Come and join us across the globe
The fourth edition of the World AVM Congress , organized by Dr. Jean Raymond and Dr. Daniel Roy, welcomed over 400 enthusiastic participants from all over the world. Three full congress days dedicated to a single vascular disease allowed the audience to gain plenty of knowledge from different faculties.
Drs. Mounayer and Chapot showed their different approaches to the vein access to endovascular management for AVMs. This route was clearly one of the stars of the meeting, with promising results for occlusion and curative rates for the disease. Nevertheless, it is a technique that requires good indications, training and mastery of in embolization therapies.
Early in the mornings, during breakfast meetings, Dr. Rodesh, Dr. Spetzler and Dr. Lawton gave wonderful lectures about vascular anatomy and shared their experience with spinal and posterior fossa vascular malformations. Basic sciences figure prominently in the meeting; interesting research studies were presented about AVM genetics, vascular triggers and possible targets for future medical treatments. Imaging modalities also were presented and discussed. 4D angiographic images and fusion seem to be great tools for the new treatment routes and AVM understanding.
Dr. Spetzler and Dr. Lawton demonstrated their great experience and results in surgical management in brain, posterior fossa and spinal AVMs, showing that training, dedication and teamwork do lead to excellent results and outcomes for patients. It was also an opportunity to hear the tributes for the pioneers of the specialty and AVM management such as Drs. Picard, Kerber, Lownie, Spetzler, Dion and Berenstein. Morbi Mortality reviews were done in a very educational and didactic way by Dr. Boccardi, which offered participants a very enlightening way of learning do’s and don’ts in the management of AVMs.
Finally, there was a lively discussion and debate about how the community should perform their clinical activity based on the best evidence available, and if there is space for other levels of studies other than randomized control trials. Ongoing trials like MARS or TOBAS could give future new perspectives and evidence on the management of unruptured AVMs.
The eleventh World Stroke Congress was attended by no fewer than 2,600 participants, gathering numerous specialists from all over the world. For attendees, it was a fantastic opportunity to hear the latest about a disease that has been growing consistently in the last few years, especially after the strong evidence of RCT in mechanical thrombectomy (MT). MT was widely discussed and presented during the meeting. We got to hear the experiences from several places with different realities: USA, Canada, Australia, France, Singapore, Brazil and others.
The current dilemma is how to bring patients to a capable center faster and adequately treat the stroke: solutions could come from novel apps and algorithms, adequate neurological scales, advanced stroke mobile units, or organization rationale for better care. Several speakers discussed how to establish a stroke care program. In developing countries, this could be a critical issue, moreover when reimbursement of health treatment costs is still not available in many of them.
Moreover, thrombectomy has been shown to be cost-effective in several countries and health systems, like England, Spain and now with an ongoing trial in Brazil. So, these data will be very helpful for so many places that have been struggling with advanced stroke care implementation. Images are now a big part of the treatment chain in stroke.
How to study a stroke was debated in several lectures: how to use advanced images and their usefulness, the role of automated software, and how to study a patient in late window or after recanalization.
Furthermore, who should perform thrombectomies was a hot discussion: the need for more dedicated doctors is a reality and an urgent need in many places. Thus, the optimal way of training, volume and places is still a matter of debate.
A recent publication has calculated 15-20 endovascular thrombectomies per 100.000 habitants, which will represent a big challenge for INR teams in the near future. Several trial results were also revealed during this congress, such as BEST for posterior circulation strokes, which showed no significant differences between EVT and the medical group, demonstrating that the benefits in this territory are still unclear.
Finally, the WSO Award for Stroke Services was presented to a South American doctor, Dr. Sheila Martins from Porto Alegre, Brazil, for her great dedication and work for stroke treatment development in her country. She makes us all proud and is an example to all of us.
Rodrigo Rivera MD
26th October, 2018
Santiago, Chile