ISC 2025 | Key trials to look out for at ISC 2025: PRESTIGE-AF and DISTAL
Valeria Caso, MD, PhD, FESO, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy, comments on the trials she is excited to hear about at the 2025 international stroke conference (ISC). She highlights two trials: the PRESTIGE-AF trial (NCT03996772), which assesses anticoagulation therapy in patients with atrial fibrillation who have had an intracerebral hemorrhage, and the DISTAL trial (NCT05029414), which seeks to determine the benefit of endovascular therapy in patients with distal occlusion of the middle cerebral artery in acute stroke. This interview took place at the 2025 International Stroke Conference (ISC), held in Los Angeles, CA.
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Transcript
What I am particularly looking for at the ISC conference are two trials. One is the PRESTIGE-AF trial, which is a very important trial about secondary prevention in patients with AF who had an intracerebral hemorrhage. This is still an open question because we do not know what the safety profile and the efficacy, yes we know, but the safety profile in restarting anticoagulation with NOAC in a patient who had an intracerebral hemorrhage...
What I am particularly looking for at the ISC conference are two trials. One is the PRESTIGE-AF trial, which is a very important trial about secondary prevention in patients with AF who had an intracerebral hemorrhage. This is still an open question because we do not know what the safety profile and the efficacy, yes we know, but the safety profile in restarting anticoagulation with NOAC in a patient who had an intracerebral hemorrhage. Until now we have some data from meta-analysis, from some randomized trials, but still we don’t have an answer if it’s safe to restart anticoagulation. So this PRESTIGE trial is a European trial funded by the European Union and hard work started in 2017. So I’m really looking forward because this is an unmet need for our patients, especially in this high-risk patient who had a stroke and then had a bleeding. So for them, it’s a crucial question to be answered. The second trial that I’m really looking forward is the DISTAL trial which is organized by the University of Bern and it’s about the distal occlusion of the middle cerebral artery in acute stroke. Currently we treat with thrombectomy, M1, M2 occlusion and we know that thrombectomy on top of thrombolysis is the best option that we can offer to our patient. However, we still do not have certainty about M3 because these are very tiny vessels and we don’t know if maybe the risk of rupture or even the futility is higher than the benefit of re-canalization in this patient. And this is a crucial question because it’s also quite expensive and there are currently not dedicated catheters, for example, many catheters come from cardiology. So if Urs Fischer and his team can show a benefit, then there will be an unmet need for these patients. Because often when there’s an M3, we do like this, what shall we do? Especially if they cannot do a thrombolysis. So this will certainly be an important result for our patients.
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