Welcome to the WSC 2022 Interactive Program

Background and Aims

Acute ischemic stroke may be due to embolism from atherosclerotic carotid arteries. DNA of oral and gastrointestinal tract bacteria, mainly viridans streptococci group, have been detected in thrombus aspirates of ischemic stroke patients as well as in carotid endarterectomy samples. Viridans streptococci are known to possess thrombogenic properties. We studied whether the presence of viridans streptococci group bacteria can be confirmed in thrombus aspirates and in carotid artery specimens using bacterial immunohistochemistry.

Methods

Thrombus aspirates from 46 ischemic stroke patients (63.0 % male; mean age, 66.5 years) treated with mechanical thrombectomy as well as 48 carotid artery samples (62.5 % male; mean age, 66.4 years) from Tampere Sudden Death Study (TSDS), representing a cross section from the population, were immunostained with an in-house antibody cocktail against three species of viridans streptococci. Control samples with reference bacteria as well as liver and gut samples from the TSDS cases were stained to show the specificity of the antibody cocktail.

Results

Of the thrombus aspirate samples 39 (84.8 %) were clearly and strongly positive for viridans streptococci group bacteria. Most streptococci were detected inside neutrophil granulocytes, but there were also remnants of bacterial biofilm as well as free bacterial infiltrates in some samples. Of the carotid artery samples considerably less, 8 (16.7 %) were clearly immunopositive.

Conclusions

We confirmed that streptococci can be found in aspirated thrombi of acute ischemic stroke patients as well as in carotid artery samples. Our results suggest that viridans streptococci group bacteria play an important role in the pathogenesis of ischemic stroke.

Background and Aims

The mechanism of stroke caused by atherosclerotic plaque of middle cerebral artery (MCA) was differed according to the pattern of lesion. The aim of this study was to compare the characteristics of wall shear stress (WSS) according to the stroke mechanism in the patients with atherosclerotic plaque of MCA.

Methods

We prospectively recruited consecutive patients with symptomatic and asymptomatic atherosclerosis of the MCA (≥50% diameter stenosis). The mechanism of stroke caused by atherosclerosis of the MCA was determined by a lesion pattern on diffusion-weighted image. The characteristics of the MCA plaque and WSS were measured by high-resolution vessel wall imaging and GT-Flow software. The characteristics of the MCA plaque and WSS were compared among patients with asymptomatic atherosclerosis of the MCA and those with stroke caused by different mechanism.

Results

A total of 110 patients (46 asymptomatic, 32 artery-to-artery embolism, and 32 local branch occlusion) were investigated. Plaque in the distal MCA was more common in the artery-to-artery embolism patients and plaque in the middle MCA was more common in the local branch occlusion patients. Location of plaque enhancement and maximum WSS in the artery-to-artery embolism patients were more prevalent in the upstream point and those in the local branch occlusion patients were more prevalent in minimum lumen area. Elevated variability of maximal WSS was related to the stroke caused by artery-to-artery embolism.

Conclusions

Stroke caused by artery-to-artery embolism are more related to the elevated variability of maximum WSS and are commonly developed at upstream point of plaque.

Background and Aims

Acute stress hyperglycemia increases risks of in-hospital mortality after ischemic stroke, and hyperglycemia is one of the most important factors for intracranial artery stenosis (ICAS). This study evaluated the relationship between stress hyperglycemia ratio (SHR) with and without intracranial atherosclerotic stenosis (ICAS) and the prognosis of patients with minor stroke.

Methods

This is a multicenter retrospective observational cohort study. Patients with imaging of eligible CTA and MRA who had acute minor ischemic stroke were enrolled. SHR was calculated as admission blood glucose (ABG) divided by estimated average glucose (EAG). EAG was estimated with HbA1c: [EAG= (1.59 x HbA1c)-2.59], derived by previous reports.

The primary outcome was stroke recurrence during hospitalization. The interaction of SHR levels with presence of ICAS on the primary outcome was investigated with the use of multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were applied to determine the nonlinear relationship between SHR and primary outcome. A two-piecewise linear regression model was used to define the SHR threshold.

Results

Among 660 participants included, 189 (30.98%) has ICAS. In ICAS patients, each 0.1 unit increase in SHR was associated with a 0.46-fold increase in the risk of recurrence (HR,1.46,95% CI,1.32-1.62, P<0.001). There was a significant interaction between SHR levels and ICAS (p=0.002). The results of sensitive analysis were consistent after adjusting Diabetes Mellitus. In RCS analysis, higher level of SHR was associated with an increased risk of recurrence with a threshold of 0.75.

