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

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