1
Poster Abstracts Thursday, November 10, 2005 $449 Background: There is increased evidence for the contribution of oxidative stress to ischemia/reperfusion-induced damage in a conse- cutive two-phase pattern: an immediate direct cytotoxic effects and subsequent redox-mediated inflammatory insult. The present study was designed to assess the neuroprotective mechanisms of edaravone, a novel free radical scavenger, through attti-oxidative and attti-inflam- matory pathways, from the early period to up to 7 days after ischemia/ reperfusion in mice. Methods: Mice were subjected to 60-rain ischemia followed by reperfusion. They were divided into the edaravone group (n - 72) and the vehicle (control) group (n - 36). Infarct volume and neurological deficit scores were evaluated at several time points after ischemia. Immunohistochemical analysis for 4-hydroxy-2-nonenal (HNE), 8-hydroxy-deoxyguanosine (8-OHdG), Iba-l, inducible nitric oxide synthase (iNOS), and nitrotyrosine were performed at 24 hours, 72 hours or 7 days after reperfusion. Result: Edaravone, even when adnffnistrated 6 hours after onset of ischemia/reperfusion, significantly reduced the infarct volume (68.10 ± 6.24%, P < 0.05) and improved the neurological deficit scores (P < 0.05) at 24 hours after reperfusion. Edaravone markedly suppressed the accumulation of HNE modified protein and 8-OHdG at the penumbra area during the early period after reperfusion (P < 0.05), and reduced microglial activation, iNOS expression and nitrotyrosine formation at the late period. Conclusion: We demonstrated that edaravone has anti-oxidant properties as well as anti-inflammatory effects resulting in reduction of iNOS production. Both actions are important for the neuropro- tective effects of edaravone in stroke. Our results are considered important for extension of the therapeutic time window in acute cerebral ischemia. 1372 Intravenous Thrombolytic Therapy in Acute Ischemic Stroke in a University Hospital of South India Prasad V ~, Kaul S ~, Meena A ~, Suvarna S 1, Jayalakstmff S 1, Jayanthi M 1, Borgohain R 1. 1Nizam's Institute of Medical Sciences ~, Panjagutta, Hyderabad, India Background: Use of thrombolytic therapy for ischenffc stroke in India is limited. We report our experience of recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke at a University hospital in south India. Methods: Data of patients of acute ischemic stroke treated with rt-PA consecutively, as per the criteria of National Institute of Neurological diseases and stroke (NINDS), between September 2000 to February 2003 was analyzed. Neurological status was measured with the National Institute of Health Stroke Scale (NIHSS) at baseline, at 24 hours, and at 7 days after the administration of rt-PA. Results: Out of 2100 patients of stroke admitted in the Nizam's Institute of Medical Sciences, a University hospital, only 60 patients (3%) reached hospital within 3 hours of onset, of whom, 30 patients received rt-PA. The causes of non-adnffrdstration were intracerebral hemorrhage (10), non-aftbrdability (10), uncontrolled hypertension (2) and reluctance to accept the risk of complications (8). Among the patients who received thrombolytic treatment, there were 20 men and 10 women (mean age 48 years; range 31-67). Two patients (7%) died of intracerebral hemorrhage. The NIHSS scores of survived patients at baseline, 24 hours and day 7 were 10,4 and 2.4 respectively. Conclusion: Very few stroke patients reach hospital within the window period. Among these about a half do not get treatment due to high cost and fear of complications. The outcome in thrombolysed patients are comparable to those reported in NINDS study. 1373 Risk factors and detemliuants of mortality in patients of Intracerebral Hemorrhage in a Tertiary Hospital in South ImUa P~asad V l, Srinivas B ~ , Keerthi AS 1, Sita Jayalakshmi S 1, Meena AK ~ , Borgahain R ~, Kaul S ~ . 1Nizam's Institute of Medical SeieneeJ, Panjagutta, Hyderabad, India Background: Tiffs study aims to find the risk factors and determinants of mortality in patients of Intracerebral hemorrhage (ICH) from India as limited information is available on this subject. Methods: One year data on all patients of CT proved ICH admitted in Nizam's Institute of Medical Sciences, a tertiary referral center and the main Ulffversity hospital of Indian city of Hyderabad, was analyzed. Comparison of parameters was made between the survivors and dead patients. Results: ICH constituted 150 out of 549 (27%) stroke patients admitted between February 2004 and January 2005. Mean age of ICH patients was 53 years (range 22 to 82). The male to female ratio was 2.3:1. The risk factors constituted hypertension in 134 (89%), amyloid angiopathy 5 (3%), vascular malformations 5 (3%). Mean hospital stay was 9 days. Overall mortality was 49 (33%). Factors associated with mortality were increased age, low Glasgow Coma Scale (< 7), renal impairment, basal ganglionic involvement, and initial hematoma volume, midlnie shift and hydrocephalus on CT scan brain. Metabolic abnormalities and infections did not contribute to mortality. Surgical evacuation of hematoma was done in 44 patients out of whom 28 (64%) survived. Conehision: ICH constituted more than one fourth of all stroke patients. Mean age was less than reported from west. Hypertension was the commonest risk factor. Initial low level of consciousness, bigger hematoma volume and basal gangliordc location with midline shift were bad prognostic factors. Aggressive management of infec- tions, correction of dyselectrolytemia and early surgical evacuation led to successful outcome. 1374 rtPA Treatment in Acute Ischemic Stroke and outcome in a University Hospital in India ] ] 1 Prasad V l, Srinivas B ~, Keerthi AS , Sita Jayalakshmi S , Meena AK , Borgahain R 1, Kaul S 1 . ~Nizam's Institute of Medical ScienceJ, Panjagutta, Hyderaba, India Background: There are concerns regarding the feasibility of thrombolytic therapy for acute ischemic stroke (AIS) in an Indian setting. This study aims to present our experience of rt-PA in AIS patients at the main University hospital referral center at Hyderabad, India. Methods: Data of patients of AIS treated with rt-PA consecutively, between August 2000 and Dec 2004 was analyzed. The enrollment criteria and management protocol were the same as those at National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trials. Neurological status was measured with the National Institute of Health Stroke Scale (NIHSS) at baseline, at 24 hours, 7 days, 3 months and 1 year. Barthel index and Rankin's score were measured at 3 months and 1 year after the administration of rt-PA. Results: Thirtyseven patients with a mean age of 48 years were treated within a period of 53 months. Six patients (16.2%) died within first seven days after admission [2 of ICH (5.4%), 2 of malignant cerebral edema (5.4°,5), 1 of recurrent massive stroke (2.7°,5) and 1 of severe LVF (2.7°,5)]. The mean NIHSS scores at baseline, 24 hours, day 7, 3 months and 1 year were 13.6, 7.8, 6.3, 2.3 and 1.4 out of 37, 37, 31, 29 and 29 patients respectively. The Barthel index among survivors 0a - 29) at 3 months and 1 year was 88.4 and 84.8), respectively. Conehisions: Intravenous thrombolysis with rt-PA for acute stroke patients was feasible in a University Hospital setting in India and the outcome was comparable to that in NINDS study. 1375 Pre-ischenlic treatment of Pentoxitylline reduces cortical and striatal infarcts vohune in rat model of Focal Cerebral ISdleufia

