Page 93 - Hospital Authority Convention 2017

Masterclasses

M2.1 Cerebral Revascularisation for Stroke Prevention 13:15 Convention Hall A

Mechanical Thrombectomy in Acute Ischaemic Stroke – from Science to Service
Lui WM
Department of Neurosurgery, Queen Mary Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
Intravenous thrombolysis is an effective treatment for acute ischaemic stroke. However, vascular recanalisation rates remain
low especially in the setting of large artery occlusion. On the other hand, endovascular intra-arterial therapy addresses this
issue with superior recanalisation rates compared with intravenous thrombolysis. Although previous randomised controlled
studies of intra-arterial therapy failed to demonstrate its superiority, the failings may be attributed to a combination of inferior
intra-arterial devices and suboptimal selection criteria. The recent results of several randomised controlled trials have
demonstrated significantly improved outcomes, underpinning the advantage of newer intra-arterial devices and superior
recanalisation rates, leading to renewed interest in establishing intra-arterial therapy as the gold standard for acute ischaemic
stroke.

In this presentation, the current evidence on endovascular therapy in acute ischemic stroke will be reviewed and the major
challenges in the implementation of this therapy will be discussed. We address the challenges of the generalisability of trial
results to different patient populations, socio-economic aspect, implementation of endovascular therapy in the acute setting
for large populations within various geographical contexts, and approaches to evaluating future innovations in the field of
neuroendovascular care. Tuesday, 16 May

M2.2 Cerebral Revascularisation for Stroke Prevention 13:15 Convention Hall A

Cerebral Revascularisation: Microsurgical Approach on Stroke Prevention
Yuen SC
Department of Neurosurgery, Tuen Mun Hospital, Hong Kong

Ischemic stroke is a major cause of morbidity and mortality in our population. Acute stroke treatment has evolved rapidly in
the past decade. Once a medical disease, emergent large-vessel occlusions can be effectively treated by neuroendovascular
procedures. For stroke prevention, neurosurgeons are actually playing an active role in past decades. Carotid endarterectomy
is one of the most well studied procedures in neurosurgery. Large-scale trials have demonstrated definitive benefit in patients
with severe carotid stenosis, both symptomatic and asymptomatic. With the introduction of stenting techniques, major
trials have not proven these to be superior to carotid stenosis. Carotid endarterectomy remains an important procedure for
preventing stroke.

In 1967, Yasargil performed the first successful superficial temporal artery to middle cerebral artery (STA-MCA) bypass.
Since then, this procedure has been used to treat cerebrovascular occlusive diseases. Symptomatic internal carotid artery or
middle cerebral artery stenosis or occlusion are major indications. However, different studies did not show favourable results
except the Japanese EC-IC Bypass Trial. In addition, endovascular techniques also replace bypass for stenosis. STA-MCA
still has a role in selected patients who failed to respond to medical treatment and endovascular therapy.

This presentation will share the experience of Tuen Mun Hospital in managing ischemic stroke patients by microvascular
procedures, carotid endarterectomy and EC-IC bypass.

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