Conference

International Stroke Conference
Pre-Conference Symposia: February 18, 2020
Sessions: February 19–21, 2020

Rachel Forman, MD
@bustinclots247

I had the privilege to attend this important symposium shedding light on different aspects of stroke disparities. As someone who is passionate about stroke community education and addressing healthcare disparities, it was really incredible to be able to listen in person to people I have admired throughout my training.  The symposium was moderated by Drs. Bruce Ovbiagele and Amytis Towfighi. 

The first talk was by Dr. Mitchell Elkind (Columbia University), who began by describing disparities: “… a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” He also mentioned that approximately 1/3 of people in the United States, or more than 100 million people, identify as belonging to a racial or ethnic minority population. Another interesting point from the discussion is that Hispanic and Asian men and women are less likely to use EMS versus white men and women, and that black women are less likely than white women to use EMS (Journal of the American Heart Association, Smith 2015). We were then introduced to his work with the Northern Manhattan Study (NOMAS): a study of the population in Washington Heights (beginning in 1990) that has enrolled over 4,400 people from the surrounding community with neurological conditions. This work is ongoing and exciting (and, importantly, includes a diverse patient population).

An interview with Dr. Noortje Maaijwee, MD, PhD, a neurologist specializing in neurorehabilitation. She is a full-time faculty member in the Department of Neurology and Neurorehabilitation at the Lucerne Cantonal Hospital in Switzerland. She completed her medical school and residency at Radboud University Nijmegen Medical Centre in the Netherlands. Her primary area of research interest includes stroke in young adults, long-term consequences of stoke, and quality of life issues after suffering a stroke. During her PhD, Dr. Maaijwee defended a thesis on “Long-term neuropsychological and social consequences after stroke in young adults.”

Interviewed by Dr. Rohan Arora, MD, Assistant Professor of Neurology, director of stroke fellowship at the Hofstra Northwell School of Medicine and medical director of the stroke program at LIJ Forest Hills, a part of Northwell Health, New York.

In this interview, Dr. Maaijwee discusses highlights from the European Stroke Organization Conference, held May 22–24 in Milan, Italy.

Dr. Arora: At ESOC 2019, what were some major breakthroughs? 

Dr. Maaijwee: The indications and contra-indications for acute treatment of ischemic stroke by IV thrombolysis and endovascular therapy are ever-changing. For example, the time-window when treatment is successful. In the Large Clinical Trials session on the first day of ESOC, a meta-analysis was presented that showed that intravenous thrombolysis increases the percentage of good clinical outcome (modified Rankin Score (mRS) 0-1) at 3 months, if treatment is started between 4.5–9 hours after onset of symptoms in select patients with CT or MRI perfusion mismatch.¹

European Stroke Organisation Conference
May 22–24, 2019

Elena Zapata-Arriaza, MD
@ElenaZaps

The annual European Stroke Organisation Conference was held May 22 to 24 in Milan. There were countless sessions with a high scientific quality. In particular, the scientific communications session “Endovascular Treatment – Clinical Practice,” held on May 22, revealed interesting findings. Among all the refreshing results, I would like to highlight the following:

Dr. Georgios Tsivgoulis, from the National & Kapodistrian University of Athens, showed interesting data about a systematic review and meta-analysis of bridging therapy (BT) versus direct mechanical thrombectomy(MT) in stroke patients with large vessel occlusion (LVO). The mentioned systematic review included 38 studies with a sample of 11.798 patients. The main conclusions of the study exposed that pretreatment with IVT does not increase complication nor results in measurably delayed reperfusion in LVO patients treated with MT. In addition, their results, also showed a potential benefit on functional outcome and mortality in patients receiving BT compared to direct MT.

European Stroke Organisation Conference
May 22–24, 2019

Raffaele Ornello, MD

At the 5^th European Stroke Organisation Conference, there was an interesting session on Thursday, May 23, about small vessel disease (SVD), a frequent cause of ischemic and hemorrhagic stroke.

Professor Leif Østergaard from Aarhus University presented the role of the alterations of capillary hemodynamics in the pathogenesis of SVD, while Professor Nikolaus Plesnila from the University of Munich discussed the role of pericytes in brain ischemia and neurodegeneration.

European Stroke Organisation Conference
May 22–24, 2019

Alan C. Cameron, MB ChB, BSc (Hons), MRCP

The 5^th European Stroke Organisation Conference (ESOC 2019) has opened with a fantastic session in Milan on Wednesday! The conference was opened by ESO President Bart van der Worp, Conference Chair Jesse Dawson, and Chair of the Local Organising Committee Danilo Toni, who welcomed over 5,500 participants from 94 countries to the conference, which has doubled in size since inception over the last four years.

Ten landmark studies were presented at the official welcome. Key highlights include results from RESTART, which answers whether to start or avoid antiplatelet therapy after ICH in patients taking antiplatelets for the prevention of occlusive vascular disease. Remarkably, restarting antiplatelet therapy does not increase major haemorrhagic events. In contrast, restarting antiplatelet therapy may reduce recurrent ICH and protect against recurrent major vascular events. This provides reassuring evidence on restarting antiplatelet medication for secondary prevention of occlusive vascular disease in patients with ICH.

RESILIENT demonstrates the overwhelming efficacy of mechanical thrombectomy persists when implemented in the challenges of a developing country healthcare system such as Brazil. In this setting, thrombectomy decreases disability with a number needed to treat of only 6.6, has low complication rates and no increase in symptomatic ICH compared to medical therapy. We must now ensure the tremendous benefits of thrombectomy are available to more patients globally, including developing countries.