D2D Visit Report – Dr. Kateriine Orav

I first had the idea to apply for the ESO Department to Department Visit programme after attending the very inspiring ESO-ESMINT-ESNR Stroke Winter School in Bern in the beginning of 2020. It made me curious about stroke management in clinical practice in the largest Stroke Centre in Switzerland, providing endovascular therapy for a population bigger than the entire Estonia. The COVID-19 pandemic did however pose several obstacles, so more than a year later the stars finally aligned and I was able to visit Inselspital in Bern.

The team in Inselspital was very welcoming and this is just one of the reasons why it has become a popular host for awardees of the ESO grant. With Dr. Mirjam Heldner we decided on a programme that aligned best with my interests. I spent the mornings joining rounds in the Stroke Unit with Dr. David Seiffge and the residents. I was fascinated by the well organized secondary prevention programme in the clinic. We had many interesting patients in the stroke unit during my visit, including patients who were eligible for PFO closure, left atrial appendage closure and event recorder implantation. Several questions about antithrombotic therapy in complex scenarios came up. I was especially impressed with the evaluation and management of atherosclerotic carotid artery disease. All patients with atherosclerotic changes or stroke with suspicion of artery-to-artery embolism received at least two modalities of imaging of the extra- and intracranial vessels. I was also able to attend the weekly neurovascular meeting, where treatment strategies for eligible patients were discussed with an interdisciplinary team.

In the afternoons I divided my time between the emergency room, the neurovascular lab and the stroke follow-up outpatient clinic. In the emergency room I was able to observe the pathways for patients who came in with a stroke alarm. Inselspital uses MRI as the main imaging modality for acute stroke patients so it was interesting to note the advantages but also difficulties this poses. Having a neuroradiologist on call around the clock certainly was alluring! In the neurovascular sonography unit the team was hard at work investigating the vessels of stroke patients. As my experience with neurovascular ultrasound is limited, I learned about the possibilities of the  investigation and the benefit of using this modality for following up stroke patients. In the outpatient clinic I was able to appreciate the wellstructured follow-up programme of stroke patients to ensure the continuity of secondary prevention strategies.

I would like to thank the European Stroke Organization and the team in Inselspital for this excellent educational opportunity and for being so accommodating through the obstacles that the global pandemic posed. Many  thanks to the wonderful team who welcomed me so warmly in Inselspital! I returned to Tallinn with many fond memories of the week and numerous ideas to discuss with my colleagues.