22. European Stroke Conference 914 Interventional neurology Mechanical thrombectomy in severe thromboembolic stroke A. Kuntze Söderqvist1, M. Kaijser2, T. Andersson3 Clinical Neurosciences, Karolinska Institute and Dept of Neuroradiology, Karolinska Univer-sity Hospital, Stockholm, Sweden, Stocholm, SWEDEN1, Clinical Neurosciences, Karolinska Institute and Dept of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden, Stock-holm, SWEDEN2, Clinical Neurosciences, Karolinska Institute and Dept of Neuroradiology, Karo-linska University Hospital, Stockholm, Sweden, Stockholm, SWEDEN3 Background & purpose: Evaluation of safety, effectiveness and outcome for mechanical thrombec-tomy in the treatment of severe acute ischemic stroke (sAIS) secondary to large artery occlusion. Methods: Consecutive patients presenting with acute ischemic stroke (AIS) at the Karolinska Uni-versity Hospital, Stockholm, Sweden from September 2005 through December 2011 and treated with mechanical thrombectomy were retrospectively investigated. TICI scores were evaluated on pre- and post-procedure angiographies and a TICI-score of 2b or 3 was regarded as successful revas-cularisation. The definition of symptomatic intracranial haemorrhage (SICH) at 24 h was subarach-noid hemorrhage or parenchymal haemorrhage type 2 in conjunction with a ≥ 4 points decline in the NIHSS score, or if the bleed caused death. A modified Rankin Scale (mRS) score ≤ 2 at follow-up was considered as favourable functional outcome. In this analysis we have focused on patients with sAIS in the anterior circulation, defined as preinterventional NIHSS of 12 or more. Results: 192 pa-tients were treated with mechanical thrombectomy for AIS in the anterior circulation, 129/192 had a preinterventional NIHSS of 12 or more. Among the 84 patients with NIHSS 12-19 a clinically successful thrombectomy, defined as a reduction in NIHSS of 4 or more, was achieved in 64%, and 44% had a final NIHSS of 5 or less, and favourable functional outcome was established in 51%. With preinterventional NIHSS 20-35, the corresponding figures were 51%, 13% and 36% (47% among those having an preinterventional mRS = 0), respectively. SICH was found in 14/192 pa-tients (7%), with no significant difference when comparing the different groups of preinterventional NIHSS. Conclusions: This study shows that mechanical thrombectomy is an effective and safe treat-ment in severe acute ischemic stroke and large artery occlusions with excellent long-term functional outcome even in patients with a high preinterventional NIHSS. 830 © 2013 S. Karger AG, Basel Scientific Programme 915 Interventional neurology Two years experience with endovascular therapy for large vessel acute ischemic stroke: re-sults and outcome of 165 consecutive patients. J.S.H. Højgaard1, M.C. Cortsen2, M.C. Cronquist3, M.H. Holtmannspötter4, J.K. Kelsen5, D.K. Krieger6, D.K. Kondziella7, S.M. Mogensen8, T.S. Stavngaard9, J.S. Stensballe10, H.S. Sønder-gaard11, Å.W. Wagner12, K.H. Hansen13 Department of Neurology, Rigshospitalet University Clinic, Copenhagen, DENMARK1, De-partment of Neurointervention, Rigshospitalet University Clinic, Copenhagen, DENMARK2, Department of Neurointervention, Rigshospitalet University Clinic, Copenhagen, DENMARK3, Department of Neurointervention, Rigshospitalet University Clinic, Copenhagen, 4, Department of Neurology, Rigshospitalet University Clinic, Copenhagen, DENMARK5, Department of Neurology, Rigshospitalet University Clinic, Copenhagen, DENMARK6, Department of Neurology, Rigshos-pitalet University Clinic, Copenhagen, DENMARK7, Department of Neuroanaesthesiologylogy, Rigshospitalet University Clinic, Copenhagen, DENMARK8, Department of Neurointervention, Rigshospitalet University Clinic, Copenhagen, DENMARK9, Blood Bank, Section of Transfusion Medicine, Rigshospitalet University Clinic, Copenhagen, DENMARK10, Department of Neurology, Rigshospitalet University Clinic, Copenhagen, DEN-MARK11, Department of Neurointervention, Rigshospitalet University Clinic, Copenhagen, DEN-MARK12, Department of Neurology, Rigshospitalet University Clinic, Copenhagen, DENMARK13 Background: Endovascular therapy (EVT) for acute ischemic stroke (AIS) has been performed on a regular basis since 2011 at our clinic – from 1. june 2011 on a 24-hour basis. In our region with a population of 2,5 million there are 4 IV thrombolysis (IVT) centers and 1 EVT center. All stroke patients evaluated for IVT have a CT/ CTA. EVT is considered in patients with large vessel occlu-sion, no significant signs of infarction and a time from onset <6-8 hours. A close collaboration be-tween the IVT and the EVT centers has been established. Most patients with large vessel occlusion are transferred receiving bridging IVT. The aim of this presentation is to present our expierience with this concept.. Methods: From a continous database parameters such as age, time of onset, type of vessel occlusion, NIHSS, time to admission/EVT/recanalisation, recanalisation score (TICI) and outcome - mRS at 24 hours and 3 months. Data for 2011 have been processed, whereas data for 2012 presently are evaluated and will be ready at the meeting. Results: 165 patients were treated from 1. january 2011 untill 31. december 2012; 2011 n=42, 2012: n= 123. The following results are based on the 2011 cohort. This comprised male n=24 female n=18 median age 60 (11-91), NIHSS median 16,1 (2-25). The causative occlusion was ICA 21% MCA 60% BA 19%. 71% had received IVT. The EVT procedure usually consisted of mechanical thrombectomy using a stent retriever, in some cases assisted by local intra arterial rt PA and intra/extracranial stenting. In 74% of the patients a recanalisation of TICI ≥2b was achieved. At 3 month follow-up 55 % had a mRS ≤2 and the mor-tality was 19%. The complication rate with symptomatic ICH was <5%. Conclusion: An operational multidisciplinary center for EVT in acute large vessel stroke has been established now treating more than 10 patients a month. The complication rate is low. Although this study was not randomised/ controlled the results seem to favour EVT in stroke patients with large vessel occlusion.
Karger_ESC London_2013
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