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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.
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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
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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.
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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
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Sablot D, Leibinger F, Dutray A, Van Damme L, Nguyen Them L, Farouil G, Jebali C, Arquizan C, Ibanez-Julia MJ, Laverdure A, Allou T, Chaabane W, Fadat B, Olivier N, Smadja P, Tardieu M, Lachcar M, Mas J, Ousji A, Jurici S, Mourand I, Ferraro A, Dumitrana A, Bensalah ZM, Damon F, Tincau OA, Valverde D, Mekue-Fotso V, Bonafe A, Ortega L, Gaillard N. Is off-label thrombolysis safe and effective in a real-life primary stroke center? A retrospective analysis of data from a 5-year prospective database. Rev Neurol (Paris) 2022; 178:1079-1089. [PMID: 36336491 DOI: 10.1016/j.neurol.2022.08.003] [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: 01/07/2022] [Revised: 07/21/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) use for acute ischemic stroke (AIS) varies among countries, partly due to guidelines and product labeling changes. The study aim was to identify the characteristics of patients with AIS treated with off-label IVT and to determine its safety when performed in a primary stroke center (PSC). METHODS This observational, single-center study included all consecutive patients admitted to Perpignan PSC for AIS and treated with IVT and patients transferred for EVT, between January 1, 2015 and December 31, 2019. Data of patients treated with IVT according to ("in-label group") or outside ("off-label") the initial guidelines and manufacturer's product specification were compared. Safety was assessed using symptomatic intracerebral hemorrhage (SIH) as the main adverse event. RESULTS Among the 892 patients in the database (834 screened by MRI, 93.5%), 746 were treated by IVT: 185 (24.8%) "in-label" and 561 (75.2%) "off-label". In the "off-label" group, 316 (42.4% of the cohort) had a single criterion for "off-label" use, 197 (26.4%) had two, and 48 (6.4%) had three or more criteria, without any difference in IVT safety pattern among them. SIH rates were comparable between the "off-label" and "in-label" groups (2.7% vs. 1.1%, P=0.21); early neurological deterioration and systematic adverse event due to IVT treatment were similar in the 2 groups. "Off-label" patients had higher in-hospital (8.7% vs. 3.8%, P=0.05) and 3-month mortality rates (12.1% vs 5.4%, P<0.01), but this is explained by confounding factors as they were older (76 vs 67 years, P<0.0001) and more dependent (median modified Rankin scale score 0.4 vs 0.1, P<0.0001) at admission. CONCLUSIONS "Off-label" thrombolysis for AIS seems to be safe and effective in the routine setting of a primary stroke center.
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Affiliation(s)
- D Sablot
- Neurology Department, Perpignan, France; Regional Health agency of Occitanie, Montpellier, France.
| | | | - A Dutray
- Neurology Department, Perpignan, France
| | | | | | - G Farouil
- Radiology Department, Perpignan, France
| | - C Jebali
- Emergency Department, Perpignan, France
| | - C Arquizan
- Neurology Department, Montpellier, France
| | | | | | - T Allou
- Neurology Department, Perpignan, France
| | | | - B Fadat
- Neurology Department, Perpignan, France
| | - N Olivier
- Neurology Department, Perpignan, France
| | - P Smadja
- Radiology Department, Perpignan, France
| | - M Tardieu
- Radiology Department, Perpignan, France
| | - M Lachcar
- Emergency Department, Perpignan, France
| | - J Mas
- Neurology Department, Perpignan, France
| | - A Ousji
- Emergency Department, Perpignan, France
| | - S Jurici
- Neurology Department, Perpignan, France
| | - I Mourand
- Neurology Department, Montpellier, France
| | - A Ferraro
- Neurology Department, Perpignan, France
| | | | | | - F Damon
- Neurology Department, Perpignan, France; Emergency Department, Perpignan, France
| | | | | | | | - A Bonafe
- Radiology Department, Perpignan, France; Neuroradiology Department, Montpellier, France
| | - L Ortega
- Emergency Department, Perpignan, France
| | - N Gaillard
- Neurology Department, Perpignan, France; Neurology Department, Montpellier, France
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Ion I, Parvu T, Farouil G, Sablot D. Hemiballism-hemichorea revealing carotidal stenosis. Rev Neurol (Paris) 2022; 178:859-861. [PMID: 35868870 DOI: 10.1016/j.neurol.2022.03.016] [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] [Received: 12/07/2021] [Revised: 01/08/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- I Ion
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - T Parvu
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - G Farouil
- Department of Interventional Neuroradiology, Service of Radiology, CH Perpignan, Perpignan, France.
| | - D Sablot
- Department of Neurology, CH Perpignan, Perpignan, France.
