Risultati per: Sindromi coronariche acute

Stroke, Volume 53, Issue Suppl_1, Page A5-A5, February 1, 2022. Context:Current guidelines recommend bed rest for 24 hours after receiving intravenous alteplase which may not be necessary and delay rehabilitation in a large proportion of acute ischemic stroke patients.Objective:To determine the feasibility of “early mobilization protocol” within the intensive care unit (ICU) in patients with acute ischemic stroke who received intravenous alteplase.Methods:All consecutive patients were admitted to the ICU with an acute ischemic stroke who received intravenous alteplase from October 2019-June 2021 were considered for “early mobilization protocol”. Patients≥18 years of age with minor, moderate or severe ischemic stroke (NIHSS score ≤22) were eligible and mobilization was initiated within 13-24 hours after intravenous alteplase administration. Exclusion criteria included hemodynamic instability, on mechanical ventilation, unstable neurological examination or progressive symptoms, or presence of external ventricular drain for hemorrhagic transformation within 24 hours of intravenous alteplase.Results:A total of 137 patients (56.8%) patients were eligible among 241 patients who were admitted to our institution with acute ischemic stroke after receiving intravenous alteplase. Mean age (±SD) was 63.4±16.6 and 66.2±17.0 years for the patients included and excluded in the early mobilization protocol, respectively. The mean NIHSS score (±SD) at baseline was 5.3±4.4 and 9.9±7.3 for the patients included and excluded in the early mobilization protocol, respectively. Early mobilization protocol was initiated at 18.3±3.6 hours in eligible patients compared with routine mobilization initiated at 41.6±19.8 hours in excluded patients (p

Stroke, Volume 53, Issue Suppl_1, Page AWMP29-AWMP29, February 1, 2022. Background:Stroke is the leading cause of disability and the 5th leading cause of death in the US. The advent of tissue plasminogen activator (TPA) was a game changer in the treatment of acute ischemic stroke. Today at Cedars Sinai Medical Center, we have implemented the use of Tenecteplase (TNK) for our Code Brain patients, a more cost-effective, easier- to- use thrombolytic. TNK is non- inferior to TPA and studies show a potential benefit in reperfusion of large vessel occlusions (NEJM, 2018).Hypothesis:To decrease the ED and inpatient door-to-needle (DTN) times, and thrombolytic with thrombectomy (bridge) door-to-groin (DTG) puncture times, by June 20, 2021 using TNK, as measured by data acquired 6 months prior to TNK implementation (July 20, 2020 through January 19, 2021) and data acquired 6 months after TNK implementation (January 20, 2021 through June 20, 2021).Implementation:We performed a retrospective chart review of times for patients who received TNK alone and: for those who received bridge therapy after TNK implementation. These times were compared with 6 months of data prior to TNK implementation.Results:Our review of the data revealed that the median times for ED DTN, in-house DTN and bridge DTP were 46, 61.5, and 98.5 minutes respectively. Data for six months after the implementation of TNK reveals that the median times for ED DTN, in-house DTN and bridge DTP were 48, 51.5, and 88 minutes respectively.Conclusions:We discovered that although ED DTN times were unremarkable, our in-house DTN times and bridge DTP times markedly improved. In fact, for the first time, we have surpassed the American Heart Association benchmark of 90 minutes DTP times. We conclude that TNK is easier to administer, more cost effective, and decreased our treatment times for our in-house Code Brain patients who received TNK alone and our Code brain patients who received bridge therapy. We will continue to track and trend this data and seek out areas of improvement.

