Ideal Cardiovascular Health Metrics Are Associated with Disability Independently of Vascular Conditions.

BACKGROUND:Vascular risk factors may be associated with disability independently of vascular events. We examined whether the American Heart Association's 7 ideal cardiovascular health (CVH) metrics were independently associated with disability in a nationally representative cohort. METHODS:Adults age ≥20 years from the National Health and Nutrition Examination Survey 2005-2012 were included. Ideal CVH was calculated as a composite of 7 measures, each scored 0-2. Primary predictors were number of ideal CVH metrics and score of CVH metrics. The outcome was a dichotomous score from 20 activities of daily living (ADL) and instrumental ADLs. Unadjusted and adjusted weighted logistic models estimated associations between ideal CVH and disability. The data were analyzed in 2015. RESULTS:Among 22692 participants, mean age was 46.9 years. Cardiac disease and stroke were present in 6.6% and 2.8%; 90.3% had poor physical activity and 89.9% poor diet. Among 3975 individuals with full CVH data, in fully adjusted models, OR for disability was 0.90 (95% CI 0.83-0.98) per point increase in ideal CVH score, and 0.84 (0.73-0.97) per additional number of ideal CVH metrics. CONCLUSIONS:CVH metrics were strongly and significantly associated with reduced odds of disability independently of vascular and non-vascular conditions. Poorer CVH may cause subclinical vascular disease resulting in disability

Baseline demographics of study population^*.

<p>Baseline demographics of study population^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150282#t002fn001" target="_blank">*</a>}.</p

The association between ideal cardiovascular indicators and disability in unadjusted and adjusted models^†.

<p>The association between ideal cardiovascular indicators and disability in unadjusted and adjusted models<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150282#t003fn001" target="_blank">^†</a>.</p

Definitions of the 7 ideal cardiovascular health factors.

<p>Definitions of the 7 ideal cardiovascular health factors.</p

Interactions between ideal cardiovascular health indicators and covariates^*.

<p>Interactions between ideal cardiovascular health indicators and covariates^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150282#t004fn002" target="_blank">*</a>}.</p

Abstract Number: LBA4 Platelet Function Testing and Acute Thrombotic Events in Intracranial Aneurysm Patients Undergoing Flow Diversion

Introduction Introduction The role of platelet function testing in patients with intracranial aneurysms undergoing flow diversion remains controversial with limited evidence of its influence on thrombotic outcomes. We report an observational cohort analysis evaluating the association of P2Y12 assay testing with thrombotic events in patients undergoing flow diversion. Methods We performed a retrospective review of our prospectively maintained procedural database to identify patients who underwent flow diversion between January 2020 and July 2022. One physician within our practice never performs P2Y12 assay testing. All other physicians utilize P2Y12 assay testing as part of routine practice. These two different patient cohorts were compared. Acute thrombotic events were our primary outcome. Secondary outcomes included delayed intracerebral hemorrhage, intimal hyperplasia without clinical sequalae, and transient neurologic deficits. Results We identified 150 patients who underwent flow diversion at our institution between January 2020 and July 2022. Median age was 59 years old (Interquartile range (IQR) 49–67), with 113 females (82.5%) and 24 males (17.5%). Out of 150 patients, 93 (62.0%) patients were treated by physicians who performed routine pre and postoperative testing of aspirin and Plavix assays, with subsequent adjustment of antithrombotic dosing accordingly, while 57 patients (38.0%) were treated by the single physician who prescribes aspirin and clopidogrel pre‐operatively without testing. In all, seven out of 150 patients (4.7%) had an acute thrombotic event requiring intraarterial anti‐thrombotic infusion or urgent thrombectomy, or both. Of these, six where from the 93 patient testing cohort (6.5%), and one in 57 patients non‐testing cohort (1.8%) (p = 0.2). Patients who had a thrombotic event were more likely to have underlying atrial fibrillation (28.6% vs 4.9%, p = 0.01) but otherwise had similar demographics, vascular risk factors, maximal aneurysmal diameter, and parent vessel diameter (Table 1). In a multivariable analysis adjusting for age, maximal aneurysm diameter, ruptured aneurysms, and atrial fibrillation, P2Y12 sensitivity assay testing was not significantly associated with acute thrombotic events in aneurysm patients undergoing flow diversion (Odds Ratio (OR) = 0.15, 95% Confidence Interval (CI) = 0.01‐2.67), p = 0.2). Secondary outcomes were also comparable between both groups; transient neurologic deficits were noted in 4/93 in the testing group (4.3%), and 6/57 in the non‐testing group (10%) (p = 0.14), intracranial hemorrhage occurred in only 2 patients, both in the testing group (p = 0.3), and mild intimal hyperplasia was observed in 18.3% in the testing group versus 12.3% in the non‐testing group (p = 0.33). Conclusions Platelet function testing showed no significant correlation with thrombotic events or outcomes in our cohort. The role of platelet function testing remains controversial, albeit widely used in patients undergoing flow diversion of intracranial aneurysms

Abstract 058: General anesthesia versus conscious sedation during endovascular thrombectomy for distal vessel occlusions

