Author: Rajiv Advani, Oslo University Hospital
The annual 2023 SVIN meeting took place in Miami and most attendees arrived in Florida almost flooded amidst a storm. The weather cleared up on the first day and the congress program didn’t fail to disappoint.
The first session was a GNIC-SVIN joint session focussing on the goals set forward by Mission Thrombectomy. Representatives from the WSO, ESO, ESMINT, MENO-SINA, JSNET, WFITN, and SVIN put forward realistic and sustainable goals for the increased delivery of mechanical thrombectomy worldwide. Existing data show that only 1.9% of stroke sufferers are treated with mechanical thrombectomy in Europe, a number that needs to be increased, if the global burden of stroke is to be reduced. A new report from the GNIC is eagerly awaited and aims to facilitate the delivery of mechanical thrombectomy worldwide.
One of the hot topics on the first day was inevitably innovation in neuroimaging and AI. Moderators Albert Yoo (@AlbertJYoo) and Eugene Lin led us thru a session which reminded us that AI had been in our clinical lives since automated CTP was available. Furthermore, the pitfalls of CTP are still prevalent and shouldn’t be underestimated. Advances in imaging and imaging interpretation are now no longer limited to CTP in ischemic stroke, but also encompass AVM, Cerebral venous sinuses and Cerebral veins. Staying up to date in the field of neuroimaging has become more challenging but one thing is certain; AI is here to stay.
Another session on Day 1 gave us an introduction to neuroangiography and was clearly in demand, with standing room only. Highlights included the talks by Hazem Shoirah (@Shoirahz) who led us thru a number of chameleons we can potentially encounter in daily practise including carotid webs, mural and intra mural thrombi. Waleed Brinjikji (@WBrinjikji) introduced us to the Appian way in the endovascular treatment of venous fistulas, being able to access all levels using the azygous system. Cindy Kenmuir (@CynthiaKenmuir) walked us thru the endovascular approach to treating CVST including a crash course in the venous anatomy. Endovascular treatment of CVST is currently underused and will be on the rise in the next few years.
On Day two, the SVIN-AHA joint debate session, included enthralling debates on the use of adjunctive lytics, asymptomatic carotid stenting, emergent stenting in ICAD and MSU – are they here to stay? The debates featured compelling arguments from @JimSiegler @Hariskamalmd @DanielVelaMD @ShadiYaghi2 @Mouhammad_Jumaa @CharlesBeaman @AlexandraCzap and Pat Lyden. The conclusions in short were: lytics aren’t dead, yet, ICAD is not understood well enough, yet and asymptomatic carotid stenting is on the rise and is most like here to stay. MSU’s according to @AlexandraCzap are definitely here to stay!
The SVIN Europe session featured debates on low NIHSS LVO, MeVO and MMA embolization. Persuasive arguments were made by @FishingNeurons @CheesemakerMD @rgrandi @Neuroconsult Marc Ribo and Mikayel Grigoryan. The short version: Low NIHSS LVO is a challenge in setting of ICAD, and low NIHSS doesn’t always capture the eloquence of stroke symptoms. MeVO is a hot topic and the RCTs we are eagerly waiting for (DISTAL, ESCAPE MEVO, amongst others) aren’t yet ready to provide us with more clear answers, but in the meantime, just because you can #GTVO doesn’t mean you always should.
Amongst all the original presentations there were also presentations of clinical trial data from SEGA, ENRICH, ALLY, CHESS and PERFORMACE II. SVIN 2023 was a lively update on interventional neurology, and we are already looking forward to seeing everyone at SVIN 2024.
For this and other updates make sure you check out X @svinsociety and #svin2023.
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