Embargoed for 9:57 A.M. CT/10:57 A.M. ET Session A20 Abstract 140

Embargoed for 9:57 A.M. CT/10:57 A.M. ET Session A20 Abstract 140

Thursday TIP ABSTRACT

Embargoed for 9:57 a.m. CT/10:57 a.m. ET – Session A20 – Abstract 140

Control #: 17-ISC-A-4290-AHA

Matthew Mercuri, M.D., Weill Cornell Medicine, New York City, New York; (570) 878-0160;.

Epilepsy in the elderly linked to increased ischemic stroke risk

Session Assignment

A20 - Community/Risk Factors Oral Abstracts II(Abstract: 140; Speaking Time: 2/23/2017 9:57:00 AM - 2/23/2017 10:09:00 AM)

Title

Association between Epilepsy and the Risk of Ischemic Stroke or Myocardial Infarction

Author Block

Matthew A Mercuri, Alexander E Merkler, Neal S Parikh, Michael E Reznik, HoomanKamel, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Res Inst and Dept of Neurology, Weill Cornell Med, New York City, NY

Disclosure Block:
M.A. Mercuri: None.A.E. Merkler: None.N.S. Parikh: None.M.E. Reznik: None. H. Kamel: Research Grant; Significant; NIH grant K23NS082367.

Abstract Content

Background: Vascular brain injury can result in epilepsy. It is posited that seizures in elderly patients might reflect subclinical vascular disease and thus herald future clinical vascular events.
Hypothesis: Seizures in elderly patients are associated with an increased risk of ischemic stroke or myocardial infarction (MI).
Methods: We obtained inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries ≥66 years of age. The predictor variable was epilepsy, defined as two or more inpatient or outpatient claims with a diagnosis of seizure. The primary outcome was a composite of ischemic stroke or acute MI. The predictors and outcomes were all ascertained with previously validated ICD-9-CM code algorithms. Survival statistics and Cox proportional hazards models were used to assess the relationship between epilepsy and incident ischemic stroke or MI while adjusting for demographic characteristics and vascular risk factors. Patients were censored at the first occurrence of a stroke or MI, at the time of death, or on December 31, 2014.
Results: Among 1,548,556 beneficiaries with a mean follow-up of 4.4 (±1.8) years, 15,055 (1.0%) developed epilepsy and 121,866 (7.9%) experienced an ischemic stroke or acute MI. Patients with seizures were older (76.1 versus 73.7 years) and had a significantly higher burden of vascular comorbidities than the remainder of the cohort. The annual incidence of stroke or acute MI was 3.28% (95% confidence interval [CI], 3.10-3.47%) in those with seizures versus 1.79% (95% CI, 1.78-1.80%) in those without (unadjusted hazard ratio [HR], 1.89; 95% CI, 1.78-2.00). After adjustment for demographics and risk factors, epilepsy had a weak association with the composite outcome (adjusted HR, 1.36; 95% CI, 1.29-1.44), a stronger association with ischemic stroke (adjusted HR, 1.77; 95% CI, 1.65-1.90), and no association with acute MI (adjusted HR, 0.95; 95% CI, 0.86-1.04).
Conclusions: We found an association between epilepsy in elderly patients and future ischemic stroke but not acute MI. Therefore, seizures might signify occult cerebrovascular disease but not necessarily occult disease in other vascular beds.

Thursday TIP ABSTRACT

Embargoed for 1:42 p.m. CT/2:42 p.m. ET, Thursday, Feb. 23, 2017

Session A25 – Abstract LB10 in Grand Ballroom B

Control #: 17-ISC-LB-5305-AHA

Ali Ehsan Sifat, Graduate Student/Research Assistant, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, Texas; (806) 340-1570; .

E- cigarettes may pose the same or higher risk of stroke severity as tobacco smoke

Session Assignment

A25 - Late-Breaking Science Oral Abstracts I (Presentation #: LB10; Speaking Time: 2/23/2017 1:42:00 PM - 2/23/2017 1:54:00 PM)

Title

E-cigarette Exposure Alters Brain Glucose Utilization and Stroke Outcome

Author Block

Ali E. Sifat, Buvaneshwar Vaidya, Heidi Villalba, Mohammad A. Kaisar, Luca Cucullo, Thomas Abbruscato, TTUHSC Sch of Pharmacy, Amarillo, TX

Disclosure Block:
A.E. Sifat: None.B. Vaidya: None.H. Villalba: None.M.A. Kaisar: None.L. Cucullo: None.T. Abbruscato: None.

