21st Singapore International Stroke Conference

^{Asia contributes to a significant proportion of the global stroke burden, with Southeast Asia bearing a disproportionate representation to that burden. Most countries in SE Asia are low to middle income, and stroke incidence and prevalence are rising due to the ageing population. Stroke is a major cause of death and disability in these countries, which will put considerable strain on their healthcare systems and potentially undermine the gains achieved in the decades of socioeconomic development. Understanding the stroke epidemiology would enable individualised and targeted population health measures, thereby helping to improve primary and secondary prevention of stroke in these countries in the years to come.}

^{Evidence of hyperacute stroke reperfusion treatment keeps evolving over past decades.They have set the milestones of guiding treatment to benefit more  acute stroke patients to achieve good functional recovery . As frontline clinical team it is paramount to form a comprehensive workflow and pathway based on latest evidence.}

^{Early mobilisation is a cornerstone of stroke rehabilitation, yet severe motor impairment and reduced balance often limit opportunities for safe and effective gait practice in the early phases post stroke. This talk focuses on the role of Robotic Assisted Gait Rehabilitation (RAGR) as a key enabler of early mobilization in acute and subacute stroke care.}

^{Exoskeletons are wearable robotic devices designed to provide physical support and assist lower limb movement. They can help compensate for existing weakness and support task-specific, repetitive stepping practice, allowing patients to commence upright standing and walking earlier than may be possible with conventional therapy alone.}

^{The session will explore how RAGR supports high dose gait training, reduces therapist physical burden and enhances safety while maintaining active patient participation. Evidence for its impact on mobility outcomes, walking endurance, and patient's perceived value of robotic-assisted gait training will be reviewed alongside practical considerations such as patient selection, timing of introduction and implementation within rehabilitation services.}

^{The talk aims to position RAGR as a complementary tool to optimize early stroke recovery rather than a replacement for conventional physiotherapy sessions.}

^{Update on the current evidence for surgical revascularisation in ICAD as well as the challenges.}

^{Community reintegration following stroke remains complex, with many survivors facing persistent unmet physical, psychosocial, and caregiving needs after hospital discharge. This talk will describe an initiative by engaging stroke survivors / caregivers at key time points post discharge.}

^{Using standardized assessments and patient reported concerns, the team identifies emerging issues and delivers tailored advice alongside with timely referrals to appropriate professionals or community services.}

^{By aligning care with individual needs, this model closes gaps in post stroke support, enables safer transitions of care, and enhances self management, while ensuring efficient use of healthcare resources and improving patient and caregiver outcomes.}

^{Recovery from stroke does not end at discharge—it continues at home, where patients and families often face uncertainty and new responsibilities. This session explores the vital role of community nursing in empowering stroke survivors and equipping caregivers with the knowledge, confidence, and practical skills required to provide safe and effective care.}

^{Emphasis will be placed on caregiver education and support, home-based rehabilitation guidance, psychosocial care, and strategies to enhance overall well-being for stroke survivors living in the community. Through a holistic and person-centred approach, this presentation highlights how sustained community support strengthens recovery, promotes independence, and improves quality of life.}

1. Ms Gan Hui Hui, Senior Principal Speech Therapist, Speech Therapy, Singapore General Hospital, Singapore

2. Ms Clara Teo

3. Ms Doris Wu, Senior Occupational Therapist and Head of Allied Health, Rehabilitation Services, PSD, Singapore

^{The prevention and management of stroke is rapidly evolving from a reactive, one-size-fits-all model to a proactive and personalised continuum, powered by the integration of multi-modal data. This presentation will explore this revolution, highlighting the ways in which diverse data sources are converging to enhance care across the full spectrum for stroke prevention and management. We will showcase the impact of digital innovations, such as wearable sensors, smartphone-based remote photoplethysmography and artificial intelligence, all of which enable real-time risk monitoring and personalised behavioural interventions. The current status of artificial intelligence-driven joint-tracking technologies and other solutions to support community rehabilitation for more effective and accessible recovery solutions will also be discussed.}

^{Intracerebral hemorrhage (ICH) remains one of the most devastating forms of stroke, with surgical management historically limited by the morbidity of open craniotomy and inconsistent functional benefit. Advances in minimally invasive surgery (MIS) have shifted the paradigm toward targeted clot evacuation with reduced collateral injury. This workshop-based lecture will examine the technical evolution from traditional exposure to trans-sulcal, parafascicular approaches that leverage tubular retractors, neuronavigation, and white matter tract preservation principles.}

