European
Stroke Conference
Inhaltsbereich:
Press - Sponsors - Press
Office
Welcome to the ESC press area!
In this section
you will find all the information you need about the European Stroke
Conference.
Please find the "ESC Press Releases" for information about the latest meeting
in Nice 2008!
Press Release
Nice, 15/05/2008
PDF Download (41,5 kb)
Stroke research fields new findings / Optimized
treatment methods bring greater safety / Establishment of a European stroke
network
Nice, 15/05/2008. More than 3,500
doctors and stroke researchers from more than 82 countries met in Nice, in the
south of France, from 13 to 16 May 2008 for the XVII. European Stroke
Conference. The latest experimental and clinical research findings were
presented and discussed, together with opportunities for implementing them as
quickly as possible in practical concepts for treating and preventing
cerebrovascular accidents. Interest focused on the findings of major clinical
trials investigating the efficacy, benefits and risks of new treatment concepts
in the battle against strokes which were presented here for the first time. They
not only yield important consequences with regard to possible ways of reducing
the recurrence and first manifestation of strokes, but also the chance of
significantly improving the stroke patients’ chances of survival and optimizing
their rehabilitation as a whole.
As in the past, the XVII. European Stroke Conference 2008 was characterized by
numerous events of very high standard. Under the chairmanship of German stroke
expert Prof. Dr. Michael G. Hennerici (Neurological Clinic, Mannheim University
Hospital), the committee responsible for the programme had put together a large
range of topics subdivided into various co-conferences and satellite symposia.
TIA satellite symposium ensures transparency in determining types of stroke
The Conference opened on 13 May with the
2nd TIA satellite symposium, after the first such symposium in Paris two years
previously. Its aim was to make the treatment of different types of stroke more
transparent. TIA = transient ischaemic
attack is a transient cerebrovascular disturbance which precedes the actual
stroke in roughly ten percent of all cases. The general symptoms are similar to
those of a genuine stroke, the only difference between them being that the
symptoms of
a TIA are transient in nature, i. e. they are only present for a short period of
time. Since TIA gives warning of an impending stroke, the symposium discussed
which clinical techniques and apparatus could be used to identify these
high-risk
patients. The conventional definition of TIA must be discarded and each TIA
patient treated as an emergency like every other stroke patient in one of the
current stroke units or, in future, in outpatient clinics specially programmed
for TIA.
Michael G. Hennerici: “In the second year of its existence, the TIA symposium
shows that we are right to treat this as a separate subject. The considerable
echo among participants and numerous new impulses which we can directly
incorporate into our clinical work will help us to conduct a more highly
differentiated and ultimately more efficient battle against strokes, their
causes and consequences, to the benefit of our patients, by more effectively
identifying high-risk patients.”
Nursing and physiotherapy day
For the second time, the ESC had organized a one-day event by nursing staff and physiotherapists whose work in the stroke units of acute clinics and rehabilitation centres has become indispensable and increasingly specialized. With different organization and training in the individual European countries, but also throughout the world, speakers from all disciplines and areas of competence presented the latest scientific and clinically relevant findings which were avidly discussed by the participants in a one-day programme organized by Professor Hömberg, Germany, and Professor Bernhardt, Australia.
Concomitant teaching courses and symposia closely related to practical conditions
Numerous topics, such as stroke in
newborn babies, adolescents or old age, complications and rehabilitation
following a stroke or aspects associated with nursing care for stroke patients,
were addressed by experts in concomitant teaching courses and debated with
doctors treating stroke patients from around the world.
Another important area for investigation developed from the field of cerebral
microangiopathy, also known as “Small Vessel Disease” (i. e. a constriction or
reduction of small cerebral arteries). A mini-symposium entitled “White matter
lesions and Alzheimer’s dementia – disentangling the confusion” focused
attention on the phenomenon that these chronically cumulative circulatory
disturbances damage the fibres linking neuron groups and cause the symptoms of
vascular dementia. In old age, they overlap with primarily degenerative neuronal
changes, of which Alzheimer’s dementia is the most common. Unlike the case with
the more frequent types of stroke in which complete regions of the brain die as
a result of vascular occlusion, many older people develop numerous cicatrices in
the small blood vessels affected within the “white matter”. Michael G. Hennerici
explained the problem: “One question of interest to the scientists at the
symposium was, for example, how such cicatrices develop and whether they might
also play a causative or supporting part in Alzheimer’s and other forms of
dementia. A whole series of common treatment or preventive strategies would then
be possible.”
