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#WeekendLecture
#ISC22
Highlights
300 invited talks
Nearly 200 oral abstracts
>1000 posters
Here we review some of trials and presentation from Main Events at #ISC22
#ISC22
Highlights
300 invited talks
Nearly 200 oral abstracts
>1000 posters
Here we review some of trials and presentation from Main Events at #ISC22
#ISC22 Highlights
#RESCUE_Japan LIMIT
EVT for acute LVO with #large ischemic #Core
NIHSS>6, #ASPECT 3-5 , CT or MRI (~85%)
<6hr, or DWI/FLAIR mismatch <24hr
🚶mRS 0-3 at 90d: 31 vs 12.8%, RR 2.43🩸sICH,<48hr: 9 vs 4.9% NS
⚫️Death: 18 vs 23.5%, NS
nejm.org/doi/full/10.10…
#RESCUE_Japan LIMIT
EVT for acute LVO with #large ischemic #Core
NIHSS>6, #ASPECT 3-5 , CT or MRI (~85%)
<6hr, or DWI/FLAIR mismatch <24hr
🚶mRS 0-3 at 90d: 31 vs 12.8%, RR 2.43🩸sICH,<48hr: 9 vs 4.9% NS
⚫️Death: 18 vs 23.5%, NS
nejm.org/doi/full/10.10…
#ISC22 Highlights
#Rescue-BT EVT with or w/o #tirofiban in LVO stroke
GPIIb/IIIa-R inhibitor could ⏬reocclusion after MT
55🏥in🇨🇳AIS<24hr, no IVT, ASPECT≥6
950pts
🚶mRS at 90d: 3 vs 3
🩸sICH: 9.7 vs 6.4%, NS
⚫️Death: 18.1 vs 16.9%
Treatment effect modification in LAA subgroup
#Rescue-BT EVT with or w/o #tirofiban in LVO stroke
GPIIb/IIIa-R inhibitor could ⏬reocclusion after MT
55🏥in🇨🇳AIS<24hr, no IVT, ASPECT≥6
950pts
🚶mRS at 90d: 3 vs 3
🩸sICH: 9.7 vs 6.4%, NS
⚫️Death: 18.1 vs 16.9%
Treatment effect modification in LAA subgroup
#WeekendLecture
#HistoryofEVT
It’s no secret that #EVT for AIS has been a complete game changer for the field resulting in dramatic reduction in death & disability
Join us to explore the #history of EVT in collaboration with @SVINJournal, to celebrate the inaugural issue
#HistoryofEVT
It’s no secret that #EVT for AIS has been a complete game changer for the field resulting in dramatic reduction in death & disability
Join us to explore the #history of EVT in collaboration with @SVINJournal, to celebrate the inaugural issue
Many thanks to @Mahmoudneuro, #RaulNogueira and @DiogoHaussen whose review entitled:
👉“Tx Advancements in the Endovascular Management of Stroke” celebrates the advances in #ETV
🆓 #openaccess
✅ahajournals.org/doi/full/10.11…
👉“Tx Advancements in the Endovascular Management of Stroke” celebrates the advances in #ETV
🆓 #openaccess
✅ahajournals.org/doi/full/10.11…
1st #Fun fact: Interventional treatment of AIS dates all the way back to 1950s‼️
Sussman & Fitch reported 3 cases of IA infusion of fibrinolytics
Didn’t work 😫. Probably because they were performed in a non-hyperacute fashion
But this laid the foundation for years of refinement
Sussman & Fitch reported 3 cases of IA infusion of fibrinolytics
Didn’t work 😫. Probably because they were performed in a non-hyperacute fashion
But this laid the foundation for years of refinement
#WeekendLecture
#Tenecteplase #TNK
Part 1
✅3rd generation rtPA
🧬Targeted genetic upgrade
3 specific alterations to #alteplase molecule:
👉⬆️Half life
👉⬆️Binding affinity for #fibrin
👉⬆️Resistance to inactivation by #PAI-1
bit.ly/3pqbEb1
#Tenecteplase #TNK
Part 1
