22. European Stroke Conference 706 Acute stroke: clinical patterns and practice Analysis of Incidence and Procedural Factors accociated with Cerebral infarction Related to Catheter Procedure Y. Morita1, T. Kato2, K. Su3, M. Kimura4, S. Hirose5, E. Minamino6, E. Nakane7, S. Miyamoto8, T. Izumi9, T. Haruna10, M. Inoko11, R. Nohara12 Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN1, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN2, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN3, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN4, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN5, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN6, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN7, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN8, Cardiovascular Cen-ter, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN9, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN10, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN11, Cardiovascular Center, The Tatsuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JAPAN12 Background: Catheter procedures can cause cerebral infarction mainly by atherosclerotic debris from the aorta and embolization of thrombus or air. Due to improvement in devices and the increase in the transradial approach in cardiac catheterization, complications related to catheterization are ex-pected to decrease. However, patients who undergo catheterization are at greater risk of atheroscle-rosis. The purpose of this study was to examine the incidence and procedural factors of symptomatic and asymptomatic cerebral infarction related to catheterization identified by diffusion MRI images. Methods and Results: Among 1,237 procedures of diagnostic or interventional catheriazation from August 2010 to Augsut 2012, we retrospectively analyzed 84 patients who had gone MRI within 14 days after the procedure. Among these, 10 patients who developed a neurological deficit underwent MRI for the suspicion of cerebral infarction (group A), and the other 74 patients were asymptomat-ic( group B) who incidentally underwent MRI for various reasons. MRI revealed that 5 of 10 patients in group A had new cerebral infarction. In group B, we compared procedural factors from patients who developed a new lesion (n=22, 29.7%) and patients who did not (n=52, 71.3%). More cathe-ters were used (median: 3 vs. 2, P<0.05), but there was no influence of the catheter sizes, approach sites, diagnostic or interventional procedures, coronary angiography, left ventriculography, contrast volume or fluoroscopy time. Sypmtomatic cerebral infarction occurred in 5 of 1237 (0.4%) proce-dures, which was similar to previously reported rates. Conclusions: The incidence of symptomatic or asymptomatic complications of cerebral infarction is closely related to cardiac catheterization compared to the several reports around a decade ago. Multiple catheter usage was associated with increased risk of new cerebral infarction and careful procedural plannig is warranted. 718 © 2013 S. Karger AG, Basel Scientific Programme 708 Acute stroke: clinical patterns and practice Early major worsening in ischemic stroke: predictors and outcome G. Ntaios1, D. Lambrou2, D. Cuendet3, P. Michel4 University of Larissa, Larissa, GREECE1, Neurology Service, CHUV, Lausanne, SWITZER-LAND2, University of Lausanne, Lausanne, SWITZERLAND3, Neurology Service, CHUV, Univer-sity of Lausanne, Lausanne, SWITZERLAND4 Introduction: We aimed to investigate the characteristics and outcome of patients suffering early major worsening (EMW) after acute ischemic stroke (AIS) and assess the parameters associated with it. Methods: All consecutive patients with AIS in the ASTRAL registry until 10/2010 were included. EMW was defined as an NIHSS increase ≥8 points within the first 24 hours after admis-sion. The Bootstrap version of the Kolmogorov-Smirnov test and the χ2-test were used for the com-parison of continuous and categorical covariates respectively between patients with and without EMW. Multivariate logistic regression analysis was performed to identify independent predictors of EMW. Results: Among 2155 patients, 43 (2.0%) had an EMW. EMW was independently associated with hemorrhagic transformation (OR:22.6, 95%CI:9.4-54.2), cervical artery dissection (OR:9.5, 95%CI:4.4-20.6), initial dysarthria (OR:3.7, 95%CI:1.7-8.0) and intravenous thrombolysis (OR:2.1, 95%CI:1.1-4.3), whereas a negative association was identified with initial eye deviation (OR:0.4, 95%CI:0.2-0.9). Favorable outcome at 3 and 12 months was less frequent in patients with EMW compared to patients without (11.6% vs. 55.3% and 16.3% vs. 50.7% respectively), and case fatality was higher (53.5% vs. 12.9% and 55.8% vs. 16.8% respectively). Stroke recurrence within 3 months in surviving patients was similar between patients with and without EMW (9.3% vs. 9.0% respec-tively). Conclusions: Worsening of ≥8 points in the NIHSS score during the first 24 hours in AIS patients is related to cervical artery dissection and hemorrhagic transformation. It justifies urgent re-peat parenchymal and arterial imaging. Both conditions may be influenced by targeted interventions in the acute phase of stroke.
Karger_ESC London_2013
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