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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

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Abstract No: EP-73  Submission Number: 725

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  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.

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