London, United Kingdom 2013 5 Acute stroke: current treatment Leukoaraiosis, i.v.thrombolysis and risk of intracerebral haemorrhage: Report from a single centre and a pooled analysis of existing reports. L. Willer1, H.K. Christensen2, P. Meden3, C. Ovesen4, AM Abild5, I. Havsteen6, A. Christensen7 Bispebjerg Hospital, Copenhagen, DENMARK1, Bispebjerg Hospital, Copenhagen, DEN-MARK2, Bispebjerg Hospital, Copenhagen, DENMARK3, Bispebjerg Hospital, Copenhagen, DEN-MARK4, Bispebjerg Hospital, Copenhagen, DENMARK5, Bispebjerg Hospital, Copenhagen, DEN-MARK6, Bispebjerg Hospital, Copenhagen, DENMARK7 Background and purpose: Conflicting evidence exist if leukoaraiosis (LA) influences the risk of hae-morrhagic transfromation (HT) and symptomatic intracerebral haemorrhage (sICH) after i.v. throm-bolysis. The aim of this analysis was to evaluate if leukoaraiosis increases the risk of HT and sICH after i.v.thrombolysis. Methods: This report is based on analysis of single-center data from consecutive patients admitted with ischemic stroke and treated with iv thrombolysis (311 patients) and a pooled analysis of four other repoorts identified by a systematic review. In our new data, baseline CT was assessed for LA by Fazekas score and all cases of HT identified by a single neuroradiologist blinded for clinical data. Patients with HT and neurological deterioration of alt least 4 points were considered sICH. Four re-ports were identified and results pooled based on respective authors definition of sICH and LA, our results were added and an unadjusted pooled risk was calculated. Results: In our cohort, 23 patients (7.4%) developed HT. HT was significantly more frequent in pa-tients with any degree of LA (n=13 of 113; 11.5%) than without LA (n=10 of 198; 5.1%). In univar-iate analysis, Chi square test, LA increased the risk of HT OR 2.4 (95% CI, 1.40 to 5.78; p = 0.04). One patient developed sICH. The pooled analysis included 1537 patients, 68 (4.4%) developed sICH. sICH was significantly more frequent in patients with any degree of LA (n=31 of 454; 6.8%) than without LA (n=37 of 1083; 3.4%). Leukoaraiosis increased the risk of sICH: OR 2.07(95% CI, 1.23 to 3.48; p=0.005). Conclusions: This analysis confirmed LA as a risk factor of HT after i.v. thrombolysis, and a pooled risk analysis showed an increased risk of sICH. The pooled analysis is limited by confering different methods of registration. The increase in risk is statistically significant but LA should not be regarded a contraindication of i.v. thrombolysis. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 223 4 Acute stroke: current treatment Intravenous Thrombolysis in Patients with Acute Ischemic Stroke due to Internal Carotid Ar-tery Occlusion – A Serbian Experience with Thrombolysis in Ischemic Stroke (SETIS) Z. Zivanovic1, J. Sekaric2, S. Gvozdenovic3, A. Lucic-Prokin4, T. Kokai-Zekic5, S. Lukic6, M. Zarkov7, P. Slankamenac8 on behalf of SETIS Group Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA1, Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA2, Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA3, Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA4, Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA5, Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA6, Department of neurol-ogy, Clinical Centre of Vojvodina, Novi Sad, SERBIA7, Department of neurology, Clinical Centre of Vojvodina, Novi Sad, SERBIA8 BACKGROUND: Stroke due to internal carotid artery occlusion (ICAo) are associated with poor prognosis. The benefit of intravenous thrombolysis in patients with acute ischemic stroke and ICAo remains unclear. The aim of this study was to estimate the efficacy and safety of intravenous throm-bolysis among patients with acute stroke due to ICAo comparing to patients with acute stroke of other causes. METHODS: Data were from the Serbian Experience with Intravenous Thrombolysis in Ischemic Stroke (SETIS), a prospective, multicenter study in Serbia of all patients treated with intravenous rtPA for acute ischemic stroke during seven years period. Patients were divided into two groups, those with and those without ICAo which was diagnosed by carotid ultrasound, CT or MR angiogra-phy. We analyzed the differences in baseline characteristics, 3-month functional outcome measured by mRS, death and intracranial bleeding between these two groups. RESULTS: From a total of 760 patients who received rtPA, patients with posterior circulation stroke were excluded. Among 648 included patients there were 73 (11.3%) with symptomatic ICAo. Av-erage age in group with ICAo was 59.8 vs. 60.6 in group without. We found significant differences in sex (82.2% males in group with ICAo vs. 61.7% in group without; p=0.0003) and in baseline NIHSS score (15.4 with ICAo vs. 12.8 without; p<0.0001). Comparing outcome in two groups, we found significant differences in excellent functional outcome (mRS 0-1) (31.5% with ICAo vs. 59.3% without; p<0.0001), and favorable functional outcome (mRS 0-2) (45.2% with ICAo vs. 69.1% without; p<0.0001), but no significant differences in death (6.9% with ICAo vs. 11.1% with-out; p=0.359) at 3 months. Any intracranial bleeding was seen in 9.6% of patients with ICAo and in 20.3% of those without, which was significant (p=0,041) but the differences of symptomatic intrace-rebral hemorrhage was non-significant (2.7% with ICAo and 8.0% without; p=0.168). CONCLUSION: Acute stroke patients with ICAo treated with rtPA have a worse outcome than pa-tients without it, but still have benefit in reduction of patients dependent in activities of daily living.
Karger_ESC London_2013
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