American Heart Association

ESOC 2022: ESMINT-ESO Joint Symposium: Persistent Frontiers Facing Acute Reperfusion Therapies

Ammad Mahmood, MBChB, BMedSci
@AMahmoodNeuro

A joint symposium between ESO and ESMINT discussed the challenges faced in acute reperfusion therapies, including patient selection and therapeutic targets.

Endovascular thrombectomy for mid-sized artery occlusions – Raul Nogueira

The importance of IV thrombolysis (IVT) therapy in this patient population was highlighted, and what constitutes mid-sized arteries considered. The anatomical variation of the M2 segment of the MCA makes this definition critical — there is generally agreement on EVT for clots in the proximal portion of larger M2 vessels. The terminology of DMVO — distal medium vessel occlusions — separates proximal dominant M2 occlusions from non-dominant M2 occlusions, as well as M3, ACA, and PCA territories. The literature suggests DMVOs cause 25-40% of acute ischemic stroke either as the primary finding or a secondary embolization complicating mechanical thrombectomy. Although IVT for this population is advocated, only half achieve reperfusion and around 25-33% have functional independence after DMVO stroke, highlighting the room for improvement potentially with EVT. Registry data showed DMVO stroke had moderately high baseline NIHSS with similar rates of reperfusion and complication with EVT compared with more proximal occlusions and up to two-thirds of patients achieving functional independence at 90 days. Patient selection in DMVO stroke needs to take into consideration many factors, including correlation of imaging and clinical findings to determine the eloquence of the area of brain involved, as well as technical considerations of the EVT procedure, such as tortuosity of the vessel, which can making procedures higher risk.

By |May 17th, 2022|clinical, Conference, treatment|Comments Off on ESOC 2022: ESMINT-ESO Joint Symposium: Persistent Frontiers Facing Acute Reperfusion Therapies

ESOC 2022: “Stroke, Thrombosis and Cancer”

Aurora Semerano, MD
@semerano_aurora

European Stroke Organisation Conference

May 4-6, 2022

Among other themes, this year ESOC has represented a unique opportunity to discuss cancer-related stroke in a dedicated Scientific Session titled “Stroke, thrombosis and cancer,” chaired by Blanca Fuentes (Spain) and Leo Bonati (Switzerland).

Indeed, cancer is recently emerging as a risk factor for arterial thromboembolism, including stroke. Among ischemic stroke patients, comorbid cancer is a devastating condition associated with increased stroke severity, disability, and mortality. Importantly, the optimal strategies to prevent and acutely treat stroke in cancer patients are yet to be established, with high recurrence rates despite antithrombotic therapies, and there are currently limited resources to assist stroke clinicians in the specific management of cancer patients.

By |May 11th, 2022|clinical, Conference|Comments Off on ESOC 2022: “Stroke, Thrombosis and Cancer”

ESOC 2022: “Scientific Session 17 – Can Artificial Intelligence and Data Science Improve Care of Stroke? The Art of the Possible”

Tolga D Dittrich, MD
@to_dittrich

European Stroke Organisation Conference
May 4-6, 2022

The session chaired by William Whiteley (UK) and Iris Grundwald (UK) focused on current applications and possible future areas of utilization of artificial intelligence (AI) in the field of stroke.

Helle Collatz Christensen from Denmark gave the opening lecture on early stroke detection in the emergency setting. Since experience has shown that emergency medical services do not always correctly recognize a relevant proportion of stroke symptoms at an early stage, the question for Professor Christensen was how to improve stroke recognition. “AI can help us,” Christensen said. Christensen and his team collected telephone contacts between emergency callers and the dispatcher. Based on this data, an AI algorithm was developed that analyzes conversations for stroke suspicious patterns to identify suspected stroke cases early and inform the dispatcher. Existing data on AI recognition of cardiac arrest is already promising. However, Christensen sees one of the challenges in that stroke is different from cardiac arrest due to various possible symptoms.

By |May 11th, 2022|clinical, Conference|Comments Off on ESOC 2022: “Scientific Session 17 – Can Artificial Intelligence and Data Science Improve Care of Stroke? The Art of the Possible”

ESOC 2022: ESC-ESO Joint Symposium: Evaluation of Cardiac Source of Stroke

Aurora Semerano, MD
@semerano_aurora

European Stroke Organisation Conference

May 4-6, 2022

The European Society of Cardiology (ESC) – European Stroke Organization (ESO) Joint Symposium, chaired by Marta Rubiera (Spain) and Wolfram Döhner (Germany), was a special occasion at ESOC 2022 to discuss both the heart-brain interactions in stroke and the precious collaborations with our closest cousins, the cardiologists.

