XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
Poster Session: Prognostic predictors
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Renal dysfunction in acute stroke: an independent predictor of long term all combined vascular events and overall mortality
G. Tsagalis
T. Akrivos
S. Skalidi
E. Manios
K. Xynos
A. Laggouranis
K. Vemmos
Alexandra Hospital
GREECE
Background: Limited data exists regarding serum creatinin levels after acute stroke and its prognostic significance on early and late outcome. The aim of this study was to assess renal function status in patients with acute stroke and investigate any prognostic significance on the outcome. Methods: A consecutive series of 1356 first-ever stroke patients were followed up for a 10-year period. Creatinin levels were measured upon admission. Patients were divided into 3 groups on the basis of the estimated Glomerular Filtration Rate (eGFR), that was calculated from the modified equation of the Modification Diet for Renal Disease in ml/min/1.73m2: group-a eGFR>90 of body surface area (BSA), group-b 90≥eGFR≥60 of BSA and group-c eGFR<60 of BSA. Statistical analyses were performed by means of Cox’s regression and Kaplan-Meier curves. Results: Our study population consisted of 823 men and 527 women with a mean age of 71.4±11.3. After adjustment for basic demographic, stroke risk factors and stroke severity on admission, eGFR was an independent predictor for stroke mortality at 10 years. Patients in group-b and group-c had a Hazard Ratio of 1.51 (95%CI 1.14-2.0, p=0.004) and 2.17 (95%CI 1.60-2.83, p<0.001) respectively, compared to patients of group-a. The probability of 10 year survival was significantly different among groups (long rank test 93.2, p=0.001): in group-a patients was 46.0 (95%CI 36.2-55.2), in group-b 33.5 (95%CI 27.2-39.8) and in group-c 15.4 (95%CI 9.9-20.9). During the 10- year period 371 vascular events occurred. The probability to be alive free of vascular events was also significantly different among the 3 groups (long rank test 27.9, p=0.001): in group-a patients was 55.4 (95%CI 45.2-65.6), in group-b 39.1 (95%CI 30.5-47.7) and in group-c 29.8 (95%CI 20.8-38.8). Conclusion: Renal function on admission to the hospital is an independent prognostic factor for stroke mortality over a 10-year period. Patients with renal dysfunction experienced more combined vascular events during the same period.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
A multiparameter panel method for outcome prediction following aneurysmal subarachoid hemorrhage.
N. Turck
L. Vutskis
P. Sanchez-Pena
X. Robin
A. Hainard
M. Gex-Fabry
C. Fouda
M. Mueller
L. Puybasset
J.C.Sanchez
Department of Structural Biology and Bioinformatics
Medical and University center
Ch-1211 Geneva, Switzerland
SWITZERLAND
Background: Accurate early prediction of long-term neurological outcome following aneurysmal subarachnoid hemorrhage (aSAH) remains imprecise. Using a combination of clinical scores together with recently identified stroke-related biomarkers (H-FABP, NDKA, UFD1, PARK7, S100ß), the aim of this study was to develop a multiparameter diagnostic panel to facilitate early outcome prediction following aSAH. Methods: A series of 112 consecutive patients (41 men and 71 women; age 50.5 ± 13.9 years) admitted within 48 hours following aSAH onset and treated by surgical clipping or coiling within 2 days after admission were included. The World Federation of Neurological Surgeons (WFNS) and Fisher scores at admission and the Glasgow Outcome Score (GOS) at 6 months were evaluated. Initial (i.e. at hospital admission) blood concentrations of H-FABP, NDKA, UFD1, PARK7, Troponin I and S100ß were determined using enzyme-linked immunosorbent assay (ELISA). Results: Individually, WFNS and H-FABP were the best predictors of unfavourable outcome (GOS 1-3) with a specificity of 94 and 92% and a sensitivity of 45 and 42%, accordingly. Multivariate analysis defined a panel characterized by WFNS (score at > 2), H-FABP (5.88 µg/L), S100β (0.51 µg/L), Troponin I (0.315 µg/L), NDKA (11.08 µg/L), UFD-1 (271.5 µg/L) where at least 3 out 6 parameters should be above the cut-off value to predict unfavourable outcome. The panel specificity and sensitivity were 100% and 70% and univariate logistic regression indicated that patient with a positive panel presented about 6 more risks to have poor outcome at 6 months. Conclusions: The use of a multiparameter panel in conjunction with clinical status and computed tomography at the admission may focus attention on patients at risk of poor outcome after aSAH.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
High frequency of magnetic resonance perfusion-weighted imaging abnormalities in lacunar infarcts and relationship to clinical outcome
