Welcome to the WSC 2022 Interactive Program
The congress will officially run on Singapore Standard Time (SGT/UTC+8)
To convert the congress times to your local time Click here
*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
Opening by Chairs
President Award
President Award Presentation by Chair
CHANCE to Reduce Residual Recurrent Risk of Ischemic Cerebrovascular Events
WSO Leadership Award
WSO Leadership Award by Chair
The Big Battle is Won in Prevention
Angels Awards
Future Leaders Certificates
TENECTEPLASE VERSUS ALTEPLASE IN STROKE PATIENTS WITH LARGE VESSEL OCCLUSION: RESULTS FROM THE ACT TRIAL
Abstract
Background and Aims
We sought to determine if intravenous tenecteplase is more effective or safer in patients with acute ischemic stroke presenting with large vessel occlusion when compared to alteplase.
Methods
This is a post-hoc analysis of the Alteplase compared to Tenecteplase pragmatic, phase 3, registry linked randomized controlled trial. Patients with intracranial internal carotid, M1- and M2-segments middle cerebral and basilar artery occlusion at baseline were included. Primary outcome was 90-day modified Rankin Scale 0-1. Secondary outcomes included 90-day mRS 0-2, mortality, symptomatic intracerebral haemorrhage, and eTICI 2b-3 rates on initial and final angiography. Effect modification of treatment-outcome association by occlusion location were assessed. Sensitivity analysis restricted to patients with ICA and M1-MCA occlusions were conducted.
Results
Of 1577 patients, 514 (32.6%) were included (135 [26.3%] ICA occlusion, 254 [49.4%] M1-MCA, 94 [18.3%] M2-MCA and 31 [6.0%] basilar occlusions). 90-day mRS 0-1 was achieved in 85 (32.7%) in the tenecteplase vs. 74 (29.1%) in the alteplase group. Secondary outcomes were similar in both groups. eTICI 2b-3 proportions on initial (19[9.4%]) vs. (20[10.2%]) and final angiography (172 [84.7%] vs. 175 [89.3%]) were comparable between tenecteplase and alteplase, respectively. Difference in primary outcome for tenecteplase vs. alteplase was larger in patients with ICA occlusions (26.1% vs. 18.2%) compared to M1-MCA (35.4% vs. 29.1%), M2-MCA (32.1% vs. 39.0%) and basilar occlusions (45.4% vs. 45.0%), respectively (Pinteraction=0.03). Sensitivity analyses showed similar results, but no effect modification of treatment-primary outcome association by occlusion location.
Conclusions
Intravenous tenecteplase has similar benefit as alteplase in patients with AIS and large vessel occlusions.
Q&A
TENECTEPLASE IMPROVES REPERFUSION ACROSS THE SPECTRUM OF LYSIS TO ANGIOGRAPHY TIMES: A POOLED ANALYSIS OF THE MELBOURNE STROKE REGISTRY, EXTEND-IA, AND EXTEND-IA TNK TRIALS
Abstract
Background and Aims
Tenecteplase (TNK) improves reperfusion compared to alteplase in patients with large vessel occlusion (LVO). To determine whether this improvement varies across the spectrum of thrombolytic-to-initial-angiographic-assessment times, we performed a comparative analysis of TNK and tPA reperfusion rates and assessed their relationship to time.
Methods
Subjects were LVO patients pooled from the Melbourne Stroke Registry and the EXTEND-IA and EXTEND-IA TNK trials. The primary outcome, early reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion at initial angiographic assessment. We compared the treatment effect of tPA and TNK accounting for thrombolytic-to-initial-assessment times via mixed effects Poisson modelling. Stratified by thrombolytic choice, we assessed the association between time-to-angiographic-assessment to the primary outcome via logistic regression models. Models were adjusted for occlusion site, time from symptom onset to thrombolysis, and study as a random effect.
Results
Among 947 patients included in the primary analysis, reperfusion was observed in 201 (21%) patients (TNK: 112/510 [22%], tPA: 89/434 [20%]). Times from thrombolytic-to-initial-assessment were longer in those who received tPA (median: 65min vs. 98min, p<0.01). Accounting for thrombolytic-to-initial-assessment time, TNK was associated with higher rates of reperfusion (aIRR 1.46 (95% CI:1.10-1.94). In both treatment cohorts, thrombolytic-to-initial-assessment was significantly associated with reperfusion (see Figure, TNK: aOR 1.11 per 15min [95% CI:1.05-1.17] vs. tPA: aOR 1.06 per 15min [95% CI:1.00-1.12], pinteraction=0.49).
Conclusions
Increased reperfusion with TNK persists across the spectrum of thrombolytic-to-initial-angiographic-assessment times.
