22. European Stroke Conference 926 Interventional neurology Thrombectomy of Acute Vertebrobasilar Occlusion using Stent Retrievers: Initial Experience (18 Patients). J. Zamarro Parra1, M. Espinosa de Rueda Ruiz2, G. Parrilla Reverter3, B. García-Villalba Navari-das4, F. Hernández Fernández5, E. Carreón Guarnizo6, A. Morales Ortiz7, E. Andreu Reinón8, C. Lucas Ródenas9, F.A. Martínez García10, B. Escribano Soriano11, M. Garrote12, A. Moreno Diéguez13 Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN1, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN2, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN3, Hospi-tal Universitario Virgen de la Arrixaca, Murcia, SPAIN4, Hospital Universitario Virgen de la Arrixa-ca, Murcia, SPAIN5, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN6, Hospital Univer-sitario Virgen de la Arrixaca, Murcia, SPAIN7, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN8, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN9, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN10, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN11, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN12, Hospital Universitario Virgen de la Arrixaca, Murcia, SPAIN13 BACKGROUND: Acute vertebrobasilar occlusion is an ominous disease with few proved effec-tive treatments. Experience with stent retrievers is scarce and limited to combined therapies (stent retrievers associated with previous intravenous fibrinolysis, intra-arterial thrombolysis, or other mechanical devices). We present our experience with 18 patients treated with direct thrombectomy by using stent retrievers METHODS: Eighteen patients with vertebrobasilar occlusion were treated with direct thrombectomy by using stent retrievers at our hospital. The mean age was 67.5 years. Clinical presentation was sudden deterioration in consciousness level in 61.2% and progressive or fluctuating brain stem symptoms in 38.8%. Stroke subtype (TOAST) was atherothrombotic (33.3%), undetermined (33.3%), cardioembolic (27.7%), and of unusual etiology (5.5%). RESULTS: The occlusion site was the vertebral artery in 1 case, proximal basilar artery in 4, middle basilar artery in 6, distal basilar artery in 5, and unilateral posterior cerebral artery in 2 cases. SRs included the Solitaire AB in 8 cases, Solitaire FR in 5 cases, and Trevo Pro in 5 cases. An 8F Merci balloon guide catheter was used in 15 patients, and a Neuron 6F, in 3 patients. Post-clot retrieval definitive intra-cranial stents were used in 5 patients (27.7%). Postprocedural TICI ≥ 2b was achieved in 17 patients (94.4%). Clinically, 72.2% of patients experienced an improved NIHSS score at discharge, 22.2% died, and in 5.5% the NIHSS scores did not change. The mRS score at 3 months was 0-2 in 9 pa-tients (50%) and 3-5 in 5 patients (27.7%). CONCLUSION: Thrombectomy with stent retrievers is feasible in the treatment of vertebrobasilar occlusion. These initial results must be confirmed by fur-ther prospective studies with a larger number of cases. 836 © 2013 S. Karger AG, Basel Scientific Programme 927 Interventional neurology NeuroAnesthesiology for endoVascular Interventions under General Anesthesia – Treatment Effects (NAVIGATE). Protocol and baseline data. J. Bösel1, S. Mundiyanapurath2 University of Heidelberg, Dept. of Neurology, Heidelberg, GERMANY1, University of Heidel-berg, Dept. of Neurology, Heidelberg, GERMANY2 Background: Mechanical thrombectomy with and without intraarterial rt-PA is increasingly used for treatment of media infarction due to acute occlusion of the MCA or ICA. These interventions are most often performed under general anaesthesia. Some evidence suggests detrimental effects of gen-eral anesthesia but the mechanisms behind this are unknown. We hypothesize that hypotension and hypocapnia (as a result of hyperventilation) possibly associated with general anesthesia and invasive ventilation might compromise cerebral perfusion. Methods: In this prospective analysis of a retrospectively collected data set, all consecutive patients with acute proximal MCA or ICA occlusion that were mechanically recanalised under general an-esthesia during the years 2008-2013 were/will be included in the analysis with the exclusion of pa-tients with severe COPD. The following parameters were/will be assessed: blood pressure, exspira-tory CO2-levels, sedation and ventilation parameters before, during, and after the intervention. In February 2012, a new standard operating procedure (SOP) for mechanical recanalisation was es-tablished, which included the implementation of target levels for the blood pressure and the exspira-tory CO2-levels during the intervention. The two patient groups before and after implementation of this SOP will be analysed in the parameters mentioned above, according to protocol adherence, us-ing descriptive and explorative statistics. Results: 80 patients were included from the pre-SOP study phase. Of these, 60% were male, the av-erage age was 63 and the average NIHSSS 22. Since implementation of the SOP, 40 patients were included in the study. Study and data analysis are ongoing. The detailed study protocol and the pa-tients ´ baseline data will be presented and discussed. Conclusion: We assume that a standardized approach to neuroanesthesia for endovascular interven-tional acure stroke treatment including circulatory and respiratory target levels will be advantageous.
Karger_ESC London_2013
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