TAST 2011 — Thrombolysis and Acute Stroke Treatment in 2011

Thursday, December 1, 2011 - Saturday, December 3, 2011

The New York Academy of Sciences

Presented By

Presented by the New York Academy of Sciences

Designed to serve a multidisciplinary audience of physicians, clinicians, and scientists interested in cerebrovascular disease, this 2.5-day conference will explore the state-of-the-art and future directions of research and clinical practice leading to enhanced medical care in the acute treatment of ischemic stroke.

The majority of strokes are due to thrombotic or thromboembolic blockage of an artery supplying the brain. Prompt treatment with thrombolytic agents can restore blood flow, limiting brain damage and improving recovery prognosis after ischemic stroke. Use of thrombolytic agents, including recombinant tissue-type plasminogen activator (rt-PA), over the past thirty years has enhanced patient outcomes, but has also highlighted many other aspects of the medical setting that impact treatment success. This symposium will explore these facets of acute intervention and a number of unaddressed issues related to the medical setting of stroke that provide opportunities for improving treatment. Following on ten previous international symposia on the theme of thrombolytic treatment in acute ischemic stroke (i.e. TTAST, TAST), the New York Academy of Sciences is proud to undertake the 11th meeting in this series (TAST 2011) to focus on these issues.

The program will feature keynote and plenary lectures, short oral and poster presentations selected from abstract submissions, a mini-symposium, and a hands-on workshop on Advanced Multi-modal Neuroimaging and Ultrasound Techniques. There will be multiple opportunities for audience and panel discussion. Speakers will be asked to respond to sets of questions during their presentations to foster the generation of data-driven, multidisciplinary ideas, to explore ischemic stroke as a systemic disease related to other disease entities (hypertension, diabetes, and disorders of aging), and to better address the evolution of ischemic brain injury.

Highlighted topics include: (i) the neurovascular unit and its injury; (ii) the safety and efficacy of thrombolytic agents currently used or being developed for acute stroke treatment; (iii) new views of the penumbra; (iv) time window considerations and optimized delivery conditions; (v) stabilization of brain tissue for patient recovery; (vi) enhancing the safety of plasminogen activators; (vii) factors that influence risk and benefit; and (viii) alternative approaches in stroke treatment.

Live Webinar for Session II

Session II: Clinical Management of Medical Issues in the Acute Setting will be broadcast via live webinar on December 2nd, 2:00–5:20 pm. You can register for this webinar by clicking the Register for Webinar link, above.

Registration Pricing

	By: 11/30/2011	Onsite: 12/01/2011
Member	$350	$450
Student / Postdoc / Fellow Member	$175	$225
Student / Postdoc / Fellow Nonmember	$175	$225
Nonmember Corporate	$575	$675
Nonmember Not for Profit	$450	$550

Registration for the conference includes the option to RSVP for the satellite workshop preceding the scientific sessions on December 1, 2011 from 1–5 pm, Advanced Multi-modal Neuroimaging and Ultrasound Approaches to Hyperacute Stroke Diagnosis, Treatment, and Monitoring, at no extra cost.

Participants interested in this workshop only may register to attend only this satellite session at www.nyas.org/tast2011workshop.

Scientific Co-Organizers

Gregory J. del Zoppo, MD

University of Washington School of Medicine

Andrei V. Alexandrov, MD

University of Alabama at Birmingham

Scientific Advisory Committee

Etsuro Mori, MD, PhD

Tohoku University

Markku Kaste, MD, PhD

Helsinki University

John R. Marler, MD

Rockville, MD

International Advisory Board

Gudrun Boysen, MD

University of Copenhagen

Thomas G. Brott, MD

The Mayo Clinic

Alastair Buchan

University of Oxford

László Csiba, MD, PhD

University of Debrecen

Steven M. Davis, MD

University of Melbourne

Andrew Demchuk, MD

University of Calgary

Geoffrey Donnan, MD

Florey Neuroscience Institutes

Werner Hacke, MD, PhD

University of Heidelberg

Karsten Overgaard, MD

University Hospital of Copenhagen, Gentofte Hospital

Shirley Otis, MD

Scripps Clinic–La Jolla

Paul Trouillas, MD

Hôpital Neurologique

Lawrence Wong, MD, FRCP

Chinese University of Hong Kong

Take Yamaguchi, MD

National Cardiovascular Center

This meeting is part of our Translational Medicine Initiative, sponsored by the Josiah Macy Jr. Foundation and The Mushett Family Foundation.

