Dr Juveria Siddiqui attended the UK Neurointerventional Group annual meeting this summer and has kindly recorded some of her highlights from the meeting for us below:
The UK Neurointerventional Group (UKNG) Summer meeting was hosted in Bristol from 9-10th June 2017. It was well-attended by consultant and registrar INRs countrywide, as well as industry representatives. The main focus of the meeting was understandably stroke intervention, with talks covering various aspects of this topic on both days.
The meeting kicked off with a talk on setting up a 24/7 stroke service by UK experts in the field: Dr Andy Clifton (St George’s, London), Professor Phil White (Newcastle), Dr Peter Flynn (Belfast) and Dr Robert Lenthall (Nottingham). Professor White has been closely involved with NHS England’s commissioning of thrombectomy in stroke (announced earlier this year), and discussed American data on mortality citing that smaller units are associated with poorer stroke outcomes.
This suggests that, given the wide range of patient numbers presenting to individual HASUs per year, not every HASU should necessarily provide a stroke thrombectomy service, in order to maintain numbers and encourage skills preservation in units that are service providers. HASUs will likely be expected to demonstrate the numbers performed and their adherence to guidelines in order to continue performing thrombectomy. Following the DAWN trial, which assessed functional outcomes following thrombectomy 6-24 hours following ictus (including wakeup strokes) and terminated early due to high efficacy, the number of stroke patients eligible for thrombectomy is likely to increase.
Following this, talks from Dr Andy Clifton on his experience of implementing a 24/7 stroke thrombectomy service at St George’s Hospital demonstrated that this process required meticulous planning and also discussed the possible hurdles that one may experience. The unit is busy, accepting many patients beyond St George’s catchment area. Dr Clifton discussed the work pattern of the INRs in this unit, based on a 1 in 5-6 rota.
Dr Sanjeev Nayak from Royal Stoke University Hospital followed this with his experience, primarily of stentriever in thrombectomy. His experience of a current 1 in 2 rota covering all neuro-intervention highlighted the need for service expansion and recruitment for the longevity of an INR-led thrombectomy service.
My presentation covered data from the Royal London Hospital’s HASU; a yearlong audit at our unit emphasised that robust initial imaging (CT and CTA) must be a pre-requisite in the quick diagnosis of those eligible for thrombectomy.
Dr Adam Rennie from Great Ormond Street Hospital presented the new RCPCH/Stroke associated Paediatric Stroke guidelines. These guidelines aim to increase awareness of stroke in babies and children, and recommend early unenhanced CT and CTA (neck and intracranial) in any child who is FAST positive but also children with unexplained focal neurological deficit or decreased conscious level. MRI should also be performed if it can be carried out in a timely manner.
The guest speaker, Professor Matthew Gounis, a bioengineering researcher at the University of Massachusetts, USA, provided an intriguing insight into the in-depth laboratory models assessing different clot types and the best modes of retrieval. Use of a balloon guide catheter was associated with improved revascularisation outcomes. There are certain clot types that are easily retrieved, and some that are irretrievable regardless of technique.
There were also a number of excellent talks unrelated to stroke; Dr Wilhelm Kuker’s experience in the pearls and pitfalls of carotid stenting, Dr Andy Clifton’s approach to intracranial vascular lesions in connective tissue disorders and Mr Mario Teo’s neurosurgical management of Moyamoya by vascular anastomosis, following his fellowship at Stanford.
Overall, the meeting was well-organised, interesting and varied, and as well as learning, gave me the opportunity to meet friendly and approachable INRs from all over the UK. There were also useful simulator sessions available. I would recommend the meeting to any budding neuro-interventionalist.
Look out for highlights from the BSNR Annual Meeting in the next couple of weeks, and apologies for the delay in the September journal round-up which will be available next week.