ESO-admin – European Stroke Organisation

Clotting and Re-bleeding: Focus on ICH survivors

ESO-admin — Fri, 30 Jul 2021 12:49:15 +0000

30/07/2021/in ESO, Stroke Research /by ESO-admin

By Aristeidis H. Katsanos, MD¹and Linxin Li, MD²

¹McMaster University & Population Health Research Institute, Hamilton, ON, Canada and

²Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

Intracerebral hemorrhage (ICH) is a devastating disease, as while just under a third of strokes are ICH they account for 49% of the global burden of death from stroke. Despite the advances in primary and secondary ischemic stroke prevention, neither the incidence nor the case fatality rates of ICH have substantially decreased since the 1980s, in contrast to the case of ischemic stroke. The management of ICH survivors with co-morbid cardiovascular diseases is particularly challenging, and requires balancing the benefit of ischemic vascular preventative treatments, such as antithrombotic and lipid lowering agents, against their propensity to increase the risk of re-bleeding.

One approach is to identify simply risk factors that can potentially stratify patients into different risk categories. In a recent study with pooled individual patient data from two prospective, population-based cohorts of patients with a first-ever ICH in the UK,¹ the authors identified lobar ICH as the principal risk factor for recurrent ICH and comorbid AF as the principal risk factor for ischemic stroke and all serious vascular events. Of interest, when putting hematoma location and AF together, they showed that risk of recurrent ICH would outweigh the risk of ischemic stroke only for patients with lobar ICH who did not have comorbid AF, highlighting the importance of reducing risks of thromboembolic events if we were to reduce overall risks of stroke burden after ICH. This echoed with findings from another study in the US which found that ICH was associated with an increased risk of ischemic stroke and myocardial infarction compared to patients without ICH.²

It is perhaps not surprising that patients with ICH were at high risk of ischemic events. In the UK study, one out of five patients had comorbid AF, and one out of three patients reported a history of previous occlusive vascular disease.¹ Consequently, at the time of the ICH, half of the patients were on antithrombotic medication treatment, with a third of antithrombotics being anticoagulant drugs, while a third of the patients were on statin treatment.¹ However, most of the patients had their antithrombotic drugs stopped after the ICH.

What should we do about these patients who not only have high risk of recurrent ICH but also high risk of ischemic events?

The Restart or Stop Antithrombotics Randomised Trial (RESTART)³ has been pivotal in trying to answer the question on resuming vs. stopping antiplatelet agents after an ICH. Treatment strategies regarding the cessation vs. (re-)start of antithrombotic medications especially anticoagulants or statins after an ICH are also currently being explored by numerous ongoing randomized controlled clinical trials. In addition to available treatment options there is also an unmet need for novel therapeutic approaches that can ameliorate the thromboembolic risk without increasing the risk of re-bleeding in ICH survivors, especially during the early stages after the ICH ictus. Clotting vs. re-bleeding, we still have many hurdles to overcome before we know the answer.

REFERENCES

Li L, Poon MTC, Samarasekera NE, Perry LA, Moullaali TJ, Rodrigues MA, et al. Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studies. Lancet Neurol. 2021;20:437-447.
Murthy SB, Zhang C, Diaz I, Levitan EB, Koton S, Bartz TM, T.DeRosa J, et al. Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events in Participants From 4 Population-Based Cohort Studies. JAMA Neurol.2021; 78:809-816
RESTART collaboration. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. Lancet. 2019; 393: 2613-2623

The post Clotting and Re-bleeding: Focus on ICH survivors first appeared on European Stroke Organisation.

Anticoagulation After Intracranial Haemorrhage

ESO-admin — Wed, 12 Feb 2020 12:24:23 +0000

12/02/2020/in ESO, Stroke Research /by ESO-admin

Are you unsure whether to start anticoagulation for atrial fibrillation after intracranial haemorrhage? Time to randomise!

By: Dr Tom Moullaali, Centre for Clinical Brain Sciences, University of Edinburgh; George Institute for Global Health, Sydney
Twitter: @tom_moullaali

Do you start or avoid oral anticoagulation for atrial fibrillation (AF) in patients with a history of intracranial haemorrhage?

