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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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Beretta S, Carone D, Pedrazzini FA, Chauveau F, Cho TH. Head down positioning before recanalization in acute ischemic stroke. Eur Stroke J 2024; 9:277-278. [PMID: 37658693 PMCID: PMC10916825 DOI: 10.1177/23969873231198331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Affiliation(s)
- Simone Beretta
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Department of Neuroscience, Fondazione IRCCS San Gerardo Monza, Monza, Italy
| | - Davide Carone
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Fabien Chauveau
- Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028, Université Claude Bernard Lyon 1, Lyon, France
| | - Tae-Hee Cho
- Neurovascular Unit, Hospices Civils de Lyon, Lyon, France
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Chalet L, Debatisse J, Wateau O, Boutelier T, Wiart M, Costes N, Mérida I, Redouté J, Langlois JB, Lancelot S, Léon C, Cho TH, Mechtouff L, Eker OF, Nighoghossian N, Canet-Soulas E, Becker G. The PREMISE database of 20 Macaca fascicularis PET/MRI brain images available for research. Lab Anim (NY) 2024; 53:13-17. [PMID: 37996697 PMCID: PMC10766538 DOI: 10.1038/s41684-023-01289-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
Non-human primate studies are unique in translational research, especially in neurosciences where neuroimaging approaches are the preferred methods used for cross-species comparative neurosciences. In this regard, neuroimaging database development and sharing are encouraged to increase the number of subjects available to the community, while limiting the number of animals used in research. Here we present a simultaneous positron emission tomography (PET)/magnetic resonance (MR) dataset of 20 Macaca fascicularis images structured according to the Brain Imaging Data Structure standards. This database contains multiple MR imaging sequences (anatomical, diffusion and perfusion imaging notably), as well as PET perfusion and inflammation imaging using respectively [15O]H2O and [11C]PK11195 radiotracers. We describe the pipeline method to assemble baseline data from various cohorts and qualitatively assess all the data using signal-to-noise and contrast-to-noise ratios as well as the median of intensity and the pseudo-noise-equivalent-count rate (dynamic and at maximum) for PET data. Our study provides a detailed example for quality control integration in preclinical and translational PET/MR studies with the aim of increasing reproducibility. The PREMISE database is stored and available through the PRIME-DE consortium repository.
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Affiliation(s)
- Lucie Chalet
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France
- Olea Medical, La Ciotat, France
| | - Justine Debatisse
- Institut des Sciences Cognitives Marc Jeannerod (ISCMJ), UMR 5229 CNRS, Bron Cedex, France
| | | | | | - Marlène Wiart
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France
| | | | | | | | | | | | - Christelle Léon
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France
| | - Tae-Hee Cho
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Laura Mechtouff
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Hospices Civils de Lyon, Lyon, France
- CREATIS, CNRS UMR 5220, INSERM U1206, Université Lyon 1, INSA Lyon, Bât. Blaise Pascal, Villeurbanne, France
| | - Norbert Nighoghossian
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Canet-Soulas
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France.
| | - Guillaume Becker
- CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM U1060, INRA U1397, Lyon, France.
- Lyon Neuroscience Research Center, University Claude Bernard Lyon 1, INSERM U1028, CNRS UMR 5292, Lyon, France.
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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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Bani-Sadr A, Trintignac M, Mechtouff L, Hermier M, Cappucci M, Ameli R, de Bourguignon C, Derex L, Cho TH, Nighoghossian N, Eker OF, Berthezene Y. Is the optimal Tmax threshold identifying perfusion deficit volumes variable across MR perfusion software packages? A pilot study. MAGMA 2023; 36:815-822. [PMID: 36811716 DOI: 10.1007/s10334-023-01068-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Accurate quantification of ischemic core and ischemic penumbra is mandatory for late-presenting acute ischemic stroke. Substantial differences between MR perfusion software packages have been reported, suggesting that the optimal Time-to-Maximum (Tmax) threshold may be variable. We performed a pilot study to assess the optimal Tmax threshold of two MR perfusion software packages (A: RAPID®; B: OleaSphere®) by comparing perfusion deficit volumes to final infarct volumes as ground truth. METHODS The HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated by mechanical thrombectomy after MRI triage. Mechanical thrombectomy failure was defined as a modified thrombolysis in cerebral infarction score of 0. Admission MR perfusion were post-processed using two packages with increasing Tmax thresholds (≥ 6 s, ≥ 8 s and ≥ 10 s) and compared to final infarct volume evaluated with day-6 MRI. RESULTS Eighteen patients were included. Lengthening the threshold from ≥ 6 s to ≥ 10 s led to significantly smaller perfusion deficit volumes for both packages. For package A, Tmax ≥ 6 s and ≥ 8 s moderately overestimated final infarct volume (median absolute difference: - 9.5 mL, interquartile range (IQR) [- 17.5; 0.9] and 0.2 mL, IQR [- 8.1; 4.8], respectively). Bland-Altman analysis indicated that they were closer to final infarct volume and had narrower ranges of agreement compared with Tmax ≥ 10 s. For package B, Tmax ≥ 10 s was closer to final infarct volume (median absolute difference: - 10.1 mL, IQR: [- 17.7; - 2.9]) versus - 21.8 mL (IQR: [- 36.7; - 9.5]) for Tmax ≥ 6 s. Bland-Altman plots confirmed these findings (mean absolute difference: 2.2 mL versus 31.5 mL, respectively). CONCLUSIONS The optimal Tmax threshold for defining the ischemic penumbra appeared to be most accurate at ≥ 6 s for package A and ≥ 10 s for package B. This implies that the widely recommended Tmax threshold ≥ 6 s may not be optimal for all available MRP software package. Future validation studies are required to define the optimal Tmax threshold to use for each package.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France.
- CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France.
| | - Mathilde Trintignac
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Matteo Cappucci
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | | | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Tae-Hee Cho
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Omer Faruk Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
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6
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Fontaine J, Leboube S, Bochaton T, Thibault H, Amaz C, Cho TH, Paccalet A, Crola Da Silva C, Duhamel S, Buisson M, Rascle L, Bidaux G, Ovize M, Nighoghossian N, Mechtouff L. Specific inflammatory profile of acute ischemic stroke patients with left atrial enlargement. Front Cardiovasc Med 2023; 10:1190857. [PMID: 37539088 PMCID: PMC10394294 DOI: 10.3389/fcvm.2023.1190857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/22/2023] [Indexed: 08/05/2023] Open
Abstract
Background The inflammatory process underlying atrial myopathy may affect the inflammatory response activated in acute ischemic stroke (AIS). Objectives We aimed to assess whether left atrial enlargement (LAE) as a marker of atrial myopathy is associated with a different profile of circulating inflammatory markers in AIS patients. Methods HIBISCUS-STROKE is a cohort study including anterior circulation AIS patients treated with mechanical thrombectomy following MRI. Ten circulating inflammatory markers were measured at admission and 6, 24, and 48 h after admission. LAE was defined as a left atrial volume index (LAVi) ≥34 ml/m2. A multiple logistic regression model was performed to detect an independent association between the area under the curve (AUC) of these markers and LAE. Results We included 143 patients. Of them, 85 (59.4%) had LAE. On univariable analysis, we found that patients with LAE had higher soluble form suppression of tumorigenicity 2 (sST2), soluble tumor necrosis factor receptor I (sTNFR1), and vascular cellular adhesion molecule-1 (VCAM-1) AUC, were older, mostly female, had a higher National Institutes of Health Stroke Scale (NIHSS) score and blood glucose level at admission, had more often hypertension, and a cardioembolic source of AIS, such as atrial fibrillation, while they were less frequently current smokers and had a lower rate of tandem occlusion than patients without LAE. On multivariable analysis, we found that among circulating inflammatory markers, only high VCAM-1 (OR: 9.13, 95% CI: 3.21-25.9) and sST2 (OR: 3.40, 95% CI: 1.68-6.86) AUC remained associated with LAE. Conclusions High VCAM-1 and sST2 levels within the first 48 h are associated with LAE in AIS patients.
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Affiliation(s)
- Julia Fontaine
- Stroke Department, Hospices Civils de Lyon, Bron, France
| | - Simon Leboube
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
- Cardiac Intensive Care Unit, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bochaton
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
- Cardiac Intensive Care Unit, Hospices Civils de Lyon, Lyon, France
| | - Hélène Thibault
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
- Department of Cardiovascular Functional Exploration, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center-INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Stroke Department, Hospices Civils de Lyon, Bron, France
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
| | - Alexandre Paccalet
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Crola Da Silva
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
| | - Suzanne Duhamel
- Department of Cardiovascular Functional Exploration, Hospices Civils de Lyon, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center-INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Lucie Rascle
- Stroke Department, Hospices Civils de Lyon, Bron, France
| | - Gabriel Bidaux
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
| | - Michel Ovize
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
- Clinical Investigation Center-INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Stroke Department, Hospices Civils de Lyon, Bron, France
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
| | - Laura Mechtouff
- Stroke Department, Hospices Civils de Lyon, Bron, France
- Univ-Lyon, CarMeN Laboratory, Inserm U1060/INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
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Bani-Sadr A, Mechtouff L, Bourguignon CDE, Mauffrey A, Boutelier T, Cho TH, Cappucci M, Ameli R, Hermier M, Derex L, Nighoghossian N, Berthezene Y. Brain-Blood Barrier Permeability and Kinetics of Inflammatory Markers in Acute Stroke Patients Treated by Thrombectomy. Neurology 2023:WNL.0000000000207460. [PMID: 37290975 PMCID: PMC10401692 DOI: 10.1212/wnl.0000000000207460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the relationship between baseline blood-brain barrier (BBB) permeability and the kinetics of circulating inflammatory markers in a cohort of acute ischemic stroke (AIS) patients treated with mechanical thrombectomy. METHODS The HIBISCUS-STROKE cohort includes AIS patients treated with mechanical thrombectomy following admission MRI, and undergoing a sequential assessment of circulating inflammatory markers. Baseline dynamic-susceptibility perfusion MRI was post-processed with arrival time correction to provide K2 maps reflecting BBB permeability. After co-registration of apparent-diffusion-coefficient and K2 maps, 90th percentile of K2 value was extracted within baseline ischemic core and expressed as a percentage change compared to contralateral normal appearing white matter. Population was dichotomized according to median K2 value. Uni- and multiple variable logistic regressions analyses were performed to investigate factors associated with increased pretreatment BBB permeability in the whole population and in patients with symptoms onset <6h. RESULTS In the whole population (n=105 patients, median K2=1.59), patients with increased BBB permeability had higher serum levels of MMP-9 at H48 (p=0.02), higher CRP serum level at H48 (p=0.01), poorer collateral status (p=0.01), and larger baseline ischemic core (p<0.001). They were more likely to have hemorrhagic transformation (p=0.008), larger final lesion volume (p=0.02), and worst neurologic outcome at 3-months (p=0.04). The multiple variable logistic regression indicated that increased BBB permeability was only associated with ischemic core volume (Odds Ratio (OR)= 1.04; 95% Confidence Interval (CI): [1.01; 1.06], p<0.0001).Restricting analysis to patients with symptoms onset < 6h (n=72, median K2=1.27), subjects with increased BBB permeability had higher serum levels of MMP-9 at both H0 (p=0.005), H6 (p=0.004), H24 (p=0.02) and H48 (p=0.01), higher CRP levels at H48 (p=0.02) and larger baseline ischemic core (p<0.0001). The multiple variable logistic analysis showed that increased BBB permeability was independently associated with higher H0 MMP-9 levels (OR=1.33; 95% CI: [1.12; 1.65]; p=0.01) and larger ischemic core (OR=1.27; 95% CI: [1.08; 1.59]; p=0.04). DISCUSSION In AIS patients, increased BBB permeability is associated with larger ischemic core. In the subgroup of patients with symptoms onset <6h, increased BBB permeability is independently associated with higher H0-MMP-9 levels and larger ischemic core.
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Frey BM, Shenas F, Boutitie F, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Barow E, Königsberg A, Schlemm E, Pedraza S, Lemmens R, Thijs V, Muir KW, Nighoghossian N, Simonsen CZ, Gerloff C, Thomalla G. Intravenous Thrombolysis in Patients With White Matter Hyperintensities in the WAKE-UP Trial. Stroke 2023. [PMID: 37226772 DOI: 10.1161/strokeaha.122.040247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND White matter hyperintensities of presumed vascular origin (WMH) are the most prominent imaging feature of cerebral small vessel disease (cSVD). Previous studies suggest a link between cSVD burden and intracerebral hemorrhage and worse functional outcome after thrombolysis in acute ischemic stroke. We aimed to determine the impact of WMH burden on efficacy and safety of thrombolysis in the MRI-based randomized controlled WAKE-UP trial of intravenous alteplase in unknown onset stroke. METHODS The design of this post hoc study was an observational cohort design of a secondary analysis of a randomized trial. WMH volume was quantified on baseline fluid-attenuated inversion recovery images of patients randomized to either alteplase or placebo in the WAKE-UP trial. Excellent outcome was defined as score of 0-1 on the modified Rankin Scale after 90 days. Hemorrhagic transformation was assessed on follow-up imaging 24-36 hours after randomization. Treatment effect and safety were analyzed by fitting multivariable logistic regression models. RESULTS Quality of scans was sufficient in 441 of 503 randomized patients to delineate WMH. Median age was 68 years, 151 patients were female, and 222 patients were assigned to receive alteplase. Median WMH volume was 11.4 mL. Independent from treatment, WMH burden was statistically significantly associated with worse functional outcome (odds ratio, 0.72 [95% CI, 0.57-0.92]), but not with higher chances of any hemorrhagic transformation (odds ratio, 0.78 [95% CI, 0.60-1.01]). There was no interaction of WMH burden and treatment group for the likelihood of excellent outcome (P=0.443) or any hemorrhagic transformation (P=0.151). In a subgroup of 166 patients with severe WMH, intravenous thrombolysis was associated with higher odds of excellent outcome (odds ratio, 2.40 [95% CI, 1.19-4.84]) with no significant increase in the rate of hemorrhagic transformation (odds ratio, 1.96 [95% CI, 0.80-4.81]). CONCLUSIONS Although WMH burden is associated with worse functional outcome, there is no association with treatment effect or safety of intravenous thrombolysis in patients with ischemic stroke of unknown onset. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01525290.
