stroke treatment – European Stroke Organisation

Back To Bedside: First, do no harm?

Carine Legio — Fri, 27 Feb 2026 04:36:07 +0000

27/02/2026/in ESO, Stroke Research /by Carine Legio

Author: Iain McGurgan

Lausanne University Hospital, Switzerland

Iain McGurgan presents the fourth episode of the Back to Bedside programme.

In acute stroke care, decisions that shape long-term outcomes must be made within minutes. This case examines the complexity of acute treatment when risk factors and potential contraindications lie within the gray areas of existing guidelines, underscoring the challenges of translating evidence-based recommendations into individualised decision-making at the patient’s bedside.

Learn more and listen to the presentation

ESOC is Europe’s leading forum for advances in research and clinical care of patients with cerebrovascular diseases. ESOC 2026 will live up to its expectation, and present to you a packed, high quality scientific programme including major clinical trials, state-of-the-art seminars, educational workshops, scientific communications of the latest research, and debates about current controversies. Learn more.

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In Memoriam – Professor Emeritus Nils Wahlgren

Carine Legio — Wed, 25 Feb 2026 09:50:59 +0000

25/02/2026/in ESO, Stroke Research /by Carine Legio

It is with deep sorrow that we announce the sudden passing of Professor Emeritus Nils Wahlgren.

Professor Wahlgren was a visionary leader in stroke medicine and a pioneer whose work transformed acute stroke care across Europe and beyond. He founded the SITS International Stroke Thrombolysis Registry, creating a global platform that has shaped clinical practice and research for decades. As the leading investigator of the SITS-MOST study, he laid the scientific foundation for the approval of intravenous thrombolysis in acute ischemic stroke in Europe — a milestone that has benefited countless patients.

Nils also served as Chairman of the Karolinska Stroke Update from 1996 until his retirement, fostering international collaboration and advancing knowledge in the field of stroke medicine. At Karolinska University Hospital, he was the driving force behind the establishment of the Hyperacute Stroke Triage (HASTA) system in the Stockholm region and a strong advocate for the implementation of endovascular treatment in stroke care. His vision, determination, and unwavering commitment have enabled us today to work in a field that is both scientifically pioneering and profoundly meaningful.

Beyond his remarkable professional achievements, Nils was a colleague, mentor, and friend to many. He meant an extraordinary amount of colleagues at SITS, as well as to colleagues at Karolinska Institutet and Karolinska University Hospital, where many shared long and close professional and personal relationships with him.

We remember him with warmth, laughter, and gratitude — and with great pride in all that he accomplished during his lifetime. His legacy will continue to inspire future generations of clinicians and researchers.

Our thoughts are especially with his family, whom we came to know through his vivid and loving stories. We extend our heartfelt condolences to them during this difficult time.

Memoria eius in operibus vivit.

–

Simona Sacco, ESO president

Niaz Ahmed, Professor of Neurology, Karolinska Institutet, Senior consultant Karolinska University Hospital, FESO

The post In Memoriam – Professor Emeritus Nils Wahlgren first appeared on European Stroke Organisation.

Back To Bedside: Fading Memory

Carine Legio — Fri, 23 Jan 2026 04:36:36 +0000

23/01/2026/in ESO, Stroke Research /by Carine Legio

Author: Ellis van Etten

Leiden University Medical Center, the Netherlands

In the third episode of the Back to Bedside programme, Ellis van Etten presents a case of a basilar artery occlusion presenting with amnesia, highlighting the diagnostic challenges of strokes in the posterior circulation. The presentation walks participants through key clinical clues.

Learn more and listen to the presentation

In an era overflowing with neuroimaging, vascular studies, lab tests, and AI-powered diagnostics, it’s easy to forget the value of simply looking at the patient. But when it comes to clinical reasoning, no algorithm can replace a skilled clinician.

This monthly case series is here to sharpen your bedside techniques, challenge your diagnostic thinking, and help you stay grounded in what matters most: the patient.

