2-07-42 Endovascular treatment of traumatic lesions in supraaortic vessels with stent graft

S84

Cerebrovascular

male. Average age was 83 years. Average hospital stay was 9 days. Reported types of stroke were: ischemic 88%, hemorrhagic 29% and 4.4% had uncertain diagnosis. Of the ischemic strokes, 53.8% were male; the reported varieties of these strokes were: thrombotic 59.3%, embolic 17.8 lacunar disease 4.3%, non specified 18.5%, transient ischemia 2.07%. The hemorrhagic types were: parenchymatous diagnosis 74.2%. subarachnoidal18.Q%, non specified 8.8%. Of those patients with specified (1962: 1380 ischemic, 802 hemorrhagic), relevant past medical history included (total (ischemic/hemonhagic)): arterial hypertension 881 (582/2QQ), tobacco use 853 (485/188), previous cardiovascular disease 440 (378/82), previous cerebrovascular disease 398 (327/71), diabetes mellitus 391 (3Ol/QO). The way to make the diagnosis was: CT scan 1238 (793/445), MRI 419 (329/QO), lumbar puncture 13 (7/8), other (including the clinical diagnosis alone) 191 (121i70). The estimated delay to arrive to a medical center was: ~8 hours, 584 (353/231); 8-12 hours, 312 (207/105588); 12-24 hours, 315 @X/89); ~24 hours, 888 (475I213). In this same group, the categories of complications most frequently reported were neurologic 335 (117/158), pulmonary 157 (113.&I), genitourinary 28 (19/Q), gastrointestinal 13 (Q/4), making a total of (354/234). A surgical treatment was indicated in 175 (39/138) and the mortality in this group was 50 (3/47). There were 340 deaths (17.3% of the total), 171 in the ischemic group, and 189 in the hemorrhagic, being attributed to neurologic cause in 78 (45%) and 134 (79%) respectively. Concluslon: Our data show the first epidemiological information about stroke in Mexico.

12-07-41

Ft. Del Colle, E. De Fanti I, M. Turazzini, P. Battaglia ‘, M. Silvestri, L. Targa’, R. Schiavon ’ Department of Neurology, Legnago Hospital (Verona), /taQ 1 Clinical Chemistry Laboratory; Legnago Hospital (Verona), kaly Paraoxonase (PON) is an enzyme linked to HDL particles. Recently PON was identified as a genetic risk factor for coronary heart disease (CAD) patients. We have investigated whether the 191 polymorphism, linked to high PON activity (B allele), was associated with ischemic stroke. 31 consecutive patients (pts) with history of isolated ischemic stroke were tested for PON activity and some other important risk factors. namely. homocyst(e)ine (HCY), fibrinogen (FBG), lipoprotein (a) [LP(a)], total cholesterol FC), HDL-c, LDL-c, triglyceride (TG), and lipoperoxides (LPO). Results: Stroke patients

Control group

p

pts above

PON (W/l) HCY (pmoVl) FOG (a/l) W4 (94 TC (mmo!II) HDL-c (mmo!fl)

209 (176) 17.5 (14.7) 4.11 * 1.05 0.31 (0.43) 6.06 l 1.09 1.61 zk 0.64 3.70 i 0.99 4.06 * 0.43 1.55 (1.09) 3.99f 1.36

116 (150) 11.6 (3.6) 2.27 + 0.60 0.07 (0.11) 5.16 f 0.94 1.46io.40 3.15 * 0.90 3.15 f 1.45 0.99 (0.7) 4.53f 1.40


64.5% 56.3% 90.3% 51.6%

LDL-c (mmol/I) TiHDLs (mmolll) TO (mmo!A) LPO (fimoffl) median (Q3 -I&).

dl

16.1%

mean f sd; * dl = decisional level

PON activity showed a trimodal curve of distribution (low-AA, intermediate-AB and high-BBallele activity) in both groups; however in stroke group intermediate and high activity peaks prevailed, accounting for an increased median value. HCY, FBG, Lp(a) and TotaVHDL cholesterol levels were significantly elevated in stroke patients compared with the control group. HCY and FBG levels were reciprocally correlated (r = 0.42 p < 0.05), whereas PON was not correlated with any parameters. In conclusion, this preliminary study confirms the association of FBG, HCY, Lp(a) with ischemic stroke and point out to high PON activity as an independent risk factor for ischemic stroke. To our knowledge the latter observation has not been published so far.

