More serious sequelae and more deaths. French stroke specialists are surprised to find that Covid-19 is aggravating this health problem in different ways.
- With Covid-19, strokes are more serious, less well treated, less operated and recur more often.
- Stroke specialists advocate for the maintenance of an effective chain of relief and the development of alternative treatments.
A study conducted throughout France over a period from the start of the epidemic to the first weeks of confinement shows that Covid-19 greatly aggravates strokes.
More severe strokes
First, the medical imaging performed on emergency patient arrival showed more serious strokes, with occlusion of the large arterial trunks. “We also saw patients who had a stroke and, simultaneously, an occlusion of an artery in a leg. It is very particular”, says Dr. Michael Obadia, neurologist. “One hypothesis is that Covid-19 was an aggravating factor in a subtype of stroke with occlusion of large vessels, possibly of atheromatous origin”, continues the specialist.
In patients with Covid-19, the characteristics of the clots appear to have rendered thrombolysis ineffective. “Thrombolysis did not work on any stroke with occlusion of large vessels among the patients we treated”, explains Dr. Simon Escalard, interventional neuroradiologist. He specifies : “for strokes with occlusion of large arteries, the occurrence of several simultaneous arterial occlusions was frequent, making thrombectomy more complicated. The rate of multiple occlusions was 50% in Covid-19 patients compared to 8 to 9% of cases in normal time”. These patients were more severe, with a poor clinical prognosis.
A 2nd stroke within 24 to 48 hours
Furthermore, despite satisfactory treatment in the acute phase, 40% of patients presented with a 2nd stroke within 24 to 48 hours, which is usually very rare.
Finally, the experts note a significant reduction in the number of strokes treated by mechanical thrombectomy (reduction of 21% out of 1,513 patients included in 32 centres) as well as a worrying increase in treatment times.
“Everything seems more serious and deteriorating much faster with Covid-19. All the limits of our treatments have been exacerbated in this context”, summarizes Dr. Jean Philippe Désilles, interventional neuroradiologist. “In fact, excess mortality was observed as well as an increase in disability in patients who survived. We also observed an intra-hospital mortality rate of 42% versus 12% in 2019, with identical care” , he adds.
“Quickly offer alternatives to the usual treatments”
Stroke is both an absolute medical emergency and a major public health issue (1st cause of death among women in Europe and 1st source of disability in France). Rapid and expert care is essential, because every minute of delay is deleterious, causing the destruction of neurons and irreversible damage to the brain.
“At a time when a second wave of stroke patients and positive Covid patients is announced, it is important to maintain an effective chain of help through the immediate call of 15 in the event of any symptom suggestive of stroke. Being able to quickly offer alternatives to the usual treatments, which are mostly ineffective in the event of Covid infection, is a major therapeutic challenge for these patients. concludes Dr. Candice Sabben, neurologist.
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