Conclusions

SHR was significantly associated with higher risk of recurrence of stroke in patients with ICAS.

Background and Aims

Recent trials have failed to show the superiority of direct oral anticoagulant (DOAC) agents over antiplatelet agents in patients with embolic stroke of undetermined source (ESUS). Detecting atrial fibrillation (AF) is crucial to prevent recurrence in ischemic stroke patients. We aimed to examine the relation between left atrial volume index (LAVI) and the global longitudinal peak strain (GLPS) with AF in ischemic stroke patients.

Methods

We prospectively included 678 consecutive patients with ischemic stroke. LAVI and GLPS were assessed using three-dimensional transthoracic echocardiography with speckle-tracking imaging. Logistic regression analysis was used to examine the independent association between LAVI, GLPS, and AF. To evaluate the predictability of LAVI and GLPS for the presence of AF, we used optimism-corrected c-statistics calculated by 100 bootstrap repetitions and the net reclassification improvement (NRI).

Results

The mean patient age was 68 years (mean, standard deviation 13; male, 60%). Patients with AF (18%) were older (75 vs. 66 years, P < 0.001) and had a higher LAVI (42ml/m² vs. 75 ml/m², P < 0.001) and higher GLPS than those without AF (-14.0 vs. -17.3, P < 0.001). For 89 patients classified with ESUS, the ESUS AF group had higher GLPS (n = 12, -15.6 vs. -18.3, respectively; P = 0.002) than the other groups (n = 77). Adding GLPS to age, hypertension and the LAVI significantly improved NRI, with an overall NRI improvement of 6.1 % (P = 0.03).

Conclusions

The LAVI and GLPS with speckle-tracking imaging echocardiography may be helpful in discriminating patients with AF.

Background and Aims

Cerebral arterial stenosis (CAS) is prevalent in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). This study investigated the impact of CAS on stroke recurrence risk in these patients.

Methods

The East-Asian ischemic STroke patients with Atrial Fibrillation cohort enrolled 2287 patients with AIS and AF from 14 stroke centers. In this case-cohort study, we identified 95 patients with recurrent stroke and randomly sampled 114 patients (5%) as a subcohort for comparison. CAS and clinically relevant stenosis were assessed with MR or CT angiography. We assessed total stenosis burden score (TSBS) by adding stenosis scores (1: ≤50%, 2: >50%, 3: occlusion) of 22 intracranial and 4 extracranial segments and categorized into 3 groups (0,1-5,≥6).

Results

The recurrence group was more likely to have CAS (82% vs. 62%, p=0.004), relevant CAS (29% vs. 19%, p=0.008), and TSBS of ≥6 (41% vs. 20%, p=0.0004) than control group. On weighted Cox proportional hazard analysis after adjusting conventional vascular risk factors and anticoagulant use, CAS was associated with an increased risk of recurrence (aHR 3.06, 95% CI [1.52-6.16], p=0.002). The increase in recurrence risk was observed in both relevant (3.37,[1.47-7.76],p=0.004) and irrelevant CAS groups (2.88,[1.37-6.09],p=0.006). There was a dose-response relationship between the recurrence risk and TSBS; TSBS of ≥6 (4.66,[1.99-10.91],p<0.001) showed higher HR than TSBS of 1-5 (2.35,[1.08-5.13],p=0.031).

Conclusions

Our findings suggest that CAS may increase the recurrence risk in AF-AIS patients by almost 3 times or higher, and should be considered for future risk estimation and secondary stroke prevention strategy.

Background and Aims

In recent studies, Intracranial arterial calcification (IAC) is known to be associated with ischemic stroke. IAC is information that can be easily obtained by a non-enhanced brain CT scan during an early stage of stroke. We investigated the relationship between IAC and early neurological deterioration in acute ischemic stroke.

Methods

Consecutive patients with acute cerebral infarction who had been through brain imaging from Jan 2014 to May 2017 were included in the study. For cerebral atherosclerosis, intracranial arterial calcification status at the cavernous portion of the internal carotid artery and cerebral atherosclerosis score as the sum of major cerebral arterial stenosis was measured from brain CT angiography. Early neurological deterioration (END) was defined as an increment change of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥2 points within the first 5 days after admission.