Are you unsure about the balance of potential benefits (prevention of serious thromboembolic events, including ischaemic stroke) and harms (increased risk of recurrent intracranial haemorrhage or other major bleeding)? Or about the influence of timing, or of patient factors such as brain imaging markers of cerebral small vessel disease, on the safety of the treatment?

These uncertainties might be responsible for the dramatic variation in clinical practice across the world – 14% vs. 91% of patients who meet clinical criteria for oral anticoagulation (AF and CHA2DS2-VASc score of ≥2) receive treatment in Europe and Japan, respectively.

A 2017 Cochrane Review concluded that evidence from randomised controlled trials is needed to provide robust supporting evidence for these difficult decisions; now is a good time to consider getting involved!

Here in the UK, the Start or Stop Anticoagulants Randomised Trial (www.SoSTART.ed.ac.uk) recently randomised its 190^th patient, meeting the minimum target sample size set by the study team. Elsewhere, in the Netherlands, the Apixaban versus Antiplatelet drugs or no antithrombotic drugs after anticoagulation-associated intraCerebral HaEmorrhage in patients with Atrial Fibrillation trial (http://apache-af.nl/) is also close to completing recruitment. These, and other small pilot trials will provide important safety and feasibility data needed to show a large, multicentre, international trial can be delivered. Congratulations are in order to all study teams for recruiting: keep up the hard work, and keep randomising!

Finally, the Edoxaban for Intracranial Hemorrhage Survivors with AF trial (ENRICH-AF, http://www.phri.ca/research-study/enrich-af/) aims to provide definitive evidence in a larger sample of 1200 patients across 250 sites in 20 countries. The primary efficacy objective is to evaluate whether edoxaban (60/30 mg daily) compared to standard of care (either no antithrombotic therapy or antiplatelet monotherapy) reduces the risk of stroke (composite of ischaemic, haemorrhagic and unspecified stroke) in high-risk atrial fibrillation (CHA2DS2-VASc of ≥2) patients with previous intracranial haemorrhage. The primary safety objective is to document the incidence of clinically relevant major bleeding.

Can you help the ENRICH-AF team achieve their goal? If you’re unsure whether to start or avoid anticoagulation for your patient with atrial fibrillation and a history intracranial haemorrhage, it’s time to randomise!

The post Anticoagulation After Intracranial Haemorrhage first appeared on European Stroke Organisation.

Stroke Winter School Bern, January 2020

ESO-admin — Fri, 07 Feb 2020 07:27:00 +0000

07/02/2020/in ESO, Stroke Research /by ESO-admin

By Alex Alban Christensen, Odense, Denmark

Flying into Switzerland, this amazing country of multilinguism, direct democracy, technology, fantastic nature and its very own take on European culture, our high expectations were initially hampered by a greeting of pouring rain.

Luckily those of us that had done their homework had brought umbrellas.

We found our way to the Inselspital and the SITEM, a newly constructed glassy framed building, being home to a 7 Tesla MRI for research purposes as well as to the Stroke Winter School for the upcoming 4 days, while offering spectacular views of the Jungfrau, Eiger and Mönch mountain range.

The last accreditations were retrieved with anticipation, and then, the alphorns sounded to kick off the lectures. Precision and punctuality are known as Swiss attributes, and it was noted that even the Italians were on time!

The course aimed to bring young neurologists and neurointerventionalists together and take new knowledge and inspiration home to their respective stroke settings and networks, and we thus arrived as teams of two, consisting of one neurologist and one neurointerventionalist.

To facilitate participation from all around Europe and beyond, the course fee including hotel costs, delightful 3 course dinners every night, local transport – and of course the first cocktail in the Abflugbar – was kept very low, or as ESO President elect Dr. Bart van der Worp explained, the cost of two newly released Swiss 1/4 Franc gold coins in the Albert Einstein version.

The Swiss surely know a thing or two about economics!

The lectures, provided by local and international experts, had a general focus on acute stroke treatment, but there were also important slots for topics like preventional medicine, palliation in stroke or the organization of a stroke network. Imagine the best of lectures in the bigger conferences in an intimate setting, and you have the Stroke winter school 2020.

There were workshops with practical simulations for the interventionalists that were very well received, and the neurologists went through an emergency room stroke simulation as well as workshops with interventionalists, were treatment choices and perspectives could be discussed.

