London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 301 45 Acute stroke: new treatment concepts Safety and efficacy of Sonothrombolysis in Acute Ischemic Stroke – experience from Chennai, India.Safety and efficacy of Sonothrombolysis in Acute Ischemic Stroke – experience from Chennai, India. S.M. Rajappa1, S. Sivakumar2 Cerebrovascular and Vasculitis Research Foundation, Chennai, INDIA1, CVRF, CHENNAI, INDIA2 Background Early recanalization which is a powerful predictor of stroke outcome, is seen with with i.v. tissue plasminogen activator (tPA) in about 28% of cases. Sonothrombolysis (combined thrombolysis with i.v. tPA and continuous 2 MHz Transcranial Doppler (TCD) offers additional benefit. Objective We sought to investigate whether early recanalization occurred and stroke outcome improved by Sonothrombolysis in acute ischemic stroke. Design/Methods Prospective, interventional study from a Stroke center at Chennai, India from 2002 till 2012. 176 patients underwent Sonothrombolysis within 3 hours of symptom onset. Patients were followed up between 18-120 months. After an informed consent, TCD monitoring of recanalization was conduct-ed for 2 hours, using a head frame and attachable 2 MHz TCD probes obtained from Spencer Tech-nologies, Seattle, WA. The relative contribution of clinical, TCD and MRI / CT scan information on stroke outcome were evaluated. Improvement in modified Rankin Scale Score (mRSS), was used as a measure of good outcome after sonothrombolysis. Safety end point was symptomatic intracerebral hemorrhage (sICH) within 72 hours of treatment. Primary combined end point was complete reca-nalization on TCD or dramatic clinical recovery. Secondary end points were recovery at 24 hours and outcome at 3 months by mRSS. Results There were 104 men and 72 women. In 54.8% of patients, the median time to treatment was 0-90 min and in 45.2 % the treatment time was 91-180 min. The Median time from stroke onset to tPA treatment was 1 hour and 53 min. The Median time from Emergency Room arrival to tPA was 56 min. Median NIHSS score before tPA 13.4. Dramatic recovery was seen in 23.38%. Functional in-dependence (MRSS 0-1) was present in 31.45 % & (MRSS 0-2) in 19.35 %. Functional Dependence (MRSS 3-5) was noted in 20.16%. 2.4% developed symptomatic intracerebral hemorrhage (sICH) and 1.4 % of patients expired. Conclusions A high incidence of intracranial stenosis were present. Sonothrombolysis enhances the benefits of iv tPA. TCD may be helpful in selecting patients for combined i.v. and intra-arterial thrombolysis. 46 Acute stroke: new treatment concepts Erythropoietin serum level in patients with atherosclerotic symptomatic and asymptomatic ca-rotid stenoses A. A. Shmonin1, L.N. Stukova2, E.A. Bondareva3, E.V. Melnikova4, Y.V. Emanuel5 Saint-Petersburg I. P. Pavlov State Medical University, Saint-Petersburg, RUSSIAN FEDER-ATION1, Saint-Petersburg I. P. Pavlov State Medical University, Saint-Petersburg, RUSSIAN FED-ERATION2, Saint-Petersburg I. P. Pavlov State Medical University, Saint-Petersburg, RUSSIAN FEDERATION3, Saint-Petersburg I. P. Pavlov State Medical University, Saint-Petersburg, RUS-SIAN FEDERATION4, Saint-Petersburg I. P. Pavlov State Medical University, Saint-Petersburg, RUSSIAN FEDERATION5 Background. It is generally held that high serum level of protective cytokines (for example IGF) can reduce cerebral injury in patients with high risk of cerebrovascular disease. We hypothesized that high erythropoietin serum level can associated with low frequency of transient ischemic attack (TIA) and stroke occurrence. Methods. We searched 123 patients aged 50-80 years with bilateral or unilateral 60-99% atherosclerotic internal carotid artery stenoses. Our exclusion criteria were acute stroke or TIA, diabetes, carotid occlusion, history of heart or vascular surgical intervention, history of stroke in posterior circulation, systemic diseases, oncology, hematologic diseases, dementia or severe cognitive impairment and atrial fibrillation. Only 40 patients didn’t have exclusion criteria and were included in our investigation. The control group consisted of 11 patients without carotid artery stenoses and exclusion criteria. We used a duplex ultrasound scanning for carotid artery ste-noses verification and a typical immunopherment analysis to test erythropoietin serum level. Statis-tical analyses were performed with Mann-Whitney test. Results. Erythropoietin serum level in pa-tients with carotid stenoses was 9,43±4,3 IU/ml and it didn’t significantly differ from control group - 7,68±2,7 IU/ml (р>0,05). All results were in reference range. Our hypothesis was not confirmed. But we got higher erythropoietin serum level in patients with symptomatic carotid stenoses 10±4,5 IU/ml than in group with asymptomatic carotid stenoses - 6,5±1,8 IU/ml (р<0,05). These findings demonstrate that TIA and stroke can lead to increase of erythropoietin serum level in patients with carotid stenoses. Function of this phenomenon requires further investigations. Conclusions. Fre-quency of TIA and stroke occurrence isn’t associated with erythropoietin serum level in patients with carotid stenoses. Erythropoietin serum level was higher in patients with symptomatic carotid stenoses than in group with asymptomatic carotid stenoses. Keywords: atherosclerosis, carotid ar-tery stenosis, erythropoietin serum level, transient ischemic attack, stroke, humans.
Karger_ESC London_2013
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