5th European Stroke Science Workshop (ESSW) Report

5th European Stroke Science Workshop

28 – 30 November 2019 / Garmisch-Partenkirchen, Germany

With >150 participants contributing expertise in different areas of stroke research, 2019 has seen another successful year for the European Stroke Science Workshop. During slightly over 2 days, participants discussed a wide range of topics from basic science, translational research to clinical trials. In addition to hearing from the world’s most renowned speakers, it was also great to see many emerging young stroke physicians/researchers this year.

The workshop, chaired by Keith Muir (Glasgow, UK), Anne Joutel (Paris, France) and Gotz Thomalla (Hamburg, Germany) was opened with a keynote lecture by David Kleinfeld (San Diego, US) on “Microvascular biology and basis for small penetrating vessel ischaemia”, where he demonstrated the very delicate approaches used in his laboratory to understand some of the fundamental biology of the microvascular structure of the brain.

The subsequent scientific programme included seven sessions with carefully selected topics, covering all aspects of stroke care and research. All sessions started with a keynote lecture that provided an overview of the topic and also set the scene for another four presentations with more focused angles:

Session I: Stroke Recovery

The session started with a very thought provoking keynote lecture from Nick Ward (London, UK), who thoroughly addressed the framework for recovery after stroke, which consisted of input and output approaches modulated by the brain status. The following presentations then covered more detailed topics within this framework, ranging from upper limb rehabilitation, robot-assisted rehab, to brain networks after stroke and the role of SSRIs. Despite several neutral trials, there are still many promising aspects in stroke recovery that are worth continued effort and a more comprehensive and more intensive approach is perhaps where the future should be.

Session II: Small Vessel Disease & Cognitive Impairment

This is one of the sessions that triggered a lot of fruitful discussions. Sarah Pendlebury (Oxford, UK) delivered a comprehensive lecture on “Predicting vascular cognitive impairment: insights from OXVASC”, followed by focused talks on treatment approaches for vascular cognitive impairment, prediction of drug responses by mendelian randomisation, perivascular spaces and retinovascular imaging to investigate small vessel disease. Apart from understanding the role of traditional risk factors (such as blood pressure) in small vessel disease, the field is certainly seeing growing numbers of research tools which may help to shed more light into the pathology behind the disease itself.

Session III: Advances in pathophysiology & Stroke research

Although many of the participants of the workshop were clinicians, this session addressing more basic science approaches in stroke research also attracted a lot of attention. The keynote lecture was given by Mark Nelson (Manchester, UK) on “new concepts in CBF regulation in health and disease” where he addressed the roles of ion channels in small vessel disease. The other novel approaches discussed including iPS cell, functional ultrasound imaging, magnetic particle imaging and ways to measure small vessel reactivity in vivo. Being mostly at the lab stages at the moment, hopefully these advances will move to the bedside.

Session IV: Intracerebral haemorrhage (ICH)

In his keynote lecture, David Werring (London, UK) pointed to us the future directions for ICH research, stressing that a more holistic approach involving primary prevention, acute treatment and secondary prevention is perhaps the way forward for reducing the overall burden of ICH. Other aspects of ICH were also discussed, including microbleeds and deep ICH. As for acute management after ICH, several ongoing trials will perhaps give us more insight on the use of haemostatic therapies.  Although being one of the most promising approaches, the participants also agreed that more trial evidence is needed before minimally invasive haematoma management becomes routine.

Session V: New Targets for treatment

Stephanie Debette (Bordeaux, France) gave a very clear overview of how genetic studies may help in future stroke management. She emphasised that systemic in depth functional exploration of numerous GWAS risk loci is as important as (if not more than) continuous hunt for more risk SNAPs. Presentations on thrombus perviousness, collaterals, distal emboli and anti-inflammatory treatment of atheroma also stimulated heated discussion.

Session VI: Acute Stroke Management

Else Sandset (Oslo, Norway) guided us through several recent clinical trials/studies in acute blood pressure management, starting from trials done in pre-hospital settings, to those focusing on patients undergoing reperfusion therapy (IVT or EVT), and to those recruiting patients who were not eligible for reperfusion. The session concluded that although pre-hospital blood pressure seemed feasible and safe and there are several ongoing trials in the area, evaluation of acute management strategies tailored according to specific imaging patterns will perhaps offer more guidance on how best to treat blood pressure in the acute phase. Other approaches of acute stroke management were also discussed including ischaemic per-conditioning, posterior circulation reperfusion, advances in prehospital diagnosis and treatment and the role of stimulating the sphenopalatine ganglion.

Session VII: Future Reperfusion Strategies

The workshop concluded with promising future strategies for reperfusion. Michael Hill (Calgary, Canada) explained the rationale and design of the promising ESCAPE NA1 trial and we look forward to hearing the results early next year. Imaging selection for reperfusion, modes for thrombectomy referrals, thrombolysis for lacunar strokes and rescue stenting for futile recanalization was also covered. Together with the lively discussion, it was great to see the closing session being delivered by four young female researchers in this field.

Altogether, with the beautiful snowy scenery of the Eibsee lake shining under the blue sky, the 5th European Stroke Science Workshop was again an absolutely successful event. The brilliant talks and networking opportunities are extremely stimulating and we look forward to the next workshop in 2021!