Abstract
February 2023 marked 3 years since the first lockdown of the COVID-19 pandemic, and 2022 was the year when our professional lives returned to normal. The pandemic has taught us many lessons. We learned about the robustness of our healthcare systems. Reports on the quality of stroke care have varied from country to country. In this issue, Blauenfeldt et al. report data from national health registries on quality of stroke care in Denmark during the pandemic. In their Danish population, the overall quality of acute stroke care remained high, with just minor fluctuations.
From a research perspective, one of the lessons has been understanding the importance of meeting in person. Research is about collaboration and collaboration is about networks. Countless clinical trials and observational studies have been developed during coffee breaks at conferences and other social events, underlining the importance of social interaction in research. Nearly 3 years without the possibility to broaden networks face-to-face have been particularly challenging for the next generation of stroke researchers. Visiting fellowships have been nearly impossible and the informal interaction with peers and seniors alike at events has been limited. It is therefore extremely welcome to see the return of is activities such as the ESO winter school in Bern, the summer school in Birmingham and the research workshop in Edinburgh, where our younger colleagues may establish strong connections for future research collaboration.
The European Stroke Organisation is liasing closely with Boehringer-Ingelheim to monitor and respond to the current situation regarding alteplase shortage. This includes consideration of alternatives. In this issue of the ESJ, the ESO expedited recommendation on use of tenecteplase in acute ischaemic stroke is published. In this, tenecteplase has been recommended over alteplase when treatment is administered in mobile stroke units and in patients with large vessel occlusion stroke treated with 4.5 h of symptom onset. The guideline also advises that alteplase and tenecteplase may be used interchangeably in patients treated within 4.5 h of stroke. Colleagues around the world have already described logistical benefits of switching from alteplase to tenecteplase and we will likely learn from more real-world experience in the years to come. Identifying the optimal dose of tenecteplase has required exploration but now seems to be reaching a consensus. The ESO guideline recommends the 0.25 mg/kg dose. This choice is incidentally supported by the results of a network meta-analysis that you may also read in this edition.
As clinicians, we have time to formulate our choices, but what do our stroke patients actually comprehend in the acute stroke setting? Schuster et al. have investigated acute ischaemic stroke patients’ ability to recall risks and benefits associated with intravenous thrombolysis. It is perhaps no surprise that patients with acute ischaemic stroke who were eligible for intravenous thrombolysis could remember only about half of the information presented to them. Perhaps more surprising is that patients remembered the risks associated with intravenous thrombolysis less well than control participants. Does this reflect optimism and trust in their clinician?
The work-up of possible cardioembolic stroke aetiology is advancing. Two studies in this issue examine cardiac computed tomography. In a substudy of the Mind the Heart, Rinkel et al. detected cardiac thrombi in one in 12 patients with an acute ischaemic stroke. Likewise, Braillion et al. suggest that a brain-cardiac CT protocol may assist in stratifying atrial fibrillation risk.
February 2023 unfortunately also marked 1 year of the war in Ukraine, a country that already faced challenges. A World Health Organization situation report on stroke in Ukraine in 2021, estimated that around 130,000 people annually suffer stroke there, and that mortality of stroke was higher than in most other European countries. However, another lesson learned from the pandemic was the simplicity of organising remote educational meetings, and their value in maintaining links in preparation for recovery. Together with the Ukrainian Stroke Community the European Stroke Organisation has organised regular webinars covering topics from acute stroke care to rehabilitation and follow-up. This has led to fruitful discussions and it has been impressive to witness the enthusiasm among our Ukrainian colleagues to improve stroke care despite incredibly difficult circumstances.