Stroke Update. Claire J. Creutzfeldt, MD January 12, 2018
|
|
|
- Mariah Harrell
- 6 years ago
- Views:
Transcription
1 Stroke Update Claire J. Creutzfeldt, MD January 12, 2018
2 Disclosures None relevant to this presentation I receive funding from the NINDS
3 What s new in stroke? A new model for cardioembolic stroke: atrial cardiopathy Expanding indications for NOACs? Thrombectomy update Expanding the time window
4 What s new in stroke? A new model for cardioembolic stroke: atrial cardiopathy Expanding indications for NOACs? Thrombectomy update Expanding the time window
5 What we know.
6 How are Afib and Stroke related? ASSERT study. Circulation 2014; 129:
7 Ischemic stroke in North American and European Studies Ischemic stroke subtypes Other, known Other, unknown (cryptogenic) Large Artery Cardioembolic Small artery (lacunes) Lancet Neurology 2014; 13: 429-
8 A new model for stroke & atrial fibrillation? Stroke 2016; 47:
9 Afib as a marker for atrial cardiopathy Often cohabitates with other atrial abnormalities Fibrosis Endothelial dysfunction Impaired myocyte function Chamber dilatation Mechanical dysfunction Stroke 2016; 47:
10 Abnormal atria and stroke Stroke 2016; 47: Stroke 2014; 45: 2787.
11 Abnormal atria and stroke Stroke 2016; 47:
12 Other atrial factors and stroke: LAA Windsock 4% Chicken Wing Cactus 12% J Am Coll Cardiol 2012; 60: Cauliflower
13 A new model for stroke & atrial fibrillation? Other arrhythmias Enlarged L atrium PTFV1 Lab biomarkers (NT-proBNP) CT/MR/Echo LAA morphology Stroke 2016; 47:
14 A new model for stroke & atrial fibrillation? Stroke 2016; 47:
15 Elevated NT-proBNP Relative Risk Reduction of 70% on warfarin! Stroke 2013; 44:
16 What s new in stroke? A new model for cardioembolic stroke: atrial cardiopathy Expanding indications for NOACs? Thrombectomy update Expanding the time window
17 Brief reminder NOAC efficacy Lancet 2014; 383:
18 Brief reminder NOAC safety Lancet 2014; 383:
19 A new model for stroke & atrial fibrillation? Apixaban Dabigatran Edoxaban Rivaroxaban Other arrhythmias Enlarged L atrium PTFV1 Lab biomarkers (NT-proBNP) CT/MR/Echo LAA morphology Stroke 2016; 47:
20 NAVIGATE ESUS Rivaroxaban vs ASA for secondary stroke prevention ESUS Halted Primary outcome: Early Stroke or systemic embolization; major bleed Industry sponsored RE-SPECT ESUS Dabigatran vs ASA ESUS Primary outcome: Recurrent stroke (ischemic or hemorrhagic) Industry sponsored ATTICUS Apixaban vs ASA ESUS + suggestion of cardiac risk* Primary outcome: imaging evidence of new ischemia (FLAIR, DWI) at 12mo University Hospital Tuebingen (Germany) ARCADIA Apixaban vs ASA ESUS + atrial cardiopathy Primary outcome: Recurrent stroke; symptomatic intracranial hemorrhage or major bleed NINDS *LA size >45mm, spontaneous echo contrast in LAA, LAA flow velocity <=0.2m/s, atrial high rate episodes, CHAD2VASC score >=4, PFO. Severe LA enlargement on echo, PTFV1, NT-proBNP
21 What s new in stroke? A new model for cardioembolic stroke: atrial cardiopathy Expanding indications for NOACs? Thrombectomy update Expanding the time window
22 Endovascular Thrombectomy
23 26.5% 46.0% Lancet 2016; 387:
24 HERMES collaboration: efficacy of endovascular thrombectomy NNT to reduce disability by at least one level = 2.6 Lancet 2016; 387:
