Is penumbral imaging mandatory for potential thrombectomy in patients arriving beyond six hours? Capsule: There is general agreement amongst stroke experts that patient selection is essential for successful thrombectomy. The introduction of penumbral imaging may allow for improved patient evaluation but comes at a higher cost. Is there sufficient evidence that such imaging is made mandatory prior to initiation of treatment? Host: Joanna Wojczal, Poland CT is enough: Ashfaq Shuaib, Canada In the presence of CMBs, antithombotic therapy should be avoided. Host: David Werring, UK No: Laszlo Csiba, Hungary
Mobile stroke units are useful and cost effective. Capsule: IV tPA was approved as an effective treatment for acute ischemic stroke ( AIS) within 4.5 hours more than 20 years ago. It also was shown that the sooner the tPA is administered the better are the chances of beneficial outcome – “Time is Brain". Therefore, MSUs with CT scan were introduced with the ability to give tPA in the ambulance and by that to save time. It is still an unsettled issue whether MSUs actually have an impact on patient’s outcome and are cost effective. This debate will try to shade light on this controversial issue. No: Krassen Nedeltchev, Switzerland Should TIA patients be routinely treated with both ASA and clopidogrel Host: Agnieszka Słowik, Poland No: David Spence, Canada
Should symptomatic extracranial vertebral artery stenosis be stented? Capsule: Stenosis in the vertebro-basilar system accounts for about a quarter of all posterior circulation strokes. The risk profile is similar to that seen for carotid stenosis. Recent phase 2 trials have shown that extracranial vertebral stenosis can be stented with low risk but whether this reduces recurrent stroke risk compared with best medical therapy alone remains controversial. The debate will consider whether based on current evidence stenting should be recommended for recently symptomatic extracranial vertebral artery stenosis. Yes: Laszlo Csiba, Hungary No: Hrvoje Hecimovic, Croatia
Do DWI negative strokes exist? Capsule: Stroke is a clinical entity. Its exact identification is crucial as therapeutic options nowadays are associated with some risks. DWI MRI is considered the best imaging technique for the confirmation of acute ischemic stroke (AIS). it’s sensitivity, however, is not perfect, with debatable underlying reasons, raising the question do AIS with negative DWI imaging really exist. Host: Adrian Perry-Jones, UK Yes: Jonathan Streifler, Israel No: Krassen Nedeltchev, Switzerland Should all patients with ESUS be anticoagulated? Host: Natan Bornstein, Israel Yes: David Spence, Canada No: Jonathan Streifler, Israel
Should statins be given to people over age 80 for stroke prevention? Capsule: There is considerable evidence that the use of statins results in a reduction of cardiovascular morbidity and mortality. Long-term treatment with statins can lead to side effects including muscle and liver damage. Clinical trials evaluating the efficacy of statins have mostly enrolled subjects less than 75 years of age. Can we extrapolate the evidence to older individuals in whom the risk for side-effects may be higher? Host: Ashfaq Shuaib, Canada Yes: David Spence, Canada No: Vida Demarin, Croatia
Does the main benefit of AIS come from tPA or stroke unit care? Capsule: The presence of a dedicated stroke unit allows for the management of all patients with suspected AIS. Treatment with tPA can only be offered to a smaller subset of AIS patients but the improvement in some treated patients can be very significant. In an era of limited resources, such we focus on ensuring that all AIS patients be admitted to a stroke unit or recommend develop of fast triage methods for timely thrombolysis? Host: Agnieszka Słowik, Poland Stroke unit: Ashfaq Shuaib, Canada Is there a role for neurosurgery in intracerebral hemorrhage?