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22. European Stroke Conference 10:30-12:30 Oral Session Room 2,3,4 Acute stroke:emergency management, stroke units and complications B Chairs: J. Betlehem, Hungary and P. Amarenco, France 10 Acute stroke: emergency management, stroke units and complications B 10:30 - 10:40 Flow augmentation to prevent malignant MCA infarction in subjects presenting with moderate to large ischemic cores A.M. Demchuk1, J. Modi2, M. Eesa3, T. Stewart4, K. Zander5, K. Thackeray6, A. Shuaib7, M. Goyal8 for the SENTIS Trial Investigators University of Calgary, Calgary, CANADA1,University of Calgary, Calgary, CANADA2, Uni-versity of Calgary, Calgary, 3, University of Calgary, Calgary, CANADA4, Co-Axia, Inc., Maple Grove, USA5, NAMSA, Minneapolis, USA6, University of Alberta, Edmonton, CANADA7, University of Calgary, Calgary, CANADA8 Background and Purpose- Hemicraniectomy is a proven treatment for malignant MCA in-farction by decompressing infarcted brain preventing herniation and by improving perfusion pressure/collateral flow limiting infarct expansion. A novel catheter treatment (NeuroFlo) also produces flow augmentation which increases cerebral blood flow/volume without producing in-creased hemorrhagic risk. A post-hoc analysis sought to compare the impact of NeuroFlo versus control in the SENTIS trial for “malignant” outcomes in subjects with moderate/large baseline ischemic cores in the MCA territory defined by interpretation of CT early ischemic changes us-ing baseline ASPECTS. Methods—The SENTIS trial baseline CT scans were interpreted by consensus for baseline AS-PECTS blind to treatment assignment and outcome. An ASPECTS>=7 is a small core while an ASPECTS<7 is a moderate/large core in the MCA territory. Clinical outcome defined by 3 month mRS. Results—Of the 515 patients enrolled in the SENTIS trial. A total of 145 subjects had a pre-ran-domization “moderate/large ischemic core” of baseline ASPECTS <7 . There were no imbal-ances in any baseline characteristics (77 in treatment arm and 68 in non-treatment arm). mRS 5-6 was seen in 21.4% of treatment arm and 35.8% of non-treatment arm (mRS 0-2/3-4/5-6 (3-level shift) in the two treatment arms p-value 0.3429 (Cochran-Mantel-Haenszel test); mRS 3-4 vs. 5-6 in the two treatment arms p-value 0.0262 (Chi-square test)). A large core baseline ASPECTS <5 (n=48) revealed an mRS 5-6 in 17.4% of treatment arm and 40% of non-treat-ment arm (p=NS). Conclusions—This post-hoc exploratory analysis of the SENTIS trial using NeuroFlo flow augmentation suggests a potential effect on preventing a “malignant” outcome in subjects with baseline moderate-large or large infarct cores as determined by prerandomization ASPECTS. Flow augmentation holds promise as an option for such patients, since endovascular thrombec-tomy is more suitable for small ischemic cores. 112 © 2013 S. Karger AG, Basel Scientific Programme


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