Prof. Petr Widimsky,
World Stroke Day on 29 October 2016 recognises that although stroke is a serious and complex disease, there are ways to significantly reduce its impact. This year's campaign motto is "Stroke is Treatable".
Read this article by Professor Petr Widimsky, Chairperson of the new ESC Council on Stroke.
Stroke is one of the two frequently fatal cardiovascular diseases – along with myocardial infarction. While mortality and morbidity due to myocardial infarction dropped dramatically during the last 20 years, until recently mortality and morbidity after stroke remained extremely high.
Ischemic strokes caused by a large artery occlusion result in 70-85% of patients with unfavourable outcomes (25-35% mortality plus around 50% with permanent severe disability). A significant step forward was made in 2015, when seven randomised trials performed in the United States, Canada and Europe convincingly demonstrated that catheter-based thrombectomy (performed with stent-retrievers) significantly improved outcomes of patients with moderate-to-severe ischemic stroke. The risk of unfavourable outcome dropped from 70% (when patients are treated with iv.thrombolysis) to 50% (when catheter-based thrombectomy is done immediately, usually in addition to iv.thrombolysis).
A major problem which is discussed nowadays is how to quickly implement this effective treatment of acute stroke to wide populations. Involvement of interventional cardiologists (after appropriate neurovascular training) in regions with no or with only limited availability of neurointerventional radiology might be an option – but the effectivity and safety of such an approach remain to be demonstrated.
Left: occlusion of the middle cerebral artery in acute stroke with part of brain with limited blood suply (red circle).
Right: the same patients after successfull thrombectomy – blood supply to the brain fully restored (red circle).
Despite the above-mentioned significant improvements in treatment, there are still too many patients who remain severely disabled or die after stroke. Therefore, besides the important challenge to improve stroke care, better concepts for prevention of stroke may be at least as important. Approximately half of ischemic strokes have origin in the heart (cardio-embolic strokes): atrial fibrillation, valvular heart disease, congenital heart disease, infective endocarditis, left ventricular thrombi etc. Therefore, the role of cardiologists in stroke prevention is critical and is increasing. The only way to improve stroke care is through close multidisciplinary cooperation: neurologist, cardiologists, radiologists, neurosurgeons, vascular surgeons, intensivists, rehabilitation specialists and other stroke specialists should work closely together.
The European Society of Cardiology in recognition of this situation decided to create a new, multidisciplinary constituent body – the ESC Council on Stroke. This interdisciplinary group of experts started its work very recently - in September 2016. The Council Board nucleus is composed of 6 experts from 3 different specialties: two neurologists (Prof. Diener and Prof. Mazighi), one vascular surgeon (Prof. Halliday) and three cardiologists (Prof. Wolfram Doehner, Prof. Isabelle Van Gelder and myself, Prof. Petr Widimsky).
The membership of the council is still rising – over 600 collegues from many countries already joined the council. We welcome new members – physicians, nurses and other health care specialists interested in stroke.
Membership is free.
We are looking forward to contributing towards the battle against stroke in close partnership with all interested colleagues.
Prof. Petr Widimsky, MD, DrSc., FESC
ESC Council on Stroke Chairperson 2016-2018
Our mission: To reduce the burden of cardiovascular disease
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