The tone throughout was jovial and informal, and discussion and questions were strongly encouraged. There could be no doubt of the sincere goal of the organizers and faculty members to make this the very best experience possible for the participants, with the larger perspective of improving future stroke care in the respective local setting.

A main focus of a joint ESO-ESMINT course was to strengthen the relationship between the teaming neurologist and neurointerventionalist. It may sound trivial, but there is a real value in getting better understanding for the issues that our close colleagues in stroke treatment are facing. Even before this course, I have personally seen this need, and felt that we should talk plenty more!

We should not work in our own disciplines for ourselves, but together as a team, which will both make it more fun and lead to better results for our patients.

Personally, I now feel better prepared to discuss the pros and cons of thrombectomy via the ACOM or of the antegrade versus retrograde approach in a tandem lesion, and look forward to more dialogue. Finding this time in a busy day can be a problem, but is something that I will aim for.

Each night, we went out to dinner in amazing locations around Bern.

One highlight was taking the Gurtenbahn up to the 855 m hilltop of Gurten, overlooking Bern. Finally, we were treated to some snow, and those of use living in a snow deprived temperate climate rejoiced.

The view was fantastic as was the food, and in general the social events in the evenings gave us all, course participants and faculty members, a chance of getting to know each other and to exchange professional experiences, as well as needed conversations far away from work related topics.

On the day before departure, after dinner we were invited to the Abflugbar, or Departure bar, in central Bern, and we all had a great time socializing deep into the night. Rumors say that Bern`s nightlife was tested further afterwards.

To quote the farewell greetings of a young German colleague from the newly created Stroke Winter School 2020 WhatsApp group, it was an “inspiring week meeting so many unique, dedicated and smart doctors from all over Europe and beyond”.

I fully subscribe to this, and I am confident that all of you will go home and be a part of taking stroke medicine to the next level in your countries.

For young neurologists and neurointerventionalists reading this blog, participation in the ESO Stroke Winter School can only be encouraged. You will be happy to have been part of the experience.

On the last day, the sun was finally shining, as if the city wanted to bid us farewell in its full glory.

What a beautiful and unique city it is, and going back to our Danish island of Fyn, we will miss it.

The post Stroke Winter School Bern, January 2020 first appeared on European Stroke Organisation.

ESO WISE Stroke Leadership Workshop

ESO-admin — Mon, 03 Feb 2020 13:43:53 +0000

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Pre-conference event – ESO WSO 2020 – 6 November – 18.00 – 20.00

Promoting gender equity in stroke leadership – global perspective

The ESO WISE Workshop is aimed at stroke neurologists, physicians and researchers at all career stages. The workshop is being offered in Vienna as part of the pre-conference programme of ESO WSO 2020 on 6 November 2020. You can register for the full conference on the ESO WSO 2020 website.

Registration is open to all on “first-come-first-served” basis via the ESO head office (esoinfo@eso-stroke.org).

WISE welcomes female health professionals in the field of stroke. For more information check out our website, or email our Chair, Christine Kremer (christine.kremer@skane.se )

Moderator: Christine Kremer

TIME

TOPIC

SPEAKER


18.00 – 18.05	Introduction	Yvonne Zuurbier and Mirjam Heldner

18.05 – 18.30	The facts – where do we stand
	South America	Paula Munoz Venturelli
	North America	Amy Guzick, United States
	Europe	Diana Aguiar de Sousa, Portugal
	Asia Pacific	Cheryl Carcel, Australia
	Africa	Gloria Ekeng, Nigeria

18.30 – 18.45	The importance of role models, mentors and sponsors	Urs Fischer, Switzerland

18.45 – 19.00	“Change the system” – tailoring leadership to women	Joanna Wardlaw, United Kingdom

19.00 – 19.15	How to overcome cultural challenges to women leadership in low-middle countries?	Gisele Silva, Brazil

19.15 – 19.30	Feminization of Medicine – and impact on delivery of acute stroke care	Shelagh Coutts, Canada

19.30 – 19.55	Panel discussion

19.55 – 20.00	Closing remarks

The post ESO WISE Stroke Leadership Workshop first appeared on European Stroke Organisation.