1372 Intravenous thrombolytic therapy in acute ischemic stroke in a university hospital of South India

Embed Size (px)

Citation preview

Page 1: 1372 Intravenous thrombolytic therapy in acute ischemic stroke in a university hospital of South India

Poster Abstracts Thursday, November 10, 2005 $449

Background: There is increased evidence for the contribution of oxidative stress to ischemia/reperfusion-induced damage in a conse- cutive two-phase pattern: an immediate direct cytotoxic effects and subsequent redox-mediated inf lammatory insult. The present study was designed to assess the neuroprotective mechanisms of edaravone, a novel free radical scavenger, through attti-oxidative and attti-inflam- matory pathways, from the early period to up to 7 days after ischemia/ reperfusion in mice. Methods: Mice were subjected to 60-rain ischemia followed by reperfusion. They were divided into the edaravone group (n - 72) and the vehicle (control) group (n - 36). Infarct volume and neurological deficit scores were evaluated at several time points after ischemia. Immunohistochemical analysis for 4-hydroxy-2-nonenal (HNE), 8-hydroxy-deoxyguanosine (8-OHdG), Iba-l , inducible nitric oxide synthase (iNOS), and nitrotyrosine were performed at 24 hours, 72 hours or 7 days after reperfusion. Result: Edaravone, even when adnffnistrated 6 hours after onset of ischemia/reperfusion, significantly reduced the infarct volume (68.10 ± 6.24%, P < 0.05) and improved the neurological deficit scores (P < 0.05) at 24 hours after reperfusion. Edaravone markedly suppressed the accumulat ion of HNE modified protein and 8-OHdG at the penumbra area during the early period after reperfusion (P < 0.05), and reduced microglial activation, iNOS expression and nitrotyrosine formation at the late period. Conclusion: We demonstrated that edaravone has anti-oxidant properties as well as anti- inflammatory effects resulting in reduction of iNOS production. Both actions are important for the neuropro- tective effects of edaravone in stroke. Our results are considered important for extension of the therapeutic time window in acute cerebral ischemia.

