A Lancet Issue Devoted to Stroke

Abstract

Marc Fisher MD Kennedy Lees MD Section Editors: The dominant theme of the January 27, 2007 issue of Lancet is stroke. In a new editorial policy the Lancet decided to publish themed issues of particular interest to both general clinicians and specialist researchers. Stroke is undoubtedly a disease that requires special attention: approximately 1% of the 6.5 billion people living on our planet—twice the population of Canada or 8 times the population of Switzerland—will die each year of stroke. Many of these strokes are either preventable or could be delayed to a more advanced age. Considering such figures, the Lancet editors have to be congratulated for their decision, which is an important step in the struggle to reduce the burden of stroke in our societies. They have carefully selected original articles, seminars, and reviews on stroke. In the following we will comment on the 4 original articles. ### Wahlgren N, Ahmed N, Davalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Kuelkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G, for the SITS-MOST investigators. Thrombolysis with alteplase for acute ischemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet. 2007;369:275–282. The European Agency for the Evaluation of Medicinal Products (EMEA) mandated a postlicensing observational registry of thrombolysis use in Europe as a condition of licensing. The web-based SITS-MOST registry was launched in response to this need and collected more than 6000 patients from nearly 300 European centers. #### Methods Any European center was eligible as long as they agreed to enter all consecutive patients and agreed to site monitoring and aggregrate data reporting. Both experienced and inexperienced thrombolysis sites were eligible. The primary outcomes were safety outcomes: symptomatic ICH and death at 3 months from treatment. #### Results Patients enrolled in the registry were typically similar to those enrolled in prior trials and stroke thrombolysis registries. The mortality rate was 11.3% and symptomatic ICH rate 7.3%. Excellent functional outcome was achieved in 39% of patients. #### Interpretation This experience represents the largest stroke thrombolysis registry globally. It documents the safety and effectiveness of alteplase for stroke in routine clinical …