In this episode of the NCS Podcast Hot Topics series, host Eric Lawson, MD, speaks with Stephan Mayer, MD, about the FASTEST clinical trial and the decades-long effort to determine whether ultra-early hemostatic therapy can improve outcomes for patients with spontaneous intracerebral hemorrhage (ICH). Dr. Mayer shares how the idea of using recombinant factor VIIa in ICH first emerged and how earlier trials helped shape the questions researchers are asking today.

The conversation explores what FASTEST revealed about the relationship between treatment timing, hematoma expansion and functional outcomes — and why identifying the patients most likely to benefit remains so important. Dr. Mayer also discusses the role of the CTA spot sign, the risks that must be weighed with factor VIIa and how lessons from FASTEST are informing the next phase of research.

Drs. Lawson and Mayer also discuss where hemostatic therapy could fit within the Code ICH approach and how advances in imaging and radiomics may help clinicians recognize ongoing bleeding sooner and better target treatment.

The views expressed on the NCS Podcast are solely those of the host and guest and do not necessarily reflect the opinions or official positions of the Neurocritical Care Socie

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