ESO Voice of Stroke

Endovascular thrombectomy has transformed the treatment of large vessel occlusion stroke. But as its use expands, important questions remain about where its boundaries lie.
In this episode of Voice of Stroke, we explore three recent studies examining patient selection and treatment intensity at the margins of thrombectomy practice.
This episode discusses:
• The CHOICE-2 trial and adjunctive intra-arterial alteplase after successful thrombectomy
• Whether ischaemic core volume may refine patient selection beyond ASPECTS in large-core stroke
• The AURORA pooled analysis examining the role of time in imaging-selected patients treated in the extended 6–24-hour window
Featuring discussion of recent research published in JAMA, Stroke, and Neurology.
Written by: Robert Hurford, Voice of Stroke Podcast Editor, and Linxin Li, Voice of Stroke Editor-in-Chief.
Read the full transcript here
References
·      Renú A, Fernández-Couto MD, de la Riva P, et al. Adjunctive Intra-Arterial Alteplase After Successful Thrombectomy for Acute Ischemic Stroke: The CHOICE-2 Randomized Clinical Trial. JAMA. 2026.
·      Jiang X, Zhao Z, Zhang Y, et al. Intra-arterial thrombolysis following endovascular recanalization for large vessel occlusion stroke: a systematic review and meta-analysis. Neurology. 2025.
·      Kim H, Ryu WS, Inoue M, et al. Defining the Therapeutic Ceiling of Endovascular Thrombectomy in Large-Core Stroke: Beyond the Limits of ASPECTS. Stroke. 2026. 
·      Sarraj A, Hassan AE, Abraham MG, et al. Endovascular thrombectomy for large ischemic stroke across ischemic injury and penumbra profiles. JAMA. 2024.
·      Sarraj A, Thomalla G, Yoshimura S, et al. Endovascular thrombectomy for patients with large-core ischaemic stroke presenting up to 24 h after onset (ATLAS). Lancet. 2026.
·      Nogueira RG, Jovin TG, Lansberg MG, et al. Time to Treatment in Stroke Thrombectomy and Outcomes in the Extended Time Window: A Meta-Analysis. Neurology. 2026.

Cerebral small vessel disease is increasingly recognised as one of the leading causes of stroke, cognitive impairment and dementia worldwide. Despite its enormous clinical impact, disease-modifying therapies remain limited.
In this episode of Voice of Stroke, we explore how advances in biomarker discovery and cerebrovascular physiology are reshaping our understanding of cSVD and identifying promising new therapeutic targets.
This episode discusses:
The global burden of cerebral small vessel disease
Cerebrospinal fluid and blood biomarkers for disease characterisation and progression
Cerebral autoregulation as an emerging physiological biomarker
The potential role of phosphodiesterase-5 inhibitors and other therapies targeting cerebral vascular function
Featuring discussion of recent research published in:
International Journal of Stroke
Nature Aging
Alzheimer's Research & Therapy
Frontiers in Neurology
Written by: Annemijn Algra, Voice of Stroke Podcast Editor, and Linxin Li, Voice of Stroke Editor-in-Chief.
Read the full transcript
References
1.        Lam BYK, et al. Global burden of cerebral small vessel disease determined from large MRI studies: A systematic review and meta-analysis. International Journal of Stroke. 2026.
2.        Hristovska I, et al. Identification of distinct and shared biomarker panels in different manifestations of cerebral small-vessel disease through proteomic profiling. Nature Aging. 2026.
3.        Yang D, et al. Plasma extracellular vesicle proteins biomarker for cerebral small vessel disease related cognitive impairment. Alzheimer's Research & Therapy. 2026.
4.        Webb AJS, et al. The role of impaired autoregulation in cerebral small vessel disease and vascular cognitive impairment. International Journal of Stroke. 2026.
5.        Yan L, et al. Phosphodiesterase-5 inhibitors for cerebral small vessel disease-related ischemic stroke and cognitive decline: Systematic review and meta-analysis. Frontiers in Neurology. 2026.

