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Premat K, Dechartres A, Baptiste A, Guedon A, Mazighi M, Spelle L, Denier C, Tuilier T, Hosseini H, Lapergue B, Di Maria F, Bricout N, Henon H, Gory B, Richard S, Chivot C, Courselle A, Velasco S, Lamy M, Costalat V, Arquizan C, Marnat G, Sibon I, Lenck S, Shotar E, Allard J, Sourour N, Degos V, Alamowitch S, Clarençon F. Comparison of rescue intracranial stenting versus best medical treatment alone in acute refractory large vessel occlusion: study protocol for the PISTAR multicenter randomized trial. J Neurointerv Surg 2024:jnis-2024-021502. [PMID: 38538057 DOI: 10.1136/jnis-2024-021502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Mechanical thrombectomy (MT) has become a standard treatment for acute ischemic strokes (AIS). However, MT failure occurs in approximately 10-30% of cases, leading to severe repercussions (with mortality rates up to 40% according to observational data). Among the available rescue techniques, rescue intracranial stenting (RIS) appears as a promising option. OBJECTIVE This trial is poised to demonstrate the superiority of RIS in addition to the best medical treatment (BMT) in comparison with BMT alone, in improving the functional outcomes at 3 months for patients experiencing an AIS due to a large vessel occlusion refractory to MT (rLVO). METHODS Permanent Intracranial STenting for Acute Refractory large vessel occlusions (PISTAR) is a multicenter prospective randomized open, blinded endpoint trial conducted across 11 French University hospitals. Adult patients (≥18 years) with an acute intracranial occlusion refractory to standard MT techniques will be randomized 1:1 during the procedure to receive either RIS+BMT (intervention arm) or BMT alone (control arm). RESULTS The primary outcome is the rate of good clinical outcome at 3 months defined as a modified Rankin Scale score ≤2 and evaluated by an independent assessor blinded to the randomization arm. Secondary outcomes include hemorrhagic complications, all adverse events, and death. The number of patients to be included is 346. Two interim analyses are planned with predefined stopping rules. CONCLUSION The PISTAR trial is the first randomized controlled trial focusing on the benefit of RIS in rLVOs. If positive, this study will open new insights into the management of AIS. TRIAL REGISTRATION NUMBER NCT06071091.
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Affiliation(s)
- Kévin Premat
- Department of Interventional Neuroradiology, Sorbonne Université, APHP, 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
| | - Amandine Baptiste
- Clinical Research Unit, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexis Guedon
- Department of Neuroradiology, Lariboisière Hospital, Paris, France
| | - Mikael Mazighi
- Department of Vascular Neurology, Lariboisière Hospital, Paris, France
| | - Laurent Spelle
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Christian Denier
- Department of Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
| | - Titien Tuilier
- Department of Neuroradiology, Henri-Mondor Hospital, Creteil, France
| | - Hassan Hosseini
- Department of Vascular Neurology, Henri-Mondor Hospital, Créteil, France
| | | | - Federico Di Maria
- Department of Interventional and Diagnostic Neuroradiology, Foch Hospital, Suresnes, 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, CHRU de Nancy, Nancy, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Cyril Chivot
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - Audrey Courselle
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Stéphane Velasco
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Mathias Lamy
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Vincent Costalat
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Stephanie Lenck
- Department of Interventional Neuroradiology, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Julien Allard
- Department of Interventional Neuroradiology, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Degos
- Department of Anesthesiology and NeuroIntensive Care, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Sonia Alamowitch
- Department of Neurology, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Sorbonne Université, APHP, Pitié-Salpêtrière Hospital, Paris, France
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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.
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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
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Sablot D, Touzé E, Ellie E, Alamowitch S, De Broucker T, Guillon B, Sellal F, Crozier S, Sibon I. Medical demography at stroke centers: Current situation in France. Rev Neurol (Paris) 2024; 180:171-176. [PMID: 37880036 DOI: 10.1016/j.neurol.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/20/2023] [Accepted: 08/23/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Following the 2010-2014 French national stroke action plan, the number of stroke center (SC) has gradually increased in France, allowing a homogeneous coverage and access to neurovascular care in organized and territorially defined structures. However, operational difficulties within SCs have been progressively reported over the last few years. The objective of this study was to identify the medical staff shortages in SC that may contribute to these difficulties. METHODS A survey on the medical staffing level as of January 1, 2021 was sent to all French SC managers. Specific questions related on vacancies, need of interim medical staff, and participation in out-of-hour healthcare services. RESULTS Among the 139 SC managers contacted, 122 (88%) filled in the questionnaire. Analysis of the data showed that over 879 physician positions opened, 163 (18.5%) remained vacant for a mean of two years, and that in 51 SCs (41.9%), more than two positions were unfilled. In 13 of these 51 SCs, the out-of-hour healthcare services relied on less than four practitioners, defining a critical situation, and three other SCs had to close temporarily (2) or permanently (1). Moreover, 39.2% of SCs with at least one vacancy used interim physicians, for a median period of 12.5 weeks/year (IQR 5-18). CONCLUSION This study highlights the significant medical staff shortage in French SCs. In the absence of urgent measures, more SCs will close, jeopardizing the regional network and access to care for stroke patients.
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Affiliation(s)
- D Sablot
- Service de neurologie, hôpital St-Jean, Perpignan, France.
| | - E Touzé
- Stroke Unit, CHU de Caen, université de Caen, Caen, France
| | - E Ellie
- Service de neurologie, hôpital de la côte basque, Bayonne, France
| | - S Alamowitch
- Département des urgences cérébrovasculaires, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - T De Broucker
- Service de neurologie, hôpital Delafontaine, St-Denis, France
| | - B Guillon
- Stroke unit, hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - F Sellal
- Service de neurologie, hôpital Louis-Pasteur, Colmar, France
| | - S Crozier
- Département des urgences cérébrovasculaires, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - I Sibon
- Stroke unit, CHU de Bordeaux, université de Bordeaux, Bordeaux, France
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Marnat G, Lapergue B, Gory B, Kyheng M, Labreuche J, Turc G, Olindo S, Sibon I, Caroff J, Smadja D, Chausson N, Clarençon F, Seners P, Bourcier R, Pop R, Olivot JM, Mazighi M, Moulin S, Janot K, Cognard C, Alamowitch S, Gerschenfeld G. Intravenous thrombolysis with tenecteplase versus alteplase combined with endovascular treatment of anterior circulation tandem occlusions: A pooled analysis of ETIS and TETRIS. Eur Stroke J 2024; 9:124-134. [PMID: 37837202 PMCID: PMC10916828 DOI: 10.1177/23969873231206894] [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: 06/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Tandem occlusions are a singular large vessel occlusion entity involving specific endovascular and perioperative antithrombotic management. In this context, data on safety and efficacy of prior intravenous thrombolysis (IVT) with tenecteplase is scarce. We aimed to compare IVT with tenecteplase or alteplase in patients with acute tandem occlusions intended for endovascular treatment. PATIENTS AND METHODS A retrospective pooled analysis of two large observational registries (ETIS (Endovascular Treatment of Ischemic Stroke) and TETRIS (Tenecteplase Treatment in Ischemic Stroke)) was performed on consecutive patients presenting with anterior circulation tandem occlusion treated with IVT using either alteplase (ETIS) or tenecteplase (TETRIS) followed by endovascular treatment between January 2015 and June 2022. Sensitivity analyses on atherosclerosis related tandem occlusions and on patient treated with emergent carotid stenting were conducted. Propensity score overlap weighting analyses were performed. RESULTS We analyzed 753 patients: 124 in the tenecteplase and 629 in the alteplase group. The overall odds of favorable outcome (3-month modified Rankin score 0-2) were comparable between both groups (49.4% vs 47.1%; OR = 1.10, 95%CI 0.85-1.41). Early recanalization, final successful recanalization and mortality favored the use of tenecteplase. The occurrence of any intracranial hemorrhage (ICH) was more frequent after tenecteplase use (OR = 2.24; 95%CI 1.75-2.86). However, risks of symptomatic ICH and parenchymal hematoma remained similar. In atherosclerotic tandems, favorable outcome, mortality, parenchymal hematoma, early recanalization, and final successful recanalization favored the tenecteplase group. In the carotid stenting subgroup, PH were less frequent in the tenecteplase group (OR = 0.18; 95%CI 0.05-0.69). CONCLUSION In patients with tandem occlusions, IVT with tenecteplase seemed reasonably safe in particular with increased early recanalization rates. These findings remain preliminary and should be further confirmed in randomized trials.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | - Benjamin Gory
- Neuroradiology, Nancy University Hospital, Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Maeva Kyheng
- Biostatistics, Lille University Hospital, Lille, France
| | | | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, INSERM U1266, Université Paris Cité, FHU NeuroVasc, Paris, France
| | | | - Igor Sibon
- Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Jildaz Caroff
- Interventional Neuroradiology − NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Didier Smadja
- Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Nicolas Chausson
- Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | | | - Pierre Seners
- Neurology, Fondation Rothschild, Paris, Île-de-France, France
| | | | - Raoul Pop
- Neuroradiology, Strasbourg University Hospital, Strasbourg, France
| | | | - Mikael Mazighi
- Neurology, Lariboisiere Hospital, and Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris Cité, INSERM 1144, FHU Neurovasc, Paris, France
| | - Solène Moulin
- Neurology, Stroke Unit; Reims University Hospital, Reims, France
| | - Kevin Janot
- Neuroradiology, Tours University Hospital, Tours, France
| | | | - Sonia Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Gaspard Gerschenfeld
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
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Zhu F, Kerleroux B, Pruvo JP, Naggara O, Caroff J, Berge J, Alamowitch S, Desal H, Boulouis G. Breaking the glass ceiling for Mechanical Thrombectomy access in France. J Neuroradiol 2024; 51:43-46. [PMID: 38135248 DOI: 10.1016/j.neurad.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Affiliation(s)
- François Zhu
- Imagerie Adaptative Diagnostique et Interventionnelle (IADI), University of Lorraine; INSERM U1254; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Basile Kerleroux
- Department of Neuroradiology, CHU Timone, 264 Rue Saint-Pierre, Marseille, France
| | - Jean Pierre Pruvo
- Neuroradiology Department. Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Lille, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences; INSERM U1266; Université Paris-Cité, Paris, France; Pediatric Radiology Department, APHP Necker-Enfants Malades University Hospital, Université Paris-Cité, Paris, France
| | - Jildaz Caroff
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
| | - Jérôme Berge
- Neuroradiology department, University Hospital, Bordeaux, France
| | - Sonia Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, CIC-IT 1415, CHRU de Tours, INSERM 1253 iBrain, Tours, Centre Val de Loire, France.
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Checkouri T, Gerschenfeld G, Seners P, Yger M, Ben Hassen W, Chausson N, Olindo S, Caroff J, Marnat G, Clarençon F, Baron JC, Turc G, Alamowitch S. Early Recanalization Among Patients Undergoing Bridging Therapy With Tenecteplase or Alteplase. Stroke 2023; 54:2491-2499. [PMID: 37622385 DOI: 10.1161/strokeaha.123.042691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) with alteplase or tenecteplase before mechanical thrombectomy is the recommended treatment for large-vessel occlusion acute ischemic stroke. There are divergent data on whether these agents differ in terms of early recanalization (ER) rates before mechanical thrombectomy, and little data on their potential differences stratified by ER predictors such as IVT to ER evaluation (IVT-to-EReval) time, occlusion site and thrombus length. METHODS We retrospectively compared the likelihood of ER after IVT with tenecteplase or alteplase in anterior circulation large-vessel occlusion acute ischemic stroke patients from the PREDICT-RECANAL (alteplase) and Tenecteplase Treatment in Ischemic Stroke (tenecteplase) French multicenter registries. ER was defined as a modified Thrombolysis in Cerebral Infarction score 2b-3 on the first angiographic run, or noninvasive vascular imaging in patients with early neurological improvement. Analyses were based on propensity score overlap weighting (leading to exact balance in patient history, stroke characteristics, and initial management between groups) and confirmed with adjusted logistic regression (sensitivity analysis). A stratified analysis based on pre-established ER predictors (IVT-to-EReval time, occlusion site, and thrombus length) was conducted. RESULTS Overall, 1865 patients were included. ER occurred in 156/787 (19.8%) and 199/1078 (18.5%) patients treated with tenecteplase or alteplase, respectively (odds ratio, 1.09 [95% CI, 0.83-1.44]; P=0.52). A differential effect of tenecteplase versus alteplase on the probability of ER according to thrombus length was observed (Pinteraction=0.003), with tenecteplase being associated with higher odds of ER in thrombi >10 mm (odds ratio, 2.43 [95% CI, 1.02-5.81]; P=0.04). There was no differential effect of tenecteplase versus alteplase on the likelihood of ER according to the IVT-to-EReval time (Pinteraction=0.40) or occlusion site (Pinteraction=0.80). CONCLUSIONS Both thrombolytics achieved ER in one-fifth of patients with large-vessel occlusion acute ischemic stroke without significant interaction with IVT-to-EReval time and occlusion site. Compared with alteplase, tenecteplase was associated with a 2-fold higher likelihood of ER in larger thrombi.
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Affiliation(s)
- Thomas Checkouri
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
| | - Gaspard Gerschenfeld
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
| | - Pierre Seners
- Service de Neurologie, GHU Paris Psychiatrie et Neurosciences, France (P.S.)
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
- Service de Neurologie, Hôpital Fondation Rothschild, Paris, France (P.S.)
| | - Marion Yger
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
| | - Wagih Ben Hassen
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, France (W.B.H.)
| | - Nicolas Chausson
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
- Service de Neurologie, Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes (N.C.)
| | | | - Jildaz Caroff
- AP-HP, Service de Neuroradiologie interventionnelle (NEURI), Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France (J.C.)
| | - Gaultier Marnat
- Service de Neuroradiologie diagnostique et interventionnelle (G.M.), France
- CHU de Bordeaux, France (G.M.)
| | - Frédéric Clarençon
- AP-HP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France (F.C.)
| | - Jean-Claude Baron
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
| | - Guillaume Turc
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
| | - Sonia Alamowitch
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
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7
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Dimancea A, Mattioni S, Nouet A, Drir M, Santin A, Marrot B, Shotar E, Corcy C, Bottin L, Sourour NA, Premat K, Alamowitch S, Carpentier A, Degos V, Clarençon F, Lionnet F, Lenck S. Preventive treatment of unruptured intracranial aneurysms in adult patients with sickle cell anemia: A cohort study. J Neuroradiol 2023; 50:511-517. [PMID: 36781119 DOI: 10.1016/j.neurad.2023.02.003] [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: 09/15/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms are frequent in patients with sickle cell anemia, while subarachnoid hemorrhage is a major cause of death and disability in young adult patients. Several characteristics, such as younger age and smaller size at rupture, may incline therapeutic decision towards exclusion treatments. Clinical guidelines on treatment of unruptured intracranial aneurysms in this population are still missing. We aimed to assess the safety and efficacy of the treatment of unruptured intracranial aneurysm in patients with sickle cell anemia, using an adapted hematological preparation regimen. PATIENTS AND METHODS Adult patients with sickle cell anemia and treated unruptured aneurysms by endovascular therapy or neurosurgery were included in this retrospective cohort study. Treatment decision was reached after multi-disciplinary assessment. A pre-operative blood transfusion protocol was undertaken targeting a HbS below 30%. Demographic data, hematological preparation parameters and clinical and radiological outcomes were documented. RESULTS AND CONCLUSIONS Twenty-five procedures were performed in 18 patients encompassing 19 aneurysms treated by embolization and 6 by surgery. Median age at treatment was 34 years-old and median aneurysm dome size was 4.4 mm. Immediate aneurysm exclusion rate was 85.7% after endovascular therapy and 100% after neurosurgery. Median follow-up was 6 months, with all patients being asymptomatic at last follow-up. Two transitory ischemic neurological deficits, as well as four cases of iodine-induced encephalopathy were identified after embolization. No complication occurred after surgery. Endovascular therapy by coiling and neurosurgical treatment of unruptured intracranial aneurysms appears to be safe in patients with sickle cell anemia and should be considered given the specific hemorrhagic risk observed in this population. A rigorous hematological preparation, associated with a dedicated peri‑operative protocol and an adequate therapeutic strategy are essential prerequisites.