Results

A total of 861 patients were included with 384 female patients (mean age = 71.6 ± 12.8 years). We confirmed that there was a significant difference in having traditional vascular risk factors except for atrial fibrillation, in the severe calcification group (N=238). Multivariable logistic regression analysis revealed that severe calcification of the intracranial artery was independently associated with END (odds ratio = 1.72, confidence interval = 1.11 – 2.67).

Conclusions

Severe calcification of the intracranial artery is independently associated with END. A nonenhanced brain CT scan is a very useful tool for the prediction of early neurological deterioration in acute ischemic stroke.

Background and Aims

Risk factors and causes of acute ischemic stroke (AIS) are more varied in young adults, with around one-third having unknown etiologies. Precise stroke characterisation is important, influencing management and prognostication. We aim to describe stroke subtypes and risk factors in a young adult population in Singapore.

Methods

Consecutive young AIS patients aged 18-50 years admitted to a comprehensive stroke centre from 2020-2021 were included. Stroke workup including neuroimaging and vascular imaging, thrombophilia screening, echocardiogram, transcranial Doppler with bubble study and ambulatory electrocardiogram monitoring were performed at discretion of the treating neurologist. Stroke subtype and risk factors were adjudicated using Trial of Org 10172 in Acute Stroke Treatment (TOAST) and adapted International Pediatric Stroke Study (IPSS) classifications after at least 3-months follow-up, and compared between younger (18-39 years) and older (40-50 years) age groups.

Results

A total of 226 AIS patients were included; mean age 43±5.5 years and 69.9% male (n=158). The most common stroke subtypes were small-vessel disease and undetermined etiology (Figure 1A). A myriad of IPSS risk factors were identified in 93.8% study population (Table 1), and 75.9% patients with TOAST subtype undetermined etiology (Figure 1B). Cardiac disorders, prothrombotic states and arteriopathy were more common in the younger age group (Figures 1B; 28.1% vs. 14.9%, p=0.017; 22.8% vs. 9.2%, p=0.005; 15.8% vs. 5.7%; p=0.021, respectively), while atherosclerosis more prevalent in older age group (67.8% vs. 33.3%; p<0.001).

Conclusions

Young adults have diverse etiologies for AIS, and should be evaluated systematically. Further categorisation into IPSS risk factors may help direct long-term, individualised management.

Background and Aims

Infarct size and location have a critical effect on ischemic stroke classification; studying their role independently of stroke etiology is challenging. We performed a retrospective, hypothesis-generating study assessing risk factor profile and infarct size in single subcortical infarcts.

Methods

We selected consecutive acute ischemic stroke patients, admitted to our Stroke Unit within 2008-2015, with adequate-quality brain MRI-DWI scans showing single subcortical infarction. Vascular territories were evaluated according to Tatu (1996-1998) atlas. Lesion volume was determined via 3D reconstruction of manually segmented MRI-DWI lesion contours. Association with risk factors was assessed with logistic regression models, controlling for stroke etiology (TOAST).

Results

We included 205 patients (72.7% males, median age 70 [IQR: 59–76]) with single acute subcortical infarction, of which: 13 cardioembolic (CE), 18 large-vessel occlusion (LVO), 121 small-vessel occlusion (SVO), 53 cryptogenic. Median infarct volume was 620 mm³ (IQR: 280–1020). Total number of major vascular risk factors in single patients (among hypertension, diabetes, hypercholesterolemia, smoke) decreased with larger infarct volume (-0.23 [CI:-0.46–0.00] for one log (10x) volume increase, p=0.05; Figure 1). Apart from hypertension (OR 1.28 [CI:0.63-2.55]), other risk factors suggested association with smaller infarct size (Figure 2): smoke (OR 0.55 [CI:0.31-0.98]), diabetes (OR 0.71 [CI:0.39-1.26]), hypercholesterolemia (OR 0.75 [CI:0.43-1.29]). Among minor risk factors, ipsilateral non-stenosing carotid plaque was associated with larger infarcts (OR 1.83 [CI:0.97-3.61]), left atrial dilation with smaller lesions (OR 0.46 [CI:0.22-0.96]).

Conclusions

In this exploratory analysis, we found relationships between cerebrovascular risk factors and subcortical single infarct size that may be valuable to refine assessment of the underlying stroke mechanism.

Background and Aims

Post cardiac surgery cerebrovascular event or stroke (CVA) can be a source of significant morbidity. We sought to assess predictive factors of post-operative stroke in cardiac surgery utilising cardiopulmonary bypass (CPB). This was done via a single centre retrospective observational study

Methods

This study is a retrospective observational study. The participants were all patients who underwent cardiac surgery with cardiopulmonary bypass at Liverpool Hospital, NSW from January 2016 to December 2018.

