Impact of thrombectomy on emergency care, medical management focus of symposium

Stroke Pre 2 Story 1The success of using thrombectomy to treat victims of acute ischemic stroke is driving the re-evaluation of emergency care processes and the management of patients following treatment. These issues will be discussed Tuesday, Feb. 16, during ISC Pre-Conference Symposium I, “Stroke in the Real World: To Infinity and Beyond: Endovascular Therapy and Systems of Care.”

The daylong symposium will feature didactic presentations and debates in the morning, with two sets of four breakout sessions in the afternoon. During lunch, faculty members will review the results of clinical trials studying the treatment of acute ischemic stroke. The symposium will conclude with speakers from Australia, Canada, the European Union, Israel, South Korea and the United States discussing stroke management issues in their countries.

“What do you do with thrombectomy patients? How do they need to be managed medically? Also, what needs to be done to change our healthcare system so people will be able to receive this therapy?” asked Ted Wein, MD, symposium chair. “How will it change the landscape of how patients are identified and transported? We will hear ideas from around the world about how people are trying to get this done.”

Symposium presentations and debates will follow a sequence most stroke patients face, starting with pre-hospital screening, followed by issues of emergency treatment and where treatment should occur. The morning will conclude with a debate about imaging techniques, said Wein, assistant professor of neurology and neurosurgery at McGill University, Montreal.

“There have been five trials with positive results showing what an efficacious therapy thrombectomy is,” he said. “The No. 1 problem is that there are a limited number of people in each city who have the technical expertise to do this. Second, the biggest challenge is how do we get the right patients to the right hospitals.”

Two speakers will debate where emergency patients should be transported after strokes. Michael D. Hill, MD, MSc, associate professor in the departments of Clinical Neurosciences, Community Health Sciences and Medicine at the University of Calgary, Alberta, Canada, will state the case for going to the nearest stroke center. Edward C. Jauch, MD, MS, professor and director of the Division of Emergency Medicine at the Medical University of South Carolina, Charleston, will argue for taking patients to a Comprehensive Stroke Center.

“This will highlight what changes need to be made in 911 services, how EMS personnel evaluate and triage patients in the field, and how ambulance drivers know which hospital should provide care,” Wein said.

A presentation by Mai N. Nguyen-Huynh, MD, assistant professor of neurology at the University of California, San Francisco, will address how community hospitals evaluate patients to identify whether they should be transferred to a Comprehensive Stroke Center.

A key to evaluation is imaging technology, which will be debated. Gregory W. Albers, MD, professor of neurology and neurological services at Stanford University, Palo Alto, California, will support the use of advanced penumbral imaging/collateral imaging. Andrew M. Demchuk, MD, professor of neurology in the Department of Clinical Neurosciences at the University of Calgary, will state the case for the use of CTA/MRA and ASPECTS imaging.

In the afternoon, interactive breakout sessions will look at topics such as interpreting imaging, reimbursement issues, the financial implications of using thrombectomy, including how its use affects the transfer of patients, and the medical management of patients following thrombectomy.

“What are the common complications, and what are the medical challenges related to thrombectomy?” Wein said. “We want to make sure everybody is prepared to deal with these complications. Some patients may stay at the Comprehensive Stroke Center, but other patients may be sent to their community centers because there is concern that if all patients are brought to the comprehensive centers, the centers will be overwhelmed. Post-thrombectomy management is going to be important for individuals to understand.”

Please note that there is a separate fee to register for the ISC Pre-Conference Symposium I, “Stroke in the Real World: To Infinity and Beyond: Endovascular Therapy and Systems of Care.” If you have already registered for ISC and would like to add it to your registration, please contact the Registration Resource Center.