22. European Stroke Conference 22 Acute stroke: current treatment LYTIC EFFECT OF TPA IN ACUTE STROKE MARKEDLY DECREASES OVER TIME TO TREATMENT M. MUCHADA LOPEZ1, M. RUBIERA DEL FUEYO2, D. RODRIGUEZ-LUNA3, J. PAGOLA PEREZ DE LA BLANCA4, A.A. FLORES FLORES5, J. ARAUJO KALLAS6, E. SANJUAN ME-NENDEZ7, P. MELER AMELLA8, M. RIBO JACOBI9, J. ALVAREZ-SABIN10, C.A. MOLINA CATERIANO11 VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN1, VALL D’HE-BRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN2, VALL D’HEBRON UNIVERSI-TARY HOSPITAL, BARCELONA, SPAIN3, VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN4, VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN5, VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN6, VALL D’HE-BRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN7, VALL D’HEBRON UNIVERSI-TARY HOSPITAL, BARCELONA, SPAIN8, VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN9, VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN10, VALL D’HEBRON UNIVERSITARY HOSPITAL, BARCELONA, SPAIN11 Background Although the efficacy of thrombolytic treatment depends on time, it is not known if the effect of tPA on recanalization (RE) is also time dependent. As RE is only achieved in 30-40% of cases, patients selection based on accurate information is crucial. We aim to identify the impact of time-to-treatment (TTT) on tPA related RE in patients with acute ischemic stroke. Methods Consec-utive patients with intracranial acute occlusion treated with IV Tpa were included. TCD examination was performed before and 1 hour after tPA administration, to identify occlusion location and RE. Pa-tients were grouped according to localization occlusion in proximal and distal occlusion. We sequen-tially analyzed RE according to TTT looking for significant 30min-cut off points. Results From 555 patients, 55.3% had proximal occlusion, and 44.7% distal occlusion. Mean TTT was 171.6±64.6 and 6.3% were treated after 270min. RE occurred in 35.7% of all treated patients. We could not find a lineal association between TTT and RE, but the sequential analysis showed that patients treated after 270min had a lower RE rate. After adjusting, glycemia and TTT≤270 were emerged as independent-ly predictors (OR 0.994; 95% CI 0.990-0.999; p=0.014) and (OR 0.280; 95% CI 0.095- 0.829; p=0.022) of RE, respectively. In patients with proximal occlusion, RE was observed in 40.5%. The cut off point TTT>90 was associated with lower RE in univariate analysis. However in the logistic regression analysis only hyperglycemia (OR 0.993; 95% CI 0.987-0.999; p=0.028) and NIHSS (OR 0.923; 95% CI 0.866-0.983; p=0.013) predicted lack of RE. In distal occlusions, TTT≤270 emerged as the only independent predictor of RE(p<0.000). No pacient recanalized after 270min in this group of patients. Conclusions The effect of tPA on RE decreases with time. Treatment after 270min pre-dicted lack of RE, especially in distal occlusions. Moreover, in proximal occlusions we observed a trend towards lower RE in patients treated after 90min. 288 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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