recanalization of the primary occlusion; I¼incomplete or partialrecanalization of the primary occlusion with no distal flow;II¼incomplete or partial recanalization of the primary occlusionwith distal flow; or III¼complete recanalization of the primaryocclusion with distal flow. The Thrombolysis in Cerebral Infarction(TICI) Score was defined as follows: 0¼no perfusion; 1¼ pene-tration, but no distal branch filling; 2a¼ perfusion with incomplete(<50%) distal branch filling; 2b¼perfusion with incomplete (>50%)distal branch filling; and 3¼full perfusion with filling of all distalbranches. We compared these methods of assessment to one anotherand with good clinical outcome (modified Rankin Score 0 to 2).Results AOL and TICI scores showed moderate to substantialagreement (k¼0.660, 95% CI (0.518 to 0.801). Good clinicaloutcome was seen in 60% of patients with AOL II/III scores(p¼0.462) and in 71% with TICI 2/3 scores (p¼0.854). The twomethods did not significantly differ in predicting outcome (p¼0.52).Conclusion In conclusion, TICI reperfusion scores and AOL recan-alization scores comparably predicted clinical outcome in ourpatient population. However, further investigation should beperformed, possibly with the aid of other imaging modalities, tofurther differentiate between these parameters and their relation-ship to clinical outcome.

Disclosures R Sugg: None. W Holloway: None. C Martin: None. N Akhtar: None.M Rymer: 2; C; Concentric.

O-004 MANAGEMENT OF ACUTE STROKE IN ELDERLY PATIENTS:EXAMINING THE ROLE OF NEUROVASCULARINTERVENTION

doi:10.1136/neurintsurg-2011-010097.4

1J Maksimovic, 1J Phillips, 1K Fraser, 2D Nair, 2D Wang, 2A Talkad, 3J Klopfenstein,1S Meagher. 1Department of Radiology, University of Illinois College of Medicine atPeoria, Peoria, Illinois, USA; 2Department of Neurology, University of Illinois College ofMedicine at Peoria, Peoria, Illinois, USA; 3Department of Neurosurgery, University ofIllinois College of Medicine at Peoria, Peoria, Illinois, USA

Objective Advanced age is a known risk factor for poorer outcomesafter surgical and interventional procedures. The objective of thisstudy is to evaluate the role of neurointerventional procedures in thetreatment of acute stroke in elderly patients. The impact ofneurovascular interventional therapy on patient outcomes will becompared with less invasive methods of treatment such as intra-venous thrombolytic therapy and conservative management.Methods Retrospective review of medical records of patients$75 years of age who were admitted to our facility with a diagnosisof acute ischemic stroke between 2006 and 2010 was performed.These patients were stratified into three categories according tomanagement: (1) conservative management including diagnosticcerebral angiograms as part of work-up, (2) administration ofintravenous t-PA with or without subsequent diagnostic cerebralangiograms, and (3) neurovascular intervention with or withoutprior intravenous t-PA. Types of intervention included intra-arterialt-PA and use of mechanical thrombolytic techniques. Patients whoinitially presented with intracranial hemorrhage and those withincomplete medical records at time of review were excluded.Outcomes measured were NIH stroke scale (NIHSS) scores atadmission and at discharge, complications related to hemorrhagicconversion of ischemic stroke, survival to discharge from thehospital, and discharge disposition. Student t test was used forstatistical analysis.Results A total of 379 patients were included in this study. Theconservative management group consisted of 266 patients. 66patients were given intravenous t-PA without neurovascular inter-vention. 47 patients received neurovascular intervention with orwithout prior intravenous t-PA. In the first group, the averageNIHSS score at admission was 4.71 (SD 6.69) and at discharge was

