Los Angeles welcomes ISC 2016

164210524_SubArticle3_largePlease join us in sunny Los Angeles for the International Stroke Conference Feb. 17-19, 2016, where you’ll experience exceptional education, meet with exhibitors showcasing new stroke products and services, and network with colleagues who share your interests in investigating stroke prevention, diagnosis, treatment and rehabilitation.

Los Angeles is home to several innovative hospitals, including two Joint Commission American Heart Association/American Stroke Association Comprehensive Stroke Centers — Cedars-Sinai Medical Center and Ronald Reagan University of California Los Angeles Medical Center.

Both medical institutions are among the 2014-2015 U.S. News & World Report‘s “Best Hospitals.” UCLA Medical Center was ranked No. 5 in the country and No. 1 in California. The medical center ranked nationally in 15 adult and eight pediatric specialties, including No. 7 in adult neurology and neurosurgery. Cedars-Sinai Medical Center ranked 12th nationally and in 12 adult specialties, including 18th in neurology and neurosurgery.

Los Angeles has even more to discover and experience beyond its status as the hub for superb medical care. The city draws visitors for its incredible cultural attractions, dynamic restaurant scene, famous theme parks, endless nightlife, diverse neighborhoods and stellar shopping. Add in the area’s serene backdrop of sun, warm beaches and distant mountains, and Los Angeles offers something for everyone.

Mark your calendar for Feb. 17-19.



Expand your ISC 2015 education with Stroke OnDemand™ Premium

180411666_SubArticle2_largeYou still can experience the in-depth expert educational programming of ISC 2015 in Nashville with Stroke OnDemand™ Premium.

Stocked with access to more than 150 hours of science, you will have unlimited online and mobile access to synchronized slide and audio videos of the presentations. Plus get downloadable PDFs of the presenter slides and MP3s (computer and tablets). You also can access the three pre-conference symposia:

  • State-of-the-Science Stroke Nursing Symposium
  • Stroke in the Real World: Working Man Blues: Challenges in Inpatient Stroke Care
  • Emerging Trends for Stroke Trials: Biomarkers, Adaptive Trial Design, Repair Trials and New Endpoints

View sessions at your convenience online and from your iPhone, iPad or Android mobile device or tablet. Add the optional, complimentary DVD-ROM for viewing without an Internet connection and only pay additional shipping charges. DVD-ROMs ship 10 to 12 weeks after the conference.

Purchase now and view presentation content anytime, anywhere. Don’t miss out on the Premium Professional member discount.

Trials highlighted at ISC show success of endovascular therapy

SubArticle1_largeAfter two decades of essentially no positive results in acute stroke therapy trials, thrombectomy showed substantial therapeutic effects in a trio of endovascular therapy trials presented during ISC 2015. The three trials presented follow similarly positive results from MR CLEAN, published in late 2014.

“The most exciting science at this meeting was clearly the endovascular trials,” said Kyra Becker, MD, ISC 2015 Program Committee chair. “We saw the primary results from SWIFT PRIME, EXTEND-IA and ESCAPE. The trials were all overwhelmingly positive and the results very consistent. The chance of a good outcome nearly doubled in subjects who underwent endovascular therapy.”

Both ESCAPE and EXTEND-IA were presented at ISC and simultaneously published in the New England Journal of Medicine. Most patients in both trials received intravenous tPA. The addition of endovascular therapy significantly improved outcomes at 90 days compared to medical treatment alone.

Preliminary data from SWIFT PRIME showed significant improvement in functional outcomes at 90 days, the primary endpoint.

There were no significant safety concerns in any of these trials, said Dr. Becker, professor of neurology and neurological surgery, and co-director of the UW Medicine Stroke Center at the University of Washington, Seattle.

“It is very clear that time is of the utmost importance,” she said. “Based on the data presented to date, it appears that therapy should be delivered within six hours of symptom onset, and the sooner reperfusion is achieved, the better the chances for a good outcome. The question now is how we get these patients with an occlusion of large intracranial vessels to a comprehensive stroke care center that can provide endovascular therapy in a timely fashion.”

MR CLEAN researchers presented a post-hoc analysis of the effect of anesthesia on endovascular outcomes. The data suggest that patients who received endovascular treatment under general anesthesia fared more poorly than patients who received treatment under conscious sedation. The association between general anesthesia and worse outcomes is not conclusive, Dr. Becker said, but the results support the findings in other studies. The clinical implication is that endovascular therapy should be performed under conscious sedation whenever possible.

If there is a downside to these promising data, it is the epidemiology of stroke. Dr. Becker cautioned that the percentage of stroke patients who actually qualify for endovascular therapy is smaller than headlines might suggest.

About 85 percent of strokes are ischemic, she said. But only about 10 percent of stroke patients now receive tPA, a factor in the success of all four trials. Only a small percentage of patients treated with tPA will be eligible for endovascular therapy based on their vascular pathology and other factors.

“These trials represent a huge win, but the intervention is not applicable to the majority of patients with stroke,” she said. “What we know for now is that endovascular therapy works in patients with severe stroke due to occlusion of a large intracranial vessel when they are treated in an expedient fashion, and that is a very good thing.”