A.Y.Poppe
S.B.Coutts
J.C.Kosior
M.D.Hill
C.M.O'Reilly
A.M.Demchuk
For the VISION 1 and 2 Study Groups
Calgary Stroke Program, Foothills Medical Centre, University of Calgary
CANADA
Background: Lacunes can be associated with early clinical deterioration known as “capsular warning syndrome”. Imaging techniques to predict this deterioration are needed. Perfusion-weighted imaging (PWI) may hold promise, but few studies have evaluated MR perfusion in lacunes.We sought to determine the frequency MRI PWI abnormalities in lacunes and whether such findings predicted early clinical deterioration, final infarct lesion size and functional outcome at 90 days. Methods: Patients with ischemic stroke or TIA were enrolled into a prospective MR imaging study. MRI was performed within 24 hours of the event and follow-up imaging at 30 or 90 days. Imaging for patients with a TOAST classification of small-vessel disease was reviewed to identify lesions meeting lacunar criteria (solitary, subcortical lesions,20mm greatest diameter). Multiple perfusion parameters (MTT, Tmax, TTP, CBF, CBV) were qualitatively assessed and infarct volumes measured. Early clinical deterioration (NIHSS worsening of 2 points within 3 days of event) and 90-day modified Rankin Scale score (mRS) were recorded. Results: Of 517 enrolled patients, 36 met radiological lacunar criteria (7%). Fourteen patients were excluded due to inadequate perfusion studies. Of the remaining 22 patients, 15 (68.2%) had abnormal PWI (1 abnormal perfusion parameter) at the site of the DWI lesion. MTT was the most common abnormal PWI parameter (13 patients) and CBV the least common (3 patients). Five patients (22.7%) experienced early clinical deterioration: 4 of 15 patients (26.7%) with abnormal PWI and 1 of 7 patients (14.3%) with normal PWI (p = NS). PWI abnormalities were not associated with a worse 90-day NIHSS or mRS score, nor did they predict infarct volume growth. Discussion: Magnetic resonance PWI abnormalities are seen in two-thirds of lacunar infarcts. MTT is the most sensitive parameter of PWI abnormality in lacunes but abnormal perfusion does not appear to be predictive of clinical deterioration, infarct growth or 90-day functional outcome.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Transcranial Doppler ultrasonography predicts cardiovascular events after TIA
K. Holzer
L. Esposito
A. Bockelbrink
B. Hemmer
H. Poppert
Technical University of Munich, Klinikum rechts der Isar
GERMANY
Background: Transient ischemic attack (TIA) patients are at high risk of further vascular events. Besides clinical characteristics, evidence of acute cerebral ischemia and large-artery disease have been reported to be associated with an increased stroke risk after TIA. We assessed the value of extracranial (ECD) and transcranial (TCD) Doppler and duplex ultrasonography on the cerebrovascular and cardiovascular prognosis after TIA. Methods: Clinical data, diffusion-weighted imaging, and ultrasonographic findings were collected in 176 consecutive TIA patients admitted to the Stroke Unit. At a mean follow-up of 31 months, new cerebral ischemic and other vascular events were recorded. Results: ECD revealed extracranial stenoocclusive disease in 34 (19.3%) patients, whereas TCD showed intracranial stenoocclusive disease in 14 (8.6%) and reactive collateral blood flow in 6 (3.7%) cases. 22 (13.8%) patients experienced an ischemic stroke (IS) or TIA, 5 (3.1%) a myocardial infarction (MI) or acute coronary syndrome (ACS), and 5 (3.1%) underwent coronary or peripheral artery revascularization. Multivariate analysis identified pathological ECD and TCD findings as predictors of new cerebral ischemic events (ECD: hazard ratio (HR) 4.30, 95% confidence interval (CI) 1.75-10.57, p=0.01; TCD: HR 4.73, 95% CI 1.86-12.04, p=0.01). Abnormal TCD findings additionally were a predictor of new cardiovascular ischemic events including revascularization procedures (HR 18.51, 95% CI 3.49-98.24, p=0.001). Discussion: TIA patients with pathological TCD findings are not only at high risk of further cerebral ischemic events but also cardiovascular disease. Therefore routine screening tests for coronary artery disease and aggressive prevention therapies should be considered in these patients.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Peripheral Artery Disease is an Independent Predictor of 6-month Mortality and Subsequent Vascular Events in Patients with Acute Ischemic Stroke
D.H.Kim
J. Kim
S.R.Kim
S.M.Jun
Chungnam National University Hospital;Donggang General Hospital;Bong Seng Memorial Hospital
SOUTH KOREA
