Franco Appiani

We are waiting for you in Barcelona!

@DoctorSITHo @crisguijarro1 Hola muy cierto el post. Solo una pequeña corrección vocación se escribe con “c”

El maltrato institucional es una trituradora de vocaciones médicas. La romantización de la vocación se ha usado demasiado como excusa para justificar la esclavitud profesional. El burnout galopa agitado por las necesidades del servicio. #estatutopropio #estatutomedico

STROKE: Trends in Stroke Treatment Delays (2014 to 2023): Fewer patients arrive to the hospital within 4.5 hours of stroke onset, especially non-White patients. Exaggerated during COVID-19 but not coming back. We need better, faster access to care. Link: ahajournals.org/doi/10.1161/ST…

#MondayTip #MeVO After #ISC2025, what’s next for stroke management in medium vessel occlusion? 🤔 DISTAL, ESCAPE-MeVO & DISCOUNT showed no EVT benefit over BMT Will this change your practice? @FishingNeurons @mayank_G0 @TudorGJovin

#ISC2025 Day 3: ANGEL-TNK: IntraArterial TNK (4-24hs) post-EVT (TICI 2b-2) improved 90d mRS0-1 (40.5% vs 26.4%, OR 1.44), no ↑sICH. Promising for LVO. #Stroke

#ISC2025 Day 3: LAMP Trial (China, n=636) GLP-1 (Liraglutide) in minor AIS/TIA+T2DM. 🔥90d new stroke 7.9% vs. 13.8% (HR 0.56, 0.34-0.91). 🚀mRS 0-1: 87.3% vs. 77.3%. #StrokePrevention

#ISC2025 Day 3: HOPE Trial (China, n=372) tPA in late window (4.5-24h) w/ CTP mismatch. 🔥90d mRS 0-1: 40.3% vs. 26.3% (RR 1.52, 1.1-2). ⚠️sICH 3.8% vs. 0.5%. #LVO #Stroke

#ISC2025 Day 3: PEARL Trial (China, n=324) Intra-arterial tPA + EVT vs. best medical tx for LVO. 🔥90d mRS 0-1: 44.8% vs. 30.2% (RR 1.45, 1.1-1.96). ⚠️sICH 4.3% vs. 5%. #Stroke

#ISC2025 #Stroke #PRESTIGE-AF: DOACs in post-stroke AF lowered recurrent stroke risk (HR 0.5) but raised major bleeding, esp. recurrent ICH (HR 10.9). Quantitive Net benefit likely positive.

#ISC2025 2nd Day: Great resume from @EdmontonStroke! I share it here. For me the most relevant is #IDENTIFY (Intensive BP <130 mmHg for 24 h after EVT, in AIS <6hs). No difference in outcome (mRS 3-6 at 90 days: 71% vs. 67.5% 1.05 (0.92, 1.2). #MedTwitter #Neurology #stroke

Great talk on #AI in #stroke detection by Santi Ortega-Gutierrez @CerebrovascLab #ISC25 @AHAScience @StrokeAHA_ASA @SVINJournal @SVINSociety @YNIScommittee @SNISinfo

#ISC2025 Today: Multiple trials, including #DISCOUNT, #DISTAL & #ESCAPE-MeVO showed no benefit of EVT in MeVO/DMVO strokes. Safety concerns. Evidence challenges EVT use in distal occlusions. #Stroke #NeuroTwitter #MedTwitter

#DISCOUNT trial (DMVO stroke): EVT+BMT vs. BMT alone stopped early due to safety concerns. sICH: 12% (EVT+BMT) vs. 6% (BMT). Trial aimed to assess EVT efficacy but raised safety issues. #ISC2025 #ISC25 #stroke #MedTwitter

🚀 ESMINT proudly endorses the PREVENT Registry! 🌟 Their work to make thrombectomy safer for stroke patients is crucial. Vessel perforation with intracranial bleeding is a rare but life-threatening complication. More on endorsed clinical trials at esmint.eu/research.

Presented at #ISC25: In the ESCAPE-MeVO trial involving patients with ischemic stroke due to medium-vessel occlusion, thrombectomy within 12 hours did not lead to a better functional outcome and lower mortality at 90 days than usual care. Full trial results: nej.md/40LTUaL Editorial: Medium- and Distal-Vessel Occlusion — The Limit of Thrombectomy? nej.md/40Hu9bP

ESCAPE Trial

Endovascular treatment for medium-vessel stroke did not improve outcomes over standard care. Mortality and intracranial hemorrhage were higher in the EVT group. Study findings challenge current EVT practices for medium-vessel occlusions. #ISC2025 @NEJM nejm.org/doi/full/10.10…

DISTAL Trial: EVT for stroke due to medium/distal vessel occlusion showed no benefit over best medical treatment alone at 90 days. No reduction in disability or mortality, but higher symptomatic hemorrhage risk. #ISC2025 #NEJM #Stroke nejm.org/doi/full/10.10…

3 - Adjunct emergent stenting in AIS with intracranial stenosis improved reperfusion (90.9% vs 77.9%) and 90‑day functional independence (42.2% vs 28.4%), with higher overall complications yet no rise in symptomatic hemorrhage.

2 - CHABLIS-T II: In AIS patients with favorable penumbra, tenecteplase given up to 24h boosted reperfusion (33.3% vs 10.8%) and recanalization, yet didn’t improve clinical outcomes. These findings underscore the need to further link reperfusion with function.

Stroke February Highlights (3) 1- Cardiac CT detected high‐risk cardioembolic sources in ~1 in 12 acute ischemic stroke patients—with 24× odds vs. stroke mimics. Cardiac thrombus was the most common finding, supporting CT’s complementary role in AIS doi.org/10.1161/STROKE…