Dr. Lina Palaiodimou

Dr. Lina Palaiodimou

In the ever-evolving landscape of stroke research and treatment, the European Stroke Organisation Conference (ESOC) stands as a beacon of innovation and collaboration. Navigating the frontiers of stroke management, like a true Viking, requires courage, resilience, and a relentless pursuit of knowledge. ESOC 2018 brought together a confluence of minds dedicated to charting new paths and pioneering approaches towards improved patient outcomes post-stroke.

The presentation of the “Intravenous Thrombolysis in Stroke Patients with Unknown Time of Symptom Onset – Results of the Randomized Controlled WAKE-UP Trial” by Götz Thomalla at ESOC 2018 undoubtedly captured significant attention and sparked important discussions within the stroke community. This trial addressed a critical challenge in acute stroke management: treating patients with an unknown time of symptom onset. By assessing the mismatch between the ischemic lesion visualized on diffusion-weighted imaging (DWI) and the absence of ischemic changes on fluid-attenuated inversion recovery (FLAIR) imaging, the WAKE-UP trial aimed to select patients likely within a time window suitable for thrombolysis. Showing positive results favoring the administration of alteplase among acute stroke patients with an unknown time of onset and a DWI-FLAIR mismatch, the WAKE-UP trial paved the way for a paradigm shift in acute stroke management guidelines, challenging the conventional time-based approach to thrombolysis eligibility and introducing advanced neuroimaging into routine clinical practice.

In the setting of secondary stroke prevention, the “Primary results of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial” presented by S. Claiborne Johnston during ESOC 2018, was a significant milestone in stroke prevention research. This trial examined the effectiveness of combining aspirin and clopidogrel in reducing the risk of major ischemic events in patients who had recently experienced a minor stroke or high-risk TIA, which was indeed confirmed according to the presented results. The results of the POINT trial had important implications for clinical practice, being one of the pivotal trials suggesting that dual antiplatelet therapy may be considered as a treatment option for patients at high risk of recurrent stroke following a minor ischemic stroke or TIA. However, as with any medical intervention, it’s essential for clinicians to weigh the potential benefits against the risks (since dual antiplatelet treatment was also associated with a higher risk of major hemorrhage at 90 days during the POINT trial) and individual patient factors before making treatment decisions.
Another challenge in stroke care, secondary prevention management after an embolic stroke of undetermined source (which is still debated to date), was also addressed during ESOC 2018. The “Rivaroxaban for secondary stroke prevention after embolic stroke of undetermined source: main results of the NAVIGATE ESUS trial”, presented by Robert Hart during ESOC 2018, investigated the efficacy and safety of rivaroxaban in preventing recurrent stroke in patients who had experienced an embolic stroke of undetermined source. The primary outcomes of the NAVIGATE ESUS trial did not reveal a significant difference in the rate of recurrent stroke or systemic embolism between patients treated with rivaroxaban and those administered aspirin. This outcome diverged from initial expectations regarding rivaroxaban’s efficacy as a potential therapy for secondary stroke prevention in this specific patient cohort. These results underscore the intricate nature of stroke prevention and underscore the imperative for further investigation to better comprehend the underlying mechanisms and identify optimal treatment approaches for various stroke subtypes.

In the management of primary intracerebral hemorrhage, the “Results from the tranexamic acid for primary intracerebral haemorrhage-2 (TICH-2) trial” were also presented during ESOC 2018 by Nikola Sprigg. The TICH-2 trial investigated the efficacy of tranexamic acid in improving outcomes for patients with intracerebral hemorrhage, a stroke subtype which remained largely underrepresented in stroke trials and conferences. While the trial did not demonstrate a significant improvement in functional status among patients treated with tranexamic acid compared to placebo, it did show a reduction in early deaths and serious adverse events. The TICH-2 trial’s findings underscore the complexity of managing intracerebral hemorrhage and highlight the importance of continued research efforts to identify effective treatment strategies for this devastating condition.

The studies presented at ESOC 2018 exemplified the ongoing pursuit of excellence in stroke research and the collaborative efforts of researchers and clinicians worldwide to advance stroke care and improve patient outcomes. As the journey towards enhancing stroke management and prevention continues, the insights gleaned from these trials have undoubtedly shaped clinical practice and pave the way for improved outcomes for individuals affected by stroke.