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Affiliation(s)
- Benedikt M Frey
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Farhad Shenas
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France; Université Lyon 1, FranceCNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France (F.B.)
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany (M. Ebinger)
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (M. Endres)
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.)
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt, Girona, Spain (S.P.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L.)
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Belgium (R.L.)
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Belgium (R.L.)
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (V.T.)
- Austin Health, Department of Neurology, Heidelberg, VIC, Australia (V.T.)
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
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Bani-Sadr A, Cho TH, Cappucci M, Hermier M, Ameli R, Filip A, Riva R, Derex L, De Bourguignon C, Mechtouff L, Eker OF, Nighoghossian N, Berthezene Y. Assessment of three MR perfusion software packages in predicting final infarct volume after mechanical thrombectomy. J Neurointerv Surg 2023; 15:393-398. [PMID: 35318959 DOI: 10.1136/neurintsurg-2022-018674] [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: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the performance of three MR perfusion software packages (A: RAPID; B: OleaSphere; and C: Philips) in predicting final infarct volume (FIV). METHODS This cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were post-processed by three packages to quantify ischemic core and perfusion deficit volume (PDV). Automatic package outputs (uncorrected volumes) were collected and corrected by an expert. Successful revascularization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B. Uncorrected and corrected volumes were compared between each package and with FIV according to mTICI score. RESULTS Ninety-four patients were included, of whom 67 (71.28%) had a mTICI score ≥2B. In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (p>0.15). Conversely, assessment of PDV showed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference -40.9 mL) and B (median absolute difference -67.0 mL) overestimated FIV to a lesser degree than package C (median absolute difference -118.7 mL; p=0.03 and p=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (p≥0.99). CONCLUSIONS Automated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same dataset. This highlights the need for routine expert evaluation and correction of automated package output data for appropriate patient management.
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Affiliation(s)
- Alexandre Bani-Sadr
- Neuroradiology, Hospices Civils de Lyon, Bron, France .,MYRIAD, CREATIS, Villeurbanne, France
| | - Tae-Hee Cho
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Hermier
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Roxana Ameli
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Andrea Filip
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Roberto Riva
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Laurent Derex
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | | | | | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France.,MYRIAD, CREATIS, Villeurbanne, France
| | | | - Yves Berthezene
- Neuroradiology, Hospices Civils de Lyon, Bron, France.,MYRIAD, CREATIS, Villeurbanne, France
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Heinze M, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Puig J, Lemmens R, Thijs V, Muir KW, Nighoghossian N, Königsberg A, Jensen M, Barow E, Lettow I, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. Predictors of Early Neurological Improvement and Its Relationship to Thrombolysis Treatment and Long-Term Outcome in the WAKE-UP Study. Cerebrovasc Dis 2023; 52:560-566. [PMID: 36863328 DOI: 10.1159/000528805] [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: 09/06/2022] [Accepted: 12/07/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The aims of this study were to evaluate the relationship of clinical and imaging baseline factors and treatment on the occurrence of early neurological improvement (ENI) in the WAKE-UP trial of MRI-guided intravenous thrombolysis in unknown onset stroke and to examine the association of ENI with long-term favorable outcome in patients treated with intravenous thrombolysis. METHODS We analyzed data from all patients with at least moderate stroke severity, reflected by an initial National Institutes of Health Stroke Scale (NIHSS) score ≥4 randomized in the WAKE-UP trial. ENI was defined as a decrease in NIHSS of ≥8 or a decline to zero or 1 at 24 h after initial presentation to the hospital. Favorable outcome was defined as a modified Rankin Scale score of 0-1 at 90 days. We performed group comparison and multivariable analysis of baseline factors associated with ENI and performed mediation analysis to evaluate the effect of ENI on the relationship between intravenous thrombolysis and favorable outcome. RESULTS ENI occurred in 93 out of 384 patients (24.2%) and was more likely to occur in patients who received treatment with alteplase (62.4% vs. 46.0%, p = 0.009), had smaller acute diffusion-weighted imaging lesion volume (5.51 mL vs. 10.9 mL, p ≤ 0.001), and less often large-vessel occlusion on initial MRI (7/93 [12.1%] versus 40/291 [29.9%], p = 0.014). In multivariable analysis, treatment with alteplase (OR 1.97, 95% confidence interval [CI] 0.954-1.100), lower baseline stroke volume (OR 0.965, 95% CI: 0.932-0.994), and shorter time from symptom recognition to treatment (OR 0.994, 95% CI: 0.989-0.999) were independently associated with ENI. Patients with ENI had higher rates of favorable outcome at 90-day follow-up (80.6% vs. 31.3%, p ≤ 0.001). The occurrence of ENI significantly mediated the association of treatment with a good outcome, with ENI at 24 h explaining 39.4% (12.9-96%) of the treatment effect. CONCLUSION Intravenous alteplase increases the odds of ENI in patients with at least moderate stroke severity, especially when given early. In patients with large-vessel occlusion, ENI is rarely observed without thrombectomy. ENI represents a good surrogate early marker of treatment effect as more than a third of good outcome at 90 days is explained by ENI at 24 h.
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Affiliation(s)
- Marlene Heinze
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Medical Park Berlin Humboldtmühle, Klinik für Neurologie, Berlin, Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt-Edifici M2, Girona, Spain
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven - University of Leuven, Experimental Neurology, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, UK
| | | | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Iris Lettow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt-Edifici M2, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bani-Sadr A, Mechtouff L, Bourguignon CD, Mauffrey A, Boutelier T, Cho TH, Cappucci M, Ameli R, Hermier M, Derex L, Nighoghossian N, Berthezene Y. Brain-blood barrier permeability and kinetics of inflammatory markers in acute stroke patients treated by thrombectomy. J Neuroradiol 2023. [DOI: 10.1016/j.neurad.2023.01.055] [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: 03/02/2023]
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Bani-Sadr A, Pavie D, Mechtouff L, Cappucci M, Hermier M, Ameli R, Derex L, De Bourguignon C, Cho TH, Eker O, Nighoghossian N, Berthezene Y. Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy. Eur Radiol 2023; 33:4502-4509. [PMID: 36633674 DOI: 10.1007/s00330-022-09387-x] [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: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the relationships between brush sign and cerebral collateral status on infarct growth after successful thrombectomy. METHODS HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated with thrombectomy after MRI triage and undergoing a day-6 MRI including FLAIR images to quantify final infarct volume (FIV). Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score ≥ 2B. Infarct growth was calculated by subtracting FIV from baseline ischemic core after co-registration and considered large (LIG) when > 11.6 mL. Brush sign was assessed on T2*-weighted-imaging and collaterals were assessed using the hypoperfusion intensity ratio, which is the volume of Time-To-Tmax (Tmax) ≥ 10 s divided by the volume of Tmax ≥ 6 s. Good collaterals were defined by a hypoperfusion intensity ratio < 0.4. RESULTS One hundred and twenty-nine patients were included, of whom 45 (34.9%) had a brush sign and 63 (48.8%) good collaterals. Brush sign was associated with greater infarct growth (p = 0.01) and larger FIV (p = 0.02). Good collaterals were associated with a smaller baseline ischemic core (p < 0.001), larger penumbra (p = 0.04), and smaller FIV (p < 0.001). Collateral status was not significantly associated with brush sign (p = 0.20) or with infarct growth (p = 0.67). Twenty-eight (22.5%) patients experienced LIG. Univariate regressions indicated that brush sign (odds ratio (OR) = 4.8; 95% confidence interval (CI): [1.9;13.3]; p = 0.004) and hemorrhagic transformation (OR = 1.7; 95%CI: [1.2;2.6]; p = 0.04) were predictive of LIG. In multivariate regression, only the brush sign remained predictive of LIG (OR = 5.2; 95%CI: [1.8-16.6], p = 0.006). CONCLUSIONS Brush sign is a predictor of LIG after successful thrombectomy and cerebral collateral status is not. KEY POINTS • Few predictors of ischemic growth are known in ischemic stroke patients achieving successful mechanical thrombectomy. • Our results suggest that the brush sign-a surrogate marker of severe hypoperfusion-is independently associated with large ischemic growth (> 11.6 mL) after successful thrombectomy whereas cerebral collateral status does not.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France. .,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France.
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Matteo Cappucci
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,Research On Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University. Domaine Rockfeller, 8 Avenue Rockfeller, 69373 Cedex 08, Lyon, France
| | | | - Tae-Hee Cho
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Omer Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
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Mechtouff L, Debs N, Frindel C, Bani-Sadr A, Bochaton T, Paccalet A, Crola Da Silva C, Buisson M, Amaz C, Berthezene Y, Eker OF, Bouin M, de Bourguignon C, Mewton N, Ovize M, Bidaux G, Nighoghossian N, Cho TH. Association of Blood Biomarkers of Inflammation With Penumbra Consumption After Mechanical Thrombectomy in Patients With Acute Ischemic Stroke. Neurology 2022; 99:e2063-e2071. [PMID: 36316128 DOI: 10.1212/wnl.0000000000201038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to assess the relationship between blood biomarkers of inflammation and lesion growth within the penumbra in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). METHODS The HIBISCUS-STROKE cohort enrolled patients admitted in the Lyon Stroke Center for an anterior circulation AIS treated with MT after brain MRI assessment. Lesion growth within the penumbra was assessed on day 6 MRI using a voxel-based nonlinear coregistration method and dichotomized into low and high according to the median value. C-reactive protein, interleukin (IL)-6, IL-8, IL-10, monocyte chemoattractant protein-1, soluble tumor necrosis factor receptor I, soluble form suppression of tumorigenicity 2 (sST2), soluble P-selectin, vascular cellular adhesion molecule-1, and matrix metalloproteinase-9 were measured in sera at 4 time points within the first 48 hours. Reperfusion was considered as successful if Thrombolysis in Cerebral Infarction score was 2b/2c/3. A multiple logistic regression model was performed to detect any association between area under the curve (AUC) of these biomarkers within the first 48 hours and a high lesion growth within the penumbra. RESULTS Ninety patients were included. The median lesion growth within the penumbra was 2.3 (0.7-6.2) mL. On multivariable analysis, a high sST2 AUC (OR 3.77, 95% CI 1.36-10.46), a high baseline DWI volume (OR 3.65, 95% CI 1.32-10.12), and a lack of successful reperfusion (OR 0.19, 95% CI 0.04-0.92) were associated with a high lesion growth within the penumbra. When restricting analyses to patients with successful reperfusion (n = 76), a high sST2 AUC (OR 5.03, 95% CI 1.64-15.40), a high baseline DWI volume (OR 3.74, 95% CI 1.22-11.53), and a high penumbra volume (OR 3.25, 95% CI 1.10-9.57) remained associated with a high lesion growth within the penumbra. DISCUSSION High sST2 levels within the first 48 hours are associated with a high lesion growth within the penumbra.
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Affiliation(s)
- Laura Mechtouff
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France.
| | - Noelie Debs
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Carole Frindel
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Alexandre Bani-Sadr
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Thomas Bochaton
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Alexandre Paccalet
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Claire Crola Da Silva
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Marielle Buisson
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Camille Amaz
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Yves Berthezene
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Omer Faruk Eker
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Morgane Bouin
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Charles de Bourguignon
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Nathan Mewton
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Michel Ovize
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Gabriel Bidaux
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Norbert Nighoghossian
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Tae-Hee Cho
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
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14
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Peter-Derex L, Philippeau F, Garnier P, André-Obadia N, Boulogne S, Catenoix H, Convers P, Mazzola L, Gouttard M, Esteban M, Fontaine J, Mechtouff L, Ong E, Cho TH, Nighoghossian N, Perreton N, Termoz A, Haesebaert J, Schott AM, Rabilloud M, Pivot C, Dhelens C, Filip A, Berthezène Y, Rheims S, Boutitie F, Derex L. Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2022; 21:781-791. [PMID: 35963261 DOI: 10.1016/s1474-4422(22)00235-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/22/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The incidence of early seizures (occurring within 7 days of stroke onset) after intracerebral haemorrhage reaches 30% when subclinical seizures are diagnosed by continuous EEG. Early seizures might be associated with haematoma expansion and worse neurological outcomes. Current guidelines do not recommend prophylactic antiseizure treatment in this setting. We aimed to assess whether prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral haemorrhage. METHODS The double-blind, randomised, placebo-controlled, phase 3 PEACH trial was conducted at three stroke units in France. Patients (aged 18 years or older) who presented with a non-traumatic intracerebral haemorrhage within 24 h after onset were randomly assigned (1:1) to levetiracetam (intravenous 500 mg every 12 h) or matching placebo. Randomisation was done with a web-based system and stratified by centre and National Institutes of Health Stroke Scale (NIHSS) score at baseline. Treatment was continued for 6 weeks. Continuous EEG was started within 24 h after inclusion and recorded over 48 h. The primary endpoint was the occurrence of at least one clinical seizure within 72 h of inclusion or at least one electrographic seizure recorded on continuous EEG, analysed in the modified intention-to-treat population, which comprised all patients who were randomly assigned to treatment and who had a continuous EEG performed. This trial was registered at ClinicalTrials.gov, NCT02631759, and is now closed. Recruitment was prematurely stopped after 48% of the recruitment target was reached due to a low recruitment rate and cessation of funding. FINDINGS Between June 1, 2017, and April 14, 2020, 50 patients with mild-to-moderate severity intracerebral haemorrhage were included: 24 were assigned to levetiracetam and 26 to placebo. During the first 72 h, a clinical or electrographic seizure was observed in three (16%) of 19 patients in the levetiracetam group versus ten (43%) of 23 patients in the placebo group (odds ratio 0·16, 95% CI 0·03-0·94, p=0·043). All seizures in the first 72 h were electrographic seizures only. No difference in depression or anxiety reporting was observed between the groups at 1 month or 3 months. Depression was recorded in three (13%) patients who received levetiracetam versus four (15%) patients who received placebo, and anxiety was reported for two (8%) patients versus one (4%) patient. The most common treatment-emergent adverse events in the levetiracetam group versus the placebo group were headache (nine [39%] vs six [24%]), pain (three [13%] vs ten [40%]), and falls (seven [30%] vs four [16%]). The most frequent serious adverse events were neurological deterioration due to the intracerebral haemorrhage (one [4%] vs four [16%]) and severe pneumonia (two [9%] vs two [8%]). No treatment-related death was reported in either group. INTERPRETATION Levetiracetam might be effective in preventing acute seizures in intracerebral haemorrhage. Larger studies are needed to determine whether seizure prophylaxis improves functional outcome in patients with intracerebral haemorrhage. FUNDING French Ministry of Health.
