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esoc15

As the first European Stroke Organisation Conference has drawn to a close, I want to thank all faculty members and delegates for their intellectual and practical support to the preparation and delivery of what has I believe been an outstanding success. When the overwhelming wish of our association was expressed just 11 months ago that we should establish a new conference, we barely dared to hope for 800-1,000 delegates in our first year. The reality was that 84 countries were represented in Glasgow, and that delegate numbers were close to 2,700. To accompany the presentations to a packed auditorium in our first plenary session alone there were two simultaneous online publications in the New England Journal of Medicine and one in Lancet, and we had new results presented from two additional fresh NEJM publications and an Annals of Neurology paper. In the afternoon, we heard the first multicentre, blinded RCT of an experimental approach in stroke, a stem cell RCT, the complete results of the desmoteplase programme and a further new thrombectomy trial. By the time we retired to the poster session and welcome reception, the exhibition hall was buzzing with excitement. The enthusiasm and cheerfulness were tangible, affecting everyone from the most junior researchers through to old hands. The sun shone on the entire conference, literally. I attribute the success to a huge amount of good fortune, to the efforts of a vast team and to the enthusiasm of every delegate. It would be unfair to single out any one contribution but I am convinced that it was those numerous individual contributions, offered generously and constructively, that allowed us to take advantage of the good fortune. To be present at this inaugural conference was reward enough for anyone working in stroke, because it was a once in a career occasion that we will each remember with great fondness. It was rather like a birth, a christening and a wedding, all rolled into one. Certainly, we have shown what a large and happy family we are in stroke medicine, and that Europe stands not alone but with societies and individuals all across the world. We will build on this success, we will maintain the spirit and principles that informed ESOC 2015, and I promise that by 10-12 May 2016 in Barcelona we will have another outstanding programme. For now, I express my sincere thanks to everyone for their support and hope that each of you left Glasgow with enthusiasm, new friendships and shared optimism for the future, for our patients and our specialty.

KL

IST-3 Bibliography: published full papers in peer-reviewed journals

  1.  Innes K. Thrombolysis for acute ischaemic stroke: core nursing requirements. British Journal of Nursing 2003;12(7):416-24
  2. Kane I, Lindley R, Lewis S, Sandercock P. Impact of stroke syndrome and stroke severity on the process of consent in the Third International Stroke Trial. Cerebrovascular Diseases 2006;21:348-52

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=91541&Ausgabe=231712&ProduktNr=224153&filename=91541.pdf

  1. Whiteley W, Lindley R, Wardlaw J, Sandercock P. Third International Stroke Trial. Int J Stroke. 2006;1:172-6.

http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2006.00043.x/full

  1. Sandercock P, Lindley R, Wardlaw J, Protocol 06PRT/1269: Third International Stroke Trial (IST-3). Lancet

     http://www.thelancet.com/journals/lancet/misc/protocol/06PRT-1269.

  1. Wardlaw JM, Bath P, Sandercock P, Perry D, Palmer J, Watson G, Lloyd S, Geddes J, Farrall A. The NeuroGrid stroke exemplar clinical trial protocol. Int J Stroke. 2007;2:63-9 http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2007.00092.x/full
  2. The third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials 2008;9(1):37. http://www.trialsjournal.com/content/9/1/37
  3. SCOPE (Stroke Complications and Outcomes Prediction Engine) Collaborations and IST. Predicting outcome in hyper-acute stroke: validation of a prognostic model in the Third International Stroke Trial (IST3). JNNP 2008;79:397-400

http://jnnp.bmj.com/content/79/4/397.full.pdf+html

  1. EPITHET-where next? Sandercock P, Wardlaw J, Dennis M, Lindley R, Hankey G, Matz K, Peeters A, Phillips S, Gubitz G, Prasad K, Ricci S, Celani MG, Righetti E, Cantisani T, Arauz A, Berge E, Slot KB, Kobayashi A, Czlonkowska A, Correia M, Murray V, Lyrer P, Venables G; IST-3 Collaborative Group. Lancet Neurology 2008;7(7):570-1.

