1
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Marnat G, Finistis S, Moreno R, Sibon I, Pop R, Mazighi M, Clarençon F, Rosso C, Dargazanli C, Darcourt J, Olivot JM, Boulouis G, Janot K, Moulin S, Bourcier R, Consoli A, Richard S, Arquizan C, Vannier S, Richter S, Gentric JC, Papagiannaki C, Naggara O, Eker OF, Lapergue B, Caroff J, Gory B. Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results. J Neurointerv Surg 2023; 15:e248-e254. [PMID: 36357169 DOI: 10.1136/jnis-2022-019527] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice. METHODS The Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up. RESULTS Among the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0-2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158). CONCLUSIONS In tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.
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Affiliation(s)
- Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Stefanos Finistis
- Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Ricardo Moreno
- Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Igor Sibon
- Neurology, CHU de Bordeaux, Bordeaux, France
| | - Raoul Pop
- Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Mikaël Mazighi
- Interventional Neuroradiology, Fondation Rothschild, Paris, France
- Neurology, GH Lariboisiere Fernand-Widal, Paris, France
| | - Frédéric Clarençon
- Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
- Sorbonne University, Paris, France
| | - Charlotte Rosso
- Neurology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Cyril Dargazanli
- Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | | | | | | | | | - Solène Moulin
- Neurology, University Hospital Centre Reims, Reims, France
| | | | | | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | | | | | | | | | | | | | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | | | - Jildaz Caroff
- Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
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2
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Le Floch A, Clarençon F, Rouchaud A, Kyheng M, Labreuche J, Sibon I, Boulouis G, Gory B, Richard S, Caroff J, Blanc R, Seners P, Eker OF, Cho TH, Consoli A, Bourcier R, Guillon B, Dargazanli C, Arquizan C, Denier C, Eugene F, Vannier S, Gentric JC, Gauberti M, Naggara O, Rosso C, Turc G, Ozkul-Wermester O, Cognard C, Albucher JF, Timsit S, Bourdain F, Le Bras A, Richter S, Moulin S, Pop R, Heck O, Moreno R, L'Allinec V, Lapergue B, Marnat G. Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry. J Neurointerv Surg 2023; 15:e289-e297. [PMID: 36460462 DOI: 10.1136/jnis-2022-019672] [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: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone. METHODS We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0-2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients. RESULTS Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004). CONCLUSIONS In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.
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Affiliation(s)
- Agathe Le Floch
- Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Frédéric Clarençon
- Interventional neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
| | - Aymeric Rouchaud
- Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
- CNRS, XLIM, UMR 7252, Université de Limoges, Limoges, Nouvelle-Aquitaine, France
| | - Maeva Kyheng
- Biostatistics, CHU Lille, Lille, Hauts-de-France, France
| | | | - Igor Sibon
- Neurology, CHU de Bordeaux, Bordeaux, France
| | | | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Raphaël Blanc
- Departement of interventional neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Pierre Seners
- Neurology, Fondation Rothschild, Paris, Île-de-France, France
| | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Tae-Hee Cho
- Neurology, CHU Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Arturo Consoli
- Interventional Neuroradiologie, Hopital Foch, Suresnes, Ile-de-France, France
| | | | - Benoit Guillon
- Stroke unit, CHU Nantes, Nantes, Pays de la Loire, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Caroline Arquizan
- Neurology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | | | | | | | | | | | - Olivier Naggara
- Neuroradiology, GHU Paris Pôle Neuro Sainte-Anne, Paris, Île-de-France, France
| | - Charlotte Rosso
- Neurology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Guillaume Turc
- Neurology, GHU Paris Pôle Neuro Sainte-Anne, Paris, Île-de-France, France
| | | | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, Occitanie, France
| | | | | | - Frederic Bourdain
- Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Anthony Le Bras
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
- Neuroradiology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | | | - Solène Moulin
- Neurology, University Hospital Centre Reims, Reims, Champagne-Ardenne, France
| | - Raoul Pop
- Neuroradiolology, CHU Strasbourg, Strasbourg, Alsace, France
| | - Olivier Heck
- Neurology, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Ricardo Moreno
- Department Of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
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3
