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22. European Stroke Conference 25 Acute stroke: current treatment Do Acute Stroke Therapies offer benefit to the elderly? S. Chaturvedi1, M. Dhakar2, P. Bhattacharya3, G. Norris4, R. Madhavan5, K. Rajamani6 Wayne State University, Detroit, USA1, Wayne State University, Detroit, USA2, Wayne State Uni-versity, Detroit, USA3, Wayne State University, Detroit, USA4, Wayne State University, Detroit, USA5, Wayne State University, Detroit, USA6 Background: Treatment decisions are challenging in the elderly (≥70 years) with acute stroke as they are under-represented in clinical trials. We tested the hypothesis that intravenous tPA and endovascular inter-ventions would improve outcomes from acute stroke in the elderly, compared to the natural history of the disease. Methods: A retrospective chart review of patients ≥70 years of age with ischemic stroke at an urban center was conducted. Patients received either no thrombolysis (control), or tPA, or endovascular interventions. Primary outcomes were in-hospital death, intracranial hemorrhage(ICH), modified Rankin Score(mRS) at discharge and discharge destination. To ensure comparability of the control group to patients receiving tPA or intervention; subjects with NIHSS less than 5 were excluded. Results: In all, 153 patients (32.7% controls, 37.2% rt-PA and 30.1% with endovascular interven-tion) were included. Median NIHSS in the endovascular patients (20) was higher than controls (10;p=0.048) and tPA patients (11;p=0.0002). There was no difference in risk factors except for hypercholesterolemia, which was lower among the controls. After adjustment for age, NIHSS and hypercholesterolemia, tPA was superior to no treatment, with nearly 6 times greater odds of home/ rehabilitation discharge and 3 times greater odds of mRS≤2. In the adjusted analysis, endovascular patients had similar rates of death OR1.32(0.43-4.10) and ICH 1.85(0.53-6.50) as controls. The odds of achieving mRS≤2 or home/rehabilitation discharge were not different than controls. Com-pared to elderly tPA patients, the endovascular group had a lower adjusted odds of achieving an mRS≤2. In a subgroup of severe strokes (NIHSS>10), rates of death and ICH among the endovas-cular patients was not significantly different from controls. The likelihood of achieving an mRS≤2 was similar to controls. There was a small trend towards home/rehabilitation discharge compared to controls (41.7%vs.33.3%). Conclusions: In the elderly, IV tPA should be offered as it is safe and reduces disability. Results of endovascular intervention in the elderly require more study before widespread use. 290 © 2013 S. Karger AG, Basel Scientific Programme 26 Acute stroke: current treatment Rescue thrombectomy after failure of intravenous thrombolysis in patients with acute isch-emic stroke and proximal occlusion : preliminary results of a multicenter prospective observa-tional study. Ph. Desfontaines1, D. Brisbois2, N. Onclinx3, C. Daout4, O. Cornet5, L. Dieudonné6, K. Windhau-sen7 Centre Hospitalier Chrétien, Department of Neurology, Liège, BELGIUM1, Centre Hospi-talier Chrétien, Department of Neuroradiology, Liège, BELGIUM2, Centre Hospitalier Chrétien, Department of Neurology, Liège, BELGIUM3, Centre Hospitalier Chrétien, Department of Neurol-ogy, Liège, BELGIUM4, Centre Hospitalier Chrétien, Department of Neuroradiology, Liège, BEL-GIUM5, Centre Hospitalier du Bois de l’Abbaye et de Hesbaye, Department of Neurology, Seraing, BELGIUM6, Centre Hospitalier Régional de Huy, Department of Neurology, Huy, BELGIUM7 Background : Intravenous (iv) thrombolysis has a poor rate (less than 30 %) of recanalisation in proximally occluded mean cerebral artery (MCA). Thrombectomy has been shown to achieve a higher rate of recanalisation, up to 80%. It has been shown that the outcome of stroke patients is closely related to the recanalisation rate. We prospectively developed a protocol of thrombectomy performed after failure of iv thrombolysis in patients with acute ischemic stroke and a proximal (M1 or M2) MCA occlusion or distal ICA occlusion. Material and methods : All patients admitted within the time window (4,5 hours) for iv thrombolysis had an angioscanner to assess the level of occlusion of MCA. In case of no clinical recovery after iv thrombolysis, a thrombectomy was performed un-der general anaesthesia in case of persisting proximal occlusion. The device used is the Solitair FR. The mRS and the NIHSS were performed at discharge, 3 and 6 months. A ct scan is performed at 24 hours and an angioMRI at one month. Results : 12 patients underwent the procedure. There were 2 cases of failure in whom the thrombectomy could not be performed. The mean age is 63 +/- 10,4 years. The mean NIHSS at admission is 16 +/- 2. From stroke onset, the mean time of iv rTPA is 109 +/- 47 min, the mean time of stent deployment is 317 +/- 60 min. The mean follow up is 7 +/- 4 months. Good outcome (mRS 0 to 2) rate is 80% (8/10 patients). Intracranial haemorrhage occurred in 50% of the cases (5/10) without clinical worsening. The post procedure angiography showed 9 complete recanalisations (TIMI = 3) and 1 partial recanalisation (TIMI = 2a). Conclusions : our first results seem to show a positive trend in the outcome of stroke patients with failure of iv thrombol-ysis and proximal MCA occlusion, without an exceeding rate of complications. The number of pa-tients is too small to perform any statistical analysis, but the observational study is going on in the light of these preliminary results.


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