Concomitant scientific symposia, such as
“New developments in primary and secondary prevention after stroke”, at which
such internationally renowned experts as professors Hans-Christoph Diener
(University of Duisburg/Essen), Ralph L.
Sacco (Miami University) and Graeme J. Hankey (Royal Perth Hospital, Australia)
reported on new methods for preventing a recurrence of strokes, drew attention
to one of the eagerly awaited highlights of the XVII. European Stroke
Conference, namely reports on the results of the largest clinical trial ever
undertaken, involving thousands of patients throughout the world in the past few
years.
PRoFESS (“Prevention Regimen For Effectively avoiding Second Strokes”) – the largest trial undertaken to date on preventing subsequent strokes
Detailed background information on this trial and the other trials outlined here, as well as on the professional careers of the speakers, can be found in your Press Folder.)
1. PRoFESS trial: Comparison of a fixed-dose combination of extended-release dipyridamole and acetylsalicylic acid (ASA, also known as “Aspirin”) with clopidogrel.
It is assumed that this combination is more suitable for reducing the risks of a stroke recurrence. The latest results presented by Prof. Dr. Ralph L. Sacco are attached to the press kit.
2. PRoFESS trial: Telmisartan versus Placebo
The risk of recurrent stroke may be
reduced by blocking the renin-angiotensin system with angiotensin-converting
enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB). Furthermore,
evidence suggests that ARBs additionally reduce the risk of stroke through
mechanisms independent of their blood pressure lowering effects. PRoFESS
investigated in a placebo-controlled trial whether telmisartan reduced the risk
of further strokes in comparison to conventional treatment.
The latest results presented by Prof. Dr. Salim Yusuf are attached to the press
kit.
3. PRoFESS trial: Cognitive and functional outcomes after stroke
PRoFESS investigated whether the
fixed-dose combination of acetylsalicylic acid plus extended-release
dipyridamole (ER-DP) compared to clopidogrel and telmisartan can reduce the risk
of dementia due to further strokes. Angiotensin II receptor blockers can
theoretically reduce the risk of vascular dementia or alleviate the severity of
a recurrent stroke. Experimental data also suggest that dipyridamole may have a
favourable delaying effect on the development of vascular dementia through
special mechanisms including: prevention of new vascular lesions, anti-oxidant
and anti-inflammatory effects, and an increase in cerebral perfusion.
The latest results presented by Prof. Dr. Hans-Christoph
Diener are attached to the press kit.
4. Trial: EVA-3S: Endarterectomy versus Angioplasty in patients with Symptomatic Severe carotid Stenosis
Carotid angioplasty and stenting (CAS)
is hitherto considered a less invasive method for treating severe carotid
stenosis that can demonstrably be achieved through surgical carotid
endarterectomy (CEA). The purpose of the trial was to investigate whether this
is correct and whether this method is as safe as surgery, with the same degree
of long-term protection. Conducted as a multicentre trial involving several
French research facilities, this randomized, non-inferiority trial (EVA-3S)
initially assumed that the treatment form under investigation was at least
equivalent to a standard treatment. First results from the EVA 3S trial
presented at ESC 2006 in Brussels indicated that CEA is superior. The final
two-year results are presented by Prof. Dr. Jean-Louis Mas:
In this study of patients with symptomatic carotid
stenosis of 60% or more, the 30-day risk of any stroke or death was
significantly higher after stenting than after endarterectomy, but the rates of
ipsilateral stroke between 31 days and 4 years were very low in both groups. Our
study strongly suggests that carotid stenting is as effective as carotid
endarterectomy for long-term prevention of ipsilateral stroke, at least for the
first 4 years following the perioperative period, but its safety needs to be
improved before it can become a widespread alternative to carotid endarterectomy
in patients with symptomatic
carotid stenosis.
