22. European Stroke Conference 3 Acute stroke: current treatment & new treatment concepts 8:50 - 9:00 Baseline clinical predictors of Major neurologic improvement after Mechanical thrombec-tomy achieved recanalization J.A. Desai1, M.A. Almekhlafi2, V.K. Nambiar3, S. Mishra4, M. Eesa5, B.K. Menon6, O. Volny7, M. Goyal8, A.M. Demchuk9 University of Calgary, Calgary, CANADA1,University of Calgary, Calgary, CANADA2, Uni-versity of Calgary, Calgary, CANADA3, University of Calgary, Calgary, CANADA4, Universi-ty of Calgary, Calgary, CANADA5, University of Calgary, Calgary, CANADA6, University of Calgary, Calgary, CANADA7, University of Calgary, Calgary, CANADA8, University of Cal-gary, Calgary, CANADA9 Background: The Solitaire and Trevo Retrievers are novel self-expanding stent like devic-es designed to rapidly restore flow in acute ischemic strokes. Major neurologic improvement >/=50% improvement in NIHSS score within 24h) after intravenous thrombolysis is a strong predictor of good clinical outcome. The objective of the present study is to identify clinical pre-dictors of major neurologic improvement (MNI) in acute ischemic stroke patients treated with mechanical thrombectomy Methods: This is a longitudinal cohort of anterior circulation acute ischemic stroke patients treated with stentriever devices at a quaternary stroke center. Patient demographics, radiologic and clinical data were collected. Percent improvement (Baseline NIHSS -24h-NIHSS)/baseline NIHSS X 100 was calculated. We tested differences between groups using the Chi-squared test for categorical variables and the Kruskal-Wallis test for continuous variables. Subsequent uni-variate analysis was performed using logistic regression. Results: Results are summarized in table1. 105 patients with anterior circulation stroke under-went mechanical thrombectomy between January 2011 and October 2012. Successful recanali-zation was achieved in 79.05% of patients within a median time of 260min from last seen well. MNI was present in 63.81% (67/105) patients. Females (p=0.036) and patients who received IV-tPA prior to mechanical thrombectomy (p=0.026) achieved MNI more frequently. Faster imaging to recanalization (p=0.029) and procedure time (p=0.021) was associated with MNI. In univariate logistic regression analysis IV-tPA (OR 2.82, p=0.028, 95%CI 1.12-7.15); and groin puncture to recanalization time (OR 0.99, p=0.036, 95%CI 0.97-1) were correlated to MNI. Conclusion: Female gender and Iv-tPA associated with MNI post-mechanical thrombectomy. Pretreatment processes resulting in faster imaging to recanalization and procedure times are also associated with MNI. The role of bridging therapy needs clarification. 2 Acute stroke: current treatment & new treatment concepts 8:40 - 8:50 Endovascular recanalization becomes more effective over time than standard IV throm-bolysis within 4.5 hours from stroke onset B.J. Kim1, T.H Park2, K.B. Lee3, B-C. Lee4, K-H. Yu5, J.K. Cha6, J. Lee7, S. J. Lee8, J-M. Park9, Y-J. Cho10, J-T. Kim11, J.C. Choi12, J. Lee13, J. Lee14, H-J. Bae15 Seoul National University Bundang Hospital, Seongnam si Gyeonggi do, SOUTH KO-REA1, Seoul Medical Center, Seoul, SOUTH KOREA2, Soonchunhyang University Hospital Seoul, Seoul, SOUTH KOREA3, Hallym University Sacred Heart Hospital, Anyang-si, SOUTH KOREA4, Hallym University Sacred Heart Hospital, Anyang-si, SOUTH KOREA5, Dong-A University Hospital, Busan, SOUTH KOREA6, Yeungnam University Medical Center, Daegu, SOUTH KOREA7, Eulji University Hospital, Daejeon, SOUTH KOREA8, Eulji General Hospi-tal, Seoul, SOUTH KOREA9, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, SOUTH KOREA10, Chonnam National University Hospital, Gwangju, SOUTH KOREA11, Jeju National University Hospital, Jeju, SOUTH KOREA12, Korea University College of Medicine, Seoul, SOUTH KOREA13, Korea University College of Medicine, Seoul, SOUTH KOREA14, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, SOUTH KOREA15 Background. Intravenous infusion of recombinant tissue plasminogen activator (IV-tPA) is cur-rently a standard therapy for hyperacute ischemic strokes within 4.5 hours, but had relatively lower rate of immediate recanalization. We sought to determine whether endovascular recanal-ization might be a superior strategy to achieve a better clinical outcome. Methods. From a total of 14792 acute ischemic stroke cases admitted to 11 stroke centers nationwide between April 2008 and January 2012, we analyzed 872 subjects who arrived ≤4.5 hours from onset, initial NIHSS score ≥10-point, and had reperfusion treatment. Endovascular cases (N=355), consisted of 98 endovascular-only and 257 combined IV-tPA with endovascular treatment, were com-pared to 517 IV-tPA cases. Good outcome was defined as a modified Rankin Scale score 0 – 2. A propensity score was generated and inverted probability of treatment weighted methods were applied. As Solitaire (TM) neurothrombectomy stenting device became widely available in Ko-rea late 2010, specified subgroup was created according to the date of hospital arrival before and after January 2011. Results. For 872 hyperacute stroke cases, mean age of onset was 69.8 +/- 11.8, time interval between onset to arrival was median 1.3 hours interquartile range, 0.7 – 2.1 and NIHSS score was median 16 13 – 19. Until December 2010, endovascular treatment was not associated with good outcome at discharge (adjusted OR, 0.97; 95% CI, 0.59 – 1.60) and at 3 months (adjusted OR, 0.41; 95% CI, 0.22 – 0.73; available in 572 cases) than IV-tPA. After January 2011, however, endovascular recanalization showed significantly higher associa-tions with good outcome at discharge (adjusted OR, 1.81; 95% CI, 1.02 – 3.21) and at 3 months (adjusted OR, 1.98; 95% CI, 1.05 – 3.71). Conclusion. For endovascular recanalization of isch-emic strokes within 4.5 hours from onset, we observed a clear trend toward improved clinical outcomes after January 2011 over standard IV-tPA treatment. 10 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
To see the actual publication please follow the link above