22. European Stroke Conference 570 Acute stroke: emergency management, stroke units and complications HEMORRHAGIC TRANSFORMATION OF ACUTE ISCHEMIC STROKE: INCIDENCE, PROGNOSIS AND RISK FACTORS. ANALYSES OF 146 PATIENTS FROM THE SYN-THESIS EXPANSION TRIAL. C. Motto1, S. Lanfranconi2, P. Basilico3, P. Doneda4, A. Gatti5, I. Santilli6, R. Tortorella7, E. Botto8, C. Serrati9, B. Censori10, M. Longoni11, G. Bono12, E. Agostoni13, A. Ciccone14 for Synthesis Expansion Investigators Stroke Unit - AO Niguarda Ca’ Granda, Milano, ITALY1, Ospedale Policlinico, Milano, ITA-LY2, Ospedale Policlinico, Milano, ITALY3, Neuroradiology AO Niguarda Ca’ Granda, M, ITALY4, Stroke Unit AO Niguarda Ca’ Granda, Milano, ITALY5, Stroke Unit AO Niguarda Ca’ Granda, Mi-lano, ITALY6, Stroke Unit AO Niguarda Ca’ Granda, Milano, ITALY7, Ospedale Manzoni, Lecco, ITALY8, Stroke Unit, Ospedale S. Martino, Genova, ITALY9, Ospedali Riuniti, Bergamo, ITALY10, Ospedale Manzoni, Lecco, ITALY11, Ospedale di Circolo, Va-rese, ITALY12, Neurology-Stroke Unit AO Niguarda Ca’ Granda, Milano, ITALY13, Ospedale Poma, Mantova, ITALY14 Background: Hemorrhagic transformation (HT) of ischemic stroke is the most frequent and feared complication of revascularization treatments. The aim of this study was to identify predictive HT factors in acute ischemic stroke treated with intravenous (IV) t-PA or endovascular treatment. Meth-ods: We analyzed 146 patients included in the Synthesis Expansion study, a randomized multicenter controlled trial on fast-track endovascular treatment compared to IV t-PA for acute ischemic stroke. Demographic, clinical, radiological and functional features (7-day NIHSS, 90-day mRS) were eval-uated. All CT scans were centrally reviewed in blind to treatment allocation and clinical outcome. HTs were divided in subtypes according to ECASS classification. Results: HT was observed in 28% of patients (6% symptomatic). Variable significantly associated to HT were basal NIHSS (OR for every NIHSS increase of one point 1.1; 95%CI 1.05-1.2; p=0.001), heparin administration (OR 3.0; 95%CI 1.1-7.9; p=0.024), Total Anterior Circulation stroke (OR 8.7; 95%CI 1.7-45.3; p=0.01), MCA hyperdensity (OR 2.4; 95%CI 1.1-5.2; p=0.021), ASPECT score </=7 (OR 3.8; 95%CI 1.4- 10.1; p=0.007), and infarct volume (p<0.0001). No correlation was observed between HT, age, and other clinical features. HT was significantly associated to 7-day clinical severity (NIHSS ≥ 14: OR 3.1; 95%CI 1.4-6.9; p=0.007), and inversely associated to 90-day favorable outcome (mRS</=1 OR 0.1; 95%CI 0.03-0.4; p<0.0001). Among HT subtypes, only parenchymal hematoma type 2 impact-ed the prognosis with in-hospital mortality of 50%. HT type 1 was not associated to significant 90- day mRS worsening (OR for mRS</=1 0.4; 95%CI 0.1-1.8). Conclusions: HT is relatively frequent in acute ischemic stroke treated with thrombolysis and is an indicator of stroke severity. 646 © 2013 S. Karger AG, Basel Scientific Programme 571 Acute stroke: emergency management, stroke units and complications Results from the Victorian Stroke Telemedicine Project (VST): One year clinical phase. C. Bladin1, N. Moloczij2, F. Kung3, S. Ermel4, D.A. Cadilhac5, on behalf of the VST Project Investigators Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, AUS-TRALIA1, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA2, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Mel-bourne, AUSTRALIA3, Bendigo Health, Bendigo, AUSTRALIA4, Stroke and Ageing Research Cen-tre, Monash University, Melbourne, AUSTRALIA5 Background: Telemedicine can improve the delivery of stroke thrombolysis in rural hospitals but is not widely used for acute stroke care in Australia. The Victorian Stroke Telemedicine (VST) project has completed the first year of implementation of a comprehensive model of stroke care incorporat-ing a program for stroke education, communication, and clinical support for decision making. Methods: A network of urban-based neurologists was on call 24 hours a day for one regional hos-pital 200 kms from Melbourne (Australia). Neurologists predominately conducted telemedicine via desktop computers. Telemedicine consultations were undertaken for patients with suspected stroke symptoms and who arrived within 4 hours of onset. Patient clinical data were collected and a 3 month outcome follow-up conducted. Results: A stroke thrombolysis rate of 5% was observed in the year prior to VST. Stroke telemedi-cine consults were undertaken for 35 patients, whereby 74% were full video-conferencing consulta-tions (video/audio/brain imaging), 26% were telephone only, and the technology worked flawlessly 52% of the time. The median length of a telemedicine consult was 20 minutes (IQR 11-29 mins). Four of the 35 patients did not fit the VST eligibility criteria. Of the eligible patients, 61% were male, median age 66 years (range 32-90), median NIHSS 7; and 42% (n=13) received t-PA, with a median door to needle time of 89 minutes. One patient who received t-PA experienced a symptomat-ic intracerebral haemorrhage. Discharge outcome data: 55% of patients scored a Rankin of 0-1; 58% returned home; and 10% died in hospital. Conclusions: Overall VST was feasible, increased access to thrombolysis in eligible patients with excellent clinical outcomes. There is continuing work to streamline clinical processes and overcome technology problems, particularly in the use of mobile wireless broadband. Stroke telemedicine is due for expansion in 2013 following further Australian government funding.
Karger_ESC London_2013
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