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ESOC 2023 | ESOC 2023 highlights: practice changing updates in ICH and AIS

Aristeidis Katsanos, MD, McMaster University, Hamilton, Ontario, Canada, highlights some of the key clinical trial updates shared at ESOC 2023. The meeting featured anticipated data from numerous studies addressing a wide variety of clinical questions, many of which are likely to inform future pivotal trials or lead to changes in clinical practice standards. Dr Katsanos comments on the excitement he shared with many attendees to see some positive trials in the intracerebral hemorrhage (ICH) space. The ENRICH trial assessed the effectiveness of early minimally invasive surgical intervention in patients with spontaneous, supratentorial ICH, demonstrating a statistically significant improvement in 6-month uW-mRS scores in the surgery arm, compared to those receiving medical management alone. This is the first randomized, controlled trial to demonstrate a benefit of surgery for ICH. Additionally, INTERACT3 enrolled over 7000 patients, testing the feasibility and efficacy of employing a goal-directed care bundle that focused on blood pressure control, glycemic control, treatment of pyrexia, and anticoagulation reversal. The significant improvements in patient outcomes treated with the care bundle reflects the importance of active management of ICH. In the acute ischemic stroke (AIS) space, key trials included: ELAN, testing early versus late initiation of direct oral anticoagulants in ischemic stroke patients with atrial fibrillation; OPTIMAL-BP, looking at the effect of intensive blood pressure lowering after intra-arterial thrombectomy; and SECRET, comparing the safety and efficacy of rivaroxaban to standard treatment, warfarin or low molecular-weight heparin, in cerebral venous thrombosis. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.

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