22. European Stroke Conference 77 Stroke prognosis Long-term quality of life and functional outcome after decompressive craniectomy for malig-nant middle cerebral artery infarction. D.D DEVOS1, N.G. Gavrylova2, S.D. DEBIAIS3, T.R. RONZIERE4, G.M. MARC5, S.T. TIMSIT6, B.G. GUILLON7, M.S. SEVIN8 Department of Neurology, Nantes University Hospital, Nantes, FRANCE1, Department of Neurology, Tours University Hospital, Tours, FRANCE2, Department of Neurology, Tours Univer-sity Hospital, Tours, FRANCE3, Department of Neurology, Rennes University Hospital, Rennes, FRANCE4, Department of Neurology, Angers University Hospital, Angers, FRANCE5, Department of Neurology, Brest University Hospital, Brest, FRANCE6, Department of Neurology, Nantes Uni-versity Hospital, Nantes, FRANCE7, Department of Neurology, Nantes University Hospital, Nantes, FRANCE8 Background– Decompressive craniectomy after malignant middle cerebral artery (MCA) infarction improves survival. Long-term functional outcome and quality of life of these patients have been poorly studied and uncertainties persist on the late benefit of this procedure. Methods – From Jan-uary 2004 to December 2010, 62 consecutive patients with malignant MCA infarction were treated with decompressive craniectomy according to the European Stroke Organization recommendations criteria. Patients were followed for a minimum of 2 years (mean 34 months, range 24–84 months) after surgery and were evaluated with the modified Rankin scale (mRs), the stroke impact scale (SIS) and the life satisfaction checklist (LiSat-11). Family caregivers answered the proxy version of the SIS and the Zarit Burden Interview (ZBI). Results – Mean age of the patients was 46.6 years, and 74 % were male. Long-term survival was 74%. 68% (31/44) and 77% (24/31) of the survivors were functionally independent (mRs≤3) at 12 and after 24 months of follow-up, respectively. No patient was in a vegetative state (mRs=5). After 24 months, the mean patient assessment of global stroke recovery was 45%. According to the LiSat checklist, 64% found their life satisfying. 92.5% of the survivors had a retrospective acceptance of craniectomy. 75% of the caregivers regarded their burden as mild. Delayed timing of surgery, involvement of more than one vascular territory, and internal carotid occlusion were independently associated with higher mortality. Timing of surgery and age were negatively correlated with functional outcome. Conclusion – Patients with malignant MCA infarction treated with decompressive craniectomy display a sustained, long-term functional improvement that lasts far after the first year of their stroke. At 2 years and later, most of them are functionally independent and found their life satisfying. Our data suggest that early surgery is asso-ciated with survival and favorable long term functional outcome. 320 © 2013 S. Karger AG, Basel Scientific Programme 78 Stroke prognosis The effect of chronic kidney disease and anemia on clinical characteristics and outcomes of stroke patients in nationwide surveys of acute cerebrovascular disease in Israel (NASIS-2004, 2007, 2010) Y. Feldman-Idov1, O. Azrilin2, D. Tanne3, B. Gross4 Western Galilee Hospital-Nahariya, Nahariya, ISRAEL1, Western Galilee Hospital-Nahariya, Nahariya, ISRAEL2, Tel Aviv Sourasky Medical Center, Tel Aviv, ISRAEL3, Western Galilee Hospi-tal- Nahariya, Nahariya, ISRAEL4 Background: There is growing evidence that chronic kidney disease (CKD) and anemia are inde-pendent risk factors for vascular events and predictors of poor outcome and prognosis. Objective: To investigate the effect of CKD and anemia on clinical characteristics and outcomes of acute stroke patients. Methods: The data was collected from 3 consecutive nationwide surveys and in-cluded all adult hospitalized patients with acute stroke. The questionnaire included data regarding demographics, risk factors, clinical presentation, stroke severity (NIHSS), type, etiology, disability (mRS) and mortality (during hospitalization and 30, 90, and 365 days post hospitalization). CKD was defined as GFR≤60 mL/min/1.73m2 and anemia was defined as hemoglobin <12g/dl for fe-males and <13g/dl for males. Patients were classified into 4 groups: (1) CKD+anemia, (2) CKD+no anemia, (3) no CKD+anemia, (4) no CKD+no anemia. All correlations were age adjusted. Results: A total of 6261 patients with the mean age of 69.8+/-13.6, were evaluated. Stroke severity, stroke territory, type of stroke, and cardio-embolic etiology differed between the 4 groups (p<0.05): Pa-tients with CKD+anemia had the highest rate (26.2%) of severe stroke (NIHSS>10), cardioembolic events (25.0%), and ischemic stroke (75.0%) and the lowest rate of TIA (16.3%) and lacunar stroke (19.8%). Disability and mortality rates also differed between the groups (p<0.001): Patients with CKD+anemia had the highest severe disability (mRS 4-5) and death rates (31.5%, 13.1% respective-ly), and highest mortality rates in all time points studied. Cox proportional hazard models for mor-tality (adjusted for conventional risk factors) showed the significant effect of anemia on mortality in all time points, whereas CKD was found independently affecting only the hospital mortality. No interaction was found between CKD and anemia. Conclusions: CKD and anemia are associated with severe stroke and disability, and are independent predictors of mortality.
Karger_ESC London_2013
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