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Conference Coverage: Highlights from the International Stroke Conference 2024

February 16, 2024

The American Heart Association’s International Stroke Conference wrapped up on February 9, 2024. Below are highlights from the cerebrovascular and brain health research presented at the meeting.

Common antidepressants appear safe for most stroke patients

Selective serotonin/serotonin-norepinephrine reuptake inhibitors (SSRI/SNRIs) are associated with improved stroke, but some clinicians withhold the medications over bleeding risk concerns. In this study, researchers aimed to quantify the association between early initiation of SSRI/SNRIs and adverse bleeding events among acute ischemic stroke patients, determine the bleeding risks among patients receiving anticoagulation or dual antiplatelet therapy, and evaluate bleeding risks between anti-depressant classes. Their findings suggest that patients with ischemic strokes who took SSRI/SNRIs for post-stroke depression and anxiety experienced no increased risk for abnormal bleeding, even if they also were taking antithrombotics. However, researchers determined that taking SSRIs and SNRIs in combination with dual antiplatelet therapy increased the risk of a hemorrhagic stroke by 29% and other serious bleeding problems by 10%. Read more.

Lying flat equals better outcomes for stroke thrombectomy candidates

In this NIH-funded multisite clinical trial, researchers sought to determine whether zero-degree head positioning of large-vessel occlusion (LVO) thrombectomy candidates was associated with greater clinical stability and/or improvement as compared to 30-degree positioning in the pre-thrombectomy period. The trial was ended early because of the magnitude of benefit seen at the first interim analysis. The researchers found that placing patients with an acute ischemic stroke cause by LVO flat on their bed as they await mechanical thrombectomy is a simple, extremely effective way to improve short-term outcomes. Read more.

Adjunctive corticosteroid therapy does not improve outcomes after stroke

A short course of low-dose methylprednisolone added to endovascular thrombectomy after acute ischemic stroke did not improve disability outcomes, according to the randomized MARVEL trial from China. However, researchers did find that adjunctive corticosteroid therapy was associated with a lower rate of mortality. Read more.

Timing of thrombolysis before thrombectomy has significant impact on outcome

The benefit of IV thrombolysis (IVT) for acute ischemic stroke declines with longer time from symptom onset, but it's been unclear whether a similar time dependency exists for IVT followed by thrombectomy. In this meta-analysis, researchers compared IVT plus thrombectomy vs. thrombectomy alone in six randomized trials. They found that the benefit associated with IVT plus thrombectomy was time dependent and statistically significant only if the time from symptom onset to expected administration of IVT was short. Read more.

Faster anticoagulation reversal linked to better outcomes in patients with intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is the deadliest stroke subtype, and mortality rates are especially high in anticoagulation-associated ICH. Specific anticoagulation reversal strategies have been developed, but it has been unclear as to whether there is a time-dependent treatment effect for door-to-treatment (DTT) times in clinical practice. In this cohort study of 9,942 patients, researchers found that earlier anticoagulation reversal was associated with improved survival for patients with ICH. These findings support intensive efforts to accelerate evaluation and treatment for patients with ICH. Read more.