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London, United Kingdom 2013 14 Interventional neurology A 15:10 - 15:20 Mechanical recanalization for acute ischemic stroke: evolution of technique and materials during a 4-year experience at University Medical Centre Ljubljana, Slovenia M. Jeromel1, Z.V. Milosevic2, A. Resman-Gaspersic3, V. Svigelj4, K. Surlan-Popovic5, B. Zvan6 Clinical Institute of Radiology, Department for Diagnostic and Interventional Neurora-diology, University medical centre Ljubljana, Ljubljana, SLOVENIA1,Clinical Institute of Radiology, Department for Diagnostic and Interventional Neuroradiology,University medical centre Ljubljana, Ljubljana, SLOVENIA2, Division Vascular and Intensive Neurology, Depart-ment of Neurology, University medical centre LJubljana, Ljubljana, SLOVENIA3, Division Vascular and Intensive Neurology, Department of Neurology, University medical centre LJu-bljana, Ljubljana, SLOVENIA4, Clinical Institute of Radiology, Department for Diagnostic and Interventional Neuroradiology,University medical centre Ljubljana, Ljubljana, SLOVENIA5, Division Vascular and Intensive Neurology, Department of Neurology, University medical centre LJubljana, Ljubljana, SLOVENIA6 Background: Endovascular mechanical recanalization technique, materials and duration have an important impact on overall stroke patient outcome. Evolution of technique and materials during a 4-year experience at our tertiary institution were analyzed. Patients and methods: 138 patients (57 during first two, 31 during third and 50 during fourth year) with acute ischemic stroke were treated with mechanical recanalization (thrombectomy). All kind of devices (permanent stents, retrievers, aspiration systems, stent-retrievers) used by four skilled interventional neuroradiologists were analyzed. Successful recanalization rate (de-fined as Thrombolysis in cerebral infarction - TICI - score 2b and 3), procedure duration time (time from procedure onset to recanalization), as well as procedure-related complication rate were analyzed. Results: A successful recanalization was achieved in 72 %, 93 % and 92 % of patients treated during first two, third and fourth year. During first two years, flow restoration was achieved with permanent intracranial stent implantation in 33 % of patients. The need for permanent stent implantation in intracranial arteries diminished to 9.7 % and 6 % during the following two years. Stent-retriever devices were more commonly used as a primary option device during following years and were used as a single device for intracranial thrombectomy in 83 % of pa-tients treated during the fourth year. According to improvement of technique and materials, median procedure duration time shortened from 107 min to 56 min (intequartile range from 34.5 to 73 min) and 42.5 min (interquartile range from 35 to 53 min). Procedure-related com-plication rate also reduced from 5.0 % to 3.3 % and 2 % during studied years. Conclusion: Our experiences prove that endovascular mechanical revascularization performed by skilled interventional neuroradiologists can be effective and safe procedure for intracranial large vessel occlusion in subset of acute stroke patients. Evolution of endovascular technique and materials in recent years resulted in significant reduction of median procedure duration time and procedure-related complication rate. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 151 13 Interventional neurology A 15:00 - 15:10 ENDOVASCULAR THERAPY FOR ACUTE ISCHEMIC STROKE AND THE ROLE OF INTRA-ARTERIAL VASODILATORS. Department of Neurology, Upstate Medical University, Syracuse, NY, United States Z. El Zammar1, R Sangha2, J.G Latorre3, K Patel4, A Sood5 Upstate Medical University, Syracuse, USA1,Upstate medical University, syracuse, USA2, Upstate medical University, syracuse, USA3, Upstate medical University, syracuse, USA4, Up-state medical University, syracuse, USA5 Introduction: Intra-arterial therapy (IAT) for acute ischemic stroke (AIS) using Intra-arterial (IA) rt-PA +/- thrombectomy is an option for those who are either not candidate or failed Intra-venous (IV) rt-PA. Little is known about age specific outcomes. Our objectives are to describe radiographic and clinical outcomes in a cohort of AIS patients who underwent IAT and evaluate the role of IA vasodilators in reperfusion therapy. Methods: Consecutive patients underwent IAT between 12/2006-07/2012 were enrolled. Pa-tients demographic, baseline and 24 hour NIHSS, use of IA thrombolytic, mechanical devices, and vasodilator use, 30 day modified Rankin Scale (mRS), radiological outcomes were re-corded. Radiological outcomes 24 hour head CT and Thrombolysis in myocardial infarction (TIMI) grading at the time of intervention and clinical outcomes 24 hour NIHSS and 30 day mRS were compared between vasodilator (VD) and non-vasodilator (NVD) groups. Results: Fifty-three AIS patients 60% male; mean age 59.8 ± 14.8; median baseline NIHSS 19 (9-40) received IAT. Fifteen patients failed IV rt-tPA, IA rt-tPA was given in 41, thrombectomy was used in 42, and 20 patients received IA VD (15 Verapamil; 5 Nitro-glycerine). Partial to complete reperfusion (TIMI II-III) was seen in 70% of the whole cohort. TIMI III was observed in 60% of VD group vs. 27% in NVD group; P = 0.01. VD use was associated with higher TIMI III OR 3.8; 95%CI, 1.04 - 14.03; P = 0.03.In the whole cohort, good outcomes were observed in 49% on mRS (0-3) and in 58% on 24 hr NIHSS (drop in score by >4 points from baseline). An increase chance of good mRS by 8% per year younger than 60 yr (P=0.03) was seen. No observed significant difference in the rate of good outcome between VD and NVD groups. Conclusions: IAT for AIS achieved a high rate of reperfusion in our cohort. IA vasodilators use was associated with higher rate of complete reperfusion. However, there was no difference in the rate of good outcome between VD and NVD groups. Younger age had an increased chance for better functional outcome. More studies are needed to further evaluate the role of IA vasodi-lators in AIS management.


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