London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 303 49 Acute stroke: new treatment concepts Safety and 12-months outcome of carotid endarterectomy versus carotid stenting in acute stroke patients: a single center experience. A. Rocco1, M. Diomedi2, S. Di Legge3, F. Sallustio4, R. Gandini5, E. Pampana6, A. Ippoliti7, B. Rizzato8, G. Koch9, D. Samà10, S. Napolitano11, P. Stanzione12 Department of Neuroscience, University of Tor Vergata, Rome, ITALY1, Department of Neuro-science, University of Tor Vergata, Rome, ITALY2, Stroke Unit, Department of Neuroscience, Uni-versity of Tor Vergata, Rome, ITALY3, Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome, ITALY4, Department of Diagnostic Imaging, Molecular Imaging, Interventional Ra-diology and Radiation Therapy, University of Tor Vergata, Rome, ITALY5, Department of Diagnos-tic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Tor Vergata, Rome, ITALY6, Division of Vascular Surgery, Department of Surgical Sciences, University of Tor Vergata, Rome, ITALY7, Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome, ITALY8, Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome, ITA-LY9, Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome, ITALY10, Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome, ITALY11, Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome12 Background: Carotid endarterectomy (CEA) remains the gold standard for secondary stroke preven-tion in symptomatic extracranial carotid artery disease (ECAD). Recent single-center reports have evaluated the risk and benefits of CEA and/or carotid artery stenting (CAS) performed within few days after stroke onset showing encouraging results. The aim of this study was to compare peri and postprocedural complications and 12-months clinical outcome of CAS versus CEA in patients ad-mitted for an acute TIA or stroke attributable to ECAD. Methods: We prospectively evaluated TIA and stroke patients admitted in the stroke unit of the Uni-versity of Rome Tor Vergata. National Institute of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), magnetic resonance (MR) imaging and MR-angiography or computed tomog-raphy (CT) and CT angiography were timely performed on admission. Patients with symptomatic extracranial carotid artery stenosis were selected for CAS or CEA based on vessel and plaque mor-phology, age, degree of stenosis and comorbidities. Periprocedural and post-procedural adverse event soon after the procedure and in the next 12 months follow–up was reported. Results: 89 patient were evaluated. 49 in CAS group and 40 in CEA group (70+/-12.3 years vs 68+/- 8.77). CAS patients were treated later in comparison with CEA (3.86+/-3.46 days vs 1.90+/-3.74; p=0.01) and were more severe at onset (NIHSS 6(0-20) vs 3(0-12); p=0.02). Hospitalisation length was greater in CEA patients (8,17+/-4,97 days vs 7.55+/-3,09; p=0.06). Periprocedural complica-tions (death, stroke, brain and systemic haemorrhages, arrhythmias or hypotension) were more fre-quent in CAS group, especially in aged patient. The two groups showed similar functional outcome at 6 and 12 months. Conclusion: Based on our and previous experiences, although CEA remain the first choice, CAS could be considered as a valid alternative procedure in acute stroke patients with contraindications for surgery. 50 Acute stroke: new treatment concepts Cerebral Flow Augmentation and outcomes in acute ischemic stroke patients with good base-line ASPECTS and absence of M1 occlusion: a post-hoc analysis of the SENTIS trial M. Goyal1, M. Eesa2, A.M. Demchuk3, J. Modi4, T. Stewart5, K. Zander6, L. Thackeray7, B.K. Me-non8, M. Almekhlafi9, A. Shuaib10 University of Calgary, Calgary, CANADA1-10 Background: Baseline ASPECTS is an important determinant of outcomes after acute ischemic stroke. Outcomes in patients with proximal occlusions are dependent on the quality of recanali-zation. Cerebral flow augmentation with the NeuroFlo device may be an alternative therapy for patients outside the traditional time windows. We present an exploratory post hoc analysis in the category of patients with small core and mild to moderate severity stroke in the absence of M1 oc-clusion. Methods: SENTIS was a randomized, prospective, multicenter trial designed to compare standard stroke treatment with and without NeuroFlo. We included patients with NIHSS 5-15, with no M1 occlusion based on vascular imaging. We also analyzed a larger cohort of patients with NIHSS 5-10, with the premise of a low likelihood of having an M1 occlusion. Both groups had baseline AS-PECTS score of 7-10. 90-day mRS was compared in both groups. Results: 515 patients were enrolled in the SENTIS trial. Vascular imaging identified 71 patients with ASPECTS 7-10 and NIHSS 5-15 and no M1 occlusion. A second analysis was performed on 172 pa-tients that had a small core (ASPECTS 7-10) with NIHSS 5-10, with a low likelihood of having M1 occlusion. In those patients with moderate stroke and no M1 occlusion, 56.7% in the treatment arm had good outcome vs 42.5% in the control arm (Figure 1a). In the larger group with no vascular im-aging 71.6% of patients in the treatment arm had a good outcome (mRS 0-2) as opposed to 60.9% in the control arm (Figure 1b). The 3-level shift analysis showed a p-value of 0.09 and 0.24 respective-ly (Cochran-Mantel-Haenszel test). Conclusions: This exploratory post-hoc analysis suggests that there is a trend towards good out-comes in mild to moderate severity stroke patients with good baseline ASPECTS score and with a low likelihood of having an M1 occlusion when treated with the NeuroFlo device.
Karger_ESC London_2013
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