For a full list of sponsors, please view the Sponsors tab.

Agenda

* Presentation times are subject to change.

Day 1: Thursday, December 1, 2011
SATELLITE WORKSHOP
Advanced Multi-modal Neuroimaging and Ultrasound Approaches to Hyperacute Stroke Diagnosis, Treatment, and Monitoring (Optional) * * Registration for this workshop is included in the conference registration; if you wish to register for this workshop only, visit www.nyas.org/tast2011workshop
12:30 PM	Registration
Tutorial Session
1:00 PM	Advanced Multimodal CT/MRI Approaches to Hyperacute Stroke Diagnosis, Treatment and Monitoring David S. Liebeskind, MD, University of California at Los Angeles
1:45 PM	Multimodal Neuroimaging: Ultrasound and Catheter Angiography (including a 10-minute demo) Andrei V. Alexandrov, MD, University of Alabama Hospital, Birmingham
Hands-on Demonstrations
2:30 PM	Ultrasound examination and monitoring demonstrations provided by: • CareFusion • Multigon Industries, Inc. • Others TBD
Case / Interactive Problem-solving Session
3:30 PM	5 cases studies (Using Audience Response System)
5:00 PM	Workshop Concludes
CONFERENCE
4:30 PM	Registration Conference and Poster Set-up
5:30 PM	Opening Remarks Brooke Grindlinger, PhD, The New York Academy of Sciences Gregory J. del Zoppo, MD, University of Washington Andrei V. Alexandrov, MD, University of Alabama at Birmingham
6:00 PM	Keynote Address 1 Acute Treatment of Stroke in Ten Years; How It Will Be Different Antoine M. Hakim, MD, PhD, University of Ottawa
6:50 PM	Reception and Poster Viewing
8:20 PM	Day 1 Concludes
Day 2: Friday, December 2, 2011
7:30 AM	Registration, Breakfast, and Poster Viewing
Session I: The Science of Acute Stroke Intervention
Session Chairs: Gregory J. del Zoppo, MD, University of Washington and Wolf-Dieter Heiss, MD, Max-Planck Institute, Cologne
8:30 AM	Introduction Chair / Co-chair
8:40 AM	Population Risk Changes: Forecasts and Speculation About the Future of Stroke George Howard, PhD, University of Alabama School of Public Health
9:00 AM	Pathophysiologically Targeted Therapy of Acute Stroke: Brain And Beyond Ulrich Dirnagl, MD, Center for Stroke Research, Berlin
9:20 AM	The Penumbra: How Does Tissue Injury Evolve? Wolf-Dieter Heiss, MD, Max-Planck Institute for Neurological Research
9:40 AM	How Early Tissue Injury and Intervention Promote Tissue Recovery Eng H. Lo, PhD, Massachusetts General Hospital
10:00 AM	Coffee Break and Poster Viewing
10:30 AM	Panel Discussion Session I — all session speakers
Data Blitz Session — Hot Topic/Updates
11:00 AM	Current Treatment of Basilar Occlusion Perttu Lindsberg, MD, PhD, Helsinki University Central Hospital
	Basilar Artery Occlusion: Time for a Randomised Trial? Wouter Schonewille, MD, University Medical Center Utrecht
	Third International Stroke Trial of Intravenous Thrombolysis With iv rtPA in Acute Ischaemic Stroke: Baseline Characteristics of the 3035 Patients Randomised Gord Gubitz, MD, Dalhousie University
12:00 PM	Networking Lunch and Poster Viewing
Lunchtime Workshop: How to Make Acute Intervention More Widely Available
1:00 PM	Improving Public Education and Reaction to Stroke Symptoms Mark J. Alberts, MD, Northwestern University Feinberg School of Medicine
1:15 PM	How to Organize Pre-Hospital Services to Save Time William G. Barsan, MD, University of Michigan Hospital
1:30 PM	How to Organize the ER to Save Time Edward C. Jauch, MD, MS, FAHA, FACEP, Medical University of South Carolina
1:45 PM	Panel Discussion
Session II: Clinical Management of Medical Issues in the Acute Setting
This session will be broadcast via live webinar on December 2. Click here to register. Session Chairs: Etsuro Mori, MD, PhD, Tohoku University and Geoffrey A. Donnan, MD, FRACP FRCP, Florey Neuroscience Institutes
