Cardiovascular and Interventional Radiological Society of Europe

Stroke – online course

55 | 25(for CIRSE members)

Description

Please note that this course is no longer CME accredited, but we are working on a new accredited version.

Authors: A. Krajina and S. Protto

Reviewers: L. Kamper, H. van Overhagen, C. Nice, M. Tsitskari and R. Uberoi

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 operationally defined as a neurological deficit lasting more than 24 h or an imaging finding in a patient with transient symptoms. Correspondingly, a transient ischaemic attack (TIA) is defined as a self-limiting episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without acute infarction, lasting less than 24 h. Thus, imaging has a central role in the evaluation of patients with acute stroke. Generally, multimodal computed tomography (CT) is performed because it is widely available in most centres, and is a fast imaging technique, but stroke magnetic resonance imaging (MRI) has also been used extensively . Both imaging techniques enable the differential diagnosis between intracranial or subarachnoidal haemorrhage and ischaemic stroke, and allow evaluation of the anatomy of the cerebral and cervical vasculature, the location of the occlusive lesion and 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 to the affected areas. While IVT has been endorsed by different stroke treatment guidelines for almost 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 a stroke event 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 (TICI score)
  • Understand the discrepancy between angiographic and clinical outcome
  • Demonstrate competence in performing a mechanical thrombectomy procedure
  • Be familiar with the materials needed for transarterial thrombectomy (i.e. guiding catheters, microcatheters, microguidewires)
  • Know the most commonly used thrombectomy devices (stent-retrievers, hydrodynamic devices)
  • 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.

Upon purchase, access to complete and revisit the course is granted for an enrolment period of 90 days.

Release date: March 2019