22. European Stroke Conference 113 Stroke prognosis Natural history of large vessel occlusion stroke K. Skagen1, M. Skjelland2, D. Russell3, E.A. Jacobsen4 Oslo University Hospital, Oslo, NORWAY1, Oslo University Hospital, Oslo, NORWAY2, Oslo University Hospital, Oslo, NORWAY3, Oslo University Hospital, Oslo, NORWAY4 Background Large vessel occlusion stroke is believed to be associated with poor patient prognosis with mortality from MCA occlusions reported as high as 80%. Due to the lack of studies looking specifically at natural history of large vessel occlusion stroke these data are largely derived from post hoc analysis from studies and clinical trials were patients failed recanalization making accurate assessment of natural history difficult. Despite lack of evidence from randomized controlled trials mechanical recanalization procedures are increasingly being used in clinical practice. Method This is a single Centre cohort study analyzing prospectively collected patient data in a clinical setting. Clinical outcome (mRs at 90 days) was compared for two cohorts; patients who recanalized after endovascular intervention (n= 62), and patients with persistent large vessel occlusion (n= 85) not selected for endovascular therapy, representing natural history of large vessel occlusion. Results For persistent large vessel occlusion mortality was 22.3 %. After stratifying NIHSS, looking at patients with persistent large vessel occlusion and NIHSS <10, 15 (88.2 %) patients achieved good outcome (mRs ≤2) and no patients died. Two patients with NIHSS >20 achieved good outcome at 90 days. No statistical difference in mortality was found for NIHSS >20 when comparing the natural history group with the group of patients receiving endovascular treatment. Conclusion Patients presenting with large vessel occlusion stroke is a heterogeneous group with variation in clinical presentation and outcome. Our study showed higher proportion of patients with good outcome and lower mortal-ity compared to results from published literature. For NIHSS <10 we could not demonstrate signif-icant benefit of recanalization on outcome. Clinical studies looking specifically at natural history of large vessel occlusions providing robust data on prognosis is needed. 340 © 2013 S. Karger AG, Basel Scientific Programme 114 Stroke prognosis Guadeloupian patients prognostic and functional outcome one year after a first stroke S. GALANTH1, B. TRESSIERES2, P. FOUCAN3, A. LANNUZEL4, C. ALECU5 University Hospital Pointe à Pitre Abymes, Pointe à Pitre, FRANCE1, University Hospital Pointe à Pitre Abymes, Pointe à Pitre, FRANCE2, University Hospital Pointe à Pitre Abymes, Pointe à Pitre, FRANCE3, University Hospital Pointe à Pitre Abymes, Pointe à Pitre, FRANCE4, University Hospital Pointe à Pitre Abymes, Pointe à Pitre, FRANCE5 Background and Purpose: Caribbean stroke patients are younger than the North Atlantic ones; there-fore stroke social costs must be higher in these countries. Social and functional outcome follow-up studies show a great variability of results. We performed a prospective study of Guadeloupian suc-cessive patients admitted at University Hospital of Pointe à Pitre between December 2010 and Feb-ruary 2011 for a first hemispherical stroke in order to describe their functional outcome, mortality rate and quality of life one year post stroke. Methods: Patients were evaluated at emergency, at hos-pital discharge and one-year post stroke using National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Functional Independance Measure (FIM) scale. The quality of life was estimated using MOS-SF-36 scale. Results: Among 140 patients admitted for stroke sug-gesting signs, 78 patients (33w) had a first stroke and were included. Haemorrhagic stroke represent-ed 24.4%. Mean age was 62.1 ±17.7 years, 70.5% of patients had hypertension, 29.4% diabetes, and 24.0% renal chronic failure. Mortality was 29.4% and recurrence rate 2.6% one year post stroke. We evaluated 39 of 55 survivors (71%). Scales evolution (emergency vs. one year later) was: NIHSS 6.2±4.9 vs 3.3±3.9 (p<0.001), mRS 2.2±1.6 vs 2.1±1.8 (p=0.467), FIM 103.2±28.2 vs 101.7±31.5 (p=0.313). BMI was significantly higher and quality of life altered. In multivariate analysis, aphasia, hemianopia and incontinence significantly influenced follow up FIM score (p<0.001). Conclusion: One year after a first stroke, the level of dependence was stable and quality of life altered, despite a significant improvement of neurological handicap.
Karger_ESC London_2013
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