see IGNITING HOPE, page 13 In his address yesterday, AHA President Keith Churchwell, MD, FAHA, shared his personal story and vision for the future of medicine. Rooted in the values instilled by his parents — a pioneering journalist and an inspiring educator who challenged their children by constantly asking, “What can you do to help?” — Churchwell spoke of the power of perseverance, community and responsibility to drive meaningful change in health care. Reflecting on the strides made in stroke care, Churchwell highlighted the successes of the Get With The Guidelines-Stroke program, which has revolutionized the delivery of acute stroke care and fostered a community for like-minded researchers. “You, the real drivers behind (this program), are a force for good, a concrete answer to the question, ‘How can I help?’” he told the audience. Despite these recent advancements, Churchwell underscored the pressing challenges of hypertension and health equity. Citing alarming statistics, he warned that if current trends persist, the prevalence of hypertension and stroke will surge dramatically by 2050. “The fact that patients aren’t hearing the alarm bells going off and responding to them shows how far we need to go in this effort. The messages, the messengers — everything needs to be re-evaluated,” he said, calling for a renewed focus on blood INSIDE News Bench to bedside programming 11 Intracranial hemorrhage and inflammation 3 Results from Late-Breaking Science presented at the Opening Session Thursday, Feb. 6 DAY 2 Balancing clinical practice and scholarship 6 4 Conference International Stroke Visit ISC 2025 Conference Coverage for even more daily articles, videos and late-breaking science from #ISC25. VIEW MORE STORIES FROM #ISC25 Science & Technology Hall map and exhibitor list Pages 8-9 see OPENING SESSION, page 13 Communities at risk: Small changes lead to big improvements Churchwell calls on health care professionals to tackle hypertension and advance health equity. Igniting hope for the future During Wednesday’s Opening Session, AHA Chief Science and Medical Officer Mariell Jessup, MD, FAHA, acknowledged the city of Los Angeles and those impacted by the recent fires. “Amid this profound tragedy, our souls were lifted by the firefighters, paramedics, neighbors and so many others stepping up to help those in need,” she said. “Moments like these require us to hold space in our hearts for both the grief of what’s been lost, and the hope for a brighter future. We see this same sentiment reflected in stroke care.” Citing the recent Circulation article “Forecasting the Burden of CVD and Stroke in the United States Through 2050” Jessup said stroke prevalence could double by 2050. However, she reported that deaths from stroke have been reduced by one-third since the creation of the American Stroke Association. She outlined several initiatives that are helping stroke researchers and clinicians change the future of health: • In its 20th year, the association’s Get With The Guidelines-Stroke Mariell Jessup, MD, FAHA Keith Churchwell, MD, FAHA
2 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 THURSDAY, FEB. 6 11 a.m.-12:30 p.m. Main Event Hall LB16 | TRANScranial Direct Current Stimulation for Post-Stroke Motor Recovery: A Phase 2 Study (TRANSPORT2) Main Results Wayne Feng, Duke University School of Medicine, Chapel Hill, North Carolina LB17 | Intensive Blood Pressure Lowering After Thrombectomy in Ischemic Stroke Patients: A Randomized Clinical Trial Xuening Zhang, West China Hospital, Chendu, China LB18 | Coordinated, Collaborative, Comprehensive, Family-Based, Integrated, Technology-Enabled Post-Stroke Care George Howard, University of Alabama-Birmingham, Birmingham, Alabama LB19 | The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial 2 Final Results Ken Butcher, University of New South Wales, Randwick, NSW, Australia LB20 | Atorvastatin Treatment and Rebleeding in Cerebral Cavernous Malformations: A Randomized, Placebo-Controlled, DoubleBlinded Clinical Trial Issam A. Awad, University of Chicago Medical Center, Chicago, Illinois CLOSING MAIN EVENT FRIDAY, FEB. 7 11 a.m.-1:05 p.m. Main Event Hall LB37 | Effects of Direct Oral Anticoagulants Versus No Anticoagulation in the Prevention of Stroke in Intracerebral Haemorrhage Survivors With Atrial Fibrillation (PRESTIGE-AF) Trial Roland Veltkamp, Imperial College London, London, United Kingdom LB38 | Intra-Arterial Tenecteplase Thrombolysis for Acute LVO After Successful Mechanical Thrombectomy Recanalization (ANGEL-TNK) — A Multicenter, Prospective, Randomized, OpenLabel, Blinded Endpoint Trial Miao Zhongrong, Beijing Tiantan Hospital, Beijing, China LB39 | The Optimal Dosage of Adjunctive Intra-Arterial Tenecteplase Following Successful Endovascular Thrombectomy in Patients With Large Vessel Occlusion Acute Ischemic Stroke (DATE) Trail Xianhua Hou, The First Affiliated Hospital, Army Medical University, Chongqing, China LB40 | Extending the Time Window for Tenecteplase by Effective Reperfusion of Penumbral Tissue in Patients With Large Vessel Occlusion (ETERNALLVO): A Multicenter, Prospective, Open-Label, Blinded Endpoint, Controlled, Phase 3, Superiority Trial Vignan Yogendrakumar, The Ottawa Hospital, Ottawa, ON, Canada LB41 | Treatment With Intravenous Alteplase in Ischemic Stroke Patients With Onset Time Between 4.5 And 24 Hours Min Lou, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China LB42 | Intra-Arterial Alteplase for Acute Ischemic Stroke After Mechanical Thrombectomy (PEARL): A Multicenter Randomized Trial Yamei Tang, Sun Yat-sen Memorial Hospital, Guangzhou, China LB43 | A Randomized Controlled Trial of Antithrombotic Therapy in Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation and Atherosclerosis: The ATISNVAF Trial Shuhei Okazaki, NHO Osaka National Hospital, Osaka, Japan LB44 | Liraglutide in Acute Minor Ischemic Stroke or High-Risk Transient Ischemic Attack Patients With Type 2 Diabetes Mellitus (LAMP): A Randomized Clinical Trial Huili Zhu, The First Affiliated Hospital of Jinan University, Guangzhou, China LB45 | BXOS110 for Acute Ischemic Stroke Treatment (BEST): A Multicenter, Double-Blind, Randomized, Placebo-Controlled, Phase 2 Trial Yarong Ding, Beijing Tiantan Hospital, Beijing, China See Online Program Planner for more information. Learning Studios and symposia scheduling 6:30-8 a.m. Innovations and Expert Guidance in Antiplatelet Reversal and Bleeding Management Supporter: Clinical Care Options, LLC JW Marriott Los Angeles, Platinum Ballroom E 5:30-7:30 p.m. Factoring Solutions to the Management of Stroke Care in the Settings of Secondary Prevention and AF Total CME supported by an educational grant from Bristol Myers Squibb and Johnson & Johnson Innovative Medicine Alliance JW Marriott Los Angeles, Room: Gold 3-4 (Ground Floor) 6-7:30 p.m. Staying Ahead in Stroke Prevention: The Rise of New Anticoagulation Approaches Medscape Education on behalf of Bayer JW Marriott, Ballroom Platinum A-D Satellite Symposia Learning Studios THURSDAY, FEB. 6 Late-Breaking Science 9:15-9:45 a.m. Advancing Stroke Care: Deepening the Collaboration Between Neurology and Cardiology Medtronic Learning Studio I 10-10:30 a.m. Evolution of Stroke Treatment and Building a CSC With New 088 Technology Terumo Neuro Learning Studio I 10-10:30 a.m. Scaling Stroke Triage With AI: Virtual Innovation for Neuroscience Excellence (VINE) Sevaro Learning Studio II in Meeting Room 306AB 12:45-1:15 p.m. Considerations and Learnings With Newer Generation Flow Diverters Medtronic Learning Studio I 12:45-1:15 p.m. Disrupting the Status Quo: Aldosterone in the Pathogensis of Hypertension AstraZeneca Learning Studio II in Meeting Room 306AB 1:30-2 p.m. Build a Thriving Telestroke Program: Best Practices and Common Pitfalls TeleSpecialists Learning Studio I 2:15-2:45 p.m. Optimizing Blood Pressure Variability (BPV): Management Strategies for Stroke Care Chiesi Learning Studio I 3:30-4 p.m. Cracking the Code of Cryptogenic Stroke: Robotic TCD for PFO Detection NeuraSignal Learning Studio I 3:30-5 p.m. Fourth Annual Company Showcase NHLBI and NINDS Showcase Learning Studio II in Meeting Room 306AB These events are not part of the official International Stroke Conference 2025 as planned by the International Stroke Conference Program Committee.
3 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Intracranial hemorrhage is one of the most dangerous types of stroke, with a devastating mortality rate. Understanding the role of inflammation in intracranial hemorrhage may be a critical step toward improving treatments and bringing those death rates down. That will be the crux of the session on Thursday titled “Bench to Bedside and Beyond — What Do We Know About the Role of Inflammation in an Intracranial Hemorrhage?” In managing intracranial hemorrhages, the impact of vascular permeability is an important, related question, said Sahily Reyes-Esteves, MD, PhD, neurology instructor at the University of Pennsylvania’s Perelman School of Medicine. “Intracranial hemorrhages inherently cause a breakdown of the blood-brain barrier and a spillage of blood contents into the brain parenchyma,” Reyes-Esteves said. “However, beyond the initial hematoma, we have learned that there are persistent waves of barrier leakiness that contribute to the inflammatory response” after the hemorrhage. “Is it all bad? Is it all good? The answer is probably somewhere in the middle,” she said. “Understanding the nuances in this balance is important to understanding how vascular permeability affects outcomes after intracranial hemorrhage.” Reyes-Esteves will discuss those questions and more in her presentation, “The Role of Vascular Permeability in Neuroinflammation After Intracranial Hemorrhage.” She said vascular permeability’s impact is the subject of much research. “Clinically, we have long observed that cerebral edema after intracranial hemorrhage is associated with worse outcomes,” she said. “Does vascular permeability inherently lead to edema and bad outcomes? Perhaps not. Current research is looking to understand the role of the peripheral and brain intrinsic immune response in vascular permeability after intracranial hemorrhage and how it impacts ‘good’ or ‘bad’ healing.” The difference between that “good” and “bad” healing is not as black-andwhite as it seems. There has long been an impression that the inflammatory response after intracranial hemorrhage was all bad, Reyes-Esteves said, but that may not be the case. “I think it is important as clinicians to understand not just the detrimental effects of inflammation, but the potentially beneficial ones as well, as they can inform the development of new therapies that harness the immune response for brain healing,” she said. Also at Thursday’s session, a researcher will describe a novel drug candidate that could decrease inflammation and cerebral edema in the wake of intracerebral hemorrhage – which is a subset of intracranial hemorrhage. Linda Van Eldik, PhD, director of the Sanders-Brown Bench to Bedside and Beyond — What Do We Know About the Role of Inflammation in an Intracranial Hemorrhage? 7:30-9 a.m. | Thursday, Feb. 6 Room 152 UPCOMING SESSION Reyes-Esteves Eldik see INFLAMMATION, page 13 Intracranial hemorrhage and inflammation Research on vascular permeability, drug candidate provides insights into this life-threatening event.
