Introduction: The Extracranial-Intracranial bypass (EC-IC) surgery is performed to restore blood flow to the brain and prevent both hemorrhagic and ischemic strokes in Moyamoya disease (MMD) patients. There is a lack of contemporary data regarding EC-IC utilization, racial disparities, related mortality, and disability in the US. Method: Using ICD 9-CM codes 437.5 and 39.28, MMD and EC-IC procedures were extracted from National Inpatient Sample 2005-2015. The weighted discharge was used to generate national estimates. Predictors of revascularization utilization were evaluated using multivariable logistic regression analysis to avoid confounding effect. Disability was defined as non-home discharges, after excluding mortality. Results: Of total 24,484 admissions for MMD, 3,965 (16.2%) underwent revascularization. The mean age of revascularization patients was (SE) ~42 (0.52) years and F: M ratio of 3:1. After multivariable logistic model analysis, higher utilization rates were found in 40-59 year age group (48.3%, OR:1.29; P=0.02), who had ischemic strokes (9.2%, OR:1.38; P=0.03), and conventional cerebral angiography (30.2%, OR:1.80; P=0.001). Lower utilization rates were found in African Americans (14.9%, OR: 0.66; P=0.004), Hispanics (5.7%, OR: 0.60; P=0.03), Medicare recipients (13.6%, OR: 0.55; P=0.009), Northeast (11.5%, OR: 0.47; P= 0.003), Midwest (22.7%, OR: 0.55; P= 0.02), and South (24.8%, OR: 0.46; P=0.0002) compared to the West region. There is no utilization difference in gender female (72.4%, OR: 0.89; P=0.36). After EC-IC surgery, 79% were discharged home, 21% discharged to assistive facilities, and 0.6% died. After adjusting for hospital characteristics and associated comorbidities, lower disability (OR: 0.75; P=0.04) and the mortality rate was reported (OR: 0.80; P=0.71) among revascularization. Conclusions: This nationally representative date within the US suggests that though there is no gender disparity in utilization of EC-IC bypass surgery, there is a significant racial and regional disparity in the utilization of the procedure. Patients undergoing revascularization had better functional outcomes. Further research is needed to identify potential predictors for underutilization in these cohorts.

Background: Stroke impacts several aspects of patients’ lives and sexual dysfunction post stroke has been reported in 40%-50% of patients. Current investigations have revealed links to depression, however this has not been examined specifically in mild stroke. Objective: To determine prevalence and factors associated with sexual dysfunction after mild stroke Design/methods: A retrospective study was conducted on a self-report questionnaire completed by a convenience sample of patients during a hospital follow-up appointment in the stroke clinic. Patients were asked about sexual dysfunction after stroke and if yes, to specify the cause: safety concern, physical limitation, consequence or change in libido. In addition, patients completed a PHQ-9 to measure depression, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). A thorough review of clinical history including NIHSS, mRS and demographics was completed by researchers. Descriptive statistics were used to identify and understand the patient population. Mild stroke was defined as NIHSS ≤ 5. Results: In our study of 135 patients, 21 (16%) did not respond to the sexual dysfunction question. Of the 114 who responded, only 11 (9.6%) reported sexual dysfunction and 9 (81%) attributed their sexual dysfunction to physical limitations. Descriptive statistics of the respondent subgroup indicate that the cohort was 59% male with a median (IQR) age of 64 (57,75) and that 52% were living with someone at the time. The mean NIHSS on discharge was 1 (IQR 0-3) and 77% were ischemic strokes. Few patients experienced post stroke depression (21.9%, N=25), and the cohort reported low levels of fatigue (median FAS=19). Low incidence and response rates precluded an analysis of specific predictors in this cohort. Conclusion: Physical limitations are reported to be the main cause of post stroke sexual dysfunction. Roughly 1 in 10 patients with mild stroke reported experiencing sexual dysfunction, however twice as many did not respond to the question. Therefore, the true incidence is unclear, prompting the need for further investigation on post stroke sexual dysfunction in mild stroke.

