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ISC 2023 | Key data at ISC 2023: DAPT vs IVT, alteplase vs tenecteplase, and EVT in large core stroke

The International Stroke Conference (ISC) 2023 made headlines with reports of several practice-changing trial outcomes. Thanh Nguyen, MD, Boston Medical Center, Boston University School of Medicine, Boston, MA, talks on some of the highlights from this year’s meeting. Firstly, the findings of the ANGEL-ASPECT and SELECT2 trials were key news. Both studies investigated the effect of endovascular therapy (EVT) versus best medical management (BMM) in patients with acute stroke due to large vessel occlusion with a large ischemic core, as determined by non-contrast CT (ASPECTS 3-5) or perfusion imaging. The use of EVT within 24 hours from last known was associated with a significant improvement in mRS scores at 90 days, compared to BMM. Secondly, the ARAMIS trial read out, which showed dual antiplatelet therapy to be non-inferior to alteplase for minor non-disabling ischemic stroke within 4.5 hours. The TRACE II trial was also presented, showing that tenecteplase was non-inferior to alteplase in over 1400 patients with ischemic stroke treated within 4.5 hours of symptom onset. Prof. Nguyen also comments on CATIS 2 and BEST‐II, which looked at the optimal timing and targets for blood pressure lowering in acute stroke management. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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