22. European Stroke Conference 930 Interventional neurology Stenting with Distal Cerebral Protection for Patients with Subtotal ICA Occlusion - A Single Center Registered Study M.K. Zhou1, H.B. Zheng25 West China Hospital, Chengdu, CHINA1, West China Hospital, Chengdu, CHINA2 Background Subtotal occlusion of internal carotid artery (ICA) are atheromatous lesions with high-grade (95-99% ) stenosis, which has been correlated to high risk for thrombosis and embolism. Management of patients with subtotal ICA occlusion remains controversial. Previous studies of ca-rotid endarterectomy for such cases showed conflicting results. However, patients with subtotal ICA occlusions were excluded from randomized carotid artery stenting (CAS) trial, because the possible presence of intraluminal thrombus at the lesion site increased risk for embolic neurological compli-cations. Therefore, exploring the feasibility and safety of CAS with various protection devices for these patients, which potentially minimizes the risk of distal embolization is worthwhile. Methods In a prospective, single-center study, from Jan 2005 to Dec 2011, the periprocedural and long-term outcomes of 47 consecutive patients with subtotal occlusive carotid artery who underwent CAS with distal cerebral protection were analyzed. Results A distal filter was used for cerebral protection in 47 patients. Carotid artery stenting was performed successively in all but one patients. The procedural success rate of CAS was 97.9%.One patients developed an ipsilateral TIA 30 minutes after CAS. Stroke in progress after operation was arrested in one patient,who recover to normality 36 hours later. One patient developed asymptomatic hemorraghe. Two patients died within the 30-day period following the procedure, one from myo-cardial infarction, the other from intracranial hemorraghe. Clinical follow-up was performed for all patients. The median follow-up period was 15 months. Asymptomatic restenosis more than 70% oc-curred in one patients, and asymptomatic occlusion occurred in another patients. The overall surviv-al rate in the mean follow-up period was 95.7%. Conclusions Carotid stenting under distal cerebral protection seems to be a feasible and safe pro-cedure to manage patients with severe carotid stenosis. With careful patient selection and technical expertise, endovascular management could be considered as a treatment option in subtotal carotid occlusions. 838 © 2013 S. Karger AG, Basel Scientific Programme 931 Interventional neurology Achieving an IV Needle to Arterial Puncture Time under 60 Minutes in Acute Endovascular Stroke Therapy is Feasible S. Mishra1, M.A. Almekhlafi2, V Nambiar3, J. Desai4, O Volny5, A.M. Demchuk6, M. Goyal7 University of Calgary, Calgary, CANADA1, University of Calgary - King Abdulaziz University, Calgary, 2, University of Calgary, Calgary, 3, University of Calgary, Calgary, 4, University of Cal-gary, Calgary, 5, University of Calgary - HBI, Calgary, 6, University of Calgary - HBI, Calgary,- CANADA7 BACKGROUND The importance of time in acute ischemic stroke management cannot be overemphasized. The IMS-III trial reports an 88-minute time interval from IV bolus administration to arterial groin puncture. We assessed the feasibility of achieving a shorter time interval in routine practice. METHODS This a longitudinal cohort of acute anterior circulation stroke patients treated in our center between Jan 2011 to Dec 2012. Times were prospectively collected at the times of patients’ presentations. RESULTS Out of 105 patients, 64 (60.6%) received IV tPA. The median age was 64 years with a median NI-HSS score of 18(iqr 9). The onset to IV needle time was 130 minutes (iqr 111). All patients were treated via endovascular therapy with a median and mean times of IV needle to arterial puncture times of 46 and 49.7 minutes, respectively. Of all treated with IV tPA, 39 patients (60.9%) had the arterial puncture within 60 minutes of the IV bolus time. Endovascular recanalization was achieved in 78.1% resulting in a median 24-hour NIHSS score of 6 (iqr 11). Significant improvement in the 24-hour NIHSS scores (drop of 50% or more from baseline to 24 hours) was noted in 70.3%. CONCLUSION An IV needle to arterial puncture time under 60 minutes was feasible in about 60% of patients treat-ed with IV tPA and endovascular therapy in our cohort. Potential delays of this time interval in ran-domized trials may include the time needed to obtain consent for enrolment into the trial and the time to activate the endovascular team. Future trials should still aim to achieve a fast IV needle to arterial puncture time given the potential for significant clinical improvement when these times are shortened.
Karger_ESC London_2013
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