ISC 2025 | Major unmet needs in the treatment of stroke

Bijoy Menon

There are a few. So in the recovery or the rehab space, as I mentioned, you know, like, there’s this opportunity to do more to help our patients. The TRANSPORT-2 trial that I mentioned, although it was neutral, is one effort in that domain to actually see whether patients could recover better post-stroke with various techniques. This was testing transcranial direct stimulation, but there are other techniques out there too, some being tested in clinical trials that I think would be the next frontier in how we help our patients who are already suffering from stroke and have disabilities. For that, I think, is still a gap in our field, but very promising technology tools and some very interesting clinical trials being planned. In the extended time window thrombolysis space, as I mentioned, patient selection is still an issue. Who are the patients that we should actually be treating and treating safely? So some of the trial results that would be presented today would show, would, you know, maybe discuss this issue. But I do think with more trials coming in, we would be able to identify which patients we should be treating and which patients not. So that I think, you know, like, is another gap. Maybe prevention?

Lauren Sansing

Yeah, maybe two more. I’ll add, we’re still searching for that effective brain protectant, the effective cerebral protectant both in ischemic stroke, the ischemic brain, and the patients after just cerebral hemorrhage and other brain hemorrhages. So there’s an enormous body of emerging preclinical research that are honing in on different target pathways and some ongoing trials that are showing Phase II safety, potential feasibility of some of these approaches. But I think that is still a huge unmet need. And how do we best select what’s working in the preclinical space to bring into clinical trials? What is the right way of actually selecting the candidates and then translating to people is a major barrier. And we’re trying to innovate on how to actually learn how to do that better as well. And then prevention, right? There’s an increasing burden of stroke, particularly in the young. And there are effective risk factor medications that can improve control of diabetes, help with weight loss, reduce cardiovascular endpoints. But getting that out into the communities and getting risk factors under control, starting in young adults to reduce the risk of burden of stroke over their entire lifespan is a major effort. And ways that we can innovate to do that better is a major research need.

Bijoy Menon

On the second day, there was an interesting trial that Dr. Awad presented on the use of atorvastatin, which is a statin, and it’s also a ROCK 2 inhibitor. But for people who have what we call, you know, cavernous malformations in the brain, CCMs. And I think, you know, although that trial was, it was a small study, it was neutral from that perspective. It was positive in the sense that it was actually showing that these focused therapies could work. These are people who, you know, like are young, who have strokes, right? And so I do think, you know, that we would soon be able to identify new treatment targets for people with those type of what I would call vascular lesions and consequent strokes. But that’s an area of promise. I think in the next few years, we’ll see more and more therapies.

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