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Tartarin H, Morotti A, Van Etten ES, Hausman-Kedem M, Charidimou A, Jouvent E, Susen S, Cordonnier C, Pasi M, Boulouis G. Uncommon Causes of Nontraumatic Intracerebral Hemorrhage. Stroke 2024; 55:1416-1427. [PMID: 38572651 DOI: 10.1161/strokeaha.123.043917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Nontraumatic intracerebral hemorrhage is an important health issue. Although common causes such as hypertension and cerebral amyloid angiopathy predominantly affect the elderly, there exists a spectrum of uncommon etiologies that contribute to the overall incidence of intracerebral hemorrhage. The identification of these rare causes is essential for targeted clinical management, informed prognostication, and strategic secondary prevention where relevant. This topical review explores the uncommon intracerebral hemorrhage causes and provides practical clues for their clinical and imaging identification. By expanding the clinician's differential diagnosis, this review aims to bridge the gap between standard intracerebral hemorrhage classification systems and the nuanced reality of clinical practice.
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Affiliation(s)
- Hugo Tartarin
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy (A.M.)
| | - Ellis S Van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.S.V.E.)
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv Unisversity, Israel (M.H.-K.)
| | | | - Eric Jouvent
- Neurology Department, Lariboisière Hosp, APHP and Université Paris Cité, France (E.J.)
| | - Sophie Susen
- Hematology and Transfusion Department, Centre Hospitalier Universitaire de Lille, France (S.S.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, France (C.C.)
| | - Marco Pasi
- Stroke unit, CHU Tours, Centre Val de Loire, France (M.P.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
- INSERM 1253 iBrain, Tours, Centre Val de Loire, France (G.B.)
- CIC-IT 14.15, Tours, Centre Val de Loire, France (G.B.)
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Scopelliti G, Rossi C, Kuchcinski G, Boulouis G, Moulin S, Cordonnier C, Hénon H, Casolla B. Fatigue after spontaneous intracerebral haemorrhage: prevalence and associated factors. Neurol Sci 2024; 45:2127-2135. [PMID: 37993682 DOI: 10.1007/s10072-023-07196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Fatigue is a major complaint in stroke survivors, but data focusing on intracerebral haemorrhage (ICH) survivors are scarce. In a cohort of spontaneous ICH survivors, we assessed the long-term prevalence of fatigue and its associated factors. METHODS We included consecutive 1-year ICH survivors from the prospective, observational, single-centre Prognosis of Intracerebral Haemorrhage (PITCH) study. We evaluated fatigue (defined as a score ≥ 4 in Chalder Fatigue Scale); the severity of neurological, depressive, and anxiety symptoms; and functional disability 1, 3, and 6 years after ICH. We performed univariable and multivariable models to evaluate clinical factors and brain magnetic resonance imaging (MRI) small vessel disease (SVD) markers associated with fatigue. RESULTS Of 255 1-year ICH survivors, 153 (60%) underwent fatigue screening and were included in this study. Seventy-eight patients (51%) reported fatigue at 1-year, 56/110 (51%) at 3-year, and 27/67 (40%) at 6-year follow-up. Patients with fatigue exhibited more severe concomitant depressive/anxiety symptoms, but the severity of depressive symptoms was the only clinical factor significantly associated with 1-year fatigue in multivariable analysis (adjusted odds ratio 1.4 for one-point increase; 95% confidence interval 1.2-1.6). Patients with severe cortical atrophy at baseline had increased risk of fatigue at 1-year follow-up compared to patients with mild/no cortical atrophy (adjusted odds ratio 2.5; 95% confidence interval 1.1-5.8). CONCLUSIONS Fatigue after ICH is frequent and long-lasting, and it is associated with cortical atrophy (but not with other MRI markers of cerebral SVD). The link between fatigue and depressive symptoms may represent a potential therapeutic target.
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Affiliation(s)
- Giuseppe Scopelliti
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
- Neurology and Stroke Unit, Luigi Sacco Hospital, Milan, Italy
| | - Costanza Rossi
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Grégory Kuchcinski
- Department of Neuroradiology, Inserm, U1172-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, INSERM U1253 iBrain, University Hospital of Tours, Centre Val de Loire, Tours, France
| | | | - Charlotte Cordonnier
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France.
| | - Hilde Hénon
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Barbara Casolla
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
- UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France
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Agbonon R, Forestier G, Bricout N, Benhassen W, Turc G, Bretzner M, Pasi M, Benzakoun J, Seners P, Derraz I, Legrand L, Trystram D, Rodriguez-Regent C, Charidimou A, Rost NS, Bracard S, Cordonnier C, Eker OF, Oppenheim C, Naggara O, Henon H, Boulouis G. Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke. J Neurol 2024; 271:2631-2638. [PMID: 38355868 DOI: 10.1007/s00415-024-12205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT), the association of pre-existing cerebral small vessel disease (cSVD) with symptomatic intracerebral hemorrhage (sICH) remains controversial. We tested the hypothesis that the presence of cerebral microbleeds (CMBs) and their burden would be associated with sICH after EVT of AIS. METHODS We conducted a retrospective study combining cohorts of patients that underwent EVT between January 1st 2015 and January 1st 2020. CMB presence, burden, and other cSVD markers were assessed on a pre-treatment MRI, evaluated independently by two observers. Primary outcome was the occurrence of sICH. RESULTS 445 patients with pretreatment MRI were included, of which 70 (15.7%) demonstrated CMBs on baseline MRI. sICH occurred in 36 (7.6%) of all patients. Univariate analysis did not demonstrate an association between CMB and the occurrence of sICH (7.5% in CMB+ group vs 8.6% in CMB group, p = 0.805). In multivariable models, CMBs' presence was not significantly associated with increased odds for sICH (-aOR- 1.19; 95% CI [0.43-3.27], p = 0.73). Only ASPECTs (aOR 0.71 per point increase; 95% CI [0.60-0.85], p < 0.001) and collaterals status (aOR 0.22 for adequate versus poor collaterals; 95% CI [0.06-0.93], p 0.019) were independently associated with sICH. CONCLUSION CMB presence and burden is not associated with increased occurrence of sICH after EVT. This result incites not to exclude patients with CMBs from EVT. The risk of sICH after EVT in patients with more than10 CMBs will require further investigation. REGISTRATION Registration-URL: http://www. CLINICALTRIALS gov ; Unique identifier: NCT01062698.
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Affiliation(s)
- Rémi Agbonon
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Géraud Forestier
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France.
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther-King, 87042, Limoges, France.
| | - Nicolas Bricout
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Wagih Benhassen
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Guillaume Turc
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martin Bretzner
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Marco Pasi
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Joseph Benzakoun
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Pierre Seners
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Laurence Legrand
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Denis Trystram
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Christine Rodriguez-Regent
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Andreas Charidimou
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Serge Bracard
- Neuroradiology Department, Lorraine University, INSERM U1254 CHRU Nancy, Nancy, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Omer F Eker
- Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | - Catherine Oppenheim
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Hilde Henon
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Grégoire Boulouis
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neuroradiology Department, CHU de Tours, Centre Val de Loire Region, Tours, France
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Bibi R, Bankole NDA, Donnard B, Giubbolini F, Boucherit J, Barrot V, Herbreteau D, Ifergan H, Janot K, Boulouis G, Bala F. Safety and efficacy of Surpass Evolve Flow diverter for intracranial aneurysms: A study of 116 patients. Neuroradiol J 2024; 37:184-191. [PMID: 38146676 DOI: 10.1177/19714009231224408] [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: 12/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Flow diverter embolization is a recognized method for treating intracranial aneurysms. This study evaluates the safety and efficacy of the Surpass Evolve flow diverter in treating intracranial aneurysm. MATERIAL AND METHODS From May 2019 to June 2022, our center prospectively enrolled patients presenting with both ruptured and unruptured intracranial aneurysms. We assessed aneurysm occlusion, along with the occurrence of ischemic and hemorrhagic complications, and mortality at 6-months. The 3-month occlusion rate was determined using MR angiography, while the 6-month occlusion rate employed the O'Kelly-Marotta (OKM) grading scale on DSA. RESULTS A total of 116 patients with 120 aneurysms received treatment with the Surpass Evolve device. The average aneurysm size was 6.6 mm (range: 2-30 mm). All patients were administered two loading doses of ticagrelor (180 mg) one day before the procedure and 2 h pre-embolization. A procedural complication occurred in one case, involving wire-related perforation of an M3 branch distant from the giant aneurysm; however, this evolved favorably. There were no reported deaths linked to the treatment. Permanent neurological deficits were observed in 3 (2.5%) patients, primarily due to early in-stent thrombosis. MR angiography results at 3 months indicated complete occlusion for 87 out of 115 (75.6%) monitored aneurysms. The 6-month DSA showed neck remnant or complete occlusion (OKM grade C or D) in 86 out of the 107 (80.4%) patients who underwent follow-up. CONCLUSION The Surpass Evolve stands out as a reliable and effective flow diverter for the management of intracranial aneurysms.
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Affiliation(s)
- Richard Bibi
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Nourou Dine Adeniran Bankole
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
- Clinical Investigation Center (CIC), INSERM, University Hospital of Tours, Tours, France
| | - Baptiste Donnard
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Francesca Giubbolini
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Julien Boucherit
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
- Department of Neuroradiology, Rennes University Hospital, Rennes, France
| | - Valère Barrot
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Denis Herbreteau
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Héloïse Ifergan
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Kevin Janot
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
- Clinical Investigation Center (CIC), INSERM, University Hospital of Tours, Tours, France
| | - Fouzi Bala
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
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Burel J, Boulouis G, Zhu F, Kerleroux B, Shotar E. From 2018 to 2023: A five-year journey of trainee-led network research by the Jeunes en Neuroradiologie Interventionnelle (JENI)-Research Collaborative. J Neuroradiol 2024:S0150-9861(24)00112-3. [PMID: 38556368 DOI: 10.1016/j.neurad.2024.03.002] [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: 02/09/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Julien Burel
- Department of Radiology, Rouen University Hospital, Rouen, Normandy, France.
| | - Grégoire Boulouis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France
| | - François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Basile Kerleroux
- Department of Neuroradiology, APHM La Timone, Marseille, France; Department of Radiology, Centre Hospitalier de Bastia, Bastia, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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Cohen C, Lenck S, Talbi A, Ifergan H, Premat K, Boulouis G, Janot K, Boch AL, Magni C, Herbreteau D, Sourour N, Shotar E, Barrot V, Clarençon F. Intracranial dural arteriovenous fistulas: association with cerebral venous thrombosis, baseline aggressiveness, and clinical outcomes. A retrospective multicenter study on 263 consecutive patients and literature review. Neurosurg Focus 2024; 56:E9. [PMID: 38428003 DOI: 10.3171/2024.1.focus23748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The pathogenesis of intracranial dural arteriovenous fistulas (icDAVFs) is controversial. Cerebral vein thrombosis (CVT) and venous hypertension are recognized predisposing factors. This study aimed to evaluate the incidence of association between icDAVF and CVT and describe baseline aggressiveness and clinical outcomes for icDAVFs associated with CVT. The authors also performed a literature review of studies reporting icDAVF associated with CVT. METHODS Two hundred sixty-three consecutive patients in two university hospitals with confirmed icDAVFs were included. A double-blind imaging review was performed to determine the presence or absence of CVT close or distant to the icDAVF. Location, type (using the Cognard classification), aggressiveness of the icDAVF, clinical presentation, treatment modality, and clinical and/or angiographic outcomes at 6 months were also collected. All prior brain imaging was analyzed to determine the natural history of onset of the icDAVF. RESULTS Among the 263 included patients, 75 (28.5%) presented with a CVT concomitant to their icDAVF. For 18 (78.3%) of 23 patients with previous brain imaging available, CVT preceding the icDAVF was proven (6.8% of the overall population). Former/active smoking (OR 2.0, 95% CI 1.079-3.682, p = 0.022) and prothrombogenic status (active inflammation or cancer/coagulation trouble) were risk factors for CVT associated with icDAVF (OR 3.135, 95% CI 1.391-7.108, p = 0.003). One hundred eighty-seven patients (71.1%) had a baseline aggressive icDAVF, not linked to the presence of a CVT (p = 0.546). Of the overall population, 11 patients (4.2%) presented with spontaneous occlusion of their icDAVF at follow-up. Seven patients (2.7%) died during the follow-up period. Intracranial DAVF + CVT was not associated with a worse prognosis (modified Rankin Scale score at 3-6 months: 0 [interquartile range {IQR} 0-1] for icDAVF + CVT vs 0 [IQR 0-0] for icDAVF alone; p = 0.055). CONCLUSIONS This was one of the largest studies focused on the incidence of CVT associated with icDAVF. For 6.8% of the patients, a natural history of CVT leading to icDAVF was proven, corresponding to 78.3% of patients with previous imaging available. This work offers further insights into icDAVF pathophysiology, aiding in identifying high-risk CVT patients for long-term follow-up imaging. Annual imaging follow-up using noninvasive vascular imaging (CT or MR angiography) for a minimum of 3 years after the diagnosis of CVT should be considered in high-risk patients, i.e., smokers and those with prothrombogenic status.
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Affiliation(s)
- Clara Cohen
- 1Department of Neuroradiology, University Hospital of Orléans
| | - Stéphanie Lenck
- 2Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris
| | - Atika Talbi
- 2Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris
| | - Héloïse Ifergan
- 3Department of Interventional Neuroradiology, University Hospital of Tours
| | - Kévin Premat
- 2Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris
| | - Grégoire Boulouis
- 3Department of Interventional Neuroradiology, University Hospital of Tours
- 4INSERM 1253 iBrain, Tours University, Tours
| | - Kévin Janot
- 3Department of Interventional Neuroradiology, University Hospital of Tours
| | - Anne-Laure Boch
- 5Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris; and
| | | | - Denis Herbreteau
- 3Department of Interventional Neuroradiology, University Hospital of Tours
| | - Nader Sourour
- 2Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris
| | - Eimad Shotar
- 2Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris
- 6INSERM, CNRS, Institut de la Vision, Sorbonne Université, Paris, France
| | - Valère Barrot
- 3Department of Interventional Neuroradiology, University Hospital of Tours
| | - Frédéric Clarençon
- 2Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris
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Ospel JM, Boulouis G. Evolving Role of Imaging in Acute Ischemic Stroke Care. Stroke 2024; 55:765-768. [PMID: 38126180 DOI: 10.1161/strokeaha.123.044264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Johanna Maria Ospel
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, AB, Canada (J.M.O.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, Centre d'investigation Clinique, Innovation Technologique (CIC-IT) 1415, Centre Hospitalier Régional Universitaire de Tours (CHRU) de Tours, INSERM 1253 iBrain, Tours, France
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Hua VT, Benhammida S, Nguyen TP, Boulouis G, Doucet A, Caucheteux N, Soize S, Moulin S. Brush Sign on pre-treatment imaging is associated with good functional outcome in stroke patients treated with mechanical thrombectomy: A prospective monocentric study. J Neuroradiol 2024:S0150-9861(24)00093-2. [PMID: 38367958 DOI: 10.1016/j.neurad.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The Brush Sign (BrS) is a radiological biomarker (MRI) showing signal decrease of subependymal and deep medullary veins on paramagnetic-sensitive magnetic resonance sequences. Previous studies have shown controversial results regarding the prognostic value of BrS. We aimed to assess whether BrS on T2*-weighted sequences could predict functional prognosis in patients treated with mechanical thrombectomy (MT). METHODS We included all consecutive patients with large artery occlusion related stroke in anterior circulation treated with MT between February 2020 and August 2022 at Reims University Hospital. Multivariable logistic regression models were used to investigate factors associated with BrS and its impact on outcomes. RESULTS Of the 327 included patients, 124 (37,9%) had a BrS on baseline MRI. Mean age was 72 ± 16 years and 184 (56,2 %) were female. In univariate analysis, BrS was associated with a younger age (67 vs 74; p<0.001), a higher NIHSS score (16(10-20) vs 13(8-19); p = 0.047) history of diabetes (15.3% vs 26.1 %; p = 0.022) and a shorter onset to MRI time (145.5 (111.3-188.5) vs 162 (126-220) p = 0.008). In multivariate analyses, patients with a BrS were younger (OR:0.970 (0.951 - 0.989)), tend to have a higher NIHSS score at baseline (OR:1.046 (1.000 - 1.094) and were less likely to have diabetes (OR: 0.433; 0.214-0.879). The presence of BrS was independently associated with functional independence (OR: 2.234(1.158-4,505) at 3 months but not with mortality nor with symptomatic intracerebral hemorrhage. CONCLUSION BrS on pre-treatment imaging could be considered as a biomarker of physiological adaptation to cerebral ischemia, allowing prolonged viability of brain tissue and might participate in the therapeutic decision.
