1
|
Achour J, Reche M, Valbuena T, Chapuis C, Guillon B, Galet O, Adel-Patient K, Bernard H, Hazebrouck S. Sunflower seed allergy: Identification of novel 2S-albumins as potential marker allergens. Allergy 2024. [PMID: 38619510 DOI: 10.1111/all.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Affiliation(s)
- J Achour
- Université Paris Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé, Gif-sur-Yvette, France
| | - M Reche
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - T Valbuena
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - C Chapuis
- Université Paris Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé, Gif-sur-Yvette, France
| | - B Guillon
- Université Paris Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé, Gif-sur-Yvette, France
| | - O Galet
- Avril SCA 11/13, rue de Monceau, Paris, France
| | - K Adel-Patient
- Université Paris Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé, Gif-sur-Yvette, France
| | - H Bernard
- Université Paris Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé, Gif-sur-Yvette, France
| | - S Hazebrouck
- Université Paris Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé, Gif-sur-Yvette, France
| |
Collapse
|
2
|
Sablot D, Touzé E, Ellie E, Alamowitch S, De Broucker T, Guillon B, Sellal F, Crozier S, Sibon I. Medical demography at stroke centers: Current situation in France. Rev Neurol (Paris) 2024; 180:171-176. [PMID: 37880036 DOI: 10.1016/j.neurol.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/20/2023] [Accepted: 08/23/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Following the 2010-2014 French national stroke action plan, the number of stroke center (SC) has gradually increased in France, allowing a homogeneous coverage and access to neurovascular care in organized and territorially defined structures. However, operational difficulties within SCs have been progressively reported over the last few years. The objective of this study was to identify the medical staff shortages in SC that may contribute to these difficulties. METHODS A survey on the medical staffing level as of January 1, 2021 was sent to all French SC managers. Specific questions related on vacancies, need of interim medical staff, and participation in out-of-hour healthcare services. RESULTS Among the 139 SC managers contacted, 122 (88%) filled in the questionnaire. Analysis of the data showed that over 879 physician positions opened, 163 (18.5%) remained vacant for a mean of two years, and that in 51 SCs (41.9%), more than two positions were unfilled. In 13 of these 51 SCs, the out-of-hour healthcare services relied on less than four practitioners, defining a critical situation, and three other SCs had to close temporarily (2) or permanently (1). Moreover, 39.2% of SCs with at least one vacancy used interim physicians, for a median period of 12.5 weeks/year (IQR 5-18). CONCLUSION This study highlights the significant medical staff shortage in French SCs. In the absence of urgent measures, more SCs will close, jeopardizing the regional network and access to care for stroke patients.
Collapse
Affiliation(s)
- D Sablot
- Service de neurologie, hôpital St-Jean, Perpignan, France.
| | - E Touzé
- Stroke Unit, CHU de Caen, université de Caen, Caen, France
| | - E Ellie
- Service de neurologie, hôpital de la côte basque, Bayonne, France
| | - S Alamowitch
- Département des urgences cérébrovasculaires, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - T De Broucker
- Service de neurologie, hôpital Delafontaine, St-Denis, France
| | - B Guillon
- Stroke unit, hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - F Sellal
- Service de neurologie, hôpital Louis-Pasteur, Colmar, France
| | - S Crozier
- Département des urgences cérébrovasculaires, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - I Sibon
- Stroke unit, CHU de Bordeaux, université de Bordeaux, Bordeaux, France
| |
Collapse
|
3
|
Olindo S, Gaillard N, Chausson N, Turpinat C, Dargazanli C, Bourgeois-Beauvais Q, Signate A, Joux J, Mejdoubi M, Piotin M, Obadia M, Desilles JP, Delvoye F, Holay Q, Gory B, Richard S, Denier C, Robinet-Borgomano E, Carle X, Desal H, Guillon B, Viguier A, Lamy M, Pico F, Landais A, Boulanger M, Renou P, Gariel F, Jean P, Yann L, Papillon L, Marnat G, Smadja D. Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry. Int J Stroke 2024; 19:180-188. [PMID: 37724713 DOI: 10.1177/17474930231204343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented. AIMS In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. METHODS CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study. RESULTS Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2-15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27-14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24-0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89-0.97), p = 0.001). CONCLUSION CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials.
Collapse
Affiliation(s)
- Stephane Olindo
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Nicolas Chausson
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Cedric Turpinat
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | | | - Aissatou Signate
- Department of Neurology, University Hospital of Martinique, Fort-de-France, France
| | - Julien Joux
- Department of Neurology, University Hospital of Martinique, Fort-de-France, France
| | - Mehdi Mejdoubi
- Department of Neuroradiology, University Hospital of Martinique, Fort-de-France, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mickael Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Quentin Holay
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Gory
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | | | | | - Xavier Carle
- Department of Neurology, Hôpital de La Timone, Marseille University Hospital, Marseille, France
| | - Hubert Desal
- Department of Neuroradiology, Nantes University Hospital, Nantes, France
| | - Benoit Guillon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Alain Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Matthias Lamy
- Department of Neurology, Poitiers University Hospital, Poitiers, France
| | - Fernando Pico
- Department of Neurology, Versailles Hospital, Versailles, France
| | - Anne Landais
- Department of Neurology, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | | | - Pauline Renou
- Stroke Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Florent Gariel
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Papaxanthos Jean
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Lhermitte Yann
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Lisa Papillon
- Stroke Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Didier Smadja
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| |
Collapse
|
4
|
Hermida A, Ader F, Millat G, Jedraszak G, Maury P, Cador R, Catalan PA, Clerici G, Combes N, De Groote P, Dupin-Deguine D, Eschalier R, Faivre L, Garcia P, Guillon B, Janin A, Kugener B, Lackmy M, Laredo M, Le Guillou X, Lesaffre F, Lucron H, Milhem A, Nadeau G, Nguyen K, Palmyre A, Perdreau E, Picard F, Rebotier N, Richard P, Rooryck C, Seitz J, Verloes A, Vernier A, Winum P, Yabeta GAD, Bouchot O, Chevalier P, Charron P, Gandjbakhch E. NEXN Gene in Cardiomyopathies and Sudden Cardiac Deaths: Prevalence, Phenotypic Expression, and Prognosis. Circ Genom Precis Med 2024; 17:e004285. [PMID: 38059363 DOI: 10.1161/circgen.123.004285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Few clinical data are available on NEXN mutation carriers, and the gene's involvement in cardiomyopathies or sudden death has not been fully established. Our objectives were to assess the prevalence of putative pathogenic variants in NEXN and to describe the phenotype and prognosis of patients carrying the variants. METHODS DNA samples from consecutive patients with cardiomyopathy or sudden cardiac death/sudden infant death syndrome/idiopathic ventricular fibrillation were sequenced with a custom panel of genes. Index cases carrying at least one putative pathogenic variant in the NEXN gene were selected. RESULTS Of the 9516 index patients sequenced, 31 were carriers of a putative pathogenic variant in NEXN only, including 2 with double variants and 29 with a single variant. Of the 29 unrelated probands with a single variant (16 males; median age at diagnosis, 32.0 [26.0-49.0] years), 21 presented with dilated cardiomyopathy (prevalence, 0.33%), and 3 presented with hypertrophic cardiomyopathy (prevalence, 0.14%). Three patients had idiopathic ventricular fibrillation, and there were 2 cases of sudden infant death syndrome (prevalence, 0.46%). For patients with dilated cardiomyopathy, the median left ventricle ejection fraction was 37.5% (26.25-50.0) at diagnosis and improved with treatment in 13 (61.9%). Over a median follow-up period of 6.0 years, we recorded 3 severe arrhythmic events and 2 severe hemodynamic events. CONCLUSIONS Putative pathogenic NEXN variants were mainly associated with dilated cardiomyopathy; in these individuals, the prognosis appeared to be relatively good. However, severe and early onset phenotypes were also observed-especially in patients with double NEXN variants. We also detected NEXN variants in patients with hypertrophic cardiomyopathy and sudden infant death syndrome/idiopathic ventricular fibrillation, although a causal link could not be established.
Collapse
Affiliation(s)
- Alexis Hermida
- Cardiology, Arrhythmia, and Cardiac Stimulation Service (A.H.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
| | - Flavie Ader
- Unité Pédagogique de Biochimie, Département des Sciences Biologiques et Médicales, UFR de Pharmacie-Faculté de Santé, Université Paris Cité (F.A.)
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | - Gilles Millat
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | - Guillaume Jedraszak
- Molecular Genetics Laboratory (G.J.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
| | | | - Romain Cador
- Service de Cardiologie, Hôpital Saint Joseph, Paris (R.C.)
| | | | - Gaël Clerici
- Service de Cardiologie, Centre hospitalier universitaire, Saint Pierre, La Réunion (G.C.)
| | - Nicolas Combes
- Service de Cardiologie, Clinique Pasteur, Toulouse (N.C.)
| | - Pascal De Groote
- France CHU Lille, Service de Cardiologie & Inserm U1167, Institut Pasteur de Lille (P.D.G.)
| | | | | | | | - Patricia Garcia
- Unité Mort Inattendue du Nourrisson, Hôpital de la Conception, APHM, Marseille (P.G.)
| | | | - Alexandre Janin
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | | | - Marylin Lackmy
- Unité de Génétique Clinique, CHU de Guadeloupe, Pointe à Pitre (M. Lackmy)
| | - Mikael Laredo
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | | | - Hugues Lucron
- Service de Cardiologie pédiatrique, CHU Martinique, Fort-de-France (H.L.)
| | | | - Gwenaël Nadeau
- Service de génétique clinique CH Métropole Savoie, Chambéry (G.N.)
| | | | - Aurélien Palmyre
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Elodie Perdreau
- Département médico chirurgical de cardiologie pédiatrique (E.P.), Hôpital Louis Pradel, HCL, Lyon
| | - François Picard
- Service de Cardiologie, Hôpital Cardiologique Haut Leveque, Bordeaux (F.P.)
| | | | - Pascale Richard
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | - Julien Seitz
- Service de Cardiologie, Hôpital Saint Joseph, Marseille (J.S.)
| | - Alain Verloes
- Departement de génétique, Hôpital Robert Debré, APHP (A. Verloes)
| | | | | | - Grace-A-Dieu Yabeta
- Service de Cardiologie, CH Ouest Guyane, Saint-Laurent-du-Maroni (G.-A.-D.Y.)
| | - Océane Bouchot
- Service de Cardiologie, CH Annecy Genevois, Annecy, France (O.B.)
| | | | - Philippe Charron
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Estelle Gandjbakhch
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| |
Collapse
|
5
|
Le Floch A, Clarençon F, Rouchaud A, Kyheng M, Labreuche J, Sibon I, Boulouis G, Gory B, Richard S, Caroff J, Blanc R, Seners P, Eker OF, Cho TH, Consoli A, Bourcier R, Guillon B, Dargazanli C, Arquizan C, Denier C, Eugene F, Vannier S, Gentric JC, Gauberti M, Naggara O, Rosso C, Turc G, Ozkul-Wermester O, Cognard C, Albucher JF, Timsit S, Bourdain F, Le Bras A, Richter S, Moulin S, Pop R, Heck O, Moreno R, L'Allinec V, Lapergue B, Marnat G. Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry. J Neurointerv Surg 2023; 15:e289-e297. [PMID: 36460462 DOI: 10.1136/jnis-2022-019672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone. METHODS We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0-2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients. RESULTS Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004). CONCLUSIONS In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.
Collapse
Affiliation(s)
- Agathe Le Floch
- Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Frédéric Clarençon
- Interventional neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
| | - Aymeric Rouchaud
- Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
- CNRS, XLIM, UMR 7252, Université de Limoges, Limoges, Nouvelle-Aquitaine, France
| | - Maeva Kyheng
- Biostatistics, CHU Lille, Lille, Hauts-de-France, France
| | | | - Igor Sibon
- Neurology, CHU de Bordeaux, Bordeaux, France
| | | | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Raphaël Blanc
- Departement of interventional neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Pierre Seners
- Neurology, Fondation Rothschild, Paris, Île-de-France, France
| | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Tae-Hee Cho
- Neurology, CHU Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Arturo Consoli
- Interventional Neuroradiologie, Hopital Foch, Suresnes, Ile-de-France, France
| | | | - Benoit Guillon
- Stroke unit, CHU Nantes, Nantes, Pays de la Loire, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Caroline Arquizan
- Neurology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | | | | | | | | | | | - Olivier Naggara
- Neuroradiology, GHU Paris Pôle Neuro Sainte-Anne, Paris, Île-de-France, France
| | - Charlotte Rosso
- Neurology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Guillaume Turc
- Neurology, GHU Paris Pôle Neuro Sainte-Anne, Paris, Île-de-France, France
| | | | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, Occitanie, France
| | | | | | - Frederic Bourdain
- Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Anthony Le Bras
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
- Neuroradiology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | | | - Solène Moulin
- Neurology, University Hospital Centre Reims, Reims, Champagne-Ardenne, France
| | - Raoul Pop
- Neuroradiolology, CHU Strasbourg, Strasbourg, Alsace, France
| | - Olivier Heck
- Neurology, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Ricardo Moreno
- Department Of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| |
Collapse
|
6
|
Nehme A, Arquizan C, Régent A, Isabel C, Dequatre N, Guillon B, Capron J, Detante O, Lanthier S, Poppe AY, Boulouis G, Godard S, Terrier B, Pagnoux C, Aouba A, Touzé E, de Boysson H. Comparison of patients with biopsy positive and negative primary angiitis of the central nervous system. Rheumatology (Oxford) 2023:kead542. [PMID: 37802919 DOI: 10.1093/rheumatology/kead542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE There is limited evidence on when to obtain a central nervous system (CNS) biopsy in suspected primary angiitis of the central nervous system (PACNS). Our objective was to identify which clinical and radiological characteristics were associated with a positive biopsy in PACNS. METHODS From the multicenter retrospective Cohort of Patients with Primary Vasculitis of the CNS (COVAC), we included adults with PACNS based on a positive CNS biopsy or otherwise unexplained intracranial stenoses with additional findings supportive of vasculitis. Baseline findings were compared between patients with a positive and negative biopsy using logistic regression models. RESULTS 200 patients with PACNS were included, among which a biopsy was obtained in 100 (50%) and was positive in 61 (31%). Patients with a positive biopsy were more frequently female (OR 2.90, 95% CI 1.25-7.10, p = 0.01) and more often presented with seizures (OR 8.31, 95% CI 2.77-33.04, p < 0.001) or cognitive impairment (OR 2.58, 95% CI 1.11-6.10, p = 0.03). On imaging, biopsy positive patients more often had non-ischemic parenchymal or leptomeningeal gadolinium enhancement (OR 52.80, 95% CI 15.72-233.06, p < 0.001) or ≥ 1 cerebral microbleed (OR 8.08, 95% CI 3.03-25.13, p < 0.001), and less often had ≥ 1 acute brain infarct (OR 0.02, 95% CI 0.004-0.08, p < 0.001). In the multivariable model, non-ischemic parenchymal or leptomeningeal gadolinium enhancement (aOR 8.27, 95% CI 1.78-38.46), p < 0.01) and absence of ≥ 1 acute brain infarct (aOR 0.13, 95% CI 0.03-0.65, p = 0.01) were significantly associated with a positive biopsy. CONCLUSIONS Baseline clinical and radiological characteristics differed between biopsy positive and negative PACNS. These results may help physicians individualize the decision to obtain a CNS biopsy in suspected PACNS.