5. Trial: SPACE: Stent-protected Percutaneous Angioplasty of the Carotid v. Endarterectomy
The SPACE trial with a similar protocol
from German-speaking countries is also devoted to the subject of optimum
treatment of symptomatic carotid stenosis. Although the first 30-day results
reported in Brussels were unable to statistically prove the exact equivalence of
CAS and CEA, they did not indicate any advantage of CAS over CEA. Altogether
1,214 patients with symptomatic carotid stenosis took part in the trial. The
final results of the trial after two years’ follow-up were now presented by
Prof. Dr. Peter A. Ringleb:
The rate of any periprocedural stroke or death plus
ipsilateral ischaemic stroke within two years was 8.5% in the CEA- and 9.2% in
the CAS-group (Odds ratio 1.10; 95%CI 0.74 to 1.63; intention-to-treat data).
The absolute number of recurrent ischaemic events after the periprocedural
period up to two years was low, 10 events after CEA (1.7%) and 12 after CAS
(2.0%). Excluding those patients who had not received the allocated treatment
modality the results were similar, 7.6% in the CEA- and 9.2% in the CAS-group
(Odds-Ratio 1.23, 95% CI 0.81-1.88, per-protocol-analysis). Thus, based on the
results of the SPACE trial, the rate of recurrent ipsilateral ischaemic strokes
during a medium range follow up period is
similarly low for both CEA and CAS treated patients.
6. Trial: CLEAR IVH: Clot lysis, safety and 30 day functional outcomes
Severe brain haemorrhages are among the
most serious forms of stroke and frequently result in death or extremely severe
permanent disability. For patients with such intracerebral haemorrhage
associated with intraventricular haemorrhage (IVH), the reported fatality rates
range from 50 to 75 percent. There is no effective treatment available to date.
However, experimental and individual clinical observations give rise to the hope
that at least some patients can be helped through a combination of neurosurgery
and medication:
Prof. Dr. Daniel F. Hanley presents the first findings
of a small Euro-American safety study: To assess
the effect of drug delivery site on clot lysis, we compared overall clot lysis
rate to rate of clot lysis in the 3rd
and 4th ventricular regions closest to the extra ventricular drainage. With this
intervention, we found low rates of 30 day mortality (17%), rebleeding (5%) and
bacterial ventriculitis (2%). The low mortality compared to expected mortality
in the 60 to 80% range strongly suggests that removal of blood form the
ventricles will be beneficial to individuals with IVH. A trial of this life
saving therapy is needed urgently.
7. Trial: SITS-ISTR (Safe Implementation of Thrombolysis in Stroke – International Stroke Treatment Register) results for 664 patients treated with rt-PA between 3 and 4.5 hours after ischaemic stroke onset
SITS-MOST, the largest rt-PA monitoring study in acute stroke worldwide, recruited 6,483 patients from 285 centres in 14 European countries. It was an open, prospective observational study for monitoring the safety of such centres in Europe which treat acute strokes through thrombolytic therapy. It confirmed that rt-PA is as safe and effective in clinical routine as In randomised controlled trials. The conclusion was that the treatment should be encouraged also in high quality stroke centres without previous experience from thrombolysis in stroke. SITS-MOST was one of the conditions raised by European regulatory authorities for approval of rt-PA in acute stroke within 3 hours of symptoms onset, the other condition was a randomised controlled trial for patients treatable between 3 and 4.5 hours after onset, the ECASS 3 study. This study in now completed and the results will be reported at the World Stroke Conference in Vienna later this year.
Prof. Dr. Nils Wahlgren reports:
The SITS International Stroke Treatment Register
(SITS-ISTR) which includes all SITS-MOST data but now expanded to almost 20,000
patients treated world-wide, reports to this conference the results for 664
patients treated between 3 and 4.5 hours after stroke onset. These patients were
slightly younger, had more often a current infarct visible on baseline CT scan,
were less frequently treated in centres with no previous experience from
thrombolysis and were less hypertensive. After correction for differences in
prognostic baseline variables, the proportions of patients with symptomatic
intracerebral haemorrhage, with death and with independence for activities of
daily living at three months follow up was practically identical. The conclusion
is that treatment initiation in stroke patients between 3 and 4.5 hours after
symptoms onset is as safe and as effective as for patients treated within the
current European guidelines. The results will be complementary to those reported
by the ECASS study group later this year. An extension of the treatment window
to 4.5 hours should depend on confirmation by the ECASS 3 study.
