Second ESO Stroke Conference Gets Off to Flying Start

May 11, 2016

BARCELONA — The second European Stroke Organisation Conference (ESOC) got off to a flying start yesterday with six major new clinical trials presented at the introductory session, three of which have simultaneous publications in The New England Journal of Medicine (NEJM).

In addition, the second plenary session of the day at the meeting saw another host of randomized trials on the schedule, including one simultaneous publication in The Lancet.

With more than 3700 delegates registered, including many of the worldwide opinion leaders, and a buzzing exhibition area, the meeting appears to have established itself as a major player in the international stroke field, an impressive feat given that the idea of holding a new European stroke meeting was only conceived less than 2 years ago.

"I am stunned by the number of participants we have here," president of ESO and chair of the conference planning group, Kennedy Lees, MD, University of Glasgow, United Kingdom, commented to Medscape Medical News. "We started with nothing 18 months ago, then we had a great first meeting in Glasgow last year, and now we've added another 1000 delegates this year. That is truly success."

Opening the meeting, chair of the local organizing committee, Angel Chamorro, MD, Hospital Clinic de Barcelona, Spain, described the ESO conference as "the most exciting European meeting in the stroke field."

"A large auditorium packed to the brim shows that efforts have paid off." He congratulated Professor Lees in particular for his hard work in making this happen, he added.

In his opening talk, Professor Lees emphasizes that the aim of the conference is "to place science first."

"This meeting is about furthering research," he said. "We are doing this by blind scoring of abstracts by multiple raters, including a diverse range of speakers including rising stars, and we have expanded the faculty from last year. We have also refreshed the majority of our speakers from last year and we aim to continue turning over faculty every year. We have kept the registration fees lower than comparable conferences and we've offered discounts to those from developing countries and to trainees, et cetera."

He said last year's inaugural ESO conference in Glasgow "might have seemed like beginner's luck," coinciding with release of some of the new thrombectomy studies, but "this year's meeting has even more simultaneous publications in leading journals, and other trials presented here are still in the process of submitting to leading medical journals."

He added: "While the thrombectomy field is now going into a consolidation phase where all the new results are being digested, there is a huge amount of other work going on which will be featured this week."

He emphasized that all the trials at the plenary and late-breaking news sessions contain new material. "Anything presented at previous meetings or which has already been published will be identified."

He told Medscape Medical News, "I've learned fascinating things just from the two first major sessions of the meeting. I'm really excited by all the scientific results were seeing."

Among the scientific highlights, Professor Lees identified the following major new clinical trials:

  • ENCHANTED, suggesting a role for lower dose tissue plasminogen activator (tPA) in stroke (an NEJM simultaneous publication).

  • SOCRATES, on the use of the new antiplatelet agent, ticagrelor, in stroke (another NEJM simultaneous publication).

  • ATACH II, suggesting that intensive blood pressure–lowering may not be useful after all in acute cerebral hemorrhage (ICH; also to be published in the NEJM).

  • PATCH, a randomized trial suggesting that platelet infusions may be harmful for patients presenting with ICH who have been taking antiplatelet agents (simultaneously published in The Lancet).

"While ENCHANTED and SOCRATES didn't quite reach significance, both drugs involved are already marketed and the results of both trials are encouraging so that is important information that doctors will have to make their own minds up about," Professor Lees commented to Medscape Medical News.

He said the ATACH II trial questioned the previous results of the INTERACT-2 trial and "undermines the confidence we had in blood pressure lowering for ICH patients which INTERACT-2 gave us."

Of the PATCH trial, Professor Lees said, "This is telling us very clearly something that we didn't know — to avoid platelet transfusion in patients with ICH on antiplatelet agents — a very powerful result."

Other new studies presented on the first day of the meeting included the following:

  • 3-year results from the IST-3 trial suggesting favorable long-term mortality and safety results with tPA given within 6 hours of stroke onset.

  • PREDIVA, a trial of intensive vascular care in the prevention of dementia in stroke patients, which showed a main neutral result but with some hints of benefits.

  • SIESTA, a randomized trial of sedation vs general anesthesia for endovascular therapy for acute stroke, the early results of which have shaken things up by suggesting that general anesthesia may be just as good as keeping the patients awake; this is contrary to some of the subgroup analyses from the recent endovascular trials.

"And all this is only some of what was presented on the first day," Professor Lees added. "We've only just started. There is much more to come. This includes some further analyses of the endovascular trials as well as several sessions on how to address the practical details of such therapy: how to set up services and choose patients, et cetera. And there is a complete session of late-breaking trials on Thursday which had to be added to accommodate the latest submissions."

Results from most of the major clinical trials presented at the ESOC will be covered in separate articles on Medscape Medical News.

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