2.00 (SD 3.53). 24 patients (9.0%) in this group did not survive todischarge, and two patients (0.8%) developed intracranial hemor-rhage after admission. In the second group, the average NIHSS scoreat admission was 11.26 (SD 7.38) and at discharge was 3.91 (SD5.60). Eight patients (12.1%) in this group did not survive todischarge, and five patients (7.5%) developed intracranial hemor-rhage. In the third group, the average NIHSS score at admission was18.33 (SD 7.19) and at discharge was 8.48 (SD 6.38). 21 patients(44.7%) did not survive to discharge, and 11 patients (23.4%)developed intracranial hemorrhage. Three patients (6.4%) in thethird group were discharged to home, with the remaining survivingpatients requiring inpatient rehabilitation or a skilled nursing. 29patients (43.9%) in the second group and 156 (58.6%) patients in thefirst group were discharged to home.Conclusions Patients who were treated with neurovascular interventionhad higher rates of intracranial hemorrhage and death, and greaterrequirement for rehabilitation or skilled nursing at discharge comparedto patients who were treated conservatively. Patients receiving neuro-vascular intervention had significantly higher NIHSS scores on presen-tation, likely at least partially accounting for their poorer outcomes.Preliminary review of the data demonstrates that the current triageprocess is effective in reserving aggressive therapy for more severelyaffected patients where the benefits may outweigh the risks.

O-005 ENDOVASCULAR THERAPY FOR ACUTE ISCHEMIC STROKEDUE TO PROXIMAL INTRACRANIAL ANTERIORCIRCULATION OCCLUSION TREATED BEYOND 8 H FROMTIME LAST SEEN WELL: A SUBSET ANALYSIS OF THEMERCI REGISTRY

doi:10.1136/neurintsurg-2011-010097.5

1R Nogueira, 2M Rymer, 3W Smith, 4H Lutsep, 5G Walker, 6D Liebeskind, 7R Budzik,8T Devlin, 9T Jovin. 1Interventional Neurology, Emory University School of Medicine/Grady Memorial Hospital, Atlanta, Georgia, USA; 2Department of Neurology, SaintLuke’s Medical Center, Kansas City, Missouri, USA; 3Department of Neurology, UCSF,San Francisco, California, USA; 4Department of Neurology, Oregon Stroke Center,Oregon Health & Science University, Portland, OR; 5Concentric Medical, MountainView, California, USA; 6Department of Neurology, UCLA, Los Angeles, California, USA;7Interventional Neurology, Riverside Methodist Hospital, Columbus, Ohio, USA;8Department of Neurology, Erlanger Medical Center, Chattanooga, Tennessee, USA;9Interventional Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA

Background and Purpose Current selection criteria for reperfusiontherapy are based on strict time windows. Recent data suggest thatthe mismatch between stroke severity and the amount of ischemiccore at presentation may be more important than time whenselecting patients for reperfusion treatment. We describe aprospectively collected cohort of anterior circulation stroke patientstreated beyond 8 h from time last seen well (TLSW).Methods The Merci Registry was a multicenter prospective registryof stroke patients with acute proximal intracranial arterial occlusiontreated with Merci thrombectomy with or without adjunctive useof other devices or drugs. We performed a subset analysis of allconsecutive patients meeting the following criteria: (1) anteriorcirculation occlusion, (2) treatment initiated >8 h from TLSW.Results A total of 1000 patients were enrolled. Out of these, 112were treated >8 h from TLSW and had complete follow-up data.Their baseline characteristics were as following: mean age,62.7615.1; male gender, 56.3%; baseline NIHSS 15.0565.8 (median15); mean time from symptom onset to puncture (hr), 13.82610.6(median, 10.74); mean procedural duration (hr), 2.0661.0 (median1.95); IV rt-PA use, 10.7%; IA thrombolytic use, 42%; GpIIbIIIainhibitor use, 14.3%; other devices use, 46.5%; proximal occlusionstenting, 28.6%.The occlusion sites included: ICA, 41.1%; MCA-M1,51.8%; MCA-M2, 7.1%. 50% of the patients had “wake-up” strokeswhile 18.8% of the patients had witnessed strokes with onset

A2 J NeuroIntervent Surg July 2011 Vol 3 Suppl 1

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