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ESOC Conference Insights: Day 1 Research Reviews
In this research review of Day 1 of the European Stroke Organisation Conference (ESOC) in Lyon, France, Neurology Learning Network Section Editor, Armou Sarraj, MD, shares insights from 4 presentations. Dr Sarraj will be providing key insights and coverage of ESOC as the conference continues.
Apixaban for treatment of embolic stroke of undetermined source (ATTICUS)
Researchers aimed to determine whether the direct oral factor Xa inhibitor apixaban, started within 28 days after index stroke, is superior to aspirin in preventing new ischemic lesions in subjects with remote cardiac monitoring. Primary endpoint was detection of new ischemic lesions in flair and diffusion-weighted (DWI) MRI at 12-months follow-up.
The study enrolled “ESUS-Enriched population of ESUS patients with risk profile for cardiac thromboembolism (ie, left atrium [LA] size > 45 mm, spontaneous echo contrast in LA appendage, LA appendage flow velocity ≤ 0.2 cm/s, atrial high-rate episodes, CHA2DS2-Vasc score ≥ 4, patent foramen ovale).
Findings showed no difference in the primary outcome of new ischemic lesions on follow-up MRI, and no difference in the secondary outcome of clinical cerebrovascular event.
Endovascular treatment for acute basilar artery occlusion: a multicenter randomized controlled trial (ATTENTION)
This was a multicenter, randomized clinical trial, conducted in China, of acute ischemic strokes due to basilar occlusion presenting within 12 hours and with a stroke severity of National Institutes of Health Stroke Scale (NIHSS) > 10.
Of 342 patients, 228 were randomized to mechanical thrombectomy and 114 to best medical management.
Mechanical thrombectomy resulted in improved 90-day functional outcome (mRS 0-3) as follows: 46% vs 22.8% with best medical management.
All secondary outcomes also improved with mechanical thrombectomy, including functional independence (mRS 0-2), shift/ordinal analysis, NIHSS improvement 24 to 72 hours/5 to 7 days and quality of life.
Anesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS)
This was a multicenter randomized trial, conducted in France, assessing the use of general anesthesia (GA) vs procedural sedation in patients with large vessel occlusion undergoing endovascular thrombectomy.
Of 273 randomized patients, 135 were given GA vs 138 given procedural sedation.
The researchers concluded that there was no difference in the primary outcome (mRS 0-2; GA 34% vs procedural sedation 39%)
Effect of early vs standard approach to tracheostomy among patients with severe stroke receiving mechanical ventilation (SETPOINT2)
In this randomized clinical trial, 382 patients were assigned to an early tracheostomy strategy (n = 188) or to a standard tracheostomy (control group) strategy (n = 194).
The proportion without severe disability (modified Rankin Scale score, 0-4, primary outcome) at 6 months was not significantly different in the early tracheostomy vs the control group (43.5% vs 47.1%; difference, −3.6% [95% CI, −14.3% to 7.2%]; adjusted odds ratio, 0.93 [95% CI, 0.60-1.42]; P = .73)
Clinicians found that there was no difference in any secondary or safety outcomes.
The trial concluded that among patients with severe stroke receiving mechanical ventilation, a strategy of early tracheostomy, compared with a standard approach to tracheostomy, did not significantly improve the rate of survival without severe disability at 6 months.
References
Poli S. Apixaban for treatment of embolic stroke of undetermined source – ATTICUS randomized trial. Presented at: European Stroke Organisation Conference; May 4, 2022; Lyon, France.
Noguerira R. Endovascular treatment for acute basilar artery occlusion – a multicenter randomized controlled trial (ATTENTION). Presented at: European Stroke Organisation Conference; May 4, 2022; Lyon, France.
Chabanne R. Procedural sedation versus general anesthesia in anterior circulation large vessel occlusion thrombectomy: the anesthesia management in endovascular therapy for ischemic stroke (AMETIS) randomized controlled trial. Presented at: European Stroke Organisation Conference; May 4, 2022; Lyon, France.
Bosel J. Early vs standard tracheostomy in ventilated patients with severe stroke: results of the randomized, multicenter, international trial SETPOINT2. Presented at: European Stroke Organisation Conference; May 4, 2022; Lyon, France.
