London, United Kingdom 2013 10 Interventional neurology A 14:30 - 14:40 CONTRAST EXTRAVASATION AFTER ENDOVASCULAR THROMBOLYTIC THERAPY OF ISCHEMIC STROKE: A STUDY WITH DUAL ENERGY CT. A. Renú1, H. Ariño2, L. Llull3, A. López4, S. Amaro5, X. Urra6, A. Cervera7, V. Obach8, A. Chamorro9 Hospital Clínic, Barcelona, SPAIN1,Hospital Clínic, Barcelona, SPAIN2, Hospital Clínic, Barcelona, SPAIN3, Hospital Clínic, Barcelona, SPAIN4, Hospital Clínic, Barcelona, SPAIN5, Hospital Clínic, Barcelona, SPAIN6, Hospital Clínic, Barcelona, SPAIN7, Hospital Clínic, Bar-celona, SPAIN8, Hospital Clínic, Barcelona, SPAIN9 Background The presence of CT hyperdensities after endovascular thrombolytic therapy (ETT) of ischemic stroke is a common finding with uncertain clinical significance, and the differentiation between contrast extravasation and brain hemorrhage is challenging. Dual Energy CT (DE-CT) is a novel technique that allows an accurate differentiation between these hyperdensities. The objec-tive of the study was to evaluate the clinical significance of the presence of CT hyperdensities after ETT in a cohort of patients studied with DE-CT. Methods A prospective cohort of 93 patients treated with ETT (42 primary ETT, 51 rescue ETT) was an-alyzed. According to DE-CT findings, patients were classified into three groups: no hyperdensi-ty (non-HD, n=37), contrast extravasation alone (CE, n=22) and brain hemorrhage (BH, n=34). Dramatic early recovery (DER) was defined as 8 points NIHSS decrease or 0-2 score at 24h. The rate of new hemorrhagic transformations (HT) was recorded at follow-up neuroimaging. Outcome was evaluated at 90 days with the Rankin Scale (bad outcome 3-6). Results Baseline variables were similar among the defined DE-CT groups. The rate of DER was sig-nificantly lower in CE (40%) and BH (22%) compared to non-HD group (65%). Moreover, patients with CE disclosed a higher incidence of delayed HT at follow up neuroimaging (36%) compared to non-HD patients (15%). The rates of bad outcome at 90 days were 27% in no-HD group, 68% in CE group and 68% in BH group (p=0.001). In multivariate models adjusted by the effect of confounders (age, NIHSS and ETT modality), both the presence of CE (OR 15.8; 95% CI 3.18-78.94) and BH (OR 11.8; 95%CI 2.93-47.29) remained as independent predictors of bad outcome. Conclusions Contrast extravasation on DE-CT is a harbinger of BH in thrombolysed patients and it is associ-ated to bad clinical outcome. These results further support the clinical relevance of blood brain Cerebrovasc Dis 2013; 35 (suppl 3)1-854 149 barrier disruption in acute stroke. 18 Rehabilitation and reorganisation after stroke B 15:50 - 16:00 Ischemic infarctions of frontal operculum significantly interfere with recovery from dys-phagia. M. Galovic1, G. Kägi2, N. Leisi3, M. Müller4, J. Weber5, E. Abela6 Cantonal Hospital St. Gallen, Sankt Gallen, SWITZERLAND1,Cantonal Hospital St. Gal-len, Sankt Gallen, SWITZERLAND2, Cantonal Hospital St. Gallen, Sankt Gallen, SWITZER-LAND3, Cantonal Hospital St. Gallen, Sankt Gallen, SWITZERLAND4, Cantonal Hospital St. Gallen, Sankt Gallen, SWITZERLAND5, University Hospital Bern, Bern, SWITZERLAND6, Cantonal Hospital St. Gallen, Sankt Gallen, SWITZERLAND7 Background: This longitudinal lesion study aims to define the supratentorial neuronal network underlying swallowing and to establish MRI based predictors of impaired recovery from dys-phagia in ischemic stroke patients. Methods: A review of the literature yielded 11 supratento-rial regions of interest (ROI) related to swallowing. Atlas-based localization analysis of these ROIs was performed in consecutive patients with MRI-proven first-time acute supratentorial stroke. Standardized swallowing assessment was carried out within 48 hours and 8-10 days after admission. Results: In a prospective analysis of 94 patients, 34 (36%) were classified as having acute dysphagia, which was prolonged (>7 days) or transient (<=7 days) in 17 (18%) cases respectively. There were no between group differences in age, gender, stroke etiology, risk factors, pre-stroke disability, lesion side or the degree of age related white matter changes. The NIH Stroke Scale (7,5+-11 vs. 4+-6, p=0.008) and the lesion size (21ml+-59 vs. 6ml+-17, p=0.002) were shown to be location-independent predictors of dysphagia. Correcting for these two confounders with a multiple logistic regression model, significant adjusted odds ratios (aOR) of acute dysphagia were demonstrated for the internal capsule (aOR=5.3, p=0.003), the insular cortex (aOR=3.7, p=0.012) and the periventricular white matter (aOR=3.5, p=0.012). In a multivariate model of prolonged vs. transient dysphagia significant odds were demonstrat-ed only for the frontal operculum (aOR=37.4, p=0.007). Conclusions: The insular cortex, the internal capsule and the periventricular white matter represent critical nodes of the supraten-torial neuronal network underlying swallowing. Lesions of these regions are associated with significantly elevated odds of acute dysphagia. Lesions of the frontal operculum substantially influence the recovery of swallowing function in dysphagic stroke patients, whereas dysphagia tends to be transient in subcortical stroke. 14:30-16:00 Oral Session Room 17 Interventional neurology A Chairs: R. Ackrman, USA and I. Linfatne, USA
Karger_ESC London_2013
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