Background: Cognitive symptoms are easily overlooked despite its effect on quality of life after stroke. In patients with minimal physical residual symptoms, the true burden of cognitive impairment is unknown. Objective: To evaluate the risk factors and burden associated with cognitive impairment after mild stroke. Methods: A retrospective observational cohort study of 56 patients (51 ischemic, 5 hemorrhagic) evaluated at the stroke clinic between July 2016 and June 2017 was performed. Patients completed a questionnaire including demographics and history including previously known cognitive impairment. Cognition was evaluated with the Montreal Cognitive Assessment Score (MOCA). Results: The median age of the group studied was 61.5 years. Sixty-six percent (66.1%) patients were men and 76.8% Caucasian. The median discharge NIH score was 1. This study group did not have a previous diagnosis of dementia. About 4% (n=2) of patients presented to clinic <6 weeks, 71.4% (n=40) 6-12 weeks, 17.9% (n=10) 12-24weeks and 7.1% (n=4) >24 weeks from discharge. Cognitive assessment at the stroke clinic after discharge identified 19.6% patients with mild impairment, 16.1% with moderate impairment and 14.3% with dementia. MOCA scores were lower in those greater than 65 years of age ( p =0.022), living in facilities post-stroke ( p =0.007), have history of stroke and diabetes mellitus ( p =0.011, 0.019). Education level did not show significant difference in MOCA scores ( p =0.283). Those who were employed prior to their stroke have a higher MOCA score compared to those who were unemployed ( p =0.001). Of those previously working, 50% were able to return to work and this group had higher MOCA scores ( p =0.011). Of those who stopped driving, 19.6% was due to cognitive concerns. Conclusion: In our study, about 50% of the mild stroke patients were found to have some degree of cognitive impairment. Factors that may suggest a higher risk for cognitive impairment after stroke include those age greater than 65, history of stroke and diabetes, unemployment and living in a facility. Post-stroke cognitive impairment was found to be associated with inability to return to work and drive. Since cognitive impairment can impact life quality, screening even in mild stroke could be beneficial.

Background: Depression after stroke can severely inhibit a patient’s recovery. While it affects roughly a third of all stroke survivors, there is a lack of literature evaluating depression in patients with minimal or no residual deficits. Objectives: To evaluate variables associated with depression in patients with minimal or no residual deficits. Methods: A retrospective analysis of patients with mild stroke, intracerebral hemorrhage (ICH) or TIA at our institution who presented to the stroke clinic from December 2016-July 2017 was conducted. A questionnaire gathering clinical and sociodemographic information, as well as levels of depression, was administered. Patients were assessed using the PHQ-2 and PHQ-9 depression scales. A Wilcoxon Ranked Sum test was used to analyze variables affecting depression. Statistical significance was set at 0.05. Results: In total, 72 patients (58 ischemic, 5 ICH and 9 TIA) were identified. Approximately 4% (n=3) presented to clinic <6 weeks, 66.7% (n=48) 6-12 weeks, 23.6% (n=17) 12-24 weeks, and 5.6% (n=4) > 24 weeks from discharge. The median discharge NIH score was 1.5. Roughly 24% of patients (n=17) reported depression via the PHQ-9. Of these patients, 59% (n=10) reported depression prior to stroke and 41% (n=7) developed new depression. The median age was 62.5 years, 63.9% were female, and 70.8% Caucasian. Diabetic and unmarried patients reported significantly more depression ( p=0.005, 0.03) while patients attending occupational therapy were less depressed ( p=0.010 ). Age ( p=0.23 ), history of cancer ( p=0.95 ), prior stroke ( p=0.55 ), incontinence ( p=0. 27), stroke location (Right: p=0.72 ; Left: p=0.244 ), ability to return to work ( p=0.64 ), driving status ( p= 0.36), and discharge destination ( p=0. 09) did not significantly affect depression levels. Of the patients with no prior depression, 11.2% developed new depression after stroke. Conclusion: In our study, a quarter of stroke and TIA patients with little to no residual deficits reported depression and roughly 1 in 10 reported new depressive symptoms. Depression is still a prevalent and concerning outcome that can have a major effect on a patient’s functional status. Further studies of depression in patients with minimal to no symptoms are needed.