EU announces establishment of the “European Stroke Network (ESN)” in Nice
In Bologna in 2005, ESC
representatives had already demanded that public research facilities should make
a significant contribution towards the investigation of strokes, their causes
and consequences, avoidance strategies and possibilities for rehabilitation.
Both nationally and internationally, Europe and the individual Member States
were called upon to set new highlights and step up their activities.
After intensive deliberations and expertises by leading scientists, the European
Commission has now responded to this demand and will invest more than 21 million
euros to support central research into strokes for a period of five years. Dr.
Manuel Hallen, head of health research in the EU, announced the establishment of
a “European Stroke Network” (ESN) with 30 institutional partners from 14
European countries at the XVII. European Stroke Conference in Nice. The Network
is based on two complementary projects in the field of vascular and cerebral
research, namely EUSTROKE (The European Stroke Research Network) and ARISE
(Affording Recovery In Stroke), which are coordinated by Prof. Stephen Meairs in
Mannheim and Prof. Ulrich Dirnagl in Berlin.
Dr. Hallen reports:
Pooling of competences and resources promotes
cooperation and collaboration amongst European teams, helps to avoid duplication
of effort and increases our chances to make discoveries that can benefit human
health. Research like this will give hope to reduce and eventually prevent
strokes and future suffering of patients and their families. EUSTROKE aims at
improving our understanding of the neurovascular unit in the brain, which should
lead to better prevention and treatment of stroke. ARISE will investigate a
number of novel, promising therapies, including safer thrombolytics, therapies
to induce repair of lost function, as well as a fast way to selectively cool the
brain. Together, they combine expertise in clinical as well as pre-clinical
stroke research. A common ESN Trial Platform will help obtain clinical proof of
principle and translate research findings into effective therapy of stroke.
For the first time relevant comorbidities, gender, age
and long term outcomes will be investigated. Services of this advanced ESN Trial
Platform, which will boast over 350 European stroke centers, will be offered to
the European stroke research community.
Johann Jakob Wepfer Prize 2008
awarded to Marie-Germaine Bousser
Prof. J.-L. Mas, Prof. M.G. Bousser, Prof. M.G. Hennerici
The Johann Jakob Wepfer Prize worth 20,000 euros, which has been awarded by the ESC Committee since 2005 for outstanding achievements in clinical work and basic stroke research, was this year awarded to the French doctor and scientist Professor Marie-Germaine Bousser, Paris, for her work in the field of stroke research, especially its genetic and molecular bases in the early forms encountered in young people. The award is coupled with the request to present a paper from her work, a request which she gladly took up with an excellent and as always highly interesting presentation “about some translations in vascular neurology”. The laudation was presented by the Dutch neurologist Prof. Jan van Gijn from the University Medical Center Utrecht, another outstanding pioneer in stroke research who captivated the over 2,500 listeners with his wit, charm and competence.
The essence of the XVII. European Stroke Conference lies in the numerous reports from the participants’ laboratories and clinics: more than 1,000 papers were presented this year and discussed in parallel sessions and poster presentations during these three days. Prof. Dr. Michael G. Hennerici’s balance as chairman of the programme committee was thoroughly positive: “In terms of both quality and quantity, this was the best and largest stroke conference ever organized worldwide. Growing interest by basic and clinical research, as well as recognition from the general public and both national and international supporting institutions, allows us to hope that the risk of suffering a stroke can be minimized, prevention and quality of life improved, and that the damage following an attack can quickly and effectively be limited still further. Early rehabilitation can support this process.”
www.eurostroke.eu
For further information, contact:
Prof. Dr. Michael G. Hennerici
Dept. of Neurology
University of Heidelberg / Klinikum Mannheim
Theodor-Kutzer-Ufer
68135 Mannheim, Germany
Phone
Fax +49 621 383 38 07
hennerici@neuro.ma.uni-heidelberg.de
m.g.hennerici@eurostroke.org
Along with cardiac infarctions and cancer, strokes count among the most common causes of death in Europe today and represent the most common cause of permanent disability. Since 1990 the European Stroke Conference has been held annually in different European cities. It not only provides an international forum for exchanging opinions and discussing latest research findings related to cerebrovascular disorders, but it also is the largest conference in Europe dedicated to this subject.
Informationen über diese Website
Webmaster:
Marion R. Hennerici · hennerici@eurostroke.eu
Copyright: M.R. Hennerici · All Rights Reserved