clinical

Dixon Yang, MD

International Stroke Conference 2022
February 9–11, 2022

Session: Thursday Main Event
Moderators: Dr. Louise McCullough, Dr. Tudor Jovin
Speakers: Dr. Gary Rosenberg, Dr. Bradford Worrall, Dr. Suja Rajan, Dr. Ekaterina Barkradze, Dr. Angel Chamorro, Dr. Xin Cheng, Dr. Laurent Spelle

The Thursday Main Event of the International Stroke Conference included awards and a wide range of exciting late breaking science. To start, Dr. McCullough, ISC 2022 Program Chair from McGovern Medical School at UTHealth, presented the Thomas Willis Award to Dr. Rosenberg of the University of New Mexico. Dr. Rosenberg’s lecture discussed his work on identifying biomarkers in Binswanger’s disease, especially in the context of frequently co-existent Alzheimer’s disease. In particular, his work focused on matrix metalloproteinases (MMPs), which are involved in ischemic brain injury and VCI. The MarkVCID consortium explored angiogenic growth factors, cytokines, MMPs, and MRI biomarkers in Binswanger’s disease. Importantly, data from MarkVCID was used to create a Vascular Damage Score, which is a composite of MRI diffusion biomarkers and CSF AD pathology to help discern Binswanger’s disease and AD. Then, Dr. Worrall from the University of Virginia received the ISC Outstanding Stroke Research Mentor Award. He gave encouraging remarks on the importance of mentorship in training the next generation of clinicians and researchers.

Sishir Mannava, MD
@sishmannMD

International Stroke Conference 2022
February 9–11, 2022

Learning Studio Session: Speakers Panel on “Technology and Health in the Stroke Field”
Moderators: Dr. Nicole Gonzales and Dr. Lauren Fournier
Speakers: Dr. James Grotta, Dr. Sunil Sheth, Dr. Amanda Jagolino, Dr. Eliza Miller, Dr. Jennifer Rasmussen Winkler, Dr. Alicia Zha

The panel discussed many aspects of technology and health in the stroke field and what it has brought to us post-pandemic. In regard to telemedicine/telestroke care, some major advantages that the panel discussed are: increased outreach to communities that wouldn’t have received the care, including specific sub-populations of patients such as those who live very far away, postpartum care, and care for disabled patients who are unable to travel. Dr. Sheth highlighted that acute telestroke care isn’t the only advantage, the future hope is that we can use telestroke care consultation more for preventative stroke that may have a major impact on overall health care. 

Sishir Mannava, MD
@sishmannMD

Anadani M, Maïer B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Gory B, Richard S, Sibon I, et al. Magnitude of Blood Pressure Change After Endovascular Therapy and Outcomes: Insight From the BP-TARGET Trial. Stroke. 2022.

Blood pressure (BP) control after endovascular therapy (EVT) for large vessel occlusion is an oft-debated topic. Many stroke providers, although aware of the potential harm of reperfusion injury, do not know how aggressive to be with BP lowering. The risk with acute lowering of BP is also the risk of hypoperfusion and placing the penumbra at risk of worsening ischemic damage. The authors of this work conducted a post-hoc analysis of the BP TARGET trial (recently published and showing neutral results from intensive BP lowering in patients with successful reperfusion after EVT) to assess the association between change in systolic blood pressure at different time intervals with clinical and radiographic outcomes.

This was a secondary observational post-hoc analysis of the original BP TARGET trial, which enrolled patients with anterior circulation large vessel occlusion stroke and had acute ischemic stroke with successful reperfusion with EVT but had SBP > 130 mmHg at end of procedure (considered the baseline SBP). Patients in the BP TARGET trial were randomized 1:1 to intensive SBP treatment to be achieved within 1 hour of randomization (target 100-129 mmHg) or standard SBP treatment (130-185mmHg). BP was measured every 15 minutes for 2 hours after randomization, then every 30 minutes for 6 hours and then every hour for the remaining 16 hours. The authors defined ΔSBP as baseline SBP minus the mean of achieved SBP levels during 3 periods post-reperfusion: 15 to 60 minutes (ΔSBP15–60M), 1 to 6 hours (ΔSBP1–6H), and 6 to 24 hours (ΔSBP6–24H).

Tolga D. Dittrich, MD
@to_dittrich

Cash RE, Boggs KM, Richards CT, Camargo Jr CA, Zachrison KS. Emergency Medical Service Time Intervals for Patients With Suspected Stroke in the United States. Stroke. 2022.

In acute stroke care, time is arguably the most critical outcome-determining factor. In addition to early recognition of stroke symptoms, prompt transport to a qualified hospital by emergency medical services (EMS) is essential to ensure optimal care. Cash and colleagues evaluated EMS time intervals for adults with suspected stroke in the United States between 2018 and 2019 and examined differences by geographic location.

Approximately 410,000 call-outs were considered, of which the vast majority of transports (98%) were ground-based. A comparison of ground-based and air-bound transports revealed that the time between dispatch and hospital arrival was considerably longer for air-bound transports (ground-based vs. air-bound (median, IQR): 35 min [27-45] vs. 56 min [43-70]), demonstrating disparity to the disadvantage of rural and border regions. In each transport group, 10% of the patients had pre-hospital times outside the target recommendations (≥58 minutes in the ground-based transport group, ≥86 minutes in the air-bound transport group).¹