Abstract Content

Background: Use of electronic cigarettes (e-Cig) is a growing health concern in both smoking and nonsmoking populations and rigorous studies are needed to investigate the effects of the nicotine exposure via e-Cig on the neurovascular unit (NVU) and stroke outcome. Previous studies by our group have shown that nicotine and tobacco smoke (TS) exposure exerts specific effects on paracellular blood-brain barrier (BBB) permeability in response to stroke conditions. Methods: In the present study, we specifically tested the effects of chronic e-Cig vaping on ischemic stroke outcome and brain glucose utilization. Nicotine was administered to mice by either osmotic pump at a dose of 4.5 mg/kg/day for 1, 7, 14 days or by e-Cig vapor (2.4% nicotine) delivered by an electronic nicotine delivery system for 7, 10, 14, & 30 days. Ischemia-reperfusion injury was induced by transient middle cerebral artery occlusion (tMCAO) followed by 24 hour reperfusion. Glucose transport was estimated with an in situ brain perfusion technique using radiolabeled glucose as a substrate. Brain deoxy-D-glucose uptake was also determined in brain slices exposed to 30 minute oxygen glucose deprivation (OGD) utilizing an acute brain slices (ABS) technique. Results: Nicotine exposure for 7 and 14 days resulted in a significant reduction in D-glucose influx rate (Kin) across the BBB, with a 49% reduction in 14 days nicotine infused animals. E-cig exposure for 7 and 14 days also decreased deoxy-D-glucose uptake in ABS experiments exposed to OGD. Interestingly, both 10 days and 30 days e-Cig exposed animals developed worsened stroke outcome, as measured by TTC staining and measurement of neurological deficits, which outpaced the stroke damage promoted by TS exposure. Both e-cig and TS exposure for 30 days significantly downregulated circulating levels of thrombomodulin, suggesting a pro-coagulant predisposition and potential risk for stroke and worsened secondary brain injury. Conclusions: These data suggest, from a cerebrovascular perspective, that e-Cig vaping is not safer than tobacco smoking, and may pose a similar, if not higher risk for stroke severity. We believe this exacerbation of stroke outcome could be due to an enhanced glucose deprived and/or thrombotic state at the NVU.

Thursday TIP ABSTRACT

Embargoed for 2:30 p.m. CT, Thursday, Feb. 23, 2017

Session A23 – Abstract 160

Jordi Jimenez-Conde, M.D., Ph.D., Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; (011) 617 955 3850; .

Biological, not chronological age, better predictor of stroke recovery

Session Assignment

A23 - Basic and Preclinical Neuroscience of Stroke Recovery Oral Abstracts II(Abstract 160; Speaking Time: 2/23/2017 2:30:00 PM - 2/23/2017 2:42:00 PM)

Title

DNA-Methylation and Aging. Contribution of Biological Age to Recovery after Ischemic Stroke

Author Block

Jordi Jimenez-Conde, Carolina Soriano-Tarraga, Eva Giralt-Steinhauer, Marina Mola, Rosa Vivanco-Hidalgo, Angel Ois, Ana Rodriguez-Campello, Elisa Cuadrado-Godia, JaumeRoquer, Inst Hosp del Mar d'InvestigacióMedica. IMIM, Barcelona, Spain

Disclosure Block:
J. Jimenez-Conde: None.C. Soriano-Tarraga: None.E. Giralt-Steinhauer: None.M. Mola: None.R. Vivanco-Hidalgo: None.A. Ois: None.A. Rodriguez-Campello: None.E. Cuadrado-Godia: None.J. Roquer: None.