25 HERMES: What about timing? Lancet 2016; 387:
26 Who and how late can we go?
27 Can we extend the intervention time window? DAWN Prospective, randomized looking at intervention vs medical management in patients presenting w/in 6-24h Imaging: MR-DWI or CTPrCBF DEFUSE 3 Prospective, randomized looking at intervention vs medical management in patients presenting w/in 6-16h of stroke onset Imaging: CT perfusion/cta or MR DWI/PWI/MRA
28 DAWN Study Methods: Workflow 6-24h - Age 18 - NIHSS 10 - Pre-mRS TLSW to Randomization: 6-24h NCCT/DWI: <1/3 MCA Territory CTA/MRA: ICA-T and/or MCA-M1 (Tandem Occlusions Allowed) RAPID CTP/DWI CIM: Informed Consent A. 80 y/o: 1. NIHSS 10 + core <21cc B. <80 y/o: 2. NIHSS 10 + core <31cc 3. NIHSS 20 + core <51cc Slide courtesy of Dr. Tudor Jovin 1:1 Randomization: - CIM subgroup - ICA-T vs M vs 12-24h Control Thrombectomy 90-day mrs
29 DAWN: Randomization and follow-up Randomized (n=206) Trevo + MM N=107 Stratification by clinical core mismatch, time, and occlusion location MM N=99 Final FU available day complete 1 withdrew after 30 day visit* ITT cohort * 30 day mrs carried forward in 4 pts 100% follow-up to 30 days Slide courtesy of Dr. Tudor Jovin Final FU available day complete 2 LTFU after 30 days* 1 withdrew after 30 day visit*
30 DAWN: Demographics Treatment arm N=107 Control arm N=99 P-value Age (years) (median, [IQR]) 72.0 [ ] 73.0 [ ] 0.51 NIHSS, baseline (median, [IQR]) 17 [13-21] 17 [14-21] 0.64 Sex, male (%) 39.3% 51.5% 0.09 Race White/Caucasian 66.0% 63.6% 0.77 Black or African American 21.7% 15.2% 0.28 Other* 12.3% 21.2% 0.09 IV-tPA administered 4.7% 13.1% 0.05 Slide courtesy of Dr. Tudor Jovin
31 DAWN: Medical history Treatment arm N=107 Control arm N=99 P-value Hypertension 79.0% 75.8% 0.62 Heart failure 18.8% 15.5% 0.58 Coronary artery disease 31.4% 24.0% 0.27 Atrial fibrillation 41.3% 25.0% 0.02 Diabetes mellitus 25.2% 31.6% 0.35 Dyslipidemia 58.8% 59.4% 1.00 Current smoker (within last year) 20.4% 23.5% 0.61 Previous ischemic stroke 12.1% 11.1% 1.00 Slide courtesy of Dr. Tudor Jovin
32 DAWN: Patient presentation Treatment arm N=107 Time since time last seen well to randomization (hrs) Mean ± SD Median (Q1, Q3) Range (min, max) 13.4 ± (10.2, 16.0) (6.1, 23.5) Control arm N= ± (9.4, 15.8) (6.4, 23.9) P- value 0.53 Stroke sub-population Wake up stroke 64.5% 47.5% 0.01 Witnessed stroke 10.3% 14.1% 0.52 Un-witnessed stroke 25.2% 38.4% 0.05 Slide courtesy of Dr. Tudor Jovin
33 DAWN: Adjudicated safety outcomes P=0.3 P< % P= % 10.5% 13.0% 4.8% 3.2% sich rate Neurological deterioration Stroke related mortality Trevo MM
34 DAWN: Primary outcome mrs 0/uW mrs 10 mrs 1/uW mrs 9.1 mrs 2/ uw mrs 7.6 mrs 3/ uw mrs 6.5 mrs 4/ uw mrs 3.3 mrs 5-6/ uw mrs 0 48% TREVO 9% 22% 17% 13% 13% 26% Probability of superiority > CONTRO L 4% 5% 4% 16% 34% 36% 13% 73% relative risk reduction of dependency in ADL s NNT for any lower disability 2.0 Slide courtesy of Dr. Tudor Jovin
35 90 Day mrs 0-2 by TLSW to Randomization Trevo MM P-value 6-12h 55.1% 20.0% < h 43.1% 7.4% <0.001 Slide courtesy of Dr. Tudor Jovin Trevo MM
36 DAWN: Conclusions Appropriately selected patients in the 6-24h time window can benefit from thrombectomy Treatment in this late window is effective NNT 2.0 for any lower disability NNT 2.8 to increase those achieving functional independence Treatment in the later window appears safe
37 Can we extend the intervention time window? DAWN Prospective, randomized looking at intervention vs medical management in patients presenting w/in 6-24h Imaging: MR-DWI or CTPrCBF DEFUSE 3 Prospective, randomized looking at intervention vs medical management in patients presenting w/in 6-16h of stroke onset Imaging: CT perfusion/cta or MR DWI/PWI/MRA
