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ESOC 2025 | Unanswered questions that remain following clinical trial updates at ESOC 2025

Valeria Caso, MD, PhD, FESO, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy, comments on the unanswered questions that remain following results from several clinical trials presented at ESOC 2025. Prof. Caso suggests that the neutral outcomes may be due to poor patient selection and that studies need to be designed to focus on subsets of patients. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.

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Transcript

There is a lot of unanswered questions because now you see there are a lot of nurse-led and physiotherapist-led studies taking care of patients after a stroke. And unfortunately, these results were all neutral. But there is clearly, there will be a benefit in patients who are more closely followed up by a dedicated team than with usual care. So probably there was not a good patient selection because many of these patients were mild...

There is a lot of unanswered questions because now you see there are a lot of nurse-led and physiotherapist-led studies taking care of patients after a stroke. And unfortunately, these results were all neutral. But there is clearly, there will be a benefit in patients who are more closely followed up by a dedicated team than with usual care. So probably there was not a good patient selection because many of these patients were mild. So probably if we need more severe patients, because if severe patients are more closely followed up, it’s clear that they will benefit more than those who are not closely followed up. And they focus on the reduction of risk of having a recurrence. However, if you have only half a year of follow-up, you will not see a difference. So probably these studies need to be designed more focused on a different type of patient because absolutely care matters. And the better and more intensive is the care, especially for patients after a stroke, because a patient with a stroke is disabled. It’s not a cardiac stroke or an eye stroke or an oncological stroke who can move by himself, go to do the follow-ups and so on. A stroke patient is disabled. So we have to really show that this dedicated treatment is also a return of investment because we reduced also the indirect cost by relatives and so on. And it’s also for the quality of life of the patients who are cared for. Others are what we do with small vessel, with middle cerebral artery occlusion. Still, there seems to be a reduction of the damage, but still there is no better outcome. So a lot of unanswered questions are still to be answered.

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