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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 717 702 Acute stroke: clinical patterns and practice Thrombolysis in Clinical-Diffusion Matched Patients: Beneficial Effect of Recanalization W.K. Seo1, S.I. Suh2, J.H. Kim3, K. Oh4, S.B. Koh5 Department of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA1, Department of Radiology, College of Medicine, Korea University, Seoul, SOUTH KOREA2, De-partment of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA3, Depart-ment of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA4, Department of Neurology, College of Medicine, Korea University, Seoul, SOUTH KOREA5 Background & Objective: Beneficial effect of diffusion-perfusion mismatch after thromboly-sis in acute stroke patients has been reported repeatedly. However, the high sensitivity of diffu-sion- weighted images (DWIs) causes abnormal signal changes in area of brain which is correspond-ing to the symptoms even within the therapeutic time window. Therefore, it is confusing whether to perform thrombolysis or not in clinical-diffusion matched acute stroke patients. Methods :In this retrospective study, prospectively collected data of patients with anterior circulation stroke treated by thrombolysis within 6 hours after the onset of symptoms were analyzed. Semi-quantitative as-sessment of lesion volume was performed using DWI-ASPECTS. Clinical-diffusion match (CDM) was diagnosed when DWI-ASPECTS was lower than 6 point, and initial NIHSS higher than 8 point. We assessed factors which can predict clinical outcome among the patients with acute stroke patients with CDM. Results: During the study period, data of 95 patients (57 male, 64.53 ± 12.05 year-old) were analyzed. Mean initial NIHSS was 12.73 ± 5.63. Clinical-diffusion match was pos-itive in 41 (43.16%) patients. Positive CDM was associated with higher initial NIHSS and less fa-vorable outcome than negative CDM. Time from symptom onset to treatment was longer in CDM positive without statistical significance. Among the patients with positive CDM, favorable outcome was associated with initial NIHSS (OR 0.678, 95%CI 0.504 – 0.912) and recanalization (OR 19.17, 95% CI 1.56 – 235.874) after logistic regression analysis. Early improvement was associated with only recanlization (100% in positive early improvement, 33.3% in negative early improvement, p < 0.001). Conclusions: CDM was one of the important determinant for prognosis after thrombolysis in acute stroke patients. Among the patients with CDM positive, recanalization was independently associated with favorable outcome and early improvement. 704 Acute stroke: clinical patterns and practice Direct access to hospital offering intravenous thrombolysis therapy improves functional out-come of patients with moderate to severe ischemic stroke D.H. Kim1, E.H. Jeong2, J.K. Cha3, S.M. Jun4, S.W. Kim5, S.H. Choi6 Dong-A University, Busan, SOUTH KOREA1, Dong-A University Hospital, Busan, SOUTH KO-REA2, Dong-A University Hospital, Busan, SOUTH KOREA3, Bong Seng Memorial Hospital, Bu-san, SOUTH KOREA4, Busan ST. Mary’s Medical Center, Busan, SOUTH KOREA5, Bumin Hospi-tal, Busan, SOUTH KOREA6 Background and purpose: Delayed hospital admission is a major factor limiting early thrombolytic therapy in patients with acute ischemic stroke (AIS). Referral from another hospitals is one of the primary causes of delayed arrival after AIS. We investigated whether direct access to hospital offer-ing intravenous thrombolysis therapy could be associated with a good functional outcome in AIS pa-tients treated with thrombolysis. Methods: We enrolled ischemic stroke patients who had received intravenous thrombolysis within three hours from symptom onset at our hospital for 51 months. We investigated onset-to-arrival time and onset-to-rtPA time according to admission mode. We divided into two groups: those with mild (NIHSS</=7) and those with moderate to severe (NIHSS >7) stroke. We then performed univariate analysis and multiple logistic regression to assess the association between a direct admission and fa-vorable outcome (mRS score of 0-2) at 90 days in each group. Results: A total of 234 patients (male 55.6%, with a mean age 66.5 years and median NIHSS score 10) were included. Patients who were directly admitted to our stroke center, whether self-referred or who had used an emergency medical service, had a shorter onset-to-arrival time (41 14–155, 65 20–153 vs. 121 28–174 min, P<0.001) and onset-to-rtPA time (86 30–190, 105 35–195 vs. 155 141–215 min, P<0.001) than the group referred from other hospitals. In patients with moder-ate- to-severe stroke, direct admission was associated with a good outcome with an odds ratio of 2.23 (95% CI: 1.06-4.68, p=0.034), after adjusting for the baseline variables. Conclusions: Thrombolysis after direct admission to hospital offering intravenous thrombolysis therapy could shorten onset-to-rtPA therapy time and improve stroke outcome in AIS patients.


Karger_ESC London_2013
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