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Affiliation(s)
- A Dimancea
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Mattioni
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - A Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - M Drir
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France
| | - A Santin
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - B Marrot
- Department of Radiology, Tenon University Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - C Corcy
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - L Bottin
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France
| | - N A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - K Premat
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Alamowitch
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - A Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - V Degos
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - F Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; GRC BioFast. Paris VI University. Paris. France
| | - F Lionnet
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - S Lenck
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; Inserm UMR 1127, Paris Brain Institute, Paris, France.
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8
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Rosso C, Belkacem S, Amor-Sahli M, Clarençon F, Leger A, Baronnet F, Dormont D, Alamowitch S, Lehericy S, Samson Y. Persistent perfusion abnormalities at day 1 correspond to different clinical trajectories after stroke. J Neurointerv Surg 2023; 15:e26-e32. [PMID: 35701108 DOI: 10.1136/neurintsurg-2022-018953] [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: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Perfusion abnormalities after thrombolysis are frequent within and surrounding ischemic lesions, but their relative frequency is not well known. OBJECTIVE To describe the different patterns of perfusion abnormalities observed at 24 hours and compare the characteristics of the patients according to their perfusion pattern. METHODS From our thrombolysis registry, we included 226 consecutive patients with an available arterial spin labeling (ASL) perfusion sequence at day 1. We performed a blinded assessment of the perfusion status (hypoperfusion-h, hyperperfusion-H, or normal-N) in the ischemic lesion and in the surrounding tissue. We compared the time course of clinical recovery, the rate of arterial recanalization, and hemorrhagic transformations in the different perfusion profiles. RESULTS We identified seven different perfusion profiles at day 1. Four of these (h/h, h/H, H/H, and H/N) represented the majority of the population (84.1%). The H/H profile was the most frequent (34.5%) and associated with 3-month good outcome (modified Rankin Scale (mRS): 63.5%). Patients with persistent hypoperfusion within and outside the lesion (h/h, 12.4%) exhibited worse outcomes after treatment (mRS score 0-2: 23.8%) than other patients, were less frequently recanalized (40.7%), and had more parenchymal hematoma (17.8%). The h/H profile had an intermediate clinical trajectory between the h/h profile and the hyperperfused profiles. CONCLUSION ASL hypoperfusion within the infarct and the surrounding tissue was associated with poor outcome. A more comprehensive view of the mechanisms in the hypoperfused surrounding tissue could help to design new therapeutic approaches during and after reperfusion therapies.
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Affiliation(s)
- Charlotte Rosso
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Samia Belkacem
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Mélika Amor-Sahli
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frédéric Clarençon
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Interventional Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne Leger
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Flore Baronnet
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Didier Dormont
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sonia Alamowitch
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Stéphane Lehericy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Samson
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
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9
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Parrot A, Barral M, Amiot X, Bachmeyer C, Wagner I, Eyries M, Alamowitch S, Ederhy S, Epaud R, Dupuis-Girod S, Cadranel J. [Hereditary hemorrhagic telangiectasia]. Rev Mal Respir 2023; 40:391-405. [PMID: 37062633 DOI: 10.1016/j.rmr.2023.02.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/26/2023] [Indexed: 04/18/2023]
Abstract
Hereditary hemorrhagic telangiectasia, also known as Rendu-Osler - Weber disease, is a rare, autosomal dominant vascular disease, with prevalence of 1/5,000. The condition is characterized by muco-cutaneous telangiectasias, which are responsible for a hemorrhagic syndrome of variable severity, as well as arteriovenous malformations (AVMs) appearing in the lungs, the liver, and the nervous system. They can be the source of shunts, which may be associated with high morbidity (neurological ischemic stroke, brain abscess, high-output heart failure, biliary ischemia…). It is therefore crucial to establish a clinical diagnosis using the Curaçao criteria or molecular diagnosis based on genetic analysis of the ENG, ACVRL1, SMAD4 and GDF2 genes. In most cases, multidisciplinary management allows patients to have normal life expectancy. Advances in interventional radiology and better understanding of the pathophysiology of angiogenesis have resulted in improved therapeutic management. Anti-angiogenic treatments, such as bevacizumab (BVZ, an anti-VEGF antibody), have proven to be effective in cases involving bleeding complications and severe liver damage with cardiac repercussions. Other anti-angiogenic agents are currently being investigated, including tyrosine kinase inhibitors.
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Affiliation(s)
- A Parrot
- Service de pneumologie, centre de compétence de la maladie de Rendu-Osler, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - M Barral
- Service de radiologie, hôpital Tenon, AP-HP, 75020 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - X Amiot
- Service de gastroentérologie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bachmeyer
- Service de médecine interne, hôpital Tenon, AP-HP, 75020 Paris, France
| | - I Wagner
- Service d'ORL, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Eyries
- Service de génétique, hôpital de la Pitié-Salpetrière, AP-HP, 75020 Paris, France
| | - S Alamowitch
- Service des urgences cérébrovasculaires, hôpital de la Pitié-Salpetrière, AP-HP, 75020 Paris, France
| | - S Ederhy
- Service de cardiologie et GRC no 27, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - R Epaud
- Service de pédiatrie, centre intercommunaux de Créteil, Créteil, France
| | - S Dupuis-Girod
- Service de génétique, centre de référence pour la maladie de Rendu-Osler, hospices civils de Lyon, hôpital Mère-Enfant, 69500 Bron, France
| | - J Cadranel
- Service de pneumologie, centre de compétence de la maladie de Rendu-Osler, hôpital Tenon, AP-HP, 75020 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
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10
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Olindo S, Albucher JF, Bejot Y, Berge J, Cordonnier C, Guillon B, Sablot D, Tardy J, Alamowitch S, Sibon I. Tenecteplase in acute ischemic stroke: Review of the literature and expert consensus from the French Neurovascular Society. Rev Neurol (Paris) 2023; 179:150-160. [PMID: 36369068 DOI: 10.1016/j.neurol.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intravenous alteplase is the only thrombolytic treatment approved for patients with acute ischemic stroke (AIS). Although no randomized controlled trial (RCT) has shown the superiority of tenecteplase over alteplase in AIS, tenecteplase is increasingly used off-label in Stroke Units. The purpose of the present work was to provide an up-to-date set of expert consensus statements on the use of tenecteplase in AIS. METHODS Members of the working group were selected by the French Neurovascular Society. RCTs comparing tenecteplase and alteplase in the treatment of AIS were reviewed. Recent meta-analysis and real-life experience data on tenecteplase published until 30th October 2021 were also analyzed. After a description of the available data, we tried to answer the subsequent questions about the use of tenecteplase in AIS: What dosage of tenecteplase should be preferred? How effective is tenecteplase for cerebral artery recanalization? What is the clinical effectiveness of tenecteplase? What is the therapeutic safety of tenecteplase? What are the benefits associated with tenecteplase ease of use? Then expert consensus statements for tenecteplase use were submitted. In October 2021 the working group was asked to review and revise the manuscript. In November 2021, the current version of the manuscript was approved. EXPERT CONSENSUS A set of three expert consensus statements for the use of tenecteplase within 4.5hours of symptom onset in AIS patients were issued: (1) It is reasonable to use tenecteplase 0.25mg/kg when mechanical thrombectomy (MT) is planned. (2) Tenecteplase 0.25mg/kg can be used as an alternative to alteplase 0.9mg/kg in patients with medium- or small-vessel occlusion not retrievable with MT. (3) Tenecteplase 0.25mg/kg could be considered as an alternative to alteplase 0.9mg/kg in patients without vessel occlusion. CONCLUSIONS These expert consensus statements could provide a framework to guide the clinical decision-making process for the use of tenecteplase according to admission characteristics of AIS patients. However, existing data are limited, requiring inclusions in ongoing RCTs or real-life registries.
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Affiliation(s)
- S Olindo
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - J-F Albucher
- Unité Neuro-Vasculaire, Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Y Bejot
- Service Hospitalo-Universitaire de Neurologie, CHU de Dijon Bourgogne, Dijon, France
| | - J Berge
- Service de Neuro-Radiologie, Hôpital Pellegrin, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - C Cordonnier
- Université Lille, Inserm, CHU Lille, U1172, LiINCog, Lille Neuroscience and Cognition, Lille, France
| | - B Guillon
- Unité Neurovasculaire, Hôpital G&R Laënnec, CHU de Nantes, Nantes, France
| | - D Sablot
- Service de Neurologie, Hôpital de Perpignan, Perpignan, France
| | - J Tardy
- Unité Neuro-Vasculaire, Clinique des Cèdres, Cornebarrieu, France
| | - S Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Salpêtrière-Saint Antoine, AP-HP, Sorbonne Université, Stare Team, iCRIN, Institut du cerveau, Inserm UMRS 938, Paris, France
| | - I Sibon
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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11
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Boutitie L, Verny M, Alamowitch S, Zerah L. [Cerebral amyloid angiopathy and atrial fibrillation: anticoagulant dilemma]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:81-89. [PMID: 37115683 DOI: 10.1684/pnv.2023.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Cerebral amyloid angiopathy and atrial fibrillation are two frequent comorbidities in older patients, leading to a therapeutic dilemma on the risk-benefit ratio of long-term anticoagulation. These patients both have a risk of cardioembolic complications due to atrial fibrillation, and a risk of cerebral haemorrhage from cerebral amyloid angiopathy. Since there is no therapeutic consensus, the best therapeutic strategy should be discussed during a multidisciplinary staff, based on four risk estimations: 1) the baseline risk of intracerebral haemorrhage without anticoagulation; 2) the risk of ischaemic stroke without anticoagulation; 3) the expected increase of intracerebral haemorrhage with anticoagulation; 4) the expected reduction in ischaemic stroke risk with anticoagulation. The risk of intracerebral haemorrhage varies according to the cerebral amyloid angiopathy phenotype. Patients with transient neurological episode or cortical superficial siderosis have the highest risk of intracerebral haemorrhage. Direct oral anticoagulant should be preferred to vitamin K antagonists, as the risk of intracerebral haemorrhage is lower with direct oral anticoagulants. If anticoagulation is introduced, a close clinical and radiological monitoring should be performed every 6-12 months minimum. If it has been decided not to anticoagulate, left atrial appendage occlusion should be proposed. In all situations, close blood pressure control is essential to reduce the risk of intracerebral haemorrhage.
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Affiliation(s)
- Léa Boutitie
- Département de gériatrie, Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris Paris, France
| | - Marc Verny
- Département de gériatrie, Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris Paris, France, Sorbonne Université, Team Neuronal Cell Biology and Pathology, UMR CNRS 8256, Paris, France
| | - Sonia Alamowitch
- STARE Team, iCRIN, Institut du cerveau et de la moelle épinière, ICM, Paris, France, Urgences cérébrovasculaires, Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Lorène Zerah
- Département de gériatrie, Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris Paris, France, Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, Paris, France
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12
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Guedon AF, Ricard L, Laurent C, De Moreuil C, Urbanski G, Deriaz S, Gerotziafas G, Elalamy I, Audemard A, Chasset F, Alamowitch S, Sellam J, Boffa JJ, Cohen A, Wahl C, Abisror N, Maillot F, Fain O, Mekinian A. Identifying high-risk profile in primary antiphospholipid syndrome through cluster analysis: French multicentric cohort study. RMD Open 2023; 9:rmdopen-2022-002881. [PMID: 36894193 PMCID: PMC10008476 DOI: 10.1136/rmdopen-2022-002881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/03/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Antiphospholipid syndrome (APS) is an autoimmune disease characterised by thrombosis (arterial, venous or small vessel) or obstetrical events and persistent antiphospholipid antibodies (aPL), according to the Sydney classification criteria. Many studies have performed cluster analyses among patients with primary APS and associated autoimmune disease, but none has focused solely on primary APS. We aimed to perform a cluster analysis among patients with primary APS and asymptomatic aPL carriers without any autoimmune disease, to assess prognostic value. METHODS In this multicentre French cohort study, we included all patients with persistent APS antibodies (Sydney criteria) measured between January 2012 and January 2019. We excluded all patients with systemic lupus erythematosus or other systemic autoimmune diseases. We performed hierarchical cluster analysis on the factor analysis of mixed data coordinates results with baseline patient characteristics to generate clusters. RESULTS We identified four clusters: cluster 1, comprising 'asymptomatic aPL carriers', with low risk of events during follow-up; cluster 2, the 'male thrombotic phenotype', with older patients and more venous thromboembolic events; cluster 3, the 'female obstetrical phenotype', with obstetrical and thrombotic events; and cluster 4, 'high-risk APS', which included younger patients with more frequent triple positivity, antinuclear antibodies, non-criteria manifestations and arterial events. Regarding survival analyses, asymptomatic aPL carriers relapsed less frequently than the others, but no other differences in terms of relapse rates or deaths were found between clusters. CONCLUSIONS We identified four clusters among patients with primary APS, one of which was 'high-risk APS'. Clustering-based treatment strategies should be explored in future prospective studies.