Background and objectives: The ability to stratify stroke patients based on their risk of future cardiovascular events should allow for more effective treatment. Low ankle-brachial index (ABI) is known to be a simple measure for assessing subclinical peripheral artery disease (PAD ) as well as a marker for other cardiovascular events. However, little is known about the relationship between PAD and prognosis after cerebral infarction. Our objective was to evaluate the influence of PAD on early mortality and non-fatal vascular events in patients with first-ever ischemic stroke. Methods: Of first-ever ischemic stroke patients who were admitted within 7 days of stroke onset between April 2006 and March 2007, 203 patients who survived for at least 14 days after stroke were enrolled in the present study. We collected demographic, clinical, and laboratory data on all patients. We measured a resting ABI in order to detect PAD (defined as ABI score < 0.9 in any leg). We assessed all cause mortality, non-fatal stroke, and non-fatal IHD within six months after cerebral infarction. Results: Twenty four patients (11.8%) had PAD, 32 patients (15.8%) had coronary heart disease, and seven patients (3.4%) had both. The rate of 6-month mortality and non-fatal vascular events was 10.3%. Univariate analysis revealed that high HbA1C (p=0.04), low Apo(a)/Apo(b) (p=0.03), PAD (p<0.001), high fibrinogen (p=0.019), and initial high NIHSS score (p=0.001) were significantly associated with the primary outcome. Multivariate regression analysis after adjustment for confounders showed that NIHSS score at admission (OR, 1.12; 95%; 1.00-1.2) and PAD (OR, 4.27; 95%; 1.2-15.1) were independent predictors of 6-month mortality and subsequent vascular events. Conclusions: Our findings indicate that PAD evaluated by ABI is an independent risk factor of early mortality and subsequent vascular events in patients with first-ever ischemic stroke. Therefore, ischemic stroke patients with disseminated atherosclerotic disease require aggressive therapy.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
External validation of the stroke thrombolytic predictive instrument in daily clinical practice
M. Uyttenboogaart
R.E.Stewart
P.C. Vroomen
G.J.Luijckx
J. De Keyser
University Medical Center Groningen
THE NETHERLANDS
Background – The stroke thrombolytic predictive instrument (s-TPI) has been developed to predict outcome after intravenous treatment with recombinant tissue plasminogen activator (rtPA) for acute ischaemic stroke. The aim of this study was to assess the external validity of the s- TPI for the prediction of outcome of rtPA treatment in daily practice. Methods – From a prospectively generated database comprising 301 consecutive stroke patients treated with intravenous rtPA, we calculated probabilities of good outcome (modified Rankin scale (mRS) 0-1) and very poor outcome (mRS 5-6) by using the s-TPI. We compared these probabilities with the observed outcome using receiver-operator characteristics (ROC) curves and calibration curves. We also performed subgroup analyses for different onset to treatment time windows. Results – According to the s-TPI, the mean predicted probability of a good and a very poor outcome in the validation cohort were 0.45 and 0.17, respectively. The area under the ROC curves were 0.80 (4.5 hour time window), 0.82 (3 hour time window) and 0.77 (3-4.5 hours time window) for predicting good outcome, and 0.78 (4.5 hours), 0.80 (3 hours) and 0.74 (3-4.5 hours) for predicting very poor outcome. Calibration curves revealed a slight overestimation of probabilities of a good outcome and underestimation of probabilities of a very poor outcome. Conclusions – The s-TPI appears to be reasonably valid for predicting outcome after rtPA treatment in daily practice. The slight overestimation of a good and underestimation of a very poor outcome may be explained by population differences between the derivation and validation cohort.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Intracranial large artery disease is an independent risk factor for 6-month vascular outcomes among ethnic South Asian ischemic stroke patients
D.A.De Silva
F.P.Woon
M.P.Lee
C. Chen
H.M.Chang
M.C.Wong
National Neuroscience Institute, Singapore
Singapore General Hospital campus
SINGAPORE
