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260 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 7 Vascular imaging Internal Cerebral Vein Asymmetry on Follow-up Computerized Tomographic Angiography after Intravenous Thrombolysis in Acute Anterior Circulation Ischemic Stroke is Associated with Poor outcome V.K. Sharma1, H.L. Teoh2, B.P.L. Chan3, R.C. Seet4, P.R. Paliwal5 National University of Singapore, Singapore, SINGAPORE1, National University Health System, Singapore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, National University of Singapore, Singapore, SINGAPORE4, National University of Singapore, Singapore, SINGAPORE5, National University of Singapore, National University of Singapore, SINGAPORE6 Background- Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. We hypothesized that venous drainage would be impaired in patients with acute occlusion of ICA or MCA. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other and consistently seen on CTA. Even minor asymmetry in their filling can be identified. Since systemic thrombolysis can alter the vascular findings in patients who achieve arterial recanalization, we evaluated the relationship between ICV asymmetry on fol-low- up CTA and functional outcome. Methods- Consecutive AIS patients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/ neurora-diologists. Functional outcome was assessed by modified Rankin Scale (mRS) at 3-months, dichoto-mized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome. Results- Of 2238 patients with AIS, 226 (10.1%) anterior circulation AIS patients received intrave-nous thrombolysis. Median age 65yrs (range 19-92), 44% males and median National Institute of Health Stroke Scale (NIHSS) 16-points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) while 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was as-sessed in 103 (45.5%) patients. Admission NIHSS score (OR1.08;95%CI 1.001-1.157,p=0.048) and ICV asymmetry on follow-up CTA (OR 23.9;95%CI 5.15-63.99,p <0.0001) predicted poor outcome at 3-months. Conclusion- ICV asymmetry on follow-up CTA after intravenous thrombolysis can serve as an early predictor of poor functional outcome. 6 Vascular imaging Progression of Intracranial Stenosis: Transcranial Doppler (TCD) Diagnosis Y.S. Lee1, D. Kim2, J. Moon3 SMG-SNU Boramae Medical Center, Seoul, SOUTH KOREA1, SMG-SNU Boramae Medical Center, Seoul, SOUTH KOREA2, SMG-SNU Boramae Medical Center, Seoul, SOUTH KOREA3 Background: Progression of intracranial stenosis may increase the risk of stroke, therefore adequate diagnosis is important. TCD may be useful for this purpose, however, optimal diagnostic criteria have not been defined well. We compared long-term TCD changes with MRA to validate TCD cri-teria for progression of stenosis. Methods: We retrospectively review the patients who underwent TCD and MRA simultaneously and followed-up longer than 1-year interval. Stenosis was diagnosed with MRA and the degree was graded as normal, mild, moderate, severe or occlusion by two neurol-ogists independently. Progression was defined by the change of the grade in follow-up MRA. Incre-ment of mean flow velocity (> 20cm/s; velocity criteria) or percent change (> 20%; percent criteria) was validated. Results: Among 164 patients included (84 males, mean age 64 years, mean fol-low- up period 35 months), 245 middle cerebral (MCA) and 161 basilar arteries (BA) were analyzed. Progression was observed in 5.7% among MCA and 5.0% among BA. Increment of mean flow ve-locity was 16cm/s and 30cm/s in progression group respectively (p<0.05). According to ROC anal-ysis, AUC for progression was 0.718 (p=0.006) in MCA and 0.851 (p=0.001) in BA. Sensitivity and specificity with velocity criteria were 29%/94% in MCA and 75%/94% in BA. With percent criteria, sensitivity and specificity were 43%/85% in MCA and 88%/80% in BA. Conclusion: Diagnosis of progression in intracranial stenosis is feasible with TCD and the diagnostic yield is better in BA than in MCA. Specificity is higher with velocity criteria while sensitivity is higher with percent criteria. These results need to be validated with a well-designed prospective study.


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