ESMINT News

The ESMINT proposal for Standards of Practice in Interventional Stroke Treatment
11 September, 2015 - 10:45

Neurointerventional treatment of acute ischemic stroke - 
Standards of Practice

Intense medical research and technology development have recently produced powerful new techniques to treat acute ischemic stroke. The positive results of multiple randomized thrombectomy trials revolutionized the management of this devastating condition and generated a sudden increase in demand for properly equipped institutions and trained personal.

Due to the temporary shortage of these conditions ESMINT, as a leading medical society of the field in Europe, declares its professional standpoint on the basic requirements for neurointerventional treatment of acute ischemic stroke.

Ischemic stroke is a neurovascular disease. As such, all aspects of its treatment require expertise in the neurovascular field. Hence, it should be treated (either invasively or conservatively) by a trained neurovascular team. In this regard, the invasive treatment itself (thrombectomy, thrombaspiration, etc.) should be exclusively performed in neurointerventional units by properly trained personnel.

The requirements for a neurointerventional unit are set by the Standards of Practice in Interventional Neuroradiology – INR, as approved by UEMS as of 04-02-2011 (https://www.esmint.eu/training-education). An updated version of the Standards are expected to be published by a multisociety working group of ESMINT, ESNR and the UEMS Division of Neuroradiology in the near future.

The increased demand for a round the clock interventional service creates a significant challenge for most neurointerventional sites. ESMINT recommends that sites without sufficient number of trained neurointerventionists may employ dedicated specialists without full training in neurointerventions as supervised members of the neurointerventional team.

Such individuals need to be trained to collect the necessary knowledge and experience level. ESMINT offers didactic education and certified exams through its ECMINT training course (https://www.esmint.eu/training-education/ecmint). The practical training needs to be provided by the clinical site. ESMINT strongly discourages practicing neurointerventional treatment of acute ischemic stroke by independent physicians or physician groups not being trained and not belonging to a neurointerventional team.


Background

ESMINT has been established in order to promote the benefits of minimally invasive neurological therapies in Europe through education, training and support for high quality scientific research.

ESMINT encourages and supports medical practitioners and scientists working to develop and improve minimally invasive methods for the treatment of neurological diseases. These methods will naturally evolve and currently involve the use of image guidance and medical devices such as endovascular catheters to perform treatments with minimum associated trauma.

The Society promotes the safe application of such techniques and their practice by suitably trained and competent practitioners throughout Europe. ESMINT encourages the setting of international standards for practice and research and encourages their use and appropriate implementation.

The Society consists of individuals and groups of members working or training in geographical Europe in the field of minimally invasive neurological therapy. The members determine the organisational structure of the Society and are expected to aspire to the highest standards of ethical and scientific medical practice.

More at http://www.esmint.eu/

Registration open for ECMINT 1.3
7 September, 2015 - 15:21

ESMINT is organising a series of residential training courses in partnership with the Oxford Neurovascular and Neuroradiology Research Unit (ONNRU), Oxford University. ECMINT is a 2 year program for trainees in interventional neuroradiology and endovascular neurosurgery. The Course is comprehensive with a curriculum compliant with the requirements of the UEMS specialist section. It teaches trainees all components needed to practice the subspecialty.

The third ECMINT course will be held again at St. Anne's college, Oxford, from 14-18 December 2015. The focus will be "Stroke". Students are encouraged to complete all 4 courses in sequence but completion of each element will credited for CME points. The ESMINT accreditation committee will undertake certification of students completing the course.

Registration for ECMINT 1.3 is now open!

More information & registration

 

The ESMINT News: August 2015
4 September, 2015 - 14:05

Check-out our newsletter containing the latest information from the ESMINT website and society.

Read the ESMINT Newsletter August 2015

President's Letter August/September 2015
26 August, 2015 - 11:30

Read the latest letter from our president Istvan Szikora summarizing ESMINT's recent activities and achievements of the past half year and outlining his vision for the ESMINT Society.

Read the full President's Letter

ESMINT's proposal for standards of practice in interventional stroke treatment
5 August, 2015 - 09:42

ESMINT will announce its proposal for standards of practice in interventional stroke treatment on Friday morning, September 11 during the Nice Congress. The proposal will be preceded by a debate among all faculty and participants.

Read the ESMINT Congress Program

Teaching the INR Curriculum – ECMINT 1.2
13 July, 2015 - 14:08

The second event in the European Course in Minimally Invasive Neurological Therapy (ECMINT)teaching series took place last month in Oxford.

The theme was Treatment of Intracranial Aneurysms and the 4-day residential course included teaching of generic principle common to all forms of minimally therapies and particularly to endovascular treatments. Dr Shelley Renowden {Chairman of ESMINT Education Committee} directed and Alison Clarke was in charge of the local organization.

Forty-nine students participated. They completed a series of formative and summative tests. The end-of-course examination was, for the first time, completed on-line with the assistance of the Swedish company, Orzone AB, of Gothenburg under the supervision of the ESMINT Accreditation Committee Chairman, Prof. Tommy Andersson. The event attached 20 EACCME credits and 26 RCR class1 CME credits.