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Affiliation(s)
- Alexis F Guedon
- Sorbonne Université,Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Laure Ricard
- Sorbonne Université,Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Charlotte Laurent
- Sorbonne Université,Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Hôpital Saint-Antoine, AP-HP, Paris, France
| | | | - Geoffrey Urbanski
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sophie Deriaz
- Service de Médecine Interne, CHRU et université de Tours, Tours, France
| | - Grigorios Gerotziafas
- Service de Hémostase et Hématologie Biologique, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - Ismail Elalamy
- Service de Hémostase et Hématologie Biologique, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | | | - Francois Chasset
- Service de Dermatologie et Vénérologie, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - Sonia Alamowitch
- Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Centre de Recherche de Saint Antoine, INSERM, UMRS 938, Sorbonne Université Paris, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie, CRSA INSERM, UMRS 938, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Jean Jacques Boffa
- Service de Néphrologie, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Clémentine Wahl
- Sorbonne Université, Service d'hématologie biologique, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Noemie Abisror
- Sorbonne Université,Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Hôpital Saint-Antoine, AP-HP, Paris, France
| | - François Maillot
- Service de Médecine Interne, CHRU et université de Tours, Tours, France
| | - Olivier Fain
- Sorbonne Université,Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Arsène Mekinian
- Sorbonne Université,Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Hôpital Saint-Antoine, AP-HP, Paris, France
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Alamowitch S, Turc G, Palaiodimou L, Bivard A, Cameron A, De Marchis GM, Fromm A, Kõrv J, Roaldsen MB, Katsanos AH, Tsivgoulis G. European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke. Eur Stroke J 2023; 8:8-54. [PMID: 37021186 PMCID: PMC10069183 DOI: 10.1177/23969873221150022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/21/2022] [Indexed: 02/05/2023] Open
Abstract
Within the last year, four randomised-controlled clinical trials (RCTs) have been published comparing intravenous thrombolysis (IVT) with tenecteplase and alteplase in acute ischaemic stroke (AIS) patients with a non-inferiority design for three of them. An expedited recommendation process was initiated by the European Stroke Organisation (ESO) and conducted according to ESO standard operating procedure based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. We identified three relevant Population, Intervention, Comparator, Outcome (PICO) questions, performed systematic reviews of the literature and meta-analyses, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert consensus statements were provided if insufficient evidence was available to provide recommendations based on the GRADE approach. For patients with AIS of <4.5 h duration who are eligible for IVT, tenecteplase 0.25 mg/kg can be used as a safe and effective alternative to alteplase 0.9 mg/kg (moderate evidence, strong recommendation). For patients with AIS of <4.5 h duration who are eligible for IVT, we recommend against using tenecteplase at a dose of 0.40 mg/kg (low evidence, strong recommendation). For patients with AIS of <4.5 h duration with prehospital management with a mobile stroke unit who are eligible for IVT, we suggest tenecteplase 0.25 mg/kg over alteplase 0.90 mg/kg (low evidence, weak recommendation). For patients with large vessel occlusion (LVO) AIS of <4.5 h duration who are eligible for IVT, we recommend tenecteplase 0.25 mg/kg over alteplase 0.9 mg/kg (moderate evidence, strong recommendation). For patients with AIS on awakening from sleep or AIS of unknown onset who are selected with non-contrast CT, we recommend against IVT with tenecteplase 0.25 mg/kg (low evidence, strong recommendation). Expert consensus statements are also provided. Tenecteplase 0.25 mg/kg may be favoured over alteplase 0.9 mg/kg for patients with AIS of <4.5 h duration in view of comparable safety and efficacy data and easier administration. For patients with LVO AIS of <4.5 h duration who are IVT-eligible, IVT with tenecteplase 0.25 mg/kg is preferable over skipping IVT before MT, even in the setting of a direct admission to a thrombectomy-capable centre. IVT with tenecteplase 0.25 mg/kg may be a reasonable alternative to alteplase 0.9 mg/kg for patients with AIS on awakening from sleep or AIS of unknown onset and who are IVT-eligible after selection with advanced imaging.
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Affiliation(s)
- Sonia Alamowitch
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, STARE team, iCRIN, Institut du Cerveau, Sorbonne Université, Paris, France
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1266, Paris, France
- FHU NeuroVasc, Paris, France
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, National & Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Andrew Bivard
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - Alan Cameron
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Gian Marco De Marchis
- Department of Neurology & Stroke Center, University Hospital Basel, Switzerland
- Department of Clinical Research, University of Basel, Switzerland
| | - Annette Fromm
- Department of Neurology, Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National & Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
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Guédon A, Ricard L, Laurent C, De Moreuil C, Urbansky G, Deriaz S, Gerotziafas G, Elalamy I, Alexandra A, Chasset F, Alamowitch S, Sellam J, Boffa J, Cohen A, Abisror N, Maillot F, Fain O, Mekinian A. Analyse exploratoire des profils à haut risque dans le syndrome primaire des antiphospholipides par l’analyse de clusters : étude de cohorte multicentrique française. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Gerschenfeld G, Liegey JS, Laborne FX, Yger M, Lyon V, Checkouri T, Tricard-Dessagne B, Marnat G, Clarençon F, Chausson N, Turc G, Sibon I, Alamowitch S, Olindo S. Treatment times, functional outcome, and hemorrhage rates after switching to tenecteplase for stroke thrombolysis: Insights from the TETRIS registry. Eur Stroke J 2022; 7:358-364. [PMID: 36478758 PMCID: PMC9720850 DOI: 10.1177/23969873221113729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/27/2022] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION The encouraging efficacy and safety data on intravenous thrombolysis with tenecteplase in ischemic stroke and its practical advantages motivated our centers to switch from alteplase to tenecteplase. We report its impact on treatment times and clinical outcomes. METHODS We retrospectively analyzed clinical and procedural data of patients treated with alteplase or tenecteplase in a comprehensive (CSC) and a primary stroke center (PSC), which transitioned respectively in 2019 and 2018. Tenecteplase enabled in-imaging thrombolysis in the CSC. The main outcomes were the imaging-to-thrombolysis and thrombolysis-to-puncture times. We assessed the association of tenecteplase with 3-month functional independence and parenchymal hemorrhage (PH) with multivariable logistic models. RESULTS We included 795 patients, 387 (48.7%) received alteplase and 408 (51.3%) tenecteplase. Both groups (tenecteplase vs alteplase) were similar in terms of age (75 vs 76 years), baseline NIHSS score (7 vs 7.5) and proportion of patients treated with mechanical thrombectomy (24.1% vs 27.5%). Tenecteplase patients had shorter imaging-to-thrombolysis times (27 vs 36 min, p < 0.0001) mainly driven by patients treated in the CSC (22 vs 38 min, p < 0.001). In the PSC, tenecteplase patients had shorter thrombolysis-to-puncture times (84 vs 95 min, p = 0.02), reflecting faster interhospital transfer for MT. 3-month functional independence rate was higher in the tenecteplase group (62.8% vs 53.4%, p < 0.01). In the multivariable analysis, tenecteplase was significantly associated with functional independence (ORa 1.68, 95% CI 1.15-2.48, p < 0.01), but not with PH (ORa 0.68, 95% CI 0.41-1.12, p = 0.13). CONCLUSION Switch from alteplase to tenecteplase reduced process times and may improve functional outcome, with similar safety profile.
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Affiliation(s)
- Gaspard Gerschenfeld
- AP-HP, Service des Urgences
Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne
Université, Paris, France
- STARE Team, iCRIN, Institut du Cerveau
et de la Moelle épinière, ICM, Paris, France
| | | | | | - Marion Yger
- AP-HP, Service des Urgences
Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne
Université, Paris, France
- STARE Team, iCRIN, Institut du Cerveau
et de la Moelle épinière, ICM, Paris, France
| | - Victoire Lyon
- Service de Neurologie Vasculaire, CHU
de Bordeaux, Bordeaux, France
| | - Thomas Checkouri
- AP-HP, Service des Urgences
Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne
Université, Paris, France
- STARE Team, iCRIN, Institut du Cerveau
et de la Moelle épinière, ICM, Paris, France
| | | | - Gaultier Marnat
- Service de Neuroradiologie diagnostique
et interventionnelle, CHU de Bordeaux, Bordeaux, France
| | - Frédéric Clarençon
- AP-HP, Service de Neuroradiologie,
Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Nicolas Chausson
- Service de Neurologie, Unité
Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Guillaume Turc
- Service de Neurologie, GHU Paris
Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc,
Paris, France
| | - Igor Sibon
- Service de Neurologie Vasculaire, CHU
de Bordeaux, Bordeaux, France
| | - Sonia Alamowitch
- AP-HP, Service des Urgences
Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne
Université, Paris, France
- STARE Team, iCRIN, Institut du Cerveau
et de la Moelle épinière, ICM, Paris, France
- CRSA, Sorbonne Université, INSERM, UMRS
938, Hôpital Saint-Antoine, Paris, France
| | - Stéphane Olindo
- Service de Neurologie Vasculaire, CHU
de Bordeaux, Bordeaux, France
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16
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Elegamandji B, Alamowitch S, Crozier S, Sabben C, Deltour S, Obadia M, Benyounes N, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular Arrhythmia Following Patent Foramen Ovale Percutaneous Closure. JACC Cardiovasc Interv 2022; 15:2315-2322. [PMID: 36008269 DOI: 10.1016/j.jcin.2022.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patient-reported symptomatic episodes, so the true incidence and timing of AF after PFO closure remain unknown. OBJECTIVES The aim of this study was to prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure on the basis of loop recorder monitoring. METHODS Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 at a single center by means of implantable loop recorder monitoring in patients considered at higher risk for AF (age ≥ 55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder monitoring in other patients. The primary endpoint was the incidence of AF, atrial flutter, or supraventricular tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed using a stepwise logistic regression model. RESULTS A total of 225 patients were included. The primary endpoint occurred in 47 patients (20.9%), including 13 (9.9%) and 24 (28.9%) among patients monitored with external loop recorders and implantable loop recorders, respectively. Overall, the median delay from procedure to arrhythmia was 14.0 days (IQR: 6.5-19.0 days), and one-half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted OR: 1.67 per 10-year increase; 95% CI: 1.18-2.36), device left disc diameter ≥25 mm (adjusted OR: 2.67; 95% CI: 1.19-5.98) and male sex (adjusted OR: 4.78; 95% CI: 1.96-11.66). CONCLUSIONS Using loop recorder monitoring for ≥28 days, supraventricular arrhythmia was diagnosed in 1 in 5 patients, with a median delay of 14 days, suggesting that this postprocedural event has so far been underestimated.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Marie Hauguel-Moreau
- INSERM U-1018, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Thomas Wallet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Benjamin Elegamandji
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Sonia Alamowitch
- Sorbonne Université, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Sophie Crozier
- Sorbonne Université, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Candice Sabben
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Sandrine Deltour
- Neurology Department, Raymond-Poincaré Hospital (AP-HP), Garches, France
| | - Michaël Obadia
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Nadia Benyounes
- Cardiology Department, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France.
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17
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Alamowitch S, Sabben C, Deltour S, Benyounes N, Obadia M, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patients-reported symptomatic episodes, thus true incidence and timing of AF after PFO closure remain unknown.
Objective
To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring.
Methods
Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model.
Results
A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2).
Conclusion
Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Laredo
- Hospital Pitie-Salpetriere , Paris , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, cardiology , Boulogne Billancourt , France
| | - T Wallet
- Hospital Pitie-Salpetriere , Paris , France
| | | | - C Sabben
- Fondation Rothschild, Neurology , Paris , France
| | - S Deltour
- Hopital Raymond Poincare, Neurology , Garches , France
| | - N Benyounes
- Fondation Rothschild, Cardiology , Paris , France
| | - M Obadia
- Fondation Rothschild, Neurology , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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18
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Lapostolle A, Weisenburger-Lile D, Yger M, Alamowitch S, Fain O. Bradykinin-Mediated Angioedema Following Tenecteplase Administration in an Acute Ischemic Stroke. Stroke 2022; 53:e446-e447. [PMID: 36069184 DOI: 10.1161/strokeaha.122.040052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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)
- Arnaud Lapostolle
- AP-HP, Department of Neurology, Saint-Antoine Hospital, Paris, France (A.L., M.Y.)
| | | | - Marion Yger
- AP-HP, Department of Neurology, Saint-Antoine Hospital, Paris, France (A.L., M.Y.)
| | - Sonia Alamowitch
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, CRSA, INSERM, UMRS 938 Sorbonne Université, Paris, France STARE team, iCRIN, ICM, Paris, France (S.A.)
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France (O.F.).,UPMC University Paris 06, Paris, France (O.F.).,Sorbonne Universités, UPMC University Paris 06, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France (O.F.)
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19
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Olivot J, Finitsis S, Lapergue B, Marnat G, Sibon I, Richard S, Viguier A, Cognard C, Mazighi M, Gory B, Piotin M, Blanc R, Redjem H, Escalard S, Desilles J, Delvoye F, Smajda S, Maïer B, Hebert S, Mazighi M, Obadia M, Sabben C, Seners P, Raynouard I, Corabianu O, de Broucker T, Manchon E, Taylor G, Maacha MB, Thion L, Lecler A, Savatovsjy J, Wang A, Evrard S, Tchikviladze M, Ajili N, Lapergue B, Weisenburger‐Lile D, Gorza L, Buard G, Coskun O, Consoli A, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Nighoghossian N, Riva R, Eker O, Turjman F, Derex L, Cho T, Mechtouff L, Lukaszewicz A, Philippeau F, Cakmak S, Blanc‐Lasserre K, Vallet A, Marnat G, Gariel F, Barreau X, Berge J, Menegon P, Sibon I, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey J, Briau P, Pangon N, Bourcier R, Detraz L, Daumas‐Duport B, Alexandre P, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C, Gory B, Bracard S, Anxionnat R, Braun M, Derelle A, Liao L, Zhu F, Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour J, Douarinou M, Audibert G, Voicu M, Alb I, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Bourst P, Beaumont M, Chen (Mitchelle) B, Guy S, Georges V, Bechiri F, Macian‐Montoro F, Saleme S, Mounayer C, Rouchaud A, Gimenez L, Cosnard A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre P, Derraz I, Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, ter Schiphorst A, Alias Q, Boustia F, Ferre J, Raoult H, Gauvrit J, Vannier S, Guillen M, Ronziere T, Lassalle V, Tracol C, Malrain C, Boinet S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Samson Y, Léger A, Crozier S, Baronnet F, Alamowitch S, Bottin L, Yger M, Degos V, Spelle L, Denier C, Chassin O, Chalumeau V, Caroff J, Chassin O, Venditti L, Sarov M, Legris N, Naggara O, Hassen WB, Boulouis G, Rodriguez‐Régent C, Trystram D, Kerleroux B, Turc G, Domigo V, Lamy C, Birchenall J, Isabel C, Lun F, Viguier A, Cognard C, Januel A, Olivot J, Raposo N, Bonneville F, Albucher J, Calviere L, Darcourt J, Bellanger G, Tall P, Touze E, Barbier C, Schneckenburger R, Boulanger M, Cogez J, Guettier S, Gauberti M, Timsit S, Gentric J, Ognard J, Merrien FM, Wermester OO, Massardier E, Papagiannaki C, Triquenot A, Lefebvre M, Bourdain F, Bernady P, Lagoarde‐Segot L, Cailliez H, Veunac L, Higue D, Wolff V, Quenardelle V, Lauer V, Gheoca R, Pierre‐Paul I, Pop R, Beaujeux R, Mihoc D, Manisor M, Pottecher J, Meyer A, Chamaraux‐Tran T, Le Bras A, Evain S, Le Guen A, Richter S, Hubrecht R, Demasles S, Barroso B, Sablot D, Farouil G, Tardieu M, Smadja P, Aptel S, Seiler I. Parenchymal hemorrhage rate is associated with time to reperfusion and outcome. Ann Neurol 2022; 92:882-887. [DOI: 10.1002/ana.26478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Bertrand Lapergue
- Department of Neurology Foch Hospital Versailles Saint‐Quentin en Yvelines University Suresnes France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology University Hospital of Bordeaux France
| | - Igor Sibon
- Department of Neurology, Stroke Center University Hospital of Bordeaux France
| | - Sebastien Richard
- Université de Lorraine, CHRU‐Nancy, Department of Neurology, Stroke Unit F‐54000 Nancy France
- CIC‐P 1433 , INSERM U1116, CHRU‐Nancy, F‐54000 Nancy France
| | - Alain Viguier
- Acute Stroke Unit‐ CIC 1436‐UMR 1214, CHU Toulouse France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiolology CHU Toulouse France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology FHU Neurovasc, INSERM 1148, Université de Paris Cité Rothschild Foundation, Paris France
- Diagnostic and Therapeutic Neuroradiology, F‐54000 Nancy France
| | - Benjamin Gory
- Université de Lorraine, IADI, INSERM U1254 F‐54000 Nancy France
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Nadal E, Rosso C, Lenck S, Corcy C, Alamowitch S, Blanc C. Ne pas se fier aux apparences. Rev Neurol (Paris) 2022. [DOI: 10.1016/j.neurol.2022.02.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Elhorany M, Rosso C, Shotar E, Baronnet-Chauvet F, Premat K, Lenck S, Crozier S, Corcy C, Bottin L, Mansour OY, Talbi A, El-din ESAT, Fadel WA, Sourour NA, Alamowitch S, Samson Y, Clarençon F. Safety and effectiveness of mechanical thrombectomy for primary isolated distal vessel occlusions: A monocentric retrospective comparative study. J Neuroradiol 2022; 49:311-316. [DOI: 10.1016/j.neurad.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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Guédon AF, Catano J, Ricard L, Laurent C, de Moreuil C, Urbanski G, Deriaz S, Gerotziafas G, Elalamy I, Audemard A, Chasset F, Alamowitch S, Sellam J, Maillot F, Boffa JJ, Cohen A, Abisror N, Fain O, Mekinian A. Non-criteria manifestations in primary antiphospholipid syndrome: a French multicenter retrospective cohort study. Arthritis Res Ther 2022; 24:33. [PMID: 35078523 PMCID: PMC8788111 DOI: 10.1186/s13075-022-02726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background From this retrospective study, we aimed to (1) describe the prevalence and characteristics of non-criteria features in primary antiphospholipid syndrome (p-APS) and (2) determine their prognostic value. Methods This retrospective French multicenter cohort study included all patients diagnosed with p-APS (Sydney criteria) between January 2012 and January 2019. We used Kaplan-Meier and adjusted Cox proportional hazards models to compare the incidence of relapse in p-APS with and without non-criteria manifestations. Results One hundred and seventy-nine patients with p-APS were included during the study time, with a median age of 52.50 years [39.0; 65.25] and mainly women (n = 112; 62.6%). Among them, forty-three patients (24.0%) presented at least one non-criteria manifestation during the follow-up: autoimmune cytopenias (n = 17; 39.5%), Libman Sachs endocarditis (n = 5; 11.6%), APS nephropathy (n = 4; 9.3%), livedo reticularis (n = 8; 18.6%), and neurological manifestations (n = 12; 27.9%). In comparison to p-APS without any non-criteria manifestations (n = 136), p-APS with non-criteria features had more arterial thrombosis (n = 24; 55.8% vs n = 48; 35.3%; p = 0.027) and more frequent pre-eclampsia (n = 6; 14.3% vs n = 4; 3.1%; p = 0.02). The prevalence of triple positivity was significantly increased in patients with non-criteria features (n = 20; 47.6% vs n = 25; 19.8%; p = 0.001). Patients with p-APS and non-criteria manifestations (n = 43) received significantly more additional therapies combined with vitamin K antagonists and/or antiaggregants. Catastrophic APS (CAPS) tended to be more frequent in p-APS with non-criteria features (n = 2; 5.1% vs none; p = 0.074). The p-APS with non-criteria manifestations had significantly increased rates of relapse (n = 20; 58.8% vs 33; 33.7%; p = 0.018) in bivariate analysis, but in survival analyses, the hazard ratio (HR) of relapse was not significantly different between the two groups (HR at 1.34 [0.67; 2.68]; p = 0.40). Conclusions The presence of non-criteria features is important to consider, as they are associated with particular clinical and laboratory profiles, increased risk of relapse, and need for additional therapies. Prospective studies are necessary to better stratify the prognosis and the management of p-APS.
