Current Cerebrovascular Research from India: Summary of Meeting Proceedings of “Stroke and Neurovascular Masterclass, Anvi 2019”

Abstract

The “Stroke and Neurovascular Masterclass, ANVI
2019” was a two-day intensive program focused on pro‐
viding comprehensive knowledge on medical and inter‐
ventional management of ischemic stroke with specific
emphasis on “rarities” and “tips and tricks.” The primary
focus of the rarities was on stroke in the young and cere‐
bral vasculitis. Workshops on thrombolytic therapy, vas‐
cular neuroimaging, live endovascular session, live
transcranial Doppler workshop with demonstration of

findings in specific pathological conditions, and “hands-
on” Botox injection for spasticity were the highlights of

the program. The masterclass was held at “The Westin,”
Gurgaon, on 23 and 24 November 2019. It was organ‐
ized by the “Stroke and Neurovascular Interventions
Foundation” and “Artemis Agrim institute of Neuro‐
science” under the aegis of the “World Stroke Organiza‐
tion,” the “Indian Stroke Association,” and the ‘Society
of Therapeutic Neurointervention’. The conference was
organized by Dr. Rajsrinivas Parthasarathy and chaired
by Dr. Vipul Gupta and Dr. Sumit Singh. The meeting
was highly subscribed and attended by over 350 neurol‐
ogists and neurointerventionists from India and the
neighboring countries. The masterclass was granted 14.5
credit hours by the Delhi Medical Council.
The first symposium on 23 November 2019 was on
focal vasculopathy and vessel wall imaging. The first
talk was on “MRI vWI: the principles, differentiating
etiologies (atherosclerosis, vasculitis, moyamoya, or
RCVS?), and pitfalls” by Dr Daniel Mandell (30
minutes). This was followed by a talk on moyamoya
angiopathy (the correlation between collateral type and
ischemic versus hemorrhagic presentation? When to do
surgery? and on watershed shift after revascularization
surgery) by Dr Mark Bain (15 minutes). The session
concluded with a talk by Dr Sylvain Lanthier on the
approach to etiological diagnosis of artery disease (15
min). The second symposium was on secondary preven‐
tion in stroke. The lessons learnt from NAVIGATE
ESUS and RESPECT ESUS were discussed by Dr Ash‐
faq Shuaib (15 min). Following that, atrial fibrillation
type and burden and stroke risk (15 minutes), recurrent

ischemic stroke while on NOAC “what to consider” (10
minutes), to bridge or not to bridge—(anticoagulants)
(15minutes) were reviewed by Dr Jukka Putaala. There‐
after, “DAPT” “is it 21 days or 3 months” and the role
of Ticagrelor in suspected resistance’ was examined by
Dr SP Gorthi (15 min). The third symposium was on
stroke in the young and vasculitis/vasculopathy. “Rare
etiologies for stroke in young” (including metabolic
stroke) (20 min) and “searching for explanations for
cryptogenic stroke in the young” (15 min) were dis‐
cussed by Dr Jukka Putaala. Thereafter, “Spectrum of
single-organ vasculitis of CNS. Primary angiitis, amy‐
loid beta-related angiitis, and inflammatory amyloid
angiopathy” (20 min), “Primary angiitis of CNS: diag‐
nosis and its therapeutic challenges” (20 min), and “Sec‐
ondary vasculitis: the rare and commonly overlooked
etiologies” were reviewed by Dr Sylvain Lanthier.
Genetic cerebral small vessel disease (CADASIL, CAR‐
ASIL, and COL4A1) was discussed by Dr R Bhatia (15
min).
A book on neurointervention (100 interesting case stud‐
ies in Neurointervention: tips and tricks) edited by Dr
Vipul Gupta, Dr Ajit Puri, and Dr Rajsrinivas Partha‐
sarathy was launched in the meeting in the presence of
professor NK Mishra and professor VS Mehta. There‐
after, the post-lunch sessions started off with the latest
developments in stroke sciences. The topics covered
were a) Cerebral microbleeds: the relevance for initiat‐
ing antiplatelets, anticoagulants, and thrombolysis (PN
Sylaja); b) Extending thrombolysis indications: 4.5–9
hours/wake up/early repeat r-tpa/low NIHSS/my diffi‐
cult decisions (MV Padma Srivastava); c) Extending
horizons for MT: stretching the envelope! (V Gupta);
and d) MISTIE 3 trial “endoscopic clot evacuation?”
(Aditya Gupta). Thereafter, “Pediatric stroke etiology,
thrombolysis, and thrombectomy” (Urs Fischer), and
“Borderlands of stroke, migraine, and other headaches”
(Sumit Singh) were discussed. The sixth symposium
commenced with a talk on intracranial atherosclerosis
“timing, high risk features, and vessel wall imaging” by
Dr Rajsrinivas Parthasarathy (15 min) and was followed