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Anadani M, Januel AC, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian Montoro F, Rosso C, Ben Hassen W, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, de Havenon A, Liebeskind DS, Maier B, Gory B. Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry. J Neurointerv Surg 2023; 15:14-19. [PMID: 35115393 DOI: 10.1136/neurintsurg-2021-018170] [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: 08/29/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is unknown whether collateral status modifies the effect of pretreatment intravenous thrombolysis (IVT) on the outcomes of patients with large vessel occlusions treated with endovascular therapy (EVT). We aimed to assess whether collateral status modifies the effect of IVT on the outcomes of EVT in clinical practice. METHODS We used data from the ongoing prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France. Patients with anterior circulation proximal large vessel occlusions treated with EVT within 6 hours of symptom onset were enrolled. Patients were divided into two groups based on pretreatment with IVT. The two groups were matched based on baseline characteristics. We tested the interaction between collateral status and IVT in unadjusted and adjusted models. RESULTS A total of 1589 patients were enrolled in the study, of whom 55% received IVT. Using a propensity score matching method, 724 no IVT patients were matched to 549 IVT patients. In propensity score weighted analysis, IVT was associated with higher odds of early neurological improvement (OR 1.74; 95% CI 1.33 to 2.26), favorable functional outcome (OR 1.66; 95% CI 1.23 to 2.24), excellent functional outcome (OR 2.04; 95% CI 1.47 to 2.83), and successful reperfusion (OR 2.18; 95% CI 1.51 to 3.16). IVT was not associated with mortality or hemorrhagic complications. There was no interaction between collateral status and IVT association with any of the outcomes. CONCLUSIONS Collateral status does not modify the effect of pretreatment IVT on the efficacy and safety outcomes of EVT.
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Affiliation(s)
- Mohammad Anadani
- Neurosurgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | | | - Stephanos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaoniki, Greece
| | - Frédéric Clarençon
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | | | - Raphael Blanc
- Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | | | | | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Christian Denier
- Neurology, Hôpital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | | | - Maxime Gauberti
- Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Department of Neurology, CHU Limoges, Limoges, France
| | | | - Charlotte Rosso
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Wagih Ben Hassen
- Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France.,INSERM U1166, Paris, France
| | - Guillaume Turc
- Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | | | | | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,CHU Rennes Service de Radiologie et d'Imagerie Médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Valerie Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | - Frederic Bourdain
- Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Louis Veunac
- Department of Radiology and Interventional Neuroradiology, CHU de Bordeaux, Bordeaux, France
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - Benjamin Maier
- Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
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4
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Skutecki J, Audibert G, Finitsis S, Consoli A, Lapergue B, Blanc R, Bourcier R, Sibon I, Eugène F, Vannier S, Dargazanli C, Arquizan C, Anxionnat R, Richard S, Fahed R, Marnat G, Gory B. General anesthesia or conscious sedation for endovascular therapy of basilar artery occlusions: ETIS registry results. Rev Neurol (Paris) 2022; 178:771-779. [PMID: 35871014 DOI: 10.1016/j.neurol.2022.03.020] [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: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Acute basilar artery occlusions (BAO) are associated with poor outcome despite modern endovascular treatment (EVT). The best anesthetic management during EVT is not known and may affect the procedure and clinical outcome. We compared the efficacy and safety of general anesthesia (GA) and conscious sedation/local anesthesia (CS/LA) in a large cohort of stroke patients with BAO treated with EVT in current clinical practice. METHODS Data from the ongoing prospective multicenter Endovascular Treatment In Ischemic Stroke Registry of consecutive acute BAO patients who had EVT indication from January 1st, 2015, to December 31st, 2021, were retrospectively analyzed. Two groups were compared: patients treated with CS/LA versus GA (both types of anesthesia being performed in the angiosuite). Good outcome was defined as modified Rankin Scale (mRS) score 0-3 at 90 days. RESULTS Among the 524 included patients, 266 had GA and 246 had CS/LA (67 LA). Fifty-three patients finally did not undergo EVT: 15 patients (5.9%) in the GA group and 38 patients (16.1%) in the CS/LA group (P < 0.001). After matching, two groups of 129 patients each were retained for primary analysis. The two groups were well balanced in terms of baseline characteristics. After adjustment, CS/LA compared to GA was not associated with good outcome (OR=0.90 [95%CI 0.46-1.77] P=0.769) or mortality (OR=0.75 [0.37-1.49] P=0.420) or modified thrombolysis in cerebral infarction score 2b-3 (OR=0.43 [0.16-1.16] P=0.098). On mixed ordinal logistic regression, the modality of anesthesia was not associated with any significant change in the overall distribution of the 90-day mRS (adjusted OR=1.08 [0.62-1.88] P=0.767). CONCLUSIONS Safety, outcome and quality of EVT under either CS/LA or GA for stroke due to acute BAO appear similar. Further randomized trials are warranted.
