Page 234

Karger_ESC London_2013

234 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 10 Brain imaging Hypoperfusion Intensity Ratio is Associated with Infarct Growth and Functional Outcome in Acute Ischemic Stroke: A DEFUSE 2 substudy. J-M. OLIVOT1, M. Mlynash2, M. Inoue3, R Bammer4, M Straka5, H Wheeler6, S Kemp7, M Marks8, M. Lansberg9, G.W. Albers10 Stanford Stroke Center, Stanford University, stanford, USA1, Stanford Stroke Center, Stanford University, Stanford, USA2, Stanford Stroke Center, Stanford University, Stanford, USA3, Stanford Stroke Center, Stanford University, Stanford, USA4, Stanford Stroke Center, Stanford University, Stanford, USA5, Stanford Stroke Center, Stanford University, Stanford, USA6, Stanford Stroke Cen-ter, Stanford University, Stanford, USA7, Stanford Stroke Center, Stanford University, Stanford, USA8, Stanford Stroke Center, Stanford University, Stanford, USA9, Stanford Stroke Center, Stanford University, Stanford, 10 Background: The hypoperfusion intensity ratio (HIR) is the percentage of the Tmax>6s perfusion le-sion which has more than a 10 second delay. In acute stroke patients, a high HIR has been associat-ed with poor collaterals and larger acute ischemic lesions. We investigate the relationships between HIR, infarct growth and clinical outcome among the patients in the DEFUSE 2 study. Methods: DEFUSE 2 patients with a baseline Tmax>6s perfusion lesion were dichotomized into high vs. low HIR groups based on whether they had values above or below the median HIR (0.4). Initial DWI growth velocity was calculated by the volume of the baseline DWI lesion divided by the delay from symptom onset to MRI. Infarct growth was calculated by the difference between the infarct volume measured on 5 day FLAIR and baseline DWI. Good functional outcome was a modi-fied Rankin scale (mRS)<2 at 90 days . Results: 99 patients (90%) met the inclusion criteria. Median initial infarct growth velocity was 3.2 ml/h (IQR:1,8) and increased with HIR quartiles (p<0.001). Patients with a high HIR expe-rienced faster initial infarct growth than patients with a low HIR 7 mL/h (IQR:3,18) vs. 2 mL/h (IQR:0,3), p<0.001. Median infarct growth was 49 mL (IQR:11,106) and increased with HIR quar-tiles (p<0.001). In comparison with patients with low HIR, high HIR was associated with larger infarct growth 83 mL (IQR: 45,167) vs. 20 mL (IQR:4,67), p<0.001. This relationship was ob-served among both reperfusers and non reperfusers. Patient with a good functional outcome (n=42) had lower HIR than those who did not. 30% (IQR: 19,46) vs. 43% (IQR:30,55), p=0.006. After adjustment for age, baseline DWI volume and early reperfusion, low HIR was associated with an in-creased rate of good functional outcome. Odds ratio: 4 (95%CI: 1-14), p=0.014. Conclusion: In acute stroke patients undergoing endovascular treatment, a lower percentage of the perfusion lesion with a severe Tmax delay is associated with slower and less extensive infarct growth as well as more favorable clinical outcomes. 9 Brain imaging Spot signs in intracerebral hemorrhage: Useful for identifying patients at risk for hematoma enlargement? T. Rizos1, N. Dörner2, E. Jenetzky3, M. Sykora4, S. Mundiyanapurath5, S. Horstmann6, R. Velt-kamp7, S. Rohde8, M. Bendszus9, T. Steiner10 Heidelberg University, Heidelberg, GERMANY1, Heidelberg University, Heidelberg, GERMA-NY2, German cancer research center, Heidelberg, GERMANY3, Heidelberg University, Heidelberg, GERMANY4, Heidelberg University, Heidelberg, GERMANY5, Heidelberg University, Heidelberg, GERMANY6, Heidelberg University, Heidelberg, GERMANY7, Heidelberg University, Heidelberg, GERMANY8, Heidelberg University, Heidelberg, GERMANY9, Klinikum Frankfurt Höchst, Frank-furt, GERMANY10 Background and purpose: Spot Signs (SpS) on computed tomographic angiography (CTA) may predict hematoma expansion in acute spontaneous intracerebral hemorrhage (SICH). We investigat-ed associations between the presence of SpS, hematoma expansion, and clinical outcome in acute SICH. Methods: This prospective observational study included SICH patients presenting within 6 hours of symptom onset. Secondary hematomas, purely intraventricular hematomas, incomplete CT evalua-tion, hematoma evacuation prior to follow-up brain imaging, and incomplete follow-up data were excluded. Presence of SpS, hematoma location, hematoma volume, and substantial hematoma ex-pansion after 24h were documented. Clinical outcome was assessed by the mRS at discharge and at 3 months. Results: 101 patients (median age 73 years (IQR 60-79); male: 61.4%) met inclusion criteria. Me-dian time from onset to CTA was 128 minutes (IQR 90-209 minutes). SpS were detected in 27 pa-tients (26.7%). SpS patients had higher initial hematoma volumes than patients without SpS (36.0ml vs 14.39ml, p=0.005). Hematoma expansion was more frequent in SpS patients (59.3% vs. 21.6%, p<0.001) and associated with the presence of SpS in the univariate analysis (OR 5.273, CI 2.047- 13.584, p=0.001) and in multivariable analysis adjusted for the initial hematoma volume (OR 4.678, CI 1.781-12.288, p=0.002). Sensitivity of SpS to predict hematoma expansion was 0.5, specificity 0.84. No difference in 3-months clinical outcome was observed between patients with and without SpS (median mRS 4 and 4, p= 0.457). Conclusions: The clinical usefulness of SpS needs to be further explored. Particularly low sensitivity may limit application of the SpS in clincial routine. Future prospective studies should focus on the prevalence of SpS in consecutive ICH populations.


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