1 / 20

Abstract No: EP-73  Submission Number: 725

Abstract No: EP-73  Submission Number: 725. The authors declare no conflicts of interest No financial support was taken for this retrospective study. ASNR 2015 Annual Meeting Abstract No: EP-73 Submission Number: 725 Our Clinical and Radiological Experiences

deanna
Download Presentation

Abstract No: EP-73  Submission Number: 725

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abstract No:EP-73  Submission Number:725

  2. The authors declare no conflicts of interest No financialsupportwastakenforthis retrospectivestudy

  3. ASNR 2015 Annual Meeting Abstract No: EP-73 Submission Number: 725 Our Clinical and Radiological Experiences in Diagnosis of Acute Ischemic Stroke with Intra-arterial Thrombolytic Treatment Omer Fatih Nas1, Aylin Bican Demir2, Mustafa Bakar2, OzlemTaskapılıoglu2 , Bahattin Hakyemez1 1Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey  2Department of Neurology, Uludag University Faculty of Medicine, Bursa, Turkey

  4. Purpose • Stroke is the 3rd leading cause of death in our country as well in the world. • Furthermore, it causes labor loss especially within middle-aged patient group because of its morbidity. • We present our experience about 40 patients who had intra-arterial stroke treatment in our clinic.

  5. MaterialsandMethods • WecarriedoutDigitalSubtractionAngiogaphy(DSA) andintraarterialtreatmenttothepatientsadmittedtotheemergencydepartmenthavingstroke, neurologicdeficitsand not havingintracranialhemorrhage on ComputerizedTomography (CT) between 2008 and 2013.

  6. Results • Therewere 27 (67.5%) male and 13 (32.5%) female patients and the average age was63.5 years(23-78). • The National Institutes of Health Stroke Scale (NIHSS) scores were 7–29 (20.5) at the first initial neurological examination.

  7. Results • Therewereinfarcts on magneticresonanceimaging (MRI) examinations in middlecerebralartery (MCA) territory of 35, anteriorcerebralartery (ACA) of 2 andbasilarartery of 3 patients. • Infarctswerepresent in MCA territory of 33 (MCA M1: 6, MCA M2: 11, MCA M3: 6 and MCA total infarcts: 10), internalcarotidartery (ICA) of 2, ACA of 2 andbasilarartery of 3 patients on DSA examinations.

  8. Results • Sixpatientshavedied in thefollow-upperiod, 4 because of intracranialhemorrhageand 2 of sepsis. • The tissue plasminogen activator (tPA) dose applied to the patients was 12 mg (6-20 mg).

  9. Results • TheNIHSS scores after 24 hours were between 7– 24 (6-20 on average). • Statisticallysignificant improvement in the NIHSS scores after the intra-arterial treatment was observed (p ≤ 0,05).

  10. Table 1: Patients' demographic, clinical andradiological features

  11. CT T2 Figure 1: 60-year-old femalepatientwithrightarm 1/5 andleftleg 2/5 palsyand motor aphasy. Normal cranial CT ve MRI findings.

  12. Figure 2: Diffusion MRI imagesindicate acute infarction at the area supplied by left MCA.

  13. CBV CBF MTT Figure 3: Perfusion MRI images: diffusion-perfusion mismatch at the area supplied by MCA.

  14. A B Figure 4: DSA images. An abruptinterruptionand total occlusion at thesuperiordivision of M2 segment of theleft MCA (A). Injection of 10 mg tPAintothesuperiordivision of M2 segmentthrough a microcatheter (B).

  15. A B Figure 5: DSA image. An abruptinterruptionand total occlusion at thesuperiordivision of M2 segment of theleft MCA (A). Control DSA: Complete reopening on the superior division of M2 segment after intra-arterial tPA (B).

  16. PreoperativeCT 1st week 1stmonth Figure 6: 60-year-old femalepatient. CT imagesobtainedbeforeandafterintraarterialtPAapplication.

  17. Conclusions • Intraarterialtreatmentforacuteischemicstroke is an approvedandreadilyappliedmethodrecently. Intraarterialtreatment is especiallyvaluable in ICA andproximal MCA occlusions, becausetrombolyticagent can be easilyinjectedintothetargetedthrombosedsegment.

  18. Conclusions • Whilecompleterecanalisationwasachieved in 30% andpartial in 48% of patientswiththrombolytictherapy, theprocedurewasunsuccessful in 22% of them. Clinicalstatus of patientswithcompleteandpartialrecanalisationgotbetter at 3rdmonth.

  19. Conclusions • With this study, we wanted to share our experience in intraarterial thrombolytic therapy and emphasize the needfor larger series of data in literature.

  20. References 1-Randall T. Higashida Anthony J. Furlan. Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for AcuteIschemicStroke. Stroke.2003;34:109-137. 2- Bentsen L. , Ovesen C. , Christensen A. F. , Christensen H. Does the admission blood pressure associate with short- and long term outcome in stroke patients treated withthrombolysis? A single centre study. Int J Hypertens. 2013 3- İdıcula TT, Waie-Andreassen U, Brogger J, Naess H, Lundstadsyeen MT, Thomassen L. effect of physiologic derangement in patients with  stroke treated with thrombolysis. J StrokeCerebrovasc. Dis. 2008; 17:141-146. 4- Hatcher MA, Starr JA . Role of tissue plasminogen activator in acute ischemic stroke.Ann Pharmacother 2011;45:364-371. 5- Leigh R, Krakauer JW. MRI-guidedselection of patientsfortreatment of acuteischemicstroke. Curr Opin Neurol. 2014;27:425-433.

More Related