258 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 4 Vascular imaging Dynamic changes during follow-up of intramural hematoma in patients with acute sponta-neous internal carotid artery dissection M.R. Heldner1, M. Nedeltchewa2, R. Wiest3, X. Yan4, M. El-Koussy5, J. Slotboom6, J. Gralla7, E. Mathier8, J. Hulliger9, M. Sturzenegger10, S. Jung11, H.P. Mattle12, M. Arnold13, U. Fischer14 Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZER-LAND1, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZER-LAND2, Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND3, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND4, Department of Diagnostic and Interventional Neurora-diology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND5, Department of Diag-nostic and Interventional Neuroradiology, Inselspital, University of Bern, Switzerland, Bern, SWIT-ZERLAND6, Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND7, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND8, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND9, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND10, Department of Neurology and Department of Diagnostic and Interventional Neuroradiology, In-selspital, University of Bern, Switzerland, Bern, SWITZERLAND11, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND12, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND13, Department of Neurology, Inselspital, University of Bern, Switzerland, Bern, SWITZERLAND14 BACKGROUND: We aimed to assess the dynamic changes of the intramural hematoma in patients with acute spontaneous internal carotid artery dissection (sICAD) at multiple follow-up time points with magnetic resonance imaging (MRI) and magnetic resonance arteriography (MRA). METHODS: We prospectively performed MRI and MRA in 10 patients (30% women, mean age 46) with sICAD. Imaging was performed at days 0, 1, 3, 7 and months 1.5, 3 and 6 after admission. We measured the size of the hyperintense intramural hematoma at T1w cervical MRI with fat suppres-sion technique and the degree of the stenosis of the extracranial ICA on contrast-enhanced MRA ac-cording to NASCET criteria. RESULTS: Mean interval from symptom onset to first MRI was 2 (SD 2.7) days. Two patients had an ischemic stroke, three a TIA and five local symptoms only. Overall, intramural hematoma de-creased in all patients over time and at 3 months, intramural hematoma was no longer visible in 90%, and at 6 months in all patients. However, in 9 patients intramural hematoma temporarily in-creased, mainly during the first week after admission. Four patients (40%) showed a transitory in-crease in the degree of the ICA stenosis on MRA, one of them a temporary occlusion of the ICA. CONCLUSION: Intramural hematoma in patients with sICAD shows dynamic changes with a tem-porary increase in the volume of the intramural hematoma in the majority of patients and an early temporary increase in the degree of the ICA stenosis in 40% of patients. Therefore, early follow-up imaging should be considered, especially in case of new clinical symptoms. 3 Vascular imaging Intra- and inter-rater reproducibility of Transcranial Doppler (TCD) Criteria in Assessing Re-canalization during intravenous thrombolysis for Acute Ischemic Stroke G. Tsivgoulis1, K. Vadikolias2, I. Heliopoulos3, S.N. Vasdekis4, K. Barlinn5, D. Athanasiadis6, R. Bavarsad Shahripour7, C. Piperidou8, A.V. Alexandrov9 Department of Neurology, Democritus University of Thrace,, Alexandroupolis, GREECE1, De-partment of Neurology, Democritus University of Thrace,, Alexandroupolis, GREECE2, Department of Neurology, Democritus University of Thrace,, Alexandroupolis, GREECE3, Vascular Unit, Third Department of Surgery, School of Medicine, University of Athens School, Athens, GREECE4, Com-prehensive Stroke Center, University of Alabama Hospital,, Birmingham, AL, USA5, Vascular Unit, Third Department of Surgery, School of Medicine, University of Athens School,, Athens, GREECE6, Comprehensive Stroke Center, University of Alabama Hospital,, Birmingham, AL, USA7, Depart-ment of Neurology, Democritus University of Thrace,, Alexandroupolis, GREECE8, Comprehensive Stroke Center, University of Alabama Hospital,, Birmingham, AL, USA9 Background&Purpose: Early restoration of blood flow is a strong independent predictor of favorable functional outcome after reperfusion therapies in acute ischemic stroke (AIS). TCD (Transcranial Doppler) non-invasively monitors the residual flow at the site of occlusion in real time. We sought to evaluate the intra- and inter-rater reproducibility of TCD Subjects&Methods: Consecutive AIS pa-tients with proximal intracranial occlusions underwent intravenous thrombolysis with simultaneous TCD-monitoring at four tertiary care stroke centers. Residual flow signals at the site of occlusion were monitored at a constant angle of insonation. Recanalization was assessed by ultrasound using TIBI criteria at 30, 60 and 90 minutes following tPA-bolus. Two independent readers blinded to the clinical information of the patients assessed stored TCD recordings and the reliability of TIBI cri-teria was investigated between and within sonographers using Cohen κ coefficient. Results: A total of sixty stored TCD images from consecutive 20 AIS patients mean age 61±14 years; 60% men; median baseline NIHSS-score 14 (IQR 9-19) were evaluated. The inter-rater reliability for evalua-tion of TIBI grades and assessment of complete recanalization in was very good (Cohen’s κ: 0.838 and 0.874 respectively; p<0.001). Similarym the intra-rater reliability for assessment of TIBI grades and diagnosis of complete recanalization was satisfactory (Cohen’s κ: 0.858 and 0.899 respectively; p<0.001) Conclusions: TIBI criteria for grading recanalization have high intra- and inter-rater repro-ducibility among experienced sonographers. Since recanalization is currently used as a biomarker of therapeutic activity in early phase trials of reperfusion therapies in AIS, ultrasound may consitute an alternative, cost-effective non-invasive modality for accurate detection of recanalization.
Karger_ESC London_2013
To see the actual publication please follow the link above