ISC 2018: Pushing the limits of stroke science and care

Attendees during opening of the exhibit hall at the International Stroke Conference at the George R Brown Convention Center.The International Stroke Conference 2018 — being held a month earlier than normal, Jan. 24-26 at the Los Angeles Convention Center in California — will bring together thousands of renowned scientists, researchers, healthcare providers and other professionals.

The world’s premier meeting for stroke science and care will offer more than 1,500 presentations related to prevention, diagnosis, treatment and rehabilitation to inspire attendees. The programming emphasizes basic, clinical and translational sciences as they evolve toward a more complete understanding of stroke pathophysiology to develop more effective prevention and treatment.

Conference sessions will include outstanding debates, invited symposia, oral and poster abstract presentations, and special lectures on recent advances and state-of-the-science technologies. Don’t miss the latest trial results from some of the most exciting clinical trials in the stroke field, including DEFUSE 3, PRISMS, COMPASS, PHAST-TRAC, THRIVES, EXTEND-IA TNK, CASSISS and ARISE II.

The 2018 program also features three pre-conference symposia:

  • The State-of-the-Science Stroke Nursing Symposium is a can’t-miss forum for nursing, rehabilitation and other healthcare professionals who treat patients and families in all phases of stroke treatment.
  • The ISC Pre-Conference Symposium I: “Stroke in the Real World: There Will Be Blood: Management and Treatment of ICH” will highlight scientific advances in intracerebral hemorrhage while emphasizing application in the real world.
  • The ISC Pre-Conference Symposium II: “Stroke in the Lab World: Reversing Stroke Translational Research — Bedside-to-Bench and Back Again” will address challenges facing traditional “forward-translation” stroke research.

In addition to the outstanding science, the International Stroke Conference presents a vibrant exhibit hall — the Science & Technology Hall. Make time in your schedule to visit with the more than 90 exhibitors who will be showcasing the latest products and services tailored to all aspects of cerebrovascular disease and treatment.

Register today for ISC 2018 and enjoy a discounted rate until Jan. 2. We hope you’ll join us next month at ISC 2018.


Acute Ischemic Stroke Guidelines 2018 to be released at ISC

The Acute Ischemic Stroke Guidelines 2018 will change the way clinicians treat large vessel/severe strokes. You’ll hear about it first — on Jan. 24, at the International Stroke Conference 2018 in Los Angeles, California. Make sure to attend this one-hour presentation to learn the implications for your practice and patients.

The session offers new guidelines for four main areas:
Systems of Care
Speaker: Opeolu Adeoye, MD, University of Cincinnati Gardner Neuroscience Institute, Neurocritical Care Program, Cincinnati, Ohio
Time: 1:30-1:41 p.m.

IV Thrombolysis
Speaker: Alejandro A. Rabinstein, MD, Mayo Clinic, Rochester, Minnesota
Time: 1:41-1:52 p.m.

Endovascular Treatment
Speaker: Thabele M. Leslie-Mazwi, MD, Massachusetts General Hospital, Boston, Massachusetts
Time: 1:52-2:03 p.m.

In-Hospital Care
Speaker: William J. Powers, MD, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Time: 2:03-2:14 p.m.


Interactive learning opportunities abound at ISC 2018

The International Stroke Conference 2018 — a 2½-day meeting Jan. 24-26 at the Los Angeles Convention Center in California — is dedicated to the science and treatment of cerebrovascular disease. The conference provides unique opportunities for you to meet and learn from colleagues with wide-ranging interests and expertise through a variety of educational sessions, from lectures to interactive training.

Engaging and interactive programming

Game of Strokes
Wednesday, Jan. 24
Can you guess the correct answer before the timer runs out? Three teams of stroke professionals from around the world will test their knowledge in a game show-style competition. Those in the audience can play along using the ISC 2018 Mobile Meeting App.

Cerebrovascular Education and Discovery Talks
Wednesday, Jan. 24
3-4 p.m.
In this session dedicated to cerebrovascular education and discovery, leaders in the field will give short (18 minutes or less), powerful talks on innovative, engaging ideas about stroke research, education and policy.