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Affiliation(s)
- Laure Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France.
| | - Frédéric Philippeau
- Stroke Unit, Department of Neurology, Fleyriat Hospital, Bourg en Bresse, France
| | - Pierre Garnier
- Stroke Centre, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nathalie André-Obadia
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Philippe Convers
- Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France; Clinical Neurophysiology Unit, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Laure Mazzola
- Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France; Clinical Neurophysiology Unit, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Michel Gouttard
- Stroke Unit, Department of Neurology, Fleyriat Hospital, Bourg en Bresse, France
| | - Maud Esteban
- Stroke Centre, Lyon University Hospital, Lyon, France
| | | | | | - Elodie Ong
- Stroke Centre, Lyon University Hospital, Lyon, France
| | - Tae-Hee Cho
- Stroke Centre, Lyon University Hospital, Lyon, France
| | | | - Nathalie Perreton
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne Termoz
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Julie Haesebaert
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne-Marie Schott
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Muriel Rabilloud
- Department of Biostatistics, Lyon University Hospital, Lyon, France; Biometry and Evolutionary Biology Laboratory, CNRS UMR 5558, Biostatistics Health Team, Villeurbanne, France
| | - Christine Pivot
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Carole Dhelens
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Andrea Filip
- Department of Neuroradiology, Neurological Hospital, Lyon University Hospital, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Neurological Hospital, Lyon University Hospital, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Florent Boutitie
- Department of Biostatistics, Lyon University Hospital, Lyon, France; Biometry and Evolutionary Biology Laboratory, CNRS UMR 5558, Biostatistics Health Team, Villeurbanne, France
| | - Laurent Derex
- Stroke Centre, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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15
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Seners P, Arquizan C, Fontaine L, Ben Hassen W, Heldner MR, Strambo D, Nagel S, Carrera E, Mechtouff L, McCullough-Hicks M, Mohammaden MH, Cottier JP, Henon H, Aignatoaie A, Laksiri N, Papassin J, Lucas L, Garnier P, Triquenot A, Mione G, Hajdu S, Costalat V, Potreck A, Detante O, Bonneville F, Berthezene Y, Bracard S, Sibon I, Bricout N, Boutet C, Mordasini P, Michel P, Oppenheim C, Olivot JM, Nogueira RG, Albers GW, Baron JC, Turc G, Cognard C, Marnat G, Menegon P, Ledure S, Dargazanli C, Cho TH, Nighoghossian N, Eker O, Gouttard S, Haussen D, Debiais S, Charron V, Charron N, Leys D, Ozsancak C, Delpech M, Brunel H, Papagiannaki C, Girardin E, Richard S, Gory B, Zbinden M, Dobrocky T, Ringelb P, Möhlenbruch M. Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion. Stroke 2022; 53:3429-3438. [DOI: 10.1161/strokeaha.122.039182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with large vessel occlusion is unknown. Perfusion imaging may identify subsets of large vessel occlusion–related minor stroke patients with distinct response to bridging therapy.
METHODS:
We conducted a multicenter international observational study of consecutive IVT-treated patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) who had an anterior circulation large vessel occlusion and perfusion imaging performed before IVT, with a subset undergoing immediate thrombectomy. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month modified Rankin Scale score 0 to 1. We searched for an interaction between treatment group and mismatch volume (critical hypoperfusion–core volume).
RESULTS:
Overall, 569 patients were included (172 and 397 in the bridging therapy and IVT groups, respectively). After propensity-score weighting, the distribution of baseline variables was similar across the 2 groups. In the entire population, bridging was associated with lower odds of achieving modified Rankin Scale score 0 to 1: odds ratio, 0.73 [95% CI, 0.55–0.96];
P
=0.03. However, mismatch volume modified the effect of bridging on clinical outcome (
P
interaction
=0.04 for continuous mismatch volume); bridging was associated with worse outcome in patients with, but not in those without, mismatch volume <40 mL (odds ratio, [95% CI] for modified Rankin Scale score 0–1: 0.48 [0.33–0.71] versus 1.14 [0.76–1.71], respectively). Bridging was associated with higher incidence of symptomatic intracranial hemorrhage in the entire population, but this effect was present in the small mismatch subset only (
P
interaction
=0.002).
CONCLUSIONS:
In our population of large vessel occlusion-related minor stroke patients, bridging therapy was associated with lower rates of good outcome as compared with IVT alone. However, mismatch volume was a strong modifier of the effect of bridging therapy over IVT alone, notably with worse outcome with bridging therapy in patients with mismatch volume ≤40 mL. Randomized trials should consider adding perfusion imaging for patient selection.
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Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM U1266, FHU NeuroVasc, France (P.S., J.-C.B., G.T.)
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France (P.S.)
| | - Caroline Arquizan
- Neurology Department, CHRU Gui de Chauliac, Montpellier, France (C.A.)
| | - Louis Fontaine
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (L.F., J.-M.O.)
| | - Wagih Ben Hassen
- Radiology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc,France (W.B.H., C.O.)
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (M.R.H.)
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switerland (D.S., S.H., P. Michel)
| | - Simon Nagel
- Neurology Department, Heidelberg University Hospital, Germany (S.N.)
- Klinikum Ludwigshafen am Rhein gGmbH, Germany (S.N.)
| | - Emmanuel Carrera
- Neurology Department, Geneve University Hospital, Switzerland (E.C.)
| | | | | | - Mahmoud H. Mohammaden
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine, Atlanta, GA (M.H.M., R.G.N.)
| | | | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (H.H.)
| | | | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France (N.L.)
| | - Jérémie Papassin
- Neurology Department, Stroke Unit, CHU Grenoble Alpes, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, France (J.P., O.D., I.S.)
| | - Ludovic Lucas
- Stroke Unit, Bordeaux University Hospital, France (L.L.)
| | - Pierre Garnier
- Neurology Department, St Etienne University Hospital, France (P.G.)
| | - Aude Triquenot
- Neurology Department, Rouen University Hospital, France (A.T.)
| | - Gioia Mione
- Neurology Department, Nancy University Hospital, France (G.M.)
| | - Steven Hajdu
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switerland (D.S., S.H., P. Michel)
| | - Vincent Costalat
- Radiology Department, CHRU Gui de Chauliac, Montpellier, France (V.C.)
| | - Arne Potreck
- Neuroradiology Department, Heidelberg University Hospital, Germany (A.P.)
| | - Olivier Detante
- Neurology Department, Stroke Unit, CHU Grenoble Alpes, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, France (J.P., O.D., I.S.)
| | - Fabrice Bonneville
- Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, France (F.B.)
| | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, France (Y.B.)
| | - Serge Bracard
- Neuroradiology Department, Nancy University Hospital, France (S.B.)
| | - Igor Sibon
- Neurology Department, Stroke Unit, CHU Grenoble Alpes, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, France (J.P., O.D., I.S.)
| | | | - Claire Boutet
- Radiology Department, St Etienne University Hospital, France (C.B.)
| | - Pasquale Mordasini
- Neuroradiology Department, Inselspital, University Hospital and University of Bern, Switzerland (P. Mordasini)
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switerland (D.S., S.H., P. Michel)
| | - Catherine Oppenheim
- Radiology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc,France (W.B.H., C.O.)
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (L.F., J.-M.O.)
| | - Raul G. Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine, Atlanta, GA (M.H.M., R.G.N.)
| | | | - Jean-Claude Baron
- Neurology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM U1266, FHU NeuroVasc, France (P.S., J.-C.B., G.T.)
| | - Guillaume Turc
- Neurology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM U1266, FHU NeuroVasc, France (P.S., J.-C.B., G.T.)
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16
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Hatami N, Cho TH, Mechtouff L, Eker OF, Rousseau D, Frindel C. CNN-LSTM Based Multimodal MRI and Clinical Data Fusion for Predicting Functional Outcome in Stroke Patients. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:3430-3434. [PMID: 36085793 DOI: 10.1109/embc48229.2022.9871735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Clinical outcome prediction plays an important role in stroke patient management. From a machine learning point-of-view, one of the main challenges is dealing with heterogeneous data at patient admission, i.e. the image data which are multidimensional and the clinical data which are scalars. In this paper, a multimodal convolutional neural network - long short-term memory (CNN-LSTM) based ensemble model is proposed. For each MR image module, a dedicated network provides preliminary prediction of the clinical outcome using the modified Rankin scale (mRS). The final mRS score is obtained by merging the preliminary probabilities of each module dedicated to a specific type of MR image weighted by the clinical metadata, here age or the National Institutes of Health Stroke Scale (NIHSS). The experimental results demonstrate that the proposed model surpasses the baselines and offers an original way to automatically encode the spatio-temporal context of MR images in a deep learning architecture. The highest AUC (0.77) was achieved for the proposed model with NIHSS. Clinical Relevance- - We present the first deep learning approach predicting the clinical outcome of stroke patients treated by mechanical thrombectomy which integrates imaging data at the voxel level with key clinical metadata. Combining clinical and imaging data to evaluate the potential benefit from therapy closely mirrors the clinical decision process. Our promising results suggest our predictive model could assist in acute stroke management.
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17
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Rascle L, Nighoghossian N, Cho TH, Bochaton T, Paccalet A, Da Silva CC, Buisson M, Amaz C, Fontaine J, Ong E, Derex L, Berthezene Y, Eker OF, Mewton N, Ovize M, Mechtouff L. Inflammatory profile and white matter hyperintensity burden in acute ischemic stroke patients. J Neuroimmunol 2022; 371:577934. [DOI: 10.1016/j.jneuroim.2022.577934] [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] [Received: 03/29/2022] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
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18
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Bochaton T, Leboube S, Paccalet A, Crola Da Silva C, Buisson M, Mewton N, Amaz C, Varillon Y, Bonnefoy-Cudraz E, Rioufol G, Cho TH, Ovize M, Bidaux G, Nighoghossian N, Mechtouff L. Impact of Age on Systemic Inflammatory Profile of Patients With ST-Segment-Elevation Myocardial Infarction and Acute Ischemic Stroke. Stroke 2022; 53:2249-2259. [PMID: 35354295 DOI: 10.1161/strokeaha.121.036806] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aging is associated with a chronic low-grade inflammatory state. This condition may affect the acute inflammatory response involved in ST-segment-elevation myocardial infarction (STEMI) or acute ischemic stroke (AIS). We sought to compare the profile of a set of circulating inflammatory markers between young and older patients admitted for STEMI or AIS. METHODS HIBISCUS-STEMI (Cohort of Patients to Identify Biological and Imaging Markers of Cardiovascular Outcomes in ST Elevation Myocardial Infarction) and HIBISCUS-STROKE (Cohort of Patients to Identify Biological and Imaging Markers of Cardiovascular Outcomes in Stroke) are 2 cohort studies that enrolled patients with STEMI treated with primary percutaneous coronary intervention in the cardiac intensive care unit of Lyon and patients with AIS treated with mechanical thrombectomy in the Lyon Stroke Center, respectively from 2016 to 2019. Patients were classified as older if they were ≥65 years and as young if they were <65 years. In both cohorts, CRP (C-reactive protein), IL (interleukin)-6, IL-8, IL-10, MCP (monocyte chemoattractant protein), sTNF-RI (soluble tumor necrosis factor receptor I), sST2 (soluble form suppression of tumorigenicity 2), and VCAM-1 (vascular cellular adhesion molecule-1) were measured on serum collected at 5 time points using enzyme-linked immunosorbent assay. A multiple logistic regression model was performed to detect an association between area under the curve of circulating inflammatory markers within the first 48 hours and older age. RESULTS A total of 260 patients with STEMI and 164 patients with AIS were included. Of them, there were 76 (29%) and 105 (64%) older patients with STEMI and AIS, respectively. Following multivariable analysis, a high area under the curve of IL-6 and sTNF-RI, a low lymphocyte count, and a high neutrophil-lymphocyte ratio at 24 hours were associated with older age in patients with STEMI and AIS. CONCLUSIONS Older patients had higher IL-6 and sTFN-RI levels within the first 48 hours associated with a lower lymphocyte count and a higher neutrophil-lymphocyte ratio at 24 hours in both cohorts.
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Affiliation(s)
- Thomas Bochaton
- Cardiac Intensive Care Unit (T.B., E.B.-C.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Simon Leboube
- Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Alexandre Paccalet
- Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Claire Crola Da Silva
- Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407 (M.B., N.M., C.A., Y.V., M.O.)
| | - Nathan Mewton
- Clinical Investigation Center, INSERM 1407 (M.B., N.M., C.A., Y.V., M.O.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407 (M.B., N.M., C.A., Y.V., M.O.)
| | - Yvonne Varillon
- Clinical Investigation Center, INSERM 1407 (M.B., N.M., C.A., Y.V., M.O.)
| | - Eric Bonnefoy-Cudraz
- Cardiac Intensive Care Unit (T.B., E.B.-C.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Gilles Rioufol
- Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Tae-Hee Cho
- Louis Pradel Hospital, Stroke Center, Hôpital Pierre Wertheimer (T.-H.C., N.N., L.M.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Michel Ovize
- Clinical Investigation Center, INSERM 1407 (M.B., N.M., C.A., Y.V., M.O.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Gabriel Bidaux
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude-Bernard University, F-69500 Bron, France (G.R.)
| | - Norbert Nighoghossian
- Louis Pradel Hospital, Stroke Center, Hôpital Pierre Wertheimer (T.-H.C., N.N., L.M.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
| | - Laura Mechtouff
- Louis Pradel Hospital, Stroke Center, Hôpital Pierre Wertheimer (T.-H.C., N.N., L.M.).,Hospices Civils de Lyon, F-69500 Bron, France. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500 Bron, France (T.B., S.L., A.P., C.C.D.S., N.M., E.B.-C., T.-H.C., M.O., G.B., N.N., L.M.)
