London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 295 34 Acute stroke: new treatment concepts Cerebral augmentation induced by external counterpulsation is associated with cerebral auto-regulation in ischemic stroke patients with cerebral large artery occlusive disease W. Lin1, J. Liu2, H. W. Leung3, L. Xiong4, J. Han5, X. Chen6, L. K. Sing Wong7 Chinese University of Hong Kong, Sha Tin, HONG-KONG1, Shenzhen Institution of Advanced Technology, Chinese Academy of Sciences, Shenzhen, CHINA2, Chinese University of Hong Kong, HONG-KONG, HONG-KONG3, Chinese University of Hong Kong, HONG-KONG, HONG-KONG4, , HONG-KONG, HONG-KONG5, , HONG-KONG, HONG-KONG6, Chinese University of Hong Kong, Sha Tin, HONG-KONG7 Background: External counterpulsation (ECP) is a novel treatment for ischemic stroke. We found ECP augmented blood pressure and cerebral blood flow of ischemic stroke patients with cerebral large artery occlusive disease previously. We hypothesized that ECP-induced cerebral augmentation was associated with impairment of cerebral autoregulation. Methods: We recruited 30 acute ischemic stroke patients with large artery occlusive disease. Each patient was given ECP treatment with cuff pressure of 150mmHg. Mean cerebral blood flow veloc-ities (CBFV) of bilateral middle cerebral arteries were monitored using transcranial dopper before ECP and during ECP respectively for 3 minutes. Continuous beat-to-beat blood pressure was simul-taneously recorded. Cerebral autoregulation was evaluated using Autoregulatory index (ARI) based on baseline blood pressure and CBFV. ECP-induced cerebral augmentation was assessed by CAI (Cerebral Augmentation Index), which was increase percentage of mean CBFV induced by ECP compared with baseline. Person’s correlation was used to identify the relationship between CAI and ARI. Data was analyzed based on whether it was ipsilateral or contralateral to the infarct. Results: Median NIHSS of stroke patients was 4 and mean time after stroke onset was 5.68 days. Ipsilateral ARI of patients was 6.15±1.46 while contralateral ARI was 5.92±1.94. Mean CBFV of both sides significantly increased during ECP, both p<0.01. (ipsilateral CAI: 4.85±5.67; contralat-eral CAI: 5.58±5.12). CAI was significantly associated with ARI on infarct ispilateral side (r=0.39, p=0.04). No significant relationship of CAI and ARI on the contralateral side was observed. Conclusion: Cerebral autoregulation after stroke onset affects ECP-induced cerebral flow increase on infarct ipsilateral side. It helps to explore the application of ECP in ischemic stroke, especially in choosing suitable patient group to reach maximal therapeutic effects of ECP on cerebral blood aug-mentation. 35 Acute stroke: new treatment concepts Multimodal CT does not significantly delay intravenous rtPA X. Huang1, K. Muir2 University of Glasgow, Glasgow, UNITED KINGDOM1, University of Glasgow, Glasgow, UNIT-ED KINGDOM2 Background: Multimodal CT (non-contrast CT, CT perfusion CTP and CT angiography CTA) provides addi-tional information on arterial occlusion and tissue perfusion in acute ischaemic stroke and is a valu-able research tool that may also aid clinical decisions. However, additional imaging may delay initi-ation of intravenous rtPA and thus potentially reduce treatment benefit. We examined delay in giving IV thrombolysis in patients undergoing multimodal CT as part of an ongoing clinical trial comparing thrombolytic agents that uses multimodal CT as an outcome biomarker but not a selection criterion. Methods: Time intervals between relevant process factors (symptom onset, hospital arrival, start and end of multimodal CT scan, treatment initiation) were reviewed from 61 consecutive patients participating in an acute stroke thrombolysis trial (ATTEST). Onset to treatment time (OTT) and door to needle time (DNT) were compared with historical controls from a database of all patients who received IV thrombolysis in 2010. Results: Median (IQR) times for multimodal CT patients for OTT and DNT were 197 (60) minutes and 37 (21) minutes, compared to 177.5 (77.5) minutes, and 35 (17.5) minutes respectively in the historical control group, not significantly different (Mann-whitney U tests, p=0.09and p=0.14 respectively). Within the multimodal CT group, OTT and DNT did not differ between the first and second half of the study patients. Conclusion: Multimodal CT did not add delay in door to needle time in study patients compared to historical controls. However, since these studies were obtained as part of a research protocol that did not re-quire their analysis or interpretation prior to study entry (and treatment delivery), this reflects acqui-sition time rather than processing or interpretation time. Studies that require these additional steps require to evaluate treatment times to ensure that they are not affected.
Karger_ESC London_2013
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