Blog
About

6
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Action Plan for Stroke in Europe 2018–2030

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references 98

          • Record: found
          • Abstract: found
          • Article: not found

          A randomized trial of intraarterial treatment for acute ischemic stroke.

          In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis). We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confidence interval [CI], 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage. In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Randomized assessment of rapid endovascular treatment of ischemic stroke.

             Oh Young Bang,  ,  D. Hill (2015)
            Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation. We randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group). Patients with a proximal intracranial occlusion in the anterior circulation were included up to 12 hours after symptom onset. Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. Workflow times were measured against predetermined targets. The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention would lead to lower scores on the modified Rankin scale than would control care (shift analysis). The trial was stopped early because of efficacy. At 22 centers worldwide, 316 participants were enrolled, of whom 238 received intravenous alteplase (120 in the intervention group and 118 in the control group). In the intervention group, the median time from study CT of the head to first reperfusion was 84 minutes. The rate of functional independence (90-day modified Rankin score of 0 to 2) was increased with the intervention (53.0%, vs. 29.3% in the control group; P<0.001). The primary outcome favored the intervention (common odds ratio, 2.6; 95% confidence interval, 1.7 to 3.8; P<0.001), and the intervention was associated with reduced mortality (10.4%, vs. 19.0% in the control group; P=0.04). Symptomatic intracerebral hemorrhage occurred in 3.6% of participants in intervention group and 2.7% of participants in control group (P=0.75). Among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality. (Funded by Covidien and others; ESCAPE ClinicalTrials.gov number, NCT01778335.).
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

                Bookmark

                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
                © 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).

                Funding
                Funded by: European Stroke Organisation, FundRef ;
                Categories
                Guideline

                Comments

                Comment on this article