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Affiliation(s)
- Alexis F Guédon
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France
| | - Jennifer Catano
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France
| | - Laure Ricard
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France
| | - Charlotte Laurent
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France
| | | | - Geoffrey Urbanski
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sophie Deriaz
- Service de Médecine Interne, Hôpital Tours, Tours, France
| | - Grigorios Gerotziafas
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Hémostase et Hématologie biologique, F-75012, Paris, France
| | - Ismail Elalamy
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Hémostase et Hématologie biologique, F-75012, Paris, France
| | | | - Francois Chasset
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de dermatologie et vénérologie, F-75012, Paris, France
| | - Sonia Alamowitch
- AP-HP, Service des Urgences cérébro-vasculaires, Hôpital Pitié-Salpétrière, Centre de recherche de Saint Antoine, INSERM, UMRS 938, Sorbonne Université, Paris, France
| | - Jérémie Sellam
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de rhumatologie, F-75012, Paris, France
| | | | - Jean Jacques Boffa
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de népjrologie, F-75012, Paris, France
| | - Ariel Cohen
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de cardiologie, F-75012, Paris, France
| | - Noémie Abisror
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France
| | - Olivier Fain
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France
| | - Arsène Mekinian
- AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Sorbonne Université, F-75012, Paris, France.
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Januel E, Perol L, Arrivé L, Alamowitch S, Fain O, Mekinian A. Anti-PD1-R checkpoint inhibitor related severe relapsing myelitis. Acta Neurol Belg 2021; 121:1855-1857. [PMID: 32661739 DOI: 10.1007/s13760-020-01434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/03/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Edouard Januel
- Neurology Department, Saint Antoine Hospital, APHP, Sorbonne Université, Paris, France
| | - Louis Perol
- Service de médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3D), Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Arrivé
- Radiology Department, Saint Antoine Hospital, APHP, Sorbonne Université, Paris, France
| | - Sonia Alamowitch
- Neurology Department, Saint Antoine Hospital, APHP, Sorbonne Université, Paris, France
| | - Olivier Fain
- Service de médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3D), Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Arsene Mekinian
- Service de médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3D), Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France.
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Gerschenfeld G, Smadja D, Turc G, Olindo S, Laborne FX, Yger M, Caroff J, Gonçalves B, Seners P, Cantier M, l'Hermitte Y, Aghasaryan M, Alecu C, Marnat G, Ben Hassen W, Kalsoum E, Clarençon F, Piotin M, Spelle L, Denier C, Sibon I, Alamowitch S, Chausson N. Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy. Neurology 2021; 97:e2173-e2184. [PMID: 34635558 DOI: 10.1212/wnl.0000000000012915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/21/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate in routine care the efficacy and safety of IV thrombolysis (IVT) with tenecteplase prior to mechanical thrombectomy (MT) in patients with large vessel occlusion acute ischemic strokes (LVO-AIS), either secondarily transferred after IVT or directly admitted to a comprehensive stroke center (CSC). METHODS We retrospectively analyzed clinical and procedural data of patients treated with 0.25 mg/kg tenecteplase within 270 minutes of LVO-AIS who underwent brain angiography. The main outcome was 3-month functional independence (modified Rankin Scale score ≤2). Recanalization (revised Treatment in Cerebral Ischemia score 2b-3) was evaluated before (pre-MT) and after MT (final). RESULTS We included 588 patients (median age 75 years [interquartile range (IQR) 61-84]; 315 women [54%]; median NIH Stroke Scale score 16 [IQR 10-20]), of whom 520 (88%) were secondarily transferred after IVT. Functional independence occurred in 47% (n = 269/570; 95% confidence interval [CI] 43.0-51.4) of patients. Pre-MT recanalization occurred in 120 patients (20.4%; 95% CI 17.2-23.9), at a similar rate across treatment paradigms (direct admission, n = 14/68 [20.6%]; secondary transfer, n = 106/520 [20.4%]; p > 0.99) despite a shorter median IVT to puncture time in directly admitted patients (38 [IQR 23-55] vs 86 [IQR 70-110] minutes; p < 0.001). Final recanalization was achieved in 492 patients (83.7%; 95%CI 80.4-86.6). Symptomatic intracerebral hemorrhage occurred in 2.5% of patients (n = 14/567; 95% CI 1.4-4.1). DISCUSSIONS Tenecteplase before MT is safe, effective, and achieves a fast recanalization in everyday practice in patients secondarily transferred or directly admitted to a CSC, in line with published results. These findings should encourage its wider use in bridging therapy. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that tenecteplase within 270 minutes of LVO-AIS increases the probability of functional independence.
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Affiliation(s)
- Gaspard Gerschenfeld
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Didier Smadja
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Guillaume Turc
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Stephane Olindo
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - François-Xavier Laborne
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Marion Yger
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Jildaz Caroff
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Bruno Gonçalves
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Pierre Seners
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Marie Cantier
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Yann l'Hermitte
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Manvel Aghasaryan
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Cosmin Alecu
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Gaultier Marnat
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Wagih Ben Hassen
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Erwah Kalsoum
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Frédéric Clarençon
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Michel Piotin
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Laurent Spelle
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Christian Denier
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Igor Sibon
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Sonia Alamowitch
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France
| | - Nicolas Chausson
- From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.), Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine (G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique (F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie (G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie (C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie (E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.), Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle (M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France.
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Assan F, Bottin L, Francès C, Moguelet P, Tavolaro S, Barbaud A, de Zuttere D, Alamowitch S, Chasset F. Antiphospholipid-negative Sneddon's syndrome: A comprehensive overview of a rare entity. Ann Dermatol Venereol 2021; 149:3-13. [PMID: 34740467 DOI: 10.1016/j.annder.2021.08.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/26/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022]
Abstract
The term Sneddon's syndrome (SS) has been used since 1965 to describe a vasculopathy characterized by a combination of cerebrovascular disease with livedo racemosa. SS may be classified as antiphospholipid+ (aPL+) or antiphospholipid- (aPL-). Little is known about aPL- SS; in this review we describe the epidemiology and pathogenesis of aPL- SS, as well as the clinical and histologic features. We discuss recent findings in terms of neurologic and cardiac involvement. Moreover, differential diagnoses of conditions that may present with both livedo racemosa and stroke are discussed. Finally, we discuss real-life practical issues such as the initial investigations to be performed, long-term follow-up, and therapeutic management of aPL- SS patients.
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Affiliation(s)
- F Assan
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, 75020 Paris, France
| | - L Bottin
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Neurologie, Hôpital Saint-Antoine, 75012 Paris, France
| | - C Francès
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, 75020 Paris, France
| | - P Moguelet
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Pathologie, Hôpital Tenon, 75020 Paris, France
| | - S Tavolaro
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Radiologie, Hôpital Tenon, 75020 Paris, France
| | - A Barbaud
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, 75020 Paris, France
| | - D de Zuttere
- Service d'Explorations Fonctionnelles, Hôpital Franco-Britannique, 92300 Levallois-Perret, France
| | - S Alamowitch
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Neurologie, Hôpital Saint-Antoine, 75012 Paris, France
| | - F Chasset
- Sorbonne University, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, 75020 Paris, France.
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26
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Ricard L, Laurent C, Papo M, Deriaz S, Catano J, Alamowitch S, Kayem G, Chasset F, De Moreuil C, Boffa JJ, Gerotziafas G, Elalamy I, Bornes M, Maillot F, Audemard-Verger A, Planche V, Ballot E, Fain O, Mekinian A. Clinical and prognostic significance of antinuclear antibodies in primary antiphospholipid syndrome: A multicenter retrospective study. Joint Bone Spine 2021; 89:105297. [PMID: 34656751 DOI: 10.1016/j.jbspin.2021.105297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The antiphospholipid syndrome (APS) (1) is defined by the development of vascular thrombosis, or pregnancy morbidity in the presence of persistent antiphospholipid antibodies (aPL). Antinuclear antibodies (ANA) can be detected in primary APS patients without any clinical systemic autoimmune disease. The presence of ANA antibodies could confer a specific phenotype in primary APS. OBJECTIVE To evaluate the characteristics of APS patients with antinuclear antibodies without other autoimmune disease (ANA positive APS patients) in comparison with primary APS without ANA or secondary APS patients with associated systemic lupus erythematosus (SLE). METHODS Clinical and biologic data from 195 APS were retrospectively collected and patients were classified as primary APS with positive ANA (ANA-positive APS), primary APS without any ANA (ANA-negative APS), and SLE-associated APS (SLE-APS). RESULTS Fourty patients (21%) were classified into ANA-positive APS group, 77 (39%) in ANA-negative APS and 78 (40%) in SLE-APS. In ANA-positive APS patients, 20 patients (51%) had arterial thrombosis, 14 (41%) had veinous thrombosis and 19% had obstetrical complications. There was no difference between the three groups for the frequency of thrombotic manifestations and obstetrical complications. ANA-positive APS patients had more non-criteria manifestations than ANA-negative APS (48% versus 25%; P≤0.01). ANA-positive APS had more triple aPL positivity (59% versus 18%; P<0.001) and more thrombosis and obstetrical recurrences (63% versus 36%; P<0.01) in comparison with ANA-negative APS patients. ANA-positive APS had more triple aPL positivity than SLE-APS patients (54% versus 33%; P<0.05). ANA-positive APS and SLE-APS patients had similar clinical manifestations, and recurrences. Despite a limited follow-up (28 months (11-50)) none of the ANA-positive APS develop SLE. Antiplatelet and anticoagulant therapies were similar for the three groups. SLE-APS patients received more immunomodulatory therapies. CONCLUSION ANA positivity in patients with APS enables to individualize a subset of patients with a more severe phenotype. Whereas the ANA positivity does not seem to be associated with the risk to develop SLE, prospective studies with a longer follow-up are necessary, in particular to evaluate the effect of additional therapies in this subset of APS.
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Affiliation(s)
- Laure Ricard
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Charlotte Laurent
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Matthias Papo
- Médecine interne institut e3m, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Sophie Deriaz
- Médecine interne, CHRU Hôpitaux de Tours, Tours, France
| | - Jennifer Catano
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Sonia Alamowitch
- Service de neurologie et d'urgences neurovasculaires, hôpital Saint-Antoine, Paris, France
| | - Gilles Kayem
- Obstétrique, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - François Chasset
- Service de dermatologie, faculté de médecine, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | | | | | - Grigorios Gerotziafas
- Inserm UMR-S938 Cancer Biology and Therapeutics, Research Group "Cancer-Hemostasis-Angiogenesis" CRSA, institut universitaire de Cancérologie, Sorbonne université, Paris, France; Department of thrombosis and haemostasis, service d'hématologie Biologique, faculté de médecine, hôpital Tenon, hôpitaux universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France
| | - Ismail Elalamy
- Inserm UMR-S938 Cancer Biology and Therapeutics, Research Group "Cancer-Hemostasis-Angiogenesis" CRSA, institut universitaire de Cancérologie, Sorbonne université, Paris, France; I M Sechenov First Moscow State Medical University, Department of Obstetrics and Gynecology, Moscow, Russia
| | - Marie Bornes
- Department of thrombosis and haemostasis, service d'hématologie Biologique, faculté de médecine, hôpital Tenon, hôpitaux universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France
| | | | | | | | - Eric Ballot
- Immunologie biologique, hôpital Saint-Antoine, Paris, France
| | - Olivier Fain
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Arsène Mekinian
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France.
