Here are the show notes for the StrokeFM episode covering the SVIN 2021 meeting.In this episode of StrokeFM, host Dr. Houman Khosravani sits down with Dr. Ameer Hassan, the President of the Society of Vascular and Interventional Neurology (SVIN), to discuss the major takeaways from the SVIN 2021 Annual Meeting in Phoenix, Arizona.Dr. Hassan shares critical updates on clinical trials, his personal philosophy on bridging therapy versus direct-to-angio, and the nuance of managing intracranial atherosclerotic disease (ICAD).Dr. Ameer Hassan, DO, FAHA, FSVINHead of the Neuroscience Department at Valley Baptist Medical CenterProfessor of Neurology and Radiology at the University of Texas Rio Grande ValleyPresident of SVINDr. Hassan provided a rundown of the pivotal trials presented or discussed at the meeting:Subdural Hematoma Embolization: The SQUID trial (sponsored by Balt) and the EMBOLISE trial (sponsored by Medtronic) are investigating the embolization of the middle meningeal artery for chronic and acute-on-chronic subdurals.Large Core Infarcts: The TESLA trial (PI Dr. Sam Zaidat) is moving forward, looking at thrombectomy in patients with large core infarcts, similar to the SELECT2 and IN EXTREMIS trials. The goal is to be more inclusive with mechanical thrombectomy.Bridging vs. Direct: The SWIFT DIRECT trial showed no statistical difference between direct-to-cath lab versus bridging lytics.AURORA Analysis: Confirmed that treating endovascular patients is safe, though the "number needed to treat" suggests patient selection (collaterals and salvageable tissue) remains vital.Dr. Hassan advocates for individualized medicine rather than a blanket policy.Scenario A: If the angio suite is empty and the team is ready, he takes the patient straight to the cath lab.Scenario B: If there is a delay (e.g., room occupied) or the patient requires transfer, he utilizes IV thrombolytics (TNK or Alteplase).Rationale: "Time is brain." If you can't cut immediately, lytics provide a bridge.Dr. Hassan discussed the risks of aggravating ulcerated plaque during acute interventions.Acute Stenting: Data suggests acute stenting is relatively safe, but Dr. Hassan prefers angioplasty first for ICAD.The "Wait and See" Approach: Based on the WEAVE registry data, waiting 5–7 days allows the "hot plaque" to cool down, significantly lowering stroke risk during stenting (from ~20% acute risk down to ~2-4% delayed risk).Hardware Selection:Dissection/ICAD: Prefers self-expanding stents (e.g., Wingspan) or Enterprise stents if dissection is suspected.Vertebral/Other Anatomy: May use balloon-mounted stents (e.g., Resolute Onyx) depending on distal vs. proximal diameters.AI Integration: Technologies like Viz.ai, Rapid, and Brainomix are essential for converting linear workflows (serial phone calls) into parallel processing (alerting the whole team simultaneously).Advanced Imaging: Moving toward advanced imaging (CTP) for the 6–24 hour window to identify salvageable tissue.New Journal: SVIN has launched a new journal titled Stroke: Vascular and Interventional Neurology.SVIN 2021 Highlights: Trials, Stenting Strategies, and the Future of Thrombectomy with Dr. Ameer Hassan🎙️ Guest Profile📋 Key Clinical Trial Updates🧠 Clinical Pearls: Dr. Hassan’s Practice1. Bridging Lytics vs. Direct to Angio2. Intracranial Stenting and "Hot Plaque"🚀 The Future of Stroke Systems

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