Page 166 - Hospital Authority Convention 2017
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Symposiums                                                                   Symposiums
      HOSPITAL AUTHORITY CONVENTION 2017


             SS4.1     Recent Advances in Acute Ischaemic Stroke Management              09:00  Theatre 2

            Recent Advances in Acute Ischaemic Stroke Management
            Tse MMY
            Department of Medicine, Queen Mary Hospital, Hong Kong
            Three most important evidence-based new advances in acute ischaemic stroke (AIS) management include: (1) introduction of
            stroke unit; (2) the use of intravenous (IV) thrombolysis; and (3) intra-arterial (IA) mechanical thrombectomy in eligible patients.
            Efficacy of IV recombinant tissue plasminogen activator (rtPA) in treating patients with AIS presented within three hours
            from onset was first proven in 1995. Over the following 20 plus years, this practice changing evidence leads to significant
            changes in hospital systems especially in the emergency work flow logistic; all aim to facilitate its delivery and to shorten the
            door to needle (DTN) time. Percentage of AIS patients benefited from IV thrombolysis has increased steadily from about 2%
            to over 15% in some countries. These are the results of enhanced hospital work flow logistics and relaxation of various non
            evidence-based restrictions on IV rtPA use.

            Despite these efforts, there are various restrictions on IV rtPA use and its efficacy in treating patients with large vessel
            occlusion (LVO) is generally poor. Only about 10% of patients with ICA and 20% to 30% with proximal middle cerebral artery
            occlusion responded favourably with IV therapy. IA mechanical thrombectomy is targeted to improve clinical outcome in
            this subgroup of patients. Evidence in 2015 strongly supported endovascular therapy in treating this subgroup of patients.
            Meta-analysis of the five most recently published randomised control trials showed that IA therapy has an absolute benefit
            of 20% over IV therapy alone. The average number needed to treat is five for one patient to achieve functional independence.
            In response to these overwhelming bodies of evidence, the US and EU have updated its AIS management guidelines that
            advocating IA therapy should be offered to eligible patients with LVO and appropriate measures should be taken to optimise
            current hospital pathway so that IA therapy can be delivered promptly.














             SS4.2     Recent Advances in Acute Ischaemic Stroke Management              09:00  Theatre 2

            Mechanical Thrombectomy in Acute Stroke – Radiologist’s Perspective
            Lee R
            Department of Radiology, Queen Mary Hospital, Hong Kong

            Intra-arterial thrombectomy is currently an option for treatment of acute ischemic stroke within six hours of symptom onset
      Wednesday, 17 May  the hospital where patient admitted? Posterior circulation ischaemic stroke? In-hospital stroke? Computed tompgraphy on
            (Class 1; Level A). How to implement this service is indeed a great challenge.
            Who should lead the team? Who should perform the procedure? Drip and ship to comprehensive stroke centre or treated in
            brain, angiography alone or do we need additional imaging modalities? General anaesthesia or monitoring anaesthetic care?
            Should we treat in octogenarian ? Hardware arrangement?




























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