Abstract Content

Background: Stroke has a great impact in functional status of patients, although there are substantial interindividual differences in recovery capacity. Apart from stroke severity, age is considered an important predictor of outcome after stroke, but aging is not only due to chronological age. There are age-related DNA-methylation changes in multiple CpG sites across the genome that can be used to estimate the biological age (b-Age), and we seek to analyze the impact of this b-Age in recovery after an ischemic stroke. Methods: We include 600 individuals with acute ischemic stroke assessed in Hospital del Mar (Barcelona). Demographic and clinical data such as chronological age (c-Age), vascular risk factors, NIHSS at admission, recanalization treatment (rtPA or endovascular treatment), previous modified Rankin scale (p-mRS) and 3 months post stroke functional status (3-mRS) were registered. Biological age (b-Age) was estimated with Hannumm algorithm, based on DNA methylation in 71 CpGs. Results: The bivariate analyses for association with 3-mRS showed a significant results of NIHSS, c-Age, b-Age, p-mRS, and current smoking (all with p<0.001). Recanalization treatment showed no significant differences in bivariate analysis. In multivariate ordinal models, b-Age kept its significance (p=0.025) nullifying c-Age (p=0.84). Initial NIHSS, p-mRS and recanalization treatment kept also significant results (p<0.001). Conclusions: Biological Age, estimated by DNA methylation, is an independent predictor of stroke prognosis, irrespective to chronological age. "Healthy aging” affects the capacity of recovering after an ischemic stroke.

Thursday TIP ABSTRACT

Embargoed for 3 p.m. CT/4 p.m. ET – Session P25 – Poster TP165 (Hall E)

Control #: 17-ISC-A-4377-AHA

Benjamin R. Kummer, M.D., Weill Cornell Medical College, New York, N.Y.; (917)328-3765;

Parkinson’s disease may have link to stroke

Session Assignment

P25 - Community/Risk Factors Posters II (Poster: TP165; Speaking Time: 2/23/2017 6:15:00 PM - 2/23/2017 6:45:00 PM)

Title

Associations between Parkinson Disease and Stroke

Author Block

Benjamin R Kummer, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Res Inst, Weill Cornell Med and Dept of Biomedical Informatics, Columbia Univ Medical Ctr, New York, NY; Ashley E Aaroe, HoomanKamel, Costantino Iadecola, Babak B Navi, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Res Inst and Dept of Neurology, Weill Cornell Med, New York, NY

Disclosure Block:
B.R. Kummer: None.A.E. Aaroe: None.H. Kamel: None.C. Iadecola: None. B.B. Navi: Research Grant; Modest; NIH grant K23NS091395, Florence Gould Endowment for Discovery in Stroke.

Abstract Content

Introduction Cerebral ischemia and vascular risk factors are associated with the development of Alzheimer disease (AD). While Parkinson disease (PD) is also a common neurodegenerative condition, the relationship between ischemic stroke and PD remains unclear. Some evidence suggests a shared pathogenic pathway between both diseases. Methods We used inpatient and outpatient claims data from 2008-2014 in a 5% sample of Medicare beneficiaries ≥66 years of age. Our variables of interest were: 1) a hospital-based diagnosis of ischemic stroke and 2) an outpatient or hospital-based diagnosis of idiopathic PD. Previously validated ICD-9-CM code algorithms were used to identify all diagnoses. We used Cox proportional hazards modeling to characterize the relationship between ischemic stroke and PD, while adjusting for demographics and vascular risk factors. We assessed both the association between PD and subsequent stroke, as well as stroke and subsequent PD. In a separate but identically designed set of analyses, we characterized the relationship between ischemic stroke and AD as a point of comparison. Results Our analysis encompassed nearly 1.6 million patients with a mean age of 73(+/- 8) years, of whom 57% were female. The annual incidence of ischemic stroke was 1.75% (95% confidence interval [CI], 1.67-1.85%) after a diagnosis of PD versus 0.96% (95% CI, 0.96-0.97%) in those without PD (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.19-1.32). In contrast, the annual incidence of ischemic stroke was 1.96% (95% CI, 1.89-2.03%) after a diagnosis of AD versus 0.96% (95% CI, 0.96-0.97%) in those without AD (aHR, 0.98; 95% CI, 0.95-1.02). The annual incidence of PD was 0.97% (95% CI, 0.92-1.03%) after ischemic stroke versus 0.39% (95% CI, 0.38-0.39%) in those without ischemic stroke (aHR, 1.62; 95% CI, 1.53-1.72). In contrast, the annual incidence of AD was 3.66% (95% CI, 3.56-3.78%) after a diagnosis of ischemic stroke versus 1.17% (95% CI, 1.16-1.17%) in those without ischemic stroke (aHR, 1.67; 95% CI, 1.61-1.72). Conclusions Among Medicare beneficiaries, the relationships between stroke and PD were similar to those between stroke and AD. As in AD, a link may exist between cerebrovascular disease and PD.

