For 2018, via the ESO newsletter, we are focusing the spotlight on prominent ESO members under 45. In January we introduced you to Georgios K. Tsivgoulis. For February, we learned more about Else Charlotte Sandset. In March we presented Urs Fischer. In April you met Charlotte Cordonnier.

Hopefully you were able to meet some of these prominent young members in person during the ESOC in May. From the ESOC, the Young Stroke Physicians and Researchers Committee published daily interviews with Ayse Tanritanir, Stefania Nannoni, and Maren Ranhoff Hov. 

In the June edition of this series Marialuisa Zedde answered questions for July, we introduced Jesse Dawson and in August we met Diana Aguiar de Sousa.

This month we introduce, Robert Mikulik, head of the stroke research program at St. Anne`s Hospital Brno, Czech Republic. Robert is also the Chair of the ESO EAST project and a former member of the ESO Executive Committee and ESOC planning committee.

 

How has the stroke management changed in the last year in your country and what are the future goals?

In the Czech Republic, the change in stroke management was driven mostly by introducing reperfusion therapies into clinical practice. So the very first changes were already happening 20 years ago when we started to build our experience with intravenous thrombolysis. Since 2003, when Actilyse was approved, every neurology department had to become familiar with thrombolytic treatment. Moreover, since 2006, many university and some other hospitals started to offer interventional treatment. In 2010, stroke units were required to be certified by the Ministry of Health to be included in the official network of stroke units. In 2012, triage of patients was regulated by the Ministry of Health so essentially since then, any acute stroke that happens in the Czech Republic must be transferred to a certified stroke unit where further therapy is provided according to state of the art evidence. In the last few years, primarily the Czech Stroke Society has been organising many quality improvement programs. Due to a focused effort to improve quality of stroke services and involvement of key stakeholders such as hospitals, the Czech Stroke Society and the Ministry of Health, the Czech Republic had over a 20% thrombolytic rate in 2017 at population level (around 30% at hospital level) and a door-to-needle time of around 25 minutes. During ESOC in Prague, we proposed action 20-20-20, and we believe that in 2020, our national thrombolytic rate will be not only over 20%, but our door-to-needle time will also be below 20 minutes.

What was the effect of ESO EAST project on stroke care?

ESO-EAST aims to improve stroke care quality in Central and Eastern European countries. To achieve this ambitious goal, many stroke experts, stroke national leaders and national professional societies have joined ESO-EAST. ESO-EAST built a bit on our own experience with implementing the evidence in the Czech Republic, although we did find that this experience isn’t directly transferable to all other countries due to a variety of factors. The first goal of ESO-EAST was to provide information regarding what the current quality of stroke services is, which is frequently unknown in many healthcare systems. For this purpose we launched the Registry of Stroke Care Quality (RES-Q) and we’ve been very happy with the progress in collecting many quality metrics. This year, we should have the very first reasonably reliable data on quality of stroke services at an international level.  This is not only in Eastern European countries, but also other countries, both within Europe and globally, that have joined RES-Q. The goal for all of the involved experts and societies for the future is to use information from RES-Q to develop measures to targets gaps in stroke care quality which are tailored to each country.

What are the frontiers of clinical research about stroke now?

My personal opinion is that although in the last 20 years we have learned how to effectively treat stroke, we have a bigger challenge in terms of implementing this knowledge into clinical practice. Therefore, I would propose to shift our research interest towards implementation science now, and focus on getting the best treatment to the most patients.