I2 07

42

Endovascular treatment of traumatic supraaortic vessels with stent graft

traumatic lesions and dissections of large arteries with a new stent graft device. In 1990 the first clinical case of an aottic aneurysm was performed and reported by Us. Between 1992 and July 1998, 25 patients were encountered with traumatic arterial lesions and these were treated with the stent/graft technique. Sixteen were located in supraaortic vessels. Fourteen of the patients were men and two were women. Their ages ranged from 22 to 87 years. The lesions encountered were 9 post-traumatic arteriovenous fistulas and 7 false aneurysms. These were located in the subclavian artery (Q), axillaiy artery (3), common carotid artery (3), And internal carotid artery (1). The cause of the arterial lesions was penetrating trauma in all but one case. The penetrating trauma was gunshot, stab injury, and iatrogenic. The guiding principle of repair was occlusion of the arterial injury within the arterial lumen. As with evety new procedure, time is needed to define the future role of this new approach in any event, some speculations can be made in regard to the less invasiveness, less pain and disability and finally less cost and recovery time of the et&vascular procedure that compares favorably to the standard surgical approach. Furthermore the endoluminal use of stent graft could be included in the future in the armamentarium of trauma centers both in the civil and military environments to control temporarily or definitively massive bleeding.

2-07-43

Neurologic

H. Sierra, M. DiEgidio, Ramos Mejia Hospital,

1 Serum paraoxonase activity is an independent risk factor for stroke: Comparison with homocystein, fibrinogen and lipoprotein parameters

Parameter

Diseases

lesions in

C.J. Schonholz, J.C. Parodi, P. Lylyk. Department oflnterventional Radiology, Clinica La Sagmda Familia, Buenos Aires, Argentina, Department of Vascular Surgery; lnstituto Cardiovascular de Buenos Aires, Argentina, Department of Endovascular Neurosurgery, ENERI, Clinica MBdica Belgrano Buenos Aires, Argentina Recent vast increase in civilian arterial trauma has taugM that false aneurysms and arteriovenous fistulas in some locations are dangerous to approach and difficult to repair. In supraaortic vessel, access to the traumatized area can be cumbersome and entails some risks of injury of the adjacent structures. In 1978 we started to develop a system to treat endoluminally aneurysms,

behqet disease: A case report

M. Bendersky, J. Bueri. Department Buenos Aires, Argentina

of Neurology;

Behpet disease (B.D.) is an inflammatory disorder of unknown cause distinguished by the triad of relapsing iridocyclitis, recurrent oral and genital ulceration and cutaneous manifestations. The CNS is affected in about 30% of patients with B.D. It’s extremely uncommon in Argentina. Case Report: M.F., a 35 years old woman, had a 3 year history of recurrent oral and genital ulceration, sporadic red eyes and headaches for 1 year. She suffered 2 transient left hemiparesis and ataxia with partial recovering and a progressive cognitive impairment. She had scars of acne vulgaris in her face and torso, a slight left hemiparesis with piramidal signs, a left ataxia and some arcaic reflexes. She was desotiented, her attension scattered, and she had failures in evocation, recognition, abstract thinking and construction. MRI showed multiple confluent lesion hypointense in Tl and hyperintense in T2 in both cerebral hemispheres, basal ganglia brainstem and cerebellum. Four LP were made, all of them showed lymphocytic pleoytosis in a range of 100 and 80 mg% proteins. All cultures and serologies were negative. During her hospitalization, the patient’s left eye became red and she lost visual acuty. The diagnosis of anterior uveitis was made. Treatment with deltisone and clorambucil gave a mild improvement of the symptoms. As far as we know, this is the first case of neurologic B.D. reported in our country

2-07-44

Antiplatelet therapy does not effect on subsequent stroke severity

J. Sivenius’ , L. Cunha’. H.-C. Diener3, C. Forbes4, P. Riekkinen Sr. ‘, P. Smets5, A. Lowenthal 6, for the ESPSP Working Group. ‘Department of Neurology University of Kuopio, Finland, 2 Department of Neurolog)! University of Coimbra, Portugal, 3 Department of Neurolcg)! University of Essen, Germany 4Department of Medicine, Ninewells Hospital and Medical Stool, Dundee, UK, 5Department of Statistics, Free University of Brussels, Belgium, 6 Medical Research, OCMW; Antwerp, Belgium Background: The assessment of the severity of subsequent stroke has not been evaluated in major placebo-controlled studies with antiplatelet therapy in patients with TIA and stroke. ESPSP recruited 8,802 patients in four treatment groups: placebo, 2 x 25 mg acetylsalicylic acid (ASA) 2 x 200 mg dipyridamole (DP) and the combination of 50 mg ASA and 400 mg DP a day. Seventy-six percent of the patients had a stroke as the qualifying event, while 24% had a TIA. All patients were followed 3-monthly for 2 years. ASA + DP prevented stroke significantly better than placebo or either agent alone. Methods and Results: In the ESPSP, the study protocol included assessment of severity of endpoint stroke by recording of the modified Rankin scale once the stroke had clinically stabilized, and no further impairment was obsewed. There were 824 new stroke events during the follow-up. Of them, in 701 patients the initial Rankin scale was known, and also evaluated after each non-fatal recurrent stroke. The difference of Rankin scale between treatment groups was analysed after recurrent stroke. To prevent the effect of a handicap at entry due to a previous stroke and the effect of the treatment on the number of events during follow-up, two transformations were carried out with the raw data set. The data was normalised for the total number of events per treatment group so that the sum of all categories of the Rankin scale was 100%. After this, there was no difference between the treatment groups. Progress in