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(08)70123-6/fulltext

  1. Oxfordshire community stroke project clinical stroke syndrome and appearances of tissue and vascular lesions on pre-treatment CT in hyper-acute ischemic stroke among the first 510 patients in the Third International Stroke Trial (IST-3). Kobayashi A, Wardlaw J, Lindley R, Lewis S, Sandercock P, Czlonkowska A; IST-3 Collaborative Group.Stroke 2009;40(3):743-8.

http://stroke.ahajournals.org/content/40/3/743.full

  1. Should more patients with acute ischaemic stroke receive thrombolytic treatment? Wardlaw J, Murray V, Sandercock P,BMJ 2009; 339.      http://www.bmj.com/content/339/bmj.b4584
  2. The Third International Stroke Trial: Thrombolysis (IST-3) in Poland: are we recruiting the right patients? Czlonkowska A, Kobayashi A, Lewis S, Sandercock P, Lindley R, Baranska-Gieruszczak M on behalf of the IST-3 collaborative group. Polish Journal of Neurology and Neurosurgery. 2009; 43, 3:228-235.

http://www.termedia.pl/Original-paper-The-Third-International-Stroke-Trial-Thrombolysis-IST-3-in-Poland-are-we-recruiting-the-right-patients-,15,12742,0,1.html

  1. Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials2011, 12:252

http://www.trialsjournal.com/content/12/1/252

  1. How many patients might receive thrombolytic therapy in the light of the ECASS-3 and IST-3 data? Jan Bembenek, Adam Kobayashi, Peter Sandercock, Anna Czlonkowska. Int J Stroke 2010; 5:428–431.

http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00479.x/full

  1. ‘Where are we now with intravenous thrombolysis for acute ischaemic stroke’? Peter Sandercock, Joanna Wardlaw, and Richard Lindley. Int J Stroke 2010; 5: 381–382: http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00465.x/abstract
  2. Statistical analysis plan for the third International Stroke Trial (IST-3); part of a ‘thread’ of reports of the trial. Int J Stroke 2012; 7: 186–18. http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00782.x/full
  3. The IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012; 379(9834):2352-2363.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60768-5/fulltext

  1. Wardlaw J M, Murray V, Berge E, del Z G, Sandercock P, Lindley R L et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; 379(9834):2364-2372. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60738-7/fulltext
  2. IST-3 Collaborative Group. Effect of thrombolysis with alteplase within 6h of acute ischaemic stroke on long-term outcomes (the third international stroke trial [IST-3]): 18-month follow-up of a randomised controlled trial. Lancet Neurology 2013;12:768-76. doi:10.1016/S1474-4422(13)70130-3.

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70130-3/fulltext

  1. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J, Sandercock P. Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome. An analysis of the Third International Stroke trial. Stroke 2014;45:1000-6: http://dx.doi.org/1161/STROKEAHA.113.004362
  2. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J et al. Effect of Alteplase Within 6 Hours of Acute Ischemic Stroke on All-Cause Mortality (Third International Stroke Trial). Stroke Published online before print November 4, 2014, http://dx.doi.org/1161/STROKEAHA.114.006890
  3. Mair G, von Kummer R, Adami A, White PM, Adams ME, Yan B et al. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial. Neuroradiology 2014 October 7. http://dx.doi.org/10.1007/s00234-014-1441-0
  4. Impact of treatment delay, age and stroke severity of the effects of intravenous thrombolysis with alteplase in acute ischaemic stroke: an individual participant data meta-analysis of randomised trials Emberson J and the Stroke Thrombolysis Trialists Collaboration Lancet. 2014 Aug 5. pii: S0140-6736(14)60584-5. http://dx.doi.org/10.1016/S0140-6736(14)60584-5 .
  5. Mair G, Boyd EV, Chappell FM, von Kummer R, Lindley RI, Sandercock P, Wardlaw JM IST-3 Collaborative Group. Sensitivity and specificity of the Hyperdense Artery Sign for arterial obstruction in acute ischemic stroke Stroke (in press)
  6. Lindley RI, Wardlaw JM, Whiteley W, Cohen G, Blackwell B, Murray G, Sandercock P & the IST-3 Collaborative Group. Alteplase for acute ischemic stroke: outcomes by clinically important subgroups in the Third International Stroke Trial Stroke (submitted for publication)

Link to video of public lecture on stroke and thrombolysis by Peter Sandercock

http://www.ed.ac.uk/schools-departments/clinical-brain-sciences/news/latest-news/public-lectures-epilepsy-stroke

Editorials and commentaries on IST-3 since 2012

 

