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Milan, 24 May 2019

The 5^th annual European Stroke Organisation Conference maintains broad scope on final day with insights from acute care to multi-faceted support programmes

• IMPACT-24B: Sphenopalatine ganglion stimulation improves outcome from Acute Ischaemic Stroke in a Dose-Dependent Manner in a subgroup of ischaemic stroke patients
• COMPASS MIND & NAVIGATE MIND: No significant effect with different anti-coagulation strategies on stroke lesion burden
• INSPIRE-TMS & STROKE-CARD CARE PROGRAMME: Specially-designed multi-component support programmes offer promising secondary prevention options

Additional information, including video interviews with principle investigators and summary slides are available on the ESOC 2019 Media Portal. Email your request for access to this password-protected resource to: ESCO@ESO-stroke.org.

Delegates from around the world are drawn to the European Stroke Organisation Conference (ESOC) by the depth and breadth of its scientific programme. The appeal of the programme may be due to the youthful spirit of the various organising committees. Prof Kennedy Lees commented, “The average age of the committee members has decreased by approximately 25 years since the inaugural event in 2015.”

As ESOC 2019 draws to a close, the organising committees are already looking ahead. ESOC will consolidate its position as the world’s largest scientific meeting of stroke experts next year in a collaboration with the World Stroke Organization (WSO). The jointly organised ESO-WSO Conference is taking place in Vienna from 13 to 15 May 2020.

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IMPACT-24B:

Sphenopalatine Ganglion Stimulation Improves Outcome from Acute Ischemic Stroke in a Dose-Dependent Manner – Further insights

 In pre-clinical models, ImpACT-24 trials showed that stimulation of the sphenopalatine ganglion (SPG) leads to an increase in cerebral collateral blood flow and reduction in infarct size. This approach was shown to be feasible in the first in-human study of 253 patients in the ImpACT-24A trial. ImpACT-24B sought to demonstrate safety and efficacy of the approach in 1,000 patients with confirmed cortical involvement (CCI) within 8 to 24 hours after stroke.

The study’s sensitivity analyses showed a clear dose-response relationship, with an inverted U-shape dose effect curve. The optimal dose range was 1-38% of the maximal dose applied: At optimal stimulation levels, for every 100 patients treated with SPG stimulation; potentially 29 more will have a favourable long-term disability outcome, thus this collateral-enhancing therapy expands therapeutic options for the subgroup of acute ischemic stroke patients with clear cortical involvement ineligible of i.v. thrombolysis up to 24 hours after stroke.

Prof Jeffrey Saver concluded: “The cumulative evidence indicates that sphenopalatine ganglion stimulation is an efficacious therapy for patients with cortical acute ischaemic stroke 8–24 hours after onset who are ineligible for intravenous thrombolytic therapy.”

The research is published today in The Lancet.

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COMPASS MIND:

Results of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) Randomized Trial MRI and Neurocognitive Deterioration Sub-study (COMPASS MIND)

 & NAVIGATE MIND:

Effects of Rivaroxaban vs Acetylsalicylic Acid on the Occurrence of the Clinical and MRI-Defined Infarcts and Microbleeds in NAVIGATE-ESUS – Results of NAVIGATE MIND MRI Sub-study

The COMPASS-MIND and NAVIGATE-MIND were brain-imaging substudies of large clinical trials assessing the effect of rivaroxaban, a novel oral anticoagulant on prevention of recurrent stroke, seen clinically or on a brain scan. COMPASS randomised 27,395 stable patients with cardiovascular disease to rivaroxaban (low dose)  with or without aspirin, whilst NAVIGATE randomised 7,213 with a likely embolic stroke of unknown source to full-dose rivaroxaban versus aspirin.

1,445 patients in COMPASS and 728 patients in NAVIGATE had an MRI at baseline and the end of the study.

There was a non-significant reduction in infarcts on brain scans on rivaroxaban with aspirin compared to patients on aspirin alone in COMPASS-MIND, with a similar effect when including symptomatic strokes (OR 0.53, 0.27 – 1.03).