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Affiliation(s)
- Vi Tuan Hua
- Stroke Unit, Reims University Hospital, Reims, France
| | | | | | | | | | | | | | - Solène Moulin
- Stroke Unit, Reims University Hospital, Reims, France.
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Janot K, Boulouis G, Forestier G, Bala F, Cortese J, Szatmáry Z, Bardet SM, Baudouin M, Perrin ML, Mounier J, Couquet C, Yardin C, Segonds G, Dubois N, Martinez A, Lesage PL, Ding YH, Kadirvel R, Dai D, Mounayer C, Terro F, Rouchaud A. WEB shape modifications: angiography-histopathology correlations in rabbits. J Neurointerv Surg 2024; 16:302-307. [PMID: 37192788 DOI: 10.1136/jnis-2023-020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND WEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in rabbits treated with the Woven EndoBridge (WEB) procedure. METHODS Quantitative WSM was assessed using flat-panel computed tomography (FPCT) during follow-up by calculating height and width ratio (HR, WR), defined as the ratio between either measurement at an index time point and the measurement immediately after WEB implantation. The index time point varied from 1 day to 6 months. HR and WR were evaluated with angiographic and histopathological assessments of aneurysm healing. RESULTS Final HR of devices varied from 0.30 to 1.02 and final WR varied from 0.62 to 1.59. Altogether, at least 5% of HR and WR variations were observed in 37/40 (92.5%) and 28/40 (70%) WEB devices, respectively, at the time of final assessment. There was no significant correlation between complete or incomplete occlusion groups and HR or WR (p=0.15 and p=0.43). Histopathological analysis revealed a significant association between WR and aneurysm healing and fibrosis 1 month following aneurysm treatment (both p<0.05). CONCLUSION Using longitudinal FPCT assessment, we observed that WSM affects both the height and width of the WEB device. No significant association was found between WSM and aneurysm occlusion status. Although presumably a multifactorial phenomenon, the histopathological analysis highlighted a significant association between width variations, aneurysm healing and fibrosis in the first month following aneurysm treatment.
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Affiliation(s)
- Kevin Janot
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Géraud Forestier
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Fouzi Bala
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Jonathan Cortese
- NEURI The Brain Vascular Center, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | | | | | | | | | - Jérémy Mounier
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Claude Couquet
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Catherine Yardin
- Histology, Cytology, Cellular Biology and Cytogenetics, University Hospital of Limoges, Limoges, France
| | | | | | | | | | | | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Charbel Mounayer
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Faraj Terro
- Cell Biology, University Hospital of Limoges, Limoges, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
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10
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Zhu F, Kerleroux B, Pruvo JP, Naggara O, Caroff J, Berge J, Alamowitch S, Desal H, Boulouis G. Breaking the glass ceiling for Mechanical Thrombectomy access in France. J Neuroradiol 2024; 51:43-46. [PMID: 38135248 DOI: 10.1016/j.neurad.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Affiliation(s)
- François Zhu
- Imagerie Adaptative Diagnostique et Interventionnelle (IADI), University of Lorraine; INSERM U1254; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Basile Kerleroux
- Department of Neuroradiology, CHU Timone, 264 Rue Saint-Pierre, Marseille, France
| | - Jean Pierre Pruvo
- Neuroradiology Department. Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Lille, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences; INSERM U1266; Université Paris-Cité, Paris, France; Pediatric Radiology Department, APHP Necker-Enfants Malades University Hospital, Université Paris-Cité, Paris, France
| | - Jildaz Caroff
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
| | - Jérôme Berge
- Neuroradiology department, University Hospital, Bordeaux, France
| | - Sonia Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, CIC-IT 1415, CHRU de Tours, INSERM 1253 iBrain, Tours, Centre Val de Loire, France.
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11
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Costalat V, Lapergue B, Albucher JF, Labreuche J, Henon H, Gory B, Sibon I, Boulouis G, Cognard C, Nouri N, Richard S, Marnat G, Di Maria F, Annan M, Duhamel A, Cagnazzo F, Jovin T, Arquizan C. Evaluation of acute mechanical revascularization in large stroke (ASPECTS ⩽5) and large vessel occlusion within 7 h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol. Int J Stroke 2024; 19:114-119. [PMID: 37462028 DOI: 10.1177/17474930231191033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/01/2023]
Abstract
RATIONALE Mechanical thrombectomy (MT), the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO), is generally not offered to patients with large baseline infarct (core). Recent studies demonstrated MT benefit in patients with anterior circulation stroke and large core (i.e. Alberta Stroke Program Early Computed Tomography Score, ASPECTS 3-5). However, its benefit in patients with the largest core (ASPECTS 0-2) remains unproven. AIM To compare the efficacy and safety of MT plus best medical treatment (BMT) and of BMT alone in patients with ASPECTS 0-5 (baseline computed tomography (CT) or magnetic resonance imaging (MRI)) and anterior circulation LVO within 7 h of last-seen-well. SAMPLE SIZE ESTIMATE To detect with a two-sided test at 5% significance level (80% power) a common odds ratio of 1.65 for 1-point reduction in the 90-day modified Rankin Scale (mRS) score in the MT + BMT arm versus BMT arm and to anticipate 10% of patients with missing primary endpoint, 450 patients are planned to be included by 36 centers in France, Spain, and the United States. METHODS AND DESIGN LArge Stroke Therapy Evaluation (LASTE) is an international, multicenter, Prospectively Randomized into two parallel (1:1) arms, Open-label, with Blinded Endpoint (PROBE design) trial. Eligibility criteria are diagnosis of AIS within 6.5 h of last-seen-well (or negative fluid-attenuated inversion recovery (FLAIR) if unknown stroke onset time), ASPECTS 0-5 (ASPECTS 4-5 for ⩾80-year-old patients), and LVO in the anterior circulation (intracranial internal carotid artery (ICA) and M1 or M1-M2 segment of the middle cerebral artery (MCA)). STUDY OUTCOMES The primary endpoint is the day-90 mRS score distribution (shift analysis) with mRS categories 5 and 6 coalesced into one category. Secondary endpoints include day-180 mRS score, rates of 90-day and 180-day mRS score = 0-2 and 0-3, rate of decompressive craniectomy, the National Institutes of Health Stroke Scale (NIHSS) score change, revascularization and infarct volume growth at 24 h, and quality of life at day 90 and 180. Safety outcomes (90-day all-cause mortality, procedural complications, symptomatic intracerebral hemorrhage, and early NIHSS score worsening) are recorded. A dynamic balanced randomization (1:1) is used to distribute eligible patients into the experimental arm and control arm, by incorporating the center and these pre-specified factors: baseline ASPECTS (0-3 vs 4-5), age (⩽70 vs >70 years), baseline NIHSS (<20 vs ⩾20), intravenous thrombolysis (no vs yes), admission mode (Drip-and-Ship vs Mothership), occlusion site (intracranial ICA vs MCA-M1 or M1-M2), intravenous fibrinolysis (no vs yes), and last-seen-well to randomization time (0-4.5 vs >4.5-6.5 h). DISCUSSION The LASTE trial will determine MT efficacy and safety in patients with ASPECTS 0-5 and LVO in the anterior circulation. TRIAL REGISTRATION LASTE Trial NCT03811769.
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Affiliation(s)
- Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | | | - J F Albucher
- Department of Neurology, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Julien Labreuche
- Department of Biostatistics, Lille University Hospital, Lille, France
| | - Hilde Henon
- Department of Neurology, Hôpital Salengro, Lille, France
| | - Benjamin Gory
- Department of Neuroradiology, Hôpital Central, Nancy, France
| | - Igor Sibon
- Department of Neurology, Hôpital Pellegrin, Bordeaux, France
| | | | - Christophe Cognard
- Department of Neuroradiology, Hôpital Pierre-Paul Riquet, Toulouse, France
| | | | | | - Gauthier Marnat
- Department of Neuroradiology, Hôpital Pellegrin, Bordeaux, France
| | | | - Mariam Annan
- Department of Neurology, Hôpital Bretonneau, Tours, France
| | - Alain Duhamel
- Department of Biostatistics, Lille University Hospital, Lille, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Tudor Jovin
- Cooper Neurological Institute, Camden, NJ, USA
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France
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12
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Hoche C, Henderson A, Ifergan H, Gaudron M, Magni C, Maldonado I, Cottier JP, Pasi M, Boulouis G, Cohen C. Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study. AJNR Am J Neuroradiol 2023; 45:30-36. [PMID: 38323978 PMCID: PMC10756568 DOI: 10.3174/ajnr.a8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/29/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND PURPOSE Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome. MATERIALS AND METHODS We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models. RESULTS A total of 197 consecutive patients were included (period 2019-2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16-1.13, P = .047; OR = 1.02, 95% CI, 1.00-1.04, P = .003; OR = 8.92, 95% CI, 0.63-125.77, P = .043). ICE was independently associated with ICH (P = .047), but not with poorer clinical outcome (6-month mRS >2, P = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, P = .002; <.001; .002; <.001; .002; 0.011; <0.001; 0.015). CONCLUSIONS ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood-brain barrier alteration as a major determinant of ICH.
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Affiliation(s)
- Clémence Hoche
- Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France
| | - Alba Henderson
- Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France
| | - Héloïse Ifergan
- From the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France
| | - Marie Gaudron
- Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France
| | - Christophe Magni
- Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France
| | | | - Jean-Philippe Cottier
- From the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France
| | - Marco Pasi
- Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- From the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France
| | - Clara Cohen
- Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France
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13
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Pascarella R, Antonenko K, Boulouis G, De Boysson H, Giannini C, Heldner MR, Kargiotis O, Nguyen TN, Rice CM, Salvarani C, Schmidt-Pogoda A, Strbian D, Hussain S, Zedde M. European Stroke Organisation (ESO) guidelines on Primary Angiitis of the Central Nervous System (PACNS). Eur Stroke J 2023; 8:842-879. [PMID: 37903069 PMCID: PMC10683718 DOI: 10.1177/23969873231190431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 11/01/2023] Open
Abstract
The European Stroke Organisation (ESO) guideline on Primary Angiitis of the Central Nervous System (PACNS), developed according to ESO standard operating procedures (SOP) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, was elaborated to assist clinicians in the diagnostic and treatment pathway of patients with PACNS in their decision making. A working group involving vascular neurologists, neuroradiologists, rheumatologists, a neuropathologist and a methodologist identified 17 relevant clinical questions; these were addressed according to the patient/population, intervention, comparison and outcomes (PICO) framework and systematic literature reviews were performed. Notably, each PICO was addressed with respect to large vessel (LV)-PACNS and small vessel (SV)-PACNS. Data to answer many questions were scarce or lacking and the quality of evidence was very low overall, so, for some PICOs, the recommendations reflect the ongoing uncertainty. When the absence of sufficient evidence precluded recommendations, Expert Consensus Statements were formulated. In some cases, this applied to interventions in the diagnosis and treatment of PACNS which are embedded widely in clinical practice, for example patterns of cerebrospinal fluid (CSF) and Magnetic Resonance Imaging (MRI) abnormalities. CSF analysis for hyperproteinorrachia and pleocytosis does not have evidence supporting their use as diagnostic tools. The working group recommended that caution is employed in the interpretation of non-invasive vascular imaging due to lack of validation and the different sensitivities in comparison with digital subtraction angiography (DSA) and histopathological analyses. Moreover, there is not a neuroimaging pattern specific for PACNS and neurovascular issues are largely underreported in PACNS patients. The group's recommendations on induction and maintenance of treatment and for primary or secondary prevention of vascular events also reflect uncertainty due to lack of evidence. Being uncertain the role and practical usefulness of current diagnostic criteria and being not comparable the main treatment strategies, it is suggested to have a multidisciplinary team approach in an expert center during both work up and management of patients with suspected PACNS. Highlighting the limitations of the currently accepted diagnostic criteria, we hope to facilitate the design of multicenter, prospective clinical studies and trials. A standardization of neuroimaging techniques and reporting to improve the level of evidence underpinning interventions employed in the diagnosis and management of PACNS. We anticipate that this guideline, the first comprehensive European guideline on PACNS management using GRADE methodology, will assist clinicians to choose the most effective management strategy for PACNS.
