Abstract Number ‐ 199: Acute Treatment of Aneurysmal Subarachnoid Patients with Flowdiversion: A Single Center Real World Experience

Introduction Subarachnoid hemorrhage patients presenting with complex morphology, and those with dissecting /fusiform aneurysms, blister aneurysms have historically posed a challenge for acute endovascular treatment. Flow diversion as a treatment for ruptured intracranial aneurysms is a last resort given the need for dual antiplatelet therapy in the acute setting. Methods We present our single center experience, real world experience in the acute treatment of patients with subarachnoid hemorrhage with pipeline flow diversion device. Results 6 patients presented acutely with a subarachnoid hemorrhage. Two of those had saccular intracranial aneurysms, 1 with a blister aneurysm, and 3 with dissecting aneurysms. 1 patient presented with a ruptured anterior choroidal artery location dissecting aneurysm, 1 with PCA blister aneurysm, 1 with intradural vertebral artery dissecting aneurysm, 1 saccular posterior communicating artery aneurysm, and another with a ruptured complex morphology anterior choroidal artery aneurysm, and 1 with dissecting PCA aneurysm. All patients were emergently loaded with dual antiplatelet therapy consisting of either aspirin and clopidogrel, or aspirin and ticagrelor or pletal and ticagrelor. 1 patient was treated with surface modified pipeline device with shield technology. Technical success was achieved in 100% of these patients. No acute in stent thrombosis was seen in this cohort. Four patients had no residual filling or recurrence at the 1st follow‐up at a median interval of 2–12 months. 1 patient died from fulminant vaso spasm. Follow‐up is pending in 1 patient. Conclusions In carefully selected patients, flow diversion in the acute setting is tolerated and can be an alternative treatment strategy with an acceptable safety profile

Infectious Burden and Risk of Stroke: The Northern Manhattan Study

BACKGROUND: Common infections may be associated with stroke risk, though no single infection is likely a major independent predictor. OBJECTIVE: To determine the association between a composite measure of serologies to common infections (Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, Herpes Simplex Virus 1 and 2) and stroke risk in a prospective cohort study. DESIGN: Prospective cohort followed longitudinally for median 8 years. PATIENTS: Randomly selected stroke-free participants from a multiethnic urban community. SETTING: Northern Manhattan Study (NOMAS). MAIN OUTCOME MEASURE: Incident stroke and other vascular events. RESULTS: All five infectious serologies were available from baseline samples in 1625 participants (mean age 68.5 ± 10.1 years; 64.9% women). Cox proportional hazards models were used to estimate associations of each positive serology with stroke. Individual parameter estimates were then combined into a weighted index of infectious burden (IB) and used to calculate hazard ratios and confidence intervals (HR, 95% CI) for association with risk of stroke and other outcomes, adjusted for risk factors. Each individual infection was positively though not significantly associated with stroke risk after adjusting for other risk factors. The IB index was associated with an increased risk of all strokes (adjusted HR per standard deviation 1.39, 95% CI 1.02–1.90) after adjusting for demographics and risk factors. Results were similar after excluding those with coronary disease (adjusted HR 1.50, 95% CI 1.05–2.13) and adjusting for inflammatory biomarkers. CONCLUSION: A quantitative weighted index of infectious burden was associated with risk of first stroke in this cohort. Future studies are needed to confirm these findings and to further define optimal measures of IB as a stroke risk factor

Abstract Number ‐ 203: #BEFASTChallenge: Social Media Dance Campaign for Stroke Symptoms Awareness

Introduction Public stroke education campaigns have traditionally utilized mass media. We hypothesized that a worldwide stroke awareness social media campaign, utilizing dance videos to express the BE‐FAST acronym for stroke signs and symptoms, could reach a large audience at a low cost. Methods Mission Thrombectomy 2020+ officially launched the #BEFASTChallenge, a Social Media (SoMe) public stroke educational campaign, on May 15, 2022, World Stroke Thrombectomy Day, after an internal “lead‐in” phase starting the first week of May 2022. The campaign was volunteer designed and implemented. The public and their followers were encouraged to post a video of their dance depicting each letter of BE‐FAST, tag the post with #BEFASTChallenge, and nominate others to participate. We tracked the SoMe posts from May 4th through July 13, 2022, on Facebook (FB), Twitter (TW), and Instagram (IG) platforms by searching #BEFASTChallenge on each SoMe site. We ascertained campaign adoption, public reach, and interaction by measuring original posts, views, likes, retweets, shares, and comments. Results There were 4 countries represented in the original posts on SoMe with the vast majority being from the US. The first post was on May 4, and the last was on July 13 (71 days), resulting in a daily average of 0.55 posts. The largest number of posts occurred on the launch date (16 posts). There were 39 original posts, which accumulated 170 retweets, 44 quote tweets, 755 likes, 32 comments, and 14 shares. The videos had 13,821views (Table 1). Conclusions We report that the preliminary analysis of a volunteer‐driven SoMe public stroke campaign utilizing dance to express stroke symptoms demonstrates feasibility, reaching a modest audience directly with good interaction. A similar professionally implemented SoMe campaign could lead to increased and more sustained user engagement to raise public stroke symptom awareness

Abstract Number ‐ 203: #BEFASTChallenge: Social Media Dance Campaign for Stroke Symptoms Awareness

Introduction Public stroke education campaigns have traditionally utilized mass media. We hypothesized that a worldwide stroke awareness social media campaign, utilizing dance videos to express the BE‐FAST acronym for stroke signs and symptoms, could reach a large audience at a low cost. Methods Mission Thrombectomy 2020+ officially launched the #BEFASTChallenge, a Social Media (SoMe) public stroke educational campaign, on May 15, 2022, World Stroke Thrombectomy Day, after an internal “lead‐in” phase starting the first week of May 2022. The campaign was volunteer designed and implemented. The public and their followers were encouraged to post a video of their dance depicting each letter of BE‐FAST, tag the post with #BEFASTChallenge, and nominate others to participate. We tracked the SoMe posts from May 4th through July 13, 2022, on Facebook (FB), Twitter (TW), and Instagram (IG) platforms by searching #BEFASTChallenge on each SoMe site. We ascertained campaign adoption, public reach, and interaction by measuring original posts, views, likes, retweets, shares, and comments. Results There were 4 countries represented in the original posts on SoMe with the vast majority being from the US. The first post was on May 4, and the last was on July 13 (71 days), resulting in a daily average of 0.55 posts. The largest number of posts occurred on the launch date (16 posts). There were 39 original posts, which accumulated 170 retweets, 44 quote tweets, 755 likes, 32 comments, and 14 shares. The videos had 13,821views (Table 1). Conclusions We report that the preliminary analysis of a volunteer‐driven SoMe public stroke campaign utilizing dance to express stroke symptoms demonstrates feasibility, reaching a modest audience directly with good interaction. A similar professionally implemented SoMe campaign could lead to increased and more sustained user engagement to raise public stroke symptom awareness

Global impact of COVID-19 on stroke care

BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.status: publishe

Global impact of COVID-19 on stroke care.

BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p \u3c 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes

Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Background: Prior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (-6.4% (95% CI -7.0% to -5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: -5% (95% CI -5.9% to -4.3%), p=0.06; moderate: -8.3% (95% CI -10.2% to -6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. 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% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION There was a global decline and shift to lower volume centers of stroke admission volumes, 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. TRIAL REGISTRATION INFORMATION This study is registered under NCT04934020