As exciting as the endovascular results were, ISC 2015 covered more than clot removal. The CADISS study compared anticoagulant therapy to antiplatelet therapy for the prevention of stroke in patients following carotid and vertebral artery dissection.

“Until now, we hadn’t any evidence from prospective randomized controlled trials regarding the appropriate antithrombotic treatment in patients with dissection, but providers were staunchly adherent to their beliefs,” Dr. Becker said. “This study showed that the risk of stroke/recurrent stroke in this population is exceedingly low and that the risk does not seem to vary by which antithrombotic is used. These data are very reassuring and suggest that it’s hard to go wrong with either treatment.”

Another study, ICARE, was a Phase III randomized controlled trial of evaluating intensive, individualized therapy for upper arm deficits compared to usual care. While the study showed no differences in the primary outcomes among the treatment groups, the trial was a success and should spur efforts to develop and test more effective stroke recovery and rehabilitation strategies, she said.

Seven presentations highlighted during Late-Breaking Science Oral Abstracts

MainArticlePost_largeREVSeven abstracts were presented February 12 during the Late-Breaking Science Oral Abstract session.

• • •
Aspirin is not effective for primary prevention of stroke in elderly Japanese patients with vascular risk factors. Lead author Shinichiro Uchiyama, MD, Tokyo Women’s University, reported a subanalysis from the Japanese Primary Prevention Project.

The open label study followed 14,464 patients with vascular risk factors for stroke over a median of about five years. Patients were randomized a group taking 100 mg of aspirin daily or a group taking no aspirin in addition to their standard medications. Researchers found a nonsignificant reduction in the incidence of ischemic stroke (p=.061), offset by a nonsignificant increase in the incidence of intracranial hemorrhage (p=.078) associated with aspirin. There was no difference in the cumulative rate of fatal or nonfatal stroke between the two groups.

“There is always the question of how well you can extrapolate a Japanese stroke population to Western populations,” said session moderator Steven Greenberg, MD, PhD, John J. Conway endowed chair in neurology at Massachusetts General Hospital and professor of neurology at Harvard Medical School, Boston. “But these results suggest no evidence of benefit to aspirin for primary stroke prevention.”

• • •
The VERiTAS Study of large vessel flow measures in the posterior circulation to predict subsequent vertebrobasilar (VB) stroke showed stronger results. Patients with low flow in the large VB vessels as measured by quantitative MRA had a hazard ratio of 18 for a subsequent VB stroke. Low-flow status emerged as a significant predictor of VB stroke (p=0.04). Results were presented by lead author Sepideh Amin-Hanjani, MD, professor and program director of neurovascular surgery, the University of Illinois at Chicago.

“This was a small study, 72 patients, but very exciting,” Dr. Greenberg said. “These low-flow patients are the people whose risk of a subsequent event is so high that they might benefit from even a risky procedure to reopen flow. VB flow could be a good way to select patients for trials. Stay tuned for follow-up.”

• • •
The ongoing controversy over the management of patients with cryptogenic stroke and patent foramen ovale (PFO) moved closer to resolution. Lead author David Kent, MD, MS, professor of medicine and director of Predictive Analytics and Comparative Effectiveness (PACE), Tufts Medical Center, Boston, presented a pooled analysis of 2,303 patients across three PFO closure trials. Individual trials showed no significant difference between closure and medical therapy. The meta-analysis showed a hazard ratio of 0.41 for recurrent stroke (p=.0433) following closure. PFO closure had no impact on the composite primary outcome of stroke, transient ischemic attack or death.

“There is intriguing evidence in the larger numbers,” Dr. Greenberg said. “We are beginning to see convincing evidence that there is a lower recurrent stroke risk with closure. Also of note, this study was not industry-sponsored; it was an independent analysis.”

• • •
MR CLEAN, the first trial of thrombectomy with second-generation devices, reported the number-needed-to-treat. Clinicians need treat only three to five patients for every less disabled outcome and seven patients per nondisabled outcome. The analysis was presented by lead author May Nour, MD, PhD, fellow and clinical instructor in neurology and radiology, University of California, Los Angeles.

• • •
Mohamed Labib, MD, CM, neurosurgeon at the University of Ottawa presented early results for a standardized process for evacuating intraparenchymal hemorrhage. The process, Minimally invasive Subcortical Parafascicular Access for Clot Evacuation (MiSPACE), showed a statistically significant improvement in GCS and no fatalities in 35 patients across 10 centers.

• • •
Madeleine Hunter, an undergraduate at Columbia University, New York, showed a strong association between increased P-wave terminal force in EKG lead V1 (PTFV1) and cryptogenic and cardioembolic stroke independent of any history of atrial fibrillation and heart failure.

• • •
Jesse Dawson, MD, clinical reader, University of Glasgow, United Kingdom, presented preliminary data from an early trial of vagus nerve stimulation for patients with upper limb weakness after stroke. The treatment is based on vagus nerve stimulation used for epilepsy. Although the small study was not powered to detect significant improvements in the primary endpoint (the Upper Extremity Fugl-Meyer score), the possible response of some subjects showed promise. A confirmatory study is under way in the U.S.