22. European Stroke Conference 21 Acute stroke: emergency management, stroke units and complications B 12:20 - 12:30 Tempo of penumbral tissue loss in acute stroke: the collaterals set the pace. S. Jung1, M. Gilgen2, J. Slotboom3, M. El-Koussy4, C. Zubler5, M.L. Mono6, M. Heldner7, P. Mordasini8, G, Schroth9, H.P. Mattle10, M. Arnold11, U. Fischer12, J. Gralla13 Department of Neurology and Neuroradiology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND1,Department of Neurology, Inselspital,Univer-sity Hospital Bern and University of Bern, Bern, SWITZERLAND2, Department of Neurora-diology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND3, Department of Neuroradiology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND4, Department of Neuroradiology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND5, Department of Neurology, Inselspital,Univer-sity Hospital Bern and University of Bern, Bern, SWITZERLAND6, Department of Neurology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND7, Depart-ment of Neuroradiology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND8, Department of Neuroradiology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND9, Department of Neurology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND10, Department of Neurology, Inselspital,University Hospital Bern and Uni-versity of Bern, Bern, SWITZERLAND11, Department of Neurology, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND12, Department of Neuroradiolo-gy, Inselspital,University Hospital Bern and University of Bern, Bern, SWITZERLAND13 OBJECTIVE: To identify factors that determine the evolution of the penumbra in patients who received endovascular therapy because of proximal middle cerebral artery (MCA) occlusion. METHODS: 51 patients with M1 or M2 occlusions in whom at least minimal reperfusion (TICI score > 0) was achieved were included in this analysis. Their penumbra was assessed with per-fusion (PWI) and diffusion weighted imaging (DWI). Loss of penumbral volume was defined as difference of post- minus pre-treatment DWI-volumes and calculated in percent of pre-treat-ment penumbral volume. Correlations between baseline characteristics, reperfusion, collaterals, time to reperfusion and penumbral volume loss were assessed using analysis of covariance. RESULTS: Collaterals (p=0.003), reperfusion (p=0.003) and their interaction (p=0.007) inde-pendently influenced penumbral tissue loss, but not time from MR (p=0.052) or from symptom onset to reperfusion (p=0.728). When collaterals were poor 22% of penumbral volume was lost, when moderate 8% and when good 7%. Patients achieving good reperfusion and having good collaterals experienced a linear penumbral loss of 5% each hour (p=0.012) corresponding to a mean loss of 0.47 mL penumbra per hour, while in patients with poor or moderate collaterals loss was nonlinear and larger. INTERPRETATION: Collaterals and reperfusion are the main factors determining loss of pen-umbral volume in patients with MCA occlusions. In patients with good collaterals, time to suc-cessful reperfusion accounts only for a minor fraction of penumbral volume loss and collaterals may slow down penumbra loss. These results support the hypothesis that good collaterals ex-tend the time window for acute stroke treatment. 118 © 2013 S. Karger AG, Basel Scientific Programme
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