Displaying One Session

e-Poster Discussion
Session Type
e-Poster Discussion
Room
Station 2 (E-Poster Area)
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM

DECOMPRESSIVE NEUROSURGERY FOR PATIENTS WITH CEREBRAL VENOUS THROMBOSIS. A PROSPECTIVE MULTICENTER REGISTRY (DECOMPRESS2)

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
06:30 PM - 06:35 PM

Abstract

Group Name

The DECOMPRESS2 study group

Background And Aims

Decompressive neurosurgery (DN) may be life-saving in patients with cerebral venous thrombosis (CVT) with large lesions and impending brain herniation. The ESO-EAN Guidelines made a strong recommendation for this intervention, supported by a low level of evidence (retrospective studies, small sample sizes), which could overestimate the treatment effect. We aimed to report the outcomes of CVT patients treated by DN in a large multicenter cohort.

Methods

We included consecutive CVT patients treated by DN at the participating centres. Outcomes were evaluated at discharge and 6 months. The primary outcome was modified Rankin Scale (mRS) 0-4 vs. 5-6. Secondary outcomes were complete recovery (mRS 0-1), independence (mRS 0-2), severe dependence (mRS 4-5) and death.

Results

118 patients (80 women, median age 38 years) were included from 14 centers in Europe, Asia, and America. DN (115 craniectomies, 36 hematoma evacuations) was performed a median of 1 day after diagnosis. 71 (60.2%) patients were comatose before surgery. Pupillary reflexes were absent unilaterally in 27 (22.9%) and bilaterally in 9 (7.6%). 65 (55.1%) patients had a mRS 0-4 at discharge and 61.9% at 6 months. Mortality during hospital admission was 24.6% and 31.4% at 6 months. Complete recovery (1.7 to 11.4%) and independence (6.8 to 29.5%) increased between discharge and 6 months, while severe dependence decreased (from 49.1 to 13.3%).

Conclusions

Mortality and functional dependence were higher than those reported in previous studies of DN in CVT. Still, 2/3rd of patients were alive and 1/3rd independent by 6 months.

Trial Registration Number

Not applicable

Hide

DOES TRANEXAMIC ACID IMPROVE OUTCOME FOR PATIENTS WITH SURGICALLY TREATED INTRA-CEREBRAL HAEMORRHAGE? RESULTS FROM THE TRANEXAMIC ACID FOR INTRA-CEREBRAL HAEMORRHAGE-2 (TICH-2) TRIAL

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
06:35 PM - 06:40 PM

Abstract

Group Name

TICH-2 Investigators

Background And Aims

The MISTIE-III trial of minimally invasive surgical clot evacuation and alteplase in patients with intracerebral haemorrhage (ICH) showed favourable outcomes where haematoma volume was reduced to <15 mL. We hypothesised that tranexamic acid (TXA, an antifibrinolytic drug) would reduce post-operative ICH volume and improve functional outcome at 90 days.

Methods

In the TICH-2 trial, patients were randomised to TXA or placebo within 8 hours of ICH. In participants who were treated surgically, we compared outcomes (modified Rankin Scale, mRS) between those who received TXA versus placebo. Analyses comprised binary or ordinal logistic regression (odds ratio, OR, with 95% confidence intervals, CI).

Results

Of the 2316 randomised patients, 121 (TXA 57, placebo 64) underwent neurosurgical intervention including craniotomy (41%), hematoma drainage (20%) and extra-ventricular drainage (18%). In the TXA group, there were more patients with IVH (33 vs 25; p-value=0.038) otherwise groups did not differ. Outcome of patients was no different in TXA versus placebo; median mRS 5 vs 5 (OR 0.86, 95% CI 0.36-1.95; p=0.73). Similarly, TXA had no effect on early or hospital death, of hospital length of stay. However, TXA increased the number of patients with haematoma volume <15 mL at 24 hours post randomization (OR 2.88, 95% CI 1.20-6.92; p-value 0.018).

Conclusions

Although the outcome of patients who had surgery was not improved by TXA, it increased the number with optimal haematoma clearance suggesting TXA might be an important part of care for surgically treated ICH.

Trial Registration Number

EudraCT number. 2012-004108-37

Hide

RESULTS OF THE RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PHASE 2 REMEDY TRIAL ASSESSING THE SAFETY AND TOLERABILITY OF RECOMBINANT HUMAN TISSUE KALLIKREIN (DM199) IN ACUTE ISCHAEMIC STROKE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
06:40 PM - 06:45 PM

Abstract

Group Name

the ReMEDy Trial Investigators

Background And Aims

Human tissue kallikrein (KLK1) is an endogenous, vasoactive serine protease and an important vasoregulator that is approved for use in China to treat acute ischaemic stroke. Chinese clinical data suggest that KLK1 therapy may be beneficial following ischaemic stroke. DM199 is a recombinant form of human KLK1 and was evaluated in Australia in a Phase 2 clinical trial (ReMEDy, clinicaltrials.gov NCT03290560).

