase CTA (mCTA).

Methods: Baseline imaging data of consecutive patients from Jan 2016 to Dec 2020 who underwent mechanical thrombectomy were retrospectively reviewed. Patients with terminal ICA and M1 MCA and baseline imaging including mCTA and CTP perfusion were included. Collaterals were assessed on mCTA as good, intermediate, or poor. CTP was processed with RAPID. Correlation of hypoperfusion volumes (HV) defined as Tmax delay >4s, >6s, >8s,>10 s and CBF<30%, and the collateral score was tested with Kruskal-Wallis test. Subgroup analysis for onset-to-CT time <180min, >180min, and unknown&wake-up stroke was performed.

Results: 120 patients were included in the analysis (50% men, mean age 70.5 years, median baseline NIHSS 16, median baseline ASPECTS 8). The median time from the onset to CT was 82 min. 46 patients had good collaterals, 63 intermediate, and 11 poor collaterals. The clot localization did not differ between the collateral grades (p=0.91). HVs were lower in patients with good collaterals when compared to patients with poor or intermediate collaterals and except for Tmax >4s, this difference was statistically significant, Table 1. HVs were numerically lower for the onset-to-CT time <180min in patients with poor collaterals compared to >180mins and unknown&wake-up stroke subgroups with poor collaterals but the difference did not reach statistical significance, Table 2.

Conclusion: Automatically-derived HVs correlate with mCTA collateral score.

Table 1.

Comparison of hypoperfusion volumes for different collateral grades.

Hypoperfusion volumes (ml), median (IQR)	Collateral score			p-value*
	Good	Intermediate	Poor
Tmax>10s	41 (23 – 64)	87 (60 – 119)	125 (59 – 149)	<0.001
Tmax>8s	75 (53 – 102)	111 (95 – 147)	156 (81 – 172)	<0.001
Tmax>6s	131 (99 - 158)	154 (131 – 197)	185 (89 – 216)	0.01
Tmax>4s	203 (162 – 294)	246 (198 – 313)	262 (157–350)	0.17
CBF<30%	9 (0 – 22)	27 (12 – 41)	65 (33 – 103)	<0.001

*

Derived from Kruskal-Wallis test.

Table 2.

Comparison of hypoperfusion volumes in patients with poor collaterals and different times from the symptom onset to CT.

Hypoperfusion volumes (ml), median (IQR)	Onset to CT time			p-value*
	<180 min, (n=8)	>180 min (n=1)	Unknown & Wake-up (n=2)
Tmax>10s	36 (12 – 56)	132	167 (116 – 218)	0.58
Tmax>8s	64 (32 – 91)	161	187 (147 – 226)	0.59
Tmax>6s	110 (60 - 144)	186	216 (185 – 246)	0.58
Tmax>4s	188 (145 – 285)	231	289 (284–294)	0.76
CBF<30%	7 (0 – 19)	89	76 (65 – 87)	0.77

*

Derived from Kruskal-Wallis test.

Disclosure: No

P0362 / 828

SUSCEPTIBILITY VESSEL SIGN IN ACUTE STROKE: DOES THE PRESENCE OF AN SVS DEPEND ON TIME FROM SYMPTOM ONSET IN ADDITION TO STROKE ETIOLOGY?

G. Charbonnier ^1,2, L. Bonnet¹, F. Vuillier¹, A. Biondi², T. Moulin¹, M. Dillmann¹

¹Besançon University Hospital, Neurology, Besançon, France, ²Besançon University Hospital, Interventional Neuroradiology, Besançon, France

Background and aims: The presence of a Susceptibility Vessel Sign (SVS) in the acute phase of proximal occlusion ischemic stroke indicates the presence of deoxyhemoglobin in the thrombus. Thrombi composition changes over time. The aim of this study was to investigate whether the absence of SVS is associated with a shorter symptom onset (SO) to imaging time.

Methods: We retrospectively analyzed all patients referred for mechanical thrombectomy at Besançon University Hospital between 1 January 2015 and 31 December 2020 for whom readable T2*-weighted imaging was available. We compared patient characteristics according to the presence or absence of an SVS. We also studied the subgroup for whom the exact SO time was known. We performed a univariate statistical analysis, then a multivariate analysis on the variables that were statistically significant in the univariate analysis.

Results: Of the 389 patients included, 309 (79.4%) were SVS+. We found no significant difference between SVS- and the time between SO and imaging in the whole cohort. In the multivariate analysis, SVS- was associated with anticoagulant treatment (p <0.01 ; OR 2.57; 95% CI [1.32; 4.98]), and SVS+ with carotid terminus occlusion (p=0.042; OR 0.431; 95% CI [0.179 ; 0.924]). In the known SO subgroup, SVS- was significantly associated with a shorter SO-imaging time (p<0.001), and this was confirmed in the multivariate analysis (p=0.013; OR 0.911; 95% CI [0.842; 0.973]).

Conclusions: In the acute phase of proximal occlusion ischemic stroke, absence of SVS was associated with a shorter SO–imaging time for patients with a known SO time.

Disclosure: No

P0363 / 1119

REPERFUSION INJURY CONTRIBUTES TO POOR OUTCOME IN PATIENTS WITH RECANALIZATION AFTER THROMBECTOMY

Y. He ¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, School of Medicine, Department of Neurology, Hangzhou, China

Background and aims: Although cerebral reperfusion injury has been extensively studied in animal models, proof in human stroke is far from adequate. We aimed to 1) explore the presence of reperfusion injury in acute ischaemic stroke patients with recanalization after mechanical thrombectomy; 2) analyze the impact of reperfusion injury on neurological outcome.

Methods: We enrolled anterior circulation large artery occlusion patients with recanalization after mechanical thrombectomy who underwent i) computed tomography perfusion on admission and immediately after recanalization to clarify reperfusion region, ii) imaging immediately after recanalization to clarify lesion not due to reperfusion, and iii) imaging at 24 hours after recanalization to clarify expansion of lesion within the reperfusion region potentially due to reperfusion after ischaemia (defined as “radiological observed reperfusion injury”). Poor outcome was defined as 3-month modified Rankin Scale score of 3 to 6.

Results: Among 227 patients included in the final analysis, 119 (52.4%) were identified to present radiological observed reperfusion injury. The median volume of reperfusion region and radiological observed reperfusion injury was 56.0 (interquartile range 36.6, 76.6) mL and 22.3 (interquartile range 11.0, 36.9) mL respectively. The ratio of reperfusion injury to reperfusion region was 6.9 (interquartile range 0.0, 52.3) % and was independently associated with poor outcome (odds ratio = 1.574 per 10%, 95% confidence interval = 1.324-1.873, p < 0.001).

Conclusions: Our findings suggested that radiological observed reperfusion injury was relatively frequent in stroke patients with recanalization after mechanical thrombectomy and contributed to poor outcome despite successful recanalization.

Disclosure: No

P0364 / 1442

CORRELATION BETWEEN CT ANGIOGRAPHY SOURCE IMAGE INFARCT VOLUME AND RAPID CT PERFUSION CORE VOLUME

O. Aykac ¹, F. Ger Akarsu¹, F. Altuntas Kaya¹, Z. Mehdiyev¹, A.O. Ozdemir¹

¹ Eskisehir Osmangazi University, Neurology, Eskisehir, Turkey

Background and aims: RAPID automated software, which processes computed tomography perfusion data, is a reliable diagnostic tool used to estimate the size of the ischemic core and evaluate the collateral status. Contrast-enhanced ASPECT score is also an important predictor of ischemic core. We aimed to compare CT angiography source image infarct volume and RAPID CT perfusion core volumes for determining infarct volume before endovascular treatment.

Methods: Between January 2019 and December 2020, patients with symptom time greater than 4.5 hours, who were examined with RAPID automatic software and CT angiography source imaging, were retrospectively analyzed. Infarct volume was measured as CBF<30% value with the CTP RAPID automatic software. Images were then transferred to a separate station for analysis and final infarct volume calculation. Volumetric measurements were made by two independent blinded investigators. The presence of correlation between volumetric measurements was analyzed.

Results: Forty-nine (M 27, F 22) patients met inclusion criteria. The median age was 69 years (27-88). Admission NIHSS was 13 (3-25). The correlation between CT angiography source image infarct volume and CBF<30% measured with the CTP RAPID automated software was moderate (r=682, p<0.001).

Conclusions: Our study was shown that the case could be selected by calculating the volumetric ischemic core volume with CT angiography source images 4.5 hours later, and this finding was correlated with the RAPID software.

Disclosure: No

P0365 / 1452

EVALUATION OF PERFUSION IMAGING IN LATE WINDOW THROMBECTOMY IN EVERYDAY CLINICAL PRACTICE : RESULTS OF A PROSPECTIVE REGISTRY FROM A NETWORK OF BELGIAN HOSPITALS

E. Fouarge ¹, C. Ciobanu¹, O. Cornet², F. Delvoye¹, F. Dister², D. Brisbois², P. Desfontaines¹

¹Centre Hospitalier Chrétien, Stroke Unit, Liège, Belgium, ²Centre Hospitalier Chrétien, Interventional Neuro-radiology, Liège, Belgium

Background and aims: Clinical benefit of late window thrombectomy (6 to 24 hours) has been shown by DEFUSE3 and DAWN trials. We evaluate prospectively the outcome of late window thrombectomy (LWT) in a network of 9 Belgian community based hospitals located at a distance of less than 100 km from the comprehensive stroke centre (CSC).

Methods: From 2019 to 2021, 260 thrombectomy procedures were performed, 48 of which in the late window. MRI was performed and the Rapid Processing of Perfusion and Diffusion (RAPID) automated software platform (iSchemaView, Menlo Park, CA) was used to determine imaging eligibility. All patients were evaluated by the modified Rankin scale at 3 months. Data were compared with those of early thrombectomy (EWT, < 6 hours).

Results: The number of thrombectomies was increased by 18 % (n=48/260) over 3 years. Mean age was 70,6 years and mean NIHSS at admission was 14 +/- 5. Mean DWI volume was 37 +/- 31 ml and the mean mismatch volume was 72 +/- 65 ml. The percentage of mRS </= 2 was 25% in the LWT whereas it was 52,9% in the EWT (p = 0.04). The mortality rate was 18,7%, similar in both groups.

Conclusions: The use of the RAPID software in everyday practice leads to a substantial increase (18%) of the number of thrombectomies over 3 years. The percentage of good outcome in the LWT is quite good (25%) but significantly lower than in the EWT.

Disclosure: No

P0366 / 1104

CORRELATION BETWEEN LOCAL CEREBRAL PERFUSION AND EEG FREQUENCY IN PATIENTS WITH SUSPECTED ACUTE ISCHEMIC STROKE

M.N. van Stigt ^1,2, K. Klein Gunnewiek², A.A.G.A. van de Munckhof^1,2, L.C.C. van Meenen¹, H.A. Marquering^3,4, C.B.L.M. Majoie⁴, Y.B.W.E.M. Roos¹, J.H.T.M. Koelman^1,2, W.V. Potters^1,2, J.M. Coutinho¹

¹Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, Netherlands, ²Amsterdam UMC, University of Amsterdam, Clinical Neurophysiology, Amsterdam, Netherlands, ³Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, Netherlands, ⁴Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Amsterdam, Netherlands

Background and aims: Prehospital detection of large vessel occlusion stroke of the anterior circulation (LVO-a) would enable direct transportation of these patients to an endovascular thrombectomy (EVT) capable hospital. The ongoing ELECTRA-STROKE study (NCT03699397) evaluates dry electroencephalography (EEG) as a potential prehospital LVO-a detection instrument. Here, we analyzed the correlation between CT perfusion and EEG data.

Methods: A 32-channel dry electrode EEG recording was performed in patients who presented to the emergency room with a suspected stroke or known LVO-a, prior to EVT. CT perfusion was performed as part of standard clinical practice. For each EEG electrode position, we determined EEG frequency band powers. Additionally, we used CT perfusion data to calculate the mean cerebral perfusion in ml/min/100g for a sphere with a radius of 30 mm around this electrode position. We related local cerebral perfusion to local EEG frequency band powers using Spearman’s correlation.

Results: Data of 8 patients were analyzed. Mean age was 62 years (SD±12) and 5 patients (63%) were male. Seven patients had an ischemic stroke (4 LVO-a), and 1 had a transient ischemic attack. Median time from arrival at the emergency room to start of the EEG recording was 40 minutes (IQR:31-49). Relative delta and theta power were negatively correlated with cerebral perfusion (r=-0.19, p=0.006 and r=-0.31, p<0.005, respectively). Relative alpha power was positively correlated with cerebral perfusion (r=0.36, p<0.005). No correlation was found for the relative beta power.

Conclusions: EEG frequency is correlated with local cerebral perfusion, as measured with CT perfusion.

Disclosure: Yes

P0367 / 853

ASSESSMENT OF THROMBUS USING FILTERED PHASE IMAGES OF SUSCEPTIBILITY-WEIGHTED IMAGING IN PATIENTS WITH LARGE VESSEL OCCLUSION OF ACUTE ISCHEMIC STROKE

S. Park ¹, J.-w. Lee¹

¹ Inje University Haeundae Paik Hospital, Department of Neurology, Busan, Korea, Republic of

Background and aims: Recognizing the location and length of the thrombus in large vessel occlusion (LVO) of acute ischemic stroke (AIS) can be helpful for effective endovascular recanalization therapy (ERT). We hypothesized that the aliasing or dipole effect generated from filtered phase image of susceptibility-weighted imaging (SWI) will have advantages in delineating thrombus. This study aimed to compare the depiction of the thrombus in SWI, multiphase CT angiography (mCTA), and Noncontrast-CT (NCCT) with reference to thrombus measured in digital subtraction angiography (DSA).

Methods: Among LVO patients who underwent ERT with MCA(middle cerebral artery) occlusion, we screened patients who had SWI, mCTA, and NCCT taken before the endovascular procedure. Of the 1553 patients, 15 were included. We defined concordantly measured thrombus (CMT) as having the same location as the thrombus observed in the reference and differing in length by less than 5 mm. In this study, the CMTs of SWI-m (magnitude images), SWI-mp(magnitude with phase images), mCTA, and NCCT were analyzed.

Results: In SWI-m, SWI-mp, mCTA, and NCCT, CMTs were 33.3%(5/15), 73.3%(11/15), 40%(6/15), and 26%(4/15). The CMT between SWI-mp and SWI-m was significantly different (p=0.031). The strength of agreement referred to the length of thrombus measured in DSA was excellent for SWI-mp (intra-class correlation coefficient 0.96), and poor for mCTA (0.25). There was a significant difference in CMT between SWI-mp and mCTA (p=0.039).

Conclusions: The SWI using the filtered phase image is more concordantly matches with the location and length of the thrombus measured in the DSA than other imaging modalities.

Disclosure: No

P0368 / 192

NORMAL APPEARING ISCHAEMIC BRAIN TISSUE ON CT AND OUTCOME AFTER INTRAVENOUS ALTEPLASE

G. Mair ¹, P.A. Sandercock¹, J.M Wardlaw¹

¹ University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom

Background and aims: Obvious ischaemic brain lesions on non-enhanced CT likely represent infarction. Conversely, viable ischaemic brain lesions may be non-visible on CT. We tested whether, within 6 hours, patients with normal appearing ischaemic brain tissue (NAIBT) on CT are identifiable, and if NAIBT yields better outcomes with alteplase.

Methods: With data from the Third International Stroke Trial (IST-3, large randomised-controlled trial of intravenous alteplase for ischaemic stroke) we used receiver-operating characteristic analysis to find a baseline National Institutes of Health Stroke Scale (NIHSS) threshold for identifying patients with medium-large ischaemic brain lesions on imaging 24-48 hours after stroke onset. Using this NIHSS threshold to select patients <6hrs, we tested whether favourable outcome after alteplase (six-month Oxford Handicap Score 0-2) differed between patients with NAIBT versus with visible lesions using logistic regression (controls: age, NIHSS, time from stroke to CT).

Results: Baseline NIHSS⩾12 best identified patients at 24-48hr with medium-large ischaemic lesions (area under curve=0.79, sensitivity=72.3%, specificity=71.9%). 1404/2961(47.4%) patients in IST-3 with CT <6hrs had NIHSS⩾12 (median age 83 years[inter-quartile 76-87], hours from stroke onset 2.3[1.6-3.3], 829[59.0%] female, 704[50.1%] allocated alteplase). Of these, 745/1404(53.1%) had visible baseline ischaemic lesions, 659/1404(46.9%) did not (NAIBT). Adjusted odds ratio for favourable outcome after alteplase was 1.54(95% confidence interval=1.01-2.36), p=0.045 with NAIBT versus 1.61(0.97-2.67), p=0.066 with visible lesions. Alteplase interaction p-value=0.895.

Conclusions: Patients with ischaemic stroke and NIHSS ⩾12 commonly have sizeable ischaemic brain lesions (visible <6hr or not). In IST-3, non-visible lesions at baseline are associated with favourable outcome after alteplase.

Disclosure: No

P0369 / 401

A FEASIBILITY STUDY ON APPLYING DEEP LEARNING METHODS TO QUANTITATIVE T₂ MRI RELAXATION TIMES FOR STROKE ONSET TIME ESTIMATION

B. L. McGarry ^1,2, E. Zihni¹, M. Knight², R. Damion², P. Clatworthy^3,4,5, K. Muir⁶, R. Kauppinen⁷, J.D. Kelleher^8,1, PRECISE4Q Predictive Modelling in Stroke

¹Technological University Dublin, PRECISE4Q Predictive Modelling in Stroke, Dublin, Ireland, ²University of Bristol, School of Psychological Science, Bristol, United Kingdom, ³Southmead Hosptial North Bristol NHS Trust, Stroke Neurology, Bristol, United Kingdom, ⁴Southmead Hospital North Bristol NHS Trust, Stroke Neurology, Bristol, United Kingdom, ⁵University of Bristol, Bristol Medical School, Bristol, United Kingdom, ⁶University of Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom, ⁷University of Bristol, Department of Electrical and Electronic Engineering, Bristol, United Kingdom, ⁸Technological University Dublin, ADAPT Research Centre, ICE Research Institute, Dublin, Ireland

Background and aims: Quantifying MRI T₂ relaxation times enables more accurate estimates of stroke onset time than DWI and FLAIR signal intensities. Separately, deep learning (DL) improved the timing ability of DWI and FLAIR. Therefore, T₂combined with DL could be a powerful stroke timer. However, existing T₂acute stroke datasets are too small for DL methods. We studied how the performance of a DL model predicting stroke onset time changes as the number of trainingsamples increases to determine whether a large prospective T₂stroke study should be pursued.

Methods: T₂ maps from 27 ischaemic stroke patients (< 9 hours onset, Figure 1) and a 3D convolutional neural network (CNN) with two convolutional and max-pooling layers, a dense layer and SoftMax output (Table 1) was used to predict a patient as within or beyond 4.5 hours symptom onset (n = 10 and 17 respectively). Three cross-validation processes using 3, 7, and 9 folds were run so that the portion of training data increased as the number of folds increased. Stratified sampling for all folds preserved class distributions.

Results: The average AUROC increased as the number of cross-validation folds increased (Table 2).

Conclusions: AUROCs showed overall model performance was low due to the small dataset, but the AUROC performance increased with more folds suggesting a larger dataset would yield higher performance. This observation is promising as it suggests that applying DL to T₂ relaxation time data is feasible for stroke onset time estimation and warrants collecting larger T₂ datasets.

Disclosure: No

P0370 / 965

COMPUTED TOMOGRAPHY PERFUSION IMAGING-BASED INTRAVENOUS THROMBOLYSIS IN MINOR STROKE PATIENTS

A. Mengel¹, J. Sartor-Pfeiffer ¹, M. Lingel¹, M. Krumbholz¹, M.-I. Stefanou¹, F. Hennersdorf², U. Ernemann², U. Ziemann¹, K. Feil¹, S. Poli¹

¹Eberhard-Karls University of Tübingen, Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Tübingen, Germany, ²Eberhard-Karls University of Tübingen, Department of Diagnostic and Interventional Neuroradiology, Tübingen, Germany

Background and aims: The benefit of intravenous thrombolysis (IVT) in patients with non-disabling minor stroke remains unclear, although these patients are at risk of secondary deterioration. Aim of our study was to compare efficacy and safety of computed tomography perfusion (CTP)-based IVT within 4.5 hours after symptom onset in minor stroke patients compared to standard care.

Methods: We collected data retrospectively between 01/2013 and 03/2019 of acute ischemic minor stroke patients (NIHSS ⩽ 5) without large vessel occlusion or contraindications for IVT, who underwent multimodal CT imaging. Primary endpoint was modified Rankin Scale (mRS) at 90 days.

Results: Of 267 included patients (mean age 75±13 years, 45.3% female, median NIHSS on admission 3 (2, 4)), 201 (75.3%) received IVT and 66 (24.7%) received standard care. IVT-treated patients performed clinically better in median NIHSS after 24 hours (1 vs. 1, p=0.012), NIHSS difference between admission and discharge (-3 vs. -1, p=0.004) and mRS at discharge (0 vs. 1, p=0.013). We found no difference in mRS after 90 days (0 vs. 1, p=0.84) between groups. IVT complications were low (1.1% symptomatic intracranial hemorrhage in IVT). In logistic regression, CTP deficit had no influence on outcome.

Conclusions: IVT might improve outcome in minor stroke. Patients with deficit in CTP did not improve more than patients without CTP deficit (mRS 90 days). Results should be evaluated in randomized controlled trails.

Disclosure: No

P0371 / 973

ASSISTANCE FROM ASPECT SOFTWARE COULD IMPROVE TELESTROKE PERFORMANCE

A. Barragán ¹, A. Fuerte¹, E. Zapata², A. De Albóniga-Chindurza², L. Amaya³, A. Hermosín⁴, J. de la Torre⁵, B. Pardo², R. de Torres¹, F. Delgado⁶, A. Gonzalez², J. Montaner¹, Centro Andaluz de Teleictus (CATI)

¹Hospital Universitario Virgen Macarena, Seville, Spain, ²Hospital Universitario Virgen del Rocio, Seville, Spain, ³Hospital Universitario de Torrecárdenas, Almeria, Spain, ⁴Hospital Puerta del Mar, Cádiz, Spain, ⁵Hospital de Jerez, Jerez de la Frontera, Spain, ⁶Hospital Universitario Reina Sofia, Córdoba, Spain

Background and aims: CATI is a centralized telestroke network in southern Europe. It is integrated by more than 20 vascular neurologists who provide remote assistance to more than 30 small hospitals. This results in considerable inter-professional variability in patient assessment and decision-making. To reduce this variability, artificial intelligence (AI) based diagnostic support systems have been developed.

The aim of the study is to analyze the impact that such software would have had on our network to see if it could be a useful tool that deserves to be implemented in daily practice at CATI.

Methods: Brain CTs studies of 350 acute stroke suspicions attended in CATI were analyzed prospectively with respect to neuroimaging by conventional radiologists, telestroke neurologists, and finally, in a retrospective way, by AI software. Concordance statistical analyses were made. Data about the software failures and usefulness in terms of the theoretical changes in patient management were also collected.

Results: The interobserver agreement between general radiologist, telestroke neurologist, and the software in ASPECT score was moderate (κ=0.48). We detected mistakes in 20%of the studies, most of them influenced by the study technique.

IA software use would have supposed a change in the management of 15% of patients: increasing treatment rates(7%), avoiding futile transfers to thrombectomy centers(4%), or avoiding unnecessary consultations(4%).

Conclusions: AI software like e-ASPECTS can be useful in large telestroke networks like CATI. Although it must be supervised for possible mistakes, its usefulness may be decisive in supporting decision-making in complex situations.

Disclosure: No

P0372 / 1621

A COMPARISON OF CLINICAL CHARACTERISTICS AND OUTCOMES FOR CT ANGIOGRAPHY AND CT PERFUSION PATIENT EVALUATION

F. Purroy ^1,2,3, D. Vazquez-Justes¹, Y. Gallego¹, G. Mauri¹

¹Hospital Universitari Arnau de Vilanova de Lleida, Stroke Unit, Lleida, Spain, ²IRBLleida, Lleida, Spain, ³UdL, Lleida, Spain

Background and aims: CT angiography (CTA) and perfusion (CTP) is increasingly performed routinely as a diagnostic tool in acute ischemic stroke (AIS).  The objective of this study was to evaluate clinical characteristics and outcomes in stroke code AIS patients according to CTA and CTP findings.

Methods: We compared clinical characteristics, management, and outcomes among three groups of patients: absence of LVO and absence of CTP abnormalities (LVO- CTP-), absence of LVO but presence of CTP abnormalities (LVO- CTP+); and presence of LVO and presence of CTP abnormalities (LVO+).

Results: We included 134 consecutive AIS patients. LVO- CTP- (n=76 [56.7%]) were younger than LVO- CTP+ (n=16 [11.9%]) and LVO+ (n=42 [31.3%]): 70.7 (16.3) years vs. 74.4 (16.1) years vs. 79.0 (11.7) years, p=0.018. The distribution of vascular risk factors was similar between groups. Small vessel disease etiology was significantly overrepresented in LVO- CTP-, while cardioembolism was higher in LVO+. Unknown onset stroke was more frequent in LVO+ (47.5%) than in LVO- CTP- (37.5%) and LVO- CTP+ (31.2%). LVO+ patients presented the highest basal NIHSS (13.0 [8.3-20.0]). LVO-CTP+ patients had higher basal NIHSS than CTP- patents. Final diagnosis of TIA was highest in LVO- CTP- patients. The proportion of patients treated with reperfusion therapies was higher in LVO+ (85.7%) and LVO-CTP+ (60%) patients than in LVO-CTP-mRs at discharge was similar between LVO-CTP- and LVO-CTP+ (2.0 [1.0-3.0])

Conclusions: CTP and CTA findings are related to etiology and initial stroke severity. In addition to patients with LVO, CTP could add prognostic information in non LVO patients.

Disclosure: No

P0373 / 198

POSTERIOR CIRCULATION ALBERTA STROKE PROGRAM EARLY COMPUTED TOMOGRAPHY SCORE (PC-ASPECT) FOR THE EVALUATION OF CEREBELLAR INFARCTS

T. Altiparmak ¹, B. Nazliel¹, H.Z. Batur Caglayan¹, N. Tokgoz², A. Akyol Gürses¹, M. Ucar²

¹Gazi University Faculty of Medicine, Neurology, Ankara, Turkey, ²Gazi University Faculty of Medicine, Radiology, Ankara, Turkey

Background and aims: Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The pc-ASPECT score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates.

Methods: We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study.

Results: Patients with a pc-ASPECT score < 7 were more likely to present with impaired consciousness (p<0.001), multiple posterior circulation infarcts (p<0.001), hydrocephalus (p<0.001), lesions of the vermis (p= 0.028), and peduncle (p= 0.024), perfusion deficits in the total of PICA, AICA, SCA (p<0.05), and basilar artery stenosis (p=0.005), ischemia in additional anatomical structures in the posterior circulation (p<0.001) compared with those with a score ⩾ 7.

Conclusions: Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the NIHSS score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiological parameters predicting long-term prognosis.

Disclosure: No

P0374 / 1565

CT ANGIOGRAPHY COLLATERAL SCORE HELPS TO OPTIMIZE PATIENT SELECTION FOR INTER-HOSPITAL TRANSFER IN LATE-WINDOW STROKE WITHOUT ADVANCED IMAGING

J.A. Sousa ¹, C. Bernardes¹, R. Machado¹, L. Cruz², L. Santos-Martins³, J. Paiva-Simões⁴, A.I. Martins¹, C. Brás¹, C. Cecília¹, L. Almendra¹, C. Machado¹, B. Rodrigues¹, O. Galego², C. Nunes², R. Veiga², G. Santo¹, F. Siva¹, E. Machado², J. Sargento-Freitas^1,3, coimbra

¹Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal, ²Centro Hospitalar e Universitário de Coimbra, Neuroradiology, Coimbra, Portugal, ³Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal, ⁴Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal

Background and aims: Many primary stroke center (PSC) lack advanced imaging techniques to triage patients presenting with stroke onset beyond 6 hours for transfer to a comprehensive stroke center (CSC).

We aimed to evaluate transferred patients presenting to PSC in late-window submitted to thrombectomy and the role of computed tomography angiography (CTA) in optimizing transfer decisions.

Methods: This study was a retrospective cohort study of consecutive anterior circulation LVO-AIS patients transferred from seven PSC to our CSC. Collateral score was classified using PSC single-phase CTA according to Tan scale (good collaterals: ⩾2). Good outcome was defined as 90-day modified Rankin Scale ⩽ 2 or equal to pre-morbid.

Results: We included 601 transferred patients, of which 54.6% were female. The number of transferred patients presenting to the PSC beyond 6h of symptom onset was 67 (11.1%). Transfer time to CSC was similar between early versus late-presenting patients [140(83-197) vs 139 (72-206) min,].The median NIHSS was also similar [18(9-27) vs 16(4-28)] as well as median ASPECTS at the PSC in both groups [10(8-10) vs 9.5 (7.5-10]. Transferred patients with good collaterals and presenting beyond 6h to the PSC had better outcomes than patients with poor collaterals presenting within 6h (59.5% vs 14.7%, p<0.001). Among transferred patients presenting in the late-window to the PSC, CTA good collateral score predicted good outcome after EVT (OR: 3.72, 95%CI 1.2-11.8, p=0.026)

Conclusion: In PSC without advanced imaging, CTA collateral score may help to select late-presenting patients for transfer for thrombectomy

Disclosure: No

P0375 / 86

DIAGNOSTIC UTILITY OF CT PERFUSION IN THE TELESTROKE SETTING

K. Arora ¹, A. Gaekwad¹, J. Evans², W. O'Brien², T. Ang³, C. Garcia-Esperson⁴, C. Blair⁵, L.S. Edwards⁶, B.L.A. Chew⁴, N.J Spratt⁷, C. Delcourt⁸, M. Parsons⁶, K. Butcher¹

¹Prince of Wales Clinical School, University of New South Wales, Clinical Neurosciences, Randwick, Australia, ²Gosford Hospital, Department of Neurosciences, Gosford, Australia, ³Royal Prince Alfred Hospital, Departments of Neurology and Radiology, Camperdown, Australia, ⁴John Hunter Hospital, Department of Neurology, New Lambton Heights, Australia, ⁵Ingham Institute for Applied Medical Research Institute, Sydney Brain Centre, Liverpool, Australia, ⁶South Western Sydney Clinical School, University of New South Wales, Department of Neurology and Neurophysiology, Liverpool, Australia, ⁷The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia, ⁸The George Institute for Global Health, University of New South Wales, Neurological and Mental Health Division, Newtown, Australia

Background: In the absence of Magnetic Resonance Imaging, definitive diagnosis of acute ischaemic stroke (AIS) is challenging, particularly in telestroke settings. Although the prognostic utility of CT perfusion (CTP) has been questioned, its diagnostic value remains under-appreciated, especially for cases where there is no visible intracranial occlusion. This study assessed the diagnostic utility of CTP in the acute telestroke setting.

Methods: Acute and follow-up data from consecutive suspected stroke patients assessed by a state-wide Telestroke service between March 2020 and August 2021 at 12 sites were analysed. All patients were assessed with multimodal CT, including CTP which was post-processed with automated volumetric software. Diagnostic sensitivity and specificity were calculated for multimodal CT and each individual component (non-contrast CT (NCCT), CT angiogram (CTA) and CTP).

Results: During the study period, 1000 patients were assessed, including 91 patients with intra-cerebral haemorrhage in whom CTP was not performed. Complete multimodal CT examination was obtained in 831 patients, 457 of whom were diagnosed with AIS. Acute CTP demonstrated AIS in 19.5% of patients with normal NCCT and CTA (sensitivity 73.3%, 95%CI: [69.0, 77.3] vs 53.8%, 95%CI: [49.1, 58.5], p<0.001). Multimodal CT including CTP demonstrated the highest negative predictive value (75.2%, 95%CI: [72.2, 77.9]). Patients with stroke not evident on CTP had small volume infarcts (1.2mL IQR: [0.5mL, 2.7mL]).

Conclusion: CTP permits definitive diagnosis of cerebral ischaemia in 1 in 5 patients with normal NCCT and CTA. Patients for whom CTP is not diagnostic have small infarcts that are generally not amenable to reperfusion therapies.

Disclosure: No

P0376 / 1062

INCIDENCE AND UTILITY OF INCIDENTAL FINDINGS ON NON-ECG GATED CARDIAC CT ANGIOGRAPHY DURING ACUTE STROKE IMAGING

P. Lee ¹, G. Dhillon², D. Dabreo², M. Pourafkari², Z. Jaff³, D. Tampieri², J.G. Boyd³, B. Durafourt³, L. Boisse Lomax³, A.Y. Jin³, R. Appireddy³, S. Jalini³

¹Queen’s University, Kingston, Canada, ²Queen’s University, Radiology, Kingston, Canada, ³Queen’s University, Medicine, Kingston, Canada

Background and aims: Emerging literature suggests the utility of cardiac CTA in the etiological diagnosis for stroke by detecting cardiac sources of emboli in patients with cryptogenic stroke. In addition, other incidental findings can influence further workup/management. In this study, we assessed the prognostic, diagnostic and management implications of these incidental findings.

Methods: We performed a prospective study of patients presenting with symptoms of acute stroke from September-August 2021. Patients underwent routine CT imaging with an extended field of view to include the entire heart. Images were analyzed for quality. If an abnormality was found, relevant confirmatory tests were performed at the discretion of the physician.

Results: Findings among 86 recruited patients were classified as cardiac thrombi (10/86; 11.6%) versus incidentals (14/86,16.6%). In cardiac thrombi group, LAA thrombus was found in 9 patients, 5 of whom presented with atrial fibrillation (AF) whereas 4 had no known AF and required anticoagulation as per standard of care. Findings within the incidentals group included Pulmonary Embolism (4.6%), Aortic Thrombus (1.1%), New Diagnosis or Progression of cancer (3.4%), Large Hiatus hernia (1.1%), Severe Coronary calcification (1.1%), Apical aneurysm (1.1%). Of the incidental findings, 19% required further diagnostic workup/confirmation, 56% had prognostic significance with 12.5% influencing mortality. A total of 56% of the incidental findings required changes to patient management.

Conclusions: Approximately one in six of patients undergoing non-ECG gated cardiac CTA for cardiac sources of emboli during acute stroke imaging have incidental findings. Approximately half of these findings lead to changes in patient management.

Disclosure: No

P0377 / 1048

ROLE OF CARDIAC COMPUTED TOMOGRAPHY IN HYPERACUTE STROKE ASSESSMENT: ONE-YEAR EXPERIENCE

S. Tomari ¹, B.L. Alvin Chew², B. Soans³, S. Al-Hadethi³, T. Ottavi², T. Lillicrap¹, Y. Tomari Kashida¹, C. Ostman², C. Levi⁴, M. Parsons⁵, C. Garcia-Esperon⁴, N. Spratt⁴

¹Hunter Medical Research Institute, Newcastle, Australia, ²John Hunter Hospital, Neurology, Newcastle, Australia, ³John Hunter Hospital, Radiology, Newcastle, Australia, ⁴University of Newcastle, College of Health, Medicine, and Wellbeing, Newcastle, Australia, ⁵University of New South Wales, South Western Sydney Clinical School, Sydney, Australia

Background and aims: Cardiac computed tomography (CT) has a similar yield to echocardiography in intracardiac thrombi detection. We hypothesized that performing cardiac CT with hyperacute stroke imaging may reduce the time to cardiac imaging and thus increase thrombus detection.

Methods: Consecutive patients with suspected stroke who underwent multimodal brain imaging and were prospectively recruited from 1^st December 2020 to 30^th November 2021, and underwent concurrent non-gated cardiac CT. We divided patients into two groups by National Institutes of Health Stroke Scale (NIHSS) <4 or ⩾4, and compared clinical characteristics and cardiac findings between them.

Results: A total of 314 patients were assessed (median 69 years old and 192 men). Final diagnoses were ischemic stroke (n=205), transient ischemic attack (TIA) (n=21) and stroke-mimic syndromes (n=88). Of ischemic stroke patients, 133 had an identified etiology and 72 were cryptogenic. Cardiac CT identified an intracardiac thrombi in seven (5.2%) in those with a stroke of confirmed etiology and one (1.4%) in those presenting with a cryptogenic stroke, but no intracardiac thrombus in TIA or stroke-mimic patients. Of the 314 patients, 116 had NIHSS <4, and 198 ⩾4. The NIHSS ⩾4 group was older (median 70 years versus 67 years, p=0.023) and more likely to have a diagnosis of cardioembolic (29% versus 18%, p=0.034) or cryptogenic stroke (27% versus 16%, p=0.035), and to have intracardiac thrombus (4.0% vs. 0%, p=0.033).

Conclusions: Cardiac CT identified intracardiac thrombus in the hyperacute stroke. A cutoff of NIHSS ⩾4 may be useful to stratify patients for cardiac CT.

Disclosure: No

P0378 / 1480

AUTOMATED PREDICTION OF ISCHEMIC LESION AGE FROM UNENHANCED CT: A VALIDATION STUDY

A. Marcus ¹, L. Chen¹, C. Ghezzou Cuervas-Mons¹, C. Hallett¹, D. Rueckert¹, P. Bentley¹

¹ Imperial College London, Brain Sciences, London, United Kingdom

Background and aims: Imaging biomarkers of ischemic lesion temporal evolution guide treatment decisions regarding stroke reversibility and haemorrhage risk. Unenhanced computerised tomography (UECT) is the most widely available tool for estimating a “tissue clock”. Currently this method relies on manual sampling of CT attenuation values within the lesion and contralateral brain. Here we validate a novel automated method for i) segmenting ischemic regions; and ii) predicting lesion age using an optimized model of imaging features.

Methods: We identified 1852 UECT images with visible acute/subacute ischemic lesions from patients presenting with stroke over the first 72 hours. In 783, experts manually segmented ischemic regions, which were used to: i) train neural networks for acute or subacute ischemic lesion segmentation; ii) train Radiomic and Convolutional Neural Network (CNN) models relating segmented imaging features to Time from Stroke Onset. These models were applied to the remaining dataset, to segment ischemic lesions; from which Onset Times were estimated using the above models, and relative lesion intensity.

Results: Performance of lesion age estimation using Expert-segmented lesions was: R2= 0.41 for Relative Intensity; 0.61 for Radiomic ; and 0.65 for CNN models. Performance for Automated-segmented lesions was: 0.33 for Relative Intensity; 0.47 for CNN; and 0.55 for CNN+Radiomic. In patients presenting <4.5 and 4.5-12 hours, CNN+Radiomic increased the number of correctly classified cases (i.e. Recall) by ~50% relative to Intensity models.

Conclusion: An automated pipeline for interrogating lesion age using Unenhanced CT shows moderate accuracy. The method significantly outperforms current manual methods, based solely on intensity.

Disclosure: No

P0379 / 1121

OPTIMAL CT PERFUSION THRESHOLDS FOR CORE AND PENUMBRA IN ACUTE POSTERIOR CIRCULATION ISCHAEMIC STROKE

L.S. Edwards ^1,2,3, C. Cappelen-Smith^1,2,3, D. Cordato^1,2,3, A. Bivard⁴, L. Churilov⁴, M. Parsons^1,3,2

¹Liverpool Hospital, Neurology and Neurophysiology, Sydney, Australia, ²University of New South Wales, South Western Sydney Clinical School, Sydney, Australia, ³Ingham Institute of Applied Medical Research, Sydney Brain Centre, Sydney, Australia, ⁴University of Melbourne, Melbourne brain centre at the Royal Melbourne Hospital, Melbourne, Australia

Background and aims: CT-perfusion (CTP) has advanced stroke care by improving diagnostic accuracy and expanding eligibility to acute therapies. Current thresholds for core and penumbra are based upon studies of anterior-circulation stroke. We examined the optimal CTP thresholds for acute posterior-circulation ischaemic stroke (PCS).

Methods: Data were analysed from 331-patients diagnosed with a PCS enrolled in the International-stroke-perfusion-registry (INSPIRE). Thirty-nine-patients with baseline multimodal-CT with occlusion of a large posterior-circulation (PC) artery and follow up diffusion-weighted-MRI at 24-48 hours were included. Receiver-operating-curve analysis was used to determine the optimal perfusion parameter and thresholds. Linear regression was used for volume analysis. Analysis of the PC including subregions was performed.

Results: Mean-transit-time (MTT) and delay-time (DT) were the leading thresholds to characterise ischaemic penumbra (AUC=0.73). Optimal thresholds for penumbra were a DT>1 second and MTT>145%. DT also provided the best estimate of infarct core (AUC=0.74) with an optimal core-threshold at a DT>1.5 seconds. CTP was most accurate in the calcarine (Penumbra-AUC [DT>1 second]=0.75, Core-AUC [MTT>135%]=0.79) and cerebellar regions (Penumbra-AUC [DT>0.5 seconds]=0.65, Core-AUC [DT>1.5 seconds]=0.79). On volume analysis, MTT>160% demonstrated the smallest mean-volume difference (MVD) and good correlation between the penumbral-estimate and follow-up MRI (R²=0.71). MTT>170% resulted in the smallest MVD between the core-estimate and follow-up MRI, but with poor correlation (R²=0.11).

Conclusions: CTP has significant diagnostic utility in PCS. Accuracy of CTP varies by brain region. Optimal thresholds to define penumbra were DT>1 second and MTT>145%. The optimal threshold for core was DT>1.5 seconds. However, CTP core volume estimates should be interpreted with caution.

Disclosure: No

P0380 / 1118

U-NET MODELS BASED ON COMPUTED TOMOGRAPHY PERFUSION PREDICT TISSUE OUTCOME IN PATIENTS WITH DIFFERENT REPERFUSION PATTERNS

Y. He ¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, School of Medicine, Department of Neurology, Hangzhou, China

Background and aims: Evaluation of cerebral perfusion is important for treatment selection in patients with acute large vessel occlusion (LVO). To assess ischemic core and tissue at risk more accurately, we developed a deep learning model named U-net using computed tomography perfusion (CTP) images.

Methods: A total of 110 acute ischemic stroke patients undergoing endovascular treatment with major reperfusion (⩾80%) or minimal reperfusion (⩽20%) were included. Using baseline CTP, we developed two U-net models: one model in major reperfusion group to identify infarct core; the other in minimal reperfusion group to identify tissue at risk. The performance of fixed-thresholding methods was compared with U-net models.

Results: In major reperfusion group, the model estimated infarct core with a dice score coefficient (DSC) of 0.61 and an area under the curve (AUC) of 0.92, while fixed-thresholding methods had a DSC of 0.52. In minimal reperfusion group, the model estimated tissue at risk with a DSC of 0.67 and an AUC of 0.93, while fixed-thresholding methods had a DSC of 0.51. In both groups, excellent volumetric consistency (intraclass correlation coefficient was 0.951 in major reperfusion and 0.746 in minimal reperfusion) was achieved between the estimated lesion and the actual lesion volume.

Conclusions: In patients with anterior LVO, the CTP-based U-net models were able to identify infarct core and tissue at risk on baseline CTP superior to fixed-thresholding methods, providing individualized prediction of final lesion in patients with different reperfusion patterns.

Disclosure: No

P0381 / 1438

UTILITY OF MULTIPHASE CT ANGIOGRAPHY IN THE MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE IN A STROKE CENTER

J. Alcalá¹, C. Amarante¹, F. Ostos ^1,2, J. Bernard Andreu³, F. Ballenilla³, I. Lizasoain^2,4, L. Ibáñez³, P. Calleja^1,2

¹Hospital Universitario 12 de Octubre, Centro de Ictus. Servicio de Neurología, Madrid, Spain, ²Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain, ³Hospital Universitario 12 de Octubre, Servicio de Radiología, Madrid, Spain, ⁴Universidad Complutense de Madrid, Unidad de Investigación Neurovascular. Dpto. Farmacología y Toxicología, Facultad de Medicina., Madrid, Spain

Background and aims: Multiphase CT Angiography (mCTA) using time-variant color map is a radiological technique that facilitates the detection of arterial occlusions in patients with acute ischemic stroke. It also provides information of the cerebral vasculature in arterial, peak venous and late venous phases, and improves the identification of collateral circulation without a significant increase in the radiation dose. In this study we evaluated its utility in routine clinical practice.

Methods: This is a single-center, retrospective study which includes consecutive patients with ischemic stroke due to large vessel occlusion who were eligible for endovascular thrombectomy, in whom a mCTA was performed. A comparative analysis was performed, stratifying patients according to good (grade 4-5) or poor-intermediate (0-3) collateral flow.

Results: A total of 53 patients have been included. Collateral grade 4-5 was identified in 26 patients whereas the remaining 27 presented grade 0-3. No significant differences in age, sex or vascular risk factors were identified. Patients with good collateral flow had a longer time from the symptom onset to cranial CT. In addition, they had lower severity on arrival (NIHSS 12.8 vs. 18.4, p<0.01). The group with good collateral flow had a smaller ischemic core on perfusion CT (4.9% vs. 22.4%, p=0.01). There were no significant differences in arterial recanalization or post-procedural complications.

Conclusions: mCTA is a useful tool in the evaluation of patients with acute ischemic stroke. It provides a better identification of collateral circulation with a good correlation with CT perfusion.

Disclosure: No

P0382 / 1126

NON-POROUS THROMBI ARE LESS PERVIOUS AND EASIER TO BE RETRIEVED: IMPLICATION FROM SCANNING ELECTRON MICROSCOPY STUDY

Y. He ¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, School of Medicine, Department of Neurology, Hangzhou, China

Background and aims: Scanning electron microscopy (SEM) studies found that the porosity of thrombi might vary among individuals. However, its relationship with the clinical presentation and efficacy of mechanical thrombectomy (MT) remains unknown. We aimed to characterize the ultrastructure of thrombi and explore its association with the complexity of MT and clot perviousness.

Methods: SEM was used to observe the morphological features of different components of thrombi obtained from patients with anterior circulation large vessel occlusion undergoing MT and determine the porosity of thrombi by semi-quantitative analysis. Non-porous thrombi were defined as thrombi with porosity < 2%. Clot perviousness on baseline computed tomographic images was also evaluated using thrombus attenuation increase (TAI). We assessed the complexity of MT by attempts of retrieval > 3 and procedural duration > 60 min, defined as the time interval between groin puncture and recanalization.

Results: A total of 49 thrombi were analyzed and 31 (63.3%) were classified as non-porous thrombi. The presence of non-porous thrombi was independently associated with procedure > 60 min (odds ratio: 0.152, 95% confidence interval: 0.031-0.734, p=0.019) and attempts > 3 (odds ratio: 0.194, 95% confidence interval: 0.046-0.822, p=0.026) after adjustment. Additionally, receiver operating characteristic curve analysis indicated that TAI < 17.9 Hounsfield unit could predict the presence of non-porous thrombi with an area under the curve of 0.915.

Conclusions: Non-porous thrombi on SEM are easier to be retrieved during MT and could be identified as less pervious clot on computed tomographic images.

Disclosure: No

P0383 / 1431

COMPARISON OF THE PROGNOSTIC UTILITY OF RAPID AUTOMATED SOFTWARE WITH VISUAL PARAMETERS IN THROMBECTOMY-TREATED PATIENTS

S. Trillo ¹, E. Valiente¹, C. Ramos¹, J. Vega², P. García-García², E. de la Fuente¹, Á. Aizpún¹, C. Hervás¹, C. González-Ávila¹, Á. Ximénez-Carrillo¹, J.L. Caniego², J. Vivancos¹

¹Hospital Universitario La Princesa, Neurology, Madrid, Spain, ²Hospital Universitario La Princesa, Radiology, Madrid, Spain

Background and aims: Mechanical thrombectomy(MT) has become a first-line treatment for MCA stroke with large vessel occlusion, neuroimaging parameters can predict outcome after MT. Automated software might provide accurate parameters with prognostic utilility. The aim of our study is to compare the prognostic utility of RAPID software in perfusion CT(PCT) parameters with other neuoimaging visual variables.

Methods: We performed a retrospective study of consecutive patients with stroke and M1/terminal carotid occlusion treated with thrombectomy in our center from August 2020-March 2021. We studied parameters provided by the RAPID software (10 variables) that were compared with other 5 variables of known prognostic value: ASPECTS in baseline CT(ASPECTSb), ASPECTS-CBV and ASPECTS-CBF in PCT, Tan scale(CT-angiography) and PATHS(PCT) in source images. Outome was evaluated using mRS-3m and mortality.

Results: N = 54. Mean age 72.9 (SD 14.7) Women 37%, ASPECTSb median 8 [6-9]. Terminal carotid occlusion 14 cases (25.9%). mRS-3m⩽2 35.2%. Studying the visual neuroimaging variables, we identifed a better prediction with the ASPECTS-CBV (rho = 0.52; p <0.001) and PATHS (rho = 0.48; p <0.001). The best estimator with RAPID was the reduction in CBF <34%, median 21 ml [0-74.5], associated with mRS-3m with rho = 0.52 (p <0.001). CBF <34% predicted mortality with area under the curve (AUC) of 0.84 (CI 0.71-0.96; p <0.001), similar to ASPECTS-CBV (AUC 0.83: CI 0.7- 0.93; p <0.001).

Conclusions: In our study RAPID software showed a similar prognostic valued than visual neuroimaging parameters. However, its automated processing might provide more reliability

Disclosure: No

P0384 / 1425

HYPERGLYCAEMIA PREDICTS COLLATERAL STATUS IN PATIENTS PRESENTING WITHIN 24 HOURS OF ACUTE ISCHAEMIC STROKE

V. Biswas ¹, K. Muir¹

¹ University of Glasgow, Glasgow, United Kingdom

Background and aims: The hypoperfusion intensity ratio (HIR) describes the proportion of hypoperfused tissue with severely delayed contrast arrival and therefore provides an index of collateral flow. Higher HIR has been associated with faster infarct growth and poor clinical outcome. Hyperglycaemia is associated with poorer leptomeningeal collaterals in animal models. We investigated hyperglycaemia and collateral blood flow in a prospective observational study.

Methods: We analysed CT Perfusion [CTP] scans from patients imaged <24 hours after symptom onset using RAPID.

We defined penumbra as Tmax>6 seconds, ischaemic core as Tmax>6 seconds and relative cerebral blood flow [CBF]<30%, HIR as Tmax >10s / Tmax>6s volume, high HIR as >0.2 and hyperglycaemia as admission glucose >7.0mmol/l. We used binary logistic regression to identify factors relating to poor collateral status.

Results: 185 patients were recruited from 29/03/18 to 31/12/21.

Of 168 patients with final diagnosis of AIS, 3 did not undergo CTP, 3 scans were not evaluable by the software and 2 patients did not have admission blood glucose recorded. 160 patients’ scans were analysed.

Mean age was 67, median onset to CTP with interquartile range was 246 (159-782), median NIHSS was 6 (4-11).

High HIR (poor collaterals) was significantly associated with admission hyperglycaemia (p=0.023, odds ratio 2.4, 95% confidence intervals 1.133 to 5.166) after adjusting for onset to CTP time and presence of known diabetes. Diabetes was not significantly associated.

Conclusions: Hyperglycaemia but not prior diagnosis of diabetes is significantly associated with poorer collateral status on CTP within 24h of symptom onset.

Disclosure: No

P0385 / 1172

COMPARISON OF HYPOPERFUSION LESION VOLUMES AND TARGET MISMATCH ON CT PERFUSION FROM DIFFERENT SOFTWARE PROGRAMS

V. Biswas ¹, A. Mahmood¹, F. McVerry², N. MacDougall¹, X. Huang¹, M. Parsons³, A. Bivard⁴, C. Levi⁵, B. Campbell³, S. Davis³, K. Muir¹

¹University of Glasgow, Glasgow, United Kingdom, ²Western Health and Social Care Trust Londonderry County Borough, Derry, United Kingdom, ³University of Melbourne, Melbourne, Australia, ⁴University of Melbourne, Melbourne, United Kingdom, ⁵University of Newcastle, Callaghan, Australia

Background and aims: CT Perfusion [CTP] post-processing software employs different processing algorithms. We compared three commonly used software platforms.

Methods: We analysed CTP from four studies recruiting patients prospectively <6h after stroke onset using MIStar, RAPID, and Brainomix.

Penumbra was defined as delay time [DT]>3 seconds or Tmax>6 seconds, ischaemic core as DT>3 seconds or Tmax>6 seconds and relative cerebral blood flow [CBF]<30%, and target mismatch as core<70ml and penumbra⩾15ml.

Absolute and percentage differences between core and penumbra volumes were calculated. Outliers, non-processed scans and those concordant for no perfusion lesion were excluded. Bias and 95% limits of agreement [LOA] were calculated by the Bland-Altman method.

Results: We analysed 339 CTP examinations from 374 patients.

Pairwise comparisons showed small absolute volume biases for core and penumbra but wide LOA and percentage biases (Figure).

Overall agreement for target mismatch was 72.8% (43.8% with and 29% without mismatch), of 224 patients suitable for analysis. Target mismatch presence in individual software ranged from 51% to 65%.

In 224 evaluable scans, agreement for absence of perfusion lesion (0ml volume) was seen in 28 (13%) while agreement for presence of a total volume lesion was seen in 156 (70%). Disagreement over 0ml lesions (core or penumbra) was present in 105 scans (47%) (Table).

Software with 0ml lesion	Software with lesion >0ml present	Tissue	Number of patients	Median (IQR) ml
RAPID	MIStar	Core	57	5 (2-11)
		Penumbra	13	5 (3-11)
	Brainomix	Core	30	2 (2-4)
		Penumbra	21	10 (7-15)
MIStar	RAPID	Core	3	4 (4-5)
		Penumbra	10	5 (3-11)
	Brainomix	Core	3	1 (1-6)
		Penumbra	25	11 (6-16)
Brainomix	Mistar	Core	29	2 (1-4)
		Penumbra	15	4 (3-13)
	RAPID	Core	5	5 (5-6)
		Penumbra	7	23 (4-33)

Conclusions: CTP processing software exhibited small mean bias for core and larger bias for penumbra volume estimates but with wide limits of agreement. While overall agreement on target mismatch criteria was high, disagreement in 27.2% may have consequences for individual treatment decisions.

Disclosure: No

P0386 / 1193

AUTOMATED CT PERFUSION RELIABILITY IN INFARCT CORE VOLUME PREDICTION IN ACUTE ISCHEMIC STROKE DUE TO TANDEM OCCLUSION

G. Lacidogna ¹, A.P. Mascolo¹, F. Sallustio¹, F. Marrama¹, A. Rocco¹, F. Mori¹, I. Maestrini¹, F. D’Agostino¹, F. Pitocchi², M. Colucci², V. Da Ros², M. Diomedi¹

¹Tor Vergata University - Stroke center, Rome, Italy, ²Tor Vergata University - Interventional Radiology Unit, Rome, Italy

Background and aims: To investigate automated perfusion CT (CTP) reliability in predicting ischemic core volume in acute ischemic stroke (AIS) due to tandem occlusion compared to MCA occlusion alone.

Methods: Between March 2019 and January 2021 all consecutive AIS due to MCA occlusion, referred to our tertiary stroke center, who performed an automated CTP and achieved a successful recanalization (mTICI = 3) after mechanical thrombectomy (MT), were retrospectively divided into two groups: tandem group (TG) and control group (CG) according to the presence of ICA occlusion. Demographic, functional, clinical, radiological, time intervals, safety and outcome measures were collected. Predicted ischemic core volume (PIV) was quantified by automated CTP with RAPID software with <30% relative CBF threshold; final infarct volume (FIV) was semiquantitatively calculated on MRI performed within 48h from MT. Parenchimal haematoma with mass effect (PH2) were excluded.

Results: Among 319 AIS patients, 18 were included in the TG and 28 in CG. A significant correlation was found between the PIV and FIV in both TG (tau=0.743 p<0,001) and CG (tau=0.358 p=0,003). In the Bland Altmann plot, 95% of the PIV and FIV differences fall in the ±2SD range respectfully to their mean difference (8,74 ± (17,42) pointing at an agreement between measures. No linear relationship between PIV and FIV means and differences (β=0,457 p<0,057) was found excluding positional bias.

Conclusion: In optimally reperfused patient, prediction of ischemic core volume evaluated by CT perfusion automated software RAPID seems to be as reliable in tandem occlusion as for MCA occlusion alone.

Disclosure: No

IMAGING – NON ACUTE INCLUDING NEUROSONOLOGY

P0387 / 1553

RELATION OF ENLARGED PERIVASCULAR SPACES TO OTHER MARKERS OF CEREBRAL SMALL VESSEL DISEASE

F. Rodriguez Lara ¹, A. Pinheiro^2,3, S. Demissie^2,3, O. Martinez⁴, A. Charidimou⁵, S. Gosh³, C. DeCarli⁴, S. Seshadri³, M. Habes⁶, P. Maillard⁴, J.R. Romero^5,3

¹Boston University School of Medicine, Boston, United States, ²Boston University School of Public Health, Department of Biostatistics, Boston, United States, ³NHLBI’s Framingham Heart Study, Framingham, United States, ⁴University of California Davis Health, Davis, United States, ⁵Boston University School of Medicine, Department of Neurology, Boston, United States, ⁶University of Texas Health, San Antonio, United States

Background: Enlarged perivascular spaces (EPVS) signal cerebral small vessel disease (CSVD) and dysfunction of brain perivascular drainage. Coexistence of EPVS with other CSVD manifestations likely increases an individuals’ risk of adverse neurological outcomes, but the relation of EPVS with other CSVD measures remains unclear. We related EPVS to ischemic and hemorrhagic CSVD manifestations to better understand the overall burden of subclinical vascular brain injury in individuals with visible EPVS.

Methods: Framingham Heart Study participants with CSVD ratings on brain MRI were included (N=2454, mean age 54±12 years; 52% women). EPVS were rated in Basal Ganglia (BG) and Centrum Semiovale (CSO), grades 1-4, dichotomized into low and high burden (grades 1-2 vs. 3-4), and a mixed score reflecting high burden (grades 3/4) in none, one or both regions. We related EPVS to covert brain infarcts (CBI), white matter hyperintensities (WMH) and cerebral microbleeds (CMB) using multivariable logistic regression analyses adjusted for age, sex and vascular risk factors.

Results: High BG-EPVS burden was associated with CBI (OR 3.73, 95%CI 2.30–6.04), and extensive WMH (OR 5.30, 3.16-8.89); high CSO-EPVS burden was associated with CBI (OR 1.52, 1.00-2.33) and extensive WMH (OR 5.83, 3.81-8.91). The mixed EPVS burden score showed a dose-effect relation to CBI and WMH. No significant associations were observed with CMB.

Conclusions: EPVS burden is independently associated with ischemic markers of CSVD, with stronger associations as high burden of EPVS spreads across brain regions. Further studies are needed to elucidate the causal relations between EPVS and other CSVD manifestations.

Disclosure: No

P0388 / 1306

DOPPLER FLOW CHARACTERISTICS OF EXTRACRANIAL ARTERIES PREDICT AORTIC VALVE PATHOLOGIES IN PATIENTS WITH ISCHEMIC STROKE

I. Maier ¹, L. Wilde¹

¹ University Medicine Göttingen, Neurology, Göttingen, Germany

Background and aims: Neurovascular ultrasound (nvUS) of the extracranial arteries is an integral part of the etiologic workup in patients with ischemic stroke (IS). Aortic valve disease shares similar vascular risk profiles and is a common comorbidity. Aim of this study was to investigate the predictive value of specific doppler flow characteristics for aortic valve disease.

Methods: Retrospective, single center analysis of IS-patients receiving nvUS of the extracranial common- (CCA) and internal carotid artery (ICA) and transthoracic echocardiography (TTE). A rater blinded for the TTE results investigated doppler flow curves for the following characteristics: ‘pulsus tardus et parvus’ for aortic stenosis (AS) and ‘bisferious pulse’, ‘diastolic reversal’ and ‘no dicrotic notch’ for aortic insufficiency (AI).

Results: From 1320 patients, 75 (5.7%) showed an AS and 482 (36.5%) an AI. In 61 (4.6%) patients the AS- and in 100 (7.6%) the AI was at least moderate to severe. After adjustment for age and cardio-vascular risk factors, the following flow pattern predicted aortic valve disease: 1) ‘pulsus tardus et parvus’ was highly predictive for a moderate to severe AS (OR 1419.5, 95%CI 358.3-5623.4, p<0.001) and 2) ‘no dicrotic notch’ (OR 37.1, 95%CI 4.4-316.8, p=0.001), a ‘bispherious pulse’ (OR 10.2, 95%CI 3.1-33.6, p<0.001) and a ‘diastolic reversal’ (OR 9.6, 95%CI 2-47, p=0.005) predicted a moderate to severe AI.

Conclusions: Doppler flow characteristics of the CCA and ICA are highly predictive for aortic valve disease. The consideration of these flow characteristics can be useful to streamline diagnostic and therapeutic measures, especially in the out-patient setting.

Disclosure: No

P0389 / 1259

TOPOGRAPHICAL ASSOCIATION BETWEEN LEFT VENTRICULAR MYOCARDIAL STRAIN AND BRAIN LESIONS IN ACUTE STROKE PATIENTS

D. Chung ¹, J.E. Shim¹, J. Seo¹, S.J. Park², J.-W. Chung¹, O.Y. Bang¹, G.-M. Kim¹, W.-K. Seo^1,3

¹Samung Medical Center, Neurology, Seoul, Korea, Republic of, ²Samsung Medical Center, Cardiology, Seoul, Korea, Republic of, ³Sungkyunkwan university, Samsung Advanced Institute of Health Sciences & Technology, Seoul, Korea, Republic of

Background and aims: Based on the established fact that insula is known to be implicated in cardio-autonomic dysfunction, we investigated the influence of acute stroke lesions on cardiac contractility using support vector regression lesion-symptom mapping to elucidate their topographical associations.

Methods: Patients with acute ischemic stroke within 7 days were selected from Samsung Medical Center Stroke Registry from 2016 to 2017. Patients with moderate to severe cardiac comorbidities were excluded. To evaluate LV systolic function, LV global and regional strain were measured by 2-dimensional speckle-tracking echocardiography. Acute stroke lesions were visually delineated based on diffusion-weighted images obtained at admission, and these lesion masks were drawn using in-house machine-learning based program.

Results: Of a total of 776 patients, 424 were enrolled in this study and 63 subjects had strokes including insular cortex lesions. A map of SVR-β map revealed that right insula and left inferior parietal cortex were associated with LV global longitudinal strain(GLS) (p< 0.05). Regional myocardial long-axis strain was also associated with right insula and left parietal cortex lesions. And it was found that the location of left parietal cortex lesion moved from the inferior region to the superior region according to the direction from the apex to the base along the long axis of LV.

Conclusions: Stroke lesions in right insula and left parietal cortex were topographically associated with LV GLS and regional long-axis strain, perhaps explaining why these regions have been implicated in the change of LV systolic function in acute stroke patients without cardiac comorbidities.

Disclosure: No

P0390 / 700

FREE-WATER IMAGING IN THE PENUMBRA OF SUB-CORTICAL ISCHEMIC STROKE LESIONS

F.L. Nägele ¹, M. Petersen¹, C. Mayer¹, C. Gerloff¹, G. Thomalla¹, B. Cheng¹

¹ University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany

Background and aims: Free-water imaging enables the identification of subtle changes in extracellular free-water content potentially indicative of vascular oedema not visible on conventional MRI. Here, we aim to explore the spatial extent of free-water alterations beyond sub-cortical stroke lesions and their relationship to symptoms.

Methods: Twenty-six patients with sub-cortical infarct with mean age of 67.4 (SD 11.3) and mean NIHSS score of 4.6 (SD 3.3) received 3T MR imaging 3-6 days after symptom-onset. Stroke lesion segmentation was performed based on FLAIR, DWI and T1w-MRI. Regions of interest surrounding stroke lesions were created by iterative voxel-wise (2 mm) dilatations of initial lesion masks, resulting in 8 unique tissue shells. Free-water maps were derived from diffusion-weighted MRI. Mean free-water within tissue shells and stroke lesions was extracted and normalized to corresponding contralateral regions. Free-water was compared across tissue shells and lesions and between hemispheres, utilizing linear mixed-effects modelling. Correlations between free-water and NIHSS were examined.

Results: Location of measurement significantly predicted increase in free-water. Lesions (+40.6% [mean], 40.1% [SD]) and 2mm tissue shells (+24% [mean], +29.3% [SD]) were significantly different comparing to the mean of more distant shells (Figure.1). Ipsilesional free-water was significantly increased in all tissue shells, but was not significantly associated with baseline NIHSS.

Conclusions: Our results show that free-water is significantly altered beyond visible sub-acute stroke lesions. It may therefore be a more sensitive indicator of vascular oedema comparing to conventional MRI. Larger, longitudinal studies will be needed to determine the clinical significance of our explorative study.

Disclosure: No

P0391 / 1380

REPERFUSION FAILURE AFTER SUCCESSFUL THROMBECTOMY OF LARGE VESSEL OCCLUSION (LVO) STROKE: CLINICAL AND IMAGING EVIDENCE

M. Barbagallo ¹, M. Zahn¹, J. Held^1,2, N. Bence³, J. Bellomo⁴, V. Stumpo⁴, A. Schwarz^1,2, C.H.B. Van Niftrik^4,2, M. Sebök^4,2, M. Piccirelli³, L. Michels³, A. Luft^1,2,5, Z. Kulcsar^3,2,6, L. Regli^4,2, G. Esposito^4,2, J. Fierstra^4,2, T. Schubert^3,2, S. Wegener^1,2

¹University Hospital Zurich, Neurology, Zurich, Switzerland, ²University of Zurich, Clinical Neuroscience Center, Zurich, Switzerland, ³University Hospital Zurich, Neuroradiology, Zurich, Switzerland, ⁴University Hospital Zurich, Neurosurgery, Zurich, Switzerland, ⁵Cenereo Center for Neurology and Rehabilitation, Vitznau, Switzerland, ⁶University of Zurich, Center of Applied Biotechnology and Molecular Medicine, Zurich, Switzerland

Background and aims: Mechanical thrombectomy (MT) is the mainstay of treatment in stroke patients with LVO. However, despite ideal post-interventional results, almost half of patients experience insufficient recovery. Such reperfusion failure or futile recanalization is currently defined solely based on clinical outcome. Our goal was to further characterize the occurrence and consequences of reperfusion failure using advanced hemodynamic imaging.

Methods: We chose patients from the IMPreST study (NCT04035746), which includes pre- and repeated post-MT perfusion weighted imaging (PWI), Blood Oxygenation-Level dependent cerebrovascular reactivity (BOLD-CVR) MRI, intravoxel incoherent motion MRI (IVIM) and non-invasive optimal vessel analysis (NOVA) up to 3 months after stroke.

We stratified patients based on their first (d1-2) follow-up PWI into: 1) hypoperfusion 2) normalization 3) hyperperfusion of the initially affected area.

Results: Of 49 patients, we identified 16 with successful recanalization (TICI 2b/3) and perfusion imaging on day 1-2 after MT. Cerebral blood flow returned to normal in 7, below normal in 3 and above normal in 6 patients (Figure 1). Hyperperfusion tended to be associated with older age, less beneficial outcome, and lower CVR in the affected MCA territory. Further analyses of PWI, BOLD-CVR, IVIM and NOVA will be presented at the conference.

Conclusions: In this unique dataset of multimodal hemodynamic imaging along with clinical characterization in patients who received MT for LVO stroke, we found substantial inhomogeneity in perfusion outcomes after successful MT. We anticipate that post-MT imaging will generate important knowledge about reperfusion failure, which will help to better understand and prevent this condition.

Disclosure: No

P0392 / 1479

LARGER INTRAPARENCHYMAL HEMORRHAGE VOLUME IS ASSOCIATED WITH MORE SEVERE PERIHEMATOMAL BLOOD-BRAIN BARRIER DISRUPTION

R. Leigh ¹, N. Walborn¹, R. Avadhani¹, I. Awad², D. Hanley¹, W. Ziai¹

¹Johns Hopkins University School of Medicine, Neurology, Baltimore, United States, ²University of Chicago Medicine and Biological Sciences, Neurovascular Surgery, Chicago, United States

Background and aims: Blood-brain barrier disruption (BBBD) is known to occur locally in primary intraparenchymal hemorrhage (IPH) due to mass effect and may occur globally with implications for functional outcome.

Methods: This post-hoc analysis of the MISTIE-III trial which evaluated minimally invasive surgery+alteplase in ICH >30 mL included patients who had MRI with perfusion weighted imaging (PWI) performed at 7-10 days after IPH. BBBD was quantified using PWI source images. Regions of interest (ROI) were manually delineated in the perihematomal region and centrum semiovale of the contralateral hemisphere. Primary outcome was hemorrhage volume (HV) on diagnostic and end-of-treatment (EOT) CT scans. Secondary outcome was functional outcome assessed at 1 and 6 months. The relationship between BBBD, HV, and functional outcome was assessed using linear regression.

Results: There were 37 patients (18 surgical) in MISTIE-III with required imaging performed at 8.3(1.4) mean(sd) days after ictus. Median age was 67 and 38% were women. More severe BBBD in perihematomal ROI was associated with larger diagnostic ICH volume (p=0.045, n=34) and EOT volume (p=0.032, n=37), but not with intraventricular hemorrhage volume. There were trends between higher BBBD measured in the contralateral hemisphere and worse functional outcome at 1 month (p=0.050, n=37) and 6 months (p=0.055, n=37).

Conclusions: Although it is well known that the BBB is disrupted locally in IPH, this is the first study to quantify this injury and demonstrate an association with HV. More studies are needed to determine if remote disruption of the BBB is predictive of outcome after IPH.

Disclosure: Yes

P0393 / 1053

ARTIFICIAL INTELLIGENCE FOR THE MONITORING OF CEREBRAL HEMODYNAMICS

C. Kulyk¹, A. Fattorello Salimbeni ², F. Favruzzo², F. Viaro², A. Pieroni², T. von Oertzen¹, M.R. Vosko¹, C. Baracchini²

¹Johannes Kepler University, Linz, Austria, ²University of Padua School of Medicine, Padua, Italy

Introduction: Transcranial Color Doppler (TCD) allows the continuous measurement of cerebral hemodynamics; however, the applicability is limited because of operator-dependency. Innovative systems can integrate ultrasound, robotics and artificial intelligence algorithms, enabling continuous insonation of intracranial vessels. We evaluated the safety and feasibility of artificial intelligence assisted robotic TCD (AI-TCD) for prolonged monitoring in different clinical settings.

Material and methods: Instructed sonographers at two large university centers used the AI-TCD (The NovaGuide™ Intelligent Ultrasound, NovaSignal Corp., USA) to find the middle cerebral artery flow and automatically track the signal in case of head movements. Patients were investigated in seven different settings (outpatient clinic, stroke unit, neuro-intensive care unit (ICU), anesthesiology ICU, neuroradiological and cardiological interventional suites and operation theater for carotid endarterectomy). Examinations characteristics including duration, temporal windows, technical aspects and adverse effects were collected.

Results: We performed 47 AI-TCD monitorings on 38 patients (27 in Linz, 11 in Padova). All AI-TCD examinations were safe in all patients. Yet, the examination was feasible in 5 of 7 settings. It was not possible during carotid endarterectomy since the device was interfering with the surgical field and during endovascular intracranial procedure as the system was not radiotransparent and did not allow simultaneous radiological intra-procedural control.

Conclusions: AI-TCD proved to be safe and feasible in most intensive, interventional and acute clinical settings. Handling with the device was comfortable and allowed good data acquisition. Further developments are needed in order to extend the range of settings in which this new technology might be successfully applied.

Disclosure: No

P0394 / 529

CORRELATION BETWEEN TRANSCRANIAL DUPLEX SONOGRAPHY AND PERFUSION MRI TO IDENTIFY CEREBRAL HYPERPERFUSION AFTER STROKE THROMBECTOMY

M. Kneihsl ¹, N. Hinteregger², O. Nistl², H. Deutschmann², S. Horner¹, D. Pinter¹, B. Poltrum¹, S. Fandler-Höfler¹, I. Hatab¹, M. Haidegger¹, D. Thaler¹, F. Fazekas¹, C. Enzinger¹, T. Gattringer^1,2

¹Medical University of Graz, Department of Neurology, Graz, Austria, ²Medical University of Graz, Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Graz, Austria

Background: Increased middle cerebral artery (MCA) flow velocities on transcranial duplex sonography (TCD) were observed in individual patients after stroke thrombectomy and associated with intracranial hemorrhage and poor outcome. However, the retrospective study design did not allow elucidation of the underlying pathomechanism, and the relationship between TCD and parenchymal perfusion abnormalities remains to be determined.

Methods: Successfully recanalized anterior circulation stroke thrombectomy patients were prospectively investigated with TCD and MRI including contrast-enhanced perfusion sequences within 48 hours post-intervention. Increased MCA flow on TCD was defined as >30% mean blood flow velocity in the treated compared to the contralateral MCA. MRI blood flow maps served to assess hyperperfusion rated by neuroradiologists blinded to TCD.

Results: All included 226 thrombectomy patients underwent postinterventional TCD and 92 patients additionally had perfusion MRI (41%). 85 patients (38%) showed increased postinverventional MCA flow on TCD. Of those, 10 patients (12%) had an underlying focal stenosis or vasospasm. Increased TCD blood flow in the recanalized MCA was associated with intracranial hemorrhage, larger infarct size and poor 90-day outcome (p<0.001, multivariable adjustment). In the subgroup that had both TCD and perfusion MRI available (n=92), 29 patients had increased ipsilateral MCA flow velocities on TCD (31%). Of those, 25 patients also showed parenchymal hyperperfusion on MRI (86%, p<0.001; diagnostic accuracy:77%). Hyperperfusion severity on MRI correlated with MCA flow velocities on TCD (r=0.457, p<0.001).

Conclusions: TCD is a reliable tool to identify post-reperfusion hyperperfusion, correlates well with perfusion MRI, and indicates bleeding complications and poor outcome after stroke thrombectomy.

Disclosure: No

P0395 / 1339

MULTI-DELAY ARTERIAL SPIN LABELING MRI FOR EVALUATING CEREBRAL BLOOD FLOW AFTER ISCHEMIC STROKE

S. Luijten ¹, P.-J. van Doormaal¹, D. Dippel², B. Roozenbeek², A. van der Lugt¹, E. Warnert¹

¹Erasmus MC University Medical Center, Radiology and Nuclear Medicine, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands

Background and aims: Arterial spin labeling (ASL) MRI may be useful for evaluating cerebral blood flow (CBF) restoration after ischemic stroke. We aimed to quantify CBF after large vessel occlusion ischemic stroke.

Methods: We included patients (n=46) with ischemic stroke due to anterior large vessel occlusions and who had follow-up MRI (3 Tesla) imaging at 24 hours available. Patients were stratified according to recanalization status assessed on MRA (successful versus unsuccessful). CBF estimates were acquired using pseudocontinuous ASL with 7 post-labeling delays (PLDs, range 0.8-3.5s). We extracted mean±SD CBF (ml/100g/min) values from the ischemic core delineated on diffusion-weighted imaging (DWI) at 24 hours, contralateral core by mirroring the ischemic core to the unaffected hemisphere, and contralateral grey matter (GM). In recanalized patients, we also identified salvaged penumbra as tissue with a Tmax ⩾6s on baseline CT perfusion minus the ischemic core. Comparisons of CBF between different brain regions within each group were performed with ANOVA.

Results: Among patients with successful recanalization (n=39), mean±SD CBF (ml/100g/min) was highest in the ischemic core (83.6 ± 33.8), followed by the salvaged penumbra (53.9 ± 23.0), contralateral core (53.8 ± 14.9), and GM (51.2 ± 18.4; p<0.001). Among patients with unsuccessful recanalization (n=7), mean CBF was substantially lower in the ischemic core (16.8 ± 9.0) than in the contralateral core (56.4 ± 30.2) and GM (51.5±24.8; p<0.01).

Conclusion: Hyperperfusion is often seen in infarcted, but not in salvaged, brain tissue following successful recanalization. Conversely, hypoperfusion is seen in infarcted brain tissue in case of non-successful recanalization.

Disclosure: No

P0396 / 556

IMPORTANCE OF TRANSCRANIAL DOPPLER MONITORING IN PATIENTS WITH ACUTE CERVICAL DISSECTION

C. Delfino ¹, E. Mazzon², A. Brunser², V. Díaz², P. Muñoz Venturelli³

¹Universidad del Desarrollo, Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Santiago de Chile, Chile, ²Clínica Alemana, Universidad del Desarrollo, Unidad de Tratamiento del Ataque Cerebrovascular (UTAC), Santiago de Chile, Chile, ³Clínica Alemana, Universidad del Desarrollo, Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Santiago de Chile, Chile

Background: Transcranial Doppler (TCD) ultrasonography is a practical and bedside diagnostic method to evaluate patients with acute cervical artery dissection (CAD). The purpose of this study was to determine the prevalence of abnormal findings in TCD in CAD patients and compare them with and without stroke.

Methods: From July 2018 to February 2021, consecutive patients with CAD admitted to Clínica Alemana de Santiago were included. Standard TCD, microembolic signals (MES) monitoring and breath hold Index (BHI) test were performed during the first days after admission.

Results: We found that of the 94 CAD patients admitted, 72% were women. The mean age at diagnosis was 40 years (SD 8.8). Most of the CAD arteries were from the posterior circulation (41% right vertebral artery and 28% left vertebral artery). Most patients had a good prognosis, although six patients had a CAD related stroke. 38% of the patients had an abnormal DTC and the most frequent finding was the presence of collateral flow (23%). A significant association was found between CAD related stroke and the presence of MES in DTC), when compared to CAD patients without stroke. (22% vs 1%, respectively, p=0.032).

Conclusions: This study supports the use of DTC in the acute management of patients, focusing on the presence of MES as an indicator of stroke. This can be of particular utility in centers where more sophisticated evaluations are unavailable.

Disclosure: No

P0397 / 1192

PHASE CONTRAST MRI CAN SEPARATE CONVENTIONAL ⩾50% CAROTID STENOSIS AND NEAR-OCCLUSION WITH HIGH SENSITIVITY AND SPECIFICTY

M. Holmgren ¹, E. Johansson²

¹Umeå University, Umeå, Sweden, ²Umeå University, Clinical Science, Umeå, Sweden

Background and aims: Carotid near-occlusion is difficult to diagnose. ESO guidelines make no management recommendation because of the diagnostic issues. ICA flow ⩽110 ml/min on phase-contrast MRI (PC-MRI) was 100% sensitive and specific for near-occlusion in a small study (n=29). For other modalities, no single parameter separates near-occlusion and conventional stenosis with both >90% sensitivity and specificity. We aimed to analyze the sensitivity and specificity of PC-MRI for diagnosing near-occlusion in a larger sample.

Methods: We prospectively examined consecutive patients with 50-100% carotid stenosis on at least one cervical side with CTA and PC-MRI (Venc 110 cm/s). The degree of stenosis was determined with CTA, categorized as <50% stenosis, conventional ⩾50% stenosis, near-occlusion and occlusion. ICA and MCA flow was assessed with PC-MRI and analyzed in absolute and relative numbers. Both cervical sides were analyzed.

Results: We included 132 participants, mean age 73 years, 68% men. Of 264 cervical sides, 95 had <50% stenosis, 87 conventional ⩾50% stenoses, 52 near-occlusions, 13 occlusions and 17 were excluded as CTA could not clearly separate conventional ⩾50% stenosis and near-occlusion. ICA flow had the best diagnostic performance. Excluding occlusions, ICA flow ⩽121 ml/min was 94% (49/52) sensitive and 97% specific (177/182) for near-occlusion. However, near-occlusions were sometimes mistaken for occlusion (Table).

Conclusions: ICA flow ⩽121 ml/min is accurate for separating near-occlusion and conventional stenosis – the best single parameter to date of any modality. However, PC-MRI with arterial flow settings (Venc 110 cm/s) sometimes did not detect the flow, mistaking some near-occlusions for occlusion.

		CT-Angiography
		<50% stenosis	⩾50% conventional stenosis	Near-occlusion	Occlusion
PCMRI	>121 ml/min	94	83	3	1*
	⩽121 ml/min	1	4	39	0
	No flow seen	0	0	10	12

*

Likely spontaneous recanalization.

Disclosure: No

P0398 / 552

THE INFLUENCE OF BLOOD PRESSURE ON CONTRAST EXTRAVASATION ON DUAL ENERGY COMPUTED TOMOGRAPHY AFTER ENDOVASCULAR TREATMENT FOR ISCHEMIC STROKE

M.M.Q. Robbe ^1,2, F.M.E. Pinckaers^1,2, R.J. van Oostenbrugge^3,2, J. Staals³, W.H. van Zwam^1,2, A.A. Postma¹

¹Maastricht University Medical Centre, Department of Radiology and Nuclear Medicine, Maastricht, Netherlands, ²School for Cardiovascular Diseases (CARIM), Maastricht, Netherlands, ³Maastricht University Medical Centre, Department of Neurology, Maastricht, Netherlands

Background: Blood brain barrier (BBB) disruption can lead to contrast extravasation (CE) and hemorrhage after endovascular treatment (EVT) for acute ischemic stroke. High blood pressure is a risk factor for BBB disruption. However, to date, the influence of blood pressure on CE after EVT is unknown.

Methods: We analyzed 458 patients who underwent EVT between January 2010 and December 2019 for acute ischemic anterior circulation stroke in our center and who met our inclusion criteria. All patients received immediate post-procedural dual energy computed tomography (DECT). Blood pressure measurements were obtained at the emergency room and upon arrival in the angio suite. CE was quantified by measuring the maximum parenchymal iodine concentration on DECT.

Results: CE was observed in 374/458 patients. There was no significant difference in blood pressure characteristics between patients with or without CE. Univariate linear regression (per 10 mmHg increment) showed no association between iodine concentration and emergency room pulse pressure (β=-0.018, 95%CI=-0.12-0.081)_{EmergencyRoom}, mean arterial pressure (β=0.091, 95%CI=-0.046-0.23)_{EmergencyRoom}, diastolic (β=0.11, 95%CI =-0.034-0.25)_{EmergencyRoom} and systolic blood pressure (β=0.028, 95%CI =-0.061-0.12)_{EmergencyRoom}, nor between iodine concentration and the angio suite pulse pressure (β=-0.01, 95%CI =-0.11-0.091)_AngioSuite, mean arterial pressure (β=0.075, 95%CI =-0.045-0.19)_AngioSuite, diastolic (β=0.088, 95%CI=-0.036-0.21)_AngioSuite and systolic blood pressure (β=0.033, 95%CI =-0.051-0.12)_AngioSuite. Likewise, multivariable linear regression showed also no association between blood pressure and iodine concentration.

Conclusion: Blood pressure was not associated with maximum iodine concentration on DECT in patients treated with EVT for acute ischemic stroke.

Disclosure: No

P0399 / 1382

MULTISPRECTRAL OPTOACOUSTIC IMAGING OF CEREBROVASCULAR DISEASE

M. Zahn ^1,2,3, B. Lafci^4,5, H. Handelsmann^1,2,3, A.C. Steiner^1,2,3, P. Baumgartner^1,2,3, F. Fierz^6,2, J. Gunzinger^6,2, A.R Luft^1,2,3,7, A. Boss⁸, D. Razansky^4,5, S. Wegener^1,2,3

¹University Hospital Zurich, Department of Neurology, Zurich, Switzerland, ²University of Zurich, Zurich, Switzerland, ³Clinical Neuroscience Center, Zurich, Switzerland, ⁴Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland, ⁵Institute for Biomedical Engineering, ETH Zurich, Department of Information Technology and Electrical Engineering, Zurich, Switzerland, ⁶University Hospital Zurich, Department of Ophthalmology, Zurich, Switzerland, ⁷Cereneo Center for Neurology and Rehabiliation, Vitznau, Switzerland, ⁸Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland

Background and aims: Atherosclerosis and inflammatory changes of the neck and brain arteries could lead to ischemic stroke. Treatment guidelines focus on stenosis degree and vessel morphology based on duplex sonography, which only provides a limited characterization of the plaque and the associated vessel wall. We tested the potential of multispectral optoacoustic tomography (MSOT) to characterize plaques and inflammatory vessel wall changes in patients with cardiovascular disease.

Methods: To this end, 11 stroke patients and 6 patients with suspicion of giant cell arteritis (GCA) have been included in the study. Affected arteries, either carotid or superficial temporal artery (STA), were examined with MSOT. The method relies on detection of acoustic echoes generated by light absorption in biological tissues, thus enabling high-resolution imaging of disease specific biomarkers with optical contrast. We concentrated on the assessment of lipid content and oxygenation state to find markers for the type (atherosclerotic vs inflammatory) and severity of cerebrovascular disease.

Results: Very preliminary findings in the affected STA of a patient with GCA indicate that indeed, total haemoglobin (tHb) might be higher on the inflamed vessel wall (tHb 1,93 a.u. versus 0,08 a.u.). Analysis of the lipid content in carotid plaques is ongoing and will be presented at the conference.

Conclusions: Our preliminary results indicate that MSOT may serve as a non-invasive method to characterize cerebrovascular disease with haemoglobin (Hb) being a new marker for severity of inflammation in the effected vessel wall. More patients will be included to validate the results.

Disclosure: No

P0400 / 250

IN VIVO DETECTION OF ¹⁸F-MK-6240 BINDING AFTER ISCHEMIC STROKE

L. Michiels ¹, L. Thijs², N. Mertens³, S. Sunaert⁴, M. Vandenbulcke⁵, G. Verheyden², M. Koole³, K. Van Laere⁶, R. Lemmens¹

¹KU Leuven University Hospitals, Neurology, Leuven, Belgium, ²KU Leuven, Rehabilitation Sciences, Leuven, Belgium, ³KU Leuven, Nuclear Medicine and Molecular Imaging, Leuven, Belgium, ⁴KU Leuven University Hospitals, Radiology, Leuven, Belgium, ⁵KU Leuven University Hospitals, Psychiatry, Leuven, Belgium, ⁶KU Leuven University Hospitals, Nuclear Medicine and Molecular Imaging, Leuven, Belgium

Background and aims: The risk of Alzheimer disease is increased after stroke and this association is partially independent of vascular risk factors. Preclinical data suggests a role of ischemia in development of Alzheimer pathology by hyperphosphorylation of tau. Therefore, ischemic stroke possibly triggers formation of neurofibrillary tangles (NFT), which can be detected in vivo using ¹⁸F-MK-6240 PET.

Methods: We included patients with a first ischemic stroke to undergo ¹⁸F-MK-6240 PET/MR. Patients were scanned 2-4 weeks after stroke and 6 months later. We quantified ¹⁸F-MK-6240 images using standardized uptake value ratios (SUVR_90-120min) with the cerebellum as reference region and applied a region-based voxel-wise partial volume correction. We defined the lesion and consecutive peri-ischemic areas as volumes-of-interest (Figure 1).

Results: Within the first month after stroke (n=17; 6M/11F; median age 73 years [IQR: 62-82]), ¹⁸F-MK-6240 PET signal was increased in the lesion. However, this was likely driven by blood brain barrier breakdown, hampering a reliable data analysis (Figure 2). At 6 months after the event (n=13; 5M/8F; median age 71 years [IQR: 60-79]), ¹⁸F-MK-6240 binding was increased in the ischemic lesion compared to 20 age-matched controls (9M/11F; median age 71.5 years [IQR: 66-76]; ratio_{lesion/controls}=1.62±0.54; one-sample t-test: p=0.0015) and gradually decreased in the surrounding tissue (one-way within-subject ANOVA(F(1.2, 14.8)=18.0, p=0.00043; Figure 3).

Conclusions: NFT may form after ischemic stroke and spread in the peri-ischemic brain parenchyma. Further follow-up is required to gain more insight in the spatial and temporal dynamics of this tauopathy after ischemic stroke.

Figure 1

Figure 2

Figure 3

Disclosure: No

P0401 / 415

ASSOCIATION BETWEEN SPONTANEOUS INTERNAL CAROTID ARTERY DISSECTION AND PERIVASCULAR ADIPOSE TISSUE ATTENUATION ON COMPUTED TOMOGRAPHY ANGIOGRAPHY

K. Cheng ^1,2, A. Lin^1,2,3, X. Stecher⁴, T. Bernstein⁵, P. Zuñiga⁴, E. Mazzon^6,7, A. Brunser⁶, V. Diaz⁶, G. Martinez⁶, W. Cameron¹, J. Yuvaraj^1,2, S.J. Nicholls^1,2, S. Patel⁸, D. Dey³, D.T. Wong^1,2, P.M. Venturelli^7,6,9

¹Monash University and Monash Heart, Monash Cardiovascular Research Centre, Victorian Heart Institute, Melbourne, Australia, ²Monash University, Department of Medicine, Melbourne, Australia, ³Cedars-Sinai Medical Centre, Biomedical Imaging Research Institute, Los Angeles, United States, ⁴Clínica Alemana de Santiago, Universidad del Desarrollo, Departamento de Imagenología, Santiago, Chile, ⁵Clínica Alemana de Santiago, Universidad del Desarrollo, Departamento de Imagenología, Santiago, Chile, ⁶Clínica Alemana de Santiago, Universidad del Desarrollo, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Santiago, Chile, ⁷Clínica Alemana, Universidad del Desarrollo, Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile, ⁸Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia, ⁹University of Sydney, The George Institute for Global Health, Sydney, Australia

Background and aims: Studies with high-resolution magnetic resonance imaging and positron emission tomography has suggested vessel wall inflammation as a pathogenic factor in spontaneous cervical artery dissection (sCAD). Computed tomography (CT) attenuation of coronary artery perivascular adipose tissue (PVAT) is an established non-invasive biomarker of coronary inflammation, with higher CT attenuation values reflecting greater degree of vascular inflammation. We aimed to evaluate the association between CT attenuation of PVAT surrounding internal carotid artery (ICA; PVAT_carotid) with sCAD in the underlying vessel.

Methods: Prospective observational study of 56 consecutive patients with CT-verified acute ICA sCAD between 2011 and 2018. Of these, 6 patients underwent follow-up CTA. 22 patients who underwent CTA for acute neurological symptoms but did not have dissection formed the control group. PVAT_carotid was measured using semiautomated software (Autoplaque v2.5).

Results: PVAT_carotid surrounding dissected ICA is significantly higher than non-dissected contralateral ICA (-58.7±10.2 vs. -68.9±8.1, P<0.0001) and ICA of patients without dissection (-58.7±10.2 vs. -69.3±9.3, P<0.0001). After median follow-up of 89 days, there was significant reduction in PVAT_carotid around dissected ICA (-57.5±13.4 to -74.3±10.5 HU, P<0.05); while no change in PVAT_carotid was observed around non-dissected contralateral ICA (-71.0±4.4 to -74.1±4.1, P=0.19). In multivariable analysis, ICA dissection was an independent predictor of PVAT_carotid following adjustment for age and presence of ICA occlusion.

Conclusions: PVAT_carotid is elevated in the presence of sCAD and may decrease following acute event. Further imaging and histopathologic studies are needed to assess whether PVAT_carotid associates with inflammation in the underlying carotid vessels.

Disclosure: No

P0402 / 1045

ASSESSMENT OF CEREBRAL VASOMOTOR REACTIVITY IN PATIENTS WITH ACUTE MILD STROKE AND TRANSIENT ISCHEMIC ATTACK (TIA) WITH DIFFERENT ETIOPATHOGENESIS: PRELIMINARY RESULTS

N. Brunelli ¹, C. Altamura¹, C.M. Costa¹, M. Marcosano¹,C. Vico¹, A. Fallacara², F. Vernieri¹

¹Campus Bio-Medico University of Rome, Headache and Neurosonology Unit, Neurology Unit, Rome, Italy, ²Policlinico of Bari “Aldo Moro”, Neurology Unit, Bari, Italy

Background and aims: an impaired vasomotor reactivity (VMR) represents a negative prognostic factor for vascular and degenerative cognitive deterioration^1-2. Only few studies have addressed VMR in acute stroke phase³. We aim to investigate if VMR, calculated through the breath holding index (BHI), is a prognostic marker of clinical outcome in stroke/TIA patients.

Methods: in this longitudinal observational study (January 2020-2023) we enroll patients with acute stroke or TIA of anterior circulation with NIHSS < 8. The study observation period of 12 months includes 4 assessments: T1 (48-72h from onset), T2 (1 month follow up (FU)), T3 (6 months FU) and T4 (12 months FU). Clinical scales and cognitive tests are performed every time. VMR is evaluated at T1 and T3.

Results: from January 2020 to December 2021, 92 patients (67.4% men) with a median age of 66.5 (57-75.25) years were enrolled. 70.7% had a stroke. The median NIHSS at onset was 2 (2-3). The median pre-mRS was 0 (0), the median mRS at baseline was 1 (0-1). We found an inverse correlation between the adjusted mean MMSE and Pulsatility Index (PI) of Middle Cerebral Artery (MCA) (p=0.004) and PI of Posterior Cerebral Artery (PCA) (p=0.025) and between the mean MOCA and PI of MCA (p=0.025) and PI of PCA (p=0.011) at baseline. 83 patients were evaluated at T2, 63 at T3 and 36 at T4.

Conclusion: an inverse correlation may exist between cognitive tests and PI of MCA/PCA. An impaired VMR could be found in acute phase independently from etiopathogenesis

Disclosure: No

P0403 / 1183

DIAGNOSING CAROTID NEAR-OCCLUSION WITH POSTOPERATIVE CT-ANGIOGRAPHY

E. Johansson ¹, A.J Fox²

¹Umeå University, Clinical Science, Umeå, Sweden, ²Sunnybrook Health Science Centre, Medical Imaging, Toronto, Canada

Background and aims: Carotid near-occlusion is a severe stenosis that causes the distal internal carotid artery (ICA) diameter to decrease. ESO guidelines have no management recommendation for near-occlusion due to diagnostic issues. We aimed to create a hypothesis for a new reference standard for near-occlusion diagnosis: “Distal ICA diameter increases after revascularization”.

Methods: Controlled prospective study. Participants with ⩾50% carotid stenosis that underwent carotid revascularization were examined with CTA pre- and postoperatively. Preoperative CTAs were assessed by 2 experts using current state-of-the-art assessment approach. Then, the same experts assessed preoperative and postoperative CTAs side-by-side to assess distal ICA diameter change. Strict blinding between all assessments was arranged.

Results: 77 participants were included, 45 (58%) had suspicion of near-occlusion on preoperative CTA. 41 participants had near-occlusion on postoperative assessment. Preoperative and postoperative assessments agreed in 80% (56/70) of cases with a clear preoperative diagnosis. Many disagreements were near-occlusion mistaken for mimics or vice versa (figure). In all such cases, each expert made the same mistake on the preoperative assessment. Seven cases had unclear preoperative diagnosis, 3 had clear near-occlusion on the postoperative assessment, 4 clearly did not.

Conclusions: Increase in distal ICA diameter after revascularization is a reasonable reference standard to diagnose near-occlusion as it detects mistakes in preoperative assessments and allows for the first time of assessment of unclear cases. This method currently has virtually no role in clinical routine assessment, but may be useful as a reference test in future diagnostic studies of near-occlusion.

Disclosure: No

P0404 / 1122

INTEROBSERVER AGREEMENT ON THE HEIDELBERG BLEEDING CLASSIFICATION ON MAGNETIC RESONANCE IMAGING

N.A. van der Ende ^1,2, S.P. Luijten², S. Cornelissen², L. Kluijtmans³, G.J. Lycklama à Nijeholt⁴, A.M. van Hattem², A.A. Postma⁵, R.P. Bokkers⁶, A. Netland Khanevski⁷, L. Thomassen⁷, U. Waje-Andreassen⁷, N. Logallo⁷, S. Bracard⁸, B. Gory⁸, B. Roozenbeek^1,2, D.W. Dippel¹, A. van der Lugt²

¹Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Radiology & Nuclear Medicine, Rotterdam, Netherlands, ³Isala Klinieken, Radiology & Nuclear Medicine, Zwolle, Netherlands, ⁴Haaglanden Medical Center, Radiology & Nuclear Medicine, The Hague, Netherlands, ⁵Maastricht University Medical Center and School for Mental Health and Sciences, Radiology & Nuclear Medicine, Maastricht, Netherlands, ⁶University Medical Center Groningen, Radiology & Nuclear Medicine, Groningen, Netherlands, ⁷Haukeland University Hospital, Neurology, Bergen, Norway, ⁸University Hospital of Nancy, Department of Diagnostics and Interventional Neuroradiology, Nancy, France

Background and aims: The Heidelberg Bleeding Classification (HBC), developed for computed tomography, is also frequently used to classify intracranial hemorrhage (ICH) on magnetic resonance imaging (MRI) (Table 1). We aimed to determine the interobserver agreement of ICH according to the HBC on MRI in ischemic stroke patients treated with reperfusion therapy.

Methods: We used MRI scans including a gradient-echo or susceptibility-weighted imaging of ischemic stroke patients within 1 week after reperfusion therapy. Five observers, blinded to clinical characteristics except for suspected location of the infarction, independently rated ICH according to the HBC in random pairs. We calculated percent agreement and Cohen’s kappa (κ). If observers scored more than one ICH, only one ICH was taken into account for the percent agreement and κ. The order in which ICHs were prioritized was as follows: class 1 or 2 > class 3; 3a > 3b > 3c > 3d. To take the degree of disagreement into account, weighted κ with quadratic weights was calculated for no ICH and class 1 and 2.

Results: Among 198 scans, observers agreed on the presence of any ICH in 181/198 (91.4%; κ 0.826) patients. There was agreement on the HBC in 148/198 (74.7%; κ 0.610) patients (Table 2). In 16 patients, additional ICHs in class 3 were scored. Weighted κ for no ICH and class 1 and 2 was 0.911.

Conclusion: The presence of any ICH can be reliably scored on MRI. Agreement of ICH according to the HBC is substantial and disagreements are small.

Disclosure: No

P0405 / 1516

EFFECTS OF NORADRENALINE AND LABETALOL ON CEREBRAL BLOOD FLOW

J. Birnefeld ¹, K. Petersson², J. Malm¹, A. Eklund³, A. Wåhlin⁴, L. Zarrinkoob⁵

¹Umeå University, Department of Clinical Sciences, Umeå, Sweden, ²Umeå University, Umeå, Sweden, ³Umeå University, Department of Radiation Sciences, Umeå, Sweden, ⁴Umeå University, Department of Applied Physics and Electronics, Umeå, Sweden, ⁵Umeå University, Department of Surgical and Perioperative Sciences, Umeå, Sweden

Background and aims: Noradrenaline and labetalol are commonly used for blood pressure control in neurointensive care and acute stroke but their effects on cerebral blood flow rates are controversial among clinicians. We investigated total cerebral blood flow rates before and after administration of noradrenaline and labetalol.

Methods: Sixteen healthy volunteers aged 30-50 years were evaluated with phase contrast MRI. Intraarterial blood pressure monitoring was used. First, intravenous noradrenaline was administered to a target mean arterial pressure (MAP) of 20% above baseline (max dose 0.25 μg/kg/h). Subsequently, intravenous labetalol was given to a target MAP of 15% below baseline (max dose 150 mg). Total cerebral blood flow was defined as the sum of flow rates in the internal carotid arteries and vertebral arteries.

Results: Target noradrenaline MAP was achieved in 15 subjects (94%; median increase 19 mmHg). For labetalol, target MAP was reached in 4 subjects (25%; median decrease 9 mmHg). Median doses of noradrenaline and labetalol were 0.16 μg/kg/h and 138 mg respectively. Baseline median total cerebral blood flow was 772 ml/min (IQR 674-871 ml/min). After administration of noradrenaline, median total cerebral blood flow decreased to 705 ml/min (n=16; IQR 599-748 ml/min; p=0.001). There was no change in total cerebral blood flow after administration of labetalol (median 789 ml/min; n=16; IQR 734-900 ml/min; p=0.41).

Conclusion: Administration of noradrenaline decreased cerebral blood flow in healthy volunteers. Administration of labetalol did not change cerebral blood flow, but only 25% of subjects reached target MAP despite high doses.

Disclosure: No

P0406 / 1308

ACUTE CHANGES IN THE COUPLING STRENGTH BETWEEN BRAIN STRUCTURE AND FUNCTION FOLLOWING A STROKE

J. Brügger ^1,2, P.J. Koch^1,2,3,4, M.G. Preti^5,6, C.-H. Park^1,2, A. Cadic-Melchior^1,2, M. Ceroni^1,2, L. Fleury^1,2, S. Avanzi^1,2, M.J. Wessel^1,2,7, P. Maceira Elvira^1,2, T. Popa^1,2, N.H. Meyer⁸, O. Blanke^8,9, J. Adolphsen¹⁰, C. Jagella¹⁰, C. Constantin¹¹, V. Alvarez¹², J.-A. Ghika¹², B. Léger¹³, E. Beanato^1,2, P. Vuadens¹³, J.-L. Turlan¹³, A. Mühl¹³, D. San Millán¹¹, C. Bonvin¹², D. Van de Ville^5,6, F.C. Hummel^1,2,9

¹Ecole Polytechnique Fédérale de Lausanne, Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, Geneva, Switzerland, ²Ecole Polytechnique Fédérale de Lausanne, Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics and Brain Mind Institute, Sion, Switzerland, ³University of Lübeck, Department of Neurology, Lübeck, Germany, ⁴University of Lübeck, Center of Brain, Behavior and Metabolism (CBBM), Lübeck, Germany, ⁵Ecole Polytechnique Fédérale de Lausanne, Medical Image Processing Laboratory, Institute of Bioengineering, Geneva, Switzerland, ⁶University of Geneva, Department of Radiology and Medical Informatics, Geneva, Switzerland, ⁷University Hospital Würzburg, Department of Neurology, Würzburg, Germany, ⁸Ecole Polytechnique Fédérale de Lausanne, Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, Geneva, Switzerland, ⁹Geneva University Hospitals, Department of Neurology, Geneva, Switzerland, ¹⁰Berner Klinik Montana, Crans-Montana, Switzerland, ¹¹Hôpital du Valais, Department of Radiology, Sion, Switzerland, ¹²Hôpital du Valais, Department of Neurology, Sion, Switzerland, ¹³Clinique Romande de Réadaptation, Sion, Switzerland

Background and aims: In MRI-based neuroimaging research, functional (fMRI) and diffusion-weighted MRI (DWI) are widespread, but evaluated largely independently with a lack of knowledge about the link between both. Recent methodological advancements allow to quantify the coupling strength between them through the Structural Decoupling Index (SDI). This study aimed at determining the influence of a lesion on the structure-function interaction and at contrasting it with results obtained from healthy older adults (HOA).

Methods: DWI and resting-state fMRI was acquired in 44 stroke patients with motor deficits (66.7+/-7y) and 33 HOA (66.3+/-13.7y). Patients were scanned in the first week after stroke. The SDI was calculated for every individual and for every cortical region of the Glasser atlas.

Results: The SDI was affected in several brain networks in patients with a lesion in the right hemisphere but not the left. Notably, we observed a higher SDI (i.e. lower structure-function coupling strength) in the ipsi- compared to the contralesional hemisphere in the ventral attention network (p=0.031), whereas no hemispheric difference was found in HOA. In the limbic and default mode networks, the SDI was significantly higher in the left hemisphere compared to the right in HOA (p=0.003/p=0.023), but not in patients.

Conclusions: We show that a stroke in the acute phase impacts the coupling strength between brain structure and function in several brain networks with a potential importance of lesion site. A crucial next step will be to see how this relates to recovery and the underlying functional and structural neural reorganization.

Disclosure: No

P0407 / 1617

PREDICTORS OF CONGRUENCY BETWEEN CLINICAL AND RADIOGRAPHIC OXFORSHIRE COMMUNITY STROKE PROJECT CLASSIFICATION SUBTYPES

J.B. Clares de Andrade ¹, J. Mohr², F. Lima³, L. Barros⁴, G. Meira⁵, E. Barros⁵, G. Silva¹

¹Universidade Federal de Sao Paulo, Sao Paulo, Brazil, ²Columbia University, New York City, United States, ³Hospital Geral de Fortaleza, Fortaleza, Brazil, ⁴Universidade Estadual do Ceara, Fortaleza, Brazil, ⁵Centro Universitario Sao Camilo, Sao Paulo, Brazil

Background and aims: Oxfordshire Community Stroke Project (OCSP) classification has been widely used to assess ischemic stroke patient subsets based on clinical characteristics alone; However, the correlation between patient clinical presentation and imaging findings is yet to be determined. Our study aims to describe baseline characteristics of OCSP subtypes and evaluate predictors of this relation.

Methods: Patients with a confirmed diagnosis of ischemic stroke admitted to a Comprehensive Stroke Center in Brazil from February 2015 to October 2017 were eligible for our cohort. Patients underwent computed tomography (CT) at admission and a follow-up neuroimaging within 7 days as per the institution protocol. All patients were classified at admission by trained staff. The radiographic OCSP classification was assessed retrospectively based on the last follow-up neuroimaging.

Results: The overall agreement rate ranged from 65.5 to 88.7%. Lower values of NIH, absent hyperdense MCA sign, higher ASPECTS and absent brainstem symptoms were related to a higher risk of misclassification. The treatment with tPA was associated with a reclassification in total anterior circulation patients. For predicting radiographic posterior involvement, vertigo (OR 2.9, 95% IC 1.7-5.1, p<0.001) and brainstem symptoms (35, 20.5-60.2, p<0.001) were directly associated with correct classification, but motor and higher cerebral function were not correlated.

Conclusions: The clinical OCSP classification presented with good congruency rates with neuroimaging findings overall. However, LACI patients are often misclassified when considering radiological criteria. Moreover, among patients with a severe clinical presentation at admission, the OCSP classification could act as a predictor of satisfactory reperfusion after thrombolytic therapy.

Disclosure: No

P0408 / 910

COMPARISON OF DIFFUSION WEIGHTED IMAGING B0 AND SUSCEPTIBILITY WEIGHTED IMAGING OR GRADIENT-ECHO MRI FOR DETECTION OF POST-ISCHEMIC INTRACRANIAL HEMORRHAGE

S. Luijten ¹, N. van der Ende², S. Cornelissen¹, L. Kluijtmans³, G. Lycklama a Nijeholt⁴, A. van Hattem¹, A. Postma⁵, R. Bokkers⁶, A. Khanevski⁷, L. Thomassen⁷, U. Waje-Andreassen⁷, N. Logallo⁷, S. Bracard⁸, B. Gory⁸, B. Roozenbeek², D. Dippel², A. van der Lugt¹

¹Erasmus MC University Medical Center, Radiology and Nuclear Medicine, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands, ³Isala Klinieken, Radiology, Zwolle, Netherlands, ⁴Haaglanden Medisch Centrum, Radiology, Den Haag, Netherlands, ⁵Maastricht Universitair Medisch Centrum, Radiology, Maastricht, Netherlands, ⁶Universitair Medisch Centrum Groningen, Radiology, Groningen, Netherlands, ⁷Haukeland University Hospital, Neurology, Bergen, Norway, ⁸University Hospital of Nancy, Diagnostic and Interventional Neuroradiology, Nancy, France

Background and aims: Diffusion weighted imaging (DWI) is commonly acquired to assess infarction after ischemic stroke, but may also be sensitive for detection of intracranial hemorrhage (ICH) when B0 images are used. We aimed to compare DWI B0 versus susceptibility-weighted imaging (SWI) or gradient-echo (GRE) MRI for detection of post-ischemic intracranial hemorrhage (ICH).

Methods: We used follow-up MRI data from ischemic stroke patients acquired within 1 week after reperfusion therapy. Five neuroradiologists first rated 50 DWI B0 images each. After a minimum of 4 weeks, to prevent recollection bias, the paired SWI/GRE images of the same patients were evaluated as reference. Presence of ICH (yes/no) was determined and further classified according to the Heidelberg Bleeding Classification. We used the McNemar test to assess whether there was a difference in detection of ICH between SWI/GRE and DWI B0 images, and used Cohen’s Kappa to assess the inter-method agreement.

Results: 227 paired images had sufficient diagnostic quality. ICH was identified in 112 patients on SWI/GRE images and in 71 patients on DWI B0 images (p<0.001). Characteristics of ICHs that were not detected on DWI B0 are summarized in the table. The agreement between SWI/GRE and DWI B0 for detection of ICH was moderate (ĸ 0.58).

Conclusion: SWI/GRE images are more accurate than DWI B0 images for detection of post-ischemic ICH, especially for small and more diffuse hemorrhages.

Disclosure: No

P0409 / 925

ESTIMATION OF COMPENSATION FOR CIRCLE OF WILLIS ANASTOMOSES IN PATIENTS WITH SIGNIFICANT CAROTID STENOSIS - TCD STUDY

R. Stang ^1,2, H. Pál³, B. Csányi³, Z. Mihály⁴, Z. Czinege⁴, A. Varga⁴, P. Sótonyi⁴, T. Horváth⁵, D. Bereczki¹, R. Debreczeni¹

¹Semmelweis University, Neurology Department, Budapest, Hungary, ²Semmelweis University, János Szentágothai Neurosciences School of PhD Studies, Budapest, Hungary, ³Semmelweis University, Faculty of Medicine, Budapest, Hungary, ⁴Semmelweis University, Department of Vascular Surgery, Budapest, Hungary, ⁵University of Physical Education, Research Center for Sport Physiology, Budapest, Hungary

Background: The circle of Willis (CoW) variations are common. Transcranial Doppler (TCD) is a non-invasive method for monitoring velocity changes in cerebral vessels. Since Valsalva maneuver (VM) activates cerebral autoregulation, vasoreactivity can be estimated by TCD. The aim was to analyze the relationship between CoW structure and vasoreactivity with TCD metrics in patients with significant internal carotid artery (ICA) stenosis.

Methods: Patients with significant ICA stenosis were studied. CoW was depicted by CT angiography, aplastic and hypoplastic segments (compromised CoW) and normal segments (non-compromised CoW) were defined. We determined during VM by TCD the following variables: Cerebral Valsalva Ratio – CVR; Autoregulation Index – ARI; 2b time (beginning of VM’s late second phase) and overshoot time (time of maximum blood flow velocity of VM’s fourth phase). These variables were compared between CoW groups with Mann-Whitney U test or Kruskal-Wallis test.

Results: 56 patients were studied. CVR was significantly lower in compromised ipsilateral posterior CoW group (p=0.04). CVR was almost significantly lower in patients with two compromised ipsilateral CoW segments (p = 0.06) and showed a tendency for increase parallel with the number of CoW segments (p=0.06). There was no significant difference between CoW groups by OS time, 2b time and ARI variables.

Conclusions: The compensatory function of the CoW was demonstrated by TCD during VM in patients with significant ICA stenosis. VM registered by TCD could be a functional complementary test method to CoW imaging, further studies are needed to find its place in shunt selection process for ICA revascularization.

Disclosure: No

P0410 / 1522

CEREBRAL COLLATERAL CIRCULATION AND CAROTID PLAQUES IN VARIOUS NEUROVASCULAR PRESENTATIONS

T. Tegos ¹, M. Zilakaki¹, I. Papagiannis¹, I. Saoulidis¹, E. Papatolis¹, A. Tsolaki¹, V. Kimiskidis¹

¹ Aristotelian University of Thessaloniki, A Neurology Department, AHEPA Hospital, Thessaloniki, Greece

Background and aims: To identify the echodensity, stenosis of carotid plaques and cerebral collateral circulation that were associated with various ipsilateral presentations (retinal/amaurosis fugax, cerebrovascular/transient ischemic attack and stroke, asymptomatic).

Methods: 90 patients, with 90 plaques associated with various neurovascular presentations were studied. The duplex images of the plaques were analysed echomorphologically in a computer by means of Grey Scale Median (GSM) [echolucent (low GSM), echogenic (high GSM)]. The percentage (%) reduction of the mean velocity in the middle cerebral artery (PRMCA) on transcranial Doppler, during clamping in carotid endarterectomy, was evaluated to distinguish the competent cerebral collateral circulation (low PRMCA) from the non-competent one (high PRMCA).

Results: The retinal symptoms were associated with plaques of low median GSM (0), severe median stenosis (90%) and low median PRMCA (0.31) as contrasted with the cerebrovascular symptoms (17, 85%, 0.47 respectively) and asymptomatic status (32, 83%, 0.4 respectively) [(p=0.011 (GSM), p=0.57 (stenosis), p=0.76 (PRMCA)]. The retinal and the cerebrovascular symptoms were distinct in terms of GSM (p=0.003) and PRMCA (p=0.005) but not stenosis(p=0.418).

Conclusions: The retinal symptoms were produced by echolucent plaques and rather competent cerebral collateral circulation whereas the cerebrovascular ones by less echolucent plaques and a less competent cerebral collateral circulation. Asymptomatic status was associated with rather echogenic plaques and an intermediate cerebral collateral circulation.

Disclosure: No

P0411 / 507

AUTOMATICALLY QUANTIFYING SIGNIFICANT EMBOLIC EVENTS FROM EXTENDED TRANSCRANIAL DOPPLER ULTRASOUND MONITORING DURING HIGH STROKE RISK PROCEDURES

C. Thibeault¹, A. Dorn¹, S. Radhakrishnan¹, R. Hamilton ¹

¹ NovaSignal Corp., Innovation, Los Angeles, United States

Background: The identification of solid and gaseous embolic showers (ES) during surgical procedures can offer important insight to clinicians. While TCD can provide that at the point of care, historically, identification has been done manually. This is often intractable during long-term monitoring and existing commercial algorithms offer poor performance in the presence of ES. This work explores three algorithms for detecting and quantifying the length of ES.

Methods: The algorithms analyze MMode windows for regions of activity consistent with ES. The performance was validated on clinical data collected with the NovaGuide Intelligent Robotic Ultrasound at sites investigating both right-to-left shunting and intraoperative cardiac procedures. Regions of embolic activity were manually labeled (227 ES, 355 controls). The performance was evaluated first as a binary classifier and then scored based on the length of ES. This matching score (MS) measures how well an ES is quantified (MS∈[-1.0,1.0]).

Results: As illustrated in Table 1, there are tradeoffs. For example, while Shunt Grade Assist (SGA) provides high sensitivity and execution speed, it has lower specificity and MS. However, the lower MS was from small underestimations of ES that are heavily penalized.

Conclusions: These algorithms offer options for clinicians. The lack of automated methods for detecting ES during high-risk procedures can be filled by the more computationally efficient methods. While those with higher precision can be employed in post-processing or anywhere real-time processing is unnecessary.

Table 1.

Algorithm	Sensitivity	Specificity	MS	Time/Segment
SGA	99.6%	86.5%	0.84	0.010s (0.0009)
CountROI	98.7%	93.8%	0.87	0.299s (0.495)
OutlierROI	99.1%	94.1%	0.90	0.214s (0.380

Disclosure: Yes

DIAGNOSIS/INVESTIGATION OF STROKE ETIOLOGY

P0412 / 911

INTERNAL CAROTID ARTERY ANEURYSM PRESENTING AS UNILATERAL TONGUE SWELLING DUE TO HYPOGLOSSAL NERVE PALSY

N. Vella ¹, E. Flossmann¹, V. Nelatur¹

¹ Royal Berkshire Hospital, Reading, United Kingdom

Background and aims: Unilateral tongue swelling is an infrequent and less well-known presentation of hypoglossal nerve palsy. We describe a case resulting from internal carotid artery aneurysm (ICA) resulting in a hypoglossal and vagus nerve palsy.

Methods: A 39 year old male presented to hospital with a severe headache following an episode of vomiting. This was investigated and diagnosed as being a migraine and he was discharged. He re-presented to hospital 2 weeks later with a swollen tongue, hoarse voice and swallowing difficulty. On examination he had unilateral left-sided tongue swelling (Figure1), uvula deviation, tongue deviation, a vocal cord palsy and reduced movement of the palate.

Figure 1

A CT angiogram of the carotid artery demonstrated a saccular aneurysm of the ICA at the skull base (Figure 2) and he was diagnosed with a hypoglossal and vagus nerve palsy secondary to dissection and aneurysm of the ICA caused by vomiting. He was treated with dual anti-platelet therapy, anti-hypertensive medication and weight loss advice.

Figure 2

Results: Hypoglossal nerve palsy is known to cause tongue weakness and on examination the tongue will deviate to the affected side. A lesser known presentation is of unilateral tongue swelling in the denervated side.

Conclusions: Whilst cranial nerve palsy secondary to ICA dissection is well described, the presentation of unilateral tongue swelling as a result of hypoglossal nerve palsy is less well-known. Cases presenting in this way should undergo imaging of the skull base and carotid arteries in a timely manner to prevent stroke occurrence.

Disclosure: No

P0413 / 406

IMPACT OF ECHOCARDIOGRAPHY PERFORMED BY NEUROLOGISTS IN THE INTEGRATED PROCESS FOR STROKE CARE IN CARDIAC IMAGING UNITS

I.A. López Dequidt ¹, C. Peña Gil², M. Rodriguez Yañez¹, E. Rodriguez Castro¹, M.A. Martínez Monzonis², J.R. González Juanatey², M. Santamaría Cadavid¹, S. Arias Rivas¹, V. Gonzalez Salvado

¹Clinical Hospital of Santiago de Compostela, Neurology, Santiago de Compostela, Spain, ²Clinical Hospital of Santiago de Compostela, Cardiology, Santiago de Compostela, Spain

Background and aims: In recent years, neurologists have trained in transthoracic echocardiography (TTE) for the detection of cardiac pathology in patients with ischemic stroke. We designed a prospective study with the objective of analyzing the impact of the generalized performance of echocardiography by neurologists working in a network with a Cardiac Imaging Unit.

Methods: We studied in the Neurology Department of Santiago de Compostela Clinical Hospital from 2017 to 2020 the ischemic stroke and TIA hospital admissions with undetermined stroke etiology. The objectives were to evaluated by TTE performed by neurologists the presence of structural heart pathology and clinically relevant heart pathology with direct implications in therapeutic management for secondary stroke prevention. Cardiovascular events were also analyzed during follow-up.

Results: TTE was realized in 769 patients, structural heart pathology was detected in 58.6% of patients and clinically relevant heart pathology in 35.8% (some with ⩾1 types). The mean NIHSS on admission was lower in patients without structural heart pathology than in patients with structural heart disease: 3.4 (± 0.26) vs 5.19 (± 0.28) p <0.0001. The presence of structural heart pathology induces an increase in relative risk of cardiovascular events in the follow-up of 1.57 (95% CI 1.02 - 2.41).

Conclusions: TTE performed by neurologist within an integrated stroke care process is an accessible tool, with high diagnostic profitability with direct clinical-therapeutic implications in the secondary stroke prevention and also in the prevention of cardiovascular events in the future of patients who have had a stroke or TIA.

TYPE OF STRUCTURAL HEART PATHOLOGY	n= 566	%
Ventricular hypertrophy moderate or severe	155	20.16%
Left atrial enlargment moderate or severe in sinusal rhythm	89	11.57%
Atrial septal aneurysm and patent foramen ovale	85	11.05%
Akinetic myocardial infarcts	63	8.19%
Prosthetic valves and devices	46	5.98%
Mitral or aortic valvulopathy moderate or severe	43	5.59%
Ventricular heart function failure	32	4.16%
Intracardiac thrombi	15	1.95%
Native and prosthetic valve Endocarditis	13	1.69%
Aortic root enlargment	11	1.43%
Dilated cardiomyopathy with ventricular function < 35%	10	1.30%
Intracardiac tumors	4	0.52%

TYPE OF CLINICALLY RELEVANT HEART PATHOLOGY	n= 248	%
Left atrial enlargment moderate or severe in sinusal rhythm	89	11.57%
Atrial septal aneurysm and patent foramen ovale	85	11.05%
Ventricular heart function failure	32	4.16%
Intracardiac thrombi	15	1.95%
Native and prosthetic valve Endocarditis	13	1.69%
Dilated cardiomyopathy with ventricular function < 35%	10	1.30%
Intracardiac tumors	4	0.52%

Disclosure: No

P0414 / 499

CLINICAL DIAGNOSIS AND MRI IMAGING IN PATIENTS WITH TRANSIENT AND MINOR NEUROLOGICAL SYMPTOMS: A COHORT STUDY

W. Whiteley ¹, A. MacRaild¹, Y. Wang², M. Dennia¹, R. Al-Shahi Salman¹, A. Gray¹, M. Reed¹, C. Graham^1,1, J. Wardlaw¹

¹University of Edinburgh, Edinburgh, United Kingdom, ²Kunming Medical University, Kunming, China

Background: The utility of MRI brain in patients with transient or minor neurological symptoms (TMNS) is uncertain. We estimated the proportion of participants with TMNS with MRI evidence of acute ischemia at different clinical probabilities of TIA/minor stroke.

Methods: Cohort of TMNS participants with MRI ⩽5 days from onset. Clinicians at different levels of training gave a diagnostic probability before MRI: ‘probable’ when TIA/stroke was most likely diagnosis; ‘possible’ when TIA/stroke was not the most likely diagnosis; or ‘uncertain’. Post-hoc, each clinical syndrome was defined blind to MRI findings as: NINDS criteria TIA/stroke; IHS migraine aura; non-TIA focal symptoms, or non-focal symptoms. MRI evidence of acute ischemia was defined by 2 neuroradiologist reads. We measured the occurrence of stroke for at least 90 days and up to 18 months after recruitment.

Results: 272 participated (47% female, mean age 60, SD 14). The proportion of participants with MR evidence of acute ischemia was, at stroke/TIA clinical probabilities: probable,31%(95%CI:21–42%); possible,17%(12–24%); uncertain,20%(10–36%). MRI evidence of acute infarct was found in: NINDS criteria TIA/stroke 42%(32–53%); migraine aura, 11%(3–25%); non-TIA focal symptoms, 16% (10–25%); and no focal features, 3%(0–18%). By 18 months, stroke occurred in 9/61(18%) patients with MRI evidence of acute infarct and 2/211 (1%) without (age adjusted HR 13,95%CI:3–62;p<0.0001).

Conclusions: MRI evidence of acute brain ischemia was found in about 1 in 6 TMNS patients with a non-stroke/TIA initial diagnosis or uncertain diagnosis. Methods to target MRI to those most likely to benefit are needed.

Disclosure: No

P0415 / 904

ULTRASOUND-GUIDED DIAGNOSIS OF AN UNCOMMON STROKE: A CASE OF GIANT CELL ARTERITIS

M. Baldini ¹, S. Giannoni¹, E. Grifoni², E. Cioffi³, E. Bertini¹, E. Cosentino², C. Grisanti¹, S. Colon¹, A. Segneri⁴, L. Guidi¹, L. Masotti²

¹San Giuseppe Hospital, Department of Neurology, Empoli, Italy, ²San Giuseppe Hospital, Internal Medicine, Empoli, Italy, ³San Giuseppe Hospital, Internal Medicine and Rheumatology, Empoli, Italy, ⁴San Giuseppe Hospital, Departmento of Radiology, Empoli, Italy

Giant cell arteritis (GCA) is an immune-mediated vasculitis of large- and medium-sized vessels like superficial temporal arteries, extradural vertebral (VA) and carotid arteries (CA). Stroke happens in 3% to 7% of the cases and identifying GCA properly is important because potentially curative treatment exists.

An 83-year-old woman had a sudden onset of postural instability and bilateral hypoacusia. Laboratory tests didn’t show significant pathological findings.

TC-Angiography showed a filiform lumen of right VA and occlusion of left VA, right AICA and left PICA. Brain MRI pointed out restricted diffusion lesions in bilateral cerebellar dentate nuclei, consistent with acute ischemic stroke (Figure 1).

Ultrasonography didn’t show relevant anomalies in CA; instead, VA presented an homogeneous, hypoechogenic and concentric dark area (the so-called “halo sign”) around the lumen of the bilateral V2 segment (Figure 2).

The uncommon stroke localization and the ultrasound findings suggested vasculitic etiology of lesions, like GCA. An ultrasound examination of the TA was performed and, interestingly, it highlighted the “halo sign” also in the bilateral temporal arteries.

MR-angiography confirmed the previous intracranial vascular findings. Finally, the patient performed a 18FDG-PETwhich highlighted increased FDG uptake of inflamed vertebral artery walls. Patient was treated with a high dose of iv steroids and oral antiplatelet therapy, with improvement of clinical status.

In our patient clinical diagnosis of GCA was challenging due to limited classical symptoms. Arguments in favor of arteritis were the symmetric involvement of the VA, the sonographic halo sign and atypical stroke localization.

Figure 1 e Figure 2

Disclosure: No

P0416 / 1073

CLOT BURDEN IN CERVICAL ARTERIAL DISSECTION: CORRELATION OF THE INTRAMURAL THROMBUS VOLUME WITH THE EXTENSION OF THE CEREBRAL INFARCT

D. López-Mena ¹, A. Hampshire¹, H.A. Montenegro-Rosales², C.V. Cano-Nigenda¹, F.E. Serrano-Arias¹, H.E. Valdez-Ruvalcaba¹, F. De León-Mendoza¹, A.A. Bailón-Velasco¹, A. Arauz¹

¹Instituto Nacional de Neurología y Neurocirugía, Stroke clinic, Ciudad de Mexico, Mexico, ²Instituto Nacional de Neurología y Neurocirugía, Endovascular therapy, Ciudad de Mexico, Mexico

Background and aims: Cervical Arterial Dissection (CeAD) is a cause of stroke in young adults, and its pathophysiology is not defined. We aimed to correlate the volume of the intramural thrombus with cerebral infarct extension in patients with CeAD.

Methods: We analyzed patients treated at the Instituto Nacional de Neurología y Neurocirugía with a confirmed diagnosis of CeAD by computed tomography or magnetic resonance imaging. Volumetric measurements were performed in the ITK-SNAP program in cubic millimeters (mm³). Thrombus volume was assessed by two teams, with inter-observer agreement analysis. We subsequently performed correlation analysis with the Alberta Stroke Protocol Program Early CT Score (ASPECTS) or posterior circulation ASPECTS (pc-ASPECTS).

Results: We studied 71 patients: 17 with Carotid Arterial Dissection (CAD) and 54 with Vertebral Arterial Dissection (VAD). Median age was 39 (33-49) for patients with CAD; 40 (35-47) for VAD. The most common symptom in both presentations was headache. The median time to diagnosis was 1 (0 - 6) days in CAD and 4 (0 - 10) days in VAD. The median thrombus volume was 608 (468-1601) mm³ in CAD and 57.24 (0-262) mm³ in VAD. Spearman’s correlation coefficient between carotid thrombus volume and ASPECTS was 0.718 (p=0.172) and vertebral thrombus volume and pc-ASPECTS was 0.157 (p=0.591).

Conclusions: In this study, we did not find a correlation between intramural thrombus volume and the extent of cerebral infarct using the ASPECTS or pc-ASPECTS. More studies are required to confirm these findings.

Disclosure: No

P0417 / 1190

THE ROLE OF COMPETING STROKE ETIOLOGIES IN STROKE PATIENTS WITH ATRIAL FIBRILLATION

A. Zietz ¹, A.A Polymeris¹, F. Helfenstein², L. Hert^1,3, B. Wagner¹, D. Seiffge⁴, C. Traenka^1,5, V.L Altersberger^1,5, T. Dittrich¹, J. Fladt¹, S. Thilemann¹, G.M. De Marchis¹, H. Gensicke¹, L.H Bonati¹, P. Lyrer¹, S.T Engelter^1,5, N. Peters^1,5,6

¹University Hospital Basel and University of Basel, Department of Neurology and Stroke Center, Basel, Switzerland, ²University Hospital Basel and University of Basel, Switzerland, Department of Clinical Research, Basel, Switzerland, ³University Hospital Basel, Department of Intensive Care Medicine, Basel, Switzerland, ⁴University Hospital and University of Bern, Department of Neurology, Inselspital, Bern, Switzerland, ⁵University of Basel, Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland, ⁶Klinik Hirslanden, Stroke center, Zürich, Switzerland

Background: Oral anticoagulation (OAC) is the treatment of choice in secondary prevention in stroke related to Atrial Fibrillation (AF). Nevertheless, stroke recurrence may occur under OAC, indicating potentially different stroke etiologies.

Methods: Observational study based on the prospective “Novel oral anticoagulants in stroke patients” (NOACISP-Longterm)-registry (inclusion period 2013-2020) enrolling stroke patients with AF. Etiology of index and recurrent stroke was classified according to the TOAST criteria. We analyzed the stroke etiologies and association between etiology and incident recurrent ischemic stroke using Cox proportional hazard models (adjusted for confounding demographic and vascular factors).

Results: Among 959 patients (median age 81 [74,86], 46% female) index stroke etiology was available in 912. In patients without recurrent ischemic stroke, index stroke was more often cardioembolic (78.0% vs. 65.3%) and less often classified as Large-Artery Atherosclerosis (LAA) (1.7 vs 5.6%) or more than one possible etiology (13.1% vs 26.4%). Overall, 72 patients had recurrent stroke (7.9%) during a median follow-up time of 2 years. Recurrent stroke was less frequent cardioembolic (66.3%), while LAA (8.5 %) and more than one etiology (18.5 %) slightly increased compared to the baseline stroke etiology. Index stroke due to LAA (aHR 3.42 [1.22, 9.62], p= 0.038) or more than one possible etiology (aHR 2.21 [1.26, 3.86], p= 0.007) was associated with recurrent stroke.

Conclusions: In patients treated with OAC for AF-stroke, index stroke due to LAA or more than one possible etiology was associated with recurrent ischemic stroke. Patients should undergo thorough etiological work-up to identify other stroke etiologies.

Disclosure: No

P0418 / 1107

ETIOLOGY AND RISK FACTORS OF ISCHEMIC STROKE IN PREGNANCY AND PUERPERIUM

A. Richardt ¹, K. Aarnio¹, L. Karjalainen², A. Korhonen¹, K. Rantanen¹, H. Laivuori^3,4,5, M. Gissler^6,7, M. Tikkanen², P. Ijäs¹

¹University of Helsinki and Helsinki University Hospital, Neurology, Helsinki, Finland, ²University of Helsinki and Helsinki University Hospital, Obstetrics and Gynecology, Helsinki, Finland, ³University of Helsinki and Helsinki University Hospital, Medical and Clinical Genetics, Helsinki, Finland, ⁴Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland, ⁵Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Obstetrics and Gynecology, Tampere, Finland, ⁶Karolinska Institute, Academic Primary Health Care Centre & Department of Molecular Medicine and Surgery, Stockholm, Sweden, ⁷Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland

Background and aims: Ischemic stroke (IS) is an uncommon but potentially life-changing event during pregnancy and postpartum period. The aim of this study was to analyse the demographics, etiology and risk factors of pregnancy-associated IS in Finland.

Methods: We collected a population-based, nationwide, retrospective cohort of patients diagnosed with IS during pregnancy or postpartum period in Finland from 1987 to 2016. Women were identified by linking Medical Birth Register and Hospital Discharge Register data. The diagnosis and temporal relationship of IS to pregnancy were verified and detailed clinical data collected from patient records.

Results: A total of 97 women, with median age 30.7 years (interquartile range 26.6-35.0), were diagnosed with IS during pregnancy or postpartum period. From all ISs, 44 (45.4 %) presented within the first 6 weeks postpartum. The etiology of IS by TOAST classification was undetermined in 56 (57.7 %), other determined in 26 (26.8 %), cardioembolism in 13 (13.4 %), and small-vessel occlusion in 2 (2.1 %) patients. The most common other determined etiologies were dissection of cervico-cerebral arteries (n=10, 38.5 %) and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (n=4, 15.4 %). The etiologic evaluation was incomplete in 19 (19.6 %) and negative in 35 (36.1 %) cases. A total of 15 (15.5 %) patients had embolic strokes of undetermined sources (ESUSs).

Conclusions: Most pregnancy-associated-ISs present within six weeks after delivery. Rare causes and cardioembolism were frequent, but in over half of the women the etiology remained undetermined.

Disclosure: No

P0419 / 1131

INCIDENCE OF MALIGNANT NEOPLASM IN YOUNG ADULTS WITH ISCHEMIC STROKE IN ARAGON

M. Viscasillas Sancho ¹, H. Tejada Meza^1,2,3, Á. Lambea Gil^1,2, D. Sagarra Mur^1,2, M. Serrano Ponz^1,2, J. Marta Moreno^1,2

¹Hospital Universitario Miguel Servet, Neurology, Stroke Unit, Zaragoza, Spain, ²Instituto de Investigación Sanitaria (IIS) de Aragón, Grupo de Investigación en Neurociencias, Zaragoza, Spain, ³Hospital Universitario Miguel Servet, Radiology, Interventional Neuroradiology, Zaragoza, Spain

Background and aims: The incidence of ischemic stroke in young adults is increasing. In addition to the high prevalence of classic vascular risk factors, other causes such as cancer have been reported. Nonetheless, only few studies show its impact on young adults. The aim is to describe and analyze the incidence of cancer in young adults with ischemic stroke in Aragon (Spain).

Methods: 552 patients ranging from 18 to 50 years admitted to Aragon for ischemic stroke between 2008 and 2015 were studied, with a median follow-up of 8.25 years (interquartile range 6.1-10.5). The diagnosis of a malignant neoplasm was investigated in their medical history.

Results: 45 patients (8.2%) presented malignant neoplasia at some point, 3 of them both pre- and post-stroke: 21 (3.8%) developed before admission, with a median of 76 months (17.0-147.5), while 27 (4.9%) developed later, with a median of 62 months (27.0-91.0). 20 of these patients developed a malignant neoplasm between the ages of 18 and 50, with an annual incidence of 0.45% person-years, 3 times more than that estimated in Spain for that age group (0.15%). Women had a significantly (p = 0.012) higher proportion of pre-stroke cancer (6.7%) than men (2.3%). In men, the most frequent neoplasms were hematological (21.7%) and respiratory (17.4%), while in women they were breast (32.0%) and endocrine (20.0%).

Conclusions: Cancer may be a relevant emerging cause of ischemic stroke in young adults. Future studies are expected to offer specific recommendations on the best diagnostic and therapeutic approach.

Disclosure: No

P0420 / 1066

EVALUATION OF ENDOTHELIAL GLYCOCALYX INJURY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

M. Thays Beckhauser ¹, C.H. Miranda², M. Rodrigues Camilo¹, R.K. Vale Martins-Filho¹, R. Arruda¹, M. de Almeida Pinheiro¹, T. Paulo Zanata Trombetta¹, O. Pontes-Neto¹

¹Ribeirão Preto Medical School - University of São Paulo, Neuroscience and Behavioral Sciences, Ribeirão Preto, Brazil, ²Ribeirão Preto Medical School - University of São Paulo, Internal Medicine, Ribeirão Preto, Brazil

Background and aims: The Endothelial Glycocalyx (EG) is a structure present in the endothelial surface of blood vessels, which has an essential role in vascular permeability, inflammation, and as endothelial anti-adhesive barrier, with a protective effect on vascular functions. The main constituents of EG are proteoglycans, glycoproteins, and glycosaminoglycans. This study aims to assess EG dysfunction in patients with acute ischemic stroke (AIS).

Methods: A total of 56 patients with AIS admitted to a public comprehensive stroke center in Brazil were included. EG injury was evaluated by sequential serum dosage of syndecan-1, hyaluronan-1, and chondroitin sulfate (aggrecan) on admission, and between 24-48 hours after the initial symptoms in patients and in a control group of 20 helathy individuals without stroke.

Results: A total of 56 patients with AIS were evaluated, with a mean age of 63.7±13.56 years, 62.5% male, 64.2% with hypertension, 42.8% with dyslipidemia, 25% smokers, 23.2% alcoholics, and 19.6 with diabetes. The mean NIHSS on admission was 12.5±8.53, and the most common site of arterial occlusion was the middle cerebral artery (37.5%).

Among the 20 control subjects, the mean age was 61.4 ± 10.45 years, 45% were male. The syndecan-1 levels between 24-48 hours were higher among patients then controls (78.9 ± 66.9 ng/dL versus 53.1 ± 52.5 ng/dL, p=0.023). We found no diference between hyaluronan-1, and chondroitin sulfate (aggrecan) levels in patients and controls.

Conclusions: Syndecan-1 blood levels are elevated in AIS patients with may reflect EG disfunction in the acute phase of ischemic stroke.

Disclosure: No

P0421 / 1194

NON-STENOTIC, COMPLICATED ATHEROSCLEROTIC PLAQUE IN EMBOLIC STROKE OF UNDETERMINED SOURCE (ESUS): A POSSIBLE ETIOLOGY?

C.M. Rapillo ¹, I. Lombardo², C. Sarti³, D. Accavone¹, G.D. Scrima¹, E. Fainardi², P. Nencini¹, M. Nesi¹

¹Careggi, University Hospital, Stroke Unit, Florence, Italy, ²Careggi, University Hospital, Neuroradiology, Florence, Italy, ³Careggi, University Hospital, Stroke Unit; Neurofarba Department, Florence, Italy

Background and aims: Embolic stroke of undetermined source (ESUS) represents approximately 17% of ischemic strokes. Atherosclerotic non-stenotic plaque, defined as < 50% arterial lumen stenosis according to the TOAST classification, with high-risk features may be a possible underestimated embolic source in ESUS patients.

Methods: We retrospectively assessed the prevalence of symptomatic non-stenotic plaque in the ESUS patients admitted to the Stroke-Unit of Careggi University Hospital, Florence, in 2019. We included unilateral non-lacunar ischemic strokes with a complete work-up including echocardiography, at least a 24-hours ECG monitoring, extracranial and intracranial vessel image (CT or MRI angiography or Ultrasound). Non-stenotic plaques were considered at high embolic risk if ulceration, intraplaque hemorrhage, lipid rich necrotic core, or fibrous cap were detected on angio CT by an experienced neuroradiologist.

Results: Fifty seven out of 342 (16%) patients with ischemic stroke admitted directly to the Stroke-Unit and defined as ESUS at the discharge, had a non-stenotic atherosclerotic carotid plaque homolateral to the stroke. At one year follow-up, 35 patients were diagnosed with an alternative embolic source (i.e., atrial fibrillation) and were excluded. Among the other 22 17 patients had a CT-Angiography of epiaortic vessels, and 4 patients (1% of the ischemic stroke) had a high-risk non-stenotic plaque homolateral to the ischemic lesion.

Conclusions: Further studies are needed to further evaluate a possible role of non-stenotic complicated atherosclerotic plaques in ESUS patients. A prospective analysis including blood biomarkers may allow to better evaluate the pathogenic role of those plaques.

Disclosure: No

P0422 / 1188

OBSTRUCTIVE SLEEP APNOEA SCREENING IN STROKE INPATIENTS

P. Gallogly ¹, S. Saber¹, R. Beyrouti¹, H. Townsley¹

¹ The National Hospital for Neurology and Neurosurgery, Stroke, London, United Kingdom

Background and aims: Obstructive Sleep Apnoea (OSA) is a common, under diagnosed and potentially modifiable, independent risk factor for stroke. It is associated with increased mortality and poorer recovery post stroke. Royal College of Physicians’ guidelines recommend screening acute stroke admissions for OSA, and referring those screening positive for specialist assessment. The STOP-BANG questionnaire is a validated screening tool. Through quality improvement methodology we aimed to improve rates of OSA screening in our stroke unit.

Methods: A baseline audit of all inpatients over one week was performed. Our first Plan Do Study Act (PDSA) cycle involved face to face staff education, and introducing a STOP-BANG smartphrase in our electronic healthcare system. Our second PDSA cycle involved further education (including emails), reminder posters in strategic areas, and introducing the screening outcome in an electronic stroke workup checklist.

Results: Baseline data revealed 0% of 32 inpatients were screened for OSA. Our first PDSA cycle improved screening rates to 27% (33/122 patients). Our second PDSA cycle improved screening rates to 29% (29/100 patients). Barriers to screening included limited availability of doctors to screen all patients, patients with severe strokes unable to answer questionnaire and rapid turnover of hyperacute stroke patients limiting screening opportunities.

Conclusions: An acute stroke admission is a valuable opportunity for OSA screening, and the STOP-BANG questionnaire can be used to improve screening rates. Educating and utilising the wider multi-disciplinary team, and screening patients in post discharge followup clinics may be a more effective approach to ensuring all patients are screened.

Disclosure: No

P0423 / 457

REDUCED MAGNETIC RESONANCE ANGIOGRAPHY SIGNAL INTENSITY IN THE MIDDLE CEREBRAL ARTERY IPSILATERAL TO SEVERE CAROTID STENOSIS MAY BE A PRACTICAL INDEX OF HIGH OXYGEN EXTRACTION FRACTION

T. Mori ¹, K. Yoshioka¹, Y. Miyazaki¹

¹ Shonan Kamakura General Hospital, Stroke Treatment, Kamakura, Japan

Background: Angiographic “slow flow” in the middle cerebral artery (MCA), caused by carotid stenosis, may be associated with high oxygen extraction fraction (OEF). Furthermore, if the MCA slow flow is related to an MCA’s reduced relative signal intensity (rSI) on MR angiography, the reduced rSI may be related to a high OEF. Therefore, we investigated whether the MCA slow flow ipsilateral to carotid stenosis was associated with a high OEF and aimed to create a practical index to estimate the high OEF.

Methods: We included patients who underwent digital subtraction angiography (DSA) and MRA between 2015 and 2019 to evaluate carotid stenosis. We evaluated MCA slow flow by image count using DSA, MCA rSI, minimal luminal diameter (MLD) of the carotid artery, carotid artery stenosis rate (CASr), and whole-brain OEF (wb-OEF). When MCA slow flow was related to a high wb-OEF, and we identified the determinants of MCA slow flow, we evaluated their association with high wb-OEF.

Results: One hundred and twenty-seven patients met our inclusion criteria. Angiographic MCA slow flow was associated with high wb-OEF. We identified MCA rSI and MLD as determinants of angiographic MCA slow flow. The upper limits of MCA rSI and MLD for angiographic MCA slow flow were 0.89 and 1.06 mm, respectively. The wb-OEF was higher in patients with an MCA rSI ⩽0.89 and ipsilateral MLD ⩽1.06 mm than patients without this combination.

Conclusion: The combination of reduced MCA rSI and ipsilateral narrow MLD is a feasible index of high wb-OEF.

Disclosure: No

P0424 / 1368

RESTRICTION IN HIPPOCAMPAL DIFFUSION IN 3 PATIENTS WITH TRANSIENT GLOBAL AMNESIA

A. Franco Salinas ¹, L. Ruiz-Escribano Menchén², L. Quirós Illán², C. Pérez de Leonardo², P. Luque Lineros³

¹Hospital Universitario Virgen Macarena, Neurology, Sevilla, Spain, ²Hospital General Universitario de Ciudad Real, Neurology, Ciudad Real, Spain, ³Hospital Universitario Virgen Macarena, Internal Medicine, Sevilla, Spain

Background and aims: Transient global amnesia is a distinctive syndrome in older individuals characterized by memory loss without impairment of other cognitive function, and affected subjects are able to engage in complex activities. The spell is characterized by anterograde amnesia. Most transient global amnesia episodes last hours, usually resolves within 24 to 48 hours; and are single events, although they may repeat in a minority of individuals, recurrences are noted in approximately 20% of patients. The nature of transient global amnesia is not totally clear; but can be closely imitated by disorders such as partial complex seizures, migraine, and possibly transient ischemia of the hippocampus.

Methods: 3 female patients of 64, 67 and 77 years of age. Were admitted for sudden memory loss. They did not present any other neurological focus.

Results: A complete study was carried out. Laboratory tests were normal. Neuroimaging found right hippocampal infarction in 2 of them and left in another. Despite the neuroimaging findings, the event was self-limited; the patients recovered their baseline situation in 24 hours.

Conclusions: The last several patients with transient global amnesia have had normal diffusion-weighted MRI studies. However, some studies reported that imaged during episodes of transient global amnesia showed abnormal diffusion MRI signal in the hippocampus. Permanent infarctions were not found. Other investigators have found frontal lobe abnormalities by diffusion-weighted MRI or PET. These studies do not prove an ischemic etiology for transient global amnesia; rather, they indicate transient dysfunction in the hippocampus or its connections.

Disclosure: No

P0425 / 1523

THE UTILITY OF CARDIAC RHYTHM MONITORING IN YOUNG ADULTS WITH TRANSIENT ISCHAEMIC ATTACK AND MINOR STROKE

C. Sivakumar ¹, H. Townsley¹, K. Ellis², J. White², A. Dados¹, R. Alijam¹, A. Kaushik¹, R. Bell³, G. Quattrocci^1,4, A. Chandratheva¹

¹National Hospital for Neurology & Neurosurgery, Comprehensive Stroke Service, London, United Kingdom, ²University College London Medical School, London, United Kingdom, ³University College London Hospital, Cardiology, London, United Kingdom, ⁴North Middlesex Hospital, Neurology, London, United Kingdom

Background and aims: We aimed to evaluate the utility of cardiac rhythm monitoring in young patients with Transient Ischaemic Attack (TIA) or Minor Stroke (NIHSS<5).

Methods: Consecutive patients aged ⩽55 years attending a London Hospital TIA clinic 1st January 2019-31st December 2020 were retrospectively reviewed. Demographics, vascular risk factors, aetiology(TOAST criteria¹), 24-to-72 hours-ECG-Holter were recorded.

Results: Of 236, 92(38%) mimics, 144 TIA (46%), minor stroke (49%) or retinal stroke (5%) median age 44 years(IQR 16). Thirteen(9%) were multi-territory. 65(46%) had unknown aetiology, 26(19%) cardioembolic, 23(16%) other, 16(11%) small-vessel and 10(7%) large-vessel. On average 1.9 vascular risk factors/patient, but 29% had ⩾3 risk factors.

123(85%) of ECG at presentation showed normal sinus rhythm and four(3.2%) atrial fibrillation(AF)/paroxysmal AF. 106(74%) patients underwent ECG-Holter monitor, six(4.2%) showed known(2) or new AF [median age 41.5(36-53), CHADVASCS² Score 2-4]. 3(2.1%) had supraventricular or ventricular tachycardia. All four patients with new diagnoses of AF were identified on acute ECG. All patients with known or new AF had at least one significant vascular risk factor, most common being smoking. Two showed left atrial dilation on Echocardiogram with no left ventricular hypertrophy or left axis deviation on presentation ECG.

Conclusions: In nearly half cases of young stroke/TIA aetiology remains unknown. 72 hours ECG monitoring was of low yield with new AF found in only 3.2%, which in all cases was already identified by their acute ECG. One third of patients has left atrial dilation and at least one vascular risk factor.

Disclosure: No

P0426 / 1318

A CASE OF SPONTANEOUS INTRACRANIAL ARTERY DISSECTION DUE TO ALPHA-1-ANTRYTRIPSIN DEFICIENCY

A. Negrilă ¹, R. Badea^1,2, B. Cășaru¹, C. Tiu^1,2

¹Emergency University Hospital, Bucharest, Romania, Neurology, Bucharest, Romania, ²“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Background and aims: Spontaneous intracranial artery dissection is a rare cause of ischemic stroke amongst the young. Intracranial artery dissections have a predilection for the vertebral and basilar arteries and cases have been most often reported in eastern Asian patients. Several pathologies that affect the wall vessel have been mentioned in association. Alpha-1antytripsin deficiency can cause extracranial artery dissection, but intracranial involvement has not been as often described.

Methods: We present a case report of a spontaneous intracranial artery dissection due to alpha-1 antitrypsin deficiency.

Results: A 36 years old, Caucasian, male patient presented to our clinic for symptoms consisting of transient left sided paraesthesia and speech disturbances lasting for 30 minutes. He had a history of arterial hypertension. A brain magnetic resonance imaging was performed and was suggestive of an acute ischemic lesion in the left anterior cerebral artery territory. TOF sequences raised the suspicion of a possible vascular malformation involving the left anterior cerebral arterial. CT angiography and digital subtraction angiography were performed as follow-up and imaging confirmed an arterial dissection of the left anterior cerebral artery. Further etiologic workup regarding vessel disease was normal with the except of low levels of alpha-1 antitrypsin enzyme. The patient had no pulmonary or hepatic involvement.

Conclusions: Alpha-1 antitrypsin deficiency needs to be considered as a cause of intracranial arterial dissection presenting with stroke amidst the young.

Disclosure: No

P0427 / 1597

THROMBI ASSOCIATED WITH IRON DEFICIENCY ANEMIA AS A CAUSE OF STROKE: SYSTEMATIC REVIEW AND CASE SERIES

A.C. Cordeiro¹, T. Pinho e Melo², A.C. Fonseca ²

¹Universidade de Lisboa, Lisboa, Portugal, ²Hospital de Santa Maria, Neurology, Lisboa, Portugal

Background and aims: Cases of iron deficiency anemia associated with thrombi formation have been described in patients with ischemic stroke. We aimed to analyze the characteristics of ischemic strokes due to thrombi associated with iron deficiency anemia.

Methods: We conducted a systematic literature review using Pubmed and EMBASE databases since inception to May 2021 and reviewed a series of cases admitted to the stroke unit of an university hospital. Inclusion criteria were adult patients with iron deficiency anemia with an acute ischemic stroke or transient ischemic attack (TIA), with detection of thrombi. Patients with evidence of underlying vessel atherosclerotic changes were excluded.

Results: 311 articles were found, 85 were assessed for full-text screening with 27 being included. Forty-one patients were included, 36 from the systematic review and 5 from the hospital case series. Included patients had a mean age of 43.9 years and 36 were women (87.8%). The most frequent etiology of iron deficiency anemia was hemorrhage due to uterine fibroids (61%). 85.4% of patients had an ischemic stroke and 14.6% had a TIA. The most common sites of thrombosis detection were the Internal Carotid Artery, Common Carotid Artery and the Aortic Arch. In addition to anemia, 73.2% had thrombocytosis and 6 patients had other prothrombotic changes. After start of treatment, complete resolution of the thrombus occurred in all patients within a median time of 13.7 days.

Conclusions: Iron deficiency anemia is a rare cause of stroke associated with thrombi formation especially in young women.

Disclosure: No

P0428 / 1640

COMBINATION OF THROMBUS MARKERS AND BIOMARKERS TO DETECT THE CAUSE OF THE STROKE; RESULTS FROM THE ITACAT MULTICENTRIC REGISTRY

J. Pagola ¹, J. Juega¹, M. Rodriguez¹, J. Camacho¹, L. Dorado², M. Hernandez², H. Quesada³, P. Cardona³, M. Ribo¹, C. Molina¹

¹Vall d’Hebron Hospital, Barcelona, Spain, ²Germans Trias i Pujol Hospital, Badalona, Spain, ³Bellvitge Hospital, Hospitalet de Llobregat, Spain

Background and aims: We combined biomarkers and markers obtained from histological/immune analysis of the clot to the detect the cause of the stroke.

Methods: We conducted a prospective observational study of consecutive patients with acute stroke who underwent thrombectomy that obtained extracted thrombus (ITACAT study). Several staining were performed to evaluate red blood cells/fibrin (hematoxylin/eosin), platelets (CD61) and leucocytes (CD4). We analysed the blood to test D Dimer, BNP and Lpa in every patient. All patients received CT angio to detect extra/intracranial vascular stenosis and 30-day cardiac monitoring to diagnose AF. According to TOAST classification the thrombi were classified in cardioembolic etiology CE (T-CE), due to symptomatic atherosclerosis (T-AT) and without any cause (T-CRYP). We excluded strokes due to double cause or incomplete workup

Results: Of the 199 patients: 45 were T-AT, 107 were T-CE and 47 were T-CRYP. T-AT group had higher percentage of CD4 6.74% (4-14) Vs. T-CE (3.15% (1.32-5.57) Vs .T-CRYP 3.62% (1-9) (p<0.01), lower percentage of platelets: T-AT 56.34% (41-68) Vs. CE 68.04% (51-82) Vs. CRYP 68.12% (61-87) (p=0.001). T-CE had higher level of BNP: T-AT 308pg/ml (130-816) Vs. T-CE (1863 pg/ml (558-3868) Vs .T-CRYP 185 (81-468) (p<0.001). CD4 below 4% predicted T-CE or T-CRYP with sensitivity 75% and specificity 61% (AUC 0.73) better than CD61 (AUC 0.69) or BNP (AUC 0.65).

Conclusions: A low percentage of CD4 in thrombus predicted better T-CE or T-CRYP than the percentage of platelets or BNP levels.

Disclosure: No

P0429 / 827

THE USEFULNESS OF THE VARIATION OF BRAIN NATRIURETIC PEPTIDE TO PREDICT OCCULT ATRIAL FIBRILLATION AFTER CRYPTOGENIC STROKE

Y. Tateishi ¹, K. Yamashita¹, T. Kanamoto¹, D. Torimura¹, T. Banzono¹, Y. Tomita¹, T. Hirayama¹, T. Shima¹, A. Nagaoka¹, S. Yoshimura¹, T. Miyazaki¹, E. Sadakata², T. Izumo², A. Tsujino¹

¹Nagasaki University Hospital, Department of Neurology and Strokology, Nagasaki, Japan, ²Nagasaki University Hospital, Department of Neurosurgery, Nagasaki, Japan

Background and aims: We aimed to clarify the usefulness of the variation of brain natriuretic peptide (BNP) value over the one-time BNP value at admission for the detection of occult atrial fibrillation (AF) in patients with cryptogenic stroke (CS).

Methods: To detect occult AF, we performed continuous heart-rhythm monitoring during hospitalization, one-time 24-hour Holter monitoring, and usual care for 90 days after discharge. Plasma BNP levels were measured at admission and 7 days thereafter. The high and the low variation of BNP were determined according to the quartile deviation of the subtracted BNP value between the values at admission and one week. Logistic regression analysis was conducted to reveal the independent predictor of occult AF based on the results of univariate analyses.

Results: Of 361 patients with CS, 59 patients had occult AF (16%). In patients with the high and the low variation of BNP, occult AF was detected 43/160 (27%) and 14/180 (8%), respectively. In univariate analyses, age, NIHSS score, the BNP value at admission, the high variation of BNP, ischemic lesion volume, and left atrial diameter (LAD) were associated with occult AF. Multiple logistic regression analysis revealed that the NIHSS score (Odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), LAD (OR 1.08, 95% CI 1.02-1.14), and the high variation of BNP (OR 2.81, 95% CI 0.35-5.85) were independent predictors of occult AF meanwhile the one-time BNP value was not.

Conclusions: One-fourth of CS patients with the high variation of BNP during one week had occult AF.

Disclosure: No

P0430 / 1491

DUPLEX ULTRASOUND AS A ESSENTIAL TOOL IN EARLY DIAGNOSIS OF STROKE RELATED TO GIANT CELL ARTERITIS

E. Martínez Campos ¹, M. Herrera¹, N. Aymerich¹, C. Jauregui², V. Aldasoro², A. Ostolaza¹, M. Gil Alzueta¹

¹Universidad Pública de Navarra, Neurology, Pamplona, Spain, ²Universidad Pública de Navarra, Rheumathology, Pamplona, Spain

Background and aims: Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. Diagnostic criteria are not well established. Even though, ischemic stroke it’s a rare complication, vertebrobasilar system is the most frequently affected. We present a case of vertebrobasilar stroke associated with GCA.

Methods: We present a 75-years-old male with vascular risk factors with limited episodes of right leg weakness, diplopia and dysarthria. He described weight loss, headache and jaw claudication.

We found a mycrocitic anemia and raised C-reactive protein and erythrocyte sedimentation rate. GCA was suspected and temporal artery(TA) study was added in the early routinary duplex examination. Brain MRI, angio-MRI, PET and temporal artery biopsy were also requested.

Results: High resistive vertebral artery waveform was seen in cervical duplex ultrasound. We observed an “Halo sign” in both TA, and increased intima-media thickness (IMT) in TA and their frontal branches. High dose methylprednisolone bolus therapy was initiated, with a quick clinical improvement. In the MRI, occipital and mesencephalic strokes were seen. Later, angio-MRI shown a vessel-wall inflammation in vertebral arteries. Finally, the diagnosis of ACG was confirmed by a TA biopsy.

Conclusions: Non-invasive techniques as angio-MRI and duplex can lead to diagnosis of GCA and, sometimes may replace biopsy. In this case, Duplex ultrasound was a crucial tool for ACG early diagnosis. Its accessibility, rapidity, and non-invasive procedure makes it a very useful technique, so we should consider it as a basic complementary test in the suspicion of a stroke related to ACG.

Disclosure: No

P0431 / 1571

SILENT MYOCARDIAL INFARCTION IN PATIENTS WITH ISCHEMIC STROKE: A CARDIAC MAGNETIC RESONANCE IMAGING STUDY

A.C. Fonseca ¹, J.P. Marto², P. Alves¹, N. Inácio³, M. Viana-Baptista², T. Pinho e Melo¹, J. Ferro¹, A.G. Almeida⁴

¹Hospital de Santa Maria, Neurology, Lisboa, Portugal, ²Hospital Egas Moniz, Lisbon, Portugal, ³Hospital Beatriz Angelo, Loures, Portugal, ⁴Hospital de Santa Maria, Cardiology, Lisboa, Portugal

Background and aims: Silent myocardial infarction (SMI) has been referred in population based studies as a novel risk factor for cardiac embolism and cerebral infarction.

We aimed to determine the prevalence of SMI in a cohort of ischemic stroke patients that underwent cardiac magnetic resonance (CMR) and to determine if SMI was most frequently associated to an undetermined stroke etiology.

Methods: We included consecutive ischemic stroke patients that were admitted to two university hospitals from 2014 to 2018. To be included patients had to have a complete etiological investigation. Patients were excluded if they history of myocardial infarction or morphological changes in their transthoracic echocardiogram that pertained to the TOAST classification. Etiological classification was performed using TOAST and subdivided in three groups: cardioembolic (atrial fibrillation), undetermined etiology and other specific etiology (small or large vessels disease). CMR was obtained using an Achieva 3 Tesla system with conventional LGE evaluation for left ventricular fibrosis.

Results: 117 patients were included with a mean age of 68.6 years, 55 (47.0%) were female. Stroke etiology was cardioembolic (AF) in 19 patients (16.2%), undetermined in 57 (48.7%) and other specifc etiology in 41 (35.0%). Five patients were found to have evidence of SMI on CMR (4.27% 95%CI 1.40-9.69%). Four of the patients with SMI had an “other specific etiology” and one an “undetermined etiology”.

Conclusions: The prevalence of SMI was similar to what is reported in a general unselected population. The majority of SMIs were found in patients with small vessels and large vessels disease.

Disclosure: No

P0432 / 1044

ATRIAL CARDIOPATHY AND EMBOLIC STROKE OF UNKNOWN SOURCE IN PATIENTS YOUNGER THAN 60 YEARS: A RETROSPECTIVE STUDY

A. Cascio Rizzo ¹, A. Di Pietro², G. Giussani¹, A. Moreo³, E.C. Agostoni¹

¹ASST Grande Ospedale Metropolitano Niguarda, Neurology & Stroke Unit, Milan, Italy, ²University of Campania “Luigi Vanvitelli”, Division of Neurology, Naples, Italy, ³ASST Grande Ospedale Metropolitano Niguarda, Division of Cardiology, Milan, Italy

Background and aims: Atrial Cardiopathy (AC) is now increasingly considered a potential source of cardiac embolism and has been shown to be associated with embolic stroke of unknown source (ESUS) and atrial fibrillation (AF) detection. Considering the lower AF incidence in younger patients, we can hypothesize than many ESUS are not the result of left atrial cardioembolism. We aim to investigate the prevalence of AC in ESUS patients, in other stroke etiologies and among different ESUS subgroups, in a patient population younger than 60 years.

Methods: We retrospectively included 440 consecutive ischemic stroke patients and compared the prevalence of AC, defined as left atrial enlargement (measured by left atrial volume index), between ESUS patients and other stroke etiologies (large-artery atherosclerosis[LAA], small-vessels disease[SVD], cardioembolic [CE]). Then we compared baseline characteristics and other echocardiographic parameters between different stroke etiologies and ESUS subgroups.

Results: The prevalence of AC was lower in ESUS patients (14%) compared to the other etiologies (34% LAA, 21.51%SVD, 62% CE). No differences were found among ESUS patients based on PFO finding, while patients older than 50 years had a higher prevalence of AC, ipsilateral non-stenosing carotid plaque and other minor-risk cardiac sources of embolism. ESUS patients were younger, with less hypertension, dyslipidemia and coronary artery disease.

Conclusions: AC is a less frequent cause of stroke in ESUS patients younger than 60 years. The systematic outpatient monitoring to exclude covert AF in this age group should be avoided and efforts should be directed to searching for and considering other causes of occult embolism.

Disclosure: No

P0433 / 1487

A STUDY OF ATRIAL CARDIOPATHY IN VARIOUS SUBTYPES OF ACUTE ISCHEMIC STROKE

S. Pandey ¹, P. Renjen¹, D. Chaudhary¹, K. Ahmad¹

¹ Indraprastha Apollo Hospitals, Neurology, New Delhi, India

Background: Atrial cardiopathy (determined by presence of any one of following PTFV1>5000microvolt .ms, NTpro BNP> 250 pgm/ml, severe LA enlargement) is importent risk factor in cryptogenic stroke. This study find atrial cardiopathy in all subtypes of ischemic stroke.

Aims: To determine prevalence of atrial cardiopathy in various subtypes of acute ischaemic.

Methods: A total of 110 acute ischemic stroke patients were enrolled from December 2019 to June 2021. Patients were classified in stroke subtypes based on TOAST classification. Atrial cardiopathy was determined by Distribution of atrial cardiopathy in each group was analyzed and inference were drawn pertaining to the aims and objectives of the study.

Results: Atrial cardiopathy by LA diameter found equally in cardioembolic and undetermined group i.e. 38.46 % as compared to patients with large artery, small artery, other determined cause group. Atrial cardiopathy was significantly higher in patients with cardioembolic, undetermined group (48.78%, 24.39% respectively) as compared to patients with large artery, small artery, other determined cause group. Proportion of patients with atrial cardiopathy by ECG criteria (PTFV1>5000 microvolt mili second) was significantly higher in, undetermined group (44.12%) as compared to cardioembolic, large artery, small artery, other determined cause group.

Conclusions: Our study suggests that every patient of undetermined cause of stroke (cryptogenic stroke) should be evaluated for atrial cardiopathy. Every patient should be evaluated with left atrial size, NT pro BNP and PTFV1. These three parameters will add to our management of atrial cardiopathy as a modifiable stroke risk factor.

Disclosure: No

P0434 / 1574

ACUTE MULTITERRITORIAL ISCHEMIC STROKE WITHOUT KNOWN ATRIAL FIBRILLATION. UPDATE OF A PROSPECTIVE REGISTRY

D. García López ¹, A. Ponz De Tienda¹, A. Piera Balbastre¹, A. Martin Beçhet¹, R. Gil Gimeno¹, J.M. Santonja Llavata¹, R. Chamarro Lázaro¹, R. Silla Serrano¹, G. Cervera Ygual¹, M. Frías Collado¹, M.N. Srur Colombo¹, R.A. Regajo Gallego¹, P. Magro Pose¹, J.M. LÁINEZ ANDRÉS¹

¹ Hospital Clínico Universitario, Valencia, Spain

Background and aims: Description of a prospective registry of patients with acute multiterritorial ischemic stroke (MIS) without known atrial fibrillation (AF).

Methods: Ongoing prospective registry of acute MIS since January 2018. MIS were defined as DWI+ lesions with restricted diffusion on ADC map on ⩾ 2 distinct vascular territories. Patients with previously known AF were excluded. Etiology was searched following a stepwise approach: 1) basic initial studies (blood tests, MRI, MRA/CTA, TT-echocardiogram and 24-48h cardiac rhythm monitoring) 2) neoplasm biomarkers, thrombophilic state study, whole-body-CT scan and long-term cardiac rhythm monitoring, and 3) PET-CT.

Results: 157 MIS were identified, 140 without known AF. Demographic characteristics: Mean age 68.81 years; 41% female; hypertension 65%, dyslipemia 49%, diabetes mellitus 32.5%; previous stroke 18.3%; known neoplasm 25,52%. The distribution of ischemic lesions were as follows: bilateral carotid territory n=63 (45%), unilateral carotid + vertebrobasilar n=53 (37.86%), bilateral carotid + vertebrobasilar n=24 (17.14%). Etiologies found in order of frequency: undetermined/cryptogenic n=52 (37.14%), cardioembolic n=31 (22.14%), neoplasm n=31 (22.14%), combined 11 (7.86%); vasculitic n=6 (4.29%) aterothrombotic n=4 (2.86%), antiphospholypid syndrome n=2 (1.43%), post-endovascular procedure n=1 (0.71%), CADASIL n=1 (0.71%) and HSA-related vasospasm n=1 (0.71%)

Conclusions: Multiterritorial ischemic stroke can be due to many different etiologies and poses a diagnostic challenge. A thorough research procedure must be performed in order to identify these etiologies and apply a more individualized treatment.

Disclosure: No

P0435 / 963

PREDICTING THE MECHANISM OF CRYPTOGENIC ISCHEMIC STROKE IN PATIENTS WITH CANCER

B. Knepp ¹, B.B. Navi^2,3, N.M. LeMoss², C. Iadecola^2,3, L.M. DeAngelis⁴, M.S.V. Elkind⁵, H. Hull¹, G.C. Jickling^1,6, F.R. Sharp¹, B.P. Ander¹, B. Stamova¹

¹University of California at Davis School of Medicine, Neurology, Sacramento, United States, ²Weill Cornell Medicine, Neurology, New York, United States, ³Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States, ⁴Memorial Sloan Kettering, Neurology, New York, United States, ⁵Columbia University, Neurology, New York, United States, ⁶University of Alberta, Medicine, Edmonton, Canada

Background and aims: Comorbid cancer is common in ischemic stroke patients, particularly in those with no identifiable cause (cryptogenic). Peripheral blood biomarkers predicting cryptogenic stroke etiologies have been investigated; however, comorbid cancer-plus-stroke (CS) likely has a distinct molecular signature that could impair biomarker performance. We examined peripheral blood biomarkers that could predict cryptogenic stroke mechanism in patients with comorbid cancer.

Methods: mRNA-Sequencing and microRNA-Sequencing were performed in peripheral whole blood of 13 cardioembolic (CE), 11 non-cardioembolic (nonCE, including large vessel, small vessel, other determined), and 16 cryptogenic CS patients, plus 30 vascular risk factor matched controls. Genes differentially expressed between the CS-CE, CS-nonCE, and control groups (potential biomarkers; Group FDR<0.1 and individual contrasts p<0.05) underwent backwards elimination and various Support Vector Machine (SVM) classifiers were examined (varying gamma/cost parameters). The best SVM model was used to predict CS-cryptogenic stroke mechanism.

Results: In total, 80 mRNA and 27 microRNA were identified as potential predictors. The best SVM model used all 107 predictors and correctly classified 12/13 CS-CE and 11/11 CS-nonCE patients in 10-fold cross validation. When this model was deployed on the 16 CS-cryptogenic patients, 11 (69%) were predicted to have cardioembolic and 5 (31%) were predicted to have non-cardioembolic stroke mechanism.

Conclusions: We found peripheral blood gene expression can differentiate cardioembolic and non-cardioembolic stroke in patients with comorbid cancer and that this model could predict stroke mechanism in cryptogenic patients. Such biomarker panels could be useful for mechanistic ascertainment and treatment of stroke in patients with cancer.

Funding: K23NS091395, R01NS097000

Disclosure: No

P0436 / 1068

SUPRACARDIAC AND NON-STENOTIC PLAQUES COULD BE A SIGN FOR RECURRENT STROKE IN ESUS PATIENTS: AN OBSERVATIONAL STUDY

M. Sezgin ¹, I. Kamaci¹, E. Ekizoglu¹, N. Yesilot¹, O. Çoban¹

¹ İstanbul University School of Medicine, Neurology, Istanbul, Turkey

Background and aims: The concept of embolic stroke of undetermined etiology (ESUS) has been used widely in the last decade. We aimed to analyze the relation between supracardiac plaques and stroke recurrence in the ESUS group.

Methods: We searched our stroke database for stroke cases with unknown etiologies between November 2014 and September 2020. The ESUS criteria were applied among these patients, and those who fulfilled the criteria were included in the study group. The intracranial and extracranial angiography images were evaluated for plaques intricately. The ESUS patients were divided into 2 groups according to stroke recurrence in the follow-up period. The demographical, clinical, and imaging data were compared between the groups.

Results: Sixty patients have fulfilled the ESUS criteria however only 39 of them with a follow-up duration of more than 3 months were included in the study. Six of them had a recurrent ischemic stroke. There was no difference between groups for gender distribution, mean age, and vascular risk factors namely hypertension, diabetes, and hyperlipidemia. However, history of stroke was found more frequently in the recurrence group (p=0,03). Both groups received similar treatments regarding acute and secondary prevention for stroke. Infarct localization, asymptomatic infarcts, and hemorrhagic transformation did not differ between groups (p>0,05). Finally, right and left-sided supracardiac plaques were found more frequently in the stroke recurrence group(p=0,01; p<0,00).

Conclusions: Nonstenotic plaques might be associated with stroke recurrence in ESUS patients. Supracardiac plaques may be considered as a candidate to determine high-risk patients for stroke recurrence.

Disclosure: No

P0437 / 1600

ISCHEMIC AND THROMBOEMBOLIC VASCULAR COMPLICATIONS FOLLOWING COVID 19 VACCINATION

M. Boumaaz ¹, H. Moklis², Z. Mouhib², S. Ahchouch², I. Asfalou², A. Benyass²

¹Mohamed V Military Hospital, Mohamed V University, Cardiology Department, Rabat, Morocco, ²Mohamed V Military Hospital, Cardiology Department, Rabat, Morocco

Background and aims: The initiation of a global mass vaccination against COVID-19 seems to decrease mortality and hospitalization for vaccinated people. However, side effects may occur. This short review illustrates some cases of vascular complications following the COVID-19 vaccination, affecting young people with ischemic, embolic complications or a combination of the two.

Patients and methods:

Observation 1: a 46 years old woman consulted for a sudden left sided hemiparesis seven days following the second dose of covid-19 vaccine. The initial brain scan was normal and she received thrombolytic treatment. Control scan showed signs of ischemic stroke of right superficial cerebral artery with haemorrhagic transformation. Supra-aortic ultrasound was performed showing a fresh mobile thrombus with complete obstruction of the right internal carotid artery.

Observation 2: a 52 year old patient admitted for accute dyspnea, three days after receiving the third dose of covid-19 vaccine. CT angiography revealed a thrombosis of left pulmonary artery. Five days later, an ischemic vascular accident occurs confirmed by CT scan, so we made a supra-aortic ultrasound revealing a thrombosis of right proximal internal carotid artery.

Discussion and results: Incidence of vascular complications due to the covid 19 vaccination is discussed with possible hypotheses.

Conclusions: COVID-19 vaccines are considered safe since the proven benefits of vaccination in protecting against COVID-19. Nonetheless, health professionals must be aware of all possible complications, early diagnosis and quick initiation of the appropriate treatment may enhance the outcome.

Disclosure: No

P0438 / 1583

MACHINE LEARNING ANALYSIS OF TROMBI AND PLASMA EXOSOMES OF LARGE VESSEL OCCLUSION STROKE PATIENTS

H. Quesada ^1,2, J.J. Bech³, A. Paipa¹, B. Lara¹, O. Chirife⁴, S. Aixut⁴, L. Aja⁴, R. Barranco⁴, A. Nuñez¹, J. Pagola⁵, C. de la Torre³, L. Dorado⁶, B. Cucurull³, M.A. de Miquel⁴, P. Cardona¹

¹Hospital Universitari de Bellvitge, Stroke Unit. Neurology Department, L’Hospitalet de Llobregat, Barcelona, Spain, ²IDIBELL Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain, ³Josep Carreras Leukaemia Research Institute, Badalona, Barcelona, Spain, ⁴Hospital Universitari de Bellvitge, Neurointerventional Radiology, L’Hospitalet de Llobregat, Barcelona, Spain, ⁵Hospital Universitari de la Vall d’Hebron, Stroke Unit. Neurology Department, Barcelona, Spain, ⁶Hospital Universitari Germans Trias i Pujol, Stroke Unit. Neurology Department, Badalona, Barcelona, Spain

Background and aims: Thrombi obtained by mechanical thrombectomy from large vessel occlusion stroke patients are increasingly studied to reclassify undeterminded source (ESUS) into atherothrombotic (AT) and cardioembolic (CAR) etiologies. However, thrombi are not always available, particularly with current aspiration techniques. This situation may be overcome by performing proteomic analysis on samples more easily obtained from groin puncture, such as plasma exosomes (PE).

Methods: Proteins obtained from thrombi and PE samples were analyzed by liquid chromatography coupled to mass spectography (LC-MSMS). LC-MSMS raw data were analyzed with software MaxQuant (1.6.7.0) using its built-in search engine Andromeda to interrogate a human database downloaded from Uniprot. Statistical analysis and machine learning (ML) studies were performed with the aid of R software. Proteins in AT and CAR etiologies with a Pearson correlation coefficient higher than 0.5 were removed for ML models.

Results: A total of 60 thrombi and 63 PE from stroke patients were analised, in a similar number for AT, CAR and ESUS etiologies. Machine Learning (ML) models to attempt to re-classify the ESUS thrombi and PE into any of the other categories (AT or CAR) were built. From a total of 11 ESUS patients with both thrombi and PE samples analysed, a prediction match was found in 7 of them (63,63%).

Conclusions: ML models based on proteomic analysis can classify ESUS thrombi and plasma exosomes samples into AT and CAR etiologies. High matching prediction with both samples suggest that simpler obtained samples, such as plasma exosomes can be used.

Disclosure: No

P0439 / 919

IMPORTANCE OF THE INFECTIOUS-INFLAMMATORY ANTECEDENTS IN ISCHEMIC STROKE

J. García-García ¹, B. Serrano-Serrano¹, S. Sanchez-Zafra¹, F. Hernández-Fernández¹, Ó. Ayo-Martín¹, J.D. Molina-Nuevo², G. Serrano-Heras³, T. Segura¹

¹Complejo Hospitalario Universitario de Albacete, Neurology, Albacete, Spain, ²Complejo Hospitalario Universitario de Albacete, Radiology, Albacete, Spain, ³Complejo Hospitalario Universitario de Albacete, Research Unit, Albacete, Spain

Background and objective: A significant percentage of ischemic strokes are classified as of undetermined etiology. It has been postulated that infectious-inflammatory antecedents could favor a prothrombotic state and trigger cerebral ischemia. The aim of this study is to compare the history of infection-inflammation in the different types of ischemic stroke (IS) and to analyze whether there is a higher percentage of this antecedent in the group of undetermined origin. We were also interested in knowing whether the histopathological and microbiological analysis of thrombi differed in patients with a history of infection/inflammation.

Methods: Patients with IS registered in a prospective single-center registry from June 2014 to May 2020 and treated with endovascular treatment (EVT) were included

Results: We included 368 patients with IS undergoing EVT; 21.7% were classified as having undetermined etiology. 17.9% had a history of infection-inflammation prior to stroke, the percentage being higher in the undeterminated etiology group (25%) compared to the rest of the etiological groups: Atherothrombotic 6.3%, Cardioembolic 21%, Infrequent 11.1%. Mutivariate analysis showed that a history of infection-inflammation was independently associated with the classification of stroke as of undetermined etiology (OR=2.14). No significant associations were found between histopathological type of thrombus and history of infection-inflammation. However, we found 3.8% of septic thrombi, half of them with a history of infection-inflammation.

Conclusions: In the group of IS of undetermined etiology, there is a significant percentage of patients with a history of infection-inflammation. This fact supports the hypothesis that infection-inflammation facilitates thrombus formation that could cause cerebral infarction.

Disclosure: No

P0440 / 663

MARKERS OF ATRIAL CARDIOPATHY IN NON-MINOR EMBOLIC STROKES OF UNDETERMINED SOURCE

M. Acampa ¹, P.E. Lazzerini², C. Domenichelli¹, R. Tassi¹, F. Guideri¹, G. Martini¹

¹Azienda Ospedaliera Universitaria Senese, Stroke Unit, Department of Emergency-Urgency and Transplants, Siena, Italy, ²University of Siena, Department of Medical Sciences, Surgery and Neurosciences, Siena, Italy

Background and aims: Embolic strokes of undetermined source (ESUS) represent one third of ischemic strokes. Although embolism is presumably the underlying mechanism, the current definition of ESUS seems to be too broad, including strokes due to heterogeneous mechanisms such as occult cardiac conditions, aortic arch plaques, atherosclerosis of large cervical and intracranial arteries, that can be differently associated with clinical stroke severity. The aim of our study was to assess the possible association between neurological deficit severity and presence of atrial cardiopathy in ESUS.

Methods: We enrolled 217 patients with ESUS (103M, 114F). Patients were divided into 2 groups according to the severity of neurological deficit at the time of presentation (96 minor strokes with NIHSS⩽5, 121 non-minor strokes with NIHSS>5). The following indices of atrial cardiopathy were evaluated: P-wave-dispersion, P-wave-max, P-wave-min, P-wave-mean, P-wave-index, P-wave-axis, atrial size.

Results: Patients with non-minor stroke were significantly older (73±12 vs 67±14y, p:0.0003); they had higher values of P-wave-dispersion (50±15 vs 46±13, p:0.03), P-wave-max (131±21 vs 125±15 ms,p:0.01), P-wave-mean (108±18 vs 103±14 ms, p:0.03), P-wave-index (16±4 vs 15±5 ms, p:0.04), atrial size (20±6 vs 18±4 cm², p:0.03), in comparison with minor stroke patients. Furthermore, an abnormal P-wave-axis was detected more frequently in non-minor strokes (20% vs 8%,p:0.01).

Conclusions: The presence of markers of atrial cardiopathy in ESUS patients with non-minor stroke suggests that clinical stroke severity at the time of presentation could be associated with different pathogenic subtypes of ESUS.

Disclosure: No

P0441 / 661

THE GENETIC BACKGROUND OF RIGHT-TO-LEFT SHUNTS (RLS)

K. Arikawa ¹, H. Zhang², W. Cao²

¹Fudan University, Shanghai Medical College, Shanghai, China, ²Huashan Hospital, Fudan University, Shanghai, China

Background: Right-to-Left shunt (RLS) is a pathological connection (shunt) between the right and left cardiac and/or pulmonary circulation, therefore, classifying into intracardiac and intrapulmonary types. In previous studies, RLS has been shown to be associated with cryptogenic ischemic strokes and migraines. This review analyzes the underlying mutation(s) accounting for the development of RLS in multiple generations of Chinese families and its association with females and patients with migraines.

Methods: We researched PubMed resources until the 10th of January 2022 that reported genetic mutations involved in RLS development and the association between RLS and females and patients with migraines, using the following keywords [“Right-to-left shunts / RLS”, “genetic mutations” (or polymorphism) and “migraines”].

Results: Studies have reported possible genetic mutations involved in intracardiac RLS development [including pure patent foramen ovale (PFO), PFO with atrial septal defect (ASD) with or without family inheritance] such as GATA4/6, NKX2-5, TBX5, MYH6, HOXL2, LBX2, HYDIN, ACTC1, PPCDHGA4 and SLFN14. For intrapulmonary RLS such as hereditary hemorrhagic telangiectasias (HHT) and arteriovenous malformations (AVMs), the possible mutations include the ENG, ACVRL1 and SMAD4 gene.

Study and Patient Characteristics of the included studies on Intracardiac RLS :

Author, Year, Province	Study Design	Genetic mutation	Genotyping method	Pedigree present?	Patient group	Sample size	Control size
Wei SU, 2018, Wuhan	Case-control	PPCDHGA4, SLFN14	NanoDropTM ND-2000 spectrophotometer, PCR + WES	Yes	A 3-generation family with 6 ASD members	16	183
Jing WANG, 2018, Qinghai		LBX2	WES, Sanger sequencing, CRISPR/Cas9	Yes	Chinese Mongolian family with 4 ASD-II members	300 (178 Chinese Mongolian and 132 Chinese Han)	400
Yong LIU, 2018, Yunnan		FOXL2, MYH6, HYDIN	WES, Sanger sequencing, multiplexed MassARRAY	No	5 Han patients with ASD-II	452 (212 male and 240 female)	519 (252 male and 267 female)
Haisong BU, 2020, Hunan		GATA4	WES, Sanger sequencing	Yes	A 3-generation family with 3 CHD patients	3 (1 male and 2 female)	9
Ye WANG, 2016.		ACTC1	WES, Sanger sequencing, Luciferase reporter system	Yes	Family with 4 ASD-II patients	4	1

*

WES = whole-exome sequencing.

Conclusions: Despite the lack of evidence on the mechanism of how mutations contributes to RLS development, the reporting of mutations in previous studies demonstrates that RLS could be associated with genetics. In addition, specific mechanism of how RLS is more prevalent in females or is associated with migraines are still unclear, allowing for further exploration.

Disclosure: No

P0442 / 969

NOVEL DIAGNOSTIC APPROACHES TO IDENTIFY ANTIPHOSPHOLIPID ANTIBODIES IN CRYPTOGENIC STROKE AND SERONEGATIVE ANTIPHOSPHOLIPID SYNDROME: PRELIMINARY RESULTS IN A CASE SERIES

O.G. Schiavo ^1,1, A. Capozzi^2,3, R. Misasi², M. Sorice⁴, S. Truglia², F. Conti², I. Berto¹, A. Ciacciarelli¹, N. Caracciolo¹, D. Toni¹, M. De Michele¹

¹La Sapienza University of Rome, Emergency Department - Stroke Unit - Policlinico Umberto 1 - Rome, Rome, Italy, ²La Sapienza University of Rome, Lupus Clinic, Rome, Italy, ³La Sapienza University of Rome, Rome, Italy, ⁴La Sapienza University of Rome, Pathology, Rome, Italy

Backgrounds and aims: Ischemic stroke (IS) is the most severe thrombotic event in antiphospholipid syndrome (APS), a systemic autoimmune disease characterized by thrombosis and circulating anti-phospholipid antibodies (aPL). Seronegative (SN)-APS refers to a group of patients with clinical diagnosis of APS but negative aPL criteria: anti-cardiolipin antibodies (aCL) and anti-β 2 glycoprotein I antibodies (aβ 2 GPI) detected by ELISA assay and the lupus anticoagulant (LA) detected by clotting assays. We aimed to evaluate the role of new antigenic targets and methodological approaches in detecting circulating aPL in a cohort of patients with neurological involvement and suspected SN-APS.

Methods: Five cases of IS and SN-APS, diagnosed between 2017 and 2018 in the Lupus Clinic and the Stroke Unit/Emergency Department of the Sapienza University of Rome were studied. We investigated the potential clinical usefulness of “new” antigenic targets, cardiolipin/vimentin (CL/Vim) and the immunostaining on thin-layer chromatography (TLC) plates, in detecting circulating aPL.

Results: Laboratory tests for aPL criteria were persistently negative in all patients. Extensive work-up to rule out other causes of stroke was performed. APS diagnosis was confirmed by positivity for aCL by TLC-immunostaining and/or anti-L/Vim by ELISA, on two occasions twelve weeks apart. Anti-vitamin K anticoagulants were started after confirmation of the APS and no stroke recurrence occurred in the 3-years follow-up.

Conclusions: These preliminary data suggest new diagnostic tools for identifying aPL in young stroke patients. If confirmed, these diagnostic tools could become standard procedures in routine clinical practice to make an accurate and timely APS diagnosis.

Disclosure: No

P0443 / 995

EVALUATION OF THE CEREBRAL VASOMOTOR REACTIVITY IN PATIENTS WITH TRANSIENT ISCHEMIC ATTACKS

N. Nekrasova¹, O. Tovazhnyanska¹, S. Rudenko ¹, L. Tikhonova¹, O. Markovska¹

¹ Kharkiv National Medical University, Department of Neurology, Kharkiv, Ukraine

Background and aims: Cerebral vasomotor reactivity (CVR) is a variation in cerebral blood flow in response to certain vasoconstrictive or vasodilatory stimuli. CVR measurement allows us to evaluate the distribution of blood flow in various regions of the brain and draw certain conclusions about the progression of the disease and the response to the ongoing management. The objective of the study was to evaluate CVR in patients with transient ischemic attacks (TIA) using standardized breath-holding and hyperventilation tests.

Methods: We included 41 patients (62 ± 4 years old) who were diagnosed with TIA. CVR was evaluated using transcranial Doppler ultrasound, comparing the breath-holding and hyperventilation tests as triggering vasoactive factors.

Results: CVR was evaluated as normal in 7 patients (17%) and CVR abnormalities were found in 34 patients (83%). At the same time, a certain pattern was detected: the greater the adaptive capabilities decrease in response to hypocapnia induced by hyperventilation, the less they increase in response to hypercapnia induced by breath-holding maneuver.

Conclusions: Obtained data indicating a negative correlation between hypocapnic and hypercapnic CVR. This indicates a change in regional blood flow, perhaps a decrease in the compensatory and adaptive potential of cerebral circulation in ischemic conditions and in the post-ischemic period. In some cases, this may also indicate the presence of more severe vascular impairment and suggests a negative prognosis regarding possible subsequent ischemic episodes (TIA and stroke). This data may have significant diagnostic value and requires further study in order to modify therapeutic tactics.

Disclosure: No

P0444 / 1366

CLINICAL AND AETIOLOGICAL SUBTYPES OF ACUTE ISCHEMIC STROKES OF SRI LANKA; SIGNIFICANCE OF INTRACRANIAL ARTERIAL STENOSIS

C. Mettananda ¹, M. Perera¹, R Imtiaz², H Meegahapola², C Jayalath², C Sirigampola³, A Upasena³, W Sathkorala³, U. Ranawaka^4,2

¹University of Kelaniya, Pharmacology, Ragama, Sri Lanka, ²University of Kelaniya, Medicine, Ragama, Sri Lanka, ³North Colombo Teaching Hospital, Radiology, Ragama, Sri Lanka, ⁴North Colombo Teaching Hospital, Professorial Medical Unit, Ragama, Sri Lanka

Background and aims: Stroke epidemiology of Asia is different to western countries yet data from South-Asia is sparse. Therefore, we aimed to describe stroke subtypes in a Sri Lankan cohort.

Methods: We prospectively collected all acute ischemic strokes admitted to a stroke unit of Sri Lanka from 2019-2021. Ischaemic strokes were classified into clinical and aetiological subtypes using Oxfordshire Community Stroke Project (OCSP) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications respectively.

Results: All 169 acute ischemic strokes admitted to the stroke unit were subtyped. Clinically, 26(15.4%) were of total anterior circulation (TACI), 41(24.3%) partial anterior circulation(PACI), 84(49.7%) lacunar(LACI) and 18(10.7%) posterior-circulation infarcts(PoCI). Aetiologically, 15(8.9%) were large artery Disease(LAD), 4(2.4%) cardioembolic, 14(8.3%) small vessel disease(SDV), 6(3.6%) of other defined causes and 130(76.9%) of undermined. 43 of them had magnetic resonance arteriography(MRA). Aetiological subtyping including MRA data were, 17(39.9%) LAD, 2(4.7%) cardioembolic, 9(20.9%) SVD, 4(9.3%) other defined cause and 11(25.6%) undetermined. LAD strokes had, extracranial-carotid stenosis in 2(13.3%), intracranial-internal carotid artery stenosis(ICAS) in 10(66.7%) and intracranial-posterior circulation stenosis in 3(20.0%). MRA and carotid doppler both were done in 26 patients and 10(38.5%) had intracranial-ICAS on MRA without extracranial-carotid stenosis on doppler.

Conclusions: Prevalence of LAD and cardioembolic strokes were less, while LACI were high In this Sri Lankan stroke cohort compared to western statistics. This is the first data on intracranial-ICAS of Sri Lankans. The majority of LAD strokes were due to intracranial arterial stenosis and therefore would be missed if only dopplers were done without cerebral angiography.

Disclosure: No

P0445 / 1291

HOW GOOD ARE NEUROLOGISTS? A PROSPECTIVE OBSERVATIONAL STUDY ASSESSING THE DIAGNOSTIC ACCURACY OF NEUROLOGISTS IN THE EMERGENCY SETTING

C.J. Schankin¹, B.-V. Popa-Todirenchi¹, S. Eich¹, M. Branca², A. Galimanis¹, M. Beyeler¹, N. Belachew³, M. Heldner¹, J. Kaesmacher³, T. Meinel¹, H.P. Mattle¹, M. El-Koussy³, U. Fischer ^1,4

¹Inselspital, Bern University Hospital, Department of Neurology, Bern, Switzerland, ²University of Bern, CTU Bern, Bern, Switzerland, ³Inselspital, Bern University Hospital, Department of Neuroradiology, Bern, Switzerland, ⁴University Hospital Basel, Department of Neurology, Basel, Switzerland

Background and aims: In the emergency room (ER), swift and correct diagnosis in patients with acute neurological deficits is crucial. The aim of this study was to assess the accuracy of neurologists making the correct clinical diagnosis in the ER based solely on clinical grounds.

Methods: In this monocentric prospective observational study, neurologists at three different stages of their career (board-certified neurologists, residents and last year medical students) committed to a specific diagnosis of an acute neurological deficit including lesion location and affected blood vessel. The primary outcome was the accuracy of the first clinical diagnosis in the ER with the discharge diagnosis as reference.

Results: Of 800 patients with suspected stroke, 588 had emergency MRI, 175 had CT, and had 37 both. Vascular pathology was found in 567 patients (76%, 508 ischemia/TIA, 59 haemorrhage); non-vascular pathologies were epileptic seizures in 72, migraine attacks in 33, and others in 128 patients. Intracranial vessel occlusion was present in 227 of 410 patients with ischemic stroke.

Compared to residents, neurologists were significantly better in predicting vascular pathologies (accuracy 0.86 [95%CI: 0.83-0.89] vs. 0.79 [0.76-0.82]; p<0.001), presence of occlusion, the lesion territory, and the affected blood vessel. Compared to students (accuracy 0.80 [0.74-0.86]), neurologists were also better, however the difference was not significant (p=0.098), probably due to the low number of students involved.

Conclusions: Neurologists have a high accuracy in predicting vascular pathologies in patients with acute neurological deficits. Trained neurologists are therefore crucial to triage patients with acute neurological deficits in ERs.

Disclosure: No

P0446 / 528

NON-INVASIVE IN VIVO THROMBUS IMAGING IN PATIENTS WITH ISCHAEMIC STROKE OR TRANSIENT ISCHAEMIC ATTACK

B. Whittington ¹, D. Newby¹, E. Tzolos¹, E. Van Beek¹, M. Dweck¹, W. Whiteley², J. Wardlaw², T. Clark³, M. Williams¹, C. Lucatelli³, R. Bing¹, P. Slomka⁴

¹University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom, ²University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ³University of Edinburgh, Edinburgh Imaging Facility QMRI, Edinburgh, United Kingdom, ⁴Cedars-Sinai Medical Center, Department of Imaging, Los Angeles, United States

Background and aims: ¹⁸F-GP1 is a novel positron-emitting radiotracer, highly specific for activated platelets and thrombus. In a pilot proof-of-concept study, we aimed to determine its potential clinical application in establishing the role and origin of thrombus in stroke.

Methods: Eleven patients with recent ischaemic stroke (n=9) or transient ischaemic attack (n=2) underwent ¹⁸F-GP1 positron emission tomography (PET) and computed tomography (CT) angiography at median of 11 (4-7) days from symptom onset. ¹⁸F-GP1 uptake (maximum and mean target-to-background ratios (TBR) was assessed in the carotid arteries and brain.

