The Latest Research on Vascular Diseases

This transcript has been edited for clarity.

Dear colleagues, I am Christoph Diener from the Faculty of Medicine at the University of Duisburg-Essen in Germany. Today, I would like to report on several interesting studies that were published in December 2022.

Propranolol for Familial Cerebral Cavernomas

I would like to start with familial cavernous malformations in the brain.

There was an interesting observation a few years ago that angiocavernomas in the skin respond to treatment with propranolol. Therefore, a study was conducted in people with familial cavernous malformations in the brain.

In this small pilot study, 57 patients received propranolol or placebo and were followed for 2 years. The rate of symptomatic intracerebral hemorrhage or focal neurologic deficits was reduced by 50% in those who received propranolol. Now, this is a pilot study, and the results have to be replicated in a much larger phase 3 trial.

Blood Pressure Lowering in Patients With Stroke

The next study, published in The Lancet, investigated the possible benefit of lowering increased blood pressure in patients with stroke who undergo mechanical thrombectomy.

This study was done in China and included 821 patients who had a systolic blood pressure above 140 mm Hg after mechanical thrombectomy. They were randomly assigned to receive either aggressive blood pressure–lowering therapy with a target of ≤ 120 mm Hg or intensive treatment with a target of between 140 mm Hg and 180 mm Hg.

The primary endpoint was functional recovery, assessed according to scores on the modified Rankin scale. The aggressive blood pressure–lowering treatment was clearly inferior to control.

This is hopefully the last of the many studies investigating lowering increased blood pressure in ischemic stroke because all the studies were clearly negative or neutral.

Remote Ischemic Conditioning for Stroke Prevention

The next study, which was published in The Lancet Neurology, deals with remote ischemic conditioning.

A study in China had previously shown that remote ischemic conditioning using arm ischemia improves the outcome of acute ischemic stroke. The follow-up study investigated this approach in people with symptomatic intracranial stenosis. The study recruited more than 3000 patients, and half of them were subjected to 30 minutes of intermittent ischemia of the arms for 1 year.

The primary outcome was fatal or nonfatal recurrent stroke, and there was no difference [between the study groups]. There was also no difference in mortality. Obviously, this approach does not work in secondary stroke prevention.

Vaccination for Newly Diagnosed or Recurrent Glioblastoma

The next study was published in JAMA Oncology.

I think this is a breakthrough study. This was the first study that investigated vaccination in people with newly diagnosed or recurrent glioblastoma. This vaccine is developed from lysate-loaded dendritic cells from the tumor.

The study recruited 331 patients, with 232 patients randomized to receive the vaccine and 99 to the placebo group. The survival time was significantly prolonged after vaccination, but we need larger replication studies.

Dimethyl Fumarate in Radiologically Isolated Syndrome

My next study is about so-called radiologically isolated syndrome. These patients have no symptoms but show the typical signs of multiple sclerosis (MS) on brain MRI.

In this small study, 44 patients were put on dimethyl fumarate and 43 on placebo, and they were followed for 96 months.

The hazard ratio for a first clinical MS event was reduced by almost 20%. There was also a decrease in the number of new demyelinating lesions in the brain. Logically, dimethyl fumarate had more adverse events. Now we need more studies for radiologically isolated syndrome.

Simvastatin for Early Parkinson's Disease

The next study is on Parkinson's disease and was published in JAMA Neurology.

A preclinical model showed that simvastatin has a disease-modulating effect. Therefore, a randomized study was done in 235 patients with early Parkinson's disease. They were treated for 24 months with simvastatin or placebo. Unfortunately, there was no benefit.

Deferiprone in Parkinson's Disease

The last study, published in The New England Journal of Medicine, deals with the observation of increased iron content in the substantia nigra in people with Parkinson's disease.

This study investigated deferiprone, which is a chelation binder, in 372 patients with newly diagnosed Parkinson's disease and no need for L-DOPA. Unfortunately, the active treatment was clearly inferior to placebo. This indicates that iron in the brain is a biomarker of Parkinson's disease but not the cause of Parkinson's disease.

Dear colleagues, I've discussed seven interesting studies from December 2022. Hopefully you will watch my videos also in 2023. I am Christoph Diener from the University of Duisburg-Essen in Germany. Thank you very much for watching and listening.

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