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19
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Chalet L, Boutelier T, Christen T, Raguenes D, Debatisse J, Eker OF, Becker G, Nighoghossian N, Cho TH, Canet-Soulas E, Mechtouff L. Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy. Front Cardiovasc Med 2022; 9:861913. [PMID: 35355966 PMCID: PMC8959629 DOI: 10.3389/fcvm.2022.861913] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 01/01/2023] Open
Abstract
The ischemic penumbra is defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core. Early reperfusion aims to save the ischemic penumbra by preventing infarct core expansion and is the mainstay of acute ischemic stroke therapy. Intravenous thrombolysis and mechanical thrombectomy for selected patients with large vessel occlusion has been shown to improve functional outcome. Given the varying speed of infarct core progression among individuals, a therapeutic window tailored to each patient has recently been proposed. Recent studies have demonstrated that reperfusion therapies are beneficial in patients with a persistent ischemic penumbra, beyond conventional time windows. As a result, mapping the penumbra has become crucial in emergency settings for guiding personalized therapy. The penumbra was first characterized as an area with a reduced cerebral blood flow, increased oxygen extraction fraction and preserved cerebral metabolic rate of oxygen using positron emission tomography (PET) with radiolabeled O2. Because this imaging method is not feasible in an acute clinical setting, the magnetic resonance imaging (MRI) mismatch between perfusion-weighted imaging and diffusion-weighted imaging, as well as computed tomography perfusion have been proposed as surrogate markers to identify the penumbra in acute ischemic stroke patients. Transversal studies comparing PET and MRI or using longitudinal assessment of a limited sample of patients have been used to define perfusion thresholds. However, in the era of mechanical thrombectomy, these thresholds are debatable. Using various MRI methods, the original penumbra definition has recently gained a significant interest. The aim of this review is to provide an overview of the evolution of the ischemic penumbra imaging methods, including their respective strengths and limitations, as well as to map the current intellectual structure of the field using bibliometric analysis and explore future directions.
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Affiliation(s)
- Lucie Chalet
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Olea Medical, La Ciotat, France
| | | | - Thomas Christen
- Grenoble Institut Neurosciences, INSERM, U1216, Univ. Grenoble Alpes, Grenoble, France
| | | | - Justine Debatisse
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Omer Faruk Eker
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, Villeurbanne, France
- Neuroradiology Department, Hospices Civils of Lyon, Lyon, France
| | - Guillaume Becker
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stroke Department, Hospices Civils of Lyon, Lyon, France
| | - Tae-Hee Cho
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stroke Department, Hospices Civils of Lyon, Lyon, France
| | - Emmanuelle Canet-Soulas
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laura Mechtouff
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stroke Department, Hospices Civils of Lyon, Lyon, France
- *Correspondence: Laura Mechtouff
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20
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Rascle L, Bani Sadr A, Amaz C, Mewton N, Buisson M, Hermier M, Ong E, Fontaine J, Derex L, Berthezène Y, Eker OF, Cho TH, Nighoghossian N, Mechtouff L. Does the Brush-Sign Reflect Collateral Status and DWI-ASPECTS in Large Vessel Occlusion? Front Neurol 2022; 13:828256. [PMID: 35309551 PMCID: PMC8924293 DOI: 10.3389/fneur.2022.828256] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The relevance of the brush-sign remained poorly documented in large vessel occlusion (LVO). We aimed to assess the relationship between the brush-sign and collateral status and its potential impact on baseline diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) in acute ischemic stroke (AIS) patients eligible to mechanical thrombectomy (MT). Methods Consecutive patients admitted in the Lyon Stroke Center with anterior circulation AIS due to intracranial internal carotid artery (ICA) and/or M1 or M2 segment of the middle cerebral artery (MCA) occlusion eligible for MT were included. The brush-sign was assessed on T2-gradient-echo MRI. Collateral status was assessed on digital subtraction angiography according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score. Results In this study, 504 patients were included, among which 171 (33.9%) patients had a brush-sign. Patients with a brush-sign more frequently had a poor collateral status [72 (42.1%) vs. 103 (30.9%); p = 0.017]. In univariable analysis, a DWI-ASPECTS < 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS < 7 while the latter remained associated with younger age [odds ratio (OR) 0.97, 95% CI.96–0.99], male sex (OR 1.79, 95% CI 1.08–2.99), a higher National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, 95% CI 1.1–1.21), a poor collateral status (OR 9.35, 95% CI 5.59-16.02), MCA segment (OR 2.54, 95% CI 1.25–5.38), and intracranial ICA (OR 3.01, 95% CI 1.16–8) occlusion. Conclusions and Relevance The brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT04620642.
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Affiliation(s)
- Lucie Rascle
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | | | - Camille Amaz
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Nathan Mewton
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Marc Hermier
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Elodie Ong
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
- *Correspondence: Laura Mechtouff
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21
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Bani-Sadr A, Cho TH, Cappucci M, Hermier M, Ameli R, Filip A, De Bourguignon C, Riva R, Derex L, Mechtouff L, Eker O, Nighoghossian N, Berthezène Y. Évaluation des logiciels de perfusion irm dans la prédiction du volume final de l'infarctus après thrombectomie mécanique. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Schlemm L, Braemswig TB, Boutitie F, Vynckier J, Jensen M, Galinovic I, Simonsen CZ, Cheng B, Cho TH, Fiehler J, Puig J, Thijs V, Fiebach J, Muir K, Nighoghossian N, Ebinger M, Pedraza S, Thomalla G, Gerloff C, Endres M, Lemmens R, Nolte CH. Cerebral Microbleeds and Treatment Effect of Intravenous Thrombolysis in Acute Stroke: An Analysis of the WAKE-UP Randomized Clinical Trial. Neurology 2021; 98:e302-e314. [PMID: 34782419 PMCID: PMC8792812 DOI: 10.1212/wnl.0000000000013055] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Cerebral microbleeds (CMBs) are common in patients with acute ischemic stroke and are associated with increased risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis. Whether CMBs modify the treatment effect of thrombolysis is unknown. Methods We performed a prespecified analysis of the prospective randomized controlled multicenter Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial including patients with acute ischemic stroke with unknown time of symptom onset and diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch on MRI receiving alteplase or placebo. Patients were screened and enrolled between September 2012 and June 2017 (with final follow-up in September 2017). Patients were randomized to treatment with IV thrombolysis with alteplase at 0.9 mg/kg body weight or placebo. CMB status (presence, number, and distribution) was assessed after study completion by 3 raters blinded to clinical information following a standardized protocol. Outcome measures were excellent functional outcome at 90 days, defined by modified Rankin Scale (mRS) score ≤1, and symptomatic ICH according to National Institutes of Neurological Disease and Stroke trial criteria 22 to 36 hours after treatment. Results Of 503 patients enrolled in the WAKE-UP trial, 459 (91.3%; 288 [63%] men) were available for analysis. Ninety-eight (21.4%) had at least 1 CMB on baseline imaging; 45 (9.8%) had exactly 1 CMB; 37 (8.1%) had 2 to 4 CMBs; and 16 (3.5%) had ≥5 CMBs. Presence of CMBs was associated with a nonsignificant increased risk of symptomatic ICH (11.2% vs 4.2%; adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 0.99–5.43, p = 0.052) but had no effect on functional outcome at 90 days (mRS score ≤1: 45.8% vs 50.7%; adjusted OR 0.99, 95% CI 0.59–1.64, p = 0.955). Patients receiving alteplase had better functional outcome (mRS score ≤1: 54.6% vs 44.6%, adjusted OR 1.61, 95% CI 1.07–2.43, p = 0.022) without evidence of heterogeneity in relation to CMB presence (p of the interactive term = 0.546). Results were similar for subpopulations with strictly lobar (presumed cerebral amyloid angiopathy related) or not strictly lobar CMB distribution. Discussion In the randomized-controlled WAKE-UP trial, we saw no evidence of reduced treatment effect of alteplase in patients with acute ischemic stroke with ≥1 CMBs. Additional studies are needed to determine the treatment effect of alteplase and its benefit-harm ratio in patients with a larger number of CMBs. Trial Registration Information ClinicalTrials.gov identifier NCT01525290; ClinicalTrialsRegister.EU identifier 2011-005906-32. Classification of Evidence This study provides Class II evidence that for patients with acute ischemic stroke with unknown time of onset and diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch who received IV alteplase, CMBs are not significantly associated with functional outcome at 90 days.
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Affiliation(s)
- Ludwig Schlemm
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Tim Bastian Braemswig
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Jan Vynckier
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon, Lyon, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Jochen Fiebach
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
| | - Keith Muir
- Institute of Neuroscience and, University of Glasgow, Glasgow, United Kingdom
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon, Lyon, France
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Salvador Pedraza
- Department of Radiology, Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium.,VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany .,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
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23
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Mechtouff L, Paccalet A, Crola Da Silva C, Buisson M, Mewton N, Amaz C, Bonnefoy-Cudraz E, Leboube S, Cho TH, Nighoghossian N, Ovize M, Bochaton T. Prognosis value of serum soluble ST2 level in acute ischemic stroke and STEMI patients in the era of mechanical reperfusion therapy. J Neurol 2021; 269:2641-2648. [PMID: 34694426 DOI: 10.1007/s00415-021-10865-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Soluble form suppression of tumorigenicity 2 (sST2) is known to have prognostic value in ST-elevation myocardial infarction (STEMI) and could impact mortality after acute ischemic stroke (AIS). However, before considering sST2 as a therapeutic target, the kinetics of release and its association with adverse clinical events in both STEMI and AIS patients have to be determined. METHODS We prospectively enrolled 251 STEMI patients, treated with primary percutaneous coronary intervention, and 152 AIS patients treated with mechanical thrombectomy. We evaluated the level of sST2 in patient sera at five time point (admission, 4, 24, 48 h and 1 month from admission for STEMI patients and admission, 6, 24, 48 h and 3 months from admission for AIS patients). Major adverse clinical events (MACE) (all-cause death, acute myocardial infarction, stroke or hospitalization for heart failure) in STEMI patients and all-cause death in AIS patients were recorded during a 12-month follow-up. RESULTS Mean age of the study population was 59 ± 12 and 69 ± 15 years in STEMI and AIS patients, respectively. In STEMI patients, sST2 peaked 24 h after admission (25.5 ng/mL interquartile range (IQR) [14.9-29.1]) whereas an earlier and lower peak was observed in AIS patients (16.8 ng/mL IQR [15.2-18.3] at 6 h). Twenty-five (10.0%) STEMI patients experienced a MACE and 12 (7.9%) AIS patients had all-cause death within the first 12 months. A high level of sST2 at 24 h was associated with MACE in STEMI patients (hazard ratio (HR) = 2.5; 95% confidence interval (CI) [1.1-5.6], p = 0.03) and all-cause death in AIS patients (HR = 11.7; 95% CI [3.8-36.2], p < 0.01) within the first 12 months. CONCLUSIONS The study highlights that sST2 levels at 24 h are associated with an increased risk to adverse clinical events in both diseases.
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Affiliation(s)
- Laura Mechtouff
- Stroke Center, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France.
| | - Alexandre Paccalet
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
| | - Claire Crola Da Silva
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
| | - Marielle Buisson
- Centre d'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Nathan Mewton
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
- Centre d'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Camille Amaz
- Centre d'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Eric Bonnefoy-Cudraz
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Simon Leboube
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
- Service d'explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Tae-Hee Cho
- Stroke Center, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
| | - Norbert Nighoghossian
- Stroke Center, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
| | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
- Centre d'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
- Service d'explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Thomas Bochaton
- CarMeN Laboratory, INSERM U1060, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
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24
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Malherbe C, Cheng B, Königsberg A, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Puig J, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Wouters A, Gerloff C, Hilgetag CC, Thomalla G. Game-theoretical mapping of fundamental brain functions based on lesion deficits in acute stroke. Brain Commun 2021; 3:fcab204. [PMID: 34585140 PMCID: PMC8473841 DOI: 10.1093/braincomms/fcab204] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/21/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022] Open
Abstract
Lesion analysis is a fundamental and classical approach for inferring the causal contributions of brain regions to brain function. However, many studies have been limited by the shortcomings of methodology or clinical data. Aiming to overcome these limitations, we here use an objective multivariate approach based on game theory, Multi-perturbation Shapley value Analysis, in conjunction with data from a large cohort of 394 acute stroke patients, to derive causal contributions of brain regions to four principal functional components of the widely used National Institutes of Health Stroke Score measure. The analysis was based on a high-resolution parcellation of the brain into 294 grey and white matter regions. Through initial lesion symptom mapping for identifying all potential candidate regions and repeated iterations of the game-theoretical approach to remove non-significant contributions, the analysis derived the smallest sets of regions contributing to each of the four principal functional components as well as functional interactions among the regions. Specifically, the factor 'language and consciousness' was related to contributions of cortical regions in the left hemisphere, including the prefrontal gyrus, the middle frontal gyrus, the ventromedial putamen and the inferior frontal gyrus. Right and left motor functions were associated with contributions of the left and right dorsolateral putamen and the posterior limb of the internal capsule, correspondingly. Moreover, the superior corona radiata and the paracentral lobe of the right hemisphere as well as the right caudal area 23 of the cingulate gyrus were mainly related to left motor function, while the prefrontal gyrus, the external capsule and the sagittal stratum fasciculi of the left hemisphere contributed to right motor function. Our approach demonstrates a practically feasible strategy for applying an objective lesion inference method to a high-resolution map of the human brain and distilling a small, characteristic set of grey and white matter structures contributing to fundamental brain functions. In addition, we present novel findings of synergistic interactions between brain regions that provide insight into the functional organization of brain networks.
