Ep. 558 Advancements in Stroke Thrombectomy: Techniques & Training with Dr. Blaise Baxter and Dr. James Milburn

BackTable Vascular & Interventional

Are your current stroke interventions in line with the latest clinical data? Dr. Blaise Baxter, interventional radiologist at Sutter Health, and Dr. Jim Milburn, interventional neuroradiologist at the Ochsner Health, join host Dr. Michael Barraza to discuss the latest advancements in stroke interventions.

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This podcast is supported by:

Imperative Care
https://imperativecare.com/stroke/zoom-stroke-solution/

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SYNPOSIS

The episode begins with a discussion on the different pathways to becoming a neurointerventionalist, emphasizing why interventional radiologists are uniquely equipped for this transition. They dive into cutting-edge stroke interventions, sharing key takeaways from major trials on large core and medium vessel occlusions. Dr. Baxter and Dr. Milburn highlight the HERMES trial, which showed that endovascular thrombectomy led to beneficial effects on patients with anterior circulation occlusion. They then cover the BAOCHE trial, which showed better functional outcomes with thrombectomy over medical therapy.

Milburn and Baxter also share their perspectives on the shifting role of perfusion imaging and why the field may be moving beyond it. To close the discussion, the doctors underscore the powerful impact of rehabilitation in driving patient recovery, and stress the ongoing need for innovation and improved training in the field of neurointerventional radiology.

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TIMESTAMPS

00:00 - Introduction
06:18 - Training and Certification in Neurointervention
13:11- Large Core Trials and Their Impact
19:42 - CT Perfusion and Treatment Decisions
29:45 - Understanding Stroke Scale Scores and ICAD
30:31 - Thrombectomy Trials and Treatment Strategies
34:48 - Challenges in Randomizing Patients for Trials
44:25 - Advancements in Robotics and Stroke Treatment
51:37 - Future Directions in Stroke Rehabilitation
53:11 - Global Thrombectomy Adoption and Training

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RESOURCES

Hermes trial: Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X

BAOCH trial: Jovin TG, Li C, Wu L, et al. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med. 2022;387(15):1373-1384. doi:10.1056/NEJMoa2207576