Susan Jeffrey

February 21, 2017

Hard on the heels of the longest game and biggest comeback in Super Bowl history, stroke professionals from all over the world will meet in Houston for the International Stroke Conference (ISC) 2017, February 22 to 24.

Bruce Ovbiagele, MD, chairman of neurology at the Medical University of South Carolina in Charleston and chair of the International Stroke Conference 2017 Program Committee, discussed upcoming meeting highlights with Medscape Medical News.

One new addition is a game-show type competition called Game of Strokes, what's described in the program as a "friendly intellectual war" between teams representing global regions, including this year Team Europe, Team Asia/Australia, and Team Canada/USA. Producer and moderator of the game is Jose Biller, MD, Loyola University, Maywood, Illinois.

"All of these contestants are stroke experts, but the whole idea is to instill and reinforce key stroke knowledge, and by key stroke knowledge I am referring to knowledge about stroke diagnostics and therapeutics, among other fundamental concepts, integral to scientifically informed practice of stroke medicine," Dr Ovbiagele said. "It will be a fun-filled session where people compete for the highest points to win what we're calling the Gold Brain trophy at the end of it. While we will inscribe the name of region and its members on the trophy each year, it's really just about having friendly bragging rights for the winning region each year, while most importantly fostering a stimulating environment in which to learn or relearn. We will aim to have different permutations and combinations of regions each successive year."

South America and Africa were not purposely excluded, he noted. "We plan to have them in future Game of Strokes competitions, but we thought it would be unwieldy to have more than three teams of five contestants competing at the same time."

Attendees can use the ISC 2017 Mobile Meeting app to play along in the room, and for those who can't attend the conference, the session will be streamed live. (Game of Strokes, Thursday, February 23, 1:30 pm to 3:00 pm CT, Grand Ballroom C)

Another new session is called Crossfire Debates, Dr Ovbiagele noted. These are three debates on "hot, controversial topics" in the field of stroke research. The audience will be polled before and after each debate.

One debate will focus on research into the treatment of asymptomatic carotid artery stenosis, while another will look at the utility of surgical treatment of asymptomatic arteriovenous malformations (AVMs) of a certain size and location.

"There are people in the community who think that for small readily accessible AVMs, the risk of surgery is not so great, and the natural history is not so benign, such that perhaps these select patients should receive surgery," Dr Ovbiagele noted. Results of the recent ARUBA trial suggested it was better not to intervene, he said, "but that trial included a broad swath of patients with arteriovenous malformation, so this is really talking about, can we pick people who would benefit from surgery with relatively lower risk from that surgery?"

The last debate will look at acute stroke management and whether patients with large vessel occlusion should be transferred immediately to a center that offers mechanical thrombectomy or should first be treated with thrombolysis at the nearest hospital capable of administering the latter, but not the former. (Closing Main Event, Friday, February 24, 10:30 am CT, Hall C)

Finally, a new series of lectures fashioned after TED talks are the CED Talks (Cerebrovascular Education and Discovery), Dr Ovbiagele said. "They are being delivered by four premier stroke researchers, all winners of major ISC awards in the past, so we're looking forward to exciting talks," he said. "They will use minimal slides, no more than six slides, so it's really about being able to convey your message to the audience in a direct and compelling way as much as possible, and then there will be an opportunity to ask a few questions after each talk." This session will also be live-streamed.

CED Talks: Thursday, February 23, 8:45 am to 10:00 am CT

  • Exosomes as a Restorative Treatment for Stroke: Michael Chopp, PhD, Detroit, Michigan

  • Padding the Pacific: The Pace of Translation in Stroke Research: S. Claiborne Johnston, MD, PhD, Austin, Texas

  • Rebuilding Function After Stroke: Robert Adams, MD, MS, Charleston, South Carolina

  • Penumbral Selection for Reperfusion Therapy: It's About Brain!: Stephen M. Davis, MD, Victoria, Australia

Late-Breaking Science

Key clinical science trial results, of course, are always a central part of the meeting. Dr Ovbiagele pointed, for example, to a trial to be presented on Friday that compared early vs delayed statin treatment in patients with acute ischemic stroke (LB17).

