Stroke: Perspectives from Asia

Stroke is a major cause of death and disability globally, and even more-so in Asia [1]. Stroke in Asian countries have different epidemiological patterns compared to other parts of the world. In the spectrum of cerebrovascular diseases, there is evidence of higher frequencies of spontaneous intraparenchymal haemorrhage, intracranial atherosclerosis, radiation vasculopathy, moyamoya disease, strokes related to infectious aetiologies and central nervous system infections as well as cerebral venous thrombosis. As such, the educational emphasis differs in Asia [2].

While there are rapid advances in the epidemiology, diagnosis, and management of each of these conditions, this information is not readily available in an easily accessible educational resource. Having this knowledge readily available would have a significant impact on the understanding and management of these conditions by clinicians who are caring for patients with stroke in Asia while offering refreshing perspectives for those working beyond Asia.

The Asian Stroke Advisory Panel (ASAP) was formed in 1999 by a group of key opinion leaders in stroke and cerebrovascular neurology. The group was unified by the shared vision of increasing the level of public awareness about stroke, sharing best practices, and spearheading research initiatives of stroke from diagnosis to treatment, rehabilitation, and prevention [3]. The panel has produced public education materials for wide distribution in multiple languages spoken in Asia on stroke risk factors, symptoms, and actions to be taken as soon as possible (ASAP), in the form of posters, brochures, bookmarks, and cards. The Panel has organised continuing medical education webinars covering topics of practical and clinical value to the busy clinician such as thrombolysis, thrombectomy, radiation vasculopathy, cerebral venous thrombosis, neurosonology, heart and brain, intracerebral haemorrhage, intracranial large artery disease, anti-thrombotic failure, and most recently, cerebral small vessel disease. Research publications by the group cover a range of topics from early stroke mortality, stroke complications, young stroke, systems of stroke care, consensus statement on stroke care during the COVID-19 pandemic, and most recently, pharmacological therapies to improve neuro-recovery after a stroke [4‒9]. The Panel has also published two hand-books on Stroke in Asia [10, 11], as well as a journal supplement-cum-book of interesting case reports in stroke in Asian countries [12]. The core activities, publications and resources are collectively represented in the website of the ASAP; https://www.asianstrokeadvisory.com [3].

This new initiative in the form of a supplement has taken another significant step, by covering a range of clinically important topics – up-to-date reviews of topics that have been covered in our webinars including but not limited to stroke epidemiology in Asia, intracranial haemorrhage, intracranial stenosis, moyamoya disease and syndrome, radiation vasculopathy, stroke from infection, cerebral venous thrombosis, bites and stings as causes of stroke, and stroke in the young; a systematic review on anti-platelet treatment in moyamoya disease; a protocol for a systematic search and review of pharmacological therapies to improve outcomes after stroke; original research papers on pre-hospital RACE scale for prediction of large vessel occlusion, alteplase, and tenecteplase in suspected large vessel occlusion, perfusion-imaging guided thrombectomy in the 6–16 h window, polymorphism in RNF213rs112735431 gene and CYP2C19, hub-and-spoke acute care and 1-year outcomes in large artery intracranial stenosis; and three interesting case reports.

This focused supplement will arm the clinician with contemporary knowledge and be acquainted with perspectives on stroke relevant to Asia and Asians. It may also spark new research ideas that would help fill the gaps in stroke knowledge and stroke care in our part of the world. Happy reading!