38 DEFUSE 3 Study Methods: Workflow 6-16h NCCT/DWI: ASPECTS 6; DWI core <25ml CTA/MRA: ICA-C or T and/or MCA-M1 (Tandem Occlusions Allowed) Control 90-day mrs Informed Consent 1:1 Randomization - Age NIHSS 6 - Pre-mRS 2 - TLSW to puncture: 6-16h Target Mismatch Profile On CT perfusion or MRI: -ischemic core volume <70ml -mismatch ratio 1.8 AND -mismatch volume 15ml Thrombectomy
39 Summary Atrial cardiopathy is an emerging risk factor for both stroke and Afib NOACs are effective and safe for stroke prevention after Afib can we extrapolate this to secondary prevention in the setting of atrial cardiopathy? Thrombectomy is coming/already here at a hospital near you in a later time window 6-24h
12/4/2017. Disclosures. Study organization. Stryker Medtronic Penumbra Viz Route 92. Data safety monitoring board Tudor G.
12/4/2017 Update on Stroke Trials:Extending the Window DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo NP001713
The DAWN of a New Era for Wake-up Stroke
The DAWN of a New Era for Wake-up Stroke Alan H. Yee, D.O. Stroke and Critical Care Neurology Department of Neurology University of California Davis Medical Center Objectives Review Epidemiology and Natural
Stroke Treatment Beyond Traditional Time Windows. Rishi Gupta, MD, MBA
Stroke Treatment Beyond Traditional Time Windows Rishi Gupta, MD, MBA Director, Stroke and Neurocritical Care Endovascular Neurosurgery Wellstar Health System THE PAST THE PRESENT 2015 American Heart Association/American
Mechanical thrombectomy beyond the 6 hours. Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital
Mechanical thrombectomy beyond the 6 hours Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital Disclosures None Worldwide statistics 1 IN 6 people will have a stroke at some
CVA Updates Karen Greenberg, DO, FACOEP. Director Neurologic Emergency Department Crozer Chester Medical Center
CVA Updates 2018 Karen Greenberg, DO, FACOEP Director Neurologic Emergency Department Crozer Chester Medical Center Disclosure I have the following financial relationship with the manufacturer of any commercial
Is there even a time window?
Is there even a time window? A brief summary of key 2018 trials: DAWN and DEFUSE-3 For Neurosciences Update Conference, February 22, 2018 Maxim D. Hammer, M.D. Executive Summary Based on DAWN and DEFUSE-3,
Thrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE
Thrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE ESUS Progression of haematoma Anticoagulation Large ICH
Intra-arterial Stroke Therapy: 2018 Update
Intra-arterial Stroke Therapy: 2018 Update Expanding the Treatment Window Parita Bhuva, M.D. Medical Director Enrolling investigator Stryker Neurovascular (DAWN trial) Disclosures Most common large vessel
Management and Investigation of Ischemic Stroke By Etiology
Management and Investigation of Ischemic Stroke By Etiology Andrew M. Demchuk MD FRCPC Director, Calgary Stroke Program Deputy Dept Head, Clinical Neurosciences Heart and Stroke Foundation Chair in Stroke
CT Perfusion is Essential for Stroke Triage. Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center
CT Perfusion is Essential for Stroke Triage Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center CT Perfusion is Essential for Stroke Triage Disclosures:
Endovascular Therapy: Beyond the Guidelines
Endovascular Therapy: Beyond the Guidelines Ashutosh P. Jadhav, MD PhD Assistant Professor, Neurology and Neurological Surgery Center for Neuro-endovascular Therapy UPMC Stroke Institute Pittsburgh, PA
Interventional Treatment of Stroke
Interventional Treatment of Stroke Andrew F. Ducruet, MD Barrow Neurological Institute 2018 BNI Stroke Rehab Symposium October 13, 2018 Disclosures Consultant: Medtronic, Penumbra, Cerenovus Lecture Overview
Stroke Case Studies. Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow
Stroke Case Studies Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow Case 1 64 year old female with dysphasia and right arm weakness 3 hours prior CT head: dense M1 sign. No established ischaemia
Cryptogenic Stroke: A logical approach to a common clinical problem
