By Dr Sarah Gorey
Herzlich Willkommen zu ESOC 2023 in München!
What a wonderful first day of ESOC! A jam-packed day including a fascinating plenary and multiple scientific sessions, not to mention catching up with friends and colleagues from around the world. I have really enjoyed reading and viewing the posters today. Here are some that caught my eye…
Kicking off with pre-hospital stroke care, van de Wijdeven et al from Rotterdam examined prehospital stroke scales to identify LVO in the anterior circulation in a prospective cohort of 288 patients, and concluded that all pre-hospital stroke scales performed well for LVOs, but G-FAST (gaze-deviation in addition to FAST) was the only score to also predict M2 occlusions.
Barone et al, from Bologna, Italy looked for predictors of recurrence after TIA in the short and long term, and report that recurrent TIA is the main predictor for short term recurrent stroke, but hypertension is more important for long-term recurrent stroke, in a study of over 1000 patients attending TIA clinics in Bologna. These authors remind us of the importance of good management of risk factors like hypertension for secondary prevention. Additionally, Murthy et al from Weill Cornell, New York report low adherence with secondary prevention strategies amoung patients after ICH and suggest more study is required to establish an evidence base for appropriate cardiovascular preventive treatments after ICH. Also in the ICH section, Holloway et al report data from SSNAP detailing that in hospital mortality of ICH has fallen in the UK over the last decade but that outcomes of ICH still lag behind that of ischaemic stroke.
In the Neurointervention section, I was interested to see Enriquez et al’s poster externally validating a clinical prediction score for EVT in older adults: these authors report that the tool, comprising age, admission NIHSS, ASPECT and pre-stroke mRS could predict poor outcome after EVT, with a c-statistic of 0.75 (0.69-0.82). I will be watching out to see if this easily calculated tool can make the translation to clinical practice. Nearby, also in the Neurointervenion section, Madden et al present the Northern Irish experience with endovascular stenting of tandem occlusions- intrepretability of this report is limited by low number of cases and controls, but of note, early stent re-occlusion rates were high.
In Epidemiology and Risk Factors, Data from the German Stroke Registry authored by Meissner, report patient with diabetes mellitus undergoing EVT for LVO have worse outcomes compared to patients without diabetes even after controlling for comorbidities and stroke severity.
Neilson et al, from Glasgow report an interesting association between sensory-neural hearing loss and stroke of small vessel disease aetiology in a retrospective case-control study of 631 patients. These authors hypothesise that sensory-neural hearing loss may have an ischaemic basis.
I was interested to read about the DOAC dipstick point of care test described by Ziegler et al, from Mannheim: this technology could potentially be used to test urine samples from acute stroke patients for presence of DOAC metabolite to confirm presence or absence of DOAC in the system to aid acute decision making for thrombolysis, when accurate drug history is not possible. So far only 21 patients have been included in this study but keep an eye out for this interesting concept in future!
A number of groups reporting on inequalities and biases in stroke treatments and in stroke research caught my eye: Najm and colleagues from Calgary, Canada describe in their poster how patients who present with acute stroke of unknown time of onset are less likely to receive acute reperfusion therapies, but that these patients also older, more likely to be female, and have more severe strokes. We need to be careful in our selection of patients for acute stroke treatments not to over-exclude these patients from potentially very beneficial interventions. Similarly, Hahn and colleagues from Mainz describe that patients in registry data for whom data is missing is not random: these patients are also more likely to be more disabled, with higher mRS both at baseline and after stroke treatment.
I was also struck by the stark data presented by Ouyang et al from a prospective population study in Ulaanbaatar, Mongolia, detailing the comparatively young age on onset of first stroke (59+/-13 years), and delay to CT scanning (10 hours) as well as low thrombolysis rates (0.9%). Global inequalities in Stroke care and access to acute diagnostics and treatment remains a challenge.
Under the theme of Atherosclerosis, Dubenko et al from Kharkiv, Ukraine studied patients with carotid atherosclerosis with acute stroke, remote stroke, without stroke and controls (no carotid stenosis) reported levels of E-selectin and Lp-PLA2 differed between groups, being highest in symptomatic carotid stenosis undergoing CEA after stroke. From Turkey, Arsava and colleague report an association between bone mineral density and calcification in intracranial atherosclerosis.
In the imaging section, Toeback and colleagues from Basel elegantly described how leptomeningeal collaterals are associated with large artery atherosclerosis, but these collaterals were not as prevalent in cardioembolic stroke, amoung a cohort of 147 patients.
Environmental exposures to vascular disease is topical and Clancy et al’s work on exposure to hazardous substances is worth a read: this group report a increased risk of vascular dementia with pesticides and fertilisers, but no association between small vessel disease and contact sport. They caution that larger epidemiological studies are required to investigate these associations further. Another topical theme is sleep, and Hyuk Sung Kwon and colleagues from Guri in South Korea presented their e-poster on the association between sleep duration and dissatisfaction with sleep quality and ischameic stroke in young patients (Poster ID P1147)
I was impressed by Alsubaie et al’s work, from Jeddah in Saudi Arabia, where they have improved their door to needle time for thrombolysis by implementing MSD guidelines and Code Drill simulation training (poster ID P914). Similar simulation training reported by Irvine et al in Belfast Northern Ireland, (E-Poster ID 1440) resulted in a 28 minute reduction in door-to-needle time!
In the Rehab and Recovery section, Aked et al from Lund, Sweden, report neuropsychiatric symptoms remain common 3-4 years after stroke with lots of over-lap existing between depression and fatigue highlighting that these outcomes which are very important to stroke patients are difficult to treat and require further study. On a similar theme, Sanak et al from Czech Republic reported that in their cohort of 145 patients with excellent functional outcomes (measured by mRS, 0) stroke patients still reported poorer quality of life scores at 3 months, again highlighting the need for patient-centred outcome measures in stroke research. Finally, Kudiersky et al from Sheffield describe the feasibility and acceptability of aerobic training for stroke patients in the stroke unit, with knock on modest benefits in independence at 3 months. Patients described the intervention as giving them a “sense of achievement”, making them feel “mentally sharper”, feeling “knackered” after it but also that it was “something to look forward to” – and to be honest I can totally identify with them. That is how I feel about ESOC day 1 today, – physically fatigued, hopefully mentally sharper and looking forward to Day 2 tomorrow!