Another interesting trial is looking at head position in stroke (LB1), he said. The study is examining whether lowering the head of a patient's bed to being flat vs at a 30-degree incline will improve outcome. "It's not clear what to do, and various physicians do different things," he said. "On one hand, it is thought that making the head of the bed flat may improve collateral blood supply to the brain, thereby allowing it to benefit from alternative flow patterns around the area of blockage from the stroke, while on the other it is felt that keeping the bed flat for many stroke patients who can't protect their airways may lead to greater risk of aspiration pneumonia that could greatly worsen stroke outcomes." This study looks at that question.

Opening Main Event: Wednesday, February 22, 2017, Hall C, 11:20 am CT

  • LB1: Head Position in Stroke Trial: An International Cluster Cross-over Randomized Trial   

  • LB2: Aster Trial. Contact Aspiration versus Stent Retriever Front Line for Recanalization in Acute Cerebral Infarction

  • LB3: Prospective, Multi-Center Study of Flow Diversion for Small and Medium-Sized Aneurysms: Results of the Premier Trial  

Thursday Main Event: Thursday, February 23, 2017, Hall C, 11:00 am

  • LB4: Intensive Versus Guideline Antiplatelet Therapy for Preventing Recurrence in Patients With Acute Ischemic Stroke or TIA: Main Results From the Triple Antiplatelets For Reducing Dependency In Ischaemic Stroke (TARDIS) Trial  

  • LB5: Cilostazol Versus Aspirin in Ischemic Stroke Patients With Intracerebral Hemorrhage or Multiple Microbleeds  

  • LB6: Resumption of Oral Anticoagulation After Intracerebral Hemorrhage Is Associated With Decreased Mortality and Favorable Functional Outcome  

  • LB7: Efficacy and Safety of Nimodipine in Vascular Mild Cognitive Impairment: A Randomized Placebo Controlled Trial

  • LB8: Second Generation Hydrogel-coated Coils for the Endovascular Treatment of Intracranial Aneurysms: Final Results of a Randomized Controlled Trial  

Late-Breaking Science Oral Abstracts I: Thursday, February 23, Grand Ballroom B, 1:30 pm

  • LB9: Ticagrelor Versus Aspirin in Acute Stroke or Transient Ischemic Attack of Atherosclerotic Origin

  • LB10: E-cigarette Exposure Alters Brain Glucose Utilization and Stroke Outcome

  • LB11: Shake, Rattle & Roll Trial — Improving Blood Pressure Control Among African Americans

  • LB12: Safety and Feasibility of Combination of Ticagrelor and Aspirin in Patients With Minor Stroke or TIA: Interim Analyses of the Platelet Reactivity in Acute Stroke or Transient Ischemic Attack (PRINCE) Trial

  • LB13: Effect of a Nationwide Hospital-based Stroke Network on Key Processes of Evidence-based Stroke Care: The China National Stroke Prevention Project

  • LB14: Rapid Increase in Endovascular Thrombectomy for Acute Ischemic Stroke in the United States: Data From Get With the Guidelines-Stroke

  • LB15: Inter-Hospital Transfer Prior to Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry

Closing Main Event: Friday, February 24, Hall C, 1:30 pm

  • LB16: Randomized Trial of Hemostatic Therapy for "Spot Sign" Positive Intracerebral Hemorrhage: Primary Results From the SPOTLIGHT/STOP-IT Study Collaboration

  • LB17: Randomized Controlled Trial of Early Versus Delayed Statin Therapy in Patients With Acute Ischemic Stroke

  • LB18: A Randomized Double-Blind Pilot Study Assessing Vagus Nerve Stimulation (VNS) During Rehabilitation for Improved Upper Limb Motor Function After Stroke  

Major Awards

Finally, the three major ISC awards will be again be presented, but this year will be the start of a new award honoring individuals who have shown excellence in the successful mentoring of the next generation of stroke scientists.

"Unfortunately, people don't get paid or broadly recognized for being good mentors, but we know that mentorship is imperative to developing the next generation of stroke researchers," Dr Ovbiagele said. "So using the imprimatur of ISC, we wanted to start to recognize and appreciate those people who are taking the effort and time to routinely invest in the careers of up and coming stroke researchers."

