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Boisseau W, Benomar A, Ducroux C, Fahed R, Smajda S, Diestro JDB, Charbonnier G, Ognard J, Burel J, Ter Schiphorst A, Boulanger M, Nehme A, Boucherit J, Marnat G, Volders D, Holay Q, Forestier G, Bretzner M, Roy D, Vingadassalom S, Elhorany M, Nico L, Jacquin G, Abdalkader M, Guedon A, Seners P, Janot K, Dumas V, Olatunji R, Gazzola S, Milot G, Zehr J, Darsaut TE, Iancu D, Raymond J. The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study. AJNR Am J Neuroradiol 2024:ajnr.A8149. [PMID: 38388684 DOI: 10.3174/ajnr.a8149] [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: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions. MATERIALS AND METHODS A portfolio of 60 cases was sent to clinicians with varying backgrounds and experience. Responders were asked whether they considered conservative management or rescue therapy (stent retriever, aspiration, or intra-arterial thrombolytics) a treatment option as well as their willingness to enroll patients in a randomized trial. Agreement was assessed using κ statistics. RESULTS The electronic survey was answered by 31 physicians (8 vascular neurologists and 23 interventional neuroradiologists). Decisions for rescue therapies were more frequent (n = 1116/1860, 60%) than for conservative management (n = 744/1860, 40%; P < .001). Interrater agreement regarding the final management decision was "slight" (κ = 0.12; 95% CI, 0.09-0.14) and did not improve when subgroups of clinicians were studied according to background, experience, and specialty or when cases were grouped according to the level of occlusion. On delayed re-questioning, 23 of 29 respondents (79.3%) disagreed with themselves on at least 20% of cases. Respondents were willing to offer trial participation in 1295 of 1860 (69.6%) cases. CONCLUSIONS Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.
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Affiliation(s)
- W Boisseau
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - A Benomar
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - C Ducroux
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - R Fahed
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - S Smajda
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - J D B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G Charbonnier
- Interventional Neuroradiology Department (G.C.), Besançon University Hospital, Besançon, France
| | - J Ognard
- Interventional Neuroradiology Department (J.O.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - J Burel
- Department of Radiology (J. Burel), Rouen University Hospital, Rouen, France
| | - A Ter Schiphorst
- Neurology Department (A.T.S.), CHRU Gui de Chauliac, Montpellier, France
| | - M Boulanger
- Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France
| | - A Nehme
- Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France
| | - J Boucherit
- Department of Radiology (J. Boucherit), Rennes University Hospital, Rennes, France
| | - G Marnat
- Department of Neuroradiology (G. Marnat), University Hospital of Bordeaux, Bordeaux, France
| | - D Volders
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - Q Holay
- Radiology Department (Q.H.), Hôpital d'Instruction des armées Saint-Anne, Toulon, France
| | - G Forestier
- Neuroradiology Department (G.F.), University Hospital of Limoges, Limoges, France
| | - M Bretzner
- Neuroradiology Department (M. Bretzner), CHU Lille, University Lille, Inserm, U1172 Lille Neuroscience & Cognition, F-59000, Lille, France
| | - D Roy
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - S Vingadassalom
- Interventional Neuroradiology Department (S.V.), CHRU Marseille, La Timone, France
| | - M Elhorany
- Department of Neuroradiology (M.E.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France
- Department of Neurology (M.E.), Tanta University, Tanta, Egypt
| | - L Nico
- Department of Radiology (L.N.), University Hospital of Padova, Padova, Italy
| | - G Jacquin
- Neurovascular Health Program (G.J.), Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - M Abdalkader
- Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - A Guedon
- Department of Neuroradiology (A.G.), Lariboisière Hospital, Paris, France
| | - P Seners
- Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Fondation Rothschild Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (P.S.), UMR_S1266, INSERM, Université de Paris, Paris, France
| | - K Janot
- Interventional Neuroradiology (K.J.), University Hospital of Tours, Tours, France
| | - V Dumas
- Radiology Department (V.D.), University Hospital of Poitiers, Poitiers, France
| | - R Olatunji
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S Gazzola
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - G Milot
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - J Zehr
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - T E Darsaut
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D Iancu
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - J Raymond
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
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Lahlouh M, Chenoune Y, Blanc R, Piotin M, Escalard S, Fahed R, Szewczyk J, Passat N. Automated Aortic Anatomy Analysis: from Image to Clinical Indicators. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38082844 DOI: 10.1109/embc40787.2023.10340921] [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: 12/18/2023]
Abstract
Most cerebrovascular diseases (including strokes and aneurysms) are treated endovascularly with catheters that are navigated from the groin through the vessels to the brain. Many patients have complex anatomy of the aortic arch and supra-aortic vessels, which can make it difficult to select the best catheters for navigation, resulting in longer procedures and more complications or failures. To this end, we propose a framework dedicated to the analysis of the aortic arch and supra-aortic trunks. This framework can automatically compute anatomical and geometrical features from meshes segmented beforehand via CNN-based pipeline. These features such as arch type, tortuosity and angulations describe the navigational difficulties encountered during catheterization. Quantitative and qualitative validation was performed by experienced neuroradiologists, leading to reliable vessel characterization.Clinical relevance- This method allows clinicians to determine the type and the anatomy of the aortic arch and its supra-aortic trunks before endovascular procedures. This is essential in interventional neuroradiology, such as navigation with catheters in this complex area.