Collapse
Affiliation(s)
- Ahmad Nehme
- Neurology, Université Caen-Normandie, CHU Caen-Normandie, Caen, France
| | | | - Alexis Régent
- Internal Medicine, Université Paris-Cité, Hôpital Cochin, AP-HP, Paris, France
| | | | | | | | - Jean Capron
- Neurology, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Olivier Detante
- Université Grenoble Alpes, INSERM, U1216, Neurology, CHU Grenoble Alpes, Grenoble Institute Neurosciences, Grenoble, France
| | | | - Alexandre Y Poppe
- Neurology, Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | | | | - Benjamin Terrier
- Internal Medicine, Université Paris-Cité, Hôpital Cochin, AP-HP, Paris, France
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Achille Aouba
- Université Caen-Normandie, Internal Medicine, CHU Caen-Normandie, Caen, France
| | - Emmanuel Touzé
- Neurology, Université Caen-Normandie, CHU Caen-Normandie, Caen, France
| | - Hubert de Boysson
- Université Caen-Normandie, Internal Medicine, CHU Caen-Normandie, Caen, France
| |
Collapse
|
7
|
Cholley B, Bojan M, Guillon B, Besnier E, Mattei M, Levy B, Ouattara A, Tafer N, Delmas C, Tonon D, Rozec B, Fellahi JL, Lim P, Labaste F, Roubille F, Caruba T, Mauriat P. Correction: Overview of the current use of levosimendan in France: a prospective observational cohort study. Ann Intensive Care 2023; 13:94. [PMID: 37770809 PMCID: PMC10539228 DOI: 10.1186/s13613-023-01193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, 75015, Paris, France.
- Université Paris Cité, INSERM, UMR_S 1140 "Innovations Thérapeutiques en Hémostase", 75006, Paris, France.
| | - Mirela Bojan
- Pôle Cardiopathies Congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 92350, Le Plessis-Robinson, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, 76000, Rouen, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-les Nancy, France
| | - Bruno Levy
- CHRU Nancy, Critical Care, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-Les Nancy, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Nadir Tafer
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Clément Delmas
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - David Tonon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix-Marseille University, 13385, Marseille CEDEX 05, France
| | - Bertrand Rozec
- Department of Anaesthesiology and Critical Care, Institut du Thorax, Laennec Hospital, CHU de Nantes, and Nantes Université, CHU Nantes*, CNRS, INSERM, 44000, Nantes, France
| | - Jean-Luc Fellahi
- Department of Cardiothoracic Anaesthesiology and Critical Care, Louis Pradel University Hospital, Lyon, France
| | - Pascal Lim
- Cardiology department, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - François Labaste
- Department of Anaesthesiology and Critical Care Medicine, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Cardiology Department INI-CRT PhyMedExp INSERM, CNRS CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Philippe Mauriat
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| |
Collapse
|
8
|
Meinel TR, Kaesmacher J, Buetikofer L, Strbian D, Eker OF, Cognard C, Mordasini P, Deppeler S, Mendes Pereira V, Albucher JF, Darcourt J, Bourcier R, Guillon B, Papagiannaki C, Costentin G, Sibolt G, Räty S, Gory B, Richard S, Liman J, Ernst M, Boulanger M, Barbier C, Mechtouff L, Zhang L, Marnat G, Sibon I, Nikoubashman O, Reich A, Consoli A, Weisenburger D, Requena M, Garcia-Tornel A, Saleme S, Moulin S, Pagano P, Saliou G, Carrera E, Janot K, Boix M, Pop R, Della Schiava L, Luft A, Piotin M, Gentric JC, Pikula A, Pfeilschifter W, Arnold M, Siddiqui A, Froehler MT, Furlan AJ, Chapot R, Wiesmann M, Machi P, Diener HC, Kulcsar Z, Bonati L, Bassetti C, Escalard S, Liebeskind D, Saver JL, Fischer U, Gralla J. Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial. J Neurointerv Surg 2023; 15:e102-e110. [PMID: 35902234 DOI: 10.1136/jnis-2022-019207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). METHODS We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. RESULTS We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. CONCLUSIONS We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT03192332.
Collapse
Affiliation(s)
- Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Omer Faruk Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sandro Deppeler
- Neuro Clinical Trial Unit, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Vitor Mendes Pereira
- Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Jean Darcourt
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Benoit Guillon
- Department of Neurology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | | | | | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, INSERM U1254, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, CHRU-Nancy, Université de Lorraine, INSERM U1116, Nancy, France
| | - Jan Liman
- Department of Neurology, Klinikum Nürnberg, Nürnberg, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Gottingen, Germany
| | - Marion Boulanger
- Deparment of Neurology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Charlotte Barbier
- Department of Neuroradiology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Laura Mechtouff
- Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France
| | - Liqun Zhang
- Department of Neurology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arno Reich
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arturo Consoli
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - David Weisenburger
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Heborn, Barcelona, Spain
| | | | - Suzana Saleme
- Department of Neuroradiology, CHU Limoges, Limoges, France
| | | | - Paolo Pagano
- Department of Neuroradiology, CHU Reims, Reims, France
| | - Guillaume Saliou
- Service of Interventional and Diagnostic Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Kevin Janot
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France
| | - Marti Boix
- Stroke Unit, Department of Neurosciences, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Raoul Pop
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Andreas Luft
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Michel Piotin
- Department of interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Aleksandra Pikula
- Department of Neurology, University Health Network - Toronto Western Hospital - University of Toronto, Toronto, Ontario, Canada
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael T Froehler
- Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony J Furlan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Paolo Machi
- Department of Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Leo Bonati
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Claudio Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Escalard
- Department of interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - David Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, University of California, Los Angeles, California, USA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, University of California, Los Angeles, California, USA
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Cholley B, Bojan M, Guillon B, Besnier E, Mattei M, Levy B, Ouattara A, Tafer N, Delmas C, Tonon D, Rozec B, Fellahi JL, Lim P, Labaste F, Roubille F, Caruba T, Mauriat P. Overview of the current use of levosimendan in France: a prospective observational cohort study. Ann Intensive Care 2023; 13:69. [PMID: 37552372 PMCID: PMC10409690 DOI: 10.1186/s13613-023-01164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. METHOD The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. RESULTS The patients included (n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock (n = 250, 41.5%), decompensated heart failure (n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment (n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation (n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. CONCLUSIONS We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied.
Collapse
Affiliation(s)
- Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, 75015, Paris, France.
- Université Paris Cité, INSERM, UMR_S 1140 "Innovations Thérapeutiques en Hémostase", 75006, Paris, France.
| | - Mirela Bojan
- Pôle Cardiopathies Congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 92350, Le Plessis-Robinson, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, 76000, Rouen, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-les Nancy, France
| | - Bruno Levy
- CHRU Nancy, Critical Care, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-Les Nancy, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Nadir Tafer
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Clément Delmas
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - David Tonon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix-Marseille University, 13385, Marseille CEDEX 05, France
| | - Bertrand Rozec
- Department of Anaesthesiology and Critical Care, Institut du Thorax, Laennec Hospital, CHU de Nantes, and Nantes Université, CHU Nantes*, CNRS, INSERM, 44000, Nantes, France
| | - Jean-Luc Fellahi
- Department of Cardiothoracic Anaesthesiology and Critical Care, Louis Pradel University Hospital, Lyon, France
| | - Pascal Lim
- Cardiology department, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - François Labaste
- Department of Anaesthesiology and Critical Care Medicine, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Cardiology Department INI-CRT PhyMedExp INSERM, CNRS CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Philippe Mauriat
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
| |
Collapse
|
10
|
Riescher S, Dos Santos A, Lecomte R, Lenoble C, Guillon B. A case report of unilateral cerebral vasculitis in adults: keep in mind Lyme neuroborreliosis. BMC Infect Dis 2023; 23:283. [PMID: 37142957 PMCID: PMC10158163 DOI: 10.1186/s12879-023-08259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB), due to infection of the nervous system by the spirochete Borrelia burgdorferi, occurs in 15% of Lyme disease cases. However, neurovascular involvement is uncommon, especially recurrent stroke related to cerebral vasculitis in the absence of CSF pleocytosis. CASE PRESENTATION We report the case of a 58-year-old man without any medical history who exhibited recurrent strokes in the same vascular territory (left internal carotid). Multiple biological screening, neuroimaging methods, and cardiovascular examinations failed to provide a diagnosis and treatment that could have prevented recurrences. Finally, B. burgdorferi sensu lato serology testing in blood and cerebrospinal fluid enabled diagnosis of LNB, in relation to a cerebral vasculitis. The patient experienced no further stroke after four weeks of doxycycline treatment. CONCLUSION B. burgdorferi central nervous system infection must be considered in case of unexplained recurrent and/or multiple strokes, especially if cerebral vasculitis is suspected or demonstrated on neuroimaging.
Collapse
Affiliation(s)
- Stanislas Riescher
- Service de Médecine interne, Nantes University Hospital Center, Nantes cx 1, France
| | - Amélie Dos Santos
- Service de Neurologie, Nantes University Hospital Center, Nantes, France
| | - Raphaël Lecomte
- Service de Maladies infectieuses et Tropicales, Nantes University Hospital Center, Nantes, France
| | - Cédric Lenoble
- Service de Neurologie, Nantes University Hospital Center, Nantes, France
| | - Benoit Guillon
- Service de Neurologie, Nantes University Hospital Center, Nantes, France.
| |
Collapse
|
11
|
Olindo S, Albucher JF, Bejot Y, Berge J, Cordonnier C, Guillon B, Sablot D, Tardy J, Alamowitch S, Sibon I. Tenecteplase in acute ischemic stroke: Review of the literature and expert consensus from the French Neurovascular Society. Rev Neurol (Paris) 2023; 179:150-160. [PMID: 36369068 DOI: 10.1016/j.neurol.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intravenous alteplase is the only thrombolytic treatment approved for patients with acute ischemic stroke (AIS). Although no randomized controlled trial (RCT) has shown the superiority of tenecteplase over alteplase in AIS, tenecteplase is increasingly used off-label in Stroke Units. The purpose of the present work was to provide an up-to-date set of expert consensus statements on the use of tenecteplase in AIS. METHODS Members of the working group were selected by the French Neurovascular Society. RCTs comparing tenecteplase and alteplase in the treatment of AIS were reviewed. Recent meta-analysis and real-life experience data on tenecteplase published until 30th October 2021 were also analyzed. After a description of the available data, we tried to answer the subsequent questions about the use of tenecteplase in AIS: What dosage of tenecteplase should be preferred? How effective is tenecteplase for cerebral artery recanalization? What is the clinical effectiveness of tenecteplase? What is the therapeutic safety of tenecteplase? What are the benefits associated with tenecteplase ease of use? Then expert consensus statements for tenecteplase use were submitted. In October 2021 the working group was asked to review and revise the manuscript. In November 2021, the current version of the manuscript was approved. EXPERT CONSENSUS A set of three expert consensus statements for the use of tenecteplase within 4.5hours of symptom onset in AIS patients were issued: (1) It is reasonable to use tenecteplase 0.25mg/kg when mechanical thrombectomy (MT) is planned. (2) Tenecteplase 0.25mg/kg can be used as an alternative to alteplase 0.9mg/kg in patients with medium- or small-vessel occlusion not retrievable with MT. (3) Tenecteplase 0.25mg/kg could be considered as an alternative to alteplase 0.9mg/kg in patients without vessel occlusion. CONCLUSIONS These expert consensus statements could provide a framework to guide the clinical decision-making process for the use of tenecteplase according to admission characteristics of AIS patients. However, existing data are limited, requiring inclusions in ongoing RCTs or real-life registries.
Collapse
Affiliation(s)
- S Olindo
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - J-F Albucher
- Unité Neuro-Vasculaire, Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Y Bejot
- Service Hospitalo-Universitaire de Neurologie, CHU de Dijon Bourgogne, Dijon, France
| | - J Berge
- Service de Neuro-Radiologie, Hôpital Pellegrin, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - C Cordonnier
- Université Lille, Inserm, CHU Lille, U1172, LiINCog, Lille Neuroscience and Cognition, Lille, France
| | - B Guillon
- Unité Neurovasculaire, Hôpital G&R Laënnec, CHU de Nantes, Nantes, France
| | - D Sablot
- Service de Neurologie, Hôpital de Perpignan, Perpignan, France
| | - J Tardy
- Unité Neuro-Vasculaire, Clinique des Cèdres, Cornebarrieu, France
| | - S Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Salpêtrière-Saint Antoine, AP-HP, Sorbonne Université, Stare Team, iCRIN, Institut du cerveau, Inserm UMRS 938, Paris, France
| | - I Sibon
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| |
Collapse
|
12
|
Marnat G, Holay Q, Darcourt J, Desilles JP, Obadia M, Viguier A, Caroff J, Denier C, Papillon L, Barreau X, Cognard C, Berge J, Bourgeois-Beauvais Q, Landais A, Boulanger M, Macian F, Guillon B, Pico F, Lamy M, Robinet-Borgomano E, Richard S, Gory B, Sibon I, Gaillard N, Chausson N, Olindo S. Dual-layer carotid stenting for symptomatic carotid web: Results from the Caroweb study. J Neuroradiol 2022; 50:444-448. [PMID: 36563743 DOI: 10.1016/j.neurad.2022.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & PURPOSE Carotid Web (CaW) is a growingly recognized cause of ischemic stroke, associated with a high recurrence risk. Several therapeutic strategies have been proposed as a tertiary prevention including carotid stenting, endarterectomy and antithrombotic medications. Among these, carotid stenting with dual-layer stent may be promising to adequately cover the focal arterial dysplasia. Our aim was to investigate the safety and efficacy of the Casper stent in the treatment of symptomatic CaW. METHODS We conducted a retrospective analysis of consecutive patients presenting with a symptomatic CaW and included in the ongoing prospective observational multicenter CAROWEB registry. The study period was January 2015 to December 2021. Inclusion criteria were CaW treated with dual-layer Casper stent. Patients treated with other types of carotid stent, endarterectomy or antithrombotic medication were excluded. Clinical and radiological initial data and outcomes were recorded. RESULTS twenty-seven patients (with 28 caw) were included. median age was 52 (iqr: 46-68). median delay between index cerebrovascular event and cervical stenting was 9 days (IQR: 6-101). In all cases, the cervical carotid stenting was successfully performed. No major perioperative complication was recorded. No recurrent stroke or transient ischemic attack was observed during a median follow-up time of 272 days (IQR: 114-635). Long-term imaging follow-up was available in 25/28 (89.3%) stented CaW with a median imaging follow-up of 183 days (IQR: 107-676; range: 90-1542). No in-stent occlusion or stenosis was detected. CONCLUSION In this study, carotid stenting with dual-layer Casper stent in the treatment of symptomatic CaW was effective regarding stroke recurrence prevention and safe, without procedural nor delayed detected adverse event. However, the optimal therapeutic approach of symptomatic CaW still needs to be explored through randomized trials.