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Affiliation(s)
- Caroline Malherbe
- University Medical Center Hamburg-Eppendorf, Institute of Computational Neuroscience, Hamburg, Germany.,Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Königsberg
- Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tae-Hee Cho
- Neurology, Université Claude Bernard Lyon 1, Lyon, France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité, Universitätsmedizin Berlin, Berlin, Germany.,Medical Park Berlin Humboldtmühle, 13507 Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Vincent Thijs
- Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Robin Lemmens
- Neurology, UZ Leuven, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | | | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
| | - Anke Wouters
- Neurology, UZ Leuven, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Christian Gerloff
- Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus C Hilgetag
- University Medical Center Hamburg-Eppendorf, Institute of Computational Neuroscience, Hamburg, Germany.,Department of Health Sciences, Boston University, Boston, MA, USA
| | - Götz Thomalla
- Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Barow E, Boutitie F, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Nickel A, Puig J, Roy P, Lemmens R, Thijs V, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. 24-hour blood pressure variability and treatment effect of intravenous alteplase in acute ischaemic stroke. Eur Stroke J 2021; 6:168-175. [PMID: 34414292 DOI: 10.1177/23969873211014758] [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: 08/06/2020] [Accepted: 04/14/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction To assess the association between 24 h blood pressure variability (BPV) on functional outcome and treatment effect of intravenous alteplase in acute ischaemic stroke. Patients and methods In all patients with acute ischaemic stroke of unknown onset randomised in the WAKE-UP (Efficacy and Safety of magnetic resonance imaging [MRI]-based Thrombolysis in Wake-Up Stroke) trial, blood pressure (BP) was measured before randomisation and after initiation of treatment at regular intervals up to 24 hours. Individual BPV was measured by coefficient of variation (CV) of all BP values. Primary outcome measure was favourable outcome defined by a modified Rankin Scale (mRS) score 0 or 1 at 90 days after stroke. Results BP measurements were available for 498 of 503 patients randomised (177 women [35.5%], mean age [SD] of 65.2 [11.5] years). Systolic BPV was not associated with the treatment effect of thrombolysis (test for interaction, p = 0.46). The adjusted odds ratio (aOR) for favourable outcome with alteplase, adjusted for age, stroke severity and baseline BP on admission, did not show an association across the quintiles of increasing systolic BPV with an aOR 1.89 (95% confidence interval [CI], 0.76-4.70) in the lowest quintile to aOR 1.05 (95% CI, 0.43-2.56) in the highest quintile. Higher mean systolic BP was associated with a smaller treatment effect of thrombolysis with a significant interaction (p = 0.033). The aOR for favourable outcome with alteplase decreased with quintiles of increasing mean systolic BP from aOR 3.16 (95% CI, 1.26-7.93) in the lowest quintile to aOR 0.84 (95% CI, 0.34-2.10) in in the highest quintile. Conclusions There was a significant interaction between mean systolic BP and treatment effect of thrombolysis with higher mean systolic BP being associated with poorer outcome. BPV was not associated with outcome after thrombolysis.ClinicalTrials.gov identifier NCT01525290.
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Affiliation(s)
- Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Medical Park Berlin Humboldtmühle, Klinik für Neurologie, Berlin, Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Nickel
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, Girona, Spain
| | - Pascal Roy
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia.,Austin Health, Department of Neurology, Heidelberg, Australia
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, UK
| | | | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Königsberg A, DeMarco AT, Mayer C, Wouters A, Schlemm E, Ebinger M, Cho TH, Endres M, Fiebach JB, Fiehler J, Galinovic I, Puig J, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G, Cheng B. Influence of stroke infarct location on quality of life assessed in a multivariate lesion-symptom mapping study. Sci Rep 2021; 11:13490. [PMID: 34188114 PMCID: PMC8241844 DOI: 10.1038/s41598-021-92865-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.
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Affiliation(s)
- Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Andrew T DeMarco
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, USA
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anke Wouters
- Neurology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Neurologie der Rehaklinik Medical Park Humboldtmühle, An der Mühle 2-9, 13507, Berlin, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190, Salt, Girona, Spain
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, HeidelbergVictoria, VIC, 3084, Australia
- Department of Neurology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Oude Markt 13, Bus 5005, 3000, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Herestraat 49, Bus 602, 3000, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190, Salt, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, 8200, Aarhus, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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27
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Nighoghossian N, Cho TH, Mechtouff L. Lenin's Stroke. Case Rep Neurol 2021; 13:384-387. [PMID: 34248574 PMCID: PMC8255750 DOI: 10.1159/000515657] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Lenin's stroke remains a matter of debate. Here, we propose to assess the potential mechanisms. Lenin died on January 21, 1924 at the age of 53 years. Although some doctors suggested that the origin of his health problems was neurosyphilis, the autopsy findings were consistent with a severe atherosclerosis. This process might account for his recurrent ischemic strokes. In view of the family vascular history, an early hereditary atherosclerosis may be proposed.
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Affiliation(s)
- Norbert Nighoghossian
- Department of vascular neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U1060, INRA U1397, INSA de Lyon, Université Lyon 1, Bron, France
| | - Tae-Hee Cho
- Department of vascular neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U1060, INRA U1397, INSA de Lyon, Université Lyon 1, Bron, France
| | - Laura Mechtouff
- Department of vascular neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U1060, INRA U1397, INSA de Lyon, Université Lyon 1, Bron, France
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28
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Mechtouff L, Bochaton T, Paccalet A, Crola Da Silva C, Buisson M, Amaz C, Derex L, Ong E, Berthezene Y, Dufay N, Ovize M, Mewton N, Cho TH, Nighoghossian N, Eker OF. A lower admission level of interleukin-6 is associated with first-pass effect in ischemic stroke patients. J Neurointerv Surg 2021; 14:248-251. [PMID: 33883212 DOI: 10.1136/neurintsurg-2021-017334] [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: 01/17/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND First-pass effect (FPE) defined as a complete or near-complete reperfusion achieved after a single thrombectomy pass is predictive of favorable outcome in acute ischemic stroke (AIS) patients. We aimed to assess whether admission levels of inflammatory markers are associated with FPE. METHODS HIBISCUS-STROKE (CoHort of Patients to Identify Biological and Imaging markerS of CardiovascUlar Outcomes in Stroke) includes AIS patients with large vessel occlusion treated with mechanical thrombectomy following brain MRI. C-reactive protein, interleukin (IL)-6, IL-8, IL-10, monocyte chemoattractant protein-1, soluble tumor necrosis factor receptor I, soluble form suppression of tumorigenicity 2, matrix metalloproteinase-9 (MMP-9), soluble P-selectin, and vascular cellular adhesion molecule-1 were measured in admission sera using an ELISA assay. FPE was defined as a complete or near-complete reperfusion (thrombolysis in cerebral infarction scale (TICI) 2c or 3) after the first pass. A multivariate logistic regression analysis was performed to assess independent factors associated with FPE. RESULTS A total of 151 patients were included. Among them, 43 (28.5%) patients had FPE. FPE was associated with low admission levels of IL-6, MMP-9, and platelet count, an older age, lack of hypertension, lack of tandem occlusion, a shorter thrombus length, and a reduced procedural time. Following multivariate analysis, a low admission level of IL-6 was associated with FPE (OR 0.66, 95% CI 0.46 to 0.94). Optimal cut-off of IL-6 level for distinguishing FPE from non-FPE was 3.0 pg/mL (sensitivity 92.3%, specificity 42.3%). CONCLUSION A lower admission level of IL-6 is associated with FPE.
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Affiliation(s)
- Laura Mechtouff
- Stroke Department, Hospices Civils de Lyon, Lyon, France .,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Thomas Bochaton
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Cardiac Intensive Care Unit, Hospices Civils de Lyon, Lyon, France
| | | | | | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | - Elodie Ong
- Stroke Department, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | | | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Stroke Department, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Stroke Department, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Omer F Eker
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
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29
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Alhazmi H, Bani-Sadr A, Bochaton T, Paccalet A, Da Silva CC, Buisson M, Amaz C, Ameli R, Berthezene Y, Eker OF, Ovize M, Cho TH, Nighoghossian N, Mechtouff L. Large vessel cardioembolic stroke and embolic stroke of undetermined source share a common profile of matrix metalloproteinase-9 level and susceptibility vessel sign length. Eur J Neurol 2021; 28:1977-1983. [PMID: 33682255 DOI: 10.1111/ene.14806] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Embolic stroke of undetermined source (ESUS) accounts for up to 25% of ischemic strokes. Identification of biomarkers that could improve the prediction of stroke subtype and subsequently of stroke prevention still remains a major issue. METHODS The HIBISCUS-STROKE cohort includes ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. Presence and length of susceptibility vessel sign (SVS) were assessed by gradient-recalled echo T2*-weighted imaging. Matrix metalloproteinase-9 (MMP-9) was measured on sera collected at admission. A multiple logistic regression model was performed to detect independent markers distinguishing cardioembolic (CE) from large-artery atherosclerosis (LAA) subtype. RESULTS A total of 147 patients were included, of them the etiology was distributed as follows: 86 (58.5%) CE, 26 (17.7%) LAA, and 35 (23.8%) ESUS. The optimal cutoff for differentiating CE from LAA subtype was 14.5 mm for SVS length (sensitivity, 79.7%; specificity, 72.7%) and 1110 ng/ml for admission MMP-9 level (sensitivity, 85.3%; specificity, 52.2%). Multivariate analysis revealed that current smoking (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.01-0.93), tandem occlusion (OR 0.01, 95% CI 0.01-0.21), SVS length (OR 0.78, 95% CI 0.63-0.97), and admission MMP-9 level (OR 0.99, 95% CI 0.99-1.00) were inversely associated with CE subtype. SVS length and MMP-9 level did not differ between ESUS and CE subtypes. CONCLUSION SVS length and admission MMP-9 level may improve the prediction of CE subtype whose profile is close to ESUS, thus suggesting a common cardiac embolic source.
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Affiliation(s)
- Hanan Alhazmi
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Alexandre Bani-Sadr
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Alexandre Paccalet
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Claire Crola Da Silva
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Roxana Ameli
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Yves Berthezene
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Tae-Hee Cho
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
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30
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Debatisse J, Wateau O, Cho TH, Costes N, Mérida I, Léon C, Langlois JB, Taborik F, Verset M, Portier K, Aggour M, Troalen T, Villien M, Makris N, Tourvieille C, Bars DL, Lancelot S, Confais J, Oudotte A, Nighoghossian N, Ovize M, Vivien D, Contamin H, Agin V, Canet-Soulas E, Eker OF. A non-human primate model of stroke reproducing endovascular thrombectomy and allowing long-term imaging and neurological read-outs. J Cereb Blood Flow Metab 2021; 41:745-760. [PMID: 32428423 PMCID: PMC7983495 DOI: 10.1177/0271678x20921310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/19/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
Stroke is a devastating disease. Endovascular mechanical thrombectomy is dramatically changing the management of acute ischemic stroke, raising new challenges regarding brain outcome and opening up new avenues for brain protection. In this context, relevant experiment models are required for testing new therapies and addressing important questions about infarct progression despite successful recanalization, reversibility of ischemic lesions, blood-brain barrier disruption and reperfusion damage. Here, we developed a minimally invasive non-human primate model of cerebral ischemia (Macaca fascicularis) based on an endovascular transient occlusion and recanalization of the middle cerebral artery (MCA). We evaluated per-occlusion and post-recanalization impairment on PET-MRI, in addition to acute and chronic neuro-functional assessment. Voxel-based analyses between per-occlusion PET-MRI and day-7 MRI showed two different patterns of lesion evolution: "symptomatic salvaged tissue" (SST) and "asymptomatic infarcted tissue" (AIT). Extended SST was present in all cases. AIT, remote from the area at risk, represented 45% of the final lesion. This model also expresses both worsening of fine motor skills and dysexecutive behavior over the chronic post-stroke period, a result in agreement with cortical-subcortical lesions. We thus fully characterized an original translational model of ischemia-reperfusion damage after stroke, with consistent ischemia time, and thrombus retrieval for effective recanalization.
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Affiliation(s)
- Justine Debatisse
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Siemens-Healthcare SAS., Saint-Denis, France
| | - Océane Wateau
- Cynbiose SAS, Marcy-L’Etoile, France
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S 1237, “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen Normandie, GIP Cyceron, Caen, France
| | - Tae-Hee Cho
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât. Blaise Pascal, Villeurbanne, France
- Hospices Civils of Lyon, Lyon, France
| | | | | | - Christelle Léon
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | | | - Karine Portier
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Mohamed Aggour
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - Nikolaos Makris
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât. Blaise Pascal, Villeurbanne, France
| | | | - Didier Le Bars
- Hospices Civils of Lyon, Lyon, France
- CERMEP – Imagerie du Vivant, Lyon, France
| | - Sophie Lancelot
- Hospices Civils of Lyon, Lyon, France
- CERMEP – Imagerie du Vivant, Lyon, France
| | | | | | - Norbert Nighoghossian
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Michel Ovize
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Denis Vivien
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S 1237, “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen Normandie, GIP Cyceron, Caen, France
- Department of Clinical Research, Caen-Normandy Hospital, CHU Caen, Caen, France
| | | | - Véronique Agin
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S 1237, “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen Normandie, GIP Cyceron, Caen, France
| | - Emmanuelle Canet-Soulas
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Omer Faruk Eker
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât. Blaise Pascal, Villeurbanne, France
- Hospices Civils of Lyon, Lyon, France
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31
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Basalay MV, Wiart M, Chauveau F, Dumot C, Leon C, Amaz C, Bolbos R, Cash D, Kim E, Mechtouff L, Cho TH, Nighoghossian N, Davidson SM, Ovize M, Yellon DM. Abstract P752: Neuroprotection by Remote Ischemic Conditioning in the Setting of Acute Ischemic Stroke: A Preclinical Two-Centre International Study. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Currently, reperfusion is the only existing treatment strategy for patients with acute ischemic stroke. However, reperfusion may cause further brain damage. One of the feasible therapies targeting reperfusion injury is remote ischemic conditioning (RIC).
The main objective of this study was to test the neuroprotective effects of RIC in a rat model of acute ischemic stroke in a randomized and blinded two-centre MRI study with a priori sample size calculation
.
Methods:
Eighty male Sprague Dawley rats underwent 90-min middle cerebral artery occlusion. Multiparametric MRI was performed per-occlusion to ascertain focal cerebral ischemia (inclusion criteria) and to control interindividual variability in the analysis. RIC was started 10 min before reperfusion, and consisted of 4 cycles of 5-min left hind limb ischemia. The primary endpoint of the study was infarct size measured on T2-weighted MRI at 24h, corrected for edema, and
expressed as percentage of the area-at-risk of infarction
. Secondary endpoints were hemispheric space-modifying edema, infarct growth between per-occlusion and 24h MRI, and neurofunctional outcome measured by neuroscores.