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Ducroux C, Nehme A, Rioux B, Panzini MA, Fahed R, Gioia LC, Létourneau-Guillon L. NCCT Markers of Intracerebral Hemorrhage Expansion Using Revised Criteria: An External Validation of Their Predictive Accuracy. AJNR Am J Neuroradiol 2023; 44:658-664. [PMID: 37169542 PMCID: PMC10249705 DOI: 10.3174/ajnr.a7871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/06/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Several NCCT expansion markers have been proposed to improve the prediction of hematoma expansion. We retrospectively evaluated the predictive accuracy of 9 expansion markers. MATERIALS AND METHODS Patients admitted for intracerebral hemorrhage within 24 hours of last seen well were retrospectively included from April 2016 to April 2020. The primary outcome was revised hematoma expansion, defined as any of a ≥6-mL or ≥33% increase in intracerebral hemorrhage volume, a ≥ 1-mL increase in intraventricular hemorrhage volume, or de novo intraventricular hemorrhage. We assessed the predictive accuracy of expansion markers and determined their association with revised hematoma expansion. RESULTS We included 124 patients, of whom 51 (41%) developed revised hematoma expansion. The sensitivity of each marker for the prediction of revised hematoma expansion ranged from 4% to 78%; the specificity, 37%-97%; the positive likelihood ratio, 0.41-7.16; and the negative likelihood ratio, 0.49-1.06. By means of univariable logistic regressions, 5 markers were significantly associated with revised hematoma expansion: black hole (OR = 8.66; 95% CI, 2.15-58.14; P = .007), hypodensity (OR = 3.18; 95% CI, 1.49-6.93; P = .003), blend (OR = 2.90; 95% CI, 1.08-8.38; P = .04), satellite (OR = 2.84; 95% CI, 1.29-6.61; P = .01), and Barras shape (OR = 2.41, 95% CI; 1.17-5.10; P = .02). In multivariable models, only the black hole marker remained independently associated with revised hematoma expansion (adjusted OR = 5.62; 95% CI, 1.23-40.23; P = .03). CONCLUSIONS No single NCCT expansion marker had both high sensitivity and specificity for the prediction of revised hematoma expansion. Improved image-based analysis is needed to tackle limitations associated with current NCCT-based expansion markers.
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Affiliation(s)
- C Ducroux
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
- Neurovascular Health Program (C.D., L.C.G.)
- Department of Medicine (C.D., R.F.), Division of Neurology, The Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - A Nehme
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
| | - B Rioux
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
- Centre for Clinical Brain Sciences (B.R.), University of Edinburgh, Edinburgh, UK
| | - M-A Panzini
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
| | - R Fahed
- Department of Medicine (C.D., R.F.), Division of Neurology, The Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - L C Gioia
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
- Neurovascular Health Program (C.D., L.C.G.)
