Session Report Presidential Symposium Award & Large Clinical Studies

At this year’s Presidential Symposium Award & Large Clinical Studies session, the presentations demonstrated the evolving landscape of stroke research. With studies ranging from artificial intelligence in clinical decision-making to mobile health interventions and post-stroke dementia risk, the session showed ambition, innovation, and practical insight. Here’s what stood out.

One of the most talked-about studies was the GOLDEN BRIDGE II trial, which explored the use of an artificial intelligence-based clinical decision support system (AI-CDSS) to improve outcomes in patients with acute ischaemic stroke. The AI tool integrated data from hospital records, imaging, and clinician input to help guide treatment decisions around stroke etiology and secondary prevention. Over 21,000 patients from 77 hospitals were included, making this a substantial trial. The findings were promising: patients managed with the help of AI-CDSS had significantly better outcomes, with a 30% relative reduction in new vascular events after one year. However, because the randomisation was done at the hospital level rather than the patient level, variations in care between hospitals could have influenced the results. Nonetheless, the trial represents a strong case for the future role of AI in stroke care.

Another trial investigated a rather different approach to stroke prevention — a non-invasive treatment known as enhanced external counterpulsation (EECP). This method was tested in patients with severe intracranial arterial stenosis, a group at high risk for recurrent strokes. Patients received daily one-hour sessions of EECP, and researchers monitored changes in cerebral vasodilatory reserve (CVR) over six months using imaging techniques. The results suggested that EECP improved CVR and reduced the risk of further strokes. Though still considered early-stage evidence, it’s a compelling proof of concept that invites further exploration in larger trials.

A separate study based in Ghana tackled the challenge of blood pressure control in stroke survivors. The trial introduced a nurse-led, mobile health intervention that included home blood pressure monitoring, regular educational calls, and medication reminders. Over a 12-month period, patients receiving the intervention were significantly more likely to achieve blood pressure targets compared to those receiving usual care. This is an encouraging example of how relatively simple, scalable interventions — especially when delivered through mobile technology — can make a meaningful difference.

The long-term consequences of stroke were the focus of a five-year prospective cohort study examining the risk factors for post-stroke dementia. Researchers followed over 700 patients, conducting baseline MRI scans and cognitive assessments. They found that just under 9% developed dementia over the follow-up period. Those who did were more likely to have metabolic syndrome, low HDL cholesterol, small vessel disease, and atrial fibrillation. Interestingly, the risk of dementia appeared to increase over time rather than immediately after stroke. Female sex and receiving reperfusion therapy were associated with a lower risk.

Falls are a major concern for stroke survivors living in the community, and the FAST trial was the first to demonstrate that a tailored, home-based intervention could significantly reduce fall rates. The programme combined home safety adjustments, exercise integrated into daily routines, and support for community mobility. Participants in the intervention group had a one-third reduction in falls compared to those receiving usual care. The findings point to the value of personalised, practical support in stroke recovery — a relatively low-tech but high-impact approach that could be widely adopted.

Finally, the ESTREL trial addressed whether dopamine could enhance motor recovery after stroke. Patients were given either levodopa/carbidopa or a placebo over a five-week period, with motor function assessed using standardised tools. Despite the theoretical basis for dopamine’s role in neuroplasticity, the trial found no benefit. This negative result is valuable in its own right, helping to refine therapeutic focus and guide future research.

Altogether, these studies paint a rich picture of current directions in stroke research. From high-tech innovations to community-based interventions, the common thread is a growing emphasis on personalisation, prevention, and evidence-based care.