Collapse
Affiliation(s)
- Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Quentin Holay
- Department of Interventional Neuroradiology, Rothschild foundation hospital, Paris, France
| | - Jean Darcourt
- Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild foundation hospital, Paris, France
| | - Michael Obadia
- Department of Neurology, Rothschild foundation hospital Paris, France
| | - Alain Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, CHU Bicêtre APHP, Kremlin Bicêtre, France
| | - Christian Denier
- Department of Neurology, CHU Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Lisa Papillon
- Department of Neurology, Stroke Unit, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jerome Berge
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | - Anne Landais
- Department of Neurology, Point à Pitre Hospital, Pointe à Pitre, France
| | - Marion Boulanger
- Department of Neurology, Caen University Hospital, Caen, University Caen Normandy, France
| | - Francisco Macian
- Department of Neurology, Limoges University Hospital, Limoges, France
| | - Benoit Guillon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Fernando Pico
- Department of Neurology, Versailles Hospital, Le Chesnay, France
| | - Mathias Lamy
- Department of Neurology, Poitiers University Hospital, Poitiers, France
| | | | - Sébastien Richard
- Neurology Department, Nancy University Hospital, Nancy, France - INSERM U1116, Nancy, France
| | - Benjamin Gory
- France Department of Interventional and Diagnostic Neuroradiology, Nancy University Hospital, Nancy, France
| | - Igor Sibon
- Department of Neurology, Martinique University Hospital, Fort-de-France, France
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Nicolas Chausson
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Stephane Olindo
- Department of Neurology, Martinique University Hospital, Fort-de-France, France
| | | |
Collapse
|
13
|
Riescher S, Guillon B, Dos Santos A, Lecomte R. Neuroborréliose révélée par des infarctus cérébraux : la vascularite focale du Lyme. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Ter Schiphorst A, Peres R, Dargazanli C, Blanc R, Gory B, Richard S, Marnat G, Sibon I, Guillon B, Bourcier R, Denier C, Spelle L, Labreuche J, Consoli A, Lapergue B, Costalat V, Obadia M, Arquizan C. Endovascular treatment of ischemic stroke due to isolated internal carotid artery occlusion: ETIS registry data analysis. J Neurol 2022; 269:4383-4395. [PMID: 35357557 DOI: 10.1007/s00415-022-11078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO. METHODS We analyzed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value). RESULTS Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate of procedural complications was 36%, including stent thrombosis (n = 7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead. CONCLUSION Our study suggests that EVT in AIS patients with moderate/severe initial deficit due to CICAO led to high rate of recanalization at day 1, and a 40% rate of favorable outcome at 3 months. There was a high rate of procedural complication which is of concern. Randomized controlled trials assessing the superiority of EVT in patients with CICAO and severe deficits are needed.
Collapse
Affiliation(s)
- Adrien Ter Schiphorst
- Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Roxane Peres
- Department of Neurology, Fondation Rothschild Hospital, Paris, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, INSERM U1116, 54000, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - Benoit Guillon
- Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Christian Denier
- Department of Neurology, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Julien Labreuche
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, 59000, Lille, France
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | | | - Vincent Costalat
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
| | - Michael Obadia
- Department of Neurology, Fondation Rothschild Hospital, Paris, France
| | - Caroline Arquizan
- Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| |
Collapse
|
15
|
Monnin C, Besutti M, Ecarnot F, Guillon B, Chatot M, Chopard R, Yahia M, Meneveau N, Schiele F. Prevalence and severity of cognitive dysfunction in patients referred for transcatheter aortic valve implantation (TAVI): clinical and cognitive impact at 1 year. Aging Clin Exp Res 2022; 34:1873-1883. [PMID: 35275374 DOI: 10.1007/s40520-022-02102-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022]
Abstract
AIM We estimated the proportion and severity of cognitive disorders in an unselected population of patients referred for transcatheter aortic valve implantation (TAVI). Second, we describe clinical and cognitive outcomes at 1 year. METHODS Eligible patients were aged ≥ 70 years, with symptomatic aortic stenosis and an indication for TAVI. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction (CD), defined as no CD if score ≥ 26, mild CD if 18-25; moderate CD if 10-18, and severe CD if < 10. We assessed survival and in-hospital complications at 6 months and 1 year. RESULTS Between June 2019 and October 2020, 105 patients were included; 21 (20%) did not undergo TAVI, and thus, 84 were analyzed; median age 85 years, 53.6% females, median EuroScore 11.5%. Median MoCA score was 22 (19-25); CD was excluded in 18 (21%), mild in 50 (59.5%), moderate in 15 (19%) and severe in 1. Mean MoCA score at follow-up was 21.9(± 4.69) and did not differ significantly from baseline (21.79 (± 4.61), p = 0.73). There was no difference in success rate, in-hospital complications, or death across CD categories. CONCLUSION The clinical course of patients with mild or moderate CD is not different at 1 year after TAVI compared to those without cognitive dysfunction.
Collapse
Affiliation(s)
- Charles Monnin
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
| | - Matthieu Besutti
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France.
- EA3920, University of Franche-Comté, 25000, Besancon, France.
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
| | - Marion Chatot
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
- EA3920, University of Franche-Comté, 25000, Besancon, France
| | - Mohamed Yahia
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
- EA3920, University of Franche-Comté, 25000, Besancon, France
| | - François Schiele
- Department of Cardiology, University Hospital Besancon, 25000, Besancon, France
- EA3920, University of Franche-Comté, 25000, Besancon, France
| |
Collapse
|
16
|
Assif M, Lamy C, De Gaalon S, Caroit Y, Bourcier R, Preterre C, Guillon B. Cervical Artery Dissection in Young Women: Risk of Recurrence During Subsequent Pregnancies. Neurol Clin Pract 2022; 11:e803-e808. [PMID: 34992962 DOI: 10.1212/cpj.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
Objectives To assess the risk of recurrence of cervical artery dissection (CAD) during pregnancy and puerperium in women with a history of CAD and then help physicians with providing medical information to women who wish to become pregnant. Methods Women aged 16-45 years who were admitted to our center for a CAD between 2005 and 2017 were identified from the hospital database, and those with spontaneous and symptomatic CAD were included. They were then contacted to answer a questionnaire that was specifically designed in regard to the recurrence of CAD and pregnancies after the primary CAD. Results Ninety-one patients satisfied our inclusion criteria, and 89 were included in the analysis. During a median follow-up of 7.0 years, 4 women (4.4%) had recurrent CAD, although none during pregnancy or puerperium. Eighteen women (20%) had a total of 20 full-term pregnancies, occurring at least 6 months after CAD. Of these 20 pregnancies, 13 (65%) were vaginal deliveries, and 7 (35%) were cesarean sections. The reason for the absence of pregnancies after the initial CAD was unrelated to the vascular event in 89% of cases, but 8% of the women had been advised by a physician to avoid any future pregnancy or they had been recommended to undergo abortion or sterilization. Conclusion In this study, there were no CAD recurrences during subsequent pregnancies or postpartum, irrespective of the type of delivery. Thus, pregnancy after a history of CAD appears to be safe.
Collapse
Affiliation(s)
- Myriam Assif
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Catherine Lamy
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Solène De Gaalon
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Yolande Caroit
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Romain Bourcier
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Cécile Preterre
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Benoit Guillon
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| |
Collapse
|
17
|
Guidoux C, Sibon I, Alamowitch S, Godeneche G, Guillon B, Timsit S, Sablot D, Cordonnier C, Tardy J, Granier M, Extramiana F, Cohen A, Touze E, Gaillard N. Capacities of atrial fibrillation detection after stroke: a French nationwide survey. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AFib) is a major contributor to recurrent but preventable ischemic Stroke (IS)/TIA. However, majority of stroke patients suffer from paroxysmal asymptomatic AFib, which implies stroke health system to implement accurate AFib detection strategies to large scale population. Current practices of AFib screening methods provided by Stroke Units (SU) organization and network in France are currently unknown and uncovered by dedicated guidelines.
Purpose
To assess the methodology of Afib screening in French SU.
Methods
A French Nationwide survey was led (September-November 2020) with on-line structured questionnaires sent to individual targeted stroke-physicians (SP) and heads of SU in France.We analyzed qualitative and quantitative availability and current use of AFib detection tools during acute inhospital and outpatient subacute and chronic post-IS phases.
Results
67% of 140 heads of SU and 33% of SP responded across all continental and overseas French regions.Main clinical characteristics that lead to search Afib are: TIA/IS recurrence under antiplatelet therapy (97%), patient's age (74%), proximal occlusion of a major cerebral artery (72%). Afib is highly suspected when there is: recent brain IS in multiple vascular territories (100%), previous IS in another vascular territory (98%), left atrial enlargement (96%), burst of supraventricular tachycardia <30s (94%). In-hospital cardiac monitoring is considered to be mandatory by 90% of SU teams but only 1/3 of those possess telemetry out of intensive care unit. Outpatient cardiac monitoring is considered of major interest/necessary by 100% of SP. When first line 24-hour Holter monitor is normal and Afib is highly suspected, 75% of the SP required outpatient noninvasive monitoring (NIM) for at least 7 days and more than half required insertable cardiac monitor (ISC). ISC are implanted each year by SU for <10 patients in 44% and <50 patients in 94%. The delay IS-ICM implantation is <1 month in 10%, 1–3 months in 52%, 3–6 months in 29% and >6 months in 9%. Accessibility to outpatient monitoring modalities is graded: fairly easy for 24/48h-Holter (85%) and ISC (68%); rather difficult/impossible for 3–7 days NIM (51%), 8–21 days NIM (75%) or e-ECG tools (99%). Main obstacles to monitoring abilities development in SU were lack of: manpower (80%), efficient network with cardiologists (56%), familiarity of techniques (42%); and technical equipment cost (44%). 96.5% of SU teams deem necessary practice decision support flowchart with cardiologist partnership but 19% use for it.
Conclusion
The survey raises concern about lack of a systematic strategy and shortcomings for Afib detection capacities. These results are a call to establish practice-guidelines and to promote an improvement plan for AFib detection (selection of the patients, tools and prioritization of the exams) after TIA/IS in France which will require a strong collaboration between neurologists and cardiologists.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer
Collapse
Affiliation(s)
- C Guidoux
- University Hospital Bichat APHP, Neurology, Paris, France
| | - I Sibon
- University Hospital of Bordeaux, Neurology, Bordeaux, France
| | - S Alamowitch
- University Hospital of Saint-Antoine, Neurology, Paris, France
| | - G Godeneche
- University Hospital of La Rochelle, Neurology, La Rochelle, France
| | - B Guillon
- University Hospital of Nantes, Neurology, Nantes, France
| | - S Timsit
- University Hospital of Brest, Neurology, Brest, France
| | - D Sablot
- University Hospital of Perpignan, Neurology, Perpignan, France
| | - C Cordonnier
- Lille University Hospital, Neurology, Lille, France
| | - J Tardy
- Clinique des Cèdres Château d'Alliez, Neurology, Toulouse, France
| | - M Granier
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | - F Extramiana
- University Hospital Bichat APHP, Cardiology, Paris, France
| | - A Cohen
- University Hospital of Saint-Antoine, Cardiology, Paris, France
| | - E Touze
- University Hospital of Caen, Neurology, Caen, France
| | - N Gaillard
- University Hospital Gui de Chauliac, Neurology, Montpellier, France
| | | |
Collapse
|
18
|
Monnin C, Besutti M, Ecarnot F, Guillon B, Chatot M, Chopard R, Yahia M, Meneveau N, Schiele F. Cognitive dysfunction among patients referred for transcatheter aortic valve implantation: results of the Montreal Cognitive Assessment and clinical impact at 6 months. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Detection of Cognitive Dysfunction (CD) is not routinely performed among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We sought to determine whether CD has an impact on the clinical course of these patients, during hospitalization at the time of TAVI and up to 6 months afterwards.
Methods
The MoCA was performed before TAVI by an experienced operator in an unselected population of patients referred for TAVI. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if <10. Multivariate Cox logistic regression analysis was used to determine the impact of CD on procedural success of TAVI, length of stay, 6 month survival, re-admission, and change in clinical status (changes in NYHA class and/or functional status).
Results
MoCA was performed in 83 consecutive patients. TAVI was performed using femoral access and local anesthesia in all patients. There were no procedural deaths, and 2 deaths at 6 months. The median age was 85 years, and median Euroscore I was 11.62. The median MOCA score was 22, CD was excluded in 17 (20%), mild in 50 (60%), moderate in 15 (18%) and severe in one patient. No difference was observed in rate of procedural success, 6 month mortality, re-admission, degree of dyspnea by NYHA between the different cognitive groups. Length of stay after the TAVI procedure was lower in patients without CD, compared to those with CD at any level: 3±1 days versus 4.3±1 days, p=0.045, and p=0.02 by multivariate analysis (figure).
Conclusion
Among patients referred for TAVI, mild or moderate CD was observed in 80% of patients. Patients without CD had a shorter length of stay at the time of TAVI, but CD was not associated with worse prognosis or clinical status at 6 months.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- C Monnin
- University Hospital of Besancon, Besancon, France
| | - M Besutti
- University Hospital of Besancon, Besancon, France
| | - F Ecarnot
- University Hospital of Besancon, Besancon, France
| | - B Guillon
- University Hospital of Besancon, Besancon, France
| | - M Chatot
- University Hospital of Besancon, Besancon, France
| | - R Chopard
- University Hospital of Besancon, Besancon, France
| | - M Yahia
- University Hospital of Besancon, Besancon, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - F Schiele
- University Hospital of Besancon, Besancon, France
| |
Collapse
|
19
|
Mathonier C, Badoz M, Besutti M, Schiele F, Meneveau N, Guillon B, Chopard R. Available bleeding scoring systems poorly predict major bleeding in the acute phase of pulmonary embolism. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Bleeding prediction scores may help to guide acute management of patients with pulmonary embolism (PE). However, existing scoring systems have not been validated for in-hospital assessment. We aimed to compare 6 available bleeding scores, in a real-life cohort for the prediction of major in-hospital bleeding.
Methods
We recorded in-hospital characteristics of 2,754 PE patients included in a prospective observational multicenter cohort study contributing 18,028 person-days of follow-up. We assessed the VTE-BLEED, RIETE, ORBIT, HEMORRA2HAGES, ATRIA, and HAS-BLED scores at baseline. ISTH-defined bleeding events were independently adjudicated. The accuracy of the scores for the prediction of in-hospital bleeding was evaluated and compared.