Some comments:

“It has been a great pleasure taking part in ECMINT 1.2 and once again I would like to extend my appreciation to you, Prof. Byrne, Dr. Renowden and the rest of the course organisation team/tutors for a wonderful job done. I look forward to taking part in ECMINT 1.3 in December”

Dear Alison, The course was amazing, the professors were awesome and you were unbeliavable for the degree of implication, so many thanks and I hope you'll have the most wonderful 5 months until December!”

 

Details of ECMINT 1.3 {themed on treatments for STROKE}, will be published next month with registration for returning students opening in early August and for new registrations in early September.

ESMINT is grateful to the following organisations for financial assistant to support the ECMINT program: BALT, Blockade Medical, Codman, Covidien, MicroVention, Neuravi, Penumbra, Sequent Medical.

Results of VISSIT published
27 March, 2015 - 08:35

After the SAMMPRIS trial, the VISSIT study using the Pharos Vitesse stent also showed inferior results to medical therapy in symptomatic intracranial stenosis. 

“…the use of a balloon-expandable stent compared with medical therapy resulted in an increased 12-month risk of added stroke or TIA in the same territory, and increased 30-day risk of any stroke or TIA”, states the conclusion of the paper published yesterday in JAMA.

The study was performed in vast majority in US centres.

The full article is available here: http://jama.jamanetwork.com/article.aspx?articleid=2208809

ESMINT announces new Stroke Grant
25 May, 2015 - 13:00

ESMINT is now offering a grant for a one-year research fellowship to support the training of a young physician in research related to stroke endovascular management in European laboratories or clinics.

The beneficiary of this new programme will be supported with US $15,000.

The deadline for applications is 20th August 2015.

For more information about the ESMINT Stroke Grant please click here.

Downloads

Stroke Grant Information [PDF - 462kB]

ECMINT 1.2 accredited by EACCME
11 May, 2015 - 15:55

20 CME Credits

ECMINT 1.2 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists.

European Course in Minimally Invasive Neurological Therapy (ECMINT) 1.2 is designated for a maximum of, or up to 20 European CME credits (ECMEC).

More information

European Stroke Organisation conference report, 17-19 April 2015
23 April, 2015 - 15:10

The European Stroke Organisation conference (ESOC) took place in Glasgow on April 17-19 2015. As a partner society, ESMINT was involved in several well-attended workshops and joint sessions with ESO. Additionally there was a guideline meeting for the ESO/ESMINT/ESNR/EAN/EANS/EuSEM (“6E”) guidelines for organisation of acute endovascular treatment in stroke centers.

More important, another three new thrombectomy studies have been presented at ESOC for the first time. SWIFT-PRIME and REVASCAT have been published in parallel simultaneously in the NEJM.

REVASCAT is a randomized trial of revascularization with Solitaire FR device vs. best medical therapy in patients with anterior circulation large vessel occlusion within eight hours of symptom onset in Catalonia. Patients with acute ischemic stroke ineligible for IV tPA treatment and non-responders to IV tPA were included. Thrombectomy reduced the severity of disability over the range of the modified Rankin scale (adjusted odds ratio for improvement of 1 point, 1.7; 95%CI, 1.05 to 2.8) and led to higher rates of functional independence (a score of 0 to 2) at 90 days (43.7% vs. 28.2%; adjusted odds ratio, 2.1; 95%CI, 1.1 to 4.0, ARR 15.5%). Another outstanding feature of this study is that only eight patients who met the eligibility criteria were treated outside the trial at participating hospitals.

THERAPY is a randomized trial that compared the Penumbra system in various development stages in combination with different types of separators with best medical therapy (Separator and Separator 3D used in 82%, Ace in 27%). The study has been stopped due to lack of equipoise after enrolling 108 patients with 96 follow-up data sets available. Key inclusion criteria were IV tPA within 4.5 h and clot length larger than 8 mm as measured by CT. The study revealed no superiority of the mixed endovascular arm for the primary endpoint in the intention-to-treat analysis. The mRS 0-2 (day 90) was 30.4% in the medical therapy group and 38.0% in the endovascular arm (ARR 7.6%, p=0.521). However, pre specified per-protocol analysis of ordinal mRS showed superiority of the endovascular treatment (OR 2.28 95%CI (1.05 to 4.96)). As THERAPY used unique selection criteria, impact is difficult to assess across this small population.

The French THRACE study is a randomized trial of endovascular revascularization in stroke with any device approved in France vs. best medical therapy in patients with large vessel occlusion within six hours. The patient recruitment is stopped. Currently, the 90-days data of the very recently enrolled patients are still incomplete. However, the preliminary results were reported. In this preliminary analysis based on 385 enrolled patients with available outcome data, the mRS 0-2 (day 90) was 42.1% in the medical therapy group and 54.2% in the endovascular group (ARR 12.2%, p=0.016). Occlusions were M1 in 85%, ICA in 14.5% and BA in 0.5%. This no company-sponsored public trial is very important as it shows the benefit of endovascular revascularization on a countrywide scale even when wide inclusion criteria are applied.

Additionally, more subgroup analyses of SWIFT-PRIME, ESCAPE, EXTEND-IA and MR Clean have been presented. In a positive atmosphere, future steps in the development of thrombectomy have been discussed concerning optimization of workflow, definition of patient selection criteria, training of future Neuroradiologists and refinements of techniques.

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