In NAVIGATE, there was similar non-significant overall reduction in MRI -identified or clinically- identified stroke with rivaroxaban versus aspirin (HR 0.75, 0.35 – 1.58).  This supports evidence that rivaroxaban has potential added benefit in reducing ischaemic stroke, but may be limited by the increased risk of bleeding in these populations.

Principal Investigator Prof Mike Sharma said: “The composite of MRI infarcts and clinical stroke in COMPASS were non-significantly reduced, suggesting effects may be similar to the overall trial.”

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INSPIRE-TMS:

Effects of a Multicomponent Support Program for Intensified Secondary Prevention in Patients with Transient Ischemic Attack and Minor Stroke

& STROKE-CARD CARE PROGRAMME:
Pragmatic Trial of a Multifaceted Intervention to Prevent Future Cardiovascular Events and Improve Quality of Life After Acute Ischaemic Stroke or TIA

Following a minor stroke or transient ischaemic attack, there is a high risk of having another stroke or a heart attack.

INSPIRE-TMS and Stroke-Card were randomized controlled trials each assessing the efficacy of a different specially-designed multi-component support programme in the prevention of recurrent vascular events or death in patients with prior ischaemic stroke or transient ischaemic attack. Both studies enrolled more than 2,000 participants and both interventions showed encouraging results.

The studied populations were slightly different with respect to severity of stroke and functional independence.

The INSPIRE-TMS support programme, which consisted of 8 outpatient visits with motivational interviewing and information on secondary prevention over a period of 2 years, did not result in any significant reduction in cardiovascular events and death at annual follow-up up to five years compared to usual care (annual visit). However, the support programme did result in better control of several target risk factors.

Principal Investigator, Prof Heinrich Audebert, commented, “The support programme improved achievement of secondary prevention targets but this did not translate to lower rate of major vascular event. A possible explanation for this might be that target risk factor control was much better in the control group than expected, diluting the effect of the intervention.”

The Stroke-Card Care Programme’s intensified post-stroke disease approach (one outpatient multidisciplinary re-assessment at 3 months post-discharge) resulted in a decrease in recurrent stroke, heart disease or vascular death at 12 months compared to standard care (STROKE-CARD 5.4% vs Standard care 8.3%, hazard ratio, 0.63, 95%CI 0.45-0.88, p = 0.007). At the same time interval, participants in the Stroke-Card Care Programme also reported a better quality of life compared to those who received standard care.

Principal Investigator, Prof Peter Willeit commented, ““We believed pragmatic intervention, STROKE CARD care can be easily translated to low-cost routine care practice. Our study also emphasized that stroke care does not end with hospital discharge. We should be extending care to a 3-month follow-up by the multidisciplinary team.”

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Issued by the ESOC 2019 PR Committee

For more information, to schedule interviews or for access to the password-protected Media Portal, please send your request to: ESOC@ESO-stroke.org.

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By: Derya ULUDUZ, Prof. M.D., Istanbul University, Cerrahpasa School of Medicine, Neurology Department. Istanbul, Turkey

The Rare Causes of Ischemic Stroke session took place on 23 May at 16.30 chaired by Dr Derya Uludüz and Dr Zdravka Poljakovic. Prof Uluduz pointed that rare causes require awareness and additional diagnostic techniques to prevent recurrences, provide future risk assessment and family counselling. To be familiar with those rare causes is important.

The first speaker was Prof Alexander Persu with his topic fibromuscular dysplasia (FMD). He mentioned that even FMD is a systemic disease, we should consider FMD in patients with severe chronic migraine headache, pulsatile tinnitus, stroke or carotid-vertebral dissections. And patients with FMD should undergo at least once in a lifetime full body CTA/MRA. He also suggested that young women with migraine and resistant hypertension should not only be evaluated for renal arteries but also cerebral arteries.

The very interesting topic cannabis and stroke was covered by Prof Michael Hill. He told us that cannabis use is a consequence rather than cause of bad behaviour in teens. Epidemiological evidence is modest for association between cannabis use and stroke and confounded by smoking, alcohol and other drug exposures. And there is a temporal association between cannabis and stroke where no other etiology is found. Cannabis use generally result with multiple intracranial stenosis causing stroke.

