Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018

Abstract

The purpose of the European Stroke Organisation-Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. The meeting started 22 years ago as Karolinska Stroke Update, but since 2014 it is a joint conference with European Stroke Organisation. Importantly, it provides a platform for discussion on the European Stroke Organisation guidelines process and on recommendations to the European Stroke Organisation guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guideline procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. This year's European Stroke Organisation-Karolinska Stroke Update Meeting was held in Stockholm on 11-13 November 2018. There were 11 scientific sessions discussed in the meeting including two short sessions. Each session except the short sessions produced a consensus statement (Full version with background, issues, conclusions and references are published as web-material and at www.eso-karolinska.org and http://eso-stroke.org) and recommendations which were prepared by a writing committee consisting of session chair(s), scientific secretary and speakers. These statements were presented to the 250 participants of the meeting. In the open meeting, general participants commented on the consensus statement and recommendations and the final document were adjusted based on the discussion from the general participants Recommendations (grade of evidence) were graded according to the 1998 Karolinska Stroke Update meeting with regard to the strength of evidence. Grade A Evidence: Strong support from randomised controlled trials and statistical reviews (at least one randomised controlled trial plus one statistical review). Grade B Evidence: Support from randomised controlled trials and statistical reviews (one randomised controlled trial or one statistical review). Grade C Evidence: No reasonable support from randomised controlled trials, recommendations based on small randomised and/or non-randomised controlled trials evidence.The full document which is available as online supplement contains background, issues, conclusions and references used to establish ESO-Karolinska recommendations for each session (except for the short sessions).

<p>Clinical Utility of CYP2C19 Genotype-Guided Antiplatelet Therapy in Patients at Risk of Adverse Cardiovascular and Cerebrovascular Events: A Review of Emerging Evidence</p>

“…72 Similarly, a 2018 European consensus statement does not address the use of CYP2C19 testing to guide clopidogrel prescribing in either acute stroke or secondary prevention. 73…”

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

“…Furthermore, despite documented overall cost-effectiveness, prolonged ECG monitoring is often restricted due to higher cost at the individual level and limited man power as well as technical resources [11,82]. Beside patients' characteristics such as older age, laboratory, as well as ECG findings, echocardiography might aid patient selection for prolonged ECG monitoring [11,13,83,84]. Echocardiography, in particular TTE, seems to be a reasonable method to guide AF screening considering its comparatively low costs and wide availability [85].…”

Transcranial Doppler Monitoring of Acute Reperfusion Therapies in Acute Ischemic Stroke Patients with Underlying Large Vessel Occlusions

“…5,6 Advanced neuroimaging is increasingly becoming readily available following the publication of the positive results from recent extended time treatment trials and the adoption of their treatment protocols by international guidelines. [7][8][9][10][11][12] In any case, AIS management is continuously becoming more demanding and complicated, therefore close monitoring with continuous clinical re-assessments are Large vessel occlusion accounts for up to 20% of ischemic strokes. Intravenous thrombolysis and mechanical thrombectomy are two effective and complementary reperfusion therapies of acute ischemic stroke, the former exclusively applicable in patients with large vessel occlusions.…”