Stroke, Volume 53, Issue Suppl_1, Page AWMP6-AWMP6, February 1, 2022. Introduction:It is uncertain whether lowered head position improves penumbral perfusion in ischemic stroke. Although a transcranial Doppler trial in large vessel occlusion (LVO) patients suggested improvement, a large pragmatic clinical trial in mixed stroke patients was neutral. We tested the tolerability and effect on penumbral perfusion of 20-degree head-down (Trendelenburg) positioning in patients with acute LVO stroke using automated quantitative CT perfusion (CTP).Methods:We enrolled LVO patients aged ≥60, 0-24h after onset, with ≥30mL anterior circulation CTP lesion volume (delay time [DT] >3, MISTAR software). CTP was repeated after 5 minutes of 20-degree Trendelenburg positioning using a custom-designed foam wedge. Neurological status (National Institutes of Health Stroke Scale [NIHSS]) and blood pressure were recorded in routine (30 degree up) and Trendelenburg position. Trendelenburg positioning was maintained for 24h if perfusion lesion volume significantly decreased (≥5mL) and reperfusion treatment was suboptimal.Results:The target of 25 patients were enrolled (14 [56%] male, median age 76 (interquartile range [IQR]71-84), baseline modified Rankin scale score 0 [IQR0-0], median NIHSS 20 [IQR 13-24]). Most patients (15/25 [60%]) had an acute M1 middle cerebral artery (MCA) occlusion, 6 (24%) an occluded M2 MCA and 4 (16%) an occluded ICA. Stroke etiology was predominantly (15/25 [60%]) cardioembolic.Median (IQR) DT >3seconds lesion volume was significantly reduced by Trendelenburg compared with conventional horizontal CT positioning (114mL [94-204] vs 149mL [76-153] p=0.0027)). This was not explained by changes in blood pressure, which was unaltered (mean 148mmHg (+/- standard deviation 29) vs 143 (+/-27); p=0.129). Head position did not alter clinical severity (NIHSS 13 [IQR 9-28]) in both positions). A significant lesion volume reduction with Trendelenburg positioning was seen in 15/25 patients (60%); 7 received continued Trendelenburg positioning due to incomplete reperfusion. Head down positioning was well tolerated in the majority (4/7 [57%]), without serious adverse events.Conclusion:Head-down (Trendelenburg) positioning improves penumbral perfusion in acute LVO ischemic stroke and is well-tolerated.

Stroke, Volume 53, Issue Suppl_1, Page AWP249-AWP249, February 1, 2022. Background:Acute hyperglycemia occurs in over 40% of ischemic stroke patients, increases hemorrhagic transformation (HT) and worsens stroke outcome. Previous rodent studies reported deleterious effects of hyperglycemia on stroke outcome during acute stroke (within hours to days), however, its impact during subacute stroke period (days to weeks) remains unclear. Moreover, the mechanisms underlying hyperglycemia’s worsening of stroke outcomes remains elusive. In this study, we investigated the effect of acute hyperglycemia on immune responses and stroke outcome in acute and subacute phases.Method:Male C57/BL6 mice were subjected to middle cerebral artery occlusion (MCAO) for 30 min, followed by reperfusion to mimic ischemic stroke. Acute hyperglycemia was induced by glucose injection 10 min before MCAO. For the acute phase study, mice were sacrificed at 4.5 hrs to assess blood-brain barrier leakage (Evans blue) and brain immune cell populations (flow cytometry), and at 24 hrs to evaluate brain infarct, swelling and HT. In the sub-acute phase, mice were allowed to survive 14 days after stroke to evaluate mortality rate, neurological deficit, and motor-sensory dysfunction using a rotating beam test.Result:In the acute phase, hyperglycemia rapidly increased BBB leakage by 4.5 hrs after stroke, when compared to the normoglycemia group (p

Stroke, Volume 53, Issue Suppl_1, Page ATP192-ATP192, February 1, 2022. Background:Adrenomedullin (AM), an endogenous peptide, is secreted in response to cerebral ischemia, contributing to neuroprotection by exerting anti-inflammatory and vasodilatory effects. Although previous studies showed elevated levels of mid-regional fragment of pro-AM (MR-proAM), a stable marker of AM, predict unfavorable outcome in acute ischemic stroke (AIS), the role of the biomarker remains to be determined.Methods:Firstly, plasma MR-proAM levels were measured in consecutively enrolled patients with AIS within 4.5 hours of the onset and compared with those of healthy controls. Propensity score was used to match the baseline difference. Secondly, variables associated with the increased MR-proAM levels were evaluated in AIS. Finally, it was determined whether MR-proAM levels are associated with a large penumbra which was defined as ICA/M1 occlusion with NIH stroke scale ≥ 6 and ischemic core volume ≤ 50 ml calculated by the RAPID software.Results:MR-proAM levels in AIS (n = 122; median age, 77 years; male, 59%; median NIHSS 6.5) were higher (median 0.68 vs. 0.42 nmol/L, p < 0.001) compared with controls (n = 1298; median age, 58 years; male, 33%). The difference remained after matching of baseline (p=0.004). In patients with AIS, MR-proAM levels were correlated with NIHSS (r = 0.367, p < 0.001) and eGFR (r = -0.527, p < 0.001). MR-proAM levels did not correlate with ischemic core volume (r = 0.065, p = 0.478), but significantly increased in AIS patients with cardioembolic stroke (CES) (n = 53) (0.80 vs. 0.59 nmol/L, p < 0.001) and ICA/M1 occlusion (n = 40) (0.78 vs. 0.63 nmol/L, p = 0.048). Interestingly, MR-proAM levels were higher (0.85 vs. 0.62, p < 0.001) in AIS patients with a large penumbra (n = 24) compared to those without (n = 98), and the difference remained after adjustment of baseline factors (OR [95% confidence interval], 1.43 [1.10-2.02], p = 0.004).Conclusions:MR-proAM levels increase in patients with AIS, especially in those with large vessel occlusion and clinical imaging mismatch. MR-proAM is a potential biomarker for ischemic penumbra.

