1
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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.
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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
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2
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Maïer B, Di Meglio L, Desilles JP, Solo Nomenjanahary M, Delvoye F, Kyheng M, Boursin P, Ollivier V, Dupont S, Rambaud T, Hamdani M, Labreuche J, Blanc R, Piotin M, Halimi JM, Mazighi M, Ho-Tin-Noe B. Neutrophil activation in patients treated with endovascular therapy is associated with unfavorable outcomes and mitigated by intravenous thrombolysis. J Neurointerv Surg 2024; 16:131-137. [PMID: 37068937 DOI: 10.1136/jnis-2022-020020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/21/2022] [Accepted: 03/25/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Accumulating evidence indicates that neutrophil activation (NA) contributes to microvascular thromboinflammation in acute ischemic stroke (AIS) due to a large vessel occlusion. Preclinical data have suggested that intravenous thrombolysis (IVT) before endovascular therapy (EVT) could dampen microvascular thromboinflammation. In this study we investigated the association between NA dynamics and stroke outcome, and the impact of IVT on NA in patients with AIS treated with EVT. METHODS A single-center prospective study was carried out, including patients treated with EVT for whom three blood samples (before, within 1 hour, 24 hours post-EVT) were drawn to measure plasma myeloperoxidase (MPO) concentration as a marker of NA. Unfavorable outcome was defined as a modified Rankin score of 3-6 at 3 months. RESULTS Between 2016 and 2020, 179 patients were included. The plasma MPO concentration peaked significantly 1 hour post-EVT (median increase 21.0 ng/mL (IQR -2.1-150)) and returned to pre-EVT baseline values 24 hours after EVT (median change from baseline -0.8 ng/mL (IQR -7.6-6.7)). This peak was strongly associated with unfavorable outcomes at 3 months (aOR 0.53 (95% CI 0.34 to 0.84), P=0.007). IVT before EVT abolished this 1 hour post-EVT MPO peak. Changes in plasma MPO concentration (baseline to 1 hour post-EVT) were associated with unfavorable outcomes only in patients not treated with IVT before EVT (aOR 0.54 (95% CI 0.33 to 0.88, P=0.013). However, we found no significant heterogeneity in the associations between changes in plasma MPO concentration and outcomes. CONCLUSIONS A peak in plasma MPO concentration occurs early after EVT and is associated with unfavorable outcomes. IVT abolished the post-EVT MPO peak and may modulate the association between NA and outcomes.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
- Neurology Department, Hôpital Saint-Joseph, Paris, France
- FHU NeuroVasc, Paris, France
| | - Lucas Di Meglio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
- FHU NeuroVasc, Paris, France
| | - Mialitiana Solo Nomenjanahary
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Maeva Kyheng
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Véronique Ollivier
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Sébastien Dupont
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Thomas Rambaud
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | | | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Jean-Michel Halimi
- Nephrology Department, Tours Hospital, Tours, France
- EA4245-Transplantation, Immunology and Inflammation, University of Tours, Tours, France
| | - Mikaël Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
- FHU NeuroVasc, Paris, France
- Department of Neurology, Lariboisiere Hospital, Université Paris Cité, Paris, France
| | - Benoit Ho-Tin-Noe
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
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3
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Sabben C, Charbonneau F, Delvoye F, Strambo D, Heldner MR, Ong E, Ter Schiphorst A, Henon H, Ben Hassen W, Agasse-Lafont T, Legris L, Sibon I, Wolff V, Sablot D, Elhorany M, Preterre C, Nehme N, Soize S, Weisenburger-Lile D, Triquenot-Bagan A, Mione G, Aignatoaie A, Papassin J, Poll R, Béjot Y, Carrera E, Garnier P, Michel P, Saliou G, Mordasini P, Berthezene Y, Costalat V, Bricout N, Albers GW, Mazighi M, Turc G, Seners P. Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study. Stroke 2023; 54:928-937. [PMID: 36729389 DOI: 10.1161/strokeaha.122.042283] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/03/2023]
Abstract
Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery (PCA) occlusion is unknown. Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6hrs from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the PCA and treated either with BMM + EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin score [mRS] 0-2 or return to baseline mRS). Secondary outcomes were 3-month excellent recovery (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and early neurological deterioration. Results: Overall, 752 patients were included (167 and 585 patients in the BMM + EVT and BMM alone groups, respectively). Median age was 74 (IQR 63-82) years, 329 (44%) patients were female, median NIHSS was 6 (IQR 4-10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the two groups following propensity-score weighting. EVT was associated with a trend towards lower odds of good functional outcome (OR=0.81; 95%CI: 0.66-1.01; P=0.06) and was not associated with excellent functional outcome (OR=1.17; 95%CI: 0.95-1.43; P=0.15). EVT was associated with a higher risk of sICH (OR=2.51; 95%CI: 1.35-4.67; P=0.004) and early neurological deterioration (OR=2.51; 95%CI: 1.64-3.84; P<0.0001). Conclusions: In this observational study of patients with proximal PCA occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of sICH and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.
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Affiliation(s)
- Candice Sabben
- Neurology Department (C.S., P.S.), Rothschild Foundation Hospital, Paris, France
| | | | - François Delvoye
- Interventional Neuroradiology Department (F.D., M.M.), Rothschild Foundation Hospital, Paris, France
| | - Davide Strambo
- Stroke Center, Neurology Service (D.S., P.M.), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, University Hospital and University of Bern, Switzerland (M.R.H.)
| | - Elodie Ong
- Stroke Department, Hospices Civils de Lyon, France (E.O.)
| | | | - Hilde Henon
- Neurology department, Stroke Center, University of Lille, Inserm U1171, CHU Lille, LilNCog - Lille Neuroscience & Cognition, France (H.H.)
| | - Wagih Ben Hassen
- Neuroradiology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France (W.B.H.)
| | | | - Loïc Legris
- Neurology Department, Stroke Unit, Grenoble Alpes University Hospital, University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France (L.L.)
| | - Igor Sibon
- Stroke Unit, Bordeaux University Hospital, France (I.S.)
| | - Valérie Wolff
- Stroke Unit, Strasbourg University Hospital, France (V.W.)
| | - Denis Sablot
- Neurology Department, CH Perpignan, France (D.S.)
| | - Mahmoud Elhorany
- Interventional Neuroradiology Department, Pitié-Salpétrière Hospital, Paris, France (M.E.)
