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The Glasgow Neurosociety
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in association with SI, or Surgical Neurology International, and SI Digital are happy to present
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the abstracts and discussion of the 10th anniversary Glasgow Neurosociety meeting held in November of 2022 in Glasgow, Scotland.
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Hassan Ishmael is president of the Glasgow Neurosociety at that time. He's from the Wolfson School of Medicine at the University of Glasgow in Scotland and the United Kingdom
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Faculty commentators are Likith L. Akhandi, who's the consultant neurosurgeon at the Queen Elizabeth University Hospital in Glasgow
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And Amy Davidson, a neurologist, also at the University of Glasgow, also at the Institute of Infection, Immunity, and Inflammation in Glasgow, Scotland.
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Other Glasgow neuro hosts were Alidith Middleton, Vice President of Glasgow neuro, and Edica Choudry, another Vice President of Glasgow neuro. Hi, welcome back, everyone So our next presentation
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is by Dela Aziz, and it's comparing person or surgical procedures in treatment of crowded arteries to losis. So I'll now pass you over to Abdul Akhil, talk a little bit more about this. So thank
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you for that introduction, Ailey. So my research was basically, it's quite simple, really. I wanted to find out the best surgical procedure
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a very common issue. Corotid artery stenosis is one of the biggest causes for ischemic stroke and that's a massive, massive cause and mortality around the world now, such as superseded malignancies.
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Soma research was comparing three main procedures, Corotid and artery rectomy.
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CEA, Corotid artery centing and trans-crotid artery revascularisation. Corotid and artery rectum
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has been around for a few years now, it's been about 50 years. It's quite an invasive procedure. It's tried and tested and it still works and that's why it's kind of first line for your risk
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reduction procedures and the NHS. Your step above that would be cross-archist stenting, which is a little bit newer and a little bit less invasive. But the newer one that's not green bot to the UK
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as transcroted artery revascularization. So my research is basically just comparing three fundamental measures from these procedures as a literature review, which would have been the mortality rate
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stroke rate and my rate post procedure at 30 days. And it's quite simply showed that T-car or transcroted artery revascularization had the lowest mortality rate, the lowest stroke
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rate at 30 days, which was quite
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interesting really, but not a surprise when you consider how brand new it is. It's only currently been used in the USA for a trial basis. So yeah, that's really what my
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research was about Do you want me to
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just talk about like implications for practice?
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Oh, that would be beautiful, please, by all means. Okay, so the implication for practice right now are low, to be honest, because as though experimental procedure, the paper that I used in my
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research was only a single arm trial for the T-car, because it's such a new sort of procedure that they've not had chances around a randomized trial on it yet. So the implications are really for
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further research than anything else, to research this new procedure, to see if it's actually worth taking forward and bringing it to the UK and implementing it in NHS as a viable option. And that's
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really what it's for.
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Isn't it interesting? I think I'd - can I ask first, though? Yeah. So it's interesting. I remember this is kind of, I think, discussion during the postures. Now, one of the things, when you
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start off a new procedure is you're going to be super selective in what cases you do and you're not taking any risk by doing complex studies. So how do you extrapolate that information or did you
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actually use very similar compared or is controlled when you were comparing with other two procedures which are much more commonly performed much more, you know, in word-commerce risk averse in a
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way, you know, you're taking higher risk with these procedures. So how did you try to eliminate that kind of bias?
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So all the papers had sort of similar baseline characteristics of the participants within their study but there were definitely differences within the characteristics but I sort of looked at that and
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that was
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one of the things that stuck out, was that any cross archery centing the paper in particular and the tea card paper, their participants had a lot more patience with existing cardiac complications
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and the crotter understanding paper, about 18 of their participants had had a previous MI. And so that's why I excluded the MI figures from the results of my paper. I mean, it is there, but it's
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just not the
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main part of that talk about because, you know, if the participants do have higher MI rates previously, that would reflect on that. So I wouldn't really say that was because of the t-car. But
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that's sort of how I used it to compare the three. But generally speaking, the papers were competing sort of moderate to severe stenosis and adult males, and majority of them, they were the
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whirlwind in the studies as well The majority of the world were. White males.
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We're the single operator for both procedures. For both procedures, what do you mean? So, the single operator in the sense, is it by a particular institute based or is it or a single surgeon or
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an operator based? So the three papers are different. So for T-Car, that was a multi-center trial in America So obviously different surgeons, but each of them had sort of
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different standards for their surgeon recruitment requirements. I couldn't really find any particular surgical requirements for this growth in
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the correct way, 'cause that was a slightly older paper,
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but it was sort of rigorous testing and qualification required for the T-Car paper.
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And you said about the complication and the safety issues, but what about the outcome? What was the outcome measure used and was there a difference in the overall outcome? And what outcome measures
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were used? So the outcome measures were like the mortality rate, stroke rate, MI rate, and like cranial nerve injury, post procedure,
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that's kind of all included in the trial case So all complications rather than, you know, neurological, okay, yeah, that's good. Thank you very much. Thank
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you. So I must admit, I don't know much about T-car at all, so this has all been very interesting for me. So just to pick up on that last point, so the really used outcome measures they were
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trying to prove it was safe, so like the kind of phase two trial I guess, do you have any kind of longitudinal data? Is it as good as an indirect rate to me? Like, does it last as long or we
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saved a growth? Do we know that we have a sense of that yet? I don't know if that's a apologies. I don't know a lot about it. I don't know if that's a silly question. Oh, no, that's a really
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good important question, actually, because the indirect rate to me is an older procedure, we do have long data on it. And that's why it's still used. It's relatively safe, long-term And it's a
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similar sort of situation with a stenting, but because T-CART is so new, they've not actually had a chance to do a random-ass trial when I let alone long-term data. So that's why there's only 30-D
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post-op data in that trial. And
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there were a few participants that have fallen up to a year, but that's really it, to be honest. There's definitely not enough data on it to say, you know, implicated in practice, which is why I
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said it doesn't warrant implication practice, implication before the research, so it looks promising. And is that someone taking up the grips involved in the study? Are they following these
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patients up long, Richard and I, or is there another, have we now got an RCT set up? You know, how we're trying to move this forward? It sounds like it might be very clinically relevant, you
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know, so I'm just ingested to see how we're taking it on. I'm not sure about that, to be honest, I don't know what Presented movie, or some movie.
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Hopefully, hopefully that was the point of the.
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Great, thank you very much. Thank you.
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Lovely, and I guess before we wrap up any final comments or anything from yourself, Abdullah?
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No, that's so, thank you very much. Appreciate your questions and your interest. Lovely, thank you very much, and that concludes this panel recording. We hope you enjoy these presentations.
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