By Dr Kateriine Orav, Department of Neurology, North Estonia Medical Center, Tallinn, Estonia
For the second day of the virtual ESOC 2021 conference many interesting E-posters remain to be explored. The virtual format of the conference truly allows to view an extensive selection of E-posters from the comfort of one’s home.
Several E-posters caught my eye in the rapidly expanding field of heart-brain research. Prolonged cardiac monitoring for the detection of atrial fibrillation is an essential part of etiological workup in ESUS patients. However, this may not be possible in all patients in all settings. The authors of FREQUENT PAROXYSMAL ATRIAL COMPLEXES AND SUPRAVENTRICULAR TACHYCARDIA COULD GUIDE THE DIAGNOSIS OF HIDDEN ATRIAL FIBRILLATION IN PATIENTS WITH ESUS (Sanchez Fernandez et al.) have shown that cardiac rhythm biomarkers such as frequent atrial paroxysmal complexes and paroxysmal supraventricular tachycardia may indicate a higher rate of occult atrial fibrillation in stroke patients and therefore may be useful in selecting patients for prolonged cardiac monitoring.
Cardiac CT has become a useful tool in the etiological workup of stroke. In SEQUENTIAL CARDIAC CT TO DETERMINE CARDIAC THROMBI DISSOLUTION RATE IN ACUTE ISCHEMIC STROKE Beemsterboer et al. have evaluated the cardiac thrombi dissolution rate during the acute phase of stroke. They demonstrated that cardiac thrombi may resolve within days of stroke occurrence, thus cardiac thrombi might not be detected on later imaging. Early cardiac imaging therefore may improve detection of cardioembolic source in stroke.
Treating patients with lacunar stroke can be challenging as they may show early neurological deterioration (END). The authors of EARLY NEUROLOGICAL DETERIORATION IN LACUNAR STROKE: CLINICAL AND IMAGING PREDICTORS AND ASSOCIATION WITH LONG-TERM OUTCOME (Vynckier et al.) showed that END is common, occurring in 1 in 6 lacunar stroke patients. They demonstrate radiological and clinical variables that are associated with END including lower NIHSS on admission, capsular warning syndrome, ventral pontine infarction and hypoperfusion on imaging. Importantly, acute dual antiplatelet therapy was associated with reduced risk of END in this study.
Recanalization therapy of stroke in the prolonged time window currently requires penumbral imaging. However, this is not feasible in all settings. Several studies evaluated surrogate markers on native CT imaging for selecting patients eligible for treatment in the extended time window. In CEREBRAL ATTENUATION CHANGES ON NON-ENHANCED CT: A SURROGATE FOR CT PERFUSION–BASED PENUMBRAL TISSUE AND INFARCT CORE IN ACUTE ISCHEMIC STROKE (Alzahrani et al.) the authors showed that specific brain attenuation ratios on native CT can differentiate penumbral and core lesions. Based on the findings in CURRENT ROLE OF ADVANCED NEUROIMAGING AND ITS CORRELATION WITH NON-CONTRAST COMPUTED TOMOGRAPHY IN THE LATE WINDOW TREATMENT SELECTION (Rodrigo-Gisbert et al.) the authors suggest that simplified imaging in stroke patients in the extended time window may be reasonable in patients with an ASPECTS score ≥6 on non-contrast CT imaging.
Enjoy the rest of the conference and make sure to also head to the E-poster Gallery to discover more research in areas of interest to you!