ESO annual stroke evidence update 2025.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Stroke Medicine

Background:

• Stroke medicine is rapidly evolving with new evidence.
• The European Stroke Organisation (ESO) provides updates to bridge guideline revisions.
• These updates synthesize recent advances to inform stroke care.

Purpose of the Study:

• To synthesize new evidence published in 2025 across key stroke domains.
• To identify advances in acute treatment, prevention, rehabilitation, imaging, systems of care, and outcomes.
• To provide a curated overview of recent developments in stroke management.

Main Methods:

• Searched major stroke and internal medicine journals.
• Reviewed abstract proceedings from international stroke conferences.
• Selected studies based on methodological quality, clinical relevance, and potential impact.

Main Results:

• Endovascular thrombectomy showed no benefit for Moyamoya disease (MeVO) strokes.
• Tenecteplase before thrombectomy improved outcomes for Large Vessel Occlusion (LVO) strokes.
• Early intensive blood pressure lowering in acute Intracerebral Hemorrhage (ICH) improved functional recovery.
• Triple-pill therapy and early DOAC initiation reduced recurrent strokes.
• Factor XIa inhibitor asundexian reduced ischemic stroke risk.
• Mobile stroke units are cost-effective in high-volume systems.
• Brain stimulation and training show promise for post-stroke cognitive impairment.

Conclusions:

• No routine role for EVT in MeVO.
• Tenecteplase is reinforced for LVO bridging thrombolysis.
• Early intensive blood pressure lowering is strengthened for acute ICH.
• Further research needed on EVT subgroups, intra-arterial thrombolysis, and imaging selection pathways.