Mayank Goyal and Lars Thomassen chaired the session on “Reperfusion and Acute Ischemic Stroke” a report the following.

Once again the ESOC starts with a bang with some great presentations and excellent data!

A new DAWN? Wednesday morning, the session on reperfusion in acute ischemic stroke went directly into the core of the second revolution in stroke treatment – thrombectomy in the late time window– and showed that sophisticated medicine can be simplified. Dr. Simon Nagel from the Heidelberg group showed that simplified selection criteria for thrombectomy, using plain clinical data and non-contrast CT, predicts good outcome in clinical practice. This approach will speed up diagnostics, be more inclusive, save time and money and most probably will benefit the patient.

Bridge over troubled water? Dr. Kaesmacher from Bern and Dr. Pérez de la Ossa from Barcelona both demonstrated that IV thrombolysis as bridging therapy before thrombectomy is good for the patient, but that it is not a sufficiently strong weapon to tackle the disastrous large clots, neither in the mothership nor in the drip-and-ship setting. The success of thrombolysis is related to age and stroke severity, which we cannot modify, but also to time, which certainly can be dealt with. Dr. Ajmi from Stavanger, Norway, demonstrated the effect of simulation, teamwork and steady training to reduce door to needle time and improve patient outcome.

When is a little not enough? Dr. Seners from France showed that using the same bridging dose as recently published in NEJM, EXTEND IA TNK study, tenecteplase was not more effective than standard dose alteplase. It is possible that TNK may open the vessel faster as in this study, the time from drug administration to first run of the angiogram was much longer. Dr. Cameron warned against advocating lower doses of alteplase based on a SITS analysis. The next European Stroke Organisation Conference might show data on the higher, but safe NOR-TEST tenecteplase dose.