A series of debates tested expert response to current acute stroke controversies during the final day of the Charing Cross (CX) 2021 Digital Edition (19–22 April, online). A major talking point at the Acute Stroke Controversies session was the use of intravenous thrombolysis for the treatment of basilar thrombosis—with 58% of attendees voting that the procedure is favoured over thrombectomy for the majority of patients.
The session heard arguments for and against the technique, with Wouter Schonewille (Utrecht, The Netherlands) presenting evidence that endovascular thrombectomy should be limited to patients with a moderate to severe deficit. Shelley Renowden (Bristol, UK) argued that outcomes in basilar artery occlusion depend on a number of factors, chiefly the degree of and speed to recanalisation, which she said is “undoubtedly superior” with mechanical thrombectomy, using new thrombectomy devices.
She emphasised that thrombectomy in addition to standard medical treatment, compared to standard medical treatment alone is more effective in basilar artery occlusions in those with NIHSS of 10 or higher, within 6–8 hours of onset.
In an earlier session, which tackled Carotid Endarterectomy and Stenting Controversies, polling suggested that a majority believe that stenting should be only considered in the extracranial vertebral arteries—and not the intracranial arteries. Andrew Clifton (London, UK) and Thomas Liebig (Munich, Germany) argued the motion, with 64% of the audience siding with Clifton, who claimed that previous clinical trials have demonstrated “no statistically-significant benefit” to extracranial or intracranial stenting in preventing recurrent stroke, noting that he could not advocate intracranial stenting.
Peter Schneider (San Francisco, USA) and Alun Davies (London, UK) also contested the issue of safety and effectiveness in carotid artery stenting in asymptomatic patients. Despite Schneider’s assertion that there is “no evidence” medical management alone is adequate for lesions that would currently be considered for repair, the CX audience ultimately sided with Davies—with 85% voting against the motion ‘Carotid artery stenting in asymptomatic patients is safe and effective’.
In a further poll found, 79% of attendees could not back the motion that local anaesthesia is safer than general anaesthesia for carotid endarterectomy. Gert Jan de Borst (Utrecht, The Netherlands), aruging against the motion, claimed that evidence to suggest local anaesthesia is safer is inconclusive