How should clinicians think about hypertension in 2026?
In this episode of Voice of Stroke, we explore recent evidence addressing one of the most important questions in vascular prevention: not simply whether to lower blood pressure, but which treatments work best, who should be treated, and how hypertension-related vascular disease may influence stroke mechanisms and secondary prevention.
This episode discusses: 
Meta-analyses evaluating the efficacy and tolerability of antihypertensive drugs and combinations
Blood pressure lowering in isolated diastolic hypertension
An exploratory analysis of the ARCADIA trial examining high-risk hypertension features and recurrent stroke prevention
Featuring discussion of recent studies published in The Lancet, JAMA, European Heart Journal and JAMA Neurology.
Written by Voice of Stroke Podcast Editor-In-Chief Linxin Li and Co-Editor Maria Magdalena Gabriel.
Read the full transcript here.
References
Ridha M et al. Hypertension With High-Risk Features in Cryptogenic Stroke: An Exploratory Analysis of the ARCADIA Randomized Clinical Trial. JAMA Neurology. 2026.
Bidel Z et al. Blood pressure lowering in isolated diastolic hypertension and cardiovascular risk: an individual patient data meta-analysis. European Heart Journal. 2026.
Wang N et al. Blood pressure-lowering efficacy of antihypertensive drugs and their combinations. The Lancet. 2025.
Wang N et al. Adverse Effects and Treatment Discontinuation of Blood Pressure-Lowering Drugs and Combinations. JAMA. 2026.
Blood Pressure Treatment Efficacy Calculator: https://www.bpmodel.org/blood-pressure-treatment-efficacy-calculator/

In this episode of Voice of Stroke we explore major recent advances in intracerebral haemorrhage research.
This episode discusses:
The TRIDENT trial and long-term blood pressure lowering after ICH
Perihaematomal oedema growth as a biomarker of secondary brain injury
Translational neuroimmunology and inflammatory signalling after haemorrhage
Highlights from the ESO ICH Academy Meeting in Maastricht
Featuring discussion of recent publications in the New England Journal of Medicine, Stroke, and Annals of Neurology.
Written by Voice of Stroke Podcast Editor-in-Chief Linxin Li and Co-editor Annemijn Algra.
Listen on Spotify, Apple Podcasts, and via the European Stroke Organisation website.
Read the full transcript here.

References
1. The Trident Research Group. Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage. N Engl J Med. 2026; 394: 1571-1582. doi: 10.1056/NEJMoa2515043. https://www.nejm.org/doi/full/10.1056/NEJMoa2515043
2. Samarasekera N et al. Perihematomal Edema and Functional Outcome After Intracerebral Hemorrhage: A Meta-Analysis of Individual Participant Data. Stroke 2026; 57: 1310-1324. doi: 10.1161/STROKEAHA.125.053991. https://www.ahajournals.org/doi/epdf/10.1161/STROKEAHA.125.053991
3. Parry-Jones A et al. Hematoma Interleukin-1 ReceptorAntagonist Concentrations PredictLong-Term Outcome in AcuteHuman Intracerebral Hemorrhage. Ann Neurol 2026; 00: 1-16. doi: 10.1002/ana.78237. https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.78237
4. ICH Academy Meeting: https://eso-stroke.org/resources/eso-ich-academy-meeting-iam/

In this episode of Voice of Stroke, we explore the latest evidence shaping stroke prevention in atrial fibrillation (AF) – a condition responsible for up to a quarter of all ischaemic strokes.
This episode examines emerging strategies and unresolved questions in AF management, including:
Whether left atrial appendage closure (LAAC) can replace anticoagulation in patients eligible for oral therapy
The role of catheter ablation in reducing recurrent stroke risk after AF-related stroke
New population data on blood pressure control and stroke risk, particularly in younger AF patients
Key insights:
Anticoagulation remains the cornerstone of stroke prevention, but limitations persist
LAAC may reduce bleeding risk but does not yet clearly outperform anticoagulation in eligible patients
Catheter ablation did not reduce recurrent stroke risk in current trial evidence
Blood pressure is a critical—and potentially under-recognised—driver of stroke risk in AF, especially in younger populations
Together, these findings refine how we approach AF stroke prevention, balancing procedural interventions, pharmacological therapy, and risk factor management.
This episode was written by Voice of Stroke Podcast editor Umberto Pensato and Editor-in-Chief Linxin Li.
Read the full transcript here.

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References 
Landmesser U et al. Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation. N Endl J Med. 2026; 394: 1270-1280. doi: 10.1056/NEJMoa2513310. https://www.nejm.org/doi/full/10.1056/NEJMoa2513310
Doshi SK et al. Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation. N Engl J Med. 2026 Mar 28. doi: 10.1056/NEJMoa2517213 https://www.nejm.org/doi/full/10.1056/NEJMoa2517213
Kimura K et al. Catheter Ablation and Oral Anticoagulation for Secondary Stroke Prevention in Atrial Fibrillation: The STABLED Randomized Clinical Trial. JAMA Neurol. 2026 Mar 2:e260155. doi: 10.1001/jamaneurol.2026.0155. https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745
Jeong MH et al. Impact of blood pressure on the risk of stroke and all-cause mortality in patients with atrial fibrillation across different age groups: a nationwide population-based study. Heart Rhythm. 2026 Mar 24:S1547-5271(26)02172-7. doi: 10.1016/j.hrthm.2026.03.1917. https://www.heartrhythmjournal.com/article/S1547-5271(26)02172-7/fulltext