Stroke thrombectomy (CME) – online course
Authors: A. Krajina, J. Fiehler and P. Cimflova
Reviewers: S. Hopf-Jensen, A. Mahnken, C. Nice, B. Peynircioglu and D. Vorwerk
This course corresponds to chapter 220.127.116.11.5 Stroke in the EBIR curriculum in the European Curriculum and Syllabus for IR.
Mechanical thrombectomy has been shown to have extremely high clinical benefits in patients suffering from acute ischaemic stroke due to large vessel occlusion. In the last six years, comprehensive cerebrovascular centres have been organised in many countries around the world to provide emergent endovascular treatment 24 hours a day, seven days a week. Accreditation processes have been established to maintain a high standard of this therapy.
The basic principles of emergent stroke care include:
- Round-the-clock service (24/7)
- Accessible neurological examination
- Diagnostic imaging
- Immediate transport between hospitals to ensure timeliness
- Identification and triage of candidates for endovascular therapy
- Expertise of operators
- A postoperative intensive care unit with sufficient capacity
- Regular quality improvement processes based on clinical outcome assessments at each centre.
This course is designed for advanced training and the authors recommend that the CIRSE Academy “Stroke” course be studied prior to this course.
The first part of the course focuses on anatomical changes of the cerebral arteries and arterial anomalies that are important for intracranial catheterisation, such as tortuosity of the vessels or underlying vascular disease. In the pathophysiology section, the authors provide insight into the development of ischaemic stroke during the first 24 hours and review neurological signs that may help in the triage of stroke patients involving both anterior and posterior circulation stroke. In addition to a summary of current indications for endovascular treatment, the borderline indications and the influence of age are discussed. A chapter on mechanical thrombectomy technique summarises technical tricks to achieve reperfusion “first pass effect” successfully, what to do in case of failed thrombectomy attempts (including acute stenting) and how to deal with periprocedural complications. The next section summarises post-procedural management and follow-up protocol. The outcomes section summarises currently used measures of angiographic and functional outcomes and discusses the incidence of futile recanalisation.
- Anatomy: Extracerebral and intracerebral arterial variations and age-related changes relevant to potential catheterisation difficulties
- Neurological signs of the large vessel occlusion
- Evolution of the ischaemic stroke during the first 24 hours
- Role of individual collaterals
- Posterior circulation stroke
- Indications and contraindications:
- Summary of current indications, including 6-24-hour time window
- Endovascular therapy beyond six hours of symptom onset
- Borderline indications and indications which are under research
- Consider the age and whether there is any pre-existing condition in the patient
- The technique of mechanical thrombectomy (Techniques for treatment video)
- Post-procedural management and follow up:
- Manage the first 24 hours after recanalisation
- Manage the period after the first 24 hours
- Modified Rankin scale
- Futile recanalisation i.e., therapy failure
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 18.104.22.168.5 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 and a half hours 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 February 3, 2025. 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: February 2023