Back to Bedside reminds us why bedside neurology still matters greatly. From asking the right questions to interpreting subtle signs and deciding what really needs to be tested, clinical skills remain at the heart of good stroke care.

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The ESO YSPR Committee: Looking back on 2025, looking ahead to 2026

Carine Legio — Thu, 01 Jan 2026 14:33:12 +0000

01/01/2026/in ESO, Stroke Research /by Carine Legio

Author: Märit Jensen & Ellis van Etten

As 2025 has drawn to a close, the ESO YSPR committee reflects on a productive and inspiring year and looks forward to launching exciting initiatives throughout 2026.

A major highlight of 2025 was ESOC in Helsinki, Finland. Once again, the conference provided an excellent platform for scientific exchange and networking among stroke professionals from across Europe and beyond. The YSPR Research Design Workshop was well received, giving young researchers the opportunity to present their study ideas and receive structured, constructive feedback from experienced mentors.

Together with the European Stroke Journal (ESJ), the YSPR Young Reviewer Programme continued successfully in 2025. The participants for the current round have been selected, and this cycle will conclude in April 2026. Building on the strong interest and engagement seen so far, the call for new candidates for the ESJ Young Reviewer Programme will open after ESOC 2026.

The Department to Department Programme continued to offer valuable opportunities for young stroke physicians to experience different clinical and research environments across Europe. Those interested in applying are encouraged to read the previous participant reports published on the ESO blog, which provide insightful first-hand perspectives on the programme.

The ESO blog continues to be an important platform for presenting current topics and sharing perspectives. Working on the blog remains a great part of our committee work. We would like to thank everyone who contributed over the past year, and we are always happy to welcome new guest bloggers with fresh views on timely and relevant stroke-related topics.

Looking ahead to 2026

The coming year will mark the start of a new YSPR initiative: Back to Bedside. This programme aims to present short, focused clinical vignettes with clear take-home messages, highlighting the importance of clinical reasoning and bedside neurology in everyday stroke care. In case you have missed the first episodes, you can listen here to Episode 1 and Episode 2

Finally, we would like to thank all ESO members, collaborators, mentors, and participants for their continued support and engagement.

We wish everyone a successful 2026 and look forward to seeing you in person in Maastricht at the 12^th ESOC!

The post The ESO YSPR Committee: Looking back on 2025, looking ahead to 2026 first appeared on European Stroke Organisation.

ESO Webinar Report — When the Weather Strikes: Understanding Stroke Risk in the Era of Climate Extremes

Stefania De Vito — Thu, 18 Dec 2025 09:00:13 +0000

18/12/2025/in ESO, Stroke Research /by Stefania De Vito

Author: Anna Gardin

X: @AnnaGardin1

The 26th webinar of the European Stroke Organisation’s educational series focused on the critical topic, “When the weather strikes: understanding stroke risk in the era of climate extremes”. Moderated by Dr Marieta Peycheva and Dr Vojtech Novotny, the session was delivered by two expert neurologists.

The first speaker, Dr. Vasileios Tentolouris Piperas (from the National and Kapodistrian University of Athens, Greece), presented evidence linking air pollution and wildfires to increased stroke risk. Climate change, defined as a long-term shift in average weather patterns, is contributing to an increase in intense and destructive wildfires. In Europe alone, approximately 1 million hectares were burned in 2025 up to October 28th, an area equivalent to Montenegro. Wildfires are significant sources of pollution, as well as the energy production industry and the urban traffic. One of the main air pollutants is the Particulate Matter (PM) 2.5, extremely small particles associated with cerebrovascular risk. The talk highlighted that outdoor air pollution is now recognised as the second most important modifiable risk factor globally for stroke-related disability, according to the 2025 World Stroke Organisation fact sheet. Epidemiological data confirms that exposure to wildfires or high PM 2.5 concentrations leads to a short-term rise in cerebrovascular events, especially within the first few days and among adults over 65. Long-term exposure also increases stroke incidence and mortality. The mechanisms involve the activation of sensory receptors in the respiratory system, leading to a sympathetic response (vasospasm/arrhythmias); an inflammatory response causing oxidative stress and hypercoagulable states; and the potential translocation of particles that contribute to platelet aggregation and atherosclerotic plaque formation. It was suggested that future interventions should focus on reducing pollution in high-risk areas globally, such as South Asia and Northern Africa, but also monitor susceptible areas in Europe, like the Mediterranean and the Balkans.

