International Stroke Conference
February 19–21, 2020

Kat Dakay, DO

Use of the transradial technique as an alternative to traditional femoral access in neuroendovascular procedures has increased substantially over the last few years after studies have demonstrated its advantages and lower risk of access site complications.[1]   

However, there is a learning curve that one must traverse when adopting the transradial approach. This year, the International Stroke Conference dedicated a symposium to a multifaceted discussion about the benefits, challenges, and potential complications unique to transradial access. 

The session was moderated by Dr. Tudor Jovin and Dr. Nathan Manning, and speakers included Dr. Michael Levitt, Dr. Eric Peterson, Dr. Marios Psychogios, and Dr. Brian Snelling. Some major topics discussed:

1. Why go radial?

There are several reasons to consider utilizing the transradial approach. Dr. Peterson discussed one major reason, patient preference — with a transradial approach, there is no need for patients to lay flat postoperatively, which can make even small tasks like using the restroom awkward and cumbersome. Increased awareness of the transradial method by the general public has led to increasing patient requests to use this approach. Anecdotally, as a fellow explaining and obtaining consent for diagnostic angiograms, many patients have said to me, “I really hope you can use my hand instead of the leg.” As the popularity of transradial access in both cardiology and neuroendovascular procedures grows, this is likely to become more common. Objectively, one study demonstrated that 24/25 patients who underwent prior transfemoral cerebral angiography and subsequently underwent transradial angiography preferred the radial method.[2] Another reason Dr. Peterson discussed is that in patients with obesity or significant arch tortuosity, transfemoral access can prove challenging and the radial approach may be easier in selected cases. Lastly, and probably the most compelling and important reason, which both Dr. Peterson and Dr. Levitt discussed, is that it is safer. Multiple cardiology trials have demonstrated that transradial procedures are safer than transfemoral procedures with an overall lower risk of major complications and mortality.[1, 3] 

International Stroke Conference
February 19–21, 2020

Session: “Screening for Cognition and Factors Related to Brain Health,” Thursday, February 20, 2020

Moderators: Dr. Ronald M. Lazar, Birmingham, AL; and Dr. Rebecca F. Gottesman, Baltimore, MD

Abstract: It is increasingly recognized that vascular risk factors promote cognitive decline, both independently and interactively with neurodegenerative disease. Because these risk factors are modifiable, evaluation in the setting of primary care represents a unique opportunity for early detection and treatment.

Shashank Shekhar, MD, MS
@ArtofStroke

The session had four presentations. Dr. Walter N. Kernan Jr. from New Haven, CT, led the first talk on “Evaluating cognition in elderly at primary care.” He explained why primary care is important in recognizing cognitive issues. He went on to explain the spectrum of cognitive impairment, which ranges from subjective, mild cognitive impairment (annual risk of progression?), dementia (annual risk of progression 7%). He then laid out a simple flow chart of evaluating cognition in the primary setting: identifying the 1) signal, 2) case finding, 3) Classification and management. The signal could be in the form of reporting by patient or family, the observation by a physician, or casual inquiry. Case finding refers to using assessment tools such as Memory Impairment screen, MMSE, MOCA, etc., to screen for cognition. The final step is to confirm the diagnosis, identify any treatable causes, identify functional impairment, classify etiology, and further neuropsychiatric assessment.

Dr. Virginia J. Howard from Birmingham, AL, gave the second presentation on “Considerations in cognitive assessment in disparate populations.” Her talk focused on disparities related to sex, age, disability, socioeconomic status, and geographic locations. She identified barriers to recruitment and retention at different levels, i.e., individual to research institutions. She suggested engaging community leaders in the research process and using community outreach programs, and that preparing a realistic budget would greatly help achieve the goal. Changes are also required in the study design, i.e., in-home evaluations, and identifying all levels of influences and barriers at the institution and community would help with more recruitment and higher retention.

International Stroke Conference
February 19–21, 2020

Session: “Widening the Lens of Telestroke: From the ED Across the Stroke Continuum,” Thursday, February 20, 2020

Speakers:
Jennifer Majersik, MD: Physician at the University of Utah – Expansion of Telestroke Networks
Matthew Koenig, MD: Physician at Queens Medical Center – Tele-ICU
Steven Cramer, MD: UCLA, University of California Irvine – Tele-rehabilitation
Christine Holmstedt, DO: Medical University of South Carolina – Outpatient Telestroke Follow-up

Stephanie Lyden, MD, BS

This talk provided multiple examples of varied practice settings that use telemedicine to provide patient care. The talk started with Dr. Jennifer Majersik discussing the Expansion of Telestroke Networks. She initially explained the process of consulting a neurologist via telestroke. This is often being utilized by community hospitals that do not have a local neurologist to consult. She explained that there are different levels of acuity (hyper-acute with telestroke vs acute with emergent teleneurology vs non-urgent with scheduled teleneurology) within teleneurology consults. She noted that with a telestroke consult, the main questions addressed include whether the patient is eligible for tPA or thrombectomy, both of which are time sensitive, and the goal of these consults is for them to be completed within 10-30 minutes.