✅3rd generation rtPA
🧬Targeted genetic upgrade
3 specific alterations to #alteplase molecule:
👉⬆️Half life
👉⬆️Binding affinity for #fibrin
👉⬆️Resistance to inactivation by #PAI-1
bit.ly/3pqbEb1
#WeekendLecture
#TNK
👉⬆️T1/2 allows single bolus dosing and⬆️clot exposure to TNK
👉Higher affinity to fibrin-rich clots & + potent/faster clot #lysis vs alteplase
👉 < consumption of fibrinogen/plasminogen/ a2- antiplasmin👉⬇️systemic fibrinolytic effect👉⏬risk for bleeding
#TNK
👉⬆️T1/2 allows single bolus dosing and⬆️clot exposure to TNK
👉Higher affinity to fibrin-rich clots & + potent/faster clot #lysis vs alteplase
👉 < consumption of fibrinogen/plasminogen/ a2- antiplasmin👉⬇️systemic fibrinolytic effect👉⏬risk for bleeding
#WeekendLecture
#TNK
First analysis in stroke patients was a #dose-scalation safety study
There was no #symptomatic ICHs in dosis of 0.1-0.2-0.4mg/kg, and 15% (2 of 13) in 0.5mg/kg
No differences in clinical outcomes
bit.ly/3DNHamV
#TNK
First analysis in stroke patients was a #dose-scalation safety study
There was no #symptomatic ICHs in dosis of 0.1-0.2-0.4mg/kg, and 15% (2 of 13) in 0.5mg/kg
No differences in clinical outcomes
bit.ly/3DNHamV
#WeekendLecture
Intracranial Atherosclerotic Disease #ICAD
#ICAD leads to changes ranging from minor wall thickening to #hemodynamically significant luminal stenosis and is one of the most #common causes of #stroke worldwide
ahajournals.org/doi/10.1161/CI…
🧵
Intracranial Atherosclerotic Disease #ICAD
#ICAD leads to changes ranging from minor wall thickening to #hemodynamically significant luminal stenosis and is one of the most #common causes of #stroke worldwide
ahajournals.org/doi/10.1161/CI…
🧵
#WeekendLecture
#ICAD
✅10% of stroke, based on autopsy studies
bit.ly/3v6Lhrd
✅More prevalent in #African Americans, #Hispanics, and #Asians as compared with whites
bit.ly/3AuSiDt
Other risk factors in table
#ICAD
✅10% of stroke, based on autopsy studies
bit.ly/3v6Lhrd
✅More prevalent in #African Americans, #Hispanics, and #Asians as compared with whites
bit.ly/3AuSiDt
Other risk factors in table
#WeekendLecture
#ICAD
In postmortem studies
👉degree of luminal #stenosis
👉% of the plaques containing >40% #lipid area
👉prevalence of intraplaque #hemorrhage, #neovasculature and #thrombus,
were higher in those #plaques associated with #infarct
🔹karger.com/Article/Abstra…
#ICAD
In postmortem studies
👉degree of luminal #stenosis
👉% of the plaques containing >40% #lipid area
👉prevalence of intraplaque #hemorrhage, #neovasculature and #thrombus,
were higher in those #plaques associated with #infarct
🔹karger.com/Article/Abstra…
#WeekendLecture
#GeneticsAndStroke
#Genetics is involved in several #stroke related conditions, such as small vessel disease #SVD, aneurysms, dissections, cavernomas, and intracranial #hemorrhages
Check this 🧵!
Prepared by @J_Rosales_MD
Edited by @interneurona
#GeneticsAndStroke
#Genetics is involved in several #stroke related conditions, such as small vessel disease #SVD, aneurysms, dissections, cavernomas, and intracranial #hemorrhages
Check this 🧵!
