1
|
Giroud M, Planton M, Darcourt J, Raposo N, Brandicourt P, Mirabel H, Hervé D, Viguier A, Albucher JF, Pariente J, Olivot JM, Bonneville F, Péran P, Calviere L. MRI hypoperfusion as a determinant of cognitive impairment in adults with Moyamoya angiopathy. Eur Stroke J 2024:23969873241240829. [PMID: 38501882 DOI: 10.1177/23969873241240829] [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: 03/20/2024] Open
Abstract
INTRODUCTION In Moyamoya angiopathy (MMA), mechanisms underlying cognitive impairment remain debated. We aimed to assess the association of cognitive impairment with the degree and the topography of cerebral hypoperfusion in MMA. METHODS A retrospective analysis of neuropsychological and perfusion MRI data from adults with MMA was performed. Ischemic and haemorrhagic lesion masks were created to account for cerebral lesions in the analysis of cerebral perfusion. Whole brain volume of hypoperfused parenchyma was outlined on perfusion maps using different Tmax thresholds from 4 to 12 s. Regional analysis produced mean Tmax values at different regions of interest. Analyses compared perfusion ratios in patients with and without cognitive impairment, with multivariable logistic regression analysis to identify predictive factors. RESULTS Cognitive impairment was found in 20/48 (41.7%) patients. Attention/processing speed and memory were equally impaired (24%) followed by executive domain (23%). After adjustment, especially for lesion volume, hypoperfused parenchyma volume outlined by Tmax > 4 s or Tmax > 5 s thresholds was an independent factor of cognitive impairment (OR for Tmax > 4 s = 1.06 [CI 95% 1.008-1.123]) as well as attention/processing speed (OR for Tmax > 4 s = 1.07 [CI 95% 1.003-1.133]) and executive domains (OR for Tmax > 5 s = 1.08 [CI 95% 1.004-1.158]). Regarding cognitive functions, patients with processing speed and flexibility impairment had higher frontal Tmax compared to other ROIs and to patients with normal test scores. DISCUSSION Cerebral hypoperfusion emerged as an independent factor of cognitive impairment in MMA particularly in attention/processing speed and executive domains, with a strong contribution of frontal areas. CONCLUSION Considering this association, revascularization surgery could improve cognitive impairment.
Collapse
Affiliation(s)
- Marine Giroud
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Mélanie Planton
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jean Darcourt
- Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Nicolas Raposo
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | | | - Hélène Mirabel
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Dominique Hervé
- Neurology Department, Hospital Paris Lariboisière, Paris, France
| | - Alain Viguier
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jean-François Albucher
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jérémie Pariente
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jean Marc Olivot
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Fabrice Bonneville
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
- Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Lionel Calviere
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| |
Collapse
|
2
|
Clarençon F, Durand-Zaleski I, Premat K, Baptiste A, Chabert E, Ferrier A, Labeyrie MA, Reiner P, Spelle L, Denier C, Tuilier T, Hosseini H, Rodriguez-Régent C, Turc G, Fauché C, Lamy M, Lapergue B, Consoli A, Barbier C, Boulanger M, Bricout N, Henon H, Gory B, Richard S, Rouchaud A, Macian-Montoro F, Eker O, Cho TH, Soize S, Moulin S, Gentric JC, Timsit S, Darcourt J, Albucher JF, Janot K, Annan M, Pico F, Costalat V, Arquizan C, Marnat G, Sibon I, Pop R, Wolff V, Shotar E, Lenck S, Sourour NA, Radenne A, Alamowitch S, Dechartres A. Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial. Int J Stroke 2024; 19:367-372. [PMID: 37740419 DOI: 10.1177/17474930231205213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
RATIONALE Mechanical thrombectomy (MT) associated with the best medical treatment (BMT) has recently shown efficacy for the management of acute ischemic stroke (AIS) secondary to a large vessel occlusion. However, evidence is lacking regarding the benefit of MT for more distal occlusions. AIM To evaluate the efficacy in terms of good clinical outcome at 3 months of MT associated with the BMT over the BMT alone in AIS related to a distal occlusion. METHODS The DISCOUNT trial is a multicenter open-label randomized controlled trial involving French University hospitals. Adult patients (⩾18 years) with an AIS involving the anterior or posterior circulation secondary to a distal vessel occlusion within 6 h of symptom onset or within 24 h if no hyperintense signal on fluid attenuation inversion recovery acquisition will be randomized 1:1 to receive either MT associated with the BMT (experimental group) or BMT alone (control group). The number of patients to be included is 488. STUDY OUTCOMES The primary outcome is the rate of good clinical outcome at 3 months defined as a modified Rankin scale (mRS) ⩽2 and evaluated by an independent assessor blinded to the intervention arm. Secondary outcomes include recanalization of the occluded vessel within 48 h, angiographic reperfusion in the experimental group, 3-month excellent clinical outcome (mRS ⩽ 1), all adverse events, and death. A cost utility analysis will estimate the incremental cost per quality-adjusted life year (QALY) gained. DISCUSSION If positive, this study will open new insights in the management of AISs. TRIAL REGISTRATION ClinicalTrials.gov: NCT05030142 registered on 1 September 2021.
Collapse
Affiliation(s)
- Frédéric Clarençon
- Sorbonne Université, GRC BioFast, APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
| | - Kévin Premat
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Amandine Baptiste
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Unité de recherche clinique, Paris, France
| | - Emmanuel Chabert
- Department of Neuroradiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Anna Ferrier
- Department of Vascular Neurology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Peggy Reiner
- Department of Vascular Neurology, Lariboisière Hospital, Paris, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology, Kremlin-Bicêtre Hospital, Kremlin-Bicêtre, France
| | - Christian Denier
- Department of Vascular Neurology, Kremlin-Bicêtre Hospital, Kremlin-Bicêtre, France
| | - Titien Tuilier
- Department of Neuroradiology, Henri-Mondor Hospital, Créteil, France
| | - Hassan Hosseini
- Department of Vascular Neurology, Henri-Mondor Hospital, Créteil, France
| | | | - Guillaume Turc
- Department of Vascular Neurology, Sainte-Anne Hospital, Paris, France
| | - Cédric Fauché
- Department of Neuroradiology, Poitiers University Hospital, Poitiers, France
| | - Matthias Lamy
- Department of Vascular Neurology, Poitiers University Hospital, Poitiers, France
| | | | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | - Charlotte Barbier
- Department of Neuroradiology, Caen University Hospital, Caen, France
| | - Marion Boulanger
- Department of Vascular Neurology, Caen University Hospital, Caen, France
| | - Nicolas Bricout
- Department of Neuroradiology, Lille University Hospital, Lille, France
| | - Hilde Henon
- Department of Vascular Neurology, Lille University Hospital, Lille, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Sébastien Richard
- Department of Neurology, INSERM U1116, Stroke Unit, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France
| | | | - Omer Eker
- Department of Neuroradiology, Lyon University Hospital, Lyon, France
| | - Tae-Hee Cho
- Department of Vascular Neurology, Lyon University Hospital, Lyon, France
| | - Sébastien Soize
- Department of Neuroradiology, Reims University Hospital, Reims, France
| | - Solène Moulin
- Department of Vascular Neurology, Reims University Hospital, Reims, France
| | | | - Serge Timsit
- Department of Vascular Neurology, Brest University Hospital, Brest, France
| | - Jean Darcourt
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | | | - Kévin Janot
- Department of Neuroradiology, Tours University Hospital, Tours, France
| | - Mariam Annan
- Department of Vascular Neurology, Tours University Hospital, Tours, France
| | - Fernando Pico
- Department of Vascular Neurology, Versailles Hospital, Versailles, France
| | - Vincent Costalat
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Caroline Arquizan
- Department of Vascular Neurology, Montpellier University Hospital, Montpellier, France
| | - Gautier Marnat
- Department of Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Department of Vascular Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Raoul Pop
- Department of Neuroradiology, Strasbourg University Hospital, Strasbourg, France
| | - Valérie Wolff
- Department of Vascular Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Eimad Shotar
- Sorbonne Université, GRC BioFast, APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Sorbonne Université, GRC BioFast, APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader-Antoine Sourour
- Sorbonne Université, GRC BioFast, APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Anne Radenne
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Unité de recherche clinique, Paris, France
| | - Sonia Alamowitch
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| |
Collapse
|
3
|
Sahin C, Giraud A, Jabrah D, Patil S, Messina P, Bozsak F, Darcourt J, Sacchetti F, Januel AC, Bellanger G, Pagola J, Juega J, Imamura H, Ohta T, Spelle L, Chalumeau V, Mircic U, Stanarčević P, Vukašinović I, Ribo M, Sakai N, Cognard C, Doyle K. Electrical impedance measurements can identify red blood cell-rich content in acute ischemic stroke clots ex vivo associated with first-pass successful recanalization. Res Pract Thromb Haemost 2024; 8:102373. [PMID: 38617048 PMCID: PMC11015511 DOI: 10.1016/j.rpth.2024.102373] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Background Electrochemical impedance spectroscopy can determine characteristics such as cell density, size, and shape. The development of an electrical impedance-based medical device to estimate acute ischemic stroke (AIS) clot characteristics could improve stroke patient outcomes by informing clinical decision making. Objectives To assess how well electrical impedance combined with machine learning identified red blood cell (RBC)-rich composition of AIS clots ex vivo, which is associated with a successfully modified first-pass effect. Methods A total of 253 clots from 231 patients who underwent thrombectomy in 5 hospitals in France, Japan, Serbia, and Spain between February 2021 and October 2023 were analyzed in the Clotbase International Registry. Electrical impedance measurements were taken following clot retrieval by thrombectomy, followed by Martius Scarlet Blue staining. The clot components were quantified via Orbit Image Analysis, and RBC percentages were correlated with the RBC estimations made by the electrical impedance machine learning model. Results Quantification by Martius Scarlet Blue staining identified RBCs as the major component in clots (RBCs, 37.6%; white blood cells, 5.7%; fibrin, 25.5%; platelets/other, 30.3%; and collagen, 1%). The impedance-based RBC estimation correlated well with the RBC content determined by histology, with a slope of 0.9 and Spearman's correlation of r = 0.7. Clots removed in 1 pass were significantly richer in RBCs and clots with successful recanalization in 1 pass (modified first-pass effect) were richer in RBCs as assessed using histology and impedance signature. Conclusion Electrical impedance estimations of RBC content in AIS clots are consistent with histologic findings and may have potential for clinically relevant parameters.
Collapse
Affiliation(s)
- Cansu Sahin
- Department of Physiology, University of Galway, Galway, Ireland
- Centre for Research in Medical Devices (CÚRAM)- Science Foundation Ireland (SFI), University of Galway, Galway, Ireland
| | | | - Duaa Jabrah
- Department of Physiology, University of Galway, Galway, Ireland
| | - Smita Patil
- Department of Physiology, University of Galway, Galway, Ireland
- Centre for Research in Medical Devices (CÚRAM)- Science Foundation Ireland (SFI), University of Galway, Galway, Ireland
| | | | | | - Jean Darcourt
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Federico Sacchetti
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Guillaume Bellanger
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Jorge Pagola
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Jesus Juega
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Laurent Spelle
- Department of Interventional Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Uros Mircic
- Department of Neuroradiology, Centre for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Ivan Vukašinović
- Department of Neuroradiology, Centre for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Center of Serbia, Belgrade, Serbia
| | - Marc Ribo
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Karen Doyle
- Department of Physiology, University of Galway, Galway, Ireland
- Centre for Research in Medical Devices (CÚRAM)- Science Foundation Ireland (SFI), University of Galway, Galway, Ireland
| |
Collapse
|
4
|
Bellanger G, Darcourt J, Januel AC, Cognard C. The reversed umbrella: displacement of a Contour device into an MCA aneurysm 18 months after treatment. J Neurointerv Surg 2024; 16:213-215. [PMID: 36941045 DOI: 10.1136/jnis-2022-019814] [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: 10/29/2022] [Accepted: 02/05/2023] [Indexed: 03/22/2023]
Abstract
SummaryThe Contour is a promising new device designed to treat large-neck intra-cranial aneurysms. We describe a first case of Contour device displacement 18 months after initial treatment.A patient with a 10 mm unruptured right middle cerebral artery bifurcation aneurysm was treated with a 9 mm Contour. The device was correctly positioned at the neck during treatment and at the 6 month angiography follow-up. At 18 months follow-up we noticed a full displacement of the device into the aneurysm dome. The Contour had a reversed shape and the aneurysm was still fully opacified. No neurological event occurred during the whole follow-up. Contour may be a promising tool but needs to be assessed over a long-term period.
Collapse
Affiliation(s)
| | - Jean Darcourt
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | | | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| |
Collapse
|
5
|
Chicanne G, Darcourt J, Bertrand-Michel J, Garcia C, Ribes A, Payrastre B. What can we learn from the platelet lipidome? Platelets 2023; 34:2182180. [PMID: 36880158 DOI: 10.1080/09537104.2023.2182180] [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: 03/08/2023]
Abstract
Besides their proteome, platelets use, in all responses to the environmental cues, a huge and diverse family of hydrophobic and amphipathic small molecules involved in structural, metabolic and signaling functions; the lipids. Studying how platelet lipidome changes modulate platelet function is an old story constantly renewed through the impressive technical advances allowing the discovery of new lipids, functions and metabolic pathways. Technical progress in analytical lipidomic profiling by top-of-the-line approaches such as nuclear magnetic resonance and gas chromatography or liquid chromatography coupled to mass spectrometry enables either large-scale analysis of lipids or targeted lipidomics. With the support of bioinformatics tools and databases, it is now possible to investigate thousands of lipids over a concentration range of several orders of magnitude. The lipidomic landscape of platelets is considered a treasure trove, not only able to expand our knowledge of platelet biology and pathologies but also to bring diagnostic and therapeutic opportunities. The aim of this commentary article is to summarize the advances in the field and to highlight what lipidomics can tell us about platelet biology and pathophysiology.