Results
We observed 82 first in-hospital major bleeding events (3.0% (95% CI, 2.4–3.7)). Overall, the predictive power of bleeding scores was poor, with a C index ranging from 0.57 to 0.69 (Figure 1). The RIETE score had the numerically highest model fit and best discriminatory capacity, but without reaching statistical significance versus the ORBIT, HEMORR2HAGES, and ATRIA scores. The VTE-BLEED and HAS-BLED scores had significantly lower C indices, integrated discrimination improvement, and net reclassification improvement compared to the four others.
Conclusion
Currently available scoring systems have insufficient accuracy for the prediction of in-hospital major bleeding in patients with acute PE. The development of acute-PE-specific risk scores is needed to optimally target patients that warrant bleeding-prevention strategies.
Funding Acknowledgement
Type of funding sources: None. Figure 1
Collapse
Affiliation(s)
- C Mathonier
- University Hospital of Besancon, Besancon, France
| | - M Badoz
- University Hospital of Besancon, Besancon, France
| | - M Besutti
- University Hospital of Besancon, Besancon, France
| | - F Schiele
- University Hospital of Besancon, Besancon, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - B Guillon
- University Hospital of Besancon, Besancon, France
| | - R Chopard
- University Hospital of Besancon, Besancon, France
| |
Collapse
|
20
|
Monnin C, Besutti M, Ecarnot F, Guillon B, Chatot M, Chopard R, Yahia M, Meneveau N, Schiele F. Assessment of cognitive dysfunction using the Montreal Cognitive Assessment test: rate, severity and comparison with the Clock test alone in a population of patients referred for TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although not recommended in routine practice, the detection and quantification of Cognitive Dysfunction (CD) in older patients might have an impact on clinical decisions. We assessed the rate and severity of CD in an unselected population of patients referred for Transcatheter Aortic Valve Implantation (TAVI) using the Montreal Cognitive Assessment (MoCA) and using the Clock Drawing Test (ClockT) alone.
Methods
The MoCA was performed before TAVI by an experienced operator. The ClockT was scored out of 10 points according to the Rouleau rating scale. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if <10. Inter-observer reliability of scoring on the ClockT was estimated with the Bland-Altman method. Agreement between MoCA scores and the ClockT for ruling out and for detecting CD were measured with the Kappa coefficient.
Results
MoCA was performed in 83 consecutive patients referred for TAVI, median age 85 years. The mean time required for assessment was 11±2 min for the MoCA and 3±2 min for the ClockT. The mean MoCA score was 21±4.5: CD was excluded in 17 (20%) pts, mild CD was found in 50 (60%), moderate in 15 (18%) and severe in one (1%). The median ClockT score was 8 (interquartile 6; 9), with excellent inter-observer concordance (Kappa= 0.84). Overall, 51% of the variance of the MoCA score was explained by the ClockT alone according to multiple regression. A ClockT <7 detected a group with significantly lower MoCA score, compared to pts with higher ClockT scores (figure).
Conclusion
Among patients referred for TAVI, CD can be excluded using the MoCA test in 20%, while moderate or severe CD is observed in 18%. The ClockT alone is faster to implement, reliable to interpret and enabled detection of patients with moderate CD when Rouleau scoring was <7.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- C Monnin
- University Hospital of Besancon, Besancon, France
| | - M Besutti
- University Hospital of Besancon, Besancon, France
| | - F Ecarnot
- University Hospital of Besancon, Besancon, France
| | - B Guillon
- University Hospital of Besancon, Besancon, France
| | - M Chatot
- University Hospital of Besancon, Besancon, France
| | - R Chopard
- University Hospital of Besancon, Besancon, France
| | - M Yahia
- University Hospital of Besancon, Besancon, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - F Schiele
- University Hospital of Besancon, Besancon, France
| |
Collapse
|
21
|
Mathonier C, Meneveau N, Besutti M, Ecarnot F, Falvo N, Guillon B, Schiele F, Chopard R. Available Bleeding Scoring Systems Poorly Predict Major Bleeding in the Acute Phase of Pulmonary Embolism. J Clin Med 2021; 10:jcm10163615. [PMID: 34441911 PMCID: PMC8396851 DOI: 10.3390/jcm10163615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
We aimed to compare six available bleeding scores, in a real-life cohort, for prediction of major bleeding in the early phase of pulmonary embolism (PE). We recorded in-hospital characteristics of 2754 PE patients in a prospective observational multicenter cohort contributing 18,028 person-days follow-up. The VTE-BLEED (Venous Thrombo-Embolism Bleed), RIETE (Registro informatizado de la enfermedad tromboembólica en España; Computerized Registry of Patients with Venous Thromboembolism), ORBIT (Outcomes Registry for Better Informed Treatment), HEMORR2HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol) scores were assessed at baseline. International Society on Thrombosis and Haemostasis (ISTH)-defined bleeding events were independently adjudicated. Accuracy of the overall original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared. We observed 82 first early major bleedings (3.0% (95% CI, 2.4–3.7)). The predictive power of bleeding scores was poor (Harrel’s C-index from 0.57 to 0.69). The RIETE score had numerically higher model fit and discrimination capacity but without reaching statistical significance versus the ORBIT, HEMORR2HAGES, and ATRIA scores. The VTE-BLEED and HAS-BLED scores had significantly lower C-index, integrated discrimination improvement, and net reclassification improvement compared to the others. The rate of observed early major bleeding in score-defined low-risk patients was high, between 15% and 34%. Current available scoring systems have insufficient accuracy to predict early major bleeding in patients with acute PE. The development of acute-PE-specific risk scores is needed to optimally target bleeding prevention strategies.
Collapse
Affiliation(s)
- Camille Mathonier
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
- EA3920, University of Burgundy Franche-Comté, 25000 Besançon, France
- F-CRIN, INNOVTE Network, CHU de Saint-Étienne-CIC 1408, Hôpital Nord-Médecine Vasculaire et Thérapeutique, CEDEX 2, 42055 Saint-Etienne, France
| | - Matthieu Besutti
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
- EA3920, University of Burgundy Franche-Comté, 25000 Besançon, France
| | - Nicolas Falvo
- Department of Vascular Medicine, University Hospital of Dijon, 21079 Dijon, France;
| | - Benoit Guillon
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
- EA3920, University of Burgundy Franche-Comté, 25000 Besançon, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
- EA3920, University of Burgundy Franche-Comté, 25000 Besançon, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France; (C.M.); (N.M.); (M.B.); (F.E.); (B.G.); (F.S.)
- EA3920, University of Burgundy Franche-Comté, 25000 Besançon, France
- F-CRIN, INNOVTE Network, CHU de Saint-Étienne-CIC 1408, Hôpital Nord-Médecine Vasculaire et Thérapeutique, CEDEX 2, 42055 Saint-Etienne, France
- Correspondence:
| |
Collapse
|
22
|
Belguidoum S, Meneveau N, Motreff P, Ohlman P, Boussaada M, Silvain J, Guillon B, Descotes-Genon V, Lefrançois Y, Morel O, Amabile N. Relationship between stent expansion and fractional flow reserve after percutaneous coronary intervention: a post hoc analysis of the DOCTORS trial. EUROINTERVENTION 2021; 17:e132-e139. [PMID: 32392171 PMCID: PMC9724874 DOI: 10.4244/eij-d-19-01103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The best criteria for adequate stent expansion assessment by intracoronary imaging remain debated and their correlation with post-PCI FFR values is unknown. AIMS This study aimed to analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. METHODS This post hoc analysis of the DOCTORS study included non-ST-elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN III criteria. RESULTS The study included N=116 patients (age: 60.8±11.5 years; male gender: 71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN III expansion. FFR values were, respectively, 0.93 (0.91-0.95) versus 0.95 (0.92-0.97) in patients with optimal+acceptable versus unacceptable ILUMIEN III expansion (p=0.22), 0.94 (0.91-0.97) versus 0.95 (0.93-0.97) in patients with optimal versus non-optimal DOCTORS expansion (p=0.23), and 0.95 (0.92-0.97) versus 0.92 (0.90-0.95) in patients with minimal stent area ≥4.5 mm2 versus <4.5 mm2 (p=0.03). CONCLUSIONS In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN III or DOCTORS OCT criteria and final post-PCI FFR values.
Collapse
Affiliation(s)
- Salim Belguidoum
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Patrick Ohlman
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Olivier Morel
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
| |
Collapse
|
23
|
Badoz M, Favoulet B, Serzian G, Ecarnot F, Guillon B, Chopard R, Meneveau N. Impact of early (<7 days) pacemaker implantation after cardiac surgery on long-term pacemaker dependency. Pacing Clin Electrophysiol 2021; 44:1018-1026. [PMID: 33969505 DOI: 10.1111/pace.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to investigate pacemaker dependency after at least 1 year in patients with early (<7 days) implantation, compared to those who received a pacemaker ≥7 days after cardiac surgery. Secondary endpoints were length of hospital stay and in-hospital complications. METHODS Retrospective analysis of 108 consecutive patients who received a pacemaker after cardiac surgery between 06/2012 and 06/2018. Characteristics and outcomes were compared between patients with early (<7 days) and late (≥7 days) implantation. Patients were followed up with evaluation of pacemaker dependency between April and June 2019. We identified predictors of dependency by logistic regression. RESULTS In total, 63.9% were men, average age 71.9 ± 11.8 years; 32 (29.6%) had early implantation, and 76 (70.4%) late implantation. After a median 3.2 years [IQR 1.9, 4.5] of follow-up, 30 patients (27.8%) had died, and there was no difference in pacemaker dependency among survivors (66.7% vs. 46.5%, early vs. late respectively, p = .15). Patients in the early group had a shorter length of stay (11.5 [9.0, 14.0] vs. 15.0 [11.5, 20] days, p = .002) and less often had new-onset atrial fibrillation (AF) post-surgery (22.7% vs. 47.8%, p = .05). The only significant predictor of dependency was aortic valve replacement surgery (OR = 4.70, 95% CI [1.36 to 16.24]). CONCLUSION Early implantation of a permanent pacemaker (<7 days after cardiac surgery) does not impact on the proportion of patients with long-term (>12 months) pacemaker dependency, but is associated with shorter length of stay and less frequent new-onset AF. These findings warrant prospective confirmation in randomized trials.
Collapse
Affiliation(s)
- Marc Badoz
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Baptiste Favoulet
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France
| | - Guillaume Serzian
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
| |
Collapse
|
24
|
Alings M, Descamps O, Guillon B, Leosdottir M, Maggioni AP, Recasens L, Speidl WS, Tripodi RV, Landmesser U, Catapano AL, Pirillo A. Implementation of clinical practices and pathways optimizing ACS patients lipid management: Focus on eight European initiatives. ATHEROSCLEROSIS SUPP 2021; 42:e59-e64. [PMID: 33589225 DOI: 10.1016/j.atherosclerosissup.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Post-acute coronary syndrome (ACS) patients are at very high cardiovascular risk. Despite current guidelines strongly recommend to reduce LDL-C levels and initiation of high-intensity statins as early as possible in patients admitted with an ACS, less than half of ACS patients receive a high intensity statin, and a high percentage of has LDL-C well above the goal despite therapy. There are multiple reasons for that, including physician lack of guideline adherence, patient lack of compliance with treatment, and lack of standardized procedures. Furthermore, although the prevalence of familial hypercholesterolemia is higher among patients with ACS, this condition remains poorly estimated. To fill these gaps, some European countries have launched local initiatives for the in-hospital and post-discharge ACS patient lipid management. It appears that ensuring optimal therapy during hospitalization and dedicated follow-up protocols results in a significant improvement of lipid levels in these very high risk patients, which may translate into a reduced risk of recurrent future events.
Collapse
Affiliation(s)
- Marco Alings
- Department of Cardiology, UMC Utrecht, Netherlands
| | | | - Benoit Guillon
- CHU of Besançon, Cardiology Department, Besançon, France
| | | | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care & Research, Italy; ANMCO Research Center of the Heart Care Foundation, Florence, Italy
| | | | - Walter S Speidl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | | | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, German Center for Cardiovascular Research (DZHK), Partner Site Berlin; Berlin Institute of Health (BIH), Berlin, Germany
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
| |
Collapse
|
25
|
Pico F, Lapergue B, Ferrigno M, Rosso C, Meseguer E, Chadenat ML, Bourdain F, Obadia M, Hirel C, Duong DL, Deltour S, Aegerter P, Labreuche J, Cattenoy A, Smadja D, Hosseini H, Guillon B, Wolff V, Samson Y, Cordonnier C, Amarenco P. Effect of In-Hospital Remote Ischemic Perconditioning on Brain Infarction Growth and Clinical Outcomes in Patients With Acute Ischemic Stroke: The RESCUE BRAIN Randomized Clinical Trial. JAMA Neurol 2021; 77:725-734. [PMID: 32227157 DOI: 10.1001/jamaneurol.2020.0326] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Treatment with remote ischemic perconditioning has been reported to reduce brain infarction volume in animal models of stroke. Whether this neuroprotective effect was observed in patients with acute ischemic stroke remains unknown. Objective To determine whether treatment with remote ischemic perconditioning administered to the leg of patients with acute ischemic stroke can reduce brain infarction volume growth. Design, Setting, and Participants This proof-of-concept multicenter prospective randomized open-label with blinded end point clinical trial was performed from January 12, 2015, to May 2, 2018. Patients were recruited from 11 stroke centers in France. Of the 188 patients who received magnetic resonance imaging within 6 hours of symptom onset and were confirmed to have carotid ischemic stroke, 93 were randomized to receive treatment with lower-limb remote ischemic perconditioning in addition to standard care (the intervention group), and 95 were randomized to receive standard care alone (the control group). Interventions Randomization on a 1:1 ratio to receive treatment with remote ischemic perconditioning (4 cycles of 5-minute inflations and 5-minute deflations to the thigh to 110 mm Hg above systolic blood pressure) in addition to standard care or standard care alone. Main Outcomes and Measures The change in brain infarction volume growth between baseline and 24 hours, measured by a diffusion-weighted sequence of magnetic resonance imaging scans of the brain. Results A total of 188 patients (mean [SD] age, 67.2 [15.7] years; 98 men [52.1%]) were included in this intention-to-treat analysis. At hospital admission, the median National Institutes of Health Stroke Scale score was 10 (interquartile range [IQR], 6-16) and the median brain infarction volume was 11.4 cm3 (IQR, 3.6-35.8 cm3); 164 patients (87.2%) received intravenous thrombolysis, and 64 patients (34.0%) underwent mechanical thrombectomy. The median increase in brain infarction growth was 0.30 cm3 (IQR, 0.11-0.48 cm3) in the intervention group and 0.37 cm3 (IQR, 0.19-0.55 cm3) in the control group (mean between-group difference on loge-transformed change, -0.07; 95% CI, -0.33 to 0.18; P = .57). An excellent outcome (defined as a score of 0-1 on the 90-day modified Rankin Scale or a score equal to the prestroke modified Rankin Scale score) was observed in 46 of 90 patients (51.1%) in the intervention group and 37 of 91 patients (40.7%) in the control group (P = .12). No significant differences in 90-day mortality were observed between the intervention and control groups (14 of 90 patients; Kaplan-Meier estimate, 15.8% vs 10 of 91 patients; Kaplan-Meier estimate, 10.4%, respectively; P = .45) or with symptomatic intracerebral hemorrhage (4 of 88 patients [4.5%] in both groups; P = .97). Conclusions and Relevance In this study, treatment with remote ischemic perconditioning, during or after reperfusion therapies, had no significant effect on brain infarction volume growth at 24 hours after symptom onset. Trial Registration ClinicalTrials.gov Identifier: NCT02189928.