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Ter Schiphorst A, Duflos C, Mourand I, Gaillard N, Dargazanli C, Corti L, Prin P, Lippi A, Ayrignac X, Charif M, Wacongne A, Bouly S, Lalu T, Sablot D, Blanchet-Fourcade G, Landragin N, Jacob F, Sayad C, Derraz I, Cagnazzo F, Lefevre PH, Gascou G, Beaufils O, Costalat V, Arquizan C. A regional strategy to decrease the time to thrombectomy in patients with low probability of treatment by thrombolysis. Rev Neurol (Paris) 2021; 178:558-568. [PMID: 34903351 DOI: 10.1016/j.neurol.2021.11.001] [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: 07/06/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The best transportation strategy for patients with suspected large vessel occlusion (LVO) is unknown. Here, we evaluated a new regional strategy of direct transportation to a Comprehensive Stroke Center (CSC) for patients with suspected LVO and low probability of receiving intravenous thrombolysis (IVT) at the nearest Primary Stroke Center (PSC). METHODS Patients could be directly transported to the CSC (bypass group) if they met our pre-hospital bypass criteria: high LVO probability (i.e., severe hemiplegia) with low IVT probability (contraindications) and/or travel time difference between CSC and PSC<15 minutes. The other patients were transported to the PSC according to a "drip-and-ship" strategy. Treatment time metrics were compared in patients with pre-hospital bypass criteria and confirmed LVO in the bypass and drip-and-ship groups. RESULTS In the bypass group (n=79), 54/79 (68.3%) patients met the bypass criteria and 29 (36.7%) had confirmed LVO. The positive predictive value of the hemiplegia criterion for LVO detection was 0.49. In the drip-and-ship group (n=457), 92/457 (20.1%) patients with confirmed LVO met our bypass criteria. Among the 121 patients with bypass criteria and confirmed LVO, direct routing decreased the time between symptom discovery and groin puncture by 55 minutes compared with the drip-and-ship strategy (325 vs. 229 minutes, P<0.001), without significantly increasing the time to IVT (P=0.19). CONCLUSIONS Our regional strategy led to the correct identification of LVO and a significant decrease of the time to mechanical thrombectomy, without increasing the time to IVT, and could be easily implemented in other territories.
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Affiliation(s)
- A Ter Schiphorst
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - C Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, University Montpellier, Montpellier, France
| | - I Mourand
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - N Gaillard
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - C Dargazanli
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - L Corti
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - P Prin
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - A Lippi
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - X Ayrignac
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - M Charif
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - A Wacongne
- Department of Neurology, CHRU Carémeau, Nîmes, France
| | - S Bouly
- Department of Neurology, CHRU Carémeau, Nîmes, France
| | - T Lalu
- Department of Neurology, CH de Béziers, Béziers, France
| | - D Sablot
- Department of Neurology, CH de Perpignan, Perpignan, France
| | | | - N Landragin
- Department of Neurology, Clinique du Millénaire, Montpellier, France
| | - F Jacob
- Emergency Department, CH de Millau, Millau, France
| | - C Sayad
- Emergency Department, CH de Mende, Mende, France
| | - I Derraz
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - F Cagnazzo
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - P-H Lefevre
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - G Gascou
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - O Beaufils
- Emergency Department, CHRU Gui de Chauliac, Montpellier, France
| | - V Costalat
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - C Arquizan
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France.
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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
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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
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Sablot D, Farouil G, Leibinger F, Van Damme L, Aptel S, Fadat B, Tardieu M, Dutray A, Gascou G, Olivier N, Seiller I, Nguyen Them L, Smadja P, Ibanez-Julia MJ, Arquizan C, Mas J, Jurici S, Dumitrana A, Ferraro A, Costalat V, Bonafe L. Endovascular treatment for acute ischemic stroke at a primary stroke center: First results of the Perpignan center. Rev Neurol (Paris) 2021; 178:377-384. [PMID: 34556344 DOI: 10.1016/j.neurol.2021.05.006] [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: 01/18/2021] [Revised: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Converting a high-volume primary stroke center (PSC) into a stroke center that can perform emergency endovascular treatment (EVT) could reduce the time to thrombectomy. We report the first results of a newly established EVT facility at the Perpignan PSC and their comparison with the targets defined by the established guidelines. PATIENTS AND METHOD For this comprehensive observational study, data of patients with acute ischemic stroke (AIS) due to proximal large vessel occlusion (LVO) and treated by EVT at the Perpignan PSC from December 5, 2019 to September 15, 2020 were extracted from an ongoing prospective database. RESULTS During the study period, 37 patients underwent EVT at the Perpignan PSC. The median (range) symptom-onset to recanalization time was 262min (100-485min). The median (range) intra-hospital times were: 20min (2-58min) for door-to-imaging, 57min (30-155min) for imaging-to-puncture, 55min (15-180min) for puncture-to-recanalization, and 137min (59-319min) for door-to-recanalization. At 3 months post-AIS, the favorable outcome (modified Ranking Score: 0-2) rate was 50% and the mortality rate was 19.4%. These results are comparable to those of previous clinical trials, and meet the targets defined by the current consensus statements for EVT. DISCUSSION AND CONCLUSION Our results show the feasibility and safety of EVT in a PSC for patients with AIS due to LVO. The implementation of this strategy may be important for shortening the time to thrombectomy.
