Stroke FM Stroke FM

The Society of Vascular and Interventional Neurology (SVIN) held its first Hybrid Annual Meeting November 17-20, 2021, virtually and on-site in Phoenix, AZ. It provided an opportunity for top-of-the-line education, networking opportunities, and discussions. Please visit their website: https://svin2021.com for further details and access to the conference. Become a member of SVIN and the CSC. In this episode, our host @neuroccm joins SVIN's new President Dr. Ameer Hassan @AmeerEHassan to discuss meeting highlights, and some key take-home messages from some of the great science presented at the meeting.
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This is an official Canadian Stroke Consortium (CSC) - StrokeFM Podcast episode:
Neuroprotection and stroke care
What does the future hold?  Where are we coming from and where are we going?  These and other exciting topics of discussion in conversation with Dr. Michael Hill (Calgary Stroke Program) as we chat about ESCAPE NA1 and ESCAPE NEXT. ESCAPE-NEXT is a multi-centre, randomized, double-blinded, placebo-controlled, parallel Group, single-dose trial designed to determine the efficacy and safety of Nerinetide in participants with acute ischemic stroke undergoing endovascular thrombectomy excluding thrombolysis. This is an official CSC Podcast episode (Season 2, Episode 8). As usual, see our Disclaimer about this educational podcast. 

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In this episode we get together with Dr. Tess Fitzpatrick @TessFitzNeuro (first author on a recent paper on this topic: Quality of anticoagulation using intravenous unfractionated heparin for cerebrovascular indications) and Dr. Katherine Sawicka @KatherineSawic1 (our resident guru in Clinical Epidemiology and lover of all things research methods) to discuss challenges with anticoagulation using unfractionated heparin infusions. This is not to be confused with the fact that this agent provides a very good modality to providing anticoagulation and has very specific uses, but in the real world setting, IV infusion of this agent causes issues with the quality of anticoagulation achieved. We discuss how there may be better alternatives specifically low molecular weight heparin (LMWH) when it comes to use cases in stroke. Anticoagulating a patient with acute stroke is always a challenging topic, and there are nuances to be considered, to reduce the risk of hemorrhage, and therefore we looked back at the use of unfractionated heparin infusion in stroke and talk about how some considerations are very important to keep in mind. As usual - please note our disclaimer.

On this inaugural joint CSC (Canadian Stroke Consortium) Stroke FM episode, two colleagues from Calgary's Stroke program Bijoy Menon @bijoymenon and Andrew Demchuk discuss nuances of the soon-to-be-published MR CLEAN-NO IV trial (direct to EVT vs. bridging therapy) after the trial's results were showcased at ISC 2021. We look forward to future episodes as the joint CSC-Stroke FM collaboration unfolds on this podcast. We aim to highligh new and exciting scientific breakthroughs, educational topics, and all things part of the chain of survival for stroke care.

Please join the CSC! - you can join for FREE for several membership types:


Nurses and Allied Healthcare Practitioners
Trainees (medical students, residents, fellows)
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JOIN the CSC - In order to receive ongoing special updates, unique educational opportunities, and being part of Canada's (indeed the worlds!) stroke community.
Thanks for the support from the CSC and its partners. Our music is graciously provided by BrkmstrCylinder.

AHA International Stroke Conference 2021


In this episode @neuroccm highlights three studies from #ISC2021 AHA's International Stroke Conference.
We have the distinct privilege of having music by BreakMasterCylinder who has graciously contributed their compositions to our podcast focused on Stroke Education and awareness. We are most thankful - Please Follow @BrkmstrCylinder and contribute at Patreon. 

Featured Studies:

ANGIO-CAT Study
"Nonetheless this represents an extremely exciting time, and the message should not be lost that patients with large vessel occlusions can be screened to some degree of reliance clinically and imaged using a flat panel CT with what appears to be a safe modality, and then be taken to thrombectomy and not be denied thrombolysis if needed. This study shows a major speed-up effect in workflow processes.  It is quite possible that future studies with higher number of patients, in a multicenter setting, could tease out outcome differences as well.  Therefore overall, this is an incredibly positive step forward - Our tools are only as good as the people able to deliver them, and this workflow improvement study certainly opens the door to further optimization of hyperacute stroke care." excerpt from a news piece by @neuroccm for Neurodiem.

BEST-MSU Study
"Taken together, 17% more patients were treated with TPA, the full 30% or more in the golden hour, with significantly improved patient-centered outcomes.  There were 10% more patients with a modified Rankin score of 0 or 1 at 90 days. Overall, this is an important step forward in pushing the boundaries of bringing the treatment to the patient, and if this is ultimately found to be cost effective this represents yet another hyperacute innovation in acute stroke treatment. This may have specific relevance to both large, populated centers that are spread apart geographically, and certainly more austere environments as well." excerpt from a news piece by @neuroccm for Neurodiem.

MR CLEAN-NO-IV Study
Direct to EVT (early window) vs. Thrombolysis + EVT - designed as a superiority study. "They did not show superiorly nor non-inferiority of direct to EVT vs. combination treatment. There were no differences in symptomatic intracranial hemorrhage which is a particularly important finding, given that one could expect a higher rate with the TPA group. Dr. Yvo Roos, in a post-presentation interview with the AHA, suggest that hemorrhage rates may be more related to either delayed recanalization or simply that reperfusion itself is the main culprit for hemorrhage rather than onboard thrombolytic.  This is provocative and needs further study and further details need to be reviewed. Certainly, there is biological plausibility and that patients are heterogeneous enough in their physiology and baseline neurovascular characteristics that reperfusion as a physiologic insult can result in such findings.

The important takeaway message here is that for patients that are eligible to receive thrombolysis – that thrombolysis should not be withheld in the era of thrombectomy, and thrombolysis should be delivered in a timely manner.

Taken together, there appears to be more science and understanding of criteria that are still necessary to be discovered with regards to which patient should go a stroke center capable of delivering thrombolysis versus directly to center that can provide comprehensive care with both modalities." excerpt from a news piece by @neuroccm for Neurodiem.

In this episode, two keen Resident MDs Drs. Ryan Muir (PGY4) and Jaime Cazes (PGY1) join us for an in-depth at how things are going! A recent look back from within the 2'nd wave of COVID (in Canada), which thankfully is subsiding. They provide insight into how COVID has impacted their residency training, what our program has done, and how new learning opportunities have manifested in the form of Virtual Care. #TakeCare Everyone and keep looking out for your #Wellness as we look forward to better days!