2:00 PM	Introduction Chair / Co-Chair: Optimization of Patient Selection — Clinical Ramifications
2:10 PM	Optimization of Patient Selection — Acute Image Acquisition and Relation to Pathophysiology Andrew Demchuk, MD, University of Calgary
2:30 PM	Hyperglycemia and Ischemic Stroke: The SHINE Trial Karen C. Johnston, MD, MSc, University of Virginia
2:50 PM	Tissue Injury and Cerebral Blood Flow — the Case for Neuroprotection Alastair Buchan, MD, University of Oxford, Oxford
3:10 PM	Combined Intravenous — Intra-Arterial Treatment Approaches: IMS3 Joseph P. Broderick, MD, University of Cincinnati
3:30 PM	Enhancing the Use of Thrombolysis Geoffrey A. Donnan, MD, FRACP, FRCP, Florey Neuroscience Institutes
3:50 PM	Treatment of Acute Ischemic Stroke: Systemic or Local? Rüdiger von Kummer, MD, PhD, Technische Universität Dresden, Germany
4:20 PM	Coffee Break and Poster Viewing
4:50 PM	Panel Discussion Session II — all session speakers
5:20 PM	Keynote Address 2 How Baseline Severity Affects Safety and Efficacy Outcomes in Acute Intervention Trials Philip B. Gorelick, MD, MPH, University of Illinois at Chicago
6:10 PM	Day 2 Concludes
Day 3: Saturday, December 3, 2011
7:30 AM	Registration, Breakfast, and Poster Viewing
Session III: Evolution of Tissue Injury
Session Chairs: Markku Kaste, MD, PhD, Helsinki University and Werner Hacke, MD, PhD, University of Heidelberg
8:30 AM	Introduction Chair / Co-chair
8:40 AM	Unexpected Roles of Glia in Acute Ischemic Injury Maiken Nedergaard, MD, PhD, University of Rochester Medical School
9:00 AM	Does Inhibiting SURI Complement rtPA in Cerebral Ischemia? J. Marc Simard, MD, PhD, University of Maryland School of Medicine, Baltimore
9:20 AM	Safety and Efficacy of 0.6mg/kg rt-PA — Optimum rt-PA Dose Revisited Etsuro Mori, MD, PhD, Tohoku University Graduate School of Medicine
9:40 AM	Ancillary Approaches to Plasminogen Activators Andrei V. Alexandrov, MD, University of Alabama Hospital
10:00 AM	Selection of Treatment Responders: Only for the Late Time Window? Werner Hacke, MD, PhD, University of Heidelberg
10:20 AM	Coffee Break and Poster Viewing
10:50 AM	Panel Discussion Session III — all session speakers
11:20 AM	Keynote Address 3 Aging and the Integrity of the Neurovascular Unit Gregory J. del Zoppo, MD, University of Washington
12:10 PM	Networking Lunch and Poster Viewing
12:50 PM	Poster Session
Data Blitz Session — Hot Topics/Updates
1:50 PM	Aspects on Pretreatment Diffusion Weighted Imaging for Intravenous rt-PA Therapy: Samurai rt-PA Registry Masatoshi Koga, MD, National Cerebral and Cardiovascular Center
	Impact of Collateral Perfusion Augmentation in Select Groups of Acute Ischemic Stroke Patients Stefan Schwab, MD, University Clinic Erlangen
	Endovascular Therapy in Young Acute Ischemic Stroke Patients and The Role of Intra-Arterial Vasodilators in the Process of Recanalization Ziad El-Zammar, MD, MRCP, SUNY Upstate Medical University
Session IV: Conditions of Agent Delivery and Its Optimization
Session Chairs: John Marler, MD, Rockville, MD, and Thomas G. Brott, MD, The Mayo Clinic
2:50 PM	Introduction Chair / Co-Chair: Summary of Clinical Trial Outcomes (What Haven't we Learned?)
3:00 PM	Rationale For The Timing Of Treatment James C. Grotta, MD, University of Texas Medical School at Houston
3:20 PM	Intersection of Pre- and In-hospital Care of Stroke Markku Kaste, MD, PhD, Helsinki University Central Hospital
3:40 PM	Intracranial Arterial Topography and Fragility as Barriers to Endovascular Intervention Thomas G. Brott, MD, The Mayo Clinic
4:00 PM	Paths Forward: When Old Data is Not Enough John Marler, MD, Rockville, MD
4:20 PM	Panel Discussion Session IV — all session speakers
4:50 PM	Closing Remarks
5:15 PM	Conference Concludes