- Neurology Department, Faculty of Medicine, Tanta University, Egypt (M.E.)
| | | | - Nour Nehme
- Neurology Department, André Mignot Hospital, Versailles, France (N.N.)
| | | | | | - Aude Triquenot-Bagan
- Neurology Department, Rouen University Hospital, F-76000, Rouen, France (A.T.-B.)
| | - Gioia Mione
- Neurology Department, University Hospital of Nancy, France (G.M.)
| | | | - Jérémie Papassin
- Neurology Department, CH Metropole Savoie, Chambery, France (J.P.)
| | - Roxana Poll
- Neurology Department, Rene Dubois Hospital, Pontoise, France (R.P.)
| | | | - Emmanuel Carrera
- Neurology Department, Geneve University Hospital, Switzerland (E.C.)
| | - Pierre Garnier
- Neurology Department, Stroke Unit, CHU St Etienne, France (P.G.)
| | - Patrik Michel
- Stroke Center, Neurology Service (D.S., P.M.), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Guillaume Saliou
- Diagnostic and Interventional Radiology Department (G.S.), Lausanne University Hospital and University of Lausanne, Switzerland
| | | | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, France (Y.B.)
| | - Vincent Costalat
- Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France (V.C.)
| | - Nicolas Bricout
- Interventional Neuroradiology Department, CHU Lille, France (N.B.)
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., P.S.)
| | - Mikael Mazighi
- Interventional Neuroradiology Department (F.D., M.M.), Rothschild Foundation Hospital, Paris, France
- Neurology Department, Lariboisière Hospital, APHP Nord, INSERM 1148, Université Paris Cité, Paris, France (M.M.)
- FHU Neurovasc (M.M., G.T.)
| | - Guillaume Turc
- FHU Neurovasc (M.M., G.T.)
- Neurology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France (G.T.)
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR_S1266, Université Paris Cité, France (G.T., P.S.)
| | - Pierre Seners
- Neurology Department (C.S., P.S.), Rothschild Foundation Hospital, Paris, France
- Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., P.S.)
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4
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Sabben C, Charbonneau F, Delvoye F, Mazighi M, TURC G, Seners P. Abstract 89: Mechanical Thrombectomy Or Medical Management Alone For Isolated Posterior Cerebral Artery Occlusion. An International Multicentric Observational Study. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.89] [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] [Indexed: 02/05/2023]
Abstract
Introduction:
Whether endovascular therapy (EVT) added on best medical management (BMM, including intravenous thrombolysis [IVT] if indicated), as compared to BMM alone, is beneficial in acute ischemic stroke (AIS) with isolated posterior cerebral artery occlusion is unknown.
Methods:
We conducted a multicenter international observational study of consecutive AIS patients admitted within 6hrs from last seen well in 26 stroke centers in France, Switzerland and USA with isolated proximal posterior cerebral artery strokes (P1 or P2 occlusions) and treated either with EVT+BMM or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin score [mRS] 0-2). Secondary outcomes were excellent functional outcome (mRS 0-1) and symptomatic intracranial hemorrhage (sICH) at 24hrs. We searched for an interaction between treatment group and (1) occlusion site (P1
vs
. P2), (2) NIHSS score (<10
vs.
≥10), and (3) IVT use.
Results:
Overall, 810 AIS patients were included (180 and 630 in the EVT+BMM and BMM alone groups, respectively). Median age was 74yo (IQR 63-83), 352 (44%) were female, median NIHSS was 6 (IQR 4-10), 594 (73%) received IVT, and occlusion site was P1 in 205 (25%) and P2 in 605 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity-score weighting. EVT was not associated with good (adjusted OR=0.86; 95%CI: 0.67-1.09;
P
=0.21) or excellent (adjusted OR=1.10; 95%CI: 0.87-1.39;
P
=0.42) functional outcome but was associated with higher risk of sICH (OR=2.71; 95%CI: 1.41-5.21;
P
=0.003). No interaction was found between EVT effect and (1) NIHSS score, (2) occlusion site, or (3) IVT use for either outcome.
Conclusion:
In our population of AIS patients with isolated P1 or P2 occlusion, EVT was not associated with higher rates of good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of sICH. Randomized trials are warranted.
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5
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Allard J, Delvoye F, Pop R, Labreuche J, Maier B, Marnat G, Sibon I, Zhu F, Lapergue B, Consoli A, Spelle L, Denier C, Richard S, Piotin M, Gory B, Mazighi M, Redjem H, Escalard S, Dessilles JP, Delvoye F, Smajda S, Maier B, Solène H, Mazighi M, Obadia M, Sabben C, Pierre S, Igor R, Corabianu O, de Broucker T, Manchon E, Taylor G, Maacha MB, Thion LA, Augustin L, Julien S, Wang A, Evrard S, Tchikviladze M, Ajili N, WeisenburgerLile D, Gorza L, Buard G, Coskun O, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Barreau X, Berge J, Menegon P, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey JS, Briau P, Pangon N, Coussy A, Papillon L, Papaxanthos J, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Humbertjean L, Lacour JC, Riou-Comte N, Voicu M, Alb L, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Macian-Montoro F, Saleme S, Mounayer C, Rouchaud A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, Ter Schiphorst A, Ferre JC, Raoult H, Ronziere T, Lassale M, Paya C, Gauvrit JY, Tracol C, Langnier-Lemercier S. 24-Hour Carotid Stent Patency and Outcomes After Endovascular Therapy: A Multicenter Study. Stroke 2023; 54:124-131. [PMID: 36542074 DOI: 10.1161/strokeaha.122.039797] [Citation(s) in RCA: 1] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Management of extracranial internal carotid artery steno-occlusive lesion during endovascular therapy remains debated. Stent occlusion within 24 hours of endovascular therapy is a frequent event after acute carotid artery stenting, and we currently lack large population results. We investigated the incidence, predictors, and clinical impact of stent occlusion after acute carotid artery stenting in current clinical practice. METHODS Patients treated by endovascular therapy with acute carotid artery stenting between 2015 and 2019 in 5 large-volume endovascular-capable centers were retrospectively analyzed. Patients were separated in 2 groups according to the stent patency at 24 hours after carotid artery stenting. We compared baseline characteristics, treatment modalities, and clinical outcome depending on 24-hour stent patency. Primary end point was favorable outcome, defined as a modified Rankin Scale score 0-2 at 3 months. RESULTS A stent occlusion was observed in 47/225 patients (20.9%). Patients with stent patency had a lower baseline National Institutes of Health Stroke Scale (median [interquartile range]: 13 [7-17] versus 18 [12-21]) and had more often stroke of atherothrombotic origin (77.0% versus 53.2%). A higher stent patency rate was found for patients treated with P2Y12 antagonists at the acute phase (odds ratio [OR]' 2.95 [95% CI' 1.10-7.91]; P=0.026) and treated with angioplasty (OR' 2.42 [95% CI' 1.24-4.67]; P=0.008). A better intracranial angiographic reperfusion was observed in patients with 24-hour stent patency compared with patients without stent patency (OR' 8.38 [95% CI' 3.07-22.78]; P<0.001). Patients with a stent patency at 24 hours had a higher chance of favorable outcome (OR' 3.29 [95% CI, 1.66-6.52]; P<0.001) and a lower risk of death (OR' 0.32 [95% CI, 0.13-0.76]; P=0.009). CONCLUSIONS One out of 5 patients treated with carotid artery stenting during endovascular therapy presented a stent occlusion within 24 hours. This event was associated with worse functional outcome. Stroke etiology, P2Y12 antagonist administration, quality of intracranial reperfusion, and angioplasty were associated with 24-hour stent patency.