The second speaker, Professor Anita Arsovska (from the University Clinic of Neurology, University Ss Cyril and Methodius in Skopje, North Macedonia), discussed how ambient temperature extremes and rapid fluctuations affect stroke occurrence, defining climate change as a fundamental threat to human health. Research consistently links both high and low temperatures to increased stroke events, though the pattern differs by stroke subtype. Ischemic stroke risk peaks during warmer months and is associated with heat extremes and heat waves, with effects often immediate, occurring within the first four days. In contrast, intracerebral hemorrhage shows a stronger association with cold temperatures. The effects of cold often exhibit a longer lag, extending up to 30 days, reflecting delayed consequences of cold-induced blood pressure changes. Rapid temperature fluctuations (e.g., changes between 5 and 8 degrees Celsius) also increase stroke risk. Pathophysiologically, extreme cold triggers vasoconstriction and hypertension, increasing hemorrhagic risk, while extreme heat leads to dehydration and hypercoagulable states, increasing ischemic risk. The elderly and those with comorbidities like heart failure are highly vulnerable. It was proposed that public health strategies should include early warning systems using machine learning models combined with weather data to forecast high-risk days and enhance hospital preparedness. Furthermore, incorporating temperature risk into discharge planning and patient counseling is crucial.

Finally, during the Q&A session, the speakers agreed that incorporating climate-related risk factors into professional education and national registries is an essential next step for the stroke community.

Learn more about our Educational Webinars: ESO Educational Webinars -European Stroke Organisatoin

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Open Call – Delphi Panel for the ESO White Paper

Carine Legio — Tue, 16 Dec 2025 07:43:55 +0000

16/12/2025/in ESO, Stroke Research /by Carine Legio

Open Call – Delphi Panel for the ESO White Paper on Reversible Cerebral Vasoconstriction Syndrome (RCVS) and Posterior Reversible Encephalopathy Syndrome (PRES)

The ESO Guideline Board invites experienced stroke clinicians and subject-matter experts to join the Delphi voting panel for the ESO White Paper on PRES RCVS in development. We are seeking Delphi panellists who can contribute their expertise by evaluating and voting on draft consensus statements relating to the defined PICO questions of the project.

Role of Delphi Panel Members

Delphi panellists will:

Participate in multiple rounds of anonymous voting on draft consensus statements.

Provide quantitative ratings on a 9-point Likert scale (from strong disagreement to strong agreement).

Offer qualitative written feedback, including suggestions for improving clarity, scope, and clinical relevance.

Review revised statements across iterative rounds until consensus (or stable non-consensus) is reached.

Panellists will not be responsible for authoring text or conducting literature reviews – their role is strictly to evaluate the proposed guidance through structured voting.

Introduction to the ESO White Paper Format

The European Stroke Organisation (ESO) White Papers serve as expert consensus–based clinical guidance in areas of stroke care where robust evidence is limited, evolving, or currently insufficient to support full evidence-based guideline recommendations. As outlined in the ESO Standard Operating Procedure (SOP), White Papers use a transparent, structured, and iterative consensus method, drawing on multidisciplinary expertise to formulate practical clinical guidance for high-priority topics.

A central component of developing White Papers is the modified Delphi process, an established method designed to gather expert judgement through multiple rounds of anonymous voting, structured feedback, and iterative refinement. This ensures that all expert perspectives, irrespective of seniority, geography, or discipline, are weighted equally and transparently in formulating consensus statements.

To uphold the methodological rigor described by ESO, the Delphi panel must include a sufficiently broad and diverse group of experienced clinicians from across Europe and beyond.

