Du 22 au 24 Mai 2019, plus de 4500 participants venus du monde entier, et 1800 résumés soumis et résultats d’essais cliniques ont été présenté à l'occasion de la Conférence Européenne sur les Accidents Vasculaires Cérébraux.
ESOC est un événement mondial incontournable permettant aux cliniciens et aux scientifiques de présenter, discuter et échanger des compétences sur le sujet de l'AVC en rapide évolution. Cette année, plusieurs membres du laboratoire HESPER ont présenté leurs travaux lors du 5ème Congrès ESOC qui a eu lieu à Milan.
Claire Della Vecchia, PhD student
Preventing participation restrictions after stroke: investigation of coping behaviors strategies used by patients as determinants of participation after mild and moderate/severe stroke
C. Della Vecchia1, M. Préau2, A. Termoz3, J. Haesebaert3, M. Viprey3, A. Dima4, A.M. Schott3.
1University Lyon 1 / University Lumiere Lyon 2, University Claude Bernard Lyon 1- HESPER EA 7425 / GRePS EA 4163, Lyon / Bron, France.
2University Lumiere Lyon 2 / University of Aix-Marseille, GRePS EA 4163 / INSERM UMR 912 SESSTIM, Bron / Marseille, France.
3University Lyon 1 / Hospices Civils of Lyon, University Claude Bernard Lyon 1- HESPER EA 7425 / Public Health Department, Lyon, France.
4University of Lyon, University Claude Bernard Lyon 1- HESPER EA 7425, Lyon, France
Background and Aims: The WHO International Classification of Functioning, Disability and Health (ICF) defines participation restrictions as “problems individuals experience in involvement in life situations”. Disabled individuals develop specific behaviors and actions to manage consequences of disabilities in daily life: this is called coping. As it was suggested that coping is a determinant of participation in some disabling conditions, we investigated coping strategies as determinants of participation in mild and moderate/severe stroke patients.
Methods: Self-administered questionnaires were sent at 6 months post-stroke to mild and moderate/severe stroke patients from the Stroke 69 cohort. Participation was measured with the Stroke Impact Scale (SIS.2.0) (0 to 100 (=excellent participation)), and coping strategies with the Brief Cope (4 dimensions: positive thinking, problem solving, avoidance, and seeking for social support). Univariate and multivariate linear regression analyses adjusted for potential confounders were performed.
Results: Among the 122 respondents, 83 had mild stroke (NIHSS ≤ 6) and 39 had a moderate/severe stroke. The two groups were similar regarding the significant association of positive thinking (acceptance, humor and positive reframing) and better participation (p<0.05). They were different regarding problem solving (active coping and planning) associated with higher participation score (β=2.9, p<0.05) only in moderate/severe stroke group, and avoidance which was negatively associated with participation (β=-4.2, p<0.05) only in mild stroke group.
Conclusions: We identified similar and different coping strategies associated with participation restrictions in mild vs moderate/severe stroke patients. This could help to design rehabilitation program and appropriate support which specifically address coping strategies improvement to prevent participation restrictions.
Julie Haesebaert, Medical Doctor, Assistant Professor
Gender inequities in stroke, does thrombectomy change the deal?
J.Haesebaert, MD, PhD1,2, A. Termoz, MPH1,2, M. Viprey, PharmD, PhD1,2, E. Bravant, MPH1,2 , N. Perreton, MPH2, N. Nighoghossian, Professor, MD, PhD3 L. Derex, MD, PhD1,3, A.M. Schott, Professor, MD PhD 1,2
- Univ Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon
- Hospices Civils de Lyon, Public Health Department, F-69003 Lyon, France
- Hospices Civils de Lyon, Stroke Medicine Department, Bron, France
Introduction: Implementation of mechanical thrombectomy leads to new stroke care organization challenges. It is necessary to ensure that this won’t increase inequities in access to reperfusion therapies at acute phase. We aimed to study gender inequities in access to thrombectomy in a French prospective population-based cohort study.
Methods: All patients managed for confirmed ischemic stroke (IS) from November 2015 to December 2016 in the Rhône French county were prospectively included in the STROKE69 cohort (NCT02596607). We studied patients and stroke characteristics, management times, access to thrombectomy and 3-Month outcome (good for mRS=0-2) according to gender.
Results: The 1543 included IS patients comprised 766 (49.6%) women and 777 (50.4%) men. Women were older (mean age+/-SD 78+/-14.5 versus 70.5+/-14.3, p<0.001), and more severe at admission (NIHSS>=15 22% versus 16%, p=0.005) than men. They less frequently called emergency medical services (54% versus 64%, p<0.001) and were less managed in stroke unit (54% versus 68%, p<0.001) than men. Prehospital times were not significantly different but door-to-imaging time was longer for women than men (2h40 versus 2h27, p=0.01). Finally, for women versus men respectively, 9% versus 11% were treated with thrombectomy (adjusted OR*=0.9 (0.6-1.3), p=0.627), 22% versus 26% were treated with thrombectomy and/or thrombolysis (adjusted OR*=0.9 (0.7-1.2), p=0.537) and 51.7% versus 68.5% had good 3-month outcome (adjusted OR*=1.3 (0.9-1.9), p=0.093).
Conclusion: Disparities in stroke features and acute care pathway existing between gender do to not translate in differences in reperfusion strategies access or 3-month outcome.
* adjusted on age and NIHSS at admission.
Is there an association between social deprivation and access to stroke reperfusion therapy? French population based cohort study.
Background and Purpose. A number of studies found an association between socio-economic status of individuals and poorer stroke management. However, few focused specifically on acute ischemic stroke (IS) treatment with controversial results. The aim of the present study was to determine whether social deprivation was associated with a poorer access to reperfusion therapy, either intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) in a population-based cohort.