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Affiliation(s)
- Julien Allard
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.).,University of Paris' France (J.A., M.M.)
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.)
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, France (R.P.).,Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France (R.P.).,University of Strasbourg, INSERM UMR-S1255, France (R.P.)
| | - Julien Labreuche
- Department of Biostatistics, CHU Lille, University of Lille, France (J.L.)
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.).,LVTS, INSERM U1148, University of Paris, France (BM., M.M.)
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France (G.M.)
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France (I.S.)
| | - François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, France (B.G., F.Z.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (B.L.)
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (A.C.)
| | - Laurent Spelle
- Department of Neuroradiolology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France (L.S.)
| | - Christian Denier
- Department of Neurology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France (C.D.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, France (S.R.).,CIC-P 1433, INSERM U1116, CHRU-Nancy, France (S.R.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, France (B.G., F.Z.).,IADI, INSERM U1254, Université de Lorraine, Nancy, France (B.G.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.).,LVTS, INSERM U1148, University of Paris, France (BM., M.M.).,University of Paris' France (J.A., M.M.)
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6
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Olivot J, Finitsis S, Lapergue B, Marnat G, Sibon I, Richard S, Viguier A, Cognard C, Mazighi M, Gory B, Piotin M, Blanc R, Redjem H, Escalard S, Desilles J, Delvoye F, Smajda S, Maïer B, Hebert S, Mazighi M, Obadia M, Sabben C, Seners P, Raynouard I, Corabianu O, de Broucker T, Manchon E, Taylor G, Maacha MB, Thion L, Lecler A, Savatovsjy J, Wang A, Evrard S, Tchikviladze M, Ajili N, Lapergue B, Weisenburger‐Lile D, Gorza L, Buard G, Coskun O, Consoli A, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Nighoghossian N, Riva R, Eker O, Turjman F, Derex L, Cho T, Mechtouff L, Lukaszewicz A, Philippeau F, Cakmak S, Blanc‐Lasserre K, Vallet A, Marnat G, Gariel F, Barreau X, Berge J, Menegon P, Sibon I, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey J, Briau P, Pangon N, Bourcier R, Detraz L, Daumas‐Duport B, Alexandre P, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C, Gory B, Bracard S, Anxionnat R, Braun M, Derelle A, Liao L, Zhu F, Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour J, Douarinou M, Audibert G, Voicu M, Alb I, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Bourst P, Beaumont M, Chen (Mitchelle) B, Guy S, Georges V, Bechiri F, Macian‐Montoro F, Saleme S, Mounayer C, Rouchaud A, Gimenez L, Cosnard A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre P, Derraz I, Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, ter Schiphorst A, Alias Q, Boustia F, Ferre J, Raoult H, Gauvrit J, Vannier S, Guillen M, Ronziere T, Lassalle V, Tracol C, Malrain C, Boinet S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Samson Y, Léger A, Crozier S, Baronnet F, Alamowitch S, Bottin L, Yger M, Degos V, Spelle L, Denier C, Chassin O, Chalumeau V, Caroff J, Chassin O, Venditti L, Sarov M, Legris N, Naggara O, Hassen WB, Boulouis G, Rodriguez‐Régent C, Trystram D, Kerleroux B, Turc G, Domigo V, Lamy C, Birchenall J, Isabel C, Lun F, Viguier A, Cognard C, Januel A, Olivot J, Raposo N, Bonneville F, Albucher J, Calviere L, Darcourt J, Bellanger G, Tall P, Touze E, Barbier C, Schneckenburger R, Boulanger M, Cogez J, Guettier S, Gauberti M, Timsit S, Gentric J, Ognard J, Merrien FM, Wermester OO, Massardier E, Papagiannaki C, Triquenot A, Lefebvre M, Bourdain F, Bernady P, Lagoarde‐Segot L, Cailliez H, Veunac L, Higue D, Wolff V, Quenardelle V, Lauer V, Gheoca R, Pierre‐Paul I, Pop R, Beaujeux R, Mihoc D, Manisor M, Pottecher J, Meyer A, Chamaraux‐Tran T, Le Bras A, Evain S, Le Guen A, Richter S, Hubrecht R, Demasles S, Barroso B, Sablot D, Farouil G, Tardieu M, Smadja P, Aptel S, Seiler I. Parenchymal hemorrhage rate is associated with time to reperfusion and outcome. Ann Neurol 2022; 92:882-887. [DOI: 10.1002/ana.26478] [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: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Bertrand Lapergue
- Department of Neurology Foch Hospital Versailles Saint‐Quentin en Yvelines University Suresnes France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology University Hospital of Bordeaux France
| | - Igor Sibon
- Department of Neurology, Stroke Center University Hospital of Bordeaux France
| | - Sebastien Richard
- Université de Lorraine, CHRU‐Nancy, Department of Neurology, Stroke Unit F‐54000 Nancy France
- CIC‐P 1433 , INSERM U1116, CHRU‐Nancy, F‐54000 Nancy France
| | - Alain Viguier
- Acute Stroke Unit‐ CIC 1436‐UMR 1214, CHU Toulouse France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiolology CHU Toulouse France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology FHU Neurovasc, INSERM 1148, Université de Paris Cité Rothschild Foundation, Paris France
- Diagnostic and Therapeutic Neuroradiology, F‐54000 Nancy France
| | - Benjamin Gory
- Université de Lorraine, IADI, INSERM U1254 F‐54000 Nancy France
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Delvoye F, Di Meglio L, Consoli A, Nomenjanahary MS, Dupont S, Labreuche J, Maier B, Piotin M, Blanc R, Escalard S, Boursin P, Hamdani M, Redjem H, Smajda S, Hébert S, Sabben C, de Noordhout AM, Jandrot-Perrus M, Lapergue B, Mazighi M, Ho-Tin-Noé B, Desilles JP. High thrombus platelet content is associated with a lower rate of first pass effect in stroke treated by endovascular therapy. Eur Stroke J 2022; 7:376-383. [DOI: 10.1177/23969873221108740] [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: 02/07/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background and purpose: First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays. Patients and methods: Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass. Results: AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content. Discussion and conclusion: Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.
