by Yasmin Aziz

Poster Walk with Yasmin Aziz

Day 1 of ESOC started off strong!  The poster hall was full of studies from groups all around the world.  Topics ranged from primary prevention and risk factor management to acute intervention, stroke imaging, and rehabilitation.  Some of my personal highlights from the session can be found below:

  • LVO and Minor Stroke—How Many Make it to the Angiography Suite?

Stroke patients with minor symptoms sometimes don’t get CTA—but should they?  Ros-Arlanzόn et al. sought to determine characteristics of LVOs (inclusive of anterior and posterior MeVO) presenting with minor stroke (NIHSS≤5), their vascular territory distribution (i.e., anterior vs. posterior), and treatment.  Using 3 major stroke centers in Spain over a 3-year period, 919 (of 5,474 stroke alerts) were considered minor stroke.  A total of 16.2% had LVO on imaging, of which 44% were treated (M1>M2).  The authors conclude that minor symptoms alone should not preclude CT angiography and advanced imaging, as thrombectomy was pursued in nearly half of these patients.

  • CTH and LVO Detection—Can AI Make It Feasible?

A hyperdense MCA sign is a favorite stroke neurologist trick to determine the presence of LVO – but can computers do it better?  Rai et al. tested the ability of Brainomix 360 Triage Stroke software on 612 acute stroke cases, of which half were due to either ICA, M1, or M2 vessel occlusion based on neuroradiologist interpretation.  Triage Stroke was able to detect anterior circulation LVO on CTH alone with 67% sensitivity and 93% specificity.  When compared to a reference standard called Triage LVO using CTA, sensitivity for detection increased to 89% while specificity remained the same.  Notably, the sensitivity decreased to 48% when neuroradiologists attempted to detect LVO on CTH alone.  The authors conclude that AI technology, particularly when coupled with NIHSS, can increase LVO detection rates when CTA is unavailable.

  • TRICH Score—The Triple Threat Needed for ICH Patients?

ICH is frequently caused by refractory hypertension, but how do we know whose BP will be refractory?  Yeung et al. aimed to develop and test a score to predict the need for at least 3 anti-hypertensive medications required for appropriate control after ICH.  Baseline predictors for needing at least a 3-drug regimen were derived using multivariate logistic regression using nearly 500 patients in the Hong Kong University registry.  Results were then validated in approximately 200 patients outside of this registry.  Factors deemed significant with appropriate points to comprise the TRICH score were as follows: Age <60 (0.5), male sex (0.5), eGFR <60mL/min/1.73m2 (1), and elevated admission SBP (190-240mmHg [1] vs >240mmHg [2]).  Authors note a c-statistic >0.7 in the development and validation cohorts, with a score of ≥1.5 predicting the need for a 3 drug anti-hypertensive regimen (sensitivity between 63-69%).  The authors conclude that the use of the TRICH score requires further validation for generalizability but has the potential to minimize healthcare costs.

  • Bilingualism–Does it Translate to Recovery?

If the lattes and the scenery doesn’t have you googling “how to live in Switzerland” by now, maybe the next poster topic will convince you to live in a country with 4 official languages.  Palacino et al. compared 71 bilingual patients to 207 monolingual patients with aphasia over 3 years.  Despite no significant differences in patient demographics, cardiovascular risk factors, presenting NIHSS, or intervention, early bilingual patients had significantly greater improvement in language recovery between admission and discharge NIHSS compared to monolingual patients.  The authors conclude that early bilingualism is protective against severe aphasia in stroke. 

  • Covert Strokes, Atrial Fibrillation, and Stroke—Taking the “L” Out of ELAN?

Covert infarcts are a frequent finding on brain imaging for patients with first time ischemic stroke due to Afib.  In a secondary analysis of the ELAN study, Kneihsl et al. sought to determine whether their presence modifies the safety and/or efficacy of DOAC initiation time, determined by composite risk of recurrent ischemic stroke, sICH, systemic hemorrhage, systemic embolism, and vascular death within 30d.  Of nearly 1700 patients, 40% had covert infarcts.  DOAC initiation decreased stroke recurrence risk by nearly 3% in patients with covert infarctions, but not in patients without them.  The authors conclude that ischemic stroke patients with afib and covert infarction on imaging may represent a specific subgroup benefiting from early DOAC initiation.

  • ENRICH —Coming to a Stroke Population Near You?

The stroke world celebrated this year when minimally invasive surgery to remove supratentorial ICH was proven to be effective—but how many patients are expected to benefit from this intervention?  Apostolaki-Hansson et al. assessed all patients with spontaneous ICH in the Swedish Stroke Register over a 3-year period in Skåne county, a population of 1.37 million.  The authors conclude that approximately 2.8% of patients with spontaneous ICH would meet eligibility criteria for minimally invasive surgery, which would increase their population’s ICH-related surgery rate by 29%.

  • Virtual Assistant in Stroke Recovery—Computer, Companion, or Both?

Recovery from stroke can be a long journey, with patients often unable to seek emotional support or answers to all of their questions.  In the RES-Q+ collaborative project funded by the EU and performed by Mavromati et al., 40 participants ( stroke survivors and caregivers) underwent 35 sessions in a 4-stage approach to determine if a virtual assistant could help with these problems.  The authors were able to distill 4 distinct themes from participants regarding the virtual assistant, including 1) deficiency of post-discharge support, 2) view of the virtual assistant as a means of information and support, 3) personification of the virtual assistant, and 4) distinct limitations of using the virtual assistant.  The authors list their intention to have the virtual assistant speak non-English languages and to optimize its emotional intelligence.

Thanks for reading!  Please look forward to more posts from our poster sessions!