Abstract
This issue of the European Stroke Journal is the last one for 2021, and it finishes off the sixth year of the journal. As editors, we are pleased to see the continued excellent development of the journal. The journal continues to grow and to thrive, and the publication metrics are stronger and stronger. The European Stroke Journal will receive its first impact factor in 2022.
Volume six issue four is filled with articles of high clinical relevance. A systematic review and meta-analysis on prevalence of fatigue after stroke by Dr Alghamdi and colleagues, shows that fatigue is prevalent among stroke survivors, but data vary between studies. Time of assessment, stroke type and geographical location might explain this variation.
Research on intracerebral hemorrhage (ICH) is in focus also in this issue. Dr Goeldlin and colleagues report that treatment with antiplatelet drugs is a relevant risk factor for larger baseline hematoma volume, early (<24 h) hematoma expansion, mortality and morbidity in patients with ICH. The observations warrant further studies on treatment options for this condition. In a post-hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial, Drs Anadani and colleagues found an interaction between race/ethnicity and response to BP lowering treatment after ICH, with white patients having an association between intensive blood pressure reduction and worse outcome.
Acute therapy of ischemic stroke is also highlighted in this issue. An updated analysis by Drs McMeekin and colleagues of the number of UK stroke patients eligible for endovascular thrombectomy shows that overall numbers changed little but evidence from ongoing trials and demographic changes have the potential to increase the need for EVT significantly. Drs Duvekot and colleagues report that CT angiography evaluations in daily clinical practice are highly accurate for large vessel occlusions, whereas the detection of occlusions in middle sized vessels seems more challenging. In a meta-analysis based on individual patient data, Dr Westendorp and colleagues found that preventive antibiotic therapy after stroke did not improve functional outcome for any specific patient sub-group.
Different aspects on stroke in particular subsets of patients are also well featured in this issue. Dr Basu and colleagues report that among patients with minor stroke or TIA in the POINT trial, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women. From the Norwegian Stroke in the Young Study, Dr Nawaz and colleagues report that among patients ≤49 years with ischemic stroke, no less than 1/2 of males and 1/3 of females had prevalent atherosclerosis, which was associated with worse long term outcomes. In a case series of cerebral venous sinus thrombosis, Dr Ochoa-Ferraro and colleagues highlight the importance of recognizing homocystinuria as an underlying cause.
Do micro embolic signals (MES) detected using transcranial doppler (TCD) help in risk stratification in stroke patients? A systematic review and meta-analysis by Drs Sudheer and colleagues showed a 30% prevalence of MES following acute stroke/TIA. The presence of MES increased the chance of recurrence of cerebral ischemia but was not associated with poor functional outcomes and mortality in the studied subgroup.
Most studies on silent cerebral infarcts and other imaging markers of small vessel disease have been performed in European and North American cohorts. In a cohort of older adults of Amerindian ancestry (the Atahualpa Project), Drs Del Brutto and colleagues report that high-burden small vessel disease predicted mortality also in this cohort.
Deferral of consent for participation in a clinical study is a relatively novel procedure, in which informed consent is obtained after randomization and study treatment. Deferred consent can be used in emergency situations, where small therapeutic time windows limit possibilities for patients to provide informed consent. In a qualitative survey from the Netherlands, Drs van den Bos and colleagues found that deferred consent was considered acceptable by most study participants who provided consent for acute stroke randomised trials, but their recall and comprehension of consent was overall limited.
This issue includes two trial protocols. Dr Demeyere and colleagues have prepared the Long term psychological consequences of stroke (OX-CHRONIC) study which will study cognition in relation to mood and fatigue after stroke. Drs Grosse and colleagues have set up the Rationale, Design and Methods of the Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA (PRODAST) study, which in a very large real world cohort will assess the issue of safety and efficacy of early start of anticoagulation in patients with ischemic stroke and atrial fibrillation.
The European Stroke Journal is regularly rotating members of the editorial board. After an open call, we are pleased to warmly welcome the following persons as new members of the editorial board (effective from January 2022): Anna Bersano, Daniel Bos, Israel Fernandez Cadenas, Barbara Casolla, Bastian Cheng, Gian Marco De Marchis, Nele Demeyere, Ana Catarina Fonseca, Bianca Fuentes, Petra Ijäs, Dalius Jatuzis, Elias Johansson, Aristeidis Katsanos, Dearbhla Kelly, Zhe Kang Law, Xinyi Leng, Linxin Li, and Marco Pasi. At the same time, we thank some of our most senior colleagues who now have completed a 6-year term in the board: Ale Algra, Oscar Benavente, Martin Brown, Antoni Davalos, Franz Fazekas, Werner Hacke, Jaap Kappelle, Kursad Kutluk, Peter Langhorne, Maarten Lansberg, Ayrton Massaro, Peter Sandercock, Nils Wahlgren, and Lawrence Wong. Your support for the journal during the important early period has been invaluable.
By the end of the year, the second term of Bo Norrving as editor-in-chief of the ESJ comes to an end. The ESO executive committee and his vice-editors Didier Leys and Karin Klijn wish to express their gratitude for his invaluable contribution and energy for the ESJ. The ESJ would not have been where it is now without his continuous efforts and leadership over the past 6 years. We warmly welcome Professor Kennedy R. Lees as the new editor. Ken is well known to everyone in the stroke field, both through his high academic merits as well as from his time as President of ESO during which time ESJ was founded. Together with his long experience in publishing, we trust that he will expertly lead the journal into the next phase.