22. European Stroke Conference 953 Interventional neurology Is Near infrared spectroscopy a useful monitoring tool in patients undergoing recanalization for acute stroke? C. Hametner1, M. Gondan2, P. Stanarcevic3, S. Stampfl4, S. Rohde5, J. Boesel6 Heidelberg University - Department of Neurology, Heidelberg, GERMANY1, Heidelberg Uni-versity - Department of Medical Biometry, Heidelberg, GERMANY2, Clinical Center of Serbia - Department of Neurology, Belgrade, SERBIA3, Heidelberg University – Department of Neurora-diology, Heidelberg, GERMANY4, Heidelberg University – Department of Neuroradiology, Heidel-berg, GERMANY5, Heidelberg University - Department of Neurology, Heidelberg, GERMANY6 Background: Endovascular recanalization (ER) procedures are an uprising treatment method for acute ischemic stroke, usually performed under general anesthesia, thus limiting clinical evaluation. Near infrared spectroscopy (NIRS) has recently been suggested to correlate with regional cerebral blood flow and oxygenation. The aim of this pilot study is to investigate whether NIRS is a useful non-invasive de-vice to reflect changes in microcirculation and guide management during ER. Methods: Prospective analysis of patients with acute ischemic stroke anterior circulations stroke of the medi-an cerebral artery designated for ER between 08/2009 and 07/2012. The NIRS device INVOS 5100 device (Somanetics Corp, Detroit, MI) was attached by frontal optodes before or at the start of ER unitil at least 6h thereafter. Blood pressure, SpO2, heart rate and ECG were measured automatical-ly by a monitoring system (Draeger Medical Systems, Infinity Delta). Time points of pre-defined events (i.e. (1) intubation, (2) begin angiography, (3) restorationof blood flow, (4) recanalization (TICI), (5) extubation) were assessed and correlated with NIRS values. Deviations of circulation and respiration parameters were also correlated with the NIRS-rSO2 signal. NIRS dynamics and cumulative were correlated with clinical parameters as length of mechanical ventilation, intensive care/stroke unit length of stay and clinical status at discharge. Descriptive and explorative statistics were applied using SPSS. Results and conclusion: Of 63 patients included in this study 43 (68%) had sufficient NIRS data quality and were eligible for analysis. Median population age was 73 (interquartile range 25%: 65; 75%: 79). NIHSS at admis-sion was 19 (15;20) in median. Total NIRS recording time was 894.5 hours, mean recording time was 20.8 hours per patient. Final results of the NIRS analysis including event correlation, vital func-tion correlation, outcome correlation will be presented at the conference. 850 © 2013 S. Karger AG, Basel Scientific Programme 954 Interventional neurology Endovascular Treatment of a Patient with Tandem Occlusion of CCA and MCA after Bladder Surgery M.H. Sorgun1, A. Arat2, C. Togay Işıkay3 Ankara University Faculty of Medicine Department of Neurology, Ankara, TURKEY1, Ankara University Faculty of Medicine Department of Radiology, Ankara, TURKEY2, Ankara University Faculty of Medicine Departments of Neurology, Ankara, TURKEY3 Background: Treatment of acute ischemic stroke due to common carotid artery (CCA) occlusion is not well-de-fined. We report a case of acute ischemic stroke with thromboembolism of the anterior and middle cerebral arteries due to proximal CCA occlusion after bladder surgery. Case Report: A 53-year-old man was admitted with a sudden onset of right sided weakness and aphasia two hours after he was operated for the bladder cancer. He had chronic hypertension for five years in the med-ical history. On admission to the stroke unit his blood pressure was 180/100 mmHg. Otherwise, his physical examination was unremarkable. Neurological examination revealed sensorimotor aphasia, right sided hemiplegia and Babinski sign. The National Institute of Health Stroke Scale (NIHSS) score was 15 and modified Rankin Scale (mRS) score was 5. Routine laboratory tests and elec-trocardiography were normal. The cranial computerized tomography (CT) was unremarkable and ASPECT score was 10. Diffusion-weighted imaging (DWI) showed acute ischemic lesions in the frontal and parietal lobes. CT angiography (CTA) displayed occlusion of the left middle and anterior cerebral arteries and CCA in the origine. The cerebral digital substraction angiography (DSA) was compatible with CTA. Mechanical thrombectomy with Solitaire stent for intracranial occlusion and then ballon angioplasty for CCA occlusion were performed without any complications. Recanaliza-tion of the left middle and anterior cerebral arteries and 20% stenosis of CCA was documented by control CTA. The patient had a NIHSS score of 6 and mRS score of 3 on discharge. Thrombolytic treatment and stent implantation were not applied in this patient because antithrombotic agents were not eligible after bladder surgery. Conclusion: Mechanichal thrombectomy of the distal intracranial artery followed by angioplasty of the proxymal artery in the early period of acute ischemic stroke seems to be most effective treatment in the pa-tients with tandem occlusion who underwent an operation recently or not eligible for thrombolytic/ antithrombotic therapy for other reasons.
Karger_ESC London_2013
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