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Affiliation(s)
- François Delvoye
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- University of Liege, Liège, Belgium
| | - Lucas Di Meglio
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Arturo Consoli
- Interventional Neuroradiology Department, Hopital Foch, Suresnes, France
| | | | - Sébastien Dupont
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | | | - Benjamin Maier
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Solène Hébert
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Candice Sabben
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | | | - Martine Jandrot-Perrus
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | | | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
- Université de Paris, Paris, France
- FHU Neurovasc, Department of Neurology, Hopital Lariboisère, APHP Nord, Paris, France
| | - Benoit Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
- Université de Paris, Paris, France
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8
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Marnat G, Finistis S, Delvoye F, Sibon I, Desilles JP, Mazighi M, Gariel F, Consoli A, Rosso C, Clarençon F, Elhorany M, Denier C, Chalumeau V, Caroff J, Veunac L, Bourdain F, Darcourt J, Olivot JM, Bourcier R, Dargazanli C, Arquizan C, Richard S, Lapergue B, Gory B. Safety and Efficacy of Cangrelor in Acute Stroke Treated with Mechanical Thrombectomy: Endovascular Treatment of Ischemic Stroke Registry and Meta-analysis. AJNR Am J Neuroradiol 2022; 43:410-415. [PMID: 35241418 PMCID: PMC8910798 DOI: 10.3174/ajnr.a7430] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke. MATERIALS AND METHODS We performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion). RESULTS In the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%). CONCLUSIONS Cangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.
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Affiliation(s)
- G. Marnat
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - S. Finistis
- Aristotle University of Thessaloniki (S.F.), AhepaHospital, Thessaloniki, Greece
| | - F. Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - I. Sibon
- Department of Neurology (I.S.), Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - J.-P. Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M. Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - F. Gariel
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - A. Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | | | - F. Clarençon
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | - M. Elhorany
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | | | - V. Chalumeau
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - J. Caroff
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - L. Veunac
- Neuroradiolology (L.V.), Centre Hospitalier Cõte Basque, Bayonne, France
| | | | - J. Darcourt
- Neuroradiolology (J.D.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - R. Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - C. Dargazanli
- Departments of Interventional Neuroradiology (C. Dargazanli)
| | - C. Arquizan
- Neurology (C.A.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S. Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France
| | - B. Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - B. Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France,Université de Lorraine (B.G.), Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Nancy, France
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9
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Freiherr von Seckendorff A, Delvoye F, Levant P, Solo Nomenjanahary M, Ollivier V, Bourrienne MC, Di Meglio L, Piotin M, Escalard S, Maier B, Hebert S, Smajda S, Redjem H, Mazighi M, Blanc R, Ho-Tin-Noé B, Désilles JP. Modeling Large Vessel Occlusion Stroke for the Evaluation of Endovascular Therapy According to Thrombus Composition. Front Neurol 2022; 12:815814. [PMID: 35153990 PMCID: PMC8829452 DOI: 10.3389/fneur.2021.815814] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
More than 40% of endovascular therapy (EVT) fail to achieve complete reperfusion of the territory of the occluded artery in patients with acute ischemic stroke (AIS). Understanding factors influencing EVT could help overcome its limitations. Our objective was to study the impact of thrombus cell composition on EVT procedures, using a simulation system for modeling thrombus-induced large vessel occlusion (LVO) in flow conditions. In an open comparative trial, we analyzed the behavior of size-standardized platelet-rich and red blood cells (RBC)-rich thrombi during simulated stent retriever-mediated EVT procedures. Sixteen simulated EVT procedures were performed (8 RBC- vs. 8 platelet-rich thrombi). Platelet-rich thrombi were associated with a higher number of stent retriever passes (p = 0.03) and a longer procedure duration (p = 0.02) compared to RBC-rich thrombi. Conversely, RBC-rich thrombi released more embolic fragments than platelet-rich thrombi (p = 0.004). Both RBC-rich and platelet-rich thrombi underwent drastic compaction after being injected into the in vitro circulation model, and histologic analyses showed that these EVT-retrieved thrombi displayed features comparable to those previously observed in thrombi from patients with AIS patients having LVO, including a marked structural dichotomy between RBC- and platelet-rich areas. Our results show that the injection of in vitro-produced thrombi in artificial cerebrovascular arterial networks is suitable for testing recanalization efficacy and the risk of embolization of EVT devices and strategies in association with thrombus cell composition.