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Affiliation(s)
- Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Katherina Antonenko
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Grégoire Boulouis
- Neuroradiology - Diagnostic and Interventional Neuroradiology, CIC-IT 1415, INSERM 1253 iBrain, Tours University Hospital, Centre Val de Loire Region, France
| | - Hubert De Boysson
- Service de Médecine Interne, CHU de Caen, Avenue de la Côte de Nacre, Caen, France; Université Caen Normandie, Caen, France
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mirjam R Heldner
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Odysseas Kargiotis
- Stroke Unit, Metropolitan Hospital, Ethnarchou Makariou 9, Piraeus, Greece
| | - Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Claire M Rice
- Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Carlo Salvarani
- Rheumatology, Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Antje Schmidt-Pogoda
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital HUCH, Helsinki, Finland
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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14
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Malka D, Janot K, Pasi M, Desilles JP, Marnat G, Sibon I, Consoli A, Dargazanli C, Arquizan C, Gory B, Richard S, Naggara O, Clarençon F, Rosso C, Bourcier R, Eker O, Caroff J, Lapergue B, Boulouis G. Effects of weather conditions on endovascular treatment case volume for patients with ischemic stroke. J Neuroradiol 2023; 50:593-599. [PMID: 37442271 DOI: 10.1016/j.neurad.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Weather conditions have been shown to influence the occurrence of cardiovascular events. We tested the hypothesis that weather parameters may be associated with variations of case volume of endovascular treatment (EVT) for acute ischemic stroke. METHODS Individual data from the ETIS (Endovascular Treatment in Ischemic Stroke) French national registry were matched to local weather stations. Meteorological parameters (rainfall, humidity, atmospheric pressure, air temperature) were gathered from national online resources. Weather readings and EVT case volumes were annually standardized per weather station and EVT center, and their associations tested with non-parametric univariable and generalized linear statistical models. RESULTS Between 2015 and 2021, 9913 EVT procedures addressed by 135 primary stroke units were matched to weather conditions. The mean daily case volume per center was 0.41 [StDev 0.33], and there was a median of 0.84 procedures daily linked to a weather station [StDev 0.47]. We found lower atmospheric pressure (β estimate -0.04; 95%CI[-0.07;-0.03], p<0.001), higher humidity (β estimate 0.07; 95%CI [0.05;0.09], p<0.001) and lower temperatures (β estimate -0.08; 95%CI[-0.10;-0.06], p<0.001) to be associated with higher standardized EVT daily case volumes. These associations were stable when testing them across strata of binned EVT standardized case volumes. CONCLUSIONS Our study suggests that lower ambient temperature, lower atmospheric pressure, and higher air humidity are associated with significantly more daily EVT cases in a European temperate country. These results may provide insight into both system of care optimization at times of climate change and intracranial LVO pathophysiology. REGISTRATION-URL: https://clinicaltrials.gov/ct2/show/NCT03776877.
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Affiliation(s)
- David Malka
- Diagnostic and Interventional Neuroradiology Department, Tours University Hospital, INSERM UMR 1253 iBrain, 2 Bd Tonnellé, Centre Val de Loire, Tours, France
| | - Kevin Janot
- Diagnostic and Interventional Neuroradiology Department, Tours University Hospital, INSERM UMR 1253 iBrain, 2 Bd Tonnellé, Centre Val de Loire, Tours, France
| | - Marco Pasi
- Stroke Unit, Tours University Hospital, INSERM UMR 1253 iBrain, Tours, Centre Val de Loire, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Arturo Consoli
- Department of Neuroradiology and Stroke Unit, Foch Hospital, Suresnes, France, University of Versailles Saint-Quentin-des-Yvelines, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Caroline Arquizan
- Stroke Unit, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Nancy F-54000, France; IADI, INSERM U1254, Université de Lorraine (B.G.), Nancy F-54000, France
| | - Sébastien Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Nancy F-54000, France; CHRU-Nancy, CIC-P 1433 (S.R.), INSERM U1116, Nancy F-54000, France
| | - Olivier Naggara
- Department of Neuroradiology, INSERM 1266 IMABRAIN, Saint Anne Hospital Centre, Île-de-France, Paris, France
| | | | - Charlotte Rosso
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Inserm U 1127, CNRS UMR 7225, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Paris F-75013, France
| | - Romain Bourcier
- CHU Nantes, CNRS, INSERM, l'institut du thorax, Institut du thorax Nantes Université, 14 Lyon HCL, Nantes F-44000, France
| | - Omer Eker
- Neuroradiolology Department, Hospices Civils de Lyon, Lyon, France
| | - Jildaz Caroff
- Neuroradiolology Department, CHU Kremlin Bicêtre, Paris, France
| | - Bertrand Lapergue
- Department of Neuroradiology and Stroke Unit, Foch Hospital, Suresnes, France, University of Versailles Saint-Quentin-des-Yvelines, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, Tours University Hospital, INSERM UMR 1253 iBrain, 2 Bd Tonnellé, Centre Val de Loire, Tours, France.
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15
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Picherit A, Kerleroux DB, Forestier G, Marnat G, Boutet C, Ifergan H, Hak JF, Guedon A, Lecler A, Heck O, Paya C, Burel J, Masy M, Lauvin MA, Rodallec M, Eugene F, Zhu F, Pop R, Boucebci S, Soize S, Boulouis G, Bourcier R. "National survey for preliminary evaluation of neuroradiological protocols in patients with infective endocarditis". J Neuroradiol 2023; 50:548-555. [PMID: 36858150 DOI: 10.1016/j.neurad.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The aim of this study was to identify imaging protocols in patients with infective endocarditis through a nationwide survey. METHODS An electronic evolutionary survey was sent to interventional Neuroradiologists among neuroradiological centers, under the aegis of the Société Française de Neuroradiologie. Among 33 contacted centers, 25 completed the survey (21 universitary hospitals and 4 peripheric hospitals). RESULTS Most of the centers (88%) used systematic imaging screening in IE patients. MRI was the first imaging method used in 66% of cases, while CT was used in 44%. When no IIA was detectable in CT-scan screening, 6 (54,54%) stopped investigations, while 9 (81,81%) continued with MRI exploration in case of hemorrhage, ischemia or enhancement. Sulcal hemorrhage on MRI was an indication of complementary DSA in 25 centers (100%). Regarding IIA characterization, 12 centers (48%) used systematic DSA, whereas for 10 centers (40%), DSA was conditioned by hemorrhage or patient status. CONCLUSION We highlighted large variations in Neuroimaging exploration and follow-up of IE patients in real-world practices. Expert guidelines able to standardize practices are warranted to improve the management of this serious and often misdiagnosed pathology.
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Affiliation(s)
| | | | - Géraud Forestier
- department of Neuroradiology, University Hospital of Limoges (France)
| | - Gaultier Marnat
- department of Neuroradiology, University Hospital of Bordeaux (France)
| | - Claire Boutet
- department of Neuroradiology, University Hospital of Saint-Etienne (France)
| | - Héloïse Ifergan
- department of Neuroradiology, University Hospital of Tours (France)
| | - Jean-François Hak
- department of Neuroradiology, University Hospital of Marseilles (France)
| | - Alexis Guedon
- department of Neuroradiology, Lariboisière Hospital, Paris (France)
| | - Augustin Lecler
- department of Neuroradiology, Hospital Fondation Rothschild, Paris (France)
| | - Olivier Heck
- department of Neuroradiology, University Hospital of Grenoble (France)
| | - Christophe Paya
- department of Neuroradiology, University Hospital of Reunion Island (France)
| | - Julien Burel
- department of Neuroradiology, University Hospital of Rouen (France)
| | - Matthieu Masy
- department of Neuroradiology, Hospital of Valencienne (France)
| | | | - Mathieu Rodallec
- department of Cardiology, Centre Cardiologique du Nord, Saint-Denis (France)
| | - Francois Eugene
- department of Neuroradiology, University Hospital of Rennes (France)
| | - François Zhu
- department of Neuroradiology, University Hospital of Nancy (France)
| | - Raoul Pop
- department of Neuroradiology, University Hospital of Strasbourg (France)
| | - Samy Boucebci
- department of Neuroradiology, University Hospital of Poitiers (France)
| | - Sébastien Soize
- U department of Neuroradiology, niversity Hospital of Reims (France)
| | | | - Romain Bourcier
- department of Neuroradiology, University Hospital of Nantes (France).
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16
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Nehme A, Arquizan C, Régent A, Isabel C, Dequatre N, Guillon B, Capron J, Detante O, Lanthier S, Poppe AY, Boulouis G, Godard S, Terrier B, Pagnoux C, Aouba A, Touzé E, de Boysson H. Comparison of patients with biopsy positive and negative primary angiitis of the central nervous system. Rheumatology (Oxford) 2023:kead542. [PMID: 37802919 DOI: 10.1093/rheumatology/kead542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE There is limited evidence on when to obtain a central nervous system (CNS) biopsy in suspected primary angiitis of the central nervous system (PACNS). Our objective was to identify which clinical and radiological characteristics were associated with a positive biopsy in PACNS. METHODS From the multicenter retrospective Cohort of Patients with Primary Vasculitis of the CNS (COVAC), we included adults with PACNS based on a positive CNS biopsy or otherwise unexplained intracranial stenoses with additional findings supportive of vasculitis. Baseline findings were compared between patients with a positive and negative biopsy using logistic regression models. RESULTS 200 patients with PACNS were included, among which a biopsy was obtained in 100 (50%) and was positive in 61 (31%). Patients with a positive biopsy were more frequently female (OR 2.90, 95% CI 1.25-7.10, p = 0.01) and more often presented with seizures (OR 8.31, 95% CI 2.77-33.04, p < 0.001) or cognitive impairment (OR 2.58, 95% CI 1.11-6.10, p = 0.03). On imaging, biopsy positive patients more often had non-ischemic parenchymal or leptomeningeal gadolinium enhancement (OR 52.80, 95% CI 15.72-233.06, p < 0.001) or ≥ 1 cerebral microbleed (OR 8.08, 95% CI 3.03-25.13, p < 0.001), and less often had ≥ 1 acute brain infarct (OR 0.02, 95% CI 0.004-0.08, p < 0.001). In the multivariable model, non-ischemic parenchymal or leptomeningeal gadolinium enhancement (aOR 8.27, 95% CI 1.78-38.46), p < 0.01) and absence of ≥ 1 acute brain infarct (aOR 0.13, 95% CI 0.03-0.65, p = 0.01) were significantly associated with a positive biopsy. CONCLUSIONS Baseline clinical and radiological characteristics differed between biopsy positive and negative PACNS. These results may help physicians individualize the decision to obtain a CNS biopsy in suspected PACNS.
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Affiliation(s)
- Ahmad Nehme
- Neurology, Université Caen-Normandie, CHU Caen-Normandie, Caen, France
| | | | - Alexis Régent
- Internal Medicine, Université Paris-Cité, Hôpital Cochin, AP-HP, Paris, France
| | | | | | | | - Jean Capron
- Neurology, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Olivier Detante
- Université Grenoble Alpes, INSERM, U1216, Neurology, CHU Grenoble Alpes, Grenoble Institute Neurosciences, Grenoble, France
| | | | - Alexandre Y Poppe
- Neurology, Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | | | | - Benjamin Terrier
- Internal Medicine, Université Paris-Cité, Hôpital Cochin, AP-HP, Paris, France
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Achille Aouba
- Université Caen-Normandie, Internal Medicine, CHU Caen-Normandie, Caen, France
| | - Emmanuel Touzé
- Neurology, Université Caen-Normandie, CHU Caen-Normandie, Caen, France
| | - Hubert de Boysson
- Université Caen-Normandie, Internal Medicine, CHU Caen-Normandie, Caen, France
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17
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Guetarni Z, Bernard R, Boulouis G, Labeyrie MA, Biondi A, Velasco S, Saliou G, Bartolini B, Daumas-Duport B, Bourcier R, Janot K, Herbreteau D, Michelozzi C, Premat K, Redjem H, Escalard S, Bricout N, Thouant P, Arteaga C, Pierot L, Tahon F, Boubagra K, Ikka L, Chabert E, Lenck S, Guédon A, Consoli A, Saleme S, Forestier G, Di Maria F, Ferré JC, Anxionnat R, Eugene F, Kerleroux B, Dargazanli C, Sourour NA, Clarençon F, Shotar E. Longitudinal radiological follow-up of individual level non-ischemic cerebral enhancing lesions following endovascular aneurysm treatment. J Neurointerv Surg 2023:jnis-2023-020060. [PMID: 37770183 DOI: 10.1136/jnis-2023-020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/07/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Non-ischemic cerebral enhancing (NICE) lesions following aneurysm endovascular therapy are exceptionally rare, with unknown longitudinal evolution. OBJECTIVE To evaluate the radiological behavior of individual NICE lesions over time. METHODS Patients included in a retrospective national multicentric inception cohort were analyzed. NICE lesions were defined, using MRI, as delayed onset punctate, nodular, or annular foci enhancements with peri-lesion edema, distributed in the vascular territory of the aneurysm treatment, with no other confounding disease. Lesion burden and the longitudinal behavior of individual lesions were assessed. RESULTS Twenty-two patients were included, with a median initial lesion burden of 36 (IQR 17-54) on the first MRI scan. Of the 22 patients with at least one follow-up MRI scan, 16 (73%) had new lesions occurring mainly within the first 200 weeks after the date of the procedure. The median number of new lesions per MRI was 6 (IQR 2-16). Among the same 22 patients, 7 (32%) had recurrent lesions. The median persistent enhancement of a NICE lesion was 13 weeks (IQR 6-30). No factor was predictive of early regression of enhancement activity with lesion regression kinetics mainly being patient-dependent. CONCLUSIONS The behavior of individual NICE lesions was found to be highly variable with an overall patient-dependent regression velocity.
