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Poster Abstracts Thursday, November 10, 2005 $439
moyamoya syndrome associated, respectively, with protein C defi- ciency, protein S deficiency and SCD, had successful revascularization surgery (encephaloduroarteriosynangiosis). Several patients had nmlti- ple risk factors, whereas no risk factor could be identified in 11 (10.6%). Because of the high prevalence and importance of nmltiple risk factors, a comprehensive investigation, including hematologic, neuroimaging and metabolic studies should be considered in every child with stroke.
1329 Intpact of initial Cerebral Infarction volutne nleasured in Diffusion-Weighted MRI on clinical outcome in Acute Stroke Patients: a pilot study
Sanak, D t, Horak, D e, Nosal, V 3, Bartkova, A t, Zelenak, K 4, He,zig, R t, Bucil, j 2 Kinca, E ~, Burval S 2, Kanovsky, pt. 1Stro]c e Center, Department of Neurology, University Hospital, Olomouc, Czech Republic; 2Department of Radiology, University Hospital Olomouc, Czech Republic; 3Department of Neurology, University Hospital Martin, Slovalc Republic; 4Department of RadiMogy, University Hospital, Martin, Slovalr Republic
Backgrouml anti Purpose: Magnetic resonance imaging may help to identify those acute stroke patients, who have the most potential benefit from thrombolytic therapy. The aim of our study was to assess the relationship between the initial volume of cerebral infarction (CI) and (1) 24-hour and (12) 90-day clinical outcome in acute CI patients fulfilling the inclusion criteria for thrombolytic therapy examined by a standard MRI protocol. Methods: The initial infarct volmne (VDWI-I) and infarct volmne after 24 hours were quantified in 43 acute CI patients on diffusion weighted images. Neurological deficits were evaluated using NIH Stroke Scale at the admission and 24 hours later, 90-day clinical outcome using modified Rankin Scale. The relationship between infarct volume and neurological deficit severity was assessed, searching for maxinmnl VDWI-I associated with a good clinical outcome. Results: VDWI-I ranged from 0.7 to 321 cnl3.24-hour infarct volunle reduction was found in 6 patients. 24-hour clinical outcome improved significantly (lJ - 0.0002) in 87% of patients with VDWI-I < 100 cm3 (Group 1) and deteriorated significantly (lJ - 0.018) in 100% of patients with VDWLI>100 cm3 (Group 2). 90-day mortality was 0% in Group 1 versus 86% in Group 2. 90-day clinical outcome was significantly better in Group 1 versus Group 2 (p -- 0.002). Conclusions: The MRI-DWI quantification of initial infarct volume could be of the benefit for the clinical outcome prediction in acute stroke patients.
1330 Bcuelit of Transesophageal Eehocardiography forthe Diagnosis of ISdlenlic Stroke cause and for the monitoring tile effectiveness of Anticoagulation Therapy
Bartkova, A t, Sovova, E a, Sanak, D ~, Vlachova, I t, Krupka, B t, Herzig R 1, Marek, D 2, Hutyra, M z, Kanovsky p1.2Stroke Center, Department of Neurology, University Hospital, Olomouc, Czech Republic; 21st Department of Internal Medicine, University Hospital, Olomoue, Czech Republic
Background: Transesophageal echocardiography (TEE) is being used for the detection of cardiac morphological abnormalities, including the presence of intracardiac thrombus and other sources for possible brain embolization. Our study evaluated its benefit inthe diagnostic work-up of ischemic stroke (IS), both in determining etiology and in monitoring treatment effects in patients with demonstrated left atrial thrombus. Methods: A group of 237 IS patients presenting with sinus rhythm and with no extracardiac stroke causes underwent TEE. Anticoagulant therapy was started and TEE was repeatedly controlled after 8 and 16 months in patients with thrombus presence.
Results: Left atrial thrombus was found in 26.5%, spontaneous echocontrast in 8.3%, patent foramen ovale in 5.7%, atrial septum defect in 1.7 %, atrial septum aneurysm in 2.1%, hypokinesis o f the left ventricular wall in 11.0%, and sclerotic plaques in the aorta in 27.8% of IS patients. Left atrimn auricle ejection velocity differed statisti- cally significantly between patients with thrombus (Subgroup A) and without thrombus (Subgroup B) (lJ -- 0.042). During repeated TEE checks performed in Subgroup A patients, thrombus was still present in 52.4% after 8, and in 44.4% after 16 months. Conclusion: TEE should be realized as early as possible in IS patients with unclear etiology or clinical suspicion for cardiogenic emboliza- rich. TEE is also suitable for follow-up monitoring of the effectiveness of anticoagulation therapy in patients with intracardiac thrombus.
1331 Tile MRC Thixd International Stroke Trial LIST-3): basdine characteristics of patients recruited in the expansion phase
Sandercock, p 1 Kane, 11, Lindley, R 2, Lewis, S 1, Dennis, M 1, Wardlaw, j1. 1Division of Clinical Neuroseienees, University Of Edinburgh, Scotland; 2tVestern Clinical School University of Sydney, Australia
Background: Recombinant tissue plasmJnogen activator (rt-PA) is approved in many countries for use in selected patients with acute ischaernic stroke who can be treated within 3 hours of symptom onset. IST-3 seeks to determine whether a wider variety of patients may benefit. This analysis describes the characteristics of the patients randomised in the initial phase of the study. Methods: IST-3 is an international, nmlti-centre, randomJsed, controlled trial of intravenous rt-PA versus control, in patients with acute ischaernic stroke who can be enrolled and treated within 6 hours of symptom onset. Results: The study began in May 2000 and, by 21st April 2005, 335 patients had been recruited from 18 centres in 7 countries. The median time to randomisation was 4 hours. At baseline: 67% of patients were aged over 70; 35% were in atrial fibrillation; 53% had total anterior circulation, 34% partial anterior, 9% lacunar and 4% posterior circulation stroke syndromes. The Data Monitoring Committee has reviewed the unblinded data in strict confidence and has urged the trialists to increase recruitnient to meet the target for the main phase of the trial (2005-2009), funded by the Medical Research Council (MRC), which aims to recruit up to 6000 patients from up to 400 centres. Conehision: The trial is recruiting patients that might benefit from thrombolysis, but do not precisely meet the current treatment criteria. By continuing to recruit such patients, reliable evidence will enierge on the effects of thrombolysis in a wider variety of patients.
1332 Baseline CT characteristics of the first 317 patients in the NIRC Third International Stroke Trial LIST-3)
Sandereock, p1, Katie, 11, Lindley, R 2, Lewis, S 1, Dennis, M 1, Wardlaw, j1. 2Division of Clinical Neurosciences, University Of Edinburgh, Scotlan& 2Western Clinical School, University of Sydney, Australia
Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is approved for the treatnlent o f selected patients with acute ischaemJc stroke. The Medical Research Coundl (MRC) IST-3 is a large-scale randomised controlled trial of i.v. rt-PA witlfin 6 hours of onset in 6000 patients, which seeks to determine whether a wider variety of patients may benefit from treatment. Aim: To determine whether appropriate patients were recruited in the early 'start-up" phase of the trial. Methods: Blinded review of CT scans by an expert neuroradiologist. Results: We assessed the pre-randomJsation CT appearances of the first 317 patients in the trial. Attenuation patterus consistent with early