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Affiliation(s)
- J Skutecki
- Department of Anesthesiology and Surgical Intensive Care, CHRU-Nancy, Université de Lorraine, 54000 Nancy, France
| | - G Audibert
- Department of Anesthesiology and Surgical Intensive Care, CHRU-Nancy, Université de Lorraine, 54000 Nancy, France
| | - S Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece.
| | - A Consoli
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Foch Hospital, Suresnes, France
| | - B Lapergue
- Department of Neurology, Versailles Saint-Quentin en Yvelines University, Foch Hospital, Suresnes, France
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - R Bourcier
- Inserm 1087, Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, CNRS, University of Nantes, Nantes, France
| | - I Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - F Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | - S Vannier
- Stroke Unit, Department of Neurology, University Hospital of Rennes, Rennes, France
| | - C Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui-de-Chauliac, Montpellier, France
| | - C Arquizan
- Department of Neurology, CHRU Gui-de-Chauliac, Montpellier, France
| | - R Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, 54000 Nancy, France; Inserm U1254, IADI, Université de Lorraine, 54000 Nancy, France
| | - S Richard
- Stroke Unit, Department of Neurology, CHRU-Nancy, Université de Lorraine, 54000 Nancy, France; CIC 1433 Plurithematic, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - R Fahed
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - G Marnat
- Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, 54000 Nancy, France; Inserm U1254, IADI, Université de Lorraine, 54000 Nancy, France
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5
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de Havenon A, Elhorany M, Boulouis G, Naggara O, Darcourt J, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Arquizan C, Dargazanli C, Maïer B, Seners P, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Fahed R, Finitsis SN, Gory B. Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion. J Neurointerv Surg 2022; 15:422-427. [PMID: 35450929 DOI: 10.1136/neurintsurg-2022-018715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes. METHODS We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect. RESULTS We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901). CONCLUSIONS We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Mahmoud Elhorany
- Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Benjamin Maïer
- Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Pierre Seners
- Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | | | | | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Charlotte Rosso
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | - Louis Veunac
- Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Robert Fahed
- Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Stephanos Nikolaos Finitsis
- Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
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Pop R, Finitsis SN, Arquizan C, Elhorany M, Naggara O, Darcourt J, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Albucher JF, Le Bras A, Evain S, Wolff V, Timsit S, Gentric JC, Bourdain F, Veunac L, Papagiannaki C, Gory B. Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors. J Neurointerv Surg 2022; 15:415-421. [PMID: 35428738 DOI: 10.1136/neurintsurg-2022-018769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
BackgroundEndovascular treatment (EVT) for basilar artery occlusions (BAO) is associated with a higher rate of futile recanalization compared with anterior circulation procedures. We aimed to identify the incidence and predictors of poor clinical outcome despite successful reperfusion in current clinical practice.MethodsWe used data from the ETIS (Endovascular Treatment in Ischemic Stroke) registry, a prospective multicenter observational registry of stroke treated with EVT in France. Patients undergoing EVT for acute BAO from January 2014 to May 2019 successfully treated within 8 hours from onset were included. Predictors of 90-day poor outcome (modified Rankin Scale (mRS) 4–6) were researched within patients with successful (modified Thrombolysis In Cerebral Infarction (mTICI 2b-3)) and excellent (mTICI 2c-3) reperfusion.ResultsAmong 242 patients treated within 8 hours, successful reperfusion was achieved in 195 (80.5%) and excellent reperfusion in 120 (49.5%). Poor outcome was observed in 107 (54.8%) and 60 (50%) patients, respectively. In patients with successful early reperfusion, age, higher initial National Institutes of Health Stroke Scale (NIHSS) score, lower posterior circulation Alberta Stroke Programme Early CT Score (pc-ASPECTS), and absence of prior intravenous thrombolysis were independent predictors of poor outcome. The only treatment factor with an independent predictive value was first-pass mTICI 2b-3 reperfusion (adjusted OR 0.13, 95% CI 0.05 to 0.37, p<0.001). In patients with excellent early reperfusion, independent predictors were age, initial NIHSS score, first-pass mTICI 2c-3 reperfusion, and hemorrhagic transformation on post-interventional imaging.ConclusionsEarly successful reperfusion with EVT occurred in 80.5% of patients, and the only treatment-related factor predictive of clinical outcome was first pass mTICI 2b-3 reperfusion. Further research is warranted to identify the optimal techniques and devices associated with first pass reperfusion in the posterior circulation.
