What's Hot at International Stroke Conference 2014?

Susan Jeffrey

February 07, 2014

Stroke researchers blasted by snow across the United States will get a break when they travel to the International Stroke Conference (ISC) next week, held this year in sunny San Diego, California.

Chairman of the Program Committee again this year is Steven M. Greenberg, MD, PhD, professor of neurology at Harvard Medical School, John J. Conway Endowed Chair in Neurology, and director of Hemorrhagic Stroke Research at Massachusetts General Hospital Stroke Research Center in Boston.

Dr. Greenberg discussed some of the expected highlights of this year's program with Medscape Medical News.

Latest Research

Of primary interest, as always, is the top research, presented in hunDr.eds of oral sessions and posters, symposia, and lectures.

Among the most eagerly anticipated trials presented for the first time at this year's meeting is the Field Administration of Stroke Therapy–Magnesium (FAST-MAG) trial, looking at the potential effects of magnesium in acute stroke, Dr. Greenberg said.

"We're excited about any acute stroke trial of a new therapy, but what makes this trial 100% unique is that its focus is on a time window that we all understand is important when giving a protective treatment," the prehospital setting, he said. "This involved just a tremendous and really a successful partnership between academic centers and the EMS [emergency medical service] apparatus in the participating cites that allowed EMS personnel to become trained in study enrollment and enroll patients in this ultra-early treatment."

The results are not yet known, "but if the study shows success, then of course we'll all be very interested in magnesium, but we're going to be really interested in this time window, and I think that will shift the focus of acute stroke care to therapies that we can give in the field, and decide that time might be the most important variable," he added. "If the study doesn't show benefit, then we will continue to look for other beneficial approaches, but right now, looking at this time window is completely new and very exciting I think for everybody attending the conference."

Plenary Session I: Wednesday, February 12, Hall E, Opening Plenary Session

  • LB1: The Urico-ictus Study: A Randomized Trial of Efficacy and Safety of Uric Acid Administration in Acute Stroke

  • LB2: Impact of Treatment Delay, Age and Stroke Severity on the Effects of Intravenous Thrombolysis With Alteplase in Acute Ischemic Stroke: An Individual Patient-Data Meta-Analysis

Plenary Session II: Thursday, February 13, Hall E, Keynote Abstracts

  • 214: The Field Administration of Stroke Therapy–Magnesium (FAST-MAG) Phase 3 Trial: Primary Results

  • 215: Hyperhomocysteinemia as a Model of Vascular Dementia and Its Effects on Amyloid Pathology in a Transgenic Mouse Model

  • 216: Risk of Thrombosis Remains Elevated for 12 Weeks After Labor and Delivery

Late Breaking Science Oral Abstracts: Thursday, February 13, 1:30 pm; Ballroom 20B-C

  • LB3: Blood Pressure Variability in INTERACT2: An Important Determinant of Outcome Following Intracerebral Hemorrhage

  • LB4: Effect of Chronic Blood Pressure Lowering on Cognition in Patients With Recent Lacunar Stroke: The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial

  • LB5: Genomewide Association Study of Intracranial Aneurysm Identifies a New Association on Chromosome 7

  • LB6: Safety Endpoints and Thromboembolic Events for the First 250 Patients Enrolled in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Trial (CLEAR IIII)

  • LB7: Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack and Intracranial Artery Stenosis: Subgroup Analysis of CHANCE

  • LB8: Dabigatran Provides Marked Protection from Hypertension-Carotid Artery Stenosis-Induced Vascular Cognitive Impairment

  • LB9: Intravenous Thrombolysis or Endovascular Therapy for Acute Ischemic Stroke Associated With Cervical Internal Carotid Artery Occlusion: The ICARO-3 Study


Plenary Session III: Friday, February 14, Hall E, Keynote Oral Abstracts

  • LB10: Transcranial Doppler Is Superior to Echocardiography for Detection of Patent Foramen Ovale

  • LB11: Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF)

  • LB12: Improving Door-to-Needle Times in Acute Ischemic Stroke: Principal Results From the Target: Stroke Initiative

The "Next Big Thing" for Stroke

Last year, the program debuted a new forward-looking session to examine the "next big things" in the stroke field, but "at lightning speed." Leading investigators participating were asked to float new ideas of where stroke research could go next in their area but in a talk with a hard cutoff of 5 minutes.

"I think it was quite successful and well-received last year," he said. "Based on the good feedback we had on that session, we're going to repeat it and incorporate it into one of the plenary sessions to allow as many people as possible to attend the session."

Ten "brave souls" will take on various fields ranging from the most molecular of stroke science to highest-level population epidemiology, and everything in between, he said. "I say brave, because they have to give a different talk from their usual talk. They have to shorten their presentation to exactly 5 minutes, and I somewhat jokingly tell the speakers that no P values are allowed.

"Every presentation will be forward-looking and I hope in many cases provocative, and be fun and entertaining for the audience, but more importantly to stimulate discussions about the future of stroke all across the board," Dr. Greenberg added.

The Next Big Thing in Stroke (at Lightning Speed); Plenary Session III, Friday, February 14, 11:00 am, Hall E

  • 11:00 S. Claiborne Johnston, MD, San Francisco, California

  • 11:06 A. Gregory Sorensen, MD, Washington, DC

  • 11:12 S. Thomas Carmichael, MD, PhD, Los Angeles, California

  • 11:18 Jeffrey L. Saver, MD, Los Angeles, California

  • 11:24 Monique M.B. Breteler, MD, PhD, Bonn, Germany

  • 11:30 Ulrich Dimagl, MD, Berlin, Germany

  • 11:36 Hugh Markus, MD, Cambridge, United Kingdom

  • 11:42 Lawrence Wong, MD, Shatin, Hong Kong

  • 11:48 Leigh R. Hochberg, MD, PhD, Boston, Massachusetts

  • 11:54 Walter Koroshetz, MD, Bethesda, Maryland

Diet, Endovascular Therapy, and Lessons Learned

Dr. Greenberg pointed to several symposia that will take a step back to examine developments in the field in the bigger picture.