Prof Emmanuel Touze was the next speaker with title connective tissue disorders and stroke. He explained that connective tissue disorders are a group of diseases that affect connective tissue and usually chronic diseases. He explained clinical symptoms of different connective tissue disorders. Ehler Danlos disease can cause aneurysms, dissection, carotid cavernous fistula and rupture of large and medium sized arteries and cerebrovasculary manifestations occur in about 10% of patients. Osteogenesis imperfecta has the vasculary involvement due to atrial fibrillation, heart failure and aortic dissection. Cerebravascular manifestations are fairly rare and most commonly observed as cerebral artery dissections. Also he mentioned about Marfan Syndrome that has cerebravascular synptoms less that 5%. Marfan syndrome is mainly present with cardioembolic stroke and extension of aortic dissection.

Prof Armin Grau talked about the role of infections in stroke and Dr Jana Becker talked about vasculitis and stroke. She explained that primary central nervous system vasculitis has a wide range of clinical symptoms and it is often difficult to diagnose. Symptoms may sometimes overlap with reversible cerebral vasocontruction syndrome.

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A conversation with Francisco Moniche, stroke neurologists and researcher at Hospital Universitario Virgen del Rocío and one of the presenters at the Young Stroke Physicians and Researchers (YSPR) session at ESOC 2019, in Milan, Italy. Francisco Moniche presented a a randomized multicenter cell therapy for acute ischemic stroke patients.

Interviewed by Johannes Kaesmacher, MD, Neuroradiologist, University Hospital Bern, Inselspital, University of Bern.

Dear Francisco, many thanks for agreeing to do this interview. Would you mind telling us a bit how you got involved in stroke research?

Since I was studying Medicine, I feel passionate about stroke and its consequences. The arrival of recanalization therapies has been a revolution in stroke but there are many things to be done to improve this dramatic disease, from prevention to further improve acute management and rehabilitation and recover neurological deficits. Last years all the focus has been put on the acute management, but there is a need to improve also our knowledge on stroke recovery and discover new therapies. I have the opportunity to work in an excellent tertiary hospital with high volume of stroke patients and where research is stimulated, that allowed me to get involved in this field.

Why did you choose this topic?

Stem cell therapy is a fascinating field, rapidly growing and getting increasing interest in the stroke research community. One of my mentors, Dr. Gil-Peralta inspired me to start doing research in cell therapy in stroke and in my hospital, there is an important basic research center (Institute of Biomedicine of Seville IBIS) with several investigators focus on stem cell therapy. Also, I have the luck to work with Dr. Joan Montaner that have a huge experience in stroke research that boosts my research. This context allowed me to get involved in this topic and discover the new opportunities of this field.

Translation from basic science results to bedside treatment remains a huge challenge, especially regarding the treatment of acute ischemic stroke. In your opinion, what are the main reasons for the failure to translate positive basic and animal science findings to successful randomized-controlled clinical trials?

There are several reasons for the failure to translate basic science results to bedside. One of them are due to lack of multicenter randomized blinded controlled trials in animal models of stroke that could affect the quality of final results of basic research. Also, the big jump needed to translate mice or rats research to the complex human brain is always challenging and difficult. Another important issue regarding stroke research are the comorbidities, that are so frequent in human but not in animal models.

What have been the most difficult challenges regarding your research career so far?

One of the most difficult challenges is the lack of time for research in a very busy life. Another important challenge is to set up a project such as an academic trial that I’m currently doing and get other researches involved in it. Academic trials are complex to get started and also have an unfair competition with industry-promoted trials.

How do you balance work life and free time/home life?

That’s a difficult point, as I have already kids and as a stroke neurologist, research has to be done mostly during the “free time”. There are always things to be done in research and the balance with family is complex. However, it is important to clearly separate the time with the family and the time for working and doing research. Enjoy the family makes me happier and recharge my batteries to push harder when it’s time to work.

How did you experience the session and how will it influence your research project?