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Affiliation(s)
- Zakaria Guetarni
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Remy Bernard
- Department of Neurosurgical Anesthesiology and Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Grégoire Boulouis
- Department of Interventional Neuroradiology, CHU de Tours, Tours, France
| | | | - Alessandra Biondi
- Department of Interventional Neuroradiology, Besançon University Hospital, Besancon, France
| | - Stéphane Velasco
- Department of Interventional Neuroradiology, CHU de Poitiers, Poitiers, France
| | - Guillaume Saliou
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Bruno Bartolini
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Benjamin Daumas-Duport
- Department of Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Romain Bourcier
- Department of Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Kevin Janot
- Department of Interventional Neuroradiology, CHU de Tours, Tours, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, CHU de Tours, Tours, France
| | - Caterina Michelozzi
- Department of Interventional Neuroradiology, Michallon Hospital, La Tronche, France
| | - Kevin Premat
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Simon Escalard
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Nicolas Bricout
- Department of interventional Neuroradiology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Thouant
- Department of Neuroradiology, F Mitterand Hospital, Dijon, France
| | - Charles Arteaga
- Radiology Department, Hôpital d'Instruction des Armées Sainte-Anne Bibliothèque, Toulon, Provence-Alpes-Côte d'Azu, France
| | - Laurent Pierot
- Department of Interventional Neuroradiology, University Hospital Reims, Reims, France
| | - Florence Tahon
- Department of Neuroradiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Kamel Boubagra
- Department of Neuroradiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Leon Ikka
- Department of Interventional Neuroradiology, Bicetre Hospital, Le Kremlin Bicetre, France
| | - Emmanuel Chabert
- Department of Neuroradiology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Stephanie Lenck
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexis Guédon
- Department of Interventional Neuroradiology, Hopital Lariboisiere, Paris, France
| | - Arturo Consoli
- Diagnostic and Therapeutic Neuroradiology Department, Hopital Foch, Suresnes, Île-de-France, France
| | - Suzana Saleme
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Géraud Forestier
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Federico Di Maria
- Diagnostic and Therapeutic Neuroradiology Department, Hopital Foch, Suresnes, Île-de-France, France
| | | | - René Anxionnat
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Francois Eugene
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Basile Kerleroux
- Department of Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Nader-Antoine Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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18
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Bilgin C, Ibrahim M, Azzam AY, Ghozy S, Elswedy A, Kobeissi H, Sobhi Jabal M, Kadirvel R, Boulouis G, Naggara O, Fiehler J, Psychogios M, Lee S, Wildgruber M, Kemmling A, Al-Mufti F, Kossorotoff M, Sporns PB, Kallmes DF. Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:635-644. [PMID: 36592199 DOI: 10.1007/s00062-022-01246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke. PURPOSE To investigate the efficacy and safety of MT in pediatric LVO. METHODS A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI). RESULTS In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%). CONCLUSION In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | | | - Ahmed Y Azzam
- Faculty of Medicine, October 6 University, 6th of October City, Egypt
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam Elswedy
- Uppsala University Faculty of Medicine, Uppsala, Sweden
| | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA
| | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Grégoire Boulouis
- Department of Neuroradiology, Université de Tours, CHRU Bretonneau, Tours, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris City, INSERM U1266, GHU Paris, Sainte-Anne Hospital, Paris, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Stanford Stroke Center, Stanford University, Palo Alto, CA, USA
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Valhalla, NY, USA
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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19
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Orly J, Bisdorff A, Fraissenon A, Joly A, Boulouis G, Guibaud L, Tavernier E, Mallet S, Marcelin C, Miquel J, Martin L, Droitcourt C, Gusdorf L, Abasq C, Dadban A, Chiaverini C, Vabres P, Herbreteau D, Boccara O, Wassef M, Maruani A. Intramuscular capillary-type hemangioma: Diagnosis, treatment, and outcomes. A French multicentric retrospective study of 66 cases. Eur J Radiol 2023; 165:110962. [PMID: 37423018 DOI: 10.1016/j.ejrad.2023.110962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Intramuscular capillary-type hemangiomas (ICTHs) are rare entities, belonging to the group of intramuscular "hemangiomas." The diagnosis remains challenging. We aimed to assess the diagnostic criteria, treatments and outcomes of ICTHs. METHODS This retrospective study collected all cases of ICTH followed up in 9 French hospital centers, reviewed by an adjudication expert group. RESULTS Among 133 patients screened, 66 with ICTH were included. The median age of patients at diagnosis was 28.0 years, interquartile range (21.0---36.0). The lesion, mainly presenting as a gradually increasing mass (83.9%), was painless (88.9%) and was located in the head and neck (42.4%). MRI (available in all cases) mainly revealed a well-delineated lesion, isointense to the muscle on T1-weighted images, with enhancement after contrast injection; hyperintense on T2-weighted images; and containing flow voids. Among the 66 cases, 59 exhibited typical ICTH features and 7 shared some imaging features with arteriovenous malformations. These latter were larger than typical ICTHs and more painful and appeared on imaging as less well delimited and more heterogeneous tissue masses, with larger tortuous afferent arteries, earlier draining vein opacification and mild arteriovenous shunting. We propose to name these lesions arteriovenous malformation (AVM)-like ICTH. Pathological reports were similar in typical and AVM-like ICTH, showing capillary proliferation with mainly small-size vessels, negative for GLUT-1 and positive for ERG, AML, CD31 and CD34, with low Ki67 proliferation index (<10%), and adipose tissue. The most frequent treatment for ICTH was complete surgical resection (17/47, 36.2%), preceded in some cases by embolization, which led to complete remission. CONCLUSIONS ICTH can be diagnosed on MRI when it is typical. Biopsy or angiography are required for atypical forms.
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Affiliation(s)
- Jordan Orly
- CHRU Tours, Department of Dermatology, Unit of Pediatric Dermatology, Tours, France; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France
| | - Annouk Bisdorff
- Reference Center for Vascular Anomalies FAVA-multi, University Hospital of Lariboisière, Coordinator of the Constitutive Center for Superficial Arteriovenous Malformations in Children and Adults, AP-HP, Department of Neuroradiology, Paris, France
| | - Antoine Fraissenon
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France; Service de Radiologie Mère-Enfant, Hôpital Nord, Saint-Etienne, France; CREATIS, UMR 5220, U1294 Lyon, France
| | - Aline Joly
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Maxillo-facial Surgery, Tours, France
| | - Grégoire Boulouis
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Neuroradiology and Interventional Radiology, Tours, France
| | - Laurent Guibaud
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France; CHRU Tours, Clinical Investigation Center INSERM 1415, Tours, France
| | - Stéphanie Mallet
- University Hospital Center of Marseille, Department of Dermatology, Marseille, France
| | - Clément Marcelin
- University Hospital Center of Bordeaux, Department of Radiology, Bordeaux, France
| | - Juliette Miquel
- University Hospital Center of La Réunion, Department of Pediatric Dermatology, Saint-Pierre, La Réunion, France
| | - Ludovic Martin
- University Hospital Center of Angers, Department of Dermatology, Angers, France
| | | | - Laurence Gusdorf
- University Hospital Center of Reims, Department of Dermatology, Reims, France
| | - Claire Abasq
- University Hospital Center of Brest, Department of Dermatology, Brest, France
| | - Ali Dadban
- University Hospital Center of Amiens, Department of Dermatology, Amiens, France
| | | | - Pierre Vabres
- University of Bourgogne, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Dijon, France
| | - Denis Herbreteau
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Neuroradiology and Interventional Radiology, Tours, France
| | - Olivia Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Necker), University Hospital Necker-Enfants Malades, Paris, France
| | - Michel Wassef
- University Hospital of Lariboisière, AP-HP, Department of Pathology, Paris, France
| | - Annabel Maruani
- CHRU Tours, Department of Dermatology, Unit of Pediatric Dermatology, Tours, France; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France.
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20
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Janot K, Charbonnier G, Marnat G, Sporns P, Burel J, Papagiannaki C, Forestier G, Hak JF, Agripnidis T, Bolognini F, Lebedinsky PA, Ifergan H, Bibi R, Herbreteau D, Adeniran Bankole ND, Biondi A, Barreau X, Guédon A, Shotar E, Clarençon F, Kerleroux B, Boulouis G, Bala F, Rouchaud A. Persistent flow inside the Woven EndoBridge at angiographic follow-up: A multicenter study. Interv Neuroradiol 2023:15910199231185805. [PMID: 37403459 DOI: 10.1177/15910199231185805] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The occurrence of persistent intra-device filling (BOSS 1, using the Bicêtre Occlusion Scale Score (BOSS)) in aneurysms treated with a Woven Endobridge (WEB) device is infrequent based on angiographic follow-up. To date, three monocentric case series were published studying BOSS 1 cases. Through a multicenter retrospective study, we aimed to report the incidence, and risk factors of intra-WEB persistent filling. METHODS We reached out to European academic centers that treat patients using WEB devices and requested de-identified data of patients treated with a WEB device and underwent angiographic follow-up, at least 3 months after embolization, to assess the BOSS 1 occlusion score. We compared baseline characteristics, treatment modalities, and aneurysm data of the included BOSS 1 patients with those of a control group consisting of non-BOSS 1 patients (n = 116) who had an available angiographic follow-up. Univariable and multivariable models were employed for analysis. RESULTS Among the pooled sample of 591 aneurysms treated with WEB, the rate of persistent flow (BOSS 1) at angiographic follow-up was 5.2% (n = 31 out of 591), performed after an average of 8.7 ± 6.3 months. In the multivariable-adjusted analysis, dual antiplatelet therapy in the postoperative period (adjusted odds ratio [aOR] 4.3 [95% CI 1.3-14.2]), and WEB undersizing (aOR 10.8 [95% CI 2.9-40]) were independently associated with a BOSS 1 persistent flow result. CONCLUSION Persistent blood flow within the WEB device during angiographic follow-up (BOSS 1) is an uncommon occurrence. Our findings indicate that post-procedural dual antiplatelet therapy and undersizing of the WEB device are independently associated with the presence of BOSS 1 at follow-up.
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Affiliation(s)
- Kevin Janot
- Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Guillaume Charbonnier
- Interventional Neuroradiology Department, University Hospital of Besançon, Besançon, France
| | - Gaultier Marnat
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Peter Sporns
- Interventional Neuroradiology Department, University Hospital of Basel, Basel, Switzerland
- Interventional Neuroradiology Department, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Julien Burel
- Interventional Neuroradiology Department, University Hospital of Rouen, Rouen, France
| | | | - Geraud Forestier
- Interventional Neuroradiology Department, University Hospital of Limoges, Limoges, France
| | - Jean-Francois Hak
- Interventional Neuroradiology Department, University Hospital of Marseille, Marseille, France
| | - Thibault Agripnidis
- Interventional Neuroradiology Department, University Hospital of Marseille, Marseille, France
| | | | | | - Heloise Ifergan
- Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Richard Bibi
- Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Denis Herbreteau
- Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | | | - Alessandra Biondi
- Interventional Neuroradiology Department, University Hospital of Besançon, Besançon, France
| | - Xavier Barreau
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Alexis Guédon
- Interventional Neuroradiology Department, Lariboisière Hospital, Paris, France
| | - Eimad Shotar
- Neuroradiology Department, Pitié Salpêtrière Hospital, Paris, France
| | | | - Basile Kerleroux
- Interventional Neuroradiology Department, Saint Anne Hospital, Paris, France
| | - Grégoire Boulouis
- Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Fouzi Bala
- Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology Department, University Hospital of Limoges, Limoges, France
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21
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Scopelliti G, Benzakoun J, Ben Hassen W, Bretzner M, Bricout N, Puy L, Turc G, Boulouis G, Oppenheim C, Naggara O, Cordonnier C, Henon H, Pasi M. Diffusion-Weighted Imaging Lesion Reversal in Older Patients With Stroke Treated With Mechanical Thrombectomy. Stroke 2023. [PMID: 37203564 DOI: 10.1161/strokeaha.123.042491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Diffusion-weighted imaging lesion reversal (DWIR) is frequently observed after mechanical thrombectomy for acute ischemic stroke, but little is known about age-related differences and impact on outcome. We aimed to compare, in patients <80 versus ≥80 years old, (1) the effect of successful recanalization on DWIR and (2) the impact of DWIR on functional outcome. METHODS We retrospectively analyzed data of patients treated for an anterior circulation acute ischemic stroke with large vessel occlusion in 2 French hospitals, who underwent baseline and 24-hour follow-up magnetic resonance imaging, with baseline DWI lesion volume ≥10 cc. The percentage of DWIR (DWIR%), was calculated as follows: DWIR%=(DWIR volume/baseline DWI volume)×100. Data on demographics, medical history, and baseline clinical and radiological characteristics were collected. RESULTS Among 433 included patients (median age, 68 years), median DWIR% after mechanical thrombectomy was 22% (6-35) in patients ≥80, and 19% (interquartile range, 10-34) in patients <80 (P=0.948). In multivariable analyses, successful recanalization after mechanical thrombectomy was associated with higher median DWIR% in both ≥80 (P=0.004) and <80 (P=0.002) patients. In subgroup analyses performed on a minority of subjects, collateral vessels status score (n=87) and white matter hyperintensity volume (n=131) were not associated with DWIR% (P>0.2). In multivariable analyses, DWIR% was associated with increased rates of favorable 3-month outcomes in both ≥80 (P=0.003) and <80 (P=0.013) patients; the effect of DWIR% on outcome was not influenced by the age group (P interaction=0.185) Conclusions: DWIR might be an important and nonage-dependent effect of arterial recanalization, as it seems to beneficially impact 3-month outcomes of both younger and older subjects treated with mechanical thrombectomy for acute ischemic stroke and large vessel occlusion.
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Affiliation(s)
- Giuseppe Scopelliti
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Joseph Benzakoun
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Wagih Ben Hassen
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Martin Bretzner
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, France (M.B., N.B.)
| | - Nicolas Bricout
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, France (M.B., N.B.)
| | - Laurent Puy
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (G.T.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Centre Val de Loire, INSERM U1253 iBrain, France (G.B.)
| | - Catherine Oppenheim
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Olivier Naggara
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
- Neurology Department, University Hospital of Tours, Centre Val de Loire Region, France (M.P.)
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22
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Hanning U, Bechstein M, Kaesmacher J, Boulouis G, Chapot R, Andersson T, Boccardi E, Psychogios M, Cognard C, de Dios Lascuevas M, Rodrigues M, Rodriguez Caamaño I, Gargalas S, Simonato D, Zupancic V, Daller C, Meyer L, Broocks G, Guerreiro H, Fiehler J, Martínez-Galdamez M, Kalousek V. Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program. Clin Neuroradiol 2023; 33:137-145. [PMID: 35829740 PMCID: PMC9277595 DOI: 10.1007/s00062-022-01192-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. METHODS During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. RESULTS A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). CONCLUSION Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.
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Affiliation(s)
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kaesmacher
- Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, Institut national de la santé et de la recherche médicale (INSERM) Team 1253 iBrain, Tours University Hospital, Tours, Centre Val de Loire Region, France
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Edoardo Boccardi
- Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Marios Psychogios
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Christophe Cognard
- Neuroradiology Department, Pierre-Paul-Riquet/Purpan University Hospital, Toulouse, France
| | | | - Marta Rodrigues
- Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Sergios Gargalas
- Diagnostic and Interventional Neuroradiology Department, John Radcliffe Hospital, Oxford, UK
| | - Davide Simonato
- Interventional Neuroradiology Department, University Hospital of Padua, Padua, Italy
| | - Vedran Zupancic
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Cornelia Daller
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Mario Martínez-Galdamez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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23
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Legrand L, Le Berre A, Seners P, Benzakoun J, Ben Hassen W, Lion S, Boulouis G, Cottier JP, Costalat V, Bracard S, Berthezene Y, Ozsancak C, Provost C, Naggara O, Baron JC, Turc G, Oppenheim C. FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters. AJNR Am J Neuroradiol 2023; 44:26-32. [PMID: 36521962 PMCID: PMC9835925 DOI: 10.3174/ajnr.a7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.