Treatment of Small-Vessel Disease: Lessons From the Clinical Trials; Thursday, February 13, 3:30 pm; Ballroom 20D

One session brings together investigators from trials that have included patients with small-vessel disease, such as SPS3, INTERACT2 (Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial 2), and the not-yet reported FAST-MAG, he noted. "So this will be a chance for us to be able to look across these different types of small-vessel disease, very different approaches, looking for lessons learned from both negative and borderline-positive studies," he said.

What Is the Ideal Diet for Stroke Prevention? Wednesday, February 12, 7 am, Room 33

For the first time in many years, he said, a symposium will examine what is currently known about the role of diet in stroke prevention. "The data are still fairly thin, but stroke was one of the outcomes that seemed to be affected by the Mediterranean diet in a randomized trial," the PREDIMED (Prevención con Dieta Mediterránea) trial. "This will be a chance to review the data on something that hits close to home for everybody who eats."



Negative Randomized Studies in Endovascular Therapy for Acute Stroke: Can Different Study Designs Lead to Different Results? Thursday, February 13, 8:40 am, Ballroom 20B-C

Last year, several studies looking at endovascular therapy for stroke, including the IMS III (International Management of Stroke III) trial, were negative for a benefit of endovascular therapy with or without thrombolytic therapy for acute stroke. A symposium this year will digest these results and look at the question of whether the findings relate to having "the wrong treatment, or the wrong study design," he said, and navigate a way forward in this field where progress so often outpaces the efficacy data.

"So I think that really a running theme for ISC is to digest the old studies and then move on to the new ones that need to be done in a field that refuses to stand still," Dr. Greenberg said. "It's good that it refuses to stand still because we need new treatments but until we have some positive trials, I think this will be a kind of tension as to how to integrate the past trial results in the real world where people are coming in the door with stroke and we have to make decisions on the most rational therapies to help them."

Major Awards

Major awards this year again honor some great names in stroke research, he said.

The Thomas Willis Lecture, for achievement in basic science, will be given by Patricia J. Hurn, PhD, from the University of Texas, who Dr. Greenberg said, has been a "great voice" for the biology of immune response, particularly how hormonal differences affect immune response and how that may relate to well-known sex differences in stroke risk and outcome.

"This is an area that's seen a lot of growth and I think in a lot of ways, Patty provided the biological underpinnings of this area to take off the way it has," he said. "It's become particularly relevant with questions about how hormone replacement therapy intersects with stroke."

Winner of the William M. Feinberg Award for Excellence in Clinical Stroke is William Powers, MD, from the University of North Carolina, Chapel Hill, who has been "such a strong voice over a long period of time for understanding the role of blood flow in various kinds of both stroke and nonstroke neurologic disease," said Dr. Greenberg. Dr. Powers "probably came most into focus for a very difficult trial that was ultimately negative," he added, COSS (Carotid Occlusion Surgery Study), which compared medical therapy with extracranial–intracranial bypass surgery in patients with symptomatic atherosclerotic internal carotid artery occlusion with hemodynamic cerebral ischemia.

The David G. Sherman Lecture is a lifetime achievement honor in basic or clinical research and goes this year to Marc Fisher, MD, University of Massachusetts Medical School, Worcester, current editor of Stroke, the flagship journal of the stroke field. In this role, Dr. Fisher "has really taken on this role as fair arbiter of the active debates in the stroke field, and a wise voice, and that really sets beautifully into the context of the Sherman as a career achievement award," he said. "Marc has many years to go in the stroke field, and we look forward to them, to even today he's had a very positive impact on the field, especially in bridging from animal models to human-based studies."

  • Thomas Willis Lecture: Thursday, February 13, 11:40 am, Hall E: Stroke and Innovation, Patricia D. Hurn, PhD

  • William M. Feinberg Award for Excellence in Clinical Stroke: Friday, February 14, 12:03 pm, Hall E: Hemodynamics and Stroke Risk in Carotid Artery Occlusion, William Powers, MD

  • David G. Sherman Lecture: Wednesday, February 12, 11:40 am, Hall E: Considering the Future of Academic Vascular Neurology, Marc Fisher, MD

  • Mordecai Y.T. Globus New Investigator Award in Stroke: Thursday, February 13, 10:32 am, Hall E: In Vivo Molecular Imaging of Thrombosis and Thrombolysis Using a Fibrin-binding PET Probe (212), Francesco Blasi, PharmD, PhD

  • Stroke Care in Emergency Medicine Award: Thursday, February 13, 10:46 am, Hall E: Stroke Severity Adjusted EMS Triage Has Benefits for Bypassed Primary Stroke Centers. Evan Allen, MBA

Medscape Medical News will be onsite, providing in-depth news coverage and feature interviews, beginning Wednesday, February 12. Follow us on Twitter (@MedscapeNeuro) and Facebook. Follow ISC on Twitter @HeartNews, #ISC13.

Next year's ISC is planned for February 10-15, 2015, in Nashville, Tennessee.

Dr. Greenberg reports receiving research grants from the National Institutes of Health and participating as a Consultant/Advisory Board member for Hoffman-Laroche, MRI review committee.

International Stroke Conference (ISC) 2014: February 12-14, 2014. San Diego Convention Center, San Diego, California.


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