Cryptogenic Stroke: A logical approach to a common clinical problem Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist CardioVascular Associates of Mesa Mesa, Arizona Speakers Bureau Boston Scientific
ESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times
ESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times Michael D Hill, Mayank Goyal on behalf of the ESCAPE Trial
5/31/2018. Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment. Disclosures. Impact of clot burden
Good Outcome (%) Rankin 0-2 at 90 days 5/31/2018 Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment Disclosures Cerenovus: I am on Executive Committee for ARISE2 Trial
Ongoing Acute Stroke Studies 10/5/2015
Ongoing Acute Stroke Studies 10/5/2015 Wade S. Smith, MD, PhD Director UCSF Neurovascular Service Daryl R. Gress Professor of Neurocritical Care and Stroke Disclosures NIH U10 NS 086494 (PI) NorCal RCC
How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval
How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval Peter Howard MD FRCPC Disclosures No conflicts to disclose How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular
RBWH ICU Journal Club February 2018 Adam Simpson
RBWH ICU Journal Club February 2018 Adam Simpson 3 THROMBOLYSIS Reperfusion therapy has become the mainstay of therapy for ischaemic stroke. Thrombolysis is now well accepted within 4.5 hours. - Improved
Cryptogenic Strokes: Evaluation and Management
Cryptogenic Strokes: Evaluation and Management 77 yo man with hypertension and hyperlipidemia developed onset of left hemiparesis and right gaze preference, last seen normal at 10:00 AM Brought to ZSFG
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination pulse 80/min reg, BP 160/95
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE. Matthew Starr, MD Stroke Attending
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE Matthew Starr, MD Stroke Attending DISCLOSURES None DEBATE Should PFO be closed? * * Sometimes yes THE CASE AGAINST PFO CLOSURE 1. Did the PFO cause the
Endovascular Treatment of Ischemic Stroke
Endovascular Treatment of Ischemic Stroke William Thorell, MD Associate Professor Neurosurgery UNMC Co-Director Stroke and Neurovascular Center Nebraska Medicine Overview Definitions of terms Review basic
Endovascular Neurointervention in Cerebral Ischemia
Endovascular Neurointervention in Cerebral Ischemia Beyond Thrombolytics Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington 72 y/o female with a recent diagnosis
Endovascular Stroke Therapy
Endovascular Stroke Therapy Update with Emphasis on Practical Clinical and Imaging Considerations Sachin Kishore Pandey, MD, FRCPC Disclosures I have no relevant financial disclosures or conflict of interest
Acute Stroke Treatment: Current Trends 2010
Acute Stroke Treatment: Current Trends 2010 Helmi L. Lutsep, MD Oregon Stroke Center Oregon Health & Science University Overview Ischemic Stroke Neuroprotectant trials to watch for IV tpa longer treatment
framework for flow Objectives Acute Stroke Treatment Collaterals in Acute Ischemic Stroke framework & basis for flow
Acute Stroke Treatment Collaterals in Acute Ischemic Stroke Objectives role of collaterals in acute ischemic stroke collateral therapeutic strategies David S Liebeskind, MD Professor of Neurology & Director
AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke (ARCADIA)
AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke (ARCADIA) NIH StrokeNet Clinical Trial PIs: Hooman Kamel, Mitchell Elkind, Will Longstreth, David Tirschwell Study Statistician:
Direct oral anticoagulants for Embolic Strokes of Undetermined Source? George Ntaios University of Thessaly, Larissa/Greece
Direct oral anticoagulants for Embolic Strokes of Undetermined Source? George Ntaios University of Thessaly, Larissa/Greece Disclosures Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis.