4 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Many advanced practice providers would like to make research and scholarship part of their careers, but not many can find the time to do so. Being overburdened with clinical work not only limits the time available for scholarly work, but it can lead to burnout and increased job turnover. On Thursday, the session “Ramping Up Advanced Practice Provider Scholarship” will provide tips, tricks, tools and advice on how to meet your scholarship goals. Attempting an academic research project on your own can be daunting. But as a health care professional, you probably already have a network of colleagues in place — or you have the tools to build one — that can help you achieve research goals that are difficult to accomplish alone. Cesar Velasco, BSN, RN, stroke program coordinator at WellSpan Ephrata Community Hospital in Ephrata, Pennsylvania, will offer guidance on how to do this in his presentation, “CrossHybrid Projects: Using Your Network to Build Team Science.” Velasco said the key is to form a collaborative team of experts from other research centers, institutions or private organizations. “A network, small or large, may lend added resources and key levels of experience that not everyone is capable of having themselves, unless you are very accomplished — and I would argue even those individuals rely heavily on industry connections or existing relationships with experts in their fields of practice to accomplish projects of interest,” he said. One area where this networking can be especially useful is in developing cross-hybrid projects, which Velasco defines as an approach to generating a solution by combining various experiences, resources or methodologies to solve a problem with greater adaptability and efficiency. As an example, Velasco cited the Association of Neurovascular Clinicians, of which he is a member. The association uses a team of stroke coordinators, advanced practice professionals and neurologists to help educate nurses in Latin American countries where information on the management of neurovascular patients is limited. Together, the team has pitched the concept to a network of industry sponsorship partners to support the endeavor, he said. “Although the process is ongoing, the concept would be even more difficult to get off the ground if it relied heavily on one individual.” Velasco said it is important for medical professionals to put themselves out there to build a network, which means selfmarketing skill sets, ideas and even connections. “Once you have your network, learn from your colleagues and discover common interests or goals that you wish to achieve,” he said. “Don’t be discouraged about failing. Nothing is accomplished successfully without failing first. “We learn professionally from our setbacks, and a reliable network or team of experts who work together with you will know what is needed to bounce back toward the direction of your end-goal project.” Even with an established network, burnout can be a significant issue among medical professionals who are overwhelmed with clinical responsibilities to the point that scholarly goals are pushed aside. Skye Coote, NP, MN, stroke nurse practitioner and nursing lead for the Melbourne Mobile Stroke Unit at the Royal Melbourne Hospital in Australia, said it doesn’t have to be that way. Recognition for scholarly work — be it academic research, conference presentations or papers — can help health care professionals avoid burnout by feeling valued. “A lack of feeling valued, visible and recognized contributes to burnout, while positive recognition can reduce burnout,” she said. “It’s often not possible to leave jobs that are causing burnout, so finding an alternative path — even if it is something that is done on the side — can bring that reward and positive reinforcement that is otherwise lacking in general health care.” Coote’s presentation, “Avoiding Burnout: Finding Balance Through Scholarly Recognition,” will also be part of Thursday’s session. Coote said that academic accomplishments are often more recognized and lauded than clinical care, and working on these projects can help health care professionals remember why they pursued their career in the first place — for instance, perhaps to find better ways to care for patients or to improve patient outcomes. “Being involved in a project that meets the goals for why you got into health care … can reignite the spark,” she said. Other presentations in the scholarship session are “APPs as Practitioner Researchers: Lessons Learned From the Road Less Traveled” by Anne W. Alexandrov, PhD, RN, CCRN, ANVP-BC, NVRN-BC, FAAN, FAHA; “Building Scholarship Into the APP Role: Negotiating and Enhancing the Practitioner Researcher Position” by Dawai M. Olson, PhD, RN; and “Identifying and Tearing Down Barriers to APP Scholarship,” by Nicole Schumacher. Ramping Up Advanced Practice Provider Scholarship 7:30-9 a.m. | Thursday, Feb. 6 Room 502A UPCOMING SESSION Velasco Coote Become an AHA Certified Professional PAID ADVERTISEMENT Visit us at ISC in HeadQuarters and the VIP Lounge @Booth #1049 to learn more! Offer gold standard telehealth stroke care. Improve quality and consistency of care in telehealth stroke. Sign up to be a beta tester or volunteer in the development of the Stroke Coordinator Certification for a free hat. In Development: Stroke Coordinator Certification Balancing clinical practice and scholarship The right approaches can help you find a way to pursue scholarly research projects.
5 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Managing stroke outcomes — and knowing how other medical facilities manage them — is critical to the quality of stroke care. Using real-world data and reports from multiple sources near and far can identify gaps in care and help address unmet needs in institutions and their communities. These sources will be the topic of a session Friday, “Leveraging Real-World Data to Enhance Stroke Outcomes.” Monique Kilkenny, PhD, MPH, will provide an overview of the International Network for Standardized Population Insights and Real-World Evidence for Stroke, or INSPIRESTROKE, in her presentation, “Importance of Global Collaboration: An Introduction to the (INSPIRESTROKE) Initiative.” Kilkenny said INSPIRESTROKE brings together the scientific community to monitor care and outcomes following stroke internationally, comparing countrylevel observational data and outcomes with best-practice standards to ensure findings are reliable and robust. “INSPIRE-STROKE aims to support routine pooling and reporting of country-level administrative data on these outcomes and to seek further international input and preparation on the standardization of methods,” said Kilkenny, who is head of big data, epidemiology and prevention in the Stroke and Aging Research Group at Monash University School of Clinical Sciences in Melbourne, Australia. “Standardization is important to be able to compare apples with apples,” she said. “This is crucial for several reasons, including consistency and accuracy, efficiency, scalability and quality control.” The network, Kilkenny said, will also help researchers compare stroke outcomes among countries to identify best practices, understand disparities, guide policy and resource allocation, improve public health and enhance research and collaboration. Stroke care providers can also use local data to help improve their patient outcomes. The AHA’s Get With The Guidelines® – Stroke initiative is an in-hospital program for improving stroke care by promoting adherence to the latest scientific treatment guidelines. Since the initiative’s launch in 2003, more than 2,000 hospitals have entered Register today for the Removing Barriers to Equitable Health eModules learn.heart.org Access for Free These free accredited activities will allow healthcare professionals to explore the disparities in health outcomes for various populations, examine how environmental factors and structural racism can create barriers to health, and discover best practices and solutions to help overcome those barriers. CE and MOC credits available This activity is supported by an educational grant from Bristol Myers Squibb. Module 2: Health Care Systems Module 1: Public Health PAID ADVERTISEMENT Accessing data to improve outcomes Resources hold a key to enhancing quality and equitable delivery of stroke care. see OUTCOMES, page 15 Leveraging Real-World Evidence to Enhance Stroke Outcomes 7:30-9 a.m. | Friday, Feb. 7 Main Event Hall UPCOMING SESSION Kilkenny ISC News is produced for the American Heart Association/American Stroke Association’s International Stroke Conference by Ascend Media, LLC (ascendmedia.com). After you have read this issue of ISC News, please share with colleagues or deposit it in an approved paper recycling bin. ©2025 by the American Heart Association/American Stroke Association 7272 Greenville Ave. Dallas, TX 75231 1-888-4-STROKE stroke.org Paid advertisements are not reviewed by the AHA/ASA for scientific accuracy.
