Dixon Yang, MD
International Stroke Conference 2022
February 9–11, 2022
Session: Thursday Main Event
Moderators: Dr. Louise McCullough, Dr. Tudor Jovin
Speakers: Dr. Gary Rosenberg, Dr. Bradford Worrall, Dr. Suja Rajan, Dr. Ekaterina Barkradze, Dr. Angel Chamorro, Dr. Xin Cheng, Dr. Laurent Spelle
The Thursday Main Event of the International Stroke Conference included awards and a wide range of exciting late breaking science. To start, Dr. McCullough, ISC 2022 Program Chair from McGovern Medical School at UTHealth, presented the Thomas Willis Award to Dr. Rosenberg of the University of New Mexico. Dr. Rosenberg’s lecture discussed his work on identifying biomarkers in Binswanger’s disease, especially in the context of frequently co-existent Alzheimer’s disease. In particular, his work focused on matrix metalloproteinases (MMPs), which are involved in ischemic brain injury and VCI. The MarkVCID consortium explored angiogenic growth factors, cytokines, MMPs, and MRI biomarkers in Binswanger’s disease. Importantly, data from MarkVCID was used to create a Vascular Damage Score, which is a composite of MRI diffusion biomarkers and CSF AD pathology to help discern Binswanger’s disease and AD. Then, Dr. Worrall from the University of Virginia received the ISC Outstanding Stroke Research Mentor Award. He gave encouraging remarks on the importance of mentorship in training the next generation of clinicians and researchers.
Dr. Rajan from UTHealth School of Public Health began the late-breaking science sessions with her team’s economic evaluation of mobile stroke units (MSUs). In a prospective multicenter study, they evaluated multi-faceted health care utilization and quality-of-life (QoL). They showed patients treated in MSUs had slightly lower stroke-related health use and slightly better QoL at 1 year when compared to standard management. After considering the upstream cost of MSUs, this translated to about $33K per quality-adjusted life-year (QALY) in all patients and only $11K per QALY in those with premorbid mRS 0-1, which are both lower than the accepted threshold for stroke patients. This cost may be reduced even further with increased MSU patient volume.
Next, Dr. Barkradze from the University of Alabama presented recent results from ACTION-CVT, which retrospectively compared efficacy of DOACs and warfarin in central venous sinus thrombosis (CVST). They found no difference between the two anticoagulant classes in recurrent venous thromboembolism (extension or new) or imaging outcomes of partial or complete recanalization. Further, the DOAC group had significant less major hemorrhage events. The authors concluded DOACs are a possible alternative to warfarin in CVST, adding to the anticipation of upcoming randomized control trial data.
Dr. Chamorro from the Hospital Clinic of Barcelona then presented novel data from the CHOICE study, which evaluated the safety and efficacy of adjunct intraarterial alteplase following successful (TICI 2b or 3) mechanical thrombectomy in large vessel occlusion. In his group’s phase 2b double-blind placebo-controlled randomized trial, they found improved outcomes (mRS 0-1) in the alteplase group when compared to placebo with an absolute risk reduction of 18%. There were similar angiographic results and no increased risk of intracranial hemorrhage. However, the study was stopped short due to placebo manufacturing issues; thus, the authors concluded a larger follow-up study is needed.
Dr. Cheng (Huashan Hospital Fudan University) then shared her team’s latest results from the CHABLIS-T study, which evaluated thrombolysis using tenecteplase (TNK) for ischemic stroke up to 24 hours after last-known-well with CT perfusion imaging selection. In the first stage of this trial, the CHABLIS team compared 0.25mg/kg or 0.32mg/kg TNK in those with an anterior circulation occlusion and significant penumbra on CT perfusion from 4.5 to 24 hours from last-known-well. They found the lower dose had slightly high reperfusion rates than the higher dose. About 9% of patients developed symptomatic intracranial hemorrhage after TNK and also had mechanical thrombectomy. Thus, the group chose the lower dose in their ongoing phase 2b study.
Lastly, Dr. Spelle from Bicetre University Hospital shared his team’s data on Onyx™ for endovascular treatment of unruptured cerebral arteriovenous malformations. Their observational, prospective and multicenter study compared Onyx™ alone, Onyx™ as pre-treatment to neurosurgery, and Onyx™ as pre-treatment to radiosurgery. They reported a low treatment-associated mortality across groups (1 in 24 from intracranial hemorrhage possibly related to Onyx™). The overall cure rate for all modalities was about 75%, with total occlusion achieved by Onyx™ alone in 63%, and the remainder requiring adjunctive procedures. Amongst surviving patients, almost all had stable to improved mRS.