Objective: To determine the factors associated with patient's level of understanding (LoU) of stroke after hospital discharge. Background: Stroke is a complex disease entity. Despite extensive in-hospital education, many do not understand there condition irrespective of educational and socioeconomic background. Design/methods: A prospective questionnaire-based study was conducted on patients presenting to stroke clinic for the first-time after hospital discharge and completed prior to evaluation by the patient. LoU was categorized as "Very good" (75-100[percnt]), "Good" (50-75[percnt]), "Poor" (25-50[percnt]) and "not at all" (0-25[percnt]). A dichotomized approach of >50[percnt] or 50[percnt] LoU in patients following up in clinic after hospital discharge (p=0.016). Patients who indicated reading, or having a family member read the stroke discharge instructions had a LoU of >50[percnt] (p=0.04). Smoking status and use if illicit drugs was associated with <50[percnt] LoU (p=0.021, p=<0.01). A trend towards LoU of >50[percnt] was seen in patients with LOS >3 days (p=0.05). In total, only 28[percnt] of patients (n=23) indicated a "very good" LoU. Conclusions: Patients with motor dysfunction have higher LoU of stroke as compared to non-motor symptoms. Novel inpatient educational strategies and stroke clinic follow-up are essential to improve LoU in stroke patients.

Objective: To determine the factors associated with patient’s level of understanding (LoU) of stroke after hospital discharge. Background: Stroke is a complex disease entity. Despite extensive in-hospital education, many do not understand there condition irrespective of educational and socioeconomic background. Design/methods: A prospective questionnaire-based study was conducted on patients presenting to stroke clinic for the first-time after hospital discharge and completed prior to evaluation by the patient. LoU was categorized as “Very good” (75-100[percnt]), “Good” (50-75[percnt]), “Poor” (25-50[percnt]) and “not at all” (0-25[percnt]). A dichotomized approach of >50[percnt] or 50[percnt] LoU in patients following up in clinic after hospital discharge (p=0.016). Patients who indicated reading, or having a family member read the stroke discharge instructions had a LoU of >50[percnt] (p=0.04). Smoking status and use if illicit drugs was associated with 50[percnt] was seen in patients with LOS >3 days (p=0.05). In total, only 28[percnt] of patients (n=23) indicated a “very good” LoU. Conclusions: Patients with motor dysfunction have higher LoU of stroke as compared to non-motor symptoms. Novel inpatient educational strategies and stroke clinic follow-up are essential to improve LoU in stroke patients. Disclosure: Dr. Taboada has nothing to disclose.

Objective: To determine factors associated with successful follow-up in stroke clinic after hospital discharge. Background: Stroke is a complex disease entity with up to 1 in 4 strokes being recurrent. Follow-up in the stroke clinic is necessary for the secondary prevention, post-stroke complications, patient education, and rehabilitation services. Methods: A retrospective case-control study was conducted evaluating TIA, ischemic stroke and ICH patients with first scheduled outpatient follow-up after hospital discharge. The study was conducted over a 5-month period. Clinical data including demographics, stroke type, NIHSS, mRS, presence or absence of hemiparesis or aphasia, social and vascular risk factors, admitting service, length of stay, disposition, use of templated stroke-discharge instructions, and presence or absence of a written follow-up appointment on discharge instructions was collected. Patients in the successful and unsuccessful (no show) follow-up groups were compared. Statistical significance using Pearson's chi-squared testing was determined. Results: A total of 160 patients were identified, of which 52[percnt] presented to clinic (n=83). For all stroke patients, factors associated with successful follow-up were admission to the neurology service (p=0.015), use of templated stroke-specific discharge instructions (p=0.007), and presence of written time and date for follow-up on those instructions (p<0.001). Patients with NIHSS <5 on admission or discharge were more likely to follow-up in clinic (p=0.003 and p=0.006 respectively). There was borderline statistical significance for successful follow-up in patients discharged home as compared to rehab or a skilled nursing facility (p=0.05). All other analyzed variables were non-significant. Conclusions: Stroke clinic follow-up is best achieved in patients admitted to the neurology service. Ensuring standardized discharge instructions with provided time and date of outpatient appointment is the key for successful follow-up.