Confirmed speakers and presentations include:

  • Donna A. Perez-Pinzon, Miami, Florida. Neonatal Stroke: Little Brains, Big Consequences
  • Thomas G. Brott, Jacksonville, Florida. Free Fallin’ – Can the Megadrop in Stroke Mortality Continue?
  • Philip Bath, Nottingham, United Kingdom. Blood Pressure in Acute Stroke: To Treat or Not to Treat – That Is Still the Question
  • A. M. Hakim, Ottawa, Ontario, Canada. Small Vessel Disease – A Major Health Challenge and Opportunity

Crossfire Debates
Held during the closing Main Event, the debates feature experts who will discuss some of the hottest controversies in stroke. For each topic, two or more authorities will pitch opposing viewpoints, including rebuttals. The audience will vote on who made the stronger case. Debate topics will include:

  • Anticoagulation therapy should not be restarted in patients with anticoagulation-related lobar intracerebral hemorrhage
  • Hemicraniectomy versus not in patients over 60
  • Prolonged cardiac ambulatory monitoring wide use versus not

Learning in the Science & Technology Hall

Simulation Zone
In this interactive training area, you can test your stroke knowledge, skills and critical thinking using two displays:

  • Body Interact is a screen-based 3-D immersive training platform that virtualizes acute and chronic neurovascular disorders with a lifelike patient. The simulation includes dynamic monitoring, dialoguing, diagnostic tests, medications, imaging, intervention options and performance debriefing.
  • The Mentice VIST® G5 Simulator is a portable high-fidelity endovascular simulator enabling hands-on procedural training for clinicians and medical professionals. The modules include a wide variety of training scenarios to challenge the learner’s technical skills, clinical decision-making abilities and procedural proficiency.

Expert Theater
Learn about products and therapeutic treatments from industry supporters while you enjoy a complimentary lunch provided by the American Stroke Association.

Nursing symposium highlights leading-edge techniques

Explore innovative best clinical practices in the stroke continuum of care on Tuesday, Jan. 23, during the State-of-the-Science Stroke Nursing Symposium at ISC 2018. The daylong symposium will feature a plenary program and breakout sessions for nursing, rehabilitation and healthcare professionals who work with patients and families in all phases of stroke treatment.

Leaders in the stroke nursing and rehabilitation field will present the latest information on treating and managing stroke patients from the time they enter the hospital in the emergency department through rehabilitation. Topics will include:

  • The integration of mission lifeline severity-based stroke triage algorithm into stroke systems of care
  • Stroke bundled payment for care improvement: experiences and unexpected outcomes at three organizations
  • Evidence-based strategies for preventing stroke and stroke complications
  • Acute care: advances in clinical research, practice and quality improvement
  • Rehabilitation and recovery: facilitating admission, progression and discharge for stroke

For registration and housing information, visit (Note: There is a separate registration fee to attend the Stroke Nursing Symposium.)

Thank you to ISC 2017 supporters

The American Heart Association/American Stroke Association would like to thank the International Stroke Conference 2017 supporters.

  • Avizia
  • Boehringer Ingelheim Pharmaceuticals Inc.
  • CSL Behring
  • Erlanger Neuroscience Institute
  • FUJIFILM Visual Sonics
  • Houston Methodist DeBakey Heart & Vascular Center
  • Intouch Health
  • Medtronic
  • Memorial Healthcare System
  • Nico Corporation
  • Nico-Lab Ltd.
  • OhioHealth
  • Saint Luke’s Marion Bloch Neuroscience Institute
  • St. John Health System
  • St. Jude Medical
  • Stryker Neurovascular
  • Telespecialists
  • Tenet Health System – Sunrise Neurology
  • Wolters-Kluwer

Additionally, we would like to acknowledge the following companies for their generous educational grants in support of ISC 2017.

  • Chiesi
  • Medtronic

Expand your learning, earn CME with Stroke OnDemand™

Experience the in-depth educational programming of ISC 2017 and earn CME, thanks to the new and improved Stroke OnDemand™ program.

Stroke OnDemand provides access to more than 150 hours of presentations from the conference through downloadable PDFs of presenter slides and accompanying audio files in an MP3 format.

You also can access the three pre-conference symposia:

  • State-of-the-Science Stroke Nursing Symposium
  • Pre-Conference Symposium I: Stroke in the Real World — Thinking From the Heart — Management of Cardiac Disease to Improve Stroke Outcomes
  • Pre-Conference Symposium II: Bridge Over Troubled Water — Issues in Translational Stroke Research

Stroke OnDemand provides online access to the 2017 AHA/ASA International Stroke Conference presentations. You’ll learn about the latest advances in basic, clinical and translational sciences impacting stroke pathophysiology, with a focus on more effective prevention and treatment.

Your OnDemand program contains the following features:

  • Slides with synchronized audio. This technology recreates the live session experience.
  • Online access from any computer, tablet or smartphone. Start watching on one device and pick up where you left off on another device.
  • New CME Credits. Watch a session and then click on the CME Test button. Earning credits is easy, fast and convenient.
  • PDFs of presentations can be downloaded onto your computer for easier review and note-taking.
  • MP3 audio files are easily loaded onto your favorite MP3 player, so you can listen to sessions on the go.
  • USB drive is available for an additional fee. Access your sessions even when an Internet connection isn’t available.

