Overview from the 2025 International Stroke Conference
Mar 3, 2025
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Dr. Seemant Chaturvedi, a stroke neurology expert from the University of Maryland, shares cutting-edge insights from the International Stroke Conference. He discusses important advancements in stroke treatments, including the role of endovascular therapy and findings from trials such as ESCAPE-MeVO and PRESTIAGE-AF. Chaturvedi also explores the complexities of anticoagulant use post-brain hemorrhage and innovative approaches like transcranial direct current stimulation for recovery. His expert insights emphasize the ongoing evolution of stroke care and research.
Recent stroke trials question the benefits of thrombectomy for medium vessel occlusions, emphasizing the need for cautious clinical application.
The Prestige AF trial indicates a potential net benefit of DOACs in preventing ischemic strokes, albeit with increased hemorrhagic risk.
Deep dives
Current Trials on Endovascular Therapy for Medium Vessel Occlusions
Recent trials have examined the efficacy and safety of endovascular therapy for medium vessel occlusions (MEVOs) in stroke cases, challenging previous norms that focused primarily on large vessel occlusions. The DISTAL trial, involving 540 patients, reported no significant difference in functional status at 90 days between patients receiving thrombectomy and those who did not, alongside a concerning increase in symptomatic intracranial hemorrhage. Similarly, the ESCAPE-MEVO trial showed comparable results, highlighting a higher mortality rate in thrombectomy patients. These findings suggest that thrombectomy for MEVOs may not offer clear benefits and warrant more cautious application in clinical practice despite the common consideration for such treatments at thrombectomy-capable centers.
Intravenous Thrombolysis Following Thrombectomy
The ANGEL TNK trial explored the potential benefits of administering intra-arterial thrombolysis after thrombectomy, aimed at addressing residual thrombi and improving patient outcomes. Involving 255 patients treated within 24 hours of stroke onset, the trial found that those receiving TNK had a better rate of favorable outcomes compared to the control group. However, while the results were thought-provoking, they contrasted with previous studies indicating no clear benefit from post-thrombectomy thrombolysis. This discrepancy highlights the ongoing debate within the medical community regarding the integration of intra-arterial thrombolysis following successful thrombectomy.
Insights from the Prestige AF Trial on Anticoagulation Post-Hemorrhage
The Prestige AF trial assessed the safety of reintroducing direct acting oral anticoagulants (DOACs) in patients with atrial fibrillation who had a history of intracerebral hemorrhage. Results showed a striking reduction in ischemic strokes among those who resumed DOACs compared to those on aspirin, although there was an associated increase in hemorrhagic events as well. The data suggested that the overall net clinical benefit slightly favored DOACs, though the findings were not statistically definitive. With ongoing larger trials in progress, this research highlights the necessity for individualized patient assessment in determining the optimal approach to secondary stroke prevention.
Dr. Andy Southerland talks with Dr. Seemant Chaturvedi about the latest findings from the International Stroke Conference, focusing on advancements in stroke treatment and recovery.
