Page 848

Karger_ESC London_2013

22. European Stroke Conference 949 Interventional neurology Lesion Location of Intracerebral Hemorrhage after Multi-Modal Reperfusion Treatment in patients with acute Middle Cerebral Artery occlusion 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: Recent data suggests that timely endovascular therapy (ET) results in higher chances for reperfusion and good outcome in selected patients with proximal middle cerebral artery occlu-sion (MCAO). Structures of the deep MCA filed such as the basal ganglia, are particularly vulnera-ble to hemorrhagic injury following systemic thrombolysis but whether the same is true for patients undergoing ET remains unknown. Methods: We reviewed all prospectively accrued data of patients with acute MCAO that subsequently underwent ET. We accrued data on demographics, risk factors and hemorrhagic changes. We further studied patients with intra-cerebral hemorrhages (ICH) using ASPECTS criteria for hemorrhage location and ECASS-3 criteria for type of hemorrhagic trans-formation. Neurological and functional disabilities were evaluated with the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) respectively. Results: Ninety three patients met inclusion criteria (age range 27-87). Of these, 27 (29.0%) patients had any ICH (mean volume 16.1cm³) but only 5 of those (5.3%) had symptomatic ICH (sICH). The overall mor-tality for all patients with ICH was 25.9%. Median ASPECTS score for all ICH was 8 (range 3-9). Most ICH involved subcortical regions (n=19; 70.4%) with the lentiforme nucleus being involved in 17. Only 7 patients (28.0%) with ICH had good outcomes (mRS ≤2) and all had ASPECTS scores of 8-9. In contrast, sICH more frequently involved the insula (p=0.034). In a logistic regression model testing ICH-ASPECTS < 7, age over 80 and ICH location we could only identify ASPECTS < 7 as independent risk factor for sICH. Conclusions: ICH predominantly involves subcortical regions after ET in patients with acute MCAO. An ICH with an ASPECTS score of <7 was a significant predictor for sICH. 848 © 2013 S. Karger AG, Basel Scientific Programme 950 Interventional neurology Baseline DWI-ASPECTS predicts clinical outcome in acute stroke patients with major vessel occlusion after endovascular therapy M. Hayakawa1, H. Yamagami2, S. Sato3, K. Toyoda4, Y. Matsumaru5, Y. Enomoto6, Y. Egashira7, Y. Okada8, K. Kitagawa9, K. Kimura10, N. Tanahashi11, T. Hyogo12, N. Sakai13, S. Yoshimura14 for the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan study group Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, JAPAN1, Department of Neurology, National Cerebral and Cardiovascular Center, Suita, JAPAN2, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, JAPAN3, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, JAPAN4, Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, JAPAN5, Department of Neurosurgery, Gifu University, Gifu, JAPAN6, Department of Neurosur-gery, Gifu University, Gifu, JAPAN7, Department of Cerebrovascular Disease, National Hospital Or-ganization Kyusyu Medical Center, Fukuoka, JAPAN8, Department of Neurology, Osaka University, Suita, JAPAN9,Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, JAPAN10, Department of Neurology, Saitama International Medical Center, Saitama Medical University, Hi-daka, JAPAN11, Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, JAPAN12, Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, JA-PAN13, Department of Neurosurgery, Gifu University, Gifu, JAPAN14 Background and purpose The Alberta Stroke Program Early CT Score (ASPECTS) on diffusion-weighted imaging (DWI) has been reported as a predictor of the stroke outcome following intravenous thrombolysis (IVT). We investigated whether baseline DWI-ASPECTS is related to clinical outcome in acute stroke patients with major vessel occlusion after endovascular therapy (EVT). Methods The RESCUE-Japan registry prospectively registered 1,442 stroke patients with major vessel occlu-sion who were admitted to 84 Japanese stroke centers within 24 hours after onset from July 2010 to June 2011. We analyzed all acute stroke patients with internal carotid artery or middle cerebral artery (M1 or M2 segments) occlusions treated with EVT with/without IVT from the registry. The endpoints at 3 months include; favorable outcome defined as a modified Rankin scale (mRS) score 0-2, poor outcome defined as a mRS score 5-6, and death. Results A total of 294 patients (71.1+/-11.8 years old, 178 men) was included. Median baseline NIHSS score was 17 (IQR 12-21) and median baseline DWI-ASPECTS was 7 (6-9). Substantial recanaliza-tion (TICI grading score 2b or 3) was obtained in 162 patients (55.9%) at the end of EVT. The out-come was favorable in 104 patients (35.7%), poor in 93 (31.8%) and fatal in 37 (12.7%). On mul-tivariate analyses, DWI-ASPECTS was significantly related to favorable outcome (OR, 1.19; 95% CI, 1.01-1.41 per 1-point increase), poor outcome (0.81; 0.69-0.95) and death (0.79; 0.65-0.95). Substantial recanalization (OR, 1.19; 95% CI, 1.01-1.41 and 0.38; 0.19-0.75, respectively), NIHSS score (0.95; 0.90-0.99 and 1.08; 1.02-1.14, per 1-point increase, respectively) and age (0.96; 0.93- 0.99 and 1.05; 1.01-1.08, per 1-year increase, respectively) were also independent predictors of both favorable and poor outcomes, but not death. Conclusions Baseline DWI-ASPECTS predicts stroke outcome at 3 months after EVT.


Karger_ESC London_2013
To see the actual publication please follow the link above