London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 279 5 Acute stroke: current treatment Can we predict disappearance of the hyperdense MCA sign after thrombolysis? P.I. ELOFUKE1, M.J. MACLEOD2, J.M. REID3 ABERDEEN ROYAL INFIRMARY, ABERDEEN, UNITED KINGDOM1, ABERDEEN UNI-VERSITY/ ABERDEEN ROYAL INFIRMARY, ABERDEEN, UNITED KINGDOM2, ABERDEEN ROYAL INFIRMARY, ABERDEEN, UNITED KINGDOM3 BACKGROUND Disappearance of the hyperdense middle cerebral artery sign (HMCAS-D) fol-lowing iv thrombolysis for ischemic stroke improves outcome.Recent studies suggest that thrombus Hounsfield unit (HU) quantification on the non-contrast CT scan can predict re-canalization after thrombolysis,and vessel recanalization is unlikely if thrombus length exceeds 8 mm.Ability to pre-dict vessel recanalisation could guide patient selection for interventional acute stroke therapies.We aimed to investigate whether thrombus HU or other factors could predict HMCAS-D. METHODS Patients with HMCAS from our hospital were identified from the Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) between December 2009 and November 2012. Demo-graphics, stroke severity (NIHSS),extent of ischemic change (ASPECTS), blood pressure, serum glu-cose and presence of AF were recorded. MCA vessel hyperattenuation and occlusion site was mea-sured blinded to outcome. RESULTS 57/216 patients with HMCAS were identified (26%). 24 (42%) patients had disappearance of HMCAS (HMCAS-D) on the 24 hour post thrombolysis scan.There was no difference in age, gender, stroke severity, degree of early ischemic change, onset to treatment time, AF, glucose or blood pressure. Patients with HMCAS-D at 24 hours had a lower mean NIHSS (7.7 vs. 17.7, p<0.001), higher ASPECTS score (7.0 vs. 3.9, p<0.001), and lower haemorrhage rate (13 vs. 32%, p=0.012). There was no difference in MCA HU level or HU ratio compared to con-tralateral MCA. HMCAS-D was more likely in hyperdense arteries located in distal M1 (15/24), compared to involving the whole M1 (4/15, p=0.03). Mean MCA thrombus length was smaller in HMCAS-D group (14mm vs.21mm, p=0.02).Hyperdense arteries with thrombus length ≤8mm were more likely to disappear post thrombolysis. CONCLUSION HMCAS-D is associated with improved clinical outcome and was most likely in distal M1 occlusions,with MCA thrombus length ≤8mm. HDMCA HU did not predict HMCAS-D. 6 Acute stroke: current treatment Re-Analysis of the INSULINFARCT Trial With Respect to Admission Glucose Does Not Demonstrate Benefit of Intravenous Insulin in Hyperglycemia P. Mandava1, C . Rosso2, Y . Samson3, T.A. Kent4 Baylor College of Medicine, Houston, USA1, Pitie-Saltpetrie Hospital, Paris, FRANCE2, Pit-ie- Saltpetrie Hospital, Paris, FRANCE3, Baylor College of Medicine, Houston, USA4 Introduction: Hyperglycemia has been reported to worsen outcome in ischemic stroke patients. Some stroke patients show an increase or persistently high glucose following admission. It was pre-viously reported that intravenous insulin (IIT) did not improve outcome relative to subcutaneous insulin (SIT) in ischemic stroke patients regardless of admission glucose when the goal was to main-tain glucose below 126 mg/dl. A larger growth of MRI infarct volume was seen in the IV group. We tested here whether there is a differential response to IV insulin if patients are hyperglycemic on ad-mission. Methods: We used the dataset from the published INSULINFARCT trial to divide subjects based on admission glucose > or < than 140 mg/dl. For the parent trial, subjects with were treated random-ly with IV or SQ insulin regardless of presence or absence of hyperglycemia. For this study, we matched subjects on baseline factors to avoid imbalances that could otherwise explain differences in outcome. Outliers for which there was no good match were eliminated from analysis. We selected admission glucose of 140mg/dl since this is the threshold most studies show an adverse effect on outcome. We compared 90 day functional outcomes, hemorrhage and growth of lesion size and in-cidence of hypoglycemia. Results: Fifty subjects remained after matching in the low glucose group (mean glucose = 109 mg/ dl IIT and 107 for SIT) and 18 in the high glucose group (mean = 172 mg/dl IIT and 167 for SIT). Good matching was achieved on baseline NIHSS and age. We found no benefit from IV insulin in either group. Infarct growth was significantly higher in the high glucose group only (69.7 cc vs 33.9 cc, P=0.048). Hypoglycemia did not explain these differences. Conclusion: A higher baseline glucose did not predict improvement with IV insulin and these pa-tients showed greater growth in infarct volume. Aggressive insulin therapy to treat hyperglycemia should await results of prospective randomized trials.
Karger_ESC London_2013
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