London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 659 593 Acute stroke: emergency management, stroke units and complications Intravenous thrombolysis throughout the years – analysis of early mortality S. Varanda1, J. Pinho2, R. Maré3, J. Fontes4, C. Ferreira5 Neurology Department, Hospital de Braga, Braga, PORTUGAL1, Neurology Department, Hos-pital de Braga, Braga, PORTUGAL2, Neurology Department, Hospital de Braga, Braga, PORTU-GAL3, Neurology Department, Hospital de Braga, Braga, PORTUGAL4, Neurology Department, Hospital de Braga, Braga, PORTUGAL5 Background: The implementation of multidisciplinary units specialized in the treatment of patients with acute stroke led to a significant reduction of its mortality. The in-hospital mortality rate after in-travenous thrombolysis (IVT) in acute ischemic stroke (AIS) varies between 10 and 15%. Objectives: Determine early mortality rate, evaluate its modification throughout the years and study the impact of different variables in mortality of patients with AIS, which have undergone IVT in a Stroke Unit. Methods: All patients with AIS, which underwent IVT at the Stroke Unit of Hospital de Braga, be-tween 2007 and 2012, were retrospectively identified. Studied variables included demographic data, co-morbidities, NIHSS and ASPECTS scores at admission and clinic-to-needle time. An analysis of 30-day survival was completed to identify predictors of mortality, namely, the year of IVT. Results: 292 IVT were performed, 55% in male patients with a median age of 68 years and a medi-an baseline NIHSS of 13. The early-mortality rate was 5.8%. Seventeen patients died and the most frequent cause of death was intracranial hemorrhage followed by extensive cerebral infarction. In univariate analysis, the identified predictors of mortality were: ASPECTS < 8; one point increments in the admission NIHSS; admission NIHSS > 12; increase of NIHSS by four points at 24 hours; oc-currence of symptomatic intracranial haemorrhage. In multivariate analysis, adjusted to the NIHSS and ASPECTS at admission, no change was observed in mortality according to the year of IVT. Discussion: The early mortality rate of our centre is slightly inferior to the one described in the liter-ature. The variables we found related to an increase of the mortality risk had already been identified in previous studies. We didn’t found early mortality differences conditioned by the year of IVT. We consider that the accurate use of the criteria established for this treatment may have contributed for these results. 594 Acute stroke: emergency management, stroke units and complications Telestroke between a emergency medical center and a stroke unit: a French experience during 8 months. S. Deltour1, Y. L’Hermitte2, G. Mutlu3, S. Crozier4, A. Leger5, C. Zavanone6, Y. Samson7 Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE1, Unit Emergency Hos-pital Marc Jacquet, Melun, FRANCE2, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE3, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE4, Stroke Unit, HOS-PITAL PITIE SALPETRIERE, Paris, FRANCE5, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE6, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE7 Actually the number of stroke units is insufficient to accommodate all emergency patients with sus-pected stroke, the deployment of telemedicine is essential to improve access to health care as soon as possible in these patients. In this context, a network of telemedicine was established between the emergency unit in Melun and stroke unit in Paris. We report the results of our experiments during eight months. METHODS From October 2011 to June 2012, we experienced a telemedicine device between these two sites separated by 57 km. In the emergency unit, all the doctors have been trained to screen patients with suspected stroke. A tele-consultation was carried out according to the availability of senior neuro-vascular for any patient with suspected acute stroke, arriving at Melun’s Hospital. The first contact between the neurovascular and the patient was routinely made after conducting a brain scan and blood tests, using a camera. The NIHSS (score international clinical severity of initial clinical) was carried out jointly with the emergency and neurovascular doctor. Based on the data, the patient was thrombolysis. DISCUSSION Twenty-three teleconsultations were conducted. The median age was 60, 3 years, mainly men (65%) with a median NIHSS of 12,5 . The diagnosis was stroke for 20 of them (19 infarcts and 1 hemato-ma). Only 3 patients had no strokes: 1 seizure, 1 migrainous aura and one inorganic deficit. Time median teleconsultation was 30 minutes. Among the 19 infarcts, 8 were thrombolysis (1patient of 4) 210 minutes after the onset of symptoms. The strong rate of thrombolysis proves the efficiency of the selection of the patients by the emergency team trained in neurovascular. CONCLUSION In this context, telestroke appears as a crucial area for improvement to facilitate access to thrombol-ysis. Functionality of such a system based on a multi-disciplinary motivation and depends heavily on the resources allocated to ist implementation.
Karger_ESC London_2013
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