Results: ¹⁸F-GP1 uptake was identified in 9/11 patients: 5 in the carotid arteries only, 2 in the brain only and 2 in both the brain and carotid arteries. In those with carotid uptake, 4 had >70% stenosis and 3 had non-stenotic disease. One case had bilateral stenotic disease but only the culprit carotid artery showed ¹⁸F-GP1 uptake. Overall, uptake was higher in the ipsilateral carotid artery (TBRmax 2.51±0.95, TBRmean 1.70±0.48) compared to the contralateral non-culprit artery (TBRmax 1.66±0.55, TBRmean 0.79±0.20). Four cases showed visual uptake within the brain (TBRmax of 6.63±2.27 and TBRmean 3.73±2.67) corresponding to areas of CT-defined infarction. There was no brain ¹⁸F-GP1 uptake in the 7 cases without CT-defined acute cerebral infarction.

Conclusions: ¹⁸F-GP1 PET-CT is a non-invasive method of identifying in vivo cerebrovascular thrombosis which holds major promise in understanding the role and origin of thrombus in stroke.

Acknowledgments: Funded by British Heart Foundation (RG/16/10/32375, FS/CRTF/21/24129).

Life Molecular Imaging provided GP1 reagents.

Disclosure: No

P0447 / 939

DETECTION RATES OF ATRIAL FIBRILLATION BY PROLONGED RHYTHM MONITORING WITH OR WITHOUT PRESELECTION BY BIOMARKERS IN PATIENTS WITH EMBOLIC STROKES OF UNDETERMINED SOURCE

P. Dorin ¹, R. Zubal¹, G. Kägi¹, N. Ehl², J. Vehoff¹

¹Kantonsspital St. Gallen, Neurology, St. Gallen, Switzerland, ²Kantonsspital St. Gallen, Cardiology, St. Gallen, Switzerland

Background and aims: Cryptogenic stroke (CS) makes up about one quarter of all ischemic strokes. ESUS defines a subset of CS with embolic stroke pattern and no evidence of major risk cardioembolic sources, significant atherosclerosis and lacunar stroke. Up to 25% of patients with ESUS have underlying atrial fibrillation (AF). Robust risk factors for AF are age, left atrial volume index (LAVI) and blood biomarkers. We aim to evaluate if a biomarker based preselection for 30d rhythm monitoring increases detection rate of AF in patients with ESUS.

Methods: Monocentric, retrospective data analysis of patients with ESUS between May 2019 and September 2021, fulfilling the ESUS criteria, with in-hospital rhythm monitoring for at least 24 hours without evidence of AF, who received ambulatory extended, non-invasive patch ECG monitoring with the evismo-CardioFlex® device for 28-32 days. Comparison of detection rates with or without the use of biomarkers (age, MR-proANP, left atrial volume index (LAVI), supraventricular extrasystoles during 24 hour Holter-ECG/atrial runs with >20 beats, additional chronic embolic infarct on MRI).

Results: Out of 186 patients, in 14 AF was detected by extended rhythm monitoring (7.53 %). There were 7 AF-cases in each of the two groups (without further selection criteria: 94 Patients, 7.45 %; with selection criteria: 92 Patients, 7.61 %).

Conclusions: Use of additional selection criteria for extended rhythm monitoring in ESUS patients did not increase the detection rate of AF in our cohort of patients.

Disclosure: No

P0448 / 151

MARKERS OF NEUTROPHIL EXTRACELLULAR TRAPS (NETS) IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICE – A PROGNOSTIC FACTOR FOR CEREBROVASCULAR EVENTS?

M.M. Gabriel ¹, K.K. Ravenberg¹, J. Hupe¹, G.M. Große¹, R. Schuppner¹, J. Ernst¹, K. Weissenborn¹, S. Werwitzke², A. Tiede², C. Bara³, J.S. Hanke³, J.D. Schmitto³, M. Von Köckritz-Blickwede^4,5, N. de Buhr^4,5

¹Hannover Medical School, Neurology, Hannover, Germany, ²Hannover Medical School, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany, ³Hannover Medical School, Department of Cardiac, Thoracic, Transplantation And Vascular Surgery, Hannover, Germany, ⁴University of Veterinary Medicine Hannover, Department of Biochemistry, Hannover, Germany, ⁵University of Veterinary Medicine Hannover, Research Center For Emerging Infections And Zoonoses (RIZ), Hannover, Germany

Background and aims: Neutrophil extracellular traps (NETs) and antimicrobial peptides (LL-37) both counteract infections. Furthermore, NETs are crucially involved in an inflammatory and prothrombotic interplay and are shown to contribute to cardioembolic thrombus formation. Their impact on cerebrovascular and bleeding events in patients with left ventricular assist device (LVAD), who are susceptible to bacterial infections and systemic inflammation, has not been investigated yet.

Methods: 72 patients with LVAD and 35 age and sex matched healthy controls were prospectively recruited. Cell-free DNA as one parameter for NETs, LL-37 and DNase activity as NET regulators were measured and correlated with clinical data, including presence of infections, blood-based laboratory findings and outcome events such as TIA, stroke or bleedings within 180 days after study inclusion.

Results: Cell-free DNA and LL-37 levels were higher in LVAD supported patients compared to controls (cell-free DNA p=0.016; LL-37 p=0.036). The concentration of cell-free DNA was not associated with hemodynamic LVAD forces but increased with the severity of heart insufficiency (NYHA: p<0.0001; NT-pro-BNP: p=0.013). Patients with cerebrovascular events (CVEs) between LVAD implantation and study inclusion showed increased cell-free DNA levels compared to those without (p=0.027). LL-37 levels were associated with major bleedings (p=0.014), and tended to be higher in patients with fatal outcome (n=4; p=0.059) or CVEs (TIA n=1, ischemic strokes n=2, intracranial hemorrhages n=3, p=0.053) within 180 days of follow up.

Conclusions: Mediators of NET-formation might play an important role in pathogenesis of CVEs and bleeding events in patients under LVAD therapy.

Disclosure: No

P0449 / 1287

VALIDATION OF THE PARANASPP APPLICATION, A TOOL FOR PREHOSPITAL NATIONAL INSTITUTES OF HEALTH STROKE SCALE IN PATIENTS WITH SUSPECTED ACUTE STROKE

H.F. Bugge ^1,2,3, M. Guterud^2,1,4, K. Larsen^2,5, J. Røislien^6,2, H. Ihle-Hansen⁷, M. Toft^3,1, M.R. Hov^2,3, E.C. Sandset^2,7

¹University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ²Norwegian Air Ambulance Foundation, Research, Oslo, Norway, ³Oslo University Hospital, Department of Neurology, Oslo, Norway, ⁴Oslo University Hospital, Department of Prehospital Medicine, Oslo, Norway, ⁵University of Oslo, Institute of Basal Medical Science, Oslo, Norway, ⁶University of Stavanger, Faculty of Health Sciences, Stavanger, Norway, ⁷Oslo University Hospital, Department of Neurology, Stroke Unit, Oslo, Norway

Background: Prehospital delay is a contributor to treatment delay in patients suffering acute stroke. Most prehospital stroke scales are based on National Institutes of Health Stroke Scale (NIHSS), but do not have the diagnostic accuracy of NIHSS. The ParaNASPP project have developed a mobile application to aid paramedics to perform NIHSS. In this study we aim to validate the ParaNASPP application.

Methods: 23 stroke physicians scored NIHSS on 20 unique videos portraying acute stroke symptoms, using the ParaNASPP application or the standard paper form. Bland Altman plots with 95% Limits of Agreement (LoA) were calculated comparing the groups using the application and paper to the pre-defined scores, and then directly between the two groups. NIHSS scores were then dichotomised to ⩽ 5 and ⩾ 6, and Cohens Kappa calculated.

Results: The ParaNASPP application group scored NIHSS with LoA (-2.33, 2.71) and a mean difference from the pre-defined scores of 0.19. The paper group LoA were (-2.60, 2.55) with a mean difference -0.03. Direct comparison between the groups gave LoA (-3.12, 3.55), and mean difference 0.21. Kappa score for the application group was 0.93 and for the paper group 0.89 when compared to the dichotomised pre-defined scores, and 0.84 for comparison between groups.

Conclusions: Scores from the ParaNASPP application differ slightly more than our-predefined goal of +/-3 when compared to the paper group, but is well within when compared to the pre-defined score of each case. We consider this within acceptable clinical variance and the ParaNASPP application validated for clinical use.

Disclosure: No

P0450 / 211

THE UTILITY OF THE FAST TEST IN PATIENTS TRANSFERRED TO AN EMERGENCY DEPARTMENT OF A LONDON CSC (COMPREHENSIVE STROKE CENTRE)

H. Bhatt ¹, C. Jennings¹, N. Quah Qin Xian¹, B. Chaudhry¹, H. Amin¹, C. Barmpagianni¹, S. Jamil¹, S. Banerjee¹, as

¹ Imperial College Healthcare Trust, London, United Kingdom

Background and aims: The FAST test has been widely used to prompt the public to consider a diagnosis of ischaemic stroke. We aimed to look at the usefulness of the FAST test in diagnosing ischaemic stroke in patients brought in via the London Ambulance Service (LAS) to a stroke thrombolysis and thrombectomy centre.

Methods: We retrospectively reviewed notes for all patients conveyed by LAS, as a thrombolysis call to Charing Cross Hospital between September 2019 and August 2020 (N = 1150). We analysed the proportion of patients assessed to be FAST positive, in addition to the final diagnosis. We assessed the prevalence of six common stroke risk factors (hypertension, diabetes mellitus, previous stroke, atrial fibrillation, smoking and dyslipidaemia) in all patients and compared whether there was a difference in prevalence between confirmed stroke and non-stroke patients.

Results: 918 out of 1150 patients were FAST positive (79.8%). The sensitivity for diagnosing ischaemic stroke was 90.0%, but the specificity was 29.3%. The FAST test was 87% sensitive and 25% specific for any neurovascular diagnosis. The positive predictive value of the FAST test was 37.1%. Common mimics included migraine and seizures. In the FAST positive cohort, there was significantly more hypertension and atrial fibrillation in stroke patients (p <0.05).

Conclusions: The FAST test is highly sensitive for diagnosing neurovascular events; though its positive predictive value was poor in an emergency department setting. The presence of hypertension or AF in those presenting as FAST positive may be more suggestive of an underlying stroke diagnosis.

Disclosure: No

PROGNOSIS AND OUTCOME AFTER STROKE

P0451 / 1464

FIBRINOGEN CONCENTRATION IN ACUTE ISCHAEMIC STROKE AND FUNCTIONAL INDEPENDENCE AT DISCHARGE

M.J. Hernandez Garcia ¹, D. Padilla Leon¹, C. Hernandez Javier¹, G. Gonzalez Toledo¹, M. Crespo Rodriguez¹, M. Lobato Gonzalez¹, A. Bartolome Yumar¹, F. Carrillo Padilla¹

¹ Hospital Universitario de Canarias, Neurologia, San Cristóbal de La Laguna, Spain

Background and aims: Association between fibrinogen levels and vascular thrombosis of coronary and peripherical arteries has been described, although their role in cerebrovascular disease is not well-defined. Some studies correlate higher fibrinogenemia with worst functional result in ischaemic stroke patients. Our aim is to investigate the association between fibrinogen levels and acute vascular events outcome in our population.

Methods: We retrospectively reviewed patients admitted with suspected acute vascular event over a period of one year and we analyzed their fibrinogen levels at admission and their functional independence at discharge (mRS scale).

Results: We analyze 393 patients: 262 ischemic stroke (IS), 33 haemorragic stroke (HS), 46 transient ischemic attacks (TIA) and 52 stroke mimics (SM). We found higher fibrinogenemia in patients with TIA (461 mg/dL) and IS(457 mg/dL). In the IS group, patients with good outcome (mRS 0-2) and patients with minor symptoms (mRS 0-1) had lower levels of fibrinogen (440 mg/dL and 438 mg/dL) than those with bad functional outcome mRS (⩾3)(493 mg/dL) (p=0.002). In HS patients lower levels of fibrinogen were found in patients with better functional result (mRS 0-2) (398 mg/dL vs 420 mg/dL), no statistically significant.

Conclusions: Our patients with ischaemic etiology (TIA and IS) showed higher levels of fibrinogen than SM or HS. Patients in both IS and HS groups with higher fibrinogenemia showed a worst functional result.

It is necessary to design more studies in order to better establish which variables affect hyperfibrinogenemia and if it could be used as a short-term prognostic factor.

Disclosure: No

P0452 / 174

INFLUENCE OF THE GUT MICROBIOME IN ISCHEMIC STROKE RISK AND ISCHEMIC STROKE OUTCOME

M. Lledós ^1,2, N. Cullell^1,3, J. Cárcel-Márquez¹, E. Muiño¹, C. Gallego-Fabrega¹, L. Llucià-Carol^1,4, J.M. Martín-Campos¹, A. Aguilera-Simón⁵, R. Marín⁵, P. Camps-Renom⁵, J. Martí-Fabregas⁵, L. Prats-Sanchez⁵, I. Fernández-Cadenas¹

¹Sant Pau Research Institute, Stroke Pharmacogenomics and Genetics Laboratory, Barcelona, Spain, ²Universitat de Barcelona, Departament de Genètica, Microbiologia i Estadística, Barcelona, Spain, ³Fundación Docència I Recerca Mútua Terrassa, Stroke Pharmacogenomics and Genetics Laboratory, Terrassa, Spain, ⁴Institut d’Investigacions Biomèdiques de Barcelona, Department of Brain Ischemia and Neurodegeneration, Barcelona, Spain, ⁵Hospital de la Santa Creu i Sant Pau, Department of Neurology, Barcelona, Spain

Background and aims: The composition of the gut microbiota is a modifiable factor associated with the risk of stroke and with post-stroke neurological outcome. However, most of the studies have been performed in animal models using 16s rRNA sequencing. We aimed to identify microbiota taxa associated with risk of ischemic stroke (IS), neurological outcome in the acute phase (first 24h), and functional outcome at 3 months.

Methods: We studied first faecal sample after IS in 89 patients and we included 12 controls. We performed shotgun metagenomics sequencing to analyse the taxonomic profiles. Differential relative abundance of taxa was tested using Negative Binomial Generalized Linear Model in different comparisons: case vs control, neurological deterioration vs improvement as assessed by NIHSS score change during the acute phase (ΔNIHSS), and functional outcome at 3 months (mRS). Analyses were adjusted for age, sex, and stroke subtype (TOAST classification).

Results: We identified multiple taxa associated with IS risk (Fusobacterium, p=1.40x10^-6, ß=2.62,), as well as confirmed some that had already been identified (Lactobacillus, p=4.27x10^-11, ß=3.40). Furthermore, we identified new taxa associated with higher risk of stroke severity in the acute phase measured with NIHSS at baseline (6h) (Negativibacillus, p=5.34x10^-5, ß=-1.22) and at 24h (Lentisphaeria, p=1.94x10^-5, ß=-4.61). Last, we identified one genus (Acidaminococcus, p=3.11x10^-62, ß=-0.56) related to poor functional outcome at 3 months (mRS⩾3) after IS.

Conclusions: We found multiple new taxonomic profiles associated with stroke, revealing that gut microbiome could be an important factor associated with stroke risk and stroke acute and long-term outcome.

Disclosure: No

P0453 / 190

PREDICTION OF DEMENTIA USING CT IMAGING IN STROKE (PRODUCTS) - A PROSPECTIVE OBSERVATIONAL COHORT STUDY

M. Hafdi ¹, M. Taylor-Rowan², L. McGuire², E. Richard^3,4,T. Quinn²

¹Amsterdam UMC/University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ²University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom, ³Amsterdam UMC/University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands, ⁴Radboud University Medical Centre, Department of Neurology, Donders Institute of Brain, Behaviour and Cognition, Nijmegen, Netherlands

Aim: A better understanding of who will develop dementia after stroke can inform patient care. Neuroimaging may have prognostic utility. Globally, access to MRI is limited, but CT-imaging is readily available in acute stroke. We explored the prognostic utility of acute CT-brain imaging for predicting dementia.

Methods: We obtained data from the Assessing Psychological Problems In Stroke-A Longitudinal Evaluation (APPLE) cohort, recruiting patients with acute stroke. Cognitive function and incident dementia was assessed at 1, 6, 12 and 18-month visits and supplemented with information on dementia diagnosis from electronic health records. Acute CT-scans were rated using ordinal scales for neurodegenerative and cerebrovascular changes, including old infarcts, white matter lesions (WMLs), medial temporal lobe atrophy (MTA), and general atrophy, combined together to a ‘brain frailty’ score.

Results: Of 195 participants in this analysis, 33% had developed dementia after 2-4 years follow-up. Old infarction was not associated with dementia (HR;95%CI:1.35;0.79-2.31), but WMLs, MTA and atrophy were associated with incident dementia both individually (HR;95%CI:1.35;1.18-1.54, 1.42;1.24-1.63, 1.27;1.12-1.43 respectively) and as brain frailty score (HR;95%CI:1.84;1.40-2.42 per point increase). Discrimination was fair with Area Under the Curves ranging from 0.67-0.71. When integrated in a prediction model together with clinical parameters, pre-stroke modified Rankin scale (mRS), WMLs, and MTA were the strongest predictors of dementia, with good combined discrimination (c-statistic:0.75).

Conclusions: Neurodegenerative changes on acute CT-imaging are suitable markers for incident poststroke dementia, addressing the need for an easily available biomarker for dementia prediction and offering good opportunities for selecting the right target population for preventive interventions.

Disclosure: No

P0454 / 277

PROGNOSIS OF PATIENTS ASSISTED IN THE EMERGENCY UNIT BY THE “TIA PROTOCOL” IN A THIRD-LEVEL HOSPITAL AT 90 DAYS

M. Marín Gracia^1,2,3, D. Cantero Lozano^4,5, F.J. Rodriguez Peguero ¹

¹Santa Barbara Hospital, Neurology, Soria, Spain, ²Vithas Hospital, Neurology, Málaga, Spain, ³Aragon Research Institution, Zaragoza, Spain, ⁴Santa Barbara Hospital, Cardiology, Soria, Spain, ⁵Monteprincipe Hospital, Arrhythmias/Cardiology, Boadilla de Monte, Spain

Background and aims: Care models developed for the fast management of patients with transient ischemic attack (TIA) have previously proven to be safe, effective and reduce recurrence rates. Our aim is to know the prevalence of cardiovascular events at 90 days.

Methods: Oobservational, analytical and cross-sectional study. Adult patients of both genders attended in the Emergency Department using the “TIA Protocol” between January-2016 and December-2019 were included. Clinical variables, complementary tests, treatment and cardiovascular events (stroke/TIA, acute coronary syndrome or death due to cardiovascular causes) were collected at 90 days. The study was approved by the Aragon Research Ethics Committee.

Results: TIA-Protocol was carried out in 163 out of 591 patients diagnosed with TIA in the Emergency Department. Brain computed tomography and neurosonology were performed at 100%, Holter-ECG-24h at 52.1% (detecting atrial fibrillation in 3.6%). Brain magnetic resonance imaging was performed to 78.4% with diffusion weight image lesion in 13.5%. The 90-day prevalence of cardiovascular events were 4.9%(8): 3.1% stroke (5TIA), acute coronary syndrome 0.6% (1), death from cardiovascular causes 1.2% (2). Major adverse cardiovascular events (MACE) were significantly associated with history of ischemic heart disease (p=0.014). Death from cardiovascular causes was associated with history of AF (p=0.008), anticoagulation (p=0.007) or no antiplatelet treatment at discharge (p=0.012). There was a tendency to association with type-2 diabetes mellitus (p=0.050).

Conclusions: Fast care TIA protocols allow early care avoiding hospital admissions without implying an increase in the incidence of cardiovascular events or recurrence of stroke or TIA at 90 days.

Disclosure: No

P0455 / 268

A POPULATION-BASED STUDY OF DO NOT RESUSCITATE ORDERS IN STROKE PATIENTS BEFORE AND DURING THE PANDEMIC

L. Morgenstern ¹, L. Lisabeth¹, G. Zhang², X. Shi², N. Khan¹, D. Zahuranec¹

¹University of Michigan, Stroke Program, Ann Arbor, United States, ²University of Michigan, Biostatistics, Ann Arbor, United States

Background and aims: We studied use of do not resuscitate (DNR) orders in the Brain Attack Surveillance in Corpus Christi (BASIC) study before and during the COVID-19 pandemic.

Methods: All hospitalized stroke cases were ascertained in Nueces County, Texas, USA during an equal time period before the pandemic (January, 2019-Feb, 2020) and during the pandemic (March, 2020-April, 2021). We compared use of DNR orders before and during the pandemic using logistic regression adjusted for demographic and clinical variables including initial stroke severity (NIHSS score). Nueces County is geographically isolated making complete case capture likely. Cases were validated by stroke physicians using source documentation.

Results: There were more cases during the pandemic (N=716) than pre-pandemic (N=681). Median NIHSS score was 5 (IQR 9) during the pandemic and 4 (IQR 9) pre-pandemic (p=0.03). During the pandemic 18.0% of stroke patients had DNR orders compared with 13.3% pre-pandemic (p=0.016). Other demographic and risk factors were similar in the two time periods. In models adjusted for age, sex, race-ethnicity, NIHSS score, diabetes, hypertension, current smoking and stroke history, DNR orders were not more common in the pandemic compared with pre-pandemic (p=0.2), but stroke severity (NIHSS score) remained significantly higher during the pandemic (p<0.01).

Conclusions: In this population-based study, greater use of DNR orders were seen during the pandemic than before the pandemic. The greater use of DNR orders may be due, in part, to the worse stroke severity presenting to hospitals during the pandemic.

Acknowledgment: This study was supported by NIH R01NS38916.

Disclosure: No

P0456 / 304

FACTORS ASSOCIATED WITH POOR OUTCOME IN ISCHEMIC STROKE PATIENTS WITH AND WITHOUT THROMBOLYTIC THERAPY

N. Panyai¹, S. Tiamkao¹, K. Thepsuthammarat², K. Kongbunkiat ³

¹Khon Kaen University, Internal Medicine, Khon Kaen, Thailand, ²Khon Kaen University, Khon Kaen, Thailand, ³Khon Kaen University, North-Eastern Stroke Research Group, Khon Kaen, Thailand

Background and aims: The predictors of poor outcome in ischemic stroke may benefit clinicians in arranging therapy and counseling on disease. Our objective is to determine the factors that contributed to the poor prognosis of ischemic stroke patients before discharge in Thailand.

Methods: This study was a retrospective analytic study. The data were obtained from electronic medical records of stroke patients dispatched to evaluate the quality of care in 11 Ministry of Public Health service regions around Thailand between October 1st, 2014 – September 30th, 2017. The modified Rankin Scale (mRS) was used to classify poor outcomes, with a score of 4-6 defining a poor clinical outcome.

Results: A total of 1174 ischemic stroke patients were collected. The factors associated with poor outcome in rtPA group included hemiparesis (OR 5.79,95%CI 2.16-15.49), initial National Institutes of Health Stroke Scale (NIHSS) [6 - 22 (2.26, 95%CI 1.30-3.92), > 22 (3.79,95% CI 1.35-10.60)], initial mRS 4 - 6 (7.90,95%CI 4.48-13.92), large vessel type of stroke (2.88,95%CI 1.71-4.82), pneumonia (5.08,95%CI 2.29-11.26), intracranial hemorrhage (2.90,95%CI 1.34-6.30), and need for intubation (3.61,95%CI 1.66-7.81), The factors associated with poor outcome in non-rtPA group included previous history stroke (2.88,95%CI 1.15-7.22), history of coronary artery disease (19.50,95%CI 3.64-104.48), aphasia (4.35,95%CI 1.34-14.07), and initial mRS 4 - 6 (53.23,95%CI 20.55-137.91).

Conclusions: Numerous factors are related to a poor outcome in ischemic stroke patients before discharge. Specific risk factors, such as pneumonia and intracranial hemorrhage, can be identified, prevented, and treated early, thereby improving the outcome of stroke patients upon discharge.

Disclosure: No

P0457 / 328

CORRELATION OF POSTERIOR CIRCULATION ARTERIAL OCCLUSION AND COLLATERAL STATUS WITH LONG-TERM FUNCTIONAL OUTCOME: DEVELOPMENT OF THE POSTERIOR CIRCULATION CLOT BURDEN SCORE

A. Salerno ¹, G. Marie², G. Sirimarco¹, G. Saliou², P. Michel¹

¹Lausanne University Hospital and University of Lausanne, Stroke Center, Department of Clinical Neurosciences, Lausanne, Switzerland, ²Lausanne University Hospital and University of Lausanne, Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland

Background and aims: Currently developed non-invasive angiography scores in acute stroke have either been developed for the anterior circulation or exclusively for basilar artery occlusions. We aimed at developing a posterior circulation clot burden score (pc-CBS) including collaterals based on CT- and MR-angiography that correlates with long-term functional outcome.

Methods: For development of the score, 444 patients with acute posterior circulation occlusions were retrospectively assessed in the ASTRAL registry. We used a semiquantitative CTA and MRA grading system to assess the clot burden and collateral flow. We assessed 13 segments of the posterior circulation/circle of Willis for presence of contrast opacification on CTA and signal enhancement on MRA and subtracted points for each affected segment (Figure 1). Interrater reliability was assessed with Cohen’s kappa statistics. Prognostic weighting of each arterial segment both of recanalized and untreated patients is based on its partially adjusted correlations with the ordinal modified Rankin score at 3 months. We will then investigate whether the global pc-CBS independently correlates with long-term outcome.

Results: Baseline data are shown in Table 1. On CTA, interrater reliability showed significant inter-observer accordance for all the segments (Table 2) (MRA: ongoing analysis). Results of prognostic weighting of each arterial segment, and the correlation of the global pc-CBS with long-term outcome will be presented at the congress.

Conclusions: The pc-CBS score has the potential to independently predict outcome in posterior circulation strokes, both in recanalized and untreated patients. External validation of the score is needed and planned in a further analysis.

FIGURE 1.

A score of 0 indicates occlusion of all major posterior circulation segments and absence of efficient Posterior Communicating Arteries (PCoA). PCoA is rated as either absent/hairline (diameter <1,0 mm), smaller than the ipsilateral P1, equal or bigger than the ipsilateral P1. Foetal variants with PCA arising from the anterior circulation and absence of P1 have been excluded from the current analysis. Stenosis do not affect scoring unless they generate a hairline aspect of the artery. Figure adapted from Salerno et al, Int J Stroke, 2021.

Table 1

	Total patients (N = 444 )
Age	69,55 (median)
Female sex	166/444 (37%)
Pre-stroke mRS>2	49/444 (2%)
Cerebrovascular risk factors and pre-treatment
Hypertension	321/444 (72%)
Smoking (or stopped <2ys)	91/444 (20%)
Hypercholesterolemia	336/444 (76%)
Diabetes or glucose intolerance	96/444 (22%)
Atrial fibrillation	75/444 (17%)
Antiplatelet	131/444 (30%)
Anticoagulant	9/444 (2%)
NIHSS at admission <5	145/437 (33%)
Treatment:
None	201/444 (45%)
rtPA	90/444 (20%)
Bridging	73/444 (16%)
EVT	79/444 (18%)
Complete recanalization at 24h	107/319 (34%)
Etiology (TOAST):
Large artery atherosclerosis	144/444 (32%)
Cardioembolic	109/444 (25%)
ESUS	85/444 (19%)
Dissection	29/444 (7%)
Multiple causes	31/444 (7%)
PFO/ASD	18/444 (4%)
Other/rare or undetermined cause	28/444 (6%)
Most proximal occlusion site:
Right extracranial vertebral a.	56/444 (13%)
Left extracranial vertebral a.	54/444 (12%)
Right V4 vertebral a.	93/444 (21%)
Left V4 vertebral a.	91/444 (20%)
Proximal basilar a.	51/444 (11%)
Middle basilar a.	70/444 (16%)
Distal basilar a.	88/444 (20%)
Right P1 posterior cerebral a.	89/444 (20%)
Left P1 posterior cerebral a.	80/444 (18%)
Right P2 posterior cerebral a.	98/444 (22%)
Left P2 posterior cerebral a.	102/444 (23%)
3 month mRS:
0-2	217/422 (23%)
Mortality	83/422 (20%)

Table 2

	Total patients (N = 60 )
CTA interrater reliability for Circle of Willis grading:
Overall agreement	0.92 **
Right A1 anterior cerebral a.	1.00 **
Left A1 anterior cerebral a.	1.00 **
Anterior communicating a.	0.75 *
Right posterior communicating a.	0.81 **
Left posterior communicating a.	0.81 **
Right P1 posterior cerebral a.	0.96 **
Left P1 posterior cerebral a.	0.87 **
Right V4 vertebral a.	1.00 **
Left V4 vertebral a.	1.00 **

*

Substantial agreement, ** almost perfect agreement

CTA interrater reliability for posterior circulation occlusion grading:
Overall agreement	0.89 **
Right extracranial vertebral a.	0.77 *
Left extracranial vertebral a.	0.64 *
Right V4 vertebral a.	0.89 **
Left V4 vertebral a.	0.72 *
Proximal basilar a.	0.83 **
Middle basilar a.	0.91 **
Top of the basilar a.	0.92 **
Right P1 posterior cerebral a.	0.95 **
Left P1 posterior cerebral a.	0.67 *
Right P2 posterior cerebral a.	0.92 **
Left P2 posterior cerebral a.	0.90 **

*

Substantial agreement, ** almost perfect agreement

Disclosure: No

P0458 / 296

EFFECT OF METFORMIN ON OUTCOME AFTER ACUTE ISCHEMIC STROKE IN PATIENTS WITH DIABETES MELLITUS TYPE 2

C. Kersten ¹, I. Knottnerus², E. Heijmans², M. Haalboom², A. Zandbergen³, H. den Hertog⁴

¹Medisch Spectrum Twente, Neurology, Enschede, Netherlands, ²Medisch Spectrum Twente, Enschede, Netherlands, ³Erasmus Medisch Centrum, Rotterdam, Netherlands, ⁴Isala, Zwolle, Netherlands

Background and aims: Diabetes mellitus is a well-known risk factor for ischemic stroke and is associated with unfavorable outcome after stroke. Metformin is recommended as first-line treatment in these patients. Pre-stroke metformin use might have neuroprotective properties resulting in reduced stroke severity. However, results of the effects of pre-stroke metformin use on functional outcome are conflicting. In this study, we aimed to assess the association between metformin use and functional outcome in patients with type 2 diabetes mellitus and acute ischemic stroke.

Methods: We used data from patients with known type 2 diabetes mellitus who were admitted with acute ischemic stroke between 2017 and 2021 in the Isala Hospital Zwolle and Medisch Spectrum Twente (MST) Enschede, the Netherlands. The association between pre-stroke metformin use and favorable functional outcome at 3 months (defined as modified Rankin Scale (mRS) <3) was expressed as Odds Ratios (OR) with corresponding confidence intervals (CI). Adjustments were made for age, sex, hyperglycemia on admission and revascularization treatment by means of multiple logistic regression.

Results: Nine hundred thirty seven patients were included of whom 592 patients (63%) used metformin. Six hundred seventy eight (74%) patients were hyperglycemic on admission. Median mRS was 3 (IQR 2-6) and 593 patients (63%) had a favorable outcome. Pre-stroke metformin use was associated with favorable outcome (aOR of 1.94 (95%- CI 1.45-2.59)).

Conclusions: In this study, we showed that pre-stroke metformin use was associated with favorable outcome after acute ischemic stroke in patients with diabetes mellitus type 2.

Disclosure: No

P0459 / 369

ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS

D. Caimano ¹, F. Letteri², F. Capasso³, N. Limbucci³, P. Nencini⁴, C. Sarti¹, F. Alemseged⁵, G. Bigliardi⁶, A. Morotti⁷, D. Toni⁸, A. Zini⁹, F. Arba⁴

¹University of Florence, NEUROFARBA Department, Florence, Italy, ²Ospedale San Jacopo, Pistoia, Italy, ³Careggi University Hospital, Neurovascular Interventional Unit, Florence, Italy, ⁴Careggi University Hospital, Stroke Unit, Florence, Italy, ⁵Royal Melbourne Hospital, University of Melbourne, Department of Medicine and Neurology, Melbourne, Australia, ⁶Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy, ⁷ASST Spedali Civili di Brescia, Dipartimento di Scienze Neurologiche e della Visione, Brescia, Italy, ⁸University of Rome La Sapienza, Department of Human Neurosciences, Rome, Italy, ⁹IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Department of Neurology and Stroke Center, Bologna, Italy

Background and aims: Although stroke occurs frequently in patients with cancer, there is scarce evidence regarding the safety and efficacy of endovascular treatment (EVT) in patients with acute ischemic stroke and concurrent cancer. We performed a systematic review and meta-analysis to summarize the existing literature.

Methods: We searched for English written observational studies reporting data on safety and efficacy of EVT in patients with acute ischemic stroke and concurrent cancer. Outcomes of interest were: functional independency (modified Rankin Scale [mRS] ⩽2); mortality at three months; successful recanalization (modified Treatment In Cerebral Ischemia [mTICI] 2b or 3); occurrence of any hemorrhagic transformation (symptomatic and asymptomatic). We pooled data with Maentel-Haenszel model to calculate cumulative odds ratios (ORs).

Results: We included six studies in the meta-analysis, with a total of 1882 patients, of whom 138 (7%) with cancer. We observed various definitions of cancer across included studies. Patients with cancer were less likely functionally independent at three months (25% vs 43%, OR = 2.14; 95% CI = 1.30-3.50) and had a five-fold increased probability of death (36% vs 10%, OR=5.76; 95% CI= 3.08-10.77). There was no difference in successful reperfusion (84% vs 81%, OR=1.44; 95% CI=0.82-2.53); patients with cancer had increased risk of any hemorrhagic transformation after treatment (49% vs 34%, OR=1.95; 95% CI=1.28-2.96).

Conclusions: Patients with acute ischemic stroke and cancer have similar EVT recanalization but higher probability of functional dependence, death, and hemorrhagic transformation compared with patients without cancer. Our results may help communication with patients and carers.

Author	Design	Country andInclusion Period	Sample Size, N	Patients with cancer, N	Group Type	Age, Median (IQR) or Mean (±SD)	NIHSS,Median (IQR) or Mean (±SD)	treated with IVT, N(%)#	Any ICH, N(%)	Anterior Circulation Stroke, N (%)	Onset To Groin Puncture time, min (IQR)	Successful reper-fusion, N(%)*	Three months mortality, N(%)	Good Functional Outcome, N(%)**
Jung et al.13	Retro-spective, SC	Korea,2011-2015	329	19	Cancer	69 (58-75)	16 (6-20)	3 (16)	4	19 (100)	NA	12 (63)	12 (63)	3 (16)
					Control	NA	NA	154 (50)	NA	272 (88)		261 (84)	27 (10)	135 (48)
Cho et al.18	Retro-specitive, MC	Korea,2011-2016	378	27	Cancer	69 (9.95)	11 (7-14)	17 (63)	12 (44)	All ACS	NA	23 (85)	9 (33)	10 (37)
					Control	70.1 (11.46)	12 (9-15)	203 (58)	115 (33)			290 (83)	29 (8)	139 (40)
Lee et al. 201914	Retro-spective, SC	Korea,2012-2017	253	26	Cancer	63.2 (11.6)	14 (10-18)	5 (19)	17 (62)	NA	232 (154-504)	23 (88)	8 (31)	6 (23)
					Control	68.8 (11.3)	13 (9-17)	79 (35)	92 (41)		293 (208-547)	205 (91)	20 (9)	95 (42)
Ozaki et al.15	Retro-spective, SC	Canada,2015-2019	300	18	Cancer	68.5 (26.3)	16.5 (6.5)	3 (17)	4 (22)	16 (84)	NA	18 (100)	3 (17)	4 (22)
					Control	71.4 (15.3)	15.8 (7.8)	155 (57)	NA	255 (90)		238 (84)	39 (14)	114 (40)
Lee et al. 202116	Retro-spective, SC	Korea,2014-2020	341	34	Cancer	64.5 (11.4)	18 (11-23)	9 (27)	14 (41)	30 (88)	238 (170-508)	26 (77)	9 (27)	11 (32)
					Control	68.9 (14)	15 (8-19)	80 (26)	73 (24)	253 (82)	330 (185-603)	269 (88)	21 (7)	NA
Ciolli et al.17	Retro-spective, SC	Italy,2008-2016	281	14	Cancer	73 (61-68)	20 (10-23)	5 (36)	6 (43%)	NA	205 (168-368)	10 (71)	9 (64)	3 (21)
					Control	72 (60-79)	16 (10-21)	127 (48)	108 (40%)		268 (195-494)	208 (78)	38 (14)	117 (44)

Disclosure: No

P0460 / 365

A RETROSPECTIVE REVIEW OF THE PROGNOSTIC VALUE OF GRAEB’S SCORE IN SUBARACHNOID HEMORRHAGE PATIENTS WITH CONCURRENT INTRAVENTRICULAR HEMORRHAGE

G. Wong ¹

¹ The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR of China

Background and aims: Subarachnoid haemorrhage (SAH) often bears a grim diagnosis with high rates of morbidity and mortality. Intraventricular haemorrhage (IVH) can also accompany aneurysmal ruptures, lending more complexity to management. We aimed to investigate the prognostic values of using Graeb’s Score as a clinically applicable semi-qunatitative method.

Methods: A retrospective review of 100 patients who had undergone catheter embolization after a diagnosis of SAH and with concurrent IVH were selected in a regional neurosurgical center in Hong Kong. The study was approved by hospital ethics committee.

Results: All patients had external ventricular drain insertion done. 28% eventually had ventriculo-peritoneal(VP) shunts . The average acute hospital stay in this cohort was 71 days. The degree of IVH extension in showed a positive correlation with survival rates and functional outcomes at 6 months and 12 months (mGS with mRS by 6 months: r(35) = 0.27, p = 0.11; mGS with mRS by 12 months: r(35) = 0.26, p = 0.12).

Conclusions: Our study results supported that degree of IVH correlated with poorer functional outcomes, with a trend not reaching statistical significance. For future studies, it would be of interest to evaluate whether aggressive management of IVH would improve outcomes.

Disclosure: No

P0461 / 463

IMMIMENT STUDY: EPIDEMIOLOGY AND OUTCOME OF PATIENTS WITH MINOR STROKE AND HIGH-RISK TRANSIENT ISCHEMIC ATTACK. OBSERVATIONAL DATA FROM THE NORDICTUS GROUP

M.E Ramos-Araque ^1,2, M. Castellanos³, L. Naya Rios³, J. Molina⁴, M. Castañón Apilánez⁴, J. Marta-Moreno⁵, H. Tejada-Meza^5,6, M. Temprano Fernández⁷, A. González C⁷, D. Vidal de Francisco⁸, J. Tejada García⁸, J.L. Maciñeiras Montero⁹, P. Vicente Alba⁹, J.M. García Sánchez¹⁰, B. Aguilera Irazabal¹⁰, M. Martínez-Zabaleta¹¹, I. Albajar Gómez¹¹, A. Pinedo Brochado¹², I. Azkune Calle¹², MM. Freijo¹³, A Moreno-Estebanez¹³, E. Palacio Portilla¹⁴, L Manrique Arregui¹⁴, M. Rodríguez-Yáñez¹⁵, M Santamaría-Cadavid¹⁵, Y. Herrero Infante¹⁶, E. Porqueres-Bosch¹⁶, J. Trejo-Gabriel-Galan¹⁷, A. Echavarria-Iñiguez¹⁷, C. Tejero-Juste¹⁸, J. Rodríguez Montolio¹⁸, F. Julián-Villaverde¹⁹, M. Moreno García¹⁹, L. López-Mesonero¹, L. Redondo-Robles¹, N Aymerich²⁰, J Korroza²⁰, J.F. Arenillas², NORDICTUS Research Network

¹Instituto de Investigación Biomédica de Salamanca, Hospital Universitario de Salamanca, Neurology, Salamanca, Spain, ²Hospital Clínico Universitario de Valladolid, Neurology, Stroke Unit, Valladolid, Spain, ³Instituto de Investigación Biomédica de A Coruña, Hospital Universitario de A Coruña, Neurology, A Coruña, Spain, ⁴Hospital Universitario Central de Asturias, Neurology, Stroke Unit, Oviedo, Spain, ⁵Hospital Universitario Miguel Servet, Neurology, Stroke Unit, Zaragoza, Spain, ⁶Hospital Universitario Miguel Servet, Radiology, Neurointerventionism Unit, Zaragoza, Spain, ⁷Hospital Universitario de Cabueñes, Neurology, Gijón, Spain, ⁸Complejo Asistencial Universitario de León, Neurology, León, Spain, ⁹Complejo Hospitalario Universitario de Vigo, Neurology, Vigo, Spain, ¹⁰Hospital de Basurto, Neurology, Bilbao, Spain, ¹¹Hospital Universitario de Donostia, Neurology, San Sebastián, Spain, ¹²Hospital Galdakao-Usansolo, Neurology, Bizkaia, Spain, ¹³Cruces Hospital, Biocruces Research Health Institute, Neurology, Barakaldo, Spain, ¹⁴Hospital Universitario Marqués de Valdecilla, Neurology, Santander, Spain, ¹⁵Complejo Hospitalario Universitario de Santiago, Neurology, Santiago de Compostela, Spain, ¹⁶Hospital Universitario de Álava, Neurology, Stroke Unit, Vitoria, Spain, ¹⁷Hospital Universitario de Burgos, Neurology, Burgos, Spain, ¹⁸Hospital Clínico Universitario Lozano Blesa, Neurology, Zaragoza, Spain, ¹⁹Hospital San Pedro, Logroño, Spain, ²⁰Hospital Universitario de Navarra, Neurology, Navarra, Spain

Background and aims: Stroke recurrence, which is particularly high in patients with acute minor stroke (AMS) and high-risk transient ischemic attack (HR-TIA), has been shown to decrease when double antiplatelet therapy is administered in the first 21-30 days after the vascular event. We aimed to investigate the incidence, therapeutical management and outcome of patients with non-cardioembolic AMS and HR-TIA.

Methods: We retrospectively analyzed data from all stroke patients evaluated at the emergency department of 19 Spanish hospitals belonging to the NORDICTUS Spanish Stroke Research network between July-December 2019. Patients with non-cardioembolic AMS (NHISS ⩽5) and HR-TIA (ABCD2 ⩾6 or ipsilateral stenosis ⩾50%) were included (IMMINENT criteria), and follow-up visits between 30-90 days after the index event were performed. Clinical, demographic and neuroimaging variables, treatment administered and rate of stroke recurrence, death and other major vascular events during the follow-up period were recorded.

Results: Of 8275 stroke patients, 1679 (20%) had IMMINENT inclusion criteria (1524 AMS, 155 HR-TIA). Incidence per 100.000 inhabitants was 44 and 4 patients per-year, respectively. Reperfusion therapy was given to 145 (9%) patients, single antiplatelet therapy was initiated in 1074 (64%). Recurrent stroke or death occurred in 78 patients (4.6 %), 55 (71%) in the first month.

Conclusions: Twenty percent of our stroke patients present as AMS or HR-TIA. Our data confirm that these population have a high risk of stroke recurrence/death especially during the first month after the index event. Regardless guidelines recommendations, single antiplatelet therapy was the most frequent antithrombotic strategy used in these patients.

Disclosure: Yes

P0462 / 1143

SCAIL PLAQUE INFLAMMATION-STENOSIS SCORE COMPARED WITH OXFORD CAROTID STENOSIS AND ESSEN STROKE RISK SCORES TO PREDICT LATE IPSILATERAL ISCHAEMIC STROKE AFTER SYMPTOMATIC CAROTID STENOSIS

S. Gorey ^1,2, J.J. McCabe^1,3, P. Camps-Renom^4,5, N. Giannotti⁶, J. McNulty², S. Coveney^1,7, S. Murphy^1,2,8, M. Barry⁹, J. Harbison^1,10,11, S. Cronin^1,12, D. Williams^1,13, G. Horgan¹, E. Dolan¹⁴, T. Cassidy¹⁵, C. McDonnell¹⁶, E. Kavanagh¹⁷, S. Foley², S. Collins¹, M. O’Connell¹⁶, A. Fernández-León¹⁸, R. Delgado-Mederos⁴, M. Marnane^2,8, J. Martí-Fàbregas⁴, P.J Kelly^1,2,8

¹Health Research Board, Stroke Clinical Trials Network Ireland, Dublin, Ireland, ²University College Dublin, School of Medicine, Dublin, Ireland, ³Addenbrooke’s Hospital, Cambridge, United Kingdom, ⁴Hospital de la Santa Creu i Sant Pau, Department of Neurology, Barcelona, Spain, ⁵Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau, Barcelona, Spain, ⁶University of Sydney, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Sydney, Australia, ⁷Tallaght University Hospital, Department of Age-Related Health Care, Dublin, Ireland, ⁸Mater Misericordiae University Hospital, Acute Stroke Service, Dublin, Ireland, ⁹St Vincent’s University Hospital, Department of Vascular Surgery, Dublin, Ireland, ¹⁰St James’s Hospital, Neurovascular Service, Dublin, Ireland, ¹¹Trinity College Dublin, Department of Medical Gerontology, Dublin, Ireland, ¹²Cork University Hospital, Department of Neurology, Cork, Ireland, ¹³RCSI University of Medicine and Health Sciences, School of Medicine, Dublin, Ireland, ¹⁴Connolly Hospital Blanchardstown, Department of Geriatric Medicine, Dublin, Ireland, ¹⁵St Vincent’s University Hopsital, Department of Geriatric Medicine, Dublin, Ireland, ¹⁶Mater Misericordiae University Hospital, Department of Vascular Surgery, Dublin, Ireland, ¹⁷Mater Misericordiae University Hospital, Department of Radiology, Dublin, Ireland, ¹⁸Hospital de la Santa Creu i Sant Pau, Department of Nuclear Medicine, Barcelona, Spain

Background and aims: The Oxford Carotid Stenosis tool (OCST) and Essen Stroke Risk Score (ESRS) have been robustly validated to predict recurrent stroke. The SCAIL score combines plaque inflammation and stenosis and has been independently-validated to predict early and late recurrent stroke. We compared SCAIL with OCST and ESRS to predict ipsilateral late stroke recurrence in patients with symptomatic carotid stenosis.

Methods: We pooled three near-identical prospective cohort studies of recent non-severe ischaemic stroke or TIA (<30 days, modified Rankin<3) and ipsilateral internal carotid artery stenosis. All patients had carotid ¹⁸FDG-PET/CT and revascularisation decision blinded to PET/CT data. Patients were censored at revascularisation for OCST analysis.

Results: Of 212 patients, (45 [21%] mild, 92 [44%] moderate, 75 [35%] severe) 50.9% had CEA/stenting. There were 20 post-PET ipsilateral recurrent strokes in 835 patient-years follow-up (median follow-up 4 years, interquartile range 1.27-6.1 years)

On multivariate Cox regression, baseline SCAIL predicted recurrent stroke (adjusted HR 1.8; 95% CI 1.1-2.95, p=0.018). The HR for OCST was 1.0 (95% CI 0.99-1.008, p=0.96) and ESRS was 1.33 (95% CI 0.96 – 1.86, p=0.08) (all HRs per 1-point score increase).

The c-statistic for SCAIL was 0.66 (95% CI 0.54-0.78) versus 0.61 (95% CI 0.49-0.73) for OCST and 0.61 (95% CI 0.49-0.73) for ESRS. No statistical difference was observed between risk scores (p=0.6).

Conclusions: The SCAIL score independently predicted stroke recurrence, and had favourable discrimination compared to OCST and ESRS scores. SCAIL may have utility for future patient selection for randomised trials of carotid revascularisation.

Disclosure: No

P0463 / 816

DIFFERENCES IN LONG-TERM DISABILITY, INSTITUTIONALISATION AND QUALITY OF LIFE BETWEEN AETIOLOGICAL SUBTYPES OF STROKE: IMPLICATIONS FOR COST-EFFECTIVENESS STUDIES

R. Luengo-Fernandez ¹, L. Li¹, M. Downer¹, P. Rothwell¹, on behalf of OXVASC

¹ University of Oxford, Centre for Prevention of Stroke and Dementia, Oxford, United Kingdom

Background and aims: Studies evaluating cost-effectiveness of interventions to prevent or treat particular subtypes of stroke often use outcome data averaged across all strokes due to a lack of published data on subtype-specific outcomes. We therefore evaluated 10-year outcomes after ischaemic stroke by TOAST subtype in a population-based incidence study.

Methods: Patients with incident stroke were ascertained from 2002-2018 in the Oxford Vascular Study and followed until 2020. Disability was assessed using the modified Rankin Scale, and quality of life using the EQ-5D. Ten-year quality-adjusted life years were estimated by combining utility and survival information.

Results: Among 2,540 patients ascertained with incident stroke, 2,196 (86%) having an ischaemic event, aetiological subtype was cardioembolic in 664, cryptogenic in 527, small vessel in 277, and large artery atherosclerotic in 220. Adjusting for age, sex and risk factors, compared to cardioembolic stroke, 10-year mortality risk was lower after large artery stroke (aHR 0.49; 95% CI 0.37-0.66), small vessel stroke (0.47; 0.36-0.62), and cryptogenic stroke (0.46; 0.36-0.59). Disability was also lower after cryptogenic stroke (aOR 0.15; 0.08-0.31), small vessel stroke (0.22; 0.11-0.48) and large artery stroke (0.37; 0.17-0.82) than after cardioembolic stroke. 10-year quality-adjusted life expectancy was lowest in patients with cardioembolic stroke (2.71 years; 2.45-2.98), and highest in patients with cryptogenic stroke (5.86; 5.56-6.15) and small vessel stroke (5.82; 5.42-6.20).

Conclusion: Long-term outcomes after ishaemic stroke vary substantially according to aetiological subtype. Studies evaluating cost-effectiveness of interventions should use outcomes for the subtype targeted by treatment rather than those averaged across all stroke.

Disclosure: No

P0464 / 516

ADMISSION DIASTOLIC BLOOD PRESSURE & MEAN ARTERIAL PRESSURE ARE THE PREDICTORS OF MASSIVE CEREBRAL EDEMA AND FUNCTIONAL OUTCOME AFTER SEVERE STROKE TREATED BY THROMBOLYTICS

K.L. Koo ¹, J. Ooi², K.K. Neoh¹, S.H. Chew¹, I. Looi¹

¹Seberang Jaya Hospital, Neurology, Penang, Malaysia, ²Queen Elizabeth Hospital, Neurology, Kota Kinabalu, Malaysia

Aims: To determine the pre-intravenous thrombolysis(IVT) predictors for outcomes among the patients presented with severe anterior circulation stroke.

Methods: Admission diastolic BP(dBP) was a significant predictor of massive cerebral edema(CE) in a retrospective analysis of 65 patients who only received IVT in two centres without thrombectomy service. Patients with severe stroke were analysed separately and the significant variables were subsequently subjected to multivariate analyses. Severe stroke was defined as ASPECTS ⩽8, massive CE as involvement at least 1/3 of the hemisphere with midline shift >1mm, & favourable outcome as mRS of 0-2 at 90 days.

Results: Among the thirty-six (55.4%) patients with severe stroke (meanASPECTS 7.8), dBP was positively associated with favourable outcome [β:0.007, p=0.04] and negatively correlated with massive CE [β:-0.001, p=0.007]. Initial NIHSS and dBP were the only independent predictors for a favourable outcome in multivariate analysis. A linear regression showed no significant correlation between admission NIHSS and dBP. A higher admission MAP was also correlated with a lower risk of massive CE [R2=0.1798, p=0.01]. Both dBP & MAP were not associated with mortality, parenchymal hemorrhage and ASPECTS change. Patients with normal dBP (ranged 65-89) were less likely to experience favourable outcome compared to the high dBP (ranged 93-143) [p=0.02]. Both normal dBP & MAP (<110mmHg) were significantly associated with the risk of massive CE.

Conclusion: Among patients with severe stroke defined by lower ASPECTS, a low to normal admission dBP & MAP prior to IVT were associated with the development of massive CE & less favourable outcome.

Disclosure: No

P0465 / 495

STANDARDIZING PROGNOSTICATION OF BASAL GANGLIA HEMORRHAGE: A NOVEL SCORING SYSTEM

R. Varshney ¹, N. Arora¹, V. Khullar¹

¹ ABVIMS & Dr RML Hospital, Neurosurgery, New Delhi, India

Background: Spontaneous ICH prognostication score cannot be generalized to basal ganglia hemorrhages. Our study aimed in developing a novel scoring system for prognosticating basal ganglia hemorrhages, including factors likely to influence mortality or survival. The purpose of this grading scale is to provide a standard assessment tool that will allow consistency in communication, prognostication, and treatment selection in clinical care and clinical research.

Method: A retrospective study of 351 patients with spontaneous primary basal ganglia hemorrhage admitted to our hospital. The patients were either managed conservatively or underwent operative intervention. Using univariate and multivariable logistic regression, the association between various plausible factors and 90-day mortality was tested. Statistically significant variables were used to develop a novel scoring system and the association between 90-day mortality and modified ICH score was calculated.

Results: We analyzed 339 cases, overall, 90-day mortality was 37.75% (n=128). The survival rate in patients having modified ICH score of 7 or less than 7 was 91.66%, however, it decreased to 12.19% in patients having a score > 7. A modified ICH score of 7 or less than 7 could predict the survival in 93.8% (95% CI 89.7-96.7) of patients who were alive after 90 days and had a specificity of 85.9%%. The positive predictive value of modified ICH score 7 or < 7 was 91.7% (95%CI 87.1-95.0).

Conclusion: The modified ICH score is a useful tool for predicting 90-days mortality, the area under the ROC curve was 93% which was higher than any other studies for spontaneous ICH.

	ALIVE(n) (%)	EXPIRED(n) (%)	TOTAL(n)
Age group (years)
Less than 60	170 (69.7)	74 (30.3)	244
60 and above	41 (43.2)	54 (56.8)	95
Side
Left side	92 (55.8)	73 (44.2)	165
Right side	119 (68.4)	55 (31.6)	174
Co morbidities
Present	92 (88.5)	12 (11.5)	104
Absent	119 (50.6)	116 (49.4)	235
IVH
Absent	125 (92.6)	10 (7.4)	135
Present	83 (49.1)	86 (50.9)	169
With Hydrocephalus	3 (8.6)	32 (91.4)	35
Volume
Less than 15 cc	23 (82.1)	5 (17.9)	28
15-30 cc	181 (81.5)	41 (18.5)	222
More than 30 cc	7 (7.9)	82 (92.5)	89
GCS categories
13-15	69 (87.3)	10 (12.7)	79
8-12	114 (69.1)	51 (30.9)	165
Less than 8	28 (29.5)	67 (70.5)	95
Midline Shift
Less than 5mm	150 (90.4)	16 (9.6)	166
More than 5mm	61 (35.3)	112 (64.7)	173
Sex
Male	154 (61.1)	98 (38.9)	252
Female	57 (65.5)	30 (34.5)	87
Use of antiplatelet/oral anticoagulants
Present	46 (42.2)	63 (57.8)	109
Absent	108 (46.9)	122 (53.0)	230
Smoking/Alcohol
Present	98 (61.2)	62 (38.7)	160
Absent	94 (52.5)	85 (47.4)	179

Variable	P value
Age group	<0.001
Gender	0.47
Side of bleed	<0.001
IVH	<0.001
Co-morbidities	<0.001
Volume of Hematoma	<0.001
GCS categories	<0.001
Midline Shift	<0.001
Use of antiplatelet/Oral anticoagulants	0.41
Smoking/alcoholism	0.10

Total score	Outcome
	Alive	Expired	Total
Less than or equal to 7	198	18	216
More than 7	13	110	123
Total	211	128	339

Disclosure: No

P0466 / 572

ACUTE ISCHEMIC STROKE PATIENTS WITH PARKINSON’S DISEASE

C. Gonçalves ¹, A. Avanzo¹, M. Serôdio¹, M. Magriço¹, A. Pinho¹, R. Ventura¹, J. Marto^1,2, M. Viana-Baptista^1,2

¹Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Neurology, Lisbon, Portugal, ²NOVA Medical School, Lisbon, Portugal

Background and aims: Recent evidence suggests a higher risk of acute ischemic stroke (AIS) in patients with Parkinson’s Disease (PD). However, the characteristics, in-hospital complications, safety of acute recanalization treatments, and prognosis of AIS in patients with PD were seldom studied. We aimed to characterize patients with AIS and PD including those submitted to acute recanalization treatments.

Methodology: In a retrospective study of consecutive patients with AIS from January-2016 to August-2021, we identified patients with PD by reviewing Neurology Outpatient Clinic reports and pre-stroke medication. We characterized the occurrence of symptomatic intracranial hemorrhage, in-hospital complications, in-hospital mortality, and 3-month outcome. In patients submitted to acute recanalization treatments, a case-control (3:1) analysis was performed.

Results: We included 42 patients with PD, with a mean age of 81.4 (SD 7.7) years of age. Fifteen (35.7%) patients with pre-stroke modified Rankin Scale >2. Median NIHSS was 15 (IQR 7–19). Five (11.9%) patients received intravenous thrombolysis and 11 (26.1%) endovascular treatment. Four (9.5%) patients had a symptomatic intracranial hemorrhage, 12 (28.6%) pneumonia, 12 (28.6%) urinary tract infection and 25 (59.5%) any medical complication. In-hospital mortality was 23.8% (n=10), and 20 (47.6%) patients had an unfavorable outcome at 3-months. In the case-control analysis, none of the studied outcome were associated with PD.

Conclusion: In our study, patients with PD and AIS had a high prevalence of in-hospital complications and poor prognosis. In patients submitted to acute recanalization treatments, PD was not associated with the different studied outcomes.

Disclosure: No

P0467 / 1292

ROUTINE INFLAMMATORY MARKERS FOR OUTCOME PREDICTION IN STROKE PATIENTS TREATED WITH ENDOVASCULAR THERAPY

L. Fabisch ¹, T. Schoch¹, M. Kneihsl¹, G. Wünsch², M. Haidegger¹, H. Deutschmann³, C. Enzinger¹, T. Gattringer^1,3, S. Fandler-Höfler¹

¹Medical University of Graz, Department of Neurology, Graz, Austria, ²Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria, ³Medical University of Graz, Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Graz, Austria

Background and aims: Inflammation plays an important role in the pathophysiology and prognosis of acute ischemic stroke. While various inflammatory blood markers are related to outcome in large vessel occlusion stroke (LVOS), it remains unclear which specific markers have the greatest potential for outcome prediction. Furthermore, data on early dynamic changes of these markers are lacking. Therefore, we analysed the effect of different routine inflammatory blood markers including their early changes on functional outcome after endovascular therapy for LVOS.

Methods: We investigated consecutive patients treated with endovascular therapy for anterior circulation LVOS over an eight-year period. Inflammation parameters (differential blood count and respective ratios, serum glucose and CRP) were assessed upon hospital admission and at day 1. Uni- and multivariable analysis including other outcome-relevant variables targeted unfavourable functional outcome defined as modified Rankin Scale scores of 3-6 three months post-stroke.

Results: We identified 428 patients (median age 69 years, median baseline NIHSS 15). At admission, the strongest predictors of unfavourable outcome were higher serum glucose (Cohen’s d=0.48, p<0.001), neutrophil count (d=0.42, p<0.001) and neutrophil to lymphocyte ratio (NLR, d=0.33, p<0.001). On day 1 after admission, higher serum glucose (d=0.57, p<0.001), CRP (d=0.44, p=0.002) and NLR (d=0.33, p=0.01) showed the strongest associations with outcome. Additionally, a CRP increase within 24 hours after stroke was a strong predictor for unfavourable outcome (d=0.40, p<0.001).

Conclusion: Among routine inflammatory parameters, serum glucose, neutrophil count, NLR and early increase in CRP show the strongest associations with functional outcome in LVOS patients treated with endovascular therapy.

Disclosure: No

P0468 / 1099

CONSULTATION TO THE EMERGENCY TELEPHONE TRIAGE SERVICE IS ASSOCIATED WITH BETTER OUTCOME OF PATIENTS WITH CEREBROVASCULAR DISEASES. A PROPENSITY SCORE ANALYSES WITH POPULATION-BASED REGISTRY

R. Deguchi ¹, Y. Katayama², T. Nishimura¹, H. Himura¹, Y. Mizobata¹

¹Osaka City University Graduate School of Medicine, Traumatology and Critical Care Medicine, Osaka, Japan, ²Osaka University Graduate School of Medicine, Traumatology and Acute Critical Medicine, Suita, Japan

Background and aims: Telephone triage service is the emergency medical system for the citizens who worry about ambulance call. In this service, citizens can consult to the nurses about the urgency of their illness, and the nurses decide the requirement of ambulance dispatch. Although the service has been introduced in many countries, its impact in the emergency patients has not been reported. We evaluated the effect of the telephone triage service to outcomes of the hospitalized patients with cerebrovascular diseases using propensity score matched analysis.

Methods: This was a retrospective descriptive epidemiological study. The study included patients with cerebrovascular diseases who were transported by ambulances of the Osaka City fire department from January 2016 to December 2019. The main outcome was discharge to home at the day 21 of the hospitalized patients.

Results: The number of patients eligible for the analyses was 11,786. Of these patients, 263 patients (2.2%) consulted to the telephone triage services and were directed by the nurses to be transported to the hospital by the ambulance. On the other hand, 11,523 patients (97.8%) called ambulance service directly by their decision. In propensity score matching, 263 patients were matched from each group. The number of patients who discharged from the hospital in the telephone triage consulting group was significantly more than that of who did not use it (crude OR; 2.06 (95%CI; 1.46-2.92, p<0.01) ).

Conclusions: The consultation of telephone triage service might be associated with better outcomes of patients with cerebrovascular diseases transported by ambulance.

Disclosure: No

P0469 / 613

A NEW PROGNOSTIC SCALE IN ISCHEMIC STROKE: SELCUK SCORE

C. Özgüncü ¹, Ş. Öztürk¹, M.K. Körez¹, R. Aygül¹, A.H. Ekmekci¹, H. Gümüş¹, G. Özdemir¹, F. Eren¹, A. Ünlü¹, A. Nayman¹, A. Mammadli¹, S.E. Yilmaz¹, S. Tekneci¹

¹ Selcuk University, Konya, Turkey

Background and aims: The incidence of stroke is increasing all over the world. Prognostification scales with higher predictive values are getting more important. Our aim in this study was to develop a new, simple and useful prognostic scale with high predictive power to help predict prognosis in stroke.

Methods: Blood and imaging data and clinical parameters of 1697 stroke patients were analyzed retrospectively to evaluate hospital mortality. Binary logistic regression analysis was applied and appropriate parameters were determined. Hosmer-Lemeshow was used for the calibration and internal validation was applied to the model. Comparisons were made with other scores evaluated in the literature with the help of ROC analysis and machine learning methods.

Results: Consciousness, length of hospital stay, albumin level, NIHSS, lesion volume, periventricular hypodensity, age were determined as parameters. A scoring model was created between 0-8.5 points. The threshold value was determined as >3 according to the Youden index criterion. The sensitivity of the model in predicting mortality was 83.6%(78.4-88), selectivity was 81.2% (79.1-83.2). The AUC value for our developed model was found to be 0.884 (0.868-0.899) (p<0.001) and this value was higher than many of the prognostification scales in the literature.

Conclusions: Our new scoring system has better predictive power than the compared studies for mortality. Although it is proven that the system works correctly by internal validation, it should be tested in different environments with external validation. After further clinical validation studies our model is anticipated to be useful and promising in clinical daily practice.

Disclosure: No

P0470 / 1064

CLINICAL OUTCOMES OF RADIATION-INDUCED CAROTID STENOSIS

X. Zhang ¹, Y. Yu², K. Yang³, X. Bai¹, T. Wang¹, Y. Feng¹, R. Xu¹, B. Yang¹, X. Wang⁴, L. Jiao¹, Y. Ma¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Peking Union Medical College, Department of Clinical Medicine, Beijing, China, ³Xuanwu Hospital, Capital Medical University, Department of Evidence-Based Medicine, Beijing, China, ⁴Xuanwu Hospital, Capital Medical University, Medical Library, Beijing, China

Background and aims: Clinical outcomes of radiation-induced carotid stenosis are still unclear. Therefore, this study is aimed to evaluate the short-term and long-term outcomes after surgery for radiation-induced carotid stenosis.

Methods: PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant RCTs and observational studies which reported short- and long- term outcomes after carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) for carotid stenosis induced by radiation, and examination of grey literature were also conducted by independent reviewers. Only studies conducted from 1 January 2000 to 1 January 2022 and published in English were included.

Results: A total of 26 studies with 1002 patients were included. CEA was performed in 364 patients and CAS in 638 patients. The estimated rate of short-term stroke was 0.19% (95% CI=0-0.90%), and the rate of long-term stroke was 2.68 % (95% CI=1.19-4.57%). The rate of CNI in CEA group was significantly higher than that in CAS group [risk ratio (RR)=6.03, 95% CI=1.63-22.22, P=0.007)], however, there was a tendence of decreasing year after year. The univariate meta-regression analysis showed that the risk of stroke in CAS group were significantly higher than CEA group in both short-and long term [incidence rate ratio (IRR) =3.62, 95% CI=1.21-10.85, P=0.22; IRR=2.95, 95% CI=1.02-8.59, P=0.046), respectively].

Conclusions: This study found that CEA can yield better results for these patients than CAS. Nonetheless, as large-scale studies have not yet been conducted, and there is a definite need for further research studies in the future.

Disclosure: No

P0471 / 1070

FACTORS INFLUENCING RECANALIZATION AFTER MECHANICAL THROMBECTOMY WITH FIRST PASS EFFECT FOR ACUTE ISCHEMIC STROKE

X. Zhang ¹, X. Bai¹, J. Wang¹, Y. Zhang¹, A.A Dmytriw², T. Wang¹, R. Xu¹, L. Li¹, Y. Feng¹, C. Severiche Mena³, K. Yang⁴, X. Wang⁵, H. Song⁶, Q. Ma⁶, L. Jiao¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Neuroradiology&Neurointervention Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States, ³Pontifical Bolivarian University, Medellín, Antioquia, Colombia, ⁴Xuanwu Hospital, Capital Medical University, Department of Evidence-Based Medicine, Beijing, China, ⁵Xuanwu Hospital, Capital Medical University, Medical Library, Beijing, China, ⁶Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China

Background and aims: First pass effect (FPE) is increasingly recognized as a predictor of good outcome in large vessel occlusion (LVO). This study aimed to elucidate the factors influencing recanalization after mechanical thrombectomy (MT) with FPE in treating acute ischemic stroke (AIS).

Methods: Main databases were searched for relevant randomized controlled trials (RCTs) and observational studies reporting influencing factors of MT with FPE in AIS. Recanalization was assessed by the modified Thrombolysis in Cerebral Ischemia (mTICI) score. Both successful (mTICI 2b-3) and complete recanalization (mTICI 2c-3) were observed. Risk of bias was assessed through different scales according to study design.

Results: A total of 17 studies and 6186 patients were included. Among them, 2068 patient achieved recanalization with FPE. The results of analyses showed that age (mean deviation (MD):1.21, p=0.012), female gender (odds ratio (OR):1.12, p=0.046), diabetes mellitus (DM) (OR:1.17, p=0.032), occlusion of internal carotid artery (ICA) (OR:0.71, P=0.033), occlusion of M2 segment of middle cerebral artery (OR:1.36, p=0.019), duration of intervention (MD:-27.85, p<0.001), time of onset to recanalization (MD:-34.63, p=0.004), general anesthesia (OR:0.63, p<0.001) and use of balloon guide catheter (BGC) (OR:1.60, p=0.003) were significantly associated with successful recanalization with FPE. At the same time, age, female gender, duration of intervention, general anesthesia, use of BGC, and occlusion of ICA were associated with complete reperfusion with FPE, but M2 occlusion and DM were not.

Conclusion: Age, gender, occlusion site, anesthesia type and use of BGC were influencing factors for both successful and complete recanalization after first pass thrombectomy.

Disclosure: No

P0472 / 627

THROMBOLYSIS’ BENEFITS ON POST-STROKE APHASIA RECOVERY – THE BULGARIAN EXPERIENCE

D. Kalpachka ^1,2, R. Kalpachki^1,2

¹‘St. Anna’ University Hospital, Department of Neurology, Sofia, Bulgaria, ²South-West University ‘Neofit Rilski’ (SWU), Blagoevgrad, Bulgaria

Background and aims: Poststroke aphasia is one of the most devastating stroke-related consequences for patients social interaction and daily activities. The aim of our study is to evaluate the improvement of aphasia recovery in stroke patients with or without thrombolysis.

Methods: Our study is a single-center prospective observational study conducted at the Stroke Unit of the Saint Anna University Hospital, Sofia during Dec 2020 – Dec 2021. Patients treated with thrombolysis and nontreated patients underwent 2 aphasia assessments through BEST (Bedside Evaluation Screening Test) twice – 24 - 72 hours after the symptom onset and 6-8 weeks after the first assessment. The BEST assesses conversational expression, naming objects, describing objects, repeating sentences, pointing to objects, pointing to parts of a picture and reading. Brain computed tomography (CT) scans were evaluated regarding infarct volume and localization, and severity of stroke was assessted through the National Institute of Health Stroke Scale (NIHSS).

Results: The study included 35 patients: 14 patients treated with thrombolysis and 21 nontreated patients. Both groups improved over time. 9 of patients after thrombolysis and only 2 nontreated patients improved significantly, 3 of patients after thrombolysis and 6 nontreated patients increased their language performance moderately. 13 nontreated patients and only 2 patients underwent thrombolysis showed poor improvement in the re-evaluation.

Conclusions: Our study demonstrates that patients treated with thrombolysis experience greater improvement in language performance than the nontreated patients. Reperfusion treatment can be added to severity of the stroke, size and location of the lesion as predictor of aphasia recovery.

Disclosure: No

P0473 / 651

THE CLINICAL VALUE OF MIR-23A-3P IN ACUTE ISCHEMIC STROKE AND ITS REGULATION OF CYP2C19

H. Xu ¹, J. Yang^2,3, J. Hao⁴, X. Yang⁴

¹Chengdu Medical College, School of Pharmacy, Chengdu, China, ²Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Department of Neurology, Chengdu, China, ³Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China, ⁴Chengdu Medical College, School of Bioscience and Technology, Chengdu, China

Background: The exosomal miRNAs have been emerged as biomarkers and therapeutic targets for various diseases,however,the function of exosome miRNAs in acute ischemic stroke (AIS) remains largely unknown.We investigated the feasibility of circulating exosome miR-23a-3p as a biomarker of AIS and elucidated the regulation of CYP2C19 by miR-23a-3p.

Methods: The serum samples from AIS patients and normal controls were collected.The exosomes were extracted from the serum,and confirmed by transmission electron microscope (TEM), Nanoparticle Tracking Analysis (NTA), western blot with the specific exosome biomarkers CD9, CD63 and Tsg101.QRT-PCR was used to analyze the expression of exosome miR-23a-3p. In order to confirm that miR-23a-3p can regulate CYP2C19 expression,we used dual luciferase reporter gene assay and qRT-PCR to detect the the regulatory effect of miR-23a-3p on CYP2C19 in L02 cells. Serum exosomes were purified and labeled with Dio green fluorescence, to detect the entry of exosomes into hepatocytes L02 by fluorescence confocal microscopy.Serum exosomes and L02 cells were co-incubated, and CYP2C19 mRNA and protein levels in hepatocytes were measured by qRT-PCR and western blot.

Results: QRT-PCR analysis showed that the level of exosomes miR-23a-3p was down -regulated in AIS patients compared with that of control group, and the expression level of miR-23a-3p could be used as a biomarker for acute ischemic stroke; miR-23a-3p could regulate CYP2C19 expression via binding to the coding sequence of CYP2C19;serum exosomes could enter hepatocyte L02 and regulate CYP2C19 mRNA and protein expression.

Conclusion: Exosome miR-23a-3p can be used as a biomarker for AIS and regulate CYP2C19 expression in hepatocytes.

Disclosure: No

P0474 / 733

CLINICAL AND LABORATORY PREDICTORS OF RECURRENT ISCHEMIC STROKE MORTALITY

M. Abdelbary ¹, H. Ali², H. Elnady^2,2

¹Mohamed Abdelbary, Neurology, Sohag, Egypt, ²Sohag University, Sohag, Egypt

Background and aims: Recurrent ischemic stroke (RIS) is frequent with a considerable variation in prevalence and mortality across Populations, in this study, we try to clarify predictors of mortality in recurrent ischemic stroke patients,.

Methods: This is a retrospective study of major vascular events, recurrence, and mortality among survivors of consecutive 55 recurrent ischemic stroke patients admitted to the neurology department at Sohag University hospital from 1st August 2018 to 1st November 2018, and their follow up after one year after RIS, according to one-year mRS Patients subdivided into Group A (patients with mRS 5 or less) and Group B (patients with mRS 6 ). The prevalence of another recurrence, myocardial infarction (MI) was estimated. Multivariate logistic regression analysis was used to examine predictors of one-year recurrent ischemic stroke mortality.

Results: We found a high mortality rate of the Egyptian population compared to previous publications (34.4% ), patient in group B had higher age than group A but the p value not statistically significant ( p value 0.44) and high admission national institute of health stroke scale NIHSS ( p value 0.007) and, patient with group B has low hemoglobin level compared to Group A p value 0.002) and high triglyceride level ( p value 0.006) in multivariate logistic regression analysis leukocytosis and renal impairment are independent predictors of mortality

Conclusions: High NIHSS, leukocytosis, anemia, and abnormal serum creatinine on admission are predictors of mortality after recurrent ischemic stroke

Disclosure: No

P0475 / 722

CLINICAL OUTCOME OF STROKE PATIENTS THAT RECEIVED INTRAVENOUS THROMBOLYSIS - FIRST 400 CASES

B. Ciopleias ¹, R. Chiujdea¹, R. Makk¹, A. Urdea¹, R. Iliescu¹, R. Zosin¹, E. Gavan¹, R. Gioroc¹, A. Nechifor¹, A. Grigoroiu¹, A. Banu¹, T. Nemeth¹, L. Irincu¹, I. Despa¹, A. Zarnoveanu¹, L. Ungureanu¹, M. Chioasca¹, D. Rusu¹, R. Rancz¹, S. Diaconu^1,2, C. Falup-Pecurariu^1,2

¹County Emergency Clinical Hospital, Neurology, Brasov, Romania, ²Transilvania University, Faculty of Medicine, Neurology, Brasov, Romania

Background: Our stroke center started the intravenous thrombolysis program in stroke in March 2019, from that moment over 400 patients benefitted from this procedure.

The aim of this study is to assess the outcome of the patients with stroke that undergone intravenous thrombolysis in our stroke center.

Material and method: This is a retrospective study in which we analyzed the outcome of the first 400 patients after intravenous thrombolysis in our stroke center admitted in our department from 1^st March 2019 to 31^th August 2021, using patients medical records, NIHSS score at admission, after 7 days from the procedure and the modified Rankin Scale at discharge.

Results: In the study group the mean age was 68.9 years (55.75% males) most patients presented anterior circulation ischemic stroke. Severity of stoke at admission based on the mean NIHSS score was 11 points. The median time from onset of symptoms to hospital presentation was 77 minutes. The mean NIHSS score after 7 days since thrombolysis was 4 points, with a modified Rankin scale of 2 points at discharge. A percentage of 6.5% of patients died during hospitalization, most of them from stroke related complications. Severe intraprocedural complications were rare. Secondary hemorrhagic transformation was encountered in 14,25% of the patients.

Conclusion: Intravenous thrombolysis improves the outcome of patients with ischemic stroke, reduces disability and increases the quality of life in ischemic stroke patients.

Disclosure: No

P0476 / 787

SOLUBLE UROKINASE RECEPTOR (SUPAR) AS A PROGNOSTIC BIOMARKER IN THE ISCHEMIC NEUROVASCULAR EVENT: A NEW CANDIDATE?

R. Macrez ¹, A. Rochey¹, E. Laporte², T. Pierrat³, D. Vivien⁴, B.D Roussel⁵

¹University of Caen/ CHU de Caen/ Inserm U1237/ BB@C Institute, Emergency Medicine, Caen, France, ²University of Caen/ CHU de Caen/ Inserm U1237/ Cyceron/ BB@C Institut, Department of Neurology, Caen, France, ³CHU de Caen, Emergency Medicine, Caen, France, ⁴University of Caen/ CHU de Caen/ Inserm U1237/ BB@C Institute, Caen, France, ⁵Inserm U1237, Caen, France

Aim: We evaluated soluble urokinase-type plasminogen activator receptor (suPAR) levels in stroke and transient ischemic attack (TIA) patients and assessed their prognostic value regarding 3 months outcomes concerning regarding risk of cerebral infarction after TIA and risk of stroke recurrence.

Materials and methods: The study included 111 stroke, 26 TIA and 164 healthy subjects For stroke an TIA patients, blood sample were from a biological collection named Biostroke, an observational, prospective, monocentric study performed at the emergency department of university hospital of Caen. For healthy subjects, blood sample are from the blood French institute. suPAR concentrations were measured using a commercial ELISA kit. The mean follow-up period was 3 months.

Results: The suPAR level of expression was significantly higher in both stroke and TIA groups compared to controls (ng/ml, 3.08±1.55 and 2.78±1.04 vs 1.71±0.42, p<0,0001), but there was no significant difference between stroke patients and TIA patients. suPAR levels in TIA patients who were considered at high risk of stroke recurrence at 3 months (ABCD2 ⩾ 4) was significantly higher compared to low risk patients (ABCD2⩽ 3) (ng/ml, 3.05±1.06 vs 1.95±0.67, p = 0.0035). An elevated plasma suPAR concentration was associated with mortality and risk of recurrence during the follow-up period (p=0.003).

Conclusion: Stroke and TIA patients showed higher suPAR levels compared to healthy subjects. Elevated plasma suPAR concentrations seems to be a good candidate to predict the risk of stroke post TIA, risk of recurrence and mortality 3 month after the stroke onset.

Disclosure: No

P0477 / 786

DYNAMIC CHANGE OF TRIGLYCERIDE LEVELS DURING AN ORAL TRIGYLCERIDE TOLERANCE TEST AFTER ISCHAEMIC STROKE AND THE RISK OF RECURRENT VASCULAR EVENTS

A.H. Nave^1,2,3,4, N. Kaynak ¹, K. Mai^3,4,5, B. Siegerink⁶, U. Laufs⁷, P. Heuschmann^8,9, T.G. Liman^2,1, M. Ebinger¹⁰, M. Endres^2,1,3,4,11

¹Charité- Universitätsmedizin Berlin, Department of Neurology and experimental Neurology, Berlin, Germany, ²Center for Stroke Research Berlin, Charité- Universitätsmedizin Berlin, Berlin, Germany, ³German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany, ⁴Berlin Institute of Health (BIH), Berlin, Germany, ⁵Charité- Universitätsmedizin Berlin, Department of Endocrinology and Metabolism, Berlin, Germany, ⁶Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, Netherlands, ⁷Universitätsklinik Leipzig, Department of Cardiology, Leipzig, Germany, ⁸University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany, ⁹University Hospital Würzburg, Clinical Trial Center Würzburg, Würzburg, Germany, ¹⁰Medical Park Humboldtmühle, Department of Neurology, Berlin, Germany, ¹¹German Center for Neurodegnerative Diseases, partner site Berlin, Berlin, Germany

Background and aims: Hypertriglyceridemia, especially non-fasting triglyceride levels are considered as risk factors for cardiovascular disease. However, risk stratification based on triglyceride levels in ischaemic stroke (IS) patients is missing. We aimed to examine the association of the response to an oral triglyceride tolerance test (OTTT) with recurrent vascular events following IS in the “Berlin Cream and Sugar Study”.

Methods: Consecutive blood samples were taken at baseline and after three (t1), four (t2), and five (t3) hours following an ingestion of 250 ml of cream from patients with first-ever IS. Patients were categorized into three groups based on the relative change from baseline in triglyceride levels for each time point. Hazard ratios (HR) were calculated for the highest relative increase compared to lowest via multivariable cox regression for recurrent vascular events at 1 year adjusting for risk factors.

Results: 523 patients had a follow-up. Compared to the lowest tertile of relative change, patients in the highest tertile were younger, more likely to be male and active smokers, and less likely to have hypertension. A high relative increase was associated with a lower risk for recurrent vascular events at t1 (HR: 0.91, 95% Confidence Interval 0.44-1.87), increasingly so at t2 (HR: 0.51, 0.24-1.08) and t3 (HR: 0.33, 0.15-0.72).

Conclusions: This explorative analysis suggests that a high increase from baseline in triglyceride levels following OTTT after IS is associated with lower risk of recurrent vascular events at one year. Further studies are needed to explain the underlying pathophysiology and validate this finding.

Disclosure: Yes

P0478 / 825

IMPACT OF RHYTHMIC TRANSCRANIAL MAGNETIC STIMULATION ON DISABILITY LEVEL IN PATIENTS IN LATE RECOVERY PERIOD OF ISCHEMIC CAROTID STROKE

V. Mishchenko ¹, O. Dmytriieva¹, D. Kutikov¹, Y. Kiziurina¹

¹ SI Institute of Neurology,Psychiatry and Narcology of NAMS of Ukraine, Department of Vascular pathology of the brain and neurorehabilitation, Kharkiv, Ukraine

Background and aims: Growing prevalence of a severe disability after ischemic stroke requires expansion of rehabilitation methods. Rhythmic transcranial magnetic stimulation (rTMS) might be a promising new method to decrease disability in patients in late recovery period (LRP) of ischemic carotid stroke (ICS).

Materials: Thirty-eight patients with ICS (22 patients with damages in right hemisphere and 16 patients with damages in left hemisphere) of 53-72 years old (mean age was 62.85±1.75) were observed. Patients were in LRP of ICS (6-12 months, average 9.47±0.34 months). All patients received rTMS for 10 sessions with a scaling of disability and electroencephalography (EEG) monitoring before and after the rTMS.

Results: After rTMS intervention, according to the modified Rankin scale (mRS) the prevalence of moderate-to-severe impairment decreased due to transition of patients to categories with milder impairment [Figure 1]. After the rTMS intervention, mean mRS point decreased from 1.95±0.16 to 1.53±0.14 (p<0.05). All examined patients showed a reduction of dependence on assistance in everyday life (Barthel Index 53.87±2.16 vs. 68.70±4.15 before and after rTMS intervention respectively). After the rTMS, on EEG there was observed positive dynamics manifested in a decrease of paroxysmal activity. Regularity and modularity of alpha activity increased otherwise interhemispheric amplitude asymmetry of alpha activity decreased.

Conclusions: A 10-day rTMS intervention in LRP of ICS leads to a decrease of the severity of motor disorders, and increase daily activity and general well-being of patients.

Disclosure: No

P0479 / 873

PREDICTING RISK OF BLEEDING ON ANTIPLATELET THERAPY IN YOUNG STROKE PATIENTS

N. Hilkens ¹, J. Verhoeven¹, T. Van Lith¹, M. Ekker¹, L. Rutten-Jacobs², N. Maaijwee³, C. Klijn¹, E. Richard¹, F.-E. De Leeuw¹

¹Radboud University Medical Center, Department of Neurology, Donders Center for Medical Neuroscience, Nijmegen, Netherlands, ²F. Hoffmann – La Roche Ltd, Basel, Switzerland, ³Luzerner Kantonsspital, Neurocentre, Department of Neurology and Neurorehabilitation, Luzern, Switzerland

Background and aim: Antiplatelet treatment is associated with an increased risk of bleeding. Accurate identification of patients at highest risk of major bleeding could help to target preventive actions. It is unknown whether currently available prediction models adequately predict bleeding risk in young stroke patients. We aimed to validate existing prediction models for major bleeding in young stroke patients and compare predictors of bleeding among young and older patients.

Methods: We studied risk of bleeding on antiplatelet treatment in 430 patients with TIA or ischemic stroke on antiplatelet treatment, aged 18-50 years, included in the FUTURE study. We assessed performance of the S₂TOP-BLEED and REACH scores with the c-statistic. Next, we performed multivariable Cox regression analysis to investigate the association of known predictors in young stroke patients.

Results: During 3809 person-years of follow-up, 66 patients experienced a bleeding event. C-statistic of existing models were 0.41 (95% CI 0.34-0.48) for S₂TOP-BLEED and 0.49 (95% CI 0.42-0.57) for REACH. Female sex was a strong predictor of bleeding in young patients (HR 3.1, 95% CI 1.7-5.7) while it was protective at older age (HR 0.77; 0.69-0.86). The association between age and risk of bleeding was stronger in older patients compared to young stroke patients (Figure).

Conclusion: Bleeding events are frequently occurring adverse events in young stroke patients. Patients at risk cannot be identified, as prediction models for major bleeding developed in older patient populations show poor performance in young stroke patients. A young stroke-specific prediction model for bleeding on antiplatelet therapy is required.

Disclosure: Yes

P0480 / 981

PILOT STUDY FOR CRITICAL CEREBRAL VENOUS THROMBOSIS PREDICTION: VENTISCA SCORE

J. Alonso Maroto ¹, S. Trillo Senín¹, E. De la Fuente Sanz¹, C. Aguirre Hernández¹, M.d.C. Ramos Martín¹, E. Valiente Gordillo¹, M. Domínguez Gallego¹, J. Vega Villar², J.L. Caniego Monreal², J.A. Vivancos Mora¹

¹Hospital Universitario de La Princesa, Neurology, Madrid, Spain, ²Hospital Universitario de La Princesa, Radiology, Madrid, Spain

Background and aims: Critical cerebral venous thrombosis (C-CVT) poses a potentially extreme clinic situation. The objective of this study is to determine its clinical and radiological risk profile and to assess the hypothetical predictive capability of a new score, VENTISCA (VEnous siNus Thrombosis multImodal riSk SCAle).

Methods: We conducted an observational retrospective study with prospective data collection from patients suffering from CVT between January 2008 and May 2021 in our center. CVT derived from brain neoplastic or local infection were excluded. Data regarding their evolution and prognosis were collected. We defined C-CVT as CVT requiring orotracheal intubation (OTI) or endovascular treatment (EVT), as well as those associating inpatient mortality or functional dependency measured by a modified Rankin score (mRs)>2 at three months. Up to 10 points were assigned to the VENTISCA score based on the existence of GCS⩽13, NIHSS>6, encephalopathy, status epilepticus, haemorrhagic infarct and superior longitudinal sinus (SLS) and transverse-sigmoid-jugular (TSJ) axis affection.

Results: N=40. Mean age 50,98 years(SD 19,96), 57,5% women. GCS 15(14-15), NIHSS 1(0-4), encephalopathy 42,5%, status epilepticus 15%, SLS 60% and TSJ 40% affection, haemorrhagic infarct 32,5%. OTI and ETV 7 cases(17,5%), mRS>2 at three months 17,5%. Criteria for C-CVT met in 30% of cases. A VENTISCA score>2 predicted C-CVT with OR 41,7(6-288) (p<0,001) and AUC 0,86(0,61-1) (p<0,001), and independently predicted functional dependency and OTI and ETV requirement.

Conclusions: C-CVT is a rare yet devastating disease. In our pilot study the clinicoradiological VENTISCA score proved to be of prognostic value to detect C-CVT upon presentation.

Disclosure: No

P0481 / 1227

CLINICAL AND RADIOLOGICAL PREDICTORS OF FUTILE RECANALIZATION IN PATIENTS WITH ACUTE ISCHEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY

M. Parisi ^1,2, L. Ciolli^1,3, L. Vandelli¹, F. Rosafio¹, L. Picchetto¹, G.M. Borzì¹, R. Ricceri¹, M.L. Dell’Acqua¹, G. Vandelli^1,3, L. Giacobazzi^1,3, S. Maffei¹, S. Meletti^3,1, S. Vallone⁴, G. Bigliardi¹

¹Stroke Unit, Neurology Unit, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Department of Neuroscience, Modena, Italy, ²University of Bari “Aldo Moro”, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy, ³University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy, ⁴Neuroradiology Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Department of Neuroscience, Modena, Italy

Background and aims: Mechanical thrombectomy represents the most effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion. Nevertheless, almost one-half of patients have a poor clinical outcome following successful recanalization. This study investigated risk factors for futile recanalization (FR) in AIS patients after thrombectomy.

Methods: A retrospective study was conducted in consecutive patients admitted to our hospital between 2018 and 2021 with proximal anterior circulation occlusion treated with thrombectomy with a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. The FR group was identified by a modified Rankin Scale (mRS) > 2 at 90 days. Multivariate logistic regression analyses were performed to evaluate independent risk factors for FR.

Results: A total of 227 patients were included and 48,7% of them had FR. In multivariate analyses older age (OR:1.08, 95% IC: 1.04-1.11), female sex (p=0,046), basal NIHSS (OR:1.10, 95% IC: 1.03-1.18) and plasma glucose level at admission (OR:1.01, 95% IC: 1.00-1.02), duration of procedure (OR:1.02, 95% IC: 1.01-1.02), and CBF<30% (OR:1.03, 95% IC: 1.01-1.06) were independent predictors of FR.

Conclusions: Older age, higher baseline NIHSS, female, higher plasma glucose level, and a longer time to recanalization are independent risk factors for FR in AIS patients treated with thrombectomy.

Disclosure: No

P0482 / 1218

BALANCE AT THREE MONTHS POST STROKE PREDICTS COGNITIVE PERFORMANCE UP TO TWO YEARS FOLLOW-UP

S. Verstraeten ¹, R. Mark², M. Sitskoorn²

¹Maxima MC, medical psychology, Veldhoven, Netherlands, ²Tilburg University, Cognitive Neuropsychology, Tilburg, Netherlands

Background and aims: Cognitive deficit after stroke is prevalent and persistent, but not always easy to observe, while motor impairment is. Traditionally, the focus has always been on motor problems. Unrecognized cognitive deficit might compromise rehabilitation and/or return to vocational activities. The aim of the current study was to explore the link between cognitive (measured subjectively and objectively) and motor functioning after stroke and whether motor functioning at three months could predict future cognition.

Methods: Subjective cognitive complaints (Checklist for cognitive and emotional consequences following stroke), motor (Berg Balance Scale, 10-meter walk test) and cognitive functioning (information processingspeed, cognitive flexibility, working memory) were evaluated in stroke patients (n=47) at three months, one and two years post stroke. Both cross-sectional and longitudinal data analyses were conducted using Spearman Rank Correlation Coefficients and logistic regression.

Results: Balance at three months post stroke was correlated to measures of information processing speed and cognitive flexibility and these increased over time. Balance was also the strongest predictor of cognitive functioning at one and two years follow up. Gait showed a link with cognitive performance at three months, but this was not strong at follow up.

Conclusions: Balance at three months post stroke should serve as a red flag for both underlying and future problems in information processing speed and cognitive flexibility. Balance should therefore be assessed immediately after stroke. This will predict cognition at three months and later and all these factors should be taken into consideration in the follow up treatments of stroke patients.

Disclosure: No

P0483 / 1305

SIRTUIN 6 LEVELS ARE INDEPENDENTLY ASSOCIATED WITH POST-STROKE MORTALITY: PILOT DATA FROM THE COSMOS COHORT

M. Arnold ¹, L. Liberale^2,3, S. Ministrini², Y.M. Puspitasari², G. Beer², F. Montecucco³, N. Scherrer¹, J. Schweizer¹, M. Christ-Crain⁴, M. Katan¹, G. Camici²

¹University Hospital Zurich, Neurology, Zurich, Switzerland, ²University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland, ³University of Genoa, Internal Medicine, Genoa, Italy, ⁴University Hospital Basel, Endocrinology, Basel, Switzerland

Background and aims: Sirtuin 6 (SIRT6) is a ubiquitous isoform of the Sirtuins family that was recently described as a longevity gene. In a murine model of acute brain ischemia, SIRT6 knockdown was associated with larger cerebral infarct-size, worse neurological outcome, and higher mortality, indicating a possible protective role of SIRT6 in brain ischemia. In this study, we aimed at evaluating the prognostic value of SIRT 6 serum levels in patients with acute ischemic stroke (AIS).

Methods: Serum levels of SIRT6, collected within 72h from symptom-onset, were measured by a commercially available immunoassay in 317 consecutively-enrolled AIS patients from the COSMOS cohort (NCT00390962). The primary endpoint was 90-day mortality. The independent prognostic value of SIRT6 was assessed with multivariate logistic and Cox-proportional hazard-regression.

Results: 35 patients (11%) deceased within 90-day follow-up. After adjustment for established risk-factors (age, NIHSS, heart failure, atrial fibrillation, and C-reactive protein), SIRT6 levels were negatively associated with mortality with an OR of 0.06 (95%-CI 0.003-0.99, p=0.049, per log₁₀ unit increase). The optimal cut-off derived by Youden-index for survival was 624 pg/ml (aproximating the 10^th percentile in the cohort). Patients with SIRT6 levels below 624 pg/ml had a higher risk of death with a HR of 5.05 (95%-CI 2.12-12.01, p<0.001) in multivariable Cox-regression.

Conclusion: In this pilot study SIRT-6 levels were significantly associated with 90-day mortality after AIS. These results confirm the previous observations in animal models in a well-characterized patient cohort. Further studies are needed to validate the potential value of SIRT6 as a prognostic biomarker.

Disclosure: No

P0484 / 1319

MORTALITY PREDICTION MODEL FOR NON-REPERFUSED ISCHEMIC STROKE AND INTERNAL VALIDATION BY BOOTSTRAPPING

L. Amaya-Pascasio ¹, P. Martínez-Sánchez², M. Blanco-Ruiz², R. Milán-Pinilla², A. Arjona-Padillo², J.M. García-Torrecillas³

¹Torrecárdenas University Hospital, Department of Neurology. Stroke Center, Almería, Spain, ²Torrecárdenas University Hospital, Neurology. Stroke Centre, Almería, Spain, ³Torrecárdenas University Hospital, Emergency Department. Research Biomedical Unit, Almería, Spain

Background and aims: Non-reperfused ischemic stroke (NRIS) constitutes a high percentage of all admitted strokes; approximately 65 % of ischemic strokes are not candidates for reperfusion measures. Our aim is to identify variables directly associated with an increased risk of mortality on admission for an NRIS from clinical-administrative databases in order to develop a predictive model of mortality in this population with adequate discriminatory capacity. An internal validation will be performed using resampling methodology.

Methods: Source of information: Minimum Basic Data Set (MBDS), period 2013-2015, all hospitalization episodes in Spain due to NRIS. The baseline predictive model was developed using logistic regression, assessing its discriminative power using area under the curve (AUC) and its fit-calibration using non-clustered X2-Pearson test. A second model was then run after resampling the first with 1000-replacements; the performance of both models was compared using the AUC.

Results: Overall, 117,468 NRIS episodes were analyzed. In-hospital mortality rate:6%. The predictive model after bootstrapping detected the following factors associated with mortality risk (Odds Ratio,OR): Age (OR:1.086, 95%CI:1.082-1.090), Sex female (OR:1.206, 95%CI:1.152-1.263), Readmission (OR:1.954, 95%CI:1. 784-2.141), Ischemic heart disease (OR:1.451, 95%CI:1.282-1.642), Hypertension (OR:0.836, 95%CI:0.795-0.879), Atrial fibrillation (OR:1. 193, 95%CI:1.100-1.294), Dyslipidemia(OR:0.688, 95%CI:0.646-0.733) and Heart failure(OR:1.482, 95%CI:1.415-1.552). AUC was 0.759, IC95%:0.753-0.764. Calibration (X2-Pearson=0.401). Baseline and post-bootstrapping models showed no change in AUC (p<0.05).

Conclusions: 1). Factors associated with NRIS mortality were detected using a predictive model, with moderate-high discriminative power and internally validated by bootstrapping. 2). This model can be an auxiliary tool in the risk stratification of this patient population.

Disclosure: No

P0485 / 1444

ASSESSMENT OF COGNITIVE IMPAIRMENTS WITH STROKE RELATED DISABILITY AND ITS CORRELATIVE ANALYSIS IN POST-STROKE PATIENTS

C. Rustamova ¹, S. Musayev¹, Y. Musayeva¹

¹ Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan

Background and aims: This study is aimed to explore the rate of post-stroke disability and cognitive deficits among patients who conducted an ischemic stroke.

Methods: We examined 92 patients (men - 48(52%)women - 44(48%) aged from 42 to 80 years, average age - 61.75±10.25 years)in post-stroke patients with ischemic type at the Tashkent Medical Academy in neurology department. Level of disability was assessed by the Modified Rankin Scale (mRS). The Mini Mental State Examination (MMSE) scale was used for determining the cognitive functions.

Results: According to the mRS score, ischemic stroke (IS)patients were divided into patients without symptoms (controls,mRS = 0),patients without obvious disability (mRS =1),and patients with mild to severe disability(mRS =2–5).IS patients with different mRS levels demonstrated significant differences in age, tobacco smoke exposure, previous stroke history, cognitive function. According to the MMSE scale,mild dementia (26.17±0.94)was observed in 12 patients(13%),moderate dementia (13.25 ± 1.68) in 18 patients(19%),severe dementia(8.14±1.36) in 6 patients(7%).Cognitive level was negatively correlated with functional disability.In the present study, 39% of stroke patients showed cognitive impairment (MMSE ⩽ 26).IS patients without obvious disability levels(mRS score 1)are associated with lower MMSE,while those with mild to severe disability levels (mRS score 2–5)are associated with a previous stroke history,lower MMSE.

Conclusions: Disability and cognitive disturbances continue to be a significant issue for individuals after a stroke, and health workers should perform targeted assessments and interventions to decrease these impairments, and pay special attention to individuals who are at greatest risk of post-stroke disability.

Disclosure: No

P0486 / 1214

ASSOCIATION OF ADMISSION NEUTROPHIL ELASTASE LEVEL WITH THE OUTCOMES OF SUPER-ACUTE ISCHEMIC STROKE

L. Li ¹, Z. Han¹, Y. Huang¹, L. Zhong¹, Q. Ma¹, Y. Luo¹

¹ Xuanwu hospital, Capital medical university, Department of Neurology, Beijing, China

Background and aims: This study aims to evaluate the association of neutrophil elastase (NE) with super-acute ischemic stroke (s-AIS) prognosis, and with the outcome of patients received intravenous thrombolysis (IVT).

Methods: Among 736 patients prospectively recruited at the stroke center from 2018 to 2020, 345 patients diagnosed with confirmed s-AIS (symptoms occur within 6 hours) were included. NE concentration was measured by ELISA in plasma collected on admission. Endpoints included symptomatic intracerebral hemorrhage (sICH), death and poor outcome (mRS > 2) at 3 months. For the cohort received IVT, poor response was defined as 3-months-mRS > 2. Logistic regression models were performed to evaluate NE’s association with endpoints after AIS or response to IVT.

Results: Higher admission NE levels were associated with sICH, higher mortality, as well as poor outcome after stroke and poor response to IVT. In the logistic regression analysis, NE > 172.5 ng/ml was an independent predictor of poor outcome (odds ratio = 5.098 (2.211-12.441), p < 0.001), together with age, IVT, and admission NIHSS. Regarding IVT, NE > 174.4 ng/ml was an independent predictor of poor response (odds ratio = 8.935 (2.041-39.121), p = 0.004), together with admission NIHSS. The addition of NE concentration to clinical predictors of efficacy of IVT improved discrimination and reclassification (total IDI = 7.7 (3.2, 12.2), p <0.001, continuous NRI = 53.2 (21.9, 84.6), p <0.001).

Conclusions: Plasma NE provides complementary prognostic information to identify patients with poor outcome after s-AIS, as well as patients with poor response to IVT.

Disclosure: No

P0487 / 1501

TOPOLOGICAL ACUTE ISCHEMIC STROKE VOLUMES ARE PROGNOSTIC TO OUTCOMES MEASURED BY 90-DAY MODIFIED RANKIN SCALE

J. Cummock ^1,2, R. Ghosh^1,2, J. Volpi³, S. Wong^4,5,6,7, K. Wong^4,5,6

¹Houston Methodist Research Institute, Systems Medicine and Bioengineering, Houston, United States, ²Texas A&M University, College of Medicine, Bryan, United States, ³Houston Methodist Institute for Academic Medicine, Department of Neurology, Houston, United States, ⁴Houston Methodist Cancer Center, Systems Medicine and Bioengineering, Houston, United States, ⁵The Ting Tsung and Wei Fong Chao Center for BRAIN, Houston, United States, ⁶Houston Methodist Institute for Academic Medicine, Department of Radiology, Houston, United States, ⁷Texas A&M University, College of Medicine, Department of Neuroscience and Experimental Therapeutics, Bryan, United States

Background and aims: In acute ischemic stroke (AIS), total infarct volume is an independent predictor of 90-day stroke outcome and an important measurement for deciding patient treatment. The goal of this work is to combine clinically relevant patient variables with topological segmented stroke volumes into a novel predictive model to provide physicians with actionable intelligence early in the treatment plan.

Methods: 824 confirmed AIS patients evaluated at Houston Methodist Hospital from 2016-2018 were analyzed. Patient baseline was established using the triage NIHSS score, and diffusion DWI was obtained within 48 hours of admission. Stroke volumes were semi-automatically segmented with manual delineation [ESOC 2020 K. Wong] and anatomically mapped using the Laboratory of Neuro Imaging Probabilistic Brain Atlas and John Hopkins University DWI-based white matter atlas. Patient clinical variables were combined with topological infarct volume quantitation in a logistic regression model to predict dichotomized 90-day modified Rankin Scale (mRS) score (0-2 versus 3-6).

Results: Our model predicted dichotomized mRS outcome with an accuracy of 0.7476 and AUC of 0.7952 (p<0.001, DeLong’s test). For comparison, a baseline model of clinical factors plus total infarct volume only resulted in an accuracy of 0.7184 and AUC of 0.7593. Significant predictors (p<0.05) included age, sex, initial NIHSS score, total infarct volume, and stroke volumes in the left corona radiata, right corona radiata, left internal capsule, and brainstem.

Conclusions: Our predictive model incorporates topological stroke volume quantitation with clinical variables to accurately predict stroke outcome, helping physicians identify patients at high risk for adverse outcomes.

Outcome Prediction Patient Characteristics
Patient Characteristics and Stroke Distribution	Dichotomized Outcome (mRS)
	Overalln = 824	Good (mRS 0-2)n = 489	Poor (mRS 3-6)n = 335
Age, years (SD)	66.80 (15.16)	63.91 (14.93)	71.02 (14.52)
Men, no. (%)	403 (48.9)	256 (52.4)	147 (43.9)
NIHSS score (SD)	6 (7)	4 (5)	9 (8)
Total Infarct Volume, mL	15.6 (48.1)	4.6 (11.0)	31.7 (71.3)

Dichotomized mRS Outcome Prediction	Clinical Variables +Total Infarct Volume +Topological Stroke Volumes	Clinical Variables +Total Infarct Volume
Sensitivity	0.5522	0.4866
Specificity	0.8814	0.8773
Positive Predictive Value	0.7613	0.7309
Negative Predictive Value	0.7418	0.7138
F-score	0.6401	0.5842
Accuracy	0.7476 (95% CI: 0.7165, 0.7769)	0.7184 (95% CI: 0.6864, 0.7489)

Binomial Logistic Regression for Outcome Prediction
Predictor Variables	Estimate	p-value	AUC	AIC
Univariate model:
Age	0.03	<0.001	0.6313	1072.02
Sex (Men)	-0.34	<0.05	0.5424	1111.64
NIHSS score	0.12	<0.001	0.7195	1007.35
Total Infarct Volume	0.03	<0.001	0.6708	1016.52
Multivariate model: Clinical Variables + Total Infarct Volume
Age	0.03	<0.001	0.7593	929.51
Sex (Men)	-0.36	<0.05
NIHSS score	0.09	<0.001
Total Infarct Volume	0.03	<0.001
Multivariate model: Clinical Variables + Total Infarct Volume + Topological Stroke Volumes (only significant variables shown)
Age	0.04	<0.001	0.7952	910.67
Sex (Men)	-0.43	<0.05
NIHSS score	0.09	<0.001
Total Infarct Volume	0.03	<0.05
Stroke Volume in Left corona radiata	0.95	<0.01
Stroke Volume in Right corona radiata	0.75	<0.05
Stroke Volume in Left internal capsule	1.26	<0.05
Stroke Volume in Brainstem	1.39	<0.001

Disclosure: No

P0488 / 544

IMPACT OF AGE AND SEX DIFFERENCES ON OUTCOMES AFTER MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE

D. Černík ¹, D. Šaňák², F. Cihlář³, M. Köcher², P. Divišová²

¹Masaryk Hospital, Krajská zdravotní a.s., Ústí nad Labem, Czech Republic, ²Palacký University Medical School and Hospital, Olomouc, Czech Republic, ³Masaryk Hospital Ústí nad Labem KZ a.s. and Faculty of Health Studies, J.E. Purkinje University, Radi, Ústí nad Labem, Czech Republic

Background and aims: Despite technical success and early management of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all treated patients reach a good clinical outcome. Different factors may have impact on outcome, thus we aimed to evaluate a possible impact of age and sex on clinical outcome.

Methods: Consecutive AIS patients treated with MT in both centers between years 2010 and 2018 were enrolled in the retrospective analysis. Clinical outcome after 3 months was assessed with modified Rankin scale (mRS) with a score 0-2 for good outcome. Recanalisation was rated using the Thrombolysis in Cerebral Infarction (TICI) scale. Enrolled patients were compared by gender and defined age subgroups: 18-50, 50-65, 65-80 and 80-90 years.

Results: In total, 1215 patients (607 males, mean age 71±12 years) were included in the analysis. Overall, no sex difference was found in mRS 0-2 after 3 months (49.9%vs. 44.9%; p=0.08) including the age defined subgroups. More women died within 3 months (29 vs. 25%; p=0.056) as they were older than males (74 vs. 69 years, p <0.00001), had more diabetes (31.4 vs. 25.9%, p=0.032) and hypertension (81.3 vs. 73.6%, p=0.002). No difference was found in technical results of MT between all compared patients’ subgroups.

Conclusion: No impact of sex on clinical outcome after MT was found in AIS patients including the defined age subgroups. Higher mortality in women can be related to higher age and more frequent diabetes and hypertension. The study was supported by the grant IGA-KZ-2021-1-15 and IGA UPOL_013_2022.

Disclosure: No

P0489 / 1294

PULSE WAVE VELOCITY RATIO IS INDEPENDENTLY ASSOCIATED WITH EARLY FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE

K. Kowalczyk ¹, D. Gąsecki¹, M. Kwarciany¹, A. Rojek¹, K. Narkiewicz², B. Karaszewski¹

¹Medical University of Gdańsk, Department of Adult Neurology, Gdańsk, Poland, ²Medical University of Gdańsk, Department of Hypertension and Diabetology, Gdańsk, Poland

Background and aims: Increased pulse wave velocity (PWV), a marker of arterial stiffness, is a risk factor for cerebrovascular events, including ischemic stroke. PWV is a prognostic factor of functional outcome after ischemic stroke. However, the role of a newly described aortic-brachial stiffness gradient, defined as carotid-femoral PWV/carotid-radial PWV (a PWV ratio), in predicting prognosis after ischemic stroke is unknown,

Methods: Carotid femoral and carotid-radial PWV were measured using SphygmoCor® device in ischemic stroke patients at day 6 (±2) of hospitalization in Department of Adult Neurology, Gdańsk, Poland. In all patients, basic clinical data and modified Rankin scale (mRS) score were obtained. Early favourable outcome was defined as mRS score of 0-1 point at the day of the PWV measurement.

Results: In the recruited 185 patients, aged 62.1±12.1 years, 66% males, National Institutes of Health Stroke Scale (NIHSS) score of 6 (3-8), 42 (23%) had early favourable outcome. In the Student’s t test, the PWV ratio was lower in the favourable outcome group (1.12±0.28 vs 1.29±0.45). In a multivariate logistic regression analysis, including covariate such as age, sex, baseline NIHSS, haemoglobin level, and the use of recombinant tissue plasminogen activator, the relationship between stroke outcome and the PWV ratio was statistically significant (odds ratio, 3.59; 95% confidence interval, 1.18-10.94; p=0.025). After adjustment, carotid-femoral and carotid-brachial PWV alone were not associated with outcome in the studied group.

Conclusions: Lower PWV ratio may be a new predictor of better early functional outcome in patients after ischemic stroke.

Disclosure: No

P0490 / 852

PROGNOSIS AT 6 MONTHS FOR NONAGENARIAN PATIENTS HOSPITALIZED FOR CEREBRAL INFARCTION

E. Cambiaire ¹, G. Charbonnier², F. Vuillier², A. Biondi², T. Moulin², L. Bonnet²

¹Université de Franche Comté, Faculté de médecine, Besançon, France, ²Université de Franche Comté, Médecine, Besançon, France

Background and aims: There have been few studies of the treatment and prognosis of nonagenarians with cerebral infarction, and the results of these studies vary greatly.

The primary aim of our study was to describe the prognosis at 6 months of nonagenarians hospitalized for a cerebral infarction. The secondary aim was to identify the independent predictive factors associated with prognosis.

Methods: We performed a retrospective study of a multicenter, prospective, French cohort and included all nonagenarian patients hospitalized for a cerebral infarction between January 1, 2015 and September 30, 2020.

Results: Of the 331 patients included in the study, 164 (49%) had a favorable prognosis at 6 months, defined as either an mRS of 0–3 or a return to the pre-stroke mRS. Mortality was 37%. At 6 months, 40% of patients were living at home and 22% were living in a care facility. We found the following factors to be independently associated with a poor prognosis at 6 months: age (p=0.03), living in

a care facility before the cerebral infarction (p<0.01), NIHSS < 5 at admission (p<0.01), proximal occlusion (p<0.01), and symptomatic haemorrhagic transformation (p<0.01). Intravenous thrombolysis was independently associated with a favorable outcome (p=0.03). Mechanical thrombectomy was not significantly associated with prognosis at 6 months (p=0.79).

Conclusions: Almost half of the nonagenarian patients hospitalized for cerebral infarction had a favorable prognosis at 6 months.

Disclosure: No

P0491 / 490

DEATH AND ADL-DEPENDENCY AFTER SCORING ZERO ON THE NIHSS, A SWEDISH RETROSPECTIVE REGISTRY-BASED STUDY

D. Darehed ^1,2, M. Reinholdsson^2,3, A. Viktorisson^2,3, T. Abzhandadze^2,3, K. Stibrant Sunnerhagen^2,3

¹Umeå University, Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå, Sweden, ²University of Gothenburg, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Research Group, Gothenburg, Sweden, ³Sahlgrenska University Hospital, Gothenburg, Sweden

Background and aims: The National Institutes of Health Stroke Scale (NIHSS) is commonly used to evaluate stroke severity. A caveat is that NIHSS is less sensitive for cognitive, brainstem and cerebellar functions, underestimating the severity in these domains. Studies on patients scoring zero points on the NIHSS (0-NIHSS) at admission are scarce, and sometimes these patients are even considered having a TIA. We aimed to study death and ADL-dependency after 0-NIHSS strokes.

Methods: Our retrospective registry-based study included a total of 6491 adult patients with stroke admitted to three different stroke units in Gothenburg, Sweden, from November 2014 to June 2019. The main outcome was a composite measure including either death or ADL-dependency at 3 months, among previously ADL-independent patients. Analyzes of patient characteristics were followed by adjusted analyses including multiple confounders.

Results: 5945 patients had data on NIHSS at admission, of whom 1301 had a 0-NIHSS stroke and were previously ADL-independent. The median age was 72 years, 547 (42%) were women, 82 (6%) suffered a hemorrhagic stroke and 502 (40%) were physically inactive before the stroke. Three months after the stroke 15 (1%) were dead, and 50 (4%) had become ADL-dependent. Physical inactivity (OR 2.48, 95% CI 1.40-4.38) and age (OR 1.05 per year, 95% CI 1.02-1.08) significantly increased the risk of death or ADL-dependency.

Conclusions: One in twenty is either dead or have become ADL-dependent at 3 months, highlighting that 0-NIHSS strokes are not benign. Elderly and physically inactive patients are at greater risk of an adverse outcome.

Disclosure: No

P0492 / 743

BLOOD PRESSURE CONTROL DECREASED FROM 2011 TO 2019 IN PATIENTS 90 DAYS AFTER STROKE

D. Levine ¹, L. Morgenstern¹, M. Kwicklis¹, X. Shi¹, E. Case¹, L. Lisabeth¹

¹ University of Michigan, Ann Arbor, United States

Background and aims: Stroke survivors’ recurrent stroke risk is highest during the 90 days after stroke, and blood pressure (BP) control reduces recurrent stroke. We assessed whether 90-day BP control changed from 2011 to 2019, and temporal changes varied by ethnicity and sex.

Methods: We conducted a prospective cohort study of 1,944 expert-adjudicated stroke cases ⩾45 years in the Brain Attack Surveillance in Corpus Christi (BASIC) project with BP measurements from 2011-2019. We measured BP in patients’ homes at ~90 days post-stroke using standardized procedures and validated oscillometric devices and used the average of three BP measurements. Control equalled BP <130/80 mmHg. We used inverse probability weights to account for attrition due to 90-day mortality and non-participation in baseline and outcome interviews. Using logistic regression, we examined the association between BP control with time (year) and demographic differences in trends through interactions with time adjusting for patient factors.

Results: Median age was 66 years (interquartile range, 58-76 years), 60% were Mexican American, 49% were women. From 2011 through 2019, BP control declined from 40.6% to 28.8% (P for trend<0.001, Figure). Odds of BP control decreased over time after adjustment for sociodemographics, health insurance, regular primary care, clinical factors, and stroke features (odds ratio per one-year increase, 0.95; 95% CI, 0.91, 0.99). Trends in BP control did not differ by ethnicity (P=0.08) or sex (P=0.52).

Conclusions: BP control decreased from 2011 to 2019 in patients 90 days after stroke. Results suggest stroke survivors need effective, sustainable strategies to achieve BP control.

Disclosure: No

P0493 / 136

NEUROIMAGING MARKERS OF DUAL IMPAIRMENT IN COGNITION AND PHYSICAL PERFORMANCE FOLLOWING STROKE: THE NORWEGIAN COGNITIVE IMPAIRMENT AFTER STROKE (NOR-COAST) STUDY

M.S. Einstad ¹, T. Schellhorn^2,3, P. Thingstad¹, S. Lydersen⁴, E.B. Aamodt^2,3, M.K Beyer^2,3, I. Saltvedt^1,5, T. Askim¹

¹Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Trondheim, Norway, ²Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway, ³University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ⁴Norwegian University of Science and Technology, Department of Mental Health, Faculty of Medicine and Health Sciences, Trondheim, Norway, ⁵St. Olavs Hospital, Trondheim University Hospital, Department of Geriatric Medicine, Trondheim, Norway

Background and aims: Dual impairment of physical performance and cognition increases risk of functional decline after stroke. The primary aim of this study was to investigate to which extent pre-stroke cerebral pathology was associated with post-stroke dual impairment in cognition and physical performance. Secondary aims were to examine if white matter hyperintensities, medial temporal lobe atrophy, and stroke lesion volume and location were associated with dual impairment.

Methods: Participants from the Nor-COAST study with available MRI data at baseline were included in this cross-sectional study. Logistic regression analyses were applied with impairment status (no impairment, impaired cognition, impaired physical performance, and dual impairment) as dependent variable and MRI markers as covariates. Pre-existing brain pathologies were classified into neurodegenerative, cerebrovascular, or mixed pathology. Stroke volume and location were also determined from the study-specific MRI scans.

Results: Participants’ (n=348) mean (SD) age was 72.3 (11.3) years, 148 (42.5%) were females. Participants with dual impairment (n=99) were significantly older, experienced more severe stroke, had a higher comorbidity burden and poorer pre-stroke function. Stroke lesion volume (OR 1.03, 95% CI 1.00 to 1.05, p=0.035) but not stroke lesion location or pre-existing pathology was associated with dual impairment after adjusting for age and sex.

Conclusions: In this large cohort of stroke survivors, we found no association between pre-existing brain pathology and dual impairment of physical performance and cognition early after stroke. However, stroke lesion volume was associated with dual impairment, highlighting the role of stroke severity in functional decline.

Disclosure: No

P0494 / 1470

INFLUENCE OF DEHYDRATION ON COLLATERAL CIRCULATION AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE ISCHEMIC STROKE TREATED WITH ENDOVASCULAR TREATMENT

M. Guasch-Jiménez ¹, P. Camps-Renom¹, C. Toscano-Prat¹, D. Guisado-Alonso¹, A. Martínez-Domeño¹, L. Prats-Sánchez¹, I. Fernández-Cadenas¹, A. Ramos-Pachón¹, I. Fernández-Pérez², C. Avellaneda-Gómez², E. de Celis-Ruiz³, J. Rodríguez-Pardo³, M.d.M. Freijo⁴, A. Luna⁴, F. Moniche⁵, B. Pardo-Aliana⁵, J.F. Arenillas⁶, E. Cortijo⁶, J. Martí-Fàbregas¹

¹Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Neurology, Barcelona, Spain, ²Hospital del Mar, Neurology, Barcelona, Spain, ³University Hospital La Paz, Neurology, Madrid, Spain, ⁴University Hospital Cruces, Neurology, Barakaldo, Spain, ⁵University Hospital Virgen del Rocío, Neurology, Sevilla, Spain, ⁶University Hospital of Valladolid, Neurology, Valladolid, Spain

Background and aims: Dehydration has been associated with poor outcome in stroke patients. We hypothesize that dehydration is associated with collateral circulation (CC) and dehydrated patients with and acute ischemic stroke (AIS) would have worse CC, which could lead to a worse functional outcome, even after endovascular treatment (EVT).

Methods: We conducted a prospective multicentre study of patients with an anterior circulation EVT-treated AIS. We assessed admission hydration through a plasma osmolarity (pOsm) formula. CC was quantified with an automated and validated software (Brainomix Ltd., Oxford, UK) on baseline CT-angiography. Primary endpoint was the association between CC (expressed as the percentage of change between both hemispheres) and dehydration (pOsm ⩾295mmol/L). Secondary outcomes were disability at discharge and at 90 days, evaluated by modified Rankin score (mRS). We performed univariable and multivariable Cox regression analyses.

Results: We recruited 301 patients, 260 of whom were treated with EVT. Dehydration was detected in 65.8% (119/181). We did not find an association between CC and pOsm dehydration [collateral score 71 vs 73, p=0.875]. Median mRS score at discharge in dehydrated patients was 3 vs 2 (p=0.012). In multivariable logistic regression analysis dehydration was an independent predictor of worse functional outcome at discharge [OR 0.40 for mRS 0-2 (95%CI 0.20-0.81)] and at three months [OR 0.44, (95%CI 0.20-0.98)].

Conclusions: Dehydration is associated with worse functional outcome in AIS patients treated with EVT, but it is not related to CC status on CT-angiography.

Disclosure: No

P0495 / 1316

DETAILED MULTI-DOMAIN NEUROPSYCHOLOGICAL EVALUATION OF STROKE PATIENTS IN THE FIRST WEEK AFTER STROKE ONSET: DIVERSITY OF COGNITIVE AND MOTOR PROFILES

L. Fleury ¹, M. Ceroni¹, D. de Leon Rodriguez¹, P. Menoud¹, A. Cadic-Melchior¹, J. Brügger¹, N. Meyer¹, S. Avanzi^1,2, T. Popa¹, E. Raffin^2,1, T. Morishita^2,1, S. Micera², O. Blanke², D. Van de Ville², G. Kwakkel³, D. San Millan⁴, C. Constantin⁴, C. Jagella⁵, J. Adolphsen⁵, J.-L. Turlan⁶, A. Mühl⁶, B. Léger⁶, V. Alvarez⁷, P. Vuadens⁶, J.-A. Ghika⁴, C. Bonvin⁴, M.J Wessel^2,1, P.J Koch^2,1, F.C Hummel^2,1,8

¹Swiss Federal Institute of Technology (EPFL), Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, Sion, Switzerland, ²Swiss Federal Institute of Technology (EPFL), Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, Geneva, Switzerland, ³Amsterdam University Medical Center, Amsterdam, Netherlands, ⁴Hôpital du Valais (HVS), Hôpital de Sion, Sion, Switzerland, ⁵Berner Klinik Montana, Crans-Montana, Switzerland, ⁶Clinique Romande de Réadaptation, Sion, Switzerland, ⁷Hôpital du Valais (HVS), Sion, Switzerland, ⁸University of Geneva Medical School, Clinical Neuroscience, Geneva, Switzerland

Background and aims: Motor deficits of the upper extremity are the key impediment for stroke survivors to go back to normal life. Cognitive deficits are also debilitating for reintegration and impact the course of motor recovery. While most studies focus on deficits in one domain, the present study aims at providing a precise, detailed description of the motor and cognitive profiles of stroke patients when assessed in the acute phase.

Methods: 70 patients underwent an extensive multi-domain neuropsychological assessment using 30 tests covering all neurocognitive domains from the DSM-V. Patients were recruited based on the presence of an upper extremity motor impairment. They were assessed during the first week after the stroke.

Results: The majority (80%) of the patients did not only show a motor deficit, but also cognitive impairments (MoCA score below 26), irrespective of the severity of motor impairment. The extensive evaluations revealed that all neurocognitive domains were impacted. The executive and attentional functions were the most often affected (~ 40% of patients).

Conclusions: A considerable part of patients with motor impairment shows also cognitive deficits in the acute phase after stroke onset. Most prominently, attentional and executive functions were affected. This might have a significant impact on functional recovery and rehabilitation. Such information might pave the way to more personalized treatments of motor deficits considering the cognitive profile of the individual patient. To achieve this, further investigations of the relationships and impact between the different domains for the longitudinal evolution of recovery will be necessary.

Patients characteristics
Age	67,6 ± 13,8
Gender
Males	48 (68,6 %)
Females	22 (31,4 %)
Affected hemisphere
Right	35 (52,9 %)
Left	32 (45,7 %)
Bilateral	3 (4,3 %)
NIHSS at inclusion	5,8 ± 4,6
Days since stroke at evaluation	5,6 ± 2,9

Disclosure: No

P0496 / 334

EFFECT OF FRAILTY ON OUTCOMES OF ENDOVASCULAR TREATMENT FOR ACUTE ISCHEMIC STROKE IN ELDERLY PATIENTS

B.Y. Tan ¹, J.S. Ho¹, A. Leow¹, M.L. Chia¹, L.F. Tan², L.L. Yeo¹

¹National University Hospital, Singapore, Neurology, Singapore, Singapore, ²Alexandra Hospital, Singapore, Division of Healthy Ageing, Singapore, Singapore

Background: Frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. We aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in elderly patients.

Methods: In this cohort study, consecutive AIS patients age ⩾70 years receiving EVT at a comprehensive stroke center were included. Patients with CFS of 1-3 were defined as not frail, and CFS >3 was defined as frail. Primary outcome was Modified Rankin Score (mRS) at 90 days. Secondary outcomes included successful reperfusion, symptomatic intracranial hemorrhage, in-hospital mortality and long-term carer requirement.

Results: A total of 198 elderly patients were included, with mean age 78.1 years and 52.0% being female. Frail patients were more likely to be female, had more co-morbidities and had significantly lower albumin levels. CFS was significantly associated with poor functional outcome after adjustment for age, onset to puncture time and NIHSS (adjusted OR 1.54, 95% CI 1.04-2.28, p=0.032). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; p=0.002). On ordinal shift analyses, frailty was associated with an unfavorable shift in the mRS outcomes, even after adjusting for age, NIHSS and onset to puncture time (Figure 1).

Conclusions: Frailty was associated with poorer functional outcome at 90 days post-EVT in elderly patients ⩾70 years. The CFS may be a useful tool to help optimize patient selection for EVT.

Disclosure: No

P0497 / 891

NETS AS MARKERS OF ISCHEMIC STROKE PROGNOSIS

A. Moraga ¹, B. Diaz-Benito¹, L. Alzamora¹, C. Marcos¹, C. Peña-Martinez¹, F. Ostos¹, A. Martínez-Salio¹, M.Á. Moro², I. Lizasoain¹

¹Universidad Complutense, Hospital Doce de Octubre, Pharmacology, Madrid, Spain, ²Spanish National Center for Cardiovascular Research, Madrid, Spain

Background and aims: Neutrophil extracellular traps (NETs) are a double-edged sword component of innate immunity, aiding in host defence against pathogens yet contributing to the deleterious effects of inflammation, immunothrombosis and tissue damage following stroke. NETs are released during stroke following neutrophil activation by DAMPs and are mainly composed of cytosolic and granule proteins on a decondensed chromatin scaffolding.¹ The goal of our study is to explore the role of NETs in the prognosis of ischemic stroke, as potential markers of neuroinflammation and brain damage.

Methods: 250 patients who suffered acute ischemic stroke were recruited. Data regarding age, sex, cardiovascular risk factors, stroke aetiology and severity (NIHSS) and previous functional status (mRS) were collected. Only previously “independent” patients were included (mRS ⩽2). NIHSS was reassessed at 24 hours following admission as an indicator of short-term prognosis while new mRS scores at 3 months were used as reference for long-term prognosis. Specific ELISAs were performed using plasma retrieved upon admission to quantify levels of NETs markers: myeloperoxidase, elastase, histone, and cell-free DNA.

Results: Here we show that increased levels of plasma NETs upon admission are linked to worse outcomes at 24 hours and 3 months depending on aetiology (atherothrombotic or cardioembolic) in patients who suffered an ischemic stroke.

Conclusions: Our results demonstrate that different plasma markers of NETosis play distinct roles in the prediction of short- and long-term prognosis in stroke. Further research is warranted to determine the exact underlying pathophysiological mechanisms.

Reference: 1. Papayannopoulus V. Nat Rev Immunol. 2018

Disclosure: No

P0498 / 1498

IMPROVEMENT OF COGNITIVE FUNCTION AFTER CAROTID STENTING

C. Tejero-Juste ¹, O. Fabre-Pi¹, S. Ballesta Martinez¹, J. Rodriguez Montolio¹, E. Jara Jimenez¹, J. Espinosa Rueda¹

¹ Hospital Clínico Universitario Lozano Blesa, Neurologia, Zaragoza, Spain

Background and aims: The effect of carotid artery stenting (CAS) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS. We aimed to study the changes in postprocedural cognitive function after CAS. The objective is to analyze the impact of carotid revascularization on cognitive performance after a 6-month period in patients, who have undergone CAS.

This a nonrandomized and prospective single-center experience.

Methods: This study was performed in our center from October 2020 to Mars 2021 and included 35 patients with carotid stenosis who received CAS. Neuropsychologic evaluation included general cognitive (MoCA), language (category and phonological verbal fluency), and executive functions (Trail Making Test A and B). Patients were examined twice, 1-week before surgery and 6 months postoperatively. The criterion to be included in the ‘responder’ group was the following: to obtain a positive difference between post-revascularization and pre-revascularization neuropsychological assessment ⩾1 standard deviation in ⩾2 tests.

Results: After the follow-up period, there was improvement in neuropsychologic evaluation in 13 patients (37%), When comparing cognitive performance before and after carotid revascularization, significant differences were observed in semantic fluency (P=0.004).

Conclusion: CAS may improve cognitive function in patients with significant carotid stenosis.

Disclosure: No

P0499 / 1093

ASSOCIATION BETWEEN LOW-GRADE INFLAMMATION AND STROKE RECURRENCE

K. Abdurakhmonova ¹, G. Rakhimbaeva¹

¹ Tashkent Medical Academy, Tashkent, Uzbekistan

Background and aims: Association of low-grade inflammation (LGI) status with recurrent stroke has not been fully studied. The study aimed to use LGI score and to study its relationship with stroke recurrence in patients who initially presented with first-ever ischemic stroke.

Methods: 126 patients studied. 21 (16.7%) patients experienced a recurrent stroke with a median follow-up of 24 months. Blood samples were obtained from each subject within 24 h after admission. C-reactive protein (CRP) level, white blood cell (WBC) count and neutrophil-to lymphocyte ratio (NLR) were conceived as low-grade inflammation biomarkers.

Results: The average levels of CRP, WBC count, and NLR were 2.3 mg/L, 8.3×10⁹/L and 2.8, respectively. In univariate analysis, the older age (HR, 1.041; 95% CI, 1.019–1.050; P<0.001), high level of CRP (HR, 1.021; 95% CI, 1.010–1.022; P<0.001) and NLR (HR, 1.089; 95% CI, 1.069–1.121; P<0.001) ) were associated with increased risk of recurrent stroke . The LGI status was also an independent predictor of recurrent stroke (HR, 1.109; 95% CI, 1.081–1.129; P<0.001).

Conclusions: Patients with stroke recurrence had a higher LGI score (P < 0.001) than those without recurrence. This study showed that an increased LGI score was connected with a higher risk of stroke recurrence.

Disclosure: No

P0500 / 1141

FUNCTIONAL OUTCOME AND CHARACTERISTICS OF ACUTE ISCHEMIC STROKE PATIENTS REQUIRING MECHANICAL VENTILATION

H. Isokuortti ¹, J.J. Virta², S. Curtze³, M. Tiainen³

¹Helsinki University Hospital, Neurosurgery, Helsinki, Finland, ²Helsinki University Hospital, Intensive Care, Helsinki, Finland, ³Helsinki University Hospital, Neurology, Helsinki, Finland

Background and aims: To examine the mortality and functional outcome of acute ischemic stroke patients requiring mechanical ventilation.

Methods: We included all adult patients treated in Helsinki University Hospital in 2016-2020 who were admitted due to an ischemic stroke (either stroke or thrombosis seen on imaging) and needed mechanical ventilation. We excluded patients with in-hospital strokes, strokes caused by septic emboli, meningitis or sinus thrombosis, and treatment solely as potential organ donors.

We retrospectively collected data on demographics, medical history and index stroke. Our outcomes of interest were modified Rankin Scale (mRS) at three months, as well as mortality and living arrangements at 12 months.

Results: Median age of the cohort (N=121) was 69 years (IQR 60-74) and median NIHSS at admission 17 (IQR 9-24). Forty-four (36%) were female. The most commons indications for intubation were unconsciousness (GCS <8, 51%), respiratory failure (28%), agitation (7%) and procedural sedation (7%)

Three month mRS was available for 114 (94%) patients with the following distribution: 0-2 18%, 3-5 28%, and 6 (dead) 54%. Data for living arrangements at 12 months was available for 113 (93%), 58% had died and 30% lived at home.

The best outcomes were seen in patients intubated pre-procedurally or because of agitation (12-month mortality 28% and 44% lived at home). In contrast, 12-month mortality was highest (59%) in patients intubated because of unconsciousness or respiratory failure.

Conclusions: Outcome is often poor in acute ischemic stroke patients who require mechanical ventilation. The indication for intubation is strongly associated with prognosis.

Disclosure: No

P0501 / 382

SCATTERED CEREBRAL INFARCTION IN THE CORONA RADIATA PREDICTS WORSE OUTCOMES

Y. Kobayashi ¹

¹ Nagano Munincipal Hospital, Nagano, Japan

Background and aims: Intracranial branch atheromatous disease often results in progressive motor deficits in the lenticulostriate arteries (LSA). In some patients with LSA infarction, magnetic resonance imaging (MRI) revealed single lesions at the LSA origin from the middle cerebral artery spreading in a scattered manner toward the distal area. This study aimed to elucidate the clinical characteristics of such cases.

Methods: This was a single-center, retrospective study comprising 1840 consecutive patients admitted to the Ina Central Hospital, Japan. Two neurologists selected patients on the basis of MRI data. Patients with a single mass of infarct lesion from the origin were classified as the single group, whereas patients with infarct lesions as a single mass at LSA origin but divided and independent as the infarct area extended distally were classified as the scattered group. We compared the clinical characteristics and outcomes in these groups.

Results: The single and scattered groups included 119 and 35 patients, respectively. Univariate analysis demonstrated that patients in the scattered group showed significantly more worsening after hospitalization in terms of the National Institute of Health Stroke Scale (NIHSS) scores compared with those in the single group (P < 0.05). Moreover, this can easily lead to increased disease severity (P < 0.016). In a multivariate analysis, group (single or scattered) (odds ratio, 2.5, P < 0.03) was an independent predictor of symptom worsening.

Conclusions: Scattered infarction in the corona radiata is an aggravating factor leading to worse outcomes.

Disclosure: No

P0502 / 734

EFFICACY AND OUTCOMES OF REPERFUSION THERAPIES FOR ACUTE ISCHEMIC STROKE IN COVID-19 PATIENTS: A NATION-WIDE MULTI-CENTER STUDY

J. Jurkevičienė ¹, M. Vaišvilas¹, R. Masiliūnas², V. Matijošaitis³, A. Vaitkus³, D. Geštautaitė³, S. Taroza⁴, P. Puzinas⁵, E. Galvanauskaitė⁶, D. Jatužis², A. Vilionskis⁷

¹Stroke Centre, Republican Vilnius University Hospital, Vilnius, Lithuania, ²Center of Neurology, Vilnius University, Vilnius, Lithuania, ³Lithuanian University of Health Sciences, Department of Neurology, Kaunas, Lithuania, ⁴Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania, ⁵Republican Panevėžys Hospital, Department of Neurology, Panevėžys, Lithuania, ⁶Republican Šiauliai Hospital, Department of Neurology, Šiauliai, Lithuania, ⁷Clinic of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania

Background and aims: Acute ischemic stroke (AIS) is a possible complication of coronavirus disease (COVID-19). Data on reperfusion therapies (RT) – intravenous thrombolysis and endovascular treatment (EVT) – and long-term outcomes in COVID-19 stroke patients is lacking. We sought to evaluate functional outcome (mRS) and 3-month case fatality in COVID-19 stroke patients after RT.

Methods: We performed a retrospective nation-wide pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 AIS patients, treated with RT between March 16, 2020 and June 30, 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality.

Results: 31 subjects and 31 matched controls were included. Median baseline NIHSS score in the COVID-19 group was 16, compared to 12 among controls (P=0.028). The timeliness metrics (onset-to-door, door-to-needle and door-to-puncture times) did not differ significantly between the two groups. Rates of ischemic changes and symptomatic intracranial hemorrhages did not differ significantly between the two groups at 24 hours after RT. Higher rate of respiratory failure was observed in the COVID-19 group in compare to controls (64.5% vs. 22%, P = 0.007). Median NIHSS 24 hours after reperfusion was 16 in COVID-19 group and 5 in controls (P=0.003). mRS 0-2 at discharge was observed in 22.6% of COVID-19 patients compared to 51.8% of controls (P=0.018). Three-month case fatality was 54.8% in COVID-19 group versus 12.9% in controls (P=0.001).

Conclusions: COVID-19 positive stroke patients had worse functional outcomes at discharge and higher 3-month case fatality.

Disclosure: No

P0503 / 473

POST-STROKE EXECUTIVE FUNCTION IMPAIRMENTS IN RELATION TO WHITE MATTER DAMAGE DUE TO STROKE LESIONS VERSUS LEUKOARAIOSIS

G. Hobden ¹, M. Moore¹, E.G. Chiu¹, S. Pendlebury¹, N. Demeyere¹

¹ University of Oxford, Oxford, United Kingdom

Background and aims: There is a high prevalence of executive function impairments among stroke survivors. However, the underlying aetiology remains unclear. We address whether focal stroke-specific white matter damage or diffuse comorbid white matter damage (leukoaraiosis) is more associated with executive function impairments.

Methods: This project is a retrospective analysis of data collected within the Oxford Cognitive Screening programme. Patients were recruited in the acute stage of stroke if they had a confirmed diagnosis of stroke, were at least 18 years of age, were able to remain alert for 20 minutes, and were able to provide informed consent. Patients in the present analysis completed follow up neuropsychological assessment at six-months with the Oxford Cognitive Screen-Plus to assess executive function. Stroke lesions were manually delineated on acute clinical brain scans allowing us to quantify focal stroke-specific white matter damage using the HCP-842 tractography atlas. Leukoaraiosis was visually rated on clinical scans using the Age-Related White Matter Changes scale.

Results: This study included data from 90 stroke patients (mean age = 73.76 years; 47.78% female). Multiple linear regression analyses showed that the presence of leukoaraiosis predicted poorer executive functioning six-months after stroke (B = -0.33, p = .031, 95% CI [-0.64 -0.03]). However, post-stroke executive functioning was not predicted by stroke-specific damage to white matter tracts.

Conclusions: These results provide novel insight into the neural substrates underlying post-stroke executive dysfunction and highlight the prognostic utility of using routine clinical CT scans to assess leukoaraiosis.

Disclosure: No

P0504 / 1186

THE EFFECT OF ANEMIA ON CLINICAL OUTCOME IN STROKE PATIENTS AFTER ENDOVASCULAR THROMBECTOMY

A. Ceulemans ¹, F. Pinckaers², L. Jacobi³, W. van Zwam³, R. van Oostenbrugge¹

¹MUMC+, Neurology, Maastricht, Netherlands, ²MUMC+, Radiology and Neurology, Maastricht, Netherlands, ³MUMC+, Radiology, Maastricht, Netherlands

Background and aims: Whether anemia is an independent predictor for worse clinical outcome in acute ischemic stroke (AIS) patients, treated with endovascular thrombectomy (EVT), remains unclear in large populations.

Methods: We prospectively included 518 AIS-patients who received EVT, in the Maastricht University Medical Center+, between January 2010 and December 2019. Hb-levels (in g/dl) were determined at admission, and categorized into two groups: 1) anemia (male = ⩽12.9; female = ⩽11.9) and 2) no-anemia (male = ⩾13.0; female = ⩾12.0). Multiple imputation was used to handle missing data. Uni- and multivariate regression analysis was used to determine the association between anemia and clinical outcome (mRS). Confounders taken into account included: cardiovascular-risk factors, presence of collaterals and recanalization post-EVT.

Results: Anemia was present in 22.58% of all patients. Univariable ordinal regression showed a significant association between anemia and mRS at 90 days (cOR: 2.06; 95%CI: [1.36 – 3.12]), whilst not in multivariable ordinal regression (cOR: 1.42; 95%CI: [0.68 – 2.94]). Likewise, anemia was significantly associated with poor functional outcome, i.e. mRS 3-6 at 90 days, in univariable logistic regression (OR: 2.61; 95%CI: [1.53 – 4.45]), whilst not in multivariable logistic regression (OR: 1.77; 95%CI: [0.81 – 3.86]). Additionally, univariable logistic regression showed a significant association between anemia and mortality at 90 days (cOR: 2.170; 95%CI: [1.31 – 3,60]), whilst not in multivariable logistic regression (cOR: 1.31; 95%CI: [0.57 – 3.01]).

Conclusions: Anemia is not an independent predictor for worse clinical outcome in AIS-patients treated with EVT. However, subgroup analysis (mild anemia, moderate/severe anemia, no-anemia and polyglobulia) is warranted.

Disclosure: No

P0505 / 533

THE IMPACT OF STROKE ON THE ABILITY TO LIVE AN INDEPENDENT LIFE AT OLD AGE. A COMMUNITY BASED STUDY ON VERY OLD SWEDISH MEN

E. Lindvall ¹, K. Franzon¹, E. Lundstrom¹, L. Kilander¹

¹ Uppsala University, Medical Sciences, Uppsala, Sweden

Background and aims: The long term stroke impact on disability have been investigated only in a few studies with a control group from the same cohort. We hypothesized that stroke would have an effect on the incidence of dementia, ability to perform activities of daily living, walking outside independently and being able live in one’s own home. We also analysed the predictive value of baseline variables.

Methods: We included 1147 non-stroke males, from the Uppsala longitudinal study of adult men (ULSAM), between 69 and 74 years of age. Follow up data was collected at age 85 to 89 years. Stroke data was obtained through national registries. Dementia was diagnosed through review of cognitive test data and medical charts. The primary outcome, Preserved functions, was a composite outcome consisting of four criteria: no dementia, preserved personal ADL functions, ability to walk outside unassisted and not living in an institution. We used logistic regression to derive Odds Ratios (OR).

Results: Among 481 survivors with outcome data, 64 (13%) had a stroke. Two thirds (67%) fulfilled the criteria for Preserved Functions. The OR for having Preserved functions was 0.20 [95% CI 0.11-0.37] in stroke victims. The OR of not having dementia was 0.40 [95%CI 0.22-0.72]. Individuals with stroke had lower quality of life scores (60 vs 72/100 on a visual analogue scale, p=0.002). No baseline variables were independently able to predict Preserved functions.

Conclusion: Stroke has long lasting consequences for physical and mental functions at old age.

Disclosure: No

P0506 / 716

IMPROVEMENT IN QUALITY OF LIFE AFTER A “SLEEP APNEA-HYPOPNEA SYNDROME TREATMENT PROGRAM” IN PATIENTS WITH ACUTE ISCHEMIC STROKE

S. Banda Ramírez ¹, A.M. Domínguez Mayoral¹, C. García Campos¹, S. Perez Sánchez¹, J. Montaner Villalonga¹

¹ Hospital Universitario Virgen Macarena, Sevilla, Spain

Background and aims: Obstructive Sleep Apnea (OSA) has been proposed as a factor that worsens prognosis in patients with ischemic stroke (IS). Our main aim was to determine if an OSA treatment program could improve quality of life following IS.

Methods: The intervention group of this quasi-experimental study included patients with acute IS<72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and modified Rankin score (mRS) were applied as endpoints sixth months after IS in both groups.

Results: 54 vs 62 patients were included in the active and control group respectively. In the active group, 50.8% of patients accepted the proposed treatment with CPAP. An improvement in SF-36 items was detected: physical functioning (p=0.008), physical role functioning (p=0.002), bodily pain (p=0.008), general health perceptions (p <0.001), vitality (p=0.001) and emotional role functioning (p=0.015). The percentage of patients with physical component ⩾ 50 was 38.18% in the active vs 15.52% in the control group (p=0.003). An association between the percentage of patients with physical component ⩾50 and age<70 (66.7% vs 30%, p <0.001) and mRS at the sixth month⩽2 (96.7% vs 32.60% p=0.01) was verified on the multivariate analysis.

Conclusions: OSA treatment following IS improves quality of life impacting positively in several relevant SF-36 items.

Disclosure: No

P0507 / 1644

MORTALITY FOLLOWING HEMICRANIECTOMY FOR MALIGNANT MIDDLE CEREBRAL ARTERY INFARCTION – EXPERIENCE FROM A TERTIARY NEUROSCIENCE CENTRE

M. Ghosh¹, M. Pauls ¹, S. Shribman¹, S. Haddad¹, K.M. Thu¹, M. Aurora², A. Shtaya², B. Clarke¹, P. Minhas², A. Pereira¹

¹St Georges Hospital, Neurology, London, United Kingdom, ²St Georges Hospital, Neurosurgery, London, United Kingdom

Background and aims: Malignant middle cerebral artery infarction (MMCAI) has an untreated mortality rate of approximately 80%. However, many treated patients still suffer severe disability. We analysed real-world experience from a tertiary neuroscience centre and compared outcomes to trial data where post-operative mortality was 24%.

Methods: Electronic Intensive Care Unit admissions were retrospectively reviewed to identify patients who underwent hemicraniectomy for MMCAI from January 2016 to December 2021. Data were gathered on demographics, thrombectomy treatment, time to surgery and discharge modified Rankin Score (mRS) including mortality. Data were analysed using Excel. Statistical analysis was performed using the Mann-Whitney U test.

Results: 34 patients (65% male) were identified. Mean age was 45 years. Seven patients died (21% mortality), of whom six (86%) died within two weeks. Comparing the discharge mRS in patients above the mean age (20 patients) to those younger (14 patients) showed a significant difference (p=0.015) where 25% of patients ⩾45 years died and 75% were dependent (mRS 4-5) while 7% of patients <45 died and 78% were dependent. Only in the younger group were any patients independent (14%). There was no significant difference in the average number of comorbidities, age, or baseline mRS. Time to surgery was not associated with increased mortality.

Conclusions: While overall mortality was similar to trial data, older people fared significantly worse suggesting careful consideration should be taken when counselling them their families for surgery in the future.

Disclosure: No

P0508 / 1364

FUNCTIONAL OUTCOME AND DEATH THREE YEARS AFTER DISCHARGE FROM AN INTENSIVE REHABILITATION HOSPITAL IN MODERATE SEVERE STROKE PATIENTS

C. Barbato ¹, E. Barucci², G. Insalata², G. Papi², V. Rinnoci³, I. Donnini³, M. Martini³, C. Falsini³, B. Hakiki³, A. Romoli³, P. Polcaro³, F. Casamorata³, C. Macchi³, F. Cecchi³, E. Salvadori², A. Poggesi¹

¹University of Florence and IRCCS Fondazione Don Carlo Gnocchi, NEUROFARBA Department, Neuroscience Section, Florence, Italy, ²University of Florence, NEUROFARBA Department, Neuroscience Section, Florence, Italy, ³IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy

Background and aims: Long-term outcomes after moderate-severe stroke are hardly known. Our aim was to describe functional outcome three years after discharge from an intensive stroke rehabilitation hospital.

Methods: This study was a single-center, prospective observational study. All patients (aged> 18 years old) discharged from January 2018 to June 2019 from IRCCS Fondazione Don Carlo Gnocchi in Florence, with a diagnosis of stroke were contacted by telephone 3 years after stroke. Study outcome was modified Rankin Scale (mRS).

Results: Among 201 patients, we obtained telephone information for 116 (mean age 73.7±13.7, 57% male). Forty-two (36%) patients died, fifty-three (48%) had a mRS score 3 to 5, sixteen (14%) a mRS score 0 to 2. From multivariate logistic regression models, predictors of death were: older age, (OR=1.75, CI-95%:1.02-1.13, p<0.006), clinical severity (intensive vs sub-intensive neurological rehabilitation unit OR=0.19, CI-95%:0.19-0.61, p<0.006), poorer functional improvement during rehab-stay (OR=0.424, CI-95%:0.185-0.974, p<0.043) and presence of neglect at the time of index-stroke (OR=0.22, CI-95%:0.06-0.77, p<0.018). From multivariate linear regression models, age (beta=0.232, p=0.004) pre-stroke functional status (beta=0.162, p=0.004), functional status at discharge (beta=0.324, p=0.001), and neglect (beta=0.228, p=0.004) were predictors of long-term functional status (mRS score).

Conclusions : Our results confirm that stroke is a severe disease with high mortality and poor functional status in the log-term despite intensive acute neurological rehabilitation. The presence of neglect is a strong predictor of functional long-term outcome. Improving knowledge about long-term outcomes may enable to identify a tailored rehabilitative approach after stroke.

Disclosure: No

P0509 / 330

GENDER DIFFERENCES IN MORTALITY AFTER STROKE IN THAI PATIENTS. A NATIONAL COHORT STUDY

A.-R. Abdel-Fattah ¹, T. Pana¹, S. Tiamkao², K. Sawanyawisuth³, N. Kasemsap², M. Mamas⁴, P. Myint¹

¹University of Aberdeen, Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom, ²Khon Kaen University, Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, ³Khon Kaen University, Ambulatory Medicine Division, Department of Medicine, Faculty of Medicine, Khon Kaen, Thailand, ⁴Keele University, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom

Background and aims: Gender differences in patients hospitalised with stroke is a major public health concern carrying important implications to service provision. There has not yet been a study specifically focussing on patients in Thailand. We aimed to assess the gender differences in mortality following ischaemic-stroke (IS) and haemorrhagic-stroke (HS) in a large Thai-cohort.

Methods: All stroke admissions of patients between 2004-2015 were included from a Thai national-insurance database. The association between gender and mortality by stroke-type was assessed at one, 12 and 60-months using multivariable Cox-regression models.

Results: There were 543,763 patients included; women made up 46.6 % of patients with IS (n=172,800) and 41.3% of patients with HS (n=69,828). Women were older than men in both IS and HS groups (mean age:67.1, SD(13.4) vs. 64.1(12.9) and 64.2(14.3) vs. 59.1(13.9)), respectively. Women had higher prevalence of comorbidities and stroke-specific risk factors compared to men. When comparing mortality by stroke-type, mortality was higher in women post-IS at one-month (HR:1.17, 95%CI:1.15-1.20), one-year (HR:1.10, 95%CI:1.09-1.12) and five-years follow-up (HR:1.02, 95%CI:1.01-1.03). Similarly, mortality post-HS was also higher in women at all three follow-up timepoints (one-month HR:1.08, 95%CI:1.06-1.10, one-year HR:1.04, 95%CI:1.03-1.06, and five-years HR:1.09, 95% CI:1.08-1.11).

Conclusions: In Thai patients hospitalised with stroke, women have a greater burden of stroke-specific risk factors. The mortality outcome of women with stroke is consistently higher than that of men, which appears to be irrespective of stroke-type or duration following stroke, up to five-years after discharge. Whether this difference is attributable to differences in management or physiology warrants further evaluation.

Disclosure: No

P0510 / 1300

SHORT- AND LONG-TERM MORTALITY AFTER LACUNAR INFARCT

M. Altmann ¹, O.M. Rønning^1,2, B. Fure^3,4, P. Selnes¹, A.S Reichenbach¹, E. Saxhaug Kristoffersen^1,5, B. Thommessen¹

¹Akershus University Hospital, Neurology, Lørenskog, Norway, ²University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ³Örebro University, School of Medical Sciences, Örebro, Sweden, ⁴Central Hospital Karlstad, Department of Internal Medicine, Karlstad, Sweden, ⁵University of Oslo, Department of General Practice, Institute of Health and Society, Oslo, Norway

Background and aims: Lacunar infarcts account for about 20 – 35 % of all ischemic strokes. Short-time prognosis seems to be favorable. However, in the long-term there is an excess risk for death, recurrent stroke, and development of cognitive impairment. The aim of this study was to investigate short- and long-term mortality rate in a cohort of patients with well-defined pure lacunar infarcts.

Methods: Patients included in the study “Lacunar infarcts - Clinical syndromes, risk factors and diagnostic aspects” with lacunar infarct (verified on MRI or CT) were included between February 2011 and January 2013. We determined mortality rate after 3 months and 1, 3, 5 and 8 years. Multivariate regression analyses were used to identify predictors of mortality, adjusted for age, sex, NIHSS, MMSE and mRS.

Results: In all, 103 patients with lacunar infarcts were included. Mean age 69.7 years (range 37-92), 62 men (60.2%), mean NIHSS 3 (range 0-11), mean mRS 2 (range 0-5), mean MMSE 26 (range 14-30). No patients died within the first 3 months post-stroke. The 1-year mortality was 1/103 (1%), 3 years mortality was 10/103 (9.7%), 5 years mortality 20/103 (19.4%) and after 8 years 29/103 (28.2%) patients had died.

In the multivariate regression analysis, only age was significantly associated with mortality.

Conclusions: Mortality rate after lacunar infarct is low in the short- and long-term. Age was the only predictor significantly associated with mortality.

Disclosure: No

P0511 / 1568

HOW DOES SOCIO-PROFESSIONAL CATEGORY AFFECT RETURN TO WORK AFTER STROKE?

B. Bouamra ¹, K. Chakroun¹, V. Cote¹, E. Medeiros de Bustos¹, L. Bonnet¹, G. Charbonnier¹, J. Dobson¹, T. Moulin¹

¹ CHU Jean Minjoz, Neurology, Besançon, France

Objectives: To investigate the impact of socio-professional category (SPC) on return to work after stroke.

Methods: We performed a retrospective, multicenter study of patients in our region hospitalized for stroke. We included patients between 18 and 65 years old who were in employment before their hospitalization and were followed up at between 3 and 9 months.

Results: The distribution of SPCs in our cohort of 1235 patients differed from the French general population (p<0.001), with an overrepresentation of laborers, tradespeople, office workers, and farmers. Pathology was correlated with SPC (p=0.021). Overall, 56% of patients had returned to work (92% with the same role, 81% with the same working hours); 44% had not returned to work (including 28% of patients with mRS=0 at follow-up), primarily taking sick leave (83.5%), disability pension (5.5%), or early retirement (6%), or had been dismissed (5%).

Multivariate analysis showed that SPC (p<0.01), age, mRS at discharge and follow-up, time to follow-up, anticoagulant treatment, anxiety/depression, and pathology were associated with return to work. Laborers and office workers were less likely to return to work (40% and 53%) than farmers (76%), managers (73%), tradespeople (65%), and intermediate professions (63%).

Pain reported at follow-up (p<0.001), decreased Multifactorial Fatigue Inventory score (p<0.001), Hamilton rating scale for depression score (p<0.001), and decreased MoCA score (p=0.012) also affected return to work.

Conclusions: Tailored treatment of patients according to SPC, in combination with better interdisciplinary collaboration between health professionals, is key to helping patients return to work.

Disclosure: No

P0512 / 1563

PLASMA BIOMARKER DYNAMIC PROFILES PREDICT EARLY NEUROLOGICAL RECOVERY AFTER ACUTE ISCHEMIC STROKE

D. Gabriel ¹, I. Silva², J. Simrén³, Â. Carneiro⁴, S. Ribeiro⁵, H. Mota Dória⁶, R. Varela¹, A. Aires⁷, K. Minta⁸, R. Antunes⁹, R. Felgueiras¹, P. Castro⁷, K. Blenow³, R. Magalhães¹⁰, H. Zetterberg³, M. Correia¹, L.F. Maia¹

¹Hospital de Santo António, Centro Hospitalar Universitário do Porto, Neurology Department, Porto, Portugal, ²Universidade do Porto/Instituto de Investigação e Inovação em Saúde e - Instituto de Biologia Molecular e Celular, Porto, Portugal, ³Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, ⁴Hospital de Braga e Serviço de Neurorradiologia, Centro Hospitalar Universitário do Porto, Neuroradiology Department, Porto, Portugal, ⁵Instituto de Investigação e Inovação em Saúde & Instituto de Patologia e Imunologia Molecular (IPATIMUP), Porto, Portugal, ⁶Hospital de Santo António - Centro Hospitalar Universitário do Porto, Neuroradiology Department, Porto, Portugal, ⁷Centro Hospitalar Universitário de São João, Neurology Department, Porto, Portugal, ⁸Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Sahlgrenska, Sweden, ⁹Hospital de Santo António - Centro Hospitalar Universitário do Porto, Polyvalent Intensive Care Unit, Porto, Portugal, ¹⁰Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal

Background and aims: We investigated if blood-based protein biomarkers early dynamic profile changes could predict early neurological recovery in acute ischemic stroke (AIS) patients successfully recanalized after mechanical thrombectomy (MT).

Methods: We used ultrasensitive Single-molecule array (Simoa) to measure glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), total-tau (t-tau) and ELISA for brevican in a prospective study of AIS patients with anterior circulation large vessel occlusion successfully recanalized after MT. Plasma was collected at admission, upon treatment, 24 and 72-hours after treatment. Both clinical and neuroimaging outcomes were considered.

Results: Fifty-four patients were included in the study. Thirty-five patients (64.8%) had early neurological recovery or 24 hours CT-ASPECTS ⩾ 8. Baseline biomarker levels did not differentiate between outcome groups. Biomarker longitudinal profiles were distinct with time and outcome: GFAP levels exhibited an early and prominent increase between admission and upon treatment, NfL increase was less pronounced between admission and up to 24h. T-tau increased between treatment and 24h. Remarkably, GFAP rate-of-change (pg/mL/h) between admission and immediately after recanalization predicted early neurological recovery (AUC=0.88,p<0.001), with superior discriminative capacity than admission CT-ASPECTS (AUC=0.75,p<0.01). T-tau rate-of-change provided only moderate discriminative capacity (AUC=0.71,p<0.05). Additionally, in AIS patients with admission CT-ASPECTS<9, both GFAP and NfL rate-of-change predicted early neurological recovery (AUC=0.82 and 0.77, p<0.05).

Conclusion: Plasma GFAP, NfL and T-tau early rate-of-change may anticipate early neurological recovery of AIS patients at 24 hours.

Disclosure: No

P0513 / 1076

MECHANICAL THROMBECTOMY IN NONAGENARIANS

X. Zhang ¹, X. Bai¹, Y. Zhang², W. Yang³, T. Wang¹, Y. Feng¹, Y. Wang⁴, K. Yang⁵, X. Wang⁶, Y. Ma¹, L. Jiao¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Xuanwu Hospital, Capital Medical University, Medical Administration Division, Beijing, China, ³Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, United States, ⁴China Medical University, Shenyang, China, ⁵Xuanwu Hospital, Capital Medical University, Department of Evidence-Based Medicine, Beijing, China, ⁶Xuanwu Hospital, Capital Medical University, Medical Library, Beijing, China

Background and aims: This study aimed to summarize the current evidence on mechanical thrombectomy (MT) in nonagenarians and to provide updated clinical evidence of its feasibility, effectiveness, and safety in nonagenarians.

Methods: PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for relevant randomized controlled trials and observational studies that reported the clinical outcomes of nonagenarians with acute ischemic stroke after undergoing mechanical thrombectomy. Risk of bias was assessed using different scales.

Results: Thirteen studies and 657 patients were included. The estimated rate of successful revascularization was 80.82% (95% confidence interval [CI]: 77.48% - 83.97%), and the rate of favorable outcome (modified Rankin score [mRS] 0 - 2) was 21.60% (95% CI: 13.81% - 30.41%). The rate of good outcome (mRS score 0 - 3) was 23.08% (95% CI: 18.88% - 27.55%). The estimated risk of death during hospitalization was 20.55% (95% CI: 15.93% - 25.55%), while the mortality rate at 3 months was 44.38% (95% CI: 33.66% - 55.36%). The rate of intracranial hemorrhage (ICH) occurrence was 12.84% (95% CI: 5.27% - 22.68%), while the rate of symptomatic intracranial hemorrhage (sICH) was 3.52% (95% CI: 1.67% - 5.85%). The rate of hospital-related complications was 26.93% (95% CI: 10.53% - 47.03%).

Conclusions: MT in nonagenarians demonstrated a high rate of successful revascularization. Conversely, the rate of futile revascularization is high with a low functional independence proportion. Therefore, MT should not be indiscriminately advocated in nonagenarians. Satisfactory results require careful selection of patients.

Disclosure: No

P0514 / 706

DIFFERENCES IN MORTALITY RATES IN ISCHEMIC STROKES DURING THE 4 WAVES OF COVID-19

A. Nechifor¹, A. Zarnoveanu¹, R. Chiujdea¹, R. Zosin¹, R. Gioroc¹, E. Gavan¹, B. Ciopleias ¹, C. Kakucs², L. Irincu¹, I. Despa¹, L. Ungureanu¹, S. Diaconu^1,2, C. Falup-Pecurariu^1,2

¹County Emergency Clinical Hospital, Neurology, Brasov, Romania, ²Transilvania University, Faculty of Medicine, Neurology, Brasov, Romania

Background: During the COVID-19 pandemic the number of cardioembolic events seem to increase. Mortality in ischemic stroke (IS) patients could be related with this infection.

Aim of the study: To assess the mortality rates in IS during the four waves of COVID-19.

Methods: Retrospective study, based on Hospital registry of Clinical County Hospital of Brașov, Romania. We evaluated patients with IS and modified Rankin Scale (mRS) score of 6/death at discharge during the first wave (14.03.2020-14.05.2020), the second wave (01.10.2020-15.01.2021), the third wave (01.03.2021-15.04.2021) and the fourth wave (10.10.2021-20.11.2021).

Results: There were 341 patients with IS (46,33% females). For the first wave there were 82 patients (41,46% females), the second wave there were 146 IS patients (47,94% females), the third wave 57 IS patients (42,1% females), and the fourth wave there were 56 IS patients (53,57% females).

The total number of patients with mRS score of 6/death having IS was 71: in the first wave 12 patients (14,63%), in the second wave were 27 patients (18,49%), in the third wave 15 patients (26,31%) and in the fourth wave 17 patients (30,35%).

Among all patients with IS we identified 79 with COVID-19 and among patients with mRS score of 6/death 23 with COVID-19: i. the first wave 7/1 patients (14,28%); ii. the second wave 43/8 patients (18,6%); iii. the third wave 13/6 patients (46,15%); iv. the fourth wave 16/8 patients (50%).

Conclusions: During the four waves evaluated, the mortality in patients with IS COVID-19 negative and positive tends to increase.

Disclosure: No

P0515 / 915

RELEVANCE OF DELAYED REPERFUSION FOR TISSUE AND CLINICAL OUTCOMES IN PATIENTS TREATED WITH THROMBECTOMY

A. Mujanovic ¹, N. Jungi¹, C.C Kurmann¹, T.R Meinel², L. Grunder¹, M. Beyeler², M.F Lang¹, E.I Piechowiak¹, S. Jung², T. Klail¹, A. Hoffmann¹, D.J Seiffge², M.R Heldner², T. Dobrocky¹, P. Mordasini¹, M. Arnold², J. Gralla¹, U. Fischer², J. Kaesmacher¹

¹University Hospital Bern Inselspital, University Institute of Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ²University Hospital Bern Inselspital, Department of Neurology, Bern, Switzerland

Background: There is paucity of data regarding the effects of delayed reperfusion (DR) on clinical outcomes in patients with incomplete reperfusion following mechanical thrombecotmy (MT). We hypothesized DR has a strong association with tissue and clinical outcome in patients with incomplete reperfusion after MT (extended Thrombolysis in Cerebral Infarction (eTICI) 2a-2c).

Methods: Single-institution’s stroke registry retrospective analysis of patients admitted between 01.02.2015-08.12.2020. DR was defined as the absence of any perfusion delay, on 24h contrast-enhanced follow-up perfusion imaging, while persistent perfusion deficit (PPD) denotes a perfusion delay corresponding to the angiographic deficit directly after the intervention. The association of perfusion outcome (DR & PPD) with the occurrence of new infarcts and functional independence was evaluated using logistic regression analyses. Comparison of predictive accuracy was evaluated calculating area under the curve (AUC) for models with and without perfusion outcome.

Results: We analyzed 566 patients (mean age 74, 49.6% female). DR patients with new infarcts were observed seldomly (emboli-type: 9.2%, confluent-type 4.3%), while there were common in PPD patients (emboli-type: 25%, confluent-type 63.2%, p=0.001). After adjustment for confounders, DR was a strong predictor of functional independence (aOR 2.73 [95% CI 1.57 – 4.83]). There was an improvement in predictive accuracy when implementing perfusion outcome in the analysis (AUC 0.77 vs 0.75, p=0.12).

Conclusion: Occurrence of DR is closely associated with tissue outcome and functional independence. The current data proposes that DR may be more impactful outcome parameter than eTICI alone, which suggests it as a good outcome surrogate for medical rescue therapies.

Disclosure: No

P0516 / 967

BLOOD PRESSURE VARIABILITY INDICES FOR OUTCOME PREDICTION AFTER THROMBECTOMY IN STROKE USING HIGH-RESOLUTION DATA

C. Inauen ¹, J.M. Boss², M. Katan³, A.R. Luft³, Z. Kulcsar⁴, J.F. Willms², S.Y. Bögli⁵, E. Keller²

¹University Hospital Zurich, Zurich, Switzerland, Neurocritical Care Unit, Dept. of Neurosurgery and Inst. of Intensive Care Medicine; Department of Neurology; Zurich, Switzerland, ²University Hospital Zurich, Neurocritical Care Unit, Dept. of Neurosurgery and Inst. of Intensive Care Medicine, Zurich, Switzerland, ³University Hospital Zurich, Department of Neurology, Zurich, Switzerland, ⁴University Hospital Zurich, Department of Neuroradiology, Zurich, Switzerland, ⁵University Hospital Zurich, Neurocritical Care Unit, Dept. of Neurosurgery and Inst. of Intensive Care Medicine; Department of Neurology, Zurich, Switzerland

Background and aims: Blood pressure variability (BPV) is associated with outcome after endovascular thrombectomy in acute large vessel occlusion stroke. We aimed to provide the optimal sampling frequency and BPV index for outcome prediction using high-resolution blood pressure (BP) data.

Methods: Three-month outcome and BP measured at 1 Hz for up to 24 hours were extracted from 34 patients treated at Neurocritical Care Unit. Outcome was dichotomized (mRS 3-6 unfavorabl) and associated with systolic BPV (as calculated using standard deviation, coefficient of variation, averaged real variability, successive variation (SV), number of trend changes, and a spectral approach using the power of specific BP frequencies). BP values were downsampled by either averaging or omitting all BP values within each prespecified time bin to compare the different sampling rates.

Results: Out of 34 patients (age 72±12.7 years, 67.6% male), 10 (29.4%) achieved a favorable and 24 (70.6%) an unfavorable outcome. No group differences were found in mean absolute systolic (130±18mmHg, p=0.82) and diastolic (59±10mmHg). BPV only reached predictive significance when using SV extracted from downsampled (averaged over 5 minutes) systolic BP data (median 4.8 mmHg [3.8, 7.1]) in patients with favorable vs. 7.1 mmHg [5.5, 9.7] in those with unfavorable outcome, AUC=0.74 (CI: 0.57-0.85), p=0.031), or the power of mid-range frequencies between 1/20 to 1/5 minutes (AUC=0.75 (CI: 0.59-0.86), p=0.020).

Conclusions: Using high-resolution BP data of 1Hz, downsampling by averaging all BP values within 5 minute intervals is essential to find relevant differences in systolic BPV, as noise can be avoided.

Disclosure: No

P0517 / 443

PATIENT RANK-BASED CURRICULUM LEARNING FOR PREDICTING FUNCTIONAL OUTCOME IN STROKE AFTER THROMBECTOMY

N. Hatami ¹, L. Mechtouff², T.-h. Cho², D. Rousseau³, C. Frindel¹

¹INSA-Lyon/Creatis, Lyon, France, ²Hospices Civils de Lyon, Lyon, France, ³Université d’Angers, Angers, France

Background and aims: Functional outcome is heterogeneous after acute ischemic stroke (AIS). In the present study, we aimed to predict functional outcome from MRI imaging data (without clinical variables) using a machine learning algorithm in AIS patients.

Methods: HIBISCUS-STROKE cohort enrolled patients admitted in the Lyon Stroke Center for anterior circulation AIS due to large vessel occlusion treated with mechanical thrombectomy following MRI. From total of 119 patients, 34% had mRS<=2. We proposed a multi-modal Convolutional Neural Network-Long Short-Term Memory (CNN-LSTM) for processing five image modules, i.e. ADC, CBF, CBV, DWI and Tmax. We applied a curriculum learning, a class of learning in which first start with only “easy” patients (from the model’s perspective) and then gradually includes more difficult patients. The training has two main steps: first a CNN-LSTM ranks the patients from 1 to 10 based on their “easiness” (Fig.1), and then another CNN-LSTM uses the rank information to gradually learn the mRS scores by including different ranked patients at different learning stages/iterations (Fig.2). A patient is easy if the model predicts its mRS score correctly 10 our of 10 during the 10-fold cross-validation.

Figure 1.

Figure 2.

Learning curve of the CNN-LSTM using rank-based curriculum learning.

Results: Six different measures are used to evaluate the performance of the models: classification accuracy, F1 score, sensitivity, specificity, Mean-Absolute-Error (MAE) and Area Under the Curve (AUC).

Model	AUC	MAE	Accuracy	Specificity	Sensitivity	F1 score
Standard CNN-LSTM	0.62±0.04	0.42±0.01	0.63±0.04	0.61±0.04	0.61±0.04	0.60±0.03
Proposed CNN-LSTM	0.68±0.05	0.38±0.01	0.69±0.02	0.65±0.03	0.66±0.03	0.64±0.02

Conclusions: The proposed CNN-LSTM using patient ranks for curriculum learning outperforms the standard model in predicting functional outcome in stroke.

Acknowledgments: ANR-16-RHUS-0009

Disclosure: No

P0518 / 1390

THE RECOVERY FROM APHASIA RELATED TO INSULAR CORTEX INVOLVEMENT IN MONOLINGUAL AND BILINGUAL STROKE PATIENTS

A. Baborikina ^1,2, E. Naudiņš^3,4, A. Balodis^4,5, E. Miglāne^2,6

¹Riga Stradiņš University, Faculty of Residency, Riga, Latvia, ²Pauls Stradiņš Clinical University Hospital, Department of Neurology, Riga, Latvia, ³University of Latvia, Faculty of Residency, Riga, Latvia, ⁴Pauls Stradiņš Clinical University, Diagnostic Radiology Institute, Riga, Latvia, ⁵Riga Stradiņš University, Department of Radiology, Riga, Latvia, ⁶Riga Stradiņš University, Department of Neurology and Neurosurgery, Riga, Latvia

Background and aims: There is some evidence of impact of multilingualism on language recovery as well as negative impact of specific location of stroke.Our aim was to investigate the relationship between recovery from aphasia in bilingual and monolingual stroke sufferers depending on insular cortex(IC) involvement.

Methods: The severity of aphasia was rated using NIHSS language score on admission, on the discharge and after 3 months.CT images were evaluated by certified radiologist to identify IC lesion.In the study 71 monolingual and 69 bilingual patients were included.Patients were divided into 4 groups:monolinguals with IC lesion (MIC+),monolinguals without IC lesion(MIC-),bilinguals with IC lesion(BIC+),bilinguals without IC lesion(BIC-).

Results: IC involvement was confirmed in 36.1% of patients in monolingual and 20.3% in bilingual group.Both bilingual and monolingual patients with IC lesion had more severe aphasia on admittance,than patients without IC lesion:MIC+ 2.50±0.84, BIC+ 2.50±0.84, MIC- 1.77±0.76 and BIC- 1.73±0.74 with no significant differences among groups.On discharge the majority of patients showed an improvement but significant differences were not confirmed. After 3 months evaluation revealed the most favourable results in BIC- group where aphasia was scored 0.33±0.66 whereas in MIC- group it was equal to 0.65±0.63(p=0.01).All IC+ patients improved significantly in comparison to the first assessment in hospital, but showed no difference depending on mono and bilinguality.

Conclusions: Bilingual patients showed less severe aphasia comparing to monolingual patients 3 months after stroke, but only in the cases when IC was not affected.Insular cortex lesion may be more severe predictor of less favourable outcome of aphasia than bilinguality.

Disclosure: No

P0519 / 1067

ASSOCIATION BETWEEN LOW ANKLE-BRACHIAL INDEX AND POOR OUTCOMES IN PATIENTS WITH EMBOLIC STROKE OF UNDETERMINED SOURCE

M. Han ¹, J.W. Jung², I.H. Lee², J.H. Kim¹, J. Heo¹, H. Lee¹, Y.D. Kim¹, H.S. Nam¹

¹Yonsei University College of Medicine, Neurology, Seoul, Korea, Republic of, ²Yonsei University College of Medicine, Seoul, Korea, Republic of

Background and aims: We investigated whether low ankle-brachial index (ABI) is associated with major adverse cardiovascular event (MACE) and all-cause mortality in patients with embolic stroke of undetermined source (ESUS) and whether this association differs by the presence and type of arteriogenic embolism.

Methods: We enrolled ESUS patients who underwent transesophageal echocardiography and ABI during hospitalization. Arteriogenic embolism was defined as complex aortic plaque or non-stenotic relevant artery plaque. Low ABI was defined as ABI < 0.9.

Results: A total of 829 patients were enrolled and followed up for a median of 45.8 (IQR, 30.2–68.4) months. Of them, 42 (5.1%) had low ABI and 370 (44.6%) had arteriogenic embolism. Multivariable Cox regression analysis showed that ABI < 0.9 was independently associated with MACE (HR 2.038, 95% CI 1.093–3.801; p = 0.025) and mortality (HR 3.608, 95% CI 1.538–8.465; p = 0.003). Subgroup analysis for patients with arteriogenic embolism showed that low ABI was independently associated with MACE (HR 2.513, 95% CI 1.257–5.023; p = 0.009) and mortality (HR 5.681, 95% CI 2.151–15.008; p < 0.001). In patients without arteriogenic embolism, low ABI was associated with neither MACE or mortality. Among arteriogenic embolism, low ABI was independently associated with MACE and mortality only in patients with complex aortic plaque.

Conclusions: We found that low ABI was associated with an increased risk of MACE and all-cause mortality in ESUS patients. Additionally, the association was only valid in patients with arteriogenic embolism, especially those with complex aortic plaque.

Disclosure: No

P0520 / 1581

PREDICTORS OF HEMORRHAGIC TRANSFORMATION AFTER A SUCCESSFUL MECHANICAL THROMBECTOMY

J.A. Sousa ¹, C. Bernardes¹, R. Machado¹, L. Cruz², L. Santos-Martins³, J. Paiva-Simoes⁴, A.I. Martins¹, C. Brás¹, L. Almendra¹, C. Cecilia¹, C. Machado¹, B. Rodrigues¹, O. Galego², C. Nunes², R. Veiga², G. Santo¹, F. Silva¹, E. Machado², J. Sargento-Freitas¹, coimbra

¹Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal, ²Centro Hospitalar e Universitário de Coimbra, Neuroradiology, Coimbra, Portugal, ³Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal, ⁴Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal

Background and aims: Hemorrhagic transformation (HT) is the most dreadful complication of mechanical thrombectomy (MT) and is associated with clinical deterioration and mortality. We aimed to investigate clinical, neuroimaging and procedural predictors of HT after a successful MT.

Methods: We performed a retrospective cohort study including patients with anterior circulation large vessel occlusion submitted to MT and successful reperfusion (mTICI >= 2b). We collected clinical, demographic, imaging and procedural variables. Collateral score 0-3 according to. Our primary outcome of interest was HTdefined according to the European Collaborative Acute Stroke Study criteria as PH1 or PH2 in the follow-up CT scan.Univariable and multivariable analyses were performed to identify predictors of HT.

Results: We included 463 patients. 89 (19.2% )developed HT. Alberta Stroke Program Early Computed Tomography (ASPECTS) scores (p=0.048), collateral score (p<0.001) and National Institute of Health Stroke Scale (NIHSS) (p<0.001) were associated with HT. Collateral score (OR=0.33, 95%CI 0.20-0.52, p<0.001) and baseline NIHSS (OR=1.23, 95%CI 1.10-1.21, p<0.001) were independent predictors of HT. Patients with HT had lower rates of functional independence at 3 month (16.9% vs 52.4%, p<0.001) and a higher rate of mortality (37.1% vs 12%, p<0.001).

Conclusions: Recanalized patients with higher NIHSS, lower ASPECTS and collaterals are at risk of HT which is associated with worse outcomes and higher mortality.

Disclosure: No

P0521 / 1383

LOOKING BACK, BEFORE LOOKING FORWARD. FIVE YEARS DATA FROM RES-Q REGISTRY IN ROMANIA

C. Tiu ¹, E. Terecoasa¹, M. Sabau², M. Simu³, S. Tuta⁴, V. Tiu⁵, B. Casaru¹, R. Radu¹, C. Ghita¹, R. Balasa⁶, C. Panea⁵

¹Spitalul Universitar de Urgenta Bucuresti, Bucharest, Romania, ²County Hospital Oradea, Neurology, Oradea, Romania, ³County Hospital Timisoara, Timisoara, Romania, ⁴National Institute of Neurology and Neurovascular disorders, Bucharest, Romania, ⁵University Emergency Hospital Elias, Bucharest, Romania, ⁶County Hospital Tg Mures, Tg Mures, Romania

Background and aims: RES-Q Registry is the first stroke database in Romania. The aim is to map key performance indicators for quality of stroke care and to improve stroke management

Methods: Each center registers all stroke patients hospitalized in march, yearly.

Results: The number of participated centers has increased from 10 in 2017 to 36 in 2021. In five years we have registered 8467 patients. The median age was 71.46 years, median NIHSS at admittance 7.8 points, 82.8% ischemic strokes. Despite improvement in revascularization procedures (intravenous thrombolysis increased from 2.27% in 2017 to 10.56 in 2021, and mechanical thrombectomy from 0,1% to 1,7%) median Modified Rankin Score at discharge did not change significantly and mortality has increased (from 15.09% in 2017 to 19.03% in 2021). A reason for increased mortality is due to Covid-19 pandemic (poor access to primary care, more severely ill, increased door to needle time due to epidemiologic circuits), but beside this, there are unsolved problems, such as the very low percentage (below 1%) of decompressive hemicraniectomy, the reduced capacity to actively detect atrial fibrillation ( 36.9% of patients are still screened for AF only by repeated ECG), the low percentage of carotid imaging (56.7%) and revascularization procedures (less than 7% of symptomatic carotid stenosis).

Conclusion: For a better prognosis of stroke we need to increase the number of properly financed stroke units, the educational activities, and to elaborate and implement a national stroke plan.

Disclosure: No

P0522 / 1624

CLINICAL PRESENTATION AND LONG-TERM OUTCOMES OF CEREBRAL VENOUS THROMBOSIS IN A NORWEGIAN POPULATION

S. Grewal Dharmi ¹, K.G. Vetvik¹, S. Zarnovicky², J.M. Hansen³, K.W Faiz¹, E.S. Kristoffersen¹

¹Akershus University Hospital, Department of Neurology, Lørenskog, Norway, ²Akershus University Hospital, Department of Radiology, Lørenskog, Norway, ³University of Copenhagen, Danish Headache Centre, Copenhagen, Denmark

Background and aims: Most data on cerebral venous thrombosis (CVT) are from selected referral centres not necessarily reflecting a primary CVT population. We have previously found the incidence of CVT among adults in Norway to be 1.96 (95%CI 1.49-2.55) per 100 000/year. The purpose of this study was to describe the clinical presentation and outcomes of CVT in an unselected Norwegian population.

Methods: A retrospective cross-sectional hospital population-based study conducted at Akershus University Hospital serving roughly 10% of the total Norwegian population. Patients were identified through chart reviews based on the relevant International Classification of Diseases (10^th revision) codes for new CVT-cases in a 10-year period between January 1st, 2010 and December 31st, 2019.

Results: 77 patients aged 19-85 years were identified and included. The median age was 49 years and 51% were females. Headache was the most prevalent symptom, reported in 85%. 23% had seizures at presentation. Only 1 patient had Glasgow Come Scale < 9 at admission and 79% had a Glasgow Come Scale of 15. In most patients thrombosis occurred in multiple sinuses/veins. Risk factors were found in almost 3/4 of the patients, and most of the patients had a combination of two or more risk factors. 51% had a modified Rankin Scale score of 0 and 10% had a score >2 in the long-term.

Conclusions: We will present more data on the long-term prognosis after CVT in an unselected population at the ESO congress 2022.

Disclosure: No

P0523 / 1472

A RETROSPECTIVE ANALYSIS OF OUTCOMES IN MECHANICAL THROMBECTOMY FOR BASILAR ARTERY OCCLUSION IN RELATION TO BASELINE STROKE SEVERITY AND THROMBOLYSIS

A. Aggarwal ¹, G. Muddegowda¹, P. Ferdinand¹, A. Warusevitane¹, I. Natarajan¹, J. Chembala¹, J. Weerathunga¹, H. Chandrashekar¹, Z. Pencz¹, S. Rana¹, S. Nayak², Z. Hashim², C. Jadun², C. Roffe³

¹Royal Stoke University Hospital, Department of Neurosciences, Stoke-on-Trent, United Kingdom, ²Royal Stoke University Hospital, Department of Interventional Neuroradiology, Stoke-on-Trent, United Kingdom, ³Keele University, School of Medicine, Keele, United Kingdom

Background and aims: Basilar artery occlusion (BAO) has poor prognosis, with high mortality. Baseline National Institutes of Health Stroke Scale (NIHSS) is a major determinant of outcome. We examined outcomes and complications of mechanical thrombectomy (MT) in relation to stroke severity and thrombolysis.

Methods: BAO MT patients from a single comprehensive stroke centre (Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust), between 2010-2021, were subdivided into pre-MT NIHSS ⩽20 and >20. Outcomes were recanalization (TICI of 2b-3), PH2 intracerebral haemorrhage (ICH) at 22-36h, independent survival (mRS of 0-2) at 90d, and death at 90d.

Results: 47/732 (6.4%) MTs were done for BAO (mean age: 66.2 SD 13.5; male/female: 61.7%/38.3%; median onset-to-groin-puncture time: 365 IQR 331 min).

Table 1.

Outcomes.

	NIHSS ⩽20	NIHSS >20
Number of BAO MTs	19	28
Thrombolysis	52.6% (10/19)	82.1% (23/28)
TICI 2b-3	84.2% (16/19)	100.0% (28/28)
ICH	0.0% (0/17)	8.0% (2/25)
mRS 0-2	42.1% (8/19)	25.0% (7/28)
Death	26.3% (5/19)	39.3% (11/28)

Table 2.

Effect of thrombolysis on outcomes.

	NIHSS ⩽20	NIHSS >20
TICI 2b-3	OR 2.6 (95% CI 0.2-34.5) p=0.48	OR 4.3 (95% CI 0.1-240.0) p=0.48
ICH	OR 0.9 (95% CI 0.0-50.2) p=0.96	OR 1.2 (95% CI 0.0-28.4) p=0.93
mRS 0-2	OR 5.3 (95% CI 0.7-39.5) p=0.11	OR 1.4 (95% CI 0.1-15.3) p=0.78
Death	OR 0.5 (95% CI 0.1-4.0) p=0.51	OR 0.8 (95% CI 0.1-5.8) p=0.83

Conclusions: Thrombectomy for BAO is infrequent. Outcomes are better in patients with baseline NIHSS ⩽20. Considering the guarded prognosis of untreated BAO, outcomes in this series are reasonable with 25% independent survivors and less than 40% deaths in the more severe subgroup. While thrombolysis appeared to be associated with better outcomes in both groups, this was not significant due to the small number of cases.

Disclosure: No

P0524 / 274

GENDER DIFFERENCES IN MORTALITY OF HOSPITALISED STROKE PATIENTS. SYSTEMATIC REVIEW AND META-ANALYSIS

A.-R. Abdel-Fattah ¹, T. Pana¹, T. Smith², Z. Pasdar¹, M. Aslam¹, M. Mamas³, P. Myint¹

¹University of Aberdeen, Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom, ²University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, ³Keele University, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom

Background and aims: Gender differences in mortality after stroke by stroke-type remains unclear due to paucity of literature. We aimed to address this evidence gap regarding the gender differences in stroke mortality, stratified by stroke-type, and quantify the evidence base.

Methods: The literature was systematically searched using Ovid-EMBASE, Ovid-Medline, and Web-of-Science databases, searched from inception until November-2021. The quality-of-evidence was appraised using CASP Cohort-study-checklist and data were meta-analysed by stroke-type from admission through to five-years follow-up.

Results: Forty-one studies were included (n=8,128,700; mean age 68.5yrs; 47.1% female) and 36 studies were deemed appropriate for meta-analysis (n=7,979,004). Compared to men, women who had an ischaemic-stroke (IS) had lower mortality risk in-hospital (Risk:0.94; 95%CI 0.91-0.97) at one-month (Risk:0.87; 95%CI 0.77-0.98), 12-months (Risk:0.94; 95%CI 0.91-0.98) and five-years (Risk:0.93 95%CI 0.90-0.96). After a haemorrhagic-stroke (HS), women had higher mortality risk in-hospital (Risk:1.03; 95%CI 1.01-1.04) however no gender difference was found following discharge. Studies with stroke-of-unspecified-type (SUT) reported higher mortality-risk in women in-hospital (Risk:1.02; 95%CI 1.00-1.04) however, lower risk of mortality (Risk:0.95; 95%CI 0.90-0.99) between one and 12-months post-stroke.

Conclusions: The gender differences in mortality risk after stroke varies by stroke-type and duration since stroke onset. The current evidence base shows that women are at lower mortality risk, compared to men, following IS irrespective of time in adjusted models. In addition, beyond the in-hospital period where women are at higher mortality risk, there is no gender difference following HS after hospital discharge. Further research on gender differences post-HS is warranted to better understand this relationship.

Disclosure: No

P0525 / 820

DEPENDENCY IN ACTIVITIES OF DAILY LIVING, HRQOL AND CORRELATED CONDITIONS 3-4 YEARS AFTER FIRST-EVER STROKE

J. Aked^1,2, H. Delavaran^1,3, F. Wennerström⁴, M. Stenman^1,5, A. Lindgren ^1,5

¹Lund University, Department of Clinical Sciences, Neurology, Lund, Sweden, ²Blekinge Hospital, Department of Medicine, Karlskrona, Sweden, ³Danderyd University Hospital, Department of Cardiology, Stockholm, Sweden, ⁴Skåne University Hospital, Department of Emergency Medicine, Lund, Sweden, ⁵Skåne University Hospital, Department of Neurology and Rehabilitation Medicine, Lund, Sweden

Background and aims: Up-to-date stroke outcome data helps estimate current and future impact of stroke. We assessed dependency and health-related quality of life (HRQoL) 3-4 years after first-ever stroke.

Methods: Stroke survivors from a population-based cohort of 400 individuals with first-ever ischemic stroke or intracerebral hemorrhage in 2015-16 were followed-up via clinic/home visits, or telephone. Dependency was assessed with Barthel Index (BI). HRQoL was assessed with Short Form Survey-36, question 1 (SF-36). These findings were related to fatigue according to Fatigue Assessment Scale (FAS); cognition evaluated with Montreal Cognitive Assessment (MoCA); depression evaluated with Patient Health Questionnaire-9 (PHQ-9); and stroke severity evaluated with National Institutes of Health Stroke Scale (NIHSS) at follow-up. Ordinal and multiple regression was used to determine baseline and follow-up variables associated with HRQoL and functional dependency.

Results: At 3-4-year follow-up, 151 (38%) participants had died, 202 (51%) were followed-up in-person or via telephone, and 47 (12%) were lost-to-follow-up. Among followed-up survivors, 125 (62%) were completely independent (BI=100) in ADL. Meanwhile, 134 (69%) of 195 respondents reported good-excellent overall health. Dependency was significantly associated with follow-up NIHSS (B:-3.81;95%CI:-4.77--2.85); needing in-home care before stroke (B:-18.34; 95%CI:-26.95--9.73), and post-stroke fatigue at follow-up (B:-0.65;95%CI:-1.05--0.26). Post-stroke fatigue was independently associated with worse HRQoL (SF-36) (HR:1.15;95%CI:1.08-1.22; p<0.001).

Conclusions: Most 3-4-year stroke survivors are independent and report good health. Fatigue is independently associated with both dependency and HRQoL, even after correction for cognition and depression and may need specific intervention.

Table 1.

Baseline characteristics of followed-up stroke survivors and those lost to follow-up.

	Stroke survivors followed up at 3-4 years (n=202)	Stroke survivors lost to follow-up (n=53)	P*
Sex, female n (%)	80 (40)	29 (40)	1.00
Age, median (IQR)	72 (65-79)	72 (60-86)	0.78
NIHSS at admission, median (IQR)	3 (2-8)	4 (2-6)	0.95
Pre-stroke depression, n (%)	23 (11)	7 (17)	0.31
Pre-stroke cognitive impairment, n (%)	8 (4)	7 (17)	<0.01
Living situation at baseline, n (%)			<0.01
Own home w/o home care	185 (92)	34 (72)
Own home with home care	13 (6)	9 (19)
Assisted living/nursing home	4 (2)	4 (9)
Stroke subtype, n (%)			0.18
Ischemic stroke	178 (88)	37 (79)
Intracerebral hemorrhage	23 (11)	9 (19)
Undetermined	1 (1)	1 (2)

*

Chi-square used for categorical variables; Mann Whitney-U-test for ordinal variables

Table 2.

Multiple regression analysis of associations between follow-up assessments at 3-4 years and dependency in activities of daily living (ADL) (n=167).

Barthel Index, total score	B	95% CI for B	SE B	β	R2	ΔR2
Model					0.68	0.66
Age	-0.082	-0.27 - 0.11	0.10	-0.05
Sex, male	-3.69	-8.00 - 0.63	2.18	-0.08
NIHSS at follow-up	-3.81***	-4.77- -2.85	0.49	-0.53
CCI at baseline	-2.53**	-4.22 - -0.83	0.86	-0.14
Living with care at baseline†	-18.34***	-26.95 - -9.74	4.35	-0.21
Living alone at follow-up†	0.34	-4.23 – 4.91	2.31	0.01
Recurrent stroke†	-8.15*	-14.92 - -1.39	3.31	-0.12
FAS, total score	-0.65***	-1.05 - -0.26	0.20	-0.25
MoCA, total score	0.37	-0.13 – 0.88	0.25	0.10
PHQ-9, total score	0.78	-0.02 – 1.58	0.40	0.14

*

p<0.05; **p<0.01; ***p<0.005 (Bonferroni-adjusted p-level); † No as reference category

B values represent the change in the dependent variable when thepredictor is increased 1 unit and the other predictors are held constant.

Barthel Index: scale 0-100 where 0 is maximum dependency in ADL and 100 is independence

ADL: activities in daily living; NIHSS: National Institutes of Health Stroke Scale; CCI: Charlson Comorbidity Index; FAS: Fatigue Assessment Scale; MoCA: Montreal Cognitive Assessment; PHQ-9: Patient Health Questionnaire.

Table 3.

Ordinal multivariable regression analysis of associations between follow-up assessments at 3-4 years and HRQoL (SF-36, question 1) (n=167).

	HR (95% CI)	p
Age at baseline	1.02 (0.99-1.05)	0.15
Sex, male	0.69 (0.37-1.29)	0.24
NIHSS at follow-up	1.04 (0.90-1.20)	0.60
CCI at baseline	1.03 (0.81-1.32)	0.79
Living with in-home care before stroke*	1.75 (0.49-6.25)	0.39
Living alone at follow-up	1.17 (0.60-2.27)	0.64
Recurrent stroke*	0.78 (0.29-2.11)	0.63
FAS, total score	1.15 (1.08-1.22)	<0.001
MoCA, total score, inverse HR	1.04 (0.97-1.12)	0.25
PHQ-9, total score	1.03 (0.91-1.16)	0.65

*

No as reference category

NIHSS: National Institutes of Health Stroke Scale; CCI: Charlson Comorbidity Index; FAS: Fatigue Assessment Scale; MoCA: Montreal Cognitive Assessment; PHQ-9: Patient Health Questionnaire.

Disclosure: No

P0526 / 1648

INFLUENCE OF HEMATOCRIT ON RECANALIZATION RESULT AND CLINICAL OUTCOME AFTER ENDOVASCULAR THERAPY FOR ANTERIOR CIRCULATION LARGE VESSEL OCCLUSION

H. Moustafa ¹, S. Winzer¹, L. Schnekenberg¹, S. Daniella¹, E. Altascha¹, J. Barlinn¹, L.-P. Pallesen¹, K. Barlinn¹, T. Siepmann¹, D. Kaiser², K. Hädrich², J. Linn², J. Gerber², V. Puetz¹

¹University Hospital Carl Gustav Carus, Department of Neurology, Dresden, Germany, ²University Hospital Carl Gustav, Department of Neuroradiology, Dresden, Germany

Background and aims: In patients with acute ischemic stroke, high hematocrit may improve cerebral oxygenation but impair microcirculation. Consequently, in stroke patients with anterior circulation large vessel occlusion (acLVO) who receive endovascular therapies (EVT), hematocrit-levels may influence reperfusion results and functional outcome. The aim of our work was to identify an optimal range of hematocrit for obtaining a good clinical outcome and reperfusion.

Methods: From our prospective EVT database, we included consecutive (01/16-12/20) patients with acLVO. Baseline hematocrit was determined retrospectively based on electronic chart review. We analyzed the percentages of patients with good clinical outcome (mRS score 0-2) at 3 months and reperfusion (mTICI scores 2b to 3) according to categorised baseline hematocrit levels (0.16-0.30; 0.31-0.35; 0.36-0.40; 0.41-0.45; 0.46-0.51).

Results: Among 750 patients with available baseline data (median age 77 years [IQR 16], NIHSS score 16 [IQR 9], 53.5% female), we achieved reperfusion in 628 patients (83.8%) and 245 patients (32.7%) had a good clinical outcome. Clinical outcome showed a U-shaped relationship of baseline hematocrit with good clinical outcome rates, with highest rates of good clinical outcome among patients with medium-ranged hematocrit (0.16-0.30: 25%; 0.31-0.35: 27.1%; 0.36-0.40: 35.1%; 0.41-0.45: 40.1%; 0.46-0.51: 22.7%; p=0.036). The reperfusion rate tended to be lower in patients with very high hematocrit (0.16-0.30: 82.4%; 0.31-0.35: 80.7%; 0.36-0.40: 85.9%; 0.41-0.45: 85.4%; 0.46-0.51: 72.7%; p=0.322).

