ESO Voice of Stroke

Atrial Fibrillation and Stroke Prevention – What's New?

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: https://eso-stroke.org/wp-content/uploads/ESO-Podcast-EP3_Transcript.pdf [https://eso-stroke.org/wp-content/uploads/ESO-Podcast-EP3_Transcript.pdf] ----- 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 [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 [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 [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 [https://www.heartrhythmjournal.com/article/S1547-5271(26)02172-7/fulltext]

What's new in the field of lipids, and can it help us prevent stroke?

In this episode of Voice of Stroke, we explore new evidence shaping how lipid management can reduce stroke risk across both primary and secondary prevention. This episode explores: * Reassessing statin side effects using large-scale randomised trial data * The role of PCSK9 inhibition (VESALIUS-CV) in reducing vascular events in high-risk patients without prior stroke * Long-term data linking LDL, lipoprotein(a), and inflammation to stroke risk decades later Together, these findings clarify safety concerns, expand preventive options, and highlight the importance of long-term risk prediction in stroke care. This episode was written by Linxin Li, Editor-in-Chief of the Voice of Stroke Podcast, and Co-Editor Ahmad Nehme. Note: Full transcript available here. [https://eso-stroke.org/wp-content/uploads/ESO-Podcast_EP2_Transcript.pdf] The following publications were mentioned in this podcast: * NEJM paper on the VESALIUS-CV trial [https://www.nejm.org/doi/full/10.1056/NEJMoa2514428] * Lancet paper on statin side effects [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01578-8/fulltext] * Lancet Neurology paper on prediction of long-term stroke risk [https://www.sciencedirect.com/science/article/pii/S1474442225003060] * 2026 AHA/ACC guideline on lipid management [https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423] * International Journal of Stroke review on lipid management [https://journals.sagepub.com/doi/10.1177/17474930261418388]

Beyond the Window – What ISC 2026 Tells Us About Treating Stroke Earlier or Later

In this first episode of Voice of Stroke, we examine three key trials presented at ISC 2026 that challenge how we define time boundaries in acute stroke care. This episode explores: · Extending intravenous thrombolysis beyond 4.5 hours in non-large vessel occlusion stroke (OPTION) · Tenecteplase within 24 hours for basilar artery occlusion (TRACE-5) · Ultra-early recombinant factor VIIa in intracerebral haemorrhage (FASTEST) Together, these trials refine our understanding of patient selection, risk, and benefit across ischaemic and haemorrhagic stroke. This month's Voice of Stroke episode was written by Linxin Li, Editor-in-Chief of the Voice of Stroke Podcast. Read the full transcript here: https://eso-stroke.org/wp-content/uploads/ESO-podcast_EP1_Transcript.pdf [https://eso-stroke.org/wp-content/uploads/ESO-podcast_EP1_Transcript.pdf]

Welcome to the Voice of Stroke Podcast

Welcome to Voice of Stroke, brought to you by the European Stroke Organisation. Your fast, reliable update on the science driving stroke care forward. Each month, we spotlight key papers from the world's leading journals and discuss how it can inform and refine clinical practice. From breakthrough randomised controlled trials to cross-disciplinary insights, Voice of Stroke brings you concise, evidence-based takeaways — straight from the front lines of research.