ISC symposium delves into recent advances in small vessel disease

Advances and insights into the management of small vessel disease from contemporary clinical trials is the focus of the “Treatment of Small Vessel Disease: Lessons from the Clinical Trials” session February 13.


Kennedy Lees, MD, FRCP, FESO, FRSE (UK)

The session will begin with important news from Jeffrey Saver, MD, FAHA, FAAN, said Co-moderator Kennedy Lees, MD, FRCP, FESO, FRSE (UK), professor of cerebrovascular medicine and director of the Acute Stroke Project at the University of Glasgow, United Kingdom. Saver, who is a professor of neurology and the director of the stroke and vascular neurology program at the University of California, Los Angeles, will discuss results from “Ultra-early Magnesium Treatment in Suspected Lacunar Stroke,” a randomized, placebo-controlled clinical trial that evaluated the neuroprotective benefits of field-administered magnesium given very early after the onset of subcortical ischemic stroke. A decade ago, a subgroup analysis of a different trial suggested possible benefits from magnesium in lacunar and hypertensive stroke patients, probably through lowering blood pressure, and FAST-MAG may further those findings, Lees said.

Philip Bath, MB, BS, MD, FRCPath, FRCP, FESC, professor of stroke medicine at the University of Nottingham, United Kingdom, will discuss the Efficacy of Nitric Oxide in Stroke (ENOS) Trial in his presentation “Is It Time to Stop Testing Blood Pressure Treatment and Start Lowering It Instead?” This study looked at the efficacy and safety of lowering blood pressure with nitric oxide and continuing prior antihypertensive medications in stroke patients. Bath is likely to have an “inkling” of the much-awaited results, Lees said.

Blood pressure reduction in patients with intracranial hemorrhage was also the focus of the recently completed INTERACT-2 (Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial). During this session, Craig Anderson, MD, professor of stroke medicine and clinical neuroscience at the University of Sydney, will present subgroup results in “Does the Location or Etiology of ICH Influence Response to Acute Blood Pressure Lowering.” The main trial “reported an overall neutral effect of blood pressure lowering in all ICH patients but a strong beneficial trend,” Lees said. “It will be intriguing to learn from Dr. Anderson if subcortical strokes — likely associated with small vessel disease — respond differently than larger lobar bleeds in terms of blood pressure lowering,” Lees added.

Finally, Oscar Benavente, MD, FRCPC, professor of neurology and research and director of stroke and cerebrovascular health program at the University of British Columbia, Vancouver, Canada, will present “MRI Correlates and Cognitive Outcomes in SPS3.” The Subcortical Strokes Trial (SPS3) was a randomized comparison of aspirin alone versus aspirin plus clopidogrel for the secondary prevention of stroke in patients with MRI-identified symptomatic lacunar infarcts. In the main trial, there was no significant difference in efficacy or safety between treatment strategies. This subgroup analysis will “be able to tell us more about which MRI appearances are associated with certain outcomes or treatment needs,” Lees said.

Clinicians with an interest in the management of patients with small vessel disease should plan on attending this session, said Lees, whose co-moderator will be Charlotte Cordonnier, MD, staff neurologist in the stroke unit at Lille University Hospital, France.

This session will present some of the latest clinical trial results in the treatment of small vessel disease and the discussion among the experts should be illuminating.