Conclusion: In stroke patients with acLVO who received EVT, baseline hematocrit level was associated with clinical outcome, with medium-ranged hematocrit (0.41-0.45) being associated with highest good functional outcome rates.

Disclosure: No

P0527 / 290

REDEFINING DISABILITY - THE ADDED VALUE OF PATIENT REPORTED OUTCOME MEASURES AFTER TIA AND MINOR STROKE

M. Olive-Gadea ¹, D. Cano², M. Muchada¹, E. Montiel², M. Baladas², E. Sanchez Gavilan², K. Paredes², M. Rubiera¹, M. Ribo¹, C. Molina¹

¹Hospital Unviersitari Vall d’Hebron, Stroke Unit, Barcelona, Spain, ²Vall d’Hebron Institut de Recerca, Barcelona, Spain

Background and aims: Long-term outcome assessment of stroke patients is based on modified Rankin Scale (mRS), but beyond the motor impairment, the impact of functional disability in the well-being of stroke survivors is not fully captured by the mRS. Patient-reported outcome measures (PROMs) are standardized and validated assessments that consider clinical outcomes from the patient perspective. We aim to analyze PROMs in patients with TIA and minor stroke.

Methods: We included consecutive ischemic stroke patients that minor stroke or TIA (NIHSS 0-5) from April 2020 to October 2021, with 90-day mRS follow-up of 0-2. All patients participated in the PROMs-through-App program (NORA, NoraHealth Barcelona Spain). Patients were asked to answer the following scales at 90 days: the Hospital Anxiety and Depression Scale (HADS), the 10-item PROMIS Global Health survey (v1.2), and the Fatigue Assessment Scale (FAS).

Results: We evaluated 261 patients, 56.5% were male, median age was 73(61-83) years, median baseline NIHSS was 2(0-3). Response rates were HADS: 74.3%(n=194), PROMIS: 75.1%(n=196) and FAS: 77.8%(n=203). At 90 days, 22.3% of the responders presented a poor HADS-anxiety sub-score and 22.3% HADS-depression sub-score; 47.6% of them showed alterations in the mental domain and 30.4% in the physical domain of PROMIS; 43.0% of the patients reported fatigue according to FAS.

Conclusions: The mRS alone may underestimate disability of mild stroke survivors. PROMS along with mRS should be considered as composite end-point in TIA and minor stroke trials.

Disclosure: No

P0528 / 1645

AGE OVER 80 IS ASSOCIATED WITH POOR DISCHARGE OUTCOMES AFTER ENDOVASCULAR THROMBECTOMY: FLORIDA STROKE REGISTRY

V. Sharashidze ¹, K. Wang², H. Gardener², C. Gutierrez², D. Rose², S. Koch², N. Krementz², C. Dong², B. Mehta³, A. Jameson², D. Yavagal², T. Rundek², J. Romano², R. Sacco², N. Asdaghi²

¹NYU, New York, United States, ²University of Miami, Miami, United States, ³Memorial Healthcare System, Miami, United States

Introduction: Elderly patients (⩾ 80 years of age ) were under-represented in randomized trials of endovascular thrombectomy (EVT). In the large Florida Stroke Registry, we aimed to evaluate the practice pattern and EVT outcomes in this population.

Methods: From Jan 2010 to Apr 2020, 8,344 patients underwent EVT. Multivariate analysis with generalized estimating equations assessed differences in demographics, clinical presentation, and discharge outcomes between patients < 80 and ⩾ 80 years of age.

Results: Among 8,344 EVT patients (mean age 71±15, 49% male), 32.9% were ⩾ 80 years of age. Patients ⩾ 80 years were more likely to have hypertension (76% vs 63%), atrial fibrillation (Afib) (56% vs 26%), presented earlier to the hospital (onset to arrival 108 vs. 126 min) with more severe NIHSS (17 (IQR=11) vs. 15(IQR=11)) as compared to their younger counterparts. Short-term discharge outcomes and treatment complications are shown in the Table. In multivariable analysis age⩾80 was associated with lower odds of independent ambulation (OR: 0.37, CI 0.32, 0.43) and being discharged to home/rehab (OR: 0.36, CI 0.33, 0.40).

Conclusion: In this large study, elderly patients account for one-third of EVT-treated patients and have a more severe neurological presentation and present early to the hospital. Age ⩾ 80 is an independent predictor of poor endovascular outcomes in routine practice.

Disclosure: No

P0529 / 1275

THE RISK OF RECURRENT VASCULAR EVENTS A DECADE AFTER STROKE IN YOUNG ADULTS BETWEEN 18-49 YEARS OLD

E. Verburgt ¹, J. Verhoeven¹, M. Ekker¹, M. Schellekens¹, E. Boot¹, M. van Alebeek², P. Brouwers³, R. Arntz³, G. van Dijk⁴, R. Gons⁵, I. van Uden⁵, T. den Heijer⁶, P. de Kort⁷, K. de Laat⁸, A. van Norden², S. Vermeer⁹, M. van Zagten¹⁰, R. van Oostenbrugge¹¹, M. Wermer¹², P. Nederkoorn¹³, H. Kerkhoff¹⁴, F. Rooyer¹⁵, F. van Rooij¹⁶, I. van den Wijngaard¹⁷, A. Tuladhar¹, F.-E. de Leeuw¹

¹Radboud University Medical Centre, Neurology, Nijmegen, Netherlands, ²Amphia Hospital, Neurology, Breda, Netherlands, ³Medical Spectrum Twente, Neurology, Enschede, Netherlands, ⁴Canisius-Wilhelmina Hospital, Neurology, Nijmegen, Netherlands, ⁵Catharina Hospital, Neurology, Eindhoven, Netherlands, ⁶Sint Franciscus Gasthuis Hospital, Neurology, Rotterdam, Netherlands, ⁷Elisabeth-Tweesteden Hospital, Neurology, Tilburg, Netherlands, ⁸Haga Hospital, Neurology, The Hague, Netherlands, ⁹Rijnstate Hospital, Neurology, Arnhem, Netherlands, ¹⁰Jeroen Bosch Hospital, Neurology, ‘s-Hertogenboch, Netherlands, ¹¹Maastricht University Medical Centre, Neurology, Maastricht, Netherlands, ¹²Leiden University Medical Centre, Neurology, Leiden, Netherlands, ¹³Amsterdam University Medical Centre, Neurology, Amsterdam, Netherlands, ¹⁴Albert Schweitzer Hospital, Neurology, Dordrecht, Netherlands, ¹⁵Zuyderland Hospital, Neurology, Sittard-Geleen, Netherlands, ¹⁶Medical Centre Leeuwarden, Neurology, Leeuwarden, Netherlands, ¹⁷Haaglanden Medical Centre, Neurology, The Hague, Netherlands

Background and aims: Young adults (18-49 years) with a first-ever ischemic stroke have a long life expectancy, which is affected by unclear risk of recurrent vascular events, as previous studies were conducted before current secondary prevention regimens. Therefore, we aimed to investigate the current long-term risk of recurrent vascular events after a first-ever ischemic stroke or transient ischemic attack (TIA) in young adults.

Methods: Patients were included from the multicenter prospective Dutch ODDYSEY study, aged between 18-49 years with imaging proven first-ever ischemic stroke or TIA between 2013 and 2021 from 17 hospitals in the Netherlands, with follow-up until 15/12/2021. The main outcomes were the cumulative and annual risks of self-reported recurrent vascular events, analyzed with Kaplan Meier survival analyses.

Results: We included 1318 patients (median age=44.2; IQR=38.4-47.5 years, 52.6% men, 7.4% ischemic stroke and 92.6% TIA, median follow-up time=3.1 years). 220 (16.6%) participants reported at least one recurrent vascular event. The cumulative 8-year risk was 23.4% (95% CI=19.9-26.7) of any vascular event, 21.5% (CI=14.8-27.6) of recurrent cerebral ischemia (n=165) and 7.2% (CI=5.0-9.4) of other vascular events (n=57). The annual risk is highest in the first years after ischemic stroke or TIA and decreases thereafter.

Conclusions: After eight years, one in four young patients had a new self-reported vascular event after their initial stroke or TIA. Patients with a first-ever stroke or TIA at young age remain at high risk of new vascular events, especially in the first few years.

Annual and cumulative risk of recurrent vascular events with available date (n=1302).

Disclosure: No

P0530 / 1264

THE INFLUENCE OF FRAILTY IN GERIATRIC PATIENTS ON NEUROLOGICAL OUTCOME AND MORTALITY AFTER ENDOVASCULAR TREATMENT IN STROKE – AN ANALYSIS OF THE GERMAN STROKE REGISTRY

M. Schnieder ¹, H. Metz¹, M. Bähr², A.C. Alegiani³, S. Wunderlich⁴, C. Huber⁴, C. Nolte⁵, A. Reich⁶, J. Pinho⁶, G. Petzold⁷, S. Tiedt⁸, C. von Arnim⁹, J. Liman², GSR-ET investigators

¹University Medical Center Göttingen, Neurology, Göttingen, Germany, ²University Medical Göttingen, Neurology, Göttingen, Germany, ³University Medical Center Hamburg-Eppendorf, Neurology, Hamburg, Germany, ⁴Technical University of Munich, Neurology, München, Germany, ⁵Charité Berlin, Neurology, Berlin, Germany, ⁶RWTH Aachen University, Neurology, Aachen, Germany, ⁷University Hospital Bonn, Neurology, Bonn, Germany, ⁸University Hospital of Munich, Neurology, München, Germany, ⁹University Medical Center Göttingen, Geriatrics, Göttingen, Germany

Frailty is a clinical syndrome in elderly patients and is associated with an increased risk of adverse health-care outcome. The Hospital Frailty Risk Score (HFRS), an ICD-10 diagnostic code-based score, has been proven to be capable of identifying patients which are at high risk of adverse outcomes. Previous, small single center analysis could demonstrate an impact of frailty on neurological outcome and mortality in geriatric patients in endovascular treated patients with stroke. Thus, we aimed to investigate this question in a large multicentric stroke cohort.

We retrospectively analyzed the German Stroke Registry (GSR) regarding the impact of frailty on endovascular treatment in stroke. We calculated the HFRS in all patients ⩾ 65 years. Regression analysis was performed on mortality and neurological outcome and we corrected for factors associated with an impact on outcome such as ASPECTS and Tici.

1559 patients fulfilled the inclusion criteria. The mean HFRS was 2.5(± 3.8). 1257(80.5%) patients had a low-frailty risk (HFRS <5), 230(14.7%) had a moderate-frailty risk (HFRS 5-15) and 25(1.6%) a high-frailty risk (HFRS >15). 29.6%(372) of the low-frailty risk group, 16.6 %(38) of the moderate-frailty risk group and 0%(0) of the high frailty risk group had a good outcome (p<0.001). Multivariate regression analysis showed a significant influence on mortality (CI (95%) 0.915 - 0.977; OR 0.946) and neurological outcome after three months measured by the mRS (CI (95%) 1.065 - 1.236; OR 1.174).

We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.

Disclosure: No

P0531 / 1146

IMPACT OF ADMISSION HYPONATREMIA ON OUTCOME AFTER REPERFUSION THERAPY IN ACUTE ISCHEMIC STROKE

A. Pelouto ¹, E.J. Hoorn¹, A.A.M. Zandbergen², H.M. den Hertog³

¹Erasmus Medical Center, Internal Medicine-Nephrology, Rotterdam, Netherlands, ²Erasmus Medical Center, Internal Medicine, Rotterdam, Netherlands, ³Isala Hospital, Neurology, Zwolle, Netherlands

Background and aims: Hyponatremia (serum sodium <136 mmol/L) is common in patients with ischemic stroke and is associated with unfavourable outcomes. Whether this association also exists in patients undergoing reperfusion therapy is unknown. Hyponatremia might aggravate susceptibility to ischemia/reperfusion injury by Ca²⁺ overload and increase oxidative stress. Hence, we studied whether admission hyponatremia is associated with unfavourable outcomes after intravenous thrombolysis (IVT) and/or intra-arterial thrombectomy (IAT) in acute ischemic stroke.

Methods: We analysed data of patients with ischemic stroke who underwent IVT and/or IAT in Isala hospital between January 2019 and December 2020. Primary outcome measure was unfavourable outcome (modified Rankin Scale score > 2) at 3 months. Secondary outcome measure was in-hospital mortality. Multivariable logistic regression models were applied to adjust for age, sex, pre-stroke Activities of Daily Living dependency, Charlson Comorbidity Index (CCI), NIHSS score, atrial fibrillation, hypertension, smoking status, and admission hyperglycemia (serum glucose >7.8mmol/l).

Results: We included 729 patients who presented with ischemic stroke (mean age 73 ± 13 years, 370 (51%) male, 478 (65%) underwent IVT only, 116 (16%) IAT only, 135 (19%) both). Ninety-eight (13%) of the patients was hyponatremic on admission. Admission hyponatremia was independently associated with poor functional outcome at 3 months, (adjusted odds ratio(aOR) 1.73, 95%CI 1.01-2.96) and with in-hospital mortality (aOR 2.32, 95%CI 1.17-4.61).

Conclusions: Admission hyponatremia is independently associated with unfavourable outcome at 3 months and in-hospital mortality in patients with acute ischemic stroke who underwent reperfusion therapy. Future intervention studies should determine whether correction of hyponatremia improves these outcomes.

Disclosure: No

P0532 / 458

INTRA-CRANIAL CALCIFICATION – A PROGNOSTIC AND PREDICTIVE VALUE FOR POST STROKE COGNITIVE DECLINE AND BRAIN ATROPHY ON LONG TERM FOLLOW UP

E. Seyman ¹, U. Sadeh-Gonik², I. Berman², G. Shendler², P. Berman², J. Molad¹, N. Bornstein³, E. Ben-Assayag¹, H. Hallevi¹

¹Tel-Aviv Sourasky Medical Center, Stroke Department, Division of Neurology, Tel- Aviv, Israel, ²Tel Aviv Sourasky Medical Center, Radiology Department, Tel-Aviv, Israel, ³Shaare Zedek Medical Center, Brain Center, Jerusalem, Israel

Background: Vascular calcifications are considered to be part of active atherosclerosis. Coronary calcification have long become a prognostic marker. Calcifications of intracranial vessels(ICC) are frequently observed on non-contrast CT and their effect on post-stroke cognitive impairment(PSCI) remains unclear. Our aim was to explore the association of ICC with long-term cognitive and advanced MRI measures in a large prospective cohort of mild stroke/transient ischemic attack(TIA) patients.

Methods: Data from the Tel Aviv brain acute stroke cohort(TABASCO) was analyzed. This prospective cohort study(n=575)aimed to identify predictors of PSCI. The ICC score(ICCS) on initial NCCT was calculated using a calcium quantification application. Participants underwent a 3T-MRI and comprehensive cognitive assessments at enrollment, 6, 12 and 24 months thereafter.

Results: Baseline data were available for 531 subjects(mean age 67.4 years,59.5% males). The incidence of cognitive impairment at the two-year time mark was doubled in the high ICCS group(26% vs.13.7%,p<0.001).On multiple regression analysis higher ICCS was associated with brain atrophy manifested by lower normalized white matter(WM), gray matter(GM), hippocampal and thalamic volumes(β=-0.178,β=-0.200,β=-0.137,β=-0.157;p<0.05)and with lower cognitive scores at baseline,6- and 12-month post-stroke (β-0.14,β=-0.12, β=-0.12,respectively;p<0.05). Microstructural damage, defined by DTI analysis of the normal appearing white matter(NAWM), as well as all small vessel disease(SVD) markers were significantly increased in the high ICCS group(p<0.001, p=0.002, respectively).

Conclusion: Our findings suggest that the ICCS correlates with brain atrophy, the extent of SVD and long-term PSCI. This score, which is a readily available imaging marker, can assist in post-stroke prognostication and help provide individually tailored therapy by adjusting treatment targets in stroke survivors.

Table 1.

Multiple regression models exploring the association between the ICC score and advanced brain MRI measures. Model 1 – unadjusted. Model 2- adjusted for age, gender, education years and vascular risk factors: history of hypertension, T2DM, dyslipidemia.

	Model 1			Model 2
	β	SE	P	β	SE	P
Total WM volume, normalized to ICV	-0.31	0.32	<0.001	-0.18	0.34	0.001
Total GM volume, normalized to ICV	-0.32	0.35	<0.001	-0.20	0.36	<0.001
Total hippocampus volume, normalized to ICV	-0.24	0.01	<0.001	-0.14	0.01	0.01
Total thalamic volume, normalized to ICV	-0.25	0.01	<0.001	-0.16	0.01	0.006
Frontal cortex thickness	-0.20	0.01	<0.001	-0.09	0.02	0.15
Temporal cortex thickness	-0.31	0.02	<0.001	-0.16	0.02	0.004
Parietal cortex thickness	-0.28	0.01	<0.001	-0.15	0.01	0.008
Occipital cortex thickness	-0.21	0.01	<0.001	-0.11	0.01	0.07
Total NAWM volume	-0.16	11504.4	0.014	-0.07	10259.3	0.26
Ischemic lesion volume, mm2	0.05	1299.5	0.49	__	__	__
NAWM FA values, mm2/sec	-0.11	0.002	0.10	__	__	__
NAWM MD values, mm2/sec	0.26	<0.001	<0.001	0.12	<0.001	0.06
NAWM λ|| values, mm2/sec	0.27	<0.001	<0.001	0.13	<0.001	0.05
NAWM λ⊥ values, mm2/sec	0.24	<0.001	<0.001	0.12	<0.001	0.07

Table 2.

Multiple regression analysis exploring the relation between ICC score and prospective longitudinal cognitive outcomes. Model 1 – unadjusted. Model 2- adjusted for age, gender, education years, stroke severity (NIHSS) and the presence of acute lesion in MRI.

	Model 1			Model 2
	β	SE	P	β	SE	P
Total cognitive score at admission	-0.17	1.51	0.002	-0.14	1.71	0.02
Total cognitive score at 6 months	-0.19	1.32	<0.001	-0.12	1.45	0.03
Total cognitive score at 12 months	-0.16	1.36	0.004	-0.12	1.41	0.04
Total cognitive score at 24 months (n=507)	-0.19	1.32	0.001	-0.1	1.42	0.15

Disclosure: No

P0533 / 1371

FUNCTIONAL, MOTOR AND LANGUAGE OUTCOME ARE ASSOCIATED WITH LESION CHARACTERISTICS – A PROOF-OF-CONCEPT STUDY BASED ON DATA FROM A VERY EARLY REHABILITATION TRIAL

T. Kaffenberger ¹, B.C. Campbell², V.N Thijs^1,3, K.H Afifi⁴, G. Sharma², V. Venkatraman⁵, N. Yassi^2,6, J. Bernhardt¹

¹The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia, ²Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia, ³Austin Health, Department of Neurology, Heidelberg, Australia, ⁴Menofia University, Schibin al-Kaum, Egypt, ⁵Royal Melbourne Hospital, University of Melbourne, Parkville, Australia, ⁶The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia

Background and aims: Ischemic stroke (IS) lesion characteristics on brain imaging have important associations with outcome. However, the precise interaction between lesion volume, location and outcome after IS is not entirely understood. We analysed the importance of these lesion characteristics on functional, motor and language outcome in IS patients from A Very Early Rehabilitation Trial (AVERT).

Methods: We collected acute brain CT/MRI scans from seven Australian and one New Zealand site. Ischemic lesions were manually masked, segmented using a stroke-specific CT-MRI-brain atlas, and percentages per atlas region affected were calculated for 399 IS patients. Using random forests, we analysed the importance of lesion volume and lesion location on the modified Rankin scale (mRS), the gross motor function of the Rivermead Motor Assessment (RMA) and the National Institutes of Health Stroke Scale (NIHSS) language subcomponent at 3 months.

Results: Total lesion volume was the most important variable for poor functional outcome (mRS>2, AUCcv(cross validated) 0.69(IQR 0.69–0.7) and poor motor outcome (RMA <10, AUCcv 0.68(IQR 0.67–0.68). Poor language outcome (NIHSS aphasia>1, AUCcv 0.85(IQR 0.84–0.85) was primarily associated with lesions of the left superior temporal and inferior frontal region, the left external capsule and the left superior longitudinal fasciculus rather than total lesion volume.

Conclusions: This proof-of-concept study showed the impact of total lesion volume on functional and motor outcome while lesion location was associated with language outcome. Outcome prediction studies should take this into account by focusing on specific outcome parameters.

Disclosure: No

P0534 / 1150

LOBAR HEMORRHAGE, MICROBLEEDS AND CORTICAL SUPERFICIAL SIDEROSIS AS PREDICTORS OF 5-YEAR MORTALITY IN ICH: THE FRENCH BREST STROKE REGISTRY

P.-Y. Rousseau ¹, A. Brouazin¹, M. Consigny^1,2, A. Jourdain¹, A. Leblanc¹, I. Viakhireva¹, F.-M. Merrien¹, F. Rouhart¹, P. Goas¹, S. Timsit^1,3

¹CHU Brest, Brest, France, ²INSERM CIC 1412, Brest, France, ³Université de Brest - INSERM, EFS, UMR 1078, Brest, France

Background and aims: Long-term mortality and its predictors, especially MRI factors, are poorly studied. We investigated 5-year mortality after a first-ever primary ICH in a large population-based registry from France.

Methods: 30-day ICH survivors from the Brest Stroke Registry were followed up to 5 years. Clinical, vascular risk factors and CT radiological characteristics were compared between survivors and dead patients by univariate and multivariable cox proportional hazard regression models. The same comparison was performed for the subgroup of patients who had an MRI. Characteristics considered were: microbleeds, superficial siderosis, deep and periventricular white matter lesions.

Results: From 2008 to 2017, 352 patients were included. 5-year mortality rate was 53.12%. Independent predictive risk factors for death were age⩾75 (HR=2.42 [1.61–3.65]), Atrial Fibrillation (AF) (HR=2.04 [1.37–3.02]), Atherosclerotic diseases (HR=3.64 [1.57–8.45]), GCS<8 (HR=4.01 [1.91–8.39]), NIHSS⩾15 (HR=2.12 [1.34–3.37]), mRS at discharge⩾3 (HR=1.70 [1.03–2.80]), lobar location of ICH (HR=1.44 [1.01–2.04]), while Fibrates was protective (HR=0.29 [0.09–0.94]). Concerning MRI subgroup, 180 patients were included. High number of microbleeds (⩾10) and superficial siderosis were associated with late mortality (HR=1.90 [1.06–3.39] and HR=3.35 [1.76–6.40]) independently of vascular risk factors.

Conclusions: Clinical severity factors and preexisting comorbidities were predictors of long mortality. Patients with advanced small vessel diseases on MRI had the worse prognosis, particularly those with probable amyloid angiopathy. AF as prognosis raises the question of the best treatment for patients with ICH and AF, while atherosclerotic diseases the question of adapted vascular prevention.

Disclosure: No

STROKE COMPLICATIONS

P0535 / 1548

CLINICAL-RADIOLOGICAL PROFILE OF PATIENTS WITH ISCHEMIC STROKE AND SEIZURES

C. González Ávila ¹, P. Paños¹, S. Trillo Senin¹, C. Ramos¹, E. De la Fuente¹, Á. Ximénez-Carrillo¹, J.A. Vivancos Mora¹

¹ Hospital Universitario de la Princesa, Neurology, Madrid, Spain

Background and aims: Post-stroke seizures are a frequent complication and difficult to diagnose. The aim of our study was to describe the profile of patients with ischemic stroke(IS) and seizures during the acute/subacute phase of stroke and its prognostic implication.

Methods: A retrospective observational study with prospective data recruitment was performed. All patients with final diagnosis of ischemic stroke and seizures who required hospital admission in Neurology department (2016/01/01 to 2019/12/31) were studied. Characteristics of stroke and seizures were collected and prognostic factors were studied.

Results: 70 patients were included. Average age was 80.13(SD 11.64), 43 were women(61.4%), median mRS before IS was 1[0-3]. Median NIHSS was 16[7-23]. Stroke location was more frequent in left hemisphere(46 cases, 65.7%) and anterior circulation(M1 infarcts in 21 cases, 30%).

Focal motor seizures were the most frequent(26 cases, 37.1%), seizures were the first presentation of stroke in 8 cases (11.4%) and happened during the first week in 64 cases(91.42%). Status epilepticus(SS) was suspected in 26 cases(37.1%). Delayed start of antiepileptic drugs(AED) in 7 cases(10%). Seizure control was achieved in 39 cases (55.7%). In-hospital mortality was 25 cases(35.7%).

Seizure control was associated with mRS at 3 month(p<0.001). The use of a second AED(p=0.001), no seizure control and SS were associated with in-hospital mortality(p<0.001). AED underdosing was associated with one-year mortality(p<0.043).

Conclusions: Seizures were diagnosed in patients with severe strokes in the carotid territory. The therapeutic delay was significant. There was no control of seizures in almost half of the cases being associated with high morbidity and mortality.

Disclosure: No

P0536 / 1622

PREVALENCE AND RISK FACTORS OF LATE SEIZURE IN ISCHAEMIC STROKE PATIENTS

P. Janský ¹, T. Růžičková¹, A. Olšerová¹, L. Šťovíčková¹, J. Paulasová-Schwabová¹, V. Šulc¹, H. Magerová¹, I. Šarbochová¹, J. Otáhal², P. Jiruška², P. Marusič¹, J. Reichl³, M. Vosko³, A. Tomek¹

¹Charles University and Motol University Hospital, Department of Neurology, Prague, Czech Republic, ²Czech Academy of Sciences, Institute of Physiology, Prague, Czech Republic, ³Kepler Universitätsklinikum, Med Campus III, Department of Neurology 2, Linz, Austria

Background and aims: Ischaemic stroke is an important cause of structural epilepsy in adults. The SeLECT score is a major prediction model for late post-stroke seizures. The aim of our study is to determine the prevalence of late post-stroke seizures and to compare the association of SeLECT score risk factors (severity of the stroke, large-artery atherosclerosis, early seizures, cortical involvement, the involvement of the middle cerebral artery territory) with the occurrence of late seizures in ischaemic stroke patients.

Methods: Retrospective analysis of consecutive supratentorial ischaemic stroke survivors with a negative history of epilepsy, admitted to two major comprehensive stroke centers in the Czech Republic and Austria in one year period (2015). The follow-up information was collected from available medical documentation, structured telephone questionnaire, and patient visits, the median follow-up period was 3.3 years.

Results: 315 patients were included (59% men, average age 69 years, median NIHSS 4, 29.2% received intravenous thrombolysis, in 6.3% mechanical thrombectomy was done). Late seizures occurred in 24 patients (7.6%). The seizure and seizure-free groups differed significantly in cortical involvement of the ischaemic lesion (70.8% vs. 38.5%, p = 0.002), a significant difference in the rest of SeLECT score risk factors was not found.

Conclusions: Late seizures occurred in 7.6% of ischaemic stroke survivors. Cortical involvement of the ischaemic lesion was the only SeLECT score parameter with a significant difference between seizure and seizure-free groups.

Disclosure: No

P0537 / 812

NETS AND POST-STROKE INFECTION

L. Alzamora ¹, A. Moraga¹, B. Díaz-Benito¹, C. Lopez-Ponce¹, P. Martín¹, V. Duran-Laforet¹, M.A. Moro², I. Lizasoain¹

¹Universidad Complutense de Madrid, Hospital 12 de Octubre, Neurovascular Research Unit, Madrid, Spain, ²Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain

Background and aims: Infection is a common complication in the acute phase after stroke and an added cause of morbimortality in these patients. Hence, identifying patients at risk of infection following stroke-induced immunosuppression is of paramount importance in the task of improving outcomes. Neutrophil extracellular traps (NETs) are large structures released by neutrophils that aid in host defence against pathogens. However, NETs contribute to inflammation, immunothrombosis and tissue damage following stroke. The goal of this study is to explore the role of NETs in the development of acute infections after ischemic stroke.

Methods: 218 patients who suffered acute ischemic stroke were recruited. Data regarding age, sex, cardiovascular risk factors, stroke etiology and severity (NIHSS) were collected. Patients were reassessed at 24 hours to recalculate NIHSS and at 3 months to evaluate post-stroke mRS scores. NETs markers were quantified by ELISA in plasma obtained upon admission. Data regarding infection were retrospectively retrieved from discharge records. 

Results: 17.8% of patients suffered at least one infection during their inpatient hospital stay. Our results show that patients who developed infections had worse short-term (24 hours-NIHSS) and long-term (3 months-mRS) prognoses. Unprecedentedly, we found that higher levels of elastase (NETs marker) upon admission correlated with the development of infections.

Conclusions: We anticipate our research to be a starting point for the identification of patients at risk of post-stroke infections through elastase levels upon admission, to prompt early interventions and improve patient care. 

Disclosure: No

P0538 / 1085

RISK FACTORS FOR NEW ISCHEMIC CEREBRAL LESIONS AFTER CAROTID ARTERY STENTING

X. Zhang ¹, Y. Feng¹, X. Bai¹, T. Wang¹, X. Lu¹, K. Yang², F. Ling¹, Y. Ma¹, L. Jiao¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Xuanwu Hospital, Capital Medical University, Department of Evidence-Based Medicine, Beijing, China

Background and aims: New ischemic cerebral lesions (NICL) are commonly occur after carotid artery stenting (CAS) with an incidence rate ranging from 18 to 58% and are detected by diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI). Numerous studies have reported that NICL could increase the risk of future cerebrovascular events and cognitive impairment. This study aimed to identify risk factors for NICL after CAS.

Methods: Relevant literature reporting risk factors for NICL after CAS were searched. Randomized controlled trials, case-control studies, or cohort studies were included in accordance with the pre-specified eligibility criteria.

Results: The final analyses included a total of 21 studies and 1,907 participants, including 764 NICL-positives and 1,143 NICL-negatives. Determinants for NICL-positivity were age (mean deviation (MD): 2.60; 95% confidence interval (CI): [1.53-3.68]), symptomatic carotid lesions (odds ratio (OR): 1.77; 95% CI: [1.39-2.25]) and smoking (OR: 0.74; 95% CI: [0.58-0.94]). For symptomatic patients, risk factors for NICL-positive included diabetes mellitus (OR: 1.76; 95% CI: [1.09-2.82]), but smoking (OR: 0.54; 95% CI: [0.31-0.93]) was a protective factor. Risk factors for centers with high NICL incidence were age (MD: 2.05; 95% CI: [0.93-3.17]) and symptomatic carotid lesions (OR: 1.77; 95% CI: [1.29-2.45]).

Conclusions: Older age and symptomatic carotid lesions are associated with an increased risk of post-CAS NICL whereas smoking is associated with a decreased risk. Risk factors for NICL in symptomatic patients is diabetes mellitus, while those for patients at centers with high incidence are age and symptomatic carotid lesions.

Disclosure: No

P0539 / 1448

OPTIC NERVE SONOGRAPHY TO DETECT CEREBRAL EDEMA AFTER ISCHEMIC STROKE

P. Baumgartner ¹, M. Zahn¹, H.-L. Handelsmann¹, K. Geier¹, S. Petrus¹, M. Hänsel¹, A. Luft^1,2, S. Wegener¹

¹University Hospital Zurich and University of Zurich, Department of Neurology, Zurich, Switzerland, ²Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland

Background and aims: Malignant middle cerebral artery (MCA) infarction due to extensive, space-occupying brain edema is one of the most feared complications of large MCA infarcts. Patients at risk are monitored based on clinical symptoms, which can be complicated by comorbidities such as delirium or systemic infections. Readily available, non-invasive methods to monitor intracranial pressure in stroke patients could facilitate treatment decisions such as hemicraniectomy. We are investigating whether optic nerve sonography (ONS) can detect brain edema early after stroke.

Methods: We repeatedly measured the optic nerve sheath diameter (ONSD) through transorbital ultrasound in 60 stroke patients and 30 non-stroke control subjects. Brain edema was also assessed with neuroimaging (CT/MRI). Stroke patients were grouped by severity of edema (no edema, sulcal effacement, ventricle compression and midline shift >3mm, or requiring hemicraniectomy).

Results: ONSD was increased on the ipsi- as well as the contralateral side in all patients after stroke. Highest ONSD values were found in patients who developed large brain edema with midline shifts >3mm. Strikingly, the largest ONSD were found early after stroke, within 12 hours after symptom onset (7.4 ± 0.7mm in midline shift group vs. 6.4 ± 0.6mm in stroke patients without edema, p<0.01) (Figure 1).

Conclusions: Ultrasound assessment of the ONSD is able to identify patients at risk of developing malignant MCA infarction within 12h of stroke. After showing the feasibility of the method, we now plan to find an ONSD threshold for prospectively predicting the development of a malignant course of MCA infarcts.

Disclosure: No

P0540 / 1484

RELATIONSHIP BETWEEN ANTICHOLINERGIC BURDEN AND POST-STROKE DELIRIUM

F. Vandervorst ¹, K. Guldolf², R. Gens¹, L. Seynaeve¹, S. De Raedt¹

¹UZ Brussel, Neurology, Brussels, Belgium, ²OLV Aalst, Neurology, Aalst, Belgium

Background and aims: Anticholinergic drug exposure may trigger delirium, however studies are conflicting. Our aim is to investigate the relationship between anticholinergic drug load and the development of post-stroke delirium (PSD).

Methods: In a dataset of 514 patients with acute ischemic stroke, we used a retrospective chart review based on DSM-5 criteria to diagnose PSD within the first week after stroke onset. Data on the use of anticholinergic drugs before and during the first week of hospitalisation were retrieved from the medical records. Drugs were classified according to the anticholinergic drug scale (ADS).

Results: 201 patients (39%) developed a PSD. 52 (26%) patients with PSD used anticholinergic drugs before stroke onset, in comparison with 96 (33%) patients without PSD (p=0.094). The cumulative ADS score and the number of anticholinergic drugs were similar in both groups. 172 (86%) patients with PSD used anticholinergic drugs during hospitalisation vs 225 (70%) patients without PSD (p<0.001). The median cumulative ADS score and number of anticholinergic drugs during hospitalisation were higher in patients with vs without PSD (respectively 1 (interquartile range (IQR) 1-2) vs 1 (0-2), p<0.001 and 1 (1-2) vs 1 (0-1), p<0.001). After adjustment for age, NIHSS on admission and known cognitive dysfunction, only the cumulative ADS score (OR 1.25; 95%CI 1.03-1.51, p=0.022) and the number of anticholinergic drugs (OR 1.44; 95%CI 1.12-1.84, p=0.005) remained associated with PSD.

Conclusions: High anticholinergic burden during but not before hospitalisation was associated with post-stroke delirium.

Disclosure: No

P0541 / 762

PREVALENCE OF SELF-REPORTED FATIGUE AND ASSOCIATED FACTORS IN INDIVIDUALS WITH CHRONIC STROKE IN THAILAND

J. Saengsuwan ¹, K. Potchana¹, P. Kittipanya-Ngam¹

¹ Khon Kaen University, Department of Rehabilitation Medicine, Khon Kaen, Thailand

Background and aims: Stroke is a leading cause of death and disability worldwide. Apart from the main factors after stroke such as weakness and decreased sensation, patients also experience other problems such as pain, depression and fatigue. The aim of the study was to investigate post-stroke fatigue and associated factors in patients with chronic stroke.

Methods: Forty-one chronic stroke patients (24 men and 17 women) participated in the study. Fatigue was identified by the Fatigue Assessment Scale. Signs of depression (PHQ-2), pain (numeric rating of pain score), fear of falling (Falls Efficacy Scale), quality of life (Global Quality of Life Scale), cognitive function (Thai Mini-Mental Status Examination), ambulatory level (Functional Ambulation Category), disability level (Modified Rankin Scale) and level of physical activity (Stroke Physical Activity Questionnaire) were recorded.

Results: The average age of participants was 55.3 years. The median post stroke time was 2 years. Thirteen (31.7 %) participants reported fatigue. Patients with fatigue had lower quality of life (Global Quality of Life Scale of 65.4 vs. 81.4). The only factor found to be associated with fatigue was signs of depression (PHQ-2 score of ⩾ 3). In patients with signs of depression, the odds ratio of having fatigue was 12.0 (95 % CI 1.2 - 121.8).

Conclusion: Fatigue is found in nearly a third of chronic stroke patients and affected their quality of life. The presence of signs of depression increases the chances of having fatigue.

Disclosure: No

P0542 / 1494

PRE-STROKE CARDIOVASCULAR MEDICATION USE AND POST-STROKE DELIRIUM

F. Vandervorst ¹, K. Guldolf², R. Gens¹, A. Ourtani¹, S. De Raedt¹

¹UZ Brussel, Neurology, Brussels, Belgium, ²OLV Aalst, Neurology, Aalst, Belgium

Background and aims: Preoperative use of beta-blockers has been associated with postoperative delirium. Our aim is to investigate whether pre-stroke use of different antihypertensive medications, antithrombotic drugs or statins might predict the development of post-stroke delirium (PSD), independent of known predictors such as age, NIHSS on admission and premorbid cognitive dysfunction.

Methods: In a dataset of 514 patients with acute ischemic stroke, 204 patients (39%) developed a delirium within the first week after stroke onset, using a retrospective chart review based on DSM-5 criteria. Data on pre-stroke use of beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, diuretics, antiplatelet drugs, anticoagulants and statins were retrieved from the medical records.

Results: 204 (40%) out of 514 patients used beta-blockers prior to stroke onset, 107 (21%) calcium channel blockers, 131 (26%) ACE inhibitors, 73 (14%) angiotensin II receptor antagonists, 135 (27%) diuretics, 164 (32%) statins, 220 (43%) antiplatelet drugs and 66 (13%) anticoagulants. In univariate analysis, pre-stroke use of beta-blockers (48 vs 39%, p = 0.001), antiplatelet drugs (48 vs 29%, p= 0.045) and anticoagulants (18 vs 9%, p= 0.002) were all positively associated to PSD. However, none of them remained an independent predictor of PSD after adjustment for age, NIHSS on admission and premorbid cognitive dysfunction.

Conclusion: Pre-stroke use of different classes of antihypertensive drugs, including beta-blockers, is not associated with PSD.

Disclosure: No

P0543 / 1459

THE PREVALENCE OF MENTAL HEALTH DISORDERS AFTER STROKE IN YOUNG ADULTS

M. Saapar ¹, R. Vibo¹, J. Kõrv¹

¹ University of Tartu, Department of Neurology and Neurosurgery, Tartu, Estonia

Background and aims: Mental health problems are prevalent among young stroke patients for a long time after stroke but are often neglected.

Methods: The 18–54 years old ischaemic stroke patients from the Estonian Young Stroke Registry, who were hospitalized in 01.01.2017–30.09.2020 were invited to a follow-up visit at 1–3.5 years after stroke. The patients filled in self-reported screening tests for post-traumatic stress disorder (PTSD Checklist for DSM-5, PCL-5) and depression, anxiety, asthenia and sleep disorders (Emotional State Questionnaire, EST-Q). Stroke severity and functional outcome were assessed with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale, respectively.

Results: We included 105 patients (59% males), with mean age at stroke onset 44.6 years (SD±8.2) and mean NIHSS 4.5 (SD±5.2). The median time of follow-up visit was 1.2 years after stroke (Q1–Q3 = 1.0–2.4) and the mean mRS score was 1.1 (SD±0.9). The prevalence of asthenia was 44.8%, sleep disorders 43.8%, depression 21.9%, generalized anxiety 21.9%, PTSD 20.4%, and any of these 58.1%. There were no differences by sex nor age group, but patients with a higher mRS score (0–1 vs. ⩾2) had a higher prevalence of asthenia (67.7 vs. 33.8; p=0.001), sleep disorders (61.8 vs. 35.2; p=0.010), depression (44.1 vs. 11.3; p<0.001) and PTSD (32.4 vs. 14.5; p= 0.034), but not anxiety (32.4 vs. 16.9; p=0.073).

Conclusions: Mental health disorders are very common among young patients’ post-stroke and associated with worse functional outcome.

Disclosure: No

P0544 / 340

DECOMPRESSIVE HEMICRANIECTOMY SERVICE OVERVIEW IN A LARGE TERTIARY NEUROSCIENCE CENTER IN THE UK

K. Varmpompiti ¹, Y.-H. Mah¹, S. Ankolekar¹

¹ King’s College Hospital NHS Foundation Trust, Neurosciences, London, United Kingdom

Background: Malignant middle cerebral artery (MCA) syndrome is the term describing the rare and rapid neurological deterioration secondary to effects of space occupying cerebral oedema following a large MCA territory infarct. In select cases, surgical intervention with a decompressive hemicraniectomy (DHC), can help counter the deleterious effects of cerebral oedema and reduce mortality and disability.

Methods: We reviewed the Electronic Health Records for all patients who received a DHC at King’s College Hospital NHS Foundation Trust between January 2013 and May 2018 and present the population characteristics, and examine potential features that influence outcomes.

Results: A total of 63 patients received a DHC over the 64-month period, with an even split across the sexes. The mean age was 49 years (SD 9.76) at surgery. 31.7% of patients received preceding thrombolysis therapy, and 24% of patients were operated on more than 48hrs after the indexing stroke. The incidence of mortality at discharge was 15.8%.

Factors conferring lower discharge mortality rates included, age less than 60 years (p=0.063), and sole MCA territory involvement (p=0.025). The latter was also associated with fewer complications (p=0.026), and shorter ITU admissions (p=0.059). Operations performed beyond 48 hours of stroke did not have a significantly greater discharge mortality rate (p=0.39).

Conclusion: Despite our small sample size due to the rarity of the procedure, our single centre review suggests age, and extent of injury are factors to consider when referring for DHC, while an interval greater than 48 hours after stroke and prior thrombolysis, are less important.

Disclosure: No

P0545 / 98

CAROTID ENDARTERECTOMY FOR ASYMPTOMATIC INTERNAL CAROTID ARTERY STENOSIS: PREDICTIVE FACTORS FOR 30-DAY STROKE AND MORTALITY RATES: ARETROSPECTIVE COHORT STUDY

A. Mousa ¹, M.A. Elkalla², S. Koussayer³

¹Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt, Vascular Surgery & Endovascular Therapy, Cairo, Egypt, ²Helwan University, Cairo, Egypt, ³King Faisal Specialist Hospital & Research Center, Vascular Surgery & Endovascular Therapy, Riyadh, Saudi Arabia

Background and aims: We analyzed the perioperative results of carotid endarterectomy for patients presented with asymptomatic internal carotid artery stenosis, and the potential predictors of 30-day mortality and stroke rates.

Methods: Consecutive successive carotid endarterectomies were performed and analyzed retrospectively during the period from January 2016 and December 2020. Univariate and multivariate analyses were used to recognize significant predictor values for the development of 30-day stroke and mortality rate.

Results: Among 4-year study period, 457 individuals with unilateral internal carotid artery stenoses were recruited. The overall 30-day stroke and death rates were 3.7%. Using the multivariate analysis, male gender, history of cardiac surgery, diabetes, hypertension, and the need for selective carotid shunting were identified as independent predictors for 30-day mortality and stroke rates. We reported no predictor value in 25% (n=114) of patients, while 45.7% (n=209), 20.5% (n=94), and 5.5% (n=26) were having one, two, and three risk factors respectively. Thirty-day death rate and stroke for patients with no identified predictor values were 1% (n=5). Whereas the corresponding values for patients with one, two, and three predictor values were 0.8% (p=0.7) in contrast to patients with no predictors; 1.5% (p=0.03) in contrast with patients with no predictors (p=0.05) in contrast with patients with one predictor, and 3% (p<0.001) compared to patients with no predictors, one predictor, or two predictors respectively.

Conclusions: A ruled out perioperative risk does exist in patients with asymptomatic carotid stenosis undergoing carotid endarterectomy. Thus, questioning the indication for surgery in such patients.

Disclosure: No

P0546 / 562

DO STROKE CARE PROCESSES MODIFY CLINICAL OUTCOMES IN PATIENTS WITH STROKE ASSOCIATED PNEUMONIA? A REGISTRY COHORT STUDY IN ENGLAND AND WALES

M. Lobo Chaves¹, M. Gittins², B. Bray³, A. Vail², C. Smith ¹

¹University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom, ²University of Manchester, Centre for Biostatistics, Manchester, United Kingdom, ³King’s College London, School of Population Health and Environmental Sciences, London, United Kingdom

Background and aims: It is unclear whether modern stroke unit care reduces the adverse impact of stroke complications, such as stroke-associated pneumonia (SAP), on clinical outcomes. We investigated the relationship between SAP and clinical outcomes, adjusting for the confounding effects of stroke care processes and their timing.

Methods: The Sentinel Stroke National Audit Programme provided patient data for all confirmed strokes between April 2013 and December 2018. SAP was defined as new antibiotic initiation for suspected pneumonia within the first 7 days from stroke admission. We compared SAP vs non-SAP for the outcomes: length of stay, discharge modified Rankin Scale, and in hospital mortality in appropriate multilevel mixed models. Each model was adjusted for patient and clinical characteristics, as well as markers of stroke care and their timing within the first 72hrs. The appropriate effect estimates and corresponding 95% Confidence Intervals (CIs) were reported.

Results: Of 201,778 patients, SAP occurred in 14.2%. After adjustment for acute stroke care processes and clinical characteristics, patients with SAP maintained an increased risk of longer length of in-hospital stay (IRR of 1.27; 95% CI 1.25, 1.30), increased odds of worse functional outcome at discharge (OR of 2.9; 95% CI 2.9, 3.0) and increased risk of in-hospital mortality (HR of 1.78; 95% C.I. 1.74, 1.82).

Conclusions: We show for the first time that SAP remains associated with worse clinical outcomes, even after adjusting for processes of acute stroke care and their timing. These findings highlight the importance of continued research efforts aimed at preventing SAP.

Disclosure: No

P0547 / 1630

PREDICTING HEMORRHAGIC TRANSFORMATION IN POSTERIOR CIRCULATION STROKE PATIENTS NOT SUBMITTED TO REPERFUSION THERAPIES

J.B. Clares de Andrade ¹, J. Mohr², F. Costa³, J. Malheiros³, R. Ikeda³, L. Barros⁴, F. Lima⁵, O. Pontes-Neto⁶, K. Merida⁷, L. Franciscato⁶, M. Marques⁷, R. Miranda⁸, G. Silva^1,8

¹Universidade Federal de Sao Paulo, Sao Paulo, Brazil, ²Columbia University, New York City, United States, ³Centro Universitario Sao Camilo, Sao Paulo, Brazil, ⁴Universidade Estadual do Ceara, Fortaleza, Brazil, ⁵Hospital Geral de Fortaleza, Fortaleza, Brazil, ⁶Universidade de Sao Paulo, Ribeirao Preto, Brazil, ⁷Hospital Instituto de Neurologia de Curitiba, Curitiba, Brazil, ⁸Hospital Israelita Brasileiro Albert Einstein, Sao Paulo, Brazil

Introduction: Posterior Circulation (PC) stroke represents one-fifth of all ischemic strokes, with peculiar physiological characteristics. Hemorrhagic Transformation (HT) is a dreaded complication among stroke patients. Many predictive scores of this complication have been proposed, but none is specifically designed for PC stroke patients. We propose a scoring system to assess the HT risk in PC stroke patients not submitted to reperfusion therapies (RT)

Methods: We retrospectively evaluated data of patients with a diagnosis of PC stroke not treated with RT from 5 Comprehensive Stroke Centers (4 in Brazil, 1 in the US), from 2015 to 2018. All patients underwent CT Scan or MRI at admission and a follow-up neuroimaging within 7 days. Independent variables identified in a logistic regression analysis were used to produce a predictive grading score.

Results: We included 952 patients in the final analysis. The overall incidence of HT was 8.7%. Male gender (1 point), NIH Stroke Scale at admission ⩾ 5 points (1), blood glucose at admission ⩾ 160mg/dL (1) and cardioembolism (2) were independently associated with HT. The AUC of the grading score (0 to 5 points) was 0.713 (95% CI 0.65-0.78). The cutpoint was 3 points – with a sensibility of 53% and specificity of 81%. Subjects with a score ⩾ 3 points had an OR of 4.8 (95% CI 2.9-7.9, p<0.001) for HT.

Conclusions: Our score is accurate in identifying patients at higher risk of HT. This score may help researchers to evaluate secondary prevention and stratifying patients in the context of even clinical trials.

Disclosure: No

P0548 / 342

INTEGRATING NOVEL NEUROIMAGING MEASUREMENTS AND CIRCULATING BIOMARKERS FOR THE PREDICTION OF SECONDARY INJURY FOLLOWING STROKE: FROM BENCH TO BEDSIDE. PROTOCOL PRESENTATION OF THE NIMBLE STUDY

A. Sodero ¹, L. Tudisco¹, B. Piccardi², V. Palumbo², E. Conti^3,4, A.L. Allegra Mascaro^3,4, P. Nencini², G.D. Scrima¹, C.M. Rapillo¹, S. Biagini¹, E. Fainardi⁵, I. Lombardo⁵, G. Busto⁵, N. Limbucci⁶, S. Nappini⁶, L. Renieri⁶, F. Capasso⁶, A.M. Gori⁷, B. Giusti⁷, A. Fanelli⁶, T. Biagioli⁶, A. Murri⁶, L. Tenori⁸, G. Pracucci¹, L. Tofani¹, A. Ferrara⁶, E. Aletto⁶, J. Kennedy⁹, M. Baldereschi¹⁰, C. Sarti^1,2, on behalf of theTReeS (Translational Research on Stroke) Study Group

¹University of Florence, NEUROFARBA, Florence, Italy, ²Careggi University Hospital, SOD Stroke Unit, Florence, Italy, ³Neuroscience Institute, National Research Council, Pisa, Italy, ⁴European Laboratory for Non-Linear Spectroscopy, Florence, Italy, ⁵University of Florence, Department of Biomedical, Experimental and Clinical Sciences, Florence, Italy, ⁶Careggi University Hospital, Florence, Italy, ⁷Careggi University Hospital, Atherothrombotic Diseases Center, Florence, Italy, ⁸University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy, ⁹University of Oxford, Acute Vascular Imaging Centre, Radcliffe Department of Medicine, Oxford, United Kingdom, ¹⁰Neuroscience Institute, National Research Council, Florence, Italy

Background and aims: Infarct-Growth(IG) and Brain Edema(BE) represents the most feared complications of acute ischemic stroke(IS). Investigating interactions between circulating and neuroimaging-biomarkers, in relation to stroke outcomes, and understanding the reorganization of neurons at cellular and subcellular level during ischemia may provide information to prevent or contrast clinical deterioration after IS. To achieve this goal, we constituted a research group composed by clinical (neurologists, neuroradiologists, interventional-neuroradiologists, biologists, nurses, statisticians) and preclinical researchers and we planned to perform joint research on humans and animal stroke-model.

Methods: Clinical section: monocentric prospective observational study conducted in Careggi University Hospital. Two-hundred patients with acute(<12hours) IS of anterior circulation irrespective of reperfusion therapies planned to be enrolled. Neuroradiological studies: (baseline) brainCT, AngioCT, PerfusionCT; (24hours) brainCT; (7days) brainMRI. Circulating-biomarkers (baseline and 24hours): interleukins, metalloproteases, acute-phase reagents, metabolomics. Clinical-status: (baseline, 24hours-7days) NIHSS; (3-months) mRankin scale.

Preclinical section: mouse model of photothrombotic occlusion and recanalization. Functional evaluation. Circulating biomarkers (see above) at baseline and 24 hours. In vivo BBB (advanced optical imaging techniques) and ex-vivo BE (Evans-blue diffusion) evaluation.

Results: Clinical outcomes: correlations between (1)Clinical-status and (2)anatomical distortion (Harston et al.2018), (3)IG from CTPcore-MRI, (4)circulating-biomarkers. Preclinical outcomes: analyzes of how structural rewiring of perilesional neurons correlates with vessel-extravasation and circulating-biomarkers at different timepoints after stroke.

Conclusions: We will verify to what extent the animal model can reliably reproduce significant parameters that are evaluated in stroke patients. Once validated, data on structural plasticity on mice shall be used to infer mechanisms determining clinical deterioration due to IG and BE.

Disclosure: No

P0549 / 628

A NEW WORLD UPON GRAY COLORS

A. Ferreira ¹, A.R. Silva¹, S. Marques¹, R. Maré¹

¹ Hospital de Braga, Neurology, Braga, Portugal

Background and aims: Central dyschromatopsia is a poorly recognized entity in clinical practice and represents a rare complication of bilateral infarction of the posterior cerebral circulation.

Methods: We present a patient with an acquired central dyschromatopsia and review the literature on published reports of this entity.

Results: 91 years-old female, with a history of hypertension, diabetes, atrial fibrillation and a previous cardioembolic ischemic stroke in the left vertebrobasilar territory, without sequelae, hypocoagulated.

She was admitted to our hospital claiming sudden loss of color perception, describing everything in “gray tones with color desaturation”, red being the best perceived color. She had no other ocular symptoms including eye pain, tearing, or photophobia. She denied headache, trauma or loss of consciousness. No history of non-compliance or changes in medication.

Fundoscopy revealed well-defined contours on both optical discs, an age-related vascular pattern and unaltered maculas. On examination she had left upper quadrantanopsy and inability to perceive colors, but not shapes and faces, in the entire visual field. Brain CT revealed a recent right temporo-occipital cortico-subcortical infarct and left occipital and cerebellar sequelae. Angiographic study was unremarkable. Anticoagulant therapy was maintained.

Conclusions: The sudden onset and absence of ophthalmological findings allowed us to establish a central vascular etiology for the dyschromatopsia. This entity should be especially considered when other cortical signs are present.

The role of different areas of the primary and associative visual cortex in color processing and how a defect results in central dyschromatopsia is not yet fully understood.

Disclosure: No

P0550 / 857

PREDICTION OF ACUTE MYOCARDIAL INFARCTION IN ASIAN PATIENTS WITH ACUTE ISCHEMIC STROKE: THE CTRAN SCORE

L. Chen ¹, S. Yan¹, Y. He¹, W. Zhong¹, X. Gong¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, Department of Neurology, Hangzhou, China

Background and aims: Patients with acute ischemic stroke (AIS) are susceptible to acute myocardial infarction (AMI), which would lead to a dramatic increase of in-hospital mortality.

Methods: We consecutively included AIS patients who were admitted within 7 days from symptom onset in our prospectively maintained database (NCT 04487340) from January 2016 to December 2020. In the derivation cohort from 70 centers, we developed a score to predict in-hospital AMI by integrating the bedside accessible predictors identified via multivariable logistic regression. Then in the validation cohort from 22 centers, we externally evaluated the performance of this score.

Results: Overall, 96,367 patients were included. In-hospital AMI occurred in 392 (0.41%) patients. The final model, named CTRAN, incorporated five predictors including the history of Coronary heart disease, malignant Tumor, Renal insufficiency, Age and baseline National Institutes of Health Stroke Scale score. The CTRAN score was confirmed in the validation cohort using receiver operating characteristic curve, which yielded an area under the curve (AUC) of 0.758 (95% confidence interval [CI], 0.718-0.798).

Conclusions: The CTRAN score could be a good tool for clinicians to identify AIS patients at high in-hospital AMI risk.

Disclosure: No

P0551 / 846

A PANEL OF BLOOD BIOMARKERS PROVIDES A HIGH SENSITIVITY TO RULE OUT STROKE-ASSOCIATED PNEUMONIA

J. Faura¹, A. Penalba¹, G. Ezcurra², M. Olivé-Gadea³, M. Álvarez-Larruy⁴, D. Vidal-de Francisco⁵, A. Domínguez-Mayoral⁶, C. Avellaneda⁷, M.M. Freijo⁸, E. Zapata-Arriaza⁹, G. Serrano-Heras¹⁰, L. Muñoz-Narbona², C. Alcahut¹⁰, I. Fernández-Pérez⁷, S. Pérez-Sánchez⁶, M. Millán², M. Rubiera³, L. Dorado², J. Montaner^1,6, A. Bustamante ²

¹Vall d’Hebron Institute of Research (VHIR), Barcelona, Spain, ²Hospital Universitari Germans Trias i Pujol, Badalona, Spain, ³Hospital Universitari Vall d’Hebron, Barcelona, Spain, ⁴Hospital de Mataró, Mataró, Spain, ⁵Hospital de Jaén, Jaen, Spain, ⁶Hospital Universitario Virgen Macarena, Sevilla, Spain, ⁷Hospital del Mar, Barcelona, Spain, ⁸Hospital de Cruces, Bilbao, Spain, ⁹Hospital Universitario Virgen del Rocío, Sevilla, Spain, ¹⁰Hospital Universitario de Albacete, Albacete, Spain

Background and aims: Stroke-associated pneumonia (SAP) represents a frequent and severe complication. Despite the fact that preventive antibiotics are not useful for SAP prevention, antibiotics are overused in front of SAP suspicions. We aimed to evaluate the usefulness of a blood-biomarker panel to rule-out SAP in stroke patients.

Methods: PROTEUS was a prospective, observational, multicenter study including ischemic stroke patients (NIHSS>3). Blood samples were obtained within 24 hours after stroke onset (T1) and from 24 to 48 hours (T2). SAP was diagnosed according to modified CDC criteria. C-reactive protein (CRP), serum amyloid A (SAA) and mid-regional proadrenomedullin (MR-proADM) were measured by immunoassays. The biomarker panel was defined with PanelomiX algorithm, optimizing accuracy. The additional predictive value over clinical predictors was evaluated by comparing areas under ROC curves with DeLong method.

Results: From July-2018 to May-2021, 340 patients were enrolled. SAP was diagnosed in 26 patients (7.6%). CRP, SAA and MR-proADM showed higher levels in SAP (figure). The biomarker panel disclosed 83% and 91% sensitivity, and 60% and 76% specificity, at T1 and T2, respectively. After adjustment by clinical predictors coming from previous literature, the panel remained an independent predictor for SAP, improving accuracy over clinical predictors from 0.77 (0.69-0.86) to 0.86 (0.79-0.92) at T1 and from 0.86 (0.80-0.92) to 0.92 (0.87-0.97) at T2.

Conclusions: Inflammatory and stress biomarkers improved sensitivity to rule out SAP in acute stroke patients. These results might be used to prevent antibiotic overuse in stroke units, by identifying patients at a low risk of SAP.

Disclosure: No

P0552 / 923

PREVALENCE AND PREDICTIVE FACTORS FOR SARCOPENIA IN CHRONIC STROKE PATIENTS: A PRELIMINARY STUDY

C. Nimphan ¹, K. Laosuwan¹, J. Saengsuwan¹, R. Vichiansiri¹

¹ Khon Kaen University, Physical Medicine and Rehabilitation, Khon Kaen, Thailand

Background and aims: Sarcopenia is a syndrome described as generalised and progressive loss of muscle mass and strength, associated with an increased risk of disability, hospitalisation and death. The aim of this study was to describe the prevalence and predictive factors for sarcopenia in chronic stroke patients.

Methods: This cross-sectional study included 37 chronic stroke patients who visited a rehabilitation department in Thailand, using the Asian Working Group for Sarcopenia 2019 consensus definition. Age, sex, body mass index (BMI), socioeconomic status, comorbid disease, alcohol intake, smoking, history of falls, depression, aetiology of stroke, duration of stroke, stroke severity (National institutes of Health Stroke Scale and the Modified Rankin Scale), ambulation level (Functional Ambulation Classification), Oral Health Assessment Tool, Mini Nutritional Assessment-Short Form score, Stroke Physical Activity Questionnaire and cognitive status (Montreal Cognitive Assessment) were recorded.

Results: Study participants included 25 men and 12 women with a mean age of 60 years. The prevalence of sarcopenia was 32.4 % (40 % in men and 16.7 % in women). Small calf circumference (odds ratios [OR] 9.3, 95 % confidence interval [CI] 1.8 - 49.6) and low BMI (OR 7.4, 95 % CI 1.5 - 35.3) were predictive factors for sarcopenia.

Conclusions: Low BMI and small calf circumference were predictive factors of sarcopenia in chronic stroke patients.

Disclosure: No

P0553 / 941

CIRCULATING MARKERS OF INFLAMMATION AS EARLY INDICATOR FOR LOWER RESPIRATORY INFECTIONS IN ACUTE ISCHAEMIC STROKE

I.M.C. Hasse ¹, G.M. Grosse¹, R. Schuppner¹, T. van Gemmeren¹, M.M. Gabriel¹, K. Weissenborn¹, R. Lichtinghagen², H. Worthmann¹

¹Hanover Medical School, Department of Neurology, Hannover, Germany, ²Hanover Medical School, Institute of Clinical Chemistry, Hannover, Germany

Background and aims: Patients with acute ischaemic stroke (AIS) are at high risk for stroke-associated infections (SAI). We hypothesized that increased concentrations of systemic inflammation markers, as identified in a pilot study, predict SAI and unfavorable outcome.

Methods: In 223 prospectively recruited patients with AIS, blood samples were taken at ⩽24h, 3d and 7d after stroke to determine IL-6, IL-10, CRP and LBP. Outcome was assessed by the modified Rankin Scale (mRS) at 90d. Patients were thoroughly examined regarding development of SAI.

Results: 47 patients developed SAI, with 15 lower respiratory tract infections (LRTI). The temporal pattern of IL-6, CRP and LBP differed between patients with and without SAI (IL-6 24h: p⩽0.001, 3d: p⩽0.001, 7d: p⩽0.001; LBP 24h: p=0.042, 3d: p⩽0.001, 7d: p⩽0.001; CRP 24h: p=0.145, 3d: p⩽0.001, 7d: p⩽0.001). However, these associations for IL-6 and LBP (⩽24h) with total SAI were not proven after adjustment for age, WBC, reduced consciousness and NIHSS. Nevertheless, when considering the subgroup of LRTI, in patients who presented early (⩽12h after stroke, n=139), IL-6 was independently associated with LRTI (OR: 1.066, 95%CI: 1.007-1.128, p=0.027). The ROC-analysis for prediction of LRTI showed an AUC of 0.685 for IL-6 and 0.827 for the combination of IL-6 and NIHSS.

Conclusions: Selected blood biomarkers were not predictive for total SAI. At early stages (⩽12h) IL-6 was independently associated with outcome-relevant LRTI. Further studies need to clarify the use of biochemical markers to identify patients prone to SAI.

Disclosure: No

P0554 / 1381

EVALUATION OF RISK PREDICTION EQUATION FOR NEW-ONSET RENAL INSUFFICIENCY IN PATIENTS WITH ACUTE ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK

H. Zhou ¹, Y. Pan¹, W. Chen¹, Y. Suo¹, X. Meng¹, Y. Wang¹

¹ Beijing Tiantan Hospital, Capital Medical University, Neurology, Beijing, China

Background and aims: Most research discussed the adverse effects of kidney disease on the stroke prognosis. The effect of brain injury on kidney function remains unexplored. Recently, a new risk prediction equation for incident chronic kidney disease has been proposed. We aimed to evaluate this equation for predicting new-onset renal insufficiency in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).

Methods: The patients enrolled in this study were from The Third China National Stroke Registry (CNSR-III), except for patients without baseline or 3-mo eGFR and patients with baseline eGFR < 60 ml/min/1.73 m². The risk prediction equation of patients with or without diabetes was validated respectively. The clinical outcome was the incident eGFR< 60 mL/min/1.73 m² at 3 months. The area (AUC) under the receiver operating characteristic curve and Hosmer-Lemeshow goodness-of-fit test were used to assess discrimination and calibration.

Results: During the 3-mo follow-up period, 34 incident cases (4.27%) of reduced eGFR occurred among 797 patients with diabetes, and 42 incident cases (1.84%) of reduced eGFR occurred among 2288 patients without diabetes. The risk prediction equation showed good discrimination in patients with diabetes (AUC 0.82, 95%CI 0.74-0.90) or without diabetes (AUC 0.77, 95%CI 0.67-0.86). The risk prediction equation was well-calibrated (Hosmer-Lemeshow test) in patients with diabetes (p = 0.81) or without diabetes (p = 0.38).

Conclusions: Risk prediction equations demonstrated high discrimination and well calibration in patients with AIS or TIA, which could help clinical screen high-risk patients with new-onset renal insufficiency after stroke.

Disclosure: No

P0555 / 1257

COVID-19 INFECTION INFLUENCE ON ISCHEMIC STROKE PATIENTS AND THEIR TREATMENT – SINGLE CENTRE EXPERIENCE

T. Sakelarova ¹, D. Kalpachka^1,2, R. Kalpachki^1,2

¹‘St. Anna’ University Hospital, Department of Neurology, Sofia, Bulgaria, ²South-West University “Neofit Rilski” (SWU), Blagoevgrad, Bulgaria

Background and aims: For the last year and a half, the Covid-19 infection took a big part of our daily and professional life. We compared ischemic stroke patients and ischemic stroke patients with Covid-19 infection. The main indicators we used are National Institutes of Health Stroke Scale (NIHSS) score, hospital stay duration and mortality.

Methods: It is a retrospective, observational, single-center study in the Department of Neurology, Saint Anna Hospital, Sofia, Bulgaria. The data was collected through our internal database and Res-Q registry. The included patients are all ischemic stroke patients treated in the Department for the period November 2020 – December 2021. We have evaluated them using NIHSS, prior modified Rankin Scale(mRS), rate of recanalization therapy, and hospital mortality.

Results: During the above-mentioned period 1112 ischemic stroke patients have been treated in our Department. Seventy-one patients had Covid–19(6.4%). From them 70.1% were with severe infection – with bilateral pneumonia. These patients were with higher median NIHSS on admission compared with patients without Covid–19 - 15 versus 11.6. Reperfusion treatment was done in 19.7% in the Covid group and 27.4% in the other. The hospital stay was significantly longer in the Covid group. The in-hospital mortality rate in the Covid group was 52.11% versus 18.48% in the non-Covid.

Conclusion: From the evaluated ischemic stroke patients, the group with Covid–19 infection had more severe stroke, longer hospitalization stay and higher mortality rate compared with the non–Covid group. The rate of reperfusion treatment is also lower in the Covid group.

Disclosure: No

P0556 / 914

EVALUATION OF PHYSIOLOGICAL VARIABLES IN DETERMINING TIME TO MORTALITY AFTER STROKE ASSOCIATED PNEUMONIA

A. Onochie-Williams ¹, C. Heal², C.J Smith³, A.K Kishore⁴

¹University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom, ²University of Manchester, Centre for Biostatistics, Manchester Academic Health Science Centre, Manchester, United Kingdom, ³Salford Royal Foundation Trust, Greater Manchester Comprehensive Stroke Centre, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance, Manchester, United Kingdom, ⁴University of Manchester, Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom

Background and aims: Stroke-associated pneumonia (SAP) frequently complicates stroke and is associated with significant mortality. The aim of this study was to investigate the relationships between the National Early Warning (NEWS) score, and its components, including respiratory rate, heart rate, temperature, oxygen saturations, oxygen requirement, and alertness level, derived prior to antibiotic initiation, with time-to-mortality in SAP.

Methods: Data for patients with SAP (n=254) were extracted from a core dataset of stroke patients admitted to Manchester Centre for Clinical Neurosciences (2013-2021). Clinician diagnosis of SAP was made if pneumonia occurred within 7 days of hospital admission. Kaplan-Meier survival curves were generated to assess parameters influencing survival at pre-defined time periods (1 year and 5 years). The association of these parameters with time-to-mortality were analysed using multivariable Cox regression models.

Results: The median age was 82y (72y-88y), 50.8% were male, and median NIHSS was 9. Mortality within 1 year was 58.3% and 70.9% within 5 years. In the Kaplan-Meier analyses, respiratory rate ⩽18/minute and a total NEWS score <3 were significantly associated with survival at both 1y and 5y, and heart rate <86 beats/minute significantly associated with survival at 1y. In the multivariable analyses, time-to-mortality was independently associated with respiratory rate only (HR 1.094, 95% CI 1.045-1.145, p<0.001).

Conclusion: This study has identified parameters within the NEWS score that are associated with survival in SAP patients. Further studies are warranted to identify physiological parameters which could guide optimal treatment and improve outcomes in SAP patients.

Disclosure: No

P0557 / 855

ACCURACY OF SARC-F QUESTIONNAIRE AS A SCREENING METHOD FOR SARCOPENIA IN CHRONIC STROKE PATIENTS: A PRELIMINARY STUDY

K. Laosuwan ¹, J. Saengsuwan¹, R. Vichiansiri¹, C. Nimphan¹

¹ Khon Kaen University, Rehabilitation medicine, Khon Kaen, Thailand

Background and aims: Sarcopenia is defined as an age-related decline in skeletal muscle mass and muscle strength or physical performance. The European Working Group on Sarcopenia in Older People revised consensus in 2018 (EWGSOP2) recommended the SARC-F questionnaire as a screening test for sarcopenia. The aim of the study was to evaluate the accuracy of the SARC-F questionnaire in stroke patients and to determine whether the same or different cut-off points should be applied.

Methods: Ambulatory stroke patients aged ⩾ 40 years with residual hemiparetic deficits were included. The Asia Working Group for Sarcopenia revised criteria in 2019 (AWGS 2019) was used to diagnose sarcopenia. The specificity, sensitivity, negative and positive predictive values, and area under the curve (AUC) were calculated.

Results: Thirty-seven participants with chronic stroke were enrolled. Their average age was 60 years. Sarcopenia was identified in 12 patients (32.4 %). SARC-F score demonstrated the highest Youden’s index when the cut-off point was 5 (AUC 0.71, 95 % CI 0.53-0.89). The sensitivity, specificity, positive predictive value, and negative predictive value were 66.7 % (95 % CI 34.9 % – 90.1 %), 72 % (95 % CI 50.6 % – 87.9 %), 53.3 % (95 % CI 26.6 %– 78.7 %), and 81.8 % (95 % CI 59.7 % - 94.8 %), respectively.

Conclusion: The SARC-F questionnaire is deemed suitable as a screening tool for sarcopenia in stroke patients. To improve the accuracy of SARC-F questionnaire in diagnosing sarcopenia in chronic stroke patients, the cut-off score of 5 should be applied.

Disclosure: No

P0558 / 988

ASSOCIATION OF N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE LEVEL WITH IN-HOSPITAL COMPLICATIONS AFTER AN ACUTE ISCHEMIC STROKE

M.L. Ruiz Franco ¹, E. Guevara Sánchez², L. Amaya Pascasio², M. Quesada López², J.M. García Torrecillas³, P. Martínez Sánchez²

¹Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almeria, Spain, ²Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almería, Spain, ³Department of Emergency Medicine. Torrecárdenas University Hospital, Almería, Spain

Background and purpose: Previous studies have shown the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and the stroke mortality and functional outcome after an acute ischemic stroke (AIS). However, the knowledge about its association with systemic and neurological in-hospital complication is scarce. Our purpose is to analyze it.

Methods: Observational study that included consecutive AIS patients during a 1-year period (2020). We analyzed vascular risk factors, pre stroke treatments, laboratory data (including NT-proBNP), stroke severity, acute treatments, and the development of in-hospital complications (systemic and neurologic). Multivariate analyses, that included NT-proBNP levels, were performed to identify if NT-proBNP is independently associated with complications. The receiver operating characteristic curve (ROC) curve was performed to obtain the optimal NT-proBNP cutoff point for the development of in-hospital complications.

Results: A total of 308 patients were included. Median of age (IQR) 63 (23.5) years old; 69,5% males. Median of NT-proBNP (IQR) 254 (1218) pg/dl. Ninety-six (31.1%) developed systemic and 62 (20.12%) neurological complications. The multivariate analyses showed that NT-proBNP was associated with systemic complications (OR 1.138, 96% CI 1.009 – 1.284) but not with neurological complications, adjusted by confounders. The ROC curve showed the predictive value of NT-proBNP with an area under the curve of 0.708. (95% CI, 0.639–0.777; p <0.001) and pointed to 296.5 pg/dL of NT-proBNP (66.7% sensitivity and 62.1% specificity) as the optimal cutoff level for developing systemic complications during hospitalization (Figure).

Conclusion: NT-proBNP could be a predictor of systemic, but not neurological, in-hospital complications in patient with ischemic stroke.

Disclosure: No

P0559 / 1595

THE RELATIONSHIP BETWEEN BLOOD GLUCOSE LEVELS AND HEMORRHAGIC TRANSFORMATION RISK IN PATIENTS TREATED BY MECHANICAL THROMBECTOMY -NEUROLOGY DEPARTMENT OF MEDICAL UNIVERSITY OF BIALYSTOK EXPERIENCE

D. Jakubowicz-Lachowska ¹, K. Rutka², A. Kułakowska¹,J. Kochanowicz¹

¹Medical University of Bialystok, Neurology, Bialystok, Poland, ²Medical University of Bialystok, Radiology, Bialystok, Poland

Background and aims: 85% of strokes are ischaemic. Around 40% of ischaemic strokes (IS) are caused by a large artery occlusion. Mechanical thrombectomy (MT) is one treatment option for IS. One the most feared complications of intervention with mechanical thrombectomy is hemorrhagic tranformation. Searching for factors increasing the risk of HT are very important. In the studies conducted so far, elevated glucose levels are one such factor. We investigated the relationship between blood glucose (BG) levels and risk of hemorrhagic transformation (HT) in patients treated by mechanical thrombectomy.

Methods: This is a retrospective study in patients who underwent thrombectomy from 12.2017 to 12.2019 at our department. Outcome measures were HT on post-procedure head CT.

Results: We retrospectively reviewed the records of patients with ischemic stroke treated with MT in the age range of 41-89 years, referred to our neurology ward between (12.2017-12.2021). We enrolled 143 patients (71 males and 72 females). Patients treated with thrombolysis accounted for 69.2%. Hemorrhagic transformation occurred in 51 (35,7%) patients, intracranial hemorrhage was found in 49 (96,1%) patients and 2 (3,9%) had isolated subarachnoid hemorrhage. Among patients undergoing thrombectomy, it was found that higher BG levels were statistically significantly associated with higher odds of HT (OR=2,19 95% C.I. 0.969–4,933; p<0.05).

Conclusions: In our study higher baseline GLU levels are associated with increased risk of hemorrhagic transformation in patients undergoing mechanical thrombectomy.

Disclosure: No

CEREBROVASCULAR MANIFESTATIONS OF COVID-19 AND OTHER INFECTIONS

P0560 / 729

CEREBRAL VENOUS SINUS THROMBOSIS IN THE SETTING OF COVID-19 VACCINATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

M.I. Stefanou ¹, L. Palaiodimou¹, D.A. de Sousa², J.M. Coutinho³, M. Papadopoulou⁴, V. Papaevangelou⁵, T.I. Vassilakopoulos⁶, S. Tsiodras⁷, D.K. Filippou⁸, G. Tsivgoulis¹

¹National and Kapodistrian University of Athens, Second Department of Neurology, Athens, Greece, ²University of Lisbon, Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHULN, Lisbon, Portugal, ³University of Amsterdam, Department of Neurology, Amsterdam UMC, Amsterdam, Netherlands, ⁴University of West Attica, Department of Physiotherapy, Athens, Greece, ⁵National and Kapodistrian University of Athens, Third Department of Pediatrics, Athens, Greece, ⁶National and Kapodistrian University of Athens, Third Department of Critical Care Medicine, Athens, Greece, ⁷National and Kapodistrian University of Athens, Fourth Department of Internal Medicine, Athens, Greece, ⁸National and Kapodistrian University of Athens, Department of Anatomy and Surgical Anatomy, Athens, Greece

Background and aims: Cerebral venous sinus thrombosis (CVST) has been acknowledged as a rare adverse event related to thrombosis-thrombocytopenia syndrome (TTS) following COVID-19 vaccination.

Methods: A systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases was performed, with the aim to calculate the odds ratio of TTS-CVST versus non-TTS-CVST (1) after vector-based vaccines and (2) after non-vector-based vaccines; (3) the in-hospital mortality ratio of TTS-CVST compared to non-TTS-CVST; and (4) the dependency or death at discharge among TTS-CVST compared to non-TTS-CVST cases.

Results: Two eligible studies were included in the meta-analysis, comprising a total of 211 patients with CVST associated with COVID-19 vaccination. Vector-based COVID-19 vaccination was associated with a higher likelihood of TTS-associated CVST than with non-TTS-CVST (OR: 52.34, 95%CI: 9.58-285.98). TTS-CVST was also associated with higher likelihood of in-hospital mortality (OR: 13.29; 95%CI: 3.96-44.60) and death or dependency at discharge compared to non-TTS-CVST (OR: 6.70; 95%CI: 3.15-14.26). TTS-CVST was recorded with a shorter interval between vaccination and symptom onset [Mean Difference (MD):-6.54 days; 95%CI:-12.64 ─ -0.45], affecting younger patients (MD:-9.00 years; 95%CI: -14.02 ─ -3.99) without risk factors for thromboses (OR:2.34; 95%CI: 1.26-4.33), and was complicated more frequently with intracerebral hemorrhage (OR:3.60; 95%CI: 1.31-9.87) and concomitant thromboses in other sites (OR:11.85; 95%CI: 3.51-39.98) compared to non-TTS-CVST cases.

Conclusions: TTS-CVT following COVID-19 has distinct clinical phenotype and prognosis compared to non-TTS-CVT. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS-CVT cases following COVID-19 vaccination.

Disclosure: No

P0561 / 432

SHARED GENETIC MECHANISMS AMONG STROKE POST-COVID-19 CASES AND ISCHEMIC STROKE SUBTYPES

L. Llucià-Carol ^1,2, E. Muiño¹, C. Gallego-Fabrega^1,3, J. Cárcel-Márquez^4,1, N. Cullell^1,3, M. Lledós^1,5, J. Martín-Campos¹, T. Segura⁶, E. González-Villa⁶, G. Serrano-Heras⁷, J. Martí-Fàbregas⁸, E. Jiménez-Xarrié⁸, R. de Cid⁹, A. de Felipe Mimbrera¹⁰, J. Masjuan¹⁰, S. García-Madrona¹⁰, A. Domínguez Mayoral^11,12, P. Menéndez Valladares^11,12, J. Montaner Villalonga^11,12, L. Lloret Iglesias¹³, M. L DeDiego¹⁴, J. Perez-Tur^15,16, A.M. Planas^2,17, I. Férnandez-Cadenas^1,3

¹Biomedical Research Institute Sant Pau (IIB Sant Pau), Stroke Pharmacogenomics and Genetics Laboratory, Barcelona, Spain, ²Institut d’Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Department of Brain Ischemia and Neurodegeneration, Barcelona, Spain, ³Fundación Docència I Recerca Mútua Terrassa, Stroke Pharmacogenomics and Genetics Laboratory, Terrassa, Spain, ⁴Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain, ⁵Universitat de Barcelona, Departament de Genètica, Microbiologia i Estadística, Barcelona, Spain, ⁶University Hospital of Albacete, Department of Neurology, Albacete, Spain, ⁷University Hospital of Albacete, Research Unit, Albacete, Spain, ⁸Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology, Barcelona, Spain, ⁹Health Research Institute Germans Trias i Pujol (IGTP), Genomes for Life-GCAT Lab Group - Program of Predictive and Personalized Medicine of Cancer (PMPPC), Barcelona, Spain, ¹⁰Hospital Universitario Ramón Y Cajal, Madrid, Spain, ¹¹Institute of Biomedicine of Seville, Seville, Spain, ¹²Hospital Universitario Virgen Macarena, Seville, Spain, ¹³Instituto de Física de Cantabria (IFCA-CSIC), Santander, Spain, ¹⁴Centro Nacional de Biotecnología (CNB-CSIC), Department of Molecular and Cell Biology, Madrid, Spain, ¹⁵Institute of Biomedicine of Valencia (IBV), Valencia, Spain, ¹⁶Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Valencia, Spain, ¹⁷Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

Background and aims: SARS-CoV2 infection may increase stroke risk. The biological mechanisms underlying ischemic stroke occurrence during COVID-19 remains unclear.

Methods: A Genome-Wide Association Study (GWAS) from MEGASTROKE was used to generate Polygenic risk scores (PRSs) across four p-value thresholds (p=0.05-p=5e-8) using PRSice-2. For all ischemic stroke (AIS) we used 34217 cases and 406111 controls, large-artery atherosclerosis (LAA) 4373 cases 297290 controls, cardioembolic (CE) 7193 cases 355468 controls and small-vessel occlusion (SVO) 5386 cases 343560 controls. For undetermined stroke etiology (UND) 984 cases and 5590 controls from a Spanish stroke cohort were used. PRSs were tested in 54 patients with an ischemic stroke that occurred after COVID-19 hospitalization (<8 days)(IS-COV). IS-COV cases were genotyped with Axiom Spain Biobank Array (11 UND, 6 CE, 6 LAA, 5 SVO, 2 infrequent cause and 24 unknown etiology). 726 population controls were also genotyped.

Results: We found significant associations of IS-COV with PRS_AIS (threshold= 5e-5, p= 0.04; R²= 0.01, number of SNPs= 60), PRS_CE (threshold= 5e-8, p= 0.02, R²= 0.01, SNPs= 4; threshold= 0.05, p= 5.9e-4, R²= 0.03, SNPs=19308), PRS_LAA(threshold= 5e-5, p= 6.5e-3, R²= 0.02, SNPs= 81; threshold= 1e-4, p= 0.02, R²= 0.01, SNPs= 146; threshold= 0.05, p =1.3e-3, R²= 0.03, SNPs= 20722) and PRS_UND (threshold= 1e-4, p= 0.04, R²= 0.01, SNPs=10; threshold= 0.05, p =1.5e-6, R²= 0.06, SNPs= 3416). We did not find any association between PRS_SVOand IS-COV.

Conclusions: CE, LAA and UNDshared genetic mechanisms with ischemic stroke cases due to COVID-19. We found no association between SVO and IS-COV.

Disclosure: No

P0562 / 694

VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA: A POSSIBLE PATHOGENETIC ROLE OF CHADOX1 NCOV-19 VACCINE ENCODED SOLUBLE SARS-COV-2 SPIKE PROTEIN

M. De Michele ¹, P. Piscopo², A. Crestini², R. Rivabene², G. d’Amati³, M. Leopizzi⁴, L. Stefanini⁵, F. Pulcinelli⁶, A. Chistolini⁷, M. Iacobucci⁸, O.G. Schiavo¹, I. Berto⁹, E. Nicolini¹, L. Petraglia¹, M.T. Di Mascio¹, D. Toni⁹

¹Sapienza University of Rome, Emergency Department, Stroke Unit, Rome, Italy, ²Istituto Superiore di sanità, Department of Neuroscience, Rome, Italy, ³Sapienza University of Rome, Department of Radiology, Oncology and Pathological Science, Rome, Italy, ⁴Sapienza University of Rome, Department of Medico-surgical sciences and Biotechnologies, Rome, Italy, ⁵Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy, ⁶Sapienza University of Rome, Department of Experimental Medicine, Rome, Italy, ⁷Sapienza University of Rome, Hematology, Department of Translational and Precision Medicine, Rome, Italy, ⁸Sapienza University of Rome, Neuroradiology Unit, Department of Human Neurosciences, Rome, Italy, ⁹Sapienza University of Rome, Department of Human Neurosciences, Rome, Italy

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare syndrome of unclear aetiology occurring after vaccinations against COVID-19. The aim of this study was to investigate the DNA vaccine-encoded Sars-cov-2 soluble spike protein (SP) as a potential trigger of platelet activation in VITT.

Methods: We studied three VITT patients and seven healthy controls (HCs) within 3 weeks from the first dose of ChAdOx1 nCoV-19. Serum levels of SP, soluble angiotensin-converting enzyme 2 (sACE2), and platelet response to VITT serum stimulation were studied. A thrombus retrieved from middle cerebral artery during mechanical thrombectomy of one VITT patient, was analysed by immunohistochemistry for SP and ACE2. Neutrophil extracellular traps (NETs) markers and coagulation parameters were also measured.

Results: We detected SP and sACE2 in all VITT patients, and in two and three out of 7 HCs, respectively. VITT sera markedly activated platelets and this activation was inhibited by both anti-SP and anti-FcγRIIA blocking antibodies. The retrieved thrombus showed positive immunohistochemical labelling of platelets using an anti-SP antibody with reduced ACE2 expression, compared to a thrombus from a pre-pandemic stroke patient. Markers of endothelial dysfunction, NETs and hypercoagulability state were present in VITT sera.

Conclusions: The present data provide first evidence that DNA vaccine-encoded Sars-cov-2 SP is detectable in VITT sera (up to several weeks post-vaccination) and in a platelet-rich thrombus, and suggest that SP may contribute to the initial platelet stimulation in VITT patients. Anti-PF4/polyanion antibodies development could represent an epiphenomenon, which amplifies platelet aggregation, NETosis, and coagulation cascade.

Disclosure: No

P0563 / 1599

CEREBROVASCULAR DISEASES IN PATIENTS WITH SARS-COV-2 INFECTION: A NATIONAL SERIES

J.B. Clares de Andrade ¹, F. Lima², F. Rocha², S. Martins³, R. Bazan⁴, D. Rangel⁵, L. Viana⁶, O. Pontes-Neto⁷, A. Conforto⁸, L. Januzzi⁹, P. Magalhaes¹⁰, K. Merida¹¹, V. Gagliardi¹², A. Majdoub¹³, G. Silva¹

¹Universidade Federal de Sao Paulo, Sao Paulo, Brazil, ²Hospital Geral de Fortaleza, Fortaleza, Brazil, ³Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ⁴Universidade Estadual Paulista, Botucatu, Brazil, ⁵Hospital Regional do Sertao Central, Quixeramobim, Brazil, ⁶Hospital Israelita Brasileiro Albert Einstein, Sao Paulo, Brazil, ⁷Universidade de Sao Paulo, Ribeirao Preto, Brazil, ⁸Universidade de Sao Paulo, Sao Paulo, Brazil, ⁹Universidade Federal de Alagoas, Maceio, Brazil, ¹⁰Hospital Municipal Sao Jose, Joinville, Brazil, ¹¹Hospital Instituto de Neurologia de Curitiba, Curitiba, Brazil, ¹²Hospital Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil, ¹³Hospital Santa Marcelina, Sao Paulo, Brazil

Background and aims: There is a higher incidence of cerebrovascular disease (CVD) in patients with SARS-CoV-2 infection. We aim to describe a national series of CVD in patients with confirmed SARS-CoV-2 infection.

Methods: Fourteen Brazilian Stroke Centers registered clinical, neuroimaging and laboratory findings from April to November 2020.

Results: We included 344 patients in the final analysis. Age ranged from 20-95 (median 57[57, 75] years). Cerebral ischemia (CI) occurred in 83.7%(n=288), intraparenchymal hemorrhage (IPH) 6.7%(n=23), central venous thrombosis (CVT) 5.2%(n=18) and subarachnoid hemorrhage (SAH) 4.4% (n=15). CVD was the first symptom of SARS-CoV-2 in 37.8% of cases – among those with SAH, 60% had no systemic symptoms. CI cases had higher values of Dimer-D compared to others. Involvement of at least two arterial territories occurred in 13.8%. Among IPH patients, 25% were under anticoagulation with heparin. Patients with SAH had a spontaneous etiology in 35.7%. Dimer-D levels at admission were associated with worse outcomes (mRS3-6) (OR1.14, 95%CI1.008-1.29, p=0.03), in an adjusted analysis. The time of onset of neurological symptoms (TONS) since SARS-CoV-2 infection was indirectly related to neurological severity at admission (-0.17, p=0.04,). In-hospital treatment with corticosteroids was associated with in-hospital encephalopathy (OR2.5,95%CI 1.01-6.16,p=0.04). Poor outcome (mRS3-5) occurred in 54.1% of cases.

Conclusions: Patients with CVD and SARS-CoV-2 are at higher risk of unfavorable outcomes. The TONS since infection is related to neurologic severity; and serum Dimer-D levels may be useful for prognostication. The higher prevalence of non-aneurysmal SAH cases suggests pathophysiological mechanisms other than a hypercoagulable state.

Disclosure: No

P0564 / 745

STROKE CARE IN CROATIA DURING COVID-19 PANDEMIC THROUGH RES-Q REGISTRY DATA

A. Mestrovic ¹, Z. Poljakovic², I. Peric², Z. Hucika³, M. Seferovic³, I. Cindric⁴, D. Erak⁵, A. Svinger-Muic⁶, R. Marcec⁷, K. Sabolek Lovrec⁷, S. Svalina⁸, S. Majski⁸, H. Budincevic¹

¹Sveti Duh University Hospital, Department of Neurology, Zagreb, Croatia, ²University Hospital Center Zagreb, Department of Neurology, Zagreb, Croatia, ³General Hospital Zabok, Department of Neurology, Zabok, Croatia, ⁴General Hospital Virovitica, Department of Neurology, Virovitica, Croatia, ⁵General Hospital Sibenik, Department of Neurology, Sibenik, Croatia, ⁶General Hospital Karlovac, Department of Neurology, Karlovac, Croatia, ⁷County Hospital Cakovec, Department of Neurology, Cakovec, Croatia, ⁸General County Hospital Vukovar, Department of Neurology, Vukovar, Croatia

Background and aims: The Registry of Stroke Care Quality (RES-Q) is a tool for monitoring the quality of stroke care in hospitals throughout Europe. The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations and revascularization procedures.

The aim was to compare results captured from RES-Q registry in Croatia in March 2019 and March 2020 and March 2021, before, during the first wave, and third wave of the COVID-19 pandemic in Croatia

Patients and methods: Data on demographics, stroke care pathway, specific acute treatment, and prevention issues, in all acute stroke admissions in Croatia during March 2019 and March 2020, and March 2021 through the RES-Q registry were analyzed.

Results: The study included 1 comprehensive stroke center and 7 primary stroke centers in Croatia, which captured data in all three periods. We have noted a reduction of stroke patients’ admissions during the COVID-19 pandemic for 26.6% during the first wave and for 16.7% during the third wave.

Figure 1.

shows the map of Croatia with participating centers.

Table 1.

Shows the number of patients recruited by participating centers.

Croatia – Hospitals with recruited patients	2019	2020	2021
University Hospital Center Zagreb (IVT & MT available)	117	58	81
Sveti Duh University Hospital-Zagreb	47	48	60
General Hospital Zabok	28	27	26
General Hospital Virovitica	32	32	15
General hospital Sibenik	29	24	24
General Hospital Karlovac	26	20	27
County Hospital Cakovec	25	16	27
General County Hospital Vukovar	23	15	14

Table 2.

Shows patients’ main baseline characteristics and outcome measures.

Main baseline data and outcome results	2019	2020	2021
Recruited patients	327	240	274
Main stroke types (%)
Ischemic	79.20	84.17	76.64
Intracerebral hemorrhage	9.79	10.00	11.68
Subarachnoid hemorrhage	4.28	0.83	3.65
Transient ischemic attack	6.12	4.17	8.03
Recurrent stroke (%)	14.68	12.92	19.71
Age (median) - years	74	75	75
% Female patients	53.52	48.33	51.67
Atrial fibrillation	27.22	32.08	26.28
NIHSS (median)	6	6	7
% NIHSS performed	36.59	58.33	57.66
CT/MR performed on admission (%)within 1 hour	93.8871.86	95.4272.92	10085.61
Intravenous thrombolysis rate (%)	10.04	13.37	14.26
Door-to-Needle time (median)	54.5	64	41
Mechanical thrombectomy rate (%)with/without iv thrombolysis	2.32	3.46	4.76
Door-to-Groin time (median)	54.5	64	55.5
mRS (discharge) median	3	3	3
Hospital stay (median)	8	7	8
Mortality rate (%)	11.01	12.92	8.39
Dysphagia screening (%)	74.31	81.25	81.75
Rehabilitation asessment (%)	81.65	76.67	95.26
Discharge
Home	59.94	61.25	57.30
Same center	3.98	5.00	7.66
Another center	14.68	9.58	15.69
Social facility care	10.40	11.25	10.95
Secondary prevention
%antihypertensives (all stroke)	86.60	84.69	89.64
% antiplatelets after ischemic stroke without AF	86.88	94.87	96.10
% anticoagulants (prescribed in all AF patients)	78.57	76.56	81.67
% statins prescribed	56.70	57.89	60.96

Conclusion: Our results showed a reduction of stroke patients’ admissions in both periods; reduced numbers of female patients and patients with subarachnoid hemorrhage, and transfers among hospitals with prolonged door-to-needle time and door-to-groin time during the first wave of COVID-19 pandemic. The usage of revascularization therapies has shown a slight increase in the evaluated period.

Disclosure: No

P0565 / 424

PREVALENCE OF CEREBROVASCULAR MRI MARKERS IN HOSPITALIZED PATIENTS WITH COVID-19

T.J. van Lith ¹, N.T Wijers², W.M Sluis³, F.J. Meijer⁴, K. Kamphuis - Van Ulzen⁴, J. de Bresser⁵, J.W. Dankbaar⁶, F.A Klok⁷, A.M Tuladhar¹, S.CC Cannegieter⁸, M.JH Wermer², HB van der Worp³, M.V Huisman⁷, F.E. de Leeuw¹

¹Radboud University Medical Center, Neurology, Nijmegen, Netherlands, ²Leiden University Medical Center Leiden, Neurology, Leiden, Netherlands, ³University Medical Center Utrecht, Neurology, Utrecht, Netherlands, ⁴Radboud University Medical Center, Radiology, Nijmegen, Netherlands, ⁵Leiden University Medical Center Leiden, Radiology, Leiden, Netherlands, ⁶University Medical Center Utrecht, Radiology, Utrecht, Netherlands, ⁷Leiden University Medical Center Leiden, Thrombosis and Hemostasis, Leiden, Netherlands, ⁸Leiden University Medical Center Leiden, Clinical Epidemiology, Leiden, Netherlands

Background and aims: COVID-19 is complicated by symptomatic ischemic stroke in 1% to 3% in small selected studies of hospitalized patients. We aimed to assess the prevalence of cerebrovascular MRI markers and its causes in large samples of unselected patients with COVID-19, compared to healthy controls, which is unknown.

Methods: CORONIS is an ongoing observational cohort study in adult hospitalized patients with COVID-19. Patients without clinically overt stroke undergo standardized questionnaires, cognitive assessment, blood sampling, cardiac echo, telemetry and brain MRI within 90 days after COVID-19 infection. Controls undergo standardized questionnaires and brain MRI. MRI markers include (acute) ischemic lesions, microbleeds, white matter hyperintensities, and intracranial vessel wall abnormalities and contrast enhancement. Brain MRI will be repeated after 3 months in a subset of patients. Cognitive function and functional outcome are assessed after 3 and 12 months after baseline measurements.

Results: This is an ongoing study with preliminary results. Between April and December 2021, we recruited 88 patients with a median age of 59 years (IQR 49.3-67.8), of whom 59 (67%) are men and 25 (28%) had been admitted to the ICU. DWI lesions were found in 1 patient (1%), microbleeds in 22 patients (23%) and white matter hyperintensities in 66 (75%). Intracranial vessel wall enhancement was seen in 16%. Control results will follow.

Conclusions: The CORONIS study will provide insight into the frequency and risk factors of MRI markers of cerebrovascular lesions and its relation with long-term functional outcome in hospitalized adult patients with COVID-19.

Disclosure: No

P0566 / 1506

STROKE AND HIV INFECTION IN A TERTIARY HOSPITAL SETTING IN FREETOWN, SIERRA LEONE. CLINICAL PERSPECTIVES AND OUTCOMES

M. Baldeh ^1,2, D. Youkee², J. O’Hara², S. Lakoh¹, C. Sackley^2,3

¹University of Sierra Leone, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone, ²King’s College London, King’s Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, London, United Kingdom, ³University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom

Background and aims: Stroke accounts for about 10% of global mortality and is a major cause of death in Sub-Saharan Africa. Increased risk of stroke is linked to HIV, especially in the young, resulting in a considerable rise in stroke incidence in Sub-Saharan Africa. Although there is increasing access to ART, the burden of advanced HIV, treatment failure, and undiagnosed infection remains high. The aim of this study is to assess the epidemiological burden and nature of HIV-related stroke in a major tertiary hospital in Sierra Leone.

Methods: A prospective observational hospital-based stroke register was used to recruit all people with stroke aged 18 years and above from May 1, 2019, to October 8, 2021. The National AIDS (NAS) register was used to confirm the retroviral status and adherence to ARV therapy. Focal neurological deficit and associated stroke presentation were confirmed clinically via CT imaging.

Results:

• Provisional findings demonstrate 1106 patients recruited in the first 24 months. 927 of the total were classified as stroke.

• 473 (51%) of total stroke patients were tested for HIV, 35/473 (7.4%) were HIV+ve, 48% were male, and a mean age of 48 years.

• Stroke type: Ischaemic (68.6%), Haemorrhagic (17.1%), Sub-arachnoid (2.9%), and Undetermined (11.4%). Complications included hypertension: 62.7%, and diabetes mellitus: 11.8%.

Conclusions:

• This is the first study done in Sierra Leone on the prevalence of stroke in People Living with HIV infection (PLHIV).

• Further work is required to assess longer-term outcomes, secondary stroke prevention, and the effects of antiretroviral therapy.

Disclosure: No

P0567 / 361

ISCHEMIC STROKE SHORTLY AFTER VACCINATION AGAINST SARS-COV-2: A CASE-CONTROL STUDY

L. Vinciguerra¹, V. Puglisi², A. Giossi ¹, V. De Giuli¹, F. Caprioli², C. Costanzi², E. Pari², M.C. Trapasso², S.M. Tripodi², B. Censori²

¹ASST Cremona, Neurology Unit, Cremona, Italy, ²ASST Cremona, Cremona, Italy

Background and aims: Vaccination against SARS-CoV-2 has been associated with rare occurrences of cerebral venous thromboses. Very little data exist about arterial ischemic strokes. We have assessed the features of ischemic strokes occurring shortly after vaccination against SARS-CoV-2 in the Cremona area, Italy.

Methods: From February 1, to July 31, 2021, all patients with ischemic stroke within four weeks of vaccination against COVID-19 admitted to our stroke unit were consecutively collected, and their main features were compared with those of all other patients with ischemic strokes admitted during the same period.

Results: Sixteen strokes shortly after vaccination were collected. They represented 10.5% of all ischemic strokes. Median interval from vaccination was 12 days (range 1-24). Fifteen (93.8%) had received the BNT162b2 (Pfizer–BioNTech) vaccine and 1 (6.2%) the ChAdOx1 nCoV-19 (AstraZeneca). Two patients (12.5%) had mild thrombocytopenia on admission (128,000 and 142,000/ml), without any evidence of bleeding or venous thrombosis. Thrombolysis and/or thrombectomy were carried out in 4 cases (25.0%). When compared with 137 strokes without recent vaccination, none of the demographic, clinical, and laboratory features of post-vaccination strokes were significantly different.Conclusions: This is the largest description of ischemic strokes shortly after COVID-19 vaccination. Strokes features were mostly similar to those of other stroke patients. Thus, the relatively high percentage of such patients probably relates to the very high fraction of elderly people vaccinated against SARS-CoV-2 in the Cremona area, rather than to a consequence of vaccination. These data may also be useful to counsel patients about future vaccinations.

Disclosure: No

P0568 / 346

EFFECTS OF LOW MOLECULAR WEIGHT HEPARIN AND FONDAPARINUX ON MORTALITY, HEMORRHAGIC AND THROMBOTIC COMPLICATIONS IN COVID-19 PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

L. Palaiodimou ¹, P. Fragkou², M.-I. Stefanou¹, A. Katsanos³, V. Lambadiari², D. Paraskevis², E. Andreadou², D. Dimopoulou², C. Zompola¹, P. Ferentinos², T. Vassilakopoulos², A. Kotanidou², P. Sfikakis², S. Tsiodras², G. Tsivgoulis¹

¹National and Kapodistrian University of Athens, Second Department of Neurology, Athens, Greece, ²National and Kapodistrian University of Athens, Athens, Greece, ³Population Health Research Institute, McMaster University, Hamilton, Canada

Background and aims: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation (AC) dose in COVID-19.

Methods: We conducted a living systematic review and meta-analysis on the effects of different low molecular weight heparin (LMWH) and/or fondaparinux doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients. MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH or fondaparinux among confirmed COVID-19 cases.

Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between AC and mortality during the following comparisons: a) no AC versus any AC; b) prophylactic versus higher than prophylactic AC; c) prophylactic versus therapeutic AC; d) intermediate versus therapeutic AC; and e) lower than therapeutic versus therapeutic AC. However, the risk for all-cause mortality was higher in patients receiving prophylactic versus intermediate AC (OR=2.01; 95%CI: 1.19-3.39). No associations were detected between the intensity of AC and the risk of thrombotic and hemorrhagic events, except the significantly lower risk for hemorrhage in patients on prophylactic compared to higher AC doses.

Conclusions: The risk for all-cause mortality was significantly higher in patients receiving prophylactic AC compared to those on an intermediate dose of AC. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies.

Disclosure: No

P0569 / 1507

FUNCTIONAL OUTCOME OF STROKE IN ACUTE SARS-COV2 INFECTION: A MULTICENTER STUDY IN MEXICO

D. Hernández-Santamaría ¹, V. Cano-Nigenda², A. Arauz³, A. Ruíz-Franco¹, A. Hampshire², D. López-Mena², A.I. Camacho Gamez², R.A. García Santos⁴, D.S. López González⁴, M.S. RodrígueZ RodrígueZ⁵, F.J. Soto Moreno⁵, M. González Navarro⁵

¹Juárez Hospital of Mexico, Neurology, Mexico City, Mexico, ²National Institute of Neurology, Cerebrovascular disease, Mexico City, Mexico, ³National Institute of Neurology, Medical Director, Mexico City, Mexico, ⁴National Institute of Respiratory Diseases, Neurology, Mexico City, Mexico, ⁵National Institute of Respiratory Diseases, CIENI-INER, Mexico City, Mexico

Background and aims: Coronavirus disease 2019 (COVID-19) has been associated with stroke. Our proposal was to estimate the functional outcome (FO) of stroke associated with acute SARS-CoV2 infection in Mexico.

Methods: We performed an observational, retrospective, multicenter study that included patients with stroke from May 2020 to November 2021. The population was divided in patients with COVID-19 (defined by positive PCR or thórax tomography with CO-RADS 4-5) and without COVID-19. FO was assessed with the modified Rankin scale (mRs) at discharge as good (0-2) or poor (3-6).

Results: 998 patients with stroke were included, 87(8.7%) had COVID-19 diagnosis, 534(53.5%) were men, the mean age was lower in COVID-19 patients [59±15 versus 65±15 years old (range 16-99); p=0.002]. There were 762(76.4%) patients with ischemic stroke (IS), 164(16.4%) spontaneous intracerebral hemorrhage (SIH), 50(5%) transient ischemic attack (TIA) and 22(2.2%) cerebral venous thrombosis (CVT). TIA was more frequent in non COVID-19 patients [48(5.2%) versus 2(2.2%)] while CVT was more frecuent in COVID-19 patients [8(9.1%) versus 14(1.5%)]. There was no significant difference between the frequencies of IS and SIH between groups. COVID-19 patients had poorer FO than non COVID-19 patients [66(75.8%) versus 580(63.6%); p=0.023]. Mortality was also higher in patients with COVID-19 [14(16 %) versus 54(5.9%); p=0.002].

Conclusions: In our study, functional outcome of stroke in patients with acute SARS-CoV2 infection was worst than in patients without it. Also mortality was higher in these patients. Prompt diagnosis and high-quality acute stroke treatment should be emphasized in patients with SARS-CoV2 infection.

Disclosure: No

P0570 / 1176

CEREBRAL MICROBLEEDS IN PATIENTS WITH NEUROLOGICAL SYMPTOMS ASSOCIATED WITH COVID-19: DISTRIBUTION AND POSSIBLE PATHOPHYSIOLOGICAL MECHANISMS

A. Accorroni ¹, L. Sveikata^1,2,3, M. Uginet¹, G. Breville¹, P. Stancu¹, K.-O. Lövblad⁴, G. Allali⁵, F. Assal¹

¹Geneva University Hospital, Clinical Neurosciences, Geneva, Switzerland, ²Massachusetts General Hospital, Harvard Medical School, Neurology, Boston, United States, ³Lithuanian University of Health Sciences, Institute of Cardiology, Kaunas, Lithuania, ⁴Geneva University Hospital, Neuroradiology, Geneva, Switzerland, ⁵Lausanne University Hospital and University of Lausanne, Leenaards Memory Center, Lausanne, Switzerland

Cerebral microbleeds (CMB) emerged as a possible complication of COVID-19. We aimed to assess CMB presence, distribution, and potential underlying pathophysiological mechanisms in hospitalised COVID-19 patients.

In a cohort of 112 COVID-19 patients with neurological symptoms admitted to the Geneva University Hospital between March 2020 and May 2021, we assessed CMB distribution, and associations with clinical/radiological variables. Neuroimaging was performed on a 1.5 T MRI with susceptibility-weighted images, 3D time-of-flight angiography, and 3D-contrast-enhanced fat-saturated T1 black blood VISTA sequences. Two neurologists rated CMB using the Microbleed Anatomic Rating Scale and white matter hyperintensities using the Age-Related White Matter Changes score.

53 patients (47.0%) had CMB; in 45.3% of cases, CMB were found in lobar regions with a predilection for temporal (58.3%) and frontal (29.2%) lobes. Deep CMB were present in 18.9%, with corpus callosum CMB found in 15.0%, in 35.9% CMB distribution was mixed. CMB presence was not related to intubation, pulmonary involvement, nor to radiologic signs of endothelitis. Patients with CMB were more likely to have a higher burden of white matter hyperintensities (OR 1.13, p=0.005, 95% CI: 1.03-1.24), to have hypertension as a comorbidity (OR= 2.34, p= 0.04, 95% CI: 1.04 – 5.30) and to suffer from an acute stroke during hospitalisation (OR: 3.50 p= 0.012, 95% CI:1.31-9.18).

In our sample, COVID-19 patients with neurological symptoms had a high burden of CMB. Their distribution suggests that they may be related to cardiovascular risk factors and cerebral amyloid angiopathy. CMB were also associated with an increased risk of acute stroke.

Disclosure: No

P0571 / 1089

PREVALENCE OF STROKE IN MUCORMYCOSIS PATIENTS WITH COVID-19 INFECTION IN INDIA

P. Tangri ¹, A.K. Pandit¹, P.M.P. Srivastava¹, P.A.K. Srivastava¹, V. VY¹, R. Ranjan¹, R.K. Singh¹, D. MR¹, A. Das¹, A. Agarwal¹, S. Misra^1,1

¹ All India Institute of Medical Sciences, Department of Neurology, New Delhi, India

Background: During the second wave of COVID-19, India suffered from a catastrophic outburst of cases and rapid transmission of disease due to the highly infectious delta strain (B.1.617.2). Patients infected with this strain underwent prolonged hospitalisations, suffered from severe symptoms. A sudden surge of fungal infections, primarily Mucormycosis was observed.

Methods: We conducted a case-control study to study various risk factors and form of intracranial involvement in cases of Mucormycosis.

Results: Study included 121 patients in total; out of which 61 were Mucormycosis patients with prior COVID-19 infection. 30 out of 61 Mucormycosis patients had intracranial involvement with majority having stroke in the form of the either infarct (10 patients, 34%); or haemorrhage (3 patients, 10%) and thrombosis of artery involvement (8 patients, 29%). Other intracranial form of involvement was abscess (6 patients, 20%) and meningitis (2 patients, 7%). The most frequent type of infarcts were lacunar infarcts and the most common location of infarcts were middle cerebral artery (MCA) or anterior cerebral artery (ACA). Patients were treated with administration of Amphotericin B and Posaconazole. Telephonic follow-up was conducted after a time period of about 90 days and their health condition was recorded on basis of modified ranking scale (mRS). Out of the 30 Mucormycosis infection patients displaying the occurrence of stroke, 10 patients could not survive.

Conclusion: Intracranial Mucormycosis in COVID19 patients presenting with stroke were observed frequently and had mortality in about one-third cases.

Disclosure: No

P0572 / 171

RECURRENCE OF CEREBRAL VENOUS THROMBOSIS IN PATIENTS IMMUNIZED AGAINST SARS-COV-2: A COHORT STUDY

J. Barreto de Farias ¹, J. Paste Silva¹, L. Rodrigues Ribeiro¹, G. Praxedes Freire¹, P. Fernandes Abbade¹, P.A. Castro Carvalho de Jesus¹, V.L. Peixoto Pereira Botelho¹, E. Aguiar Wittlich¹, T. Cerqueira-Silva¹, P.A. Pereira de Jesus¹, J. Oliveira-Filho¹

¹ Federal University of Bahia, Salvador, Brazil

Background and aims: Cerebral venous thrombosis (CVT) is a rare neurological condition. Several cases of CVT have been described in patients with SARS-CoV-2 infection and following vaccination against COVID-19 with ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines through vaccine-induced thrombotic thrombocytopenia (VITT). This study aims to analyze the CVT recurrence rate in patients immunized against SARS-CoV-2.

Methods: Ambispective cohort study. Patients aged > 18 years and diagnosed with CVT between 2000-2021 were included and prospectively evaluated for vaccine-related events.

Results: A total of 67 patients were included, 18 of which are still under etiological investigation (26.9%). Mean age was 43.5 ± 13.5 years and 47 patients were female (70.1%). Use of oral contraceptives was the most frequent cause in the sample (35.8%). Two patients in the sample had CVT from vaccine-induced thrombotic thrombocytopenia (VITT) with ChAdOx1 nCoV-19 vaccines (3.0%) and one had CVT from SARS-CoV-2 infection (1.5%). After the index CVT event, 33 patients have been immunized against SARS-CoV-2 with two doses (49.3%), 7 patients have been immunized with one dose (10.4%), 6 patients have not yet been immunized (9.0%). Of the 40 patients immunized after the index event, 28 (70%) were using oral anticoagulants and the remaining 12 patients had already completed one year of anticoagulation. There was no recurrence of CVT after immunization.

Conclusions: Despite being related to a higher occurrence of CVT through VITT, vaccines against SARS-CoV-2 do not appear to increase the risk of CVT recurrence in this population.

Disclosure: No

ATHEROSCLEROSIS & STROKE

P0573 / 584

PLATELETS-DERIVED MIR-200A-3P MODULATE THE EXPRESSION OF ET-1 AND VEGFA IN ENDOTHELIAL CELLS VIA TARGETING MAPK14

J. Yang ^1,2, H. Xu³, J. Hao⁴, X. Yan³

¹Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Department of Neurology, Chengdu, China, ²Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China, ³Chengdu Medical College, School of Pharmacy, Chengdu, China, ⁴Chengdu Medical College, School of Bioscience and Technology, Chengdu, China

Background and purpose: Platelets play a pivotal role in acute ischemic stroke (AIS),especially in atherosclerosis formation, through active interaction with various cells,such as neutrophils,monocytes, and vascular endothelial cells.However,the underlying mechanism of interaction between platelets and endothelial cells in the AIS remains incompletely clear.The aim of this study was to screen for different miRNAs from AIS patients and healthy controls,to investigate a potential release of miRNAs from activated platelets and to elucidate the miRNA function in the development of AIS.

Methods: Based on the data of RNA-seq, levels of 5 selected miRNA in platelets isolated from whole blood were examined by qRT-PCR.To harvest miR-200a-3p-enriched MV,platelets were transfected with Cy5-miR-200a-3p mimic.Platelets-derived MV (PMV) were identified by NTA,TEM and western blotting.Protein content and mRNA levels of cell lysate were analyzed by western blot assay and qRT-PCR, while serum ET-1and VEGFA levels were detected by ELISA.

Results: Our study found that miR-200a-3p expression was significantly elevated in both serum MVs and platelets of AIS patients compared with healthy controls,which was associated with the severity and development of AIS.Moreover, platelets could remotely modulate ET-1 and VEGFA levels in vascular endothelial cells through release of miR-200a-3p-containing PMV to targeting MAPK14.Furthermore, platelet miR-200a-3p levels with serum ET-1 and VEGFA levels could document a moderate predictive biomarker for AIS occurrence.

Conclusions: Our results presented the new evidence that activated platelets could remotely modulate ET-1 and VEGFA expression in vascular endothelial cells via releasing miR-200a-3p-enriched PMV, which provides a potential miRNA-based predictive biomarker and therapeutic strategy for AIS.

Disclosure: No

P0574 / 1329

PREVALENCE OF COMPLEX AORTIC ATHEROSCLEROTIC PLAQUES IN PATIENTS WITH ISCHEMIC STROKE

Z.B. Özata ¹, L.A. Rinkel¹, V. Guglielmi¹, C.F.P. Beemsterboer¹, N.-S. Groeneveld¹, N.H.J. Lobé², M. Boekholdt³, B.J. Bouma³, F.F. Muller¹, L.F.M. Beenen², H.A. Marquering⁴, C.B.L.M. Majoie², Y.B.W.E.M. Roos¹, A. van Randen², N. Planken², J.M. Coutinho¹

¹Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, Netherlands, ²Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Amsterdam, Netherlands, ³Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands, ⁴Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine & Biomedical Engineering and Physics, Amsterdam, Netherlands

Aim and objectives: Atherosclerotic plaques in the aorta are associated with an increased risk of ischemic stroke. Our aim was to report the prevalence and characteristics of complex aortic atherosclerotic plaques (CAAP) in patients with acute ischemic stroke.

Methods: We used data from Mind-the-Heart, a prospective cohort study of ischemic stroke patients undergoing cardiac computed tomography (CT) during acute stroke work-up. We assessed the prevalence of CAAP (defined as non-calcified plaques with >4mm thickness, ulceration or superimposed thrombus), and compared functional outcome (modified Rankin scale score) and stroke recurrence at 90 days in patients with and without CAAP.

Results: We included 452 patients with acute ischemic stroke. The prevalence of CAAP was 106/452 (23%) in all patients and 33/163 (20%) in patients with cryptogenic stroke. Frequency of CAAP characteristics were 99 (22%) for plaque thickness>4mm, 29 (6%) for ulceration and 7 (2%) for superimposed thrombus. CAAP were present in the descending aorta (74/452, 17%), aortic arch (27/452, 6%) and ascending aorta (5/452, 1%). There was no association between CAAP and worse functional outcome (adjusted common odds ratio 1.41, 95% confidence-interval CI 0.91–2.19). Recurrent ischemic stroke rates were similar between patients with and without CAAP (5% in both groups).

Conclusion: CAAP were present in almost a quarter of acute ischemic stroke patients, but mostly in the descending aorta. We found no association with functional outcome or stroke recurrence.

Disclosure: No

P0575 / 104

ASSESSMENT OF THE DIAGNOSTIC ACCURACY OF TRANSCRANIAL DOPPLER ULTRASOUND (TCD) FOR MIDDLE CEREBRAL ARTERY (MCA) ATHEROSCLEROSIS STENOSIS ⩾70%

M. Toudou Daouda ¹, C. Alecu²

¹Centre Hospitalier Sud Francilien, Neurology, Corbeil-Esonnnes, France, ²Centre Hospitalier Universitaire de Nice, Neurology, Nice, France

Background and aims: Intracranial stenosis (ICAS) is a common cause of ischemic cerebrovascular events (ICE) and is associated with a high risk of stroke recurrence. Several studies had shown that TCD is a reliable method to diagnosis ICAS comparable to DSA or CTA, but there are not enough data for the detection of ICAS⩾70%. We aimed to assess the accuracy of TCD compared to CTA in the diagnosis of MCA stenosis ⩾70%.

Methods: A prospective observational study of routine care was carried out, including 40 patients aged ⩾18 years hospitalized for ICE in whom MCA stenosis was identified on CTA. For each stenosis, TCD findings were compared to the degree of stenosis blindly identified on CTA used as the gold standard. The prevalence of inadequate acoustic windows was 22.5%.

Results: To detect a stenosis ⩾70%, PSV⩾320 cm/s had a sensitivity of 80% and a specificity of 61.9% ( p=0.009 ), and stenotic/prestenotic ratio (SPR) ⩾3 had a sensitivity of 77.8% and a specificity of 84.6% ( p<0.001 ). MCA/ACA velocities ratio <0.7 had a sensitivity of 71.4% and a specificity of 64.3% to detect upstream amortization of MCA secondary to downstream M1 stenosis ⩾70% ( p=0.044 ). We find a high linear correlation between degree of stenosis measured on CTA with PSV (r=0.637, p<0.001 ), SPR (r=0.725, p<0.001 ), and MCA/ACA ratio (r=-0.601, p=0.004 ).

Conclusions: This study shows that SPR⩾3 and PSV⩾320cm/s had a high sensitivity to detect MCA stenosis ⩾70%. MCA/ACA ratio is a good indirect sign of the M1 MCA stenosis ⩾70%.

Disclosure: No

P0576 / 662

VALIDATION OF PREDICTION MODELS OF IPSILATERAL ISCHEMIC STROKE IN PATIENTS WITH MEDICALLY TREATED ASYMPTOMATIC CAROTID STENOSIS

M. Poorthuis ¹, J. Greving², F. Visseren³, M. Bots², G. de Borst⁴

¹UMC Utrecht, Department of Neurology, Utrecht, Netherlands, ²UMC Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands, ³UMC Utrecht, Department of Vascular Medicine, Utrecht, Netherlands, ⁴UMC Utrecht, Department of Vascular Surgery, Utrecht, Netherlands

Background: Improvement in medical therapy has reduced the risk of stroke in patients with asymptomatic carotid stenosis (ACS) substantially, challenging the routine use of carotid revascularization procedures. Prediction models might identify a group of patients that remain at high stroke risk despite medical therapy in whom carotid revascularization procedures might have a clinical benefit. We identified prediction models to predict stroke in patients with ACS and externally validated these models.

Methods: A systematic search was conducted for prediction models of the incidence of stroke in medically treated ACS patients. Prediction models were validated in a cohort of 613 ACS patients who were included in the SMART-study. 22 patients developed an ipsilateral hemispheric or retinal infarct during the first 10-years of follow-up (4059 person-years; 10-year risk of 5.4%). Discrimination was assessed using c-statistics and agreement between predicted and observed 10-year risks using calibration plots.

Results: Two articles presented seven prediction models. These were originally developed in the Asymptomatic Carotid Artery Stenosis (ACAS) trial (4 models) and Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study (3 models). Evaluating the performance of the models in showed c-statistics between 0.56 and 0.65. ACAS Model 3, with the highest c-statistic of 0.65 (95%CI 0.54-0.76), showed good concordance between predicted and observed risks after recalibration. The 10-year risk of ipsilateral ischemic stroke was 6.7% (95%CI 2.8%-10.5%) in the highest tertile of risk.

Conclusion: The recalibrated ACAS model 3 showed the best performance and can inform medically treated ACS patients about their ipsilateral stroke risk.

Disclosure: No

P0577 / 244

INTRACRANIAL ARTERIAL STENOSIS WITH RNF213 P.R4810K VARIANT ASSOCIATES WITH A LOW ATHEROSCLEROTIC BURDEN

M. Ohara ¹, T. Yoshimoto², S. Okazaki¹, Y. Gon¹, K. Todo¹, T. Sasaki¹, J. Takasugi³, N. Ohara³, M. Ihara², H. Mochizuki¹

¹Osaka University Graduate School of Medicine, Suita, Japan, ²National Cerebral and Cardiovascular Center, Suita, Japan, ³Kobe City Medical Center General Hospital, Kobe, Japan

Figure 1

Background and aims: The p.R4810K variant of ring finger protein 213 gene (RNF213) is a major susceptibility gene for moyamoya disease and intracranial arterial stenosis in East Asia. We hypothesized that if intracranial arterial stenosis is induced by a non-atherosclerotic mechanism, patients with RNF213 p.R4810K variant may have a lower cumulative atherosclerotic burden.

Methods: A total of 112 participants with intracranial arterial stenosis were enrolled in this multicenter cross-sectional study. We compared the prevalence of atherosclerotic risk factors and three different cardiovascular risk scores between carriers and non-carriers. Patients with moyamoya disease were excluded from the study.

Results: The RNF213 p.R4810K variant carriers were younger than the non-carriers (P < 0.001). The prevalence of each atherosclerotic risk factor was not significantly different between the carriers and non-carriers. The Essen stroke risk score (carriers: 2.3 ± 1.5 vs. non-carriers: 2.9 ± 1.5, P = 0.047), Framingham risk score (10.7 ± 6.4 vs. 15.3 ± 6.2, P = 0.001), and Suita risk score (35.4 ± 15.8 vs. 48.7 ± 15.2, P < 0.001) were significantly lower in the variant carriers (Figure 1). Among the three risk scores, the Suita score showed the highest predictive accuracy for the variant carriers.

Conclusions: RNF213 p.R4810K variant carriers have a lower cumulative atherosclerotic burden than non-carriers in patients with intracranial arterial stenosis. New therapeutic approaches beyond the standard management of atherosclerotic risk factors are required to prevent the development of intracranial arterial stenosis.

Disclosure: No

P0578 / 1504

CLINICAL IMPLICATION OF CAROTID PLAQUE IMAGING IN SYMPTOMATIC STROKE PATIENTS.

T. Zadi ¹, P. Nederkoorn², J. Hendrikse³, M. Kooi⁴, A. van der Lugt¹, D. Bos⁵

¹Erasmus Medical Center, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands, ²Academic Medical Center, Department of Neurology, Amsterdam, Netherlands, ³University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht, Netherlands, ⁴Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, Maastricht, Netherlands, ⁵Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands

Background and aims: The decision to perform carotid endarterectomy (CEA) in symptomatic stroke patients is driven by the extent of luminal narrowing(>70%). Symptomatic patients with <70% stenosis are currently not qualified for CEA. However, increasing evidence demonstrates that specific vulnerable plaque characteristics harbor large risks of stroke, independent of the degree of luminal narrowing. The aim of this study is to investigate imaging biomarkers as selection criteria for CEA in patients with a carotid stenosis of <70%, and their risk of a recurrent stroke.

Methods: The PARISK-study is a prospective cohort study with TIA/minor-stroke patients with ipsilateral carotid artery stenosis (<70%). We included 238 patients (29% women, mean age 66 years) whom underwent a magnetic-resonance-imaging (MRI), computed-tomographic-angiography, ultrasonography and transcranial-Doppler at baseline. Follow-up was at 3 months, every single year (case record form) and after two-year (MRI). An endpoint was the occurrence of an ipsilateral recurrent stroke. Trained readers blinded for clinical data evaluated the assessments of clinical and imaging characteristics.

Results: Most patients had (NASCET) 0-30% stenosis (146/200,76%). Lipid-rich necrotic core had the highest occurrence in recurrent stroke patients(33/56,59%), yet comparable to the occurrence in patients without recurrent stroke(109/182,60%). However, intraplaque hemorrhage (IPH) was seen less in recurrent stroke patients(26/56,46%), yet exceptionally higher represented compared to the patients without recurrent stroke(61/182,34%). Analysis of the risk of recurrent stroke showed a significant correlation with IPH(HR 2.299[95%CI:1.282-4.123]).

Conclusions: The use of imaging features as described in guidelines, gives an overestimation of high-risk patients. However, IPH might be a potential independent predictor of ipsilateral ischemic stroke.

Disclosure: No

P0579 / 1394

ASSOCIATION OF INTIMA-MEDIA-THICKNESS WITH FIRST PASS REPERFUSION IN PATIENTS WITH LARGE ANTERIOR VESSEL OCCLUSION UNDERGOING ENDOVASCULAR THERAPY

S. Winzer ¹, K. Laske¹, D. Kaiser², K. Hädrich², T. Siepmann¹, K. Barlinn¹, J. Barlinn¹, J.C. Gerber², V. Puetz¹, L.-P. Pallesen¹

¹Carl Gustav Carus University Hospital, Technische Universität Dresden, Neurology, Dresden, Germany, ²Carl Gustav Carus University Hospital, Technische Universität Dresden, Neuroradiology, Dresden, Germany

Background and aims: First pass reperfusion (FPR) is associated with favourable outcome after endovascular therapy (EVT) in stroke patients with anterior circulation large vessel occlusion (acLVO). Stroke etiology may influence FPR rates with presumably lower values in patients with large artery disease. We tested whether intima-media-thickness (IMT) on duplex-sonography of the common carotid artery as a marker of atherosclerosis is associated with lower chance for FPR.

Methods: We retrospectively analysed consecutive patients with acute ischemic stroke due to acLVO from our prospective EVT registry. We determined IMT on routinely performed duplex-ultrasound examinations and categorized IMT into normal, borderline increased and increased according to age-dependent thresholds and assessed the association of successful FPR with IMT.

Results: Among 298 patients with acLVO who presented during the study period (median age 75 years [IQR 17], 143 [48%] male, baseline NIHSS score 17 [IQR 8], 61,4% i.v. thrombolysis), FPR was achieved in 126 (42.3%) cases. There was no difference in mean IMT between patients with FPR compared to patients without FPR (0.85mm [IQR 0.16] vs. 0.34mm [IQR 0.22]; p=0.61). Furthermore, age-dependent IMT thresholds were not associated with FPR (normal IMT: 45% vs. 51% [p=0.38]; borderline increased IMT 38% vs. 31% [p=0.29] and increased IMT 17% vs. 18% [p=0.87], respectively).

Conclusion: In patients with acute ischemic stroke due to acLVO who received EVT, IMT as a marker of atherosclerotic large artery disease was not associated with FPR.

Disclosure: No

P0580 / 1020

WHAT IS THE IMPACT OF FULL COLLAPSE IN THE RISK OF ISCHEMIC STROKE IN PATIENTS WITH CAROTID NEAR-OCCLUSION? A META-ANALYSIS

A. García Pastor ¹, A.M. Iglesias Mohedano¹, Y. Fernandez Bullido¹, M. Vales Montero¹, F. Díaz Otero¹, P. Vázquez Alén¹, A. Gil Núñez¹

¹ Hospital General Universitario Gregorio Marañón, Neurology, Madrid, Spain

Background and aims: Natural history of carotid near-occlusion (CNO) is still not well known. The presence of full collapse (FC) has been identified as a predictor of increased risk of stroke in patients with CNO. However some studies did not confirm this. Our aim was to investigate the impact that FC may have on the risk of stroke in patients with CNO treated medically.

Methods: We performed a Pubmed search from inception to December 2021. Studies including patients with CNO treated only with medical treatment and recording the presence or absence of FC were selected for this meta-analysis. The primary outcome was ipsilateral ischemic stroke or retinal ischemia. Two follow-up periods were considered: short-term (90 days) and long-term (1 year). Patients with CNO with FC (FC+) and without FC (FC-) were compared.

Results: 4 studies were eligible including 296 patients (107 FC+ and 189 FC-). The primary outcome occurred in the short-term follow-up in 28 patients (9.5%): 16 in the FC+ group (15%) and 12 in the FC- (7.6%) and in 41 patients (13.8%) in the long-term, 19 (17.8%) FC+ and 22 (11.6%) FC-. The pooled risk ratio (RR) at short-term for the FC+ group was 1.86 (95% CI 0.61 – 5.67) with I²=21%, and at long-term 1.44 (0.37 – 5.68), I²=57%.

Discusion: These results do not seem to confirm the increased risk of stroke associated with FC. Larger studies are needed to clarify the effect of FC on the risk of stroke in patients with CNO.

Disclosure: No

P0581 / 1098

DISTINCT LIPID PROFILES OF RADIATION-INDUCED CAROTID PLAQUES FROM ATHEROSCLEROTIC CAROTID PLAQUES REVEALED BY UPLC-QTOF-MS AND DESI– MSI

X. Zhang ¹, W. Li¹, T. Wang¹, J. Zhu², X.-Y. Li², F. Peng³, J. Dai³, J. Wang⁴, L. Zhang⁴, Y. Wang¹, X. Chen⁵, T. Xue⁵, C. Ding³, C. Wang², L. Jiao¹

¹Xuanwu Hospital, Capital Medical University, Department of Neurosurgery, Beijing, China, ²Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China, ³National Center for Occupational Safety and Health, Beijing, China, ⁴Liaocheng Brain Hospital, Department of Neurosurgery, Liaocheng, China, ⁵Zhongguancun Biological and Medical Big Data Center, Beijing, China

Background and aims: Radiotherapy is a standard treatment for head and neck tumors that significantly increases patients’ long-term survival rates. However, late cerebrovascular complications, especially carotid artery stenosis (CAS), have gained increasing attention. Investigation of biomarkers of radiation-induced CAS may help to elucidate the mechanism by which radiation induces damage to blood vessels and identify possible preventive measures against such damage.

Methods: In this study, we used lipidomics strategy to characterize the lipids present in 8 radiation-induced carotid plaques (RICPs) and 12 atherosclerotic carotid plaques (ASCPs). We also used desorption electrospray ionization–mass spectrometry imaging (DESI–MSI) to map the spatial distribution of the screened lipids from 2 RICPs samples and 2 ASCPs samples.

Results: The results showed that 31 metabolites in RICPs were significantly higher than that in ASCPs, 24 of which were triglycerides (TGs). We used four machine learning models to select potential indicators from the 31 metabolites. Six TGs [TG(17:2/17:2/18:0), TG(17:1/17:2/18:0), TG(17:0/17:2/18:0), TG (17:2/17:2/20:0), TG(17:1/17:2/20:0), TG(15:0/22:0/22:2)] were found to be the potential markers for distinguishing RICPs and ASCPs (AUC = 0.83). The DESI–MSI results suggested that the 6 TGs were localized in the collagen fiber regions and confirmed the differences of these TGs between the two kinds of plaques.

Conclusions: The 6 TGs primarily localized in the collagen fiber regions of plaques are likely to be potential indicators for the differentiation of RICPs from ASCPs which may have implications in the mechanisms and possible preventive measures against RICPs.

Disclosure: No

P0582 / 619

CHANGING CAROTID PLAQUE BURDEN DURING FOLLOW-UP: A LONGITUDINAL STUDY IN TIA AND ISCHEMIC STROKE PATIENTS

D.H.K. van Dam-Nolen ^1,2, O. Belmadani¹, M. Kassem³, C. Lucci⁴, M.I. Liem⁵, P.J. Nederkoorn⁵, J. Hendrikse⁴, M.E. Kooi³, A. van der Lugt¹, D. Bos^1,6

¹Erasmus University Medical Center Rotterdam, Radiology and Nuclear Medicine, Rotterdam, Netherlands, ²Erasmus University Medical Center Rotterdam, Neurology, Rotterdam, Netherlands, ³CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Radiology and Nuclear Medicine, Maastricht, Netherlands, ⁴University Medical Center Utrecht, Radiology and Nuclear Medicine, Utrecht, Netherlands, ⁵Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, Netherlands, ⁶Erasmus University Medical Center Rotterdam, Epidemiology, Rotterdam, Netherlands

Background: In patients with carotid atherosclerosis, specific plaque morphology, including total plaque burden, is predictive for recurrent stroke risk. Merely few studies are done on how plaque burden changes over time. This study’s aim was to investigate to what extent plaque burden changes during follow-up, which factors are associated with change and how this affects stroke risk.

Methods: This study was embedded in the PARISK-study, a prospective cohort study including symptomatic patients with carotid stenosis, having carotid MRI at baseline and after 2-years follow-up. We performed blinded visual assessments of plaque burden change (regression/stable/progression). We tested for differences in clinical characteristics between plaque change groups using chi-squared and ANOVA-tests. Kaplan-Meier curves were used to compare 5-year recurrent stroke rates in plaque change groups.

Results: Of all 77 included patients (mean age 66±8 years,66.2% men), 21(27.3%) patients showed plaque regression, 35(45.5%) did not show changes, and 21(27.3%) showed progression. Patients with stable plaques were older (mean age regression group:65±7 years, stable group:69±7, progression group:64±9,P=0.04) and had more often calcified plaques (percentage in regression group:80.0%, stable group:96.8%, regression group:76.2%,P=0.07). Although not statistically significant, patients with a regressed/stable plaque seemed to be more at risk for recurrent events than patients with progression (P=0.12,Figure).

Conclusions: Most carotid plaques did not change during follow-up. But remarkably, as many plaques showed regression as progression. This provides novel insights into the natural course of atherosclerosis and needs to be studied further to investigate whether plaque change is harmful of beneficial regarding stroke risk.

Disclosure: No

P0583 / 1159

ELECTRONEGATIVE LOW DENSITY LIPOPROTEIN IS ASSOCIATED WITH STENOSIS SEVERITY IN PATIENTS WITH RECENT ISCHEMIC STROKE AND CAROTID ATHEROSCLEROSIS

P. Camps-Renom ¹, N. Puig¹, A. Aguilera-Simón¹, R. Marín¹, J. Martí-Fàbregas¹, J.L. Sánchez-Quesada², A. Martínez-Domeño¹, L. Prats-Sánchez¹, A. Ramos-Pachón¹, M. Guasch-Jiménez¹, D. Guisado-Alonso¹, S. Benítez²

¹Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Stroke Unit - Neurology, Barcelona, Spain, ²Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Cardiovascular Biochemistry, Barcelona, Spain

Background and aims: Electronegative low-density lipoprotein (LDL(−)) is a modified LDL found in the circulation. Percentage of LDL(−) correlate to the severity of coronary artery disease. We studied the association between LDL(-) and plaque stenosis in patients with a recent ischemic stroke.

Methods: We conducted a prospective study (2016-2019) of patients with recent (<7 days) anterior circulation ischemic stroke and at least one atherosclerotic plaque in the internal carotid artery. Cardioembolic strokes were excluded. A blood sample was obtained at day 7±1. We also included a control group without prior history of vascular disease. Percentage of LDL(-) was obtained by isolation from total LDL by anion-exchange chromatography in an AKTA-FPLC system (GE Healthcare, USA). Multivariable logistic regression analyses were performed comparing LDL(-) percentage between stroke patients and controls, and between patients with ⩾50% and <50% stenosis.

Results: We included 64 stroke patients and 27 control participants. Diabetes (42.2%vs.18.5%), Dyslipidemia (67.2%vs.25.9%) and statin therapy (54.7%vs.22.2%) were more frequently observed in stroke patients. LDL concentration was higher in control participants than in stroke patients (median LDL 3.09vs.2.41mmol/L; p=0.002). Contrariwise, the percentage of LDL(-) was higher in stroke patients (median percentage 7.9vs.6.5; P=0.004). Among stroke patients, those presenting ⩾50% carotid stenosis showed higher percentages of LDL(-) (median percentage 8.7vs.6.2; P=0.001), but similar concentrations of total LDL. In the multivariable analysis, LDL(-) was independently associated with stenosis severity (OR=1.22, 95%CI 1.03-1.45; p=0.025).

Conclusion: Percentage of LDL(-) is associated with stenosis severity in patients with a recent ischemic stroke and carotid atherosclerosis.

Disclosure: No

P0584 / 835

SYSTEMIC INFLAMMATION IS ASSOCIATED WITH PROGRESSION OF SYMPTOMATIC INTRACRANIAL ATHEROSCLEROTIC STENOSIS UNDER OPTIMAL MEDICAL TREATMENT

X. Tian ¹, H. Liu², J. Abrigo³, L. Lan⁴, S. Li¹, Y. Liu¹, B. Ip¹, K. Ma¹, S.H. Ma¹, F. Fan¹, V. Ip¹, Y. Soo¹, A. Lau¹, V. Mok¹, T. Leung¹, X. Leng¹

¹The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong, SAR of China, ²Coventry University, Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry, United Kingdom, ³The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, Hong Kong, SAR of China, ⁴First Affiliated Hospital of Sun Yat-sen University, Department of Neurology, Guangzhou, China

Background and aims: There is a considerable risk of stroke relapse or progression of luminal stenosis in symptomatic intracranial atherosclerotic stenosis (sICAS), despite optimal medical treatment. We aimed to explore for biomarkers associated with sICAS progression.

Methods: Patients with 50-99% sICAS confirmed by computed tomography angiography (CTA) at baseline, who were scheduled for a follow-up CTA at 1 year, were enrolled. All patients received guideline-recommended optimal medical treatment. Laboratory tests including complete blood count, lipid profile and blood chemistry were performed at baseline and at least twice during 1-year follow-up. We analyzed the associations of these biomarkers at baseline/during follow-up with progression of sICAS, defined as recurrent relevant ischemic stroke or transient ischemic attack (TIA) or progression in luminal stenosis by >10% on follow-up versus baseline CTA.

Results: Among 44 patients, sICAS progressed in 11 (25.0%) patients within 1 year, 6 with recurrent relevant ischemic stroke/TIA and 5 with progression in luminal stenosis only. A higher mean level by 1 standard deviation of white blood cell (WBC) (adjusted odds ratio 2.51; 95% confidence interval 1.09-5.79; p=0.031), neutrophil (6.45; 1.73-24.07; p=0.006), neutrophil/lymphocyte ratio (NLR) (3.45; 1.29-9.24; p=0.014) and monocyte (2.93; 1.04-8.26; p=0.043) during follow-up were significantly associated with sICAS progression, independent of confounders in multivariate analyses. However, baseline levels of blood biomarkers were not significantly associated with sICAS progression.

Conclusions: Higher levels of WBC, neutrophil, NLR and monocyte were associated with progression of sICAS under currently optimal medical treatment. Systemic inflammation could be a therapeutic target in secondary prevention of sICAS.

Disclosure: No

P0585 / 1267

COMBINING HEMODYNAMIC ANALYSIS AND CAROTID PLAQUE TISSUE CHARACTERIZATION TO ASSESS PLAQUE VULNERABILITY

J. Dong ¹, L. Jiao¹

¹ Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China 45 Changchun St, Xicheng District, Beijing, China 100053, Department of Interventional Neuroradiology, Beijing, China

Objective: The purpose of this study was to assess the vulnerability of plaque using a combination of morphological characteristics of carotid plaque tissue and local hemodynamics.

Methods: carotid plaques have been obtained from 8 patients with severe carotid stenosis that underwent carotid endarterectomy. Histological analyses of tissue sections were subsequently performed and divided plaques with IPH (presence of IPH) and non-IPH (plaque with absence of IPH) groups. In total, 15 IPH groups and 31 non-IPH groups were involved in this study. For carotid tissue morphological factors included plaque area, lumen area, wall area, fiber cap area, eccentric radio, and plaque composition. For hemodynamic factors, time-averaged wall shear stress (WSS), minimum WSS, maximum WSS, and oscillatory shear index were calculated using computational fluid dynamics (CFD).

Result: Vessel area, plaque area, and fiber cap area were significantly different between the IPH and non-IPH groups (P <0.05). higher time-averaged WSS (0.78 vs 0.67pa), and max OSI (0.19 vs 0.08) were observed in the IPH group compared to the non-IPH group. In the IPH group, when using the combined analysis with pathological specimens and WSS, the WSS of the region with IPH was significantly higher than the region without IPH (1.04 vs. 0.28 Pa, p = 0.001).

Conclusions: A larger wall area, plaque area, fiber cap area, and higher time-averaged WSS were associated with IPH. The combined analysis of pathological specimens and WSS might help to evaluate the risk of carotid IPH.

Disclosure: No

RARE CAUSES, STROKE IN THE YOUNG (INCLUDING PAEDIATRIC STROKE)

P0586 / 1558

RARE PEDIATRIC STROKE: ISOLATED POSTERIOR CEREBRAL ARTERY DISSECTION

D. Chaudhari ¹, A. Mishra², P.N. Renjen¹, K. Ahmad¹,S. Pandey¹, N. Sahu¹, S. Jain¹

¹Indraprastha Apollo Hospital, New Delhi, Neurosciences, New Delhi, India, ²Holy Family Hospital, New Delhi, Critical Care Medicine, New Delhi, India

Background: Most Intracranial arterial dissections involve the vertebrobasilar system and to a lesser extent the middle and anterior cerebral arteries. Isolated dissection involving the posterior cerebral artery (PCA) is extremely uncommon.

Methods: A twelve-year-old boy, with a normal developmental history and no significant past history, presented to the emergency room of our hospital with the complaint of sudden onset diminution of vision since 4 days. He had difficulty seeing objects towards the left. It was associated with headache that was occipital in nature. He also reported an episode of sudden onset numbness in left side of the body.

Results: Visual field testing revealed an incongruous incomplete homonymous hemianopia with macular sparing. MRI brain showed ill-defined area of altered signal intensity in the right occipito-temporal lobe and adjoining part of thalamus with restricted diffusion, consistent with a right sided PCA territory infarct. In MR angiography, there was luminal narrowing and effacement of right sided PCA in the proximal part and the distal branches showed diffuse effacement. DSA revealed acute disruption of right P1-P2 junction, near total occlusion with loss of distal run off due to dissection. The patient was managed with a more conservative approach with low dose anti-platelet therapy and was discharged in a stable condition with improvement reported in the visual deficits.

Conclusions: Isolated PCA dissections are rare but most commonly occur near the P1-P2 junction. The diagnosis of intracranial dissection and dissecting aneurysms is predominantly made by DSA, which remains the gold standard technique.

Disclosure: No

P0587 / 1010

PREDICTORS AND INCIDENCE OF LONG-TERM HEADACHE IN REVERSIBLE VASOCONSTRICTION SYNDROME AND EXTERNAL VALIDATION OF THE RCVS2 SCORE

N. Kumar ¹, S. Kumar¹, V. Arsenios-Lioutas¹

¹ Beth Israel Deaconess Medical Center, Neurology, Boston, United States

Background and aims: Angiographic vasospasm in reversible cerebral vasoconstriction syndrome (RCVS) is often undetectable at symptom onset and diagnosis relies on clinical presentation. Although thunderclap headache is a hallmark feature, the incidence and predictors of long-term headaches (LTH) are incompletely understood. Our study aims were twofold: to examine sensitivity and specificity of a recently developed score (RCVS₂) for vasospasm detection in real-world clinical contexts and describe the incidence and predictors of LTH beyond the acute phase of RCVS.

Methods: Retrospective analysis of patients with clinical diagnosis of RCVS in a tertiary hospital between 2017-2021. We examined associations between demographic factors, comorbidities, medications, imaging characteristics and LTH (defined as present >6 months). We examined the association between RCVS₂score and angiographic vasospasm and computed sensitivity, specificity, negative and positive predictive value based on established cutoffs (cutoff score >5 as positive RCVS₂score; <2 as negative)

Results: We included 55 patients, 50.5 (±13.7) years, and 41 (75%) were female. 25(49%) patients had LTH; only prior history of headache was significantly associated with LTH [0R 4.3, 95%CI (1.1-16.2), p=0.03]. We found a significant association between RCVS₂ score and angiographic vasospasm [OR 1.49, 95%CI (1.18-1.88), p=0.001]; sensitivity, specificity, positive and negative predictive value were 64%, 94%, 95% and 58% respectively.

Conclusions: Approximately 50% of RCVS patients experienced LTH; only prior headache history was associated with incidence. The RCVS2 score had significant association with high specificity and positive predictive value for angiographic vasospasm, validating its utility in improving the accuracy of diagnosis in the clinical setting.

Disclosure: No

P0588 / 518

ACUTE TRIAGE OF CHILDHOOD STROKE IN EASTERN DENMARK

J. Bindslev ¹, C. Hoei-Hansen², M. Boerresen², N. Laugesen¹, K. Hansen¹, T. Truelsen¹

¹University Hospital of Copenhagen, Rigshospitalet, Neurology, Copenhagen, Denmark, ²University Hospital of Copenhagen, Rigshospitalet, Pediatrics, Copenhagen, Denmark

Background and aims: Delays in the diagnosis of pediatric stroke can hinder access to recanalization therapies that have the potential to improve outcome. In 2017 a pediatric stroke protocol was implemented in Eastern Denmark; all children with suspected stroke were triaged by a team of neurovascular specialists.

This study aimed to examine the precision of triage by acute recanalization indication.

Methods: Prospective, consecutive registration of pediatric patients with suspected stroke symptoms referred to the neurovascular team from Jan 1^st, 2020 and through Dec 2021, Eastern Denmark (census 2.6 million). Based on the provided clinical information, patients were triaged to a pediatric emergency department (PED) or an acute stroke evaluation(ASE). All patients were retrospectively followed-up for clinical presentations, paraclinical examinations, and final diagnosis.

Results: A total of 163 patients with 166 suspected stroke events were referred to the neurovascular team; 48 (28.9%) were triaged to an ASE and 118 (71.1%) to a PED. CeVD were present in 7 of 48 (14.5%) events triaged to an ASE and in 9(7.6%) triaged to a PED. Two children underwent acute recanalization therapy of which both were triaged to ASE.

The most common stroke mimics were migraine(24.7%) and seizures (10.8%). Non-CeVD neurological emergencies (i.e. status epilepticus and encephalitis) were present in 5 (10.4%) events triaged to an acute stroke assessment respectively in 9 (8.5%) triaged to a PED.

Conclusions: Triage by the neurovascular team identified all pediatric candidates for recanalization therapies and suggested a need for fast assessment of children with suspected stroke.

Disclosure: Yes

P0589 / 1476

LARGE VESSEL OCCLUSION STROKE IN A 17 YEAR OLD MALE WITH PAEDIATRIC INFLAMMATORY MULTI-SYSTEM SYNDROME ASSOCIATED WITH SARS-COV-2

V. Levee ¹, R. Lewis¹, L. Dixon¹, J. Kwan¹, D. Kalladka¹

¹ Charing Cross Hospital, Imperial College London, Stroke, London, United Kingdom

Background: Paediatric Cov-2 infections have been less severe than in adults, however some have developed a newly defined syndrome, Paediatric Inflammatory Multisystem Syndrome associated with CoV-2 (PIMS -TS). Its presentation is variable and can cause multi-system involvement. It belongs to the common spectrum of pathogen-triggered hyperinflammatory states, including atypical Kawasaki disease.

Case summary: 17 year old male of Ghanaian origin, with no significant past medical history, presented with a one-week history of general malaise, fevers and sore throat. He developed severe chest pain and cardiogenic shock, with a CRP of 200, raised troponin and global hypokinesia on echocardiogram with an ejection fraction of 20%. He was positive for SARS-CoV-2 antibodies (though PCR-antigen negative at admission) and fit the criteria for myocarditis secondary to PIMS-TS. He was treated for sepsis, commenced on IV methylprednisolone and needed intubation, sedation and cardiothoracic ICU level care. On weaning sedation after 3 days, he was found to have left middle cerebral artery syndrome with NIHSS 16. CT head and CT angiogram showed a left MCA ischaemic stroke, and a thrombus in the Sylvian MCA branch. This was treated with antiplatelets. His disease markers and motor deficits improved significantly, however he has cognitive impairment and low mood.

Conclusion: PIMS-TS related LVO anterior circulation infarct is rare. It necessitates urgent recognition and multi-specialty involvement as currently management is not standardised.

Axial DWI (A), ADC (B) MRI demonstrate large left MCA territory infarct. Axial MRA (C) shows occlusion of the left M2 branches, signal drop-out on SWI (D)

Disclosure: No

P0590 / 517

DIFFERENCES BETWEEN SINGLE AND MULTIPLE CERVICOCEPHALIC ARTERY DISSECTIONS

A. Aydoğan ¹, M. Sezgin¹, E. Ekizoğlu¹, S. Ömerhoca^2,1,D. Aygun^3,1, N. Yeşilot¹, O. Çoban¹

¹Istanbul University Istanbul Faculty of Medicine, Fatih, Turkey, ²Istanbul Bağcilar Research and Training Hospital, Neurology Department, Istanbul, Turkey, ³Istanbul Medicine Hospital, İstanbul, Turkey

Background and aims: The factors contributing to the development of multiple rather than single cervicocephalic artery dissections are not well known. We aimed to investigate the differences of clinical and laboratory features between these two conditions.

Methods: The clinical and laboratory features of the patients with single artery dissection(SAD) and multiple artery dissection (MAD) were compared.

Results: Among 36 patients, 30 had SAD(13 women;43.4%) and 6 had MAD(3 women;50%) with a total of 13 dissected arteries. The mean age was 45.6±9 in the SAD;39.3±10.5 in the MAD groups(p=0.425). Hypertension, diabetes mellitus and family history of stroke were present in 10 patients with SAD, but were not seen in MAD group, smoking rates were similar. Trauma preceded dissection in 6 (20%) patients with SAD and in 1(16.6%) with MAD(p=0.85). Cervical artery dissections were more frequently seen in SAD group in comparison to MAD group(25 patients; 83.4% versus 3 patients; 50%,respectively)(p=0.07). Dissections of the anterior circulation arteries were more frequently occurred in MAD than SAD group; being 8(61.5%) of 13 artery dissections in MAD versus 14(46.6%) patients with SAD(p=0.37). Sedimentation and CRP values were higher in MAD group(33.16±17.96 and 10.40±15.64 mm/h) than in SAD group(22.38±22.5 and 9.41±11.16 mg/dl)(p=0, 1 and p=0.29).

Conclusion: MAD may not be associated with trauma and classical vascular risk factors but rather with inflammatory state of the patient. These patients seem to have more frequently artery dissections of anterior circulation and are younger than patients with SAD who had mostly cervical artery dissections.

Disclosure: No

P0591 / 1003

THROMBECTOMY FOR PEDIATRIC CEREBRAL VENOUS THROMBOSIS. CASE REPORT AND LITERATURE REVIEW

C. Motto ¹, M. Piano², R. Vaccari³, S. Bergamoni³, E. Stacul⁴, C. De Giacomo⁴, E. Agostoni⁵

¹ASST Grande Ospedale Metropolitano Niguarda, Stroke Unit - Neurological Department, Milan, Italy, ²ASST Grande Ospedale Metropolitano Niguarda, Interventional Neuroradiology, Milan, Italy, ³Grande Ospedale Metropolitano Niguarda, Infantile Neuropsychiatry, Milano, Italy, ⁴ASST Grande Ospedale Metropolitano Niguarda, Pediatry, Milan, Italy, ⁵ASST Grande Ospedale Metropolitano Niguarda, Neurological Department, Milan, Italy

Background and aims: Mechanical thrombectomy in Cerebral Venous Thrombosis (CVT) aims to achieve a rapid recanalization of the sinuses restoring the cerebral venous drainage. In adult it should be considered in patients with a high risk of poor outcome. In pediatric CVT it has been reported in rare case and small series.

Methods: Case report and literature review.

Results: At age of 12-year a girl had left transverse sinus thrombosis with left temporo-parietal haemorrhagic infarction without disability. The diagnostic workup showed only the presence of the G20210A prothrombin gene mutation in heterozygosis. She was treated with anticoagulation for two years. At age of 16-year she experienced headache, vomiting, and decrease of consciousness. Brain CT scan did not show acute lesions. CT angiography demonstrated thrombosis of superior sagittal sinus (SSS), right transverse and sigmoid sinus. Due to extensive thrombosis, involvement of multiple sinuses, and mental status disturbances, a mechanical thrombectomy was performed. Almost complete recanalization of the occluded sinuses was achieved. No complications were observed. Anticoaugulation was restarted. Brain MRI and MR-venography after 7 days showed almost complete sinuses recanalization; no parenchymal lesions were detected. The girl was discharged after 10 days without neurological deficits with anticoagulant therapy for long life. At 2-year follow-up she did not complain any symptoms.

Conclusions: Thrombectomy could be a therapeutic option in carefully selected pediatric patients with CVT and risk of poor outcome. A multicenter registry of all pediatric patients treated with thrombectomy is desirable to provide data on safety and efficacy of this treatment.

Disclosure: No

P0592 / 1025

RECURRENCE OF CERVICAL ARTERY DISSECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

E. Lounsbury¹, N. Niznick¹, R. Mallick², B. Dewar², A. Davis², D. Fergusson², D. Dowlatshahi^2,3, M. Shamy ^2,3

¹University of Ottawa, Medicine, Ottawa, Canada, ²Ottawa Hospital Research Institute, Ottawa, Canada, ³University of Ottawa, Department of Medicine, Ottawa, Canada

Background and aims: Cervical artery dissection (CAD) involving the carotid or vertebral arteries is an important cause of stroke in younger patients. The purpose of this systematic review is to assess the risk of recurrent dissection in this population.

Methods: A systematic review and meta-analysis was conducted on studies in which patients experienced radiographically confirmed dissections involving an extracranial segment of the carotid or vertebral artery and in whom CAD recurrence rates were reported. Eligible studies included randomized controlled trials, observational studies, or case series, with a minimum follow-up period of 1 month, examining all-comers with one or more radiographically confirmed dissections involving an extracranial segment of the carotid or vertebral artery, and in which incidence of recurrent cervical artery dissection was reported.

Results: Data were extracted from 27 eligible studies (n=3714 patients). Analysis of outcomes was performed by pooling incidence rates with random effects models weighting by inverse of variance. The incidence of recurrent CAD was 5% overall (95% CI 3-8%), 2% at 1 month (95% CI 1-5%) and 8% at 1 year in studies with sufficient follow-up (95% CI 4-15%). The incidence of recurrence associated with ischemic events was 2% (95% CI 1-3%).

Conclusions: Meta-analysis suggests low rates of recurrent cervical artery dissection and even lower rates of recurrent dissection associated with ischemia. Further patient-level data and clinical subgroup analyses would improve applicability to individual patients.

Disclosure: No

P0593 / 206

CEREBRAL VENOUS THROMBOSIS DUE TO VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA AFTER A SECOND CHADOX1 NCOV-19 VACCINE DOSE

K. Krzywicka ¹, A. van de Munckhof¹, J. Zimmerman², F. Bode², G. Frisullo³, T. Karapanayiotides⁴, M. Sánchez van Kammen¹, M. Heldner⁵, M. Arnold⁵, J. Ferro⁶, D. Aguiar de Sousa⁷, J. Coutinho¹, Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group

¹Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ²Universitätsklinikum Bonn, Department of Neurology, Bonn, Germany, ³Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Neurology, Rome, Italy, ⁴School of Medicine and Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Second Department of Neurology, Thessaloniki, Greece, ⁵Inselspital, Bern University Hospital, University of Bern, Department of Neurology, Bern, Switzerland, ⁶Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal, ⁷Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Department of Neurosciences and Mental Health, Lisbon, Portugal

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare side effect of the ChAdOx1 nCoV-19 COVID-19 vaccine (AstraZeneca/Oxford) and often manifests as cerebral venous thrombosis (CVT). So far, CVT-VITT has only been reported after a first ChAdOx1 nCoV-19 dose.

Methods: We report cases (March-December 2021) of CVT-VITT after a second ChAdOx1 nCoV-19 vaccine dose from an international CVT-VITT registry. We classified certainty of VITT diagnosis using criteria of the United Kingdom Expert Haematology Panel.

Results: Out of 124 CVT cases that developed after ChAdOx1 nCoV-19 vaccination, 120 were after a first dose (61 definite, 20 probable, 10 possible and 29 unlikely VITT), and 4 after a second dose (1 definite, 1 probable, 1 possible and 1 unlikely VITT). None of the four patients had any symptoms after the first ChAdOx1 nCoV-19 dose. All cases had symptom onset between 1 and 6 days after the second vaccination, thrombocytopenia, and increased D-dimer levels. Anti-PF4 antibodies were positive in 2/3 tested cases. Two patients presented in a coma and died during admission.

Conclusion: CVT-VITT can occur after a second dose of ChAdOx1 nCoV-19 vaccine, but was reported substantially less often after a second than after a first vaccine dose. In some cases, symptom onset of VITT may be more rapid after a second than after the first dose, although the small number of cases precludes firm conclusions.

Disclosure: No

P0594 / 564

CEREBROVASCULAR DISEASE ASSOCIATED WITH SYSTEMIC SCLEROSIS: CASE SERIES AND SYSTEMATIC REVIEW

M. Rosso ¹, S. Ramaswamy¹, S.R. Levine^1,2,3

¹SUNY Downstate Health Sciences University, Neurology, Brooklyn, United States, ²Jaffe Stroke Center, Maimonides Medical Center, Neurology, Brooklyn, United States, ³Kings County Hospital Center, Neurology, Brooklyn, United States

Background and aims: Central nervous system involvement in systemic sclerosis (SSc) has traditionally been considered uncommon. Recent studies suggest that SSc might be associated with an increased risk of cerebrovascular disease (CBVD), independent of conventional cardiovascular risk factors. We present a case series of patients with symptomatic CBVD associated with SSc and a systematic literature review.

Methods: A retrospective chart review of patients with SSc and CBVD seen at Henry Ford (1980-1997), Wayne State (1998-2001), Mount Sinai (2001-2009), SUNY Downstate University (2010-2021) was performed. MEDLINE/EMBASE/WoS were searched for “systemic sclerosis”, “scleroderma”, “CREST”, “cerebrovascular”, “cerebrovascular accident”, “cerebrovascular disease”, “stroke”.

Results: 14 patients with SSc and CBVD were included in our case series (mean age 48.5 years, 85% female). CBVDs were ischemic stroke (n=9, 64.1%), hemorrhagic stroke (n=1, 7.2%), cerebral venous thrombosis (n=1, 7.2%), ischemic optic neuropathy (n=1, 7.2%), possible ischemic stroke (negative CT head) (n=2, 14.3%).

Systematic review: 932 abstracts were screened after removal of duplicates (Fig.1); 110 articles were selected yielding 93 patients (mean age 48 years, 78.5% female). CBVDs were vasculitis (n=22, 23.7%), any intracranial hemorrhage (n=19, 20.4%), ischemic stroke (n=18, 19.3%), unruptured aneurysms (n=10, 10.7%), small vessel disease (n=6, 6.4%), Moya-Moya syndrome (n=4, 4.3%), others (n=14, 15%).

Conclusions: We identify a heterogenous spectrum of CBVD etiology in SSc patients, with ischemic stroke being the most common in our case series, vasculitis in literature. A complex interaction between chronic inflammation, autoimmune mechanisms, endothelial dysfunction seem to underlie the heterogeneity of CBVD in SSc.

Disclosure: No

P0595 / 1539

HIGH PREVALENCE OF FIRST-DEGREE RELATIVES WITH YOUNG CARDIOVASCULAR DISEASE IN PATIENTS WITH ISCHEMIC STROKE AT YOUNG AGE

I.M. Veen ¹, J. Verhoeven¹, M. Ekker¹, M. Schellekens¹, E. Boot¹, A.M. Tuladhar¹, F.E. de Leeuw¹

¹ Radboud University Medical Center, Donders Center for Medical Neuroscience, Neurology, Nijmegen, Netherlands

Background and aims: Previous studies reported a family history of cardiovascular disease among stroke patients over 50 years, but in patients and family members < 50 years this has almost never been investigated. We assessed the proportion of young ischemic stroke patients, aged 18 through 49 years old, with a family history of young cardiovascular disease (with onset <50). Family history suggests a genetic component, but shared environmental and modifiable factors may also be involved. Therefore, we compared the prevalence of classical cardiovascular risk factors between patients with and without a family history.

Methods: This study is part of the Radboudumc sample (n=121) of the ODYSSEY study, a multicenter prospective cohort study on the causes and consequences of young stroke in the Netherlands. All participants were asked on their family history via a structured interview.

Results: A family history of young cardiovascular disease was present in 29 patients (24.0%). Compared to patients without a family history, patients with a family history of young cardiovascular disease, more often suffered from stroke due to atherosclerosis (12.0% vs 27.6%, = 0.075) and showed a trend towards a higher presence of cardiovascular risk factors, especially in hypertension (30.4%, 48.3% =0.078).

Conclusions: We found a high prevalence of family history of young cardiovascular disease in young stroke, mainly due to atherosclerosis due to vascular risk factors, suggesting a genetic contribution of these causes of stroke in the young.

Disclosure: No

P0596 / 621

RECURRENT RIGHT HEMISPHERE STROKE IN A YOUNG WOMAN CASE REPORT: A WEB OF RARE CAUSES

L. Maure Blesa ¹, D. Lopez de Mota Sanchez¹, M. De la Calle Cuevas¹, P. Ibañez de la Cadiniere Ortiz¹, M.J. Arias Villarán¹, A.L. Nystrom Hernandez¹, A. Bolivar Puente², M.J. García Sanchez³, C. Rodríguez Fernández³, M. Oses¹, I. Navas Vinagre¹, M.A. Garcia Torres¹

¹Hospital Fundación Jiménez Díaz, Neurology, Madrid, Spain, ²Hospital Fundación Jiménez Díaz, Radiology, Madrid, Spain, ³Hospital Fundación Jiménez Díaz, Interventional Neuroradiology, Madrid, Spain

Background and aims: Ischemic stroke among young patients and its percentage of unknown etiology is very relevant, being Carotid web (CW) spectrum an increasingly recognized mechanism.

Methods: Case report.

Results: A 25 year old woman with history of migraine with aura, smoker and a prior cryptogenic right hemispheric stroke came to our hospital with a new similar episode. AngioCT showed a non-calcified soft plaque in the right internal carotid artery (ICA) (Figure 1) . AngioMRI revealed a linear protusion in the posterior wall of the right ICA, interpreted as CW (Figure 2) . Digital substraction angiography (DSA) couldn’t demonstrate any wall irregularities at the time. After thorough evaluation, other etiologies including thrombophilia, migrainous infarction, autoimmunity and genetics were considered.

During the following year, she had two new episodes of right hemisphere ischemic stroke under correct treatment with antiplatelet and then anticoagulant therapy. AngioCT showed persistence of the initial structure in the right ICA. However, its smaller size and the lack of an axial septum wasn’t conclusive of a CW, indicating a Small Protruding Lesion (SPL), possibly an earlier stage of the same entity.

DSA and right ICA stenting were performed without incidences (November 2021, figure 3) . The patient has been asymptomatic since.

Conclusions: Although considered less thrombogenic, SPL may represent a mechanism of recurrent embolic stroke of undetermined source. As previously proposed for CW spectrum, we reinforce the indication of stenting as an approach to this pathology when other treatments have failed.

Figure 1

Figure 2

Figure 3

Disclosure: No

P0597 / 289

DIRECT ORAL ANTICOAGULANTS FOR THE TREATMENT OF CEREBRAL VENOUS THROMBOSIS (DOAC-CVT)

K. Krzywicka ¹, M. Sánchez van Kammen¹, D. Aguiar de Sousa², M.R Heldner³, S. Aaron⁴, D. Jiang⁵, R. Leker⁶, K. Jood^7,8, N. Yesilot⁹, B. Casolla¹⁰, W. Kam¹¹, T. Kleinig¹², R. Lemmens¹³, A. Conforto¹⁴, M. Barboza¹⁵, H. Christensen¹⁶, C. Nolte¹⁷, K. Prasad¹⁸, A. Kobayashi¹⁹, F. Dentali²⁰, A. Arauz²¹, A. Alasheev²², M. Hernandez Perez²³, T. Wu²⁴, E. Kristoffersen²⁵, M.S. Cotelli²⁶, F. Al-Ajlan²⁷, X. Ji²⁸, J. Putaala²⁹, T. Tatlisumak^8,7, J.M Ferro³⁰, J.M Coutinho¹

¹Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ²Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Department of Neurosciences and Mental Health, Lisbon, Portugal, ³Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Department of Neurology, Bern, Switzerland, ⁴Christian Medical College Hospital, Department of Neurology, Vellore, India, ⁵Xuanwu Hospital Capital Medical University, Department of Neurology, Beijing, China, ⁶Hadassah-Hebrew University Medical Center, Department of Neurology, Jerusalem, Israel, ⁷Sahlgrenska Academy at University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden, ⁸Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden, ⁹Istanbul Faculty of Medicine, Neurology, Istanbul, Turkey, ¹⁰Centre Hospitalier Régional Universitaire de Nice, Department of Neurology, Nice, France, ¹¹Duke University Hospital, Department of Neurology, Durham, United States, ¹²Royal Adelaide Hospital, Department of Neurology, Adelaide, Australia, ¹³University Hospital Leuven, Department of Neurology, Leuven, Belgium, ¹⁴São Paulo University Hospital, Department of Neurology, São Paulo, Brazil, ¹⁵Hospital Dr. Rafael A. Calderon Guardia, Department of Neurology, San José, Costa Rica, ¹⁶Bispebjerg & Frederiksberg Hospitals, University of Copenhagen, Department of Neurology, Copenhagen, Denmark, ¹⁷Charité Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany, ¹⁸Rajendra Institute of Medical Sciences, Department of Neurology, New Delhi, India, ¹⁹Uniwersytet Kardynała Stefana Wyszyńskiego, Department of Neurology, Warsaw, Poland, ²⁰University of Insubria, Varese, Italy, ²¹Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico, ²²Sverdlovsk Regional Clinical Hospital #1, Department of Neurology, Yekaterinenburg, Russian Federation, ²³Hospital Germans Trias, Department of Neurology, Badalona, Spain, ²⁴Christchurch Hospital, Department of Neurology, Christchurch, New Zealand, ²⁵Akershus Universitetssykehus, University of Oslo, Deparment of Neurology, Oslo, Norway, ²⁶Azienda Sanitaria Locale di di Vallecamonica-Sebino, Department of Neurology, Valcamonica, Spain, ²⁷King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, ²⁸Xuanwu Hospital Capital Medical University, Department of Neurosurgery, Beijing, China, ²⁹Helsinki University Hospital, Department of Neurology, Helsinki, Finland, ³⁰Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

Background and aims: Patients with cerebral venous thrombosis (CVT) are commonly treated with anticoagulants for 3-12 months to prevent recurrence of venous thrombotic events. Until recently, vitamin K antagonists (VKA) were the oral anticoagulant of choice in patients with CVT. Direct oral anticoagulants (DOACs) are more practical in use than VKA and carry a lower risk of intracranial haemorrhage in other conditions. An exploratory randomized controlled trial including 120 patients with CVT suggested that dabigatran has a similar efficacy and safety profile as VKA in CVT. Data from a real-world setting are warranted to confirm those findings.

Methods: DOAC-CVT is an international, prospective, comparative cohort study. Patients are eligible if they are >18 years old, have a radiologically confirmed CVT, and have started oral anticoagulant treatment (DOAC or VKA) within 30 days of CVT diagnosis. The primary endpoint is a composite of major bleeding and symptomatic recurrent venous thrombosis at 6 months of follow-up. Anticipating a 3:2 ratio in DOAC:VKA use, we aim to recruit a sample size of 500 patients.

Results: As of January 2022, 162 patients have been included from 17 participating centres across 8 countries. Recruitment is ongoing. Researchers with an interest in joining DOAC-CVT may contact the coordinating investigator at [e-mail]

Conclusion: DOAC-CVT will provide real-world data on the comparative efficacy and safety of DOACs vs. VKA for prevention of recurrence of venous thrombotic events after CVT.

Disclosure: No

P0598 / 1134

NEUTROPHIL TO LYMPHOCYTE RATIO PREDICTS THE OCCURRENCE OF ARTERIAL DISSECTION IN YOUNG STROKE PATIENTS

C. Sales ¹, T. Wijeratne²

¹Western Health, Neurology, Melbourne, Australia, ²Western Health, Department of Neurology, Melbourne, Australia

Arterial dissection is one of the most common causes of stroke occurring in young patients. There is evidence to show that inflammation is central to its pathogenesis as demonstrated by biochemical studies and functional neuroimaging. The neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) are simple and readily available biomarkers which may provide information on an individual’s state of inflammation. In this retrospective review, we compared the NLR and PLR values on admission of young stroke patients with or without MRI-confirmed arterial dissection. Compared to controls, young stroke patients with arterial dissection had higher PLR (152.64 vs 183.89) and NLR (3.73 vs 6.65) values, with the latter achieving statistically significant levels (p=0.03). Furthermore, Receiver Operator Curve (ROC) analysis shows that the area under the curve for NLR was 0.682 (p=0.03) while that of the PLR was 0.631 (p=0.118). This study demonstrates the utility of NLR in predicting the occurrence of cervical dissection among young stroke patients

Disclosure: No

P0599 / 851

BDNF IMPORTANCE IN NEUROPLASTICITY IN CHILDREN AFTER ISCHEMIC STROKE

N. Lupusor ¹, S. Hadjiu^1,2, S. Mariana^1,2, C. Calcii^1,2, L. Feghiu^1,3, C. Griu¹, L. Cuznets^1,2, N. Revenco^1,2, S. Groppa^1,3

¹State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova, Republic of, ²Research Institute for Mother and Child Health Care, Chisinau, Moldova, Republic of, ³National Epileptology Center, Chisinau, Moldova, Republic of

Background and aims: Recent research demonstrates the role of neurotrophic factors, especially brain-derived neurotrophic factor (BDNF), in neuroplasticity and functional recovery after stroke. The aim of the study: assessment of BDNF serum levels in children who have suffered an ischemic stroke and establishment the correlation between BDNF serum levels and neurological deficits.

Methods: The study included a sample of 32 children (3-12 years) who have suffered an ischemic stroke and 32 healthy children, in the same age group, were included in the control group. Enzyme-linked Immunosorbent Assay was used to test serum BDNF levels in peripheral blood, 6 months after ischemic stroke. Post-stroke neurological impairment were measured by Pediatric Stroke Outcome Measure (PSOM). Excel and SPSS were used for statistical analysis.

Results: Study results showed that, compared to the control group, children who have suffered ischemic stroke, showed significantly lower serum BDNF levels (p<0.01). According to the PSOM total scores, 29 children (86.4%) had moderate to severe deficits, with scores between 1 and 7 points. Low BDNF levels correlated with increased PSOM scores (rxy = -0.74, p <0.05).

Conclusions: In children with ischemic stroke, significantly lower serum BDNF levels were observed 6 months after the disease compared to the control group, while low BDNF levels correlated with elevated PSOM scores. Being a neurotrophic factor, BDNF is important for brain neuroplasticity and stroke recovery. Thus, in order to improve the outcome of recovery in children with stroke, the potential role of the therapeutic application of BDNF should continue to be considered.

Disclosure: No

P0600 / 1486

UTILITY OF BLOOD TESTS SCREENING IN YOUNG PATIENTS WITH TRANSIENT ISCHAEMIC ATTACK OR MINOR STROKE

H. Townsley ¹, C. Sivakumar¹, K. Ellis², J. White², A. Dados¹, R. Alijam¹, A. Kaushik¹, R. Bell¹, G. Quattrocchi^1,3, A. Chandratheva¹

¹National Hospital for Neurology & Neurosurgery, Comprehensive Stroke Service, London, United Kingdom, ²University College London Medical School, London, United Kingdom, ³North Middlesex University Hospital NHS Trust, Neurology Department, London, United Kingdom

Background and aims: We aimed to evaluate the utility of screening blood tests in young Transient Ischaemic Attack(TIA) or minor stroke(NIHSS⩽5).

Methods: We reviewed consecutive patients aged ⩽55 years attending a London hospital TIA clinic 1^st January 2019-31^st December 2020. Vascular risk factors, aetiology(TOAST), and blood tests - ANA, ANCA, HIV, syphilis, hepatitis B/C serology, thrombophilia screening (anti-cardiolipin antibodies, lupus anticoagulant, Prothrombin G20210A, Factor V Leiden mutations, protein C/S) - were recorded.

Results: Of 236: 92(38%) mimics, 144 TIA(46%), minor stroke(49%) or retinal stroke(5%). Mean age 42 years(SD 10.5). 65(46%) were unknown aetiology. On average 1.9 vascular risk factors/patient, but 29% had ⩾3 risk factors.

One of 62(2%) positive for hepatitis B -new diagnosis. One of 99(1%) known positive for HIV. Unrelated to aetiology. No syphilis identified.

Autoimmune testing yield was low. Of 96, 18(19%) had abnormal ANA, of which 14(78%) had low titres(1:80). One(1:1280) was diagnosed with Sjogren’s syndrome, unrelated to aetiology.

Of 97(67%) ANCA screens, seven(7%) were positive, only two with elevated PR3 levels. None changed management.

Thrombophilia screening was positive in 17/110(16%). Four diagnosed with antiphospholipid syndrome and anticoagulated – two known Systemic Lupus Erythematous, one with recurrent miscarriages. The remainder did not change management: one protein C and S deficiency, two heterozygous Factor V Leiden and one Prothrombin G20210A mutation. Seven had subsequent negative tests, two awaiting repeat.

Conclusions: Young stroke blood screening had low yield in absence of clinical context. Extensive thrombophilia testing is costly and better focused on those with associated clinical features.

Disclosure: No

P0601 / 1590

CARDIAC PAPILLARY FIBROELASTOMA: A RARE CAUSE OF EMBOLIC STROKE

I. Oyarzun Irazu ¹, A. Cabrera Muras¹, D. Martinez Condor¹, C. Gutierrez Albizuri¹, O. Quintana Lopez¹, N. Roncero Colina¹, B. Huete Anton¹, J.C. Garcia-Monco Carra¹

¹ Basurto University Hospital, Neurology, Bilbao, Spain

Background and aims: Cardiac primary tumours are extremely rare. The most frequently detected are myxoma and fibroelastoma. Papillary fibroelastoma (PF) is mainly found in aortic and mitral valves. It can be diagnosed based on transthoracic echocardiography, but transesophageal echocardiography increases sensitivity among smaller tumours.

PF is generally detected as an incidental finding, although it can be presented as cardiac symptomatology or embolization, being the ischemic stroke the most common presentation.

We describe two ischemic stroke cases due to PF.

Methods: Case 1: a 38-year-old male presented an ischemic stroke in the left posterior cerebral artery territory. Transthoracic echocardiography showed a hyperechogenic mass in the mitral valve (image 1). The examination did not show other findings.

Case 2: a 66-year old male suffered an ischemic stroke in the right cerebral posterior artery territory. Usual examination did not show any pathological results. Transesophageal echocardiography showed a subvalvular mitral hyperechogenic mobile mass (11x5.5 mm) (image 2).

Results:

Case 1: surgical intervention extracted a 12x14 mm tumour. Histopathologic examination confirmed a PF.

Case 2: surgery was postponed due to CoVid-19 pandemic. Treated with DOAC until surgery was performed. No new events. Histopathology exam confirmed the diagnosis.

Neither of the patients had complications during the follow-up. No medical treatment was needed for secondary prevention.

Conclusion: PF should be considered among etiological diagnoses of embolic strokes, bearing in mind secondary prevention could vary, since surgery could be a reasonable option. Transesophageal echocardiography may be a suitable option when other causes are excluded.

Image 1 Image 2

Disclosure: No

P0602 / 313

BI-ALLELIC LOSS-OF-FUNCTION MUTATIONS IN THE ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE CAUSE EARLY-ONSET MOYAMOYA ANGIOPATHY

S. Guey ^1,2, D. Hervé², M. Kossorotoff³, F. Bergametti¹, G. Ha⁴, H. Guenou⁴, J. Hadjadj⁵, M. Arnould¹, J.-L. Balligand⁶, G. Uzan⁴, E. Tournier-Lasserve^1,2,5

¹Université de Paris, Inserm, INSERM UMR-S 1161, Paris, France, ²AP-HP, Hôpital Lariboisière, Service de Neurologie, Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l’Oeil, Paris, France, ³AP-HP, University Hospital Necker-Enfants Malades, French Center for Pediatric Stroke, Department of Pediatric Neurology, Paris, France, ⁴Université Paris-Saclay, INSERM, UMR-S-MD 1197, Villejuif, France, ⁵AP-HP, Hôpitaux Lariboisière- Saint-Louis, Service de Génétique Moléculaire Neurovasculaire, Paris, France, ⁶Université Catholique de Louvain (UCLouvain) and Cliniques Universitaires Saint-Luc, Pole of Pharmacology and Therapeutics (FATH), Institute of Experimental and Clinical Research (IREC), Brussels, Belgium

Background: Moyamoya angiopathy (MMA) is a rare cerebrovascular condition whose pathophysiology is poorly known. Mutations in a few genes have been identified in Mendelian moyamoya syndromes (MMS), explaining only a small proportion of these MMS. The identification of missing genes would help to unravel MMA mechanisms.

Aim: To identify new genes involved in autosomal recessive (AR) forms of MMA.

Methods: Whole exome sequencing (WES) data from 6 consecutive consanguineous unrelated MMA probands, were interrogated under an AR hypothesis. Western blot analysis of endogenous endothelial progenitor cells lysates and transfected cells expressing mutant cDNA were used to characterize mutation consequences.

Results: 34 homozygous rare coding variants were identified in a total of 33 distinct genes. NOS3, which encodes the endothelial nitric oxide (NO) synthase, was the only gene to be mutated in more than one proband. The c.1502+1G>C splice-site variant leading to a premature termination codon, and the absence of expression of the protein, was identified in proband M084. The c.1942T>C missense variant leading to the p.Cys648Arg substitution, and an unstable protein, was identified in the proband M035. A childhood-onset was observed in both probands.

Conclusion: Bi-allelic loss-of-function (LOF) mutations in NOS3, the enzyme which produces the main vascular source of NO, lead to early-onset MMA. These data, with the previous identification of early-onset MMA due to biallelic LOF mutations in GUCY1A3, which encodes a subunit of the major NO receptor [Hervé, AJHG 2014], pinpoint the role of the NO pathway in MMA pathophysiology.

Disclosure: No

P0603 / 1128

INITIAL PRESENTING SYMPTOMS OF CADASIL DISEASE – DATA FROM CZECH COHORT OF PATIENTS

H. Magerova ¹, H. Vlaskova², A. Olserova¹, J. Paulasova Schwabova¹, I. Sarbochova¹, P. Jansky¹, H. Horakova¹, M. Laczo¹, D. Kala³, J. Laczo¹, M. Vyhnalek¹, J. Otahal⁴, A. Tomek¹

¹2nd Faculty of Medicine, Charles University and Motol University Hospital, Department of Neurology, Prague, Czech Republic, ²1st Faculty of Medicine, Charles University and General University Hospital, Department of Paediatrics and Inherited Metabolic Disorders, Prague, Czech Republic, ³Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic, ⁴Institute of Physiology of the Academy of Sciences of the Czech Republic, Department of Developmental Epileptology, Prague, Czech Republic

Background and aims: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral angiopathy leading to variety of symptoms including recurrent subcortical strokes, migraine headaches, or progressive cognitive decline. The aim of our study was to evaluate the first presenting symptoms of CADASIL in Czech cohort of patients.

Methods: 87 CADASIL patients were included in the study. All patients were symptomatic with diagnosis genetically verified between years 2011 - 2021. Detailed medical history was taken.

Results: The most common presenting symptom was migraine headache (42,53%), followed by stroke (35,63%), cognitive decline (12,64%), psychiatric changes (4,59%), hearing loss (2,3%), and epileptic seizure (2,3%). Mean age of the first symptom was 41,38 years (SD 10,89). Mean onset age of migraine was 35,54 years (SD 10,83), of stroke 45,04 years (SD 7,77), of cognitive decline 47,9 years (SD 9,26), of psychiatric changes 49,5 years (SD 12,40), of hearing loss 33 years (SD 1,41), and of epileptic seizure 40,5 years (SD 10,61).

Conclusions: According to our data, the most common initial presenting symptom of CADASIL is adult-onset migraine headache. Stroke was the first manifestation in 36% of patients with average age of onset 45 years. Cognitive decline was the presenting feature in more than 10% of patients and psychiatric changes (mostly depression) in 5% patients. CADASIL diagnosis should be considered also in patients with sudden onset hearing loss.

Disclosure: No

P0604 / 1012

CLINICAL CHARACTERISTICS AND OUTCOME PREDICTORS IN PATIENTS WITH CERVICAL ARTERY DISSECTION

J. Cvjetinovic¹, J. Milojkovic¹, A. Lucic^2,1, S. Ruzicka Kaloci^2,1, V. Suknjaja^2,1, Z. Zivanovic ^2,1

¹University Clinical Center of Vojvodina, Department od Neurology, Novi Sad, Serbia, ²Faculty of Medicine University in Novi Sad, Department of Neurology, Novi Sad, Serbia

Background and aims: Cervical artery dissection (CAD) is one of the most common causes of stroke among young people. Aim of this study was to analyze the clinical characteristics of patients with CAD, and compare them in relation to outcome, as well as to involvement circulation (anterior or posterior).

Methods: A study was conducted at the Department of Neurology, University Clinical Center of Vojvodina in Novi Sad during the period from 2010 to 2020. In the first part, the demographic, clinical and radiological characteristics and outcome of patients with CAD, were analyzed. Then, patients were divided into two groups, with favorable (mRS 0-1) and unfavorable outcome (mRS 2-6), and these characteristics were compared between these two groups. The comparation was also performed on the basis of the artery affected by dissection (carotid and vertebrobasilar basin).

Results: Out of a total of 66 patients, 42% were females. Sixty-three percent of patients had carotid dissection. Neck pain and headache are more common in vertebrobasilar dissection ( 62.5% vs 38.1%, p=0.04 and 83.3% vs 59.5%, p=0.04), and these patients were younger (45.1 years vs 50.9 years, p=0.04). Patients who had a favorable outcome were significantly younger (46.1 years vs. 54.6 years, p=0.04), had lower NIHSS score on admission (1.8 vs 9.5, p<0.001), and less likely have diabetes (2.2% vs 19.0%, p=0.03). Favorable outcome had 61.2% of patients with carotid dissection and 80.0% with vertebrobasilar dissection (p=NS).

Conclusion: Younger age, milder neurological deficit at admission, and absence of diabetes were predictors of favorable outcome.

Disclosure: No

P0605 / 1419

VERTEBROBASILAR DOLICHOECTASIA: INTERVENTION OR SYMPTOMATIC CONTROL?

L. Dias ^1,2, B. Martins^1,2, G. Alves³, M.L. Silva³, A. Costa^1,2, M. Carvalho^1,2, P. Abreu^1,2, P. Castro^1,2,4

¹Centro Hospitalar Universitário de São João, E.P.E., Neurology, Porto, Portugal, ²Medical Faculty, Porto University, Clinical Neurosciences and Mental Health, Porto, Portugal, ³Centro Hospitalar Universitário de São João, E.P.E., Neuroradiology, Porto, Portugal, ⁴Centro Hospitalar Universitário de São João, E.P.E., Stroke Unit, Porto, Portugal

Background and aims: Intracranial arterial dolichoectasia is rare, affecting mainly the posterior circulation. Mostly asymptomatic, it may cause symptoms due to cranial nerve/brainstem compression, which can be difficult to manage.

Methods: Case Report.

Results: A 55-year-old man with hypertension, dyslipidaemia, and polycystic kidney disease was admitted due to sudden onset severe headache. Neurologic examination revealed a right upper homonymous quadrantanopia. Brain CT/CTA disclosed large and tortuous vertebral arteries, with multiple mural calcifications and an intramural hematoma of the right V4 segment. MRA and cerebral angiography confirmed a vertebrobasilar dolichoectasia with a dissecting aneurysm. MRI identified a recent left occipital ischemic lesion, due to embolism from the vertebral dissection. Search for connective tissue diseases was inconclusive, however, a variant of the MY121 gene (c4625G>A, R1542Q) was identified. The patient was discharged under acetylsalicylic acid (AAS). Two years later he developed frequent episodes of vertigo with vomiting, triggered by cephalic movements, with headache worsening and progressive dysphagia. Brain CT showed a significant increase in the aneurysm’s dimensions, with brainstem compression. Anti-emetic, analgesic therapeutic and clopidogrel were started. Clinical improvement was transient. After multidisciplinary discussion, the patient was submitted to endovascular treatment with three Flow Diverter, followed by double anti-aggregation (AAS 250 mg and clopidogrel 75 mg). Intra-sent thrombosis complicated with stent occlusion occurred shortly after the procedure, culminating in extensive brainstem ischemia and the patient’s death.

Conclusions: Giant vertebrobasilar dolichoectasia is a rare vascular disorder. The authors would like to highlight the difficulties in intervention given aneurism size and location.

Disclosure: No

P0606 / 569

DECOMPRESSIVE SURGERY IN CEREBRAL VENOUS SINUS THROMBOSIS WITH VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA

K. Krzywicka ¹, D. Aguiar de Sousa², A. van de Munckhof¹, M. Sánchez van Kammen¹, E. Lindgren^3,4, A. Scutelnic⁵, M.R Heldner⁵, A. Devroye⁶, V. Dizonno⁷, J. Pelz⁸, A. Aujayeb⁹, A. Günther¹⁰, S. Schoenenberger¹¹, F. Giammello¹², M. Wiedmann¹³, M. Petruzzellis¹⁴, R. Lemmens¹⁵, E.S Kristoffersen¹⁶, M. Bandettini di Poggio¹⁷, S. Chatterton¹⁸, K. Jood^3,4, J.A Kremer Hovinga¹⁹, T. Kleinig²⁰, S. Middeldorp²¹, M.M Levi^22,23, S. Poli²⁴, A. Ciccone²⁵, M. Kruip²⁶, J. Putaala²⁷, T. Tatlisumak^3,4, M. Arnold⁵, T.S Field⁷, M. Wittstock²⁸, D. Michalski⁸, M. Skjelland²⁹, F.J Bode³⁰, J. Zimmerman³⁰, E. De Maistre³¹, F. Bonneville³², T. Geeraerts³³, K. Garambois³⁴, J.-F. Payen³⁵, C. Cordonnier³⁶, J.M Coutinho¹, J.M Ferro³⁷, Cerebral Venous Sinus Thrombosis with Thrombocytopenia Syndrome Study Group

¹Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam, Netherlands, ²Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Department of Neurosciences and Mental Health, Lisbon, Portugal, ³Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden, ⁴Sahlgrenska Academy at University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden, ⁵Inselspital, Bern University Hospital, University of Bern, Department of Neurology, Bern, Switzerland, ⁶University Hospital Leuven, Department of Neurology, Leuven, Belgium, ⁷University of British Columbia, Vancouver Stroke Program, Division of Neurology, Vancouver, Canada, ⁸Leipzig University Hospital, Department of Neurology, Leipzig, Germany, ⁹Northumbria Healthcare NHS Foundation Trust, Respiratory Department, Cramlington, United Kingdom, ¹⁰Jena University Hospital, Department of Neurology, Jena, Germany, ¹¹Heidelberg University Hospital, Department of Neurology, Heidelberg, Germany, ¹²Polyclinic Hospital G. Martino Messina, Department of Neurology, Messina, Italy, ¹³Oslo University Hospital, Department of Neurosurgery, Oslo, Norway, ¹⁴AOU Consorziale Policlinico di Bari, Department of Neurology, Bari, Italy, ¹⁵University Hospitals Leuven, Department of Neurology, Leuven, Belgium, ¹⁶Akershus University Hospital, Department of Neurology, Oslo, Norway, ¹⁷Policlinic San Martino Hospital, Department of Neuroscience, Genoa, Italy, ¹⁸Royal North Shore Hospital, Department of Neurology, Sydney, Australia, ¹⁹Inselspital, Bern University Hospital, University of Bern, Department of Hematology, Bern, Switzerland, ²⁰Royal Adelaide Hospital, Department of Neurology, Adelaide, Australia, ²¹Radboud University Medical Center, Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Nijmegen, Netherlands, ²²National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom, ²³Amsterdam University Medical Centers, University of Amsterdam, Department of Vascular Medicine, Amsterdam, Netherlands, ²⁴Eberhard-Karls University, Department of Neurology & Stroke, Tuebingen, Germany, ²⁵Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Department of Neurology, Mantua, Italy, ²⁶Erasmus University Medical Center, Department of Hematology, Rotterdam, Netherlands, ²⁷Helsinki University Hospital, Department of Neurology, Helsinki, Finland, ²⁸University Hospital Rostock, Department of Neurology, Rostock, Germany, ²⁹Oslo University Hospital, Department of Neurology, Oslo, Norway, ³⁰Universitätsklinikum Bonn, Department of Neurology, Bonn, Germany, ³¹CHU Dijon, Department of Biological Haematology, Dijon, France, ³²Toulouse University Hospital, Department of Neuroradiology, Toulouse, France, ³³Toulouse University Hospital, Department of Anesthesiology and Critical Care, Toulouse, France, ³⁴University Hospital of Grenoble, Grenoble, France, ³⁵CHU Grenoble, Grenoble, France, ³⁶University of Lille, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France, ³⁷Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

Background and aims: Cerebral venous sinus thrombosis with thrombosis with thrombocytopenia syndrome (CVST-TTS) is a serious adverse drug reaction after adenoviral SARS-CoV-2 vaccinations. CVST-TTS patients may need decompressive surgery to avoid fatal brain herniation, but despite this intervention, many CVST-TTS patients die during the initial hospital admission. Here, we describe the characteristics and outcomes of CVST-TTS patients who underwent decompressive surgery and explore predictors of mortality in CVST-TTS patients.

Methods: We used data from an ongoing international registry collecting data from patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March and 9 December 2021. TTS was defined in accordance with the Brighton Collaboration case definition.

Results: Out of 97 CVST-TTS patients, 29 (30%) underwent decompressive surgery. All operated patients had an intracerebral haemorrhage before the surgery. In-hospital mortality was 19/29 (66%) in the operated and 23/68 (34%) in the non-operated group. In the operated group, the highest mortality rate was among patients who were in coma before the surgery (14/15, 93% vs 4/12, 33% in those not in coma), had bilateral absence of the pupillary response (7/7, 100% vs 8/16, 50% in patients with uni/bilateral pupillary response) and platelet count <50 x10³/μL (11/14, 79% vs 6/12, 50% in cases with a platelet count ⩾50 x10³/μL).

Conclusion: Mortality rate of CVST-TTS patients who underwent decompressive surgery is extremely high. Among the operated patients, coma before the surgery, bilateral absence of the pupillary response, and platelet count <50 x103/μL were the predictors of mortality.

Disclosure: No

CARDIOEMBOLISM & HEART-BRAIN INTERACTIONS

P0607 / 672

SHUNT SIZE IS ASSOCIATED WITH STROKE RECURRENCE IN MEDICALLY MANAGED PATIENTS WITH CRYPTOGENIC STROKE AND PATENT FORAMEN OVALE

I.C. Lim ¹, Y.H. Teo¹, J. Fang¹, Y.N. Teo¹, Y.Q. Lee¹, X. Chen¹, L.L. Yeo², C.-H. Sia³, B.Y. Tan²

¹Yong Loo Lin School of Medicine, National University of Singapore, Department of Medicine, Singapore, Singapore, ²National University Hospital, Division of Neurology, Department of Medicine, Singapore, Singapore, ³National University Heart Centre, Department of Cardiology, Singapore, Singapore

Introduction: Whilst guidelines suggest a role of patent foramen ovale (PFO) closure in selected cryptogenic stroke patients, a great proportion of these patients are managed medically. The natural history of this group of patients is unclear. Hence, we aimed to evaluate the relationship between shunt size and long-term clinical outcomes in medically managed cryptogenic stroke patients with PFO.

Methods: This cohort study identified 234 cryptogenic stroke patients who had a positive transcranial doppler (TCD) ultrasound bubble study with agitated saline. Patients who had undergone PFO closure were excluded. The subjects were divided into two groups, and were classified according to their Spencer Grading, small (Spencer Grade 1, 2, or 3; n=135) and large shunt (Spencer Grade 4 or 5; n=99). Univariate and multivariate analyses identified factors associated with recurrent ischemic stroke.

Results: The mean age of the participants were 50.5±0.860, of which 31.1% (n=73) were female, 55.1% (n=129) Chinese, 7.7% (n=18) Malay, 16.7% (n=39) Indian, 20.5% (n=48) from other races, and the median ROPE score was 6 (IQR: 5-7). Comparing to patients without recurrent ischemic stroke, patients with recurrent ischemic stroke had a lower left ventricular ejection fraction, higher prevalence of thrombophilia, post-stroke systemic embolism, and large PFO shunts (Table 1). On multivariate analysis, only a large PFO shunt was significantly associated with a higher risk of recurrent ischemic stroke, aOR 3.97 (95% CI 1.02-15.4), p=0.047.

Table 1.

Comparing Baseline Characteristics of PFO Patients with and without Recurrent Stroke.

