22. European Stroke Conference 9 Translational stroke research 9:50 - 10:00 Molecular Correlates of Neuroimaging Findings in Acute Ischemic Stroke: Early Oxida-tive Stress Biomarkers of Ischemic Penumbra S. Lorenzano1, N.S. Rost2, H. Li3, A. Chutinet4, R.E. Green5, T. Thankachan6, B. Thornell7, K. Arai8, O. Wu9, G.J. Harris10, E.H. Lo11, J.B. Blumberg12, S.K. Feske13, K.L. Furie14 Massachusetts General Hospital and Harvard Medical School, Boston, USA1,Massachu-setts General Hospital and Harvard Medical School, Boston, USA2, Massachusetts General Hospital and Harvard Medical School, Boston, USA3, Massachusetts General Hospital and Harvard Medical School, Boston, USA4, Massachusetts General Hospital and Harvard Medical School, Boston, USA5, Massachusetts General Hospital and Harvard Medical School, Boston, USA6, Massachusetts General Hospital and Harvard Medical School, Boston, USA7, Massa-chusetts General Hospital and Harvard Medical School, Boston, USA8, Massachusetts General Hospital and Harvard Medical School, Boston, USA9, Massachusetts General Hospital and Harvard Medical School, Boston, USA10, Massachu-setts General Hospital and Harvard Medical School, Boston, USA11, Tufts University, Boston, USA12, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA13, Massa-chusetts General Hospital/Harvard Medical School and Rhode Island Hospital/Alpert Medical School of Brown University, Boston, USA14 Background: Advanced neuroimaging techniques may provide fundamental data with regard to brain tissue viability in acute ischemic stroke (AIS). We sought to assess whether plasma bio-markers of oxidative stress predict diffusion-perfusion mismatch in AIS patients. Methods: We prospectively measured plasma levels of oxidative stress biomarkers such as F2-isoprostane (F2-isoP), total and perchloric acid Oxygen Absorbance Capacity (ORAC-TOT and ORAC-PCA), urinary levels of 8-oxo-7,8-dihydro-2’-deoxyguoanosine (8-OHdG), and plasma inflam-matory and tissue-damage biomarkers such as high-sensitivity CRP (hs-CRP), matrix metallo-proteinase (MMP) 2 and MMP-9, in consecutive AIS patients presenting within 9 hours from symptom onset. Diffusion- (DWI) and perfusion-weighted (PWI) MRI sequences were ana-lyzed using semi-automated volumetric method. Mismatch was defined as baseline mean transit time (MTT) volume on PWI minus DWI volume. A percent mismatch cut-off of 20% was con-sidered clinically significant. Results: Mismatch >20% was present in 153/216 (70.8%) patients (69.2+/-14.3 years; 41.2% women). Compared to those without MRI evidence of mismatch or mismatch ≤20%, patients with mismatch >20% were more likely to have higher F2-isoP (p= 0.15) and ORAC-PCA (p= 0.02). After adjustment for confounders, multivariate binary logis-tic regression demonstrated that plasma F2-isoP (OR 2.44 95% CI 1.19-4.98; p= 0.01) was an independent molecular predictor of PWI-DWI mismatch >20%. ORAC-TOT significantly cor-related with mismatch salvage volume (Spearman’s ρ= 0.18, p= 0.049) and mismatch salvage percentage (Spearman’s ρ= 0.21, p= 0.025). Conclusions: Elevated hyperacute plasma levels of F2-isoP are associated with radiographic evidence of mismatch in AIS subjects. If validated, these findings may provide further understanding of the role of oxidative stress in cerebral tis-sue fate during acute ischemia. 10:30-11:25 Auditorium Opening/ Wepfer Award/Lecture 11:25-12:30 Oral Session Auditorium Large clinical trials 1 Chairs: G. Hankey, Australia and K. Lees, UK 1 Large clinical trials (RCTs) A 11:25 - 11:40 Rapid blood pressure lowering in acute intracerebral haemorrhage: main results of the INTERACT2 trial C.S. Anderson1 The INTERACT2 Investigators The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, AUSTRALIA1 Background: Early lowering of elevated blood pressure (BP) in acute intracerebral haem-orrhage (ICH) may improve outcome. Based on encouraging results of the pilot phase, the second, main phase, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Tri-al (INTERACT2) was designed to test the efficacy of early intensive BP lowering in a broad range of adults with ICH, the most serious and least treatable form of stroke. Methods: INTERACT2 was an investigator initiated and conducted, international, multicentre, prospective, open treatment, assessor blinded endpoint, randomised controlled trial. Eligi-ble patients with spontaneous ICH within 6 hours of onset and elevated systolic BP (150-220 mmHg) were centrally allocated to receive intensive (to a target systolic level of <140 mm Hg within 1 hour) or standard (systolic level <180 mm Hg) BP lowering treatment using intrave-nous agents. The primary outcome was a poor outcome, defined as death or major disability according to scores 3-6 on the modified Rankin Scale at 90 days. The key secondary outcome was an ordinal analysis on this scale. Serious adverse events and mortality were also com-pared. The trial is registered (ACTRN1260800036239, NCT00716079, ISRCTN73916115) and funded by the National Health and Medical Research Council (NHMRC) of Australia. Results: Between October 2008 and August 2012, a total of 2839 patients (mean age 63.5 years; 62.9% male) were enrolled from 144 hospitals in 21 countries. Data on the primary out-come at 90 days were known in 2794 (98.3%) patients. Conclusions: The main results of INTERACT2 will be presented to provide, for the first time, evidence for any beneficial effects of early intensive BP lowering in ICH. 32 © 2013 S. Karger AG, Basel Scientific Programme
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