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Affiliation(s)
- L Legrand
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - A Le Berre
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - P Seners
- Department of Neurology (P.S.), Hôpital Fondation Rothschild, Paris, France
| | - J Benzakoun
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - W Ben Hassen
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - S Lion
- Edmus Services (S.L.), Fondation Edmus, Lyon, France
| | - G Boulouis
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - J-P Cottier
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - V Costalat
- Department of Interventional Neuroradiology (V.C.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S Bracard
- Department of Diagnostic and Interventional Neuroradiology (S.B.), University Hospital of Nancy, Institut National de la Santé et de la Recherche Médicale U947, Nancy, France
| | - Y Berthezene
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Lyon, France
| | - C Ozsancak
- Department of Neurology (C. Ozsancak), Orleans Hospital, Orleans, France
| | - C Provost
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - O Naggara
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - J-C Baron
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - G Turc
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - C Oppenheim
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
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24
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Raymond J, Gentric JC, Magro E, Nico L, Bacchus E, Klink R, Cognard C, Januel AC, Sabatier JF, Iancu D, Weill A, Roy D, Bojanowski MW, Chaalala C, Barreau X, Jecko V, Papagiannaki C, Derrey S, Shotar E, Cornu P, Eker OF, Pelissou-Guyotat I, Piotin M, Aldea S, Beaujeux R, Proust F, Anxionnat R, Costalat V, Corre ML, Gauvrit JY, Morandi X, Brunel H, Roche PH, Graillon T, Chabert E, Herbreteau D, Desal H, Trystram D, Barbier C, Gaberel T, Nguyen TN, Viard G, Gevry G, Darsaut TE, _ _, _ _, Raymond J, Roy D, Weill A, Iancu D, Bojanowski MW, Chaalala C, Darsaut TE, O’Kelly CJ, Chow MMC, Findlay JM, Rempel JL, Fahed R, Lesiuk H, Drake B, Santos MD, Gentric JC, Nonent M, Ognard J, El-Aouni MC, Magro E, Seizeur R, Timsit S, Pradier O, Desal H, Boursier R, Thillays F, Roualdes V, Piotin M, Blanc R, Aldea S, Cognard C, Januel AC, Sabatier JF, Calviere L, Gauvrit JY, Raoult H, Eugene F, Bras AL, Ferre JC, Paya C, Morandi X, Lecouillard I, Nouhaud E, Ronziere T, Trystram D, Naggara O, Rodriguez-Regent C, Kerleroux B, Barbier C, Gaberel T, Emery E, Touze E, Papagiannaki C, Derrey S, Eker OF, Riva R, Pellisou-Guyotat I, Guyotat J, Berhouma M, Dumot C, Biondi A, Thines L, Bougaci N, Charbonnier G, Bracard S, Anxionnat R, Gory B, Civit T, Bernier-Chastagner V, Barreau X, Marnat G, Jecko V, Penchet G, Gimbert E, Huchet A, Herbreteau D, Boulouis G, Bibi R, Ifergan H, Janot K, Velut S, Brunel H, Roche PH, Graillon T, Peyriere H, Kaya JM, Touta A, Troude L, Boissonneau S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Boch AL, Cornu P, Nouet A, Costalat V, Bonafe A, Dargazanli C, Gascou G, Lefevre PH, Riquelme C, Corre ML, Beaujeux R, Pop R, Proust F, Cebula H, Ollivier I, Spatola G, Spell L, Chalumeau V, Gallas S, Ikka L, Mihalea C, Ozanne A, Caroff J, Chabert E, Mounayer C, Rouchaud A, Caire F, Ricolfi F, Thouant P, Cao C, Mourier KL, Farah W, Nguyen TN, Abdalkader M, Huynh T, Tawk RG, Carlson AP, Silva LAO, Froio NDL, Silva GS, Mont’Alverne FJA, Martins JL, Mendes GN, Miranda RR. Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2022; 138:1393-1402. [PMID: 37132535 DOI: 10.3171/2022.9.jns22987] [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: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study that comprises two randomized trials and multiple registries.
METHODS
Results from the TOBAS curative and pre-embolization registries are reported. The primary outcome for this report is death or dependency (modified Rankin Scale [mRS] score > 2) at last follow-up. Secondary outcomes include angiographic results, perioperative serious adverse events (SAEs), and permanent treatment-related complications leading to an mRS score > 2.
RESULTS
From June 2014 to May 2021, 1010 patients were recruited in TOBAS. Embolization was chosen as the primary curative treatment for 116 patients and pre-embolization prior to surgery or SRS for 92 patients. Clinical and angiographic outcomes were available in 106 (91%) of 116 and 77 (84%) of 92 patients, respectively. In the curative embolization registry, 70% of AVMs were ruptured, and 62% were low-grade AVMs (Spetzler-Martin grade I or II), while the pre-embolization registry had 70% ruptured AVMs and 58% low-grade AVMs. The primary outcome of death or disability (mRS score > 2) occurred in 15 (14%, 95% CI 8%–22%) of the 106 patients in the curative embolization registry (4 [12%, 95% CI 5%–28%] of 32 unruptured AVMs and 11 [15%, 95% CI 8%–25%] of 74 ruptured AVMs) and 9 (12%, 95% CI 6%–21%) of the 77 patients in the pre-embolization registry (4 [17%, 95% CI 7%–37%] of 23 unruptured AVMs and 5 [9%, 95% CI 4%–20%] of 54 ruptured AVMs) at 2 years. Embolization alone was confirmed to occlude the AVM in 32 (30%, 95% CI 21%–40%) of the 106 curative attempts and in 9 (12%, 95% CI 6%–21%) of 77 patients in the pre-embolization registry. SAEs occurred in 28 of the 106 attempted curative patients (26%, 95% CI 18%–35%, including 21 new symptomatic hemorrhages [20%, 95% CI 13%–29%]). Five of the new hemorrhages were in previously unruptured AVMs (n = 32; 16%, 95% CI 5%–33%). Of the 77 pre-embolization patients, 18 had SAEs (23%, 95% CI 15%–34%), including 12 new symptomatic hemorrhages [16%, 95% CI 9%–26%]). Three of the hemorrhages were in previously unruptured AVMs (3/23; 13%, 95% CI 3%–34%).
CONCLUSIONS
Embolization as a curative treatment for brain AVMs was often incomplete. Hemorrhagic complications were frequent, even when the specified intent was pre-embolization before surgery or SRS. Because the role of endovascular treatment remains uncertain, it should preferably, when possible, be offered in the context of a randomized trial.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | - Elsa Magro
- Department of Neurosurgery, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | - Lorena Nico
- Department of Radiology, CHU Saint-Etienne, France
| | - Emma Bacchus
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ruby Klink
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | | | - Jean-François Sabatier
- Neurosurgery, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Daniela Iancu
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Alain Weill
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Michel W. Bojanowski
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Chiraz Chaalala
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Xavier Barreau
- Neuroradiology Department, Pellegrin Hospital Group, CHU Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, Pellegrin Hospital Group, CHU Bordeaux, France
| | | | - Stéphane Derrey
- Neurosurgery, Charles Nicolle Hospital, Rouen Normandy University Hospital, Rouen, France
| | | | - Philippe Cornu
- Neurosurgery, Mercy Salpetriere Hospital AP-HP, Paris, France
| | | | | | | | - Sorin Aldea
- Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | | | - François Proust
- Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - René Anxionnat
- Interventional Neuroradiology Department, University of Lorraine, Laboratory IADI INSERM U1254, CHRU Nancy, France
| | | | | | | | | | - Hervé Brunel
- Departments of Interventional Neuroradiology and
| | | | | | - Emmanuel Chabert
- Interventional Neuroradiology Department, CHU Clermont-Ferrand, France
| | - Denis Herbreteau
- Interventional Neuroradiology Department, Bretonneau Hospital, Tours, France
| | - Hubert Desal
- Interventional Neuroradiology Department, CHU de Nantes, France
| | - Denis Trystram
- Interventional Neuroradiology Department, University of Paris, INSERM U1266, IPNP, GHU Paris, France
- Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | | | | | - Thanh N. Nguyen
- Departments of Radiology,
- Neurology, and
- Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and
| | | | - Guylaine Gevry
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Tim E. Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Boisseau W, Darsaut TE, Fahed R, Findlay JM, Bourcier R, Charbonnier G, Smajda S, Ognard J, Roy D, Gariel F, Carlson AP, Shotar E, Ciccio G, Marnat G, Sporns PB, Gaberel T, Jecko V, Weill A, Biondi A, Boulouis G, Bras AL, Aldea S, Passeri T, Boissonneau S, Bougaci N, Gentric JC, Diestro JDB, Omar AT, Al-Jehani HM, Hage GE, Volders D, Kaderali Z, Tsogkas I, Magro E, Holay Q, Zehr J, Iancu D, Raymond J. Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study. AJNR Am J Neuroradiol 2022; 43:1437-1444. [PMID: 36137654 PMCID: PMC9575541 DOI: 10.3174/ajnr.a7648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE MCA aneurysms are still commonly clipped surgically despite the recent development of a number of endovascular tools and techniques. We measured clinical uncertainty by studying the reliability of decisions made for patients with middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS A portfolio of 60 MCA aneurysms was presented to surgical and endovascular specialists who were asked whether they considered surgery or endovascular treatment to be an option, whether they would consider recruitment of the patient in a randomized trial, and whether they would provide their final management recommendation. Agreement was studied using κ statistics. Intrarater reliability was assessed with the same, permuted portfolio of cases of MCA aneurysm sent to the same specialists 1 month later. RESULTS Surgical management was the preferred option for neurosurgeons (n = 844/1320; [64%] responses/22 raters), while endovascular treatment was more commonly chosen by interventional neuroradiologists (1149/1500 [76.6%] responses/25 raters). Interrater agreement was only "slight" for all cases and all judges (κ = 0.094; 95% CI, 0.068-0.130). Agreement was no better within specialties or with more experience. On delayed requestioning, 11 of 35 raters (31%) disagreed with themselves on at least 20% of cases. Surgical management and endovascular treatment were always judged to be a treatment option, for all patients. Trial participation was offered to patients 65% of the time. CONCLUSIONS Individual clinicians did not agree regarding the best management of patients with MCA aneurysms. A randomized trial comparing endovascular with surgical management of patients with MCA aneurysms is in order.
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Affiliation(s)
- W Boisseau
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - T E Darsaut
- Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Fahed
- Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - J M Findlay
- Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - G Charbonnier
- Departments of Interventional Neuroradiology (G. Charbonnier, A.B.)
| | - S Smajda
- Departments of Interventional Neuroradiology (S.S.)
| | - J Ognard
- Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - D Roy
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - F Gariel
- Departments of Neuroradiology (F.G., G.M.)
| | - A P Carlson
- Department of Neurosurgery (A.P.C.), University of New Mexico Hospital, Albuquerque, New Mexico
| | - E Shotar
- Department of Neuroradiology (E.S.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France
| | - G Ciccio
- Department of Interventional Neuroradiology (G. Ciccio), Centre Hospitalier de Bastia, Bastia, Corse, France
| | - G Marnat
- Departments of Neuroradiology (F.G., G.M.)
| | - P B Sporns
- Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology (P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Gaberel
- Department of Neurosurgery (T.G.), University Hospital of Caen, Caen, France
| | - V Jecko
- Neurosurgery (V.J.), University Hospital of Bordeaux, Bordeaux, France
| | - A Weill
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - A Biondi
- Departments of Interventional Neuroradiology (G. Charbonnier, A.B.)
| | - G Boulouis
- Department of Neuroradiology (G.B.), University Hospital of Tours, Tours, Indre et Loire, France
| | - A L Bras
- Department of Radiology (A.L.B.), Groupement Hospitaliser Bretagne Atlantique-Hôpital Chubert, Vannes, Bretagne, France
| | - S Aldea
- Neurosurgery (S.A.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - T Passeri
- Department of Neurosurgery (T.P.), Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - S Boissonneau
- Department of Neurosurgery (S.B.), La Timone Hospital
- L'Institut National de la Santé et de la Recherche Médicale (S.B.), Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France
| | - N Bougaci
- Neurosurgery (N.B.), Besançon University Hospital, Besançon, France
| | - J C Gentric
- Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - J D B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A T Omar
- Division of Neurosurgery (A.T.O.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - H M Al-Jehani
- Department of Neurosurgery, Radiology and Critical Care Medicine (H.M.A.-J.), King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
| | - G El Hage
- Department of Neurosurgery (G.E.H.), Centre Hospitalier de l'Université de Montréal,Montreal, Québec, Canada
| | - D Volders
- Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Z Kaderali
- Division of Neurosurgery (Z.K.), GB1-Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - I Tsogkas
- Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - E Magro
- Department of Neurosurgery (E.M.), Centre Hospitalier Universitaire Cavale Blanche, UBO L'Institut National de la Santé et de la Recherche Médicale, LaTIM UMR 1101, Brest, France
| | - Q Holay
- Department of Radiology (Q.H.), Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - J Zehr
- Department of Mathematics and Statistics (J.Z.), Pavillon André-Aisenstadt,Montreal, Québec, Canada
| | - D Iancu
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - J Raymond
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
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Kossorotoff M, Kerleroux B, Boulouis G, Husson B, Tran Dong K, Eugene F, Damaj L, Ozanne A, Bellesme C, Rolland A, Bourcier R, Triquenot-Bagan A, Marnat G, Neau JP, Joriot S, Perez A, Guillen M, Perivier M, Audic F, Hak JF, Denier C, Naggara O. Recanalization Treatments for Pediatric Acute Ischemic Stroke in France. JAMA Netw Open 2022; 5:e2231343. [PMID: 36107427 PMCID: PMC9478769 DOI: 10.1001/jamanetworkopen.2022.31343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is to date limited evidence that revascularization strategies are associated with improved functional outcome in children with acute ischemic stroke (AIS). OBJECTIVES To report clinical outcomes and provide estimates of revascularization strategy safety and efficacy profiles of intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) in children with AIS. DESIGN, SETTING, AND PARTICIPANTS The KidClot multicenter nationwide cohort study retrospectively collected data of children (neonates excluded) with AIS and recanalization treatment between January 1, 2015, and May 31, 2018. Data analysis was performed from January 1, 2015, to May 31, 2019. EXPOSURE IVT and/or EVT. MAIN OUTCOMES AND MEASURES Primary outcome was day 90 favorable outcome (modified Rankin Scale [mRs] 0-2, with 0 indicating no symptoms and 6 indicating death). Secondary end points included 1-year favorable outcome (mRs, 0-2), mortality, and symptomatic intracerebral hemorrhage. Other measures included the Pediatric National Institutes of Health Stroke Scale (pedNIHSS), with pedNIHSS 0 indicating no symptoms, 1 to 4 corresponding to a minor stroke, 5 to 15 corresponding to a mild stroke, greater than 15 to 20: severe stroke, and the adult Alberta Stroke Program Early CT Score (ASPECTS), which provides segmental assessment of the vascular territory, with 1 point deducted from the initial score of 10 for every region involved (from 10 [no lesion] to 0 [maximum lesions]). RESULTS Overall, 68 children were included in 30 centers (IVT [n = 44]; EVT [n = 40]; 44 boys [64.7%]; median [IQR] age, 11 [4-16] years; anterior circulation involvement, 57 [83.8%]). Median (IQR) pedNIHSS score at admission was 13 (7-19), higher in the EVT group at 16 (IQR, 10-20) vs 9 (6-17) in the IVT only group (P < .01). Median time from stroke onset to imaging was higher in the EVT group at 3 hours and 7 minutes (IQR, 2 hours and 3 minutes to 6 hours and 24 minutes) vs 2 hours and 39 minutes (IQR, 1 hour and 51 minutes to 4 hours and 13 minutes) (P = .04). Median admission ASPECTS score was 8 (IQR, 6-9). The main stroke etiologies were cardioembolic (21 [30.9%]) and focal cerebral arteriopathy (17 [25.0%]). Median (IQR) time from stroke onset to IVT was 3 hours and 30 minutes (IQR, 2 hours and 33 minutes to 4 hours and 28 minutes). In the EVT group, the rate of postprocedure successful reperfusion (≥modified Treatment in Cerebral Infarction 2b) was 80.0% (32 of 40). Persistent proximal arterial stenosis was more frequent in focal cerebral arteriopathy (P < .01). Death occurred in 3 patients (4.4%). Median pedNIHSS reduction at 24 hours was 4 (IQR, 0-9) points. Intracerebral hemorrhage occurred in 4 patients and symptomatic intracerebral hemorrhage occurred in 1 patient, all in the EVT group. The median mRS was 2 (IQR, 0-3) at day 90 and 1 (IQR, 0-2) at 1 year, which was not significantly different between EVT and IVT only groups, although different in initial severity. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that use of EVT and/or IVT is safe in children with AIS.
