1284 Thrombolysis in acute ischemic stroke in patients older than 75 years — the effectiveness and...
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Poster Abstracts Thursday, November 10, 2005 $427 investigate hyperintense cerebral fluid space on fluid-attenuated inversion recovery (FLAIR) images as a MRI reperfusion injury marker in ischemic stroke patients. Method: Twenty four patients tPA treated in a general Hospital that performed MRI in tile acute ischenffc stroke (AIS) were selected: 5 with HT (HT group), 19 without HT (non-HT group). One neuroradio- logist blinded to all clinical information evaluated the FLAIR images for presence of sulcal hyperintensity (SH) on cortex. We create a score (SH score) to quantify the SH based in the extension of tiffs hyperintensity (from zero to 10). The People's Republic of Clffna curve was used to determine tile best cat-off point. We analyze the relationship among the SH, HT and neurological outcome (NIHSS). Results: All patients in HT group showed SH on FLAIR (100%), whereas in the non-HT group 58% showed SH 0P - 0,13). The mean NIHSS score in 3 months was 3,36 ± 4,2 for the HT group and 0,86 ± 1,21 for the non-HT group (p -- 0,087). Tile mean SH score was 4,6 ± 2,9 in HT group and 1,53 ± 2,11 in non-HT group (p -- 0,013). The best cut-off point in the SH score was 3,5 (sensitivity 80% and spedfidty 89%). The negative predictive value of tile SH score was 94%. Conclusion: Detection of SH on FLAIR is usefull in predict tile HT in patients with AIS tPA treated. 1283 Intravenous Thtonlbolysis hi the Acute IsclleiiliC Sllroke - the South of Brazil experience Friedrich, M 1'2 , Ouriques-Martins, SC 1, Brondani, R 1, Araujo, M.D2., Manenti E l, Rech, R l, Jaeger, C l, Silveira, D l, Ruschel K l, Folgierini, M 3, Krutter, D 3, Vedolin, L 3, Ehlers JA 1 . SStro]ce Team, Vascular Unit of the ~Ide de Deus Hospital, Porto Alegre, Brazil," ZStroke Team, Vascular Unit of the Sdo Lucas Hospital, PUC, Porto Alegre, Brazil; 3Neuroradiologist, Vascular Unit of the Bide de Deus Hospital, Porto Alegre, Brazil Background: With the approval of tissue plasminogen activator (rt-PA) for the acute ischemic stroke management, the evolution of this emergency has changed dramatically. Only a few hospitals in our country have an efficient hospital-based method for the evaluation and intervention of the hyperacute stroke patient. We present the two-year implementation of the VU, in 2 hospitals, developed to treat this patients in a short period. We measured the safety, feasibility and effectiveness of treatment. Methods: We studied 101 consecutive patients with ischemic stroke that arrived in the emergency room in tile 2 hospitals. Rt-PA treatment was applied according to the NINDS criteria. Results: 101 patients (112%) were treated with trombolysis. At the end of the hospitalization, 51% recovered with full independent function. The rate of hemorrhage was 4,6%. The mortality rate was 16%. The improvement in tile time-to-approach to the patient was progressive over the course of tile present study because of the regular training and retraining for all the involved personnel. Tile median time from arrival of the patient to neurologist assistance was 20 minutes (time door-to-neurologist), door-to-CT scan 34 minutes and door-to- needle 83 minutes. Conclusions: Fibrinolysis was effectively applied in the routine management of stroke patients in 2 general hospitals. The VU changed the approach of tile stroke patient, with a faster evaluation, diagnosis and start reperfusion treatment with safety. The approach improved with the continuous training. I284 TbXoulbolysis in Acute Ischemie Slxoke in patients older than 75 years - the effectiveness and safety Ouriques-M~rtins, SC l, Brondani, R l, Friedrich, M l, Passos p1, Manenti E l, Rech, R l, Jaeger, C l, Silveira, D l, Folgierini, M a, Krutter, D a, Vedolin, L ~, Ehlers JA 1. 