7th ESO ESMINT ESNR Stroke Winter School Report

ESO-admin — Fri, 31 Jan 2020 11:04:32 +0000

By Urs Fischer, Pasquale Mordasini, Jan Gralla, Simon Jung

The 7^th ESO ESMINT ESNR Stroke Winter School was held in Bern, Switzerland from the 28^thJanuary to 31^st of January 2020. This year the first time at the location SITEM (Swiss Institute for Translational and Entrepreneurial Medicine). The local organizing committee were Prof. Jan Gralla, PD Dr. Pasquale Mordasini, PD Dr. Simon Jung, PD Dr. Mirjam Heldner and Prof. Urs Fischer. Joëlle Schilling, Michela Mordasini and Helena Gerber actively supported them.

We had the difficult task to select 65 participants out of 128 applicants, but eventually 32 rising stroke physicians and 33 neurointerventionalists arrived in Bern from the following 21 different countries: Africa, Armenia, Bulgaria, Croatia, Czech Republic, Denmark, Egypt, Estonia, Germany, Greece, Israel, Italy, Lithuania, Netherlands, Norway, Portugal, Romania, Serbia, Slovakia, Switzerland, Ukraine, United Kingdom.

The primary aim of the 7^th ESO ESMINT ESNR Stroke Winter School was bringing together European stroke physicians and neurointerventionalists in order to enhance interdisciplinary management of patients with acute ischaemic stroke.

The Stroke Winter School started on the 28^th of January 2020 with the welcome of the president of the European Stroke Organization (ESO) Prof. Bart Van der Worp the representative of the president of the European Society of Minimal Invasive Neurological Therapy (ESMINT) and as well of the committee of the Interventional Neuroradiology Section of the European Society of Neuroradiology (ESNR).

The 34 speakers (12 from EU, 20 from Switzerland and one from Vietnam and USA) including neurologists, interventional and non-interventional neuroradiologists, neurosurgeons, and neuropediatricians led challenging discussions. The teaching program included 33 lectures and 4-6 tutorials. The focus of the lectures was interdisciplinary treatment of acute stroke. There were sessions on acute stroke imaging, acute treatment strategies including endovascular approaches, stroke treatment in difficult circumstances and needs to set up an interdisciplinary stroke center. In the afternoon tutorials were given separately for neurointerventionalists and stroke physicians. Neurointerventionalists had the opportunity for structured hands-on teaching in small groups on endovascular procedures with animal models and management of complications of endovascular treatment. Stroke physicians could learn neuroangiography on a model and they were taught interpretations of CT and MRI by neuroradiologists.

A special highlight for the interventional neurointerventionalists were the hands-on teaching sessions with the animal model. Small groups of 4-5 participants were given the opportunity to perform diagnostic angiography and endovascular treatment procedures such as thrombectomy with multiple devices.

Another highlight was the stroke simulation course: stroke physicians and neurointerventionalists took part in a real-life setting with simulated clinical stroke cases: physicians had to take care of the stroke patient and to decide on acute stroke management. Physicians were observed by colleagues and professionals and received feedback on their performance.

During the Stroke Winter School a faculty meeting was held with members of the ESO, ESMINT and ESNR in order to discuss future common strategies to enhance the quality of stroke management. Main topic was the training of future neurointerventionalists in areas with a current lack of experienced staff.

During the Stroke Winter School participants and faculty had three joint dinners to favor socialization and networking.

The following sponsors contributed to the realization of the Stroke Winter School:

Stryker, Microvention, Penumbra, Bracco, Cerenovus, Medtronic, Balt, Vascular Medical, Rapid medical, Perflow, Phenox, Siemens, Boehringer Ingelheim.

The local organizing committee thanks all the invited speakers for giving time and efforts to the Stroke Winter School, for coming to Bern, and for delivering high quality lectures. Their interest and passion to teach the upcoming generation of stroke physicians and neurointerventionalists was clearly visible.

We are pleased to announce that there will be an 8th ESO ESMINT ESNR Stroke Winter School from 2-5 February 2021 in Bern.

The post 7th ESO ESMINT ESNR Stroke Winter School Report first appeared on European Stroke Organisation.

Join an ESO Committee

ESO-admin — Wed, 29 Jan 2020 11:02:29 +0000

We would like to take the opportunity to remind all ESO members that ESO supports several committees to further its mission. ESO committees are comprised of dedicated ESO members. All members are encouraged to join a committee which aligns with their interests. Members can nominate themselves or someone else for committee membership. There are no additional fees associated with committee membership.