Endovascular Clot Retrieval. Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital
Endovascular Clot Retrieval Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital Something you can do tomorrow Melbourne half marathon 2016 In 2009 Simple approach to stroke - blocked artery,
Acute Stroke Care: the Nuts and Bolts of it. ECASS I and II ATLANTIS. Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center
Acute Stroke Care: the Nuts and Bolts of it Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center ECASS I and II tpa for patients presenting
Subclinical AF: Implications of device based episodes
Subclinical AF: Implications of device based episodes Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Clinical Trials and Consulting: Medtronic, Boston Scientific
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with Non-fluent dysphasia R facial weakness Background Ischaemic heart disease Hypertension Hyperlipidemia L MCA branch
Updates in Stroke Management. Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy
Updates in Stroke Management Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy Disclosure I have no actual or potential conflict of interest
NOAs for stroke prevention in Atrial Fibrillation: potential advantages in the elderly patients. Giancarlo Agnelli
NOAs for stroke prevention in Atrial Fibrillation: potential advantages in the elderly patients Giancarlo Agnelli Internal & Cardiovascular Medicine - Stroke Unit University of Perugia, Italy My talk today
Stroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University
Stroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University Disclosures Research Grants and speaking fees St. Jude
Defining Sub-Clinical Atrial Fibrillation and its management
Defining Sub-Clinical Atrial Fibrillation and its management Jeff Healey MD, MSc, FRCP, FHRS PHRI Chair in Cardiology Research Population Health Research Institute McMaster University, Canada Sub-Clinical
How Can We Properly Manage Patients With Stroke of Undetermined Origin?
How Can We Properly Manage Patients With Stroke of Undetermined Origin? : Spotlight on Embolic Stroke of Undetermined Source (ESUS) MI SUN OH Department of Neurology, Hallym University Scared Heart Hospital,
Broadening the Stroke Window in Light of the DAWN Trial
Broadening the Stroke Window in Light of the DAWN Trial South Jersey Neurovascular and Stroke Symposium April 26, 2018 Rohan Chitale, MD Assistant Professor of Neurological Surgery Vanderbilt University
Controversies in Risk Stratification
Controversies in Risk Stratification Things are not as simple as they seem Banff 2017 2015 MFMER 3494750-5 Relative importance Triggers vs Substrate in Pathophysiology of AF AF burden Paroxysmal? Persistent?
Unclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018
Unclogging The Pipes Zahraa Rabeeah MD Chief Resident February 9,2018 Please join Polleverywhere by texting: ZRABEEAH894 to 37607 Disclosures None Objectives Delineate the differences between TPA vs thrombectomy
Left Atrial Appendage Closure: The Rationale
Left Atrial Appendage Closure: The Rationale JOHN D. HUMMEL, MD DIRECTOR OF CLINCAL ELECTROPHYSIOLOGY RESEARCH PROFESSOR OF CLINICAL INTERNAL MEDICINE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER 1 Disclosures
La gestione dell ictus ischemico o emorragico nel paziente sotto NAO
La gestione dell ictus ischemico o emorragico nel paziente sotto NAO Antonio Carolei e Cindy Tiseo Clinica Neurologica e Stroke Unit Avezzano - Sulmona Università degli Studi dell Aquila Abano Terme, 10