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Affiliation(s)
- Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
- Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
- University of Strasbourg, INSERM UMR-S1255, Strasbourg, France
| | | | - Caroline Arquizan
- Neurology, Hôpital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France
| | - Mahmoud Elhorany
- Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Olivier Naggara
- Radiology, Saint Anne Hospital Centre, Paris, Île-de-France, France
| | - Jean Darcourt
- Radiology, Hôpital Purpan, Toulouse, Midi-Pyrénées, France
| | - Frédéric Clarençon
- Sorbonne Universite, Paris, Île-de-France, France
- Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, University Hospital Centre Bordeaux, Bordeaux, Aquitaine, France
| | | | | | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Raphaël Blanc
- Departement of interventional neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Neurology, Hopital Foch, Suresnes, Île-de-France, France
- Université de Versailles Saint-Quentin-en-Yvelines, Versailles, Île-de-France, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | - Marion Boulanger
- Department of Neurology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Maxime Gauberti
- Neuroradiology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Aymeric Rouchaud
- Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, Nouvelle-Aquitaine, France
| | - Francisco Macian
- Department of Neurology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Charlotte Rosso
- Urgences cérébro-vasculaires, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
| | - Guillaume Turc
- Neurology, Groupe Hospitalier Universitaire Paris psychiatrie & neurosciences, Paris, Île-de-France, France
| | | | | | - Anthony Le Bras
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
- CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Neurology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Serge Timsit
- Department of Neurology, Centre Hospitalier Universitaire de Brest, Brest, Bretagne, France
| | | | - Frédéric Bourdain
- Department of Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Louis Veunac
- Department of Neuroradiolology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Chrysanthi Papagiannaki
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France
- IADI, INSERM U1254, Universite de Lorraine, Nancy, Lorraine, France
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7
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Anadani M, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Liebeskind DS, de Havenon A, Saleme S, Macian F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Maier B, Gory B. Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry. J Neurointerv Surg 2021; 14:551-557. [PMID: 34140288 DOI: 10.1136/neurintsurg-2021-017553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Studies have suggested that collateral status modifies the effect of successful reperfusion on functional outcome after endovascular therapy (EVT). We aimed to assess the association between collateral status and EVT outcomes and to investigate whether collateral status modified the effect of successful reperfusion on EVT outcomes. METHODS We used data from the ongoing, prospective, multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry. Collaterals were graded according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) guidelines. Patients were divided into two groups based on angiographic collateral status: poor (grade 0-2) versus good (grade 3-4) collaterals. RESULTS Among 2020 patients included in the study, 959 (47%) had good collaterals. Good collaterals were associated with favorable outcome (90-day modified Rankin Scale (mRS) 0-2) (OR 1.5, 95% CI 1.19 to 1.88). Probability of good outcome decreased with increased time from onset to reperfusion in both good and poor collateral groups. Successful reperfusion was associated with higher odds of favorable outcome in good collaterals (OR 6.01, 95% CI 3.27 to 11.04) and poor collaterals (OR 5.65, 95% CI 3.32 to 9.63) with no significant interaction. Similarly, successful reperfusion was associated with higher odds of excellent outcome (90-day mRS 0-1) and lower odds of mortality in both groups with no significant interaction. The benefit of successful reperfusion decreased with time from onset in both groups, but the curve was steeper in the poor collateral group. CONCLUSIONS Collateral status predicted functional outcome after EVT. However, collateral status on the pretreatment angiogram did not decrease the clinical benefit of successful reperfusion.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA .,Neurology, Neurosurgery, Medical University of South Carolina,College of Medicine, Charleston, South Carolina, USA