The primary outcome was cerebrovascular accident or stroke (CVA). Univariate and Multivariate analysis via Firth’s Logistic regression with regards to stroke was performed.

Results

A thousand and ninety-two patients in a three-year period were analysed. In this cohort, stroke rate was 3.1%. Via univariate analysis of factors in relation to stroke post cardiopulmonary bypass, recent or past stroke (OR 5.43 vs 2.32), diabetes mellitus (OR 1.92), dialysis dependence (OR 5.67), elective procedures (OR 0.34), aortic procedures (OR 4.02), bypass and cross-clamp time (OR 1.02 & 1.04), post-operative AF (OR 2.28) as well as hypoperfusion times all reached the significance level of P<=0.1 to be included in the multivariate analysis. Multivariate analysis to find independent factors in relation to stroke yielded diabetes mellitus (OR 2.49, p=0.025), Dialysis dependence (OR 3.82, p=0.03), aortic procedures (OR 3.93, p=0.014) and elective procedures (OR 0.24, p=0.026) and independently predictive or protective with regards to post-operative stroke.

Conclusions

Independent predictors of stroke in this single centre cohort included dialysis dependence, diabetes and aortic procedures. Elective procedures were shown to be an independent protective factor.

Background and Aims

. The carotid stenosis is graded based on the degree of narrowing.Carotid near occlusion can be subdivided into Carotid near occlusion with full collapse & with out full collapse.

The reported short term risk of recurrent ipsilateral ischemic stroke among patients with Symptomatic carotid near occlusion varies between 5-43% with a high risk probabaly limited for near occlusion with full collapse , lower for near occlusion with out full collapse.

The aim of this study was to assess the risk of recurrent ipsilateral stroke in patients with symptomatic near occlusion with & with out full collapse

Methods

We consecutively included patients eligible for revascularization with > 70%carotid stenosis (n=300), near occlusion with out full collapse(n=80) and near occlusion with full collapse (n= 54).The primary end point was pre operative recurrent ipsilateral ischemic stroke with in 90 days after the presenting event.

Results

The 90 days risk of recurrent ipsilateral stroke was 15% ( 95 % CI 9-20%among ≥ 70% stenosis, 22%( 95% CI 6-38%) among near occlusion with out full collapse and 30% (95% CI16-44) among near occlusion with full collapse ( p=0.001, log rank test). In multi variate analysis, near occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke( adjusted HR 2.6 , 95 % CI1.3-5.3) and near occlusion with out full collapse tended to have a higher risk (adjusted HR 2.0,95% CI 0.9-4.5)than ≥70% carotid stenosis.

Conclusions

symptomatic carotid near occlusion causes a high short term risk of recurrent ipsilateral stroke, especially near occlusion with full collapse

Background and Aims

Existing studies that directly compared the outcomes of patients with intracranial atherosclerotic disease (ICAD) and extracranial carotid atherosclerotic disease (ECAD) compared only long-term outcomes, with no attention paid to short-term outcomes. Therefore, we aimed to directly compare the 90-day outcomes of patients with ICAD, ECAD, and concurrent ICAD and ECAD (ICAD + ECAD).

Methods

Patients with symptomatic ICAD and/or ECAD were prospectively enrolled between 2016 and 2021. The 90-day outcomes analyzed were death, myocardial infarction (MI), ischemic stroke, and major adverse cardiovascular events (MACE; death, MI, and/or ischemic stroke).

Results

Of 371 patients included in the analysis, 240 (64.7%) patients had ICAD only, 93 (25.0%) patients had ECAD only, and 38 (10.3%) patients had ICAD + ECAD. On multivariate analysis with ICAD as the reference comparator, the risk of 90-day clinical outcomes was highest among patients with ICAD + ECAD, with adjusted hazard ratios of 9.32 (95% CI=1.58, 54.8; p=0.014), 4.54 (95% CI=1.45, 14.2; p=0.006), and 8.52 (95% CI=3.54, 20.5; p<0.001) for 90-day MI, ischemic stroke, and MACE respectively. Among patients with ECAD only, the risks of 90-day MI, ischemic stroke, and MACE were similar, with adjusted hazard ratios of 9.91 (95% CI=2.10, 46.7; p=0.004), 3.98 (95% CI=1.48, 10.7; p=0.006), and 8.09 (95% CI=3.87, 16.9; p<0.001) respectively.

