222 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel Table 1. Baseline characteristics and univariable analysis of predictors of fa-vorable outcome Total (n=112) Favorable outcome (n=53) Unfavorab-le outcome (n=59) P Sex, male 64(57) 35(66.0) 29(49.2) 0.071 Age, y 69.1±10.4 67.1±10.5 70.9±10.1 0.053 Old cerebrovascular accident 51(45.5) 23(43.4) 28(47.5) 0.667 Diabetes Mellitus 32(28.6) 13(24.5) 19(32.2) 0.369 Hypertension 70(62.5) 27(50.9) 43(72.9) 0.017† Atrial fibrillation 60(53.6) 19(35.8) 41(69.5) <0.001† Initial systolic blood pressure, mmHg 146.0±27.2 145.1±26.5 146.7±28.0 0.76 Initial glucose, mg/dl 146.4±53.0 150.6±61.3 142.6±44.3 0.43 Baseline NIHSS 17(12,20) 13(11,19) 17(14,21) 0.001 Initial occlusion site 0.048† ICA 49(43.8) 18(34.0) 31(52.5) MCA 63(56.3) 35(66.0) 28(47.5) Treatment 0.104 IAT 47(42.0) 18(34.0) 29(49.2) IV tPA + IAT 65(58.0) 35(66%) 30(50.8) Onset to treatment, minute 251.5±87.3 248.4±92.1 254.2±83.4 0.726 Recanalization (TICI≥2b) 71(63.4) 42(79.2) 29(49.2) 0.001† ASPECS>7 63(56.3) 45(84.9) 18(30.5) <0.001† †Significant. NIHSS indicates National Institutes of Health Stroke Scale; ICA, Internal ca-rotid artery; MCA, Middle cerebral artery; IAT, Intra-arterial therapy; IV-tPA, Intravenous tissue plasminogen activator; TICI, Thrombolysis in cerebral in-farction; ASPECTS, Alberta Stroke Program Early CT Score 3 Acute stroke: current treatment Different effect of recanalization according to the baseline Alberta Stroke Program Early CT Score in intra-arterial therapy of acute ischemic strokes D. Song1, T.J. Song2, H.S. Nam3, Y.D. Kim4, J.H. Heo5 Yonsei University College of Medicine, Seoul, SOUTH KOREA1, Yonsei University College of Medicine, Seoul, SOUTH KOREA2, Yonsei University College of Medicine, Seoul, SOUTH KO-REA3, Yonsei University College of Medicine, Seoul, SOUTH KOREA4, Yonsei University College of Medicine, Seoul, SOUTH KOREA5 Introduction As recanalization rate has become higher with recent advances in endovascular devices, intra-arterial therapy (IAT) is increasingly used in acute ischemic stroke. Although recanalization of the occluded artery is the powerful predictor of functional outcome, successful recanalization is not always translated to improved clinical outcome. The Alberta Stroke Program Early CT Score (ASPECTS), a systematic approach to quantify the extent of early ischemic change on CT within the MCA territory, has been confirmed to predict clinical response IAT. However the relationship between ASPECTS and recanalization effect on clinical outcome has not been clarified. Methods We retrospectively identified 112 consecutive anterior circulation stroke patients, who underwent IAT in our institution between January 2009 and May 2012. ASPECTS was measured retrospectively by two authors blinded to clinical information. Recanalization was defined as thrombolysis in cerebral infarction (TICI) ≥2b. Primary outcome was favorable outcome, defined as 90 day modified Rankin Score ≥2 Results The median baseline NIHSS was 17 (IQR, 12-20). 71(63%) were recanalized and 53(47%) achieved favorable outcome. In the univariable analyses, favorable outcome group had more frequent recanalization (79.2% vs. 49.2%; p=0.001) and more frequent >7 ASPECTS (84.9% vs. 30.5%; p<0.001). In the multivariable analysis adjusting for sex, age, hypertension, atrial fibril-lation, NIHSS, occlusion site, and onset to treatment time, both recanalization (OR, 6.7; 95% CI, 2.0-23.2; p=0.002) and >7 ASPECTS (OR, 9.9; 95% CI, 3.2-30.6; p<0.001) was independent pre-dictor of favorable outcome. In this model, significant interaction between recanalization and >7 ASPECTS was noted (p=0.067). Recanalization was independent predictor of favorable outcome in the patients with >7 ASPECTS (OR, 9.9; 95% CI, 2.4-41.6; p=0.002), but not in the patients with ≤7 ASPECTS (OR, 0.94; 95% CI, 0.9-10.2; p=0.959) Conclusion Effect of recanalization on clinical outcome is different according to the baseline ASPECTS in IAT of acute ischemic stroke. ASPECTS might be used to select proper IAT candidate.
Karger_ESC London_2013
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