  1. Lyden PD. In anticipation of International Stroke Trial-3 (IST-3). Stroke 2012;43:1691-4
  2. Leys L, Cordonnier C. rt-PA for ischaemic stroke: what will the next question be?. Lancet 2012;379:2320-1
  3. Donnan GA, Davis SM. IST-3: a major contribution to thrombolysis research. International Journal of Stroke 2012;7:566-7
  4. Furlan AJ. IST-3: no pragmatic answers. International Journal of Stroke 2012;7:568-9
  5. Hoffman JR, Cooper RJ. How is more negative evidence being used to support claims of benefit: the curious case of the international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:473-6
  6. Fatovich DM. Believing is seeing: stroke thrombolysis remains unproven after the third international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:477-9
  7. Kleinig TJ, Churilov L, Parsch CS, Dewey HM, Barber PA. Stroke thrombolysis and the third international stroke trial: examining “the totality of the evidence”. Emergency Medicine Australasia 2012;25:107-9
  8. Hughes S. IST-3: tPA benefits sustained out to 18 months. Medscape. 2013. Article ID 806690. [http://www.medscape.com]
  9. Anderson C. Thrombolysis with alteplase after stroke: extending outcomes. Lancet Neurology 2013;12:731-2
  10. Evidence and doubt in the translation of research into care. Lancet 2014;384:638

Correspondence since 2012

 

  1. Fatovich DM, MacDonald SP, Brown SG, Smith B, Newman DH, Shreves AE, Barer D, Durtis D, Sandercock P, Wardlaw J, Dennis M, Murray G, Lindley R. Thrombolysis in acute ischaemic stroke. Lancet 2012;380:1053-5
  2. Shinton R, Sandercock P, Wardlaw JM, Hudson I. Questions about authorisation of alteplase for ischaemic stroke. Lancet 2014;384:659-63
  3. Dai Q, Sun W, Liu X,Whiteley WN, Thompson D, Sandercock P. Letter by Dai et al regarding article “Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the Third International Stroke Trial”. Stroke 2014;45:e132-3

 

