262 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 10 Vascular imaging Cortical vein grading in anterior circulation proximal vessel occlusion – a predictor of collat-eral extent, perfusion and outcome? R. PARTHASARATHY1, M. KATE2, J . REMPEL3, A. SHUAIB4 UNIVERSITY OF ALBERTA HOSPITAL, EDMONTON, CANADA1, UNIVERSITY OF AL-BERTA HOSPITAL, EDMONTON, CANADA2, UNIVERSITY OF ALBERTA HOSPITAL, ED-MONTON, CANADA3, UNIVERSITY OF ALBERTA HOSPITAL, EDMONTON, CANADA4 Background: Presence of collateral blood channels are important in determining outcome in proxi-mal cerebral arterial occlusions. The blood flowing through the capillary bed reconstitute in the cor-tical veins in the involved territory. Quantifying venous outflow based on contrast reconstitution of cortical veins in patients with acute proximal occlusion may predict the collateral extent, perfusion and clinical outcomes at 90 days. Methods: We studied patients with a proximal occlusion in the anterior circulation and complete re-constitution of the venous sinuses upto the jugular vein bilaterally on imaging Computed Tomogra-phy angiography (CTA). There was an average cerebral transit time of 6.73 seconds for the contrast before the scanner reached the skull base. The superficial Superficial middle cerebral vein (SMCV), Vein of Labbe (VOL), Vein of trolard (VOT), Basal vein of Rosenthal (BVR) (included as part of superficial system as it drains the temporal lobe),and deep veins Internal Cerebral vein (ICV) and Thalamostriate vein (TSV) were scored based on contrast filling: 0 – none, 1 –intermediate and 2 – fully reconstituted. Superficial and deep vein composite hemispheric scores on the affected side and the inter-hemispheric score difference was computed. Results: Thirty nine patients were included in the study. A cortical 3 veins (SMCV+VOT+VOL) inter –hemispheric score difference (max -6; min -0) of 4 to 6 (p=0.019) and 4 veins (SMCV+VOT+VOL+BVR) inter -hemispheric score difference (max – 8; min – 0) of 4 to 8 (p=0.023) significantly predicted poor clinical outcome (mRS 3 to 6) on logistic regression analy-sis. A high score difference represented poor venous outflow from the affected hemisphere. While, admission NIHSS (p=0.032) predicted outcomes, ASPECTS (0.903), insular cortex involvement (p=0.313) and CTA collateral grading based on Miteff et.al. (p=0.396) did not. Conclusion: Evaluation of the venous flow pattern predicts outcome especially in patients with mod-erate collateral status. Further prospective studies will help in determining if the venous score de-scribed above will help in determining prognosis in acute stroke. 9 Vascular imaging The association between intraplaque hemorrhage and plaque ulceration in atherosclerotic plaques of the carotid arteries A.C. van Dijk1, M.T.B. Truijman2, B. Hussain3, A.A.J. de Rotte4, M.I. Liem5, P.J. Koudstaal6, R.J. van Oostenbrugge7, W.H. Mess8, L.J. Kappelle9, P.J. Nederkoorn10, J. Hendrikse11, M.E. Kooi12, A. van der Lugt13 Erasmus Medical Center, Rotterdam, THE NETHERLANDS1, Maastricht University Medical Center, Maastricht, THE NETHERLANDS2, Erasmus Medical Center, Rotterdam, THE NETH-ERLANDS3, University Medical Center Utrecht, Utrecht, THE NETHERLANDS4, Amsterdam Medical Center, Amsterdam, THE NETHERLANDS5, Erasmus Medical Center, Rotterdam, THE NETHERLANDS6, Maastricht University Medical Center, Maastricht, THE NETHERLANDS7, Maastricht University Medical Center, Maastricht, THE NETHERLANDS8, University Medical Center Utrecht, Utrecht, THE NETHERLANDS9, Amsterdam Medical Center, Amsterdam, THE NETHERLANDS10, University Medical Center Utrecht, Utrecht, THE NETHERLANDS11, Maastricht University Medical Center, Maastricht, THE NETHERLANDS12, Erasmus Medical Center, Rotterdam, THE NETHERLANDS13 Background A vulnerable atherosclerotic plaque is more prone to rupture and can cause throm-bo- embolism and cerebral ischemia. The presence of specific vulnerable plaque components like intraplaque hemorrhage (IPH) may predict plaque rupture. Plaque rupture can be visible as plaque ulceration on non-invasive imaging. We investigated the association between IPH and plaque ulcer-ation. Methods Patients with recent (≤ 3 months) amaurosis fugax, TIA or minor ischemic stroke of the anterior circulation and a 30-69% ipsilateral carotid artery stenosis (ECST) who were treated medically, underwent MDCTA and MRI of the carotid artery at baseline as part of the Parisk-study (Plaque-At-RISK). The Parisk-study is an ongoing study focusing on the identification of the vul-nerable plaque in patients with a symptomatic 30-69% carotid artery stenosis (ClinicalTrials.gov NCT01208025). The presence of an ulceration was assessed at MDCTA and defined as extension of contrast material of >1 mm into the atherosclerotic plaque on at least two orthogonal planes. IPH was assessed at 3T MRI (GE; 3D-T1W-FS-SPGR sequence or Philips; IR-T1w-TFE sequence) and defined as a hyperintense signal in the plaque compared to the sternocleidomastoid muscle. A chi2- test and univariable logistic regression was used to assess the association between IPH and ulcer-ation. Results Between 2010 and 2012, 108 patients were included in the Parisk-study. In 75 patients both MDCTA and MRI were available for analysis. Twenty (13%) ulcerations and 38 (25%) IPHs were present in the 150 carotid arteries. Ulcerations were significantly more often found in patients with IPH compared with those without IPH (24% vs. 10%; p=0.03). IPH was significantly related to the presence of an ulceration (OR 2.85; 95%CI 1.08-7.54). Conclusion IPH on MRI is associated with plaque ulceration on MDCTA. Serial studies are needed to evaluate whether IPH in asymptom-atic patients increases the risk for plaque rupture and subsequent symptoms.
Karger_ESC London_2013
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