Thomas Meinel, MD

European Stroke Organisation Conference
September 1–3, 2021

The first part of the symposium was the awards ceremony for the presidential awards for 2021 and 2020 for exceptional late-stage researchers. The awardees were Professor Michael Brainin, past ESO and WSO president and founder of the ESO European Stroke Master programme, followed by Professor Bo Norrving, editor-in-chief of the European Stroke Journal, ESO founding member, past WSO president, and past ESO vice-president. Both were honored for their outstanding contributions to both stroke research and development of the ESO.

Next up were the awardees of the Scientific Excellence Award of 2021 and 2020. The first awardee was Professor Georgios Tsivgoulis, the vice-president of ESO. He not only contributed significantly to the recent guidelines on intravenous thrombolysis and blood pressure management, but he also has an impressive scientific track record with a special focus on evidence synthesis. The second awardee was Professor Urs Fischer, the former ESO secretary general. He is the principal investigator of several multicenter international trials answering burning questions of present stroke care with important results presented at this conference. Both awardees pointed out that clinical research is a team effort and dedicated their award to the study teams, collaborators, and PhD students.

As the first speaker of the scientific portion, Rainer Malik presented his research on genetics of white matter hyperintensities. Within the impressive laboratory and imaging database of the UK biobank, his analysis of 16,511 individuals showed that HTRA1 not only represents a risk gene for white matter hyperintensity burden, but was also associated with aneurysm, dissections, heart valve replacement and migraine with aura. The pathophysiology of the diminished protease activity might open new avenues towards prevention of stroke and vascular dementia.

The next speaker, Mark Bakker, presented the improved predictive capacity of a trait-level genetic risk score of 18 variants to predict cerebral aneurysm subarachnoid hemorrhage. This approach has already been helpful in coronary artery disease and especially improved the prediction in women. For this impressive analysis, he was among the recipients of the Young Investigator Award.

Laura Van der Kamp was also awarded the Young Investigator Award for her research on risk of rupture of intracranial  aneurysm in the setting of documented aneurysm growth on follow-up imaging. Pooling 15 international cohorts, the team developed the triple-S-prediction model factoring in size, shape and site of the aneurysm to predict rupture up to two years after follow-up. This score helps clinicians to balance aneurysm rupture risk against the expected risk of aneurysm treatment.

Jara Cárcel-Márquez presented data on her genetic analysis of a cohort of >800,000 individuals using the genome wide association study (GWAS) pairwise approach to identify genetic risk factors of cardioembolic stroke. The study team identified 40 novel loci and confirmed 4 known loci associated with cardioembolic stroke and 51 loci associated with atrial fibrillation. Insights into the pathogenesis of the genes (contraction, conduction and action potentials) might provide novel targets for detection and prevention of stroke in patients with atrial fibrillation and cardioembolic stroke.

Luis Prats-Sánchez reported on an analysis from the Microbleeds International Collaborative Network (MICON). In his analysis, he showed that statin therapy had no differential effect in patients with cerebral microbleeds at baseline, also irrespective of their anatomical distribution. This is important since the fear of intracranial hemorrhage should not be a reason to withhold this effective treatment in patients with microbleeds at baseline.

The next speaker of this excellent session was Jessica Gong from Australia. In her talk, she pointed out the enormous burden of cognitive decline and dementia after stroke. The study identified high-risk patients for cognitive decline and strengthens the fact that long-term cognitive sequelae of stroke should be included in upcoming trials.

Alvi Rahman presented his impressive analysis of the Clinical Practice Research Datalink of the UK on the association of oral anticoagulation and the risk of dementia in patients with atrial fibrillation. Using sophisticated statistical design, he could show that use of anticoagulation decreased the risk of dementia by roughly 10% with a pathophysiologically plausible lag time of around 2 years. The effect was also even more beneficial in older patients and underlines the importance of anticoagulation in patients with atrial fibrillation irrespective of stroke prevention.

The last speaker was Richard J. Perry reporting on the features and treatment of cerebral venous thrombosis after vaccination against COVID-19. The study showed that vaccine-induced immune thrombotic thrombocytopenia seldomly causes very severe cerebral venous thrombosis. Anticoagulation and immunoglobulin treatment might be effective treatment options. However, the benefits of the vaccination are not put into question by this study. 

Overall, this session of mostly young researchers and brilliant international studies was very encouraging and opens new avenues towards individualized treatment decisions and further clinical studies. During the lively Q&A period, the lead authors directly answered questions and received the well-deserved (virtual) applause of the stroke community.