Collapse
Affiliation(s)
- Fernando Pico
- Department of Neurology and Stroke Center, Versailles Mignot Hospital, Versailles, France.,University of Versailles Saint-Quentin-en-Yvelines and Paris-Saclay University, Saint-Aubin, France.,Laboratoire de Recherche Vasculaire Translationnelle, Inserm U1148, Paris, France
| | - Bertrand Lapergue
- University of Versailles Saint-Quentin-en-Yvelines and Paris-Saclay University, Saint-Aubin, France.,Neurology and Stroke Center, Hôpital Foch, Suresnes, France
| | - Marc Ferrigno
- Department of Degenerative and Vascular Cognitive Disorders, Inserm U1171, Université de Lille, Lille, France.,Department of Neurology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Charlotte Rosso
- Assistance Publique-Hopitaux de Paris, Service des Urgences Cerebro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France.,Centre National de la Recherche Scientifique, Inserm U1127, Unite Mixte de Recherche 7225, Institut du Cerveau et de la Moelle Epiniere, Sorbonne Universite, Paris, France
| | - Elena Meseguer
- Assistance Publique-Hôpitaux de Paris, Department of Neurology and Stroke Center, Bichat University Hospital, Universite Paris Diderot, Sorbonne Cite, Paris, France
| | - Marie-Laure Chadenat
- Department of Neurology and Stroke Center, Versailles Mignot Hospital, Versailles, France
| | | | - Michael Obadia
- Neurology and Stroke Center, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Catherine Hirel
- Department of Neurology and Stroke Center, Versailles Mignot Hospital, Versailles, France.,University of Versailles Saint-Quentin-en-Yvelines and Paris-Saclay University, Saint-Aubin, France
| | - Duc Long Duong
- Department of Neurology and Stroke Center, Versailles Mignot Hospital, Versailles, France
| | - Sandrine Deltour
- Assistance Publique-Hopitaux de Paris, Service des Urgences Cerebro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Philippe Aegerter
- Assistance Publique-Hôpitaux de Paris, Vieillissement et Maladies Chroniques, IndianaSERM, Unité Mixte de Recherche 1168, Universite de Versailles Saint-Quentin-en-Yvelines, Versailles, France.,Department of Biostatistics, Université de Lille, Lille, France
| | - Julien Labreuche
- Unité de Recherche EA 2694-Sante Publique: Epidemiologie et Qualite des Soins, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Amina Cattenoy
- Délégation à la Recherche Clinique, Versailles Mignot Hospital, Versailles, France
| | - Didier Smadja
- Stroke Unit, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Hassan Hosseini
- Assistance Publique-Hopitaux de Paris, Stroke Center, Henri Mondor Hospital, Université Paris-Est Créteil, Creteil, France
| | - Benoit Guillon
- Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Valérie Wolff
- Stroke Unit, Strasbourg University Hospital, Strasbourg, France
| | - Yves Samson
- Assistance Publique-Hopitaux de Paris, Service des Urgences Cerebro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Charlotte Cordonnier
- Department of Degenerative and Vascular Cognitive Disorders, Inserm U1171, Université de Lille, Lille, France.,Department of Neurology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Amarenco
- Laboratoire de Recherche Vasculaire Translationnelle, Inserm U1148, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of Neurology and Stroke Center, Bichat University Hospital, Universite Paris Diderot, Sorbonne Cite, Paris, France
| |
Collapse
|
26
|
Guillon B, Tauzin H, Ecarnot F, Meneveau N. How can optical coherence tomography be used to optimize percutaneous coronary intervention? Cardiovasc Diagn Ther 2020; 10:1415-1428. [PMID: 33224765 DOI: 10.21037/cdt.2020.04.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optical coherence tomography (OCT) imaging provides high resolution assessment of coronary parietal and endoluminal abnormalities. Clinical evidence and intuitive utilization make this tool relevant for use in daily practice in the catheterization laboratory. In the present review, we summarize the benefits of OCT for the optimization of percutaneous coronary intervention (PCI) in daily practice. First, we focus on the characterization of lesion type with a view to anticipating challenges during PCI. Then, we describe the utility of OCT to identify culprit lesions and ambiguous angiographic findings. Finally, we outline targets for optimization after PCI and the mechanisms underlying stent failure.
Collapse
Affiliation(s)
- Benoit Guillon
- Department of Cardiology, University Hospital Besançon, Besançon, France.,EA3920, University of Franche-Comté, Besançon, France
| | - Hélène Tauzin
- Department of Cardiology, University Hospital Besançon, Besançon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Besançon, France.,EA3920, University of Franche-Comté, Besançon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Besançon, Besançon, France.,EA3920, University of Franche-Comté, Besançon, France
| |
Collapse
|
27
|
Constant Dit Beaufils P, Preterre C, De Gaalon S, Labreuche J, Mazighi M, Di Maria F, Sibon I, Marnat G, Gariel F, Blanc R, Gory B, Consoli A, Zhu F, Richard S, Fahed R, Desal H, Lapergue B, Guillon B, Bourcier R. Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study. Eur J Neurol 2020; 28:229-237. [PMID: 32935401 DOI: 10.1111/ene.14539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT. METHODS Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22-36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4-6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. RESULTS Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44-2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47-2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22-2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77-5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. CONCLUSIONS Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
Collapse
Affiliation(s)
| | - C Preterre
- Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France
| | - S De Gaalon
- Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France
| | - J Labreuche
- CHU Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, University of Lille, Lille, France
| | - M Mazighi
- Department of Interventional Neuroradiology Fondation Ophtalmologique A. De Rothschild, Unité INSERM 1148, Université de Paris, Paris, France
| | - F Di Maria
- Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - I Sibon
- Department of Neurology, CHU Bordeaux, Stroke Unit, Université de Bordeaux, Bordeaux, France
| | - G Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - F Gariel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - R Blanc
- Department of Interventional Neuroradiology Fondation Ophtalmologique A. De Rothschild, Unité INSERM 1148, Université de Paris, Paris, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - A Consoli
- Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - F Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - S Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine (S.R.), Nancy, France.,INSERM U1116, CHRU-Nancy, Nancy, France
| | - R Fahed
- Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France.,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - H Desal
- Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France.,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - B Lapergue
- Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - B Guillon
- Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France
| | - R Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France.,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | | |
Collapse
|
28
|
Chopard R, Badoz M, Eveno C, Ecarnot F, Falvo N, Kalbacher E, Capellier G, Guillon B, Schiele F, Meneveau N. Early prescription of direct oral anticoagulant for the treatment of intermediate-high risk pulmonary embolism: a multi-center, observational cohort study. Thromb Res 2020; 196:476-482. [PMID: 33091699 DOI: 10.1016/j.thromres.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The safety and efficacy of direct oral anticoagulants (DOACs) in intermediate-high risk pulmonary embolism (PE) are unknown. The aims of the present study were to describe outcomes of patients receiving early apixaban or rivaroxaban prescription rather than the recommended delayed prescription strategy. METHODS Retrospective post-hoc analysis based on prospectively collected data from a multicenter cohort including all consecutive PE patients stratified as intermediate-high risk. Group definitions were: early group with DOAC prescription <72 h after admission; delayed group with DOAC prescription between 72 h and discharge. The 30-day primary efficacy outcome was a clinical composite of all-cause death and hemodynamic decompensation. The 30-day primary safety outcome was major bleeding. RESULTS Among 2411 patients admitted with PE, 302 were treated with a DOAC for an intermediate-high risk PE: 34.2% in the early group and 65.9% in the delayed group. The primary outcome occurred in 4.8% (including 1 death and 4 hemodynamic decompensations) in the early DOAC group and in 9.0% in the delayed DOAC group (OR, 0.44, 95% CI 0.15-1.30). The rate of major bleeding did not differ between groups (OR, 0.99; 95% CI 0.45-2.18). The length of stay was numerically shorter in the early group whereas the other outcomes did not differ significantly. CONCLUSION The rate of 30-day outcomes was low in patients receiving a DOAC earlier after admission. Patients in the early DOAC group had a numerically shorter length of stay, with similarly low rates of death and bleeding, and similar RV function recovery compared to the delayed strategy.
Collapse
Affiliation(s)
- Romain Chopard
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France.
| | - Marc Badoz
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - Charly Eveno
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - Fiona Ecarnot
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - Nicolas Falvo
- Department of Internal Medicine, University Hospital, 2 Boulevard du Maréchal de Lattre de Tassigny, 21000 Dijon, France
| | - Elsa Kalbacher
- Medical Oncology Unit, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - Gilles Capellier
- Medical Intensive Care Unit, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - Benoit Guillon
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - François Schiele
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| | - Nicolas Meneveau
- Department of Cardiology, EA3920, University Hospital Besançon, Boulevard Fleming, 25030 Besançon, France
| |
Collapse
|
29
|
Lionnet A, Cueff C, de Gaalon S, Manigold T, Sévin M, Testard N, Guillon B. Cause cardiache di embolia cerebrale. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
30
|
Mac Grory B, Nackenoff A, Poli S, Spitzer MS, Nedelmann M, Guillon B, Preterre C, Chen CS, Lee AW, Yaghi S, Stretz C, Azher I, Paddock J, Bakaeva T, Greer DM, Shulman JG, Kowalski RG, Lavin P, Mistry E, Espaillat K, Furie K, Kirshner H, Schrag M. Intravenous Fibrinolysis for Central Retinal Artery Occlusion: A Cohort Study and Updated Patient-Level Meta-Analysis. Stroke 2020; 51:2018-2025. [PMID: 32568646 DOI: 10.1161/strokeaha.119.028743] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Central retinal artery occlusion results in sudden, painless, usually permanent loss of vision in the affected eye. There is no proven, effective treatment to salvage visual acuity and a clear, unmet need for an effective therapy. In this work, we evaluated the efficacy of intravenous tissue-type plasminogen activator (IV alteplase) in a prospective cohort study and an updated systematic review and meta-analysis. METHODS We enrolled consecutive patients with acute central retinal artery occlusion within 48 hours of symptoms onset and with a visual acuity of <20/200 from January 2009 until May 2019. The primary outcomes were safety and functional visual acuity recovery. We compared rates of visual recovery between those treated with alteplase within 4.5 hours of symptom onset to those who did not receive alteplase (including an analysis restricted to untreated patients presenting within the window for treatment). We incorporated these results into an updated systematic review and patient-level meta-analysis. RESULTS We enrolled 112 patients, of whom 25 (22.3% of the cohort) were treated with IV alteplase. One patient had an asymptomatic intracerebral hemorrhage after IV alteplase treatment. Forty-four percent of alteplase-treated patients had recovery of visual acuity when treated within 4.5 hours versus 13.1% of those not treated with alteplase (P=0.003) and 11.6% of those presenting within 4 hours who did not receive alteplase (P=0.03). Our updated patient-level meta-analysis of 238 patients included 67 patients treated with alteplase within 4.5 hours since time last known well with a recovery rate of 37.3%. This favorably compares with a 17.7% recovery rate in those without treatment. In linear regression, earlier treatment correlated with a higher rate of visual recovery (P=0.01). CONCLUSIONS This study showed that the administration of intravenous alteplase within 4.5 hours of symptom onset is associated with a higher likelihood of a favorable visual outcome for acute central retinal artery occlusion. Our results strongly support proceeding to a randomized, placebo-controlled clinical trial.
Collapse
Affiliation(s)
- Brian Mac Grory
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Alex Nackenoff
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Sven Poli
- Department of Neurology with Focus on Neurovascular Diseases, and Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Germany (S.P.)
| | - Martin S Spitzer
- Eye Clinic, University Hospital Hamburg-Eppendorf, Germany (M.S.S.)
| | - Max Nedelmann
- Department of Neurology, Sana Regio Klinikum, Pinneberg, Germany (M.N.)
| | - Benoit Guillon
- Department of Neurology, CHU de Nantes - Laennec Nantes, France (B.G., C.P.)
| | - Cécile Preterre
- Department of Neurology, CHU de Nantes - Laennec Nantes, France (B.G., C.P.)
| | - Celia S Chen
- Department of Ophthalmology, Flinders Medical Center and Flinders University, Adelaide, Australia (C.S.C.)
| | - Andrew W Lee
- Department of Neurology, Flinders University and the Calvary Wakefield Hospital, Adelaide, Australia (A.W.L.)
| | - Shadi Yaghi
- Department of Neurology, New York University School of Medicine (S.Y.)
| | - Christoph Stretz
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Idrees Azher
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - John Paddock
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Tatiana Bakaeva
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI.,Division of Ophthalmology, Department of Surgery (T.B.), Warren Alpert Medical School of Brown University, Providence, RI.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (T.B.)
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, MA (D.M.G., J.G.S.)
| | - Julie G Shulman
- Department of Neurology, Boston University School of Medicine, MA (D.M.G., J.G.S.)
| | | | - Patrick Lavin
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Ophthalmology and Visual Sciences (P.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Eva Mistry
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Kiersten Espaillat
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Karen Furie
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Howard Kirshner
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Matthew Schrag
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
31
|
Salomon du Mont L, Parmentier AL, Puyraveau M, Mauny F, Guillon B, Rinckenbach S, Costa P. To assess hemodynamic disturbances to the ostia of the renal arteries generated by the implantation of EVAR with a suprarenal fixation. Medicine (Baltimore) 2020; 99:e19917. [PMID: 32358359 PMCID: PMC7440303 DOI: 10.1097/md.0000000000019917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The treatment of abdominal aortic aneurysm (AAA) is increasingly performed via endovascular aneurysm repair (EVAR). Different types of fixation are possible with EVAR, i.e., below (infrarenal fixation) or above (suprarenal fixation) the renal arteries. Hemodynamic alterations in renal arterial flow with suprarenal (SR) fixation remain to be demonstrated. The IFIXEAR (Impact of Supra-renal Fixation of EVAR on Hemodynamics of Renal Arteries) study is designed to assess the hemodynamic effects at the ostia of at least 1 renal artery, generated immediately post-surgery by the implantation of an aortic stent with SR fixation. METHODS IFIXEAR is a prospective, 2 center study. Every patient undergoing elective EVAR with SR fixation is eligible for inclusion. Patients with previous hemodynamic disturbances to the ostia of 1 of the renal arteries are not eligible. All patients undergo echocardiography and renal arteries duplex ultrasound within a month before surgery, and at 1 and 12 months after surgery. The primary endpoint is hemodynamic disturbance, defined as a peak systolic velocity greater than 120 cm/second, at the ostia of 1 of the renal arteries in the immediate postoperative period. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee "Comité de Protection des Personnes Ouest V" under the number 18/019-2 on April 20, 2018. All patients provide written informed consent before inclusion. The University Hospital of Besancon is the trial sponsor. Results of the study will be submitted for publication in a peer-reviewed international medical journal. REGISTRATION The trial is registered with ClinicalTrials.gov (Identifier: NCT03594786, principal investigator: Dr Patricia Costa, Registered on April 24, 2018).