Background and Purpose Intracranial large artery disease (ICLAD) is common among ethnic South Asian ischemic stroke patients. Among ethnic Chinese, ICLAD carries a poor prognosis, but there is no such data for ethnic South Asians. We studied the impact of ICLAD on 6-month outcomes among ethnic South Asians ischemic stroke patients. Methods We prospectively recruited consecutive ethnic South Asian ischemic stroke patients admitted to a tertiary teaching hospital in Singapore. ICLAD was assessed by transcranial color-coded Doppler or magnetic resonance angiography. Outcomes at 6 months, including recurrent stroke, transient ischemic attack, myocardial infarction and mortality were ascertained via telephone assessment, blinded to ICLAD status. Results Among the 240 patients recruited into the study, 216 had adequate assessment of intracranial large arteries, of which 94% (202) had outcome at 6 months ascertained. Baseline characteristics of the 202 patients were median age of 64 years, 70% male, 80% hypertensive, 62% diabetic, 35% smokers, 5% had atrial fibrillation and 39% coronary artery disease (CAD). The stroke subtype distribution was 27% large vessel stroke, 11% cardioembolic stroke, 39% small vessel stroke, 3% due other etiology and 10% undetermined etiology. The prevalence of ICLAD was 52%. At 6 months, the incidence of vascular events or mortality was 8% (9 vascular events, 7 deaths). At 6 months, the incidence of vascular outcomes was higher among patients with ICLAD (12%) than those without (3%) (p=0.018). Male gender (p=0.043) and CAD (p=0.001) were also associated with outcomes at 6 months. There were no associations between 6-month outcome with age, hypertension, diabetes, atrial fibrillation, smoking and stroke subtype. Using binary regression, ICLAD was significantly associated with outcome at 6 months (p=0.045), independent of gender and CAD status. Conclusions ICLAD is an independent predictor of subsequent vascular events or mortality within 6 months of acute ischemic stroke among ethnic South Asians.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Cognitive impairment predicts for recurrent vascular events and dependency in non-demented Singaporean ischemic stroke patients
K. Narasimhalu
S. Ang
M.C.Wong
H.M.Chang
C. Chen
National Neuroscience Institute (Singapore General Hospital Campus)
SINGAPORE
Background: Previous studies have examined the prognostic effect of dementia following a first ever stroke. There have been few studies and none in Asians evaluating the effect of cognitive impairment no dementia (CIND) on recurrent vascular events and dependency after a stroke. Methods: Consenting patients underwent a baseline neuropsychological assessment between 3-4 months after index stroke, and were followed up annually for up to 5 years. Cox proportional regression was performed to determine hazards ratios (HR) for the outcomes of recurrent vascular events or dependency at final follow-up visit as measured by the modified Rankin Scale (mRS). Results: 419 non-demented patients were followed up for a mean of 3.2 years. Patients with cognitive impairment were older, male, less educated, and had more severe strokes. After multiple regression analysis, cognitive impairment (HR 1.94, CI 1.02-3.58) was the sole independent predictor of recurrent vascular events while cognitive impairment (HR 3.18, CI 1.48-6.80), diabetes (HR 2.29, CI 1.34-3.92), and age (HR 1.05, CI 1.02-1.08) were independent predictors of dependency as defined by a mRS score of 3-5. Conclusions: Cognitive impairment is a strong independent predictor of recurrent vascular events after stroke in non-demented patients. Moreover, cognitive impairment, age, and diabetes are independent predictors of dependency after stroke.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Cardiac troponin T elevation after stroke: The relationships between elevated serum troponin T, stroke location, and prognosis
P.W.Chung
H.S.Moon
B.C.Seo
H.S.Song
Y.B.Kim
P.W.Chung
Kangbuk Samsung Hospital.Sungkyunkwan university school of medicine
SOUTH KOREA
Background: Serum cardiac troponin T (cTnT) is regarded as a specific marker of acute coronary syndrome. The clinical implications of increased serum cTnT in stroke patients remain unclear. The aim of the present study was to identify the relationships between elevated serum cTnT and stroke severity, location and prognosis. Method: From JAN 2005 to DEC 2006, 455 consecutive patients who were admitted to Kangbuk Samsung hospital due to acute ischemic stroke were recruited. Diagnosis of acute ischemic stroke was confirmed by diffusion-weighted imaging MRI within 3 days of stroke onset. Patients who did not undergo echocardiography and electrocardiography were excluded. Patients with cardiac diseases, such as acute myocardial infarction (ACC/AHA criteria), congestive heart failure and valvular heart disease, and other debilitating medical problems were also excluded. The patients were divided into 2 groups: elevated cTnT group (≥0.01 ng/ml) and normal cTnT group (<0.01 ng/ml). Results: Serum cTnT was elevated in 10.8% (45/416) of the patients. The clinical and epidemiologic characteristics were comparable between groups. Stroke severity, as assessed by the National Institutes of Health Stroke Scale Score was significantly worse in patients with elevated serum cTnT than patients with normal serum cTnT (8.46+/-1.98 vs. 5.29+/-2.25, p = 0.035). Insular lobe involvement was more common in patients with elevated serum cTnT than those with normal cTnT (28.9% vs. 15.1%, p = 0.042). Prognosis was worse in patients with elevated serum cTnT than in those with normal cTnT (the rate of favorable outcome as assessed by modified Rankin scale ; 17.8% vs. 27.4%, p = 0.027). The results analyzed by univariate and multivariate regression indicated that elevated cTnT was independently related to insular involvement, cardioembolism and stroke severity. Conclusion: Elevated serum cTnT in acute ischemic stroke was associated with severe neurological deficit at stroke onset, insular lobe damage and worse prognosis.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
