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Karger_ESC London_2013

London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 709 686 Acute stroke: clinical patterns and practice Predicting factors and outcome of delayed spontaneous recanalization after acute middle cere-bral artery occlusion S.H. Choi1, D.H. Kim2, J.K. Cha3, E.H. Jeong4, S.W. Kim5 Bumin Hospital, Busan, SOUTH KOREA1, Department of Neurology, College of Medicine, Dong-A University, Busan, SOUTH KOREA2, Department of Neurology, College of Medicine, Dong-A University, Busan, SOUTH KOREA3, Department of Neurology, College of Medicine, Dong-A University, Busan, SOUTH KOREA4, Busan ST. Mary’s Medical Center, Busan, SOUTH KOREA5 Backgroud and objective : Little is known regarding the predicting factors of a delayed sponta-neous recanalizaton (DSR) and its influence on clinical outcome in acute ischemic stroke (AIS). Multi-modal MRI enable us to estimate information regarding of viable brain tissues, collateral cir-culation and the status of vessel occlusion. The present study was designed to evaluate the predict-ing factors and difference of the 90-day clinical outcome according to the presense of DSR in AIS with an acute MCA occlusion using a multi-modal MRI. Methods : We retrospectively studied in patients with AIS admitted to our stroke center from 2009 into 2011. We included patients as followed: 1) those patients who have symptomatic MCA occlu-sion, 2) those patients who did not take any kind thrombolysis including IV and/or IA, 3) those pa-tients who had MRI including diffusion and perfusion weighted images (TTP map and CBV map) at baseline and follow-up MRA within 24 hours after events. To determine the factors that were related with DSR and good clinical outcome, we performed multiple logistic regression analysis. Results : Sixty-eight patients with an acute MCA occlusion were included in this study (the mean age ; 67.2±12.1 years, symptom to image time ; 3.7±2.0 hours and mean NIHSS ; 13.3± 5.7). Af-ter follow-up images, 13 (19.1%) had a DSR on MRA. The prevalence of an atrial fibrillation (OR 5.55; 95% CI 1.63-18.95; p=0.006) and the increase in the rCBV ratio on the PWI (OR 6.48; 95% CI 1.08-38.98; p=0.041) were independent factors in the presence of DSR on the follow-up images. However, the presence of a DSR had no significant effect on the 90-day clinical outcome after AIS. Conclusions : The present study suggested that information derived from the PWI on MRI might be helpful to predict the occurrence of a DSR after AIS. In addition, the presence of a DSR might not ensure a favorable clinical outcome after AIS. 687 Acute stroke: clinical patterns and practice Development of a simple Index to predict excellent outcome among patients receiving iv thrombolysis for acute stroke. J.M. Calleja-Castillo1, P González-Latapí2, A. González-Cañedo3, J. Santos-Zambrano4 National Institute of Neurology, Mexico., Mexico City, MEXICO1, National Institute of Neu-rology, Mexico., Mexico CIty, MEXICO2, National Institute of Neurology, Mexico., Mexico City, MEXICO3, National Institute of Neurology, Mexico., Mexico CIty, MEXICO4 Background: Well-defined criteria exist for treatment of acute stroke with iv thrombolysis. Nev-ertheless, few thrombolysed patients achieve an excellent functional outcome (mRS<3 at three months). Extended time-to-treatment (TTT), clinically severe stroke (measured through the NIH stroke Scale, NIHSS) and early hypodense lesion on CT scan are considered predictors of bad func-tional outcome. We hereby propose that an index derived from the combination of these elements can strongly predict excellent outcome and may be used to discern patients who would benefit from IV alteplase or other treatments. Methods: We prospectively identified and treated 20 acute stroke patients with iv thrombolysis. A neurologist performed NIHSS score at arrival. The baseline CT was read using the validated ASPECTS score. TTT was carefully recorded. Modified Rankin scores (mRs) at 90 days were registered and served as the main outcome measure for the study. We then developed a simple index mathematically combining time-to-treatment, NIHSS and APECTS score: (NIHSS*TTT)/ASPECTS and explored its capability as a means to better predict excellent out-come (min value=1, max value=90). We performed bivariate analysis with the appropriate statistical tests for comparing index results and outcome in patients in the excellent outcome group with the rest of the patients. Results: Median age at stroke onset was 58. 11 patients (55%) were female. Mean NIHSS for all pa-tients was 12. There was a significant difference in mean index in the excellent outcome group (3.9 vs 10.5, p=.019). Excellent outcome was observed in 9 patients (45%). In patients with an Index val-ue </=10 (n=15, 75%), 8 had an excellent prognosis (53%, p=.319). In patients with an Index value </=5 (n=9, 45%) 8 patients (89%) had an excellent prognosis p<0.01). Conclusion: Our mathematical Index may be useful in determining which patients will most likely respond favourably to iv thrombolysis. Prospective validation is needed.


Karger_ESC London_2013
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