Thursday TIP ABSTRACT

Embargoed for 2:30 p.m. CT/3:30 p.m. ET – Session A25 – Poster TP183 (Hall E)

Control #: 17-ISC-A-4270-AHA

Lakshmi Warrior, M.D., John H. Stroger Hospital of Cook County, Chicago, Illinois may be reached through Alexandra Normington, Director of Media at Cook County Health & Hospitals System at (312) 864-4783 or .

Biological, not chronological age, better predictor of stroke recovery

Session Assignment

P25 - Community/Risk Factors Posters II(Poster TP183; Speaking Time: 2/23/2017 6:15:00 PM - 2/23/2017 6:45:00 PM)

Title

Food Insecurity Screening in Stroke Patients

Author Block

Lakshmi Warrior, Michael Kelly, Kathy Chan, John H. Stroger Hosp of Cook County, Chicago, IL

Disclosure Block:
L. Warrior: None.M. Kelly: None.K. Chan: None.

Abstract Content

Introduction: Food insecurity refers to a state of being without reliable access to sufficient quantity of affordable, nutritious food. Food insecurity is gaining recognition as a risk factor for uncontrolled hypertension and diabetes and possibly for stroke. Our hospital serves a population of uninsured and underinsured patients. We sought to determine the prevalence of food insecurity in our population of patients recently discharged from the hospital with stroke. Methods: Patients recently discharged from the hospital with stroke were screened for food insecurity in the neurology stroke clinic from March 23, 2016 to July 28, 2016. Food insecurity screening consisted of validated, two question screening tool. Electronic medical records were reviewed of patients who were screened. Information regarding insurance, zip code, reason for neurology consult, history of hypertension, history of diabetes, history of stroke and BMI were abstracted. Results: A total of 216 neurology patients were screened. Forty-nine patients (22.7%) were identified as food insecure. Sixty-four patients presented to the neurology clinic for diagnosis of stroke. Twelve of these (18.8%) were found to be food insecure. In this food insecure stroke group, 11/12 (84.6%) were diagnosed with hypertension, 7/12 (58.3%) had diabetes, and 2/12 (16.7%) had previous diagnosis of stroke. In the food secure stroke group, 35/52 (67.3%) had diagnosis of hypertension, 15/52 (28.8%) had diagnosis of diabetes, and 11/52 (21.2%) had previous diagnosis of stroke. Conclusions: Food insecurity is a prevalent issue in our patient population. Food insecurity may lead to an increased risk of stroke risk factors such as diabetes and hypertension and complicate their management. Understanding the magnitude of the problem may allow considered interventions.

Control #: 17-ISC-A-2848-AHA

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP14 – Poster TMP49 (Hall E)

David L. Roth, Ph.D., Johns Hopkins University, Baltimore, Maryland; (410) 955-0491; .

Symptoms of depression in stroke survivors may predict caregiver depression

Session Assignment

MP14 - Clinical Rehabilitation and Recovery Moderated Poster Tour(Poster: TMP49; Speaking Time: 2/23/2017 6:10:00 PM - 2/23/2017 6:15:00 PM)

Title

Depressive Symptoms after Stroke are Linked Longitudinally between Stroke Survivors and Their Family Caregivers

Author Block

David L. Roth, Orla C. Sheehan, Jin Huang, Johns Hopkins Univ, Baltimore, MD; J. David Rhodes, Suzanne E. Judd, Univ of Alabama at Birmingham, Birmingham, AL; William E. Haley, Univ of South Florida, Tampa, FL

Disclosure Block:
D.L. Roth: None.O.C. Sheehan: None.J. Huang: None.J.D. Rhodes: None.S.E. Judd: None.W.E. Haley: None.

