CONNECT: Coordinating Options for Neurovascular Patients Needing Electrophysiology Consults and Treatments.

Background And Purpose: Though Event Monitors (EM) and Implantable Loop Recorders (ILR) are prevalent in stroke workups, complex processes to obtain placement of these device might result in delays. Our aim was to determine if the CONNECT (Coordinating Options for Neurovascular patients Needing Electrophysiology Consults and Treatments) pathway could improve Stroke-to-Electrophysiology (EP) communications, increase EM and ILR device placements prior to discharge, shorten placement time, and preserve satisfaction.

Methods: We assessed device placements when an EP consult was obtained [Pre-CONNECT (5/1/21-4/30/22), CONNECT (5/1/22-4/30/23)] for patients with stroke.

Holo-Stroke: Assessing for Immersive Stroke Care Through Stroke Hologram Teleportation.

Augmented reality enables the wearer to see both their physical environment and virtual objects. Holograms could allow 3D video of providers to be transmitted to distant sites, allowing patients to interact with virtual providers as if they are in the same physical space. Our aim was to determine if Tele-Stroke augmented with Holo-Stroke, compared with Tele-Stroke alone, could improve satisfaction and perception of immersion for the patient.

INTERP: Interpreter requirements needed for tissue plasminogen activator evaluations and resulting performance: a retrospective review.

Aim: To examine the influence of interpreter service needs (IS) on rt-PA administration time metrics.

Methods: Retrospectively reviewed prospectively collected data from Comprehensive Stroke Center database (January 2011- April 1, 2021) and EMR.

Inclusion: Subjects for whom a "stroke code" was activated.

Multicenter comparison using two AI stroke CT perfusion software packages for determining thrombectomy eligibility.

Background: Stroke AI platforms assess infarcted core and potentially salvageable tissue (penumbra) to identify patients suitable for mechanical thrombectomy. Few studies have compared outputs of these platforms, and none have been multicenter or considered NIHSS or scanner/protocol differences. Our objective was to compare volume estimates and thrombectomy eligibility from two widely used CT perfusion (CTP) packages, Viz.

(VISIION-S): Viz.ai Implementation of Stroke augmented Intelligence and communications platform to improve Indicators and Outcomes for a comprehensive stroke center and Network - Sustainability.

Objectives: As Comprehensive Stroke Centers (CSCs) strive to improve neuro-intervention (NIR) times, process improvements are put in place to streamline workflows. Our prior publication (VISIION) demonstrated improvements in key performance indicators (KPIs). The purpose VISIION-S was to analyze whether those results were sustainable.

Encephalopathy only stroke codes (EoSC) do not result in rt-PA treatments.

Background: Isolated mental status changes as a presenting sign (EoSC+), are not uncommon stroke code triggers. As stroke alerts, they still require the same intensive resources be applied. We previously showed that EoSC+ strokes (EoSC+ Stroke+) account for 0.

Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Background And Purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.

RAcial Disparities in Ich after IV-tPA and Neurointerventional Treatment (RADIANT).

Objective: To study the rate of symptomatic intracerebral hemorrhage (SxICH) and major systemic hemorrhage (MSH) after acute stroke treatments among different ethnicities/races.

Background: Studies have reported ethnic/racial disparities in intravenous tPA treatment (IV tPA). The adverse outcome of tPA and/or intra-arterial intervention (IA) among different ethnicities/races requires investigation.

Novel Definition of Stroke "Good Responders" Predicts 90-Day Outcome after Thrombolysis.

Introduction: Identifying predictors of good response in thrombolytic-treated stroke is important to clinical care, resource allocation, and research design. We developed a simple, novel measure of "Good Responders" to assess if 2 short-term variables could predict 90-day outcomes after thrombolysis in stroke.

Methods: Intravenous thrombolysis-treated stroke cases from June 2004 to June 2018 were analyzed from a stroke registry.

Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke.

Background: We investigated patterns in the time from recombinant tissue-type plasminogen activator (rt-PA) treatment to symptomatic intracranial hemorrhage (sICH) onset in acute ischemic stroke.

Methods: We retrospectively reviewed all admitted "stroke code" patients from 2003 to 2017 at the University of California San Diego Medical Center from a prospective stroke registry. We selected patients that received IV rt-PA within 4.

Mapping a Reliable Stroke Onset Time Course Using Signal Intensity on DWI Scans.

Background And Purpose: Identifying a last known well (LKW) time surrogate for acute stroke is vital to increase stroke treatment. Diffusion-weighted imaging (DWI) signal intensity initially increases from onset of stroke but mapping a reliable time course to the signal intensity has not been demonstrated.

Methods: We retrospectively reviewed stroke code patients between 1/2016 and 6/2017 from the prospective; Institutional review board (IRB) approved University of California San Diego Stroke Registry.

"Encephalopathy Only Stroke Codes" (EoSC) Rarely Result in Stroke as Final Diagnosis.

Stroke codes prompted by isolated encephalopathy often result in nonstroke final diagnoses but require intensive stroke center resources. We assessed the likelihood of "Encephalopathy only Stroke Codes (EoSC)" resulting in a true stroke (EoSC CVA+) final diagnosis. 3860 patients were analyzed in a prospective stroke code registry from 2004 to 2016.

Isolated Anisocoria as a Presenting Stroke Code Symptom is Unlikely to Result in Alteplase Administration.

