N AO M DAT E X 3M VER NEW ITAIR RETRIE ge 10 SOL NT pa STE Turn to
March 2024 | Issue 53
www.neuronewsinternational.com
Featured in this issue:
DIRECT STROKE TRIAGE: Recent data “affirm” benefits
Profile Michihiro Tanaka page 16
Shining a light on hereditary brain aneurysms Rebecca Middleton page 18
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indings from the EMBOLISE, MAGIC-MT and STEM trials—all of which were disclosed for the first time at the 2024 International Stroke Conference (ISC; 7–9 February, Phoenix, USA)—evaluated the addition of minimally invasive MMA embolisation to standard medical care, as compared to standard care alone, and found that the procedure was linked to reduced failure rates without an increased occurrence of serious complications. “This is a landmark moment in the treatment of SDHs,” said ISC 2024 chair Tudor Jovin (Cooper University Health Care, Camden, USA). “This is a moment to which I draw parallels with the thrombectomy trials in 2015. It’s a similar situation—this technique has been in practice at certain centres, inconsistently—but, now, we have level-one evidence from not one but three trials of unequivocal benefit, both in patients who require surgery and those receiving medical management only.” The EMBOLISE randomised controlled trial (RCT) was the
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Thrombectomy gains approval for stroke in Brazil
MMA embolisation trials represent “major shift” in subdural haematoma treatment Three recently presented clinical trials have demonstrated positive outcomes associated with middle meningeal artery (MMA) embolisation in chronic subdural haematoma (SDH) patients, representing a “landmark moment” and “major shift” in the treatment of this condition.
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first of these studies to be delivered at ISC, with leading investigators Jason Davies (State University of New York, Buffalo, USA) and Jared Knopman (Weill Cornell Medical College, New York, USA) taking to the podium to outline first-time data. The trial enrolled 400 adults—all of whom were about to undergo surgery for a subacute or chronic SDH, and considered able to care for themselves and likely to survive for at least one year—across 39 US hospitals. Patients were randomly assigned to receive either surgery alone, or surgery plus MMA embolisation using the Onyx liquid embolic system (Medtronic), to help reduce SDH progression or recurrence. EMBOLISE’s primary endpoint was the rate of SDH recurrence requiring surgical drainage within 90 days, which was observed in 4.1% of patients who underwent surgery plus MMA embolisation, compared to 11.3% with surgery alone— a “highly significant” difference. In addition, at 90 days after surgery, increasing disability and neurological dysfunction was found to be statistically comparable between these two groups, occurring in 11.9% of surgery-plus-embolisation patients and 9.8% of surgery-only patients. As per a 30-day safety endpoint in the trial, serious adverse events attributed to MMA Continued on page 2
A “HISTORICAL MILESTONE” for stroke patients in Brazil was achieved on 24 November 2023, with the country’s Ministry of Health (MOH) publishing Order 1.996/2023 to add mechanical thrombectomy to the list of procedures covered by the Brazilian public health system. According to the World Stroke Organization (WSO), “this achievement crowns the efforts of a tireless network of stroke neurologists and neurointerventionists”. Much of the basis for the approval came from the RESILIENT trial, which was initiated by Raul Nogueira (University of Pittsburgh Medical Center, Pittsburgh, USA) and Sheila Martins (Federal University of Rio Grande do Sul, Porto Alegre, Brazil) more than a decade ago to evaluate the procedure in large vessel occlusion (LVO) acute ischaemic stroke. Having essentially been “demanded” by the Brazilian MOH, RESILIENT ultimately replicated the findings of the five major stroke thrombectomy trials from 2015, producing results “overwhelmingly favouring” the procedure versus the existing standard of care in lower- and middle-income countries. Subsequent analyses established the procedure’s costeffectiveness as well. Presentation and publication of these data were followed by a decision from the MOH Secretary of Science, Technology, Innovation and Strategic Health Supplies to make the intervention available up to 24 hours from symptom onset in LVO acute ischaemic stroke patients.