Methods

ReMEDy was a randomised, double-blind, placebo-controlled study in patients aged >18 years. Patients were randomised within 24h of ischaemic stroke onset and eligibility required NIHSS 6-25 at the time of randomization. For patients receiving reperfusion therapy (thrombolysis or thrombectomy), the qualifying NIHSS score had to be assessed >1h post-treatment. Patients received an initial intravenous infusion and subsequent subcutaneous injection of DM199 or placebo on day 1 with further subcutaneous injections every 3 days over the subsequent 22 days. Evaluations for safety, tolerability, pharmacokinetics and functional improvement were made regularly through 90 days post-stroke. The primary outcome was safety of DM199 as assessed by the incidence of serious adverse events. Secondary outcomes included efficacy based on the modified Rankin scale (mRS), plasma concentrations of DM199 and pharmacodynamics.

Results

A total of 92 patients were randomized to DM199 or placebo between January 2018 and October 2019 at 12 Australian sites. Final results including modified Rankin Scale outcomes will be available for the conference.

Conclusions

The results will determine whether further evaluation of DM199 in a phase 3 trial is warranted.

Trial Registration Number

clinicaltrials.gov NCT03290560

Hide

VALIDATION OF THE AUSTRIAN PREHOSPITAL STROKE SCALE (APSS) TO PREDICT SEVERE STROKE WITH LARGE VESSEL OCCLUSION

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
06:45 PM - 06:50 PM

Abstract

Background And Aims

Prediction of large vessel occlusion (LVO) is of utmost relevance for the pre-hospital transportation triage. The Austrian Prehospital Stroke Scale (APSS) score for LVO prediction was developed using critical synthesis of previously published LVO-scores. The aim of this study was to validate the APSS score, and compare it to other LVO-scores.

Methods

APSS consisted of 5 items: “facial palsy”, “motor arm”, “language”, “motor leg” and “gaze deviation”. The score ranged from 0 to 9 points. Data from 741 consecutive stroke patients with acute vessel imaging admitted to an independent universitary comprehensive stroke center were used to test the predictive performance of the APSS, and other LVO-scores (CPSS, 3I-SS, FAST-ED, G-FAST and RACE).

Results

In the prediction of treatable LVO APSS showed the highest area under the curve (0.834) and highest sensitivity (69%) as compared to other LVO scores. Specificity (85%), positive predictive value (75%), negative predictive value (81%) and accuracy (79%) were comparable to other LVO scores. Receiver operating curve analysis revealed an optimal cut-off point for LVO prediction at APSS equal to 4 points.

Conclusions

The easy assessable 5-item APSS score tended to outperform other LVO scores. Real-life prospective evaluation in a pre-hospital setting is ongoing.

Trial Registration Number

Not applicable

Hide

IMPLEMENTATION OF AN ACUTE STROKE TREATMENT PROGRAM IN ARMENIA: FIRST-YEAR EXPERIENCE WITH THROMBOLYSIS AND THROMBECTOMY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
06:50 PM - 06:55 PM

Abstract

Background And Aims

Acute ischemic stroke (AIS) treatment was not commonly available in Armenia before 2019, when the government initiated a funded National Stroke Program. Herein we present the first-year experience at the Erebouni Medical Center (EMC), in Yerevan, and focus on feasibility and quality.

Methods

Consecutive patients with AIS admitted to the EMC Stroke Center from February 1 to December 31, 2019, were enrolled. They were treated according to internationally recognized guidelines offering rt-PA within the first 4.5 hours and/or thrombectomy within the first 24 hours of stroke.

Results

Out of 1583 patients, 286 (18.1%) were selected for treatment: 179 (62.6%) received intravenous rt-PA, 62 (21.7%) intravenous rt-PA followed by thrombectomy and 45 (15.7%) underwent only thrombectomy.

The mean admission NIHSS was 11.7 (±6.2). The mean door-to-needle and onset-to needle time were 49.4 (±20.8) and 145.8 (±50.7) minutes, respectively. Door-to-groin time was 96.7 (±59.2) and door-to-recanalization time was 142 (±68.2) minutes. The average hospital stay was 6.6±6.7 days. At discharge, 209 (72.6%) patients had an NIHSS≤ 4.

Hemorrhagic complications occurred in 11 patients (6.1%) in the rt-PA population and were fatal in 2 cases. In thrombectomy population, successful recanalization (TICI 2b-3) was achieved in 85% and symptomatic hemorrhage occurred in 6.5% of cases. In-hospital all-cause mortality was 11.8%.

