22. European Stroke Conference 5 Interventional neurology B 9:10 - 9:20 Large vessel occlusion stroke: effect of recanalization on outcome depends on NIHSS score K. Skagen1, M. Skjelland2, D. Russell3, E.A. Jacobsen4 Oslo University Hospital, Oslo, NORWAY1,Oslo University Hospital, Oslo, NORWAY2, Oslo University Hospital, Norway, NORWAY3, Oslo University Hospital, Oslo, NORWAY4 Background Intravenous thrombolysis with tissue plasminogen activator (tPA) is the only FDA-approved medical treatment for acute ischemic stroke. Large vessel occlusions (LVO) es-timated to account for up to 40% of all acute ischemic strokes, are often refractory to IV throm-bolysis and have a worse prognosis. Mechanical recanalization procedures are therefore in-creasingly used in clinical practice for patients with LVO refractory to or presenting outside the accepted time window for IV thrombolysis. Methods This is a single center cohort study ana-lyzing prospectively collected data on patients with LVO in a clinical setting. Clinical outcome was compared for two cohorts; patients who recanalized after endovascular intervention (n= 62), and patients not selected for endovascular therapy with persistent large vessel occlusion (n= 100). All patients included were evaluated with perfusion imaging and perfusion-diffusion mismatch together with clinical symptoms formed basis for selecting patients for endovascular treatment. Results Recanalization was associated with an increased proportion of patients with good clinical outcome (mRs ≥2) at 90 days (OR 2.6, 95 % CI 1.2-5.6; p=0.017). When compar-ing mortality and good function in the two groups and pre-treatment NIHSS scores we found no significant effect of recanalization on outcome for patients with NIHSS <10. Furthermore for patients with NIHSS <10 treated conservatively there was no mortality at 90 days compared to 3 deaths in the group who received endovascular therapy. Conclusion Mechanical recanali-zation in patients with LVO was associated with better function at 90 days. This effect differed however, depending on the patient’s pre-treatment NIHSS score with scores more than 10 need-ed to show significant effect on outcome. 4 Interventional neurology B 9:00 - 9:10 Prior IV thrombolysis has probably no impact on early recanalization and clinical out-come after endovascular treatment of the occluded cerebral artery in acute ischemic stroke patients D. Sanak1, D. Skoloudik2, T. Veverka3, M. Kuliha4, M. Kral5, M. Kocher6, M. Roubec7, K. Langova8, V. Prochazka9, R. Herzig10, P. Kanovsky11 Comprehensive Stroke Center, Department of Neurology, Palacký University Hospital, Olomouc, CZECH REPUBLIC1,Comprehensive Stroke Center, Department of Neurology, Palacký University Hospital, Olomouc, CZECH REPUBLIC2, Comprehensive Stroke Center, Department of Neurology, Palacký University Hospital, Olomouc, CZECH REPUBLIC3, Com-prehensive Stroke Center, Department of Neurology, University Hospital, Ostrava, CZECH REPUBLIC4, Comprehensive Stroke Center, Department of Neurology, Palacký University Hospital, Olomouc, CZECH REPUBLIC5, Comprehensive Stroke Center, Department of Ra-diology, Palacký University Hospital, Olomouc, CZECH REPUBLIC6, Comprehensive Stroke Center, Department of Neurology, University Hospital, Ostrava, CZECH REPUBLIC7, Depart-ment of Medical Biophysics, Palacký University Medical School and Institute of Molecular and Translational Medicine, Olomouc, CZECH REPUBLIC8, Comprehensive Stroke Center, De-partment of Radiology, University Hospital, Ostrava, CZECH REPUBLIC9, Comprehensive Stroke Center, Department of Neurology, Palacký University Hospital, Olo-mouc, CZECH REPUBLIC10, Comprehensive Stroke Center, Department of Neurology, Palacký University Hospital, Olomouc, CZECH REPUBLIC11 Background: Although different endovascular approaches are now largely used in the treatment of acute intracranial arterial occlusion (IAO) in ischemic stroke (IS), intravenous thrombolysis (IVT) is still considered standard obligatory treatment option within first 4.5 hours from stroke onset. The aim was to assess the impact of prior IVT before endovascular treatment (EVT) of IAO on early recanalization and clinical outcome in acute IS patients. Methods: In retrospec-tive study, 372 consecutive acute IS patients with IAO treated with EVT were included and divided into 2 groups according to the presence/absence of prior IVT use. Stroke severity was assed using National Institutes of Health Stroke Scale (NIHSS), 90-day clinical outcome using modified Rankin Scale (mRS) with good outcome defined as 0-2. Early neurological improve-ment (ENI) was defined as a decrease of >/= 4 NIHSS points after 24 hours. Early recanaliza-tion was quantified using Thrombolysis in Cerebral Ischemia scale. Symptomatic intracerebral hemorrhage (SICH) was evaluated according to SITS-MOST criteria. Results: Study set con-sisted of 193 patients (51% males, mean age 62.9 +/- 13.8 years) treated with prior IVT (Group 1) and of 179 patients (60% males, mean age 65.5 +/- 12.4 years) treated without IVT (Group 2). Patients treated with prior IVT had significantly higher baseline NIHSS (18 vs. 15 points, p-0.0001). No difference was found in recanalization rate (80.9 vs. 87.6%, p-0.089) including complete (41.6 vs. 46.4%, p-0.403), presence of ENI (45.3 vs. 50.7%, p-0.186), occurrence of SICH (4.1 vs. 4.0%, p-1.000), good clinical outcome (43.8 vs. 51.7%, p-0.146) and 3-month mortality (22.7 vs. 23.0 %, p-1.000) between groups. Conclusion: Prior IVT probably does not increase the chance for early recanalization and good clinical outcome after EVT of IAO in acute IS patients. Acknowledgement: Supported by the IGA MH CR grants NT/11386-5/2010 and NT/11046-6/2010. 178 © 2013 S. Karger AG, Basel Scientific Programme
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