Cerebrovascular Diseases s9 1 l-07-04 1 The efficacy of carotid endarterectomy (CEA) in patients with asymptomatic carotid stenosis (ACS). A meta-analysis 0. Benavente, D. Moher ‘, R. Hart. Division of Neurology, The University of Texas Health Science Center at San Antonio, Texas, USA, ’ Clinical Epidemiology Unit, Universiiy of Ottawa, Ottawa, Canada Objective: To estimate the efficacy and safety of CEA for stroke prevention in patients with ACS (150% stenosis). Methods: Six randomized trials comparing CEA vs. medical treatment were identified. Outcomes analyzed: ipsilateral stroke, all strokes, vascular deaths and perioperative complications: stroke and death. Reaulta: In the medical group (n = 1,215), the incidence of ipsilateral stroke was 1.7%/year. Surgical therapy (n = 1,225) was associated with a relative risk reduction of ipsilateral stroke = 56% [Cl: 0.30-0.62 (p < O.OOOOl)], and a 4% absolute risk reduction over 4.6 years, The incidence of all strokes was reduced in surgical patients = 36% (p < 0.003). There was no difference in vascular death (p < 0.2). The surgical group during the perioperative period suffered an increase in stroke OR = 4.9 (p < O.OOOOl), and vascular death OR = 3 (p < 0.07); the incidence of perioperative stroke and death was 2.5% and 0.6% respectively. Concluskms: CEA is highly efficacious for reducing ipsilateral stroke in patients with ACS. However, the benefit of endarterectomy for asymptomatic unselected patients is relatively small. In order to prevent one stroke during a 5 year follow-up, 25 patients would need to be operated. Routine CEA for ACS awaits reliable identification of high-risk subgroups; medical management is a sensible alternative. 1 l-07-05 1 Vascular amyloidosis and cerebral hemorrhage: A frequent association, not necessarily pathogenic L. Cattier, F. Araya, R. Avendaho, C. Vergara. Servicio de Neurologia, Hospital de/ Salvador, Santiago, Chile Cerebral amyloid angiopathy (CAA) has been considered as a pathogenic factor in non-traumatic lobar hemorrhage. We have compiled 37 brains with spontaneous cerebral hemorrhage (14 lobar, 16 at basal ganglia and 5 of cerebellum-brainstem), studying histologically the deep and cortical vessels with Hematoxilina-Eosina, Gomorf, Congo red and PTAH. We studied 25 men and 12 women with a mean age of 65 f 10 years old. 26 out of 32 patients had chronic hypertension. All of them but one had amyloid deposition in the leptomeninge and adventitia. We consider definite CAA when we observed amylbid deposition in the muscular layer of superficial and deep vessels. CAA was detected in 16 of 37 hemorrhages, 5 of 14 lobar, 6 of 16 deep and 3 of 5 cerebellum-brainstem. In all cases we observed other vascular changes independently of the location and volume of amyloid deposition. There were arteries and venous dilatation, tortuosism of vessels, thickening of the muscular and adventitia, lam- inar degeneration and fibrinoid necrosis. We also observed microaneurysms in the hemorrhage zone or at its vicinities. These findings were correlated with arterial hypertension. This series gives a clue to the role that arterial hypertension would have in the production of degenerative process leading to hemorrhage. We conclude that CAA would be part of this process, but its pathogenic role is controversial. I l-07 06 Changes in cerebral blood flow (CBF) during obstructive sleep apneas (OSA) S. Cocorullo 1,2, G. Montiel ‘, P. Schlottmann I, P. Lylyk’, E. Lehkuniec ‘, S. Muchnik’ , Parera I. Casas ’ . ’ /D/M, Buenos Aires, Argentina, *ENfFf/, Buenos Aires, Argentina Objectlve: To evaluate cerebral hemodynamic changes (CHC) using Tran- scranial Doppler (TCD) during OSA. Material and Methods: We carried out four studies in three male patients with OSA, aged 56-64 years. Two patients had a history of strokes. One of them was evaluated during a “symptoms free” period and during a progressive neurological deficit. The third patient had not a history of cerebra-vascular disease. The following variables were continuously recorded during the study: 1) Pressure end tidal (PetCO2 Datex). 2) Toracoabdominal movements (Respi- trace). 3) Transcutaneous carbon dioxide and oxygen tension (Ptc CO2 /02, Sensor Medics). 