| | - Stephanos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Frédéric Clarençon
- Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Neuroradiology, Sorbonne Université, Paris, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Romain Bourcier
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Neuroradiology, CHU de Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | | | - Raphael Blanc
- Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | | | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Laurent Spelle
- Department of Neuroradiolology, CHU Kremlin Bicêtre, Paris, France
| | | | | | | | - David S Liebeskind
- Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpétrière, Paris, France
| | | | - Guillaume Turc
- Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Department of Neurology, CHU Toulouse, Toulouse, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,Department of Neurology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Stroke unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | - Louis Veunac
- Department of Neuroradiolology, CH Côte Basque, Bayonne, France
| | - Benjamin Maier
- Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
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8
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Muszynski P, Anadani M, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Maïer B, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Gory B, Finitsis SN. Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results. J Neurointerv Surg 2021; 14:neurintsurg-2021-017380. [PMID: 34045317 DOI: 10.1136/neurintsurg-2021-017380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice. METHODS Patients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0-2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram. RESULTS A total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality. CONCLUSIONS Successful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.
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Affiliation(s)
- Patricio Muszynski
- Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA.,Neurology, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | - Sébastien Richard
- Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Neurology, Stroke Unit, CHU Bordeaux, Bordeaux, France
| | | | | | - Benjamin Maïer
- Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | | | - Arturo Consoli
- Diagnostic and Therapeutic Neuroradiology, Foch Hospital, Suresnes, France
| | | | | | - Laurent Spelle
- Interventional Neuroradiolology, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, CHU Pitié-Salpêtrière, Paris, France
| | - Charlotte Rosso
- Neurology, Stroke Unit, CHU Pitié-Salpêtrière, Paris, France
| | | | - Guillaume Turc
- Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Neurology, Stroke Unit, CHU Toulouse, Toulouse, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
| | | | - Sarah Evain
- Neurology, Stroke Unit, CH Bretagne Atlantique, Vannes, France
| | | | - Raoul Pop
- Interventional Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Neurology, Stroke Unit, CHU Brest, Brest, France
| | | | | | | | - Benjamin Gory
- Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France .,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Stephanos Nikolaos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
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9
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Maïer B, Finitsis S, Bourcier R, Papanagiotou P, Richard S, Marnat G, Sibon I, Dargazanli C, Arquizan C, Blanc R, Piotin M, Lapergue B, Consoli A, Eugene F, Vannier S, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Viguier A, Cognard C, Wolff V, Pop R, Mazighi M, Gory B. First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. J Neurointerv Surg 2021; 14:neurintsurg-2021-017505. [PMID: 33972458 DOI: 10.1136/neurintsurg-2021-017505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/09/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA). OBJECTIVE To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT. METHODS We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0-2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes. RESULTS We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA. CONCLUSIONS Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.