Abstracts published since trial results made public in 2012

  1. Sandercock P, Wardlaw JM, Lindley RI, Dennis MS, Cohen G. The third international stroke trial (IST-3) main results part I: primary and secondary outcomes among 3035 patients randomised. Cerebrovascular Diseases 2012;33 Suppl 2:16
  2. Lindley RI, Sandercock P, Wardlaw JW, Dennis MS, Cohen G. The third international stroke trial (IST-3) of thrombolysis main results III. Effect of iv thrombolysis with iv t-PA on death or dependency in the 3035 patients randomized: subgroup analysis. Cerebrovascular Diseases 2012;33(suppl 2):79 (Abst.1) [Ref 19448]
  3. Roots A, Birns J, Bhalla A, Rudd A. Nurse-led telemedicine-directed hyper-acute stroke trial randomisation and management of post-thrombolysis anaphylaxis. Cerebrovascular Diseases 2012;33(suppl 2):477-8 (Abst.2022) [Ref 19403]
  4. Farrall A, Wardlaw J, Sandercock P, Lindley R, Cohen G, von Kummer R, et al. The third international stroke trial (IST-3) of intravenous thrombolysis with rt-PA: baseline imaging features among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:61-2 (Abst.142)
  5. Sandercock P; IST-3 Collaborative Group. The Third International Stroke Trial (IST-3) of thrombolysis. Main results & implications for clinical practice. Cerebrovascular Diseases 2012;34 Suppl 1:6-7 (Abst.S5-1)
  6. Sandercock PAG, Wardlaw JM, Lindley RI, Cohen G; IST3 collaborative group. The third international stroke trial (IST-3) of intravenous rt-PA: effect of age and time on treatment effect among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:6
  7. Lindley RI, Sandercock PA, Wardlaw JM, Dennis MS, Cohen G, IST-3 Collaborative Group. Third international stroke trial (IST-3): subgroup effects of iv rt-PA < 6 hrs in acute ischemic stroke on symptomatic intracranial haemorrhage and outcome at 6 months. Stroke 2013;44 (Abst.TMP23)
  8. Sandercock PA, Wardlaw JM, Lindley RI, Dennis MS, IST-3 Collaborative Group. Third international stroke trial (IST-3): effect of iv rt-pa < 6 hours in acute ischaemic stroke on living circumstances and health related quality of life at six months. Stroke 2013;44 (Abst.WMP22)]
  9. Wardlaw J, Carpenter T, von Kummer R, Cohen G, Lindley R, Sandercock P. Perfusion imaging in patients randomised to rt-PA or control in the third international stroke trial (IST-3): baseline characteristics and association with outcome. Stroke 2013;44 (Abst.A10)
  10. Wardlaw J, von Kummer R, Farrall A, Cala L, von Heijne A, Peeters A, etal. The impact of ischemic and structural brain tissue changes on response to rt-PA: an analysis of imaging from 3035 patients in the third international stroke trial. Stroke 2013;44 (Abst.A104)
  11. Sandercock P, Wardlaw J, Dennis M, Cohen G, Whiteley W, Lindley, et al. Impact of thrombolysis on important aspects of daily life at 18 months in the third International Stroke Trial (IST-3). International Journal of Stroke 2013;8 Suppl 3:4
  12. Whiteley WN, Cohen G, Wardlaw J, Lindley R, Sandercock PAG. IST-3 trial: impact of rt-PA on survival to 18 months post ischaemic stroke. Cerebrovascular Diseases 2013;35(Suppl 3):19 (Abst.6)
  13. Sandercock PAG, Lindley RI, Wardlaw JM, Dennis MS, Cohen G. The third international stroke trial (IST-3): benefits of iv thrombolysis on functional outcome and health-related quality of life (HRQoL) persist to 18 months after treatment. Cerebrovascular Diseases 2013;35(Suppl 3):34 (Abst.4)
  14. Wardlaw JM, Carpenter T, Cohen G, von Kimmer R, Lindley R, Sandercock P. Does perfusion imaging lesion size or mismatch influence six month outcomes after rt-PA given up to six hours after acute ischaemic stroke? The third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):111 (Abst.12)
  15. Whiteley WN, Thompson D, Cohen G, Lindley R, Wardlaw JM, Sandercock PAG. Predictions of intracranial haemorrhage and the risks and benefits of rtPA in acute ischaemic stroke: an analysis of the IST-3 trial. Cerebrovascular Diseases 2013;35(Suppl 3):169 (Abst.4)
  16. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R. Combining CT angiography with non-contrast CT to predict infarct on follow up CT in acute ischaemic stroke. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):237 (Abst.15)
  17. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R, Farrall AJ. Association of non-contrast CT and CT angiography with baseline clinical deficit and functional outcome. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):405 (Abst.226)
  18. Sakka E, Perry D, Buchanan D, Innes K, Sandercock P, Lindley RI, Wardlaw JM. Medical image management for multicentre trials. Experience from the Third International Stroke Trial (IST-3) with 6576 scans. Cerebrovascular Diseases 2013;35(Suppl 3):562 (Abst.24)
  19. Mair G, Wardlaw JM, von Kummer R, Sandercock PA. Response to thrombolysis treatment in ischemic stroke patients with and without arterial occlusion on computed tomographic angiography: the Third International Stroke Trial. Stroke 2014;45(Suppl 1) (Abst.A6)
  20. Khatri P, Tayama D, Cohen G, Lindley RI, Wardlaw JM, Yeatts SD, et al. Effect of IV rtPA in mild strokes in the third international stroke trial (IST3): a post hoc analysis. Stroke 2014;45(Suppl 1) (Abst.ATMP21)

 

 

 

IMG_1409

The European Stroke Organisation (ESO) announced on May 9th, 2014, that the first ESO Stroke Conference will be held in Glasgow on April 17-19, 2015. Here topics it will be nice to be there with all my colleagues. In the pipeline we have a couple of nice contributions

QJM Advance Access originally published online on July 2, 2010

ABCD and ABCD2 scores of ≥3 may be clinically useful in identifying TIA outpatients at raised risk of stroke in the medium to long term.

QJM 2010 103(9):679-685

see for ABCD Rothwell PM, Giles MF, Flossman E, Lovelock CE, Redgrave JNE, Warlow CP, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischemic attack. Lancet (2005) 366:29–36

or Sciolla R, Melis F, for the SINPAC Group. Rapid identification of high-risk transient ischemic attacks. Prospective validation of the ABCD Score. Stroke (2008) 39:297–302