^{Participants will review patient selection criteria, imaging-based trajectory planning, operative setup, and stepwise clot evacuation techniques. Emphasis will be placed on corridor design, minimizing retraction injury, optimising haemostasis strategies, and complication avoidance in a real world surgical practise.}  

^{By integrating anatomical precision with modern technology, minimally invasive parafascicular surgery offers a reproducible framework aiming to reduce surgical morbidity while optimizing functional recovery in appropriately selected ICH patients.}

^{Haemostasis is minimally invasive parafascicular surgery is an essential skill to perfect, given the risk of postoperative bleeding and haematoma re-expansion. This lecture will combine a description of haemostatic options available, with examples of previous cases.}

Chairpersons:

Clin Asst Prof Carol Tham, National Neuroscience Institute

Clin Asst Prof Pang Yee Hau, National Neuroscience Institute

^{The talk will describe the AcT clinical trial which led to approval of tenecteplase for acute ischameic stroke treatment within 3 to 4.5 hours of onset by the FDA and the Singapore HSA, and supporting data from other Phase 3 trials. Furthermore, the role of tenecteplase in bridging therapy, adjunctive intra-arterial therapy after recanalisation in stroke thrombectomy, and in the late time window of 4.5 to 24 hours after stroke onset will be discussed.}

^{Implementing artificial intelligence in stroke imaging is fundamentally an exercise in real-world medicine: aligning algorithms with operational constraints, heterogeneous data quality, and the clinical realities of time-critical decision making. This lecture will discuss practical strategies for deploying AI solutions to address stroke imaging challenges in Asian populations, emphasizing generalizability, equity, and system-level impact rather than model novelty. I will outline how AI can support consistent interpretation of routine CT and CTA, accelerate triage, and improve communication across hospitals that differ in staffing, imaging protocols, and downstream treatment capacity.}

^{A particular focus will be placed on the “last mile” barriers that often determine success, including workflow integration, calibration to local prevalence and practice patterns, transparent handling of uncertainty, and prospective monitoring for drift and unintended bias. Using Korea’s emergency care environment as a motivating context, I will describe how AI-enabled decision support may contribute to more reliable regional routing and capacity-aware triage within coordinated response frameworks, with the goal of reducing avoidable delays and inter-hospital “round trips” that can erode the therapeutic window.}

^{I will conclude by proposing an implementation-oriented framework for translating AI outputs into actionable, auditable decisions across diverse Asian health systems.}

^{In this talk, I will explore the various haemostatic therapies used in the spontaneous intracerebral haemorrhage including factor VII, tranexamic acid, desmopressin and specific DOAC reversal agents. I will present evidence based on randomised controlled trials and meta-analyses of RCTs. Lastly, I will highlight several ongoing RCTs to watch out for.}

^{The past 3 decades saw a paradigm shift in the management of intracranial aneurysms, with a pivot towards the endovascular approach along with innovative advances in endovascular devices.}

1:15pm to 2:00pm - Poster Presentation Session 1

1:15pm – 2:00pm: Poster Presentations

Chairperson:

Clin Assoc Prof Chang Hui Meng, National Neuroscience Institute

^{Ischaemic stroke occurring despite therapeutic anticoagulation in patients with atrial fibrillation (AF) is an increasingly recognised and clinically challenging scenario. Such “breakthrough” strokes raise fundamental questions regarding stroke mechanism, adherence to or efficacy of anticoagulation, and optimal secondary prevention strategies, yet high-quality evidence to guide management remains limited. This talk will provide a practical, mechanism-driven approach for evaluating and treating AF patients who experience stroke while on oral anticoagulation.We will first review the epidemiology and prognosis of breakthrough stroke, highlighting that these events are not rare and carry a high risk of recurrence and mortality. A structured diagnostic approach will be emphasised, focusing on confirmation of adherence and drug exposure, identification of competing or non-cardioembolic stroke mechanisms, and recognition of atrial cardiopathy or advanced vascular disease that may contribute to residual risk.The second part will address therapeutic dilemmas, including whether to change anticoagulant class, dosing schedule, or dose, add antiplatelet therapy, or pursue non-pharmacological strategies such as left atrial appendage occlusion. Emerging data from observational studies and ongoing trials will be critically appraised, with discussion of potential benefits and harms across different patient phenotypes.Finally, we will explore future directions, including precision medicine approaches and the need for randomized evidence to inform practice. The goal is to equip clinicians with a rational, evidence-informed approach to managing this complex and high-risk population while identifying key gaps for future research.}

1:15pm to 2:00pm - Poster Presentation Session 2