London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 277 1 Acute stroke: current treatment Importance of pre-treatment neuroimaging in identifying acute stroke patients with large in-farcts who are unlikely to respond to IA therapy D.F. Frei1, A.J. Yoo2, D. Heck3, F. Hellinger II4, V. McCollom5, D. Fiorella6, A. Turk III7, T. Malisch8, O. Zaidat9, M. Alexander10, Z.A. Chaudhry11, R.G. Gonzalez12, L. Barraza13, A. Bose14, S.P. Sit15 for the START Investigators Swedish Medical Center, Englewood, USA1, Massachusetts General Hospital, Boston, USA2, For-syth Medical Center, Winston-Salem, USA3, Florida Hospital, Orlando, USA4, Mercy Health Cen-ter, Oklahoma City, USA5, Stony Brook Medical Center, Stony Brook, USA6, Medical University of South Carolina, Charleston, USA7, Alexian Brothers Medical Center, Elk Grove Village, USA8, Medical College of Wisconsin, Milwaukee, USA9, Cedars-Sinai Medical Center, Los Angeles, USA10, Massachusetts General Hospital, Boston, USA11, Massachusetts General Hospital, Boston, USA12, Penumbra, Inc., Alameda, USA13, Penumbra, Inc., Alameda, USA14, Penumbra, Inc., Alameda, USA15 Background: The Penumbra START Trial is a multicenter, prospective trial with a goal of testing whether core infarct size on pre-treatment neuroimaging predicts clinical response to IA stroke ther-apy. Methods: Major inclusion criteria include presence of proximal artery occlusion of the anterior circulation, baseline NIHSS score ≥10, evaluable pre-treatment imaging (noncontrast CT NCCT, CTA source imaging, CT perfusion or MRI DWI) and treatment with the Penumbra System within 8 hours. Core infarct size was determined by a blinded imaging Core Lab. As prespecified, infarcts were trichotomized into small (ASPECTS 8-10 NCCT, CTA-SI or lesion volume <50 cc CTP or DWI), moderate (ASPECTS 5-7 or volume 50-100 cc) or large (ASPECTS 0-4 or volume >100 cc). To date, 147 patients are enrolled at 27 centers, including 101 patients with Core Lab review and 90-day evaluation. Good clinical outcome is defined by 90-day mRS 0-2. Review is still ongo-ing; statistical analysis is from the 101 patients with complete information. Results: Mean age is 66. Median NIHSS score is 19. Overall rate of TIMI 2-3 revascularization is 83%. Forty-five patients had a good outcome (44.5%); 28 died (27.7%). The number of evaluable scans for each modality is: 32 CTP, 79 CTA-SI, 78 NCCT and 6 DWI. In aggregate analysis pooling all modalities, there is a statistically significant relationship between core infarct size and good outcome, in that worse out-comes were seen only in the large infarct group. The good outcome rate is 54.9% in small, 54.3% in moderate and 16.7% in large infarcts (p=0.0005), despite similar recanalization rates (79% small, 91% moderate, 83% large). Independent predictors of good outcome were age, NIHSS score, time from onset to recanalization and infarct volume. Conclusion: Pre-treatment neuroimaging is essen-tial for identifying patients with large infarcts who are unlikely to respond to IA therapy. These re-sults support the use of strict imaging criteria in patient selection. 2 Acute stroke: current treatment Gender differences in outcome following rt-PA are mainly due to the influence of race P. Mandava1, S.B. Murthy2, M. Munoz3, D. McGuire4, R.P. Simon5, A.V. Alexandrov6, K.C. Al-bright7, A.K. Boehme8, S. Martin-Schild9, S. Martini10, T.A. Kent11 Baylor College of Medicine, Houston, USA1, Baylor College of Medicine, Houston, USA2, Bay-lor College of Medicine, Houston, USA3, Morehouse School of Medicine, Atlanta, USA4, More-house School of Medicine, Atlanta, USA5, University of Alabama Birmingham, Birmingham, USA6, University of Alabama Birmingham, Birmingham, USA7, University of Alabama Birmingham, Birmingham, USA8, Tulane University, New Orleans, USA9,University of Cincinnati, Cincinnati, USA10, Baylor College of Medicine, Houston, USA11 Introduction: There are conflicting reports of the influence of gender on outcomes following rt-PA. We hypothesized that baseline factors are more important than gender in determining outcome fol-lowing rt-PA and tested this in 3 datasets. Method: We tested this hypothesis with 2 methods. Using the NINDS dataset, we compared out-comes following rt-PA based on gender to a pooled sample at the same baseline NIHSS and age. We matched subjects on a range of baseline variables and compared outcomes following rt-PA com-pared to placebo. We added two datasets from the Southeastern USA to the NINDS sample for this analysis. Results: At similar NIHSS and age, 90 day outcomes were identical between males and females. 43.1% of males and 44.0% of females achieved a mRS 0-1 after receiving rt-PA, (p=1.00). Rela-tive to placebo, 33% more males and 17.8% more females achieved a mRS 0-1 after rt-PA (p>.05), suggesting a trend toward lower response in females to rt-PA. However, when we factored race, we found virtually identical response to rt-PA for Caucasian males and females with a strong positive trend for African American (AA) males. However, AA females showed rt-PA response rates no dif-ferent from placebo. After baseline matching, rt-PA outcomes (mRS 0-2) were significantly worse in AA than Caucasian females: 37% vs. 63%; p=.027. We found a similar trend for poor short term outcome in AA females after pooling the 3 datasets (p=.054 for mRS 0-1). Among demographic fac-tors that could explain this difference was a 4 fold higher incidence of diabetes in AA females even though there was good matching on baseline glucose. Conclusion: Overall differences reported for gender outcomes in stroke in Caucasians are not likely due to response to rt-PA. Differences in outcome following rt-PA in females were mostly explained by the poor overall outcomes following rt-PA in African American females. The mechanism for the dramatically poorer outcomes in AA females needs to be investigated. Acute stroke: current treatment (PO 1 - 31)
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