Collapse
Affiliation(s)
- Gaëtan Chicanne
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France
| | - Jean Darcourt
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France
| | - Justine Bertrand-Michel
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France.,MetaboHUB-MetaToul, National Infrastructure of Metabolomics and Fluxomics, Toulouse, France
| | - Cédric Garcia
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France.,Laboratory of Haematology, University Hospital of Toulouse, Toulouse, France
| | - Agnès Ribes
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France.,Laboratory of Haematology, University Hospital of Toulouse, Toulouse, France
| | - Bernard Payrastre
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France.,Laboratory of Haematology, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
6
|
Marnat G, Finistis S, Moreno R, Sibon I, Pop R, Mazighi M, Clarençon F, Rosso C, Dargazanli C, Darcourt J, Olivot JM, Boulouis G, Janot K, Moulin S, Bourcier R, Consoli A, Richard S, Arquizan C, Vannier S, Richter S, Gentric JC, Papagiannaki C, Naggara O, Eker OF, Lapergue B, Caroff J, Gory B. Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results. J Neurointerv Surg 2023; 15:e248-e254. [PMID: 36357169 DOI: 10.1136/jnis-2022-019527] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice. METHODS The Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up. RESULTS Among the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0-2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158). CONCLUSIONS In tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.
Collapse
Affiliation(s)
- Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Stefanos Finistis
- Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Ricardo Moreno
- Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Igor Sibon
- Neurology, CHU de Bordeaux, Bordeaux, France
| | - Raoul Pop
- Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Mikaël Mazighi
- Interventional Neuroradiology, Fondation Rothschild, Paris, France
- Neurology, GH Lariboisiere Fernand-Widal, Paris, France
| | - Frédéric Clarençon
- Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
- Sorbonne University, Paris, France
| | - Charlotte Rosso
- Neurology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Cyril Dargazanli
- Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | | | | | | | | | - Solène Moulin
- Neurology, University Hospital Centre Reims, Reims, France
| | | | | | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | | | | | | | | | | | | | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | | | - Jildaz Caroff
- Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| |
Collapse
|
7
|
Anadani M, Finitsis S, Pop R, Darcourt J, Clarençon F, Richard S, de Havenon A, Liebeskind D, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Blanc R, Lapergue B, Consoli A, Eugène F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Papagiannaki C, Olivot JM, Le Bras A, Evain S, Wolff V, Timsit S, Gentric JC, Bourdain F, Veunac L, Maïer B, Ben Hassen W, Gory B. ASPECTS evolution after endovascular successful reperfusion in the early and extended time window. Interv Neuroradiol 2023:15910199231196953. [PMID: 37671452 DOI: 10.1177/15910199231196953] [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: 09/07/2023] Open
Abstract
BACKGROUND The Alberta Stroke Program Early CT scan Score (ASPECTS) is a reliable imaging biomarker of infarct extent on admission but the value of 24-hour ASPECTS evolution in day-to-day practice is not well studied, especially after successful reperfusion. We aimed to assess the association between ASPECTS evolution after successful reperfusion with functional and safety outcomes, as well as to identify the predictors of ASPECTS evolution. METHODS We used data from an ongoing prospective multicenter registry. Stroke patients with anterior circulation large vessel occlusion treated with endovascular therapy (EVT) and achieved successful reperfusion (modified thrombolysis in cerebral ischemia (mTICI) 2b-3) were included. ASPECTS evolution was defined as one or more point decrease in ASPECTS at 24 hours. RESULTS A total of 2366 patients were enrolled. In a fully adjusted model, ASPECTS evolution was associated with lower odds of favorable outcome (modified Rankin Scale (mRS) score 0-2) at 90 days (adjusted odds ratio (aOR) = 0.46; 95% confidence interval (CI) = 0.37-0.57). In addition, ASPECTS evolution was a predictor of excellent outcome (90-day mRS 0-1) (aOR = 0.52; 95% CI = 0.49-0.57), early neurological improvement (aOR = 0.42; 95% CI = 0.35-0.51), and parenchymal hemorrhage (aOR = 2.64; 95% CI, 2.03-3.44). Stroke severity, admission ASPECTS, total number of passes, complete reperfusion (mTICI 3 vs. mTICI 2b-2c) and good collaterals emerged as predictors of ASPECTS evolution. CONCLUSION ASPECTS evolution is a strong predictor of functional and safety outcomes after successful endovascular therapy. Higher number of EVT attempts and incomplete reperfusion are associated with ASPECTS evolution at day 1.
Collapse
Affiliation(s)
- Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Stephanos Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, France
| | - Jean Darcourt
- Department of Neuroradiolology, CHU Toulouse, France
| | | | - Sébastien Richard
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France
- CIC-P 1433, INSERM U1116, CHRU-Nancy, Nancy, France
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - David Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core & UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, France
| | | | - Jildaz Caroff
- Department of Neuroradiolology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Christian Denier
- Department of Neurology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | | | | | - Suzana Saleme
- Department of Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Francisco Macian
- Department of Neurology, University Hospital of Limoges, Limoges, France
| | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpêtrière, Paris, France
| | - Guillaume Turc
- Department of Neurology, Hôpital Saint-Anne, Paris, France
| | | | | | | | - Anthony Le Bras
- Department of Neurology, CH Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Department of Neuroradiolology, CH Bretagne Atlantique, Vannes, France
| | | | | | | | | | - Louis Veunac
- Department of Neuroradiolology, CH Côte Basque, Bayonne, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Wagih Ben Hassen
- Department of Neuroradiolology, Hôpital Saint-Anne, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
- Université de Lorraine, IADI, INSERM U1254, Nancy, France
| |
Collapse
|
8
|
Meinel TR, Kaesmacher J, Buetikofer L, Strbian D, Eker OF, Cognard C, Mordasini P, Deppeler S, Mendes Pereira V, Albucher JF, Darcourt J, Bourcier R, Guillon B, Papagiannaki C, Costentin G, Sibolt G, Räty S, Gory B, Richard S, Liman J, Ernst M, Boulanger M, Barbier C, Mechtouff L, Zhang L, Marnat G, Sibon I, Nikoubashman O, Reich A, Consoli A, Weisenburger D, Requena M, Garcia-Tornel A, Saleme S, Moulin S, Pagano P, Saliou G, Carrera E, Janot K, Boix M, Pop R, Della Schiava L, Luft A, Piotin M, Gentric JC, Pikula A, Pfeilschifter W, Arnold M, Siddiqui A, Froehler MT, Furlan AJ, Chapot R, Wiesmann M, Machi P, Diener HC, Kulcsar Z, Bonati L, Bassetti C, Escalard S, Liebeskind D, Saver JL, Fischer U, Gralla J. Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial. J Neurointerv Surg 2023; 15:e102-e110. [PMID: 35902234 DOI: 10.1136/jnis-2022-019207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). METHODS We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. RESULTS We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. CONCLUSIONS We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT03192332.
Collapse
Affiliation(s)
- Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Omer Faruk Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sandro Deppeler
- Neuro Clinical Trial Unit, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Vitor Mendes Pereira
- Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Jean Darcourt
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Benoit Guillon
- Department of Neurology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | | | | | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, INSERM U1254, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, CHRU-Nancy, Université de Lorraine, INSERM U1116, Nancy, France
| | - Jan Liman
- Department of Neurology, Klinikum Nürnberg, Nürnberg, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Gottingen, Germany
| | - Marion Boulanger
- Deparment of Neurology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Charlotte Barbier
- Department of Neuroradiology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Laura Mechtouff
- Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France
| | - Liqun Zhang
- Department of Neurology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arno Reich
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arturo Consoli
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - David Weisenburger
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Heborn, Barcelona, Spain
| | | | - Suzana Saleme
- Department of Neuroradiology, CHU Limoges, Limoges, France
| | | | - Paolo Pagano
- Department of Neuroradiology, CHU Reims, Reims, France
| | - Guillaume Saliou
- Service of Interventional and Diagnostic Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Kevin Janot
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France
| | - Marti Boix
- Stroke Unit, Department of Neurosciences, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Raoul Pop
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Andreas Luft
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Michel Piotin
- Department of interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Aleksandra Pikula
- Department of Neurology, University Health Network - Toronto Western Hospital - University of Toronto, Toronto, Ontario, Canada
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael T Froehler
- Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony J Furlan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Paolo Machi
- Department of Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Leo Bonati
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Claudio Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Escalard
- Department of interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - David Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, University of California, Los Angeles, California, USA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, University of California, Los Angeles, California, USA
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Geeraerts T, Guilbeau-Frugier C, Garcia C, Memier V, Raposo N, Bonneville F, Gales C, Darcourt J, Voisin S, Ribes A, Piel-Julian M, Bounes F, Albucher JF, Roux FE, Izopet J, Telmon N, Olivot JM, Sié P, Bauer J, Payrastre B, Liblau RS. Immunohistologic Features of Cerebral Venous Thrombosis Due to Vaccine-Induced Immune Thrombotic Thrombocytopenia. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/4/e200127. [PMID: 37236806 DOI: 10.1212/nxi.0000000000200127] [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] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Vaccine-induced immune thrombotic thrombocytopenia (VITT), a recently described entity characterized by thrombosis at unusual locations such as cerebral venous sinus and splanchnic vein, has been rarely described after adenoviral-encoded COVID-19 vaccines. In this study, we report the immunohistological correlates in 3 fatal cases of cerebral venous thrombosis related to VITT analyzed at an academic medical center. METHODS Detailed neuropathologic studies were performed in 3 cases of cerebral venous thrombosis related to VITT after adenoviral COVID-19 vaccination. RESULTS Autopsy revealed extensive cerebral vein thrombosis in all 3 cases. Polarized thrombi were observed with a high density of neutrophils in the core and a low density in the tail. Endothelial cells adjacent to the thrombus were largely destroyed. Markers of neutrophil extracellular trap and complement activation were present at the border and within the cerebral vein thrombi. SARS-CoV-2 spike protein was detected within the thrombus and in the adjacent vessel wall. DISCUSSION Data indicate that neutrophils and complement activation associated with antispike immunity triggered by the vaccine is probably involved in the disease process.
Collapse
Affiliation(s)
- Thomas Geeraerts
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Céline Guilbeau-Frugier
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Cédric Garcia
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Vincent Memier
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Nicolas Raposo
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Fabrice Bonneville
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Céline Gales
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jean Darcourt
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Sophie Voisin
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Agnès Ribes
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Marie Piel-Julian
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Fanny Bounes
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jean François Albucher
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Franck-Emmanuel Roux
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jacques Izopet
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Norbert Telmon
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jean Marc Olivot
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Pierre Sié
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jan Bauer
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Bernard Payrastre
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Roland S Liblau
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France.
| |
Collapse
|
10
|
Darcourt J, Brinjikji W, François O, Giraud A, Johnson CR, Patil S, Staessens S, Kadirvel R, Mohammaden MH, Pisani L, Rodrigues GM, Cancelliere NM, Pereira VM, Bozsak F, Doyle K, De Meyer SF, Messina P, Kallmes D, Cognard C, Nogueira RG. Identifying ex vivo acute ischemic stroke thrombus composition using electrochemical impedance spectroscopy. Interv Neuroradiol 2023:15910199231175377. [PMID: 37192738 DOI: 10.1177/15910199231175377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Intra-procedural characterization of stroke thromboemboli might guide mechanical thrombectomy (MT) device choice to improve recanalization rates. Electrochemical impedance spectroscopy (EIS) has been used to characterize various biological tissues in real time but has not been used in thrombus. OBJECTIVE To perform a feasibility study of EIS analysis of thrombi retrieved by MT to evaluate: (1) the ability of EIS and machine learning to predict red blood cell (RBC) percentage content of thrombi and (2) to classify the thrombi as "RBC-rich" or "RBC-poor" based on a range of cutoff values of RBC. METHODS ClotbasePilot was a multicentric, international, prospective feasibility study. Retrieved thrombi underwent histological analysis to identify proportions of RBC and other components. EIS results were analyzed with machine learning. Linear regression was used to evaluate the correlation between the histology and EIS. Sensitivity and specificity of the model to classify the thrombus as RBC-rich or RBC-poor were also evaluated. RESULTS Among 514 MT,179 thrombi were included for EIS and histological analysis. The mean composition in RBC of the thrombi was 36% ± 24. Good correlation between the impedance-based prediction and histology was achieved (slope of 0.9, R2 = 0.53, Pearson coefficient = 0.72). Depending on the chosen cutoff, ranging from 20 to 60% of RBC, the calculated sensitivity for classification of thrombi ranged from 77 to 85% and the specificity from 72 to 88%. CONCLUSION Combination of EIS and machine learning can reliably predict the RBC composition of retrieved ex vivo AIS thrombi and then classify them into groups according to their RBC composition with good sensitivity and specificity.
Collapse
Affiliation(s)
- Jean Darcourt
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| | - Waleed Brinjikji
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | | | | | - Collin R Johnson
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Smita Patil
- Department of Physiology, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
- CÚRAM - SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Belgium
| | - Ramanathan Kadirvel
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mahmoud H Mohammaden
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | | | - Nicole M Cancelliere
- Department of Neurosurgery, Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Department of Neurosurgery, Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | | | - Karen Doyle
- Department of Physiology, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
- CÚRAM - SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Belgium
| | | | - David Kallmes
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| | - Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, Pittsburg, PA, USA
| |
Collapse
|
11
|
Hedjoudje A, Darcourt J, Bonneville F, Edjlali M. The Use of Intracranial Vessel Wall Imaging in Clinical Practice. Radiol Clin North Am 2023; 61:521-533. [PMID: 36931767 DOI: 10.1016/j.rcl.2023.01.007] [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: 03/17/2023]
Abstract
Three-dimensional vessel wall MR imaging has gained popularity in the diagnosis and management of patients with cerebrovascular disease in clinical practice. Vessel wall MR imaging is an imaging technique that delivers a fundamentally different viewpoint by emphasizing on the pathology of the vessel wall as opposed to traditional descriptions that focus on the vessel lumen. It shows a crucial power in detecting vessel wall changes in patients with diseases including, but not limited to, central nervous system vasculitis, moyamoya disease, aneurysms, dissections, and intracranial atherosclerotic disease.