Collapse
Affiliation(s)
- Lucie Salomon du Mont
- Vascular and Endovascular Surgery Department, University Hospital Besancon
- EA3920, Université de Bourgogne Franche-Comté F-25000 Besançon
| | - Anne-Laure Parmentier
- Inserm CIC 1431, CHU Besançon, F-25000 Besançon
- Laboratoire Chrono-Environnement UMR 6249, CNRS, Université de Bourgogne Franche-Comté F-25000 Besançon
| | - Marc Puyraveau
- Inserm CIC 1431, CHU Besançon, F-25000 Besançon
- Laboratoire Chrono-Environnement UMR 6249, CNRS, Université de Bourgogne Franche-Comté F-25000 Besançon
| | - Frédéric Mauny
- Inserm CIC 1431, CHU Besançon, F-25000 Besançon
- Laboratoire Chrono-Environnement UMR 6249, CNRS, Université de Bourgogne Franche-Comté F-25000 Besançon
| | - Benoit Guillon
- EA3920, Université de Bourgogne Franche-Comté F-25000 Besançon
- Department of Cardiology
| | - Simon Rinckenbach
- Vascular and Endovascular Surgery Department, University Hospital Besancon
- EA3920, Université de Bourgogne Franche-Comté F-25000 Besançon
| | - Patricia Costa
- Vascular Medicine Unit, Vascular and Endovascular Surgery department, University Hospital Besancon, France
| |
Collapse
|
32
|
Daou O, Winiszewski H, Besch G, Pili-Floury S, Belon F, Guillon B, Marx T, Chocron S, Capellier G, Perrotti A, Piton G. Initial pH and shockable rhythm are associated with favorable neurological outcome in cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation. J Thorac Dis 2020; 12:849-857. [PMID: 32274152 PMCID: PMC7139075 DOI: 10.21037/jtd.2019.12.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background There is uncertainty about best selection criteria for extracorporeal cardiopulmonary resuscitation (eCPR) in the setting of refractory cardiac arrest. We aimed to identify factors associated with a favorable neurological outcome, and to build a score calculable at the time of ECMO insertion predicting the prognosis. Methods Retrospective analysis of all patients who underwent eCPR between 2010 and 2017 in a single university hospital. Primary end point was survival with favorable neurological outcome at intensive care unit (ICU) discharge defined as a Cerebral Performance Category of 1 or 2. Results Overall low-flow time of the 113 included patients was 84 [55–122] minutes. Eighteen patients (16%) survived with a favorable neurological outcome. By multivariate logistic regression analysis, initial shockable rhythm, and arterial blood pH at the time of eCPR implantation ≥7.0, were independent predictors of survival with favorable neurological outcome. All of the patients presenting with both non-shockable rhythm and pH <7.0 at the time of eCPR implantation died in the ICU. Conclusions At the time of eCPR start, only initial shockable rhythm and arterial pH ≥7.0 predicted neurological outcome. A selection of the patients who might benefit from eCPR, based upon initial rhythm and arterial pH rather than on low flow time, should be further evaluated.
Collapse
Affiliation(s)
- Oussama Daou
- Department of cardiology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Hadrien Winiszewski
- Medical Intensive Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Guillaume Besch
- Anaesthesia and Surgical Intensive Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Sebastien Pili-Floury
- Anaesthesia and Surgical Intensive Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - François Belon
- Medical Intensive Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Benoit Guillon
- Department of cardiology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Tania Marx
- Emergency department, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Sidney Chocron
- Cardiac Surgery Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Gilles Capellier
- Medical Intensive Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Andrea Perrotti
- Cardiac Surgery Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | - Gaël Piton
- Medical Intensive Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| |
Collapse
|
33
|
|
34
|
Razanamahery J, Malakhia A, Guillon B, Humbert S, Magy-Bertrand N. Multiple arterial thrombosis and pericarditis revealing histiocytosis successfully treated with MEK-inhibitor cobimetinib. Clin Exp Rheumatol 2020; 38:173-174. [PMID: 31376269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - Benoit Guillon
- Department of Cardiology, University Hospital, Besançon, France
| | - Sébastien Humbert
- Department of Internal Medicine, University Hospital, Besançon, France
| | | |
Collapse
|
35
|
Mas JL, Derex L, Guérin P, Guillon B, Habib G, Juliard JM, Marijon E, Massardier E, Meneveau N, Vuillier F. Reprint of : Transcatheter closure of patent foramen ovale to prevent stroke recurrence in patients with otherwise unexplained ischaemic stroke: Expert consensus of the French Neurovascular Society and the French Society of Cardiology. Rev Neurol (Paris) 2019; 176:53-61. [PMID: 31787326 DOI: 10.1016/j.neurol.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.
Collapse
Affiliation(s)
- Jean-Louis Mas
- Service de neurologie et unité neurovasculaire, DHU NeuroVasc Sorbonne Paris-Cité, université Paris-Descartes, hôpital Sainte-Anne, Inserm U1266, 1, rue Cabanis, 75014 Paris, France.
| | - Laurent Derex
- HESPER EA 7425, service de neurologie et unité neurovasculaire, hôpital neurologique, hospices civils de Lyon, 69677 Bron cedex, France
| | - Patrice Guérin
- Unité de cardiologie interventionnelle, institut du thorax et du système nerveux, CHU de Nantes, 44093 Nantes, France
| | - Benoit Guillon
- Unité neurovasculaire, institut du thorax et du système nerveux, CHU de Nantes, 44093 Nantes, France
| | - Gilbert Habib
- IRD, MEPHI, service de cardiologie, IHU-Méditerranée infection, université Aix-Marseille, hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Jean-Michel Juliard
- Service de cardiologie, université Paris-Diderot, hôpital Bichat, Inserm U1148, AP-HP, 75877 Paris, France
| | - Eloi Marijon
- Unité de rythmologie, département de cardiologie, hôpital Européen Georges-Pompidou, 75015 Paris, France
| | | | - Nicolas Meneveau
- EA 3920, Service de cardiologie, université de Franche-Comté, université de Bourgogne-Franche-Comté, CHU Jean-Minjoz, 25000 Besançon, France
| | - Fabrice Vuillier
- Service de neurologie, université de Franche-Comté, CHU de Jean Minjoz, 25000 Besançon, France
| |
Collapse
|
36
|
Chamorro Á, Brown S, Amaro S, Hill MD, Muir KW, Dippel DWJ, van Zwam W, Butcher K, Ford GA, den Hertog HM, Mitchell PJ, Demchuk AM, Majoie CBLM, Bracard S, Sibon I, Jadhav AP, Lara-Rodriguez B, van der Lugt A, Osei E, Renú A, Richard S, Rodriguez-Luna D, Donnan GA, Dixit A, Almekhlafi M, Deltour S, Epstein J, Guillon B, Bakchine S, Gomis M, du Mesnil de Rochemont R, Lopes D, Reddy V, Rudel G, Roos YBWEM, Bonafe A, Diener HC, Berkhemer OA, Cloud GC, Davis SM, van Oostenbrugge R, Guillemin F, Goyal M, Campbell BCV, Menon BK. Glucose Modifies the Effect of Endovascular Thrombectomy in Patients With Acute Stroke. Stroke 2019; 50:690-696. [PMID: 30777000 DOI: 10.1161/strokeaha.118.023769] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Hyperglycemia is a negative prognostic factor after acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy (EVT) in patients with large-vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of EVT in acute stroke. Methods- Seven randomized trials compared EVT with standard care between 2010 and 2017 (HERMES Collaboration [highly effective reperfusion using multiple endovascular devices]). One thousand seven hundred and sixty-four patients with large-vessel stroke were allocated to EVT (n=871) or standard care (n=893). Measurements included blood glucose on admission and functional outcome (modified Rankin Scale range, 0-6; lower scores indicating less disability) at 3 months. The primary analysis evaluated whether glucose modified the effect of EVT over standard care on functional outcome, using ordinal logistic regression to test the interaction between treatment and glucose level. Results- Median (interquartile range) serum glucose on admission was 120 (104-140) mg/dL (6.6 mmol/L [5.7-7.7] mmol/L). EVT was better than standard care in the overall pooled-data analysis adjusted common odds ratio (acOR), 2.00 (95% CI, 1.69-2.38); however, lower glucose levels were associated with greater effects of EVT over standard care. The interaction was nonlinear such that significant interactions were found in subgroups of patients split at glucose < or >90 mg/dL (5.0 mmol/L; P=0.019 for interaction; acOR, 3.81; 95% CI, 1.73-8.41 for patients < 90 mg/dL versus 1.83; 95% CI, 1.53-2.19 for patients >90 mg/dL), and glucose < or >100 mg/dL (5.5 mmol/L; P=0.004 for interaction; acOR, 3.17; 95% CI, 2.04-4.93 versus acOR, 1.72; 95% CI, 1.42-2.08) but not between subgroups above these levels of glucose. Conclusions- EVT improved stroke outcomes compared with standard treatment regardless of glucose levels, but the treatment effects were larger at lower glucose levels, with significant interaction effects persisting up to 90 to 100 mg/dL (5.0-5.5 mmol/L). Whether tight control of glucose improves the efficacy of EVT after large-vessel stroke warrants appropriate testing.
Collapse
Affiliation(s)
- Ángel Chamorro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C., S.A., A.R.).,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.C., S.A., A.R.)
| | - Scott Brown
- Altair Biostatistics, St Louis Park, MN (S. Brown)
| | - Sergio Amaro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C., S.A., A.R.).,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.C., S.A., A.R.)
| | - Michael D Hill
- Calgary Stroke Program, Departments of Clinical Neurosciences, Medicine, Community Health Sciences, and Radiology (M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Diederik W J Dippel
- Department of Neurology (D.W.J.D., E.O., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wim van Zwam
- Department of Radiology (W.v.Z.), Maastricht University Medical Center Maastricht, the Netherlands
| | - Ken Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (K.B.)
| | - Gary A Ford
- Stroke Unit, Oxford University Hospitals and Division of Medical Sciences, Oxford University, United Kingdom (G.A.F.)
| | - Heleen M den Hertog
- Department of Neurology, Isala Klinieken, Zwolle, the Netherlands (H.M.d.H.).,Department of Neurology, Medisch Spectrum Twente, Enschede, Netherlands (H.M.d.H., E.O.)
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital (P.J.M.), University of Melbourne, Parkville, Australia
| | - Andrew M Demchuk
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Charles B L M Majoie
- Department of Radiology (C.B.L.M.M., O.A.B.), Academic Medical Center Amsterdam, the Netherlands
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, INSERM U 947 (S. Bracard), Université de Lorraine and University Hospital of Nancy, France
| | - Igor Sibon
- Stroke Unit University and University Hospital of CHU Bordeaux, France (I.S.)
| | | | | | - Aad van der Lugt
- Department of Radiology (A.v.d.L., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Elizabeth Osei
- Department of Neurology (D.W.J.D., E.O., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Medisch Spectrum Twente, Enschede, Netherlands (H.M.d.H., E.O.)
| | - Arturo Renú
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C., S.A., A.R.).,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.C., S.A., A.R.)
| | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, France (S.R.)
| | - David Rodriguez-Luna
- Stroke Unit, Neurology Department, Vall d'Hebron University Hospital, Spain (D.R.-L.)
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health (G.A.D.), University of Melbourne, Parkville, Australia
| | - Anand Dixit
- University of Newcastle upon Tyne, United Kingdom (A.D.)
| | - Mohammed Almekhlafi
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Sandrine Deltour
- Urgences Cerebro-Vasculaires Sorbonne University and Pitié-Salpêtrière Hospital, APHP, Paris, France (S.D.)
| | - Jonathan Epstein
- INSERM CIC 1433 Clinical Epidemiology (J.E.), Université de Lorraine and University Hospital of Nancy, France
| | - Benoit Guillon
- Stroke Unit, University and University Hospital of Nantes, France (B.G.)
| | - Serge Bakchine
- Neurology-Stroke Unit University and University Hospital of Reims, France (S. Bakchine)
| | - Meritxell Gomis
- Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain (M. Gomis)
| | | | | | - Vivek Reddy
- Department of Neurology, University of Pittsburgh Medical Center, PA (V.R.)
| | - Gernot Rudel
- Department of Neurology, Klinikum Dortmund, Germany (G.R.)
| | - Yvo B W E M Roos
- Department of Neurology (Y.E.W.E.M.R.), Academic Medical Center Amsterdam, the Netherlands
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.)
| | - Hans-Christoph Diener
- Department of Neurology, University Hospital Essen University Duisburg-Essen, Germany (C.D.)
| | - Olvert A Berkhemer
- Department of Neurology (D.W.J.D., E.O., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (A.v.d.L., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (C.B.L.M.M., O.A.B.), Academic Medical Center Amsterdam, the Netherlands
| | - Geoffrey C Cloud
- Department of Clinical Neuroscience, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Australia (G.C.C.)
