2019 AHA ISC Stroke News Day 1

WEDNESDAY | FEBRUARY 6, 2019 INSIDE 2019 ISC EXHIBITORS AND MAP PAGES 8-9 @AHAmeetings facebook.com/ahameetings strokeconference.org #ISC19 STROKE NEWS ON THE MOVE Search “AHA Conference” in Google Play or the App Store to download the free AHA Mobile Meeting Guide App. Selecting patients for thrombectomy — beyond clinical trials to the real world J Mocco, MD, admits that the title for today’s debate is tongue-in-cheek. “Nobody knows exactly the right way to do everything, but the idea is to create some great conversation and debate around some of the key things that people wonder about right now in the com- munity,” said Mocco, category chair of the committee that created “I Know the Best Way to Select Patients and Perform Stroke Throm- bectomy.” Indeed, data from a dozen or so clinical trials in recent years have created buzz in the thrombectomy community. And that’s the rub, said Mocco, professor of neurological surgery in the Mount Sinai Health System in New York. “The data, although suggestive in varied directions, is supportive, but non-definitive to any particular conclusions,” he said. “The session presenters are presenting their beliefs based on their interpretation of the data, and Mocco see THROMBECTOMY , page 10 Researchers explore uncommon causes of stroke and how they impact treatment W hat happens when you don’t find any of the more common causes of stroke: carotid stenosis, atrial fibrillation, hyperlipidemia, diabetes, hyper- tension and cardiovascular diseases? That was the primary question at Tuesday’s symposium that provided clinical pearls for identifying rarer causes of stroke. These include CNS vasculitis, vasospasm, genetic disorders of small vessels, moyamoya disease, radiation, genetic collagen vasculopathies, endocarditis, infectious causes and mitochondrial disorders. “We don’t see these disorders very often, but when we do, we should make sure we rec- ognize them because treatment may be differ- ent than for traditional stroke,” said Theodore Wein, MD, program committee chair. Vasculitis is probably the most common of the uncommon causes of stroke, said Wein, assistant professor of neurology and neurosur- gery in the Stroke Prevention Clinic at McGill University in Montreal, Québec. Much of the symposium was devoted to CNS vasculitis, including how to distinguish it from vasospasm and atherosclerosis; the rheumatological perspective; the most effective imaging methods; the new immunosuppres- sant agents available; and treatment endpoints that can help you determine when more aggressive therapy is warranted to ensure patient well-being. Other highlights included discussions on: • When to treat endocarditis with antibiotics versus when to replace the heart valve to prevent stroke • Surgical and nonsurgical challenges for treating fibromuscular dysplasia, moyamoya disease and other rare causes of blood vessel abnormalities that can cause stroke • The role of traditional therapies for reducing the risk of stroke in patients with these disorders Breakout sessions focused on specific patient subsets: stroke in pregnancy, stroke in cancer patients and stroke from infectious causes such as HIV and varicella zoster virus (VZV). Presenters wrapped up the symposium with a session on stroke in transgender pa- tients and the association between high-dose hormones and stroke risk. Novel Approaches to Prehospital Stroke Care in the Endovascular Era: The Future Ain’t What It Used to Be 7-8:30 a.m. Thursday Kalakaua Ballroom A UPCOMING SESSION Technology advances may enhance prehospital stroke care N ew devices, technologies and mathematical models have poten- tial to improve prehospital care for stroke patients, said Sherita Chapman, MD, co-moderator of today’s session. In the endovascular era, selecting patients for treatment is no longer only time-based. So the potential to identify large artery occlusion and optimize pa- tient triage in the field has strong impli- cations in acute stroke care. “Before, there was a strong fo- cus on improving the recognition of stroke symptoms in the field, EMS prenotification and transport times,” said Chap- man, assistant professor of neurology at the University of Virginia in Charlottesville. “Now, we’re also asking first responders to be able to identify the severity of the stroke and make important triage decisions based on the severity in the field.” Chapman will co-moderate the session with Robert Mikulik, MD, associate profes- sor of neurology and head of the Complex Cerebrovascular Center at St. Anne’s Uni- versity Hospital in Brno, Czech Republic. Among symposiumpresenters, Chris- topher P. Kellner, MD, assistant professor of neurosurgery at Mount Sinai in New York, will share details on volumetric impedance phase shift spectroscopy (VIPS) and its potential to triage patients with severe stroke. VIPS is a visor-like, non-invasive device that patients wear to help detect severe stroke. Kellner recently published a study on VIPS. Kyle B. Walsh, MD, MS, assistant pro- fessor of emergency medicine at the Uni- versity of Cincinnati, has looked at eight stroke sensor devices in various stages see PREHOSPITAL , page 10 Chapman Nobody knows exactly the right way to do everything, but the idea is to create some great conversation and debate around some of the key things that people wonder about right now in the community. J Mocco, MD