1Stroke Team, Vascular Unit of the Bide de Deus Hospital Porto Alegre, Brazil," 2Neuroradiologist, Vascular Unit of the Bide de Deus Ho@ital, Porto Alegre, Brazil Background: Elderly patients frequently are excluded from thrombo- lyric therapy in acute ischemic stroke (AIS). A higher risk of bleeding is found for older patients, but they do not have increase in the mortality. We compare the use of tissue plasnffnogen activator (rtPA) in patients older and younger than 75 years to evaluate tile effectiveness and safety of the thrombolysis in old patients. Methods: We prospectively studied all consecutive patients with AIS treated with rtPA by the stroke team from December 2002 to December 2004 in the Vascular Unit in the M~e de Deus Hospital. We compare tile patients with < 75 years old with patients >75 years old. Results: Thrombolytic therapy was used in 55 patients with AIS in tiffs period. Patients older than 75 years represented 51% of this group (128 patients). The mean of the inicial NIHSS score was 12,6 ± 8,9 for the older patients and 11,7 ± 7,9 for the younger group. In 3 months, 56<'/0 of the patients in tile older group and 64% in the younger group had no disability (NIH 0-1), p - o 0,35. The intracranial symptomatic hemorrhage rate was 7,4% in the group with <75 years old. No patient older than 75 years had symptomatic, hemorrhage. The mortality rate was 14% in the older group and zero in the younger group (p - 0,11). Conclusions: The neurological outcome for older patients was similar to that found in the younger group. Our data confimt that age is not a valid exclusion criterion for thrombolisys. 1285 Intra-arterial Tl~ombolysis in Acute Ischemic Stroke - the 2 years experience in a Vascular Unit in the South of Brazil Ouriques-Martins, S 1, Brondani, R 1, Passos, pJ, Manenti E 1, Rech, R ~ , Jaeger, C ~, Silveira, D ~, Folgierini, M 2, Krutter, D 2, Vedolin, L 2, Ehlers JA 1. Friedrich, M 1. 1Stroke Team, Vascular Unit of the Mde de Deus Hospital, Porto Alegre, Brazil," 2Neuroradiologist, Vascular Unit of the M~.e de Deus Hospital, Porto Alegre, Brazil," 3Interventiona[ Neuroradiologist, Vascular Unit of the Bide de Deus Hospital, Porto Alegre, Brazil Background: The purpose of this study was to evaluate the safety and effectiveness of catheter-based therapy for acute ischemic stroke (AIS) in the 2 years of the implementation of the Vascular Unit (VU) in the M~e de Deus Hospital. Methods: The AIS patients due to occlusion of middle cerebral artery trunk, internal carotid artery or basilar artery, that arrived in the emergency room with symptoms onset up to 6 hours were treated with endovascular therapy whenever possible. We studied all consecutive patients with AIS treated with catheter-based therapy in the VU from December 2002 to December 2004. The proximal occlusion was diagnosed by computed tomography angiography. Tile neurological outcome was assessed by NIH Stroke Scale score and modified Rankin Score (mRs). Results: Endovascular treatment was used in 14 patients with AIS: 9 rtPA IA, 4 rtPA IV (0,6 mg/kg) followed by rtPA IA (up to 0,3 mg/ kg) and 1 mechanical thrombolysis. Four patients need angioplasty for complete recanalization. The baseline mean NIHSS score was 18 ± 11,4 and in 3 months after treatment was 4,7 ± 4,4. In tiffs time, 36% of the patients had no disability (NIHSS -- 0 or 1) and 43% had functional independence (mRankin 0-2). One patient (17%) had symptomatic hemorrhage with good outcome. The mortality rate was 145'; (12 patients). The mean time from arrival of the patient to IV rtPA was 59 minutes and tile door-to-needle time (IA) was 95 minutes. Conehisions: Catheter-based thrombolysis was safety and effective in patients with severe AIS.