Theodoros Karapanayiotides (Greece) introduced the basics of POCUS (Point of Care Ultrasound), a handheld device for rapid ultrasound cardiac investigation that could become a useful additional instrument for stroke neurologists. In the busy hospital setting with limited daily slots for echocardiography, indeed, POCUS could represent an extension of physical examination, that can rapidly answer specific questions and help to establish the timing of subsequent diagnostics, before referring to the cardiology service for full cardiac investigation.

By |May 11th, 2022|clinical, Conference|Comments Off on ESOC 2022: ESC-ESO Joint Symposium: Evaluation of Cardiac Source of Stroke

ESOC 2022: “Scientific Communications 10 – Prognosis and Outcome After Stroke”

Andy Lim, MBA FACEM GAICD
@ALim0211

European Stroke Organisation Conference
May 4-6, 2022

Pictured, left to right: Ann-Cathrin Probst (Germany), Andy Lim (Australia), Lynda Lisabeth (US).
Pictured, left to right: Ann-Cathrin Probst (Germany), Andy Lim (Australia), Lynda Lisabeth (US).

Sadly, we reached the final day of the 8th European Stroke Organisation Conference in Lyon, France.

My time was spent in the Gratte-Ciel 1-3 room, where we presented the outcomes of eight new studies. Here are eight learning points from our session.

By |May 11th, 2022|clinical, Conference|Comments Off on ESOC 2022: “Scientific Communications 10 – Prognosis and Outcome After Stroke”

ESOC 2022: ISNI-ESO Joint Symposium: Update on Stroke Immunology

Aurora Semerano, MD
@semerano_aurora

European Stroke Organisation Conference

May 4-6, 2022
Scientific Session – ISNI-ESO Joint Symposium: The immunology of stroke – an update

This year, ESOC hosted a Joint Symposium with the International Society of Neuroimmunology (ISNI), to discuss the most recent advances on the immunology of stroke. The session, chaired by Craig Smith (United Kingdom) and Corinne Benakis (Germany), was conducted by a great line-up of speakers, who discussed the role of inflammation in stroke both in the brain and at the systemic level, the important consequences of immune involvement, and the perspectives of immunotherapies in stroke.

Adam Denes (Hungary) focused on the close interactions between microglial cells and the neurovascular unit: Among their heterogenous functions in health and disease, indeed, microglia have been discovered to have close contact with cells of cerebral blood vessels (smooth muscle cells, astrocyte, pericytes, endothelial cells). As a result, it is likely that microglia have an influence on neurovascular coupling by sensing hypercapnia, whereas microglial dysfunction may impair hypercapnia-induced vasodilation in the cerebral cortex. This newly recognized function might be pivotal in stroke, especially in contributing to the so-called no-reflow phenomenon. Importantly, variants of microglial or microglia-regulated genes show strong associations with disturbance in cerebral blood flow. Further investigations, including genome wide association studies in humans, are warranted to explore correlation between gene variants in microglia and small vessel and neurodegenerative disorders.

By |May 10th, 2022|clinical, Conference|Comments Off on ESOC 2022: ISNI-ESO Joint Symposium: Update on Stroke Immunology

ESOC 2022: “Large Clinical Trials 2 – Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST)”

Tolga D Dittrich, MD
@to_dittrich

European Stroke Organisation Conference
May 4-6, 2022

About one in four ischemic strokes occurs during sleep. Previous studies have shown that such patients can still benefit from IV thrombolysis with alteplase if they exhibit a DWI/FLAIR mismatch on MRI.

The randomized TWIST trial investigated the effect of IV thrombolysis with tenecteplase (0.25 mg/kg) on functional outcome in patients with wake-up stroke. Advanced neuroimaging was not required for inclusion in the trial. The key eligibility criteria were a minimum NIHSS of 3 points and a possible treatment initiation within the first 4.5 hours after awakening. The study excluded patients with high NIHSS (>25 points) and premorbid functional impairment (mRS >2).

