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22. European Stroke Conference 12 Interventional neurology A 14:50 - 15:00 The initial state of leptomeningeal collaterals versus successful reperfusion: which param-eter better predicts favorable outcome following endovascular revascularization? J.C. Gerber1, V. Puetz2, P. Krukowski3, M. Hruba4, A. Abramyuk5, A. Bormann6, I. Dzialows-ki7, U. Bodechtel8, K. Engellandt9, H. Kitzler10, M. Kuhn11, H. Schneider12, R. von Kummer13 University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neurora-diology, Dresden, GERMANY1,University Hospital Carl Gustav Carus at the Technische Uni-versitaet Dresden, Neurology, Dresden, GERMANY2, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY3, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY4, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY5, University Hospital Carl Gustav Carus at the Tech-nische Universitaet Dresden, Neuroradiology, Dresden, GERMANY6, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neurology, , 7, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neurology, Dresden, GERMANY8, Uni-versity Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY9, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY10, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Informatics and Biometrics, Dresden, GERMANY11, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY12, Uni-versity Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Neuroradiology, Dresden, GERMANY13 Background Reliable criteria are needed to decide for endovascular therapy (EVT) in acute ischemic stroke (AIS) patients. The leptomeningeal collateral status (CS) may be prognostic for good outcome in AIS patients. We assessed CS on CT angiography (CTA) and the reperfusion grade after EVT in stroke patients to compare their predictive power for favorable outcome. Methods Consecutive patients with AIS in the anterior circulation and with pre-therapeutic CTA who had EVT between 01/2010 and 12/2011 were included in this retrospective study. Reperfusion grade (Thrombolysis in Cerebral Infarction TICI, 0 “no reperfusion” to 3 “full perfusion”) and CS (0 “no collaterals” to 3 “complete and quick collateralization”) were rated independent-ly and blinded to clinical data. We used analysis of variance and logistic regression to compute predictive values of CS and TICI for favourable functional outcome (modified Rankin Scale scores 0-2) at 3 months. Results We included 73 patients (42 men (57%); median age 69 years (range 36-90); median NI-HSS score 16 (8-34). The initial collateral status of patients was: CS 0: n=3 (4.1%), CS 1: n=7 (9.6%), CS 2: n=40 (54.8%), CS 3: n=22 (30.1%). Reperfusion grades were: TICI 0: n=7 (9.6%), TICI 1: n=4 (5.5%), TICI 2a: n=18 (24.7%), TICI 2b: n=34 (46.6%), TICI 3: n=10 (13.7%). At 3 months, 18 patients had a favourable outcome (27.7%) and 15 patients had died (23.1%). In univariate analysis CS (p=0.05) and TICI (p=0.00) predicted favorable functional outcome. However, in multivariate logistic regression only successful reperfusion (TICI 2/3) (p=0.011) but not CS (p=0.118) predicted favorable outcome. Conclusion Pre-therapeutic leptomeningeal collateral status on CT-angiography did not predict favorable outcome after endovascular revascularization in patients with anterior circulation ischemic stroke. In line with previous results successful reperfusion was an independent predictor of fa-vorable outcome in our patient cohort. 11 Interventional neurology A 14:40 - 14:50 Perfusion-based selection leads to improved outcomes compared with time-based selection for endovascular reperfusion therapy in acute ischemic stroke Y. Curran1, M. Soltanolkotabi2, S.K. Prabhakaran3, R.A. Bernstein4, M.A. Alberts5, V. Lee6, J.J. Conners7, M.C. Hurley8, S.A. Ansari9, A. Shaibani10 Northwestern University Feinberg School of Medicine, Chicago, USA1,Northwestern University Feinberg School of Medicine, Chicago, USA2, Northwestern University Feinberg School of Medicine, Chicago, USA3, Northwestern University Feinberg School of Medicine, Chicago, USA4, Northwestern University Feinberg School of Medicine, Chicago, USA5, Rush University Medical Center, Chicago, USA6, Rush University Medical Center, Chicago, USA7, Northwestern University Feinberg School of Medicine, Chicago, USA8, Northwestern Univer-sity Feinberg School of Medicine, Chicago, USA9, Northwestern University Feinberg School of Medicine, Chicago, USA10 Background:Controversy exists on the role of perfusion imaging-based selection of patients with acute ischemic stroke for endovascular reperfusion therapy. We hypothesized that perfu-sion imaging based selection would improve functional outcomes at 3 months compared to time based selection alone. Methods:We reviewed data from consecutive AIS patients treated with ERT at 4 centers from 2006-2011. We excluded patients with initial NIHSS score<8 and those with posterior circulation occlusions. We collected data on demographics, initial NIHSS score, IV tPA, use of perfusion imaging(CT/MRI), time from onset to groin puncture, initial and fi-nal reperfusion grade using the TICI scale,procedural complications using ECASS criteria,and functional outcome defined as mRS 0-2 at 3 months. Using univariable statistics and multivari-able logistic regression, we assessed whether patients who underwent perfusion imaging had better outcomes than those selected based on time alone. Results:185 patients(mean age 66.7 y;median NIHSS 19;MCA occlusion 73%, and ICA occlusion 27%)were included. TICI 2b/3 reperfusion grade was achieved in 49.7% while symptomatic hemorrhage(PH1/PH2/perfora-tion) occurred in 10.8%. Good outcome at 3 months was seen in 41.7%. Perfusion imaging was used in 69(37.3%)patients(45 CT/24 MRI)and was associated with increased onset-to-groin puncture time(359 vs. 298 min,P=0.019). Patients who underwent perfusion imaging were also older(73vs.63 y,P<0.001). Those who underwent perfusion imaging were more likely to have good outcome(53.6 vs. 34.5%,P=0.011). In multivariable analysis, perfusion imaging remained a predictor of good outcome(adj. OR 2.35, 95% CI 1.17-4.72), independent of initial NIHSS score(adj. OR 0.91,95% CI 0.86-0.97), TICI 2b/3(adj. OR 4.94, 95 CI 2.50-9.76), and IV tPA use(adj. OR 2.50,95% CI 1.26-4.94). Conclusions:In this multi-center study, AIS patients who underwent perfusion imaging were over 2-fold more likely to have good outcome following ERT despite a delay in time to treatment and age imbalance between groups. Further studies should continue to address the optimal perfusion imaging thresholds for patient selection for ERT. 150 © 2013 S. Karger AG, Basel Scientific Programme


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