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4 key takeaways from ISC 2023: AFib detection, improved stroke survival and more
Leading researchers, physicians and other specialists from all over the world gathered in Dallas on Feb. 8-10 for International Stroke Conference (ISC) 2023, an annual event hosted by the American Stroke Association (ASA).
ISC 2023 was jam-packed with fascinating sessions, late-breaking studies and more. These are some of the biggest studies shared with attendees during the three-day event:
1. Insertable cardiac device boosts AFib detection by a significant amount
Heart rhythm issues such as atrial fibrillation (AFib) could be much more common in stroke patients than previously believed, according to new a follow-up study of the Stroke AF trial. Also, researchers noted, the heightened risk does not appear to fade as time goes on.
The study’s authors used an insertable cardiac device (ICM)—Medtronic’s Reveal Linq ICM, to be exact—to continuously track the hearts of stroke patients for three years. Overall, signs of AFib were detected in more than 20% of patients who received the device. Among patients who did not receive an ICM and just received normal follow-up care, however, AFib was detected in just 2.5% of patients.
This 10-fold increase in AFib detection, and the fact that a majority of the incidents occurred more than 30 days after the initial stroke, suggests that the long-term cardiac monitoring of stroke patients may provide significant value.
“We found that the rate of AFib continued to increase over the course of the three years, therefore, it’s not just a short-lived event and self-resolving related to the initial stroke,” lead author Lee H. Schwamm, MD, a vascular neurologist with Massachusetts General Hospital and Harvard Medical School, said in a prepared statement. “Fibrillation is common in these patients. Relying on routine monitoring strategies is not sufficient and neither is placing a 30-day continuous monitor on the patient.”
Medtronic funded this analysis.
2. New brain medication improves stroke survival
ApTOLL, a toll-like receptor 4 (TLR4) antagonist developed and distributed by aptaTargets, is associated with improved outcomes among stroke patients, according to a new study presented at ISC 2023.
The new medication was designed to limit tissue damage in the brain. Researchers examined data from 150 adult patients from France or Spain who were randomly assigned to either receive 0.05mg/kg of ApTOLL, 0.2 mg/kg of ApTOLL or a placebo. The average patient age was 70 years old, and all patients were treated from July 2021 to April 2022. Each patients also underwent mechanical blood clot removal, and tPA was given out when needed.
Overall, the larger dose was associated with significant reductions in mortality and the amount of brain damage identified by medical imaging exams compared to a placebo; no changes were noted among patients given the smaller dose.
In addition, the authors noted, 64% of patients given the higher dose of ApTOLL were free of disability 90 days after their stroke; this was true for just 47% of patients in the placebo group.
“The results are promising because for the first time a medicine studied as a neuroprotectant demonstrated not only a biological benefit by reducing the volume of damaged brain tissue, but also a reduction in long term disability and risk of death,” senior author Marc Ribó, MD, an interventional neurologist at Hospital Vall d’Hebron in Spain, said in a prepared statement.
3. Lowering blood pressure right away after vascular treatment may do harm
It may not be safe to lower the systolic blood pressure of stroke patients immediately after mechanical clot removal, according to a new study presented at ISC 2023.
Researchers examined data from 120 patients with an average age of 70 years. Patients were treated at one of three high-volume stroke centers from January 2020 to February 2022. Overall, the team found that “there may only be marginal benefit” associated with rapidly working to lower a stroke patient’s systolic blood pressure following treatment. There was actually some evidence that it could lead to a higher risk of long-term disability.
“Healthcare professionals should be cautious when lowering blood pressure after endovascular treatment, as there are some signs that blood pressure that’s too low may be harmful,” lead author Eva Mistry, MBBS, a stroke neurologist and assistant professor in the department of neurology and rehabilitation medicine at the University of Cincinnati, said in a prepared statement. “Individual patients might require lowering of blood pressure due to medical and neurological reasons, however, it should not be done as blanket practice with all patients. It may benefit some patients and needs to be customized,” she said.
4. Two cardiovascular medications may be effective treatments for small vessel stroke
Cilostazol and isosorbide mononitrate, two common cardiovascular medications, may offer clinicians a new way to treat patients who have experienced a lacunar stroke, according to new data presented at ICS 2023.
The study included data from more than 350 patients who experienced a lacunar stroke from February 2018 to May 2022 at one of 26 stroke centers in the United Kingdom. The average age was 64 years old, and 69% were men. Patients were randomly chosen to either receive one of the medications, both of the medications or neither medication for one full year.
Overall, the study results suggested that these medications may offer potential benefits for lacunar stroke patients. In fact, taking both medications at the same time appeared to reduce the risk of cognitive issues and increase the patient’s mood and quality of life.
However, the team warned, more research is still needed to confirm these findings.
“We saw good hints of efficacy, particularly for isosorbide mononitrate on reducing recurrent stroke and cognitive impairment, and we also found that both medications together seemed to work synergistically, rather than counteracting any benefit,” lead study investigator Joanna M. Wardlaw, MD, chair of applied neuroimaging at the University of Edinburgh in the U.K., said in a prepared statement. “This is very encouraging since no study has previously found any medications that positively affect cognitive impairment in small vessel disease strokes. So, we cautiously hope that these medications may have wider implications for other types of small vessel disease.”
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