It was very interesting and inspiring. Mentors has an important role in everyone’s career and it is important to realize that even the best European neurologist and researches did have difficulties along their career but put a strong effort in their dreams to achieve success.

We want to thank all presenters and the mentors for a great session! 

<p>The post Interview with Francisco Moniche first appeared on European Stroke Organisation.</p>

Controversies in Stroke I

By: Prof. Anita Arsovska, MD, PhD, University Clinic of Neurology, Medical Faculty, University “Ss Cyril and Methodius”, Skopje, Republic of North Macedonia, FESO, FEAN, SAFE Board Member

The 23^rd of May started with a very exciting and interactive morning session from 08:15-09:45 in the Gold Room,  entitled Controversies in Stroke I, chaired by Martin Dichgans (Germany) and Turgut Tatlisumak ( Sweden). The session started with a burning question: Intravenous thrombolysis before endovascular trombectomy? Yes or no? And than Yvo Roos (The Netherlands) tried to convince the audience to answer yes, providing an overview from the recent studies and own experience. He actually concluded that the answer is still coming and that we need to wait and see the results of DIRECT-MT (expected at ISC 2020) and MrClean No-IV and other trials expected later that year, however in the meantime, we need to include patients in trials or stick to the current evidence….IVT+IMT.

Afterwards, Urs Fischer (Switzerland) in a very charming way gave an excellent lecture entitled IVT before EVT? Not Always! He personally disclosed that he actually loves thrombolysis and it is the drug that he loves the most, however, first we have to answer the following questions: Preinterventional reperfusion: how often and how good? Is IVT plus MT better than MT alone in IVT eligible patients? Which patients should be included in trials? Does one approach fit all? Quoting the latest studies including his own rich experience, he concluded that IVT is currently the standard of care in all patients with LVO, IVT should only be skipped in the framework of well designed RTCs, and only patients with low probability of early recanalization after IVT and immediate access to direct MT should be included.We need an initiative to tailor stroke treatment strategies in the future (precision medicine).

The session continued with the second topic : Restarting oral anticoagulation after ICH – No (Roland Veltkamp, Germany) and Yes (Karin Klijn, The Netherlands). Dr. Veltkamp stated that there is limited evidence that would support restarting someone with an OAC-related ICH on an OAC and that we need to personalize therapy election and shared decision making as best preventive approach. His “opponent” Dr. Klijn, after presenting current evidence, concluded that we should recommencing OAC in high risk ischemic event; microbleeds have no influence; if AF: OACs are preferable over Vit K antagonists; there should be no rush (unless very igh risk ischemia), probably best after 7-8 weeks, it is still unsure if NOACs are safe to be started sooner and we need to randomize our patients in the multiple RTC’s that are ongoing/starting soon.

The third topic elaborated : Extending the window for reperfusion therapy- Do we need perfusion imaging-yes (“defended” by Henry Ma, Australia) and no- presented by Götz Thomalla from Germany. Basically, Dr. Ma presented the benefits of the perfusion imaging, that can identify the ischemic core- poor outcome and risk of haemorrhage, identify the ischemic penumbra- potential benefit, exclude stroke mimics and provide precision medicine, concluding that yes, we do need perfusion imagiing to extend the reperfusion time window for reperfusion. On the other hand, Dr. Thomalla presented a more practical approach, firstly asking the audience if at their stroke center, they have perfusion imaging available for acute stroke imaging 24/7? The actual situation is that 45% had it only during office hours or not at all, 38% had CT perfusion, 11% had CT perfusion and MRI and only 4% had MRI and perfusion imaging. He later asked also a very useful question: At your stroke center, which CT perfusion parameter do you use to define the ischemic core? And surprisingly, the majority of the participants did not know (45%), and the rest of them had doubts between absolute or relative cerebral blood flow of volume. After detailed overview of current studies and evidence, he concluded that perfusion imaging is valuable for research and helpful as diagnostic tool in acute ischemic stroke; there is uncertainty as to the optimal perfusion parameters and thresholds, there are limitations to quantification of ischemic core by CT perfusion, we do not need perfusion imaging to guide MT in extended or unknown time of symptom onset or to guide IVT in unknown symptom onset, penumbral imaging requiring perfusion is only needed to guide IVT on kknown late time window; for the vast majority of patients, we do not need perfusion imaging to guide reperfusion treatment with IVT or MT and Stroke centers must have perfusion imaging available 24/7 but should not waste time in doing perfusion imaging in the majority of patients in whom it is not required!

