With the 2016 International Stroke Conference off to a great start, we took the opportunity to sit down with Dr Albert Favate, MD, division chief of vascular neurology and co-Director of the Comprehensive Stroke Care Center at NYU Langone Medical Center and member of Neurology Advisor’s Editorial Advisory Board to discuss hot topics in stroke care and patient management.
Neurology Advisor: Last year, results from MR CLEAN, EXTEND-IA, ESCAPE, and SWIFT PRIME dominated the headlines with insights on endovascular therapy. What topic do you expect to be a major research focus this year?
Dr Albert Favate: Major interventional trials have proven that combined IV tPA and intra-arterial intervention are in fact now standard of care treatments in the paradigm of the acute stroke scenario. Now, I believe further attention is being paid to the rapid recognition and appropriate triage of stroke patients to tertiary centers within the optimal treatment time window.
NA: Are there any particular sessions taking place this year that you feel are a must-go for stroke specialists?
Dr Favate: The plenary sessions are always important to attend, however this year’s basic science sessions include significant research in stroke pathophysiology. There is also important research concerning markers in stroke, further understanding of the ischemic penumbra, and developments in neuroprotection. Discussions on where stroke management will be in the next 5 to 10 years are also beneficial to attend.
Other areas of increased attention are cognitive impairment in stroke and the prevention of stroke-related dementia, as well as endovascular intervention in pediatric stroke. This is particularly interesting as pediatric stroke is not frequently identified early in clinical course, and I am personally interested in hearing about how other stroke networks identify this patient subgroup, new protocols, and developments in pediatric-sized vessel instrumentation.
NA: Time to treatment vs quality of care will be debated at the meeting. What do you think the general sentiment is on this? Are there currently solutions underway to help facilitate this decision?
Dr Favate: Recognition and triage in the field with transport to a primary, bypass primary, or tertiary center can impact the care we provide to stroke patients. This challenge is being addressed by placing an emphasis on the development of telestroke systems used in the field and education of emergency medical technician/paramedic personnel in fast stroke scale tools to help determine appropriate triage to a tertiary center. This is a topic fueled by emotion as it has the potential to have an unfavorable effect on outcome metrics for stroke teams.
A major quality marker for stroke teams is if quality care with favorable metrics is being provided, in both time measures and outcomes. The American Heart Association’s “Get With The Guidelines” program is a useful tool for this and will be emphasized at the conference.
NA: What do you think is the greatest clinical challenge or obstacle facing stroke specialists today?
Dr Favate: The most critical issue facing the stroke subspecialty is efficient management with good outcomes. The amount of funding to develop new protocols, new instruments, and stroke education are well worth paying attention to. The stroke center operation is data driven and is evolving at a fast pace, however this necessitates growth with more allied health professionals and data management and statistical personnel.
However, I think two big questions need to be addressed: Are we as stroke specialists in control of allocated funding for our respective stroke programs? And is the quality process over-burdening the cost structure of stroke programs?
NA: What regulatory or practice management issues are neurologist stroke specialists currently facing?
Dr Favate: As the number of stroke centers continues to blossom across the U.S., there will be a need to control the number of stroke centers in a geographic location based on population. More importantly, regulation may lead to a lower cost of providing stroke care, as an increased number of strokes will lead to better management outcomes. Stroke neurologists need to be aware that as stroke metrics drive improvement in patient outcomes, this may lead to increasing control of stroke center location in a consumer-driven market. Stroke centers caring for stroke patients with multiple morbidities influence outcomes and must be weighted accordingly. As a result of this, some centers may not receive federal and/or state funding due to location or bad outcomes.
For more coverage of ISC 2016, go here.