By Lauren Koffman, DO, MS
Between May 22 and 24 over 5,000 people from over 100 countries were present in Milan, Italy for the European Stroke Organization Conference (ESOC). As a first time participant, I was excited to explore the conference offerings. This year’s conference was held at the Milano Convention Center, the largest in Europe and over 2,400 abstracts were submitted for the meeting.
The three-day conference was full of events ranging from digital poster presentations, workshops, scientific meetings, networking events and exhibitions. The conference seamlessly integrated technology into their sessions with the downloadable ESOC phone app. The app made it possible to participate in the debates with pre- and post-debate voting, and included a feature “Ask the Speaker” for the PI live sessions.
The “Controversies in Stroke” session included lively debates presented by PIs for trials that released their results during the meeting. On the topic “Extending the window for reperfusion therapy-Do we need perfusion imaging?,” Dr. Henry Ma argued for the pro position and supported his claim with data recently published in The Lancet. His pooled analysis of data from EXTEND, ECASS-4 and EPITHET showed that alteplase improved functional outcomes at three months when given 4.5-9 hours after onset or in wake up stroke patients when imaging demonstrated perfusion mismatch (OR 1.86, p= 0.011). There was a higher incidence of symptomatic hemorrhage in alteplase treated patients (4.7% vs. 0.5%) but there was no significant difference in mortality (14% vs. 9%).
Another somewhat controversial topic covered in the debate was “Intravenous thrombolysis before endovascular thrombectomy-Not always.” Dr. Urs Fischer argued that some patients may benefit from directly proceeding to mechanical thrombectomy, without pre-treatment with alteplase. Dr. Fischer’s work as PI for SWIFT DIRECT aims to determine if patients with anterior circulation large vessel occlusions have non-inferior functional outcome at 90 days when treated with direct mechanical thrombectomy compared to those that received intravenous thrombolysis with mechanical thrombectomy.
During the Presidential Symposium there was a trials update, where there were several trials of interest, many relating to neurocritical care management of patients with intracerebral hemorrhage (ICH). Dr. T. Moullaali presented a pooled analysis of INTERACT2 and ATACH-II data to investigate optimal blood pressure control in ICH. In this study 3,829 participants were analyzed looking at “magnitude” of reduction in one hour, “achieved” (mean) and “variability” (standard deviation). Results showed positive linear associations for levels of achieved SBP and SBP variability with neurologic deterioration, death and any serious adverse event. Furthermore, there were trends to unfavorable outcomes with large SBP reductions (> 60mmHg) in one hour. They concluded that achieving and sustaining lower SBP was associated with better outcomes.
This trial was followed by Dr. N. Sprigg discussing “Transexamic acid for intracerebral haemorrhage-2 (TICH-2) Trial: Results of one-year follow-up data. TICH-2 previously showed no significant improvement in functional outcome (shift in mRS) at 90 days despite reduction hematoma expansion, but there were no long-term follow-up data reported. This study showed that TXA did not significantly improve functional outcome but did improve survival at one year in patients with ICH.
While free time could be spent exploring highlights in Milan including the Duomo and Galleria Vittoria Emanuele II, it was also a central point for travel throughout northern Italy. Lake Como was only a short train ride away, making it an easy afternoon adventure for a boat ride on the lake. Other nearby cities included Turin, Bergamo and Verona. After attending this year’s meeting I look forward to next year’s which will be held in Vienna on May 12-15, 2020.
Preferred forms of transportation at beautiful Lake Como.
Enjoying aperol spritzes while overlooking the Duomo di Milano.
The Milano Convention Center was nestled in the modern CityLife area of Milan.
Taking a stroll along the canals of the Navigli neighborhood.