Conclusions

These outcomes are encouraging and are within the range of previously published results at experienced centers. Further work to achieve better outcomes and develop stroke centers country-wide is in progress. This experience can be helpful to other cities establishing new AIS treatment programs.

Trial Registration Number

N/A

Hide

A TABLET-BASED CLINICAL DECISION SUPPORT SOLUTION DEMONSTRATING STROKE OUTCOME PREDICTION BY ARTIFICIAL INTELLIGENCE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
06:55 PM - 07:00 PM

Abstract

Background And Aims

Artificial intelligence (AI) methods are increasingly developed for the clinical setting. This is true also in stroke. While high-performing models are a prerequisite for the clinical setting, the doctor on-site will not be using the model directly, but a solution that was built around it. Here, it is paramount that AI products follow the state-of-the-art with regards to usability and presentation of results. Thus, we have developed the prototype of an iPadOS-based clinical-decision-support tool equipped with a state-of-the-art stroke outcome prediction model following best practices regarding user experience (UX) and user interface (UI).

Methods

Our tool was designed in an iterative release-feedback process with emergency personnel and clinicians of stroke units, paying special attention to including routine image inspection tools and seamless integration of AI-based components. Furthermore, we carried out workshops to determine the most helpful way of explaining AI predictions.

Results

The software deploys an AI-based predictive model utilizing acute stroke imaging and the available set of clinical parameters of the current stroke patient for mRS prediction. Next to the predicted outcome, quantitative relevance of each input is presented, indicating which image modality or clinical parameter carried the most significant contribution for prediction. Finally, significance maps are shown as an overlay on imaging to present the decision-making of AI components.

Conclusions

Our solution demonstrates the ability of an AI-based clinical-decision-support system to bring state-of-the-art technology to the clinical setting and to patient care. This is the first step for utilizing the power of AI to advance stroke treatment.

Trial Registration Number

Not applicable

Hide

CT PERFUSION BASED IV THROMBOLYSIS IN PATIENTS WITH MINOR NOT CLEARLY DISABLING STROKE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
07:00 PM - 07:05 PM

Abstract

Background And Aims

The randomized controlled PRISM trial could not show improved functional outcome in patients with minor non-disabling acute ischemic stroke when treated with intravenous thrombolysis (IVT) versus controls. Enrollment into PRISM was based on non-contrast CT (NCCT) imaging. We investigated whether IVT is beneficial in patients with regional hypoperfusion on CT perfusion (CTP+) versus patients without regional hypoperfusion (CTP-).

Methods

Single-center, observational study including adult patients with non-disabling stroke and a maximum NIHSS of 5 who received CTP and were treated with IVT within 4.5 hours of symptom onset or symptom recognition in unknown onset stroke between 2013 and June 2019. Primary outcome was mRS at 90d (shift analysis). Secondary outcomes included the NIHSS at 24 hours, NIHSS delta from baseline to 24 hours, symptomatic intracranial hemorrhage (SICH) as well as final infarct volume.

Results

From a total of 242 IVT-treated minor stroke patients with CTP, 114 were CTP+ and 128 CTP-. No significant differences with respect to mRS at 90 days, 24-hour NIHSS, NIHSS delta from baseline to 24 hours, and SICH were noted. CTP+ patients had higher NIHSS at stroke onset than at hospital admission (p<0.001), more often visible infarction on follow-up CT (p<0.001), and suffered more often from atrial fibrillation (p=0.041). CTP- patients were more often classified as stroke due to small-vessel occlusion (p<0.001).

Conclusions

CTP might help to select minor stroke patients who could benefit from IVT. A large randomized controlled trial should investigate this hypothesis.

Hide

CLINICAL EFFECT OF ARGATROBAN COMBINED WITH CLOPIDOGREL IN TREATMENT OF ACUTE CEREBRAL INFARCTION

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
07:05 PM - 07:10 PM
Presenter

Abstract

Group Name

No

Background And Aims

Argatroban is an intravenous injection with anticoagulant effection. We observe the clinical efficacy and safety of agatroban combined with clopidogrel in acute cerebral infarction.

Methods

174 patients with acute cerebral infarction were randomly divided into two groups: Argathorban combined with clopidogrel group (Argathorban group) and clopidogrel group (87 cases each). NIHSS, mRS and ADL were assessed 7 and 14 days after treatment.

Results

There were significant differences in NIHSS and mRS between the two groups on the 7th day after treatment (P < 0.05). The NIHSS, mRS and ADL of the two groups at 14 days after treatment were significantly different from those at admission (P < 0.05); the NIHSS and mRS of the Argathraban group were lower than those of the clopidogrel group, and the ADL was higher than that of the clopidogrel group, with significant difference (P < 0.05). The NIHSS of stenosis group was higher than that of middle cerebral artery stenosis group (P < 0.05). The total effective rate of the middle cerebral artery stenosis group was significantly lower than that of the middle cerebral artery normal group (P <0.05).