4) Cerebral blood flow velocity (CBFV) was obtained by TCD using 2 MHz transducer fixed with a headband. The study was staged as follows: a- asleep without apneas (baseline val- ues). b- with-OSA 5 10 seconds (Initial OSA). c-with-OSA 2 20 seconds (Final OSA). d- post apnea (POA). Results: Comparison of baseline values with OSA/POA values, revealed significant differences (P < 0.05 one way ANOVA) for CBFV. CEFV diastolic CBFV systolic CBRl Pulsatiri Index XfSD X&SD mean X f SD X*SD Initial OSA 67ilO% 773~6% 71f9% 123f30% Final OSA 90*13% 93 i 9% 69f 11% 107f9% PA0 113i 10% 109fB% 109f 10% 96327% PtcO2 decreased by 42-60%, while PtcCOp increased by 19-26%. Discussion: Initial changes in CBFV may be explained by decrease in CBF due to a drop in the mean arterial pressure, provoked by a thoracic pressure decrease. Final changes in CBFV may be explained by increase in CBF due to a drop in Pa02 and/or increase in PaC02. Reduced perfusion and hypoxemia. may be predispose to intermittent cerebral ischemic injury. I__/ 1 07 07 Antiphospholipid antibodies in young Saudis with ischemic stroke AK. Daif, S. Al Rajeh, A. Ogunniyi. Dept of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia The role of the antiphospholipid antibodies (aPL) as a predisposing factor either singly or in combination with other risk factors for cerebral ischemia in young Saudi patients was investigated in this study. Out of 61 cases studied, 10 (16.4%) possessed aPL which were predominantly of the IgG isotype. The mean age and sex ratio of the aPL positive cases were not different from those in whom the aPL were negative. The aPL positive cases however had a significantly higher frequency of prior stroke events and transient ischemic attacks before the index event (p = 0.02). Angiographic abnormalities were present in 5 of the aPL positive cases and were confined to intracranial vessels. The yield of aPL when investigating young patients with ischemic strokes would be expected to be higher in those reporting with prior events or recurrent transient ischemic episodes. 1 l-07-08 1 Cerebral mycotic aneurysms (MA) F. Diaz. Neurologi, U. Chile Hosp, Trudeau, Santiago, Chile Between 1963-l 993 we studied 13 patients, most of them young and women, all with rheumatic heart disease and subacute bacterial endocarditis (SBA), with mitral valve involvement predominantly. 7 had multiple and 6 single CMA. Mayor localization was in distal branches. 9 in middle cerebral artery (MCA), 2 in MCA + posterior cerebral artery (PCA), 1 in PCA and 1 in carotid siphon. Clinical-angiographical manifestations were intracerebral hemorrage in 6, sub- arachnoid in 4 and subdural in 2. In only 1 patient it was silent. Rupture of the aneurysm was the initial feature of an uderlying not diagnosed SBA in most patients and in a minority it first ocurred during the management of it. Medical treatment alone has a mortality 6/6, and associated to surgical treatment of the aneurysm and subsequent cardiac valve replacement only 2/5. l-07-09 Adventage of stroke unit comparing to the stroke team in the department of Neurology J. Tatay, E. Diez Tejedor, M. Lara, A. Frank, P. Barreiro. Dept. Neurology, Stroke Unit, University Hospital La Paz, Autonoma University; Madrid, Spain Background: The importance of Stroke Unit in the treatment of cerebrovascu- lar disease is well known related with General Ward, but not comparing in the same department of Neurology. We value in our Department, the repercusion of this Unit, before and after it comes into operating. Methods: We compare two homogeneous sample, which correspond pa- tients admitted during year before (1994) and the first year to agree to come into operating the Stroke Unit (1995). The management and the sanitary personal was similar. We applied the analysis Chi-square to our results. Results: During the Stroke Unit running, the length of stay has been reduced into 23.5% and the admissions increased in 21%. The complications were less in 1995: pneumonia -14.9%, urinary infection -31.6%, failure renal -92.65% (p < O.OOl), deepvenous thrombosis -66.1% (p < 0.05), swelling brain -56% (p 4 O.OOl), seizures -45.6%. The whole complications was decreased in 40.9% (p < 0.001). The mortality in the acute phase was similar (4.42%). Conclusions: Since the Stroke Unit come into operating we have reduced the complications and the length of stay, decreased cost what has allowed to increased the admissions. 1-07-l 0 Factors associated with early hospitalisation of patlents with subarachnoid hemorrhage M. Djibuti, A. Tsiskarfdze, G. Kuchuchidze. R. Shakarishvili. Samjishvi/i institute of Neurology, Tbilisi, Georgia Background: Early diagnosis and admission to neurosurgical attention are axiomatic for the optimal care of patients with aneurysmal subarachnoid hem-