Stroke, Volume 53, Issue Suppl_1, Page A134-A134, February 1, 2022. Intro & Background:Following the publication of the randomized clinical trials in 2015 and 2018 on endovascular stroke therapy (EVT), procedural utilization has increased. The effect of EVT utilization on clinical outcomes in acute ischemic stroke (AIS) at the population-level, however, remains incompletely characterized.Methods & Materials:We performed a retrospective cross-sectional analysis using the Texas Public Use Data File with records from January 2016 through the first quarter of 2020. This dataset includes full sample data on all patients hospital discharged from all state-licensed hospitals. AIS hospitalizations were identified as those with a primary diagnosis of AIS by ICD-10 diagnostic codes. Patients

Stroke, Volume 53, Issue Suppl_1, Page AWP95-AWP95, February 1, 2022. Background:Acute stroke assessment and management is a time critical process. The emergency “stroke call” should include a standardised NIHSS assessment, initial observations and investigations and a decision regarding thrombolysis and thrombectomy. We found this to be daunting for trainees, and it has been documented that physician experience impacts upon door-to-needle time.Aims:The aim of our simulation training was to provide a safe environment to improve the ability and confidence of trainees in leading stroke calls with a view to improving acute stroke care and patient access to revascularization therapies.Method:We designed a one-day simulation course aimed at internal medicine trainees who are expected to lead stroke calls currently or in the immediate future. The candidates are surveyed to establish baseline confidence and complete questionnaires to assess knowledge about managing acute strokes. Here we present data from the first 18 attendees. The course is led by stroke consultants, assisted by members of the multidisciplinary team, including medical trainees, stroke specialist nurses and a paramedic. Alongside structured seminars, simulated acute stroke scenarios lead each candidate through patient handover, assessment, investigation and management decisions followed by a structured debrief. Clinical results, equipment and live monitoring are used to increase the fidelity of the simulation.Results:The course improved candidates’ confidence in leading a thrombolysis call from a mean of 2.83/10 to 7.11/10, found to be statistically significant on Paired T-Test(t=9.69, p=

Stroke, Volume 53, Issue Suppl_1, Page AWMP1-AWMP1, February 1, 2022. Approved thrombolytic agents are limited in their use for the treatment of acute ischemic stroke (AIS) due to their benefit-risk profile beyond 4.5 h since last known normal (LKN). TMS-007 is a small molecule, SMTP family member with a novel mode of action: promotion of plasminogen-fibrin binding to enhance physiological thrombolysis while inhibiting inflammation at the site of thrombosis. TMS-007 may extend the treatment time window based on nonclinical pharmacological evidence. We evaluated TMS-007 in a randomized, placebo-controlled, double-blind, dose-escalation phase 2a study. TMS-007 or placebo was administered as a single intravenous infusion at a dose of 1, 3, or 6 mg/kg to AIS patients who were ineligible for t-PA or thrombectomy within 12 h of LKN. The number of patients allocated to placebo and TMS-007 at doses 1, 3, and 6 mg/kg were 38, 6, 18, and 28, respectively. The combined TMS-007 dosing group (Group T; n = 52) was compared with placebo group (Group P; n = 38). The average age was ~72 years old and time since LKN to treatment was ~9 h in both groups (not significantly different). The incidence of symptomatic intracranial hemorrhage (ICH) with worsening NIHSS score of

