Page 224

Karger_ESC London_2013

224 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 7 Stroke prognosis RECURRENCE OF STROKE AFTER PREGNANCY: A FREQUENCY STUDY sA. Cruz-Herranz1, I. Illán-Gala2, P. Martínez-Sánchez3, B. Fuentes4, E. Díez-Tejedor5 Department of Neurology and Stroke Centre. La Paz University Hospital. IdIPAZ Health Re-search Institute. Autónoma University of Madrid, Madrid, SPAIN1, Department of Neurology and Stroke Centre. La Paz University Hospital. IdIPAZ Health Research Institute. Autónoma Uni-versity of Madrid, Madrid, SPAIN2, Department of Neurology and Stroke Centre. La Paz Univer-sity Hospital. IdIPAZ Health Research Institute. Autónoma University of Madrid, Madrid, SPAIN3, Department of Neurology and Stroke Centre. La Paz University Hospital. IdIPAZ Health Research Institute. Autónoma University of Madrid, Madrid, SPAIN4, Department of Neurology and Stroke Centre. La Paz University Hospital. IdIPAZ Health Research Institute. Autónoma University of Ma-drid, Madrid, SPAIN5 OBJECTIVES: The risk of recurrent stroke after pregnancy in the Spanish population unclear, our goal is to evaluate it. METHODS: Observational study of women under 45 with transient ischemic attack (TIA), cere-bral infarction (CI), cerebral venous thrombosis (CVT) or cerebral hemorrhage (CH) treated in the Stroke Unit of a hospital in Madrid between 1996-2010. Clinical data were collected prospective-ly in a database. Information on reproductive history after stroke was obtained through telephone surveys (2011). Variables: demographic data, vascular risk factors, stroke type, outcomes, medical advice about pregnancies after stroke, number of pregnancies after stroke, neurological monitoring during pregnancy, antithrombotic treatments during pregnancy/puerperium, fertility treatments ad-ministered, and haemorrhagic or ischemic stroke during pregnancy/puerperium. RESULTS: 81 women: 52 CI, 15 TIA, 10 CVT and 4 CH. Mean age 34 (± 6.6) years. Median fol-low- up 6 years (range 1-15). Twenty-five pregnancies after stroke in 19 patients (12 CI, 3 TIA, 3 CVT and 1 CH). No fertility treatments were followed. Only 10 pregnancies were monitored neu-rologically. Eighty-seven point five percent of pregnancies (whithout previous CH) continued pre-ventive antithrombotic treatment. There was no recurrence of stroke during pregnancy/puerperioum whereas 3 recurrences (2 CI and 1 TIA) were observed in the non-pregnant group (P= NS). CONCLUSION: The recurrence of stroke after pregnancy is very low. This should be considered when counseling these patients. 6 Stroke prognosis Outcome in patients with low NIHSS score despite central vessel occlusion: single center retro-spective comparison of conservative treatment and thrombolysis M.R. Heldner1, S. Jung2, Ch. Zubler3, A. Weck4, P. Mordasini5, M.L. Mono6, Ch. Ozdoba7, R. Lüdi8, M El-Koussy9, H.P. Mattle10, G. Schroth11, M. Arnold12, J. Gralla13, U. Fischer14 Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZER-LAND1, Department of Neurology and Department of Diagnostic and Interventional Neuroradiol-ogy; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND2, Diagnostic and Inter-ventional Neuroradiology; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND3, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND4, Diagnostic and Interventional Neuroradiology; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND5, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND6, Diagnostic and Interventional Neuroradiology; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND7, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND8, Diagnostic and Interventional Neuroradiology; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND9, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND10, Diagnostic and Interventional Neuroradiology; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND11, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND12, Diagnostic and Interventional Neuroradiology; Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND13, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND14, BACKGROUND: There is a controversy on thrombolysis in patients with minor neurological defi-cits despite persistent vessel occlusion on multimodal imaging. This study compared clinical course and outcome in thrombolysed patients (TPs) and non thrombolysed patients (nonTPs) with low NIHSS scores and central vessel occlusion. METHODS: From January 2004 to June 2012 3517 patients with acute ischemic stroke or TIA were treated in our emergency department. 70 patients had occlusions of the internal carotid or the main stem of the middle cerebral artery with baseline NIHSS scores ≤5. 39/56% were treated conservatively, 31/44% were thrombolysed (intravenously, endovascularly or both). RESULTS: Successful recanalisation (TIMI 2-3) on MR- or CT-arteriog-raphy at 24 hours was more often observed in TPs than in nonTPs (82.8% vs. 9.1%, p<0.0001). Neurological deterioration (increase of NIHSS score ≥1 compared to baseline) was observed in 25% of nonTPs versus 6.9% of TPs after 24 hours (p<0.0001), in 32.4% respectively 10% at hospital dis-charge (p<0.0001), and in 51.5% respectively 19.4% at 3 months (p<0.0001). Symptomatic intrace-rebral hemorrhage occurred in one TP and in none of nonTPs. TPs tended to have better outcomes at 3 months than nonTPs (mRS 0-2: 87.1% vs. 69.4%, p=0.084) but comparable survival rates (91.7% vs. 93.5%). CONCLUSION: Half of nonTPs with mild deficits and central vessel occlusion deterio-rated within 3 months compared to 1/ 5 thrombolysed patients. TPs had similar complications rates. These data suggest, that thrombolysis is safe in these patients. Randomized trials in patients with central vessel occlusions and mild or rapidly improving symptoms are needed.


Karger_ESC London_2013
To see the actual publication please follow the link above