What is a TIA?

International Journal of Stroke is at the NSRI scientific retreat in the Hunter Valley; the session is being chaired by the amazing and highly regarded clinician Marie-Germaine Bousser. So, the question posed for this discussion, headed by Simon Koblar, Helen Dewey and Dominique Cadilhac is 'What is TIA?' And the consensus is that no one can agree - how this condition is defined and how to run cohorts which supply data that is novel, relevant in Australia and of interest to public health...

Sixth International Stroke Summit

Sixth International Stroke Summit

Juehua Zhu, Gelin Xu, Xinfeng Liu

Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

Correspondence Xinfeng Liu, Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305 Zhongshan East Road, Nanjing 21002, Jiangsu, China

E-Mail: xfliu2@yahoo.com.cn

To establish a platform for international communication in stroke management, Jinling hospital launched an annual conference, the International Stroke Summit in 2004. The summit has been successfully run for six times and has been endorsed by World Stroke Organization since 2007. More than 1000 doctors and researchers have participated in each meeting.

The Sixth International Stroke Summit was held on July 9-11, 2010 in Nanjing, China. The conference motif of bridging the gap between developing and developed countries in stroke management was high appropriate. Hot debate and grand attention had been focused on topics such as the development of endovascular treatment of extracranial and intracranial atherosclerotic diseases, clinical trials of stroke treatment, stroke registry and genetic factors for stroke.

On the first day of this conference, the National Neuroendovascular Association was set up. The association constitutes neurologists, vascular surgeons and intervention clinicians from major medical centers in China. The mission of such a unique association is to shed more light on the standardization of endovascular treatment in China.

Distinguished from the previous meetings, two sections specialized on endovascular therapy and an international discussion was established. In the intervention section, clinicians talked about their own experiences with cerebral angiography and stenting. In the international section, stroke specialists from America, Australia, Finland, Netherlands, Japan, India, Brazil and China shared the latest developments in stroke research.

Prof. Xinfeng Liu, the chairperson of this summit, introduced the frontier of neuroendovascular treatment. He mentioned that IV-tPA can be beneficial for acute ischemic stroke up to 4.5h from stroke onset. However, due to low recanalization rate and high re-closure rate after thrombolysis, especially in patients with severe stroke and patients with T-shaped artery occlusion, few patients who meet the criteria for IV tPA thrombolysis can benefit from it. For these patients, intra-arterial thrombolysis, mechanical thrombectomy may be the better treatment choice. Dr. Liu also introduced the recently published CREST study¹. Younger patients would benefit more from carotid stenting, older patients from endarterectomy. The CREST study proved carotid artery stenting together with endarectomy to be powerful weapons against stroke.

Dr. Yongjun Wang from Tiantan Hospital lectured on the improvement of stroke management worldwide. He introduced the GWTG-stroke program carried out in USA which raised the percentage of patients receiving standard treatment under stroke guidelines; from 41% in 2003 to 83% in 2009². This study underlined the importance of guidelines in stroke treatment. In the Canadian Stroke Strategy and British National Stroke Strategy, the importance of patient education, primary prevention, pre-hospital management, acute stroke units and subacute rehabilitation units as well as secondary prevention were highlighted. Dr. Wang said stroke management in China lagged far behind than that in these western countries. The ongoing Golden Bridge Project of Stroke Care is a first attempt in China at a national public health campaign; hopefully this project will be active throughout China in the next five years.

Dr. Yukito Shinohara, a principal investigator of the Cilostazol Stroke Prevention Study (CSPS), introduced a clinical trial for stroke prevention (CSPSII). CSPSII is a randomized, multicenter, double-blind, parallel-group study, included 2757 non-cardioembolic stroke patients from 278 centers between December 2003 and December 2008. Patients randomized to cilostazol group (1337 patients), received 100 mg twice daily and aspirin group (1335 patients), received 81 mg once daily. The duration of treatment lasted a minimum of one year and a maximum of five years. Eighty-two strokes occurred in cilostazol-treated patients, and two of these events were fatal. In the aspirin group, there were 119 strokes, including three deaths. Hemorrhagic stroke or hemorrhage requiring hospitalization occurred in 23 patients in the cilostazol group and 57 in the aspirin group. Dr. Shinohara pointed out that cilostazol would be an alternative to aspirin and clopidogrel in our arsenal against secondary stroke.

About 1200 domestic and overseas delegates participated in this meeting. Many others watched the summit via live Internet broadcast. Thirty selected abstracts submitted to the conference were published in Cerebrovascular Diseases³. The organizers announced that the next meeting, the Seventh International Stroke Summit, will be held on July, 2010 in Nanjing, China. They encouraged the clinicians and researches to join this Nanjing summer gathering and continue their contribution to boost east west academic communication. Detailed information concerning the conference is available on the website: www.stroke.net.cn

References

1. Brott TG, Hobson RW, 2nd, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 363(1): 11-23.

2. Fonarow GC, Reeves MJ, Zhao X, Olson DM, Smith EE, Saver JL, et al. Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation. 121(7): 879-91.

3. Sixth International Stroke Summit. Cerebrovasc Dis. 2010; 30: 207-19.

Stroke in Nepal

Did you know there are only 10 neurologists working on stroke in Nepal? We have just received a heartfelt article on this for the journal, and it reminds you why you build international relationships where you share information resources and time; the World Stroke Organization is such a valuable resource and source of support for developing countries. Those in the west cannot imagine working in these conditions; non-existent time windows, no public campaigns or government support, no rehabilitation options, no telemedicine, very high risk of disability and death. Not to mention palliative care, family support and information etc.