The World Stroke Academy (WSA) is the educational platform of the WSO. It facilitates educational activities (e.g. webinars, eLearning modules) and supports the WSO mission by providing high-quality stroke education to healthcare professionals. It provides evidence-based educational materials in a variety of formats to meet the needs of the WSO membership. This article introduces the WSA, its core activities, and outlines how to access the many educational resources it offers. The WSA offers high-quality peer-reviewed stroke education material and uses outcome metrics to assess and improve the quality of medical training of healthcare professionals. This article also highlights the importance of identifying knowledge and knowledge-to-action gaps through the creation of special projects and initiatives. It describes three areas in which the WSA has carried out recent educational initiatives namely: Life after stroke., women in stroke and Stroke Checklist/Pre-printed stroke orders. WSA material is freely available, and we would encourage the global stroke community to use, and contribute to, its resources.

Background and Purpose: Poor mental health and depression are well-recognized sequelae of stroke; however, the association between stroke and subsequent risk of suicide is unknown. Methods: We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to September 15, 2020, using keywords and database-specific subjects. We independently adjudicated and selected observational studies that reported suicide attempts or death by suicide in stroke survivors and a comparison group, consisting either of people without a history of stroke or the general population. We evaluated study quality using the Newcastle Ottawa scale. Using random-effects meta-analysis, we calculated the pooled adjusted risk ratio (RR) of suicide in stroke survivors and separately calculated the pooled adjusted RR of suicide attempt and death by suicide. Using prespecified analyses, we explored study-level factors to explain heterogeneity. Results: We screened 4093 articles and included 23 studies of fair quality, totaling over 2 million stroke survivors, of whom 5563 attempted suicide or died by suicide. Compared to the nonstroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% CI, 1.53–1.96, I 2 =93%), with a significantly ( P =0.03) higher adjusted risk of suicide attempt (RR, 2.11 [1.73–2.56]) than of death by suicide (RR, 1.61 [1.41–1.84]). A longer follow-up time in cohort studies was associated with a lower risk of suicide (RR, 0.97 [0.95–0.99] for every 1-year increase). Conclusions: Stroke should be considered as a risk factor for suicide. Comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in stroke survivors.

Background: Endovascular thrombectomy (EVT) is effective in reducing disability in selected patients with stroke and large vessel occlusion (LVO), but access to this treatment is suboptimal. Aim: We examined the proportion of patients with LVO who did not receive EVT, the reasons for non-treatment, and the association between time from onset and probability of treatment. Methods: We conducted a retrospective cohort study of consecutive patients with acute stroke and LVO presenting between January 2017 and June 2018. We used multivariable log-binomial models to determine the association between time and probability of treatment with and without adjustment for age, sex, dementia, active cancer, baseline disability, stroke severity, and evidence of ischemia on computerized tomography. Results: We identified 256 patients (51% female, median age 74 [interquartile range, IQR 63.5, 82.5]), of whom 59% did not receive EVT. The main reasons for not treating with EVT were related to occlusion characteristics or infarct size. The median time from onset to EVT center arrival was longer among non-treated patients (218 minutes [142, 302]) than those who were treated (180 minutes [104, 265], p = 0.03). Among patients presenting within 6 hours of onset, the relative risk (RR) of receiving EVT decreased by 3% with every 10-minute delay in arrival to EVT center (adjusted RR 0.97 CI95 [0.95, 0.99]). This association was not found in the overall cohort. Conclusions: The proportion of patients with acute stroke and confirmed LVO who do not undergo EVT is substantial. Minimizing delays in arrival to EVT center may optimize the delivery of this treatment.

Background: People with neurological conditions are at a higher risk of suicide compared to the general population. Despite the known association of stroke with depression and suicidal ideation, it is unclear if stroke is associated with a higher risk of suicide. Methods: We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to July 26, 2020 using keywords and database-specific subject. We independently adjudicated and selected observational studies that compared the risk of suicide in stroke survivors to a comparison group, consisting either of people without history of stroke or the general population. We evaluated study quality using the Newcastle Ottawa scale. Using random effects meta-analysis, we calculated the pooled adjusted risk ratio (RR) of suicide in stroke survivors, and separately calculated the pooled adjusted RR of death by suicide and suicide attempt. Using prespecified analyses, we explored study-level factors to explain heterogeneity. Results: We screened 4023 articles and included 23 studies, of fair quality, totaling over 2 million stroke survivors, of whom 5563 committed suicide. Compared to the non-stroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% confidence interval, 1.54-1.95, I 2 = 93%), with a significantly (P=0.03) higher adjusted risk of suicide attempt (RR 2.09, 1.69-2.58) than of death by suicide (RR 1.61, 1.44-1.80). Observed heterogeneity could not be explained by pre-specified meta-regression and subgroup analyses. Conclusions: Stroke should be recognized as an independent risk factor for suicide. Comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in stroke survivors.