Cardiovascular and Interventional Radiological Society of Europe

Stroke (2022 – CME) – online course

Description

Authors: A. Krajina and S. Protto

Reviewers: T. Cleveland, S. Hopf-Jensen, M. Husainy, C. Nice and D. Vorwerk

This course corresponds to chapter 2.2.1.1.5 Stroke in the EBIR curriculum in the European Curriculum and Syllabus for IR.

 

Abstract

Ischaemic stroke (IS) is defined as an episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction and based on pathological, imaging, or other objective evidence of cerebral, spinal cord, or retinal focal ischaemic injury in a defined vascular distribution or an imaging finding in a patient with transient symptoms. Correspondingly, a transient ischaemic attack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without imaging evidence of brain infarction.
Imaging has a central role in the evaluation of patients with acute stroke and helps to determine the stroke subtypes and their aetiology. Generally, multimodal computed tomography (CT) is performed as it is widely available in most centres, and it is a fast imaging technique. However, stroke magnetic resonance imaging (MRI) has also been used extensively. Both imaging techniques enable differential diagnosis between haemorrhagic and ischaemic stroke, allow evaluation of the anatomy of the cerebral and cervical vasculature, detection of the occlusive lesion location and assessment of the extent of irreversible and/or reversible changes.
Prompt and effective revascularisation of the affected area is crucial for improving the patient´s prognosis. The time window between symptom onset and treatment is a pivotal factor in determining the final outcome. Therefore, in recent decades, several therapies have been developed, namely, intravenous thrombolysis (IVT) and intra-arterial interventions, that aim to rapidly restore perfusion in the affected areas. While IVT has been endorsed by different stroke treatment guidelines for more than two decades, the efficacy of intra-arterial therapy was demonstrated only recently. Based on diverse technical approaches, stent retriever-based mechanical thrombectomy (MT) provided a breakthrough in the efficacy and safety of intra-arterial treatment of IS.

 

Learning objectives

  • Become familiar with the most up-to-date literature on this topic
  • Understand the differences between stroke events in the posterior and anterior circulation
  • Know the most commonly used neurological classifications/scores (NIHSS; modified Rankin scale)
  • Know and understand the indications and contraindications for mechanical thrombectomy
  • Be familiar with the factors which strongly influence the indication for stroke treatment (time window; imaging findings)
  • Understand the most commonly used scales for angiographic outcome (modified/expanded TICI score)
  • Understand the discrepancy between angiographic and clinical outcome
  • Demonstrate competence in performing a mechanical thrombectomy procedure
  • Be familiar with the materials used for transarterial thrombectomy (i.e., guiding catheters, microcatheters, microguidewires, distal access catheters)
  • Know the most commonly used thrombectomy devices (stent-retrievers, aspiration catheters)
  • Know the potential risks and complications (dissection, perforation, thrombus dislodgement) and their management
  • Demonstrate competence in performing intra-arterial thrombolysis

 

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter 2.2.1.1.5 Stroke in the EBIR curriculum.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). The CME accreditation for this course will expire on December 24, 2024. A non-CME accredited version of the course will remain available for two more years.

The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: December 2022