Introduction Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. Methods A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. Results We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3–3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1–1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4–176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2–91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7–47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5–25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4–9.1) and 1.9% received endovascular treatment (95% CI 1.3–2.5), highest country rates were 20.6% and 5.6%. Conclusion We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.

OBJECTIVE:To investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels.METHODS:This prospective multicentre study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood-sampling for D-dimers-measuring (ELISA-test), and MR-/CT-venography. Predictive value of clinical variables and D-dimers for CVT were calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established using multivariate logistic regression.RESULTS:CVT was confirmed in 25.8% (94/359) patients by neuroimaging. The optimal estimate of clinical probability was based on 6 variables: seizure(s) at presentation (4 points), known thrombophilia (4 points), oral contraception (2 points), duration of symptoms >6 days (2 points), worst headache ever (1 point) and focal neurological deficit at presentation (1 point) (AUC 0.889).We defined 0-2 points as low CVT probability (NPV 94.1%). 186 (51.8%) patients had a low probability score, of whom 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34/120) in patients with a moderate (3-5 points) and 92.5% (49/53) in patients with a high (6-12 points) probability score. All low CVT probability patients with CVT had D-dimers >500µg/L. Predictive value of D-dimers for CVT for ≥675µg/l (best cut-off) vs. ≥500µg/l respectively was: Sens:77.7%/Spec:77%/NPV:90.7%/ACC:77.2% vs. Sens:89.4%/Spec:66.4%/NPV:94.6%/ACC:72.4%. To the clinical score added D-dimers >500µg/L resulted in the best CVT prediction score explored (at the cut-off≥6 points: Sens:83%/Spec:86.8%/NPV:93.5%/ACC:84.4%/AUC:0.937).CONCLUSION:The proposed new clinical score in combination with D-dimers may be helpful for prediction of CVT as a pretest score;none of the CVT patients showed low clinical probability for CVT and D-dimers <500µg/L.