Keynote Speakers

Gregory J. del Zoppo, MD

University of Washington

Philip B. Gorelick, MD, MPH

University of Illinios at Chicago

Antoine M. Hakim, MD, PhD

University of Ottawa

Speakers

Mark J. Alberts, MD

Northwestern University Feinberg School of Medicine

Andrei V. Alexandrov, MD

University of Alabama at Birmingham

William G. Barsan, MD

University of Michigan Hospital

Joseph P. Broderick, MD

University of Cincinnati

Thomas G. Brott, MD

The Mayo Clinic

Alastair Buchan, MD

University of Oxford, Oxford

Andrew Demchuk, MD

University of Calgary

Ulrich Dirnagl, MD

Center for Stroke Research, Berlin

Geoffrey A. Donnan, MD, FRACP, FRCP

Florey Neuroscience Institutes

James C. Grotta, MD

University of Texas Medical School at Houston

Werner Hacke, MD, PhD

University of Heidelberg

Wolf-Dieter Heiss, MD

Max-Planck Institute for Neurological Research

George Howard, PhD

University of Alabama School of Public Health

Edward C. Jauch, MD, MS, FAHA, FACEP

Medical University of South Carolina

Karen C. Johnston, MD

University of Virginia

Markku Kaste, MD, PhD

Helsinki University Central Hospital

David S. Liebeskind, MD

University of California at Los Angeles

Eng H. Lo, PhD

Massachusetts General Hospital

John R. Marler, MD

Rockville, MD

Etsuro Mori, MD, PhD

Tohoku University Graduate School of Medicine

Maiken Nedergaard, MD, DMSc

University of Rochester Medical School

J. Marc Simard, MD, PhD

University of Maryland School of Medicine

Rüdiger von Kummer, MD, PhD

Technische Universität Dresden

Thursday, December 1

Satellite Workshop

Multimodal Neuroimaging: Ultrasound and Catheter Angiography
Andrei V. Alexandrov, MD, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham

Transcranial Doppler (TCD) and portable carotid duplex ultrasound aid neurological examination at bedside. These tests help determine pathogenic mechanism of stroke including occlusion location, stenosis severity, recanalization, re-occlusion, hyperperfusion, embolization, right-to-left shunting, collaterals, vasomotor reactivity, and intracranial steal.

Systemic administration of tissue plasminogen activator (tPA) remains the fastest way to initiate treatment for acute ischemic stroke. Since tPA works by induction of partial recanalization of large thrombi, early augmentation of fibrinolysis to improve recanalization is desirable. This augmentation is feasible and can be safely achieved at bedside with 2 MHz pulsed wave Doppler. Transcranial ultrasound delivery in an operator-independent and dose-controlled manner has been successfully tested in healthy volunteers and tPA treated patients (Barlinn K, et al. ISC 2011, Barretto A, et al. ISC 2012).

Catheter angiography and intra-arterial (IA) reperfusion procedures are in continuing development. Compared to IA, iv tPA has lower revascularization rates, yet patients treated with systemic thrombolysis achieve favorable functional outcomes likely due to earlier treatment initiation. Currently, no evidence exists that primary intra-arterial (IA) revascularization could be any better than systemic tPA within the 3 hour time window. Ongoing IMS-3 trial will answer the question whether bridging iv-tPA-IA protocol is any better than systemic tPA alone. Newest technologies like stenting or stentrievers (SARIS, SWIFT trials) offer faster recanalization, and thus have a potential to decrease onset-to-treatment time. In turn, fast endovascular procedures may provide an alternative to systemic tPA, and they should be compared in a randomized trial of a device vs standard of care.

