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22. European Stroke Conference 3 Acute stroke: current treatment Comparison of risk-scoring systems in predicting symptomatic intracerebral hemorrhage af-ter intravenous thrombolysis C.H. Chen1, S.F. Sung2, S.C.C. Chen3, H.J. Lin4, Y.W. Chen5, M.C. Tseng6 Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, TAI-WAN1, Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, TAIWAN2, Department of Medical Research, Ditmanson Med-ical Foundation Chia-Yi Christian Hospital, Chia-Yi, TAIWAN3, Department of Neurology, Chi-Mei Medical Center, Tainan, TAIWAN4, Department of Neurology, Landseed Hospital, Tao-Yuan, TAI-WAN5, Senior researcher, Landseed Hospital, Tao-Yuan, TAIWAN6 Background: Various risk score models have been developed to predict symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis for acute ischemic stroke. In this study, we aimed to determine the prediction performance of these risk scores in a Taiwanese population Methods: Prospectively collected data from four hospitals were used to calculate probability of SICH with the scores developed by Cucchiara et al, the HAT score, the Safe Implementation of Thrombolysis in Stroke (SITS) SICH risk score, the GRASPS score, and the SPAN-100 index. We used logistic regression to evaluate the effectiveness of each risk model in predicting SICH and the c statistic to assess performance. Results: A total of 548 patients were included. The rates of SICH was 7.3% by the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% by the European-Australasian Coop-erative Acute Stroke Study (ECASS) II definition, and 3.5% by the SITS - Monitoring Study (SITS-MOST) definition. The Cucchiara score, the HAT score, and the SITS SICH risk score were signifi-cant predictors of SICH for all three definitions, while the GRASPS score and the SPAN-100 index predicted well only for one or two definitions of SICH. The c statistic was highest for the HAT score and lowest for the SPAN-100 index across the definitions of SICH. Conclusion: The Cucchiara score, the HAT score, and the SITS SICH risk score predicted SICH rea-sonably well regardless of which SICH definition was used. However, only the HAT score had an acceptable discriminatory ability. 278 © 2013 S. Karger AG, Basel Scientific Programme 4 Acute stroke: current treatment Intravenous thrombolysis for acute ischemic stroke guided by tissue at risk identification on perfusion computed tomography J.C. Portilla Cuenca1, J.A. Fermin Marrero2, F. Lopez Espuela3, R. Romero Sevilla4, I. Bragado Trigo5, A. Falcon Garcia6, G. Gamez Leyva7, M. Gomez Gutierrez8, M. Calle Escobar9, A. Serrano Cabrera10, P.E. Jimenez Caballero11, M. Caballero Muñoz12, A. Roa Montero13, I. Redondo14, I. Casa-do Naranjo15 Hospital San Pedro de Alcantara, Caceres, SPAIN1, Hospital San Pedro de Alcantara, Caceres, SPAIN2, Hospital San Pedro de Alcantara, Caceres, SPAIN3, Hospital San Pedro de Alcantara, Ca-ceres, SPAIN4, Hospital San Pedro de Alcantara, Caceres, SPAIN5, Hospital San Pedro de Alcantara, Caceres, SPAIN6, Hospital San Pedro de Alcantara, caceres, SPAIN7, Hospital San Pedro de Alca-ntara, Caceres, SPAIN8, Hospital San Pedro de Alcantara, Caceres, SPAIN9, Hospital San Pedro de Alcantara, Caceres, SPAIN10, Hospital San Pedro de Alcantara, Caceres, SPAIN11, Hospital San Pe-dro de Alcantara, Caceres, SPAIN12, Hospital San Pedro de Alcantara, Caceres, SPAIN13, Hospital San Pedro de Alcantara, caceres, SPAIN14, Hospital San Pedro de Alcantara, Caceres, SPAIN15 Background: Despite expansion of therapeutic window for alteplase treatment to 4.5 hours, for many reasons, the proportion of treated patients remains low. Perfusion computed tomography (PCT) may be a tool to select potential candidates for intravenous thrombolysis when stroke time onset is unknown and tissue at risk is identifiable. We aimed to assess the safety and efficacy of this approach on the patients treated beyond SIST-MOST and ECASS III guidelines. Methods: Pro-spective observational study of all consecutive patients treated with alteplase in our stroke unit. We differentiate two groups according to identification of tissue at risk on PCT, analyzing early neuro-logical improvement (defined as decrease of ≥ 4 points in NIHSS at 24 hours), symptomatic hemor-rhagic transformation at 36 hours, and independency (Rankin ≤2) and mortality at 90 days. Results: A total of 127 patients were treated with alteplase. In 24 (18.9%) a PCT-guided thrombolysis was performed. Basal NIHSS was 14,2 (SD 5,58), without differences between groups (14,15 vs 14,25 p 0,973). Early neurological improvement was observed in 45.7 % (50% vs 44.7%, p 0,63) and symp-tomatic hemorrhagic transformation in 1.6% (4,2% vs 1%, p 0,257). At 90 days, 52 % of patients were independent (62.5% vs 49.5%, p 0,25) and 13.4% (8.3% vs 14.6%, p 0,42) was dead. In mul-tivariate analysis, PCT-guided thrombolysis was not associated with any safety or efficacy variable. Conclusion: In our study, PCT-guided intravenous thrombolysis seems effective and safe, allowing to increase the number of patients treated. These results should be confirmed in randomized studies.


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