Abstract
This final issue of the fifth year of the European Stroke Journal is an extra thick volume. We are proud that so many choose to publish their research in our journal. Also, we are very grateful to all those who have provided excellent and constructive reviews for the submitted papers. We realize that many of you are experiencing difficulties relating to the COVID-19 pandemic and we appreciate your continuous support for the journal in these times.
In this issue, you will find a guide on how to set up a simulation training program for stroke care by the ESO Simulation committee. Implementation of simulation programs may contribute to building and maintaining safe and standardized high level of stroke care.
A Dutch study of long term follow up of almost 20.000 patients with intracerebral haemorrhage demonstrates that these patients are at high risk of recurrent intracerebral haemorrhage, but also of ischaemic stroke and other vascular complications, which warrants clinical trials to determine the optimal secondary prevention. In a pooled analysis of INTERACT 1 and 2, of sex differences in treatment, radiological features and outcome after intracerebral haemorrhages, the authors found differences in baseline characteristics between men and women, but no differences in occurrence of the combined endpoint of death or major disability, in haematoma growth, or in the effect of randomized blood pressure lowering treatment.
Colleagues from Denmark assessed the reasons behind prehospital delay in patients with acute ischaemic stroke, intracerebral haemorrhage or TIA. Having a bystander, knowledge of stroke symptoms, and understanding the seriousness of a stroke, all led to faster help-seeking. Addressing the modifiable factors continues to be an important responsibility for all of us.
Although rt-PA and intraarterial thrombectomy are now established treatments for acute ischaemic stroke, further studies continue to shed light on our understanding of their benefits and effects, and limits. A study from Portugal and Spain found that a spontaneous systolic blood pressure drop after mechanical thrombectomy predicts dramatic neurological recovery, and discusses the reasons for this observation. A post-hoc analysis of ECASS-4 (assessing rt-PA in the 4,5-9 hour time window in patients with a MRI perfusion-diffusion penumbral mismatch, stopped early because of slow recruitment) found no significant evidence for an association between a DWI-FLAIR mismatch on initial stroke and excellent clinical outcome after rt-PA.
Optimization of secondary prevention after stroke associated with atrial fibrillation also remains important. Timing of anticoagulation is a matter of debate and subject of ongoing trials, but an international study shows that in this debate it does not matter whether the location of the ischaemic stroke is in the anterior or posterior circulation. Another international effort developed and validated a nomogram including age, NIHSS score, revascularization and type and timing of oral anticoagulation for the prediction of 3 month outcome in patients receiving oral anticoagulation for atrial fibrillation after stroke.
Furthermore, you may learn about the rare but important complication of cerebral venous sinus thrombosis in patients with bacterial meningitis, and about the effect of non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia investigated in the randomized trial NORTHSTAR.
Finally, you will find the protocols for STATICH (STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage), of the ENCLOSE study (Early detection of small volume stroke and thromboembolic sources with computed tomography), of BAT2 (The Bleeding with Antithrombotic Therapy Study 2), and of Mind the Heart (ECG-gated cardiac CT-angiography in acute ischemic stroke).
We look forward to the year 2021, with many excellent submissions of your best research for publication in the European Stroke Journal.
C.J.M. Klijn and Bo Norrving.