Prepared by @J_Rosales_MD
Edited by @interneurona
#Weekendlecture
#Genetic & #SVD
🧬🧠
✅1,5% of cerebral #SVD are #monogenic disorders
✅AR, AD or X-linked
☝🏼Absence of family history doesn't rule out diagnosis because of
👉de novo mutation
👉reduced expression or
👉incomplete penetrance
✅ahajournals.org/doi/10.1161/ST…
#Genetic & #SVD
🧬🧠
✅1,5% of cerebral #SVD are #monogenic disorders
✅AR, AD or X-linked
☝🏼Absence of family history doesn't rule out diagnosis because of
👉de novo mutation
👉reduced expression or
👉incomplete penetrance
✅ahajournals.org/doi/10.1161/ST…
#Weekendlecture
#Genetic & #SVD
When to #suspect?🕵️♀️
✅early onset stroke without vascular RFs
✅systemic features and neuroimaging of an specific monogenic disorder
✅consanguinity
✅negative work up for other causes of SVD
👉ahajournals.org/doi/10.1161/ST…
#Genetic & #SVD
When to #suspect?🕵️♀️
✅early onset stroke without vascular RFs
✅systemic features and neuroimaging of an specific monogenic disorder
✅consanguinity
✅negative work up for other causes of SVD
👉ahajournals.org/doi/10.1161/ST…
#WeekendLecture
#CarotidArteryDisease #CAD
#CAD causes ~ 10-20% of #strokes
Atherosclerosis occurs most frequently at carotid #bifurcation, an area of low vessel-wall shear stress and oscillatory/turbulent blood flow
Welcome to this mini review!
#CarotidArteryDisease #CAD
#CAD causes ~ 10-20% of #strokes
Atherosclerosis occurs most frequently at carotid #bifurcation, an area of low vessel-wall shear stress and oscillatory/turbulent blood flow
Welcome to this mini review!
#WeekendLecture
#CAD
Endothelial dysfunction
⬇️
Inflammatory response to Lp retention in arterial wall
⬇️
Accelerated accumulation of Lp in subendothelial matrix
⬇️
Macrophages
⬇️
VSCM migrate/proliferate to fibroblast-like cells👉 production of EC matrix
atm.amegroups.com/article/view/7…
#CAD
Endothelial dysfunction
⬇️
Inflammatory response to Lp retention in arterial wall
⬇️
Accelerated accumulation of Lp in subendothelial matrix
⬇️
Macrophages
⬇️
VSCM migrate/proliferate to fibroblast-like cells👉 production of EC matrix
atm.amegroups.com/article/view/7…
#WeekendLecture
#CAD
Stroke Mechanisms
✅#artery_to_artery embolization: retinal (amaurosis fugax) or cerebral circulation
✅#thrombosis in situ
✅#Flow reduction in high grade stenosis: #watershed infarcts, repetitive and brief TIAs (ie limb shaking)
nejm.org/doi/full/10.10…
#CAD
Stroke Mechanisms
✅#artery_to_artery embolization: retinal (amaurosis fugax) or cerebral circulation
✅#thrombosis in situ
✅#Flow reduction in high grade stenosis: #watershed infarcts, repetitive and brief TIAs (ie limb shaking)
nejm.org/doi/full/10.10…
#WeekendLecture
Stroke outcome #prognostication
☝️#Stroke clinicians are routinely asked by patients and families regarding prognosis.
🧠The cognitive process underlying prognostication is #complex, poorly understood, and sometime #biased by personal experiences
Stroke outcome #prognostication
☝️#Stroke clinicians are routinely asked by patients and families regarding prognosis.