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Guidoux C, Sibon I, Alamowitch S, Godeneche G, Guillon B, Timsit S, Sablot D, Cordonnier C, Tardy J, Granier M, Extramiana F, Cohen A, Touze E, Gaillard N. Capacities of atrial fibrillation detection after stroke: a French nationwide survey. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AFib) is a major contributor to recurrent but preventable ischemic Stroke (IS)/TIA. However, majority of stroke patients suffer from paroxysmal asymptomatic AFib, which implies stroke health system to implement accurate AFib detection strategies to large scale population. Current practices of AFib screening methods provided by Stroke Units (SU) organization and network in France are currently unknown and uncovered by dedicated guidelines.
Purpose
To assess the methodology of Afib screening in French SU.
Methods
A French Nationwide survey was led (September-November 2020) with on-line structured questionnaires sent to individual targeted stroke-physicians (SP) and heads of SU in France.We analyzed qualitative and quantitative availability and current use of AFib detection tools during acute inhospital and outpatient subacute and chronic post-IS phases.
Results
67% of 140 heads of SU and 33% of SP responded across all continental and overseas French regions.Main clinical characteristics that lead to search Afib are: TIA/IS recurrence under antiplatelet therapy (97%), patient's age (74%), proximal occlusion of a major cerebral artery (72%). Afib is highly suspected when there is: recent brain IS in multiple vascular territories (100%), previous IS in another vascular territory (98%), left atrial enlargement (96%), burst of supraventricular tachycardia <30s (94%). In-hospital cardiac monitoring is considered to be mandatory by 90% of SU teams but only 1/3 of those possess telemetry out of intensive care unit. Outpatient cardiac monitoring is considered of major interest/necessary by 100% of SP. When first line 24-hour Holter monitor is normal and Afib is highly suspected, 75% of the SP required outpatient noninvasive monitoring (NIM) for at least 7 days and more than half required insertable cardiac monitor (ISC). ISC are implanted each year by SU for <10 patients in 44% and <50 patients in 94%. The delay IS-ICM implantation is <1 month in 10%, 1–3 months in 52%, 3–6 months in 29% and >6 months in 9%. Accessibility to outpatient monitoring modalities is graded: fairly easy for 24/48h-Holter (85%) and ISC (68%); rather difficult/impossible for 3–7 days NIM (51%), 8–21 days NIM (75%) or e-ECG tools (99%). Main obstacles to monitoring abilities development in SU were lack of: manpower (80%), efficient network with cardiologists (56%), familiarity of techniques (42%); and technical equipment cost (44%). 96.5% of SU teams deem necessary practice decision support flowchart with cardiologist partnership but 19% use for it.
Conclusion
The survey raises concern about lack of a systematic strategy and shortcomings for Afib detection capacities. These results are a call to establish practice-guidelines and to promote an improvement plan for AFib detection (selection of the patients, tools and prioritization of the exams) after TIA/IS in France which will require a strong collaboration between neurologists and cardiologists.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer
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Affiliation(s)
- C Guidoux
- University Hospital Bichat APHP, Neurology, Paris, France
| | - I Sibon
- University Hospital of Bordeaux, Neurology, Bordeaux, France
| | - S Alamowitch
- University Hospital of Saint-Antoine, Neurology, Paris, France
| | - G Godeneche
- University Hospital of La Rochelle, Neurology, La Rochelle, France
| | - B Guillon
- University Hospital of Nantes, Neurology, Nantes, France
| | - S Timsit
- University Hospital of Brest, Neurology, Brest, France
| | - D Sablot
- University Hospital of Perpignan, Neurology, Perpignan, France
| | - C Cordonnier
- Lille University Hospital, Neurology, Lille, France
| | - J Tardy
- Clinique des Cèdres Château d'Alliez, Neurology, Toulouse, France
| | - M Granier
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | - F Extramiana
- University Hospital Bichat APHP, Cardiology, Paris, France
| | - A Cohen
- University Hospital of Saint-Antoine, Cardiology, Paris, France
| | - E Touze
- University Hospital of Caen, Neurology, Caen, France
| | - N Gaillard
- University Hospital Gui de Chauliac, Neurology, Montpellier, France
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Elalamy I, Gerotziafas G, Alamowitch S, Laroche JP, Van Dreden P, Ageno W, Beyer-Westendorf J, Cohen AT, Jimenez D, Brenner B, Middeldorp S, Cacoub P. SARS-CoV-2 Vaccine and Thrombosis: An Expert Consensus on Vaccine-Induced Immune Thrombotic Thrombocytopenia. Thromb Haemost 2021; 121:982-991. [PMID: 33946120 PMCID: PMC8322589 DOI: 10.1055/a-1499-0119] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
Historically, the vaccination strategies developed in the second half of the 20th century have facilitated the eradication of infectious diseases. From the onset of COVID-19 pandemic to the end of April 2021, more than 150 million cases and 3 million deaths were documented worldwide with disruption of the economic and social activity, and with devastating material, physical, and psychological consequences. Reports of unusual and severe thrombotic events, including cerebral and splanchnic venous thrombosis and other autoimmune adverse reactions, such as immune thrombocytopenia or thrombotic microangiopathies in connection with some of the SARS-CoV-2 vaccines, have caused a great deal of concern within the population and the medical community. This report is intended to provide practical answers following an overview of our knowledge on these thrombotic events that are extremely rare but have serious consequences. Vaccine hesitancy threatens to reverse the progress made in controlling vaccine-preventable diseases. These adverse events must be put into perspective with an objective analysis of the facts and the issues of the vaccination strategy during this SARS-CoV-2 pandemic. Health care professionals remain the most pertinent advisors and influencers regarding vaccination decisions; they have to be supported to provide reliable and credible information on vaccines. We need to inform, reassure, and support our patients when the prescription is made. Facing these challenges and observations, a panel of experts express their insights and propose a tracking algorithm for vaccinated patients based on a 10-point guideline for decision-making on what to do and not to do.
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Affiliation(s)
- Ismail Elalamy
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Grigoris Gerotziafas
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Sonia Alamowitch
- AP-HP, Service des Urgences cérébro-vasculaires, Hôpital Pitié-Salpétrière, Paris, France
- Centre de recherche de Saint Antoine, INSERM, UMRS 938, Sorbonne Université Paris, France
| | - Jean-Pierre Laroche
- Service de médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, Montpellier cedex 5, France
- Médipôle, 1139, chemin du Lavarin, Avignon, France
| | - Patrick Van Dreden
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Walter Ageno
- Department of Emergency Medicine and Thrombosis Center, Ospedale di Circolo and Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Haematology and Haemostaseology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander T. Cohen
- Department of Haematological Medicine, Guys and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - David Jimenez
- Respiratory Department, Ramon y Cajal Hospital (IRYCIS), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Benjamin Brenner
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut National de la Santé et de la Recherche Médicale, INSERM, Paris, France
- CNRS, FRE3632, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, Paris, France
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Assan F, de Zuttere D, Bottin L, Tavolaro S, Courvoisier DS, Barbaud A, Alamowitch S, Francès C, Chasset F. Echocardiographic features in antiphospholipid-negative Sneddon's syndrome and potential association with severity of neurological symptoms or recurrence of strokes: a longitudinal cohort study. Eur Heart J Cardiovasc Imaging 2021; 22:119-128. [PMID: 31898726 DOI: 10.1093/ehjci/jez312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/19/2019] [Accepted: 12/07/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS Sneddon's syndrome (SS) may be classified as antiphospholipid positive (aPL+) or negative (aPL- SS). An association between Libman-Sacks (LS) endocarditis and strokes has been described in aPL+ patients. To describe cardiac involvement in aPL- SS and assess the potential association between LS endocarditis and severity or recurrence of neurological symptoms. METHODS AND RESULTS This longitudinal cohort study included aPL- SS patients followed in our departments between 1991 and June 2018. All patients underwent transthoracic 2D and Doppler echocardiography at diagnosis. Follow-up echocardiography was performed annually and the potential relationship between LS endocarditis development and neurovascular relapse as well as long-term cardiac worsening was prospectively assessed. We included 61 patients [52 women; median age 45 (range 24-60)]. For valvular involvement, 36 (59%) patients showed leaflet thickening; 18 (29.5%) had LS endocarditis at baseline. During a median follow-up of 72 months, LS endocarditis developed in eight (17.4%) patients, and 13 (28.3%) showed significant worsening of their cardiac status, including two who needed valvular replacement. After adjusting for baseline antithrombotic treatment regimen, neither the presence of LS endocarditis at baseline nor development during follow-up was associated with neurological relapse [hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.33-4.74, P = 0.92] and [HR: 0.38, 95% CI: 0.02-1.89, P = 0.31], respectively. CONCLUSION A long-term follow-up is needed to detect cardiac complications in aPL- SS. No change in neurological relapse was observed in patients presenting LS endocarditis occurrence during follow-up without any modification in antithrombotic treatment. Further research is necessary to assess the usefulness of treatment escalation in these patients.
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Affiliation(s)
- Florence Assan
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Dermatology and Allergology Department, Hôpital Tenon, 4 rue de la Chine 75020 Paris, France
| | - Dominique de Zuttere
- Functional exploration Department, Hôpital Francp-Brittanique, 4 rue Kléber 92300 Levallois-Perret, France
| | - Laure Bottin
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Neurology Department, Hôpital Saint Antoine, 184 rue du Faubourg Saint-Antoine 75012 Paris, France
| | - Sebastian Tavolaro
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Radiology Department, Hôpital Tenon, 4 rue de la Chine 75020 Paris, France
| | - Delphine S Courvoisier
- Division of rheumatology, Department of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Annick Barbaud
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Dermatology and Allergology Department, Hôpital Tenon, 4 rue de la Chine 75020 Paris, France
| | - Sonia Alamowitch
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Neurology Department, Hôpital Saint Antoine, 184 rue du Faubourg Saint-Antoine 75012 Paris, France
| | - Camille Francès
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Dermatology and Allergology Department, Hôpital Tenon, 4 rue de la Chine 75020 Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine Sorbonne Université, APHP Dermatology and Allergology Department, Hôpital Tenon, 4 rue de la Chine 75020 Paris, France
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30
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Mas JL, Guillon B, Charles-Nelson A, Domigo V, Derex L, Massardier E, Arquizan C, Vuillier F, Timsit S, Béjot Y, Detante O, Sablot D, Guidoux C, Sibon I, Dequatre-Ponchelle N, Touzé E, Canaple S, Alamowitch S, Aubry P, Teiger E, Derumeaux G, Chatellier G. Patent foramen ovale closure in stroke patients with migraine in the CLOSE trial. The CLOSE-MIG study. Eur J Neurol 2021; 28:2700-2707. [PMID: 33938088 DOI: 10.1111/ene.14892] [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: 03/09/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of patent foramen ovale (PFO) closure to reduce the frequency of migraine attacks remains controversial. METHODS This was a planned sub-study in migraine patients enrolled in a randomized, clinical trial designed to assess the superiority of PFO closure plus antiplatelet therapy over antiplatelet therapy alone to prevent stroke recurrence in patients younger than 60 years with a PFO-associated cryptogenic ischaemic stroke. The main outcome was the mean annual number of migraine attacks in migraine patients with aura and in those without aura, as recorded at each follow-up visit by study neurologists. RESULTS Of 473 patients randomized to PFO closure or antiplatelet therapy, 145 (mean age 41.9 years; women 58.6%) had migraine (75 with aura and 70 without aura). Sixty-seven patients were randomized to PFO closure and 78 to antiplatelet therapy. During a mean follow-up of about 5 years, there were no differences between antiplatelet-only and PFO closure groups in the mean annual number of migraine attacks, both in migraine patients with aura (9.2 [11.9] vs. 12.0 [19.1], p = 0.81) and in those without aura (12.1 [16.1] vs. 11.8 [18.4], p > 0.999). There were no differences between treatment groups regarding cessation of migraine attacks, migraine-related disability at 2 years and use of migraine-preventive drugs during follow-up. CONCLUSIONS In young and middle-aged adults with PFO-associated cryptogenic stroke and migraine, PFO closure plus antiplatelet therapy did not reduce the mean annual number of migraine attacks compared to antiplatelet therapy alone, in migraine patients both with and without aura.
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Affiliation(s)
- Jean-Louis Mas
- Stroke Unit, Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, INSERM 1226, Paris, France
| | - Benoît Guillon
- Stroke Unit, Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Anaïs Charles-Nelson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Centre d'Investigations Cliniques 1418 (CIC1418), Paris, France
| | - Valérie Domigo
- Stroke Unit, Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, INSERM 1226, Paris, France
| | - Laurent Derex
- Stroke Unit, Department of Neurology, Hospices Civils de Lyon, EA 7425 HESPER, Claude Bernard Lyon 1 University, Lyon, France
| | | | - Caroline Arquizan
- Department of Neurology, Gui de Chauliac Hospital, INSERM 1226, Montpellier, France
| | - Fabrice Vuillier
- Stroke Unit, Department of Neurology, CHU Besançon, Besançon, France
| | - Serge Timsit
- Stroke Unit, Department of Neurology, CHRU Brest, Bretagne Occidentale University, INSERM 1028, Brest, France
| | - Yannick Béjot
- Stroke Unit, Department of Neurology, Dijon Stroke Registry, CHU Dijon, EA7460 Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University of Burgundy, Dijon, France
| | - Olivier Detante
- Stroke Unit, CHU Grenoble, INSERM 836-UJF-CEA-CHU, Grenoble, France
| | - Denis Sablot
- Stroke Unit, Department of Neurology, Perpignan Hospital, Perpignan, France
| | - Céline Guidoux
- Stroke Unit, Department of Neurology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Igor Sibon
- Stroke Unit, Department of Neurology, University Hospital, Bordeaux University, CNRS 5287, Bordeaux, France
| | | | - Emmanuel Touzé
- Normandie Université, Université Caen Normandie, CHU Caen Normandie, INSERM U1237, Caen, France
| | - Sandrine Canaple
- Stroke Unit, Department of Neurology, Laboratoire de Neurosciences Fonctionnelles et Pathologies, Centre Hospitalier Régional et Universitaire, Amiens, France
| | - Sonia Alamowitch
- Service de Neurologie, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, INSERM, UMRS 938, Paris, France
| | - Pierre Aubry
- Department of Cardiology, Bichat Hospital, Paris, France
| | - Emmanuel Teiger
- Department of Cardiology, Henri Mondor Hospital, AP-HP, UPEC, Créteil, France
| | - Geneviève Derumeaux
- Department of Physiology, Henri Mondor Hospital, APHP, INSERM U955, Créteil, France
| | - Gilles Chatellier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Centre d'Investigations Cliniques 1418 (CIC1418), Paris, France
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Chantran Y, Capron J, Doukhi D, Felix J, Féroul M, Kruse F, Chaigneau T, Dorothée G, Allou T, Ayrignac X, Barrou Z, de Broucker T, Cret C, Turc G, Peres R, Wacongne A, Sarazin M, Renard D, Cordonnier C, Alamowitch S, Aucouturier P. Letter to the editor: Serum anti-Aβ antibodies in cerebral amyloid angiopathy. Autoimmun Rev 2021; 20:102870. [PMID: 34118456 DOI: 10.1016/j.autrev.2021.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yannick Chantran
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France; Département d'Immunologie Biologique, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Jean Capron
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France; Service de Neurologie et d'Urgences Neurovasculaires, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Diana Doukhi
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France
| | - Johanna Felix
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France
| | - Mélanie Féroul
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France
| | - Florian Kruse
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France
| | - Thomas Chaigneau
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France
| | - Guillaume Dorothée
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France
| | | | - Xavier Ayrignac
- Service de Neurologie, CHU Montpellier, Hôpital Guy de Chauliac, Montpellier, France
| | - Zina Barrou
- Service de Gériatrie, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Thomas de Broucker
- Service de Neurologie, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Corina Cret
- Service de Neurologie, Centre Hospitalier de Meaux, Meaux, France
| | - Guillaume Turc
- Service de Neurologie, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU NeuroVasc, Paris, France
| | - Roxane Peres
- Service de Neurologie, Hôpital Lariboisière, AP-HP, Paris, France
| | - Anne Wacongne
- Service de Neurologie, CHU Nîmes, Hôpital Caremeau, Nîmes, France
| | - Marie Sarazin
- Service de Neurologie de la Mémoire et du Langage, Centre Hospitalier Sainte-Anne, Université Sorbonne Paris Cité, Paris, France
| | - Dimitri Renard
- Service de Neurologie, CHU Nîmes, Hôpital Caremeau, Nîmes, France
| | - Charlotte Cordonnier
- U1172 - LilNCog - Lille Neuroscience & Cognition, Inserm, CHU Lille, Univ. Lille, Lille, France
| | - Sonia Alamowitch
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France; Service de Neurologie et d'Urgences Neurovasculaires, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Pierre Aucouturier
- UMRS 938, Hôpital St-Antoine, Sorbonne Université, Inserm, Paris, France; Département d'Immunologie Biologique, Hôpital Saint-Antoine, AP-HP, Paris, France.