1372 Intravenous Thrombolytic Therapy in Acute Ischemic Stroke in a University Hospital of South India

Prasad V ~, Kaul S ~, Meena A ~, Suvarna S 1, Jayalakstmff S 1, Jayanthi M 1, Borgohain R 1. 1Nizam's Institute of Medical Sciences ~, Panjagutta, Hyderabad, India

Background: Use of thrombolytic therapy for ischenffc stroke in India is limited. We report our experience o f recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke at a University hospital in south India. Methods: Data of patients of acute ischemic stroke treated with rt-PA consecutively, as per the criteria of National Institute of Neurological diseases and stroke (NINDS), between September 2000 to February 2003 was analyzed. Neurological status was measured with the National Institute of Health Stroke Scale (NIHSS) at baseline, at 24 hours , and at 7 days after the administration of rt-PA. Results: Out of 2100 patients o f stroke admitted in the Nizam's Institute of Medical Sciences, a University hospital, only 60 patients (3%) reached hospital within 3 hours o f onset, of whom, 30 patients received rt-PA. The causes of non-adnffrdstration were intracerebral hemorrhage (10), non-aftbrdabili ty (10) , uncontrolled hypertension (2) and reluctance to accept the risk o f complications (8). A m o n g the patients who received thrombolytic treatment, there were 20 men and 10 women (mean age 48 years; range 31-67). Two patients (7%) died of intracerebral hemorrhage. The NIHSS scores o f survived patients at baseline, 24 hours and day 7 were 1 0 , 4 and 2.4 respectively. Conclusion: Very few stroke patients reach hospital within the window period. A m o n g these about a half do not get treatment due to high cost and fear of complications. The outcome in thrombolysed patients are comparable to those reported in NINDS study.

1373 Risk factors and detemliuants of mortality in patients of Intracerebral Hemorrhage in a Tertiary Hospital in South ImUa

P~asad V l, Srinivas B ~ , Keerthi AS 1, Sita Jayalakshmi S 1, Meena A K ~ , Borgahain R ~, Kaul S ~ . 1Nizam's Institute of Medical SeieneeJ, Panjagutta, Hyderabad, India

Background: Tiffs s tudy aims to find the risk factors and determinants of mortali ty in patients of Intracerebral hemorrhage (ICH) from India as limited information is available on this subject. Methods: One year data on all patients of CT proved ICH admitted in Nizam's Institute o f Medical Sciences, a tertiary referral center and the main Ulffversity hospital of Indian city of Hyderabad, was analyzed. Comparison o f parameters was made between the survivors and dead patients. Results: ICH constituted 150 out o f 549 (27%) stroke patients admitted between February 2004 and January 2005. Mean age of ICH patients was 53 years (range 22 to 82). The male to female ratio was 2.3:1. The risk factors constituted hypertension in 134 (89%), amyloid angiopathy 5 (3%), vascular malformations 5 (3%). Mean hospital stay was 9 days. Overall mortali ty was 49 (33%). Factors associated with mortality were increased age, low Glasgow Coma Scale (< 7), renal impairment , basal ganglionic involvement, and initial hematoma volume, midlnie shift and hydrocephalus on CT scan brain. Metabolic abnormalities and infections did not contribute to mortality. Surgical evacuation of hema toma was done in 44 patients out of whom 28 (64%) survived. Conehision: ICH constituted more than one fourth of all stroke patients. Mean age was less than reported from west. Hypertension was the commonest risk factor. Initial low level of consciousness, bigger hema toma volume and basal gangliordc location with midline shift were bad prognostic factors. Aggressive management of infec- tions, correction o f dyselectrolytemia and early surgical evacuation led to successful outcome.

1374 rtPA Treatment in Acute Ischemic Stroke and outcome in a University Hospital in India

] ] 1 Prasad V l, Srinivas B ~, Keerthi AS , Sita Jayalakshmi S , Meena A K , Borgahain R 1, Kaul S 1 . ~Nizam's Institute of Medical ScienceJ, Panjagutta, Hyderaba, India

Background: There are concerns regarding the feasibility of thrombolytic therapy for acute ischemic stroke (AIS) in an Indian setting. This s tudy aims to present our experience of rt-PA in AIS patients at the main University hospital referral center at Hyderabad, India. Methods: Data of patients of AIS treated with r t-PA consecutively, between August 2000 and Dec 2004 was analyzed. The enrollment criteria and management protocol were the same as those at National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trials. Neurological status was measured with the National Institute of Health Stroke Scale (NIHSS) at baseline, at 24 hours, 7 days, 3 months and 1 year. Barthel index and Rankin ' s score were measured at 3 months and 1 year after the administration of rt-PA. Results: Thirtyseven patients with a mean age of 48 years were treated within a period o f 53 months. Six patients (16.2%) died within first seven days after admission [2 of ICH (5.4%), 2 o f malignant cerebral edema (5.4°,5), 1 of recurrent massive stroke (2.7°,5) and 1 of severe LVF (2.7°,5)]. The mean NIHSS scores at baseline, 24 hours , day 7, 3 mon ths and 1 year were 13.6, 7.8, 6.3, 2.3 and 1.4 out o f 37, 37, 31, 29 and 29 patients respectively. The Barthel index among survivors 0 a - 29) at 3 months and 1 year was 88.4 and 84.8), respectively. Conehisions: Intravenous thrombolysis with r t-PA for acute stroke patients was feasible in a University Hospital setting in India and the outcome was comparable to that in NINDS study.

1375 Pre-ischenlic treatment of Pentoxitylline reduces cortical and striatal infarcts vohune in rat model of Focal Cerebral ISdleufia