🧠The cognitive process underlying prognostication is #complex, poorly understood, and sometime #biased by personal experiences
#WeekendLecture
#StrokePrognostication
#Fact: Clinicians, even those with expertise in stroke, perform poorly in predicting clinical outcomes
In this case-based study, overall accuracy for predicting death or disability at discharge was <20%😩
#JURaSSIC
n.neurology.org/content/81/5/4…
#StrokePrognostication
#Fact: Clinicians, even those with expertise in stroke, perform poorly in predicting clinical outcomes
In this case-based study, overall accuracy for predicting death or disability at discharge was <20%😩
#JURaSSIC
n.neurology.org/content/81/5/4…
#WeekendLecture
#StrokePrognostication
☝️Several prognostic #models have been developed to aid prognostication after ischemic stroke
These models #outperform clinician #judgment in predicting stroke outcomes
ie:
onlinelibrary.wiley.com/doi/10.1111/en…
@GeorgeNtaios
#StrokePrognostication
☝️Several prognostic #models have been developed to aid prognostication after ischemic stroke
These models #outperform clinician #judgment in predicting stroke outcomes
ie:
onlinelibrary.wiley.com/doi/10.1111/en…
@GeorgeNtaios
#WeekendLecture
#PregnancyAndStroke
#Pregnancy and #puerperium confer an ⬆️ risk for ischemic as well as hemorrhagic stroke, with incidence rates being 3-fold higher as compared with nonpregnant women
👉doi.org/10.1016/j.ncl.…
a short 🧵
#PregnancyAndStroke
#Pregnancy and #puerperium confer an ⬆️ risk for ischemic as well as hemorrhagic stroke, with incidence rates being 3-fold higher as compared with nonpregnant women
👉doi.org/10.1016/j.ncl.…
a short 🧵
#WeekendLecture
#PregnancyAndStroke
@DrRickSwartz @patrice_lindsay et al metaanalysis
👉11 studies
👉>85 million #pregnancy and #postpartum admissions in various countries
👉overall incidence of #stroke was 30 per 100,000 hospitalizations👈
@IntJStroke
journals.sagepub.com/doi/10.1177/17…
#PregnancyAndStroke
@DrRickSwartz @patrice_lindsay et al metaanalysis
👉11 studies
👉>85 million #pregnancy and #postpartum admissions in various countries
👉overall incidence of #stroke was 30 per 100,000 hospitalizations👈
@IntJStroke
journals.sagepub.com/doi/10.1177/17…
#WeekendLecture
#PregnancyAndStroke
RFs:
☑️Age, >40yo OR3.1
☑️Race/ethnicity
☑️Migraine, thrombophilia, SLE, 🫀disease, HTN, thrombocytopenia, diabetes
☑️Pregnancy complications
✅For hemorrhagic stroke: aneurysms, AVM, Hypertensive Disorders of Pregnancy
journals.lww.com/greenjournal/F…
#PregnancyAndStroke
RFs:
☑️Age, >40yo OR3.1
☑️Race/ethnicity
☑️Migraine, thrombophilia, SLE, 🫀disease, HTN, thrombocytopenia, diabetes
☑️Pregnancy complications
✅For hemorrhagic stroke: aneurysms, AVM, Hypertensive Disorders of Pregnancy
journals.lww.com/greenjournal/F…
#WeekendLecture
#CerebralMicrobleeds #CMB
Radiological construct: small (2–10 mm diameter) round or ovoid #hypointense foci with associated #blooming with enhanced visibility on #MRI sequences sensitive to #susceptibility effects
thelancet.com/journals/laneu…
#CerebralMicrobleeds #CMB
Radiological construct: small (2–10 mm diameter) round or ovoid #hypointense foci with associated #blooming with enhanced visibility on #MRI sequences sensitive to #susceptibility effects
thelancet.com/journals/laneu…
#WeekendLecture
#CMB
🔬#Pathology: recent or old microhaemorrhages
🩸Microvessel injuries, ie: dilatation/fragmentation of the wall, amyloid-ß (in CAA) and fibrin extravasation
🩸Extravasation of red blood cells
🩸#hemosiderin-laden macrophages
karger.com/Article/FullTe…
#CMB
🔬#Pathology: recent or old microhaemorrhages
🩸Microvessel injuries, ie: dilatation/fragmentation of the wall, amyloid-ß (in CAA) and fibrin extravasation
🩸Extravasation of red blood cells