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Affiliation(s)
- D Sablot
- Neurology Department, Perpignan hospital, Perpignan, France; Regional health agency of Occitanie, Montpellier, France.
| | - G Farouil
- Radiology Department, Perpignan hospital, Perpignan, France
| | - F Leibinger
- Intensive care unit, Perpignan hospital, Perpignan, France
| | - L Van Damme
- Neurology Department, Perpignan hospital, Perpignan, France
| | - S Aptel
- Radiology Department, Perpignan hospital, Perpignan, France
| | - B Fadat
- Neurology Department, Perpignan hospital, Perpignan, France
| | - M Tardieu
- Radiology Department, Perpignan hospital, Perpignan, France
| | - A Dutray
- Neurology Department, Perpignan hospital, Perpignan, France
| | - G Gascou
- Neuroradiology Department, University hospital of Montpellier, Montpellier, France
| | - N Olivier
- Neurology Department, Perpignan hospital, Perpignan, France
| | - I Seiller
- Radiology Department, Perpignan hospital, Perpignan, France
| | - L Nguyen Them
- Neurology Department, Perpignan hospital, Perpignan, France
| | - P Smadja
- Radiology Department, Perpignan hospital, Perpignan, France
| | | | - C Arquizan
- Neurology Department, University hospital of Montpellier, Montpellier, France
| | - J Mas
- Neurology Department, Perpignan hospital, Perpignan, France
| | - S Jurici
- Neurology Department, Perpignan hospital, Perpignan, France
| | - A Dumitrana
- Neurology Department, Perpignan hospital, Perpignan, France
| | - A Ferraro
- Neurology Department, Perpignan hospital, Perpignan, France
| | - V Costalat
- Neuroradiology Department, University hospital of Montpellier, Montpellier, France
| | - L Bonafe
- Radiology Department, Perpignan hospital, Perpignan, France; Neuroradiology Department, University hospital of Montpellier, Montpellier, France
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8
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Mahmoudi M, Dargazanli C, Cagnazzo F, Derraz I, Arquizan C, Wacogne A, Labreuche J, Bonafe A, Sablot D, Lefevre PH, Gascou G, Gaillard N, Scott C, Costalat V, Mourand I. Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol 2020; 41:1670-1676. [PMID: 32819893 DOI: 10.3174/ajnr.a6741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Clinical outcomes after endovascular treatment for acute basilar artery occlusions need further investigation. Our aim was to analyze predictors of a 90-day good functional outcome defined as mRS 0-2 after endovascular treatment in MR imaging-selected patients with acute basilar artery occlusions. MATERIALS AND METHODS We analyzed consecutive MR imaging-selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b-3 and 3, respectively. Outcome at 90 days was analyzed in univariate and multivariate analysis regarding baseline patient treatment characteristics and periprocedural outcomes. RESULTS One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases (n = 90; 95% CI, 73.3%-88.6%). At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes (interquartile range, 280-540 minutes). In multivariable analysis, complete reperfusion (OR = 6.59; 95% CI, 2.17-20.03), lower pretreatment NIHSS (OR = 0.77; 95% CI, 0.64-0.94), the presence of posterior communicating artery collateral flow (OR = 2.87; 95% CI, 1.05-7.84), the absence of atrial fibrillation (OR = 0.18; 95% CI, 0.03-0.99), and intravenous thrombolysis administration (OR = 2.75; 95% CI, 1.04-7.04) were associated with 90-day favorable outcome. CONCLUSIONS In our series of MR imaging-selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome.
