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By Bojana Žvan and Anita Arsovska

The 11th Conference on Acute Stroke with International Attendance took place in Ljubljana, Slovenia, on the 01st of December, 2017. It was traditionally organized by Prof. Dr. Bojana Žvan (FESO), President of the National Stroke Society of Slovenia.

AKUTNA MOŽGANSKA KAP XI

The meeting hosted invited speakers from Europe, who shared their knowledge and experience in the diagnosis and treatment of acute stroke. Prof. Erih Tetičkovič (Slovenia) opened the meeting with his plenary lecture entitled “ The path from the past to the present of neurosonology” where he talked about the role and practical application of extracranial and transcranial Doppler sonography. Prof. Kurt Niederkorn (Austria) explained “Is management in stroke unit essential for all patients with stroke?” and than Prof. Anita Arsovska (Macedonia) showed the impact of early diagnosis of patients with cerebral venous sinus thrombosis on better outcome in her lecture. Prof. Zuzana Gdovinova (Slovakia) delivered the lecture “Systemic thrombolysis in patients with acute ischemic stroke on anticoagulant therapy”. Academician Prof. Vida Demarin, FESO (Croatia) talked about the impact of nutrition on prevention of stroke, alongside the other factors, such as physical activity, stress management, and avoiding harmful habits. The role of Mediterranean diet and its protective effect were highlighted.

This was also the first meeting with the topic of Telestroke in Slovenia, where numerous experts from homeland and foreign countries with theoretical and practical experience, were gathered. Prof. Bojana Žvan’s lecture was “Organization of the national centre and TeleKap network – Can a vision become a reality?”  where she described a vision of organization by establishing a Slovenian national TeleStroke centre and network, and suggested guidelines and recommendations that are important for system operation. Dr. Marjan Zaletel explained “How to improve communications within the TeleKap network?” and Dr. Matija Zupan provided “Data analysis of patients with stroke treated in the TeleKap network”. These lectures provided insight into the deficiencies and possibilities of further improvements of the quality system in the TeleStroke network.

We have also had the opportunity to listen the lecture about the retrospective study of patients with acute ischemic stroke, who were treated with mechanical revascularization with the help of consultations inside the national network TeleKap, which consists of 12 Slovenian hospitals. The results from the study showed thrombectomy as safe and effective treatment method, furthermore the results also showed mechanical revascularization as an effective treatment of recanalization in the basilar artery occlusion (which was not included in multicenter studies). Parameter values and results in TeleKap study are similar to those from the latest multicentre randomised clinical trials, which show 43.7% (REVASCAT)to 71% (EXTEND-IA) increase in mRS evaluation values. This study also confirmed the idea that the selection of patients for endovascular treatment and transfer of these patients to proper tertiary centres are today additional objectives of the TeleStroke network.

Two top experts from Germany (Dr. Voelkel Nicolas and Dr. Hubert Gordian) with 15 years of experience in the Bavarian telestroke network – TEMPiS were invited speakers at this meeting. They described the telemedical project TEMPiS (The Telemedical Projekt for integrated Stroke Care) that laid the foundation of the telemedicine in the field of telestroke. This is also the project that was an exemplar for Prof. Bojana Žvan, author of the TeleStroke project in Slovenia. Operation of the Bavarian system wass described and quality control in the system was presented. An important aspect was also a continuous education in the system that also ensures a high quality and a possibility of system improvement. It is also important that in the TEMPiS network they established their own stroke register with quality indicators, which were compared to the same indicators of the German stroke register. The TEMPiS network had better results for 17 indicators compared to the German register. Their improvement of delays in systemic intravenous thrombolysis delays in hospitals were stated in details, as well as their continuous improvement to the unbelievable 35 minutes.

Interesting lectures on imitators and chameleons of a stroke in the TeleStroke network brought awareness on limitations of diagnostic processes in the telemedicine in stroke. They highlighted the great importance of help through the TeleStroke network for improvement of stroke treatment outcomes. Lectures on palliative care of patients with stroke also raised great interest in the audience, presenting the need for international guidelines and home recommendations for palliative treatment of acute stroke.

All lectures of this scientific meeting were published in a textbook, that will be of great help to all experts who face stroke on a daily basis, as well as for trainee specialists in neurology, internal medicine, radiology, urgent medicine, and medical students.

This meeting provided an excellent opportunity to establish a network for future cooperation.