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22. European Stroke Conference 578 Acute stroke: emergency management, stroke units and complications The role of CT-angiography in acute stroke: frequency of occlusion and associated factors and complications of their use J.A. Matias-Guiu1, C. Serna-Candel2, P. Simal3, A.M. García4, C. Gómez-Escalonilla5, J.A. Egi-do6, 650 © 2013 S. Karger AG, Basel Scientific Programme J. Matias-Guiu7 Department of Neurology. Institute of Neurosciences, IdISSC. Hospital Clinico San Carlos, Madrid, SPAIN1, Department of Neurology. Institute of Neurosciences, IdISSC. Hospital Clini-co San Carlos, Madrid, 2, Department of Neurology. Institute of Neurosciences, IdISSC. Hospital Clinico San Carlos, Madrid, SPAIN3, Department of Neurology. Institute of Neurosciences, IdISSC. Hospital Clinico San Carlos, Madrid, SPAIN4, Department of Neurology. Institute of Neurosciences, IdISSC. Hospital Clinico San Carlos, Madrid, SPAIN5, Department of Neurology. Institute of Neu-rosciences, IdISSC. Hospital Clinico San Carlos, Madrid, SPAIN6, Department of Neurology. Insti-tute of Neurosciences, IdISSC. Hospital Clinico San Carlos, Madrid, SPAIN7 Background. Nowadays, demonstration of arterial occlusion in acute stroke may be relevant due to the advances achieved in reperfusion therapies. This study evaluates the frequency of arterial occlu-sion and its associated factors in acute stroke, as well as the complications derived from CT-angiog-raphy (CTA) use. Methods. Retrospective study of patients diagnosed with acute stroke in our centre over a period of 6 months. Results. Data from a total of 157 patients were obtained (mean NIHSS 5, 60% were admitted at the Emergency Room at a maximum of 8 hours from the onset of stroke). CTA was performed in 45% of cases, of which occlusion was detected in 52%. Occlusion was observed in middle cerebral artery (53%) and basilar artery (18%). Univariate analysis and multinomial logistic regression showed that NIHSS (17 vs 7, p<0.001) and atrial fibrillation (64% vs 32%, p=0.006) were associated to occlu-sion. ROC analysis reveled that the area under the curve of NIHSS was 0.789. An NIHSS equal to 6 allowed a sensitivity of 0.85 for the diagnosis of arterial occlusion in our sample, whereas sensitivity dropped to 0.6 if a cut-off point of NIHSS equal to 12 was used. There were no cases of contrast-in-duced nephropathy. There was one case of allergic reaction to contrast. The door-to-needle time for thrombolysis in patients undergoing CTA was 61.2+/- 24 vs 53.5 +/- 34.3 minutes in the group of patients who did not (p=0.495). Conclusions. Arterial occlusion is frequent in acute stroke. NIHSS is the main associated factor, with an optimal cut-off point of 6. Other factors such us atrial fibrillation may be useful to predict arterial occlusion. CTA in this setting is safe. 579 Acute stroke: emergency management, stroke units and complications STARTUP OF AN INTERHOSPITAL NETWORK FOR THE INTERVENTIONAL TREAT-MENT OF ACUTE ISCHAEMIC STROKE IN THE SPANISH REGION OF MADRID A. Ximénez-Carrillo1, G. Reig2, G. Zapata Wainberg3, M. Alonso de Leciñana4, A. Cruz5, B. Fuen-tes6, P. Martínez7, A. García Pastor8, A. García García9, J. Díaz10, J. Egido11, A. Gil12, J. Masjuan13, E. Díez-Tejedor14, J. Vivancos15 Stroke Unit. Hospital de La Princesa. On behalf of MADRID STROKE NETWORK, Madrid, SPAIN1, Stroke Unit. Hospital de La Princesa, Madrid, SPAIN2, Stroke Unit. Hospital de La Princ-esa, Madrid, SPAIN3, Stroke Unit. Hospital Ramón y Cajal, Madrid, SPAIN4, Stroke Unit. Hospital Ramón y Cajal, Madrid, SPAIN5, Stroke Unit. Hospital La Paz, Madrid, SPAIN6, Stroke Unit. Hos-pital La Paz, Madrid, SPAIN7, Stroke Unit. Hospital Gregorio Marañón, , 8, Stroke Unit. Hospital Clínico San Carlos, Madrid, SPAIN9, Stroke Unit. Hospital 12 de Octubre, Madrid, SRI LANKA10, Stroke Unit. Hospital Clínico San Car-los, Madrid, SPAIN11, Stroke Unit. Hospital Gregorio Marañón, Madrid, SPAIN12, Stroke Unit. Hos-pital Ramón y Cajal, Madrid, SPAIN13, Stroke Unit. Hospital La Paz, Madrid, SPAIN14, Stroke Unit. Hospital de La Princesa, Madrid, SPAIN15 BACKGROUND: The aim of this study is to describe a new initiative of the Madrid Stroke Net-work to implement the interventional treatment of acute ischemic stroke in the region of Madrid and its preliminary results. METHODS: Our protocol is based on a weekly rotatory shift between 3 Stroke Centers. Stroke Code system is carried out following the regular protocol by the 6 stroke units of the region. If endovascular treatment is indicated the interhospital transference is done, pri-marily or after completing IV thrombolysis, to the on-call center for interventionism. We performed a prospective registry of consecutive patients selected for endovascular treatment following a proto-col agreed by the Madrid Stroke Network. We present the baseline characteristics, reperfusion rates, outcomes and short term adverse events of the patients treated in three stroke units engaged in an or-ganized system since its startup in February 2012. RESULTS: During 10 months we have performed 87 endovascular treatments. The results of the first 3.5 months are: Treated patients: 29 (8.2 patients/ month). Mean age: 66.86(SD 11.99) years. Women: 37.9%. Median baseline NIHSS: 17 (IQR=6). Patients treated with IV rt-PA: 62.1%. Interhospital transfers 58.6%. Anterior circulation 93.1% (MCA 86.2%). Stent-retriever: 96.5%. Reperfusion rates: TICI≥ 2a=82.7%. Median onset-interven-tionism time: 260(IQR 192.5) minutes. Mean onset-reperfusion time: 316.66(SD 100.04) minutes. Immediate complications: 13.79% (2 arterial ruptures,1 arterial dissection; others: 1; none lethal). Symptomatic hemorrhage 3.4%; Median NIHSS at discharge= 3(IQR=11). Median pre and postreat-ment NIHSS difference= 12 (p<0.001). Independence at 90 days (mRS< 3): 51.7%. 90 days mortal-ity: 6.9%. CONCLUSION: The implementation of this new interhospital network increases the ac-cessibility and allows an effective and safe application of endovascular treatment for acute ischemic stroke in the region of Madrid.


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