Eligibility Criteria

To ensure a high-quality and diverse panel (minimum 20 active voters), applicants should:

Have at least 10 years of clinical experience (10 years since graduation from Medical School), preferably in stroke medicine or a related neurological or interdisciplinary field. The same requirement of 10 years of experience after graduation also applies to voting members of the ESO Guidelines MWGs (Module Working Groups).

Possess recognised expertise relevant to the White Paper’s clinical topic.

Be willing to participate in approximately 2-4 rounds of online voting over a defined period.

Commit to providing thoughtful, constructive feedback reflecting current best clinical practice.

We particularly welcome applications from a broad range of clinical backgrounds, geographic regions, and career stages to ensure a balanced representation. Participation is voluntary, not reimbursed and does not confer authorship.

Why Participate?

Serving as a Delphi panellist contributes directly to shaping high-quality, internationally visible clinical guidance. Your input will:

Help fill evidence gaps where clinicians urgently require structured recommendations.

Ensure the guidance reflects diverse professional viewpoints, clinical realities, and practical considerations across Europe.

Strengthen the credibility, transparency, and applicability of the final White Paper.

All Delphi panel members will be acknowledged in supplementary materials accompanying the published White Paper.

How to Apply

Interested individuals are invited to submit:

A brief expression of interest,

A CV in English,

A short description of clinical background and expertise,

Contact information and institutional affiliation.

Please send your application to guidelines@eso-stroke.org by 28 January 2026.

This is a unique opportunity to contribute to ESO’s impactful work and shape the future of stroke care.

We strongly encourage you to consider applying.

The post Open Call – Delphi Panel for the ESO White Paper first appeared on European Stroke Organisation.

Back To Bedside: The Stroke Impostor

Carine Legio — Thu, 11 Dec 2025 18:34:22 +0000

11/12/2025/in ESO, Stroke Research /by Carine Legio

Author: Bogdan Ciopleias

Faculty of Medicine, Transilvania University Brasov, Romania

X: @bciopleias

In the second episode of the Back to Bedside programme, Bogdan Ciopleias presents a compelling case of a stroke mimic, highlighting the diagnostic challenges encountered in acute neurovascular care. The presentation walks participants through key clinical clues.

Learn more and listen to the presentation

This monthly case series is here to sharpen your bedside techniques, challenge your diagnostic thinking, and help you stay grounded in what matters most: the patient.

The post Back To Bedside: The Stroke Impostor first appeared on European Stroke Organisation.

8th ESSW Garmisch Session Report: Session I – Acute Reperfusion and Thrombectomy

Noémie — Thu, 11 Dec 2025 14:42:15 +0000

11/12/2025/in ESO, Stroke Research /by Noémie

Author: Grégoire Boulouis and Floris Schreuder

Session I, convened by Grégoire Boulouis and Zuzana Gdovinová, opened the workshop with high energy and a strong scientific pulse, centered on acute reperfusion strategies and the evolving landscape of mechanical thrombectomy (MT). A lively debate on intra-arterial thrombolysis (IAT) after MT set the tone, followed by two forward-looking presentations on neuroprotection and device innovation. The auditorium remained deeply engaged throughout, with active discussion and expert insights reflecting the spirit of the ESO Stroke Science Workshop.

Intra-Arterial Thrombolysis After Mechanical Thrombectomy: Evidence, Risks, and Rationale—A Structured Debate

The chairs introduced the session’s core question—whether intra-arterial thrombolysis should be used following mechanical thrombectomy—before inviting a pre-vote. This seamlessly launched into the keynote debate. Urs Fischer opened with a punchy, data-driven case for “giving the juice.” He highlighted recent evidence, including the disproportionate effect size observed in the CHOICE trial, while underscoring the need for replication before changing practice. Ongoing trials such as TECNO, he noted, will be essential to clarify the true benefit and magnitude of post-MT IAT.

