ESOC Conference Day 2 Insights: Research Reviews

Neurology Learning Network Section Editor, Amrou Sarraj, MD, continues his on-site breaking news coverage of the European Stroke Organisation Conference (ESOC) taking place in Lyon, France. Dr Sarraj shares insights on the INTERSTROKE Study as well as discussing the efficacy of tranexamic acid (TXA) in patients with intracerebral hemorrhage and showcasing the impact of interleukin-6 on carotid plaque features.

INTERSTROKE Study

This international, case-controlled study comprises 13,447 cases of acute first stroke compared against 13,472 community and hospital controls to assess the association of acute febrile illness and influenza vaccine with first-ever stroke.

Data show that influenza vaccine administration was associated with nearly half the odds of developing stroke (aOR: 0.53, 95% CI: 0.46-0.60), including ischemic stroke (aOR: 0.57, 95% CI: 0.50-0.67) and hemorrhagic stroke (aOR: 0.34, 95% CI: 0.25-0.46).

Researchers found that patients with ischemic stroke were more likely to have a febrile illness in the 4 weeks preceding stroke, and that geographic variation in association between stroke and influenza vaccine had a significant decrease in participating countries except those in South Asia and Africa.

Treatment of Intracerebral Hemorrhage in Patients on Non-vitamin K Antagonist (TICH-NOAC)

 This multicenter, double-blind, placebo-controlled, randomized clinical trial, conducted in Switzerland, assessed tranexamic acid (TXA) efficacy in patients with intracerebral hemorrhage (ICH) while on a non-vitamin K antagonist.

This study included 63 patients (32 TXA, 31 placebo) randomized to receive intravenous tranexamic acid 1 g loading dose given as 100-mL infusion over 10 minutes, followed by another 1 g in 250-mL infused over 8 hours or saline 0.9% in identical dosage.

Results of main data analysis showed differences in the following:

• Hematoma expansion (HE): TXA, 47% vs placebo, 45%; OR, 0.98; 95% CI, 0.36-2.71
• Symptomatic HE: TXA, 25% vs Placebo, 29%; OR, 0.74; 95% CI, 0.23-2.32
• Modified Rankin Scale score: cOR: 1.11; 95% CI: 0.44-2.80

The TXA arm showed the following results:

• Higher National Institutes of Health Stroke Scale
• Longer onset to treatment time
• More frequent lobar hematoma

This study was ultimately terminated early due to insufficient funding.

Association of Interleukin-6 (IL6) With High-Risk Carotid Plaque Features

To evaluate the independent dose-response relationship between interleukin-6 (IL6; log transformed) and carotid plaque, 4334 patients were evaluated. Of all the patients, 1267 had vulnerable plaque and 1474 had plaque progression.

Researchers presented the following data results:

• Severity: β, 0.09; 95% CI, 0.03-0.14; P = 1.3 x 10-3
• Vulnerability: OR, 1.21; 95% CI, 1.05-1.40; P = 7.4 x 10-3
• Progression at 5-year follow-up: OR, 1.44; 95% CI, 1.23-1.69, P = 9.1 x 10-4

To conclude, the clinicians introduced the future implications of this study. They determined that (1) trials of anti-IL6 to prevent stroke due to carotid atherosclerosis are warranted, and (2) decreasing circulating levels of uric acid could be a new potential intervention to prevent stroke in patients with carotid atherosclerosis.

References

Schwarzbach C. Acute febrile illness, influenza vaccination and the risk of acute stroke - the INTERSTROKE study. Presented at: European Stroke Organisation Conference; May 5, 2022; Lyon, France.

Lyrer P. Treatment of intracerebral hemorrhage in patients on non-vitamin K oral anticoagulants with tranexamic acid (TICH-NOAC). Presented at: European Stroke Organisation Conference; May 5, 2022; Lyon, France.

Tatuene JK. Circulating interleukin-6 predicts carotid plaque severity, vulnerability, and progression in the Cardiovascular Health Study. Presented at: European Stroke Organisation Conference; May 5, 2022; Lyon, France.