Transcript of 1284 Thrombolysis in acute ischemic stroke in patients older than 75 years — the effectiveness and...
Poster Abstracts Thursday, November 10, 2005 $427
investigate hyperintense cerebral fluid space on fluid-attenuated inversion recovery (FLAIR) images as a MRI reperfusion injury marker in ischemic stroke patients. Method: Twenty four patients tPA treated in a general Hospital that performed MRI in tile acute ischenffc stroke (AIS) were selected: 5 with HT (HT group), 19 without HT (non-HT group). One neuroradio- logist blinded to all clinical information evaluated the FLAIR images for presence of sulcal hyperintensity (SH) on cortex. We create a score (SH score) to quantify the SH based in the extension of tiffs hyperintensity (from zero to 10). The People's Republic of Clffna curve was used to determine tile best cat-off point. We analyze the relationship among the SH, HT and neurological outcome (NIHSS). Results: All patients in HT group showed SH on FLAIR (100%), whereas in the non-HT group 58% showed SH 0P - 0,13). The mean NIHSS score in 3 months was 3,36 ± 4,2 for the HT group and 0,86 ± 1,21 for the non-HT group (p -- 0,087). Tile mean SH score was 4,6 ± 2,9 in HT group and 1,53 ± 2,11 in non-HT group (p -- 0,013). The best cut-off point in the SH score was 3,5 (sensitivity 80% and spedfidty 89%). The negative predictive value of tile SH score was 94%. Conclusion: Detection of SH on FLAIR is usefull in predict tile HT in patients with AIS tPA treated.
1283 Intravenous Thtonlbolysis hi the Acute IsclleiiliC Sllroke - the South of Brazil experience
Friedrich, M 1'2 , Ouriques-Martins, SC 1, Brondani, R 1, Araujo, M.D2., Manenti E l, Rech, R l, Jaeger, C l, Silveira, D l, Ruschel K l, Folgierini, M 3, Krutter, D 3, Vedolin, L 3, Ehlers JA 1 . SStro]ce Team, Vascular Unit of the ~Ide de Deus Hospital, Porto Alegre, Brazil," ZStroke Team, Vascular Unit of the Sdo Lucas Hospital, PUC, Porto Alegre, Brazil; 3Neuroradiologist, Vascular Unit of the Bide de Deus Hospital, Porto Alegre, Brazil
Background: With the approval of tissue plasminogen activator (rt-PA) for the acute ischemic stroke management, the evolution of this emergency has changed dramatically. Only a few hospitals in our country have an efficient hospital-based method for the evaluation and intervention of the hyperacute stroke patient. We present the two-year implementation of the VU, in 2 hospitals, developed to treat this patients in a short period. We measured the safety, feasibility and effectiveness of treatment. Methods: We studied 101 consecutive patients with ischemic stroke that arrived in the emergency room in tile 2 hospitals. Rt-PA treatment was applied according to the NINDS criteria. Results: 101 patients (112%) were treated with trombolysis. At the end of the hospitalization, 51% recovered with full independent function. The rate of hemorrhage was 4,6%. The mortality rate was 16%. The improvement in tile time-to-approach to the patient was progressive over the course of tile present study because of the regular training and retraining for all the involved personnel. Tile median time from arrival of the patient to neurologist assistance was 20 minutes (time door-to-neurologist), door-to-CT scan 34 minutes and door-to- needle 83 minutes. Conclusions: Fibrinolysis was effectively applied in the routine management of stroke patients in 2 general hospitals. The VU changed the approach of tile stroke patient, with a faster evaluation, diagnosis and start reperfusion treatment with safety. The approach improved with the continuous training.