Collapse
Affiliation(s)
- Abderrahmane Hedjoudje
- Department of Diagnostic and Interventional Neuroradiology, Sion Hospital, CHVR, Sion, Switzerland; Laboratoire D'imagerie Biomédicale Multimodale (BioMaps), Université Paris-Saclay, CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Orsay, France.
| | - Jean Darcourt
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Fabrice Bonneville
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Myriam Edjlali
- Laboratoire D'imagerie Biomédicale Multimodale (BioMaps), Université Paris-Saclay, CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Orsay, France; Department of Radiology, APHP, Hôpitaux Raymond-Poincaré & Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, Paris, France
| |
Collapse
|
12
|
Fukutomi H, Yamamoto T, Sibon I, Christensen S, Raposo N, Marnat G, Albucher JF, Olindo S, Calvière L, Sagnier S, Viguier A, Renou P, Guenego A, Poli M, Darcourt J, Debruxelles S, Drif A, Thalamas C, Sommet A, Rousseau V, Mazighi M, Bonneville F, Albers GW, Cognard C, Dousset V, Olivot JM, Tourdias T. Location-weighted versus Volume-weighted Mismatch at MRI for Response to Mechanical Thrombectomy in Acute Stroke. Radiology 2023; 306:e220080. [PMID: 36194114 PMCID: PMC9885343 DOI: 10.1148/radiol.220080] [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: 01/10/2022] [Revised: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023]
Abstract
Background A target mismatch profile can identify good clinical response to recanalization after acute ischemic stroke, but does not consider region specificities. Purpose To test whether location-weighted infarction core and mismatch, determined from diffusion and perfusion MRI performed in patients with acute stroke, could improve prediction of good clinical response to mechanical thrombectomy compared with a target mismatch profile. Materials and Methods In this secondary analysis, two prospectively collected independent stroke data sets (2012-2015 and 2017-2019) were analyzed. From the brain before stroke (BBS) study data (data set 1), an eloquent map was computed through voxel-wise associations between the infarction core (based on diffusion MRI on days 1-3 following stroke) and National Institutes of Health Stroke Scale (NIHSS) score. The French acute multimodal imaging to select patients for mechanical thrombectomy (FRAME) data (data set 2) consisted of large vessel occlusion-related acute ischemic stroke successfully recanalized. From acute MRI studies (performed on arrival, prior to thrombectomy) in data set 2, target mismatch and eloquent (vs noneloquent) infarction core and mismatch were computed from the intersection of diffusion- and perfusion-detected lesions with the coregistered eloquent map. Associations of these imaging metrics with early neurologic improvement were tested in multivariable regression models, and areas under the receiver operating characteristic curve (AUCs) were compared. Results Data sets 1 and 2 included 321 (median age, 69 years [IQR, 58-80 years]; 207 men) and 173 (median age, 74 years [IQR, 65-82 years]; 90 women) patients, respectively. Eloquent mismatch was positively and independently associated with good clinical response (odds ratio [OR], 1.14; 95% CI: 1.02, 1.27; P = .02) and eloquent infarction core was negatively associated with good response (OR, 0.85; 95% CI: 0.77, 0.95; P = .004), while noneloquent mismatch was not associated with good response (OR, 1.03; 95% CI: 0.98, 1.07; P = .20). Moreover, adding eloquent metrics improved the prediction accuracy (AUC, 0.73; 95% CI: 0.65, 0.81) compared with clinical variables alone (AUC, 0.65; 95% CI: 0.56, 0.73; P = .01) or a target mismatch profile (AUC, 0.67; 95% CI: 0.59, 0.76; P = .03). Conclusion Location-weighted infarction core and mismatch on diffusion and perfusion MRI scans improved the identification of patients with acute stroke who would benefit from mechanical thrombectomy compared with the volume-based target mismatch profile. Clinical trial registration no. NCT03045146 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Nael in this issue.
Collapse
Affiliation(s)
- Hikaru Fukutomi
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Takayuki Yamamoto
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Igor Sibon
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Soren Christensen
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Nicolas Raposo
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Gaultier Marnat
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Jean-François Albucher
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Stéphane Olindo
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Lionel Calvière
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Sharmila Sagnier
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Alain Viguier
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Pauline Renou
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Adrien Guenego
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Mathilde Poli
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Jean Darcourt
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Sabrina Debruxelles
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Amel Drif
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Claire Thalamas
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Agnès Sommet
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Vanessa Rousseau
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Mikael Mazighi
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Fabrice Bonneville
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Gregory W. Albers
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Christophe Cognard
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Vincent Dousset
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Jean Marc Olivot
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Thomas Tourdias
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | | |
Collapse
|
13
|
Villemaire A, Adam G, Fayolle H, Roques M, Darcourt J, Caron P, Bonneville F. Is systematic Gadolinium injection relevant during MRI follow-up for non-functioning pituitary macroadenomas? J Neuroradiol 2023; 50:3-8. [PMID: 36055429 DOI: 10.1016/j.neurad.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare the performance of coronal contrast-enhanced T1-weighted (ceT1-w) and T2-weighted (T2-w) sequences for diagnosing progression during the MRI follow-up of Non-Functioning Pituitary MacroAdenomas (NFPMAs). PATIENTS AND METHODS 106 patients, who had at least two MRIs for the follow-up of NFPMA, were enrolled retrospectively. The largest adenoma diameter was measured on coronal ceT1-w sequences and separately on T2-w sequences for all follow-up MRIs. Interobserver variability was also assessed by 2 independent neuroradiologists in a sample series of 100 examinations. Progression was defined by an increase ≥ 2 mm in diameter between 2 MRIs. Progression thresholds of 3 and 4 mm were also tested. The results of ceT1-w and T2-w sequences were analysed for concordance. RESULTS 93.1% concordance was achieved between ceT1-w and T2-w coronal sequences in 580 follow-up MRIs. In the case of progression detected on at least one sequence, 64.4% concordance was documented for a 2-mm threshold, 87.7% for 3-mm and 97.1% for 4-mm. Discordance was mainly observed on the first postoperative MRI and in case of NFPMAs with multiple recurrences. Kappa was better for diagnosing progression on T2-w than on ceT1-w sequences (0.67 vs. 0.54). It should be noted that 100% agreement was observed between the 2 sequences in the 82 follow-up MRIs of patients with complete surgical resection. CONCLUSION 93.1% concordance was achieved for coronal ceT1-w and T2-w sequences during the MRI follow-up of NFPMAs, thus challenging systematic injection of gadolinium. If MRI without gadolinium injection is a first-line option, our results suggest that ceT1-w sequences should be reserved for the first postoperative MRI and for the follow-up of aggressive and recurrent NFPMAs.
Collapse
Affiliation(s)
- Axel Villemaire
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France.
| | - Gilles Adam
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France
| | | | - Margaux Roques
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France
| | - Jean Darcourt
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France
| | - Philippe Caron
- Endocrinology-Metabolic and nutrition Diseases, CHU Toulouse, Toulouse, France
| | | |
Collapse
|
14
|
Marnat G, Holay Q, Darcourt J, Desilles JP, Obadia M, Viguier A, Caroff J, Denier C, Papillon L, Barreau X, Cognard C, Berge J, Bourgeois-Beauvais Q, Landais A, Boulanger M, Macian F, Guillon B, Pico F, Lamy M, Robinet-Borgomano E, Richard S, Gory B, Sibon I, Gaillard N, Chausson N, Olindo S. Dual-layer carotid stenting for symptomatic carotid web: Results from the Caroweb study. J Neuroradiol 2022; 50:444-448. [PMID: 36563743 DOI: 10.1016/j.neurad.2022.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & PURPOSE Carotid Web (CaW) is a growingly recognized cause of ischemic stroke, associated with a high recurrence risk. Several therapeutic strategies have been proposed as a tertiary prevention including carotid stenting, endarterectomy and antithrombotic medications. Among these, carotid stenting with dual-layer stent may be promising to adequately cover the focal arterial dysplasia. Our aim was to investigate the safety and efficacy of the Casper stent in the treatment of symptomatic CaW. METHODS We conducted a retrospective analysis of consecutive patients presenting with a symptomatic CaW and included in the ongoing prospective observational multicenter CAROWEB registry. The study period was January 2015 to December 2021. Inclusion criteria were CaW treated with dual-layer Casper stent. Patients treated with other types of carotid stent, endarterectomy or antithrombotic medication were excluded. Clinical and radiological initial data and outcomes were recorded. RESULTS twenty-seven patients (with 28 caw) were included. median age was 52 (iqr: 46-68). median delay between index cerebrovascular event and cervical stenting was 9 days (IQR: 6-101). In all cases, the cervical carotid stenting was successfully performed. No major perioperative complication was recorded. No recurrent stroke or transient ischemic attack was observed during a median follow-up time of 272 days (IQR: 114-635). Long-term imaging follow-up was available in 25/28 (89.3%) stented CaW with a median imaging follow-up of 183 days (IQR: 107-676; range: 90-1542). No in-stent occlusion or stenosis was detected. CONCLUSION In this study, carotid stenting with dual-layer Casper stent in the treatment of symptomatic CaW was effective regarding stroke recurrence prevention and safe, without procedural nor delayed detected adverse event. However, the optimal therapeutic approach of symptomatic CaW still needs to be explored through randomized trials.
Collapse
Affiliation(s)
- Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Quentin Holay
- Department of Interventional Neuroradiology, Rothschild foundation hospital, Paris, France
| | - Jean Darcourt
- Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild foundation hospital, Paris, France
| | - Michael Obadia
- Department of Neurology, Rothschild foundation hospital Paris, France
| | - Alain Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, CHU Bicêtre APHP, Kremlin Bicêtre, France
| | - Christian Denier
- Department of Neurology, CHU Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Lisa Papillon
- Department of Neurology, Stroke Unit, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jerome Berge
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | - Anne Landais
- Department of Neurology, Point à Pitre Hospital, Pointe à Pitre, France
| | - Marion Boulanger
- Department of Neurology, Caen University Hospital, Caen, University Caen Normandy, France
| | - Francisco Macian
- Department of Neurology, Limoges University Hospital, Limoges, France
| | - Benoit Guillon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Fernando Pico
- Department of Neurology, Versailles Hospital, Le Chesnay, France
| | - Mathias Lamy
- Department of Neurology, Poitiers University Hospital, Poitiers, France
| | | | - Sébastien Richard
- Neurology Department, Nancy University Hospital, Nancy, France - INSERM U1116, Nancy, France
| | - Benjamin Gory
- France Department of Interventional and Diagnostic Neuroradiology, Nancy University Hospital, Nancy, France
| | - Igor Sibon
- Department of Neurology, Martinique University Hospital, Fort-de-France, France
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Nicolas Chausson
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Stephane Olindo
- Department of Neurology, Martinique University Hospital, Fort-de-France, France
| | | |
Collapse
|
15
|
Panni P, Lapergue B, Maïer B, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Blanc R, Consoli A, Eugène F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Darcourt J, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Arquizan C, Gory B. Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke. Clin Neuroradiol 2022; 32:939-950. [PMID: 35412044 DOI: 10.1007/s00062-022-01156-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice. METHODS We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr. RESULTS Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization (mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3-7.9; p 0.009). CONCLUSION The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr predictor.
Collapse
Affiliation(s)
- Pietro Panni
- Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy.
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Stephanos Finitsis
- AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Sébastien Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine, 54000, Nancy, France.,CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Igor Sibon
- Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - Raphaël Blanc
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | | | | | | | | | | | | | | | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpétrière, Paris, France
| | | | - Guillaume Turc
- Department of Neurology, Hôpital Saint-Anne, Paris, France
| | | | | | | | | | - Anthony Le Bras
- Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Neurology, CHBA Bretagne Atlantique, Vannes, France
| | - Valérie Wolff
- Department of Neurology, CHU Strasbourg, Strasbourg, France
| | - Raoul Pop
- Neuroradiology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | | | | | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, 54000, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France
| | | |
Collapse
|
16
|
Roques M, Catalaa I, Raveneau M, Attal J, Siegfried A, Darcourt J, Cognard C, de Champfleur NM, Bonneville F. Assessment of the hypervascularized fraction of glioblastomas using a volume analysis of dynamic susceptibility contrast-enhanced MRI may help to identify pseudoprogression. PLoS One 2022; 17:e0270216. [PMID: 36227862 PMCID: PMC9560146 DOI: 10.1371/journal.pone.0270216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Although perfusion magnetic resonance imaging (MRI) is widely used to identify pseudoprogression, this advanced technique lacks clinical reliability. Our aim was to develop a parameter assessing the hypervascularized fraction of glioblastomas based on volume analysis of dynamic susceptibility contrast-enhanced MRI and evaluate its performance in the diagnosis of pseudoprogression. METHODS Patients with primary glioblastoma showing lesion progression on the first follow-up MRI after chemoradiotherapy were enrolled retrospectively. On both initial and first follow-up MRIs, the leakage-corrected cerebral blood volume (CBV) maps were post-processed using the conventional hot-spot method and a volume method, after manual segmentation of the contrast-enhanced delineated lesion. The maximum CBV (rCBVmax) was calculated with both methods. Secondly, the threshold of 2 was applied to the CBV values contained in the entire segmented volume, defining our new parameter: %rCBV>2. The probability of pseudoprogression based on rCBVmax and %rCBV>2 was calculated in logistic regression models and diagnostic performance assessed by receiving operator characteristic curves. RESULTS Out of 25 patients, 11 (44%) were classified with pseudoprogression and 14 (56%) with true progression based on the Response Assessement in Neuro-Oncology criteria. rCBVmax was lower for pseudoprogression (3.4 vs. 7.6; p = 0.033) on early follow-up MRI. %rCBV>2, was lower for pseudoprogression on both initial (57.5% vs. 71.3%; p = 0.033) and early follow-up MRIs (22.1% vs. 51.8%; p = 0.0006). On early follow-up MRI, %rCBV>2 had the largest area under the curve for the diagnosis of pseudoprogression: 0.909 [0.725-0.986]. CONCLUSION The fraction of hypervascularization of glioblastomas as assessed by %rCBV>2 was lower in tumours that subsequently developed pseudoprogression both on the initial and early follow-up MRIs. This fractional parameter may help identify pseudoprogression with greater accuracy than rCBVmax.