6 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Surgery with the ARTEMIS device shows shortterm benefit in patients with deep intracerebral hemorrhage Intracerebral hemorrhage accounts for 10% of all U.S. stroke cases per year but 30% to 40% of early stroke mortality. In the MIND study, researchers explored whether minimally invasive surgery with the ARTEMIS Neuro Evacuation Device could improve outcomes in patients primarily with deep and lobar intracerebral hemorrhages. The ARTEMIS tool uses neuro-navigation and an endoscope to visualize and evacuate the hemorrhage through a tiny endoscope sheath. Its low-profile access has the potential to minimize injury to surrounding brain tissue. MIND — a multicenter, openlabel, randomized trial — studied patients with moderate to large volume (20-80 cc) supratentorial intracerebral hemorrhage who presented within 24 hours of symptom onset. The patients were randomized 2:1 to minimally invasive surgery with the ARTEMIS device and medical management as defined by the American Heart Association/ American Stroke Association guidelines or to medical management alone. The study’s primary effectiveness endpoint was a 180-day ordinal modified Rankin score (mRS). The primary safety endpoint was 30-day mortality. Cases were stratified for severity and intracerebral hemorrhage location. The Early Minimally Invasive Removal of ICH (ENRICH) trial Late-breaking results from five trials presented at Opening Main Event At Wednesday’s Opening Main Event, researchers highlighted findings on minimally invasive surgery for intracerebral hemorrhage, transradial versus transfemoral angiography and outcomes of endovascular therapy for medium or distal vessel occlusion compared to medical management. The trials found: • Minimally invasive surgery for intracerebral hemorrhage did not improve longer-term patient outcomes. • Transradial angiography offers advantages over transfemoral angiography. • In patients receiving best medical treatment for medium or distal vessel occlusion, adding endovascular treatment did not reduce disability and death, the DISTAL trial found. • Endovascular therapy provided no added benefit over usual care, results from the ESCAPE-MeVO trial showed for medium vessel occlusion. • The DISCOUNT trial found mechanical thrombectomy wasn’t superior to usual care for treatment of distal vessel occlusion. recently demonstrated that minimally invasive surgery improves functional outcomes in patients with lobar intracerebral hemorrhage at 180 days. Based on a planned interim analysis, enrollment of patients with deep hemorrhages in the ENRICH trial was stopped early due to a lack of observed benefit in this subgroup, further underscoring the focus on patients with lobar hemorrhages. In the MIND study, enrollment was stopped after 236 patients, with 167 (70.8%) presenting with deep intracerebral hemorrhage and 72 (29.2%) with lobar intracerebral hemorrhage. After minimally invasive surgery, intracerebral hemorrhage volume was reduced by 81.5% to 6.0 cc in the deep and 80.4% to 8.1 cc in the lobar cohorts, respectively. Despite improvement in functional outcomes at 30 days in both cohorts, however, minimally invasive surgery with the ARTEMIS device was not superior to medical management only. “While minimally invasive surgery did not improve disability outcomes or reduce mortality at 180 days, we did see a substantial reduction in symptomatic perihematomal edema and improved modified Rankin scores at 30 days,” said MIND co-investigator David Fiorella, MD, PhD, director of the Cerebrovascular Center at Stony Brook University Hospital in New York. Fiorella also noted that fewer surgical patients were intubated, and they spent less time in the ICU and in the hospital at 30 days, compared with the medical management group. “Our data suggests that minimally invasive surgery is effective at eliminating or reducing early reversible intracerebral hemorrhage damage but can’t reverse enough of the persistent damage to maintain the significance,” he said. “But with limited treatment options for reducing disability at 30 days and getting patients out of the ICU or hospital earlier, the ARTEMIS procedure remains a viable option, particularly for patients with deep intracerebral hemorrhage.” Fiorella said significant advancements in our understanding of minimally invasive surgical techniques have been made since the MIND study began. The results of ongoing randomized clinical trials, like the Dutch ICH Surgery Trial, are likely to paint a clearer picture of whether endoscopic intracerebral hemorrhage evacuation improves long-term functional outcomes, he said. Transradial angiography offers better patientcentered outcomes compared with transfemoral angiography Although the transradial approach for cerebral angiography has gained popularity in recent years, evidence has been lacking regarding its efficacy and safety compared with the traditional transfemoral approach. The TRACE trial, a direct comparison of the efficacy and safety of the two approaches for cerebral angiography and neurointervention, found that the transradial approach provides notable advantages. TRACE is an investigatorinitiated, multicenter, open-label trial with blinded endpoint assessment. The trial randomized 858 patients scheduled for diagnostic cerebral angiography 1:1 to an intervention group (transradial angiography; 431 patients) or control group (transfemoral angiography; 427 patients). The study was conducted at 13 sites in China from September 2023 to November 2024. The primary endpoint, the success rate of diagnostic cerebral angiography, was lower in the transradial angiography group (91.0%, 392 patients) compared with Fiorella Ni