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (S.M.D.), University of Melbourne, Parkville, Australia
| | - Robert van Oostenbrugge
- Department of Neurology (R.v.O.), Maastricht University Medical Center Maastricht, the Netherlands
| | - Francis Guillemin
- INSERM CIC 1433 Clinical Epidemiology (F.G.), Université de Lorraine and University Hospital of Nancy, France
| | - Mayank Goyal
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (B.C.V.C.), University of Melbourne, Parkville, Australia
| | - Bijoy K Menon
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | | |
Collapse
|
37
|
Rubimbura V, Guillon B, Fournier S, Amabile N, Chi Pan C, Combaret N, Eeckhout E, Kibler M, Silvain J, Wijns W, Schiele F, Muller O, Meneveau N, Adjedj J. Quantitative flow ratio virtual stenting and post stenting correlations to post stenting fractional flow reserve measurements from the DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting) study population. Catheter Cardiovasc Interv 2019; 96:1145-1153. [DOI: 10.1002/ccd.28615] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Benoit Guillon
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | | | | | - Chan Chi Pan
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | | | - Eric Eeckhout
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Marion Kibler
- Departement de cardiologie, Nouvel Hôpital Civil Centre Hospitalier Universitaire Strasbourg France
| | - Johanne Silvain
- Université Paris 6, ACTION Study Group, Institut de Cardiologie (AP‐HP) Centre Hospitalier Universitaire Pitié‐Salpêtrière, INSERM UMRS Paris France
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Ireland
| | - Francois Schiele
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | - Olivier Muller
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Nicolas Meneveau
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | - Julien Adjedj
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
- Department of Cardiology Arnault Tzanck Institute Saint Laurent du Var France
| |
Collapse
|
38
|
Drouard-de Rousiers E, Lucas L, Richard S, Consoli A, Mazighi M, Labreuche J, Kyheng M, Gory B, Dargazanli C, Arquizan C, Marnat G, Blanc R, Desal H, Bourcier R, Sibon I, Lapergue B, Piotin M, Blanc R, Redjem H, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Mazighi M, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Maacha MB, Wang A, Evrard S, Tchikviladze M, Afanasiev V, Ajili N, Sensenbrenner B, Lapergue B, Coskun O, Consoli A, Di Maria F, Rodesch G, Del Sette B, Russo R, Mizutani K, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Nighoghossian N, Riva R, Eker O, Turjman F, Derex L, Cho TH, Mechtouff L, Lukaszewicz AC, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE, Marnat G, Gariel F, Barreau X, Berge J, Veunac L, Menegon P, Sibon I, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Bourcier R, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, L’allinec V, Girot JB, Desal H, de Gaalon S, Guillon B, Gory B, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour JC, Bonnerot M, Riou-Comte N, Costa I, Chatelain A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Gaillard N, et Lucas Corti IM, Francois E, Vannier S. Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy. Stroke 2019; 50:3164-3169. [DOI: 10.1161/strokeaha.119.026448] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Nonagenarians represent a growing stroke population characterized by a higher frailty. Although endovascular therapy (ET) is a cornerstone of the management of acute ischemic stroke related to large vessel occlusion, the benefit of reperfusion among nonagenarians is poorly documented. We aimed to assess the impact of ET-related reperfusion on the functional outcome of reperfusion in this elderly population.
Methods—
A retrospective analysis of clinical and imaging data from all patients aged over 90 included in the ETIS (Endovascular Treatment in Ischemic Stroke) registry between October 2013 and April 2018 was performed. Association between post-ET reperfusion and favorable (modified Rankin Scale [0–2] or equal to prestroke value) and good (modified Rankin Scale [0–3] or equal to prestroke value) outcome were evaluated. Demographic and procedural predictors of functional outcome, including the first-pass effect, were evaluated. Results were adjusted for center, admission National Institutes of Health Stroke Scale, and use of intravenous thrombolysis.
Results—
Among the 124 nonagenarians treated with ET, those with successful reperfusion had the lowest 90-day modified Rankin Scale (odds ratio, 3.26; 95% CI, 1.04–10.25). Only patients with successful reperfusion after the first pass (n=53, 56.7%) had a reduced 90-day mortality (odds ratio, 0.15; 95% CI, 0.05–0.45) and an increased rate of good outcome (odds ratio, 4.55; 95% CI, 1.38–15.03). No increase in the rate of intracranial hemorrhage was observed among patients successfully reperfused.
Conclusions—
Successful reperfusion improves the functional outcome of nonagenarians who should not be excluded from ET. The first-pass effect should be considered in the procedural management of this frail population.
Collapse
Affiliation(s)
- Eve Drouard-de Rousiers
- From the Department of Neurology, Stroke Center (E.D.-d.R., B.L.), Foch Hospital, Suresnes, France
| | - Ludovic Lucas
- Department of Neurology, Stroke Unit, Bordeaux University Hospital, France (L.L.)
| | | | - Arturo Consoli
- Department of Interventional Neuroradiology (A.C), Foch Hospital, Suresnes, France
| | - Mikaël Mazighi
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (M.M., R. Blanc)
| | - Julien Labreuche
- University of Lille, University Hospital of Lille, EA2694 -Santé publique: épidémiologie et qualité des soins, France (J.L., M.K.)
| | - Maéva Kyheng
- University of Lille, University Hospital of Lille, EA2694 -Santé publique: épidémiologie et qualité des soins, France (J.L., M.K.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, France (B.G.)
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology (C.D.), CHRU Gui de Chauliac, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology (G.M.), University Hospital of Bordeaux, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (M.M., R. Blanc)
| | - Hubert Desal
- Department of Neuroradiology, University Hospital of Nantes, France (H.D., R. Bourcier)
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (H.D., R. Bourcier)
| | - Igor Sibon
- Department of Neurology, Stroke Center (I.S.), University Hospital of Bordeaux, France
| | - Bertrand Lapergue
- From the Department of Neurology, Stroke Center (E.D.-d.R., B.L.), Foch Hospital, Suresnes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Guillon B, Moris M, Besutti M, Lefrancois Y, Amabile N, Combaret N, Ohlmann P, Belle L, Silvain J, Schiele F, Meneveau N. 5032Evaluation of the EAPCI OCT criteria for optimization of angioplasty in the DOCTORS study population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The recent expert consensus of the EAPCI suggested OCT criteria for the optimization of PCT after stent implantation. Using the data from the randomized, controlled DOCTORS study, we aimed to analyze the proportion of OCT criteria that were met immediately after stent implantation, and to evaluate the changes made to the revascularization strategy in order to optimize the procedure.
Methods
The DOCTORS study population consisted of patients admitted for non ST elevation myocardial infarction (NSTEMI) and presenting an indication for PCI with stent implantation of the target lesion. In the 120 patients randomized to the OCT-guided group, OCT was performed after initial coronary angiography and repeated immediately after stent implantation. The operator was required to evaluate quantitative measures of the reference diameter and reference area of the vessel and the length of the lesion based on the OCT images acquired before PCI. All OCT images were analyzed in a centralized core laboratory by 2 independent operators blinded to the angiographic findings. Post-PCI optimization targets to be achieved following stent implantation included optimal stent expansion (minimal stent area (MSA)/average reference lumen >80%), avoidance of landing zone in plaque burden >50% or lipid rich tissue; avoidance of large malapposition regions (axial distance <0.4 mm and <1 mm length), no extensive irregular tissue protrusion, and limited dissections (<60°, flap limited to intima, <2 mm length).
Results
Among the 120 patients who had an OCT run performed immediately after stent implantation, 50 patients (42%) had stent under-expansion, 59 (49%) had landing zone in plaque burden >50% or lipid rich tissue, 27 (22.5%) had stent malapposition, 25 (20.8%) had extensive irregular tissue protrusion and 45 (37.5%) had extensive edge dissection. Only 2 patients (1.7%) fullfiled all criteria of post-PCI optimization immediately after stent implantation, while no criterion was reached in 15 patients (12.5%). Post-stent overdilation was performed in all patients with stent underexpansion, and in 22/27 patients (81.5%) with stent malapposition. Additional stent implantation was performed in 32 patients (24 for landing zone in plaque burden >50% and 8 for extensive adventitial edge dissection). Overall, the use of OCT led the operator to optimize the procedural strategy in 60 patients (50%).
Conclusion
The proportion of suboptimal results as evaluated by OCT and based on the EAPCI criteria immediately after stent implantation was very high in the DOCTORS study, even though the choice of stent in these patients was based on pre-PCI OCT data. The post-PCI OCT findings led to a change of strategy to optimize the procedure in 50% of patients. It remains to be determined through a larger prospective study whether this optimization of PCI strategy is associated with a clinical benefit in the long term.
Collapse
Affiliation(s)
- B Guillon
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - M Moris
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - M Besutti
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - Y Lefrancois
- Hospital Belfort-Montbeliard, Montbeliard, France
| | - N Amabile
- Institut Mutualiste Montsouris, Paris, France
| | - N Combaret
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - L Belle
- Hospital of Annecy, Annecy, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | - F Schiele
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - N Meneveau
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| |
Collapse
|
40
|
Mas JL, Derex L, Guérin P, Guillon B, Habib G, Juliard JM, Marijon E, Massardier E, Meneveau N, Vuillier F. Transcatheter closure of patent foramen ovale to prevent stroke recurrence in patients with otherwise unexplained ischaemic stroke: Expert consensus of the French Neurovascular Society and the French Society of Cardiology. Arch Cardiovasc Dis 2019; 112:532-542. [PMID: 31378692 DOI: 10.1016/j.acvd.2019.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.
Collapse
Affiliation(s)
- Jean-Louis Mas
- Service de neurologie et unité neurovasculaire, DHU NeuroVasc Sorbonne Paris-Cité, université Paris-Descartes, hôpital Sainte-Anne, Inserm U1266, 1, rue Cabanis, 75014 Paris, France.
| | - Laurent Derex
- HESPER EA 7425, service de neurologie et unité neurovasculaire, hôpital neurologique, hospices civils de Lyon, 69677 Bron cedex, France
| | - Patrice Guérin
- Unité de cardiologie interventionnelle, institut du thorax et du système nerveux, CHU de Nantes, 44093 Nantes, France
| | - Benoit Guillon
- Unité neurovasculaire, institut du thorax et du système nerveux, CHU de Nantes, 44093 Nantes, France
| | - Gilbert Habib
- IRD, MEPHI, service de cardiologie, IHU-Méditerranée infection, université Aix-Marseille, hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Jean-Michel Juliard
- Service de cardiologie, université Paris-Diderot, hôpital Bichat, Inserm U1148, AP-HP, 75877 Paris, France
| | - Eloi Marijon
- Unité de rythmologie, département de cardiologie, hôpital Européen Georges-Pompidou, 75015 Paris, France
| | | | - Nicolas Meneveau
- EA 3920, Service de cardiologie, université de Franche-Comté, université de Bourgogne-Franche-Comté, CHU Jean-Minjoz, 25000 Besançon, France
| | - Fabrice Vuillier
- Service de neurologie, université de Franche-Comté, CHU de Jean Minjoz, 25000 Besançon, France
| |
Collapse
|
41
|
Rakhimov AV, Barabash AS, Basharina-Freshville A, Blot S, Bongrand M, Bourgeois C, Breton D, Breier R, Birdsall E, Brudanin VB, Burešova H, Busto J, Calvez S, Cascella M, Cerna C, Cesar JP, Chauveau E, Chopra A, Claverie G, De Capua S, Delalee F, Duchesneau D, Egorov VG, Eurin G, Evans JJ, Fajt L, Filosofov DV, Flack R, Garrido X, Gomez H, Guillon B, Guzowski P, Hodák R, Holý K, Huber A, Hugon C, Jeremie A, Jullian S, Karaivanov DV, Kauer M, Klimenko AA, Kochetov OI, Konovalov SI, Kovalenko V, Lang K, Lemière Y, Le Noblet T, Liptak Z, Liu XR, Loaiza P, Lutter G, Maalmi J, Macko M, Mamedov F, Marquet C, Mauger F, Minotti A, Mirsagatova AA, Mirzayev NA, Moreau I, Morgan B, Mott J, Nemchenok IB, Nomachi M, Nova F, Ohsumi H, Oliviero G, Pahlka RB, Pater JR, Palušová V, Perrot F, Piquemal F, Povinec P, Pridal P, Ramachers YA, Rebii A, Remoto A, Richards B, Ricol JS, Rukhadze E, Rukhadze NI, Saakyan R, Sadikov II, Salazar R, Sarazin X, Sedgbeer J, Shitov YA, Šimkovic F, Simard L, Smetana A, Smolek K, Smolnikov AA, Snow S, Söldner-Rembold S, Soulé B, Špavorova M, Štekl I, Tashimova FA, Thomas J, Timkin V, Torre S, Tretyak VI, Tretyak VI, Umatov VI, Vilela C, Vorobel V, Warot G, Waters D, Zampaolo M, Žukauskas A. Development of methods for the preparation of radiopure 82Se sources for the SuperNEMO neutrinoless double-beta decay experiment. RADIOCHIM ACTA 2019. [DOI: 10.1515/ract-2019-3129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
A radiochemical method for producing 82Se sources with an ultra-low level of contamination of natural radionuclides (40K, decay products of 232Th and 238U) has been developed based on cation-exchange chromatographic purification with reverse removal of impurities. It includes chromatographic separation (purification), reduction, conditioning (which includes decantation, centrifugation, washing, grinding, and drying), and 82Se foil production. The conditioning stage, during which highly dispersed elemental selenium is obtained by the reduction of purified selenious acid (H2SeO3) with sulfur dioxide (SO2) represents the crucial step in the preparation of radiopure 82Se samples. The natural selenium (600 g) was first produced in this procedure in order to refine the method. The technique developed was then used to produce 2.5 kg of radiopure enriched selenium (82Se). The produced 82Se samples were wrapped in polyethylene (12 μm thick) and radionuclides present in the sample were analyzed with the BiPo-3 detector. The radiopurity of the plastic materials (chromatographic column material and polypropylene chemical vessels), which were used at all stages, was determined by instrumental neutron activation analysis. The radiopurity of the 82Se foils was checked by measurements with the BiPo-3 spectrometer, which confirmed the high purity of the final product. The measured contamination level for 208Tl was 8–54 μBq/kg, and for 214Bi the detection limit of 600 μBq/kg has been reached.