	No recurrent stroke n=223	Recurrent stroke n=11	P-value
Baseline demographics
Age	50.4 ± 13.3	52.3 ± 11.6	0.651
Female	70 (31.4%)	3 (27.3%)	0.774
Race			0.006
Chinese	125 (56.1%)	4 (36.4%)	0.200
Malay	18 (8.1%)	0 (0.0%)	0.327
Indian	33 (11.1%)	6 (54.5%)	<0.001
Others	47 (21.1%)	1 (9.1%)	0.337
Large shunt (Spencer Grade 4 or 5)	91 (40.8%)	8 (72.7%)	0.036
ROPE score	6 (IQR: 5-7)	5 (IQR: 4-7)	0.448
Smoker	22 (9.9%)	2 (18.2%)	0.375
DM	32 (14.3%)	2 (18.2%)	0.725
HTN	73 (32.7%)	4 (36.4%)	0.803
HLD	50 (22.4%)	3 (27.3%)	0.707
IHD	11 (4.9%)	0 (0.0%)	0.451
CCF	0 (0%)	0 (0%)	.
Known stroke/TIA	22 (9.9%)	1 (9.1%)	0.933
Known VTE	3 (1.4%)	0 (0.0%)	0.698
Stroke characteristics
NIHSS	6 (IQR: 1-14)	8 (IQR: 4.5-18)	0.228
Unilateral infarct	198 (88.8%)	10 (90.9%)	0.827
Infarct characteristics
Subcortical and brainstem	2 (0.9%)	1 (9.1%)	0.019
Subcortical and cerebellar	2 (0.9%)	0 (0.0%)	0.752
Subcortical	74 (33.1%)	4 (36.4%)	0.835
Cortical and cerebellum	5 (2.3%)	0 (0.0%)	0.615
Cortical	105 (47.1%)	4 (36.4%)	0.478
Cerebellar	16 (7.2%)	1 (9.1%)	0.815
Brainstem and cerebellar	1 (0.4%)	0 (0.0%)	0.824
Brainstem[U1]	18 (8.1%)	1 (9.1%)	0.904
Echocardiographic Parameters
Atrial Septal Aneurysm	2/196 (1.0%)	0/10	0.748
LVEF	61.3 ± 6.5	56.8 ± 8.0	0.036
LA diameter	35.9 ± 6.3	35.5 ± 8.4	0.843
Other Characteristics
Presence of thrombophilia	16/121 (13.2%)	3/6 (50.0%)	0.013
Systemic embolism manifestations	1 (0.4%)	1 (9.1%)	0.002
New AF detected	3 (1.3%)	0 (0.0%)	0.699

Conclusion: In medically managed cryptogenic stroke patients with PFO, a large PFO shunt is associated with a higher risk of recurrent ischemic stroke.

Disclosure: No

P0608 / 1430

ATRIAL IMAGING AND CARDIAC RHYTHM IN CRYPTOGENIC EMBOLIC STROKE: A PRELIMINARY ANALYSIS OF ARIES STUDY

R. Rigual ¹, S. Castrejón-Castrejón², L. Fernández-Gassó³, J. García-Castro¹, G. Ruiz-Ares¹, M. Martínez-Cossiani², J. Rodríguez-Pardo¹, E. de Celis-Ruiz¹, L. Casado¹, J.C. Manso¹, M. Alonso de Leciñana¹, E. Díez-Tejedor¹, E. Pérez-David³, J.L. Merino², B. Fuentes¹

¹Hospital Universitario La Paz. IdiPaz Health Research Institute. Universidad Autónoma de Madrid, Department of Neurology and Stroke Center, Madrid, Spain, ²Hospital Universitario La Paz. IdiPaz Health Research Institute. Universidad Autónoma de Madrid, Robotic and Cardiac Electrophysiology Unit, Department of Cardiology, Madrid, Spain, ³Hospital Universitario La Paz. IdiPaz Health Research Institute. Universidad Autónoma de Madrid, Cardiac Image Unit, Department of Cardiology, Madrid, Spain

Background and aims: Cryptogenic stroke is frequently related to cardioembolic sources previously unknown. We aim to analyze atrial fibrillation (AF), parafibrillatory status (para-AF) and echocardiographic signs of atrial dysfunction in patients with cryptogenic stroke.

Methods: The ARIES (Atrial Imaging and cardiac Rhythm In Embolic Stroke) study includes consecutive patients with cryptogenic stroke. Cardiologic work-up consists in 30-day ECG monitoring (Nuubo) and advanced left atrial echocardiography function. Patients are classified as non-AF, AF, para-AF defined as >3000 atrial ectopic beats/day or >2 “micro-AF” episode (fibrillatory burst <30 seconds)/day). Signs of atrial dysfunction are defined by phasic left atrial strain (reservoir, conduit, and contraction). We compare echocardiographic signs of atrial dysfunction according to rhythm and report stroke etiology changes and stroke recurrence at 90 days.

Results: 78 patients completed 90 days follow-up. Stroke etiology remained cryptogenic in 44 patients (55%), 30 (37.5%) were reclassified as cardioembolic. AF was found in 26 (32.5%) patients and para-AF in 22 (27.5%). Para-AF patients had lower left atrial strain compared to non-AF (reservoir 22.2±9.8 vs 32.8±12, p=0.004; conduit -9.6±4.8 vs -14.4±9, p=0.008; contraction 12.6±4.8 vs 17.9±7.8, p=0.025). We found no significant differences in strain between AF and para-AF patients. There were three stroke recurrences (3.8%), 2/3 in para-AF patients.

Conclusion: In this preliminary analysis, we found AF in 32.5% patients with cryptogenic stroke and para-AF in 27.5%. Para-AF patients showed signs of atrial dysfunction similarly to AF patients and early stroke recurrence. Longer follow-up is required to confirm these findings

Disclosure: No

P0609 / 1369

INFECTIOUS ENDOCARDITIS AND VASCULAR CEREBRAL DISEASE: A RETROSPECTIVE REVIEW OF TEN YEARS

M. de la Calle Cuevas ¹, L. Maure Blesa¹, D. Lopez de Mota Sanchez¹, M.J. Arias Villarán¹, A.L. Nystrom Hernández¹, L. Olivié García¹, A. Herranz Bárcenas¹, I. Zamarbide Capdepón¹, M. Oses¹, I. Navas Vinagre¹, A. García Torres¹

¹ Fundación Jiménez Díaz, Neurology, Madrid, Spain

Background and aims: Cerebrovascular disease (CVD) is the most frequent neurological complication of Infectious endocarditis (IE). There are no protocols for its diagnosis and management. The objective of this work is to describe the epidemiological data, the clinical complications, management and prognosis of IE patients.

Methods: Retrospective study of IE patients attended in a Spanish tertiary hospital, during a 10 years period (August 2011-2021). The epidemiological data and CVD complications are described.

Results: 196 patients with IE were 65% male with a median age of 69 years, 65% had hypertension, 31% diabetes, 49% dyslipidemia, 34% atrial fibrillation. 18% smokers and 4% illicit drug consumption. 41% were anticoagulated. 15% had an immunodeficiency state (12 VIH infection and 17 with other causes). 19% patients had clinical or radiological CVD, which makes the brain the principal organ affected followed by spleen (8%) and lung (3%). Ischemic CVD meant 66%, hemorrhagic 31% and a combination of both in a 3%. High mortality rate (24%) was even higher in patients with CVD (47%) vs 19% in patients without it.

Most patients did not receive reperfusion therapy because low NIHSS score, critical clinical situation or established stroke. Only 3 patients received reperfusion therapy. Two of them thrombectomy (died because of systemic complications) and one intravenous fibrinolysis who achieved a complete recovery.

Conclusions: CVD is the most common neurological complication in IE, which carries a high mortality rate. It is important to establish protocols for managing this complication, in order to improve the prognosis of these patients.

Disclosure: No

P0610 / 1508

THE UTILITY OF STRUCTURAL CARDIAC IMAGING IN YOUNG ADULTS WITH TRANSIENT ISCHAEMIC ATTACK AND MINOR STROKE

C. Sivakumar ¹, H. Townsley¹, K. Ellis², J. White², A. Dados¹, R. Alijam¹, A. Kaushik¹, R. Bell³, G. Quattrocchi^1,4, A. Chandratheva¹

¹National Hospital for Neurology & Neurosurgery, Comprehensive Stroke Service, London, United Kingdom, ²University College London Medical School, London, United Kingdom, ³University College London Hospital, Cardiology, London, United Kingdom, ⁴North Middlesex Hospital, Neurology, London, United Kingdom

Backgrounds and aims: We aimed to evaluate the utility of cardiovascular investigations in young patients with Transient Ischemic Attack (TIA) or Minor Stroke (NIHSS <5).

Methods: Consecutive patients aged ⩽55 years attending a London Hospital TIA clinic 1st January 2019-31st December 2020 were retrospectively reviewed. Demographics, vascular risk factors, aetiology (TOAST criteria¹), Echocardiogram (transthoracic, TTE, +/- bubble) were recorded.

Results: Of 236, 92(38%) mimics, 144 TIA(46%), minor stroke(49%) or retinal stroke(5%), median age 44 years(IQR 16). Thirteen(9%) were multi-territory. 65(46%) had unknown aetiology, 26(19%) cardioembolic, 23(16%) other, 16(11%) small-vessel and 10(7%) large-vessel. On average 1.9 vascular risk factors/patient, but 29% had ⩾3 risk factors.

107(74%) underwent TTE. 7(6.5%) had Ejection Fraction <50%, and 50% of these had BMI>30 kg/m2. Twenty(18%) had enlarged left atrium, of which two(10%) had AF, seven(6%) Patent Foramen Ovale(PFO) and two(2%) atrial septal aneurysm(ASA). Twenty-six(23%) patients were found to have valve dysfunction however only four(3.6%) had moderate to severe regurgitation. No intra-cardiac thrombus or aortic root atheroma were found.

Seven(7%) patients had a PFO on TTE. Thirty-nine(28%) had bubble echocardiogram. PFO found in 25[65%, median age 40(17-53)]. Eighteen(48%) underwent closure. Main indicators for bubble echo were unknown aetiology(18 cases,41%), multi-territory strokes(11, 25%), migraine(8,18%) or confirmation of possible PFO/ASA on TTE(5,11%).

Conclusions: PFO was found in more than two-thirds of those assessed with clinically targeted Bubble TTE. Of those without bubble echo nearly half remain of unknown aetiology. Clear criteria and clinical pathways for requesting bubble echo could aid clinicians in identifying patients more consistently.

Disclosure: No

P0611 / 1330

PROLONGED CONTINUOUS ARRHYTHMIAS MONITORING AFTER PFO CLOSURE WITH ROOTI-RX SUPRACUTANEOUS DEVICE: PROTOCOL PRESENTATION AND PRELIMINARY RESULTS OF THE ARMONIC STUDY

G.D. Scrima ¹, G. Nardi², N. D’Ettore², P. Demola², G. Pracucci¹, M. Stolcova², R. Nistri³, A. Cramaro⁴, S. Mugnai⁴, S. Trapani⁴, F. Ristalli², D. Accavone¹, C. Rapillo¹, A. Mattesini², B. Piccardi⁵, P. Nencini⁵, C. Di Mario², C. Sarti^1,5, F. Meucci², on behalf of the Heart and Brain Team of Careggi University Hospital

¹University of Florence, NEUROFARBA, Florence, Italy, ²Careggi University Hospital, Structural Interventional Cardiology, Florence, Italy, ³Careggi University Hospital, Department of Heart and Vessels, Florence, Italy, ⁴Careggi University Hospital, Neurosonology Unit, Florence, Italy, ⁵Careggi University Hospital, Stroke Unit, Florence, Italy

Background and aims: One of the most frequent adverse event of the patent foramen ovale (PFO)-closure is atrial fibrillation (AF), also other arrhythmia could occur. Since a study of prolonged monitoring of heart rhythm in these patients is lacking we aim to fill this gap.

Methods: Single centre pilot prospective study on patients undergoing PFO-closure. Each patient will be submitted to a continuative 28-days monitoring (7-days pre, 21-days post-closure) of heart rhythm with a supracutaneous device (Rooti-RX). Registered parameters: mean heart rate (mHR), AF, supraventricular/ventricular ectopic beats, sustained/non-sustained supraventricular (SVT) and ventricular tachycardia (VT). Pre/post-closure results will be compared and corrected for age, sex, cardiovascular (CV) risk factors, atrial volume, morphological/functional characteristics of PFO, device used. Patients with documented AF will perform cerebral-MRI at 6 months to detect silent embolic events.

Results: We plan to enroll at least 50 patients. Seven already enrolled, 85.7% male, mean age 49 years. Two patients presented AF after PFO-closure (one with Gore, one with Ultrasept), one had multiple CV risk factors and dilated atrium (36ml/m2). After PFO-closure we observed a significant increase of mHR (p=0.037) and a non-significant increase of BESV/BEV, the onset of non-sustained SVT and VT (17 beats in a single patient). No pathological pauses were found. No clinical neurological events reported.

Conclusions: These are preliminary data. The understanding of the frequency, predictors, and embolic potentials of post-closure arrythmias could allow to identify a subgroup of patients deserving a preventive antiarrhythmic therapy and the use of anticoagulants instead of antiplatelets after PFO-closure.

Disclosure: No

P0612 / 670

ARE TROPONIN LEVELS IN THE SETTING OF AN ACUTE ISCHAEMIC STROKE A PREDICTOR OF A CARDIAC CAUSE: A SINGLE-CENTRE RETROSPECTIVE OBSERVATIONAL STUDY

A. Duncan ¹, D. Khalil¹, O. Lynch¹

¹ OLOL Hospital Drogheda, Stroke Medicine, Drogheda, Ireland

Background and aims: Measuring troponin levels is currently recommended by the AHA and ESO as a baseline investigation in the management of patients presenting with an acute ischaemic stroke. This study aims to investigate the value of high-sensitivity Troponins in the setting of an acute ischaemic stroke as a biomarker of predicting underlying cardiac disease.

Methods: This is a single-centered retrospective observational study. The inclusion criteria consisted of a confirmed acute ischaemic stroke on MRI/CT during the calendar year 2020. Exclusion criteria consisted of the absence of any one of the following; Troponin levels measured on acute presentation, Echocardiogram, or 72-hour Holter. The primary outcome is to investigate potential predictors of high Troponin levels using a regression model.

Results: There was a total of 222 confirmed ischaemic strokes in our center. 127 patients met the inclusion/exclusion criteria. 21.5% of patients had a raised Troponin at the time of acute presentation. A logistic regression model shows that increasing age (p-value 0.05) and a diagnosis of atrial fibrillation/flutter (p-value 0.018) are significant predictors of a raised Troponin. There were no statistically significant associations between sex, the vascular territory of stroke, or ECHO findings. The R-squared value of our model is 0.38. Patients were 3.3 times more likely to have atrial fibrillation/flutter if they had a raised Troponin level.

Conclusion: A raised Troponin in the setting of an acute ischaemic stroke could potentially be a biomarker for atrial fibrillation or flutter. This has important prognostic outcomes and changes management in the sub-acute setting.

Disclosure: No

P0613 / 444

INFLAMMATION AND HAEMOSTASIS IN THE STRATIFICATION OF BLEEDING AND THROMBOTIC RISK OF ATRIAL FIBRILLATION ON ORAL ANTICOAGULANT THERAPY: INSIGHTS FROM STRAT-AF STUDY

F. Alfano ¹, R. Marcucci¹, A.M. Gori¹, F. Cesari¹, E. Lotti¹, B. Giusti¹, A. Bertelli¹, A. Kura¹, L. Mannini¹, R. De Cario¹, E. Salvadori², A. Poggesi2, C. Barbato²

¹University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy, ²University of Florence, NEUROFARBA Department, Neuroscience Section, Florence, Italy

Background and aims: In anticoagulated atrial fibrillation (AF) patients the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. We hypothesize that circulating and neuroimaging-based markers and their interaction might improve the prediction of bleeding risk in AF patients treated with any type of oral anticoagulant.

Methods: The Strat-AF study is an observational, prospective, single-center study enrolling patients with AF, aged 65 years or older, and with no contraindications to undergo magnetic resonance imaging (MRI). Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral MRI and circulating biomarkers assessment at baseline and after 18 months. The main outcomes are the evaluation of cerebral microangiopathy and the onset of ischemic or hemorrhagic stroke related to the levels of the aforesaid biomarkers. 

Results: Starting from September 2017, 170 patients were enrolled. Follow-up clinical evaluation and MRI were performed at 18 months. On multivariate analysis independent predictors were: at baseline, low levels of vWF for microbleeds, elevated levels of IL-6 for hyperintensity of white matter; at follow-up, hypofibrinolysis for new non-lacunar infarcts, elevated levels of IL-8 for new lacunar infarcts and high ETP-peak levels for microbleeeds.

Conclusions: The Strat-AF study may be an essential step towards the exploration of the role of multiple biomarker models in predicting stroke risk in AF and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater improvement in clinical outcomes in a cost-effective fashion.

Disclosure: No

P0614 / 144

IMPACT OF LEFT VENTRICULAR LATE DIASTOLIC DYSFUNCTION AND LEFT ATRIAL DILATATION ON LONG-TERM RISK OF ISCHEMIC STROKE IN POST-STEMI PATIENTS

S. Chimed ¹, E. Erdenetsog², B. Khuyag²

¹Sor Clinic, Ulaanbaatar, Mongolia, ²Intermed Hospital, Cardiology Department, Ulaanbaatar, Mongolia

Background and aims: Ischemic stroke (IS) after ST-segment elevation myocardial infarction (STEMI) is a devastating complication linked to left atrial (LA) dilatation. In the present study, we aimed to investigate the impact of left ventricular (LV) diastolic dysfunction and LA remodeling on long-term risk of IS in post-STEMI patients.

Methods: Patients with STEMI who were treated with primary percutaneous coronary intervention (PCI) were selected. Speckle-tracking derived strain rate estimation was used to evaluate LV late diastolic function (SRa), while LA volume index (LAVi) ⩾28 ml/m²considered as a LA dilatation. First ischemic stroke after index STEMI was chosen for study endpoint.

Results: A total of 524 post-STEMI patients who were treated with primary PCI were included (mean age 60±14, 85% male). At baseline, 214 patients (41%) had LA dilatation, as assessed by LAVi ⩾28 ml/m², while LA was not dilated for 310 patients (59%). The LV SRa was significantly impaired in patients with LA dilatation compared to patients without LA dilatation (0.86±0.23 s^-1 vs. 0.72±0.27 s^-1, p<0.001). During median follow-up of 27 months (IQR 13-41 months), IS occurred for 6 patients (1.1%). After adjustment of LA dilatation, LV SRa (HR=0.023, 95% CI 0.001-0.763, p=0.035) was significantly associated with IS in post-STEMI patients. Furthermore, patients with LV SRa ⩽ 0.6 s^-1 had significantly higher cumulative event rate compared to patients with LV SRa > 0.6 s^-1 (Figure 1).

Conclusions: Impairment of LV SRa early after STEMI is associated with LA dilatation and independent predictor of IS in post-STEMI patients.

Disclosure: No

P0615 / 1237

MYOCARDIAL INJURY IN CEREBRAL VENOUS THROMBOSIS

S. Litmeier ¹, R. von Rennenberg¹, T.B. Braemswig¹, H.J. Audebert¹, J.F. Scheitz¹, M. Endres¹, C.H. Nolte¹

¹ Charité-Universitätsmedizin Berlin, Neurology, Berlin, Germany

Background and aims: Myocardial injury indicated by elevation of cardiac troponin (hs-TnT) is described in several neurological diseases such as ischaemic stroke or subarachnoid haemorrhage. Data on significance of myocardial injury in cerebral venous thrombosis (CVT) is scarce. CVT-patients are generally younger than ischaemic stroke patients and they do not share cardiovascular risk factors that are common in other forms of myocardial injury. Therefore, evaluation of myocardial injury in CVT-patients might be of great interest to better understand the heart-brain-axis.

Methods: All consecutive CVT-patients with measurement of hsTnT on admission admitted to Charité-Universitätsmedizin Berlin between 2010 and 2021 were analyzed retrospectively. According to European Society of Cardiology guidelines myocardial injury was defined as hsTnT levels above the 99^th percentile (14 ng/l) of the assay (Roche Elecsys). We performed univariate comparisons using χ²- or Mann-Whitney-U-test.

Results: Of 66 CVT-patients, hs-TnT levels were available in 46 patients. Mean age was 53 years and 24/46 patients were female. In 25/46, no cardiovascular risk factor and in 38/46 no cardiac comorbidity (coronary artery disease, heart failure, cardiac arrhythmias) was present. Myocardial injury was present in 12/46 CVT-patients (26%). In univariate comparison, myocardial injury was associated with ischaemic infarction (p=0.014), haemorrhagic infarction (p=0.010), subarachnoid haemorrhage (p=0.025), and older age (p<0.001).

Conclusions: Even though CVT-patients are younger than common ischaemic stroke patients and cardiac comorbidities are rare, myocardial injury is frequent. The association with CVT causing brain lesions emphasizes the importance of the heart-brain-axis.

Disclosure: No

P0616 / 578

ONCE VERSUS TWICE DAILY DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH RECENT STROKE AND ATRIAL FIBRILLATION

A. Polymeris ^1,2, A. Zietz¹, F. Schaub¹, L. Meya^1,2, C. Traenka^1,2, S. Thilemann¹, B. Wagner¹, L. Hert³, V. Altersberger¹, D. Seiffge⁴, T. Dittrich¹, I. Piot^1,2, J. Kaufmann^1,2, L. Barone^1,2, L. Dahlheim⁵, S. Flammer⁵, N. Avramiotis¹, N. Peters^1,2,6, G.M. De Marchis¹, L. Bonati¹, H. Gensicke^1,2, S. Engelter^1,2, P. Lyrer¹

¹University Hospital Basel and University of Basel, Department of Neurology and Stroke Center, Basel, Switzerland, ²Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland, ³University Hospital Basel and University of Basel, Department of Intensive Care Medicine, Basel, Switzerland, ⁴University Hospital and University of Bern, Department of Neurology, Inselspital, Bern, Switzerland, ⁵Medical Faculty, University of Basel, Basel, Switzerland, ⁶Hirslanden Hospital, Department of Neurology and Stroke Center, Zurich, Switzerland

Background: Data on the safety and effectiveness of once-daily (QD) versus twice-daily (BID) direct oral anticoagulants (DOAC) in comparison to vitamin K antagonists (VKA) and to one another in patients with atrial fibrillation (AF) and recent stroke are scarce.

Methods: Based on prospectively obtained data from the observational registry Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients (NOACISP)-LONGTERM (NCT03826927) from Basel, Switzerland, we compared the occurrence of the primary outcome – the composite of recurrent ischemic stroke, major bleeding and all-cause death – among consecutive AF patients treated with either VKA, QD DOAC or BID DOAC following a recent stroke using cox proportional hazards regression adjusting for potential confounders.

Results: We analyzed 956 patients (median age 80 years, 46% female), of whom 128 received VKA (13.4%), 264 QD DOAC (27.6%) and 564 BID DOAC (59%). Over a total follow-up of 1,596 patient-years, both QD DOAC and BID DOAC showed a lower hazard for the composite outcome compared to VKA (adjusted HR [95%-CI] 0.71 [0.49,1.04] and 0.69 [0.49,0.95], respectively). Upon direct comparison, the hazard for the composite outcome did not differ between patients treated with QD versus BID DOAC (adjusted HR [95%-CI] 0.95 [0.71,1.29]). Secondary analyses focusing on the individual components of the composite outcome revealed no clear differences in the risk-benefit profile of QD versus BID DOAC.

Conclusion: The overall benefit of DOAC over VKA seems to apply to both QD and BID DOAC in AF patients with a recent stroke, without evidence that one DOAC dosing regimen is more advantageous than the other.

Disclosure: No

P0617 / 1323

A HIGHLY SPECIFIC PREDICTIVE MODEL FOR THE DETECTION OF ATRIAL FIBRILLATION USING CLINICAL AND RHYTHM BIOMARKERS

M.R. de Torres Chacon ¹, F. Sanchez Fernandez¹, A. Barragan Prieto¹, J.A. Tamayo Toledo², J.A. Cabezas Rodriguez³, I. Villegas Rodriguez⁴, D. Fernandez⁵, R. Rivera⁶, A. Arjona⁷, J. Fernandez Perez⁷, P. Martinez Sanchez⁷, G. Sanz Fernandez⁸, E. Murillo Espejo⁸, C. de la Cruz Cosme⁹, A. Gallardo Tur⁹, R. Valverde Moyano¹⁰, C. Carmona Medialdea¹⁰, S. Perez Sanchez¹, A. Dominguez Mayoral¹, M.A. Gamero Garcia¹, R. Acevedo¹, F. Moniche Alvarez³, R. Cozar¹¹, J. Montaner¹, SUR-Project Study Group

¹Hospital Virgen Macarena, Neurology, Seville, Spain, ²Hospital Regional Universitario Malaga, Neurology, Malaga, Spain, ³Hospital Virgen del Rocio, Neurology, Seville, Spain, ⁴Hospital Universitario San Cecilio, Neurology, Granada, Spain, ⁵Hospital Universitario Virgen de las Nieves, Neurology, Granada, Spain, ⁶Hospital Universitario Virgen de las Nieves, Cardiology, Granada, Spain, ⁷Hospital Universitario Torrecárdenas, Neurology, Almeria, Spain, ⁸Hospital Universitario Juan Ramon Jimenez, Neurology, Huelva, Spain, ⁹Hospital Virgen de la Victoria, Neurology, Malaga, Spain, ¹⁰Hospital Universitario Reina Sofia, Neurology, Cordoba, Spain, ¹¹Hospital Virgen Macarena, Cardiology, Seville, Spain

Background: Hidden atrial fibrillation (AF) is one of the most frequent underlying etiologies in cryptogenic stroke and its rapid detection can avoid new vascular episodes. Easy-to-use AF predictive models might help to select those patients for prolonged cardiac monitoring after stroke.

Methods: A prospective multicenter study with prolonged 30 days Holter cardiac monitoring in patients after ESUS in the Andalusian population was conducted. Patients were included up to 12 months after index stroke. Baseline demographics, stroke characteristics and AF detection rates were analyzed. A predictive model for hidden AF was elaborated including clinical and cardiac rhythm variables.

Results: 352 patients were monitored. Mean age 67.8 years, 161 women (46.4%). Hidden AF detection rate was 17% (60). Comparing AF and no-AF patients, we found that AF patients were older (72.26 (±10.53) vs 66.97 (±11.32) years, p=0.001), had large vessel occlusion stroke (31.6% (19) vs 15.7% (46), p=0.005), frequent atrial paroxysmal complexes (FAPC) on 24h-holter after stroke (36.8% vs. 20.2%; p= 0.009) and left atria enlargement (40.42 mm (±5.24) vs 37.96 (±5.38), p=0.007). The area under the ROC curve of the selected parametric model was 0.735 (CI 0.676-0.789) with a specificity of 99% (figure 1).

Conclusions: According to our study, elderly patients with large vessel occlusion ESUS, left atrial enlargement and 24-hour Holter FAPC are those with the highest risk of hidden AF. The huge specificity of the model allows selection of candidates for prolonged cardiac monitoring and even for early initiation of anticoagulants waiting for holter-monitoring results.

Disclosure: No

P0618 / 942

TRANSCRANIAL DOPPLER MONITORING DURING TRANSCATHETER AORTIC VALVE IMPLANTATION – IS IT MORE TO THE EMBOLIC LOAD THAN WE ALREADY KNOW – CASE SERIES

I.-F. Bratu ¹, A. Ribigan¹, R. Badea¹, S. Mihaila-Baldea², C. Udroiu², D. Vinereanu², F. Antochi¹

¹Emergency University Hospital Bucharest, Neurology, Bucharest, Romania, ²Emergency University Hospital Bucharest, Cardiology, Bucharest, Romania

Background and aims: Transcatheter aortic valve implantation (TAVI) is a procedure used in patients with severe aortic valve stenosis. Previous studies have underlined the importance of transcranial Doppler monitoring (TCDm) during TAVI in identifying procedural aspects associated with increased cerebral embolic load. The aim of this case series is to present the work-flow and preliminary results in inferences regarding the factors influencing the microembolic load attributed to TAVI during the pre-, peri- and postprocedural periods.

Methods: Case series of 3 patients admitted to our hospital between 2019-2020. 2 patients were male and 1 female, with mean age at procedure of 75 y.o. (73-77). TCDm was performed using TCD_X, Atys Medical, 2014 - hardware for 30 minutes before TAVI, 8 hours before TAVI and for the duration of the procedure. TAVI intervention time was splited into 5 divisions: introduction of the STIFF guide, pre-balloon dilation and pacing, valve introduction in the ascending aorta, valve passage through the aortic arch and pacing and valve expansion.

Results: The most emboligenic procedure times were related to pre-balloon dilation, valve passage and expansion, findings pinpointed by other studies as well. However, TCDm revealed that preprocedural manipulations, such as positioning of the transesophageal ultrasonography transducer determined microemboli displacement. Moreover, the postprocedural monitoring revealed a higher microembolic load than the preprocedural period.

Conclusions: We chose to present this case series to prove the usefulness of long-term TCDm in patients with TAVI. Improvement of technique can reduce subsequent microembolic load and its impact on cognition and cerebrovascular events.

Disclosure: No

P0619 / 1019

NEUROIMAGING MARKERS OF CEREBROVASCULAR DISEASE AND COGNITION IN ADULTS WITH MODERATE-SEVERE COMPLEXITY CONGENITAL HEART DISEASE

T.S Field ¹, S. Mangat², V. Dizonno¹, M. Shymka¹, H. Payette¹, J. Andrade³, M.K. Heran², K. LeComte⁴, J. Grewal³

¹University of British Columbia, Medicine/Neurology, Vancouver, Canada, ²University of British Columbia, Radiology, Vancouver, Canada, ³University of British Columbia, Medicine/Cardiology, Vancouver, Canada, ⁴Pacific Adult Congenital Heart Disease Clinic, Providence Health Care, Vancouver, Canada

Background and aims: Epidemiological studies have identified an increased risk of premature stroke and dementia in adults with congenital heart disease (ACHD), with a dose-response relationship with lesion complexity. We report our baseline cognitive and neuroimaging findings to date from a longitudinal observational study of brain health in moderate-severe complexity ACHD.

Methods: Participants are recruited from a large provincial subspecialty clinic. Individuals aged ⩾18 and without a contraindication to MRI with moderate-severe complexity CHD are invited to participate. Participants undergo brain MRI including time-of-flight imaging and cognitive assessment with the MoCA and NIH Toolbox-Cognitive Battery. Recruitment began in Fall 2020.

Results: Sixty participants have been recruited to date. Baseline clinical, cognitive and imaging characteristics are summarized in Table 1.

Conclusions: This young cohort has an overall greater-than-expected burden for age of cerebral microbleeds and white matter hyperintensities in the context of previous cardiac surgery. Previously unknown incidental findings of clinical significance identified included a subclinical embolic infarct and unilateral Moyamoya vascular morphology. Further analysis is pending to assess the relationship between lesion complexity, surgical history and other risk factors with neuroimaging findings. Despite prevalent neuroimaging abnormalities, overall cognitive performance by both screening and more sensitive measures is normal. Repeat neuroimaging at Year 3 will identify new incident findings and cognitive performance will be reassessed annually to assess for longitudinal change.

Table 1.

	N=60
Age in y, mean (SD)  Range	33.2 (7.4)19-47
Sex, n(%)
Male	34 (58)
Female	25 (42)
Race-ethnicity, n(%)
white	45 (76)
East Asian	4 (7)
South Asian	6 (10)
Other	4 (7)
Highest-complexity cardiac lesion, n(%)
SEVERE COMPLEXITY	17 (28)
Fontan circulation	2
Double-outlet ventricle	1
Pulmonary atresia	4
Pulmonary valvular obstructive disease	1
D-Transposition of the great arteries	7
Tricuspid dysplasia with severe regurgitation	1
Truncus arteriosus	1
MODERATE COMPLEXITY	43 (72)
Anomalous pulmonary venous return	2
AV septal defect	1
Coarctation of the aorta	16
Complex aortic valve disease	8
Ebstein anomaly	2
Pulmonary valve stenosis	2
Pulmonary valve regurgitation	4
Subvalvular aortic stenosis	4
Tetralogy of Fallot	2
Ventricular septal defect with aortic or mitral valve disease	2
Antithrombotic use, n(%)
Any	24 (40)
Antiplatelet	14 (23)
Anticoagulant	10 (17)
Cognitive performance
MoCA, mean (SD)	27.3 (2.4)
MoCA <26, n(%)	9 (15)
NIHTB corrected fluid composite T-score (SD)	48.9 (10.5)
NIHTB corrected crystallized composite T-score (SD)	50.4 (10.6)
NIHTB corrected total composite T-score (SD)	50.2 (10.0)
	N=56 (review of additional scans pending)
Neuroimaging, n(%)
Any deep or periventricular white matter hyperintensities	34 (61)
Cerebral microbleeds	27 (48)
Cortical superficial siderosis	0 (0)
Lacunar infarcts	0 (0)
Embolic infarcts	3 (5)
Primary hemorrhagic infarcts	1 (2)
MR angiography variants or abnormalities	25 (45)
Benign anomaly/variant	1 (2)
Of clinical concern	4
Absent vert	3
PICA ends in vert	2
Vertebral artery origin from aorta	3
Right-sided aortic arch	3
Hypoplastic A1	9
Unilateral/bilateral fetal PCA	1
Unilateral moyamoya

Disclosure: No

P0620 / 896

NATRIURETIC PEPTIDES MAY HELP TO IDENTIFY PEOPLE WITH LOW RISK OF NEWLY DETECTED ATRIAL FIBRILLATION: DATA FROM THE BIOSIGNAL COHORT

A. Cameron ¹, M. Arnold², H.K. Cheng¹, J. Lin¹, J. Yang¹, J. Schweizer², V. Schütz², T. Pokorny², C. Inauen², L.P. Westphal², M. Arnold³, U. Fischer^3,4, L.H. Bonati⁴, G.M. De Marchis⁴, T. Kahles⁵, K. Nedeltchev⁵, C.W. Cereda⁶, G. Kägi^3,7, A. Bustamante⁸, J. Montaner^8,9, G. Ntaios¹⁰, C. Foerch¹¹, K. Spanaus¹², L. Sahle¹², A. von Eckardstein¹², J. Dawson¹, M. Katan^2,4

¹University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom, ²University of Zurich, Department of Neurology, Zurich, Switzerland, ³Universit Hospital Bern, Department of Neurology, Bern, Switzerland, ⁴University Hospital Basel and University of Basel, Department of Neurology, Basel, Switzerland, ⁵Cantonal Hospital Aarau, Department of Neurology, Aarau, Switzerland, ⁶Regional Hospital of Lugano, Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland, ⁷Cantonal Hospital St. Gallen, Department of Neurology, St. Gallen, Switzerland, ⁸Vall d’Hebron Institute of Research (VHIR), Neurovascular Research Laboratory, Barcelona, Spain, ⁹Hospital Universitario Virgen Macarena, Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Seville, Spain, ¹⁰University of Thessaly, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, Larissa, Greece, ¹¹Goethe University, Department of Neurology, Frankfurt, Germany, ¹²University Hospital of Zurich, Institute of Clinical Chemistry, Zurich, Switzerland

Background: Prolonged cardiac monitoring is performed to search for newly detected atrial fibrillation (NDAF) after ischaemic stroke (IS), but access is limited. We aimed to assess the utility of midregional proatrial natriuretic peptide (MRproANP) and N-terminal pro B-type natriuretic peptide (NTproBNP) to identify people who are unlikely to have NDAF after IS, and who may not need prolonged cardiac monitoring.

Methods: We conducted an analysis of people included in the BIOSIGNAL study (NCT02274727) with no history of AF and who had ⩾3 days of cardiac monitoring. Univariable and multivariable logistic regression analyses were performed to identify variables associated with absence of NDAF. AUROC curves were constructed incorporating clinical variables from multivariable analysis ± MRproANP or NTproBNP. We compared AUROCs for models including clinical variables versus clinical variables + MRproANP or NTproBNP using the Likelihood-Ratio Test for nested models. We compared AUROCs for models including clinical variables + MRproANP versus clinical variables + NTproBNP using De Long’s test.

Results: We included 621 people: 243 (39.1%) female and mean±SD age 67±14 years. Clinical variables included in multivariate analysis were age, NIHSS score, lipid-lowering therapy, creatinine concentration and smoking. AUROCs for models including clinical variables ± log-MRproANP or log-NTproBNP are presented in Table 1.

Model	AUROC (95%CI)	Likelihood-ratio p-value(versus clinical variables)
Clinical variables	0.68 (0.62-0.74)	-
Clinical variables + log-MRproANP	0.72 (0.66-0.78)	p=0.001
Clinical variables + log-NTproBNP	0.71 (0.65-0.77)	p=0.009

In direct comparison of AUROCs for models with clinical variables + log-MRproANP versus log-NTproBNP, MRproANP and NTproBNP performed similarly (AUC 0.72, 95%CI 0.66-0.78 versus AUC 0.71, 95%CI 0.65-0.77, p=0.28).

Conclusions: The natriuretic peptides MRproANP and NTproBNP may help identify people who are unlikely to have NDAF after IS.

Disclosure: Yes

P0621 / 974

CARDIAC CT FOR INTRA-CARDIAC THROMBUS DETECTION IN EMBOLIC STROKE OF UNDETERMINED SOURCE (ESUS)

R. Barnea ¹, I. Nardi-Agmon¹, E. Auriel¹, A. Hamdan¹

¹ Rabin Medical Center, Tel-Aviv University, Neurology, Petach Tikva, Israel

Background and aims: Embolic stroke of undetermined source (ESUS) is a common medical challenge regarding secondary prevention strategy. Cardiac imaging is the cornerstone of embolic stroke workup, in an effort to diagnose high-risk cardio-embolic sources. Cardiac computed tomography angiography (CCTA) is an emerging imaging modality with high diagnostic performance for intra-cardiac thrombus detection. The yield of CCTA implementation in ESUS workup is unknown. Thus, the aim of this study was to assess the utility of CCTA in detecting intra-cardiac thrombi in the routine ESUS workup.

Methods: This is a retrospective observational analysis of ESUS cases managed in our vascular neurology unit between 2019 and 2021. Within this ESUS registry, consecutive patients undergoing CCTA were included and carefully analyzed.

Results: During the study period 1066 Ischemic stroke cases were treated and evaluated. 266/1066 (25%) met ESUS criteria and 129/266 (48%) underwent CCTA. In 22/129 (17%) patients, intra-cardiac thrombus was detected: left ventricular thrombus in 13 (10.1%) patients, left atrial appendage (LAA) thrombus in 8 (6.2%) patients, and left atrial (LA) thrombus in 1 (0.8%) patient. Only 5/22 (23%) of these thrombi were suspected, but could not be confirmed, in trans-thoracic echocardiogram (TTE). Overall, 27/129 (21%) patients were found to have an indication (including pulmonary embolism) for commencing anticoagulation (AC) treatment, rather than anti-platelets.

Conclusion: CCTA improves the detection of intra-cardiac thrombi in addition to standard care in ESUS patients. The implementation of CCTA in routine ESUS workup can change secondary prevention strategy in a high proportion of patients.

Disclosure: No

P0622 / 89

YIELD OF ECHOCARDIOGRAPHY IN ISCHEMIC STROKE AND TIA PATIENTS WITH ESTABLISHED INDICATIONS FOR PERMANENT DIRECT ORAL ANTICOAGULANT THERAPY

T. Meinel ¹, K. Brignoli¹, E. Buffle¹, S. Jung¹

¹ Stroke Research Center Bern, Inselspital, University of Bern, Bern, Switzerland

Background: We aimed to determine the diagnostic yield of transthoracic (TTE) and transesophageal echocardiography (TEE) in ischemic stroke and TIA patients with established indications for direct OAC (DOAC) prior to the index event.

Methods: Retrospective cohort study of consecutive patients with preceding established indications for permanent full-dose DOAC presenting to a single comprehensive stroke center with ischemic stroke or TIA. Choice of echocardiography modality was based on expert recommendations. The primary outcome was a composite of prespecified treatment-relevant high-risk findings adjudicated by an expert panel based on TTE and TEE reports according to evidence-based recommendations. Secondary outcomes included biomarkers associated with the primary outcome.

Results: Of 424 patients included (median[IQR] age, 78[70-84] years; 175[41%] females; NIHSS 4[1-12], 67% atrial fibrillation), 191(45%) underwent TTE, 101(24%) TEE and 132(32%) did not receive echocardiography. Median time from index stroke to echocardiography was 2(1-3) days. TTE identified 26(14%) patients with 35certainly treatment-relevant pathologies. TEE identified 16(16%) patients with 20certainly treatment-relevant pathologies. Most treatment-relevant findings represented hints to coronary heart disease and valvular pathologies. In further 3(2%) of patients on TTE and 4(4%) of patients on TEE, other potentially relevant findings were identified. Variables associated with certainly treatment-relevant high-risk pathologies included more severe stroke, diabetes, and laboratory biomarkers (NT-proBNP, CRP, D-Dimer and troponin).

Conclusions: In those patients with established indications for permanent DOAC and stroke that received echocardiography, bothTEE and TEE identified a similar proportion of treatment-relevant high-risk pathologies of about 1 in 7 patients. Diabetes, NT-proBNP,and D-Dimer were independent predictors of treatment-relevant high-risk findings.

Disclosure: No

P0623 / 577

ACUTE NEUROLOGICAL COMPLICATIONS ASSOCIATED WITH INFECTIVE ENDOCARDITIS. CHARACTERISTICS AND THERAPEUTIC MANAGEMENT

C. Gutierrez Albizuri ¹, A. Cabrera Muras¹, I. Oyarzun Irazu¹, D. Martínez Cóndor¹, S. Kapetanovic García¹, J.M. García Sánchez¹, M. De la Peña Trigueros², Á. Ortiz de Salazar Varona³, J.C. García-Moncó Carra¹

¹Basurto University Hospital, Neurology, Bilbao, Spain, ²Basurto University Hospital, Infectious Diseases, Bilbao, Spain, ³Basurto University Hospital, Cardiac Surgery, Bilbao, Spain

Background and aims: Acute cerebrovascular complications in association with infective endocarditis (IE) are frequent, linked to various factors and affect therapeutic decision-making. They are sparsely documented in literature, especially regarding acute management.

Methods: We conducted a restrospective study of IE patients in our hospital between 2019-2021. We gathered epidemiological, microbiological, clinical and therapeutic characteristics of those with neurological complications.

Results: Data from 91 patients were collected. 19 (21%) experienced acute neurological complications. Median age was 75 with majority of males (14:5) without previous IE. Native valve (74%) and S.epidermidis involvement (37%) prevailed. In 9/19 cases (47%) the neurological complication was the form of presentation, predominantly with ischemic stroke (73%), frequently multifocal and the majority affecting anterior circulation. 5/19 patients received antiplatelet therapy and 8/19 anticoagulation during the course of IE. 3 patients underwent mechanical thrombectomy obtaining complete perfusion, substantial reduction in NIHSS score and 1 case of hemorrhagic transformation. Mortality in patients with neurological complications was of 31%. Amongst survivors, neurological outcome at 3-6 months was favorable with a mRankin score of 3 or less in 84%.

Conclusions: Neurological complications of IE are frequent, mostly cerebrovascular, and are often the form of presentation. Despite their severity, functional prognosis can be favorable. It is essential to optimise treatment guidelines: mechanical thrombectomy appears to be a feasible and promising option in selected patients with IE and ischemic stroke. Further research and evidence-based recommendations are needed in order to guide decisions on antiplatelet and anticoagulant therapies in IE.

Disclosure: No

P0624 / 478

PREDICTORS OF MOBILITY IMPAIRMENT IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION: STRAT-AF STUDY

B. Formelli ¹, C. Barbato¹, E. Barucci¹, F. Cesari², B. Giusti², A.M. Gori², E. Fainardi³, R. Marcucci², F. Pescini¹, E. Salvadori⁴, A. Poggesi⁴

¹Azienda Ospedaliera Universitaria Careggi, NEUROFARBA, Florence, Italy, ²Azienda Ospedaliera Universitaria Careggi, Atherothromobotic Disease Centre, Florence, Italy, ³Azienda Ospedaliera Universitaria Careggi, Neuroradiology Department, Florence, Italy, ⁴Azienda Ospedaliera Universitaria Careggi, Stroke Unit, Florence, Italy

Backgrounds: Atrial Fibrillation (AF) presents significant associations with many other comorbidities. Our aim was to evaluate longitudinal determinants of motor impairment in elderly AF patients.

Methods: The Strat-AF study (Stratification of cerebral bleeding risk in AF) is an observational, prospective study, conducted in 2017-2020 on AF patients ⩾65 years referring to Thrombosis Center of Careggi University Hospital. All participants underwent clinical visit and brain MRI at baseline and after 18-months. Mobility assessment included Short Physical Performance Battery (SPPB) and falls in last year.

Results: 194 patients (mean age 78.1±6.7 years) were enrolled, 133 completed follow-up. Mean SPPB score (9.4±2.1 at baseline and 9.5±2.2 at follow-up) was abnormal (<=10) in 124 (64%) patients at baseline and 80 (60%) at follow up. Sixty-nine (36%) patients reported ⩾1 fall during previous year. Baseline characteristics associated with SPPB score (correlation analyses, r and p values for baseline and follow-up respectively) included: higher CHADS-VASc score (r=-.292, p=001; r=-.367, p=001), lower MoCA (r=.319, p=001; r=.267, p=002), higher depressive symptoms (r=-.185, p=010; r=-.237, p=006), and worse functional performance (basic preserved (r=.316, p=001; r=.377, p=001) and instrumental lost (r=-.386, p=001; r=-.425, p=001) ADL). Many of these factors were also associated with recent falls. Among neuroimaging variables, non-lacunar infarcts (r=-.153, p=.047; r=-.177, p=.049) and severe medial temporal lobe atrophy (r=-.157, p=.042) were associated with SPPB.

Conclusions: In our cohort, motor impairment and history of falls were frequent findings, resulting associated with many clinical factors, including cognitive performance. Both vascular and neurodegenerative lesions seem to influence mobility.

	SPPB
	Baseline		Follow-up		ANOVA
	r	p	r	p
Age	-.272	.001	-.419	.001	.022
Sex	-.255	.001	-.293	.001	.128
Years of education	.133	.064	.155	.075	.389
Euro QoL	.261	.001	.377	.001	.101
Living conditions	.103	.151	.200	.021	.027*
ADL	.316	.001	.377	.001	.730
IADL	-.386	.001	-.425	.001	.244
Psychiatric disorders	-.107	.137	-.126	.147	.226
GDS	-.185	.010	-.237	.006	.114
Memory disorder	-.162	.024	-.308	.001	.034*
MoCA	.319	.001	.267	.002	.949
Stroke	-.175	.015	-.224	.010	.554
Hypertension	.007	.926	.068	.435	.290
Diabetes mellitus	-.044	.546	-.099	.256	.920
Dyslipidemia	-.026	.718	.001	.991	.429
Physical activity	-.240	.001	.212	.014	.970
Smoke	.050	.486	.173	.047	.089
Alcohol use	.129	.072	.165	.057	.236
Ischemic heart disease	-.027	.710	-.093	.284	.255
Heart failure	-.187	.009	-.228	.008	.367
BMI	-.011	.883	-.012	.887	.882
CHADS-VASC2	-.292	.001	-.367	.001	.310
HAS-BLED	-.121	.092	-.082	.348	.213
Polypharmacotherapy	-.201	.005	-.157	.071	.664
Falls in the last year	-.138	.056	-.128	.144	.846
Falls in the last year-number (n=34)	-.351	.042	-.401	.079	.025
Finger tapping	-.359	.001	-.417	.001	.745
Gait impairment	-.447	.001	-.501	.001	.195
Gait speed (4 meters)	.608	.001	.567	.001	.077
Baseline SPPB			.714	.001

	Falls in the last year
	nonen=125	at least onen=69(34 at baseline + 35 at FU)	p
Age, years (mean value±SD)	77.7±7	78.8±6	.264
Sex (males)	89 (71%)	29 (42%)	.001
Years of education	9.2±4.3	9±4.3	.756
Euro QoL	64.7±17.8	63.8±19.2	.753
Living conditions (living alone)	22 (17.6%)	23 (33.3%)	.013
ADL (preserved items)	5.8±0.6	5.6±0.7	.062
IADL (lost items)	0.5±1.1	0.7±1.6	.402
Psychiatric disorders	50 (40%)	45 (65%)	.001
Geriatric Depression Scale (GDS)	3.2±3.1	4.6±3.3	.005
Memory disorder (subjective)	52 (42%)	36 (52%)	.157
Montreal Cognitive Assessment	21.9±3.8	21.4±4.3	.477
Stroke	24 (19%)	18 (26%)	.265
Hypertension	99 (79%)	60 (87%)	.179
Diabetes mellitus	15 (12%)	10 (15%)	.620
Dyslipidemia	62 (50%)	36 (52%)	.731
Physical activity	46 (37%)	19 (28%)	.191
Smoke	81 (65%)	38 (55%)	.183
Alcohol use	69 (55%)	31 (45%)	.171
Ischemic heart disease	17 (14%)	10 (15%)	.863
Heart failure	13 (10%)	14 (20%)	.057
BMI	26.3±3.5	26.6±4.3	.533
CHADS-VASC2	3.5±1.4	4.2±1.5	.001
HAS-BLED	1.8±0.8	1.7±0.8	.412
Polypharmacotherapy (number)	3.3±1.5	4.3±1.5	.001
Gait impairment	38 (30%)	31 (45%)	.043
Finger tapping	1.1±0.4	1.3±0.7	.013
Gait speed (4 meters)	1±0.3	0.9±0.3	.091
SPPB (score)	9.6±1.9	9±2.5	.082

Disclosure: No

P0625 / 1403

ANALYSIS OF CEREBRAL THROMBI IN STROKE FROM INFECTIVE ENDOCARDITIS DISPLAYS UNIQUE IMMUNE FEATURES

A. Semerano ¹, A. Genchi¹, B. Dell’Acqua¹, G.S. Gullotta¹, A. Bergamaschi¹, F. Sanvito¹, M. Callea¹, S. Grassi¹, P. Panni¹, F. Simionato¹, F. Scomazzoni¹, C. Michelozzi¹, L. Roveri¹, M. Filippi¹, G. Martino¹, D. Strambo², M. Bacigaluppi¹

¹San Raffaele Scientific Institute, Milan, Italy, ²Lausanne University Hospital, Lausanne, Switzerland

Background: Infective endocarditis (IE) is a life-threatening disease, but its pathophysiology remains poorly understood. Among complications, stroke from cerebral embolization is prognostically the most relevant. Immuno-thrombotic mechanisms are possible contributors to the formation and embolization of endocarditic vegetations. The analysis of cerebral thrombi retrieved by endovascular thrombectomy in patients with stroke from IE is a potential opportunity to complement the diagnostic investigation and to provide new insights into pathogenesis of IE.

Methods: We conducted a multimodal analysis on cerebral thrombi retrieved by endovascular thrombectomy in patients with ischemic stroke from IE (n=8) and controls (n=21). By histological and microbiological analysis, we searched for the presence of microorganisms within the thrombotic material, and we comprehensively examined the structural composition and the immune signature of cerebral thrombi.

Results: In all cerebral thrombi retrieved from stroke patients with IE we could detect the direct presence of invading pathogens. Compared to controls, thrombi from IE displayed a unique composition, characterized by higher levels of platelets and macrophages, as well as lower amount of red blood cells and B cells. Neutrophil number did not differ in thrombi from IE and controls; however, the former showed a peculiar neutrophil activation characterized by higher prevalence of Neutrophil Extracellular Traps (NETs) deposition characterized by cell- and filopodia-dominant morphology.

Conclusions: Analysis of cerebral thrombi represents an adjunctive diagnostic tool in patients with suspected IE. Both macrophage predominance and peculiar neutrophil activation characterize the composition of cerebral thrombi from IE, reinforcing the pivotal role of immuno-thrombosis in the disease course.

Disclosure: No

P0626 / 1398

ANTITHROMBOTIC TREATMENT AND CLINICAL EVENTS AFTER LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION AND INTRACEREBRAL HEMORRHAGE

R. Rigual ¹, G. Galeote², J. García-Castro¹, G. Ruiz-Ares¹, J. Rodríguez-Pardo¹, E. de Celis-Ruiz¹, L. Casado¹, M. Alonso de Leciñana¹, A. Jurado-Román², S. Jiménez-Valero², R. Moreno², E. Díez-Tejedor¹, B. Fuentes¹

¹Hospital Universitario La Paz. IdiPaz Health Research Institute. Universidad Autónoma de Madrid, Department of Neurology and Stroke Center, Madrid, Spain, ²Hospital Universitario La Paz. IdiPaz Health Research Institute. Universidad Autónoma de Madrid, Interventional Cardiology Section, Department of Cardiology, Madrid, Spain

Background and aims: Left atrial appendage closure (LAAC) is an alternative treatment in patients with atrial fibrillation (AF) and previous intracerebral hemorrhage (ICH) in whom resumption of anticoagulant treatment might increase hemorrhagic risk. There is no consensus for long-term antithrombotic treatment (AT) after LAAC. Our aim is to describe AT and clinical events in patients with AF and previous ICH during long-term follow-up.

Methods: A retrospective, observational study including patients with AF and previous ICH treated by LAAC between July 2013 and October 2021. AT was classified as none, single antiplatelet, double antiplatelet, low dose oral anticoagulation (LDOA) or full dose oral anticoagulation (FDOA) at discharge LAAC, 3-months and at last follow-up visit. Clinical events include ischemic stroke (IS) and ICH during follow-up.

Results: We report results of 40 patients with a mean age at LAAC of 76.9 years. During follow-up (mean duration 35±5.1 months), three patients (7.5%) presented IS (mean time LAAC-IS 20.6±12.7 months) and two (5%) ICH (mean time LAAC-ICH 49±15 months). AT varied during follow-up as they received more frequently LDOA (59.5%) at discharge, single antiplatelet treatment (48.6%) at 3-months and no AT (45.7%) at last follow-up visit. Five patients (12.5%) presented IS or ICH, all of them under single antiplatelet treatment.

Conclusion: In our study, patients with AF and previous ICH treated with LAAC presented few events, most of them at long-term follow-up and all of them under single antiplatelet treatment. Further studies are needed to clarify the optimal AT in these patients.

Disclosure: No

P0627 / 276

ISCHEMIC AND HEMORRHAGIC STROKE COMPLICATIONS IN LONG-TERM FOLLOW-UP AFTER AORTIC VALVE REPLACEMENT DUE TO SEVERE AORTIC STENOSIS

D. Cantero Lozano^1,2,3, M. Marin Gracia^4,5,6, F.J. Rodríguez Peguero ⁴

¹Santa Barbara Hospital, Cardiology, Soria, Spain, ²Clinico Lozano Blesa Hospital, Cardiology, Zaragoza, Spain, ³Monteprincipe Hospital, Arrhythmias/Cardiology, Boadilla de Monte, Spain, ⁴Santa Barbara Hospital, Neurology, Soria, Spain, ⁵Vithas Hospital, Neurology, Málaga, Spain, ⁶Aragon Research Institution, Zaragoza, Spain

Background and aims: Decision between biological (BAVR) and mechanical (MAVR) prosthesis in severe aortic stenosis (AS) depends on the characteristics of the patient, the prosthesis and the need for anticoagulation. Thromboembolic events based on the prosthetic type have not been compared in anticoagulated patients. Our aim is to determine differences in survival and stroke complication rates between both groups.

Methods: Retrospective multicentre study of patients operated for severe AS between 2006-2015. A propensity score matching analysis was conducted in patients with anticoagulant treatment.

Results: 314 patients with BAVR and 96 with MAVR were included. No differences were found in terms of embolic stroke (12,7%VS 15,1% p =0,559) or hemorrhagic stroke (3,6%vs4,7%, p=0,641) between groups. After a propensity score subanalysis, 66 BAVR and 36 MAVR with similar age were included. There were no differences either in the ischemic stroke end-point (BAVR 19,7% vs 21,2% MAVR, p=0.860) nor hemorraghic rate (BAVR 6,1% vs 3,3% MAVR, p=0,507). The ischemic and hemorrhagic event-free survival (log-rank:0,541,HR 1,03) showed that the use of MAVR was not associated with an increased risk of events.

Conclusions: No differences were demonstrated in terms of survival, or neurological complications (ischemic and hemorrhagic stroke) regarding the prosthesis type. This may question the use of MAVR in patients who need anticoagulation for another reason because it is not associated with better long-term results.

Disclosure: No

P0628 / 1525

PATENT FORAMEN OVALE AND OBSTRUCTIVE SLEEP APNEA: A PROBLEMATIC ASSOCIATION

S. Matos ¹, C. Saleiro², T. Alves³, C. Cecília¹, G. Santo¹, F. Silva¹, L. Paiva², J. Sargento Freitas^1,4, M. Costa²

¹Coimbra University Hospital Centre, Neurology Department, Coimbra, Portugal, ²Coimbra University Hospital Centre, Cardiology Department, Coimbra, Portugal, ³Coimbra University Hospital Centre, Internal Medicine Department, Coimbra, Portugal, ⁴Faculty of Medicine, Coimbra University, Coimbra, Portugal

Background and aims: Conditions that affect intrathoracic pressure favor right-to-left shunt through patent foramen ovale (PFO) causing stroke due to paradoxical embolism. We aimed to assess if the presence of obstructive sleep apnea (OSA) in patients with high-risk PFO is related to an increased risk of wake-up stroke.

Methods: Retrospective analysis of patients with prior stroke, admitted in a tertiary center for percutaneous closure of PFO, between 06/2004 and 11/2021. Demographic, clinical and imaging data were collected. The occurrence of wake-up stroke was evaluated in patients with and without a diagnosis of OSA (confirmed by polysomnography).

Results: We identified 236 patients, mean age of 48.7±10.6 years, majority female (56.8%). The most frequent comorbidities were dyslipidemia in 41.9%(n=99) and arterial hypertension in 31.4%(n=74), followed by overweight/obesity 18.2%(n=43) and smoking 16.5%(n=39). Less frequently, patients had diabetes mellitus or coronary heart disease. The diagnosis of OSA was made in 15(6.4%) patients. Nineteen (8.1%) patients presented with wake-up stroke. In the group with OSA, 55.6% presented with wake-up stroke, while in patients without this pathology only 13.1% of strokes had this presentation (P=0.001). Overweight/obesity was the only different vascular risk factor between groups. The presence of OSA is associated with an 8-fold higher risk of having wake-up stroke (OR 8.304, 95% CI 1.99-34.61). This association persists even after adjusting for overweight/obesity.

Conclusions: In patients with high-risk PFO, OSA is associated with wake-up stroke. This study suggests that OSA could be an important and potentially treatable risk factor in patients with both conditions.

Disclosure: No

P0629 / 791

COST-EFFECTIVENESS ANALYSIS OF TRANSTHORACIC ECHOCARDIOGRAPHIC ASSESSMENT IN PATIENTS WITH ISCHEMIC STROKE OR TIA OF UNDETERMINED CAUSE

G. van der Maten ^1,2, X. Pouwels², H. Koffijberg², M. Meijs³, C. von Birgelen^3,2, H. den Hertog⁴, ATTEST Study Group

¹Medisch Spectrum Twente, Neurology, Enschede, Netherlands, ²University of Twente, Health Technology & Services Research, Enschede, Netherlands, ³Medisch Spectrum Twente, Cardiology, Thoraxcentrum Twente, Enschede, Netherlands, ⁴Isala Hospital, Neurology, Zwolle, Netherlands

Background: The multicenter cross-sectional ATTEST study recently assessed 1084 patients with ischemic stroke or TIA of undetermined cause and found that routine transthoracic echocardiography (TTE) detects abnormalities with treatment implications (i.e., major cardiac sources of embolism) in only 1% of patients, of whom most (91%) also had major ECG abnormalities. In this study, we performed a cost-effectiveness analysis of different TTE strategies.

Methods: We compared the cost-effectiveness of 3 strategies of TTE assessment:

(1) TTE in all patients;

(2) TTE only in patients with major ECG abnormalities; and

(3) TTE not performed.

Input data were derived from ATTEST and systematic literature reviews. A Markov model was developed that simulated recurrent ischemic stroke or TIA and intracerebral and gastro-intestinal bleeding complications in patients with ischemic stroke or TIA of undetermined cause. Primary outcome was the additional costs per additional quality-adjusted life-year (QALY) from a Dutch societal perspective.

Results: Performing TTE in all patients resulted in 0.0094 additional QALYs and €525 additional costs per patient as compared with not performing TTE (€56.081/QALY). Performing TTE only in patients with major ECG abnormalities led to 0.0089 additional QALYs and €104 additional costs per patient as compared with not performing TTE (€11.637/QALY).

Conclusions: In patients with ischemic stroke or TIA of undetermined cause, a strategy of performing TTE only in patients who also had major ECG abnormalities resulted in the most favorable ratio of additional costs per additional QALY. This supports performing TTE only in patients, who also have major ECG abnormalities.

Disclosure: Yes

INTRACEREBRAL HAEMORRHAGE

P0630 / 117

INTRACEREBRAL HAEMORRHAGE INCIDENCE AND HAS_BLED SCORE IN ADJUSTED MORBIDITY GROUPS: COULD BE USEFUL?

J.L. Clua-Espuny ^1,2, B. Lorman-Carbo^2,1, E. Muria-Subirats³, J. Ballesta-Ors¹, M.A. Gonzalez-Henares¹, M. Palleja-Millan², F.M Martin-Lujan^4,2

¹Institut Catala de la Salut. EAP Tortosa-Est. SAP Terres de l’Ebre, Primary Care, Tortosa, Spain, ²Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, IDIAP JGol, Reus, Spain, ³Institut Catala de la Salut. EAP Amposta. SAP Terres de l’Ebre, Primary Care, Tortosa, Spain, ⁴Institut Catala de la Salut. Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Primary Care, Reus, Spain

Background and aims: Intracerebral haemorrhage (ICH) is an important public health problem among patients with chronic comorbid conditions and previous studies found that HAS-BLED score could be used as ICH predictor. The Adjusted Morbidity Grouper (AMG risk score) modelling is aligned with the European framework for addressing patients with chronic comorbid conditions with reduction of outcome variability among regions. The aims were to relate the HAS_BLED score, AMG-complexity stratification and the ICH incidence.

Methods: Multicentre, retrospective, community-based cohort study including patients AGM-4 with no prior history of ICH and followed up from 01/01/2015-31/12/2019 obtained from electronic clinical records of the Catalan Institute of Health (Spain). The primary outcome was occurrence of ICH. Demographic, clinical, and pharmacological variables were included. Adjusted logistic regression analyses were carried out to detect HAS_BLED prognostic for ICH.

Results: 4,686 subjects. 57.2% women. Median age 84 years [75-90]. A HAS-BLED score ⩾3 was associated to higher ICH-risk in the AMG-4 (OR 1.2 [CI95% 1.0-1.7]). More men than women scored ⩾3 (65.6% vs 32.8%, p <0.001). ICH rates in HAS-BLED ⩾3 was 95.1/10,000 person-year (95%CI 94.8-95.3), and 78.1/10,000 person-year (95%CI 77.9-78.3) in HAS-BLED <3. The best AUC (0.7) was obtained for AMG-4 subgroup with the highest complexity level (5).

Conclusions: HAS_BLED score may be useful for identifying risk of ICH among AMG-4 subgroup with the highest complexity level, but not at the total AMG-4 population. The HAS-BLED score could support the intensity about tackling modifiable factors as the deprescription of risk-bleeding drugs.

Disclosure: No

P0631 / 918

O2L-001, AN EXTENDED-RELEASE FORMULATION OF OPTIMIZED W253R/R275S TISSUE PLASMINOGEN ACTIVATOR, FOR EFFICIENT AND SAFE TREATMENT OF HAEMORRHAGIC STROKE

E. Louet^1,2, M. Ianszen¹, M.-J. Guichard¹, C. Gaudin¹, J. Parcq ¹

¹Op2Lysis, Caen, France, ²Normandie Univ, UNICAEN, INSERM UMR-S U1237, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France

Background and aims: Intracerebral haemorrhage (ICH) is an unmet medical need affecting more than 3 million people every year worldwide. ICH leads to the formation of an intracerebral hematoma with subsequent deleterious lesions. Previous large clinical trials showed that minimally invasive surgery with thrombolytic therapy may be an option with a more effective and safer thrombolytic agent than those available on the market. Here we tested O2L-001, with a new rtPA variant (W253R/R275S rtPA, named OptPA), as a therapeutic opportunity for ICH patients.

Methods: OptPA was produced in CHO cell line before nanoprecipitation using the NANOp2Lysis technological platform and resuspension in an extended-release polymer solution to obtain O2L-001. The capacity of O2L-001 to trigger plasminogen activation was measured in vitro on S-2251 substrate. Ex vivo models of 5ml and 30ml human blood clots were used to characterize the minimal duration and concentration of thrombolytic agent to achieve large clot thrombolysis.

Results: O2L-001 has 81% less capacity to activate plasminogen in plasmin in the absence of fibrin compared to rtPA. On 5ml hematoma, O2L-001 was as effective as rtPA 1mg/ml at concentrations as low as 0.1mg/ml, and showed 36% higher dissolution capacity at 1 mg/mL . In the best translational model, with clinical size hematomas, a single injection of 1 mg/mL O2L-001 lead to 61% more hematoma reduction than rtPA.

Conclusion: O2L-001 is a new hope for the treatment of ICH patients, with a safer and better thrombolytic capacity to reduce deleterious mass-effect and decrease disability.

Disclosure: No

P0632 / 1268

THIRTY-DAY MODIFIED RANKIN SCALE SCORE PREDICTS 90-DAY VALUES IN ACUTE INTRACEREBRAL HAEMORRHAGE: A POST-HOC ANALYSIS OF THE ANTIHYPERTENSIVE TREATMENT OF ACUTE CEREBRAL HEMORRHAGE-2 TRIAL

C.I. Coleman ^1,2, M. Concha³, B. Koch⁴, B. Lovelace⁴, M.J. Christoph⁴, A.T. Cohen⁵

¹University of Connecticut School of Pharmacy, Storrs, United States, ²Evidence-based Practice Center, Hartford Hospital, Hartford, United States, ³Sarasota Memorial Hospital, Sarasota, United States, ⁴Alexion, AstraZeneca Rare Disease, Boston, United States, ⁵Guy’s and St. Thomas’ Hospitals, King’s College London, London, United Kingdom

Background and aims: Thirty-day modified Rankin Scale (mRS) score is a reliable predictor of 90-day values in ischemic stroke, but whether the same is true for intracerebral haemorrhage (IrCH) is unclear. We assessed the ability of 30-days mRS to predict 90-day values by calculating the utility-weighted difference in these values and the proportion of patients with a mRS difference ⩽1.

Methods: Patients with acute IrCH, alive at 30-days and having a mRS score reported at 30- and 90-days were included. EuroQol-5D-3-level (EQ-5D-3L) data from ATACH-2 was utilized for utility-weighting the mRS. The minimally important clinical difference (MICD) in utility-weighted mRS was calculated using a distribution-based (0.5 standard deviations) approach. Ordinal regression was performed to identify predictors of 90-day mRS score.

Results: Of the 1,000 subjects randomized in ATACH-2, 898 were included in this post-hoc analysis. The mean difference in utility-weighted mRS between the 30- and 90-day assessments was −0.08 ±0.15 and the percentage of mRS assessments within 1-point of each other was 87.6%. The mean EQ-5D-3L for all patients was 0.67±0.26, with the corresponding MICD for utility-weighted mRS=0.13. Ordinal regression demonstrated 30-day mRS was the most potent predictor of 90-day values (χ²=302.9, p<0.0001), followed by 24-hour NIHSS, age, country, length-of-stay, mechanical ventilation, haematoma location and heart failure history (χ²=44.0-6.4, p<0.04 for all)(Figure).

Conclusions: Thirty-day mRS was a strong predictor of 90-day values and the mean difference in utility-weighted mRS between the two time points was less than the MICD. Thirty-day mRS may be a reasonable proxy for 90-day values.

Disclosure: Yes

P0633 / 1367

ADVANCED CEREBRAL AMYLOID ANGIOPATHY: A RISK FACTOR FOR RECURRENT CEREBRAL HEMORRHAGE

M. Domínguez ¹, S. Trillo¹, P. Iriarte¹, E. De la Fuente¹, C. Diez¹, C. Ramos¹, E. Valiente¹, J. Alonso¹, G. Zapata¹, J. Vega¹, J. Vivancos¹

¹ Hospital Universitario La Princesa, Madrid, Spain

Background and aims: Cerebral amyloid angiopathy (CAA) is an important cause of recurrent cerebral hemorrhage (RCH). Nevertheless, risk factors associated with recurrence are still not fully defined. The objective of this study is to delimitate risk factors for RCH in patients with CAA.

Methods: A retrospective observational study with prospective data recruitment was performed. Patients with final diagnosis of CAA who required hospital admission (2011/01/01-2018/12/31) due to lobar intracerebral hemorrhage (ICH) or convexal subarachnoid hemorrhage (cSAH) were studied. Baseline characteristics and SWI-weighted MRI findings at admission were related with further appearance of RCH in the following 2 years. Advanced CAA was defined as >5 microbleeds and >4 sulci with siderosis.

Results: 71 patients were included, with 66 (92.9%) cases of ICH and 5 (7.04%) of cSAH. Average age was 78.77 years (SD 8.49). 15.4% referred daily alcohol intake. 15.4% already had previous lobar ICH history. During follow-up, 15 patients (21.1%) developed RCH, 10 (66.6%) of whom recurred with the same type of hemorrhagic event.

RCH was associated with alcohol intake (33.3%% vs. 10.7%; p=0.032) and previous lobar ICH (53.3% vs. 5.4%; p<0.001). In SWI-weighted brain MRI > 3.5 microbleeds (AUC 0.72; p=0.033) and >4.5 sulci with siderosis (AUC 0.8; p=0.016) were associated with RCH. Patients with advanced CAA presented a high risk of RCH, OR 46.4 (95% CI 4.72-456.03; p=0.001).

Conclusions: Baseline and neuroimaging characteristics are associated with the risk of RCH, especially in patients with advanced CAA. Further study of these factors could help define this risk.

Disclosure: No

P0634 / 492

MACROPHAGE INFLAMMATORY PROTEIN-1 ALPHA UPREGULATION IS ASSOCIATED WITH POOR PERIHEMATOMAL PERFUSION AND IN-HOSPITAL LETHALITY IN ACUTE HYPERTENSIVE INTRACEREBRAL HEMORRHAGE

I. Shchukin^1,2, M. Martynov^1,2, M. Fidler¹, M. Kazieva¹, I. Koltsov ^1,2

¹Pirogov Russian National Research Medical University, Moscow, Russian Federation, ²Federal Center of Brain Research and Neurotechnologies, Moscow, Russian Federation

Background and aims: Macrophage inflammatory protein-1 alpha (MIP-1a) is a major chemotactic proinflammatory cytokine produced by macrophages. Hypoxic-ischemic injury causes MIP-1a upregulation in the human brain. In acute intracerebral hemorrhage (ICH), there could be perihematomal hypoperfusion. Therefore, there also could be a link between hypoperfusion in the perihematomal region and the inflammatory response, leading to more pronounced damage to the brain. The current pilot study aimed to investigate this potential relationship.

Methods: In 24 acute ICH patients, CT perfusion at admission was performed, and blood plasma samples were collected and stored at -80 degrees Celsius. MIP-1a concentration was measured using a multiplex immunoassay. Mean CBV/CBF/MTT values were averaged from at least 20 evenly spaced regions of interest in every case. ICH outcomes data were obtained from medical records. The study was approved by the Local Ethics Committee.

Results: Independently of hematoma volume, baseline MIP-1a concentration was associated with perihematomal CBV at admission (by -0.029 ml/100g per 1 pg/ml, 95% CI from -0.011 to -0.048, p = 0.004) and mean perihematomal CBF at admission (by -1.230 ml/100g/min per 1 pg/ml, 95% CI from -0.103 to -2.358, p = 0.034). MIP-1a was significantly higher in patients who died in comparison with survivors (26.0 [17.3 – 30.6] vs. 5.7 [2.0 – 17.5], p = 0.035, with an effect size given by rank-biserial correlation of -0.706).

Conclusions: Higher MIP-1a levels are associated with poor perihematomal perfusion. MIP-1a could be utilized as an independent prognostic biomarker in acute hypertensive ICH.

Disclosure: No

P0635 / 681

POTENTIAL ROLE OF CIRCULATING EXTRACELLULAR VESICLES IN THE OUTCOME OF PATIENTS WITH INTRACEREBRAL HAEMORRHAGE

L. Casado-Fernández ¹, F. Laso-García¹, M. Gutiérrez-Fernández¹, M.C. Gómez-de Frutos¹, L. Otero-Ortega¹, S.B. Bravo², B. Fuentes¹, E. Alonso-López¹, J. Rodríguez-Pardo¹, G. Ruiz-Ares¹, R. Rigual¹, E. de Celis¹, E. Díez Tejedor¹, M. Alonso de Leciñana¹

¹La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Neurology and Cerebrovascular Diseases Research Group, Department of Neurology and Stroke Center, Madrid, Spain, ²Health Research Institute of Santiago de Compostela (IDIS), Proteomic Unit, Santiago de Compostela, Spain

Background and aims: Extracellular vesicles (EVs) are proposed to be involved in recovery after brain damage. We analysed the content of circulating EVs from patients suffering acute intracerebral haemorrhage (ICH) according to their outcomes.

Methods: Prospective observational study. Clinical characteristics, NIHSS score, ICH volume and outcome (mRS) were registered. Protein content of EVs from blood samples at 24 hours and 7 days was analysed by quantitative mass spectrometry (DIA SWATH). Comparisons were made between patients with good or poor outcome at 6 months (good outcome defined as >10 points or >50% improvement in NIHSS compared to baseline, and mRS 0-2).

Results: N=45 patients. Mean age 68.35 years (SD 13.7), 16/45 (35.5%) had good outcomes. In this initial analysis, out of 198 proteins identified, 51 showed different levels in patients when compared by outcome (>two-fold change, p<0.05). At 24h, proteins associated with inflammation (PGRP1, DEF1) were observed. These proteins decreased at 7 days in patients with good outcome but not in patients with poor outcome. Also, in patients with good outcome, proteins related to immunomodulation (VNN2), neurogenesis (RhoGAP01, ATRN) and apoptosis control (14-3-3z) were higher at 7 days when compared with those at 24 hours and with patients with poor outcome.

Conclusions: Protein content of circulating EVs in ICH patients differs depending on their clinical outcome, with higher levels of proteins related to protection and repair processes and lower levels of inflammatory proteins in patients with good outcome. Further studies are needed to determine the role of these proteins in recovery.

Disclosure: No

P0636 / 314

BLOOD DERIVED EXTRACELLULAR VESICLES AS A NOVEL AND AFFECTIVE TREATMENT IN A CEREBRAL HEMORRHAGE RAT MODEL. SAFETY AND PROTEIN CONTENT ANALYSIS

F. Laso-García ¹, L. Casado-Fernández¹, M.C. Gómez-de Frutos¹, D. Piniella-Alcalde¹, J.K. Arizaga-Echebarria¹, M. Pérez-Mato¹, E. Alonso-López¹, L. Otero-Ortega¹, S.B. Bravo², M.d.P. Chantada-Vázquez², B. Fuentes¹, E. Díez-Tejedor¹, M. Gutiérrez-Fernández¹, M. Alonso de Leciñana¹

¹IdiPAZ Health Research Institute, Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain, ²Health Research Institute of Santiago de Compostela (IDIS), Proteomic Unit, Santiago de Compostela, Spain

Background and aims: Our group has previously demonstrated the efficacy of blood-derived extracellular vesicles (EVs) administration in improving functional recovery in a rat intracerebral hemorrhage (ICH) model. We thereafter analyzed safety, brain tissue integrity, and proteins content of circulating EVs from ICH rats treated with EVs.

Methods: Allogenic and xenogenic (human) EVs were obtained from the blood of subjects with spontaneous good outcome after ICH to be used as a treatment. We studied four groups of Sprague-Dawley rats: healthy (N=10), ICH controls (N=20), ICH treated with i.v. allogenic EVs (AEVs, N=10), or xenogenic EVs (XEVs, N=10) at 24h. For safety studies, circulating inflammatory cytokines and neoformations in organs (H&E) were analyzed. Brain tissue integrity was analyzed by Diffusion Tensor Imaging. Protein content of circulating EVs at 28d after treatment was analyzed by quantitative mass spectrometry (DIA SWATH).

Results: Neither immune response nor tumor formation after treatment was observed. Both treatments improved tissue integrity compared to controls at 28d (p<0,05). Notably, among 1646 proteins identified in EVs, values of RASH and SYT1 (related with angiogenesis and trafficking of synaptic vesicles) were higher in AEVs group at 28d; and FA7, LSAMP, and PCSK9 (related with angiogenesis, axon targeting, and neuronal growth) in XEVs group at 28d compared with ICH control group at 28d.

Conclusions: The administration of blood-derived EVs, regardless of origin, is safe. Higher values of proteins involved in biological processes potentially related to brain repair may account for the improvement of tissue integrity and functional evolution of the treated subjects.

Disclosure: No

P0637 / 844

BRAIN PERI-HEMATOMAL AREA, A STRATEGIC INTERFACE FOR BLOOD CLEARANCE: A HUMAN NEUROPATHOLOGICAL AND TRANSCRIPTOMIC STUDY

L. Puy ¹, R. Perbet², M. Figeac², B. Duchêne², V. Deramecourt², C. Cordonnier², V. Bérézowski²

¹Lille University Hospital, Lille Neuroscience & Cognition research centre UMR-S1172, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France, ²Lille University Hospital, Lille, France

Background and purpose: Enhancing the blood clearance process is a promising therapeutic strategy for ICH. We aimed to investigate the natural kinetic of this process after ICH in human brain tissue with a focus on the monocyte-macrophage scavenger receptor (CD163)/hemoxygenase-1 (HO-1) pathway.

Methods: All ICH patients who came to autopsy after ICH in the Lille Neurobank were included in this post-mortem study. Paraffin-embedded tissue was extracted from four strategic areas: hematoma, peri-hematomal area (PHA) and ipsilateral surrounding brain tissue. Iba1, CD163 and HO-1 were immunolabelled. RNA extraction was proceeded from the PHA of six cases to perform transcriptomic analysis.

Results: We included 19 ICH cases (median age: 79 [71-89] years; median delay ICH-death: 13 [5-41] days). The PHA concentrated most of reactive microglia, CD163/HO-1 activities and iron deposits. We found a surge in the blood clearance process from day 7 to day 15 after ICH onset. Transcriptomic analysis showed that HO-1 was the most differentially up-regulated gene (2.81 ± 0.39, adjusted p-value = 1.11x10^-10) and CD163 the sixth (1.49 ± 0.29, adjusted p-value = 1.68x10^-5). We also identified several up-regulated genes that exert a beneficial role aiming at terminating inflammation and enhancing tissue repair.

Conclusion: We provide histological and genomic-based evidence in humans for the predominant expression of CD163/HO-1 pathway in the PHA, with a strategic time-window: from day 7 to day 15 after ICH. An anti-inflammatory environment seems to be suitable to enhance the natural blood clearance process. Our findings contribute to identify innovative therapeutic strategies for ICH.

Disclosure: No

P0638 / 461

METABOLIC CHANGES SURROUNDING INTRACEREBRAL HEMORRHAGE IN THE RAT COLLAGENASE MODEL

S. Proesmans ¹, R. Raedt¹, V. Baekelandt², C. Germonpré¹, E. Christiaen³, B. Descamps³, P. Boon¹, C. Vanhove³, V. De Herdt¹

¹Ghent University, 4Brain Lab, Department of Head and Skin, Gent, Belgium, ²KU Leuven, Laboratory for Neurobiology and Gene Therapy, Department of Neurosciences, Leuven Brain Institute, Leuven, Belgium, ³Ghent University, IBiTech MEDISIP-Infinity Lab, Gent, Belgium

Background: Metabolic changes surrounding intracerebral hemorrhage (ICH) are a point of controversy. We investigated the nature, extent and localisation of glucose uptake and diffusion changes in the perihematomal region (PHR) in the acute phase post-ICH and investigated the cellular changes associated with these metabolic alterations by histology.

Methods: Sprague-Dawley rats were injected with 0.6U collagenase (n=16) for striatal ICH induction or with saline (n=10) as control. ¹⁸F-FDG-PET, T2w-MRI and DWI-MRI were performed on day -1 and +1. A subset of animals was also scanned on day 3 and 7. Post-ICH PET and ADC images were compared voxel-per-voxel to the baseline mean and overlayed on T2w-images. Neurons, astrocytes and microglia were quantified using immunohistochemistry (NeuN/GFAP/Iba-1) on day 2 and 8 in the piriform cortex (PC).

Results: Regions of decreased glucose uptake and increased ADC were observed in the PHR of all animals, and were most pronounced at day 1 and 3 (volume D1vs.D7 and D3vs.D7:p<0.05) in the PC and basal ganglia respectively. The ipsilateral PC showed 33-36% less neurons, 40-70% more astrocytes and 110-140% more microglia compared to contralateral at both day 2 and 8 (p<0.05).

Conclusions: We found decreased glucose uptake and increased diffusion in the PHR in our rat model, which were maximal in volume at day 1 and 3 post-ICH, in the PC and basal ganglia respectively. Neuronal loss may play a role in the acutely decreased PET-signal. Further research is needed to elucidate the mechanisms involved in the partial recovery of the metabolic deficit by day 7.

Disclosure: No

P0639 / 983

POSITIVE PREDICTIVE VALUE OF AMYLOID CATEGORY USING AN ICH CLASSIFICATION

D. Vázquez-Justes ¹, G. Mauri-Capdevila¹, J. Sanahuja-Montesinos¹, M. Paul-Arias¹, M. Baraldés-Rovira¹, F. Purroy¹

¹ Hospital Universitari Arnau Vilanova, Neurology, Lleida, Spain

Introduction: Intracerebral Hemorrhage (ICH) etiology is one predictor of mortality. Amyloid angiopathy (CAA) is one devastating etiology. Its diagnostic can be reached only by postmortem analysis. For in vivo diagnosis, there exist the Boston criteria and different etiologic classifications, the most used SMASH-U. But this classification doesn’t require Boston criteria for diagnosis.

Objective: To determine which proportion of patients with probable CAA by Boston criteria were classified of amyloid using SMASH-U classification.

Methods: We included patients with acute ICH between 2015 and 2020 of our hospital. We excluded patients who did not have brain MRI available in the work-up. We followed boston criteria to identify patients with possible and probable CAA. According to the distribution of both bleeds and microbleeds, patients were classified as HTN-ICH, CAA-ICH or mixed-ICH.

We selected those patients with probable CAA and calculated the proportion with respect to patients who had been previously classified as amyloid using the SMASH-U classification.

Results: 104 patients were included. Of these, 19 (18.3%) were classified as amyloid using SMASH-U. Of these, 10 patients (52.6 %) had probable CAA per Boston criteria. 8 (42.1 %) patients had mixed-ICH. 1 (0.9%) had isolated lobar bleeding without microbleeds (possible CAA).

Conclusions: Almost half of the patients who were classified as amyloid with an ICH etiologic classification did not meet for probable amyloid with Boston criteria. CAA could be misdiagnosed with the only requisition of lobar ICH in >55 y.o. Adequate investigation might be warranted in order to correctly identify those CAA related ICH.

Disclosure: No

P0640 / 871

RISKS FOR MAJOR BLEEDING AND INTRACRANIAL HAEMORRHAGE IN FRAIL PATIENTS

L.A.R. Zwart ¹, T. Germans², R. Vogels³, S. Simsek⁴, M. Hemels⁵, R. Jansen⁶

¹Vrije Universiteit Amsterdam, Ageing and Public Health, Amsterdam, Netherlands, ²North West Hospital, Cardiology, Alkmaar, Netherlands, ³North West Hospital, Neurology, Alkmaar, Netherlands, ⁴North West Hospital, Internal Medicine, Alkmaar, Netherlands, ⁵Radboud Universiteit, Cardiologie, Nijmegen, Netherlands, ⁶North West Hospital, Geriatric Medicine, Alkmaar, Netherlands

Background and aims: To investigate factors that heighten the risk for major bleeding (MB) and intra cranial haemorrhage (ICH) in frail patients.

Methods and results: Patients of 65 and older visiting the Fall and Syncope Clinic (FSC), between November 2011 and January 2020, who underwent an MRI of the brain were eligible. Cerebral small vessel disease was assessed. 479 patients were included into this analysis. Mean follow-up was 7 years per patient (1 month - 8 years and 5 months). Frailty was present in 312 patients (65%). In total, 33 MBs occurred: 16 ICH, 3 traumatic and 14 gastrointestinal. There were a total of 603.4 treatment years with OAC, 8 MB occurred (bleeding rate 1.32 per 100 treatment years), of which 2 were ICH (bleeding rate 0.33 per 100 treatment years). The risk for MB was increased by cognitive decline, as measured with the Mini Mental State Examination <26 points, (OR 2.9, CI 95% 1.2-7.0), and the use of antiplatelet agents (APA) (OR 2.0, CI 95% 1.0-4.1). Of cerebral small vessel disease, the risk for ICH was only heightened by white matter hyperintensities (WMH) (OR 4.0, CI 95% 1.1-14.3). The use of APA (OR 0.7, CI 95% 0.2-3.1) or OAC (OR 1.4, CI 95% 0.5-3.9) did not elevate the risk for ICH.

Conclusion: Frail patients do not have a clearly elevated risk for MB, and the use of OAC did not evidently heightened the risk for ICH. The number of MBs was low, and ICHs very low, despite extensive follow-up.

Disclosure: No

P0641 / 603

CIRCLE OF WILLIS MORPHOLOGY IN PRIMARY INTRACEREBRAL HAEMORRHAGE

M. Xu ¹, Q. Wu¹, Y. Cheng¹, S. Zhang¹, W. Tao¹, S. Zhang¹, D. Wang¹, M. Liu¹, B. Wu¹

¹ West China Hospital, Sichuan University, Department of Neurology, Chengdu, China

Background and aims: To study the distribution of Circle of Willis (CoW) morphology and its association with ICH etiology and cerebral small vessel disease (CSVD) burden.

Methods: Patients with primary ICH who had brain MRIs were consecutively enrolled between March 2012 and January 2021. CoW morphology, CSVD features, and the combined CSVD burden (including global CSVD burden, total hypertensive arteriopathy [HA] burden, and total cerebral amyloid angiopathy [CAA] burden) were assessed. CoW morphology included poor CoW (defined as CoW score 0-2), incomplete CoW, and complete fetal-variant of the posterior communicating artery (CFPcoA).

Results: Among 296 patients enrolled, 215 were included in the analysis. There was no significant difference among HA-, CAA-, and mixed-ICH in each CoW morphology. Exploratory subgroup analyses suggested that poor CoW was associated with a greater incidence of HA-ICH and low incidence of mixed-ICH in patients aged <60 years, while mixed-ICH occurred more frequently in patients with CFPcoA, especially in those without hypertension history (all p<0.05). Additionally, incomplete CoW was correlated with a larger incidence of lacunes (adjusted OR 2.114, 95% CI 1.062-4.207), microbleeds ⩾5 (adOR 2.437, 95% CI 1.187-5.002), and therefore the combined CSVD burden (adOR 1.194, 95% CI 1.004-1.419 for global CSVD burden, adOR 1.343, 95% CI 1.056-1.707 for total CAA burden), independent of modifiable vascular risk factors, but not age and sex.

Conclusions: The CoW might therefore have a potential impact on ICH etiology, and is associated with a greater CSVD burden. Our findings are novel, and need to be verified in future studies.

Disclosure: No

P0642 / 799

STROKE SEVERITY, IMAGING AND COURSE IN PATIENTS WITH ORAL ANTICOAGULATION-RELATED INTRACEREBRAL HEMORRHAGE

J. Grundtvig ^1,2, C. Ovesen¹, D. Gaist^3,4, L. Christensen^1,2, T. Steiner^5,6, H. Christensen^1,2, on behalf of the COOL-ICH Study Group (J. Marstrand, P. Meden, S. Rosenbaum, H. K. Iversen, C. Kruuse, T. Christensen, K. Ægidius, I. Havsteen)

¹Bispebjerg Hospital, Department of Neurology, Copenhagen NV, Denmark, ²University of Copenhagen, Department of Clinical Medicine, Copenhagen Ø, Denmark, ³Odense University Hospital, Research Unit for Neurology, Odense, Denmark, ⁴University of Southern Denmark, Department of Clinical Research, Odense, Denmark, ⁵Klinikum Frankfurt Höchst, Department of Neurology, Frankfurt am Main, Germany, ⁶University of Heidelberg, Department of Neurology, Heidelberg, Germany

Background and aims: Oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) now accounts for up to 20% of incident cases of ICH. We aimed to compare stroke severity, imaging, and course in patients with ICH associated to vitamin K-antagonists (VKA) versus non-vitamin K-antagonist oral anticoagulants (NOAC).

Methods: In the COOL-ICH study we obtained data on all patients (N = VKA – 272, NOAC – 129) admitted in the Capital Region of Denmark from January 2010 until May 2018 with an acute OAC-related ICH. Patients with a pre-admission modified Rankin Scale >= 5, an underlying cause for the ICH, or arrival > 24 hours after symptom onset were excluded. Data were analyzed using univariate analyses.

Results: Median time from symptom onset until admission was 3.95 versus 2.55 hours in VKA- versus NOAC-treated patients, p = 0.03. No differences were observed in median Glasgow Coma Scale (GCS) (14 versus 14), National Institute of Health Stroke Scale (8 versus 8.5), or hematoma volume (20 versus 21.1 mL). Spot sign on admission scan occurred more frequently in patients on VKA versus patients on NOAC (59.1 versus 28.6 %, p = 0.04). Outcomes were similar: neurological deterioration within 24 hours (VKA 44.9 versus NOAC 51.2 %, p = 0.28), ability to walk three months after stroke (VKA 29.5 versus NOAC 21.1 %, p = 0.11), or three-month mortality (VKA 48.9 versus NOAC 50.4 %, p = 0.86).

Conclusions: In unselected, consecutive patients with OAC-ICH we observed comparable severity, course, and outcomes in patients with ICH pretreated with VKA and NOAC.

Disclosure: Yes

P0643 / 798

THE EFFECTS OF MIDLINE SHIFT IN ACUTE INTRACEREBRAL HAEMORRHAGE: DATA FROM THE RIGHT-2 AND TICH-2 TRIALS

K. Krishnan ^1,2, L.J Woodhouse², Z. Law³, R. Dineen⁴, J. Appleton^5,6, J. Wardlaw⁷, P. Bath^2,1, N. Sprigg^2,1

¹Nottingham University Hospitals NHS Trust, Stroke, Department of Acute Medicine, Nottingham, United Kingdom, ²University of Nottingham, Stroke Trials Unit, Nottingham, United Kingdom, ³National University of Malaysia, Department of Medicine, Kuala Lumpur, Malaysia, ⁴Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom, ⁵University Hospitals of Birmingham NHS Foundation Trust, Stroke, Department of Medicine, Birmingham, United Kingdom, ⁶University of Birmingham, Institute of Applied Health Research, College of Dental and Medical Sciences, Birmingham, United Kingdom, ⁷University of Edinburgh, Centre for Clinical Brain Sciences, UK Dementia Research Centre, Edinburgh, United Kingdom

Background: Poor prognosis is associated with intracerebral haemorrhage (ICH) haematoma volume and characteristics but the effect of midline shift is unclear. We examined the effects of midline shift on early and late functional outcomes in ICH.

Methods: Clinical and CT scan data from 1063 ICH participants recruited within 6 hours of symptom onset and randomised to control were analysed from the Rapid Intervention with Glyceryl Trinitrate Trial (RIGHT-2) and Tranexamic acid for hyperacute intracerebral haemorrhage (TICH-2) trials. Midline shift was measured as the difference (mm) between the septum pellucidum to the line drawn between the anterior most part of the anterior falx and the posterior most point of posterior falx. Functional outcome was assessed using the modified Rankin scale (mRS) at day 90. Logistic regression was performed to assess the effect of midline shift on early neurological deterioration, death at day 7, day 90 and mRS.

Results: In 1063 participants, the mean time from stroke onset to CT was 2.0 (0.9) hours, mean haemorrhage volume was 24.0 (27.2) cm3, and midline shift was present in 312 participants at baseline. There was strong association between ICH volume and midline shift (p<0.001). In 1055 patients, 762 (72%) had poor functional outcome (mRS>2) at day 90. After adjusting for baseline variables, midline shift was independently associated with early neurological deterioration (OR 2.12, 95% CI 1.44-3.12) and poor mRS at day 90 (OR 1.44, 95% CI 1.04-1.99).

Conclusion: The presence of midline shift at baseline is associated with poor functional outcome in acute ICH.

Disclosure: No

P0644 / 95

ADJUSTED MORBIDITY GROUPS AND INTRACEREBRAL HAEMORRHAGE: A RETROSPECTIVE PRIMARY CARE COHORT STUDY

J.L. Clua-Espuny ^1,2, B. Lorman-Carbo^3,2, E. Muria-Subirats⁴, J. Ballesta-Ors², M.A. Gonzalez-Henares¹, M. Palleja-Millan⁵, F.M Martin-Lujan^1,5, Ebrictus Research Group

¹Institut Catala de la Salut. Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Primary Care, Tortosa, Spain, ²Institut Catala de la Salut. EAP Tortosa-Est. SAP Terres de l’Ebre, Primary Care, Tortosa, Spain, ³Institut Catala de la Salut. Universitat Rovira i Virgili, Primary Care, Tortosa, Spain, ⁴Institut Catala de la Salut. EAP Amposta. SAP Terres de l’Ebre, Primary Care, Tortosa, Spain, ⁵Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, IDIAP JGol, Reus, Spain

Background and aims: Intracerebral haemorrhage (ICH) is an important public health problem leading to high rates of death and disability. Guidelines in Europe aim to decrease ICH mortality. The Adjusted Morbidity Grouper (AMG risk score) modelling is aligned with the European framework for addressing patients with chronic comorbid conditions from a clinical approach with reduction of outcome variability within and among regions. The aims were to relate the AMG-complexity stratification and the ICH incidence and potentially modifiable risk factors.

Methods: Multicentre, retrospective, community-based cohort study including patients AMG-4, without previous ICH and followed up from 01/01/2015-31/12/2019. GMA-complexity was categorized as low (levels 2 and 3) and high (levels 4 and 5), obtained from electronic records of Catalan Institute of Health (Spain). The primary outcome was occurrence of ICH along the study. Demographic, clinical, and pharmacological variables were included. Adjusted logistic regression analyses were carried out to detect prognostic variables for ICH.

Results: 4,686 subjects were included. 57.2% women. Median age 84 years [75-90]. The high-complexity subgroup had highest ICH incidence [129.0/10,000 person-year (95%CI 128.6-129.3)] and mortality (p <0.001). The independent predictive factors of ICH were: high-complexity (HR1.59 [95%CI 1.15-2.20; p <0.01]), age ⩾80 years (HR1.77 [95%CI 1.15-2.20; p <0.01]) and antiplatelet treatment (HR1.48 [95%CI 1.07-2.05; p = 0.02]). Mortality differences became not significant when an ICH occurred (p = 0.091).

Conclusions: AMG-4 had higher ICH incidence vs elderly and general population. The AMG complexity index can identify vulnerable ICH groups in which to consider the risk-benefit of deprescription.

Disclosure: No

P0645 / 412

PREDICTORS OF EARLY TIME FROM SYMPTOM ONSET IN SPONTANEOUS ICH

P. Balali ¹, R. Joundi¹, A. Katsanos¹, L. Catanese¹, V. Lioutas², F. Carvalho², E. Heistand², M. Sharma¹, M. Selim², A. Shoamanesh¹

¹McMaster University/Population Health Research Institute, Division of Neurology, Hamilton, Canada, ²Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Neurology, Boston, United States

Background and aims: To maximize treatment efficacy in hematoma expansion treatment trials, eligibility should be confined to patients presenting in the first few hours following intracerebral hemorrhage (ICH). However, a large proportion of patients with ICH have unknown symptom onset time, limiting the number of eligible patients. We aimed to determine whether baseline clinical and neuroimaging variables are associated with early symptom onset to presentation time in patients with spontaneous ICH.

Methods: We used a stepwise multivariate logistic regression model with backward elimination to determine baseline clinical, laboratory, and radiological predictors of symptom onset to baseline CT scan time of ⩽3 hours in patients with spontaneous ICH participating in the iDEF randomized trial.

Results: A total of 292 patients with ICH were included, of whom 133 (45.6%) had a symptom onset-to-CT time of ⩽3 hours. Baseline Glasgow Coma Scale score (OR: 1.19 per 1-score increase, 95%CI: 1.02-1.39), baseline ICH volume (OR: 1.02 per 1ml increase, 95%CI: 1.00-1.04), absolute perihematomal edema volume (OR: 0.97 per 1ml increase, 95%CI: 0.95-0.99), NIH stroke scale (OR: 1.06 per 1-score increase, 95%CI: 1.00-1.12), and white blood cell count (OR: 0.88 per 10³ cell/ml increase, 95%CI: 0.82-0.95) were independently associated with symptom onset-to-CT time of ⩽3 hours (c-statistic=0.70).

Conclusions: Baseline clinical and neuroimaging features are associated with time from symptom onset to CT scan in spontaneous ICH patients. Future research is required to determine whether a reliable validated score can be developed to broaden eligibility of hyperacute ICH trials to patients with unknown symptom onset time.

Disclosure: No

P0646 / 747

SPEED OF HAEMATOMA GROWTH AND OUTCOME IN ACUTE INTRACEREBRAL HAEMORRHAGE

M. Ouyang ¹, S. You², X. Wang¹, T.J Moullaali^1,3, E.C. Sandset^4,5, L. Woodhouse^6,7, C. Delcourt^1,8,9, C.S Anderson^1,10,11, P.M Bath^6,7

¹The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia, ²The Second Affiliated Hospital of SooChow University, Department of Neurology and Clinical Research Center of Neurological Disease, Jiangsu, China, ³Centre for Clinical Brain Sciences, University of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom, ⁴Oslo University Hospital, Department of Neurology, Oslo, Norway, ⁵The Norwegian Air Ambulance Foundation, Research and Development Department, Oslo, Norway, ⁶Stroke Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom, ⁷Stroke, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, ⁸Central Clinical School, University of Sydney, Sydney, Australia, ⁹Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia, ¹⁰Royal Prince Alfred Hospital, Neurology Department, Sydney, Australia, ¹¹The George Institute China at Peking University Health Science Center, Beijing, China

Background and aims: Rapid haematoma growth predicts worse outcome in intracerebral haemorrhage (ICH). This study aimed to quantify the strength of association for speed of early haematoma growth (EHG) over 24 hours and clinical outcomes in ICH.

Methods: Post-hoc analysis of the Blood pressure in Acute Stroke Collaboration (BASC) ICH dataset. Generalised linear mixed models were used to determine associations of EHG speed ([haematoma volume at 24hr - baseline volume] / [follow-up CT time – time from symptom onset to CT] mL/hr) and clinical outcomes (mRS scores at 90-days and neurological deterioration at 7 days defined by each trial) with adjustment of prognostic variables (p<0.10) and source trial as a random effect for clustering.

Results: 1584 patients (mean age 64.1+13.3 years, female 35.4%) were included with median speed of EHG of 0.09 (IQR 0.03-0.31) mL/hr. EHG speed (every 0.2 ml/hr increase) was associated with an increased risk of unfavourable shift of mRS (adjusted odds ratio 1.25, 95% confidence interval 1.20-1.31), death and major disability according to mRS 3-6 (1.18, 1.09-1.27), death (1.26, 1.19-1.33), any serious adverse events (1.26, 1.19-1.33) at 90 days, and neurological deterioration on the NIHSS (1.13, 1.08-1.17). Associations were consistent with categorical measures of EHG: ‘fast’ (>0.20 mL/hr) versus ‘slow’ (<0.04 mL/hr).

Conclusions: More rapid EHG is associated with adverse outcomes after ICH.

Disclosure: Yes

P0647 / 1215

EXPLORING VARIATIONS IN PROPORTIONAL ADMISSION OF PRIMARY INTRACEREBRAL HAEMORRHAGE

J. Harbison ^1,2, J. McCormack¹, R. Collins¹, T. Cassidy¹

¹National Office of Clinical Audit, Irish National Audit of Stroke, Dublin, Ireland, ²Trinity College Dublin, Medical Gerontology, Dublin, Ireland

Background and aims: The Irish National Audit of Stroke records admission of Stroke Patients to all National Stroke services. We have noted a substantial difference in the ratio of Ischaemic stroke versus primary intracerebral haemorrhages between units. A number of hypotheses have been advanced including differences in unit size, variations in catchment area predisposing against presentation of minor stroke and differences in stroke definition used, ASA vs WHO

Methods: Evaluation of INAS data 2018-2020 and reported Organisational Audit data 2021. All subjects are scanned and receive an ICD10 code. Data were analysed using t-tests, ANOVA for grouped data and Correlations for continuous data.

Results: Ratio of IS to PICH varied between 2.7 and 6.7, Mean 5.3. Services with Neurosurgery had a lower ratio (mean 3.2). Large Hospitals (Category 4) had a lower ratio than smaller (Category 2 + 3) hospitals. (Mean 4.7 to 5.6 p=0.47 t-test). There was no association with rurality of catchment (highly rural (mean): 5.4, moderately rural: 5.4, mainly urban: 5.2 (ANOVA F 0.05 p=0.95). There was no association number of total admissions (r=0.1 p=0.9) with age and sex adjusted inpatient 30 day Ischaemic stroke mortality rate (r=0.24 p=0.25), Haemorrhagic stroke mortality rate (r=-0.07, p=0.78) or reported use of differing stroke definitions (Mean AHA 5.2 vs Mean WHO 5.4, p=0.7).

Conclusions: Larger hospitals admit a slightly higher proportion of patients with PICH. There were no other organisational or geographical associations found. The reason for the variability between hospitals remains unclear.

Disclosure: No

P0648 / 1631

EPIDEMIOLOGY AND CLINICAL PRESENTATION OF SPONTANEOUS CEREBELLAR HEMORRHAGE IN A NORWEGIAN POPULATION

N. Koubaa ¹, K.T. Larsen¹, V. Hillestad², M.N. Selseth², S.H. Jahr¹, K.W Faiz¹, J. Sundseth³, A. Sundseth¹, M. Altmann¹, B. Thommessen¹, E.C. Sandset⁴, O.M. Rønning¹, E.S. Kristoffersen¹

¹Akershus University Hospital, Department of Neurology, Lørenskog, Norway, ²Akershus University Hospital, Department of Radiology, Lørenskog, Norway, ³Oslo University Hospital, Department of Neurosurgery, Oslo, Norway, ⁴Oslo University Hospital, Department of Neurology, Oslo, Norway

Background and aims: Most data on cerebellar hemorrhage (cICH) are from selected referral centres not necessarily reflecting a primary cICH population. The purpose of this study was to explore the incidence and mortality of cICH in an unselected Norwegian population.

Methods: A retrospective cross-sectional single centre study conducted at Akershus University Hospital, serving as the primary hospital for roughly 10% of the total Norwegian population. Patients were identified through electronic chart reviews based on manually screening for the relevant International Classification of Diseases (10^th revision) codes for all ICH-cases between January 1st, 2009 and December 31st, 2019. cICH cases caused by tumor, vascular malformations and trauma were not included.

Results: 89 patients aged 26-94 years were identified and included. The median age was 75 years and 47% were females. The overall incidence of cICH was 2.2 (95% CI 1.7-2.9) per 100 000/year. The median hematoma volume was 8.6 ml. 29% were associated with on-going anticoagulant therapy. 12% underwent surgery. In-hospital mortality was 30% and the overall 3 months, 1- and 2-years mortality was 35%, 43% and 48%, respectively. 26% had modified Rankin Scale score 0-2 after 3 months.

Conclusions: The incidence of cICH in an unselected population was 2.2/100 000/year. Few patients underwent surgery. The mortality rates were similar to supratentorial ICH.

Disclosure: No

P0649 / 794

LONG-TERM ANXIETY IN SPONTANEOUS INTRACEREBRAL HAEMORRHAGE SURVIVORS

G. Scopelliti ¹, B. Casolla¹, G. Boulouis², G. Kuchcinski³, S. Moulin⁴, D. Leys¹, H. Hénon¹, C. Cordonnier¹, M. Pasi¹

¹Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Neurology, Lille, France, ²Inserm UMR 1266, GHU Paris Psychiatrie et Neurosciences, Centre Hospitalier Sainte-Anne, Paris University, Neuroradiology, Paris, France, ³Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Neuroradiology, Lille, France, ⁴Centre Hospitalier Universitaire Reims, Hôpital Maison Blanche, Neurology, Reims, France

Background and aims: Anxiety is common in several neurological conditions, but it has been poorly investigated after spontaneous intracerebral hemorrhage (ICH). In consecutive ICH survivors we assessed long-term prevalence of anxiety, and its clinical and radiological determinants.

Methods: Using Hospital Anxiety and Depression scale (HADS), we evaluated ICH survivors enrolled in the prospective, single center Prognosis of Intracerebral Hemorrhage (PITCH) study. Prevalence of anxiety (defined as a HADS-anxiety subscale score > 7), along with neurological symptoms severity, functional disability, and cognitive impairment scores, was evaluated at three time points: 1-2, 3-5, and 6-8 years after ICH. Clinical and radiological characteristics associated with anxiety were evaluated in univariate and multivariable models.

Results: Of 560 patients with spontaneous ICH, 255 were alive 1 year later, 179 of whom underwent HADS questionnaire and were included in the study. Thirty-one patients (17%; 95% confidence interval [CI] 12-23) had anxiety at 1-2 years, 38 (27%; 95% CI 19-34) at 3-5 years, and 18 (21%; 95% CI 12-30) at 6-8 years follow-up. In patients with anxiety, the prevalence of associated depressive symptoms was 48.4% at 1-2 years, 60.5% at 3-5 years, and 55.5% at 6-8 years follow-up. Among clinical and radiological baseline characteristics, only lobar ICH location was significantly associated with anxiety at 1-2 years follow-up (odds ratio 2.8; 95% CI 1.2-6.5). Anxiety was not associated with concomitant neurological symptoms severity, functional disability, or cognitive impairment.

Conclusions: Anxiety is frequent in ICH survivors, often in association with depressive symptoms, even many years after the index event.

Disclosure: No

P0650 / 597

ASSOCIATION BETWEEN CIRCULATING INFLAMMATORY BIOMARKERS AND FUNCTIONAL OUTCOME OR PERIHAEMATOMAL OEDEMA AFTER INTRACEREBRAL HAEMORRHAGE: A SYSTEMATIC REVIEW AND META-ANALYSIS

C. Kirby¹, J. Barrington¹, L. Sondag², J. Loan¹, F. Schreuder², B. McColl³, C. Klijn², R. Al-Shahi Salman¹, N. Samarasekera ¹

¹The University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²Radboud University Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands, ³The University of Edinburgh, Centre for Discovery Brain Sciences & UK Dementia Research Institute, Edinburgh, United Kingdom

Background and aims: Inflammatory responses after intracerebral haemorrhage (ICH) may be therapeutic targets. We aimed to quantify associations between individual circulating inflammatory biomarkers and functional outcome or perihaematomal oedema (PHO).

Methods: We searched OVID Medline and EMBASE in April 2021 for studies that measured an inflammatory biomarker and functional outcome or PHO in ⩾5 adults after ICH. We extracted aggregate data and used random effects meta-analysis to pool standardised mean differences where at least two studies investigated the association between the same biomarker and the same measure of functional outcome or PHO.

Results: Of 8615 articles identified, 93 (n=17702 patients) examined an association between ⩾1 biomarker and clinical outcome and were included in narrative synthesis. Twenty studies of nine biomarkers met criteria for meta-analysis. Higher levels of CRP (SMD 0.80; 95% CI 0.44, 1.17, p<0.0001), fibrinogen (SMD 0.32; 95% CI 0.04, 0.61, p=0.025) and white blood cell (WBC) count (SMD 0.27; 95% CI 0.11, 0.44, p=0.001) were associated with higher dichotomised modified Rankin Scale score at 90 days. The pooled effect sizes for CRP were greater in studies with lower median cohort ages.

Sixteen studies (n=1299) examined the association between 21 inflammatory biomarkers and PHO but differences in the method and timing of PHO measurements precluded meta-analysis. We did not find any biomarker associated with both PHO and clinical outcome in >1 study.

Conclusions: Higher levels of WBC, CRP and fibrinogen are associated with poorer outcomes after ICH. Research is needed to identify serum biomarkers which may be therapeutic targets.

Disclosure: No

P0651 / 626

IMPACT OF ANTITHROMBOTIC TREATMENT ON ASSOCIATIONS BETWEEN PREHOSPITAL SYSTOLIC BLOOD PRESSURE AND OUTCOMES IN ACUTE, SPONTANEOUS INTRACEREBRAL HAEMORRHAGE

K.T. Larsen ^1,2,3, M.N. Selseth^4,3, S.H. Jahr^2,3, V. Hillestad⁴, N. Koubaa², E.C. Sandset^5,6, O.M. Rønning^2,3, E.S. Kristoffersen^2,7

¹Oslo University Hospital, Department of Geriatric Medicine, Oslo, Norway, ²Akershus University Hospital, Department of Neurology, Lørenskog, Norway, ³University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ⁴Akershus University Hospital, Department of Diagnostic Imaging, Lørenskog, Norway, ⁵Oslo University Hospital, Department of Neurology, Oslo, Norway, ⁶The Norwegian Air Ambulance Foundation, Oslo, Norway, ⁷University of Oslo, Institute of Health and Society, Department of General Practice, Oslo, Norway

Background and aims: In acute intracerebral haemorrhage (ICH), both elevated blood pressure (BP) and antithrombotic treatment (AT) at onset are unfavourable. We aimed to explore interactions between AT and prehospital systolic BP (SBP) on outcomes.

Methods: Adult patients with spontaneous ICH diagnosed by computed tomography within 24 hours of onset, consecutively admitted to a primary stroke centre during 2012-2019, were included. The first recorded prehospital SBP was analysed per 5 mmHg increment. Outcomes were initial haematoma volume (transformed), haematoma expansion, in-hospital death, shift on the modified Rankin Scale (mRS) at discharge, and death at 90 days. AT was antiplatelet and/or anticoagulant treatment. Associations between prehospital SBP and outcomes according to AT subgroups were explored by multivariable regression. Modification by AT was assessed by adding interaction terms to the models.

Results: 200 women and 220 men aged median 76 (IQR 68-85) years were included. 252/420 (60%) were using AT. In the ‘no AT’ subgroup, no associations were found between prehospital SBP and outcomes. In the AT subgroup, prehospital SBP was associated with haematoma volume (coef. 0.03, 95%CI 0.00-0.07), in-hospital death (OR 1.11, 95%CI 1.04-1.18), and shift on the mRS (common OR 1.07, 95%CI 1.02-1.12). For these outcomes, there were significant interactions between AT and prehospital SBP (p=0.009, p=0.041, p=0.002; Figure). No significant associations or interactions were found for haematoma expansion or death at 90 days.

Conclusions: In ICH patients, AT modifies effects of prehospital SBP on outcomes. These findings may have implications for future studies on early BP lowering in ICH.

Disclosure: No

P0652 / 1314

PERCUTANEOUS GASTROSTOMY TUBE PLACEMENT AFTER INTRACEREBRAL HEMORRHAGE: EXTERNAL VALIDATION OF THE GRAVO SCORE

D. Lin¹, M. Minyetty¹, B. Gogia¹, S. Hasan¹, E. Heistand¹, F. Carvalho¹, S. Marchina¹, V. Lioutas¹, M. Selim ¹, S. Kumar¹

¹ Beth Israel Deaconess Medical Center, Harvard Medical School, Neurology, Boston, United States

Background and aims: Dysphagia after intracerebral hemorrhages (ICH) can lead to enduring impairments of food intake. A new tool called the GRAVo score was recently developed to predict percutaneous gastrostomy (PEG) tube placement for nutritional support after ICH but requires external validation. Our aim was to externally validate the GRAVo score.

Methods: Subjects for this analysis were selected from a previously completed, multicenter, randomized, clinical trial, Intracerebral Hemorrhage Deferoxamine Trial (i-DEF) and underwent a review of prospectively collected data. GRAVo scores were computed duplicating previously established methods for assigning scores to the following variables: Glasgow Coma Scale ⩽12 (2 points), Race (1 point for Black), Age > 50 years (2 points), and ICH Volume >30 cc (1 point).

Results: A total of 38 out of 291 subjects in this cohort underwent PEG placement. The average GRAVo score in the non-PEG placement group and PEG placement groups were, 2.56 (SD 1.38) versus 3.55 (SD 1.37), respectively (p <0.0001). Logistic regression analysis demonstrated that GRAVo score significantly increased the risk of PEG placement (OR 1.62; 1.25-2.11 95% CI) after adjustment for exposure to deferoxamine. External validation of the GRAVo score yielded an AUROC of 0.7052 (95% CI 0.6082-0.7822) [Figure].

Conclusions: The results of our external validation demonstrates the validity of GRAVo scores for predicting PEG tube placement after an ICH. However, its performance was more modest compared to the derivation cohort. These findings should be taken into consideration when using it to assist clinical decision-making regarding PEG placement after an ICH.

Disclosure: No

P0653 / 971

PRESCRIPTION OF ANTIEPILEPTIC DRUGS IN SEIZURES AFTER INTRACEREBRAL HEMORRHAGE IS ASSOCIATED WITH BETTER PROGNOSIS

M. Paul-Arias ¹, M. Baraldés-Rovira¹, G. Mauri-Capdevila¹, J. Sanahuja-Montesinos¹, F. Purroy¹, D. Vázquez-Justes¹

¹ Hospital Universitari Arnau de Vilanova, Neurology, Lleida, Spain

Background and Aims: Seizures after Intracerebral Hemorrhage (ICH) are relatively frequent (about 20% of patients). However, impact on prognosis of prescription of antiepileptic drugs (AED) are controversial, especially after early onset seizures.

We aimed to analyze the impact on outcome of prescription of AED in seizures after ICH.

Methods: We retrospectively reviewed a cohort of patients with ICH. We recorded demographic characteristics, classified seizures as early or late onset if they appeared before or later than 7 days, respectively. We analyzed if they received AEDs and their outcome.

Primary outcome was mRS scale at 3 months.

Results: We reviewed 234 patients with ICH who came in the acute phase of stroke (<8hours) to our hospital. 94 (40.2%) were woman. Mean age was 73 (DE12) years. 40 (17%) had early seizure after ICH and 31 (77.5%) of these received treatment with AED. Levetiracetam was the most prescribed drug (90.3%).

Patients who received AEDs had a significantly better evolution than those without prescription. mRS at 3 months was significantly higher among those patients without prescription of AEDs (median mRS 4.5 [IQR: 3-6]) than in patients who received (median mRS 3 [IQR: 2-4]) (p<0.05).

Conclusions: AEDs prescription in early seizure after ICH is frequent. Levetiracetam was the most prescribed.

Our results suggest that receiving treatment with AEDs after early seizure could be related to a better evolution at 3 months, ant therefore, could be indicated.

Future studies would be necessary to evaluate the impact of AEDs on prognosis of acute symptomatic seizures.

Disclosure: No

P0654 / 1208

CLINICAL FRAILTY IS INDEPENDENTLY ASSOCIATED WITH 28-DAY MORTALITY FOLLOWING ACUTE INTRACEREBRAL HAEMORHAGE

B.D Lewis ¹, E.A Warburton², N.R. Evans¹

¹University of Cambridge, Department of Medicine, Cambridge, United Kingdom, ²University of Cambridge, Department of Clinical Neurosciences, Cambridge, United Kingdom

Background and aims: Effective prognostication in individuals admitted with spontaneous intracerebral haemorrhage (ICH) is vital for clinical decision-making, but can be challenging. Clinical frailty – the loss of physiological reserve to withstand a stressor event – is an increasingly recognised risk factor for poor outcomes after ischaemic stroke, yet the role of frailty in ICH outcomes is less clear. This study investigates whether frailty is independently associated with 28-day mortality following ICH.

Methods: Pre-stroke frailty was measured retrospectively and blinded to outcomes for 118 individuals presenting with ICH using a validated frailty index (FI), yielding a frailty score of 0-1. The relationship between 28-day mortality following ICH and FI was assessed using multivariable logistic regression that adjusted for age, sex, neurosurgical intervention, and ICH volume (calculated using the abc/2 method).

Results: Forty (33.9%) individuals with ICH died by 28 days. Frailty was independently associated with 28-day mortality, with a 0.1 increase in FI independently associated with an adjusted odds ratio of death of 1.09 (95% CI 1.01-1.18). ICH volume was also independently associated with mortality (aOR 1.00, 95% CI 1.00-1.01). In contrast, none of age (aOR 1.00, 95% CI 0.99-1.01), sex (aOR 1.13, 95% CI 0.96-1.33), or neurosurgical intervention (aOR 1.42, 95% CI 0.98-2.05) were independently associated with mortality.

Conclusion: Individuals with higher pre-stroke frailty are more likely to die following spontaneous ICH, independent of age, sex, neurosurgical intervention, and ICH volume. This finding supports the importance of evaluating frailty in order to inform prognosis and clinical management in acute ICH.

Disclosure: No

P0655 / 1456

THE EFFECT OF CONCOMITANT ANTIPLATELET AND STATIN EXPOSURE ON INTRACEREBRAL HEMORRHAGE OUTCOME

A. Andreev ¹, J.-Y. Wang¹, M. Wilson¹, M.H Selim¹, V.-A. Lioutas¹

¹ Harvard University/Beth Israel Deaconess Medical Center, Neurology, Boston, United States

Background and aims: Clinical equipoise exists regarding the role of statins in intracerebral hemorrhage (ICH), especially those of lobar location. We explored whether concomitant exposure to statins and antiplatelets has an additive effect on hematoma expansion (HE) and functional outcome of ICH.

Methods: Retrospective cohort of consecutive patients with acute spontaneous ICH. We divided patients into 4 groups; those taking antiplatelets (APL) alone, statins (STAT) alone, both drugs, or none. We examined the relationship between medication exposure to and substantial HE (defined as relative volume increase ⩾33% between baseline and 24-hour CT scans) and functional outcome (dichotomized modified Rankin Scale⩽2 vs>2), stratifying our analyses by ICH location (lobar vs non-lobar).

Results: 622 patients (70.5 (±14.2) years, 275(44%) female were included. Median baseline ICH volume was 17.3(6.1-45.5) and median time from symptom onset to baseline scan 3.8(1.7-8.3) hours. 285(46%) ICH were lobar. 94(15%) patients on APL alone; 94 (15%) on STAT; 139(22%) on APL+STAT. Across the entire cohort, exposure to either drug alone or concomitant APL+STAT had no significant effect on HE or 90-day outcome. Although lobar ICH had significantly higher hematoma volume median 35.7, IQR(13.8-66.2)ml vs 9.6, IQR(3.7-22.6), p<0.00001, there was no significant differential effect of either APL, APL+STAT or STAT by ICH location.

Conclusions: In this retrospective cohort of 622 patients, concomitant exposure to APL+STAT, was not significantly associated with HE or 90-day functional outcome, irrespective of ICH location. Larger, prospective randomized studies are necessary to delineate the effects of these medications on ICH recurrence and cardiovascular outcomes.

Disclosure: No

P0656 / 1328

TIME TRENDS IN SURVIVAL AFTER FIRST PRIMARY INTRACEREBRAL HAEMORRHAGE AND ISCHAEMIC STROKE BETWEEN 2000 AND 2015 IN THE SOUTH LONDON STROKE REGISTER(SLSR)

X. Li ¹, C. Wolfe^1,2,3, Y. Wang¹

¹King’s College London, Department of population health sciences, London, United Kingdom, ²National Institute for Health Research (NIHR) Biomedical Research Centre, London, United Kingdom, ³National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom

Background and aims: Survival after stroke is an important factor to monitor stroke burden. Recent data on survival by stroke subtype in the general population is limited. This study estimates time trends in survival of first-ever primary intracerebral haemorrhage(PICH) and ischaemic stroke(IS) over a 16-year period.

Methods: Population-based case ascertainment of PICH and IS was conducted, and all participants who had their first-ever ICH and IS between 2000 and 2015 were identified. We assessed time trends in survival across 4 time periods (2000–2003; 2004–2007; 2008–2011, 2012-2015) using proportional-hazards Cox modelling, adjusted for demography, pre-stroke factors, case-mix variables, and processes of care. Kaplan-Meier curves were performed.

Results: In total, 528 with PICH and 3128 patients with IS were registered. In the PICH group, the mean age was 64.4 years, 57.8% were male. Compared with the earliest study period (2000–2003), mortality rates remained unchanged in 2012–2015 (hazard ratio[HR]: 0.951 [95% CI, 0.347–2.607]; P=0.92). No changes were observed in both sexes and in patients aged >= 65 years (HR per year 0.938; 95%CI 0.824- 1.067). In the IS group, the mean age was 65.5 years, 56.6% were male. The adjusted overall mortality decreased by 24% (HR per year: 0.976; 95% CI 0.959-0.993) between 2000-2003 and 2012- 2015. Survival improvements were also observed in both sexes and patients aged >= 65 years (HR per year 0.975; 95%CI 0.959- 0.992).

Conclusions: Survival after IS has improved over the past decades, while no change was observed in survival following PICH.

Disclosure: No

P0657 / 1499

WE ARE NOT THE SAME: GEOGRAPHIC DIFFERENCE IN INCIDENCE AND EPIDEMIOLOGY FOR INTRACEREBRAL HAEMORRHAGE IN SPAIN.NEUROEPI STUDY

R.J. Milán Pinilla ¹, M. Marina Blanco-Ruiz¹, L. Amaya Pascasio¹, A. Arjona Padillo¹, J.M. García Torrecillas², P. Martínez-Sánchez¹

¹Stroke Centre, Torrecárdenas University Hospital, Department of Neurology., Almería, Spain, ²Torrecárdenas University Hospital, Emergency Department, Almería, Spain

Background: Spain is geographically divided into 17 autonomous communities (AC) with different socio-cultural and environmental characteristics. Our aim is to identify whether these differences are related to the prevalence of risk factors for non-traumatic intracerebral haemorrhage (IH) as well as the IH in-hospital incidence and mortality rate.

Methods: Observational study based on the hospital episode database, collected by the Spanish National Health Service. Patients older than 18 years with IH as the main diagnosis at discharge during 2017 were included. Data about comorbidities, lifestyle and socio-economic factors were obtained from an European health survey (2014). Air pollution was obtained from the National inventory of atmospheric emissions. In-hospital Incidence and mortality rates were estimated based on the population registered in the National Statistics Institute. A descriptive analysis was performed.

Results: 10060 episodes of IH were included. We found significant statistical differences in all the risk factors studied between ACs. The north-west ACs had the highest incidence (42/100.000 inh.) whereas the Canary Islands had the lowest (11.9/100.00 inh.). The IH in-hospital incidence was higher in those AC with larger alcohol intake, older population, and higher unskilled occupation rate (p<0.05). The in-hospital mortality rate was higher in the ACs with higher unskilled occupation rate and greater NO2 levels (p<0.05).

Conclusions: Estimated in-hospital incidence and mortality of IH in the Spanish population and the presence of comorbidities and risk factors differed among Spanish ACs. Alcohol intake and unskilled occupations were related to greater IH incidence, whereas unskilled occupations and greater NO2 levels were associated with higher mortality.

Disclosure: No

SAH, ANEURYSMS AND VASCULAR MALFORMATIONS

P0658 / 354

SUBARACHNOID HEMORRHAGE BENEFIT OF TREATMENT PREDICTION MODELS (SHARP): PERSONALIZED DECISION-MAKING IN ANEURYSMAL SUBARACHNOID HEMORRHAGE

J. de Winkel ¹, D. van Klaveren², R. Dammers³, S.A. Dijkland¹, P.-J. van Doormaal⁴, M. van der Jagt⁵, R.S. Kerr⁶, A.J. Molyneux⁶, D.WJ. Dippel¹, B. Roozenbeek¹, H.F. Lingsma²

¹Erasmus MC University Medical Center Rotterdam, Department of Neurology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands, ³Erasmus MC University Medical Center Rotterdam, Department of Neurosurgery, Rotterdam, Netherlands, ⁴Erasmus MC University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands, ⁵Erasmus MC University Medical Center Rotterdam, Department of Intensive Care Adults, Rotterdam, Netherlands, ⁶University of Oxford, Nuffield Department of Surgical Sciences, Oxford, United Kingdom

Background and aims: We aimed to develop models to predict benefit from endovascular compared to neurosurgical aneurysm treatment in patients with aneurysmal subarachnoid hemorrhage.

Methods: We used data from the randomized International Subarachnoid Aneurysm Trial (ISAT). We used multivariable regression modelling to predict functional outcome (modified Rankin Scale; mRS) at 12 months, and any rebleed or retreatment of the target aneurysm within 10 years. We defined benefit as the difference in predicted probability of favorable functional outcome (mRS 0-2), and of no rebleed or retreatment, with endovascular and neurosurgical aneurysm treatment. We considered a benefit of ⩾5% clinically relevant. Model performance was expressed with the c-statistic.

Results: We included 2143 patients with a mean age of 51.7 years. In the ISAT population, average predicted benefit was 6% (95% CI 3-8%) in favor of endovascular aneurysm treatment, for favorable functional outcome, but 11% (95% CI 9-13%) in favor of neurosurgical aneurysm treatment, for no rebleed or retreatment. We identified 646 patients (30%) who had no clinically relevant benefit of endovascular aneurysm treatment in terms of functional outcome, but had a relevant benefit of neurosurgical treatment in terms of risk of retreatment or rebleed. The c-statistic was 0.74 (95% CI 0.71-0.77) for the prediction of favorable functional outcome, and 0.69 (95% CI 0.65-0.72) for rebleed or retreatment.

Conclusions: On average, endovascular aneurysm treatment leads to superior functional outcome. However, a substantial proportion of patients has limited expected benefit, and could be considered for neurosurgical treatment because of lower rebleed and retreatment rates.

Disclosure: No

P0659 / 927

SCREENING FOR INTRACRANIAL ANEURYSMS IN RELATIVES OF PATIENTS WITH UNRUPTURED INTRACRANIAL ANEURYSMS: AN OBSERVATIONAL PROSPECTIVE COHORT STUDY

L. Mensing ¹, R. van Tuijl², J. Greving³, A. Algra³, B. Velthuis², G. Rinkel¹, Y. Ruigrok¹

¹UMC Utrecht Brain Centre, Neurology and Neurosurgery, Utrecht, Netherlands, ²UMC Utrecht, Radiology, Utrecht, Netherlands, ³Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands

Background and aims: Lifetime risk of aneurysmal subarachnoid haemorrhage (aSAH) is high for persons with a positive family history for aSAH. Screening has been shown effective for first degree relatives (FDRs) of aSAH patients, with unruptured intracranial aneurysms (UIAs) identified in up to 10% at first screening, while UIA prevalence in the general population is 3.2%. Whether screening is also effective for FDRs of UIA patients is unknown. We aimed to determine the yield of screening in this group of FDRs.

Methods: With 3-Tesla MRA we screened 461 FDRs, aged 20 – 70 years, of patients with one or more UIAs and with a negative family history for aSAH at the University Medical Centre Utrecht between April 2017 and October 2021. We determined UIA prevalence and clinical management of UIAs identified.

Results: We detected 23 UIAs, resulting in a 5% prevalence (95% confidence interval; 3 – 7%). Mean aneurysm size was 2mm (range 1 – 5mm) and 5-year risk of rupture was assessed with the PHASES score with a mean value of 0.7% (range 0.4 – 1.3%). The appropriate management of the UIAs was determined by a multidisciplinary team, for none of the UIAs preventive treatment was advised but follow-up imaging to detect growth for all instead.

Conclusions: We found a 5% UIA prevalence in persons with a family history positive for UIA. Follow-up for growth and need for preventive treatment should determine the cost-effectiveness of screening in FDRs of patients with UIAs.

Disclosure: No

P0660 / 956

SCREENING FOR UNRUPTURED INTRACRANIAL ANEURYSMS IN PERSONS ⩾35 YEARS WITH HYPERTENSION AND WHO SMOKE(D)

L. Mensing ¹, R. van Tuijl², J. Greving³, A. Algra³, B. Velthuis², G. Rinkel¹, Y. Ruigrok¹

¹UMC Utrecht Brain Centre, Neurology and Neurosurgery, Utrecht, Netherlands, ²UMC Utrecht, Radiology, Utrecht, Netherlands, ³Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands

Background and aims: Lifetime risk of aneurysmal subarachnoid haemorrhage (aSAH) is high for persons with a positive family history for aSAH, and screening has been shown effective for first degree relatives (FDRs) of aSAH patients. As lifetime aSAH risk is also high in persons ⩾35 years with hypertension and a history of smoking, screening might also be effective in these persons and therefore, we aimed to determine the yield of screening in them.

Methods: From a prospective single-centre observational cohort-study at the University Medical Centre Utrecht (SMART-ORACLE, NCT01932671) in which CT-angiography (CTA) of the carotid arteries was performed, we retrospectively retrieved all 501 patients ⩾35 years with hypertension and a history of smoking but no family history for aSAH scanned between 2013 and 2019. CTAs were re-evaluated for the presence of UIAs by experienced neuro-radiologists. In patients with UIAs, follow-up imaging to detect aneurysm growth was performed.

Results: We detected 26 UIAs, resulting in a 5.2% prevalence (95%CI; 3.6 – 7.5%). Mean aneurysm size was 3mm (range 1 – 16mm) and mean 5-year risk of rupture according to the PHASES score was 0.9% (range 0.4 – 5.3%). After a mean follow-up of 55 months (range 14 – 100) aneurysmal growth was detected in one patient. The appropriate management of the UIAs was determined by a multidisciplinary team and preventive UIA treatment was advised only for this patient.

Conclusions: We found a 5.2% UIA prevalence in persons ⩾ 35 years who have hypertension and smoke(d). The effectiveness of screening in this patient group requires further study.

Disclosure: No

P0661 / 166

PREDICTORS OF OPTIMAL TREATMENT TIME FOLLOWING ANEURYSMAL SUBARACHNOID HEMORRHAGE ACROSS TWO TERTIARY REFERRAL CENTERS IN AUSTRALIA

T. Nguyen ¹, C. Stirling², L. Nichols², R. Chandra^3,4, S. Rehman¹, M.-J. Buscot¹, K. Smith⁵, L. Blizzard¹, L. Lai³, H. Asadi³, A. Dubey⁶, J. Froelich⁶, N. Thani⁶, M. Reeves⁷, A. Thrift⁴, S. Gall^1,4

¹University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia, ²University of Tasmania, School of Nursing, Hobart, Australia, ³Monash Health, Clayton, Australia, ⁴Monash University, Clayton, Australia, ⁵Ambulance Victoria, Doncaster, Australia, ⁶Royal Hobart Hospital, Hobart, Australia, ⁷Michigan State University, East Lansing, United States

Background and aims: We explored predictors of very early (⩽12.5h) and early (12.5-24h) treatment compared to late (>24h) treatment following aneurysmal subarachnoid haemorrhage (aSAH) in order to inform interventions to reduce treatment delays.

Methods: Confirmed first-ever aSAH cases were identified from two Australian tertiary referral centers during 2010-2016. We used medical and ambulance records to extract details of participants, including time from onset to either endovascular coiling or neurosurgical clipping, demographics, severity of aSAH (mFisher grade; WFNS), risk factors, pre-hospital care, and presenting symptoms. Factors associated with treatment ⩽12.5h or 12.5-24h compared to >24h on univariable multinomial regression were entered into a multivariable model including purposefully selected confounders to identify factors independently associated with time to treatment.

Results: Among 482 patients (mean [SD] age 54.1 [14.5] years; 69.9% female) with aSAH, median (IQR) time to treatment was 19.4 (10.6, 31.0) hours with 30% treated ⩽12.5h, 32% treated 12.5-24h and 38% treated >24h from onset. In multivariable analyses (Table 1), arriving by ambulance and presenting with stroke-like symptoms predicted treatment ⩽12.5h and 12.5-24h. More extensive aSAH on CT imaging (mFisher grade 2-3) predicted treatment ⩽12.5h. In contrast, people living further away from treating hospital and having diagnostic cerebral angiography more often had treatment >24h from onset.

Conclusions: A substantial proportion of people after aSAH were not treated within timeframes associated with better outcomes. Presentation with stroke-like symptoms and ambulance arrival were associated with more timely treatment. Interventions to improve community awareness and recognition of aSAH may reduce delay to treatment.

Table 1.

Predictors of receiving aSAH treatment ⩽12.5 hours and within 12.5-24 hours compared to treatment >24 hours.

Predictor of time to treatment	⩽ 12.5 hoursAdjusted OR (95%CI)	12.5 - 24 hoursAdjusted OR (95%CI)
Age (year)	0.982 (0.964 - 1.002) a	0.983 (0.966 - 1.000) a
Sex
Male
Female	1.65 (0.86 - 3.14) a	2.03 (1.12 - 3.67)* a
Geographical location
Major cities
Inner regional	0.96 (0.54 - 1.69) b	1.30 (0.74 - 2.26) b
Outer regional	1.11 (0.46 - 2.68)	1.40 (0.65 - 3.03)
Remote area	0.56 (0.13 - 2.46)	1.22 (0.36 - 4.15)
Socioeconomic status
Advantaged
Disadvantaged	0.96 (0.56 - 1.64) b	0.82 (0.49 - 1.38) b
Distance to treating hospital (km)	0.993 (0.989 - 0.997) b	0.997 (0.995 - 0.999) b
Alcohol use
Never drink
Social drinker	0.59 (0.25 - 1.41) a	0.97 (0.48 - 1.97) a
Heavy drinker	1.76 (0.69 - 4.50)	1.21 (0.52 - 2.78)
Ex-heavy drinker	1.25 (0.29 - 5.39)	1.11 (0.28 - 4.44)
Symptoms
Stroke-like symptom(s)
Common symptoms only	0.46 (0.29 - 0.73) c	0.73 (0.47 - 1.14) c
Arrived by ambulance
No
Yes	10.00 (3.97 - 25.15) a	4.07 (2.07 - 7.98) a
Triage group
1
2	2.82 (1.25 - 6.37) a	1.98 (0.93 - 4.25) a
3	0.73 (0.32 - 1.64)	1.10 (0.54 - 2.26)
4+	0.89 (0.23 - 3.51)	0.92 (0.32 - 2.66)
WFNS
1-2 (better clinical condition)
3-5 (worse clinical condition)	0.82 (0.41 - 1.65) a	0.66 (0.35 - 1.26) a
Modified Fisher Scale
0-1 (less extensive aSAH)
2-3 (more extensive aSAH)	4.16 (1.28 - 13.49) a	1.69 (0.73 - 3.92) a
4 (most extensive aSAH)	2.92 (0.94 - 9.04)	1.51 (0.67 - 3.39)
Diagnostic cerebral angiography
No
Yes	0.28 (0.12 - 0.63) a	0.65 (0.29 - 1.43) a
Ventriculostomy
No
Yes	1.02 (0.54 - 1.91) a	0.90 (0.51 - 1.59) a
Interfacility transfer
No
Yes	0.78 (0.38 - 1.60) a	1.14 (0.62 - 2.13) a
Arrived at 1st hospital out of hours
No
Yes	0.86 (0.54 - 1.36) c	3.32 (2.11 - 5.24) c

a

Adjusted for age, sex, alcohol use, arrived by ambulance, distance to treating hospital, interfacility transfer, triage groups, WFNS, modified Fisher Scale, DSA and ventriculostomy.

b

Adjusted for socioeconomic groups, geographical locations and distance to treating hospital.

c

No adjustment needed.

Disclosure: No

P0662 / 1426

IMPACT OF COVID-19 PANDEMIC ON THE OUTCOME OF ANEURYSMAL SUBARACHNOID HAEMORRHAGE

L. Popa ¹, S. Petrescu^1,2, G. Vulpe¹, S. Dima³, R. Neamtu³, R. Stanciulescu³, H. Nicolae^1,2, C.A. Panea^1,2

¹Elias Emergency University Hospital, Neurology, Bucharest, Romania, ²Carol Davila University of Medicine and Pharmacy, Neurology, Bucharest, Romania, ³Elias Emergency University Hospital, Neurointerventional Radiology, Bucharest, Romania

Background and aims: Non-traumatic aneurysmal subarachnoid haemorrhage (ASH) represents the extravasation of blood between the arachnoid and pia mater. We aimed to compare the outcome and prognostic factors of patients admitted to our department with ASH between 01.2021 and 12.2021 (corresponding to a national and regional peak of COVID-19 cases) to those admitted between 01.2017 and 12.2019 (pre-pandemic ASH cohort).

Methods: We conducted a retrospective study including patients consecutively admitted to the Neurology Department in Elias Emergency University Hospital in Bucharest, Romania, between 01.2017 and 12.2021 with an established diagnosis of ASH. Seventy-two patients were included – 52 admitted during the pre-pandemic and 20 during the peak pandemic period. Mean age was similar in the two groups (54.5 and 53 years, respectively).

Results: Mortality rates did not differ significantly (40% during the pandemic period vs. 36.54% during pre-pandemic). Endovascular treatment was a positive predictor of survival in both groups (OR= 15 (p=0.016 in the pandemic and 5.76 (p=0.009) in the pre-pandemic group), while aneurysmal diameter of less than 1 cm only predicted survival in the latter (OR=8.13, p=0.01). A Hunt and Hess score greater than 2 and leukocytosis over 15 000/mm³ on admission were predictors of mortality in both groups. SARS-CoV-2 infection occurred in 15% of the patients admitted during the pandemic period and showed no significant correlation with morbi-mortality.

Conclusion: Mortality of AHS patients remained high during the pandemic and did not appear to be directly influenced by SARS-CoV-2 infection. Larger cohort studies are needed to confirm present results.

Disclosure: No

P0663 / 1343

PREDICTORS AND CLINICAL RELEVANCE OF CIRCULATING AND CEREBROSPINAL FLUID NEUROFILAMENT LIGHT CHAIN LEVELS IN SPONTANEOUS SUBARACHNOID HEMORRHAGE

D. Santana ¹, L. Llull¹, R. Torné², A. Renú¹, X. Urra¹, S. Rudilosso¹, A. Rodríguez¹, R. Mellado³, Á. Chamorro¹, S. Amaro¹

¹Hospital Clínic de Barcelona, Neurology, Barcelona, Spain, ²Hospital Clínic de Barcelona, Neurosurgery, Barcelona, Spain, ³Hospital Clínic de Barcelona, Anesthesiology, Barcelona, Spain

Background and aims: Neuroaxonal injury is a component of early brain injury after spontaneous subarachnoid hemorrhage (SAH) and can be tracked through the quantification of serum and cerebrospinal fluid neurofilament light (sNF-L and csfNF-L, respectively) levels. We aimed to assess the predictors and prognostic relevance of NF-L levels in SAH.

Methods: We included a prospective cohort of 52 SAH patients who had hydrocephalus treated with external ventricular drain at hospital admission. NF-L levels were evaluated in paired serum and CSF samples obtained within 72 hours of bleeding onset. Baseline traits including age, WFNS, mFisher grades and aneurysm size were recorded. The association of NF-L levels with baseline variables and clinical outcome [poor outcome, modified Rankin Scale score at 90 days (mRS-90d) >2] was assessed through correlation and logistic regression analyses respectively.

Results: 52 patients (77% females, 52% WFNS I-III, 89% mFisher 4, median age 57) were included in the study. sNF-L levels were significantly correlated with higher WFNS (rho=0.391, p=0.004) and higher admission glucose levels (rho=0.398, p=0.003), while no associations were found between baseline variables and csfNF-L levels. In binary regression models adjusted for age, WFNS, mFisher, aneurysm size and baseline glucose levels, higher sNF-L were associated with poor outcome [adjusted-OR(per IQR of increase)=2.39, 95%CI=1.04-5.50, p=0.041], whereas no significant association was found between csfNF-L and clinical outcome.

Conclusions: Serum but not CSF NF-L levels are associated with initial bleeding severity and clinical outcome at 90 days after SAH and could be useful as a surrogate endpoint in clinical trials.

Disclosure: No

P0664 / 837

THE VANISHING OF THE ANTERIOR COMMUNICATING ARTERY (ACOA) SYNDROME: IS THERE A RELATIONSHIP WITH THE SHIFT FROM SURGICAL CLIPPING TO ENDOVASCULAR REPAIR OF ANEURYSMS?

A.M. Buunk ¹, J.M. Spikman¹, R.JM. Groen²

¹University Medical Center Groningen, Neurology, subdepartment Neuropsychology, Groningen, Netherlands, ²University Medical Center Groningen, Neurosurgery, Groningen, Netherlands

Background and aims: Historically, rupture and repair of anterior communicating artery (ACoA) aneurysms has been found to lead to the ‘ACoA syndrome’: severe memory loss, confabulation, and behavioural changes. However, in more recent studies, the existence of a distinct syndrome has been disputed. We aimed to investigate the ACoA syndrome, by combining analyses of our own data with a systematic review of the literature.

Methods: As part of the ACoA syndrome, impairments in memory, executive functions and social cognition are expected. These neurocognitive functions were compared between patients with ACoA aneurysms and patients with aneurysms in other locations. Subsequently, a systematic review was performed in PubMed and Embase, including relevant studies on neurocognitive and behavioural consequences of ACoA aneurysms, from the 1960s until 2021.

Results: Regarding our own data, no significant differences were found in neurocognitive functions between the ACoA and non-ACoA group. The systematic review showed evidence for the ACoA syndrome in the majority of studies between the 1960s and 2000. From 2000 onwards, several studies directly compared patients with ACoA aneurysms and other aneurysms, finding no differences in neurocognitive functioning.

Conclusions: We hypothesize that the neurosurgical clipping of ACoA aneurysms could be related to the symptoms of the ACoA syndrome. This is based on the temporal co-occurrence of two phenomena since 2000: (1) in recent studies, including analysis of our own data, no evidence for a specific neurocognitive profile linked to ACoA aneurysms is found, and (2) the rise of endovascular occlusion as the treatment of choice.

Disclosure: No

P0665 / 1474

CLINICAL RELEVANCE OF INTRACRANIAL BRAIN VOLUMES CHANGES AFTER SPONTANEOUS SUBARACHNOID HEMORRHAGE: A LONGITUDINAL SYNTHETIC MRI STUDY

D. Santana ¹, L. Llull¹, R. Torné², A. Renú¹, X. Urra¹, S. Rudilosso¹, A. Rodríguez¹, R. Mellado³, Á. Chamorro¹, C. Laredo⁴, S. Amaro¹

¹Hospital Clínic de Barcelona, Neurology, Barcelona, Spain, ²Hospital Clínic de Barcelona, Neurosurgery, Barcelona, Spain, ³Hospital Clínic de Barcelona, Anesthesiology, Barcelona, Spain, ⁴Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Magnetic Resonance Imaging Core Facility, Barcelona, Spain

Background and aims: Spontaneous aneurysmal subarachnoid hemorrhage (SAH) induces diffuse brain damage including initial global cerebral edema and delayed volume loss. We aimed to evaluate the clinical relevance of longitudinal brain volume changes after SAH.

Methods: Forty-seven SAH patients (median age 54, 81% WFNS I-III, 53% mFisher 4) evaluated longitudinally through Synthetic-MRI (SyMRI) within 5+/-2 days (T0) and at 90 days (T90) after bleeding were included in the analysis. SyMRI allowed the automatic extraction of intracranial volumes, including brain parenchyma fraction (BPF), gray matter fraction (GMF), white matter fraction (WMF) and myelin fraction (MyF). Volume measures were normalized by intracranial volume ad expressed as % of change from T1 to T90. Poor clinical outcome was defined as a modified Rankin Scale score >2 at 90 days.

Results: In multivariate regression models adjusted by confounders (age, sex, WFNS, mFisher score and aneurysm size), poor clinical outcome was associated with volume reductions of BPF (aOR=0.702, 95%CI=0.514-0.958, p=0.026) and GMF (aOR=0.832, 95%CI=0.697-9.993, p=0.042), while changes in WMF or MyF were not associated with clinical outcome. BPF volume reduction from T1 to T90 was associated with older age, higher initial WFNS and greater aneurysm size.

Conclusions: Older age and higher initial severity were associated with global brain volume reduction from the acute phase to 90 days after bleeding. Poorer clinical outcome was significantly associated with reduction of global and gray matter brain volumes. These results support the role of global brain volumetric measures as potential neuroimaging surrogate biomarkers in SAH.

Disclosure: No

COGNITION AND VASCULAR COGNITIVE IMPAIRMENT

P0666 / 1447

TIME OF REPERFUSION AND COGNITIVE FUNCTION

J. Costa Novo ¹, E. Rieffel², G. Coca Velarde³, P. Barros¹, M. Veloso¹, H. Costa¹, L. Paredes⁴, T. Gregório⁴, V. Battistella¹

¹Vila Nova de Gaia/Espinho Hospital Centre, Neurology, Vila Nova de Gaia, Portugal, ²Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil, ³Fluminense Federal University, Niteroi, Brazil, ⁴Vila Nova de Gaia/Espinho Hospital Centre, Internal Medicine, Vila Nova de Gaia, Portugal

Background and aims: Cognitive changes that result from cerebrovascular disease contribute to a poor functional outcome with reduced quality of life and greater dependence. Some studies suggest that the cognitive and psychological dysfunction after stroke tends to improve in the first few months but then remains stable over the long term. Among patients undergoing mechanical thrombectomy (MT), to our knowledge, there are no comparative studies that assess cognitive outcomes according to the degree and time of reperfusion.

We aim to assess cognitive function and evaluate the impact of reperfusion time and extent of ischemic injuries in cognitive performance. We postulate that speed treatment in the acute phase of stroke could influence cognitive outcome.

Methods: We evaluated patients with right anterior circulation strokes that underwent MT between January 2018 and August 2020. Cognitive evaluation was assessed using the modified Addenbrooke Cognitive Rating scale. Statistical analysis will be performed with T-student test or Wilcoxon/Mann Whitney test depending on the numerical variable distribution for the two-group comparison. Fisher’s Exact Test will be used for categorical variables association. The level of significance adopted will be 0.05.

Results: The study is still ongoing and up to now forty-five patients were included. The final data will be available in two weeks. Data presentation will include baseline characteristics, acute stroke treatment (intravenous thrombolysis, reperfusion score, time between symptom and vascular recanalization), neuroimaging evaluation and adjusted cognitive outcomes.

Conclusions: Final results will be available in two weeks and will be presented at the conference.

Disclosure: No

P0667 / 636

ASSOCIATION BETWEEN COGNITIVE FUNCTION EARLY AFTER STROKE AND SUBJECTIVE COGNITIVE COMPLAINT THREE MONTHS LATER

A. Zanin¹, M. Reinholdsson^2,3, T. Abzhandadze ^2,3

¹University of Padua, Padua, Italy, ²University of Gothenburg, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine, Gothenburg, Sweden, ³Sahlgrenska University Hospital, Department of Occupational Therapy and Physiotherapy, Gothenburg, Sweden

Background and aims: Cognitive deficits are common after stroke, and they have been linked with later cognitive decline and dementia. Subjective cognitive complaints have been identified as a further risk factor for post-stroke dementia. The aim was to study if cognitive function screened early after stroke could predict self-reported cognitive difficulties three months after stroke.

Methods: Data were retrieved from three Swedish registers between November 2014 – June 2019. Cognitive screening at acute stroke units was performed using the Montreal Cognitive Assessment (MoCA, ⩾ 26 indicated intact cognition). Information about subjective cognitive complaints was retrieved from a three months follow-up questionnaire. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS, ⩽ 3 indicated minor stroke). Binary logistic regression analyses were performed.

Results: A total of 1969 patients were included in the study (median age, 73 [range 20-99] years; male, 58.6%). Of the patients, 40% had intact cognition as screened at acute stroke units and 37% reported at least one subjective cognitive complaint. Intact cognition during the acute and sub-acute phases of stroke was associated with lower odds of experiencing a subjective cognitive complaints three months after stroke (odds ratio 0.74, 95% confidence interval 0.61 - 0.91, p = 0.004). This effect remained unchanged regardless of age and stroke severity.

Conclusions: Cognitive function early after stroke was associated with subjective cognitive complaint three months post-stroke. Cognitive screening should be done routinely in stroke units to identify patients at risk of future cognitive decline.

Disclosure: No

P0668 / 1514

NEUROVASCULAR COUPLING IMPAIRMENT IS ASSOCIATED WITH LOWER PERFORMANCE IN LANGUAGE-RELATED SUBCATEGORY OF COGNITIVE FUNCTION AT 90 DAYS-AFTER STROKE

J. Ferreira ¹, F. Alves², A. Aires^1,3, P. Castro-Chaves^4,5, L. Fonseca⁶, E. Azevedo^1,3, P. Castro^1,3

¹Faculty of Medicine of University of Porto, Porto, Portugal, UnIC@RISE, Department of Clinical Neurosciences and Mental Health, Porto, Portugal, ²Faculty of Medicine of the University of Porto, Porto, Portugal, Porto, Portugal, ³Centro Hospitalar Universitário São João, Neurology, Porto, Portugal, ⁴Faculty of Medicine of the University of Porto, Porto, Portugal, UnIC@RISE, Department of Surgery and Physiology, Porto, Portugal, ⁵Centro Hospitalar Universitário São João, Internal Medicine, Porto, Portugal, ⁶Centro Hospitalar Universitário São João, Porto, Portugal, Internal Medicine, Porto, Portugal

Background and aims: Impairment of the neurovascular coupling (NVC) was found to be crucial in the development of dementia in several animal models. Whether this can explain the cognitive impairment (CIM) post stroke is not well studied. We aimed to determine if NVC status at 90 days after stroke correlates with cognitive performance.

Methods: In a cross-sectional analysis of a prospective study that included ischemic stroke with occlusion in anterior circulation, with Modified Rankin Score (mRS)⩽4 and without dementia. Cerebral blood flow (CBFV) was assessed by transcranial Doppler at both P2 segment of the posterior cerebral artery secured by a probe-holder. NVC was determined by the peak relative increase in CBFV during a visual stimulus paradigm that consisted in 5 cycles (20-sec stimuli, 20-sec resting) of a checkerboard inversion. CIM was defined as of scoring at least 2 SD below the native language normative data for the Montreal Cognitive Assessment.

Results: We analyzed 78 patients. CIM were detected in 39 (50%). The magnitude of CBFV increase was not associated with a CIM (adjusted odds ratio 1.01, 95% CI 0.94–1.06, p=0.88) in a multivariate model. Although, impaired NVC is associated with lower performance in language-related subitem of cognitive function (multivariate Linear Regression 1.84, 95% CI, p=0.03).

Conclusions: NVC was not associated with global cognitive function within 90 days-after stroke, although is associated with lower performance in language-related subitem. The ongoing prospective study will aim to show in the NVC can be predictor for future CIM.

Disclosure: No

P0669 / 1094

DIFFUSION TENSOR IMAGING TO PREDICT VOXELWISE PROGRESSION OF LEUKOARAIOSIS IN CHRONIC STROKE PATIENTS

K.C. Kern ¹, C.B. Wright², R. Leigh³

¹NINDS, Stroke Branch, Bethesda, United States, ²NINDS, Division of Clinical Research, Bethesda, United States, ³Johns Hopkins University, Neurology, Baltimore, United States

Background: Progression of leukoaraiosis after stroke may herald post-stroke cognitive decline. White matter microstructural changes measured via diffusion tensor imaging (DTI) likely precede development of white matter hyperintense (WMH) lesions on FLAIR and may elucidate the pathophysiology of lesion progression.

Methods: Patients recruited at least 3 months after ischemic stroke underwent serial brain MRI over at least 1 year. T1 and FLAIR images were used to automatically segment WMH lesions for each timepoint. Timepoints were aligned to a midpoint space and baseline lesions were dilated by 2mm to create a lesion penumbra. Penumbra voxels were classified as progressing if they were segmented as new lesions and demonstrated increasing FLAIR signal intensity over time. Aligned DTI images included free water (FW) and FW-corrected fractional anisotropy (FA-tissue) and mean diffusivity (MD-tissue). Logistic regression and area under the ROC curve (AUC) were used to test whether baseline DTI metrics predicted voxelwise lesion progression.

Results: For 13 patients imaged over 1 to 2 years (mean age 73 years, 38% female), we detected mean lesion growth of 1.9 mL. Each baseline DTI metric was associated with lesion progression, but FW had the greatest mean AUC (0.79±0.05) and the greatest AUC for all subjects’ pooled voxels (AUC=0.76). Baseline FLAIR intensity also predicted FLAIR progression (AUC=0.84), but adding FW augmented the discriminatory performance (AUC=0.86, Wald p<0.0001).

Conclusions: Elevated baseline white matter FW is associated with FLAIR lesion progression over the next year. These results implicate FW accumulation in the pathophysiology of WMH lesion development.

Disclosure: No

P0670 / 1239

COGNITIVE TESTING FOLLOWING TRANSIENT ISCHAEMIC ATTACK: A SYSTEMATIC REVIEW OF CLINICAL ASSESSMENT TOOLS

T. Chithiramohan ¹, A. Hammant², L. Beishon¹

¹University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom, ²University of Leicester, Leicester, United Kingdom

Background and aims: Cognitive deficits are prevalent after transient ischaemic attack (TIA) and result in loss of function, poorer quality of life and increased risk of dependency and mortality. This systematic review aimed to synthesise the available evidence on cognitive assessment in TIA populations to determine the prevalence of cognitive deficits, and the optimal tests for cognitive assessment.

Methods: Medline, Embase, PsychINFO and CINAHL databases were searched. Articles were screened on title, abstract and full texts and quality assessment was performed using the National Institute of Health Tool. Data were extracted on study characteristics, prevalence of TIA deficits, and key study findings. Due to significant heterogeneity, meta-analysis was not performed.

Results: Twenty-five full text articles met the inclusion criteria. There was significant heterogeneity in terms of the cognitive test used, definition of cognitive impairment and TIA, time point post-event, and analysis methods. Most studies used the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) (n=23). Prevalence of cognitive impairment ranged from 2-100%, depending on the time-point and cognitive domain studied. The MoCA was more sensitive than the MMSE for cognitive deficits. Deficits were common in executive function, attention, and language. No studies assessed diagnostic test accuracy against a reference standard diagnosis of cognitive impairment.

Conclusions: In conclusion, recommendation on cognitive tests in TIA is hampered by significant heterogeneity between studies, as well as a lack of diagnostic test accuracy studies. Future research should focus on harmonising tools, definitions, and time-points, and validating tools specifically for the TIA population.

Disclosure: No

P0671 / 1325

USING MEMTRAX MEMORY TEST TO DETECT POST-STROKE COGNITIVE IMPAIRMENT AFTER ISCHEMIC STROKE

X. Liu ^1,2, J. Zhang³, M.F. Bergeron⁴, J.W. Ashford^5,6, X. Zhou⁷, L. Zhong^1,2, X. Zhao¹, X. Chen⁸

¹The First Affiliated Hospital of Kunming Medical University, Department of Neurology, Kunming, China, ²Yunnan Provincial Clinical Research Center for Neurological diseases, Kunming, China, ³Bothwin Clinical Study Consultant, Shanghai, China, ⁴SIVOTEC Analytics, Boca Raton, United States, ⁵War Related Illness and Injury Study Center, Palo Alto, United States, ⁶Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, United States, ⁷SJN Biomed Ltd., Kunming, China, ⁸The First Affiliated Hospital of Dali University, Department of Neurology, Dali, China

Background and aims: Whereas the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s cognitive examination-revised (ACE-R) are the tests for the traditional detection of post-stroke cognitive impairment (PSCI), these instruments take an undue time to administer and do not assess highly relevant cognitive processing speed. Thus, a shorter valid PSCI assessment instrument with cognitive processing speed measured is urgently in demand. We aimed to find out whether the MemTrax (MTx) memory test could be validated and practical for this purpose.

Methods: A cross-sectional study was designed.All subjects were MRI-confirmed acute ischemic stroke. Patients who met the criteria for vascular cognitive disorders (VASCOG Statement 2014) at the point of 90-day follow-up were diagnosed as PSCI.

Results: Among 104 participants, 60 were diagnosed as PSCI. MTx-%C (percent correct) was significantly lower in the PSCI group than the non-PSCI group (P<0.001). The optimized cut-off point was 78%, with 90.0% of sensitivity and 84.1% of specificity. Moreover, the area under curve (AUC) was 0.919. MTx-RT (response time) was significantly longer in the PSCI group as compared to the non-PSCI group (P<0.001). The composite score (MTx-Cp = MTx-%CÐ1/ MTx-RT ) was significantly lower in the PSCI group than the non-PSCI group (P<0.001). Using 46.3 as a cut-off point, the sensitivity and specificity of distinguishing PSCI from non-PSCI were 80.0% and 93.2% with an AUC of 0.925.

Conclusions: With an implementation time of only 5 minutes or less, the MemTrax memory test is a viable and potentially valuable tool in screening for PSCI among AIS patients.

Disclosure: No

P0672 / 581

GLOBAL VARIATION IN TESTS OF COGNITIVE AND PHYSICAL FUNCTION: ANALYSIS OF SIX INTERNATIONAL RANDOMIZED CONTROLLED TRIALS OF CARDIOVASCULAR INTERVENTIONS

A. Katsanos ¹, S.F. Lee¹, T. Cukierman-Yaffe², L. Sherlock³, G. Muniz-Terrera³, M. Canavan⁴, R. Joundi¹, M. Sharma¹, A. Shoamanesh¹, A. Derix⁵, H. Gerstein¹, S. Yusuf¹, M. O’Donnell⁴, J. Bosch¹, W. Whiteley³

¹McMaster University, Hamilton, Canada, ²Tel Aviv University, Tel Aviv, Israel, ³University of Edinburgh, Edinburgh, United Kingdom, ⁴National University of Ireland, Galway, Ireland, ⁵Bayer Pharmaceuticals, Leverkusen, Germany

Background and aims: Better understanding of global variation in simple tests of cognition and function in older adults would aid the delivery and interpretation of multi-national studies of the prevention of dementia and functional decline.

Methods: In six RCTs that measured cognition with the Mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), and instrumental activities of daily living (IADL) with the Standardised Assessment of Everyday Global Activities (SAGEA), we estimated average scores by global region with multilevel mixed-effects models. We estimated the proportion of participants with cognitive or functional impairment with previously defined thresholds (MMSE⩽24 or MoCA⩽25, SAGEA⩽7), and with a country-standardised z-score threshold of cognitive or functional score of ⩽1.

Results: In 91,396 participants (mean age 66.6 years [SD 7.8], 31% females) from seven world regions, all global regions differed significantly in estimated cognitive function (z-score differences 0.11–0.45, p<0.001) after accounting for individual-level factors, centre and study. After country standardization the between-region differences were small (all z score differences <0.15, p>0.015).

In different regions, the proportion of trial participants with MMSE⩽24 or MoCA⩽25 ranged from 23–36%; the proportion below a country-standardised z-score threshold of ⩽1 ranged from 10–14%.

The differences in prevalence of impaired IADL (SAGEA⩽7) ranged from 2–6% and by country-standardised thresholds from 3–6%.

Conclusions: Accounting for country-level factors reduced large differences between world regions in estimates of cognitive impairment. Measures of IADL were less variable across world regions, and could give better estimates of dementia prevalence.

Disclosure: No

P0673 / 1493

VALIDATION OF THE OXFORD COGNITIVE SCREEN-PLUS IN SUBACUTE AND CHRONIC STROKE

S. Webb¹, R. Roberts¹, E.G. Chiu¹, G. Hobden¹, S. King², E. Garratt², N. Demeyere ¹

¹University of Oxford, Oxford, United Kingdom, ²Oxford Health NHS Foundation Trust, Oxfordshire Stroke Rehabilitation Unit, Abingdon, United Kingdom

Background and aims: Stroke survivors are routinely screened for cognitive impairment with screening tools which often fail to detect subtle impairments. The Oxford Cognitive Screen – Plus (OCS-Plus) is a brief computer tablet-based screening tool designed to detect more subtle impairments. Here, we examine its psychometric properties in stroke.

Methods: 300 stroke survivors from two in-patient stroke units in the UK were recruited, and a subset was followed up at 6-months post-stroke. All participants completed the OCS and OCS-Plus. A subset additionally completed the Montreal Cognitive Assessment (MoCA), and further format- and construct-matched neuropsychological tests. Due to the tablet-based format, OCS-Plus provides standardised assessment for non-specialist administration and automatic real time impairment classification against a matched normative set. [s1]

Results: Incidence of cognitive impairment was higher in subacute stroke survivors compared to chronic stroke survivors, with the highest rates of impairment found for visuospatial and executive subtests. We provide sensitivity and specificity for each of the subtests in the OCS-Plus screen compared to neuropsychological test performance. Notably, many of those who were unimpaired on the MoCA and Oxford Cognitive Screen, demonstrated impairment on neuropsychological testing and OCS-Plus screening. Construct validity criteria were met and exceeded the psychometric findings in healthy control data.

Conclusion: The OCS-Plus is a valid cognitive screening tool for use in stroke. OCS-Plus is able to detect subtle cognitive impairment at a similar level to neuropsychological assessment.

Disclosure: No

P0674 / 537

CAUSAL EVIDENCE FOR TASK REGULATION BY ANTERIOR CINGULATE CORTEX: AN EXPERIMENTAL PROSPECTIVE STUDY IN PATIENTS WITH STROKE IN THE FRONTAL LOBE

J. Oerlemans ¹, R. Alejandro², D. Hemelsoet¹, P. Boon¹,C. Holroyd², V. De Herdt¹

¹University Hospital Ghent, Department of Neurology, Gent, Belgium, ²University of Ghent, Department of Experimental Psychology, Gent, Belgium

Background and aims: The number of stroke survivors is increasing, which means an increasing number of patients that experience stroke sequelae in daily life and that have a higher risk of developing post-stroke mood disorders. The anterior cingulate cortex (ACC) is responsible for task regulation and control over other neural networks in the prefrontal cortex; ACC dysfunction may be implicated in the development of neuropsychological disorders post-stroke.

The aim of this study is to:

(1) provide evidence of the causal role for task regulation of ACC by demonstrating that its functions are affected by ACC damage and

(2) investigate the contribution of ACC dysfunction to the development of neuropsychological disorders, in patients with stroke in the frontal lobe.

Methods: We aim to recruit 200 patients with a stroke in the frontal lobe (both ischemic or haemorrhagic) at Ghent University Hospital, Belgium. Participants will perform two behavioural tasks and fill in questionnaires gauging for apathy and/or depression. We will collect behavioural data, EEG-data and the results of the questionnaires, and use statistical techniques including event-related brain potential (ERP) analysis and voxel-based lesion symptom mapping (VSLM) to compare the data between patients with ACC lesions and patients with lesions in other parts of the frontal lobe.

Results: We have currently recruited 20 patients; mean age 59.8 (±16,83) years, 10 female. Analysis and recruitment are ongoing: methodology and preliminary results of the VLSM (including lesion overlap map) and ERP-analysis will be presented at the congress.

Disclosure: No

P0675 / 321

EFFECT OF CAROTID ARTERY STENTING ON COGNITIVE FUNCTION IN PATIENTS WITH CAROTID ARTERY STENOSIS IN A SAMPLE OF EGYPTIAN PATIENTS

A. El Zayat ¹

¹ Nasser Institute, Neurology, Cairo, Egypt

Background: Carotid artery stenosis(CAS) caused by atherosclerosis is an independent risk factor for cerebral ischemia and has also been associated with impaired cognitive function. It is reasonable to assume that treatment strategies targeting the improvement of the carotid artery stenosis may be effective for delaying the progression of cognitive impairment in patients with carotid stenosis.

Objective: To investigate the effect of carotid artery stenting on neurocognitive function in patients with CAS.

Methods: This prospe.ctive study was conducted on 45 patients with CAS who suffered also from cognitive impairment examined in the outpatient clinic and the Department of Neurology, Al-Azhar University Hospitals and Nasser Institute from August2018 to February2020.

Results: The patients in the two groups did not differ with regard to baseline characteristics, educational level, vascular risk factors and neuropsychological examinations prior to therapy. There has been significant improvement in the total Montreal Cognitive Assessment score in both stent group and control group after 3 months. Regarding the MMSE, there has been significant improvement in the stent group only, while the improvement was not significant in the control group. There has been significant improvement in the stent group compared to the control group in MoCA percentage of change. There has been significant improvement in the visuoexecutive domain only. On the other hand, the percentage of change in the other cognitive domains improved but insignificantly.

Conclusion: Our results indicated that 3 months after the procedure, carotid artery stenting was associated with significant improvement in cognitive function in patients with carotid stenosis.

Groups
Parameters	Stent (n=25)	Control (n=20)	P value
Gender
Male	14 (56%)	13 (65%)	0.540
Female	11 (44%)	7 (35%)
Age	65.1 ± 8	65.6 ± 5.4	0.863
Risk factors
HTN	18 (72%)	14 (70%)	0.883
Diabetic	13 (52%)	12 (60%)	0.592
Smoker	11 (44%)	12 (60%)	0.286
Dyslipidemia	10 (40%)	8 (40%)	1.000
No of Risk factors
1	5 (20%)	4 (20%)	0.855
2	12 (48%)	8 (40%)
3	7 (28%)	6 (30%)
4	1 (4%)	2 (10%)
Education level
> 6yr education	19 (76%)	16 (80%)	1.000
< 6yr education	6 (24%)	4 (20%)
Degree of stenosis
Moderate (50%-69%)	12 (48%)	11 (55%)	0.641
Severe (70%-99%)	13 (52%)	9 (45%)
Location
Left	15 (60%)	11 (55%)	0.736
Right	10 (40%)	9 (45%)

Disclosure: No

P0676 / 859

SELF-REPORTED COGNITIVE AND EMOTIONAL FUNCTIONING AT 3 MONTHS PREDICTS DAYTIME SLEEP AND FATIGUE 12 MONTHS AFTER ISCHEMIC STROKE: A STRUCTURAL EQUATION MODELLING ANALYSIS

E. Kliem ^1,2, A. Labberton³, M. Barra^2,4, E. Gjestad^1,5, A. Olsen^6,1, B. Thommessen⁷, B. Indredavik^8,9, R. Grambaite^1,2

¹Norwegian University of Science and Technology, Department of Psychology, Trondheim, Norway, ²Akershus University Hospital HF, The Health Services Research Unit – HØKH, Lørenskog, Norway, ³Norwegian Institute of Public Health, Division for Health Services, Oslo, Norway, ⁴University of Bergen, BCEPS, Bergen, Norway, ⁵Trondheim University Hospital, Clinic of Medicine, Trondheim, Norway, ⁶Trondheim University Hospital, Department of Physical Medicine and Rehabilitation, Trondheim, Norway, ⁷Akershus University Hospital HF, Department of Neurology, Lørenskog, Norway, ⁸Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, Trondheim, Norway, ⁹Trondheim University Hospital, Department of Medicine, Stroke Unit, Trondheim, Norway

Background and aims: Post-stroke fatigue and daytime sleep are common, multidimensional, burdensome, and insufficiently understood sequelae. We studied their relationships with self-reported cognition and emotional symptoms.

Methods: Ischemic stroke patients without reported history of dementia or depression completed postal surveys 3- and 12-months post-stroke. Compared to pre-stroke, self-reported changes in cognition (concentration/memory) and fatigue were classified dichotomously (worsened vs. improved/unchanged), and increased daytime sleep ordinally (no/unsure/yes). Post-stroke emotional symptoms were assessed with the Hospital Anxiety and Depression Scale. We fitted five structural equation models: An integrated model where cognition (C) and emotional symptoms (E) at 3 months predict both daytime sleep (D) and fatigue (F) at 12 months; two models where cognition or emotional symptoms predict daytime sleep or fatigue (CF-ED;CD-EF); and two models where cognition and emotional symptoms at 12 months mediate the relationship between these symptoms at 3 months and later daytime sleep and fatigue (CCF-EED;CCD-EEF). All models included age, sex, stroke severity (NIH Stroke Scale; NIHSS), and difficulties sleeping at night.

Results: Of 156 patients (NIHSS(mean±SD)=3.6±4.3, age=73.0±10.8, 41% female) 37.9% reported increased daytime sleep and 50.0% fatigue at 12 months. Model CD-EF and the integrated model showed good fit across four measures (RMSEA⩽.06;CFI/TLI⩾.95;p(χ²)>.05). For model CF-ED, only CFI/TLI indicated good fit. No mediation models were supported.

Conclusions: Self-reported cognition and emotional symptoms at 3 months predict increased daytime sleep and fatigue at 12 months. This highlights the relevance of monitoring these stroke sequalae for opportunities to counter lingering impairment in daytime functioning.

Disclosure: No

P0677 / 845

COGNITIVE PHENOTYPES AND FACTORS ASSOCIATED WITH COGNITIVE DECLINE IN A COHORT OF ELDERLY PATIENTS WITH ATRIAL FIBRILLATION. THE STRAT-AF STUDY

E. Salvadori ¹, C. Barbato¹, B. Formelli¹, E. Barucci¹, F. Pescini², F. Cesari³, B. Giusti³, A.M. Gori³, E. Fainardi⁴, R. Marcucci³, A. Poggesi¹

¹University of Florence, NEUROFARBA Department, Florence, Italy, ²Azienda Ospedaliera Universitaria Careggi, Stroke Unit, Florence, Italy, ³Azienda Ospedaliera Universitaria Careggi, Atherothromobotic Disease Centre, Florence, Italy, ⁴Azienda Ospedaliera Universitaria Careggi, Neuroradiology Department, Florence, Italy

Background and aims: Knowledge gaps exist regarding cognitive consequences of atrial fibrillation (AF) beyond stroke. This study aims to assess in elderly AF patients the presence of distinctive cognitive phenotypes, the prevalence and progression of cognitive impairment according to clinical criteria, and their association with clinical and neuroimaging characteristics.

Methods: STRAT-AF (STRATifying cerebral bleeding risk in Atrial Fibrillation) is a prospective, observational study enrolling ⩾65 years old AF patients on oral anticoagulants. Baseline evaluation included a comprehensive clinical, functional, and neuropsychological assessment and brain MR. At baseline cognitive profiles were identified with cluster analysis. At follow-up, cognitive decline was defined as a worsening in at least 1 cognitive test.

Results: Considering 182 included patients (mean age 77.7±6.7 years, 63% males), 82 (45%) had cognitive impairment that was associated with lower education (p=.047), functional status (p=.001), and global cortical atrophy (p=.042). Cluster analysis created 3 groups: dysexecutive (n=32, 17%), amnestic (n=45, 25%), and normal (n=105, 58%). Dysexecutive group was older (p=.003) and had higher thromboembolic risk (p=.001), amnestic group had worse cognitive (p=.001) and functional (p=.001) abilities. Out of 128 followed-up patients (mean time-frame 17±2.2 months), 35 (27%) had cognitive decline, that was less frequent in normal group (12%) compared to dysexecutive (45%) and amnestic (55%) (p<.001).

Conclusions: In our cohort of elderly AF patients, both dysexecutive and amnestic cognitive phenotypes emerged and seemed associated with different clinical profiles, without an evident role of neuroimaging characteristics. Further efforts are needed to clarify mechanisms subsiding the relation between AF and cognitive impairment.

Disclosure: No

P0678 / 300

STRATEGIC WHITE MATTER HYPERINTENSITY LOCATIONS FOR COGNITIVE IMPAIRMENT IN COMMUNITY-DWELLING INDIVIDUALS: RATIONALE AND DESIGN OF THE META VCI MAP STUDY

F.A.S. de Kort ¹, J.M. Biesbroek¹, Meta VCI Map Consortium

¹ UMC Utrecht, Neurology, Utrecht, Netherlands

Background: White matter hyperintensities (WMH) are a major cause of cognitive impairment. Location of WMH is likely to be a stronger determinant for cognitive impairment than total WMH burden. However, a comprehensive map of strategic WMH locations for cognitive impairment in nondemented community-dwelling individuals, and corresponding normative data, is currently lacking.

Aims: To obtain normative data for total and tract specific WMH volumes per decade and to identify strategic white matter regions where WMH are most strongly associated with cognitive performance in nondemented community-dwelling individuals.

Methods: We will harmonize individual person data from 16 cohorts (estimated total of 20,000 participants), through the Meta VCI Map consortium (www.metavcimap.org). WMH maps are registered to the MNI-152 template and are used to derive normative data on total and white matter tract-specific WMH volumes per decade. Subsequent steps will include voxel-based lesion-symptom mapping (including voxels affected by WMH in ⩾5 persons) and region of interest-based analyses to identify strategic white matter locations for cognitive impairment.

Preliminary results: Image processing is completed for 7 cohorts, comprising a total of 7328 participants. In this merged study sample, 63,7% of white matter voxels was affected by WMH in ⩾5 persons (figure 1).

Conclusions: This study will identify white matter regions where WMH are most strongly associated with cognitive impairment and provide age-related normative data on burden and location of WMH. These results will enable an individualized approach to interpreting WMH burden and location in relation to cognitive complaints in clinical practice.

Disclosure: No

P0679 / 1279

EFFICACY OF SEQUENTIAL DI-3-N-BUTYLPHTHALIDE THERAPY FOR PREVENTING POST-STROKE COGNITIVE IMPAIRMENT IN PATIENTS WITH ACUTE ISCHEMIC STROKE

X. Liu ^1,2, J. Zhang³, L. Zhong^1,2, X. Zhao¹, X. Chen⁴

¹The First Affiliated Hospital of Kunming Medical University, Department of Neurology, Kunming, China, ²Yunnan Provincial Clinical Research Center for Neurological diseases, Kunming, China, ³Bothwin Clinical Study Consultant, Shanghai, China, ⁴The First Affiliated Hospital of Dali University, Department of Neurology, Dali, China

Background and aims: Cognitive impairment is common after stroke, which has dramatically affected patients’ quality of life and increased the risk of recurrence of stroke and mortality. This study aimed to evaluate whether the sequential DI-3-N-butylphthalide (DNBP) therapy in the acute phase of acute ischemic stroke(AIS) can preventing post-stroke cognitive impairment (PSCI) in the next three months.

Methods: This was a retrospective cohort. Patients who had AIS treated in our hospital from January 2020 to December 2020 were recruited. The primary outcome was the incidence of PSCI at day 90. Logistic regression was performed to detect those independent risk factors.

Results: A total of 104 patients (65.61±11.67 years old) who had AIS were enrolled. Among these patients, 47 were treated with DNBP while another 57 were not. Univariate analysis showed several variables were statistically significant for the PSCI outcome including mental job (OR=0.45), sleep length (OR 4.57), treatment with DNBP (OR=0.21), baseline MoCA score (OR 0.20), baseline MemTrax correction (MTx-%C) (OR 0.25). Incidence of PSCI was 38.3% (18/47) in DNBP group and 65.9% (29/57) in Non-DNBP group.

Logistic regression showed that the presence of education (OR 0.362, 95% CI 0.142~0.921, p=0.033), number of cerebral infarction (OR 4.031, 95% CI 1.189~13.664, p=0.025), treatment of DNBP (OR 0.078, 95% CI 0.020~0.303, p<0.001), and baseline MTx-%C (OR 0.156, 95% CI 0.042~0.608, p=0.007) were significantly associated with the incidence of PSCI.

Conclusion: The results of our study indicated that patients with AIS who treated with DNBP may reduce the incidence of PSCI.

Disclosure: No

P0680 / 157

PEAK WIDTH OF SKELETONIZED MEAN DIFFUSIVITY AND ITS ASSOCIATION WITH GLOBAL COGNITION AFTER MILD STROKE

A.C.C. Jochems ¹, S. Muñoz Maniega¹, U. Clancy¹, D. Jaime Garcia¹, F.M. Chappell¹, S. Wiseman¹, O.K.L. Hamilton¹, R. Brown¹, E.V. Backhouse¹, C. Arteaga¹, W. Hewins¹, A. Kampaite¹, M.E. Bastin¹, M. del C. Valdés Hernández¹, F.N. Doubal¹, J.M. Wardlaw¹

¹ Centre for Clinical Brain Sciences, UK Dementia Research Institute at University of Edinburgh, Edinburgh, United Kingdom

Background and aims: Peak-width of skeletonized mean diffusivity (PSMD, http://www.psmd-marker.com) is an MRI marker of cerebral small vessel disease (SVD). SVD is associated with cognitive impairment, stroke and dementia. We aimed to investigate the relationships between PSMD and cognition after mild stroke.

Methods: Patients with mild lacunar or cortical stroke underwent MRI and cognitive assessments within 3 months after stroke and at 1-year, in an ongoing study. We ran linear regressions cross-sectionally at baseline and 1-year of PSMD with global cognition (Montreal Cognitive Assessment; MoCA), adjusted for age, sex, premorbid IQ, stroke severity (National Institutes of Health Stroke Scale) and disability (modified Rankin Score).

Results: We included 93 participants; mean age at baseline 67.6 (SD 9.7); 32% female; mean MoCA score 24.1 (SD 3.4). At baseline, MoCA was not associated with PSMD (β=-0.022, 95%CI -0.209,0.165, p=0.817). Lower MoCA scores were associated with lower premorbid IQ (β=0.506, 95%CI 0.338, 0.674, p<0.001), older age (β=-0.291, 95%CI -0.478,-0.103, p=0.003), and worse NIHSS (β=-0.286, 95%CI -0.467,-0.104, p=0.002). At 1-year, MoCA remained strongly associated with premorbid IQ (β= 0.449, 95%CI 0.276,0.622, p<0.001) and age (β=-0.224, 95%CI -0.419,-0.030, p=0.025), with weak evidence that an association with PSMD might be emerging (β=-0.171, 95%CI -0.374,0.033 higher PSMD per 1-point MoCA decrease, p=0.100).

Conclusions: PSMD may become more associated with global cognition at 1-year after stroke, possibly once acute effects have settled down. Future work, with larger sample sizes, could look at longitudinal associations, specific cognitive domains and disability after stroke, as cognition is closely related to disability.

Disclosure: No

P0681 / 1177

IDENTIFYING NEUROCOGNITIVE DISORDER AFTER STROKE: RESEARCH DIAGNOSTIC CRITERIA VERSUS CLINICAL DIAGNOSIS

E. Gjestad ^1,2, S. Aam^3,4, R. Munthe-Kaas^5,6, I. Saltvedt^3,4, E. Kliem¹, J. Saltyte Benth^6,7, L. Bielauskas⁸, T. Ryum¹, R. Sakshaug Eldholm^3,4, R. Grambaite^1,2,7

¹Norwegian University of Science and Technology, Department of Psychology, Trondheim, Norway, ²St. Olav University Hospital, Clinic of Medicine, Trondheim, Norway, ³Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, Trondheim, Norway, ⁴St. Olav University Hospital, Department of Geriatrics, Trondheim, Norway, ⁵Bærum Hospital, Vestre Viken Hospital Trust, Department of Medicine, Drammen, Norway, ⁶University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ⁷Akershus University Hospital, Health Services Research Unit (HØKH), Lørenskog, Norway, ⁸Michigan Medicine, Neuropsychology Section of Psychiatry, Ann Arbor, United States

Background and aims: Diagnostic procedures and prevalence of post-stroke dementia vary among studies. Three models for research diagnostics, aiming to identify neurocognitive disorder (NCD), were described in our previous study: Model A (cognitive tests), B (cognitive tests and functional measures) and C (the Global Deterioration Scale). We aimed to examine the accuracy of the research diagnoses by comparing them to a clinical diagnosis.

Methods: Participants of the Nor-COAST study were examined three years post-stroke. The procedure for research diagnostics was the same as in our previous publication. In addition, a neuropsychological examination consisting of cognitive, emotional and functional measures was employed. Each cognitive domain was assessed with at least two tests. Clinical diagnoses (normal cognition, mild and major NCD) were determined by a group of clinical psychologists. Agreement between the diagnoses was assessed by Cohen’s kappa.

Results: 29 patients (age (Mean±SD)=67.8±10.5, Modified Rankin Scale=1.0±1.0, National Institutes of Health Stroke Scale=0.6±1.4, 24% female) were included. Agreement between clinical diagnosis and models A and B was fair (kappa=0.37(95% CI 0.10-0.63) and 0.33(0.05-0.60)), while agreement between clinical diagnosis and model C was weak (kappa not different from zero).

Conclusions: Agreement between research-based and clinical diagnosis in classifying post-stroke NCD was rather low, however, it increased when including objective cognitive measures. Using cognitive tests may thus improve the diagnostic accuracy. Patients’ young age and mild stroke severity may bias results, and more research with more representative stroke samples is needed.

Disclosure: No

SMALL VESSEL DISEASE

P0682 / 1138

RELATIONSHIP BETWEEN EEG ALPHA-BAND OSCILLATIONS AND LANGUAGE, PROCESSING AND EXECUTIVE ABILITIES IN PATIENTS WITH CEREBRAL SMALL VESSEL DISEASES

L. Guan ¹, Y. Wang¹, M. Zhao¹, G. Hu¹

¹ Beijing Tiantan Hospital affiliated to Capital Medical University, Department of Neurology, Beijing, China

Background and aims: EEG alpha-band oscillations had cognitive significance in well described cognitive domains. However, specific parameters of EEG alpha-band oscillations have not been identified to indicate different cognitive function. We aimed to assess the relationship between EEG alpha-band oscillations and language, processing and executive impairment, as well as to identify the most useful parameter of EEG alpha-band oscillations in patients with cerebral small vessel disease (CSVD).

Methods: This is a cross-sectional study in which 76 patients were recruited. Static EEG alpha-band oscillations were analyzed by using dispersion of amplitude-frequency characteristics. Language, executive and processing abilities were evaluated by using Verbal Fluency Test (VFT) and Color Trails Test (CTT) respectively. Both linear and logistic regression as well as Spearman’s correlation were used to assess the relationship between EEG alpha-band oscillations and cognitive function.

Results: PFα(O1) and PFα(O2) were higher in high-counting groups than those in low-counting groups in Animal, Fruit, Vegetable and composite performance of VFT. After adjusting age and education, PFα(O1) still showed significant association with composite performance (OR=2.27, 95%CI: 1.02~5.03, p=0.044). Moreover, CTT-1 time, CTT-2 time and CTT-1 error were all significantly associated with PFα(O1), PFα(O2) and ΔPFα(O1;F3) (p values <0.5). After adjusting age and education, PFα(O1) was associated with CTT-1 time (β=-21.55, 95% CI: -33.49~-9.61; P<0.001) and CTT-1 error (β=0.4, 95% CI: 0.2~0.77; P=0.007).

Conclusions: EEG alpha-band oscillations were correlated with language ability, executive and processing abilities in patients with CSVD. Specific parameters of EEG alpha-band oscillations were identified to correspond to different cognitive function.

Disclosure: No

P0683 / 419

BRAIN WHITE MATTER HYPERINTENSITIES-PREDICTED AGE REFLECTS NEUROVASCULAR HEALTH IN MIDDLE-TO-OLD AGED SUBJECTS

C.-P. Chung ¹

¹ Taipei Veterans General Hospital, Neurological Institute, Taipei, Taiwan, Province of China

Background and aims: Age-related neurovascular structural and functional impairment is a major etiology of dementia and stroke in the elderly. There is no single marker representative of neurovascular age yet. This study aims to develop and validate a white matter hyperintensities (WMH)-based model for characterizing individuals’ neurovascular biological age.

Methods: In this prospective single-site study, the WMH-based age prediction model was constructed based on 491 healthy participants (21-89 years) using machine learning approach and then applied to a middle-to-old aged testing dataset (n = 726, 50-92 years) for external validation.

Results: In the training dataset, the constructed linear regression model with log-transformed WMH volumes showed well balanced complexity and accuracy (root mean squared error = 10.20 and mean absolute error = 2.80 years). The established brain age estimator also had comparable generalizability to the testing dataset (root mean squared error = 7.76 and mean absolute error = 6.38 years). In the testing dataset, the WMH-predicted age difference was negatively associated with visual executive function. Individuals with older predicted-age for their chronological age had greater cardiovascular burden, particularly hypertension, diabetes, and cardiovascular disease risks than individuals with normal or delayed predicted-age.

Conclusion: These findings support our WMH-based age measurement being able to reflect neurovascular health and having potential diagnostic and prognostic value for clinical or research purpose in age-related neurovascular disorders.

Disclosure: No

P0684 / 428

LONGTERM CHANGE OF WHITE MATTER HYPERINTENSITIES IN SPORADIC SMALL VESSEL DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS

A.C.C. Jochems ^1,2, C. Arteaga^1,2, T. Ritakari^1,2, M. Hooley³, F.M. Chappell¹, F.N. Doubal^1,2, S. Muñoz Maniega¹, J.M. Wardlaw^1,2

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²UK Dementia Research Institute at University of Edinburgh, Edinburgh, United Kingdom, ³University of Edinburgh, Centre for Discovery Brain Sciences, Edinburgh, United Kingdom

Background and aims: White matter hyperintensities (WMH) are the commonest imaging feature of small vessel disease (SVD) and increase poor clinical outcomes. Unlike WMH progression, WMH regression is rarely discussed. With this systematic review and meta-analysis, we aim to assess longitudinal intra-individual WMH volume changes in sporadic SVD.

Methods: We searched EMBASE and MEDLINE for studies reporting WMH volume changes using MRI on ⩾2 time-points in adults with sporadic SVD. Population groups (healthy/community-dwelling, stroke, cognitive, other vascular risk factors, depression) were determined from study characteristics. Meta-analyses included random-effects models to report mean WMH change (change in ml, % of intracranial volume [%ICV], or ml/year), 95%CI and prediction intervals (PI) using unadjusted data.

Results: We included 10,741 participants from 39 papers. Mean WMH volume increased over time by: 1.74 mL (95% CI 1.23, 2.26; PI -1.24, 4.73 mL; 27 papers, N=7411, mean time interval 2.7 years, SD=1.65); 0.25%ICV (95% CI 0.12, 0.38; PI -0.11, 0.62; 5 papers, N=880, mean time interval 3.0 years, SD=0.88); or 0.61 mL/year (95% CI 0.37, 0.85; PI -0.25, 1.46; 7 papers, N=2450). 13/39 papers specifically mentioned, and/or provided data, showing WMH regression. WMH regression varied, occurring in up to 1/3 of healthy/community-dwelling participants and stroke participants, and in some participants with Alzheimer’s disease.

Conclusions: On average, WMH volumes increase, but also regress in up to 1/3 of participants. WMH regression should not be dismissed. Research into underlying mechanisms, associated factors and clinical correlates is needed, as WMH regression could be an important intervention target.

Disclosure: No

P0685 / 1355

SUBCLINICAL SIGNS SUSPECT FOR INFLAMMATION ON MRI IN SPORADIC AND HEREDITARY CEREBRAL AMYLOID ANGIOPATHY

R. van der Zwet ¹, S. Voigt¹, E.A. Koemans¹, J. van Bergen¹, I. Rasing¹, K. Kaushik¹, E.S. van Etten¹, T.W. van Harten², M.J.P. van Osch², G.M. Terwindt¹, M.A.A. van Walderveen², M.J.H. Wermer¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Leiden University Medical Center, Radiology, Leiden, Netherlands

Background and aims: Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a rare, but treatable CAA phenotype. Recent studies suggest that mild or subclinical episodes of inflammation can occur, as demonstrated on MRI. We determined the frequency of subclinical MRI lesions suggestive of inflammation with no clinical signs or symptoms in sporadic CAA (sCAA) and Dutch-type hereditary CAA (D-CAA).

Methods: In this cross-sectional study, we included sCAA patients and D-CAA mutation carriers from our ongoing CAA natural history studies (AURORA and FOCAS) at the Leiden University Medical Center between 2018 and 2020. Absence of clinical symptoms was confirmed by an interview and neurological examination. 3-Tesla MRI scans were assessed for presence of asymmetric cortical-subcortical white matter hyperintensity (WMH) lesions on FLAIRimages suggestive of inflammation.

Results: We included 44 sCAA patients (mean age 73 years, 57% with a history of intracerebral hemorrhage (ICH)) and 46 D-CAA mutation carriers (mean age 50 years, 57% with a history of ICH). Two (5%, 95%CI: 1-14) sCAA patients and one (2%, 95%CI: 0-10) D-CAA mutation carrier had a cortical-subcortical WMH lesion that was suspected of inflammation. All lesions were <1cm and were located in the frontal or parietal lobes. One sCAA patient had multiple lesions and presented with lobar ICH in the same hemisphere as these lesions one week after MRI (figure 1).

Conclusions: Subclinical MRI lesions suggestive of inflammation are a rare radiological finding in sCAA and D-CAA. Even though these small lesions are subclinical with an unclear pathophysiological substrate, they might precede CAA-related intracerebral hemorrhage.

Disclosure: No

P0686 / 322

RISK FACTORS FOR WHITE MATTER HYPERINTENSITIES AND ITS LONG-TERM OUTCOME AFTER SPONTANEOUS INTRACEREBRAL HEMORRHAGE

Z. Li ¹, X. Wang¹, W. Wang¹, X. Zhao¹

¹ Beijing Tiantan Hospital, Neurology, Beijing, China

Background and objective: We aim to explore which factors are associated with extensive WMH in different regions, and whether they are associated with long-term functional outcomes in ICH patients.

Methods: We prospectively enrolled 306 consecutive spontaneous ICH patients who had brain magnetic resonance scans. We rated CSVD biomarkers including WMH, perivascular spaces (PVS), cerebral microbleeds (CMBs), and lacunes with validated visual rating scale. We analyzed the associations between WMH and clinical risk factors and one-year poor functional outcome after first-ever ICH by using logistic regression.

Results: Extensive periventricular WMH was appeared in 62 patients (20.3%), extensive deep WMH was presented in 151 patients (49.3%). After adjustment of confounders, factors associated with periventricular WMH included increasing age (OR, 1.09; 95%CI, 1.05 - 1.13), prior hypertension history (OR, 4.56; 95%CI, 1.62-12.81), high basal ganglia PVS degrees (OR, 2.31; 95%CI, 1.03- 5.18) and extensive deep WMH (OR, 16.06; 95%CI, 5.31- 48.59). Increasing age (OR, 1.04; 95%CI, 1.01-1.06), periventricular WMH (OR, 14.61; 95%CI, 4.93- 43.33), the presence of CMB (OR,1.89; 95%CI, 1.08-3.32) and lacunes (OR,1.93; 95%CI, 1.10-3.38) were independent predictors of increased deep WMH severity. However, neither periventricular WMH (OR,0.95 95% CI, 0.45-2.01) nor deep WMH (OR, 1.26; 95% CI, 0.66-2.39) was significantly associated with 1-year poor mRS after adjustment for potential confounding factors.

Conclusions: WMH has different risk factors in spontaneous ICH patients. The presence or burden of WMH was not significantly associated with one-year poor functional outcome after ICH in this cohort.

Table 1.

Univariable and multivariable associations for extensive periventricular WMH and extensive deep WMH.

