Important studies presented at ESOC 2017
- DAWN study – mechanical thrombectomy between 6 and 24 hours from symptom onset significantly prevented disability in patients with severe strokes and ‘mismatch’ on brain imaging. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG; DAWN Trial Investigators. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018 Jan 4;378(1):11-21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11. PMID: 29129157. https://www.nejm.org/doi/full/10.1056/nejmoa1706442
- CLOSE and Gore-REDUCE – PFO closure significantly reduces recurrent stroke in younger adults with cryptogenic stroke. Sondergaard L, Kasner SE, Rhodes JF, et al.; Gore REDUCE Study Investigators. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. New England Journal of Medicine 2017;377(11):1033-1042. https://pubmed.ncbi.nlm.nih.gov/28902580/
- PICASSO study – Probucol significantly reduces recurrent cardiovascular events in ischemic stroke patients with a high risk of cerebral haemorrhage. Kim BJ, Lee EJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kang DW; PICASSO investigators. Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial. Lancet Neurol. 2018 Jun;17(6):509-518. doi: 10.1016/S1474-4422(18)30128-5. PMID: 29778364. https://pubmed.ncbi.nlm.nih.gov/29778364/
- NOR-TEST study – No significant difference in functional outcome between acute stroke patients who received standard of care, alteplase, and those who received tenecteplase. Logallo N, Novotny V, Assmus J, Kvistad CE, Alteheld L, Rønning OM, Thommessen B, Amthor KF, Ihle-Hansen H, Kurz M, Tobro H, Kaur K, Stankiewicz M, Carlsson M, Morsund Å, Idicula T, Aamodt AH, Lund C, Næss H, Waje-Andreassen U, Thomassen L. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol. 2017 Oct;16(10):781-788. doi: 10.1016/S1474-4422(17)30253-3. Epub 2017 Aug 2. PMID: 28780236. https://pubmed.ncbi.nlm.nih.gov/28780236/
- RATS-3 (benefit of early intensive cognitive linguistic therapy. Four weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia.Nouwens F, de Lau LM, Visch-Brink EG, et al. Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3). European Stroke Journal. 2017;2(2):126-136. doi:10.1177/2396987317698327 https://journals.sagepub.com/doi/full/10.1177/2396987317698327
- T3 (nurse-initiated intervention to reduce disability). This evidence-based, theory-informed implementation trial, previously effective in stroke units, did not change patient outcomes or clinician behavior in the complex emergency department (ED) environment. Implementation trials are warranted to evaluate alternative approaches for improving ED stroke care. Nurse-Initiated Acute Stroke Care in Emergency Departments. The Triage, Treatment, and Transfer Implementation Cluster Randomized Controlled Trial. Sandy Middleton, Simeon Dale, N. Wah Cheung, Dominique A. Cadilhac, Jeremy M. Grimshaw, Chris Levi, Elizabeth McInnes, Julie Considine, Patrick McElduff, Richard Gerraty, et al. Originally published 16 May, 2019. https://doi.org/10.1161/STROKEAHA.118.020701 Stroke. 2019;50:1346–1355 https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.020701
- ASTER (contact aspiration versus stent retriever) – Among patients with ischemic stroke in the anterior circulation undergoing thrombectomy, first-line thrombectomy with contact aspiration compared with stent retriever did not result in an increased successful revascularization rate at the end of the procedure. Lapergue B, Blanc R, Gory B, et al. Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER Randomized Clinical Trial. JAMA. 2017;318(5):443–452. doi:10.1001/jama.2017.9644 https://jamanetwork.com/journals/jama/article-abstract/2646719
- VISTA Collaborators – The benefits of thrombectomy are confirmed and the importance of rapid treatment emphasized. Weimar C, Ali M, Lees KR, Bluhmki E, Donnan GA, Diener HC. The Virtual International Stroke Trials Archive (VISTA): Results and Impact on Future Stroke Trials and Management of Stroke Patients. International Journal of Stroke. 2010;5(2):103-109. doi:10.1111/j.1747-4949.2010.00414.x https://journals.sagepub.com/doi/abs/10.1111/j.1747-4949.2010.00414.x
- HERMES Collaborators: The benefits of mechanical thrombectomy for acute ischaemic stroke are greater with a smaller ischaemic core but it remains effective with increasing volume. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016 Apr 23;387(10029):1723-31. doi: 10.1016/S0140-6736(16)00163-X. Epub 2016 Feb 18. PMID: 26898852. https://pubmed.ncbi.nlm.nih.gov/26898852/
- TO-ACT Study: No significant benefit from endovascular treatment in severe cerebral venous sinus thrombosis. Coutinho JM, Zuurbier SM, Bousser M, et al. Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial. JAMA Neurol.2020;77(8):966–973. doi:10.1001/jamaneurol.2020.1022 https://jamanetwork.com/journals/jamaneurology/fullarticle/2765968#:~:text=The%20TO%2DACT%20(Thrombolysis%20or,with%20standard%20medical%20care%20alone.
