22. European Stroke Conference 47 Acute stroke: new treatment concepts Cerebral Flow Augmentation and outcomes in acute ischemic stroke patients with moderate severity stroke and good baseline ASPECTS: a post-hoc analysis of the SENTIS trial M. Goyal1, M. Eesa2, A.M. Demchuk3, J. Modi4, T. Stewart5, K. Zander6, L. Thackeray7, B.K. Me-non8, M. Almekhlafi9, A. Shuaib10 University of Calgary, Calgary, CANADA1-10 Background: Small ischemic core at presentation as determined by baseline Alberta Stroke Program Early CT Score (ASPECTS) is an important determinant of outcomes after acute ischemic stroke. Given the considerable variation in clinical stroke severity; this together with the ASPECTS can be important factors determining long-term prognosis. Cerebral flow augmentation with the NeuroFlo device may be an alternative therapy for patients outside the traditional time windows for endovas-cular therapy or with challenging vascular access. We present an exploratory post hoc analysis in the category of patients with small core and moderate severity stroke category as determinants on out-comes from the SENTIS trial. Methods: SENTIS was a randomized, prospective, multicenter trial designed to compare standard stroke treatment with and without NeuroFlo treatment in stroke patients with baseline NIHSS scores of 5-18 in where treatment could be initiated within 14h of symptom onset. Long-term outcome was measured with mRS at 90 days. We compared the 90-day mRS outcome in patients with moderate severity stroke (NIHSS 8-15) and good baseline ASPECTS (7-10) between treatment and control arms. Results: A total of 515 patients were enrolled in the SENTIS trial. Of these 152 patients had a small core (ASPECTS 7-10) with NIHSS 8-15. There were 79 patients in the treatment group mean age 67.1±14.9;median NIHSS 11 and 72 patients in the control arm mean 68.0±14.3;median NIHSS 10 and no imbalances in baseline characteristics with either arm. A good outcome as defined by mRS 0-2 was seen in 52.2% of the treatment arm and 41.4% of the non-treatment arm(Fig). A 3-level shift analysis for the three mRS groups 0-2/3-4/5-6 (Cochran-Mantel-Haenszel test) showed a p-value of 0.14(Fig 1). Conclusions: This exploratory post-hoc analysis suggests that there is a trend towards good out-comes in moderate severity stroke patients with good baseline ASPECTS score when treated with 302 © 2013 S. Karger AG, Basel Scientific Programme the NeuroFlo device. 48 Acute stroke: new treatment concepts Telemedicine – is tele-EEG, tele-electrophysiology and telecytology possible – a feasibility stu-dy U.K. Meyding-Lamade1, E. Craemer2, F. Idris Hj Fitri3, N. Ahmad4, D. Durani Hj binti Ain5, B. Bassa6, T. Lenhard7, C. Jacobi8, C. Mohs9, B. Kress10 Krankenhaus Nordwest GmbH, Frankfurt, GERMANY1, Krankenhaus Nordwest GmbH, Frankfurt, GERMANY2, Universiti of Brunei Darussalam, Gadong, BRUNEI DARUSSALAM3, Universiti Brunei Darussalam, Gadong, BRUNEI DARUSSALAM4, Brunei Darussalam, Gadong, BRUNEI DARUSSALAM5, Krankenhaus Nordwest, Frankfurt, GERMANY6, Universitätsklinikum Heidelberg, Heidelberg, GERMANY7, Krankenhaus Nordwest, Frankfurt, GERMANY8, Kranken-haus Nordwest, Frankfurt, GERMANY9, Krankenhaus Nordwest, Frankfurt, GERMANY10 Background:Stroke is a major public health problem; the availability of specialized acute neurologi-cal departments and stroke units is crucial for survival of patients, but not reached yet in many parts of the world.A high end class stroke and teaching network by the help of telemedicine is established by a transcontinental cooperation between the Department of Neurology and Neuroradiology, Kran-kenhaus Nordwest (KHNW), Frankfurt/Main, Germany and Jerudong Park Medical Centre (JPMC), Brunei Darussalam since 07.2010. Successful treatment of stroke includes differential diagnosis techniques, we need the whole spec-trum of special neurological laboratories, EEG, Electrophysiology as well as all examination of CSF. This pilot study was conducted to validate the feasibility of tele-electrophysiology, tele-cytol-ogy and tele-electroencephalography carried out between KHNW and JPMC, which is separated by a distance of 12,000km. Methods: 20 randomly selected patients for tele-electrophysiology, 10 EEG´s and 10 samples of CSF were examined in both hospitals and were analyzed by both. Somatosensory evoked potential on the median nerve of the arm and tibial nerve of the leg and the nerve conduction were examined, CSF samples were analyzed via a secure internet connection from JPMC to KHNW. Results: The tele-electrophysiological part exhibits that findings made by neurologists from both sides are identical, also the cytological part shows that both sides made the same results; the tele-eletroencephalographical part shows also feasibility although there was a considerable inter-rat-er variability. Conclusion: All these studies revealed that evaluation of tele-cytology, tele-electroencephalography and tele-electrophysiology is feasible. The quality of diagnosis and treatment of acute stroke depends on the ability to recognize know and treat differential diagnosis and stroke mimics – therefore the whole spectrum of neurological labora-tories is urgently needed. As there is a lack of neurological knowledge in many areas of the world, this might be a useful fu-ture tool to deliver expert advice from one part of the world to another part of the world.
Karger_ESC London_2013
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