Collapse
Affiliation(s)
- Margaux Roques
- Department of Neuroradiology, Toulouse Hospital, Toulouse, France
- * E-mail:
| | - Isabelle Catalaa
- Department of Neuroradiology, Toulouse Hospital, Toulouse, France
| | - Magali Raveneau
- Department of Neuroradiology, Toulouse Hospital, Toulouse, France
| | - Justine Attal
- Department of Radiotherapy, IUCT Toulouse (Toulouse University Cancer Institute), Toulouse, France
| | | | - Jean Darcourt
- Department of Neuroradiology, Toulouse Hospital, Toulouse, France
| | | | | | | |
Collapse
|
17
|
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Fischer U, Kaesmacher J, Strbian D, Eker O, Cognard C, Plattner PS, Bütikofer L, Mordasini P, Deppeler S, Pereira VM, Albucher JF, Darcourt J, Bourcier R, Benoit G, Papagiannaki C, Ozkul-Wermester O, Sibolt G, Tiainen M, Gory B, Richard S, Liman J, Ernst MS, Boulanger M, Barbier C, Mechtouff L, Zhang L, Marnat G, Sibon I, Nikoubashman O, Reich A, Consoli A, Lapergue B, Ribo M, Tomasello A, Saleme S, Macian F, Moulin S, Pagano P, Saliou G, Carrera E, Janot K, Hernández-Pérez M, Pop R, Schiava LD, Luft AR, Piotin M, Gentric JC, Pikula A, Pfeilschifter W, Arnold M, Siddiqui AH, Froehler MT, Furlan AJ, Chapot R, Wiesmann M, Machi P, Diener HC, Kulcsar Z, Bonati LH, Bassetti CL, Mazighi M, Liebeskind DS, Saver JL, Gralla J. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet 2022; 400:104-115. [PMID: 35810756 DOI: 10.1016/s0140-6736(22)00537-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether thrombectomy alone is equally as effective as intravenous alteplase plus thrombectomy remains controversial. We aimed to determine whether thrombectomy alone would be non-inferior to intravenous alteplase plus thrombectomy in patients presenting with acute ischaemic stroke. METHODS In this multicentre, randomised, open-label, blinded-outcome trial in Europe and Canada, we recruited patients with stroke due to large vessel occlusion confirmed with CT or magnetic resonance angiography admitted to endovascular centres. Patients were randomly assigned (1:1) via a centralised web server using a deterministic minimisation method to receive stent-retriever thrombectomy alone or intravenous alteplase plus stent-retriever thrombectomy. In both groups, thrombectomy was initiated as fast as possible with any commercially available Solitaire stent-retriever revascularisation device (Medtronic, Irvine, CA, USA). In the combined treatment group, intravenous alteplase (0·9 mg/kg bodyweight, maximum dose 90 mg per patient) was administered as early as possible after randomisation for 60 min with 10% of the calculated dose given as an initial bolus. Personnel assessing the primary outcome were masked to group allocation; patients and treating physicians were not. The primary binary outcome was a score of 2 or less on the modified Rankin scale at 90 days. We assessed the non-inferiority of thrombectomy alone versus intravenous alteplase plus thrombectomy in all randomly assigned and consenting patients using the one-sided lower 95% confidence limit of the Mantel-Haenszel risk difference, with a prespecified non-inferiority margin of 12%. The main safety endpoint was symptomatic intracranial haemorrhage assessed in all randomly assigned and consenting participants. This trial is registered with ClinicalTrials.gov, NCT03192332, and is closed to new participants. FINDINGS Between Nov 29, 2017, and May 7, 2021, 5215 patients were screened and 423 were randomly assigned, of whom 408 (201 thrombectomy alone, 207 intravenous alteplase plus thrombectomy) were included in the primary efficacy analysis. A modified Rankin scale score of 0-2 at 90 days was reached by 114 (57%) of 201 patients assigned to thrombectomy alone and 135 (65%) of 207 patients assigned to intravenous alteplase plus thrombectomy (adjusted risk difference -7·3%, 95% CI -16·6 to 2·1, lower limit of one-sided 95% CI -15·1%, crossing the non-inferiority margin of -12%). Symptomatic intracranial haemorrhage occurred in five (2%) of 201 patients undergoing thrombectomy alone and seven (3%) of 202 patients receiving intravenous alteplase plus thrombectomy (risk difference -1·0%, 95% CI -4·8 to 2·7). Successful reperfusion was less common in patients assigned to thrombectomy alone (182 [91%] of 201 vs 199 [96%] of 207, risk difference -5·1%, 95% CI -10·2 to 0·0, p=0·047). INTERPRETATION Thrombectomy alone was not shown to be non-inferior to intravenous alteplase plus thrombectomy and resulted in decreased reperfusion rates. These results do not support omitting intravenous alteplase before thrombectomy in eligible patients. FUNDING Medtronic and University Hospital Bern.
Collapse
Affiliation(s)
- Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Omer Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Christoph Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Patricia S Plattner
- Neuro Clinical Trial Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandro Deppeler
- Neuro Clinical Trial Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vitor M Pereira
- Division of Neurosurgery, Department of Surgery and Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Jean Darcourt
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Guillon Benoit
- Department of Neurology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | | | | | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, INSERM U1116, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Jan Liman
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Marielle Sophie Ernst
- Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Marion Boulanger
- Department of Neurology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Charlotte Barbier
- Department of Neuroradiology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Laura Mechtouff
- Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France
| | - Liqun Zhang
- Department of Neurology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arno Reich
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arturo Consoli
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Bertrand Lapergue
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Heborn, Barcelona, Spain
| | - Suzana Saleme
- Department of Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Francisco Macian
- Department of Neurology, University Hospital of Limoges, Limoges, France
| | | | - Paolo Pagano
- Department of Neuroradiology, CHU Reims, Reims, France
| | - Guillaume Saliou
- Service of Interventional and Diagnostic Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Kevin Janot
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France
| | - María Hernández-Pérez
- Stroke Unit, Department of Neurosciences, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Raoul Pop
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Andreas R Luft
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland; Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Jean Christophe Gentric
- Department of Neuroradiology, Brest University Hospital, Brest, France; GETBO, INSERM Unit UMR 1034, Brest, France
| | - Aleksandra Pikula
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, NY, USA
| | - Michael T Froehler
- Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony J Furlan
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Paolo Machi
- Department of Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology IMIBE), Essen, Germany
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Leo H Bonati
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mikael Mazighi
- Department of Neurology, Lariboisière Hospital, University of Paris, FHU NeuroVasc, INSERM 1148, Paris, France; Department of Interventional Neuroradiology, Adolphe de Rothschild Hospital Foundation, University of Paris, FHU NeuroVasc, INSERM 1148, Paris, France
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
19
|
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.
Collapse
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.
| | | |
Collapse
|
20
|
Messina P, Garcia C, Rambeau J, Darcourt J, Balland R, Carreel B, Cottance M, Gusarova E, Lafaurie-Janvore J, Lebedev G, Bozsak F, Barakat AI, Payrastre B, Cognard C. Impedance-based sensors discriminate among different types of blood thrombi with very high specificity and sensitivity. J Neurointerv Surg 2022; 15:526-530. [PMID: 35478173 DOI: 10.1136/neurintsurg-2021-018631] [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: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intracranial occlusion recanalization fails in 20% of endovascular thrombectomy procedures, and thrombus composition is likely to be an important factor. In this study, we demonstrate that the combination of electrical impedance spectroscopy (EIS) and machine learning constitutes a novel and highly accurate method for the identification of different human thrombus types. METHODS 134 samples, subdivided into four categories, were analyzed by EIS: 29 'White', 26 'Mixed', 12 'Red' thrombi, and 67 liquid 'Blood' samples. Thrombi were generated in vitro using citrated human blood from five healthy volunteers. Histological analysis was performed to validate the thrombus categorization based on red blood cell content. A machine learning prediction model was trained on impedance data to differentiate blood samples from any type of thrombus and in between the four sample categories. RESULTS Histological analysis confirmed the similarity between the composition of in vitro generated thrombi and retrieved human thrombi. The prediction model yielded a sensitivity/specificity of 90%/99% for distinguishing blood samples from thrombi and a global accuracy of 88% for differentiating among the four sample categories. CONCLUSIONS Combining EIS measurements with machine learning provides a highly effective approach for discriminating among different thrombus types and liquid blood. These findings raise the possibility of developing a probe-like device (eg, a neurovascular guidewire) integrating an impedance-based sensor. This sensor, placed in the distal part of the smart device, would allow the characterization of the probed thrombus on contact. The information could help physicians identify optimal thrombectomy strategies to improve outcomes for stroke patients.
Collapse
Affiliation(s)
| | - Cédric Garcia
- INSERM, U1048, Toulouse, France.,Université Toulouse III Paul Sabatier, Toulouse, France.,Department of Hematology, CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | | | - Jean Darcourt
- INSERM, U1048, Toulouse, France.,Université Toulouse III Paul Sabatier, Toulouse, France.,Department of Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | | | | | | | | | | | | | | | - Abdul I Barakat
- LadHyX, CNRS, Ecole Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Bernard Payrastre
- INSERM, U1048, Toulouse, France.,Université Toulouse III Paul Sabatier, Toulouse, France.,Department of Hematology, CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | - Christophe Cognard
- INSERM, U1048, Toulouse, France.,Université Toulouse III Paul Sabatier, Toulouse, France.,Department of Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Hôpital Purpan, Toulouse, France
| |
Collapse
|
21
|
de Havenon A, Elhorany M, Boulouis G, Naggara O, Darcourt J, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Arquizan C, Dargazanli C, Maïer B, Seners P, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Fahed R, Finitsis SN, Gory B. Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion. J Neurointerv Surg 2022; 15:422-427. [PMID: 35450929 DOI: 10.1136/neurintsurg-2022-018715] [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: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes. METHODS We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect. RESULTS We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901). CONCLUSIONS We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
Collapse
Affiliation(s)
- Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Mahmoud Elhorany
- Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Benjamin Maïer
- Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Pierre Seners
- Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | | | | | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Charlotte Rosso
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | - Louis Veunac
- Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Robert Fahed
- Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Stephanos Nikolaos Finitsis
- Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | | |
Collapse
|
22
|
Pop R, Finitsis SN, Arquizan C, Elhorany M, Naggara O, Darcourt J, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Albucher JF, Le Bras A, Evain S, Wolff V, Timsit S, Gentric JC, Bourdain F, Veunac L, Papagiannaki C, Gory B. Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors. J Neurointerv Surg 2022; 15:415-421. [PMID: 35428738 DOI: 10.1136/neurintsurg-2022-018769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/02/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
BackgroundEndovascular treatment (EVT) for basilar artery occlusions (BAO) is associated with a higher rate of futile recanalization compared with anterior circulation procedures. We aimed to identify the incidence and predictors of poor clinical outcome despite successful reperfusion in current clinical practice.MethodsWe used data from the ETIS (Endovascular Treatment in Ischemic Stroke) registry, a prospective multicenter observational registry of stroke treated with EVT in France. Patients undergoing EVT for acute BAO from January 2014 to May 2019 successfully treated within 8 hours from onset were included. Predictors of 90-day poor outcome (modified Rankin Scale (mRS) 4–6) were researched within patients with successful (modified Thrombolysis In Cerebral Infarction (mTICI 2b-3)) and excellent (mTICI 2c-3) reperfusion.ResultsAmong 242 patients treated within 8 hours, successful reperfusion was achieved in 195 (80.5%) and excellent reperfusion in 120 (49.5%). Poor outcome was observed in 107 (54.8%) and 60 (50%) patients, respectively. In patients with successful early reperfusion, age, higher initial National Institutes of Health Stroke Scale (NIHSS) score, lower posterior circulation Alberta Stroke Programme Early CT Score (pc-ASPECTS), and absence of prior intravenous thrombolysis were independent predictors of poor outcome. The only treatment factor with an independent predictive value was first-pass mTICI 2b-3 reperfusion (adjusted OR 0.13, 95% CI 0.05 to 0.37, p<0.001). In patients with excellent early reperfusion, independent predictors were age, initial NIHSS score, first-pass mTICI 2c-3 reperfusion, and hemorrhagic transformation on post-interventional imaging.ConclusionsEarly successful reperfusion with EVT occurred in 80.5% of patients, and the only treatment-related factor predictive of clinical outcome was first pass mTICI 2b-3 reperfusion. Further research is warranted to identify the optimal techniques and devices associated with first pass reperfusion in the posterior circulation.
Collapse
Affiliation(s)
- Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
- Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
- University of Strasbourg, INSERM UMR-S1255, Strasbourg, France
| | | | - Caroline Arquizan
- Neurology, Hôpital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France
| | - Mahmoud Elhorany
- Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Olivier Naggara
- Radiology, Saint Anne Hospital Centre, Paris, Île-de-France, France
| | - Jean Darcourt
- Radiology, Hôpital Purpan, Toulouse, Midi-Pyrénées, France
| | - Frédéric Clarençon
- Sorbonne Universite, Paris, Île-de-France, France
- Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, University Hospital Centre Bordeaux, Bordeaux, Aquitaine, France
| | | | | | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Raphaël Blanc
- Departement of interventional neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Neurology, Hopital Foch, Suresnes, Île-de-France, France
- Université de Versailles Saint-Quentin-en-Yvelines, Versailles, Île-de-France, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | - Marion Boulanger
- Department of Neurology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Maxime Gauberti
- Neuroradiology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Aymeric Rouchaud
- Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, Nouvelle-Aquitaine, France
| | - Francisco Macian
- Department of Neurology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Charlotte Rosso
- Urgences cérébro-vasculaires, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
| | - Guillaume Turc
- Neurology, Groupe Hospitalier Universitaire Paris psychiatrie & neurosciences, Paris, Île-de-France, France
| | | | | | - Anthony Le Bras
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
- CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Neurology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Serge Timsit
- Department of Neurology, Centre Hospitalier Universitaire de Brest, Brest, Bretagne, France
| | | | - Frédéric Bourdain
- Department of Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Louis Veunac
- Department of Neuroradiolology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Chrysanthi Papagiannaki
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France
- IADI, INSERM U1254, Universite de Lorraine, Nancy, Lorraine, France
| |
Collapse
|
23
|
Patil S, Darcourt J, Messina P, Bozsak F, Cognard C, Doyle K. Characterising acute ischaemic stroke thrombi: insights from histology, imaging and emerging impedance-based technologies. Stroke Vasc Neurol 2022; 7:353-363. [PMID: 35241632 PMCID: PMC9453827 DOI: 10.1136/svn-2021-001038] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment of acute ischaemic stroke (AIS) focuses on rapid recanalisation of the occluded artery. In recent years, advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure. Despite ongoing developments and progress in AIS imaging techniques, it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment. Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients. In this review, what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined. This review also discusses the evidence that AIS thrombus composition varies with aetiology, questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment. Furthermore, this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition. Further use of new emerging technologies based on bioimpedance, as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced. Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.