The use of different laboratory parameters to estimate the prevalence of “aspirin resistance” among patients with first-ever and recurrent non-cardioembolic ischemic stroke
R. Gan
S.J.Agustin
J.L.Padilla
M.P.Yumul
P.T.Ong
C. Sum
P. Kuperan
S.H.Lee
N. Venketasubramanian
National Neuroscience Institute (Singapore)
SINGAPORE
Background: Studies have shown increased risk of vascular events in patients with “aspirin resistance” (AR). Prevalence of AR has been reported at 5 - 45 % with no consensus on laboratory definition of AR. We aimed to estimate the frequency of AR in stroke patients using different laboratory platelet aggregation parameters and to correlate the different laboratory methods of assessing platelet aggregation. METHODS: We recruited patients with first or recurrent noncardioembolic ischemic stroke occurring 45 ± 15 days prior who were on aspirin 100 mg/day and controls. Demographics, stroke subtype, and risk factors were recorded. Platelet function studies were performed by (1) light transmission aggregometry (LTA) using arachidonic acid (AA, 0.5 mM), ADP (10 uM), and collagen (2 ug/ml), (2) VerifyNow® RPFA-ASA, and (3) Multiplate® whole blood platelet function analyzer using ASPItest, ADPtest, and COLtest. We defined AR among patients on aspirin as LTA platelet aggregations by arachidonic acid (AA) >/=20%, ADP >/=70%, or collagen >/=60%; and RPFA ≥550 ARU. LTA in all subjects were correlated with corresponding Multiplate® test results by linear regression. This study was approved by the IRB and funded by NMRC of Singapore. RESULTS: Thirty-one controls (mean age 57 ± 4 yrs, 52% women) and 104 patients (first stroke n=61, mean age 64 ± 8 yrs, 51% women; recurrent stroke n=43, mean age 67 ± 9 yrs, 30% women) were included in this study as of 31 December 2007. Frequency of AR was 1% by LTA AA (first stroke 0%, recurrent stroke 2%), 33% by LTA ADP (first stroke 38%, recurrent 18%), 20% by LTA collagen (first stroke 15%, recurrent 23%), and 4% by RPFA (first stroke 7%, recurrent 0%). Comparison of test results between the LTA and Multiplate® showed low correlation for ADP (R=0.10) but good correlation for collagen (R=0.61) and AA (R=0.76). CONCLUSIONS: Frequency of AR in stroke patients varies from 1 to 33% depending on platelet function test used. LTA AA correlates best with Multiplate® ASPItest.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Cholinesterase Modulations Predict 12 month Neurological outcome and survival of Acute Ischemic Stroke
E. Ben-Assayag
S. Shenhar-Tsarfaty
K. Ofek
L.T.Soreq
I. Bova
L. Shopin
S. Berliner
I. Shapira
H. Soreq
N.M.Bornstein
Tel Aviv Sourasky Medical Center and Sackler and Tel Aviv University, Tel-Aviv, Israel
ISRAEL
Background: Stroke is the third leading cause of death and a major cause of adult disability; however, to date there is no objective parameter to identify stroke patients that are prone to develop such disabilities from those with better recovery prospects. Methods: AChE activities, Cholinergic Status and inflammatory biomarkers were determined in serum samples from 264 ischemic stroke patients during the acute phase and 12 month thereafter. The neurological deficit was evaluated using the NIH Stroke Scale (NIHSS). SPSS/WIN software was used for comparison of patients with matched controls. Results: When compared to matched controls, stroke patients showed generally lower serum AChE activities both in the acute phase of stroke and 12 months thereafter (p<0.001). A multivariate stepwise linear regression model was employed to test for putative associations with 12 months-NIHSS scores. This encompassed vascular risk factors, use of medications and baseline serum AChE activity, NIHSS score, inflammatory biomarkers as independent variables. The only variables retained in the final 12 months multivariable model of outcome were the baseline NIHSS score and serum AChE activity (p<0.0001 and p=0.001, Model R2 =0.471). Moreover, excessive reduction in the Cholinergic Status during the acute phase distinguished subsequent non-survivor patients from survivors, who showed increased Cholinergic Status (p= 0.035). Conclusions: Our findings demonstrate the putative value of Cholinergic Status and AChE activity for prognosis of recovery prospects following acute ischemic stroke. Understanding of the association between cholinergic and inflammatory reactions and their effects on the neurological outcome in acute ischemic stroke may foreshadow previously non-perceived post-stroke treatment strategies.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Lower Pre-treatment Cerebral Blood Volume Increases Hemorrhagic Risks After Intra-arterial Revascularization in Acute Stroke
