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STROKE IN 2018

Stroke management — recent advances and residual challenges

  • Year in Review
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From Nature Reviews Neurology

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The past year saw progress in acute treatment of ischaemic stroke, but large inequalities in stroke services were revealed, warranting strategical initiatives to improve treatment access. Reclassification of stroke as a disease of the nervous system in the WHO International Classification of Diseases 11th revision is likely to help such initiatives.

Key advances

  • Trials have confirmed that thrombectomy beyond 6 h and up to 24 h since stroke onset substantially benefits patients with large vessel occlusion and salvageable brain tissue1,2.

  • A mismatch of MRI findings in patients with wake-up stroke was shown to identify patients whose stroke onset was probably <4.5 h earlier and who could benefit from thrombolysis3.

  • Substantial inequalities in stroke services between and within countries were revealed; in Europe, research priorities and targets in stroke between 2018 and 2030 have been set8.

  • In the newly released WHO International Classification of Diseases 11th revision, stroke and all cerebrovascular diseases are placed under Diseases of the Nervous System with definitions for global use of the different codes10.

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Fig. 1: The imaging mismatch between diffusion-weighted imaging (DWI) and fluid attenuation inversion recovery (FLAIR) imaging that indicated a probable benefit of thrombolysis in the WAKE-UP trial.

References

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  6. Al-Shahi Salman, R. et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol. 17, 885–894 (2018).

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  7. Aguiar de Sousa, D. et al. Access to and delivery of acute ischaemic stroke treatments: a survey of national scientific societies and stroke experts in 44 European countries. Eur. Stroke J. https://doi.org/10.1177/2396987318786023 (2018).

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  8. Norrving, B. et al. Action plan for stroke in Europe 2018–2030. Eur. Stroke J. 3, 309–336 (2018).

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  9. Lindsay, P. et al. World Stroke Organization global stroke services guidelines and action plan. Int. J. Stroke 9 (Suppl. A100), 4–13 (2014).

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  10. [No authors listed.] ICD-11: a brave attempt at classifying a new world. Lancet 391, 2476 (2018).

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Author information

Authors and Affiliations

  1. Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden

    Bo Norrving

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  1. Bo Norrving
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Correspondence to Bo Norrving.

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Competing interests

The author has received honoraria from AstraZeneca and from Bayer for Data Safety Monitoring Board work in the SOCRATES, THALES and NAVIGATE-ESUS trials. He is also editor-in-chief for the European Stroke Journal.

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Norrving, B. Stroke management — recent advances and residual challenges. Nat Rev Neurol 15, 69–71 (2019). https://doi.org/10.1038/s41582-018-0129-1

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