EAN 2025 | EAN/ESO joint session at EAN 2025: latest developments in the stroke field

In the session, so the EAN/ESO joint session at EAN, we have been discussing most of the recent news on both intravenous thrombolysis and endovascular treatments. And we also had some insights into the future on ongoing trials and how this may change treatments. So first we have been discussing in this session intravenous thrombolysis and there are quite a few things that are new in intravenous thrombolysis so treatment of minor stroke is always something that is important and there is some discussion on when to treat or not to treat and there was also a review about this aspect and how can we decide on the emergency setting whether symptoms are disabling or not disabling and what to do with intravenous thrombolysis treatments. Also the implementation of tenecteplase is something that has been ongoing in many countries we do have the ESO recommendations on the application of tenecteplase recently about I think one year ago but still there are countries still updating their own protocols and you know approving the use of tenecteplase for ischemic stroke so this is definitely a question that is very timely and has been also discussed. Also the question of bridging therapy so doing intravenous thrombolysis and endovascular treatment we had several trials in the last years and we had the meta-analysis of those trials and this information has been also discussed so what to do with intravenous thrombolysis in patients with large vessel occlusion. The main message is we should continue doing intravenous thrombolysis the same way, both in drip-and-ship and mothership setting, always give thrombolysis if the patient has an indication. We have been also discussing the future of endovascular treatment, especially new treatments. So Professor Urs Fischer was discussing what can we do to improve reperfusion treatments and for example trials like TENECTO which are assessing the possible benefit of additional intra-arterial thrombolysis after a thrombectomy. There is not so successful so it’s successful but still it’s not a full recanalization how this can improve the recanalization of the patients and other studies that are ongoing or are in discussion. For example, maybe a new trial assessing the treatment of MeVo and DiVo, so medium vessel occlusions and distal vessel occlusions. So that was a major news in stroke in the last year. So there were several trials, three trials, assessing distal vessel occlusion treatments with endovascular treatments. And these trials were neutral, so there was no benefit of endovascular treatment in these patients. And even there were some signs of increased intracranial bleeding. So there are now concerns in clinical practice on how to proceed and also in terms of research. There are a hypothesis of having at least new trials assessing more specific groups of patients and that was also a discussion. So we had very interesting insights into also the future of ischemic stroke treatments and also on the recent news both of intravenous thrombolysis and endovascular treatment. So we discussed large-core trials and this expansion of treatment to large-core patients and how to select patients and what are the challenges for the implementation as well. And we also had this discussion I already mentioned on the challenges and how can we ensure that all patients are treated and how can we improve treatment rates across Europe. So it was a very interesting session and we definitely are looking forward to the next year discussions on what will happen in between.

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