A.C.Bhatt
N.A.Vora
A.J.Thomas
A Majid
M. Kassab
M. Hammer
K. Uchino
L. Wechsler
T.G.Jovin
R. Gupta
Michigan State University
USA
Background and Prupose: Intra-arterial therapies are being utilized more frequently for patients presenting with acute cerebral occlusions, but has been limited by the potential for hemorrhage. We sought to determine if pre-treatment CT perfusion parameters may help to identify patients at a higher risk of developing intracranial hemorrhages after intra-arterial stroke revascularization treatment. Methods: We retrospectively reviewed all patients at the University of Pittsburgh Medical Center and Michigan State University between January 2006 and June 2007 who underwent CT perfusion imaging of the brain prior to intra-arterial thrombolysis. Demographic information, angiographic variables, and types of endovascular interventions were recorded. The mean transit time and cerebral blood volumes were recorded for the ipsilateral and contralateral middle cerebral artery territories. A binary logistic regression model was constructed to determine the potential independent of developing intracranial hemorrhage. Results: A total of 57 patients (33 from the University of Pittsburgh and 24 from Michigan State University) with a mean age of 66 ± 13 years and mean NIHSS of 16 ± 5 were studied. The overall recanalization (TIMI 2 or 3 flow) was 72% for the cohort and the overall rate of symptomatic hemorrhage was 5 of 57 patients (9%). The overall hemorrhage rate including asymptomatic hemorrhage was 19 of 57 patients (33%). The only variable found to be predictive of the development of any hemorrhage post intervention was a reduced pre-treatment cerebral blood volume (OR 0.49, 95% CI [0.35-0.91], p<0.022). Conclusion: A reduced pre-treatment ipsilateral cerebral blood volume value prior to endovascular revascularization of an acute MCA or ICA occlusion significantly increases the risk of an intracranial hemorrhage
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Selected metalloproteinases as biomarkers for plaque vulnerability in patients with carotid artery stenosis
S. Sadikovic
H. Poppert
J. Pelisek
L. Esposito
A. Bockelbrink
B. Hemmer
P. Heider
Technical University of Munich
GERMANY
Background Metalloproteinases (MMP) have been found to play an important role in weakening a vulnerable plaque by matrix degradation of its fibrous cap. However, the clinical utility of these biomarkers has not yet been established. The aim of this study was to investigate the value of selected soluble MMPs as a parameter of plaque vulnerability in patients with carotid artery stenosis. Methods Serum levels of collagenases (MMP-1,-8), gelatinases (MMP-2,-9), stromelysin (MMP-3) and matrilysin (MMP-7) were determined by ELISA in 144 patients with carotid artery stenosis (76 asymptomatic, 68 symptomatic) and 16 healthy controls. Results In symptomatic patients elevated serum levels were found for MMP- 7 (p<0.001) MMP -8 (p<0.05), and MMP-9 (p<0.05) whereas no significant correlation was found for MMP-1, MMP-2 and MMP-3. Discussion MMP-7, -8 and -9 are promising candidates to serve as biomarkers in the evaluation of plaque vulnerability. They might once play a role as part of a scoring system intended to improve decision making on invasive therapy in individual patients with hitherto asymptomatic carotid artery sclerosis.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Reversed flow in the basilar artery in acute vertebrobasilar ischemia is associated with favourable prognosis
V.K.Sharma
H.L.Teoh
B.K.C.Ong
B.P.L.Chan
National University Hospita
SINGAPORE
