The European Stroke Organisation Conference (ESOC) has been gaining in size and popularity since its inception in 2015 and is now firmly established as the premier European forum for stroke research and a world-renowned platform for the release of major study data. An unprecedented number of high quality and late breaking submissions has prompted the decision to extend elements of this year’s program. “We are delighted and humbled by the quantity and quality of submissions we have received for this year’s conference,” said Bart van der Worp, ESO President. “It is testimony to the dedication of our colleagues around the world that so much progress is being made towards improving patient lives and outcomes. It also recognises the global standing of this conference and the achievement of many of our aspirations for it.”
ESOC 2019 is expecting more attendees that ever before with approximately 5,400 healthcare professionals and patient advocates, sharing and gaining insights into the latest research and developments in stroke care. Topics will include data from pivotal studies of pre-hospital and hyperacute care, new secondary prevention and neuro-restorative approaches, as well as rehabilitation, that will shape and influence clinical practice. This year’s conference features a record number of abstracts – 2018 in total (249 orals, 1769 posters) – the vast majority of these abstracts will be uploaded to the Scientific Programme on the ESOC 2019 website and the European Stroke Journal website on 22 May at 06:00 CET.
Embargoed media briefings will be held before the plenaries on Wednesday, 22 May, and Thursday, 23 May, between 08:00 and 10:00 CET where the lead investigators will present highlights from RESCUE-Brain; RESTART; ASTER 2,;EXTEND, ECASS-4 and EPITHET meta-analysis; INTERACT2 / ATACH-II IPD; RATULS; CROMIS among others. Accredited press who are unable to attend ESOC 2019 in person may register to participate in the live webcast of these events (see registration details below).
The ESOC 2019 programme features something for every discipline in stroke management and care. The following summaries represent a small sample of what can be shared ahead of the conference, with much more detail from many more studies and initiatives to be presented throughout the meeting.
Remote ischaemic conditioning is an elegant approach rendering brain tissues resistant to ischaemia/reperfusion injury. RESCUE-Brain is the first randomised controlled study to assess the effect of per-conditioning in patients with stroke. If successful, this will be a new tool to reduce ischaemic injury and, if confirmed in further studies, one which will also improve outcomes for stoke survivors.
The safety of restarting blood thinners after an intracerebral haemorrhage is unknown, despite evidence suggesting an ongoing greater risk of recurrent ischaemic events than recurrent bleeds. The RESTART trial is the first study to randomise patients to restart an antiplatelet drug after recovery from an intracerebral haemorrhage and will provide the first reliable evidence to help resolve this common, challenging clinical dilemma. Scheduled for simultaneous publication in The Lancet (Rustam Al-Shahi Salman).
· ASTER 2
Mechanical thrombectomy is the cornerstone of acute ischaemic stroke treatment in the subgroup of patients with large vessel occlusion and salvageable tissue. However, successful recanalisation is not achieved in all patients. ASTER 2 is the first head-to-head randomised controlled study comparing the combined effect of contact aspiration and stent-retriever with stent-retriever alone on revascularisation rates in acute stroke patients receiving thrombectomy. The study will provide further evidence on the first-line approach for thrombectomy in patients with ischaemic stroke.
· EXTEND, ECASS-4 and EPITHET – meta-analysis of individual patient data
Endovascular treatment is indicated in patients with large vessel occlusion, but intravenous thrombolysis continues to be the mainstay of treatment in most patients with ischaemic stroke. However, thrombolysis is currently recommended only up to 4.5 hour after stroke onset. Perfusion imaging may identify patients with salvageable brain function who could benefit from thrombolysis beyond 4.5 hours or with symptoms on waking. This systematic review of individual patient data includes the results of three major randomised controlled studies of alteplase versus placebo in ischaemic stroke patients treated >4.5 hours after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT-perfusion. Scheduled for simultaneous publication in The Lancet (Geoffrey Alan Donnan).
· INTERACT2 / ATACH-II IPD Pooling Project
The optimal blood pressure control target in patients with acute intracerebral haemorrhage is still a controversial topic and a common dilemma in clinical practice. This meta-analysis of individual patient data from the two largest studies of blood pressure control in patients with acute intracerebral haemorrhage aims to provide a final answer on the optimal blood pressure control target in this setting. The results of this analysis will provide recommendations on the levels of blood pressure that are associated with better clinical outcomes in intracerebral haemorrhage. Scheduled for simultaneous publication in Lancet Neurology (Tom Moullaali).
RATULS is the largest study to have evaluated robot-assisted training for upper limb function after stroke. It will provide the much needed evidence on the efficacy and cost-effectiveness of this novel intervention. If effective, robot-assisted training could revolutionise the delivery of rehabilitation across stroke units in the future. Scheduled for simultaneous publication in The Lancet (Helen Rogers)
· Microbleed International Collaborative Network (CROMIS)
The presence of multiple, very small and asymptomatic old bleeds in the brain are increasingly identified with the greater use of specialised MRI scans, but pose significant concerns about the safety of starting blood-thinning drugs to prevent ischaemic stroke. This collaborative study of multiple cohorts world-wide will provide the best evidence available as to balance of risk and benefit from starting these medications in the light of such MRI findings. Scheduled for simultaneous publication in Lancet Neurology (David Werring)
These and other research results will be highlighted throughout the conference in daily media briefings and releases.
For the complete ESOC 2019 Scientific Programme or more information about the conference, visit https://eso-conference.org/2019. Keep up to date by following ESOC 2019 on Twitter (@ESOstroke) and using the conference hashtag #ESOC2019 and Facebook https://www.facebook.com/EuropeanStrokeOrganisation/.