Stroke OnDemand is available to AHA members for $599. Non-member price is $799, or join today and save.

Triple antiplatelet therapy no better than guideline for stroke, TIA

Philip M. Bath, MD, discusses the TARDIS trial.

Triple antiplatelet therapy with aspirin, clopidogrel and dipyridamole is not superior to guideline-based agent treatment with aspirin + dipyridamole or clopidogrel alone for preventing recurrent strokes. Late-breaking results of the TARDIS (Triple Antiplatelets for Reducing Dependency in Ischemic Stroke) trial were announced during the Main Event at ISC 2017 in Houston.READ MORE

Lying flat, sitting up similar for mild and moderate stroke recovery

Head position doesn’t matter when patients are recovering from a mild to moderate stroke. The first head-to-head trial of lying flat versus sitting up showed no statistically or clinically significant differences in death or disability 90 days after admission between the two positions.

“The lying-flat position has been suggested to offer benefits to patients with acute ischemic stroke based on nonrandomized studies that suggest increased blood flow in the major vessels and increased perfusion in the cerebral hemispheres,” said Craig Anderson, MD, PhD, executive director of The George Institute for Global Health in Sydney, Australia.

“The sitting position may reduce cerebral edema in large strokes, as has been suggested in patients with head injury,” he said. “There was no difference in any of the measures of disability, but conversely, we didn’t show any extra harms. We didn’t find any extra risk of pneumonia.”

Anderson presented the results of the Head Position in Stroke Trial (HeadPoST) at the International Stroke Conference in Houston. The nursing intervention trial compared the unadjusted shift in modified Rankin Score or mRS 90 days after admission for acute stroke in more than 11,000 patients across 114 hospitals in nine countries between March 2015 and August 2016.

Secondary outcomes included a binary shift in mRS of 0-2 and 3-6, total length of hospital stay at 90 days after the initial admission, and shifts in NIHSS scores and death at seven days. Safety endpoints were any serious adverse event, especially pneumonia. The trial design included several prespecified subgroups, including sex, age, country of admission, severity by NIHSS, ischemic stroke subtype and time to intervention.

HeadPoST used a novel multicenter cluster crossover design in which hospitals were randomized to treat clusters of 70 consecutive patients in either a lying-down or sitting-up position, then switching to the other position for the next cluster of 70 patients. Patients were kept in the assigned position for the first 24 hours unless there was a contraindication or patients were unable to tolerate the position.

Patients in the trial had mild to moderate strokes with a median NIHSS of just four and the highest score below 10. Most patients were in their late 60s and had the typical risk factors for stroke, Anderson said. They were admitted a mean of 14 hours after onset, and 12 percent received tPA.

There has been no consensus on the more appropriate position for acute stroke patients, Anderson noted. The lying-down position is more often used in resource-poor hospitals that may have a shortage of elevated beds that allow easier patient positioning.

The use of the lying-down position has become more popular in the West as a way to offer perceived benefits of reperfusion as suggested by transcranial Doppler studies. At the same time, there have been suggestions that the supine position increases risk for aspiration pneumonia.

Current AHA/ASA guidelines for the early management of acute ischemic stroke recommend the lying-down position for the early treatment of patients with acute ischemic stroke who are not hypoxic, but only if the patient tolerates the lying-down position. The guidelines also recommend sitting up at 30o or higher for patients at risk for airway obstruction or suspected elevated intracranial pressure.

The trial found no differences in mRS 90 days after admission between the two strategies (OR 1.01, p=0.84) or in any other outcomes. The only clinically significant difference between the two positions was the time spent in the allocated position. Patients were four times more likely to abandon the lying-down position because it was uncomfortable (p<0.0001).

“We have been successful in evaluating a simple nursing intervention,” Anderson said. “We can’t make any clear recommendations regarding benefits or harms for head positioning in acute stroke. This may lead to review of various guidelines.”

Watch for Unofficial Satellite Event, Expert Theater presentations

story3_smallExhibitors, universities, nonprofit organizations and industry supporters will offer independently organized learning opportunities — Unofficial Satellite Events and Expert Theater presentations — during ISC 2017.

ISC 2017 Unofficial Satellite Event

This symposium is an additional opportunity for learning. It is not part of the official International Stroke Conference 2017 as planned by the International Stroke Conference Program Committee.

