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22. European Stroke Conference 249 Brain imaging Imaging Surrogates in Acute Stroke Trials: a Systematic Review G.W.J. Harston1, N. Rane2, J. Kennedy3 University of Oxford, Oxford, UNITED KINGDOM1, Oxford Radcliffe Hospitals NHS Trust, Oxford, UNITED KINGDOM2, University of Oxford, Oxford, UNITED KINGDOM3 Background The failure of ischemic stroke therapies to translate to clinical practice has been blamed on patient heterogeneity, poor patient selection and inappropriate surrogate outcomes. Imaging is often used to address these problems. We systematically reviewed the literature to identify imaging surrogates that have been used effectively in trials. Methods EMBASE and MEDLINE were searched from 1995 to 2012 for randomized control trials in isch-emic stroke (<48hrs) that used imaging criteria for inclusion/exclusion of participants, for subgroup selection or outcome. strokecenter.org and the Virtual International Stroke Trials Archive were man-ually searched. Studies using imaging solely to identify hemorrhage were excluded. Results 7476 studies were identified and two authors independently screened and selected the 72 articles that met the criteria. Of these 41 used one or more imaging selection criterion, 23 used imaging-based subgroups and 41 used imaging outcomes. Imaging was used to identify core infarct, ischemic pen-umbra or mechanisms at which to target interventions. Core infarct was identified using CT hypodensity or diffusion-weighted MRI (DWI) consistent-ly across positive and negative studies. 20 different methods for identifying penumbra were used, most commonly a mismatch between inconsistently defined thresholds in perfusion-weighted imag-ing (PWI) and DWI. Trials using penumbral surrogates as inclusion criteria have yet to yield a new treatment approach. Post hoc subgroup analyses of these trials can identify individuals with capacity to benefit, but the criteria have not been validated a priori. Imaging used for mechanistic identifica-tion was successful in phase 2 studies. Conclusion Imaging surrogates are used extensively in stroke research. Core infarct and stroke mechanisms ap-pear to be identified consistently and used effectively. Attempts to identify a true penumbra are in-consistent and have not been successful in identifying patients for intervention. 418 © 2013 S. Karger AG, Basel Scientific Programme Etiology of stroke and risk factors (PO 250 - 330) 250 Etiology of stroke and risk factors Comparison of Ankle-Brachial Indexes Calculated by Different Methods for concomitant Ce-rebral Atherosclerosis in Ischemic Stroke Y. Do1, M.G. Kang2, M.J Lee3, J.H. Park4, H.K. An5, J.K. Do6, D.K. Lee7 Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, SOUTH KOREA1, Department of Neurology, Andong General Hospital, Andong, SOUTH KOREA2, Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, SOUTH KOREA3, Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, SOUTH KOREA4, Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, SOUTH KOREA5, Department of Neurology, Catholic University of Daegu School of Med-icine, Daegu, SOUTH KOREA6, Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, SOUTH KOREA7 Background Stroke is associated with peripheral arterial disease which can be easily detectable by ankle-brachial index (ABI). It has been documented that stroke patients with abnormal ABI have more extracranial atherosclerosis than those without. However, the best calculation method of ABI for the presence of concomitant cerebral atherosclerosis has not yet been determined. The present study was conduct-ed to investigate the cerebral arterial steno-occlusive status in ischemic stroke patients according to ABI calculated by different methods. Methods We reviewed data of patients with acute ischemic stroke or TIA. Steno-occlusions of all the patients were assessed with MR or CT angiography. Posterior tibial (PT) and dorsalis pedis (DP) arterial and brachial systolic blood pressures were measured using a hand-held Doppler scanning probe and sphygmomanometer. Four different ABIs were calculated as the ratio of the higher (ABI-H, guide-lines method), lower (ABI-L), or one (ABI-PT or ABI-DP) of the systolic blood pressures of PT and DP on the higher of the brachial blood pressures. Results Among 145 patients, abnormal (</=0.9) ABI-H, ABI-L, ABI-PT, and ABI-DP were 19 (13.1%), 36 (24.8%), 29 (20%), and 30 (20.7%), who had more extracranial steno-occlusion than normal ABI (P<0.05). Receiver-operator characteristic curve analysis demonstrated the significant differences in ABI-H, ABI-L, and ABI-DP between patients with extracranial steno-occlusion and those without (P<0.05), but not ABI-PT (P=0.078). Conclusion Stroke patients with abnormal ABI may be more likely to have extracranial arterial steno-occlusion than those without, even in Asians who have more intracranial atherosclerosis than Caucasians. In stroke patients, guidelines method which measure blood pressures of both PT and DP may be better to predict the presence of concomitant extracranial atherosclerosis than method which measure only PT like automatic devices.


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