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Affiliation(s)
- M Mahmoudi
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - F Cagnazzo
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - I Derraz
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Arquizan
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - A Wacogne
- Neurology Department (A.W.), Centre Hospitalier Universitaire Caremeau, Nimes, France
| | - J Labreuche
- Biostatistics Department (J.L.), Centre Hospitalier Universitaire Lille, Lille, France
| | - A Bonafe
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - D Sablot
- Neurology Department (D.S.), Centre Hospitalier de Perpignan, Perpignan, France
| | - P H Lefevre
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - N Gaillard
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Scott
- Department of Reanimation (C.S.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - I Mourand
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
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Vigneron C, Lécluse A, Ronzière T, Bouillet L, Boccon-Gibod I, Gayet S, Doche E, Smadja D, Di Legge S, Dumont F, Gaudron M, Ion I, Marcel S, Sévin M, Vlaicu MB, Launay D, Arnaud I, Girard-Madoux P, Héroum C, Lefèvre S, Marc G, Obadia M, Sablot D, Sibon I, Suissa L, Gobert D, Detante O, Alamowitch S, Fain O, Javaud N. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study. J Intern Med 2019; 286:702-710. [PMID: 31319000 DOI: 10.1111/joim.12962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS In a case-control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. RESULTS Fifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis-related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32-7.01; P = 0.009] and treatment with angiotensin-converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17-17.07; P < 0.001]. CONCLUSIONS This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
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Affiliation(s)
- C Vigneron
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - A Lécluse
- Neurologie, CHU Angers, Angers, France
| | - T Ronzière
- Neurologie, CHU Pontchaillou, Rennes, France
| | - L Bouillet
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - I Boccon-Gibod
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - S Gayet
- AP-HM, Médecine Interne, Centre de Compétence Angioedèmes non Histaminiques, Hôpital la Timone, Marseille, France
| | - E Doche
- AP-HM, Neurologie, Hôpital la Timone, Marseille, France
| | - D Smadja
- Neurologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - S Di Legge
- Neurologie, CH du Pays d'Aix-CH Intercommunal Aix-Pertuis, Aix-en-Provence, France
| | - F Dumont
- Neurologie, CH Tourcoing, Tourcoing, France
| | - M Gaudron
- Neurologie, CHU Tours, Tours, France
| | - I Ion
- Neurologie, CHU Nîmes, Nîmes, France
| | - S Marcel
- Neurologie, CH Métropole Savoie, Chambéry, France
| | - M Sévin
- Neurologie Institut du Thorax et du Système Nerveux, CHU Nantes, Nantes, France
| | - M B Vlaicu
- AP-HP, Service de Neurochirurgie, Hôpital Pitié Salpétrière, INSERM U955, Hôpital Orsay, Paris, France
| | - D Launay
- U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, Département de Médecine Interne et Immunologie Clinique, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), Université de Lille, CHU de Lille, Lille, France
| | - I Arnaud
- Neurologie, CHU Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - C Héroum
- Neurologie, GH Portes-de-Provence, Montélimar, France
| | - S Lefèvre
- Institut d'allergologie, CHR Metz-Thionville, Metz, France
| | - G Marc
- Neurologie, CH Saint-Nazaire, Saint-Nazaire, France
| | - M Obadia
- Neurologie, Fondation Ophtalmologique Rothschild, Paris, France
| | - D Sablot
- Neurologie, CH Perpignan, Perpignan, France
| | - I Sibon
- Neurologie, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - L Suissa
- Neurologie, CHU Nice, Nice, France
| | - D Gobert
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - O Detante
- Neurologie, CHU de Grenoble, Grenoble, France
| | - S Alamowitch
- AP-HP, Service de Neurologie, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, Paris, France
| | - O Fain
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - N Javaud
- AP-HP, Urgences, CréAk, Hôpital Louis Mourier, Université Paris 7, Colombes, France
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Grimaldi-Bensouda L, Le Heuzey JY, Ferrieres J, Leys D, Davy JM, Martinez M, Smadja D, Ellie E, Sablot D, Nighoghossian N, Benichou J, Touze E, Abenhaim L. P3595Non-valvular atrial fibrillation, anticoagulants and stroke: the stroke prevention and anticoagulants (SPA) case-control study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3595] [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: 11/12/2022] Open
Affiliation(s)
| | - J.-Y. Le Heuzey
- European Hospital Georges Pompidou, Cardiologie, Paris, France
| | - J. Ferrieres
- Faculté de Médecine du l'Université de Toulouse, Hôpital Rangueil, TSA 50032, Cardiologie, Toulouse, France
| | - D. Leys
- Université de Lille; Inserm U 1171; CHU Lille, Lille, France
| | - J.-M. Davy
- University Hospital of Montpellier, Département de Cardiologie et Maladies Vasculaires, Montpellier, France
| | - M. Martinez
- Centre Hospitalier de Dax, Service de Neurologie-Unité Neurovasculaire, Dax, France
| | - D. Smadja