Results:
Two animals died in each group. In total, 47 rats were included in the analysis after applying the pre-defined inclusion criteria (23 in control group and 24 in RIC group). Infarct size was significantly reduced in the RIC group (mean, interquartile range: 19% [8% ; 32%] vs control: 40% [17% ; 59%], p=0.028). This infarct-limiting effect was still statistically significant after adjustment for apparent diffusion coefficient (ADC) lesion size in multivariate analysis. In the subgroup of rats with ADC lesion > 100 mm3, infarct size reduced from 58% [40%; 66%] to 32% [27%; 40%], p=0.004. In line with this result, RIC significantly improved neuroscores (6 [3 ; 8] vs control: 9 [7 ; 11], p=0.032). The other secondary endpoints were not statistically different between groups.
Conclusions:
RIC in the setting of acute stroke in rats is safe, reduces infarct size and improves functional recovery in a two-centre international study using translational imaging endpoints.
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Affiliation(s)
| | - Marlene Wiart
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Lyon, France
| | - Fabien Chauveau
- Université Lyon, Lyon Neuroscience Rsch Cntr, CNRS UMR5292, Inserm U1028, Lyon, France
| | - Chloe Dumot
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Lyon, France
| | - Christelle Leon
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Cntr, CIC 1407, HCL, Louis Pradel Hosp, Lyon, France
| | | | - Diana Cash
- Dept of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, James Black Cntr, London, United Kingdom
| | - Eugene Kim
- Dept of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, James Black Cntr, London, United Kingdom
| | - Laura Mechtouff
- Stroke department, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Stroke department, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Stroke department, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | | | - Michel Ovize
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Lyon, France
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, London, United Kingdom
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32
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Debs N, Cho TH, Rousseau D, Berthezène Y, Buisson M, Eker O, Mechtouff L, Nighoghossian N, Ovize M, Frindel C. Impact of the reperfusion status for predicting the final stroke infarct using deep learning. Neuroimage Clin 2020; 29:102548. [PMID: 33450521 PMCID: PMC7810765 DOI: 10.1016/j.nicl.2020.102548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Predictive maps of the final infarct may help therapeutic decisions in acute ischemic stroke patients. Our objectives were to assess whether integrating the reperfusion status into deep learning models would improve their performance, and to compare them to current clinical prediction methods. METHODS We trained and tested convolutional neural networks (CNNs) to predict the final infarct in acute ischemic stroke patients treated by thrombectomy in our center. When training the CNNs, non-reperfused patients from a non-thrombectomized cohort were added to the training set to increase the size of this group. Baseline diffusion and perfusion-weighted magnetic resonance imaging (MRI) were used as inputs, and the lesion segmented on day-6 MRI served as the ground truth for the final infarct. The cohort was dichotomized into two subsets, reperfused and non-reperfused patients, from which reperfusion status specific CNNs were developed and compared to one another, and to the clinically-used perfusion-diffusion mismatch model. Evaluation metrics included the Dice similarity coefficient (DSC), precision, recall, volumetric similarity, Hausdorff distance and area-under-the-curve (AUC). RESULTS We analyzed 109 patients, including 35 without reperfusion. The highest DSC were achieved in both reperfused and non-reperfused patients (DSC = 0.44 ± 0.25 and 0.47 ± 0.17, respectively) when using the corresponding reperfusion status-specific CNN. CNN-based models achieved higher DSC and AUC values compared to those of perfusion-diffusion mismatch models (reperfused patients: AUC = 0.87 ± 0.13 vs 0.79 ± 0.17, P < 0.001; non-reperfused patients: AUC = 0.81 ± 0.13 vs 0.73 ± 0.14, P < 0.01, in CNN vs perfusion-diffusion mismatch models, respectively). CONCLUSION The performance of deep learning models improved when the reperfusion status was incorporated in their training. CNN-based models outperformed the clinically-used perfusion-diffusion mismatch model. Comparing the predicted infarct in case of successful vs failed reperfusion may help in estimating the treatment effect and guiding therapeutic decisions in selected patients.
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Affiliation(s)
- Noëlie Debs
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France.
| | - Tae-Hee Cho
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France.
| | - David Rousseau
- LARIS, UMR IRHS INRA, Université d'Angers, Angers, France.
| | - Yves Berthezène
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Marielle Buisson
- Department of Cardiology, Clinical Investigation Center, CarMeN INSERM U1060, INRA U1397, INSA Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France.
| | - Omer Eker
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Laura Mechtouff
- Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France; Department of Cardiology, Clinical Investigation Center, CarMeN INSERM U1060, INRA U1397, INSA Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France.
| | - Norbert Nighoghossian
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France.
| | - Michel Ovize
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Carole Frindel
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France.
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Frey BM, Boutitie F, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Ford I, Galinovic I, Königsberg A, Puig J, Roy P, Wouters A, Magnus T, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. Neurol Res Pract 2020; 2:40. [PMID: 33324940 PMCID: PMC7678217 DOI: 10.1186/s42466-020-00087-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial. Methods WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0–1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase. Results Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p < 0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047–4.236). Conclusions Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.
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Affiliation(s)
- Benedikt M Frey
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France.,Université Lyon 1, F-69100 Villeurbanne, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100 Villeurbanne, France
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.,Neurologie der Rehaklinik Medical Park Humboldtmühle, An der Mühle 2-9, 13507 Berlin, Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190 Salt, Girona, Spain
| | - Pascal Roy
- Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France.,Université Lyon 1, F-69100 Villeurbanne, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100 Villeurbanne, France
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Oude Markt 13, bus 5005, 3000 Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Herestraat 49, bus 602, 3000 Leuven, Belgium
| | - Tim Magnus
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC 3084 Australia.,Department of Neurology, Austin Health, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Oude Markt 13, bus 5005, 3000 Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Herestraat 49, bus 602, 3000 Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190 Salt, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Mechtouff L, Bochaton T, Paccalet A, Da Silva CC, Buisson M, Amaz C, Derex L, Ong E, Berthezene Y, Eker OF, Dufay N, Mewton N, Ovize M, Cho TH, Nighoghossian N. Association of Interleukin-6 Levels and Futile Reperfusion After Mechanical Thrombectomy. Neurology 2020; 96:e752-e757. [PMID: 33262232 DOI: 10.1212/wnl.0000000000011268] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess whether interleukin-6 (IL-6) level is a marker of futile reperfusion in patients with acute ischemic stroke (AIS) with large vessel occlusion treated with mechanical thrombectomy (MT). METHODS The Cohort of Patients to Identify Biological and Imaging Markers of Cardiovascular Outcomes in Stroke (HIBISCUS-STROKE) includes patients with AIS treated with MT after MRI. We performed a sequential assessment of IL-6 (admission, 6 hours, 24 hours, 48 hours and 3 months from admission). Among patients with successful reperfusion (Thrombolysis in Cerebral Infarction scale 2b/3), reperfusion was considered effective if 3-month modified Rankin Scale (mRS) score was 0 to 2 and futile if 3-month mRS score was 3 to 6. Our model was adjusted for the main confounding variables. RESULTS One hundred sixty-four patients represent the study population. One hundred thirty-three patients had successful reperfusion (81.1%), while in 46 (34.6%), reperfusion was classified as futile. In single-variable analyses, high IL-6 levels at 6, 24, and 48 hours in combination with a higher age, a prestroke mRS score >2, a history of hypertension or diabetes, lack of current smoking, a higher baseline NIH Stroke Scale score, the absence of associated intravenous thrombolysis, an intracranial internal carotid artery or a tandem occlusion, and an increased infarct growth were associated with futile reperfusion. After multivariable analyses, a high IL-6 level at 24 hours (odds ratio 6.15, 95% confidence interval 1.71-22.10) remained associated with futile reperfusion. CONCLUSIONS IL-6 is a marker of futile reperfusion in the setting of MT.
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Affiliation(s)
- Laura Mechtouff
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France.
| | - Thomas Bochaton
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Alexandre Paccalet
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Claire Crola Da Silva
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Marielle Buisson
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Camille Amaz
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Laurent Derex
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Elodie Ong
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Yves Berthezene
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Omer Faruk Eker
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Nathalie Dufay
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Nathan Mewton
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Michel Ovize
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Tae-Hee Cho
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
| | - Norbert Nighoghossian
- From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France
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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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Debatisse J, Eker OF, Wateau O, Cho TH, Wiart M, Ramonet D, Costes N, Mérida I, Léon C, Dia M, Paillard M, Confais J, Rossetti F, Langlois JB, Troalen T, Iecker T, Le Bars D, Lancelot S, Bouchier B, Lukasziewicz AC, Oudotte A, Nighoghossian N, Ovize M, Contamin H, Lux F, Tillement O, Canet-Soulas E. PET-MRI nanoparticles imaging of blood-brain barrier damage and modulation after stroke reperfusion. Brain Commun 2020; 2:fcaa193. [PMID: 33305265 PMCID: PMC7716090 DOI: 10.1093/braincomms/fcaa193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
In an acute ischaemic stroke, understanding the dynamics of blood-brain barrier injury is of particular importance for the prevention of symptomatic haemorrhagic transformation. However, the available techniques assessing blood-brain barrier permeability are not quantitative and are little used in the context of acute reperfusion therapy. Nanoparticles cross the healthy or impaired blood-brain barrier through combined passive and active processes. Imaging and quantifying their transfer rate could better characterize blood-brain barrier damage and refine the delivery of neuroprotective agents. We previously developed an original endovascular stroke model of acute ischaemic stroke treated by mechanical thrombectomy followed by positron emission tomography-magnetic resonance imaging. Cerebral capillary permeability was quantified for two molecule sizes: small clinical gadolinium Gd-DOTA (<1 nm) and AGuIX® nanoparticles (∼5 nm) used for brain theranostics. On dynamic contrast-enhanced magnetic resonance imaging, the baseline transfer constant K trans was 0.94 [0.48, 1.72] and 0.16 [0.08, 0.33] ×10-3 min-1, respectively, in the normal brain parenchyma, consistent with their respective sizes, and 1.90 [1.23, 3.95] and 2.86 [1.39, 4.52] ×10-3 min-1 in choroid plexus, confirming higher permeability than brain parenchyma. At early reperfusion, K trans for both Gd-DOTA and AGuIX® nanoparticles was significantly higher within the ischaemic area compared to the contralateral hemisphere; 2.23 [1.17, 4.13] and 0.82 [0.46, 1.87] ×10-3 min-1 for Gd-DOTA and AGuIX® nanoparticles, respectively. With AGuIX® nanoparticles, K trans also increased within the ischaemic growth areas, suggesting added value for AGuIX®. Finally, K trans was significantly lower in both the lesion and the choroid plexus in a drug-treated group (ciclosporin A, n = 7) compared to placebo (n = 5). K trans quantification with AGuIX® nanoparticles can monitor early blood-brain barrier damage and treatment effect in ischaemic stroke after reperfusion.
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Affiliation(s)
- Justine Debatisse
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France.,Siemens-Healthcare SAS, Saint-Denis, France
| | - Omer Faruk Eker
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât. Blaise Pascal, 7 Avenue Jean Capelle, Villeurbanne 69621, France.,Hospices Civils of Lyon, 69000 Lyon, France
| | | | - Tae-Hee Cho
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France.,Hospices Civils of Lyon, 69000 Lyon, France
| | - Marlène Wiart
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - David Ramonet
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | | | | | - Christelle Léon
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - Maya Dia
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Sciences, Lebanese University-Beirut, Lebanon
| | - Mélanie Paillard
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | | | - Fabien Rossetti
- Univ Lyon, Institut Lumière Matière, CNRS UMR5306, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | | | | | | | - Didier Le Bars
- Hospices Civils of Lyon, 69000 Lyon, France.,CERMEP - Imagerie du Vivant, Lyon, France
| | - Sophie Lancelot
- Hospices Civils of Lyon, 69000 Lyon, France.,CERMEP - Imagerie du Vivant, Lyon, France
| | | | | | | | - Norbert Nighoghossian
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France.,Hospices Civils of Lyon, 69000 Lyon, France
| | - Michel Ovize
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France.,Hospices Civils of Lyon, 69000 Lyon, France
| | | | - François Lux
- Univ Lyon, Institut Lumière Matière, CNRS UMR5306, Université Claude Bernard Lyon 1, 69000 Lyon, France.,Institut Universitaire de France (IUF), France
| | - Olivier Tillement
- Univ Lyon, Institut Lumière Matière, CNRS UMR5306, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - Emmanuelle Canet-Soulas
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France
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Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, Ong E, Fontaine J, Rascle L, Riva R, Schiavo D, Benhamed A, Douplat M, Bony T, Tazarourte K, Tuttle C, Eker OF, Berthezène Y, Ovize M, Nighoghossian N, Mechtouff L. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. J Neurol 2020; 268:2314-2319. [PMID: 32902732 PMCID: PMC7479751 DOI: 10.1007/s00415-020-10199-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/13/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.
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Affiliation(s)
- Cécile Plumereau
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Matteo Cappucci
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Elodie Ong
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Lucie Rascle
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Roberto Riva
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - David Schiavo
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bony
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Célia Tuttle
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France. .,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.
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Mechtouff L, Bochaton T, Paccalet A, Crola Da Silva C, Buisson M, Amaz C, Derex L, Ong E, Berthezene Y, Eker OF, Dufay N, Mewton N, Ovize M, Cho TH, Nighoghossian N. Matrix Metalloproteinase-9 and Monocyte Chemoattractant Protein-1 Are Associated With Collateral Status in Acute Ischemic Stroke With Large Vessel Occlusion. Stroke 2020; 51:2232-2235. [PMID: 32568655 DOI: 10.1161/strokeaha.120.029395] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In ischemic stroke, inflammatory status may condition the development of collateral circulation. Here we assessed the relationship between systemic inflammatory biomarkers and collateral status in large vessel occlusion before mechanical thrombectomy. METHODS HIBISCUS-STROKE is a cohort study including acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. MMP-9 (matrix metalloproteinase-9) and MCP-1 (monocyte chemoattractant protein-1) were measured on blood sampling collected at admission. Collateral status was assessed on pretreatment Digital subtraction angiography and categorized into poor (Higashida score, 0-2) and good (Higashida score, 3-4). A multiple logistic regression model was performed to detect independent markers of good collateral status. RESULTS One hundred and twenty-two patients were included, of them 71 patients (58.2%) had a good collateral status. In univariate analysis, low MMP-9 levels (P=0.01), high MCP-1 levels (P<0.01), a low National Institute of Health Stroke Score (P=0.046), a high diastolic blood pressure (P=0.049), the absence of tandem occlusion (P=0.046), a high Alberta Stroke Program Early CT Score (P<0.01) and a low volume on the diffusion-weighted imaging (P<0.01) were associated with good collateral status. Following multivariate analysis, low MMP-9 levels (P=0.02) and high MCP-1 levels (P<0.01) remained associated with good collateral status. CONCLUSIONS Low MMP-9 and high MCP-1 levels were associated with good pretreatment collateral status in patients with acute ischemic stroke with large vessel occlusion. These results might suggest a relationship between collateral status and inflammation.