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Media Release

Milan, 23 May 2019

Studies at the 5^th annual European Stroke Organisation Conference highlight diversity and commonality across geography and gender

• RESILIENT: A randomised trial demonstrating efficacy and feasibility of endovascular treatment in resource limited healthcare systems
• VIST, VAST and SAMMPRIS (pooled analysis): Opening up extracranial stenotic vessels of posterior circulation arteries outside of the brain may be beneficial, and larger clinical trials are needed
• Gender differences: Although commonly presenting with similar, non-specific symptoms at the time of a TIA or stroke, women were more likely to be given an alternative diagnosis

Additional information, including video interviews with principle investigators and summary slides are available on the ESOC 2019 Media Portal. Email your request for access to this password-protected resource to: ESCO@ESO-stroke.org.

The global footprint of the 5^th annual European Stroke Organisation Conference is reflected in the many submissions on national studies from around the world. In some instances, there are clear cultural nuances, while others offer insights that are broadly applicable to the field of stroke worldwide. Two studies of this kind (from Brazil and Canada) are highlighted in this release, alongside a pooled analysis of data from three studies conducted in three different countries (The Netherlands, UK and US).

RESILIENT:

Randomization of Endovascular Treatment with Stent-Retriever and/or Thromboaspiration vs Best Medical Therapy in Acute Ischemic Stroke due to Large Vessel Occlusion Trial – Final Results

There are many reasons why the health services in some low and middle-income countries do not routinely provide endovascular treatment (EVT) to patients with Large Vessel Occlusion (LVO).  This trial in Brazil sought to provide local validation of findings from landmark clinical trials conducted in high-income countries, which demonstrate the benefit of this approach. RESILIENT is a Brazilian Stroke Network/Ministry of Health collaboration.

This multicentre, randomised, controlled trial compared mechanical thrombectomy to medical management in patients with LVO ≤8hours from ischaemic stroke onset (NIHSS ≥8 and ASPECTS ≥6). The trial’s Data Safety Monitory Board recommended early termination due to “clear crossing of the boundary for efficacy at the first interim analysis”. At this time, 221 patients had been enrolled and 174 patients had completed 90-day-follow-up.

Despite the acknowledged limitations of the healthcare system, including reduced availability of experienced endovascular centres and outpatient rehabilitation; RESILIENT showed that EVT was clearly superior to medical management in this setting. Principal investigator Dr Sheila Martins presented the trial’s results on behalf of the RESILIENT collaborative: “We hope these results will encourage more low and middle-income countries to increase the use of EVT to improve outcomes for more LVO patients.” She received clamorous applause from the audience.

VIST, VAST and SAMMPRIS:

Stenting for Symptomatic Vertebral Artery Stenosis: Pooled Individual Patient Data Analysis

Although symptomatic vertebral artery stenosis has been associated with a high risk of recurrent stroke, particularly in the first few weeks after symptoms, there is still controversy whether or not it should be the preferred therapeutic approach in patients with this condition.

Considering this, the authors performed an individual patient pooled analysis of the 354 participants included in three previous large randomised controlled clinical trials – VIST, VAST AND SAMMPRIS – that compared vertebral stenting with medical treatment for symptomatic vertebral stenosis.

There was no evidence of significant benefit of vertebral stenting over medical treatment, although there was a trend towards lower recurrence rates in patients receiving stenting for extracranial vertebral stenosis. Further larger trials are required to ascertain whether there is benefit in this subgroup.

Principal investigator Prof Hugh Markus commented: “Stenting for intracranial stenosis did not show benefit from either strategy. Stenting for extracranial stenosis might be beneficial, so we are planning the VIST 2 – interested investigators please contact info@cambridgestroke.com!”

This paper is now published in Lancet Neurology.