By |May 10th, 2022|clinical, Conference|Comments Off on ESOC 2022: “Large Clinical Trials 2 – Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST)”

ESOC 2022: Presidential Symposium Awards & Large Clinical Studies & Trials

Andy Lim, MBA, FACEM, GAICD
@ALim0211

European Stroke Organisation Conference
May 4-6, 2022

The 8th European Stroke Organisation Conference continued into the second day on Thursday, May 5. Seven large clinical studies and trials were presented at the Presidential Symposium Awards & Large Clinical Studies & Trials session. For those who missed out, here is a summary of take-home learning points.

ESOC 2022, Centre de Congrès de Lyon, May 5, 2022
ESOC 2022, Centre de Congrès de Lyon, May 5, 2022

INTERSTROKE: Influenza vaccination may confer a relevant potential to lower stroke risk (both ischemic and hemorrhagic).

By |May 10th, 2022|clinical, Conference|Comments Off on ESOC 2022: Presidential Symposium Awards & Large Clinical Studies & Trials

ESOC 2022: Official Welcome and Large Clinical Trials

Ammad Mahmood, MBChB, BMedSci
@AMahmoodNeuro

European Stroke Organisation Conference
May 4-6, 2022

For the first time since 2019, the European Stroke Organisation Conference was able to meet again in person in Lyon, France, with over 4,000 delegates joining in person and virtually.

Tenecteplase in AIS
Much anticipated tenecteplase phase III trial results were top of the bill to open the conference. First up were the results of the Canadian AcT trial comparing tenecteplase 0.25mg/kg to alteplase in 1600 patients routinely eligible for IV thrombolysis. Non-inferiority margins were met, and safety outcomes were comparable between groups. This was a substantial addition to the body of evidence in favor of non-inferiority of tenecteplase 0.25mg/kg compared to alteplase. Adaptation of guidelines in light of these findings may be on the horizon, though results from further trials such as the ATTEST-2 trial will be of great value.

By |May 10th, 2022|clinical, Conference|Comments Off on ESOC 2022: Official Welcome and Large Clinical Trials

Article Commentary: “Tailored Sitting Tai Chi Program for Subacute Stroke Survivors”

Farah Aleisa, MD

Zhao J, Chau JPC, Chan AWK, Meng Q, Choi KC, Xiang X, Zhao Y, He R, Li Q. Tailored Sitting Tai Chi Program for Subacute Stroke Survivors: A Randomized Controlled Trial. Stroke. 2022.

Ancient Chinese medicine suggests that Chi is aligned with our body fluids and stability of the nervous system, and it delivers functional and healing resources to all parts of the body, including the brain. It believes in the resting alert status of the body to activate circulation and facilitate oxygenation to the organs and cells. Its main outcome is harmonizing the nervous system. There are many energy channels connecting organs, glands, and cells, which are equivalent to the chemical and nervous signals. One of the modern definitions of Chi is the functionality of the chemical interactions in different body systems through enzymes, hormones, and even neurotransmitters; the methodology of Chi depends on the mind focus, breathing exercise, and specific body movements that all collaborate to enhance the efficiency of the inner chemical activities.

Dr. Zhao and his team studied the efficacy of a tailored Tai Chi rehabilitation program among stroke survivors who suffered from residual disabilities post-stroke events. The best time for rehabilitation for stroke patients is the first few days, post-stroke event, and the highest rate of recovery is up to 6 months. Beyond the 6 months period, recovery is still possible but in a much slower rate. This is the first study designed as an assessor-blind randomized controlled trial looking for the benefits of tailored Tai Chi exercises in the subacute stroke population. It enrolled patients from April 2020 to August 2020. Four separate inpatient neurology units of two tertiary A-level traditional Chinese medicine (TCM) hospitals in Kunming, China, included stroke survivors aged over 18 years, with a clinical diagnosis of ischemic stroke, with history of first-ever stroke, in the subacute stage of stroke, who can sit independently with or without cushions, use and raise at least one arm while sitting, and who are able to communicate. Few exclusion criteria were applied, like severe stroke with NIH stroke scale >16, cognitive impairment, hearing or visual disabilities, and pregnant women. Participants were randomized on a 1:1 ratio to the intervention or control groups with a block size of 8 stratified by NIHSS score (< 6 or ≥ 6) by an independent statistician according to a computer-generated randomization sequence.

By |May 6th, 2022|clinical, rehabilitation|Comments Off on Article Commentary: “Tailored Sitting Tai Chi Program for Subacute Stroke Survivors”