The UKSF 2022 conference returned as an in-person conference at the ACC in Liverpool. The three-day conference is the UK’s largest multidisciplinary stroke conference with 2022 having record abstract submissions. This report is a snapshot of some of the sessions.
The first day had a well subscribed session on state-of-the-art secondary prevention. Dr Alan Cameron (University of Glasgow) presented how we select patients for cardiac monitoring and what might be the optimal duration to improve detection of atrial fibrillation (AF) after stroke and transient ischaemic attack (TIA). Studies advise we should monitor for longer, which is challenging in the NHS, we therefore need to target the monitoring, perhaps using biomarkers and rule out those who are unlikely to have AF. The PRECISE study will develop a prognostic model using biomarkers and the Cardiac Monitoring Study EOI will look at duration.
Professor Andrew Ross Naylor (University Hospitals of Leicester, UK) asked what stroke physicians need to know about carotid arterial disease surgical management and the new guidelines. He advised to intervene within 14 days and that carotid endarterectomy (CEA) is preferable to stenting, but we still don’t know the optimal timing of intervention as more data is needed. Dual antiplatelet therapy (DAPT) for 21 days is recommended in these patients but there needs to be discussion between stroke physicians and vascular surgeons about the role of DAPT after CEA.
Professor David Werring (UCL, UK) looked at the dilemma of when to start anticoagulation after ischaemic stroke caused by AF when the current data does not cover the early stages after stroke – how do we balance risk of stroke versus risk of intracranial haemorrhage (ICH)? There is no clear consensus on timing in the guidelines and we need more data on severe strokes and infarct size; OPTIMAS may tell us more, but early oral anticoagulants (DOACs) look promising.
Dr Gargi Banerjee (UCL) reviewed cerebral amyloid angiopathy and new emerging research in the area. Boston 2.0 now expands the clinical presentation, reducing the age range to 50 alongside a change in the imaging criteria. Iatrogenic CAA was discussed with ever growing case reports for this rare condition.
The second day opened with standing room only in the medico-legal aspects of stroke care with Dr Neil Baldwin (Winfield Hospital, UK) giving an insight into this complex area with case examples. He highlighted that stroke is blessed with a large amount of guidance to support decisions and emphasised the need for clear documentation recording the risks and benefits of care given.
The Princess Margaret memorial lecture was given by Professor Tom Robinson (University of Leicester, UK) recapping the research: To treat or not to treat acute stroke hypertension – is it still an important question? With ICH he advised we need careful lowering particularly over the 1st hour and need to sustain it and reduce variability. With large vessel occlusion, intense blood pressure lowering may increase the risk of ischaemia. The take home message was to restart the oral antihypertensives as soon as able instead of continued use of IV agents.
The second day closed with an interactive and informative session providing a practical approach to assessing the front door patient with vertigo given by Dr Diego Kaski (University College London) exploring how to differentiate between peripheral and central causes to help differentiate between the strokes and the mimics. He gave a practical demonstration of the HINTS+ assessment and the Semont manoeuvre to treat benign positional vertigo (BBPV) but warned to watch out for possible AICA territory strokes as they mimic vestibular issues.
The final day opened looking at stroke in older adults, is it all about age or is it about frailty? Dr Agarwal (Addenbrookes Hospital, UK) noted that age was the most significant factor in ischaemic stroke and early death in the first week after ICH is more likely in older adults. Age should not be a contraindication for thrombectomy as older adults still benefit from intervention, but frailer adults had poorer outcomes.
Dr Jonathan Hewitt, (Cardiff University, UK), looked at multi-morbidity – 50% of those over 65 have two or more conditions and many of these conditions cluster; the more conditions, the worse the outcome after stroke.
Dr Terry Quinn (University of Glasgow, UK) focused on delirium after stroke, only 7% is hyperactive with the rest hypoactive. It is common and will affect at least 1 in 4 strokes and up to half of patients with ICH. Delirium impacts upon rehab engagement and has a legacy effect with functional decline, 5x risk of mortality and higher risk of institutionalisation. Use the 4AT to screen as it has sensitivity and specificity of 0.9 and consider screening twice daily with those at high risk, particularly within the first 24-72 hours. Prevent delirium with basic clinical care, avoid sedatives and use MDT care to treat it.
The closing plenary, what’s hot and what’s next, gave a taster of future stroke innovation. Among the talks, Dr Graham McClelland (North East Ambulance service, UK) looked at the changing face of pre-hospital care and how it might impact on patient selection and taking treatments into the community to the patient. Rachael Jones (national stroke nursing forum, UK) presented on how non-medical staff from the MDT can impact on new ways of working to enhance TIA diagnostics, investigations and secondary prevention, which was in keeping with other speakers who discussed the use of ACPs, non-medical consultants and physician associates as part of the stroke workforce.
This is a brief insight into some of the talks from a packed multi-disciplinary agenda, more to come this year in Birmingham from the 4th of December 2023.