7 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 the transfemoral angiography group (95.8%, 409 patients); incidence difference, −4.8% [95% CI, −8.1% to -1.5%]; RR, 0.95 [95% CI, 0.92-0.98]; P = 0.46). Duration of both angiography and fluoroscopy was longer in the transradial group than in the transfemoral group. But patient bedridden time and visual analog scale score were lower in the transradial angiography group. Also, no significant difference was found between the groups in the incidence of angiographic complications during and within 24 hours after the procedure. “Our findings offer valuable insights into these two access routes, helping to clarify the trade-offs between procedural success, patient comfort and complication rates, which are critical for informed clinical decision-making,” said principal investigator Wei Ni, MD, a neurosurgeon at Huashan Hospital and Fudan University in China. “Although the transradial approach for cerebral angiography may have a slightly lower success rate and longer procedural time compared to the transfemoral approach, it provides notable advantages in patient comfort, shorter bedridden time and comparable complication rates.” Ni noted that developing more efficient transradial angiography devices is essential for enhancing the success rate of transfemoral angiography. Endovascular therapy did not provide an added benefit in patients with distal or medium vessel occlusion stroke The DISTAL trial is one of the first and largest randomized-controlled trials reporting on the effect of endovascular thrombectomy (EVT) plus best medical therapy versus best medical therapy alone for patients with acute ischemic stroke due to a medium or distal vessel occlusion. Results of the trial described Wednesday showed that EVT did not reduce disability or death compared with the best medical therapy alone. DISTAL — a multicenter, international, prospective, openlabel, blinded-endpoint superiority trial — studied 543 patients 1:1 with an acute ischemic stroke due to a medium or distal vessel occlusion. The patients were randomized 1:1 to EVT plus usual careor usual care alone over three years. The primary efficacy outcome was the distribution of disability levels on the modified Rankin Scale at 90 days. “Based on previous evidence, we limited the target vessels to previously understudied vessel segments in which evidence of a treatment benefit was missing, which included the non- or co-dominant M2 segment; M3 or M4 segment of the middle cerebral artery; the A1, A2 or A3 segment of the anterior cerebral artery; and the P1, P2 or P3 segment of the posterior cerebral artery,” said principal investigator Marios Psychogios, MD, director of diagnostic and interventional neuroradiology at University Hospital Basel in Switzerland. Co-principal investigator Urs Fischer, MD, director of the neurology department at the University Hospital Bern in Switzerland, noted that the study’s limitation to non- or co-dominant M2 occlusions, which perfuse less than half of the media territory, is a key strength of the DISTAL trial compared with other trials. For dominant M2 occlusions, there was compelling evidence from a HERMES sub-analysis that endovascular therapy would be beneficial, he said. Still, EVT in addition to best medical therapy did not lead to a reduction in disability or death compared with best medical therapy alone. This finding was consistent among all studied subgroups, particularly in patients with moderate to severe strokes with a National Institute of Health Stroke Scale score of 6 or above, people who did not receive intravenous thrombolysis, and those age 70 or younger. No patient was lost to follow-up. Although the results of the DISTAL trial were neutral, the researchers suggest that clinicians should consider offering EVT to selected patients on a case-to-case basis. “Endovascular therapy in addition to best medical therapy does not lead to increased rates of symptomatic intracranial hemorrhage or death, and overall endovascular therapy for medium or distal vessel occlusion appears to be a safe procedure,” Dr. Psychogios said. “An important finding from DISTAL was that the natural course of medium distal vessel occlusion stroke is worse than expected, increasing the pressure on finding novel effective treatment options.” DISTAL will serve to inform the design of future randomized clinical trials studying the effects of EVT in people with distal or medium vessel occlusion stroke. The study was published simultaneously in the New England Journal of Medicine. Endovascular therapy did not provide an added benefit in patients with medium vessel occlusion stroke The ESCAPE-MeVO trial, reporting on the effect of endovascular thrombectomy (EVT) plus usual care for patients with acute ischemic stroke due to a medium distal vessel occlusion, found EVT did not provide an added benefit. The study —a prospective, open-label, blinded-endpoint trial — included 530 patients in five countries who had an acute ischemic stroke due to a medium distal vessel occlusion (in A2, M2, P2 or more distal arterial segments). The patients were randomized 1:1 within 12 hours from the last known well/favorable baseline noninvasive brain imaging to EVT plus usual care (255 patients) or usual care only (274 patients). The study period ran from April 2022 to June 2024. Eligible patients in both treatment groups received guidelinedirected anti-thrombolytic therapy. The primary outcome was the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included the Barthel Index score, mortality at 90 days, infarct volume and patient reported quality of life. In the study, EVT treatment did not improve outcomes at 90 days, compared with usual care. Excellent functional outcomes (mRS 0-1 at 90 days) occurred in 41.6% of patients in the EVT group and 43.1% in the usual care group [adjRR = 0.95, CI 0.79-1.15, p=0.61]. In the EVT group, 13.3% of patients died, compared with 8.4% in the usual care group. Symptomatic intracranial hemorrhage occurred in 2.2% of patients in the usual care group and 5.4% of patients in the EVT group (p=0.08). “Ten years ago, we tackled large vessel occlusion, showing in multiple scenarios that endovascular therapy treatment is good for patients with large vessel occlusion. In ESCAPEMeVO, we asked the next question: ‘Is endovascular therapy efficacious when the clots are smaller and the strokes are less severe?’” said principal investigator Mayank Goyal, MD, FAHA, a clinical professor of radiology and clinical neurosciences at the University of Calgary Fischer Goyal Hill see LATE-BREAKING SCIENCE, page 12 Psychogios
