International Stroke Conference 2017

I have attended the International Stroke Conference (ISC) every year since my third year of residency in 2013. It is by far the most educational and most fun conference for me as a stroke neurologist. This is the premiere conference for stroke and most of the groundbreaking trials are presented here. I remember the ISC 2015 in Nashville where several of the endovascular stroke trials were presented which essentially revolutionized the care of stroke patients. This year’s stroke conference was in Houston.

Over the course of two and a half days, lots of original research was presented in addition to multiple symposiums by invited speakers. There were several debates discussing the controversial topics in stroke. An interesting addition this year was activity by the name of “Games of Strokes” where teams representing Asia, Europe and USA went against each other in a game show style quiz session. Guess who won!
Lots of late-breaking trials were presented and many them focused on selecting the right antiplatelet agent for stroke prevention. I will mention some those trial below:

TARDIS Trial: This trial looked into utility of triple antiplatelet therapy (intensive treatment) for stroke prevention as compared to guideline based antiplatelet treatment. Recurrent TIA’s and strokes were not reduced in the intensive treatment arm and it was also associated with more events of major bleeding.
PICASSO Trial: This trial investigated the role of cilostazol in safety and effectiveness as compared to aspirin in cardiovascular events. In their results, compared with aspirin, the number of strokes were less with cilostazol but there were more myocardial infarctions in cilostazol group.
SOCRATES subgroup analysis: SOCRATES trial looked into efficacy of ticagrelor as compared to aspirin in prevention of recurrent stroke. The trial, which was published last year did not show any superiority over aspirin. Subgroup analysis of the trial was presented at ISC where they showed ticagrelor was superior to aspirin in preventing strokes in patients with ipsilateral atherosclerotic stenosis.
PRINCE TRIAL interim analysis: This study is looking into combination antiplatelet therapy. One arm is receiving ticagrelor plus aspirin and the other arm is getting clopidogrel and aspirin. We will have to wait for the final results as the preliminary data does not provide any substantial information.
I found all these trials quite interesting. The more options we have for antiplatelet agents, the better it is. I think in future, the choice of antiplatelet agent can be more personalized based on patient’s profile in the era of precision medicine.
One last study I wanted to mention presented by Biffi et. al. looked into resumption of anticoagulation in ICH patients. We routinely end up in this scenario where the patient has had an ICH and they also need to be on long term anticoagulation for conditions like atrial fibrillation for stroke prevention. This study looked into this and showed that resumption of oral anticoagulation was associated with decreased mortality and favorable outcome in the long term. These findings are provoking and suggest that we look at this in prospective randomized fashion.
As ISC came to an end, I returned home with lots of new information and ideas. It was great seeing all the friends from residency and fellowship times. Looking forward to the next years International Stroke Conference when it returns to LA!


Muhammad Alvi, MD
Assistant Professor Neurology, West Virginia University, Morgantown, WV 

Mud Alvi is an Assistant Professor of Neurology at West Virginia University. His research interest includes Cerebral Small Vessel Disease and its association with Stroke and Dementia. He tweets @wvstrokedoc

Posted by Muhammad ALVI on Mar 29, 2017 10:40 AM America/Chicago