Methods. Between November 2015 and June 2016, all consecutive patients aged over 18 years with a suspected acute stroke admitted to any emergency department (ED) or stroke unit (SU) of the Rhône area were prospectively included in the STROKE 69 cohort. In the present study only patients with confirmed IS were included. The socioeconomic status was measured for each patient using the European Deprivation Index (EDI). We conducted multivariate logistic regression analysis adjusted for potential to assess the association between EDI and access to reperfusion therapy.
Results. A total of 1231 consecutive IS patients were included, 241 (19.6%) received a reperfusion therapy. Compared to patients who did not receive reperfusion therapy, 27.0% of the treated patients were deprived (level 5 of EDI) and the difference was not statistically significant (adjOR 1.08 (95%CI 0.64-1.82). Among other potential risk factors a direct admission in a comprehensive stroke center and a high stroke severity (NIHSS>=20) were associated with a higher access to reperfusion therapy, adjOR 2.99 (95% CI 1.59-5.64), and adjOR 3.31 (95% CI 1.47-7.45) respectively.
Conclusions. Although several studies have found social deprivation associated with a less good quality of care of acute IS patients, we did not find in this population-based cohort any significant association between socioeconomic deprivation and access to reperfusion therapy. This might suggest that the successive national plans to improve acute stroke management have been somewhat successful concerning social inequities reduction.
Aurélie Rochefolle, interne en pharmacie hospitalière
Evaluation de la poursuite du traitement de prévention secondaire post-AVC, primordial pour éviter la récidive d’AVC.
Background and Aims: One of the main challenges after ischemic stroke (IS) is to prevent recurrence by controlling risk factors such as hypertension, diabetes, dyslipidemia and atrial fibrillation. In this way, secondary prevention treatments are effective but adherence of patients constitutes a key issue. This study describes the persistence of different secondary prevention treatments during the first year post-stroke.
Methods: All IS patients admitted in any emergency department or Stroke Unit (SU) of the Rhône are (France) were included in the STROKE69 cohort (November 2015 - December 2016). Data on treatment prescription at hospital admission and upon hospital discharge were collected from medical files. Data on treatment prescriptions at 3 and 12 months were collected by a mailed self-questionnaire and telephone interview with the patient and/or his/her caregiver.
Results: The analysis was conducted within the 374 IS patients who were managed in a SU. Men represented 62% (n=231) and mean age was 68.2±14.7 years. At 12 months, the number of patients under treatment decreased respectively from 64 to 48% (-16%) for antihypertensive treatment, from 77 to 49% (-28%) for lipid lowering drugs, from 93 to 64% (-29%) for antiplatelets or anticoagulants and from 13 to 8% (-5%) for antidiabetics. Antiarrhytmics increased from 2 to 3% (+1%). Most treatment stops occurred in the first three months.
Conclusions: These results suggest that preventive treatments after an IS are not appropriately maintained over time. We have to further investigate the reasons for these stops: control of risk factors, non-persistence due to patient or to physician (non-adherence to guidelines).
Yufeng Xue, PhD student
Initial brain imaging type choice in acute suspected stroke patients: current status and associated factors
Background and Aims: Brain imaging is recommended for patients with suspected stroke for appropriate management and treatment in the acute phase. Both computed tomography (CT) and Magnetic resonance imaging (MRI) could be a reasonable initial choice as brain imaging. For medical centers with both techniques available, the choice may be associated with factors related to patients, to stroke symptoms and severity or to management organization.
Methods: The study was performed within the database of STROKE 69, a population-based cohort study of all adult patients with suspected stroke admitted within the 24 hours after symptoms onset in one of the emergency departments (ED), Primary Stroke Center (PSC) or comprehensive stroke center (CSC) of the Rhône county from November 2015 to December 2016. To identify factors associated with the choice of initial brain imaging, a multivariate logistic regression was performed.
Results: Among the 3244 patients with suspected stroke enrolled in STROKE69 cohort, 95.8% underwent brain imaging within the first 24h, among those, 74.6% had CT as initial choice versus 25.4% who had an MRI. In multivariate analyses, several factors were associated with a lower probability of having an MRI as initial brain imaging vs CT. These were either patients’ characteristics such as older age (> 80 years old, OR: 0.39 [95%CI, 0.29 to 0.54], P < 0.01), history of other ischemic heart disease (OR: 0.60 [95%CI, 0.36 to 0.98], P = 0.045), preexisting disability (OR: 0.56 [95%CI, 0.36 to 0.85], P = 0.008), without history of dyslipidemia (OR: 0.74 [95%CI, 0.55 to 1.00], P = 0.048), use of anticoagulants (OR: 0.52 [95%CI, 0.33 to 0.80], P < 0.01) or symptoms characteristics such as wake-up stroke (OR: 0.42 [95%CI, 0.30 to 0.58], P < 0.01) or factors associated with overall management such as longer onset-to-door time (> 6 hours, OR: 0.38 [95%CI, 0.23 to 0.60], P < 0.01), initially admitted to ED or ICU (ED, OR: 0.03 [95%CI, 0.02 to 0.04], P < 0.01; ICU, OR: 0.02 [95%CI, 0.001 to 0.08], P < 0.01), transported personally (OR: 0.65 [95%CI, 0.44 to 0.95], P = 0.03) and admitted during working hours ((OR: 0.65 [95%CI, 0.50 to 0.84], P < 0.01).
Conclusions: Beside accessibility, this study showed that a number of other parameters could influence the choice or first imaging in front of a stroke suspicion which are linked to patients’ characteristics, type of stroke symptoms and type of organization.