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Highlights of the 10th International Symposium on Thrombolysis and Acute Stroke Therapy, 21–23 September 2008, in Budapest

TAST 2008 was the 10th symposium in the series of International Symposia on Thrombolysis and Acute Stroke Therapy, which started in Heidelberg, Germany, in 1990 and has since then been organised every second year. The most recent TAST symposia was organised in Hong Kong, China, in 2006. When possible, the symposium has been organised either right before or immediately after the World Stroke Conference. Originally, the topic of the symposium was only thrombolysis but then neuroprotecting agents in acute stroke were included, and later on treatment of acute intracerebral haemorrhage (ICH) was also included. The symposia have always been well attended by experts from all over the world. Most of the presentations have been invited plenary lectures given by world-class experts, which was also the case in TAST 2008 in Budapest. Another tradition of TAST is that there is only one series of lectures so that the participants have the possibility to listen to all of them and actively take part in discussions. Because of the high quality of presentations, all the lectures would merit to be referred to in the present highlights but because the abstracts have been published in this journal, we selected only a few highlights of the congress for this short overview. Nils Wahlgren (Stockholm, Sweden) presented data from SITS-MOST and SITS-ISTR. SITS-ISTR data prove that alteplase given at 3–4.5 h after stroke onset is as safe as when initiated o3 h. The data also suggest that increased blood pressure should be more actively treated after the initiation of thrombolysis. Etsuro Mori (Sendai, Japan) gave a lecture on JACT and J-ACTII, which verified the efficacy of 0.6 mg/kg alteplase within 3 h of onset, while MELT suggested that intraarterial urokinase is safe and effective in MCA occlusion within 6 h. Heinrich Audebert (Berlin, Germany) presented data of TEMPIS, telestroke network in Bavaria, Germany. The use of telestroke had increased the number of systemic thrombolyses from 3.2% (2003) to 10% (2007) and less symptomatic haemorrhage developed than in the SITSMOST register. Ka Sing Lawrence Wong (Hong Kong, China) presented increasing use of rt-PA in Asia, according to data from Singapore, Korea, Japan, India, China and Hong-Kong. Markku Kaste (Helsinki, Finland) presented SITS-MOST data from Finland. In Finland, more thrombolysis is provided per million inhabitants than in any other EU member state, and Helsinki University Central Hospital administered more stroke thrombolysis than any other European hospital. László Csiba (Debrecen, Hungary) presented the utility of ultrasonography in the diagnosis, treatment and treatment monitoring of acute stroke. Andrei V. Alexandrov (Birmingham, AL, USA) presented experiences on sonothrombolysis enhanced by bubbles, which can double recanalisation rates. Joseph Broderick (Cincinnati, OH, USA) described the study design of the IMSIII trial, a combination of i.v. and i.a. thrombolysis, and thrombolysis with recanalising devices. Nine hundred subjects are planned to be randomised to either i.v. or i.v./i.a. combined therapy. Perttu Lindsberg (Helsinki, Finland) reported that i.v. thrombolysis is equally safe and effective as i.a. thrombolysis in basilar artery occlusion but in experienced centres, he proposed that combined therapy should be considered. Nikolai Steffenhagen (Calgary, Canada) reported that in the post hoc analysis of the CASES study, patients with minor stroke (o5 NIHSS) treated with thrombolysis 74.7% had a good outcome (mRS 0–1), and only 2.6% had sICH. Kazunori Toyoda (Osaka, Japan) reported that lowering systolic blood pressure to o138 mmHg during the initial 24 h in 244 patients with haemorrhagic stroke seemed to predict a favourable early functional outcome. Patrick Lyden (San Diego, CA, USA) presented the interim result of ICTUSL, an i.v. thrombolysis plus hypothermia study. The target temperature was reached in all patients with a new protocol and a larger catheter. The results revealed that endovascular cooling can safely be combined with thrombolytic therapy. Natan Bornstein (Tel Aviv, Israel) reported on the unfavourable effect of hyperglycaemia in acute stroke and proposed that the minimum threshold to treat hyperglycaemia mentioned previously was too high, and possibly4140–185 mg/dl should trigger administration of insulin. Kennedy Lees described the study design of carbamylated erythropoietin (CEPO), a CEPO in acute ischaemic stroke, a Phase I trial. CEPO does not have the hematopoietic effects of EPO but it has been shown to be Correspondence: László Csiba , University of Debrecen, Medical and Health Science Centre, Department of Neurology, H-4012 Moricz Zs. krt. 22. Debrecen, Hungry. Tel: +36 52 415176; Fax: +36 52 453590; e-mail: csiba@dote.hu Department of Neurology, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungry Department of Neurology, Helsinki University Central Hospital, University of Helsinki, Finland