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Mahmoud E, Rosso C, Shotar E, Premat K, Lenck S, Corcy C, Baronnet-Chauvet F, Crozier S, Bottin L, Talbi A, Mansour OY, Tag-Eldin ESA, Fadel WA, Sourour NA, Alamowitch S, Samson Y, Clarençon F. Safety and effectiveness of mechanical thrombectomy for primary isolated distal vessel occlusions: retrospective observational comparative study. J Neuroradiol 2021. [DOI: 10.1016/j.neurad.2021.04.006] [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: 10/21/2022]
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Terre A, Johanet C, Alamowitch S, Chasset F, Bornes M, Kayem G, Fain O, Mekinian A. Syndrome des antiphospholipides séronégatif : résultats de la recherche d’antiphospholipides non conventionnels dans une série rétrospective de 391 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.019] [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: 11/17/2022]
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Marnat G, Lapergue B, Sibon I, Gariel F, Bourcier R, Kyheng M, Labreuche J, Dargazanli C, Consoli A, Blanc R, Piotin M, Mazighi M, Richard S, Gory B, Redjem H, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Ben Maacha M, Bourdain F, Decroix JP, Wang A, Evrard S, Tchikviladze M, Coskun O, Di Maria F, Rodesh G, Leguen M, Tisserand M, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Nighoghossian N, Riva R, Eker O, turjman F, Derex L, Cho TH, Mechtouff L, Claire Lukaszewicz A, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE, Barreau X, Berge J, Menegon P, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey JS, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, L’allinec V, Girot JB, Desal H, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Humbertjean L, Mione G, Lacour JC, Bonnerot M, Riou-Comte N, Costalat V, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Arquizan C, Gaillard N, Mourand I, Corti L, Cagnazzo F, Anadani M, Spiotta A, Alawieh A, Turjman F, Haussen D, Nogueira R, Papanagiotou P, Siddiqui AH, Dorn F, Cognard C, Ribo M, Psychogios M, Labeyrie MA, Biondi A, Andrew Grossberg J, Guenego A, Darcourt J, Vukasinovic I, Pomero E, Davies J, Renieri L, Hecker C, Muchada Muchada M, Houdart E, Turner R, Turk A, Chaudry I, Lockau J, Kastrup A, Behme D, Shallwani H, Christopher M, Mione G. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions. Stroke 2020; 51:3713-3718. [DOI: 10.1161/strokeaha.120.030038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose:
The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice.
Methods:
We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed.
Results:
The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome.
Conclusions:
Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.
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Affiliation(s)
- Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, France (G.M., F.G.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France (B.L.)
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, France (I.S.)
| | - Florent Gariel
- Department of Neuroradiology, University Hospital of Bordeaux, France (G.M., F.G.)
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (R.B.)
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Maeva Kyheng
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins—Lille—France (M.K., J.L.)
| | - Julien Labreuche
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins—Lille—France (M.K., J.L.)
| | - Cyril Dargazanli
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France (C.D.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (A.C.)
| | | | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Sebastien Richard
- Université de Lorraine, CHRU-Nancy, Department of Neurology, Stroke Unit, F-54000 Nancy, France (S.R.)
- INSERM U1116, CHRU-Nancy, F-54000 Nancy, France (S.R.)
| | - Benjamin Gory
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France (B.G.)
- Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.)
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Guedeney P, Silvain J, Hauguel-Moreau M, Sabben C, Deltour S, Zeitouni M, Reibel I, Ferrante A, Alamowitch S, Gandjbackch E, Hidden Lucet F, Hammoudi N, Montalescot G. Incidence and delay of atrial tachycardia after patent foramen ovale closure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the large randomized trials evaluating patent foramen ovale (PFO) closure vs. medical treatment in secondary prevention of stroke, the incidence of atrial fibrillation has been reported more frequently with PFO closure (2.9–6.6%) than with medical treatment (0.4–1.9%). These episodes were clinically reported and may not reflect the real incidence detected by prolonged ECG recording.
Purpose
To evaluate the incidence and timing of supraventricular tachycardia (SVT) after percutaneous PFO closure.
Methods
Prolonged cardiac monitoring was proposed to patients undergoing PFO closure at the tertiary center of Pitié Salpétrière Hospital, Paris. According to the estimated risk of SVT, two different approaches were used to monitor cardiac rhythm. A 3-year permanent recording using REVEAL™ XT or LINQ was proposed to high risk patients (age >45 years, multiple CV risk factors, prior palpitations or supraventricular ectopic activity during Holter monitoring prior to the intervention). A 4-week, 15-lead ECG continuous recording using the patch-free, wire-free, wearable Cardioskin™ system was proposed to lower risk patients. Endpoints of interest were the occurrence of SVT episodes (>30 seconds) and unplanned medical consultation or hospitalization for this reason
Results
From October 2018 to January 2020, a total of 64 patients underwent prolonged ECG monitoring including 32 (50.0%) and 32 (50.0%) patients with Cardioskin™ and REVEAL™ systems, respectively. A SVT was recorded in 11 (17.4%) patients, including atrial fibrillation (AF) in 6 (9.5%) patients. The median delay of SVT occurrence was 33.0 (14.0–39) days after the procedure (Figure 1) and 18 (10.8–34.8) days for the 6 patients with AF. Unplanned hospitalization or emergency medical visit for symptomatic SVT occurred in 5 (45.5%) patients. Antiarrhythmic medication and oral anticoagulation were initiated in 10 (90.1%) and 7 (63.6%) of the 11 patients, respectively, and SVT recurrences were recorded in 5 (45.5%) patients. No stroke was reported in any of the 11 patients during follow-up. There were no significant differences with respect to baseline and procedural characteristics among patients with or without SVT during follow-up.
Conclusion
Atrial tachycardia is frequent (17.4%) after PFO closure and long-term continuous ECG recording suggests that the incidence is higher than the clinical episodes reported in the randomized trials. This arrhythmic complication of PFO closure seems limited to the first 4 months following the procedure. Larger studies need now to confirm our findings.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | | | - C Sabben
- Fondation Rothschild, neurology, Paris, France
| | - S Deltour
- Hospital Pitie-Salpetriere, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Paris, France
| | - I Reibel
- Hospital Pitie-Salpetriere, Paris, France
| | - A Ferrante
- Hospital Pitie-Salpetriere, Paris, France
| | - S Alamowitch
- Hospital Saint-Antoine, Service de Neurologie et d'Urgences Neurovasculaires,, Paris, France
| | | | | | - N Hammoudi
- Hospital Pitie-Salpetriere, Paris, France
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Januel E, Bottin L, Yger M, Leger A, Crozier S, Baronnet F, Deltour S, Delorme S, Capron J, Borden A, Marro B, Clarençon F, Sourour NA, Samson Y, Rosso C, Alamowitch S. Ischaemic strokes associated with COVID-19: is there a specific pattern? J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-323942. [PMID: 33122394 DOI: 10.1136/jnnp-2020-323942] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/02/2020] [Accepted: 10/12/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Edouard Januel
- AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
| | - Laure Bottin
- AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
| | - Marion Yger
- AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
| | - Anne Leger
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
| | - Sophie Crozier
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
| | - Flore Baronnet
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
| | - Sandrine Deltour
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
| | - Stephen Delorme
- AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
| | - Jean Capron
- AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
| | - Alaina Borden
- AP-HP, Service de Neurophysiologie, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
| | - Beatrice Marro
- AP-HP, Service de Radiologie, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
| | - Frédéric Clarençon
- AP-HP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Nader Antoine Sourour
- AP-HP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Yves Samson
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, INSERM U 1127, CNRS UMR 7225, infrastructure stroke network, STAR team, F-75013, Institut du Cerveau et de la Moelle Épinière, Paris, Île-de-France, France
| | - Charlotte Rosso
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, INSERM U 1127, CNRS UMR 7225, infrastructure stroke network, STAR team, F-75013, Institut du Cerveau et de la Moelle Épinière, Paris, Île-de-France, France
| | - Sonia Alamowitch
- AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
- Sorbonne Université, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine, INSERM, Paris, Île-de-France, France
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Elhorany M, Boulouis G, Hassen WB, Crozier S, Shotar E, Sourour NA, Lenck S, Premat K, Fahed R, Degos V, Elhfnawy AM, Mansour OY, Tag El-Din ESA, Fadel WA, Alamowitch S, Samson Y, Naggara O, Clarençon F. Outcome and recanalization rate of tandem basilar artery occlusion treated by mechanical thrombectomy. J Neuroradiol 2020; 47:404-409. [PMID: 32910987 DOI: 10.1016/j.neurad.2020.08.004] [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: 08/23/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tandem basilar artery occlusions (tBAO) are defined as concomitant basilar artery and extracranial dominant vertebral artery occlusions. The prognosis of such tBAO treated by mechanical thrombectomy (MT) has been scantly reported. The purpose of our study was to compare the safety and effectiveness of MT for patients with tBAO compared to those with non-tandem basilar artery occlusions (ntBAO). PATIENTS AND METHODS Retrospective analysis of a database of patients who underwent MT at two academic centres. All patients treated for BAO were retrieved. Patients with tBAO, defined as a concomitant BAO and extracranial vertebral artery (VA) occlusion or severe stenosis ≥70% (V1 or proximal V2 segment) were compared with patients with ntBAO. RESULTS A total of 15 patients with tBAO and 74 patients with ntBAO were enrolled. Successful reperfusion (modified thrombolysis in cerebral infarction score ≥2b) was obtained in 73.3% versus 90.5% (OR = 0.29, 95%CI: 0.07-1.15), good clinical outcome (3-months modified Rankin scale ≤2) was reached by 26.7% versus 32.4% (OR = 0.76; 95% CI: 0.24-2.63) and mortality at 3-months was 46.7% versus 31% (OR = 1.94; 95%CI: 0.63-6) of patients with tBAO versus ntBAO, respectively. Two patients (13.3%) with tBAO and three (4%) with ntBAO had symptomatic intracranial haemorrhage (OR = 3.64; 95% CI: 0.55-24). CONCLUSION Mechanical thrombectomy for patients with tandem basilar artery occlusion tends to be associated with lower rates of successful reperfusion and good clinical outcome, and higher rate of mortality. Larger multicentre studies are warranted to better precise the proper selection and management of such patients.
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Affiliation(s)
- Mahmoud Elhorany
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Department of Neurology, Faculty of Medicine, Tanta University, Egypt
| | - Grégoire Boulouis
- INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
| | - Wagih Ben Hassen
- INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
| | - Sophie Crozier
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Stephanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Kevin Premat
- Sorbonne University, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Robert Fahed
- Department of Interventional Neuroradiology, Fondation A. de Rothschild, Paris, France
| | - Vincent Degos
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Anaesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Ahmed Mohamed Elhfnawy
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | | | | | - Wael Ahmed Fadel
- Department of Neurology, Faculty of Medicine, Tanta University, Egypt
| | - Sonia Alamowitch
- Sorbonne University, Paris VI University, Paris, France; Department of Vascular Neurology, Saint-Antoine University Hospital, Paris, France
| | - Yves Samson
- Sorbonne University, Paris VI University, Paris, France; Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Naggara
- INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
| | - Frédéric Clarençon
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
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Bersano A, Kraemer M, Touzé E, Weber R, Alamowitch S, Sibon I, Pantoni L. Stroke care during the COVID-19 pandemic: experience from three large European countries. Eur J Neurol 2020; 27:1794-1800. [PMID: 32492764 PMCID: PMC7300856 DOI: 10.1111/ene.14375] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023]
Abstract
In order to cope with the exponentially increasing number of patients infected with SARS-CoV-2, European countries made enormous efforts to reorganize medical assistance and several diseases, including stroke, were particularly impacted. We report the experience of stroke neurologists from three European countries (Italy, France and Germany) that faced the pandemic at diverse time points and with different approaches, depending on their resources and healthcare system organization. Pre-hospital and in-hospital acute stroke pathways were reorganized to prioritize COVID-19 management and, in severely affected regions of Italy and France, stroke care was centralized to a limited number of centers, whereas the remaining stroke units were dedicated to patients with COVID-19. Access to acute stroke diagnostics and time-dependent therapies was limited or delayed because of reduced capacities of emergency services due to the burden of patients with COVID-19. A marked reduction in the number of patients presenting with transient ischaemic attack and stroke was noted in the emergency departments of all three countries. Although we only have preliminary data, these conditions may have affected stroke outcome. These indirect effects of the COVID-19 pandemic could negate the efforts of stroke neurologists over the last few years to improve outcome and reduce mortality of stroke patients. Although the SARS-CoV-2 infection rate is slowing down in Europe, the effects of ending lockdown in the next months are unpredictable. It is important for the European and world stroke community to share what has been learned so far to be plan strategies to ensure stroke care in the future and upcoming challenging times.
