Abstract
This third 2018 issue of the European Stroke Journal (ESJ) appears after a highly successful European Stroke Organisation Conference (ESOC) in Gothenburg. ESOC demonstrated continual scientific development in the stroke field, as well as the strengthened position of the ESO with its multitude of activities. At the ESOC, the European Stroke Action Plan 2018 to 2030 was launched – more to follow on this in these pages in due course. In the present issue of the journal, you will find the reports from two other ESO projects, the management, prognosis of and pathophysiological insights in stroke subgroups and long-term management of stroke. This issue also contains the protocol for two trials.
The 4th European Stroke Science Workshop took place in November last year, and convened >120 stroke experts to discuss latest results and hot topics in clinical, translational and basic stroke research. Since its inception in 2011, the European Stroke Science Workshop has become a cornerstone of the academic activities of the ESO. We are pleased to provide our readers with the comprehensive report from the proceedings.
Waje-Andreassen and colleagues report on the ESO certification of Stroke Units and Stroke Centres, detailing the certification criteria and the auditing process for stroke units and stroke centres, which aim to standardise and harmonise care for stroke patients. This ESO activity is a major step forward towards high-quality stroke care across Europe.
Cauldwell and colleagues provide a timely review on management of one of the most challenging areas in clinical practice: stroke and pregnancy. Part of the challenge comes from the need to pay attention to two patients at the same time – the mother and the child. In another paper, new insights into cerebral blood flow and perfusion are provided by Arsava and colleagues in the report on the effect of carotid artery stenting on capillary transit time heterogeneity in patients with carotid artery stenosis. It is exciting that cerebral vascular imaging now can monitor not only the anatomy and gross effects of large artery arterial obstructions to flow but also takes us to the next level of studying effects on capillary perfusion.
A key characteristic of stroke is the plethora of multimorbidities and risk factors, one of the most important being cardiac disease. In a large register study of stroke risk in patients with stable coronary artery disease, Cordonnier and colleagues report on incidence and determinants of cerebrovascular events. In this patient group, they found a substantial risk of stroke, a quarter of which were intracerebral haemorrhages. The study raises awareness of the hazard of the association of antiplatelet drugs with oral anticoagulants and emphasises the need for further studies to determine the best balance between ischemic stroke prevention and haemorrhagic risks in high-risk patients.
Three papers raise attention to one of the neglected areas in stroke care – the secondary complications in the long term and the need for a systematic follow-up on the most important domains. In an Irish study, Walsh and colleagues found that one-quarter of stroke survivors discharged to the community fell repeatedly and mostly indoors in the first year. In a sister study, they reported that the experience of one fall and recurrent falls was independently associated with higher costs of care. In a German study, Hotter and colleagues using a systematic post stroke checklist identified significant unmet needs and gaps in health and social care in long-term stroke patients, highlighting the need for further research and actions in this field.
The ESJ welcomes submissions of trial protocols and is pleased to include two innovative studies in the present issue: the XILO-FIST study on allopurinol after TIA and stroke, and the PRECIOUS trial on prevention of complications to improve outcome in elderly patients with acute stroke using a multi-interventional factorial design.
Finally, Didier and myself are pleased to warmly welcome professor Karin Klijn as the new Associate Editor of the journal. Karin is highly merited and well known to most of you: her broad competence will be a most valuable addition to the editorial team.
We wish you happy reading, and we hope to see many of you in Montreal in October for the World Stroke Congress.
Bo Norrving, Editor-in-Chief
Lund University, Lund, Sweden
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Didier Leys, Vice Editor
University of Lille, Lille, France
Karin Klijn, Associate Editor
Radboud University, Nijmegen, The Netherlands