ISC updates advances in stroke treatment

Plenary Session III during

Bruce Ovbiagele, MD, MSc

The International Stroke Conference 2016 proved that the meeting’s past is again its prologue.

During each ISC, ideas and trials are reviewed, modified and revisited for improvement. For example, ISC 2015 served as fodder for ISC 2016’s three pre-conference symposia that looked at basic science, real-world applications of science and nursing that focused on science topics.

“Many of the items discussed at the pre-conference symposia were really follow-up on science and advances made last year,” said Bruce Ovbiagele, MD, MSc, ISC 2016 Program Committee vice chair and ISC 2017 Program Committee chair. “They were about how to implement those advances.”

This year’s conference spotlighted the results of new clinical trials on the role of insulin resistance and identification of atrial fibrillation in stroke, long-term effects of established stroke treatments and new treatments.

“It was good to hear debates about whether patients who have major strokes should be taken to a primary stroke center first and then transferred to a comprehensive stroke center or go straight to comprehensive center,” Ovbiagele said.

“We had a second debate about which imaging techniques are best for identifying patients who would benefit from endovascular therapies. We also heard about a wonderful new program to coordinate stroke care in 21 hospitals in the Kaiser medical system and how it greatly improved their door-to-needle time. It could be an example for many people and places.”

New science was also prominent in the IRIS, CREST, ARUBA and FIND-AF clinical trials’ results released during Plenary Sessions I and II:

  • In IRIS, researchers looked at patients who had insulin resistance and a recent ischemic stroke or TIA. Patients were randomized to treatments with pioglitazone or placebo. After five years, the risk of new stroke or heart attack for patients receiving pioglitazone decreased. “That is very important because it gives us yet another weapon in our armamentarium to improve outcomes for patients who experience stroke if they have insulin resistance,” Ovbiagele said.
  • In CREST, researchers compared data gathered over 10 years for patients with carotid stenosis who were randomized to receive carotid stenting or carotid enderectomy. “There was no difference in terms of new strokes or new events, and the risk of having an event was very low because we think background medical treatment has improved to such a degree that people are not having as many recurring events after they have these procedures,” Ovbiagele said. “With the use of antithrombotics, statins and blood pressure medicines, we are really reducing the risk of recurring events.”
  • ARUBA featured five-year data from patients who had asymptomatic arteriovenous malformations in the brain, a follow-up to trial results first released in 2014. In the trial, patients received surgical treatment or conservative medical treatment. “Those who received surgical intervention were at a substantial disadvantage,” Ovbiagele said. “There was an 80 percent relative risk reduction difference between both arms. It is helpful to know that surgical intervention for these patients is harmful. We know what we should not do at this point.”
  • In FIND-AF, researchers examined advanced and prolonged holter monitoring in ischemic stroke patients and TIA patients for atrial fibrillation detection for one year after the event. “What they found was a significant detection of atrial fibrillation in those patients who were exposed to the repeated and enhanced cardiac monitoring,” Ovbiagele said. “This is important because it would change management of these patients, who would otherwise receive post-stroke treatment with an antiplatelet medication versus being on an anticoagulant, which would be indicated in patients with known atrial fibrillation.”

Read about the results of trials released during Plenary Session III.

Several elements of ISC 2016 will likely be re-examined at ISC 2017 on Feb. 22-24 in Houston, Texas. But there’ll also likely be a greater emphasis on topics of global relevance, more specialty areas associated with stroke and a mentoring award, Ovbiagele said.

“We are reaching out to the World Hypertension League, the World Heart Federation and other organizations to have more international perspectives in the development of our sessions,” he said. “Those topics also will cut across other specialties that have an impact on stroke.”

The new award will recognize excellence in academic mentoring.

“Good mentoring of junior scientists is under-recognized and undervalued,” Ovbiagele said. “We want people who are mentees to nominate their mentors and explain what they have done to further their careers. It is an avenue to elevate the tremendous importance of academic mentoring.”

Ovbiagele encourages ISC participants to go the AHA/ASA website to submit ideas for session topics and abstracts for presentation and to register to attend ISC 2017. The deadline to submit session suggestions for ISC 2017 is next Tuesday, March 15th.