Abstract Content

Background: Multiple previous investigations have documented persistent elevations in depressive symptoms after stroke for stroke survivors and for family caregivers. However, relatively few studies have examined both groups simultaneously, and none have tested for possible predictive linkages in longitudinal analyses.
Methods: We collected interview data from 248 stroke survivors and their primary family caregivers who were enrolled in the Caring for Adults Recovering from the Effects of Stroke (CARES) project. CARES is an ancillary study to the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke survivors and caregivers were interviewed at 9-, 18-, 27- and 36-months after an adjudicated stroke event. Measures administered to both groups included the 20-item Center for Epidemiological Studies Depression Scale (CESD) and the 12-item Short Form Health Survey (SF-12) of health-related quality of life. Cross-lagged panel analyses were used to investigate linkages between stroke survivors and caregivers over time on these measures.
Results: Clinically significant levels of depressive symptoms, as defined by a score of 16 or more on the CESD, were found for 17.0% of the stroke survivors and 13.7% of the caregivers at 9-months after stroke. Longitudinal models revealed that high stroke survivor depressive symptoms at 9-months post-stroke predicted increases in caregiver depressive symptoms at 18-months post-stroke (standardized adjusted regression coefficient = 0.18, p = 0.003). No longitudinal predictive effects were found for caregiver depressive symptoms on stroke survivor outcomes or for the SF-12 measures.
Conclusions: Clinically significant levels of depressive symptoms were relatively rare 9-months after stroke in this population-based sample of stroke survivors and family caregivers. Stroke survivor depressive symptoms longitudinally predict caregiver depressive symptoms, but caregiver well-being was not found to longitudinally predict stroke survivor depression or quality of life. Treating elevated depressive symptoms in stroke survivors may also improve caregiver well-being.

Control #: 17-ISC-A-3665-AHA

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP18 – Poster TMP88 (Hall E)

Archit Bhatt, M.D., M.P.H., Providence Brain and Spine Institute, Portland, Oregan; (503) 216-1150; .

Men more likely than women to get “ultrafast” stroke treatment

Session Assignment

MP18 - In-hospital Treatment & Vascular Cognitive Impairment Moderated Poster Tour(Poster TMP88; Speaking Time: 2/23/2017 5:25:00 PM - 2/23/2017 5:30:00 PM)

Title

Male Gender Predicts Ultrafast Administration of Intravenous Tissue Plasminogen Activator in a Twenty-Six Hospital Network

Author Block

Archit Bhatt, Lindsay Lucas, Elizabeth Baraban, Providence Brain and Spine Inst, Portland, OR

Disclosure Block:
A. Bhatt: None.L. Lucas: None.E. Baraban: None.

Abstract Content

Background: The benefits of intravenous tissue-type plasminogen activator (IV-Alteplase) in acute ischemic stroke (AIS) are time dependent. Current guidelines recommend a 60-minute door-to-needle (DTN) time for IV-Alteplase. Moreover, for every 15-minute reduction in treatment time, clinical outcomes are improved by an estimated 4%. In this study, we identified characteristics of patients with DTN times less than 30 minutes (i.e. “ultrafast DTN”). Methods: Data obtained from the 26-hospital Providence Health and Services Get With the Guidelines stroke registry were used to identify patients with ultrafast DTN. IV-Alteplase-treated AIS patients over age 18 who were discharged from the hospital between 2009 and 2015 were included. A mixed effects logistic regression model with backwards elimination was used to identify which of the following variables were significant in predicting ultrafast DTN: year of discharge, age, gender, NIHSS score, weekend or evening admission, telestroke usage, hospital arrival time, mode of arrival (EMS vs private car), medical history of dyslipidemia, diabetes, atrial fibrillation, or hypertension, consult with a stroke neurologist, and the certification of the hospital. Parametric bootstrapped p-values, mean estimates and percentile confidence intervals were calculated. Results: We identified 2,695 AIS patients who received IV-Alteplase between 2009 and 2015. Of those, only 108 (3.9%) had ultrafast DTN times. In the final bootstrap analysis, ultrafast DTN patients were more likely to be male (adjusted odds ratio (AOR) = 2.23; p<.001), ambulance arrivals (AOR = 4.76; p<.001), weekday arrivals (AOR = 1.89; p<.001), more severe cases (AOR per NIHSS point = 1.03; p=0.04), and more recently discharged (AOR per year = 1.34; p<.001). Conclusion: In our large hospital network, we found that only a small proportion of AIS patients received ultrafast Alteplase administration, with males twice as likely as females to receive treatment in less than 30 minutes. This study highlights the necessity to further understand the role gender plays in treatment-related decisions.