The fights Chris Andersen is looking forward to at ISAH 2026

Chris Andersen chairs the ISAH 2026 scientific committee, and in this episode he does something scientific chairs are not supposed to do: he says out loud which of the field’s habits he thinks are expensive, unproven, and probably wrong. Aggressive intra-arterial treatment of vasospasm gets it first. Prognostic pessimism in grade 5 patients gets it next, as the self-fulfilling prophecy that may explain more of our improved mortality than any therapy does.

He is careful to hedge and happy to be proven wrong. That, more or less, is the design brief for the meeting.

Worth listening for

• Why SAH never had the endovascular revolution ischaemic stroke did, and what has actually moved the mortality curve.

• DCI as the ARDS of subarachnoid haemorrhage: one syndrome, several mechanisms, a graveyard of single therapies. The fix is many smaller cups, not one Holy Grail.

• The quietly damning number from his PhD: across twenty years of SAH randomised trials, fewer than 10% measured health-related quality of life.

• His prediction that may make him look foolish by 2030: the adaptive immune system is part of why DCI takes days to appear.

Where this shows up in the program

Almost everything Chris previews in this episode is on the schedule. The guidelines session on Thursday morning puts Nima Etminan (2026 ESO/EANS/ESMINT) and Nerissa Ko (2023 AHA/ASA) on the same stage, with Thabele Leslie-Mazwi moderating a panel he cheerfully predicts will need referees.

The lumbar drain debate is Thursday afternoon: Stefan Wolf defending EARLYDRAIN, Amal Abou-Hamden against. Three years after the trial, uptake is still patchy and Chris’s explanation of why is worth hearing before you watch it argued.

The DCI mechanisms he is betting on have their own afternoon. Thursday 14:00–15:00: Isabel Hostettler on early brain injury, Alex Choi on the adaptive immune system and DCI, Jens Dreier on cortical spreading depolarisations, then Loch Macdonald on what is on the horizon. Sherif Mahmoud covers the under-dosing problem on Thursday morning, and Emanuela Keller opens the augmented intelligence conversation on Wednesday.

Friday belongs to trials: Craig Anderson and Nerissa Ko debate platform and registry studies, Shane English asks why so many aSAH trials have failed, and the meeting closes with a proposal for a global alliance in aneurysm care, which is the idea Chris and Oli spend the last part of the episode on.

Listen above, or go to the full episode and transcript on NeuroResus.

ISAH 2026 runs 17–20 November at the Sheraton Grand Hyde Park, Sydney. See the program or register here.