Abstract Details

Title Conservative Management Versus Acute Therapy for Mild Ischemic Stroke Patients with Large Vessel Occlusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 056

Objective

Background BACKGROUND: LVO is a frequent cause and independent predictor of clinical outcome in acute ischemic stroke (AIS). Despite various available treatment modalities, optimal therapy for LVO patients presenting with mild symptoms is not known.

Design/Methods DESIGN/METHODS: Retrospective chart review of AIS patients admitted between January 2010 and August 2011. Inclusion criteria: symptom onset within 8 hours, LVO as cause of symptoms, initial NIHSS < 8. Patient demographics, administered therapies and short term clinical outcomes were analyzed.

Results RESULTS: Sixty-three patients presented within 8 hours of symptoms onset and had NIHSS<8. There was evidence of LVO in 26 patients (41.3%), with involvement of anterior circulation in 18 (28.6%). Ten of the anterior circulation LVO patients (56%) were managed conservatively, while 8 patients (44%) received intra-arterial intervention, IV t-PA or combination. Patients in the conservative arm were older than the acute therapy group (mean age 67.5±19.1 vs 52.1±11.3; p=0.05), but other characteristics [male 50 vs 62.5%; median preadmission modified Rankin score (mRS) of 0 in both groups; vascular risk factors] did not significantly differ. Mean NIHSS on admission in conservative arm was 4.9±2.3 compared to 6±1.2 in acute intervention group (p=0.22). Mean NIHSS on discharge were 3.1±3.5 vs 7±6.6 (p=0.16) in the two groups, respectively. At the 30-day follow-up, mRS?2 was achieved only in 50% of both groups (p=0.82). There was one death in the conservative treatment group.

Conclusions CONCLUSIONS: Acute LVO with mild symptoms remains a therapeutic challenge. Our data shows no striking difference in short term outcomes between acute and conservative treatment groups, but this is a small retrospective analysis. Interestingly, acute therapy was more often administered to younger patients. Since moderate disability is observed on follow-up, we believe that a prospective, larger cohort is warranted to find optimal treatment approach.

Authors/Disclosures
Russell M. Cerejo, MD (Allegheny health Network) PRESENTER	Dr. Cerejo has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Ischemaview.
Esteban Cheng-Ching, MD (Miami Valley Hospital)	Dr. Cheng-Ching has received publishing royalties from a publication relating to health care.
Muhammad S. Hussain, MD (Cleveland Clinic)	Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tiger Medical.
Craig McDonald, MD (UC Davis Dept. of PM&R)	Dr. McDonald has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sarepta Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PTC Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Solid Biosciences. Dr. McDonald has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Solid Biosciences. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edgewise Therapeutics. The institution of Dr. McDonald has received research support from Sarepta Therapeutics. The institution of Dr. McDonald has received research support from PTC Therapeutics. The institution of Dr. McDonald has received research support from Edgewise Therapeutics. The institution of Dr. McDonald has received research support from Capricor Therapeutics. The institution of Dr. McDonald has received research support from Italfarmaco. Dr. McDonald has received research support from NS Pharma. The institution of Dr. McDonald has received research support from NIH (NINDS). The institution of Dr. McDonald has received research support from Parent Project Muscular Dystrophy. The institution of Dr. McDonald has received research support from Muscular Dystrophy Association. Dr. McDonald has received personal compensation in the range of $500-$4,999 for serving as a Member National Advisory Board for Medical Rehabilitation Research with NIH.
Ken Uchino, MD (Cleveland Clinic Foundation)	Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.
	No disclosure on file
Gabor Toth, MD (Cleveland Clinic Foundation)	Dr. Toth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dynamed. Dr. Toth has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Toth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kaneka. Dr. Toth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra.

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