Collapse
Affiliation(s)
- Alimardon V. Rakhimov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
- Institute of Nuclear Physics of Uzbekistan Academy of Sciences , Tashkent , 100214 , Uzbekistan
| | - A. S. Barabash
- NRC “Kurchatov Institute”, ITEP , 117218 Moscow , Russia
| | | | - S. Blot
- University of Manchester , Manchester M13 9PL , UK
| | - M. Bongrand
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - Ch. Bourgeois
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - D. Breton
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - R. Breier
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
| | - E. Birdsall
- University of Manchester , Manchester M13 9PL , UK
| | - V. B. Brudanin
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
- National Research Nuclear University MEPhI , 115409 Moscow , Russia
| | | | - J. Busto
- CPPM, Universite d’Aix Marseille, CNRS/IN2P3 , F-13288 Marseille , France
| | - S. Calvez
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - M. Cascella
- University College London , London WC1E 6BT , UK
| | - C. Cerna
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - J. P. Cesar
- University of Texas at Austin , Austin, TX 78712 , USA
| | - E. Chauveau
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - A. Chopra
- University College London , London WC1E 6BT , UK
| | - G. Claverie
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - S. De Capua
- University of Manchester , Manchester M13 9PL , UK
| | - F. Delalee
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - D. Duchesneau
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc , CNRS/IN2P3, LAPP, 74000 Annecy , France
| | - V. G. Egorov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - G. Eurin
- University College London , London WC1E 6BT , UK
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - J. J. Evans
- University of Manchester , Manchester M13 9PL , UK
| | - L. Fajt
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - D. V. Filosofov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - R. Flack
- University College London , London WC1E 6BT , UK
| | - X. Garrido
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - H. Gomez
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - B. Guillon
- LPC Caen, ENSICAEN, Université de Caen , CNRS/IN2P3, F-14050 Caen , France
| | - P. Guzowski
- University of Manchester , Manchester M13 9PL , UK
| | - R. Hodák
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - K. Holý
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
| | - A. Huber
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - C. Hugon
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - A. Jeremie
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc , CNRS/IN2P3, LAPP, 74000 Annecy , France
| | - S. Jullian
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - D. V. Karaivanov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
- Institute for Nuclear Research and Nuclear Energy (INRNE) , 72 Tzarigradsko chaussee, Blvd., BG-1784 Sofia , Bulgaria
| | - M. Kauer
- University College London , London WC1E 6BT , UK
| | - A. A. Klimenko
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - O. I. Kochetov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | | | - V. Kovalenko
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - K. Lang
- University of Texas at Austin , Austin, TX 78712 , USA
| | - Y. Lemière
- LPC Caen, ENSICAEN, Université de Caen , CNRS/IN2P3, F-14050 Caen , France
| | - T. Le Noblet
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc , CNRS/IN2P3, LAPP, 74000 Annecy , France
| | - Z. Liptak
- University of Texas at Austin , Austin, TX 78712 , USA
| | - X. R. Liu
- University College London , London WC1E 6BT , UK
| | - P. Loaiza
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - G. Lutter
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - J. Maalmi
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - M. Macko
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - F. Mamedov
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - C. Marquet
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - F. Mauger
- LPC Caen, ENSICAEN, Université de Caen , CNRS/IN2P3, F-14050 Caen , France
| | - A. Minotti
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc , CNRS/IN2P3, LAPP, 74000 Annecy , France
| | - A. A. Mirsagatova
- Institute of Nuclear Physics of Uzbekistan Academy of Sciences , Tashkent , 100214 , Uzbekistan
| | - N. A. Mirzayev
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
- Institute of Radiation Problems of Azerbaijan National Academy of Sciences , AZ1143 B. Vahabzade 9 , Baku , Azerbaijan
| | - I. Moreau
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - B. Morgan
- University of Warwick , Coventry CV4 7AL , UK
| | - J. Mott
- University College London , London WC1E 6BT , UK
| | - I. B. Nemchenok
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - M. Nomachi
- Osaka University , 1-1 Machikaney arna Toyonaka , Osaka 560-0043 , Japan
| | - F. Nova
- University of Texas at Austin , Austin, TX 78712 , USA
| | - H. Ohsumi
- Saga University , Saga 840-8502 , Japan
| | - G. Oliviero
- LPC Caen, ENSICAEN, Université de Caen , CNRS/IN2P3, F-14050 Caen , France
| | - R. B. Pahlka
- University of Texas at Austin , Austin, TX 78712 , USA
| | - J. R. Pater
- University of Manchester , Manchester M13 9PL , UK
| | - V. Palušová
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
| | - F. Perrot
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - F. Piquemal
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - P. Povinec
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
| | - P. Pridal
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | | | - A. Rebii
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - A. Remoto
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc , CNRS/IN2P3, LAPP, 74000 Annecy , France
| | - B. Richards
- University College London , London WC1E 6BT , UK
| | - J. S. Ricol
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - E. Rukhadze
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
| | - N. I. Rukhadze
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - R. Saakyan
- University College London , London WC1E 6BT , UK
| | - I. I. Sadikov
- Institute of Nuclear Physics of Uzbekistan Academy of Sciences , Tashkent , 100214 , Uzbekistan
| | - R. Salazar
- University of Texas at Austin , Austin, TX 78712 , USA
| | - X. Sarazin
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
| | - J. Sedgbeer
- Imperial College London , London SW7 2AZ , UK
| | - Yu. A. Shitov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - F. Šimkovic
- Faculty of Mathematics, Physics and Informatics , Comenius University , SK-842 48 Bratislava , Slovakia
| | - L. Simard
- LAL, Université Paris-Sud, CNRS/IN2P3, Université Paris-Saclay , F-91405 Orsay , France
- Institut Universitaire de France , F-75005 Paris , France
| | - A. Smetana
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - K. Smolek
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - A. A. Smolnikov
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - S. Snow
- University of Warwick , Coventry CV4 7AL , UK
| | | | - B. Soulé
- CENBG, Université de Bordeaux, CNRS/IN2P3 , F-33175 Gradignan , France
| | - M. Špavorova
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - I. Štekl
- Institute of Experimental and Applied Physics , Czech Technical University in Prague , CZ-12800 Prague , Czech Republic
| | - F. A. Tashimova
- Institute of Nuclear Physics of Uzbekistan Academy of Sciences , Tashkent , 100214 , Uzbekistan
| | - J. Thomas
- University College London , London WC1E 6BT , UK
| | - V. Timkin
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - S. Torre
- University College London , London WC1E 6BT , UK
| | | | - V. I. Tretyak
- Joint Institute for Nuclear Research (JINR) , Dubna , 141980 , Russian Federation
| | - V. I. Umatov
- NRC “Kurchatov Institute”, ITEP , 117218 Moscow , Russia
| | - C. Vilela
- University College London , London WC1E 6BT , UK
| | - V. Vorobel
- Charles University, Prague, Faculty of Mathematics and Physics , CZ-12116 Prague , Czech Republic
| | - G. Warot
- Univ. Grenoble Alpes, CNRS, Grenoble INP , LPSC-IN2P3, 38000 Grenoble , France
| | - D. Waters
- University College London , London WC1E 6BT , UK
| | - M. Zampaolo
- Univ. Grenoble Alpes, CNRS, Grenoble INP , LPSC-IN2P3, 38000 Grenoble , France
| | - A. Žukauskas
- Charles University, Prague, Faculty of Mathematics and Physics , CZ-12116 Prague , Czech Republic
| |
Collapse
|
42
|
Meneveau N, Guillon B, Planquette B, Piton G, Kimmoun A, Gaide-Chevronnay L, Aissaoui N, Neuschwander A, Zogheib E, Dupont H, Pili-Floury S, Ecarnot F, Schiele F, Deye N, de Prost N, Favory R, Girard P, Cristinar M, Ferré A, Meyer G, Capellier G, Sanchez O. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases. Eur Heart J 2018; 39:4196-4204. [DOI: 10.1093/eurheartj/ehy464] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/13/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon, France
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon, France
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
| | - Benjamin Planquette
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou and Université Paris Descartes, 20 rue Leblanc, Paris, France
| | - Gaël Piton
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
- Medical Intensive Care Unit, University Hospital Jean Minjoz, Boulevard Fleming, Besancon, France
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation Brabois, Institut Lorrain du Coeur et des Vaisseaux, CHRU de Nancy, Rue du Morvan, Vandoeuvre les Nancy, France
- U1116, Faculté de Médecine de Nancy, 9 Avenue de la Forêt de Haye, Vandoeuvre les Nancy, France
| | - Lucie Gaide-Chevronnay
- Pôle Anesthésie Réanimation, Hôpital Michallon, CHU Grenoble Alpes, Avenue Maquis du Grésivaudan, La Tronche, France
| | - Nadia Aissaoui
- Department of Critical Care Unit, Hôpital Européen-Georges-Pompidou (HEGP), Assistance Publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, Paris, France
- Université Paris-Descartes, Inserm U970, 56 rue Leblanc, Paris, France
| | - Arthur Neuschwander
- Surgical Intensive Care Unit, Hôpital Européen-Georges-Pompidou (HEGP), Assistance Publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, Paris, France
| | - Elie Zogheib
- Cardiothoracic Intensive Care Department, Amiens University Hospital, Amiens, France
- INSERM U1088, Jules Verne University of Picardy, Chemin du Thil, Amiens, France
| | - Hervé Dupont
- Cardiothoracic Intensive Care Department, Amiens University Hospital, Amiens, France
- INSERM U1088, Jules Verne University of Picardy, Chemin du Thil, Amiens, France
| | - Sebastien Pili-Floury
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
- Surgical Intensive Care Unit and Department of Anesthesiology, University Hospital Jean Minjoz, Boulevard Fleming, Besancon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon, France
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon, France
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
| | - Nicolas Deye
- Service de Réanimation médicale et toxicologique, Hôpital Lariboisière, Assistance Publique-hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, Paris Cedex 10, France
- Inserm UMR-S 942, Hôpital Lariboisière, 41 Boulevard de la Chapelle, Paris Cedex 10, France
| | - Nicolas de Prost
- Service de Réanimation médicale, Hôpital Henri Mondor, Assistance Publique-hôpitaux de Paris (AP-HP), 51 avenue du Maréchal de Lattre de Tassigny, Créteil Cedex, France
| | - Raphaël Favory
- Centre de Réanimation, CHU de Lille—Hôpital Salengro, Rue Emile Laine, Lille Cedex, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, L’Institut Mutualiste Montsouris, 42 boulevard Jourdan, Paris, France
| | - Mircea Cristinar
- Hôpitaux Universitaires de Strasbourg, 1 Quai Louis Pasteur, Strasbourg, France
| | - Alexis Ferré
- Service de réanimation médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique—Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France
| | - Guy Meyer
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou and Université Paris Descartes, 20 rue Leblanc, Paris, France
| | - Gilles Capellier
- EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France
- Medical Intensive Care Unit, University Hospital Jean Minjoz, Boulevard Fleming, Besancon, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou and Université Paris Descartes, 20 rue Leblanc, Paris, France
| |
Collapse
|
43
|
Meneveau N, Capellier G, Blanquette B, Guillon B, Pili-Floury S, Kimmoun A, Gaide-Chevronnay L, Aissaoui N, Zogheib E, Ecarnot F, Schiele F, De Prost N, Girard P, Deye N, Sanchez O. P3556Extracorporeal membrane oxygenation in patients with pulmonary embolism. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Meneveau
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - G Capellier
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - B Blanquette
- European Hospital Georges Pompidou, Paris, France
| | - B Guillon
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - S Pili-Floury
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - A Kimmoun
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | | | - N Aissaoui
- European Hospital Georges Pompidou, Paris, France
| | - E Zogheib
- University Hospital of Amiens, Amiens, France
| | - F Ecarnot
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - F Schiele
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - N De Prost
- University Hospital Henri Mondor, Creteil, France
| | - P Girard
- Institut Mutualiste Montsouris, Paris, France
| | - N Deye
- Hospital Lariboisiere, Paris, France
| | - O Sanchez
- European Hospital Georges Pompidou, Paris, France
| |
Collapse
|
44
|
L’Allinec V, Ernst M, Sevin-Allouet M, Testard N, Delasalle-Guyomarch B, Guillon B, Mazighi M, Desal H, Bourcier R. Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients. J Neurointerv Surg 2018; 10:e29. [DOI: 10.1136/neurintsurg-2017-013714] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 11/04/2022]
Abstract
BackgroundAnticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs.MethodsWe analyzed three patient groups from two prospective registries: APs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with IV-rtPA and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified Rankin Scale (mRS) ≤2 and safety (radiologic intracranial hemorrhage (rICH), symptomatic intracranial hemorrhage (sICH) and death rate at 3 months) between groups.Results333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the NAP-MT group and NAP-IVTMT groups, respectively. Multivariate analysis showed that the AP-MT group had a lower risk of rICH (OR 2.77, 95% CI 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (OR 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the NAP-IVTMT group. No difference was found between the AP-MT and NAP-MT groups.ConclusionsWith regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. However, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group.
Collapse
|
45
|
Alexandre PL, Bourcier R, Eugène F, Delasalle-Guyomarch B, Guillon B, Kerleroux B, Saleme S, Marnat G, Boucebci S, Mirza M, Ferré JC, Papagiannaki C, Desal H. La thérapie combinée par fibrinolyse intraveineuse et thrombectomie est-elle requise en cas d’occlusion de la terminaison carotidienne ? J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
46
|
L’Allinec V, Sevin-Allouet M, Testard N, Guyomarch B, Guillon B, Mazighi M, Desal H, Bourcier R. Efficacité et sécurité de la thrombectomie mécanique chez les patients anticoagulés. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
47
|
Bourcier R, Alexandre PL, Eugène F, Delasalle-Guyomarch B, Guillon B, Kerleroux B, Saleme S, Marnat G, Boucebci S, Mirza M, Ferré JC, Papagiannaki C, Desal H. Is bridging therapy still required in stroke due to carotid artery terminus occlusions? J Neurointerv Surg 2017; 10:625-628. [PMID: 29146829 DOI: 10.1136/neurintsurg-2017-013398] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa. OBJECTIVE To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT). MATERIAL AND METHODS Patients with ICA-O treated with MT alone or BT were retrospectively examined and compared. Demographic data, vascular risk factors, treatment modalities, complications, technical and clinical outcomes were recorded. A propensity score (PS) analysis was used to compare modified Rankin Scale (mRS) score at 3 months and intracerebral hemorrhage (ICH) between groups. RESULTS 141 consecutive patients (60% BT/40% MT) were included between January 2014 and June 2016. Baseline characteristics did not differ between the groups. There was no significant difference in the rate of Thrombolysis in Cerebral Infarction 2b/3, distal emboli, and median number of passes between the groups. There was a significant difference between BT and MT groups in the median time between imaging and groin puncture (median 97 min vs 75, p=0.007), the rate of ICH (44% vs 27%, p=0.05), but not for symptomatic ICH (18% vs 13%, p=0.49). With PS, there was a trend towards a higher rate of ICH (OR=2.3, 95% CI 0.9 to 5.9, p=0.09) in the BT group compared with the MT alone group, with no difference in mRS score ≤2 at 3 months (OR=1.6, 95% CI 0.7 to 3.7, p=0.29). CONCLUSION There was no significant difference in clinical outcomes between patients receiving bridging therapy versus direct thrombectomy. Bridging therapy delayed time to groin puncture and increased ICH rate.
Collapse
Affiliation(s)
- Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | | | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | | | - Benoit Guillon
- Stroke Unit, University Hospital of Nantes, Nantes, France
| | | | - Suzana Saleme
- Interventional Neuroradiology, CHU Limoges, Limoges, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Samy Boucebci
- Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France
| | | | | | | | - Hubert Desal
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| |
Collapse
|
48
|
Guillon B, Marcucci C, Chatot M, Chopard R, Meneveau N, Genet B, Braik N, Schiele F. P4280Contemporary predictors of contrast-induced acute kidney injury. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Guillon B, Marcucci C, Chatot M, Chopard R, Meneveau N, Genet B, Braik N, Schiele F. P6446Impact of the definition used on incidence and prognosis of CI-AKI after coronary angiography for acute coronary syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
50
|
Guillon B, Piton G, Capellier G, Chatot M, Bonnet B, Pili-Floury S, Perrotti A, Chocron S, Schiele F, Meneveau N. P4247Veno-arterial extracorporeal membrane oxygenation in high risk pulmonary embolism. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|