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Affiliation(s)
- Laura Mechtouff
- Stroke Department (L.M., L.D., E.O., T.-H.C., N.N.), Hospices Civils de Lyon, France.,INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon, France.,INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Alexandre Paccalet
- INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Claire Crola Da Silva
- INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407 (M.B., C.A., N.M., M.O.), Hospices Civils de Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407 (M.B., C.A., N.M., M.O.), Hospices Civils de Lyon, France
| | - Laurent Derex
- Stroke Department (L.M., L.D., E.O., T.-H.C., N.N.), Hospices Civils de Lyon, France
| | - Elodie Ong
- Stroke Department (L.M., L.D., E.O., T.-H.C., N.N.), Hospices Civils de Lyon, France.,INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Yves Berthezene
- Neuroradiology Department (Y.B., O.F.E.), Hospices Civils de Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044 (Y.B.), University Lyon 1, France
| | - Omer Faruk Eker
- Neuroradiology Department (Y.B., O.F.E.), Hospices Civils de Lyon, France
| | - Nathalie Dufay
- NeuroBioTec, CRB (N.D.), Hospices Civils de Lyon, France
| | - Nathan Mewton
- Clinical Investigation Center, INSERM 1407 (M.B., C.A., N.M., M.O.), Hospices Civils de Lyon, France
| | - Michel Ovize
- Clinical Investigation Center, INSERM 1407 (M.B., C.A., N.M., M.O.), Hospices Civils de Lyon, France.,INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Tae-Hee Cho
- Stroke Department (L.M., L.D., E.O., T.-H.C., N.N.), Hospices Civils de Lyon, France.,INSERM U1060, CarMeN laboratory (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C.), University Lyon 1, France
| | - Norbert Nighoghossian
- Stroke Department (L.M., L.D., E.O., T.-H.C., N.N.), Hospices Civils de Lyon, France
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Mechtouff L, Bochaton T, Paccalet A, Crola Da Silva C, Buisson M, Amaz C, Bouin M, Derex L, Ong E, Berthezene Y, Eker OF, Dufay N, Mewton N, Ovize M, Nighoghossian N, Cho TH. Matrix Metalloproteinase-9 Relationship With Infarct Growth and Hemorrhagic Transformation in the Era of Thrombectomy. Front Neurol 2020; 11:473. [PMID: 32582006 PMCID: PMC7296118 DOI: 10.3389/fneur.2020.00473] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 02/14/2020] [Accepted: 04/30/2020] [Indexed: 01/12/2023] Open
Abstract
Objective: To assess the relationship between matrix metalloproteinase 9 (MMP-9), a proteolytic enzyme involved in the breakdown of the blood-brain barrier, and infarct growth and hemorrhagic transformation in acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the era of mechanical thrombectomy (MT) using the kinetics of MMP-9 and sequential magnetic resonance imaging (MRI). Methods: HIBISCUS-STROKE is a cohort study including AIS patients with LVO treated with MT following admission MRI. Patients underwent sequential assessment of MMP-9, follow-up CT at day 1, and MRI at day 6. The CT scan at day 1 classified any hemorrhagic transformation according to the European Co-operative Acute Stroke Study-II (ECASS II) classification. Infarct growth was defined as the difference between final Fluid-Attenuated Inversion Recovery volume and baseline diffusion-weighted imaging volume. Conditional logistic regression analyses were adjusted for main confounding variables including reperfusion status. Results: One hundred and forty-eight patients represent the study population. A high MMP-9 level at 6 h from admission (H6) (p = 0.02), a high glucose level (p = 0.01), a high temperature (p = 0.04), and lack of reperfusion (p = 0.02) were associated with infarct growth. A high MMP-9 level at H6 (p = 0.03), a high glucose level (p = 0.03) and a long delay from symptom onset to groin puncture (p = 0.01) were associated with hemorrhagic transformation. Conclusions: In this MT cohort study, MMP-9 level at H6 predicts infarct growth and hemorrhagic transformation.
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Affiliation(s)
- Laura Mechtouff
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France
| | - Thomas Bochaton
- CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France.,Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Alexandre Paccalet
- CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France
| | - Claire Crola Da Silva
- CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Morgane Bouin
- Cellule Recherche Imagerie, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Laurent Derex
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Elodie Ong
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France
| | - Yves Berthezene
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Nathalie Dufay
- NeuroBioTec, CRB, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Nathan Mewton
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Michel Ovize
- CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France.,Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Norbert Nighoghossian
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France
| | - Tae-Hee Cho
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Université de Lyon, Lyon, France
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Seners P, Turc G, Lion S, Cottier JP, Cho TH, Arquizan C, Bracard S, Ozsancak C, Legrand L, Naggara O, Debiais S, Berthezene Y, Costalat V, Richard S, Magni C, Nighoghossian N, Narata AP, Dargazanli C, Gory B, Mas JL, Oppenheim C, Baron JC. Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion. J Cereb Blood Flow Metab 2020; 40:667-677. [PMID: 30890074 PMCID: PMC7026851 DOI: 10.1177/0271678x19836288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/01/2023]
Abstract
In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax ≥ 10 s volume/ Tmax ≥ 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR (P = 0.006), shorter thrombus on T2*-imaging (P < 0.001) and more distal occlusion (P = 0.006). However, the relationship between HIR and early recanalization was robust only for thrombus length <14 mm. In summary, the present study disclosed an association between lower HIR and early post-thrombolysis recanalization. Early post-thrombolysis recanalization is therefore determined not only by thrombus site and length but also by severity of ischemia.
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Affiliation(s)
- Pierre Seners
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Guillaume Turc
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Stéphanie Lion
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Jean-Philippe Cottier
- Department of Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSALyon, Lyon, France
| | | | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U 947, Nancy, France
| | | | - Laurence Legrand
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Olivier Naggara
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Séverine Debiais
- Department of Neurology, Bretonneau Hospital, University of Tours, Tours, France
| | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | | | - Norbert Nighoghossian
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSALyon, Lyon, France
| | - Ana-Paula Narata
- Department of Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U 947, Nancy, France
| | - Jean-Louis Mas
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Catherine Oppenheim
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Jean-Claude Baron
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
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Barow E, Boutitie F, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Ford I, Galinovic I, Nickel A, Puig J, Roy P, Wouters A, Magnus T, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial. JAMA Neurol 2020; 76:641-649. [PMID: 30907934 DOI: 10.1001/jamaneurol.2019.0351] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The rationale for intravenous thrombolysis in patients with lacunar infarcts is debated, since it is hypothesized that the microvascular occlusion underlying lacunar infarcts might not be susceptible to pharmacological reperfusion treatment. Objective To study the efficacy and safety of intravenous thrombolysis among patients with lacunar infarcts. Design, Setting, and Participants This exploratory secondary post hoc analysis of the WAKE-UP trial included patients who were screened and enrolled between September 2012 and June 2017 (with final follow-up in September 2017). The WAKE-UP trial was a multicenter, double-blind, placebo-controlled randomized clinical trial to study the efficacy and safety of intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time, guided by magnetic resonance imaging. All 503 patients randomized in the WAKE-UP trial were reviewed for lacunar infarcts. Diagnosis of lacunar infarcts was based on magnetic resonance imaging and made by consensus of 2 independent investigators blinded to clinical information. Main Outcomes and Measures The primary efficacy variable was favorable outcome defined by a score of 0 to 1 on the modified Rankin Scale at 90 days after stroke, adjusted for age and severity of symptoms. Results Of the 503 patients randomized in the WAKE-UP trial, 108 patients (including 74 men [68.5%]) had imaging-defined lacunar infarcts, whereas 395 patients (including 251 men [63.5%]) had nonlacunar infarcts. Patients with lacunar infarcts were younger than patients with nonlacunar infarcts (mean age [SD], 63 [12] years vs 66 [12] years; P = .003). Of patients with lacunar infarcts, 55 (50.9%) were assigned to treatment with alteplase and 53 (49.1%) to receive placebo. Treatment with alteplase was associated with higher odds of favorable outcome, with no heterogeneity of treatment outcome between lacunar and nonlacunar stroke subtypes. In patients with lacunar strokes, a favorable outcome was observed in 31 of 53 patients (59%) in the alteplase group compared with 24 of 52 patients (46%) in the placebo group (adjusted odds ratio [aOR], 1.67 [95% CI, 0.77-3.64]). There was 1 death and 1 symptomatic intracranial hemorrhage according to Safe Implementation of Thrombolysis in Stroke-Monitoring Study criteria in the alteplase group, while no death and no symptomatic intracranial hemorrhage occurred in the placebo group. The distribution of the modified Rankin Scale scores 90 days after stroke also showed a nonsignificant shift toward better outcomes in patients with lacunar infarcts treated with alteplase, with an adjusted common odds ratio of 1.94 (95% CI, 0.95-3.93). Conclusions and Relevance While the WAKE-UP trial was not powered to demonstrate the efficacy of treatment in subgroups of patients, the results indicate that the association of intravenous alteplase with functional outcome does not differ in patients with imaging-defined lacunar infarcts compared with those experiencing other stroke subtypes.
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Affiliation(s)
- Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Centre National de la Recherche Scientifique, Unité de Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS Centre National de la Recherche Scientifique Unité de Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U1206, Institut National des Sciences Appliquées-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alina Nickel
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Salt, Girona, Spain
| | - Pascal Roy
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven, Leuven, Belgium.,Vlaams Instituut voor Biotechnologie, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Tim Magnus
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven, Leuven, Belgium.,Vlaams Instituut voor Biotechnologie, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS Centre National de la Recherche Scientifique Unité de Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U1206, Institut National des Sciences Appliquées-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Salt, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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42
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Trucksess MW, Page SW, Wood GE, Cho TH. Determination of Deoxynivalenol in White Flour, Whole Wheat Flour, and Bran by Solid-Phase Extraction/Liquid Chromatography: Interlaboratory Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.4.880] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A liquid chromatographic (LC) method for determining deoxynivalenol (DON) in white flour, whole wheat flour, and bran at or above the U.S. Food and Drug Administration advisory level of 1 μg/g was evaluated by an interlaboratory study. Test samples of processed wheat (flour and bran) were extracted by blending with acetonitrile-water (84 + 16). Extracts were filtered and passed through a solid-phase extraction (SPE) column. The eluate was then chromatographed on a reversed-phase LC column with a water-methanol gradient. DON was measured at 220 nm. Naturally contaminated white flour, whole wheat flour, and bran samples and spiking solutions of DON to be added to the 3 commodities at 0.5,1.0, and 2.0 μg/g were sent to 4 collaborators in Kansas, Louisiana, Missouri, and Washington states. Three collaborators completed the study. Average recoveries of DON from the 3 commodities spiked at 0.5, 1.0, and 2.0 (μg/g were 94, 87, and 97%, respectively. Within-laboratory relative standard deviations for repeatability (RSDr) ranged from 3.1 to 21.7% and between-laboratory relative standard deviations for reproducibility (RSDR) ranged from 10.8 to 38.7%. On the basis of the results of this study, the SPE/LC method for DON in white flour, whole wheat flour, and bran was adopted as a peer-verified method by AOAC INTERNATIONAL
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Affiliation(s)
- Mary W Trucksess
- U.S. Food and Drug Administration, Division of Natural Products, Washington, DC 20204
| | - Samuel W Page
- U.S. Food and Drug Administration, Division of Natural Products, Washington, DC 20204
| | - Garnett E Wood
- U.S. Food and Drug Administration, Division of Programs and Enforcement Policy, Washington, DC 20204
| | - Tae-Hee Cho
- Seoul Public Health and Environment Institute, Seoul, Korea
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43