Advances in Neuro-Endovascular Care for Acute Stroke
Advances in Neuro-Endovascular Care for Acute Stroke Ciarán J. Powers, MD, PhD, FAANS Associate Professor Program Director Department of Neurological Surgery Surgical Director Comprehensive Stroke Center
Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices
Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices Joey English MD, PhD Medical Director, Neurointerventional Services California Pacific Medical Center Hospitals, San Francisco,
ACUTE ISCHEMIC STROKE
ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE HHS Stroke Annual Review March 7 and March 8, 2018 Objectives To review the stroke endovascular mechanical thrombectomy evidence
CLOSE. Closure of Patent Foramen Ovale, Oral anticoagulants or Antiplatelet Therapy to Prevent Stroke Recurrence
CLOSE Closure of Patent Foramen Ovale, Oral anticoagulants or Antiplatelet Therapy to Prevent Stroke Recurrence Guillaume TURC, MD, PhD Paris Descartes University Sainte-Anne hospital Paris, France On
Updates on Endovascular Therapy
Updates on Endovascular Therapy 5 th Annual Intermountain Stroke Conference October 16, 2017 M. Shazam Hussain, MD, FRCP(C), FAHA Director, Cerebrovascular Center Associate Professor, CCLCM Staff, Vascular
Endovascular Treatment Updates in Stroke Care
Endovascular Treatment Updates in Stroke Care Autumn Graham, MD April 6-10, 2017 Phoenix, AZ Endovascular Treatment Updates in Stroke Care Autumn Graham, MD Associate Professor of Clinical Emergency Medicine
Controversies in Risk Stratification
Controversies in Risk Stratification There are more questions than answers So---Let me pose the questions Banff 2016 2015 MFMER 3494750-5 Relative importance Triggers vs Substrate in Pathophysiology of
PFO Management update
PFO Management update May 12, 2017 Peter Casterella, MD Swedish Heart and Vascular 1 PFO Update 2017: Objectives Review recently released late outcomes of RESPECT trial and subsequent FDA approval of PFO
ACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke
ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center
Trial and Cost Effectiveness Evaluation of Intra arterial Thrombectomy in Acute Ischemic Stroke
Trial and Cost Effectiveness Evaluation of Intra arterial Thrombectomy in Acute Ischemic Stroke S. Bracard, F. Guillemin, X. Ducrocq for the THRACE investigators Disclosure Personal: No disclosure Study
Asif Serajian DO FACC FSCAI
Anticoagulation and Antiplatelet update: A case based approach Asif Serajian DO FACC FSCAI No disclosures relevant to this talk Objectives 1. Discuss the indication for antiplatelet therapy for cardiac
Mechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016
Mechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016 none DISCLOSURES Where did we come from? Spiotta, et
Emergency Treatment of Ischemic Stroke
Emergency Treatment of Ischemic Stroke JEFFREY BOYLE, M.D., PHD CLINICAL DIRECTOR OF STROKE AT AVERA MCKENNAN AVERA MEDICAL GROUP NEUROLOGY SIOUX FALLS, SD Conflicts of Interest None I will discuss therapies
True cryptogenic stroke
True cryptogenic stroke Arne Lindgren, MD, PhD Dept of Clinical Sciences Lund, Neurology, Lund University Dept of Neurology and Rehabilitation Medicine Skåne University Hospital Lund, Sweden Disclosures
Boehringer-Ingelheim satellite symposium Ligue cardiologique belge 13/05/2017
Boehringer-Ingelheim satellite symposium Ligue cardiologique belge 13/05/2017 Dr André Peeters Service de Neurologie Cliniques Universitaires Saint-Luc / U.C.L. 1200 BRUXELLES Introduction 1. Aim NOACS
Acute Stroke Management What is State of the Art?