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Affiliation(s)
- Aurélien Freiherr von Seckendorff
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Paul Levant
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Mialitiana Solo Nomenjanahary
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Véronique Ollivier
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Marie-Charlotte Bourrienne
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Lucas Di Meglio
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Solène Hebert
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Benoit Ho-Tin-Noé
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Jean-Philippe Désilles
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- *Correspondence: Jean-Philippe Désilles
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10
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Piotin M, Fahed R, Redjem H, Smajda S, Desilles JP, Escalard S, Maïer B, Hebert S, Delvoye F, Mazighi M, Blanc R. The ARTISSE intrasaccular device for intracranial aneurysm treatment: short-term, mid-term and long-term clinical and angiographic results. J Neurointerv Surg 2021; 14:957-961. [PMID: 34611032 DOI: 10.1136/neurintsurg-2021-017806] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/21/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The concept of intra-aneurysmal flow disruption has emerged as a new paradigm for the treatment of primarily bifurcation aneurysms. The purpose of this study was to determine the clinical and angiographic outcomes of patients treated with the new ARTISSE intrasaccular device (ISD). METHODS Selected patients with bifurcation aneurysms that matched the indications of the ARTISSE ISD defined by the manufacturer were treated in a single center. Clinical and angiographic follow-up was conducted at 6 and 36 months. Aneurysm occlusion was assessed using the Raymond-Roy classification scale. RESULTS Nine subjects with nine unruptured bifurcation aneurysms were enrolled. Mean aneurysm size was 7.2±1.2 mm (range 5.5-9.7 mm). An adequate aneurysm occlusion (defined as a complete occlusion or a neck remnant) was achieved in 6/9 patients (66.7%) at 6 months and 4/7 patients (57.1%) at 36 months follow-up. Two of the nine subjects experienced a major stroke (22.2%), including one on postoperative day 1 due to a procedure-related parent vessel occlusion and subsequent ischemic stroke. The other major stroke occurred within the 36-month follow-up period during treatment of a separate aneurysm with coils, leading to perforation with hemorrhagic stroke causing a permanent neurological deficit. CONCLUSION The ARTISSE ISD was successfully deployed in all nine cases. There were, however, several procedure-related complications and results in terms of angiographic aneurysm occlusion were modest.
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Affiliation(s)
- Michel Piotin
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France .,Laboratory for Vascular Translational Science UMRS 1148, INSERM, Paris, France
| | - Robert Fahed
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France.,Department of Medicine / Division of Neurology and Department of Medical Imaging / Division of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hocine Redjem
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Jean Philippe Desilles
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France.,Laboratory for Vascular Translational Science UMRS 1148, INSERM, Paris, France
| | - Simon Escalard
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Solène Hebert
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France.,Laboratory for Vascular Translational Science UMRS 1148, INSERM, Paris, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France.,Laboratory for Vascular Translational Science UMRS 1148, INSERM, Paris, France
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11
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Marnat G, Delvoye F, Finitsis S, Lapergue B, Gariel F, Consoli A, Desilles JP, Mazighi M, Dargazanli C, Bourcier R, Darcourt J, Chalumeau V, Elhorany M, Clarençon F, Richard S, Gory B, Sibon I. A Multicenter Preliminary Study of Cangrelor following Thrombectomy Failure for Refractory Proximal Intracranial Occlusions. AJNR Am J Neuroradiol 2021; 42:1452-1457. [PMID: 34117019 DOI: 10.3174/ajnr.a7180] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Rescue endovascular and pharmacologic approaches are increasingly being adopted after recanalization failure of acute large-vessel occlusion strokes with mechanical thrombectomy, with encouraging results. The safety and efficacy of glycoprotein IIb/IIIa inhibitors in ischemic stroke have been investigated, though cangrelor, a recent intravenous P2Y12-receptor inhibitor with a rapid onset/offset of action and a short half-life, may be a valuable option. We compared the safety and efficacy of cangrelor with those of glycoprotein IIb/IIIa inhibitors for refractory occlusions. MATERIALS AND METHODS We performed a retrospective analysis of the ongoing prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke Registry in France between May 2012 and February 2020. Refractory intracranial occlusions of the anterior and posterior circulation were included and defined as recanalization failure of large-vessel occlusion stroke, perioperative target artery reocclusion, or high risk of early reocclusion related to an arterial wall lesion. The primary end point was a favorable outcome, defined as a 90-day mRS of 0-2. Secondary end points were reperfusion, intracranial hemorrhage, and procedural complications. RESULTS Among 69 patients, 15 were treated with cangrelor, and 54, with glycoprotein IIb/IIIa inhibitors. The favorable outcome (adjusted OR = 2.22; 95% CI, 0.42-11.75; P = .348) and mortality (adjusted OR = 0.44; 95% CI, 0.06-3.16; P = .411) rates were similar in both groups. There was no difference in the rates of any intracranial hemorrhage (adjusted OR = 0.40; 95% CI, 0.08-2.09; P = .280), symptomatic intracranial hemorrhage (6.7% versus 0.0%, P = .058), or procedural complications (6.7% versus 20.4%, P = .215). Reperfusion rates were higher in the cangrelor group, though the difference did not reach statistical significance (93.3% versus 75.0% for modified TICI 2b-3; adjusted OR =10.88; 95% CI, 0.96-123.84; P = .054). CONCLUSIONS Cangrelor seems to be as safe as glycoprotein IIb/IIIa inhibitors for managing refractory intracranial occlusion and leads to satisfactory brain reperfusion. Cangrelor is a promising agent in this setting, and additional studies are warranted to confirm our findings.