Collapse
Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland .,Physiology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
24
|
Marque JF, Calvière L, Brandicourt P, Cognard C, Bonneville F, Darcourt J. Etude en IRM de la perfusion cérébrale dans le moya moya en fonction de la révélation ischémique ou hémorragique de la maladie. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.027] [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: 11/26/2022]
|
25
|
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]
|
26
|
Marnat G, Finistis S, Delvoye F, Sibon I, Desilles JP, Mazighi M, Gariel F, Consoli A, Rosso C, Clarençon F, Elhorany M, Denier C, Chalumeau V, Caroff J, Veunac L, Bourdain F, Darcourt J, Olivot JM, Bourcier R, Dargazanli C, Arquizan C, Richard S, Lapergue B, Gory B. Safety and Efficacy of Cangrelor in Acute Stroke Treated with Mechanical Thrombectomy: Endovascular Treatment of Ischemic Stroke Registry and Meta-analysis. AJNR Am J Neuroradiol 2022; 43:410-415. [PMID: 35241418 PMCID: PMC8910798 DOI: 10.3174/ajnr.a7430] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke. MATERIALS AND METHODS We performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion). RESULTS In the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%). CONCLUSIONS Cangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.
Collapse
Affiliation(s)
- G. Marnat
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - S. Finistis
- Aristotle University of Thessaloniki (S.F.), AhepaHospital, Thessaloniki, Greece
| | - F. Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - I. Sibon
- Department of Neurology (I.S.), Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - J.-P. Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M. Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - F. Gariel
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - A. Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | | | - F. Clarençon
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | - M. Elhorany
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | | | - V. Chalumeau
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - J. Caroff
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - L. Veunac
- Neuroradiolology (L.V.), Centre Hospitalier Cõte Basque, Bayonne, France
| | | | - J. Darcourt
- Neuroradiolology (J.D.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - R. Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - C. Dargazanli
- Departments of Interventional Neuroradiology (C. Dargazanli)
| | - C. Arquizan
- Neurology (C.A.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S. Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France
| | - B. Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - B. Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France,Université de Lorraine (B.G.), Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Nancy, France
| |
Collapse
|
27
|
Dumas V, Kaesmacher J, Ognard J, Forestier G, Dargazanli C, Janot K, Behme D, Shotar E, Chabert E, Velasco S, Bricout N, Ben Hassen W, Veunac L, Geismar M, Eugene F, Detraz L, Darcourt J, L'Allinec V, Eker OF, Consoli A, Maus V, Gariel F, Marnat G, Papanagiotou P, Papagiannaki C, Escalard S, Meyer L, Lobsien D, Abdullayev N, Chalumeau V, Neau JP, Guillevin R, Boulouis G, Rouchaud A, Styczen H, Fauché C. Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study. J Neurointerv Surg 2021; 14:1180-1185. [PMID: 34916267 DOI: 10.1136/neurintsurg-2021-017935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access. METHODS We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications. RESULTS From January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0-2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043). CONCLUSION In this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT.
Collapse
Affiliation(s)
- Victor Dumas
- Radiology Department, Poitiers University Medical Center, LabCom I3M, DACTIM-MIS team, LMA CNRS 7348, Poitiers, Vienne, France
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Julien Ognard
- Interventional Neuroradiology, CHRU de Brest, Brest, Bretagne, France
| | - Géraud Forestier
- Neuroradiology Department, XLIM CNRS, UMR7252, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Cyril Dargazanli
- Department of Neuroradiology, INSERM U1191, University Hospital Center Montpellier, Montpellier, Occitanie, France
| | - Kevin Janot
- Neuroradiology Department, University Hospital of Tours, Tours, Indre et Loire, France
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University of Gottingen, Goettingen, Germany
| | - Eimad Shotar
- Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Chabert
- Neuroradiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Stéphane Velasco
- Radiology Department, Poitiers University Medical Center, Poitiers, Vienne, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Wagih Ben Hassen
- Interventional Neuroradiology, CH Sainte-Anne, INSERM UMR 1266, Paris, Île-de-France, France
| | - Louis Veunac
- Department of Radiology, Bayonne Hospital, Bayonne, France
| | - Maxime Geismar
- Neuroradiology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Lili Detraz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Jean Darcourt
- Neuroradiology Department, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | | | - Omer F Eker
- Neuroradiology Department, Neurologic Hospital, Bron, France
| | - Arturo Consoli
- Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Volker Maus
- Institute of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Florent Gariel
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, Aquitaine, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, Aquitaine, France
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospitals Bremen-Mitte, Bremen-Ost, Germany
| | | | - Simon Escalard
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, Ile de France, France
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Nuran Abdullayev
- Diagnostic and Interventional Radiology Department, University Hospital Cologne, Köln, Germany
| | - Vanessa Chalumeau
- Interventional Neuroradiology, CHU Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | | | - Rémy Guillevin
- Radiology Department, Poitiers University Medical Center, LabCom I3M, DACTIM-MIS team, LMA CNRS 7348, Poitiers, Vienne, France
| | - Gregoire Boulouis
- Neuroradiology Department, University Hospital of Tours, Tours, Indre et Loire, France
| | - Aymeric Rouchaud
- Neuroradiology Department, XLIM CNRS, UMR7252, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cédric Fauché
- Radiology Department, Poitiers University Medical Center, Poitiers, Vienne, France
| | | |
Collapse
|
28
|
Munio M, Darcourt J, Gollion C, Barbieux-Guillot M, Bonneville F, Larrue V. Large artery intracranial stenosis in young adults with ischaemic stroke. Rev Neurol (Paris) 2021; 178:206-212. [PMID: 34920893 DOI: 10.1016/j.neurol.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/25/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Large artery intracranial stenosis (ICS) is a common finding in stroke patients, but is much less prevalent in Western countries than in Asia and in young adults than in the elderly. We investigated the prevalence and causes of ICS among French young adults with ischaemic stroke. Clinical and radiological data of patients aged 18-54 years treated consecutively for acute ischaemic stroke in the anterior circulation at a tertiary stroke centre were analysed retrospectively. Patients with>50% ICS were identified. ICS was evaluated using TOF-MRA, vessel wall-MRI, digital subtraction angiography and CT-angiography. A total of 316 patients were included. ICS was diagnosed in 29 patients, resulting in a prevalence of 9.2% (95% CI, 6.2 to 13.3). The leading cause of ICS was atherosclerosis (n=13), ahead of moyamoya disease (n=4), dissection (n=2), vasculitis (n=2), and reversible cerebral vasoconstriction syndrome (n=1). The cause of ICAS could not be determined in 7 patients. ICS was found in nearly one in 10 ischaemic strokes among French young adults. Atherosclerosis was the leading cause of ICS. The cause of ICS could not be determined in almost a quarter of the patients.
Collapse
Affiliation(s)
- M Munio
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France
| | - J Darcourt
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Pierre Paul Riquet, université de Toulouse, Toulouse, France
| | - C Gollion
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France
| | - M Barbieux-Guillot
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France
| | - F Bonneville
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Pierre Paul Riquet, université de Toulouse, Toulouse, France
| | - V Larrue
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France.
| |
Collapse
|
29
|
Olivot JM, Heit JJ, Mazighi M, Raposo N, Albucher JF, Rousseau V, Guenego A, Thalamas C, Mlynash M, Drif A, Christensen S, Sommet A, Viguier A, Darcourt J, Januel AC, Calviere L, Menegon P, Caparros F, Bonneville F, Tourdias T, Sibon I, Albers GW, Cognard C. What predicts poor outcome after successful thrombectomy in early time window? J Neurointerv Surg 2021; 14:1051-1055. [PMID: 34750109 DOI: 10.1136/neurintsurg-2021-017946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Half of the patients with large vessel occlusion (LVO)-related acute ischemic stroke (AIS) who undergo endovascular reperfusion are dead or dependent at 3 months. We hypothesize that in addition to established prognostic factors, baseline imaging profile predicts outcome among reperfusers. METHODS Consecutive patients receiving endovascular treatment (EVT) within 6 hours after onset with Thrombolysis In Cerebral Infarction (TICI) 2b, 2c and 3 revascularization were included. Poor outcome was defined by a modified Rankin scale (mRS) 3-6 at 90 days. No mismatch (NoMM) profile was defined as a mismatch (MM) ratio ≤1.2 and/or a volume <10 mL on pretreatment imaging. RESULTS 187 patients were included, and 81 (43%) had a poor outcome. Median delay from stroke onset to the end of EVT was 259 min (IQR 209-340). After multivariable logistic regression analysis, older age (OR 1.26, 95% CI 1.06 to 1.5; p=0.01), higher National Institutes of Health Stroke Scale (NIHSS) (OR 1.15, 95% CI 1.06 to 1.25; p<0.0001), internal carotid artery (ICA) occlusion (OR 3.02, 95% CI 1.2 to 8.0; p=0.021), and NoMM (OR 4.87, 95% CI 1.09 to 22.8; p=0.004) were associated with poor outcome. In addition, post-EVT hemorrhage (OR 3.64, 95% CI 1.5 to 9.1; p=0.04) was also associated with poor outcome. CONCLUSIONS The absence of a penumbra defined by a NoMM profile on baseline imaging appears to be an independent predictor of poor outcome after reperfusion. Strategies aiming to preserve the penumbra may be encouraged to improve these patients' outcomes.
Collapse
Affiliation(s)
- Jean-Marc Olivot
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France .,Toulouse Neuro Imaging Center, Toulouse, France
| | - Jeremy J Heit
- Radiology, Neuroadiology and Neurointervention Division, Stanford University, Stanford, California, USA
| | - Mikael Mazighi
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Nicolas Raposo
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Jean François Albucher
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Vanessa Rousseau
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Adrien Guenego
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Claire Thalamas
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Amel Drif
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Soren Christensen
- Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Agnes Sommet
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Alain Viguier
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Jean Darcourt
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Lionel Calviere
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Patrice Menegon
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Caparros
- Neurology, Stroke Unit, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Fabrice Bonneville
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thomas Tourdias
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Igor Sibon
- Neurology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Christophe Cognard
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | |
Collapse
|
30
|
Tran K, Chevli N, Messer J, Haque W, Farach A, Satkunasivam R, Zhang J, Darcourt J, Lo S, Siva S, Butler E, Teh B. Prognostic Impact of Biologically Equivalent Dose in Stereotactic Body Radiation Therapy for Renal Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.862] [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: 10/20/2022]
|
31
|
Fontaine L, Sibon I, Raposo N, Albucher JF, Mazighi M, Rousseau V, Darcourt J, Thalamas C, Drif A, Sommet A, Viguier A, Guenego A, Januel AC, Calvière L, Menegon P, Bonneville F, Tourdias T, Albers GW, Cognard C, Olivot JM. ASCOD Phenotyping of Stroke With Anterior Large Vessel Occlusion Treated by Mechanical Thrombectomy. Stroke 2021; 52:e769-e772. [PMID: 34702062 DOI: 10.1161/strokeaha.121.035282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Determining the mechanism of large vessel occlusion related acute ischemic stroke is of major importance to initiate a tailored secondary prevention strategy. We investigated using the atherosclerosis, small vessel disease, cardiac source, other cause, dissection (ASCOD) classification the distribution of the causes of large vessel occlusion related acute ischemic stroke treated by mechanical thrombectomy. METHODS This was a predefined substudy of the FRAME (French Acute Multimodal Imaging to Select Patient for Mechanical Thrombectomy). Each patient underwent a systematic etiological workup including brain and vascular imaging, electrocardiogram monitoring lasting at least 24 hours and routine blood tests. Stroke mechanisms were systematically evaluated using the atherosclerosis, small vessel disease, cardiac source, other cause, dissection grading system at 3 months. We defined single potential cause by one cause graded 1 in a single domain, possible cause as a cause graded 1 or 2 regardless of overlap, and no identified cause without grade 1 nor 2 causes. RESULTS A total of 215 patients (mean age 70±14; 50% male) were included. A single potential cause was identified in 148 (69%). Cardio-embolism (53%) was the most frequent, followed by atherosclerosis (9%), dissection (5%) and other causes (1%). Atrial fibrillation accounted for 88% of C1. Overlap between grade 1 causes was uncommon (3%). Possible causes were identified in 168 patients (83%) and 16 (7%) had no cause identified after the initial evaluation. CONCLUSIONS Cardio-embolism, especially atrial fibrillation, was the major cause of large vessel occlusion related acute ischemic stroke. This finding emphasizes the yield of paroxysmal atrial fibrillation detection in those patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03045146.
Collapse
Affiliation(s)
- Louis Fontaine
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Igor Sibon
- Stroke Unit (I.S.), Bordeaux University Hospital, France
| | - Nicolas Raposo
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Jean-François Albucher
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Michael Mazighi
- University of Paris U1148, Rothschild Foundation Hospital, France (M.M.)
| | - Vanessa Rousseau
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Jean Darcourt
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Claire Thalamas
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Amel Drif
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Agnes Sommet
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Alain Viguier
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Adrien Guenego
- Stanford Stroke Center, Stanford University, CA (A.G., G.W.A.)
