ESMINT News

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.

Announcing the EJMINT Best Paper AWARD 2015
17 April, 2015 - 14:29

EJMINT Best paper Award 2015

Feb 2015 - Neurointerventional Newsletter
26 March, 2015 - 14:36

The Feb 2015 issue of the Neurointerventional Newsletter is now available for download by clicking the button below.

Download - Neurointerventional Newsletter, February 2015

Provided to ESMINT by Prof Michael Forsting & Stryker Neurovascular

Mechanical thrombectomy improves outcomes in acute ischemic stroke
19 February, 2015 - 10:44

ESO ESMINT ESNR

Joint statement of the European Stroke Organisation (ESO), the European Society  of Minimally Invasive Neurological Therapy (ESMINT) and the European Society of Neuroradiology (ESNR):-

Stroke resulting from rupture or interruption of blood flow in brain vessels can lead to devastating consequences for patients, their families and society. Steady progress has been achieved in the last 20 years in stroke treatment through better prevention, establishment of stroke care units and the use of clot-busting drugs (intravenous thrombolysis).

Last week, new scientific evidence from four major stroke studies was presented at the International Stroke Conference in Nashville, USA. It proved that rapid mechanical thrombectomy (clot retrieval) improves patient function after acute ischemic stroke. To achieve this benefit, patients were treated by interventional neuroradiologists in stroke centers with multidisciplinary stroke teams. This treatment should be performed as rapidly as possible in conjunction with standard intravenous thrombolysis.

ESO, ESMINT and ESNR acknowledge this significant progress in acute stroke treatment and strongly support its application in appropriately selected patients in well equipped stroke centers by properly trained neurointerventionists. Further randomized trials of thrombectomy and more detailed analysis of the current trials will help to optimize patient selection and treatment algorithms.

Detailed guidelines on mechanical thrombectomy are currently being prepared by the key European societies involved in acute stroke care. Before these detailed guidelines become available, ESO, ESMINT and ESNR have jointly updated and support the consensus statement on thrombectomy by the ESO-Karolinska Stroke Update.

Background

The European Stroke Organisation (ESO) is a society of stroke physicians, researchers, societies and patient organizations with the goal of optimizing  and harmonizing  the management of stroke in Europe by supporting medical education and stroke projects.
More on www.eso-stroke.org
Contact: esoinfo@eso-stroke.org

The European Society of  Minimally Invasive Neurological Therapy (ESMINT) is a multidisciplinary society of individuals and groups working or training in the field of minimally invasive neurological therapy in geographical Europe. It has been established in order to promote the benefits of minimally invasive neurological therapies through education, training and support for high quality scientific research.
More on www.esmint.eu
Contact email: office@esmint.eu

The European Society of Neuroradiology / ESNR Diagnostic and Interventional is a professional society organising European neuroradiologists. The Society organises Annual Scientific meetings - ESNR Congress, common European Training courses in neuroradiology - European Course of Neuroradiology (ECNR) and is a forum for professional development of European Neuroradiology.
More on www.esnr.org
Contact email : info@esnr.org

Report of the Second ESO ESMINT ESNR Stroke Winter School
13 February, 2015 - 15:04

The 2nd ESO ESMINT ESNR stroke winter school was held in Bern, Switzerland from the 3rd to 6th of February 2015. The local organizing committee were Prof. Jan Gralla, Prof. Heinrich Mattle, PD Dr. Pasquale Mordasini and Prof. Urs Fischer. They were actively supported by Katharina Wenger, Martin Zbinden, Daniela Miescher and Helena Gerber.

The first difficult task was to select 44 participants from many more applicants, but eventually 44 enthusiastic young doctors – 20 pairs of rising neurologists and neuroradiologists - arrived in Bern from 19 different countries: UK, Serbia, Germany, France, Lithuania, Slovakia, Italy, Austria, Denmark, Belgium, Portugal, Finland, Czech Republic, Hungary, Ireland, India, South Africa, Ukraine and Switzerland.

The primary aim of the second ESO ESMINT ESNR stroke winter school was bringing together young European stroke physicians and neuroradiologists in order to enhance interdisciplinary management of patients with acute ischaemic stroke.

The stroke winter school started on the 3rd of February 2015 with the welcome of the president elect of the European Stroke Organisation (ESO), Prof. Valeria Caso, the president of the European Society of Minimal Invasive Neurological Therapy (ESMINT), Prof. Istvan Szikora, and the committee member of the Interventional Neuroradiology Section of the European Society of Neuroradiology (ESNR), Prof. Jan Gralla on behalf of Prof. Olav Jansen.