Sex Differences in the Presentation and Outcomes after Transient Ischaemic Attacks and Minor Strokes

It has been shown that women are less likely than men to be diagnosed with heart attack, but what about stroke? This Canadian study of 1,648 patients showed women and men were equally likely to present with non-focal symptoms, but women were still more likely to be diagnosed with a stroke mimic. The risk of recurrent stroke within 90 days, however, were similar in men and women. Dr Yu’s findings raise questions about missed opportunities in preventing vascular events in women.

“What’s important to recognize in stroke is that the brain has so many different functions, so that when a stroke is happening, people can feel different things beyond the typical stroke symptoms,” said Dr Yu. “Accurately diagnosing TIA and stroke would change a patient’s treatment plan and could help prevent another stroke from happening.”

The research is published in the Journal of the American Medical Association (JAMA).

Issued by the ESOC 2019 PR Committee

For more information, to schedule interviews or for access to the password-protected Media Portal, please send your request to: ESOC@ESO-stroke.org.

<p>The post Studies at the 5th annual European Stroke Organisation Conference highlight diversity and commonality across geography and gender first appeared on European Stroke Organisation.</p>

In the afternoon the Large Artery Disease and Treatment Scientific Communication session took place, chaired by Anita Arsovska (North Macedonia) and Mauro Silvestrini (Italy).We had an opportunity to hear interesting lectures presented by experienced speakers.

Dr. Ntaios (Greece) presented the topic AORTIC ARCH ATHEROSCLEROSIS IN PATIENTS WITH EMBOLIC STROKE OF UNDETERMINED SOURCE: AN EXPLORATORY ANALYSIS OF THE NAVIGATE-ESUS TRIAL. On behalf of the NAVIGATE ESUS investigators, Dr. Ntaios analysed the baseline characteristics, stroke recurrence rates and response to rivaroxaban versus aspirin of participants with AAA. AAA plaques were considered to have complex features when reported as complex or ulcerated, or were ≥4mm in thickness or had a mobile thrombus present. The results showed that complex AAA was present in 8% of NAVIGATE-ESUS participants undergoing TEE and was associated with a trend for higher stroke recurrence rate. Too few events were observed among those with complex AAA to meaningfully assess the effect of antithrombotic treatment.

Dr. Humphries (UK) presented the lecture entitled RATES OF AORTIC ARCH ATHEROMA CORRELATED WITH CAROTID STENOSIS AND VASCULAR RISK FACTORS IN RETINAL ISCHEMIA PATIENTS PRESENTING TO A TERTIARY REFERRAL CENTRE TIA CLINIC, aiming to determine the rates of aortic arch atheroma (AAA) in patients with ischaemic transient (TVL) and permanent visual loss (PVL). The presented concluded that this is the first description of AAA in ischaemic visual loss. 51% have AAA, AAA is more severe in PVL and if CS >50%. Rates of AAA in PVL are comparable to patients with cerebral infarcts.

The third presentation was delivered by Dr. Greving  from The Netherlands “PREDICTING RISK OF VASCULAR EVENTS AFTER CAROTID REVASCULARIZATION MODEL DEVELOPMENT STUDY IN INDIVIDUAL PATIENT DATA FROM FOUR RANDOMISED TRIALS”. Dr. Greving  and his coworkers developed two prediction models for procedural stroke or death risk ≤30 days after CAS and CEA and one for postprocedural ipsilateral stroke risk >30 days after both procedures. Predictors of procedural risk after CAS were age, diabetes, atrial fibrillation, modified Rankin Scale (mRS) score, previous hemispheric event, serum creatinine, left-sided procedure, and ipsilateral severe carotid stenosis. Predictors of procedural risk after CEA were hypertension, mRS score, and serum creatinine. Hypertension, coronary heart disease, heart failure, and contralateral severe carotid stenosis/occlusion predicted postprocedural risk. The conclusion was that this is a good model that needs external validation before these models can be used to support treatment decisions in individual patients.

