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      Action Plan for Stroke in Europe 2018–2030

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          Abstract

          Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21–23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.

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          Most cited references67

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          Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

          The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage.
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            Inflammation and Stroke: An Overview.

            The immune response to acute cerebral ischemia is a major factor in stroke pathobiology and outcome. While the immune response starts locally in occluded and hypoperfused vessels and the ischemic brain parenchyma, inflammatory mediators generated in situ propagate through the organism as a whole. This "spillover" leads to a systemic inflammatory response first, followed by immunosuppression aimed at dampening the potentially harmful proinflammatory milieu. In this overview we will outline the inflammatory cascade from its starting point in the vasculature of the ischemic brain to the systemic immune response elicited by brain ischemia. Potential immunomodulatory therapeutic approaches, including preconditioning and immune cell therapy will also be discussed.
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              European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

              Background: Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50–60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. Methods: We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. Results: These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. Conclusion: Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.
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                Author and article information

                Journal
                Eur Stroke J
                Eur Stroke J
                ESO
                speso
                European Stroke Journal
                SAGE Publications (Sage UK: London, England )
                2396-9873
                2396-9881
                29 October 2018
                December 2018
                : 3
                : 4
                : 309-336
                Affiliations
                [1 ]Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden
                [2 ]Stroke Alliance for Europe, London, UK
                [3 ]Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
                [4 ]Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians University, Munich, and Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
                [5 ]Department of Neurology, CHU Lille, Lille, France
                [6 ]Clinical Center for Neuropsychiatry, Russian National Research Medical University, Moscow, Russia
                [7 ]Department of Neurology, Stroke Unit, University of Dokuz Eylul, Izmir, Turkey
                [8 ]International Clinical Research Center and Neurology Department, St Anne's University Hospital Brno and Masaryk University Brno, Czech Republic
                [9 ]Centre for Clinical Neurosciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
                [10 ]Department of Neurology, Radboud University Medical Centre, Nijmegen, and Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands
                [11 ]Department of Neurology with Stroke Unit, Vivantes Hospital Neukölln, Berlin, Germany
                [12 ]Stroke Unit, Department of Neurology, Hospital Vall d´Hebron Barcelona, Spain
                [13 ]Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
                [14 ]Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
                [15 ]Guy's and St Thomas' NHS Foundation Trust, Stroke NHS England and Royal College of Physicians, London, UK
                [16 ]School of Health Sciences, University of Nottingham, Nottingham, UK
                [17 ]Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
                [18 ]Stroke Unit, Department of Medicine and Cardiovascular Medicine, University of Perugia, Perugia, Italy
                Author notes
                [*]

                See Appendix 1 for the full list of the working group members.

                [*]Bo Norrving, Department of Clinical Sciences, Neurology, Department of Neurology, Skåne University Hospital, S-221 86 Lund, Sweden. Email: bo.norrving@ 123456med.lu.se
                Article
                10.1177_2396987318808719
                10.1177/2396987318808719
                6571507
                31236480
                02ba31fe-180b-49e8-aa03-9b804b080180
                © European Stroke Organisation 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 26 August 2018
                : 1 October 2018
                Funding
                Funded by: European Stroke Organisation, FundRef ;
                Categories
                Guideline

                stroke,epidemiology,prevention,treatment,stroke services,strategic planning,treaties,quality assurance,europe

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