Welcome to the ESOC 2021 Virtual Conference Calendar

Background And Aims

Early evaluation and prompt treatment are key elements for the correct management of acute ischemic stroke (AIS). The early identification of an accurate prognosis including advanced neuroimaging currently lacks a posterior circulation clot burden score (pc-CBS), and a multimodal prediction tool of posterior circulation stroke treated with endovascular treatment (EVT).

Methods

The project will be structured in a two-phase analysis using as derivation population the ASTRAL acute stroke databank of the Lausanne University Hospital: (1) development of a pc-CBS correlating with functional long-term outcome; and (2) development of a pre-EVT and post-EVT outcome prediction nomogram for patients treated up to 24 hours for posterior circulation AIS. Development of the pc-CBS and of the prognostic tools will compare the performance of classic logistic regression with two machine learning algorithms (xgboost and neural network). Both phases will undergo external validation with pooled data from other stroke centers.

Results

We expect to find a good performance of the pc-CBS and of the nomograms thanks to the combination of multimodal neuroimaging variables with clinical and procedural variables; machine learning may further improve the score’s performance, and external validation will contribute to its validity.

Conclusions

The project has the impact to develop clinical tools able to support difficult acute clinical decisions including EVT. If externally validated, these tools may also be useful for patient selection in clinical trials.

Background And Aims

Diffusion-weighted-imaging (DWI) lesions, consistent with cerebral infarction, occur in ~30% of patients with acute intracerebral hemorrhage (ICH), are associated with increased ICH volume, and have been independently associated with negative long-term outcomes. We aim to better understand the relationships between acute ICH and DWI-lesion development. Specifically, we will perform an imaging sub-study of the ongoing EVACUATE trial to explore the natural history of DWI-lesion development in patients who undergo acute hematoma evacuation versus patients who receive standard of care. We hypothesize that the removal of blood in the early stages of ICH onset could reduce the incidence of subsequent brain infarction.

Methods

Patients enrolled into the EVACUATE trial (randomized to either minimally invasive surgery or standard of care within 8 hours of symptom onset) and later-presenting conservatively managed patients otherwise meeting trial eligibility, will undergo an MRI at days 3-7 from symptom onset and will receive clinical follow-up (mRS, NIHSS, MoCA) at 90 days.

Results

Our primary outcome will be the proportion of patients who are DWI-lesion positive at days 3-7. We will recruit 137 patients (1:1.5 ratio [intervention/control]), to identify a clinically meaningful 20% difference in DWI-lesion positivity. Differences in proportions will be adjusted for baseline white matter disease and cerebral microbleeds using Firth logistic regression models.

Conclusions

Funding has been acquired and patient recruitment is due to begin in Q2 2021. The findings of this study may shed further light on ICH pathophysiology and potentially identify new treatment targets for future therapies.

Trial Registration Number

The study described above is an imaging sub-study occuring within the structure of the EVACUATE (NCT04434807) trial.

Background And Aims

Sleep apnea syndrome (SAS) is highly prevalent in acute stroke and associated with a worst neurological outcome. Hypoxemia, hyperglycemia and higher blood pressure caused by SAS may increase ischemic phenomenon leading to a bigger stroke size and a worst prognosis.

We designed PISTACIO to assess the effect of SAS treatment by auto-adaptative servo-ventilation (ASV) started the first night after stroke on stroke size progression at 7 days.

Methods

PISTACIO is a prospective investigator-initiated randomized pilot-study aiming to recruit 60 patients. We randomize patients with an ischemic stroke to receive SAS treatment by ASV in addition to standard medical care vs standard medical care alone during the first week following stroke. Patients have an MRI at admission and at 7 days. Stroke size is measured by an automatic software, Olea, in both MRI and size progression is analyzed. Stroke prognosis is evaluated with the modified Rankin score à 3 months. SAS prevalence, severity and mechanism are assessed by iterative respiratory polygraphy (the first night in control group and at 7 days and 3 months in both groups). SAS treatment observance is calculated by ASV device and considered sufficient if superior to 4 hours per night.

Results

Primary outcome is the impact of ASV on stroke size progression at 7 days. Secondary objectives are to assess AVS effects on neurological outcome at 3 months, to estimate SAS prevalence after stroke and ASV observance.

Conclusions

PISTACIO will determine feasibility, tolerability of ASV during the first week after stroke and its impact on stroke size progression.

Trial Registration Number

PISTACIO trial is registered as NCT04801069.

Background And Aims

Stroke associated pneumonia (SAP) is a common complication in 8 to 13% of stroke survivors. Previous SAP studies have focused on clinical characteristics with limited evidence currently on stroke care processes. Here, we describe the relationship between key markers of acute care process and SAP presence within the first 7 days of care

Methods

Patient-level information on all confirmed strokes between 1^st April 2013 and 31^st December 2018 was obtained from the Sentinel Stroke National Audit Programme (SSNAP). SAP was defined as antibiotic initiation for suspected pneumonia within the first 7 days of admission. Stroke care processes included markers of pre-hospital care, hyper-acute care, acute care and thrombolysis. We then modelled SAP at 7 days in multilevel logistic regression whilst adjusting for a set of predefined clinical confounders and clustering within stroke units

Results

Of 456590 stroke patients present, 39397 (8.63%) were identified with SAP during the first 7 days. The median symptom onset to arrival at hospital time was 166 minutes (Interquartile range 86-505 min), for a swallow screen it was 84 minutes (IQR 44-149), time to be seen by a stroke specialist was 699 minutes (IQR 120 – 1220), and time from symptom onset to thrombolysis was 166 minutes (IQR 86-505)

Conclusions

Final results are to be confirmed. SAP has significant short and long-term patient health implications, a clearer understanding of the non-clinically associated factors could benefit both patients and stroke care facilities, as well as provide a basis for further research in reducing the burden of SAP in stroke patients