22. European Stroke Conference 918 Interventional neurology Anatomical features of the vertebral artery for transbrachial direct cannulation of a guiding catheter to perform coil embolization of cerebral aneurysms in the posterior cerebral circula-tion T. Iwata1, T. Mori2, Y. Miyazaki3, M. Nakazaki4, Y. Takahashi5 Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center,, Ka-makura, JAPAN1, Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center,, Kamakura, JAPAN2, Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center,, Kamakura, JAPAN3, Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center,, Kamakura, JAPAN4, Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center,, Kamakura, JAPAN5 Background In cases of patients with a tortuous aortic arch, aortic diseases or occlusion of the femoral artery, it is difficult to introduce a guiding catheter (GC) into the vertebral artery (VA) through the femoral route, then transbrachial VA cannulation of a GC is attempted. However, anatomical features of the VA are uncertain for transbrachial direct cannulation of a GC. Purpose The purpose of our study was to investigate the anatomical features of the VA for transbrachial di-rect cannulation of a GC to perform coil embolization of cerebral aneurysms in the posterior cere-bral circulation. Methods Included in our retrospective analysis were patients who underwent transbrachial coil embolization of cerebral aneurysms in the posterior cerebral circulation from January 2007 to November 2012. Investigated were patient characteristics, preoperative sizes of aneurysms, aneurysms location, the angle formed by the proximal VA and the subclavian artery (AVS) and the VA diameter at the level of the fourth cervical vertebrae (VAD) in the side of the transbrachial access route. Results Twenty-one patients with twenty-two aneurysms met our criteria. Their age ranged from 26 to 76 years (average; 58 years). The locations of aneurysms were the VA (n=13), the basilar artery (BA) tip (n=3), the BA trunk (n=3), the BA superior cerebellar artery (n=1), the BA anterior inferior cer-ebellar artery (n=1) and the VA posterior inferior cerebellar artery (n=1). As the access route for direct cannulation of a GC, the right brachial artery (BrA) was used in 19 cases with 20 aneurysms and the left BrA in 2 cases with 2 aneurysms. The average AVS ranging from 45 to 95 degree was 77 degree, and the average VAD ranging from 3.6 to 4.5 mm was 4.0 mm. Conclusions Whichever brachial artery was used for the access route, transbrachial direct cannulation of a GC was successful in cases the AVS was about 45 degree or more and the VAD about 3.6 mm or more. 832 © 2013 S. Karger AG, Basel Scientific Programme 919 Interventional neurology INFLUENCE OF rTPA TREATMENT PRIOR TO MECHANICAL THROMBECTOMY ON ANGIOGRAPHIC AND CLINICAL RESULTS. J. Zamarro Parra1, E. Carreón Guarnizo2, A. Morales Ortiz3, G. Parrilla Reverter4, C. Lucas Róde-nas5, M. Espinosa de Rueda Ruiz6, F.A. Martínez García7, B. García-Villalba Navaridas8, R.M. Sánchez Gálvez9, F. Hernández Fernández10, B. Escribano Soriano11, A. Moreno Diéguez12 Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN1, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN2, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN3, Hospi-tal Universitario Virgen de la Arrixaca, Murcia, SPAIN4, Hospital Universitario Virgen de la Arrixa-ca, Murcia, SPAIN5, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN6, Hospital Univer-sitario Virgen de la Arrixaca, Murcia, SPAIN7, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN8, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN9, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN10, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN11, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN12 BACKGROUND: At our institution, rTPA treatment prior to intraarterial mechanical thrombectomy is established based on usual clinical protocol. We analyze the influence of treatment with rTPA pri-or to IAMT. METHODS: All patients treated with IAMT were divided into two groups (prior rTPA or without prior rTPA). We analyzed the clinical characteristics and results of each group, perform-ing a statistic analysis of rTPA influence on the results. RESULTS: Out of 141 IAMT patients, 61 (43.3%) received rTPA prior to IAMT. rTPA group data: n= 61; mean age=66.3; Men=55.7%; Most frequent vascular risk factors=Hypertension, Atrial Fibrillation; Most frequent etiology=cardioem-bolic 39.3%; Occluded artery= MCA 63.9%; Mean NIHSS=16.5; Complete recanalization=91.8%; Symptomatic intracranial hemorrhage= 6.5%; Procedural complications=1 (1.6%); Mean time to treatment=316 min; mRS90≤2=55.1%; Mortality=13.1%. Non-rTPA group data: n=81; mean age=69.5; Men=50%; Most frequent vascular risk factors=Hypertension, Atrial Fibrillation; Most frequent etiology=cardioembolic 40%; Occluded artery= MCA 63.9%; Mean NIHSS=17.6; Com-plete recanalization=92.5%; Symptomatic intracranial hemorrhage= 2.5%; Procedural compli-cations= 3 (3.7%); Mean time to treatment=342 min; mRS90≤2=38.4%; Mortality=27.5%. rTPA treatment prior to IAMT had a statistically significant association to lower mortality, and had no statistically significant association with recanalization rate nor with mRS90. CONCLUSIONS: rTPA treatment prior to IAMT is, in our series, associated to lower mortality. Although more studies are necessary to asses these results and this association, possible causes of this relation in our series were lower NIHSS and shorter mean time to treatment in patients treated with rTPA prior to IAMT.
Karger_ESC London_2013
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