I284 TbXoulbolysis in Acute Ischemie Slxoke in patients older than 75 years - the effectiveness and safety
Ouriques-M~rtins, SC l, Brondani, R l, Friedrich, M l, Passos p1, Manenti E l, Rech, R l, Jaeger, C l, Silveira, D l, Folgierini, M a, Krutter, D a, Vedolin, L ~, Ehlers JA 1. 1Stroke Team, Vascular Unit of the Bide de Deus Hospital Porto Alegre, Brazil," 2Neuroradiologist, Vascular Unit of the Bide de Deus Ho@ital, Porto Alegre, Brazil
Background: Elderly patients frequently are excluded from thrombo- lyric therapy in acute ischemic stroke (AIS). A higher risk of bleeding is found for older patients, but they do not have increase in the mortality. We compare the use of tissue plasnffnogen activator (rtPA) in patients older and younger than 75 years to evaluate tile effectiveness and safety of the thrombolysis in old patients. Methods: We prospectively studied all consecutive patients with AIS treated with rtPA by the stroke team from December 2002 to December 2004 in the Vascular Unit in the M~e de Deus Hospital. We compare tile patients with < 75 years old with patients >75 years old. Results: Thrombolytic therapy was used in 55 patients with AIS in tiffs period. Patients older than 75 years represented 51% of this group (128 patients). The mean of the inicial NIHSS score was 12,6 ± 8,9 for the older patients and 11,7 ± 7,9 for the younger group. In 3 months, 56<'/0 of the patients in tile older group and 64% in the younger group had no disability (NIH 0-1), p - o 0,35. The intracranial symptomatic hemorrhage rate was 7,4% in the group with <75 years old. No patient older than 75 years had symptomatic, hemorrhage. The mortality rate was 14% in the older group and zero in the younger group (p - 0,11). Conclusions: The neurological outcome for older patients was similar to that found in the younger group. Our data confimt that age is not a valid exclusion criterion for thrombolisys.
1285 Intra-arterial Tl~ombolysis in Acute Ischemic Stroke - the 2 years experience in a Vascular Unit in the South of Brazil
Ouriques-Martins, S 1, Brondani, R 1, Passos, pJ, Manenti E 1, Rech, R ~ , Jaeger, C ~, Silveira, D ~, Folgierini, M 2, Krutter, D 2, Vedolin, L 2, Ehlers JA 1. Friedrich, M 1. 1Stroke Team, Vascular Unit o f the Mde de Deus Hospital, Porto Alegre, Brazil," 2Neuroradiologist, Vascular Unit of the M~.e de Deus Hospital, Porto Alegre, Brazil," 3Interventiona[ Neuroradiologist, Vascular Unit of the Bide de Deus Hospital, Porto Alegre, Brazil
Background: The purpose of this study was to evaluate the safety and effectiveness of catheter-based therapy for acute ischemic stroke (AIS) in the 2 years of the implementation of the Vascular Unit (VU) in the M~e de Deus Hospital. Methods: The AIS patients due to occlusion of middle cerebral artery trunk, internal carotid artery or basilar artery, that arrived in the emergency room with symptoms onset up to 6 hours were treated with endovascular therapy whenever possible. We studied all consecutive patients with AIS treated with catheter-based therapy in the VU from December 2002 to December 2004. The proximal occlusion was diagnosed by computed tomography angiography. Tile neurological outcome was assessed by NIH Stroke Scale score and modified Rankin Score (mRs). Results: Endovascular treatment was used in 14 patients with AIS: 9 rtPA IA, 4 rtPA IV (0,6 mg/kg) followed by rtPA IA (up to 0,3 mg/ kg) and 1 mechanical thrombolysis. Four patients need angioplasty for complete recanalization. The baseline mean NIHSS score was 18 ± 11,4 and in 3 months after treatment was 4,7 ± 4,4. In tiffs time, 36% of the patients had no disability (NIHSS -- 0 or 1) and 43% had functional independence (mRankin 0-2). One patient (17%) had symptomatic hemorrhage with good outcome. The mortality rate was 145'; (12 patients). The mean time from arrival of the patient to IV rtPA was 59 minutes and tile door-to-needle time (IA) was 95 minutes. Conehisions: Catheter-based thrombolysis was safety and effective in patients with severe AIS.
