22. European Stroke Conference 18 Acute stroke: current treatment Pharmaco-Mechanical Intra-Arterial Thromblysis in Acute Ischemic Stroke R. Dabitz1, A.L. Arva2, U. Leppmeier3, V. Collado-Seidel4, L. Fuhry5, F. Schmidt6, K. Schöne-boom7, U. Raab8, S. Triebe9, R. Michailow10, D. Vorwerk11, G. Ochs12 Dept. of Neurology, Ingolstadt, GERMANY1, Dept. of Neurology, Ingolstadt, GERMANY2, Dept. of. Neurology, Ingolstadt, GERMANY3, Dept. of Neurology, Ingolstadt, GERMANY4, Dept. of Neurology, Ingolstadt, GERMANY5, Dept. of Neorology, Ingolstadt, GERMANY6, Dept. of Inter-ventional Radiology, Ingolstadt, GERMANY7, Dept. of Interventional Radiology, Ingolstadt, GER-MANY8, Dept. of Interventional Radiology, Ingolstadt, 9, Dept. of Interventional Radiology, Ingolstadt, GERMANY10, Dept. of Interventional Radiology, In-golstadt, GERMANY11, Dept. of Neurology, Ingolstadt, GERMANY12 Background: The prognosis of ischemic stroke due to occlusion of central intracranial arteries is poor, even with intravenous rt-PA thrombolysis. Materials and methods: We report about 66 consecutive patients (36m, 30f; mean age 61, range 23 - 86 years), treated with combined pharmaco-mechanical intra-arterial thrombolysis from 2010 to 2012. 31 pts presented with ICA and MCA tandem occlusions, 23 with occlusion of the main trunk of the MCA, and 11 of the BA, mean NIH-Stroke-Scale (NIHSS) at admission was 23, mean Rankin Scale (mRS) 4.6. 32 pts were bridged with tirofiban. Mechanical thrombectomy was performed in 32 pts with PRE-SET, in 18 pts with BONNET, in 11 pts with SOLITAIRE, in 5 pts combinations of devices and in 46 pts in combination with thrombolysis with rt-PA. In some cases permanent stenting were per-formed 286 © 2013 S. Karger AG, Basel Scientific Programme as well. Results: At discharge from ICU mean mRS was 3.6 Mortality was 19.7% (13/ 66). After rehabilitation (45 pts followed, 8 missing) the mean mRS was found 2.5: 23 pts had mRS: 0-2 (= 51 %); 12 pts had mRS: 3 (= 27%); 10 pts mRS: 4 (=22%). 18 pts showed signs of intracerebral hemorrhage, 3 of them were symptomatic, 7 pts developed malignant infarction due to failed recanalization. Conclusion: Bridging with GPIIb/IIIa-receptor-antagonists combined with intra-arterial pharmaco-mechanical thrombolysis may reduce mortality and morbidity after occlusions of the ICA, MCA or BA. Our current complication rate ranges within the expectations reported elsewhere. 19 Acute stroke: current treatment Prognosis of stroke patients treated with intravenous thrombolysis according to the type of asymptomatic haemorrhagic transformation – Serbian Experience with Thrombolysis in Isch-emic Stroke (SETIS) register D.R. Jovanovic1, M. Stefanovic-Budimkic2, V. Padjen3, Predrag Stanarcevic4, Lj. Beslac-Bumbasi-revic5, I.I. Berisavac6, M.D. Ercegovac7 on behalf of SETIS Group Neurology Clinic, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Bel-grade, SERBIA1, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA2, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA3, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA4, Neurology Clinic, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, SERBIA5, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA6, Neurology Clinic, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, SERBIA7 Background: The role of asymptomatic haemorrhagic transformation (HT) in functional outcome of stroke patients treated with intravenous thrombolysis is uncertain. The aim of this study was to in-vestigate the relation between the type of HT and outcome of thrombolysed patients. Methods: Data were obtained from the SETIS register. According to European Cooperative Acute Stroke Study (ECASS) criteria HT was classified as haemorrhagic infarction (HI1 and HI2) or pa-renchymal haematoma (PH1 and PH2). After patients with symptomatic intracerebral haemorrhage (ICH) were excluded, the outcome at 3 months across these groups has been evaluated using mod-ified Rankin score (mRS). Multivariable analysis has been performed to determine predictors of stroke outcome. Results: Out of 761 SETIS patients, 33 (4.4%) were excluded due to symptomatic ICH according to the SITS or ECASS criteria. The follow-up CT scans were available in 682 patients. The as-ymptomatic HT was recorded in 99 (14.5%) patients - 17 HI1, 27 HI2, 29 PH1, and 26 PH2. The rate of death among patients without HT, with HI1, HI2, PH1 and PH2 were 11.8%, 13.3%, 11.5%, 17.9% and 12.0%, repectively (p=0.920). Proportions of patients with bad functional outcome (mRS 4-5) were 10.3% with no HT, 20% with HI1, 7.7% with HI2, 7.1% with PH1 and 24% with PH2 (p=0.154). Proportions of patients with excellent outcome (mRS 0-1) were 58.9% with no HT, 46.7% with HI1, 60% with HI2, 28.6% with PH1, and 32% with PH2 (p=0.002). Multivariate lo-gistic regression after adjustment for age, initial National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT score, presence of hyperdense artery sign, initial glycaemia and previous antiplatelet therapy has shown no impact of asymptomatic HT on excellent or bad outcome or death of thrombolysed stroke patients (p>0.05). Conclusion: It appears that asymptomatic HT has no impact on the outcome of stroke patients treat-ed with intravenous thrombolysis.
Karger_ESC London_2013
To see the actual publication please follow the link above