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Affiliation(s)
- G Marnat
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - F Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - S Finitsis
- Aristotle University of Thessaloniki (S.F.), Ahepa Hospital, Thessaloniki, Greece
| | - B Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - F Gariel
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - A Consoli
- Department s of Neuroradiology (A.C.) and Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - J-P Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - C Dargazanli
- Department of Neuroradiology (C.D.), Centre Hospitalier Régional Universitaire Gui de Chauliac, Montpellier, France
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), University Hospital of Toulouse, Toulouse, France
| | - V Chalumeau
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - M Elhorany
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - F Clarençon
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - S Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Régional Universitaire-Nancy, Stroke Unit, Nancy, France
- Institut national de la santé et de la recherche médicale U1116 (S.R.), Centre Hospitalier Régional Universitaire-Nancy, Nancy, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, CHRU-Nancy, Nancy, France
- Institut National de la Santé et de la Recherche Mmédicale U1254 (B.G.), Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
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12
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Maïer B, Robichon E, Bourcier R, Dargazanli C, Labreuche J, Thion LA, Leguen M, Riem R, Desilles JP, Boulouis G, Delvoye F, Hebert S, Redjem H, Smajda S, Escalard S, Blanc R, Piotin M, Lapergue B, Mazighi M. Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency. Stroke 2021; 52:2964-2967. [PMID: 34134507 DOI: 10.1161/strokeaha.121.034542] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Hypotension during endovascular therapy for acute ischemic stroke is associated with worse functional outcomes (FO). Given its important role in intracranial hemodynamics, we investigated whether hypotension during endovascular therapy had the same effect on FO according to the posterior communicating artery (PComA) patency. METHODS We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Patients were included if they had middle cerebral artery occlusions. Primary outcome was favorable FO, defined by a modified Rankin Scale scores between 0 and 2 at 3 months. RESULTS One hundred forty-eight patients with middle cerebral artery occlusion were included. In patients with no PComA, an increase in minimum mean arterial pressure was positively associated with favorable FO (odds ratio per 10 mm Hg increase, 1.59 [95%CI, 1.11-2.25]; P=0.010), whereas no association was found in patients with a PComA (odds ratio, 0.77 [95% CI, 0.54-1.08]; P=0.12). Patients with no PComA and longer cumulative time with mean arterial pressure <90 mm Hg or systolic blood pressure <140 mm Hg had significantly lower rates of favorable FO, with an odds ratio per 10-minute increase of 0.75 (95% CI, 0.59-0.94; P=0.010) and 0.74 (95% CI, 0.60-0.91; P=0.003), but not in patients with a PComA. CONCLUSIONS Hypotension during endovascular therapy for middle cerebral artery occlusion is consistently associated with worse FO in patients with no PComA but not in those with a PComA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02523261.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Erwan Robichon
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | | | - Cyril Dargazanli
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France (C.D.)
| | - Julien Labreuche
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, France (J.L.)
| | - Laurie-Anne Thion
- Anesthesiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (L.-A.T.)
| | - Morgan Leguen
- Anesthesiology Department, Foch Hospital, France (M.L.)
| | - Romuald Riem
- Anesthesiology Department, Nantes Hospital, France (R.R.)
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | | | - François Delvoye
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Solène Hebert
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Inserm 1087, CNRS, UNIV Nantes (R.B.)
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | | | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
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13
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Charbonnier G, Desilles JP, Escalard S, Maier B, Ciccio G, Smajda S, Fahed R, Delvoye F, Redjem H, Blanc R, Piotin M, Mazighi M. Timing and Spectrum of Neurological Complications After Flow Diverter Implantation for Intracranial Aneurysms. Front Neurol 2021; 12:590383. [PMID: 33959085 PMCID: PMC8093792 DOI: 10.3389/fneur.2021.590383] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications. Methods: This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD. Results: Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186–1,210). Sixty-one patients presented with ischemic complications, 13 with hemorrhagic ones and 10 with compressive processes. Among 89 neurological complications 64.5% were peri-operative (occurring within the 30 days following the procedure) and 35.5% were delayed after 1 month. Conclusions: Overall, neurological complications after FD implantation were overrepresented by cerebrovascular ischemic events occurring during the peri-operative period, but also in a delayed manner after 1 year. Long-term follow-up is relevant after aneurysm intervention using FD.
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Affiliation(s)
| | | | - Simon Escalard
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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14
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Delvoye F, Loyau S, Labreuche J, Taylor G, Maier B, Piotin M, Blanc R, Escalard S, Di Meglio L, Ben Maacha M, Redjem H, Smajda S, Ciccio G, Hébert S, Sabben C, Jandrot-Perrus M, Maertens De Noordhout A, Mazighi M, Ho-Tin-Noé B, Desilles JP. Intravenous abciximab as a rescue therapy for immediate reocclusion after successful mechanical thrombectomy in acute ischemic stroke patients. Platelets 2021; 33:285-290. [PMID: 33840346 DOI: 10.1080/09537104.2021.1894326] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background - Immediate reocclusion after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is a rare but devastating condition associated with poor functional outcome.Objective - The aim of this study was to gain insights into the mechanisms underlying immediate reocclusion, and to evaluate the efficacy and safety of the glycoprotein IIb/IIIa antagonist abciximab, for its treatment.Methods - Clinical data were collected from April 2015 to April 2019 in a monocentric prospective registry of AIS patients treated by MT. All patients with immediate reocclusion were retrospectively selected and subdivided into 2 groups according to abciximab treatment status. In vitro, the separate and combined effects of abciximab and alteplase on clot formation in whole blood under flow conditions were further investigated in microfluidic chambers.Results - From 929 MT-treated patients, 21 had post-MT immediate reocclusion. Abciximab treatment in reocclusion patients (n = 10) led to higher rate of final recanalization (p < .001) while it did not increase bleeding complications. Flow chamber experiments revealed that, in contrast to alteplase, abciximab efficiently limits thrombus accretion from flowing blood by blocking platelet aggregation.Conclusions - Our results underscore a key role for platelet aggregation and the potential of Glycoprotein IIb/IIIa antagonists as a rescue therapy in post-MT immediate reocclusion.
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Affiliation(s)
- François Delvoye
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,University of Liege, Belgium
| | - Stephane Loyau
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | | | - Guillaume Taylor
- Rothschild Foundation Hospital, Intensive Care Department, Paris, France
| | - Benjamin Maier
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Michel Piotin
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Raphael Blanc
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Simon Escalard
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Lucas Di Meglio
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Malek Ben Maacha
- Clinical Research Unit, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Stanislas Smajda
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Gabriele Ciccio
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Solène Hébert
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Candice Sabben
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Martine Jandrot-Perrus
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | | | - Mikael Mazighi
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France.,Université De Paris, France.,DHU Neurovasc
| | - Benoit Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Jean-Philippe Desilles
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France.,Université De Paris, France
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15
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Hebert S, Clavel P, Maier B, Mizutani K, Delvoye F, Lapergue B, Maacha MB, Fahed R, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Gory B, Richard S, Blanc R, Piotin M, Mazighi M. Corrigendum to 'Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase' [Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 10 (October), 2020: 105052]. J Stroke Cerebrovasc Dis 2020; 30:105465. [PMID: 33309126 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105465] [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: 10/22/2022] Open
Affiliation(s)
- Solène Hebert
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France.
