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Abstract Details

Older Age, Hypertension and Diabetes Influence the Proportion of Salvageable Ischemic Tissue Following Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
P02 - (-)
048
BACKGROUND: Increasing age, hypertension(HTN), diabetes(DM), hyperlipidemia, smoking and chronic kidney disease are implicated in endothelial dysfunction. Our hypothesis was that endothelial dysfunction would decrease the penumbra volume in patients with acute ischemic stroke.
DESIGN/METHODS: Patients with ischemic stroke that underwent perfusion computed tomography (PCT) at admission from August 2011 to March 2012 were reviewed. Images were processed using Vitrea庐. Demographics and risk factors were abstracted. PCT protocol included 4 supratentorial slices, 8 mm thick. Areas of increased mean transit time were traced and marked as ischemic area. Corresponding area of preserved cerebral blood volume was labeled as penumbra area. The ischemic and penumbra areas in four slices were added and multiplied by the slice thickness (0.8 cm) to give ischemic volume (IV) and penumbra volume (PV) respectively. The proportion of penumbra (penumbra/ischemia volume) was calculated and compared across the different risk factors.
RESULTS: Of the 47 patients that underwent PCT, 43 (22 males; mean age 61.6 卤12.6 years) had perfusion abnormalities. Subjects younger than 45 years had significantly higher median IV (118.8 cm3 vs. 58.4 cm3; p=0.01) and median PV (97.9 cm3 vs. 38.7 cm3; p<0.01). The median proportion of penumbra, was significantly lower in subjects older than 45 years (72.2% vs. 82.0%; p=0.04). Other factors that demonstrated trends toward a decrease in proportion of penumbra, but did not reach statistical significance due to small numbers: HTN (72.8% vs. 80.0% ; p=0.20) and DM (67.5% vs. 75.7%; p=0.56). In our subset, smoking, hyperlipidemia and kidney disease did not affect the penumbra proportion.
CONCLUSIONS: Older patients and those with HTN or DM are less likely to have a large proportion of salvageable penumbra. While endothelial dysfunction may be a common denominator to these risk factors, the biological mechanisms underlying this phenomenon need to be elucidated.
Authors/Disclosures
Wazim Mohamed, MD (Detroit Medical Center/Wayne State University)
PRESENTER 		Dr. Mohamed has nothing to disclose.
Paul M. George, MD, PhD, MSE, FAAN (Stanford Hospital) Dr. George has received personal compensation in the range of $0-$499 for serving as a Consultant for ConductiveBio. Dr. George has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Law firms. The institution of Dr. George has received research support from Conductive Bio. The institution of Dr. George has received research support from NIH. Dr. George has received intellectual property interests from a discovery or technology relating to health care. Dr. George has received personal compensation in the range of $10,000-$49,999 for serving as a Adjudicator with Baim Insititute. Dr. George has a non-compensated relationship as a Board Member with 好色先生 that is relevant to AAN interests or activities. Dr. George has a non-compensated relationship as a International Stroke Council Program committee member with American Heart Association that is relevant to AAN interests or activities.
Abbas Jowkar, MD (Henry Ford Health System) No disclosure on file
Pratik D. Bhattacharya, MD, MPH (International Medical Clinic) Dr. Bhattacharya has a non-compensated relationship as a Research Advisor with Defeat MSA Alliance 501 (c) (3) that is relevant to AAN interests or activities.