Conclusions

Argartroban is a new thrombin inhibitor which reversibly binds to thrombin activity sites. The combination of them can improve the patient's condition more significantly and safely. Argathorban combined with clopidogrel can significantly improve mRS for acute ischemic stroke patients with no stenosis of middle cerebral artery.

Trial Registration Number

Not applicable

Hide

EARLY INITIATION OF ANTICOAGULATION FOR ISCHEMIC STROKE: CONSIDERATIONS FOR POOLED ANALYSIS OF 3 RANDOMIZED CONTROLLED TRIALS

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
07:10 PM - 07:15 PM

Abstract

Background And Aims

After acute ischemic stroke (AIS) due to Atrial Fibrillation or other embolic etiologies, initiation of anticoagulation to prevent subsequent AIS is often delayed due to concern for hemorrhagic transformation. To date, 3 randomized controlled trials (RCTs) have evaluated early use of direct oral anticoagulation (DOAC) post-ischemic stroke. Our aim is to identify methodological considerations for pooled analysis of these 3 RCTs.

Methods

RCTs evaluated were: AREST (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation), DATAS-II (Dabigatran following Acute TIA and Minor Stroke), and Triple-AXEL (Acute Stroke With Xarelto to Reduce Intracranial Hemorrhage, Recurrent Embolic Stroke, and Hospital Stay). Between-study heterogeneity in participant demographics (age, gender, coronary disease, hypertension, diabetes), time-to-randomization, and NIHSS were evaluated using ANOVA and chi-square tests.

Results

Mean time-to-randomization to apixaban in AREST was 1.9 days for TIA, 2.7 days for small-sized AIS, and 3.8 days for medium-sized AIS; to dabigatran in DATAS-II was 1.8 days; and to rivaroxaban in Triple-AXEL was 2.0 days. Median NIHSS were 3.0, 1.0, and 2.0 and mean ages were 73.5, 66.6, and 70.4 years (p<0.0001), respectively. Heterogeneity across studies was high for the prevalence of coronary disease (p<0.0001), hypertension (p=0.02) and diabetes (p=0.049).

Conclusions

AREST, DATAS-II and Triple-AXEL were each relatively small RCTs, but together in aggregate they may more accurately reflect outcomes with early DOAC therapy. Although feasible, a pooled analysis should account for differences in presenting patient characteristics (including stroke size and NIHSS). This may provide safer decisions on anticoagulation timing post-stroke.

Trial Registration Number

AREST: NCT02283294, TRIPLE AXEL: NCT02042534, DATAS II: NCT02295826

Hide

THE EFFECT OF STATIN USE IN ACUTE ISCHEMIC STROKE PATIENTS TREATED WITH THROMBOLYTIC THERAPY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 2 (E-Poster Area)
Lecture Time
07:15 PM - 07:20 PM

Abstract

Background And Aims

Statins are generally recommended for stroke prevention, however, the effects in acute period are poorly investigated. We studied the effects of statins for the acute ischemic stroke patients after thrombolysis on the stroke outcome considering statin intensity and time window.

Methods

Consecutive stroke patients who received intravenous and/or intra-arterial thrombolysis within 8 hours after index stroke between April 2004 and March 2015 were included. Efficacy outcomes were neurologic improvement (NIHSS ≤ 4 points from baseline or NIHSS=0 at 7 days) and favorable functional outcome at 3 months (mRS ≤ 2), while safety outcomes were neurological deterioration (NIHSS ≥ 4 points from baseline or death at 7days) and symptomatic hemorrhagic transformation (sHT).

Results

Among 323 patients, 229 (70.9%) were treated with statins during admission. On multivariable analysis with an application of inverse probability of treatment weighting based on a propensity score of statin use, statin use was associated with more frequent favorable functional outcomes at 3 months (OR 19.41, 95% CI 2.56–147.32, p<0.01), lower risk of neurologic deterioration (OR 0.14, 95% CI 0.05–0.34, p<0.01), and reduced risk of sHT (OR 0.10, 95% CI 0.04–0.28, p<0.01). Treatment with high-intensity statin (N=97, 42.4%) and early statin use within 24 hours (N=45, 19.6%) were not associated with better efficacy outcomes, but did not increase the risk of sHT.

Conclusions

In patients treated with thrombolysis, statin use in acute phase was associated with better functional outcome and safety. High intensity statin use and early statin use within 24 hours after thrombolysis did not increase the risk of sHT.

Trial Registration Number

Not applicable

Hide