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Affiliation(s)
- Manoëlle Kossorotoff
- Assistance publique-Hôpitaux de Paris, French Center for Pediatric Stroke, France
- Pediatric Neurology Department, Assistance publique-Hôpitaux de Paris, Inserm, Hôpital Necker-Enfants malades, Paris, France
| | - Basile Kerleroux
- Pediatric Radiology Department, Assistance publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
- GHU Paris Psychiatrie et Neurosciences, CH Sainte-Anne, Inserm, Université de Paris Cité, Institut de psychiatrie et neurosciences de Paris, Service d'imagerie morphologique et fonctionnelle, UMRS1266, Paris, France
| | - Grégoire Boulouis
- Assistance publique-Hôpitaux de Paris, French Center for Pediatric Stroke, France
- Pediatric Radiology Department, Assistance publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
- Neuroradiology, Tours University, CHRU Bretonneau, Tours, France
| | - Béatrice Husson
- Assistance publique-Hôpitaux de Paris, French Center for Pediatric Stroke, France
- Pediatric Radiology Department, Assistance publique-Hôpitaux de Paris, Université de Paris-Saclay, Hôpital Bicêtre, le Kremlin-Bicêtre, France
| | - Kim Tran Dong
- Assistance publique-Hôpitaux de Paris, French Center for Pediatric Stroke, France
| | - François Eugene
- Neuroradiology, Rennes University, CHU de Rennes, Rennes, France
| | - Lena Damaj
- Pediatric Department, Rennes University, CHU de Rennes, Rennes, France
| | - Augustin Ozanne
- Assistance publique-Hôpitaux de Paris, French Center for Pediatric Stroke, France
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Assistance publique-Hôpitaux de Paris, Paris-Saclay University, Hôpital Bicêtre, le Kremlin-Bicêtre, France
| | - Céline Bellesme
- Pediatric Stroke Unit and Pediatric Neurology Department, Assistance publique-Hôpitaux de Paris, Paris-Saclay University, Hôpital Bicêtre, le Kremlin-Bicêtre, France
| | - Anne Rolland
- Neurology Department, Nantes University, CHU de Nantes, Nantes, France
| | - Romain Bourcier
- Pediatric Department, Nantes University, CHU de Nantes, Nantes, France
| | | | - Gaultier Marnat
- Neuroradiology Department, Bordeaux University, CHU de Bordeaux, Bordeaux, France
| | - Jean-Philippe Neau
- Neurology Department. Poiters University, CHU de Poitiers, Poitiers, France
| | - Sylvie Joriot
- Pediatric Neurology Department, Lille University, CHU de Lille, Lille, France
| | - Alexandra Perez
- Pediatric Department, Strasbourg University, CHU de Strasbourg, Strasbourg, France
| | - Maud Guillen
- Neurology Department, Rennes University, CHU de Rennes, Rennes, France
| | | | - Frederique Audic
- Pediatric Neurology Department, Aix-Marseille University, CHU la Timone, Marseille, France
| | - Jean François Hak
- Neuroradiology, Aix-Marseille University, CHU la Timone, Marseille, France
| | - Christian Denier
- Pediatric Stroke Unit and Pediatric Neurology Department, Assistance publique-Hôpitaux de Paris, Paris-Saclay University, Hôpital Bicêtre, le Kremlin-Bicêtre, France
| | - Olivier Naggara
- Assistance publique-Hôpitaux de Paris, French Center for Pediatric Stroke, France
- Pediatric Neurology Department, Assistance publique-Hôpitaux de Paris, Inserm, Hôpital Necker-Enfants malades, Paris, France
- GHU Paris Psychiatrie et Neurosciences, CH Sainte-Anne, Inserm, Université de Paris Cité, Institut de psychiatrie et neurosciences de Paris, Service d'imagerie morphologique et fonctionnelle, UMRS1266, Paris, France
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27
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Girard N, Vidal V, Dangouloff Ros V, Blauwblomme T, Naggara O. Noninvasive Follow-up Imaging of Ruptured Pediatric Brain AVMs Using Arterial Spin-Labeling. AJNR Am J Neuroradiol 2022; 43:1363-1368. [PMID: 36007951 PMCID: PMC9451641 DOI: 10.3174/ajnr.a7612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions. MATERIALS AND METHODS Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses. RESULTS Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was -43 mL/100 mg/min (interquartile range, -102-5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, -62 [SD, 61] mL/100 mg/min versus -17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min). CONCLUSIONS Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.
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Affiliation(s)
- J F Hak
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - G Boulouis
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - B Kerleroux
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - S Benichi
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - S Stricker
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - F Gariel
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - L Garzelli
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
| | - P Meyer
- Pediatric Neurointensive Care Unit (P.M.)
| | - M Kossorotoff
- Department of Pediatric Neurology (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - N Girard
- Departments of Neuroradiology (N.G.)
| | - V Vidal
- Radiology (V.V.), University Hospital La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - V Dangouloff Ros
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - T Blauwblomme
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - O Naggara
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
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Masson A, Boulouis G, Janot K, Herbreteau D, Cottier JP, Bibi R, Cohen C, Obry S, Velut S, Amelot A, Ifergan H. Acute hydrocephalus and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2022; 164:2401-2408. [PMID: 35918615 DOI: 10.1007/s00701-022-05321-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Delayed cerebral infarction (DCIn) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbi-mortality; yet, the causes for DCIn remain incompletely understood. OBJECTIVE We tested the hypothesis that acute hydrocephalus could be related to the occurrence of DCIn, independently of the occurrence and severity of vasospasm. METHODS Radiological and clinical data of patients treated at a single large volume academic center for aSAH between 2017 and 2019 were retrospectively analyzed. DCIn was defined as imaging stigma of cerebral infarction visible on 6-week imaging follow-up after aSAH. Hydrocephalus was defined on baseline imaging as a relative bicaudate index above 1. Cerebral vasospasm was defined by reduction of artery diameter in comparison with initial diameter. We used uni- and multivariable models to test the associations between these variables, hydrocephalus and DCIn. RESULTS Of 164 included patients, vasospasm occurred in 58 patients (35.4%), and DCIn in 47 (28.7%). Acute hydrocephalus was present in 85 patients (51.8%) on baseline CT. No relation was found between acute hydrocephalus and delayed cerebral infarction in our multivariate analysis (adjusted OR: 1.20 95% CI [0.43-3.37]; p = 0.732). Only vasospasm occurrence was independently associated with DCIn (adjusted OR: 10.97 95% CI [4.60-26.01]). CONCLUSION Our study did not show an association between acute hydrocephalus and DCIn after aSAH, after adjustment for the presence and severity of cerebral vasospasm.
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Affiliation(s)
- Axel Masson
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France.
| | - Grégoire Boulouis
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Kevin Janot
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Denis Herbreteau
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Jean-Phlippe Cottier
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Richard Bibi
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Clara Cohen
- Department of Diagnostic Neuroradiology, Orleans Hospital Center, Orleans, France
| | - Sandra Obry
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Stéphane Velut
- Department of Neurosurgery, Bretonneau Hospital, University of Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, Bretonneau Hospital, University of Tours, Tours, France
| | - Héloïse Ifergan
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France.
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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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Kaiser DPO, Boulouis G, Soize S, Maus V, Fischer S, Lobsien D, Klisch J, Styczen H, Deuschl C, Abdullayev N, Kabbasch C, Jamous A, Behme D, Janot K, Bellanger G, Cognard C, Pierot L, Gawlitza M. Flow Diversion for ICA Aneurysms with Compressive Neuro-Ophthalmologic Symptoms: Predictors of Morbidity, Mortality, and Incomplete Aneurysm Occlusion. AJNR Am J Neuroradiol 2022; 43:998-1003. [PMID: 35738674 DOI: 10.3174/ajnr.a7550] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors for morbidity/mortality and incomplete aneurysm occlusion. MATERIALS AND METHODS We performed a secondary analysis of a previous publication, which included all patients treated with flow diversion for an unruptured aneurysm of the ICA with compression-related symptoms. RESULTS Fifty-four patients with 54 aneurysms (48 women, 88.9%; mean age, 59.2 [SD, 15.9] years; range, 21-86 years) treated with flow diversion were included. We observed morbidity and mortality rates of 7.4% and 3.7%. Increasing age (OR per decade, 3.2; 95% CI, 1.23-8.49; P = .02) and dual-antiplatelet therapy with ticagrelor (OR, 13.9; 95% CI, 1.16-165.97; P = .04) were significantly associated with morbidity/mortality. After a median follow-up of 13.3 [SD, 10.5] months, the rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 74%, 14%, and 12%. Incomplete occlusion at follow-up was less frequently observed in aneurysms treated with additional coil embolization (OR, 0.1; 95% CI, 0.01-0.86; P = .04). CONCLUSIONS Although a promising treatment for compressive ICA aneurysms, flow diversion carries a relevant risk for complications and incomplete aneurysm occlusion. Our results may help identify patients in which flow diversion may not be the ideal treatment method. Additional coil embolization increased the likelihood of complete aneurysm occlusion at follow-up.
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Affiliation(s)
- D P O Kaiser
- From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany
| | - G Boulouis
- Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France
| | - S Soize
- Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - V Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - S Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - D Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany
| | - J Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany
| | - H Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany
| | - C Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany
| | - N Abdullayev
- Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany
| | - C Kabbasch
- Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany
| | - A Jamous
- Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany
| | - D Behme
- Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany.,Department of Neuroradiology (D.B.), University Hospital Magdeburg, Magdeburg, Germany
| | - K Janot
- Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France
| | - G Bellanger
- Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - C Cognard
- Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - L Pierot
- Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - M Gawlitza
- From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany .,Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany
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Janvier P, Kerleroux B, Turc G, Pasi M, Farhat W, Bricout N, Benzakoun J, Legrand L, Clarençon F, Bracard S, Oppenheim C, Boulouis G, Henon H, Naggara O, Ben Hassen W. TAGE Score for Symptomatic Intracranial Hemorrhage Prediction After Successful Endovascular Treatment in Acute Ischemic Stroke. Stroke 2022; 53:2809-2817. [PMID: 35698971 DOI: 10.1161/strokeaha.121.038088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Determine if early venous filling (EVF) after complete successful recanalization with mechanical thrombectomy in acute ischemic stroke is an independent predictor of symptomatic intracranial hemorrhage (sICH) and integrate EVF into a risk score for sICH prediction. METHODS Consecutive patients with anterior acute ischemic stroke treated by mechanical thrombectomy issued from patients enrolled in the THRACE trial (Thrombectomie des Artères Cérébrales) and from 2 prospective registries were included and divided into a derivation (Center I; n=402) and validation cohorts (THRACE and center 2; n=507). EVF was evaluated by 2 blinded readers. sICH was defined according to the modified European cooperative acute stroke study II. Clinical and radiological data were analyzed in the derivation cohort (C1) to identify independent predictors of sICH and construct a predictive score test on the validation cohort (THRACE + C2). RESULTS Symptomatic ICH rate was similar between the two cohorts (9.9% and 8.9% respectively, P=0.9). Time from onset-to-successful recanalization >270 minutes (odds ratio [OR], 7.8 [95% CI, 2.5-24]), Alberta Stroke Program Early CT Score (≤5 [OR, 2.49 (95% CI, 1.8-8.1) or 6-7 [OR, 1.15 (95% CI, 1.03-4.46)]), glucose blood level >7 mmol/L (OR, 2.92 [95% CI, 1.26-6.7]), and EVF presence (OR, 11.9 [95% CI, 3.8-37.5]) were independent predictors of sICH and constituted the Time-Alberta Stroke Program Early CT-Glycemia-EVF score. Time-Alberta Stroke Program Early CT-Glycemia-EVF score was associated with an increased risk of sICH in the derivation cohort (OR increase per unit, 1.99 [95% CI, 1.53-2.59]; P<0.001) with area under the curve, 0.832 [95% CI, 0.767-0.898]. The score had good performance in the validation cohort (area under the curve, 0.801 [95% CI, 0.69-0.91]). CONCLUSIONS Time-Alberta Stroke Program Early CT-Glycemia-EVF score is a simple tool with readily available clinical variables with good performances for sICH prediction after mechanical thrombectomy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01062698.
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Affiliation(s)
- Paul Janvier
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Basile Kerleroux
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Guillaume Turc
- Neurolog, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France.y (G.T.)
| | - Marco Pasi
- Department of Neurology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (M.P., H.H.)
| | - Wassim Farhat
- Department of Neurology, Saint-Joseph Hospital, Paris, France (W.F.)
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (N.B.)
| | - Joseph Benzakoun
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Laurence Legrand
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France (F.C.)
| | - Serge Bracard
- Department of Neuroradiology, Nancy University (S.B.)
| | - Catherine Oppenheim
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, INSERM U1253 iBrain, University Hospital of Tours, Centre Val de Loire Region, France (G.B.)
| | - Hilde Henon
- Department of Neurology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (M.P., H.H.)
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Wagih Ben Hassen
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
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Lognon P, Gariel F, Marnat G, Darcourt J, Constant Dit Beaufils P, Burel J, Shotar E, Hak JF, Fauché C, Kerleroux B, Guédon A, Ognard J, Forestier G, Pop R, Paya C, Veyrières JB, Sporns P, Girot JB, Zannoni R, Zhu F, Crespy A, L'Allinec V, Mihoc D, Rouchaud A, Gentric JC, Ben Hassen W, Raynaud N, Testud B, Clarençon F, Kaczmarek B, Bourcier R, Bellanger G, Boulouis G, Janot K. Prospective assessment of aneurysmal rupture risk scores in patients with subarachnoid hemorrhage: a multicentric cohort. Neuroradiology 2022; 64:2363-2371. [PMID: 35695927 DOI: 10.1007/s00234-022-02987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/20/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level. OBJECTIVE In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid hemorrhage would have predicted a high risk of aneurysmal rupture or growth. METHODS Academic centers treating patients with intracranial aneurysms were invited to prospectively collect de-identified data from all patients admitted at their institution for a subarachnoid hemorrhage-related to intracranial aneurysmal rupture between January 1 and March 31, 2021 through a trainee-led research collaborative network. Each responding center was provided with an electronic case record form (CRF) which collected all the elements of the PHASES, ELAPSS, and UCAS scores. RESULTS A total of 319 patients with aneurysmal subarachnoid hemorrhage were included at 17 centers during a 3-month period. One hundred eighty-three aneurysms (57%) were less than 7 mm. The majority of aneurysms were located on the anterior communicating artery (n = 131, 41%). One hundred eighty-four patients (57%), 103 patients (32%), and 58 (18%) were classified as having a low risk of rupture or growth, according to the PHASES, UCAS, and ELAPSS scores, respectively. CONCLUSION In a prospective study of European patients with aneurysmal subarachnoid hemorrhage, we showed that 3 common risk-assessment tools designed for patients with unruptured intracranial aneurysms would have not identified most patients to be at high or intermediate risk for rupture, questioning their use for decision-making in the setting of unruptured aneurysms.