| | - Anne-Christine Januel
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Lionel Calvière
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Patrice Menegon
- Department of Neuroradiology (P.M., T.T.), Bordeaux University Hospital, France
| | - Fabrice Bonneville
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Thomas Tourdias
- Department of Neuroradiology (P.M., T.T.), Bordeaux University Hospital, France
| | | | - Christophe Cognard
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Jean-Marc Olivot
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | | |
Collapse
|
32
|
Marnat G, Delvoye F, Finitsis S, Lapergue B, Gariel F, Consoli A, Desilles JP, Mazighi M, Dargazanli C, Bourcier R, Darcourt J, Chalumeau V, Elhorany M, Clarençon F, Richard S, Gory B, Sibon I. A Multicenter Preliminary Study of Cangrelor following Thrombectomy Failure for Refractory Proximal Intracranial Occlusions. AJNR Am J Neuroradiol 2021; 42:1452-1457. [PMID: 34117019 DOI: 10.3174/ajnr.a7180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Rescue endovascular and pharmacologic approaches are increasingly being adopted after recanalization failure of acute large-vessel occlusion strokes with mechanical thrombectomy, with encouraging results. The safety and efficacy of glycoprotein IIb/IIIa inhibitors in ischemic stroke have been investigated, though cangrelor, a recent intravenous P2Y12-receptor inhibitor with a rapid onset/offset of action and a short half-life, may be a valuable option. We compared the safety and efficacy of cangrelor with those of glycoprotein IIb/IIIa inhibitors for refractory occlusions. MATERIALS AND METHODS We performed a retrospective analysis of the ongoing prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke Registry in France between May 2012 and February 2020. Refractory intracranial occlusions of the anterior and posterior circulation were included and defined as recanalization failure of large-vessel occlusion stroke, perioperative target artery reocclusion, or high risk of early reocclusion related to an arterial wall lesion. The primary end point was a favorable outcome, defined as a 90-day mRS of 0-2. Secondary end points were reperfusion, intracranial hemorrhage, and procedural complications. RESULTS Among 69 patients, 15 were treated with cangrelor, and 54, with glycoprotein IIb/IIIa inhibitors. The favorable outcome (adjusted OR = 2.22; 95% CI, 0.42-11.75; P = .348) and mortality (adjusted OR = 0.44; 95% CI, 0.06-3.16; P = .411) rates were similar in both groups. There was no difference in the rates of any intracranial hemorrhage (adjusted OR = 0.40; 95% CI, 0.08-2.09; P = .280), symptomatic intracranial hemorrhage (6.7% versus 0.0%, P = .058), or procedural complications (6.7% versus 20.4%, P = .215). Reperfusion rates were higher in the cangrelor group, though the difference did not reach statistical significance (93.3% versus 75.0% for modified TICI 2b-3; adjusted OR =10.88; 95% CI, 0.96-123.84; P = .054). CONCLUSIONS Cangrelor seems to be as safe as glycoprotein IIb/IIIa inhibitors for managing refractory intracranial occlusion and leads to satisfactory brain reperfusion. Cangrelor is a promising agent in this setting, and additional studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- G Marnat
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - F Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - S Finitsis
- Aristotle University of Thessaloniki (S.F.), Ahepa Hospital, Thessaloniki, Greece
| | - B Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - F Gariel
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - A Consoli
- Department s of Neuroradiology (A.C.) and Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - J-P Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - C Dargazanli
- Department of Neuroradiology (C.D.), Centre Hospitalier Régional Universitaire Gui de Chauliac, Montpellier, France
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), University Hospital of Toulouse, Toulouse, France
| | - V Chalumeau
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - M Elhorany
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - F Clarençon
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - S Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Régional Universitaire-Nancy, Stroke Unit, Nancy, France
- Institut national de la santé et de la recherche médicale U1116 (S.R.), Centre Hospitalier Régional Universitaire-Nancy, Nancy, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, CHRU-Nancy, Nancy, France
- Institut National de la Santé et de la Recherche Mmédicale U1254 (B.G.), Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
| | | |
Collapse
|
33
|
Renieri L, Valente I, Dmytriw AA, Puri AS, Singh J, Nappini S, Nencini P, Kaliaev A, Abdalkader M, Alexandre A, Garignano G, Vivekanandan S, Fong RP, Parra-Fariñas C, Spears J, Gomez-Paz S, Ogilvy C, Regenhardt RW, Alotaibi N, Beer-Furlan A, Joshi KC, Walker M, Vicenty-Padilla J, Darcourt J, Foreman P, Kuhn AL, Nguyen TN, Griessenauer CJ, Marotta TR, Thomas A, Patel AB, Leslie-Mazwi TM, Chen M, Levitt MR, Chen K, Cognard C, Pedicelli A, Limbucci N. Mechanical thrombectomy beyond the circle of Willis: efficacy and safety of different techniques for M2 occlusions. J Neurointerv Surg 2021; 14:546-550. [PMID: 34226193 DOI: 10.1136/neurintsurg-2021-017425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/16/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND M2 segment occlusions represent approximately one-third of non-lacunar ischemic stroke and can lead to permanent neurological deficits. Various techniques are available for mechanical thrombectomy beyond the circle of Willis, but data evaluating their effectiveness and safety are lacking. METHODS A retrospective review of patients with ischemic stroke undergoing mechanical thrombectomy for M2 occlusions from 13 centers in North American and Europe was performed. Tandem or multiple-territory occlusions were excluded. The primary outcome was 90-day modified Rankin Scale and reperfusion rates across stent-retriever, direct aspiration and combined techniques. RESULTS There were 465 patients (mean age 71.48±14.03 years, 53.1% female) with M2 occlusions who underwent mechanical thrombectomy. Stent-retriever alone was used in 133 (28.6%), direct aspiration alone in 93 (20.0%) and the combined technique in 239 (51.4%) patients. Successful reperfusion was achieved with the combined technique in 198 (82.2%; OR 2.6 (1.1-6.9)), with stent-retriever alone in 112 (84.2%; OR 9.2 (1.9-44.6)) and with direct aspiration alone in 62 (66.7%; referencecategory). Intraprocedural subarachnoid hemorrhages (iSAH) were 36 (7.7%) and were more likely to occur in patients treated with the stent-retrievers (OR 5.0 (1.1-24.3)) and combined technique (OR 4.6 (1.1-20.9)). Good clinical outcome was achieved in 260 (61.8%) patients, while 59 (14.0%) patients died. Older age, higher baseline NIHSS (National Institutes of Health Stroke Scale), parenchymal hemorrhage and iSAH were associated with poor outcome while successful recanalization and higher baseline ASPECTS (Alberta Stroke Program Early CT Score) were associated with good outcome. No differences were found among the three techniques in terms of clinical outcome. CONCLUSION Stent-retrievers and a combined approach for M2 occlusions seem more effective than direct aspiration, but with higher rates of iSAH. This leads to no detectable difference in clinical outcome at 3 months.
Collapse
Affiliation(s)
- Leonardo Renieri
- Interventional Neuroravascular Unit, University Hospital Careggi, Firenze, Italy
| | - Iacopo Valente
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Adam A Dmytriw
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ajit S Puri
- Division of Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jasmeet Singh
- Division of Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sergio Nappini
- Neurovascular Interventional Unit, University Hospital Careggi, Firenze, Italy
| | | | - Artem Kaliaev
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrea Alexandre
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Giuseppe Garignano
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Sheela Vivekanandan
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Reginald P Fong
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Carmen Parra-Fariñas
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Santiago Gomez-Paz
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christopher Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Naif Alotaibi
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - André Beer-Furlan
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Melanie Walker
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juan Vicenty-Padilla
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jean Darcourt
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Paul Foreman
- Department of Neurosurgery, Orlando Health Corp, Orlando, Florida, USA
| | - Anna L Kuhn
- Division of Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Thomas R Marotta
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ajith Thomas
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Michael Chen
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Karen Chen
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Alessandro Pedicelli
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Nicola Limbucci
- Interventional Neuroravascular Unit, University Hospital Careggi, Firenze, Italy
| |
Collapse
|
34
|
Seners P, Oppenheim C, Turc G, Albucher JF, Guenego A, Raposo N, Christensen S, Calvière L, Viguier A, Darcourt J, Januel AC, Mlynash M, Sommet A, Thalamas C, Sibon I, Rousseau V, Tourdias T, Menegon P, Bonneville F, Mazighi M, Charron S, Legrand L, Cognard C, Albers GW, Baron JC, Olivot JM. Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core. Ann Neurol 2021; 90:417-427. [PMID: 34216396 DOI: 10.1002/ana.26152] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue ("core"). Perfusion imaging may identify a subset of patients with large core who benefit from MT. METHODS We compared two cohorts of LVO-related patients with large core (>50 ml on diffusion-weighted-imaging or CT-perfusion using RAPID), available perfusion imaging, and treated within 6 hours from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre-MT era from a prospective registry. Primary outcome was 90-day modified Rankin Scale ≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio = critical hypoperfusion/core volume). RESULTS Overall, 107 patients were included (56 MT + BMM and 51 BMM): Mean age was 68 ± 15 years, median core volume 99 ml (IQR: 72-131) and MMRatio 1.4 (IQR: 1.0-1.9). Baseline clinical and radiological variables were similar between the two groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (pinteraction < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95% CI] = 6.8 [1.7-27.0] vs 0.7 [0.1-6.2], respectively). Similar findings were present for MMRatio ≥1.8 in the subgroup with core ≥70 ml. Parenchymal hemorrhage on follow-up imaging was more frequent in the MT + BMM group regardless of the MMRatio. INTERPRETATION Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021.
Collapse
Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Catherine Oppenheim
- Radiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Guillaume Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Jean-François Albucher
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Adrien Guenego
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Raposo
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Lionel Calvière
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Alain Viguier
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean Darcourt
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne-Christine Januel
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Agnes Sommet
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Claire Thalamas
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Igor Sibon
- Unité Neurovasculaire, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Vanessa Rousseau
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thomas Tourdias
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Patrice Menegon
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Fabrice Bonneville
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Hôpital Fondation A. de Rothschild, Paris, France
| | - Sylvain Charron
- Radiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Laurence Legrand
- Radiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Christophe Cognard
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Jean-Claude Baron
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| |
Collapse
|
35
|
Darcourt J, Demchuk AM, Olivot JM. Platelets and Clot Stiffness: A Challenge but Also an Opportunity Toward Achieving Consistent Complete Reperfusion. Stroke 2021; 52:2518-2520. [PMID: 34078108 DOI: 10.1161/strokeaha.121.035105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jean Darcourt
- Department of Neuroradiology (J.D.), Toulouse University Hospital.,INSERM, U1048 and Université Toulouse 3, I2MC, Toulouse (J.D.)
| | - Andrew M Demchuk
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary (A.M.D.)
| | - Jean-Marc Olivot
- Acute Stroke Unit (J.-M.O.), Toulouse University Hospital.,Clinical Investigation Center 1436 (J.-M.O.), Toulouse University Hospital
| |
Collapse
|
36
|
Bellanger G, Biotti D, Adam G, Darcourt J, Roques M, Patsoura S, Savatovsky J, Obadia M, Menjot de Champfleur N, Charif M, Labauge P, Cotton F, Durand Dubief F, Tourdias T, Dulau C, Kremer S, De Sèze J, Ciron J, Varenne F, Viguier A, Lerebours F, Larrue V, Cognard C, Bonneville F. Leptomeningeal enhancement on post-contrast FLAIR images for early diagnosis of Susac syndrome. Mult Scler 2021; 28:189-197. [PMID: 33988466 DOI: 10.1177/13524585211012349] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Leptomeningeal enhancement (LME) is a key feature of Susac syndrome (SuS) but is only occasionally depicted on post-contrast T1-weighted images (T1-WI). OBJECTIVE As post-contrast fluid-attenuated inversion recovery (FLAIR) may be more sensitive, our aim was to assess LME in SuS on this sequence. METHODS From 2010 to 2020, 20 patients with definite SuS diagnosis were retrospectively enrolled in this multicentre study. Two radiologists independently assessed the number of LME on post-contrast FLAIR and T1-WI acquisitions performed before any treatment. A chi-square test was used to compare both sequences and the interrater agreement was calculated. RESULTS Thirty-five magnetic resonance imagings (MRIs) were performed before treatment, including 19 post-contrast FLAIR images in 17 patients and 25 post-contrast T1-WI in 19 patients. In terms of patients, LME was observed on all post-contrast FLAIR, contrary to post-contrast T1-WI (17/17 (100%) vs. 15/19 (79%), p < 0.05). In terms of sequences, LME was observed on all post-contrast FLAIR, contrary to post-contrast T1-WI (19/19 (100%) vs. 16/25 (64%), p < 0.005). LME was disseminated at both supratentorial (19/19) and infratentorial (18/19) levels on post-contrast FLAIR, contrary to post-contrast T1-WI (3/25 and 9/25, respectively). Interrater agreement was excellent for post-contrast FLAIR (κ = 0.95) but only moderate for post-contrast T1-WI (κ = 0.61). CONCLUSION LME was always observed and easily visible on post-contrast FLAIR images prior to SuS treatment. In association with other MRI features, it is highly indicative of SuS.
Collapse
Affiliation(s)
| | - Damien Biotti
- Department of Neurology, Hôpital Purpan, Toulouse, France
| | - Gilles Adam
- Department of Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Jean Darcourt
- Department of Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Margaux Roques
- Department of Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Sofia Patsoura
- Department of Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Julien Savatovsky
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Michael Obadia
- Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Mahmoud Charif
- Department of Neurology, Hôpital Gui De Chauliac, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, Hôpital Gui De Chauliac, Montpellier, France
| | - Francois Cotton
- Department of Neuroradiology, Hôpital civil de Lyon, Lyon, France
| | | | - Thomas Tourdias
- Department of Neuroradiology, Hôpital Pellegrin, Bordeaux, France
| | - Cecile Dulau
- Department of Neurology, Hôpital de Hautepierre, Strasbourg, France
| | - Stéphane Kremer
- Department of Neuroradiology, Hôpital de Hautepierre, Strasbourg, France
| | - Jérôme De Sèze
- Department of Neurology, Hôpital Pellegrin, Bordeaux, France
| | - Jonathan Ciron
- Department of Neurology, Hôpital Purpan, Toulouse, France
| | - Fanny Varenne
- Department of Ophthalmology, Hôpital Purpan, Toulouse, France
| | - Alain Viguier
- Department of Neurology, Hôpital Purpan, Toulouse, France
| | | | - Vincent Larrue
- Department of Neurology, Hôpital Purpan, Toulouse, France
| | | | | |
Collapse
|
37
|
Anquetil T, Solinhac R, Jaffre A, Chicanne G, Viaud J, Darcourt J, Orset C, Geuss E, Kleinschnitz C, Vanhaesebroeck B, Vivien D, Hnia K, Larrue V, Payrastre B, Gratacap MP. PI3KC2β inactivation stabilizes VE-cadherin junctions and preserves vascular integrity. EMBO Rep 2021; 22:e51299. [PMID: 33880878 DOI: 10.15252/embr.202051299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
Endothelium protection is critical, because of the impact of vascular leakage and edema on pathological conditions such as brain ischemia. Whereas deficiency of class II phosphoinositide 3-kinase alpha (PI3KC2α) results in an increase in vascular permeability, we uncover a crucial role of the beta isoform (PI3KC2β) in the loss of endothelial barrier integrity following injury. Here, we studied the role of PI3KC2β in endothelial permeability and endosomal trafficking in vitro and in vivo in ischemic stroke. Mice with inactive PI3KC2β showed protection against vascular permeability, edema, cerebral infarction, and deleterious inflammatory response. Loss of PI3KC2β in human cerebral microvascular endothelial cells stabilized homotypic cell-cell junctions by increasing Rab11-dependent VE-cadherin recycling. These results identify PI3KC2β as a potential new therapeutic target to prevent aggravating lesions following ischemic stroke.