Conclusions

Patients with ICAD + ECAD and ECAD only have a significantly higher risk of 90-day MI, ischemic stroke, and MACE. These patients may benefit from further evaluation of the coronary arteries and more aggressive medical therapy to reduce the risk of ischemic events.

Background and Aims

Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in Asia. Increasing age is thought to relate to ICAD due to increases in vascular risk factors and general atherosclerotic burden, but ICAD is present in a substantial number of younger stroke patients. This study aims to evaluate the difference in risk factors between younger and older patients with symptomatic ICAD.

Methods

In this prospective cohort study, patients presenting with first onset of acute ischemic stroke or transient ischemic attack due to underlying ICAD of at least moderate severity (>50% stenosis) were prospectively recruited. Patients less than 60 years of age were categorised as young. Multivariate logistical regression analysis, adjusted for sex, diabetes mellitus, dyslipidaemia, and smoking status, was performed to identify risk factors independently associated with younger-onset symptomatic ICAD.

Results

A total of 252 ICAD patients were included, where 40.5% (n=102) were below 60 years. Younger ICAD patients had a higher body mass index(BMI), higher estimated glomerular filtration rate(eGFR), and higher triglyceride levels (Table 1). Older ICAD patients had a higher incidence of hypertension, co-morbidity of ischaemic heart disease, and atrial fibrillation. On transcranial doppler evaluation with breath-holding manoeuvre, a larger proportion of younger ICAD patients had an exhausted vasomotor reactivity. In the multivariate analyses, BMI (p-value <0.001), eGFR (p-value <0.001), triglyceride levels (p-value = 0.004), and exhausted vasomotor reactivity (p-value= 0.010) remained independently associated with younger ICAD.

Conclusions

This study shows that younger and older ICAD patients have varying risk factors, highlighting the potential for targeted risk factor management.

Background and Aims

The formation of atherosclerosis often initiates during childhood and adolescence and depends on risk factor exposure. Cardiovascular disease (CVD) is the leading cause of death in metabolic associated fatty liver disease (MAFLD) - the most common liver disease in adolescents. It often remains undetected but would be amenable to treatment including lifestyle interventions. We aimed to assess the association between liver fat content and intima-media thickness of the aorta (aIMT) in adolescents.

Methods

In 485 adolescents from the general population of Tyrol we carefully assessed liver fat content, aIMT and cardiovascular risk factors. Liver fat content was measured by means of the controlled attenuation parameter using FibroScan® and the aIMT was assessed by high-resolution ultrasound. A linear regression model with multivariable adjustment for potential confounders was employed to investigate the association between liver fat content and aIMT.

Results

The study participants were on average 17.0 years old (SD 1.4), 43.9% were female and 45.2% were apprentices. Liver fat content significantly predicted aIMT when adjusting for age, sex, education, BMI, systolic blood pressure, LDL-cholesterol, HbA1c, physical activity, alcohol consumption and smoking status (given as difference in aIMT for a 10 dB/m higher liver fat content: 3.3 µm, 95% CI: 0.5-6.1).

Conclusions

Liver fat content was significantly associated with aIMT in adolescents of the general population even after adjustment for traditional cardiovascular risk factors. Hence, MAFLD is an independent biomarker for early atherosclerosis in the youth and might help to identify high-risk populations for CVD.

Background and Aims

Stroke is associated with a 46% risk of recurrence in the first 14 days following the event. Carotid endarterectomy (CEA) is an effective form of stroke prevention and is recommended to be performed within 2 weeks following stroke. On the other hand, emergency CEA is controversial due to a high risk of complications.

Methods

We performed retrospective analysis of our prospectively collected database of patients operated for carotid stenosis between 2006 and 2020. We analyzed the occurrence of major adverse events, such as stroke, acute myocardial infarction or death after surgery. Further, minor adverse events, such as cranial nerve lesion, hematoma or hyperperfusion syndrome were analyzed. CEA performed within 48 hours after stroke was defined as emergency CEA.