Introduction Choice of anesthesia for endovascular thrombectomy in large vessel occlusion of the anterior circulation has been well studied, although practice patterns may still be variable. Anesthesia choice for distal vessel occlusions (DVO) presents unique challenges, however. General anesthesia (GA) may offer advantages over conscious sedation (CS) due to reduced patient movement facilitating catheter navigation, but concerns persist about potential delays and hypotension impacting collateral circulation. In our study, we aim to explore this question further. Methods In our prospectively maintained stroke registry from December 2014 to July 2023, we identified patients with DMVO defined as M2, M3, M4 occlusion, ACA occlusion, and PCA occlusion, who underwent MT for AIS. We compared patients who received CS to those who GA. Our primary outcome measures were length of procedure defined as time from entering angiography suite until final recanalization, access time to recanalization, CS to GA conversion rate, number of passes to reach TICI2b or better and first pass effect. Our secondary outcomes were length of stay, and modified Rankin Scale (mRS) at 5 days, 30 days, and 90 days. Results Total of 290 patients with DVO were identified, the median age was 73 (IQR 19). Of these, 86 patients (29.7%) underwent GA, and 200 (69.0%) received CS. CS to GA conversion was required in 36 patients (12.4%). Females accounted for 47.5% of the CS group and 38.4% of the GA group. No significant differences were found between the two groups in the racial and gender composition (p>0.1). The mean admission NIHSS was significantly higher in the GA group (16.86) compared to the CS group (12.44) as was the rate of IV thrombolysis in the CS (36.2%) group compared to GA (31.4%) group (p<0.01). The type of anesthesia used was not influenced by the laterality of the stroke in the middle cerebral artery territory (left vs right) (χ²=0.39, p=0.53). After adjusting for age, sex, IV thrombolysis, and admission NIHSS, CS usage did not result in an increase in procedural time (β=1.3, p=0.83). Furthermore, CS had no significant effect on the total number of passes (β=‐0.15, p=0.53), nor did it influence the likelihood of achieving first‐pass recanalization (β=0.28, p=0.48). No associations were found between CS use and the modified Rankin Scale (mRS) at 5 days (β=0.17, p=0.65), 30 days (β=0.22, p=0.75), or 90 days (β=0.15, p=0.67). Likewise, the length of stay in the hospital (β=1.71, p=0.77) was not significantly affected by the use of CS. Conclusion In our analysis of DMVO, the use of CS during thrombectomy appeared to be safe and feasible and comparable to GA with regards to procedural length, number of passes, and rate of first pass recanalization. Similarly, the type of anesthesia did not have an impact on clinical outcome. Further studies are needed to build on these findings and inform optimal management strategies

Abstract 232: Endovascular Thrombectomy for Distal Vessel Occlusions in Early vs Extended Time Window

Introduction There has been a growing body of literature in recent years suggesting the safety and efficacy of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) from distal vessel occlusion (DVO). Limited data is available regarding the risks and benefits of EVT in this patient population, especially when comparing the early window (6 hours from LKW) to the extended window (6‐24 hours from LKW). We aim to study this further. Methods We queried our stroke registry, a prospectively maintained database of AIS patients who presented from December 2014 to July 2023, and isolated patients with DVO who underwent EVT. DVO was defined as M2, M3, M4 occlusion, ACA occlusion, and/or PCA occlusion. We then further subdivided this into two groups, patients within the early window, and patients within the extended window. We compared characteristics between these groups using univariate analysis. We additionally performed a multivariable logistic regression analysis adjusted for Alberta Stroke Program Early CT Score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS) score, age, sex, and use of intravenous (IV) thrombolysis to investigate whether or not extended window thrombectomy was associated with worse outcome. Our primary outcomes were modified Rankin Score (mRS) at discharge and at 90 days. Results Total of 290 patients had DVO and underwent EVT. Of these, 214 had all relevant data. 147 (68.7%) underwent EVT in the early window and 67 (31.3%) received EVT in the extended window. Mean age was 72.3 (±14.4). There were more women in the extended window 51.5% vs 44.8% (χ² = 20.57, p‐value < 0.001). No significant difference was observed in the average NIHSS between early (13.7) and extended (13.9) windows (t=‐0.44, p=0.66). Similarly, the median ASPECTS score was comparable between early (9.3) and extended (9.0) windows (t=1.41, p=0.16). As expected, there was a striking difference seen in patients receiving IV thrombolysis between early (54.5%) and extended (4.5%) windows (χ²=48.48, p<0.001). Post‐operative hematoma also was not different between the early (23.8%) and extended (14.9%) windows (χ² = 0.69, p‐value = 0.40). Symptomatic intracerebral hemorrhage (SICH) was only seen in 3.4% of patient in the early window and 2.9% of patients in extended window. No significant difference was found in the mRS at discharge (early: 3.1, extended: 3.4, t=‐0.90, p=0.37) or at 90 days (early: 3.1, extended: 3.5, t=‐1.08, p=0.29). Additionally, in our multivariable logistic regression model, receiving EVT in the extended window didn't significantly affect the discharge mRS (β=0.10, p=0.27) or the 90 day mRS (β=‐0.15, p=0.38). In this model, increasing age, lower ASPECTS score, and higher admission NIHSS predicted a higher discharge mRS, while IV thrombolysis was linked to a lower discharge mRS. Higher admission NIHSS was associated with a higher mRS at both discharge and 90 days. Conclusion In our study, outcome of EVT in the extended time window in patients with DVO was comparable to EVT outcome in early window, with no increased hemorrhagic complications. More studies are required to further understand the risks and benefits of EVT in patients with DVO strok