One-day symposium dedicated to rapidly changing acute stroke care

A day-long pre-conference symposium at the International Stroke Conference 2020 will celebrate advances in acute stroke management while looking to the future for cutting-edge applications across a broad spectrum of care. An expert panel of clinicians will delve into every facet of the rapidly evolving field of acute stroke management, including triage, thrombolysis and thrombectomy during the Feb. 18 symposium “Stroke in the Real World: A Star is Born: Thrombolysis and Thrombectomy.”

Acknowledging past achievements in stroke care will lead the discussion, according to Mollie McDermott, MD, MS, of the University of Michigan and pre-conference co-chair, particularly as the specialty marks the 25th anniversary of the advent of IV tPA and the fifth anniversary of mechanical thrombectomy for acute ischemic stroke. Speakers will spotlight “real world” issues in acute stroke treatment, including exciting advances in the use of tenecteplase, extended-window thrombolysis and thrombectomy as well as the role of mobile stroke units, she said.

“With new acute stroke diagnostics and treatments emerging seemingly yearly, acute stroke diagnosis and treatment is becoming more and more complex. Long gone are the days when a non-contrast head CT and IV tPA within three hours were the mainstays of acute stroke care,” McDermott said. “In this symposium, we will look at the history of acute stroke care, and we will provide a forward-looking update on the exciting, rapidly evolving field of acute stroke management.”

In the short term, the future of acute stroke management will include ever-more precise and user-friendly tools to help providers determine who will benefit from acute stroke therapies, McDermott said. Acute stroke therapy options are expected to expand with new thrombolytic agents and fourth-generation thrombectomy devices. In the long term, less invasive therapeutic techniques such as cerebral hypothermia and directed sonothrombolysis may prove effective, McDermott said.

“Given how rapidly our field is progressing, valuable diagnostics and therapies we can’t even imagine now are almost certainly on the horizon,” she said.

Among the topics to be addressed at the symposium are the history and future of telestroke. This videoconferencing technology to guide acute stroke treatment for patients in remote (“spoke”) sites enables a stroke-trained physician (at a “hub”) to assist a local emergency medicine (or in-patient) physician with acute stroke decision-making for his or her patient. In a telestroke consult, a stroke-trained physician interviews and examines the stroke patient over video and reviews his or her medical imaging. The stroke physician makes recommendations about appropriate stroke work-up and treatment.

Stroke outcomes are far better when stroke patients can be treated quickly, and one of the major goals of telestroke programs is to allow patients to be treated promptly at their local hospital without having to be transferred, potentially delaying care. Similarly, telestroke is cost-effective from a societal perspective in that it can lead to prompt stroke treatment and obviate the need for ground and air transportation of stroke patients to larger centers.

“There is a lack of stroke expertise in many emergency rooms, especially those in more rural settings. The standard of care for acute stroke is rapidly changing, and local emergency medicine physicians may understandably not be able to keep up with the evolving guidelines and recommendations,” McDermott said. “In addition, one of the positive consequences of telestroke care is the ability to keep stroke patients in their home communities where their support systems are.”

The Pre-Conference Symposium will cover a number of other stroke management issues, including endovascular reperfusion, the pros and cons of mobile stroke units, deciding whether to “drip and ship” or use direct center routing, and even how to read a CTA. The session will provide ample opportunities for questions and answers, case studies and audience response.

According to the symposium’s other co-chair Ted Wein, MD, FRCPC, FAHA, of McGill University in Quebec, the one-day emphasis on acute stroke management will provide health care providers with a new comfort level in treating patients.

“The treatment of stroke is evolving at a rapid pace. The ISC pre-conference will challenge clinicians and academics to test their knowledge on the ever-evolving treatment of acute ischemic stroke,” Wein said. “As time windows for acute stroke intervention are rapidly changing, there is a need to provide a forum to update physicians on the latest modalities available for acute stroke therapy.”

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