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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 287 20 Acute stroke: current treatment Safety and Feasibility of Endovascular Rescue Intervention: A Case Control Analysis. E.C. Risom1, M. Steglich-Petersen2, H. Horwitz3, M. Holtmannspötter4, D.W. Krieger5 Department of Neurology Rigshospitalet, Copenhagen, DENMARK1, Department of Neurol-ogy Rigshospitalet, Copenhagen, DENMARK2, Department of Clinical Pharmacology Bispebjerg Hospital, Copenhagen, DENMARK3, Department of Neurology Rigshospitalet, Copenhagen, DEN-MARK4, Department of Neurology, Copenhagen, DENMARK5 Background: The effect of endovascular treatment after failed intravenous thrombolysis compared to intravenous trombolysis alone in patients with moderate to severe stroke has not yet been es-tablished. Endovascular therapy has become available at Copenhagen’s Rigshospitalet since 2011. Within the first 6 months of the new service, treatment was accessible only during daytime. This impasse allowed us to compare the outcome of ischaemic stroke patients undergoing endovascu-lar rescue procedures with those deemed candidates but unable to receive rescue intervention after daytime. Methods: Endovascular treated patients (n=33) were compared to those who could not be treated with rescue intervention (n=16). All patients were treated with iv-tPA as appropriate. We compared 3-months outcome (modified Rankin Scale, mRS) and mortality. Patient age, time from onset to-hospital admission, and stroke severity (NIHSS) were similar in both groups. For the en-dovascular group we also documented the quality of recanalization using thrombolysis in cerebral infarction (TICI) scores. Results: None of the patients had responded to iv-tPA therapy within the first hour. Of the endovascular treated patients 19(58%) had a favorable outcome (mRS 0-2) versus 7(44%) of the patients who did not receive intervention (p=0.5 Fisher’s exact test). Mortality was also similar in both groups, 7(21%) in those receiving rescue intervention vs. 4(25%) in the controls (p=n.s. Fisher’s exact test). The endovascular group’s recanalization rate was TICI≥2 88%. Conclu-sion: Our results suggests 1 additional favorable clinical outcome per 6 TICI≥2 recanalizations after failed intravenous thrombolysis. This data obtained during the introduction of the endovascular ser-vice at our institution reveals that thrombectomy is feasible and safe for patients with moderate to severe ischemic stroke who fail to improve with intravenous thrombolysis alone. Larger studies are needed to determine the efficacy of this intervention. 21 Acute stroke: current treatment The levels of glutamate at admission are predictors of mortality in patients with ischaemic stroke treated with rt-PA C. van Eendenburg1, T. Sobrino Moreiras2, J. Serena Leal3, Y. Silva Blas4, M. Terceño Izaga5, M. Kazimierckak6, M. Blanco González7, M. Castellanos Rodrigo8 Hospital Univesitari Dr. Josep Trueta, Girona, SPAIN1, Hospital Clínico Universitario de Santia-go de Compostela, Santiago de Compostela, SPAIN2, Hospital Universitari Dr. Josep Trueta, Girona, SPAIN3, Hospital Universitari Dr. Josep Trueta, Girona, SPAIN4, Hospital Universitari Dr. Josep Trueta, Girona, SPAIN5, Hospital Universitari Dr. Josep Trueta, Girona, SPAIN6, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, SPAIN7, Hospital Universitari Dr. Josep Trueta, Girona, SPAIN8 Introduction: Recent data suggest that the administration of rt-PA may increase mortality of treated patients, especially when the drug is administered late. This fact could be related to the increase in the excitotoxic damage that is secondary to the administration of rt-PA. The present study aims to determine whether glutamate levels are associated with an increase in mortality in patients treated with rt-PA. Patients and methods: 99 patients treated with rt-PA following the SITS-MOST criteria whose glutamate levels were analysed at admission and 24h after the administration of rt-PA were studied. The volume of hypondensity and the presence of haemorrhagic transformation were eval-uated by cranial-CT performed 24-36h after treatment. Results: Of the 99 patients, 16 (6%) died in the first 3 months of evolution. Glutamate levels both at admission (336 219,96 vs. 80 47,178 μmol/L) and at 24h (137 89,330 vs. 65 42,112 μmol/L) were significantly higher in patients who subsequently died (p<0.001). In the logistic regression model, after adjusting for those variables related to mortality in the univariate analysis, only glutamate levels remained as an independent predictor of mortality (OR 1.02; 95% CI, 1.00-1.03; p=0.005). Conclusions: Glutamate levels at ad-mission is a predictor of mortality in patients treated with rt-PA. This may be due to the excitotoxic effect of glutamate being intensified especially in those patients with the highest levels of glutamate before the administration of rt-PA.


Karger_ESC London_2013
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