Stroke Thrombectomy (CME) – Online Course

Stroke Thrombectomy (CME) – Online Course is organized by Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

Release Date: February 01, 2023
Expiration Date: February 3, 2025

Description:
Mechanical thrombectomy has been shown to have extremely high clinical benefits in patients suffering from acute ischemic stroke due to large vessel occlusion. In the last six years, comprehensive cerebrovascular centers have been organised in many countries around the world to provide emergent endovascular treatment 24 hours a day, seven days a week. Accreditation processes have been established to maintain a high standard of this therapy.

The basic principles of emergent stroke care include:

• Round-the-clock service (24/7)
• Accessible neurological examination
• Diagnostic imaging
• Immediate transport between hospitals to ensure timeliness
• Identification and triage of candidates for endovascular therapy
• Expertise of operators
• A postoperative intensive care unit with sufficient capacity
• Rehabilitation
• Regular quality improvement processes based on clinical outcome assessments at each centre.

This course is designed for advanced training and the authors recommend that the CIRSE Academy “Stroke” course be studied prior to this course.

The first part of the course focuses on anatomical changes of the cerebral arteries and arterial anomalies that are important for intracranial catheterization, such as tortuosity of the vessels or underlying vascular disease. In the pathophysiology section, the authors provide insight into the development of ischemic stroke during the first 24 hours and review neurological signs that may help in the triage of stroke patients involving both anterior and posterior circulation stroke. In addition to a summary of current indications for endovascular treatment, the borderline indications and the influence of age are discussed. A chapter on mechanical thrombectomy technique summarizes technical tricks to achieve reperfusion “first pass effect” successfully, what to do in case of failed thrombectomy attempts (including acute stenting) and how to deal with periprocedural complications. The next section summarizes post-procedural management and follow-up protocol. The outcomes section summarizes currently used measures of angiographic and functional outcomes and discusses the incidence of futile recanalization.

Learning Objectives:

• Anatomy: Extracerebral and intracerebral arterial variations and age-related changes relevant to potential catheterization difficulties
• Pathophysiology:
  • Neurological signs of the large vessel occlusion
  • Evolution of the ischemic stroke during the first 24 hours
  • Role of individual collaterals
  • Posterior circulation stroke
• Indications and contraindications:
  • Summary of current indications, including 6-24-hour time window
  • Endovascular therapy beyond six hours of symptom onset
  • Borderline indications and indications which are under research
  • Consider the age and whether there is any pre-existing condition in the patient
• The technique of mechanical thrombectomy (Techniques for treatment video)
• Post-procedural management and follow up:
  • Manage the first 24 hours after recanalization
  • Manage the period after the first 24 hours
• Outcome:
  • BELIEVE
  • Modified Rankin scale
  • Futile recanalization i.e., therapy failure