- TALOS Study: Further research of SSRIs is required to assess benefit after ischaemic stroke. Kraglund KL, Mortensen JK, Damsbo AG, Modrau B, Simonsen SA, Iversen HK, Madsen M, Grove EL, Johnsen SP, Andersen G. Neuroregeneration and Vascular Protection by Citalopram in Acute Ischemic Stroke (TALOS). Stroke. 2018 Nov;49(11):2568-2576. doi: 10.1161/STROKEAHA.117.020067. PMID: 30355209. https://pubmed.ncbi.nlm.nih.gov/30355209/
- TESPI Study – Findings support thrombolysis for acute ischaemic stroke in patients over 80 years of age. Lorenzano S, Vestri A, Lancia U, Bovi P, Cappellari M, Stanzione P, Samà D, Bruscoli M, Cavazzuti M, Zini A, Rasura M, Beccia M, Comi G, Sessa M, Gandolfo C, Balestrino M, Agnelli G, Caso V, Gerbino Promis P, Pozzessere C, Anticoli S, Perini F, Marcon M, Vinattieri A, Caruso A, Magoni M, Furlan M, Orlandi G, Di Lazzaro V, Valente M, Nencini P, Cordisco M, Verna R, Toni D. Thrombolysis in elderly stroke patients in Italy (TESPI) trial and updated meta-analysis of randomized controlled trials. Int J Stroke. 2021 Jan;16(1):43-54. doi: 10.1177/1747493019884525. Epub 2019 Oct 26. Erratum in: Int J Stroke. 2020 Nov 17;:1747493020934756. PMID: 31657284. https://pubmed.ncbi.nlm.nih.gov/31657284/
- SPACE 2 Study – A Comparison of Stenting, Endarterectomy and Best Medical Management. Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Debus ES, Fiehler J, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Niesen WD, Barlinn K, Binder A, Glahn J, Hacke W, Ringleb PA; SPACE-2 Investigators. Carotid endarterectomy or stenting or best medical treatment alone for moderate-to-severe asymptomatic carotid artery stenosis: 5-year results of a multicentre, randomised controlled trial. Lancet Neurol. 2022 Oct;21(10):877-888. doi: 10.1016/S1474-4422(22)00290-3. PMID: 36115360. https://pubmed.ncbi.nlm.nih.gov/36115360/
- PRASTRO-1 Study – The non-inferiority of prasugrel to clopidogrel for the prevention of ischaemic stroke, myocardial infarction, and death from other vascular causes was not confirmed in Japanese patients with non-cardioembolic stroke. No safety concerns were identified. Ogawa A, Toyoda K, Kitagawa K, Kitazono T, Nagao T, Yamagami H, Uchiyama S, Tanahashi N, Matsumoto M, Minematsu K, Nagata I, Nishikawa M, Nanto S, Abe K, Ikeda Y; PRASTRO-I Study Group. Comparison of prasugrel and clopidogrel in patients with non-cardioembolic ischaemic stroke: a phase 3, randomised, non-inferiority trial (PRASTRO-I). Lancet Neurol. 2019 Mar;18(3):238-247. doi: 10.1016/S1474-4422(18)30449-6. Epub 2019 Feb 12. Erratum in: Lancet Neurol. 2020 Sep;19(9):e8. PMID: 30784555.
- The GOLIATH Study – General anesthesia does not result in more infarct growth compared with conscious sedation during endovascular therapy for stroke. Simonsen CZ, Yoo AJ, Sørensen LH, et al. Effect of General Anesthesia and Conscious Sedation During Endovascular Therapy on Infarct Growth and Clinical Outcomes in Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2018;75(4):470–477. doi:10.1001/jamaneurol.2017.4474 https://jamanetwork.com/journals/jamaneurology/fullarticle/2669924
- The ANSTROKE Study – In endovascular treatment for acute ischemic stroke, no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke. Löwhagen Hendén P, Rentzos A, Karlsson JE, Rosengren L, Leiram B, Sundeman H, Dunker D, Schnabel K, Wikholm G, Hellström M, Ricksten SE. General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke). Stroke. 2017 Jun;48(6):1601-1607. doi: 10.1161/STROKEAHA.117.016554. PMID: 28522637. https://pubmed.ncbi.nlm.nih.gov/28522637/
