Rescue thrombectomy after failure of intravenous thrombolysis in acute ischemic stroke: Preliminary results of a multicenter prospective observational study

Rescue thrombectomy after failure of intravenous thrombolysis in acute ischemic stroke: Preliminary results of a multicenter prospective observational study

Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278 cognitive decline, cerebral haemorrhages and TIA like episodes. Early diagnosis...

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Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278

cognitive decline, cerebral haemorrhages and TIA like episodes. Early diagnosis is important to avoid catastrophic bleeding with antiplatelet or anticoagulant medication. Objective: To demonstrate practical difficulties in diagnosis and management of CAA in patients with vascular risk factors. Patients and methods: We present a case of pathologically proved CAA. Clinical presentation and investigation results are discussed. Results: This gentleman initially presented to psychiatric services with memory problems at the age of 76. Brain MRI showed evidence of small vessel disease. Other vascular risk factors included hypertension, previous smoking and IHD. His medication included aspirin, clopidogrel, citalopram and ramipril. At the age of 79 he had a brief episode of language difficulties lasting for a few hours. One month later he developed a similar but longer episode. CT of the brain showed a right frontal subarachnoid haemorrhage. MRI of the brain 2 days later showed a further left superficial parietotemporal bleeding. Antiplatelets were stopped and the patient made a good recovery. Further fatal intracranial bleeding occurred 2 months later. Pathological examination confirmed CAA. Conclusion: CAA is common in older patients who may have other vascular risk factors. Cognitive impairment and changes on CT or MRI are often attributed to ischemic small vessel disease. This case demonstrates the importance of obtaining specialised MRI sequences in older patients before decisions are made on the use of several antiplatelet agents or oral anticoagulation. doi:10.1016/j.jns.2013.07.949

Abstract — WCN 2013 No: 2524 Topic: 3 — Stroke Rescue thrombectomy after failure of intravenous thrombolysis in acute ischemic stroke: Preliminary results of a multicenter prospective observational study P. Desfontainesa, D. Brisboisb, N. Onclinxa, C. Daouta, O. Cornetb, L. Dieudonnéc, K. Windhausend, A. Maertens de Noordhoudte. a Neurology, C.H.C., Site Saint-Joseph, Liège, Belgium; bInterventional Neuroradiology, C.H.C., Site Saint-Joseph, Liège, Belgium; cNeurology, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgium; dNeurology, Centre Hospitalier Régional de Huy, Huy, Belgium; e University Department of Neurology, CHR de la Citadelle, Liège, Belgium Background: Intravenous (iv) thrombolysis has a poor rate (less than 30%) of recanalisation in proximally occluded mean cerebral artery (MCA). Thrombectomy has been shown to achieve a higher rate of recanalisation, up to 80%. The outcome of stroke patients is closely related to the recanalisation rate. A protocol of thrombectomy is prospectively performed in stroke patients with failure of iv thrombolysis in case of proximal MCA occlusion. Material and methods: All patients admitted within the time window (4.5 h) for iv thrombolysis had an angioscanner to assess the level of occlusion of MCA. In case of no clinical recovery after iv thrombolysis, a thrombectomy was performed under general anaesthesia in case of persisting proximal occlusion. The device used was the Solitaire FR. The mRS and the NIHSS were performed at discharge, 3 and 6 months. A CT scan was performed at 24 h, and an angioMRI at one month. Results: 16 patients underwent the procedure. There were 2 cases of procedural failure. The mean age is 64 +/− 10.5 years. The mean NIHSS at admission is 16 +/− 2. From stroke onset, the mean time of iv thrombolysis is 110 +/− 48 min, the mean time of stent deployment is 297 +/− 60 min. Good outcome (mRS 0 to 2) is 78.5% (11/14). Intracranial haemorrhage occurred in 35.7%. The postprocedure angiography showed 12/14 complete recanalisation (TIMI = 3).

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Conclusions: Our first results show a favourable outcome of stroke patients with failure of iv thrombolysis successfully recanalised by thrombectomy. doi:10.1016/j.jns.2013.07.950

Abstract — WCN 2013 No: 2528 Topic: 3 — Stroke Acute spinal cord infarction: Outcomes of a Portuguese center J. Meirelesa, A. Costab, A. Monteirob, P. Abreub. aNeurology, Hospital de São João, Porto, Portugal; bCentro Hospitalar de São João, Porto, Portugal Introduction: Acute spinal cord infarction syndrome (ASCIS) is responsible for 5–8% of all acute myelopathies. Main causes include aortic pathology, atherosclerosis and infection. Current knowledge of long-term outcome is limited, but seems to be worst for patients with severe deficits and/or no initial improvement. Objective: To examine clinical features and assess motor and functional outcome of patients with ASCIS. Patients and methods: Retrospective analysis of 104 consecutive patients with spinal cord lesions (from 1989 to 2013). Ten patients presenting with ASCIS were included. Data concerning demographic and clinical variables were analyzed. Neurological syndrome was defined and initial and long term outcomes were assessed using the American Spinal Injury Association (ASIA) motor score and the Modified Rankin Scale (mRS). Results: Five women and five men were included (mean age 56.3 years). In 60% of patients the first symptom was motor deficit. Possible causes were atherosclerosis (n = 4), hypoperfusion (n = 1), degenerative spine disease (n = 3) and cryptogenic (n = 2). Mean ASIA motor score was 71.0 ± 15.23 at onset and 75.3 ± 17.4 24 h after admission. Median mRS was significantly worse at discharge (median 4, range 1–4) when compared to admission (median 0, range 0–2) (p = 0.010), but there was no change at one year followup (median 3, range 1–4) when compared to discharge (p = 0.18). Worst ASIA scores 24 h after admission correlated with worst mRS at discharge (p b 0.05). Conclusion: In this series motor outcome was fundamentally related to the severity of the neurological deficits at presentation. Nevertheless, the majority of patients regained ambulatory capacity. doi:10.1016/j.jns.2013.07.951

Abstract — WCN 2013 No: 2550 Topic: 3 — Stroke Beyond DWI — Emerging candidate MRI biomarkers associated with risk of early stroke after TIA L. Akijiana, F. Cartyb, J. Thorntonc, R. Grechc, E. Kavanaghb, Á. Merwicka, D. Ní Chróinína, N. Hannona, Ó. Sheehana, M. Marnanea, E.L. Callalya, E.M. Fallona, G. Horgana, T. Lynchd, K. O'Rourked, J. Duggane, L. Kynee, S. Murphye, E. Dolane, D. Williamsf, P.J. Kellya. aNeurovascular Unit for Applied Translational Research and Therapeutics, Dublin, Ireland; bNeuroradiology, The Mater Misericordiae University Hospital, Dublin, Ireland; cNeuroradiology, Beaumont Hospital, Dublin, Ireland; dNeurology and Stroke, Dublin, Ireland; eMedicine for Elderly and Stroke, The Mater Misericordiae University Hospital, Dublin, Ireland; fMedicine for Elderly and Stroke, Beaumont Hospital, Dublin, Ireland Background: Early recurrent stroke is a major cause of disability after TIA. The presence of acute DWI hyperintensity after TIA