New Studies in Stroke

This review summarizes new findings on epidemiology, diagnosis, acute therapy, primary and secondary prevention of stroke published in 2015 and 2016. Recent epidemiological studies show that treatable risk factors such as hypertension, diabetes mellitus, smoking, physical inactivity, nutrition and stress can explain 90% of stroke risk. In patients with asymptomatic high degree carotid stenosis, stenting has a similar complication rate as endarterectomy. New randomised studies and results from large-scale registries indicate that systemic thrombolysis of acute ischemic stroke can be safely performed in more patients than originally labelled for. This applies to patients > 80 years, with severe strokes or with systolic blood pressure values > 160mmHg. Patients with dissection of brain supplying arteries also benefit from thrombolysis. In patients treated with non-vitamin-K dependent oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF), thrombolysis can be performed if the last intake was ago long enough that coagulation parameters are normal. The most effective treatment of acute occlusions of the distal internal carotid artery and the proximal middle cerebral artery is systemic thrombolysis with rt-PA followed by mechanical thrombectomy with a stent-retriever (number needed to treat=2.6 for good functional outcome). In patients with mild to moderate ischemic stroke or high-risk TIA, ticagrelor was not superior to aspirin in the prevention recurrent stroke, MI or vascular death. However, ticagrelor was superior to aspirin in preventing recurrent ischemic stroke. In patients with acute cerebral haemorrhage and high blood pressure, lowering of blood pressure has only minor efficacy. In patients with vitamin-K antagonist related intracerebral haemorrhage, Prothrombin complex concentrate (PPSB) is more effective than fresh frozen plasma (FFP). Occlusion of patent foramen ovale in patients with cryptogenic stroke should be restricted to selected cases.