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Affiliation(s)
- Benjamin Maïer
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France .,Université de Paris, Paris, Île-de-France, France
| | - Stephanos Finitsis
- Department of Interventional Neuroradiology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Romain Bourcier
- Department of Interventional Neuroradiology, CHU Nantes, Nantes, Pays de la Loire, France
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany.,First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens - Aretaiio Hospital, Athens, Greece
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neurology Department, CHU de Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Department of Neurology, Hospital Foch, Suresnes, Île-de-France, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Suzana Saleme
- Department of Interventional Neuroradiology, CHU Limoges, Limoges, Limousin, France
| | | | - Frédéric Clarençon
- Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.,Sorbonne University, Paris, Île-de-France, France
| | - Charlotte Rosso
- Urgences cérébro-vasculaires, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Olivier Naggara
- Department of Neuroradiology, Saint Anne Hospital Centre, Paris, Île-de-France, France
| | - Guillaume Turc
- Université de Paris, Paris, Île-de-France, France.,Department of Neurology, Saint Anne Hospital Centre, Paris, Île-de-France, France
| | - Alain Viguier
- Department of Neurology, CHU Toulouse, Toulouse, Occitanie, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hospital Purpan, Toulouse, Midi-Pyrénées, France
| | - Valerie Wolff
- Stroke unit, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Raoul Pop
- Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Department of Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
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10
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Guenego A, Bourcier R, Guillen M, Weisenburger-Lile D, Lapergue B, Gory B, Richard S, Ducroux C, Piotin M, Blanc R, Labreuche J, Lucas L, Detraz L, Aubertin M, Dargazanli C, Benali A, Vannier S, Eugene F, Lun R, Walker G, Consoli A, Fahed R. Neurological improvement predicts clinical outcome after acute basilar artery stroke thrombectomy. Eur J Neurol 2020; 28:117-123. [PMID: 32812674 DOI: 10.1111/ene.14487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO. METHODS We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI. RESULTS A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI. CONCLUSION Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.
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Affiliation(s)
- A Guenego
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.,Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - R Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France
| | - M Guillen
- Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - B Lapergue
- Neurovascular Unit, Foch Hospital, Suresnes, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - S Richard
- Stroke Unit, Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France.,INSERM U1116, CHRU-Nancy, Nancy, France
| | - C Ducroux
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - R Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - J Labreuche
- ULR 2694-METRICS: Evaluation Des Technologies De Santé et des Pratiques Médicales, Univ. Lille, CHU Lille, Lille, France
| | - L Lucas
- Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - L Detraz
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France
| | - M Aubertin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - C Dargazanli
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - A Benali
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - S Vannier
- Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - F Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - R Lun
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - G Walker
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, Division of Neurology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - A Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | - R Fahed
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.,Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
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11
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Laurent E, Lahondere A, Godillon L, Vannier S, Bonnaud I, Gaudron M, Laribi S, Grammatico-Guillon L. Enquête Suspi-AVC en Centre-Val de Loire, prise en charge initiale des suspicions d’accident vasculaire cérébral. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Tracol C, Vannier S, Hurel C, Tuffier S, Eugene F, Le Reste PJ. Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy. Rev Neurol (Paris) 2020; 176:619-625. [PMID: 32624178 DOI: 10.1016/j.neurol.2020.01.352] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/05/2020] [Accepted: 01/10/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Several predictors have been described to early diagnose malignant middle cerebral artery infarction (MMI) and select patient for hemicraniectomy. Nevertheless, few studies have assessed them among patients with acute ischemic stroke undergoing mechanical endovascular thrombectomy (MET). The overall objective in this study was to evaluate these predictors in patients undergoing MET in the purpose to guide the medical care in the acute phase. METHODS We selected patients from a prospective local database which reference all patients eligible for treatment with Alteplase thrombolysis and/or mechanical endovascular thrombectomy in acute stroke. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI. RESULTS In 32 months, 66 patients were included. Eighteen (27.3%) developed MMI. Malignant evolution was associated with: severity of neurological deficit and level of consciousness at admission, infarct size in DWI sequence and involvement of other vascular territories. Study groups didn't differ in terms of successful reperfusion. Two variables were identified as independent predictors of MMI: DWI infarct volume (p<0.001) and time to thrombectomy (p=0.018). A decision tree based on these two factors was able to predict malignant evolution with high specificity (100%) and sensibility (73%). CONCLUSION Our study proposes a practical decision tree including DWI lesion volume and delay before thrombectomy to early and accurately predict MMI in a subgroup of patients with MCA infarction undergoing MET regardless to the status of reperfusion.
