Intracerebral hemorrhage (ICH), when there is bleeding into brain tissue from the rupture of a damaged blood vessel, is one of the most devastating types of stroke. Patients often suffer from severe neurologic disability or even death. There were no proven treatments for patients with ICH until recently. 

“We now have one study that showed removing the blood in the brain tissue with a minimally invasive procedure improves quality of life for patients with intracerebral hemorrhage,” said Paul Wechsler, MD, vascular neurology fellow at the UC College of Medicine and a UC Gardner Neuroscience Institute physician. “However, only specific patients are eligible for this procedure.” 

Wechsler and his colleagues examined data from patients with ICH from the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) to estimate the number of patients who are eligible for this new procedure to remove blood in the brain. They found only approximately 3% of all patients with ICH in the study area would be eligible for the minimally invasive procedure. 

“This is a very small number and leaves the majority of patients with intracerebral hemorrhage without treatment options,” Wechsler said. “Although it is exciting to offer this new minimally invasive procedure to help some patients with intracerebral hemorrhage, more research is urgently needed to find better treatments for more patients.” 

Wechsler will present “Projecting United States Population Eligibility for Minimally Invasive Surgical Evacuation of Acute, Spontaneous Intracerebral Hemorrhage” Feb. 5 at 2 p.m. and “Eligibility for Minimally Invasive Surgical Evacuation of Acute, Spontaneous Intracerebral Hemorrhage: A Population-Based Study” Feb. 6 at 8:30 a.m.

As research into stroke rehabilitation continues, there is still relatively little known about how much people can recover after a stroke or whether there are racial disparities in this recovery.

David Robinson, MD, and his colleagues looked at GCNKSS data to explore whether Black individuals experience worse disability after stroke compared to white individuals, and whether this changes over a one-year period.

“We found that Black individuals do have worse functional outcomes after ischemic stroke when compared with white individuals, even after adjustment for factors known to impact stroke recovery,” said Robinson, a UC Gardner Neuroscience Institute physician researcher and assistant professor in the Department of Neurology and Rehabilitation Medicine in UC’s College of Medicine. “Further, there was some evidence that this effect was more prominent at later follow-up periods, suggesting that there may be environmental, socioeconomic or other social determinants impeding stroke recovery in Black individuals.”

With the total number of strokes expected to rise, Robinson said, there is a need for more research of rehabilitation, recovery and how to address the social determinants that lead to racial disparities in recovery.

Robinson will present “Racial disparities in functional outcome after ischemic stroke” Feb. 5 at 6:05 p.m.

Read more about Robinson’s research on racial disparities in stroke survival and recovery.

Stroke physicians use a method called the modified Rankin score (MRS) to identify patient outcomes after an acute stroke. The scale goes from zero to 6, with each number representing different levels of symptoms and dependence, but generally a score of zero to 2 is considered a “good outcome” with 3 to 7 being a “bad outcome.” 

This binary of outcomes is used, UC’s Eva Mistry said, to help calculate a metric called “number needed to treat,” which the Food and Drug Administration (FDA) considers when approving therapies. 

“‘Number needed to treat’ just means how many patients you need to treat with a given therapy to get a better outcome in one patient, and basically looks at how powerful a therapy is,” said Mistry, MBBS, associate professor and vice chair of research in the Department of Neurology and Rehabilitation medicine in UC’s College of Medicine and a UC Gardner Neuroscience Institute physician researcher. “That is the reason why we divide more granular and patient-centered outcomes into binary yes-or-no outcomes — because that traditionally has been the only way you can calculate the number needed to treat.” 

Studying previous methods and a newly designed method, Mistry and her team showed the number needed to treat can be calculated for each level in the MRS rather than the binary of good or bad outcome. 

“Even a one-level-better outcome on a scale of seven levels can be meaningful benefit from a patient’s perspective,” Mistry said. “This is a more patient-centric way to understand the number needed to treat for outcomes that are distributed across a scale like that.” 

Mistry said the goal of this research is for the scientific community and other stakeholders to understand the possibility of using these different methods moving forward. 

“You don’t need to ask the field to reduce this beautiful outcome into two categories,” Mistry said. “Even if the patient improved one level, we count that as a win. And if you do it that way, the number needed to treat is almost always less.”  

Mistry will present “Comparative analysis of methods to derive number needed to treat over the entire range of global disability on the modified Rankin Scale” Feb. 5 at 6:20 p.m. 

Researchers often use administrative data, such as ICD-10 codes used for insurance claims, to study clinical events like stroke because this data is more cost-effective and readily accessible than other methods.

But despite widespread use of ICD-10 codes in research, the validity of this technique has been examined infrequently. Researchers led by UC’s Laura Gutierrez Quiceno, MD, evaluated the reliability of ICD-10 codes using data from the GCNKSS.

