C94 - Hot Topics in Stroke Education and Practice
Event Time: | Monday April 23, 2018 3:30 pm to 5:30 pm |
Topic(s): | Cerebrovascular Disease and Interventional Neurology, Practice, Policy, and Ethics |
Director(s): | Pierre Fayad MD, FAAN, FAHA |
Description: | The management of acute ischemic stroke has witnessed a dramatic transformation over the past decades. More recently, the evidence-based introduction of thrombectomy in 2015, as a powerful and effective treatment for patients with intracranial large vessel occlusion (LVO) for up to 6 hours from symptom-onset, with or without intravenous thrombolysis with tPA, accelerated such changes. To translate these findings into clinical settings, acute stroke teams reorganized their screening processes, to evaluate emergently patients with CT or MR angiography and widen the window of screening and treatment from 4.5 hours for IV tPA to 6 hours for IV tPA and thrombectomy. Neurointerventionalists mobilized to perform thrombectomy emergently for eligible patients. Neurointensivists, Vascular Neurologists and Neuro-Hospitalists mobilized to provide the skills, the acute care needed before, during and following the interventions. In 2017, further revolutionary events impacted knowledge and practice. The DAWN study demonstrated that thrombectomy is highly effective at improving outcomes and preventing disability when applied for up to 24 hours from symptom-onset in eligible patients based on neurologic deficits, LVO and presence of “salvageable brain tissue”, based on imaging criteria from cerebral diffusion and perfusion studies based on the RAPID software analysis. In 2018, the DEFUSE-3 study, showed similarly demonstrated dramatic effectiveness of thrombectomy for up to 16 hours from symptom-onset in eligible patients based on variations of the DAWN criteria. These powerful findings were already incorporated in the American Heart Association Guidelines update for the management of acute ischemic stroke, whose values were endorsed by the AAN, with recommendations to treat patients for up to 24 hours with thrombectomy according to the eligibility criteria of both trials. These seismic changes, will have a massive impact on the organization and delivery of acute stroke care services in terms of human, organizational and financial costs in the years to come. Expanding the window of emergent care for up to 24 hours, will require immediate implementation, placing major strains on stroke systems of care, but most importantly on the neurologist and neurology subspecialists, who generally carry the largest burden of screening, evaluating, and treating such patients. This session will explore those changes and potential ways to meet them. Neurological education and training need to incorporate such changes in order to prepare our residents’ readiness for their future practice, once they graduate. Strong knowledge and skills in evaluating and treating stroke will undoubtedly be an essential skill of any neurologic practice, in any setting, in the future. The Panel Discussion and Q/A Session at the end will discuss the potential impact on neurology training. |
Completion Message: | |
CME Credits: | 2 |
Core Competencies: | Medical Knowledge, Patient Care, Practice-Based Learning and Improvement, Systems-Based Practice |
Start/End Time | Title | Faculty |
---|---|---|
3:30 PM - 3:35 PM | Welcome and Session Introduction | Pierre Fayad MD, FAAN, FAHA |
3:35 PM - 3:50 PM | Major Findings in DAWN and DEFUSE-3 | David S. Liebeskind MD, FAAN |
3:50 PM - 4:05 PM | Highlights From 2018 ASA/AHA Guidelines for Acute Ischemic Stroke | William J. Powers MD, FAAN |
4:05 PM - 4:20 PM | Role of Advanced Acute Stroke Imaging for the Neurologist | Gregory W. Albers MD |
4:20 PM - 4:35 PM | Stroke Training During Neurology Residency and Fellowships: Present and Future | Sunil Sheth MD |
4:35 PM - 4:50 PM | Potential Strategies to Meet Challenges of The 24-Hours Window For Acute Stroke | Lawrence R. Wechsler MD, FAAN |
4:50 PM - 5:30 PM | Panel Discussion / Questions and Answers | Faculty |
Speaker | Disclosure |
---|---|
Gregory W. Albers, MD | Dr. Albers has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with iSchemaView, Medtronic, Janssen and Bayer. Dr. Albers holds stock and/or stock options in iSchemaView, which sponsored research in which Dr. Albers was involved as an investigator. Dr. Albers holds stock and/or stock options in iSchemaView. |
Pierre Fayad, MD, FAAN, FAHA | Dr. Fayad has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Medtronic. |
David S. Liebeskind, MD, FAAN | Dr. Liebeskind has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Stryker and Medtronic. |
William J. Powers, MD, FAAN | Dr. Powers has nothing to disclose. |
Sunil Sheth, MD | Dr. Sheth has nothing to disclose. |
Lawrence R. Wechsler, MD, FAAN | Dr. Wechsler has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen and Athersys. |
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