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Affiliation(s)
- A. Bersano
- Cerebrovascular UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - M. Kraemer
- Department of NeurologyAlfried Krupp Krankenhaus EssenEssen
- University Clinic of DuesseldorfHeinrich Heine UniversityDuesseldorfGermany
| | - E. Touzé
- Université Caen NormandieInserm U1237CHU Caen NormandieService de NeurologieGIP CyceronCaen14000France
| | - R. Weber
- Department of NeurologyAlfried Krupp Krankenhaus EssenEssen
- Faculty of MedicineRuhr‐University BochumBochumGermany
| | - S. Alamowitch
- Department of NeurologyInsermUMRS 938Hôpital St‐AntoineAP‐HPSorbonne UniversitéParis
| | - I. Sibon
- Stroke UnitDepartment of NeurologyCHU BordeauxBordeaux UniversityBordeauxFrance
| | - L. Pantoni
- Stroke and Dementia Laboratory‘Luigi Sacco’ Department of Biomedical and Clinical SciencesUniversity of MilanMilanItaly
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Mekinian A, Tennenbaum J, Lahuna C, Dellal A, Belfeki N, Capron J, Januel E, Stankoff B, Alamowitch S, Fain O. Primary Sjögren's syndrome: central and peripheral nervous system involvements. Clin Exp Rheumatol 2020; 38 Suppl 126:103-109. [PMID: 33095149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
Primary Sjögren's syndrome (pSS) is a common systemic autoimmune disease characterised by exocrinopathy resulting in dryness of the mouth and eyes, unexplained fatigue and diffuse pain. Neurological involvement is uncommon in pSS, involving the central nervous system in 2-5% of cases and more frequently the peripheral nervous system in 5-15% of cases. The diagnosis of pSS is to be considered when confronted with symptoms such as mouth and eye dryness, fatigue and pain, the most frequent of pSS symptoms. Objective measures of oral and eye dryness may help assert the diagnosis of pSS, as well as ACR/EULAR criteria. Differential diagnoses have to be excluded in patients exhibiting neurological symptoms, such as cryoglobulinaemic vasculitis or multiple sclerosis, before considering a neurological involvement specific to pSS. The treatment of these neurological manifestations takes into account different parameters, such as the presence of cryoglobulinaemic vasculitis, the severity of the symptoms, a rapidly progressing evolution and the failure of previous symptomatic treatments.
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Affiliation(s)
- Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France.
| | - Juliette Tennenbaum
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Constance Lahuna
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Azzedine Dellal
- Hôpital Montfermeil, Service de Médecine Interne et Rhumatologie, Montfermeil, France
| | - Nabil Belfeki
- Hôpital de Melun, Service de Médecine Interne, Melun, France
| | - Jean Capron
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Neurologie, Paris, France
| | - Edouard Januel
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Neurologie, Paris, France
| | - Bruno Stankoff
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Neurologie, Paris, France
| | - Sonia Alamowitch
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Neurologie, Paris, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
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Elhorany M, Lenck S, Degos V, Sourour NA, Frasca Polara G, Shotar E, Godier A, Drir M, Mahtout J, Premat K, Alamowitch S, Samson Y, Clarençon F. Cangrelor and Stenting in Acute Ischemic Stroke : Monocentric Case Series. Clin Neuroradiol 2020; 31:439-448. [PMID: 32382875 DOI: 10.1007/s00062-020-00907-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/24/2020] [Accepted: 04/15/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Cangrelor is an intravenous P2Y12 receptor inhibitor with a rapid onset/offset of action and a short half-life (3-6 min). The objective was to present a preliminary experience regarding the safety and effectiveness using cangrelor, in combination with aspirin, in acute ischemic stroke patients requiring acute stenting. MATERIAL AND METHODS Retrospective analysis for patients who underwent stenting (intracranial and/or extracranial) in the setting of acute ischemic stroke with cangrelor and aspirin as antiplatelet therapy. RESULTS Cangrelor was used in 12 patients, 4 (33%) with extracranial stenting, 6 (50%) with intracranial stenting and 2 (17%) with combined extracranial and intracranial stenting. The mean age was 67 years (44-88) and 9 patients (75%) were female. The median National Institutes of Health Stroke Score at admission was 15 (IQR: 8-22). Of the patients, six (50%) received intravenous thrombolysis. All patients (100%) obtained modified thrombolysis in cerebral infarction score ≥2b. Good clinical outcome, defined as modified Rankin scale score ≤2 at 3‑months follow-up, was observed in 7 patients (58%). None of the patients experienced intraprocedural thromboembolic complications. Postprocedural stent thrombosis after cessation of cangrelor infusion due to emergency craniotomy surgery to manage malignant cerebral infarction occurred in one patient (8%). Of the patients, two (17%) experienced asymptomatic intracranial hemorrhage (ICH), one patient (8%) experienced symptomatic ICH and one (8%) retroperitoneal hematoma was observed, which was managed conservatively. CONCLUSION Cangrelor might be a safe and effective antiplatelet medication owing to its on/off activity for acute stenting in the setting of acute ischemic stroke. Further investigations through randomized studies with larger samples are necessary.
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Affiliation(s)
- Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne University, Paris VI University, Paris, France.,GRC Biofast, Paris VI University, Paris, France.,Department of Neurology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stephanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Vincent Degos
- Sorbonne University, Paris VI University, Paris, France.,GRC Biofast, Paris VI University, Paris, France.,Department of Neuro Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Giulia Frasca Polara
- Sorbonne University, Paris VI University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Anne Godier
- Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, INSERM UMRS-1140, Paris Descartes University, Paris, France
| | - Mehdi Drir
- Department of Neuro Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Jugurtha Mahtout
- Department of Neuro Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne University, Paris VI University, Paris, France
| | - Sonia Alamowitch
- Sorbonne University, Paris VI University, Paris, France.,Department of Vascular Neurology, Saint-Antoine University Hospital, Paris, France
| | - Yves Samson
- Sorbonne University, Paris VI University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne University, Paris VI University, Paris, France. .,GRC Biofast, Paris VI University, Paris, France.
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41
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Elhorany M, Lenck S, Degos V, Sourour NA, Polara GF, Shotar E, Drir M, Premat K, Alamowitch S, Samson Y, Clarençon F. Intérêt du Cangrelor dans le stenting à la phase aiguë de l’accident ischémique cérébral : une série monocentrique. J Neuroradiol 2020. [DOI: 10.1016/j.neurad.2020.01.007] [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: 10/24/2022]
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Clarençon F, Baronnet F, Shotar E, Degos V, Rolla-Bigliani C, Bartolini B, Veznedaroglu E, Budzik R, English J, Baxter B, Liebeskind DS, Krajina A, Gupta R, Miralbes S, Lüttich A, Nogueira RG, Samson Y, Alamowitch S, Sourour NA. Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry. Eur J Neurol 2020; 27:787-792. [PMID: 31997505 DOI: 10.1111/ene.14154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the safety and effectiveness of mechanical thrombectomy (MT) in patients with acute ischaemic stroke related to isolated and primary posterior cerebral artery (PCA) occlusions amongst the patients enrolled in the multicentre post-market Trevo Registry. METHOD Amongst the 2008 patients enrolled in the Trevo Registry with acute ischaemic stroke due to large vessel occlusion treated by MT, 22 patients (1.1%) [10 females (45.5%), mean age 66.2 ± 14.3 years (range 28-91)] had a PCA occlusion [17 P1 (77.3%) and five P2 occlusions (22.7%)]. Recanalization after the first Trevo (Stryker, Fremont, CA, USA) pass and at the end of the procedure was rated using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Procedure-related complications (i.e. groin puncture complication, perforation, symptomatic haemorrhage, embolus in a new territory) were also recorded. The modified Rankin Scale at 90 days was assessed. RESULTS Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range 8-16). Stroke aetiology was cardio-embolic in 68.2% of cases. Half of the patients (11/22) received intravenous tissue plasminogen activator. 54.5% of the patients were treated under general anaesthesia. Reperfusion (i.e. mTICI 2b or 3) after first pass was obtained in 65% of cases. Final mTICI 2b-3 reperfusion was obtained in all cases. Only one (4.5%) procedure-related complication was recorded (puncture site) that resolved after surgery. At 90-day follow-up, modified Rankin Scale 0-2 was obtained in 59% of the patients and 9.1% died within the first 3 months after MT. CONCLUSION Mechanical thrombectomy for PCA occlusions seems to be safe (<5% procedure-related complications) and effective. Larger repository datasets are needed.
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Affiliation(s)
- F Clarençon
- Sorbonne University, Paris, France.,Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - F Baronnet
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - V Degos
- Sorbonne University, Paris, France.,Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - C Rolla-Bigliani
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - B Bartolini
- Department of Radiology, Interventional Neuroradiology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - E Veznedaroglu
- Endovascular Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, USA
| | - R Budzik
- Interventional Neuroradiology, Riverside Methodist Hospital/Ohio Health Research Institute, Columbus, OH, USA
| | - J English
- Interventional Neurology, California Pacific Medical Center, San Francisco, CA, USA
| | - B Baxter
- Interventional Neuroradiology, Erlanger, Chattanooga, TN, USA
| | - D S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - A Krajina
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - R Gupta
- Interventional Neurology, Wellstar Health System, Atlanta, GA, USA
| | - S Miralbes
- Hospital Universitario Son Espases, Mallorca, España
| | - A Lüttich
- Hospital de Donostia, San Sebastian, España
| | - R G Nogueira
- Department of Neurology, Marcus Stroke and Neuroscience Center/Grady Memorial Hospital/Emory University, Atlanta, GA, USA
| | - Y Samson
- Sorbonne University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - S Alamowitch
- Sorbonne University, Paris, France.,Department of Vascular Neurology, Saint Antoine University Hospital, Paris, France
| | - N-A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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Vigneron C, Lécluse A, Ronzière T, Bouillet L, Boccon-Gibod I, Gayet S, Doche E, Smadja D, Di Legge S, Dumont F, Gaudron M, Ion I, Marcel S, Sévin M, Vlaicu MB, Launay D, Arnaud I, Girard-Madoux P, Héroum C, Lefèvre S, Marc G, Obadia M, Sablot D, Sibon I, Suissa L, Gobert D, Detante O, Alamowitch S, Fain O, Javaud N. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study. J Intern Med 2019; 286:702-710. [PMID: 31319000 DOI: 10.1111/joim.12962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS In a case-control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. RESULTS Fifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis-related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32-7.01; P = 0.009] and treatment with angiotensin-converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17-17.07; P < 0.001]. CONCLUSIONS This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
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Affiliation(s)
- C Vigneron
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - A Lécluse
- Neurologie, CHU Angers, Angers, France
| | - T Ronzière
- Neurologie, CHU Pontchaillou, Rennes, France
| | - L Bouillet
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - I Boccon-Gibod
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - S Gayet
- AP-HM, Médecine Interne, Centre de Compétence Angioedèmes non Histaminiques, Hôpital la Timone, Marseille, France
| | - E Doche
- AP-HM, Neurologie, Hôpital la Timone, Marseille, France
| | - D Smadja
- Neurologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - S Di Legge
- Neurologie, CH du Pays d'Aix-CH Intercommunal Aix-Pertuis, Aix-en-Provence, France
| | - F Dumont
- Neurologie, CH Tourcoing, Tourcoing, France
| | - M Gaudron
- Neurologie, CHU Tours, Tours, France
| | - I Ion
- Neurologie, CHU Nîmes, Nîmes, France
| | - S Marcel
- Neurologie, CH Métropole Savoie, Chambéry, France
| | - M Sévin
- Neurologie Institut du Thorax et du Système Nerveux, CHU Nantes, Nantes, France
| | - M B Vlaicu
- AP-HP, Service de Neurochirurgie, Hôpital Pitié Salpétrière, INSERM U955, Hôpital Orsay, Paris, France
| | - D Launay
- U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, Département de Médecine Interne et Immunologie Clinique, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), Université de Lille, CHU de Lille, Lille, France
| | - I Arnaud
- Neurologie, CHU Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - C Héroum
- Neurologie, GH Portes-de-Provence, Montélimar, France
| | - S Lefèvre
- Institut d'allergologie, CHR Metz-Thionville, Metz, France
| | - G Marc
- Neurologie, CH Saint-Nazaire, Saint-Nazaire, France
| | - M Obadia
- Neurologie, Fondation Ophtalmologique Rothschild, Paris, France
| | - D Sablot
- Neurologie, CH Perpignan, Perpignan, France
| | - I Sibon
- Neurologie, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - L Suissa
- Neurologie, CHU Nice, Nice, France
| | - D Gobert
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - O Detante
- Neurologie, CHU de Grenoble, Grenoble, France
| | - S Alamowitch
- AP-HP, Service de Neurologie, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, Paris, France
| | - O Fain
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - N Javaud
- AP-HP, Urgences, CréAk, Hôpital Louis Mourier, Université Paris 7, Colombes, France
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Drouard-de Rousiers E, Lucas L, Richard S, Consoli A, Mazighi M, Labreuche J, Kyheng M, Gory B, Dargazanli C, Arquizan C, Marnat G, Blanc R, Desal H, Bourcier R, Sibon I, Lapergue B, Piotin M, Blanc R, Redjem H, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Mazighi M, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Maacha MB, Wang A, Evrard S, Tchikviladze M, Afanasiev V, Ajili N, Sensenbrenner B, Lapergue B, Coskun O, Consoli A, Di Maria F, Rodesch G, Del Sette B, Russo R, Mizutani K, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Nighoghossian N, Riva R, Eker O, Turjman F, Derex L, Cho TH, Mechtouff L, Lukaszewicz AC, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE, Marnat G, Gariel F, Barreau X, Berge J, Veunac L, Menegon P, Sibon I, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Bourcier R, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, L’allinec V, Girot JB, Desal H, de Gaalon S, Guillon B, Gory B, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour JC, Bonnerot M, Riou-Comte N, Costa I, Chatelain A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Gaillard N, et Lucas Corti IM, Francois E, Vannier S. Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy. Stroke 2019; 50:3164-3169. [DOI: 10.1161/strokeaha.119.026448] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Nonagenarians represent a growing stroke population characterized by a higher frailty. Although endovascular therapy (ET) is a cornerstone of the management of acute ischemic stroke related to large vessel occlusion, the benefit of reperfusion among nonagenarians is poorly documented. We aimed to assess the impact of ET-related reperfusion on the functional outcome of reperfusion in this elderly population.
Methods—
A retrospective analysis of clinical and imaging data from all patients aged over 90 included in the ETIS (Endovascular Treatment in Ischemic Stroke) registry between October 2013 and April 2018 was performed. Association between post-ET reperfusion and favorable (modified Rankin Scale [0–2] or equal to prestroke value) and good (modified Rankin Scale [0–3] or equal to prestroke value) outcome were evaluated. Demographic and procedural predictors of functional outcome, including the first-pass effect, were evaluated. Results were adjusted for center, admission National Institutes of Health Stroke Scale, and use of intravenous thrombolysis.
Results—
Among the 124 nonagenarians treated with ET, those with successful reperfusion had the lowest 90-day modified Rankin Scale (odds ratio, 3.26; 95% CI, 1.04–10.25). Only patients with successful reperfusion after the first pass (n=53, 56.7%) had a reduced 90-day mortality (odds ratio, 0.15; 95% CI, 0.05–0.45) and an increased rate of good outcome (odds ratio, 4.55; 95% CI, 1.38–15.03). No increase in the rate of intracranial hemorrhage was observed among patients successfully reperfused.
Conclusions—
Successful reperfusion improves the functional outcome of nonagenarians who should not be excluded from ET. The first-pass effect should be considered in the procedural management of this frail population.
