European Stroke Organisation Conference (ESOC 2026)

Between the 6-8^th May 2026, the 12^th European Stroke Organisation Conference (ESOC 2026) took place at the MECC Maastricht, the Netherlands.

The event attracted over 4,200 participants from 96 countries, featuring 288 faculty speakers, 48 exhibitors, and over 2,000 submitted abstracts, with a programme reflecting the evolving landscape of stroke care through a mix of plenary sessions, interactive formats, and hands-on learning.

Day 1

Day 1 opened with a formal introduction and welcome from Mira Katan and Wim Van Zwam, who highlighted the scientific programme and emphasised opportunities for networking and the accompanying social events.

Morning sessions covered key advances across the stroke care pathway, including pre- and interhospital management, evolving thrombolysis strategies, and adjuncts to reperfusion. In a session with a dedicated focus on stroke in young adults, cerebrovascular complications were identified as the principal determinant of poor functional outcome in reversible cerebral vasoconstriction syndrome, with thunderclap headache and sexual activity acting as clinical markers rather than benign triggers.

The large clinical trials session addressed optimisation of endovascular stroke therapy, with several key trials presented. Adjunctive reperfusion strategies were explored in EXTEND-IA DNase and TECNO, though neither demonstrated clear efficacy despite acceptable safety profiles. Physiological optimisation was a recurring theme, with MASTERSTROKE showing no additional benefit of a higher systolic blood pressure target (170 vs 140 mmHg) during thrombectomy. Emerging neuroprotective approaches produced mixed results: intra-arterial hypothermia in the CHILL-ART study improved functional outcomes, whereas selective cooling strategies in a separate trial did not improve 90-day outcomes despite reduced incidence of intracranial haemorrhage. In OCEANIC-STROKE, 50 mg of asundexian reduced both the occurrence and severity of recurrent ischaemic stroke in patients with non-cardioembolic or high-risk transient ischaemic attack compared with placebo.

Afternoon sessions spanned rehabilitation and life after stroke and advanced imaging and AI in acute decision-making, alongside sessions on intracerebral haemorrhage treatment and recurrent stroke prevention. A session focused on Disparities in Stroke: Age, Sex, and Ethnic Differences evidenced that women experience faster cognitive decline after stroke than men and that stroke incidence is rising again in socioeconomically disadvantaged and some ethnic minority groups in a South London-based study, highlighting widening inequalities and suggesting gaps in the uptake and effectiveness of current prevention strategies.

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The fireside chats throughout the day at the ESOC Stage continued to attract strong engagement, with topics including “From Bench to Burnout? Why Become an Experimental Stroke Researcher – If at All?” and “How can we Facilitate the Best in Stroke Rehabilitation Research?”, fostering lively and interactive discussion between speakers and the audience.

Day 2

Early sessions focused on acute stroke imaging, cancer-related stroke, and the brain and heart interaction, where evidence was presented for chronic monocyte recruitment to the heart after stroke in mice and for interleukin-1β-driven innate immune memory as a mediator for post-stroke cardiac dysfunction. The ARCADE group provided a systematic review update, highlighting that atrial fibrillation detected after stroke is a continuum of burden, rather than a binary concept.

Discussions on post-stroke cognitive impairment highlighted emerging approaches to prediction and mechanisms. Imaging-based models incorporating lesion network mapping may improve risk stratification beyond lesion location alone, though larger datasets are needed. Cerebral small vessel disease was emphasised as a key driver of long-term vascular decline, with evidence linking progression to a pro-inflammatory immune profile and microstructural white matter damage.

Day 2’s clinical trial session focused strongly on thrombectomy. Trials such as ATLAS reinforced the benefit of endovascular thrombectomy in large core infarcts up to 24 hours, demonstrating consistent improvements in functional outcomes, whilst LATE-MT extended the treatment window further (24–72 hours), showing functional benefit despite increased risks, including symptomatic haemorrhage. MILD-MT suggested potential benefit of endovascular treatment in mild stroke, whilst DISTAL showed that thrombectomy for distal vessel occlusions was technically effective and safe, with non-positive clinical endpoints but signals of potential clinical benefit at 3 months in patients with more severe deficits at onset.

Beyond reperfusion, the CRAFT trial found no added benefit of intensive blood pressure lowering in patients with atrial fibrillation, while COMMITS demonstrated modest improvements in mood with motivational interviewing after stroke, without clear functional or economic benefit.

Day 3

A session on Early Treatment Strategies and Outcome Determinants in Acute Stroke focused on early risk stratification and determinants of deterioration, noting that migraine-like features in transient ischaemic attack presentations, particularly in patients aged ≤65 years, do not necessarily confer lower stroke risk, and that very early neurological deterioration varies by stroke aetiology. Further validation is required to confirm the potential benefit of dual antiplatelet therapy in large artery disease.

The clinical trials session highlighted evolving adjunctive pharmacological strategies in acute ischaemic stroke, with particular interest in antiplatelet therapies following endovascular thrombectomy.

TAPIS indicated slight benefit of early dual antiplatelet therapy of ticagrelor and aspirin, whilst the ATTRACTION trial demonstrated improved functional outcomes using tirofiban without significant increases in intracranial haemorrhage in a Chinese population. GREEN showed no benefit and a signal towards harm with glycoprotein VI inhibition, whilst GALLOP-2 suggested improved functional outcomes with GLP-1 receptor agonist therapy, albeit with increased haemorrhagic events.

Beyond acute treatment, EXCOA-CVT found no advantage of extending anticoagulation after cerebral venous thrombosis to 24 months, supporting more individualised care.

Emerging topics and future directions

ESOC 2026 underscored both the promise and complexity of adjunctive medical therapies in optimising stroke outcomes, particularly in the post-thrombectomy setting, alongside broader advances in understanding residual risk in cardioembolic stroke, cerebral amyloid angiopathy, and the growing role of AI and emerging technologies. Across the meeting, key priorities for future research emerged, including the need to refine patient selection and personalise treatment strategies, supported by deeper mechanistic insights, such as immune-cardiac interactions and inflammation-driven small vessel disease. Advances in imaging and lesion network mapping offer further promise for improving outcome prediction, though require larger, harmonised datasets, whilst persistent disparities in stroke incidence and outcomes highlight the importance of more equitable prevention and inclusive research. Collectively, these themes point to a shift from broad treatment paradigms to more individualised, mechanism-based stroke care.

Conclusion

As the meeting drew to a close, there was a shared sense of momentum, with attention turning to ESOC 2027 in Vienna, Austria, where further advances in stroke research and care are expected to build on this year’s progress.

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