London, United Kingdom 2013 4 Acute stroke: emergency management, stroke units and complications A 9:00 - 9:10 ASPECTS is a strong prognostic variable but does not modify the effect of treatment in the IMS3 study M.D. HILL1, A.M. Demchuk2, M. Goyal3, T Jovin4, R von Kummer5, T.A. Tomsick6, S.. Ye-atts7, Cerebrovasc Dis 2013; 35 (suppl 3)1-854 89 Y.Y. Palesch8, J.P. Broderick9 IMS3 Investigators University of Calgary, Calgary, CANADA1,University of Calgary, Calgary, CANADA2, Uni-versity of Calgary, Calgary, CANADA3, University of Pittsburgh, Pittsburgh, USA4, Dresden Technische Universität, Dresden, GERMANY5, University of Cincinnati, Cincinnati, USA6, Medical University of South Carolina, Charlston, USA7, Medical University of South Carolina, Charlson, USA8, University of Cincinnati, Cincinnati, USA9 Introduction The IMS-3 trial randomized acute ischemic stroke patients to IV tPA plus endovascular therapy versus IV tPA therapy alone within 3 hours from symptom onset. Brain imaging relied on base-line non-contrast CT. Previous work has suggested that only patients with favorable baseline CT scans (ASPECTS 8-10) respond to endovascular treatment. A principal secondary hypoth-esis of the trial was that subjects with significant early ischemic change on the baseline scan would not respond to endovascular therapy. Methods 656 subjects were enrolled and randomized in a 2 (endovascular+IV tPA):1 (IV tPA) ratio with primary outcome of mRS 0-2 determined at 90 days. The baseline and follow-up CT scan and CTA images, where done (N=306), were reviewed, blinded to any clinical information, by the central imaging core investigators. Cerebral angiograms of the endovascular group were reviewed by a separate angiography core lab investigators. We assessed whether the baseline ASPECTS score predicted outcome, and interacted with study treatment., We analyzed the subgroups defined by time from onset to IV tPA initiation and baseline occlusion status. These analyses were evaluated at the a priori specified alpha level of 0.01. Results The primary IMS-3 results were neutral. Baseline demographic and clinical characteristics were similar between subjects with a baseline ASPECTS score 8-10 (58% of the study sam-ple) vs 0-7. Subjects with ASPECTS 8-10 were almost twice as likely RR 1.8 CI99 1.4-2.4 to achieve a favorable outcome. There was insufficient evidence of a treatment-by-ASPECTS interaction. In the subgroups treated with onset to IV tPA under 120 minutes, in CTA-proven ICA or MCA occlusion, and in both, these results were similar. The probability of achieving recanalization of the primary arterial occlusive lesion RR 1.5 CI99 0.9-2.4 on the angiogram or achieving TICI 2b/3 reperfusion RR 1.8 CI99 1.2-2.8 was higher among subjects with higher ASPECTS scores. Conclusions ASPECTS 8-10 is a strong predictor of outcome and a predictor of reperfusion. ASPECTS does not modify the effect of endovascular treatment among acute stroke patients in the IMS3 study. 3 Acute stroke: emergency management, stroke units and complications A 8:50 - 9:00 Developing a national Stroke Thrombolysis Service during a financial crisis – The Irish National Stroke Programme. J.A. Harbison1, C. Brennan2, S. Murphy3, E. Shelley4, P. Durkan5, B. White6, A. Carroll7, D. McArdle8, L. Evans9, P.J. Kelly10 Irish National Stroke Programme., Dublin, IRELAND1,Irish National Stroke Programme., Dublin, IRELAND2, Irish National Stroke Programme., Dublin, IRELAND3, Irish National Stroke Programme., Dublin, IRELAND4, Irish National Stroke Programme., Dublin, IRE-LAND5, Irish National Stroke Programme., Dublin, IRELAND6, Irish National Stroke Pro-gramme., Dublin, IRELAND7, Directorate of Quality and Patient Safety, Health Service Exec-utive, Dublin, IRELAND8, Directorate of Quality and Patient Safety, Health Service Executive, Dublin, IRELAND9, Irish National Stroke Programme., Dublin, IRELAND10 Introduction The 2006 Irish National Audit of Stroke, showed a national stroke thrombolysis rate of 1%. A 2009 thrombolysis survey showed an improvement to 2.8%. In 2010, despite a severe economic crisis including banking collapse and IMF intervention, the Irish National Stroke Programme was established. Key aims were providing national access to 24/7 stroke thrombolysis and in-creasing the rate of safe thrombolysis to at least 7.5% by end 2012. Methods: Several initiatives were introduced: •A stroke thrombolysis training programme was developed in association with Royal College of Physicians of Ireland (>100 hospital physicians trained). •National ambulance access protocols were implemented for FAST score positive patients with-in 4.5 hours for ambulance redirection to hospitals providing 24/7 stroke thrombolysis. •National thrombolysis protocols were developed and disseminated •New stroke physician appointments were made in selected hospitals A public stroke awareness campaign was also run by the Irish Heart Foundation. In March 2012 a national thrombolysis audit was conducted. Lead hospital stroke physicians completed an on-line questionnaire and 6 hospitals were randomly selected for individual medical file audit. Results. All 24 hospitals surveyed had initiated thrombolysis protocols, with thrombolysis rates from 1% to 21%. Of 1246 stroke patients admitted during the survey period, 118 were treated with thrombolysis. From 2009 to 2012, this corresponded to a national thrombolysis rate increase from 2.8 to 9.5% (p<0.001). Symptomatic intracerebral haemorrhage (PH2) was reported in 1.7% (2/118). Mean national door to needle time was 1 hour 34 minutes. Conclusions. Despite reduced health budgets, a structured programme to reorganise stroke services and pro-vide training facilitated a rapid increase in the number of patients treated with stroke throm-bolysis, which exceeded the national 7.5% target. A national telestroke network is planned for 2013.
Karger_ESC London_2013
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