1306 circulating levels of nitric oxide in stroke

1
Poster Abstracts Thursday, November 10, 2005 $433 left middle cerebral narrowing in 22% and Basilar stenosis in 4%. Poor temporal windows were seen in 17%. Mild or moderate TCD-defined vasospasm developed in 30% and 20% developed severe TCD-defined vasospasm after 7-8 days. TCD abnormalities preceding tire focal neurological deficits by 3 days in 30%. Conclusions: A high incidence of intracranial stenosis were present. Sonothrombolysis enhances the benefits of iv TPA. TCD may be helpful in selecting patients for intra-arterial thrombolysis. Since TCD- defined vasospasm preceded the neurological deficit in patients with SAH, early intervention might reduce the incidence of vasospasm- related stroke. 1306 Circulating Levels of Nitric oxide in Stroke Nandhagopal, R ~, Krishnanroorthy, SG a, Venganmm B :, Shyam Singh 1, Latheef SAA a, Subramanyanr G 1. 1Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India Background: Physiologically, nitric oxide is a key signaling molecule in cerebral vasoregulation. Its role in the evolution of stroke is multifaceted. The purpose of this study is to evaluate the serum levels of nitric oxide in different subtypes of acute stroke. Method: Forty consecutive patients diagnosed as having ischemic or hemorrhagic stroke were evaluated with NIH stroke scale and Oxfordshire Community Stroke Project classification. Nitric oxide was measured in the serum, collected within twenty four hours of admission, as total nitrites. Result: Twenty eight patients had ischemic stroke either involving tire anterior or posterior circulation and eight had intracerebral hemor- rhage. Cerebral sino-venous thrombosis was diagnosed in four patients. Serum nitric oxide was found to be decreased (iJ < 0.026) when compared with the healthy controls (140.9 ± 3.9 vs. 59.9 ± 7.3/~mol/L). Conclusion: Circulating levels of nitric oxide fall in the different types of acute stroke syndromes. It could serve as a potential marker in tire therapeutic stroke trials. 1307 Surgical versus conservative trealrnent in the management of spontaneous Intraeerebral Hemorrhage in adults: a retrospective study Ranlos, R a, Matila, R a, Diaz, A 1. 1Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines Background: To evaluate patients who suffered from supratentorial spontaneous intracerebral hemorrhage (SICH), treated either surgi- cally or Conservatively, and to detemfine outcome in terms of tire Glasgow Coma Scale (GCS) score and blood pressure on admission, age, sex, volume of the hematoma, and the presence of intraventricular extension (lIVE) and hydrocephalus on cralfial CI" scan. Methods: We evaluated the hospital case records and cranial CT scans of adult patients diagnosed with SICH admitted in a tertiary hospital between January 2003 and August 2004. Results: Among 133 adult patients, twenty (15%) were surgically treated Mille 113 (85"/0) were managed conservatively. Age, volume of hematoma and area of henlatoma were found to be significantly different between the surgically and medically-treated groups with p-values less than the level of significance of 0.05 (0.008, 0.009 and 0.014, respectively). In tire medical group, the variables that were found to be significantly different between discharged and expired subjects were the GCS, volunre of hematoma, area of hematoma, and the presence of IVE and hydrocephalus with computed p-values less than the level of significance (0.000, 0.000, 0.001 and 0.000, res- pectively). In the surgical group, no variables were found to be significantly different between discharged and expired subjects. Conclusion: Neither medical nor surgical managenlent is superior over the other in the treatnrent of SICH. The GCS score, volume and area of henratoma, and the presence of IVE and hydrocephalus are predictors of outcome for patients treated conservatively. Surgery may not be helpful in improving the outcome of these patients. 1308 A single centre experience of Endovascular Carotid intervention since 1993: long-term event free survival rates Randall, M ~, McKevitt, F ~, Cleveland, T ~, Gaines, P~, Venables, G ~. 1Royal Hallarnshire Hospital, Sheffield, England; 2Northern General Hospital, Sheffi'eld, England Background: Endovascular intervention for symptomatic carotid stenosis (NASCET/ECST criteria) has been performed at tire Sheffield Vascular Institute for 12 years. Two radiologists TJC and PAG have over 590 cases experience between them. This study reviews the long- term follow up of these cases. Method: A nrultidisciplinary teanl of neurologists, surgeons, and radiologists selected patients for carotid stenting. Procedures were performed using recommended stentnig techniques and medications at the time ozf the procedure. Data was prospectively collected for the database. Some of the procedures were performed as part of ongoing randomised trials. Yearly outcomes for index events and stent res- tenosis were recorded. All index events were classified by a neurologist. Results: 420 carotid stenting procedures have been perforated in symptomatic individuals. Follow data of up to 5 years was available for review. Mean follow up 2.54 yrs median 2 yrs. Mean event free survival for stroke or death of all causes was 3.98 yrs (CI 3.8 - 4.17) and 4.1 yrs (CI 3.92 - 4.27) if only ipsilateral stroke is considered (Kaplan Meier). The use of a Statin (Log Rank 6.61 p - 0.01) at the time of stenting appears to have a beneficial effect on long term survival. Conehision: Our registry provides strong data to support the continued use of carotid stenting in symptomatic patients as part of randomized trials. Our non randomized patient group has similar long term outcomes when compared to tile data from previous carotid endar- terectonly and stenting trials. The database has also highlighted the importance of medical therapy in addition to the stenting procedure. 1309 COillpa~son of TranseXanial Doppler and Magnetic Resonance Angiography in tile assessment of IntraCranial Vasculature in Acute Isdlemie Stroke Raihakrishnan, R z, Sharma, V 1, Sect, R 1 , Chart, B 1, Ong, B 1 . 2Divisian of Neurology, National University Hospital, Singapore Background: Transcratfial Doppler (TCD) and magnetic resonance angiography (MRA) are widely used non-invasive methods of assessing intracratfial vasculature in stroke. We aimed to investigate tile Correlation between TCD and MRA in assessing intracranial stenosis in acute stroke patients in this study. Methods: Patients with acute ischaernic stroke presented to the Neurology Division, National University Hospital, Singapore, from November 2004 to March 2005 who underwent both TCD and MRA were included. Previously published peak velocity criteria were used for diagnosis in TCD, and visual inspection of MRA was performed. Stenoses _>50% or occlusion of a major intracranial artery were considered significant. The results of both studies on each major intracranial artery were cross-tabulated and Ctfi square test was used for statistical analysis. Results: 60 patients of equal gender proportions were included. 26 (43%) had suboptimal or absent temporal windows on TCD, 18 (69%) were females and 17 (58%) were older than 60 years. There was significant correlation between TCD and MRA when examining internal carotid artery siphons (p < 0.001), M1 segments of middle cerebral arteries (right p - 0.03, left p < 0.001), A1 segments of anterior cerebral arteries (p - 0.03) and intracralfial vertebrobasilar arteries (p < 0.001).