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Affiliation(s)
- P Lognon
- University Hospital of Tours, Tours, France
| | - F Gariel
- University Hospital of Bordeaux, Bordeaux, France
| | - G Marnat
- University Hospital of Bordeaux, Bordeaux, France
| | - J Darcourt
- University Hospital of Toulouse, Toulouse, France
| | - P Constant Dit Beaufils
- L'institut du Thorax, University of Nantes, INSERM, CNRS, Nantes, France.,University Hospital of Nantes, Nantes, France
| | - J Burel
- University Hospital of Rouen, Rouen, France
| | - E Shotar
- Pitié Salpêtrière Hospital, Paris, France
| | - J F Hak
- University Hospital of Marseille, Marseille, France
| | - C Fauché
- University Hospital of Poitiers, Poitiers, France
| | | | - A Guédon
- Lariboisière Hospital, Paris, France
| | - J Ognard
- University Hospital of Brest, Brest, France
| | - G Forestier
- University Hospital of Limoges, Limoges, France
| | - R Pop
- University Hospital of Strasbourg, Strasbourg, France
| | - C Paya
- University Hospital of Saint-Pierre, Saint-Pierre, La Réunion, France
| | - J B Veyrières
- University Hospital of Saint-Pierre, Saint-Pierre, La Réunion, France
| | - P Sporns
- University Hospital of Basel, Basel, Switzerland.,University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - J B Girot
- University Hospital of Angers, Angers, France
| | - R Zannoni
- University Hospital of Saint-Etienne, Saint-Etienne, France
| | - F Zhu
- University Hospital of Nancy, Nancy, France
| | - A Crespy
- University Hospital of Tours, Tours, France
| | - V L'Allinec
- University Hospital of Angers, Angers, France
| | - D Mihoc
- University Hospital of Strasbourg, Strasbourg, France
| | - A Rouchaud
- University Hospital of Limoges, Limoges, France
| | | | | | - N Raynaud
- University Hospital of Poitiers, Poitiers, France
| | - B Testud
- University Hospital of Marseille, Marseille, France
| | | | | | - R Bourcier
- L'institut du Thorax, University of Nantes, INSERM, CNRS, Nantes, France.,University Hospital of Nantes, Nantes, France
| | - G Bellanger
- University Hospital of Toulouse, Toulouse, France
| | - G Boulouis
- University Hospital of Tours, Tours, France
| | - Kevin Janot
- University Hospital of Tours, Tours, France.
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Grand T, Dargazanli C, Papagiannaki C, Bruggeman A, Maurer C, Gascou G, Fauche C, Bourcier R, Tessier G, Blanc R, Machaa MB, Marnat G, Barreau X, Ognard J, Gentric JC, Barbier C, Gory B, Rodriguez C, Boulouis G, Eugène F, Thouant P, Ricolfi F, Janot K, Herbreteau D, Eker OF, Cappucci M, Dobrocky T, Möhlenbruch M, Demerath T, Psychogios M, Fischer S, Cianfoni A, Majoie C, Emmer B, Marquering H, Valter R, Lenck S, Premat K, Cortese J, Dormont D, Sourour NA, Shotar E, Samson Y, Clarençon F. Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus. J Neuroradiol 2022; 49:317-323. [PMID: 35183595 DOI: 10.1016/j.neurad.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Mechanical thrombectomies (MT) in patients with large vessel occlusion (LVO) related to calcified cerebral embolus (CCE) have been reported, through small case series, being associated with low reperfusion rate and worse outcome, compared to regular MT. The purpose of the MASC (Mechanical Thrombectomy in Acute Ischemic Stroke Related to Calcified Cerebral Embolus) study was to evaluate the incidence of CCEs treated by MT and the effectiveness of MT in this indication. METHODS The MASC study is a retrospective multicentric (n = 37) national study gathering the cases of adult patients who underwent MT for acute ischemic stroke with LVO related to a CCE in France from January 2015 to November 2019. Reperfusion rate (mTICI ≥ 2B), complication rate and 90-day mRS were systematically collected. We then conducted a systematic review by searching for articles in PubMed, Cochrane Library, Embase and Google Scholar from January 2015 to March 2020. A meta-analysis was performed to estimate clinical outcome at 90 days, reperfusion rate and complications. RESULTS We gathered data from 35 patients. Reperfusion was obtained in 57% of the cases. Good clinical outcome was observed in 28% of the patients. The meta-analysis retrieved 136 patients. Reperfusion and good clinical outcome were obtained in 50% and 29% of the cases, respectively. CONCLUSION The MASC study found worse angiographic and clinical outcomes compared to regular thrombectomies. Individual patient-based meta-analysis including the MASC findings shows a 50% reperfusion rate and a 29% of good clinical outcome.
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Affiliation(s)
- Téodor Grand
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Agnetha Bruggeman
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Christoph Maurer
- Department of Neuroradiology, Klinikum Augsburg, Augsburg, GERMANY
| | | | - Cédric Fauche
- Department of Neuroradiology, CHU de Poitiers, FRANCE
| | - Romain Bourcier
- Department of Neuroradiology, Hôpital Nord Laennec, Nantes, FRANCE
| | | | - Raphaël Blanc
- Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
| | - Malek Ben Machaa
- Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
| | | | | | | | | | | | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Régional et Universitaire, Nancy, FRANCE
| | | | | | | | | | | | - Kevin Janot
- Department of Neuroradiology, CHU de Tours, France
| | | | | | | | - Tomas Dobrocky
- Department of Neuroradiology, Universitätsspital Bern, Bern, SWITZERLAND
| | - Markus Möhlenbruch
- Department of Neurology, University Heidelberg Medical Center, Heidelberg, GERMANY
| | - Theo Demerath
- Department of Neurology, University Freiburg Medical Center, Freiburg, GERMANY
| | - Marios Psychogios
- Department of Neurology, University Basel Medical Center, Basel, SWITZERLAND
| | - Sebastian Fischer
- Department of Neurology, University Bochum Medical Center, Bochum, GERMANY
| | - Alessandro Cianfoni
- Department of Neurology, University Lugano Medical Center, Lugano, SWITZERLAND
| | - Charles Majoie
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Bart Emmer
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Henk Marquering
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Rémi Valter
- Department of Public Health, Hôpital Henri Mondor, Créteil, FRANCE
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Kévin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jonathan Cortese
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Didier Dormont
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, FRANCE
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Yves Samson
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, FRANCE
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, FRANCE; GRC Biofast, Paris, FRANCE.
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Marnat G, Gory B, Sibon I, Kyheng M, Labreuche J, Boulouis G, Liegey JS, Caroff J, Eugène F, Naggara O, Consoli A, Mazighi M, Maier B, Richard S, Denier C, Turc G, Lapergue B, Bourcier R. Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome. Eur J Neurol 2022; 29:2701-2707. [PMID: 35648445 PMCID: PMC9541042 DOI: 10.1111/ene.15429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022]
Abstract
Background and purpose Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure. Methods We conducted a retrospective analysis of consecutive patients prospectively included in the ongoing observational multicenter Endovascular Treatment in Ischemic Stroke registry from January 2015 to September 2020. Patients presenting with anterior circulation LVOS treated with MT but experiencing failed intracranial recanalization defined as final modified Thrombolysis In Cerebral Infarction (mTICI) score of 0, 1 and 2a were included. Clinical and radiological outcomes were assessed along with the exploration of predictive factors of Day‐90 favorable outcome. Results The study population comprised 533 patients. Mean age was 68.8 ± 16 years, and median admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were 17 (IQR 12–21) and 7 (IQR 5–8), respectively. Favorable outcomes were observed in 85 patients (18.2%) and 186 died (39.0%). The rate of symptomatic intracranial hemorrhage was 14.1%. In multivariable analysis, younger age (odds ratio [OR] 0.96, 95% CI 0.94–0.98, p < 0.001), a lower admission NIHSS (OR 0.87, 95% CI 0.83–0.91, p < 0.001), a lower number of MT passes (OR 0.77, 95% CI 0.77–0.87, p < 0.001), a lower delta ASPECTS between initial and Day‐1 imaging (OR 0.83, 95% CI 0.71–0.98, p = 0.026) and stroke etiology [significant difference among etiological subtypes (p = 0.024) with a tendency toward more favorable outcomes for dissection (OR 2.01, 95% CI 0.71–5.67)] were significantly associated with a 90‐day favorable outcome. Conclusions In this large retrospective analysis of a multicenter registry, we quantified the poor outcome after MT failure. We also identified factors associated with favorable outcome despite recanalization failure that might influence therapeutic management.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France.,IADI, INSERM-U1254, Université de Lorraine, Nancy, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Maeva Kyheng
- CHU Lille, Department of Biostatistics, Lille, France
| | | | | | | | - Jildaz Caroff
- Neuroradiolology Department, CHU Kremlin Bicêtre, Paris, France
| | - François Eugène
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Olivier Naggara
- Department of Neuroradiology, GHU Paris, Centre Hospitalier Sainte-Anne, Université de Paris, INSERM-UMR-894, Paris, France
| | - Arturo Consoli
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin-en-Yvelines, Foch Hospital, Suresnes, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, FHU-NeuroVASC, Paris, INSERM-1148, France
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, FHU-NeuroVASC, Paris, INSERM-1148, France
| | | | | | - Guillaume Turc
- Department of Neurology, GHU Paris, Centre Hospitalier Sainte-Anne, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, University of Versailles and Saint-Quentin-en-Yvelines, Foch Hospital, Suresnes, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
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Iancu D, Collins J, Farzin B, Darsaut TE, Eneling J, Boisseau W, Olijnyk L, Boulouis G, Chaalala C, Bojanowski MW, Weill A, Roy D, Raymond J. Recruitment in a pragmatic randomized trial on the management of unruptured intracranial aneurysms. World Neurosurg 2022; 163:e413-e419. [PMID: 35395427 DOI: 10.1016/j.wneu.2022.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Comprehensive Aneurysm Management (CAM) study is a pragmatic trial designed to manage UIA patients within a care research framework. METHOD CAM is an all-inclusive study. Management options are allocated according to an algorithm combining pre-randomization and clinical judgment. Eligible patients are offered 1:1 randomized allocation of intervention versus conservative management and 1:1 randomization allocation of surgical versus endovascular treatment. Ineligible patients are registered. The primary outcome is survival without dependency (mRS<3) at 10 years. All UIA patients at one center are reported. RESULTS Between February 2020 and July 2021, 403 UIA patients were recruited: 179 (44%) in one of the RCTs and 224 (56%) in one of the registries. Conservative management was recommended for 205/403 patients (51%); of 198 (49%) patients considered for curative treatment, 159 (80%) were randomly allocated conservative (n=81) or curative treatment (n=78). These patients were younger and had larger aneurysms than those in the observation registry (P = .004). In 39/198 patients (20%), conservative management was not considered reasonable (17 patients were recommended endovascular, 2 surgery, and 20 the RCT comparing endovascular with surgical treatment). In total, 70 patients were recruited in the RCT comparing surgery and endovascular treatment. After informed discussion at time of consent, 141/159 patients (89%) agreed with the randomly allocated management plan, while 11% crossed-over to the alternative management option. CONCLUSION CAM was successfully integrated into routine practice. Meaningful conclusions can be obtained if multiple centers actively participate in the trial.
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Affiliation(s)
- Daniela Iancu
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Jennifer Collins
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Behzad Farzin
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Tim E Darsaut
- University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, Edmonton, Alberta, Canada
| | - Johanna Eneling
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - William Boisseau
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Leonardo Olijnyk
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Grégoire Boulouis
- Neuroradiology Department, Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, France
| | - Chiraz Chaalala
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Alain Weill
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada.
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Desilles JP, Solo Nomenjanahary M, Consoli A, Ollivier V, Faille D, Bourrienne MC, Hamdani M, Dupont S, Di Meglio L, Escalard S, Maier B, Blanc R, Piotin M, Lapergue B, Ajzenberg N, Vasse M, Mazighi M, Ho-Tin-Noé B, Désilles JP, Mazighi M, Piotin M, Blanc R, Redjem H, Smajda S, Seners P, Escalard S, Delvoye F, Maier B, Hebert S, Ben Maacha M, Hamdani M, Sabben C, Obadia M, Deschildre C, Lapergue B, Consoli A, Rodesch G, Maria F, Coskun O, Lopez D, Bourcier R, Detraz L, Desal H, Roy M, Clavier D, Marnat G, Gariel F, Lucas L, Sibon I, Eugene F, Vannier S, Ferre JC, LeBras A, Raoult H, Paya C, Gauvrit JY, Richard S, Gory B, Barbier C, Vivien D, Touze E, Gauberti M, Blaizot G, Ifergan H, Herbreteau D, Bibi R, Janot K, Charron V, Boulouis G. Impact of COVID-19 on thrombus composition and response to thrombolysis: Insights from a monocentric cohort population of COVID-19 patients with acute ischemic stroke. J Thromb Haemost 2022; 20:919-928. [PMID: 35032088 PMCID: PMC9906142 DOI: 10.1111/jth.15646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Resistance to fibrinolysis, levels of procoagulant/antifibrinolytic neutrophil extracellular traps (NETs), and the severity of acute ischemic stroke (AIS) are increased by COVID-19. Whether NETs are components of AIS thrombi from COVID-19 patients and whether COVID-19 impacts the susceptibility of these thrombi to thrombolytic treatments remain unknown, however. OBJECTIVES We aimed to characterize AIS thrombi from COVID-19 patients by immunohistology and to compare their response to thrombolysis to that of AIS thrombi from non-COVID-19 patients. PATIENTS/METHODS For this monocentric cohort study, 14 thrombi from COVID-19 AIS patients and 16 thrombi from non-COVID-19 patients, all recovered by endovascular therapy, were analyzed by immunohistology or subjected to ex vivo thrombolysis by tissue-type plasminogen (tPA)/plasminogen. RESULTS COVID-19 AIS thrombi were rich in neutrophils and contained NETs, but not spike protein. Thrombolysis assays revealed a mean resistance profile to tPA/plasminogen of COVID-19 AIS thrombi similar to that of non-COVID-19 AIS thrombi. The addition of DNase 1 successfully improved thrombolysis by potentiating fibrinolysis irrespective of COVID-19 status. Levels of neutrophil, NETs, and platelet markers in lysis supernatants were comparable between AIS thrombi from non-COVID-19 and COVID-19 patients. CONCLUSIONS These results show that COVID-19 does not impact NETs content or worsen fibrinolysis resistance of AIS thrombi, a therapeutic hurdle that could be overcome by DNase 1 even in the context of SARS-CoV-2 infection.
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Affiliation(s)
- Jean-Philippe Desilles
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | | | - Arturo Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Véronique Ollivier
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Dorothée Faille
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | | | - Mylène Hamdani
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Sébastien Dupont
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Lucas Di Meglio
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Bertrand Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Nadine Ajzenberg
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Marc Vasse
- Biology Department, UMR-S 1176, Foch Hospital, Suresnes, France
| | - Mikael Mazighi
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Benoît Ho-Tin-Noé
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France.