Stroke, Volume 53, Issue Suppl_1, Page ATP6-ATP6, February 1, 2022. Background:Thrombolysis remains underutilized for acute ischemic stroke (AIS) in healthcare systems in low- and middle-income countries.Aims:We aimed to investigate the factors associated with utilization of intravenous thrombolysis in an academic medical center in Lebanon.Methods:Patients presenting to a tertiary medical center in Lebanon between January 2015 and October 2019 were reviewed. Inclusion criteria were age greater than 18 years and presenting to the emergency department within 48 hours from last known well. Patient, disease, and health system response characteristics were collected and those eligible for and those who received thrombolysis within 4.5 hours onset by guidelines criteria were identified by chart review. Descriptive statistics, bivariate and multivariate analyses were performed for association with thrombolysis administration.Results:Of 373 AIS patients presenting within 48 hours of onset to the hospital, 65 (17.4%) were deemed to be candidates for thrombolysis. Forty (61.5% of eligible) received thrombolysis. Those receiving thrombolysis compared to eligible but not receiving thrombolysis were younger (median 72 vs 86, p=0.018), had higher NIHSS (median 11.5 vs 7, p=0.032), had greater likelihood of stroke code activation (79% vs 41%, p=0.011), and no anti-platelet use (22.5% vs 56%, p=0.021). The multivariate analysis showed that thrombolysis among eligible patients associated with younger age (OR 1.05 [1.01-1.10], p=0.029), a higher NIHSS (OR 1.12 [1.01-1.25], p=0.041), and stroke code activation (OR 2.81 [1.16-6.81], P=0.022).Conclusion:A good proportion of eligible AIS patients did not receive thrombolysis. To increase thrombolysis use in low- and middle-income countries, more consistent stroke code activation and education on age and stroke severity in eligibility are needed.

Stroke, Volume 53, Issue Suppl_1, Page A23-A23, February 1, 2022. Backgound:In 2011, nearly 20% of Americans lacked timely access to alteplase-capable hospitals. We update this work by assessing access to stroke centers and emergency departments (EDs) with telestroke capacity. Our objectives are to identify all US EDs with acute stroke capabilities (i.e., in a confirmed stroke center or with telestroke capacity), and to characterize the proportion of the US population with access to an ED with either capacity.Methods:We used the 2019 National ED Inventory-USA to identify all US EDs and characterize stroke capabilities by hospital stroke center status (none, acute stroke ready hospital [ASRH], primary stroke center [PSC], thrombectomy-capable or comprehensive stroke center [TSC/CSC]) and telestroke capacity. We used 2020 US Census data for census block group population and centroid. For each block group, we used ArcGIS to assess whether an ED with stroke expertise was within a 60 minute (min) response and transport time by ground emergency medical services (EMS). To determine the transport time, we used data from actual EMS stroke transports using the 2019 National EMS Information System with median EMS dispatch, response, and scene times in access calculations.Results:Of 5,587 US EDs, 2,563 (46%) were in a stroke center (691 ASRH, 1,505 PSC, 367 TSC/CSC); of these, 55% also had telestroke capacity. Of the 3,024 (54%) that were not a confirmed stroke center, 36% had telestroke. We estimate that 91% of the US population is within 60 min of a confirmed stroke center by ground EMS and 96% is within 60 min of a confirmed stroke center or telestroke ED (Figure). The percentage of the population without access to a confirmed stroke center or telestroke ED varied by region, from 1% in the Middle Atlantic to 9% in the West Mountain.Conclusion:Relative to previous reports, an increasing proportion of the US population has access to acute stroke expertise. While geographic disparities in access remain, telestroke plays an important role in filling this gap.

