Session Report: Closing Ceremony & Large Clinical Trials 2

The closing session of ESOC 2026, chaired by Urs Fischer and Else Sandset, concluded three days of high-level scientific exchange in Maastricht with the presentation of ESOC awards and a series of major late-breaking clinical trial results spanning acute stroke treatment, secondary prevention, cerebral venous thrombosis, and stroke imaging.

Craig Anderson presented secondary cognitive and imaging outcomes from the TRIDENT trial, a multinational, double-blind, placebo-controlled trial of a triple low-dose antihypertensive pill after intracerebral haemorrhage, recently published in the New England Journal of Medicine. Over a mean follow-up of 3 years, no significant difference was observed between the triple-pill and placebo groups in cognitive outcomes or MRI markers of cerebral small vessel disease, suggesting that longer follow-up or larger dedicated studies may be needed to detect potential cognitive benefits of sustained blood pressure lowering after ICH.

Mikael Mazighi presented the GREEN trial, evaluating intravenous glenzocimab as an adjunct to mechanical thrombectomy in large vessel occlusion stroke. The trial was terminated early for futility after enrolling 102 patients, with no benefit on the 90-day mRS ordinal shift and a numerical trend toward worse outcomes in the treatment arm.

The GALLOP-2 trial, presented by Hao Wang and Yiu Ming Bonaventure Ip, evaluated short-course adjunctive semaglutide in patients with anterior circulation large vessel occlusion treated with endovascular thrombectomy without prior thrombolysis. Semaglutide was associated with improved 90-day functional outcomes and a favourable mRS distribution shift compared with standard therapy, supporting further investigation of GLP-1 receptor agonists as neuroprotective agents in acute ischaemic stroke.

Diana Aguiar de Sousa presented the 24-month results of the EXCOA-CVT cluster-randomised trial, conducted across 43 centres in 21 countries, comparing 3–6 versus 12 months of anticoagulation after cerebral venous thrombosis. Consistent with the 12-month results, no evidence emerged that prolonging anticoagulation provides additional clinical benefit, supporting an individualised approach to treatment duration in clinical practice.

Marios Psychogios presented the SPINNERS trial, a multicentre non-inferiority study evaluating syngo DynaCT Sine Spin flat-detector CT versus multi-detector CT for intracranial haemorrhage detection in 251 stroke patients across 13 hospitals. Overall non-inferiority was not met, but sensitivity exceeded 96% in patients with NIHSS ≥10 and in high-volume centres, suggesting a potential role for FDCT in One-Stop Management and Direct-to-Angio workflows in selected patients.

Yilong Wang presented the TAPIS trial, simultaneously published in The Lancet, a double-blind, placebo-controlled trial of early ticagrelor-aspirin dual antiplatelet therapy combined with intravenous thrombolysis in 1,382 patients with moderate ischaemic stroke across 60 hospitals in China. Early DAPT significantly improved the rate of excellent functional outcome at 90 days (68.7% vs 62.0%; RR 1.11; p=0.0089) without a meaningful increase in symptomatic intracranial haemorrhage, representing an important advance in acute stroke care pending validation in broader populations.

Guoyong Zeng and Jeffrey L. Saver presented the INSTANT trial, simultaneously published in JAMA, evaluating intravenous tirofiban after tenecteplase in 359 patients with acute ischaemic stroke without large vessel occlusion who had an insufficient clinical response to thrombolysis. The unadjusted primary outcome favoured tirofiban (mRS 0–1: 63.8% vs 52.2%; p=0.03), though the adjusted analysis did not reach significance, and tirofiban did not increase haemorrhagic risk, suggesting a promising rescue strategy warranting confirmation in larger trials.

Xiang Luo presented the ATTRACTION trial, evaluating adjunct tirofiban after successful endovascular recanalization in 1,380 patients with anterior circulation large vessel occlusion stroke across 82 centres in China. Tirofiban significantly improved functional independence at 90 days (49.3% vs 43.3%; adjusted RR 1.15; p=0.009) without a significant increase in symptomatic intracranial haemorrhage or mortality, though external validation in broader international populations is warranted.

Elena Zapata-Arriaza presented the ATILA trial, a Spanish multicentre randomised trial comparing low-dose intravenous tirofiban versus intravenous aspirin as periprocedural antiplatelet therapy in 240 patients with tandem lesion stroke undergoing mechanical thrombectomy plus emergent carotid stenting. Tirofiban significantly reduced acute in-stent reocclusion at 24 hours (7.2% vs 16.8%; aOR 0.345; p=0.015) and intra-stent aggregation, without a statistically significant increase in symptomatic intracranial haemorrhage, supporting its use in this challenging and underrepresented patient population.

The closing session of ESOC 2026 delivered an exceptional and rich programme of late-breaking results, reflecting the breadth of global stroke research. The convergence of positive findings from TAPIS, ATTRACTION, INSTANT, and ATILA – all pointing toward early antiplatelet strategies in selected populations – alongside the nuanced results of SPINNERS and GALLOP-2, underscores the importance of patient selection and treatment context. ESOC 2026 concluded with a shared commitment to advancing stroke care through rigorous science and international collaboration.