Abstract
The present issue of the European Stroke Journal represents a landmark with the publication of no less than five guidelines from the European Stroke Organisation (ESO) and one ESO expedited recommendation. In the current era of evidence-based medicine, guidelines represent important milestones in their synthesis of existing knowledge and its transformation into recommendations to guide clinical practice. The process of preparing the ESO guidelines is very rigorous and follows an established manual. The production of guidelines is a prioritized activity of the ESO in its aims to improve standards of stroke care in Europe and beyond.
The five ESO guidelines in this issue feature some of the core areas in the management of stroke: management of transient ischemic attack, blood pressure management in acute ischaemic stroke and intracerebral haemorrhage, management of space-occupying brain infarction, endarterectomy and stenting for carotid artery stenosis, and management of covert cerebral small vessel disease (i. e. imaging-detected cerebrovascular disease with no acute cerebral symptom). The topic of the ESO expedited recommendation is on the use of short-term dual antiplatelet therapy early after minor stroke and high-risk TIA. The broad spectrum of clinical coverage of these guidelines means that there is a good reason to consult them in almost every single patient presenting with features of cerebrovascular disease.
Besides the guidelines committee activities, the ESO have several subspeciality committees in action. This issue features a white paper from the ESO Dementia Committee on cerebrovascular disease in patients with cognitive impairment providing a practical point of view with suggestions for management of cerebrovascular diseases in memory clinics. The report adds to the paper on cognitive impairment in patients with cerebrovascular disease by the same group published in the previous issue of the journal.
The original research papers in this issue have a focus on important aspects on clinical and research issues. Topics include the precision of prehospital stroke scales for different intracranial large vessel occlusion locations, markers associated with hemorrhagic transformation in patients with wake-up stroke, the relation between 24-hour blood pressure variability and treatment effect of intravenous alteplase in acute ischaemic stroke, and an automated algorithm for the Oxfordshire Community Stroke Project Classification.
Another paper delineates the characteristics, mechanisms and outcome of Ischemic stroke on hormonal contraceptives. An ambitious program to implement intravenous thrombolysis in clinical practice in the Czech Republic is presented with long term goals that relate to the Stroke Action Plan in Europe, another flagship project of the ESO. Also featured is an analysis of regulatory delays in a multinational clinical stroke trial.
This issue of the European Stroke Journal also includes three papers on different aspects on intracerebral haemorrhage (ICH), the stroke subtype with the most serious prognosis, and a field where better therapies are urgently needed. One paper describes a large variation in medical management and neurosurgical treatment of patients with supratentorial spontaneous ICH, warranting further research in this area. Another paper describes the trends in incidence of oral anticoagulant related ICH and sales of oral anticoagulants in the Capital Region of Denmark 2010–2017. Predictors and causes of death have been analyzed in a paper on the long-term mortality in young patients with spontaneous ICH based on data from The Netherlands.
Stroke is a major health problem in all parts of the world, not least in low- and middle- income countries where the infrastructure, diagnostic tools, and evidence-based therapies may be lacking. A paper from India describes the diagnostic precision of a biomarker (serum glial fibrillary acidic protein) for stroke diagnosis in regions with limited access to brain imaging. The biomarker was reported to have a high negative predictive value to rule out intracerebral haemorrhage.
This issue of the ESJ finishes off with two trial protocols: a randomized controlled trial on Colchicine for prevention of Vascular Inflammation in Non-CardioEmbolic stroke (CONVINCE), and a cluster-randomized intervention trial to improve stroke care after hospital discharge – the structured ambulatory post-stroke care program (SANO).
The 6:2 issue of the ESJ will likely have a long-lasting impact of stroke services and clinical practice. We the editors wish our readers happy reading, and we hope that this issue will serve the purpose of substantially influencing and coordinating clinical practices in the stroke field. We want to thank all authors and contributors for their continued support of the journal.