Stroke, Volume 53, Issue Suppl_1, Page AWP67-AWP67, February 1, 2022. Background and Purpose:Repetitive transcranial magnetic stimulation (rTMS) in chronic intracranial hemorrhage (ICH) is beneficial, it has been poorly investigated in rTMS for acute ICH. Our aim is to investigate safety and effects of rTMS in acute ICH.Methods:We prospectively performed high-frequency rTMS to consecutive patients with acute ICH within 24 hours from onset between April 2019 and March 2021. Exclusion criteria were: 1) subcortical ICH; 2) ventricular perforation; 3) history of symptomatic stroke; 4) surgical management for ICH; 5) disturbance of consciousness; 6) over 80 years old at admission; and 7) convulsion after onset. Inclusion criterion was 1) persistent paralysis with a NIHSS scale 1 of higher for at least 3 days after onset. The comparison was made with historical control group; patients who met the same criteria between April 2016 and March 2019. We evaluated incidence of epilepsy and exacerbation of NIHSS score in rTMS group. We also compared clinical background and outcome among groups.Results:A total of 40 patients (29 male, median age 56 years, median NIHSS score on admission 13) were enrolled. Of them, 18 patients (45%) were rTMS group. The median (IQR) time from onset to the start of rTMS is 9 (6-12) days. There were no case of epilepsy or exacerbation of NIHSS after the start of rTMS. There were no significant differences in median age (54 years vs 57 years, p=0.70), median hemorrhage volume at admission (9.3 ml vs 11.3 ml, p=0.43) or median NIHSS score on admission (13 vs 12, p=0.99) among groups. Favorable 90 days outcome (modified Rankin Scale score of 0-2) was frequently observed in rTMS group (67% vs 27%, p = 0.02).Conclusion:High-frequency rTMS may be safe and effective in acute intracranial hemorrhage patients.

Stroke, Volume 53, Issue Suppl_1, Page AWP25-AWP25, February 1, 2022. Objectives:Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy).Materials and Methods:We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders.Results:Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p=0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p=0.9) or death or non-routine discharge (p=0.2).Conclusions:Patients with acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.

Stroke, Volume 53, Issue Suppl_1, Page AWP73-AWP73, February 1, 2022. Background:Prior research with the National Inpatient Sample (NIS) has shown that women are less likely than men to receive to receive intravenous Alteplase (tPA) for acute ischemic stroke, but more recent analyses have found conflicting results and patient age has not been taken into account, nor has stroke severity.Methods:We included patients in the NIS from 2016-18 with a primary discharge diagnosis of ischemic stroke and who had an admission NIH Stroke Scale (NIHSS). The primary outcome was receipt of tPA and the exposure was patient sex. After survey weighting, we fit logistic regression models adjusted for age, race/ethnicity, NIHSS, patient income by ZIP code, hospital teaching status, hospital Census region, and hospital location according to the NCHS Urban-Rural Classification. We included interactions between our covariates and the exposure of sex.Results:After weighting, we included 384,700 patients, of which 15.1% received tPA and 49.1% were female. The rate of tPA was identical (15.1%) between male and female patients (p=0.880). In the multivariable logistic regression model, female sex had an odds ratio for tPA of 0.97 (95% CI 0.93, 1.01, p=0.163). The only covariate that had a significant interaction with sex was age (p

Stroke, Volume 53, Issue Suppl_1, Page ATMP119-ATMP119, February 1, 2022. Background:Sufficient understanding of the systemic inflammatory response after stroke will make the therapeutic strategy targeting inflammation more feasible. Here, we aimed to identify the globally alterations of circulating cytokines in super-acute ischemic stroke (AIS).Methods:A broad panel of 65 cytokines was measured in the plasma of twenty-eight AIS patients within 6 hours after stroke onset (n=28), cerebral hemorrhagic patients (n=28) and healthy controls (n=18). The diagnostic power of the candidate cytokines and their relationship with the number of lymphocytes and neutrophils were analyzed by receiver operating characteristic (ROC) and spearman rank correlation respectively.Results:The expression level of plasma IL-1beta, IL-2, IL-2R, IL-5, IL-10, CD40L, HGF, MIP-3alpha and MMP-1 were obviously up-regulated, while IL-16 was down-regulated in AIS patients compared to healthy controls. Among them, IL-2R, IL-10, IL-16, MIP-3alpha, and MMP-1 were specially altered in AIS patients, while IL-1beta, IL-2, IL-5, CD40L and HGF were elevated simultaneously in AIS patients and hemorrhagic stroke patients. Interestingly, IL-6 and TNF-beta were found to be key cytokines among the 65 inflammatory factors to distinguish cerebral hemorrhage from ischemia. Furthermore, plasma IL-1beta, IL-16, CD40L and HGF were obviously correlated with the number of lymphocytes, and IL-1beta and IL-16 were significantly associated with the number of neutrophils in AIS patients. These results suggest that lymphocytes and neutrophils associated inflammation may play a pivotal role in AIS.Conclusions:These significantly changed inflammatory mediators could serve as biomarkers for AIS diagnosis. More importantly, except for some mutual pathological processes, AIS and hemorrhage had their own distinctive pathogenesis, and transformation of this knowledge to further research may provide novel treatment strategy for AIS.