“ICD-10 standard codes designated for both acute ischemic strokes and hemorrhagic strokes demonstrated moderate sensitivity along with a reasonable positive predictive value for acute ischemic strokes and a moderate positive predictive value for hemorrhagic strokes,” said Gutierrez Quiceno, a neurology and neurocritical care fellow in UC’s College of Medicine and a UC Gardner Neuroscience Institute physician. “These findings indicate that ICD-10 codes can serve as a validated method for identifying incident stroke events, providing a foundation for their use in future research.”

Moving forward, researchers will assess whether these findings can be generalized outside the United States, as Gutierrez Quiceno noted that large cohorts in clinical studies are frequently associated with international collaborators.

Gutierrez Quiceno will present “Reliability of ICD-10 codes for Stroke in a Representative US Population” Feb. 5 at 6 p.m.

Up to three-quarters of all stroke survivors have some form of difficulty swallowing (dysphagia) after a stroke. Dysphagia can result in entry of food or liquid into the lungs and significantly impacts patients’ overall health and quality of life.    

For some patients with dysphagia, doctors need to place a feeding tube, known as percutaneous endoscopic gastrostomy or a PEG, to ensure adequate nutrition. When used long term, a PEG can cause various complications.  

Previous literature shows that placing a PEG is more common in Black patients than white patients after a stroke, but it is unclear why. Brittany Krekeler, PhD, and her colleagues reviewed 2010, 2015 and 2020 data from the GCNKSS to evaluate the influence of patient-related factors and stroke characteristics on PEG placement. 

“Patient characteristics such as age, prior stroke and stroke severity, and socioeconomic situation do not seem to be contributing to this racial difference in PEG placement,” said Krekeler, assistant professor and clinician-scientist at the UC College of Medicine’s Dysphagia Rehabilitation Laboratory. “In future work, we need to examine if other social factors could be driving this difference, such as patient preference, support, education level and health literacy, to better serve our patients in the informed decision-making process around feeding tube placement.” 

Krekeler will present “Racial Differences in Percutaneous Endoscopic Gastrostomy (PEG) Placement in Post-Stroke Dysphagia” Feb. 5 at 7 p.m.

Measuring stroke lesion load on the corticospinal tract (CST) — or determining how much of the tract is affected by the stroke — helps predict motor function and recovery after a stroke. But there are several methods to measure CST lesion load, and it was previously unclear which measurement tool was best at predicting motor outcomes during recovery. 

Brady Williamson, PhD, and colleagues compared four measurement methods and found a measurement called maximum weighted lesion load to be the best predictor of outcomes. 

“This is the point of the tract with the maximum overlap with the lesion weighted by the diameter of the tract at that point,” said Williamson, assistant professor in the Department of Radiology in UC’s College Medicine. “Weighting is important, as a similar overlap affects far more nerve fibers when the tract is compact than when it is spread out.”  

Additionally, the team found that using age-matched data for healthy comparison groups — 50 to 80 years old for stroke populations — improves the ability of maximum weighted lesion load to predict motor outcomes compared to more generic data from varied age groups. 

Williamson and his colleagues are continuing the research in two directions. First, they are comparing the effectiveness of maximum weighted lesion load to tractography-based methods.  

“Tractography is a more direct measure of white matter, so our hypothesis is that this will provide an even better metric of lesion load,” he said. “However, the drawback is that the data needed to do tractography is not always feasible to obtain clinically.” 

Second, the team will apply maximum weighted lesion load measurement to patients enrolled in the VERIFY stroke recovery study as part of a scoring algorithm to predict which patients will recover motor function after stroke. 

Williamson will present “Optimizing the Approach to Calculating CST Lesion Load for Understanding Motor Outcomes” Feb. 5 at 6:05 p.m.

With every second counting during an acute ischemic stroke, obtaining timely informed consent is a key barrier when recruiting for clinical trials. Electronic consent (eConsent) allows electronic delivery and documentation of the informed consent process, which may optimize recruitment, but UC’s Iris Davis said its utilization in acute ischemic stroke trials is limited and understudied.

Davis and colleagues conducted a post hoc analysis of eConsent adoption in the Phase 3, multicenter MOST trial to evaluate potential associations with recruitment, participant demographics, timeliness and informed consent documentation adherence. 

“eConsent in MOST was associated with higher individual site enrollment, higher remote consent rates and improved consent documentation adherence over paper consent,” said Davis, clinical research manager and NIH StrokeNet administrative codirector. “Our study outlines the potential advantages of eConsent adoption in future acute ischemic stroke clinical trials and stroke research networks.”

Davis said the most notable limitation of the study was that eConsent adoption in MOST was voluntary, and there are likely inherent differences between sites that used eConsent and those that did not.

Davis will present “The Impact of Electronic Consent on Participant Recruitment in an Acute Ischemic Stroke Clinical Trial” Feb. 5 at 7 p.m.