Variables	Extensive periventricular (WMH Score=3)		Extensive deep WMH (Score⩾2)
	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Age	1.098 (1.066 - 1.130)	1.092 (1.053 - 1.133)	1.059 (1.038 – 1.081)	1.035 (1.012 – 1.059)
History of hypertension	2.94 (1.33-6.481)	4.56(1.62-12.809)	2.186 (1.295 – 3.690)	/
Prior cerebral infarction	2.683 (1.343 – 5.359)	/	3.204 (1.581 – 6.496)	/
DBP on admission	0.977 (0.960 – 0.995)	/	/	/
High BG PVS degree	5.076 (2.653 – 9.713)	2.310 (1.030 – 5.180)	4.150 (2.076 – 8.295)	/
Extensive deep WMH	23.543 (8.275 – 66.984)	16.056 (5.306 – 48.59)	/	/
Extensive periventricular WMH	/	/	23.543 (8.275 – 66.984)	14.607 (4.925 – 43.326)
Presence of CMBs	2.395 (1.329 – 4.315)	/	2.342 (1.480 – 3.704)	1.894 (1.082 – 3.318)
Presence of lacunes	3.226 (1.795 – 5.797)	/	2.871 (1.797 – 4.586)	1.927 (1.097 – 3.384)

Table 2.

Univariate and multivariate associations between WMH and 1year unfavorable function outcome after ICH.

Imaging variables	Unadjusted		Model1
	OR (95% CI)	P	OR (95% CI)	P
Total WMH	1.71(0.98-2.98)	0.057	0.71(0.62-8.10)	0.780
PeriventricularWMH (0-2 vs 3)	1.71(0.92-3.20)	0.090	0.95(0.45-2.01)	0.900
Deep WMH (0-1 vs 2-3)	1.85(1.06-3.23)	0.030	1.26(0.66-2.39)	0.480

Disclosure: No

P0687 / 982

LOW-FREQUENCY OSCILLATIONS IN RESTING-STATE BOLD FMRI DATA REFLECT VASCULAR DYSFUNCTION IN SMALL VESSEL DISEASE: A UK BIOBANK ANALYSIS

J. Thomas ¹, P. Jezzard², A. Webb¹

¹University of Oxford, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom, ²University of Oxford, Wellcome Centre for Integrative Neuroimaging, Oxford, United Kingdom

Background and aims: Understanding of the potentially causative relationship between endothelial dysfunction and cerebral small vessel disease (cSVD), manifest as white matter hyperintensities (WMHs), is limited by current assessment methods. We determined differences in low-frequency oscillations (LFOs) in UK Biobank participants with high versus low WMH.

Methods: Resting-state BOLD-fMRI sequences were pre-processed (MCFLIRT/high-pass filtered/spatially smoothed), de-meaned, normalised, and segmented by T1-derived tissue masks. LFOs were determined for cases (selected from the top decile of WMH) versus controls (low WMH) from Welch power spectra, with the area under the curve (AUC) of significant LFOs (p<0.05, 0.04-0.15Hz) identified by Monte Carlo permutation of each timeseries, and by the total amplitude of low frequency fluctuations (ALFF). Differences between high and low WMH groups were determined by linear models, with and without adjustment for age, gender, risk factors, and mean T2-BOLD signal.

Results: In 422 cases (41% women; mean age 61.6yrs) and 418 controls, significant LFOs were seen in grey matter (97%), white matter (96%), CSF (97%), sagittal sinus (91%), and arterial tree masks (56%). LFOs were lower in parenchyma of cases before (AUC difference: grey matter p<0.001; white matter p=0.004) and after adjustment (grey matter p<0.001; white matter p=0.001), with voxel-wise differences in group-averaged ALFF throughout the parenchyma (figure 1).

Conclusions: LFOs can be readily measured in resting-state BOLD-fMRI and are decreased in patients with increased WMHs, suggesting early impairment of autonomic control. LFOs need physiological and prognostic validation to determine their potential use as a novel index of endothelial dysfunction in cSVD.

Disclosure: No

P0688 / 1270

IMAGING NEUROVASCULAR, ENDOTHELIAL AND STRUCTURAL INTEGRITY IN PREPARATION TO TREAT SMALL VESSEL DISEASES (INVESTIGATE-SVDS): SIMILARITIES AND DIFFERENCES BETWEEN SPORADIC/MONOGENIC SVD – A PRINCIPAL COMPONENTS ANALYSIS

M.S. Stringer ¹, F.M. Chappell¹, G.W. Blair¹, A. Kopczak², D. Kerkhofs³, M.J. Thrippleton¹, K. Shuler¹, I. Hamilton¹, D. Jaime Garcia¹, R. Brown¹, U. Clancy¹, E. Sakka¹, T. Poliakova¹, E. Janssen¹, S. Munoz Maniega¹, F.N Doubal¹, M. Duering², J. Staals³, M. Ingrisch², W.H Backes⁴, R. van Oostenbrugge³, M. Dichgans^2,5,6, J.M Wardlaw¹, on behalf of SVDs@Target

¹University of Edinburgh, Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom, ²LMU Munich, Institute for Stroke and Dementia Research (ISD), University Hospital, Munich, Germany, ³Maastricht University, Department of Neurology, CARIM School for cardiovascular diseases, Maastricht, Netherlands, ⁴Maastricht University, Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Schools for Mental Health & Neuroscience and Cardiovascular Disease, Maastricht, Netherlands, ⁵German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany, ⁶Munich Cluster for Systems Neurology (SyNergy), Munich, Germany, Munich, Germany

Background: Cerebral small vessel diseases (SVDs) cause a quarter of ischaemic strokes. While sporadic SVD prevalence increases with age, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can affect younger individuals. We assessed which disease burden/vascular dysfunction metrics explained most of the overall variability in clinical-imaging features and whether this differed between SVD subtypes.

Methods: We recruited patients with sporadic SVD/CADASIL in three centres, acquired clinical data, blood pressure and standardised MRI at 3T, including structural, diffusion tensor imaging, cerebrovascular reactivity (CVR), intracranial pulsatility index (PI) and blood brain barrier (BBB) function (https://harness-neuroimaging.org/investigate-svds). We centrally analysed the MRI, extracting lesion volumes, CVR, PI and BBB permeability. We ran a principal component analysis (PCA) ranking each factor by proportion of explained variance for all patients, then CADASIL/sporadic separately in sensitivity analyses.

Results: We recruited 77 patients: mean age 59.5 years, 45 (58%) sporadic (64.2 years) and 32 (41%) CADASIL (52.9 years). SVD burden, mean diffusivity (MD) and fractional anisotropy (FA) explained the largest variance followed by: venous PI, age; CVR magnitude/delay; arterial PI; blood volume; BBB leakage; and blood pressure variability (Fig:1a). In CADASIL, CVR magnitude explained the most variance (Fig:1b); in sporadic SVD, WMH and lacune burden, BBB leakage, FA and MD, venous PI, age and arterial PI explained similar variance (Fig:1c).

Conclusions: We found similar components across all SVD, and CADASIL and sporadic separately, although their relative importance and order varied. While similar vascular dysfunctions underpin SVDs, inter-relationships are complex and may reflect disease severity and/or stage.

Disclosure: No

P0689 / 1434

WHITE MATTER HYPERINTENSITIES ASSESSMENT: PERFORMANCE OF AUTOMATED COMPUTERIZED TOOLBOXES VS CLINICIANS’ MANUAL SEGMENTATION

L. Torres-Simon ¹, A. Del Cerro¹, P. Cuesta², L. Gil³, M. Yus³, F. Maestú¹

¹Universidad Complutense de Madrid, Experimental psychology, Madrid, Spain, ²Universidad Complutense de Madrid, Radiology, Madrid, Spain, ³Hospital Clinico San Carlos, Radiology, Madrid, Spain

Cerebral small vessel disease (SVD) is a common accompaniment of ageing, not only in dementia patients, but also in healthy population. Neuroimaging markers of SVD are present in practically every individual over 60 years old, and its prevalence increases with age. According to the STRIVE criteria, white matter hyperintensities (WMH) is one of the most prevalent features of SVD. Magnetic resonance imaging (MRI) is enabled to detect the lesions in the white matter of the brain. Clinical scales based in visual assessment are the most used method to detect and evaluate their severity, but did not report true quantitative information, which make difficult the evaluation of the progression. On the other hand, clinicians’ manual segmentation is the most accurate method to measure lesion volume, but it is extremely time-consuming, and it comprises high inter-rater variability making its application infeasible in routinary protocols.

For this reason, automatic segmentation tools are increasingly on clinical demand. The main objective of the present study is to identify the most accurate software for the automatic detection of WMH according to clinicians’ manual segmentations (gold standard). 45 old and cognitively healthy participants were recruited (mean age 71 SD 4,74). T1 and Flair images were used for segmentation process. Lesion segmentation tool – LST (SPM), SAMSEG (Freesurfer) and Bianca (FSL) performances were analyzed and compared with the gold standard and correlated with the clinical scale Fazekas. Deep understanding of new automated computerized methods could incredibly assist the clinicians in the diagnostic decision.

Disclosure: No

P0690 / 257

NFL AND GFAP IN EARLY AND ADVANCED CEREBRAL AMYLOID ANGIOPATHY

S. Voigt ¹, I Rasing¹, E. Koemans¹, A. de Kort², T. van Harten³, E. van Etten¹, E. van Zwet⁴, E Stoops⁵, K Dewaele⁵, H. Kuiperij², C. Klijn², W. van Roon-Mom⁶, M. van Osch³, M. van Walderveen³, M. Verbeek², G. Terwindt¹, M. Wermer¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Radboud University Medical Center, Neurology, Nijmegen, Netherlands, ³Leiden University Medical Center, Radiology, Leiden, Netherlands, ⁴Leiden University Medical Center, Biostatistics, Leiden, Netherlands, ⁵ADx NeuroSciences, Ghent, Belgium, ⁶Leiden University Medical Center, Human Genetics, Leiden, Netherlands

Objective: To investigate neurofilament light chain(NFL) and glial fibrillary acidic protein(GFAP) as candidate biomarkers in serum and cerebrospinal fluid(CSF) for neurodegeneration and reactive astrogliosis in the early and advanced stages of Cerebral Amyloid Angiopathy(CAA).

Methods: We analyzed NFL and GFAP levels with Simoa in serum and CSF of (pre)symptomatic Dutch-type hereditary CAA(D-CAA), sporadic CAA(sCAA) and control participants from the AURORA, FOCAS and BIONIC studies. We compared NFL and GFAP levels with Mann-Whitney-U and assessed their association with CAA-CSVD score on 3-Tesla-MRI and cognitive performance (MoCA) with linear regression models adjusted for confounders.

Results: We included 187 participants: 27 presymptomatic D-CAA mutation-carriers (mean age 40 years), 29 symptomatic D-CAA patients (mean age 58 years), 60 sCAA patients (mean age 72 years) and 71 controls (mean age 54 years). NFL levels were increased in symptomatic versus presymptomatic D-CAA (p<0.000 serum, p=0.003 CSF), and in sCAA versus controls ⩾55 years(p<0.000 serum/CSF). GFAP levels were increased in symptomatic versus presymptomatic D-CAA(p<0.000 serum, p=0.000 CSF), and in sCAA versus controls ⩾55 years(p<0.000 serum/CSF). GFAP CSF was increased in presymptomatic D-CAA compared with controls <55 years (p=0.020). Both NFL (r=0.46 serum, r=0.53 CSF) and GFAP levels (r=0.41 serum, r=0.52 CSF) correlated with the MoCA and the CAA-CSVD score (NFL r=0.75 serum, r=0.84 CSF, GFAP r=0.71 serum, r=0.75 CSF).

Conclusions: Our findings suggest that serum and CSF NFL and GFAP are biomarkers for advanced CAA. CSF GFAP is increased in presymptomatic D-CAA mutation-carriers years before ICH onset and therefore seems to be an early biomarker of CAA.

Disclosure: No

P0691 / 1588

LONGITUDINAL EVOLUTION OF RECENT SMALL SUBCORTICAL INFARCTS ON MAGNETIC RESONANCE IMAGING

C. Arteaga ¹, Y. Cheng², R. Muradi¹, U. Clancy¹, W. Hewins¹, D. Jaime Garcia¹, M.C. Valdés-Hernández¹, S. Wiseman¹, M. Stringer¹, M.J. Thrippleton¹, F.M. Chappell¹, S.D. Makin³, F.N Doubal¹, J.M Wardlaw¹

¹University of Edinburgh, Edinburgh Imaging and the UK Dementia Research Institute, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²Sichuan University, West China Hospital, Center of Cerebrovasccular Diseases, Department of Neurology, Chengdu, China, ³University of Aberdeen, Centre for Rural Health, Inverness, United Kingdom

Background and aims: Guidelines suggest a minimum size for lacunes derived from recent small subcortical infarcts (RSSI) of 3mm. RSSI may cause lacunes smaller than 3mm - using this 3mm threshold may underestimate small vessel disease burden. We assessed longitudinal changes in RSSI to determine final lacune sizes.

Methods: We included participants with symptomatic MRI-confirmed RSSI from two prospective stroke studies who had MRI at baseline and 12-months. We measured the RSSI maximum axial diameter at baseline and 12-months on fluid-attenuated inversion recovery, assessed cavitation status, and measured any resulting lacune diameter. We used logistic regression to assess associations between RSSI final cavity size, vascular risk factors and SVD burden at baseline.

Results: We included 108 RSSI-participants (mean age 65-years; 34% female). Median onset to baseline MRI 26 days (IQR 4-64) and onset to 12-months follow-up 412 days (IQR 374-454). Median RSSI diameter at baseline was 8.9 mm (range 1.8-18.4) and 12-months was 7.4 mm (range 2.50-18.60). Partial cavitation was present in 60% and complete cavitation was present in 30% at 12-months, with median cavity diameter of 4.4 mm (range 1.5-13.40). In 27/108 (25%) the cavity was <3mm at 12-months. At 12-months, 5% (5/108) RSSI had disappeared. Final cavity size >3mm at 12-months was associated with larger baseline RSSI (OR 1.42; 95%CI 1.20-1.68) adjusted for age, diabetes, and SVD score.

Conclusions: Almost a quarter of RSSI evolved into a lacune <3mm of diameter, and 5% completely disappeared at 12-months. Adjusting the lower 3mm threshold of lacune size should be considered.

Disclosure: No

P0692 / 233

CEREBRAL VENOUS REFLUX AND CEREBRAL AMYLOID ANGIOPATHY: AN MRI/PET STUDY

H.-H. Tsai ^1,2, B.-C. Lee³, Y.-F. Chen³, J.-S. Jeng², R.-F. Yen⁴, L.-K. Tsai²

¹National Taiwan University Hospital Beihu Branch, Neurology, Taipei, Taiwan, Province of China, ²National Taiwan University Hospital, Neurology, Taipei, Taiwan, Province of China, ³National Taiwan University Hospital, Medical Imaging, Taipei, Taiwan, Province of China, ⁴National Taiwan University Hospital, Nuclear Medicine, Taipei, Taiwan, Province of China

Background: Cerebral venous flow alterations have been considered as a contributor in white matter ischemia and cognitive impairment, but their role in cerebral amyloid angiopathy (CAA) has never been investigated.

Method: 127 patients with spontaneous intracerebral hemorrhage (ICH) were included. Presence of cerebral venous reflux (CVR) was defined as abnormal signal intensity in the dural venous sinus (cavernous, inferior petrosal, sigmoid or transverse sinus) or internal jugular vein using MR angiography. Clinical and image characteristics associated with CVR were evaluated in univariate and multivariable analyses. In CAA, univariate and multivariable models were performed to evaluate associations between the presence of CVR and cerebral amyloid retention.

Results: Compared to patients without CVR, patients with CVR (n=39, 30.7%) were older (69.8 ± 11.6 vs. 64.4 ±12.4 years) and were significantly associated with CAA-ICH (53.8% vs. 20.7%, p<0.001). In multivariable model, the presence of CVR remained independently associated with CAA-ICH (odds ratio 3.88 [1.54-9.79], p=0.004) after adjustment for age, sex, white matter hyperintensity and microbleed numbers. Patients with CVR showed higher global PiB retention after adjustment for age and sex (standardized uptake value ratio [SUVR] 1.34±0.26 vs. 1.10±0.17, adjusted p<0.001). In CAA-ICH, higher global PiB retention was found in patients with CVR than patients without CVR (SUVR 1.51±0.20 vs.1.47±0.19, p<0.001). The association between PiB retention and CVR remained significant after adjustment for age, sex and neuroimaging biomarkers (p=0.001).

Conclusion: CVR is significantly associated with CAA in spontaneous ICH, implicating the potential role of venous drainage dysfunction in cerebrovascular amyloid deposition.

Disclosure: No

P0693 / 653

TWENTY-FOUR HOUR BLOOD PRESSURE VARIABILITY AND THE VOLUME AND PROGRESSION OF CEREBRAL WHITE MATTER HYPERINTENSITIES

N.L.P. Starmans ¹, F.J Wolters², A.E Leeuwis³, E.E Bron⁴, H.P. Brunner la Rocca⁵, J. Staals⁶, G.J. Biessels¹, LJ. Kappelle¹, Heart-Brain Connection Consortium

¹University Medical Centre Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands, ²Erasmus MC, Department of Epidemiology & Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands, ³Amsterdam UMC, VU University Medical Centre, Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, Netherlands, ⁴Erasmus MC, Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology and Nuclear Medicine, Rotterdam, Netherlands, ⁵Maastricht University Medical Centre, Department of Cardiology, Maastricht, Netherlands, ⁶Maastricht University Medical Centre, Department of Neurology, Maastricht, Netherlands

Background and aims: Hypertension is a risk factor for white matter hyperintensities (WMH), but the association with blood pressure variability (BPV) and nocturnal dipping of blood pressure is less clear. We investigated whether BPV and nocturnal dipping were associated with WMH and its progression, and assessed the contributing role of cerebral perfusion.

Methods: Participants of the Heart-Brain Connection Study underwent 24-hour ambulatory blood pressure measurement and brain MRI. We determined the association of different measures of BPV and nocturnal dipping with WMH volume at baseline and after two years of follow-up with linear regression. For longitudinal analyses, we took WMH volume at follow-up as dependent variable while adjusting for baseline WMH volume. We investigated the role of cerebral perfusion, measured by baseline Qflow, as a potential mediator or moderator.

Results: Among 178 participants (mean age 65.9±8.1 years, 61 (34.3%) female), those with more diastolic nocturnal dipping had a lower burden of WMH (adjusted standardized β -0.221, 95%CI -0.403 – -0.039). In 92 participants who underwent follow-up MRI, 24-hour and daytime diastolic average real variability (ARV) were significantly associated with WMH volume progression (adjusted standardized β: 0.119, 95%CI 0.006-0.232 for 24-hour ARV, β: 0.137, 95%CI 0.026-0.248 for daytime ARV). The association between diastolic ARV and WMH progression was stronger in participants with lower baseline cerebral perfusion.

Conclusions: More diastolic nocturnal dipping was associated with lower WMH volume at baseline, while larger diastolic BPV, expressed as ARV, was associated with WMH progression. Cerebral perfusion was an effect moderator in this association.

Disclosure: No

P0694 / 191

RELATIONSHIP BETWEEN CEREBROVASCULAR REACTIVITY AND SMALL VESSEL DISEASE NEUROIMAGING FEATURES

E. Sleight ^1,2, M.S Stringer^1,2, U. Clancy^1,2, C. Arteaga^1,2, D.J Garcia^1,2, W. Hewins^1,2, F. Chappell^1,2, A. Jochems^1,2, I. Hamilton³, C. Jardine³, R. Brown^1,2, E. Sakka^1,2, S. Wiseman^1,2, M. Valdes-Hernandez^1,2, A. Kampaite^1,2, F. Doubal^1,2, I. Marshall^1,2, M.J Thrippleton^1,2,3, J.M Wardlaw^1,2, Edinburgh SVD research group

¹Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom, ²UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom, ³Edinburgh Imaging Facility RIE, University of Edinburgh, Edinburgh, United Kingdom

Background: Cerebral small vessel disease (SVD) is characterised by vascular dysfunction and tissue damage on MRI. Most prior studies have examined cerebrovascular reactivity (CVR) in relation to WMHs only. We performed a prospective observational cohort study at 3T (Mild Stroke Study 3, ISRCTN 12113543) to investigate associations between CVR and multiple SVD neuroimaging features and confirm previous 1.5T findings.

Methods: We recruited SVD patients with minor ischaemic stroke and measured CVR as the BOLD MRI response to 6% hypercapnia in deep grey matter (GM) and normal-appearing white matter (NAWM). We visually rated SVD features using the STRIVE criteria, calculated SVD score, and computed WMH volume expressed as % of intracranial volume (%ICV). We ran multivariable linear regressions of GM and NAWM CVR magnitude against SVD metrics, adjusted for vascular risk factors.

Results: 164/190 CVR datasets were processable (163/164 with full visual ratings). Median [interquartile range] age was 68.2 [57.2,74.7] years, 31% female. Median CVR were CVR_GM=0.184 [0.141,0.223] %/mmHg and CVR_NAWM=0.042 [0.033,0.055] %/mmHg. Median WMH volume was 8.089 ml (0.503 [0.235,1.117] %ICV) and median SVD score 1 [0,2]. In GM and NAWM, patients with lower CVR had higher WMH volumes (B_NAWM=-0.003 [-0.006,-0.000] %signal/mmHg per log increase in %ICV), higher Fazekas score (B_NAWM=-0.002 [-0.004,-0.000] %signal/mmHg), more lacunes (B_NAWM=-0.001 [-0.002,-0.000] %signal/mmHg), more microbleeds (B_NAWM=-0.001 [-0.002,-0.000] %signal/mmHg) and higher SVD scores (B_NAWM=-0.005 [-0.008,-0.002] %signal/mmHg). No association with brain atrophy was found.

Conclusion: CVR impairment is associated with higher SVD burden; the strength of effect varied between individual SVD lesion types.

Disclosure: No

P0695 / 214

ASSOCIATION BETWEEN RETINAL MICROVASCULAR FUNCTION AND CEREBRAL MICROPERFUSION MEASURED BY INTRAVOXEL INCOHERENT MOTION MRI

M. van Dinther ¹, P.H. Voorter², M.T. Schram³, T.J. Berendschot⁴, A.J. Houben³, C.A. Webers⁴, R.J. van Oostenbrugge¹, J.F. Jansen², W.H. Backes², J. Staals¹

¹Maastricht University Medical Center+, Neurology, Maastricht, Netherlands, ²Maastricht University Medical Center+, Radiology and Nuclear Medicine, Maastricht, Netherlands, ³Maastricht University Medical Center+, Internal Medicine, Maastricht, Netherlands, ⁴Maastricht University Medical Center+, Ophthalmology, Maastricht, Netherlands

Background and aims: The easily accessible retinal vessels provide a unique opportunity to study cerebral small vessels, since retinal and cerebral vessels share anatomical and physiological properties. Associations between retinal vessel diameters and macrostructural white matter changes, such as white matter hyperintensities (WMH), have already been demonstrated. Changes in microvascular function, for instance perfusion, probably precede these structural abnormalities. We examined whether retinal microvascular function is related to cerebral microvascular perfusion, assessed by the intravoxel incoherent motion (IVIM) effect in MRI.

Methods: Seventy participants (age 60 ± 8 years, 41% women) from the population-based Maastricht Study underwent brain IVIM diffusion imaging (3 Tesla) to determine the microvascular perfusion measures f (flowing blood volume fraction) and D* (pseudo-diffusion of circulating blood). Retinal arteriolar and venular dilation response to flicker light stimulation were measured by a dynamic vessel analyzer. Linear regression analysis was used to investigate associations between retinal vasoreactivity and IVIM measures in WMH, normal-appearing white matter (NAWM) and cortex.

Results: Higher retinal arteriolar dilation was associated with higher pseudo-diffusion (D*) in the NAWM and cortex (β 0.280 [95% CI 0.084-0.475], and β 0.310 [95% CI 0.091- 0.528], respectively), but not with the flowing blood volume fraction (f). No associations were observed between retinal venular dilation response and IVIM measures.

Conclusions: Variations in retinal microvascular function and microcirculatory properties in the brain are linked. Our study validates the physiological concepts underlying the IVIM derived measure pseudo-diffusion D*, reflecting the fast directional changes in the cerebral microcirculatory blood stream.

Disclosure: No

P0696 / 107

SYSTEMIC IMMUNE INFLAMMATION INDEX IS RELATED TO WHITE MATTER HYPERINTENSITY IN A HEALTHY POPULATION

K.-W. Nam ¹, H.-M. Kwon¹, J.-H. Park², H. Kwon²

¹Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Neurology, Seoul, Korea, Republic of, ²Seoul National University Hospital, Family Medicine, Seoul, Korea, Republic of

Background and aims: Although cerebral small vessel diseases (cSVDs) are asymptomatic subclinical pathologies, they have high clinical importance as they increase the risk of dementia and stroke. Various mechanisms have been proposed for the pathogenesis of cSVD, and inflammation is one of them. In this study, we aimed to evaluate the association between systemic immune-inflammation index (SII), a novel inflammatory marker, and cSVDs in a healthy population.

Methods: We assessed health check-up volunteers between January 2006 and December 2013. SII was calculated using the following formula: SII = (platelet counts * neutrophil counts)/lymphocyte counts. cSVD was evaluated including white matter hyperintensity (WMH) volume, silent brain infarct (SBI), and cerebral microbleeds (CMBs).

Results: A total of 3,187 subjects were evaluated (mean age: 57 ± 9 years, male sex: 53.9%). In multivariable linear regression analysis, SII [β = 0.120, 95% confidence interval (CI) = 0.050 to 0.189] was significantly associated with WMH volumes after adjusting for confounders. Age (β = 0.051, 95% CI = 0.047 to 0.055), hypertension (β = 0.181, 95% CI = 0.097 to 0.266), and diabetes (β = 0.144, 95% CI = 0.042 to 0.247) were also closely related to WMH volumes. SII did not show any statistical significance with SBI or CMBs.

Conclusions: High SII was associated with WMH volumes in a healthy population. Since this association was not seen in SBI or CMBs, WMH is most likely related to the pathology associated with inflammation among several cSVD subtypes.

Disclosure: No

P0697 / 1473

CEREBRAL VASOREACTIVITY CHANGES OVER TIME IN PATIENTS WITH DIFFERENT CLINICAL MANIFESTATIONS OF CEREBRAL SMALL VESSEL DISEASE AND DIABETES

A. Dębiec ¹, A. Stępień¹, J. Staszewski¹

¹ Military Institute of Medicine, Clinic of Neurology, Warsaw, Poland

Background and aims: Endothelial dysfunction (ED) is linked to the pathogenesis of cerebral small vessel disease (SVD) and diabetes. We aimed to assess ED and cerebrovascular reactivity (CVR) in the patients with type 2 diabetes and a diverse manifestation of SVD, with similar and extensive white matter lesions compared with a control group (CG) without the MRI markers of SVD and to evaluate the change of CVR following 24 months.

Methods: Vasomotor reactivity reserve (VMRr) and breath-holding index (BHI) of the MCA were measured by the TCD in 30 subjects with a history of lacunar stroke (LS), vascular dementia (VaD), or parkinsonism (VaP) (20 in each group), and in 10 individuals from a CG.

Results: VMRr and the BHI were impaired in patients with SVD vs. CG at the two timepoints (baseline VMRr: 55.8 ± 16 vs. 74 ± 18%, respectively, p < 0.001; BHI: 0.79 ± 0.39 vs. 1.1 ± 0.3, p =0.02; follow-up VMRr 52.7±15 vs. 71.2±20, p<0.01; BHI: 0.72±0.4 vs. 1.04±0.5, p <0.01). All the CVR measures significantly decreased over time in the subjects with SVD (Wilcoxon’s signed-rank test p <0.05), but this was not observed in the CG (p>0.1) and the decrease of CVR measures was not related to the SVD radiological progression (p>0.1).

Conclusions: The change in CVR measures is detectable over a 24-month period in patients with different manifestations of SVD and diabetes. All the CVR measures significantly declined over time in the subjects with SVD irrespective of the SVD radiological progression.

Disclosure: No

P0698 / 366

AUTOMATIC DETECTION OF INCIDENT LACUNES DURING THE COURSE OF ISCHEMIC CEREBRAL SMALL VESSEL DISEASES (CSVD)

J. Lebenberg ^1,2,3,4, R. Zhang^1,2,3,4, L. Grosset^1,2,3,4, J.-P. Guichard⁵, E. Jouvent^1,2,3,4, H. Chabriat^1,2,3,4

¹INSERM U 1141, NeuroDiderot, Paris, France, ²FHU NeuroVasc, Paris, France, ³APHP Lariboisière Hospital, Neurology, Paris, France, ⁴CERVCO Reference Center, Paris, France, ⁵APHP Lariboisière Hospital, Neuroradiology, Paris, France

Background and aims: Lacunes represent key imaging markers of cSVD. During their progression, incident lacunes are not always related to focal symptoms but can contribute to cognitive or motor worsening. To overcome random operator-errors, we developed a fully-automated detection of incident lacunes using MRI data obtained in CADASIL, a severe and progressive archetypal cSVD.

Methods: 3DT1w-MRI at 3T from 30 individuals and followed every 2 years were analyzed. For each patient, MRIs were non-linearly registered in the MNI space and normalized in intensity. First follow-up data were subtracted from baseline, and positive voxels both in the MNI-white-matter and follow-up CSF masks were considered. A K-means clustering was performed to threshold the difference map. Clusters satisfying STRIVE criteria were kept after removing false positives mostly corresponding to clusters superimposed to follow-up external CSF and skeletonized sulci or at the edges of the WM mask. For comparison, incident lesions were identified independently and visually by a neuroradiologist.

Results: Patients were between 32 and 75 yo (57% women). The median number of lacunes at baseline was 7 (IQR=[2.25;10.75]). A Wilcoxon signed-rank test computed between both approaches did not reject equivalent counting (p=0.2). A Bland-Altman evaluation attested a good agreement without any bias between methods. Even if the expert detection got better precision, a final review confirmed that some lacunes were only detected by the algorithm.

Conclusions: Our results are promising and suggest that a fully automated approach is possible to detect incident lacunes in patients with severe and progressive cSVD.

Disclosure: No

P0699 / 344

DETECTING WORSENING SVD AFTER STROKE–INCIDENT LACUNAR INFARCTS AND WHITE MATTER HYPERINTENSITY PROGRESSION

U. Clancy ¹, C. Arteaga¹, W. Hewins¹, D. Jaime Garcia¹, M. C Valdés-Hernández¹, S. Wiseman¹, M. Stringer¹, M. Thrippleton¹, A.C. Jochems¹, Y. Cheng², X. Liu³, J. Zhang⁴, S. Rudilosso⁵, E. Sakka¹, A. Kampaite¹, R. Brown¹, M.E Bastin¹, S. Muñoz Maniega¹, I. Hamilton¹, D. Job¹, I. Marshall¹, F.N Doubal¹, J.M Wardlaw¹

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²Sichuan University, Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Chengdu, China, ³The University of Hong Kong, Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong, SAR of China, ⁴Shanghai Jiao Tong University School of Medicine, Department of Neurology, Shanghai General Hospital, Shanghai, China, ⁵University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Comprehensive Stroke Center, Department of Neuroscience, Barcelona, Spain

Background and aims: Cerebral small vessel disease (SVD) causes stroke and vascular dementia. SVD progression varies between individuals. We aimed to determine associations with incident lacunar (small subcortical) infarcts and WMH changes after stroke.

Methods: We prospectively recruited patients with non-disabling stroke. After diagnostic MRI, we repeated MRI at 3-6 monthly intervals for 12 months, assessing incident infarcts visible on DWI or FLAIR and WMH volume change. We used logistic regression to determine associations with incident lacunar infarcts during follow-up, including baseline vascular risks, baseline SVD score, and composite of index plus old infarct subtype. Linear mixed-effects analysis assessed WMH change.

Results: We recruited n=203 (mean 66 years; 33% female; 55% lacunar).

Incident infarcts (n=40/203 [20%]; total 77 infarcts; 64/77 lacunar; on DWI/FLAIR) occurred median 2 (IQR 2-8) months post-stroke. Incident lacunar infarct associations (Figure 1) included total SVD score OR=1.84, 95%CI=1.23-2.86, p=0.004; diabetes OR=2.52; 0.98-6.46; p=0.05 (trend).

Median baseline WMH volume was 8.1mL (IQR 3.7-18.6). Between baseline-12 months, mean WMH volume change was +0.99mL (SD2.73); maximum growth=12.83mL; maximum shrinkage=4.27mL. WMH progression associated with previous stroke/TIA (std.β=0.54, 95%CI=0.20–0.88,p=0.002), hypertension (β=0.17, 95%CI=0.05–0.29, p=0.005), index lacunar stroke (β=0.25, 95%CI=0.004–0.50, p=0.046), and age (β=0.35, 95%CI=0.23–0.48, p=<0.001), but not smoking, diabetes, sex, or incident infarcts (n=188).

Conclusions: In a population enriched for lacunar stroke, incident infarcts, mostly lacunar, occur in 20% and associate with worse baseline SVD burden. WMH progression associates with readily identifiable clinical factors. This ongoing study highlights high-risk ‘SVD progressors’ who might benefit most from future interventions.

Disclosure: No

P0700 / 417

CEREBRAL SMALL VESSEL DISEASE IS ASSOCIATED WITH CONCURRENT PHYSICAL AND COGNITIVE IMPAIRMENTS AT PRE-CLINICAL STAGE

C.-P. Chung ¹

¹ Taipei Veterans General Hospital, Neurological Institute, Taipei, Taiwan, Province of China

Background and aims: Physio-cognitive decline syndrome (PCDS) is a clinical construct of concurrent physical mobility and cognitive impairments in healthy elderly who are at risk of dementia and disable. The present study aimed to evaluate whether cerebral small vessel disease(SVD) is associated with this phenotype of accelerated aging.

Methods: We stratified a non-demented non-stroke community-based population aged ⩾50 years into four groups: robust, isolated cognitive impairment no dementia (CIND), isolated physical mobility impairment no disable (MIND) and PCDS groups. SVD was defined by the presence of severe white matter hyperintensities(WMH), lacune(s) and cerebral microbleed(CMB). Univariate and multivariate analyses were performed to evaluate the cross-sectional relationships between SVD and PCDS.

Results: Seven hundred and nine eligible participants were included. There were 317 (44.7%) classified as robust group, 212(29.9%) as CIND group, 117 (16.5%) as MIND group and 63 (8.9%) as PCDS group. SVD(SVD score⩾2) was significantly associated with PCDS (OR=2.3; 95% CI = 1.3-4.0; p=0.003) but not with MIND or CIND. Among three SVD markers, the presence of severe WMH (OR=1.9; 95% CI=1.1-3.2; p=0.023) and lacune (OR=2.5; 95% CI = 1.3-4.8; p=0.005) were significantly and mixed CMB (OR=2.0; 95% CI=1.0-4.1; p=0.058) was borderline-significantly associated with PCDS. These significances were independent of age, sex and vascular risk factors.

Conclusion: SVD was associated with concurrent physical mobility and cognitive impairments in non-demented non-disable elderly. We’ve revealed the clinical features of SVD at early, preclinical stage and provided insights into the pathophysiology and management strategy of accelerated functional declines in the elderly.

Disclosure: No

P0701 / 1384

NFL AND GFAP IN (PRE)SYMPTOMATIC RVCL-S, A MONOGENIC SMALL VESSEL DISEASE

A.E. Wilms ¹, I. de Boer¹, N. Pelzer¹, S.G.J.G. In ‘t Veld², C.E. Teunissen², G.M. Terwindt¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Amsterdam UMC, Vrije Universiteit, Clinical Chemistry, Amsterdam, Netherlands

Background and aims: We performed a study to determine if serum and CSF neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) could be (early) biomarkers in Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic manifestations (RVCL-S). Studying mutation carriers with RVCL-S offers the possibility to also identify biomarkers for more common cerebral small vessel diseases.

Methods: We analyzed NfL and GFAP levels using the Simoa technology in paired serum and CSF of (pre)symptomatic RVCL-S mutation carriers and age-matched controls. Symptomatic mutation carriers were defined as patients with retinopathy, neurovascular deficits and/or systemic symptoms requiring treatment. NfL and GFAP levels were compared between the different groups with Mann-Whitney U test.

Results: We included n=17 presymptomatic RVCL-S mutation carriers, n=22 symptomatic RVCL-S mutation carriers, and n=69 age-matched controls. Serum NfL levels were increased in symptomatic mutations carriers when compared with controls (p<0.001) and presymptomatic mutation carriers (p<0.001). In CSF, NfL levels were increased in both symptomatic (p=0.001) and presymptomatic (p=0.033) mutation carriers compared to controls. Serum GFAP levels were increased in symptomatic mutation carriers compared with presymptomatic mutation carriers. However, no differences between serum and CSF GFAP levels were found between (pre)symptomatic mutation carriers and their age-matched control groups.

Conclusions: Our findings suggest that serum and CSF NfL levels and serum GFAP may serve as biomarkers for symptomatic disease in RVCL-S mutation carriers. Furthermore, CSF NfL levels seem to be increased before disease onset in RVCL-S mutation carriers, suggesting its potential as early biomarker for those at risk for RVCL-S.

Disclosure: Yes

P0702 / 1231

A NOVEL “DE NOVO” COL4A1 MUTATION CAUSING CEREBRAL SMALL VESSEL DISEASE WITH MULTIORGAN INVOLVEMENT: CASE REPORT AND REVIEW OF THE LITERATURE

L. Ramacciotti ¹, M. Squitieri¹, G. Giacomucci¹, A. Asaro², E.M. Valente^3,4, S. Emilia¹, A. Bianchi⁵, V. Bessi¹, A. Poggesi^1,6,7, F. Pescini⁷

¹University of Florence, NEUROFARBA, Florence, Italy, ²IRCSS Mondino Foundation, Neurogenetics research center, Pavia, Italy, ³University of Pavia, Department of Molecular Medicine, Pavia, Italy, ⁴IRCSS Mondino Foundation, Neurogenetics Research Center, Pavia, Italy, ⁵AOU Careggi, Florence, Italy, ⁶IRCSS Fondazione Don Carlo Gnocchi, Florence, Italy, ⁷AOU Careggi, Stroke Unit, Emergency Department, Florence, Italy

Background: Mutations in COL4A1 and COL4A2 genes have been recently identified as a cause of autosomal dominant hereditary multisystemic disease. COL4A1 and COL4A2-related disorders are highly variable including cerebrovascular events, migraine, epilepsy, nephropathy, muscle cramps, arterial aneurysms, and ocular anterior segment diseases.

Purpose: We report on a patient affected by COL4A1-related disease and we review literature data in order to describe clinical and neuroimaging features related to COL4A1 and COL4A2 mutations in young and adults.

Results: A judo player 17-years-old girl was admitted for right hemiparesis due to subcortical hemorrhage. On neuroimaging, subcortical subacute small infarcts, calcifications, previous small hemorrhages and subcortical leukoencephalopathy were also present. In her childhood, she was diagnosed with congenital bilateral subcapsular cataract, microhematuria, and raised creatine kinase. COL4A1 and COL4A2 analysis revealed a heterozygous novel pathogenic variant in the COL4A1 gene. The variant was not detected in her parents’ and brother’s samples, suggesting a de novo origin. We reviewed English-written case reports, series, and reviews that reported on subjects >= 16 years of age with mutations in COL4A1 or COL4A2 genes. In each eligible article (73 papers) we focused on the description of the clinical picture, as well as instrumental and laboratory data.

Conclusions: We present a novel COL4A1 mutation expanding the genotypic spectrum of COL4A1-related disorders. Moreover, we confirm the frequent occurrence of de novo pathogenic variants as causative of this disease, supporting the indication to perform genetic analysis in patients with familial or sporadic cerebral small vessel disease associated with multiorgan involvement.

Disclosure: No

P0703 / 1304

STRIVING FOR THE BEST - COMPARISON AND COMBINATION OF AUTOMATED WHITE MATTER HYPERINTENSITY SEGMENTATION TOOLS

C. Mayer ¹, F.L. Nägele¹, M. Petersen¹, M. Schell¹, B. Cheng¹, G. Thomalla¹

¹ University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany

Background: The segmentation of white matter hyperintensities (WMH) as an imaging marker of cerebral small vessel disease remains a challenging task. With manual segmentations being unbearable for large sample sizes, researchers depend on automated segmentation tools. Investigation of optimal automated approaches for WMH segmentation testing combinations of different software pipelines are scarce. We evaluated the accuracy of five selected software tools for WMH segmentation in participants of a large-scale population-based cohort.

Methods: WMH were manually segmented by two independent raters on 100 fluid-attenuated inversion recovery (FLAIR) images randomly selected from a population-based cohort. Five open-source segmentation algorithms (sysuMediaWmhSegmentation, BIANCA, LOCATE, LPA and LGA) and combinations of their processing pipeline were applied on FLAIR and multimodal MRI datasets. Accuracy was systematically evaluated based on overlap indices (DICE and Jaccard index) in comparison to manual segmentations as the gold standard.

Results: MR images of 100 individuals with a mean age of 62.8 years (51.5% female) were included in the analysis. Algorithms varied in their output. LOCATE (DICE=0.547, Jaccard=0.401) and BIANCA (DICE=0.545, Jaccard=0.396) had the highest accuracy for WMH detection. For algorithms that do not require training, LGA (DICE=0.433, Jaccard=0.296) and LPA (DICE=0.421, Jaccard=0.296) had a higher overlap than sysuMediaWmhSegmentation (DICE=0.185, Jaccard=0.106). A combination of two algorithms did not perform better than a single algorithm.

Conclusions: In this analysis, algorithms that require training (LOCATE and BIANCA) had the highest overlap with manual segmentations. If manual segmentations are no option, the best alternative serve the algorithms LGA and LPA from the Lesion Segmentation Toolbox.

Disclosure: No

P0704 / 1564

EFFECT OF CILOSTAZOL IN COMBINATION WITH ACETYLSALCYLIC ACID ON THE ENDOTHELIAL VASCULAR HOMEOSTASIS IN ACUTE LACUNAR STROKE

L. Anatskaia ¹, N. Goncharova², V. Zabarovski¹, S. Marchenko³

¹Republican Research and Clinical Center of Neurology and Neurosurgery, Department of Neurology, Minsk, Belarus, ²Republican Scientific and Practical Center for Transfusiology and Medical Biotechnologies, Minsk, Belarus, ³Minsk City Clinical Emergency Hospital, Minsk, Belarus

Background and aims: The aim of our study was to investigate the effect of cilostazol in combination with acetylsalicylic acid (ASA) in acute lacunar stroke (LS) resulting from cerebral small vessel disease (CSVD) on the levels of circulating endothelial microparticles (EMP).

Methods: Comparative analysis of the levels of circulating EMP with phenotype CD309⁺, CD146⁺, CD144⁺, CD62E⁺ in the blood of 30 patients aged 56.3±8.2 years in the first 48 hours of LS resulting from CSVD and after 10 days of Cilostazol 100 mg 2 times a day in combination with ASA 75 mg 1 time a day. The comparison group consisted of 30 patients with LS taking ASA 300 mg per day, the control group - 15 healthy donors.

Results: A significant increase in the levels of EMPs with the phenotype CD309⁺ (p=0.014), CD31⁺ (p=0.007), CD144⁺(p=0.05), CD146⁺ (p=0.046), CD62E⁺(p=0.05) was found. After 10 days of dual antiplatelet therapy with cilostazol and ASA, normalization of EMP levels with the phenotype CD309⁺, CD144⁺, CD146⁺ and CD62E⁺ was established. After 10 days of ASA antiplatelet monotherapy, increased levels of EMP with phenotype CD309⁺ (p = 0.001), CD144⁺ (p = 0.001), CD146⁺(p = 0.001) and CD62E⁺ (p = 0.001) persist relative to the data in the control group.

Conclusions: The use of dual antiplatelet therapy cilostazol with ASA in acute LS resulting from CSVD led to normalization of EMP levels with the phenotype CD309⁺, CD144⁺, CD146⁺and CD62E⁺, reflecting a restoration of vascular endothelial cell permeability and blood-brain barrier integrity.

Disclosure: No

P0705 / 890

WHITE MATTER HYPERINTENSITY SEGMENTATION BY FULLY CONVOLUTIONAL NEURAL NETWORK ON 1.5T CLINICAL MRI IN PATIENTS WITH ACUTE ISCHEMIC STROKE

S. Rudilosso ¹, E. Eloy Martínez-Heras², C. Laredo³, D. Esteller¹, S. Amaro¹, V. Obach¹, A. Renú¹, L. Llull¹, A. Rodriguez¹, D. Santana¹, Á. Chamorro¹, X. Urra¹

¹Hospital Clínic of Barcelona, Neurology, Barcelona, Spain, ²IDIBAPS, Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain, ³IDIBAPS, Magnetic Resonance Imaging Core Facility, Barcelona, Spain

Background and aims: Several automated segmentation tools for white matter hyperintensities (WMH) have been developed, but few of them were designed for patients with acute ischemic stroke (AIS). We assessed the performance of a deep convolutional neural network (dCNN) architecture from the MICCAI WMH Challenge, for WMH segmentation in patients with AIS.

Methods: Unicentric study in 28 AIS patients with 1.5T MRI obtained from different scanners used for clinical practice. We described the occlusion site, and WMH load with total Fazekas scale. We manually delineated the WMH on FLAIR (excluding AIS), and the AIS on DWI, and obtained their volumes. We used pre-trained model weights (deepNeuroSeg package) to automatically perform the WMH segmentation on FLAIR images. Subsequently, we assessed the concordance between manual and automated WMH volumes using the interclass correlation coefficient (ICC) in the whole cohort and according to median WMH and AIS volumes.

Results: Twenty-two/28 and 6/28 patients had large and small artery-occlusions, respectively. Median (IQR) total Fazekas score was 2 (1-3.5). Median WMH and AIS volumes were 6.6mL (1.7-28.5) and 7.8mL (2.2-35.4), respectively. Overall, the WMH segmentation concordance (ICC, 95%CI) was good (0.81, 0.63-0.91). ICC was higher in patients with large WMH (0.80, 0.48-0.93) and small AIS (0.90, 0.73-0.97) volumes compared with low WMH (0.28, -0.27-0.69) and large AIS (0.71, 0.32-0.90) volumes.

Conclusions: This dCNN model allows WMH segmentation in large cohorts of stroke patients from clinical practice. Further external training in large cohort data is necessary to improve the performance in patients with low WMH load.

Disclosure: No

P0706 / 1301

NEUROFILAMENT LIGHT CHAIN RELATES TO INCREASED RISK OF LONG-TERM MOTALITY IN CEREBRAL SMALL VESEL DISEASE

M.A. Jacob ¹, N. Peters^2,3,4, M. Cai¹, M. Duering⁵, S.T. Engelter^2,3, J. Kuhle⁶, F.-E. de Leeuw¹, A.M. Tuladhar¹

¹Radboud University Medical Centre; Donders Center for Medical Neuroscience, Nijmegen; The Netherlands, Department of Neurology, Nijmegen, Netherlands, ²Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland, Basel, Switzerland, ³University Center for Medicine of Aging, Felix Platter Hospital, Basel Switzerland, Basel, Netherlands, ⁴Stroke Center, Klinik Hirslanden, Zürich, Switzerland, Zürich, Switzerland, ⁵Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland, Basel, Switzerland, ⁶Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland, Basel, Switzerland

Background and aims: Cerebral small vessel disease (SVD) is an important cause of stroke and dementia and is associated with a progressive, but highly variable course and mortality. We investigated the potential role of serum neurofilament light chain (sNfL) as a predictor for mortality in SVD-patients.

Methods: This study included 503 patients with sporadic SVD from the RUN DMC study. All patients underwent blood examination, MRI, and neuropsychological testing at baseline (2006). sNfL was age-normalized using samples from 485 healthy controls. Patients were followed up until their death or December 2020. Predictors of mortality were identified via multivariable cox regression model.

Results: Out of 503 patients (mean age: 65.7 SD 8.8 years), 182 (36.3%) died during a median follow-up of 14.0 years (IQR 10.9-14.4). Elevated sNfL level at baseline was associated with an increased risk of all-cause mortality (Figure 1), independent of age, vascular comorbidity, cognition and MRI-markers of SVD (HR [95% CI]): 1.23 per 1-SD increase [1.08-1.42]). The following covariates were also associated with all-cause mortality: age, smoking, cognitive index, and white matter volume. Sensitivity analyses showed that increased sNfL-levels was associated with increased risk of mortality, specifically related to vascular deaths (HR [95% CI]): 1.28 per 1-SD increase [1.02-1.63]).

Conclusions: Baseline sNfL is associated with a 14-years risk of mortality in SVD patients, independent of age, cognition, vascular comorbidity and MRI-markers of SVD. sNfL may serve as an easily obtainable and measurable predictive marker for mortality in SVD, potentially for both scientific investigations and clinical practice.

Disclosure: No

P0707 / 1302

DISEASE MODIFIERS IN CADASIL: A GENOTYPE-DRIVEN CROSS-SECTIONAL COHORT STUDY

R.J. Hack ¹, M. Cerfontaine¹, G. Gravesteijn¹, S. Tap¹, A. Hafkemeijer¹, J. van der Grond¹, M.-N. Witjes-Ané¹, J. Rutten¹, S. Lesnik Oberstein¹

¹ Leiden University Medical Center, Leiden, Netherlands

Background and aims: NOTCH3 pathogenic variant position has recently been shown to be an important modifier of CADASIL. No study has yet assessed the effect of other known CADASIL modifiers, i.e. cardiovascular risk factors (CVRF) and sex, in the context of NOTCH3 variant position. In this study, we assessed the relative contribution of CADASIL modifiers in a cross-sectional cohort of CADASIL patients, taking NOTCH3 variant position into account.

Methods: CADASIL patients harboring a pathogenic NOTCH3 variant located in one of the 34 epidermal growth-factor-like repeats (EGFr) domains underwent cognitive examination and brain MRI. Multivariable models were used to assess the effect of NOTCH3 variant position, CVRF and sex on clinical severity and SVD imaging markers.

Results: 200 individuals participated, of which 103 harbored a EGFr 1-6 variant and 97 a EGFr 7-34 variant. An EGFr 1-6 variant was the only modifier associated with an earlier onset of stroke (HR=2.44, 95%CI:1.39 – 4.29), higher WMH volume (B=0.62, 95%CI:0.46 – 0.77) and Peak width of Skeletonized Mean Diffusivity (B=26.37, 95%CI:17.60 – 35.15). Modifiers associated with disability were hypertension (OR=3.32, 95%CI:1.70 – 6.47) and male sex (OR=2.48, 95%CI:1.41 – 4.38). Modifiers associated with higher lacune volume were an EGFr 1-6 variant (OR=4.31, 95%CI:2.31 – 8.04), male sex (OR=3.64, 95%CI: 2.03 – 6.54) and hypertension (OR=2.43, 95%CI:1.23 – 4.81). Lower brain parenchymal fraction was associated with male sex (B=-2.81, 95%CI:-3.62 – -2.00) and diabetes (B=-2.22, 95%CI:-3.91 – -0.53).

Conclusions: This study shows that NOTCH3 variant position is the strongest modifier known to date in CADASIL, followed by sex, hypertension, diabetes.

Disclosure: No

P0708 / 848

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF RETINAL CAPILLARY MICROVESSELS PREDICT BRAIN VASCULAR DAMAGE AND DYSFUNCTION IN CEREBRAL SMALL VESSEL DISEASE

S.J. Wiseman ¹, J.-F. Zhang², C. Gray¹, C. Hamid¹, M. Valdés Hernández¹, L. Ballerini¹, M.J. Thrippleton¹, C. Manning¹, M. Stringer¹, E. Sleight¹, S. Muñoz Maniega¹, A. Morgan¹, Y. Cheng³, C. Arteaga Reyes¹, D. Jaime Garcia¹, U. Clancy¹, F.N. Doubal¹, B. Dhillon¹, T. MacGillivray¹, Y.-C. Wu², J.M. Wardlaw¹

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²Shanghai General Hospital, Department of Neurology, Shanghai, China, ³West China Hospital, Department of Neurology, Chengdu, China

Background and aims: Small vessel disease (SVD) is a major cause of stroke. Microvessels that relate to the brain could be revealed by retinal imaging using optical coherence tomography angiography (OCTA). The relationship of retinal capillary vessel density (VD) and vascular branching complexity, two parameters that are used to characterize the appearance of the vessel network in OCTA imaging, to brain imaging features of SVD has not been assessed.

Methods: We quantified VD and branching complexity from OCTA retinal imaging in stroke patients with SVD, and investigate the relationships with SVD lesions, white matter damage on diffusion tensor imaging (DTI) and cerebrovascular reactivity (CVR) to CO₂.

Results: In 123 patients (mean age 68.1 ± SD 9.9 years) retinal microvessels characteristics worsened with sub-visible markers of brain tissue damage (high mean diffusivity (MD); low fractional anisotropy (FA)) and lower CVR. We report right (R) and left (L) eyes separately. After adjusting for covariates, lower VD remained associated with higher MD (standardized β; R -0.16 [95%CI -0.32 to -0.01]) and lower CVR (L 0.17 [0.03 to 0.31] and R 0.19 [0.02 to 0.36]) in normal appearing white matter (NAWM). Sparser branching associated with sub-visible white matter damage shown by higher MD (R -0.24 [-0.08 to -0.40]), lower FA (L 0.17 [0.01 to 0.33]), and lower CVR (R 0.20 [0.02 to 0.38]) in NAWM.

Conclusions: OCTA-derived retinal capillary VD and branching complexity confirm microvascular morphological changes in SVD, correlating with subvisible white matter damage and impaired CVR.

Disclosure: No

P0709 / 1056

COMPOUND HETEROZYGOUS NOTCH3 MUTATIONS IN A FAMILY WITH CADASIL

A. Domínguez-Mayoral ¹, P. Menendez¹, A. Fuerte¹, S. Pérez-Sanchez¹, J. Montaner¹

¹ Virgen Macarena Hospital, Seville, Spain

Introduction: A compound heterozygous mutation (CHM) occurs when each parent donates one alternate allele and these alleles are located at different loci within the same gene. CHM are rare in CADASIL families.

Methods: We describe the clinical cases of a family studied in our monographic outpatient’s clinic on infrequent and genetic stroke. NOTCH3 was analized by massive sequencing. The HTRA1 concentration was measured in patient’s plasma by ELISA. Skin biopsies were examined with a transmission electron microscope.

Results: At the age of 28 years, the proband patient had a protuberancial ischemic stroke. His brother suffered a pure motor ischemic stroke treated with thrombolysis at the age of 42 years. Both patients had GOM deposits in the skin biopsies vessel walls and a CHM in NOTCH-3 (c.1241C>G and c.3421G>A). The sister had an ischemic stroke at the age of 32 due to a microvascular lession causing transient subcortical aphasia and right hemiparesis. The mother had recurrent small vessels ischemic strokes and vascular cognitive impairment. These last two patients had the c.1241C>G mutation. HTRA-1 values (ng/mL) were: proband patient 25.6, brother 19.5, sister 4.4 and mother 14.4. The father had a transient ischemic attack due to atrial fibrillation at the age of 72 years (c.3421G>A mutation).

Conclusions: We report the first Spanish CADASIL family with CHM. The mutation c.1241C>G is pathogenic and the other one is a variant of uncertain significance.

Disclosure: No

P0710 / 878

NEW CEREBRAL MICROBLEEDS AFTER CATHETER-BASED STRUCTURAL HEART INTERVENTIONS

T.B. Braemswig ¹, M. Kusserow², B. Bellmann³, F. Beckhoff³, M. Reinthaler³, J. Kruppa⁴, R. von Rennenberg¹, H. Erdur¹, J.F. Scheitz¹, I. Galinovic⁵, K. Villringer⁵, D.M. Leistner⁵, H.J. Audebert¹, M. Endres¹, U. Landmesser³, K.G. Haeusler⁶, J.B. Fiebach⁵, A. Lauten³, A. Rillig³, C.H. Nolte¹

¹Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany, ²Charité - Universitätsmedizin Berlin, Berlin, Germany, ³Charité - Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany, ⁴Charité - Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany, ⁵Charité - Universitätsmedizin Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany, ⁶Universitätsklinikum Würzburg, Department of Neurology, Würzburg, Germany

Background and aims: Occurrence of new cerebral microbleeds (CMBs) after intravenous thrombolysis (IVT) in acute ischemic stroke patients is associated with an increased risk of post-IVT hemorrhagic complications. Interestingly, new CMBs are reported to occur commonly (76%) in patients undergoing cardiac surgery using extrapulmonary bypass. Data on CMBs in patients undergoing catheter-based structural heart interventions are scarce. Therefore, the aim of this exploratory analysis was to assess occurrence and predictors of new CMBs in patients undergoing catheter-based left atrial appendage closure (LAAC) and percutaneous mitral valve repair (MVR) using the MitraClip^®-System.

Methods: Eligible patients for this exploratory analysis underwent cerebral magnetic resonance imaging (MRI) and cognitive testing before and after catheter-based LAAC and percutaneous MVR during hospital-stay. The T2*-weighted MRIs were co-registered using SPM12. A linear mixed model was used to estimate cognitive deterioration.

Results: New CMBs occurred in 17 out of 47 patients (36%) after the catheter-based structural heart interventions. Patients treated with catheter-based LAAC and percutaneous MVR did not differ regarding occurrence of new CMBs. Longer duration of the procedure was significantly associated with occurrence of new CMBs in multivariable regression analysis (adjusted odds ratio [per hour]: 4.58, 95% confidence interval: 1.36 – 19.6, p=0.022). Occurrence of new CMBs was not associated with short-term cognitive deterioration.

Conclusions: New CMBs occur in approximately one-third of patients after catheter-based, left-sided structural heart interventions and are associated with longer duration of the procedure. Future studies with long-term follow-up are needed to further investigate the clinical relevance of procedure-related CMBs.

Disclosure: No

P0712 / 831

CEREBRAL ARTERY PULSATILITY, BLOOD PRESSURE, AND SMALL VESSEL DISEASE ON BRAIN IMAGING

L. Li ¹, S. Mazzucco¹, G.KK Lau¹, M.A Tuna¹, P.M Rothwell¹, On behalf of the Oxford Vascular Study

¹ Oxford University, Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom

Background and aims: Increased pulsatility of cerebral blood flow has been proposed as a cause of cerebral small vessel disease (SVD), but the apparent association could be confounded by risk factors, especially their shared relationship with blood pressure (BP). We aimed to determine if cerebral pulsatility was independently associated with SVD.

Methods: In patients with TIA/minor ischaemic stroke in a population-based study in Oxfordshire, UK (Oxford Vascular Study/2002-2018), we determined the associations of cerebral pulsatility measured on Transcranial Doppler (middle cerebral artery pulsatility index/MCA-PI) and SVD measured on MRI brain (total SVD score and individual markers) adjusting for age, sex, vascular risk factors, baseline BP, all BP measurements made in primary care up to 20 years premorbidly. We used mediation analysis to assess the contribution of MCA-PI on the causal pathway between BP and SVD.

Results: Among 1035 consecutive patients (mean/SD age=66/14.8), MCA-PI was independently associated with higher SVD burden in the fully adjusted model (top vs. bottom quartile: aOR=2.67, 95%CI 1.55-4.60), with consistent findings for each individual SVD marker (lacunes/cerebral microbleed/enlarged perivascular spaces/white matter hyperintensitites). In fully adjusted mediation analysis, 25.0% of the association between premorbid mean systolic BP and SVD was mediated by MCA-PI.

Conclusion: In patients with TIA/minor ischaemic stroke, cerebral pulsatility was positively and independently associated with the severity of SVD on MRI brain, and a significant proportion of the association between BP and SVD was mediated by MCA-PI.

Disclosure: No

P0713 / 140

SMALL VESSEL DISEASE AND LEPTOMENINGEAL COLLATERALS IN PATIENTS WITH LARGE VESSEL ISCHEMIC STROKE TREATED WITH THROMBECTOMY

G. Forestier ¹, R. Agbonon², N. Bricout³, W. Benhassen², G. Turc⁴, M. Bretzner⁵, M. Pasi⁶, J. Benzakoun², P. Seners⁴, T. Personnic⁶, L. Legrand², D. Trystram², C. Rodriguez-Regent², A. Charidimou⁷, N.S. Rost⁷, S. Bracard⁸, F. Clarençon⁹, O.F. Eker¹⁰, N. Nighoghossian¹¹, C. Cordonnier⁶, C. Oppenheim², O. Naggara², H. Henon⁶, G. Boulouis²

¹Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital / CHU Limoges, Neuroradiology, Paris, France, ²Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Neuroradiology, Paris, France, ³Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC), Neuroradiology, Lille, France, ⁴Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Neurology, Paris, France, ⁵Lille University, Neuroradiology, Lille, France, ⁶Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Neurology, Lille, France, ⁷J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Department of Neurology, Boston, United States, ⁸Université de Lorraine, Inserm, IADI, CHRU Nancy, Department of Diagnostic and Interventional Neuroradiology, Nancy, France, ⁹Pitié-Salpêtrière University Hospital, Neuroradiology, Paris, France, ¹⁰Pierre Wertheimer Hospital, Hospices Civils de Lyon, Neuroradiology, Lyon, France, ¹¹Hospices Civils de Lyon, Claude Bernard University Lyon 1, Neurology, Lyon, France

Objective: To determine the influence of the cerebral small vessel disease (cSVD) burden on collateral recruitment in patients treated with mechanical thrombectomy (MT) for anterior circulation acute ischemic stroke (AIS).

Methods: Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. Collaterals adequacy was assessed using the American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology (ASITN/SIR) score on digital subtraction angiography, and dichotomized as good (3,4) versus poor (0-2) collaterals. The cSVD burden was rated with the global cSVD score on MRI. Multivariable logistic regression analyses were used to determine relationships between cSVD and ASITN/SIR scores.

Results: A total of 312 participants were included (53.2% males, mean age 67.8 ± 14.9 years). Two hundred and seven patients had poor collaterals (66.4%), and 133 (42.6%) presented with any cSVD signature. In multivariable analysis, patients demonstrated worse leptomeningeal collaterality with increasing cSVD burden before and after adjustment for cSVD risk factors (adjusted odds ratio [aOR] 0.69; 95%CI [0,52-0,89]; p=0.005 and aOR 0.66; 95%CI [0.5-0.88], p =0.004 respectively). Using individual cSVD markers, poor collaterals were significantly associated with presence of lacunes (aOR 0.40, 95% CI [0.20–4.43], p = 0.007).

Conclusion: Our study provides evidence that in patients with AIS due to LVO treated with MT, the burden of cSVD assessed by pretreatment MRI, is associated with less robust recruitment of leptomeningeal collaterals.

Disclosure: No

P0714 / 418

FRAILTY AND DEMENTIA RISKS IN ASYMPTOMATIC CEREBRAL SMALL VESSEL DISEASE: A LONGITUDINAL COHORT STUDY

C.-P. Chung ¹

¹ Taipei Veterans General Hospital, Neurological Institute, Taipei, Taiwan, Province of China

Background and aims: Frailty has been shown to predict adverse outcomes in several diseases. We aimed to evaluate the associations between frailty profiles and dementia risk in a community-based population with asymptomatic cerebral small vessel disease (CSVD).

Methods: Individuals with asymptomatic CSVD were recruited from the community-based I-Lan Longitudinal Aging Study between 2011 and 2014 (baseline) and were followed up between 2018 and 2019. All participants underwent 3T brain MRI, as well as physical and cognitive assessments at baseline. Univariate and multivariate logistic regression analyses were performed.

Results: Among 261 participants with asymptomatic CSVD (64.8[8.4] years; 136[52.1%] men), 13(5.0%) developed dementia during a mean follow-up of 5.7(0.7) years. Dementia converters had less frequent robustness (30.8%vs.61.5%) and more frequent pre-frail/frail (69.2%vs.38.5%) than non-converters (p=0.040). Meanwhile, there was significantly more frequent mobility frailty (53.8% vs. 19.8%, p=0.009), but a similar prevalence of non-mobility frailty in dementia converters compared with non-converters. Univariate analyses showed that neither frailty severity nor CSVD burden was associated with a higher risk of dementia; it was the frailty subtype, the mobility frailty, which was significantly associated with dementia conversion in participants with asymptomatic CSVD, with an odds-ratio of 4.8 (95% CI = 1.5-14.8, p=0.007). The significance remained after adjusting for age, sex, education, baseline cognitive function, frailty severity, and CSVD score respectively.

Conclusion: Mobility frailty might be involved in the pathology of cognitive decline in CSVD and potentially serve as a marker to identify people at risk of dementia at an early stage of CSVD.

Disclosure: No

P0715 / 1350

SPATIAL DISTRIBUTION AND PREDICTORS OF INCIDENT LACUNES IN CEREBRAL SMALL VESSEL DISEASE: THE RUN DMC STUDY WITH 14-YEAR FOLLOW-UP

F. Yi ^1,2,3, M. Cai¹, M.A. Jacob¹, A.M. Tuladhar¹, F.-E. de Leeuw¹

¹Radboud University Medical Centre;Donders Centre for Medical Neurosciences, Neurology, Nijmegen, Netherlands, ²Xiangya Hospital,Central South University, Geriatrics, Changsha, China, ³National Clinical Research Centre for Geriatric Disorders, Changsha, China

Background and aims: The etiology of incident lacunes is unclear. They occur either in isolation or in close relationship with white matter hyperintensities (WMH), suggesting a shared pathophysiology. We investigated predictors and spatial distribution of incident lacunes in relation to WMH and isolated in deep gray matter over 14 years follow-up in SVD patients.

Methods: 503 patients with sporadic SVD from the ongoing longitudinal RUN DMC study with baseline assessment in 2006 and follow-up in 2011, 2015, and 2020. 382 participants who underwent at least two serial brain MRI scans were included. Incident lacunes were manually identified and the spatial relationships between incident lacunes and WMH were identified using a visual rating scale.

Results: 80 incident lacunes were identified in 43 patients (mean age 66.5±8.2 years, 37.2% women) during a mean follow-up time of 11.2±3.3 years (incidence rate 0.018 lacune/py). 60% of incident lacunes were in the subcortical white matter and 62% showed no contact with pre-existing WMH. Diastolic blood pressure (OR1.05, 95%CI:1.01-1.08), diabetes (OR2.32, 95%CI:0.97-5.26), WMH volume (OR1.05, 95%CI:1.02-1.07) were independent predictors for incident lacunes. No difference in risk factors was observed between patients with incident gray or white matter lacune-only. Patients with incident lacunes developed at the edge or inside of WMH had higher WMH volume.

Conclusions: The majority of incident lacunes occurred in isolation of preexisting MRI markers of SVD, suggesting a potential distinct relation between incident lacunes and WMH in sporadic SVD.

Disclosure: No

P0716 / 975

INTRACEREBRAL HEMORRHAGE – A PHENOTYPE OF COL4A1/2 MUTATIONS

M. Serôdio ¹, M. Magriço¹, M. Viana Baptista^1,2

¹Centro Hospitalar Lisboa Ocidental, Neurology, Lisboa, Portugal, ²NOVA Medical School | Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Chronic Diseases Research Centre (CEDOC), Lisboa, Portugal

Background and aims: COL4A1/2 genes are responsible for coding α1 and 2 chains of type IV collagen, which is present in the basement membrane of intracranial endothelium, among other tissues. Mutations of these genes are rare but increasingly reported, being involved in several neurological phenotypes. Most frequently described are porencephaly, infantile intracerebral hemorrhage (ICH), ocular disturbances, hereditary angiopathy with nephropathy, aneurysms, and muscle cramps (HANAC) syndrome, stroke and leukoencephalopathy in young age, and less frequently malformations of cortical development. Reported cases of COL4A1/2 duplications manifesting as deep ICH in the young adult are seldom.

Methods: Case report and review of the literature.

Results: A 40-year-old female, smoker and under oral contraception, suffered a left thalamic ICH, with somnolence and a left sensitive-motor syndrome. CT and MRI documented the lesion and showed bilateral lacunae and extensive leukoencephalopathy. Due to the young age, paucity of vascular risk factors and relevant personal/familial history, the patient was submitted to a small-vessel disease genetic panel that showed pathogenic duplication of the long arm of chromosome 13 involving COL4A1/2 genes. On follow-up, the patient recovered completely and suffered no further strokes. There was no involvement of other organ systems, and a new brain MRI did not show new lesions.

Conclusions: The presence of deep ICH in a young patient without vascular risk factors (namely without arterial hypertension) should raise suspicion for genetically determined small-vessel disease. Mutations of COL4A1/2 ought to be a diagnostic hypothesis, even with no further typical manifestations of these genotypes.

Disclosure: No

P0717 / 731

CEREBRAL SMALL VESSEL DISEASE AND COLLATERAL RECRUITMENT IN LARGE-VESSEL OCCLUSION STROKE

M. Haidegger ¹, U. Wießpeiner², M. Kneihsl¹, S. Fandler-Höfler¹, E. Hassler², M. Magyar², H. Deutschmann², S. Eppinger^1,2, B. Poltrum¹, C. Enzinger¹, T. Gattringer^1,2

¹Medical University of Graz, Neurology, Graz, Austria, ²Medical University of Graz, Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Graz, Austria

Background and aims: Preexisting cerebral small vessel disease (SVD) might impair recruitment of leptomeningeal collaterals in case of large vessel occlusive stroke. We sought to investigate the impact of SVD including its different morphological features on collateral status in acute stroke patients treated with mechanical thrombectomy.

Methods: We included consecutive stroke patients undergoing mechanical thrombectomy for anterior circulation large-vessel occlusion with available baseline CT-angiography which served to assess collateral status via the TAN score. White matter hyperintensities, microbleeds, enlarged perivascular spaces and lacunes were rated on postinterventional MRI blinded to collateral status. Furthermore, a quantitative SVD score combining different SVD features was calculated. Multivariable regression analysis was used to investigate the relationship between SVD and collaterals.

Results: 206 patients were included (mean age 68±12 years, 51% female). Overall, 37% had poor collateral recruitment (TAN scores 0-1, as opposed to 2-3). Neither severity of white matter hyperintensities (OR: 1.47 [95% CI: 0.72-2.97]), presence of lacunes (OR: 0.75 [95% CI: 0.40-1.40]), cerebral microbleeds (OR: 1.19 [95% CI: 0.63-2.25]), nor enlarged perivascular spaces (OR: 0.71 [95% CI: 0.37-1.40]) were associated with poor collaterals after correction for age, sex and vascular risk factors. The SVD score was also not related to collateral status (p=0.384).

Conclusions: This study shows no association of cerebral small vessel disease and its different morphological features with collateral recruitment in patients with large vessel occlusive stroke receiving mechanical thrombectomy.

Disclosure: No

P0718 / 675

CEREBRAL AMYLOID ANGIOPATHY IS ASSOCIATED WITH INTRACORTICAL LOBAR CEREBRAL MICROBLEEDS

P.-Y. Kuo ¹, B.-C. Lee², Y.-F. Chen², J.-S. Jeng³, L.-K. Tsai³, H.-H. Tsai^3,4

¹National Taiwan University, College of Medicine, Taipei, Taiwan, Province of China, ²National Taiwan University Hospital, Department of Medical Imaging, Taipei, Taiwan, Province of China, ³National Taiwan University Hospital, Department of Neurology, Taipei, Taiwan, Province of China, ⁴National Taiwan University Hospital Bei-Hu Branch, Department of Neurology, Taipei, Taiwan, Province of China

Background and aims: Lobar cerebral microbleed (CMB) is common in both cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease (HTN-SVD). Our aim was to investigate the cortico-subcortical topography in different SVDs.

Methods: Eighty-eight patients of spontaneous intracerebral haemorrhage with at least one lobar CMB were included to receive brain MRI and amyloid PET using 11C-Pittsburgh Compound B (PiB). The lobar CMBs were categorized into intracortical, juxtacortical, or subcortical area based on their relative location to cortex. The associations between CAA and lobar CMB distribution were evaluated in univariate and multivariable models. The correlation between cerebral amyloid load and lobar CMB distribution was further examined based on PiB standardized uptake value ratio (SUVR).

Results: Compared to patients with HTN-SVD (n=64, 63.1 ±11.5 years), patients with CAA (n=24, 75.2 ± 9.5 years) had a higher prevalence of intracortical CMBs (79.2% vs. 50%, p=0.016) but a lower prevalence of subcortical CMBs (8.3% vs. 59.4%, p<0.001). In multivariable model adjusted for other neuroimaging markers, absence of subcortical CMB (odds ratio 19.2 [1.6-236.9], p=0.021) is independently associated with CAA. PiB SUVR is positively correlated to intracortical CMB number (spearman’s rho=0.38, p<0.001) but negatively correlated to subcortical CMB number (spearman’s rho=-0.22, p=0.047). The association between PiB SUVR and intracortical CMB number remains significant in partial correlation analysis adjusted for age (p=0.001).

Conclusions: Patients with absence of subcortical CMBs and more intracortical CMBs are associated with clinicoradiological diagnosis of CAA and increased amyloid load on PET, suggesting underlying CAA pathology.

Disclosure: No

P0719 / 511

ASSOCIATIONS BETWEEN SLEEP APNEA RISK AND OXYGEN DESATURATION INDICES WITH CEREBRAL SMALL VESSEL DISEASE IN PATIENTS WITH STROKE

X. Liu ¹, D.C.-L. Lam², H.K.-F. Mak³, M.S.-M. Ip², K.K. Lau^1,4

¹The University of Hong Kong, Division of Neurology, Department of Medicine, Hong Kong, Hong Kong, SAR of China, ²The University of Hong Kong, Division of Respiratory Medicine, Department of Medicine, Hong Kong, Hong Kong, SAR of China, ³The University of Hong Kong, Department of Diagnostic Radiology, Hong Kong, Hong Kong, SAR of China, ⁴The University of Hong Kong, The State Key Laboratory of Brain and Cognitive Sciences, Hong Kong, Hong Kong, SAR of China

Background and aims: Obstructive sleep apnea (OSA) is associated with cerebral small vessel disease (SVD). Whether OSA-risk determined by STOP-BANG questionnaire or oxygen desaturation indices quantified by polysomnography (PSG) predicts worse cerebral SVD burden in stroke patients remains uncertain.

Methods: We recruited transient ischemic attack (TIA)/minor stroke patients from the Queen Mary Hospital Acute Stroke Unit and TIA/Stroke Outpatient Clinics during 2018-2021. We determined OSA-risk, oxygen desaturation indices [oxygen desaturation index (ODI), percentage of total desaturation time from total sleep time (DT%), minimum SpO₂ and percentage of total sleep time with an oxygen saturation<90% (CT90%)] by home PSG and studied their associations with total SVD score on MRI.

Results: In 283 patients with TIA/minor stroke (mean age 65.2 years, 64% males), OSA-risk was significantly associated with total SVD score after adjusting for age, sex, stroke history, vascular risk factors (blood pressure, hyperlipidaemia, diabetes, atrial fibrillation, smoking) and alcohol-use: [odds ratio: 1.23, 95% confidence interval (1.01-1.51)]. In 85/283 patients with PSG performed, other than the conventional apnea-hypopnea index (AHI), ODI and DT% were significantly associated with total SVD score after covariates adjustment: ODI [1.04 (1.01-1.07)], DT% [1.04 (1.01-1.08)].

Conclusions: In patients with TIA/minor stroke, OSA-risk measured by STOP-BANG and indices describing the severity of intermittent hypoxemia (ODI and DT%) other than AHI were significantly associated with a higher cerebral SVD burden. Further large-scaled prospective studies to determine whether nocturnal hypoxemia may contribute to cerebral SVD development and whether these indices provides additional information, over and above AHI, are warranted.

Disclosure: No

P0720 / 489

COMPUTATIONAL MEASURES OF PERIVASCULAR SPACE BURDEN IN THE BRAIN SHOW SENSITIVITY TO CARDIOVASCULAR RISK FACTORS

J. Bernal ¹, M. Valdés-Hernández¹, J. Escudero¹, R. Duarte¹, U. Clancy¹, F.N. Doubal¹, M.S. Stringer¹, M.J. Thrippleton¹, R.M. Touyz², J.M. Wardlaw¹

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²McGill University, Research Institute of the McGill University Health Centre, Montréal, Canada

Background: Long-term exposure to cardiovascular risk factors can harm cerebral micro-vessels, causing endothelial dysfunction and damaging the brain parenchyma. Visibility of perivascular spaces (PVS) on MRI is thought to be an early feature. Here, we investigate whether common cardiovascular risk factors (BP, smoking, diabetes) predict PVS burden.

Methods: We recruited patients with a recent non-disabling stroke. We assessed age, biological sex (f/m), mean arterial pressure (MAP=DBP+(SBP-DBP)/3), smoking history (never/ever), and diabetes diagnosis (no/yes). On T2-w MRI, we measured total PVS count and volume in the basal ganglia (BG) and centrum semiovale (CSO) computationally. We used multiple linear regression to test whether MAP, diabetes, and smoking predicted PVS measurements.

Results: Amongst 105 patients (34 female; median age 69.16 [IQR 59.88–75.47]), PVS count ranged from 81-2788 and volume normalised to intracranial volume from 0.03-0.82%.

Each mmHg higher MAP multiplies PVS counts and volumes by 1.008 [95%CI 1.001-1.016] and 1.011 [95%CI 1.001-1.022] in BG and by 1.014 [95%CI 1.001-1.027] and 1.014 [95%CI 1.001-1.028] in CSO (p-value<0.05 consistently).

Ever smokers presented higher PVS counts than never smokers (BG: 162.0 [95%CI 138.0-190.0] vs 124.0 [95%CI 104.0-148.0], Tukey test, p-value=0.004; CSO: 368.0 [95%CI 289.0-469.0] vs 265.0 [95%CI 204.0-346.0], Tukey test, p-value=0.02).

Diabetes was not associated with PVS burden (p-value>0.1).

Conclusions: Computational PVS measures are sensitive to small changes in risk factors. Smoking is associated with high PVS counts and MAP with PVS count and enlargement. These data suggest that even subtle changes in cardiovascular risk factors may adversely affect small vessel health and PVS status.

Disclosure: No

P0721 / 1395

FACTORS PROMOTING LEUKOARAIOSIS IN PATIENTS WITH CEREBRAL LARGE VESSEL OCCLUSION

T. Peisker ¹, P. Vasko¹, P. Mikulenka¹, K. Kremenova², B. Koznar³, J. Sulzenko³, I. Stetkarova¹

¹University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Neurology, Prague, Czech Republic, ²University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Radiology, Prague, Czech Republic, ³University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Cardiology, Prague, Czech Republic

Background and aims: Leukoaraiosis (LA) is a radiological hallmark of cerebral microangiopathy. It is supposed to worsen the clinical outcome in patients with acute ischemic stroke due to large vessel occlusion (LVO). The aim of our project was to assess the impact of LA on the clinical outcome and to evaluate the factors promoting LA in patients with coexistent LVO.

Methods: We analysed the group of 146 patients with acute ischemic stroke who underwent a successful mechanical recanalization of LVO. We investigated the presence of leukoaraiosis on initial CT. Further we noted the demografical data, the charge of vascular risk factors (hypertension, diabetes, smoking, atrial fibrilation) and the collateral status according to the modified Tan score on initial CT angiography.

Results: LA was detected in 70 patients (48%) and it was significantly negatively correlated with good clinical outcome in 90 days. In the logistic regression analysis LA was strongly associated with increased age and female sex (p<0,01) and it was linked to the diabetes (p<0,05). Neither collateral status nor other registered vascular risk factors were related to LA in our observation.

Conclusion: Leukoaraiosis in patients with acute LVO stroke is negatively related to good clinical outcome and is linked with increased age, female sex and diabetes, but a clear connection with leptomeningeal collaterals was not proved. The pathways of detrimental role of LA and diabetes in LVO strokes are to be determined.

Supported by Charles University research program PROGRES Q35 and UNCE/MED/002.

Disclosure: No

P0722 / 644

RISK PROFILE AND CEREBRAL SMALL VESSEL DISEASE MARKERS OF LACUNAR STROKE VERSUS DEEP INTRACEREBRAL HAEMORRHAGE

Y. Cheng ¹, M. C. Valdés Hernández², M. Xu¹, J. Liu¹, W. Tao¹, Q. Wu¹, B. An³, H. Zhao³, X. Pan³, B. Wu¹, M. Liu¹

¹West China Hospital, Sichuan University, Department of Neurology, Chengdu, China, ²Centre for Clinical Brain Sciences, Edinburgh Imaging and the UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom, ³Baotou Central Hospital, Department of Neurology, Baotou, China

Background and aims: It remains unclear what predisposes cerebral small vessel disease (SVD) to lacunar stroke (LS) in some and to deep intracerebral haemorrhage (dICH) in others. We compared risk factors and neuroimaging markers of SVD in patients with LS or dICH.

Methods: We enrolled consecutive patients with MRI-confirmed LS or dICH from two comprehensive stroke centres in China (2010–2021). Presence of lacunes, cerebral microbleeds (CMB), white matter hyperintensity (WMH) volumes and enlarged perivascular spaces (PVS) were assessed on MRI. We compared clinical and neuroimaging characteristics in ICH versus LS using logistic regression.

Results: We included 834 patients with LS (mean age, 62 ± 12 years) and 405 with dICH (58 ± 13 years). Hypertension was common in both groups (72.3% vs. 74.8%). Older age, diabetes, dyslipidaemia, smoking, and prior ischaemic stroke/TIA were associated with LS (adjusted odds ratio [aOR] [95%CI] 0.97 [0.96–0.98], 0.35 [0.24–0.48], 0.32 [0.22–0.44], 0.31 [0.22–0.44], and 0.33 [0.16–0.63]). Alcohol drinking and prior ICH were associated with dICH (aOR [95%CI] 2.33 [1.68–3.27], and 2.52 [1.30–4.91]). Lacunes were more frequent in LS (aOR [95%CI] 0.23 [0.12–0.44]). CMB and basal ganglia PVS counts >10 were more frequent in dICH (aOR [95%CI] 5.14 [2.81–9.80], and 2.73 [1.44–5.29]). WMH volumes were not different between groups (aOR [95%CI] 0.93 [0.73–1.18]).

Conclusions: Although shared with hypertension, SVD-related stroke may depend on distinct risk factor profiles and underlying SVD pathology predisposing to ischaemia or haemorrhage. This might be useful for disease risk stratification.

Disclosure: No

P0723 / 685

INSULIN RESISTANCE BASED ON POST-GLUCOSE LOAD MEASURE IS ASSOCIATED WITH PREVALENCE AND BURDEN OF SMALL VESSEL DISEASE

M. Zhou ¹, Y. Wang², Y. Pan²

¹Capital Medical University, Beijing, China/Beijing Tiantan Hospital, Department of Neurology, Beijing, China, ²Capital Medical University, Beijing, China/Beijing Tiantan Hospital, Beijing, China

Background and aims: Insulin resistance is critical in the development of macro- and micro-vascular events. However, the association of insulin resistance with cerebral small vessel disease (cSVD) is controversial. We aimed to estimate the association between insulin resistance and cSVD, using two different proxies, the insulin sensitivity index (ISI_0,120) and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)

Methods: The Polyvascular Evaluation for Cognitive Impairment and Vascular Events study recruited 3670 community-dwelling adults. We estimated the association of insulin resistance, using ISI_0,120 and HOMA-IR, with cSVD in those without history of diabetes mellitus. Cerebral SVD was measured for both main neuroimaging manifestations and total SVD burden scores.

Results: A total of 2752 subjects were enrolled. In the multivariable logistic regression analysis, the first quartile of ISI_0,120was associated with increased risk of lacunes (adjusted OR 1.96, 95% CI 1.15-3.36, P =0.01) and sever age-related white matter changes (adjusted OR 1.97, 95% CI 1.15-3.38, P =0.01), and higher total SVD burden (adjusted cOR 1.34, 95% CI 1.04-1.72, P =0.02 for 4-point scale; adjusted cOR 1.43, 95% CI 1.14-1.79, P =0.002 for 6-point scale). The association was only found between HOMA-IR and lacunes (adjusted OR 1.90, 95% CI 1.11-3.25, P =0.02) and 4-point scale of total SVD burden (adjusted cOR 1.33, 95% CI 1.04-1.70, P =0.03).

Conclusions: Insulin resistance was found to positively associate with cSVD, with ISI_0,120 presenting a more distinct association compared to HOMA-IR. It suggested the ISI_0,120 might be a more sensitive tool for predicting the risk of cSVD.

Disclosure: No

P0724 / 673

CLINICAL MANIFESTATIONS OF DEEP PERFORATOR SMALL VESSEL DISEASE: COMPARISON OF INTRACEREBRAL HAEMORRHAGES VERSUS LACUNAR ISCHAEMIC STROKE

M.B Goeldlin ^1,2, J.-L. Vynckier^1,3, M. Mueller^1,2, B.M Siepen^1,2, A. Hakim⁴, J. Kaesmacher^4,2, M. Jesse⁵, M. Mueller⁵, T.R Meinel^1,2, M. Beyeler^1,2, L. Clénin¹, B. Maamari¹, J. Gralla⁴, W. Z’Graggen^1,5, D. Bervini⁵, M. Arnold¹, U. Fischer^6,1, D.J Seiffge¹

¹Inselspital Bern University Hospital and University of Bern, Department of Neurology, Bern, Switzerland, ²University of Bern, Graduate School for Health Sciences, Bern, Switzerland, ³Onze-Lieve-Vrouwziekenhuis Campus Aalst, Department of Neurology, Aalst, Belgium, ⁴Inselspital Bern University Hospital and University of Bern, University Institute for Diagnostic and Interventional Neuroradiology, Bern, Switzerland, ⁵Inselspital Bern University Hospital and University of Bern, Department of Neurosurgery, Bern, Switzerland, ⁶University Hospital Basel, Department of Neurology, Basel, Switzerland

Background: Deep perforator arteriolopathy is the leading etiology of intracerebral haemorrhage (ICH) and lacunar strokes (LS) located in deep, non-lobar brain regions. We compared clinical and MRI characteristics and outcomes in patients with deep ICH and LS.

Methods: We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry (2013-2019). We assessed MRI markers of small vessel disease (SVD), calculating overall burden. Co-primary outcomes were modified Rankin Scale (mRS) and new ischaemic stroke or ICH at 3-months.

Results: We included 711 patients, 112 patients (15.8%) with deep ICH (mean age (SD) 65(±15.1) years, 36.8% female) and 599 patients (84.2%) with LS (mean age (SD) 69.7(±13.6) years, 39.9% female). Deep ICH was independently associated with higher SVD burden score (aOR 3.2, 95%-CI 2.2-4.7). At 3 months, deep ICH was associated with higher mRS (ordinal shift: aOR 2.2, 95%-CI 1.2-4.0). Risk of ischaemic strokes was numerically higher in deep ICH (8.6%) compared to LS (2.9%; p=0.046), but attenuated after adjustment for confounders (e.g. atrial fibrillation; aOR 2.9, 95%-CI 0.96-8.7). Recurrent ICH within 3 months occurred in only two patients with ICH, but none with LS.

Conclusions: Deep perforator arteriolopathy manifesting as ICH is less frequent but characterized by more severe disease burden on MRI and worse outcome compared to LS. The risk of subsequent ischaemic stroke seems at least as high in deep ICH as in LS, advocating for shared pathomechanisms with potential consequences for future secondary prevention strategies.

Disclosure: Yes

P0725 / 687

MEDIATION OF THE RELATIONSHIP BETWEEN INSULIN RESISTANCE AND CEREBRAL SMALL VESSEL DISEASE BY BLOOD PRESSURE IN NONDIABETIC SUBJECTS

M. Zhou ¹, Y. Wang¹, Y. Pan¹

¹ Capital Medical University / Beijing Tiantan Hospital, Beijing, China

Background and aims: To investigate whether blood pressure (BP) mediates the relationship between insulin resistance and cerebral small vessel disease (cSVD) in non-diabetic subjects.

Methods: In subjects without history of diabetes mellitus (the Polyvascular Evaluation for Cognitive Impairment and Vascular Events study, NCT03178448), resting BP was measured at baseline survey. Insulin resistance was evaluated by the insulin sensitivity index (ISI_0,120) and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) based on the standard oral glucose tolerance test. Neuroimaging features of cSVD were interpretated according to the STRIVE standard, and total burden scores were calculated. Mediation analysis was performed to examine the potential mediation role of BP in the association between insulin resistance and cSVD.

Results: Nondiabetic subjects (n=2752 [1457 females]) aged 60.9±6.6 years on average were included. Multivariable logistic regression model and General linear regression model tested the association of insulin resistance with systolic BP (SBP)/diastolic BP (DBP) and cSVD, and of SBP/DBP with cSVD. In the mediation analysis, SBP mediated 35.8%, 58.5%, and 40.4%, whereas DBP mediated 43.3%, 67.9%, and 48.4% of the detrimental effect of insulin resistance (assessed by ISI_0,120) on WMH burden, and total burden of cSVD (both total SVD score and modified total SVD score), respectively. When insulin resistance was assessed using HOMA-IR, the mediator SBP and DBP explained 67.3% and 79.0% of the association of insulin resistance with total SVD score, respectively.

Conclusions: We found that SBP/DBP plays a partial mediation role in the association between insulin resistance and WMH and total SVD burden.

Disclosure: No

P0726 / 1592

SHARED TRAJECTORIES OF AFFECTIVE AND COGNITIVE CHANGES IN PATIENTS WITH SMALL VESSEL DISEASE INDICATE INCREASED VASCULAR BRAIN BURDEN

A. Pavlović ¹, A. Stevanovic², M. Mijajlovic², N. Stojanovski², G. Tomic², J. Zidverc Trajkovic²

¹University of Belgrade, Faculty for Special Education and Rehabilitation, Belgrade, Serbia, ²University of Belgrade, Faculty of Medicine, Belgrade, Serbia

Background and aims: Cerebral small vessel disease (SVD) is associated with both cognitive decline (CD) and affective disorders. We aimed to analyse trajectories of affective and cognitive decline after the first-ever lacunar stroke.

Methods: A cohort of SVD patients was followed up for 4 years after the qualifying event for the development of depression and CD. All patients underwent clinical, neuropsychological, and magnetic resonance imaging (MRI) evaluation.

Results: A total of 257 patients were analysed, mean age 64.9±8.7 years, 54.1% female. On follow-up, 166 (64.6%) met criteria for CD and 113 (44.0%) for depressive disorder. Both CD and depression were present in 104 cases, only CD in 62, and only depression in 9 patients. Patients with CD were older (p=0.006) and more frequently female (p<0.0001) compared to CD-free cases, regardless of depressive symptom status. All symptomatic patients had a more severe total burden of SVD on MRI compared to depression-free/CD-free cases (p<0.0001). On the Fazekas scale, more severe periventricular (PV) white matter hyperintensities were detected in patients with only depression and patients with both depression and CD (p<0.05). Patients with both depression and CD exhibited the most severe scores of total SVD burden, both PV and subcortical (SC), compared to all other subgroups. In cases with CD but no depression, SC hyperintensities were more severe than PV. Patients with only depression had the best functional status (p<0.0001).

Conclusions: Subgroups of SVD patients with different cognitive and behavioral trajectories may indicate different severity and distribution of vascular brain changes.

Disclosure: No

P0727 / 591

THE INTERACTION EFFECT BETWEEN CEREBRAL LARGE-VESSEL DISEASES AND SMALL VESSEL DISEASE IN THE NICE POPULATION

R. Wang¹, R. Wang¹, Z. Guo¹, J. Xu¹, Y. Cao ¹

¹ Second Affiliated Hospital of Soochow University, Neurology, Suzhou, China

Background and aims: This study aims to investigate the relationship between cerebral large-vessel diseases and cerebral small vessel disease (CSVD) in Non-disabling ischemic cerebrovascular events (NICE) population, and the effect of different CSVD imaging features and cerebral artery stenosis on cognition.

Methods: Eligible patients were included from March 2018 to August 2019. Demographic data, large-vessel diseases indicators, CSVD imaging markers and MMSE score were collected. Logistic regression models were used to explore the relationship between cerebral large-vessel diseases and CSVD, the effect of different patterns of CSVD imaging features and cerebral artery stenosis on cognition.

Results: Included people were 204 patients (average age 64.82 years; 38.2% female). 66.2% of the patients had cerebral artery plaques. The proportion of patients with lacunes, PVWMH, DWMH, EPVS in basal ganglia, severe EPVS in centrum semiovale was 52.0%, 43.1%, 27.5%, 42.6%, 42.2%. 33.8% of the patients had cognitive dysfunction. The group with multiple plaques were older, had lower creatinine clearance rate, with more severe PVWMH and severe DWMH (P<0.05). Right carotid Intima-media thickness (IMT) (OR=62.03, P=0.0057) and left carotid IMT (OR=19.42, P=0.0326) were associated with the presence of lacune. The risk of cognitive impairment is higher in patients with intracranial and/or extracranial artery stenosis combined with severe CS-EPVS (OR=3.03, P=0.0418).

Conclusions: Large-vessel diseases coexist with CSVD imaging damages, and various risk factors coexist. Patients with artery stenosis combined CSVD imaging lesions are at higher risk for cognitive impairment. The prevention strategies for atherosclerotic stroke may also be applicable to CSVD patients.

Table 1.

Comparison between groups with and without multiple cerebral artery plaques.

Variables	Without multiple plaques (n=105)	With multiple plaques (n=105)	P Value
Age	60.97 (10.77)	68.90 (10.15)	<0.001
Female	46 (43.81%)	32 (32.32%)	0.092
Systolic blood pressure (mmHg)	148.67 (23.18)	153.44 (20.52)	0.122
Systolic blood pressure (mmHg)	84.78 (14.57)	82.36 (12.61)	0.207
BMI (kg/m2)	24.80 (22.90-27.30)	23.90 (22.00-26.30)	0.122
Ccr[mL/(min×1.73m2)]	94.76 (78.30-114.01)	77.29 (63.39-101.06)	<0.001
TC (mmol/L)	4.68 (4.20-5.38)	5.01 (4.25-5.48)	0.476
TG (mmol/L)	1.31 (0.98-2.01)	1.31 (0.96-1.85)	0.163
HDL-C (mmol/L)	1.13 (0.91-1.29)	1.15 (0.89-1.35)	0.377
LDL-C (mmol/L)	2.79 (2.40-3.31)	3.01 (2.40-3.51)	0.308
Hcy (μmol/L)	9.95 (8.12-12.40)	10.40 (8.43-13.50)	0.664
Baseline NIHSS score	1.00(0.00-2.00)	1.00(1.00-2.00)	0.834
Hypertension	77 (73.33%)	81 (81.82%)	0.147
Diabetes	24 (22.86%)	27 (27.27%)	0.467
Dyslipidemia	61 (58.10%)	61 (61.62%)	0.608
Atrial fibrillation	4 (3.81%)	6 (6.06%)	0.457
Coronary heart disease	1 (0.95%)	2 (2.02%)	0.527
History of smoking	50 (47.62%)	48 (48.48%)	0.902
History of alcoholism	15 (14.29%)	14 (14.14%)	0.976
Cerebral lacuna	45 (42.86%)	61 (61.62%)	0.007
Severe PVWMH	37 (35.24%)	51 (51.52%)	0.019
Severe DWMH	21 (20.00%)	35 (35.35%)	0.014
Severe BG - EPVS	40 (38.10%)	47 (47.47%)	0.176
Severe CS - EPVS	45 (42.86%)	41 (41.41%)	0.835

BMI=Body Mass Index, Ccr=Endogenous creatinine clearance, TC=triglycerides, TG=Triglycerides, HDL-C=High density lipoprotein cholesterol, LDL-C=Low density lipoprotein cholesterol, HCY=Homocysteine, Severe PVWMH =Severe periventricular white matter hyperintensities, Severe DWMH =Severe deep white matter hyperintensities, Severe BG - EPVS =severe enlarged perivascular space in basal ganglia, Severe CS - EPVS=Severe enlarged perivascular space in centrum semiovale

Table 2.

Relationship between cerebral large-vessel disease and lacune (with vs without)*.

Variables	OR (95%CI)	P Value
Intracranial and/or Extracranial artery stenosis	1.45(0.70,2.98)	0.3174
Right carotid IMT	62.03(3.32,1158.18)	0.0057
Left carotid IMT	19.42(1.28,294.83)	0.0326
Cerebral arterial plaque	1.87(0.84,4.16)	0.1253
Unstable plaque	1.79(0.85,3.76)	0.1245
Multiple plaques	1.39(0.66,2.92)	0.3874

*

Adjusted for the following factors: Age, Sex, Systolic blood pressure, Diastolic blood pressure, BMI(Body Mass Index), Ccr(Endogenous creatinine clearance), TC(triglycerides), TG(Triglycerides), HDL-C(High density lipoprotein cholesterol), LDL-C(Low density lipoprotein cholesterol), HCY(Homocysteine), Baseline NIHSS score, Hypertension, Diabetes, Dyslipidemia, Atrial fibrillation, Coronary heart disease, History of smoking, History of alcoholism; IMT=Intima-media thickness

Table 3.

Cognitive effects of severe CS-EPVS in patients with intracranial and/or extracranial artery stenosis*.

Intracranial and/or Extracranial artery stenosis	Severe CS-EPVS	OR (95%CI)	P Value
-	-	1.0	-
+	-	1.95(0.71,5.31)	0.1938
-	+	1.87(0.69,5.05)	0.2176
+	+	3.03(1.04,8.79)	0.0418

*

Adjusted for the following factors: Age, Sex, Systolic blood pressure, Diastolic blood pressure, BMI(Body Mass Index), Ccr(Endogenous creatinine clearance), TC(triglycerides), TG(Triglycerides), HDL-C(High density lipoprotein cholesterol), LDL-C(Low density lipoprotein cholesterol), HCY(Homocysteine), Baseline NIHSS score, Hypertension, Diabetes, Dyslipidemia, Atrial fibrillation, Coronary heart disease, History of smoking, History of alcoholism; IMT=Intima-media thickness

Disclosure: No

P0728 / 535

CEREBRAL WHITE MATTER HYPERINTENSITIES INDICATE SEVERITY AND PROGRESSION OF CORONARY ARTERY CALCIFICATION

M. Kneihsl (MD, PhD) ¹, R. Zweicker (MD)², E. Hofer (PhD)^1,3, S. Fandler-Höfler (MD, PhD)¹, M. Haidegger (MD)¹, S. Perl (MD)², C. Enzinger (MD)¹, R. Schmidt (MD)¹, T. Gattringer (MD, PhD)^1,4

¹Medical University of Graz, Department of Neurology, Graz, Austria, ²Medical University of Graz, Division of Cardiology, Department of Internal Medicine, Graz, Austria, ³Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria, ⁴Medical University of Graz, Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Graz, Austria

Background and purpose: Cerebral white matter hyperintensities (WMH) are an important brain imaging feature of cerebral small vessel disease and have been associated with subclinical atherosclerosis including coronary artery calcification (CAC). However, previous studies on this association are limited by only cross-sectional analysis. We here aimed to explore the relationship between WMH and CAC in elderly individuals both cross-sectionally and longitudinally.

Methods: The study population consisted of elderly participants without stroke and dementia from the community-based Austrian Stroke Prevention Family Study (ASPS-Fam). Baseline and follow-up assessment comprised brain MRI, coronary artery computed tomography and clinical/laboratory examination of vascular risk factors. WMH load (via semi-automated volumetric assessment) and CAC levels (via the Agatston Score) were analyzed quantitatively at baseline and after a median follow-up period of 6 years.

Results: Of 331 study participants (mean age: 65.1±10.5 years; female: 59.8%), 105 underwent follow-up. Baseline WMH load (mean: 7.9±13.7cm³) correlated with baseline CAC levels (mean Agatston Score: 149±329) in univariable (r=0.253, p=0.007) and multivariable analysis (adjusted for age, sex and hypertension; p<0.001). While baseline CAC levels were not predictive for WMH progression (mean: 1.1±2.6cm³, p>0.1), baseline WMH load was associated with increase of CAC (mean: 149±289) during the follow-up period in multivariable analysis (ß=0.321, p<0.001).

Conclusions: In this community-based cohort of elderly individuals, WMH were associated with CAC at baseline and predictive of its progression over a 6-year follow-up after adjustment for important co-variables.

Disclosure: No

P0729 / 785

OPHTHALMOLOGICAL BIOMARKERS IN RVCL-S, A MONOGENIC SMALL DISEASE

I. de Boer ¹, M. Al-Nofal², S.R. Steenmeijer², A.E. Wilms¹, S. Agirman², N. Pelzer¹, I.C. Notting², G.M. Terwindt¹

¹Leiden University Medical Center, Neurology, Leiden, Netherlands, ²Leiden University Medical Center, Ophthalmology, Leiden, Netherlands

Background and aims: Investigating mutation carriers with retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) offers the possibility to identify biomarkers in pre- and symptomatic stages of cerebral small vessel disease. Optical Coherence Tomography (OCT) and OCT angiography (OCT-A) have shown potential to detect retinal and vascular changes in several neurodegenerative diseases. We determined if these non-invasive techniques could provide possible (early) biomarker in RVCL-S patients.

Methods: Participants were scanned using OCT systems. Symptomatic mutation-carriers were defined as patients with retinopathy, neurovascular deficits, or systemic symptoms requiring treatment. Participants were recruited from our RVCL-S and healthy control cohort. Total peripapillary retinal nerve fiber layer (pRNFL) thickness, total macular volume (TMV), foveal avascular zone (FAZ) area and vessel density were measured.

Results: We included 14 eyes of presymptomatic RVCL-S mutation-carriers, 22 eyes of symptomatic RVCL-S patients, and 18 eyes of controls. Symptomatic patients had larger FAZ sizes then both presymptomatic patients (p=0.002) and controls (p<0.001). Interestingly, presymptomatic patients already had a larger FAZ then controls (p=0.041). Vascular density was decreased in RVCL-S patients (p<0.001). Symptomatic patients had decreased pRNFL thickness compared to presymptomatic patients (p=0.002) and controls (p<0.001). Total macular volume was also decreased in symptomatic patients compared to presymptomatic patients (p=0.005) and controls (p<0.001).

Conclusions: Our findings with OCT(-A) show that ophthalmological measures have great potential to serve as (early) biomarkers for RVCL-S. Newly developed precise objective instruments such as OCT(-A) may provide important non-invasive tools in determining disease activity for follow up of common small vessel diseases.

Disclosure: Yes

P0730 / 1356

THE RELATION BETWEEN SMALL VESSEL REACTIVITY AND WHITE MATTER INTEGRITY IN CADASIL - THE ZOOM@SVDS STUDY

N. Vlegels ¹, H. van den Brink¹, A. Kopczak², T. Arts³, J. Siero^3,4, B. Gesierich², A. de Luca^1,3, M. Duering^2,5,6, J. Zwanenburg³, M. Dichgans^2,5,7, G.J. Biessels¹, on behalf of the SVDs@Target group

¹University Medical Center Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands, ²Institute of Stroke and Dementia Research, LMU Munich, Munich, Germany, ³University Medical Center Utrecht, Department of Radiology, Utrecht, Netherlands, ⁴Spinoza Centre for NeuroImaging Amsterdam, Amsterdam, Netherlands, ⁵Munich Cluster for Systems Neurology (SyNergy), Munich, Germany, ⁶Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland, ⁷German Center for Neurodegenerative Disease (DZNE), Munich, Germany

Background and aims: In CADASIL, we have recently showed abnormalities in vascular reactivity to hypercapnia on 7T MRI, both in cortical grey matter (GM) and white matter (WM). Here we examine if these functional vascular abnormalities relate to structural brain damage, specifically WM integrity on diffusion tensor imaging.

Methods: 23 CADASIL patients (age mean±sd 51.1±10.1y) and 13 controls (age 46.1±12.6y) were included from the ZOOM@SVDs study (Table 1). In patients, associations between GM and WM BOLD signal change to hypercapnia and peak-width-of-skeletonized-mean-diffusivity (PSMD) were tested with linear regression. We also assessed local correlations between BOLD signal change and mean diffusivity (MD) in WM on a voxel-by-voxel level.

Results: In patients, GM BOLD signal change to hypercapnia was associated with PSMD in total WM and normal appearing white matter (NAWM) (standardized Beta(B)=-0.61, p=0.02; B=-0.63, p=0.01 respectively). There was no global relation between total WM or NAWM BOLD signal change and total WM or NAWM PSMD (B=0.14,p=0.61; B=0.12,p=0.65 respectively). The voxel-by-voxel analysis in patients showed a negative relation between BOLD signal change and MD, both in total WM and NAWM (mean±sd:-0.13±0.09,p<0.001; -0.17±0.08,p<0.001 respectively, Figure 1).

Conclusion: We observed a global and local relationship between impaired vascular reactivity to hypercapnia and decreased WM integrity in CADASIL patients. Further studies should determine whether abnormal vascular function is an actual cause of WM injury, as this may provide leads for urgently needed treatment.

Disclosure: No

SEX, GENDER AND STROKE

P0731 / 1332

SEX-BASED CASE FATALITY AFTER ISCHEMIC STROKE: NATIONWIDE RETROSPECTIVE COHORT STUDY

T. Parkkali ¹, J. Ruuskanen¹, V. Kytö²

¹Neuro Center, Turku University Hospital and Clinical neurosciences, University of Turku, Turku, Finland, ²Heart Center, Turku University Hospital and University of Turku, Turku, Finland

Background and aims: Women have been suggested to have poorer outcomes after stroke, although evidence is mixed. We sought to explore sex-based differences in case-fatality after ischemic stroke (IS).

Methods: Consecutive all-comer adult patients with IS admitted to 20 hospitals in Finland between 2005–2018 were retrospectively studied using combination of national registries (n=98,937, mean age 71.9 years, 47% women). The outcome of interest was death within one year after IS. Baseline differences between sexes (age, comorbidities, pre-IS medication, thrombolysis/thrombectomy, treating hospital, and year of IS) were balanced by inverse probability weighting.

Results: Non-adjusted 1-year case-fatality was higher in women after IS (19.2% vs. 14.1%; hazard ratio [HR] 1.40; confidence interval [CI] 1.36–1.45; p < 0.0001). Adjusted case fatality was however comparable between women and men at 30 days (7.9% vs. 7.7%, respectively) and at 1 year (16.6% vs. 16.5%, respectively) after IS (HR 1.01; CI 0.98–1.04; p=0.582). Adjusted hazard of death after IS was similar between sexes in different subgroups of patients aged <50 years, 50–69 years and ⩾70 years, revascularised and non-revascularised patients, patients with and without atrial fibrillation or with and without diabetes. Adjusted excess 1-year fatality after IS compared to the corresponding general population was 13.6% (CI 13.2–14.0%) in women and 11.3% (CI 11.0–11.7%) in men.

Conclusions: Women and men had equal risk of death after IS when adjusted for baseline differences and treatments. Excess fatality after IS was however higher in women.

Disclosure: No

P0732 / 285

CLINICAL PERSPECTIVE IN RELATION TO AGE IN PATIENTS TREATED WITH THROMBECTOMY FOR LARGE VESSEL OCCLUSION IN A STROKE CENTER IN COLOMBIA

A. Vásquez ¹, P. Correa², D. Vera², S. Cardenas², M. Ochoa Vera², M. Galvis², O. Vargas², C. Ferreira², D. Mantilla²

¹Sabana University, Bogotá, Colombia, ²Autonomous University of Bucaramanga, Bucaramanga, Colombia

Background and aims: Endovascular treatment for large vessel occlusion is accepted as a first line option with level I evidence in patients with early and late time of window of onset symptoms, and an additional option in patients that do not respond or with contraindication to systemic thrombolysis; nevertheless the efficacy and outcomes of some groups is not clear, one of them are patients aged 80 years or older, because they were excluded of the trials, so the evidence is controversial with significant heterogeneity, for that reason in our study, we decided to analyze the age in the patients treated in our stroke center, as a predictor of prognosis, and to provide a baseline for the establishment of personalized treatment plans.

Methods: observational, retrospective study of patients that received endovascular treatment for cerebrovascular disease in a Colombian stroke center between 2016-2019, continuous and categorical variables were compared using the Student’s T test and Chi Square. To determine cut-off points in the variable against death and Rankin score variable at 90th day.

Results: 108 patients were recruited, 37 of them have 80 or more years, the mean age was 72.7 years, we found age as a significant variable to predict the risk in the population over 80 years of age [RR 3.37 CI (95% 1.14-103) p = 0.029] .

Conclusions: patients under 80 years of age obtained better results in functionality and mortality.

Disclosure: No

P0733 / 1241

SEX DIFFERENCES IN INTRAVENOUS THROMBOLYSIS OUTCOMES IN ACUTE ISCHEMIC STROKE PATIENTS WITH PREADMISSION USE OF ANTIPLATELET AGENTS A POPULATION-BASED STUDY IN THE SWISS STROKE REGISTRY

R. Noseda ¹, F. Rea^2,3, A. Pagnamenta^4,5,6, P. Agazzi⁷, G. Bianco⁷, S. Sihabdeen⁷, D.J Seiffge⁸, P. Michel⁹, K. Nedeltchev¹⁰, L. Bonati¹¹, G. Kägi¹², J. Niederhauser¹³, T. Nyffeler¹⁴, A. Luft¹⁵, L.D Schelosky¹⁶, F. Medlin¹⁷, B. Rodic¹⁸, N. Peters¹⁹, S. Renaud²⁰, M.-L. Mono²¹, E. Carrera²², U. Fischer⁸, A. Ceschi^1,4,23,24, C. Cereda^7,23

¹Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland, Lugano, Switzerland, ²University of Milano-Bicocca, Milan, Italy, Milan, Italy, ³National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy, Milan, Italy, ⁴Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland, Lugano, Switzerland, ⁵Department of Intensive Care, Ente Ospedaliero Cantonale, Bellinzona, Switzerland, Bellinzona, Switzerland, ⁶Division of Pneumology, University of Geneva, Geneva, Switzerland, Geneva, Switzerland, ⁷Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland, Lugano, Switzerland, ⁸University Hospital Bern, Department of Neurology, Bern, Switzerland, Bern, Switzerland, ⁹Lausanne University Hospital, Stroke Center, Neurology Service, Lausanne, Switzerland, Lausanne, Switzerland, ¹⁰Kantonsspital Aarau, Department of Neurology, Aarau, Switzerland, Aarau, Switzerland, ¹¹University Hospital Basel and University of Basel, Department of Neurology and Stroke Center, Basel, Switzerland, Basel, Switzerland, ¹²Kantonsspital St. Gallen, Department of Neurology, St. Gallen, Switzerland, St. Gallen, Switzerland, ¹³Stroke Unit, Hopital Nyon, Switzerland, Nyon, Switzerland, ¹⁴Luzerner Kantonsspital, Center of Neurology and Neurorehabilitation, Luzern, Switzerland, Luzern, Switzerland, ¹⁵Universitätsspital Zürich, Neurology, Zürich, Switzerland, Zürich, Switzerland, ¹⁶Kantonsspital Münsterlingen, Division of Neurology, Münsterlingen, Switzerland, Münsterlingen, Switzerland, ¹⁷HFR Fribourg, Stroke Unit, Division of Neurology, Fribourg, Switzerland, Fribourg, Switzerland, ¹⁸Kantonsspital Winterthur, Neurology, Winterthur, Switzerland, Winterthur, Switzerland, ¹⁹Hirslanden Hospital, Department of Neurology and Stroke Center, Zurich, Switzerland, Zurich, Switzerland, ²⁰Pourtalès Hospital, Division of Neurology, Neuchatel, Switzerland, Neuchatel, Switzerland, ²¹Stadtspital Waid und Triemli, Stroke Unit, Zürich, Switzerland, Zürich, Switzerland, ²²Hôpitaux Universitaires de Genève, Department of Neurology, Geneva, Switzerland, Geneve, Switzerland, ²³Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland, Lugano, Switzerland, ²⁴Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland

Background and aims: To compare safety and efficacy outcomes of intravenous thrombolysis (IVT) between women and men with acute ischaemic stroke (AIS) in relation to preadmission use of antiplatelet agents (APAs).

Methods: Cohort study from the Swiss Stroke Registry of consecutive patients (from 2014-01-01 to 2020-01-31) with AIS treated with IVT stratified according to sex and assessed for preadmission use of APAs in multivariate logistic regression models. Primary safety outcome was in-hospital symptomatic intracerebral haemorrhage (sICH). Primary efficacy outcome was 3-month functional independence (FI).

Results: Study cohort included 4996 patients (2124, 43%, women, older than men, 79 versus 71 years, P<0.0001). Comparable proportions of women (39.92%) and men (40.39%) used APAs (single or dual) before admission (P=0.74). 136 (2.72%) patients presented in-hospital sICH, with similar proportions between women and men (adjOR 0.97, 95%CI 0.66-1.44). No interaction was found between patient sex and preadmission use of either single or dual APAs in relation to in-hospital sICH (P=0.89 and P=0.21, respectively). Men had higher odds of 3-month FI (adjOR 1.34, 95%CI 1.09-1.65), regardless of preadmission use of APAs (P of interaction between patient sex and preadmission use of either single or dual APAs, P=0.46 and P=0.63, respectively).

Conclusions: No sex differences were observed in the safety of IVT in AIS patients in relation to preadmission use of APAs. Men showed more favourable 3-month efficacy outcome than women following IVT, however, sex differences apparently were not explained by a sex-specific mechanism related to preadmission use of APAs.

Disclosure: No

P0734 / 1572

POST-STROKE DISABILITY: ASSOCIATION BETWEEN SEX AND PATIENT REPORTED OUTCOMES

L. Oliveira ¹, C. Tuozzo¹, A. Viswanathan¹, N. Rost¹, M. Etherton¹

¹ Harvard Medical School, J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, United States

THIS IS A PLACEHOLDER ABSTRACT FOR A STUDY WE ARE CURRENTLY FINISHING ALL ANALYSIS.

Background and aims: Acute ischemic stroke (AIS) is a leading cause of long-term disability. Understanding the singularities of post-stroke recovery in both sex holds potential to individualized interventions. Further, investigating the association between sex and patient reported outcomes provides additional information on the impact and heterogeneity in stroke outcomes. The aims of this study were to identify sex differences in stroke outcomes and relationship with patient-reported outcomes in AIS patients with 3-month follow-up.

Methods: Between February 2017 and February 2020, 398 patients admitted to our hospital with AIS were enrolled. At 3 months post-stroke, patients underwent a telephone interview including Barthel Index (BI), mRS and PROM-10 questionnaires.

RESULTS: At baseline, 236 participants were male (mean age 65) and 162 were female (mean age 70). Groups had similar rates of cardiovascular risk factors, admission NIHSS and discharge mRS. At follow-up, males were more likely to have better rates of T Physical (mean 48.92 vs. 44.67) and BI (mean 92.60 vs. 87.22). In linear regression analysis, PROMs T Physical, BI, and also PROMs Global 01 and Global 10r, which stand respectively for patient reported general health and emotional problems, were associated with female sex. Similar relationship was found with all subcomponents of PROMs Global Physical evaluation.

Conclusion: Worse measures of objective functional outcome and patient reported outcomes are associated with female sex. Incorporating PROMs into AIS outcome measures may offer additional insight into sex differences in stroke recovery.

Association between 3-month outcomes and sex of 398 AIS patients
	Univariable Analysis
3-month Outcomes	Estimates	CI	p value
TICS	0.00	-0.02, 0.02	0.90
mRS ⩾ 2, n (%)	0.09	-0.03, 0.21	0.14
Barthel Index	-0.01	-0.01, -0.00	0.02
IQCODE > 3, n (%)	-0.07	-0.24, 0.09	0.39
T Mental	-0.01	-0.02, 0.00	0.10
T Physical	-0.01	-0.02, -0.00	0.01
PROMIS Global 01	-0.11	-0.19, -0.02	0.01
PROMIS Global 09r	-0.05	-0.13, 0.03	0.25
PROMs Mental
Global Mental	-0.02	-0.05, 0.00	0.11
Global 2	-0.08	-0.15, 0.00	0.06
Global 04	-0.00	-0.08, 0.08	0.96
Global 05	-0.07	-0.15, 0.01	0.11
Global 10r	-0.08	-0.17, -0.00	0.04
PROMs Physical
Global Physical	0.04	-0.06, -0.01	0.01
Global 03	-0.10	-0.19, -0.01	0.03
Global 06	-0.08	-0.16, -0.01	0.03
Global 07r	-0.09	-0.17, -0.01	0.03
Global 08r	-0.10	-0.20, -0.01	0.03

Disclosure: No

P0735 / 1340

CAN TELESTROKE MANAGEMENT AVOID SEX DISPARITIES? OUR TEN-YEAR EXPERIENCE

L. González-Martín ¹, M. Martínez-Martínez¹, J. Fernández-Travieso¹, M.L. Almarcha-Menargues¹, P. Martínez-Sánchez^2,3, B. Fuentes-Gimeno²

¹Hospital Infanta Sofía, Department of Neurology, San Sebastián de los Reyes, Spain, ²Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Department of Neurology and Stroke Center, Madrid, Spain, ³Torrecárdenas University Hospital. University of Almería, Stroke Centre and Department of Neurology, Almería, Spain

Background and aims: Differences on acute stroke (AS) management have been described for women, but there is scarce data on how Telestroke (TS) consultations may affect these findings.

We aim to evaluate sex differences for recanalization therapies and access to Stroke Unit (SU) in our 10-year TS experience (2011-2021).

Methods: Retrospective analysis of TS consultations from a Secondary Hospital to the reference Stroke Center, comparing casuistic, demographics and clinical data according to sex in the past 10 years. Patients transferred to the SU, and number of IV thrombolysis and thrombectomy among isquemic stroke (IS) patients are evaluated as quality-of-care parameters. Analysis is performed with SPSS 24.0. This study has been evaluated and approved by local ethics committee.

Results: 630 patients were evaluated via TS, 313 women (49,6%). There were no differences in clinical or demographic characteristics among groups, except for higher DM and tobacco use for men. Women were less likely transferred to SU (40.9 % vs 53.9%, p= 0.001). rTPa was administered in 10,7% of IS for women vs 13.1% for men, p= 0.526, and there were no significant differences on thrombectomy performance according to sex (3 cases for women and 4 for men).

Conclusions: Women were less likely to be transferred to the SU in our series after multivariate analysis including age, NIHSS and basal Rankin modified scale. No differences were found on recanalization therapies administration between men and women.

Disclosure: No

P0736 / 1311

IS THERE A GENDER EFFECT ON ONE-YEAR POST STROKE DISABILITY?

A.-M. Schott ^1,2, I. Ramos², A. Termoz^1,2, L. Derex^3,2, J. Haesebaert^1,2

¹Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France, ²Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France, ³Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Service Neuro-vasculaire, Lyon, France

Background and aims: Previous studies reported sub-optimal management in women with ischemic stroke compared to men with underlying mechanisms being women older and more often living alone at the time of the stroke, or having a lower level of consciousness on admission.

Methods: In Rhône County population-based cohort “STROKE 69” we analyzed gender difference in one-year disability measured by Modified Rankin score (mRS).

Results: Among 1059 patients, one year after their ischemic stroke, 53.6% of women had a mRS ⩽2 vs 70.5% of men, and their death rate was 15.5 vs 9.7%. After adjustment for age, NIHSS score at acute phase, pre-stroke disability, and reperfusion therapy, gender was not associated with mRS nor death at 12 months (table 1). Factors associated with 12-months mRS >2 besides age were severe initial NIHSS score, pre-stroke disability or heart rhythm disorders, and no reperfusion therapy. Predictors of death at 12 months besides age were severe initial NIHSS, and no reperfusion therapy.

Conclusions: This study confirmed that less favorable one-year outcome in women seems mediated by gender differences in age, NIHSS score and pre-stroke disability.

Table 1.

Factors associated with mRS >2 at 12 months.

	OR (IC95)	p-value
Women (ref: men)	1.13 (0.8-1.57)	0.487
Age (y)	1.05 (1.04-1.07)	<0.0001
Initial NIHSS score (ref: 0-4)
5-14	3.67 (2.54-5.33)	<0.0001
15-20	18.16 (10.02-33.96)	<0.0001
>20	23.66 (11.81-49.15)	<0.0001
Patient independant (ref: dependant)	0.22 (0.13-0.35)	<0.0001
Heart rhythms disorders (ref: no)	1.74 (1.17-2.59)	0.006
Reperfusion therapy (ref: no)	0.35 (0.22-0.54)	<0.0001

Disclosure: No

P0737 / 769

SEX, GENDER AND STROKE

M. Ouyang ¹, S. Shajahan¹, X. Liu², L. Sun³, C. Carcel^1,4, X. Wang¹, C. Anderson^1,4, M. Woodward¹

¹The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia, ²School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, ³The George Institute China at Peking University Health Sciences Center, Beijing, China, ⁴Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia

Background: Studies on endovascular thrombectomy (EVT) have reported conflicting results on sex differences.

Methods: A systematic review and meta-analysis was performed on studies of sex-specific EVT treatment for acute ischaemic stroke published before 31 July 2021. Estimates were compared by study type including randomised clinical trials (RCTs) and non-RCTs (hospital-based, registry-based or administrative data). Random effects odds ratios (ORs) were generated to quantify sex differences on EVT treatment rates. The female:male ratio of ORs and 95% confidence intervals (CIs) were obtained to estimate sex differences on functional outcome.

Results: There were 6260 studies identified, of which 579 full text were reviewed. A total of 38 studies (27 non-RCT, 11 RCTs) that reported the rate of EVT treatment compared by sex were included; 8 among them estimated sex disparities of effect of EVT on functional outcome. There was no significant difference of EVT rate in women versus men, both in non-RCTs (OR 1.00, 95% CT 0.94-1.07) and RCTs (OR 0.91, 95% CT 0.77-1.07). Similarly, no sex disparities were found in the functional outcome by ordinal and binary analysis according to the full range of modified Rankin scale scores (ratio of odds 0.95, 95% CI 0.68-1.32, and 1.07, 95% CI 0.64-1.79). Pre-specified subgroup analyses were consistent across different study designs, region of study conduction, and the year of publication.

Conclusions: There is no apparent sex disparities in EVT treatment and functional outcome for acute ischaemic stroke.

Disclosure: No

P0738 / 789

EFFICACY OF SYSTEMIC THROMBOLYTIC THERAPY OF ACUTE ISCHEMIC STROKE IN WOMEN WITH RISK FACTORS

S. Kotov ¹, S. Belkina¹, E. Isakova¹, A. Kotov¹

¹ M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Department of Neurology, Moscow, Russian Federation

Background and aims: Systemic thrombolytic therapy (STT) is the method of choice for patients with acute ischemic stroke (AIS). The aim: to evaluate the effectiveness of STT in women compared with men, depending on the presence of certain risk factors of stroke.

Methods: An open, prospective, observational, non-interventional cohort study of the results of STT included 209 patients, 102 women and 107 men, aged 32 to 86 years. All patients underwent STT with alteplase medications within 4.5 hours from the onset of the first symptoms of IS. The primary endpoint of the study was survival for 28 days, the secondary endpoint was the achievement of independence in movement on the Modified Rankin Scale (MRS) - 0–2 scores.

Results: Hemorrhagic transformation after STT was more often in men, but the difference was insignificant (χ2 criterion - 0.743, p = 0.389). Women had type 2 diabetes mellitus (T2DM) more often (37.3% and 20.6%, respectively, χ2 criterion - 7.111, p = 0.008). Women with T2DM showed a better regression of symptoms (by about 1 score). The number of patients who achieved independence by day 28 (0–2 points on the MRS) - 56 women and 52 men - did not differ statistically.

Conclusion: In women who underwent STT in the acute period of AIS, the mortality rate did not differ, and the functional outcome was no worse than in men. Despite the presence of several negative factors (age, obesity, MS, hyperglycemia, T2DM, AF), women showed a tendency towards a better STT results.

Disclosure: No

P0739 / 741

CEREBROVASCULAR COMPLICATIONS: WHAT TO EXPECT DURING POSTPARTUM - CASE SERIES

I.-F. Bratu ¹, A. Ribigan¹, R. Badea¹, P. Ioan¹, A. Ciocan¹, D. Dumitrascu¹, O. Ioghen¹, B. Dorobat², A. Dimitriade², A. Carp², F. Antochi¹

¹Emergency University Hospital Bucharest, Neurology, Bucharest, Romania, ²Emergency University Hospital Bucharest, Interventional Neuroradiology, Bucharest, Romania

Background and aims: Cerebrovascular disorders are one of the most feared postpartum complications. This spectrum includes more frequently cerebral venous thrombosis, stroke, posterior reversible encephalopathy syndrome and postpartum angiopathy. Even though the risk of stroke is highest peripartum and during the first 6 weeks after parturition, recent literature highlights it remains elevated during the first year postpartum. The aim of this case series is to characterize our experience regarding the clinical presentation, etiology, management and outcomes of postpartum cerebrovascular complications.

Methods: Case series of 5 patients admitted to our department between 2014-2020. The mean age at symptom onset was 34.4 y.o. (28-41) and the mean period between parturition and clinical onset was 4.8 weeks (1-12). The patients were diagnosed with a cerebrovascular event using cerebral computed tomography, magnetic resonance angiography (MRA) and/or digital subtraction angiography (DSA) of the cervical-cerebral arteries (CCAs).

Results: All patients suffered acute ischemic stroke. 4 patients exhibited CCAs dissections affecting from 1 to all 4 CCAs. 1 patient exhibited postpartum angiopathy. Conservative or endovascular management was applied considering the territory, number of affected arteries, as well as the type of arterial wall and lumen changes (pseudoaneurysm, occlusion). Follow-up at 6 months using Doppler ultrasonography or DSA of the CCAs revealed stent patency and arterial recanalization. Further investigations revealed heterozygous MTHFR mutation and confirmed antiphospholipid syndrome in 2 cases.

Conclusions: This case series highlights various aspects of postpartum cerebrovascular complications that should not be overlooked as they may influence the management and outcome of such cases.

Disclosure: No

P0740 / 1537

SEX DIFFERENCES IN OUTCOME AFTER CAROTID REVASCULARIZATION IN SYMPTOMATIC AND ASYMPTOMATIC CAROTID ARTERY STENOSIS - A SYSTEMATIC REVIEW AND META-ANALYSES

V. Caso¹, C. Kremer ², Z. Gdovinova³, Y. Bejot⁴, A. Lal^5,6, C. Epple⁷, S. Lorenzano⁸, M.-L. Mono⁹, T. Karapanayiotides¹⁰, D. Jovanovic¹¹, J. Dawson¹²

¹Santa Maria della Misericordia, University of Perugia, stroke Unit, Perugia, Italy, ²Skåne University Hospital, Dep. Clinical Sciences Lund University, Neurology Department, Malmö, Sweden, ³Faculty of Medicine P.J. Safarik University Košice, Neurology Department, Košice, Slovakia, ⁴University Hospital of Dijon, University of Burgundy, UBFC, Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases, Dijon, France, ⁵European Stroke Organisation (ESO), Basel, Switzerland, ⁶eso, Basel, Sweden, ⁷Klinikum Hanau, Neurology Department, Hanau, Germany, ⁸Sapienza University of Rome, Department of Human Neurosciences, Roma, Italy, ⁹Municipal Hospital Waid und Triemli, Zürich; and University Hospital and University of Bern, Department of Neurology, Bern, Switzerland, ¹⁰School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Department of Neurology, Thessaloniki, Greece, ¹¹University of Belgrade, Department of Emergency Neurology, Belgrad, Serbia, ¹²University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom

Background: Sex differences regarding the safety and efficacy of carotid revacularization have been addressed in different studies with conflicting results.

Aim: To analyse the sex differences in efficacy and safety of revascularisation for carotid artery stenosis.

Findings: Regarding symptomatic carotid revascularisation, the stroke risk in males (3.6%) and females (3.9%) based on 97,452 patients (30 studies) did not differ (P=0.17). There was also no difference in the stroke risk by different time-frames defined as in-hospital, 1 month, and 10 years. For carotid stenting in symptomatic carotid stenosis, the pre-specified outcomes did not differ between females and males.

Whereas, for asymptomatic carotid artery stenosis from 4 RCTs and 17 observational studies, females compared to males had similar rates of stroke (20 studies, 329,585 patients, 0.9% vs 0.8%, OR 1.10, 95% CI 0.94-1.29, I2: 48%, P=0.24), of stroke or death (8 studies, 63,193 patients, 2.0% vs 1.8%, OR 1.33, 95% CI 1.03-1.71, I2: 52%, P=0.03) and of the composite stroke/death/MI (3 studies, 5,088 patients, 3.3% vs 3.2%, OR 1.29, 95% CI 0.68-2.43, I2: 56%, P=0.43). Furthermore, carotid stenting in asymptomatic females was associated with low risk of postprocedural stroke in both sexes.

Conclusion: Even considering the risk of bias, no significant sex differences in stroke outcome after revacularization for symptomatic and asymptomatic carotid artery stenosis. Although no statistical significance was found, further research into sex-specific differences is needed to tailor stroked treatment in both males and females.

Disclosure: No

P0741 / 1496

CEREBRAL VENOUS THROMBOSIS AMONG WOMEN; CLINICAL AND RADIOLOGICAL FEATURES AND PROGNOSTIC IMPLICATIONS

A. Honig ¹, N. Simaan², R.R. Leker¹, S. Peretz³, D. Orion⁴, Z.I. Hayosh⁴, R. Barnea³, E. Seyman⁵, E. Ben-Assayag⁵, O. Rotschild⁵, A. Filioglo¹, S. Aladdin⁴, E. Auriel³, H. Hallevi⁵, J. Molad⁵

¹Hadassah Hebrew-University Medical Center, Neurology, Jerusalem, Israel, ²Ziv Medical Center, Neurology, Safed, Israel, ³Rabin Medical Center, Neurology, Petach-Tikva, Israel, ⁴Sheba Medical Center, Neurology, Ramat-Gan, Israel, ⁵Tel-Aviv Sourasky Medical Center, Neurology and Stroke, Tel-Aviv, Israel

Background and aims: Cerebral venous thrombosis (CVT) is a leading cause of stroke in young women with unique risk factors such as oral contraceptive pills (OCP) and pregnancy. We aimed to characterize features of CVT in women.

Methods: Data from CVT databases of four academic centers was retrospectively analyzed. Comparisons of women versus men patients and younger (<50 years) versus older women were made.

Results: 508 patients (335 women, 65.9%) were included in the present cohort. Compared with men,women were younger (39.9±14.4 vs. 45.5±18.3, p=0.001), had higher rates of headache (80% vs 65%, P<0.001) and cortical vein involvement (14% vs 7%, p=0.024). No other differences were found in outcome measures, clinical presentation or involved sinus. Oral contraceptives (32%) and pregnancy (10%) were common underlying etiology among young women, whereas active malignancy (20% vs 12, p=0.015) and Behcet (7% vs 2%, p=0.003) were more common among men. No difference was found in the rates of hypercoagulopathies.

Among women, OCP usage was associated with a better functional outcome (90-day-mRS 0-1) (p=0.048). Within CVT women patients younger than 50-year-old, pregnancy was associated with higher rates of neurological deficit (41% vs 21%, p=0.011), venous infarction (10% vs 22%, p=0.009), intracerebral hemorrhage (31% vs 16%, p=0.027).

Conclusions: Clinical manifestations and underlying etiologies differ between sexes. Pregnancy and postpartum state are associated with disturbed autoregulation of the cerebral vasculature that may higher rates of venous infarction and intracerebral hemorrhage. Conversely, OCP associated CVT patients had better prognosis possibly due to higher recanalization rates.

Disclosure: No

P0742 / 1127

SEX DIFFERENCES IN TREATMENT TIMES AND OUTCOME OF ACUTE ISCHEMIC STROKE

K.M Gopisingh ¹, L.J Stolze¹, L.G Exalto², F.HM Spaander³, P.J Nederkoorn¹

¹Amsterdam University Medical Center, Neurology, Amsterdam, Netherlands, ²University Medical Center Utrecht, Neurology, Utrecht, Netherlands, ³Zaans Medical Center, Neurology, Zaandam, Netherlands

Background and aims: Increasing evidence suggests sex and sex-dependent factors affect both functional outcome and treatment times in acute reperfusion therapy in acute ischemic stroke (AIS). It is, however, still unclear or unconfirmed what underlying mechanisms these sex-dependent factors cause and how they influence stroke outcome. This study investigated whether functional outcome and treatment times differed between male and female patients with AIS and evaluated possible explanations.

Methods: Cohort study of the Amsterdam University Medical Center, a large regional comprehensive stroke center. All consecutive patients above 18 years who presented with AIS in 2019 or 2020 were included. The primary outcome was the modified Rankin Scale (mRS) at three months. Secondary outcomes were the onset-to-door time (OTD), and following reperfusion treatment also: door-to-needle time (DTN) and door-to-groin time (DTG). Possible explanatory factors were invested in multiple regression models.

Results: 1478 AIS patients were included; male: 52.7%; female: 47.3%. 50.7% of patients underwent acute reperfusion therapy (IVT, EVT, or both). Women had worse functional outcome than men (binary mRS: (male: 57.2% and female: 48.7%, p-value: <0.01)), ordinal median mRS: male: 2.00 (IQR: 1.00-4.00), female: 3.00 (IQR: 1.00-5.00, p-value: 0.07)). There were no significant differences in OTD, DTN, and DTG times, but women had a trend towards longer DTN times.

Conclusions: This study confirmed that women have worse functional outcomes. However, treatment times in acute reperfusion therapy did not differ significantly between men and women. Therefore, further research is needed on why women have worse outcomes in AIS and on possible explanations.

Disclosure: No

P0743 / 1387

ASSOCIATION OF HIGH SENSITIVITY C-REACTIVE PROTEIN WITH DEPRESSIVE SYMPTOMS UP TO THREE YEARS AFTER FIRST ISCHEMIC STROKE: PROSPECTIVE COHORT WITH INCIDENT STROKE STUDY BERLIN (PROSCIS-B)

V.L.K. Schaeff ^1,2, P. Sperber^1,3,4, S.K. Piper^5,6, M. Endres^1,2,6,7, T. Liman^1,7

¹Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany, ²Charité- Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie, Belrin, Germany, ³Experimental and Clinical Research Center (ECRC), Charité – Universitätsmedizin Berlin & Max Delbrück Center for Molecular Medicine, Berlin, Germany, ⁴German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), BerlinGermanger, Germany, ⁵Institute of Biometry and Clinical Epidemiology, Berlin, Germany, ⁶Berlin Institute of Health, Translational Research Unit of Charité – Universitätsmedizin Berlin, Berlin, Germany, ⁷German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen), partner site Berlin, Berlin, Germany

Background and aims: C-reactive protein serves as a marker of inflammation and has been linked to depression in cardiovascular disease. Here, we aimed to assess whether elevated baseline levels of CRP are associated with depressive symptoms over time in first-ever, mild-to-moderate ischemic stroke patients.

Methods: Data were used from the Prospective Cohort with Incident Stroke Berlin (PROSCIS-B; NCT01363856). CRP was measured using a high-sensitivity assay. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CESD) at three annual follow-up assessments. Linear models and linear mixed models were used to survey the impact of hs-CRP on CESD scores at each time point and over time, respectively. Confounders were chosen by a causal diagram. Subgroup analyses were performed to explore whether CRP exerts an interaction effect with sex.

Results: We included 514 patients stroke patients. Mean age was 66 (SD=13), 38 % were female, median NIHSS was 2(IQR [1-4]). At Year One 20 % were depressed, 21% at year two, and 17% at year three. Higher CRP baseline levels were associated with higher CESD scores at each time point. Higher log-transformed baseline CRP levels were associated with higher CESD Scores over time in adjusted linear mixed model (β=1.3; 95%CI 0.2–2.6). The subgroup analysis revealed a pronounced effect of CRP on higher depression symptoms in women (β=2.3; 95%CI 0.71–3.95) but not in men (β=0.6; 95%CI -0.71–1.9).

Conclusion: In our cohort higher levels of baseline hs-CRP levels were associated with more depressive symptoms over time and more pronounced in women.

Disclosure: No

P0744 / 349

PINK CARE

P. Fiori ¹, L. Allegorico², G. Capaldo², M. Massarelli², R. Gizzi³, C. Pelosi⁴, P. Savino⁴, A. Bellizzi⁴, G. Bianchino⁵, F. Botticella⁵, A. Di Gianni⁵, C. Dragonetti⁵, P. Gualtiero⁵, C. Conte⁶, G. Manganelli⁵, S. Minichiello⁵, A. Morella⁵, V. Pellecchia⁵, G. Benigni⁷, T. Damiano⁷, E. Pace⁸, M. Ferrara⁷, A. Martino⁹, E. Mazza⁹, G. Esposito¹⁰, C. Tammaro¹⁰, R. Cusano¹¹, M. Caraglia¹², A. Corbo², A. Monaco², S. D’Agostino¹³

¹University of Campania, Vanvitelli L., S. Ottone Frangipane Hospital, ASL AV, Neurology, Ariano Irpino, Italy, ²S. Ottone Frangipane Hospital, ASL AV, Neurology, Ariano Irpino, Italy, ³University of Campania, Vanvitelli L., Criscuoli - Frieri Hospital, ASL AV, Physiotherapy, S. Angelo dei Lombardi, Italy, ⁴S. Ottone Frangipane Hospital, ASL AV, Medicine, Ariano Irpino, Italy, ⁵S. Ottone Frangipane Hospital, ASL AV, Cardiology, Ariano Irpino, Italy, ⁶S. Ottone Frangipane Hospital, ASL AV, Cardiology, Ariano irpino (AV), Italy, ⁷S. Ottone Frangipane Hospital, ASL AV, Intensive Care, Ariano Irpino, Italy, ⁸S. Ottone Frangipane Hospital, ASL AV, Intensive Care, Ariano irpino (AV), Italy, ⁹S. Ottone Frangipane Hospital, ASL AV, Radiology, Ariano Irpino, Italy, ¹⁰S. Ottone Frangipane Hospital, ASL AV, Laboratory, Ariano Irpino, Italy, ¹¹University of Campania, Vanvitelli L., S. Ottone Frangipane Hospital, ASL AV, Nursing Coordinator, Ariano Irpino, Italy, ¹²University of Naples, Experimental Medicine, BIOGEM, Institute of Genetic Research, Laboratory of Molecular and Precision Oncology, Ariano Irpino, Italy, ¹³S. Ottone Frangipane Hospital, ASL AV, Emergency Department, Ariano Irpino, Italy

Our recent study showed higher rate of Paroxysmal Atrial Tachyarrhythmias (PAT) and Non-Paroxysmal Atrial Fibrillation (NPAF) in females compared to males, admitted for Acute Cerebro-Vascular events (ACV) (Fiori P. et al., submitted). The aim of our study was to identify negative haemodynamic factors accounting for higher risk of ACV in females.

We recruited 83 Other Neuropsychiatric Diseases (OND), 92 Chronic Cerebrovascular Diseases (CCVD), 552 Acute Strokes (AS) patients. They were subgrouped in no-hysterectomized (A) and hysterectomized (B).

Our preliminary results showed a rate of 9/33 (11%) PAT vs 1/33 (3%) NPAF in OND-A, 1/2 (50%) PAT in OND-B, 22/89 (25%) PAT vs 5/89 (6%) NPAF in CCVD-A, 1/4 (25%) PAT in CCVD-B, 90/519 (17%) PAT vs 94/519 (18%) NPAF in AS-A, 2/33 (6%) PAT vs 6/33 (18%) NPAF in AS-B. GCS, pre-MRS, day 7 GCS and MRS were not significantly different in AS. Although a higher percentage of A-patients had levels of BNP and ths Tro above normal range, the values were not significantly different compared to those detected in B-ones.

PAT may evolve to NPAF, especially if risk factors are present. The unexpected finding of similar rate of NPAF in no-hysterectomized compared to hysterectomized AS patients suggests that atrial disarrangement may be related to other concomitant pathological conditions. On the other hand, the presence of PAT also in OND highlights that haemodynamic factors may contribute to acute worst conditions in females, requiring careful management, which may be realized by “pink triage” and dedicated care during hospitalization and at follow-up.

Disclosure: No

PATHOPHYSIOLOGY OF STROKE / TRANSLATIONAL MEDICINE

P0745 / 780

PROGNOSTIC VALUE OF CIRCULATING ENDOTHELIAL PROGENITOR CELLS COUNT IN PATIENTS WITH ACUTE ISCHEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY

A. Aguilera-Simón ¹, J. Martí-Fàbregas², M. Soler³, N. Puig⁴, R. Marín¹, C. Gallego-Fabrega⁵, A. Martínez-Domeño², L. Prats-Sánchez², M. Guasch-Jiménez², D. Guisado-Alonso², A. Ramos-Pachón², P. Camps-Renom²

¹Sant Pau Research Institute, Neurology, Barcelona, Spain, ²Hospital de la Santa Creu i Sant Pau, Neurology, Barcelona, Spain, ³Sant Pau Research Institute, Cytometry, Barcelona, Spain, ⁴Sant Pau Research Institute, Cardiovascular Biochemistry, Barcelona, Spain, ⁵Sant Pau Research Institute, Stroke Pharmacogenomics and Genetics Laboratory, Barcelona, Spain

Background: The count of circulating Endothelial Progenitor Cells (cEPC) may increase after ischemic stroke. The impact of cEPC mobilization on clinical outcomes is still controversial. We aimed to study the prognostic value of cEPC in patients with ischemic stroke treated with mechanical thrombectomy (MT).

Methods: We conducted a prospective study of consecutive patients with an anterior circulation ischemic stroke due to large-vessel occlusion (LVO) treated with MT. A blood sample was obtained within 24 hours from MT. cEPC were identified by flow cytometry (CD133+/CD34+/CD309+). Our primary outcome was neurological deficit at day 7 as assessed by categorized NIHSS score (minor: 0-4; moderate: 5-15; moderate-severe: 16-20; severe: 21-42). The secondary outcome was modified Rankin Scale (mRS) score at discharge. We performed multivariable ordinal logistic analyses using a backward stepwise regression approach.

Results: We included 52 patients with a mean age of 74.5±11.0 years. We detected cEPC in 20 (38.5%) patients. Median NIHSS score at day 7 was higher among patients with detectable cEPC within 24h from MT (12vs.4; p=0.037). In multivariable analysis adjusted by age, sex and baseline NIHSS, early cEPC mobilization was associated with worse neurological deficits at day 7 (OR=7.14, 95%CI 1.80-28.38; p=0.005). In multivariable analysis adjusted by age, baseline NIHSS and prior mRS score, cEPC mobilization was associated with worse functional outcomes at discharge (OR =3.90, 95%CI 1.17-12.97; p=0.027).

Conclusions: In patients with ischemic stroke and LVO treated with MT, early cEPC mobilization was associated with a more severe neurological deficit at day 7 and a worse functional outcome at discharge.

Disclosure: No

P0746 / 1643

IS MEAN PLATELET VOLUME ASSOCIATED WITH THE OCCURRENCE AND/OR OUTCOME OF LARGE VESSEL OCCLUSION?

C. Azoia ¹, R. Jesus¹, R. Raimundo¹, M. Mendes¹

¹ Centro Hospitalar de Trás-os-Montes e Alto Douro, Neurology, Vila Real, Portugal

Background and aims: Platelets play a central role in ischemic stroke due to large vessel occlusion (LVO) by participating in thrombus formation and thus promoting vessel occlusion as they enlarge in size and become activated. MPV has been suggested as a surrogate marker of platelet activation as well as a prognostic factor in ischemic vascular events, but its association with the occurrence and prognosis of stroke has not been fully clarified. We aim to investigate the association between MPV and the occurrence and prognosis of LVO.

Methods: We performed a retrospective analysis of ischemic strokes submitted to thrombolysis and/or thrombectomy in a tertiary centre between 2019 and 2021. All participants received routine blood tests on admission and were categorized into LVO or non-LVO.

Results: Our sample consisted in 137 patients with 102 cases of LVO; half males, average age of 76.2 years. Median value for MPV was 9.2fL (7.2-12.5). We found no association between MPV and the occurrence of LVO nor with the prognosis of the vascular events measured as NIHSS at admission and on discharge, as well as with haemorrhagic transformation and mortality. Nevertheless, the median MPV for the group LVO was superior to that for non-LVO.

Conclusions: Most subjects of our study presented normal values of MPV, thus anticipating a lack of statistically significant association between that parameter and our variable. However, our findings were consistent with an expected tendency for patients with LVO to present higher values of MPV, as has been pointed out the literature.

Disclosure: No

P0747 / 1511

WITHDRAWN PLASTICITY OF PERISYNAPTIC ASTROGLIA DURING STROKE-INDUCED SPREADING DEPOLARIZATIONS REVEALED BY QUANTITATIVE SERIAL SECTION ELECTRON MICROSCOPY

S.A. Kirov ¹, J. Sword¹, I.V. Fomitcheva²

¹Medical College of Georgia, Neuroscience and Regenerative Medicine, Augusta, United States, ²Medical College of Georgia, Neurosurgery, Augusta, United States

Background: High astrocytes capacity for glutamate and potassium clearance aids in recovering spreading depolarization (SD)-evoked disturbance of ion homeostasis during stroke. Astrocytes are tightly coupled with neurons, combining with axons and dendrites to form the tripartite synapse. The impact of SD on the ultrastructure of a tripartite synapse is unknown.

Methods: SD was evoked by a transient bilateral common carotid artery occlusion in urethane-anesthetized mice. The DC potential and in vivo 2-photon, laser speckle, and intrinsic optical signal imaging were used to monitor onset and recovery from SD. Quantitative serial section electron microscopy was used to study astroglial processes at the axon-spine interface (ASI) during a single SD and recovery. Overall, 480 synapses were randomly selected and analyzed in 3D blind to the conditions (Sham, during SD and Recovery groups).

Results: Astroglial mitochondria were remarkably resilient to SD. Perisynaptic astroglial processes were present at the ASI during SD and after recovery. The percentage of large mushroom dendritic spines with perisynaptic astroglia has increased during recovery from SD. There was a greater decline in the docked vesicles number at bigger synapses corresponding with their larger capacity for neurotransmitter release. The length of the astroglial surround has significantly increased at mushroom spines during recovery.

Conclusions: An increase in perisynaptic astroglial ensheathment at larger synapses suggests that as these synapses release more neurotransmitter during SD, they attract astroglial processes to a discrete portion of their perimeters, further enhancing astrocytic ability to protect fine synaptic circuitry in stroke.

Acknowledgments: Supported by NIH RO1NS083858 (SAK)

Disclosure: No

P0748 / 1357

METABOLOMICS IN ACUTE STROKE

K. Siewers Christensen ¹, S.A. Simonsen², T Sinioja³, A. Sode West², A. Vittrup Heiberg⁴, T. Hyötyläinen³, H.K. Iversen⁴

¹Rigshospitalet, University of Copenhagen, Neurology, Glostrup, Denmark, ²Rigshospitalet, Neurology, Glostrup, Denmark, ³Örebro University, School of Science and technology, MTM Research Centre, Örebro, Sweden, ⁴Rigshospitalet, University of Copenhagen, Neurology, Glostrup and Copenhagen, Denmark

Background and aims: Metabolomics and lipidomics are quantitative assessment of small molecule metabolites and metabolic fluctuations in tissues. In this study we aimed to characterize the serum metabolic and lipidomic profiles of patients with hemorrhagic (ICH) and ischemic stroke (IS) compared to healthy age matched controls and relate changes to disease severity in patients with IS.

Methods: Liquid and gas chromatography combined with time-of-flight mass spectrometry (LC-QTOFMS and GC-QTOFMS) was used to analyze serum samples obtained from patients with ischemic stroke: mild (n = 20) and moderate-severe (n = 20), hemorrhagic stroke (n = 18) and age and sex matched healthy controls (n = 20). Partial least-squares discriminant analysis (PLS-DA), and non-parametric analyses (p < 0.05) using a false discovery rate (FDR) of < 0.02 were used to identify metabolites and lipids discriminating ICH, IS and controls, and relation to severity of IS.

Results: Nine lipids were identified discriminating ICH and healthy controls, consisting of four plasmalogen phosphatidylethanolamines (PEs), two triacylglycerols (TGs), two phosphatidylcholines (PCs), and Lysophosphatidylcholine (LPC)(18:2)). No significant differences in lipidomic and metabolomic profiles between ICH and IS were detected. We identified six lipids potentially related to the severity of ischemic stroke, that discriminated from healthy controls, consisting of four TGs and two PEs. Among them decreased levels of TG(18:0/18:1/20:4), TG(56:4) and TG(51:2) were associated with disease severity.

Conclusions: This study provides novel insight into the metabolic and lipidomic changes that occurs in patients with ischemic and hemorrhagic stroke.

Disclosure: No

P0749 / 267

EFFECT OF DL-3-N-BUTYLPHTHALIDE ON MITOCHONDRIAL COX7C IN MODELS OF CEREBRAL ISCHEMIA/REPERFUSION INJURY

J. Jia ^1,2, J. Deng¹, H. Jin¹, Y. Huang¹

¹Peking University First Hospital, Beijing, China, ²Beijing Children’s Hospital, Beijing, China

Background and aims: Several studies have demonstrated the protective effect of dl-3-n-Butylphthalide (NBP) against cerebral ischemia, which may be related to the attenuation of mitochondrial dysfunction. However, the specific mechanism and targets of NBP in cerebral ischemia/reperfusion remains unclear.

Methods: In this study, we used a chemical proteomics approach to search for targets of NBP, and identified cytochrome C oxidase 7c (Cox7c) as a key interacting target of NBP. Subsequently, a series of studies were conducted in cerebral ischemia/reperfusion models in vivo and in vitro to investigate the specific mechanisms of NBP and Cox7c.

Results: Our in vivo and in vitro findings indicated that NBP upregulated Cox7c in the mitochondria of vascular endothelial cells. Subsequently, NBP inhibited mitochondrial apoptosis, and the release of cytC from mitochondria to cytoplasm, increased the production of ATP, inhibited the release of reactive oxygen species (ROS), improved mitochondrial respiratory capacity, helped to maintain the mitochondrial membrane potential and the integrity of the blood-brain barrier. Besides, our research identified that NBP upregulated the HIF-1α/VEGF pathway to promote angiogenesis. Our study also found that knockdown of Cox7c eliminated the beneficial effects of NBP, while overexpression of Cox7c exerted similar effects to NBP in vivo and in vitro, further demonstrated that Cox7c is a crux target of NBP.

Conclusions: Therefore, our findings provided a novel insight into the mechanisms underlying the neuroprotective effects of NBP in cerebral ischemia/reperfusion, and also proposed for the first time that Cox7c exert critical role by protecting mitochondrial function.

Disclosure: No

P0750 / 1154

ISCHEMIC STROKE AND PERIODONTAL DISEASE: IMPACT OF THE PRESENCE OF PORPHYROMONAS GINGIVALIS WITHIN THE IINTRACRANIAL THROMBUS

A. Freiherr Von Seckendorff¹, M. Solo Nomenjanahary², J. Labreuche³, B. Ho-Tin-Noé², M. Mazighi^1,2, J.-P. Desilles^1,2, S. Delbosc ⁴, CompoCLOT study group

¹Rothschild Foundation Hospital, Department of Interventional Neuroradiology, Paris, France, ²Université de Paris/INSERM U1148, Hemostasis, Thrombo-Inflammation and Neurovascular Repair, Paris, Central African Republic, ³Université de Lille/CHU de Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, Lille, France, ⁴Université de Paris/INSERM U1148, Cardiovascular immunobiology, Paris, France

Background and aims: Despite improvements in prevention and acute management, the incidence and morbidity of acute ischemic stroke (AIS) remain on the rise. Periodontal disease (PD) is associated with an increased incidence of AIS. Porphyromonas gingivalis (Pg) is one of the most critical periodontal pathogens. Our hypothesis is that the presence of Pg modify thrombus composition and the clinical evolution of AIS patients.

Methods: We investigated 65 thrombi from the multicenter research cohort compoCLOT for the presence of Pg by immunostaining and quantified erythrocyte, platelet and neutrophil markers. Baseline clinical, radiological, biological data, dental status, and clinical outcome at 3 months of the corresponding patients were collected for comparison.

Results: Immunostaining was positive for 29.3% of thrombi (95% CI: 18.6-41.9%). Pg positive patients (Pg+) had more severe PD than Pg- patients. At 3 months, 27.8% of Pg+ patients had a favourable neurological outcome versus 55.6% in the Pg- group (p=0.052; OR=0.31 [0.09-1.01]). The percentage of complete recanalization at the end of the procedure was also lower in the Pg+ group compared to the Pg- group (42.1% versus 65.2% respectively; p=0.086). Pg+ thrombi had a tendency to be more neutrophil-rich (p=0.16).

Conclusions: The presence of Pg within thrombi was associated with severe PD and a poor clinical outcome at 3 months. The underlying mechanism could involve change in thrombus composition and increasing the risk of thrombus fragmentation during thrombectomy. This study could promote new recommendations for oral health care and optimize the clinical management of AIS patients.

Disclosure: No

P0751 / 980

ANALYSIS OF HISTOLOGICAL THROMBUS FEATURES AND OUTCOME IN DIFFERENT EMBOLIC ISCHEMIC STROKE GROUPS

V. Meļņikova¹, K. Kupča², K. Jurjāns ¹, J. Vētra¹, D. Lapse³, A. Veiss⁴, J. Nazarovs³, E. Miglāne¹

¹Pauls Stradiņš Clinical University Hospital, Department of Neurology, Rīga, Latvia, ²Rīga Stradiņš University, Faculty of Medicine, Rīga, Latvia, ³Pauls Stradiņš Clinical University Hospital, Department of Pathology, Rīga, Latvia, ⁴Pauls Stradiņš Clinical University Hospital, Department of Radiology, Rīga, Latvia

Background and aims: Determining the etiopathological source of stroke is a cornerstone for correct secondary prophylaxis, however in up to 40% the precise source of embolism cannot be determined. The aim of our study was to investigate histopathological differences of emboli retrieved during mechanical thrombectomy.

Methods: In total 40 stroke patients were included in the study. Histopathological examination was performed using Hematoxylin-and-Eosin staining. Thrombi were characterized according to their overall appearance into erythrocytic, leukocytes, fibrin and microscopically measured their area into mm2. Thrombi were stained immunohistochemically, according to manufacturer’s instructions, for CD3 positive T cells, CD68 positive monocytes, von Willebrand factor positive thromocytes and CD15 positive leukocytes. The results were compared in supposed etiopathological stroke subtype groups as cardioembolic, atherothrombotic and unspecified etiology based on the patients’ comorbidities.

Results: There were 26 cardioembolic thrombi, 7 atherothrombotic and 7 thrombi of unspecified etiology. Atherothrombotic thrombi had a higher percentage of the fibrin area versus total thrombi area than unspecified etiology thrombi (87,4% and 66,4% respectively; P=0,038) and similar tendency comparing with cardioembolic thrombi (87,4% and 75,9% respectively; P=0,099). Unspecified etiology thrombi had statistically lower fibrin/leukocytes ratio than atherothrombotic thrombi (10,7 and 27,7 repectively; P=0,026) and similar tendency comparing with cardioembolic thrombi (10,7 and 14,7 respectively; P=0,067). There were no significant differences in the proportion of other thrombus components between three mentioned groups. Stroke severity at symptom onset and outcomes did not differ between groups.

Conclusions: Listed results showed, that thrombi of unspecified etiology have partial histologic similarities as cardioembolic thrombi.

Disclosure: No

P0752 / 1273

NOVEL ISCHEMIC STROKE MODEL OF PERMANENT OCCLUSION BY ENDOVASCULAR APPROACH IN SWINE

M. Melià-Sorolla ¹, C. Castaño², A. García Serran¹, M.R. García Sort², N. DeGregorio-Rocasolano¹, A. Dávalos³, O. Martí Sistac^1,4, O. Pino⁵, J. Grífols⁵, A. Iruela⁵, A. Palomar⁵, J. Puig⁵, T. Gasull¹

¹Germans Trias I Pujol Research Institute (IGTP), Cellular and Molecular Neurobiology, Badalona, Spain, ²Germans Trias i Pujol University Hospital (HUGTP), Neurointerventional Radiology Unit, Badalona, Spain, ³Germans Trias i Pujol University Hospital (HUGTP), Stroke Unit, Badalona, Spain, ⁴Universitat Autònoma de Barcelona, Department of Cellular Biology, Physiology and Immunology, Bellaterra, Spain, ⁵Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Badalona, Spain

Background and aims: Ischemic stroke (IS) remains between the leading causes of disability and death. There is a need for neuroprotective treatments and reliable rapidly-detectable biomarkers. We intended to establish an alternative endovascular approach to generate a new IS model in pig, a mammal with gyrencephalic brain and more similar white-to-grey matter ratio to humans than rodents, to help improve transferability to the clinics.

Methods: Supraaortic vasculature was characterized in vivo with fluoroscopic angiography in a genetically heterogeneous cohort of pigs. To generate a permanent IS model in pigs, embolizing material was administered endovascularly across the RM with the pressure cooker technique (PCT) to block principal arteries of the circle of Willis (CoW). MRI sequences were applied in vivo at different timepoints. Finally, brains were obtained to study neural damage ex vivo.

Results: No alternative access to the CoW by catheter was identified angiographically with the currently available endovascular devices. Using our PCT method, we induced IS in 100% of pigs, determined both by diffuse weight imaging (DWI) and TTC staining at endpoint. In all the animals, subcortical areas where infarcted. In >85%, the embolizing material reached the middle cerebral artery (MCA) generating greater infarcts involving the cortex. Ischemic damage was further analysed through multimodal imaging techniques and ex vivo analysis of the brain.

Conclusions: We have successfully developed a novel permanent IS model in the pig using an endovascular approach.

Acknowledgements: We are deeply grateful to the CMCiB staff, Canon Medical Systems and Olea.

Disclosure: No

P0753 / 374

MRI CHARACTERIZATION OF THE ISCHEMIC STROKE MODEL OF INTRALUMINAL MIDDLE CEREBRAL ARTERY IN SWISS MICE: VALUE FOR NEUROPROTECTION STUDIES

C. Dumot¹, P. Clottes¹, E. Ong¹, C. Leon¹, B. Pillot¹, F. Chauveau², E. Canet-Soulas¹, M. Wiart ¹

¹Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France, ²BIORAN Team, Lyon Neurosciences Research Center, CNRS UMR5292, Inserm U1028, Université Claude Bernard Lyon 1, Lyon, France

Background and aims: To overcome the translational roadblock for neuroprotection studies, there is a need for better methodology in pre-clinical trials. Our aim was two-fold: (i) to characterize the model of intraluminal middle cerebral occlusion (MCAO) in Swiss mice with longitudinal MRI and (ii) to calculate sample size for a neuroprotection study.

Methods: MCAO and longitudinal MRI were performed in 54 Swiss male mice (Figure 1A). Half of the animals were subjected to permanent MCAO (pMCAO) and the other half to transient MCAO (tMCAO, 60 minutes). Sample size was calculated using tMCAO MRI data.

Results: Thirty-five mice (65%) met the inclusion criteria (Figure 1B). H24 infarct size was statistically smaller in tMCAO than in pMCAO, with a regression of DWI lesions (Figures 2A-B). In pMCAO, 80% ± 21% of the hypoperfused area got infarcted at H24 while in tMCAO it was 27% ± 21% (Figure 2C). Sample size should be 17 mice per group (i.e. (17x2)/65%=52 surgeries) to detect a 40% decrease in infarct size (Figure 2D).

Conclusions: We characterized the model of intraluminal middle cerebral artery occlusion with longitudinal MRI in Swiss mice, which had not been done to date to the best of our knowledge. MRI is a modality of choice to ascertain successful MCAO and thus improve inclusion. In addition, MRI provides quantitative measurements of lesion sizes that align with clinical endpoints.

Acknowledgment:

ANR-15-CE18-0026-01

ANR16-RHUS-0009

Figure 1.

Study design (A) and outcome of MCAO (B)

Figure 2.

Longitudinal MRI data (A-C) and sample size calculation (D)

Disclosure: No

P0754 / 423

ENDOGENOUS REGULATION OF NEUTROPHIL EXTRACELLULAR TRAPS IN ACUTE ISCHAEMIC STROKE DUE TO VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA

N. de Buhr¹, T. Baumann², C. Werlein², L. Fingerhut¹, R. Imker¹, M. Meurer¹, F. Götz², P. Bronzlik², M.P. Kühnel², D.D. Jonigk², J. Ernst², A. Leotescu², M.M. Gabriel², H. Worthmann², R. Lichtinghagen², A. Tiede², M. von Köckritz-Blickwede¹, C.S. Falk², K. Weissenborn², R. Schuppner², G.M. Grosse ²

¹University of Veterinary Medicine Hannover, Hannover, Germany, ²Hannover Medical School, Hannover, Germany

Background and aims: Vaccination is one of the most important countermeasures in the ongoing COVID19-pandemic. Pharmacovigilance concerns, however, emerged after very rare, but potentially disastrous thrombotic complications following vaccination with ChAdOx1. The underlying pathology was described as platelet factor 4 antibody mediated vaccine-induced immune thrombotic thrombocytopenia (VITT). Mechanisms of immunothrombosis including the regulation of neutrophil extracellular traps (NETs) might be of crucial importance in VITT.

Methods: In this study, we had the exceptional opportunity to investigate blood and thrombus samples of a patient who suffered severe ischaemic stroke due to VITT undergoing successful mechanical thrombectomy (MT) in comparison to 13 control stroke patients with similar clinical characteristics without VITT. Cerebral thrombi were stained for complement factors, NETs-markers, DNase and LL-37 and were histologically assessed. In blood samples before MT and 7 days later, cell-free DNA, myeloperoxidase-histone complexes, myeloperoxidase activity, DNase activity, LL-37 and inflammatory cytokines were determined.

Results: We identified NETs-markers in thrombi of all patients. The thrombus of the VITT-patient, however, exclusively revealed complement factors and high amounts of NETs-degrading DNase and LL-37, which protects NETs from degradation. In accordance, ex vivo and in vitro studies also implied a disturbed regulation of NETs in VITT-samples. Moreover, we found markedly pronounced temporal changes of specific circulating cytokines in the VITT-case.

Conclusions: The results of this study suggest a disturbed endogenous regulation of NETs in VITT involving a pro-inflammatory response and fulminant clinical course. Further studies are warranted to confirm our results and to provide deeper insights into the causative mechanisms.

Disclosure: No

P0755 / 1117

STUDY OF NEUROPROTECTIVE EFFECT OF PRE- AND POST-CONDITIONING WITH CYCLOSPORINE A IN A MOUSE MODEL OF TRANSIENT FOCAL CEREBRAL ISCHEMIA

E. Ong ¹, P. Clottes¹, C. Leon², L. Motter², M. Lo-Grasso², N. Gallo-Bona², N. Nighoghossian¹, M. Wiart², M. Paillard²

¹HCL, Lyon, France, ²U1060 CARMEN-IRIS, Lyon, France

Background and aims: Mitochondrial permeability transition pore (mPTP) opening is thought to play a crucial role in stroke-induced cell death. Cyclosporine A (CsA), a potent mPTP inhibitor, showed protection against cerebral ischemia-reperfusion (IR). We sought to study the mitochondrial effects of CsA conditioning in a mouse model of stroke.

Methods: Swiss male mice underwent 60 minutes of right middle cerebral artery occlusion, followed by 30 minutes, 24 hours or no reperfusion (Perm) or sham surgery. Animals were randomly assigned into 3 groups (n=12 mice/group) to receive: a bolus of CsA (10mg/kg) 10min before occlusion (preconditioning-preCsA) or 5min before reperfusion (postconditioning-PostCsA), or no treatment (IR). In the 24h reperfusion group, longitudinal in vivo imaging was performed to assess lesion size and neuroscores were evaluated before sacrifice. mPTP opening was evaluated by calcium retention capacity (CRC) on cortical mitochondria isolated from each hemisphere.

Results: In the non-ischemic hemisphere, CRC was similar between all groups. In the ischemic hemisphere, IR mitochondria displayed a significantly reduced CRC after either 30min or 24h reperfusion compared to sham. There was a trend of a protective effect in PreCsA and PostCsA groups on mPTP sensitivity after 24h of reperfusion only (Figure).

Conclusions: Our data suggest an early increase of mPTP sensitivity after IR in the ischemic mitochondria, partially rescued by CsA conditioning. This may have implication for patients as CsA can be safely administered at the acute stage of ischemic stroke.

Figure.

CRC results after 24h of reperfusion: right ischemic hemisphere (A) and left non-ischemic hemisphere (B)

Disclosure: No

P0756 / 1482

THROMBIN GENERATION IS RELATED TO LEUKOCYTE INFLAMMATORY PROFILE IN ACUTE ISCHEMIC STROKE

S. Falcione ¹, D. Munsterman¹, T. Joy¹, J. Kamtchum-Tatuene¹, G. Sykes¹, G. Jickling¹

¹ University of Alberta, Medicine, Edmonton, Canada

Thrombosis is central to the pathogenesis of acute ischemic stroke, with higher thrombin generation being associated with increased stroke risk. The immune system may contribute to thrombin generation in stroke, and may offer novel strategies for stroke prevention. We examined the peripheral immune system transcriptome in relationship to thrombin generation capacity in patients with acute ischemic stroke. Due to its effects on thrombin generation, patients on anticoagulants were excluded from the study. The relationship of gene expression with peak thrombin was evaluated by analysis of co-variance (ANCOVA) across peak thrombin quartiles adjusted for sex and age. In 97 patients with acute ischemic stroke, thrombin generation was variable, ranging from 252.0nM to 752.4nM peak thrombin. Increased thrombin generation was associated with differences in thromboinflammatory leukocyte gene expression, including a decrease in ADAM metallopeptidase with thrombospondin type 1 motif 13 (ADAMTS13) and an increase in NF-kB activating protein (NKAP), protein disulfide isomerase family A member 5 (PDIA5), and tissue factor pathway inhibitor 2 (TFPI2) expression. Pathways associated with peak thrombin included interleukin 6 (IL-6) signaling, thrombin signaling, and NF-kB signaling. A discriminant analysis model summarizing the immune activation associated with thrombin generation in first cohort of stroke could distinguish patients with low peak thrombin from high peak thrombin in second cohort of 112 acute ischemic stroke patients. The identified genes and pathways support a role of the immune system contributing to thrombus formation in patients with stroke. These may have relevance to reduce thrombus formation and stroke prevention.

Disclosure: No

P0757 / 375

SIMVASTATIN IS NOT PROTECTIVE AT THE ACUTE STAGE OF ISCHEMIC STROKE IN THE MOUSE MODEL OF DISTAL PERMANENT MIDDLE CEREBRAL ARTERY OCCLUSION

V. Hubert¹, S. Karpati², F. Lerouge², N. Chounlamountri³, C. Dumot^1,4, F. Chauveau^5,6, C. Watrin³, E. Canet-Soulas¹, S. Parola², C. Crola da Silva¹, T. Bochaton^1,4, T. Vorup-Jensen⁷, O. Pascual³, M. Wiart ^1,6

¹Univ-Lyon, CarMeN Laboratory, Inserm U 1060, INRA U 1397, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France, ²Université de Lyon, Ecole Normale Supérieure de Lyon, CNRS UMR 5182, Université Lyon 1, Laboratoire de Chimie, Lyon, France, ³Institut NeuroMyoGène, Université Claude Bernard Lyon 1, CNRS UMR 5310, INSERM U 1217, Lyon, France, ⁴Hospices Civils de Lyon, Lyon, France, ⁵BIORAN Team, Lyon Neurosciences Research Center, CNRS UMR 5292, Inserm U 1028, Université Claude Bernard Lyon 1, Lyon, France, ⁶CNRS, Lyon, France, ⁷Department of Biomedicine, Biophysical Immunology Laboratory, Aarhus University, Aarhus, Denmark

Background and aims: Our aim was to evaluate the effects of Simvastatin treatment given at the acute phase of ischemic stroke in a mouse model of distal permanent middle cerebral artery occlusion (dMCAO) with longitudinal multimodal in-vivo imaging.

Methods: We evaluated Simvastatin effects on infarct size and edema by imaging C57Bl/6 dMCAO mice with longitudinal MRI (Figure 1A) and on neuroinflammation by imaging CX3CR1eGFP/+ dMCAO mice with two-photon microscopy back-to-back with MRI after NanoGd injection, a multimodal nanoparticle specifically designed to get engulfed by activated macrophages (Hubert et al, Adv Sci 2021) (Figure 2A).

Results: There was no difference between Simvastatin-treated and placebo-treated groups in infarct size (Figure 1B) nor in global brain edema (Figure 1C). There was no difference between groups in the percentage of CX3CR1eGFP/+ cells that had engulfed NanoGd in the lesion at 24h and 48h (Figure 2B). There was no difference between groups either in NanoGd-induced signal voids on MRI at 72h (Figure 2C).

Conclusions: Because Simvastatin treatment has been shown to exert anti-inflammatory effects, we hypothesized that it may be protective at the acute stage of dMCAO, a model that triggers a robust inflammatory reaction. However, no effect was noted with in-vivo imaging whether on lesion size, brain edema, or phagocytic activity. Therefore, stroke patients with non-reperfused moderate cortical lesions may not benefit from statin therapy given at stroke onset.

Acknowledgment:

ANR-15-CE18-0026-01

ANR16-RHUS-0009

Figure 1.

Simvastatin does not decrease infarct size or edema in dMCAO

Fig 2.

Simvastatin does not inhibit phagocytosis activity in dMCAO

Disclosure: No

P0758 / 1217

TREATMENT STRATEGIES INVESTIGATED IN A HUMAN IN VITRO MODEL OF THE ISCHEMIC PENUMBRA

E.J.H.F. Voogd ¹, M. Cerina¹, S. Pires Monteiro¹, J. Hofmeijer¹, M. Frega¹

¹ University of Twente, Clinical neurophysiology, Enschede, Netherlands

Background and aims: Translation of effects of neuroprotective treatments from animal models to patients with ischemic stroke has failed, so far. This poses doubt on the validity of animal models, as well as the treatment strategies under study. We present a human in vitro model of the ischemic penumbra and effects of different treatment strategies.

Methods: Neurons were differentiated from human induced pluripotent stem cells (hiPSCs) and cultured on micro-electrode arrays and glass coverslips. Controlled hypoxia proportional to penumbral oxygen levels was achieved by computer-controlled climate chambers. Outcome measures included electrophysiological activity (mean firing rate and synchronous network activity) and cell viability (live dead assay including apoptosis), and were investigated during and after hypoxia, with and without treatment (i.e. optogenetic stimulation, NMDA antagonist, or hypothermia).

Results: Hypoxia led to a gradual loss of random neuronal activity and synchronicity within 48h of hypoxia, with none or partial recovery after restoration of normoxia, depending on timing of reoxygenation. Cell viability assays showed a 60% increase in apoptotic cells after 24h of hypoxia and 40% increase in dead cells after 48h of hypoxia. NMDA antagonists (APV and memantine) and hypothermia did not show neuroprotection during 48h of hypoxia, in contrary to optogenetic stimulation which completely preserved neuronal activity during hypoxia.

Conclusions: HiPSCs derived neurons exposed to hypoxia can serve as a human in vitro model of the penumbra. Hypoxia causes neuronal network impairment, with recovery depending on hypoxia duration. Early neuronal stimulation improves network recovery.

Disclosure: No

P0759 / 196

ASSESSMENT OF AMPA RECEPTOR MODULATION AGAINST ISCHEMIC REPERFUSION INJURY IN RATS BY MAGNETIC RESONANCE IMAGING

H. Sharma ¹, K. Reeta¹

¹ All India Institute of Medical Sciences, Pharmacology, New Delhi, India

Background and aim: Cerebral ischemia is a common life-threatening disease. Excessive glutamate discharge plays a vital role in ischemia-induced neuronal death which is facilitated by over-activation of glutamate receptors including α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR). The present study evaluates the effect of modulating AMPAR after ischemia reperfusion injury by impeding and stimulating the receptor at specific time points, followed by evaluation of neurological damage and post stroke recovery.

Methods: Wistar rats underwent 90 min middle cerebral artery occlusion (MCAo). Perampanel (1.5 mg/kg i.p.) was given for 5 days post reperfusion and aniracetam (50 mg/kg i.p.) was administered after 5 days of reperfusion till 7 days. After 7 days, neurological damage and Infarct size were assessed by magnetic resonance imaging (MRI) using an animal MRI 7.0 T scanner.

Results: In sham group, there was no change in signal intensity while in MCAo group significant (p<0.001) enhancement in signal intensity was detected. Sequential treatment of perampanel and aniracetam significantly (p<0.001) reduced the signal intensity when compared to MCAo group. Infarct region of MCAo rats showed significant (p<0.001) reduction in apparent diffusion coefficient (ADC) values when compared with sham group. Perampanel and aniracetam significantly (p<0.001) augmented the ADC values. Sham group exhibited no infarct, whereas MCAo group showed significant infarct in ipsilateral area (30.05±1.26%, p<0.01). Infarct percentage was significantly (p< 0.01) reduced in the sequential treatment group (7.17±1.79%).

Conclusions: This study showed neuroprotective effect of AMPAR modulation by sequential treatment of perampanel and aniracetam when given after ischemic reperfusion in rats.

Disclosure: No

P0760 / 1255

DNASE 1 UNVEILS THE PRESENCE AND UNLOCKS THE THROMBOLYTIC POTENTIAL OF INTRAVENOUSLY ADMINISTERED T-PA IN LARGE VESSEL OCCLUSION ACUTE ISCHEMIC STROKE

L. Di Meglio ¹, M. Solo Nomenjanahary¹, V. Ollivier¹, M. Mazighi^1,2,3, B. Ho-Tin-Noe¹, J.-P. Desilles^1,3, compoCLOT study group

¹INSERM U1148 Laboratory of Vascular Translational Science, TEAM 6: Hemostasis, Thrombo-Inflammation and Neurovascular Repair, Paris, France, ²Lariboisiere university hospital APHP, Department of Neurology, Paris, France, ³Rothschild Foundation Hospital, Department of Interventional Neuroradiology, Paris, France

Background and aims: Deoxyribonuclease 1 (DNase 1) has been shown to potentiate the thrombolytic activity of t-PA added ex vivo to acute ischemic stroke (AIS) thrombi. Nevertheless, it remains unknown whether extracellular DNA in AIS thrombi is responsible for intravenous thrombolysis (IVT) failure in AIS due to large vessel occlusion (LVO).

We investigated whether biologically relevant intra-thrombus concentrations of t-PA were achieved following IVT for LVO-related AIS, and whether extracellular DNA contributed to IVT failure.

Methods: A total of 103 thrombi from AIS patients with LVO having received (n=50) or not (n=53) IVT prior to mechanical thrombectomy were analyzed. While 83 thrombi were compared for t-PA content, a subset of 10 thrombi per patient group was subjected to ex vivo thrombolysis assays by addition of plasminogen, in the presence or absence of DNase 1.

Results: AIS thrombi from the IVT group contained more t-PA than those from the non-IVT group (0.093 vs 0.209 µg/mg thrombus, p<0.0001). A significant negative correlation was found between thrombus t-PA content and IVT to recanalization delay (p=1.2x10^-5). Ex vivo thrombolysis assays revealed that, whereas addition of plasminogen alone did not induce lysis of AIS thrombi from either group of patients, it caused a significant decrease in thrombus weight in the IVT group in the presence of DNase 1.

Conclusions: These results indicate that intra-thrombus t-PA concentrations reached after IVT bear a therapeutic potential that is however impaired by DNA. Our results stress the interest of DNase 1 as a thrombolytic therapy adjuvant to current IVT t-PA regimens.

Disclosure: No

P0761 / 985

ROLE OF ENDOTHELIN-1 AND NITRIC OXIDE IN ACUTE ISCHEMIC STROKE LEPTOMENINGEAL COLLATERALS ACTIVATION

A. Risitano ¹, I. Berto¹, E. Nicolini¹, L. Petraglia¹, O. Schiavo¹, R. Carnevale², V. Cammisotto³, A. Ciacciarelli¹, M. Iacobucci⁴, M.T. Di Mascio⁵, D. Toni¹, M. De Michele⁵

¹Sapienza University - Umberto I Hospital, Emergency Department - Stroke Unit, Rome, Italy, ²Sapienza University, Department of Medical and Surgical Sciences and Biotechnologies, Latina, Italy, ³Sapienza University, Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, Rome, Italy, ⁴Sapienza University - Umberto I Hospital, Department of Human Neurosciences - Neuroradiology Unit, Rome, Italy, ⁵Umberto I Hospital, Emergency Department - Stroke Unit, Rome, Italy

Background and aims: Good leptomeningeal collaterals (LMC) after large vessel occlusion (LVO) extend time window for endovascular therapy (EVT). Mechanisms regulating the LMC activation are not completely known. Aim of this study was to investigate the role of Endothelin-1 (ET1) and nitric oxide (NO) in post-stroke LMC regulation.

Methods: Ischemic stroke patients within 6 hours from LVO were included. Collateral status was evaluated on a Computed Tomography Angiography scan using the Menon scoring system. Patients were accordingly divided into three groups: poor, intermediate and good LMC. Recanalization was evaluated using Thrombolysis in cerebral infarction (TICI) score. Serum ET1 and NO were evaluated at three different time points from stroke onset: T0 (< 6h), T1 (24h), T2 (48h).

Results: We enrolled 102 patients (mean age was 76 ± 12.35): 45 with good (44.5%), 35 with intermediate (34.3%) and 22 with poor LMC (21.6%). Serum ET1 levels increased whereas NO levels decreased from T0 to T1 regardless of the collateral status. However, in patients with poor recanalization and poor LMC, serum ET1 values were higher at each time point (p 0.005). A significant association was also found between higher ET1 levels at T1 and poor outcome despite a good recanalization (p 0.030).

Conclusion: Although we found no significant association between the extent of LCM and ET1 and NO serum concentrations, present data show that the highest ET1 serum levels at 24 hours predict a poor outcome despite a good recanalization. A sustained ETA receptor mediated vasoconstriction could be hypothesized in these patients.

Disclosure: No

P0762 / 565

DEVELOPMENT OF A TRANSLATIONAL MODEL FOR CEREBRAL ISCHEMIA REPERFUSION IN ADULT MINIPIGS

J. Bobi¹, A. Taha ^1,2, V. Volovici³, J. Raben¹, R. van Noort¹, M. Stam¹, D.J Duncker¹, D.WJ Dippel², R. Dammers³, H.MM van Beusekom¹

¹Erasmus MC University Medical Center, Cardiology, Rotterdam, Netherlands, ²Erasmus MC University Medical Center, Neurology, Rotterdam, Netherlands, ³Erasmus MC University Medical Center, Neurosurgery, Rotterdam, Netherlands

Background and aims: Large animals studies are recommended to improve translation of potential neuroprotective agents in acute ischemic stroke. For practical reasons, most large animal studies are performed in relatively young subjects, in contrast to the elderly stroke patient population. Implementation of (recanalized) acute ischemic stroke models in adult minipigs could further improve translation, allowing for extensive biomarker sampling strategies and histological analyses.

Methods: Anesthetized adult (≈2years) Aachen minipigs (n=5) underwent 3D angiography to visualize the vasculature. Then craniotomy was performed to occlude the right-sided middle cerebral arteries with aneurysm clips (Fig 1). After four hours, clips were released to allow recanalization. 3D angiography was used to confirm occlusion and recanalization. Two to four hours later, animals were euthanized and brains were collected. Infarct volume was determined by TTC staining (Fig 2) and expressed as percentage of the infarcted hemisphere. Data are given as median(min-max).

Results: All animals survived until the end of the procedure, without occurrence of intracranial hemorrhage. The procedure was unsuccessful in 1 animal. Infarct size was 22.4%(10.8%-25.2%) (n=4).

Conclusions: Adult Aachen minipigs can be used for cerebral ischemia-reperfusion serving as a model for translational neuroprotective studies.

Figure 1.

3D-Angiography (A) and schematic overview (B) of clipping of multiple middle cerebral arteries in swine.

Figure 2.

Example of TTC infarct staining. Infarcted tissue does not stain red.

Disclosure: No

P0763 / 509

LONGITUDINAL CHANGE IN GLOBAL METABOLOMIC PROFILING BETWEEN THE ACUTE AND CHRONIC STAGES OF ISCHEMIC STROKE

E. Sidorov ¹, C. Xu², J. Garcia³, B. Apple³, J. Ortiz-Garcia³,D. Gordon¹, J. Chainakul³, D. Sanghera⁴

¹University of Oklahoma Health Sciences Center, Neurology, Oklahoma City, United States, ²University of Oklahoma Health Sciences Center, Statistics, Oklahoma City, United States, ³University of Oklahoma Health Sciences Center, Oklahoma City, United States, ⁴University of Oklahoma Health Sciences Center, Pediatrics, Oklahoma City, United States

Background and aims: Previous metabolome-stroke studies found multiple associations of serum metabolites with acute ischemic stroke (AIS) compared to controls, but few of them evaluated metabolome in a longitudinal fashion. We aimed to compare the metabolome of the acute and chronic stages of ischemic stroke.

Methods: We evaluated 1295 serum metabolites from the cohort of 60 stroke patients at acute and chronic stages by performing global metabolomics using ultra-high-performance liquid chromatography/mass spectrometry (LC-MS) and gas chromatography/mass spectrometry (GC-MS). We used Orthogonal Partial Least Square-Discrimination Analysis (OPLS-DA) to inspect group disparity and a mixed regression model to compare metabolites in the acute and chronic stages with Two-Stage Benjamini & Hochberg (TSBH) and Bonferroni correction for multiple testing.

Results: The OPLS-DA revealed significant separation of acute and chronic stage metabolites. Mixed regression identified 228 metabolites with TSBH, and 29 metabolites with Bonferroni correction different in acute and chronic stages. At the acute stage, there was a consistent increase of the metabolites of mono/diacylglycerols, sphingolipids, medium/long-chain fatty acids, and amino acids glycine, valine, and tyrosine. At the same time, there was a consistent decrease of the metabolites of acyl-choline related fatty acids, phospholipids, and amino acids alanine, aspartate, and tyramine. Additionally, we identified eight novel metabolites significantly altered at the acute stage of stroke.

Conclusions: Our study demonstrated significant alterations in metabolomic patterns between the acute and chronic stages of stroke, validating some case-control findings. Future investigation in a larger independent cohort is warranted to identify early biomarkers of acute ischemic stroke.

Table 1.

Subpathway analysis of metabolites with different concentrations in acute to chronic stages of stroke after TSBH correction for multiple testing.

Number of metabolites	Number (%) of metabolites elevated in acute stage (n=105)	Number (%) of metabolites decreased in acute stage (n=123)
Lipid super pathway
Sphingolipids	22 (21%)	0 (0%)
Mono- and diacylglycerols	19 (18%)	0 (0%)
Long/Medium chain fatty acids	16 (15%)	0 (0%)
Pregnolone, progestin, androgen (steroids)	6 (6%)	1 (1%)
Endocannabinoids	4 (4%)	2 (2%)
Fatty acid metabolism (Acyl-choline)	0 (0%)	11 (9%)
Fatty acid dicarboxylate, monohydroxy	0 (0%)	12 (10%)
Plasmogen	0 (0%)	5 (4%)
Phospholipids	0 (0%)	4 (3%)
Eicosanoid	0 (0%)	2 (2%)
Amino acid super pathway
Glycine; Valine	3 (3%)	1 (1%)
Tyrosine	1 (1%)	0 (0%)
Alanine and Aspartate	1 (1%)	2 (2%)
Leucine, Isoleucine, and Valine	1 (1%)	4 (3%)
Tyramine	0 (0%)	1 (1%)
Phenylalanine	0 (0%)	1 (1%)
Histidine	0 (0%)	1 (1%)
Glutamate	0 (0%)	2 (2%)
Lysine	0 (0%)	2 (2%)
Tryptophan	0 (0%)	4 (3%)
Urea cycle; Arginine and Proline	0 (0%)	5 (4%)
Other metabolite pathways
Glycolysis/Gluconeogenesis	4 (4%)	0 (0%)
Fibrinogen	2 (2%)	0 (0%)
Fibrinogen Cleavage	0 (0%)	6 (5%)
Other metabolites	11(10%)	11 (9%)
Unknown	15 (14%)	45 (37%)

Table 2.

Summary of metabolites showing significant variation between the acute and chronic stages of stroke, sorted by regression coefficients.

Metabolite	AverageAcute Stage	Average Chronic Stage	Regression Coefficient	BF corrected p-value	Metabolism
X – 15523	3.348	0.271	3.036	0.000891	Undiscovered
X – 17343	-0.562	-3.047	2.867	0.0105	Undiscovered
Glycylvaline	-0.873	-3.606	2.745	0.0199	Dipeptide
X – 21816	0.251	-1.622	1.811	0.0139	Undiscovered
1-oleoylglycerol (18:1)	1.362	-0.407	1.783	0.00406	Monoacylglycerol
2-oleoylglycerol (18:2)	1.331	-0.421	1.781	0.00173	Monoacylglycerol
4-methoxyphenol sulfate	0.694	-0.941	1.745	0.0000219	Tyrosine
N-stearoyl-sphinganine (d18:0/18:0)	0.283	-1.246	1.51	0.00014	Sphingolipids (Ceramide)
X – 18945	-0.916	-1.89	1.068	0.0335	Undiscovered
Sphingomyelin	0.337	-0.444	0.765	0.00744	Sphingolipids
N-palmitoyl-sphinganine (d18:0/16:0)	0.324	-0.399	0.731	0.000512	Sphingolipids(Ceramide)
N-palmitoyl-heptadecasphingosine	0.166	-0.443	0.591	0.0274	Sphingolipids(Ceramide)
N-stearoyl-sphingosine	0.383	-0.108	0.498	0.0156	Sphingolipids (Dihydroceramide)
N-palmitoyl-sphingosine (d18:0/16:0)	0.328	-0.043	0.355	0.0141	Sphingolipids(Ceramide)
Hydroxyproline	0	-0.494	-0.473	0.0164	Urea cycle; Arginine and Proline
X – 13431	-0.195	0.347	-0.538	0.0419	Undiscovered
X – 21831	-1.367	-0.656	-0.696	0.0499	Undiscovered
1-palmitoyl- Glycerophosphotidilinositol	-0.16	0.611	-0.753	0.0158	Phospholipid
X – 10458	-0.26	0.733	-0.884	0.000037	Undiscovered
N-Carbamoyl alanine	-0.328	0.617	-0.934	0.0419	Alanine and Aspartate
Eicosapentaenoylcholine	-0.714	0.423	-1.019	0.000207	Fatty acids (Acyl-choline)
N-linoleoylserine	-1.008	0.128	-1.094	0.00804	Fatty acids
Oleoylcholine	-0.553	0.682	-1.18	0.0474	Fatty Acid
X – 25805	-2.242	-1.078	-1.181	0.0144	Undiscovered
Stearoylcholine	-0.562	0.815	-1.277	0.0251	Fatty Acid
3-methoxytyramine sulfate	-1.268	0.1	-1.341	0.0000418	Amino acids
Glycerophosphotidilinositol	-0.43	1.119	-1.458	0.0102	Phospholipid
X – 12216	-0.674	1.057	-1.56	0.000458	Undiscovered.
X – 12849	-2.33	0.147	-2.239	0.02	Undiscovered

Data were adjusted for age, gender, ethnicity, BMI, history of hypertension, hyperlipidemia, diabetes mellitus, and glomerular filtration rate (GFR).

Disclosure: No

P0764 / 1278

WITHDRAWN CARBAMYLATION IN ACUTE ISCHEMIC STROKE THROMBI IMPAIRS TPA-MEDIATED THROMBOLYSIS AND INCREASES THROMBUS FRAILTY

V. Ollivier ¹, A. Freiherr Von Seckendorff¹, M. Solo Nomenjanahary¹, M.-C. Bourrienne¹, S. Dupont¹, J.-P. Desilles^1,2, M. Mazighi^1,3,2, B. Ho-Tin-Noé¹, compoCLOT study group

¹INSERM U1148 Laboratory of Vascular Translational Science, TEAM 6: Hemostasis, Thrombo-Inflammation and Neurovascular Repair, Paris, France, ²Rothschild Foundation Hospital, Department of Interventional Neuroradiology, Paris, France, ³Lariboisiere University Hospital APHP, Department of Neurology, Paris, France

Background: Carbamylation, a post-translational modification resulting from the interaction between isocyanic acid with free functional groups of proteins, preferentially occurs on the ε-NH2 of lysine residues, generating homocitrulline (HCit). Conversion of lysine residues of fibrin(ogen) to HCit was shown to impair t-PA-mediated fibrinolysis. Carbamylation is promoted by neutrophils through their myeloperoxidase (MPO) activity that favors isocyanic acid formation. Neutrophils are important components of acute ischemic stroke (AIS) thrombi. It remains unknown whether carbamylation occurs in such thrombi.

Objectives: To determine whether carbamylation occurs in AIS thrombi and if it affects recanalization therapy response.

Methods: Thirty thrombi recovered from AIS patients by endovascular therapy (EVT) were analyzed by anti-HCit immunostaining and quantitative measurement of fibrin(ogen)- and von Willebrand factor (vWF)-associated HCit. Correlations between fibrin(ogen) carbamylation and thrombolysis resistance were investigated in ex vivo thrombolysis assays in which AIS thrombi were treated with a mixture of tPA/plasminogen, and the lysis supernatants collecteded for quantification of carbamylated fibrin(ogen). The impact of carbamylation on EVT was determined by comparing the response to EVT of non-carbamylated and carbamylated thrombi produced in vitro and injected in-flow in an EVT simulation system.

Results: All AIS thrombi contained carbamylated fibrin(ogen) and vWF whose levels were positively correlated to thrombus MPO and DNA content. Resistance to ex vivo thrombolysis was significantly correlated with thrombus carbamylated fibrin(ogen), MPO, and DNA content. Carbamylation led to an increase in thrombus frailty and fragmentation during simulated EVT procedures.

Conclusions: Carbamylation occurs in AIS thrombi and negatively interferes with both pharmacological thrombolysis and EVT.

Disclosure: No

P0765 / 510

CHANGE OF THYROID FUNCTION AFTER ISCHEMIC STROKE AND ITS RELATION TO STROKE SEVERITY

E. Sidorov ¹, A. Paul¹, C. Xu², C. Delpirou Nouh¹, A. Chen², A. Gosmanova³, N. Gosmanov³, D.L. Gordon¹, I. Baranskaya⁴, J. Chainakul¹, R. Hamilton¹, A. Mdzinarishvili¹

¹University of Oklahoma Health Sciences Center, Neurology, Oklahoma City, United States, ²University of Oklahoma Health Sciences Center, Statistics, Oklahoma City, United States, ³University of Oklahoma Health Sciences Center, Endocrinology, Oklahoma City, United States, ⁴University of Oklahoma Health Sciences Center, Psychiatry, Oklahoma City, United States

Background and aims: Low thyroid function was previously associated with poor stroke outcomes; but, whether it changes after ischemic stroke or stays steady was not investigated. We aimed to evaluate how thyroid hormones change from first hours to days and months after stroke.

Methods: We prospectively evaluated changes in thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxin (fT4) levels from the hyper-acute (within 24 hours) to acute (3-5 days) and chronic (3-6 months) stages of ischemic stroke using a mixed regression model. In addition, we analyzed whether a change in thyroid hormones is associated with stroke severity expressed by NIHSS.

Results: TSH levels decreased from the hyper-acute (3.25 ±5.03 μIU/mL) to acute (3.01±3.07 μ IU/mL) and chronic stages of stroke (1.85±1.07 μIU/m), p-value=0.13. fT3 levels decreased from the hyper-acute (2.77±0.54 pg/ml) to acute (2.32±0.52 pg/ml) stages, but recovered during the chronic stage (2.78±0.31 pg/ml), p<0.01. fT4 levels decreased from the hyper-acute (1.26±0.25 ng/dl) to acute (1.12±0.23 ng/dl) stages, and increased in the chronic stage (1.16±0.26 ng/dl), p<0.01. Reduction of fT3 from hyper-acute to the acute stage was associated with presenting stroke severity, (r=0.04, p=0.02), while recovery of fT3 correlated with improvement of NIHSS from acute to chronic stages (PCC=-0.79; p=0.04).