8 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 The Science & Technology Hall The Science & Technology Hall offers nearly 100 exhibiting companies, HeadQuarters, Learning Studios, Innovation Zone, the Simulation Zone and many more learning and networking opportunities. ISC25 EXHIBITORS Scan the QR code for scheduled programming. Welcome First-Time Exhibitors to ISC! These companies are highlighted in red. Join us at the new Neuro Talk Theater in AHA HeadQuarters, Booth 528. Access TeleCare . . . . . . . ....1122 Accreditation Commission for Health Care . . . . . . . .... 906 Adjacent Health . . . . . . ..... 807 Aidoc Medical Ltd. . . . . . . ... 923 American Association of Neuroscience Nurses AANN . . . . . ... 1002, 1004 American Board of Neuroscience Nursing ABNN . . . . . . . ..... 1004 AmplifyMD..............817 Apex Innovations . . . . . . .... 600 Asahi Intecc USA . . . . . . ..... 801 Balt . . . . . . . . . . . .......1017 Bayer . . . . . . . . . . .....515, B11 Baylor Scott and White . . . . ... 316 Blue Sky Neurology . . . . . .... 300 BMS/J&J alliance . . . . .. 331, B1, B2 Boston Scientific . . . . . . . . . . . 318 Brain Aneurysm Foundation . . 1003 Brainomix...............811 Brainventions, Inc. . . . . . . . . 1006 Business Audio Theatre . . . . .. 423 CERENOVUS . . . . . . . . ..... 939 Ceribell . . . . . . . . . . ...... 802 Chiesi. . . . . . . . . . . ....... 311 Chiesi USA, Inc. Medical Affairs . . 310 DiaMedica Therapeutics, Inc. . . . 505 DNV.. .. .. .. .. ......... 501 DWLUSAInc. . . . . . . . ..... 800 Encompass Health Corporation . 901 Genentech . . . . . . . . . ...... 931 GENOBIOTX . . . . . . . . . . . . . 422 Genomadix Inc . . . . . . . ..... 513 Getting to the Heart of Stroke . . 400 Grace Therapeutics . . . . . . ...315 Harmony Healthcare IT . . . .. 1023 Health Scholars . . . . . . ..... 504 Hyperfine . . . . . . . . . . . . . . . 615 IDMED................1025 Image Monitoring USA . . . . . . . 500 Imperative Care . . . . . . . . . 917, B4 JAMA Network . . . . . . . . .... 606 JLKInc. . . . . . . . . . . ....... 711 Journal of Bio-X Research, a Science Partner Journal . . . ..910 Kandu . . . . . . . . . . .......912 LocumTenens.com . . . . . . .... 511 Medtronic . . . . ...523, B3, B5, B15 MenticeInc..............916 MicroTransponder Inc. . . . . ...1031 Moody Neurorehabilitation Institute . . . . . . . . . . ..... 1001 Net Smart & ANVC . . . . . . .... 616 NeuraSignal . . . . . . . . ..... 424 NeuroLogica . . . . . . . . . . . . . 425 NeurOptics..............922 NSALabs. . . . . . . . . ...... 330 Patronus Neurology, LLC . . . ... 317 Penumbra, Inc. . . . . . . . .... 1131 PerimedInc..............507 Precision Neuroscience . . . . . . 611 Pulsara . . . . . . . . . . ...... 506 Q’Apel Medical, Inc. . . . . . ... 806 RapidAI . . . . . . . . . ..... 701, B8 RosmanSearch . . . . . . . ..... 510 Route 92 Medical . . . . ... 1018, B14 SafeSeizure . . . . . . . . ...... 823 SERB Pharmaceuticals . . .. 1118, B9 Sevaro.................416 Siemens Healthineers . . . . .... 719 Solvemed Inc. . . . . . . . . ..... 516 StrokeDx, Inc. . . . . . . . . ....1124 Stryker . . . . . . . . . . ...... 339 SurgeonsLab . . . . . . . . .... 1016 Sutter Health . . . . . . . . ..... 1116 Teladoc Health . . . . . . . .... 805 TeleSpecialists, LLC . . . . . .... 410 Terumo Neuro . . . . . . .... 522, B10 The Joint Commission . . . . ... 948 Twiage. . . . . . . . . . ...... 332 United Biologics, Inc . . . . . ... 945 Vituity.................610 Viz.ai . . . . . . . . . . ....... 430 WallabyPhenox . . . . . . . ....1123 WoltersKluwer. . . . . . . . . . . . 607 World Stroke Organization . . .. 1005 Zeto...................512 Instructions for claiming CE credits 1. Log in to your account a. Go to AHA’s Professional Education Hub. b. Enter your user name and password and sign in. c. Click My Library d. Select the International Stroke Conference 2025 activity. 2. Claim Credit a. Complete the conference evaluation survey. b. Click Claim CE. c. Complete information and Save. d. Your certificate is located in “My Account” under “CE Details.” Note: CE credit for the International Stroke Conference 2025 cannot be claimed after Aug. 7, 2025, and participants are strongly encouraged to claim CE credit within 30 days of the live event. Need assistance? For customer support, call 1-877-340-9899 (8 a.m.- 6 p.m. CST, Monday through Friday) or education.help@ email.education.heart.org. Virtual attendees Request an AHA Certificate of Attendance by choosing the Programming Tab at the top navigation bar on the event platform, then choosing “Certificate of Attendance.” Note: For the ISC 2025 live event, CE credit claim is limited to participation on Feb. 5-7, 2025, only. Learn, network and relax in the new Neuro Talk Theater. Located in the AHA HeadQuarters, Booth 528, in the Science and Technology Hall, this special learning experience will be open to all attendees on Wednesday and Thursday of the conference.
9 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 : Stop by a Coffee Break for a free coffee or tea Science & Technology Hall hours and location Learn about the latest advances in stroke practices, services and technologies. See today’s schedule of events on page 2. Level 1, Halls H and K | 9 a.m.-4 p.m. | Wednesday and Thursday Simulation Zone Booth 1047 Features hands-on learning in the categories of ischemic stroke, hemorrhagic stroke, stenting/coiling and acute stroke treatment. AHA Head Quarters Booth 528 Learn more about AHA/ ASA initiatives, education, membership and publications.