Acute Stroke Management What is State of the Art? Karl-Titus Hoffmann Department of Neuroradiologie University of Leipzig / University Hospital Leipzig Disclosure Speaker name: Karl-Titus Hoffmann I have
Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective
Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Cathy Sila MD George M Humphrey II Professor and Vice Chair of Neurology Director, Comprehensive Stroke Center
Non-commercial use only
Italian Journal of Medicine 2016; volume 10:202-206 Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit Marco Masina, 1 Annalena Cicognani, 1 Carla Lofiego, 2 Simona
Study organization. Study principal investigators Tudor G. Jovin, MD Raul Nogueira, MD
DAWN STUDY- MAIN RESULTS DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo Tudor G. Jovin, MD Professor of Neurology
An international, double-blind, phase III randomized trial. Main Results
An international, double-blind, phase III randomized trial Main Results Robert Hart on behalf of the NAVIGATE ESUS Steering Committee and Investigators Sponsorship & Disclosures NAVIGATE ESUS was sponsored
Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke
Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Alexander A. Khalessi MD MS Director of Endovascular Neurosurgery Surgical Director of NeuroCritical Care University
Latest Advances in the Neurointerventional Treatment of Ischemic Stroke P A C I F I C N E U R O. O R G
Latest Advances in the Neurointerventional Treatment of Ischemic Stroke Neurointerventional Management of Ischemic Stroke 1. Thrombectomy for acute ischemic stroke 2. Carotid artery stenting 3. Management
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships
Acute Stroke Management Conference 2019: Stroke Clinical Vignettes
Acute Stroke Management Conference 2019: Stroke Clinical Vignettes Cynthia Kenmuir MD PhD Director of Stroke Program, UPMC Altoona Director of Neurointerventional Program, UPMC Altoona 2015 Guideline for
Edoxaban in Atrial Fibrillation
Edoxaban in Atrial Fibrillation Glenn Gormley, MD, PhD Senior Executive Officer and Global Head of R&D, Daiichi Sankyo Co., Ltd Nov. 4, 2014 Tuesday Background Based on the results of ENGAGE AF-TIMI 48,
Left Atrial Appendage Occlusion in the Era of Novel Anticoagulants
Left Atrial Appendage Occlusion in the Era of Novel Anticoagulants Saibal Kar, MD, FACC, FSCAI Professor of Medicine Director of Interventional Cardiac Research Heart Institute, Cedars-Sinai Medical Center,
Disclosures. CREST Trial: Summary. Lecture Outline 4/16/2015. Cervical Atherosclerotic Disease
Disclosures Your Patient Has Carotid Bulb Stenosis and a Tandem Intracranial Stenosis: How Do SAMMPRIS and Other Evidence Inform Your Treatment? UCSF Vascular Symposium 2015 Steven W. Hetts, MD Associate
2018 Update in Diagnosis and Management of Stroke
2018 Update in Diagnosis and Management of Stroke S. Andrew Josephson MD Carmen Castro Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor Chair, Department of Neurology Director,
UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015
UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015 NEW STUDIES FOR 2015 MR CLEAN ESCAPE EXTEND-IA REVASCAT SWIFT PRIME RECOGNIZED LIMITATIONS IV Alteplase proven benefit
Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS
Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS 11-8-18 Outline 1. Background 2. Anatomy of patent foramen ovale (PFO) 3. Relationship between PFO and
COMPREHENSIVE SUMMARY OF INSTOR REPORTS
COMPREHENSIVE SUMMARY OF INSTOR REPORTS Please note that the following chart provides a sampling of INSTOR reports to differentiate this registry s capabilities as a process improvement system. This list
Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients
Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School
Mechanical thrombectomy in Plymouth. Will Adams. Will Adams
Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation
Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital
Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital Disclosures Penumbra, Inc. research grant (significant) for
Comparison of Five Major Recent Endovascular Treatment Trials
Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline
What Have We Learned: Selection for Endovascular Stroke Therapy
What Have We Learned: Selection for Endovascular Stroke Therapy Raul G Nogueira, MD Associate Professor in Neurology, Neurosurgery, and Radiology Emory University Director, Neuroendovascular Service Director,
Acute Stroke Treatment Update for 2008
Acute Stroke Treatment Update for 2008 * Michael R. Dobbs, MD Assistant Professor of Neurology, Preventive Medicine, and Graduate Center for Toxicology University of Kentucky College of Medicine The Stroke
Update on Neurointerventional Therapies: Stroke and Aneurysms
Update on Neurointerventional Therapies: Stroke and Aneurysms Gary Duckwiler, MD Professor and Director Division of Interventional Neuroradiology David Geffen School of Medicine at UCLA Long Beach Memorial