We are always looking for new motivated members. The following committees have openings as from May 2020:

Brain and Heart Council
Education Committee
Guideline Board
Membership Committee
Public Relations Committee
Social Media Committee
Stroke Unit Committee
Telestroke Committee
Young Stroke Physicians and Researchers

Please nominate yourself or another ESO member here.

The post Join an ESO Committee first appeared on European Stroke Organisation.

ESO Committee Corner – Membership

ESO-admin — Tue, 28 Jan 2020 11:11:15 +0000

28/01/2020/in ESO /by ESO-admin

The ESO Membership Committee is proud to present the different types of ESO membership and its benefits in the below videos.

We hear from Janne Hamann, a Junior member who has taken part in ESO Stroke Summer and Winter Schools. Inna Lutsenko, a joint ESO/WSO Member tells us why she is proud to be a member of ESO and what benefits her young colleagues in Eastern Europe should look for in ESO, she has participated in ESO Stroke Summer School and recently competed a Department to Department visit.

Michael Knoflach, shares the benefits of becoming a full member of ESO. Spoiler Alert, he will let you know how to get the best prices for ESO Conferences including #ESOWSO2020 this May in Vienna, Austria.

Membership Committee Chair, Thompson Robinson introduces himself and speaks about the benefits and responsibilities of becoming a Fellow of ESO.

Sign up as an ESO Member today and join your colleagues in ESO`s mission to reduce the burden of stroke in Europe. If you are already an ESO Member, please ensure your dues are paid for 2020 so you can take place in the current nominations and upcoming voting.

The post ESO Committee Corner – Membership first appeared on European Stroke Organisation.

Call for members of the ESO Stroke Education Platform Editorial Board

ESO-admin — Tue, 28 Jan 2020 05:25:13 +0000

The ESO Education Committee and Young Stroke Physicians Committees are looking for interested and enthusiastic stroke neurologists or physicians, stroke researchers or associated health professionals to become members of the new Editorial Board of the ESO Stroke Education Platform.

The ESO Stroke Education Platform is a new ESO initiative to provide a coherent, and ultimately comprehensive, source of up-to-date educational content related to the clinical management of all aspects of the stroke pathway, and the world-class science and research underlying it. It will take advantage of the wealth of educational material produced through ESO supported courses and the ESO Conference, and ultimately aims to commission content to create a comprehensive and structured resource covering all aspects of stroke.

The Editorial Board will have responsibility for the hands-on management of the website, ensuring the high quality of its content, that the material remains up to date and to further develop the platform to provide a modern and innovative, web-based training environment. The Board will include representatives from the ESO Education Committee and the Young Stroke Physicians committee, but we are also looking for 2 independent members to commit to this important work. These roles are open to all, and are ideally suited to clinicians or researchers early in their careers or towards the end of their training.

If you are interested in applying, or if you wish for further information, please contact Dr Alastair Webb, chair of the ESO Education Committee, at alastair.webb@ndcn.ox.ac.uk and Daniela.niederfeld@eso-stroke.org. To apply, please send your CV and letter of motivation.

The post Call for members of the ESO Stroke Education Platform Editorial Board first appeared on European Stroke Organisation.

Beat the Clot

ESO-admin — Fri, 24 Jan 2020 07:48:38 +0000

What can we learn from histology of brain clots to improve acute phase treatment of ischemic stroke?

By Barbara Casolla, MD, PhD, Univ. Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France, Twitter: @BarbaraCasolla

Clot histology and behaviour are active areas of research in vascular neurology. In patients with acute ischaemic stroke, mechanical thrombectomy has allowed clot physical removal, opening the access to a new variety of histological data that will probably impact, in the next years, the way we treat patients.

It has been observed that thrombus composition is highly heterogeneous, and it contains crucial pathophysiological information that could influence its susceptibility to i.v. fibrinolysis and mechanical removal.

Under the microscope, the main thrombus components in patients with ischaemic stroke are red blood cells (RBC), platelets (PLT) and leukocytes. RBC/PLT ratio varies, distinguishing RBC-rich vs. PLT-rich thrombi¹.

