Introduction Chronic periodontitis and atherosclerosis share common risk factors and produce the same inflammatory markers. Many studies found a high prevalence of chronic periodontitis in patients with atherosclerosis but there is no strong evidence to support a specific association of chronic periodontitis with cerebral atherosclerosis. We aimed to study the concurrent prevalence and association of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases among the US population. Methods We performed a cross-sectional analysis of a Nationwide Inpatient Sample with adult hospitalizations to identify the primary diagnosis of cerebrovascular diseases [acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA)] with concurrent cerebral atherosclerosis and chronic periodontitis. Multivariate survey logistic regression models were fitted to evaluate the linkage of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases. Results Of total 56,499,788 hospitalizations, 0.01% had chronic periodontitis. Prevalence of chronic periodontitis was higher in 50-64 years (36.18% vs. 23.91%), males (59.19% vs. 41.06% in females), Afro-Americans (25.93% vs. 15.21%), and 0-25th percentile median-household-income-category (38.31% vs. 30.15%) compared to non-chronic periodontitis. There was significantly higher prevalence of cerebral atherosclerosis (0.71% vs. 0.41%; p<0.0001) with weak evidence of high prevalence of cerebrovascular diseases (AIS:2.21% vs. 1.97%; p=0.1563; HS:0.57% vs. 0.46%; p=0.1560) among chronic periodontitis compared to non-chronic periodontitis. In regression analysis, odds of having cerebral atherosclerosis were 2.48-folds higher in patients with chronic periodontitis compared to that without-chronic periodontitis, and cerebral atherosclerosis patients were associated with higher odds of TIA (aOR:2.40; p<0.0001), AIS (aOR:3.35; p<0.0001), and HS (aOR:1.51; p<0.0001) compared to without-cerebral atherosclerosis. No significant relationship between chronic periodontitis and cerebrovascular diseases was observed. Conclusion Although chronic periodontitis may not directly increase the risk of cerebrovascular diseases, it increases the burden of cerebrovascular diseases by evidently increasing the risk of cerebral atherosclerosis. Early identification of chronic periodontitis and atherosclerotic risk factors may help to mitigate the risk of cerebrovascular diseases.

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Atrial fibrillation (Afib) is the most common and underestimated cardiac arrhythmia with a lifetime risk of >35% after the age of 55 years and the risk continues to rise exponentially. Afib leads to stasis of blood within the atria allowing clot formation and increasing the risk for systemic embolization leading to strokes. Outcomes due to Afib can improve significantly with appropriate treatment. Thus, the need for convenient, well‐tolerated, cost‐effective cardiac monitoring for Afib is needed. The study aims to evaluate the various newer devices and compare them with traditional Holter monitoring, keeping diagnostic yield, cost-effectiveness, and patients' convenience in mind. Though Holter monitoring is simple and non-expensive, it has major limitations including limited recording capacity, inability for real-time recordings, and inconvenience to patients. Zio Patch (iRhythm Technologies, Inc; San Francisco, CA) and other loop recording devices are patient-friendly, inexpensive, and can offer real-time data for longer days. More prospective studies are needed to evaluate the sensitivity, specificity, and the actual number of patients getting benefits from newer devices by diagnosing Afib sooner and start early prevention therapy.

Mechanical thrombectomy (MT) for ischemic stroke due to large vessel occlusion is standard of care. Evidence-based guidelines on eligibility for MT have been outlined and evidence to extend the treatment benefit to more patients, particularly those at the extreme ends of a stroke clinical severity spectrum, is currently awaited. As patient selection continues to be explored, there is growing focus on procedure selection including the tools and techniques of thrombectomy and associated outcomes. Artificial intelligence (AI) has been instrumental in the area of patient selection for MT with a role in diagnosis and delivery of acute stroke care. Machine learning algorithms have been developed to detect cerebral ischemia and early infarct core, presence of large vessel occlusion, and perfusion deficit in acute ischemic stroke. Several available deep learning AI applications provide ready visualization and interpretation of cervical and cerebral arteries. Further enhancement of AI techniques to potentially include automated vessel probe tools in suspected large vessel occlusions is proposed. Value of AI may be extended to assist in procedure selection including both the tools and technique of thrombectomy. Delivering personalized medicine is the wave of the future and tailoring the MT treatment to a stroke patient is in line with this trend. K E Y W O R D Sartificial intelligence, mechanical thrombectomy, stroke significantly improved patient selection and delivery of acute stroke care. 12,13 In recent years, there has been a marked improvement in thrombectomy device technology and refinements in procedure techniques. In times of growing scientific interest and shifting focus on 798

Introduction: Transthoracic echocardiogram (TTE) is part of the standard stroke workup. If stroke remains cryptogenic after TTE and rest of the initial stroke evaluation, a transesophageal echocardiogram (TEE) is often performed. Evidence about when and in whom TEE should be done is lacking and reported effect on management vary widely. Our goal was to investigate the impact of TEE on stroke management. Methods: We performed a retrospective study of patients admitted with acute ischemic stroke (AIS) between April 2017 and December 2019 to a single, tertiary care, academic center. All patients received TTE and TEE while inpatient. Demographic data, clinical characteristics, results of echocardiograms and discharge medications were collected via chart review. Primary endpoint was change in stroke management based on TEE results. Secondary endpoint discovery of potential stroke etiology and factors associated with TEE results leading to change in management including age, multi-territory infarcts, TTE and vascular risk factors. We used Fisher’s Exact test and 2-sided Wilcoxon-Mann-Whitney rank-sum test. Results: We analyzed 92 patients with AIS who received both TTE and TEE. Median age was 56 (range 23-88), 51% were male and median NIHSS on admission was 9 (0-30). Middle cerebral artery infarct occurred in 58% and 32% had infarcts in multiple territories. Median hospital stay was 9 days (2-43). TEE revealed findings not seen on TTE in 52% and changed management in 16.3% of cases. Surprisingly, It appeared that older age was more likely to be associated with change of management based of TEE results (median age 61 vs. 55), as were multi-territory infarcts (46.7% vs 28.6%). However, neither of these results were statistically significant. Normal TTE findings were similar in both groups (60.0% vs 57.1%) and no vascular risk factors were associated with change of management based on TEE. Conclusion: TEE changes secondary stroke management in approximately one-sixth of patients and revealed new findings in about half. A larger study is needed to find factors associated with change in management based on TEE results.