ESOC Conference Day 3 Insights: Research Reviews

As the 2022  European Stroke Organisation Conference (ESOC) in Lyon, France, comes to a close, Neurology Learning Network Section Editor, Amrou Sarraj, MD, concludes his “man on ground” coverage. Dr Sarraj shares insights on the BAOCH and ACTIMIS studies as well as discussing the role of tenecteplase in intravenous thrombolysis.

Find Dr Sarraj's insights from Day 1 and Day 2 here.

Basilar Artery Occlusion Chinese Endovascular Trial (BAOCHE)

This prospective, multicenter, randomized controlled trial assessed the safety and efficacy of endovascular thrombectomy (EVT) treatment for patients with acute ischemic stroke due to basilar or bilateral vertebral occlusion, presenting 6 to 24 hours from symptom onset. Researchers compared EVT and the best medical therapy (BMT) with BMT alone.

The intention-to-treat analysis included 217 patients (110 EVT, 107 BMT). Of participants, 46.4% treated with EVT achieved a good outcome (mRS 0-3) compared with 24.3% treated with BMT (aOR: 2.92, 1.56-5.47; P = .001; NNT of 4.5).

With the results of ATTENTION and BAOCHE, we now have 2 randomized control trials showing efficacy and safety of EVT in patients with basilar occlusions presenting up to 24 hours from stroke onset.

Acute Ischemic Stroke Interventional Study (ACTIMIS) 

This phase Ib-2a exploratory, multinational, randomized, double-blind, placebo-controlled, single-parallel, escalating-dose study examined the use of glenzocimab as an add-on therapy to improve the efficacy of reperfusions therapies to treat acute ischemic stroke (ICH). A total of 166 patients were enrolled with 102 receiving glenzocimab (initially 125-1000 mg in a dose escalation for phase 1b, followed by 1000 mg in phase IIa) and 64 receiving the placebo. 

Researchers found the rates of symptomatic ICH (glenzocimab 1% vs placebo 8%), asymptomatic ICH (glenzocimab 29% vs placebo 47%), and mortality (glenzocimab 8% vs 19%) were all improved with glenzocimab. Overall mRS score distribution also favored glenzocimab.

These are encouraging early results for glenzocimab, which can provide adjunctive benefit to intravenous thrombolysis in acute stroke patients to further optimize the outcomes.

IV Thrombolysis With Tenecteplase vs Alteplase: A Propensity Score-Matched Analysis From the SITS-ISTR Registry 

An analysis from pooled, prospectively collected registry data from 20 centers across Europe compared the safety and efficacy of tenecteplase (tNK) with alteplase (tPA). Patients receiving tNK were matched with patients receiving tPA in up to a 1:3 ratio. 

The final analysis included 331 tNK-treated and 797 tPA-treated patients. Functional outcomes were available for tNK-treated and 599 aTP-treated patients. A significant shift toward better functional outcome (median [IQR] mRS scores: TNK 2 [1-3] vs tPA 2 [1-5)]; P < .001) with higher functional independence (mRS 0-2: tNK 68% vs tPA 52%; P < .001) and lower mortality (tNK 11% vs PA 23%; P < .001) was observed in patients receiving tNK. Symptomatic hemorrhages were similar between the 2 groups (tNK 1% vs tPA 1.6%; P = .621).

The results from this real-world registry complements the recently presented Alteplase Compared to Tenecteplase (ACT) trial results, supporting a tNK-based acute stroke intravenous thrombolysis approach.

References

Jovin T. Basilar Artery Occlusion Chinese Endovascular Trial (BAOCHE). Presented at: European Stroke Organisation Conference; May 6, 2022; Lyon, France.

Mazighi M. Glenzocimab, a novel antithrombotic, is associated with reduced intracranial hemorrhage and mortality rates when combined with standard-of-care reperfusion therapies: the ACTIMIS study. Presented at: European Stroke Organisation Conference; May 6, 2022; Lyon, France.

Katsanos A. Intravenous thrombolysis with tenecteplase versus alteplase in acute ischemic stroke patients within 4.5 hours from symptom onset: a propensity score-matched analysis from the SITS-ISTR registry. Presented at: European Stroke Organisation Conference; May 6, 2022; Lyon, France.