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22. European Stroke Conference 11 Acute stroke: current treatment Insufficient early recanalisation after IV thrombolsyis with tPA in large vessel occlusion - a prospective angiographic analysis of 127 patients in a regional stroke intervention network. H.-P. Haring1, K. Nussbaumer2, M. Sonnberger3, R. Topakian4, J. Trenkler5 Dpt. of Neurology, Wagner Jauregg Hospital, Linz, AUSTRIA1, Dpt. of Radiology, Wagner Jauregg Hospital, Linz, AUSTRIA2, Dpt. of Radiology, Wagner Jauregg Hospital, Linz, AUSTRIA3, Dpt. of Neurology, Wagner Jauregg Hospital, Linz, AUSTRIA4, Dpt. of Radiology, Wagner Jauregg Hospital, Linz, AUSTRIA5 Background: Recanalising occluded cerebral vessels as quick as possible is the main therapeutic target in acute stroke therapy. The Upper Austrian stroke intervention network serves a catchment area of some 1.4 million people. On the basis of a standardized protocol patients with a NIHSS > 10 suggesting large vessel occlusion are transferred to our stroke unit for possible embolectomy.The in-evitable time gap between the sending hospital and our catheter lab is bridged with standard IV tPA administration. Methods: Between January 2011 and December 2012 a total of 154 patients was transferred. After admission all patients underwent immediate cerebral angiography for subsequent embolectomy in case of persisting large vessel occlusions ( M1 segment, Internal Carotid A., Basilar A.). This al-lowed a gold standard based rating of recanalisation short after IV tPA therapy using the TICI scor-ing system. In 27 patients tPA was contraindicated which left 127 patients for our analysis. Results: The median time interval between start of IV thrombolysis and groin puncture was 95 min. (range 65´ - 150´) thereby guaranteeing complete administration of IV tPA before angiography. Full or partial recanalisation (TICI 1 - 3) was found in only 8/127 patients (6,0%) while complete oc-clusion (TICI 0) persisted in 119/127 patients (93,7%). In contrast, subsequent embolectomy using stent retriever devices (Solitaire, Trevo) resulted in complete or near complete recanalisation (TICI 2-3) in 115/127 (90,5%) patients. This percentage was even achieved when those patients without prior thrombolysis were taken into account (140/154 = 91%). Conclusion: In large vessel occlusions IV treatment with tPA goes along with a frustrating low early recanalisation rate of less than 10 % when measured on the basis of cerebral angiography 95 min-utes (range 65 - 150) after initiation of therapy. This result contrasted sharply with the high recanali-zation rate achieved with stent retriever embolectomy. 282 © 2013 S. Karger AG, Basel Scientific Programme 12 Acute stroke: current treatment Acute statin therapy in ischemic stroke: pitfalls of propensity score matching analysis W.K. Seo1, J. Lee2, J.H. Kim3, K. Oh4, S.B. Koh5 Department of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA1, Departement of biostatistics, College of Medicine, Korea University, Seoul, SOUTH KOREA2, De-partment of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA3, Depart-ment of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA4, Department of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA5 Background: The beneficial effect of lipid-lowering agent for stroke prevention has been studied well. However, controversial data are available for the effect of acute statin therapy on ischemic stroke. This retrospective case-control study was designed to investigate the effect of acute statin therapy on early functional outcome in acute ischemic stroke patients using propensity score match-ing (PSM). Methods: Patients with acute stroke hospitalized in single university hospital were re-cruited. Comparison was performed between statin-treated group and statin-untreated group in terms of favorable outcome (≤ 2 modified Rankin Score) at 3 month from the onset of stroke and mor-tality. For the vigorous adjustment, both risk-adjusted analysis and PSM analysis were performed. Results: A total of 534 patients (192 women, age 65.11 ± 13.14 years) were included. A total of 377 patients were prescribed for statin. In multivariate analysis, younger age, low initial National Insti-tute of Health Stroke Scale, and aspirin-treated group was associated with favorable outcome. Acute statin therapy was not associated with favorable outcome. Mortality was associated with history of coronary artery disease, aspirin-treated group, and statin-treated group. However, in PSM analysis, acute statin therapy was not associated with not only favorable outcome but also mortality. Conclu-sions: Acute statin therapy was not associated with early functional outcome. In terms of mortality, acute statin therapy reduced mortality during 90 days from the onset of stroke whereas the associa-tion was not significant in propensity score matching analysis. For the clarification of the effect of acute statin therapy, prospective randomized trials will be required.


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