10 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Poster tours, sessions continue today Moderated Digital Poster Sessions (Digital Poster Theaters 1 and 2) Posters DP13 – DP60 12:40-1:10 p.m. Imaging Moderated Digital Posters (Digital Poster Theater 1) Neuroendovascular Moderated Digital Posters (Digital Poster Theater 2) 1:20-1:50 p.m. Health Services, Quality Improvement and PatientCentered Outcomes Moderated Digital Posters (Digital Poster Theater 1) Intracerebral Hemorrhage Moderated Digital Posters (Digital Poster Theater 2) 3-3:30 p.m. Risk Factors and Prevention Moderated Digital Posters II (Digital Poster Theater 1) Translational Basic Science Moderated Digital Posters II (Digital Poster Theater 2) Professor-Led Poster Tours 6-7 p.m. Posters TMP1 –TMP120 1. Aneurysms and Vascular Malformations and Large Vessel Disease From Arteries to Veins (Non-Acute Treatment) Moderated Poster Tour 2. Cerebrovascular Nursing Moderated Poster Tour 3. Cerebrovascular Systems of Care Moderated Poster Tour II 4. Health Services, Quality Improvement and PatientCentered Outcomes Moderated Poster Tour II 5. Imaging Moderated Poster Tour II 6. Intracerebral Hemorrhage Moderated Poster Tour 7. Neuroendovascular Moderated Poster Tour II 8. Pediatric Cerebrovascular Disease Moderated Poster Tour 9. Risk Factors and Prevention Moderated Poster Tour II 10. Translational Basic Science Moderated Poster Tour II Regular Poster Sessions 7-7:30 p.m. Posters TP1– TP401 These posters are not included in the Wednesday 6 p.m. ProfessorLed Poster Tour Sessions. • Acute Treatment: Systemic Thrombolysis and Cerebroprotection Posters II • Brain Health Posters II • Cerebrovascular Nursing Posters II • Cerebrovascular Systems of Care Posters II • Clinical Rehabilitation and Recovery Posters II • Health Services, Quality Improvement and PatientCentered Outcomes Posters II • Imaging Posters II • Intracerebral Hemorrhage Posters II • Large Vessel Disease From Arteries to Veins (Non-Acute Treatment) Posters • Neuroendovascular Posters II • Pediatric Cerebrovascular Disease Posters • Risk Factors and Prevention Posters II • Translational Basic Science Posters II • Ongoing Clinical Trials Posters (OGCTP1 – OGCTP40) Digital Poster Sessions 12:40-1:10 p.m. | 1:20-1:50 p.m. | 3-3:30 p.m. Poster Hall, Hall G The sessions will take place in Digital Poster Theater 1 and Digital Poster Theater 2. Expert moderators will lead these sessions, which are organized by category. Each digital poster author will give a short presentation and host a Q&A with digital slides instead of a physical poster. To take part, view the Thursday Moderated Digital Poster Sessions in the online program planner or on the mobile meeting guide app. Decide which sessions you would like to attend. Then arrive at the corresponding Digital Poster Theater, where you can scan a QR code and listen on your personal device with your own earphones. Professor-Led Poster Tours 6-7 p.m. | Poster Hall, Hall G Expert moderators will lead 10 tours, which are organized by category. The moderators provide a short presentation and Q&A with each poster author in that category. To take part, view the Thursday Moderated Poster Sessions in the online program planner or on the mobile meeting guide app. Decide which category of posters you would like to attend. Then, by 5:55 p.m., arrive at the “section” sign numbered for your selected category. The Silent Theater feature will allow you to scan a QR code and listen on your device with your own earphones. Regular Poster Sessions 7-7:30 p.m.| Poster Hall, Hall G Presenters will be at their posters for informal Q&As with attendees. These one-on-one posters are not part of the Professor-Led Poster Tours. To see the posters featured in today’s Regular Poster Session, view the Thursday Poster Sessions in the online program planner or on the meeting guide app. Posters will be on display in the Poster Hall, Hall G, from 8 a.m. to 7:30 p.m. ISC 2025 offers three types of poster sessions: new digital posters, professor-led poster tours and one-on-one individual Q&A poster presentations. The conference’s moderated sessions will use Silent Theater. Attendees will need to bring personal earphones to hear the audio once they scan a QR code in the poster area.
11 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 6:00 PM Introduction Joshua Goldstein, MD, PhD (Chair) 6:10 PM Code ICH and Early Bundled Care Joshua Goldstein, MD, PhD 6:20 PM Best Practices for Early and Effective Blood Pressure Control in Patients with Intracerebral Hemorrhage Christos Lazaridis, MD, EDIC, BPhil 6:40 PM DOAC Reversal in Patients Experiencing Intracerebral Hemorrhage Ashkan Shoamanesh, MD 7:00 PM Case Presentation and Discussion Case Presenter: Joshua Goldstein, MD, PhD Panelists: Anne Alexandrov, PhD, AGACNP-BC, ANVP-BC, CCRN, FAAN; Christos Lazaridis, MD, EDIC, BPhil; Adnan Qureshi, MD; Ashkan Shoamanesh, MD 7:12PM Case Presentation and Discussion Case Presenter: Adnan Qureshi, MD Panelists: Anne Alexandrov, PhD, AGACNP-BC, ANVP-BC, CCRN, FAAN; Christos Lazaridis, MD, EDIC, BPhil; Joshua Goldstein, MD, PhD; Ashkan Shoamanesh, MD 7:24 PM Question and Answer AGENDA CHAIR Joshua Goldstein, MD, PhD FACULTY Anne Alexandrov, PhD, AGACNP-BC, ANVP-BC, CCRN, FAAN Christos Lazaridis MD, EDIC, BPhil Adnan Qureshi, MD Ashkan Shoamanesh, MD This event is not part of the official International Stroke Conference 2025 as planned by the AHA Committee on International Stroke Conference Programming. This activity is supported by educational grants from AstraZeneca Pharmaceuticals and Chiesi USA, Inc. CHAIR FACULTY This program is sponsored by BEST PRACTICES FOR MANAGING INTRACEREBRAL HEMORRHAGE PAID ADVERTISEMENT THIS PROGRAM CAN BE VIEWED ON CMEPLANET.COM Bench to Bedside and Beyond | What Do We Know About the Role of Inflammation in Intracranial Hemorrhage? 7:30-9 a.m. | Thursday, Feb. Room 152 Bench to Bedside and Beyond | Attacking the Swell: Vascular Permeability and Cerebral Edema Post-Stroke 3:30-5:45 p.m. | Thursday, Feb. 6 Room 515A 75 Years of NINDS-Supported Research to Advance Stroke Prevention, Treatment and Recovery: From Bench to Bedside and Beyond 3:30-5:45 p.m. | Thursday, Feb. 6 Room 151 Advances In Acute Ischemic Stroke Treatment: From Bench to Bedside and Back 4:40-4:50 p.m. | Thursday, Feb. 6 Room 151 Neurorecovery Post Stroke: Translating Neurovascular Plasticity From Bench to Bedside 5:10-5:20 p.m. | Thursday, Feb. 6 Room 151 Bench to bedside programming • Acute Treatment: Systemic Thrombolysis and Cerebroprotection • Advanced Practice Providers and Therapists • Aneurysms and Vascular Malformations • Brain Health • Cerebrovascular Nursing • Cerebrovascular Systems of Care • Clinical Rehabilitation and Recovery • Health Services, Quality Improvement and Patient-Centered Outcomes • Imaging • In-Hospital Care: From the ICU to Discharge • Intracerebral Hemorrhage • Large Vessel Disease from Arteries to Veins (Non-Acute Treatment) • Neuroendovascular • Pediatric Cerebrovascular Disease • Risk Factors and Prevention • Translational Basic Science • Ongoing Clinical Trials Abstract categories: Thursday Use X to post your questions/comments or talk about what is happening at ISC 2025. Use hashtag: #ISC25. Follow ISC on
