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Endovascular treatment for acute basilar artery occlusion
POSTER SESSION
910
to increase. We examined thrombectomy outcomes in elderly patients treated for AIS. 【Materials & methods】Of the 32 patients who received a thrombectomy since 1 July 2014, eight patients (25%) were older than 80 years. We retrospectively analyzed the eight patients who received thrombectomy for AIS. 【Results】All patients received a cardioembolic stroke diagnosis. The average National Institutes of Health Stroke Scale score was 17.1 points and the ASPECT score was 8.8 points. One patient had an internal carotid artery occlusion, six patients had a middle cerebral artery occlusion, and one patient had an anterior cerebral artery occlusion. Five patients used retrievable stents and a Penumbra 5MAX ACE, while the Penumbra system was used in one patient and intra-arterial thrombolytic agents were used in another patient. Reperfusion (TICI score 2b or 3) was achieved in four patients (50%). The average time from onset to recanalization was 314.8 minutes, while the average time to ICA catheterization was 63.3 minutes due to tortuous vessels. The modified Rankin Scale score of patients was more than four points at discharge (not available for one patient) due to embolization to a new territory and hemorrhagic complications. 【Conclusion】Endovascular recanalization therapy is often slow to perform in elderly patients and is associated with inferior outcomes. It is important to choose a device that shortens recanalization time and reduces the complications of endovascular recanalization therapy.
P4-7 Endovascular treatment for acute basilar artery occlusion Eisaku Sadakata
Department of Neurosurgery, Nagasaki
University Hospital, Japan.
Nobutaka Horie, Yoichi Morofuji, Tsuyoshi Izumo, and Takayuki Matuso Department of Neurosurgery, Nagasaki University Hospital, Japan
【Introduction】Acute basilar artery occlusion (ABAO) is associated with high mortality rate and poor outcome in patients treated conservatively. We treated patients with ABAO with aggressive reperfusion therapy in combination with several endovascular modalities. 【Method】We retrospectively identified 24 patients with ABAO who underwent endovascular treatment in our institution. We analyzed baseline characteristics, endovascular modalities, successful recanalization rate (Thrombolysis in Cerebral Infarction grade), and clinical outcome (modified Rankin scale). 【Result】The mean prethrombectomy National Institute of Health Stroke Scale (NIHSS) score was 18.5. Thirteen patients (54%) were cardiogenic embolism, five patients (21%) were atherosclerotic stenosis. Recanalization was
successful (TICI grade 2b-3) in 13 patients (54.2%). Favorable outcome (mRS 0-3) after 90 days were 11 cases (45.8%). 【Conclusion】Although the efficiency of endovascular reperfusion therapy in the anterior circulation is shown, it is considered to be equally effective in the posterior circulation. Aggressive endovascular reperfusion therapy may be beneficial for patients with ABAO and can clinical outcome.
P5-1 Prehospital medicine reduce the door to needle time for iv t-PA Kensuke Fujita
Department of Emergency Medicine, Hachinohe
City Hospital, Japan.
Shinichiro Osawa,1 Kensuke Kimura,2,3 Toshimi Okushima,2 Tsuyoshi Kawamura,1 Tatsuya Nodagasira,3 and Akihide Kon3 1
Department of Neurosurgery, Hachinohe City Hospital, Japan; Department of Neurology, Hachinohe City Hospital, Japan 3 Department of Emergency Medicine, Hachinohe City Hospital, Japan 2
【Background and Purpose】For the better outcome of ischemic stroke patients various approaches were discussed to shorten the door to needle time (DTNT) for iv t-PA, but few studies reported the effectiveness of prehospital medicine (PM, which includes Helicopter emergency medical service and Rapid Response Car). In our hospital we introduced HEMS in 2008 and RRC in 2009 but clinical outcomes or DTNT was not improved. In 2015 We renovate the clinical protocol for ischemic stroke in all sections (emergency department, PM, radiological department and cross-sectional doctor team). Here we show the clinical outcome of ischemic stroke treated by iv t-PA before and after the introduction of protocol 2015. 【Subjects and Methods】We compared DTNT time before & after the introduction of the new protocol 2015. For all patients treated by iv t-PA between April 2014 to March 2016, we analyzed clinical characters, DTNT and outcome. 【Result】DTNT for iv t-PA was significantly shorter in the patients treated by new protocol than before (88.0 ± 5.8 min vs 30.0 ± 2.8 min, P < .001). In addition, DTNT with PM was significantly shorter than without PM (42.0 ± 5.9 min vs. 66.3 ± 9.0 min, P = .03). 【Conclusion】Cross-sectional involvement was needed to optimize the clinical results in acute ischemic stroke patients. Under such condition, PM could contribute to reduce the DTNT.
P5-2 The effect of statin use in acute ischemic stroke patients treated with thrombolytic therapy Jong-Moo Park
Neurology, Eulji University, Republic of Korea.
