By: Märit Jensen, Rustam Al-Shahi Salman
ESO European Stroke Science Workshop 2023
Session 1: A Delicate Balance
The start of this year’s ESSW was hampered by weather conditions in Germany which led to delays and cancellations of trains and flights of many arriving researchers. As a result, the first scientific session got off to a late start, giving those who had already made it to the meeting the opportunity to directly dive into discussion at the bar.
The first session entitled “A delicate balance” then started with the keynote lecture addressing the important topic of sex and gender in stroke care and research. This was followed by 2 prize-winning presentations provided by mid-career researchers selected by the organizing committee which represents one of the new features of this year’s ESSW.
Cheryl Carcel from Australia provided the keynote lecture entitled “Integrating sex and gender to stroke care and research: why and how”. Over the past years, numerous studies have provided evidence that there are important sex- and gender-based differences in stroke treatment as well as stroke research. This comprises differences in risk-factor profiles, pre-hospital assessment, functional outcome, and enrolment in clinical trials, just to name a few. Cheryl highlighted several of these topics in her talk and provided suggestions for overcoming these limitations in future research and stroke care. She presented results from an Australian study, which systematically analysed the results of pre-hospital assessment by paramedics in patients with a later confirmed diagnosis of stroke. In this study the likelihood of having a stroke was similar for women and men but women were more likely to be assessed as having migraine, anxiety and hypertension or other non-stroke diagnosis. She also provided an example underlining the need to be cautious when interpreting sex-specific analysis from smaller trials such as in an analysis of the MR-CLEAN trial suggesting that thrombectomy is not effective in women, a finding which was no longer present in the pooled individual patient-data meta-analysis of 5 thrombectomy trials. In the second part of her talk, she discussed reasons for under representation of women in stroke trials. These include potential trial specific factors that disproportionately exclude women and potential barriers preventing women from participating in trials. Finally, she suggested means for overcoming these limitations in the future including systemic collection of sex and gender data in trials and publication of disaggregated results by sex and gender. Cheryl further pointed to the need for increasing female leadership in stroke clinical research, of which she is a perfect example.
After the keynote lecture, we moved on to the prize-winning mid-career researchers’ presentations that were given by Corinne Benakis and Anke Wouters.
Corinne provided an overview of her research on the gut-brain axis in a talk entitled “Treat outside the box – the gut-brain axis in stroke”. Briefly summarized, current knowledge proposes that stroke causes an intestinal stress response which leads to mucosal barrier dysfunction and alternation of microbiota in the gut. Gut immune cell trafficking then may lead to neuroinflammation. An evolving series of experimental studies supports this understanding. Corinne investigated the gut-brain axis in her working group in a series of impressive studies that build on each other. Based on the findings she presented her research vision of a gut-microbiota “fingerprint” to inform novel therapeutic strategies for stroke treatment.
In the second presentation, Anke Wouters from Belgium gave a talk entitled “Acute stroke imaging: the path forward”. She mainly presented unpublished results of the prospective observational CRISP2 looking at different imaging profiles of lesion growth in acute stroke patients transferred from peripheral hospitals to interventional stroke centers. In this study performed in Leuven and Stanford stroke patients referred to peripheral hospitals underwent a standardized imaging protocol including perfusion imaging and a further imaging study using MRI immediately after admission to the thrombectomy center. Several imaging parameters identified patients with fast progression of the ischaemic lesion, i.e., hypoperfusion intensity ratio (HIR), baseline core volume, a cerebral blood volume (CBV) index, and the baseline collateral status. Patients could also be divided into those with stable imaging patterns, and subgroups who deteriorated or improved. Taken together, these results advocate for the use of perfusion imaging at peripheral stroke centers, as imaging results may not only guide the need for urgent treatment, but also inform enrolment in future trials of neuroprotection.
This first session was a perfect start for this year’s meeting and lively discussions continued over dinner and drinks.