Recent Studies in Cerebrovascular Diseases in IndiaAnnual Stroke Masterclass 2017: The Summary of Meeting Proceedings

The “Annual Stroke Masterclass 2017 (ASM, 2017)” focused on providing a comprehensive knowledge on medical and interventional management of ischemic stroke with specific emphasis on “How to?” handle dilemmas, workshop on vascular neuroimaging, live endovascular session, live transcranial Doppler workshop demonstration of findings in specific pathological conditions, and “hands on” Botox in spasticity. The masterclass was held at Taj Dwarka, New Delhi on the 23rd and 24th of September 2017. It was organized by the “Stroke and Neurovascular Interventions Foundation” and “Artemis Agrim institute of Neuroscience” under the aegis of Indian Stroke Association, Indian Academy of Neurology and the Society of Therapeutic Neurointervention. The conference chairmen were Dr. Sumit Singh and Dr. Vipul Gupta and the meeting was organized by Dr. Rajsrinivas Parthasarathy.

Preconference e-learning commenced in June 2017 and was conducted for a period of three months through electronic media that included more than 500 doctors with neuroscience background from across India. The meeting was highly subscribed and attended by over 300 neurologist and neurointerventionist from India and the neighbouring countries. The ASM, 2017 was granted 14.5 credit hours by the Delhi Medical Council. The meeting started at 8.30 AM on the 23rd September 2017 with “Imaging in Stroke,” the topics discussed were: NCCT and CTA is the gold standard—lessons learnt. “The pitfall—I felt further imaging would have helped in selected cases” (Dr. David Liebeskind), perfusion imaging in acute ischemic stroke—lessons learnt; “When not to rely on it?”(Dr. Kenneth Butcher) and Vessel wall imaging—How to differentiate Intracranial atherosclerosis/vasculitis/moyamoya? Case scenarios! (Dr. A. R. Chatterjee). The dilemma theme was “Acute stroke: To intervene or not based on Imaging” (Dr. Jayanta Roy). The second session was on “Heart and Brain”; the theme was “In pursuit of atrial fibrillation.” Is “30-day’ cardiac monitoring justified?” the “pros” and “cons” (Dr. Manjinder Sandhu). The dilemma addressed was “Short (very brief) duration AF and stroke” (Dr. Rajsrinivas Parthasarathy). The next session was on non-vitamin K oral antagonists and the subject matter for discussion was “Individualizing NOAC therapy ‘How to choose your drug?’(Dr Kenneth Butcher), ‘Stopping the ooze’ while on NOAC; How to monitor anticoagulation on NOAC therapy” (Dr. Kenneth Butcher), “Left atrial appendage exclusion—a nonpharmacological alternative?” (Dr. Manjinder Sandhu) and “Early initiation of NOAC” (Dr. Kenneth Butcher). The brain teaser themes were “Dual antiplatelet and anticoagulant—when and why? & is it safe?” (Dr. Rajsrinivas Parthasarathy) and “When NOACS don’t work” (Dr. Jayanta Roy). This was followed with a debate session on thrombolytic therapy in “Acute Ischemic Stroke”. The debate was on (1) tenecteplase: “the elephant in the room?” Can we ignore the evidence anymore? (Dr. Kameshwar Prasad) versus “Large body of evidence for Alteplase trumps the evidence in favor for tenecteplase” (Dr. Subhash Kaul) and (2) “M1 occlusion low NIHSS/borderline core/delayed window period—One should consider intervention in this group of patients’ (Dr. Dheeraj Khurana) versus “I will employ a conservative approach as they are less likely to benefit” (Dr. Rohit Bhatia). The problem scenarios discussed were “Reversing NOAC effect prior to thrombolysis (Dr. Kenneth Butcher),” “MI and Stroke—How to save the brain and the heart? (Dr. Binay Kumar),” “Sherlock Holmes and Doctor Watson in Scarlet: the Dooms day; a case of aortic dissection and stroke (Dr. Srinivasan Paramasivam),” “Thrombolytic therapy and ICH—What can one do?” “Scientia potential est” and “Legs giving way—Is it the Brain or the Spine; cranial and spinal dural arteriovenous fistula presenting with spinal cord ischemia” (Dr. Rajsrinivas Parthasarathy), and “Visual loss—role for thrombolytic therapy; rule out the mimic” (Dr. Aviraj Deshmukh). The 16th session was on intracranial hemorrhage and the talks were on ‘Hematoma expansion—Is it of concern? & Intensive Blood pressure control—Is it overemphasized” and “clotting factors in ICH, Surgery in ICH & tPA in Intraventricular hemorrhage?” (Dr. Rohit Bhatia). The brain teaser themes were “Since the time of the Mummies; cocaine vasculopathy induced hemorrhage” (Dr. Anand Vaishnav), “The Pandora’s box; cranial dural arteriovenous fistula presenting as subarachnoid hamorrhage, recurrent brain stem bleed, rapidly expanding vasogenic oedema mimicking dural sinus thrombosis, obstructive hydrocephalus & seizures” (Dr. Aviraj Deshmukh and Dr. Vipul Gupta), “Sulcal hemorrhage—what could it be?, a case of Takayasu arteritis” (Dr. Mahesh Kate) and “The bleeding heart! ‘Sublata Causa, tollitur effectus’, mycotic aneurysm with ICH” (Dr. Aviraj Deshmukh). The inauguration speech was by Dr. Ashok Panagariya on: future direction for young aspiring neurologists—“The Road not Taken.” The first session after lunch was on carotid disease and the following topics were debated: “Argue the toss: Asymptomatic carotid stenosis: I intervene in this subset?” (Dr. Vipul Gupta), “Clearance for surgery in carotid disease? CABG and other!” “Dr. P. N. Sylaja” and “CREST 2 trail—Hear it from the investigator” (Dr. Jordi Blasco). The dilemma themes discussed was “Blind following carotid revascularisation—‘What went wrong?’ (Ocular ischemia resulting in neovascularity which then resulted in Ocular hyperperfusion and glaucoma following revascularisation)” (Dr. Rajsrinivas Parthasarathy), “APLA and stroke—My head is spinning!” and “When the power house malfunctions!” (Dr. Anand Vaishnav). Then, the treatment concept in basilar artery occlusion was discussed by Dr. Jordi Blasco. The day ended with simultaneous workshops for two hours each (1) neuroimaging workshop (early ischemic signs, ASPECTS scoring, posterior circulation ASPECTS, collaterals: leptomenineal, willisian and external to internal carotid, carotid plaque and stenosis, intracranial stenosis, and dissections) and (2) botox in spasticity (live hands on workshop on patients with upper and lower limb spasticity).