910
to increase. We examined thrombectomy outcomes in elderly patients treated for AIS. 【Materials & methods】Of the 32 patients who received a thrombectomy since 1 July 2014, eight patients (25%) were older than 80 years. We retrospectively analyzed the eight patients who received thrombectomy for AIS. 【Results】All patients received a cardioembolic stroke diagnosis. The average National Institutes of Health Stroke Scale score was 17.1 points and the ASPECT score was 8.8 points. One patient had an internal carotid artery occlusion, six patients had a middle cerebral artery occlusion, and one patient had an anterior cerebral artery occlusion. Five patients used retrievable stents and a Penumbra 5MAX ACE, while the Penumbra system was used in one patient and intra-arterial thrombolytic agents were used in another patient. Reperfusion (TICI score 2b or 3) was achieved in four patients (50%). The average time from onset to recanalization was 314.8 minutes, while the average time to ICA catheterization was 63.3 minutes due to tortuous vessels. The modified Rankin Scale score of patients was more than four points at discharge (not available for one patient) due to embolization to a new territory and hemorrhagic complications. 【Conclusion】Endovascular recanalization therapy is often slow to perform in elderly patients and is associated with inferior outcomes. It is important to choose a device that shortens recanalization time and reduces the complications of endovascular recanalization therapy.
P4-7 Endovascular treatment for acute basilar artery occlusion Eisaku Sadakata
Department of Neurosurgery, Nagasaki
University Hospital, Japan.
Nobutaka Horie, Yoichi Morofuji, Tsuyoshi Izumo, and Takayuki Matuso Department of Neurosurgery, Nagasaki University Hospital, Japan
【Introduction】Acute basilar artery occlusion (ABAO) is associated with high mortality rate and poor outcome in patients treated conservatively. We treated patients with ABAO with aggressive reperfusion therapy in combination with several endovascular modalities. 【Method】We retrospectively identified 24 patients with ABAO who underwent endovascular treatment in our institution. We analyzed baseline characteristics, endovascular modalities, successful recanalization rate (Thrombolysis in Cerebral Infarction grade), and clinical outcome (modified Rankin scale). 【Result】The mean prethrombectomy National Institute of Health Stroke Scale (NIHSS) score was 18.5. Thirteen patients (54%) were cardiogenic embolism, five patients (21%) were atherosclerotic stenosis. Recanalization was
successful (TICI grade 2b-3) in 13 patients (54.2%). Favorable outcome (mRS 0-3) after 90 days were 11 cases (45.8%). 【Conclusion】Although the efficiency of endovascular reperfusion therapy in the anterior circulation is shown, it is considered to be equally effective in the posterior circulation. Aggressive endovascular reperfusion therapy may be beneficial for patients with ABAO and can clinical outcome.
P5-1 Prehospital medicine reduce the door to needle time for iv t-PA Kensuke Fujita
Department of Emergency Medicine, Hachinohe
City Hospital, Japan.
Shinichiro Osawa,1 Kensuke Kimura,2,3 Toshimi Okushima,2 Tsuyoshi Kawamura,1 Tatsuya Nodagasira,3 and Akihide Kon3 1
Department of Neurosurgery, Hachinohe City Hospital, Japan; Department of Neurology, Hachinohe City Hospital, Japan 3 Department of Emergency Medicine, Hachinohe City Hospital, Japan 2
【Background and Purpose】For the better outcome of ischemic stroke patients various approaches were discussed to shorten the door to needle time (DTNT) for iv t-PA, but few studies reported the effectiveness of prehospital medicine (PM, which includes Helicopter emergency medical service and Rapid Response Car). In our hospital we introduced HEMS in 2008 and RRC in 2009 but clinical outcomes or DTNT was not improved. In 2015 We renovate the clinical protocol for ischemic stroke in all sections (emergency department, PM, radiological department and cross-sectional doctor team). Here we show the clinical outcome of ischemic stroke treated by iv t-PA before and after the introduction of protocol 2015. 【Subjects and Methods】We compared DTNT time before & after the introduction of the new protocol 2015. For all patients treated by iv t-PA between April 2014 to March 2016, we analyzed clinical characters, DTNT and outcome. 【Result】DTNT for iv t-PA was significantly shorter in the patients treated by new protocol than before (88.0 ± 5.8 min vs 30.0 ± 2.8 min, P < .001). In addition, DTNT with PM was significantly shorter than without PM (42.0 ± 5.9 min vs. 66.3 ± 9.0 min, P = .03). 【Conclusion】Cross-sectional involvement was needed to optimize the clinical results in acute ischemic stroke patients. Under such condition, PM could contribute to reduce the DTNT.
P5-2 The effect of statin use in acute ischemic stroke patients treated with thrombolytic therapy Jong-Moo Park
Neurology, Eulji University, Republic of Korea.