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Cheng B, Boutitie F, Nickel A, Wouters A, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Puig J, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G, Golsari A, Alegiani A, Beck C, Choe CU, Voget D, Hoppe J, Schröder J, Rozanski M, Nave AH, Wollboldt C, van Sloten I, Göhler J, Herm J, Jungehülsing J, Lückl J, Kröber JM, Schurig J, Koehler L, Schlemm L, Knops M, Roennefarth M, Ipsen N, Harmel P, Bathe-Peters R, Fleischmann R, Ganeshan R, Geran R, Hellwig S, Schmidt S, Tütüncü S, Krause T, Gramse V, Röther J, Michels P, Michalski D, Pelz J, Schulz A, Hobohm C, Weise C, Weise G, Orthgieß J, Pomrehn K, Wegscheider M, Mueller AK, Hennerici M, Griebe M, Alonso A, Filipov A, Marzina A, Anders B, Bähr C, Hoyer C, Schwarzbach C, Weber C, Hornberger E, Pledl HW, Klockziem M, Stuermlinger M, Wittayer M, Wolf M, Meyer N, Eisele P, Steinert S, Sauer T, Held V, Ringleb P, Nagel S, Veltkamp R, Schwarting S, Schwarz A, Gumbinger C, Hametner C, Amiri H, Purrucker J, Ciatipis M, Menn O, Mundiyanapurath S, Schieber S, Kessler T, Reiff T, Panitz V, Singer O, Foerch C, Lauer A, Männer A, Seiler A, Guerzoglu D, Schäfer JH, Filipski K, Lorenz M, Kurka N, Zeiner P, Pfeilschifter W, Dziewas R, Minnerup J, Albiker C, Ritter M, Seidel M, Dittrich R, Kallmünzer B, Bobinger T, Madzar D, Stark D, Sembill J, Macha K, Winder K, Breuer L, Koehrmann M, Spruegel M, Gerner S, Kraft P, Mackenrodt D, Kleinschnitz C, Elhfnawy A, Heinen F, Gunreben I, Poli S, Ziemann U, Gaenslen A, Schlak D, Haertig F, Russo F, Richter H, Ebner M, Ribitsch M, Wolf M, Weimar C, Zegarac V, Chen HC, Althaus K, Neugebauer H, Jüttler E, Meier J, Stösser S, Puetz V, Bodechtel U, Ostergaard L, Møller A, Damgaard D, Dupont KH, Poulsen M, Hjort N, de Morales NR, von Weitzel P, Harbo T, Marstrand J, Hansen A, Christensen H, Aegidius K, Jeppesen L, Meden P, Rosenbaum S, Iversen H, Hansen J, Michelsen L, Truelsen T, Modrau B, Vestergaard K, Oppel L, Sygehus A, Aalborg S, Swinnen B, Smets I, Demeestere J, Dobbels L, Brouns R, De Smedt A, DeKeyser J, Yperzeele L, Van Hooff RJ, Peeters A, Dusart A, Etexberria A, Hanseeuw B, London F, Leempoel J, Hohenbichler K, Younan N, Maqueda V, Laloux P, De Coene B, De Maeseneire C, Turine G, Vandermeeren Y, De Klippel N, Willems C, de Hollander I, Soors P, Hermans S, Hemelsoet D, Desfontaines P, Vanacker P, Rutgers M, Druart C, Peeters D, Bruneel B, Vancaester E, Vanhee F, Meersman G, Bourgeois P, Vanderdonckt P, Benoit A, Derex L, Mechthouff L, Berhoune N, Ritzenthaler T, Amarenco P, Hobeanu C, Gancedo EM, Calvet D, Ladoux A, Machet A, Lamy C, Mellerio C, Oppenheim C, Rodriguez-Regent C, Bodiguel E, Turc G, Birchenall J, Legrand L, Morin L, Edjali-Goujon M, Naggara O, Raphaelle S, Godon-Hardy S, Domigo V, Guiraud V, Samson Y, Leger A, Rosso C, Baronnet-Chauvet F, Crozier S, Deltour S, Yger M, Sibon I, Renou P, Sagnier S, Zuber M, Tamazyan R, Rodier G, Morel N, Felix S, Vadot W, Wolff V, Aniculaesei A, Yalo B, Bindila D, Quenardelle V, Blanc-Lasserre K, Landrault E, Breynaert L, Cakmak S, Peysson S, Viguier A, Lebely C, Raposo N, Vallet AE, Vallet P, Brugirard S, Cheripelli B, Kalladka D, Moreton F, Dani K, Tawil SE, Ramachandran S, Huang X, Warburton E, Evans N, Perry R, Patel B, Cloud G, Pereira A, Moynihan B, Lovelock C, Choy L, Khan U, Roffe C, Tyrell P, Smith C, Dixit A, Louw S, Broughton D, Shetty A, Appleton J, Sprigg N, Acosta BR, van Eendenburg C, Leal JS, Mar Castellanos Rodrigo MD, Izaga MT, Guillamon OB, Arenillas J, Calleja A, Cortijo E, Mulero P, de la Ossa NP, Garrido A, Martinez A, Esperón CG, Guerrero C, Carrera D, Vilas D, Lopez-cancio E, Palomeras E, Lucente G, Gomis M, Isern I, Becerra JL, Vicente JH, Sánchez J, Dorado L, Grau L, Ispierto L, Prats L, Almendrote M, Hernández M, Jimenez M, Sánchez ML, Torne MM, Presas S, Ustrell X, Pellisé A, Navalpotro I, Luna A, Schonewille W, Nederkoorn P, Majoie C, van den Berg L, van den Berg S, Zonneveld T, Remmers M, Fazekas F, Pichler A, Fandler S, Gattringer T, Mutzenbach J, Weber J, Höfner E, Kohlfürst H, Weinstich K, Kellert L, Bayer-Karpinska A, Opherk C, Wollenweber F, Klein M, Neumann- Haefelin T, Pierskalla A, Harloff A, Bardutzky J, Buggle F, von Schrader J, Kollmar R, Schill J, Löbbe AM, Moulin T, Bouamra B, Bonnet L, Touzé E, Bonnet AL, Touze E, Cogez J, Li L, Guettier S, Kar A, Sivagnanaratham A, Geraghty O, Bojaryn U, Nallasivan A, Gonzales MB, Rodríguez-Yáñez M, Tembl J, Gorriz D, Oberndorfer S, Prohaska E. Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial. Stroke 2020; 51:209-215. [DOI: 10.1161/strokeaha.119.027390] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Relative signal intensity of acute ischemic stroke lesions in fluid-attenuated inversion recovery (fluid-attenuated inversion recovery relative signal intensity [FLAIR-rSI]) magnetic resonance imaging is associated with time elapsed since stroke onset with higher intensities signifying longer time intervals. In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion. In this post hoc analysis, we investigated whether quantitatively measured FLAIR-rSI modifies treatment effect of intravenous alteplase.
Methods—
FLAIR-rSI of stroke lesions was measured relative to signal intensity in a mirrored region in the contralesional hemisphere. The relationship between FLAIR-rSI and treatment effect on functional outcome assessed by the modified Rankin Scale (mRS) after 90 days was analyzed by binary logistic regression using different end points, that is, favorable outcome defined as mRS score of 0 to 1, independent outcome defined as mRS score of 0 to 2, ordinal analysis of mRS scores (shift analysis). All models were adjusted for National Institutes of Health Stroke Scale at symptom onset and stroke lesion volume.
Results—
FLAIR-rSI was successfully quantified in stroke lesions in 433 patients (86% of 503 patients included in WAKE-UP). Mean FLAIR-rSI was 1.06 (SD, 0.09). Interaction of FLAIR-rSI and treatment effect was not significant for mRS score of 0 to 1 (
P
=0.169) and shift analysis (
P
=0.086) but reached significance for mRS score of 0 to 2 (
P
=0.004). We observed a smooth continuing trend of decreasing treatment effects in relation to clinical end points with increasing FLAIR-rSI.
Conclusions—
In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis. This parallels the known association of treatment effect and elapsing time of stroke onset.
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Affiliation(s)
- Bastian Cheng
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Florent Boutitie
- Service de Biostatistique, Hospices Civils de Lyon, France (F.B.)
- Université Lyon 1, Villeurbanne, France (F.B.)
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France (F.B.)
| | - Alina Nickel
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Belgium (A.W., R.L.)
- Department of Neurosciences, Experimental Neurology, KU Leuven–University of Leuven, Belgium (A.W., R.L.)
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium (A.W., R.L.)
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, France (T.-H.C., N.N.)
- Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany (M. Ebinger)
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany (M. Endres)
| | - Jochen B. Fiebach
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d’Investigació Biomèdica de Girona, Parc Hospitalari Martí i Julià de Salt, Girona, Spain (J.P., S.P.)
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia (V.T.)
- Austin Health, Department of Neurology, VIC, Australia (V.T.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (A.W., R.L.)
- Department of Neurosciences, Experimental Neurology, KU Leuven–University of Leuven, Belgium (A.W., R.L.)
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium (A.W., R.L.)
| | - Keith W. Muir
- Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, France (T.-H.C., N.N.)
- Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d’Investigació Biomèdica de Girona, Parc Hospitalari Martí i Julià de Salt, Girona, Spain (J.P., S.P.)
| | - Claus Z. Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Christian Gerloff
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Götz Thomalla
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
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Debs N, Rasti P, Victor L, Cho TH, Frindel C, Rousseau D. Simulated perfusion MRI data to boost training of convolutional neural networks for lesion fate prediction in acute stroke. Comput Biol Med 2019; 116:103579. [PMID: 31999557 DOI: 10.1016/j.compbiomed.2019.103579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/30/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022]
Abstract
The problem of final tissue outcome prediction of acute ischemic stroke is assessed from physically realistic simulated perfusion magnetic resonance images. Different types of simulations with a focus on the arterial input function are discussed. These simulated perfusion magnetic resonance images are fed to convolutional neural network to predict real patients. Performances close to the state-of-the-art performances are obtained with a patient specific approach. This approach consists in training a model only from simulated images tuned to the arterial input function of a tested real patient. This demonstrates the added value of physically realistic simulated images to predict the final infarct from perfusion.
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Affiliation(s)
- Noëlie Debs
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât, Blaise Pascal, 7 Avenue Jean Capelle, 69621, Villeurbanne, France
| | - Pejman Rasti
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), UMR INRA IRHS, Université d'Angers, 62 Avenue Notre Dame du Lac, 49000 Angers, France
| | - Léon Victor
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât, Blaise Pascal, 7 Avenue Jean Capelle, 69621, Villeurbanne, France
| | - Tae-Hee Cho
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât, Blaise Pascal, 7 Avenue Jean Capelle, 69621, Villeurbanne, France
| | - Carole Frindel
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon Bât, Blaise Pascal, 7 Avenue Jean Capelle, 69621, Villeurbanne, France
| | - David Rousseau
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), UMR INRA IRHS, Université d'Angers, 62 Avenue Notre Dame du Lac, 49000 Angers, France.
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45
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Mechtouff L, Nighoghossian N, Amaz C, Buisson M, Berthezène Y, Derex L, Ong E, Eker OF, Cho TH. White matter burden does not influence the outcome of mechanical thrombectomy. J Neurol 2019; 267:618-624. [DOI: 10.1007/s00415-019-09624-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 01/07/2023]
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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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Tozlu C, Ozenne B, Cho TH, Nighoghossian N, Mikkelsen IK, Derex L, Hermier M, Pedraza S, Fiehler J, Østergaard L, Berthezène Y, Baron JC, Maucort-Boulch D. Comparison of classification methods for tissue outcome after ischaemic stroke. Eur J Neurosci 2019; 50:3590-3598. [PMID: 31278787 DOI: 10.1111/ejn.14507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/06/2019] [Revised: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Abstract
In acute ischaemic stroke, identifying brain tissue at high risk of infarction is important for clinical decision-making. This tissue may be identified with suitable classification methods from magnetic resonance imaging data. The aim of the present study was to assess and compare the performance of five popular classification methods (adaptive boosting, logistic regression, artificial neural networks, random forest and support vector machine) in identifying tissue at high risk of infarction on human voxel-based brain imaging data. The classification methods were used with eight MRI parameters, including diffusion-weighted imaging and perfusion-weighted imaging obtained in 55 patients. The five criteria used to assess the performance of the methods were the area under the receiver operating curve (AUCroc ), the area under the precision-recall curve (AUCpr ), sensitivity, specificity and the Dice coefficient. The methods performed equally in terms of sensitivity and specificity, while the results of AUCroc and the Dice coefficient were significantly better for adaptive boosting, logistic regression, artificial neural networks and random forest. However, there was no statistically significant difference between the performances of these five classification methods regarding AUCpr , which was the main comparison metric. Machine learning methods can provide valuable prognostic information using multimodal imaging data in acute ischaemic stroke, which in turn can assist in developing personalized treatment decision for clinicians after a thorough validation of methods with an independent data set.
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Affiliation(s)
- Ceren Tozlu
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Brice Ozenne
- Neurobiology Research Unit, Rigshospitalet, Copenhagen O, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Tae-Hee Cho
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Derex
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Marc Hermier
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yves Berthezène
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France.,Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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48
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Ozenne B, Cho TH, Mikkelsen IK, Hermier M, Thomalla G, Pedraza S, Roy P, Berthezène Y, Nighoghossian N, Østergaard L, Baron JC, Maucort-Boulch D. Individualized quantification of the benefit from reperfusion therapy using stroke predictive models. Eur J Neurosci 2019; 50:3251-3260. [PMID: 31283062 DOI: 10.1111/ejn.14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/28/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Recent imaging developments have shown the potential of voxel-based models in assessing infarct growth after stroke. Many models have been proposed but their relevance in predicting the benefit of a reperfusion therapy remains unclear. We searched for a predictive model whose volumetric predictions would identify stroke patients who are to benefit from tissue plasminogen activator (t-PA)-induced reperfusion. MATERIAL AND METHODS Forty-five cases were used to study retrospectively stroke progression from admission to end of follow-up. Predictive approaches based on various statistical models, predictive variables and spatial filtering methods were compared. The optimal approach was chosen according to the area under the precision-recall curve (AUPRC). The final lesion volume was then predicted assuming that the patient would or would not reperfuse. Patients, with an acute lesion of ≤50 ml and a predicted reduction in the presence of reperfusion >6 ml and >25% of the acute lesion, were classified as responders. RESULTS The optimal model was a logistic regression using the voxel distance to the acute lesion, the volume of the acute lesion and Gaussian-filtered MRI contrast parameters as predictive variables. The predictions gave a median AUPRC of 0.655, a median AUC of 0.976 and a median volumetric error of 8.29 ml. Nineteen patients matched the responder profile. A non-significant trend of improved reduction in NIHSS score (-42.8%, p = .09) and in lesion volume (-78.1%, p = 0.21) following reperfusion was observed for responder patients. CONCLUSION Despite limited volumetric accuracy, predictive stroke models can be used to quantify the benefit of reperfusion therapies.
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Affiliation(s)
- Brice Ozenne
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Hermier
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Pascal Roy
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France.,Université Lyon I, Lyon, France
| | - Yves Berthezène
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Neurology, INSERM U894, Hôpital Sainte-Anne, Paris Descartes University, Paris, France
| | - Delphine Maucort-Boulch
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France.,Université Lyon I, Lyon, France
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49
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Eker OF, Rascle L, Cho TH, Mechtouff L, Derex L, Ong E, Berthezene Y, Nighoghossian N. Does Small Vessel Disease Burden Impact Collateral Circulation in Ischemic Stroke Treated by Mechanical Thrombectomy? Stroke 2019; 50:1582-1585. [DOI: 10.1161/strokeaha.119.025608] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omer Faruk Eker
- From the Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, France (O.F.E., Y.B.)
| | - Lucie Rascle
- Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.)
| | - Tae-Hee Cho
- Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.)
| | - Laura Mechtouff
- Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.)
| | - Laurent Derex
- Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.)
| | - Elodie Ong
- Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.)
| | - Yves Berthezene
- From the Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, France (O.F.E., Y.B.)
| | - Norbert Nighoghossian
- Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.)
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50
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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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