Background: Acute vertebrobasilar ischemia is a potentially sinister pathology with high mortality and poor functional outcome in survivors. Reversal of blood flow in the basilar artery (BA) in patients with acute vertebrobasilar occlusion has been reported with better clinical outcomes. Power motion Doppler-transcranial Doppler (PMD-TCD) is an established tool for the non-invasive assessment of cerebral blood flow. Using PMD-TCD, we evaluated the incidence of flow reversal in BA and its association with functional outcomes in our patients with acute vertebrobasilar occlusive disease. Methods: Consecutive patients with acute vertebrobasilar ischemic strokes admitted to our tertiary care stroke centre underwent PMD-TCD evaluation of the circle of Willis. Reversed BA flow was identified as low-resistance signal toward the probe between the depths of 80 to 100 mm from suboccipital or transforaminal window. Residual flow signals were determined by the Thrombolysis in brain ischemia (TIBI) flow grading system. Location of occlusion was determined as proximal, mid, and distal. Functional outcomes were assessed by modified Rankin scale at 3-months. Patients without reversed BA flow served as controls. Results: Nine out the fifty one patients (32 men, mean age 56 years) with acute vertebrobasilar ischemia revealed reversed blood flow in the basilar artery with variable mean flow velocities (mean MFV 32cm/s). 6 patients showed proximal BA occlusion while mid-BA occluions were noted in the rest. Collateral flow via bilateral posterior communicating arteries was recorded in 5 patients. Patients with reversed BA flow had lower NIHSS score (mean 6 compared to 9 in the control group). All but one patients (89%) with reversed BA flow achieved functional independence (mRS 0-2) at 3 months compared to 51% in the control group. All 3 deaths were seen in the control group. Conclusion: Reversed flow in the distal BA observed in patients with acute vertebrobasilar ischemic strokes is associated with lower stroke severity and better functional outcome.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Changes in serum concentrations of neurobiochemical markers of brain damage in patients with TIA and ischemic stroke - relation to functional outcome.
H. SIENKIEWICZ-JAROSZ
B.M.GAŁECKA-WOLSKA
C.A.BIDZIŃSKI
C.D.TURZYŃSKA
B.B.LIPSKA
C.A.SOBOLEWSKA
C.A.PŁAŹNIK
A. D. RYGLEWICZ
Institute of Psychiatry and Neurology
POLAND
Background and purpose: The aim of the present study was to analyze the relations between serum levels of S100b protein, neuron-specific enolase (NSE), C-reactive protein (CRP), d-dimers and excitatory amino-acids (EAA) and GABA with functional outcome in patients with TIA or ischemic stroke, admitted within 12 hours after onset of symptoms. Material and methods: We investigated 71 nonconsecutive patients – 54 with ischemic stroke (mean age 73.3±11.7) and 17 with TIA (mean age 68.6±12.1). The diagnosis of stroke and TIA was made on the basis of clinical symptoms and computed tomography (CT). Plasma concentration of S100b, NSE, CRP, D-dimers, EAA and GABA were assessed in blood samples taken at admission and at 12, 24, and 72 h after symptoms onset. We used standard analytical methods. Results: Significant differences between TIA and ischemic stroke group were find in the number of concurrent diseases and the levels of D-dimers at admission. We could not find any differences between the groups of patients with TIA or ischemic stroke in the levels of S100b, NSE, C-reactive protein and any of EAA assessed (p>0,05). In correlative analysis performed in the group with ischemic stroke, levels of NSE, S100b, CRP and D-dimers were correlated with the severity of neurological deficit, we observed also a positive correlation between initial levels of taurine and neurological status after 3 months. In multiple linear logistic regression we found that age, and NSE at 24 h can predict functional outcome in stroke patients. Conclusions: Our study replicated results of previous studies, showing difference in the level of D-dimers at admission between TIA and stroke patients, as well as correlations between S100b, NSE and C-reactive protein levels with severity of stroke and functional outcome. The original observation is, that taurine could also act as a prognostic factor, but this hypothesis needs further studies.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Prognostic Value of Motor Evoked Potential Obtained by Transcranial Magnetic Stimulation in Motor Recovery in Patients with acute ischaemic stroke in Kwong Wah Hospital
L.K.Helen Yip
M.C.Kwan
W.K.Cheng
K.F.Ko
T.P.Chan
Kwong Wah Hospital, Hong Kong
HONG-KONG