12 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Carotid pathologies — including carotid stenosis, carotid webs, carotid dissection and intraluminal thrombosis — are complex conditions requiring critical expertise. Understanding the latest in imaging advances, delicate decisions on care and more are the focus of a session on Thursday, “Hot Topics on Hot Carotids.” For decades, the key measurement for determining the risk of cerebrovascular events by atherosclerotic carotid disease has been based on the degree of stenosis. But that’s just one part of a bigger, evolving picture. Luca Saba, MD, dean of the School of Medicine at the University of Cagliari in Italy, said the “degree of stenosis” approach originated from landmark trials like NASCET and ECST that were conducted beginning more than 40 years ago when the only method for assessing carotid arteries was angiography. “Since angiography could only measure the degree of stenosis, this became the main parameter of interest,” Saba said. “The enormous impact of those trials, with high levels of evidence, effectively transformed this measure into dogma. However, in the past 40 years, significant advances have been made.” Saba, who is also a professor of radiology and chair of his university’s radiology department, will address those advances in his presentation, “Degree of Stenosis Isn’t Everything.” “The introduction of CT, MRI and ultrasound allows us to visualize not just the degree of stenosis, but also the underlying cause — the carotid plaque,” he said. “Over the last 20 years, it has become clear that certain morphological and structural characteristics of plaque are linked to increased vulnerability, higher risk of rupture and greater potential for risks. “Today, thanks to advancements in imaging technology, we have the ability to better characterize the plaque itself and more accurately stratify cerebrovascular risk.” Saba said degree of stenosis is an indirect parameter, and there is a growing capability of including other measurements and diagnostic tools. “The goal is to shift the focus from stenosis alone to the concept of plaque vulnerability,” he said, including demonstrating the role of different imaging techniques in identifying features that make plaque vulnerable. Intraluminal thrombus in carotid arteries is a highly dangerous condition in which a thrombus is stuck to the wall but weakly attached, meaning it could detach from the vessel at any moment, causing the patient to have a stroke. Johanna Ospel, MD, PhD, will discuss the best methods for treating these patients in her presentation, “The Intraluminal Thrombus of Damocles.” “This is a pretty precarious situation, since any mechanical manipulation that we perform during interventions could also dislodge the thrombus,” said Ospel, neuroradiology fellow and stroke researcher at the University of Calgary in Alberta. “There is a high risk of doing nothing and a high risk when intervening,” she said. “Patients with intraluminal thrombi must be watched very closely because they can have a stroke at any minute. If that happens, rapid treatment is necessary, so every minute counts.” Ospel said it is the condition’s rarity that makes it particularly challenging because it’s unlikely there will ever be enough patients to do a randomized controlled trial to fully study it. “Therefore, multicenter, retrospective pooling data is absolutely critical to gather large enough datasets to make any evidence-based treatment decisions,” she said. “This is a main difference compared to more common causes of stroke, such as carotid stenosis or atrial fibrillation, where randomized trials are feasible and have been done or are underway.” Two other presentations will be included in the session Thursday: “Caught in the (Carotid) Webs” by Shadi Yaghi, MD, FAHA, associate professor of neurology at Brown University, and “Occluded Carotid: A Fait Accompli” by Edgar A. Samaniego, MD, MS, clinical professor of neurology at the University of Iowa. Cumming School of Medicine in Alberta. The answer could depend on the results of the two other landmark trials, DISTAL (see above) and DISCOUNT (below), evaluating the efficacy of EVT for the management of acute ischemic stroke with more distal occlusions, Dr. Goyal said. Differing results will necessitate an analysis of the trials’ differences to determine criteria for future trials. “If the results are similar in all three trials, however, we may need to be more cautious in terms of how aggressive we are when selecting patients for endovascular therapy,” said ESCAPE-MeVO co-investigator Michael Hill, MD, director of the stroke unit for the Calgary Stroke Program. ESCAPE-MeVO findings were was published simultaneously in the New England Journal of Medicine. Endovascular therapy did not provide an added benefit in patients with distal vessel occlusion stroke Consistent with the DISTAL and ESCAPE-MeVO trial results, the DISCOUNT trial, reporting on the effect of mechanical thrombectomy plus usual care for patients with acute ischemic stroke due to distal vessel occlusion, found mechanical thrombectomy did not provide an added benefit. The open-label trial involving 22 French University hospitals randomized 488 patients with acute ischemic stroke involving the anterior or posterior circulation secondary to a distal vessel occlusion within six hours of symptom onset or within 24 hours if no hypertensive signal on fluid attenuation inversion recovery acquistion 1:1 to mechanical thrombectomy with best medical treatment or best medical therapy alone. The primary outcome was the rate of good clinical outcome defined as a mRS ≤2 at three months and evaluated by an independent assessor blinded to the intervention arm. An interim analysis was planned at the end of the follow-up of the first 163 patients randomized, with a stopping rule for futility defined as a conditional power of <30%. In the control group, 77% of patients (59/77 patients) observed a mRS ≤2 at three months versus 60% (45/75 patients) in the experimental arm. Intracranial hemorrhage was reported in 28 patients in the control arm (29%) and 28 patients in the experimental arm (44%). “The DISCOUNT trial was stopped after the analysis of the first 163 randomized patients because results seemed to disfavor mechanical thrombectomy, and due to a safety issue and the low conditional power of 6.3%,” said the study’s principal investigator Frédéric Clarençon, MD, PhD, head of interventional neuroradiology at the Pitié Salpêtrière Hospital in Paris. Expanding the scope of carotid pathologies Ospel Saba Clarencon LATE-BREAKING SCIENCE continued from page 7 Treatments seek to bring better outcomes in existing and rare conditions. Hot Topics on Hot Carotids 2–3 p.m. | Thursday, Feb. 6 Room 515B UPCOMING SESSION
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