Session Report: Presidential Symposium Awards and Large Clinical Studies

This year’s presidential Symposium Awards and Large Clinical Studies Session, chaired by Götz Thomalla (Hamburg, Germany) and Guillaume Turc (Paris, France), highlighted the expanding horizons of stroke research. After the presentation of ESO Awards, the Honorary Member Awards, the ESO Emerging Leaders and the Angel Awards, seven studies were presented.

Amrou Sarraj presented the results of the individual patient-data meta-analysis on the endovascular treatment (EVT) for large ischemic stroke from the “Analysis of Mechanical Thrombectomy for Large core ischemic Stroke (ATLAS)” collaboration. This meta-analysis included six randomized clinical trials and sought to evaluate the safety and efficacy of EVT versus best medical care among patients with large ischemic core. A total of 944 patients undergoing EVT and 942 receiving medical management were included. ATLAS meta-analysis demonstrates benefit of EVT in wide-spectrum of patients with large core strokes (Number needed to treat – NNT of 4 for improving 1-point or more on modified Rankin Scale – mRS). Consistent improvements were also detected in functional independence, independent ambulation and mortality.

Maarten Uyttenboogaart presented the Carotid Artery Stenting during Endovascular treatment of Stroke (CASES) trial. This is a phase III international multicenter randomized clinical trial with open label treatment and blinded outcome assessment (PROBE) with non-inferiority design, conducted in 26 EVT centers in the Netherlands and Belgium, aiming to investigate if the immediate carotid artery stenting (CAS) during EVT is non-inferior to a deferred treatment strategy for patients with acute ischemic stroke due to tandem lesions. Overall, non-inferiority was not met, since the distribution of mRS scores at 90 days between the two groups did not differ significantly. However, CAS during EVT improved recanalization rates and increased the patency of the carotid artery at 24 hours and 90 days. Moreover, CAS during EVT was safe and did not increase the rate of symptomatic ICH and mortality rate.

 

LATE-MT was presented by Jianmin Kiu. This is a randomized controlled clinical trial aiming to investigate the effectiveness of EVT treatment in the time window of 24-72 hours of onset, in acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO) of the anterior circulation, with an NIHSS score ≥6 points and favorable CT perfusion profile (infarct core volume <50 ml, mismatch ratio ≥1.8 and mismatch volume ≥1.5 ml). The results of this trial showed that EVT in the time window of 24-72 hours after onset improved 90-day functional outcome. However, this resulted in increased mortality and higher rates of symptomatic intracerebral hemorrhage (sICH) compared with standard medical care, suggesting that more selective patient targeting for EVT in the very late time window may yield better outcomes.

The MILD-MT trial aiming to investigate the safety and effectiveness of EVT for patients with mild ischemic stroke caused by acute anterior LVO through perfusion imaging screening was presented by Wenhuo Chen. This multicenter prospective randomized controlled clinical trial, conducted in China, included 144 patients in the group of combined EVT plus best medical management (BMM) and 156 in the group of BMM alone. The trial was positive, achieving the primary efficacy endpoint with higher rates of mRS score 0-1 in the group of EVT+BMM. Moreover, the trial supported the perfusion-based selection of patients with mismatch≥50 ml.

Craig Anderson presented the CRAFT trial, a multicenter, prospective, randomized, open, blinded outcome assessed (PROBE) clinical trial, aiming to determine the safety and effectiveness of more intensive blood pressure (BP) lowering in patients with atrial fibrillation (AF). In this trial each group included 838 patients, who received home BP monitoring to guide treatment. Overall, in patients with AF, the intensive home BP guided strategy (target SBP<120 mmHg) did not reduce major cardiovascular events compared with standard treatment (target SBP<135 mmHg). However, the detected heterogeneity of treatment across prespecified subgroups, with apparent benefits of intensive treatment in males, younger people, and in those on oral anticoagulant suggests an individualized approach to BP-lowering treatment targets in patients with AF.

Elizabeth Lightbody presented the COMMITS trial, a multicenter randomized controlled trial aiming to evaluate the effect of motivational interviewing (MI) compared with Attention Control (AC) and Usual Care (UC) on depressive symptoms post-stroke. A total of 1246 consecutive adult acute stroke patients across 18 sites were included. Motivational Interviewing was associated with a small but consistent reduction in depressive symptoms, without any significant functional, quality-of-life, or economic benefit. These effects were observed in a predominantly mild stroke population with low baseline psychological morbidity.

Jeffrey Saver presented the DISTALS trial, evaluating the safety and effectiveness of the Tigertriever 13 Revascularization Device in restoring blood flow in the neurovasculature in patients presenting within 24 hours of onset with an ischemic stroke with disabling neurological deficits due to a primary distal vessel occlusion (DMVO). This was a multicenter, prospective, randomized, blinded (endpoint), controlled study, conducted in 25 centers in US and Europe. Rates of sustained reperfusion at 24h were significantly higher, whereas no symptomatic ICH occurred in the EVT group using Tigertriever 13.

The second Large Clinical Trial session delivered compelling new evidence across a broad spectrum of topics, including primary prevention, acute stroke management, reperfusion therapy, and post-stroke care, leaving the audience of more than 4,000 participants eager for the upcoming sessions of the 12th European Stroke Organisation Conference 2026 in Maastricht.