Conclusion: There is a transient reduction in thyroid hormones after ischemic stroke, with recovery during the chronic stage. Stroke severity may affect the change of fT3 levels. Large-scale studies are needed to validate these findings.

Disclosure: No

P0766 / 893

HUMAN T-LYMPHOCYTES DYNAMICALLY CHANGE THEIR ACTIVATIONAL STATUS POST STROKE AND INTERACT WITH MICROGLIA CELLS EX VIVO

L. Peglau ¹, J. Ruhnau¹, T. Krüger², A. Dressel³, O. Otto⁴, J. Schulze¹, A. Vogelgesang¹

¹University Medicine Greifswald, Department of Neurology, Greifswald, Germany, ²AMEOS Clinic Ueckermünde, Department of Neurology, Ueckermünde, Germany, ³Carl-Thiem-Clinic Cottbus, Department of Neurology, Cottbus, Germany, ⁴University Greifswald, Zentrum für Innovationskompetenz: Humorale Immunreaktionen bei kardiovaskulären Erkrankungen, Greifswald, Germany

Background: Post-stroke, T-lymphocytes exert differential effects both at the infarction site and systemically. Invading T-cells can interact with brain resident microglia cells leading to alterations in their functional fate either promoting brain damage or recovery depending on the post stroke recovery phase.

Aim: We elucidated the temporal course (t₁=3 days, t₂=1 month, t₃=3 months) of peripheral blood T-cell activation. Furthermore, we assessed the interaction of pan-T-cells and double negative T-cells (DNTs) respectively with microglia ex vivo.

Methods: Full blood from stroke patients (n=10) and controls (n=8) was analysed regarding T-cell subpopulations (CD4+, CD8+, DNT) and T-cell activation (CD25, CD27, CD28, CTLA-4, PD-L1) by flow cytometry. Pan-T-cells and DNTs were isolated magnetically and incubated for 24 hours with or without microglia from healthy donors ex vivo. T-cell (HLA-DR) and microglia activation (HLA-DR, CX3CR1, CD32, CD86, CD206, CD209) were assessed by flow cytometry staining.

Results: Post stroke CD4+ and CD8+ T cell activation (CD25) persisted for one month and declined only after 3 months. Inhibitory activation markers CTLA-4 and PD-L1 were upregulated only months after stroke. Coculture of pan-T cells and microglia had little effects on microglial activation. Coculture of DNTs inhibited M2-phenotype.

Conclusions: Acutely, stroke leads to strong activation (CD25) of both CD4+ and CD8+ T-cells which only declines after 3 months. PD-L1 and CTLA-4 might have a role in terminating the persistent T-cell-activation. Pan-T-cells show little modulatory effects on microglia activation status ex vivo whereas DNTs effectively activate M1 and inhibit M2-phenotype.

Disclosure: No

P0767 / 826

INVESTIGATION OF THE RELATIONSHIP BETWEEN THROMBUS HISTOPATHOLOGY AND HYPERINTENSE ACUTE REPERFUSION MARKER IN ACUTE ISCHEMIC STROKE

S. Aksoy ¹, İ. Kulaç², H.H. Selçuk³, B. Kara³, A.B. Kızılırmak⁴, B. Yılmaz⁵, Y. Gürsoy Özdemir⁶, A. Vural⁶, A. Soysal¹

¹Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Neurology, Istanbul, Turkey, ²Koç University, Pathology, Istanbul, Turkey, ³Bakırköy Dr. Sadi Konuk Training and Research Hospital, Neuroradiology, Istanbul, Turkey, ⁴Koç University, Koç University Research Center for Translational Medicine, Istanbul, Turkey, ⁵Yeditepe University, Physiology, Istanbul, Turkey, ⁶Koç University, Neurology, Istanbul, Turkey

Background and aims: In this study, it was aimed to examine the relationship between thrombus histopathology and hyperintense acute reperfusion marker (HARM) in acute ischemic stroke.

Methods: 56 patients who underwent mechanical thrombectomy were included. NIHSS scores, clinical information about procedure, mRS scores at 90 days were recorded. Lesion and hemorrhage volumes at 24 hours were calculated. In FLAIR imaging, contrast extravasation in sulci was considered HARM-positive. Thrombi were stained with Hematoxylin-Eosin and Martius Scarlet Blue for fibrin and erythrocyte contents. Fiji and Orbit programs were used for image analysis. CD3, CD20 and CD45 stainings were performed to examine T and B lymphocytes and total leukocytes in thrombus. Differences between groups were analyzed with t-test or Mann-Whitney U, correlation analyzes were performed with Pearson or Spearman tests.

Results: HARM was negative in 27 and positive in 16 patients. There was no relationship between NIHSS scores on admission and HARM, but NIHSS scores at 24 hours were higher in HARM-positive patients (p=0.22, p=0.002). Leukocyte and neutrophil counts, lesion volume were higher in HARM-positive patients (p=0.025, p=0.047, p<0.001). Higher HARM-positivity was observed in patients with higher mRS scores (p=0.002). 52 thrombi were obtained, 37 were fibrin-rich, 15 were erythrocyte-rich. Fibrin percentage was higher, erythrocyte was lower in HARM-positive patients (p=0.007, p=0.005). No relation was found between HARM and CD3/CD20, CD3/CD45 and CD20/CD45.

	HARM+(n=16)	HARM-(n=27)	p value
Symptom-to-door (min)	62 (39.75-247)	122.5 (42.25-212.5)	0.619
Symptom-to-puncture (min)	195 (166.75-380.75)	258 (157.5-335.25)	0.936
Symptom-to-recanalization (min)	216.5 (186.25-408.75)	291 (180.75-367.5)	0.689
Duration of procedure (min)	27.5 (16.25-60.75)	24 (19-36)	0.481
Number of passes	1 (1-2)	1 (1-2)	0.366
NIHSS on admission	12.5 (9.25-15.75)	11 (9-13)	0.22
NIHSS at 24 hours	11.5 (6.5-14.75)	5 (3-8)	0.002**
Leukocyte count (/µl)	10080 (7542-13332)	7950 (6302-10222)	0.025*
Neutrophil count (/µl)	6590 (4207-11067)	4960 (3400-5932)	0.047*
Lesion volume (cm3)	135.9 (87-222.9)	19.49 (5.46-31.52)	<0.001****

Conclusions: In our study, a relationship between thrombus histopathology and HARM was shown. In future studies, a more comprehensive examination of thrombus content and radiological findings may provide important data.

Disclosure: No

P0768 / 1401

NEUROPROTECTIVE EFFECT OF REMOTE ISCHEMIC PERCONDITIONING AND POSTCONDITIONING IN A PRECLINICAL MOUSE MODEL OF ACUTE ISCHEMIC STROKE

C. Torres-Querol ¹, G. Arque^1,2, F. Purroy^1,3,4

¹Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain, ²Experimental Medicine Department, Universitat de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain, ³Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova, Clinical Neurosciences Group IRBLleida, Universitat de Lleida, Medicine Department, Lleida, Spain, ⁴Universitat de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Medicine Department, Lleida, Spain

Background and aims: Remote ischemic conditioning (RIC) is an endogenous procedure that reduces ischaemic injury by repeated transient mechanical obstruction of vessels at a remote limb from the injury site. It represents a new paradigm in neuroprotection with unknown mechanism of action. This study aimed to evaluate the neuroprotective effect of per-RIC (during ischemia) and post-RIC (after ischemia) in a preclinical mouse model of acute ischemic stroke.

Methods: A mouse model of transient focal cerebral ischemia by compressing the distal middle cerebral artery (tMCAO) for 60 min was used. Animals were classified into: Stroke group (MCAO), Stroke+Per group (RIC during MCAO) and Stroke+Post group (RIC 10 minutes after MCAO). RIC consisted of 3 x 5 min cycles of right hind limb ischemia. Infarct volume, functional neurological score and histological examination were evaluated 72h after reperfusion. Multiple inflammatory cytokines in the peripheral blood were measured using a Multiplex Assay.

Results: RIC treatments significantly reduced the infarction size 3 days after reperfusion compared to the group that did not receive RIC (n=10 each group). In addition, RIC treatments significantly improved the neurological outcome and shown specific cellular pattern and morphological profile in the peri-infarct region. MCAO had a specific cytokine profile with a peak of inflammatory expression at 6 hours post stroke. RIC treatments shown a specific time-dependent cytokine profile.

Conclusions: Our results suggest that both strategies may be used as a novel neuroprotective strategy against ischemia injury. This new preclinical mouse model will contribute to better understand RIC phenomena and further elucidate its mechanism of action.

Disclosure: No

P0769 / 842

SYSTEMATIC OBSERVATION OF BRAIN VASCULAR HIERARCHY IN A TMCAO MODEL OF PDGFRB::AI14 MICE BY TWO-PHOTON IMAGING

B. Qiu ¹, Y. Wang^1,2

¹Beijing Tiantan Hospital, Capital Medical University, Department of Neurology, Beijing, China, ²China National Clinical Research Center for Neurological Diseases, Beijing, China

Background and aims: Brain vascular responses rapidly to ischemia while the reaction of brain vessels from different vascular orders are not completely clear during ischemia and after recanalization. Here, we systematically in vivo observed and analyzed vascular hierarchy reaction in ischemic animal model in pdgfrb::Ai14 mice, which with td-tomato labeled vascular smooth muscle cells and pericytes.

Methods: Based on a long term chronic cranial window, we conducted in vivo imaging of brain cortex vascular system by two-photon microscopy in awake tMCAO mice at three time points (before ischemic stroke, during ischemia and reperfusion). Two-month-old pdgfrb::Ai14 mice were used to define a clear brain vascular hierarchy. We observed and analyzed pial arteries, penetrating arteries, pre-capillary arterioles, capillaries, post-capillary venules, ascending veins and pial veins respectively.

Results: We found that there is an obvious constriction of pial arteries, penetrating arteries and ascending veins after recanalization. There were nearly 10% capillaries no reflow after recanalization of stroke. We find an extensive dysfunction of microcirculation of flowing capillaries with obvious decreased lumen diameters, which seemed not corelate pericyte soma position along the capillaries(Figure 1).

Conclusions: There are extensive vascular reactions along the brain vascular tree after stroke recanalization, characterized by constricted penetrating arteries, pre-capillary arterioles, capillaries and pial veins. No reflow of capillaries maybe caused by constriction of upstream arteries and plug of circulatory cells, and there appears to be no direct relationship between capillary constriction and pericyte location on blood vessels.

Disclosure: No

P0770 / 1272

THE EFFECT OF HYDROGEN SULFIDE DONOR – AP39 – ON EXCITOTOXICITY IN A RAT MODEL OF BRAIN ISCHEMIA

A. Skórkowska ¹, W. Krzyżanowska¹, M. Whiteman², B. Budziszewska¹, B. Pomierny¹

¹Jagiellonian University Medical College, Department of Biochemical Toxicology, Krakow, Poland, ²University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, United Kingdom

Background and aims: Glutamate, as a primary mediator of excitotoxicity, contributes to neuronal damage in numerous pathologies including brain ischemia. The aim of the study was to check the impact of hydrogen sulfide donor AP39, a promising mitochondrially targeted compound, on extracellular glutamate concentration and transport.

Methods: Middle cerebral artery occlusion (MCAO) lasting 90 min was used to induce focal cerebral ischemia in Sprague Dawley rats. AP39 was administered intravenously in a dose of 100 nmol/kg of b.w. 10 min after restoration of blood flow in the vessel or performing sham surgery. Liquid chromatography – mass spectrometry was used to determine the extracellular glutamate level in microdialysates collected from freely moving animals. Brain structures, such as frontal cortex, striatum and hippocampus were isolated 24 hours after reperfusion. The protein level of glutamate transporter-1 (GLT-1) and cystine/glutamate antiporter (system xc^-) was analyzed by Western-blot technique.

Results: Results showed significantly decreased extracellular glutamate concentration in the motor cortex as well as in the hippocampal CA1 area of rats exposed to MCAO and treated with AP39, comparing to MCAO group. Furthermore, the administration of this compound increased the level of GLT-1 transporter in the striatal ischemic core.

Conclusions: GLT-1 transporter is responsible for glutamate reuptake from the synaptic cleft, thus it’s up-regulation in the striatum of AP39-treated rats may indicate the activation of mechanism that counteracts the phenomenon of excitotoxicity in hypoxia by examined compound.

The study supported by National Science Centre grant (2016/21/D/NZ4/03302) and funds of Jagiellonian University Medical College (N42/DBS/000118).

Disclosure: No

P0771 / 870

CIRCULATING ANTIGENIC TISSUE-TYPE PLASMINOGEN ACTIVATOR AS AN EARLY BIOMARKER OF ISCHEMIC STROKE

B. Roussel ¹, E. La Porte¹, A. Thiebaut¹, R. Schneckenburger¹, M. Jauquet¹, A. Rochey¹, J. Montaner², D. Vivien^1,3, R. Macrez^1,4

¹INSERM U1237, Caen, France, ²Hospital Universitario Virgen Macarena, Sevilla, Spain, ³CHU Caen, Department of Clinical Research, Caen, France, ⁴CHU Caen, Department of Emergency Medicine, Caen, France

Background and aims: Ischemic stroke is an emergency pathology that requires a rapid support in a dedicated hospital service. Despite the development of brain imaging and specialized units such as NVU, the time-to-treatment is too often delayed due to a bad orientation of the patients within the care course. We propose here that an assay to evaluate the levels of total antigenic circulating tPA could help to diagnose patient with ischemic stroke.

Methods: We measured tPA in citrated plasma from 129 ischemic patients of the Biostroke collection and from 158 healthy donors by ELISA (Molecular Innovations).

Results: We found higher levels of total circulating antigenic tPA in ischemic patients compared to controls (mean, 0.40 ± 0.20 and 0.13 ±0.18 respectively, p < 0.0001, Student test). The multiple logistic regression model that includes tPA plasmatic levels shows a statically difference with the model that only includes groups, age and sex (AUC with tPA: 0.9489; AUC without tPA: 0.9302; p= 0.02454, Bootstrap method); suggesting that tPA levels could improve prediction for the diagnosis of ischemic stroke patients.

Conclusions: In our prospective study, we show that measuring circulating antigenic tPA in citrated plasma discriminates ischemic stroke patients from healthy volunteers. This could help for the diagnosis of suspected ischemic patients and to guide them faster through the care course of ischemic stroke in hospital. However, this needs to be confirmed on a larger population, and also compared to stroke mimics.

Disclosure: No

P0772 / 1376

EICOSAPENTAENOIC ACID (EPA) REDUCES OXIDATIVE STRESS PROTEIN EXPRESSION IN BRAIN ENDOTHELIUM DURING INFLAMMATION

S. Sherratt^1,2, P. Libby³, D. Bhatt³, P. Mason ^3,1

¹Elucida Research LLC, Beverly, United States, ²University of New Hampshire, Durham, United States, ³Brigham and Women’s Hospital, Harvard Medical School, Boston, United States

Background and aims: Reactive oxygen species contribute to tissue injury during atherosclerosis and ischemic stroke. The omega-3 fatty acid eicosapentaenoic acid (EPA) reduced first and total ischemic strokes each by 36% in statin-treated patients with elevated cardiovascular risk (REDUCE-IT) when administered as icosapent ethyl. We measured the effects of EPA on oxidative stress protein expression using brain endothelial cells (ECs) subjected to cytokine exposure.

Methods: Human brain microvascular ECs (HBECs) were first challenged with IL-6 at 12 ng/ml for 2 h and then treated with EPA (40 µM) for 24 h. Global proteomic analysis was performed using LC/MS to measure relative expression levels of >1,000 proteins simultaneously. Only significant (p<0.05) changes in expression between treatment groups >1-fold were analyzed by differential enrichment analysis of proteomics data (DEP) and included in gene set enrichment analyses (GSEA).

Results: EPA treatment significantly modulated the expression of >500 proteins in HBECs compared with IL-6 alone. The GSEA analysis demonstrated that EPA treatment significantly modulated expression of 14 proteins involved in the cellular response to oxidative stress (GO: 0034599, adjusted-p-value = 0.0005). This included a 1.1-fold decrease in glutathione peroxidase-1, a 1.1-fold increase in thioredoxin-2, and a 1.1-fold increase in thioredoxin reductase-1. EPA also modulated expression of several peroxiredoxin (PRDX) family proteins, including a 1.1-fold decrease in PRDX5 and a 1.1-fold increase in PRDX6.

Conclusions: EPA significantly changed the expression of oxidative stress proteins in brain ECs under conditions of inflammation. These vascular effects of EPA on oxidative stress pathways may reduce atherothrombotic ischemic diseases, including stoke.

Disclosure: Yes

P0773 / 667

ENDOVASCULAR STROKE MODEL IN SWINE WITH REPERFUSION CAPABILITY – A NEW PLATFORM FOR TESTING THERAPEUTICS IN ACUTE STROKE

D. Golubczyk ¹, B. Nowak², Z. Gajewski³, M. Sady³, R. Zabielski³, K. Ferenc³, J. Olszewski³, A. Jablonski³, J. Jasieniak³, M. Kutyla³, P. Holak⁴, A. Chovsepian⁵, Y. Dening⁵, M. Janowski⁶, F. Pan-Montojo⁵, P. Walczak⁶

¹Ti-com sp. z o.o., Olsztyn, Poland, ²John Paul II Western Hospital in Grodzisk Mazowiecki, Grodzisk Mazowiecki, Poland, ³Warsaw University of Life Sciences, Center for Translational Medicine, Warsaw, Poland, ⁴University of Warmia and Mazury, Olsztyn, Poland, ⁵Ludwig-Maximilian University, Department of Psychiatry, Munich, Germany, ⁶University of Maryland, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, United States

Background and aims: Despite successful reperfusion many patients still do not achieve good outcome, challenging the search for a new generation of adjuvant therapy that could be administered immediately after thrombectomy. Testing new drug interventions requires the use of animal models, and with the limited clinical relevance of rodents, we focused on developing a suitable stroke model in pigs. Our aim was to develop endovascular, minimally invasive ischemic stroke in a pig with the possibility of reperfusion, suitable for testing the efficacy of intraarterial drugs.

Methods: IA catheter was navigated under x-ray to pharyngeal ascendant artery and pigs were transferred to 3T MRI for image-guided IA injection of procoagulant (thrombin). MRI protocol included dynamic GE-EPI for assessment of trans-catheter perfusion and monitoring thrombin-mediated clotting. IA tPA was administered after 2hrs. Lesion evolution was monitored with ADC, T2w and T1w+C and correlated with behavioral and histological readouts.

Results: Infusion of procoagulant resulted in blockage of cerebral arteries visualized on DSC and perfusion scans. Ischemic damage was detected within 15 minutes on ADC maps. Interestingly, longitudinal MRI of lesion evolution within 2 hours with ADC showed reversibility of ischemic changes in regions undergoing spontaneous reperfusion. IA tPA resulted in reperfusion to near baseline levels. T2 lesions were observed in the cortex and subcortical white matter 7 days and then 30 days after stroke.

Conclusions: Our endovascular ischemic stroke in pigs enables reperfusion and as such is an excellent, clinically relevant setting for testing the therapeutic efficacy of post-thrombectomy therapeutic strategies.

Disclosure: Yes

P0774 / 752

PROFILE OF THROMBIN GENERATION PARAMETERS AND RELATIONSHIP WITH CEREBRAL MICRO-EMBOLIC SIGNALS IN PATIENTS WITH ASYMPTOMATIC AND SYMPTOMATIC ⩾50-99% CAROTID STENOSIS

A. Subramanian ¹, S. Murphy¹, D. Smith², S. Tierney³, B. Egan³, S. Murphy⁴, R. Collins⁵, T. Coughlan⁵, D. O’Neill⁵, D. Ryan⁵, J. Harbison⁶, P. Madhavan⁷, S. O’Neill⁷, M. Colgan⁷, H. Rushe⁸, J. O’Sullivan⁹, J. O’Donnell¹⁰, G. Hamilton¹¹, D. McCabe¹²

¹Tallaght University Hospital / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH), Department of Neurology/Stroke Service, Dublin, Ireland, ²Tallaght University Hospital / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH), Vascular Neurology Research Foundation/Department of Neurology, Dublin, Ireland, ³Tallaght University Hospital / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH), Department of Vascular Surgery, Dublin, Ireland, ⁴Tallaght University Hospital / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH)/Trinity College Dublin, Department of Neurology/Stroke Service/Academic Unit of Neurology, Dublin, Ireland, ⁵Tallaght University Hospital / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH), Stroke Service/Age-Related Health Care Department, Dublin, Ireland, ⁶St. James’s Hospital, Departments of Medicine for the Elderly/Stroke Service, Dublin, Ireland, ⁷St. James’s Hospital, Vascular Surgery, Dublin, Ireland, ⁸Royal College of Surgeons in Ireland, Department of Molecular and Cellular Therapeutics/Irish Centre for Vascular Biology, Dublin, Ireland, ⁹Royal College of Surgeons of Ireland, Department of Molecular and Cellular Therapeutics/Irish Centre for Vascular Biology, Dublin, Ireland, ¹⁰Royal College of Surgeons in Ireland, Department of Haematology/Department of Molecular and Cellular Therapeutics/Irish Centre for Vascular Biology, Dublin, Ireland, ¹¹Royal Free Hampstead NHS Trust, Department of Vascular Surgery/University Department of Surgery, London, United Kingdom, ¹²Tallaght University Hospital / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH)/Trinity College Dublin/Royal College of Surgeons in Ireland, Vascular Neurology Research Foundation/Department of Neurology/Stroke Service/Irish Centre for Vascular Biology/Academic Unit of Neurology, Dublin, Ireland

Background: Data are limited on the important topic of thrombin generation biomarkers in carotid stenosis patients with or without cerebral micro-embolic signals (MES).

Aims and methods: In this prospective, multi-centre, observational study, plasma thrombin generation parameters were compared in patients with ⩾50-99% asymptomatic vs. symptomatic carotid stenosis in the early (⩽4 weeks) and late phases (⩾3 months) after TIA/ischaemic stroke. Nested longitudinal follow-up was performed in symptomatic patients. One-hour transcranial Doppler ultrasound (TCD) of the middle cerebral arteries classified patients as MES+ve or MES-ve.

Results: Data from 34 asymptomatic, 39 ‘early symptomatic’ and 31 ‘late symptomatic’ patients were analysed. Although there were trends, there were no significant differences in any thrombin generation parameters between early or late symptomatic vs. asymptomatic patients (P⩾0.17). In symptomatic patients with matched data at each timepoint, peak thrombin production (365.1 vs. 327.2nM; P=0.003) and endogenous thrombin potential [ETP] (2242.6 vs. 2078.4 nM*min; P=0.048) decreased between early and late phases overall. The fall in peak thrombin during follow-up was significant in symptomatic patient subgroups who underwent revascularisation (N=26: 362.5 vs. 317.5 nM; P=0.007) and who were MES-negative (N=14: 376.8 vs. 325.4 nM; P=0.029), but not in those on optimal medical therapy alone (N=5: 333.6 vs. 283.8nM; P=0.19).

Discussion: Thrombin generation potential decreases over time and following revascularisation in TIA/stroke patients with moderate-severe symptomatic carotid stenosis, including those who are MES-ve; some ‘negative findings’ may reflect a type II error. These data improve our understanding of haemostatic/thrombotic biomarker profiles in patients with carotid stenosis.

Disclosure: No

P0775 / 1144

DIAGNOSTIC ACCURACY OF NON-ENHANCED CT FOR DIFFERENTIATING PENUMBRA AND CORE AFTER ISCHAEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

A. Alzahrani ^1,2, J.M Wardlaw³, G. Mair³

¹University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom, ²King Abdulaziz University, Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, Jeddah, Saudi Arabia, ³University of Edinburgh, Edinburgh Imaging, and UK Dementia Research Institute at the University of Edinburgh and Centre for Clinical Brain Sciences, Edinburgh, United Kingdom

Background and aims: In patients with acute ischaemic stroke and using concurrent advanced imaging as the reference standard, we aimed to determine the diagnostic accuracy of non-enhanced CT (NECT) brain scans for differentiating penumbra from infarct core.

Methods: EMBASE, MEDLINE, and CAB Abstracts databases were searched from January 1980 to December 2020 using the key terms: ‘non-enhanced computed tomography, ‘brain ischemia’, ‘penumbra’, infarct core’ and their synonyms. The pooled sensitivity and specificity of isolated brain tissue swelling and hypoattenuation (with or without swelling) on NECT brain, to predict penumbra and infarct core respectively, were calculated using random effects models.

Results: Five studies were included, with a total of 238 participants. NECT was performed within 24 hours from stroke symptom onset in 152 (64%) and within 6 hours in 86 (36%) participants. For predicting penumbra, isolated brain swelling had a pooled sensitivity of 35% [95% confidence interval, 95%CI=18-53%] and specificity of 98% [95%CI 85-100%]. For predicting infarct core, parenchymal hypoattenuation with or without swelling had a pooled sensitivity of 68% [95%CI 34 -94%] and specificity of 98% [95%CI 90 -100%].

Conclusions: In the hyperacute period after ischaemic stroke, isolated brain tissue swelling on NECT is highly specific for penumbra while hypoattenuation of brain with or without swelling is highly specific for infarct core. The moderate sensitivity of hypoattenuation and low sensitivity of swelling mean that the absence of these features cannot be used to confirm that brain tissue is normal.

Disclosure: No

P0776 / 298

NEUTROPHIL GRANULOCYTES INTERACT WITH DAMAGED NEURONS AFTER CEREBRAL ISCHEMIA

J.-K. Strecker ¹, A. Schmidt-Pogoda¹, M. Liebmann¹, C. Beuker¹, L. Klotz¹, J. Minnerup¹

¹ University of Muenster, Neurology, Muenster, Germany

Background and aims: Cerebral ischemia is accompanied by a rapid immigration of neutrophil granulocytes into the brain with substantial impact on the final tissue damage. Here we report the discovery of a stroke induced direct interaction of immigrating neutrophils with damaged neurons observed in mice and men.

Methods: Wildtype (n=27), NR4A1-deficient (n=8) and VEC-α-Cat (n=14) mice were subjected to experimental stroke (MCAO, 30 or 45 min). Characterisation of neutrophil-neuron interaction was done using immunohistochemistry on stroke brain slices of mice and humans. Pro-inflammatory gene expression was evaluated by RT-PCR.

Results: Immunohistochemistry revealed neutrophils in direct contact to neurons within the ischemic tissue in mice and human stroke specimen. Quantification revealed an increased number of neutrophil-neuron interactions in NR4A1-deficient mice (p<0.05). In order to evaluate whether neurons attract neutrophils directly, we subjected VEC-α-Cat mice, which are characterised by reduced leukocyte infiltration, to MCAO. VEC-α-Cat mice showed upregulation of neutrophil chemoattractants and receptors Cxcl1 (11.54 fold, p=0.005), Cxcl2 (8.98 fold), Ccl2 (3.65 fold) and Cxcr2 (3.9 fold, p=0.026; WT n=6 vs. VEC-α-Cat n=6) 24h after induction of MCAO. Immunohistochemical analysis revealed neurons as the main source for Cxcl1 in VEC-α-Cat mice confirming neurons as potential neutrophil attracting cells.

Conclusion: Our data reveals a potential new damage and/or repair mechanism directly exerted by immigrating neutrophils on damaged neurons. Therefore, we hypothesise that this pathological mechanism could represent a therapeutic target for future stroke treatment.

Disclosure: No

GENETICS, ‘OMICS AND BIOMARKERS

P0777 / 809

DNASE1 POLYMORPHISM ROLE IN NETS LEVELS AND INFARCT VOLUME AFTER STROKE

B. Diaz-Benito ¹, L. Alzamora¹, A. Moraga¹, A. Garcia-Culebras², P. Mosquera¹, L. Roca¹, P. Calleja¹, M. Moro², I. Lizasoain¹

¹Universidad Complutense de Madrid, Hospital 12 de Octubre, Madrid, Spain, ²Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain

Background and aims: Neutrophils are a key component of innate immunity with a broad pathogen-neutralizing arsenal that includes large extracellular traps known as NETs. However, NETs are also believed to be decisive contributors of immunothrombosis following stroke. Mechanisms behind NET clearance are not well understood, yet there is increasing evidence that plasma-secreted DNAse1 may play an important role. A worldwide distributed single nucleotide polymorphism p.Gln244Arg is known to codify DNase1 isoforms with different activity and may be crucial in our knowledge of endogenous NETs degradation. Our goal is to dilucidate the role of DNAse1 polymorphism in ischemic stroke.

Method: 95 patients who suffered acute ischemic stroke were recruited. Admission blood samples were used to determine DNAse1 genotypes (Sanger) and levels of NETs markers (ELISA). Infarct volumes were measured using DWI-MRI images or control CT scans.

Results: Our results show that patients with a more active DNAse1 (genotype AA) had significantly lower levels of NETs markers in plasma upon admission. Notably, in this same group, infarct volumes were significantly lower than in patients with a less active DNAse1 (genotypes GA and GG). As expected, we found that lower levels of elastase also correlated (p*<0.05) with lower stroke volumes.

Conclusions: We anticipate our study to support the use of exogenous DNAse1 as a potential treatment for stroke, while it may also help explain the observed differences in outcome in otherwise comparable patients.

Disclosure: No

P0778 / 1393

THE ROLE OF NEUROVASCULAR COMPLEX DYSFUNCTION IN MOYAMOYA ARTERIOPATHY: A MOLECULAR CHARACTERIZATION

A. Potenza ¹, T. Carrozzini¹, G. Pollaci¹, G. Gorla¹, M. Dei Cas², R. Paroni², R. Ghidoni², F. Acerbi³, P. Ferroli³, I. Canavero¹, L. Gatti¹, A. Bersano¹

¹Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology IX Unit, UCV, Milan, Italy, ²University of Milan, Dept. of Health Sciences, Clinical Biochemistry and Mass Spectrometry Lab, Milan, Italy, ³Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgical Unit, Milan, Italy

Background and aims: Moyamoya arteriopathy (MA) is a rare cerebrovascular disease (CVD) characterized by ischemic/hemorrhagic strokes. The pathophysiology is unknown. A dysfunction of neurovascular complex (NC), including endothelial (EC) and vascular smooth muscle cells (VSMC) was hypothesized as a pathophysiological mechanism. Since lipids are involved in modulating NC homeostasis, their deregulation is associated with CVD. Our aim is to evaluate in MA patients (i) gene-expression (GE) profile of circulating EC and VSMC progenitors from peripheral blood and (ii) lipidomic profile in Cerebral Spinal Fluid (CSF).

Methods: A subgroup of MA patients from GEN-O-MA project was included, with healthy donors (HD) and unrelated controls (ACVD). Clinical data and blood/CSF were collected. GE profiles were carried out by qRT-PCR and a qTOF-MS-lipidomic analysis was performed.

Results: We found a peculiar GE profile of factors involved in NC dysfunction (e.g., RNF213, PTB1B, HIF-1a, ANG-2, NOTCH1-3), by comparing EC and VSMC of MA to HD/ACVD. The lipidomic analysis showed an increase in most lipid classes in CSF of MA vs ACVD, in particular ACar, CE 22:4, Cer 18:0, SM, LPC, PC, PE, EtherPC and EtherPE. The discriminant analysis for distinguishing the lipidomic profiles between the two groups showed a separation of 64% on principal component.

Conclusions: Our findings suggest that NC dysfunction could play a central role in MA pathogenesis. The validation of results on a larger population and the correlation with clinical data could help our understanding of NC role in MA, leading to the discovery of reliable biomarkers and the identification of therapeutic targets.

Disclosure: No

P0779 / 813

CAUSAL EFFECT OF FREE TRIIODOTHYRONINE LEVEL ON ISCHEMIC STROKE OUTCOME: A MENDELIAN RANDOMIZATION STUDY

D. Filimonov ¹, S. Yevtushenko², A. Fedorova¹, M. Belotserkovskaya¹, N. Trubnikova¹, A. Yeresko³

¹V.K. Gusak Institute of Urgent and Reparative Surgery, Experimental Surgery Department, Donetsk, Ukraine, ²M. Gorky Donetsk National Medical University, Child and General Neurology Department, Donetsk, Ukraine, ³L.M. Litvinenko Institute of Physical-Organic and Coal Chemistry, Department of Biologically Active Substances, Donetsk, Ukraine

Background: The Interstroke study found that 90% of ischemic stroke cases are associated with 10 modifiable risk factors. However, the factors influencing the stroke functional outcome appear to be more complex. Recent epidemiological and experimental studies showed that triiodothyronine could potentiate favorable stroke outcome, but its causality is still unclear.

Aim: To clarify the effects of free triiodothyronine level (fT3) on stroke outcomes, we adopted a Mendelian randomization (MR) approach to evaluate their causal relationship.

Methods: 2 largest GWAS-studies including 577 euthyroid individuals from Split cohort and 1731 euthyroid individuals from Dalmania cohort (Croatia) were used to obtain instrumental variables. 6 independent SNPs, genetically predicting fT3 level (rs67142165, rs13428799, rs72752186, rs4712793, rs116951285, rs10192064) with genome-wide significance and MAF>1% were adopted for MR-analysis. Summary-level data for ischemic stroke outcomes (mRs 0-2 vs. 3-6) was obtained from GISCOME-network. MR-analyses were performed using the inverse-variance-weighted method, MR-Egger regression, tests for heterogeneity and pleiotropy in the TwoSampleMR framework.

Results: Inverse-variance weighted method of MR-analysis showed that genetically predicted 1-SD increase in fT3 level is associated with reduce in risk of unfavorable (mRs 3-6) stroke outcome (OR=0.76, 95%CI 0.6-0.96, p=0.022). MR-Egger test did not reveal evidence for horizontal pleiotropy (p=0.689). Statistical significance decreased (p=0.09) after adjustment for baseline stroke severity.

Conclusions: This study showed that higher fT3 levels could be causally associated with decreased risk of unfavorable ischemic stroke outcome. In addition to recent clinical and experimental studies, this study provides one more evidence for possibility of using thyroid hormones analogs to improve stroke outcomes.

Disclosure: No

P0780 / 1360

FEATURES OF GENETIC MARKERS OF THROMBOPHILIA IN OLDER PATIENTS WITH CEREBRAL VENOUS THROMBOSIS IN THE SVERDLOVSK REGION, RUSSIA

A. Smolkin ¹, A. Alasheev¹

¹ Ural state medical university, Sverdlovsk Regional Clinical Hospital No1, Ekaterinburg, Russian Federation

Background: Sverdlovsk Regional Clinical Hospital No1 (SOKBNo1) (Ekaterinburg, Russia)

Cerebral venous thrombosis (CVT) is rare in older patients. We investigated genetic markers differ in older patients.

Methods: We used data from regional register Sverdlovsk region, a patients with CVT admitted between 2011 and 2020. The determination of genetic polymorphisms was carried out by the method of polymerase chain reaction.

Results: Data for 118 patients with CVT were available. The median age was 43.4 years (interquartile range, 18–81 years). The Older patients (⩾55 years; n=30) were less often women 15 and mean 15 (correlation 1:1). In the study of the following factors, mutations of the allele 20210A and F2 were found: 20210 G → A -3.33 % a woman, F5: 1691 G → A 4 -13,33%, F7: 10976 G → A 7 -23.33%, F13: G → T 11-36.3%, FGB: 455 G → A 10-33.33%, ITGA2: 807 C → T 14-46.6%, ITGB3: 1565 T → C 4- 13.3%, PAI-1: 675 5G → 4G 28-93.33%. High risk of thrombosis occurred in 7 patients -23.33%, more often in men.

Conclusions: in older patients the Sverdlovsk region polymorphisms of the PAI-1: 675 and ITGA2: 807 genes are more common, compared to mutations of the 20210A, F2 and F5 alleles, which may be a regional feature leading to the development of CVT. With the exclusion of other reasons, the revealed high genetic risk of thrombosis was the main cause of CVT 7 in older patients.

Disclosure: No

P0781 / 1611

BENEFICIAL AND DELETARIOUS EFFECT OF GLUCOSE ON CLINICAL PROGNOSIS IN STROKE PATIENTS TREATED BY THROMBECTOMY: A METABOLOMIC STUDY OF CEREBRAL THROMBI

E. Doche ^1,2, J.-F. Hak³, J.-M. Guigonis⁴, Y. Chau⁵, S. Lindenthal⁴, T. Pourcher⁴, L. Suissa^1,2

¹University hospital of Marseille, Stroke Unit, Marseille, France, ²Aix Marseille University, C2VN, Marseille, France, ³University hospital of Marseille, Marseille, France, ⁴University Cote d’Azur, TIRO Laboratory, Nice, France, ⁵University Hospital of Nice, Nice, France

Background and aims: Even though glucose is the main fuel of the brain, admission hyperglycemia is associated with poor functional outcome in stroke patients. This paradox may be explained by the lack of information about glycemia at stroke onset. Here, we analyzed the metabolome of cerebral thrombi to gain insight into the glucose metabolism at stroke onset.

Methods: Consecutive stroke patients successfully recanalized by mechanical thrombectomy (mTICI⩾2b) within 6 hours of stroke onset were included. Glycolytic metabolites of retrieved thrombi were analyzed by liquid chromatography tandem with mass spectrometry. Predictive factors associated with excellent clinical outcome, defined by mRS[0-1] at 3 months, were assessed in univariate analysis and logistic regression.

Results: 69 stroke patients were enrolled (age(y): 72.29±13.35; initial NIHSS: 17.75±4.95; time to recanalization(min): 255.83±58.71). 29/69(42.03%) had mRS[0-1] at 3 months. Higher NIHSS (p=0.0091) and admission glycemia (p=0.0054) were associated with poor prognosis whereas higher level of glucose in thrombi (p=0.0036) was associated with excellent prognosis. NIHSS (OR/5pts: 0.46[0.23-0.92]), admission glycemia (OR/0.5g/L: 0.31[0.11-0.90]) and glucose level in thrombus (OR/10⁶ SU: 2.46[1.32-4.61]) were independent predictors of excellent outcome.

Conclusions: For the first time, this study illustrate the opposing effect of glucose in acute phase of stroke. High glycemia at stroke onset, assessed by glucose level in thrombus, is associated with excellent outcome whereas admission hyperglycemia is deleterious. In core, entrapped glucose at stroke onset could supply ATP. In penumbra, this beneficial effect may be canceled out by lactic acidosis due to continuous supply of glucose by collaterality.

Disclosure: No

P0782 / 877

A PROTEOMICS APPROACH TOWARDS IDENTIFICATION AND VALIDATION OF BLOOD-BASED PROTEIN BIOMARKERS FOR THE DIAGNOSIS AND DIFFERENTIATION OF ISCHEMIC STROKE

S. Misra ¹, P. Singh², S. Sengupta², M. Kushwaha², Z. Rahman², D. Bhalla², P. Talwar¹, R. Chakraborty², M. Nath¹, P. Kumar¹, A. Kumar¹, P. Aggarwal³, A.K Srivastava¹, A.K Pandit¹, D. Mohania⁴, A. Gulati⁵, K. Prasad^1,6, D. Vibha¹

¹All India Institute of Medical Sciences, Neurology, New Delhi, India, ²CSIR-Institute of Genomics and Integrative Biology, New Delhi, India, ³All India Institute of Medical Sciences, Emergency Medicine, New Delhi, India, ⁴All India Institute of Medical Sciences, Dr. R.P. Centre, New Delhi, India, ⁵All India Institute of Medical Sciences, Clinical Epidemiology Unit, New Delhi, India, ⁶Rajendra Institute of Medical Sciences, Neurology, Ranchi, India

Background & aims: Stroke diagnosis is challenging in the acute phase. We aimed to determine biomarkers for the differentiation of ischemic stroke (IS) from intracerebral hemorrhage (ICH) using SWATH-MS and validate the discovered biomarkers within 24 hours using MRM proteomics.

Methods: The study was conducted at Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Serum samples were collected within 24 hours from acute stroke (IS & ICH) patients & healthy controls. SWATH-MS proteomics identified significantly differentially expressed (SDE) proteins (fold change: ±1.5, p<0.05 and confirmed/tentative selection using Boruta random forest) between IS and ICH which were then validated using protein MRM. Cut-off points were determined using Youden Index. Prediction models were developed using forward stepwise multivariate logistic regression analysis. Integrated discrimination improvement index determined the added value of biomarkers to clinical models.

Results: Discovery phase included 20 IS, 20 ICH and 40 controls while validation phase included 150 IS and 150 ICH subjects. Total 365 proteins were quantified using SWATH-MS. Between IS and ICH, 20 SDE proteins were identified. Prediction model including clinical variables (sex, hypertension, atrial fibrillation, current smoking, baseline NIHSS) and biomarkers (GFAP, MMP9, APOC1) independently differentiated IS from ICH (accuracy: 92%, sensitivity: 96%, specificity: 69%). Addition of biomarkers improved the discrimination capacity by 26% (p<0.001) compared to clinical variables alone.

Conclusion: Our study identified a range of potential protein biomarkers for the differentiation of IS. Protein biomarkers along with clinical predictors might be useful candidates in differentiating IS from ICH in acute settings.

Disclosure: No

P0783 / 1428

S100B IN ACUTE ISCHEMIC STROKE (AIS) CLOT IS A BIOMARKER FOR HAEMORRHAGIC TRANSFORMATION (HT)

S. Molina Gil ^1,2, R. Rossi^1,2, A. Douglas^1,2, D. Jabrah¹, A. Pandit², M. Gilvarry³, R. McCarthy³, K. Jood^4,5, P. Redfors^4,5, A. Nordanstig^4,5, E. Ceder⁶, D. Dunker⁶, J. Carlqvist⁶, I. Szikora⁷, J. Thornton⁸, G. Tsivgoulis⁹, K. Psychogios¹⁰, T. Tatlisumak^4,5, A. Rentzos⁶, K.M. Doyle^1,2

¹National University of Ireland Galway, Department of Physiology and Galway Neuroscience Centre, Galway, Ireland, ²CÚRAM–SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland, ³Cerenovus, Galway, Ireland, ⁴Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden, ⁵Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Department of Clinical Neuroscience, Gothenburg, Sweden, ⁶Sahlgrenska University Hospital, University of Gothenburg, Department of Interventional and Diagnostic Neuroradiology, Gothenburg, Sweden, ⁷National Institute of Clinical Neurosciences, Department of Neurointerventions, Budapest, Hungary, ⁸Royal College of Surgeons in Ireland, Beaumont Hospital, Department of Radiology, Dublin, Ireland, ⁹National & Kapodistrian University of Athens, “Attikon” University Hospital, Second Department of Neurology, Athens, Greece, ¹⁰Metropolitan Hospital, Stroke Unit, Piraeus, Greece

Background and aims: HT is a severe complication of AIS in which blood components leak through a disrupted blood-brain barrier (BBB). Peripheral immune cells are activated in stroke and are involved in the inflammatory response. Raised S100B plasma levels can indicate BBB dysfunction associated with HT. We investigated whether S100B levels in AIS clots correlated with an increased risk of HT along with the co-localisation of S100B and sub-types of white blood cells (WBCs).

Methods: Eighty cases from the RESTORE registry, a database of thrombotic material extracted via mechanical thrombectomy (MT) from patients with AIS, were studied. We selected 40 cases treated with thrombolysis and MT and 40 cases treated with MT alone. We selected 20 cases with HT and 20 closely matched cases without HT for each subgroup. We analysed a total of 122 thrombi from the 80 cases. Extracted Clot Area was measured using ImageJ. Immunohistochemistry was performed to quantify S100B in blood clots using Orbit Image Analysis. Double immunofluorescence for S100B against CD3 (T-lymphocytes), CD68 (macrophages), and CD66b (neutrophils) markers were performed to examine co-localization using confocal microscopy.

Results: Higher S100B levels in clots were associated with HT (0.33 [0.08-0.85]mm²vs. 0.07 [0.02-0.27]mm², H1=6.021, P=0.014*), but was not influenced by thrombolytic administration (P=0.386). S100B co-localised with neutrophils, macrophages and T-lymphocytes.

Conclusions: Higher S100B expression in AIS clots is associated with HT. Further investigation of S100b expression by WBCs will provide insight into the role of S100B in thromboinflammation.

Acknowledgements: Science Foundation Ireland (13/RC/2073_2), Cerenovus and CMI.

Disclosure: No

P0784 / 906

UNBIASED MULTI-TRAIT ANALYSIS OF GWAS REVEALS NEW LOCI ASSOCIATED TO STROKE RISK

J. Cárcel-Márquez ^1,2, E. Muiño¹, N. Cullell¹, L. Llucià-Carol¹, J.M. Martín-Campos¹, M. Lledós¹, C. Gallego-Fabrega¹, I. Fernández-Cadenas¹

¹Biomedical Research Institute Sant Pau (IIB Sant Pau), Stroke Pharmacogenomics and Genetics Group, Barcelona, Spain, ²Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain

Background and aims: We aimed to discover novel loci associated to stroke risk by performing phenome-wide association studies, genetic correlation analysis and multitrait-analysis of GWAS (MTAG).

Methods: We used All Strokes (AS), All Ischemic Strokes (AIS), Large-Artery Atherosclerosis Strokes (LAS), Cardioembolic Strokes (CES) and Small-Vessel Strokes (SVS) summary statistics from MEGASTROKE European cohort. We selected independent genome-wide SNVs at a p-value threshold of 1x10^-5 and performed phenome-wide association studies using Open Targets software. Traits and SNVs explored were selected after Bonferroni’s correction. Next, we conducted genetic correlations using GNOVA. Finally, we performed MTAG analysis and GWAS-pairwise analysis to validate the novel loci at a Posterior Probability>0.9. Independent loci identification, pathway analysis and QTL identification were performed in FUMA.

Results: Phenome-wide association analysis at a threshold of p-value<3x10^-8 revealed 212 traits associated to AS, 232 to AIS, 135 to LAS, 85 to CES and 108 to SVS analysis. Using GNOVA we could confirm genetic correlation at a threshold p-value<2.6x10^-5for 107 traits and AS, 108 for AIS, 93 for LAS, 17 for CES and 78 for SVS. A total of 403 MTAG analysis were performed combining the traits from the GNOVA analysis and stroke traits from MEGASTROKE leading to the identification of 27 novel loci to AS, 40 to AIS, 21 to LAS, 24 to CES and 4 to SVS.

Conclusions: Using unbiased traits selection for MTAG is a potential strategy to identify novel loci associated to stroke risk. Several unexpected traits associated with stroke included birth weight and cataracts.

Disclosure: No

P0785 / 886

EFFICIENCY OF UNAFFECTED PARTS OF THE BRAIN NETWORK DIFFERENTIALLY IMPACTS MOTOR AND ATTENTIONAL IMPAIRMENT AFTER STROKE

G.G. Evangelista ^1,2, P. Egger^1,2, J. Brügger^1,2, E. Beanato^1,2, M. Ceroni^1,2, N. Meyer¹, L. Fleury^1,2, A. Cadic-Melchior^1,2, T. Morishita^1,2, S. Avanzi^1,2, D. de Leon Rodriguez³, G. Girard^4,5, J.-P. Thiran⁴, J.-L. Turlan⁶, A. Mühl⁶, P. Vuadens⁶, J. Adolphsen⁷, C. Jagella⁷, C. Constantin⁸, V. Alvarez⁸, J.-A. Ghika⁸, D. San Millán⁸, C. Bonvin⁸, M.J. Wessel⁹, P.J. Koch¹⁰, O. Blanke^1,11, D. Van de Ville¹, F.C. Hummel^1,2,12

¹EPFL, Geneva, Switzerland, ²EPFL, Sion, Switzerland, ³University of Fribourg, Fribourg, Switzerland, ⁴EPFL, Lausanne, Switzerland, ⁵Lausanne University Hospital, Lausanne, Switzerland, ⁶CRR SUVA, Sion, Switzerland, ⁷Berner Klinik, Crans-Montana, Switzerland, ⁸Valais Hospital, Sion, Switzerland, ⁹Würzburg University Hospital, Würzburg, Germany, ¹⁰University of Lübeck, Lübeck, Germany, ¹¹Geneva University Hospital, Geneva, Switzerland, ¹²University of Geneva, Geneva, Switzerland

Background: Evidence in humans and animals strongly suggests that stroke is a network disease. To strike an optimal balance between local segregation and global integration, structural brain networks adopt a modular architecture, with dense intra-module connectivity, and a central module, called a rich-club (RC) to ensure global efficiency (GE) (Fig.1B). We hypothesize that GE relates more strongly to attentional than motor performance.

Methods: 50 subacute stroke patients (2-7 days post-stroke) underwent magnetic resonance imaging and a battery of motor and cognitive clinical tests. Probabilistic tractography was conducted using diffusion-weighted imaging, and whole-brain connectomes were constructed. Overlaying individual lesion masks onto the tractogram allowed to distinguish affected and unaffected parts of the connectomes and associate them with residual function (Fig.1A).

Results: Impairment indices for strength, dexterity and attention (Fig.1C) were more strongly correlated to the GE of the unaffected than to the GE of the total connectome. While the correlation to unaffected GE did not differ between strength and dexterity, it was more strongly correlated with attention (Fig.1D).

Conclusions: Graph analytical approaches based on evaluating unaffected, affected and total structural connectomes after stroke provide a novel opportunity to better understand and potentially predict stroke symptoms. Here, RC integrity and therefore GE of the intact connectome was more strongly associated with attention compared to motor functions, pointing to a differential impact of lesions within the RC architecture on motor and cognitive functions.

Disclosure: No

P0786 / 585

EXPRESSION PROFILE AND FUNCTIONAL PREDICTION OF PLASMA EXOSOME-DERIVED CIRCRNAS FROM ACUTE ISCHEMIC STROKE PATIENTS

K. Chen ¹, J. Hao², Y. Lin³, Y. Guo⁴, K. Liao⁴, M. Yang³, H. Cheng³, J. Yang^5,3

¹Chengdu Medical College, School of Public Health, Chengdu, China, ²Chengdu Medical College, School of Bioscience and Technology, Chengdu, China, ³Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Department of Neurology, Chengdu, China, ⁴Chengdu Medical College, International Clinical Research Center, Chengdu, China, ⁵Sichuan Provincial People’s Hospital, Department of Neurology, Chengdu, China

Background and aims: Acute ischemic stroke (AIS) is the most common type of stroke, and there are less potent biomarkers to diagnosis and therapy for AIS. Although circular RNAs (circRNAs) have emerged as promising biomarkers in the diseases, the role of circRNAs derived from plasma exosomes in AIS is still unknown to date.

Methods: Plasma exosomes from ten AIS patients and ten healthy controls were isolated, and through microarray, bioinformatics analysis, qRT-PCR and ROC curve, expression profiles and putative functions of exosomal circRNAs in the AIS were studied.

Results: Of 84569 human circRNAs detected by microarray, 198 circRNAs derived from plasma exosomes were differentially expressed (fold change⩾2, P<0.05) between AIS patients and healthy controls. By sponging miRNAs/RNA-binding proteins (RBPs) or coding proteins, differentially expressed circRNAs were in silico analyzed to regulate pathways and biological processes, including PI3K-Akt, AMPK, chemokine pathways, focal adhesion, tight junction and endocytosis. Moreover, four of twelve circRNAs verified by qRT-PCR and consisted with the microarray results (hsa_circ_0112036, hsa_circ_0066867, hsa_circ_0093708 and hsa_circ_0041685) were predicted to participate in the processes of AIS via PI3K-Akt, AMPK, chemokine pathways and endocytosis, and potential to function as diagnostic biomarkers for AIS (Area Under Curve>0.76, P<0.05).

Conclusions: Plasma exosome-derived circRNAs revealed significantly distinct expression profile between AIS patients and healthy controls, and participated in the occurrence and progression of AIS through sponging miRNA/RBPs or translating into proteins, indicating circRNAs from plasma exosomes could be crucial molecules for pathogenesis of AIS and promising candidates for predictive factors and therapeutic targets for AIS.

Disclosure: No

P0787 / 766

PHOSPHODIESTERASE 4 D GENE POLYMORPHISMS AND RISK OF ISCHEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

M. Nath ¹, P. Swarnkar¹, S. Misra¹, D. Vibha¹, P. Kumar¹

¹ All India Institute of Medical Sciences, Neurology, New Delhi, India

Background and aims: The relationship between Phosphodiesterase 4 D (PDE4D) gene polymorphism with the risk of ischemic stroke (IS) have shown discordant results. The present meta-analysis investigated the relationship between PDE4D gene polymorphism with IS risk by analyzing published epidemiological studies.

Methods: A comprehensive literature search was performed in various electronic databases, including PubMed, Embase, Cochrane Library, Trip Database, Worldwide Science, CINAHL, and Google Scholar up to 22^nd December 2021. Pooled Odds ratios (ORs) with 95% Confidence Intervals (CIs) under dominant, recessive, and allelic models were calculated, along with subgroup analysis based on ethnicity (Caucasian vs. Asian). Sensitivity analysis was performed to detect the heterogeneity between studies and Begg’s funnel plot assessed any publication biases.

Results: We identified 47 case-control studies with 20644 IS cases and 23201 control subjects, including 17 from Caucasian and 30 from Asian population. Our findings revealed a significant relationship between SNP45 gene polymorphism and risk of IS (Recessive model: OR=2.06, 95% CI=1.31-3.23), SNP83 overall (allelic model: OR=1.22, 95% CI=1.04- 1.42), Asian (allelic model: OR=1.20, 95% CI= 1.05-1.37), and SNP89 Asian (Dominant model: OR=1.43, 95% CI=1.29-1.59, recessive model: OR=1.42, 95% CI=1.28-1.58) respectively. However, no significant relationship was observed between SNP32, SNP41, SNP26, SNP56, and SNP87 gene polymorphisms and IS.

Conclusion: The results showed that SNP45, SNP83, and SNP89 polymorphism could increase stroke susceptibility in Asians but not in the Caucasian population. Genotyping of these polymorphisms could be used as a predictor for the occurrence of IS.

Keywords: Phosphodiesterase 4 D, Gene Polymorphism, Ischemic stroke, Meta-analysis.

Disclosure: No

P0788 / 1321

S-100B FAILS TO PREDICT LATE OR ANY SEIZURE AFTER ACUTE ISCHEMIC STROKE: DATA FROM THE BIOSIGNAL STUDY

N. Scherrer* ¹, G. Bicciato*¹, M. Arnold¹, M. Galovic¹, C. Inauen¹, A. Luft¹, T. Pokorny¹, L. Saleh², V. Schütz¹, J. Schweizer¹, K. Spanaus², L.P Westphal¹, C.T Nakas^3,4, M. Katan^1,5

¹University Hospital and University of Zurich, Neurology, Zurich, Switzerland, ²University Hospital Zurich, Institute of Clinical Chemistry, Zurich, Switzerland, ³University of Thessaly, Laboratory of Biometry, Volos, Greece, ⁴Inselspital and University of Bern, Institute of Clinical Chemistry, Bern, Switzerland, ⁵University Hospital and University of Basel, Neurology, Basel, Switzerland

Background and aims: Acute ischemic stroke (AIS) is the leading cause of epilepsy in the elderly. Blood biomarkers acquired in the acute phase of stroke may improve risk stratification to identify vulnerable patients for post stroke seizures, improving stroke patient management. S-100B, as serum marker of blood-brain barrier disruption, has been previously proposed as an interesting prognostic biomarker in this context. We aim to evaluate the predictive value of S-100B concerning post stroke seizures.

Methods: In a subpopulation (i.e. center of Zurich) of the prospective, multicenter ischemic stroke cohort (BIOSIGNAL study, NCT02274727), levels of S-100B were measured within 24 hours after symptom onset. The primary outcome was late seizure after stroke (> 7 days), secondary outcome was any seizure during one-year follow-up. Logistic regression models were fitted to estimate odds ratio (OR) and 95% confidence interval (CI) for the association between log-S-100B and the outcomes, while extreme gradient boosting techniques were used to assess optimal, predictive multivariable models.

Results: Among 1001 AIS patients, 39 developed late post stroke-seizure and 51 developed any seizure during one-year follow-up. After adjusting for demographic and vascular risk factors there was no significant association between log-S100B levels neither with late nor with any seizure (OR 0.68 [95% CI, 0.13–3.57], P=0.65 and OR 0.88 [95% CI, 0.37–2.06], P=0.76) respectively). Machine learning approaches led to the same conclusions.

Conclusion: Despite previous pilot studies in this large cohort study we were not able to find a significant independent association between levels of S-100B and the development of post-stroke-seizures.

Disclosure: No

P0789 / 111

BIOMARKERS PREDICT STROKE SEVERITY AND HEMORRHAGIC TRANSFORMATION AFTER ACUTE ISCHEMIC STROKE

S. Krishnamoorthy ¹, P.N. Sylaja¹, S.E. Sreedharan¹, G. Singh², D. Damayanthi³, S. Gopala³, U. Madhusoodanan³, H. Ramachandran¹

¹Sree Chitra Tirunal Institute for Medical Sciences and Technology, Neurology, Trivandrum, India, ²Sree Chitra Tirunal Institute for Medical Sciences and Technology, Achutha Menon Centre for Health Science Studies, Trivandrum, India, ³Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biochemistry, Trivandrum, India

Background and aims: Hemorrhagic Transformation (HT) is a complication occurring in acute ischemic stroke (AIS) either spontaneously or post-thrombolysis. Though clinical and imaging predictors are known, widespread applicability of biomarkers for predicting HT remains unclear. We assessed predictive values of plasma matrix metalloproteinase-9 (MMP-9), Claudin-5 and soluble suppression of tumorigenicity2 (sST2) in HT and its correlation with stroke severity in AIS based on their temporal distribution.

Methods: This prospective, observational study included first-ever AIS patients within 24h. Demographic, clinical and imaging details at admission and follow-up were documented. Follow-up imaging was conducted 24-48h after admission or post-intervention. HT was classified according to European Co-operative Acute Stroke Study-III. Univariate and bivariate analyses were carried out followed by multiple logistic regression.

Results: Mean age of the 111 who were enrolled in the study was 62.3±11.7 years and median baseline NIHSS was 12.0[IQR:8.0-18.0]. HT was detected in 30 patients. A trend of elevation was observed with all biomarkers at 12 h with median MMP-9 of 153.9ng/mL[IQR110.6-309 ng/mL] indicating marginal association with HT (P=0.05). Claudin-5 levels at 12h were also relatively elevated in patients with HT albeit not statistically significant(43.1 pg/mL[IQR:26.7– 72.6pg/mL] vs 59.4pg/mL[IQR:24.5–100.8pg/mL];P=0.4). Multiple logistic regression indicated Claudin-5 at 12h(OR9.46;95%CI:1.97 to 64.6;P=0.010) and baseline low ASPECTS score(OR20.3;95%CI:3.46 to 193;P=0.003) independently predicted HT. MMP-9 at baseline and at 12h were significantly elevated in patients with moderate to severe NIHSS scores(P=0.04).

Conclusions: Elevated MMP-9 and Claudin-5 levels combined with low baseline ASPECTS scores were significantly associated with HT and stroke severity in AIS.

Disclosure: No

CLINICAL PRACTICE, MANAGEMENT AND CARE

P0790 / 1031

POST-VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA (VITT) STROKE: LITERATURE REVIEW AND PROPOSAL OF A THERAPEUTIC ALGORITHM FOR THE ACUTE PHASE

M. De Michele ¹, J. Kahan², B. Irene³, O.G. Schiavo¹, M. Iacobucci⁴, A.E. Merkler², D. Toni³

¹Sapienza University of Rome, Emergency Department, Stroke Unit, Rome, Italy, ²Weill Cornell Medicine, Neurology, New York, United States, ³Sapienza University of Rome, Department of Human Neurosciences, Rome, Italy, ⁴Sapienza University of Rome, Neuroradiology Unit, Department of Human Neurosciences, Rome, Italy

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but catastrophic syndrome characterized by venous and arterial thrombosis, with thrombocytopenia and antibodies against platelet factor-4 (PF4)/polyanion, typically 5-30 days from the first dose of a DNA viral vector vaccine. Very rarely, acute ischemic stroke (AIS) can be the result of VITT. The aim of this study was to define the clinical and radiological characteristics, outcome and therapeutic options of VITT patients with AIS.

Methods: We carried out a systematic review of the literature till October 27, 2021 using MEDLINE, PUBMED and Google Scholar databases in order to collect all the published articles related to the development of AIS after vaccination against SARS-CoV-2.

Results: We identified 16 patients from case reports or case series published in peer-reviewed journals affected by AIS and confirmed VITT. All patients had received the first dose of ChAdOx1 ncov19 vaccine within 10 days (median). 81% (n=13/16) of the patients had occlusion of the middle cerebral artery (MCA) or its branches, 43.7% (n=7/16) also had thrombotic occlusion of the intracranial internal carotid artery. 45.4% (n=5/16) of the patients with proximal MCA occlusion developed a malignant MCA infarct. Only one patient received intravenous thrombolysis, while three patients underwent mechanical thrombectomy.

Conclusions: The management of AIS due to large vessel occlusion in VITT is challenging. Based on the available literature, we propose a therapeutic protocol for acute stroke patients presenting to the Emergency Department within the time window for reperfusion strategies.

Disclosure: No

P0791 / 596

CLINICAL SIGNIFICANCE OF STROKE NURSE IN PATIENTS WITH ACUTE ISCHEMIC STROKE RECEIVING INTRAVENOUS THROMBOLYSIS

Z. Xu ¹, Q. Deng¹, T. Jiang¹, Y. Zhang¹

¹ Nanjing First Hospital, Nanjing Medical University, Department of Neurology, Nanjing, China

Background and aims: Shorter door-to-needle time (DTN time) indicates better outcomes in AIS patients received intravenous thrombolysis. Efforts have been made by hospitals to minimize DTN time including introducing a stroke nurse. However, there are few studies to discuss the specific effect of stroke nurse on patients’ prognosis. This study aimed to analyze the effect of stroke nurse on clinical outcome of AIS patients.

Methods: In this retrospective study, we observed 1003 patients from November 2016 to December 2020 dividing in two groups, collected and analyzed AIS patients’ medical history, clinical assessment information, important timelines, 90 mRS score, etc. Comparative analysis and mediation analysis were also used.Results: A total of 418 patients was included in this study, and 199 patients were enrolled in the stroke nurse group and 219 was in the preintervention group. Baseline characteristics of patients showed no significant difference except there were more patients with previous ischemic stroke in the stroke nurse group. (p=0.008). The median DTN time decreased in the stroke nurse group (25 minutes versus 36 minutes, p<0.001) and multivariate logistic regression analysis showed the 90-day mRS clinical outcome significantly improved in the stroke nurse group (p=0.001). Mediation analysis indicated the reduction of DTN time plays a partial role on the 90 days mRS score and the stroke nurse has some direct effect on clinical outcome (p=0.006).

Conclusions: The introduction of stroke nurse is beneficial to clinical outcome of AIS patients and can be use of reference in other hospitals or centers.

Disclosure: No

P0792 / 683

PATIENT BEHAVIOUR FROM STROKE SYMPTOM TO PREHOSPITAL CONTACT: WHAT PROMPTS FIRST CALL?

I. Grimsgaard ^1,2, H.S. Eddelien^1,2, J.H. Butt^1,2,3, C. Kruuse^1,2

¹Copenhagen University Hospital - Herlev and Gentofte, Department of Neurology, Copenhagen, Denmark, ²University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark, ³Copenhagen University Hospital - Rigshospitalet, Department of Cardiology, Copenhagen, Denmark

Background: Late hospital arrival is a major factor for missed reperfusion therapy in stroke. Patient delays in help-seeking perhaps spawned by their uncertainty of the symptoms being signs of a serious disease. Stroke awareness campaigns increase public awareness of symptoms but show little effect on the patients’ acute response. We aimed to identify associations between patients’ perceived severity of symptoms, their initial response to symptoms, and how this affects hospital arrival time.

Methods: In a cross-sectional survey conducted at two stroke centres in the Capital Region of Denmark, patients with stroke or TIA were questioned on their response pattern to stroke symptoms. A post-hoc analysis was performed on patients according to early or late arrival (cut-off at 180 minutes), and patients’ perceived symptom severity (median score 25/100 as cut-off). We used descriptive statistics and logistic regression to identify associated variables.

Results: 409 patients were included. 64.5 % arrived at the hospital after 180 minutes. In late arriving patients, living alone and having an active behavioural response was associated with higher perceived severity (adjusted OR, 1.86; 95 % CI [1.10-3.15]) and (adjusted OR, 2.02; 95 % CI [1.14-3.58]), while male sex was associated with lower perceived severity (adjusted OR, 0.51; 95 % CI [0.30-0.87]).

Conclusions: Most stroke patients do not perceive their symptoms as a sign of severe disease, which is associated with late hospital arrival. Campaigns should focus more on this patient perception of disease and correct help-seeking behaviour to increase the proportion of stroke patients eligible for reperfusion therapy.

Disclosure: No

P0793 / 977

“DRIP-AND-STAY” VS “DRIP-AND-SHIP” MODEL IN A REGIONAL TELESTROKE NETWORK

A. Barragán-Prieto ¹, A. Torres¹, V. Carmona¹, B. Galeano², C. del Toro³, J.A. Cabezas⁴, A. Ollero⁵, L. Ainz⁴, A. Franco¹, A. Dominguez¹, M. Medina⁴, S. Mangas⁶, S. Maroto⁷, J.L. Garcia⁸, S. Perez¹, R. Canto⁹, J. Montaner¹, Centro Andaluz de Teleictus (CATI)

¹Hospital Universitario Virgen Macarena, Seville, Spain, ²Hospital Puerta del Mar, Cádiz, Spain, ³Hospital Universitario de Torrecárdenas, Almeria, Spain, ⁴Hospital Universitario Virgen del Rocio, Seville, Spain, ⁵Hospital Serrania, Ronda, Spain, ⁶Hospital Santa Ana, Motril, Spain, ⁷Hospital El Poniente, El Ejido, Spain, ⁸Hospital San Juan de Dios, Bormujos, Spain, ⁹HAR Sierra Norte, Constantina, Spain

Background and aims: Since 2019, Andalusia has had a centralized telestroke network (CATI), including 30 hospitals useful for treatment with intravenous treatment (IVT) and referral capacity to 6 thrombectomy nodes. After teleconsultation and IVT decision, the patient could be transferred to the hub hospital (“drip-and-ship”) or remain at the telestroke center (“drip-and-stay”) based on stroke units and telestroke neurologist consensus decision. Our aim is to analyze the safety and outcomes of these two models.

Methods: Among 2742 patients attended by CATI in the study, we selected patients treated with IVT and non-candidate to endovascular treatment (n=210). We collected variables on baseline characteristics, stroke care times, treatments, and outcomes. Two groups were formed based on the different models.

Results: 81 (38.5%) patients were “drip-and-stay”. Regarding baseline characteristics of the patients, there were no differences with respect to age, sex, risk factors, or baseline situation. In relation to response times, “Drip-and-stay” patients had longer door-telestroke alert time but shorter telestroke-needle time (p<0.05), without differences in symptoms onset-needle or door-to-needle times. All the patients were treated with alteplase. There were no differences in in-hospital mortality, systemic complications, length of stay, rates of hemorrhagic transformations, or 90-day mRS scores. However, “Drip-and-stay” patients are less likely to receive an accurate etiological diagnosis (56.2% vs 85.5%,p<0.01) and adequate secondary prevention treatment (60.6% vs 93.4%,p<0.01).

Conclusions: The “drip-and-stay” model may be safe and without differences in acute outcomes in selected patients. However, post-stroke assessment should follow proper protocols to conform to current guidelines.

Disclosure: No

P0794 / 1023

DEVELOPING A FRAMEWORK FOR UTILIZING ADJUNCT REHABILITATION THERAPIES IN MOTOR RECOVERY OF UPPER EXTREMITY POST STROKE

R. Teasell^1,2,3, A. McIntyre¹, R. Viana^1,2,3, E.A. Bateman^1,2,3, M. Murie-Fernandez⁴, S. Janzen¹, M. Saikaley ¹

¹Lawson Health Research Institute, Parkwood Institute Research, London, Canada, ²St. Joseph’s Health Care London, Parkwood Institute, London, Canada, ³Western University, Schulich School of Medicine and Dentistry, London, Canada, ⁴Hospital Ciudad de Telde, Neurorehabilitaion Unit, Canary Island, Spain

Background and aims: There have been challenges in incorporating new evidence concerning stroke rehabilitation into practice. The number of RCTs is daunting, made worse by the lack of a framework for their application. The purpose of this study is to develop a framework for the introduction of adjunct practices for the motor recovery of the upper extremity post-stroke into clinical practice.

Methods: Studies used within this framework were identified from a systematic review of 1,307 post-stroke upper extremity RCTs following PRISMA guidelines. A literature search was run in 5 established databases. English articles reporting on RCTs were eligible if they were published before April 1st, 2021, and applied an intervention to the hemiparetic upper extremity of individuals post-stroke as the primary objective of the study or recorded at least one upper extremity related outcome measure.

Results: Therapies were divided into 3 categories: 1) Basic Conventional Therapies (<15% of interventions); 2) Adjunct Therapies Designed to Enhance Conventional Therapies (>85% of interventions); 3) Treatment to Manage Complications (~9% of adjuncts). The framework divides adjunct therapies into 2 categories: 1) Treatments that prime/stimulate the brain; and 2) treatments that peripherally facilitate the upper extremity (Figure 1).

Conclusions: To allow stroke rehabilitation to continue to improve upper extremity recovery and outcomes, we propose a new intuitive framework based on a strong evidence base to guide clinicians and improve stroke rehabilitation. Under our categorization of adjunct therapies, these authors suggest the use of one primer and one facilitator in addition to conventional care.

Figure 1.

Disclosure: No

P0795 / 1533

MONITORED ISOLATION ROOM: AN ALTERNATIVE SOLUTION DURING COVID-19 CRISIS

C. Tejero-Juste ¹, O. Fabre Pi¹, D. Cheli Gracia¹, P.M. Almeida Zurita¹, J.A Cajape Mosquera¹, B. Del Moral Sahuquillo¹

¹ Hospital Clínico Universitario Lozano Blesa, Neurologia, Zaragoza, Spain

Background: Acute stroke unit care is proven to reduce mortality and morbidity. During the COVID-19 crisis, we must guarantee the provision of acute stroke care and optimize care protocols to reduce the risk of SARS-CoV-2 infection and rationalize the use of hospital resources. Our hospital developed an adapted protocol which includes individual isolation room equipped with a monitor connected to the central monitoring unit of the stroke unit, and a camera that allowed patient supervision from the control nursing unit for stroke patients with suspected or confirmed COVID-19 infection. We present a descriptive study of our experience.

Methods: Observational, extensive, and transversal study. Patients admitted to the monitored isolation room of our stroke unit between November-2020 to december-2021.

Results: 201 patients, 51,7.% women. 76.1% ischemic stroke, of which 10% had been treated with thrombolysis and 2.9% with thrombectomy. 90.3% without infectious symptoms. In 6.2% the Covid infection was known before their arrival at the emergency room, in 3 patient it was detected in the emergency room and in 4 during their stay in the isolation room. No contagions were detected within the stroke unit after the introduction of this measure.

Only 10,1% of the patients stayed in the room for more than 24 hours. Camera detect care needs in 22% of the patients. The destination at discharge was conventional stroke unit in 83.4% of the patients.

Conclusions: an isolation room monitored and controlled by video surveillance is an effective alternative to prevent infections in the stroke unit

Disclosure: No

P0796 / 1532

TRANEXAMIC ACID IN PATIENTS WITH TRAUMATIC BRAIN INJURY: A META-ANALYSIS OF 36,692 PATIENTS

H. Ghaith ¹, A. Negida², M. Gabra³, A. Azam⁴, D. Essam⁵, E. Alshial⁶, E. Ayman⁷, N. Khedr⁵

¹Al-Azhar University, Faculty of Medicine, Cairo, Egypt, ²Harvard Medical School, Department of Global Health, Boston, Massachusetts, United States, ³South Valley University, Faculty of Medicine, Qina, Egypt, ⁴October 6 University, Giza, Egypt, Faculty of Physical Therapy, October, Egypt, ⁵Zagazig University, Faculty of Medicine, Zagazig, Egypt, ⁶Damanhur University, Faculty of science, Abou Hammos, Egypt, ⁷Menofia University, Menofia, Egypt, Faculty of Medicine, Menofia, Egypt

Background: Tranexamic acid (TXA) is an antifibrinolytic agent that can help to treat and control bleeding. Recently, many studies have discussed TXA as an effective medication for traumatic brain injury (TBI). However, there is a current controversy and debate for the benefit of TXA use in TBI patients.

Methods: A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until January 2022. Studies comparing TXA versus no TXA in TBI patients were selected for the analysis, and all relevant outcomes were pooled in the meta-analysis using Review Manager Software.

Results: Ten studies with a total of 36692 patients were included in the meta-analysis. TXA could significantly cut the risk of mortality (RR 0.93, 95% CI 0.88-0.99, P=0.02) and growth of hemorrhagic mass (RR 0.87, 95% CI 0.77 to 1.00, P=0.05). No significant difference were found between TXA and placebo groups in terms of “need for neurosurgery” (RR 0.99, 95% CI 0.91-1.07, P=0.76), “deep venous thrombosis” (RR 1.01, 95% CI 0.74-1.36, P=0.97), “pulmonary embolism” (RR 0.96, 95% CI 0.76-1.22, P=0.76), “myocardial infarction” (RR 0.82, 95% CI 0.59-1.13, P=0.22), “stroke” (RR 0.92, 95% CI 0.72-1.18, P=0.52), “seizure” (RR 1.04, 95% CI 0.88-1.22, P=0.66), and “length of ICU stay” (MD 0.68, 95% CI -4.04 to 5.40, P=0.78).

Conclusions: TXA significantly reduces the incidence of mortality and growth of hemorrhagic masses in TBI patients. However, current evidence does not support any benefits in deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, or seizure.

Disclosure: No

P0797 / 327

COST-EFFECTIVENESS OF ENDOVASCULAR TREATMENT IN LARGE VESSEL OCCLUSION STROKE WITH MILD PRE-STROKE DISABILITY

R.V. McDonough ^1,2, J.M Ospel³, W.G Kunz⁴, W. van Zwam⁵, F. Pinckaers⁵, J.L Saver⁶, M.D Hill^7,1, A.M Demchuk^7,1, T.G Jovin⁸, P. Mitchell⁹, B.C. Campbell¹⁰, P. White¹¹, K. Muir¹², H. Achit¹³, S. Bracard¹⁴, S. Brown¹⁵, M. Goyal^1,7

¹University of Calgary, Department of Radiology, Calgary, Canada, ²University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany, ³University Hospital Basel, Department of Neuroradiology, Basel, Switzerland, ⁴LMU University Hospital, Department of Radiology, Munich, Germany, ⁵Maastricht University Medical Center, Department of Radiology, Maastricht, Netherlands, ⁶David Geffen School of Medicine, UCLA, Department of Neurology, Los Angeles, United States, ⁷University of Calgary, Department of Clinical Neurosciences, Calgary, Canada, ⁸Cooper University Health Care, Department of Neurology, Camden, United States, ⁹Royal Melbourne Hospital, Department of Radiology, Melbourne, Australia, ¹⁰Royal Melbourne Hospital, Department of Neurology, Melbourne, Australia, ¹¹Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom, ¹²University of Glasgow, Department of Neurology, Glasgow, United Kingdom, ¹³Nancy University Hospital, Department of Medicine, Nancy, France, ¹⁴Nancy University Hospital, Department of Neuroradiology, Nancy, France, ¹⁵Bright Research Partners, Inc, Mooresville, United States

Background and aims: The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management (BMM) in stroke patients with mild pre-existing symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild pre-stroke symptoms/disability, defined as a modified Rankin Score of 1-2.

Methods: Data are from the HERMES collaboration, which pooled patient-level data from 7 randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a healthcare and a societal perspective. Incremental cost-effectiveness ratio (ICER) and net monetary benefits (NMB) were calculated, and a probabilistic sensitivity analysis was performed.

Results: EVT plus BMM resulted in lifetime cost savings of $46,677 (healthcare perspective) or $63,667 (societal perspective) and an increment of 1.86 quality-adjusted life years (QALYs) compared to BMM alone, indicating dominance of additional EVT as a treatment strategy (Figure). The NMB was higher for EVT in addition to BMM compared to BMM alone both at the higher (100,000$/QALY) and lower (50,000$/QALY) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in QALYs for additional EVT compared to BMM only.

Conclusions: In this HERMES-based cost-effectiveness analysis of treatment for acute ischemic stroke patients with large vessel occlusion and mild pre-stroke symptoms/disability, EVT plus BMM was the dominant strategy.

Disclosure: No

P0798 / 875

PLACE OF SOCIAL AND CLINICAL HEALTH INEQUALITIES IN STROKE MANAGEMENT DURING THE COVID-19 PANDEMIC: RESULTS FROM A FRENCH REGIONAL STROKE OBSERVATORY

E. Lesaine ^1,2, F. Francis^1,3, S. Domecq^1,2, S. Miganeh-Hadi^1,2, F. Gilbert^1,2, P. Cazenave⁴, B. Ondze⁵, G. Seignolles⁶, F. Rouanet⁷, I. Sibon^7,8, F. Saillour-Glenisson^1,3, AVICOVID Study Group

¹Bordeaux Population Health, University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France, ²CHU de Bordeaux, CIC-EC 14-01, Bordeaux, France, ³CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, Bordeaux, France, ⁴Libourne Hospital Neurology, Stroke Unit, Libourne, France, ⁵Mont de Marsan Hospital Neurology, Stroke Unit, Mont de Marsan, France, ⁶Agen Hospital Neurology, Stroke Unit, Agen, France, ⁷Bordeaux University Hospital Neurology, Stroke Unit, Bordeaux, France, ⁸University of Bordeaux, INCIA CNRS UMR 5287, Bordeaux, France

Background and aims: The consequences of the COVID-19 pandemic on the management of stroke patients are causing concerns, particularly for vulnerable individuals, more likely impacted by health protection measures and modification of care support. The objective was to study the effect of the first Covid wave on the place of clinical (person at risk of severe COVID) and social vulnerabilities as health inequality on acute stroke management.

Methods: The study was based on a cohort of stroke patients included between January 2019 and August 2020 in a French regional stroke observatory. The associations between vulnerabilities (clinical: age over 65 years old, cardiovascular history; socio-economic: deprivation index) and emergency unit admission-to-imaging time were analyzed through three multivariate linear regression mixed models. Interaction terms with time period (pre, per, post-wave) were introduced.

Results: A total of 6,436 stroke patients were included in 14 hospitals. The models showed no statistically significant association between emergency unit admission-to-imaging time and advanced age (p=0.068), cardiovascular history (p=0.444) or deprivation (p=0.295), without any interaction with the COVID period. During the per (expb=1.169, 95%CI [1.006-1.359]) and post-wave (expb=1.072, 95%CI [0.984-1.168]) periods, the age-deleterious effect on stroke management time tended to decrease compared to the pre-wave period (expb=0.993, 95%CI [0.849-1.162]).

Conclusions: The COVID-19 pandemic induced no deep changes on the management time for the most vulnerable populations. An improvement time tendency is even noted for the elderly during the pre and post-wave periods.

Acknowledgements: “Alliance Tous unis contre le virus”, “Nouvelle-Aquitaine Regional-Health-Agency”, ObA2 team and healthcare professionals.

Disclosure: No

P0799 / 1047

ACUTE ISCHAEMIC STROKE IN PATIENTS WITH AF WHO ARE ALREADY TAKING A DOAC: A SINGLE-CENTRE OBSERVATIONAL STUDY OF CHARACTERISTICS, TREATMENT STRATEGIES AND OUTCOME

O.I. Vittay ¹, I. Rajput¹, R. Cameron Smail¹, M. Alazzawi¹, G. Brar¹, M. Mansor¹, S. Banerjee^1,2, J. Kwan^1,2, Imperial Stroke Research Consortium

¹Imperial College Healthcare NHS Trust, Department of Stroke & Neurosciences, London, United Kingdom, ²Imperial College London, Department of Brain Sciences, London, United Kingdom

Background and aims: Optimal management of acute ischaemic stroke in patients with atrial fibrillation (AF) who are already taking a DOAC remains unclear. We sought to examine the clinical characteristics, treatment strategies and patient outcomes for this population.

Methods: We conducted a single-centre retrospective observational study by extracting data from electronic patient records. We included consecutive patients admitted between 2018-2020 with ischaemic stroke, who were already taking a DOAC for pre-existing AF.

Results: We included 198 patients (mean age 76 years, 57% male). Vascular risk factors included hypertension (70%), diabetes (31%), dyslipidaemia (47%), previous stroke (26%), smoking history (29%) and alcohol excess (14%). Median modified Rankin score was 1 and mean NIHSS was 8. On admission, 65% were on apixaban, 28% on rivaroxaban, 4% on edoxaban, and 3% on dabigatran. Compliance issues occurred most commonly in those taking dabigatran (43%) and least in those taking apixaban (8%).

On arrival, 3% received IV thrombolysis and 13% underwent mechanical thrombectomy. At discharge, 62% remained on the same DOAC, 13% were changed to a different DOAC, 7% were changed to warfarin, 10% to aspirin/clopidogrel, and 8% had their antithrombotics withheld.

Neurological deterioration (<7 days) occurred in 9% and in-hospital mortality was 8%. At 6 months, recurrent stroke/TIA occurred in 8% and mortality was 10%.

Conclusions: AF-related ischaemic stroke in patients already taking a DOAC is associated with significant mortality and morbidity. Antithrombotic treatment strategies varied significantly between patients. These major treatment options should be subjects of future clinical trials.

Disclosure: No

P0800 / 1049

HOW HAS COVID-19 AFFECTED REFERRALS TO A TERTIARY HYPER ACUTE STROKE UNIT?

R. Sharma ¹, J. Greenan-Barrett¹, N. Mescall¹, M. Shawe-Taylor¹, A. Sen¹, R. Simister¹

¹ The National Hospital for Neurology and Neurosurgery, London, United Kingdom

Background and aims: To observe how the Covid-19 pandemic affected trends in referrals to our tertiary hyperacute stroke unit (HASU).

Methods: Referrals from emergency departments in hospitals within our sector were made electronically using the online “Refer-A-Patient” system. We reviewed 150 referrals made post-Covid, from 16^th March 2020 (when Covid restrictions were first introduced in the UK) until June 2020. These were compared with 150 referrals made pre-Covid, between March and June in 2019.

Results: The patients in the pre-Covid referral cohort were significantly older on average than the post-Covid referral cohort (p=0.0476); there were more referrals under the age of 50, and fewer over the age of 80, post-Covid.

We accepted significantly fewer patients for transfer post-Covid compared with pre-Covid (21% vs. 43% respectively, p=0.0001).

The percentage of cases with a confirmed stroke diagnosis post-transfer was marginally higher post-Covid than pre-Covid (69% vs. 59% respectively, p=0.2443). Importantly, of the patients not accepted for transfer post-Covid, none had a subsequent stroke diagnosis.

Conclusions: The Covid-19 pandemic seems to have led to a more selective approach in accepting referrals for transfer. This in turn appears to have reduced our stroke mimic rate. This poses an argument that there are benefits in being more selective. Video triage is an emerging tool, which can be used in emergency departments to aid the accuracy of selection for transfer and warrants further evaluation.

Disclosure: No

P0801 / 689

TICAGRELOR AND ASPIRIN VS CLOPIDOGREL AND ASPIRIN IN PATIENTS WITH MINOR ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK (TIA) – AN UPDATED NETWORK META-ANALYSIS

R. Lun ^1,2, G. Zitikyte², D.C. Roy², S. Dhaliwal², B. Hutton³, D. Dowlatshahi^1,3

¹The Ottawa Hospital, Department of Medicine, Division of Neurology, Stroke Program, Ottawa, Canada, ²University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada, ³Ottawa Hospital Research Institute, Ottawa, Canada

Background: We conducted an updated systematic review and network meta-analysis (NMA) on the use of ticagrelor/aspirin versus clopidogrel/aspirin in minor ischemic stroke/TIA patients given a recent landmark publication in this field.

Methods: Our original NMA searched Medline, Embase and Cochrane from inception until Feb 2021. Here, we extended our search to Dec 2021. We included RCTs that enrolled adults with acute minor stroke/TIA and treated with antiplatelets within 72h of onset, with minimum follow-up of 30 days. Primary outcome was a composite of stroke/death. Two reviewers extracted data and appraised risk of bias. Model consistency was evaluated using DIC models. Pairwise heterogeneity was checked using I² values. Fixed-effects models were fit with a Bayesian approach.

Results: Our original search identified 4014 citations, from which 5 RCTs were analyzed. Our updated search identified 311 new citations, with only one new publication fitting the inclusion criteria: CHANCE-2 is an RCT that enrolled minor stroke/TIA patients with CYP2C19 loss-of-function alleles and randomized them to ticagrelor/aspirin or clopidogrel/aspirin. Pooling of data from CHANCE-2 with the other 5 RCTs couldn’t be completed due to violation of NMA assumptions for the primary outcome: consistency models demonstrated a difference in DIC values of 8.03, favouring inconsistency. Pooling of data couldn’t proceed due to statistical heterogeneity.

Conclusions: Minor stroke/TIA patients with CYP2C19 loss-of-function alleles represent a unique subpopulation that’s different from the general population in terms of response to antiplatelets, resulting in significant heterogeneity. This suggests results from CHANCE-2 may not be generalizable to the stroke population.

Disclosure: No

P0802 / 1034

ORAL ANTICOAGULANT PRESCRIBING IN OLDER PERSONS: AN AUDIT OF A COMMUNITY HOSPITAL REHABILITATION UNIT

E. Ahern ^1,2, J. Condon^1,2, B. Okpaje¹, A. Mohamed¹, A. Saleh¹, B. Ali^1,2, M. Mannion¹, A. Walsh¹, A. Gabr^1,2, E. Shanahan^1,2, C. Peters¹, M. O’Connor^1,2

¹University Hospital Limerick, Department of Aging and Therapeutics, Limerick, Ireland, ²St Ita’s Community Hospital, Rehabilitation Unit, Newcastle West, Ireland

Background: Prescribing in older persons is complex and involves risk of drug-related harm. Prescribing appropriate anticoagulation balancing thromboembolic versus bleeding risk is essential, with consideration to comorbidities and polypharmacy. GARFIRLD-AF found 27% of adults were prescribed inappropriate anticoagulation dosing. The HSE provides anticoagulation guidelines under the medicines management programme. The European Heart Rhythm Association published a guide on the use of non-vitamin K antagonist anticoagulants in patients with AFib.

Methods: A point prevalence audit was carried out in a rehabilitation unit, including all inpatients receiving oral anticoagulants. The data collected included: age, OAC prescribed, dose, indication documentation, treatment length, if a reduced dose was prescribed and reason, creatinine clearance and reason for co-prescribing of an antiplatelet agent. Results were analysed and compared with the above guidelines.

Results: 25 inpatients were included. 9 were on an OAC (36%). All patients were over 70 years. DOACs were prescribed in 7 patients and warfarin in 2. All patients had an indication documented. All had an appropriate treatment duration documented. 3 OAC users were on a reduced dose, all of whom had an indication for same documented. 1 patient was on medications with a documented drug-drug interaction. Only 3 patients had their creatinine clearance documented. No inpatients were co-prescribed an antiplatelet.

Conclusion: Creatinine clearance is an important factor in prescribing of OAC and must be documented. Interventions to improve documentation of creatinine clearance will be explored and implemented. Consideration for drug-drug interactions in older patients with polypharmacy requires a multidisciplinary approach including pharmacy input.

Disclosure: No

P0803 / 1032

RISKS OF CAROTID ARTERY STENTING IN A CANADIAN STROKE CENTRE: A CHART REVIEW OF 50 CONSECUTIVE PATIENTS

H. Yim¹, K. Steiner², B. Dewar², D. Dowlatshahi^2,3, M. Shamy ^2,3

¹University of Ottawa, Medicine, Ottawa, Canada, ²Ottawa Hospital Research Institute, Ottawa, Canada, ³University of Ottawa, Department of Medicine, Ottawa, Canada

Background and aims: Carotid artery stenting (CAS) can be an effective treatment for the prevention of stroke, but is resource intensive, and is not without risk. We performed a retrospective chart review to assess for complications after stenting among consecutive patients at The Ottawa Hospital, a comprehensive stroke centre.

Methods: We identified consecutive patients coded as receiving stenting in our PACS system, beginning June 1 2019. Data collected from the first 50 patients included demographics, past medical history, pre-stent imaging, and complications in the first 24 hours after stenting.

Results: Analysis included 48 patients. The majority were male (32/48, 67%). The average age was 68.3 years and 25 (52%) were over age 70. In the 24 hours post procedure, 85% of patients (41/48) experienced at least one adverse event. There were no ischemic strokes though 4 patients experienced a 2-point increase in NIHSS (8%). There were no myocardial infarctions and no deaths within the first 24 hours.

Common complications included hypotension (14/48, 29%), need for a repeat CT (12/48, 25%), iatrogenic dissection (13%, 6/48), and groin hematoma (8%, 4/48). Serious adverse events include intracerebral hemorrhage (10%, 5/48), ICU admission (6.2%, 3/48), and in 2 cases the critical care outreach team was consulted (4.2%).

Conclusions: In this population of predominantly male patients over age 70 receiving CAS, post-procedural complications were common. However, none experienced ischemic stroke or MI, and none died. Consideration of these risks should be taken into account when making treatment decisions.

Disclosure: No

P0804 / 335

COMPARING THE IMPACT OF INSERTABLE CARDIAC MONITOR VERSUS STANDARD CARE AFTER ISCHEMIC STROKE ON RECURRENT ISCHEMIC STROKE RISK: META-ANALYSIS OF RANDOMISED CLINICAL TRIALS

Z.Y. Wong¹, Y.Z.H. Linus ¹, Y.K. Tan¹, C. XY Goh¹, L. LL Yeo², B. YQ Tan², C.H. Sia³

¹Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, ²National University Hospital, Department of Medicine, Division of Neurology, Singapore, Singapore, ³National University Heart Centre, Department of Cardiology, Singapore, Singapore

Background and aims: Current guidelines recommend electrocardiogram monitoring to evaluate for atrial fibrillation (AF), although there is an increasing application of the insertable cardiac monitor (ICM) to detect subclinical AF after ischemic stroke. We aim to study the impact of ICM on the incidence of AF detection, anticoagulation initiation and recurrent ischemic stroke in this population.

Methods: We performed a systematic review and meta-analysis of known trials to characterise the clinical characteristics and outcomes of using an ICM in patients with a previous history of stroke. A systematic search was performed in PubMed and Embase using a suitable search strategy from inception to 22 September 2021. Studies evaluating stroke recurrence, AF detection, and anticoagulation outcomes of insertion of ICMs in patients with previous stroke history were included.

Results: Three randomised controlled trials assessing a total of 1,231 participants were included. All 3 studies recruited ischemic stroke patients with varying etiologies, with the time of index event to enrolment varying from within 10 days to 6 months. Meta-analysis revealed that cardiac monitoring via ICM compared to standard care did not significantly affect stroke recurrence in patients (OR: 0.81, 95% CI 0.53 - 1.23, p = 0.32). Our meta-analysis also revealed a statistically significant increase in the rate of AF detection and anticoagulation initiation in these patients (Figure 1). Low heterogeneity was reported (I2=0%).

Figure 1

Conclusions: The use of ICMs, while insignificant in reducing stroke recurrence, increases the rate of AF detection and anticoagulation initiation.

Disclosure: No

P0805 / 380

MLC901 IN COMBINATION WITH ANTICOAGULANT IN EAST-EUROPEAN COHORT. A PRELIMINARY RESULT OF THE NEST REGISTRY

A. Arsovska ¹

¹ University Clinic of Neurology, University “Ss Cyril and Methodius”, Faculty of Medicine-Skopje, Faculty of Medicine-Skopje, Skopje, North Macedonia, The Republic of

Introduction: MLC 901 is a combination of herbal ingredients has been shown to be safe and effective for post stroke recovery. It is considered as an add on therapy on top of standard stroke treatment. For cardioembolic stroke, anticoagulants such as Vitamin K antagonists and direct oral anticoagulants (DOAC) are used to prevent recurrence of stroke. Safety concern in the combination of MLC901 with anticoagulant is being raised up, since most of anticoagulants are being metabolized in the liver. Evidence through a direct observational data may help to assess safety.

Method: The NeuroAiD Safe Treatment (NeST) Registry aims to assess the safety and use of NeuroAiD in clinical practice. It prospectively collects clinical data at baseline and month one to month three visits in East- European cohort. The primary outcome is safety by reporting of serious and non-serious adverse events. MLC901 was given two capsules 3x a day for three months.

Results: Total of 64 patients given MLC901.There were 38 (59 %) were given anticoagulant, 55% were male. Mean age was 55 years (±17 years). All patients were compliant to the medications. Risk factors include hypertension, diabetes mellitus and hyperlipidemia. Indications for starting anticoagulant include Ischemic stroke, Ischemic stroke with coronary artery disease post stenting, non-specified arrhythmias, AF, dilated cardiomyopathy, PFO, and cerebral venous sinus thrombosis. The anticoagulant were Dabigatran, Apixaban, Rivaroxaban, low -molecular weight heparin and Warfarin. There were no reported adverse events.

Conclusion: Patients started on combination of MLC901 and anticoagulant did not report any adverse events.

Disclosure: No

P0806 / 1040

STROKE CARE QUALITY BETWEEN 2017-2020: OBSERVATIONAL DATA FROM THE AUSTRALIAN STROKE CLINICAL REGISTRY

D.A. Cadilhac ^1,2, L. Dalli¹, J. Kim¹, S. Middleton^3,4, R. Grimley^5,1, M.F. Kilkenny^1,2, B.C. Campbell^2,6, H.M. Dewey⁷, G.A. Donnan⁶, K. Hill⁸, R.I. Lindley⁹, A. Evans^10,11, G. Cloud¹², J. Morrison², M. Lester², K. Paice², N.A. Lannin¹², on behalf of the AuSCR Consortium

¹Monash University, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Clayton, Australia, ²University of Melbourne, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia, ³St Vincent’s Health Network, Sydney, Australia, ⁴Australian Catholic University, Nursing Research Institute, Sydney, Australia, ⁵Sunshine Coast University Hospital, Birtinya, Australia, ⁶University of Melbourne, Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia, ⁷Monash University, Eastern Health Clinical School, Box Hill, Australia, ⁸Stroke Foundation, Sydney, Australia, ⁹University of Sydney, Westmead Applied Research Centre, Sydney, Australia, ¹⁰Westmead Hospital, Department of Aged Care and Stroke, Sydney, Australia, ¹¹University of Sydney, Faculty of Medicine and Health, Sydney, Australia, ¹²Monash University, Department of Neuroscience, Central Clinical School, Melbourne, Australia

Background and aims: National clinical quality registries facilitate reliable monitoring of stroke care by providing local hospital teams with data on their performance compared to national benchmarks. We aimed to assess changes in stroke care over time from public hospitals participating in the Australian Stroke Clinical Registry (AuSCR).

Methods: AuSCR stroke quality care indicators were compared between 2017 and 2020, using a matched-hospital design. Analyses were limited to adults with stroke or transient ischaemic attack admitted to hospitals contributing ⩾30 episodes each year during the study period. Descriptive statistics and linear tests for trend were used to assess changes in quality indicators across years.

Results: Among 47 eligible hospitals, admissions increased from 13,508 (2017) to 18,139 (2020). Overall, half were aged ⩾75 years, 45% were female, and 59% had a severe stroke (no differences by year). Between 2017 and 2020, improvements were observed for: endovascular retrieval (+8%; P<0.001), hyperacute antithrombotics (+6%; P<0.001), mobilisation during admission (+3%; P<0.001), swallow screen/assessment within 4 hours (+12%; P<0.001), discharge care planning (+11%; P<0.001), and discharge secondary prevention medications (+10%; P<0.001). However, delivery of thrombolysis remained unchanged (-1%; P=0.07), door-to-needle within 60 minutes decreased (-6%; P=0.008), and access to stroke unit care declined in 2020 (76% 2019 vs 72% 2020; P<0.001).

Conclusion: Improvements in many indicators of quality stroke care have been observed within Australian hospitals participating in a national registry. Declines in timeliness to thrombolysis and access to stroke units in 2020 represent a likely consequence of the COVID-19 pandemic that requires national action.

Disclosure: No

P0807 / 1313

ANNUAL INCIDENCE OF STROKE MIMICS IN A HIGH VOLUME COMPREHENSIVE STROKE CENTER AND ZERO RATE OF IVT TREATMENT IN STROKE MIMICS

K. Dvorníková ¹, M. Čábal^1,2, M. Roubec^1,2, O. Volný^1,2, P. Hon^1,2, M. Bar^1,2

¹University Hospital Ostrava, Neurology, Ostrava, Czech Republic, ²Faculty of Medicine, University Ostrava, Clinical Neurosciences, Ostrava, Czech Republic

Background and aims: Stroke mimics (SM) is a common term for stroke like episodes, which are not of vascular origin. About 3-4% patients with SM are being treated with intravenous thrombolysis (IVT). Our goal was to analyse the annual incidence of SM and a rate of IVT treatment of SM in ESO-certified stroke center (CSC).

Methods: This is a retrospective single centre observational study (July-1, 2020 to June-30, 2021) from high volume CSC. All patients with acute onset of neurological deficit admitted to stroke unit were analysed. The final diagnosis (stroke vs. SM) was based on comprehensive evaluation of patients history, comorbidities, baseline head CT +CT angiography and/or CT perfusion, follow-up MRI or further tests, of indicated (EEG, lumbar punction).

Results: Of 631 patients, 19 mimics (1,42 %) were identified, with a median age of 65 (43-95) years, 58 % were women. The most numerous SM was transient global amnesia (26,3 %), second most numerous was multifactorial vertigo (15,7 %) followed by migraine, hypertensive encephalopathy and functional deficit (10,5 % each). We also registered one case of each of the following SM: traumatic paresis of nervus radialis, intracranial abscess, brain tumor, septic encephalopathy and seizure. Within the study period, none of the patients with proven SM, received IVT.

Conclusions: Within one-year study period, there was none patient exhibiting acute onset of neurological on the basis of SM treated with IVT, which yield a well-organized system and stroke expertise in our stroke center.

Disclosure: No

P0808 / 1546

POSTERIOR CIRCULATION STROKE DIAGNOSIS IN PATIENTS WITH ACUTE VESTIBULAR SYNDROME

J. Paulasova Schwabova ¹, S. Kmetonyova¹, T. Sramkova¹, J. Jerabek¹, A. Olserova¹, I. Sarbochova¹, H. Magerova¹, P. Jansky¹, A. Tomek¹

¹ 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Department of Neurology, Praha 5, Czech Republic

Backgrounds: Diagnostics of a posterior circulation stroke (POCI) in patients with acute vertigo is a challenging task. The HINTS (Head Impulse, Nystagmus a Test of Skew) exam is a bedside oculomotor battery designed for differentiation between peripheral and central causes of vertigo. Although the sensitivity of HINTS for stroke is high, the specificity is lower.

Aims: To detect the sensitivity and specificity of HINTS in patients with acute vertigo and find out if combination HINTS and ABCD2 factors may increase the specificity and sensitivity for POCI.

Methods: This was a cross-sectional monocentric study in patients with acute vestibular syndrome lasting less than 72 hours. All patients were examined neurologically including HINTS and evaluation of NIHSS and ABCD2 (0-7 points; vascular risk stratification) scale. The anamnestic data were collected including vascular risk factors. Each patient underwent a CT scan of the brain and CT angiography of intracranial and extracranial arteries (carotid and vertebral) and brain MRI after 72 hours.

Results: All criteria were fulfilled in 129 out of 149 patients with acute vestibular syndrome. The sensitivity of HINTS was 97,4% and the specificity 53,1%; for ABCD2 (⩾4) 84,6% and 66,7%, for NIHSS 79,5% and 93,8%. The combination of HINTS and one of the risk factors change the sensitivity to 92,3% (95%CI 79,1-98,4) and the specificity to 70,4% (95% CI 59,2-80).

Conclusions: The combination of HINTS and at least one of the risk factors in patients with an acute vestibular syndrome may improve the selection toward posterior circulation stroke at ED.

Disclosure: No

P0809 / 409

MANAGEMENT AND FUNCTIONAL OUTCOMES OF ACUTE MINOR ISCHEMIC STROKE CAUSED BY LARGE ARTERY OCCLUSION

G. Sahakyan ¹, H. Manvelyan¹, A. Adamyan^1,1

¹ YSMU, Neurology AMC, Yerevan, Armenia

Patients with acute minor stroke caused by LVO pose a particular challenge in clinical decision making. Well-developed collateral circulation can lead to mild symptoms in early hours. From the other hand same collateral circulation is not a guarantee to have mild stroke or to avoid future disability.Till now it remains unclear what is the best therapeutic approach in this case.

The aim of our study is to report the risk of neurological deterioration and functional outcomes of acute minor ischemic stroke caused by LVO.

We analyzed acute ischemic stroke patient data of our hospital between February to December 2021 who benefited from reperfusion therapies.We included all patients presented with NIHSS<6 at admission and LVO visible on CT or MRI angiography.Neurological deterioration was defined as increase of NIHSS>6 in first 24 hours.Functional outcome was assessed by NIHSS score at discharge from hospital and modified Rankin scale at 3 months.

12 patients corresponded the selection criteria.Iv r-tPA was performed in 5 cases.Bridging therapy or direct mechanical trombectomy was performed in the rest 7 cases.All patients had neurological deterioration in the first 24 hours. Patients of the last group had faster recovery at discharge and better functional outcome at 3 months.

Conclusion: Patients with minor stroke caused by LVO are at high risk of neurological deterioration in the first 24 hours. Mechanical trombectomy fastens recovery and improves functional outcome.We recommend routine CT angiography in all acute stroke patients regardless of NIHSS level at admission to identify candidates for endovascular therapy the soonest possible.

Disclosure: No

P0810 / 420

ENDOVASCULAR TREATMENT OR BEST MEDICAL TREATMENT IN MINOR STROKES WITH LARGE VESSEL OCCLUSION

R. Xue ¹, W. Zhong¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, School of Medicine, Department of Neurology, Hangzhou, China

Background and aims: Several randomized clinical trials have established the safety and efficacy of endovascular treatment (EVT) for acute ischemic stroke (AIS) with National Institutes of Health Stroke Scale (NIHSS) score ⩾ 6. However, it remains uncertain whether minor AIS (NIHSS score <6) patients with large vessel occlusion (LVO) benefit from EVT. We aims to evaluate the association between EVT and clinical outcomes of minor AIS patients with anterior circulation LVO.

Methods: We collected data from a nationwide prospective registry of consecutive AIS patients in China between March 2017 and June 2021. Patients within 24 hours of onset were divided into groups receiving best medical treatment (BMT) plus EVT or BMT alone. The primary outcome was modified Rankin Scale (mRS) score 0 to 1 at 90 days. The secondary outcome was mRS score of 2 or less at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH) and 90-day mortality.

Results: 572 patients were recruited into the study. Among them, 123 patients were treated with BMT plus EVT and 449 with BMT alone. Compared with BMT alone, EVT was not associated with primary outcome (adjusted odds ratio [OR] = 0.793; 95% confidence interval [CI] = 0.515-1.219; P = .290), but was associated with sICH (adjusted OR = 3.760; 95% CI = 1.373-10.294; P = .010).

Conclusions: Our study suggests similar outcomes of EVT and BMT alone in minor strokes with anterior circulation LVO, which warrants a randomized trial in this population.

Disclosure: No

P0811 / 903

EVALUATION OF THE CURRENT CARE PROCESSES IN STROKE CARE IN 28 BELGIAN HOSPITALS VIA AN IMPROVEMENT COLLABORATIVE

C. Lens ¹, E. Coeckelberghs¹, D. Seys¹, K. Vanhaecht¹, C. Weltens², J. Demeestere³, R. Lemmens³

¹University of Leuven, Institute for Healthcare Policy, Department of Public Health KU Leuven, Leuven, Belgium, ²University Hospitals Leuven, Department of Oncology, Leuven, Belgium, ³University Hospitals Leuven, Department of Neurology, Leuven, Belgium

Background and aims: Stroke is one of the leading causes of mortality and disability. Patient outcome is improved by organized stroke care and adherence to guidelines. The aim of this study was to map stroke care variability in Flemish hospitals.

Methods: An improvement collaborative for stroke was initiated in 28 hospitals in Flanders, Belgium. Structured questionnaires were used to retrospectively study patient characteristics, process and outcome variables from the last 30 consecutive patients diagnosed with acute ischemic stroke in 2019.

Results: We included 840 patients from 28 hospitals and observed variability in documentation and performance between and within hospitals for various indicators. In most hospitals, patients were admitted to a stroke unit (86.0%, [0%-100.0%]) after receiving brain imaging (99.8%, [96.7%-100.0%]) and were started on antithrombotic drugs (92.3%[58.8%-100.0%]). Adherence to current evidence was moderate. Swallowing screening was not documented in 29.9% and performed in only 54.6%. Four other indicators clearly lacked adequate adherence: timely measurement of body temperature (15.6%, [0.0%-60.0%]) and glycaemia (84.3%, [46.7%-100.0%]), Activities of Daily Living screening (53.5%, [0.0%-100%]) and depression screening (18.3%, [0.0%-100%]). Measuring outcome on the modified Rankin scale at 90 days after stroke was only documented in 25.5% [0.0%-83.3%]).

Conclusions: We have identified large variability between hospitals caring for acute stroke patients. We will now implement a strategy for stroke care improvement, including educational material for low-performing indicators and improved documentation of outcome parameters.

Disclosure: No

P0812 / 1256

STROKE CODE: DIFFERENCES BETWEEN ACTIVATION BY AN EMERGENCY PHYSICIAN VERSUS A TRIAGE NURSE

J. Villacura Avendaño ¹, G. Munizaga², N. Rebolledo³, K. Wigodski⁴, I. Sánchez⁴, P. González³, P. Lozano³

¹Universidad de los Andes-Clínica Dávila, Neurologia, Santiago, Chile, ²Clínica Dávila, Emergency department, Santiago, Chile, ³Clínica Dávila, Santiago, Chile, ⁴Universidad de los Andes, Santiago, Chile

Stroke is a major cause of morbidity and mortality worldwide. Thrombolysis with alteplase has shown improving functional outcomes in patients with ischemic stroke, furthermore, the benefit of rtPA depends largely on how early it is administered.

In 2020 we published a poster in the ESOC showing our experience implementing the classic work algorithm to improve our Needle Door Time (DTNT) and we demonstrate that with intensive training of the entire emergency team of our hospital, we achieved a significant reduction in DTNT of 29% in a short time. Now, we wanted to estimate whether allowing the activation of the Stroke Code by the triage nurse (without waiting the evaluation of the emergency physician) can reduce de DTNT even more. We review from July to September 2021 (group 1) with the classic system activated by the emergency physician, and we compare the months from October to December (group 2) (with the the new protocol). In group 1, of the 106 stroke code activations, 38% were mimics. Of the AIS patients, 22.5% receive rtPA and the DTNT was 37 minutes. In group 2 from a total of 105 stroke code activations, 37% were mimics and the 29% of the AIS patiens received rtPA with a DTNT of 35 minutes.

In summary, in this initial experience, activation of the Stroke Code from triage by the nurse did not increase the number of mimics, did not significantly reduce DTNT and significantly increased the percentage of patients who received IV rtPA by 29%.

Disclosure: No

P0813 / 1604

PRESCRIBING FOR STROKE PATIENTS WITH ENTERAL FEEDING TUBES

G. Randle ¹, J. Vassallo¹, K. Hopwood¹

¹ Stockport NHS Foundation Trust, Stockport, United Kingdom

Background and aims: Approximately 20% of acute stroke patients require short term enteral tube feeding. An audit undertaken within one of the UKs Primary Stroke Centres in July 2020, revealed frequent and serious prescribing errors were being made for stroke patients with enteral feeding tubes (EFTs). Medication formulations given via an unlicenced EFT route of administration may result in tube occlusion, produce a greater or lesser therapeutic effect or have the potential to exacerbate gastrointestinal side effects and interact with feeding products.

Methods: A service improvement project was undertaken followed by a reaudit in July 2021 to assess if the correct route and formulation of medications were being prescribed for stroke patients with EFTs. All patients admitted with an acute stroke who had an EFT in situ on the days of the reaudit were included (n=16).

Results: The number of patients with at least one prescribing error identified reduced from 15/16 (94%) to 13/16 (81%) on reaudit. The number of medication errors identified in the 2021 study demonstrated considerably improved prescribing practice following the service improvement project, with 87 medication errors identified on the initial audit compared to just 33 on the 2021 study.

Conclusions: Establishing an agreed method to highlight the need for a medication review through collaborative multi-disciplinary team working, the provision of education and training and the formulation of a ‘prescribing considerations’ guideline, evidently instilled increased confidence in prescriber’s knowledge and skills. Further improvement can be made through deprescribing non-essential medications to reduce the risk of tube occlusion.

Disclosure: No

P0814 / 946

ALERT ON ELONGATED INTRA-HOSPITAL ACUTE STROKE MANAGEMENT TIMES: FEEDBACK FROM A FRENCH REGIONAL STROKE OBSERVATORY

S. Domecq ¹, V. Thevenet¹, E. Lesaine¹, F. Gilbert¹, M. Maugeais¹, M. Dan², E. Tidahy³, J.-M. Faucheux⁴, F. Rouanet⁵, I. Sibon⁵, F. Saillour-Glenisson¹, ObA2 Study Group

¹Université de Bordeaux - CHU Bordeaux, Bordeaux, France, ²CH Arcachon, Arcachon, France, ³CH Oloron Sainte Marie, Oloron Sainte Marie, France, ⁴CH Agen-Nérac, Agen, France, ⁵CHU Bordeaux, Bordeaux, France

Background and aims: Management times are major determinants of stroke patient outcome. The aim of this study was to describe the evolution of stroke patients’ management times since 2012 based on a cohort of stroke patients managed in the Aquitaine region hospitals.

Methods: The cohort was composed of stroke patients included between January 1st 2012 and August 31st 2020 in the Aquitaine Stroke Observatory (ObA2). Distribution of five management times was described: onset-to-door time (ODT), door-to-imaging time (DIT), imaging-to-needle time (INT), onset-to-needle time (ONT), door-to-needle time (DNT). Proportions of patients managed within target times were calculated.

Results: Study sample included 19,060 stroke patients managed in 14 hospitals (7 stroke unit – n=15,466, 7 hospitals with telestroke – n=3,594). Median ODT was 2:37, 61% of patients admitted within 4 hours from symptom onset. Proportion of patients managed within DIT target time was very low (8% for patients on thrombolysis alert, 10% for thrombolysed patients), this delay has deteriorated over time in stroke units and hospitals with telestroke. For thrombolyzed patients, ONT differed according to hospital type: in stroke unit, median ONT was 2:56, proportion within the 4:30 time-window was 90% with an improvement since 2017; in hospitals with telestroke, median ONT was 3:25 with a decrease over time in the proportion of patients treated within the target time because of elongated intra-hospital delays.

Conclusions: There is an urgent need to act with measures adapted to hospital type to improve intra-hospital delays, in particular the DIT.

Acknowledgements: Funder “Nouvelle-Aquitaine Regional-Health-Agency”, ObA2 staff, healthcare professionals.

Table 1.

Description of stroke management times in stroke unit according to year of admission. Aquitaine Stroke Observatory (ObA2), 2012-2020,*, France.

Year	All patients		Patients on thrombolysis alert		Thrombolysed patients
	ODT		DIT		ONT		DNT		DIT		INT
	n(m.d.)	median[IQR]	n(m.d.)	median [IQR]	n(m.d.)	median [IQR]	n(m.d.)	median[IQR]	n(m.d.)	median[IQR]	n(m.d.)	median[IQR]
In stroke unit	n=15,466		n=5,045		n=2,756
2012	359(776)	2:35[1:27 ; 6:49]	182(42)	0:58[0:35 ; 1:42]	51(81)	2:55[2:30 ; 3:35]	114(18)	1:26[1:03 ; 1:43]	95(37)	0:34[0:21 ; 0:48]	100(32)	0:47[0:35 ; 1:02]
2013	813(550)	2:20[1:28 ; 7:07]	455(74)	0:51[0:29 ; 1:57]	166(56)	3:00[2:19 ; 3:30]	203(19)	1:21[1:08 ; 1:37]	187(35)	0:36[0:23 ; 0:52]	174(48)	0:45[0:34 ; 0:59]
2014	899(669)	2:20[1:28 ; 6:34]	437(157)	0:44[0:28 ; 1:32]	256(76)	2:55[2:24 ; 3:35]	310(22)	1:16[1:00 ; 1:37]	252(80)	0:35[0:26 ; 0:54]	249(83)	0:36[0:28 ; 0:54]
2015	898(627)	2:22[1:27 ; 6:38]	475(117)	0:50[0:30 ; 1:32]	254(66)	2:50[2:20 ; 3:30]	306(14)	1:13[0:58 ; 1:34]	274(46)	0:41[0:26 ; 1:04]	253(67)	0:33[0:25 ; 0:47]
2016	874(791)	2:29[1:28 ; 8:00]	452(107)	0:49[0:27 ; 1:28]	224(84)	2:54[2:15 ; 3:34]	282(26)	1:17[0:59 ; 1:36]	248(60)	0:40[0:26 ; 1:07]	233(75)	0:37[0:27 ; 0:49]
2017	919(735)	2:49[1:32 ; 9:14]	443(92)	0:50[0:31 ; 1:31]	229(96)	2:58[2:25 ; 3:50]	294(31)	1:20[1:03 ; 1:38]	261(64)	0:42[0:29 ; 1:01]	243(82)	0:35[0:26 ; 0:50]
2018	987(877)	2:31[1:25 ; 8:20]	499(100)	0:55[0:34 ; 1:45]	252(118)	3:00[2:30 ; 3:45]	305(65)	1:28[1:12 ; 1:48]	301(69)	0:49[0:35 ; 1:12]	252(118)	0:40[0:30 ; 0:50]
2019	1328(1349)	3:02[1:32 ; 10:24]	606(150)	0:55[0:37 ; 1:43]	316(130)	2:54[2:20 ; 3:45]	382(64)	1:19[1:03 ; 1:45]	349(97)	0:45[0:32 ; 1:07]	321(125)	0:36[0:21 ; 0:50]
2020*	1184(831)	3:09[1:33 ; 10:27]	555(102)	1:00[0:39 ; 1:44]	217(84)	2:55[2:20 ; 3:40]	252(49)	1:22[1:05 ; 1:50]	245(56)	0:52[0:34 ; 1:13]	234(67)	0:31[0:21 ; 0:50]
Overall	8261(7205)	2:37 [1:29 ; 8:26]	4104 (941)	0:53 [0:33 ; 1:39]	1965 (791)	2:56 [2:23 ; 3:40]	2448 (308)	1:20 [1:03 ; 1:41]	2212 (544)	0:43 [0:29 ; 1:05]	2059 (697)	0:37 [0:27 ; 0:52]
In hospitals with telestroke	n=3,594		n=1,122		n=325
2012	75(81)	2:21[1:13 ; 6:10]	35(15)	0:50[0:33 ; 1:13]
2013	93(115)	3:31[1:34 ; 6:49]	44(12)	1:01[0:30 ; 1:39]
2014	81(94)	3:30[1:52 ; 9:14]	21(21)	0:55[0:28 ; 1:37]
2015	131(129)	2:34[1:29 ; 6:14]	36(52)	0:34[0:17 ; 0:57]	20(1)	3:32[2:57 ; 4:18]	20(1)	1:31[1:08 ; 1:48]	14(7)	0:30[0:14 ; 0:43]	12(9)	0:52[0:37 ; 1:16]
2016	175(168)	2:16[1:15 ; 4:29]	103(21)	0:57[0:31 ; 1:40]	27(5)	2:53[2:25 ; 3:30]	32(0)	1:37[1:17 ; 1:58]	23(9)	0:38[0:25 ; 1:01]	24(8)	1:04[0:34 ; 1:25]
2017	143(138)	2:14[1:12 ; 5:55]	68(30)	0:53[0:30 ; 1:26]	17(10)	3:15[2:40 ; 3:45]	18(9)	2:01[1:25 ; 2:20]	18(9)	0:51[0:29 ; 1:14]	15(12)	1:19[1:12 ; 1:29]
2018	409(322)	2:35[1:27 ; 6:28]	200(62)	0:53[0:35 ; 1:20]	61(33)	3:25[2:42 ; 4:17]	66(28)	1:44[1:20 ; 2:09]	66(28)	0:39[0:26 ; 0:56]	62(32)	0:59[0:47 ; 1:24]
2019	396(466)	2:46[1:23 ; 8:39]	213(16)	0:57[0:38 ; 1:31]	77(25)	3:30[2:55 ; 4:00]	89(13)	1:58[1:37 ; 2:20]	88(14)	0:42[0:34 ; 1:05]	87(15)	1:13[0:55 ; 1:29]
2020*	296(282)	2:53[1:28 ; 10:55]	167(6)	1:00[0:42 ; 1:30]	34(15)	3:27[3:00 ; 4:25]	44(5)	2:05[1:32 ; 2:43]	46(3)	0:52[0:35 ; 1:09]	40(9)	1:07[0:55 ; 1:28]
Overall	1799 (1795)	2:36 [1:24 ; 6:57]	887 (235)	0:55 [0:35 ; 1:28]	236 (89)	3:25 [2:45 ; 4:03]	269 (56)	1:50 [1:24 ; 2:18]	255 (70)	0:42 [0:30 ; 1:02]	241 (84)	1:07 [0:50 ; 1:26]

*

2012-2020: period January 1st 2012 to August 31st 2020; Patients on thrombolysis alert: time between onset of symptoms and admission less than 4 hours; thrombolysed patients: hospitals not equipped with telestroke before 2015; ODT: onset-to-door time, DIT: door-to-imaging time, ONT: onset-to-needle time, DNT: door-to-needle time, INT: imaging-to-needle time; IQR: interquartile range; m.d: missing data.

Disclosure: No

P0815 / 178

FIVE YEARS’ EXPERIENCE OF PARTICIPATION OF THE INSTITUTE OF EMERGENCY MEDICINE FROM CHISINAU, REPUBLIC OF MOLDOVA IN THE REGISTRY OF STROKE CARE QUALITY

S. Groppa^1,2, N. Ciobanu ², I. Crivorucica¹, E. Zota^1,2, S. Plotnicu^1,2, I. Smetanca¹

¹Institute of Emergency Medicine, Neurology, Chisinau, Moldova, Republic of, ²Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Neurology Nr. 2, Chisinau, Moldova, Republic of

Background: Institute of Emergency Medicine from Chisinau has joined the Registry of Stroke Care Quality (RES-Q) in 2017 and has enrolled 412 patients.

The aim of this study was to analyze the in-hospital stroke care indicators for a period of 5 years according to the data of the RES-Q registry.

Methods: We have analyzed the RES-Q data of patients with acute stroke admitted to the Institute of Emergency Medicine from Chisinau, Republic of Moldova between 2017-2021. Baseline characteristics, stroke-related factors, processes of care, and discharge destination were examined.

Results: Data were available for 412 patients with stroke, median age: 68 years. At admission, the median NIHSS score was between 7 (2017)-12 (2021). The proportion of patients with ischemic strokes receiving thrombolysis therapy has increased from 2,78% in 2017 to 10% in 2020, and median door-to-needle time decreased from 85 min (2017) to 48 min (2021). Thrombectomy began to be performed at our hospital in 2018, the proportion of patients receiving thrombectomy increased from 3,23% in 2019 to 5,77% in 2021, median door-to-groin time decreased from 228,5 min (2019) to 102 min (2021). Most of the patients received secondary prevention therapies: antihypertensive agents (89,47%-98,44%), antithrombotic medication (81,63%-100%), cholesterol-lowering medication (44,23%-59,09%). There were noted more deaths in the pandemic years (36,67% in 2021, 23,33% in 2020 vs 14,71% in 2019, 16,22% in 2018, 18,99% in 2017).

Conclusion: Evidence-based care at our hospital was consistently provided. The considerable delay in the time from stroke onset to hospital arrival remains an important issue.

Disclosure: No

P0816 / 782

CURRENT TREATMENT PRACTICE OF PATIENTS WITH MALIGNANT MIDDLE CEREBRAL ARTERY INFARCTION: RESULTS AMONG A SURVEY OF GERMAN NEUROLOGICAL INTENSIVE CARE UNITS

C. Hartmann ¹, S. Winzer¹, H. Moustafa¹, T. Siepmann¹, J. Barlinn¹, L.-P. Pallesen¹, V. Puetz¹, K. Barlinn¹, IGNITE study group

¹ University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Neurology, Dresden, Germany

Background and aims: Hemicraniectomy results in improved functional outcome and survival in patients with malignant middle cerebral artery (MMCA) infarction. However, the optimal post-procedural neurointensive management including duration of sedation and endotracheal intubation of these patients is not well defined. In this survey study of German neurointensive care units (NICU), we examined routine treatment practices in patients with MMCA infarction and hemicraniectomy.

Methods: In September 2021, members of the Initiative of German NeuroIntensive Trial Engagement (IGNITE) Network were invited to participate in a standardized anonymous online survey. The questionnaire assessed factors concerning the indication for hemicraniectomy, procedural aspects and characterization of neurointensive management following hemicraniectomy.

Results: Twenty-nine of 43 (67.4%) eligible centers responded to the online survey (83% academic hospitals, 72% with dedicated NICU). Fifteen centers (51.7%) provided a standardized operating procedure for hemicraniectomy in patients with MMCA infarction. Postprocedural management and duration of sedation was standardized in 20 centers (69%), a cerebral CT-scan was routinely performed prior to termination of sedation in 11 centers (37.9%). The routine duration of postprocedural sedation and endotracheal intubation varied among the participating centers with pursued extubation within 24 hours after hemicraniectomy in nine (31%), within 3 days in eight (27.6%) and >3 days in eight centers (27.6%). Twenty-one centers (72.4%) indicated their willingness to participate in a clinical trial to study the best neurointensive management following hemicraniectomy for MMCA infarction.

Conclusions: The results of this survey study reflect notable heterogeneity in treatment practices for patients with MMCA infarction and hemicraniectomy among NICU in Germany.

Disclosure: No

P0817 / 364

NATIONAL INSTITUTES OF HEALTH STROKE SCALE BY PARAMEDICS – INTERRATER AGREEMENT WITH STROKE PHYSICIANS IN A DIGITAL TRAINING SETTING

M. Guterud ^1,2,3, H.F. Bugge^1,4,3, J. Røislien¹, K. Larsen^1,5, E. Eriksen⁴, S.H. Ingebretsen⁴, M. Mikkelsen⁴, J. Kramer-Johansen^6,3, K.G Bache^7,5, E.C. Sandset^4,1, M.R. Hov^4,8,1

¹Norwegian Air Ambulance Foundation, Department of Research, Oslo, Norway, ²Oslo University Hospital, Division of Prehospital Services, Oslo, Norway, ³University of Oslo, Institute of Clinical Medicine, Oslo, Norway, ⁴Oslo University Hospital, Department of Neurology, Stroke Unit, Oslo, Norway, ⁵University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway, ⁶Oslo University Hospital, Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Air Ambulance Department, Division of Prehospital Services, Oslo, Norway, ⁷Østfold University College, Research and Dissemination, Halden, Norway, ⁸Oslo Metropolitan University, Department of Health Science, Oslo, Norway

Background and aims: Time spent in the prehospital phase of acute stroke care is multifactorial and crucial for acute treatment. Communication between paramedics and the in-hospital stroke team directly affects prehospital on-scene time. The aim of this study was to explore whether paramedics can reliably use the National Institutes of Health Stroke scale (NIHSS) to assess stroke severity.

Methods: Twenty-four paramedics were recruited from Oslo University Hospital (OUS) in Norway, completing the Paramedic-Norwegian Acute Stroke Prehospital Project (ParaNASPP) educational model. Twenty videos with pre-defined NIHSS scores were recorded. This underlying truth will generally be unknown in clinical practice, and four stroke physicians from OUS were included for reference. Bland Altman plots with 95% Limits of Agreement (LoA) were calculated comparing first paramedics and stroke physicians to the pre-defined scores, and with each other. To align with clinical practice NIHSS scores were also dichotomized into 0-5 or ⩾ 6, and agreement calculated using Cohen’s Kappa.

Results: LoA ranged from -4.04 to 3.29 between paramedics and the pre-defined scores, and from -2.31 to 2.34 between stroke physicians and the pre-defined scores. Comparing paramedics and stroke physicians LoA ranged from -4.58 to 3.80. Dichotomizing, Cohen’s Kappa was 0.89 between pre-defined scores and paramedics, 0.92 between pre-defined scores and stroke physicians, and 0.81 between paramedics and stroke physicians, all indicating very good agreement.

Conclusion: A standardized digital education in NIHSS scoring for paramedics seems to result in very good agreement between paramedics and both pre-defined scores and stroke physician scores.

Disclosure: No

P0818 / 377

ACUTE ISCHAEMIC STROKE IN THE CONTEXT OF CAROTID ARTERY FREE-FLOATING THROMBUS: A SINGLE-CENTRE OBSERVATIONAL STUDY OF CHARACTERISTICS, TREATMENT STRATEGIES AND OUTCOME

O.I. Vittay ¹, S. Taylor¹, K. Madani¹, S. Mehta¹, L. Dixon², N. Rane², J. Shalhoub³, S. Banerjee^1,4, J. Kwan^1,4, Imperial Stroke Research Consortium

¹Imperial College Healthcare NHS Trust, Department of Stroke & Neurosciences, London, United Kingdom, ²Imperial College Healthcare NHS Trust, Department of Radiology, London, United Kingdom, ³Imperial College Healthcare NHS Trust, Department of Vascular Surgery, London, United Kingdom, ⁴Imperial College London, Department of Brain Sciences, London, United Kingdom

Background and aims: Optimal management of carotid artery free-floating thrombus (CAFFT) and CAFFT-related strokes remains unclear. We sought to examine the clinical characteristics, treatment strategies and patient outcomes for CAFFT-related ischaemic strokes.

Methods: We conducted a single-centre retrospective observational study by extracting data from electronic patient records. We included consecutive patients admitted between 2016-2021 with ischaemic stroke and CAFFT on initial CT/MR angiogram.

Results: We included 59 patients (mean age 63, 66% male). Vascular risk factors included hypertension (42%), diabetes (19%), dyslipidaemia (27%), previous stroke (10%), smoking history (56%) and alcohol excess (14%). 6 patients (10%) were COVID-19 positive. Median modified Rankin score was 0 and mean NIHSS was 11. On admission, 42% were taking antiplatelet agents, 10% were on anticoagulant, 34% had CRP >10mg/L, and 14% had eGFR <50 ml/min/1.73m².

On arrival, 27% received IV thrombolysis and 19% underwent mechanical thrombectomy. Acute antithrombotic strategies included IV heparin (49%), low molecular weight heparin (47%), oral anticoagulation (15%), and antiplatelet agents (63%). 24 patients (41%) were referred to vascular surgery, of whom 9 (38%, 15% of total) received emergency carotid endarterectomy.

Neurological deterioration (<7 days) occurred in 14%. In-hospital mortality was 8% overall, but 67% for COVID-positive patients. At 6 months, recurrent stroke occurred in 12% and mortality was 3%.

Conclusions: CAFFT-related ischaemic stroke is associated with significant mortality and neurological morbidity. The use of different acute antithrombotic strategies and emergency carotid endarterectomy varied significantly between patients. These major treatment options should be subjects of future clinical trials.

Disclosure: No

P0819 / 1252

HEALTHCARE QUALITY OF TIME-DEPENDENT DISEASES DURING COVID-19 EPIDEMIC: THE EXPERIENCE IN STROKE

X. Gong ¹, M. Lou¹

¹ The Second Affiliated Hospital of Zhejiang University, School of Medicine, Neurology, Hangzhou, China

Background: The study aimed to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on the healthcare quality of acute ischemic stroke (AIS) patients and summarize the potential experience in response to the COVID-19 outbreak.

Methods: We continuously included AIS patients registered in the CASE-II before and during the COVID-19 pandemic. We investigated the changes of 15 key performance indicators (KPIs),the composite score developed from these KPIs,and in-hospital outcomes of AIS during the COVID-19 outbreak and analyzed potential causes of these changes.

Results: There were 5,854 AIS patients admitted in pandemic period (January 23 to April 30, 2020) and 6,807 patients in pre-pandemic period (November 1, 2019 to January 22, 2020) among 52 hospitals. The median onset-to-door time was 28 minutes longer in pandemic than in pre-pandemic period (189 [90-585] versus 161 [87-417] minutes; P=0.001), but the proportion of patients receiving reperfusion treatment and the door-to-treatment time did not differ between the two groups. The composite measure (92.5% versus 91.4%; P=0.165) and all-or-none measure (54.4% versus 50.6%;P=0.893) did not significantly differ between the two periods. The rate of antithrombotic at discharge, smoking cessation and stroke education increased by 1.2% (P=0.025) and 1.5% (P=0.001), respectively during pandemic. There was also no significant difference between the two groups in mRS score at discharge (P=0.532) and new clinical vascular events (P=0.069).

Conclusions: Although AIS inpatients decreased during COVID-19 pandemic, the healthcare quality for hospitalized stroke patients was not significantly affected. This might be attributed to the health information technology and the effective prevention measures of COVID-19.

Disclosure: No

P0820 / 1635

TIME ON SCENE BEFORE ADMISSION OF ACUTE STROKE AND STROKE MIMICS: THE AKERSHUS STUDY OF ISCHEMIC STROKE AND THROMBOLYSIS-1

A.T. Bjerkreim ¹, S.H. Jahr¹, K.W Faiz¹, K.T. Larsen¹, V. Hillestad², M.N. Selseth², E. Bergh¹, A. Reichenbach¹, A. Sundseth¹, M. Altmann¹, B. Thommessen¹, E.C. Sandset³, O.M. Rønning¹, E.S. Kristoffersen¹

¹Akershus University Hospital, Department of Neurology, Lørenskog, Norway, ²Akershus University Hospital, Department of Radiology, Lørenskog, Norway, ³Oslo University Hospital, Department of Neurology, Oslo, Norway

Background and aims: The combination of patient-related factors and paramedic on-scene time contributes to treatment delay in patients with acute stroke. The purpose of this study was to investigate the different phases of the prehospital stroke chain and its association with final diagnosis and outcome.

Methods: All consecutive patients with suspected stroke admitted with ambulance within 4.5 hours of symptom onset to the stroke fast track at Akershus University Hospital, Norway between January 2015 and December 2017 were included.

Results: 1294 patients were included. The median age was 72 years and 47% were women. 705 (54.5%) had acute ischemic stroke (AIS), 92 (7.1%) intracerebral hemorrhage (ICH), 153 (11.8%) transient ischemic attack (TIA) and 459 (35.5%) were stroke mimics. Overall, the median time (minutes (IQR)) from symptom onset to EMS call – often referred to as patient delay – was 39 (12-95), from onset to ambulance on scene 49 (22-107), from EMS call to on-scene 8 (5-12), on-scene time 18 (11-24) and from on-scene to hospital 20 (11-29). The median time from symptom onset to EMS call (minutes (IQR)) was 35 (11-94), 29 (8-73), 37 (14-76) and 50 (15-115) for AIS, ICH, TIA and stroke mimics respectively, p=0.01. The median on scene time (minutes (IQR)) was 18 (11-23), 20 (12-24), 17 (11-25) and 17 (10-26) for AIS, ICH, TIA and stroke mimics respectively, p=0.67.

Conclusions: Time to first EMS contact is a major contributor to treatment delay in acute stroke. Patients with ICH had the shortest patient delay, while stroke mimics had the longest.

Disclosure: No

P0821 / 315

TRENDS IN THE DUTCH ACUTE ISCHEMIC STROKE CARE BETWEEN 2017 AND 2020. RESULTS OF THE DUTCH ACUTE STROKE AUDIT (DASA)

L.J Stolze ¹, L.S Kuhrij², R.M van den Berg-Vos^1,3, P.J Nederkoorn¹, on behalf of the Clinical Audit Board of the Dutch Acute Stroke Audit

¹Amsterdam University Medical Center, Neurology, Amsterdam, Netherlands, ²Leiden University Medical Center, Biomedical Data Sciences, Leiden, Netherlands, ³OLVG, Neurology, Amsterdam, Netherlands

Background and aim: The Dutch Acute Stroke Audit (DASA) monitors the quality of acute stroke care in the Netherlands. This study aims to evaluate the DASA’s results and trends between 2017 and 2020.

Methods: All consecutive patients (⩾18 years old) with an acute ischemic stroke (AIS) presented in a Dutch hospital between the 1^stof January 2017 and 31^st of December 2020 were included. The results were studied per year and assessed for trends.

Results: From 2017 until 2020, 123,161 AIS-patients were included. Patients had a median age of 75 years, 46.5% were female, and they presented with a median National Institutes of Health Stroke Scale (NIHSS) of 3 after a median onset-to-door time of 148 minutes. 20.7% of patients received intravenous thrombolysis, and 6.4% received endovascular therapy (2017: 4.5%; 2020: 7.3%). The median door-to-needle time increased from 24 to 27 minutes. The door-to-groin time shortened by 4 minutes between 2017 and 2018 but rose from 51 minutes in 2018 to 56 in 2020. In 2020 68.5% of patients had a completed NIHSS; 65.8% had completed modified Rankin Scale (mRS) scores three months after presentation.

Conclusions: Over the past years, treatment times for reperfusion therapy have marginally increased. This may be explained by recent advancements, in which perfusion imaging is more often conducted. Though time-consuming, it increases the number of AIS-patients eligible for reperfusion therapy. The DASA is used to monitor these developments. Increased completeness of mRS and NIHSS is needed to provide outcomes and facilitate valid interhospital comparisons.

Disclosure: No

P0822 / 197

FACTORS ASSOCIATED WITH INCREASED SHOULDER SUBLUXATION RISK: AN AUDIT OF POST-STROKE SHOUDLER SUBLUXATION PREVALENCE ON AN ACUTE STROKE UNIT

C. Kennedy¹, C. Woolfenden¹, C. Ronzeau¹, A. Cormican¹, V. Tahtis^1,2, Y. Mah ^1,3

¹King’s College Hospital NHS Foundation Trust, London, United Kingdom, ²Imperial College London, Division of Brain Sciences, Charing Cross Campus, London, United Kingdom, ³King’s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom

Background: Shoulder subluxation is a common cause of shoulder pain following an acute stroke and has been shown to impact recovery. However, the prevalence of shoulder subluxation varies between 17-81% providing an additional challenge to developing services to address this problem.

Methods: In this service evaluation we retrospectively reviewed the electronic health records of all Stroke Unit admissions between Aug 2020 and Aug 2021 with a diagnosis of acute stroke. We proceeded to determine the prevalence of shoulder subluxation within this inpatient population, and the factors that are associated with its development.

Results: The prevalence of shoulder subluxation in our population was 30%. The median (interquartile range IQR) age, admission NIHSS score and proportion of females were 64 (IQR: 54-79) years, 9 (IQR: 4-18), and 45% respectively. The median delay between stroke onset and diagnosis of shoulder subluxation was 19 (IQR: 7.2-30) days. Factors associated with the future development of shoulder subluxation were: total NIHSS score (driven primarily by the motor components of the score), acute ischaemic stroke, and female sex.

Conclusions: The prevalence of shoulder subluxation within acute stroke inpatients was high at 30%. The distribution of total NIHSS scores, and more specifically the motor sub-questions, were significantly different between those who developed a subluxation during their admission compared with those who did not. A combination of the NIHSS score, sex, stroke type and age, may be helpful in developing a risk stratification score for shoulder subluxation in acute stroke patients.

Disclosure: No

P0823 / 373

THE IMPACT OF SARS-COV-2 INFECTION ON THE OUTCOME OF ACUTE ISCHEMIC STROKE - A RETROSPECTIVE COHORT STUDY

T.T. Takács ¹, Á.J. Berki¹, P.P. Böjti^2,1,3, R. Stang^1,3, P.A. Fritz-Reunes¹, L. Schnekenberg⁴, T. Siepmann^4,5, A. Pintér^5,6, S. Szatmári¹, D. Bereczki^1,7,8, B.B. Gunda^1,3

¹Semmelweis University, Department of Neurology, Budapest, Hungary, ²National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary, ³Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary, ⁴Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany, ⁵Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany, ⁶Semmelweis University, Department of Family Medicine, Budapest, Hungary, ⁷European Academy of Neurology, EANcore COVID-19 Task Force, Vienna, Austria, ⁸MTA-SE Neuroepidemiological Research Group, Budapest, Hungary

Background: Acute ischemic stroke (AIS) is a frequent complication of coronavirus disease (COVID-19), but the prognosis of these patients is poorly understood.

Aim: To explore the impact of COVID-19 on neurological outcome in AIS patients.

Methods: A comparative retrospective cohort study was conducted in 32 consecutive AIS patients with and 51 without COVID-19 between the 1^st of March 2020 and 1^st of May 2021. The evaluation was based on a detailed chart review for demographic data, medical history, stroke severity, cranial and vessel imaging results, laboratory parameters, COVID-19 severity, hospitalization time, in-hospital mortality, and functional deficits at discharge (modified Rankin Scale, mRS).

Results: COVID-19 AIS patients had worse initial neurological deficit (NIHSS 9 (3-13) vs. 4 (2-10); p=0.06), showed tendency to higher rate of large vessel occlusion (LVO; 13/32 vs. 14/51; p=0.21), had prolonged hospitalization (19.4 ± 17.7 vs. 9.7 ± 7 days; p=0.003), had lower chance of functional independence (mRS⩽2) (12/32 vs. 32/51; p=0.02) and showed higher in-hospital mortality (10/32 vs. 6/51; p=0.02). In COVID-19 AIS patients, LVO was more common with COVID-19 pneumonia than without (55.6% vs. 23.1%; p=0.139).

Conclusion: COVID-19-related AIS carries a worse prognosis. COVID-19 with pneumonia seems to be associated with a higher rate of LVO.

Disclosure: No

P0824 / 295

ASSOCIATION OF HYPERGLYCEMIA AND COMPUTED TOMOGRAPHIC PERFUSION DEFICITS IN PATIENTS WHO UNDERWENT ENDOVASCULAR TREATMENT FOR ACUTE ISCHEMIC STROKE

C. Kersten ¹, A. Zandbergen², O. Berkhemer³, J. Borst³, M. Haalboom⁴, Y. Roos³, D. Dippel², R. van Oostenbrugge⁵, A. van der Lugt², W. van Zwam⁵, C. Majoie³, H. den Hertog⁶

¹Medisch Spectrum Twente, Neurology, Enschede, Netherlands, ²Erasmus Medisch Centrum, Rotterdam, Netherlands, ³Amsterdam University Medical Centers, Amsterdam, Netherlands, ⁴Medisch Spectrum Twente, Enschede, Netherlands, ⁵Maastricht University Medical Centre, Maastricht, Netherlands, ⁶Isala, Zwolle, Netherlands

Background and aims: Hyperglycemia is highly prevalent in patients with acute ischemic stroke and is associated with increased risk of symptomatic intracranial hemorrhage, larger infarct size and unfavorable outcome. Furthermore, glucose modifies the effect of endovascular treatment (EVT). Hyperglycemia might lead to accelerated conversion of penumbra into infarct core. However, it remains uncertain whether hyperglycemia on admission is associated with the size of penumbra or infarct core in acute ischemic stroke.

Methods: We used CT-perfusion data from the MR CLEAN study. Hyperglycemia was defined as admission serum glucose of >7.8 mmol/L. Hyperglycemia was related to size of core, penumbra and core penumbra ratio. Hypoperfused area is mean transient time 45% higher than that of the contralateral hemisphere, core is the area with cerebral blood volume of <2 mL/100 g and penumbra with cerebral blood volume >2ml/100 g. Core-penumbra ratio is ischemic core divided by the total volume of hypoperfused tissue multiplied by 100. Adjustments were made for age, sex, NIHSS on admission, onset-imaging time and diabetes mellitus.

Results: Hundred seventy-three patients were included. Median glucose level on admission was 6.5 mmol/L (IQR 5.8-7.5 mmol/L), thirty-five patients (20%) were hyperglycemic. Patients with hyperglycemia on admission had larger core volumes and core penumbra ratio than normoglycemic patients with regression coefficient of 15.1 (95% confidence interval (CI), 1.8 to 28.3) and 11.5 (95% confidence interval (CI), 3.4 to 19.7) respectively.

Conclusions: Hyperglycemia on admission was associated with larger ischemic core volume and larger core-penumbra ratio in patients with acute ischemic stroke who underwent endovascular treatment.

Disclosure: No

P0825 / 1404

CAUSES OF READING DIFFICULTY IN ACUTE STROKE SURVIVORS: FINDINGS OF A PROSPECTIVE, EPIDEMIOLOGY VISUAL IMPAIRMENT STUDY

F. Rowe ¹, L. Hepworth¹, C. Howard², K. Hanna¹, J. Currie¹

¹University of Liverpool, Institute of Population Health, Liverpool, United Kingdom, ²Salford Royal NHS Trust, Orthoptics, Manchester, United Kingdom

Background and aims: Visual impairment is common after stroke. The purpose was to explore the visual and non-visual causes of reading difficulty experienced by stroke survivors in a large multi-centre prospective epidemiology study.

Methods: Visual assessment, including a case history, visual acuity, ocular alignment, ocular motility, visual fields, visual inattention and visual perception, was attempted for all stroke admissions to three acute stroke units.

Results: Of 1500 stroke admissions, 1204 received a visual assessment, from which 867 were confirmed to have one or more visual impairments. Of those identified with visual impairment 383 (44.17%) reported visual symptoms likely to impact reading, including 84 (9.69%) specifically reporting reading difficulties related to their vision. Ocular conditions likely to impact reading included visual acuity worse than 0.5 logMAR, complete gaze palsy on downgaze or lateral gaze, saccadic dysmetria, convergence insufficiency or paralysis, nystagmus and complete macular splitting hemianopia. Non-visual causes of reading difficulty were common (414/1204, 34.38%) with 323 non-visual causes reported by those with confirmed visual impairment (alongside or in addition to visual causes), and in 91 stroke survivors with normal visual function. Communication difficulty was the most common non-visual cause (n=270, 65.22%).

Conclusions: Reading difficulty is common in stroke survivors and difficulty with reading following stroke is multi-factorial. Whilst many have associated visual impairment, about one third have reading difficulty due to non-visual causes; typically due to communication problems. Prompt management for associated visual impairment is important to alleviate any added impact to reading function.

Disclosure: Yes

P0826 / 1201

ASYMPTOMATIC CAROTID STENOSIS CEREBROVASCULAR RISK AND FRAILTY CONDITION RISK IN A CONTEMPORARY COHORT UNDER REAL CLINICAL CONDITIONS

L. Benavente ¹, M. Gonzalez-Delgado¹, J. Chaviano², J.M. Jimenez², J.A. Del Castro³, E. Murias⁴, L.A. Camblor³, P. Vega², M. Alonso³, S. Calleja⁵

¹Universidad de Oviedo / Hospital Universitario Central De Asturias, Neurology, Oviedo, Spain, ²Hospital Universitario Central De Asturias, Radiology, Oviedo, Spain, ³Hospital Universitario Central De Asturias, Angiology and Vascular Surgery, Oviedo, Spain, ⁴Universidad de Oviedo / Hospital Universitario Central De Asturias, Radiology, Oviedo, Spain, ⁵Hospital Universitario Central De Asturias, Neurology, Oviedo, Spain

Background and aims: Carotid atheromatosis causes the 15-20% of ischemic stroke. But asymptomatic carotid stenosis (ACS) is much more frequent, and even now we have no unanswerable risk markers to lead a reliable selection for revascularization. Our aim is to show the long-term evolution ACS on medical treatment (MT) under real clinical conditions, in terms of cerebrovascular risk and a global frailty condition.

Methods: Cohort of 315 patients with ACS prospectively recorded. Finally, we included 266 patients with only MT (49 patients (15.6%) were excluded because of have been revascularizated). We recorded the conversion to symptomatic carotid and other important events on health, defined as those episodes whose entity implies hospital attention, and could show a frailty condition in these patients.

Results: Patients were mostly men (74.1%), mean age 73.11, median follow-up 42 months. Mortality occurred in 19.1%. Conversion to symptomatic happened in 5.7% (1.5% per year): 7 non-disabling stroke; 5 transient ischemic attack; 3 fugax amaurosis. Events that determined hospital care happened in 55.1%: vascular events (56.9%), including cardiac failure, peripheral artery disease failure, acute coronary syndrome, cerebrovascular disease, arrhythmias, valvular disease, renal failure; infections (23.8%); cancer (7.5%); other neurological events (8.1%) derived from cognitive impairment or seizures; others (3.7%).

Conclusions: Medical treatment shows to be the correct approach to asymptomatic carotid stenosis in a real world scenario, even not only in case of best medical treatment. But it might constitute a condition of risk and frailty to suffer other important events for health, highlighting a very vulnerable population.

Disclosure: No

P0827 / 248

HEALTHCARE STAFF’S KNOWLEDGE, EXPERIENCES AND ATTITUDES REGARDING POST-STROKE HYDRATION CARE PROVISION: A QUALITATIVE CROSS-SECTIONAL STUDY

C. Miller ¹, J. Gibson¹, S. Jones¹, A.-M. Timoroska², A. Maley³, E. Romagnoli³, B. Chesworth¹, C. Watkins¹

¹University of Central Lancashire, Stroke Research Team, Faculty of Health and Care, School of Nursing, Preston, United Kingdom, ²Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, United Kingdom, ³Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Blackpool, United Kingdom

Introduction: Stroke patients worldwide, particularly those with dysphagia, are at risk of dehydration. Dehydration after stroke is associated with poor prognosis and worse outcomes. Optimal hydration post-stroke reduces the risk of neurological deterioration and other complications. This study aimed to explore healthcare staff’s knowledge and experiences of identifying and managing dehydration in hospitalised patients after acute stroke, and of the facilitators and challenges to optimising hydration care.

Methods: Semi-structured interviews were conducted (April-October 2018) with a purposive sample of 30 multi-disciplinary staff members from two UK stroke units. Interviews were recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework (TDF).

Results: Interview data was mapped to twelve of the fourteen TDF domains. Inadequate hydration management was identified as having potentially serious consequences, and participants described the complex knowledge and skills required to provide effective hydration care. Maintaining hydration was perceived as a multidisciplinary team responsibility which required effective communication. External audits reinforced the need for initial dysphagia screening, however other areas of post-stroke hydration management were not clearly mandated; notably, there was no established method of hydration assessment. Barriers to adequate hydration care included lack of staff, out-of-hours working patterns, low priority given to hydration, patients’ co-morbidities, and complex post-stroke disabilities.

Conclusion: Staff recognised the importance of assessing and maintaining hydration but described barriers to, and variation in, clinical practice. To provide optimal care, barriers to the assessment, prevention and treatment of dehydration after stroke must be further understood and addressed. 

Disclosure: No

P0828 / 278

THE NEW LDL-C TARGET IS REACHED BY LESS THAN ONE-THIRD OF VERY HIGH-RISK STROKE PATIENTS. IMPLEMENTATION OF THE NEW DYSLIPIDEMIA GUIDELINES IS CHALLENGING FOR NEUROLOGISTS

P. Macias Sedas ¹, N. Valverde Mata¹, A. Parejo Olivera¹, B. Rebollo¹, J.M Ramirez-Moreno^2,3

¹Badajoz University Hospital, Stroke Center. Neurology., Badajoz, Spain, ²Badajoz University Hospital, Stroke Center. Neurology, Badajoz, Spain, ³Extremadura University. Faculty of Medicine and Health Sciences, Biomedical Sciences, Badajoz, Spain

Background and aims: In August 2019, the ESC/EAS published updated guidelines for the treatment of dyslipidemias. The new guidelines introduce a lower low-density lipoprotein cholesterol (LDL-C) goal and recommend more aggressive therapy for stroke patients. We aim to estimate the proportion of stroke patients who would be eligible for more aggressive therapy to lower LDL-C according to the new guidelines.

Methods: We included stroke patients admitted in a stroke center and who survived the first follow-up. LDL-C levels were measured using standard methods. We evaluated lipid-lowering therapy, LDL-C levels, and study population characteristics based on cardiovascular risk.

Results: We included 355 patients. 152 patients were classified as very high risk, 80 as high risk, and 114 as moderate risk. 310 patients were prescribed statins, 6 combined with fibrates and 7 with ezetimibe. The mean basal level (SD) of LDL-C was 91.0 (34.9) mg/dL. The mean reduction (SD) of LDL-C at 3 months was 16.6(33.6) mg/dL. Among 152 very high-risk patients, LDL-C below 55 mg/dL was achieved in 25.7%, among 80 high-risk patients, LDL-C below 70 mg/dL was achieved in 46.3% and among 114 patients with moderate risk LDL -C below 100 mg/dL was reached in 84.2%.

Conclusions: In patients admitted after stroke, the new LDL-C target is reached in less than a third of very high-risk patients. And more than half of high-risk patients are uncontrolled. Our study suggests that a significant percentage of patients will need to maximize the use of LDL cholesterol-lowering therapies according to the new guidelines.

Disclosure: No

SERVICE ORGANISATION/QUALITY IMPROVEMENT AND PATIENT CENTERED OUTCOMES

P0829 / 1485

TEMPORAL TREND OF TRANSIENT ISCHEMIC ATTACK MANAGEMENT OVER A 10-YEAR PERIOD: DATA FROM THE RHÔNE COUNTY, FRANCE

F. Isnard ¹, A. Termoz^2,1, J. Haesebaert^2,1, M. Viprey^2,1, K. Tazarourte^2,1, E. Bravant^2,1, N. Perreton², S. Cakmak³, B. Ducreux³, C. Pidoux³, S. Meyran⁴, C. Ossedat⁴, T. Bony¹, M. Douplat¹, V. Potinet¹, A. Sigal¹, L. Derex^1,2, N. Nighoghossian¹, A.-M. Schott^1,2, L. Mechtouff¹

¹Hospices Civils de Lyon, Lyon, France, ²Université Claude Bernard Lyon 1, Lyon, France, ³Hôpital Nord Ouest - Villefranche, Villefranche-sur-saône, France, ⁴St Joseph St Luc hospital, Lyon, France

Background and aims: Timely recognition and management of TIA offer opportunity to prevent subsequent stroke. Under the impetus of national plans, measures were adopted to improve TIA management, including a structured local pathway. Our objective was to compare TIA management between two periods over 10 years, before and after the implementation of these measures.

Methods: A before-and-after study was conducted with two identical population-based cohort studies in 2006-2007 (AVC69) and 2015-2016 (STROKE69) including all patients with TIA diagnosis over a seven-month period in six public and private hospitals in the Rhône county in France. The primary outcome was the adequate TIA management defined as brain and vessel imaging within 24 hours of admission and the prescription of antithrombotic treatment at discharge.

Results: We identified 109 patients TIA patients in 2006-2007, and 458 over the same period in 2015-2016. A higher proportion of patients were adequately managed in 2015-2016 compared to 2006-2007 (14/96 (15%) in 2006-2007 vs 306/452 (68%) in 2015-2016, p < 0.001). This difference was mainly driven by a marked increase of vessel imaging performed within 24 hours of admission, most often by CT angiography. Furthermore, patients called more often emergency medical dispatch before admission, were admitted with a shorter delay after symptom onset and were more likely discharged to home in 2015-2016 compared to 2006-2007.

Conclusions: Our study demonstrated an increasing rate of adequate TIA management, mainly driven by a marked increase of vessel imaging within 24 hours of admission, over a 10-year period in the Rhône county in France.

Disclosure: No

P0830 / 1052

EXPLORING THE EXPERIENCES OF ACCESS AND PARTICIPATION IN COMMUNITY-BASED POSTSTROKE SERVICES AND SUPPORT

H. Singh ^1,2, T. Nguyen², S. Hahn-Goldberg^3,4, S. Lewis³, S. Smith-Bayley², M.L. Nelson^5,6,2

¹University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Canada, ²March of Dimes Canada, Toronto, Canada, ³University Health Network, OpenLab, Toronto, Canada, ⁴University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada, ⁵Sinai Health System, Bridgepoint Collaboratory for Research & Innovation, Toronto, Canada, ⁶University of Toronto, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada

Background and aims: Over half of people living with stroke experience long-term unmet needs. Community-based stroke programs can augment health system services and are valuable resources to support stroke recovery and increase community participation. However, the experiences of people impacted by stroke within community-based stroke programs remain understudied. Thus, we explored the experiences of people impacted by stroke, including facilitators and barriers to participation, in community-based stroke programs.

Methods: This qualitative study recruited people living with stroke and caregivers/family members participating in a community-based stroke program at March of Dimes Canada. Participants completed an interview and/or asynchronously responded to questions. The interviews were audio-recorded and transcribed. Two researchers analyzed the data using inductive thematic analysis.

Results: Twenty-four people with stroke and nine caregivers/family members participated. Three preliminary themes were identified. The first theme, ‘adjusting to a new way of life,’ encompassed poststroke achievements supported by the community stroke programs (e.g. building a new self-image and confidence). The second theme, ‘the invisible and visible impact of stroke,’ included stroke sequelae supported or unsupported by the community stroke programs (e.g. communication and mobility challenges). ‘Holistic stroke services’ was the third theme, encompassing the type of stroke support considered valuable and barriers and facilitators to participating in stroke programs.

Conclusions: The poststroke experiences of participants highlighted in this study indicate the valuable role and perceived value of community-based programs in supporting people impacted by stroke. Removing the barriers identified to program participation may enhance equity, diversity, and inclusion within community-based stroke programs.

Disclosure: No

P0831 / 1046

EXPLORING THE EXPERIENCES OF CHINESE AND SOUTH ASIAN PARTICIPANTS IN CULTURALLY-TAILORED STROKE PROGRAMS

H. Singh ^1,2, T. Nguyen², S. Hahn-Goldberg^3,4, S. Lewis³, S. Smith-Bayley², J. Fulton^2,5, M.L. Nelson^6,5,2

¹University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Canada, ²March of Dimes Canada, Toronto, Canada, ³University Health Network, OpenLab, Toronto, Canada, ⁴University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada, ⁵University of Toronto, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada, ⁶Sinai Health System, Bridgepoint Collaboratory for Research & Innovation, Toronto, Canada

Background and aims: Ethnic minorities tend to have higher stroke mortality and poorer post-stroke outcomes than non-minorities. However, the poststroke experiences and needs of ethnic minorities remain understudied. Thus, this study aimed to explore the poststroke experiences and needs of people with stroke who participate in a culturally-tailored stroke program and identify opportunities for program enhancement.

Methods: This was a qualitative descriptive study. Two focus groups were conducted with individuals impacted by stroke who participated in the South Asian or Chinese culturally-tailored stroke program at March of Dimes Canada. Interviews were recorded, transcribed and thematically analyzed.

Results: The first focus group included seven individuals (six with stroke and one caregiver) attending the South Asian stroke program. The second focus group included ten individuals (nine with stroke and one caregiver) attending the Chinese stroke program. Six preliminary themes were identified: 1) personal values and belief system influences expectations of stroke recovery, 2) impact of stroke on family role, 3) barriers and facilitators to access and awareness of resources and information, 4) role of others in poststroke recovery, 5) activities perceived to support stroke recovery, and 6) barriers, facilitators and benefits of community stroke supports.

Conclusions: All participants perceived that the culturally-tailored stroke programs supported their post-stroke recovery. Stroke programs can further their impact and reach by addressing the barriers to access and awareness of stroke resources, information and supports highlighted in this study. In addition, the study findings highlight valuable opportunities for program enhancement of existing and new culturally-tailored stroke programs.

Disclosure: No

P0832 / 1029

RUN-TIA: IMPROVING THE MANAGEMENT OF TRANSIENT ISCHEMIC ATTACK

S. Pérez Sánchez ¹, R. De Torres Chacón¹, T. Busquier Cerdán², A. Barragán Prieto¹, I. Morales³, N. Pérez Sánchez², A. Franco Salinas¹, J.M. Garrido Castilla³, M. García Marín², J. Loscertales¹, C. Navarro Bustos³, J. Montaner¹

¹Hospital Universitario Virgen Macarena, Neurology, Seville, Spain, ²Hospital Universitario Virgen Macarena, Radiology, Seville, Spain, ³Hospital Universitario Virgen Macarena, Emergency Department, Seville, Spain

Background: Symptoms of a transient ischemic attack (TIA), if recognized as such, provide a critical opportunity to quickly find and treat the cause to prevent a devastating stroke. An estimated 7.5% to 17.4% of patients with TIA will have a stroke in the next 3 months. For this reason, to reduce the rate of ischemic stroke after TIA is an urgent priority for health care systems.

Methods: A rapid TIA management protocol (Radiology, Urgencies and Neurology services; RUN-TIA) was implemented in December 2020. It includes assessment by the neurologist, MRI performance, evaluation of extra- and intracranial vessels and cardiac assessment (EKG always and long-term monitoring in case of high suspicion of atrial fibrillation) at patient arrival at ED. In addition, treatment was optimized in the first 24 hours, administering the loading dose as soon as possible after symptoms onset.

Results: 134 patients were evaluated, 44.7% were female. The mean duration of TIA was 72 minutes and most frequent symptom was aphasia/speech disorder. 75% presented an ABCD2 greater or equal to 4. Regarding MRI 39.7% patients had DWI positive lesions. After the complete evaluation, 34 patients were classified as non-TIA. All patients were discharged with antiplatelet or anticoagulant therapy depending on the etiology. 3.73% of patients had a recurrence in the following year, all of them within the first month.

Conclusions: Urgent TIA assessment strategies aimed at optimizing diagnosis, treatment and risk factor control are effective in reducing stroke recurrence in the short and long term.

Disclosure: No

P0833 / 1213

COMPERATIVE ANALYSIS OF LOGISTIC FACTORS IN PATIENTS WITH HEMORRAGIC AND ISCHEMIC STROKE (DATA FROM POMERANIAN STROKE REGISTER)

E. Brelak ¹, G. Kozera², J. Antecki¹, W. Szczuchniak³, P. Sobolewski⁴

¹Regional Hospital in Kielce, Department of Neurology and Stroke Unit, Kielce, Poland, ²Medical University of Gdańsk, Medical Simulation Center, Gdańsk, Poland, ³Jan Kochanowski University, Department of Neurology and Stroke Unit in Sandomierz, Sandomierz, Poland, ⁴Collegium Medicum, Jan Kochanowski University of Kielce, Department of Neurology and Storke Unit in Sandomierz, Sandomierz, Poland

Background and aims: In the last two decades of the developed systems of stroke care, particular emphasis was placed on improving the logistic factors of managing patients with IS, which was not reflected in patients with ICH. The aim of this study was to compare the logistic factors that influence the delay in treating patients with ICH and IS with a particular focus put on analyzing the group of patients with ICH.

Methods: An observational, retrospective study included 8.790 patients with acute ischemic stroke (AIS) including 813 patients with ICH, who had been hospitalized in the stroke units and consequently reported to the Pomeranian Stroke Register (PRUM) in the period of 2009-2013.

Results: In the group of patients with ICH, onset-needle-time (ONT) and door-needle-time (DNT) were significantly shorter (195,00(110,00-378,00) vs. 305,00(155,00-720,00), p<0.001; 70,00(30,50-159,00) vs. 95,00(40,00-195,00), p<0.001, respectively). The logistic factors that had a significant impact on pre- and in-hospital procedures among patients with ICH were sparse, compared to patients with IS. In both groups, the factors that significantly delayed both pre- and in-hospital procedures were: delaying the call for assistance (p<0.001; p<0.001; p=0.019; p=0.001 respectively). The factor that shortened the duration of all procedures in both groups was high NIHSS score (p=0.005; p=0.02; p=0.037; p<0.001 respectively). In patients with ICH, the only additional factors reducing the time of in-hospital procedures were living in a rural area (p<0.001) and professional activity (p=0.043).

Conclusion: Logistic procedures managing patients with ICH compared to patients with IS were more efficient and shorter.

Disclosure: No

P0834 / 1598

FREQUENCY OF INTER-SPECIALTY CONSENSUS DECISIONS AND ADHERENCE TO ADVICE FOLLOWING DISCUSSION AT A WEEKLY NEUROVASCULAR MULTIDISCIPLINARY MEETING

C Offiah ^1,2, S Tierney³, B Egan³, D. Collins^2,4, D. Ryan^2,4, A. McCarthy^1,2, D. Smith^1,5, S. Murphy^1,2, J Mahon^2,4, E Boyle³, H Delaney⁶, R O’Donohoe⁶, A Hurley⁷, R Walsh¹, S. Murphy^1,2, P Bogdanova-Mihaylova¹, S O’Dowd¹, T Coughlan^2,4, D O’Neill^2,4, P O’Brien⁸, M Martin⁹, M. Kelly^1,2, T Omer^1,2, D. McCabe^1,2,10,11,12

¹Dept. of Neurology, Dublin, Ireland, ²Stroke Service, Dublin, Ireland, ³Dept. of Vascular Surgery, Dublin, Ireland, ⁴Dept. of Age-Related Health Care, Dublin, Ireland, ⁵Vascular Neurology Research Foundation, Dublin, Ireland, ⁶Dept. of Radiology, Dublin, Ireland, ⁷Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH) /, Dublin, Ireland, ⁸Dept. of Geriatrics and Stroke Medicine, Kildare, Ireland, ⁹Dept. of Geriatrics and Stroke Medicine, Naas General Hospital, Co, Kildare, Ireland, ¹⁰Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH) /, Dublin, Ireland, ¹¹Dept. of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, United Kingdom, ¹²Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland

Background and aims: There are limited ‘real-world’ data on the frequency of consensus decisions between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) on the management of patients with extracranial carotid/vertebral stenoses, and post-MDM ‘adherence’ to such advice. The aims of this prospective audit/quality improvement project were to collate such data at a neurovascular/stroke centre.

Methods: Data from a weekly university hospital MDM, attended by vascular neurologists, vascular surgeons, geriatricians/stroke physicians and neuroradiologists, were prospectively recorded to document the proportion of extracranial carotid/vertebral stenosis patients in whom ‘complete consensus management decisions’ were reached. Adherence to MDM decisions was analysed in patients with asymptomatic, symptomatic and ‘indeterminate symptomatic status [ISS]’ stenoses, including intervals between symptom onset to MDM discussion +/- intervention, where appropriate.

Results: 111 patients were discussed (September/2017-February/2020). Based on currently-available data, consensus regarding management was reached in 107/111 (96.4%) patients overall, with consensus in 100% (26/26) with asymptomatic carotid stenosis [ACS], 94.8% (55/58) with symptomatic carotid stenosis [SCS], and 96.3% (26/27) with ISS. Overall adherence to MDM advice was observed in 94/111 patients (84.7%): 92.3% (24/26) with ACS, 82.8% (48/58) with SCS, 81.5% (22/27) with ISS. Median interval from index TIA/stroke to intervention was 12.5 days (IQR:9-18d), and from MDM discussion to intervention was 5.5d (IQR:1-7d) in patients with 50-99% SCS in whom carotid revascularisation was advised.

Conclusions: High rates of inter-specialty consensus regarding management/adherence to proposed treatment support a collaborative, multidisciplinary model-of-care in patients with extracranial arterial stenosis. Service development should shorten the interval between MDT discussion-intervention to optimise secondary prevention.

Disclosure: No

P0835 / 1594

SOCIAL AND CULTURAL BARRIERS TO STROKE CARE IN LOW/MIDDLE INCOME COUNTRIES

F. Al-Mufti ¹, E. Feldstein¹, V. Inoa², S. Ortega³, K. Asif⁴, N. Herial⁵, G. Toth⁶, V. Urrutia⁷, S. Desai⁸, V. Szeder⁹, T. Kulman⁷, H. Masoud¹⁰, K. Limaye¹¹, D. Yavagal¹²

¹Westchester Medical Center, Neurosurgery, Valhalla, United States, ²Methodist Le Bonheur, Neurology, Memphis, United States, ³Univeristy of Iowa, Iowa City, United States, ⁴University of Illinois Chicago, Chicago, United States, ⁵Thomas Jefferson, Philadelphia, United States, ⁶Cleveland Clinic, Cleveland, United States, ⁷Johns Hopkins, Baltimore, United States, ⁸University of Pittsburgh, Pittsburgh, United States, ⁹University of California Los Angeles, Los Angeles, United States, ¹⁰SUNY Upstate, Syracuse, United States, ¹¹Indiana University School of Medicine, Indianapolis, United States, ¹²University of Miami, Miami, United States

We explore the available literature to determine region-specific social and cultural barriers to obtaining stroke care.

A literature review was performed to identify studies that described stroke care in low-income and middle-income countries (LMICs). We used the search term “stroke” along with the following terms: “burden”, “incidence”, “prevalence”, “awareness”, “transportation”, “stroke services”, “rehabilitation”, “acute stroke”, “emergency care”, “infrastructure”, “stroke services”, “quality improvement”, and “stroke units”, between January 1st, 2015 and August 1st, 2021.

We identified two broad limitations to expanding stroke care across the globe: infrastructure and education/ culture. We subdivided stroke care regionally into Middle East and North Africa (MENA), Europe, Asia, Latin America, and Subsaharan Africa. In MENA, religious health fatalism scores on questionnaires are negatively correlated with adherence to rehabilitative protocols and stroke outcome. Only 6.5% in a nationwide survey in China were aware that there was a therapeutic window for thrombolytic therapy in 2016, increased to 32.8% after a 2 year nationwide campaign. The RESILIENT trial demonstrated the effectiveness of EVT in Brazilian public hospitals, which helped convince the government to change policy and promote the use of EVT. Some African communities consider stroke to be an illness of debilitating/ paralytic, ghost, or shivering etiology.

Trust in care and compliance with preventive/rehabilitative measures may be helped by connecting NGOs such as Stroke Angels and Mission Thrombectomy 2020 with community-based/ religious leaders to correct assumptions about origin and treatment.

Disclosure: No

P0836 / 1101

STROKE SURVIVOR AND FAMILY CARER PRIORITIES FOR DEVELOPMENT OF STROKE SERVICES IN IRELAND: PRELIMINARY RESULTS OF AN EXPLORATORY QUALITATIVE STUDY

E. Sexton ¹, A. Hickey¹, D.J Williams¹, F. Horgan¹, E. Byrne¹, C. Macey², P. Cuffe³, S. Timmons⁴, R. Collins⁵, K. Bennett¹

¹RCSI University of Medicine and Health Sciences, Dublin, Ireland, ²Irish Heart Foundation, Dublin, Ireland, ³Patient Collaborator, Sligo, Ireland, ⁴University College Cork, Cork, Ireland, ⁵Tallaght University Hospital, Dublin, Ireland

Background and aims: Exploring the views of those impacted by stroke is key to the improvement and development of stroke services. This qualitative study examined experiences of care, and priorities for service development, among stroke survivors and carers in Ireland.

Methods: In-depth semi-structured interviews were conducted online or by phone with stroke survivors (n=15) and family carers (n=13), recruited through voluntary organisations and social media. Participants with communication or cognitive difficulties were included, and provided with accessible information materials. Interviews were audio-recorded and transcribed. Framework analysis was used, involving data familiarisation, coding, development of an analytic framework, charting and interpretation. The process was iterative, with ongoing revision and refining of the analytic framework.

Results: Participants reported a mix of positive and negative experiences across the care continuum. Key priorities included 1) ensuring easy navigation of services, including consistent follow-up, clear signposting and removing barriers to access; 2) support for psychosocial outcomes (e.g., mood and adjustment to life post-stroke); 3) information provision on stroke diagnosis/prognosis; and 4) the inpatient hospital experience (e.g. toilet/shower facilities, noise).

Conclusions: Findings support the implementation of the Stroke Action Plan for Europe, particularly in relation to clear, transparent and evidence-based care pathways based on equitable access; and support for psychosocial outcomes through rehabilitation and services for life after stroke. Provision of information, and the hospital experience, may need greater emphasis in quality improvement processes. Findings will be combined with a qualitative survey of healthcare professionals and used to inform economic modelling of potential service developments.

Disclosure: No

P0837 / 1108

CO-DESIGNED PERSON-CENTRED CARE TRANSITIONS FOR PEOPLE WITH STROKE – A FEASIBILITY STUDY

L. von Koch ¹, A.C. Laska², S. Lindblom¹, M. Flink¹, M. Tistad^1,3, C. Ytterberg¹

¹Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden, ²Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden, ³Dalarna University, School of Health and Wellfare, Falun, Sweden

Background and aims: It is well-known that coordination of care transitions for people with stroke between the hospital and subsequent care and rehabilitation can be improved. Therefore, in collaboration with people with stroke, significant others, and healthcare professionals, we co-designed a care transition support which included: 1) information of subsequent rehabilitation using videos, leaflets and Teach-Back, 2) discharge information by the physician regarding medication using Teach-Back, 3) a “what-matters-to-me dialogue” with the patient to make a person-centred rehabilitation plan coordinated between caregivers. This study aimed to assess the feasibility of introducing this support.

Methods: Included were people diagnosed with stroke and healthcare professionals in two acute units and two primary healthcare teams. A checklist and field-notes were kept for monitoring the delivery of the components of the care transition support.

Results: All components of the care transition support were delivered to 43% of the 28 participants with stroke (mean age 74, mean mRS 1.5). Information of subsequent rehabilitation using video, leaflets and Teach Back was provided to 57%; physician discharge information using Teach Back to 68%; and a “what-matters-to-me-dialogue” with 64% of the participants. Barriers to delivery of the care transition support included time constraints, lack of experience in method/technique, lack of guidance to embed the support in the clinic and organizational aspects e.g., staff turnover.

Conclusion: Delivery the care transition is feasible but requires iterative written and oral education, continuous feedback and reflection through sit-ins, and reminders, encouragement, and guidance to embed the intervention in clinical practice.

Disclosure: No

P0838 / 944

TRENDS OF QUALITY OF STROKE CARE IN ESTONIA 2015-2020

J. Kõrv ¹, R. Vibo¹

¹ University of Tartu, Department of Neurology and Neurosurgery, Tartu, Estonia

Background and aims: In 2015, a national quality indicators program was launched with the aim to improve quality of stroke care in Estonia.

Methods: All hospitalised acute stroke patients (ischaemic stroke and intracerebral haemorrhage) older than 19 years are included. The surveillance data from the Estonian Health Insurance Fund are linked with the Estonian Medical Prescription Center and the Causes of Death Registry. More than 90% of acute stroke patients are hospitalised.

Results: Between 2015 and 2020 the proportion of patients managed in stroke units increased from 76% (95% CI 75-78%) to 87% (95% CI 86-88%). The 30 days’ case-fatality decreased from 21% (95% CI 20-23%) to 18% (95% CI 17-20%). The proportion of iv thrombolysis for all Estonia increased from 16% (95% CI 15-18%) to 30% (95% CI 28-31%). Since 2017 mechanical thrombectomy was included into the quality analysis. The proportion of patients receiving all recanalization therapies increased between 2017 and 2020 from 22% (95% CI 20-23%) to 33% (95% CI 31-35%). The availability of inpatients rehabilitation within 30 days after admission increased between 2016 and 2019 from 17% (95% CI 16-18%) to 23% (95% CI 22-25%) but decreased to 18% (95% CI 16-19%) in 2020. At one year since cardioembolic stroke onset 52% (95% CI 49-55%) of patients surviving the first 14 days had active prescription for oral anticoagulants. No change was observed during the period.

Conclusions: The trends of quality of acute stroke care show improvement, however more emphasis should be paid on rehabilitation and secondary prevention.

Disclosure: No

P0839 / 1050

EVALUATING CONFIDENCE OF JUNIOR DOCTORS IN THEIR KNOWLEDGE OF EVIDENCE BASED CLINICAL PRACTICE AND SATISFACTION WITH STOKE EDUCATION BEFORE LAUNCHING AN ONLINE EDUCATION TOOL

T. Esmail ¹, J. Cousins¹, P. Jareonettasin², B. Lovell³, R. Simister¹, D. Turner¹, F. Humphries¹

¹University College London Hospital, Hyperacute Stroke Unit, London, United Kingdom, ²Queen Square Institute of Neurology, University College London, Department of Clinical and Experimental Epilepsy, London, United Kingdom, ³University College London Hospital, Medical Education, London, United Kingdom

Background and aims: During the pandemic it has been difficult to provide stroke education. We developed a stroke education tool (https://qs-stroke-fundamentals.thinkific.com/) with learning outcomes mapped to speciality curriculums. We evaluated junior doctors’ satisfaction in stroke education and confidence in evidence-based clinical practice.

Methods: We surveyed senior house officers (SHOs) and registrars working in a north-central London hospital. We used a Likert scale (1-5) to evaluate stroke education satisfaction, and confidence in evidence-based knowledge domains of diagnosis, mimics, thrombolysis, thrombectomy, anti-platelets and secondary prevention. We assessed differences between groups’ total scores using an unpaired one-tailed students t-test. We compared median values and interquartile ranges (IQR).

Results: 19 doctors responded. SHOs were less confident in their knowledge than registrars (mean score 15.7/25 vs 19.8,/25; P <0.05). Neurology registrars were less confident in thrombolysis and thrombectomy than stroke registrars (median value, IQR; 4 (4-5) vs 5 (3-5) respectively). There was no difference in educational satisfaction between groups (mean score 5.8 vs 6.7 P = 0.17). All participants enthusiastically supported the development of an online educational programme.

Conclusions: Registrars are more confident in their knowledge of evidence-based practice than SHOs. Neurology registrars are less confident in thrombolysis and thrombectomy than stroke registrars. We aim to repeat the survey on launch of the education tool with the hypothesis that it will improve teaching satisfaction and confidence in the evidence base behind clinical practice.

Disclosure: No

P0840 / 869

COST-EFFECTIVENESS STRATEGIES TO REDUCE ONSET TO TREATMENT TIMES IN ACUTE ISCHEMIC STROKE PATIENTS: A SYSTEMATIC REVIEW

C. Nguyen ^1,2, W. Maas³, D.-J. van der Zee¹, M. Uyttenboogaart⁴, E. Buskens^2,1, M. Lahr²

¹University of Groningen/ Faculty of Economics and Business, Operations Department, Groningen, Netherlands, ²University Medical Center Groningen, Epidemiology Department, Groningen, Netherlands, ³University Medical Center Groningen, Epidemiology Department and Neurology Department, Groningen, Netherlands, ⁴University Medical Center Groningen, Neurology Department and Radiology Department, Groningen, Netherlands

Background and aims: Several strategies reducing delays to treatment significantly improve clinical outcomes in stroke patients. Therefore, the economic impact of the strategies is crucial for stakeholders in acute stroke management. This systematic review aimed to appraise the economic evaluation of strategies reducing time to treatment in acute ischemic stroke patients.

Methods: This review was performed according to the PRISMA guidelines. A comprehensive literature search until June 2021 was conducted in EMBASE, PubMed, and Web of Science. Studies were included if they reported 1/ stroke patients treated with intravenous thrombolysis and/or endovascular thrombectomy, 2/ full economic evaluation, 3/ strategies to reduce time to treatment. Studies published before 2010, non-English articles, not original research articles (i.e., letters to editors, and reviews), conference abstracts, and case reports were excluded. Two independent reviewers assessed eligible studies, the quality of included studies, and extracted data.

Results: 18 studies were included in this review and most of the studies were assessed as having a high reporting quality. The majority of studies concerned cost-utility analysis, with the incremental cost-effectiveness ratio per quality-adjusted life year gained as the main outcome. The studies varied with respect to the perspective, time horizon, and type of model. Most strategies (15/18 studies) were cost-effective, whereas strategies in two studies could not be assessed for cost-effectiveness.

Conclusion: Our results reveal that strategies reducing time delays should be considered in evaluating stroke care services based on promising cost-effectiveness evidence. However, there is a scarcity of economic evaluations in low and middle-income countries.

Disclosure: No

P0841 / 968

WHAT FEAR OF COVID-19 VACCINE-ASSOCIATED CEREBRAL VENOUS THROMBOSIS DID TO THE NEUROLOGICAL EMERGENCY DEPARTMENT - A RETROSPECTIVE STUDY AND EXPERIENCE FROM A GERMAN UNIVERSITY HOSPITAL

M. Arndt ¹, A. Sedghi¹, M. Lesser¹, L.-P. Pallesen¹, J. Barlinn¹, V. Puetz¹, K. Barlinn¹, T. Siepmann¹

¹ University Hospital Dresden Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden, Germany

Background and aims: Cerebral venous thrombosis (CVT) is a rare complication of COVID-19 vaccines, which has been extensively covered by lay media fueling fear and vaccination skepticism. We assessed the impact of this media release on neurological emergency care.

Methods: We performed a chart review of consecutive people presenting to the neurological emergency room of our university hospital during 30 days before the first national press release on COVID-19 vaccine-related CVT on March 14^th, 2021 with those who presented during the subsequent 30 days.

Results: Among 622 patients during the total observation period, we noted an increase in the proportion of those presenting with headache (47/276 patients (17.0%), 60% females, ages 41 [30-61] median [IQR] pre-announcement versus 84/346 patients (24.3%), 65% females, ages 43 [35-63] post-announcement, p=0.03). Cardiovascular comorbidities (p=ns), neurological deficits (p=ns), imaging results (p=ns) did not differ between time periods (p=ns). None of the patients in both time periods had a diagnosis of CVT or vaccine-induced thrombotic thrombocytopenia, but fear of CVT was more prevalent after the press release (n=0(0%) vs. 32(38.1%), p<0.0001). Patients with fear of CVT presented 11 [8.5-16] days post vaccination (87.5% ChAdOx1 nCoV-19, 12.5% BNT162b2), and none of those had pathological findings on cranial imaging. On multivariate and multinominal regression analyses those with fear did not differ in the odds of undergoing cranial imaging from those without fear (OR 0.7, 95%-CI [0,26-1.87], p=ns).

Conclusions: Fear of CVT after COVID-19 vaccination seems to engender additional availment of neurological emergency care to a relevant extent.

Disclosure: No

P0842 / 325

THE HUNTER-8 PRE-HOSPITAL STROKE SCALE IN PRACTICE: DO STROKE TEAMS AND PARAMEDICS AGREE?

C. Ostman^1,2, T. Lillicrap ³, K. Alanati¹, S. Edwards⁴, J. Stabler¹, J. Thomas¹, B.L.A. Chew¹, S. Gangadharan¹, J. Emery⁴, J. Pedler⁴, C. Levi^3,1,2, M. Parsons^2,3,5,6,7,8, C. Garcia-Esperon^3,1,2, N. Spratt^3,1,2

¹John Hunter Hospital, Neurology, Newcastle, Australia, ²University of Newcastle, School of Medicine and Public Health, Newcastle, Australia, ³Hunter Medical Research Institute, Newcastle, Australia, ⁴New South Wales Ambulance Service, New South Wales, Australia, ⁵Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, Australia, ⁶University of New South Wales, South Western Sydney Clinical School, Sydney, Australia, ⁷Ingham Institute for Applied Medical Research, Sydney, Australia, ⁸Liverpool Hospital, Neurology, Sydney, Australia

Background: The Hunter-8 pre-hospital stroke scale is an 8-item version of the National Institutes of Health Stroke Scale. A Hunter-8 score ⩾8 has good performance in identification of large vessel occlusion (LVO) stroke amenable to endovascular thrombectomy (EVT). We aimed to: determine the item-by-item agreement between paramedics and stroke teams, and examine the final diagnosis in patients who were assessed as crossing the Hunter-8 LVO threshold by one of the teams but not the other.

Methods: Suspected stroke patients who were assessed by paramedics using the Hunter-8 scale in the field from July 2019 to January 2021 were included. The level of agreement was determined using a weighted kappa analysis for each individual scale item.

Results: Seventy-one patients were included. The median paramedic Hunter-8 was 7 [4-12] and the median stroke team Hunter-8 was 6 [2-10]. Forty-six patients had a final diagnosis of ischemic stroke, 10 intracerebral haemorrhage and 15 stroke mimics. The level of agreement (weighted kappa) for extinction/neglect was slight (wk=0.164), whereas it ranged from fair to substantial for the remaining items. Seven patients were scored above the LVO threshold of Hunter-8⩾8 by paramedics, but not by the stroke team. Of these patients, four underwent EVT for LVO stroke.

Conclusions: There was poor agreement for the item of neglect, highlighting a need for revisiting training strategies. Patients scored above the LVO threshold in the field, but not by the stroke team, were very likely to have a LVO, highlighting the diagnostic value of its use by paramedics.

Disclosure: No

P0843 / 1123

IMPACT OF STROKE RECOVERY ONLINE RESOURCES ON PSYCHOLOGICAL BURDEN AMONG STROKE SURVIVORS AND THEIR CAREGIVERS: A SCOPING REVIEW

M. Delvallée ¹, R. Garreau², A. Termoz^1,2, P.-M. Ploteau², L. Derex^1,3, A.-M. Schott^1,2, J. Haesebaert^1,2

¹Research on Healthcare Performance RESHAPE, INSERM U1290, University Claude Bernard Lyon 1, Lyon, France, ²Hospices Civils de Lyon, Pôle de Santé Publique, REC - Recherche et Epidémiologie Clinique, Lyon, France, ³Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Service Neuro-vasculaire, Lyon, France

Background and aims: After discharge to home, stroke patients and their informal caregivers face a significant lack of support and information which accentuates their psychosocial burden. . Online resources might provide this support and address psychosocial needs, but existing online stroke programs mainly target functional rehabilitation. We aimed to map existing literature on online resources in stroke rehabilitation dedicated to improving psychosocial recovery of patients and informal caregivers once back home.

Methods: Our scoping review included studies from 2010 to 2021 on online resources targeting psychosocial rehabilitation for stroke patients and/or informal caregivers. Articles were selected and data extracted in Rayyan independently by 2 reviewers. We described content, use and psychosocial impact of these interventions using a narrative approach.

Results: A total of 6 articles out of 1233 references screened were included in the review. Five were randomized controlled trials and one was a qualitative study. Although, interventions were very heterogeneous. Online resources were: information/resources platform (4), forum (1) and monitoring/educational platform (1). One of these was combined with case-management and another with nurse’s follow-up. Use of online resources significantly reduced incidence of depressive symptoms in three studies and one study showed a significant reduction in patient distress. In addition, global patient activation improved when combined with case-management. Only one measured the use of the online resources and identified 11.8% of regular users.

Conclusions: Few studies looked at the psychological aspect of stroke recovery. They suggest that online stroke resources might be beneficial but must be supported by trained professional.

Disclosure: No

P0844 / 811

DIAGNOSTIC ACCURACY FOR NEUROLOGICAL PATIENTS VIA TELEMEDICINE

C. Verez Sola ¹, S. Nagel¹, A. Gutschalk¹, F. Seker², J. Kuehne Escola¹, J. Purrucker¹, C. Gumbinger¹

¹Heidelberg University, Department of Neurology, Heidelberg, Germany, ²Heidelberg University, Department of Neuroradiology, Heidelberg, Germany

Background and aims: Treatment via telemedicine in neurology for acute ischaemic stroke is well established as nearly every 10th stroke patient is treated via telemedicine. Meanwhile, telemedicine in neurology is increasingly used for non-stroke neurological emergencies. The diagnostic accuracy for this cohort is not well investigated. Diagnostic accuracy for a large cohort of stroke and non-stroke patients treated via telemedicine was investigated.

Methods: We analysed teleconsultations of a random sample n=1864 (33,86%) of all patients treated in the stroke-network in 2018 and 2019. Symptoms and risk factors were assessed and preliminary diagnosis of the teleconsultations were compared to the final diagnosis as stated in the discharge letter. Data were analysed by IBM SPSS Statistics 28.0.

Results: Data of 1508 teleconsultations were analysed. Main preliminary diagnosis were “stroke” in n=834 (55,30%) cases, which were in line with the final diagnosis in n=613 (73,50%) cases. The group of “other diagnosis” (non-stroke events) as defined by teleconsultation included n=674 patients (44,69%). The largest part in this group were cases of epilepsy, which were also diagnosed with a high accuracy. Others were a heterotrophic group of diseases (cardiac, metabolic and electrolyte diseases). Preliminary and final diagnosis consisted in n=506 (75,07%) of these cases.

Conclusions: The overall diagnostic accuracy of telemedicine in non-stroke patients was similar to stroke patients, but accuracy was depending on the specified disease. Detailed analysis will be presented at the ESOC. In view of the rising number of patients with “non-stroke diagnosis” identified via telemedicine, diagnostic algorithms should be implemented.

Disclosure: Yes

P0845 / 767

THE IMPLEMENTATION OF A STROKE INPATIENT ASSESSMENT FORM FOR QUALITY IMPROVEMENT

S. Jala ^1,2, C. Bertmar³, E. O’Brien⁴, M. Krause^3,5

¹Royal North Shore Hospital, Neurology / Stroke, St Leonards, Australia, ²University of Technology Sydney, Graduate Research School, Sydney, Australia, ³Royal North Shore Hospital, Neurology, St Leonards, Australia, ⁴Royal North Shore Hospital, Neurology, TIA / Stroke Clinic, St Leonards, Australia, ⁵University of Sydney Northern Clinical School, St Leonards, Australia

Background and aim: Following the introduction of electronic medical records (eMR) in 2016 we developed a Stroke Inpatient Assessment Form (SIAF) to ensure compliance with the stroke management clinical guidelines in order to improve quality of care, patient outcomes, and safety. This tool serves as a clinical pathway and additionally enables real-time entry of clinical data. This study aims to assess if the use of SIAF improves the accuracy of documentation and data collection.

Methods: The SIAF was based on current stroke management guidelines. The data was generated using the SIAF from July 2018 to September 2019.

Results: Out of 821 stroke patients during the review period, the SIAF was used in 73% (596) of patients (76% Ischaemic; 21% Intracranial haemorrhage; and 3% unspecified), mostly by nurses. The data generated from the SIAF was used in evaluating two quality improvement projects.

Out of 596 discharge summaries 20 were found to have errors (regarding medication, follow up, and diagnosis) these errors were identified and corrected prior to discharge. The implementation of the SIAF enabled the stroke service to establish a comprehensive local stroke database. Also, a trend of improved adherence to clinical stroke guidelines in regards to hyperacute treatment, secondary prevention management and mood screening was demonstrated.

Conclusions: An electronic stroke form is a useful tool in capturing real-time data to ensure compliance to clinical stroke management guidelines hence improving patient care and outcomes. The data can be made available for evaluation of quality improvement projects and for research.

Disclosure: No

P0846 / 735

RAPID ACCESS PATHWAYS ARE ASSOCIATED WITH TIMELY CAROTID REVASCULARISATION IN ACUTE TRANSIENT ISCHAEMIC ATTACK AND STROKE PATIENTS

A. Ikponmwosa¹, M. Khoo¹, L. Sanders ²

¹St Vincent’s Hospital Melbourne, Department of Vascular Surgery, Melbourne, Australia, ²St Vincent’s Hospital Melbourne, Department of Neurosciences, Melbourne, Australia

Background: Carotid endarterectomy (CEA) for symptomatic significant carotid stenoses within 14 days is recommended to maximise intervention benefit and reduce stroke risk. However, speed and route of access to vascular surgery is variable. We evaluated whether referral pathways within our tertiary institution influenced time from symptoms to surgery.

Methods: Rapid Access Transient Ischaemic Attack (TIA) pathways exist for patients presenting to the Emergency Department (ED) and nearby Eye Hospital (EH). A retrospective record review was undertaken for all patients undergoing CEA for symptomatic carotid disease (TIA/stroke/retinal artery occlusion/amaurosis fugax) between 2019 and 2021. Patient demographics, surgery indication, referral source, subsequent management pathway (vascular outpatient (VOP)/stroke inpatient (SIP)/rapid access TIA pathways) and clinical outcomes were recorded. Primary outcomes were time to carotid imaging and time from symptom to surgery (TTS). Descriptive and non-parametric analyses were performed with Stata 16.1.

Results: A total of 118 records were analysed. Median age was 72 years (range 46-90). Median time to carotid imaging was: ED 1 day (IQR 1-4.25), EH 3 days (IQR 1-5.5), VOP 17 days (IQR 1-55.75), SIP within 1 day (IQR 0-4). Median TTS was 10 (IQR 5-60) days with 70% undergoing CEA within 14 days. Median TTS via protocolised pathways was 7.5 days (EH 7 days, ED 7.5 days) compared with SIP 10 days and VOP 58 days (p<0.0001). Peri-operative stroke rate was 1.4%.

Conclusion: Referral for CEA following protocol-based Rapid Access TIA pathways was associated with a significantly reduced time to surgery compared with both inpatient and vascular outpatient pathways.

Disclosure: No

P0847 / 732

CROATIAN EXPERIENCE ON RES-Q REGISTRY FOR MONITORING THE QUALITY OF STROKE CARE FROM 2018 TO 2021 YEAR

A. Mestrovic ¹, Z. Poljakovic², I. Peric², D. Bonifacic³, K. Korda⁴, I. Cindric⁵, M. Roje Bedekovic⁶, A. Lovrencic-Huzjan⁶, I. Pintaric⁷, R. Marcec⁸, K. Sabolek Lovrec⁸, S. Svalina⁹, S. Majski⁹, M. Crnjakovic¹⁰, F.-I. Silconi¹¹, Z. Hucika¹², M. Seferovic¹², B. Vukovic¹³, M. Boskovic¹³, D. Erak¹⁴, A. Svinger-Muic¹⁵, E. Jancic¹⁵, S. Milic¹⁶, M. Dikanovic¹⁶, T. Grzincic¹⁷, M. Simunovic¹⁷, M. Vodopic¹⁸, A. Bogoje Raspopovic¹⁸, R. Kostanjevec¹⁹, E. Pavlekovic¹⁹, A. Gorupic²⁰, M. Mioc Markovic²⁰, J.M. Poje²¹, H. Budincevic¹

¹Sveti Duh University Hospital, Neurology, Zagreb, Croatia, ²University Hospital Center Zagreb, Neurology, Zagreb, Croatia, ³Clinical Hospital Center Rijeka, Neurology, Rijeka, Croatia, ⁴Regional Hospital Vinkovci, Neurology, Vinkovci, Croatia, ⁵General Hospital Virovitica, Neurology, Virovitica, Croatia, ⁶University Hospital Center Sestre Milosrdnice, Neurology, Zagreb, Croatia, ⁷Clinical Hospital Centre, Neurology, Split, Croatia, ⁸County Hospital, Neurology, Cakovec, Croatia, ⁹General County Hospital, Neurology, Vukovar, Croatia, ¹⁰University Hospital Dubrava, Neurology, Zagreb, Croatia, ¹¹General Hospital, Neurology, Pula, Croatia, ¹²General Hospital, Neurology, Zabok, Croatia, ¹³General County Hospital, Neurology, Pozega, Croatia, ¹⁴General Hospital, Neurology, Sibenik, Croatia, ¹⁵General Hospital, Neurology, Karlovac, Croatia, ¹⁶General Hospital ‘Dr. J. Benčević’, Neurology, Slavonski Brod, Croatia, ¹⁷General Hospital, Neurology, Bjelovar, Croatia, ¹⁸General Hospital, Neurology, Dubrovnik, Croatia, ¹⁹Varazdin General Hospital, Neurology, Varazdin, Croatia, ²⁰General Hospital ‘Dr. Ivo Pedišić’, Neurology, Sisak, Croatia, ²¹General Hospital ‘Dr. Tomislav Bardek’, Neurology, Koprivnica, Croatia

Background and aims: Stroke registry is a tool for improving stroke care and achieving goals pointed in Stroke Action Plan for Europe.