Results

Since 2006 till 2020 we performed emergency CEA in 277 patients, including 196 males and 81 females. The mean age was 66 years. The surgery was performed in awake patients under local anesthesia. Stroke, myocardial infarction or death occurred in 11 (4.0%) of the 277 patients operated within 2 days after stroke. In patients operated within 24 hours after stroke, the risk of these adverse events was even lower, being 2.9% (4 out of 139). Concerning minor adverse events, hematomas were present in 16 patients (5.8%), cranial nerve paresis in 5 patients (1.8%), and vocal cord paralysis in 4 patients (1.4%). The cerebal hyperperfusion syndrome occurred in 2 patients (0.7%) operated on the day of surgery.

Conclusions

We conclude that emergency carotid endarterectomy is safe after TIA or non-disabling stroke.

Background and Aims

Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcome. We aimed to describe the clinical profile and predictors of periprocedural events in patients with symptomatic carotid stenosis who underwent CEA at our institute.

Methods

A retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. The clinical and imaging parameters and their influence on periprocedural events were analyzed.

Results

Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 patients(65%) presented with stroke. The majority (85%) had high-grade stenosis of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however, only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% of patients. None of the clinical or imaging parameters predicted the periprocedural adverse events except the presence of hemodynamic infarcts(12.8% vs 4.8%; P=0.019). The presence of co-existing significant(>50%) tandem intracranial atherosclerosis(24%) and the presence of contralateral carotid occlusion(7.5%) were not predictors of the periprocedural stroke risk(P=0.12 and 0.09 respectively).

Conclusions

There is a delay in patients undergoing CEA for symptomatic carotid stenosis. The majority have high-grade stenosis and present only after a stroke. CEA can be performed safely in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

Background and Aims

Medical management alone is insufficient to reduce secondary stroke risk. Supervised exercise combined with behaviour change support may facilitate increased physical activity and help adequately address stroke recurrence risk. This early analysis of the ENAbLE Pilot Trial aimed to test the feasibility of a supervised aerobic exercise package delivered via telehealth.

Methods

A 4-arm, assessor blinded RCT was piloted during the COVID-19 Pandemic. The remotely delivered trial included people 3 months to 10 years post stroke or TIA. The intervention involved 12 weeks of twice weekly telehealth-supervised aerobic exercise and support sessions. Feasibility data including recruitment, adherence, adverse events and ability to collect clinical outcomes to support a Phase III trial (blood pressure [primary outcome], physical activity, fatigue, and quality of life) was collected and analysed.

Results

Thirty people participated (exercise intervention n=14, control n=16) between April 2020 and July 2021. Session attendance was 80%. Three participants (10%) withdrew or were lost to follow-up, all in the experimental group. Mean exercise intensity during supervised sessions was in the target range (moderate to vigorous). Mean number of systolic BP measures recorded over 7 days was 27 (SD 2.2) of a maximum of 28, at baseline. One non-serious adverse event occurred during supervised exercise sessions. However, outside exercise sessions adverse events were higher in the experimental group who were more frequently monitored.

Conclusions

A remotely delivered program of supervised aerobic exercise delivered via telehealth was feasible. Learnings from the remote delivery of an exercise pilot trial will be shared.

Acknowledgements: Stroke Foundation Australia

Background and Aims

SPRINT INDIA trial delivers intervention in form of educational workbook, videos and SMS using internet, on cellular device, across 30 centres in 12 languages. Primary outcome was composite of recurrent stroke, transient ischemic attack, acute coronary syndrome and death at one year. Sample size was 5930 but only 4298 patients could be randomised as trial had to be stopped for futility. Only 5% primary outcomes were reported, rather than the expected 15-20% reported in India. Data analysis indicated that trial secondary stroke awareness intervention was no better than standard awareness.

Process evaluation was conducted to comprehend the futile outcomes by examining trial implementation and exploring participant’s perspectives.

Methods

Using mixed methods approach, qualitative interviews from 11 sampled sites representing regional languages in which intervention was delivered were conducted. Quantitative data includes case report forms, workbooks and questionnaires to measure intervention fidelity and contamination.

Results

Total 111 interviews of patients/caregivers (80) and health professionals (31) with 2 focus group interviews were conducted. Fidelity questionnaire was responded by 1418 (66%) out of 2148. SMS and videos at 6 weeks were viewed by 996 (70%) and 769 (54%), at 6 months 571 (40%) and 534 (38%) and at 1 year 506 (36%) and 460 (32%) respectively. Contamination questionnaire was responded by 1869 (87%) controls out of 2150 and none reported any intervention material knowledge. Average activities performed in workbook were Median (IQR): 9 (4-12) out of total 15.

Conclusions

Reasons identified for decreased viewing were repetitive content and non-availability of their own cellular device with patients.