Wednesday, Feb. 22

Time: 7 p.m.
Title: PFO Closure: Addressing the Unmet Need for Reducing the Risk of Recurrent Ischemic Stroke
Location: Four Seasons Hotel Houston
Sponsored and supported by St. Jude Medical

Expert Theater

The Expert Theater offers targeted educational programs and features products and therapeutic treatments from industry supporters. Enjoy a complimentary lunch provided by the American Stroke Association as planned by the International Stroke Conference Program Committee. The Expert Theater can be found in Booth 541 in the Science & Technology Hall.

Wednesday, Feb. 22

Time: 12:10-12:40 p.m.
Title: Introduction to ENRICH: A Randomized Control Trial in ICH
Speakers: Gustavo Pradilla, MD, assistant professor in the Department of Neurological Surgery at Emory University School of Medicine, Atlanta, and chief of the neurosurgery service and director of the Cerebrovascular Research Laboratory at Grady Memorial Hospital; Jonathan J. Ratcliff, MD, MPH, assistant professor of emergency medicine and neurology, Emergency Neurosciences and Neuroscience Critical Care, at Emory University School of Medicine, and Marcus Stroke and Neuroscience Center, Grady Memorial Hospital
Sponsored by NICO Corp.

Thursday, Feb. 23

Time: 12:10-12:40 p.m.
Title: The Link Between Cryptogenic Stroke and Atrial Fibrillation
Speaker: Eli Feen, MD, vascular neurologist and neurointensivist, WellStar Neurosciences, Marietta, Georgia
Sponsored by Medtronic, Inc.

Bridging the gap between basic, clinical researchers

story2_smallTheir challenges and goals may be the same, but basic science and clinical researchers often work in silos. ISC Pre-Conference Symposium II will bring the two groups together to open lines of communication and advance the stroke science.

“We want the junior and senior investigators and basic and clinical investigators to talk together,” said Louise D. McCullough, MD, PhD, symposium chair.

“Bridge Over Troubled Water: Issues in Translational Stroke Research” will address the unique challenges basic and clinical researchers face from 1 to 5 p.m. Feb. 21 in Room 320 A-C. Participants will explore how they can work better together, review the new grant proposal requirements from the National Institutes of Health and discuss the use of human specimens in preclinical research and international research in vascular dementia. The symposium will feature question-and-answer discussions and a wine and cheese reception.

“Many times, the two groups of researchers operate in a vacuum,” said Lauren H. Sansing, MD, MSTR, symposium co-chair. “We want to bring everyone together and talk about what is needed to move a target from the bench to a clinical trial. It would be useful for the basic scientists to understand what kinds of endpoints are used on the clinical side and what kinds of measures are useful on the animal modeling side.”

Likewise, Sansing said it would be beneficial for the clinical researchers to hear from the basic scientists about the struggles of modeling something in animals.

“How do we take a target from an animal model and think about how to better design clinical trials to measure what the actual mechanisms of benefit were in the model?” she asked.

Building animal models requires researchers to develop targets so the models reflect clinical stroke syndromes, as well as know the differences between humans and rodents when using human specimens in preclinical work. Two presentations will advise on research targets and the use of human specimens.

“We don’t always look hard enough for relevant mechanisms using human samples. That is a big part of this translational gap and why rodent therapeutic targets have not always made the jump into clinical trials,” said Sansing, assistant professor of neurology at Yale School of Medicine, New Haven, Connecticut. “We want to see how we could look at certain mechanisms using human specimens, whether they are pathological specimens in post-mortem brains or they are peripheral blood specimens, biomarkers or leukocyte responses that would be helpful in confirming if a target is relevant in patients.”

Modeling for vascular dementia faces many of the same challenges in developing translational research targets, the focus of another presentation.

“We know that vascular cognitive impairment is an incredibly important public health problem. There is cognitive impairment, but the pathology is often a mix of Alzheimer’s disease, small vessel disease and white matter disease. They all combine to cause important cognitive impairments in dementia in our patients,” Sansing said.

Just as important as the research is knowing how to bridge the gap between pre-clinical and clinical research, and how to develop grant proposals to support the work, the focus of two more symposium presentations.

“The NIH has implemented some new requirements in grant proposals, including experimental rigor and looking at the inclusion of relative biological variables in our animal models,” Sansing said.

The goal of the symposium organizers is to unite the many groups influencing stroke research, from the proposal stage to clinical implementation.

“We want to bring together perspectives from academics, the NIH and researchers who have established promising relationships with industry to hit on all of the challenges we have in moving translational targets to clinical trials. We are hoping this session pulls in people from different avenues of research,” Sansing said.