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Poster Abstracts Thursday, November 10, 2005 $433

left middle cerebral narrowing in 22% and Basilar stenosis in 4%. Poor temporal windows were seen in 17%. Mild or moderate TCD-defined vasospasm developed in 30% and 20% developed severe TCD-defined vasospasm after 7-8 days. TCD abnormalities preceding tire focal neurological deficits by 3 days in 30%. Conclusions: A high incidence of intracranial stenosis were present. Sonothrombolysis enhances the benefits of iv TPA. TCD may be helpful in selecting patients for intra-arterial thrombolysis. Since TCD- defined vasospasm preceded the neurological deficit in patients with SAH, early intervention might reduce the incidence of vasospasm- related stroke.

1306 Circulating Levels of Nitric oxide in Stroke

Nandhagopal, R ~, Krishnanroorthy, SG a, Venganmm B :, Shyam Singh 1, Latheef SAA a, Subramanyanr G 1. 1Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: Physiologically, nitric oxide is a key signaling molecule in cerebral vasoregulation. Its role in the evolution of stroke is multifaceted. The purpose of this study is to evaluate the serum levels of nitric oxide in different subtypes of acute stroke. Method: Forty consecutive patients diagnosed as having ischemic or hemorrhagic stroke were evaluated with NIH stroke scale and Oxfordshire Community Stroke Project classification. Nitric oxide was measured in the serum, collected within twenty four hours of admission, as total nitrites. Result: Twenty eight patients had ischemic stroke either involving tire anterior or posterior circulation and eight had intracerebral hemor- rhage. Cerebral sino-venous thrombosis was diagnosed in four patients. Serum nitric oxide was found to be decreased (iJ < 0.026) when compared with the healthy controls (140.9 ± 3.9 vs. 59.9 ± 7.3/~mol/L). Conclusion: Circulating levels of nitric oxide fall in the different types of acute stroke syndromes. It could serve as a potential marker in tire therapeutic stroke trials.

