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Long-term clinical outcome following emergency MR-based reperfusion therapy

Long-term clinical outcome following emergency MR-based reperfusion therapy for acute middle cerebral artery occlusion. Mori T, Nakazaki M, Tajiri H, Iwata T, Uesugi T, Soga N. Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura City, Japan.

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Long-term clinical outcome following emergency MR-based reperfusion therapy

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  1. Long-term clinical outcome following emergency MR-based reperfusion therapy for acute middle cerebral artery occlusion Mori T, Nakazaki M, Tajiri H, Iwata T, Uesugi T, Soga N Department of Stroke Treatment, ShonanKamakura General Hospital Stroke Center, Kamakura City, Japan SNR2010, Bologna

  2. Background and purpose Long-term clinical outcome following emergency MR-based reperfusion therapy for acute ischemic stroke patients remains uncertain. The aim of our retrospective study was to investigate long-term clinical outcome following emergency MR-based reperfusion therapy for acute middle cerebral artery (MCA) occlusion

  3. Patients Included for retrospective analysis were acute stroke patients who were admitted to our institution between Oct 10, 2005 and Sep 10, 2009, who were admitted within 6 hours from stroke onset, who underwent emergency MR study, which showed no visualization of the MCA who presented neurological symptoms of NIHSS score of 5 or more due to acute MCA who underwent emergency reperfusion therapy

  4. Emergency Reperfusion Therapy Intravenous rt-PA was performed in patients within 3 hours of stroke onset. Endovascular treatment was performed in patients where intravenous t-PA was not appropriate to or in whom intravenous rt-PA could not be injected within 3 hours from onset.

  5. Evaluation Baseline features: age, sex, onset-to-arrival time (OTA), onset-to-needle time(OTN), NIHSS score on admission (NIHSS adm), Clinical outcome modified Rankin scale at 3 months Long-term survival

  6. Emergency MR imaging Results

  7. Emergency MR imaging DWI, T2WI, T2*, MRA, PWI DWI PWI MRA

  8. Emergency Endovascular Treatment • Thrombectomy • Intra-arterial thrombolysis • Balloon angioplasty

  9. Features of the 42 patients Age （mean±SE）：　 75.3±1.5years old Sex (man)： 25　（60％） OTA （median）： 0.93hours OTN (median)： 2.75hours NIHSS adm (median)： 12 NIHSS at discharge (median)： 9 Hospitalization period （median）： 9.5days DWI-ASPECT score (median)： 8

  10. Long-term Clinical Outcome of the 42 patients Follow-up duration（median）： 113 days　（3.8 months) Alive：34 pts (81 %) Dead： 8pts (19 %) ｍRS at 3 months 0-2： 14 pts（33.3　％） 3-5： 20 pts（47. 7 ％） 6： 8 pts（19　　％）

  11. p non-standardized regression coefficient 95% CI -3.434 0.170 -8.406 - 1.538 eRT(1，2) 1.329 0.038 0.080 - 2.578 Age 0.041 0.148 -0.015 - 0.096 SEX(0，1) 0.284 0.634 -0.915 - 1.483 NIHSS adm 0.133 0.000 0.075 - 0.191 Af(0，1) -0.488 0.411 -1.678 - 0.702 Multiple linear regression analysis for 3-month mRSin the 42 patients ｍRS=0,1,2,3,4,5,6, emergency Reperfusion Therapy (eRT)：1＝group E, 2=group R, Sex: 0=woman 1=man, adm : admission, Af (atrial fibrillation)：0=no, 1=yes

  12. 76.1% days 1 Y 2 Y Cumulative survival probability (n=42) for any death by Kaplan-Meier method

  13. Coxproportional hazard model for survival Emergency reperfusion therapy (eRT)：1＝group E, 2=group R, adm: admission Sex: 0=woman 1=man , Af;( atrial fibrillation)：0=no, 1=yes

  14. 1 Y group E = 85.23 % (Endovascular) Cox hazard : p=0.044 group R = 68.56 % (Intravenous rt-PA) days Cumulative survival probability (n=42) for any death by Kaplan-Meier method

  15. Differences between group E and R p group E group R n=20 n=22 Age (yrs; average+-SD) 74.9 +- 9.3 75.7 +- 10.6 n.s. Sex (man; %) 16 (80.0%) 9 (40.9%) p<0.05 OAT (hrs: average +- SD) 2.0 +- 0.29 0.86 +- 1.60 p<0.001 NIHSS (median) 13.5 18.5 p=0.11 DWI-ASPECT (median) 8.5 7.5 p=0.28

  16. Conclusion After emergency MR-based reperfusion therapy, long-term survival probability was 76.1%and favorable 3-month clinical outcome was achieved in 33.3% of patients. Young, female patients with lower NIHSS score were alive longer. Patients who underwent endovascular treatment may be alive longer and have better clinical outcome than intravenous rt-PA.

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