Collapse
Affiliation(s)
- Typhaine Anquetil
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Romain Solinhac
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Aude Jaffre
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Gaëtan Chicanne
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Julien Viaud
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Jean Darcourt
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Cyrille Orset
- INSERM, UMR-S U1237 and Caen-Normandie University, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, France
| | - Eva Geuss
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | | | | | - Denis Vivien
- INSERM, UMR-S U1237 and Caen-Normandie University, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, France.,CHU Caen, Department of Clinical Research, Caen University Hospital, Caen, France
| | - Karim Hnia
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| | - Vincent Larrue
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France.,Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Bernard Payrastre
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France.,Laboratoire d'Hématologie, CHU de Toulouse, Toulouse Cedex, France
| | - Marie-Pierre Gratacap
- INSERM, UMR-S U1297 and University of Toulouse III, Institute of Cardiovascular and Metabolic Diseases (I2MC), CHU-Rangueil, Toulouse, France
| |
Collapse
|
38
|
Gollion C, Darcourt J, Munio M, Bonneville F, Larrue V. Brain Vessel Wall Contrast Enhancement Without Arterial Stenosis: Probable Primary CNS Vasculitis. Neurol Clin Pract 2021; 11:e193-e195. [PMID: 33842091 DOI: 10.1212/cpj.0000000000000825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/20/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Cédric Gollion
- Department of Neurology (CG, MM, VL), University Hospital of Toulouse, France; ToNIC (CG, FB, VL), Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS; and Department of Neuroradiology (JD, FB), University Hospital of Toulouse, France
| | - Jean Darcourt
- Department of Neurology (CG, MM, VL), University Hospital of Toulouse, France; ToNIC (CG, FB, VL), Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS; and Department of Neuroradiology (JD, FB), University Hospital of Toulouse, France
| | - Mélanie Munio
- Department of Neurology (CG, MM, VL), University Hospital of Toulouse, France; ToNIC (CG, FB, VL), Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS; and Department of Neuroradiology (JD, FB), University Hospital of Toulouse, France
| | - Fabrice Bonneville
- Department of Neurology (CG, MM, VL), University Hospital of Toulouse, France; ToNIC (CG, FB, VL), Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS; and Department of Neuroradiology (JD, FB), University Hospital of Toulouse, France
| | - Vincent Larrue
- Department of Neurology (CG, MM, VL), University Hospital of Toulouse, France; ToNIC (CG, FB, VL), Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS; and Department of Neuroradiology (JD, FB), University Hospital of Toulouse, France
| |
Collapse
|
39
|
Pyra P, Darcourt J, Aubert-Mucca M, Brandicourt P, Patat O, Cheuret E, Brochard K, Sevely A, Calviere L, Karsenty C. Case Report: Successful Cerebral Revascularization and Cardiac Transplant in a 16-Year-Old Male With Syndromic BRCC3-Related Moyamoya Angiopathy. Front Neurol 2021; 12:655303. [PMID: 33868155 PMCID: PMC8044811 DOI: 10.3389/fneur.2021.655303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background:BRCC3/MTCP1 deletions are associated with a rare familial moyamoya angiopathy with extracranial manifestations. Case: We report the case of an adolescent male presenting with progressive and symptomatic moyamoya angiopathy and severe dilated cardiomyopathy caused by a hemizygous deletion of BRCC3/MTCP1. He was treated for renovascular hypertension by left kidney homograft and right nephrectomy in infancy and had other syndromic features, including cryptorchidism, growth hormone deficiency, and facial dysmorphism. Due to worsening of the neurological and cardiac condition, he was treated by a direct superficial temporal artery to middle cerebral artery bypass to enable successful cardiac transplant without cerebral damage. Conclusions:BRCC3-related moyamoya is a devastating disease with severe heart and brain complications. This case shows that aggressive management with cerebral revascularization to allow cardiac transplant is feasible and efficient despite end-stage heart failure.
Collapse
Affiliation(s)
- Pierrick Pyra
- Pediatric Cardiology Unit, Department of Pediatrics, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Jean Darcourt
- Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Marion Aubert-Mucca
- Department of Medical Genetics, Toulouse University Hospital, Toulouse, France
| | - Pierre Brandicourt
- Department of Neurosurgery, Toulouse University Hospital, Paul Sabatier University, Toulouse, France
| | - Olivier Patat
- Department of Medical Genetics, Toulouse University Hospital, Toulouse, France
| | - Emmanuel Cheuret
- Neurology Unit, Department of Pediatrics, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Karine Brochard
- Nephrology Unit, Department of Pediatrics, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Annick Sevely
- Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Lionel Calviere
- Department of Neurology, Toulouse University Hospital, Hôpital Pierre Paul Riquet, Toulouse, France.,Toulouse Neuroimaging Center INSERM, UPS, Toulouse, France
| | - Clément Karsenty
- Pediatric Cardiology Unit, Department of Pediatrics, Children's Hospital, Toulouse University Hospital, Toulouse, France.,Inserm U1048, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
| |
Collapse
|
40
|
Roques M, Biotti D, Darcourt J, Adam G, Varenne F, Bonneville F. Microvascular ischemic isolated oculomotor nerve palsy revealed by contrast-enhanced 3D-CISS imaging. J Neuroradiol 2021; 48:466-467. [PMID: 33500138 DOI: 10.1016/j.neurad.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Margaux Roques
- Department of Neuroradiology, Hôpital Pierre Paul Riquet CHU Purpan, Toulouse, France.
| | - Damien Biotti
- Department of Neurology, Hôpital Pierre Paul Riquet CHU Purpan, Toulouse, France
| | - Jean Darcourt
- Department of Neuroradiology, Hôpital Pierre Paul Riquet CHU Purpan, Toulouse, France
| | - Gilles Adam
- Department of Neuroradiology, Hôpital Pierre Paul Riquet CHU Purpan, Toulouse, France
| | - Fanny Varenne
- Department of Ophthalmology, Hôpital Pierre Paul Riquet CHU Purpan, Toulouse, France
| | - Fabrice Bonneville
- Department of Neuroradiology, Hôpital Pierre Paul Riquet CHU Purpan, Toulouse, France
| |
Collapse
|
41
|
Darcourt J, Garcia C, Phuong DM, Michelozzi C, Bellanger G, Adam G, Roques M, Januel AC, Tall P, Albucher JF, Olivot JM, Bonneville F, Payrastre B, Cognard C. Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi. Int J Stroke 2021; 16:972-980. [PMID: 33435860 DOI: 10.1177/1747493020986626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The composition of the thrombus influences its retrievability by mechanical thrombectomy. PURPOSE Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition. METHODS This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVS+) or its negativity (SVS-) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining. RESULTS Histological analysis was performed on 102 clots. Thrombi with SVS- were significantly richer in fibrin/platelets, p = 0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases (n = 131). Clots retrieved combined therapy-rescue were richer in fibrin/platelets 63.9% versus 50.8% for aspiration first pass strategy, p = 0.03. Logistic regression analysis showed that fibrin/platelet-poor clots (<60%) were significantly more likely to be recanalized by aspiration first pass strategy compared to fibrin/platelet-rich clots (>60%) that were more likely recanalized by combined therapy-rescue after aspiration first pass strategy failure (OR = 3.5; 95% CI = 1.2-10.8; p = 0.0054). CONCLUSIONS Our results confirm that SVS- clots are rich in fibrin/platelets and suggest that these "white clots" are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.
Collapse
Affiliation(s)
- Jean Darcourt
- Department of Neuroradiology, CHU of Toulouse, France.,INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| | - Cédric Garcia
- INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France.,Laboratory of Hematology, CHU of Toulouse, France
| | | | | | | | - Gilles Adam
- Department of Neuroradiology, CHU of Toulouse, France
| | | | - Anne C Januel
- Department of Neuroradiology, CHU of Toulouse, France
| | - Philippe Tall
- Department of Neuroradiology, CHU of Toulouse, France
| | | | - Jean M Olivot
- Department of Vascular Neurology, CHU of Toulouse, France
| | | | - Bernard Payrastre
- INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France.,Laboratory of Hematology, CHU of Toulouse, France
| | - Christophe Cognard
- Department of Neuroradiology, CHU of Toulouse, France.,INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
42
|
Olivot JM, Albucher JF, Guenego A, Thalamas C, Mlynash M, Rousseau V, Drif A, Christensen S, Sommet A, Viguier A, Darcourt J, Calvière L, Menegon P, Raposo N, Januel AC, Bonneville F, Tourdias T, Mazighi M, Sibon I, Albers GW, Cognard C. Mismatch Profile Influences Outcome After Mechanical Thrombectomy. Stroke 2020; 52:232-240. [PMID: 33349010 DOI: 10.1161/strokeaha.120.031929] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) is the recommended treatment for acute ischemic stroke caused by anterior circulation large vessel occlusion. However, despite a high rate of reperfusion, the clinical response to successful MT remains highly variable in the early time window where optimal imaging selection criteria have not been established. We hypothesize that the baseline perfusion imaging profile may help forecast the clinical response to MT in this setting. METHODS We conducted a prospective multicenter cohort study of patients with large vessel occlusion-related acute ischemic stroke treated by MT within 6 hours. Treatment decisions and the modified Rankin Scale evaluation at 3 months were performed blinded to the results of baseline perfusion imaging. Study groups were defined a posteriori based on predefined imaging profiles: target mismatch (TMM; core volume <70 mL/mismatch ratio >1.2 and mismatch volume >10 mL) versus no TMM or mismatch (MM; mismatch ratio >1.2 and volume >10 mL) versus no MM. Functional recovery (modified Rankin Scale, 0-2) at 3 months was compared based on imaging profile at baseline and whether reperfusion (modified Thrombolysis in Cerebral Infarction 2bc3) was achieved. RESULTS Two hundred eighteen patients (mean age, 71±15 years; median National Institutes of Health Stroke Scale score, 17 [interquartile range, 12-21]) were enrolled. Perfusion imaging profiles were 71% TMM and 82% MM. The rate of functional recovery was 54% overall. Both TMM and MM profiles were independently associated with a higher rate on functional recovery at 3 months Adjusted odds ratios were 3.3 (95% CI, 1.4-7.9) for TMM and 5.9 (95% CI, 1.8-19.6) for MM. Reperfusion (modified Thrombolysis in Cerebral Infarction 2bc3) was achieved in 86% and was more frequent in TMM and MM patients. Reperfusion was associated with a higher rate of functional recovery in MM and TMM patients but not among those with no MM. CONCLUSIONS In this cohort study, about 80% of the patients with a large vessel occlusion-related acute ischemic stroke had evidence of penumbra, regardless of infarction volume. Perfusion imaging profiles predict the clinical response to MT.
Collapse
Affiliation(s)
- Jean-Marc Olivot
- Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Department of Neuroradiology (A.G., J.D., A.-C.J., F.B., C.C.), Centre Hospitalier Universitaire de Toulouse, France
| | - Jean-François Albucher
- Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse Neuro Imaging Center, France (J.-M.O., J.-F.A., A.V., L.C., N.R., F.B.)
| | - Adrien Guenego
- Department of Neuroradiology (A.G., J.D., A.-C.J., F.B., C.C.), Centre Hospitalier Universitaire de Toulouse, France
| | - Claire Thalamas
- Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University, CA (M. Mlynash, S.C., G.W.A.)
| | - Vanessa Rousseau
- Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France
| | - Amel Drif
- Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France
| | - Soren Christensen
- Stanford Stroke Center, Stanford University, CA (M. Mlynash, S.C., G.W.A.)
| | - Agnes Sommet
- Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France
| | - Alain Viguier
- Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse Neuro Imaging Center, France (J.-M.O., J.-F.A., A.V., L.C., N.R., F.B.)
| | - Jean Darcourt
- Department of Neuroradiology (A.G., J.D., A.-C.J., F.B., C.C.), Centre Hospitalier Universitaire de Toulouse, France
| | - Lionel Calvière
- Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse Neuro Imaging Center, France (J.-M.O., J.-F.A., A.V., L.C., N.R., F.B.)
| | - Patrice Menegon
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, France (P.M., T.T.)
| | - Nicolas Raposo
- Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse Neuro Imaging Center, France (J.-M.O., J.-F.A., A.V., L.C., N.R., F.B.)
| | - Anne-Christine Januel
- Department of Neuroradiology (A.G., J.D., A.-C.J., F.B., C.C.), Centre Hospitalier Universitaire de Toulouse, France
| | - Fabrice Bonneville
- Department of Neuroradiology (A.G., J.D., A.-C.J., F.B., C.C.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse Neuro Imaging Center, France (J.-M.O., J.-F.A., A.V., L.C., N.R., F.B.)
| | - Thomas Tourdias
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, France (P.M., T.T.)
| | - Mikael Mazighi
- Université de Paris France, U 1148, A Rothschild Foundation Hospital (M. Mazighi)
| | - Igor Sibon
- Centre Hospitalier Universitaire de Bordeaux, Unité Neurovasculaire, Université de Bordeaux, France (I.S.)
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University, CA (M. Mlynash, S.C., G.W.A.)
| | - Christophe Cognard
- Department of Neuroradiology (A.G., J.D., A.-C.J., F.B., C.C.), Centre Hospitalier Universitaire de Toulouse, France
| | | |
Collapse
|
43
|
Lteif E, Darcourt J, Vukanisnovic I, Bellanger G, Januel AC, Bonneville F, Cognard C. Remote Rupture of Intradural Carotid Artery During Mechanical Thrombectomy in a Carotid Tandem Occlusion. Cardiovasc Intervent Radiol 2020; 43:1241-1243. [DOI: 10.1007/s00270-020-02481-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/04/2020] [Indexed: 11/24/2022]
|
44
|
Meyrignac O, Bal L, Zadro C, Vavasseur A, Sewonu A, Gaudry M, Saint-Lebes B, De Masi M, Revel-Mouroz P, Sommet A, Darcourt J, Negre-Salvayre A, Jacquier A, Bartoli JM, Piquet P, Rousseau H, Moreno R. Combining Volumetric and Wall Shear Stress Analysis from CT to Assess Risk of Abdominal Aortic Aneurysm Progression. Radiology 2020; 295:722-729. [PMID: 32228297 DOI: 10.1148/radiol.2020192112] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Despite known limitations, the decision to operate on abdominal aortic aneurysm (AAA) is primarily on the basis of measurement of maximal aneurysm diameter. Purpose To identify volumetric and computational fluid dynamics parameters to predict AAAs that are likely to progress in size. Materials and Methods This study, part of a multicenter prospective registry (NCT01599533), included 126 patients with AAA. Patients were sorted into stable (≤10-mL increase in aneurysm volume) and progression (>10-mL increase in aneurysm volume) groups. Initial AAA characteristics of the derivation cohort were analyzed (maximal diameter and surface, thrombus and lumen volumes, maximal wall pressure, and wall shear stress [WSS]) to identify relevant parameters for a logistic regression model. Model and maximal diameter diagnostic performances were assessed in both cohorts and for AAAs smaller than 50 mm by using area under the receiver operating characteristic curve (AUC). Results Eighty-one patients were included (mean age, 73 years ± 7 years [standard deviation]; 78 men). The derivation and validation cohorts included, respectively, 50 and 31 participants. In the derivation cohort, there was higher mean lumen volume and lower mean WSS in the progression group compared with the stable group (60 mL ± 14 vs 46 mL ± 18 [P = .005] and 66% ± 6 vs 53% ± 9 [P = .02], respectively). Mean lumen volume and mean WSS at baseline were correlated to total volume growth (r = 0.47 [P = .002] and -0.42 [P = .006], respectively). In the derivation cohort, a regression model including lumen volume and WSS to predict aneurysm enlargement was superior to maximal diameter alone (AUC, 0.78 vs 0.52, respectively; P = .003); although no difference was found in the validation cohort (AUC, 0.79 vs 0.71, respectively; P = .51). For AAAs smaller than 50 mm, a regression model that included both baseline WSS and lumen volume performed better than maximal diameter (AUC, 0.79 vs 0.53, respectively; P = .01). Conclusion Combined analysis of lumen volume and wall shear stress was associated with enlargement of abdominal aortic aneurysms at 1 year, particularly in aneurysms smaller than 50 mm in diameter. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Mitsouras and Leach in this issue.
