Global Perspectives of Stroke WSO-ESO Session at ESOC 2017

Session Convenors: W. Hacke (Germany), J. Barrick  (United Kingdom)
Impressions contributed by the ESO Public Relations Committee

Stroke and poverty, B. Norrving (Sweden)

Global burden of disease was presented. Conclusion:  Poverty contributes to stroke and stroke contributes to poverty; Effects of poverty on stroke is not well measured, and is underrecognized; interaction between poverty and stroke differ is high, middle and low income, the concept of syndemics for stroke needs further attention and study; poverty is root cause for many diseases and for health, stroke has entered the SDG era: lighting stroke is not only a medical issue for the health care only, but requires political and governmental actions.

Lessons from Interstroke, M. O’Donnell (Ireland)

Interstroke with 10 risk factors was presented. Conclusions: Large international epidemiologic studies of risk factors for stroke, with mandatory neuroimaging is feasible in LMICs. studies are needed that require valid neuroimaging. 10 potentially modifiable risk factors are associated with about 90% of the PAR globally. In each major region (and ethnicity), in men and women, young and older populations. There are shared risk factors for ischemic stroke and ICH (7 risk factors). Each risk factors contributes, however, hypertension is the most important risk factor.We have learned that there are some regional variation in importance of individual risk factors mostly related to differences in prevalence and risk factors and magnitude of odds ratio. Common (global) population level strategies to prevent and treat common risk factors are expected to reduce the burden of stroke. There should be region-specific considerations, based on relative importance of some risk factors.

The Stroke Road Map, P. Lindsay (Canada)

The roadmap rationale is that mortality and morbidity from stroke could be significantly reduced through organized stroke care, including the implementation of evidence-based guidelines and adoption of a continuous quality improvement philosophy and programs. It offers assessment of Stroke Services Capacity and Performance Measures that would lead to better stroke care. The Implementation Plan is structured as practical steps that need to be taken and it important to stress that the World Stroke Organization offers free access to online World Stroke Academy with useful apps (e-learning modules, treatment of post-stroke spasticity etc.). The key message underlying the WSO Global Stroke Quality Action Plan is that even with the absolute minimal services available to you, at least something can be done for people with stroke that could make significant difference to their recovery and outcomes.The Challenges of Stroke Prevention in Africa, A. Bryer (South Africa)

For many years nothing happened in Africa regarding stroke treatment. However, a lot has happened during the past few years. They created a webside informing people regarding stroke risk factors. My stroke-initative was established and it will soon transform to Angels initiative. The rtPA was approved 1,5 years ago. There are 20 Stroke unite in 15 university and several private hospitals. There are 3-5 comprehensive units (EVT). The major barriers to stroke care are prehospital delays. 23 hospitals thrombolysed 586 patients in 2016. Still, there are few neurologists in Africa, for example in Kenya with population of 48 million, there are 13 neurologists and in Namibia, with a population of 2,5 million, there are 2 neurologists. There are many steps that need to be taken in order to improve this situation.

26 hospitals have stroke units.

Air Pollution and Risk of Stroke , V. Feigin (New Zealand)

Air pollution is increasing globally but potentially controllable (20% increase from 1990 to 2015). There is growing evidence for air pollution as stroke.MI trigger (86 journal articles). Still, there is lack of evidence for chronic air pollution and risk of stroke and there are no country specific data. There are many types and sources of air pollution (particulate matter Nitrogen oxides, Carbon monoxide and Dioxide, sulfur oxides and ground level ozone formed from NOx and volatile organic compounds. Most affected countries are in Africa and Asia. Evidence suggests that air pollution is a new leading risk factor for stroke accountable for 17% of the global stroke burden (30% – in developing countries). Reduction of air pollution should be included in all primary stroke prevention guidelines and sustainable goals for NCDs reduction. Reducing stroke and other diseases burden requires control of emissions from all major sources population-wide approach. Also, there is an individual approach in managing the personal exposure to air pollution (wearing appropriate masks, avoiding running and cycling in busy roads etc).