Q&A
MULTICENTER RANDOMIZED CLINICAL TRIAL OF ENDOVASCULAR TREATMENT OF ACUTE ISCHEMIC STROKE IN THE NETHERLANDS FOR LATE ARRIVALS: MR CLEAN-LATE
Abstract
Background and Aims
Endovascular treatment (EVT) for acute ischemic stroke (AIS) beyond the 6 hour time window is effective in patients selected with perfusion imaging. We aim to investigate whether selection based upon the presence of collaterals can identify an additional group of patients for which EVT is safe and effective in the 6-24 hour window.
Methods
The MR CLEAN-LATE, a Dutch multicenter, prospective, open-label, blinded end-point trial, randomized patients with an AIS due to a proximal occlusion in the 6-24h window and at least some collateral flow on CT-angiography between EVT and no EVT. Patients with an ICA-T/M1 occlusion, NIHSS>10, infarct core<25ml, and a penumbra≥core based on perfusion imaging were excluded, as they are eligible for EVT as standard care. The primary end-point is the modified Rankin Scale score (mRS) after 90 days. Treatment effect will be estimated with ordinal logistic regression (shift analysis). Secondary outcomes include intracranial hemorrhage, mortality at 90 days, stroke severity and recanalization at 24 hours, and stroke severity at 5-7 days.
Results
502 patients were included by 18 centers. The last inclusion occurred on the 27th of January 2022, and the 90-day follow-up of the last patients is scheduled before the first of May 2022. We will present the main results of the trial at the congress.
Conclusions
This study will provide insights into whether late-window EVT is effective after selection based on collateral flow.
Q&A
DIRECT MECHANICAL THROMBECTOMY VERSUS BRIDGING THERAPY FOR ACUTE ISCHAEMIC STROKE – INDIVIDUAL PATIENT DATA META-ANALYSIS OF SIX RANDOMIZED CLINICAL TRIALS.
Abstract
Background and Aims
Background and Aims: Whether direct mechanical thrombectomy (MT) in acute ischemic stroke patients with anterior circulation proximal occlusions is equally effective as bridging intravenous thrombolysis (IVT) with alteplase followed by MT is still a topic of worldwide debate. The primary aim of this study was to test non-inferiority of direct MT using pooled individual patient data of all six recently completed randomized controlled trials evaluating direct MT vs IVT followed by MT. Secondary aims included superiority testing of IVT followed by MT versus direct MT, presentation of relevant secondary outcomes, and key patient subgroups.
Methods
Methods: We performed an individual patient data meta-analysis adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects models were used to pool the individual patient data. The primary outcome used for non-inferiority and superiority testing was good functional outcome at 90 days (mRS2). Two specified non-inferiority margins were tested: 3% and 5%. Secondary outcomes included excellent functional outcome (mRS1), mortality, symptomatic intracranial hemorrhage (sICH), successful reperfusion (TICI2b), and procedure-related complications. Key subgroups included sex, age, time intervals, occlusion location, baseline stroke severity, carotid tandem occlusions.
Results
Results: Five RCTs comprising 2334 patients (1164 direct MT, 1170 bridging IVT followed by MT) were included. Results will be presented at the conference.
Conclusions
Conclusions: To be presented at the conference.
Q&A
FINAL ANGIOGRAPHIC, CLINICAL AND THROMBUS COMPOSITION RESULTS OF THE EXCELLENT REGISTRY
Abstract
Background and Aims
EXCELLENT (NCT03685578; Cerenovus) is a large, prospective, international, real-world registry of endovascular clot removal in acute ischemic stroke (AIS) with EmboTrap as the first line mechanical thrombectomy (MT) device, which included collection and analysis of the retrieved thrombus material.
Methods
Between September 2018 and March 2021, 1000 “all-comer” subjects treated per standard of care at each center (with EmboTrap as first line) were enrolled at 36 sites (28US, 6EU, 1UK, 1 Israel). The study employed blind endpoint evaluation, including a core imaging lab and an independent 90-day mRS assessment. Retrieved clot was collected per each MT maneuver from 543 subjects across 26 sites and sent for standardized analysis by independent central labs.
Results
Mean age was 70.0±14.17 years (range 18-102), 51.9% (518/999) subjects were female and 9.8% (98/998) had a pre-stroke mRS 3-5. Baseline NIHSS was 15.6±6.85 (range 0-36); 10.2% (71/696) subjects had a large core (ASPECTS 0-5); 5.0% (49/989) had posterior stroke; 55.2% (528/956) underwent MT ≤6hrs of onset; and 38.0% (380/999) received IV-tPA prior to MT. Key outcomes were first pass eTICI 2c-3=38% (315/827); final 2b-3=94.3% (780/827; median #passes=1); 90-day mRS≤2 or ≤pre-stroke 46.8% (429/916); and 90-day all-cause mortality 19.1% (176/922). In univariate analysis of clot components, high red blood cell and low platelet content were significant predictors of good mRS outcome (p<0.001 and 0.018) and negative predictors of 90-day mortality (p<0.001 and 0.011, respectively).
Conclusions
Final angiographic, clinical and thrombus composition results, along with multivariate analysis of predictors of clinical outcomes, will be presented at the time of the conference.