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Affiliation(s)
- C Tracol
- Neurology, university hospital, 37, quai de la Prevalaye, 35000 Rennes, France.
| | - S Vannier
- Neurology, university hospital, Rennes, France
| | - C Hurel
- Department of epidemiology, university hospital, Rennes, France
| | - S Tuffier
- Department of epidemiology, university hospital, Rennes, France
| | - F Eugene
- Radiology, university hospital, Rennes, France
| | - P J Le Reste
- Neurosurgery, university hospital, Rennes, France
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13
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Ducroux C, Renaud N, Bourcier R, Marnat G, Sibon I, Gory B, Richard S, Dargazanli C, Arquizan C, Eugene F, Vannier S, Labreuche J, Walker G, Blanc R, Obadia M, Consoli A, Lapergue B, Fahed R. Embolus Retriever with Interlinked Cages (ERIC) versus conventional stent retrievers for thrombectomy: a propensity score-based analysis. J Neurointerv Surg 2020; 13:255-260. [PMID: 32606101 DOI: 10.1136/neurintsurg-2020-016289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Embolus Retriever with Interlinked Cages (ERIC) is one of the latest devices for thrombectomies. It has several architectural features that are supposed to enhance its ability to remove clots and prevent distal emboli. We aimed to compare ERIC with standard stent retrievers (SRs) using propensity score (PS) matching. METHODS The clinical and radiological data of all consecutive patients treated with ERIC or standard FDA-approved stent retrievers were collected from a prospective multicenter registry. We compared procedural outcomes (recanalization rates according to the modified Thrombolysis In Cerebral Infarction (mTICI) score and procedural complications) and clinical outcomes (modified Rankin Scale (mRS) and mortality at 3 months). Matching of the populations with PS was performed to account for differences in baseline characteristics. RESULTS A total of 1230 patients were included. In both the PS-matched cohort (195 ERIC patients, 630 SR patients) and the inverse probability of treatment weighting PS-adjusted cohort (206 ERIC patients, 1024 SR patients) there was no difference in terms of successful recanalization (modified TICI score ≥2b), good clinical outcome (mRS=0-2 or equal to pre-stroke mRS), or mortality at 3 months. Patients treated with first-line ERIC had a higher rate of complete recanalization (mTICI 3); however, they also required more passes and more frequent rescue therapy than the SR patient group. CONCLUSION In a large multicenter registry with PS matching, the ERIC device provided equivalent angiographic and clinical results to conventional SRs. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov Unique identifier: NCT03776877.
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Affiliation(s)
- Célina Ducroux
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Nicolas Renaud
- Neuroradiology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Romain Bourcier
- Neuroradiology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Igor Sibon
- Neurology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
| | - Sébastien Richard
- Neurology Stroke Unit, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, Occitanie, France
| | - Caroline Arquizan
- Neurology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Francois Eugene
- Neuroradiology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Stephane Vannier
- Neurology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Julien Labreuche
- Biostatistics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Gregory Walker
- Department of Medicine - Division of Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine - Division of Neurology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Mickael Obadia
- Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Arturo Consoli
- Neuroradiology, Foch Hospital, Suresnes, Île-de-France, France
| | | | - Robert Fahed
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France .,Department of Medicine - Division of Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
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14
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Raoult H, Lassalle MV, Parat B, Rousseau C, Eugène F, Vannier S, Evain S, Le Bras A, Ronziere T, Ferre JC, Gauvrit JY, Laviolle B. DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke. AJNR Am J Neuroradiol 2020; 41:274-279. [PMID: 32001446 DOI: 10.3174/ajnr.a6379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The reasons for poor clinical outcome after thrombectomy for acute stroke, concerning around half of all patients, are misunderstood. We developed a hierarchic algorithm based on DWI to better identify patients at high risk of disability. MATERIALS AND METHODS Our single-center, retrospective study included consecutive patients with acute ischemic stroke who underwent thrombectomy for large anterior artery occlusion and underwent pretreatment DWI. The primary outcome was the mRS at 3 months after stroke onset. Multivariable regression was used to identify independent clinical and imaging predictors of poor prognosis (mRS > 2) at 3 months, and a hierarchic algorithm predictive of disability was developed. RESULTS A total of 149 patients were analyzed. In decreasing importance, DWI lesion volume of >80 mL, baseline NIHSS score of >14, age older than 75 years, and time from stroke onset to groin puncture of >4 hours were independent predictors of poor prognosis. The predictive hierarchic algorithm developed from the multivariate analysis predicted the risk of disability at 3 months for up to 100% of patients with a high predictive value. The area under the receiver operating characteristic curve was 0.87. CONCLUSIONS The DWI-based hierarchic algorithm we developed is highly predictive of disability at 3 months after thrombectomy and is easy to use in routine practice.
