London, United Kingdom 2013 Cerebrovasc Dis 2013; 35 (suppl 3)1-854 13 7 Acute stroke: current treatment & new treatment concepts 9:30 - 9:40 Diffusion-weighted imaging-lesion score of the brain stem as a predictor of functional out-come in acute basilar artery occlusion treated by mechanical thrombectomy with a Soli-taire stent D. Milhaud1, P. Machi2, A. Bonafé3, C. Arquizan4, M. C. Picot5, C. Heroum6, I. Mourand7, Department of neurology, Gui de Chauliac, Montpellier University Hospital, Montpellier, FRANCE1,Department of neuroradiology, Gui de Chauliac, Montpellier University Hospital, Montpellier, FRANCE2, Department of neuroradiology, Gui de Chauliac, Montpellier Universi-ty Hospital, Montpellier, 3, Department of neurology, Gui de Chauliac, Montpellier University Hospital, Montpellier, FRANCE4, Medical information Department, Gui de Chauliac, Montpel-lier University Hospital, Montpellier, FRANCE5, Department of neurology, Gui de Chauliac, Montpellier University Hospital, Montpellier, FRANCE6, Department of neurology, Gui de Chauliac, Montpellier University Hospital, Montpellier, FRANCE7 Background Early recanalization remains the main prognostic factor in acute basilar artery oc-clusion (ABAO). The baseline and location of brain stem ischemic damage may also influence outcomes. We evaluated the safety and efficacy of mechanical thrombectomy in ABAO and the validity of easy-to-use pre-treatment diffusion-weighted-imaging (DWI) to predict clinical out-comes. Materials and Methods This prospective study included 31 patients with ABAO, treated within 24 h of symptom onset with a Solitaire device. Initial MRI with DWI sequences was used to assess a new 12-point semiquantitative brain stem score that separately considered each side of the medullary, pons, and midbrain. Recanalization rates after stent retrieval were deter-mined. Clinical outcomes and mortality rates were assessed 180 days after treatment. Results The mean patient age was 61 years. Median pre-thrombectomy NIHSS score was 38. Success-ful recanalization (TICI 3-2b) was achieved in 23 (74%) patients. Five symptomatic intracranial hemorrhages occurred and ten symptomatic thrombotic distal migrations. A favorable outcome (mRS ≤2) was observed in 35% of patients. Overall mortality rate was 32%. According to ROC analysis, the optimal cutoff score for predicting a favorable outcome was a DWI brain stem score <3 (sensitivity 85%, specificity 64%, positive predictive value 81%, negative predictive value 70%). The cutoff score was the same for poor outcome (mRS 5-6). The interobserver reli-ability of the DWI-score was excellent with a correlation coefficient of 0.97 (0.96-0.99). In uni-variate analysis, elevated baseline glucose (p=0.008) was significantly associated with a poor outcome (mRS >2). Patients with successful recanalization tended to have better outcomes. Conclusion The Solitaire device can rapidly and effectively contribute to high recanalization and improve functional outcomes in ABAO with an acceptable complication rate. A brain stem DWI score of >3 was an additional predictor for a poor outcome. 8 Acute stroke: current treatment & new treatment concepts 9:40 - 9:50 Effect of metoclopramide on survival, aspiration, hypoxia and pneumonia in acute stroke patients fed via nasogastric tubes A.B. Warusevitane1, D.S. Karunatilake2, C. Roffe3 University Hospital of North Staffordshire, Stoke on Trent, UNITED KINGDOM1,Taunton and Somerset NHS Trust, Taunton, UNITED KINGDOM2, University Hospital of North Staf-fordshire, Stoke on Trent, UNITED KINGDOM3 Introduction Aspiration pneumonia is a major cause of mortality and morbidity in stroke patients fed via nasogastric tubes (NGTs). The aspirate is derived either directly from the oropharyngeal tract secondary to dysphagia or from the stomach due to gastro-oesophageal regurgitation and low-er oesophageal sphincter dysfunction. The latter is enhanced by the presence of an NGT, and gastroparesis secondary to stroke. As a D2 receptor antagonist of the upper gastrointestinal tract metoclopramide increases lower oesophageal sphincter tone and forward gastric peristalsis. The aim of the study was to assess whether regular treatment with metoclopramide reduces aspira-tion pneumonia and hypoxia in this patient group. Method Double blind randomised controlled trail. Patients within 7d of stroke onset and 48h of inser-tion of a NGT who have no signs of pneumonia were randomised to 10mg metoclopramide (M) or placebo (P) three times daily via the NGT for 21d or until the nasogastric feeds were discontinued. Patietns were examined daily for clinical signs of pneumonia, and all witnessed episodes of aspiration were recorded. Oxygen saturation was recorded daily. Pneumonia was diagnosed if the patient had clinical signs of pneumonia, high inflammatory markers and new radiological infiltrates in the chest radiograph. Results Sixty patients (mean age 78 years, 38 females, mean NIHSS 19) were randomised (metoclo-pramide n=30, placebo n=30). There was a significant reduction in witnessed aspiration M/P 01(03%)/14(47%), mean of lowest recorded oxygen saturation M/P 93.87%/85.14% (p <0.001) and pneumonia M/P 08/26 (p <0.001) in patients who were treated with metoclopramide. There were more survivors in the treatment group at 30 days though it was not statistically significant (M/P 22/18, absolute risk reduction 13). Conclusion Metoclopramide significantly reduced mortality, aspiration, hypoxia, and pneumonia in stroke patients fed via nasogastric tubes.
Karger_ESC London_2013
To see the actual publication please follow the link above