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Important studies presented at ESOC 2018

  • WAKE-UP Trial – Intravenous Thrombolysis in Stroke Patients with Unknown Time of Symptom Onset. Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, Cheripelli B, Cho TH, Fazekas F, Fiehler J, Ford I, Galinovic I, Gellissen S, Golsari A, Gregori J, Günther M, Guibernau J, Häusler KG, Hennerici M, Kemmling A, Marstrand J, Modrau B, Neeb L, Perez de la Ossa N, Puig J, Ringleb P, Roy P, Scheel E, Schonewille W, Serena J, Sunaert S, Villringer K, Wouters A, Thijs V, Ebinger M, Endres M, Fiebach JB, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Gerloff C; WAKE-UP Investigators. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med. 2018 Aug 16;379(7):611-622. doi: 10.1056/NEJMoa1804355. Epub 2018 May 16. PMID: 29766770. https://www.nejm.org/doi/10.1056/NEJMoa1804355
  • POINT Trial – Primary results of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke. Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, Kim AS, Lindblad AS, Palesch YY; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med. 2018 Jul 19;379(3):215-225. doi: 10.1056/NEJMoa1800410. Epub 2018 May 16. PMID: 29766750; PMCID: PMC6193486. https://www.nejm.org/doi/full/10.1056/NEJMoa1800410
  • NAVIGATE ESUS – Rivaroxaban for secondary stroke prevention after embolic stroke of undetermined source. Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, Swaminathan B, Lavados P, Wang Y, Wang Y, Davalos A, Shamalov N, Mikulik R, Cunha L, Lindgren A, Arauz A, Lang W, Czlonkowska A, Eckstein J, Gagliardi RJ, Amarenco P, Ameriso SF, Tatlisumak T, Veltkamp R, Hankey GJ, Toni D, Bereczki D, Uchiyama S, Ntaios G, Yoon BW, Brouns R, Endres M, Muir KW, Bornstein N, Ozturk S, O’Donnell MJ, De Vries Basson MM, Pare G, Pater C, Kirsch B, Sheridan P, Peters G, Weitz JI, Peacock WF, Shoamanesh A, Benavente OR, Joyner C, Themeles E, Connolly SJ; NAVIGATE ESUS Investigators. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med. 2018 Jun 7;378(23):2191-2201. doi: 10.1056/NEJMoa1802686. Epub 2018 May 16. PMID: 29766772. https://www.nejm.org/doi/full/10.1056/NEJMoa1802686
  • TICH-2 – Results from the tranexamic acid for primary intracerebral haemorrhage-2 trial. Sprigg N, Flaherty K, Appleton JP, Al-Shahi Salman R, Bereczki D, Beridze M, Christensen H, Ciccone A, Collins R, Czlonkowska A, Dineen RA, Duley L, Egea-Guerrero JJ, England TJ, Krishnan K, Laska AC, Law ZK, Ozturk S, Pocock SJ, Roberts I, Robinson TG, Roffe C, Seiffge D, Scutt P, Thanabalan J, Werring D, Whynes D, Bath PM; TICH-2 Investigators. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018 May 26;391(10135):2107-2115. doi: 10.1016/S0140-6736(18)31033-X. Epub 2018 May 16. PMID: 29778325; PMCID: PMC5976950. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31033-X/fulltext
  • EXTRAS – A trial to evaluate an extended rehabilitation service for stroke patients. Rodgers H, Howel D, Bhattarai N, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Laverty AM, McKevitt C, McMeekin P, Price CIM, Stamp E, Stevens E, Vale L, Shaw L. Evaluation of an Extended Stroke Rehabilitation Service (EXTRAS): A Randomized Controlled Trial and Economic Analysis. Stroke. 2019 Dec;50(12):3561-3568. doi: 10.1161/STROKEAHA.119.024876. Epub 2019 Oct 22. PMID: 31637972; PMCID: PMC7597995. https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024876
  • Interstroke – Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study. Peter Langhorne et al. Lancet, Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. 2018 May 19;391(10134):2019-2027. doi: 10.1016/S0140-6736(18)30802-X. Epub 2018 May 17. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30802-X/abstract
  • Gore-REDUCE – Showed that closure of a patent foramen ovale (PFO) prevents recurrent, potentially disabling stroke. Lars Søndergaard et al. NEJM Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. September 14, 2017
    N Engl J Med 2017;377:1033-1042 DOI: 10.1056/NEJMoa1707404 Vol. 377 No. 11. https://www.nejm.org/doi/full/10.1056/NEJMoa1707404
  • Phast-Trac – Showed that electrical stimulation of the throat muscles in patients with a tracheostomy after stroke improved the rate at which patients were ready for early removal of the tracheostomy and shortened the length of hospital stay. Rainer Dziewas et al. Lancet Neurol. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol. 2018 Oct;17(10):849-859. doi: 10.1016/S1474-4422(18)30255-2. Epub 2018 Aug 28. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30255-2/abstract

New ESO guidelines

  • Optimal treatment to prevent recurrent stroke
  • Which treatments should be used to reverse anticoagulation in patients developing an intracerebral haemorrhage
  • Mechanical thrombectomy should be made available to all appropriate patients presenting within 6 hours, regardless of age or stroke severity, and may be considered after longer delays with appropriate imaging
  • Optimal management for unruptured intracranial aneurysms