Background. - Studying changing patterns in stroke incidence is essential since strokes represent a burden for public health. The aim of our study was to evaluate the epidemiological trend of strokes from 2008 to 2018 in the population-based Brest Stroke Registry (BSR) focusing on patients under 60. Methods. - All first-ever-stroke, patients aged 15 and older, with imaging, in the Pays -deBrest from January 1st 2008 to December 31st 2017 were included. Cumulative incidence was calculated, by periods of two years, and temporal trends were evaluated by age group, sex, stroke subtype (ischemic or hemorrhagic) using a Poisson regression. Trends in stroke variables were specifically studied for young people. Ischemic stroke mechanism subtypes were analysed according to TOAST and SSS-TOAST classifications. Results. - Over a 10-year study period, there were 6043 first-ever-strokes: 738 intracerebral hemorrhage (ICH) and 5305 ischemic strokes (IS). Mean age was 73.55 +/- 14.25 years, 82.2% were older than 60 and 51.8% were women. IS incidence increased in young people from 30.4 [95% CI: 27.4; 33.8] to 37.3 [95% CI: 33.9; 41.0] per 100,000 inhabitants (P = 0.0025). IS incidence >= 60 decreased except for last studied period. ICH remained stable for older people but decreased in young from 5.6 [4.3; 7.1] to 2.8 [2.0; 4.0] per 100,000 inhabitants (P = 0.0250). Under 60, the main risk factors were smoking (68.6%); hypertension (27.8%); high-alcohol intake (24.4%) and dyslipidemia (21%). Most IS were minor. Work-up in the IS young population was for the large majority brain magnetic resonance imaging (MRI) (74.5%); cardiac monitoring (80%): echocardiography (83.5%); and imaging of the neck vessels (89.9%). Among IS, 19.8% were taking antihypertensive drugs and 10.9% statins. According to the TOAST classification, there were 46.7% cryptogenic strokes, which was reduced to 25.5% for other cryptogenic strokes, and 2.3% for cryptogenic embolism according SSS-TOAST classification. In IS, risk profiles, clinical parameters and prior-stroke treatments did not significantly change. Dyslipidemia and use of statins were fluctuant. Diagnostic work-up improved but the frequencies of IS mechanism subtypes remained stable.

BACKGROUND:Since 2015, mechanical thrombectomy (MT) is indicated as a treatment for patients with large vessel occlusion (LVO) at the acute phase of ischemic stroke. However, the number of stroke patients eligible for MT is poorly known. OBJECTIVE:The objective of our study was to estimate the number of patients eligible for thrombectomy within the first 24hours of an ischemic stroke, based on the clinical National Institute of Health Stroke Scale (NIHSS). METHOD:Our study concerned all ischemic strokes which occurred between January 2013 and December 2016 recorded in the population-based Brest Stroke Registry (BSR). Based on positive predictive value and negative predictive value from articles evaluating the performance of a defined NIHSS threshold to identify LVO, we first estimated the frequency of patients with LVO and then the frequency of patients eligible for MT depending on pre-stroke modified Rankin score (mRS). Our results were extrapolated to regions of metropolitan France. Two scenarios were considered: one called "stringent criteria" with mRS ≤1 and one called "real-life" criteria with mRS ≤2. RESULT:We analyzed data from 2,025 ischemic strokes with symptom onset ≤24hours. No statistical difference between patient characteristics according to the time of hospital admission (≤6H vs. 6-24H) was observed. Based on NIHSS scores, between 23.90% and 44.20% of ischemic strokes admitted within the first six hours had LVO clinical characteristics. Among them, 14.53% to 26.87% met the ``stringent eligibility'' criteria for MT and 16.9 to 31.25% for ``real-life'' criteria. Eligible patients represented 6.32% to 11.70% of all ischemic strokes, irrespective of admission time. In France, 75 to 162 persons per million inhabitants per year were eligible for endovascular therapy, depending on including criteria. Based on activity levels recorded by the French Neuroradiology Society (SFNR) in 2018, the estimated needed increase in MT showed a heterogeneous pattern region-by-region, with the greatest need in Brittany, Pays de la Loire, and Corsica. CONCLUSION:Based on NIHSS, our study provides coherent information concerning the estimated number of MT procedures to be performed in France: 4,877 to 10,494 ischemic strokes would be eligible each year in metropolitan France compared to the 6,596 thrombectomy procedures actually performed in 2018. Depending on the region, an estimated 10-20% to 90-100% increase in MT activity would be necessary to meet patient needs. These data suggest that there is still room for improvement in thrombectomy activity, particularly in certain regions of France, to allow equal access to MT to the entire French population.

Introduction: The present study sought to identify factors affecting mortality beyond 28 days in ischaemic stroke patients with whatever ischaemic mechanism.Patients and methods: A prospective population-based registry was set up in Brest County, Brittany, France. Demographic data, clinical presentation, vascular risk factors and mortality were collected from January 2008 to December 2012. At "home without help'' was used as a surrogate marker for low Rankin (0-1) at discharge from the hospital. IS was classified on the TOAST classification. Overall mortality was calculated using the Kaplan-Meier method. Multivariate analysis of mortality beyond 28 days was implemented, using a Cox model, on significant risk factors identified on univariate analysis.Results: About 3024 IS cases were followed up beyond 28 days. Overall mortality beyond 28 days was 38.49% at 60 months. On multivariate analysis, age (10 years: HR = 1.84; [1.66-2.02]), coronary artery disease (HR = 1.28; [1.05-1.56]), cardiac arrhythmia (HR = 1.36; [1.11-1.67]), peripheral artery disease (HR = 1.66 [1.29-2.13]) and incomplete assessment (HR = 1.39; [1.12-1.74]) were associated with higher mortality risk, whereas female gender (HR = 0.80; [0.68-0.94]), high Glasgow Coma Scale score (GCS > 12) (HR = 0.58; [0.45-0.76]), lacunar syndrome (HR = 0.82; [0.68-0.99], being 'at home without help' (HR = 0.50; [0.41-0.59]) and negative assessment (HR = 0.75; [0.58-0.97], compared to cardioembolism) were associated with better survival probability.Discussion: Initial clinical status, prior cardiovascular diseases and age was associated with more risk of death: an increment of 10 years almost doubled mortality. Women had more survival probability than men, controlling for age. Ischaemic stroke mechanisms were predictors of late 5-year mortality.Conclusion: Patients with negative assessment, i.e. representing truly cryptogenic ischaemic stroke, had the best survival probability probably due to fewer atherosclerotic markers.