The aim was to compare results captured from the RES-Q registry in Croatia during 2018 and the first quarters of 2019 and 2020 and 2021 year.

Methods: Data on demographics, stroke care pathway, specific acute treatment, and prevention issues, in all acute stroke admissions in Croatia during 2018 and the first quarters of 2019 and 2020 and 2021 from the RES-Q registry were analyzed. Results: Acute hospitals that provide stroke treatment recruited 579 patients for the 2018 year and 750 patients and 677 patients and 800 patients during the first quarter of 2019 and 2020 and 2021 respectively.

Figure 1.

shows a map of Croatia with all centers (green – > three periods, yellow – two periods, red – one period, black–no data).

Table 1.

shows the numbers of patients recruited by site and time period.

Croatian Hospitals with number of recruited stroke patients in RES-Q registry	2018	2019Q1	2020Q1	2021Q1
University Hospital Center Zagreb(IVT & MT available)	103++	301***	201***	214***
Sveti Duh University Hospital-Zagreb	85**	49*	49*	61*
Clinical hospital center Rijeka(IVT & MT available)	65*	0	0	115***
Regional Hospital Vinkovci	58**	36*	5*	27*
General Hospital Virovitica	30*	32*	32*	32*
University Hospital Center Sestre milosrdnice – Zagreb (IVT+MT available)	0	0	30*	96***
Clinical Hospital Centre Split (IVT & MT available)	0	54*	66*	0
County Hospital Cakovec	14*	28*	45*	31*
General County Hospital Vukovar	41*	29*	20*	23*
University Hospital Dubrava	54*	53*	0	0
General Hospital Pula	45*	34*	0	28*
General Hospital Zabok	21*	30*	28*	26*
General County Hospital Pozega	16*	9*	31*	29*
General hospital Sibenik	0	30*	25*	24*
General Hospital Karlovac	0	28*	22*	27*
General Hospital “Dr. J. Benčević” Slavonski Brod	0	31*	33*	0
General Hospital Bjelovar	23*	0	30*	0
General Hospital Dubrovnik	0	0	30*	19*
Varazdin General Hospital	0	0	0	48*
General Hospital “Dr. Ivo Pedišić” Sisak	24	6	0	0
General Hospital “dr.Tomislav Bardek” Koprivnica	0	0	29*	0

Time period: *- March; **- February-March; ***-January-March, ⁺⁺-November-December; Q1- the first quarter of the year

Table 2.

shows patients’ main baseline characteristics and outcome measures.

Main baseline data and outcome results	2018	2019	2020	2021
Recruited patients	579	750	677	800
Number of participating centers	13	15	15	15
Main stroke types (%)
Ischemic	85.64	79.47	81.83	77.0
Intracerebral hemorrhage	11.59	8.4	10.93	11.0
Subarachnoid hemorrhage	2.42	4.27	2.66	2.25
Age (median) - years	76	74	75	76
% Female patients	50,87	50.53	50.52	53.5
NIHSS (median)	8	7	7	6
% NIHSS performed	49.11	46.82	58.28	70.11
CT/MR performed on admission (%)within 1 hour	99,4780,18	98.4681.34	98.0180.13	99.3489.18
Intravenous thrombolysis (alone) rate (%)	9.29	7.38	9.42	10.88
Door-to-Needle time (median)	51	50	50	39
Mechanical thrombectomy rate (%)with/without iv thrombolysis	2.62	5,53	5.97	7.74
Door-to-Groin time (median)	118	90	66	57.5
mRS (discharge) median	3	3	3	3
Hospital stay (median)	8 days	8 days	8 days	8 days
Mortality rate (%)	14.71	11.47	14.26	9.13
Dysphagia screening (%)	96.00	87.02	97.32	91.69
Rehabilitation asessment	83.83	88.44	77.36	92.79
Discharge
Home	57.79	60.19	60.77	60.46
Same center	6.92	3.37	6.39	7.60
Another center	7.61	5.25	7.58	10.77
Social facility care	12.98	9.72	11.0	12.04
Secondary prevention
%antihypertensives (all stroke)	90.25	90.85	92.16	90.37
% antiplatelets after ischemic stroke without Afib	88.32	86.90	92.73	95.02
%anticoagulants in patients with ischemic stroke and AFib	100	99,03	80.12	98.31
% statins prescribed	53.09	61.63	63.75	77.29
%smoking cessation (in smokers)	13,84	9.62	10.84	73.00

Conclusions: Our results showed improvement of recanalization rates across Croatia (11.91 to 18.62%), with a decrease of door-to-needle time (51 to 39 minutes) and door-to-groin time (118 to 57,5 minutes) in the investigated period. Secondary stroke prevention might be improved by increasing the usage of statins and performing smoking cessation programs where is also shown substantial improvement. In the future, all stroke centers should be involved in stroke registry to achieve more accurate data which would guide us to improve stroke care in Croatia.

Disclosure: No

P0848 / 865

PREHOSPITAL VIDEO TRIAGE FOR SUSPECTED STROKE: LESSONS FROM A RAPID, MIXED-METHOD EVALUATION OF SERVICES IMPLEMENTED IN TWO REGIONS OF THE ENGLISH NATIONAL HEALTH SERVICE

A.IG Ramsay ¹, J. Ledger¹, S.M Tomini¹, C. Hall², D. Hargroves³, P. Hunter⁴, S. Payne⁵, R. Mehta⁶, R. Simister⁷, F. Tayo⁶, N.J Fulop¹

¹University College London, Applied Health Research, London, United Kingdom, ²South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, United Kingdom, ³East Kent University NHS Foundation Trust, Canterbury, Kent, United Kingdom, ⁴London Ambulance Service NHS Trust, London, United Kingdom, ⁵Patient Representative, East Kent, United Kingdom, ⁶Patient Representative, London, United Kingdom, ⁷Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, United Kingdom

Background: In 2020, North Central (NC) London and East Kent introduced prehospital video triage, where stroke and ambulance clinicians used videoconferencing to assess suspected stroke patients on scene. The aim was to reduce conveyance of non-stroke patients to stroke services and reduce transmission of Covid-19.

Methods: Rapid, mixed-method evaluation of prehospital video triage in NC London and East Kent (July 2020-September 2021), drawing on:

• • Interviews with ambulance and stroke clinicians (n=27); observations (n=12); documents (n=23);

• • Survey of ambulance clinicians (n=233) in NC London and East Kent.

• • Descriptive statistical analysis of local ambulance conveyance data (n=1,400; April-September 2020).

• • Difference-in-differences regression analysis of team-level national audit data, to understand changes in delivery of clinical interventions in NC London and East Kent relative to the rest of England (n=137,650; 2018-2020).

Results: Interview and survey data suggested clinicians perceived prehospital video triage as usable, safe, and preferable to ‘business-as-usual’. Several interrelated factors influenced implementation, including impetus of Covid-19, facilitative local governance, receptive professional values, engaging clinical leadership, active training approaches, and stable audio-visual signal; stroke clinician capacity was a potential risk to sustainability.

Neither area saw increased time from symptom onset to arrival at services, while delivery of clinical interventions either remained unchanged or improved significantly, relative to the rest of England.

Conclusions: Prehospital video triage in NC London and East Kent was perceived as usable, acceptable, and safe; it was associated with some significant improvements in secondary care processes. Key influences included national and local context, characteristics of triage services, and implementation approaches.

Disclosure: Yes

P0849 / 690

MODEL-BASED ECONOMIC EVALUATIONS OF COMMUNITY-BASED INTERVENTIONS FOR POST-STROKE CARE: A SYSTEMATIC REVIEW

C. Fitzgerald ¹, J. Sorenson¹, C. O’Neill², iPASTAR (improving Pathways for Acute STroke And Rehabilitation)

¹RCSI, Health Outcome Research Centre, Dublin, Ireland, ²Queens University, Belfast, Ireland

Background and aims: To examine published model-based economic evaluations of stroke services and/or tools that are offered to stroke survivors in the community. The focus of this process is to determine the feasibility of community-based interventions and the potential cost saving found through these pathways along with their implication on a national scale.

Methods: MEDLINE, EMBASE, Web of Science, Cochrane Library, and the NHS Economic Evaluations Database were systematically searched for papers published from July 2001 to July 2021. Studies that included Full economic evaluations (i.e. a decision-analytic modelling approach such as decision tree models, discrete event, or Markov models) were included. Abstracts were screened, followed by full-text review of potentially relevant articles.

Results: We identified 8 published models of which 6 involved markov chain progresses and 2 included decision tree analyses. The following aspects of economic modeling were found to be relevant: modeling approach and health state; health state transition probabilities; estimation of short-term, long-term, and indirect costs; health state utilities; post-stroke mortality; time horizon; model validation; and estimation of parameter uncertainty. Appraisal of these models was conducted using. The Consensus Health Economic Criteria (CHEC) list. Included economic evaluations were also assessed using The European Stroke Organisation (ESO) protocol and guidance document found in its publication ‘Improving economic evaluations in stroke: A report from the ESO Health Economics Working Group’.

Conclusions: In order to more accurately assess the long-term incremental impact of new treatments and those targeting community care of stroke, further research is needed.

Disclosure: No

P0850 / 648

TACKLING THROMBO-LYSO-PHOBIA: USING SIMULATION TO IMPROVE CONFIDENCE IN STROKE THROMBOLYSIS IN GENERAL INTERNAL MEDICAL REGISTRARS

W. Lim ¹, C. Cucknell¹, E. Abdelgadir¹

¹ Plymouth Hospitals NHS Trusts, Neurology and Stroke Department, Plymouth, United Kingdom

Background: In the South-West, the majority of out-of-hours stroke thrombolysis calls are lead by the general internal medical (GIM) registrars, not neurology/stroke specialists. There are local variations in the availability of senior and nursing stroke support to support these decisions and significant colloquial fear of carrying out stroke thrombolysis affecting medical registrar confidence and willingness to thrombolyse. This in turn may affect the door-to-needle (DTN) time and patient outcomes.

Method: Following positive feedback from a successful IMT3 stroke simulation scenario, a three-scenario course was devised and lead by the neurology team at Derriford and, supported by deanery funding was rolled out to include the entire deanery. Scenarios included thrombolysis, thrombectomy and hypertension control.

Results: Feedback from participants identified key pre-course questions and confidence, and usefulness of each scenario and overall confidence post-course. Feedback showed a progressive improvement in each participants confidence in carrying out stroke thrombolysis and there was positive written comments. 100% of participants would recommend this training to a friend.

There has been yet to show a clear improvement in door-to-needle time however this is likely compounded by the current pressures facing the NHS with COVID-19 pressures and over-crowding.

Conclusion: Stroke simulation has improved participants confidence at carrying out stroke thrombolysis out-of-hours for the GIM registrar. The authors feel that it should be included routinely in the induction and continued education of the general internal medical registrar and there is much potential to spread out to the MDT assessing stroke thrombolysis. Scenarios and learning points available on https://www.plymouthhospitals.nhs.uk/stroke.

Disclosure: No

P0851 / 588

STRATEGIES FOR IMPROVING ACCESS TO REPERFUSION STROKE THERAPY FOR RURAL POPULATIONS: A SYSTEMATIC REVIEW

A. Malavera¹, S. Massicotte², C. Paul³, A. Bivard⁴, A. Ryan³, S. Kuhle⁵, C. Levi⁶, C. Delcourt ^1,2

¹The George Institute, Sydney, Australia, ²Macquarie University, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Sydney, Australia, ³University of Newcastle, School of Medicine and Public Health, Newcastle, Australia, ⁴University of Melbourne, Department of Medicine and Neurology, Melbourne Brain Centre, Melbourne, Australia, ⁵Statewide Stroke Clinical Network, Queensland Health, Brisbane, Australia, ⁶John Hunter Hospital, University of Newcastle, Hunter Medical Research Institute, Department of Neurology, Newcastle, Australia

Background: Health disparities due to remoteness and access limitations are common in patients with stroke living in rural and regional areas. Delivery of reperfusion therapies remains a challenge and endovascular clot retrieval is only available in comprehensive stroke centres (CSC) located in urban areas.

Aims: We performed a systematic review of published strategies to improve access to reperfusion therapies for patients with acute ischaemic stroke (AIS) living in rural and regional areas.

Methods: We systematically searched in three databases (Pubmed, EMBASE, CENTRAL) for randomised controlled trials and observational studies.

Results: Of 640 citations, 337 abstracts were selected for full text screening and 82 publications were included. Strategies described to increase access to reperfusion stroke therapy for AIS patients living in rural and regional communities included: improved efficiency of transport, development of geographic information systems to organise transfer more effectively with or without moving neuro-interventionists between CSCs to reduce times, use of telemedicine to access stroke specialists, reorganisation of primary stroke centres into CSC, development of pathways and framework, provision of education and training to hospital staff, and use of large vessel occlusion screening tools in regional hospitals.

Conclusions: Several strategies have been described to improve access to reperfusion stroke therapy for patients living in regional and rural areas. Despite the limited standardisation of outcomes, our systematic review demonstrated that the overall implementation of these new and different strategies was feasible and had the potential to improve patient outcomes.

Registration: PROSPERO (CRD42021278656).

Disclosure: No

P0852 / 137

CHARACTERISTICS OF STROKE CODE PATIENTS TREATED BY A PRIVATE EMS IN ARGENTINA

A. Savia ¹, A. Apesteguía¹, A. Farías¹, ACUDIR Stroke Team

¹ ACUDIR EMS, Buenos Aires, Argentina

Backgound and aims: Stroke is a time dependent medical emergency. The incorporation of the EMS team to the Stoke Code (SC) might improve the number and timing of recanalization. We will review the EMS times, type of acute cerebrovascular syndrome, rate of recanalization and characterization of mimics.

Methods: Observational, analytic, retrospective cross-sectional study based on electronic records. From 11/2018 to 6/2021. n= 452. Data was transferred to MS Excel and analyzed with Epi Info v. 7.2.2.1 and JASP 0.14.1 for analysis of related variables we used ttest for paired variables.

Results: n=452. Acute Cerebrovascular Syndromes 54.5%(206). Alternative diagnosis 45.5%(246). Acute Ischemic Stroke (AIS) 31,2%(141), Hemorrhagic Stroke 11% (33). TIA 7,3% (32). Recanalization rate AIS 55%. Alternative diagnosis group: Sepsis 11.8%(53), Conversive syndrome 7,1%(32), Seizure 4,6%(21) Trauma 4,4% (20), Vertigo 3,3% (15), Pharmacological/Alcohol toxicity 2.87% (13), Hypoglycemia (2%) 9. The mean medical time is 32 minutes. The mean transport time is 17minutes. Interestingly, the mean Medical Time from November 2018 to March 2020 (COVID-19 pandemic declaration) was 26 minutes and from April 2020 to June 2021 was 38 minutes, a 12-minute difference with significative difference (p<0.001). Transport times show only 2 minutes of difference with no statistical difference.

Conclusions: This is one of the largest observational studies with identification of the final diagnosis of patients and the treatment modality. In our sample, we identify an important quantity of mimics and a very high recanalization ratio for AIS. We also describe the worsening in medical times after the COVID-19 lockdown in Argentina.

Disclosure: No

P0853 / 1162

STRUGGLING TO RECOVER: THE LONG TERM IMPACT OF STROKE, VIEWS FROM STROKE SURVIVORS, STROKE CARERS AND CLINICIANS

N. Kennedy ¹

¹ Ulster University, Psychology, Coleraine, United Kingdom

Background: By investigating the lasting impact stroke can leave,it can help form an understanding of how to best care for and support stroke survivors. This increased understanding could help design treatment protocols and provide stroke survivors with a better quality of life.The aim is to examine the long-term effects of stroke by gathering information from stroke survivors, carers and clinicians and to understand the standard of current care, long term support following stroke and how future care could be improved.

Methods: Three targeted questionnaires were developed for stroke survivors, carers and professions working across the whole stroke pathway. The questionnaires were distributed in UK via professional networks, the Stroke support groups, social media and newspaper advertisement.

Results: 335 stroke survivors aged between 19-95, 101 clinicians working in stroke care across acute and community, 75 respondents to the carers survey. There was common themes across all 3 surveys regarding long term impact and support following stroke; increased psychological support and acknowledgement of ‘hidden’ effects of stroke. and improved length, intensity and delivery of rehabilitation to stroke patients. Other areas of commonality between groups was increased public awareness of long lasting effects of stroke, improved transition between hospital and community care, more support for carers.

Conclusions: As an increasing number of individuals survivor stroke and are left with the consequences of wide ranging impairments, it is essential that these long term needs/support are addressed.This study helps highlight the impact of stroke and the areas of need in long term stroke recovery.

Disclosure: No

P0854 / 929

WHAT ARE THE OPPORTUNITIES AND CHALLENGES OF AUDITING POST-ACUTE STROKE CARE? SSNAP POST-ACUTE ORGANISATIONAL AUDIT (PAOA) 2021

N. Durante ¹, E. McMullen¹, L. Clark¹, R. Fisher¹, K. Stanley¹, C. Wolfe², A. Bhalla¹, M. James¹

¹King’s College London, Sentinel Stroke National Audit Programme, London, United Kingdom, ²King’s College London, Population Health Sciences, London, United Kingdom

Introduction: The Sentinel Stroke National Audit Programme (SSNAP) is a national registry of stroke services in England, Wales and Northern Ireland. An organisational audit of post acute rehabilitation was conducted in 2021, benchmarking inpatient and community based rehabilitation services against newly published national policy and guidelines.

Methods: Data were collected using an online proforma between 1 -30 April 2021. Preceding this, SSNAP hosted webinars with the 20 English Stroke Networks to support engagement from teams, including non-stroke specialist services. During data collection, guidance was provided by a helpdesk and weekly webinars. Inpatient teams responded to 47 questions and community teams answered 57. We developed 18 Key Indicators (KIs) representing high-quality stroke rehabilitation. Data was reported by public report, at national conference and in an interactive dashboard.

Results: 664 teams completed the proforma - 87.6% were stroke/neuro specific. Participating services included post-acute inpatient teams, Early Supported Discharge (ESD) teams, Community Rehab Teams (CRT), Combined ESD-CRT, 6-month assessment providers, single discipline services and other. Participation represented 6,700 WTE workforce delivering rehabilitation to 112,000 stroke patients in 12 months. Overall, 42.9% of indicators were met by teams; median of 4/12 KIs for inpatient teams, 6/15 KIs for community teams. Seven key recommendations were produced based on the Audit results.

Conclusion: Auditing complex post-acute stroke rehabilitation through a national registry is possible but requires engagement and support. Teams required dedicated time for the audit, which was challenging during a pandemic. Audit offers an important method to benchmark services and stimulate evidence based quality improvement.

Disclosure: No

P0855 / 957

IMPROVEMENT IN REPERFUSION TREATMENT RATES AT HOSPITAL-LEVEL AFTER THE ESTABLISHMENT OF A REGIONAL CENTRALIZED STROKE NETWORK (CATI)

A. Barragán-Prieto ¹, J. Loscertales¹, S. Perez-Sanchez¹, F. Moniche², P. Martinez³, J. Fernandez³, R. Valverde⁴, J.M. Fernandez⁵, MA. Gamero¹, A. Gonzalez², J. Montaner¹, Centro Andaluz de Teleictus (CATI)

¹Hospital Universitario Virgen Macarena, Seville, Spain, ²Hospital Universitario Virgen del Rocio, Seville, Spain, ³Hospital Universitario de Torrecárdenas, Almeria, Spain, ⁴Hospital Universitario Reina Sofia, Córdoba, Spain, ⁵Hospital Juan Ramón Jimenez, Huelva, Spain

Background and aims: Andalusia, with an area of 87,268 km2 and a population of 8,410,000 inhabitants, presents a great geographical dispersion, where almost 3 million inhabitants are more than 30 minutes away from a center with a stroke unit. With the aim of providing specialized care to patients in these geographical areas, a centralized telestroke network (CATI), including 30 hospitals useful for treatment with intravenous fibrinolysis and referral capacity to 6 thrombectomy nodes was established in 2019.

Methods: We conducted an observational study to compare reperfusion treatment rates in the hospitals belonging to the CATI network. Two phases were defined: the pre-implementation phase (12 months before January 2019) and the post-implementation phase (12 months after implementing the whole network).

Results: The number of stroke suspicions in the emergency department (ED) remained stable (2034 in the pre-implementation phase vs. 1881 in the post-implementation phase). The mean number of yearly reperfusion treatments by center increased by two-fold, 7 in the pre-implementation period versus 15 in the post-implementation period (p<0.01). The average number of intravenous thrombolysis (IVT) has increased by 142% (92 vs. 223) and the mean number of Endovascular Treatments (EVT) by 244% (65 vs. 224). Additionally, EVT of patients from the telestroke hospitals in the pre-implementation period comprised 7% of all EVT performed in the region, which increased to 20% after the whole implementation.

Conclusions: The development of a centralized stroke network such as CATI could be an effective way of increasing reperfusion treatment rates at remote hospitals.

Disclosure: No

P0856 / 1349

FEVER SUGAR SWALLOW (FESS) PROTOCOL ON RES-Q PLATFORM: MONITORING NURSING QUALITY OF CARE IN STROKE PATIENTS

R. Mikulík¹, S. Middleton ², S. Dale², T. Koláčná³, R. Havalda⁴, A. Urso⁵, S. Salselas⁶, E.S. Menendez⁷, R. Sedani¹, M. Vařecha¹, J. van der Merwe⁸

¹St. Anne’s University Hospital Brno, International Clinical Research Center, Brno, Czech Republic, ²St Vincent’s Hospital Melbourne and Australian Catholic University, Darlinghurst, Australia, ³Motol University Hospital, Prague, Czech Republic, ⁴IQVIA RDS Czech Republic, Prague, Czech Republic, ⁵Hospital Network Area-Regional Health Department, Regione Lazio, Italy, ⁶ULSNE Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal, ⁷Vall d’Hebron Hospital Universitari Barcelona, Barcelona, Spain, ⁸Boehringer Ingelheim International GmbH, Ingelheim/Rhein, Germany

Background and aims: Registry of Stroke Care Quality (RES-Q) is used as a quality improvement platform in stroke. RES-Q hosted data collection for the Quality in Acute Stroke Care (QASC) Europe project, a nurse-led evidence-based program for monitoring and management of Fever, hyperglycemia (Sugar) and Swallowing (FeSS Protocols) in stroke. With the end of the project in 2020, a new FeSS protocol form was developed which can be used by all RES-Q users worldwide.

Methods: RES-Q, QASC teams and Angels Initiative drafted a new version of QASC form and obtained feedback from nurses. A new FeSS form was made available to all RES-Q users in January 2022.

Results: The FeSS protocol includes information on demographics (age, gender, health history, NIHSS, pre-morbid mRS scores and stroke type). Hospitalization nursing care is divided into 3 subjects: fever (how many times in 3 days temperature monitored and if paracetamol was administered for fever >37.5°C), hyperglycemia (how many times in 3 days blood glucose levels (BGL) monitored and if insulin was administered for BGL >10mmol/L), and swallow (whether swallowing screening or assessment was done, when, by whom, and what type of screening test). The form concluded with discharge information. The form is attached to this abstract. FeSS data will be analyzed and feedback on results will be provided continuously through dashboards and in reports .

Conclusions: The FeSS form will collect evidence and provide feedback to hospitals to improve quality of nursing care with the goal to reduce death and disability after stroke.

Disclosure: No

P0857 / 452

PATIENT AND PROCESS OUTCOMES FOR ACUTE STROKE IN IRELAND: IN-HOURS VERSUS OUT-OF-HOURS

E. Loughlin ¹, A. Gabr¹, E. Marks¹, J. McCormack², J. Harbison³, J. Thornton⁴, R. Galvin⁵, M. O’Connor¹

¹University Hospital Limerick, Department of Geriatrics and Stroke Medicine, Limerick, Ireland, ²National Office of Clinical Audit, Dublin, Ireland, ³Trinity Inst. of Neurosciences (TCIN), Medical Gerontology, Dublin, Ireland, ⁴Beaumont Hospital, Interventional Neuroradiology, Dublin, Ireland, ⁵University of Limerick, School of Allied Health, Limerick, Ireland

Background and aims: There is conflicting evidence on the outcomes for acute stroke patients who present in-hours compared with out-of-hours. We aimed to assess this effect within the Irish context to inform service delivery.

Methods: A secondary analysis of data from the Irish National Audit of Stroke (INAS) was carried out for the years 2016-2019. Mortality was assessed for patients presenting in-hours (8:00-17:00 Monday-Friday) versus out-of-hours (all other times). The primary outcome measure was mortality at discharge. Secondary outcome measures were relevant patient and process outcomes.

Results: Data was available for 14,467 patients (male 56.2%; mean 72.44 years); 53.8% presented out-of-hours. Mortality in-hours and out-of-hours for ischaemic stroke was 6.54%(n=367) and 6.56% (n=452) (p=0.6) respectively. Mortality for intracerebral haemorrhage in-hours and out-of-hours was 23.1% (n=179) and 27.5% (n=308) (p=0.03) respectively. In-hours was associated with a shorter door-to-needle time of 56.7 mins (n=564; SD 38.3 mins), compared with out-of-hours of 84.2 mins (n=743; SD 55.9 mins), p<.001.

On univariate logistic regression, out-of-hours was associated with a higher odds of overall mortality compared with in-hours (n=6761) (OR 1.1; p=0.195) Adjustment for age, gender, pre-stroke modified Rankin scale, stroke subtype, arrival time <4.5 hours, thrombolysis and admission to stroke unit did not alter these findings (OR 1.1; p =.25).

Conclusions: The majority of stroke patients in Ireland present out-of-hours and outcomes including mortality are worse, particularly for haemorrhagic stroke. An ongoing process evaluation to identify barriers to timely and effective stroke treatment should focus specifically on out-of-hours factors amenable to remediation.

Disclosure: No

P0858 / 1113

DOES IMPLEMENTATION OF A STANDARDIZED PATHWAY OF STROKE CARE AFFECT FUNCTIONAL OUTCOME AFTER STROKE?

E.J. Bergh ^1,2, T. Askim¹, O.M. Rønning², J. Saltyte Benth³, B. Indredavik¹, H. Fjærtoft^1,4, B. Thommessen²

¹Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, Trondheim, Norway, ²Akershus University Hospital, Department of Neurology, Lillestrøm, Norway, ³Akershus University Hospital, Health Services Research Unit, Lillestrøm, Norway, ⁴St. Olavs University Hospital, Department of Medical Quality Registries, Trondheim, Norway

Background and aims: A national standardized pathway of stroke care to ensure optimal treatment within predefined time limits was introduced in Norway in 2018. The aim of the present study was to evaluate if the pathway had an impact on functional outcomes and mortality 3 months after stroke.

Methods: A register-based study using data from the Norwegian Stroke Registry (NSR) was performed. Patients included one year before (2017) and one year after (2019) the implementation of the pathway were compared on change in functional outcome assessed by modified Rankin Scale (mRS), the proportion of dependent patients (mRS 3-5), patients treated in stroke units and 3-month mortality.

Results: A total of 5388 in 2017 and 5621 patients in 2019 (mean age 72.5 years, 43% female) were included. The OR for dependence in 2019 versus 2017 was 1.06 (95% CI 0.9 - 1.24), p=0.520. No significant difference in 3-months mortality was found. However, the proportion of patients treated in stroke units and patients discharged home increased from 2017 to 2019.

Conclusion: After implementation of a national pathway of stroke care in Norway, no significant change in functional outcome assessed by mRS was found. More patients were treated in stroke units and the proportion of patients discharged directly home from the stroke unit increased. To the best of our knowledge, the present study is the first to evaluate implementation of a nationwide pathway of stroke care from onset until the final follow-up assessment 3 months post stroke, and its impact on important outcomes.

Disclosure: No

P0859 / 393

OF APPLES AND ORANGES - TO WHOM STROKE REGISTRY USERS WANT TO COMPARE THEMSELVES TO SET GOALS FOR HOSPITAL QUALITY INDICATORS

M.S. Kristensen¹, A.E. Kobberø¹, M. Varecha², V. Svobodová², R. Mikulik², H. Knoche ¹

¹Aalborg University, Architecture, Design and Media Technology, Aalborg, Denmark, ²St. Anne’s University Hospital Brno, Brno, Czech Republic

Background and aims: When provided to relevant stakeholders in appropriate form, feedback of care quality indicators from patient registries can lead to improvements in hospital-provided care quality. Common for design-oriented work, a small-scale qualitative study aimed at providing ideas and justifications for the design of registry feedback by understanding and unpacking needs of users regarding their goal setting of quality indicators (QI), how registry feedback currently supports them, and to what degree those needs aligned with people who instead track data about themselves.

Method: We analysed the feedback from online dashboards and reports provided by the registry of stroke care quality (RES-Q) as a case based on Munzner’s data visualization typology. Along with user needs from the self-tracking literature, we conducted thematically analysed semi-structured interviews with several RES-Q users (hospital and national coordinators, and neurologists) from the European Stroke Organization East (ESO-East).

Results: RES-Q users sought realistic goals for their QIs preferably from hospitals similar to them. International benchmarks or median values of QIs from other countries were considered by some unrealistic and demotivating when those implied or relied on contextual factors such as resources or infrastructure unavailable to them. Examples of contextual factors affecting QI included availability of equipment, specialist training levels, citizen awareness, geographic location, and services provided by emergency vehicles.

Conclusion: To set realistic goals and support learning from peers, registries should support users in comparing themselves to hospitals that share many of their contextual traits but perform better.

Disclosure: No

P0860 / 410

CAN PRE-HOSPITAL STROKE SCALES EFFECTIVELY IDENTIFY PATIENTS REQUIRING ACUTE THROMBOLYTIC TREATMENT? AN ASSESSMENT USING THE HUNTER-8 PRE-HOSPITAL STROKE SCALE

M. Lycett ¹, A. Cohen², T. Lillicrap^3,1, B.L.A. Chew¹, C. Garcia Esperon^3,1

¹John Hunter Hospital, Department of Neurology, New Lambton Heights, Australia, ²John Hunter Hospital, Department of Nephrology, New Lambton Heights, Australia, ³Hunter Medical Research Institute, Priority Research Centre for Stroke and Brain Injury, New Lambton Heights, Australia

Background and aims: Patients with acute ischaemic stroke treated with thrombolysis have better outcomes when treated early. Prehospital stroke scales are used to risk stratify patients and guide appropriate ambulance diversions. We aimed to assess the effectiveness of the Hunter-8 prehospital stroke scale in identifying patients amenable to thrombolysis versus endovascular therapy (EVT).

Methods: We retrospectively assessed consecutive patients with a modified Rankin Scale of 0-3 presenting within 4 hours of suspected ischaemic stroke to a tertiary centre over an 8 year period. CT angiographic/perfusion imaging and treatment with thrombolysis, EVT or medical therapy was correlated with paramedic-based, prospectively completed, pre-hospital Hunter-8 stroke scores. Threshold scores for prediction of thrombolysis and ECR were assessed using area under the receiver operating curve (AUROC).

Results: Of 1498 assessed patients, 368 had completed prehospital Hunter-8 scores. Ischaemic stroke was confirmed in 273 (74.3%); 89 received thrombolysis (32.7%), and 48 underwent EVT (17.6%). The median Hunter-8 score for patients receiving thrombolysis was 8, which was significantly higher than patients not offered acute stroke therapies ([7]; p = 0.006) but not significantly different to patients receiving EVT (10). A Hunter-8 score ⩾7 had the highest AUROC, 0.59, with sensitivity and specificity of 67.2% and 49.8% respectively. This was similar to the threshold of ⩾8 for patients appropriate for EVT previously reported by our group.

Conclusions: The Hunter-8 pre-hospital stroke scale effectively identifies patients appropriate for acute stroke therapies but did not accurately differentiate patients who would be treated with thrombolysis versus ECR.

Table 1.

Baseline variables, NIHSS and Hunter-8 score comparison in patients who received no reperfusion therapy, those who received thrombolysis only and those who received ECR +/- thrombolysis.

Variable	No reperfusion therapy	Thrombolysis only	ECR +/- thrombolysis	P value
N (% Male)	245 (55.1%)	75 (52.0%)	48 (66.7%)	0.249
Age Median [IQR]	75 [60-83]	76 [67-82]	71 [59-76]	0.008*
Time from Onset Median (hr) [IQR]	1.85 [1.33-3.00]	1.67 [1.25-2.33]	1.59 [1.00-3.33]	0.315
Hunter 8 Median [IQR]	7 [4-10]	8 [5-13]	10 [6-12]	0.006*

Table 2.

Sensitivity and Specificity of Hunter-8 thresholds for predicting thrombolysis +/- ECR.

Cut-off	Sensitivity	Specificity	Correctly Classified	AUROC (95% CI)
⩾1	99.2%	0.9%	34.1%	0.51 (0.50-0.51)
⩾2	97.5%	6.3%	37.1%	0.52 (0.50-0.54)
⩾3	95.1%	11.7%	39.9%	0.53 (0.51-0.56)
⩾4	87.7%	21.3%	43.8%	0.55 (0.51-0.58)
⩾5	80.3%	33.1%	49.0%	0.57 (0.52-0.61)
⩾6	73.8%	40.2%	51.5%	0.57 (0.52-0.62)
⩾7	67.2%	49.8%	55.7%	0.59 (0.53-0.64)
⩾8	57.4%	58.2%	57.9%	0.58 (0.52-0.63)

Disclosure: No

P0861 / 1440

LINCOLNSHIRE STROKE SERVICE UK: A SERVICE FIT FOR OUR OWN FAMILIES

R. Ahmed ¹, S. Goodall¹, J. Bagguley¹

¹ Stroke Association UK, London, United Kingdom

Background and aims: Transformational change of stroke services in Lincolnshire UK began in 2019 driven by the need to: reduce length of hospital stay; offer equitable community stroke rehabilitation service; improve patients’ experience with a more seamless flow across the pathway and co-design with patients.

Methods:

• Collaborative working including United Lincolnshire Hospitals NHS Trust, Lincolnshire Community Health Services NHS Trust, Stroke Association, Adult Social Care, Healthwatch Lincolnshire.

• Stroke ‘100 Day Challenge’ added momentum with emphasis on pace, outcomes, staff influence, trust and teamwork. Joint vision and values developed and the mantra, ‘to have a stroke service that is fit for our own families’.

• A pathway review undertaken.

• Collected quantitative and qualitative data (‘deep dive’ and staff engagement).

• Development of patient journal; shared use of Care Portal; jointly delivered virtual stroke prevention sessions; support for self-management through digital platforms.

Results:

• Awarded the Chief Allied Health professions officer award for Innovations and delivery systems

• Individual stroke services became the ‘Lincolnshire Stroke Service’ as collaborative/integrated working became the ‘norm’.

• A seamless pathway for Stroke Survivors.

• Acute stroke length of stay reduced to an average of 4.5 days. Well within the national average.

• Community Stroke Service is available to all patients who require it.

• Rehabilitation streams encompass personalisation; the whole stroke journey; fluid involvement of services and joint working, and clarity for patients.

Conclusions: Collaborative working, building momentum, effective review of current pathways, staff engagement and tools to support the patient journey can have a demonstrable impact service quality, patient experience and access.

Disclosure: No

P0862 / 1210

EVOLUTION OF STROKE SERVICES IN IRELAND: A FIFTEEN YEAR REVIEW

J. Harbison ^1,2, J. McCormack¹, T. Cassidy¹, R. Collins^1,2,3

¹National Office of Clinical Audit, Irish National Audit of Stroke, Dublin, Ireland, ²Trinity College Dublin, Medical Gerontology, Dublin, Ireland, ³Heath Service Executive, National Clinical Programme for Stroke, Dublin, Ireland

Background and aims: The Irish National Audit of Stroke Care (INASC) in 2006 showed that there was only one stroke unit in the country and only 1% of subjects received Thrombolysis. Through the efforts of individual clinicians and the National Clinical Programme for Stroke services have dramatically improved.

Methods: We compared data from Organisational Audits in 2006, 2015 and 2021 and process audit in 2020 to evaluate the extent of development and changes in national delivery of stroke services.

Results: The number of hospitals admitting strokes reduced by 33% over the period (36 (2006)-27 (2015)-24 (2021)). Number of stroke units increased from 1 in 2006 to 21 in 2015 and 24 in 2021. Numbers of acute /combined stroke unit beds increased (12 (2006), 150 (2015), 209 (2021)) and 71% of patients were managed in a Stroke unit in 2020. Thrombolysis rate remained constant between 2015 and 2020 (10.9%-10.6%) but thrombectomy was performed in 8.6%. Available early supported discharge services increased from 0 to 3 to 7 between 2006, 2015 and 2021.

Over this 15 year period, 30 day age and sex standardised, inpatient mortality rate for Ischaemic Stroke declined from 11.0% to 6.4%. 30 day Mortality for haemorrhagic stroke dropped from 26% to 22%.

Conclusions: In 15 years Stroke evolved from a very basic level to a point where organised stroke care is available to a substantial majority of the population. There is scope for further development to increase access to organised stroke care and interventions.

Disclosure: No

P0863 / 742

IMPACT OF THE CORONAVIRUS (COVID-19) PANDEMIC ON STROKE CODE ACTIVITIES AND OUTCOME: A RETROSPECTIVE OBSERVATIONAL STUDY

S. Jala ^1,2, C. Bertmar³, M. Wronski³, S. Day³, J. Barr³, Y.(. Hu³, E. O’Brien³, M. Coorey-Priglinger³, I. Aziz³, M. Krause^3,4, R. Elliot^5,6, M. Fry^6,5

¹University of Technology Sydney, Graduate Research School, Sydney, Australia, ²Royal North Shore Hospital, Neurology / Stroke, St Leonards, Australia, ³Royal North Shore Hospital, Neurology, St Leonards, Australia, ⁴University of Sydney Northern Clinical School, St Leonards, Australia, ⁵Northern Sydney Local Health District, Royal North Shore Hospital, Nursing and Midwifery Directorate, St Leonards, Australia, ⁶University of Technology Sydney, Faculty of Health, Sydney, Australia

Background and aim: The Coronavirus 2019 (COVID-19) pandemic has affected the delivery of healthcare around the world. We assessed the impact of the COVID-19 pandemic on hospital presentations, reperfusion treatment and outcomes in a comprehensive stroke centre.

Methods: In this observational study seven months of retrospective data from February 2020 at the beginning of the pandemic were compared to data collected for the same time frame in 2019.

Results: There was a transient reduction in stroke presentation only at the beginning of the wave of COVID-19 community transmissions in Sydney. There were significantly more haemorrhagic strokes in the COVID-19 period (n = 66, 15.4 % vs n = 95, 21.5 %, p = 0.02) and baseline stroke severity was higher (NIHSS median 3 vs 4, p = 0.049). Similar proportions of ischaemic stroke patients received reperfusion therapy in the two time periods (IV thrombolysis [n = 51, 17.3% vs n = 52, 17.9%, p = 0.838]; and ECR [n = 38, 12.9% vs n = 46, 15.9%, p = 0.30]). The time from presentation to stroke bed admission was significantly shorter during the COVID-19 period (p = 0.031). Three-month follow-up Modified Rankin Score was 2 (median) in both periods (P = 0.92).

Conclusion: There was no change in stroke presentations overall during the 2020 COVID 19 pandemic time period with the exception of the first phase of the pandemic. Baseline stroke severity scores were higher. There was no difference in the degree of disability at three-month follow-up.

Disclosure: No

P0864 / 465

FIRST, SECOND AND THIRD COVID-19 PANDEMIC WAVES AND THEIR DIFFERENT IMPACTS ON STROKE CARE: EVIDENCES FROM THE TUSCANY STROKE NETWORK

M. Baldereschi¹, V. Di Fabrizio², C. Szasz², F. Gemmi², P. Nencini³, R. Tassi ⁴, P. Palumbo⁵, G. Linoli⁶, A. Chiti⁷, G. Martini⁴, G. Orlandi⁸, for the TSN Working Group: Baruffi MC, Bertini A, Bollani E, Bracco S, Caruso A, Cosottini M, Del Dotto P, Fortini A, Frosini F, Galli R, Landini G, Laureano R, Limbucci N, Marconi R, Masotti L, Mazzoni M, Meucci G, Nocentini S, Panigada G, Pennati P, Ruggiano G, Vannini R, Volpi G.

¹National Research Council, Inst. of Neuroscience, Sesto Fiorentino - Florence, Italy, ²Agenzia Regionale Sanità, Florence, Italy, ³Stroke Unit Careggi Hospital, Firenze, Italy, ⁴Stroke Unit, Le Scotte University Hospital, Siena, Italy, ⁵Stroke Unit S. Stefano Hospital, Prato, Italy, ⁶Stroke Unit Arezzo Hospital, Arezzo, Italy, ⁷Stroke Unit, Nuovo Ospedale Apuano, Massa Carrara, Italy, ⁸Stroke Unit, Pisa Uiversity Hospital, Pisa, Italy

Background and aims: We aim at describing the impact of the first, second and third waves of the COVID-19 pandemic on stroke services in Tuscany. We measured the global impact of the COVID-19 pandemic on the volumes of both intracranial hemmorhage (ICH) and acute ischemic stroke (AIS) hospitalizations, as well as of reperfusion treatments throughout the pandemic years 2020-21 (January1, 2020 –June 30, 2021) compared with the year 2019 control period.

Methods: Retrospective, observational, multicenter study, across 3 hub-and-spoke stroke systems, and 22 stroke hospitals. The diagnoses were identified by their ICD-9 CM codes and/or classifications in stroke databases at participating centers.

Results: In comparison with the same periods of 2019, the hospitalization volumes for ICHs and for AIS declined by 26% and 30.1% respectively during the fist pandemic wave, by 11% and 24.6% during the second wave, and by 2.5% and 4% during the third wave. Reperfusion treatments decreased by 15% during the first wave, and by 11.4% and 0.3% during the second and third waves respectively. Treated patients’ functional outcome at 90days did not vary throughout the pandemic waves. Case-fatality at 30days increased from 10.3% to 10.8% for AIS, and from 26.5% to 27.6% for ICH before and after the COVID-19 outbreak.

Conclusions: The COVID-19 pandemic waves were associated with a decreasing decline in the volume of stroke hospitalizations, nevertheless fewer and probably the most severe patients were able to reach the hospital within the therapeutic windows. We observed different pattern of variations across the three hub-and-spoke systems.

Disclosure: No

P0865 / 1424

WITHDRAWN PATIENT REPORTED EXPERIENCE MEASURES IN THE UK - DEVELOPING A NATIONAL QUESTIONNAIRE

R. Ahmed ¹, C. Fincham¹, K. Yearsley¹

¹ Stroke Association UK, London, United Kingdom

Background and aims: We know that post-discharge is an area where stroke survivors are often let down, fall through the systems and do not receive the rehabilitation they need, however we have very little data to back this up, and even less to demonstrate the areas where improvements should be made. The Stroke Association in the UK is designing a questionnaire to collate patient experiences of post hospital discharge recovery. This data is referred to as Patient Reported Experience Measures (PREMS). The purpose of the questionnaire is not to measure outcomes and success of the treatment and care received, but how the stroke survivor felt about their treatment and care, and how it was delivered.

Methods: The Stroke Association will work with stroke survivors to design the questions.

The questionnaire will be distributed to 27,000 stroke survivors. It is hoped to stagger the sample at 6 months, 12 months and 24 months post-discharge

Results: Stroke Association aim to roll-out the finished questionnaire in Spring 2022. The results to be reported at ESOC 2022 will focus on questionnaire design process, content of the questionnaire and distribution.

Conclusions: The conclusions presented at ESOC 2022 will likely include the rationale and understanding of use of each question asked, the level of accessibility for as many stroke survivors as possible, and the options in place to support those for who it may not be fully accessible.

Disclosure: No

P0866 / 1164

FLYING INTERVENTION TEAM - IMPACT OF FLIGHT DISTANCE ON TIME TO TREATMENT

S. Herdegen ¹, G.J. Hubert¹, I.K. Jarsch¹, H. Wiestler¹, T. Witton-Davies², R.L. Haberl¹, N.D. Hubert¹

¹Munich Clinic, Academic Teaching Hospital of the Ludwig-Maximilians-University, TEMPiS Telemedical Stroke Center, Munich, Germany, ²Munich Clinic, Department of Diagnostic and Interventional Radiology, Munich, Germany

Background and aims: Endovascular treatment (EVT) in patients with acute ischemic stroke is time critical. Previous analyses showed that time to treatment in rural areas can be reduced by 90 minutes when deploying a Flying Intervention Team (FIT) compared to interhospital transfer. However, the impact of flight distance on time to treatment has not yet been assessed. Aim of this study was to compare process times of FIT in relation to flight distance.

Methods: This study is a secondary analysis of a prospective cohort study. Patients with indication for EVT, treated by FIT between 02-2018 and 01-2021 were included. Intervention teams based in Munich were transferred via helicopter directly to the patient located at one of 15 participating primary stroke centers (PSC). Patients were divided into three groups based on flight distance from helicopter base to PSC (<50km, 50-70km and >70km). Primary outcome was time from EVT decision to groin puncture.

Results: Of 136 patients included (mean age: 71.7, 57% female), 53 (39%) patients were located at a PSC less than 50km away from the helicopter base, 52 (38%) at a distance of 50-70km and 31 (23%) at a distance greater than 70km. Median time to treatment was 56 (Interquartile range 47-67), 62.5 (IQR 56-71) and 72 minutes (IQR 64-87.5), respectively (p <.001).

Conclusions: Time to treatment increased with growing distance from helicopter base to PSC. However, based on previous results it is expected that even at longer distances FIT is still faster than the interhospital transfer of patients.

Disclosure: Yes

P0867 / 434

PROVISION OF EVIDENCE-BASED STROKE REHABILITATION SERVICES IN THE UK: FINDINGS FROM A NATIONAL STROKE AUDIT

E. Barrett ¹, R. Fisher^1,2, F. Odion-Esene¹, S. Ralph¹, L. Clark^1,3, M. James^1,4

¹King’s College London, Sentinel Stroke National Audit Programme, Department of Population Health Sciences, London, United Kingdom, ²University of Nottingham, School of Medicine, Nottingham, United Kingdom, ³Dorset County Hospital, Dorchester, United Kingdom, ⁴Royal Devon & Exeter Hospital, Exeter, United Kingdom

Background and aims: The quality of stroke rehabilitation is monitored by the Sentinel Stroke National Audit Programme (SSNAP) in England, Wales and Northern Ireland. The 2021 SSNAP Post-Acute Organisational Audit compared current services with evidence-based standards, to drive quality improvement in post-acute stroke care.

Methods: Clinical guidelines and policy documents informed evidence-based audit questions and 17 quality indicators. Data were collected via a web-based audit proforma, with validations to ensure data accuracy. The weblink was sent to all teams participating in SSNAP and engagement was maximised through weekly webinars. Services were described as of 1^st April 2021 and were analysed using descriptive statistics.

Results: 93 post-acute inpatient and 245 community-based multidisciplinary teams participated and the majority (73% inpatient and 93% community) were stroke or stroke/neuro specific services. Median number of quality indicators met was 4/10 for post-acute inpatient teams and 6/13 for community-based multidisciplinary teams. Recommended therapy and nurse disciplines were represented in core multidisciplinary teams. Fewer than 50% of inpatient services and fewer than a third of community-based services met recommended staffing levels per bed or per patient. 58% of community services were time-limited, with only a quarter of services providing treatment 7days/week.

Conclusions: With an increasing shift of stroke rehabilitation out of hospital into the community, the quality of post-acute care becomes increasingly important for population disability outcomes. National registries such as SSNAP are important to drive service improvement towards equitable, high –quality provision of stroke rehabilitation along the whole pathway of care.

Disclosure: No

P0868 / 282

KNOWLEDGE OF STROKE RISK FACTORS AND WARNING SIGNS IN A LOCAL POPULATION IN SWITZERLAND USING THE STROKE AWARENESS QUESTIONNAIRE

P. Correia ¹, I. Alexis Meyer^1,2, S. Salmen^1,3, I. Aícua Rapún¹

¹Spitalzentrum Biel, Neurology, Stroke Unit, Bienne, Switzerland, ²Lausanne University Hospital, Neurology, Lausanne, Switzerland, ³Inselspital Bern, Neurology, Bern, Switzerland

Aims: To ascertain the degree of awareness of stroke risk factors, response in case of symptoms and knowledge of stroke treatments in a local Swiss population.

Methods: A cross-sectional survey questionnaire-based study using a validated stroke awareness questionnaire. Enrollment was over six months including patients who had suffered a stroke or a transient ischaemic attack (TIA).

Results: 69 patients were included, of whom 35% (n=24) correctly defined a TIA and only 29% (n=20) considered a TIA to be equally serious as a stroke. There was a statistically significant positive relationship (p=0.006, 95% CI: 0.1-0.53, r =0.3) between interpretation of stroke and TIA as a serious event. 56.5% (n=39) of patients were able to correctly identify a minimum of 3 stroke symptoms and 47.8% (n=32) patients responded that they would call an ambulance immediately at symptom onset. The decision to call an ambulance was significantly associated with a good knowledge of stroke risk factors (p=0.03, 95% CI: 1.09-9.92) and stroke therapies (p=0.05, 95% CI: 0.99 -7.36). 37% (n=26) of patients were able to cite 3 or more acute stroke therapies or secondary treatment medications and only 8.7% (n=6) named thrombolysis as one of these therapies.

Conclusions: Knowledge of stroke risk factors and treatments significantly influences the immediate response to stroke symptoms. Patients who recognise a stroke as a serious medical emergency are more likely to consider a TIA to be the same. Knowledge of efficient acute stroke treatments like thrombolysis needs to be emphasised in future public health programs.

Disclosure: No

P0869 / 227

PATIENT AND PUBLIC INVOLVEMENT IN CHRONIC STROKE AND APHASIA RESEARCH

M. Charalambous ^1,2, A. Kountouris³, P. Phylactou², J.-M. Annoni¹, M. Kambanaros⁴

¹University of Fribourg, Medicine Section/Neurology Department, Fribourg, Switzerland, ²Cyprus University of Technology, Rehabilitation Sciences, Limassol, Cyprus, ³Nicosia Municipality, Solidarity Network Nicosia In Action (NicInAct) Multifunctional Foundation, Nicosia, Cyprus, ⁴University of South Australia, Allied Health & Human Performance, Adelaide, Australia

Background and aims: Patient and Public Involvement (PPI) is the active partnership between researchers and patients. PPI in stroke aphasia research aims to ensure equal opportunities to make informed decisions and ensure democratic representation in citizen control PPI projects. Yet, little is known about the factors that hinder and promote the autonomous involvement of people with aphasia in stroke and aphasia PPI projects. This study aimed to explore the views and perspectives of people who live with chronic stroke, with and without aphasia, with experience in research prior to stroke, on their potential involvement as research partners.

Methods: The research team included a PPI partner with chronic stroke-induced aphasia. Semi-structured interviews were conducted online with people with chronic stroke (n=8), four with aphasia and four without. Interviews were subject to thematic analysis.

Results: Inductive thematic analysis generated four themes:

• (1) the kinds of Restrictions that make involvement in research difficult,

• (2) the preferred levels and ways of Involvement during the research process,

• (3) the Support required for active and collaborative involvement, and

• (4) the Impact of their involvement and how it benefits the study’s outcomes.

People with aphasia stressed the importance of constant contextual and third-party support to sustain their active engagement within the research team.

Conclusions: People experiencing stroke and aphasia are willing to be involved as PPI partners if researchers provide a robust support environment. The findings provide six recommendations of practical guidance for researchers to consider before commencing PPI research with people with stroke and aphasia.

Disclosure: No

P0870 / 1088

ESTABLISHING ORGANIZED STROKE CARE IN LOW-AND-MIDDLE INCOME COUNTRIES: FROM TRAINING OF NON-SPECIALIST TO IMPLEMENTATION ON BEHALF OF WORLD STROKE ORGANISATION-FUTURE STROKE LEADERS PROGRAM

I. Sebastian ¹, V. Venugopalan², M. Demers³, N. Yeghiazaryan⁴, W. Asyraf⁵, U. Gopaul⁶

¹St. Stephen’s Hospital, Neurology, Delhi, India, ²All India Institute of Medical Sciences, Neurology, Delhi, India, ³University of Southern California, California, United States, ⁴National Institute of Health, Yerevan, Armenia, Neurology, Yerevan, Armenia, ⁵Pusat Perubatan Universiti Kebangsaan, Malaysia, Neurology, Malaysia, Malaysia, ⁶University of Mauritius, Mauritius, Mauritius

Background and aims: LMICs lack adequate number of neurologists making it imperative to rely on alternative models of stroke care like task-sharing with non-specialists (physicians and nurses) for uniform delivery of stroke care. We propose a non-specialist model of stroke care with the following objectives:

1. Develop a set of training modules on evidence-based stroke care to build capacity among non-specialists

2. Develop an App (Android and iOS) to deliver and monitor evidence-based stroke care

3. Implement the non-specialist driven model of stroke care

Methods: The study will be conducted in two phases:

Capacity building Phase (3 months): A set of virtual training and technical support modules on evidence-based stroke care will be developed for training non-specialists from different non-stroke ready hospitals. Simultaneously a mobile application (Figure 1) will be developed to facilitate the use of standardized protocols for in-hospital stroke management as well as to collect baseline data of stroke patients.

Implementation Phase (6 months) : The trained non-specialists will deliver and implement evidence-based stroke management protocols. The mobile App will be used for documentation of data.

Results:

1. A pre-and-post knowledge, attitude and practices (KAP) assessment of the non-specialists will be conducted to evaluate the effectiveness of the virtual training.

2. A pre-and-post implementation data on Key quality indicators (KQIs) will be collected from the hospitals to assess the effectiveness of the non-specialist model (Table1).

Table 1.

	KEY QUALITY INDICATORS
1.	Time from stroke onset to assessment by physician/ stroke professional in hospital
2.	Proportion of stroke patients who receive CT scan within 24 hours of admission.
3.	Proportion of stroke patients who received swallowing assessment prior to receiving anything by mouth (including medications).
4.	Proportion of stroke patients who received antiplatelet drugs within 48 hours of admission.
5.	Proportion of patients who received early mobilization (between 24-48 hours) in hospital.
6.	Proportion of stroke patients who develop medical complications from baseline.
7.	Average length of hospital stay of a stroke patient.
8.	Proportion of stroke patients who received secondary prevention drugs at discharge.

Conclusions: This study will guide by evidence to establish this non-specialist model as an alternative model of stroke care especially in under-resourced countries.

Disclosure: No

P0871 / 1439

GEOGRAPHICAL ACCESSIBILITY AND TRAVEL TIME TO MECHANICAL THROMBECTOMY CENTERS IN INDIA - AN MT2020+ PILOT GEOMAPPING PROJECT

K. Asif ¹, A. Mitra², A. Roy³, N. Herial⁴, S. Ortega⁵, S. Desai⁶, J. Potter-vig⁷, M.P. Srivastava⁸, V. Huded⁹, R. Singh¹⁰, P. Sylaja¹¹, D. Yavagal¹², B. Soman²

¹University of Illinois - Chicago (UIC) and AMITA Health, IL, Neurosurgery, Chicago, United States, ²Achuta Menon Center for Health Science Studies, Public Health, Trivandrum, India, ³Jagannath Gupta Institute of Medical Sciences, Community Medicine, Kolkata, India, ⁴Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, United States, ⁵University of Iowa Hospitals and Clinics, Iowa, United States, ⁶HonorHealth Research Institute, Scottsdale, Arizona, United States, ⁷Society of Vascular and Interventional Neurology, Chicago, United States, ⁸All India Institute of Medical Sciences, New Delhi, India, ⁹NH Institute of Neuroscience, Bengaluru, India, ¹⁰Alleghany General Hospital, Pittsburg, United States, ¹¹Sri Chitra Tirunal Institute, Trivandrum, India, ¹²University of Miami and Jackson Memorial Hospitals, Miami, United States

Background: Access to mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke treatment is limited in low- and middle-income countries (LMICs). Mapping of stroke centers to study geographical access could help design hyperacute stroke services. MT 2020+ is a global stroke campaign aimed at accelerating access to mechanical thrombectomy (MT) through regional committees (RCs) worldwide. We conducted a pilot geomapping project to study access to MT-capable stroke centers in India.

Methods: We collected data on MT-capable stroke centers from all MT2020+ RCs in India in collaboration with three thrombectomy device providers. The geospatial files with the administrative boundaries and transportation layers were obtained from the Digital Vector Database obtained from the survey of India website. Centroids of the polygons and their corresponding geographic coordinates were generated. MT-capable stroke centers were geocoded with Google Geocoding API. These pairs of centroids and MT-capable centers were passed to the Google Distance Matrix API estimating the distance and driving time. All analyses were performed using reproducible algorithms in R version 4.05.

Results: Administrative boundaries comprised of 4706 sub-districts and 744 districts across 37 states & union territories. The database included data on 14526 population centers, 95% of which were major towns/cities. Choropleth maps (Figures 1 and 2) show the distance and travel time from sub-district centroids to the nearest MT capable center.

Conclusions: Access to an MT capable center within 1 hr from the sub-district centroid in India is inadequate. Geomapping analysis could provide valuable information to health policymakers in designing hyperacute stroke services.

Disclosure: No

P0872 / 323

A QUALITATIVE EVIDENCE SYNTHESIS: EXPERIENCES OF EARLY SUPPORTED DISCHARGE SERVICES FOLLOWING A STROKE FOR PEOPLE WITH STROKE, CAREGIVERS AND HEALTHCARE PROFESSIONALS’

E. O Connor ^1,2, E. Dolan², F. Horgan³, K. Robinson^1,4, R. Galvin^1,4

¹University of Limerick, School of Allied Health, Limerick, Ireland, ²Connolly Hospital, Stroke and Older Persons Care, Dublin, Ireland, ³Royal College of Surgeons in Ireland, School of Physiotherapy, Dublin, Ireland, ⁴University of Limerick, Ageing Research Centre, Health Research Institute, Limerick, Ireland

Background and aims: Early supported discharge (ESD) facilitates people with a stroke to be discharged from the hospital environment earlier than conventional care to continue their rehabilitation within the home with a multi-disciplinary team. Known benefits of ESD from Randomised Controlled Trials include reducing cost savings, length of a hospital stay, and long term dependency. The aim of this qualitative synthesis was to explore the experiences of people with stroke, family members, caregivers and healthcare professionals with ESD.

Methods: A literature search completed in 11 databases generated 3,425 articles. Qualitative or mixed methods studies that included qualitative data on the experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service were included. The Critical Appraisal Skills Programme checklist was used to appraise the methodological quality of the papers. Findings were synthesised using thematic synthesis.

Results: Fourteen studies were included with the methodological quality of the studies deemed good. Four key themes emerged:

• 1) ESD is experienced by people with stroke as a goal-focused and supportive process leading to positive outcomes,

• 2) ESD eases the transition from the hospital to the home environment but the transition from ESD to social and community services is often problematic,

• 3) Organisational, logistical and inter-professional factors are critical to the success of ESD and

• 4) The home environment enhances rehabilitation.

Conclusions: Findings highlight how important the home is in the rehabilitation process post stroke. Key practice implications indicate the necessity for increased attention to periods where care transitions occur.

Disclosure: No

P0873 / 1652

COST-EFFECTIVE ANALYSIS OF EVIDENCE BASED INTERVENTIONS UNDERLYING ACUTE ISCHEMIC STROKE: A RETROSPECTIVE STUDY OF PATIENTS IN A TERTIARY CARE HOSPITAL, DELHI, INDIA

P. Gautam ¹, A.K. Pandit¹, S. Selvaraj², M.P. Srivastava¹, A. Srivastava¹, V.V. VY¹, D.M. Divya¹

¹All India Institute of Medical Sciences, Neurology, New Delhi, India, ²Public Health Foundation of India (PHFI), Health Economics and Financing Division, New Delhi, India

Background and aims: As reported in 2010 annual income loss to family affected by cardiovascular diseases in India was 144to158 billion rupees. Another contribution to India’s poverty over next 10 years is estimated 237USD loss due to heart disease, stroke and diabetes (this will slow the growth in India’s Gross-Domestic-Product by 1%). Cost-effectiveness analysis is a tool that can be used to assess outcomes and costs in an unified-model. The objective of our analysis is to determine whether various evidence-based treatment strategies for acute ischemic stroke is cost-effective either for patient/healthcare system.

Methods: Markov-models are often used in cost-effectiveness analysis to assess cost and outcomes over a period of time underlying treatment interventions. We will develop a decision-analytic model (Markov-model) underscoring intervention strategies involving hospital, pharmaceutical and other intervention measures in a tertiary care hospital. The decision-analytic model will be designed using TreeageSoftware. We intend to estimate the health benefits and costs associated with treatment of acute ischemic stroke by various treatment strategies including hospital admission, pharmaceutical therapies, radiological and surgical interventions. Outcome will be measured in QALYs (Quality of Life Years) gained. The Incremental Cost-Effectiveness Ratios (ICER) will be obtained by dividing the difference in costs by the difference in QALYs arising from various interventions. ICER will be assessed based on threshold defined by 3 times of India’s GDP per capita in 2020 as the willingness-to-pay per QALY (as recommended by CMH,WHO).

Conclusion: The intervention will be considered cost-effective according to the ICER per QALY gained.

Disclosure: No

P0874 / 124

PREHOSPITAL STROKE NOTIFICATION: NO RECORD, IT DIDN’T HAPPEN

S. Chapman ¹, L. Chu¹, N. Dabhi¹, H. Pitchford¹, N. Roach¹, C. Aldridge¹

¹ University of Virginia, Neurology, Charlottesville, United States

Background and aims: Effective acute stroke care require communication between prehospital and hospital care teams. Stroke alert protocols with pre-hospital resource activation are associated with reduction in acute treatment times and improved outcomes. We describe associations between Emergency Medical Services (EMS) stroke pre-notification and Emergency Department (ED) stroke alert activation behavior at a Comprehensive Stroke Center.

Methods: Retrospective chart review identified stroke alerted patients that arrived via EMS between April 2020 and July 2021. Data was collected through a state-wide EMS record exchange and internal hospital databases. Descriptive statistics presented as counts and percentages.

Results: Among 472 stroke alerted patients, 45% discharged with a stroke diagnosis. EMS recorded a prehospital stroke assessment in 66% of the cases. 63.6% with a documented positive prehospital stroke assessment received a final diagnosis of stroke. EMS documented hospital stroke pre-notification in 35.4% patient records versus 45% lacking documentation. EMS records missing for 20.2%. Among the 167 records with EMS pre-notification, the ED activated a stroke pre-alert in 41.3%. Among those without documented pre-notification, the ED stroke pre-alerted 11%. Of 94 patients lacking EMS records, 31% were pre-alerted by the ED. ED stroke pre-alerts were associated with a reduction of 27 mins for thrombolytics and 115 mins for thrombectomy for door to treatment.

Conclusions: There is a need for standardization of stroke documentation and stroke alert protocols across the care continuum. More studies with prehospital linked hospital data at a national level are needed to inform proper EMS education.

Disclosure: No

P0875 / 1510

FUNCTIONAL OUTCOME OF PATIENTS WITH LARGE VESSEL OCCLUSION SUBMITTED TO ENDOVASCULAR TREATMENT OVER A 5-YEAR PERIOD IN A REGIONAL TELESTROKE NETWORK

C. Sousa Fernandes ¹, J. Sousa¹, C. Bernardes¹, I. Videira¹, F. Barros¹, A.I. Rodrigues², P. Faustino¹, E. Martins¹, D. Damas¹, C. Teles¹, T. Alves¹, C. Martins¹, E. Veigas³, F. Costa-Sousa³, L. Baptista⁴, I. Pinheiro⁴, A.P. Gomes⁵, F. Cruz⁶, J. Fidalgo⁷, H. Queirós¹, C. Maia¹, C. Nunes¹, C. Machado¹, B. Rodrigues¹, L. Almendra¹, F. Silva¹, C. Nunes¹, D. Sá⁴, E. Araújo², E. André⁶, F. Paiva⁵, J. Correia⁷, A. Gonçalves⁸, A. Gomes³, R. Veiga¹, E. Machado¹, J. Sargento-Freitas¹, G. Santo^1,9

¹Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, ²Centro Hospitalar de Leiria, Leiria, Portugal, ³Centro Hospitalar Tondela-Viseu, Viseu, Portugal, ⁴Centro Hospitalar do Baixo Vouga, Aveiro, Portugal, ⁵Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal, ⁶Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal, ⁷Unidade Local de Saúde da Guarda, Guarda, Portugal, ⁸Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal, ⁹Administração Regional de Saúde do Centro, Coimbra, Portugal

Background and aims: Stroke patients with large vessel occlusion (LVO) who are initially admitted to an endovascular treatment (EVT) center may have better prognosis. Regional telestroke networks can help to mitigate this difference. We aim to compare the functional outcome between patients submitted do EVT that were initially admitted to a primary hospital (PH) and to a comprehensive stroke center (CSC), over a 5-year period in a well-organized regional telestroke system.

Methods: Retrospective analysis of consecutive patients with LVO admitted to a single CSC and submitted to EVT between 1/01/2016 and 31/12/2020. Functional outcome at 90 days was determined using the modified Rankin Scale. Time from symptoms-onset-to-recanalization (StR), door-to-punction (DtP) and to-recanalization (DtR) at CSC were measured in minutes. Ordinal regression was performed including year of treatment and type of admission hospital as covariates. Statistical significance was set at p<0.05.

Results: We identified 1258 patients, mean age 74.66 ±12.46 years, 53.2% female and 709 (56.4%) were transferred from PH. StR was significantly higher in the PH group than in CSC group (401.07±261.46 vs 466.99±244.49, p<0.001; DtP (58.26±97.95 vs 146.44±136.99, p<0.01) and DtR (102.35±90.64 vs 190.22±123.36, p<0.01) were significantly lower in the PH. During this period, functional outcome significantly improved (β= -0.11 [IC 95% -0.18 – -0.03], p=0.008) with no influence of the admission site (β= -0.046 [IC 95% -0.27 – -0.18], p=0.691).

Conclusions: The functional outcome of stroke patients with LVO who were submitted to EVT has been improving, regardless of the site they were initially admitted to.

Disclosure: No

P0876 / 774

QUALITY AND OUTCOME OF ACUTE STROKE CARE AT THE GOVERNMENT-INITIATED REGIONAL CARDIO-CEREBROVASCULAR DISEASE CENTRE

H.-Y. Jeong ¹, S.-E. Kim², J. Lee³, J. Park⁴, J. Lee⁵, H.-J. Bae²

¹Seoul National University Hospital, Seoul National University College of Medicine, Department of Neurology, Emergency Medical Center, Seoul, Korea, Republic of, ²Seoul National University Bundang Hospital, Seoul National University College of Medicine, Department of Neurology and Cerebrovascular Center, Seongnam, Korea, Republic of, ³Seoul National University College of Medicine, Department of Preventive Medicine, Seoul, Korea, Republic of, ⁴Seoul National University Hospital, Central Division of Cardio-Cerebrovascular Disease Management, Seoul, Korea, Republic of, ⁵Korea University College of Medicine, Department of Biostatistics, Seoul, Korea, Republic of

Background: In 2008, the Ministry of Health and Welfare of South Korea launched the Regional Cardio-cerebrovascular Disease Centre (RCCVC) programme to reduce the regional disparity of stroke incidence and mortality nationwide. From 2008 to 2018, 14 RCCVCs were installed and the established RCCVC operated independently for stroke management in each region.

Methods: We evaluated the outcomes of acute stroke management after the RCCVC programme was introduced. We analysed in combination with the data of Korea Disease Control and Prevention Agency’s Acute Stroke Quality Assessment Programme and the data of Health Insurance Review and Assessment Service evaluated in 299 acute stroke care hospitals in 6 rounds from 2010 to 2018. The hospitals were analysed by dividing them into comprehensive stroke centres (CSC) in Seoul, non-CSC in Seoul, RCCVC, and non-RCCVC. The outcome measures were defect-free stroke care and mortality rate.

Results: Among 94,976 acute stroke cases (mean age, 67±14 years, male, 55%), 69,997 (73.7%) were ischaemic stroke. Defect-free care increased from 50.2% in 2010 to 86.0% in 2018 in RCCVC, which significantly reduced the gap with CSC in Seoul (62.1% in 2010, 88.0% in 2018). The 1-year mortality rate decreased from 16.4% in 2010 to 14.4% in 2018 in RCCVC, similar to that in CSC in Seoul (16.9% in 2010, 13.1% in 2018). The 1-year mortality rate was significantly reduced in RCCVC compared to non-RCCVC. (OR 0.88, 95% CI 0.78-0.99, p=0.037).

Conclusions: The RCCVC programme has improved acute stroke management and outcomes and contributed to reducing regional disparity.

Disclosure: No

P0877 / 389

TIME METRICS OF AIR VS. GROUND INTERHOSPITAL TRANSFER FOR ENDOVASCULAR THERAPY IN RURAL AREAS

I.K. Jarsch ¹, S. Herdegen¹, H. Wiestler¹, T. Witton-Davies², R.L. Haberl³, G.J. Hubert¹, N.D. Hubert¹

¹Munich Clinic, Academic Teaching Hospital of the Ludwig-Maximilians-University, TEMPiS Telemedical Stroke Center, Munich, Germany, ²Munich Clinic, Academic Teaching Hospital of the Ludwig-Maximilians-University, Clinic for Neuroradiology, Munich, Germany, ³Munich Clinic, Academic Teaching Hospital of the Ludwig-Maximilians-University, Clinic for Neurology and Neurological Intensive Care, Munich, Germany

Background and aims: Interhospital transfer to comprehensive stroke centers (CSC) for endovascular treatment (EVT) is often unavoidable for patients in remote areas. Patients are shipped either by helicopter (air transfer) or by ambulance (ground transfer). Aim of this study was to investigate time from decision for EVT until groin puncture (Δd-gp), likelihood to receive EVT and EVT outcome for patients between both modes of transportation.

Methods: We compared patients with indication for EVT, transported via air or ground transfer from 15 primary stroke centers (PSC) to 10 CSCs within the telestroke network TEMPiS (interhospital distances 23km – 123km). Primary outcome was mean Δd-gp. Secondary outcomes were probability to receive EVT after arrival and successful recanalization.

Further comparisons addressed differences in Δd-gp for transfer from close (<40km), medium (40-70km) and long (>70km) distance PSCs.

Results: 560 consecutive patients from the FIT registry were included, 49% received air transfer, 51% ground transfer. Mean Δd-gp in air transfer versus ground transfer was 160.5 min vs. 153.0 min (p=0.123). These results remained similar for long (187.4 min vs 181.2 min (p=0.678) or medium distance PSCs (152.5 min vs. 157.0 min (p=0.54). A trend was seen in short distance PSCs favoring ground transfer (157.8 min vs. 144.1 min (p=0.054).

Rate of EVT and rate of successful recanalization were similar in both groups.

Conclusions: Air transfer was not superior to ground transfer, independent of interhospital distance. Expansion of helicopter transfers may not be a suitable strategy to improve treatment for rural EVT patients.

Disclosure: Yes

P0878 / 110

INTEGRATED TIA CLINIC DURING COVID-19 PANDEMIC: SERVICE EVALUATION TO ASSESS IMPACT ON WAITING TIMES, DIAGNOSTIC OUTCOME AND 28-DAY READMISSIONS AT THE UNIVERSITY HOSPITAL SOUTHAMPTON, UK

S. Siddegowda ¹, A Keens¹, R Marigold¹, S Evans¹, P Crawford¹, NU Weir¹, EB Wood¹

¹ University Hospital Southampton NHS Foundation Trust, Department of Neurosciences, Southampton, United Kingdom

Background and aims: TIA presentations are challenging to diagnose. The rapidly escalating pandemic due to Covid-19 demanded an integrated TIA clinic( telephone and Face to face clinics). It is unclear if first specialist assessment can be safely undertaken in selected patients using telephone clinics, there by reducing patient movement to reduce risk of transmission. The aim of this study is to evaluate timeliness, diagnostic accuracy and 28-day readmission of the integrated TIA clinic in comparison to usual set up.

Methods: Two groups of patients (Pre-Covid and Covid Groups) were identified from the TIA clinic registry maintained for quality assurance and governance. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 23 (IBM, 2015).

Results: There was a 25% drop in the number of cases during the study period.

Study Group	Variable	Mean+/- SD or number or Percent	Statistical test
Pre-Covid	Female (60)Male (89)	71.6+/- 13.765.2+/- 15.5	Shapiro-Wilk test P<0.05Data is not normally distributed
	Face to Face clinic	149 (100%)
	Telephone	0 (0%)
	High risk referrals	35 (23%)
	Low risk referrals	114 (77%)
Source of referral	Ambulance	5 (3%)
	GP	32 (22%)
	Eye department	21 (14%)
	Emergency department	78 (52%)
	Medical wards	13 (9%)
Diagnosis outcome	TIA	69 (46%)	Mann-Whitney U testP= 0.466 not significant
	Non-TIA	80 (54%)
Number of referrals to clinic	High risk	35 (23%)
	Low risk	114 (77%)
Readmission within 28 days of clinic review		2/149	Mann-Whitney U testP= 0.20 not significant
Covid	Female (46)	68.7+/-17.7	Shapiro-Wilk testP<0.05Data is not normally distributed
	Male (60)Face to Face clinic	70.6+/-13.056 (53%)
	Telephone	50 (47%)
	High risk referrals	23 (22%)
	Low risk referrals	83 (78%)
Source of referral	Ambulance	10 (9%)
	GP	39 (37%)
	Eye department	10 (10%)
	Emergency department	45 (42%)
	Medical wards	2 (2%)
Diagnosis outcome	TIA	54 (51%)	Mann-Whitney U testP =0.466 not significant
	Non-TIA	52 (49%)
Number of referrals to clinic	High risk	23 (22%)
	Low risk	83 (78%)
Readmission within 28 days of clinic review		4/106	Mann-Whitney U testP= 0.20 not significant

The time to clinic in the Covid group (2.58+/-2.19 days) is significantly shorter compared to the Pre-Covid group (4.77+/-5.01, p <0.05).

There was a statistically significant improvement in time to clinic for low-risk TIA cases in the covid group.

Group	Pre-Covid-19High risk	Covid-19High risk	Pre-Covid-19Low risk	Covid-19Low risk
Mean time to clinic(days)	1.5+/- 1.4	1.3 +/- 1.0	5.7 +/- 5.2	2.9 +/- 2.3

There was no difference in the diagnosis outcome and readmission rate between groups. within 28days.

Conclusion: Integrated model of care can be used to provide timely, safe and comparable service to usual care. The risk of missing key signs can be reduced by the provision of face-to-face clinics. It offers patient choice, service closer to patient and creates flexibility within the system during unprecedented emergencies. A prospective study with a larger cohort of patients will add strength to these findings.

Disclosure: No

P0879 / 1541

OUR 10- YEAR TELESTROKE EXPERIENCE

M.L. Almarcha Menargues ¹, M. Martinez Martinez¹, J. Fernandez Travieso¹, L. Gonzalez Martin¹, P. Martinez Sanchez², B. Fuentes Gimeno³

¹Infanta Sofia University Hospital, San Sebastian de los Reyes (Madrid), Spain, ²Torrecardenas University Hospital. University of Almeria, Almeria, Spain, ³La Paz University Hospital. Institute for Health Research-IdiPAZ (Universidad Autónoma de Madrid), Department of Neurology and Stroke Center, Madrid, Spain

Background and aims: Telestroke (TS) is the use of interactive videoconferencing

technologies to assess patients with suspected acute stroke. Its use increases the patients access to stroke neurologists and improves thrombolysis rates and/or mechanical thrombectomy.

Our aim is to describe the evolution of TS parameters such as number of consultations, thrombolysis and thrombectomies from 2011-2021.

Methods: Retrospective review of consecutive TS consultations in a Secondary University Hospital. We present demographic and clinic characteristics, number of thrombolysis performed and derivations for thrombectomy.

Results: 630 patients were included, 464 (49.9%) men. Casuistics grew exponentially through the years from 10 to 132 patients evaluated per year. Vascular risk factor profile included patients with hypertension (59%), DM (23.1%), dyslipidemia (43%) and 12.7% active smokers, 13.2% had atrial fibrillation. 22% were hemorrhagic strokes. 9.7% of IS received IV thrombolysis with rTPa and 1.1 % were treated with mechanical thrombectomy. Proportion of rTPa administrastion decreased from 50 % in 2011 to 9.4% in 2021. A mean of 47.5% patients were admitted to the Stroke Unit, with a decrease through the years in the number of transfers.

Conclusions: TS is a valiable tool that need to be evaluated through the years. Our data suggest a change in thrombolysis administration. In subsequent years, number of patients increase with a decrease in the number of transfers to the SU, suggesting a higher proportion of stroke mimics attended.

Disclosure: No

P0880 / 1261

EXPLORING THE EXPERIENCES OF STROKE SURVIVORS, INFORMAL CAREGIVERS AND HEALTHCARE PROVIDERS IN SIERRA LEONE: A QUALITATIVE STUDY

J. O’Hara ¹, M. Baldeh², G. Deen², D. Parmar¹, C. McKevitt¹, C. Sackley^1,3, KCL NIHR Global Health Research Group on Stroke in Sierra Leone (SISLE)

¹King’s College London, King’s Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, London, United Kingdom, ²University of Sierra Leone, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone, ³University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom

Background and aims: Qualitative methods are increasingly used to investigate the social processes and phenomena shaping health-seeking behaviours, service provision and intervention implementation. Stroke is the second leading cause of adult death in Sub-Saharan Africa, with devastating socio-economic consequences for patients and communities. This study explores the experience of stroke in Sierra Leone from the perspectives of stroke survivors, informal caregivers, and healthcare providers involved in a longitudinal hospital-based stroke register study (SISLE) (National Institute for Health Research (NIHR) Global Health Research Group on Stroke in Sierra Leone, King’s College London (Ref: GHRG 17/63/66)).

Methods: A cross-sectional study employing semi-structured interviews with a purposive sample of stroke survivors (20), informal caregivers (20), and healthcare providers(10). Interviews were audio-recorded, translated, transcribed, coded and analysed using inductive thematic analysis.

Results: Findings present the experiences of stroke survivors, healthcare providers and informal caregivers at Connaught Hospital. Emergent themes include: care seeking behaviours, barriers and facilitators, quality of care, and suggestions for improved stroke outcomes. Major findings illustrate a need for improved stroke symptom/risk awareness (across all participant groups), multidisciplinary care, dedicated stroke wards and community rehabilitation services. Informal caregivers emerge as key pillars of support who would benefit from education resources on rehabilitation.

Conclusion: This study provides evidence from a setting which is under-researched. Findings can contribute to the development of culturally sensitive and acceptable interventions in Sierra Leone. Context-specific learnings may limit the generalisability of study findings.

Disclosure: No

P0881 / 1084

IMPACT OF THE LOCKDOWN DUE TO COVID-19 PANDEMIC IN KYRGYZSTAN ON THERAPEUTIC AND LOGISTICAL APPROACHES APPLIED TO STROKE PATIENTS

G. Abdumanapova¹, I. Lutsenko ²

¹Jalal-Abad State Medical College, Department of Neurological and Psychiatric Disorders, Jalal-Abad, Kyrgyzstan, ²Kyrgyz State Medical Academy, Online and Advanced Training, Bishkek, Kyrgyzstan

Background and aims: COVID-19 pandemic has significantly impacted stroke management in Kyrgyzstan which is only preparing for the implementation of thrombolytic therapy. We aimed to analyze how the lockdown during COVID-19 pandemic affected stroke admissions in Bishkek.

Methods: We analyzed demographic and logisitical parameters in medical records of stroke patients, filled out by specialists of the Emergency Center of Bishkek, Kyrgyzstan who arrived to see a stroke patient in 4 periods (prepandemic, beginning of pandemic, lockdown (March 22, 2020 to May 1, 2020) and the height of the pandemic).

Results: In 478 patients with stroke 80,6% were hospitalized and the rest were refused to be admitted to stroke centers or were triaged due to the shortage of the stroke beds. The median time from the stroke onset till the time of admission in the hospital during lockdown was 7,95 (3,03; 25) while before the pandemic was 6,67 (3,56; 24,8) hours, p=0,001. Stroke patients during lockdown were 2,85 times more likely to develop moderate to severe neurological deficits on the NIHSS (OR= 2,85, 95% CI) and were 1,4 times more likely not to receive antihypertensive therapy with a systolic blood pressure >180 mmHg (OR =1,4, 95% CI) due to the absence of the medicaments in emergency services.

Conclusions: During the lockdown time of the emergency services arrival to stroke patients significantly shortened due to absence of traffic but time from the stroke onset till the admission to hospitals increased due to the prolonged time in the seek of help.

Disclosure: No

P0882 / 1414

QUALITY IMPROVEMENT PROJECT: THE PROVISION OF COVID-19 VACCINATIONS TO INPATIENTS ON THE ACUTE STROKE UNIT

T. Jeyabalasingham ¹, R. Simister¹, S. Saber¹

¹ The National Hospital for Neurology and Neurosurgery, Stroke Medicine, London, United Kingdom

Background and aims: As the Omicron variant emerged and became prevalent within the UK, an increased risk of nosocomial COVID-19 infection presented itself in this busy London Stroke Unit. This posed particular risk to the Acute Stroke Unit patients some of whom had been inpatients for up to five months and therefore missed the opportunity for vaccination under the nationwide scheme, or who had not taken up the vaccine when offered in the past. An improvement project was undertaken to provide inpatient vaccination to these vulnerable patients.

Results: Of the 18 patients admitted to the unit at the beginning of December 2021, 60% had not received the full complement of COVID vaccinations. 22% of patients had not received any doses of COVID vaccination. 7 patients were identified for vaccination in the first round. 3 others would have been eligible but unfortunately tested positive prior to the first vaccination date. Informed consent was gained from those patients with capacity (40%). Next of kin were informed for the remaining patients, with a best interest decision made to proceed. The vaccination status of patients is to be reviewed in weekly Multidisciplinary Team Meetings.

Conclusions: Assessment of COVID vaccination status for long term patients will play a key role in the prevention of nosocomial infection in Stroke patients and should be undertaken where possible.

Disclosure: No

P0883 / 1402

STARTING A TIA CLINIC: OUR CLINICAL EXPERIENCE IN THE FIRST YEAR

M. Oses ¹, M.J. Arias-Villaran¹, I. Navas-Vinagre¹, I. Zamarbide¹, L. Olivié¹, M.T. Montojo-Villasanta¹, A. Herranz¹, M.A. García-Torres¹

¹ Hospital Universitario Fundación Jiménez Díaz, Neurology, Madrid, Spain

Background and aims: The Transient Ischemic Attack (TIA) Clinic is a one stop, rapid access service for patients with TIA providing secondary prevention to reduce the incidence of stroke and unnecessary acute hospital admissions. We want to describe the clinical, demographic, and prognostic characteristics of the patients treated at our center.

Methods: Retrospective observational study that includes all patients treated at fast-track TIA Clinic of the Neurology Department of Hospital Universitario Fundación Jiménez Díaz during its first working year (October 2020-2021).

Results: We have attended 70 patients, (34 TIA, 14 minor stroke, 22 TIA mimics). Patients were performed priority brain MRI (90%), echocardiogram (87%) and HolterECG (41%). In the carotid doppler ultrasonography study, 5 patients had carotid stenosis >50%. The final diagnosis was: 49% TIA, 20% minor stroke and 31% other causes (7% migraine). Follow-up at 90 days showed low recurrence (new TIA at 90-days in 1 patient) 0 strokes. TIA patients (14 men, 20 women) had mean age of 75 years, 70% had basal mRS 0, 40% of them had hypertension and 12% atrial fibrillation. Isolated aphasia was the most frequent symptom (32%). 48% of the patients received simple antiplatelet therapy (AT) and 32% double AT for 21 days.

Conclusions: The TIA clinic allows patients receiving a high quality and fast track neurovascular study avoiding hospital admissions, with a low recurrence rate and good prognosis.

Disclosure: No

P0884 / 127

PHASE 2 OF A MULTIDISCIPLINARY MULTI-MODAL STROKE SIMULATION PROGRAMME TO IMPROVE RECOGNITION AND MANAGEMENT OF COMMON POST STROKE COMPLICATIONS

Z. Mehdi ¹, S. Williams¹, C. Sanders¹

¹ Hampshire Hospital NHS Foundation Trust, Stroke Medicine, Winchester, United Kingdom

Background and aims: Simulation-based stroke education has become a well-recognised form of training. Most programmes aim to improve performance in the hyper-acute setting however, stroke patients frequently experience acute complications beyond the front door, requiring a coordinated multidisciplinary team (MDT) approach. In 2019/20, a simulation programme was developed to address this. Phase one focused on post-stroke falls, neurological deteriorations; and recognising sepsis. The second phase launched in 2021 included scenarios about seizures, communicating prognosis, and managing post-stroke chest pains.

Methods: Written feedback from 58 delegates who attended phase 1, and transcripts from 6 semi-structured interviews, were analysed to identify common challenges. Frequently mentioned situations included managing seizures; explaining diagnoses and prognosis; and managing emergencies such as chest pains. Three scenarios were developed addressing these educational needs, each followed by faculty-led debriefing sessions. Pre and post-course feedback was collected, and a deductive-thematic analysis was conducted.

Results: Thirty-nine members of the stroke MDT participated in phase 2. All attendees felt the course improved skills in managing acute emergencies on the stroke unit, and the scenarios strongly reflected real life clinical situations. Three key themes emerged from data analysis: improved knowledge, recognition, and management of seizures; enhanced communication techniques; and development of a structured approach to managing medical emergencies.

Conclusion: This simulation programme has improved the recognition and management of common post-stroke emergencies on the stroke unit, as well as enhanced communication skills. It has allowed differential learning opportunities and promoted collaborative working. The programme would be easily replicable in other stroke units.

Disclosure: No

P0885 / 1265

EXAMINING CHANGES IN STROKE RESEARCH RECRUITMENT TRENDS PRE AND POST COVID-19

M. Broderick ^1,2, L. Johnson^3,4, J. Brereton^3,4, P. Wilding², V. Dave², J. Burridge⁴, P. Bentley^1,2

¹Imperial College London, Brain Sciences, London, United Kingdom, ²Imperial College Healthcare NHS Trust, London, United Kingdom, ³University Hospitals Dorset NHS Foundation Trust, Physiotherapy, Bournemouth, United Kingdom, ⁴University of Southampton, Life Sciences, Southampton, United Kingdom

Background and aims: Covid-19 has disrupted essential stroke prevention and treatment services, stroke rehabilitation and support services and delivery of stroke research. We examine recruitment data for two stroke rehabilitation trials recruiting within a single centre in November 2019 and November 2021, to identify if/how Covid-19 impacted upon recruitment rates and processes. Both studies were managed by the same research team and comprised of comparable protocols and selection criteria.

Methods: Recruitment data from the two corresponding time periods, are reported using descriptive statistics. Field notes and direct researcher experiences are used to support observations derived from the data.

Results: Patients screened reduced by >40% in November 2021 compared to the same period in 2019, despite an almost 20% increase in admissions, recruitment reduced by 75%. Research staffing issues (sickness) resulted in missed recruitment data and opportunities in November 2021. There were changes in participant identification methods, resulting from restricted researcher screening within clinical areas; more remote screening, less attendance at clinical meetings and increased initiation of referrals from the clinical staff (Table 1). While the centre’s clinical trials portfolio expanded between 2019 and 2021 (from 11 to 17), we noted a reduction in research co-enrolment; reasons for this are unclear, however lower recruitment rates more broadly may have contributed to this.

Conclusions: Covid-19 has changed how we engage with/in clinical research. Understanding the ways in which Covid-19 has altered the research recruitment landscape will be important in the continued delivery of vital stroke research, driving clinical advancements in the field.

Disclosure: No

P0886 / 1297

THE BROADER IMPLICATIONS OF IMPLEMENTING A NEW MECHANICAL THROMBECTOMY SERVICE

S.-E. Rygg ^1,2, H. Ihle-Hansen, MD, PhD¹, E.C. Sandset, MD, PhD^1,3, R. Advani, MD, PhD¹

¹Oslo University Hospital, Ullevål, Stroke Unit, Department of Neurology, Oslo, Norway, ²Oslo University Hospital, Ullevål, Department of Geriatrics, Oslo, Norway, ³Norwegian Air Ambulance Foundation, Oslo, Norway

Background and aims: In Oslo, Mechanical Thrombectomy (MT) was up until the 1st of January 2021, provided at one secondary referral treatment center: Oslo University Hospital Rikshospitalet (OUS-R). Patients were transferred from regional hospitals on a 24/7 basis to OUS-R for MT. From January 2021, a new mechanical thrombectomy service was started in Oslo University Hospital Ullevål (OUS-U), a primary referral center. Both centers now offer MT on a 24/7 basis, OUS-R however remains a secondary referral center. Our aim was to investigate the implications of this MT service expansion.

Methods: Data was collected prospectively on MT performed at OUS-R and or OUS-U from 1st of January 2020 to 31st of December 2021.

Results: For Calendar year 2020 there were 211 MT procedures at OUS-R. In the same time frame, 118 MT procedures were called off after initial referral from other primary centers. For calendar year 2021 there were 253 MT procedures performed at both OUS-R and OUS-U (an increase of 42 MT, p<0.05). In the same timeframe there was a significant decrease in MT being called off (87, p<0.05).

Conclusions: The OUS data show that since the implementation of a new MT service at a primary referral center, more patients have been treated and the number of MT called off has decreased significantly. Implementing MT at primary referral centers leads to better MT availability and fewer MTs called off from regional referrals. Our data suggest decentralizing MT services to primary referral centers will increase its availability for patients.

Disclosure: No

P0887 / 1263

CLINICAL STAFF PERSPECTIVES OF POST-DISCHARGE STROKE CARE IN INDIA

R.J. Injety ¹, S.P Jones², J.D. Pandian¹, PN Sylaja³, MV Padma⁴, S. Sharma⁵, J.J Webster⁶, G.B. Kulkarni⁷, A. Sharma⁸, C.E. Lightbody², J.C. Weldon², J.A Kuroski², C.L. Watkins², The NIHR Global Health Research Group on IMPROVIng Stroke CarE in India (IMPROVISE) Collaboration

¹Christian Medical College & Hospital, Ludhiana, India, ²University of Central Lancashire, Lancashire, United Kingdom, ³Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, ⁴All India Institute of Medical Sciences, New Delhi, India, ⁵Indira Gandhi Medical College, Shimla, India, ⁶Baptist Christian Hospital, Tezpur, India, ⁷National Institute of Mental Health And Neuro Sciences, Bengaluru, India, ⁸Zydus Hospitals And Healthcare Research Pvt. Ltd., Ahmedabad, India

Background: Stroke is one of the most common non-communicable diseases in India, resulting in significant disability and mortality. Stroke care is often fragmented, exacerbated by a lack of public resources, information, and awareness. Post-discharge care involves rehabilitation and secondary prevention to reduce reoccurrence, mortality and improve outcomes. This study explores key components and challenges of post-discharge stroke services with clinical staff.

Methods: Semi-structured interviews with a purposive sample representing multidisciplinary stroke teams (MDTs) from seven hospitals across India (All India Institute of Medical Sciences, New Delhi; Indra Gandhi Medical College, Shimla; Christian Medical College, Ludhiana; Baptist Christian Hospital, Tezpur; Zydus Hospitals, Ahmedabad; National Institute of Mental Health and Neuro Sciences, Bengaluru and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum) were conducted and analysed in NVivo using constant comparison and thematic analysis.

Results: Based on sixty-six participants’ responses, we identified three themes: Integrated Inpatient Discharge Care Planning; Patient/Caregiver Engagement; and Post-discharge Care and Support. Discharge planning processes varied across sites. Where available, MDTs provided continued, individualized education, training and support on feeding, rehabilitation, medication, and lifestyle factors however, there was not always a documented protocol.  Post-discharge challenges included caregiver engagement, patient affordability, limited workforce availability and access to hospital/community services, especially among rural populations.

Conclusion: Discharge planning was integrated and individualised, however post-discharge management systems could be improved by formal documentation to facilitate a more consistent and comprehensive approach. Task-shifting within MDTs compensated for a lack of specialists. Post-discharge care was supported by tele-services, especially for rural populations.

Disclosure: No

P0888 / 1223

POTENTIAL FOR, AND OBSTACLES TO, ESO STROKE UNIT ACCREDITATION: A NATIONAL STUDY

J. Harbison ^1,2, J. McCormack¹, R. Collins¹, T. Cassidy¹

¹National Office of Clinical Audit, Irish National Audit of Stroke, Dublin, Ireland, ²Trinity College Dublin, Medical Gerontology, Dublin, Ireland

Background and aims: The ESO introduced an accreditation process for Stroke Units and Centres in 2018. Stroke centre accreditation involves evaluation against 44 criteria (22 essential, 22 other). As part of a National organisational audit we evaluated what proportion of units could potentially accredit and what were the predominant obstacles.

Methods: Analysis of organizational audit data (2021) and practice data (2020) against criteria from the ESO Stroke Unit Criteria. Analyses were performed by an ESO auditor.

Results: 24 hospitals admitting >50 stroke patients per year (range 64-497) and having a designated stroke unit were evaluated. Three already received ESO accreditation. Of the remaining 21, 10 (47.6%) would not be eligible on basis of size (<200 admissions/year, <6 beds). Of the remaining 11 units had achieved a median of 19 out of 22 essential criteria (range 18-21) and a median of 12 out of 22 other criteria (range 11-16). The most poorly met essential criteria were lack of a specific Junior on call doctor for Stroke 2 units (18%), although all units had specific training of junior staff, and Transcranial Doppler (TCD) available within 24 hours 3 units (27%).

The most poorly met other criteria (2 units each) were related to availability of specific neurovascular clinics, full standard operating procedures and recording of neurological outcomes.

Conclusions: Consideration should be given by ESO to means of accreditation of small units. Common grounds for non-accreditation may be relatively easily addressed with some allowance made for variations in national clinical practice e.g. TCD use.

Disclosure: No

P0889 / 1400

STRATEGIES TO IMPROVE ACCESS TO STROKE CARE IN RURAL AND REMOTE AREAS ON THE EXAMPLE OF KYRGYZSTAN

I. Lutsenko ¹

¹ Kyrgyz State Medical Academy, Online and Advanced Training Department, Bishkek, Kyrgyzstan

Background and aims: The most concentrated rural populations located in the developing countries of Asia and Africa. On the example of Kyrgyzstan, highly mountainous country where stroke services are in the process of being established, we aimed to display in the study the strategies for the equal access to stroke care development in North (central regions) and South (remote and rural regions of Kyrgyzstan).

Methods: We used the the analysis on 1780 patients of RES-Q registry ( demographic, clinical and logistical parameters) as well as results of the 48 trainings for neurologists and paramedics from capital and remote areas to present the model of implementation of the Roadmap for Stroke and its results in Kyrgyzstan.

Results: Patients in remote areas (Issyk-Kul,Osh,Naryn) demonstrated significantly more severe baseline median NIHSS (14,10 and 8 respectively) compared to patients from capital (7), p=0,001. This happens due to the lack of preparation of regional doctors for the NIHSS evaluation, differentiative therapy in ischemic stroke and intracerebral hemorrhage, absence of the state-covered neurovisualisation: With the help of Roadmap and ESO experts we lead 48 trainings for doctors and paramedics on prehospital and hospital level for the thrombolysis implementation, promoted electronic stroke registry and brought the importance to the telemedicine development.

Conclusions: In absence of the possibility of the state investing in improving stroke services, a public-private partnership may become the way out, when neuroimaging is paid for by the patient, but is located in the stroke center, which can shorten the time for the thrombolysis implementation.

Disclosure: No

P0890 / 1370

ORGANIZING HEALTHCARE FOR BETTER ACUTE ISCHEMIC STROKE TREATMENT IN METROPOLITAN AREA OF BARI, ITALY

G. Candida ¹, N.D. Loizzo¹, F. Rizzo¹, M. Parisi¹,D. Galotto¹, M. Caccamo¹, D.M. Mezzapesa¹, B. Tartaglione¹, S. Lamberti¹, M. Savarese¹,D.S. Zimatore², N. Medicamento², L. Chiumarulo², M. Petruzzellis¹

¹University of Bari Aldo Moro, Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy, ²University of Bari Aldo Moro, Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy

Background and aims: Improving the number and reducing the delay of endovascular treatment (EVT) are actually mandatory for our regional sanitary service and mostly depend on the organization, which include the emergency medical service (EMS), the primary stroke centers (spoke) and the comprehensive stroke center (hub).

Methods: We have retrospectively analyzed our data from Italian Registry of Endovascular Treatment of Stroke. Between January to October 2021, 97 patients with ischemic stroke due to large vessel occlusion were treated: 51 patients were transported directly to the hub; meanwhile 46 firstly to a spoke.

Results: Mean age was similar on two groups (73 years). The “spoke strokes” (SS) were slightly more severe (median NIHSS 18.5 vs 16) but 21% of the “hub strokes (HS)” had a pre-existing mRS score ⩾ 2. Intravenous thrombolysis was administered in 46 45% of HS and 57 58% of SS. The median door-in-door-out time of our spoke centers was 180 minutes. The median door-to-groin time of our hub was 187 minutes. The median groin-to-reperfusion time was 60 minutes in HS and 70 in SS. A good reperfusion (TICI ⩾2b) was reached in 77% of HS and in 78% of SS. 67% of HS had mRS ⩽2 at 90 days and 41% of SS had mRS ⩽2 at 90 days.

Conclusion: Our experience evidenced the better outcome when reducing the delay in starting EVT. In our region the mothership model need to be proposed to EMS protocol decision making as the best way to approach an acute stroke patient.

Disclosure: No

P0891 / 1477

COMPARING SINGLE-CENTRE STROKE ADMISSIONS IN SCOTLAND BEFORE AND DURING TWO LOCKDOWN PERIODS DUE TO THE SARS-COV-2 PANDEMIC

A. Arora ¹, A.T. Droesse¹, A. Chaudhary¹, A. Sitaram², X. Huang²

¹Medical School, University of Glasgow, Glasgow, United Kingdom, ²Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom

Background and aims: Quality care for medical emergencies has been affected by SARS-CoV-2 pandemic globally. Factors include increasing emergency admissions, public reluctance to seek medical help, and government-imposed public health measures. We aim to investigate the impact of the pandemic on our local acute stroke service.

Methods: We conducted a retrospective analysis in a Scottish tertiary neurology referral centre, comparing acute stroke service over three-month periods: pre-pandemic (04/2019-06/2019), first lockdown (04/2020-06/2020), and second lockdown (01/2021-03/2021). We compared rates of acute stroke admissions, delayed presentations (beyond 24 hours after symptoms onset), tPA rates, door-to-needle times (DTN), SARS-CoV-2-related strokes, and non-SARS-CoV-2-related strokes.

Results: Acute stroke admissions reduced significantly over the two lockdown periods compared with pre-pandemic (364 vs 398 vs 454, p<0.0001). 53/316 (16.8%) ischaemic strokes received tPA pre-pandemic, dropping to 21/245 (8.6%) during the first lockdown, and 33/231(14.3%) in the second [p=0.0111], without significant difference in DTNs. 160/527 (30.4%) strokes had delayed presentation in lockdowns, compared with 66/352 (18.8%) pre-pandemic [p<0.0001].

In the 6-month pandemic periods, 13/531 strokes (2.4%; 11 ischaemic, 2 TIAs) were related to SARS-CoV-2-infection. Age and sex were similar compared with non-SARS-CoV-2-related strokes; however, the former had a much higher baseline NIHSS (12 vs 4, p<0.05), with 2 receiving tPA.

Conclusions: As in previous studies, significant reductions in acute stroke admissions during the pandemic were noted in our centre. More patients presented delayed, thus missing the thrombolysis window. Only a small proportion of strokes were thought to be related to SARS-CoV-2-infection in our centre, but with severer symptoms.

Disclosure: No

BRAIN REORGANISATION AND RECOVERY

P0892 / 953

BRAIN VOLUMETRIC CHANGES AFTER FOUR WEEK AEROBIC TRAINING IN SUBACUTE STROKE PATIENTS – SUBGROUP ANALYSES FROM THE PHYS-STROKE TRIAL

T. Rackoll ^1,2, A. dell Orco³, H. Moussa⁴, K. Villringer¹, M. Ebinger^1,5, A. Flöel⁶, A. Nave^1,7

¹Charité Universitätsmedizin Berlin, Center of Stroke Research, Berlin, Germany, ²Berlin Institute of Health, QUEST Center for Responsible Research, Berlin, Germany, ³Charité-Universitätsmedizin Berlin, Department of Neuroradiology, Berlin, Germany, ⁴Klinikum Braunschweig, Department of Neurology, Braunschweig, Germany, ⁵Medical Park Berlin Humboldtmühle, Berlin, Germany, ⁶University Medicine Greifswald, Department of Neurology, Berlin, Germany, ⁷Charité-Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany

Background: Preclinical research indicates that aerobic training administered early after stroke might have neuroplastic effects. So far, evidence in clinical populations from randomized trials is limited. Here, we present results from a subsample of the ‘Physical Fitness Training in Patients with Subacute Stroke’ (PHYS-Stroke) trial population (ClinicalTrials.gov NCT01953549).

Methods: In the multicentre, randomised, blinded PHYS-Stroke trial, 200 patients received 20 sessions of either aerobic treadmill training or relaxation 28 days (median) after stroke. Seventy-two patients received structural and diffusion-weighted MRI pre and post intervention. Lesions were semi-automatically marked and coregistered on T1-weighted images. Change in lesion volume was estimated using a linear mixed regression model with centre as random effect and was additionally controlled for age, sex, time after stroke and respective baseline volume.

Results: Baseline characteristics of the subgroup resembled the total PHYS-Stroke population with a median age of 70 years [IQR 60, 77] and 44.4% female participants. NIHSS on admission was 9 [6 to 12] and training intervention was similarly not superior in terms of functional improvement. Mean lesion volume at baseline was 25.29 ml (SD 42.49) in relaxation vs. 27.44 ml (SD 38.23) in the training group and 35.55 ml (SD 45.05) vs. 15.68 ml (SD 57.56) post intervention, respectively. Adjusted regression model found greater lesion shrinkage in the aerobic training group (-22.2 ml, IQR -38.5, -4.9).

Conclusions: This exploratory analysis revealed a decrease in lesion volume after an early four week aerobic training intervention compared to relaxation in a moderate to severely affected subacute stroke population.

Disclosure: No

P0893 / 698

NON-PARETIC ARM MOTOR DEFICIT AND RECOVERY AS A FUNCTION OF DAMAGE LATERALIZATION AFTER STROKE: BIOMECHANICAL STUDY

S. Kotov ¹, E. Biryukova¹, A. Kondur¹

¹ M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Department of Neurology, Moscow, Russian Federation

Background and aims: Dependency of non-paretic arm motor function (MF) on lesion lateralization and paresis severity is studied on the base of a biomechanical analysis of the non-paretic arms movements.

Methods: 24 post-stroke patients, right-handers, getting rehabilitation using brain-computer interface (BCI) controlling hand exoskeleton on the base of kinesthetic movement imagination were included in the study. 12 patients have a lesion in the left hemisphere, 12 patients in the right one. Each group contained 6 patients with moderate, and 6 patients with severe paresis. The isolated movements in the arm joints were taken as the motor tests suitable for an analysis of coordination between postural and motor components of movement organization. Joint torques and a degree of joint movements isolation were used for the MF assessment.

Results: It is shown that posture maintenance of the non-paretic arm is less impaired in patients with left hemisphere damage (LHD) than in patients with right hemisphere damage(RHD). Biomechanical parameters describing a coordination of posture and movement of non-paretic arm were similar for moderate and severe paresis, for both LHD and RHD patients. Our hypothesis is that the poststroke impairment of the mechanisms of posture maintenance of the non-paretic arm is less pronounced that the impairment of the mechanisms of its movement dynamics control.

Conclusion: An effectiveness of BCI+exoskeleton approach manifested: in an increase of muscle torques both of the non-paretic and the paretic arm joints; in the recovery of a balance of hemispheres activity primarily in left hemisphere damaged patients.

Disclosure: No

P0894 / 757

ROLE OF MOTOR AND COGNITIVE NETWORKS ON UPPER EXTREMITY MOTOR RECOVERY AFTER STROKE

J. Lee ¹, H. Kim², J. Kim², W.H. Chang¹, Y.-H. Kim^1,2

¹Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Seoul, Korea, Republic of, ²SAIHST, Sungkyunkwan University, Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, Seoul, Korea, Republic of

Background and aims: Cognitive and motor functions are known to be linked with each other. In stroke patients, preserved cognitive function is known to play a role in motor recovery, but there is not enough evidence. In this study, we investigated the role of motor and cognitive networks on upper extremity motor recovery using neuroimaging data of subacute stroke patients.

Methods: One hundred eight subacute ischemic stroke patients participated. All patients underwent resting-state functional MRI (rs-fMRI) and motor function assessments at two weeks after stroke onset using the Fugl-Meyer assessment (FMA). The FMA score was obtained again at three months after stroke onset to assess motor recovery. To construct a large-scale brain network using the rs-fMRI, cortical surface parcellation was performed using Gordon atlas whose parcellation includes 333 regions of interest, and twelve resting-state networks were extracted. The linear regression was used to identify the relationship between the FMA upper extremity (FMA-UE) recovery score and resting-state networks.

Results: Strength of motor and cognitive networks including somato-motor, dorsal attention, ventral attention, fronto-parietal, and default networks were correlated with the FMA-UE recovery score. In the multiple regression analysis, there were interaction effects between somato-motor network and cognitive networks such as dorsal attention, fronto-parietal, and default networks for the FMA-UE recovery.

Conclusions: These results demonstrated that the greater the damage caused by stroke in the motor network, the more important the cognitive networks’ role on motor recovery.

Acknowledgment: This study was supported by a National Research Foundation of Korea (NRF) grant (NRF-2020R1A2C3010304, NRF-2020R1C1C1011688).

Disclosure: No

P0895 / 714

HUMAN NEUROGENESIS IN ISCHEMIC ADULT BRAIN: EFFECT OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION

M. De Michele¹, P. Piscopo², A. Crestini², R. Rivabene², L. Petraglia¹, M. Costanzo³, S. Lorenzano ³, I. Berto³, O.G. Schiavo¹, D. Belvisi³, A. Berardelli³, D. Toni³

¹Sapienza University of Rome, Emergency Department, Stroke Unit, Rome, Italy, ²Istituto Superiore di Sanità, Department of Neuroscience, Rome, Italy, ³Sapienza University of Rome, Department of Human Neurosciences, Rome, Italy

Background and aims: Ischemic stroke (IS) represents a trigger for proliferation, migration towards the ischemic lesion, and differentiation of neuroprogenitor cells into mature neurons. Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive technique inducing brain plasticity. Biomarkers such as miRNAs 17~92, Netrin-1 and Semaphorin3A play a role in neuroplasticity. We aimed to investigate the effect of rTMS on post-stroke neurogenesis by dosing serum miRs17~92, Netrin-1 and Sema3A.

Methods: We enrolled 20 IS patients within three days from symptoms onset (T0). Patients were randomized to rTMS or control (sham). rTMS was applied on stroke hemisphere daily between the 7^th and 14^th day from stroke onset. Blood samples for biomarker measurements were collected on T0, before starting the first rTMS section (T1), and at the end of the last one (T2). Five healthy controls (HC) were also enrolled in this study.

Results: Of 20 patients included, 10(50%female,mean age70.9±13.7y) were randomized to rTMS and 9 (55.6%female,mean age63.4±15.4y) to sham stimulation. Among HCs three (60%) were females (mean age52.4±23.9y). No differences were found in terms of infarct volume (p=0.624) and reperfusion treatments (p>0.05 for all) between the two groups. Compared with the sham group, levels of miRs17~92 (miR25:ΔT14-T0 p<0.026; miR106b: ΔT14-T7 p<0.004) and Netrin-1 (ΔT14-T0/ΔT14-T7 p<0.001) significantly increased in the rTMS group whereas Sema3A levels tended to decrease.

Conclusions: rTMS is a promising methodology for enhancing post-stroke neurogenesis. Our preliminary data suggest the possibility of interfering with regular plasticity phenomena of brain ischemic areas in humans by using non-invasive brain stimulation.

Disclosure: No

P0896 / 394

AUTOLOGOUS GENETICALLY-ENRICHED LEUCOCONCENTRATE FOR ISCHEMIC STROKE TREATMENT IN A MINI-PIG MODEL

V. Markosyan¹, M. Sokolov¹, A. Izmailov², G. Kundakchyan ³, A. Khamitov¹, I. Galyautdinov¹, A. Siraeva¹, V. Dudina¹, P. Samoylova¹, Z. Safiullov²

¹Kazan State Medical University, Operative Surgery and Topographic Anatomy, Kazan, Russian Federation, ²Kazan State Medical University, Medical Biology and Genetics, Kazan, Russian Federation, ³Kazan [Volga Region] Federal University, Operative Surgery and Topographic Anatomy, Kazan, Russian Federation

Background and aims: Previously in our ongoing research supported by RSF No19-75-10030, we demonstrated a reliable and reproducible model of ischemic stroke in mini-pigs. The present study highlights the results of the therapeutic efficiency of an autologous genetically-enriched leucoconcentrate (GEL) for ischemic stroke therapy.

Methods: In mini-pigs 4 hours after left middle cerebral artery occlusion accompanied with ligation of the carotid artery on the opposite side, autologous leucoconcentrate enriched with vegf, gdnf, and ncam genes (n=3) or saline (n=3) were infused intravenously. The therapeutic efficiency was estimated on 21st day after surgery. In the open field test, animals were placed in the arena (3×3 m) drawn into 6 squares, the horizontal activity was assessed by counting the number of lines crossed in 10 min. The absolute infarct volume (AIV) was calculated using digital images of the left cerebral hemispheres, which were cut into 3-mm-thick slices, and each slice was photographed. Relative infarct volume (RIV) was calculated as AIV/(AIV+V of brain).

Results: Behavioral test revealed better performance in the therapeutic group (20 [12.5;20.0]) when compared with control group (10.5 [4.2;13.8]). The RIV in the control group (0.7% [0.7;0.7]) was higher than in therapeutic group (0.6% [0.5;0.7]). Significant vasodilation was observed in the right hemisphere in both groups.

Conclusions: Intravenous infusion of an autologous GEL carrying vegf, gdnf, ncam genes has a positive effect on behavioral performance and reduces the infarct volume in mini-pigs with a model of ischemic stroke.

Disclosure: No

P0897 / 858

INFARCT SIZE AND SENSORIMOTOR RECOVERY IN A COMBINED MOUSE MODEL FOR ISCHEMIC STROKE AND ALZHEIMER’S DISEASE

R. Gens ^1,2, F. Nejati³, S. De Raedt^2,3, S. Engelborghs^2,3,4, R. Kooijman⁵, D. De Bundel¹

¹Vrije Universiteit Brussel, Department of Pharmaceutical Chemistry, Drug Analysis and Drug Information, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Brussels, Belgium, ²UZ Brussel, Department of Neurology, Brussels, Belgium, ³Vrije Universiteit Brussel, Center for Neurosciences (C4N), Brussels, Belgium, ⁴University of Antwerp, Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, Antwerp, Belgium, ⁵Vrije Universiteit Brussel, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Brussels, Belgium

Background and aims: Infarct size in combined ischemic stroke (IS)/Alzheimer’s disease (AD) mouse models may increase with advancing AD pathology. In our pilot study, we aimed to induce IS in triple transgenic (3xTg) AD mice in a preclinical (2 months old) and mild (4 months old) disease stage to estimate vulnerability and recovery through infarct size and sensorimotor functioning respectively.

Methods: IS was induced by left-sided permanent middle cerebral artery occlusion (pMCAO) in 2- and 4-months-old 3xTg AD and control mice (B6129SF2/J, n=8-16/group). Sensorimotor recovery 7 days post-pMCAO was assessed by the cylinder test and modified neurological deficit score (mNDS), and compared to baseline testing prior to pMCAO. Infarct size (% hemispheric volume) was determined by Nissl-staining.

Results: Infarct size was comparable in 3xTg AD and control mice when pMCAO was performed at 2 months (12.96%±2.03 vs 12.27%±4.83, p=0.78) and 4 months (12.42%±3.34 vs 11.91%±1.47, p=0.80). Disease stage did not affect infarct size in 3xTg AD mice (p=0.79). The cylinder test did not reveal differences between 3xTg AD vs control mice when pMCAO was performed at 2 months (p=0.50) and 4 months (p=0.22). After pMCAO at 2 months, 3xTg AD mice performed slightly better on the mNDS compared to baseline vs controls (-0.19 vs -1.88, p=0.005), whereas no differences were seen when pMCAO was performed at 4 months (p=0.88).

Conclusion: Our preliminary results suggest that AD pathology does not affect infarct size nor recovery after pMCAO in 2- and 4-months-old mice.

Disclosure: No

TECHNOLOGY INNOVATIONS: ROBOTS, VIRTUAL REALITY, ARTIFICIAL INTELLIGENCE AND MORE

P0898 / 573

TELENEUROLOGY AS A SUPPORT STRATEGY FOR STROKE PATIENTS DURING THE COVID-19 PANDEMIC IN RECIFE-BRAZIL

D.L. Rodrigues ¹, C.d.P.F. Zorzenon¹, G.H.AA Bienes¹, S.L.d.A. Matas¹, M.A. Maeyama¹, S.R.F. Carvalhaes¹, A.F.M.d.A. Silva¹, Á.S. Rodrigues², É.d.B. Mallmann², L.G. Gehre², N.C.d. Souza¹, A.P.N.d.M. Pinho¹

¹Hospital Alemão Oswaldo Cruz, Sustainability and Social Responsability Department, São Paulo, Brazil, ²Brazilian Health Ministry, Brasília, Brazil

Introduction: SARS-CoV-2 pandemic has highlighted the importance of using Telehealth technologies to offer medical care to patients. Teleneurology can provide access to specialists with quality and safety, in addition to presenting great potential in reducing care gaps, especially in the Brazilian public system.

Objective: Demonstrate the profile and impact of the population assisted by Teleneurology during the SARS-CoV-2 pandemic in 2020 and 2021, in addition to the outcomes at the end of this strategy in a city located in the northeast Brazil’s territory.

Methodology: Retrospective and cross-sectional analysis of medical records of patients treated by the team of neurologists at Hospital Alemão Oswaldo Cruz, through the Regula Mais Brasil Collaborative project in 2020 and 2021, using telehealth strategies.

Results: 657 teleconsultations (video or phone) were carried out, all from users of the public health system, and referred for neurological assessment from primary care. The median age was 45,03 ± 15,9 years and 79,3% were women. According to the international code of diseases (ICD-10), the main diagnoses referred to were Headache (51.6%), followed by Epilepsy (16.6%) and Stroke (ischemic and hemorrhagic) at 2.8%. After the first teleconsultation, 56.2% were followed by teleconsultation and 27.4% returned to primary care.

Conclusion: Using teleneurology as strategy helped to reduce the gaps in healthcare due to the closing of Primary Care Centers during the coronavirus pandemic, avoided unnecessary displacements, especially of patients with several comorbidities, in addition to ensuring the safety of users, since they were cared for in their respective homes.

Disclosure: No

P0899 / 388

IN-VIVO ROBOTIC NAVIGATION OF MAGNETIC MICRO-CATHETER AND SUPER-SELECTIVE ANGIOGRPAHY WITHIN PORCINE VASCULATURE – POTENTIAL USE FOR DISTAL VESSEL OCCLUSIONS

R. Dreyfus ¹, P. Gruber², Q. Boehler¹, C. Chautems¹, J. Berberat², L. Remonda², B. Nelson¹

¹ETH Zurich, Multi-Scale Robotics Lab, Zurich, Switzerland, ²Aarau Cantonal Hospital, Department of Neuroradiology, Aarau, Switzerland

Background and aims: A newly developed magnetic steerable micro-catheter (MSM) controlled by an electromagnetic navigation system (eMNS) offers remote control and high navigability in small and distal vessels.

Currently, endovascular therapy (EVT) of distal vessel occlusion (DVO) in acute ischemic stroke (AIS) is increasingly performed (1). Endovascular treatment of DVO requires a high degree of technical expertise and is not without risk.

Here, present a novel concept of MSM that can be applied to AIS patients with DVO using intra-arterial thrombolysis (IAT).

Method: A 2Fr micro-catheter with magnetic tip was navigated through the small branches of the external carotid artery (ECA) of a 45kg pig. The MSM tip was controlled with means of external magnetic fields generated by an (eMNS) and advanced by a motorized advancer. The operator interacted with the system via a hand-held controller. The MSM was imaged using a mono-planar angiography system (Philipps Allura Xper FD20). Once the target site was reached, a IAT mimicking contrast agent solution (50:50 Iopamiro300) was injected.

Results: The MSM was successfully navigated in small diameter, tortuous vessels (small branches of the ECA(Fig.2 a-c)). An injection of contrast agent was performed at multiple target sites (Fig.2d-e) imitating IAT application. The magnetic catheter showed high controllability for selecting multiple millimetre-sized arteries.

Conclusion: We demonstrated the feasibility of MSM using eMNS in small vessels in a porcine model. Due to the ease of use of this novel technique, MSM has the potential to facilitate EVT in AIS patients by reaching more distant vessel occlusions and addressing complex anatomical situations.

Disclosure: No

P0900 / 1503

ARTIFICIAL INTELLIGENCE: A NOVEL TOOL TO MEASURE DYNAMIC AUTOREGULATION IN SUBARACHNOID HEMORRHAGE

F. Favruzzo ¹, A. Fattorello Salimbeni¹, A. Pieroni¹, F. Viaro¹, M. Munari¹, F. Geraldini¹, C. Baracchini¹

¹ Azienda Ospedaliera di Padova, Padova, Italy

Background and aims: Subarachnoid hemorrhage (SAH) is a life-threatening type of stroke with a poor prognosis and high rates of disability and mortality. SAH frequently compromises cerebral autoregulation (CA), possibly causing an induced brain injury through the occurrence of vasospasm, delayed cerebral ischemia and brain oedema and, thus, modifying the clinical outcome of patients. Our aim is to detect early CA compromise in SAH patients through a novel, non-invasive and operator-independent technique.

Methods: In addition to conventional ICU vital parameters measurements, we employed artificial intelligent TransCranial Doppler (ai-TCD) operator-independent, real-time monitoring (Lucid Robotic System, Nova Guide®) to assess cerebral haemodynamics in patients admitted to the Neuro-intensive care unit of Padua University Hospital for spontaneous non-traumatic SAH.

Results: In these settings we observed two different patterns: 1) an effective CA with immediate decrease of cerebral vascular resistances (CVR) secondary to spontaneous/induced decrease of arterial blood pressure (ABP)/bradycardia; 2) a perturbed CA without substantial changes in CVR despite ABP modifications.

Conclusions: ai-TCD constitutes a valid non-invasive and operator-independent tool for CA monitoring in SAH patients, and may help to identify subjects at high risk of secondary SAH-related complications.

Disclosure: No

P0901 / 293

IN-VIVO ROBOTIC MAGNETIC NAVIGATION OF A DIAGNOSTIC CATHETER WITH DEPLOYMENT OF A STENT RETRIEVER IN A PORCINE VASCULATURE

M. Mattmann ¹, P. Gruber², Q. Boehler¹, C. Chautems¹, J. Berberat², L. Remonda², B. Nelson¹

¹ETH Zürich, Zürich, Switzerland, ²Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland

Background and aims: Endovascular treatment (EVT) of large vessel occlusion in acute ischemic stroke is the current gold standard. EVT using a magnetic steerable catheter (MSC) is a potential alternative to well-established manual guidewire-based EVTs to directly steer the MSC with a magnetic field. Robotic magnetic navigation systems (MNS) can simplify catheter navigation and allow for remote intervention. This has the potential to reduce procedure time and costs and also provide treatment in remote areas without specially trained medical staff.

Methods: A diagnostic MSC was developed and tested in combination with established thrombectomy devices (TD) (Solitaire X, Trevo NTX, and ERIC). The catheter has two magnets at the tip and was operated with an MNS and a motorized advancer unit (Figure 1). In-vivo experiments were performed on a 45 kg pig. The catheter position was tracked with a Philipps Allura Xper FD20 angiography system.

Results: The navigation of the MSC and the TD deployment were successfully tested in this in-vivo feasibility study. Figure 2 shows successful navigation to different arterial branches of the extracranial vasculature (a-d) and the deployment of a TD (e). Technically, the generated magnetic torque was sufficient to reliably navigate while low enough to avoid arterial damage.

Conclusions: This in-vivo study demonstrates the feasibility of MSC navigation in small vessels and the successful deployment of different TDs in an in-vivo model. Future studies need to incorporate remote operation functionality including the remote control of the patient bed and fluoroscope to make this technology suitable for clinical use.

Disclosure: No

P0902 / 901

COMPUTATIONAL MEASUREMENT OF PERIVASCULAR SPACES ON 3T MRI IN PATIENTS WITH SPORADIC SMALL VESSEL DISEASE

M. Valdes-Hernandez ¹, L. Ballerini¹, R. Duarte Coello¹, W. Xu¹, J. Bernal Moyano¹, Y. Cheng¹, F. Chappell¹, R. Brown¹, U. Clancy¹, A. Jochems¹, S. Wiseman¹, M.J. Thrippleton¹, M. Stringer¹, F. Doubal¹, J.M. Wardlaw¹

¹ University of Edinburgh, Neuroimaging Sciences, Edinburgh, United Kingdom

Background: Growing interest surrounds perivascular spaces (PVS) as a clinical biomarker of brain dysfunction given their association with cerebrovascular risk factors and disease. Here we evaluate potential variations to our previously developed computational PVS assessment method [1] (validated in 1.5T MRI) and associations of PVS with risk factors in patients with sporadic small vessel disease (SVD).

Methods: We assessed PVS in the basal ganglia (BG) and centrum semiovale (CSO) in 3T MR T2-weighted images from 110 patients with sporadic SVD using [1], and the effect of a) filtering before/after intensity normalisation, b) using overall/regional thresholds, c) inter-observer variations in threshold selection. We compared PVS measures with visual PVS scores, and their association with age, sex, presence of vascular risk factors (hypertension, diabetes, hypercholesterolaemia, ever smoked) and total Fazekas scores in multivariable models.

Results: All tested scenarios produced similar PVS measurement values (Figure 1) correlated with visual scores (Figure 2) with the exception of the BG PVS count using a unique threshold. Hypertension, increasing age, being male and high Fazekas scores were associated with BG PVS count and volume when regional thresholds were used. CSO PVS count and volume were always associated with age. When intensity normalisation was applied before filtering, CSO PVS volume was, additionally, associated with Fazekas scores (Figure 3).

Conclusions: The state-of-the-art PVS assessment method was robust against inter-observer differences in threshold, but intensity normalisation pre-filtering may be beneficial and separate thresholds for BG and CSO are needed.

Reference: [1] Ballerini et al. (2018). Scientific Reports, 8. https://doi.org/10.1038/s41598-018-19781-5

Disclosure: No

P0903 / 949

TICTUS: A SMARTPHONE APP FOR TRACKING REPERFUSION TREATMENT TIMES AND SCREENING CANDIDATES FOR ACUTE STROKE CLINICAL TRIALS

A. Barragán-Prieto ¹, C. Urbano¹, S. Perez-Sanchez¹, F. Moniche², A. Fuerte¹, M. Medina², R. Acevedo-Aguilera³, A. Gonzalez², J. Montaner¹, Neurovascular Group - IBIS

¹Hospital Universitario Virgen Macarena, Seville, Spain, ²Hospital Universitario Virgen del Rocio, Seville, Spain, ³Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain

Background and aims: In recent years, several smartphone apps have appeared to support the treatment of patients in the acute phase of stroke (AS). When developing an app for the medical environment there are a number of features that must be taken into account. We aimed to develop an app for tracking reperfusion treatment times and screening candidates for AS clinical trials.

Methods: First, we surveyed vascular neurology professionals about the requirements for an app in AS. We identified 8: 1.Secure cloud storage. 2.Registration with email, password and predefined roles. 3.Permanent timer on the screen. 4.Feedback notifications with times. 5 Possibility of downloads from the centers. 6.E-mails of possible screenings for clinical trials to coordinators. 7.Real-time visualization of results. 8.User-friendly. Second TICTUS was developed following those requirements and a pilot feasibility project was conducted. Third, TICTUS use was incorporated in daily practice of our hospitals.

Results: During this time, the application began to be used to record the times of patients who were candidates for reperfusion treatment. However, its main use has been shifted to the screening of patients who are candidates for clinical trials, achieving a recruitment rate of 70%.

Nowadays, TICTUS development is in a phase of expansion and improvement with new functions such as the customization of clinical trial criteria by a super-user at each center.

Conclusions: Advances in AS are happening very quickly. Apps that support the management of stroke patients must be dynamic in order to adopt these changes almost immediately.

Disclosure: No

P0904 / 864

SMARTWATCH MONITORING OF NATURAL BEHAVIOUR IMPROVES PREDICTION OF IN-HOSPITAL STROKE DETERIORATION

S. Waibel ¹, C. Auepanwiriyakul², A.A. Faisal², P. Bentley¹

¹Imperial College London, Brain Sciences, London, United Kingdom, ²Imperial College London, Department of Computing, London, United Kingdom

Background and aims: An accurate prognosis of in-patient deterioration is critical for risk stratifying patients and reversing life-threatening complications. Changes in motor behaviour often precede deteriorations. However, established clinical standards for measuring motor behaviour are subjective and error-prone. Here, we develop and validate BehaveAlert, a machine learning model that uses objective smartwatch derived motor predictors for deterioration prognosis following stroke.  

Methods: We recruited 198 stroke-ward patients. Patients wore smartwatches on both wrists and ankles between 9-5 pm to capture daily motor behaviour (sedentary time and statistical motor markers). We then developed and validated BehaveAlert and compared it against prognostic models using established clinical predictors (e.g., stroke severity and vital signs).  

Results: We included  119 patients,  of which 33 patients (age: 64; National Institute for Health Stroke Scale: 4) experienced deterioration within 96 hours. BehaveAlert (combining smartwatch motor predictors with optimised clinical predictors) was highly predictive of deterioration (86 ±2% of Area Under the Curve, AUC). BehaveAlert outperformed baseline step counters (71 ±2% of AUC), baseline unoptimised clinical predictors (55 ±3 %of AUC), and optimised clinical predictors (76 ±2% of AUC). Using smartwatch motor predictors from > three-hours increased accuracy compared to one-hour recordings (86 ±2% versus 82 ±2% of AUC). Using smartwatch motor markers from all four limbs improved accuracy compared to single-limb markers (86 ±2% versus 80-81 ±2% of AUC).   

Conclusions: BehaveAlert can be used for deterioration prognosis following stroke to help stratify high-risk patients to one-to-one nursing care and treatment plans. 

Disclosure: No

P0905 / 1299

CEREBRAL ARTERY-VEIN SEGMENTATION IN DIGITAL SUBTRACTION ANGIOGRAPHY USING DEEP LEARNING

R. Su ¹, M. van der Sluijs¹, S. Cornelissen¹, J. Xu², P.J. van Doormaal¹, W.H. van Zwam³, J. Hofmeijer^4,5, D. Ruijters⁶, W.J. Niessen^1,2, A. van der Lugt¹, T. van Walsum¹

¹Erasmus MC, Rotterdam, Netherlands, ²TU Delft, Delft, Netherlands, ³Maastricht UMC, Maastricht, Netherlands, ⁴University of Twente, Twente, Netherlands, ⁵Rijnstate Hospital, Arnhem, Netherlands, ⁶Philips Healthcare, Best, Netherlands

Background and aims: During neurovascular procedures, dynamic imaging of cerebral blood vessels is performed by digital subtraction angiography (DSA). Blood flow dynamics as well as changes in appearance or disappearance of vessels are visually assessed by radiologists so far. Automatic artery-vein vessel segmentation has the potential to aid this assessment by indicating changes in vessels appearance. Possible clinical applications include automatic emboli detection, visualization of AVM feeders and draining veins as well as real time navigation.

Methods: The present work describes the first study that addresses automatic artery-vein segmentation in DSA image series using deep learning. We propose a novel spatio-temporal U-Net architecture which integrates convolutional gated recurrent unit networks in the contraction branch of U-Net. The network encodes a 2D+t DSA series of variable length and decodes it into a 2D artery-vein segmentation image.

Results: To validate the feasibility, we trained the deep learning model on 58 patients and tested on 25 patients randomly selected from the MR Clean registry. The DSA series were annotated using an in-house tool developed in MeVisLab. The proposed method achieves a Dice overlap of 0.85 for vessel segmentation and a multi-class Dice of 0.62 for artery-vein segmentation, significantly outperforming U-Net and traditional k-means clustering methods.

Conclusion: Leveraging both spatial and temporal characteristics of cerebral blood vessels, the proposed deep learning-based algorithm shows capability in artery-vein segmentation in DSA series acquired during vascular procedures. This can potentially be employed in clinical applications for automatic peri-procedural vessel visualization and treatment assessment.

Disclosure: No

P0906 / 1160

QASPECTS: A FAST AI ENABLED ASPECT SCORING SYSTEM

U. Upadhyay ¹, S. Golla¹, M. Biviji², S. Tanamala¹, S. Chilamkurthy¹, J. Pandian³

¹Qure.ai, Mumbai, India, ²Dr Biviji Radiology Diagnostic Center, Nagpur, India, ³Christian Medical College, Ludhiana, India

Background and aims: Patients presenting in first hours of a stroke with clinical suspicion for MCA occlusion are scored with ASPECTS. Identifying patients with greater likelihood of poor functional outcomes (ASPECTS <8) may be helpful in LVO detection and early stages of care for supporting transfer or therapy decisions. This study aims to showcase the effectiveness of AI in detecting the severity of ischemic stroke in MCA region of brain using automated ASPECT scoring with reduced diagnosis time.

Methods: AI based solution (qAspects) was developed to report ASPECT score for given non-contrast CT (NCCT). qAspects was trained using 600 NCCTs which were prelabelled with the ASPECTS by a trained radiologist. Further, ASPECT scores were binned based on treatment outcomes (e.g. thrombolysis, thrombectomy, or both). The developed solution was validated on 150 scans. qAspects is designed to serve as an alarm towards critical cases. It sends the report over messaging platform on mobile phones for quick access.

Result: Internal validation resulted in 0.85 Pearson correlation between scores from qAspects and expert readers. The diagnostic accuracy, based on binning of ASPECTS, is 85% versus expert readers as the gold standard. Processing time for the qAspects report is less than 1 minute.

ASPECT Score	precision	recall	f1-score
0	0.83	1	0.91
1	0.8	0.8	0.8
2	1	1	1
3	0.83	0.83	0.83
4	0.8	0.8	0.8
5	0.7	0.7	0.7
6	0.45	0.83	0.59
7	0.5	0.64	0.56
8	0.73	0.35	0.48
9	0.44	0.33	0.38
10	0.82	0.9	0.86

Treatment Outcomes	precision	recall	f1-score	support
Thrombolysis	0.96	0.82	0.89	94
Thrombolysis followed by Thrombectomy	0.65	0.87	0.74	38
Thrombectomy	0.89	0.94	0.92	18
Mean	0.83	0.88	0.85	150
Accuracy	85%

Conclusion: In stroke cases, where “time is brain”, each second is important. qAspects can save precious time from diagnosis phase by scoring NCCT in less than a minute with reasonable accuracy and prevent further deterioration of the patient. qAspects present an opportunity to empower under-resourced hospitals where specialists are not available.

Disclosure: No

P0907 / 582

USE OF VIDEO HEAD IMPULSE TESTING TO ASSIST ACCURATE DIAGNOSIS OF POSTERIOR CIRCULATION STROKE IN THE EMERGENCY DEPARTMENT – A PROSPECTIVE TRIAL

J. Thomas ^1,2,3, A. Sharobeam⁴, A. Venkat⁵, C. Blair^2,1,6, N. Ozalp¹, Z. Calic¹, P. Wyllie⁷, P. Middleton^8,3,9,10, D. Cordato^1,3, M. Welgampola^11,12, C. Cappelen-Smith^1,3

¹Liverpool Hospital, Department of Neurophysiology, Liverpool, Australia, ²University of New South Wales, Sydney Brain Centre, Liverpool, Australia, ³University of New South Wales, South Western Sydney Clinical School, Liverpool, Australia, ⁴The Royal Melbourne Hospital, Melbourne Brain Centre, Parkville, Australia, ⁵Wollongong Hospital, Department of Neurology, Wollongong, Australia, ⁶Gosford Hospital, Department of Neurology, Gosford, Australia, ⁷Liverpool Hospital, Department of Emergency Medicine, Liverpool, Australia, ⁸Ingham Institute, South Western Emergency Research Institute, Liverpool, Australia, ⁹Western Sydney University, MARCS Institute for Brain, Behaviour and Development, Liverpool, Australia, ¹⁰University of Sydney, Emergency Medicine, Camperdown, Australia, ¹¹Royal Prince Alfred Hospital, Department of Neurology, Camperdown, Australia, ¹²University of Sydney, Central Clinical School, Camperdown, Australia

Background and aims: Vertigo is a common presentation to the Emergency Department (ED) with 5% of presentations due to posterior circulation stroke (PCS). Bedside investigations such as the head impulse test are used to risk stratify patients, but interpretation is operator dependent. The video head impulse test (vHIT) provides objective measurement of the vestibulo-ocular-reflex (VOR) and may improve diagnostic accuracy in acute vestibular syndrome (AVS). Our aim was to evaluate the use of vHIT as an adjunct to clinical assessment to improve diagnosis of PCS.

Methods: 161 patients with AVS were consecutively enrolled from the ED of a comprehensive stroke centre between 2018 and 2021. Patient assessment included a targeted vestibular history, HINTs examination (Head Impulse, Nystagmus and Test of skew), vHIT and subacute MRI at least 48hrs after symptom onset. The clinical, vHIT, and MRI findings were then analysed and compared between vestibular neuritis (VN), PCS and other diagnoses.

Results: The final diagnosis was VN in 32%, PCS 12%, migraine 13% and other cause AVS 43%. PCS patients were older than those with VN (mean age 68.5±10.6 vs 59±14.1 yrs, p=0.05) and had more cardiovascular risk factors (3 vs 2, p=0.009). VOR gain was reduced (<0.8) in ipsilateral horizontal and anterior canals in VN but was normal in PCS, migraine and other cause AVS. VHIT combined with HINTs was 92% sensitive and 97% specific for a diagnosis of VN.

Conclusions: VHIT combined with HINTs is a reliable tool to assist diagnosis of PCS in the ED.

Disclosure: No

P0908 / 519

INFLUENCE OF E-CTA SOFTWARE ON CT ANGIOGRAPHY-BASED DECISION MAKING

P. Mathieson ¹, K. Nagaratnam², A. Podlasek³, P. Slade⁴, G. Ford¹, G. Harston¹

¹Oxford University Hospitals NHSFT, Acute Stroke Service, Oxford, United Kingdom, ²Royal Berkshire NHSFT, Reading, United Kingdom, ³University of Dundee / University of Nottingham, Nottingham, United Kingdom, ⁴Swansea Bay UHB, Swansea, United Kingdom

Background and aims: Regulatory and clinical evidence for AI imaging software is typically based on standalone performance testing against expert consensus without clinical context. In practice, software outputs are interpreted by clinicians to support decision making with individual patient information available. We assessed the impact of decision support software for CT angiography (CTA) on clinical decision making.

Methods: Seventeen representative UK users (radiologists and stroke physicians) participated. Each reader reviewed twenty cases (stroke and non-stroke diagnoses, 50% LVO). Vignettes and non-contrast CT reports were provided with CTAs that were randomly allocated to with or without AI software (e-CTA, e-Stroke, Brainomix). Readers were asked to determine diagnosis, interpret imaging (presence of LVO) and to make treatment decisions. Ground truth radiological diagnosis was set by an expert neuroradiologist with access to follow up information. Readers could repeat scoring after two weeks with the inverse allocation of decision support.

Results: 220 case reviews were completed. Randomisation to e-CTA improved sensitivity to LVO from 89% to 97% (p=0.007) with a non-significant increase in specificity (92% to 95%, p=0.3). Confidence in identification of LVO improved from 60% to 74% (P<0.001). Diagnostic accuracy improved non-significantly 84% to 87% (p=0.3) with increased diagnostic confidence from 54% to 61% (p=0.03).

Conclusions: AI decision support has potential to improve sensitivity to LVO identification by representative users without specificity reduction. This was associated with an increased confidence of decision making. This study demonstrates the potential impact decision support software can have to support identification and treatment of LVO stroke.

Disclosure: Yes

P0909 / 707

MACHINE LEARNING-ENABLED MULTITRUST AUDIT OF STROKE CO-MORBIDITIES USING NATURAL LANGUAGE PROCESSING

A. Shek¹, Z. Jiang², J. Teo^2,1, J. Au Yeung ³, A. Bhalla³, M. Richardson^4,2,1, Y. Mah^1,5

¹King’s College London, School of Neuroscience, Institute of Psychiatry, Psychology, & Neuroscience, London, United Kingdom, ²King’s College Hospital NHS Foundation Trust, London, United Kingdom, ³Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK, Neurology / Stroke, London, United Kingdom, ⁴South London & Maudsley NHS Foundation Trust, National Institute for Health Research, Maudsley Biomedical Research Centre, London, United Kingdom, ⁵Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom

Background and purpose: With the increasing adoption of electronic records in the health system, machine learning-enabled techniques offer the opportunity for greater computer-assisted curation of these data for audit and research purposes. In this project, we evaluate the consistency of traditional curation methods used in routine clinical practice against a new machine learning-enabled tool, MedCAT, for the extraction of the stroke comorbidities recorded within the UK’s Sentinel Stroke National Audit Programme (SSNAP) initiative.

Methods: A total of 2327 stroke admission episodes from three different National Health Service (NHS) hospitals, between January 2019 and April 2020, were included in this evaluation. In addition, current clinical curation methods (SSNAP) and the machine learning-enabled method (MedCAT) were compared against a subsample of 200 admission episodes manually reviewed by our study team. Performance metrics of sensitivity, specificity, precision, negative predictive value, and F1 scores are reported.

Results: The reporting of stroke comorbidities with current clinical curation methods is good for atrial fibrillation, hypertension, and diabetes mellitus, but poor for congestive cardiac failure. The machine learning-enabled method, MedCAT, achieved better performances across all four assessed comorbidities compared with current clinical methods, predominantly driven by higher sensitivity and F1 scores.

Conclusions: We have shown machine learning-enabled data collection can support existing clinical and service initiatives, with the potential to improve the quality and speed of data extraction from existing clinical repositories. The scalability and flexibility of these new machine-learning tools, therefore, present an opportunity to revolutionize audit and research methods.

Disclosure: No

P0910 / 784

THE USING OF FUNCTIONAL MYOSTIMULATION UNDER THE BIOMECHANICAL CONTROL OF WALKING IN RECOVERY OF POSTSTROKE PATIENTS

S. Kotov ¹, N. Filatov¹, K. Petrushanskaya¹

¹ M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Department of Neurology, Moscow, Russian Federation

Background and aims: Movement disorders are the most common manifestation of stroke. To restore physical activity, various methods of non-drug treatment are used. Biomechanical control allows you to identify changes in gait, assess the degree of damage to individual muscles. A targeted effect on the affected muscles can increase the positive effect of the therapy and reduce the duration of rehabilitation.

Methods: We examined 6 patients with hemiparesis in the early recovery period of stroke. The patients underwent functional electrical stimulation (FES) of the muscles of legs under the control of biomechanical parameters.

Results: Biomechanical examination showed that patients with hemiparesis have changes in the main parameters of both legs. There was an increase in the support phase of both legs: 110-115% healthy leg (HL), 115-120% affected leg (AL). Decrease in the transfer phase 110-115% HL, 120-130% AL. An increase in the two-support phase up to 130-200%. After the FES course, a decrease in the support phase to 115-120% AL, 105-110% HL, an increase in the transfer phase 115-127% AL, 105-114% HL, a decrease in the bipartition phase to 120-180% of the norm (all percentages relative to the norm).

Conclusions: There were revealed positive results of FES under the control of biomechanical examination methods in the early recovery period of stroke. A biomechanical study made it possible to influence specific muscle groups, increasing the effectiveness of FES.

Disclosure: No

P0911 / 513

UTILISING MACHINE LEARNING AND BIG DATA TO EXPLORE THE DECISIVE PREDICTORS RESULTING IN THE AMELIORATION IN FUNCTIONAL MEASUREMENTS OF ISCHAEMIC STROKE PATIENTS

Y.-A. Chen ¹, K.-C. Hsu^2,3,4, C.-H. Lin^1,5, TSR Study Group

¹Chang Gung Memorial Hospital, Centre for Artificial Intelligence in Medicine, Taoyuan, Taiwan, Province of China, ²China Medical University, Department of Medicine, Taichung, Taiwan, Province of China, ³China Medical University Hospital, Artificial Intelligence Centre for Medical Diagnosis, Taichung, Taiwan, Province of China, ⁴China Medical University Hospital, Department of Neurology, Taichung, Taiwan, Province of China, ⁵Chang Gung University, Bachelor Programme in Artificial Intelligence, Taoyuan, Taiwan, Province of China

Background and aims: An essential issue of stroke study is to accurately identify what clinical factors influence prognosis in ischaemic stroke (IS) sufferers. This study aimed to define which clinical factors could ameliorate post-stroke cases’ conditions by comparing the 3-month follow-up modified Rankin Scale (mRS) to the discharge mRS.

Methods: We extracted 21,860 IS patients with mRS>2 (poor outcome) at discharge and 228 features such as treatments, chronic diseases and comorbidities from the Taiwan Stroke Registry. In comparison to the discharge mRS, we identified which features could predict changes in 3-month follow-up mRS from mRS>2 to mRS⩽2 (good outcome), illustrated as the dark blue flow in Figure 1. MICE imputation, Tomek Links, and extra trees (ET) classifiers were applied to model training; probability calibration finally adjusted the models’ performance. The features were also ranked according to their importance derived from ET models.

Results: Within the study dataset, about 54% of patients were males, and the average age was 71.69±11.81. When 228 features were input to ET, AUROC of the test set was 83%. We afterwards selected the 10 most influential indicators on the changes to retrain ET, while its AUROC only declined by 1%. The hospitalised treatment, discharged mRS and measurements of the Barthel Index were important decisive predictors (Figure 2).

Conclusions: Our results showed that we could accurately explore which factors caused the changes in poor IS patients’ mRS. In conclusion, future studies can focus more on what might better or deteriorate patients’ mRS to benefit patients.

Disclosure: No

P0912 / 899

USABILITY OF A COACHING PLATFORM FOR STROKE REHABILITATION: RESULTS FROM THE VCARE PROJECT EXPERIENCE IN A HOME-LIKE SCENARIO

A. Seregni ¹, P. Tropea¹, R. Re¹, A. Mannino¹, V. Biscaro², M. Caprino¹, E. Judica¹, M. Corbo¹

¹Casa di Cura del Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy, ²Need Institute Foundation, Milan, Italy

Background and aims: The continuity of care for patients with stroke requires innovative approaches merging the home-rehabilitation into the clinical-care-chain. vCare project (EU’s Horizon2020-https://vcare-project.eu) intends to meet this need by implementing a virtual coach to integrate machine learning with coaching and clinical pathway services, thus proposing personalized rehabilitation activities. This study aimed to evaluate the usability of the vCare platform, assessed both by patients and by health professionals, in a home-like scenario.

Methods: Patients with stroke experienced, autonomously but under therapists’ supervision, personalized rehabilitation treatments suggested by the vCare platform based on the neurologist’s indications. The proposed plan consisted mainly in motor and cognitive serious games in a virtual reality environment. At the end of the intervention, patients and health professionals assessed the platform’s usability by means of the SUS.

Results: 20 patients with stroke (16 ischemic, 10 females, 69.20±15.66 years) assessed motor and cognitive services with the average scores of 76.13±15.80 and 81.32±12.00, respectively. A usability of 78.50±11.26 was obtained by health professionals (n=5).

Conclusions: The vCare platform’s usability was assessed widely above the limit of acceptability (i.e., 68 points) both by patients and health professionals. These positive results prove the system’s intuitive use, fundamental to enhance patients’ adherence to the care plan, and are encouraging for ensuring continuity of treatment in the home scenario after inpatient rehabilitation in stroke patients.

Data-analysis and interpretation on potential benefits (satisfaction, usability and compliance) and ongoing activities will be presented during ESOC2022.

Disclosure: No

CASE REPORTS

P0913 / 703

RETRACTED: POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) SECONDARY TO RENAL ARTERY THROMBOSIS FOLLOWING COVID-19 VACCINATION

J. Au Yeung ¹, R. Grain², C. Koh³, Y.Y. Wang⁴

¹Guys and St Thomas NHS Trust, Clinical Pharmacology/Stroke, London, United Kingdom, ²Guys and St Thomas NHS Trust, Clinical Pharmacology/Obstetric Medicine, London, United Kingdom, ³Guys and St Thomas NHS Trust, General Medicine, London, United Kingdom, ⁴Guys and St Thomas NHS Trust, Neurology, London, United Kingdom

Abstract P0913/703 has been retracted at the request of the author due to the withdrawal of patient consent.

P0914 / 437

RECURRENT CEREBRAL INFARCTION DUE TO CEREBRAL VASCULITIS IN A PATIENT WITH ULCERATIVE COLITIS

S.H. Heo ¹, J.Y. Joo¹, H.G. Woo¹, D.-i. Chang¹

¹ Kyung Hee University Hospital, Neurology, Seoul, Korea, Republic of

Background and aims: Vascular complications are considered extraintestinal manifestations of ulcerative colitis (UC). Though there has been some controversy in the association between UC and stroke, and hypercoagulability and systemic inflammation are thought to be possible factors contributing to stroke pathogenesis.

Methods and results: A 49-year-old man presented with transient left side weakness. He underwent kidney plantation in 2017, after one year he was diagnosed with post-transplant UC through biopsy. Diffusion weighted imaging (DWI) showed high signal intensity at right parietal cortex, and MR angiography showed mild focal stenosis of right middle cerebral artery (MCA). There were no abnormal findings in the evaluation of embolic source such as echocardiography and 24-hour Holter tests. Antiplatelet treatment was started, but he had recurrent left side weakness and revisited our hospital after 3 months. DWI revealed high signal intensity at right corona radiata and basal ganglia. Brain MRA showed significant progression of left MCA stenosis. Vessel wall image was performed for additional differential diagnosis. Multiple intracranial arterial stenosis was found and multifocal, segmental, concentric enhancement and thickening of the vessel walls were found suggesting cerebral vasculitis. He was treated with methylprednisolone 500 mg/day for 5 days and his symptoms were improved. Follow-up MRA after 3 months showed moderately improving state of previous findings.

Conclusions: Serial follow-up VWIs of cerebral vasculitis in a patient with UC were provided. VWI can be a useful tool to confirm not only the diagnosis of cerebral vasculitis, but also the therapeutic effect of the immunosuppressant.

Disclosure: No

P0915 / 272

SEVERELY ISCHEMIC TISSUE WITH UNCERTAIN VIABILITY: AN ILLUSTRATION CASE

T. Nguyen ¹, B. Pham¹, K. Nguyen², T. Pham¹, T. Le³, V. Tran³, A. Truong^1,4, T. Nguyen^1,4

¹115’s People Hospital, Cerebrovascular Disease, Ho Chi Minh, Vietnam, ²University Medical Center, Neurology, Ho Chi Minh, Vietnam, ³115’s People Hospital, Neurointervention, Ho Chi Minh, Vietnam, ⁴Pham Ngoc Thach Medical University, Neurology, Ho Chi Minh, Vietnam

Background and purpose: Ischemic cores volume assessment using non-contrast computer tomography (NCCT) is based on experimental models and retrospective studies. Recently, stroke workflow has been optimized to reduce time to endovascular reperfusion for large vessel occlusion. Therefore, hypodense on NCCT may not demonstrate the volume of necrosis tissue in cases with rapid reperfusion achievement. We studied an acute stroke case with hypodense on NCCT and reversible on DWI-MRI follow-up.

Methods: We reported an acute stroke case at 115’s People hospital, Ho Chi Minh City, Viet Nam. We studied baseline clinical characteristics, National Institutes of Health Stroke Scale (NIHSS), imaging, angiography, intervention, and modified Rankin Scale (mRS) outcomes.

Results: A 62 years-old male ischemic stroke patient was admitted to the hospital at 2.5 hours after symptoms onset with NIHSS was 15. CT angiography showed right distal M1 MCA occlusion with homogeneous hypodense, which was evaluated as 3 points on ASPECTS-NCCT. The patient was treated by mechanical thrombectomy with successful reperfusion TICI of 3. Door-to-groin time was 92 minutes and pre-interventional ASPECTS-NCCT to successful reperfusion was 115 minutes. Follow-up MRI showed a heterogeneous right lesion on diffusion-weighted imaging with normal tissue intertwine, minor hemorrhage on T2*-weighted, and TOF-3D confirmed no re-occlusion or stenosis. The patient showed dramatic recovery with NIHSS was 4 at 24 hours after the procedure and mRS of 1 after 3 months follow-up.

Conclusions: Ischemic cores concept based on NCCT may be re-defined. More data are needed to confirm our findings.

Disclosure: No

P0916 / 1286

CONTRAST-INDUCED ENCEPHALOPATHY: CHALLENGING NEUROLOGICAL DIAGNOSIS

C. Pane ¹, M. Sideropulos², G. Napolitano², F.A. de Falco²

¹University Federico II, Naples, Italy, ²“Villa dei Fiori” Hospital- Acerra, Naples, Italy

Background: Contrast-induced encephalopathy(CIE) is a rare complication that presents with acute neurological disturbances following the administration of intravascular contrast media during cardiac catherization procedures. Even if pathophysiology remains unclear, the current hypothesis is disruption of the blood-brain barrier that allow the contrast agent to permeate into the CNS causing direct neurotoxicity,cerebral edema and altered neuronal excitability. CEI is extensively reported as a transient and reversible phenomenon and the prognosis can be extremely favorable even in comatose patients.

Methods: Here we describe a case of a 56-year-old woman who developed confusion, global aphasia, right hemianopia associated with hypertension and headache three hours after administration of 130 mL of hypo-osmolar and ionic contrast media for Percutaneous Coronary Intervention. Brain CT scan underlined poor differentiation of the left occipital lobe sulci secondary to edema. Prompt cerebral MRI was normal.EEG revealed diffuse slowing without focal or paroxysmal abnormalities,typical of an encephalopathic process. Brain MRI performed three days later showed two small high signal intensity on FLAIR and DWI in left temporal lobe with restricted signal on the ADC maps. Neurological examination gradually improved and seven days after the onset of symptoms she completely resolved neurological deficits.

Conclusion: CIE is a diagnosis of exclusion that requires close radiological and clinical monitoring of the patient.Clinical presentation could mimic other complication such as stroke, subarachnoid hemorrhage or posterior reversible encephalopathy syndrome and investigations are often not specific. Correct and prompt diagnosis of CIE is essential to avoid the risks associated with erroneous treatment. We emphasize the importance of awareness of this rare neurological complication following contrast administration.

Disclosure: No

P0917 / 183

BILATERAL CEREBRAL PEDUNCULAR INFARCTION WITH INCOMPLETE LOCKED-IN SYNDROME: A CASE REPORT AND LITERATURE REVIEW

Y. Liu ^1,2, X. Wang², J. Lin², D. Dai², L. Zhang², X. Leng¹

¹The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong, SAR of China, ²The First Affiliated Hospital of Harbin Medical University, Department of Neurology, Harbin, China

Background and aims: Bilateral cerebral peduncular infarction (BCPI) is a rare neurological disorder, usually presented with the locked-in syndrome (LIS) and persistent vegetative state, with a poor prognosis. We aimed to describe and discuss the etiology, clinical presentation, imaging features and prognosis of BCPI, with a new case and a literature review.

Methods: We reported a case with BCPI, and reviewed case reports and relevant clinical studies published in 1974-2021.

Results: A 57-year-old man with hypertension and uncontrolled diabetes presented with paroxysmal right limb weakness and dysarthria, which progressively worsened and developed into incomplete LIS on day 3 after admission despite prompt administration of aspirin and clopidogrel. Diffusion-weighted MR imaging showed acute infarctions in bilateral cerebral peduncles (the “Mickey Mouse ears” sign) and central pons. MR angiography revealed severe stenosis of the right posterior cerebral artery, the proximal and distal end of basilar artery and distal left vertebral artery (Figure). With progressive deterioration of the neurological function and severe pneumonia, the patient died one month after discharge. Based on the literature review, most BCPI patients presented with complete or incomplete LIS, with progressive deterioration. Large artery atherosclerosis with hypoperfusion and/or occlusion of perforator ostium are common mechanisms. Among 57 BCPI cases reported, 42 (73.7%) had a poor functional outcome or died.

Conclusions: BCPI may present with atypical symptoms at onset, with progressively worsening neurological conditions. Early and accurate recognition, timely antiplatelet treatment and management of complications are critical in BCPI, to reduce mortality and severe disability.

Disclosure: No

P0918 / 1293

LIMB SHAKING TIAS DUE TO INTRACRANIAL CAROTID DISEASE HERALDING A FULL BLOWN STROKE

R. Oguntoye ¹, S. Das¹, N. Ahmad¹

¹ Royal Wolverhampton NHS trust/New Cross Hospital, Stroke Medicine, Wolverhampton, United Kingdom

Background: Transient ischemic attacks (TIA) commonly present with negative symptoms and as such presentations as limb shaking presents a deviation from the normal and can be confused as focal seizure activity.

We present a 56yr old with a history of recurrent right limb shaking who posed a diagnostic challenge until he suffered a left hemispheric ischemic stroke.

Case Description: A 56yr old man with hypertension and T2DM presented to the clinic on 2 occasions previously with episodic transient right arm weakness and involuntary movement, the last episode before the index presentation being 4 months ago. The limb shaking episodes lasted 1min. Examinations and investigations examinations revealed nothing of note save for carotid doppler ultrasound which revealed a mixed atheroma in the carotid bulb.

Four months later, he experienced right facio-brachial paresis. Brain MRI showed left watershed ACA/MCA frontal acute infarct, CTA revealed a thrombus in the cavernous segment of the left internal carotid artery. He had a repeat CTA a week after receiving therapeutic doses of lower molecular weight heparin for 7 days and this revealed complete recanalization. Unfortunately, further MRA after 3 weeks with new symptoms while on anti-platelet suggested reformation of thrombus, young stroke screenings were unremarkable and he has since been on anti-coagulation. He has remained well since.

Conclusion: The limb shaking TIAs has been attributed to subcortical release phenomena caused by diffuse cortical hypoxia caused by carotid-occlusive disease. The case highlights the need for prompt intracranial evaluation of the carotids to forestall catastrophic future vascular events.

Disclosure: No

P0919 / 590

MOYMOYA SYNDROME SECONDARY TO SICKLE CELL DISEASE

H. Elhasin ¹, A. Hassan¹, N. Soliman¹, F. Hazin¹, T. M almansoori¹

¹ Tawam Hospital, Neurology, Al Ain, United Arab Emirates

Introduction: Moyamoya disease is chronic occlusive cerebrovascular disorder characterized by progressive bilateral stenosis of the arteries of the Circle of Willis and formation of small capillary-sized vessels and is a relatively uncommon neurovascular complication of sickle cell disease (1).

Aim of the work: To present rare case of moyamoya syndrome in an adult patient with SCD and sickle cell anemia (SCA).

Case report: A 22 years old male patient known case of (SCD) with history of recurrent sickle crisis on hyper transfusion therapy for (SCA). HE He has iron overload, remote stroke at age of 7 years old and recurrent TIAs. He was admitted with acute right sided weakness, numbness and slurred speech started 10 hours prior to admission. His symptoms resolved within 24 hours. Laboratory results revealed (Hg 9g/dl), HgF 0.3% and Hg S 36.9%. Brain MRI showed multiple tiny acute infarctions in the left centrum semiovale and remote multiple lacunar infarctions. Conventional four vessels cerebral angiogram revealed severe stenosis of the right internal carotid artery (ICA), distal left ICA, severe stenosis of the proximal left middle cerebral artery with typical radiological picture of Moyamoya. He had exchange blood transfusion and received packed RBCs, his HgbS dropped to 20%. His management was changed to regular exchange transfusions with aim to maintain HBS <30% additionally to Asprin 100 mg daily .

Conclusion: The presence of moyamoya syndrome influenced the risk of recurrence for ischemic cerebrovascular events in patients with sickle cell disease.

Disclosure: No

P0920 / 301

WITHDRAWN ANTON’S SYNDROME (VISUAL ANOSOGNOSIA) DUE TO ACUTE STROKE: A CASE REPORT

F. Erdogan Kucukdagli ¹, S. Gumusyayla¹

¹ Ankara City Hospital, Neurology Department, Ankara, Turkey

We present a case of a patient with Anton’s syndrome, who developed bilateral occipital lobe infarct. Bilateral occipital brain damage results in disfunction of visual cortex and blindness. Patients claim they can see and confabulate visual perceptions, despite loss of sight. This particular condition is a distinct feature of cortical blindness. This also is defined as visual anosognosia. In our case, a 69-year-old man has been admitted to Neurology Department due to a syncope and sudden onset blindness. According to neurological examination the patient was not aware of impaired visual perception. Video demonstrating visual anosognosia and confabulation was taken with the written consent of the patient’s son. Cranial CT and MRI revealed bilateral occipital ischemic lesions due to acute stroke. During the follow-up period, the patient was shown to have paroxysmal atrial fibrillation, which is the underlying cause of bilateral posterior cerebral artery thrombosis. With this case, we present a rare cortical perception disorder resulting from cerebrovascular disease.

Disclosure: No

P0921 / 367

CEREBELLAR COGNITIVE AFFECTIVE SYNDROME IN THE CONTEXT OF CROSSED CEREBELLAR DIASCHISIS POST PONTINE INFARCTION

A. Ourtani ^1,2, A. Diallo¹, S. Moorthamers¹, M.-D. Gazagnes¹

¹CHU Brugmann, Neurology, Brussels, Belgium, ²UZ Brussels, Neurology, Brussels, Belgium

Background and aims: We report a case of cerebellar cognitive affective syndrome in the context of crossed cerebellar diaschisis post pontine infarction.

Methods: Case report.

Results: A 51-year-old male presented at the emergency department with severe left sided facio-brachio-crural hemiparesis and dysarthria. He also complained of right sided neck pain since two days. Head and neck CT angiography revealed a dissection of the right vertebral artery. The patient was treated with IV thrombolysis. Brain MRI revealed a left paramedian pontine infarction (Figure 1). During his stay, the patient showed non-pre-existent cognitive dysfunction. Neuropsychological examination revealed deficits in the cognitive domains of executive function, spatial cognition, attention, short term memory, language and emotional control, compatible with cerebellar cognitive affective syndrome (CCAS). Brain SPECT showed the left paramedian pontine infarction and moderate hypometabolism in the right cerebellar hemisphere, most probably secondary to crossed cerebellar diaschisis (CCD), without any arguments for a neurodegenerative disease (Figure 2). Cerebrospinal fluid levels of Aβ peptide 1-42, tau and phosphorylated tau came back normal.

Conclusions: We describe a case of CCD secondary to pontine infarction, which clinically presented as CCAS. CCD is defined as attenuated blood flow and hypometabolism in the cerebellum secondary to a supratentorial lesion in the contralateral cerebral hemisphere. CCD due to pontine infarction is rare, but has already been described before. Interruption of the cortico-ponto-cerebellar pathway is thought to be the most likely mechanism of this phenomenon.

Figure 1.

MRI FLAIR (left) and DWI (right) imaging (2 days post-stroke)

Figure 2.

Brain SPECT

Disclosure: No

P0922 / 1436

MENINGOVASCULAR NEUROSYPHILIS: ILLUSTRATIVE CASE

I. Martínez Fernández ¹, F. Panadero Moratalla², F. Hernández Fernández¹, J.J. Blanch Sancho³, J.D. Molina Nuevo⁴, J.E. Solis García del Pozo³, O. Ayo Martin¹, J. García García¹, B. Serrano Serrano¹, C.M. Romero Sanchez¹,T. Segura Martin¹

¹Complejo Hospitalario Universitario de Albacete, Neurología, Albacete, Spain, ²Complejo Hospitalario Universitario de Albacete, Hematología, Albacete, Spain, ³Complejo Hospitalario Universitario de Albacete, Medicina Interna, Albacete, Spain, ⁴Complejo Hospitalario Universitario de Albacete, Radiodiagnóstico, Albacete, Spain

Background and aims: Meningovascular neurosyphilis is a classic entity, with a low incidence nowadays. Therefore, experience is limited and neuroimaging reports are scarce.

Methods: We report on a case report without any relevant past medical history who presented in the emergency room with acute-onset hemiparesis. Management, follow-up, laboratory and neuroimaging data are presented.

Results: A 45-year-old woman consulted for subacute progressive headache, dysarthria, right hemiparesis and fever for months. Baseline computed tomography (CT) showed a subacute ischemic lesion in the posterior arm of the left internal capsule and angio-CT revealed a moderate stenosis of the supraclinoid portion of the left internal carotid artery, so inflammatory process or vasospasm in the origin of the left anterior choroidal artery was suspected. An urgent lumbar puncture was performed, revealing lymphocytic meningitis with 27 cells, 1.53 g/L protein and 37mg/dL glucose, with positive serology for syphilis. The serologies performed revealed co-infection with HIV and a definitive diagnosis of meningovascular neurosyphilis. The study was completed with cerebral arteriography and treatment was started with dexamethasone, Retrovirals, Benzylpenicillin and Trimethoprim/Sulfamethoxazole. Subsequent evolution was favorable with decrease of viral load and frank improvement of paresis. A control angio-CT scan performed at 6 weeks showed complete resolution of the intracranial stenosis.

Conclusions: As previous papers have reported, co-infection with HIV and syphilis accelerates the development of meningovascular complications of the later, often with early strokes.

Disclosure: No

P0923 / 303

TRANSIENT PERIVASCULAR INFLAMMATION OF THE CAROTID ARTERY (TIPIC SYNDROME) IN A BULGARIAN PATIENT

M. Peycheva ¹, T. Zdravkova^2,3, D. Zlatareva^4,3, Z. Harizanova⁵, F. Ahmed-Popova⁵

¹Medical University Plovdiv, Department of Neurology, Plovdiv, Bulgaria, ²Medical University Plovdiv, Department of Image Diagnostics, Plovdiv, Bulgaria, ³Medical University Plovdiv, Translational Neuroscience Complex, Plovdiv, Bulgaria, ⁴Medical University Sofia, Department of Image Diagnostics, Sofia, Bulgaria, ⁵Medical University Plovdiv, Department of Human Anatomy, Histology and Embryology, Plovdiv, Bulgaria

Transient Perivascular Inflammation of the Carotid artery is a rare unclassified clinicoradiologic vascular syndrome that usually affects common carotid artery near the bifurcation and has a benign prognosis after treatment with anti-inflammatory drugs.

A 52-year-old male visited the Clinic of Neurology in UMHAT “Saint George” Plovdiv, Bulgaria in June 2021. He had cervical pain on the right side and tinnitus from a month ago.On physical and neurological examinations no pathological findings were discovered. On ultrasound examination (figure 1)

in B mode and Color Doppler mode a longitudinal, irregular thickening of the wall of the right common carotid artery near to the bifurcation was observed. The patient performed CT angiography and no stenosis was detected (figure 2).

MR imaging (figure 3) showed eccentric, spindle-shaped thickening of the wall of the right common carotid artery. The lesion affected the middle and distal segment of the artery on its ventral side. It was about 28 mm long and with the greatest width 5 mm. On postcontrast T1-weighted MRI an eccentric enhancing surrounding the carotid artery was noted. The laboratory investigations of the patient showed normal values of hs-CRP and ESR. Differential diagnosis with vasculitis, carotid dissection and thrombus were excluded. The patient received NSAIDs for a month and had an immediate reduction of the wall thickening. He continued follow up ultrasound investigations. This is the first diagnosed Bulgarian case of TIPIC syndrome that has a good recovery after treatment. Its pathophysiology remains unclear and further investigations have to be done.

Disclosure: No

P0924 / 368

SPONTANEOUS FBN1 MUTATION ACCOMPANIED BY MYH11 DUPLICATION, CAUSING AORTIC DISSECTION AND STROKE IN A YOUNG WOMAN

M. Carey ¹, K. Anderson², W. Hopkins³, E. Boyer⁴

¹University of Vermont Robert Larner, MD College of Medicine, Burlington, United States, ²University of Vermont Medical Center, Department of Clinical Genetics, Burlington, United States, ³University of Vermont Medical Center, Department of Cardiovascular Medicine, Burlington, United States, ⁴University of Vermont Medical Center, Department of Neurological Sciences, Burlington, United States

Background and aims: This case report describes a 26-year-old female patient with a history of clinically-diagnosed Marfan syndrome who initially presented for evaluation of right upper extremity plegia and dysarthria. She was found to have a left-sided middle cerebral artery stroke, the etiology of which was determined to be from a left carotid artery dissection with extension into the left internal carotid artery. The patient re-presented four months later with a new type B aortic dissection (figure 1).

Methods and results: Genetic testing was performed, and results were notable for a pathogenic variant of FBN1, confirming her clinical diagnosis of Marfan syndrome. The patient was also found to have an unexpected duplication of the entire coding region of MYH11, a gene known to be associated with the predisposition toward thoracic aortic aneurysms and dissections. Specifically, MYH11 lies in the region of chromosome 16p13.1 which, when duplicated, appears to confer increased risk for aneurysms and dissections when compared to normal copy numbers1. Recurrent duplications of chromosome 16p13.1 specifically have been identified in cases of familial aortic and cervical artery dissection2, though our patient’s family history was not suggestive of any such vascular pathology.

Conclusion: To our knowledge, this is the first case of genetically-confirmed spontaneous Marfan syndrome accompanied by MYH11 mutation, causing aortic dissection and stroke in a young woman.

Figure 1.

Spontaneous type 2 aortic dissection.

References:

1. Kuang et al., doi: 10.1371/journal.pgen.1002118. PMID: PMC3116911.

2. Erhart et al. doi: 10.1002/mgg3.371. PMID: PMC6014458.

Disclosure: No

P0925 / 1602

ARTERY OF PERCHERON INFARCTION: A CASE SERIES OF FIVE

K. Melaika ¹, K. Ryliškienė², A. Ekkert², D. Jatužis², R. Masiliūnas²

¹Vilnius University Faculty of Medicine, Vilnius, Lithuania, ²Vilnius University Center of Neurology, Vilnius, Lithuania

Occlusion of artery of Percheron (AOP) causes bilateral thalamic infarction that accounts for around 0.5% of all ischemic strokes. However, due to its unusual clinical presentation and no clear abnormalities in early medical imaging, it raises complicated diagnostic challenges, resulting in delayed diagnosis and limited treatment possibilities.

Our case series includes five patients diagnosed with bilateral thalamic stroke due to AOP occlusion, admitted to Vilnius University Hospital between December 2018 and December 2021.

Three male and two female patients had a median age of 58 years (range 55–89 years). Dysphasia (5/5), decreased vigilance (4/5), memory impairment (4/5), ophthalmoplegia (4/5), motor impairment (3/5), and spatiotemporal disorientation (3/5) were the most common clinical signs. On admission, no abnormalities were observed in one patient who underwent Computed Tomography (CT), and three who received CT Angiography. Another patient with unknown time of symptom onset had bilateral thalamic lesions on baseline CT. Thalamic lesions were reported in follow-up CT or Magnetic Resonance Imaging in all cases. High D-dimer levels were observed in 3/3 patients. One comatose patient underwent intravenous thrombolysis with recombinant tissue plasminogen activator, resulting in complete neurological recovery. At three months, slight residual memory impairment was observed in one patient, slightly improved symptoms - in two patients, and the 89 year-old patient had died.

Timely diagnosis of AOP occlusion may be difficult due to unusual clinical presentation and lack of baseline imaging abnormalities. However, if diagnosed within the therapeutic window, reperfusion therapy could lead to excellent patient outcomes even in comatose patients.

Disclosure: No

P0926 / 1030

EMBOLIC OCCLUSION OF FETAL TYPE POSTERIOR CEREBRAL ARTERY TREATED WITH ENDOVASCULAR THROMBECTOMY - REPORT OF TWO CASES

K. Matz ¹, A. Apetroae², A. Chemelli³, C. Brunner⁴, C. Nasel⁵

¹University of Continuing Education Krems, 3500 Krems, Austria, Department for Clinical Neurosciences and Preventive Medicine, Krems, Austria, ²Landes Klinikum Baden-Mödling, Neurological Departement, Mödling, Austria, ³Landes Klinikum Baden-Mödling, Radiological Departement, Mödling, Austria, ⁴University Clinic Tulln, Landsteiner Private University, Neurological Department, Tulln, Austria, ⁵University Clinic Tulln, Radiological Departement, Tulln, Austria

Background: The fetal variant of the posterior cerebral artery (fPCA) conserves a major blood flow from the anterior to the posterior cerebral circulation via a strong persistent caudal portion of the embryonic internal carotid artery. This variant is found with higher prevalence in stroke patients than in healthy control subjects (19% vs 9%).

Methods: We retrospectively reviewed patient data - patient’s history hospital charts of the admitting stroke unit and of the stroke centre performing the TE. Additional data was accessed from the endovascular part of the Austrian Stroke Unit registry. Neuroimaging data was reviewed and reanalysed by an expert neuroradiologist (CN).

Results: We present two cases where endovascular treatment in acute ischemic stroke (AIS) was complicated by this flow diversion. Though direct thrombectomy of the fPCA using a stent retriever was feasible and successful in both cases outcome remained unfavourable due to a continuous redirection of embolic material into the posterior circulation.

Conclusion: Knowledge of flow dynamics of a PCA is important for endovascular treatment of ischemic stroke because collateral supply of fPCA infarcts is insufficient and redirection of recurrent emboli into the fPCA can be triggered by concurrent blood flow impairment in the territory of the internal carotid artery.

Disclosure: No

P0927 / 629

ISCHEMIC STROKE IN A YOUNG ADULT WITH HEMOPHILIA A: A RARE CAUSE NOT TO BE MISSED

E. Tzeravini¹, S. Samara ², A. Kourampa³, G. Vakrinos⁴, A. Efthimiou⁵, M. Tzetis⁶, T. Androutsakos⁷

¹Laiko General Hospital, First Department of Propaedeutic and Internal Medicine, Athens, Greece, ²Laiko General Hospital, Athens, Greece, ³Laiko General Hospital, Blood Centre, National Reference Centre for Congenital Bleeding Disorders, Athens, Greece, ⁴Euroclinic, Department of Diagnostic and Interventional Radiology, Athens, Greece, ⁵Laiko General Hospital, Department of Neurology, Athens, Greece, ⁶Medical School, National and Kapodistrian University of Athens, Department of Medical Genetics, Athens, Greece, ⁷Medical School, National and Kapodistrian University of Athens, Department of Pathophysiology, Athens, Greece

Background and aims: Severe Hemophilia A and Moyamoya (SHAM) syndrome is a rare condition that combines Hemophilia A and Moyamoya Disease, due to an Xq28 microdeletion encompassing the F8 and BRCC3 genes.

Methods: Here, we report the case of a 19-year old male patient with Hemophilia A, that presented with right-sided hemiparesis and dysarthria. Brain Magnetic Resonance Imaging and Angiography revealed an ischemic lesion in the left lobe and stenosis of both middle cerebral arteries with a concomitant thick vascular network, compatible with Moyamoya Disease.

Results: Next generation sequencing revealed a large Xq28 deletion compatible with SHAM syndrome. The patient was treated with acetylsalicylic acid and neurosurgical intervention was scheduled.

Conclusions: Although extremely rare, physicians should consider of SHAM syndrome in any male, young patient with known Hemophilia A and symptoms of stroke, seizures or headaches with no other alternative diagnosis. Magnetic resonance angiography and chromosomal microarray analysis should be performed whenever SHAM syndrome is suspected.

Disclosure: No

P0928 / 1544

HEART AND BRAIN CONNECTION IN EVERYDAY CLINICAL PRACTICE: MULTIPLE CASE STUDIES REPORT

D. Lauer ¹, T. Peisker¹, J. Sulženko², P. Vaško¹, P. Mikulenka¹, B. Kožnar², D. Kučera², I. Štětkářová¹, P. Widimský²

¹University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Department of Neurology, Prague, Czech Republic, ²University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Department of Cardiology, Prague, Czech Republic

Background and aims: Heart and brain are two organs that have significant effect on each other. Almost one third of all ischemic strokes are caused by embolization due to atrial fibrillation (AF); however, AF is not the only cause. We are presenting three patients who all suffered from an ischemic stroke due to embolization caused by different types of heart disease.

Methods: We have performed a standardized clinical neurologic examination, CT and CT angiography to diagnose an ischemic stroke in all three patients. Appropriate therapy was then selected.

Results: The first patient, 71 years old female, with acute onset of left hemiplegia and chest pain was diagnosed with right T-type ICA occlusion combined with an acute occlusion of LAD coronary artery both due to emboli formed during AF.

The second patient, 20 years old female, with acute onset left hemiplegia was diagnosed with right proximal MCA occlusion by embolus previously formed on a mechanical mitral valve while having low INR.

The third patient, 38 years old female, who suffered from several focal to bilateral tonic-clonic seizures with persisting right hemiplegia, was diagnosed with left proximal MCA occlusion by a septic embolus due to infectious endocarditis.

First two patients were successfully treated with mechanical thrombectomy (MT), while the third patient was not eligible for acute reperfusion therapy.

Conclusions: All three patients suffered from an ischemic stroke due to embolization which could have been preventable. When dealing with a patient suffering from heart disease, it is crucial to prevent potential brain damage.

Disclosure: No

P0929 / 1450

NON-KETOTIC HYPERGLYCEMIA MIMICKING A LEFT MIDDLE CEREBRAL ARTERY STROKE

R. Leone ¹, S. Altomare¹, M.S. Aniello¹, D. Liuzzi¹, I. Plasmati¹, M. Sardaro¹, M. Superbo¹, R. Carpentiere², M. Giorelli¹

¹“Dimiccoli” General Hospital, Operative Unit of Neurology, Barletta, Italy, ²“Dimiccoli” General Hospital, Operative Unit of Radiology, Barletta, Italy

Background: Hyperglycemia is considered a potential stroke mimic. However, it rarely determines focal neurological deficits reflecting a vascular distribution. We present a case of a nonketotic hyperglycemia presenting as left MCA syndrome.

Case report: A 83-years-old woman with diabetes, hypertension, hyperlipidemia, presented to ED with fluctuating severe aphasia, right hemiparesis (maximum NIHSS: 12, OTD: 110’) and elevated blood glucose (>600s). Brain-CT was negative for hemorrhage, while head/neck CT-angiography revealed no intracranial large vessel occlusion/stenoses. EEG demonstrated left hemispheric slowing without epileptiform discharges. Thrombolysis wasn’t performed because of persistent severe hyperglycemia despite insulin. At eight hours after onset, a CT brain perfusion showed normal TTP, MTT, CBV and CBF. Once normoglycemia was achieved, neurological deficits improved and passed away within 24-hours. EEG findings normalized, too. 72-hours later, Brain-MRI was negative for acute ischemia.

Discussion: During hyperglycemia, focal neurological deficits are described, but usually ascribable to post-ictal Todd’s paresis. This doesn’t seem to be our case, because tonic-clonic movements, incontinence, tongue-biting, or trauma were not reported, and EEG findings are non-specific. Also, patient’s status correlated with improvement of glycemia. Hyperglycemia is associated with transient neuronal dysfunction in the left hemisphere based on EEG slowing without vascular impairment. The normal perfusion reflects a metabolically inactive tissue rather than ischaemic tissue (see Figure 1). It’s not clear how hyperglycemia determines reduced energy demand and laterality.

In conclusion, we report a case of hyperglycemia mimicking a left MCA syndrome without evidence of seizure or stroke reversed with medical management.

Disclosure: No

P0930 / 622

ACUTE ISCHEMIC STROKE IN PREGNANCY TREATED WITH INTRAVENOUS THROMBOLYSIS AND ENDOVASCULAR THERAPY – FIRST CASE FROM BULGARIA

D. Kalpachka ^1,2, T. Sakelarova¹, N. Alioski³, R. Kalpachki^1,2

¹‘St. Anna’ University Hospital, Department of Neurology, Sofia, Bulgaria, ²South-West University ‘Neofit Rilski’ (SWU), Blagoevgrad, Bulgaria, ³‘St. Anna’ University Hospital, Department of Neurosurgery, Sofia, Bulgaria

Background and aims: Pregnancy is usually the exclusion criterion in clinical trials for the effectiveness of intravenous thrombolysis and endovascular procedures in acute ischemic stroke. Therefore, there is currently a lack of evidence and strong recommendations for stroke management during pregnancy. We present a rare case of a pregnant woman with ischemic stroke underwent successful specific treatment.

Methods: A 36-year-old woman of 22 weeks’ gestation presented with right facial-paresis, hemiparesis, and aphasia, NIHSS - 23. Her CT-angiogram showed a large occlusive thrombus within the M1-M2 segments of the left MCA. There was initial treatment decision dilemma. As the thrombus was large, rtPA may also be ineffective. Вut mechanical thrombectomy (MT) had a risk of exposure to radiation and contrast agents. An interdisciplinary team of neurologist, radiologist, neurosurgeon - endovascular specialist and obstetrician-gynecologist decided to start with intravenous thrombolysis as a less invasive method without X-rays (128 minutes after the symptom onset, DNT 48 min). Because partial outcome, 190 minutes after the symptom onset (DGT 110 min) we switched to thrombaspiracy for more effectiveness.

Results: The clot was aspirated without complications. Final check angiogram showed complete resolution of flow within the left middle cerebral artery territory. The patient was discharged with significant improvement mRS – 1, NIHSS – 2, GLCS – 20.

Conclusions: Severe stroke in pregnancy is rare, but has grave consequences for both mother and infant. Timely decision-making is very important. Our case demonstrates that intravenous thrombolysis and mechanical thrombectomy can be provided safely and effectively during pregnancy.

Disclosure: No

P0931 / 1240

TWO THROMBECTOMIES: RESCUE THROMBECTOMY AT HOUR 40

S. Kyle¹, H. Sims ¹

¹ North Bristol NHS Trust, Stroke, Bristol, United Kingdom

Introduction: Currently evidence is limited when it comes to the benefit of thrombectomy in patients >24 hours from onset of symptom and the role of second rescue thrombectomy in patients who deteriorate again following the initial procedure is also unclear.

Case presentation: We present a case of a 63 year-female with right MCA syndrome and NIHSS 19 (mRS 0), thrombolysed and transferred to local thrombectomy centre. Angiogram demonstrated proximal M1 occlusion. Successful aspiration but residual narrowing of mid-M1 suggesting intra-cranial atherosclerotic disease (ICAD). Stent deployed but on-table103 revealed possible SAH and basal ganglia contrast-staining. Stent recaptured as risk of DAPT to preserve stent patency felt too high.

Day two, patient deteriorated in both GCS and neurology. CTA showed re-occluded M1, CTP showing large salvageable penumbra. Patient underwent rescue thrombectomy including stent deployment at M1 narrowing.

Outcome: Patient discharged home, mRS 4, with ongoing rehabilitation. Dual antiplatelet therapy changed to DOAC after 2 weeks for secondary prevention of AF.

Conclusion:

This case demonstrated several important learning points:

• Importance of rapid assessment in patients who deteriorate post-hyperacute reperfusion therapy, and the consideration of second rescue-thrombectomy.

• Patients with ICAD at higher risk of recurrent stroke and failed thrombectomy.

• Risks vs benefits of antiplatelet therapy for stents in the context of intracranial haemorrhage post-thrombectomy.

• Benefit of extended window thrombectomy when patients are carefully selected using advanced imaging such as CTP.

• Fast vs slow progressors depending on collateral supply is important in deciding whether a patient may benefit from extended window thrombectomy.

Disclosure: No

P0932 / 1579

APHASIA AS AN UNCOMMON SYMPTOM OF ANTERIOR CHOROIDAL ARTERY ISCHEMIC STROKE

A.M. González García ¹, J.A. Vizcaya Gaona¹, B. Rodríguez García¹, F.J. González Terriza¹, A. Sierra Gómez¹, L. López Mesonero¹, S. Borja Andrés¹, J.M. Velázquez Pérez¹, L. Redondo Robles¹, G. Monteiro Carvalho¹

¹ Complejo Asistencial Universitario de Salamanca, Neurology Department, Salamanca, Spain

Background and aims: In an infrequent percentage of patients, deep vascular territory ischemic strokes may present cortical symptoms, becoming greater its comorbidity and minor the efficacy of fibrinolytic therapy. We present a case report in order to enhance clinical suspicion and remark its relevance.

Methods: 83-year-old woman with vascular risk factors who abruptly presented right hemiparesis, hemianesthesia and global aphasia.

Results: Multimodal brain CT was performed, albeit no acute ischemic signs were visualized. Moreover, after few minutes, symptoms ceased, and the capsular warning syndrome diagnosis was stablished. Eventually, the patient was admitted to the Stroke Unit (SU).

Nevertheless, focal neurological deficit reappeared and a multimodal brain CT was realized again. No infarct core, artery occlusion nor perfusion impairment were objectified, and consequently, fibrinolytic therapy was administered. Nonetheless, no signs of recovery were shown.

Throughout the SU hospitalization, a brain MRI was done and a left Anterior Choroidal Artery vascular territory infarct was objectified. Additional supplementary testing was performed (transthoracic echocardiography, neurosonology study and blood testing), although no certain etiology was determined.

Unfortunately, the patient suffered from a different cerebrovascular episode, sustaining serious neurological symptoms.

Conclusions: Cortical deficit symptoms are no criteria of exclusion of Anterior Choroidal Artery ischemic stroke, representing a major comorbidity brain infarct.

Disclosure: No

P0933 / 1567

“CONFUSING STROKE PRESENTATIONS” - TWO UNUSUAL CASES IN WHICH PATIENTS WITH ACUTE STROKES PRESENTED WITH SUDDEN ONSET CONFUSION AND AMNESIA

K. Kee¹, C. Bench ¹, N. Roberts¹, P. Christie¹, A. Elnil¹, E. Lawrence¹

¹ Croydon Health Services NHS Trust, London, United Kingdom

Introduction: Classically strokes present with unilateral weakness and / or sensory deficit, aphasia, neglect, homonymous hemianopia, or cerebellar ataxia. Acute confusion is not commonly associated with stroke and tends to be classically associated with delirium and an infective cause. We present two cases in which stroke was the cause of an acute confusion state.

Case 1: 74 year old female presented with 72 hours of sudden onset acute confusion which was mainly anterograde amnesia. She had a background of hypertension and high cholesterol. Other than a raised calcium initial bloods and observations were unremarkable. A CT head on the day of admission showed an area of low attenuation behind the right head of caudate nucleus which potentially represented an established infarct. She had a lumbar puncture which ruled out encephalitis before an MRI confirmed a recent infarct in the anterior fornix.

Case 2: 58 year old female presented with a sudden onset of acute confusion. She was disoriented in place and had some autobiographical amnesia. She had a background of hypertension and Type 2 Diabetes. Routine blood tests were unremarkable. An MRI showed an acute infarct involving the anterior ventral left thalamus, body of thalamus, part of caudate and globus pallidus.

Conclusion: Although confusion is not a common presenting syndrome of stroke, in patients who have a history of sudden onset of confusion – memory loss with no other signs of delirium should have an urgent MRI to rule out acute stroke as a cause for their amnesia and confusion.

Disclosure: No

P0934 / 555

PROLONGED LOW-DOSE INTRAVENOUS THROMBOLYSIS IN EARLY RECURRENCE OF STROKE: CASE REPORT

D. Černík ¹

¹ Masaryk Hospital, Krajská zdravotní a.s., Neurology, Ústí nad Labem, Czech Republic

Background and aims: Intravenous thrombolysis (IVT) is the standard therapeutic procedure for acute ischemic stroke (AIS). In early recurrence of an AIS, the administration of repeated IVT is controversial (risk of hemorrhagic complications). Due to the location of ischemia and predicted prognosis, we consider a prolonged low dose of IVT in some cases.

The aim of the case report is to present a specific situation suitable for this therapy.

Methods: A patient (male, 67 years old) was brought in by the ambulance service for severe right lower limb paresis. CT were performed followed by standard IVT with clinical improvement. MR examination of the brain showed acute ischemia in the center of the semiovale left. At 25 hours after completion of IVT, the condition worsened sharply (plegia of the right upper limb and paresis of the right lower limb). CT didnt show a new abnormality. With regard to the localization of ischemia, we proceed to the administration of prolonged (10 hours) low-dose (20 mg rTPA) IVT.

Results: In the patient, the chosen therapy led to a significant improvement in the clinical condition (light right lateralization). No haemorrhagic complication was present.

Conclusion: According to case reports and publications of small cohorts of patients, prolonged low-dose IVT seems to be a relatively safe treatment for AIS, which we approach in very severe neurological deficits with a relatively favorable radiological finding - the extent of small ischemia in clinically important areas ,with lower potential for hemorrhagic complications.

Disclosure: No

P0935 / 1562

A LESS KNOWN CAUSE FOR CEREBRAL MICROBLEEDS – A CASE REPORT

V. Vamadevan ¹, J. David¹, L. Sekaran¹

¹ Luton and Dunstable University Hospital NHS Trust, Luton, United Kingdom

Background and aims: Anecdotal evidence suggest open heart surgery cause Cerebral Microbleed (CMB). We report such a rare case of post cardiac surgery CMB.

Methods/Description: A 40-year-old male presented to transient ischemic attack clinic, with episodes of vision disturbance during last 1 month, involving left half of visual field and lasting 10-15 minutes. He was only on Propranolol for migraine (recent attack was 4 years ago) and had undergone open heart surgery 10 months ago for cardiomyopathy. MRI head revealed large number of CMBs distributed evenly throughout lobes, cerebellum and brainstem with no features of small vessel disease or superficial siderosis.

Results/Discussion: Striking widespread CMBs tempt diagnosing cerebral amyloid angiopathy (CAA) with ‘amyloid spells’ leading to unjustified caution/contraindication for thrombolysis, antiplatelets or anticoagulation, should these be needed in future. History of previous cardiac surgery, lack of clinical/radiological small vessel disease markers and fairly equal lobar and deep CMBs, guided towards the rare but appropriate diagnosis in this case.

Conclusions: Diagnostic/therapeutic implications of post cardiac surgery CMBs need further research as this may avoid improper diagnosis/overreporting of CAA and provide proper risk stratification regarding antithrombotic/thrombolytic treatments for indicated patients.

References:

De Sciscio M, De Sciscio P, et al. Cerebral microbleed distribution following cardiac surgery can mimic cerebral amyloid angiopathy. BMJ Neurology Open. 2021;3:e000166. doi: 10.1136/bmjno-2021-000166

Patel N, Banahan C, et al. Perioperative cerebral microbleeds after adult cardiac surgery. Stroke. 2019;50:336-343. doi: 10.1161/STROKEAHA.118.023355

Greenberg SM, Charidimou A. Diagnosis of cerebral amyloid angiopathy - evolution of the boston criteria. Stroke. 2018;49(2):491-7. doi: 10.1161/STROKEAHA.117.016990

Disclosure: No

P0936 / 1397

EXERTIONAL HEAT STROKE WITH RECURRENT POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)

P. Reiner ¹, B. Soyer², M. Kindermans², C. Calligaris¹, L. Neumann¹, M. Mazighi¹, E. Jouvent¹

¹Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Neurology, Paris, France, ²Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Anesthesiology and Critical Care, Paris, France

Background and aims: Heat stroke is a thermal insult of the brain thermoregulatory system controlling heat production and dissipation. Heat strokes have been reported among joggers, causing multiple organ failure, seizure and consciousness disturbance, with posterior reversible encephalopathy syndrom (PRES) lasting for several days in most patients.

Methods: We report a clinical and radiological case of exertional heat stroke with delayed recurrent PRES.

Results: A 29-years-old amateur man runner, without past medical history, was admited to the intensive care unit for hyperthermia, confusion and hemodynamic failure after running a half-marathon in hot weather condition (28°C). He was diagnosed as heat stroke and admitted in the intensive care unit for 3 weeks, then discharged to the nephrology department due to a persistent renal impairment without neurological deficit apart from general hypotonia.

One month and 2 months after the initial collapse, the patient experienced recurrent neurological deterioration (i.e. consciousness disturbance) lasting for 14 and 8 days respectively with cerebellar and supratentorial subcortical edema including hemorrhagic transformation on MRI and CT scan, that resolved after 20 and 8 days. Of note, 24 hours before each recurrence blood pressure increased significantly and both outbreak improved at least partially.

Conclusion: This case suggests that PRES induced by heat stroke, could be delayed and responsible for loss of cerebral vascular autoregulation lasting for several weeks after the initial collapse. Particular attention should be paid on blood pressure control until cerebral autoregulation integrity is restored.

Disclosure: No

P0937 / 1009

MECHANICAL THROMBECTOMY AND TRANSCRANIAL DOPPLER MONITORING IN A PATIENT WITH MASSIVE CEREBRAL VEIN AND DURAL SINUS THROMBOSIS

B. Serrano-Serrano ¹, F. Hernández-Fernández¹, J. García-García¹, J.D. Molina-Nuevo², E. Escribano-Taravilla³, C. Jiménez-Roldán⁴, O. Ayo-Martín¹, C.M. Romero-Sánchez¹, C.A. Alcahut-Rodríguez¹, T. Segura¹

¹Complejo Hospitalario Universitario de Albacete, Neurology, Albacete, Spain, ²Complejo Hospitalario Universitario de Albacete, Radiology, Albacete, Spain, ³Complejo Hospitalario Universitario de Albacete, Intensive Care Unit, Albacete, Spain, ⁴Complejo Hospitalario Universitario de Albacete, Anesthesiology, Albacete, Spain

Background and aims: Cerebral vein thrombosis (CVT) is an uncommon cause of stroke. It can lead to venous infarction, hemorrhage, and elevated intracranial pressure. Anticoagulation is recommended as standard treatment, but in severe cases or in patients who deteriorate, endovascular mechanical thrombectomy (EVT) could be an option.

The aim of this case report is to show the clinical outcome of a patient diagnosed of CVT and treated with EVT.

Methods: Patient diagnosed of massive CVT, treated with anticoagulation and EVT. Intracranial pressure was monitored with transcranial Doppler (TCD).

Results: A 29-yer-old female with history of oral contraceptive treatment, transferred to our hospital because of progressive headache and papiledema with high cerebrospinal fluid pressure, who had developed generalized seizures, aphasia and right hemiparesia. Noncontrast CT showed sinus hyperdensity, CT venography showed transverse, sigmoid, superior sagital sinus, deep and cortical vein thrombosis. She was treated with low molecular weight heparin, without improvement. TCD showed a high pulsatility index (PI) in both middle cerebral arteries, suggestive of severe intracranial hypertension. Intravenous mannitol was started and the massive thrombosis was treated with EVT, with repermeabilisation of the previously occluded sinus. Control TCD showed a normalized PI and headache, seizures and focal deficits dissapeared.

