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22. European Stroke Conference 43 Acute stroke: new treatment concepts Thrombolytic treatment and early outcome after unclear onset stroke: Data from the Austrian Stroke Unit Registry R. Topakian1, L. Seyfang2, F.T. Aichner3 Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz, AUSTRIA1, Gesundheit Oesterreich GmbH, Bundesinstitut für Qualität im Gesundheitswesen, Vienna, AUSTRIA2, Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz, AUSTRIA3 Background: Data on the optimal management and early outcome in patients with unclear onset (UOS) are sparse. To date, the vast majority of patients with UOS are being excluded from throm-bolytic treatment (TT). We evaluated the impact of TT on early outcome after UOS in patients cap-tured in the Austrian Stroke Unit Registry. Methods: UOS patients who received TT (n=282) and UOS patients without TT (n=846) were matched in a 1:3 ratio for age, sex, pre-stroke modified Rankin Scale score, and baseline National Institute of Health Stroke Scale (NIHSS) score. Only patients with baseline NIHSS 5-25 were included. Early outcome was assessed at the time of dis-charge from the stroke unit. Results: Magnetic resonance imaging was more often used as initial im-aging modality in UOS patients undergoing TT compared to patients without TT (30.1% vs. 11.9%; p<0.001). Prior stroke and diabetes were less frequent stroke risk factors in the TT group (p<0.05), while cardioembolic stroke subtype was more frequent in the TT group (p<0.001). Substantial early neurological improvement defined as a NIHSS score reduction of ≥4 points was significantly more frequent in patients with TT compared to patients without TT (54.3% vs. 39.7%, p<0.001). How-ever, rates of symptomatic intracerebral haemorrhage (SICH) were higher in the TT group (5.3% vs. 2.5%; p<0.01). Conclusion: A large proportion of UOS patients benefit from TT and develop substantial early neurological improvement. However, TT in UOS patients is associated with higher risk of SICH. Large trials are needed to further elucidate safety and efficacy of TT after UOS and to identify subgroups of patients who may benefit from TT without increased risk of SICH. 300 © 2013 S. Karger AG, Basel Scientific Programme 44 Acute stroke: new treatment concepts Use of intra-arterial mechanical thrombectomy for acute middle cerebral artery occlusion yields similar primary recanalization but more successful reperfusion compared to fibrinolysis J.S. Lee1, S.J. Lee2, S.W. Lee3, J.M. Hong4, Y.C. Lim5, S.Y. Kim6 Ajou University School of Medicine, Suwon, SOUTH KOREA1 Background: Mechanical thrombectomy devices have been recently developed and approved for recanalization of intracranial arterial occlusions. Here, we investigated the usefulness of mechan-ical thrombectomy for effective revascularization of acute middle cerebral artery trunk occlusion (MCAO). Methods: Thirteen patients with acute ischemic stroke secondary to MCAO who underwent intra-ar-terial mechanical thrombectomy using the Penumbra system (n = 9) or Solitaire retrieval stent (n = 6) were assigned to the thrombectomy group, and 22 patients who underwent intra-arterial (IA) urokinase infusion (mean dose, 261,818 U) were assigned to the fibrinolytic group. Radiologic and clinical outcomeswere evaluated and compared between the groups. Results: The baseline characteristics did not differ between the groups. Intravenous recombinant tissue plasminogen activator was infused in 61.5% and 68.2% of patients in the thrombectomy and fibrinolytic groups, respectively (p=0.689). Recanalization of the primary arterial occlusive lesion (AOL) was almost completely achieved in both the thrombectomy and fibrinolysis groups (AOL grade II–III, 92.3% vs. 90.9%, respectively; p=0.521).However, successful cases of cerebral reper-fusion (thrombolysis in cerebral ischemia, grade IIb–III) were greater in the thrombectomy than in the fibrinolysis group (92.3% vs. 59.1%, respectively; p=0.036). Cases of parenchymal hematoma development were lower in the thrombectomy than in the fibrinolytic group (15.4% vs. 38.1%, re-spectively, p=0.158). The clinical outcome was more favourable in the thrombectomy than in the fibrinolysis group (modified Rankin Scale mRS 0, 36.4% vs. 0%; mRS 6, 9.1% vs. 30.0%, respec-tively; p=0.028). Conclusion: Mechanical thrombectomy was effective for both recanalization and reperfusion in acute MCAO cases, and the possibility of successful reperfusion is greater with this technique than by IA fibrinolysis.


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