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Scopelliti G, Casolla B, Boulouis G, Kuchcinski G, Moulin S, Leys D, Henon H, Cordonnier C, Pasi M. Long-term neuropsychiatric symptoms in spontaneous intracerebral haemorrhage survivors. J Neurol Neurosurg Psychiatry 2022; 93:232-237. [PMID: 34728587 DOI: 10.1136/jnnp-2021-327557] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Neuropsychiatric (NP) symptoms are prominent features of cognitive decline, but they have been understudied in patients with spontaneous intracerebral haemorrhage (ICH). In ICH survivors, we aimed at assessing NP symptoms prevalence and profiles, and their influence on long-term outcomes. METHODS We analysed data from consecutive 6-month ICH survivors enrolled in the Prognosis of Intracerebral Haemorrhage study. We performed NP evaluation using the Neuropsychiatric Inventory Questionnaire. Patients underwent long-term clinical follow-up after ICH (median follow-up time 7.2 years, IQR 4.8-8.2). RESULTS Out of 560 patients with ICH, 265 survived at 6 months. NP evaluation 6 months after ICH was feasible in 202 patients. NP symptoms were present in 112 patients (55%), and in 36 out of 48 patients (75%) with post-ICH dementia. Affective symptoms were present in 77 patients (38%), followed by vegetative symptoms (52 patients, 26%) and hyperactivity (47 patients, 23%). Apathy and hyperactivity were associated with post-ICH dementia and cerebral amyloid angiopathy MRI profile (all p<0.05). Apathy and hyperactivity prevailing over affective symptoms at 6-month follow-up were associated with higher risks of developing new-onset dementia (HR 5.40; 95% CI 2.27 to 12.84), while presence or severity of NP symptoms were not. CONCLUSION NP symptoms were present in more than half of 6-month ICH survivors, with higher prevalence and severity in patients with post-ICH dementia. Distinctive NP profile might be associated to cognitive status and inform on long-term dementia risk.
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Affiliation(s)
- Giuseppe Scopelliti
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Barbara Casolla
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Grégoire Boulouis
- Department of Neuroradiology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Gregory Kuchcinski
- Department of Neuroradiology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Solène Moulin
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Didier Leys
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Hilde Henon
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Charlotte Cordonnier
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Marco Pasi
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
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Cohen C, Shotar E, Boulouis G, Ifergan H, Janot K, Premat K, Lenck S, Boch AL, Aggad M, Sourour N, Herbreteau D, Barrot V, Clarençon F. Fistules artério-veineuses durales intra-crâniennes: association aux thromboses veineuses cérébrales et agressivité. Une étude multicentrique sur 264 patients. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boulouis G, Berge J, Pruvo JP, Zhu F, Boutet C, Kerleroux B, Cotton F, Sibon I, Desal H. A new legal framework for Interventional Neuroradiology in France: optimizing access to mechanical thrombectomy. J Neuroradiol 2022; 49:153-156. [PMID: 35346427 DOI: 10.1016/j.neurad.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Centre Val de Loire, INSERM U1253 iBrain, Tours, France
| | - Jérome Berge
- Neuroradiology department, University Hospital, Bordeaux, France.
| | - Jean-Pierre Pruvo
- Diagnostic and interventional neuroradiology, Lille University hospital, Lille, France
| | - François Zhu
- Service de Neuroradiologie Diagnostique et Thérapeutique CHRU Nancy, IADI INSERM U1254 Université de Lorraine
| | - Claire Boutet
- Department of Radiology, University Hospital, EA7423 TAPE, UJM, Saint Etienne, France
| | - Basile Kerleroux
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - François Cotton
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Lyon 1,Lyon France - CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, UCBL1 Villeurbanne, France
| | - Igor Sibon
- Stroke unit, Bordeaux Unversity Hospital, UMR-5287, CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France
| | - Hubert Desal
- Department of Neuroradiology, Nantes University Hospital, Nantes, France
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Boulouis G, Berge J, Pruvo JP, Zhu F, Boutet C, Kerleroux B, Cotton F, Sibon I, Desal H. Réforme des autorisations : un nouveau cadre juridique pour la NRI Française. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Masson A, Boulouis G, Janot K, Herbreteau D, Cottier JP, Bibi R, Cohen C, Obry S, Velut S, Amelot A, Ifergan H. Hydrocéphalie aiguë et infarctus cérébral retardé dans les suites d'hémorragie sous arachnoïdienne anévrismale. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Henderson A, Hoche C, Boulouis G, Ifergan H, Cottier JP, Pasi M, Gaudron M, Cohen C. Incidence, facteurs prédictifs et pronostic de l'extravasation de produit de contraste post-thrombectomie. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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43
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Ifergan H, Hak JF, Darcourt J, Charbonnier G, Biondi A, Guedon A, Houdart E, Desilles JP, Holay Q, Shotar E, Bonnet B, Kerleroux B, Janvier P, Forestier G, Rouchaud A, Cortese J, Sporns P, Schulze-Zachau V, Marnat G, Papaxanthos J, Testud B, Pop R, Burel J, Lefebvre M, Tessier G, Bibi R, Herbreteau D, Janot K, Labreuche J, Turjman F, Boulouis G. Étude rétrospective multicentrique pour évaluer l'efficacité et la sécurité de la prise en charge thérapeutique des anévrysmes fusiformes et dolichoectasies du tronc basilaire. cohorte collaborative du jeni. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kerleroux B, Husson B, Boulouis G, Chabrier S, Ozanne A, Eugene F, Bourcier R, Raynaud N, Hak JF, Naggara O, Kossorotoff M, KidClot group OBOT. Recanalization treatment for pediatric acute ischemic stroke: a nationwide french registry. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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FORESTIER G, Agbonon R, Bricout N, Benhassen W, Turc G, Bretzner M, Pasi M, Benzakoun J, Seners P, Personnic T, Legrand L, Trystram D, Rordiguez-Regent C, Charidimou A, Rost NS, Bracard S, Clarençon F, Eker OF, Nighoghossian N, Cordonnier C, Oppenheim C, Naggara O, Henon H, Boulouis G. Small vessel disease and collaterals in ischemic stroke patients treated with thrombectomy. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Duloquin G, Ferrigno M, Hassen WB, Kyheng M, Bricout N, Boulouis G, Seners P, Labreuche J, Turc G, Naggara O, Cordonnier C, Henon H, Pasi M. Pre-treatment lesional volume in older stroke patients treated with endovascular treatment. Int J Stroke 2022; 17:1085-1092. [PMID: 35225745 DOI: 10.1177/17474930211068657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies in the general stroke population treated with endovascular treatment (EVT) reported that higher pre-treatment lesional volumes were independently associated with poor neurological outcome and functional dependence after stroke. However, it has been not evaluated in older patients. AIM We test the association between the pre-treatment lesional volume on diffusion-weighted magnetic resonance imaging and relevant outcome measures in older adults with stroke treated with EVT. METHODS We included consecutive older adults with stroke (⩾80 years old) treated with EVT in two academic comprehensive stroke centers. The association between pre-treatment lesional volume and relevant outcome measures (poor outcome (modified Rankin scale 4-6), 3-month mortality and symptomatic intracerebral hemorrhage (sICH)) was evaluated using univariate and multivariable models. RESULTS Five hundred seventy-nine patients were included (mean age: 85.6 ± 4.1, median lesional volume was 10 ml; interquartile range: 3-30 ml). Pre-treatment lesional volume was associated with poor functional outcome (adjusted odds ratio (aOR): 1.87, 95% confidence interval (CI): 1.60-2.20, for +1 logarithmic increase of lesional volume), 3-month mortality (aOR: 1.50, CI: 1.28-1.76), and sICH (aOR: 1.67, CI: 1.27-2.20). A threshold lesional volume >35 ml predicted 90% of patients with poor functional outcome and a cut-off >51 ml predicted 90% of patients dead at 3 months. CONCLUSIONS Pre-treatment lesional volume might contribute, in association with other relevant clinical features, to the selection of older stroke patients who will benefit from EVT.
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Affiliation(s)
- Gauthier Duloquin
- EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Marc Ferrigno
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Wagih Ben Hassen
- Department of Neuroradiology, Paris University, Inserm U1266, GHU Paris, Saint-Anne Hospital, Paris, France
| | - Maéva Kyheng
- Département de Biostatistiques, CHU Lille, Lille, France.,University of Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
| | | | - Grégoire Boulouis
- Department of Neuroradiology, Paris University, Inserm U1266, GHU Paris, Saint-Anne Hospital, Paris, France
| | - Pierre Seners
- Université de Paris, Inserm U1266, GHU Paris Psychiatrie et Neurosciences (Department of Neurology), FHU NeuroVasc, Paris, France
| | | | - Guillaume Turc
- Université de Paris, Inserm U1266, GHU Paris Psychiatrie et Neurosciences (Department of Neurology), FHU NeuroVasc, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Paris University, Inserm U1266, GHU Paris, Saint-Anne Hospital, Paris, France
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
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Scopelliti G, Casolla B, Boulouis G, Kuchcinski G, Moulin S, Leys D, Hénon H, Cordonnier C, Pasi M. Long-term anxiety in spontaneous intracerebral haemorrhage survivors. Int J Stroke 2022; 17:1093-1099. [DOI: 10.1177/17474930221085443] [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: 11/16/2022]
Abstract
Background. Although anxiety is common in several neurological conditions, it has been poorly investigated after spontaneous intracerebral haemorrhage (ICH). Aims. In consecutive ICH survivors, we assessed the long-term prevalence of anxiety and its clinical and radiological determinants. Methods. Using the Hospital Anxiety and Depression scale (HADS), we evaluated ICH survivors enrolled in the prospective, single-centre Prognosis of Intracerebral Hemorrhage (PITCH) study. The prevalence of anxiety (defined as a HADS-anxiety subscale score > 7) was evaluated at three time points (1-2, 3-5, and 6-8 years after ICH), along with neurological symptoms severity, functional disability, and cognitive impairment scores. Clinical and radiological characteristics associated with anxiety were evaluated in univariate and multivariable models. Results. Of 560 patients with spontaneous ICH, 255 were alive 1 year later, 179 of whom completed the HADS questionnaire and were included in the study. Thirty-one patients (17%; 95% confidence interval [CI] 12-23) had anxiety 1-2 years, 38 (27%; 95% CI 19-34) 3-5 years, and 18 (21%; 95% CI 12-30) 6-8 years after ICH. In patients with anxiety, the prevalence of associated depressive symptoms was 48.4% 1-2 years, 60.5% 3-5 years, and 55.5% 6-8 years after ICH. Among clinical and radiological baseline characteristics, only lobar ICH location was significantly associated with anxiety 1-2 years after ICH (odds ratio 2.8; 95% CI 1.2-6.5). Anxiety was not associated with concomitant neurological symptoms severity, functional disability, or cognitive impairment. Conclusions. Anxiety is frequent in ICH survivors, often in association with depressive symptoms, even many years after the index event.
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Affiliation(s)
- Giuseppe Scopelliti
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Barbara Casolla
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Grégoire Boulouis
- Inserm UMR 1266, GHU Paris Psychiatrie et Neurosciences, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris University, Paris, France
| | - Grégory Kuchcinski
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neuroradiology), F-59000 Lille, France
| | - Solène Moulin
- Department of Neurology, Centre Hospitalier Universitaire Reims, Hôpital Maison Blanche, Reims, France
| | - Didier Leys
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Hilde Hénon
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Marco Pasi
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
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Forestier G, Dusonchet A, Lun F, Boulouis G. Sudden coma onset following simultaneous bilateral carotid occlusion. Acta Neurol Belg 2022; 122:213-214. [PMID: 34755322 DOI: 10.1007/s13760-021-01831-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
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Janot K, Fahed R, Rouchaud A, Zuber K, Boulouis G, Forestier G, Mounayer C, Piotin M. Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion. AJNR Am J Neuroradiol 2022; 43:87-92. [PMID: 34794946 PMCID: PMC8757548 DOI: 10.3174/ajnr.a7350] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial stents for the treatment of aneurysms can be responsible for parent artery straightening, a phenomenon with potential consequences for aneurysmal occlusion. We aimed to evaluate parent artery straightening following flow-diverter stent placement in patients with intracranial aneurysms and explored the association between parent artery straightening and subsequent aneurysm occlusion. MATERIALS AND METHODS All patients treated with flow-diverter stents for anterior circulation aneurysms located downstream from the carotid siphon between January 2009 and January 2018 were screened for inclusion. Parent artery straightening was defined as the difference (α-β) in the parent artery angle at the neck level before (α angle) and after flow-diverter stent deployment (β angle). We analyzed the procedural and imaging factors associated with parent artery straightening and the associations between parent artery straightening and aneurysmal occlusion. RESULTS Ninety-five patients met the inclusion criteria (n = 64/95 women, 67.4%; mean age, 54.1 [SD, 11.2] years) with 97 flow-diverter stents deployed for 99 aneurysms. Aneurysms were predominantly located at the MCA bifurcation (n = 44/95, 44.4%). Parent artery straightening was found to be more pronounced in patients treated with cobalt chromium stents than with nitinol stents (P = .02). In multivariate analysis, parent artery straightening (P = .04) was independently associated with aneurysm occlusion after flow-diverter stent deployment. CONCLUSIONS The use of flow-diverter stents for distal aneurysms induces a measurable parent artery straightening, which is associated with higher occlusion rates. Parent artery straightening, in our sample, appeared to be more prominent with cobalt chromium stents than with nitinol stents. This work highlights the necessary trade-off between navigability and parent artery straightening and may help tailor the selection of flow-diverter stents to aneurysms and parent artery characteristics.
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Affiliation(s)
- K. Janot
- From the Department of Interventional Neuroradiology (K.J., G.B.), University Hospital of Tours, Tours, France
| | - R. Fahed
- Department of Interventional Neuroradiology (R.F., M.P.)
| | - A. Rouchaud
- Department of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
| | - K. Zuber
- Research and Biostatistics Unit (K.Z.), Rothschild Foundation Hospital, Paris, France
| | - G. Boulouis
- From the Department of Interventional Neuroradiology (K.J., G.B.), University Hospital of Tours, Tours, France
| | - G. Forestier
- Department of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
| | - C. Mounayer
- Department of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
| | - M. Piotin
- Department of Interventional Neuroradiology (R.F., M.P.)
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Bourhis-Guizien F, Dissaux B, Boulouis G, Ben Salem D, Gentric JC, Ognard J. The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure. Tomography 2021; 7:792-800. [PMID: 34842852 PMCID: PMC8628901 DOI: 10.3390/tomography7040066] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76; 11.76] vs. 0.78 [0.32; 1.25], respectively, p < 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p < 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43; 6.92] vs. 3.08 [1.79; 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24; 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p < 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.
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Affiliation(s)
- Fanny Bourhis-Guizien
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
| | - Brieg Dissaux
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Western Brittany Thrombosis Study Group GETBO EA3878, 29609 Brest, France
| | - Grégoire Boulouis
- Neuroradiology Unit, Department of Radiology, Saint-Anne Hospital, INSERM UMR 894, 75674 Paris, France;
| | - Douraied Ben Salem
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, 29200 Brest, France
| | - Jean-Christophe Gentric
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Western Brittany Thrombosis Study Group GETBO EA3878, 29609 Brest, France
| | - Julien Ognard
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, 29200 Brest, France
- Correspondence:
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