Evidence tables & additional evidence assessed

The following evidence tables (and additional evidence assessed where applicable) are available for download

Question 1: Does thrombolysis improve functional outcomes in patients with ischaemic stroke with unknown (including wake up stroke) or late time of onset? 

Question 2: Does the use of risk stratified prediction tools (using clinical parameters) in patients with suspected TIA compared to not using risk stratified prediction tools accurately identify patients who are at high early stroke risk? 

Question 3: For patients with ischaemic stroke with anterior circulation large vessel occlusion from 6-24 hours from last seen well, does mechanical thrombectomy plus best medical therapy improve functional outcome compared to best medical therapy alone? 

Question 4: Which diagnostic investigations such as CT Angiography (CTA), MRI, MR Angiography (MRA) and Digital Subtraction Angiography (DSA), should be used and when in patients with acute intracerebral haemorrhage to detect a macrovascular abnormality? 

Question 5: Should the presence of cerebral microbleeds alter the approach to secondary prevention with antithrombotic drugs after ischaemic stroke or transient ischaemic attack? 

Question 6: Should a DOAC be preferred to a VKA in stroke prevention in AF? 

Question 7: What is the role of prolonged cardiac monitoring in the detection of AF in cryptogenic stroke? 

Question 8: What is the optimal management for secondary stroke prevention after intracranial haemorrhage in cerebral amyloid angiopathy? 

Question 9: What is the optimal management for secondary stroke prevention in CADASIL? 

Question 10: For eligible patients with ischaemic stroke and large vessel occlusion, does proceeding direct to mechanical thrombectomy improve functional outcome compared to thrombectomy plus intravenous thrombolysis (IVT) before? 

Question 11: For patients with ischaemic stroke with basilar artery occlusion presenting either within 6 hours or between 6-24 hours of stroke onset, does mechanical thrombectomy in addition to best medical therapy improve functional outcome compared to best medical therapy alone?

Question 12: For patients with ischaemic stroke and large vessel occlusion, does thrombectomy performed under general anaesthesia improve outcome compared to local anaesthesia and/or conscious sedation? 

Question 13: What is the best short term antiplatelet regimen for vascular prevention after TIA or minor stroke? 

Question 14: In patients with Novel Direct Oral Anticoagulant (NOAC) related acute intracerebral haemorrhage, do reversal methods (prothrombin complex concentrate-PCC, fresh frozen plasma –FFP, idarucizumab, andexanet alfa, tranexamic acid and Factor VIIa) improve functional outcome, mortality, haematoma expansion and normalise coagulation testing? 

Question 15: Is tenecteplase at least as good as alteplase for stroke thrombolysis? 

Question 16: What is the best method to prevent recurrent stroke in patients with patent foramen ovale? 

Question 17: What lipid-lowering treatments should be used in people who cannot tolerate statins, or in whom statins do not sufficiently lower cholesterol, after stroke or TIA?  & Question 20: How low should LDL-C be lowered in secondary vascular prevention after stroke and TIA? 

Question 18: Should antiplatelet therapy be used for vascular prevention after ICH? 

Question 19: For patients with ischaemic stroke and large vessel occlusion, does thrombectomy performed under general anaesthesia improve outcome compared to local anaesthesia and/or conscious sedation? 

Question 21: How should eating and drinking be managed towards the end of life after a stroke? 

Question 22: What is the best way to make decisions about artificial feeding and hydration after stroke? 

Question 23: What is the effectiveness of interventions aimed at improving function in people with visual field defects? 

Question 24: What are the staffing requirements for orthoptic services on acute stroke units? 

Question 25: What is the best intensity, frequency and dose of therapy for language recovery in patients with post-stroke aphasia? 

Question 26: What are the most effective treatments for dysphagia after stroke? 

Question 27: What is the best method to improve oral health after stroke? 

Question 28: Does arm functional electrical stimulation after stroke improve outcomes? 

Question 29: Does functional electrical stimulation to the lower limb improve outcomes after stroke? 

Question 30: Does robot-assisted training improve arm function after a stroke? 

Question 31: Does mirror therapy improve arm function after a stroke? 

Question 32: Does mental practice/guided imagery improve arm function after a stroke?  

Question 33: Does treadmill training (+/- body weight support) improve outcome and how should it be delivered? 

Question 34: Does constraint-induced movement therapy improve arm function after a stroke? 

Question 35: Does repetitive task training improve outcome and how should it be delivered? 

Question 36: Does exercise improve outcomes after stroke? How should it be delivered?  

Question 37: Is remotely-delivered therapy as effective as face-to-face therapy after a stroke? Are patients as satisfied with remote therapy as with face-to-face? 

Question 38: What is the best blood pressure treatment target for vascular prevention after stroke? 

Question 39: What is the role of home blood pressure monitoring in managing vascular risk after a stroke? 

Question 40: What is the effectiveness of extended rehabilitation at the end of formal therapy or treatment after a stroke?

Question 41: What staffing levels in post-acute care deliver the best outcomes for people with stroke? 

Question 42: Does assessment and treatment in Mobile Stroke Units (MSU) for suspected acute stroke patients in the out of hospital setting prior to arrival in hospital lead to better functional outcomes, improved thrombolysis and thrombectomy treatment rates with process times and improved survival compared with routine care? 

Question 43: Does transporting people with suspected acute stroke directly to a thrombectomy centre improve outcomes compared to being taken to the patient’s nearest acute stroke centre? 

Question 44: Is the use of MRI with DWI cost effective in identifying patients at high stroke risk compared with standard CT brain imaging in patients with suspected TIA? No table available – insufficient evidence. 

Question 45: What is the best antithrombotic treatment to prevent short-term vascular events and stroke after cervical artery dissection? 

Question 46 What should be the first-line imaging for acute stroke? No table available – addressed as a consensus question. 

Question 47: What is the best treatment for post-stroke depression? Question 48: What is the best method to prevent post-stroke depression? Question 49: Do interventions aimed at treating anxiety after stroke improve outcomes?  

Question 50: Do interventions aimed at treating post-stroke apathy improve outcomes?  previously How should clinicians screen for and treat post-stroke apathy? 

Question 51: What are the effects of different management strategies for post-stroke fatigue? 

Question 52: What is best way to support people with stroke to return to work? 

Question 53: Does vagal nerve stimulation improve outcomes after stroke? 

Question 54: What is the effectiveness of intensive arm recovery programmes after stroke? No table available – insufficient evidence. 

Question 55: What is the effectiveness of technological methods for the treatment of post-stroke aphasia? 

Question 56: Does person-centred self-directed rehabilitation reduce dependency after stroke? 

Question 57: For nutritionally vulnerable stroke patients, does nutritional support result in improved outcomes? 

Question 58: For patients with stroke receiving nasogastric feeding, is a nasal bridle or other restraining device associated with improved outcomes? 

Question 59: For patients with stroke, do protocols/practices that support eating and drinking at accepted/acknowledged risk improve care or patient experience?