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Feb 14, 2022 12 tweets 19 min read Read on X
#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
#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
#ISC22 Highlights
#PREMIERS
#Periodontal treatment to eliminate minority inequality & rural disparities in stroke
PD⬆️risk: stroke, MI, death
Standard vs intensive treatment of “gum disease"
280pt
NS diffs in outcomes
☝️# of dental visits correlates w/⏬ in composite outcome
#ISC22 Highlights
Economic evaluation of the #BEST_MSU study
Determine ⬆️ cost & effectiveness associated with MSU vs SM using CE analysis
✅Incremental Cost Effectiveness Ratio:📈Cost/📈QALYs
👉MSU cost effective specially in patient with no disability at baseline (mRS 0-1)
#ISC22 Highlights
#ACTION_CVT
Retrospective observational multicenter international study
#DOAC or warfarin for #CVT
845pts
Recurrent VTE or CVT: aHR 0.94,ns
Complete/partial renacalization: aHR 0.92,ns
Major hemorrhage: aHR 0.35; p 0.02
Death: 0.78,ns
👇
ahajournals.org/doi/abs/10.116…
#ISC22 Highlights
#CHOICE Trial
IA alteplase (0.225mg/kg)after successful MT
Aim: improve reperfusion in microvascular bed
Multicenter,RPCT, 2b
LVO w/ TICI2b or 2b/3 post MT
121pts (61% of sample size)
mRS 0-1 at 3m: 59 vs 40.4% p:0.47
sICH<24hr: 0 vs 3.8%
jamanetwork.com/journals/jama/…
#ISC22 Highlights

#CHABLIS_T , phase 2, 🇨🇳

#TNK 0.25 & 0.32mg/kg, no placebo, 4.5-24hr, (+)ve mismatch on CTP
Outc:
-EVT: ⏬50% hypoperfusion volume in control CTP
+EVT: TICI≥2b at initial angio
👉32.6% Low Dose; 23.3% High Dose
🩸sICH: 11.6% LD; 9,3 HD
#ISC22 Highlights
#Onyx For The EV Management Of #cAVM

140pts, not previously treated, 60% symptomatic
3 groups: Onyx embo only as curative (73), pre NSx, pre RSx
⚫️All SAE related to procedure: 7.1%
⚫️Death 4/140 (related to procedure:1)
✅Total cure 75%
#ISC22 Highlights
#BUBL study
Robotic assisted #TCD vs TTE to detect right➡️left shunt
raTCD (+) for RLS in 63.% vs 20.9% in #TTE
TTE missed 18/35 of large shunts detected by raTCD
No SAE associated to device
Technically feasible for use by health professionals with no TCD skills
#ISC22 Highlights
#EXCELLENT registry, EmboTrap
~1000pts
55% treated <6h
✅≥TICI2b 94%
#CLOT:
🩸RBC rich—> aumenta deformability/friability—>better outcome
🗜️Platelet rich-> more compressed—> modified effects of RBC clot % on outcome
#WeekendLecture
#ISC22 Highlights

A lot more of science and knowledge was shared during this #ISC22
If you missed you still can access via On Demand
professional.heart.org/en/meetings/in…

Thanks for reading!!

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More from @WorldStrokeEd

Nov 27, 2021
#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 Image
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…
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 Image
Read 21 tweets
Oct 17, 2021
#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 Image
#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 Image
#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 ImageImage
Read 11 tweets
Oct 11, 2021
#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…

🧵 Image
#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 Image
#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… Image
Read 13 tweets
Oct 4, 2021
#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 Image
#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…
#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… Image
Read 15 tweets
Aug 29, 2021
#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!
#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…
#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…
Read 12 tweets
Aug 15, 2021
#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 Image
#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… Image
#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 Image
Read 12 tweets

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