The European Stroke Conference was held this year in the ExCel Exhibition centre in London on the 29-31 of May. It was attended by more than 4000 participants, and included more than 1000 posters in addition to the multiple symposia, oral sessions and lectures. The venue was excellent and the atmosphere relaxing, friendly and very educational.

During the first day the JJ Wepfer award was presented to both W Hacke and H-C Diener, and both gave informative lectures not only about their well-known achievements but also the mistakes they made and lessons learned over the years (particularly Dr Diener).

Results of several trials were presented during those three days, and there were several learning points. We learned, first, that intensive blood pressure reduction in acute cerebral haemorrhage was safe, but this did not significantly improve functional outcome (INTERACT II). On the same topic, surgery for lobar haemorrhage did not improve overall functional outcome; but some subgroup analyses were promising and I suspect the question of who would benefit from surgery remains open  (STICH II).  In acute ischaemic stroke, Chinese traditional medicine could not stand the test of RCTs and Neuroaid failed to show any benefit (CHIMES); albumin failed as well despite previous promises (ALIAS), while rtPA continued to show long term benefit at 18 months in the IST3 trial.

In lacunar strokes, aggressive blood pressure treatment (Systolic pressure (sys) <130) compared to standard blood pressure treatment (Sys <149) did not significantly reduce stroke recurrence (SPS3). Percutaneous PFO closure after a stroke, at one moment, did not reduce recurrent events (PC Trial) but later it did (RESPECT) and thus who benefits from PFO closure after stoke is still uncertain. The Germans did new things again; they showed us that you can provide thrombolysis in an ambulance, with a neurologist on board and a CT scanner, if you lived in Berlin; and onset to rtPA time can come down from 77min to 52 min.

Disability and maintaining vessel patency after stenting symptomatic carotid stenosis is similar to carotid endarterectomy on long term follow up beyond the peri-operative stage (ICSS, EVA3S). Treat unruptured asymptomatic AVMs conservatively; ARUBA was prematurely stopped as intervention of any kind was associated with significantly higher stroke and death rates. Another study which was stopped prematurely but for different reasons was the NEST 3 trial investigating transcranial laser therapy in acute stroke; this was stopped due to futility and we learned how funding suddenly disappeared and investigators were left alone to close the study. Another important finding was that intermittent pneumatic compression is useful in reducing proximal DVT after stroke (CLOTS 3).

There is always a controversial topic; this time we learned that hemicraniectomy significantly reduces death and severe disability in malignant MCA infarct also in patients above 60 years old (DESTINY II); this certainly will take us to uncharted territories. A final learning point, relevant to UK clinicians, is that alteplase is safe in patients on warfarin with INR <1.7.

At the closing ceremony the ESO flag was handed to the French organisers from Nice and they promised it will be very nice. See you there…