Conclusions: Although guidelines are cautious in recommending the use of EVT for patients with CVT, this treatment can be effective for selected patients, specially for those who deteriorate despite anticoagulation, or patients with massive CVT. TCD seems to be a useful tool for monitoring intracranial pressure and response of these patients.

Disclosure: No

P0938 / 1283

ENDOVASCULAR TREATMENT AS THERAPY FOR CEREBRAL VENOUS THROMBOSIS IN A 2-LEVEL STROKE CENTRE IN SPAIN: A REPORT OF TWO CASES

I. Bermejo Casado ¹, J.C. Portilla Cuenca¹, E. Morales Bacas¹, L. López Gata¹, M. Duque Holguera¹, V. Romero Cantero¹, M. Martínez Acevedo¹, I. Martínez González², S.L. Moyano Calvente², I. Casado Naranjo¹

¹H. Universitario de Cáceres, Neurology, Cáceres, Spain, ²H. Universitario de Cáceres, Neurointerventional Radiology, Cáceres, Spain

Background and aims: Cerebral venous thrombosis (CVT) is a rare disease with high morbimortality. Systemic anticoagulation is the usual therapy. The use of endovascular treatment (ET) is less common (5%)¹ and its efficacy and safety are not well established². The aim of the present study is to report our experience in the use of ET of CVT during the first year of its implementation in a 2-level stroke centre³.

Methods: Two cases description.

Results: Case 1: 58-year-old male, ex-smoker with a history of haemochromatosis. Case 2: 23-year-old woman with a history of migraine, obesity and use of oral contraceptives. They were admitted to the stroke unit diagnosed of CVT by CT venography. Extensive CVT with a high risk of poor prognosis⁴was found. The cardinal symptom was prolonged headache with clinical alarm features in both cases. Acute symptomatic seizure and venous infarction, associated with haemorrhagic transformation in case 1, were presented as complications. The common thrombus location was the superior longitudinal sinus. Early anticoagulation treatment with LMWH was established. After prompt neurological impairment they received additional ET comprising mechanical thrombectomy and angioplasty. Venous sinus recanalization was achieved. The clinical evolution was favourable (mRs 0-1 points) after 3 months.

Conclusions: In our experience ET is a reasonable therapeutic alternative in those patients with severe CVT who have been refractory to the best possible medical treatment. The evidence for recommendations on the use of ET is still insufficient and requires randomised clinical trials for further information.

Disclosure: No

P0939 / 311

UNILATERAL CEREBRAL AMYLOID ANGIOPATHY: A RARE PRESENTATION OF A COMMON DISEASE

A. Ourtani ^1,2, A. Cambier¹, S. Moorthamers¹, M.-D. Gazagnes¹

¹CHU Brugmann, Neurology, Brussels, Belgium, ²UZ Brussels, Neurology, Brussels, Belgium

Background and aims: We report a case of strictly unilateral cerebral amyloid angiopathy.

Methods: Case report.

Results: A 75-year-old woman presented at the emergency department with acute onset of right hemiparesis and right homonymous hemianopsia. Medical history revealed arterial hypertension, with admission blood pressure at 181/84 mmHg. Brain CT showed an acute bleeding in the left parietal lobe with subarachnoid hemorrhage. A brain MRI confirmed these results, but also revealed a recent ischemic lesion in the left occipital lobe and multiple microbleeds in the left temporal, occipital and parietal lobes (Figure 1). According to the Boston criteria this indicates a probable cerebral amyloid angiopathy (CAA).

Conclusion: A strictly unilateral presentation of CAA is a rare phenomenon, of which only a few case reports have been published until now. The exact cause of this phenomenon remains unclear. Possible hypotheses are [a] the presence of certain unique precipitating factors, such as genetic background or [b] a different developmental stage of CAA. Further studies are needed to clarify the associated neurological manifestations, epidemiology and possible genetic association.

Figure 1.

Axial DWI images and ADC MAP (A, B) revealed a recent ischemic lesion in the left occipital lobe. Axial gradient recalled echo T2-weighted images showed left juxta cortical microbleeds (C) and left lobar hemorrhage and superficial cortical hemosiderosis (D).

Disclosure: No

P0940 / 1124

NEONATAL STROKE: CLINICAL CASE

I. Calistru ¹, C. Calcii^2,3, M. Sprincean^1,2, L. Feghiu^4,1, N. Lupusor¹, L. Cuznet³, C. Griu¹, N. Revenco^3,5, S. Hadjiu^3,2

¹Medical State University ‘Nicolae Testemițanu’, Neuropediatrics, Chisinau, Moldova, Republic of, ²Hospital of Mother and Child Healthcare, Neuropediatrics, Chisinau, Moldova, Republic of, ³Medical State University ‘Nicolae Testemițanu’, Chisinau, Moldova, Republic of, ⁴National Epileptology Center, Chisinau, Moldova, Republic of, ⁵Hospital of Mother and Child Healthcare, Pediatrics, Chisinau, Moldova, Republic of

Background: Stroke in children is a major neurological emergency, being a major cause of morbidity and mortality. It is found in the neonatal period in one of 2500-4000 live births. Perinatal hemorrhagic stroke causes significant long term morbidity including neurological and cognitive impairment.

The aim: is to evaluate the features of perinatal hemorrhagic stroke based on clinical case.

Methods: Clinical case of a child who develops hemorrhagic stroke.

Results: We present the case of a 2-week-old girl, urban resident, hospitalized from birth. Child born from the 1^st pregnancy, birth at 40-41 weeks with Apgar score 5-7 points, weight - 3450 g, cranial perimeter - 34 cm. The condition at birth very severe, resuscitated.

Neurological status: consciousness - inhibited, weakly reacting to stimuli. The child does not fix the eyes, does not follow. Muscle tone - hypotonic. OTR R=L, hyporeflexia.

In neurosonography: lateral ventricles at the anterior horns 7x3 mm. Ventricle III: width - 5 mm, depth - 10 mm. The choroid plexus - 9 mm, inhomogeneous, on the right a 3 mm diameter shaped liquid body. Cerebral parenchyma of relatively high echogenity - pronounced periventricular infiltration. CT imaging data suggestive for changes in perinatal hypoxic-ischemic encephalopathy. Hemorrhagic embolism in the cerebellum projection on the right. Signs suggestive of hyperdensity of venous cerebral sinuses.

Conclusions: Perinatal hemorrhagic stroke presents a significant long term morbidity characterized by severe neurological and cognitive deficits. Clinical manifestations in perinatal hemorrhagic stroke are different from adults, often expressed by altered consciousness, generalized hypotonia, seizures, and encephalopathy.

Disclosure: No

P0941 / 472

CONUNDRUMS OF OCULAR MOTOR APRAXIA MASQUERADING AS ACUTE ISCHEMIC STROKE

S. Majumder ¹, S. Wigmore-Sykes¹, I. Aneela¹, R. Namushi¹, N. Saravanan¹

¹ Fairfield General Hospital, Northern care Alliance, Stroke, Bury, United Kingdom

Background: Apraxia of eyelid opening (ALO) is a disabling non-motor abnormality involving inability to open the eyes voluntarily. ALO is characterised by a lack of orbicularis oculi spasm despite sustained frontalis contraction and the mechanism is unknown. We report a case of ocular motor eyelid apraxia on the background of acute ischaemic stroke.

Case report: 65-year-old gentleman admitted with 2-week history of headache and bilateral visual loss. His CT Brain, CTA and CTV, CSF analysis were normal. He required ventilatory support initially and was treated for ischaemic stroke. His repeat CT/ MRI Brain revealed bilateral cerebellar infarction.

His neurological examination revealed bilateral ptosis, complete right third nerve palsy, bilateral non-reactive pupils, vertical nystagmus, dysarthria and bilateral upper limb impaired coordination with normal power in his limbs. He demonstrated frontalis contraction and backward thrusting of the head with active eyelid opening in keeping with ALO; he couldn’t open his eyelids voluntarily.

We wanted to exclude neuromuscular or neurodegenerative condition due to his ALO. Further brain imaging didn’t reveal any structural lesions in the cortical, supranuclear, midbrain or pontine region. He had weakly positive acetylcholine receptor antibodies which became negative after few weeks. Within 2 months, he developed epilepsy partialis continua refractory to treatment and was commenced on end-of-life care. His quick progression of symptoms was suggestive of neurodegenerative condition.

Conclusion: Our case illustrates, we should investigate causes for ALO even if they present with acute ischaemic stroke to exclude neuromuscular or neurodegenerative conditions.

Manual eye opening

T2 MRI

Disclosure: No

P0942 / 155

STROKE IN A PATIENT WITH A FABRY DISEASE

Y. Adilbekov¹, Z. Akhmetzhanova², S. Medukhanova ¹, B. Adilbekova²

¹The National Centre for Neurosurgery, Department of Vascularand Functional Neurosurgery, Nur-Sultan, Kazakhstan, ²Medical University Astana, Faculty of Neurology, Nur-Sultan, Kazakhstan

Background: Fabry disease is an X-linked recessive inborn error of glycosphingolipid metabolism caused by deficiency of alpha-galactosidase A. The enzyme deficiency leads to defective storage of sphingolipid and progressive endothelial accumulation causing abnormalities in the skin, eye, kidney, heart, and brain, which can lead to a stroke.

Case: 68-year-old male patient, at the age of 47 was diagnosed with type2 diabetes mellitus. At the age of 65 creatinine level stared to increase, and suffered an ischemic stroke. Next year creatinine increased up to 520 µmol / L, urea up to 31 µmol / L, hemodialysis was recommended. Patient complaints: lower extremities numbness, burning pain, swelling, the whole body constant itching, tinnitus, insomnia, headaches, loss of appetite. On CT: left subcortical lacunar ischemic infarction.

Patient was tested for Fabry disease in 2020: Lys0-Gb3 0,6 ng/ml (normal), alpha-galactosidase A 10,7 µmol/L/h (pathologic). Alpha galactosidase activity is reduced, undefined significance variant, Fabry disease is possible. Further patient’s close relatives were screened to Fabry disease. Patient’s all three daughters appeared to be carriers.

Discussion: The patient’s Fabry disease was diagnosed late, after kidney and central nervous system damage. Pathogenetic therapy was not performed. In the second year of being on programmed hemodialysis, he died of recurrent stroke.

Conclusion: Confirmed diagnosis makes it possible to start timely treatment and avoid fatal outcome. Nevertheless, pedigree analysis and effective screening of the family and identification of several previously unrecognized affected family members, including young relatives at a relatively early stage of their disease.

Disclosure: No

P0943 / 625

A LIFE-THREATENING STROKE MIMICKER: AN EXTENSIVE AORTIC DISSECTION PRESENTING WITH ACUTE STROKE

M. Meseha ¹, O. Siddiq¹

¹ NHS, Norwich, United Kingdom

Background: Aortic dissection has a high mortality of up to 40% at the time of initial dissection and an additional 1% per hour the dissection is untreated. Patients with acute aortic dissection commonly present with chest or back pain. Less frequently, it manifests as an acute stroke. The diagnosis and management remain elusive despite medical advances. This report presents a case of acute stroke secondary to acute extensive aortic dissection extending superiorly to left MCA level and inferiorly to left common iliac artery.

Methods: 1-A previously well 61-year-old man, with no past medical history, presented with a sudden onset of right-sided weakness, aphasia, and mild neck and back pain. His wife reported that he had been unresponsive for three minutes before the onset of weakness.

Day One
His Initial NIHSS (score11)	was remarkable for right-sided weakness, aphasia, left sided gaze preference
GCS	11\15 (E4V1M6)
Blood pressure	Rt:130\90-Lt arm 95\60
Left lower limb	Cold, no palpable pulse.
Basic blood and ECG	NAD
Initial CT head and CT-angiography	No haemorrhage, mass, or collection. Grey/white matter differentiation is preserved. No hydrocephalus. Type A aortic dissection extending superiorly to the bifurcation of the brachiocephalic trunk and into the left CCA, ICA and MCA. Dissection flap extends inferiorly to the level of the aortic bifurcation and into the left CIA. (See images)

2-D\W Cardiothoracic; agreed that surgery is very risky, and the patient is unlikely to survive.

Day 2
GCS	5\15 (E2V1M2)
Blood pressure (On CCB Infusion)	Rt: 105\70- Lt: 85\55
A repeat CT head	Extensive post infarct oedema of the left MCA territory. Associated midline shift of 10 mm

3-After MDT discussion, Palliative care was in his best interest. Later, on the same day, the patient passed away.

Results:

• 1) Typical symptoms of acute aortic dissection are not always present (See table 3). CT-angiography of the entire aortic arch can expedite early diagnosis.

• 2) Emergency aortic surgery provides the only chance for survival.However, in such extensive dissection, surgeons weigh the risk and benefit of surgery.

Percentages of main symptoms and complications of Aortic dissection Type A (According to ESC Aortic diseases guidelines 2014)
Chest pain	80%
Back pain	40%
Myocardial Infarction	15%
Syncope	15%
Stroke	<10%
Acute limb ischemia	<10%
AKI	<20%

Conclusion:

• 1) Stroke secondary to acute aortic dissection- rare diagnosis and represent a diagnostic challenge for many physicians.

• 2) CT Angiography help prevent intravenous thrombolysis, which may be detrimental.

• 3) Early involvement of surgical specialities and interventional radiology may play an important role in the management of these patients.

Disclosure: No

P0944 / 1417

CEREBRAL MICROBLEED PHENOMENON IN CRITICALLY ILL PATIENT

A. Sierra-Gómez ¹, J.M. Villanueva Rincón², L. López-Mesonero¹, F.J. González Terriza¹, J.A. Vizcaya Gaona¹, A.M. González García¹, A.I. Sagredo Barra², A. Verdú Seguí², R. Manso Calderón¹, M.E. Ramos-Araque^3,1

¹Hospital Universitario de Salamanca, Neurology, Salamanca, Spain, ²Hospital Universitario de Salamanca, Radiology, Salamanca, Spain, ³Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain

Background and aims: Cerebral microbleeds (CMBs) are increasingly recognized neuroimaging findings in critically ill patients. We present a case of cerebral microbleed phenomenon after prolonged stay at intensive care unit (ICU).

Methods: A 22-year-old male were admitted to the ICU due to sepsis secondary to rupture of a pulmonary hydatid cyst. He required extracorporeal membrane oxygenation (ECMO) and pulmonary lobectomy with favorable evolution. Neurological evaluation was performed on day +22 of admission because patient developed mixed aphasia, acalculia and ataxic gait of unknown time of evolution.

Results: Brain CT was performed visualizing bihemispheric petechial lesions. Brain MRI revealed foci of microhemorrhage in the corpus callosum, both internal and external capsules, as well as bihemispheric cerebellar foci with mesencephalic and cerebral peduncle involvement in susceptibility-weighted angiography sequences (SWAN) (figure). The diagnosis of diffuse CMBs was established, in the context of critically ill patient. At 6 months of discharge the patient presented improvement of the language disorder, although he developed attentional, working memory, processing speed and calculation disorder. At 9-months MRI control no major changes were observed.

Conclusions: Cerebral microbleed phenomenon in critically ill patients have a typical distribution pattern in corpus callosum and juxtacortical white matter. Hypoxia may be the main pathophysiological mechanism, possibly secondary to disruption of the blood-brain barrier. This entity is probably misdiagnosed; therefore, in the case of patients with focal neurological deficit after septic process, clinical suspicion should be established, as well as the performance of specific brain MRI sequences.

Disclosure: No

P0945 / 1437

SUBSEQUENT ISCHAEMIC EVENT AFTER INTRACEREBRAL HEMORRHAGE- CASE REPORT

S. Djambazovska- Zikova ¹, F. Adili Gongo², S. Jovevska³, D. Vojtikiv Samoilovska⁴

¹CGH “8 th September” Skopje, Neurology, Skopje, North Macedonia, The Republic of, ²Healthcare Center Skopje, Neurology, Skopje, North Macedonia, The Republic of, ³University “Goce Delcev”, Anatomy, Stip, North Macedonia, The Republic of, ⁴Private Neurology Practice, Neurology, Tetovo, North Macedonia, The Republic of

Background and aims: Mechanisms of ischemic stroke after intracerebral hemorrhage (ICH) include blood pressure lowering, intracranial pressure elevation and microvascular changes. A combination of local compression, edema, inflammation, increased viscosity at varying stages of hemorrhage may lead to thrombotic events soon after ICH. Patients with cerebral microangiopathy may have higher risk for brain ischemia. We present a case of a 55 years old man with subsequent ischemic stroke 2 weeks after ICH.

Methods and result: The patient was admitted and treated for right occipital hematoma presented only with headache and hemianopsia. The patient had a recent past medical history of arterial hypertension and myocardial infarction. Antiplatelet therapy was discontinued. During the hospital stay he was in stable condition with slightly elevated blood pressure values, but after two weeks the clinical picture worsened with left sided hemiparesis, mild left facial palsy of central type and mild dysarthria. CT brain demonstrated hematoma resorption and MR brain demonstrated infarction in right basal ganglia. CT angiography of cerebral and cervical vessels were unremarkable.

Conclusions: Further study and new strategies are needed for early use of antiplatelet therapy in patients with cardiovascular risk to prevent secondary ischemic stroke after ICH. This case presents a challenge for deciding what are the appropriate prevention strategies: whether the antiplatelet therapy should be stopped, started or continued?

Disclosure: No

P0946 / 1601

FUNCTIONAL NEUROLOGICAL DEFICIT OR SPINAL SHOCK?

K. Mhapankar ¹, S. Ankolekar¹

¹ King’s College Hospital, Neurology/Stroke, London, United Kingdom

Background and aims: A lady in her 70s was brought by ambulance to ED as a stroke alert. She had developed neck pain followed by weakness in right upper and lower limb the preceding night. The lower limb weakness had improved to a large extent when she was examined.

Methods: She had multiple medical problems including a right hemithyroidectomy to remove a cyst. She was also undergoing severe stress due to personal problems. She had proximal right upper limb weakness on initial examination. However, she did not have any other focal neurological deficit. CT Head and CT Angiogram did not show any acute pathology. She was commenced on high dose aspirin and admitted to stroke unit for cervical spine MRI though initially it was thought to be functional.

Results: Non-contrast C-spine MRI showed signs of early cord compression. She became quadriparetic in the meantime as well as bradycardic and hypotensive. Reflexes were brisk in the upper limb with upgoing plantars. She was transferred to HDU and had a cervical spine MRI with contrast on the way. It showed signal abnormality with restricted diffusion from C1/2 to C4/5 which was highly suggestive of a cord infarction. She was put on NIV and vasopressor support in HDU and after a prolonged admission was sent to rehabilitation.

Conclusions: Though the thoracic cord is the commonest region to be infarcted, this case highlighted that any section of the cord can be affected and keeping this as a differential diagnosis when assessing stroke calls is imperative.

Disclosure: No

P0947 / 496

SUDDEN ‘STRATEGIC’ HYPERACTIVE DELIRIUM

E. Vyras ¹, P. Jareonsettasin^1,2, S. Saber¹

¹The National Hospital for Neurology and Neurosurgery, UCLH Stroke Department, London, United Kingdom, ²Queen Square Institute of Neurology, UCL, Department of Clinical and Experimental Epilepsy, London, United Kingdom

Background and aims: Rare ‘strategic’ strokes that cause sudden-onset delirium offer rare insights into the neuroanatomical basis of delirium.

Methods: We present a case report of delirium secondary to ischaemic stroke affecting the left anterior thalamus and hypothalamus.

Results: A 76-year-old male smoker with no co-morbidities presented with sudden-onset fluctuating confusion, word finding difficulties, mild right facial droop and arm weakness. He was disoriented with retrograde and anterograde amnesia, and apraxia. MRI showed an acute infarct in the left anterior thalamus, hypothalamus and internal capsule. CT Angiography showed a free-floating thrombus in the left ICA, treated with LMWH. His right-sided weakness and expressive dysphasia fully recovered. He had persistent fluctuations in confusion, aggression, emotional liability, insight and sleep-wake cycle. No metabolic, toxic, infectious or other organic cause was found. Extensive psychological and psychiatric evaluation concluded this was delirium directly secondary to his focal ischaemic lesions.

Conclusions: Left PCA territory strokes are associated with sudden delirium. The neuroanatomical structures directly responsible are unclear. The unique aspect here is the involvement of the hypothalamus, in addition to the thalamus. Disintegration of large brain networks explain why multiple cognitive domains are disrupted in delirium. Thalamic strokes disrupt the hubs of neural networks. Here the anterior thalamic lesion disrupts fronto-limbic connections. But the fluctuation of symptoms demands a mechanistic explanation. We hypothesise that the hypothalamic lesion here could disrupt the orexinergic system, causing instability in various neuromodulatory systems. The case offers a new idea: delirium requires both disintegration and destabilisation of large-scale networks.

Disclosure: No

P0948 / 922

A RARE CASE OF EIGHT-AND-A-HALF SYNDROME

S. Patel ¹, E. Jamieson¹

¹ Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Stroke Medicine, Ipswich, United Kingdom

Background and aims: Eight-and-a-half syndrome is a rare stroke presentation describing the constellation of horizontal gaze palsy, internuclear ophthalmoplegia (INO) and lower motor cranial nerve (CN) VII palsy.

Methods: A 58-year-old male presented with a 4-hour history of headache, dizziness, facial weakness, double vision and slurred speech. His medical history was significant for diabetes. Examination revealed a right facial paresis, right gaze palsy and left INO. He had a NIHSS of 6.

Results: CT head showed an established area of infarction of deep white matter area adjacent to the left lateral ventricle. DWI sequences on MRI identified a focus of restricted diffusion in the right distal pons adjacent to the lateral ventricle suggestive of acute infarct. A linear band of hypointensity was seen in the left thalamus and adjacent lentiform nucleus on susceptibility weighted sequences. He was diagnosed with a posterior circulation infarct with a right lower motor neuron palsy. He was commenced on secondary prevention with antiplatelets and a statin. Further investigations including 24-hour tape, echocardiogram and young stroke screen have been normal.

Conclusions: Eight-and-a-half syndrome, is caused by a lesion involving the paramedian pontine reticular formation which sends signals towards the ipsilateral abducens nerve and contralateral medial longitudinal fasciculus. Structures lie in close proximity to the nucleus and intra-axial fascicles of CN VII manifesting as ipsilateral facial weakness. Occlusion of the tip of the paramedian pontine artery is the most common cause. Interpretation of eye movement abnormalities in brainstem strokes can be challenging yet rewarding.

Disclosure: No

P0949 / 1222

SPONTANEOUS SPINAL EPIDURAL HEMATOMA WITH SLIGHT PURE MOTOR HEMIPARESIS IN A PATIENT UNDERGOING THERAPY WITH RIVAROXABAN BECAUSE OF PAROXYSMAL ATRIAL FIBRILLATION: A CASE REPORT

A. Janiszewska ¹, B. Anders¹, K. Kollia², A. Czaplinski¹, N. Peters¹

¹Klinik Hirslanden Zürich, Department of Neurology, Zürich, Switzerland, ²Klinik Hirslanden Zürich, Department of Neuroradiology, Zürich, Switzerland

Spontaneous spinal epidural hematoma is a rare condition which may present with diverse neurological symptoms, mimicking more common neurological emergencies, especially strokes. Our aim was to present a case of SSEH and to review the available literature for other clinical representations in order to facilitate the diagnosis of this disorder as stroke mimic, which may be encountered in clinical practice. An 84-year-old female was admitted to the hospital because of severe neck and back pain radiating into the right arm and leg, which was followed by weakness of the right upper and lower limb. Any trauma has been denied. The patient was undergoing anticoagulation therapy with rivaroxaban due to atrial fibrillation. The MRI showed a spinal epidural hematoma, dorsal on the C4/7 level on the right side with a minimal spinal cord compression and no signs of edema. After neurosurgical consultation, due to the slightness of the symptoms and the small blood volume, we have decided on conservative therapy. We started steroid therapy to avoid edema development. The rivaroxaban therapy has been stopped. The control MRIs during hospitalization showed a decrease of hematoma and a complete regression after few days. On the day of discharge, only minimal motor disfunction of the right hand was present.

In a constellation of symptoms with acute onset of pain along the spine in connection with weakness or numbness of the limb without accompanying deficits of cranial nerves, spontaneous spinal epidural bleeding should be considered as possible cause, especially by patients under anticoagulation medication.

Disclosure: No

P0950 / 1059

BENEFITS OF DETAILED CLINICAL ASSESSMENT AND ADVANCED IMAGING IN RIGHT MIDDLE CEREBRAL ARTERY STROKE

A.M. Liddy ¹, J. Lynch¹, K. Cregg¹, D. Williams¹, K. Boyle¹

¹ Beaumont Hospital, Department of Stroke Medicine, Dublin, Ireland

Background: The National Institutes of Health Stroke Scale (NIHSS) allows for rapid identification of patients who may benefit from acute stroke treatment.(1) However, an NIHSS of 0 at presentation may not outrule a potentially disabling neurological deficit.

Case: A 68-year-old, high-functioning man was seen in the emergency department 5 hours post a 10-minute episode of left facial droop and dysarthria. Initial NIHSS was 0. Cognitive slowing prompted a Montreal Cognitive Assessment (MoCA) to be performed, revealing deficits in visuospatial/executive function, language fluency and recall (score 19/30). There was no history of cognitive impairment.

Non contrast computed tomography (CT) brain was normal. CT angiogram revealed a right middle cerebral artery M2 branch occlusion and CT perfusion suggested a 31mL ischaemic penumbra in the territory of the occluded vessel without any established core. (Figure 1).

Given the acute cognitive decline and risk of further neurological deterioration the patient was treated with low-dose alteplase.

24 hour intracranial CT angiogram showed recanalisation of the M2 branch. (Figure 1). Repeat MOCA at 24 hours was 28/30 with resolution of visuospatial and recall deficits.

Conclusion: This case demonstrates the importance of detailed neurological examination, including cognitive assessment, especially in right MCA syndromes, to identify persistent but less obvious neurological deficits in patients presenting with a history of transient neurological symptoms. It also highlights the added value of advanced imaging to guide individual treatment decisions.

References:

WJ Powers et al 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke, Stroke, Jan 2018.

Disclosure: No

P0951 / 1576

FATAL CEREBRAL SINUS THROMBOSIS FOLLOWING CHADOX1 NCOV-19 VACCINE: A CASE REPORT OF VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA (VITT)

W. Szypowski ¹, A. Dębiec¹, J. Świstak¹, M. Nowocień², P. Rzepecki³, M. Możański⁴, J. Staszewski¹, A. Stępień¹

¹Warsaw Military Institute, Department of Neurology, Warsaw, Poland, ²Warsaw Military Institute, Medical Diagnostic Imaging, Warsaw, Poland, ³Warsaw Military Institute, Department of Haematology, Warsaw, Poland, ⁴Warsaw Military Institute, Department of Anaesthesiology and Intensive Care, Warsaw, Poland

Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. Although the patient received immediate anticoagulant and intravenous immune globulin treatment, he died within 24 h after hospital admission. VITT and CVST are rare conditions; however, the course may be fatal. Therefore, clinicians should be familiarized with the clinical and laboratory features of VITT.

Disclosure: No

P0952 / 165

SEVERE IRON DEFICIENCY ANAEMIA SECONDARY TO UTERINE FIBROIDS CAUSING CEREBRAL VENOUS SINUS THROMBOSIS

K.M. Lau ¹, A. Ali Sheikh¹

¹ Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Hyperacute Stroke Unit, Medical Department, London, United Kingdom

Background and aims: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke, contributing to less than 1%. We report an unusual case of severe iron deficiency anaemia (IDA) causing CVST in a young woman with menorrhagia.

Methods: Case report: A 40-year-old female with underlying anaemia presented with headache, right leg numbness and expressive dysphasia. She experienced massive menstrual bleeding prior to the symptoms onset on background of uterine fibroids. There was no history of contraceptive pills consumption, massive blood transfusion, COVID-19 infection or vaccination. Systemic review was unremarkable.

Results: Blood investigations revealed haemoglobin of 4.5g/dl, MCV 52.3fL, platelet 657x10⁹/L and low ferritin level. Coagulation profile, connective tissue disease, thrombophilia screening, serum homocysteine and HIV test were normal. Computed tomography (CT) of the head showed left temporoparietal lobe infarct and left dural venous sinus thrombosis. CT venography revealed CVST within the distal left transverse sinus and the vein of Labbe. Pelvic ultrasound showed multiple uterine fibroids. She was warfarinised and had iron and red cell transfusion. She agreed to take progesterone-only pill and interval hysterectomy after gynaecological review.

Discussion: CVST in association with IDA is rare in adults and is more prevalent in men. In IDA, hypercoagulability and venous stasis play a vital role in thrombus formation. One study found that IDA in women caused arachidonic acid-induced platelet dysfunction causing menorrhagia which is reversible with iron repletion.

Conclusion: IDA is a rare cause of CVST but should be considered in the context of relevant history and blood tests.

Disclosure: No

P0953 / 1354

ISCHEMIC STROKE DUE TO VERTEBROBASILAR DOLICHOECTASIA: CASE REPORT

A. Eltahiri ¹, A.El tahiri ; S .Bouchal; N. Chtaou; A. El Midaoui; Z. Souirti; MF. Belahsen

¹ Hassan II University Teaching Hospital, Department of Neurology, Fes, Morocco

Vertebrobasilar dolichoectasia (VBD), is an arteriopathy characterized by tortuosity, elongation, and dilatation of the vertebrobasilar arteries or their junction. VBD is a known clinical entity with a patient presentation ranging from severe symptoms such as ischemic/hemorrhagic stroke, thromboembolic lesions, or cranial nerve compression.

Here we reported the case history of a 58-year-old man with Hypertension history, admitted to the emergency department for sudden-onset left-sided weakness and speech difficulty at 3 Hours from his last known well. Neurological examination revealed left hemiplegia and left central facial paralysis with dysarthria. The patient’s NIHSS was 14. Capillary glycemia was normal. Blood pressure was 180/95 mm Hg. A cerebral computed tomography (CT) scan was normal. The CT Angiography objectives VBD with a floating thrombus of the basilar artery. The patient was received intravenous thrombolysis but the thrombectomy was not available. Neurological worsening occurred 24 hours after thrombolysis and the control CT scan objectified a pontine infarction. The patient was treated with subcutaneous low molecular weight heparin, but he died after 4 days of his hospitalization in the neurovascular unit.

VBD is a rare vasculopathy. The etiology of this disease is unknown. VBD is often asymptomatic. The most frequent complication of a VBD is the ischemia of the brainstem in 2/3 of the patients. Its main risk factors are age, male gender, hypertension, and smoking. Several imaging modalities can be used to diagnose VBD. CT Angiography remains the most sensitive and available. The treatment consists in treating its complications.

Disclosure: No

P0954 / 1641

TO BE INFECTIOUS OR NOT TO BE, THAT IS THE QUESTION

T. Jesus ¹, A. Sousa¹, E. Costa¹, S. Pinero¹, A. Palricas¹, C. Barroso¹, A. Silva¹

¹ Hospital Vila Franca de Xira, Neurology, Vila Franca de Xira, Portugal

Cortical bilateral ischemic lesions are strongly linked to an embolic cause. However, its source may not be found and strokes are then classified as embolic stroke of undetermined source. We present a case with the opposite problem: the embolic source was straightaway discovered but not its etiology.

A 72 year-old-man, with high blood pressure, diabetes and alcoholism presented to the emergency department with a one-week duration of loss of vision and gait struggles. He was disorientated, had right homonymous hemianopsia and left central facial palsy. Blood studies showed leukocytosis, high CRP and persistently elevated pro-BNP and troponin. EKG revealed ST elevation in DII and aVF which led to a transthoracic echocardiography that revealed an intracardiac mass attached to the mitral valve, compatible with vegetation after transesophageal echocardiography. Brain-MRI showed an acute left occipito-temporal infarct and multiple microembolic bilateral lesions. Blood cultures, serologies and IGRA were negative. Full-body CT-scan revealed a lung tumor with multiple adenopathies. Bronchofibroscopy and aspirative punction were compatible with non-small cell lung carcinoma. The diagnosis of nonbacterial endocardithis was admitted and anticoagulation was started. Two weeks later there was new embolization to brain and myocardium which resulted in the patient death.

In this case the embolic source was obvious, but its etiology was less clear. Nonbacterial thrombotic endocarditis is as rare cause of stroke that may occur in cancer patients due to a prothrombotic state leading to deposition of sterile thrombi in heart valves. We emphasize the importance of excluding oncologic disease in patients with this diagnosis.

Disclosure: No

P0955 / 1634

THREE CASES OF CAA-RI: CLINICAL “MOSAIC” OF AMYLOID SPELLS, MIGRAINE, AND TRANSIENT ISCHEMIC ATTACKS

A.M. Pavlovic ¹, C. Jovanovic², N. Stojanovski², A. Radojicic², M. Mijajlovic², J. Zidverc Trajkovic²

¹University of Belgrade, Faculty for Special Education and Rehabilitation, Belgrade, Serbia, ²University of Belgrade, Faculty of Medicine, Belgrade, Serbia

Background and aims: Cerebral amyloid angiopathy-related inflammation (CAA-rI) is an aggressive but potentially reversible subtype of CAA. Its clinical presentation can be misleading so we aimed to present three typical cases and discuss different transient phenomena associated with this condition.

Methods: Case report.

Results: Case 1. A 55-year-old man with hypertension presented with a transient migraine-like headache, slurred speech, and mild right-sided hemiparesis. Brain MRI indicated diffuse edema and cerebral microbleeds (CMB). A month later he deteriorated with the development of somnolence and severe right-sided hemiparesis. A course of intravenous corticosteroids resolved symptoms completely. Case 2. A 66-year-old female with hypertension presented with a 3-month history of headache and progressive memory loss. She recently experienced an episode of speech disturbance diagnosed as a transient ischemic attack (TIA). Brain MRI indicated confluent asymmetrical white matter hyperintensities (WMH) in both frontal and temporal lobes and CMB. A course of intravenous Methylprednisolone led to significant clinical and radiological improvement. Case 3. A 62-year-old female with no vascular risk factors was evaluated for a left-face, arm, and hand paresthesia indicating an amyloid spell or TIA. A similar episode occurred 6 months before. Brain MRI revealed confluent WMH in the right frontal and temporal lobe with CMB. The patient remained symptom-free during the one-year follow-up. We discuss the different clinical presentations of CAA and CAA-rI and potential mechanisms linking migraine with aura, TIA, and amyloid spells.

Conclusions: The differential diagnosis of CAA-rI comprises a spectrum of disorders and timely diagnosis enables adequate treatment.

Disclosure: No

P0956 / 1038

MULTIPLE INTRACRANIAL ANEURYSMS FOLLOWING RESECTION OF CARDIAC MYXOMA

R. Mendes Franco ^1,2, J. Sousa³, M. Matos⁴, L. Albuquerque³, E. Azevedo^2,5, P. Abreu^2,5

¹Hospital Central do Funchal – SESARAM, Department of Neurology, Funchal, Portugal, ²Centro Hospitalar Universitário de São João, Department of Neurology, Porto, Portugal, ³Centro Hospitalar Universitário de São João, Department of Neuroradiology, Porto, Portugal, ⁴Centro Hospitalar Universitário de São João, Department of Internal Medicine, Porto, Portugal, ⁵Faculty of Medicine of University of Porto, Department of Clinical Neurosciences and Mental Health, Porto, Portugal

Background and aims: Besides the most common well-known Cerebral aneurysms (CA) risk factors, other rarely associated pathologies are hypothyroidism, autoimmune diseases, and infectious/tumoral emboli. We present a case of multiple CA in a patient that had a left atrial myxoma.

Methods: Forty-seven-year-old female with a history of Addison’s disease, primary hyperthyroidism, diabetes mellitus, hyperlipidemia, and obesity. A bacteriemia with isolated Methicillin-Sensible Staphylococcus aureus associated with left atrial myxoma was diagnosed during the workup of an MCA ischemic stroke. At that time the CT angiography (CTA) was unremarkable, namely for CA. The patient underwent 11 days flucloxacillin (2 g IV every six hours) regimen and the myxoma was removed. Eight years later, when evaluated due to unspecific complaints, a left superior homonymous quadrantanopia was noticed and she repeated CT and CTA. Apart from old ischemic lesions, it showed multifocal fusiform aneurysms involving distal branches of MCA and ACA. Digital subtraction angiography confirmed the aforementioned findings, revealing an additional aneurysm in a distal branch of the right PCA. Brain MRI showed no evidence of mycotic aneurysms, and the cardiac workup was unremarkable. The follow-up and investigation continue, currently without intervention.

Results/conclusion: Myxomatous embolization seems to be the most likely etiology for the development of these multiple CA due to its late manifestation, the absence of CA in the acute phase of the mentioned bacteriemia, and no clinical, laboratory, or imagiologic evidence of mycotic emboli eight years later. This case is uncommon and also raises the discussion of the ideal therapeutic approach.

Disclosure: No

P0957 / 1197

RECURRENT STROKES BY RETROGRADE EMBOLISM FROM A THROMBOSED RIGHT DORSAL SCAPULAR ARTERY

N. Pauillac ¹, T.-H. Tran¹, M. Mazighi¹, M.-A. Labeyrie², E. Jouvent¹, P. Reiner¹

¹Hôpital Lariboisière, Department of Neurology, Paris, France, ²Hôpital Lariboisière, Interventional Neuroradiology Unit, Paris, France

Backgrounds and aims: Retrograde embolism as a cause of ischemic stroke may be underdiagnosed, but convincingly documented cases are rare.

Methods: We report the case of recurrent vertebra-basilar ischemic strokes likely related to a giant aneurysm developed from a proximal branch of the subclavian artery.

Results: A 32-year-old male presented to the stroke unit with involuntary oculomotor movements followed by left hemianopsia. Brain MRI demonstrated a bilateral posterior cerebral artery stroke. His medical history included a thalamo-mesencephalic stroke nine months earlier, and at the time of the recurrent stroke, he was taking aspirin. Investigations showed no significant abnormalities but a partially thrombosed aneurysm of 2.3 cm in diameter developed from the right dorsal scapular artery. A complete work-up excluded common etiologies, including patent foramen ovale, antiphospholipid syndrome and cardiac arrhythmia by means of a long-term implantable cardiac monitor. Conventional angiography revealed retrograde flow from the aneurysm to the ostium of the right vertebral artery during diastole. It also showed a thrombus in the right humeral artery, suggesting that the aneurysm was a source of embolism whose direction may change with the cardiac circle. Embolization of the aneurysm was performed and curative anticoagulation was carried out for 6 months, followed by Aspirin. No further recurrence occurred. Usually described after blunt chest trauma, scapular aneurysms are rare. Our patient practiced archery, which could explain its formation.

Conclusion: We report convincing evidence of recurrent retrograde embolism during diastole from a giant aneurysm of the right dorsal scapular artery to vertebra-basilar territory.

Disclosure: No

P0958 / 1633

STROKE AND NEPHROTIC PROTEINURIA: A CLINICAL CASE

T. Jesus ¹, A. Sousa¹, E. Costa¹, A. Palricas¹, C. Barroso¹, S. Pinero¹, A. Silva¹, HVFX

¹ Hospital Vila Franca de Xira, Neurology, Vila Franca de Xira, Portugal

The association between antineutrophil cytoplasmic antibodies (ANCA) and vasculitis like granulomatosis with polyangiitis or microscopic polyangiitis is well established. However, stroke as a presentation before renal or lung manifestations is very rare. We present a case of ANCA-associated vasculitis diagnosed following stroke etiologic investigations.

A 46-year-old man, with medical record of smoking, migraine and Sweet syndrome, presented to the emergency room with speech disturbances and incoordination of his right hand. The neurological examination was positive for dysarthria. Initial brain CT scan was normal but 24 hours after there was a left striatocapsular infarct, confirmed by MRI which also excluded other lesions. CT angiography was normal. Stroke workup revealed acute renal lesion (creatinine 2.02mg/dL), high sedimentation velocity (79mm/h), moderately elevated lupic anticoagulant, nephrotic proteinuria, hypoalbuminemia and positive ANCA-MPO antibodies (130/UI/mL). Renal biopsy showed glomerulus with global sclerosis, fibrocelular crescents, necrotizing lesions and interstitial fibrosis in 50%. Immunofluorescence was negative. The diagnosis of stroke associated with ANCA- vasculitis was admitted. The patient was started on steroids therapy followed by rituximab. ANCA levels lowered, renal function improved and there was complete recovery of neurological deficits.

This case emphasizes the importance of performing a complete workup of stroke etiology, especially on the young with stroke, to discover some rarer etiologies. A high degree of susception is key to make the diagnosis of autoimmune vasculitis and to promptly start adequate treatment.

Disclosure: No

P0959 / 1605

WHEN LESS IS MORE: CONSERVATIVE MANAGEMENT OF INTERNAL CAROTID ARTERY DISSECTION – A CASE REPORT

A. Nuredini ¹, M.C. Angeli¹, M. Fantoni², P. Castellini³, U. Scoditti³, A. Genovese³

¹University of Parma, Department of Neurological Sciences, Parma, Italy, ²University Hospital of Parma, Interventional Neuroradiology Unit, Parma, Italy, ³University Hospital of Parma, Stroke Unit, Parma, Italy

Traumatic carotid artery dissection (tCAD) is a leading etiology of stroke in young people. However, prevalence in the general population is low, making difficult to produce strong recommendations on treatment, that includes antiplatelets or anticoagulants and endovascular approach. We present a teaching case of conservative management with the aim of contributing to the definition of the best medical practice for extracranial tCAD.

A 46-year-old man admitted to our ED because of acute onset of dysarthria, hemianopsia and left hemisyndrome (NIHSS=11). Brain CT was negative for acute ischemia or bleeding. Angio-CT was suggestive for right extracranial tCAD. Systemic thrombolysis was performed. Angiography confirmed the diagnosis but based on clinical improvement (NIHSS=3), the localization, and flourishing compensatory collateral circles, a wait-and-see approach was decided and decoagulant treatment was set. The second day NIHSS worsened to 6. CT, angioCT and angiography were repeated and reported partial recanalization of the ICA. Again, given the rapid clinical improvement (NIHSS=2) no procedure was undertaken. Next day because of a new worsening (NIHSS=5), angio-MRI was performed, showing substantial stability of the partial recanalization of the ICA and a better definition of the known ischemic areas. One more time, no intervention was made. In the following days neurologic signs regressed progressively and the patient was discharged with a NIHSS=1.

To date, there is no strong evidence of the best approach for tCAD between medical and mechanical treatment. In our experience, conservative management is an effective approach for tCAD following a favorable multidisciplinary evaluation of neurological features and neuroimaging.

Disclosure: No

P0960 / 1490

A WARNING SIGN: A MINI-SERIES OF CAPSULAR WARNING SYNDROME

S. Godsell ¹, N. Tantirige¹, M. Ghosh¹, S. Shribman¹

¹ St George’s University Hospitals NHS Foundation Trust, London, United Kingdom

Background and aims: Capsular Warning Syndrome (CWS) is characterised by recurrent transient ischemic attacks presenting with a stereotyped lacunar syndrome. Risk of early progression to acute ischemic stroke is high, with risk reduction and appropriate management a challenge.

Methods: Case report.

Results: We present two cases of CWS in twenty-eight-year-old and seventy-six-year-old males. Both presenting with transient mild lacunar motor syndromes. Both had minimal medical history but were hypertensive at presentation. CT head and angiogram were unremarkable. Neither received thrombolysis due to resolving symptoms but received aspirin loading. Further stereotyped lacunar symptoms occurred over the following 24 hours. Dual antiplatelet therapy (DAPT) was initiated, and systolic blood pressure maintained between 120-185. MRI head identified acute infarcts in the corona radiata of both patients (Figures 1, 2). Both had mild persistent neurological deficits at discharge with modified Rankin score 1.

Conclusions: A consensus on management of CWS has not been reached. Options include DAPT, permissive hypertension and thrombolysis. DAPT inhibits platelet aggregation, with some evidence it reduces further symptom fluctuation and improves functional outcomes. However, there is no clear evidence DAPT prevents progression to infarction. Permissive hypertension is presumed to moderate effects of cerebral hypoperfusion, a proposed mechanism for CWS. Long-term benefits of thrombolysis are uncertain; the mild clinical syndrome, fluctuating nature, and risk of haemorrhage, present a dilemma in its use. Pragmatically, DAPT and permissive hypertension are safe and simple interventions with evidence for some benefit in long-term outcomes. However, more robust data is required to better inform clinical decision-making.

Disclosure: No

P0961 / 1061

NEUTROPHIL MENINGO-ENCEPHALITIS AND VENTRICULITIS IN TWO PATIENTS WITH ACUTE SARS-COV-2 INFECTION

B.O. Pîrlog ^1,2, A. Gaudemer³, L. Deconinck⁴, C. Gaudefroy⁵, P. Lavallee²

¹County Emergency Hospital, Department of Neurology, Cluj-Napoca, Romania, ²Hospital Bichat, Department of Vascular Neurology, Paris, France, ³Hospital Bichat, Department of Radiology, Paris, France, ⁴Hospital Bichat, Department of Infectious Diseases, Paris, France, ⁵Hospital Louis-Mourier, Department of Internal Medicine, Paris, France

Background and Objective: The novel coronavirus SARS-CoV-2 has become a global health emergency.

Methods: We report two patients with similar atypical neurological presentation of novel coronavirus SARS-CoV-2 infection admitted in May 2021.

Results: A 60-year-old man and a 44-year-old woman were admitted for acute left hemiparesis, respectively unusual headache with photo-, phonophobia. The diagnosis of COVID-19 was made by a positive nasopharyngeal swab RT-PCR. The initial MRI showed for both patients an aspect of unilateral ventriculitis associated with periventricular vasogenic edema and serpiginous periventricular hypo signal in SWI. Both presented in the cerebrospinal fluid, neutrophil pleocytosis WBC 354/mm³, neutrophils 91% and lymphocytes 6% for the first patient and WBC 3000/mm³, neutrophils 91%, lymphocytes 0% for the second patients, associated with hypoglycorrhachia 2,5 mmol/L compared to 7,5 mmol/L glycemia and 2,7 mmol/l compared to 5,9 mmol/L glycemia, respectively. Empirical antibiotic treatment was started, but due to lack of argument for an infection on two consecutively lumbar punctures, the treatment was stopped. Favorable evolution was observed on corticosteroid treatment. The follow-up MRI showed a net reduction of the initial findings for both patients.

Conclusion: The presented cases seem to be comparable with the first case of ventriculitis in a patient with SARS-CoV-2 reported by Moriguchi et al in 2020. The particularity of our cases is given by the serpiginous hypo signal in SWI, that was not described in the case report mentioned before. The favorable clinical and radiologic evolution on corticosteroid treatment suggests a probable inflammatory mechanism secondary of COVID.

Patient1

Patient2

Disclosure: No

P0962 / 1017

A CASE OF CHANTER SYNDROME

M. Pauls ^1,2, M. Gosh¹, A. Blight¹, A. Pereira¹

¹St George’s Hospital, London, Neurology & Stroke, London, United Kingdom, ²Cambridge University Hospital, Neurology, Cambridge, United Kingdom

An unknown male in his 40s presented having been found collapsed and unresponsive outside a pub. No history was available at all. He was very agitated, had pinpoint pupils, bitten his cheek and been incontinent of urine. A CT head showed bilateral cerebellar hypodensity suggestive of infarction so he was admitted under the stroke team.

MRI (figure 1) demonstrated changes in the cerebellum, basal nuclei and hippocampi, highly metabolically active tissues. Therefore, a toxic/metabolic aetiology was thought more likely than vascular. Urine toxicology studies were positive for cocaine and opioids. A diagnosis of Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) syndrome was made.

The patient deteriorated markedly and required a posterior fossa craniectomy. However, 3 weeks after admission, he showed some improvement: initially just moving spontaneously, looking around and tracking. His improvement continued so that by 4 months he could conduct a simple conversation.

The acute changes on imaging such as in our case may appear similar to acute ischaemia but they are in very metabolically active areas, and can occur in various toxidromes and hypoxic ischaemic brain injury. Therefore, CHANTER syndrome, which occurs in the context of opioid and benzodiazepine abuse, is an uncommon but important stroke mimic with the potential for good recovery in spite of profound imaging changes and early very severe illness.

Disclosure: No

P0963 / 1386

THE CENTRAL RETINAL ARTERY OCCLUSION: A WALKING PATIENT IN LIFE-THREATENING CONDITION

D. Černík ¹, K. Javornická¹, S. Gligić¹, Š. Brušáková¹

¹ Masaryk Hospital, Krajská zdravotní a.s., Neurology, Ústí nad Labem, Czech Republic

Background and aims: Monocular vision loss caused by acute occlusion of the central retinal artery is a rarer clinical presentation of stroke. It differs from the typical symptoms (speech disorder, decreased corner, limb mobility) mainly in that the patient is self-sufficient. The condition is often underestimated by a general practitioner, an ophthalmologist and often a neurologist. The aim is to draw attention to the seriousness of this situation with a possible fatal reversal.

Methods: The patient (male, 58 years) was admitted with loss of vision in the right eye. He was brought by the ambulance service. He was examined by a neurologist and an ophthalmologist. Distal occlusion of the right internal carotid artery (ICA) was found on the CTA. The ocular finding corresponds to occlusion of the central retinal artery. Intravenous thrombolysis (IVT) was administered with significant adjustment of vision in the right eye. Immediately after the completion of IVT, the condition worsens to left hemiplegia The new CTA shows a occlusion of the middle cerebral artery on the right.

Results: Mechanical embolectomy with complete recanalization was performed. The clinical finding has practically normalized. A follow-up examination at 2-day intervals shows asymptomatic reocclusion of the right ICA. The patient has received secondary preventive therapy. No symptoms of a new ischemic event have been reported for two years.

Conclusion: Acute monocular loss of vision is a rarer presentation of stroke, and despite the atypical clinical picture, which does not initially immobilize the patient, it can be a life-threatening condition.

Disclosure: No

P0964 / 1158

CAROTID ARTERY ANGIOPLASTY – A POTENTIALLY LIFE-SAVING DECISION IN PARTICULAR CASES OF POSTERIOR CIRCULATION STROKE

P.A. Ioan ¹, A. Ciocan¹, O. Ioghen¹, O. Rusu¹, A. Ribigan^2,1, F. Antochi^2,1

¹Emergency University Hospital Bucharest, Neurology, Bucharest, Romania, ²University of Medicine and Pharmacy Carol Davila, Neurology, Bucharest, Romania

Background and aims: Bilateral vertebral artery (VA) occlusion is a rare occurrence that can lead to acute ischemic stroke (AIS) in the posterior cerebral circulation. The literature provides a few series of cases on this topic: mostly it has been observed that these patients have a high risk of early recurrent ischemic events even with maximal medical therapy.

Methods: A 72-years-old male patient was admitted to the hospital for sudden onset of diplopia, rotatory vertigo and postural instability. He had medical history of coronary artery disease, hypertension and hyperlipidemia. Cerebral MRI showed AIS in the left cerebellum and the pons. A vertebral ultrasound raised the suspicion of bilateral VA occlusion near the origin, confirmed by a digital subtraction angiography. Basilar artery blood flow was entirely dependent upon the anterior circulation through the left posterior communicating artery (PCoA), although a significant left internal carotid artery (ICA) stenosis (75%) was identified.

Results: We proceeded with percutaneous angioplasty with stent of the left ICA stenosis. In the first 24 hours after the procedure, the patient presented two transient ischemic attacks (a maximum duration of 10 minutes) due to a peri-procedural drop in arterial pressure, without other complications.

Conclusions: Literature data suggest that patients with bilateral VA occlusion have a poor prognosis, but evidence regarding prevention of recurrent AIS is scarce. We propose performing percutaneous carotid angioplasty with stent in certain patients that also associate a significant stenosis in anterior circulation that provides blood flow to the basilar artery through patent PCoA.

Disclosure: No

P0965 / 212

JAMAICAN SUSUMBER BERRY POISONING MIMICKING ACUTE STROKE

M. Rosso ¹, J. Tamaiev², J. Perk¹, S.R Levine^1,3,4

¹SUNY Downstate Health Sciences University, Neurology, Brooklyn, United States, ²SUNY Downstate Health Sciences University, Psychiatry, Brooklyn, United States, ³Kings County Hospital Center, Neurology, Brooklyn, United States, ⁴Jaffe Stroke Center, Maimonides Medical Center, Neurology, Brooklyn, United States

Background and aims: Stroke mimics are non-vascular conditions that present with acute focal neurological deficits simulating an acute ischemic stroke. We report two cases of Susumber Berry (SB) toxicity presenting as stroke mimics and perform a systematic review.

Methods: MEDLINE/EMBASE/WoS were searched for “susumber berries”, “susumber”, “solanum torvum”.

Results: 72- and 67-year-old women presented as stroke codes 6 hours apart. The first patient was found with left gaze deviation, nystagmus, dysarthria, dysphagia, lateropulsion. The second patient showed tachycardia, agitation, dysarthria, unstable gait. Toxicology screen and head CT were negative. The patients shared a meal containing imported SB from Jamaica on the evening preceding symptoms onset. Both were discharged home with no residual symptoms.

Systematic review: 531 abstracts were screened after removal of duplicates; 5 articles were selected describing 13 patients (Fig.1). A total of 15 patients were analyzed, including our 2 patients. Fourteen patients (93%) developed dysarthria and/or unstable gait, 7 (47%) nystagmus/gaze deviation, 5 (33%) autonomic symptoms. Six (40%) required ICU admission, 3 (20%) intubation. Twelve (80%) had a rapid complete recovery, 3 were hospitalized up to one month.

Conclusions: SB toxicity can cause neurological symptoms that mimic an acute stroke typically with a posterior circulation symptom complex. Altered SB toxins (from post-harvest stressors or temperature changes) might stimulate muscarinic/nicotinic cholinergic receptors or inhibit acetylcholinesterase, causing gastrointestinal, neurological, and autonomic symptoms. In cases of multiple patients presenting simultaneously to the ED with stroke-like symptoms or when stroke-like symptoms fail to localize, a toxicological etiology should be considered.

Disclosure: No

P0966 / 618

PATHOLOGICAL YAWNING AND LAUGHTER AS AN UNUSUAL MANIFESTATION OF ACUTE ISCHEMIC STROKE

S. Moorthamers ¹, A. Ourtani², O. Revin¹, L.V. Frezals¹, M.-D. Gazagnes²

¹Brugmann University Hospital, Emergency Department, Brussels, Belgium, ²Brugmann University Hospital, Neurology Department, Brussels, Belgium

Background and aims: Abnormal yawning and pathological laughter are perceived as rare phenomenona in acute neurological disorders. In 1906, Mosso linked the occurrence of excessive yawning with brainstem ischemia. “Fou-rire-prodromique” (prodrome of crazy laughter), a pathological laughter preceding stroke, was described by Féré in 1903. Although extremely rare and too little emphasized, both yawning and laughter can reveal stroke. To caution clinicians not to be misled by these atypical symptoms, we report a posterior circulation stroke presenting with excessive yawning and pathological laughter.

Methods: Case report. A 54-year-old woman was brought to the emergency department after the acute onset of excessive repetitive compulsive yawning and a slightly slurred speech. Clinical examination showed discrete fluctuating imbalance of stance, broad-based gait, leftward veering, slight left lower facial paresis and slight left-sided dysmetria. But, the clinical picture was mainly characterized by excessive yawning, a slurred speech and spells of forced laughter triggered by trivial stimuli. Or, signs and symptoms mostly due to acute alcohol intoxication. However, brain computed tomography angiography and perfusion demonstrated a small posterior circulation ischemic stroke and the patient underwent immediate and successful thrombolysis.

Discussion: This case illustrates the challenge and pitfalls to diagnose stroke in a patient presenting with atypical symptoms as laughter and yawning, associated with minor gait ataxia and slurred speech, i.e. symptoms often seen in drunkenness.

Conclusion: Excessive yawning and pathological laughter may be the first manifestation of stroke. It should not be overlooked nor confused with acute alcohol intoxication, a known posterior circulation stroke mimic.

Disclosure: No

P0967 / 682

ARGATROBAN RESISTANCE AND SUCCESSFUL ENHANCED ANTICOAGULATION IN A CEREBRAL VENOUS SINUS THROMBOSIS CASE WITH SERPINC1 MUTATION

J. Duan ¹, H. Ma², X. Ji²

¹Xuanwu Hospital, Capital Medical University, Department of Emergency and Neurology, Beijing, China, ²Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China

Background and aims: Hereditary antithrombin(AT) deficiency could weaken the bingding with LMWH and affects the anticoagulant effect. Argatroban maybe an effective option. The efficacy of argatroban is usually proportional to the dose. However, if high dosage of argatroban was not able to extend the APTT levels to a target range, how could we do?

Methods: We report a case of a 19-year-old male who was admitted to hospital with sudden headache, nausea, vomiting and eyes swelling for 3 days. Brain CT in admission showed a high-density region in the left transverse sinus, which suggested cerebral venous sinus thrombosis (CVST)

Results: AT activity was 50.00% (reference range 80-120%) with SERPINC1 gene mutation. On the 6th day of admission, intravenous argatroban was added for anticoagulation since the AT level is still low. From the 6th day to the 10th day of admission, as the intravenous pump rate of argatroban gradually increasing from a speed of 3mg/h to 11 mg/h, it failed to achieve a target range of 1.5 to 3 times over the initial baseline level of the APTT index. We chose strongly combined anticoagulation (argatroban and LMWH) and the APTT gradually reached a target level.

Conclusions: AT deficiency due to SERPINC1 mutation is one of the causes of thrombophilia in CVST patients. Argatroban resistance needs attention. Under close monitoring of coagulation indexes, enhanced anticoagulants may be the best strategy and should be considered early if single-agent anticoagulation does not work in a timely manner.

Disclosure: No

P0968 / 449

UNUSUAL STROKE MIMIC: HEREDITARY ANGIOEDEMA TYPE I, A CASE REPORT

J. Molina-Gil ¹, B. López-López¹, Á. Criado-Antón¹, P. Zunzunegui-Arroyo¹, M. Díaz-Castela¹, A. Vargas-Mendoza¹, E. López-Cancio¹, L. Benavente-Fernández¹, C. García-Cabo¹, L. González-Fernández¹

¹ Hospital Universitario Central de Asturias, Neurology, Oviedo, Spain

Background and aims: One-third of patients initially diagnosed with a stroke are ultimately diagnosed with stroke mimic (SM). Hereditary angioedema type I (HAE-I) is a rare immune disorder characterized by a deficit of functional C1 esterase inhibitor (C1-INH) and it typically presents as recurrent and unpredictable attacks of generalized and nonpruritic edema, abdominal pain and life-threatening airway obstruction. Neurological involvement is very unusual, with a few reports of cephalea and recurrent dizziness but, although uncommon, acute hemisensory loss may be the initial manifestation. In this context it is used to consider as first the ischemic stroke.

Methods: A 32-year-old woman diagnosed with HAE-I was referred at Emergency Department suffering from 8-hour-lasting left hemisensory syndrome (facial and brachial paresthesias), with initial suspicion of a lacunar stroke.A few hours after hospital admission, she presented an acute attack of facial swelling and abdominal bloating similar to the previous HAE-I attacks.

Results: An urgent simple computed tomography scan did not show acute ischemic or hemorrhagic cerebral signals.A complete blood test did not find abnormal values. Also a video-electroencephalogram and a cranial magnetic resonance (MR) with MR angiography were performed, with no pathological findings. Patient received C1-INH concentrate with complete resolution of cutaneous, abdominal and neurological symptoms and was diagnosed with acute HAE-I attack presented as SM.

Conclusions: HAE-I is a rare condition, and its presentation as hemisensory loss infrequent, which often leads to misdiagnosis with stroke. Complaints of facial swelling and abdominal bloating should arise suspicion, especially in young people without cardiovascular risk factors.

Disclosure: No

P0969 / 688

A RARE PRESENTATION OF ISCHEMIC STROKE FROM HERPES SIMPLEX VIRUS 2 VASCULITIS

N. Tantirige ¹, S. Godsell¹, M. Ghosh¹, S. Shribman¹

¹ St George’s University Hospitals NHS Foundation Trust, Neurology, London, United Kingdom

Background and aims: Herpes simplex viruses (HSV) account for rare, but important causes of central nervous system infections. Cerebrovascular presentations of HSV include encephalitis, meningitis and more rarely stroke syndromes. We present a case of HSV-2 vasculitis presenting as an acute ischemic stroke.

Methods: Case report.

Results: A 46-year-old female presented with dysarthria and right hemiparesis. She was alert, apyrexial without features of meningism. There was no relevant past medical history. Initial examination was suspicious for a functional disorder and CT head and CT angiogram (CTA) were clear. Her deficits worsened two days later and a CTA confirmed a basilar perforator territory infarct involving the left side of the pons (fig.1). There was also irregularity and narrowing of the distal basilar artery (fig. 2) consistent with a vasculopathy. Routine screening revealed a new diagnosis of HIV infection (CD4 count 75 cells/mm³, viral load 40,000 copies/ml). A lumbar puncture revealed HSV-2 in the CSF. She was treated with anti-retroviral therapy and a 2-week course of acyclovir. Her stroke syndrome mildly improved whilst on acyclovir.

Conclusions: This case highlights the difficulties in diagnosis of atypical stroke syndromes, particularly in young patients. Admission HIV testing, early CSF analysis and CTA played a crucial role in the diagnosis of HSV-2 vasculitis in this case. Physicians should consider a wide range of differentials when looking at aetiology of stroke in HIV infected individuals, such as opportunistic infections, HIV-associated vasculitis and immune activation, some of which maybe treatable allowing for better patient outcomes.

Disclosure: No

YOUNG STROKE PHYSICIANS AND RESEARCHERS: RESEARCH DESIGN WORKSHOP FOR STUDIES IN DEVELOPMENT*

P0970 / 1277

STAKEHOLDERS’ VIEWS AND EXPERIENCES OF STROKE REHABILITATION AND RECOVERY RESEARCH IN THE ACUTE CLINICAL SETTING: STUDY DESIGN PROCESS

M. Broderick ^1,2, L. Johnson^3,4, J. Brereton^3,4, P. Wilding¹, V. Dave¹, J. Burridge⁴, P. Bentley^2,1

¹Imperial College Healthcare NHS Trust, London, United Kingdom, ²Imperial College London, Brain Sciences, London, United Kingdom, ³University Hospitals Dorset NHS Foundation Trust, Physiotherapy, Bournemouth, United Kingdom, ⁴University of Southampton, Life Sciences, Southampton, United Kingdom

Background and aims: Recruitment, particularly in the acute phase, is a key priority for stroke research. Recruitment rates to rehabilitation/recovery trials remain low. Additionally, representation of women, minority groups and those with cognitive or communication impairments has historically been poor. Recruiting acute stroke survivors brings complex ethical and practical considerations for researchers (Figure 1.). Pilot studies provide data to better understand recruitment issues and improve study design. Integral to an ongoing pilot study (ClinicalTrials.gov Identifier: NCT04475692), we designed a survey to (i) investigate stakeholders’ views and experiences of recruitment in the acute stroke setting (ii) identify similarities and differences between stakeholder groups.

Methods: The aphasia-friendly survey was developed using prior feasibility findings, the NIHR participant in research experience survey results, literature review and stakeholder consultation to identify key themes on which to base survey items The survey of a convenience sample of researchers, clinicians and research participants or their consultees at four stroke centres, addresses factors impacting recruitment to stroke rehabilitation and recovery research. (Figure 2.).

Results: Data will be presented using descriptive statistics, encompassing subgroup analysis. Results will be used to identify recruitment challenges and opportunities to improve subsequent study design.

Conclusions: Meeting recruitment targets is critical to managing research costs, reducing research waste and achieving meaningful research outcomes, thus translating medical and therapeutic innovations into clinical practice. There is a dearth of information about research stakeholders’ experiences and views to inform trial design. Addressing this gap is important in improving recruitment to rehabilitation/recovery trials.

Disclosure: No

P0971 / 1363

MODIFIED MULTI-PHASIC CTA - CARDIAC EVALUATION IN ACUTE STROKE IMAGING

S. Varadharajan ¹, M. Nedunchelian², G. Priyadharshinee², K. Muthugounder Athiyappan², P. Arunachalam², R. Shankar Iyer², S. E², M. Cherian²

¹KMCH, Neuroradiology, Coimbatore, India, ²KMCH, Coimbatore, India

Background and aims: Large proportion of strokes remain unclassified or are categorized under the embolic stroke of undetermined source (ESUS). An early cardiac screening if incorporated during CT Angiography (CTA) for acute stroke imaging has been shown to have a yield of 15-20% for identifying the cardiac source. We conducted a pilot project looking at the utility of dual-energy (DECT) in stroke patients by incorporating additional cardiac screening in our multiphasic CTA protocol.

Methods: Multiphasic CT cerebral angiography was done, followed by venous phase cardiac screening using a retrospective ECG-gated acquisition and half-rotation reconstruction. Patients with ischemic stroke with features of embolic etiology who have undergone both CTA and echocardiography were included for analysis. This was a pilot study done on a small number of patients from September to December 2020.

Results: Out of the 37 patients, 12 patients had abnormal cardiac findings: intracavitary thrombus, infarcts, LV aneurysm, and fibroelastoma. Clot detection in TTE was 2 out of 37 (5.4%) while the detection rate in CT angiography was 5 out of 37 (13.5%). The mean total radiation in terms of DLP was 5879 mGy cm, of which 805 mGy cm (13.5%) was by cardiac coverage.

Conclusions: By extending the coverage during CT Angiography in ischemic strokes of suspected embolic etiology, a higher diagnostic yield was seen for intracavitary thrombus as compared to TTE. ECG-gated cardiac screening as a part of CTA may be a promising adjunct for the detection of cardiac thrombi in patients with ischemic stroke.

Disclosure: No

P0972 / 932

EFFECTS OF THE COVID-19 PANDEMIC ON PRE - HOSPITAL CARE FOR STROKE AND TRANSIENT ISCHAEMIC ATTACK : A PROTOCOL FOR A SYSTEMATIC REVIEW AND META-ANALYSIS

E. Burton ¹, V. McCarthy², A. Merwick³, P.M Kearney¹, C. Buckley^1,4

¹University College Cork, School of Public Health, Cork, Ireland, ²University College Cork, School of Nursing and Midwifery, Cork, Ireland, ³Cork University Hospital, Department of Neurology, Cork, Ireland, ⁴Health Service Executive South East, Office of the NCAGL for Chronic Disease, Kilkenny, Ireland

Background and aims: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on health system care delivery. The aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on pre - hospital care for stroke or TIA.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review will be registered on PROSPERO. Peer-reviewed quantitative studies in English, which report the impact of the COVID-19 pandemic on pre - hospital care for adult stroke/TIA patients will be considered for inclusion. A systematic search of databases including Pubmed, Embase and Scopus from January 2020 to present day will be conducted. Studies will be screened for inclusion and, data extraction and quality assessment will be conducted by the authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance response times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Heterogeneity will be addressed as per the Cochrane Handbook criteria.

Results: Data on primary and secondary outcomes will be provided.

Conclusions: This study will summarise existing literature investigating the impact of the COVID-19 pandemic on pre - hospital care for those with stroke/TIA.

Acknowledgements: We would like to thank Virginia Conrick, librarian, and the Patient and Public Involvement Contributors who worked with us on this protocol. This study was funded by the Health Research Board CDA-2019-001.

Disclosure: No

HYPERACUTE MANAGEMENT – EXCLUDING CLINICAL TRIAL RESULTS

P0973 / 1623

IN-HOSPITAL ASPIRIN DOSE AS A RISK FACTOR OF HEMORRHAGIC TRANSFORMATION IN PATIENTS NOT SUBMITTED TO REPERFUSION THERAPIES

J.B. Clares de Andrade ¹, J. Mohr², F. Lima³, J. Carvalho³, L. Barros⁴, O. Pontes-Neto⁵, G. Silva¹

¹Universidade Federal de Sao Paulo, Sao Paulo, Brazil, ²Columbia University, New York City, United States, ³Hospital Geral de Fortaleza, Fortaleza, Brazil, ⁴Universidade Estadual do Ceara, Fortaleza, Brazil, ⁵Universidade de Sao Paulo, Ribeirao Preto, Brazil

Background and aims: Aspirin is widely indicated for secondary prophylaxis in acute ischemic stroke (AIS). However, its use may increase the risk of hemorrhagic transformation (HT). We aimed to analyze the relationship between in-hospital aspirin daily dose (IAD) and HT in patients with AIS.

Methods: We proceeded with a retrospective cohort with patients admitted to our comprehensive stroke center from 2015 to 2017. The IAD was defined by an independent staff team. All included patients performed either CT or MRI within 7 days from admission. Patients had their risk of HT assessed by the predictive score of HT in patients not submitted to reperfusion therapies (PROpHET). Regression models were adopted to evaluate the correlation between HT and IAD.

Results: We included 986 patients in our final analysis. The prevalence of any HT was 19.2% – and parenchymatous hematomas type 2 (PH-2) represented 10% (n=19) of these cases. The IAD did not have an association with any HT (p=0.09) or PH-2 (p=0.06), among all patients. Among those at higher risk of HT (PROpHET ⩾ 3), IAD was associated with PH-2 [OR1.01,95%CI 1.001-1.023, p=0.03] in an adjusted analysis. Besides, taking 200mg versus 300mg of aspirin is protective against PH-2 (OR0.102, 95%CI 0.018-0.563, p=0.009). Increased IAD was not associated with the NIHSS variation (p=0.92).

Conclusions: Increased in-hospital aspirin dose is associated with intracerebral hematoma in patients at high risk of HT. Stratifying the risk of HT may lead to individualized aspirin daily dose choice. Randomized clinical trials are needed to determine the optimal IAD in stroke patients.

Disclosure: No

P0974 / 1209

EMERGENT CAROTID STENTING DURING MECHANICAL THROMBECTOMY IN ACUTE STROKE

E. de Celis Ruiz ¹, J. Rodríguez Pardo¹, R. Rigual¹, G. Ruiz-Ares¹, L. Casado Fernandez¹, J. García Castro¹, A. Fernández Prieto², A. Álvarez Muelas², R. Frutos Martínez², A.J Barrios López², M. Alonso de Leciñana¹, B. Fuentes¹, E. Díez Tejedor¹, P. Navia²

¹Department of Neurology and Stroke Center, Neurological Sciences and Cerebrovascular Research Laboratory, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain, ²Department of Neuroradiology, La Paz University Hospital, Madrid, Spain

Background and aims: Optimal management of steno-occlusive carotid lesions in patients with acute stroke undergoing mechanical thrombectomy (MT) is still under discussion. We aimed to describe outcomes and complications of emergent carotid stenting and associated antithrombotic therapies in this setting.

Methods: Retrospective observational study of patients with carotid steno-occlusive lesions treated with MT between January 2019 and December 2021. We compared clinical characteristics, antithrombotic treatments and outcomes (at discharge and 3 months) focusing on stent occlusion, haemorrhagic transformation and modified Rankin scale (mRS) of patients with and without emergent stenting.

Results: Fifty-three patients, 37 (69.8%) men, median age 68 (61–79) years were included. Thirty-four (64%) were treated with emergent carotid stenting. We found no differences in basal characteristics between patients with and without stenting. Patients undergoing stenting had lower NIHSS scores on admission [median (IQR): 14 (7–20) vs 18 (14–23), p=0.033]. Atherothrombotic etiology and carotid dissection were more frequent in the stenting group (p=0.024). Intravenous thrombolysis rates were similar in both groups (50% vs 42.1%, p=0.581). Hemorrhagic transformation was 17.6% vs 15.8%, p=1. Eighteen (53%) patients received tirofiban and 20 (59%) iv aspirin during stent placement; amongst them there were no differences in hemorrhagic transformation rates. Stent occlusion occurred in 4 (11.8%) patients. Dependency rates (mRS 3–6) were similar between patients with and without stenting at discharge and 3 months (58.8% vs 63.3% and 57.7% vs 76.9%, respectively).

Conclusions: Emergent carotid stenting during MT seems safe regardless of the use of intravenous thrombolysis and antithrombotic therapy.

Disclosure: No

P0975 / 1639

PRE-HOSPITAL SYSTOLIC BLOOD PRESSURE AND DIAGNOSIS IN SUSPECTED STROKE: THE AKERSHUS STUDY OF ISCHEMIC STROKE AND THROMBOLYSIS-1

S.H. Jahr ¹, E.C. Sandset², K.W. Faiz¹, K.T. Larsen¹, V. Hillestad³, M.N. Selseth³, A. Sundseth¹, B. Thommessen¹, M. Altmann¹, O.M. Rønning¹, E.S. Kristoffersen¹

¹Akershus University Hospital, Department of Neurology, Lørenskog, Norway, ²Oslo University Hospital, Department of Neurology, Oslo, Norway, ³Akershus University Hospital, Department of Radiology, Lørenskog, Norway

Background and aims: Prehospital identification of stroke patients is becoming increasingly important. We aimed to investigate if prehospital blood pressure differs according to diagnosis and outcome in patients with suspected stroke.

Methods: The Stroke Unit at Akershus University Hospital has a catchment area of about 10 % of the total population. We did an observational study of all stroke fast tracks patients 2015-2017 (<4.5 hours). We compared blood pressure measurements according to discharge diagnosis (ischemic stroke, TIA, intracerebral hemorrhage (ICH) and stroke mimics), in ischemic stroke (large vessel occlusion (LVO) versus no LVO and lacunar infarct versus non-lacunar infarct) and 3-months modified Rankin Scale (mRS).

Results: 1341 patients were included. Mean age was 69.3 years. 55% was discharged with a stroke related diagnosis and 35% were stroke mimics. Patients with ICH had significantly higher pre-hospital systolic blood pressure (SBP) compared with ischemic stroke, TIA and stroke mimics (p<0.001). This difference persisted in the first hospital measurement (p=0.002). Among ischemic strokes, patients with LVO had significantly lower pre-hospital SBP compared with non-LVO patients (152 vs 164 mmHg, p<0.001). Patients with lacunar infarct had significantly higher pre-hospital SBP compared with non-lacunar (165 vs 159 mmHg, p=0.039). In ischemic stroke pre-hospital SBP was significantly higher among those with mRS 0-2 vs 3-6 at 3 months (p=0.004).

Conclusions: Prehospital SBP is highest in patients with ICH and differ in ischemic stroke patients with LVO vs non-LVO and lacunar vs non-lacunar infarct. Prehospital triage scores including SBP to identify patients with stroke should be evaluated.

Disclosure: No

P0976 / 450

EFFECT OF NVNS ON HEMODYNAMIC PARAMETERS IN THE TR-VENUS STUDY

E.M. Arsava ¹, M.A. Topcuoglu¹, I. Ay², E. Liebler³, H. Ay², TR-VENUS Investigators

¹Hacettepe University, Ankara, Turkey, ²Massachusets General Hospital, Harvard Medical School, Boston, United States, ³electroCore, Inc, Basking Ridge, United States

Background and aims: TR-VENUS (ClinicalTrials.gov identifier: NCT03733431) was a randomized, sham-controlled, single-blind, multicenter trial assessing the safety and feasibility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of stroke. The primary endpoint was a composite safety outcome defined by bradycardia (HR ⩽50 beats/min) during stimulation, ⩾20–mm Hg decrease in mean BP during stimulation, or progression of neurological deficit (⩾4–point increase in National Institutes of Health Stroke Scale score) or death within 24 hours of treatment initiation. There were no obvious safety signals; primary endpoints were similar across treatment arms. We conducted a post hoc analysis of HR and BP data to further examine potential treatment effects on these parameters.

Methods: TR-VENUS participants were randomly assigned to receive sham stimulation, standard-dose nVNS (2-minute stimulation every 10 minutes for an hour; 7 stimulations), or high-dose nVNS (2-minute stimulation every 10 minutes during hour 1 and hour 5; 14 stimulations). HR and BP were measured 2 and 5 minutes after each stimulation and 30 minutes after the final stimulation. Mean arterial pressure (MAP) change and HR were analyzed using mixed models for repeated measures.

Results: The study population included 69 subjects with ischemic (n=61) or hemorrhagic (n=8) stroke. The mean age was 70.7 ± 12.6 years, and the mean time to treatment was 5.2 ± 2.7 hours. The table shows the change in MAP and HR variables by treatment.

Conclusions: nVNS is not significantly associated with changes in HR or BP when used in the setting of acute stroke.

Disclosure: Yes

P0977 / 184

COMPARING STANDARD AND EXTENDED TIME WINDOW REPERFUSION TREATMENTS IN AN MRI BASED STROKE CARE SYSTEM: A PROSPECTIVE SINGLE-CENTRE STUDY

B. Gunda ¹, T.T. Takács¹, R. Stang¹, S. Szatmári¹, I. Sipos¹, Á.J. Berki¹, D. Bereczki¹, C. Varga², P. Barsi³, P. Maurovich-Horvat³, B. Kis⁴, I. Szikora⁴

¹Semmelweis University, Neurology, Budapest, Hungary, ²Semmelweis University, Emergency Medicine, Budapest, Hungary, ³Semmelweis University, Neuroradiology, Budapest, Hungary, ⁴National Institute of Mental Health, Neurology and Neurosurgery, Neurointervention, Budapest, Hungary

Background: Current ESO guidelines recommend extended time window reperfusion therapies based on advanced imaging, however their benefit on a population basis are not known.

Aim: To determine the caseload, treatment rates and outcomes in extended as compared to standard time windows for thrombolysis and thrombectomy.

Methods: All consecutive ischemic stroke patients with symptom onset within 24h from 1st March to 31 August 2021 were included in a prospective study undergoing MRI during working hours (from 08 to 20 h) and CT+CTA otherwise. Treatment eligibility in the extended time windows was based on DWI/PWI mismatch using current ESO guideline criteria. Clinical outcome in treated patients was assessed at 3 months.

Results: 326 patients were admitted, 131 (40%) had MRI. 66/123 (54%) patients were thrombolysed in the standard and 11/97 (11%) in the extended time window. Independent clinical outcome (mRS⩽2) was seen in 33/64 (53%) early and 4/11 (36%) late treated patients, median mRS was 2 (1-5) and 3 (1-6), p=0.18 respectively. 18/152 (11.8%) patients underwent thrombectomy in the standard and 11/174 (6.32%) in the extended time window. Independent clinical outcome (mRS⩽2) was seen in 5/15 (33%) early and 4/9 (44%) late treated patients, median mRS was 3 (2-6) and 3 (0.5-6), p=0.75 respectively.

Conclusion: With limited MRI availability extending time windows for reperfusion therapies resulted in a 17% increase in thrombolysis and a 61% increase in thrombectomy with similar clinical outcome is early and late treated patients. Advanced imaging should be available in all stroke centres to late patients.

Disclosure: No

P0978 / 1307

ASSOCIATION BETWEEN ONSET-TO-SUCCESSFUL ENDOVASCULAR RECANALIZATION AND BLOOD PRESSURE MANAGEMENT ON THE INCIDENCE OF HEMORRHAGIC TRANSFORMATIONS: A POST-HOC ANALYSIS FROM BP-TARGET TRIAL

C. Ducroux ¹, R. Fahed², W. Boisseau³, J. Labreuche⁴, S. Richard⁵, B. Lapergue⁶, I. Sibon⁷, B. Gory⁸, J. Berge⁹, A. Consoli¹⁰, J.-M. Olivot¹¹, J. Broderick¹², A. Duhamel⁴, E. Touze¹³, A. Qureshi¹⁴, A. Yavchitz¹⁵, J.-p. Desilles³, P. Boursin³, M. Ben Maacha³, M. Obadia¹⁶, R. Blanc³, M. Piotin³, M. Mazighi³

¹Ottawa Hospital Research Institute, Neurology, Ottawa, Canada, ²The Ottawa Hospital - Civic Campus, Department of Medicine / Division of Neurology, Ottawa, Canada, ³Fondation Rothschild Hospital, Interventional Neuro-radiology, Paris, France, ⁴Lille University, Biostatistics, Lille, France, ⁵Hospital of Nancy, Neurology, Nancy, France, ⁶Foch Hospital, Neurology, Suresnes, France, ⁷CHU Bordeaux, Neurology, Bordeaux, France, ⁸Hospital of Nancy, Diagnostic and Therapeutic Neuroradiology, Nancy, France, ⁹Bordeaux University Hospital, Interventional and Diagnostic Neuroradiology, Bordeaux, France, ¹⁰Foch Hospital, Neuroradiology, Suresnes, France, ¹¹Toulouse University Hospital, Neurology, Toulouse, France, ¹²University of Cincinnati College of Medicine, Neurology and Rehabilitation Medicine, Cincinnati, United States, ¹³Université Caen Normandie, Neurology, Caen, France, ¹⁴University of Missouri - Women’s and Children’s Hospital, Neurology, Columbia, United States, ¹⁵Fondation Rothschild Hospital, Clinical Research, Paris, France, ¹⁶Fondation Rothschild Hospital, Neurology, Paris, France

Background and aims: A high blood pressure following successful thrombectomy might be associated with a higher risk of hemorrhagic transformation (HT), however the Blood-Pressure (BP) Target trial did not show any benefit of intensive blood pressure target on the incidence of HT. In this post-hoc analysis, we assessed if a specific blood pressure target could have an influence on the incidence of hemorrhagic transformation at 24-36 h among patients with early (<6 hours) versus late (⩾6 hours) recanalization.

Methods: The BP-TARGET trial did not show any significant impact of an intensive systolic blood pressure target of 100-129 mm Hg after successful thrombectomy on the occurrence of HT at 24-36h. This post-hoc analysis was performed on specific subgroups of patients recanalized within 6 hours and beyond 6 hours after onset.

Results: A total of 233 patients were included. In the early reperfusion group (<6 hours, N=157), the incidence of HT was 25/74 patients (33.8%) in the intensive systolic blood pressure group and 33/83 patients (39.8%) in the standard systolic blood pressure group (p=0.44). In the late reperfusion group (⩾6 hours, N=76), the incidence of HT was 20/38 patients (52.6%) in the intensive systolic blood pressure group and 18/38 patients (47.4%) in the standard systolic blood pressure group (p=0.65). The rates of symptomatic hemorrhagic transformation, poor outcome and mortality were similar.

Conclusion: In the BP-TARGET trial, the delay between symptoms onset and successful recanalization did not influence the effect of systolic blood pressure targets on the incidence of HT.

Disclosure: No

P0979 / 1008

PROMETHEO STUDY:RESCUE THERAPY WITH ANGIOPLASTY AND/OR INTRACRANIAL STENT AFTER FAILURE OF MECHANICAL THROMBECTOMY

A. Fernández Revuelta ¹, C. Pérez García², T. Montalvo Moraleda¹, A. López-Frías², P. Simal Hernández¹, S. Rosati², M. Moreu², J. Egido¹, C. Gómez-Escalonilla¹

¹Hospital Clínico San Carlos, Stroke Unit Neurology, Madrid, Spain, ²Hospital Clínico San Carlos, Neurointerventional Radiology, Madrid, Spain

Background and aims: Guidelines for management of acute ischemic stroke due to large vessel occlusion (LVO-AIS) and failure of endovascular treatment have not been developed. We have developed a treatment protocol with tirofiban, angioplasty and/or intracranial stenting for these patients and present our results.

Methods: Review of a series of patients with LVO-AIS treated by mechanical thrombectomy without satisfactory reperfusion after 3-4 passes, in whom the proposed protocol was carried out. All patients received tirofiban perfusion, associating lysine acetylsalicylate in cases without previous antiplatelet therapy or anticoagulation, and in those who had not received intravenous thrombolysis. Then, if arterial occlusion persisted, angioplasty or intracranial stenting was performed at the discretion of neurointerventionalist. Cranial CT and angioCT were carried out at 12h. If there was no intracranial haemorrhage and no extensive lesion, dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) was started and tirofiban was discontinued. We evaluated the rate of reperfusion, symptomatic intracranial hemorrhage (sICH) and modified Rankin scale (mRs) at 3 months.

Results: 36 patients were included in this protocol from April 2019 to August 2021. Median age was 72 (63,75-79,5) and 64% were female. Median NIHSS was 17 (12-22). Median ASPECTS was 9 (7-10). Angioplasty was performed in 11.12%,stenting in 44,44% and both in 44.44%.

mTICI 2b/3 result was obtained in 70%. 34% achieved functional independence (mRs ⩽ 2). sICH rate was 6% and 3-month mortality rate was 11%.

Conclusions: Angioplasty and/or intracranial stenting was associated with a high rate of reperfusion, low rate of sICH and good clinical outcomes.

Disclosure: No

P0980 / 299

MECHANICAL THROMBECTOMY (MT) OUTCOME IN OLDER STROKE PATIENTS: LOCAL CENTER STUDY

H. Mon¹, B. Esisi ¹, R. Rayessa¹

¹ Hull University Teaching Hospitals NHS Trust, Stroke Medicine, Hull, United Kingdom

Background: Mechanical thrombectomy benefits large vessel occlusive stroke but good functional outcome (modified Rankin score mRS <2) at 90 days is not evident in elderly patients (>80 years old) as much as in their younger counterpart.

Study method: An observational study was conducted on elderly stroke patients presented to one of the tertiary stroke centers in the UK and who had MT.

The study period was from March 2018 to march 2021.

Results: We collected 22 cases and average age was 84.

81% were directly presented to our center and 19% were transferred from the District Hospital.

Atrial Fibrillation was recorded in 50% and 18% of them were thrombolysed.

Pre stroke mRS 0-2 was (54%). Average NIHSS on admission was 21 and 24 hours post procedure was 15.

Average time from symptom to groin puncture was 150 minutes.

Good MT outcomes (TICI2b-3) was achieved in 68% with single pass (31%) and 2 passes (31%). 9% had simultaneous carotid stenting.

Any type of hemorrhage( 44% )and new territory infract (4.9%) were noted.

Inpatient Mortality was 36% and 90 days was 31%.

13% was discharged to home with mRS 0-2 but 50% ended in institutional care with mRS 3-5, half of them were on palliative care.

Conclusions: Our data suggests high mortality (67%) and less favourable outcomes in the elderly. Despite this, a proportion still achieved good outcome with discharge home (13%). This study suggests that better patient selection is key considering additional factors like frailty alongside NIHSS and ASPECTS score.

Disclosure: No

P0981 / 425

CURRENT DIAGNOSIS AND TREATMENT PRACTICE OF CENTRAL RETINAL ARTERY OCCLUSION (CRAO): RESULTS FROM A SURVEY AMONG GERMAN STROKE UNITS

C. Hoyer ¹, S. Winzer², E. Matthé³, I. Heinle¹, V. Sandikci¹, D. Nabavi⁴, M. Platten¹, V. Puetz², K. Szabo¹

¹Medical Faculty Mannheim, Heidelberg University, Department of Neurology, Mannheim, Germany, ²Carl Gustav Carus University Hospital, Technische Universität Dresden, Department of Neurology, Dresden, Germany, ³Carl Gustav Carus University Hospital, Technische Universität Dresden, Department of Ophthalmology, Dresden, Germany, ⁴Vivantes Klinikum Neukölln, Department of Neurology, Berlin, Germany

Background and aims: Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency. Its optimal management and treatment, however, are still under debate. We aimed to characterize the current diagnostic and therapeutic approach in CRAO patients in German hospitals with a stroke unit (SU).

Methods: In July 2021, all 335 certified SUs in Germany were invited to participate in an anonymous online survey endorsed by the German Stroke Society. The questionnaire assessed factors concerning the organization of emergency department care, diagnostic procedures and treatment of patients presenting with unilateral visual loss (UVL) and subsequently diagnosed with CRAO.

Results: One hundred and sixty-three (49%) of the 335 eligible SUs responded to the survey. A majority (117/135; 87%) stated that patients with UVL were treated as an emergency, however in only 62/138 (45%) according to a specific hospital guideline. First-line evaluation was performed by ophthalmologists in 43/136 (32%) hospitals, and by neurologists in 85/136 (63%) hospitals. Seventy respondents (52%) indicated a lack of ophthalmological expertise in their hospital. Seventy-four of 129 (57%) respondents performed thrombolysis in patients with CRAO and 92/97 (95%) stated that – if admitted to neurology - patients with CRAO were routinely or exclusively treated on the SU (for procedures/treatment see figure 1).

Conclusions: Although our findings reflect notable heterogeneity in early intrahospital care of CRAO, they also indicate that a large number of institutions treat patients with CRAO as acute stroke patients. Streamlining interdisciplinary emergency evaluation is essential for ongoing and future prospective trials on this subject.

Disclosure: No

P0982 / 568

RAPID AND STANDARDISED ORAL ANTICOAGULATION REVERSAL IN ACUTE INTRACEREBRAL HAEMORRHAGE: A HOSPITAL QUALITY IMPROVEMENT INITIATIVE

N. Kumar ¹, C. Sivakumar¹, R. Amerikanou², D. Werring^1,3, D. Turner¹

¹Comprehensive Stroke Service, National Hospital for Neurology & Neurosurgery, London, United Kingdom, ²University College London Hospitals NHS Foundation Trust, Department of Haematology, London, United Kingdom, ³Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom

Background and aims: A protocol allowing immediate access to prothrombin complex concentrate (PCC) without needing haematology approval has previously been shown to reduce delays in administration of PCC in vitamin K antagonist-associated ICH (VKA-ICH). However, the optimal management strategy for the reversal of direct oral anticoagulants (DOACs) is less clear. A quality improvement project aimed to:

1. (1) investigate local practice for DOAC reversal;

2. (2) standardise care; and

3. (3) reduce the scan-to-needle time for reversal in DOAC-associated ICH (DOAC-ICH).

Methods: 49 patients were included: 24 pre-intervention (8 warfarin, 16 DOAC) identified by retrospective audit over a four-year period (November 2015 to September 2019); and 25 identified prospectively post-intervention (7 warfarin, 18 DOAC) over an 18-month period (December 2019 to June 2021). The intervention was a combined VKA- and DOAC-ICH protocol including standardised DOAC reversal with pre-approved PCC and tranexamic acid (TXA). Reversal agents were available for use on the hyperacute stroke unit by a trained team.

Results: After the intervention, there was a 56% reduction in the median scan-to-needle time for DOAC-ICH from 65 minutes to 28.5 minutes. The median scan-to-needle time for VKA-ICH of 31.5 minutes was maintained at 29 minutes post-intervention. Pre-intervention, DOAC-ICH patients were given (in addition to PCC) Vitamin K in 7 cases, and TXA in 7 cases, whereas post-intervention all were given TXA.

Conclusions: The introduction of a combined VKA and DOAC reversal protocol reduced scan-to-needle time and variability in the treatment of DOAC-ICH. The methodology may be adopted by other stroke services to improve care.

Disclosure: No

P0983 / 579

BLOOD PRESSURE MANAGEMENT AFTER ENDOVASCULAR STROKE THROMBECTOMY IN CANADA: A CROSS-SECTIONAL PHYSICIANS SURVEY

A. Katsanos ¹, A. Shoamanesh¹, M. Sharma¹, B. Menon², A. Demchuk², L. Catanese¹

¹McMaster University, Hamilton, Canada, ²University of Calgary, Calgary, Canada

Background and aims: There is paucity of data and lack of consensus on the optimal blood pressure (BP) management following endovascular thrombectomy (EVT), leading to substantial variability in clinical practice.

Methods: We conducted a structured, web-based, cross-sectional survey among physician members of the Canadian Stroke Consortium to investigate current views on BP management after EVT and to explore their interest in participating in a randomized controlled trial (RCT) addressing this question.

Results: 40 physicians (35 stroke neurologists, 3 neuro-interventionalists, 1 general neurologist and 1 internist) completed the survey. All respondents (except for one) worked in tertiary care centers capable of providing EVT (median of 125 procedures per year per center, range 40-400). Nine out of every ten (90%) respondents reported uncertainty on the optimal BP target after EVT, 72.5% indicated the absence of site level institutional guidelines to guide BP management after EVT, while 50% of those working in centers with established guidelines reported that these were not followed consistently. The factors respondents consider important when determining BP targets after EVT include recanalization status (92.5%) post EVT, the presence of significant ipsilateral (82.5%) or contralateral carotid stenosis (41%), and extent of infarcted tissue (69%) or the degree of collateral circulation at baseline (46%). Almost all respondents (92.5%) reported enthusiasm to participate in an RCT exploring different BP targets in this patient population.

Conclusion: Our survey demonstrates uncertainty and variable practice surrounding optimal BP control after EVT in Canadian stroke centers and highlights significant desire for an RCT addressing this question.

Disclosure: No

P0984 / 605

BLOOD PRESSURE CONTROL IN PATIENTS WITH ACUTE INTRACEREBRAL HAEMORRHAGE

B. England ¹, N. Priestley¹, P. Mihaylov¹, L. Binnie¹, L. Zhang¹

¹ St George’s University Hospitals NHS Trust, Stroke Unit, London, United Kingdom

Background and aims: Rapid control of hypertension in acute intracerebral haemorrhage (ICH) is crucial to reduce hematoma expansion and prevent worse outcomes. UK guidelines recommend reducing systolic blood pressure (SBP) to 140mmHg within 60 minutes in these patients. We investigated BP control and outcome in our hyperacute stroke ward.

Methods: Patients admitted for acute ICH between February and June 2021 were reviewed. Demographics, BP records, antihypertensive treatments, haematoma volumes, and clinical outcome were recorded.

Results: 51 patients were included in the study. 25 (49%) were male, and the mean age was 76. 37 (73%) had an SBP ⩾140mmHg on admission. Of these, 4 (10.8%) achieved SBP ⩽140mmHg within 60 minutes; a further 25 (80.6%) achieved the target SBP ⩽140mmHg at a mean time of 12.6 hours. Of patients who were normotensive on admission, 10/14 subsequently became hypertensive SBP ⩾140mmHg. In our cohort, 12 (23%) patients died. Of those, one patient was normotensive throughout. 10 of the remaining 11 patients who died were persistently hypertensive with SBP ⩾160mmHg at 2 hours post-admission, in comparison to only 1/39 in the survival group. Only limited cases had evidence of hematoma expansion, but this was not associated with mortality.

Conclusions: In our cohort, few achieved the target SBP ⩽140mmHg within 60 minutes. However, persistent SBP ⩾160mmHg up to two hours was associated with mortality. These data suggest current guidelines may be too stringent. Normotensive patients may become hypertensive after admission, and close monitoring is required. Further studies are required to confirm these findings.

Disclosure: No

P0985 / 1353

VERY EARLY NEUROLOGICAL IMPROVEMENT AS A PRIMARY OUTCOME PREDICTING FACTOR AFTER THROMBECTOMY

A. de Albóniga-Chindurza ^1,2, J. Ortega-Quintanilla¹, M. Medina^3,2, F. Moniche^3,2, E. Zapata-Arriaza^1,2, S. Pérez-Sánchez^4,2, M.Á. Gamero⁴, A. Barragán-Prieto^4,2, B. Pardo-Galiana^3,2, J.A. Cabezas^3,2, L. Ainz³, A. Cayuela⁵, J. Montaner^4,2, A. González^1,2

¹Interventional Neuroradiology, Department of Radiology, University Hospital Virgen del Rocío, Seville, Spain, ²Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBiS), Seville, Spain, ³Department of Neurology, University Hospital Virgen del Rocío, Seville, Spain, ⁴Department of Neurology, University Hospital Virgen Macarena, Seville, Spain, ⁵Unit of Clinical Management of Public Health-Prevention and Promotion of Health, Area of Sanitary Management South of Seville, Seville, Spain

Background and aims: Very early neurological improvement (VENI) corresponding to the immediate improvement in NIHSS score after treatment of stroke has been described with thrombolysis, and at 24 hours after thrombectomy. We explored the relationship between VENI and good outcome (mRS 0-2) at 3 months following endovascular treatment of stroke.

Methods: This retrospective analysis was based on a prospectively collected registry of patients treated by thrombectomy for ischemic stroke from January 2017 to July 2021. All patients were evaluated immediately before and after thrombectomy, setting the threshold for VENI at 8 points of improvement on the NIHSS. We established 3 groups: patients who do not experience VENI (non-VENI), those who present VENI and maintain improvement after 24 hours (maintained-VENI), and those who present VENI but do not maintain it 24 hours after (non-maintained-VENI).

Results: The analysis included 1702 patients: non-VENI=1419, maintained-VENI= 269 and non-maintained-VENI = 14; without significant differences in age, sex or use of anesthesia. Patients with non-maintained-VENI presented worse ASPECTS 8 (IQR 6-8) vs maintained-VENI 9 (IQR 8-10), p=.01. TICI 3 was more frequent in maintained-VENI 60.8% vs 43.4% non-VENI (p=.071). Symptom onset to recanalization time lapse was shorter in maintained-VENI than in non-VENI (226 vs 335 min, p<.001). The rate of good outcome at 3 months was 49.4% in non-VENI, 78% in maintained-VENI and, 42.9% in non-maintained-VENI (p<.001).

Conclusions: Immediate VENI could become a primary predictive tool for thrombectomy outcome with value in future clinical research endpoints.

Disclosure: No

P0986 / 1526

ENDOVASCULAR TREATMENT IN LOW NIHSS ACUTE ISCHEMIC STROKE: IS PREVENTION BETTER THAN CURE?

I. Oyarzun Irazu ¹, A. Cabrera Muras¹, D. Martinez Condor¹, C. Gutierrez Albizuri¹, O. Quintana Lopez¹, J.M. Garcia Sanchez¹, I. Caballero Romero¹, B. Aguilera Irazabal¹, J.C. Garcia-Monco Carra¹

¹ Basurto University Hospital, Neurology, Bilbao, Spain

Background and aims: The benefit of Endovascular Treatment (EVT) is uncertain for acute stroke (AIS) with large vessel occlusion (LVO) and low NIHSS (<6). AIS with low NIHSS and medial cerebral artery M1 segment occlusion (M1o) treated with EVT in our center were analysed.

Methods: Retrospective analysis comparing outcomes in patients, all with M1o, and low NIHSS treated with EVT vs:

• Outcomes in low NIHSS and medical management (BMM) patients.

• Outcomes in EVTs with NIHSS>= 6.

Modified Rankin Scale (mRS) 0-2 and mRS 0-1 at 90 days were the main objectives. Secondary objectives were related to indication (neurological deterioration, motor/speech symptoms), revascularization (TICI IIB/III, discharge NIHSS, revascularization time, 24-hour CT) and safety data (haemorrhages, death).

Results: 132 patients were included (17 EVT with low NIHSS, 13 BMM with low NIHSS, 102 EVT with >=6 NIHSS). In the first comparison, mRS 0-2 and mRS 0-1 did not show significant differences (64.7% vs. 69.2% p= 0.79; 58.8% vs. 53.8% p=0.78). Motor symptoms were more frequent in the EVT group (64.7% vs 23.3% p=0.02). Speech symptoms and neurological deterioration were also more frequent (47.1% vs 30.8%; 17.6% vs 0%), but not significantly.

In the second comparison, haemorrhages were more frequent in the high NIHSS group (5.9 vs 36.3 p=0.01). No other significant differences were found.

Conclusions: EVT did not present better functional outcomes than BMM in low NIHSS AIS.

However, the results suggest that patients with low NIHSS and disabling symptoms may benefit from ETV, being a safer option than in NIHSS>=6 patients.

Disclosure: No

P0987 / 1057

CAN RAPID THROMBOELASTOGRAPHY DETERMINE ANTICOAGULATION STATUS IN STROKE PATIENTS RECEIVING APIXABAN?

B.O. Pîrlog ¹, J.-M. Yamal², S.A. Parker³, P. Bratina⁴, A. Jacob³, B. Aiken³, K. Phan³, R. Bowry⁵, A. Czap³, J.C. Grotta⁴

¹County Emergency Hospital, Department of Neurology, Cluj-Napoca, Romania, ²University of Texas School of Public Health, Houston, United States, ³University of Texas Health Science Center at Houston McGovern Medical School, Department of Neurology, Houston, United States, ⁴Memorial Hermann Hospital–Texas Medical Center, Houston, United States, ⁵University of Texas Health Science Center at Houston McGovern Medical School, Department of Neurosurgery, Houston, United States

Background and aims: Current guidelines preclude intravenous thrombolysis (IVT) for anticoagulated ischemic stroke (IS) patients and suggest reversal agents for anticoagulated intracerebral hemorrhage (ICH) patients. There are no approved emergency decision-making coagulation tests for patients on apixaban. Thromboelastography (TEG) provides a dynamic overview of coagulation. We sought to determine a TEG parameter threshold for safe administration of IVT or hemorrhage reversal agents in stroke patients receiving apixaban.

Methods: We included acute stroke patients managed on our mobile stroke unit. TEG was performed using portable Haemonetics 6S model. We determined the TEG Rck-value; the time elapsed (minutes) from the time of blood insertion into the 6S cartridge until clot firmness reaches an amplitude of 2 mm.

Results: We enrolled 65 patients; 5 IS patients had received apixaban within 6 hours, 45 had IS and no anticoagulant (IS controls) and 15 had ICH and no anticoagulant (ICH controls). The mean Rck-value for apixaban patients was 9.6 +/-3.4, 6.1 +/-1.8 for IS controls, and 6.1 +/-1.9 for ICH controls. Literature review revealed a mean Rck-value of 7.1 +/-1.2 for controls and 8.8 +/-2.0 after apixaban dosing.

Conclusions: The Rck TEG parameter is useful for rapidly detecting the anticoagulant effect of apixaban, although there is overlap between apixaban-treated patients and controls. The data suggest using the mean Rck-value of control group as threshold below which IVT may be safe, and for considering hemorrhage reversal agents above this threshold. The safety of this approach needs validation in a large cohort of prospectively studied stroke patients.

Disclosure: No

P0988 / 168

FACTORS ASSOCIATED WITH EARLY AND DELAYED NEUROLOGICAL IMPROVEMENT IN PATIENTS TREATED WITH MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE

C. del Toro-Pérez ¹, L. Amaya¹, A. Arjona Padillo¹, P. Martínez-Sanchez¹

¹ Hospital Universitario Torrecárdenas, Almería, Spain

Background and aims: To analyze factors associated with early neurological improvement (ENI), defined as a decrease of four NIHSS points in the first 24 hours, and delayed neurological improvement (DNI), defined as a modified Rankin Scale (mRS) score <3 at three months, in patients treated with mechanical thrombectomy (MT).

Methods: Observational study based on a prospective registry of patients treated with MT (January2017-April2021). Descriptive, bivariate and multivariate logistic regression analysis was performed.

Results: 233 patients were included. Median age 72 years and baseline ERm 0, with a median NIHSS of 17 (13-21). 117 patients (50.2%) achieved ENI. Of those who did not obtain an ENI, 15 (13%) presented LNI. Multivariate analysis showed that direct transfer to the MT Center was associated with higher probability of ENI (OR 3.3, 95% CI 1.09-10.02), while a number of passes>3 (OR 0.12, 95% CI 0.03-0.43), hemorrhagic transformation (greater than HP1 or symptomatic) (OR 0.13, 95% CI 0.02-0.76) and an NT-proBNP⩾1700 (OR 0.33, 95% CI 0.12-0.94) were associated with lower probability of ENI.

A lower NIHSS at admission (OR 0.79, 95% CI 0.67-0.91) and younger age (OR 0.92, 95% CI 0.87-0.97) were associated with higher probability of achieving DNI.

Conclusions: In this study, ENI is dependent on organizational, clinical and MT procedure factors, whereas DNI is only associated with clinical factors.

Disclosure: No

P0989 / 1204

CLINICAL FRAILTY IS ASSOCIATED WITH REDUCED PENUMBRAL VOLUMES IN ACUTE ISCHAEMIC STROKE

M.E. Dohle ¹, E.A Warburton², N.R. Evans¹

¹University of Cambridge, Department of Medicine, Cambridge, United Kingdom, ²University of Cambridge, Department of Clinical Neurosciences, Cambridge, United Kingdom

Background and aims: Clinical frailty – the loss of physiological reserve to withstand a stressor event - is increasingly recognised as being associated with poor outcomes after stroke and with attenuated clinical benefit from acute reperfusion therapies. However, the mechanisms underlying these associations are poorly understood. This study investigated the relationship between frailty and penumbral volumes in hyperacute ischaemic stroke.

Methods: Total ischaemic lesion and core volumes, as well as the proportion of penumbra in the total acute stroke lesion, were measured using CT-perfusion. Frailty was measured using a validated frailty index. The relationship between frailty and the proportion of penumbra was assessed using multivariable regression adjusting for age, sex, onset-to-CT interval, and comorbidities (hypertension, atrial fibrillation, diabetes, smoking). As an exploratory mechanistic endpoint, C-reactive protein, was also measured at baseline.

Results: In 55 individuals with ischaemic stroke, increasing frailty was associated with a reduction in the proportion of penumbra in the acute stroke lesion (r_s=-0.36, p<0.01). On multivariable analysis, frailty remained independently associated with a reduced proportion of penumbra in the acute ischaemic lesion (beta=-1.31,p<0.001). Furthermore, C-reactive protein was associated with both frailty index (rs=0.38, p<0.01) and a reduction in the proportion of penumbra (rs=-0.30, p=0.02).

Conclusions: Frailer individuals having an acute ischaemic stroke present with less salvageable penumbra, independent of time from stroke onset, age, and cardiovascular risk factors. The association with C-reactive protein suggests a potential inflammatory mechanism for this relationship. These findings may explain the previously reported attenuated response to thrombolysis in frailer individuals.

Disclosure: No

P0990 / 1483

SAFETY AND EFFICACY OF COMBINED INTRAVENOUS THROMBOLYSIS PLUS MECHANICAL THROMBECTOMY VERSUS DIRECT MECHANICAL THROMBECTOMY IN DIFFERENT AGE GROUPS OF ACUTE ISCHEMIC STROKE PATIENTS

F. Marrama ¹, A.P. Mascolo¹, F. Sallustio^2,1, M. Bovino¹, A. Rocco¹, F. D’Agostino¹, V. Da Ros³, D. Morosetti³, F. Mori¹, G. Lacidogna¹, I. Maestrini¹, F. Alemseged⁴, V. Panetta⁵, M. Diomedi¹

¹University of Rome Tor Vergata, Department of Systems Medicine, Roma, Italy, ²Nuovo Ospedale dei Castelli, Roma, Italy, ³University of Rome Tor Vergata, Department of Biomedicine and Prevention, Roma, Italy, ⁴University of Melbourne, Department of Medicine and Neurology, Melbourne, Australia, ⁵L’altrastatistica srl, Roma, Italy

Purpose: To evaluate safety and efficacy of combined therapy with intravenous thrombolysis plus mechanical thrombectomy (MT) versus direct MT in different age groups of patients with acute ischemic stroke (AIS) secondary to large vessel occlusion of the anterior circulation.

Methods: We selected patients from our prospective endovascular stroke registry between January 2016 and September 2020. Patients were divided in the combined therapy group and the direct MT group. We performed a propensity score matching (PSM) according to baseline characteristics. Safety outcomes were symptomatic intracerebral hemorrhage and 3-month mortality. Efficacy outcomes were successful recanalization (modified Thrombolysis in Cerebral Infarction, mTICI, score ⩾2b) and 3-month functional independence (modified Rankin Scale, mRS, ⩽2). Finally, we performed a sensitivity analysis of patients ⩽80 and >80 years old.

Results: After PSM, we obtained 204 patients in the combined therapy group (mean age 72±11.7 years; 45.6% males) and 204 patients in the direct MT group (mean age 73±11.5 years; 41.7% males). Combined therapy was associated with higher odds of 3-month functional independence (OR 1.74; 95% CI 1.02–2.97) and lower odds of 3-month mortality (OR 0.53; 95% CI 0.31–0.90). This was confirmed for patients ⩽80 years old (n=308) (3-month functional independence: OR 1.94; 95% CI 1.06-3.54; 3-month mortality: OR 0.37; 95% CI 0.20 - 0.71), but not for those >80 years old (n=100).

Conclusion: Combined therapy over direct MT seems to be linked to a better 3-month outcome in AIS patients ⩽80 years old, but not in those >80 years old.

Disclosure: No

P0991 / 797

A NEW TIMEFRAME INDICATOR FOR ISCHEMIC STROKE TREATMENT: THE TREATMENT TO STROKE UNIT ADMISSION TIME

A. Ciacciarelli ¹, L. Bruno², L. Gentile^3,2, A. Falcou¹, G. Galardo¹, D. Toni¹

¹Sapienza University of Rome, Emergency Department Stroke Unit, Rome, Italy, ²Sapienza, University of Rome, Rome, Italy, ³IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana Ospedale Maggiore, Bologna, Italy

Background and aims: Optimal time intervals of acute ischemic stroke (AIS) treatment from symptom onset to intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT), are recommended by international guidelines. The admission to Stroke Unit (SU-A) is the next step in the correct management of AIS but the time interval between procedure termination and SU-A has never been evaluated. We aimed to investigate the time between end of MT and/or IVT and SU-A as a variable potentially impacting on clinical outcome of AIS patients.

Methods: We retrospectively reviewed the medical records of AIS patients receiving MT and/or IVT and subsequently admitted to our SU. We collected the time elapsed between the end of procedure and SU-A, neurological severity, and outcome. Primary outcome was functional independence at 90 days (mRS 0-2) and failure of early neurological improvement (fENI = 7days/discharge NIHSS ⩾ baseline NIHSS).

Results: We included 103 patients. Patients with fENI had a significantly higher time from end of procedure to SU-A (19.28hrs vs 8.16hrs, p=0.044). At multivariate analysis, this time was statistically associated with fENI when corrected by onset-to-procedure time, age, sex and, baseline NIHSS (OR:1.035, p=0,013, CI95%:1.007-1.063). End of procedure-to-SU-A time and door-to-SU-A time were not statistically different between patients with good and bad outcome at 3 months.

Conclusions: Delay in SU-A of ischemic stroke patients treated with MT and/or IVT resulted in higher rate of fENI. The admission to dedicated SU of AIS patients receiving MT and/or IVT should not be withheld or delayed.

	Time end of procedure-to-SUmedian (IQR)	p	Time door-to-SUmedian (IQR)	p
fENI	19.28 (32.77)	0.044	23.07 (36.29)	0.042
ENI	8.16 (19.72)		14.34 (21.12)
Bad Outcome	10.93 (34.7)	0.969	21.78 (37.55)	0.213
Good Outcome	14.61 (25.4)		16.87 (26.64)
Thrombectomy	15.48 (25.13)	0.603	19.20 (25.32)	0.913
Thrombolysis	15.11 (27.43)		20.78 (27.24)
Bridging	10.78 (22.73)		16.51 (28.82)
90d survival	16.27 (26.06)	0.482	20.67 (28.00)	0.590
90d death	5.75 (45.21)		19.2 (47.05)

	fENI
	OR	p	95% C.I.
End of procedure-to-SU admission time	1.035	0,013	1.007-1.063
Onset-to-end of procedure time	1.044	0.390	0.946 – 1.154
Age	1.026	0.332	0,974 - 1,081
Sex (male)	0.217	0.017	0.061 – 0.764
Baseline NIHSS	1.013	0,770	0,927 - 1,107

Disclosure: No

P0992 / 530

MORE FAST PROGRESSORS AND LOWER RECANALISATION RATES LEADS TO SMALLER SAMPLE SIZES IN ACUTE ISCHAEMIC STROKE TRIALS

A. Mahmood ¹, M. Parsons², B. Campbell³, C. Levi⁴, S. Davis³, A. Bivard³, X. Huang¹, K. Muir¹

¹University of Glasgow, Glasgow, United Kingdom, ²University of New South Wales, Sydney, Australia, ³University of Melbourne, Melbourne, Australia, ⁴University of Newcastle, Newcastle, Australia

Background: Heterogeneity of acute ischaemic stroke (AIS) inflates sample size in trial populations. In phase 2 trials, follow-up infarct volume (FIV) is a potential early biomarker for therapeutic effect but may be affected by wide variation in ischaemic progression rate (IPR).

Methods: Using pooled individual data for patients with M1 occlusions and CT perfusion from two trials of thrombolysis in AIS we explored the association of IPR (core volume (cerebral blood flow <30%) / time to scan from symptom onset, IPR>15ml/hr divided fast from slow progressors) with 24h CT FIV and independence (mRS 0-2) at 90 days. We calculated hypothetical sample sizes for different relative FIV reduction in slow and fast progressors.

Results: Fast progressors (54/76 cases) had significantly larger 24h FIV than slow progressors (22/76) (difference=115.8ml, p<0.001), amongst both patients with and without recanalisation (55.7ml,p<0.001 and 119.5ml,p=0.001 respectively). Slow progressors had a greater likelihood of functional independence (OR5.34 (1.55-20.92)). Based on 24h FIV, sample size estimates were smaller for populations with more fast progressors and with lower recanalization rates (figures 1&2).

Conclusion: Estimated sample size for a 24h FIV endpoint varied four-fold depending on the proportion of slow and fast progressors and on the likelihood of recanalization. Phase 2 trials of novel therapies should consider case mix for these parameters in their design.

Figure 1.

Sample size by proportion of fast progressors

Figure 2.

Sample size by proportion of non-recanalised patients

Disclosure: No

P0993 / 1230

IMPROVING DOOR-TO-NEEDLE TIMES IN ACUTE STROKE CARE FOLLOWING REPEATED PROCESS ANALYSIS - NEVER GIVE UP!

J. Ernst ¹, K.F. Storch^1,2, A.T. Tran¹, M.M. Gabriel¹, A. Leotescu¹, A.-L. Boeck¹, M.K. Huber¹, O. Abu-Fares³, P. Bronzlik³, F. Götz³, H. Worthmann¹, R. Schuppner¹, G.M. Grosse¹, K. Weissenborn¹

¹Hannover Medical School, Department of Neurology, Hannover, Germany, ²Hannover Medical School, Department of Anesthesiology, Hannover, Germany, ³Hannover Medical School, Department of Neuroradiology, Hannover, Germany

Background and aims: In treatment of acute ischemic stroke (AIS) fast process times and rapid initiation of therapies are of major importance. We performed a repetitive process analysis to improve the door-to-needle time (DNT) at our tertiary care center after stepwise implementation of two clinical standard operation procedure (SOP) protocols.

Methods: From May 2015 until April 2016, we prospectively analysed treatment process times of 115 AIS patients who were treated with intravenous thrombolysis (IVT) at Hannover Medical School. Considering thereby identified IVT delaying factors, we implemented SOP I in October 2016, and evaluated the treatment processes of 177 patients consecutively treated until September 2017. To check the sustainability of the achieved improvement and the effect of a further adaptation (SOP II), process times of 248 patients treated from January 2019 to February 2021 were retrospectively analysed.

Results: Following SOP I, we observed a reduction of the median DNT by 15 minutes which led to an over five times higher probability of a DNT below 30 minutes (RR 5.35, 95%-CI 2.46-11.66). The second SOP led to a further reduction of the DNT by five minutes resulting in a median DNT of 29 (interquartile range: 26) minutes and a four times higher probability to achieve IVT within 15 minutes (RR 4.2, 95%-CI 1.63-10.83).

Conclusions: Our continuous workflow analysis for patients receiving IVT in AIS treatment resulted in a median DNT reduction of about 20 minutes. Stroke care can be steadily improved via continuous alertness and targeted adaptation of workflows.

Disclosure: No

P0994 / 459

USE OF SIMULATION BASED TEAM TRAINING FOR EMERGENCY NEUROLOGY CRISIS MANAGEMENT: A PARADIGM SHIFT IN MEDICAL EDUCATION FOR NEUROLOGY RESIDENTS

Y. Sela¹, T. Capua¹, L. Dadabaev², M. Arnon¹, J. Molad², H. Hallevi², N. Giladi³, E. Seyman ²

¹Tel Aviv Sourasky Medical Center, Medical Technology and Simulation Center, Tel Aviv, Israel, ²Tel-Aviv Sourasky Medical Center, Stroke Department, Division of Neurology, Tel- Aviv, Israel, ³Tel Aviv Sourasky Medical Center, Division of Neurology, Tel Aviv, Israel

Background: In the past decade, neurologists involvement in acute patient care has dramatically increased.Models of acute neurology are reliant on efficient interdisciplinary teamwork and are integrated with the hyper-acute stroke pathways.At the Tel-Aviv medical-center, we routinely conduct a multidisciplinary simulation-based training in neurological emergencies.Our objective was to determine participant’s satisfaction,self-readiness and anxiety in managing neurological emergencies and acute stroke scenarios following such an educational intervention.

Methods: Each simulation session involved a computer enhanced mannequin simulator or live actor assistance, and consisted of 4-6 alternating scenarios including;acute stroke with thrombolytic therapy,acute coma due-to ICH,CNS infection and status epilepticus. All scenarios were based on the Emergency Neurology Life Support(ENLS) protocols.An instructor facilitated debriefing followed each scenario.Each participant completed surveys assessing satisfaction,general anxiety and feelings of self-readiness using a VAS scale of 1-4 and a validated State-Trait Anxiety Inventory-6(STAI-6) questionnaire before and after simulations.

Results: Participants came from eight medical centers across Israel.Twenty-three PGY1 neurology residents and 23 nurses with varying clinical experience(range 0.2- 22 years) participated in the training. Mean age 35.42 years, 61% female.A Wilcocxon signed rank test revealed an improved self- readiness level to diagnose (Z=-1.95,p=0.04), treat(Z=-2.62,p=0.002)neurological emergencies and manage acute stroke(Z=-3.23,p=0.001). Furthermore,participants expressed reduced anxiety levels assessed by STAI-6(Z=-1.97,p=0.05),particularly on calmness(Z=-3.26, p=0.001),relaxing (Z=-2.97, p=0.001)and contentment(Z=-2.36,p=0.05) domains. The course had high satisfaction rates(mean4,SD0).

Conclusion: This intervention improved satisfaction,self-readiness and decreased anxiety in dealing with neurological emergencies and acute stroke scenarios.Such a modality may be valuable in training medical staff,thus improving patient care in acute scenarios where “Time is brain”.

Disclosure: No

P0995 / 756

ASSESSING PRE-STROKE FUNCTIONAL STATUS IN ACUTE STROKE: DRIVING, SHOPPING, BANKING CAPABILITY AS A SIMPLE AND RAPID ALTERNATIVE TO THE MODIFIED RANKIN FOR STROKE TREATMENT DECISIONS

C. Bladin ^1,2,3, K. Bagot^2,3, J. Kim^2,3, K. Smith^1,3, D. Cadilhac^2,3

¹Ambulance Victoria, Doncaster, Australia, ²Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia, ³Monash University, Clayton, Australia

Background and aims: Rapid assessment of pre-stroke modified Rankin Scale (mRS) is integral to decision making for stroke reperfusion therapies, but accuracy is often problematic from information provided by family or third parties. We investigated if a patients’ ability to perform activities of driving, shopping, and banking (DSB) could substitute the mRS.

Methods: Data were collected as part of the Victorian Stroke Telemedicine service (October 2020 to March 2021), including patient demographics and clinical information. mRS, thrombolysis, (tPA), mechanical thrombectomy (MT), and structured questions on patients’ ability to undertake DSB. Cronbach’s alpha was used to assess collinearity between DSB items. Multivariable logistic regression models were used to assess associations between DSB, mRS and reperfusion treatments advised.

Results: 3,665 patients (n=2,091 male, 52%; mean age 67.9 years, SD=16.41) with DSB data were analysed. There was very high internal consistency between each DSB item (Cronbach’s alpha >0.9). Ability with at least one of the DSB items was strongly associated pre-stroke mRS 0-1 (OR 226, 95% CI 104-492, p<0.001), and mRS 0-2 (OR 198, 95% CI 118-334, p<0.001), and was strongly associated with receiving tPA (OR 3.47, 95% CI 1.99, 6.04, p<0.001), or MT (OR 103, 95% CI 13.6, 777, p<0.001). The association between mRS and treatment were not as strong as with DSB. Although treatment ORs were slightly stronger in males, overall gender had no meaningful impact.

Conclusions: Three quick, simple directed questions about DSB can be reliably used to identify pre-stroke level of functioning to support treatment decisions.

Disclosure: No

P0996 / 947

LEAPFROGGING THE BAYESIAN REVOLUTION IN STROKE RESEARCH – A FOUR-ARM HYPOTHETICAL STUDY FOR NEUROPROTECTION IN THE HYPERACUTE STAGE

A. Das ¹, S. Chatterjee², A. Sekhar¹

¹The Walton Centre NHS Foundation Trust, Neurology, Liverpool, United Kingdom, ²Lancashire Teaching Hospitals NHS Foundation Trust, Interventional Neuroradiology, Preston, United Kingdom

Background and aims: The treatment of acute ischemic stroke (AIS) still has multiple equipoises and the current time-consuming and inefficient process of clinical translation is a major hindrance. Bayesian approaches, including Adaptive rolling designs, offer an alternative method that can accelerate the development of novel treatments. These designs allow multiple treatment options to be tested simultaneously and Sequential Bayesian analyses are used to eliminate poorly performing ones. These features significantly reduce sample size and allow for faster and more efficient clinical translation as shown in recent trials. Unfortunately, unlike other fields, Stroke researchers are yet to adopt these methodologies.

Methods: We propose the “leapfrog design” to evaluate multiple treatments simultaneously. This allows continual treatment improvement and finding one or more treatments that are better than the current “gold standard” which is accomplished by allowing replacement of the comparison arm (the arm against which all other arms are compared) by new treatment arms that achieve a prespecified threshold for demonstrating superiority. For the hypothetical study we simulated a 4-arm study involving – a) Nerinetide b) TRPM7 c) SRC-ND2 and d) uric acid in patients undergoing thrombectomy. We used the BFDA - an R package for Bayes factor (BF) design analysis.

Results: We chose Cohen’s d = 0.4, as in early stage of development, with a BF_fail of 1/4, and BF_success of 5. The N_minand N_max were found much smaller than traditional RCT numbers.

Conclusions: This will be a much-needed paradigm shift for further progress in stroke research beyond current equipoises.

Disclosure: No

P0997 / 1232

THE ASSOCIATION OF TIME TO ARTERIAL PUNCTURE WITH PATIENT OUTCOME AFTER ENDOVASCULAR THERAPY STRATIFIED BY STROKE AETIOLOGY

Y. Zhang ¹, L. Hong¹, Y. Ling¹, L. Yang¹, S. Li¹, X. Cheng¹, Q. Dong^1,2

¹Huashan Hospital, Fudan University, Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Shanghai, China, ²Fudan University, State Key Laboratory of Medical Neurobiology, Shanghai, China

Background and aims: Randomized clinical trials and large stroke registries have demonstrated a time-dependent benefit of EVT in patients with acute ischemic stroke due to large vessel occlusion. This study aimed to investigate whether this could be applied in different stroke subtypes in a real-world single-centre cohort.

Methods: Consecutive ischemic stroke patients presenting within 24 hours after symptom onset were retrospectively assessed. Baseline multi-modal imaging was conducted before EVT. Independent predictors of functional independence (90 day mRS 0-2) and any incidence of ICH were explored using stepwise logistic regression model in the entire cohort and in stroke subtypes.

Results: From 2015 to 2020, 140 eligible patients received EVT, of which 59 were classified as LAA-related. Time from last known normal (LKN) to groin puncture was identified as an independent predictor for functional independence in CE-related strokes (OR 0.90 per 10 minutes; 95% CI 0.82-0.98; P=0.013), but not in LAA subtype and the whole cohort. Arterial puncture within 6 hours after LKN was associated with a lower ICH risk in the whole cohort (OR 0.36, 95% CI 0.17-0.75, P=0.007). Besides, compared to CE subtype, LAA subtype had a smaller baseline ischemic core, a better collateral, a slower core growth rate and numerically smaller final infarct volume.

Conclusion: Faster arterial puncture has a more pronounced effect on the functional outcome in patients of CE subtype than those of LAA subtype. Reducing time to arterial puncture is of great importance in improving the prognosis of patients after EVT, especially those of CE subtype.

Disclosure: No

P0998 / 169

MOBILE STROKE UNIT OR USUAL CARE FOR ACUTE ISCHAEMIC STROKE MANAGEMENT: SYSTEMATIC REVIEW AND META-ANALYSIS

G. Turc ¹, M. Haziahmetovic², S. Walter³, L. Churilov⁴, K. Larsen⁵, J.C. Grotta⁶, J.-M. Yamal⁷, R. Bowry⁸, A.H. Katsanos⁹, H. Zhao¹⁰, G. Donnan¹¹, S.M. Davis¹¹, M.S. Hussain¹², K. Uchino¹², S.A. Helwig³, H. Johns⁴, J.E. Weber¹³, C.H. Nolte¹³, A. Kunz¹⁴, T. Steiner¹⁵, S. Sacco¹⁶, M. Ebinger¹⁷, G. Tsivgoulis^18,19, K. Faßbender³, H.J. Audebert²⁰

¹Université de Paris & GHU Paris Psychiatrie et Neurosciences & INSERM U 1266 & FHU Neurovasc, Neurology, Paris, France, ²GHU Paris Psychiatrie et Neurosciences, Neurology, Paris, France, ³Saarland University Medical Center, Neurology, Homburg, Germany, ⁴Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Biostatistics, Victoria, Australia, ⁵The Norwegian Air Ambulance Foundation & Institute of Basic Medical Sciences, University of Oslo, Anesthesiology, Oslo, Norway, ⁶Clinical Innovation and Research Institute, Memorial Hermann Hospital-Texas Medical Center, Houston, TX, United States of America, Houston, United States, ⁷University of Texas Health Science Center at Houston, School of Public Health, Department of Biostatistics and Data Science, Houston, United States, ⁸McGovern Medical School, University of Texas Health Science Center at Houston, Department of Neurology and Neurosurgery, Houston, United States, ⁹McMaster University/Population Health Research Institute, Division of Neurology, Hamilton, Canada, ¹⁰Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Australia, Department of Neurology and Department of Medicine, Melbourne, Australia, ¹¹Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Department of Neurology and Department of Medicine, Melbourne, Australia, ¹²Cerebrovascular Center, Cleveland Clinic, Department of Neurology, and Critical Care Transport Team, Cleveland, United States, ¹³Klinik und Hochschulambulanz für Neurologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany, ¹⁴Klinik für Neurologie, Neurologische Intensivmedizin, Zentrum für Hirngefäßerkrankungen, Asklepios Fachklinikum Brandenburg, Brandenburg, Germany, ¹⁵Klinikum Frankfurt Höchst & Heidelberg University Hospital, Department of Neurology, Frankfurt, Germany, ¹⁶University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences, L’Aquila, Italy, ¹⁷Klinik und Hochschulambulanz für Neurologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin & Klinik für Neurologie Medical Park Berlin Humboldtmühle, Berlin, Germany, ¹⁸Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Second Department of Neurology, Athens, Greece, ¹⁹University of Tennessee Health Science Center, Department of Neurology, Memphis, United States, ²⁰Klinik und Hochschulambulanz für Neurologie, Campus Benjamin Franklin, Charité Universitätsmedizin & Center for Stroke Research Berlin, Berlin, Germany

Background and aims: To determine whether there is sufficient cumulative evidence to conclude that Mobile Stroke Unit (MSU) use leads to better outcomes than usual prehospital care in patients with acute ischaemic stroke (AIS).

Methods: Systematic review and meta-analysis of studies comparing MSU deployment and usual care for patients with suspected stroke, following the PRISMA guideline. In the case of articles with partially overlapping study populations, we obtained unpublished disentangled results. We also incorporated unpublished adjusted results from individual participant data of included studies.

Results: Compared with usual care, MSU use was associated with excellent outcome (mRS 0-1: adjusted OR 1.64 [95%CI 1.27 to 2.13], p<0.0001, 5 studies, n=3228, Figure), reduced disability over the full range of the mRS (adjusted common OR 1.39 [1.14 to 1.70], p=0.001, 3 studies, n=1563), good outcome (mRS 0-2: crude OR 1.25 [1.09-1.44], p=0.001, 6 studies, n=3266), shorter onset-to-intravenous thrombolysis (IVT) times (median reduction: 31 [23 to 39] minutes, p<0.0001, 13 studies, n=3322), delivery of IVT (crude OR 1.83 [1.58 to 2.12], p<0.0001, 7 studies, n=4790), and IVT within 60 minutes of symptom onset (crude OR 7.71 [4.17 to 14.25], p<0.0001, 8 studies, n=3351). MSU use was not associated with an increased risk of all-cause mortality at 7 days, at 90 days or with higher proportions of symptomatic intracranial hemorrhage after IVT.

Conclusions: In AIS patients, MSU use as compared with usual care is associated with an approximately 65% increase in the odds of excellent outcome and a 30-minute reduction in onset-to-IVT times, without safety concerns.

Disclosure: No

P0999 / 1392

ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE ISCHEMIC STROKE DUE TO DISTAL VESSEL OCCLUSION OF THE MIDDLE CEREBRAL ARTERY: A FEASIBLE AND SAFE TREATMENT

A. Fernández Revuelta ¹, T. Montalvo Moraleda¹, P. Simal Hernández¹, S. Rosati², C. Pérez García², M. Moreu², A. López-Frías², J. Egido¹, C. Gómez-Escalonilla¹

¹Hospital Clínico San Carlos, Stroke Unit Neurology, Madrid, Spain, ²Hospital Clínico San Carlos, Neurointerventional Radiology, Madrid, Spain

Background and aims: Acute ischemic stroke (AIS) due to distal vessel occlusions (DVO) are a common source of significant morbidity. Therefore, DVO is the new goal of endovascular treatment (EVT). We present safety and clinical outcomes of EVT for DVO of the middle cerebral artery (MCA).

Methods: Retrospective review of a series of 28 patients with AIS due to DVO of MCA (M3 segment) from July 2009 to September 2021. DVO was evidenced on pre-treatment angiogram and mechanical thrombectomy (MT) was done. We evaluated baseline characteristics, rate of successful reperfusion (defined as mTICI score 2b-3), rate of symptomatic intracranial haemorrhage (sICH) and functional outcomes at 3 months including functional independence (defined as modified Rankin scale (mRs) score ⩽2 or reaching baseline mRs) and mortality.

Results: Median age was 77.5 (66-83.25) and 57,14% were female. Median NIHSS was 16 (10.75-19.25) and median ASPECTS was 8,5 (7-9). Intravenous thrombolysis was administrated in 14 patients (50%). Of patients finally treated by MT, mTICI 2b-3 score was achieved in 66.67%. 2 patients (7.14%) had complications related to MT. 7 patients (25%) had ICH but it was symptomatic in 2. At 3 months, 16 patients (57.14%) reached functional independence and mortality rate was 7.14% (one due to ICH and the other due to systemic infection).

Conclusions: In our series, more than half of patients achieved functional independence at 3 months. We observed a low mortality and sICH rate. Therefore, endovascular treatment could be a safe and effective procedure in AIS due to DVO of MCA.

Disclosure: No

P1000 / 810

PREDICTING OUTCOME OF POSTERIOR CIRCULATION ACUTE ISCHEMIC STROKE FOLLOWING THROMBECTOMY USING PC-ASPECTS IN NON-CONTRAST COMPUTED TOMOGRAPHY

N.G. Laugesen ¹, A.H. Brandt², T. Stavngaard², K. Hansen^1,3, T. Truelsen^1,3

¹Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark, ²Rigshospitalet, Copenhagen University Hospital, Department of Radiology, Copenhagen, Denmark, ³University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark

Background and aims: Prediction of functional outcome for patients treated with endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) of occlusions in the posterior circulation (PC) remains controversial. The PC-Alberta Stroke program Early Computed Tomography (PC-ASPECT) score of ischemia was based on diffusion weighted MR-imaging. Our aim was to assess the prognostic value of PC-ASPECT based on non-contrast computed tomography (NCCT).

Method: A prospective single-center observational study of consecutive EVT patients during the 3-year period 2017-2019. Favorable functional outcome was defined as modified Rankin Scale (mRS) of 0-2 at 90 days. PC-ASPECT was dichotomized to <7 or ⩾7 and association with functional outcome was analysed using multivariate logistic regression adjusted for age, sex, treatment with alteplase, time to reperfusion, site of vessel occlusion and National Institute of Health Stroke Scale (NIHSS) at admission.

Results: A total of 686 patients had EVT of which 87 patients (12.7%) had AIS of the PC. Median age was 68 (Interquartile range [IQR] 57-76) and 29 (33.3%) were female. Median PC-ASPECT was 9 (IQR 7-10), median NIHSS was 14 (IQR 7-39) and basilar artery occlusion was present in 65 (74.7%). Favorable outcome was observed in 36 patients (41.1%) and mortality was 33.3%. PC-ASPECT ⩾7 was associated with favorable outcome, aOR=4.42 (95% Confidence interval [CI] 1.25-15.63), p=0.02, as was lower NIHSS, aOR=0.933 (95%CI 0.90-0.97), p<0.01. No other variables were significantly associated with a favorable outcome.

Conclusion: PC-ASPECT ⩾7 in NCCT was significantly associated with favorable functional outcome at 90 days.

Disclosure: No

P1001 / 805

SYMPTOMATIC HEMORRHAGE AND IN-STENT THROMBOSIS FOLLOWING ACUTE CAROTID STENTING IN ISCHEMIC STROKE

M.P. Kreiberg ¹, N.G. Laugesen¹, T. Stavngaard², G. Benndorf^2,3, K. Hansen^1,4, T. Truelsen^1,4

¹Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark, ²Rigshospitalet, Copenhagen University Hospital, Department of Radiology, Copenhagen, Denmark, ³Baylor College of Medicine, Department of Radiology, Houston, United States, ⁴University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark

Background and aims: Acute carotid stenting (ACS) has shown benefit in acute ischemic stroke due to internal carotid artery (ICA) stenosis or occlusion. ACS bears the risk of both, cerebral hemorrhage and stent thrombosis with antiplatelet treatment being controversial. Our aim was to evaluate the rate of symptomatic hemorrhages following ACS, and secondarily to assess functional outcome and stent patency at 90 days.

Methods: Registration of consecutive patients undergoing mechanical thrombectomy and ACS at a single center in 2019. Dual-energy Computed Tomography (DECT) was performed at 24 hours to evaluate for hemorrhage versus iodine contrast. Symptomatic hemorrhage was defined as National Institute of Health Stroke Scale (NIHSS) increase >3. Follow-up at 90 days included functional outcome using modified Rankin Scale (mRS) and evaluation of stent patency in CT-angiography. Favorable outcome was defined as mRS 0-2.

Results: 30 patients underwent ACS, median age 68 years (Interquartile range [IQR] 58-73), 8 patients (26.7%) were female and 18 patients (60.0%) received intravenous alteplase. Median NIHSS was 17 (IQR 8-21) at baseline and 8 (IQR 4-13) at 24 hours. Nine patients (30.0%) had a hemorrhage at 24 hours; 3 symptomatic of which 2 were fatal. At 90 days, 18 patients (60.0%) had favorable outcome and 2 patients had a fatal outcome (6.7%). Twenty-six patients (86.7%) had CT-angiography at 90 days, all with patent stents.

Conclusions: ACS can be associated with a significant number of symptomatic or even fatal hemorrhages. The majority of patients, however, showed patent stents and a favorable outcome.

Disclosure: No

P1002 / 998

AN ANGIOGRAPHIC EVALUATION OF NO-REFLOW PHENOMENON IN PATIENTS WITH ACUTE ICHEMIC STROKE FROM LARGE VESSELS OCCLUSION SUCCESSFULLY TREATED WITH MECHANICAL THROMBECTOMY

E. Nicolini ¹, M. Iacobucci², M. De Michele¹, A. Ciacciarelli¹, A. Falcou¹, I. Berto¹, L. Petraglia¹, D. Toni²

¹Policlinico Umberto I - Sapienza University of Rome, Stroke Unit, Rome, Italy, ²Sapienza University of Rome, Department of Human Neurosciences, Rome, Italy

Background and aims: Futile recanalization (FR) is defined as a 90-day mRS 3-6 despite successful recanalization (TICI 2b-3), and account for 29% to 60% of large vessel occlusion (LVO) ischemic stroke (IS) treated with mechanical thrombectomy (MT). Failure of early neurological improvement (fENI) describes patients successfully recanalized but not clinically improving at 24-hours or at 7-days.

No-reflow phenomenon (NRP) is a possible cause of FR and fENI, described in global ischemia animal models and human myocardial infarction as deficient microvascular reperfusion. Evidence of NRP in IS patients is scarce.

Aim of our study was to identify an angiographic marker of NRP and explore its association with clinical outcome.

Methods: We retrospectively analyzed 185 post-interventional digital subtraction angiographies of anterior circulation LVO IS patients treated with MT. We created a score, dividing middle cerebral artery territory in three segments. For each segment we gave 2 points if the capillary blush was present without any delay, 1 if delayed and 0 if absent. We called our score modified capillary index score (mCIS). We used ROC curve to define mCIS⩽3 as cut-off and marker of NRP.

Results: NRP was present in 35.1% of patients. mCIS⩽3 predicted fENI at 24 hours (aOR2.617, 95%CI1.192–5.745, p=0.016) and at 7 days (aOR4.601, 95%CI1.636–12.936, p=0.004), but not FR. Moreover, mCIS⩽3 predicted hemorrhagic transformation (aOR .444, 95%CI 1.266–4.717, p=0.008).

Conclusions: NRP is poorly investigated in IS patients. Our angiographic marker was able to predict early outcome and could help identifying patients for future research on NRP.

	All (190)	Good microvascular reperfusion (mCIS>3) (120)	No-reflow phenomenon (mCIS⩽3) (65)	p
Age mean ± SD (median)	71.9 ± 13.5 (75.0)	72.7 ± 13.7 (76.0)	69.6 ± 12.9 (72.0)	0.127
Sex
Male N (%)	78 (41.1)	44 (36.7)	32 (49.2)	0.118
Female N (%)	112 (58.9)	76 (63.3)	33 (50.8)
Hypertension N (%)	142 (74.7)	93 (77.5)	46 (70.8)	0.373
Diabetes N (%)	34 (17.9)	26 (21.7)	7 (10.8)	0.072
Smoking N (%)	36 (19.0)	25 (20.8)	10 (15.6)	0.436
Previous stroke or TIA N (%)	22 (11.6)	14 (11.7)	8 (12.3)	0.536
Heart failure N (%)	25 (13.2)	19 (15.8)	5 (7.8)	0.168
Coronary artery disease N (%)	19 (10.0)	9 (7.5)	10 (15.4)	0.127
Atrial fibrillation N (%)	93 (49.2)	58 (48.3)	31 (48.4)	1.00
Hypercolesterolemia N (%)	62 (32.6)	40 (33.3)	19 (29.2)	0.622
Carotid atherosclerosis N (%)	35 (18.5)	15 (12.5)	18 (27.7)	0.015
Tumor N (%)	36 (18.9)	24 (20)	10 (15.4)	0.552
mRS pre-stroke
0 N (%)	148 (78.3)	90 (75)	54 (84.4)	0.119
1 N (%)	19 (10.1)	11 (9.2)	8 (12.5)
2 N (%)	14 (7.4)	11 (9.2)	2 (3.1)
3 N (%)	5 (2.6)	5 (4.2)	0
4 N (%)	3 (1.6)	3 (2.5)	0
Etiology (TOAST)
Large-artery atherosclerosis N (%)	27 (14.3)	12 (10.1)	15 (23.1)	0.10
Cardioembolism N (%)	112 (59.3)	75 (63.0)	33 (50.8)
Other determined etiology N (%)	12 (6.3)	7 (5.9)	5 (7.7)
Undetermined etiology N (%)	38 (20.1)	25 (21.0)	12 (18.5)
Wake-up Stroke N (%)	52 (27.5)	33 (27.7)	19 (29.2)	0.865
Baseline NIHSS mean ± SD (median)	14.0 ± 6.0 (15.0)	14.1 ± 5.8 (15.0)	15.2 ± 6.9 (17.0)	0.248
Post interventional NIHSS mean ± SD (median)	12.0 ± 7.0 (12.0)	12.2 ± 6.7 (12.0)	13.4 ± 7.5 (14.0)	0.279
24H NIHSS mean ± SD (median)	11.0 ± 7.0 (10.0)	10.5 ± 7.0 (11.0)	11.1 ± 7.4 (9.5)	0.606
7 days/Discharge NIHSS mean ± SD (median)	7.0 ± 7.0 (5.0)	6.6 ± 6.7 (5.0)	7.1 ± 6.7 (5.0)	0.672
Early outcome 24 hours
Failure of Early Neurological Improvement N (%)	71 (37,4)	38 (31.7)	31 (47.7)	0.039
Early neurological improvement N (%)	119 (62.6)	82 (68.3)	34 (52.3)
Early outcome 7 days
Failure of Early Neurological Improvement N (%)	30 (17.9)	13 (12.1)	15 (26.8)	0.028
Early neurological improvement N (%)	138 (82.1)	94 (87.9)	41 (73.2)
90 days functional outcome
Bad outcome 3-6 N (%)	100 (53.8)	67 (56.3)	32 (51.6)	0.637
Functional indipendence (mRS 0-2) N (%)	86 (46.2)	52 (43.7)	30 (48.4)
ExcellentOutcome (mRS 0-1) N (%)	68 (36.6)	39 (32.8)	25 (40.3)	0.33
Death at 90 days N (%)	41 (22.3)	27 (22.2)	14 (23.3)	1.0
Site of Occlusion
M1 N (%)	90 (47.4)	66 (55.0)	23 (35.4)	0.040
M2 N (%)	51 (26.8)	29 (24.2)	18 (27.7)
Intracranial ICA N (%)	12 (6.3)	5 (4.2)	7 (10.8)
Tandem occlusion N (%)	37 (19.5)	20 (16.7)	17 (26.2)
Direct MT N (%)	102 (54.0)	65 (54.6)	37 (56.9)	0.877
Bridging therapy N (%)	87 (46.0)	54 (45.4)	28 (43.1)
Onset-to-recanalization Time (min) mean ± SD (median)	462.6 ± 263.3 (362.5)	468.5 ± 278.2 (351.0)	456.0 ± 245.2 (376.0)	0.763
Groin-to-recanalization Time (min) mean ± SD (median)	68.7 ± 40.5 (61.0)	70.1 ± 38.7 (61.0)	69.9 ± 42.6 (63.0)	0.977
CIS
0 N (%)	46 (25.3)	24 (20.5)	22 (34.4)	0.226
1 (N %)	20 (11.0)	13 (11.1)	7 (10.9)
2 N (%)	26 (14.3)	18 (15.4)	8 (12.5)
3 N (%)	90 (49.5)	62 (53.0)	27 (42.2)
TICI
2b N (%)	67 (35.3)	4 (34.2)	25 (38.5)	0.679
2c N (%)	16 (8.4)	9 (7.5)	3 (4.6)
3 N (%)	107 (56.3)	70 (58.3)	37 (56.9)
N° of passages
0 N (%)	4 (2.1)	-	-	0.512
1 N (%)	87 (45.8)	52 (43.3)	34 (52.3)
2 N (%)	58 (30.5)	41 (34.2)	17 (26.2)
3 N (%)	24 (12.6)	17 (14.2)	7 (10.8)
4 N (%)	14 (7.4)	9 (7.5)	5 (7.7)
5 N (%)	3 (1.6)	1 (0.8)	2 (3.1)
Technique
Thrombus aspiration N (%)	109 (58.9)	69 (58.8)	40 (61.5)	0.818
Stent retrieving N (%)	13 (7.0)	8 (6.7)	5 (7.7)
combined technique N (%)	63 (34.1)	42 (35.3)	2 (30.8)
Hemorragic Transformation N (%)	83 (43.7)	45 (37.5)	38 (58.5)	0.008
Infarct volume (ml) mean ± SD (median)	18.2 ±33.1 (6.3)	19.1 ± 38.3 (6.6)	17.0 ± 21.2 (5.9)	0.700
ECASS
HI1 N (%)	32 (38.1)	18 (39.1)	14 (36.8)	0.560
HI2 N (%)	15 (17.9)	6 (13.0)	9 (23.7)
PH1 N (%)	15 (17.9)	8 (17.4)	7 (18.4)
PH2 N (%)	22 (26.2)	14 (30.4)	8 (21.1)
sICH N (%)	17 (8.9)	9 (7.5)	8 (12.3)	0.296

	fENI at 24 hours			fENI at 7 days
	Adjusted OR	p	95% C.I.	Adjusted OR	p	95% C.I.
No-reflow phenomenon (mCIS⩽3)	2.825	0.011	1.265 - 6.308	2.814	0.046	1,018 - 7.776
Age	0.975	0.184	0.939 - 1.012	1.001	0.983	0.950 - 1.054
Sex	0.727	0.469	0.307 - 1.721	1.197	0.759	0.380 - 3.776
Hypertension	1.625	0.376	0.555 - 4.762	0.359	0.199	0.075 - 1.714
Diabetes	2.905	0.036	1.071 - 7.883	0.414	0.166	0.119 - 1.441
Tumor	0.574	0.308	0.198 - 1.667	0.427	0.169	0.127 - 1.435
N° of passages		0.058
1 passage	2.458	0.616	0.073 - 82.539	-	-	-
2 passages	0.881	0.944	0.026 - 30.108	-	-	-
3 passages	0.781	0.894	0.021 - 29.106	-	-	-
4 passages	0.472	0.690	0.012 - 18.812	-	-	-
Site of occlusion		0.144			0.254
M1	1.291	0.654	0.423 - 3.941	0.872	0.857	0.197 - 3.860
M2	1.964	0.316	0.525 - 7.351	3.599	0.174	0.568 - 22.794
ICA	0.174	0.055	0.029 - 1.038	0.843	0.873	0.103 - 6.914
Hemorragic Transformation	2.917	0.008	1.330 - 6.397	0.372	0.064	0.130 - 1.061
Baseline NIHSS	1.077	0.024	1.010 - 1.149	0.925	0.082	0.847 - 1.010
CIS		0.885			0.030
CIS(1)	1.437	0.542	0.448 - 4.614	10.230	0.005	1.992 - 52.546
CIS(2)	1.575	0.497	0.424 - 5.841	6.390	0.041	1,075 - 37.979
CIS(3)	1.228	0.736	0.372 - 4.062	7.564	0.013	1,523 - 37.561

	Hemorrhagic transformation
	Adjusted OR	p-value	95% C.I.
NoReflow	2.444	0.008	1.266 – 4.717
Age	1.001	0.957	0.970 – 1.033
Sex	0.750	0.420	0.372 – 1.510
Baseline NIHSS	1.095	0.001	1.038 – 1.154
Arterial hypertension	0.801	0.632	0.323 – 1.988
Duration of procedure - Minutes	1.003	0.499	0.995 – 1.011

Disclosure: No

P1003 / 854

LOWER BLOOD PRESSURE AFTER SUCCESSFUL MECHANICAL THROMBECTOMY IS ASSOCIATED WITH POOR FUNCTIONAL OUTCOME

T. Uphaus ¹, E. Hayani¹, S. Gröschel¹, M. Hahn¹, K. Gröschel¹

¹ University Medical Center of the Johannes Gutenberg University Mainz, Department of Neurology, Mainz, Germany

Background and aims: Mechanical thrombectomy (MT) has become a standard therapy in patients with acute ischemic stroke. However, questions on periprocedural blood-pressure (BP) management in recanalized vessels are currently unanswered. We aimed to investigate association of specific BP targets after MT with regard to functional outcome 90 days following the index event.

Methods: Within the prospective Gutenberg-Stroke Study, patients with large vessel occlusion (LVO) and complete reperfusion (TICI 2b/3) after MT were prospectively included. BP values were recorded half-hourly 24 hours post-MT. Based on the achieved BP goals patients were divided into: low-BP group (BP <160/90 mmHg) or high-BP group (BP >160/90 mmHg).

Results: A total of 253 consecutive acute ischemic stroke patients with LVO and MT (Age 73.1 ± 12.9 years, male 117/253, 46.2%) were evaluated, out of these 165 could be analyzed with respect to different BP-goals and clinical outcome. Lower-RR (n=35) after MT was associated with unfavorable functional outcomes at 90 days (mRS 4, interquartile range (IQR) 3-6 vs. 2, IQR 0-5, p=0.001, odds ratio 6.009, 95%Cl 1.994-18.110, p=0.001) and quality of life measures compared to higher-BP (n=130; EQ-5D: 0.449±0.283 vs. 0.633±0.312, p=0.009, β-Coefficient -0.146, 95%CI -270 - -0.222, P=0.021).

Conclusions: Peri-interventional BP below 160/90 mmHg following successful mechanical recanalization is associated with poor functional outcomes.

Study-Registration: DRKS00017253.

Disclosure: No

P1004 / 1074

IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVATION OF EMERGENCY MEDICAL SERVICES FOR STROKE IN ADALUSIA SPAIN

A. Palomino ¹, A. Caballero², D. Jimenez³, B. Carrera⁴, G.A. Escobar⁵, F. Hernandez³

¹Hospital Virgen del Rocio, Neurology, Sevill, Spain, ²Servicio Andaluz de Salud, Emergency, Sevill, Spain, ³Hospital universitario Virgen del Rocio, Neurology, Sevill, Spain, ⁴Servicio Andaluz de Salus, Emergency, Sevill, Spain, ⁵Hospital universitario Virgen del Rocío, Neurology, Sevill, Spain

Background and aims: The purpose of this study was to analyze the influence of the Covid-19 pandemic on the incidence of stroke in the months of lockdown in Andalusia. According to the Spanish Society of Neurology, in March 2020 there were 28% fewer activations of emergency medical services for stroke in Andalusia (Spain) than in the same period of 2019. A study carried out by the Barcelona emergency services detected a decrease of 18% in the same period. A study published in Portugal by the journal Neurology reported a 34% reduction.

Methods: The periods of March and April of the years 2019, 2020 and 2021 were studied. The study variables were: Number of activations of emergency medical services for stroke, number of stroke patients diagnosed, age, gender .

Results: 298 patients were diagnosed with stroke in 2019 and 2020. The percentage of activation of the emergency medical services was 66.7% and 55.2% in 2019 and 2020 respectively. The number of stroke diagnoses in 2021 was 353 cases and the activation percentage 56.2%. The median age of stroke patients decreases progressively each year. The percentage of men was 60% and remains stable during the three year period.

Conclusions: The decrease in the activation of the emergency medical services for stroke that was reported in the bibliography was not detected in Andalusia. In a pandemic situation, call centers must be prepared to respond to the increasing volume of calls and to ensure call centers remain accessible.

Disclosure: No

P1005 / 815

FUNCTIONAL OUTCOME OF PRE-STROKE DEPENDENT PATIENTS AFTER ENDOVASCULAR THROMBECTOMY IN ACUTE ISCHEMIC STROKE

N.G. Laugesen ¹, T. Stavngaard², G. Benndorf^2,3, J. Højgaard¹, K. Hansen^1,4, T. Truelsen^1,4

¹Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark, ²Rigshospitalet, Copenhagen University Hospital, Department of Radiology, Copenhagen, Denmark, ³Baylor College of Medicine, Department of Radiology, Houston, United States, ⁴University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark

Background and aims: The clinical trials on endovascular thrombectomy (EVT) in acute ischemic stroke included few patients with pre-stroke functional dependency (modified Rankin Scale [mRS] ⩾3). Our aim was to compare functional outcome at 90 days of patients with pre-stroke mRS⩾3 (dependent) and mRS⩽2 (independent).

Methods: A prospective single center observational study with consecutive registration of patients undergoing EVT in a large referral center from 2017-2019. In the study period, patient eligibility criteria for EVT included a relative contraindication of mRS>3. Favorable outcome at 90 days was defined as either mRS⩽2 or no change from baseline mRS.

Results: A total of 686 patients underwent EVT in the observation period of which 27 were pre-stroke dependent. Dependent patients were older, median 86 years (interquartile range [IQR] 80-91) vs. 72 (IQR 62-79), p<0.01; were less likely to receive intravenous thrombolysis, 9/27 (33.3%) vs. 369/659 (56.0%), p=0.02; had higher NIHSS at baseline, median 20 (IQR 16-24) vs. 16 (11-21), p<0.01, and at 24 hours post procedure, median 21 (IQR 14-25) vs 9 (IQR 3-18), p<0.01. Other characteristics, including reperfusion results and time of onset to reperfusion did not differ. Four dependent and 27 independent patients were lost to follow-up. Dependent patients were less likely to achieve favorable outcome, 2/23 (8.7%) vs. 317/632 (50.2%), p<0.01, and mortality rate was higher, 18/23 (78.2%) vs. 139/632 (21.9%), p<0.01.

Conclusions: Pre-stroke dependent patients had a significantly worse outcome and higher mortality compared to independent patients.

Disclosure: No

P1006 / 1091

UTILIZATION OF MECHANICAL THROMBECTOMY AND OUTCOMES AFTER ISCHEMIC STROKE IN PATIENTS WITH VERSUS WITHOUT PRE-STROKE DISABILITY IN THE CZECH REPUBLIC

A. Ganesh ¹, V. Ondrej^2,3,4, I. Kováčová³, A. Tomek⁴, M. Bar^2,5, M. Rocek⁶, R. Padr⁶, F. Cihlar⁷, M. Nevsimalova⁸, L. Jurak⁹, R. Havlicek¹⁰, M. Kovar¹¹, P. Sevcik¹², V. Rohan¹³, J. Fiksa¹³, D. Cernik¹⁴, R. Jura¹⁵, D. Vaclavik¹⁶, M.D. Hill¹, R. Mikulik^3,17, National Research Stroke Network Stroczech

¹University of Calgary, Clinical Neurosciences, Calgary, Canada, ²University Hospital Ostrava, Neurology, Ostrava, Czech Republic, ³International Clinical Research Centre, Stroke Research Program, St. Anne’s University Hospital, Brno, Czech Republic, ⁴Charles University, 2nd Medical Faculty, Neurology, Prague, Czech Republic, ⁵Faculty of Medicine, University Ostrava, Ostrava, Czech Republic, ⁶2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Radiology, Prague, Czech Republic, ⁷Masaryk Hospital, Radiology, Usti nad Labem, Czech Republic, ⁸Hospital Ceske Budejovice, Neurology, Ceske Budejovice, Czech Republic, ⁹Neurocenter, Regional Hospital Liberec, Liberec, Czech Republic, ¹⁰Military University Hospital, Neurology, Prague, Czech Republic, ¹¹Na Homolce Hospital, Neurology, Prague, Czech Republic, ¹²Faculty of Medicine in Pilsen, Charles University in Prague, Neurology, Pilsen, Czech Republic, ¹³Charles University, First Faculty of Medicine and General University Hospital, Neurology, Prague, Czech Republic, ¹⁴Masaryk Hospital Usti nad Labem - KZ a.s., Comprehensive Stroke Center, Neurology, Usti nad Labem, Czech Republic, ¹⁵University Hospital Brno and Faculty of Medicine Masaryk University, Neurology, Brno, Czech Republic, ¹⁶AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Neurology, Ostravs, Czech Republic, ¹⁷St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Neurology, Brno, Czech Republic

Background and aims: Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with pre-stroke disability, they risk being routinely excluded from such therapies in practice. We examined the utilization of mechanical thrombectomy, associated workflow, and post-stroke outcomes among patients with versus without pre-stroke disability using registry data.

Methods: We used national data on thrombolysis/thrombectomy for the Czech Republic from the SITS and RES-Q registries from 1-January-2016 to 31-December-2020. Pre-stroke disability was defined as pre-stroke modified Rankin Scale score (mRS) ⩾2. We compared the proportion of patients with versus without pre-stroke disability who received thrombectomy and examined workflow times. We also compared the delta-mRS – change in mRS from pre-stroke to 3-months in patients with versus without pre-stroke disability – in addition to intracerebral hemorrhage, mortality and discharge disposition, adjusting for age, sex, baseline stroke severity, and comorbidities.

Results: Among 9,934 patients, 1,135(11.4%) had pre-stroke mRS⩾2. Patients with pre-stroke disability were less likely to receive thrombectomy versus those without (aOR:0.51, 95%CI:0.41-0.63). When they did receive thrombectomy, patients with pre-stroke disability had longer door-to-groin-puncture times (median:71.5-minutes, IQR:14.5-122 vs 53.0-minutes, IQR:10.0-132; adjusted-difference:1.33-minutes, 95%CI:1.03-1.72). Patients with pre-stroke disability had greater delta-mRS (adjusted-difference:1.11, 95%CI:1.05-1.18), higher mortality (aOR:2.31, 95%CI:1.85-2.87), and were less likely to be discharged home (aOR:0.63, 95%CI:0.42-0.93).[AG1] There was no difference in intracerebral hemorrhage (aOR:1.09, 95%CI:0.84-1.40).

Conclusions: Patients with pre-stroke disability were less likely to receive thrombectomy and incurred greater treatment delays than patients without disability. While hemorrhagic risks were similar, they had greater accumulation of post-stroke disability and higher mortality.

Disclosure: Yes

P1007 / 1111

TRAJECTORY OF STROKE SEVERITY IN THROMBOLYSIS AND THROMBECTOMY TRIALS

H. Ma ¹, G. Thomalla², M. Hill³, G. Mayank⁴, G. Albert⁵, W. Hacke⁶, P. Ringleb⁷, B. Campbell⁸, L. Schwamm⁹, K. Toyoda¹⁰, M. Koga¹⁰, W. Steven¹¹, A. Demchuk³, C. Gerloff², F. Boutitie¹², W. Ona¹³, G. Donnan¹⁴, L. Churilov¹⁴, S. Davis⁸, T. Phan¹

¹Monash University, Medicine, Melbourne, Australia, ²Universitatsklinikum Hamburg, Hamburg, Germany, ³University of Calgary, Deaprtment of Radiology and Clinical Neuroscience, Calgary, Canada, ⁴University of Calgary, Department of Radiology, Calgary, Canada, ⁵Stanford University, Department of Medicine, Stanford, United States, ⁶University of Heidelberg, Heidelberg, Germany, ⁷University of Heidelberg, Department of Neurology, Heidelberg, Germany, ⁸University of Melbourne, Department of Medicine, Melbourne, Australia, ⁹Massachusetts General Hospital, Department of Neurology, Boston, United States, ¹⁰National Cerebral and Cardiovascular Center, Osaka, Japan, ¹¹Seton Dell Medical School Stroke Institute, Austin, United States, ¹²Hospices Civils de Lyon, Lyon, France, ¹³Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, United States, ¹⁴University of Melbourne, Melbourne, Australia

Background and aims: The aim is to compare the trajectory of National Institutes of Health Stroke Scale (NIHSS) recovery from 24 hours to 3 months between treatment arms (thrombectomy in large vessel occlusion versus alteplase and alteplase versus control).

Methods: We include thrombolysis (EXTEND-IV, ECASS4, WAKE-UP, THAWS) and thrombectomy trials (ESCAPE, DEFUSE3, EXTEND-IA) in which serial data on NIHSS are available for time 1 (baseline), 2 (day1), 3 (day 3-7), 4 (3 months). The data contains 1309 patients (excluded 445 patients with missing NIHSS data). Linear regression including mixed model were used.

Results: The mean age in thrombolysis trial was 70.0±12.3 for alteplase and 69.7±12.7 for placebo groups. In the thrombectomy trials, the mean age was 69.4±13.3 for thrombectomy and 69.2±13.8 for control group. The linear regression showing NIHSS changes at different time point for the thrombectomy versus thrombolysis trials are provided in Figure 1 In contrast to thrombectomy group, the thrombolysis group differed only in the first 24-hours (p=0.01). Testing for interaction was significant from baseline to 3 months for thrombectomy (p<0.001) but not thrombolysis (p=0.106). Figure 2 shows the sensitivity analysis for the thrombolysis trials threshold at baseline NIHSS ⩾6 and ⩾11; the NIHSS changes within 24-hour in these two groups is more dramatic than observed in the non-thresholded thrombolysis group.

Conclusion: Following thrombectomy, large clinical improvement occurs in the first week, particularly the first 24-hours. This pattern of improvement differed from that in thrombolysis trials where smaller improvement occurred only in first 24-hour.

Disclosure: No

P1008 / 1471

DID THE SEVERITY OF THE COVID-19 OUTBREAK AFFECT THE QUALITY OF ACUTE STROKE CARE? (DATA FROM ACROSS THE COUNTRY)

Z. Gdovinova ¹, M. Vitkova¹, A. Barakova², A. Cvopova²

¹P.J.Safarik University Kosice, Faculty of Medicine and L.Pasteur University Hospital, Neurology, Kosice, Slovakia, ²National Health Information Centre, Registry department, Bratislava, Slovakia

Background and aims: During the first wave of the COVID-19 pandemic Slovakia was a country with a low number of positive cases (1375 positive patients/5.458 million inhabitants). Nevertheless, a reduced number of hospitalised patients with acute stroke was observed, with no evidence of a change in the quality of acute stroke care. During the second wave of the pandemic, Slovakia became one of the countries with the highest incidence of positive patients (90 943 positive patients).The aim of our study was to determine whether the severity of the COVID-19 pandemic affected the quality of acute care of stroke.

Methods: Data from two time periods (the first wave: March–April 2020; the second wave: October–November 2020) from the stroke register at the National Health Information Centre were analysed.

Results: The total number of patients admitted with stroke during the second wave of COVID-19 was 1848, vs 1698 in the first wave. The proportion of patients treated by IVT, TE and DNT, ONT; NIHSS and mRS at discharge are in Tab. 1. We did not find difference in proportion of IVT, TE, nor in DNT, ONT and in NIHSS and mRS at discharge from hospital between the first and the second waves of the pandemic.

Conclusion: The severity of the COVID-19 outbreak did not affect the quality of acute stroke care in Slovakia, which is in line with the data from some other countries, that the quality of acute stroke care can be preserved with a well-organised stroke care system.

Table 1.

The main characteristics of the sample and results from two time periods.

	03-04/ 2020	10-11/2021	difference
Ischaemic and haemoraghic stroke (n)	1698	1848
Ischaemic stroke and TIA (n)	1331	1503
TIA (n)	189	199
Ischaemic stroke (n)	1142	1304
IVT (n)	275	333
IVT (%)	20,7	22,1	W=715, p=0,53
TE (n)	117	153
TE (%)	10,2	11,7	W=748, p=0,64
DNT (median, IQR, min, max)	29, 15-45, 6-190	30, 20-46.25, 6-155	W=34452, p=0,08
ONT (median, IQR, min, max)	130, 100-195, 15-308	130, 103-180, 25-305	W=33012, p=0,52
NIHSS (median, IQR, min, max)	3, 1-10, 0-40	4, 1-10, 0-42	W=53128, p=0,51
mRS (median, IQR, min, max)	3.0, 1-5, 0-6	3.0, 1-5, 0-6	W=51184, p=0,60

TIA – tranisent ischaemic attack, IVT – intravenous thrombolysis, TE - thrombectomy, DNT – door-to-needle time, ONT – onset-to-needle time, NIHSS - The National Institutes of Health Stroke Scale, mRS – modified Rankin Scale

Disclosure: No

P1009 / 469

EXPLORING THE ACCURATE DEFINITION OF ACUTE STROKE IMAGING OUTCOMES WITH CIRCULATING BIOMARKERS

S. Biagini ¹, J. Kennedy², A. Sodero¹, L. Tudisco¹, I. Lombardo³, E. Fainardi³, B. Piccardi⁴, C. Sarti^4,1, M. Baldereschi⁵

¹University of Florence, NEUROFARBA, Florence, Italy, ²University of Oxford, Acute Vascular Imaging Centre, Radcliffe Department of Medicine, Oxford, United Kingdom, ³University of Florence, Department of Biomedical, Experimental and Clinical Sciences, Florence, Italy, ⁴Careggi University Hospital, Stroke Unit, Florence, Italy, ⁵National Research Council, Institute of Neuroscience, Florence, Italy

Background and aims: Blood brain barrier disruption causes the major clinical-radiological complications after acute ischemic stroke treatments. The hypodense area on follow up brain CT scan is the result of the final infarct volume (FIV) and the anatomical distortion (AD) due to edema and hemorrhage. We used an objective and automated method to obtain a separate quantification of these distinct pathological processes. Our aim is to investigate the possible association between AD and a panel of circulating biomarkers reported in literature to be involved in parenchymal damage following acute ischemic stroke treatments.

Methods: We used the linear and non-linear registration method described by Harston et al. to measure AD. Relative AD (rAD; AD/FIV ratio) was also calculated to control AD for infarct size. We included in our retrospective analysis 46 anterior circulation acute ischemic stroke patients treated with systemic thrombolysis, endovascular therapy, or both, that had both baseline and 24h circulating biomarkers blood levels available for analysis.

Results: Both FIV and rAD resulted associated with higher baseline values of MMP-8 (respectively p=0.01, 95% CI 0.003-0.021 and p=0.01, 95% CI 0.000-0.002). Higher baseline levels of MMP-7 and their pre-post variation resulted associated with rAD (respectively p=0.01, 95% CI 0.01-0.10; p=0.003, 95% CI -0.09- (-0.02)).

Conclusions: Higher baseline levels of Metalloproteinases (MMP-7, MMP-8) are associated with the effects of blood brain barrier disruption quantificated with a novel neuroimaging method first applied on brain CT, that might predict outcome before reperfusion treatments and therefore support decision making with a precision medicine approach.

Disclosure: No

P1010 / 1629

IMPACT OF COVID-19 ON ACUTE STROKE CARE IN A LARGE CENTER FROM A MIDDLE- INCOME COUNTRY

R. Pirola ¹, A. Conforto¹

¹ HCFMUSP, São Paulo, Brazil

Background and aims: COVID-19 pandemic had impact on stroke care around the world, but middle and low-income countries may have struggled more to cope with the spread of the virus because of its more fragile health care systems. We aimed to measure this impact on stroke care in the largest medical center from Latin America.

Methods: We conducted an observational study from a prospective database and compared key performance indicators related to acute stroke care from stroke admissions over 1 year after the pandemic to 1 year before.

Results: We analyzed 1.555 stroke admissions. There were 808 admissions, 142 intravenous thrombolysis (IVT) and 32 mechanical thrombectomies (MT) before the pandemic versus 747 admissions, 104 IVT and 19 MT after, representing a statistically significant decline from 17,5% to 13,9% of IVT (p = 0,04) but a non-statistically significant decline in MT (p = 0,11). After the pandemic, there was an increase in door-to-imaging time compared to the previous year (39 x 27 minutes; p < 0,001), but there was no difference regarding to door-to-needle time for IVT (p 0,12) or door-to-puncture for MT (p = 0,8).

Conclusions: In the largest medical center from Latin America, COVID-19 pandemic was associated with a decline in the volume of IVT and an increase in door-to-imaging time, but there was no difference regarding to reperfusion time indicators (door-to-needle and door-to-puncture time).

Disclosure: No

P1011 / 435

WITHDRAWN N20 MONITORING PREDICTS FUNCTIONAL RECOVERY IN PATIENTS WITH ANTERIOR ACUTE ISCHEMIC STROKE TREATED WITH MECHANICAL TRHOMBECTOMY (PROMISE STUDY; CLINICALTRIALS.GOV: NCT04099615)

A. Martínez Piñeiro ¹, G. Lucente¹, A. Arbex Bassols¹, A. Ramos Fransi¹, M. Almendrote Muñoz¹, M. Millán Torné¹, N. Pérez de la Ossa-Herrero¹, M. Gomis Cortina¹, L. Dorado Bouix¹, M. Hernández Pérez¹, C. Castaño Duque¹, S. Remollo Friedemann¹, A. Garrido Pla², N. Guanyabens Buscà³, E. López-Cancio Martínez⁴, J. Coll Cantí¹, A. Dávalos Errando¹

¹Germans Trias Pujol Hospital, Neurosciences, Badalona, Spain, ²Hospital Clínic, Neurosciences, Barcelona, Spain, ³Hospital Mataró, Neurology, Mataró, Spain, ⁴Hospital Central Asturias, Neurology, Oviedo, Spain

Background and aims: Somatosensory evoked potentials (SEP) may add substantial prognostic value in acute ischemic stroke (AIS) and be implemented in prehospital setting. We aimed to study N20 SEP component of ischemic hemisphere in anterior AIS patients undergoing mechanical thrombectomy (MT).

Methods: N20 was measured in the angio-room before and continuously during MT. Its adjusted predictive value for functional independence (modified Rankin score ⩽2) and across the full range of disability at day 7 was analysed by binary and ordinal logistic regression. N20 predictive power was compared with clinical&imaging models by using Receiving Operating Characteristics Curve (ROC) analysis.

Results: 223 consecutive patients were studied (mean age,70y; median NIHSS,18). Blinded reading of SEP recordings identified presence of N20 in 110 (49.3%), absence in 58 (26%) and not assessable in 55 patients due to radiofrequency interferences. Prior to MT, presence of N20 predicted functional independence with sensitivity of 93% (Table 1). The adjusted (by age, NIHSS, ASPECTS score and serum glucose) OR for functional indpendence was 9.9 (95%CI, 3.1-44.6) (Table 2) and 6.41 (2.98-14.29) across the full range of disability (Figure 1). N20 amplitude showed higher AUC than models using current clinical and imaging pre-hospital or in-hospital factors (Figure 2). Table 3 shows N20 predictive power compared to imaging factors in 116 patients with baseline CTP/MR. Sensitivity of N20 increased to 100% (95% CI, 0.85-1) at end of MT.

Conclusions: SEP monitoring is a non-invasive, fast and bedside technique that could help eligibility of AIS patients for MT and predict functional recovery.

Disclosure: Yes

P1012 / 247

NLPR3-INFLAMMASOME INHIBITION AMELIORATES SECONDARY INFARCT GROWTH IN SUBACUTE ISCHEMIC STROKE IN MICE

M. Bellut ¹, G. Stoll¹, M. Schuhmann¹

¹ University Clinic of Wuerzburg, Neurology, Wuerzburg, Germany

Background and aims: Ischemic stroke induces a robust inflammatory response which occurs in waves, commencing immediately upon large vessel occlusion (LVO) and persisting despite successful recanalization. Induction of the NLRP3 inflammasome is a major driver of stroke-related inflammation and its blockade mitigates early stroke progression within the first 24 hours. However, it is unclear whether persistent inflammation in the subacute stroke phase further aggravates ischemic tissue damage.

Methods: We induced focal cerebral ischemia in WT-mice by 30-min transient middle cerebral artery occlusion (tMCAO). We treated animals with the NLRP3-specific inhibitor MCC950 one day after tMCAO and prophylactically. Stroke volume & functional outcome were assessed 7d after reperfusion.

Results: 30 min tMCAO lead to small-medium size stroke volumes. Inflammasome inhibition significantly improved stroke volumes and functional outcome after 7d of reperfusion. This effect was further increased after prophylactic treatment.

Conclusions: Targeting inflammation in the subacute phase of IS can still mitigate stroke development in small-medium size infarctions. In line with our previous results showing a significant impact of the NLRP3-inhibition on post-stroke outcome after an observation period of 1d, our results underline the role of the NLRP3-inflammasome as master-switch of inflammation during IS. Of note, not only the hyperacute but also the delayed treatment after reperfusion lead to better post-stroke outcomes and smaller infarct sizes that persisted for a whole week. This implies a major role of NLRP3 in both – the hyperaute and delayed inflammatory responses after IS.

Disclosure: No

P1013 / 1453

INTRAVENOUS THROMBOLYSIS PLUS MECHANICAL THROMBECTOMY VERSUS DIRECT MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE: A RETROSPECTIVE ANALYSIS FROM A TERTIARY CENTER

I. Oyarzun Irazu ¹, A. Cabrera Muras¹, D. Martinez Condor¹, C. Gutierrez Albizuri¹, O. Quintana Lopez¹, J.M. Garcia Sanchez¹, I. Caballero Romero¹, B. Aguilera Irazabal¹, A. Bilbao Gonzalez², J.C. Garcia-Monco Carra¹

¹Basurto University Hospital, Neurology, Bilbao, Spain, ²Basurto University Hospital, Biostatistics, Bilbao, Spain

Background and aims: The benefit-risk balance of intravenous thrombolysis (IVT) before mechanical thrombectomy (Bridging Therapy) in acute stroke is still uncertain. We compare the results obtained in our center.

Methods: Retrospective analysis of the mechanical thrombectomies performed in our center from January 2018 to December 2020. Two groups were compared: the bridging therapy group (BT) and the direct mechanical thrombectomy group (MT). The patients fulfilled the following criteria: anterior circulation stroke, less than 4.5 hours since symptoms onset, modified Rankin scale (mRS) 0-2 and 90 day follow-up.

The main objective was to compare the functional independence at 90 days (mRS 0-2). Secondary outcomes were the comparison of safety (haemorrhage, infections, death) and revascularization (TICI IIB/III, revascularization time, 24-hour CT result) related data.

Results: 106 patients were included. 42 in the BP group and 64 in the MT group. No significant differences were found in age, sex and NIHSS at arrival. At 90 days of follow-up 28 (66.67%) patients presented mRS 0-2 in the BP group and 40 (62.5%) patients in the MT group without statistically significant difference (OR=1.2; CI 0.53-2.72). We observed that asymptomatic hemorrhages were more frequent in the BP group (30.95% vs 18.75; 2.38 vs 3.13 in symptomatic hemorrhages). No statistically significant difference was found (p=0.35). The other secondary outcomes did not show significant differences.

Conclusions: We did not find significant differences in the functional independence, safety and revascularization outcomes between the BP group and the MT group, despite asymptomatic haemorrhages being more frequent in the first group.

Disclosure: No

P1014 / 149

DID THE STROKE CODE IN MADRID JAM DURING THE FIRST WAVE OF COVID-19?

N. Riera-Lopez ¹, J. Martinez-Gomez², N. Rodriguez-Rodill², J. Zamora³, E. Montero-Ruiz⁴, A. Gaetano³, B. Fernandez-Felix⁵, J. Rodriguez-Pardo⁶, B. Fuentes-Gimeno⁶, Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP) Study Group

¹SUMMA 112, Stroke Comission, Madrid, Spain, ²SUMMA 112, IT Department, Madrid, Spain, ³Ramon y Cajal University Hospital, Clinical Biostatistics Unit, Madrid, Spain, ⁴Ramon y Cajal University Hospital, Internal Medicine Department, Madrid, Spain, ⁵Ramon y Cajal University Hospital, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain, ⁶La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain

Background and aims: Madrid was one of the epicentres of the COVID-19 pandemic in Spain. The entire healthcare system was severely affected by the first wave of the pandemic. We aimed to assess the extent to which the acute stroke care chain was impacted.

Methods: Using the stroke code (SC) cohort of SUMMA 112 (the main emergency medical service in the region), we compared all patients in the first wave of the pandemic and in the same period of the previous year. Subsequently, we collected all anonymized records from the main hospital administrative database (minimum basic data set at hospital discharge). We used ambulance response times, concordance between pre-hospital and hospital diagnosis, hospital times, and mortality to evaluate the SC protocol. The study was approved by the Ethics Committee of the Community of Madrid.

Results: 966 SC were analysed (514 pre-pandemic and 452 during the first wave). Pre-hospital attention times were longer (39 vs. 35 minutes), patients stayed longer in the emergency room before admission (7.5 vs. 6.1 hours), the concordance between pre-hospital and in-hospital diagnostic suspicion did not change significantly (86% vs. 89%) and mortality decreased (9% vs 13%) during the first wave of the pandemic.

Pre-hospital times

Pre-hospital on-scene time (interrupted time series)

Conclusions: During the first wave of the pandemic, there were delays in care, especially in the on-scene time. Improvements in training might have prevented it. The high qualification of pre-hospital teams enabled them to maintain their diagnostic accuracy. The reduction in mortality needs further exploration.

Disclosure: Yes

P1015 / 186

ENDOVASCULAR TREATMENT IN PATIENTS WITH PRESTROKE FUNCTIONAL DEPENDENCY

A. Fernández Revuelta ¹, T. Montalvo Moraleda¹, M. Moreu², P. Simal Hernández¹, C. Pérez García², S. Rosati², A. López-Frías², J. Egido¹, C. Gómez-Escalonilla¹

¹Hospital Clínico San Carlos, Stroke Unit Neurology, Madrid, Spain, ²Hospital Clínico San Carlos, Neurointerventional Radiology, Madrid, Spain

Background and aims: According to current guidelines, benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) who have prestroke functional dependency is uncertain. We present results of efficacy and safety in a series of patients.

Methods: Review of a series of 62 patients with AIS due to anterior circulation LVO who have prestroke modified Rankin scale (mRs) ⩾3, treated by MT. We evaluated clinical and radiological characteristics, rate of successful reperfusion (defined as final mTICI score 2b-3), rate of symptomatic intracranial haemorrhage (sICH) and clinical follow-up data, including the percentage of patients with the same mRs score at baseline.

Results: 62 patients with anterior circulation AIS and prestroke mRS score ⩾3 were treated with EVT from November 2011 to November 2021. Median age was 84 (74-88) and 69.25% were female. 50% of patients had a previous history of stroke.

Median NIHSS was 19.5 (15-23) and median ASPECTS was 9 (8-10). Intravenous thrombolysis was administrated in 19 patients (30.64%). mTICI 2b-3 score was achieved in 44 patients (70.97%) and sICH rate was 3.22%. At 3 months, 16 patients (25.81%) reached baseline mRS and mortality rate was 41.93%.

Patients with mTICI2B-3 reperfusion had better functional outcomes (31.82% vs 11.11%, p=0.109) and lower mortality (31.82% vs 66.66%, p=0.02013).

Conclusions: In our series, despite a satisfactory reperfusion rate, only 25.81% of patients achieved previous baseline mRs. We have observed that successful reperfusion has been associated with a better functional prognosis and lower mortality.

Disclosure: No

P1016 / 1481

THROMBECTOMY IN CERVICAL ARTERY DISSECTION RELATED STROKE: A CHALLENGE OR AN OPPORTUNITY?

F. Boscain¹, F. Favruzzo ¹, A. Pieroni¹, F. Viaro¹, A. Fattorello Salimbeni¹, J.D. Gabrieli¹, G. Cester¹, C. Baracchini¹

¹ Azienda ospedaliera di Padova, Padova, Italy

Background and aims: Thrombolytic therapy in acute large vessel occlusion (LVO) stroke in patients with spontaneous cervical artery dissection (sCAD) has shown to be safe and effective. Data on mechanical thrombectomy (MT) are scant. Therefore, we decided to analyze safety and efficacy of MT in a series of sCAD patients and compare these results with our general stroke registry.

Methods: Consecutive patients who underwent MT from June 2015 to June 2021 were analyzed. Baseline and procedural characteristics, recanalization rates, adverse events and functional outcome of sCAD patients were compared to non-sCAD LVO patients.

Results: Out of 375 patients, 20 (5.3%) were diagnosed with sCAD. These patients were younger (52.9 ± 7.8 vs 72.5 ± 12.9 years, p < 0.001), and showed lower rates of cardiovascular burden. There was a trend towards lower ASPECTS score. In sCAD patients, tandem occlusions were more frequent (65.0% vs 14.4%, p < 0.001), groin to reperfusion time was longer (93.6 ± 34.9 vs 68.3 ± 50.2 minutes, p = 0.01) and general anesthesia was more frequently applied (70.0% vs 27.9%, p < 0.001). MT-related adverse events (10% vs 10.7%) and recanalization rates (TICI 2b-3 100.0% vs 88.5%) did not differ between the two groups, while functional outcome was better in sCAD patients (mRS 0-2 at 3 months 85.0% vs 62.0%, p = 0.049).

Conclusions: According to our study, although MT represents a procedural challenge, it constitutes a safe and effective treatment for sCAD patients with LVO stroke.

Disclosure: No

P1017 / 1152

COMBINED TECHNIQUE AS FIRST APPROACH IN MECHANICAL THROMBECTOMY: EFFICACY AND SAFETY OF REACT CATHETER COMBINED WITH STENT RETRIEVER

M. Requena ¹, C. Piñana¹, M. Olive-Gadea¹, D. Hernández¹, S. Boned¹, M. De Dios¹, M. Rodrigo¹, E. Rivera¹, M. Muchada¹, J.L. Cuevas¹, M. Rubiera¹, Á. García-Tornel¹, L.L. Gramegna², C. Molina¹, M. Ribo¹, A. Tomasello¹

¹Hospital Universitari Vall d’Hebron, Barcelona, Spain, ²IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy

Background and aims: Complete reperfusion with one attempt is the main objective of endovascular treatment of acute ischemic stroke due to large vessel occlusion. Combined technique of stent retriever and distal aspiration catheter may improve reperfusion. Our aim is to evaluate the efficacy and safety of combine technique using REACT catheters.

Methods: Prospective record of consecutive patients who underwent mechanical thrombectomy with combined technique using REACT catheters during a year. Efficacy endpoints were the rate of final successful (mTICI 2b-3) and complete reperfusion (mTICI 2c-3). Similar analysis was performed after first pass and after each individual attempt. Safety outcomes was defined as the absence of inhospital mortality, symptomatic hemorrhage or procedural complications.

Results: During this period, 102 patients were included in the registry. Median age was 78 (IQR 73-87) years, 50.0% were women and median premorbid mRS score was 1 (IQR 1-2). At admission median NIHSS score was 19 (IQR 11-21) and median baseline ASPECTS was 9 (IQR 8-10). Successful reperfusion was achieved in 91 (89.2%) patients with a rate of complete reperfusion of 64.7%. After the first pass, successful reperfusion was achieved in 55 (53.9%) patients and complete reperfusion rate of 36.3%. Rates of successful (93.6%) and complete reperfusion (42.6%) were higher among patients with premorbid mRS score 0-1 and occlusion of M1-MCA segment or internal carotid arteries.

Conclusion: Combined technique with stent retriever and REACT aspiration catheter have shown a high rate of successful recanalization and first pass effect in a sample of consecutive patients in real-life situation.

Disclosure: No

P1018 / 455

ULTRA-LONG TRANSFERS FOR ENDOVASCULAR THROMBECTOMY: MISSION IMPOSSIBLE? THE AUSTRALIA-NEW ZEALAND EXPERIENCE

C. Garcia-Esperon ¹, T. Wu², V. Carraro do Nascimento³, B. Yan⁴, C. Kurunawai⁵, T. Kleinig⁵, G. Serlkirk⁶, D. Blacker⁶, A. Barber⁷, A. Ranta⁸, A. Wong⁹, P. Mitchell⁴, C. Muller⁹, H. Rice³, L. De Villiers³, J. Jannes⁵, J. Beom Hong⁷, H. Brown³, B. Campbell⁴, D. Wilson², J. Fink², T. Ang¹⁰, T. Phillips⁶, M. Hasnain¹, F. Miteff¹, C. Levi¹, N. Spratt¹, M. Parsons¹¹, ANZ Ultra-Long EVT Transfer

¹John Hunter Hospital, Neurology, New Lambton Heights, Australia, ²Christchurch Hospital, Christchurch, New Zealand, ³Gold Coast University Hospital, Gold Coast, Australia, ⁴Royal Melbourne Hospital, Melbourne, Australia, ⁵Royal Adelaide Hospital, Adelaide, Australia, ⁶Charles Gairdner Hospital, Perth, Australia, ⁷The University of Auckland, Auckland, New Zealand, ⁸Wellington Hospital, Wellington, New Zealand, ⁹Royal Brisbane and Women’s Hospital, Brisbane, Australia, ¹⁰Royal Prince Alfred hospital, Sydney, Australia, ¹¹University of New South Wales South Western Sydney Clinical School, Sydney, Australia

Background: Endovascular thrombectomy (EVT) is key for large vessel occlusion stroke treatment, but logistically difficult in geographically remote regions. The role of repeat stroke imaging following arrival at the primary stroke centre (PSC) is uncertain.

Objective: We hypothesized that in patients transferred >480km (300miles) for EVT, and compared to phase-III EVT extended window data: EVT would have a similar proportion of patients with good (modified Rankin Scale –mRS- 0-2) and fair (mRS 0-3) outcome three-month after stroke; and, computed tomography perfusion (CTP) selection at PSC would be associated with higher proportion of mRS 0-2/0-3 at 3 months.

Methods: Retrospective analysis (2016-2021) of patients transferred >480km in Australia-New Zealand.

Findings: Amongst 136 patients, median age was 64 [53-74] years, the baseline mRS was 0-1 in 133 (97.8%) and the median baseline NIHSS score was 16 [12-22]. 79 were selected with non-contrast CT (NCCT) and CT angiography at the PSC (58.1%), 52 (38.2%) also had CTP and five NCCT alone. A total of 101 (74.2%) underwent EVT. Good outcome was found in 65 (47.8%) and fair in 86 (63.2%) at three months. CTP selection at the PSC was not associated with higher proportion of good outcome compared to brain NCCT and/or CT angiography (58.8% versus 42.7%, p=0.07) but with a higher proportion of fair outcome (78.3% versus 53.7%, p=0.004).

Interpretation: The rate of good outcome in selected patients transferred >480km for EVT was very similar to those seen in phase-III EVT extended window. CTP selection at PSC was associated with better outcomes.

Disclosure: No

P1019 / 264

TREATMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE OUTSIDE DAWN AND DEFUSE-3 CRITERIA: A REAL-WORLD RETROSPECTIVE ANALYSIS

A. Ciacciarelli ¹, E. Nicolini¹, I. Berto¹, M. De Michele¹, A. Falcou¹, M.T. Di Mascio¹, S. Lorenzano¹, L. Petraglia¹, O.G. Schiavo¹, N. Caracciolo¹, D. Toni¹

¹ Sapienza University of Rome, Emergency Department, Stroke Unit, Rome, Italy

Background and aims: Mechanical thrombectomy (MT) in late time window is proved to be effective in acute ischemic strokes (AIS) fulfilling the selection criteria of DAWN and DEFUSE-3 trials. We aimed to evaluate safety and effectiveness of MT in patients with large vessel occlusion (LVO) not satisfying DAWN or DEFUSE-3 criteria.

Methods: We retrospectively included patients with AIS with anterior circulation LVO presenting between 6-24h from last time known well and treated with MT. We grouped cases based on compliance with DAWN and/or DEFUSE-3 criteria and collected clinical and neuroimaging data. A comparison analysis was conducted. Primary outcome was functional independence at 90-days (mRS 0-2).

Results: Of 88 patients included (44.3% male, mean age 73±13y), 56 (63.6%) did not fulfill DAWN, 45 (51.1%) did not fulfill DEFUSE-3, and 38 (43.2%) did not fulfill either DAWN or DEFUSE-3 (nD-nD3) criteria. Among nD-nD3 patients, 17 (44.7%) reached functional independence at 3-months compared to 19 (38.0%) fulfilling DAWN or DEFUSE-3 (p=0.524). nD-nD3 patients with good outcome were younger (63±14yvs79±11y, p<0.001) and had lower baseline NIHSS (6±6vs15±6, p<0.001) compared to those with poor outcome. However, sICH occurred more frequently in nD-nD3 patients than in those who met the criteria (18.4vs2%, p=0.008).

Conclusions: In our cohort of patients who were outside DAWN or DEFUSE-3 inclusion criteria, MT was effective, especially in younger subjects and in those with lower NIHSS. Age and NIHSS should be considered when treating patients not fulfilling DAWN or DEFUSE-3 with MT in late time windows.

	Fulfilling DAWN or DEFUSE3 criteria n (%)	Outside DAWN and DEFUSE3 criteria n (%)	p
mRS 3-6	31 (62,0)	21 (55,3)	0,524
mRS 0-2	19 (38,0)	17 (44,7)
mRS 2-6	36 (72,0)	22 (57,9)	0,167
mRS 0-1	14 (28,0)	16 (42,1)
90 days death	11 (22,0)	6 (15,8)	0,465
TICI 0-2a	7 (14,6)	5 (13,5)	0,888
TICI 2b-3	41 (85,4)	32 (86,5)
ICH	20 (40,8)	17 (47,2)	0,556
sICH	1 (2,0)	7(18,4)	0,008

	Outside DEFUSE3 criteria			Outside DAWN criteria			Outside DAWN and DEFUSE3 criteria
	Functional Outcome n (%)			Functional Outcome n (%)			Functional Outcome n (%)
	mRS 3-6	mRS 0-2	p	mRS 3-6	mRS 0-2	p	mRS 3-6	mRS 0-2	p
Age mean (SD)	79(10)	69(13)	0,000	79(10)	65(65;13)	0,030	79(11)	63(14)	0,000
Male	9(36,0)	14(70,0)	0,023	10(33,3)	13(50,0)	0,206	8(38,1)	12(70,6)	0,046
Arterial hypertension	22(88,0)	11(55,0)	0,013	26(86,7)	15(57,7)	0,015	18(85,7)	9(52,9)	0,027
Diabetes	5(20,0)	5(25,0)	0,688	8(26,7)	5(19,2)	0,511	4(19,0)	5(29,4)	0,455
Smokers	1(4,0)	6(30,0)	0,017	2(6,7)	5(19,2)	0,156	1(4,8)	5(29,4)	0,038
History of stroke or TIA	3(12,0)	1(5,0)	0,412	4(13,3)	3(11,5)	0,839	3(14,3)	1(5,9)	0,401
Heart failure	4(16,0)	2(10,0)	0,556	6(20,0)	1(3,8)	0,068	4(19,0)	1(5,9)	0,233
Coronary artery disease	2(8,0)	0(0,0)	0,196	4(13,3)	0(0,0)	0,053	2(9,5)	0(0,0)	0,191
Atrial fibrillation	14(56,0)	6(30,0)	0,081	14(46,7)	6(23,1)	0,066	10(47,6)	6(35,3)	0,444
Hypercolestrolemia	7(28,0)	6(30,0)	0,883	8(26,7)	7(26,9)	0,983	6(28,6)	5(29,4)	0,955
Carotid atherosclerosis	6(24,0)	3(15,0)	0,453	8(26,7)	5(19,2)	0,511	6(28,6)	3(17,6)	0,431
Tumor history	5(20,0)	1(5,0)	0,141	7(23,3)	3(11,5)	0,250	5(23,8)	1(5,9)	0,132
Baseline NIHSS median (SD)	17 (6)	5 (6)	0,000	16 (6)	6 (5)	0,000	17 (6)	4 (6)	0,000
Post interventional NIHSS median (SD)	18 (6)	6 (7)	0,000	15 (6)	6 (6)	0,000	17 (7)	6 (7)	0,000
24H NIHSS median (SD)	18 (7)	5 (5)	0,000	17 (7)	2 (5)	0,000	7 (7	3 (5)	0,000
7 days/Discharge NIHSS median (SD)	10 (6)	2 (3)	0,000	12 (6)	1 (3)	0,163	13 (6)	1 (3)	0,000

	OutsideDEFUSE3 criteria			OutsideDAWN criteria			Outside DAWNand DEFUSE3 criteria
	Functional Outcome n (%)			Functional Outcome n (%)			Functional Outcome n (%)
	mRS 3-6	mRS 0-2	p	mRS 3-6	mRS 0-2	p	mRS 3-6	mRS 0-2	p
TICI
2b	7(28,0)	4(21,1)	0,129	7(24,1)	5(20,0)	0,046	5(23,8)	3(18,8)	0,224
2c	2(8,0)	1(5,3)		3(10,3)	1(4,0)		2(9,5)	1(6,3)
3	10(40,0)	14(73,7)		12(41,4)	19(76,0)		9(42,9)	12(75,0)
1-2a	5(20,0)	0(0,0)		5(17,2)	0(0,0)		4(19,0)	0(0,0)
0	1(4,0)	0(0,0)		2(6,9)	0(0,0)		1(4,8)	0(0,0)
Groin-to-reperfusion time mean (SD)	1,23 (0,82)	1,19 (1,04)	0,893	1,53 (2,07)	1,17 (13,96)	0,021	1,15 (0,80)	1,34 (1,07)	0,540

Disclosure: No