CONy 2020 Stroke Program
Section Heads:
Natan Bornstein, Israel
Hugh Markus, UK
Ashfaq Shuaib, Canada
*This program is subject to change
| Friday, March 27, 2020 | |
| 08:30-10:10 | NEUROIMAGING IN ACUTE ISCHEMIC STROKE |
| 08:30-09:20 | Is penumbral imaging mandatory for potential thrombectomy in patients arriving beyond six hours? |
| Capsule: There is general agreement amongst stroke experts that patient selection is essential for successful thrombectomy. The introduction of penumbral imaging may allow for improved patient evaluation but comes at a higher cost. Is there sufficient evidence that such imaging is required for treatment decision in patients arriving more than six hours after stroke onset or in those with sleep onset strokes? | |
| 08:30-08:40 | Host: Joanna Wojczal, Poland |
| 08:40-08:55 | Yes: Krassen Nedeltchev, Switzerland |
| 08:55-09:10 | No: Ashfaq Shuaib, Canada |
| 09:10-09:20 | Discussion and rebuttals |
| 09:20-10:10 | Do DWI negative strokes exist? |
| Capsule: Stroke is a clinical entity. Its exact identification is crucial as therapeutic options nowadays are associated with some risks. DWI MRI is considered the best imaging technique for the confirmation of acute ischemic stroke (AIS). Sensitivity, however, is not perfect, with debatable underlying reasons, raising the question: Do AIS with negative DWI imaging really exist? | |
| 09:20-09:30 | Host: Adrian Perry-Jones, UK |
| 09:30-09:45 | Yes: Jonathan Streifler, Israel |
| 09:45-10:00 | No: Krassen Nedeltchev, Switzerland |
| 10:00-10:10 | Discussion and rebuttals |
| 10:10-10:25 | Coffee Break |
| 10:25-12:05 | HEART AND BRAIN |
| 10:25-11:15 | Should all patients with embolic stroke of undetermined source (ESUS) be anticoagulated? |
| Capsule: Patients with embolic stroke of unknown source (ESUS) are more likely to have a cardioembolic source of stroke, so may benefit from anticoagulation. However, studies to date have not supported anticoagulation in all patients with ESUS. Are there robust reasons that they should be anticoagulated? | |
| 10:25-10:35 | Host: Natan Bornstein, Israel |
| 10:35-10:50 | Yes: David Spence, Canada |
| 10:50-11:05 | No: Jonathan Streifler, Israel |
| 11:05-11:15 | Discussion and rebuttals (5 min) |
| 11:15-12:05 | Is left atrial appendage closure underutilized for stroke prevention in atrial fibrillation? |
| 11:15-11:25 | Host: George Chrysant, USA |
| 11:25-11:40 | Yes: |
| 11:40-11:55 | No: Michael Glikson, Israel |
| 11:55-12:05 | Discussion and rebuttals (5 min) |
| 12:15-13:15 | Industry Supported Symposium |
| 13:15-14:15 | Lunch Break |
| 13:15-14:15 | Meet the Expert |
| 14:15-15:45 | ACUTE STROKE MANAGEMENT |
| 14:15-14:55 | Mobile stroke units (MSU) are useful and cost effective |
| Capsule: IV tPA was approved as an effective treatment for acute ischemic stroke (AIS) within 4.5 hours. It also was shown that the sooner the tPA is administered the better are the chances of beneficial outcome – “Time is Brain". Therefore, MSU with CT scan were introduced with the ability to give tPA in the ambulance and by that to save time. It is still unsettled whether MSU actually have an impact on patients’ outcome and are cost effective. This debate will try to shed light on this controversial issue. | |
| 14:15-14:25 | Host: Joanna Wojczal, Poland |
| 14:25-14:35 | Yes: Silke Walter, Germany |
| 14:35-14:45 | No: Krassen Nedeltchev, Switzerland |
| 14:45-14:55 | Discussion and rebuttals |
| 14:55-15:45 | Does the main benefit of AIS come from tPA or stroke unit care? Capsule: The presence of a dedicated stroke unit allows for the management of all patients with suspected AIS. Treatment with tPA can only be offered to a smaller subset of AIS patients but the improvement in some treated patients can be very significant. In an era of limited resources, such we focus on ensuring that all AIS patients be admitted to a stroke unit or recommend develop of fast triage methods for timely thrombolysis? |
| Host: Agnieszka Słowik, Poland | |
| 14:55-15:05 | tPA: Gary Ford, UK |
| 15:05-15:20 | Stroke unit: Ashfaq Shuaib, Canada |
| 15:20-15:35 | Discussion and rebuttals (5 min) |
| 15:45-16:00 | Coffee Break |
| 16:00-17:30 | SECONDARY STROKE PREVENTION |
| 16:00-16:45 | Should statins be given to people over age 80 for stroke prevention? |
| Capsule: There is considerable evidence that the use of statins results in a reduction of cardiovascular morbidity and mortality. Long-term treatment with statins can lead to side effects including muscle and liver damage. Clinical trials evaluating the efficacy of statins have mostly enrolled subjects less than 75 years of age. Can we extrapolate the evidence to older individuals in whom the risk for side-effects may be higher? | |
| 16:00-16:10 | Host: Ashfaq Shuaib, Canada |
| 16:10-16:25 | Yes: David Spence, Canada |
| 16:25-16:40 | No: Vida Demarin, Croatia |
| 16:40-16:45 | Discussion and rebuttals (5 min) |
| 16:45-17:30 | Should symptomatic extracranial vertebral artery stenosis be stented? |
| Capsule: Stenosis in the vertebro-basilar system accounts for about a quarter of all posterior circulation strokes. The risk profile is similar to that seen for carotid stenosis. Recent phase 2 trials have shown that extracranial vertebral stenosis can be stented with low risk but whether this reduces recurrent stroke risk compared with best medical therapy alone remains controversial. The debate will consider whether based on current evidence stenting should be recommended for recently symptomatic extracranial vertebral artery stenosis. | |
| 16:45-16:55 | Host: Hugh Markus, UK |
| 16:55-17:10 | Yes: Laszlo Csiba, Hungary |
| 17:10-17:25 | No: Hrvoje Budincevic, Croatia |
| 17:25-17:30 | Discussion and rebuttals |
| 17:30-19:00 | ANTITHROMBOTIC TREATMENTS FOR SECONDARY PREVENTION IN PATIENTS WITH ISCHEMIC STROKE |
| 17:30-18:15 | Should TIA patients be routinely treated with both ASA and clopidogrel |
| Capsule: In some studies, dual antiplatelet therapy has benefits in the short term compared to single agents. However, the duration of benefit may be limited, and there may be some patients who would not benefit. Is there sufficient evidence to recommend dual antiplatelet therapy for all patients with TIA? | |
| 17:30-17:40 | Host: Agnieszka Słowik, Poland |
| 17:40-17:55 | Yes: Jorge Celis, Colombia |
| 17:55-18:10 | No: David Spence, Canada |
| 18:10-18:15 | Discussion and rebuttals |
| 18:15-19:00 | In the presence of cerebral microbleeds (CMBs), antithombotic therapy should be avoided |
| Capsule: The presence of microbleeds (detected only with MRI) may increase both the risk of hemorrhagic and perhaps the ischemic stroke. The risk depends on the location and number of microbleeds. How dangerous is the antithrombotic therapy in patients with microbleeds? The session provides an overview about the pros and cons. | |
| 18:15-18:25 | Host: David Werring, UK |
| 18:25-18:40 | Yes: |
| 18:40-18:55 | No: Laszlo Csiba, Hungary |
| 18:55-19:00 | Discussion and rebuttals |