Objectives: To investigate whether Motor Evoked Potential (MEP) correlates with motor performance and whether MEP is an independent prognostic indicator of motor outcomes in acute ischaemic stroke. Design: This was a prospective study using single pulse transcranial magnetic stimulation (TMS) for investigating the functional role of the corticospinal tract in a group of patients with limb weakness caused by acute ischaemic stroke. Patients were being followed up to 6 months after acute stroke event. Setting: Acute Stroke Unit, Kwong Wah Hospital Subjects and Methods: Fifty-three consecutive stroke patients fulfilling the inclusion criteria were included in this study. Transcranial magnetic stimulation was used to determine the presence or absence of motor evoked potential (MEP) and stroke outcome was assessed up to 6 months. Outome measures: Main outcome measure with upper limb motor recovery was assessed by handgrip power at 0th month, 3rd month and 6th month. Secondary outcome measures included Box and Block Tests, 9 Hole Peg Test, Frenchay Arm Test and Barthel Index. Results:MEP correlated with handgrip power at initial and 3rd month post stroke. No statistical significant result was found in primary outcome measure with change of handgrip power as well as secondary outcome measures including changes of Box and Block Test, 9 Hole Peg Test and Barthel Index in MEP present versus MEP absent group. Conclusion: MEP correlates with handgrip power at initial and 3rd month post stroke. Preservation of MEP alone is not a useful parameter for prediction of motor recovery.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
C-reactive protein in acute ischemic stroke: relationship with short term outcome
H.M.den Hertog
H.B.van der Worp
J.A.van Rossum
H.M.van Gemert
R. de Jonge
P.J.Koudstaal
D.W.Dippel
on behalf of the PAIS investigators
Erasmus MC University Medical Center
THE NETHERLANDS
Background: Acute ischemic stroke may trigger an inflammatory response that leads to increased (C-reactive protein) CRP levels. This rise may be associated with poor outcome either because it reflects the inflammatory reaction or because CRP itself may contribute to brain damage induced by ischemic stroke. Aim: To determine the prognostic significance of CRP measured within 12 hours of stroke onset for the risk of death and poor outcome in patients with ischemic stroke. Methods: A total of 598 patients with ischemic stroke were examined. CRP levels were routinely obtained within 12 hours of symptom onset. CRP values were dichotomized as <7 mg/L or >=7 mg/L. We also studied a possible dose-response relationship, using the full range of CRP values. CRP values were related to the rate of death or dependency at 3 months (poor outcome; modified Rankin Scale score (mRS) >=3). A multiple logistic regression model was applied to adjust for age, sex, NIHSS (NIH Stroke Scale) score, cigarette smoking status, diabetes mellitus, hypertension, statin use, and stroke subtype. Results: After adjustment for potential confounders, patients with CRP levels >=7 mg/l had a significantly increased risk of death (adjusted OR 1.7, 95% CI 1.0-2.9) and of poor outcome (adjusted OR 1.6, 95% CI 1.0-2.4) at 3 months. A dose-response relationship was observed for CRP and death and poor outcome at 3 months. The associations were attenuated after adjustment for age, sex and NIHSS score, but remained significant. Conclusion: CRP measured in the very early phase of acute ischemic stroke is an independent prognostic factor for poor outcome.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Microalbuminuria in the acute phase of ischemic stroke and TIA
S. Debiais
I. Bonnaud
D. Saudeau
A. Autret
B. De Toffol
B. Giraudeau
J.M.Halimi
CHRU Bretonneau
37000 Tours
FRANCE
INTRODUCTION Prevalence of microalbuminuria (MA) is high among patients with acute clinical conditions (pancreatitis, myocardial infarction). Microalbuminuria seems to be a marker of widespread vascular damage, or endothelial stress, even in non-diabetic patients. Its predictive value in acute ischemic stroke remains unknown. The aim of this study was to assess the prevalence and the predictive value of MA measured during the acute phase of stroke and TIA. MATERIAL AND METHODS We prospectively included all patients with ischemic stroke or TIA, admitted in the first 48 hours after the onset of symptoms. For each patient were recorded at inclusion : clinical data, presence of vascular risk factors, NIH Stroke Scale, diagnosis, standard biological parameters, and urinary albumin excretion with a non invasive measure. The mean follow up was 3 months. RESULTS We studied 80 patients (mean age 69.3 +/- 12.5 years) diagnosed with ischemic stroke confirmed by CT, or TIA, admitted during the acute phase. Microalbuminuria was found in 34 of 80 patients (42%), more often in stroke patients than in TIA patients. The NIHSS was higher in patients with MA, but the difference was not significant. At 3 months, the proportion of patients with a bad outcome (Rankin Scale > 1) was significantly higher in patients with MA (61% vs 30%, OR= 3.09, p= 0.059). CONCLUSIONS As in myocardial infarction, MA is frequently encountered in cerebral ischemic events and is associated with a bad outcome. Therefore, urinary albumin excretion measured at the acute phase could constitute a reliable prognostic factor of bad outcome, death or recurrence of ischemic events.
