Prof. Fischer presented the first lecture on the subject of recanalization in acute stroke with a short review of the current status of acute stroke management and a focused discussion on a great deal of the unanswered questions concering reperfusion therapy, including the safety and contraindications of r-tPA, the risk of symptomatic intracranial hemorrhage, intra-venous thrombolysis for minor strokes, wake-up strokes, extending the time window, the use of alteplase vs. tenecteplase as well as the unaswered questions regarding endovascular treatment, such as extending the time window, basilar occlusion, use in cases with either low NIHSS or low ASPECTS scores.
Prof. Sacco discussed the improvement of detection and prevention of cardiac embolism with a structured review on the debated subject of cryptogenic stroke, the concept of ESUS (embolic stroke of unknown source) and the two current management strategies: a pragmatic approach (blanket anticoagulation for all) or the “detective” strategy (identification of occult AF to anticoagulate only selected patients.
Dr. Mazzucco covered the subject of patent foramen ovale (PFO) as a cause of stroke with a critical review of the available evidence focusing on the problematic question of patient selection for PFO closure; previous trials included only a highly selected population (for example, excluding elderly patients and including only non-disabling strokes).
Dr. Parry-Jones presented the subject of current treatment issues in the acute phase of intracerebral hemorrhage, stressing the importance of avoiding nihilism and emphasizing that provision high quality management, including reversal of anticoagulation, blood pressure management, appropriate surgical treatment in some cases, and good supportive care, all delivered in a timely fashion, can improve outcomes. A parallel was drawn to the ischaemic stroke concept of “time is brain”; that is true for intracerebral haemorrhage as well.
by Mihai Radu Ionescu, MD, Bucharest, Romania and Francesco Iodice, MD, Rome, Italy