NeurologyLive® Year in Review 2024: Top Stories in Stroke and Cerebrovascular Disease

In 2024, the NeurologyLive^® staff was a busy bunch, covering clinical news and data readouts from around the world across a number of key neurology subspecialty areas. From major study publications and FDA decisions to societal conference sessions and expert interviews, the team spent all year bringing the latest information to the website's front page.

Among our key focus areas is stroke and cerebrovascular disease, a field that has reported massive progress over the past several years, as well as in 2023. Although major news items often appear among the top pieces our team produces, sometimes smaller stories reach those heights for other reasons—clinical impact and interest, or concerns about the small- or big-picture parts of care, for example. Whatever the reason for the attention these stories got, their place here helps provide an understanding of the themes in this field over the course of 2024.

Here, we'll highlight some of the most-read content on NeurologyLive^® this year. Click the buttons to read further into these stories.

1. New Published Guideline Provides Recommendations for Primary Stroke Prevention Across Life Span

A new clinical guideline from the American Stroke Association published in Stroke provided evidence-based recommendations for strategies to support brain health and prevent stroke through improving healthy lifestyle behaviors and preventive care. This guideline, supported also as a clinically valuable educational tool by The American College of Obstetricians and Gynecologists, replaces the previous 2014 version and is intended to be a resource for clinicians in the implementation various prevention strategies for patients who do not have a prior history of stroke.

2. First Successful Trial in Intracerebral Hemorrhage: Lessons From ENRICH

Investigators published the full data from the ENRICH trial (NCT02880878), a large-scale study evaluating NICO’s technology, BrainPath and Myriad, as a method of treatment for patients with intracerebral hemorrhage (ICH). The multicenter, randomized study included 300 patients with ICH who were randomly assigned 1:1 within 24 hours after the time last known to be well, to minimally invasive surgical removal of the hematoma plus guideline-based medical management (surgery group) or to guideline-based medical management alone (control).

3. NICO’s Minimally Invasive Evacuation Technology Outperforms Guideline-Based Medical Management as Intracerebral Hemorrhage Treatment

Investigators have published the full dataset of the pivotal ENRICH trial (NCT02880878), the first positive trial to show improved functional and economic outcomes for intracerebral hemorrhage (ICH), in the New England Journal of Medicine. All told, results from the study showed that early intervention of minimally invasive hematoma evacuation using NICO’s technology, BrainPath and Myriad, was safe and resulted in better functional outcomes at 180 days than guideline-based medical management.

4. Exploring the Association Between Brain Lesions and Takotsubo Syndrome

Takotsubo syndrome is a type of acute heart failure syndrome that usually manifests as acute chest pain, dyspnea or syncope that mimics an acute myocardial infarction. In prior research, the understanding of the pathogenesis of this syndrome suggested that the sympathetic nervous system activation plays an important role. Frederic Schaper, MD, PhD, an instructor in neurology at Brigham and Women's Hospital, discussed the complex interplay between brain lesions and takotsubo syndrome, a heart condition caused by physical and emotional triggers.

5. Subgroup Analyses of Phase 3 CHARM Trial Show Potential Therapeutic Benefit of IV Glibenclamide in Large Hemispheric Infarction

Despite neutral top-line results, post-hoc data from the phase 3 CHARM trial (NCT02864953) showed that treatment with intravenous glibenclamide (CIRARA; Remedy Pharmaceuticals) resulted in meaningful improvements in functional outcomes among subgroups of patients with large hemispheric infarction.

6. Risk of Cryptogenic Ischemic Stroke in Young Adults Significantly Increased Through Heavy Alcohol Consumption

Published findings from a multicenter study showed a strong association between heavy alcohol consumption, particularly binge drinking, and young-onset cryptogenic ischemic stroke (CIS), independent from coexisting stroke risk factors. These data further support reducing alcohol consumption as a lifestyle intervention in young adults to mitigate their risk of ischemic stroke, including CIS.

7. Adjunctive Argatroban and Eptifibatide Fails to Show Benefit in Reducing Poststroke Disability in Phase 3 Study

Findings published in The New England Journal of Medicine from the phase 3 Multi-Arm Optimization of Stroke Thrombolysis (MOST) trial (NCT03735979) showed that adjunctive treatment with intravenous argatroban, an anticoagulant agent, or eptifibatide (Integrillin; Millennium Pharmaceuticals), an antiplatelet agent, failed to reach efficacy in reducing poststroke disability among patients with acute ischemic stroke (AIS) who were treated with intravenous thrombolysis within 3 hours after symptom onset.

8. Patient Dosing Underway for Phase 2 Study of RNA Aptamer BB-031 in Acute Ischemic Stroke

Patient dosing has begun for the phase 2 RAISE study (NCT06226805), a two-part trial assessing the safety and preliminary efficacy of BB-031 (Basking Biosciences), a first-in-class RNA aptamer targeting von Willebrand Factor (vWF) in patients with acute ischemic stroke (AIS). BB-031, an investigational agent, is designed to be safer, more effective, and able to significantly expand the population eligible to receive acute revascularization therapy.

9. Cytoprotective Therapy Edaravone Dexborneol Improves Poststroke Functional Outcomes

Published data from TASTE-SL, a placebo-controlled, parallel-group, phase 3 trial (NCT04950920), showed that treatment with edaravone dexborneol, a brain cytoprotective agent, can improve the rate of functional outcomes in patients with acute ischemic stroke (AIS) who presented within 48 hours.

10. Lower Mean Oxygen Saturation Observed in Poorer Poststroke Functional Outcomes

In a study (NCT01561677) assessing the impact of different sleep health parameters in poststroke patients, results indicated that poorer functional outcomes at 3 months were associated with lower mean oxygen saturation, but not with apnea-hypopnea index (AHI). Other parameters such as restless legs syndrome (RLS), low total sleep time (TST) and REM sleep, insomnia, depressive symptoms and fatigue were more frequent in patients with less favorable outcome.