16th World Stroke Congress 

From October 23rd to 26th, almost 3000 people gathered on-site and on-line to participate in over 100 scientific sessions as part of the 16^th World Stroke Congress. The conference was held in Abu Dhabi, the capital of the UAE, and represents the flagship annual meeting for the World Stroke Organisation (WSO).

 The programme included abstract presentations in poster and platform format, recent research findings and robust discussions about the management of patients at the borderzones of evidence-based practice. 

 Hyperacute topics included an emphasis on Code ICH as being the natural counterpart to Code (ischaemic) Stroke, to provide a vehicle for delivering blood pressure management, reversal of anticoagulation and surgery to appropriate ICH patients. Debate around the appropriateness of EVT for LVO causing large core ischaemic stroke appeared to reflect differing societal values. People working in areas of the world that would place value on survival regardless of functional outcome would favour EVT for large core, likely based on CT/CTA but without CT perfusion. People working in areas that would place the most value on survival with a non-disabling stroke outcome would tend to use CTP to provide nuance to these discussions and would be less likely to offer EVT to patients with large-core stroke. 

 Both the ATTENTION IA and POST-UK trials were presented, neither finding an improvement in outcomes when Tenecteplase or urokinase (respectively) were administered intra-arterially after posterior circulation endovascular thrombectomy. 

 Other hyperacute topics included cytoprotection, with a keynote speech given by Dr Marc Fisher providing an overview of our global efforts thus far and defining a platform from which future trials might be planned.  Also covered was an emerging international interest in extending the code stroke CT angiogram by a few centimetres to include the heart. With only an extra 5 seconds to acquire images, Dr Luciano Sposato described work demonstrating that this approach can identify cardioembolic sources such as cardioaortic thrombus, changing management in a significant minority of patients. 

 Most in the audience indicated that in general they would switch from alteplase to Tenecteplase following the recent conclusion to the global shortage of Tenecteplase. There was lack of consensus regarding whether people would switch to Tenecteplase for all indications (e.g.including extended window thrombolysis) as opposed to just where tenecteplase had been the most strongly evidence-based (e.g. in LVO patients prior to EVT). The latter approach would require hospitals to support the use of both lytic agents with some risks to safety and practicality. 

Stroke Units, with a number needed to treat for benefit approximating the benefit from tPA, were another focus. The outgoing President of the WSO Dr Sheila Martins presented on how the WSO Stroke Unit Certification process works, including a team of 70 staff and achieving certification of 81 hospitals within 10 countries around the world in the last 3 years. Dr Luciano Sposato presented his views on the value of the on-site visit during the certification process and described the common gaps in stroke units; useful information for any country or stroke society considering WSO or other Stroke Unit certification. 

 Following on from admission to a stroke unit, Dr David Werring presented the OPTIMAS trial. Patients with atrial fibrillation were randomly assigned to anticoagulation with DOACs within 4 days of stroke compared with delayed anticoagulation at 7-14 days as the control, demonstrating noninferiority with respect to the composite endpoint of recurrent ischaemic stroke, symptomatic intracranial haemorrhage, unclassifiable stroke or systemic embolism at 90 days. One of the advantages of this study was the relatively large number (n=528; 14.6%) of patients with moderate-to-severe stroke (NIHSS >10 at randomisation), adding confidence around prescribing decisions for these patients. 

 Rehabilitation topics included optimising early rehabilitation after stroke, neuromodulation to improve stroke rehabilitation, depression and fatigue after stroke and lived experience reflections of the rehabilitation process. 

 Another focus topic was the role of artificial intelligence (AI) in stroke management. Pre-hospital care could be improved with better routing of ambulances and assistance for call takers, and paramedic assessment en route to the hospital could be improved with speech recognition for aphasia or dysarthria  (Dr Jonathan Coutinho). The use of a federated data platform could help overcome data security issues and assure GDPR compliance as employed within the UMBRELLA project (Dr Carlos Molina), with potential benefits for stroke diagnosis, prognostication and stroke prevention. 

 The WSO has a focus on developing and acknowledging stroke services globally. The specific challenges of translating evidence into practice in Low and Middle Income Countries (LMIC) was therefore covered in several sessions. This included implementing EVT, setting up stroke units and delivering stroke rehabilitation. The most recent Diamond Angels Awards winners were also acknowledged, recognising excellence in stroke care around the world including several stroke centres in LMIC. 

 At the World Stroke Organization assembly on 25/10/24 Prof Jeyaraj Pandian (India) moved into the role of President of the WSO and Prof Craig Anderson (Australia) moved into the President-elect role. We’re looking forward to joining them at the 2025 WSC to be held in Barcelona October 22-25.