Collapse
Affiliation(s)
- Olivier Meyrignac
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Laurence Bal
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Charline Zadro
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Adrien Vavasseur
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Anou Sewonu
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Marine Gaudry
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Bertrand Saint-Lebes
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Mariangela De Masi
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Paul Revel-Mouroz
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Agnès Sommet
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Jean Darcourt
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Anne Negre-Salvayre
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Alexis Jacquier
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Jean-Michel Bartoli
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Philippe Piquet
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Hervé Rousseau
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Ramiro Moreno
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| |
Collapse
|
45
|
Meyrignac O, Arcis É, Delchier MC, Mokrane FZ, Darcourt J, Rousseau H, Bouhanick B. Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism. Eur J Radiol 2020; 124:108792. [DOI: 10.1016/j.ejrad.2019.108792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
|
46
|
Olivot JM, Albucher JF, Guenego A, Mlynash M, Sibon I, Viguier A, Tourdias T, Calviere L, Bonneville F, Drif A, Raposo N, Darcourt J, Christensen S, Rousseau V, Januel AC, Mazighi M, Menegon P, Sommet A, Thalamas C, Albers GW, Cognard C. Abstract 2: French Acute Cerebral Multimodal Imaging to Select Patients for Mechanical Thrombectomy Final Results. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.2] [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
Introduction:
Target mismatch (TMM) identifies salvageable penumbra independent of time from stroke onset. Current guidelines do not recommend advanced imaging to select patients for mechanical thrombectomy (MT) within 6 hours after onset but indicate that more research is needed. To address this question, we designed a prospective multicenter cohort study to compare the rate of functional neurological recovery (mRS ≤2 @ 3 months) in patients treated by MT for ICA/M1/M2 occlusions within 6 hours after onset according to the presence of a TMM on baseline imaging.
Hypothesis:
60% of patients with TMM vs. 35% of no TMM, would achieve an mRS≤2 at 3 months. Sample size calculation: 200 patients.
Methods:
Consecutive patients eligible for MT within 6 hrs after onset, who underwent CTP or DWI/PWI imaging before treatment were enrolled. No NIHSS or ASPECTS restrictions were applied. Treating teams were blinded of CTP/DWI/PWI maps. mRS at 3 months was rated by an investigator blinded to clinical/imaging/treatment information. Automatically processed maps by RAPID software were reviewed after the end of follow-up. TMM definition followed EXTEND-IA criteria: MM volume >10mL, MM ratio>1.2, Core volume <70 mL. Mismatch (MM) was defined by MM ratio>1.2 and MM volume>10 mL. Imaging-based subgroups (TMM vs. No TMM) were defined after the end of follow-up.
Results:
218 patients were enrolled. Baseline imaging profile distribution was 71% TMM, 29% no TMM, (in the no TMM group, 76% had a core volume > 70 mL); 82% MM and 18% no MM. Reperfusion(TICI 2B-3) was achieved in 86% of the patients after a median delay of 4.4 hrs (95%CI 3.6-5.9). 61% of the patients in the TMM group vs. 35% in the no TMM group had an mRS ≤2 @ 3 months, p<0.001 (adjustment for age, onset to reperfusion, NIHSS, reperfusion and baseline imbalances). Reperfusion vs. no reperfusion was associated with an increased rate of good outcome in the TMM and MM groups (61% vs. 38% p=0.039 and 60% vs. 32%, p=0.016) but not in the no TMM or No MM groups (35% vs. 33%, NS; 35 vs. 45%., NS).
Conclusion:
Patients with salvageable penumbra on advanced imaging experienced a larger benefit from MT than those without. Patients with no penumbra did not appear to benefit from reperfusion.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amel Drif
- Hopital Toulouse Purpan, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Adam G, Darcourt J, Roques M, Ferrier M, Gramada R, Meluchova Z, Patsoura S, Viguier A, Cognard C, Larrue V, Bonneville F. Standard Diffusion-Weighted Imaging in the Brain Can Detect Cervical Internal Carotid Artery Dissections. AJNR Am J Neuroradiol 2020; 41:318-322. [PMID: 31948949 DOI: 10.3174/ajnr.a6383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The ICA is the most common site of cervical artery dissection. Prompt and reliable identification of the mural hematoma is warranted when a dissection is clinically suspected. The purpose of this study was to assess to capacity of a standard DWI sequence acquired routinely on the brain to detect dissecting hematoma related to cervical ICA dissections. MATERIALS AND METHODS This was a retrospective study of a cohort of 110 patients younger than 55 years of age (40 women; mean age, 46.79 years) admitted at the acute phase of a neurologic deficit, headache, or neck pain and investigated by at least a standard 3T diffusion-weighted sequence of the brain. Among them were 50 patients (14 women; mean age, 46.72 years) with subsequently confirmed ICA dissection. In the whole anonymized cohort, both a senior and junior radiologist separately assessed, on the DWI sequences only, the presence of a crescent-shaped or circular hypersignal projecting on the subpetrosal segment of the ICA arteries, assuming that it would correspond to a mural hematoma related to an ICA dissection. RESULTS The senior radiologist found 46 subpetrosal hyperintensities in 43/50 patients with ICA dissection and none in patients without dissection (sensitivity, 86%; specificity, 100%). The junior radiologist found 48 subpetrosal hyperintensities in 45/50 patients with dissection and none in patients without dissection (sensitivity, 90%; specificity, 100%). CONCLUSIONS In our cohort, a standard DWI sequence performed on the brain at the acute phase of a stroke or for a clinical suspicion of dissection detected nearly 90% of cervical ICA dissections.
Collapse
Affiliation(s)
- G Adam
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - J Darcourt
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - M Roques
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - M Ferrier
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - R Gramada
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - Z Meluchova
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - S Patsoura
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - A Viguier
- Neurology (A.V., V.L.), Centre Hospitalier Universitaire Toulouse, Pierre-Paul Riquet Hospital, Toulouse, France
| | - C Cognard
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - V Larrue
- Neurology (A.V., V.L.), Centre Hospitalier Universitaire Toulouse, Pierre-Paul Riquet Hospital, Toulouse, France
| | - F Bonneville
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| |
Collapse
|
48
|
Michelozzi C, Darcourt J, Guenego A, Januel AC, Tall P, Gawlitza M, Bonneville F, Cognard C. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up. J Neurosurg 2019; 131:1751-1762. [DOI: 10.3171/2018.7.jns18654] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study is to present the authors’ medium-term results, with special emphasis on complications, occlusion rate of the aneurysm sac (digital subtraction angiography [DSA] and MRI), and the fate of cortical branches and perforating arteries covered (“jailed”) by the flow diverter (FD) stent.METHODSBetween January 2010 and September 2017, 29 patients (14 female) with 30 aneurysms were treated with an FD stent. Twenty-one aneurysms were at the middle cerebral artery bifurcation, 8 were in the anterior communicating artery region, and 1 was a pericallosal artery bifurcation. Thirty-five cortical branches were covered. A single FD stent was used in all patients. Symptomatic and asymptomatic periprocedural and delayed complications were reported. DSA and MRI controls were analyzed to evaluate modification of the aneurysm sac and jailed branches.RESULTSPermanent morbidity was 3.4% (1/29), due to a jailed branch occlusion, with a modified Rankin Scale (mRS) score of 2 at the last follow-up. Mortality and permanent complication with poor prognosis (mRS score > 2) rates were 0%. The mean follow-up time for DSA and MRI (mean ± SD) was 21 ± 14.5 months (range 3–66 months) and 19 ± 16 months (range 3–41 months), respectively. The mean time to aneurysm sac occlusion (available for 24 patients), including stable remodeling, was 11.8 ± 6 months (median 13, range 3–27 months). The overall occlusion rate was 82.1% (23/28), and it was 91.7% (22/24) in the group of patients with at least 2 DSA control sequences. One recanalization occurred at 41 months posttreatment. At the time of publication, at the latest follow-up, 7 (20%) of 35 covered branches were occluded, 18 (51.4%) showed a decreased caliber, and the remaining 10 (28.5%) were unchanged. MRI T2-weighted sequences showed complete sac reabsorption in 7/29 aneurysms (24.1%), and the remaining lesions were either smaller (55.2%) or unchanged (17.2%). MRI revealed asymptomatic and symptomatic ischemic events in perforator territories in 7/28 (25%) and 4/28 (14.3%) patients, respectively, which were reversible within 24 hours.CONCLUSIONSFlow diversion of bifurcation aneurysms is feasible, with low rates of permanent morbidity and mortality and high occlusion rates; however, recurrence may occur. Caliber reduction and asymptomatic occlusion of covered cortical branches as well as silent perforator stroke are common. Ischemic complications may occur with no identified predictable factors. MRI controls should be required in all patients to evaluate silent ischemic lesions and aneurysm sac reabsorption over time.
Collapse
Affiliation(s)
- Caterina Michelozzi
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | - Jean Darcourt
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | - Adrien Guenego
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | | | - Philippe Tall
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | | | - Fabrice Bonneville
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | - Christophe Cognard
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| |
Collapse
|
49
|
Humbert O, Cadour N, Paquet M, Schiappa R, Poudenx M, Chardin D, Borchiellini D, Benisvy D, Ouvrier MJ, Zwarthoed C, Schiazza A, Ilie M, Ghalloussi H, Koulibaly PM, Darcourt J, Otto J. 18FDG PET/CT in the early assessment of non-small cell lung cancer response to immunotherapy: frequency and clinical significance of atypical evolutive patterns. Eur J Nucl Med Mol Imaging 2019; 47:1158-1167. [PMID: 31760467 DOI: 10.1007/s00259-019-04573-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE This prospective study aimed (1) to assess the non-small cell lung cancer (NSCLC) evolutive patterns to immunotherapy using FDG-PET and (2) to describe their association with clinical outcome. DESIGN Fifty patients with metastatic NSCLC were included before pembrolizumab or nivolumab initiation. FDG-PET scan was performed at baseline and after 7 weeks of treatment (PETinterim1) and different criteria/parameters of tumor response were assessed, including PET response criteria in solid tumors (PERCIST). If a first PERCIST progressive disease (PD) without clinical worsening was observed, treatment was continued and a subsequent FDG-PET (PETinterim2) was performed at 3 months of treatment. Pseudo-progression (PsPD) was defined as a PERCIST response/stability on PETinterim2 after an initial PD. If a second PERCIST PD was assessed on PETinterim2, a homogeneous progression of lesions (termed immune homogeneous progressive-disease: iPDhomogeneous) was distinguished from a heterogeneous evolution (termed immune dissociated-response: iDR). A durable clinical benefit (DCB) of immunotherapy was defined as treatment continuation over a 6-month period. The association between PET evolutive profiles and DCB was assessed. RESULTS Using PERCIST on PETinterim1, 42% (21/50) of patients showed a response or stable disease, most of them (18/21) reached a DCB. In contrast, 58% (29/50) showed a PD, but more than one-third (11/29) were misclassified as they finally reached a DCB. No standard PETinterim1 criteria could accurately distinguished responding from non-responding patients. Treatment was continued in 19/29 of patients with a first PERCIST PD; the subsequent PETinterim2 demonstrated iPDhomogeneous, iDR and PsPD in 42% (8/19), 26% (5/19), and 32% (6/19), respectively. Whereas no patients with iPDhomogeneous experienced a DCB, all patients with iDR and PsPD reached a clinical benefit to immunotherapy. CONCLUSION In patients with a first PD on PERCIST and treatment continuation, a subsequent PET identifies more than half of them with iDR and PsPD, both patterns being strongly associated with a clinical benefit of immunotherapy.
Collapse
Affiliation(s)
- O Humbert
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France. .,Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), UMR E 4320, CEA, UCA, Nice, France.
| | - N Cadour
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - M Paquet
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - R Schiappa
- Department of Biostatistics, Centre Antoine-Lacassagne, UCA, Nice, France
| | - M Poudenx
- Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France
| | - D Chardin
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France.,Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), UMR E 4320, CEA, UCA, Nice, France
| | - D Borchiellini
- Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France.,Clinical Research and Innovation Office, Centre Antoine-Lacassagne, UCA, Nice, France
| | - D Benisvy
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - M J Ouvrier
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - C Zwarthoed
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - A Schiazza
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - M Ilie
- Laboratory of Clinical and Experimental Pathology, Hospital-Integrated Biobank (BB-0033-00025), Nice Hospital University, FHU OncoAge, UCA, Nice, France
| | - H Ghalloussi
- Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France
| | - P M Koulibaly
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France
| | - J Darcourt
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France.,Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), UMR E 4320, CEA, UCA, Nice, France
| | - J Otto
- Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France
| |
Collapse
|
50
|
Darcourt J, Cognard C. Response by Darcourt and Cognard to Letter Regarding Article, “Predictive Value of Susceptibility Vessel Sign for Arterial Recanalization and Clinical Improvement in Ischemic Stroke”. Stroke 2019; 50:e135. [DOI: 10.1161/strokeaha.119.025115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jean Darcourt
- Department of Neuroradiology, CHU de Toulouse, INSERM, U1048 and Université Toulouse 3, France
| | - Christophe Cognard
- Department of Neuroradiology, CHU de Toulouse, INSERM, U1048 and Université Toulouse 3, France
| |
Collapse
|