Prague has a long tradition in science, literature and the arts, with the first university in central Europe, Universitat Karlova, founded in 1348. It is also one of the most visited cities in Europe. Thus, it seemed fitting that it held the 3rd annual conference of the European Stroke Organisation (ESO) in May 2017. Over three full days, 4200 delegates from 110 countries came together in Prague to debate, discuss and share knowledge on recent advances on every single aspect of stroke care, from prevention, to acute management, neuroimaging, rehabilitation, genetics – and the list goes on!
The conference programme was abundant and included two pre-conference meetings on Monday 15th of May; the 3rd annual ESO-EAST workshop, where delegates from 23 Eastern European countries came together to improve stroke care in Eastern Europe and the ESO Trial Alliance Workshop, where more than 120 researchers across Europe discussed ways in which better European collaboration can be achieved in stroke research.
Over the next three days of the main conference, we were treated to a vast choice of high quality sessions. There were multiple parallel sessions, including for the first time four sessions specifically tailored for allied healthcare professionals, as well as workshops on various clinical stroke syndromes, acute management, neuroimaging, secondary prevention, and research methodology. Finally, with more than 1500 posters to view during breaks, the evening guided poster-walking sessions and an excellent exhibition, we were extremely busy for the whole duration of the conference!
Importantly, the conference provided an update on major clinical trials. During the opening plenary, after an introductory welcome to the conference and Prague we listened to results from many large clinical trials:
- The CLOSE and Gore-REDUCE trials, both showed that Patent foramen ovale (PFO) surgical closure, significantly reduces the risk of recurrences in young adults with cryptogenic stroke.
- Next, the DAWN study gave the extremely hopeful message that the treatment window for stroke has widened, with mechanical thrombectomy preventing disability in patients with severe strokes and “mismatch” on imaging, up to 24 hours from symptom onset. In addition, there was no significant difference in stroke related mortality or intracranial haemorrhage in the thrombectomy treated patients.
- The PICASSO study, showed that probucol can be used to reduce cholesterol level and risk of recurrent events in patients with ischaemic stroke who have high risk of cerebral haemorrhage.
- The NOR-TEST study showed that tenecteplase is as efficacious and safe as alteplase in acute stroke.
More detailed results from the opening plenary along with interviews of the primary investigators can be found here. In the afternoon of the same day, the presidential symposium continued the update on major clinical trials after the presentation of well-deserved awards; the Presidential award to Professor Joanna Wardlaw from the University of Edinburgh, ESO Research Excellence Award to Daniel Strbian from the University of Helsinki, and three of the five Young Investigators awards to UK based researchers, Shane Lyons, Vafa Alakbarzade and Alan Cameron. Important findings from the presidential symposium were:
- The TO-ACT study, showed no benefit from endovascular treatment (thrombolysis or thrombectomy) versus anticoagulation in cerebral venous thrombosis.
- Similarly, the TALOS trial did not show positive results; although citalopram use was safe in ischaemic stroke, there was no change in functional outcome or recurrent events.
- The VISTA trial showed good functional outcomes of thrombectomy, with an odds ratio of improved disability of 1.94 favouring thrombectomy and no significant change in mortality. The efficacy of thrombectomy and functional outcomes were significantly related to time from onset of stroke to puncture, reaffirming the previous motto of “time is brain”.
- The HERMES collaboration presented data that could help guide patient selection for thrombectomy, showing that the benefits of thrombectomy are greater in patients with smaller ischaemic core size on CT-perfusion and MRI while it remains effective for a volume up to at least 70mls.
- Finally, the TESPI trial advocated the use of thrombolysis in patients >80 years old within 3 hours of onset.
More details on the trials presented at the presidential symposium can be found here.
Finally, on the last day of the conference, we heard the results of important Late-Breaking clinical trials:
- The SPACE-2 trial added to the evidence of low periprocedural complications of carotid endarterectomy and stenting in patients with asymptomatic carotid artery disease.
- The PRASTRO-I study investigating prasugrel, a new platelet inhibitor, less reliant on resistance, showed no significant difference in stroke, myocardial infarction or other vascular disease between patients treated with prasugrel and those treated with clopidogrel. However this did not reach the predefined non-inferiority threshold.
- Finally, both the ANSTROKE and GOLIATH trials showed no differ- ence in functional outcomes between patients who received endo-vascular treatment with general anaesthesia and those who received sedation.
Many more studies were presented throughout the whole of the conference over more than 50 parallel sessions and 2 guided poster-walks; too many to report. But with all abstracts published online at the European Stroke Journal, you can read to your hearts content! https://goo.gl/3ysrzE
In addition to updating us in scientific advances, a recurring theme throughout the whole of the conference, was that of international collaboration. The move towards a more organised, collective effort to improve stroke care and the emphasis on the global aspects of stroke became evident from the first day of the conference, when the ESO and the Stroke Alliance for Europe (SAFE), signed a Memorandum of Understanding pledging both organisations to work together towards improving stroke care in Europe.
Next, we saw the launch of the Burden of Stroke in Europe report (http://strokeeurope.eu/) which presents sobering data on the predicted increases in coming years; with a predicted number of 819,771 stroke events in 2035, a 34% increase from 2015 and estimated approximately 4.6 million people living with stroke in Europe at that time, both the economic cost to healthcare systems and the pressure to services will increase. The importance of improving stroke care delivery was strongly highlighted in the report that called for a national stroke strategy for each European country.
Finally, the joint ESO – WHO session on Global Perspectives of Stroke, explored themes such as the effects of poverty on prevalence and outcomes, regional variations in individual risk factors and the emergence of air pollution as a stroke risk factor.
Overall, the 2017 ESOC was an amazing conference with a wealth of scientific presentations, practical workshops, ample networking opportunities and an emphasis on global perspectives and international collaboration; all in a beautiful, historic and most importantly sunny city.
I am definitely looking forward to the 4th European Stroke Organisation Conference, in May 2018, in Gothenburg and hopefully you are too!