The award will go to mentors who are not so much senior in their careers but those in mid-career, he added, "because we want to provide a timely form of encouragement to those people who are quietly doing mentoring so they keep doing it, but also to encourage those who may want to engage in mentoring but think, 'Well, it's not worth my while because the pay and the recognition is just not there.'"

The winner this year is Louise McCullough, MD, PhD, professor and chair, Department of Neurology, Roy M. and Phyllis Gough Huffington Distinguished Chair, Chief of Neurology Service, Memorial Hermann Hospital–Texas Medical Center (TMC), Houston.

"She has mentored several people who have become independent researchers," Dr Ovbiagele said. "Many of the people who wrote letters for her really lauded the time and commitment she takes, and would take, to ensure their success."

International Stroke Conference 2017 Award Winners

  • David G. Sherman Lecture: E. Clarke Haley Jr, MD, Charlottesville, Virginia, for lifetime achievement in the stroke field. "With a Little Help From My Friends: Seeking Consistent and Persuasive Evidence." Wednesday, February 22, Hall C, 11:00 am CT

  • Thomas Willis Lecture: Jaroslaw Aronowski, PhD, Houston, Texas, for contributions to the investigation and management of stroke — basic science. "Brain Damage and Repair After Intracerebral Hemorrhage." Thursday, February 23, Hall C, 10:35 am CT

  • William M. Feinberg Award for Excellence in Clinical Stroke: Steven M. Greenberg, MD, PhD, Boston, Massachusetts, for ongoing contributions to clinical science investigation and management of stroke. "Big Pictures and Small Vessels." Friday, February 24, Hall C, 11:33 am CT

  • Stroke Research Mentoring Award: Louise McCullough, MD, PhD, Houston, Texas, for outstanding achievement in the mentoring of future cerebrovascular disease researchers. Wednesday, February 22, Room 310 A-C, 8:45 am CT

  • Vascular Cognitive Impairment Award: Jennifer L. Dearborn, MD, New Haven, Connecticut, for abstract 95: "Nutrition and Cognitive Decline Over 21 Years: Results From the Atherosclerosis Risk in Communities Study (ARIC)." Wednesday, February 22, Room 310 A-C, 4:06 pm CT

  • Stroke Rehabilitation Award: Steven C. Cramer, MD, Irvine, California, will present abstract 8: "A Phase IIb Double-Blind, Randomized, Placebo-Controlled Study of GSK249320 for Stroke Recovery," Wednesday, February 22, General Assembly C, 7:00 am CT

  • Mordecai YT Globus New Investigator Award in Stroke: Yejie Shi, MD, PhD, Pittsburgh, Pennsylvania, will present abstract 127: "Endothelial-targeted Overexpression of Heat Shock Protein 27 Ameliorates Rapid Blood Brain Barrier Impairment and Improves Long Term Outcomes After Ischemia and Reperfusion," Wednesday, February 22, General Assembly B, at 9:57 am CT

  • Stroke Care in Emergency Medicine Award: Kevin Sheth, MD, New Haven, Connecticut, will present abstract 15: "Long Term Outcomes of Glyburide in Patients 70 Years of Age or Under: Subgroup Analysis From the Phase II GAMES-RP Study of Patients with Large Hemispheric Infarction," Wednesday, February 22, Grand Ballroom B, 7:00 am CT

  • Robert G. Siekert New Investigator in Stroke Award: Alessandro Biffi, MD, Boston, Massachusetts, will present abstract 54: "APOE Genotype Modifies the Effect of Blood Pressure on Long-Term Clinical Deterioration Following Intracerebral Hemorrhage," Wednesday, February 22, General Assembly B, 2:18 pm CT

  • Stroke Basic Science Award: Yao, PhD, Duluth, Minnesota, will present abstract 218: "Pericytic Laminin Regulates Blood-Brain Barrier Integrity in an Age-Dependent Manner," Friday, February 24, General Assembly C, 8:45 am CT

Medscape Medical News will be onsite, providing in-depth news coverage and feature interviews, beginning Wednesday, February 22.

Follow us on Twitter (@MedscapeNeuro) and Facebook. Follow the ISC on Twitter (@HeartNews, #ISC17).

The meeting is being held at the Houston Convention Center, Houston, Texas.

Dr Ovbiagele reports significant grant funding by the National Institutes of Health.

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