Advanced Multimodal CT/MRI Approaches to Hyperacute Stroke Diagnosis, Treatment and Monitoring
David S. Liebeskind, MD, University of California at Los Angeles

Multimodal CT/MRI, including parenchymal details, noninvasive angiography and perfusion maps, can chronicle the detailed pathophysiology of acute stroke to establish ischemic and hemorrhagic diagnoses, refine treatment, and monitor evolution of neurovascular injury that impacts subsequent neurological outcomes. These advanced multimodal CT/MRI techniques may chronicle hematoma expansion in acute hemorrhagic stroke and measure recanalization or opening of proximal arteries in ischemic stroke, and reperfusion of downstream territory and neurovascular consequences of ischemia/reperfusion including blood-brain barrier disruption, hemorrhage, infarction and edema. Recanalization and reperfusion are distinct and although related, may occur discordantly. Serial imaging with multimodal CT/MRI may now be used to document quantitative degrees of recanalization and reperfusion with standardized scales and processing algorithms that facilitate use of these surrogate imaging measures from trials to routine clinical practice. These imaging biomarkers provide the most rational link for translation of stroke treatment in animals to phased clinical trials, registries, and eventual clinical practice. Serial or repeat imaging with the same modality in a particular case may depict the dynamic nature of collateral perfusion, recanalization, and reperfusion. These commonly available imaging tools have markedly expanded our knowledge of ischemic pathophysiology in the cerebral circulation and enabled the study of mechanisms for various therapeutic interventions.

Conference

Keynote Address 1: Acute Treatment of Stroke in Ten Years — How it Will Be Different
Antoine M. Hakim, MD, PhD, University of Ottawa

Thrombolysis has been a major game-changer in stroke care. The NINDS trial published in 1995 showed that patients treated with rt-PA within 3 hours of stroke onset were at least 30% more likely to have minimal or no disability at 3 months. But this landmark study presented a challenge, namely, to take advantage of this therapy required that patients be educated on signs and symptoms of stroke, learn to react to them by calling trained paramedics, who in turn had to treat stroke as an extreme emergency, confirm the diagnosis on site, transport the patient to a pre-selected hospital where a stroke team and at least CT imaging were always available, and the drug could be administered safely. Ideally, the patient was then received in a Stroke Unit for further evaluation and institution of secondary prevention measures to avoid recurrence.

In 2008, an audit in the United Kingdom estimated that 15% of all stroke patients may be eligible to receive rt-PA but only 1% received it. In the best organized jurisdictions currently, approximately 15% of patients arriving to the Emergency Room within 2.5 hours of stroke onset receive rt-PA when the theoretical maximum may be closer to 50%. The factors contributing to these gaps will be discussed based on the results of the 2011 Audit conducted by the Canadian Stroke Network. Additional means to increase the rate of thrombolysis may include: extending the therapeutic time window, combining thrombolysis with neuroprotection, but the most immediate approach is likely maximizing patient access to the drug through the widespread use of Telestroke. These and other measures, and their likelihood in the next 10 years, will be reviewed.

Travel & Lodging

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212.298.8600

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Phone: 212.577.1133

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Use Club Quarters Reservation Password NYAS to reserve your discounted accommodations online.

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Wall Street Inn	212.747.1500
Ritz-Carlton New York, Battery Park	212.344.0800

Special Needs and Additional Information

For any additional information and for special needs, including child/family care resources available to conference attendees, please e-mail dvollmer@nyas.org or call Deanna Vollmer at 212.298.8611.

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TAST 2011 — Thrombolysis and Acute Stroke Treatment in 2011

Live Webinar for Session II

Registration Pricing

Scientific Co-Organizers

Gregory J. del Zoppo, MD

Andrei V. Alexandrov, MD

Scientific Advisory Committee

Etsuro Mori, MD, PhD

Markku Kaste, MD, PhD

John R. Marler, MD

International Advisory Board

Gudrun Boysen, MD

Thomas G. Brott, MD

Alastair Buchan

László Csiba, MD, PhD

Steven M. Davis, MD

Andrew Demchuk, MD

Geoffrey Donnan, MD

Werner Hacke, MD, PhD

Karsten Overgaard, MD

Shirley Otis, MD

Paul Trouillas, MD

Lawrence Wong, MD, FRCP

Take Yamaguchi, MD

Agenda

Day 1: Thursday, December 1, 2011

SATELLITE WORKSHOP

Tutorial Session

Hands-on Demonstrations

Case / Interactive Problem-solving Session

CONFERENCE

Day 2: Friday, December 2, 2011

Session I: The Science of Acute Stroke Intervention

Data Blitz Session — Hot Topic/Updates

Lunchtime Workshop: How to Make Acute Intervention More Widely Available