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Karger_ESC London_2013

London, United Kingdom 2013 1 Acute stroke: current treatment & new treatment concepts 8:30 - 8:40 ENDOVENOUS ALTEPLASE FACILITATES MECHANICAL THROMBECTOMY WITH STENT RETRIEVERS IN ACUTE ISCHEMIC STROKE M. Gomis1, C. Castaño2, L. Dorado3, P. García-Bermejo4, N. Pérez de la Ossa5, M. Hernán-dez6, E. Palomeras7, E. López-Cancio8, M. Millán9, A. Dávalos10 Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN1,Hospital Universitari Ger-mans Trias i Pujol, Badalona, SPAIN2, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN3, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN4, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN5, Hospital Universitari Germans Trias i Pujol, Badalo-na, SPAIN6, Hospital de Mataró, Mataró, SPAIN7, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN8, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN9, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN10 Background: The success of mechanical thrombectomy (MT) for acute ischemic stroke may be influenced by factors such as the size and composition of the occlusive thrombus. We aimed to study the effect of intravenous tPA on the number of passes (NP) of stent retrievers needed to open the occluded vessel as surrogate of fast and successful recanalization. Methods: We ret-rospectively analyzed data from our register of all acute stroke cases of the anterior circulation treated with iv-tPA plus MT or MT alone with the stent retrievers in a single comprehensive stroke centre during a period of 3 years. We prospectively recorded NP and time from groin puncture to complete recanalization (mTICI 2b/3) or to the end of the procedure in patients who failed MT. The effect of i.v tPA on NP and functional outcome was analyzed by multivar-iate logistic regression models adjusted for relevant baseline clinical and neuroimaging vari-ables. Results: A total of 79 patients were treated with iv-tPA plus MT (mean age 65; median NIHSS 18), and 75 with MT alone (mean age 67; median NIHSS 18). There were no differ-ences in TOAST and in arterial occlusion site. A total of 15 (19%) patients versus 29 (38.7%) needed more than 2 passes (p= 0.006) and 70 (88.6%) versus 57 (76%) achieved mTICI 2b/3 (p=0.032). In the overall group, NP did not correlate with age and NIHSS but correlated with groin puncture to recanalization time or to the end of the procedure (p<0.001). The logistic re-gression analysis shown that prior iv-tPA was independently associated with ≤2 passes (OR: 2.6 CI 1.2 to 5.5;p=0.008). Regarding the outcome, the logistic regression analysis shown that diabetes, NIHSS and NP ≤2 (OR:3.3 CI 1.1 to 10.1;p<0.030) but not treatment group, was as-sociated with good outcome at three months (mRS≤2). Conclusion: NP is strongly associated with functional outcome after MT. Prior iv-tPA treatment facilitates MT reducing the number of passes and favouring successful and faster arterial reacanalization. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 9 8:30-10:00 Rooms 7,8,11,12 Mini Symposium 1 Update on cerebral small vessel disease – challenges and opportunities Update on cerebral small vessel disease – challenges and opportunities Chairs: M. Dichgans, Germany and M.G. Hennerici, Germany Lacunar Stroke: Distinguishing between what we see and what we think we see B. Norrving, Sweden Imaging microvessels and microinfarcts using high field MRI G.J. Biessels, The Netherlands Brain atrophy in subcortical ischemic vascular disease: mechanisms and clini-cal correlates M. Düring, Germany Subcortical ischemic lesions in neurodegenerative dementia: innocent bystand-ers? F. Fazekas, Austria 8:30-10:00 Oral Session Room 14,15,16 Acute stroke: current treatment & new treatment concepts Chairs: A. Alexandrov, USA and C. Roffe,UK


Karger_ESC London_2013
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