- Hospital Sud-Francilien, Neurologie, Corbeil-Essonnes, France
| | - E. Ellie
- Centre Hospitalier de la Côte Basque, Service de neurologie, Bayonne, France
| | - D. Sablot
- Centre Hospitalier de Perpignan, Service de neurologie, Perpignan, France
| | - N. Nighoghossian
- Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Unité de Neurologie vasculaire, Bron, France
| | - J. Benichou
- University Hospital of Rouen, Unité de biostatistiques et méthodologie, Fédération de la recherche, Rouen, France
| | - E. Touze
- Université de Caen Normandie, Unité neurovasculaire, Caen, France
| | - L. Abenhaim
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bousquet J, Bourret R, Camuzat T, Augé P, Bringer J, Noguès M, Jonquet O, de la Coussaye JE, Ankri J, Cesari M, Guérin O, Vellas B, Blain H, Arnavielhe S, Avignon A, Combe B, Canovas G, Daien C, Dray G, Dupeyron A, Jeandel C, Laffont I, Laune D, Marion C, Pastor E, Pélissier JY, Galan B, Reynes J, Reuzeau JC, Bedbrook A, Granier S, Adnet PA, Amouyal M, Alomène B, Bernard PL, Berr C, Caimmi D, Claret PG, Costa DJ, Cristol JP, Fesler P, Hève D, Millot-Keurinck J, Morquin D, Ninot G, Picot MC, Raffort N, Roubille F, Sultan A, Touchon J, Attalin V, Azevedo C, Badin M, Bakhti K, Bardy B, Battesti MP, Bobia X, Boegner C, Boichot S, Bonnin HY, Bouly S, Boubakri C, Bourrain JL, Bourrel G, Bouix V, Bruguière V, Cade S, Camu W, Carre V, Cavalli G, Cayla G, Chiron R, Coignard P, Coroian F, Costa P, Cottalorda J, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cros V, Cuisinier F, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dujols P, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fouletier M, Fraisse P, Gabrion P, Gellerat-Rogier M, Gelis A, Genis C, Giraudeau N, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Kouyoudjian P, Lamoureux R, Landreau L, Lapierre M, Larrey D, Laurent C, Léglise MS, Lemaitre JM, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert CM, Makinson A, Mandrick K, Mares P, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Mottet D, Nérin P, Nicolas P, Nouvel F, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Portejoie F, Pujol JLE, Quantin X, Quéré I, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Robine JM, Rolland C, Royère E, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Stephan Y, Strubel D, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Tribout V, Uziel A, Van de Perre P, Venail F, Vergne-Richard C, Vergotte G, Vian L, Vialla F, Viart F, Villain M, Viollet E, Ychou M, Mercier J. MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing. J Frailty Aging 2017; 5:233-241. [PMID: 27883170 DOI: 10.14283/jfa.2016.105] [Citation(s) in RCA: 4] [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: 11/11/2022]
Abstract
The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.
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Affiliation(s)
- J Bousquet
- Professor Jean Bousquet, CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France, Tel +33 611 42 88 47,
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12
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Sablot D, Gaillard N, Colas C, Smadja P, Gely C, Dutray A, Bonnec JM, Jurici S, Farouil G, Ferraro-Allou A, Jantac M, Allou T, Pujol C, Olivier N, Laverdure A, Fadat B, Mas J, Dumitrana A, Garcia Y, Touzani H, Perucho P, Moulin T, Richard C, Heroum C, Bouly S, Sagnes-Raffy C, Heve D. Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening. Rev Neurol (Paris) 2017; 173:47-54. [PMID: 28131535 DOI: 10.1016/j.neurol.2016.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/01/2016] [Revised: 09/20/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the effects of a 1-year quality-improvement (QI) process to reduce door-to-needle (DTN) time in a secondary general hospital in which multimodal MRI screening is used before tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke (AIS). METHODS The QI process was initiated in January 2015. Patients who received intravenous (iv) tPA<4.5h after AIS onset between 26 February 2015 to 25 February 2016 (during implementation of the QI process; the "2015 cohort") were identified (n=130), and their demographic and clinical characteristics and timing metrics compared with those of patients treated by iv tPA in 2014 (the "2014 cohort", n=135). RESULTS Of the 130 patients in the 2015 cohort, 120 (92.3%) of them were screened by MRI. The median DTN time was significantly reduced by 30% (from 84min in 2014 to 59min; P<0.003), while the proportion of treated patients with a DTN time≤60min increased from 21% to 52% (P<0.0001). Demographic and baseline characteristics did not significantly differ between cohorts, and the improvement in DTN time was associated with better outcomes after discharge (patients with a 0-2 score on the modified rankin scale: 59% in the 2015 cohort vs 42.4% in the 2014 cohort; P<0.01). During the 1-year QI process, the median DTN time decreased by 15% (from 65min in the first trimester to 55min in the last trimester; P≤0.04) with a non-significant 1.5-fold increase in the proportion of treated patients with a DTN time≤60min (from 41% to 62%; P=0.09). CONCLUSION It is feasible to deliver tPA to patients with AIS within 60min in a general hospital, using MRI as the routine screening modality, making this QI process to reduce DTN time widely applicable to other secondary general hospitals.
