28 September 2023
Press
In France, somebody has a stroke every 4 minutes. To mark World Stroke Day, experts from the StrokeLink network (F-CRIN) reviewed the latest advances in French clinical research into preventive and curative treatments for strokes.
An interview was conducted in collaboration with Pr Charlotte Cordonnier (Neurologist, Lille University Hospital, StrokeLink coordinator), Pr Jean-Marc Olivot (Neurologist, Toulouse University Hospital, StrokeLink co-coordinator), Pr Isabelle Bonan (President of the SOFMER*, Rennes University Hospital), Pr Karim Tazarourte (President of the SFMU**, Lyon University Hospital) and Pr Benjamin Gory (Neuroradiologist, Nancy University Hospital).
What is a stroke? How many patients are affected by strokes in France and around the world?
Stroke is the leading cause of acquired physical disability in adults and the leading cause of death in women in France. Every year in France, around 150,000 people suffer a stroke. That’s one person every 4 minutes! Around 30% of patients die within a year of their stroke, and 70% suffer disabling after-effects. Strokes are therefore a major public health issue. There are two main types of stroke: ischaemic strokes or cerebral infarctions (80% of cases) caused by the blockage of a cerebral artery; and haemorrhagic strokes (20% of cases) caused by the rupture of a cerebral blood vessel. A stroke is a medical emergency that requires immediate treatment to limit the after-effects: EVERY MINUTE COUNTS! In France, the first step is to dial 15 to reach the emergency services and get the patient as quickly as possible to one of the 130 neurovascular units specialising in stroke treatment across France, which are open 24/7.
What treatments or solutions are currently available for these patients?
Treatment depends on the type of stroke, with the decision being made after brain imaging (CT scan or MRI). If an artery in the brain is blocked (cerebral infarction), a drug can be injected to dissolve the clot (intravenous thrombolysis). If one of the main arteries is blocked, the neuroradiologists operating on the patient will catch the clot from inside the vessels. These treatments have revolutionised the prognosis of patients with cerebral infarctions: 40% of patients treated by thrombolysis followed by mechanical thrombectomy will have no after-effects when they are discharged from hospital.
They will need treatment after discharge, in order to prevent a recurrence. This treatment will take account of the cause of the stroke as well as individual vascular risk factors (high blood pressure, high cholesterol, diabetes, etc.). In order to learn to walk or talk again, patients receive rehabilitation care. This is essential to limit the after-effects. Today, strokes are no longer inevitable.
How can we prevent strokes?
Several risk factors exist, including obesity, smoking and cholesterol. The main risk factor is high blood pressure. We advise everybody to have their blood pressure checked because more than half of those with high blood pressure are unaware of their condition. We recommend a healthy lifestyle and a balanced diet (fruit and vegetables, fish and white meat, home-cooked meals), low alcohol consumption, no smoking and regular exercise.
What role does StrokeLink play?
The StrokeLink network is a national multidisciplinary clinical research network specialising in strokes. The role of the network, which received F-CRIN accreditation in 2022, is to facilitate the design, funding and organisation of research studies and clinical trials in the field of strokes. StrokeLink brings together fundamental research units and hospital departments in the fields of neurology, emergency care, interventional and diagnostic neuroradiology, neurosurgery, neuroanesthesia, and rehabilitation. This multidisciplinary network provides the infrastructure required to initiate and coordinate ambitious industrial and academic clinical trials.
What ongoing clinical trials is STROKELINK involved in concerning strokes?
In 2022, we took part in a number of studies, including a global study into the emergency care provided in the event of brain haemorrhages (TICH3-Fr), and a study to assess the benefits of thrombectomy in patients suffering extensive cerebral infarction with a significant ischaemic penumbra*** (FRAME LP). Other studies are scheduled to start in 2023, involving in particular the study of new compounds to reduce the risk of recurring cerebral infarction, in collaboration with industrial partners. Stroke research requires international collaboration. This year, our network joined the European Stroke Organisation Trials Alliance (ESOTA), which will give French patients rapid access to innovative therapies developed by European consortia.
Why was 2022 a strategic year for strokes?
The emergence of a research network bringing together all those involved in the treatment of strokes brings real hope for stroke victims. Working with medical associations to raise public awareness is a fundamental requirement. Everybody should be able to recognise the signs of a stroke, which appear suddenly. Just one sign is enough: F - facial drooping; A - arm weakness; S - speech difficulties; T - time. It is essential to call the emergency services immediately in order to limit any after-effects: every minute counts – dial 15 FAST.
How is the F-CRIN network contributing to work on the disease?
In terms of research into neurovascular diseases, our network is now able to support each step in the development of clinical research projects on strokes. This accreditation will enable us to raise the profile of our stroke research teams and make France part of an extensive international ecosystem. Joining the national infrastructure of F-CRIN has also opened up opportunities for collaboration with the other accredited networks working on the same themes.
StrokeLink is a multidisciplinary research network specialising in stroke. Accredited by F-CRIN, it is coordinated by Prof Charlotte Cordonnier (Lille University Hospital) and Prof Jean-Marc Olivot (Toulouse University Hospital). Currently made up of around 20 centres in France, StrokeLink has already contributed to several major clinical trials and aims to promote research beyond university hospitals in order to recruit new patients, which is essential for the development of new drugs and treatments, both nationally and internationally. On the international level, the network’s members are already taking part in the Global Alliance of Independent Networks focused on Stroke trials (GAINS) and the European Stroke Organisation Trialists Alliance (ESOTA). StrokeLink also plans to collaborate with other expert centres abroad, in particular in the United Kingdom, Germany, Spain, Canada, Australia, and the United States.
The French Clinical Research Infrastructure Network (F-CRIN) is a network of excellence created in 2012 at the initiative of INSERM with financial support from the French National Research Agency (ANR), the French Ministry of Health, university hospitals, universities, foundations, and private stakeholders. Its aims are to boost the international competitiveness of French clinical research, identify and accredit research networks, facilitate the implementation of academic and industrial clinical trials, and develop the expertise of clinical researchers by pooling know-how, objectives, and resources. The network, which has a national coordination unit based in Toulouse, has already accredited and currently brings together 16 clinical investigation networks targeting diseases of general international interest (Parkinson's, sepsis, severe asthma, thrombosis, obesity, cardio-nephrology, multiple sclerosis, retinal diseases, autoimmune diseases, vaccinology, cardiology, stroke, psychotic disorders, atopic dermatitis, childhood diseases, amyotrophic lateral sclerosis), three expertise and methodology networks (rare diseases, medical devices, epidemiology) and a customised support platform offering all the services needed to conduct clinical trials. All in all, F-CRIN represents a strike force of more than 1,400 clinical research professionals. For more information: https://www.fcrin.org/
* French Society of Physical Medicine and Rehabilitation
** French Society of Emergency Medicine
*** Area of the brain affected by stroke, where oxygen is lacking
Contact presse : EVE’VOTREDIRCOM – servicepresse@votredircom.fr - 06 62 46 84 82