| | - Pierre Clavel
- Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | | | - François Delvoye
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | | | - Malek Ben Maacha
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Simon Escalard
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Jean-Philippe Desilles
- Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Hocine Redjem
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Gory
- Professor, Interventional Neuroradiology Unit, Centre Hospitalier et Régional Universitaire de Nancy, Nancy, France, 03 83 85 16 18
| | - Sébastien Richard
- Professor, Neurology unit, Centre Hospitalier et Régional Universitaire de Nancy, Nancy, France, 03 83 85 22 5
| | - Raphael Blanc
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Michel Piotin
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Mikael Mazighi
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
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16
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Delvoye F, Maier B, Escalard S, Labreuche J, Thion LA, Aknouche S, Hebert S, Redjem H, Smajda S, Ciccio G, Allard J, Sabben C, Obadia M, Maertens de Noordhout A, Olivot JM, Blanc R, Piotin M, Desilles JP, Mazighi M. Antiplatelet Therapy During Emergent Extracranial Internal Carotid Artery Stenting: Comparison of Three Intravenous Antiplatelet Perioperative Strategies. J Stroke Cerebrovasc Dis 2020; 30:105521. [PMID: 33310073 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting. MATERIAL AND METHODS Clinical data were collected from January 2015 to December 2019 in a monocentric prospective registry of AIS patients treated by EVT. All patients who underwent emergent EC-ICA stenting were sorted regarding the intravenous antiplatelet agent used during the procedure. RESULTS Among 218 patients treated by EVT for an EC-ICA occlusion of the anterior circulation during the study period, 70 underwent an emergent stenting of the EC-ICA. 60 were included in the present study, 9 received intravenous (IV) Cangrelor, 8 IV abciximab and 43 Aspirin. The rate of favorable neurological outcome, defined as modified Rankin Scale (mRS) ≤ 2 at three months were better in the Cangrelor and Aspirin groups (66,7% and 58,1%, respectively) than in the Abciximab group (37,5%), as well as, the rate of any intracranial ICH (22,2% and 37,2% vs 62,5%). The rate of acute stent reocclusion was similar between groups. CONCLUSION When used as a rescue treatment during emergent stenting of EC-ICA, Cangrelor and Aspirin present a better safety profile than Abciximab, with less intracranial hemorrhages and a higher rate of good clinical outcome. Additional studies are needed to confirm these findings.
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Affiliation(s)
- François Delvoye
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Université de Liège, Belgique.
| | - Benjamin Maier
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Simon Escalard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Julien Labreuche
- University of Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France.
| | - Laurie-Anne Thion
- Anesthesiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Soufiane Aknouche
- Clinical Research Unit, Rothschild Foundation Hospital, Paris, France.
| | - Solène Hebert
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Hocine Redjem
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Julien Allard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Candice Sabben
- Neurology Department, Rothschild Foundation Hospital, Paris, France.
| | - Michael Obadia
- Neurology Department, Rothschild Foundation Hospital, Paris, France.
| | | | | | - Raphael Blanc
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Michel Piotin
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France.
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France; FHU Neurovasc, France.
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17
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Maïer B, Delvoye F, Labreuche J, Escalard S, Desilles JP, Redjem H, Hébert S, Smajda S, Ciccio G, Lapergue B, Blanc R, Piotin M, Mazighi M. Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review. Front Neurol 2020; 11:573382. [PMID: 33193021 PMCID: PMC7659685 DOI: 10.3389/fneur.2020.573382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/16/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose: Optimal blood pressure (BP) targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) still need to be assessed, especially according to the recanalization status. Facing the lack of randomized controlled trials addressing this question, we performed a systematic review of studies assessing the post-EVT BP impact on functional outcome and symptomatic intracranial hemorrhage (sICH). Methods: Studies published after January 1, 2012 were included in the systematic review. The PRISMA checklist and flow diagram were followed for the design and reporting of this work. Results: Five studies were included in the present analysis. Despite a significant heterogeneity among studies which precluded a meta-analysis, systolic BP (SBP) was the most frequently used parameter to describe BP. BP variability (standard deviation, successive variability) after EVT was associated with worse functional outcome, especially in studies without specific BP targets after successful EVT. Lower BP values after successful EVT were associated with lower odds of sICH. Four studies evaluated the post-EVT BP impact on recanalized patients solely, with only one specifically addressing the impact of a TICI 2B vs. 2C. Interestingly, SBP reduction was inversely associated with worse outcomes in TICI 3 patients but not in TICI 2B patients, pointing to the potential value of BP management according to the exact TICI. Conclusions: BP post-EVT seems to be associated with worse functional outcomes and sICH. However, given the important heterogeneity depicted among the included studies, no decisive conclusion can be made from this systematic review, thus underlying the urgent need of randomized controlled trials evaluating this question.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Université de Paris, Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Julien Labreuche
- University Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Solène Hébert
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | | | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France.,FHU Neurovasc, Paris, France
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18
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Allard J, Ghazanfari S, Mahmoudi M, Labreuche J, Escalard S, Delvoye F, Ciccio G, Smajda S, Redjem H, Hebert S, Consoli A, Costalat V, Desilles JP, Mazighi M, Piotin M, Dargazanli C, Lapergue B, Blanc R, Maïer B. Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review. J Neurointerv Surg 2020; 13:809-815. [PMID: 33077577 DOI: 10.1136/neurintsurg-2020-016725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/07/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT. METHODS Patients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates ( ≥ TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP. RESULTS 25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73-92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2-6) vs 6 (4-6), p=0.011). CONCLUSION RCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.