🩸#hemosiderin-laden macrophages
karger.com/Article/FullTe…
#WeekendLecture
In daily practice #CMB represents a radiological marker of #small vessel disease
In general:
🩸Strictly #lobar CMBs👉CAA
🩸Strictly #deep👉hypertension-related SVD ie #arteriolosclerosis
🩸Mixed 👉combination👆, but must think #hereditary #SVD, ie #CADASIL
In daily practice #CMB represents a radiological marker of #small vessel disease
In general:
🩸Strictly #lobar CMBs👉CAA
🩸Strictly #deep👉hypertension-related SVD ie #arteriolosclerosis
🩸Mixed 👉combination👆, but must think #hereditary #SVD, ie #CADASIL
This is a very late #WeekendLecture
but you can review it anytime you want😉
🧠#Aneurysm & #Subarachnoid Hemorrhage
Unruptured intracranial aneurysms are pathologic dilations at major branching brain arteries
~3% of adult population
nejm.org/doi/full/10.10…
thelancet.com/journals/lance…
but you can review it anytime you want😉
🧠#Aneurysm & #Subarachnoid Hemorrhage
Unruptured intracranial aneurysms are pathologic dilations at major branching brain arteries
~3% of adult population
nejm.org/doi/full/10.10…
thelancet.com/journals/lance…
#WeekendLecture
#Aneurysms & #SAH
The most common presentation of intracranial aneurysm is rupture leading to #SAH
The risk of rupture depends on patient and aneurysm related factor, ie: age/gender/location/size/growth, etc
🧠ahajournals.org/doi/10.1161/ST…
🧠journals.lww.com/continuum/Abst…
#Aneurysms & #SAH
The most common presentation of intracranial aneurysm is rupture leading to #SAH
The risk of rupture depends on patient and aneurysm related factor, ie: age/gender/location/size/growth, etc
🧠ahajournals.org/doi/10.1161/ST…
🧠journals.lww.com/continuum/Abst…
#WeekendLecture
#Aneurysms & #SAH
It is well known that endovascular or neurosurgical management of #unruptured intracranial aneurysm is not free of procedural #complications
This study investigates risk factors for this complications @JAMANeuro
👇
jamanetwork.com/journals/jaman…
#Aneurysms & #SAH
It is well known that endovascular or neurosurgical management of #unruptured intracranial aneurysm is not free of procedural #complications
This study investigates risk factors for this complications @JAMANeuro
👇
jamanetwork.com/journals/jaman…
#WeekendLecture
#ESUS
In most studies ~25% of ischemic stroke are classified as #cryptogenic
In 2014 the Embolic Stroke of Undetermined Source clinical construct was introduced, as a subset from cryptogenics
Criteria & diagnostic assessment were proposed
thelancet.com/journals/laneu…
#ESUS
In most studies ~25% of ischemic stroke are classified as #cryptogenic
In 2014 the Embolic Stroke of Undetermined Source clinical construct was introduced, as a subset from cryptogenics
Criteria & diagnostic assessment were proposed
thelancet.com/journals/laneu…
#WeekendLecture
#ESUS
Although a long list of causes was described, covert AF was conceived as perhaps the most important underlying mechanism
It was hypothesized that oral #anticoagulation may⏬ the risk of stroke recurence in #ESUS
#ESUS
Although a long list of causes was described, covert AF was conceived as perhaps the most important underlying mechanism
It was hypothesized that oral #anticoagulation may⏬ the risk of stroke recurence in #ESUS
#WeekendLecture
#ESUS
A systematic review in 2017 (from several authors of the pivotal paper) showed:
👉Frequency: 17% (9-25%) of IS
👉Mean age: 65
👉Recurrence: 4.5% per year
👉Younger, lower freq of vascular RFs and milder stroke vs non-ESUS IS
ahajournals.org/doi/10.1161/st…
#ESUS
A systematic review in 2017 (from several authors of the pivotal paper) showed:
👉Frequency: 17% (9-25%) of IS
👉Mean age: 65
👉Recurrence: 4.5% per year
👉Younger, lower freq of vascular RFs and milder stroke vs non-ESUS IS
ahajournals.org/doi/10.1161/st…
