Abstract
The European Stroke Organisation Conference in Munich held in May was an on-site only conference for the first time since 2019. The meeting attracted over 4000 interested stroke physicians, allied health care professionals and researchers. Over 20 randomised controlled trials on topics ranging from hyperacute care to rehabilitation and secondary prevention were presented. For the first time, we saw positive trial results for patients suffering from spontaneous intracerebral haemorrhage. In INTERACT-3, a ‘bundle of care’ approach to the management of patients with spontaneous intracerebral haemorrhage, consisting of blood pressure control, blood glucose control, temperature control and reversal of anticoagulation had positive effects on functional outcome. Although the results were mainly driven by blood pressure control, heightening supportive care for patients with improves outcome. Furthermore, the ENRICH trial showed beneficial effects on functional outcome of a minimally invasive surgical procedure. The full peer reviewed results of the latter trial have yet to be published. Nevertheless, the presentation gave root to optimism in the ICH field. In this edition of the ESJ, we include the results of the pilot BLOC-ICH trial, a phase II randomised, placebo-controlled, clinical trial of interleukin-1 receptor antagonist in intracerebral haemorrhage: BLOcking the Cytokine IL-1 in ICH. Although only 25 patients out of a target of 80 patients could be included, even preliminary research such as this contributes to the hope that we may offer effective treatments to patients suffering ICH in the future.
The ESO conference also gave an opportunity for a simultaneous online publication in the ESJ coordinated with a research presentation at the conference. You can read the manuscript entitled ‘Ischaemic stroke despite antiplatelet therapy – causes and outcomes’ by Silimon and colleagues in this issue. Simultaneous publication increases the outreach of papers published in our journal. We aim for more simultaneous publications and will make a call for manuscripts in a coordinated effort for the 10th ESOC in Basel next year. Start planning now!
As we write this editorial, we have just received the news of the second impact factor for the European Stroke Journal. We are pleased to see this increase from 5.894 to 6.1 despite the revised calculation approach that has led comparative journals to experience decreases in impact factor over the same period, and despite increasing our content by 60% in the last year. We strive to include high-quality content representing the heterogeneity of our field. We thank our authors and reviewers for their continued efforts that contribute to the success of the journal.
Access to stroke care still varies widely throughout Europe. In a survey published in this edition, seven countries have less than one stroke unit per 1 million inhabitants, furthermore 15 countries administer intravenous thrombolysis to fewer than 10 ischaemic stroke cases per 100,000 persons. Finally, despite an increase in reperfusion rates in many countries from 2016 to 2019 this was halted in 2020. The survey results highlight the important work of The Stroke Action Plan in Europe (SAP-E). This is the largest stroke project undertaken in Europe, and has ambitious targets for the implementation of evidence based preventive actions and stroke services until 2030. The SAP-E has national coordinators in each country, it requires the involvement and dedication of Ministries of Health, and sets targets for acute treatment, stroke unit care and rehabilitation. This ambitious project has the potential to make a difference to people suffering stroke throughout Europe, and to balance the current inequity in care. The thrombolysis findings in the survey are in line with a German registry study also in this edition including 10,162 patients, which shows a substantial decline in the use of bridging therapy with intravenous thrombolysis alongside endovascular therapy from 2016 to 2021.
Other highlights include various aspects of atrial fibrillation and stroke risk, including competing risk factors, risk of recurrent stroke in patients with stroke and atrial fibrillation treated with anticoagulants, and diagnostic value of carotid intima media thickness versus clinical risk scores in determining aetiology of ischaemic stroke.
Finally, we would like to highlight the manuscript showing the effects of educational intervention in high school students in Tuscany, Italy showing a sustained improvement in stroke awareness.