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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 837 928 Interventional neurology Contrast Extravasation on Computed Tomography after Endovascular Reperfusion Treat-ment in Patients with Acute Middle Cerebral Artery Occlusion and Hemorrhagic Transforma-tion R. Eichel1, G. Keigler2, J.M. Gomori3, J.E. Cohen4, R.R. Leker5 Hadassah University Hospital, Department of Neurology, Jerusalem, ISRAEL1, Hadassah Uni-versity Hospital, Department of Neurology, Jerusalem, ISRAEL2, Hadassah University Hospital, Department of Neuroradiology, Jerusalem, ISRAEL3, Hadassah University Hospital, Department of Invasive Neuroradiology, Jerusalem, ISRAEL4, Hadassah University Hospital, Department of Neu-rology, Jerusalem, ISRAEL5 Background: Contrast Extravasation (CE) is a known phenomenon after endovascular reperfusion (ER) in acute ischemic stroke patients. The aim of the current study was to evaluate whether CE is correlated to hemorrhagic transformation after ER in patients with acute middle cerebral artery (MCA) occlusion. Methods: We reviewed all prospectively accrued data of acute MCA occlusions that subsequently underwent ER and had hemorrhagic transformation of follow up CT . We stratified the patients ac-cording to existence of CE defined as a hyperdense area with Hounsfield unit >90 that persisted on follow up CT scans. We further evaluated hemorrhage and CE for volume and site using ASPECTS criteria. Intracerebral hemorrhage (ICH) was categorized according to ECASS-3 criteria. Neurolog-ical and functional disabilities were evaluated with the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) respectively. Results: Twenty seven patients met inclusion criteria (mean 65, age range 33-85). CE was identified in 3 (11.1%) patients with a mean volume of 7.5 cm³ and the mean ASPECTS score for CE was 8 (Max-Min 7-9). CE was only seen in subcortical regions. Mean time of persistence of CE on follow up CT was 3 days (2-4 days). Lower recanalization rate TIMI 0-2 (p=0.008) were associated with CE and M2 occlusion location was inversely correlated to CE (p<0.0001). Conclusions: CE after ER in patients with acute MCA occlusion and intracerebral hemorrhage in-volves subcortical regions and is associated with lower recanalization rates and inversely correlated with M2 occlusions. 929 Interventional neurology Intra-arterial thrombolytic therapy in the sitting of ischemic stroke without angiographic ves-sel occlusion, efficacy and outcome , single center experience. O. Mansour1, M. Schumacher2, K. Sobh3 Alexandria University , Interventional neurology department, Alexandria, EGYPT1, Freiburg university hospital ,, Freiburg, GERMANY2, El Azhar university hospital, Cairo, EGYPT3 We analyzed clinical and radiological data of two group of stroke patients whose arteriography per-formed <= 6 hours of symptom onset did not visualize any vessel occlusion and DWI/FLAIR were available. Materials and methods Patients were identified from a prospectively maintained stroke database. All patients had initial neurological assessment on (NIHSS). Patients then underwent DSA after initial head computed tomography (CT) scans. Follow-up radiological assessment at 24–72 h was performed with CT and MRI. Association of stroke risk factors with clinical and radiological outcomes was estimated. Eighteen of 143 consecutive patients (12.6%) who underwent arteriog-raphy with the intention to perform intraarterial thrombolysis did not show any arterial occlusion, 11 patients had multiple SVI (group I), while 7 patients (group II) had single lesion based on initial DWI/FAIR lesion patterns. All 18 patients received IA rtap with dose ( 38 mg ; range 18-64mg) . A mean age 63 years; 28 were women,the median NIHSS score was 8 (range 2–25). Time from symp-tom onset to arteriography ranged from 115 to 315 minutes; on average, it was 226 minutes. Pre-sumed stroke cause was cardiac embolism in 8 patients (44.4%), small artery disease in 3 (16.7%), cholecystectomy in 1 (5.6%), and undetermined in 6 patients (33.3%). Neurological improvement was observed in 14 (77.8%) of the 18 patients. After mean duration of follow up of (4.8 ) months, modified Rankin Scale score (mRS) was ≤2 in (6 of 7 of group II patients (85.7%), indicat-ing a favorable outcome. Six patients (54.5%) in group II mRS had a poor outcome (mRS 3 or 4). All patients had follow-up brain imaging. Conclusion The cause of infarction may have been arteri-al obstruction with spontaneous recanalization or small vessel occlusion not visible on DSA.in both situation IA thrombolysis showed significant role in improving clinical outcome specially in those proved to be due to SVI.


Karger_ESC London_2013
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