5T Conference Agenda March 10-12, 2017

What is the Evidence Base for EVT: Updates from ISC Houston and What’s Next?

Moderators: MD Hill, J Saver

1300-1310 Welcome/Introduction – M Goyal
1310-1325 HERMES time-benefits and workflow – J Saver
1325-1340 HERMES GA – MD Hill
1340-1355 HERMES imaging – B Menon
1355-1410 HERMES perfusion – M Goyal
1410-1425 HERMES TICI – D Liebeskind
1425-1440 HERMES final infarct – C Majoie

1440-1500 Coffee break

1500-1520 Other completed EVT RCTs (THRACE, PISTE, SIESTA, THERAPY) – what’s new and important clinical pearls from these trials? – G Duckwiler
1520-1540 Recent systemic thrombolysis trials/studies- clinical impact/any implications for EVT? – A Demchuk
1540-1600 Which ongoing trials can I get involved in (to include BASICS, BEST, DAWN, DEFUSE3, COMPASS, ASTER) – MD Hill
1600-1700 Conversation - Where do we need more RCT data in acute stroke? Yes, we need more data but it is too difficult: we may not ever get it…..

•  Prehospital neuroprotection, reperfusion injury (J Saver and MD Hill)
•  Bridging tPA vs new EVT populations (B Menon, C Majoie, M Goyal and A Demchuk)
•  New EVT techniques (M Goyal and G Duckwiler)

1830-1930 Cocktails and social hour
1930-2130 Dinner and evening presentation

Keynote speaker: René Chapot (Essen, Germany)

Strokes of a Clock: Getting More Patients to EVT Much Faster!
Stroke Onset to Arrival at Stroke Center (Onset to Door)

Moderators: G Duckweiler, M Goyal

0730-0745 Prehospital processes – which field test is best? How can we use technology better? – J Saver
0745-0755 Field consultation- a PSC/CSC triage solution for rural Canada – A Demchuk
0755-0810 When is it best to go to PSC first: geographic modelling of transport decision making – MD Hill
0810-0825 When to always go to CSC bypassing a PSC– will US states need legislation? – M Jayaraman
0825-0840 New technologies for the ambulance for prehospital care and transport decisions – A Alexandrov
0840-0855 Systems of care in the USA- how are the neuro-IR organizations helping? – D Frei
0855-0910 System of care in a developing country: Challenges and solutions – R Bhatia

0910-0930 Coffee break

Stroke Centre Door to Decision to a.) Transport to CSC or b.) Perform EVT
Patient has Arrived at PSC – tPA Decision and Whether to Transport?

Moderators: A Demchuk, B Menon

0930-0940 Plain CT and stroke severity is enough for decision to transport – D Roy
0940-0950 NCCT/multiphase CTA is the perfect balance for a PSC – M Goyal
0950-1000 CTP crucial to determining salvageable brain/permeable clot at PSC – D Liebeskind
1000-1010 Is tele-stroke critical for PSC decision making? – C Fanale
1010-1020 Our PSC ELVO protocol in Rhode Island – R McTaggart
1020-1040 Q & A / extra time – Polls for which imaging strategy? Should we have telestroke in place?

Patient has Arrived at CSC – Things We Must Consider?
Patient Arrived 90 minutes After Imaging at PSC. Big Stroke, Proximal Vessel Occlusion.

1040-1050 Should we bother repeating the imaging? If so, how much? CTA? mCTA? CTP?: My perspective – B Menon
1050-1100 Examples of patients that were transferred/considered for IAT but I have not treated. – C Majoie
1100-1145 Patient coming direct to CSC: what is the ideal imaging strategy: Debate

a. CT, mCTA: B Menon, M Goyal
b. CT, CTA, CTP: C Lum, C Majoie
c. MR imaging: J Saver, D Liebeskind

1145-1215 Discussion: M Goyal, G Duckwiler, R McTaggart, D Frei
What should be the target reperfusion, clinically and in trials? mTICI 2b/3, oTICI 2b/3, eTICI 2c/3, TICI 3 only

1215-1800 Skiing or other Banff activities


ESCAPE NA1, TEMPO2, UNMASK EVT investigators meeting.
1800-1900 Social hour/cocktails
1900-1910 Special presentation Letsgetproof.com: Noreen Kamal
1910-2100 Dinner and evening discussion

Moderators: M Goyal, A Demchuk

• Difficult decision making for patients at the CSC
• Low ASPECTS/bad collaterals but early in time window
• Wakeup stroke
• Accessible but not large M2 occlusion/moderate NIHSS
• P2 occlusion with homonymous hemianopsia
• M1 occlusion but minimal deficits
• Basilar occlusion in coma
• 20 hours from LSN but the scan looks normal yet M1 occlusion?

Strokes of a Clock Continued: Safety Considerations/Time Efficiency Pearls to Achieving Fast Decision to Reperfusion. Working Fast to Optimize Reperfusion

Short snappers of maximum 5-6 minutes per presentation, 1-2 minutes for panel and 2-3 minutes for questions

Moderators: D Liebeskind, M Goyal

0745-0800 My approach to preparing for the case as efficiently as possible – M Goyal
0800-0810 My approach to no femoral pulses/difficult access – R Raychev
0810-0820 My approach to difficult tortuosity – M Eesa
0820-0830 My approach to a large ICA clot – D Heck
0830-0840 My approach to tandem critical cervical carotid stenosis/occlusion during MT – D Frei
0840-0850 My approach to isolated distal ICA occlusion with Willisian cross flow to open MCA – M Kelly
0850-0900 My approach to clot in both M2s – R Chapot
0900-0910 Our approach if patient is agitated – M Hill
0910-0920 My approach to the difficult clot – B Baxter
0920-0930 Discussion/extra time

0930-0945 Coffee break

Limiting/Managing Complications

Short snappers of maximum 5-6 minutes per presentation, 1-2 minutes for panel and 2-3 minutes for questions
0945-0955 My approach: After initial retrieval when distal embolization to a branch that is quite small but suppling eloquent territory; patient hasn’t improved – M Jayaraman
0955-1005 My approach to early reocclusion of M1 clot due to presumed intracranial stenosis? – G Duckwiler
1005-1015 When do I give up? – C Majoie
1015-1025 My approach to BP control during and after procedure – M Eesa
1025-1035 My post procedural approach to immediately after reperfusion – C McDougall
1035-1045 Discussion/extra time

Practical Technical Aspects

1045-1055 Solumbra is my first choice because… – M Jayaraman
1055-1105 Aspiration is my first choice because... – B Baxter
1105-1115 Stent retriever with BGC in the neck is my first choice because… – C Majoie
1115-1130 Discussion: Which time metrics to use for quality improvement? 30-69-90, 45-75-105, 60-90-120, etc. (audience involvement)