Background: Acute stroke codes may be activated for anisocoria, but how often these codes lead to a final stroke diagnosis or alteplase treatment is unknown. The purpose of this study was to assess the frequency of anisocoria in stroke codes that ultimately resulted in alteplase administration.

Methods: We retrospectively assessed consecutive alteplase-treated patients from a prospectively-collected stroke registry between February 2015 and July 2018.

The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics.

Introduction: Rapid imaging in acute stroke is critical and often occurs before full examination. Early, reliable examination findings clarify diagnosis and improve treatment times. The DeyeCOM sign has been described as a predictor of ischemic stroke.

Accuracy of Stroke Diagnosis in Telestroke-Guided Tissue Plasminogen Activator Patients.

Objectives: The objective of the study is to assess the accuracy of final diagnosis in telestroke-guided tissue plasminogen activator (rt-PA) patients compared with bedside evaluation using computed tomography (CT) or magnetic resonance imaging (MRI) as a surrogate for final stroke diagnosis. The overall goal was to determine if telestroke had similar diagnostic accuracy as bedside evaluations in diagnosing rt-PA-treated patients.

Materials And Methods: We analyzed all acute stroke code calls who received intravenous rt-PA at our center from October 2013 to June 2015.

Visual Determination of Conjugate Eye Deviation on Computed Tomography Scan Predicts Diagnosis of Stroke Code Patients.

Background: Head computed tomography (CT) is critical for stroke code evaluations and often happens prior to completion of the neurological exam. Eye deviation on neuroimaging (DeyeCOM sign) has utility for predicting stroke diagnosis and correlates with National Institutes of Health Stroke Scale (NIHSS) gaze score. We further assessed the utility of the DeyeCOM sign, without complex caliper-based eye deviation calculations, but simply with a visual determination method.

Dose-finding study of phototherapy on stroke outcome in a rabbit model of ischemic stroke.

Goal: While transcranial laser therapy (TLT) has been shown to improve clinical outcome in a preclinical model of ischemic stroke, optimal timing and dosing has yet to be tested adequately. The purpose of this study was to assess clinical stroke outcome in the Rabbit Small Clot Embolic Model (RSCEM) with dose escalating TLT.

Methods: We utilized the rabbit small clot embolic stroke model (RSCEM) using dose-escalating regimens.

Defining mild stroke: outcomes analysis of treated and untreated mild stroke patients.

Background: Mild deficit is a relative contraindication to administration of intravenous recombinant tissue plasminogen activator (IV rtPA) for acute ischemic stroke. However, what constitutes "mild" deficit is vague. Prior studies showed patients with mild strokes have substantial disability rates at hospital discharge and at 90 days.

The "DeyeCOM Sign": Predictive Value in Acute Stroke Code Evaluations.

Background: Rapid diagnosis in stroke is critical. Computed tomography is often performed initially, even before a neurologic examination. Gaze deviation has been correlated with stroke diagnosis in some cohorts.

Association of Hispanic ethnicity with acute ischemic stroke care processes and outcomes.

Background: Few studies have examined the actual hospital arrival mode, emergency department (ED) care processes, and early outcomes in Hispanic vs non-Hispanic acute ischemic stroke (AIS) patients. We evaluated processes and prognosis by Hispanic ethnicity among AIS patients encountered in urban setting.

Methods: We retrospectively reviewed prospectively-collected data on 1,117 AIS patients presenting within 12 hours of ictus to five hospitals in a tertiary-level stroke center network in San Diego, California.

Is the ICH score a valid predictor of mortality in intracerebral hemorrhage?

Purpose: The intracerebral hemorrhage (ICH) score utilizes a 0- to 6-point scoring system to predict 30-day mortality in ICH patients. The purpose of this analysis was to (a) validate the ICH score in an international, heterogeneous population of ICH patients; and (b) assess the usefulness of a 72-h ICH score.

Data Sources: Analyses were based on data from 399 patients in the Novo Nordisk trial F7ICH-1371.

rLOAD: does sex mediate the effect of acute antiplatelet loading on stroke outcome.

Background: Biologic sex can influence response to pharmacologic therapy. The purpose of this proof-of-concept study was to evaluate the medicating effects of estrogen in the efficacy of acute antiplatelet loading therapy on stroke outcome in the rabbit small clot embolic model.

Methods: Female and male (20/group) New Zealand White rabbits were embolized to produce embolic stroke by injecting small blood clots into the middle cerebral artery via an internal carotid artery catheter.

Does symptom onset to primary stroke center time goals affect stroke outcome?

Background: Treating acute ischemic stroke (AIS) within 4.5 hours and door-to-needle time of less than 60 minutes may optimize recovery. It is unknown if onset to Primary Stroke Center (PSC) time goals affect outcome.

Antiplatelet loading improves behavioral outcome in a rabbit model of stroke.

Background And Purpose: No approved acute therapy exists for thousands of patients with ischemic stroke who present ineligible for thrombolytics. The purpose of this proof-of-concept study was to evaluate the efficacy of acute antiplatelet loading on stroke outcome in the rabbit small clot embolic model.

Methods: Sixty male New Zealand white rabbits were embolized via small clots into the middle cerebral artery.

Vision performance with a contact lens designed to slow myopia progression.

Purpose: Recent research suggests multizone/dual-focus (DF) lens corrections may aid in controlling the progression of myopia. Recently, such a soft contact lens has become commercially available in Hong Kong (MiSight, CooperVision). The purpose of the current study was to evaluate the visual acceptability of this new lens design.