22. European Stroke Conference 9 Management and economics 17:50 - 18:00 Intra-arterial occlusion in acute ischemic stroke: relative frequency in an unselected pop-ulation. D. Beumer1, G. Saiedie2, S. Fonville3, R.J. van Oostenbrugge4, P.J. Homburg5, A. van der Lugt6, D.W.J. Dippel7 Maastricht University Medical Center, Maastricht, THE NETHERLANDS1,Erasmus MC University Medical Center, Rotterdam, THE NETHERLANDS2, Erasmus MC University Medical Center, Rotterdam, THE NETHERLANDS3, Maastricht University Medical Center, Maastricht, THE NETHERLANDS4, Erasmus MC University Medical Center, Rotterdam, THE NETHERLANDS5, Erasmus MC University Medical Center, Rotterdam, THE NETHER-LANDS6, Erasmus MC University Medical Center, Rotterdam, THE NETHERLANDS7 Background The relative frequency of proximal intracranial arterial occlusion (PIAO) in patients with acute ischemic stroke (AIS) is not well known, although this is important clinically, and for manpow-er planning and resource allocation. We estimated the proportion of patients with a relevant PIAO and assessed the percentage of patients with AIS caused by PIAO who are eligible for intra-arterial treatment. Methods We gathered data from a registry of consecutive patients with AIS presenting at the emergen-cy department from 2006 to 2012. Referrals from other hospitals were excluded. All patients underwent routine CT angiography (CTA) from the aortic arch to the intracranial circulation. PIAO of primary and secondary branches of the intracranial carotid, vertebral and basilar ar-teries were considered relevant if the neurologic symptoms of the patient were consistent with location of the occlusion. Results Of the 1103 patients with acute ischemic stroke, 618 arrived after 6 hours, 144 patients had a CTA more than 7 hours after stroke onset and 38 patients had stroke mimics. The remaining 303 patients had a mean age of 63 years (SD ±16) and 151 patients (50%) were male. The me-dian NIHSS at the emergency department was 6 (IQR 0-22) and 30 patients (10%) had atrial fibrillation. In total, 87 patients (29%; 95% CI: 24% to 34%) had a relevant PIAO. In 68 pa-tients (78%) this concerned a PIAO in the carotid, and in 19 (22%) the vertebrobasilar distri-bution (Table). A total of 76 (87%) patients was considered eligible for intra-arterial treatment, this amounts to 7.9% (95% CI: 6.4% to 9.4%) of all patients with AIS. The only significant pre-dictor of PIAO was NIHSS Score (OR per item point: 1.15, 95% CI:1.10 to 1.19) adjusted for age and sex. Conclusion In this study the relative frequency of PIAO in patients with acute ischemic stroke was 29% (95% CI: 24% to 34%) of those presenting within 6 hours. In this group, 87% of the patients was eligible for intra-arterial treatment. Table: Relevant proximal intracranial arterial occlusions in consecutive patients with acute ischemic stroke. Carotid top 21 (24%) Middle cerebral artery (M1, 47 (54%) M2) Anterior cerebral artery (A1) 0 (0%) Vertebral artery 12 (14%) Basilar artery 5 (6%) Posterior cerebral artery (P1, 2 (2%) P2) 8 Vascular surgery and neurosurgery 17:40 - 17:50 Improvement in Cerebral Hemodynamic Parameters and outcomes after Superficial Tem-poral Artery- Middle Cerebral Artery Bypass in Patients with Severe Steno-occlusive Dis-ease of Intracranial Carotid and Middle Cerebral Artery V.K. Sharma1, A.K. Sinha2, H.L. Teoh3, R.C. Seet4, B.R. Wakerley5, C. Ning6, T.T. Yeo7, S.W. Low8, K. Teo9, V.F. Chong10, S. Lwin11, L Shen12, L.Y.H. Wong13, B.P.L. Chan14 National University of Singapore, Singapore, SINGAPORE1,National University Health System, Singapore, SINGAPORE2, National University Health System, Singapore, SINGA-PORE3, National University of Singapore, Singapore, SINGAPORE4, National University Health System, Singapore, SINGAPORE5, National University Health System, Singapore, SIN-GAPORE6, National University Health System, Singapore, SINGAPORE7, National University Health System, Singapore, SINGAPORE8, National University Health System, Singapore, SIN-GAPORE9, National University Health System, Singapore, SINGAPORE10, National University Health System, Singapore, SINGAPORE11, National University of Singapore, Singapore, SINGA-PORE12, National University Health System, Singapore, SINGAPORE13, National University Health System, Singapore, SINGAPORE14 Background and Objective- Older as well as the recent extracranial-intracranial (EC/IC) bypass trial in patients with symptomatic carotid occlusion failed to demonstrate reduction in stroke recurrence. However, the role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in symptomatic intracranial steno-occlusive disease has been evaluated scarce-ly. We evaluated changes in hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass for impaired cerebral vasodilatory reserve (CVR). Methods- Patients with severe steno-occlusive disease of intracranial ICA or MCA under-went transcranial Doppler (TCD) evaluation and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-chal-lenged hexamethylpropyleneamine oxime single-photon emission computed tomography (HMPAO-SPECT). STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were fol-lowed- up for cerebral ischemic events. Results- 126 patients (80 male, mean age 56yrs; range 23-78yrs) fulfilled our inclusion crite-ria. HMPAO-SPECT showed impaired CVR in 84 (67%) patients. Fifty of them underwent STA-MCA bypass while 34 received best medical treatment. TCD and acetazolamide-chal-lenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. During follow-up (mean 35 months; range 8 to 49months), only 6/50 (12%) patients in bypass group developed cerebral ischemic events as compared to15/34 (44%) cases on medical therapy (absolute risk reduction 32%, p=0.006). Conclusion- STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in hemodynamic param-eters and reduction in stroke recurrence. 66 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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