PLT are distributed in different ways: they can be either in the middle of the thrombus or compacted on its surface, in dense structures connected by fibrin and fibrinogen, that are, in turn, bridged by von Willebrand factor (vWF). Interestingly, it has been observed that this outer shell, made of compacted aggregated platelets, fibrin, and vWF, confers resistance to tissue plasminogen activator(rtPA)-mediated thrombolysis². Indeed, rtPA cleaves plasminogen, and plasmin cleaves fibrin, but in the presence of vWF, PLT remain linked even when fibrin is cleaved. Indeed, vWF could be another therapeutic target in the acute phase of ischaemic stroke. Good news: we know an enzyme that cleaves vWF, and its name is ADAMTS13³.

RBC-rich area seems simpler: RBC are linked by a network of fibrin and, from a therapeutic point of view, it is more drug permeable and rtPA susceptible.

What about leukocytes? Neutrophils accumulate in the boundary zone between PLT and RBC. For innate immunity, neutrophils use extrapodes composed by extracellular DNA, the so called neutrophil extracellular traps (NETs), to explore and recognize new antigens. The PLT-RBC interphase is surrounded by NETs, derived from neutrophils. NETs promote thrombosis⁴ and they seem to confer resistance to pharmacological and mechanical clot lyses^5,6^,⁷. Could we add DNAase in a new thrombolytic cocktail? An intriguing question yet to be answered.

Mechanical thrombectomy can be impacted by thrombus composition as well: it has been shown that thrombus fragments removed in the first 2 passes tended to have higher RBC fraction. Fibrin-rich thrombus fragments are retrieved in later passes, suggesting that the fibrino- and PLT-dominant portions of the thrombus contributed to the resistance of mechanical removal⁸.

We are identifying molecular mechanisms of clot resistance to pharmacological and mechanical lysis, and more evidence will come soon. New targeted lytic therapies and thrombectomy devices could be personalized. Nevertheless, little is known about thrombus composition before therapy, and currently similar treatment approaches are undertaken with all clot subtypes.

Tailoring specific interventions according to the type of thrombus: can neuroimaging help? Beat the clot, part 2, is coming.

Acknowledgments for the musical title: Dr Michele Cavallari, Harvad University, USA

References

Bacigaluppi M, Semerano A, Gullotta GS, Strambo D. Insights from thrombi retrieved in stroke due to large vessel occlusion. J. Cereb. Blood Flow Metab. 2019;39:1433–1451.

Di Meglio L, Desilles J-P, Ollivier V, Nomenjanahary MS, Di Meglio S, Deschildre C, et al. Acute ischemic stroke thrombi have an outer shell that impairs fibrinolysis. Neurology. 2019;93:e1686–e1698.
Denorme F, Langhauser F, Desender L, Vandenbulcke A, Rottensteiner H, Plaimauer B, et al. ADAMTS13-mediated thrombolysis of t-PA-resistant occlusions in ischemic stroke in mice. Blood. 2016;127:2337–2345.
Fuchs TA, Brill A, Duerschmied D, Schatzberg D, Monestier M, Myers DD, et al. Extracellular DNA traps promote thrombosis. Proc. Natl. Acad. Sci. U.S.A. 2010;107:15880–15885.
Laridan E, Denorme F, Desender L, François O, Andersson T, Deckmyn H, et al. Neutrophil extracellular traps in ischemic stroke thrombi. Ann. Neurol. 2017;82:223–232.
Ducroux C, Di Meglio L, Loyau S, Delbosc S, Boisseau W, Deschildre C, et al. Thrombus Neutrophil Extracellular Traps Content Impair tPA-Induced Thrombolysis in Acute Ischemic Stroke. Stroke. 2018;49:754–757.
Peña-Martínez C, Durán-Laforet V, García-Culebras A, Ostos F, Hernández-Jiménez M, Bravo-Ferrer I, et al. Pharmacological Modulation of Neutrophil Extracellular Traps Reverses Thrombotic Stroke tPA (Tissue-Type Plasminogen Activator) Resistance. Stroke. 2019;50:3228–3237.
Duffy S, McCarthy R, Farrell M, Thomas S, Brennan P, Power S, et al. Per-Pass Analysis of Thrombus Composition in Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. Stroke. 2019;50:1156–1163.

The post Beat the Clot first appeared on European Stroke Organisation.