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Affiliation(s)
- D Sablot
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France; Agence régionale de santé Languedoc-Roussillon et Midi-Pyrénées (ARS-LRMP), 28, parc club du Millénaire, 1025, avenue Henri-Becquerel, 34067 Montpellier, France.
| | - N Gaillard
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - C Colas
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - P Smadja
- Service de radiologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - C Gely
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - A Dutray
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - J-M Bonnec
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - S Jurici
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - G Farouil
- Service de radiologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - A Ferraro-Allou
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - M Jantac
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - T Allou
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - C Pujol
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - N Olivier
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - A Laverdure
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - B Fadat
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - J Mas
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - A Dumitrana
- Service de neurologie, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - Y Garcia
- Service d'accueil des urgences/SMUR 66, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - H Touzani
- Service de neurologie, centre hospitalier, boulevard Dr-Lacroix, 11100 Narbonne, France
| | - P Perucho
- Service de la qualité, centre hospitalier Saint-Jean, 20, avenue du Languedoc, BP 4052, 66046 Perpignan, France
| | - T Moulin
- Service de neurologie, CHU Minjoz, 3, boulevard A-Flemming, 25030 Besançon, France
| | - C Richard
- Agence régionale de santé Languedoc-Roussillon et Midi-Pyrénées (ARS-LRMP), 28, parc club du Millénaire, 1025, avenue Henri-Becquerel, 34067 Montpellier, France
| | - C Heroum
- Agence régionale de santé Languedoc-Roussillon et Midi-Pyrénées (ARS-LRMP), 28, parc club du Millénaire, 1025, avenue Henri-Becquerel, 34067 Montpellier, France
| | - S Bouly
- Agence régionale de santé Languedoc-Roussillon et Midi-Pyrénées (ARS-LRMP), 28, parc club du Millénaire, 1025, avenue Henri-Becquerel, 34067 Montpellier, France
| | - C Sagnes-Raffy
- Agence régionale de santé Languedoc-Roussillon et Midi-Pyrénées (ARS-LRMP), 28, parc club du Millénaire, 1025, avenue Henri-Becquerel, 34067 Montpellier, France
| | - D Heve
- Agence régionale de santé Languedoc-Roussillon et Midi-Pyrénées (ARS-LRMP), 28, parc club du Millénaire, 1025, avenue Henri-Becquerel, 34067 Montpellier, France
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Bousquet J, Bourret R, Camuzat T, Augé P, Domy P, Bringer J, Best N, Jonquet O, de la Coussaye JE, Noguès M, Robine JM, Avignon A, Blain H, Combe B, Dray G, Dufour V, Fouletier M, Giraudeau N, Hève D, Jeandel C, Laffont I, Larrey D, Laune D, Laurent C, Mares P, Marion C, Pastor E, Pélissier JY, Radier-Pontal F, Reynes J, Royère E, Ychou M, Bedbrook A, Granier S, Abecassis F, Albert S, Adnet PA, Alomène B, Amouyal M, Arnavielhe S, Asteriou T, Attalin V, Aubas P, Azevedo C, Badin M, Bakhti, Baptista G, Bardy B, Battesti MP, Bénézet O, Bernard PL, Berr C, Berthe J, Bobia X, Bockaert J, Boegner C, Boichot S, Bonnin HY, Boulet P, Bouly S, Boubakri C, Bourdin A, Bourrain JL, Bourrel G, Bouix V, Breuker C, Bruguière V, Burille J, Cade S, Caimmi D, Calmels MV, Camu W, Canovas G, Carre V, Cavalli G, Cayla G, Chiron R, Claret PG, Coignard P, Coroian F, Costa DJ, Costa P, Cottalorda, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cristol JP, Cros V, Cuisinier F, Daien C, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dhivert-Donnadieu H, Dujols P, Dupeyron A, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fesler P, Fraisse P, Froger J, Gabrion P, Galano E, Gellerat-Rogier M, Gellis A, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hantkié H, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Journot L, Kaczorek M, Kouyoudjian P, Labauge P, Landreau L, Lapierre M, Leblond C, Léglise MS, Lemaitre JM, Le Moing V, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert JM, Makinson A, Mandrick K, Marmelat V, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Morquin D, Mottet D, Nérin P, Nicolas P, Ninot G, Nouvel F, Ortiz JP, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Picot MC, Pin JP, Pinto N, Porte E, Portejoie F, Pujol JL, Quantin X, Quéré I, Raffort N, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Rolland C, Roubille F, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Soua B, Stephan Y, Strubel D, Sultan A, Taddei-Ologeanu, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Touchon J, Tribout V, Uziel A, Van de Perre P, Vasquez X, Verdier JM, Vergne-Richard C, Vergotte G, Vian L, Viarouge-Reunier C, Vialla F, Viart F, Villain M, Villiet M, Viollet E, Wojtusciszyn A, Aoustin M, Bourquin C, Mercier J. Introduction. Presse Med 2015; 44 Suppl 1:S1-5. [DOI: 10.1016/j.lpm.2015.07.014] [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: 10/22/2022] Open
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Siri A, Carra-Dalliere C, Ayrignac X, Pelletier J, Audoin B, Pittion-Vouyovitch S, Debouverie M, Lionnet C, Viala F, Sablot D, Brassat D, Ouallet JC, Ruet A, Brochet B, Taillandier L, Bauchet L, Derache N, Defer G, Cabre P, de Seze J, Lebrun Frenay C, Cohen M, Labauge P. Isolated tumefactive demyelinating lesions: diagnosis and long-term evolution of 16 patients in a multicentric study. J Neurol 2015; 262:1637-45. [DOI: 10.1007/s00415-015-7758-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 12/31/2022]
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Bailbe M, Geny C, Sablot D. Les enjeux de la démographie en neurologie : résultat d’une enquête sur l’offre de soins de consultations de neurologie générale en Languedoc-Roussillon. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cerutti D, Bonafe A, Pelouze GA, Kassem Z, Filipov R, Runavot G, Cassarini JF, Sablot D. Angioplastie-stenting transluminale percutanée après dissection des troncs supra-aortiques. Rev Neurol (Paris) 2010; 166:333-6. [DOI: 10.1016/j.neurol.2009.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/27/2009] [Accepted: 05/22/2009] [Indexed: 10/20/2022]
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Laverdure A, Cartry O, Sablot D, Cros H. Un PRES imprévisible. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.233] [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: 10/23/2022]
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Sablot D, Cassarini JF, Akouz A, Benejean JM, Leibinger F, Faillie X, Vidry E, Ayrignac X, Castro S, Sinaya L, Bertrand JL, Garcia Y, Arnoud B, Negre C. Utilisation du rt-PA intraveineux dans l’ischémie cérébrale en Centre Hospitalier Général : l’expérience de l’Hôpital Saint-Jean de Perpignan. Rev Neurol (Paris) 2006; 162:1109-17. [PMID: 17086147 DOI: 10.1016/s0035-3787(06)75123-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Intravenous recombinant tissue plasminogen activator (rt-PA) has approval for use despite of its authorization for treatment of ischemic stroke within the 3-hour time window in 2003, is rarely used in community hospital (CH). It therefore remains questionable if the positive results of the key studies conducted in specialized centers may be extended to community hospitals less specialized in the management of stroke. METHODS We report the results of an observational cohort study including 39 patients treated with intravenous rt-Pa (according to the NINDS rt-PA stroke trail treatment protocol) at St Jean Hospital (Perpignan, France) between March 1, 2002 and August 31, 2005. Results are compared to those of the treated arm of the NINDS study. RESULTS 1.2p.cent of ischemic stroke were treated with intravenous rt-Pa. Results are similar to those of the NINDS study: The outcome was favorable (modified Rankin score (mRS) with 0 or 1) for 44p.cent of the patients (as compared to 39p.cent in the NINDS study (X2 = 0.34; p = 0.5)) and there was no significant difference in term of death or outcome as assessed by mRS at 3 months (X2 = 0.09; p = 0.75 and X2 = 0.77; p = 0.75, respectively). No symptomatic hemmorrhagic transformation related to the use of rt-Pa was observed. CONCLUSION Our results indicate that rt-PA therapy for ischemic stroke may be as safe and effective in the setting of a community hospital as it is in specialized centers.
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Affiliation(s)
- D Sablot
- Service de Neurologie, Hôpital Saint-Jean, Perpignan.
