I see nothing here that suggests there is any strategy to get survivors to 100% recovery.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=175432&CultureCode=en
Highlights from the first afternoon of ESOC 2017
*
ESO-SAFE partnership is launched with the release of the Burden
of Stroke Report, and a report on policy, access and quality of care.
* VISTA Collaborators: The benefits of thrombectomy are confirmed and the importance of rapid treatment emphasised.
*
HERMES Collaborators: The benefits of mechanical thrombectomy
for acute ischaemic stroke are greater with smaller ischaemic core but
it remains effective with increasing volume.
* TO-ACT Study: No significant benefit from endovascular treatment in severe cerebral venous sinus thrombosis.
* TALOS Study: Further research of SSRIs is required to assess benefit after ischaemic stroke.
* TESPI Study: Findings support thrombolysis for acute ischaemic stroke in patients over 80 years of age.
See
video interviews with principal investigators and summary slides at:
http://www.esoc2017.com/conference-information/conference-news.
Attendance at the third European Stroke Organisation Conference
(ESOC) outstripped demand for space in the opening plenary as more than
4,000 delegates gathered in Prague for three days of the latest clinical
study results, teaching courses and practical training. Excitement
generated by the scientific programme continued into the afternoon with
further data announcements, as well as the launch of the new partnership
between the European Stroke Organisation and the Stroke Alliance For
Europe (ESO-SAFE). Highlights from the afternoon's scientific programme
are outlined below.
Launch of the Action Plan for Stroke in Europe 2018-2030, ESO-SAFE Memorandum of Understanding and Burden of Stroke Report
The Memorandum of Understanding between the European Stroke
Organisation and the Stroke Alliance for Europe, cements a partnership
between the leading European professional and patient organisations. The
first act was to launch the Burden of Stroke Report, providing the most
accurate, up to date record of the incidence, prevalence and outcomes
from stroke as well as a report on policy, healthcare infrastructure,
service provision and quality related to stroke treatment. These
initiatives are important steps in the development of the Action Plan
for Stroke in Europe 2018 to 2030. This will guide European Union policy
on research and management of stroke for the next decade.
Modifiers of Endovascular Treatment Effect and Importance of Time Delays
Mechanical thrombectomy has revolutionised the treatment of large
vessel ischaemic stroke. In the largest study of its kind, the factors
which modify the efficacy of this treatment were assessed by the Virtual
International Stroke Trials Archive (VISTA) Collaborators. Principal
investigators, Prof Pooja Khatri (University of Cincinnati, USA) and
Prof Diederik Dippel (Erasmus University Medical Center, Rotterdam, The
Netherlands) presented an analysis of data from 14 studies.
Key findings presented by Professor Khatri:
* The odds ratio for improved disability was 1.94 (95% CI 1.6 to 2.39) with endovascular treatment compared to control.
* There was no significant difference in mortality.
* Age did not modify the effect of treatment but older age was associated with worse outcome in both groups.
Key findings presented by Prof Dippel:
* There was a significant relationship between time from onset to groin puncture and efficacy of thrombectomy.
* There was a significant relationship between time from onset to reperfusion and efficacy of thrombectomy.
"The
evidence for endovascular therapy is robust, even if we include the
prior negative trials," said Khatri. "For a one hour delay the absolute
reduction in likelihood of a good functional outcome is 9.5%," added
Prof Dippel.
Prognostic and Treatment Impact of Penumbral Imaging
Data from the ground-breaking HERMES Collaboration of the
thrombectomy randomised studies has been used to assess the effects of
CT-perfusion imaging on predicting the benefit from mechanical
thrombectomy for acute ischaemic stroke due to large vessel occlusion.
On behalf of the HERMES Collaborators, principal investigator Prof Bruce
Campbell (Royal Melbourne Hospital and The University of Melbourne,
Australia) presented findings from an assessment of the modified Rankin
Scale (mRS) scores at 90 days in 900 patients.
Key findings:
*
Ischaemic core size on CT-perfusion and MRI were independently
associated with functional outcome but did not modify the effect of
treatment
* Despite poorer outcome, endovascular
intervention was still beneficial in patients with larger ischaemic
cores, up to at least 70mls. Beyond this, benefit was uncertain.
"The
number of patients needed to treat (with mechanical thrombectomy) to
achieve good outcome tends to increase with estimated ischaemic core
volume," commented Prof Campbell. "However, overall point estimates
remain at levels that may be worthwhile at higher estimated core
volumes."
These data should help to guide patient selection for thrombectomy.
TO-ACT Study: Endovascular Treatment in Severe Cerebral Venous Sinus Thrombosis
Cerebral venous thrombosis is a rare cause of stroke and the optimal
management in severe cases is unclear. Principal investigator Prof
Jonathan Coutinho (Academisch Medisch Centrum, Amsterdam, The
Netherlands) presented the first results from the TO-ACT study in 63
patients with severe CVT, randomised to endovascular treatment with
thrombolysis and/or mechanical thrombectomy, or anticoagulation alone.
The primary outcome was mRS score at 12 months. The trial was stopped at
the first interim analysis for futility.
Key findings of the TO-ACT study:
* Endovascular treatment does not alter outcomes in severe cerebral venous sinus thrombosis.
o There was no significant difference in mRS scores between groups (OR 0.95, 0.34-2.68).
This small study demonstrated no significant benefit from endovascular treatment in severe CVT.
TALOS Study: Potential Benefit of Selective Serotonin Reuptake Inhibitors (SSRIs) After Acute Ischaemic Stroke
Previous studies have demonstrated a possible benefit from
antidepressant drugs called SSRIs after acute ischaemic stroke.
Principal investigator Prof Kristian Kraglund (Aarhus University
Hospital, Denmark) presented the initial findings of the TALOS study in
which 642 patients with acute ischaemic stroke were randomised to
receive citalopram or placebo.
Key findings from the TALOS study:
* Citalopram was safe in ischaemic stroke.
*
There was a no significant benefit from citalopram in improving
functional status (OR for mRS improvement 1.27, 0.92-1.74, p=0.14).
* There was no difference in rate of recurrent vascular events.
This
study shows that further research is required before SSRIs can be used
in stroke rehabilitation. "Although we have shown that treatment with
citalopram was safe," said Prof Kraglund. "It is not yet time to
recommend the use of SSRIs after stroke in patients without depression."
TESPI Study : First Dedicated Study of the Benefit of Intravenous Thrombolysis in Patients >80 Years of Age
Treatment with intravenous alteplase for acute ischaemic stroke
(thrombolysis) has been the standard of care for more than 20 years, but
there has not yet been a dedicated study in patients over 80 years of
age. Co-principal investigator Prof Svetlana Lorenzano (Acute Stroke
Unit, Policlinico Umberto Hospital, Rome, Italy) presented the results
of the TESPI trial in patients over 80 years of age, within 3 years of
onset. Despite early cessation of the study, there was a trend towards
benefit in this patient group consistent with findings from studies in
younger patients and subgroups of patients over the age of 80 included
in other studies.
Key findings from the TESPI study:
*
There was a non-significant increase in patients with a good functional
outcome measured using the mRS with alteplase (mRS 0-2: OR 1.35,
0.69-2.64)
* There was no increase in rates of symptomatic intracerebral haemorrhage with alteplase.
These
findings, in the light of similar results from other studies, support
the use of alteplase in this age group. "If we compare these data with
those from previous trials, the results of thrombosis within three hours
in elderly patients are similar to those reported in younger patients,"
said Prof Lorenzano.
