Prague, 18 May – Exciting new data from the late breaking sessions ensured a fitting finale to ESOC 2017. Highlights from the late breaking sessions are provided below.
SPACE 2 Study – A Comparison of Stenting, Endarterectomy and Best Medical Management
This study augments the volume of evidence demonstrating minimal differences between carotid endarterectomy (CEA) and carotid stenting (CAS) and a low overall rate of procedural complications in patients with asymptomatic carotid stenosis. Prof Tilman Reiff (University Hospital Heidelberg, Germany) presented results from this study in patients with an asymptomatic carotid stenosis, adding to the growing evidence of the relative risks and benefits of these interventions.
- Key findings from the SPACE 2 study
- In 400 patients randomised to CEA vs CAS there was a low rate of periprocedural stroke (<30days), with only 5 events (2.5%) in each arm.
PRASTRO-1 Study – A Comparison of Prasugrel and Clopidogrel (Standard of Care)
The PRASTRO-1 study, demonstrated no significant advantage of prasugrel over clopidogrel in patients with non-cardioembolic stroke. The study compared prasugrel to clopidogrel to determine whether the newer platelet inhibitor, which is felt to be less liable to patient resistance, has equivalent efficacy to the current standard of care. Prof Kazunori Toyoda (Suita- Osaka, Japan) presented the study’s results from 3,747 patients with non-cardioembolic stroke.
- Key findings from the PRASTRO-1 study
- There was no significant difference between drugs for the primary outcome of ischaemic stroke, myocardial infarction, or other vascular death (RR 1.05, 95% CI 0.76-1.44), with an equal rate of ‘any stroke’ in both groups (RR 0.99, 95% CI 0.72-1.36).
- Although event rates were similar, the study did not demonstrate ‘non-inferiority’ of prasugrel at the pre-defined threshold (RR=1.35).
General or Local Anesthesia During Endovascular Therapy (EVT)?
There is uncertainty regarding the effect of the anesthetic approach during endovascular therapy for ischaemic stroke. Observational studies suggest that general anesthesia (GA) during EVT is associated with worse outcomes compared to conscious sedation (CS). The results of the GOLIATH and ANSTROKE randomised studies should help physicians choose the best strategy for their patients.
- The GOLIATH Study assessed whether GA caused greater infarct growth and worse outcomes during EVT compared to CS. A total of 128 patients were included in the study results presented by Prof Claus Simonsen (Aarhus University Hospital, Denmark).
- Key findings of the GOLIATH study:
- There was no difference in acute infarct size between groups (median acute infarct volume 10.5 mls with GA and 13.3 mls with CS, p=0.26). Final infarct volume was higher with conscious sedation (38 mls with CS and 22 mls with GA, p=0.04).
- EVT under GA did not result in worse outcome. The odds ratio for better outcome was 1.91, 95% CI 1.03 to 3.56.
- The ANSTROKE Study compared GA and CS in 106 patients undergoing endovascular therapy for acute ischaemic stroke. The study was conducted at the Sahlgrenska University Hospital in Sweden.
- Key findings of the ANSTROKE study:
- There was no difference in the numbers of patients who were independent at 3 months (42.2% with GA vs. 40% with CS, p=1.0).