Stroke, Volume 53, Issue Suppl_1, Page AWP209-AWP209, February 1, 2022. Background:The optimal timing for the initiation of anticoagulation in patients with acute ischemic stroke (AIS) related to atrial fibrillation (AF) remains uncertain. Observational studies assessing early anticoagulant initiation (≤14 days after index AIS) have provided conflicting results from the early use of non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs).Methods:We performed a meta-analysis of prospective observational studies and RCTs to assess the efficacy and safety of early anticoagulation in AF-related AIS. We also compared the efficacy and safety between NOAC and VKA regimens. A random-effects model was used to pool the individual risk ratios (RRs) and corresponding 95% confidence intervals (CIs) between the two groups. Recurrent ischemic stroke was defined as the primary outcome.Results:Nine eligible studies (7 observational, 2 RCTs) were identified, including 6,840 patients with AF-related AIS (pooled mean baseline NIHSS score: 5.5; 95%CI: 3.7-7.2) who received early anticoagulation. The overall ischemic stroke recurrence rate was 5% (95%CI: 3.3-7%) and differed (p=0.05) between studies reporting anticoagulation initiation within a week (2.5%, 95%CI: 0.2-7.4%) or two weeks (6.7%, 95%CI:4.6-9.1%) from index event. The corresponding proportions of patients experiencing a fatal outcome, symptomatic or asymptomatic ICH were 4% (95%CI: 1.6-7.5%), 1.2% (95%CI: 0.3-2.6%) and 13.2% (95%CI: 6.4-22.1%), respectively. Of the 2 identified RCTs, 136 and 135 patients were randomized to early anticoagulation with NOAC or VKA, respectively. Both groups had a similar risk for ischemic stroke recurrence (RR=0.78; 95%CI: 0.32, 1.91; p=0.59). No significant differences were uncovered between early NOAC or early VKA treatment initiation for the outcomes of mortality (RR=0.57; 95%CI: 0.11, 2.97; p=0.51), symptomatic ICH (RR=0.38; 95%CI: 0.02, 9.10; p=0.55) or asymptomatic ICH (RR=1.10; 95%CI: 0.73, 1.67; p=0.64).Conclusions:Preliminary evidence from RCTs on early anticoagulation after AF-related AIS suggest that NOACs have comparable efficacy to VKAs in preventing ischemic stroke recurrence. Large scale RCTs are warranted to evaluate the potential superiority of NOACs in terms of safety endpoints.

Stroke, Volume 53, Issue Suppl_1, Page A128-A128, February 1, 2022. Introduction:In acute ischemic stroke, perfusion imaging facilitates detection of the occluded vessels, influences decision-making regarding therapy options, and is recommended especially in delayed time windows. In contrast to conventional CT perfusion (CTP), flat panel detector CT perfusion (FD-CTP) can be acquired directly in the angio suite. To evaluate FD-CTP imaging, we assessed clinically important qualitative and quantitative perfusion parameters in correlation to prior acquired conventional CTP using the new RAPID for Angio software.Methods:We included patients with ICA-, M1, or M2-occlusions from 6 centers. All patients underwent mechanical thrombectomy (MT) with pre-interventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch volume. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case for conventional CTP and FD-CTP imaging. A blinded reader identified the occlusion site based on visual inspection of the FD-CTP maps.Results:We included 77 patients and FD-CTP was technical adequate in 49 patients (63.6%). The final analysis included 20 patients (further reasons for exclusion were n=20 technical inadequate conventional CTP, n=2 reperfusion between scans, n=2 exceeding the time limit between scans, n=2 posterior occlusion and n=3 MRI-perfusion). Conventional rCBF 6s and CTP Mismatch/FD-CTP Mismatch showed more variability (R2= 0.57, and R2= 0.33 respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria in contrast to 18/20 (90%) patients based on conventional CTP. A blinded reader correctly determined the specific vessel occlusions in 34/38 cases (89.5%).Conclusion:In our multicenter study, time-resolved whole-brain FD-CTP was technically feasible and qualitative and quantitative perfusion results correlated overall well with conventional CTP. This potentially enables a direct to the angio approach to be established and may increase the chances of good clinical outcome.