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Affiliation(s)
- Eve Drouard-de Rousiers
- From the Department of Neurology, Stroke Center (E.D.-d.R., B.L.), Foch Hospital, Suresnes, France
| | - Ludovic Lucas
- Department of Neurology, Stroke Unit, Bordeaux University Hospital, France (L.L.)
| | | | - Arturo Consoli
- Department of Interventional Neuroradiology (A.C), Foch Hospital, Suresnes, France
| | - Mikaël Mazighi
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (M.M., R. Blanc)
| | - Julien Labreuche
- University of Lille, University Hospital of Lille, EA2694 -Santé publique: épidémiologie et qualité des soins, France (J.L., M.K.)
| | - Maéva Kyheng
- University of Lille, University Hospital of Lille, EA2694 -Santé publique: épidémiologie et qualité des soins, France (J.L., M.K.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, France (B.G.)
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology (C.D.), CHRU Gui de Chauliac, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology (G.M.), University Hospital of Bordeaux, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (M.M., R. Blanc)
| | - Hubert Desal
- Department of Neuroradiology, University Hospital of Nantes, France (H.D., R. Bourcier)
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (H.D., R. Bourcier)
| | - Igor Sibon
- Department of Neurology, Stroke Center (I.S.), University Hospital of Bordeaux, France
| | - Bertrand Lapergue
- From the Department of Neurology, Stroke Center (E.D.-d.R., B.L.), Foch Hospital, Suresnes, France
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Guedeney P, Hauguel-Moreau M, Hage G, Sabben C, Deltour S, Hammoudi N, Molho A, Mesnier J, Alamowitch S, Silvain J, Montalescot G. P3733Long term follow-up after percutaneous closure of patent foramen ovale for secondary prevention of stroke. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent randomized trials have demonstrated the superiority of percutaneous patent foramen ovale (PFO) closure for the secondary prevention of stroke compared to antithrombotic therapy. However, real-world data on long-term outcomes after percutaneous PFO closure are scarce.
Purpose
To describe real-world long-term outcomes following PFO percutaneous closure and the impact of the use of intracardiac echocardiography under local anesthesia for the procedure
Methods
All consecutive patients undergoing PFO closure in a single high-volume tertiary center from January 2006 to December 2018, for secondary prevention of stroke, transient ischemic attack (TIA) or any other paradoxical arterial embolism were prospectively studied. A systematic contrast transthoracic echocardiography (TTE) was performed 3 months after closure. Clinical endpoints of interest were the occurrence of death, stroke or transient ischemic attack, as defined in previous randomized trials.
Results
Of the 242 closure procedures performed, a total of 208 (86.3%) were performed in secondary prevention of stroke, TIA or paradoxical arterial embolism (mean age 49.8±12.7 years; 62.0% male). An atrial septal aneurysm and a large shunt were present in 137 (66.8%) and 172 (84.7%) patients, respectively. General anesthesia associated with transesophageal echocardiography was initially used in all patients with a temporal trend towards the use of local anesthesia associated with either intracardiac echocardiography (Viewflex catheter, Abbott) in 23 more cases or micro transesophageal probe in 7 cases, without periprocedural complications. Discharge medication comprised of dual antiplatelet therapy, oral anticoagulation and single antiplatelet therapy in 80.7%, 16.8% and 2.5% of the patients, respectively. Contrast TTE with Valsalva maneuver was performed at a mean delay of 3.2±0.7 months after intervention and found no or minimal residual shunt in 87.0% of patients. Clinical follow-up was available up to 12.8 years (mean 2.1±3.0 years). A total of 3 patients died from cancer or unknown cause while stroke and TIA occurred in 2 and 1 patients, respectively. Event rate for death was 0.69 events per 100 patients-years. The event rates for stroke, TIA and stroke or TIA were 0.46, 0.23 and 0.70 events per 100 patients-year of observation, respectively, which compare favorably with reported outcomes following percutaneous closure in randomized clinical trials (Figure).
Conclusion
In an experienced center, percutaneous PFO closure appears to be a safe procedure providing adequate protection against recurrent strokes over a long follow-up.
Acknowledgement/Funding
ACTION study group
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | | | - G Hage
- Hospital Pitie-Salpetriere, Paris, France
| | - C Sabben
- Fondation Rothschild, neurology, Paris, France
| | - S Deltour
- Hospital Pitie-Salpetriere, Urgences Cérébro-Vasculaires, Paris, France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Paris, France
| | - A Molho
- Hospital Pitie-Salpetriere, Paris, France
| | - J Mesnier
- Hospital Pitie-Salpetriere, Paris, France
| | - S Alamowitch
- Hospital Saint-Antoine, Service de Neurologie et d'Urgences Neurovasculaires,, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
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Chantran Y, Capron J, Alamowitch S, Aucouturier P. Anti-Aβ Antibodies and Cerebral Amyloid Angiopathy Complications. Front Immunol 2019; 10:1534. [PMID: 31333665 PMCID: PMC6620823 DOI: 10.3389/fimmu.2019.01534] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) corresponds to the deposition of amyloid material in the cerebral vasculature, leading to structural modifications of blood vessel walls. The most frequent form of sporadic CAA involves fibrillar β-amyloid peptide (Aβ) deposits, mainly the 40 amino acid form (Aβ1-40), which are commonly found in the elderly with or without Alzheimer's disease. Sporadic CAA usually remains clinically silent. However, in some cases, acute complications either hemorrhagic or inflammatory can occur. Similar complications occurred after active or passive immunization against Aβ in experimental animal models exhibiting CAA, and in subjects with Alzheimer's disease during clinical trials. The triggering of these adverse events by active immunization and monoclonal antibody administration in CAA-bearing individuals suggests that analogous mechanisms could be involved during spontaneous CAA complications, drawing particular attention to the role of anti-Aβ antibodies. However, antibodies that react with several monomeric and aggregated forms of Aβ spontaneously occur in virtually all human individuals, hence being part of the "natural antibody" repertoire. Natural antibodies are usually described as having low-affinity and high cross-reactivity toward microbial components and autoantigens. Although frequently of the IgM class, they also belong to IgG and IgA isotypes. They likely display homeostatic functions and protective roles in aging. Until recently, the peculiar properties of these natural antibodies have hindered proper analysis of the Aβ-reactive antibody repertoire and the study of their implication in CAA complications. Herein, we review and comment the evidences of an auto-immune nature of spontaneous CAA complications, and discuss implications for forthcoming research and clinical practice.
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Affiliation(s)
- Yannick Chantran
- Sorbonne Université, Inserm, UMRS 938, Hôpital St-Antoine, AP-HP, Paris, France.,Département d'Immunologie Biologique, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Jean Capron
- Sorbonne Université, Inserm, UMRS 938, Hôpital St-Antoine, AP-HP, Paris, France.,Département de Neurologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Sonia Alamowitch
- Sorbonne Université, Inserm, UMRS 938, Hôpital St-Antoine, AP-HP, Paris, France.,Département de Neurologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Pierre Aucouturier
- Sorbonne Université, Inserm, UMRS 938, Hôpital St-Antoine, AP-HP, Paris, France.,Département d'Immunologie Biologique, Hôpital Saint-Antoine, AP-HP, Paris, France
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47
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Weisenburger-Lile D, Dong Y, Yger M, Weisenburger G, Polara GF, Chaigneau T, Ochoa RZ, Marro B, Lapergue B, Alamowitch S, Elbim C. Harmful neutrophil subsets in patients with ischemic stroke: Association with disease severity. Neurol Neuroimmunol Neuroinflamm 2019; 6:e571. [PMID: 31355307 PMCID: PMC6624098 DOI: 10.1212/nxi.0000000000000571] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Abstract
Objective To better understand the functional state of circulating neutrophils in patients with ischemic stroke (IS) for planning future clinical trials. Methods We analyzed by flow cytometry activation state of circulating neutrophils and the distribution of neutrophil peripheral subsets in 41 patients with acute IS less than 6 hours before admission and compared them with 22 age-matched healthy controls. Results Our results demonstrated continuous basal hyperactivation of circulating neutrophils during acute IS, characterized by lower l-selectin expression and higher CD11b expression at the cell surface, increased ROS production by neutrophils, and greater circulating levels of neutrophil elastase. Neutrophil hyperactivation was associated with deregulation of the equilibrium between apoptotic and necrotic. Patients also had higher percentages than controls of the overactive senescent (CXCR4bright/CD62Ldim) neutrophil subset and increased percentage of neutrophils with a reverse transendothelial migration (CD54highCXCR1low) phenotype. Importantly, neutrophil alterations were associated with the clinical severity of the stroke, evaluated by its NIH Stroke Scale score. Conclusion Altogether, our results indicate that during acute IS, the inflammatory properties of circulating neutrophils rise, associated with the expansion of harmful neutrophil subsets. These changes in neutrophil homeostasis, associated with disease severity, may play an instrumental role by contributing to systemic inflammation and to the blood-brain barrier breakdown. Our findings highlight new potential therapeutic approaches of stroke by rebalancing the ratio of senescent to immunosuppressive neutrophils or decreasing reverse neutrophil transmigration or both.
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Affiliation(s)
- David Weisenburger-Lile
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Yuan Dong
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Marion Yger
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Gaëlle Weisenburger
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Giulia Frasca Polara
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Thomas Chaigneau
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Riccardo Zapata Ochoa
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Beatrice Marro
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Bertrand Lapergue
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Sonia Alamowitch
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
| | - Carole Elbim
- Sorbonne Universités (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine; INSERM (D.W.-L., Y.D., T.C., R.Z.O., S.A., C.E.), UMRS 938, CdR Saint- Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases," Hôpital St-Antoine; Service de Neurologie et d'Urgences Neurovasculaires (D.W.-L., M.Y., S.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Division of Pneumology (G.W.), Foch Hospital, F-92150, Suresnes; Division of Neurology (G.F.P.), Stroke Center, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Division of Radiology (B.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; and Division of Neurology (B.L.), Stroke Center, Foch Hospital, F-92150, Suresnes
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Panni P, Gory B, Xie Y, Consoli A, Desilles JP, Mazighi M, Labreuche J, Piotin M, Turjman F, Eker OF, Bracard S, Anxionnat R, Richard S, Hossu G, Blanc R, Lapergue B, Redjem H, Escalard S, Redjem H, Ciccio G, Smajda S, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Maacha MB, Bourdain F, Decroix JP, Wang A, Evrard S, Tchikviladze M, Coskun O, Di Maria F, Rodesh G, Leguen M, Tisserand M, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Nighoghossian N, Labeyrie PE, Riva R, Derex L, Cho TH, Mechtouff L, Claire Lukaszewicz A, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE. Acute Stroke With Large Ischemic Core Treated by Thrombectomy. Stroke 2019; 50:1164-1171. [DOI: 10.1161/strokeaha.118.024295] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Pietro Panni
- From the Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy (P.P.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U12542, University Hospital of Nancy, France (B.G., S.B., R.A.)
| | - Yu Xie
- Department of Neuroradiology, University of Lorraine, IADI, INSERM U1254, Nancy, F-54000, France (Y.X., G.H.)
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.C.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.-P.D., M.M., M.P., R.B.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.-P.D., M.M., M.P., R.B.)
| | - Julien Labreuche
- Department of Biostatistics, EA2694-Santé publique: épidémiologie et qualité des soins, Lille University, France (J.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.-P.D., M.M., M.P., R.B.)
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (F.T., O.F.E.)
| | - Omer Faruk Eker
- Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (F.T., O.F.E.)
| | - Serge Bracard
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U12542, University Hospital of Nancy, France (B.G., S.B., R.A.)
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U12542, University Hospital of Nancy, France (B.G., S.B., R.A.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, INSERM U1116, University Hospital of Nancy, France (S.R.)
| | - Gabriela Hossu
- Department of Neuroradiology, University of Lorraine, IADI, INSERM U1254, Nancy, F-54000, France (Y.X., G.H.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.-P.D., M.M., M.P., R.B.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (B.L.)
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Pariente A, Guédon A, Alamowitch S, Thietart S, Carrat F, Delorme S, Capron J, Cacciatore C, Soussan M, Dellal A, Fain O, Mekinian A. Ischemic stroke in giant-cell arteritis: French retrospective study. J Autoimmun 2019; 99:48-51. [PMID: 30737054 DOI: 10.1016/j.jaut.2019.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 12/13/2022]
Abstract
Acute cerebrovascular ischemic events are a rare and severe complication of giant cell arteritis (GCA). We aimed to determine the prevalence of GCA-related stroke, the overall survival and the relapse-free survival in patients with GCA. A multicentric retrospective analysis was performed on 129 patients with GCA diagnosed between September 2010 and October 2018 in two University Hospitals. Among 129 GCA patients, 18 (16%) presented an acute ischemic cerebrovascular event. Patients with stroke were older (83 [67-96] years versus 76 [58-96]; p = 0.014) and more frequently males (61% versus 30%; p = 0.014) than those without stroke. The frequency of anterior ischemic optic neuropathy was higher in patients with stroke (n = 6, 33%) than patients without stroke (n = 12, 11%)(p = 0.02). Overall survival was significantly decreased in GCA patients with stroke (4.4 months), comparatively to patients without stroke (221.7 months; log rank test = 0.006). The 3-years relapse-free survival was decreased in patients with stroke (8.42 versus78.0 months; log rank = 0.0001), as well as the time with sustained remission (78 versus 139 months; log rank test = 0.0004). This study shows the prevalence and risk factors of ischemic stroke in GCA.
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Affiliation(s)
- Aaron Pariente
- Service de Médecine Interne-DHU i2B, Hôpital Saint-Antoine, APHP, 75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Alexis Guédon
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Sonia Alamowitch
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, F-75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Sara Thietart
- Service de Médecine Interne-DHU i2B, Hôpital Saint-Antoine, APHP, 75012, Paris, France; Service de Médecine Interne-DHU i2B, Hôpital Saint-Antoine, APHP, 75012, Paris, France
| | - Fabrice Carrat
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Stephen Delorme
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, F-75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Jean Capron
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, F-75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Carlotta Cacciatore
- Service de Médecine Interne-DHU i2B, Hôpital Saint-Antoine, APHP, 75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Michael Soussan
- Service de Médecine nucléaire, Hôpital Avicenne, AP¨HP, Université Paris 13, Bobigny, France
| | - Azeddine Dellal
- Service de Rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Olivier Fain
- Service de Médecine Interne-DHU i2B, Hôpital Saint-Antoine, APHP, 75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France
| | - Arsene Mekinian
- Service de Médecine Interne-DHU i2B, Hôpital Saint-Antoine, APHP, 75012, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, CdR Saint-Antoine, France.
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50
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El Nawar R, Lapergue B, Piotin M, Gory B, Blanc R, Consoli A, Rodesch G, Mazighi M, Bourdain F, Kyheng M, Labreuche J, Pico F, Piotin M, Blanc R, Redjem H, Escalard S, Desilles JP, Ciccio G, Smajda S, Mazighi M, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Ben Maacha M, Bourdain F, Decroix JP, Wang A, Evrard S, Tchikviladze M, Lapergue B, Coskun O, Consoli A, Di Maria F, Rodesch G, Leguen M, Tisserand M, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Gory B, Labeyrie PE, Riva R, Turjman F, Nighoghossian N, Derex L, Cho TH, Mechtouff L, Lukaszewicz AC, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE. Higher Annual Operator Volume Is Associated With Better Reperfusion Rates in Stroke Patients Treated by Mechanical Thrombectomy. JACC Cardiovasc Interv 2019; 12:385-391. [DOI: 10.1016/j.jcin.2018.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 01/02/2023]
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