Than Dr. Caputi (Italy) gave a talk on a “RANDOMIZED STUDY COMPARING THE TYPE OF CAROTID STENT AND CEREBRAL PROTECTION DURING CAROTID ARTERY STENTING IN PATIENTS WITH HIGH-RISK PLAQUE”. A comparison of the safety and efficacy of the carotid stent Roadsaver (RS) vs. the Carotid Wallstent (CW) during carotid artery stenting (CAS) in patients with lipid-rich plaques. Both stents were randomly tested with FilterWire (FW) and MO.MA cerebral protection. The results showed that in patients with high-risk lipid-rich plaque undergoing CAS, MO.MA+RS seems to be a promising tool in limiting embolic risks.

On behalf of the Carotid Stenosis Trialists Collaboration, Dr, Poorthius (UK) oresented TIMING OF PROCEDURAL COMPLICATIONS AMONG ASYMPTOMATIC PATIENTS UNDERGOING CAROTID ENDARTERECTOMY: ANALYSIS OF VA, ACAS, ACST-1 AND GALA TRIALS. The authors aimed to assess frequency and timing of procedural complications after CEA, which may clarify underlying mechanisms and help inform safe discharge policies and concluded that half of the procedural deaths and strokes occur on the day of operation and one third after day 3 when most patients will have been discharged. This analysis of procedural complications may help in planning strategies to reduce procedural complications after CEA.

Dr. Harshfield (UK) presented “STENTING FOR SYMPTOMATIC VERTEBRAL ARTERY STENOSIS: POOLED INDIVIDUAL PATIENT DATA ANALYSIS OF VIST, VAST AND SAMMPRIS”. The pooled analysis of available data from completed vertebral artery stenting trials did not show a statistically significant benefit for either medical or interventional therapy. There was no evidence of even a trend of benefit of either strategy for IC stenosis. Stenting for EC stenosis might be beneficial, but further larger trials are required to determine whether there is benefit in this subgroup.

RARE GENETIC VARIANTS IN PATIENTS WITH CERVICAL ARTERY DISSECTION was presented by Dr. Traenka (Switzerland). The authors included 43 patients and concluded that suggestive or CeAD-causing variants were detected in 14/32 affected families. CeADcausing variants were more likely to be identified in patients with CeAD-f than in those with CeAD-r.

The last lecture was delivered by Dr. Awadh from Egypt who talked on the topis “CLOPIDOGREL ANTIPLATELET LOADING IN ISCHEMIC STROKE OF RECENT ONSET (CAIRO) TRIAL”. After the thorough analysis, the conclusion was that loading clopidogrel is safe and superior to aspirin in acute ischemic stroke within 9 hours.

<p>The post ESOC Report: Large Artery Disease first appeared on European Stroke Organisation.</p>

The Thursday morning session ‘Stroke in the Young’ was a very educative and interesting session chaired by Julia Ferrari and by Mirjam R. Heldner.

Anne-Mette Hvas was speaking about inherited and acquired thrombophilia, about lack of evidence for association between thrombophilia and ischaemic stroke, about impact of presence of thrombophilia on treatment strategies and about recommendation on thrombophilia testing in patients with ischaemic stroke.

Stéphanie Debette was speaking about when we should consider genetic causes of stroke in young adults.

Jani Pirinen talked about definite cardioembolic stroke and atrial fibrillation being rare in young patients, but cryptogenic stroke being frequent. In those patients, ECG-findings such as P-terminal force in V1, T-wave inversions, a wide QRS-T frontal angle, and a prolonged QT-time may indicate cardiomyopathy, heart failure and prior myocardial infarction.

Frank-Erik de Leeuw was speaking about stroke recurrence in young adults.

Maja Stefanovic-Budimkic was speaking about return to work after stroke. She demonstrated data from a matched cohort study with a median follow-up time of 3 years showing that IVT was an independent predictor of returning to full-time jobs after stroke and showing that around 2/5 in the IVT group vs. around 1/3 in the non-IVT group returned to paid work.

The high quality of the talks and the enthusiastic participation of the audience made this session a highlight of this year’s ESO conference.

<p>The post ESOC Session Report: Stroke in the Young first appeared on European Stroke Organisation.</p>