22. European Stroke Conference 2 Acute stroke: clinical patterns and practice 16:40 - 16:50 IS IT NEEDED AVANCED NEUROIMAGING TO SELECT PATIENTS FOR ENDO-VASCULAR TREATMENT BEYOND 4.5 HOURS OF SYMPTOMS ONSET? M. Millán1, N. Pérez de la Ossa2, C. Castaño3, J. Munuera4, M. Hernández5, M. Gomis6, P. Cuadras7, L. Dorado8, E. López-Cancio9, E. Palomeras10, P. García-Bermejo11, M. Almen-drote12, A. Dávalos13 Hospital Germans Trias i Pujol, Badalona, SPAIN1,Hospital Germans Trias i Pujol, Badalo-na, SPAIN2, Hospital Germans Trias i Pujol, Badalona, SPAIN3, Hospital Germans Trias i Pu-jol, Badalona, SPAIN4, Hospital Germans Trias i Pujol, Badalona, SPAIN5, Hospital Germans Trias i Pujol, Badalona, SPAIN6, Hospital Germans Trias i Pujol, Badalona, SPAIN7, Hospital Germans Trias i Pujol, Badalona, SPAIN8, Hospital Germans Trias i Pujol, Badalona, SPAIN9, Hospital Germans Trias i Pujol, Badalona, SPAIN10, Hospital Germans Trias i Pujol, Badalona, SPAIN11, Hospital Germans Trias i Pujol, Badalona, SPAIN12, Hospital Germans Trias i Pujol, Badalona, SPAIN13 Background and purpose: The usefulness of multimodal MR for the selection of patients with acute ischemic stroke(AIS) who may benefit from endovascular treatment(EVT) is not clear. We aimed to determine whether multimodal MR improves clinical outcomes compared with non-contrast cranial CT of patients undergoing EVT beyond 4.5 hours from stroke onset. Methods: We prospectively registered consecutive patients with acute large artery occlusion of the anterior territory who underwent EVT. According to availability, multimodal MR (dif-fusion- weighted lesion< 50% of the affected territory and documented occlusion ) or CT-AS-PECTS score≥7 and documented occlusion in a transcranial color-coded Duplex sonography were used to select patients for EVT. Recanalization(TICI 2b-3), symptomatic intracranial hemorrhage(sICH) (worsening of ≥ 4 points in the NIHSS score within 36 hours in any bleed-ing) and favorable functional outcome (modified Rankin score ≤2 at 3 months) were record-ed. Results: From a total of 208 consecutive acute ischemic stroke patients with large anterior arterial occlusion treated with EVT, 83 were admitted beyond 4.5 hours. MR was used in 59 (71%) and CT in 24 (28%) patients. No differences were found regarding age, baseline NIHSS, time from symptoms onset to groin puncture and to recanalization between groups. For MR/ CT patients recanalization was achieved in 66.1% vs 66.7%(p=0.961); sICH occurred in 5.2% vs 4.2%(p=0.847); 90th day mortality in 18.2% vs19%,(p=0.931), and favorable outcome at 3 month in 37% vs 38.1%(p=0.932). No interaction was found between neuroimaging and time from stroke onset to admission on the favorable functional outcome (p for interaction 0.996). Conclusion: In our series multimodal MR did not increase the clinical benefit among patients with AIS treated with EVT beyond 4.5 hours from symptoms onset compared with CT-AS-PECTS score. Randomized studies to investigate the best modality of neuroimaging for patient selection for EVT are needed. 168 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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