Abstract
The European Stroke Journal is now proudly going into its 5th year. In the first issue of this lustrum volume you will find a systematic review, nine original contributions on a wide variety of topics across the stroke subtypes, and a study protocol.
In the systematic review you can read how CT perfusion can help you to predict haemorrhagic transformation in patients with ischemic stroke.
Colleagues from the Health Economics Research Centre in Oxford estimated the economic burden of stroke across 32 countries in Europe in 2017. Based on 1.5 million people who were diagnosed with stroke, 9 million living with stroke, and 0.4 million deaths because of stroke, the costs for stroke mounted to 60 billion euro, of which health care accounted for 45%. Their work also shows that costs of stroke are rising over time. Food for thought for all of us who look after stroke patients as well as for insurance companies, governments, and other stakeholders.
Also from Oxford, the colleagues form the Oxford Vascular Study, draw attention to the accuracy, and at the same time residual insensitivity of hospital diagnostic coding. They point out that difference in the time trends of coding sensitivity in relation to stroke severity may cause bias in studies that assess time trend in stroke outcome. As more and more large studies based on hospital diagnostic coding are being reported, it is important to be aware of the pitfalls.
As the population continues to grow older, co-morbidity becomes increasingly important, also in patients with stroke. Based on almost 12 000 patients with first ever stroke, Riksstroke investigators demonstrate that co-morbidity has a very large effect on death and on functional outcome after stroke. From the North American Get With The Guidelines-Stroke linked to Medicare claims data, we learn that there is no reason to withhold thrombolytic therapy in patients who have the co-morbidities of gastrointestinal malignancy or gastrointestinal bleeding. A Dutch study shows that about 1 in 200 patients who are referred to the emergency department because of stroke and 1 in 125 patients with acute ischaemia have acute aortic dissection. Decreased consciousness, pain, and a low systolic blood pressure may point the clinician to this important diagnosis. A study from Switzerland highlights that in patients with ischaemic stroke associated with atrial fibrillation, the presence of small vessel disease markers influences their risk of the composite of recurrent ischaemic stroke, intracranial haemorrhage, and death, again highlighting the importance of co-morbidities in stroke patients. Colleagues from Maastricht show that in patients with stroke, small vessel disease markers and global atrophy but not the stroke lesion itself are important for occurrence of apathy, and, albeit less strongly, for depression.
The VISTA collaborators have assessed the still controversial issue of statin use in intracerebral haemorrhage. They found that patients who were on statins in the early in-hospital phase had better functional outcomes than those without statin exposure before or early after their haemorrhage. This study supports the continuation of statins in patients with intracerebral haemorrhage.
A study from Utrecht provides you with more detailed information to advise your patients with familial intracranial aneurysms: siblings of patients with aneurysmal subarachnoid hemorrhage have a significantly higher risk of both unruptured intracranial aneurysms and aneurysmal subarachnoid hemorrhage and parents have a lower risk of aneurysmal subarachnoid hemorrhage than children.
Finally, you can find the protocol for a large sham-controlled randomised trial in Denmark, investigating whether remote ischaemic conditioning, applied in the prehospital setting and continued in-hospital, may improve functional outcome in patients with acute ischaemic stroke or intracerebral haemorrhage.
We encourage you to continue submitting your excellent science to the European Stroke Journal. Have a nice read!
C.J.M. Klijn and Bo Norrving