The 32 speakers (12 from EU, 20 from Switzerland) including neurologists, interventional and non-interventional neuroradiologists, neurosurgeons, internal medicine specialists, and rehabilitation specialists led challenging discussions. The teaching program included 32 lectures and 8 tutorials. The main focus of the lectures was interdisciplinary treatment of acute stroke. There were sessions on acute stroke imaging, acute treatment strategies including endovascular approaches, stroke treatment in difficult circumstances and needs to set up an interdisciplinary stroke center. In the afternoon tutorials were given separately for neuroradiologists and neurologists. Neuroradiologists had the opportunity for structured hands-on teaching in small groups on endovascular procedures with animal models and management of complications of endovascular treatment. Neurologists could learn neuroangiography on a model and were taught CT and MRI interpretations by neuroradiologists. Both groups visited the stroke unit and had interdisciplinary case discussion.

A special highlight for the interventional neuroradiologists were the hands-on teaching sessions with the animal model. Small groups of 5 participants were given the opportunity to perform diagnostic angiography and endovascular treatment procedures such as thrombectomy with multiple devices.

During the stroke winter school a faculty meeting was held with members of the ESO, ESMINT and ESNR in order to discuss future common strategies to enhance the quality of stroke management. Topics were guideline papers, studies, potential joint conferences and workshops.

During the stroke winter school participants and faculty had three joint dinners to favour socialization.

The following sponsors contributed to the realization of the stroke winter school: Covidien, Stryker, MicroVention, Penumbra, Daichii-Sankyo, Johnson&Johnson/Codman, Siemens Neuravi, Boehringer Ingelheim and 1a medical ag.

The local organizing committee thanks all the invited speakers for giving time and efforts to the winter school, for coming to Bern, and for delivering high quality lectures. Their interest and passion to teach the upcoming generation of neurologists and neuroradiologists was clearly visible.

After the success of the first and second ESO ESMINT ESNR stroke winter school there will be a 3rd ESO ESMINT ESNR stroke winter school from the 9th to 12th of February 2016 in Bern!

Urs Fischer, Pasquale Mordasini, Jan Gralla

 

> See the course evaluations

 

Faculty and participants of the 2nd ESO ESMINT ESNR Stroke Winter School in Bern
Faculty and participants of the 2nd ESO ESMINT ESNR Stroke Winter School in Bern

Neuro-Interventionalists training in the animal lab
Neuro-Interventionalists training in the animal lab

Prof. Gralla teaching neuro-interventionalists in the animal lab
Prof. Gralla teaching neuro-interventionalists in the animal lab

Neuro-Interventionalists training in the animal lab
Neuro-Interventionalists training in the animal lab

Neuro-Interventionalists training with the simulator
Neuro-Interventionalists training with the simulator

Neuro-Interventionalists training with the simulator
Neuro-Interventionalists training with the simulator

European Course In Minimally Invasive Neurological Therapy (ECMINT)
12 February, 2015 - 21:05

ECMINT 1.1 - Embolisation of Tumours and Arteriovenous Fistulas - was held at St Anne’s college, Oxford last December (2014). There was a truly international feel to the course with 41 students attending from 19 countries and a pan-European teaching faculty.

Students were subjected to ‘formative’ and ‘summative’ quizzes. The former are intended to help them consolidate the teaching and took place at the end of 2nd and 4th day of the course. The final summative quiz was held on the last day and included questions on the entire content of the taught curriculum. Thirty-nine students achieved scores over 60% despite the concern of several that the questions were too hard. Dr. Shelley Renowden, chairman of the ESMINT Training Committee, set the tests. She is standing back-centre in the picture below.  One of the highlights of the course was the conference dinner held in the great hall at Balliol College, Oxford, which looked as if it was the set for a “Harry Potter” film.

The next course in the program (ECMINT 1.2 – Aneurysms) will be in June 2015 and students who attended ECMINT 1.1 have been given the opportunity to register in advance of others. The number of places will be increased to 60. New students will be able to complete the 2 year program when this first course (Embolisation of Tumours and Arteriovenous Fistulas) is repeated in 2016.


Dr Viccy Young, INR Fellow

“A well organised, informative course at a great venue, with an excellent panel of speakers from across the field. The mixture of lectures and tutorials covered the topics thoroughly and provided the opportunity to take advantage of the vast experience of the speakers. I will certainly be attending the other parts of the course.”

 

Three positive thrombectomy trials presented at International Stroke Conference 2015 (Nashville, TN)
12 February, 2015 - 20:38

February 11, 2015 will be an important milestone in the history of Interventional Neuroradiology. Three positive trials (ESCAPE, EXTEND-IA, and SWIFT-PRIME) evaluating mechanical thrombectomy in acute ischemic stroke were presented under the applause of a large audience. Both ESCAPE and EXTEND-IA trials were published online in NEJM the day of ISC presentation (February 11, 2014).

The positive results of MR CLEAN presented at the World Stroke Conference in Istanbul in October 2014 was prompting the performance of interim analyses in several running RCTs evaluating mechanical thrombectomy (ESCAPE, EXTEND-IA, SWIFT-PRIME) that were all positive.

The ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times) trial (presented by Michael D Hill, Calgary, Canada) was interrupted after randomization of 315 patients. Inclusion criteria were NIHSS > 5, occlusion of the middle cerebral artery trunk and its immediate branches with or without ICA occlusion, small infarct core (ASPECT 6 to 10), moderate to good collaterals on CTA. Enrollment was possible up to 12 hours. The patients received rtPA if they were eligible for this treatment.

A total of 316 patients underwent randomization before the trial was stopped: 165 in the thrombectomy group and 150 in the control group (1 patient was excluded). About 75% of patients received IV rt-PA and  stent-retrievers were used in 86.1% of patients in the thrombectomy group. The adjusted risk ratio for a mRS shift with thrombectomy at 90 days was 3.1. A mRS of 0-2 at 90 days was observed in 53.0% in thrombectomy vs. 29.3% in controls (p<0.001). Mortality was significantly lower in intervention group (10.4%) compared to 19.0% in control group. All subgroups of patients had similar benefit, including the elderly.

The EXTEND-IA (EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy) trial (presented by Stephen M Davis, Parkville, Australia) was prematurely stopped because of a positive interim analysis of the first 70 randomized patients (35 in the intervention group and 35 in the control group). Patients were eligible if they could receive rt-PA within 4.5 hours after the onset of anterior circulation ischemic stroke and had occlusion of the internal carotid artery or of the first or second segment of the middle cerebral artery on CTA or MRA, to have received IV thrombolysis < 4.5 hours. CT perfusion imaging (use of the fully automated software RAPID) was used to identify potentially salvageable brain tissue. Endovascular therapy had to be initiated (groin puncture) within 6 hours after stroke onset and completed within 8 hours after onset.

A total of 70 patients were included in the trial (35 in intervention arm and 35 in IV rt-PA arm). All patients in the intervention group were treated with Solitaire. Early reperfusion of the ischemic tissue at 24h hours was 100% in intervention group vs. 37% in the control group (p<0.001). Early neurologic improvement  (NIHSS reduction ≥ 8 points or NIHSS 0-1 at 3 days) was 80% in intervention group vs 37% in the control group (p<0.001). mRS 0-2 at 90 days was 71% in thrombectomy patients and 40% in controls (p<0.01). There was a trend towards reduction of mortality (9% in intervention group; 20% in control group; p=0.18).

The SWIFT PRIME (Solitaire™ With the Intention For Thrombectomy as PRIMary treatment for acute ischemic strokE) trial (presented by Jeffrey L Saver) was prematurely stopped after a positive interim analysis of the first 196 patients. To be included, patients have to receive IV thrombolysis 4.5 hours after stroke onset, a NIHSS between 8 and 29, CTA or MRA confirmation of large vessel occlusion (intracranial internal carotid artery or M1 segment of the MCA), and an ASPECTS > 6.

As ESCAPE and EXTEND-IA, SWIFT-PRIME was prematurely halted due to positive interim analysis. A total of 196 patients were randomized, 98 in each group (intervention and IV rt-PA). In Intervention group, TICI 2b/3 was obtained in 88.0% of patients. The OR for a mRS shift at 90 days with thrombectomy using the Solitaire™ FR stent retriever was highly significant (p= 0.0002). Good functional outcome (mRS 0-2 at 90 days) was obtained in 60.2% in intervention group and 35.5% in IV rt-PA group (p < 0.001). Death at 90 days was 9.2% in intervention group and 12.4% in rt-PA group (p=0.5).
 
In summary, following the positive results of MR CLEAN, a further 3 positive trials have validated the use of mechanical thrombectomy for patients with acute ischemic stroke with large vessel occlusion in the anterior circulation. Indeed, these results will have a tremendous impact on the management of these patients and also on the organization of stroke care.

All investigators and sponsors of these trials should be congratulated for their tremendous work!

Laurent Pierot – Reims - France

References:

  1. Goyal, M., et al., Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med, 2015. [NEJM] [PDF]
  2. Campbell, B.C., et al., Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med, 2015. [NEJM] [PDF]
Season’s Greetings from ESMINT
24 December, 2014 - 11:20

Dear Colleagues, Friends, dear Members of the Society,

The ESMINT would like to take this opportunity to wish all members, families, friends and all collaborative partners Seasonal Greetings and best wishes for the New Year.

Five years have passed since the inauguration of our Society. Due to the meaningful work of all of you we grew from 100 to more than 500 members, we established a highly successful Annual Congress in Nice and managed to establish a strong and still growing cooperation with the neurosurgical and neurological communities in Europe. Our website is active and providing a worldwide unique service: the Device Directory.

The most significant recent milestone is the launch of ESMINT’s curriculum based, structured training in neurointerventional therapy. The first ECMINT course was held in Oxford this December, organized by the ESMINT Educational Committee (chaired by Dr. Shelley Renowden) and directed by Prof. James Byrne.

On behalf of the Executive Board, I would like to thank you very much for your support throughout 2014 and we look forward to an exciting and successful 2015.

Sincerely yours,

Istvan Szikora
President

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