To qualify as an FESO, members must demonstrate scientific quality and a willingness to actively volunteer in ESO. There are no age requirements, but FESO must meet minimum standards. FESO receive additional benefits, including participation in the Council of Fellows. Visit our website for more information on how to distinguish yourself as a FESO.
We hope you enjoy getting to know the Fellows who participate in the 2020 interview series and thank them in advance for taking the time to share with our readers.
For the March issue of the ESO member newsletter, we have an interview with Gian Marco De Marchis, MD MSc FESO, Deputy Director of the Stroke Unit, University Hospital Basel, Switzerland. Gian Marco De Marchis is an active Fellow who serves as a member of the ESO guideline working group on intravenous thrombolysis as well as the public relations and social media committees.
How did ESO contribute to your own research?
ESO conferences are a platform for top-quality contents and trials. ESO helped me a lot, mainly through the networking occurring at ESO conferences. For instance, at the ESOC in Barcelona in 2016, I met clinical researchers interested in the early use of direct oral anticoagulants (DOAC) after a stroke. We decided to join forces, merged our datasets, and decided to address questions on DOAC that were left open in the four pivotal clinical trials. These patient data came from Europe, North America and Japan. The collaboration resulted in a series of joint publications. ESOC meeting act as catalysators for such collaborations across countries.
What do you see as the next horizons in early secondary stroke prevention?
There are novel therapeutic targets worth exploring to prevent recurrent strokes. Coagulation factor XI is one of them. People with severe factor XI deficiency – also known as Haemophilia C – have a 43% lower incidence of MI/stroke/TIA, without an increase in intracranial haemorrhage (Preis M et al, Blood 2019). Hence, inhibition of FXIa is a promising strategy to prevent strokes. This is also backed by Mendelian randomization evidence (Gill D et al, Stroke 2018). Two phase II, placebo controlled randomized clinical trials – PACIFIC and AXIOMATIC – are currently testing two novel oral FXIa inhibitors on a background of antiplatelet therapy in patients with non-cardioembolic stroke. This brings new hope in stroke prevention.
What about precision medicine?
Precision medicine has the potential to let us individualize prevention strategies to the patient in front of us, moving away from the “one size fits all strategy”. For instance, clopidogrel – a prodrug – needs to be activated by hepatic CYP2C19, in order to work. But one in five patients does not metabolize the drug appropriately and may, thus, be at higher risk of suffering a recurrent stroke. This was shown nicely in a post-hoc analysis from CHANCE. An alternative to clopidogrel may be ticagrelor, which does not require hepatic activation – I am looking forward to hearing the full THALES trial results (ASS+Ticagrelor vs. ASS). If THALES is positive, the question of CYP2C19 genotyping may flare up again, as poor clopidogrel metabolizers may benefit from ticagrelor combined with aspirin.
How can we achieve these goals?
Clinical trials are getting more and more demanding in terms of resources. To win this challenge, we need an alliance across stakeholders – academia, public agencies, pharmaceutical companies and foundations. When a practice-changing article is published in a top medical journal, it is a win-win situation for patients, investigators and sponsors.
We are conducting this interview amid the COVID19-pandemics – we need everybody’s help to curb the infection rate and save human lives. Both the public and private sectors are essential to develop, produce and test a vaccine and antiviral treatments in large scale. This teaching also applies to acute stroke management and prevention. When we work all together, we are much stronger.
What levels of networking do you see?
There are several layers of networking – at hospital, national and international level.
At hospital level, the big strength is to have all specialists under the same roof, which facilitates interdisciplinary exchange. For instance, we regularly re-evaluate our acute stroke pathway together with the neuroradiology team to update and optimize processes. Only thanks to the help of neuroradiology and emergency departments, we can achieve door-to-needle times <20 minutes. On the other hand, an important job of us as vascular neurologists is to do everything we can to let interventional neuroradiologists get to the occluded artery as fast as possible. For secondary prevention, we frequently interact with cardiologists, from whom we also learn a lot, as they approach the same issue from another, equally important, perspective
At the national level, in Switzerland, all stroke trialists meet yearly to discuss ongoing and planned research projects. This is a wonderful meeting, which is organized by the Swiss Stroke Society. A vital research resource at national level is the Swiss Stroke Registry (SSR): since 2014, more than 60’000 patients treated at Swiss Stroke Units and Centres have been prospectively recorded and followed-up through the SSR. Several research projects are stemming from the SSR. This is a national team effort and the credit goes to every Stroke Unit and Stroke Center.
At international level, ESO achieved –very rapidly and successfully– to connect a whole Continent in the fight against stroke. The annual conference has become a yearly milestone, after which stroke care is regularly improved. Young stroke researchers deeply appreciate ESO’s effort towards younger generations and gender balance. In this sense, I wish to acknowledge Eivind Berge, who sadly passed away – I was honoured when Eivind, on behalf of the guideline committee, asked me if I was willing to join the guideline committee on intravenous thrombolysis. Working together with top experts from different countries is an enriching experience. ESO makes that possible.
What do you do outside of work?
I spend my free time mostly with my family; my wife – who is an architect and cellist – and two kids. Their smiles are essential and they are incredibly supportive. I also enjoy mountain-biking and cooking, mainly Italian dishes like Spaghetti alle Vongole.