By Märit Jensen, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany.
Meeting all my colleagues and researchers from all over the world in person at ESOC 2022 was so much fun and stimulating. It seems like we had almost forgotten, how different it is, meeting face to face and discussing stroke research with everybody. There were so many exciting talks and posters, and it was only possible to capture a fraction of it. Luckily, we can check everything online for another couple of weeks.
Among the posters on ACUTE MANAGEMENT, I would like to highlight the poster on the ASSOCIATION OF INTRACRANIAL HEMORRHAGE AFTER ENDOVASCULAR STROKE TREATMENT WITH FUNCTIONAL OUTCOME by van der Steen et al. aiming to assess the association of the occurrence and type of intracranial hemorrhage (ICH) after endovascular therapy with functional outcome. Importantly, also asymptomatic ICH was found to be associated with worse functional outcome, which shows that identifying and monitoring patients at-risk of ICH is an important step towards further improving stroke outcome.
In the session on ACUTE MANAGEMENT – NEITHER THROMBOLYSIS NOR THROMBECTOMY, Chen et al. from Yangzhou University presented an interesting study on brain perfusion changes and blood brain barrier (BBB) damage in patients with asymptomatic carotid stenosis (THE BLOOD BRAIN BARRIER PERMEABILITY IN PATIENTS WITH ASYMPTOMATIC CAROTID ARTERY STENOSIS). Using arterial spin labeling (ASL-) MRI, dynamic susceptibility contrast (DSC-) MRI, and anatomical imaging, they studied 30 patients with asymptomatic carotid stenosis and identified areas of increased BBB permeability in regions with hypoperfusion downstream the stenosis. Moreover, hemispheric gray matter volume was smaller on the side ipsilateral to the stenosis. These findings link chronic hypoperfusion and regional atrophy via BBB damage and may provide an explanation for cognitive deficits in patients with so-called “asymptomatic” carotid stenosis.
In the past years, more and more research has focused on heart-brain interaction as diseases of the heart like atrial fibrillation, heart failure, or myocardial infarction can cause stroke. In the session CARDIOEMBOLISM & HEART-BRAIN INTERACTIONS, Cameron et al. from Glasgow presented the poster NATRIURETIC PEPTIDES MAY HELP TO IDENTIFY PEOPLE WITH LOW RISK OF NEWLY DETECTED ATRIAL FIBRILLATION: DATA FROM THE BIOSIGNAL COHORT. They found that cardiac biomarkers, NT-proBNP and MR-proANP, may help in identifying patients after stroke who are unlikely to have atrial fibrillation and therefore do not need prolonged cardiac monitoring. As the authors stated, I am convinced that this is very helpful when access is limited.
I would have loved to see a few example images on the poster presented by Lee et al. from the Hallym Neurological Insitute from Korea on CEREBRAL SMALL VESSEL DISEASE BURDEN AND FUTILE REPERFUSION AFTER ENDOVASCULAR THROMBECTOMY FOR ACUTE ISCHEMIC STROKE PATIENTS (Session on NEUROINTERVENTION – EXCLUDING CLINICAL TRIAL RESULTS). The findings were nevertheless intriguing. Addressing the question of futile reperfusion, i.e., poor outcome despite successful reperfusion, the identified the extent of visually assessed white matter hyperintensities reflecting cerebral small vessel disease as an independent predictor of failing to achieve good outcome in these patients. This raises interesting questions on the interaction between small vessel disease and outcome from acute large vessel occlusion, although, of course, there is no simple clinical consequence resulting from these findings. Imaging findings of small vessel disease should not preclude patients from endovascular treatment.
I hope my brief summaries have made you want to know more!
“Au revoir Lyon” and “Bis bald in München!”