By Dr João Pedro Marto
Department of Neurology, Hospital de Egas Moniz, Lisbon, Portugal
What a great meeting! As usual, ESOC was the perfect opportunity to meet colleagues from all around the world and listen to the top experts in the field of stroke. Additionally, we received some great news from the positive RCTs such as ELAN, ENRICH and INTERACT3 (Press Release). The exclamations of Prof. Werner Hacke (“Finally! Waited more than 20 years for a positive RCT in ICH!”) and Prof. Valeria Caso (“So good news to our ICH patients! After these results I will leave Munich so happy!”) perfectly summarized the enthusiasm of all attendees.
However, many other studies deserved our attention.
During the poster walk, I attempted to summarize some of the many interesting posters displayed on Thursday and Friday.
Among the posters on ACUTE MANAGEMENT, I would like to highlight the poster on EMERGENT CAROTID STENTING FOR ACUTE ISCHEMIC STROKE DUE TO TANDEM OCCLUSION: A META-ANALYSIS by Romoli et al. aiming to assess the safety and efficacy of emergent carotid stenting for tandem occlusions. After pooling the results from 46 studies, the authors found that emergent carotid stenting was associated with better functional outcomes and higher chance of successful recanalization, despite carrying an increased risk of sICH. These results provide important insights into the best approach for patients with tandem occlusion receiving EVT. This study was recently published on the Journal of NeuroInterventional Surgery (DOI: 10.1136/neurintsurg-2022-018683). Nevertheless, questions about the optimal timing and type of antithrombotic therapy after stenting still remain to be answered.
On the ACUTE MANAGEMENT topic, the individual patient data meta-analysis presented by Joundi et al. on the ASSOCIATION BETWEEN BLOOD PRESSURE VARIABILITY AND OUTCOMES AFTER ENDOVASCULAR THROMBECTOMY FOR ACUTE ISCHEMIC STROKE also caught my attention. By including data from 5 studies (n=3309 patients), the authors found an association between higher blood pressure variability (BPV) within the first 24h after EVT and poorer 3-month outcomes. The authors suggest that early BPV may become a novel target to improve AIS patients’ outcome after EVT. There results have made me reflect on the class of intravenous antihypertensive drugs commonly used within the first hours after EVT. If equally effective in reducing blood pressure, should we prioritize drug classes shown to have a positive impact on BPV?
On IMAGING, the work by Alhabi et al entitled INCIDENCE AND IMPACT OF THROMBUS MIGRATION BEFORE ENDOVASCULAR TREATMENT: RESULTS FROM THE ACT TRIAL showed that Tenecteplase treatment (0.25mg/kg) before EVT results in higher rates of distal thrombus migration in comparison with Alteplase (0.9mg/kg). Additionally, distal thrombus migration was associated with better functional outcomes, regardless of the thrombolytic agent used. This data, reinforces the benefits of Tenecteplase and also emphasizes the role of bridging in patients with LVO.
Focusing on PROGNOSIS AND OUTCOME and outside the scope of acute stroke treatment, I found the study by Richter et al, A PROSPECTIVE SINGLE-CENTER OBSERVATIONAL STUDY ON RAPHE HYPOECHOGENICITY AS A PREDICTOR OF POST-STROKE DEPRESSION very innovative. In AIS patients the investigators performed transcranial sonography to assess the echogenicity of the brainstem raphe. Among 99 participants, approximately one-quarter had brainstem raphe hypoechogenicity which was shown to be independently associated with the diagnosis of post-stroke depression at three months. Post-stroke depression affects a large proportion of our patients and has an enormous impact in their quality of life. Anticipating which patients are more likely to develop this complication may help in the development of individualized approaches targeted for earlier diagnosis, treatment, or even prevention.
And that’s it!
Looking forward to the ESOC 2024 in Basel! Join us in celebrating the 10th ESOC anniversary!