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Moulin T, Berger E, Lemounaud P, Vuillier F, Tatu L, Sablot D, Tabailloux D, Revenco E, Vidry E, Neidhardt A, Rumbach L. [Emergency neurology consultations in the university hospital setting: contribution of the neurologist to inpatient management]. Rev Neurol (Paris) 2000; 156:839-47. [PMID: 11033512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
While outpatient management for chronic neurological diseases is well-established, the impact of inpatient neurological examination in emergency room and university hospital remain largely underestimated. We prospectively studied the role of the neurologist in patient management, in a primary care university hospital. Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the emergency room, the initial suspected neurological diagnosis of the emergency room, the final diagnosis of the neurology team, and the patients' outcomes. For each patient, the time between admission, the call and the neurological examination were recorded. Neurological examinations were performed in 2220 patients in whom 75.6 p.100 were performed in the emergency room. These latter patients corresponded to 14 p.100 of all patients admitted in the emergency room. Of examined patients, 52 p.100 were male and mean age was 56.9 +/- 21 years. The time between admission and examination was 32 min. (+/- 36 min), irrespective of the day of the week, and depended on the suspected diagnosis: shorter in stroke and status epilepticus (p<0.05), and longer in loss of consciousness and vertigo (p<0.01). Forty-four percent of the examinations took place in the evening and night. The reasons for examinations were: stroke (28.3 p.100), epilepsy (17.7 p.100), headaches (8.4 p.100), loss of consciousness (7.9 p.100), cognitive dysfunctions (4.1 p.100), neuropathies (4 p.100) and miscellaneous (8.1 p.100). Neurological examinations modified neurological diagnosis and treatment in more than 86 p.100 of the patients. Following neurological examination, 17.2 p.100 of the patients were able to go home, while the rest were admitted to the stroke unit (27.2 p.100), the general neurological unit (27.3 p.100) or in other departments (28.3 p.100), of which intensive care unit (5.3 p.100) or neurosurgery (5.9 p.100). Emergency neurologic examination improves neurological diagnosis and has a positive impact both on treatment and, more globally, in patient management.
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Affiliation(s)
- T Moulin
- Service de Neurologie, CHU, Besançon, France
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Abstract
BACKGROUND AND PURPOSE Though there have been many reports on poststroke seizures, there is still much we do not know about them. Using a large cohort of stroke patients we analyzed the characteristics of the seizure(s) and the rate and factors involved in seizure recurrence. METHODS Out of the 3,205 patients admitted for a first-ever stroke to our department between 1984 and 1994, we retrospectively studied the data of all patients with a first-ever seizure and analyzed their evolution. Two types of seizure(s) were defined: 'early-onset' seizures (occurring within the 14 days following the stroke) and 'late-onset' ones (after the 14th day). RESULTS 159 patients were included in the study, i.e. 4.96%. There were 116 ischemic strokes and 43 primary hematomas. Cortical involvement was found in 87% of the patients. Early-onset seizures occurred in 57 patients and late-onset ones in 102 patients, 76% of which were observed within 2 years. Follow-up was performed in 135 patients with a mean follow-up period of 47 months; 68 of them presented a seizure recurrence. A 2nd seizure occurred more often in the patients with late-onset seizures (p < 0.01); recurrence was either single (24 patients) or multiple (44 patients). Univariate analysis demonstrated 3 factors for multiple recurrences: hemorrhagic component, low Rankin scale after the initial seizure and occipital involvement. Multivariate analysis determined 2 factors: occipital involvement and late onset of the 1st seizure as a predictive model of multiple recurrences. CONCLUSIONS This study confirms that poststroke seizures are frequent and must be divided into 2 types: early-onset (</=14 days) and late-onset seizures. It demonstrates that a significantly lower rate of patients with early-onset seizures develop another seizure, i.e. epilepsy, than do patients with late-onset seizures. Other factors are involved in recurrence suggesting that poststroke epilepsy probably occurs in a chronically injured brain. The problem of treatment remain unanswered.
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Affiliation(s)
- S Berges
- Department of Neurology, Besançon, France
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Abstract
OBJECTIVE To evaluate occurrence rate, clinical data, and prognostic factors of status epilepticus (SE) after stroke. METHODS From 1984 to 1994, 3,205 patients were admitted to the Department of Neurology at our institution with first-time strokes. A total of 159 of these patients had first-time poststroke seizures. Among these 159 patients, cases of SE were identified and evaluated. RESULTS SE was recognized in 31 patients (19%). In 17 patients, SE was the first epileptic symptom (initial SE), and in 4 patients, stroke began with SE (S-SE). In the 14 remaining patients, SE occurred after one or more seizure(s). After a mean follow-up period of 47 months, neurologic deterioration occurred after SE in 15 patients. This deterioration was permanent in two patients. Fifteen patients died; in five patients, death was directly related to SE. Eight of the 17 patients with initial SE and all 14 patients with SE after one or more seizure(s) developed other seizures or SE. S-SE, however, was not a predictive factor for additional seizure(s). CONCLUSIONS Status epilepticus is common among patients with poststroke seizures. Although the immediate prognosis of patients with status epilepticus is poor, status epilepticus as the presenting sign did not necessarily predict subsequent epilepsy.
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Affiliation(s)
- L Rumbach
- Department of Neurology, CHU Jean Minjoz, Besançon, France.
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