London, United Kingdom 2013 16 Interventional neurology A 15:30 - 15:40 Age-adjusted Infarct Volume Threshold for Good Outcome after Endovascular Treat-ment M. Ribo1, A.A. Flores2, E. Mansilla3, M. Rubiera4, A. Tomasello5, P. Coscojuela6, J. Pagola7, D. Rodriguez-Luna8, M. Muchada9, J. Alvarez-Sabin10, C.A. Molina11 Hospital Vall d’Hebron, Barcelona, SPAIN1,Hospital Vall d’Hebron, Barcelona, SPAIN2, Hospital Vall d’Hebron, Barcelona, SPAIN3, Hospital Vall d’Hebron, Barcelona, SPAIN4, Hos-pital Vall d’Hebron, Barcelona, SPAIN5, Hospital Vall d’Hebron, Barcelona, SPAIN6, Hospital Vall d’Hebron, Barcelona, SPAIN7, Hospital Vall d’Hebron, Barcelona, SPAIN8, Hospital Vall d’Hebron, Barcelona, SPAIN9, Hospital Vall d’Hebron, Barcelona, SPAIN10, Hospital Vall d’Hebron, Barcelona, SPAIN11 Background and purpose Infarct volume and age are strong predictors of outcome in stroke patients. We aimed to determine the impact of infarct volume on outcome according to patient age. Methods Consecutive acute stroke patients with a documented ICA/MCA occlusion who underwent endovascular procedures were studied. Patients were categorized in three groups according to age: <70 (G1), 70-79 (G2), ≥80 (G3). ASPECTS score was graded on initial CT. Time of complete recanalization (TICI≥2b) and good outcome at three months (mRS≤2) were recorded. Infarct volume was measured on the 24-36 hours control CT. Results A total of 212 patients were studied (G1: 68, G2:74, G3:72). Older patients had more hypertension and atrial fibrillation, other baseline characteristics were similar. For all patients mean infarct volume was 94.7±127cc, 35.6% had a good outcome. We observed larger infarct volumes in patients with bad outcome within each age group (G1: 22 Vs 182cc p>0.001 / G2 22 Vs 164cc p>0.001 / G3 7.6 Vs 132cc p>0.01). However, the target cutoff infarct volume that better predicted good out-come decreased as age increased: G1:49cc (S:80%, E:92.6%) G2: 32.5cc (S:80%, E:81%) G3 : 15.2cc (S:81.3%, E 86.7%). Overall, after adjusting for age, occlusion location, baseline NI-HSS and infarct volume the only predictor of good outcome was achieving a final infarct vol-ume < age-adjusted target (OR: 5.5 95%CI: 1.6-18.8; p=0.007). Probabilities to achieve an in-farct volume < age-adjusted target decreased according to baseline ASPECTS, time and degree of recanalization (figures). Conclusion According to patient age, different infarct target sizes should be targeted to ensure good outcome. This information may be used in clinical practice or design of new trials to individualize selection criteria for different age groups according to baseline ASPECTS score and time from symptom onset. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 153 TICI 2b TICI 2c TICI3 N 32 26 20 Median age (iqr) 67.5 (20) 67(22) 68(16) Median baseline NIHSS 18 (8) 17 (6) 17(10) Median baseline ASPECTS 8 (3) 8 (2) 8 (3) Proportion treated with IV tPA 43.8% 50% 65% Median imaging to reperfusion 115.5 (69) 96 (31) 74 (52) Median puncture to reperfusion 48 (55) 35 (27) 33 (18) Median onset to reperfusion 265 (196) 218 (109) 197 (82) Median 24-hour NIHSS 11 (12) 5 (10) 2 (5) Median 24-hour ASPECTS 5 (4) 7 (3) 8(2) Median NIH drop in 24 hours 8 (9) 12 (10) 11 (10) Proportion with 75% reduction 24% 50%* 65% in NIHSS at 24 hours Proportion with 24-hour sympto-matic hemorrhage (SITS-MOST) 12.5% 7.7% 5% TABLE * Fisher’s exact p 0.04 for difference between TICI 2b vs. TICI 2c
Karger_ESC London_2013
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