Oliver Flower

#CODA, #SMACC founder. Intensivist. Neurocritical Care. Education.

[Coda Change @codachange]

Important meeting. @IntSAH is one of the few forums actually taking on the uncertainty in aneurysm and SAH care rather than pretending it’s solved.
Serious people, real debates, and the kind of cross-specialty discussion we don’t get enough of.
Sydney, Nov 2026. Worth your time.

[ISAH @IntSAH]

7 editions. Never once in the Southern Hemisphere.
Until now.
The International Subarachnoid Haemorrhage Conference is coming to Sydney - 1 disease, every discipline, the faculty who are actually building the field.

📍 Sydney | 17–20 Nov 2026
🔗 https://t.co/5r0OBuj5fN
#ISAH2026

[ISAH @IntSAH]

PROTECT-U. ESO guidelines. Convener of ISAH 2019.

Nima Etminan has spent his career asking what we should actually do when we find an aneurysm.

Supporting #ISAH2026 - Sydney, Nov 17–20.

https://t.co/EDMDaY1bKA

[ISAH @IntSAH]

"Practice-changing things that maybe aren't guideline ready — but get us ready for the next version."

That's @NerissaKoMD on why ISAH matters. We'll take it.

Sydney. November. https://t.co/i0MNzWFZQQ

#ISAH2026 #aSAH

@NeurosurgUCSF

[ISAH @IntSAH]

This aSAH PechaKucha is 12+ years old. The emergency framework holds. The 2012 guidelines don't. TXA and coiling-vs-clipping have both moved on.
Sharing it as a warm-up — ISAH 2026 is running a PK competition. Best entries present in Sydney.
▶️ https://t.co/e9sRDUdXzD
#ISAH26

[ISAH @IntSAH]

Founding editor of the Journal of NeuroInterventional Surgery. Past SNIS president. 450+ publications.

@JoshuaAHirsch at #ISAH2026 - the global SAH forum.

📍 Sydney | Nov 17–20
https://t.co/EDMDaY1bKA

[ISAH @IntSAH]

Jose Suarez on what he would NOT do in a DCI trial: choose one medication with one mechanism of action. "We'll just be replicating the same failures."

It's a short answer. The implications aren't.

ISAH 2026 | Sydney | 17–20 Nov

https://t.co/DgFaBgZCh0 #ISAH26

[ISAH @IntSAH]

525+ peer-reviewed papers. 2 dozen trials. Still asking whether we're treating the right aneurysms.
J Mocco joins #ISAH2026

📍 Sydney | Nov 17–20

https://t.co/wjzygbMIdC

[ISAH @IntSAH]

SAH guidelines have an RCT purity problem.

Nerissa Ko (UCSF): for rare, variable diseases, holding out for trials that may never come isn't rigour - it's stasis.

📍 ISAH 2026 | Nov, Sydney
🔗 https://t.co/i0MNzWFZQQ

#ISAH2026 #aSAH

[ISAH @IntSAH]

2 decades building the evidence base for who's actually at risk from their aneurysm - & who isn't.
Sepideh Amin-Hanjani (Chair, AHA Stroke Council; VP, AANS) is supporting #ISAH2026 in Sydney this November.
The only global meeting dedicated to SAH.
🎟️ https://t.co/i0MNzWFZQQ

[ISAH @IntSAH]

Decades of DCI trials. Still on nimodipine.
Jose Suarez (Johns Hopkins) breaks down why: flawed models, skipped phase 2, single-pathway thinking & makes the case for combination therapy.
ISAH 2026, Sydney.
🔗 https://t.co/i0MNzWFZQQ
#ISAH26 #SubarachnoidHemorrhage #DCI

[Oliver Flower @OliFlower]

@IntSAH @stephanamayer

[ISAH @IntSAH]

More intervention ≠ better outcome.
We still haven't solved that.

Stephan Mayer joins #ISAH2026
📍 Sydney | Nov 17–20
https://t.co/wjzygbMIdC

[ISAH @IntSAH]

Nerissa Ko helped write the SAH guidelines.
We asked her why nobody follows them.

3 reasons:
→ Disease is too heterogeneous
→ Evidence base too thin
→ We haven't agreed on the right outcomes yet

That's the conversation. #ISAH2026 Sydney, November.
🔗 https://t.co/DgFaBgZCh0

[ISAH @IntSAH]

Same aneurysm.
Different clinicians.
Different decisions.
Why?

Peter Mitchell joins #ISAH2026
📍 Sydney | Nov 17–20
https://t.co/wjzygbMIdC

[ISAH @IntSAH]

Hyperventilation in SAH: drops ICP AND cerebral blood flow. In a brain already in trouble.
Prophylactic hyperventilation when ICP isn't confirmed? Guessing. Possibly harmfully.

Claude says "ish-shame-ic". It would be a shame.

#NeuroResus #SAH #FOAMed
🎧 https://t.co/NOzwQx2u7y

[ISAH @IntSAH]

Claude explained the CONSCIOUS trials. Confidently. Completely wrong.
CONSCIOUS is about clazosentan. The negative result changed the field.
Corrected on air. Told to examine its "beady, glowing eyes."
#NeuroResus #SAH #FOAMed
🎧 https://t.co/NOzwQx2u7y

[ISAH @IntSAH]

She co-wrote the 2023 AHA/ASA SAH guidelines.

She'll tell you why that wasn't enough.

Nerissa Ko joins #ISAH2026 — Sydney, Nov 17–20
🔗 https://t.co/wjzygbMIdC

[ISAH @IntSAH]

Time is brain."

Also true: dead patients don't scan well.

Stabilise first. Scan second.

Not controversial — just occasionally forgotten when everyone's rushing to CT.

#NeuroResus #SAH #FOAMed
🎧 https://t.co/2okQh1aQdF

[ISAH @IntSAH]

Guidelines simplify.
Reality doesn't.

Jose Suarez at #ISAH2026
Time to look at where recommendations help — and where they don't.
📍 Sydney | Nov 17–20
https://t.co/wjzygbMIdC