Andy Lim, MBA, FACEM, GAICD
Here we are, officially welcomed to the 8th European Stroke Organisation Conference! Results of nine large trials were released this morning, and social media is already buzzing with excitement from these results. Here are the key findings for those who might have missed out.
Three tenecteplase trial results were released today. The AcT trial, a Canadian trial of 1600 patients with acute stroke, demonstrated that tenecteplase was noninferior (5% margin) to alteplase in acute ischaemic stroke with comparable functional outcomes and no significant safety issues. NOR-TEST 2A, a Norwegian trial of 1036 stroke patients up to 4.5 hrs inclusive of wake-up stroke, could not show that tenecteplase is non-inferior. Tenecteplase yielded worse safety and functional outcome compared with alteplase. Dose chosen was 0.4mg/kg, and part B intends to test the reduced dose of 0.25mg/kg. The Australian TASTE-A trial of 104 patients demonstrated significantly smaller CT perfusion lesions in patients treated with tenecteplase compared to alteplase, indicating earlier reperfusion, with no safety concerns.
Six additional studies were presented:
• The Paramedic Norwegian Acute Stroke Prehospital Project demonstrated significantly better functional outcome in an intervention group that trained paramedics in the use of NIHSS in the pre-hospital setting at the cost of longer on-scene time.
• SPRINT showed that a structured SMS message, education video, workbook, and telephone follow-up improved lifestyle and medication adherence.
• ATTICUS, stopped early for futility, showed us that apixaban not superior to ASA with switch to apixaban in case of AF in prevention new ischaemic lesions during 12 months follow-up of an enriched embolic stroke of undetermined source population.
• SETPOINT2 taught us that early versus late tracheostomy in ventilated stroke patients did not lead to better functional outcome at six months.
• AMETIS revealed similar rates of functional independence and major periprocedural complications when comparing procedural sedation versus GA in endovascular management of stroke.
• Finally, the Chinese ATTENTION trial demonstrated significantly improved functional outcome and secondary efficacy outcomes, as well as lower overall disability and mortality, when EVT was compared with best medical management in acute basilar artery occlusion within <12hrs from the estimated time (defined as the sudden onset of stroke symptoms consistent with acute basilar occlusion, excluding previous minor prodromal symptoms, or time the patient was last known to be well).
This sets the 8th ESOC off to a great start this Wednesday 4th May in Lyon, France!