Editorial

The European Stroke Journal has entered its seventh year. Born just one year after the first ESO Conference in Glasgow, the Journal’s infancy coincided with a period of major change in treatment paradigms. Specialist stroke care and thrombolysis were already well established, though optimising their delivery to all potential patients remained a challenge. Faster digital communications have eased many barriers associated with telemedicine, allowing stroke networks to expand safely through efficient sharing of expertise and minimisation of transfer delays. This also solves communication with CT-equipped ‘mobile stroke unit’ ambulances (MSU). Synthesising the current evidence for the effectiveness of mobile stroke units is important and timely.

In this issue of the Journal, the ESO Guideline group led by Walter and her colleagues report moderate evidence for suggesting MSU management for patients with suspected stroke. Patients with acute ischaemic stroke were initiated on intravenous thrombolysis earlier, with more starting within 60 minutes from onset, and showed an improvement of functional outcomes at 90 days. They identified no safety concern among patients managed under the MSU model. This is an encouraging review, though not yet a ringing endorsement. The discussion section of the guideline is recommended reading, as it explores many of the caveats to their conclusions that include, inter alia, the potential beneficial impact on patients requiring thrombectomy, the potential for improved care of patients with intracerebral haemorrhage, the research opportunities and the thorny question of cost-effectiveness. We congratulate Walter and colleagues on summarising the present state of evidence in a balanced manner. We anticipate, however, that within a very few years this guideline is likely to be revisited. Meantime, we invite submissions to the Journal of research results that will strengthen or clarify the guidance.

Irrespective of how patients arrive at a stroke centre, optimal treatment should be provided expeditiously. For patients with large vessel occlusion, successful thrombectomy improves outcome. If thrombectomy is intended, should intravenous thrombolysis still be initiated? Members of the European Stroke Organisation Guidelines group have worked jointly with the European Society for Minimally Invasive Neurological Therapy to examine this question of dual treatment, and also report in this issue of the Journal.

They deliver a strong recommendation for patients with anterior circulation large vessel occlusion, supported by several very recent randomised trials. Whether or not admitted directly to a thrombectomy capable centre, the authors recommend initiation of intravenous thrombolysis.

This is extremely helpful advice that will be strongly welcomed. Not only does it promise potentially better outcomes for the patients with large vessel occlusion, but it should avoid the delays that can be associated with debates around availability of thrombectomy, predicted transfer times and complex care pathways. A standard protocol that emphasises speed of delivery of intravenous thrombolysis to all eligible patients is easier to specify, implement and monitor. We congratulate the authors on synthesising a large body of recent data and producing a rational, evidence-based recommendation.

The coronavirus pandemic and climate crisis have promoted web-based interactions. Communication of new ideas relies increasingly on social media. Journal metrics rely less on impact factors and more on societal impact and altmetrics. Our Journal needs to recognise and support this. From its next issue European Stroke Journal will include visual abstracts for selected content. These will provide an easily digested summary of research papers that may be retained as an aide memoire, incorporated into slide presentations and forwarded to students and colleagues. Far from replacing the original scientific content, these will provide readers with a window into the detail of the research.

This development is the first of several for ESJ that will build on the strong foundations built by Professor Bo Norrving in his term as editor in chief. We acknowledge his excellent leadership with gratitude. Bo will kindly remain as senior guest editor. Karin and I look forward to strengthening and expanding our journal’s reach over the coming years. We welcome your feedback.