ESOC Report: Large Artery Disease

In the afternoon the Large Artery Disease and Treatment Scientific Communication session took place, chaired by Anita Arsovska (North Macedonia) and Mauro Silvestrini (Italy).We had an opportunity to hear interesting lectures presented by experienced speakers.

Dr. Ntaios (Greece) presented the topic AORTIC ARCH ATHEROSCLEROSIS IN PATIENTS WITH EMBOLIC STROKE OF UNDETERMINED SOURCE: AN EXPLORATORY ANALYSIS OF THE NAVIGATE-ESUS TRIAL. On behalf of the NAVIGATE ESUS investigators, Dr. Ntaios analysed the baseline characteristics, stroke recurrence rates and response to rivaroxaban versus aspirin of participants with AAA. AAA plaques were considered to have complex features when reported as complex or ulcerated, or were ≥4mm in thickness or had a mobile thrombus present. The results showed that complex AAA was present in 8% of NAVIGATE-ESUS participants undergoing TEE and was associated with a trend for higher stroke recurrence rate. Too few events were observed among those with complex AAA to meaningfully assess the effect of antithrombotic treatment.

Dr. Humphries (UK) presented the lecture entitled RATES OF AORTIC ARCH ATHEROMA CORRELATED WITH CAROTID STENOSIS AND VASCULAR RISK FACTORS IN RETINAL ISCHEMIA PATIENTS PRESENTING TO A TERTIARY REFERRAL CENTRE TIA CLINIC, aiming to determine the rates of aortic arch atheroma (AAA) in patients with ischaemic transient (TVL) and permanent visual loss (PVL). The presented concluded that this is the first description of AAA in ischaemic visual loss. 51% have AAA, AAA is more severe in PVL and if CS >50%. Rates of AAA in PVL are comparable to patients with cerebral infarcts.

The third presentation was delivered by Dr. Greving  from The Netherlands “PREDICTING RISK OF VASCULAR EVENTS AFTER CAROTID REVASCULARIZATION MODEL DEVELOPMENT STUDY IN INDIVIDUAL PATIENT DATA FROM FOUR RANDOMISED TRIALS”. Dr. Greving  and his coworkers developed two prediction models for procedural stroke or death risk ≤30 days after CAS and CEA and one for postprocedural ipsilateral stroke risk >30 days after both procedures. Predictors of procedural risk after CAS were age, diabetes, atrial fibrillation, modified Rankin Scale (mRS) score, previous hemispheric event, serum creatinine, left-sided procedure, and ipsilateral severe carotid stenosis. Predictors of procedural risk after CEA were hypertension, mRS score, and serum creatinine. Hypertension, coronary heart disease, heart failure, and contralateral severe carotid stenosis/occlusion predicted postprocedural risk. The conclusion was that this is a good model that needs external validation before these models can be used to support treatment decisions in individual patients.

Than Dr. Caputi (Italy) gave a talk on a “RANDOMIZED STUDY COMPARING THE TYPE OF CAROTID STENT AND CEREBRAL PROTECTION DURING CAROTID ARTERY STENTING IN PATIENTS WITH HIGH-RISK PLAQUE”. A comparison of the safety and efficacy of the carotid stent Roadsaver (RS) vs. the Carotid Wallstent (CW) during carotid artery stenting (CAS) in patients with lipid-rich plaques. Both stents were randomly tested with FilterWire (FW) and MO.MA cerebral protection. The results showed that in patients with high-risk lipid-rich plaque undergoing CAS, MO.MA+RS seems to be a promising tool in limiting embolic risks.

On behalf of the Carotid Stenosis Trialists Collaboration, Dr, Poorthius (UK) oresented TIMING OF PROCEDURAL COMPLICATIONS AMONG ASYMPTOMATIC PATIENTS UNDERGOING CAROTID ENDARTERECTOMY: ANALYSIS OF VA, ACAS, ACST-1 AND GALA TRIALS. The authors aimed to assess frequency and timing of procedural complications after CEA, which may clarify underlying mechanisms and help inform safe discharge policies and concluded that half of the procedural deaths and strokes occur on the day of operation and one third after day 3 when most patients will have been discharged. This analysis of procedural complications may help in planning strategies to reduce procedural complications after CEA.

Dr. Harshfield (UK) presented “STENTING FOR SYMPTOMATIC VERTEBRAL ARTERY STENOSIS: POOLED INDIVIDUAL PATIENT DATA ANALYSIS OF VIST, VAST AND SAMMPRIS”. The pooled analysis of available data from completed vertebral artery stenting trials did not show a statistically significant benefit for either medical or interventional therapy. There was no evidence of even a trend of benefit of either strategy for IC stenosis. Stenting for EC stenosis might be beneficial, but further larger trials are required to determine whether there is benefit in this subgroup.

RARE GENETIC VARIANTS IN PATIENTS WITH CERVICAL ARTERY DISSECTION was presented by Dr. Traenka (Switzerland). The authors included 43 patients and concluded that suggestive or CeAD-causing variants were detected in 14/32 affected families. CeADcausing variants were more likely to be identified in patients with CeAD-f than in those with CeAD-r.

The last lecture was delivered by Dr. Awadh from Egypt who talked on the topis “CLOPIDOGREL ANTIPLATELET LOADING IN ISCHEMIC STROKE OF RECENT ONSET (CAIRO) TRIAL”. After the thorough analysis, the conclusion was that loading clopidogrel is safe and superior to aspirin in acute ischemic stroke within 9 hours.