11/1/2018. Disclosure. Imaging in Acute Ischemic Stroke 2018 Neuro Symposium. Is NCCT good enough? Keystone Heart Consultant, Stock Options
Disclosure Imaging in Acute Ischemic Stroke 2018 Neuro Symposium Keystone Heart Consultant, Stock Options Kevin Abrams, M.D. Chief of Radiology Medical Director of Neuroradiology Baptist Hospital, Miami,
Endovascular Treatment for Acute Ischemic Stroke
ular Treatment for Acute Ischemic Stroke Vishal B. Jani MD Assistant Professor Interventional Neurology, Division of Department of Neurology. Creighton University/ CHI health Omaha NE Disclosure None 1
Current Clinical Trials for Stroke Survivors in NJ and Philadelphia Areas
Current Clinical Trials for Survivors in NJ and Philadelphia Areas For more information go to https://clinicaltrials.gov/ and search for the title in search box Condition / Disease 1. Spatial Neglect and
I, (Issam Moussa) DO NOT have a financial interest/arrangement t/ t or affiliation with one or more organizations that could be perceived as a real
PFO Closure: Where We Are Going to after CLOSURE I Study? Issam D. Moussa, MD Professor of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, Florida Disclosure Statement of
Stroke Update Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center
Stroke Update 2015 Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center Objectives 1. Review successes in systems of care approach to acute ischemic stroke
Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists
Shawke A. Soueidan, MD Riverside Neurology & Sleep Specialists 757-221-0110 Epidemiology of stroke 2018 Affects nearly 800,000 people in the US annually Approximately 600000 first-ever strokes and 185000
ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist
ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist Pharmacy Grand Rounds 26 July 2016 2015 MFMER slide-1 Learning
Recanalization Therapy & Secondary Prophylaxis in the Elderly
Recanalization Therapy & Secondary Prophylaxis in the Elderly 21 st Annual Meeting of the Swiss Stroke Society Lausanne,11.01.2018 PD Dr. G. M. De Marchis, MD MSc Neurology & Stroke Center University Hospital
Advanced Stroke Care in the context of the Cardiovascular Patient
EASTERN MAINE MEDICAL CENTER Advanced Stroke Care in the context of the Cardiovascular Patient Advancing Science in Cardiovascular Care Samoset Conference NOV 8, 2018 Dr. Gillian Gordon Perue Conflict
Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials
Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials Figure 1: Lay Press Judgment May Belie a Deeper Examination of the Data. Truman ultimately defeated Dewey for the Presidency Subject
NEW APPROACHES AND NEW ANTICOAGULANTS FOR ATRIAL FIBRILLATION
NEW APPROACHES AND NEW ANTICOAGULANTS FOR ATRIAL FIBRILLATION MAY 1, 2015 Melissa R. Robinson, MD FACC FHRS CCDS Assistant Professor of Medicine Director of the Complex Arrhythmia Service POINTS TO MAKE
Acute Ischemic Stroke Imaging. Ronald L. Wolf, MD, PhD Associate Professor of Radiology
Acute Ischemic Stroke Imaging Ronald L. Wolf, MD, PhD Associate Professor of Radiology Title of First Slide of Substance An Illustrative Case 2 Disclosures No financial disclosures Off-label uses of some
Case 1 5/26/2017 ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE
ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE Rhonda Whiteman Racing Against the Clock Workshop June 1, 2017 Objectives To discuss the hyperacute ischemic stroke management
MODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC
MODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC Specialty: General Internal Medicine Lecturer, Department of Medicine University of Toronto Staff Physician, General Internal
Appendage Closure. Jason Rogers, MD. Director, Interventional Cardiology UC Davis Medical Center Sacramento, California
Appendage Closure Jason Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Sacramento, California Left Atrium: Atrial Fibrillation Left Atrial Appendage Left Atrium Incidence of Atrial
Speakers. 2015, American Heart Association 1
Speakers Lee Schwamm, MD, FAHA Executive Vice Chairman of Neurology, Massachusetts General Hospital Director, Stroke Service and Medical Director, MGH TeleHealth, Massachusetts General Hospital Director,
HERMES Time and Workflow Primary Paper. Statistical Analysis Plan
HERMES Time and Workflow Primary Paper Statistical Analysis Plan I. Study Aims This is a post-hoc analysis of the pooled HERMES dataset, with the following specific aims: A) To characterize the time period
Code Stroke Intervention: Endovascular Therapies for Stroke J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY
Code Stroke Intervention: Endovascular Therapies for Stroke J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY Disclosures None Part A. Objectives Epidemiology of AIS and of ELVO Concept: Acute Ischemic