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Affiliation(s)
- H Raoult
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | | | - B Parat
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | - C Rousseau
- Clinical Pharmacology (C.R., B.L.), Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique de Rennes, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - F Eugène
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | | | - S Evain
- Departments of Neurology (S.E.)
| | - A Le Bras
- Radiology (A.L.B.), Centre Hospitalier Universitaire Bretagne Atlantique, Vannes, France
| | | | - J C Ferre
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | - J Y Gauvrit
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | - B Laviolle
- Clinical Pharmacology (C.R., B.L.), Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique de Rennes, Centre Hospitalier Universitaire Rennes, Rennes, France
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15
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Vannier S, Ronziere T, Ferre JC, Lassalle V, Verin M. Reversible cerebral vasoconstriction syndrome triggered by an electronic cigarette: case report. Eur J Neurol 2015; 22:e64-5. [PMID: 25846567 DOI: 10.1111/ene.12657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S Vannier
- Department of Neurology, Rennes University Hospital, Rennes, France
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Pichat P, Vannier S, Dussaud J, Rubis JP. Assessment of solar photocatalysis to purify on-site rinse waters from tractor cisterns used in grapevine pest control: field experimentation. Water Sci Technol 2005; 52:223-30. [PMID: 16312971] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The aim of this study was to assess in a vineyard the effect of purifying by solar photocatalysis the title rinse waters (currently most often rejected) in terms of efficacy and on-site practicality for the wine grower. The on-site, self-functioning, solar purifying unit included a corrugated-steel inclined plate of area S = 1 m2 onto which a TiO2-coated thin material had been slightly pressed, a tank, and an aquarium-type pump powered by a photovoltaic panel (appropriate for isolated locations). For a vineyard of area A = 0.15 km2, the rinse water (about 90 L) corresponding to each of four typical vine treatments in summer was analysed (major pesticides for each treatment, TOC, Microtox test and, in one case, BOD5) by independent laboratories, before and after purification for 8 days. The S/A ratio tested was found insufficient even if the photocatalytic treatment markedly improved the quality of the rinse waters. From the relatively low final organic content reached in one case, it is calculated that a three-time higher S/A ratio might suffice, but new trials are necessary to determine whether it is valid for other typical cases. Inferred contribution of inorganic ions to the post-photocatalytic treatment toxicity points to the need for an additional detoxification. These field experiments have also demonstrated that the purifying prototype is robust, and easy to install and use on site by the wine grower.
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Affiliation(s)
- P Pichat
- Laboratoire Photocatalyse, Catalyse et Environnement, CNRS UMR IFoS, Ecole Centrale de Lyon, Ecully, France.
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17
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Abstract
Two new acylated flavonol glycosides were isolated along with kaempferol 3-O-beta-rutinoside from 10-year-old callus cultures of Mexican lime. The structures of these new compounds are kaempferol 3-O-beta-D-glucopyranoside-6"-(3-hydroxy-3-methyl glutarate) and kaempferol 3-O-beta-D-glucopyranoside-6"-(3-hydroxy-3-methyl glutarate)-7-O-beta-D-glucopyranoside.
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Affiliation(s)
- M A Berhow
- U.S. Department of Agriculture, ARS, Fruit and Vegetable Chemistry Laboratory, Pasadena, CA 91106
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