22. European Stroke Conference 938 Interventional neurology Carotid artery stenting safety: single-center experience P. Barros1, H. Felgueiras2, D. Pinheiro3, V. Gama4, M. Veloso5 Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL1, Centro Hos-pitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL2, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila NOva de Gaia, PORTUGAL3, Centro Hospitalar Vila Nova de Gaia/Espin-ho, Vila Nova de Gaia, PORTUGAL4, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL5 BACKGROUND Carotid angioplasty with stenting (CAS) has been suggested as an alternative to endarterectomy for the treatment of symptomatic Internal Carotid Artery (ICA) stenosis. However, results from ran-domised controlled trials have shown a higher short-term risk of stroke associated with carotid stent-ing. It´s recommended that carotid revascularization procedures should only be performed in centers with a rate of peri-procedure complications <6%. In our institution, CAS is performed since 2007 and our main goal was to evaluate the safety of this technique in the first five years of use. METHODS Systematic recording of all complications associated with the procedure, in all patients with symp-tomatic ICA stenosis who underwent CAS between 2007 and 2012. Safety was defined as the rate of major complications (stroke, TIA or death) in the first 30 days post-procedure. We have also defined minor complications: femoral hematoma, residual stenosis and symptomatic bradycardia. All proce-dures were performed with an embolic protection device. RESULTS In this 5-year period, 37 procedures have been performed (37 patients, 30 males). More than 80% of the CAS were performed in the first 14 days after cerebrovascular event. Mean age was 68, 5 years; 56.7% of patients had more than 70 years. There were two major complications: two strokes on the procedure day, both non-disabling (mRs-1 at 90 days), one ipsilateral and the other contralateral to the revascularized carotid and two minor complications: 1 femoral hematoma and a residual steno-sis. CONCLUSIONS As described in literature, periprocedure complications arise mainly from “non-disabling strokes” that occur on the day of the procedure. We emphasize two facts in our serie: a periprocedure rate of stroke/mortality < 6%, and the significant percentage of patients with more than 70 years, a group with potential less benefit from CAS. 842 © 2013 S. Karger AG, Basel Scientific Programme 939 Interventional neurology The TREVO device for recanalization therapy in acute stroke: Report of first experience in 45 patients C.H. Nolte1, S. Tütüncü2, J.F. Scheitz3, A. Rocco4, G. Bohner5, H.J. Audebert6 Department of Neurology and Center for Stroke Research Berlin, Charite, Berlin, GERMA-NY1, Center for Stroke Research Berlin, Charite, Berlin, GERMANY2, Center for Stroke Research Berlin, Charite, Berlin, GERMANY3, Department of Neurology, Charite, Berlin, GERMANY4, Department of Neuroradiology, Charite, Berlin, GERMANY5, Center for Stroke Research, Charite, Berlin, GERMANY6 BACKGROUND: Mechanical thrombectomy may be beneficial in acute stroke patients with large vessel occlusions. We report on safety and effectiveness in 45 consecutive patients treated with the TREVO stent-re-triever device. METHODS Our institution runs a prospective mechanical thrombectomy (MT) register. Patients with occlusion of the carotid T, MCA-mainstem (M1-segment) or basilar artery are considered for the MT proce-dure. Here, all patients treated with the TREVO device were analyzed. Site of vessel occlusion, delay times, successful recanalization (Thrombolysis in Cerebral Infarc-tion= 2b-3), good clinical outcome (modified Rankin Scale score 0-2) and mortality at Day 90, de-vice- related complications, and symptomatic intracranial hemorrhage (SICH according to ECASS 3-criteria) are assessed. RESULTS: Between October 2011 and November 2012, 45 patients with vessel occlusion (N=20 left anterior circulation, N=16 right anterior circulation; N=9 basilar artery occlusion) underwent MT with the TREVO device 42% female; median age (IQR) years: 72 (55-78); median NIHSS on admission (IQR): 17 (13-22), 44% with atrial fibrillation. Median time from stroke onset to start of angiography (IQR) was 198 (150-270) minutes. 78% re-ceived bridging therapy with IV rTPA. 27% received additional IA rTPA. In 27% of patients a sec-ond device was employed. Successful revascularization was obtained in 69% of patients. Median time (IQR) to recanalization was 50 (35-60) minutes. 3 patients (7%) suffered SICH. Good clinical outcome was achieved in 44% of the patients with infarction of the anterior circula-tion and 33% of patients with basilar artery occlusion. The mortality rate was 22% in both groups. No other major complications were detected. CONCLUSIONS: Our initial experience was that the use of the TREVO device was reasonably safe and effective in patients with severe stroke at our institution.
Karger_ESC London_2013
To see the actual publication please follow the link above