{
  "abstract": "Background Ischemic stroke comprises about 87% of all stroke cases in the US. 20% of these have a cardioembolic (CE) etiology, and 25% are still considered embolic strokes of undetermined sources (ESUS). ESUS strokes are associated with worse functional outcomes and survival rates, underscoring the need for understanding the clinical differences in stroke etiology.Methods We analyzed the Investigation of Clot in Ischemic Stroke and Hematoma Evacuation (INSIGHT) registry, which includes n=388 patients with ischemic stroke, 208 (53.6%) of whom had a CE stroke etiology. Of those with a CE etiology, 142 (68.3%) had an atrial fibrillation (AFIB) stroke etiology. We analyzed 123 data features, spanning across domains including demographics, past medical history, baseline blood lab values, intraoperative data, and thrombus characteristics. We found mean differences and correlations of features with stroke etiology, univariate analyses, and LASSO machine learning models to predict etiology.Results We found several novel associations between clinical variables and stroke etiology. Higher baseline prothrombin time and INR (only among patients not on anticoagulants), baseline use of antiarrhythmics and antihypertensives, and a higher baseline mRS were associated with an increased risk of both overall CE and AFIB-specific etiologies. A higher baseline platelet and RBC count was associated with a decreased risk of AFIB stroke etiology. All of these results were significant ( p < 0.05) across multiple analysis methods (figure 1). Additionally, thrombus weight and volume were negatively correlated with baseline statin use. Baseline BNP level was positively correlated with thrombus fibrin composition but negatively correlated with platelet composition (p < 0.05) (figure 2). Lastly, our LASSO models predicted CE and AFIB-specific etiologies with an AUC of 0.62 and 0.58, respectively.Conclusions Our results both discover novel associations and confirm existing knowledge about the relationship between patient characteristics and stroke etiology.Disclosures G. Branscom: None. C. Seah: None. T. Som: None. J. Vicari: None. A. Dabney: None. S. Baltan: None. F. Sohrabji: None. K. Pennypacker: None. K. Woodward: None. B. Rapoport: 4; C; Precision Neuroscience Corporation. S. Schulman: 2; C; Penumbra Scientific Advisory Board.Abstract O-002 Figure 1Correlations between quantitative features and stroke etiology1.Pearson correlations and corresponding p-values for all quantitative features vs CE stroke etiology.1.Pearson correlations and corresponding p-values for all quantitative features vs AFIB stroke etiologyAbstract O-002 Figure 2Significant correlations between thrombus histological and gross features and all numeric features. Only correlations with p < 0.05 are shown; the blank cells are non-significant. CE: cardioembolic; AFIB: atrial fibrillation; INR: International Normalized Ratio; mRS: Modified Rankin Scale; FPE: first pass effect; MSB: Martius Scarlet Blue; RBC: red blood cell; WBC: white blood cell; INR: International Normalized Ratio; mTICI: Modified Treatment in Cerebral Infarction score; NIHSS: NIH Stroke Scale; BNP: Brain Natriuretic Peptide; GCS: Glasgow Coma Scale",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "G Branscom"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "C Seah"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "T Som"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "J Vicari"
    },
    {
      "affiliations": [
        "Statistics, Texas A&M University, College Station, TX"
      ],
      "name": "A Dabney"
    },
    {
      "affiliations": [
        "Anesthesiology & Perioperative Medicine/Research, Oregon Health & Science University, Portland, OR"
      ],
      "name": "S Baltan"
    },
    {
      "affiliations": [
        "Neuroscience and Experimental Therapeutics, Texas A&M University, Bryan, TX"
      ],
      "name": "F Sohrabji"
    },
    {
      "affiliations": [
        "Neurology, University of Kentucky, Lexington, KY",
        "Center of Advanced Translational Stroke Science, Neurosurgery, and Neuroscience, University of Kentucky, Lexington, KY"
      ],
      "name": "K Pennypacker"
    },
    {
      "affiliations": [
        "Fort Sanders Regional Medical Center, Knoxville, TN"
      ],
      "name": "K Woodward"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "B Rapoport"
    },
    {
      "affiliations": [
        "Hemostasis and Thrombosis, Beth Israel Deaconness Medical Center, Boston, NY"
      ],
      "name": "S Schulman"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Kentucky, Lexington, KY"
      ],
      "name": "J Fraser"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine, New York, NY"
      ],
      "name": "C Kellner"
    }
  ],
  "title": "O-002 Using clinical and thrombus characteristics to predict the etiology of ischemic stroke: an analysis of the INSIGHT registry",
  "uid": "3bc19a62-b5b8-5851-934b-109ebc184ff0"
}