1307 Surgical versus conservative trealrnent in the management of spontaneous Intraeerebral Hemorrhage in adults: a retrospective study

Ranlos, R a, Matila, R a, Diaz, A 1. 1Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines

Background: To evaluate patients who suffered from supratentorial spontaneous intracerebral hemorrhage (SICH), treated either surgi- cally or Conservatively, and to detemfine outcome in terms of tire Glasgow Coma Scale (GCS) score and blood pressure on admission, age, sex, volume of the hematoma, and the presence of intraventricular extension (lIVE) and hydrocephalus on cralfial CI" scan. Methods: We evaluated the hospital case records and cranial CT scans of adult patients diagnosed with SICH admitted in a tertiary hospital between January 2003 and August 2004. Results: Among 133 adult patients, twenty (15%) were surgically treated Mille 113 (85"/0) were managed conservatively. Age, volume of hematoma and area of henlatoma were found to be significantly different between the surgically and medically-treated groups with p-values less than the level of significance of 0.05 (0.008, 0.009 and 0.014, respectively). In tire medical group, the variables that were found to be significantly different between discharged and expired subjects were the GCS, volunre of hematoma, area of hematoma, and the presence of IVE and hydrocephalus with computed p-values less than the level of significance (0.000, 0.000, 0.001 and 0.000, res- pectively). In the surgical group, no variables were found to be significantly different between discharged and expired subjects. Conclusion: Neither medical nor surgical managenlent is superior over the other in the treatnrent of SICH. The GCS score, volume and area of henratoma, and the presence of IVE and hydrocephalus are

predictors of outcome for patients treated conservatively. Surgery may not be helpful in improving the outcome of these patients.

1308 A single centre experience of Endovascular Carotid intervention since 1993: long-term event free survival rates

Randall, M ~, McKevitt, F ~, Cleveland, T ~, Gaines, P~, Venables, G ~. 1Royal Hallarnshire Hospital, Sheffield, England; 2Northern General Hospital, Sheffi'eld, England

Background: Endovascular intervention for symptomatic carotid stenosis (NASCET/ECST criteria) has been performed at tire Sheffield Vascular Institute for 12 years. Two radiologists TJC and PAG have over 590 cases experience between them. This study reviews the long- term follow up of these cases. Method: A nrultidisciplinary teanl of neurologists, surgeons, and radiologists selected patients for carotid stenting. Procedures were performed using recommended stentnig techniques and medications at the time ozf the procedure. Data was prospectively collected for the database. Some of the procedures were performed as part of ongoing randomised trials. Yearly outcomes for index events and stent res- tenosis were recorded. All index events were classified by a neurologist. Results: 420 carotid stenting procedures have been perforated in symptomatic individuals. Follow data of up to 5 years was available for review. Mean follow up 2.54 yrs median 2 yrs. Mean event free survival for stroke or death of all causes was 3.98 yrs (CI 3.8 - 4.17) and 4.1 yrs (CI 3.92 - 4.27) if only ipsilateral stroke is considered (Kaplan Meier). The use of a Statin (Log Rank 6.61 p - 0.01) at the time of stenting appears to have a beneficial effect on long term survival. Conehision: Our registry provides strong data to support the continued use of carotid stenting in symptomatic patients as part o f randomized trials. Our non randomized patient group has similar long term outcomes when compared to tile data from previous carotid endar- terectonly and stenting trials. The database has also highlighted the importance of medical therapy in addition to the stenting procedure.

1309 COillpa~son of TranseXanial Doppler and Magnetic Resonance Angiography in tile assessment of IntraCranial Vasculature in Acute Isdlemie Stroke

Raihakrishnan, R z, Sharma, V 1, Sect, R 1 , Chart, B 1, Ong, B 1 . 2Divisian of Neurology, National University Hospital, Singapore

Background: Transcratfial Doppler (TCD) and magnetic resonance angiography (MRA) are widely used non-invasive methods of assessing intracratfial vasculature in stroke. We aimed to investigate tile Correlation between TCD and M R A in assessing intracranial stenosis in acute stroke patients in this study. Methods: Patients with acute ischaernic stroke presented to the Neurology Division, National University Hospital, Singapore, from November 2004 to March 2005 who underwent both TCD and MRA were included. Previously published peak velocity criteria were used for diagnosis in TCD, and visual inspection of M R A was performed. Stenoses _>50% or occlusion of a major intracranial artery were considered significant. The results of both studies on each major intracranial artery were cross-tabulated and Ctfi square test was used for statistical analysis. Results: 60 patients of equal gender proportions were included. 26 (43%) had suboptimal or absent temporal windows on TCD, 18 (69%) were females and 17 (58%) were older than 60 years. There was significant correlation between TCD and MRA when examining internal carotid artery siphons (p < 0.001), M1 segments of middle cerebral arteries (right p - 0.03, left p < 0.001), A1 segments of anterior cerebral arteries (p - 0.03) and intracralfial vertebrobasilar arteries (p < 0.001).