A Neurologist’s Perspective: Exciting Research at the World Stroke Congress
The 15th World Stroke Congress was packed with insightful presentations and excellent stroke research. I am grateful for the opportunity to have shared two of our studies at this conference, Validation of Artificial Intelligence to Limit Delays in Acute Stroke Treatment and Endovascular Therapy (VALIDATE) and Artificial Intelligence Software Improving Times to Thrombectomy. Both studies highlight the benefits of AI platforms in shortening times to contact neurointerventionalists, which can improve door-to-needle times. Both studies showed that facilities using AI platforms had greater than 30 minutes faster times from patient arrival to contact with the neurointerventionalist. Time is brain, and every minute counts.
While there were so many great studies presented at WSC, there were a few that stood out as very impactful for acute stroke care that I would like to highlight.
Alteplase (tPA) has been the standard of care for acute stroke treatment, but for many reasons, most related to ease of use, there has been a recent switch to tenecteplase despite limited data to support its use in the < 4.5-hour window. ATTEST-2 was presented at WSC, a randomized trial comparing alteplase and tenecteplase, with the primary outcome being the mRS at 90 days. There were 832 tenecteplase patients and 831 alteplase patients who completed the 90-day follow-up. The 90-day outcomes showed that tenecteplase was not inferior to alteplase, but it failed to show superiority. There was no statistically significant difference in angioedema or hemorrhages, although there were higher percentages of hemorrhages in the tenecteplase group. These findings support decisions to switch to tenecteplase for logistical reasons, including faster treatment times.
The second study I would like to highlight is the TENSION trial, which evaluated the benefit of thrombectomy in large vessel occlusions in patients with large infarcts, including patients with the majority having ASPECT of 3-5. The outcomes were very impressive, showing not only a reduction in mortality but also disability for these patients who were previously thought to have unsalvageable brains. Thrombectomy was associated with an 11% reduction in mortality and an 18% increase in a patient’s ability to walk unassisted. This study is consistent with multiple other recent studies and is strong evidence that the size of the stroke already present should not be a limiting factor in who is taken for intervention.
It is an exciting time for acute stroke care as we continue to expand our armament of treatments and discover new innovations. Each one of these breakthroughs expands the opportunities to help our patients overcome strokes and go on to live full lives.