Vol. 11, No. 2, pp. 79–80. Published Jul, 2020.
All Rights Reserved by JVIN. Unauthorized reproduction of this article is prohibited
Journal of Vascular and Interventional Neurology, Vol. 11

by a talk by Dr Vipul Gupta on “Carotid and vertebral
artery dissection: imaging clues and interventional man‐
agement.” The next session on “technology masterclass”
covered the following topics: “Newer technology in
thrombus retrieval” (S Purkayastha), “Perfusion angiog‐
raphy in acute stroke” (S Schob), and “ACCLINO flex
plus stent in ICAD” (H Nordmeyer). The day concluded
with challenging case presentations by Dr A Vaishnav,
Dr J Roy, Dr V Nambiar, and Dr C Chugh at 7.30 pm.
The second day commenced at 8 am with the platform
presentation of the top three abstracts by Dr Swati Chin‐
chure, Dr Ramandeep Kaur, and Dr Dinesh. The next
session was on carotid and vertebral artery disease. The
following topics were ‘TCD in cerebrovascular disease:
diagnosis and prognostication’ (Saurabh Anand), “verte‐
bral artery stenosis: recanalization strategies” (Adnan I.
Qureshi), carotid stenting: challenging scenarios “Long
segment, collapsed lumen, surface thrombus, tandem
stenosis, arch issues, and dissection” (U Limaye) were
discussed. The mechanical thrombectomy masterclass
included the following topics: a) Difficult access: Sim‐
mons exchange over Amplatz “the technique” (Nischint
Jain); b) Carotid puncture for anterior circulation throm‐
bectomy (Jasmeet Singh); c) Transradial approach for
anterior and posterior circulation mechanical thrombec‐
tomy (Jasmeet Singh); d) Primary aspiration: “tips and
tricks for successful first pass” (J Delgado); e) “SR and

Balloon guide” technical nuances (R Parthasarathy); f)
TRAP technique: “the challenging cases” (J Singh); g)
Difficult thrombectomy “root cause analysis” “is it clot,
artery, or technique” (Stefan Schob); h) Distal thrombec‐
tomy: “what device and how to?” (S Schob); and i) My
approach to failure to reperfuse (Mathew Cherian).
The next session was on parent artery pathology and
included the following topics: a) Tandem occlusion
“stent versus no stent” and drug protocol (V Gupta); and
b) Intracranial atherosclerosis “treatment strategies” (S
Schob). Thereafter, challenging cases were discussed by
Dr Vivek Gupta and Dr Vikas Bhatia. Following that, Dr
Jeyraj Pandian discussed about the futuristic perspective
of Indian Stroke trials. Then, live case transmission of
carotid artery stenting was undertaken from Artemis
Hospitals by Dr Vipul Gupta and team. The meeting
concluded with post-lunch parallel workshops on the
following topics: ‘Thrombolysis symposium: “no ifs,
ands, or buts,” neurovascular imaging, Botox, and trans‐
cranial Doppler ultrasound.
The leading abstracts of the session are presented as fol‐
lows.