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Affiliation(s)
- Julien Allard
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Sam Ghazanfari
- Stroke Center, Hôpital Foch, Suresnes, Île-de-France, France
| | - Mehdi Mahmoudi
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Julien Labreuche
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille University Hospital Center, Lille, Hauts-de-France, France
| | - Simon Escalard
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - François Delvoye
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Gabriele Ciccio
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Stanislas Smajda
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Hocine Redjem
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Solène Hebert
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Arturo Consoli
- Neuroradiology, Hopital Foch, Suresnes, Île-de-France, France
| | - Vincent Costalat
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | | | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Benjamin Maïer
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
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19
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Hebert S, Clavel P, Maier B, Mizutani K, Delvoye F, Lapergue B, Maacha MB, Fahed R, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Blanc R, Piotin M, Mazighi M. Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase. J Stroke Cerebrovasc Dis 2020; 29:105052. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022] Open
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20
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Baharvahdat H, Blanc R, Fahed R, Pooyan A, Mowla A, Escalard S, Delvoye F, Desilles JP, Redjem H, Ciccio G, Smajda S, Hamdani M, Mazighi M, Piotin M. Endovascular treatment as the main approach for Spetzler-Martin grade III brain arteriovenous malformations. J Neurointerv Surg 2020; 13:241-246. [PMID: 32989031 DOI: 10.1136/neurintsurg-2020-016450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/01/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Because Spetzler-Martin (SM) grade III brain arteriovenous malformations (bAVMs) constitute a heterogeneous group of lesions with various combination of sizes, eloquence, and venous drainage patterns, their management is usually challenging. The aim of this study is to evaluate the clinical/imaging outcomes and the procedural safety of endovascular approach as the main treatment for the cure of SM grade III bAVMs. METHODS In this retrospective study, prospectively collected data of SM grade III bAVMs treated by endovascular techniques between 2010 and 2018 at our hospital were reviewed. Patients older than 16 years with angiographic follow-up of at least 6 months after endovascular treatment were entered in the study. The patients had a mean follow-up of 12 months. The data were assessed for clinical outcome (modified Rankin Scale), permanent neurological deficit, post-operative complications, and optimal imaging outcome, defined by complete exclusion of AVM. The independent predictive variables of poor outcome or hemorrhagic complication were assessed using binary logistic regression. RESULTS Sixty-five patients with 65 AVMs were included in the study. Mean age of the patients was 40.0±14.4. Most common presentation was hemorrhage (61.5%). The patients underwent one to eight endovascular procedures (median=2). Mean nidus diameter was 30.2±13.0. A complete obliteration of AVM was achieved in 57 patients (87.7%). Post-procedure significant hemorrhagic and ischemic complications were seen in 13 (20%) and five (7.7%) patients respectively, leading to five (7.7%) transient and four (6.2%) permanent neurological deficits. Eight patients (12.3%) experienced worsening of mRS after embolization. Ten patients (15.4%) had poor outcome (mRS 3-5) at follow-up and two (3%) died. CONCLUSIONS Endovascular treatment can achieve a high rate of complete exclusion of grade III AVM but may be associated (as in other treatment modalities) with significant important complications. CLINICAL TRIAL REGISTRATION NUMBER NCT02879071.
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Affiliation(s)
- Humain Baharvahdat
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France.,Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - Robert Fahed
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France.,Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ashkan Pooyan
- Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | - Ashkan Mowla
- Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Simon Escalard
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - François Delvoye
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | | | - Hocine Redjem
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - Gabriele Ciccio
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - Stanislas Smajda
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - Mylène Hamdani
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
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21
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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22
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Escalard S, Chalumeau V, Escalard C, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Maïer B, Piotin M. Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients. Stroke 2020; 51:3366-3370. [PMID: 32813602 PMCID: PMC7446979 DOI: 10.1161/strokeaha.120.031011] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19. METHODS We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019. RESULTS Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger (P=0.032) and had a history of diabetes mellitus more frequently (P=0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging (P=0.18 and P=0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P=0.016), higher rate of multivessel occlusion (50% versus 8.8%, P=0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores; median: 5 versus 8, P=0.006), and higher infarct core volume (median: 58 versus 6 mL, P=0.004). Successful recanalization rate was similar in both groups (P=0.767). In-hospital mortality was higher in the COVID-19 patients' group (41.7% versus 11.8%, P=0.025). CONCLUSIONS Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.
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Affiliation(s)
- Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, CHU Bicêtre, France (V.C.)
| | - Clément Escalard
- Department of Radiology, Centre Hospitalier Universitaire de Caen, France (C.E.)
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Solène Hébert
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Stanislas Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Gabriele Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
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Blanc R, Escalard S, Baharvadhat H, Desilles JP, Boisseau W, Fahed R, Redjem H, Ciccio G, Smajda S, Maier B, Delvoye F, Hebert S, Mazighi M, Piotin M. Recent advances in devices for mechanical thrombectomy. Expert Rev Med Devices 2020; 17:697-706. [DOI: 10.1080/17434440.2020.1784004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Humain Baharvadhat
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Jean Philippe Desilles
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - William Boisseau
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Department of Medicine/Division of Neurology, Department of Medical Imaging/Division of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Solène Hebert
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Boisseau W, Escalard S, Fahed R, Lapergue B, Smajda S, Maier B, Desilles JP, Delvoye F, Ciccio G, Redjem H, Hebert S, Ben Maacha M, Walker G, Gory B, Richard S, Mazighi M, Piotin M, Blanc R. Direct aspiration stroke thrombectomy: a comprehensive review. J Neurointerv Surg 2020; 12:1099-1106. [PMID: 32532857 DOI: 10.1136/neurintsurg-2019-015508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/05/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 01/22/2023]
Abstract
Mechanical thrombectomy is now the standard of care for acute ischemic stroke patients with large vessel occlusions, and can be performed with several devices and techniques. One of these techniques, direct aspiration (DA), consists of navigating a large-bore catheter up to the face of the clot and initiating forceful suction. This comprehensive review has three objectives: (1) to describe the direct aspiration technique; (2) to present the available evidence regarding predictive factors of DA success and performance compared with other techniques; and (3) to discuss the forthcoming improvements in distal aspiration.
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Affiliation(s)
- William Boisseau
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Simon Escalard
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Robert Fahed
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Department of Medicine - Division of Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Stanislas Smajda
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Benjamin Maier
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Jean Philippe Desilles
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - François Delvoye
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Gabriele Ciccio
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Hocine Redjem
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Solène Hebert
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Malek Ben Maacha
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Gregory Walker
- Department of Medicine - Division of Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine - Division of Neurology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Mikael Mazighi
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France .,Université de Paris, Paris, Île-de-France, France
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25
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Escalard S, Maïer B, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Piotin M. Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris. Stroke 2020; 51:2540-2543. [PMID: 32466736 PMCID: PMC7282400 DOI: 10.1161/strokeaha.120.030574] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. METHODS All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. RESULTS We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. CONCLUSIONS Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.
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Affiliation(s)
- Simon Escalard
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maïer
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Solène Hébert
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Gabriele Ciccio
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Desilles
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
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Delvoye F, Hervé D, Chabriat H, Mawet J. Moyamoya syndrome related to neurofibromatosis of type 1: a case report. Acta Neurol Belg 2013; 113:539-41. [PMID: 24085541 DOI: 10.1007/s13760-013-0250-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/03/2013] [Indexed: 12/01/2022]
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