Isabel Fragata delivered an equally dynamic and humorous counterargument. Drawing from real-world cases, she illustrated bleeding complications after post-MT lysis and explained why, from a pragmatic and mechanistic standpoint, IAT after MT may be illogical. She raised concerns about internal lysis, micro-catheter-related thrombus injection, and overall procedural risk, arguing that the theoretical and practical downsides outweigh the potential benefits.

Rebuttals from both speakers kept the audience fully engaged, and comments from the floor added further nuance. An audience vote captured evolving opinions, followed by a short but animated discussion that emphasized the need for better evidence and clearer guidance.

Advances in Neuroprotection: Translational Pathways Toward Enhanced Reperfusion Outcomes

The session then shifted toward future horizons in acute stroke care. Macarena Hernández-Jiménez delivered a compelling translational presentation on neuroprotection, outlining experimental advances and their potential synergy with MT. She made a convincing case for continued investment in this field, emphasizing that augmenting reperfusion with neuroprotective strategies may be key to improving outcomes.

Technological Evolution of Thrombectomy Devices: Innovations Shaping Acute Reperfusion Therapy

Uta Hanning followed with an excellent overview of technological progress in thrombectomy. She traced the historical evolution of MT devices, progressing from early stent retrievers to double-stent techniques, thrombus-specific tools, and the development of large-bore aspiration systems. Her talk highlighted how engineering refinements continue to influence procedural success and may ultimately drive better clinical outcomes.

The final discussion brought the session to a close in a vibrant atmosphere. The audience raised thoughtful questions, and the collective exchange underscored both the complexity and the momentum of current research in acute reperfusion. Altogether, the session delivered a concentrated moment of science, debate, and forward-looking insight in the pure spirit of the ESO Stroke Science Workshop.

The post 8th ESSW Garmisch Session Report: Session I – Acute Reperfusion and Thrombectomy first appeared on European Stroke Organisation.

8th ESSW Garmisch Session Report: Session VII – Prizes

Carine Legio — Thu, 11 Dec 2025 10:04:25 +0000

11/12/2025/in ESO, Stroke Research /by Carine Legio

Author: Signild Åsberg and Maarten Uyttenboogaart

X: @SignildAsberg

Save the best for last! The final session of the successful ESWW 2025 was dedicated to the award ceremony for the two best mid-career elevator pitches and the best poster. Meanwhile, the sun began to gleam above the snowy mountains surrounding the picturesque Eibsee.

The recipients of the best mid-career elevator pitch awards were Jatinder Minas (Leicester, United Kingdom) and Nina Halkes (Rotterdam, the Netherlands). Both honorees were invited to present their pitches to the entire ESWW audience.

Jatinder Minas’s presentation focused on protective and reparative processes following acute intracerebral haemorrhage (ICH). He discussed the relationship between remote diffusion-weighted imaging (DWI) lesions and poor functional outcomes in acute ICH patients and considered whether these DWI lesions represent collateral damage or indicate an overactivation of reparative mechanisms.

Nina Halkes called for a reevaluation of the duration of antiplatelet therapy (AP) in young stroke patients. She emphasised that most supporting evidence for lifelong AP stems from studies conducted in elderly populations. In younger individuals, the benefits remain uncertain and potential complications may outweigh advantages. This clinical dilemma forms the basis for the newly launched STOP trial.

The award for best mid-career poster went to Bernhard Matthias Siepen from Bern, Switzerland. In his poster, he elaborated on a phase II randomised clinical trial assessing the efficacy of a care bundle for ICH patients. The care bundle includes intensive blood pressure control, reversal of anticoagulant drugs, administration of tranexamic acid, admission to a stroke unit / ICU and neurosurgical evaluation.

During the poster presentations, senior attendees were challenged to answer questions regarding the mid-career candidates presenting their posters. Daniel Strbian from Helsinki, Finland, distinguished himself by correctly answering the majority of these questions and received the Mid-career researcher engagement award as well.

The final closing remarks were given by Rustam Al Shahi Salman, reassuring all attendees that this year, everyone could make a safe trip home.

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