London, United Kingdom 2013 7 Interventional neurology B 9:30 - 9:40 Does Transfer Status Affect Outcomes in Acute Ischemic Stroke Patients Treated Endo-vascularly? Cerebrovasc Dis 2013; 35 (suppl 3)1-854 179 Y. Curran1, M. Soltanolkotabi2, S.K. Prabhakaran3, R.A. Bernstein4, J.J. Conners5, V. Lee6, M.C. Hurley7, S.A. Ansari8, A. Shaibani9 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, Rush University Medical Center, Chicago, USA5, Rush University Medi-cal Center, Chicago, USA6, Northwestern University Feinberg School of Medicine, Chicago, USA7, Northwestern University Feinberg School of Medicine, Chicago, USA8, Northwestern University Feinberg School of Medicine, Chicago, USA9 Background:Access to intra-arterial therapy for acute ischemic stroke is limited to compre-hensive stroke centers with timely access deemed critical for success. Inter-hospital transfers represent a growing subset of patients in which outcomes have not been well-studied. Meth-ods: We retrospectively analyzed consecutive anterior circulation AIS patients that underwent IAT at 4 institutions from 2006-2011. We excluded patients selected using perfusion imag-ing. Patient demographics, medical risk factors, presentations, technical, and clinical(NIHSS and mRS scores)outcomes, complications, and mortality were studied. Symptom-onset, groin puncture, and end-of-procedure times were recorded. THRIVE scores were calculated. Suc-cessful recanalization was defined as TICI≥2b. Good functional outcome was defined as mRS 0-2 at 90 days. Patients were categorized into those who were transferred from outside insti-tutions and those who presented directly to the CSCs. Results:Of 116 patients were studied, 68(58.6%)were transferred from outside institutions. Transfers and non-transfers were sim-ilar in THRIVE scores(p=0.300), median symptom-onset to groin puncture times (306 vs. 315 minutes;p=0.572), successful recanalization(p=0.574), and symptomatic ICH(13.2 vs. 10.4,p=0.776), but differed by age(59 vs. 69 years;p=0.002), prior stroke(3% vs. 22%;p=0.002), cardiac history(17.9 vs. 36.6%, p=0.040), baseline NIHSS(20 vs. 17;p=0.005), and location of occlusion(45.6% vs. 22.9% ICA;p=0.012). Transfer patients had significantly worse outcomes at 90 days(mRS 0-2:16.2% vs. 60.4%;p<0.001). In multivariate analysis, transfer status was an independent predictor of poor functional outcome(adj. OR 0.05,0.011-0.222), adjusting for rele-vant covariates. Conclusion:Transferred AIS patients have worse functional outcomes at 90days than non-transfers, independent of baseline risk factors, stroke severity, time to IAT, and pro-cedural success/complications. Further investigation should focus on residual factors that may contribute to our findings such as baseline/final infarct volumes, pre-morbid functional status, and post-stroke care including rehabilitation. 6 Interventional neurology B 9:20 - 9:30 Relationships between DWI-ASPECTS Score , Recanalization and Clinical Outcome after Endovascular Treatment J-M. Olivot1, M. Inoue2, J. Labreuche3, A. Tai4, J.P. Desilles5, A. Rouchaud6, I. Klein7, M. Mlynash8, P. Amarenco9, M. Mazighi10 Stanford Stroke Center, Stanford, USA1,Stanford Stroke Center, Stanford, USA2, Centre Accueil et Traitement Attaque Cerebrale, Hopital Bichat et Inserm U 698 Paris Diderot Univer-sity, Paris, FRANCE3, Stanford Stroke Center, Stanford, USA4, Centre Accueil et Traitement Attaque Cerebrale, Hopital Bichat et Inserm U 698 Paris Diderot University, Paris, FRANCE5, Centre Accueil et Traitement Attaque Cerebrale, Hopital Bichat et Inserm U 698 Paris Diderot University, Paris, FRANCE6, Centre Accueil et Traitement Attaque Cerebrale, Hopital Bichat et Inserm U 698 Paris Diderot University, Paris, FRANCE7, Stanford Stroke Center, Paris, FRANCE8, Centre Accueil et Traitement Attaque Cerebrale, Hopital Bichat et Inserm U 698 Paris Diderot University, Paris, FRANCE9, Centre Accueil et Traitement Attaque Cerebrale, Hopital Bichat et Inserm U 698 Paris Diderot University, Paris, FRANCE10 Background: In patients treated for an acute ischemic stroke (AIS) by intravenous thromboly-sis, a low DWI ASPECTS score (<7) is an independent factor of poor outcome. We investigated in AIS patients, the relationship between the DWI ASPECTS at baseline and clinical outcomes according to recanalization rate achieved by endovascular treatment. Methods: Consecutive patients who suffered an AIS complicating a baseline ICA or MCA occlusion treated by endo-vascular treatment and imaged by acute DWI at Bichat University Hospital were included. AS-PECTS score was assessed by two stroke neurologist blinded from clinical information and di-chotomized into low (<7) and high (≥7). Recanalization rate was assessed by TIMI score. TIMI 3 defined a complete recanalization. Poor outcome was defined as a modified Rankin Scale (mRS)>2 at 90 days. Results: 129 patients were enrolled. The median delay from onset to MRI was 110 minutes (interquartile rangeIQR, 75-178). Median ASPECTS score was 6 (IQR, 5-8). A complete recanalization was achieved in 59 (46%) patients after a median (IQR) delay from symptom onset of 240 (208-282) minutes. Patients with complete recanalization had a higher ASPECTS score (median, 7; IQR, 5-9) than patients without (median, 6; IQR, 3-8; P=0.005). By comparison with patients with a high ASPECTS score (n=64), a low ASPECTS score (n=65) was associated with a higher rate of poor outcome (62% vs. 37%, p<0.005; crude OR, 2.78; 95%CI, 1.35-5.68). After adjustment on age and admission NIHSS score, this relationship remained significant (adjusted OR, 2.70; 95%CI, 1.09-6.73). When analysis was stratified ac-cording to complete recanalization, a low ASPECTS score was associated with poor outcome in patients who did not fully recanalize (TIMI 0-2) (43% vs. 17%; p=0.016), but not in those who experienced a complete recanalization (74% vs. 77%, p=0.78). Conclusion: A low DWI ASPECTS score is associated with a poor outcome in patients who underwent endovascular treatment. This relationship was not observed in patients who experienced a complete recanali-zation.
Karger_ESC London_2013
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