| | - L Létourneau-Guillon
- Département de Radiologie (L.L.-G.), Radio-oncologie et Médecine Nucléaire, Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
- Département de Radiologie (L.L.-G.), Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- Imaging and Engineering Axis (L.L.-G.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
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Boisseau W, Darsaut TE, Fahed R, Drake B, Lesiuk H, Rempel JL, Gentric JC, Ognard J, Nico L, Iancu D, Roy D, Weill A, Chagnon M, Zehr J, Lavoie P, Nguyen TN, Raymond J. Stent-Assisted Coiling in the Treatment of Unruptured Intracranial Aneurysms: A Randomized Clinical Trial. AJNR Am J Neuroradiol 2023; 44:381-389. [PMID: 36927759 PMCID: PMC10084896 DOI: 10.3174/ajnr.a7815] [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: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coiling may improve angiographic results of endovascular treatment of unruptured intracranial aneurysms compared with coiling alone, but this has never been shown in a randomized trial. MATERIALS AND METHODS The Stenting in the Treatment of Aneurysm Trial was an investigator-led, parallel, randomized (1:1) trial conducted in 4 university hospitals. Patients with intracranial aneurysms at risk of recurrence, defined as large aneurysms (≥10 mm), postcoiling recurrent aneurysms, or small aneurysms with a wide neck (≥4 mm), were randomly allocated to stent-assisted coiling or coiling alone. The composite primary efficacy outcome was "treatment failure," defined as initial failure to treat the aneurysm; aneurysm rupture or retreatment during follow-up; death or dependency (mRS > 2); or an angiographic residual aneurysm adjudicated by an independent core laboratory at 12 months. The primary hypothesis (revised for slow accrual) was that stent-assisted coiling would decrease treatment failures from 33% to 15%, requiring 200 patients. Primary analyses were intent to treat. RESULTS Of 205 patients recruited between 2011 and 2021, ninety-four were allocated to stent-assisted coiling and 111 to coiling alone. The primary outcome, ascertainable in 203 patients, was reached in 28/93 patients allocated to stent-assisted coiling (30.1%; 95% CI, 21.2%-40.6%) compared with 30/110 (27.3%; 95% CI, 19.4%-36.7%) allocated to coiling alone (relative risk = 1.10; 95% CI, 0.7-1.7; P = .66). Poor clinical outcomes (mRS >2) occurred in 8/94 patients allocated to stent-assisted coiling (8.5%; 95% CI, 4.0%-16.6%) compared with 6/111 (5.4%; 95% CI, 2.2%-11.9%) allocated to coiling alone (relative risk = 1.6; 95% CI, 0.6%-4.4%; P = .38). CONCLUSIONS The STAT trial did not show stent-assisted coiling to be superior to coiling alone for wide-neck, large, or recurrent unruptured aneurysms.
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Affiliation(s)
- W Boisseau
- From the Department of Radiology (W.B., D.I., D.R., A.W., J.R.), Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery
| | - R Fahed
- Departments of Neurology (R.F.)
| | - B Drake
- Neurosurgery (B.D., H.L.), University of Ottawa, the Ottawa Hospital, Ottawa, Ontario, Canada
| | - H Lesiuk
- Neurosurgery (B.D., H.L.), University of Ottawa, the Ottawa Hospital, Ottawa, Ontario, Canada
| | - J L Rempel
- Department of Radiology and Diagnostic Imaging (J.L.R.), University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - J-C Gentric
- Department of Radiology (J.-C.G., J.O.), University Hospital of Brest, Brest, France
| | - J Ognard
- Department of Radiology (J.-C.G., J.O.), University Hospital of Brest, Brest, France
| | - L Nico
- Departement of Radiology (L.N.), Service of Interventional Neuroradiology, Centre Hospitalo-universitaire de Saint-Etienne, Saint-Etienne, France
| | - D Iancu
- From the Department of Radiology (W.B., D.I., D.R., A.W., J.R.), Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - D Roy
- From the Department of Radiology (W.B., D.I., D.R., A.W., J.R.), Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - A Weill
- From the Department of Radiology (W.B., D.I., D.R., A.W., J.R.), Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - M Chagnon
- Department of Mathematics and Statistics (M.C., J.Z.), Pavillon André-Aisenstadt, Montreal, Québec, Canada
| | - J Zehr
- Department of Mathematics and Statistics (M.C., J.Z.), Pavillon André-Aisenstadt, Montreal, Québec, Canada
| | - P Lavoie
- Department of Neurosurgery (P.L.), Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - T N Nguyen
- Departments of Neurology (T.N.N.)
- Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
| | - J Raymond
- From the Department of Radiology (W.B., D.I., D.R., A.W., J.R.), Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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Boisseau W, Darsaut TE, Fahed R, Findlay JM, Bourcier R, Charbonnier G, Smajda S, Ognard J, Roy D, Gariel F, Carlson AP, Shotar E, Ciccio G, Marnat G, Sporns PB, Gaberel T, Jecko V, Weill A, Biondi A, Boulouis G, Bras AL, Aldea S, Passeri T, Boissonneau S, Bougaci N, Gentric JC, Diestro JDB, Omar AT, Al-Jehani HM, Hage GE, Volders D, Kaderali Z, Tsogkas I, Magro E, Holay Q, Zehr J, Iancu D, Raymond J. Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study. AJNR Am J Neuroradiol 2022; 43:1437-1444. [PMID: 36137654 PMCID: PMC9575541 DOI: 10.3174/ajnr.a7648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE MCA aneurysms are still commonly clipped surgically despite the recent development of a number of endovascular tools and techniques. We measured clinical uncertainty by studying the reliability of decisions made for patients with middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS A portfolio of 60 MCA aneurysms was presented to surgical and endovascular specialists who were asked whether they considered surgery or endovascular treatment to be an option, whether they would consider recruitment of the patient in a randomized trial, and whether they would provide their final management recommendation. Agreement was studied using κ statistics. Intrarater reliability was assessed with the same, permuted portfolio of cases of MCA aneurysm sent to the same specialists 1 month later. RESULTS Surgical management was the preferred option for neurosurgeons (n = 844/1320; [64%] responses/22 raters), while endovascular treatment was more commonly chosen by interventional neuroradiologists (1149/1500 [76.6%] responses/25 raters). Interrater agreement was only "slight" for all cases and all judges (κ = 0.094; 95% CI, 0.068-0.130). Agreement was no better within specialties or with more experience. On delayed requestioning, 11 of 35 raters (31%) disagreed with themselves on at least 20% of cases. Surgical management and endovascular treatment were always judged to be a treatment option, for all patients. Trial participation was offered to patients 65% of the time. CONCLUSIONS Individual clinicians did not agree regarding the best management of patients with MCA aneurysms. A randomized trial comparing endovascular with surgical management of patients with MCA aneurysms is in order.
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Affiliation(s)
- W Boisseau
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - T E Darsaut
- Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Fahed
- Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - J M Findlay
- Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - G Charbonnier
- Departments of Interventional Neuroradiology (G. Charbonnier, A.B.)
| | - S Smajda
- Departments of Interventional Neuroradiology (S.S.)
| | - J Ognard
- Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - D Roy
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - F Gariel
- Departments of Neuroradiology (F.G., G.M.)
| | - A P Carlson
- Department of Neurosurgery (A.P.C.), University of New Mexico Hospital, Albuquerque, New Mexico
| | - E Shotar
- Department of Neuroradiology (E.S.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France
| | - G Ciccio
- Department of Interventional Neuroradiology (G. Ciccio), Centre Hospitalier de Bastia, Bastia, Corse, France
| | - G Marnat
- Departments of Neuroradiology (F.G., G.M.)
| | - P B Sporns
- Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology (P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Gaberel
- Department of Neurosurgery (T.G.), University Hospital of Caen, Caen, France
| | - V Jecko
- Neurosurgery (V.J.), University Hospital of Bordeaux, Bordeaux, France
| | - A Weill
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - A Biondi
- Departments of Interventional Neuroradiology (G. Charbonnier, A.B.)
| | - G Boulouis
- Department of Neuroradiology (G.B.), University Hospital of Tours, Tours, Indre et Loire, France
| | - A L Bras
- Department of Radiology (A.L.B.), Groupement Hospitaliser Bretagne Atlantique-Hôpital Chubert, Vannes, Bretagne, France
| | - S Aldea
- Neurosurgery (S.A.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - T Passeri
- Department of Neurosurgery (T.P.), Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - S Boissonneau
- Department of Neurosurgery (S.B.), La Timone Hospital
- L'Institut National de la Santé et de la Recherche Médicale (S.B.), Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France
| | - N Bougaci
- Neurosurgery (N.B.), Besançon University Hospital, Besançon, France
| | - J C Gentric
- Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - J D B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A T Omar
- Division of Neurosurgery (A.T.O.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - H M Al-Jehani
- Department of Neurosurgery, Radiology and Critical Care Medicine (H.M.A.-J.), King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
| | - G El Hage
- Department of Neurosurgery (G.E.H.), Centre Hospitalier de l'Université de Montréal,Montreal, Québec, Canada
| | - D Volders
- Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Z Kaderali
- Division of Neurosurgery (Z.K.), GB1-Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - I Tsogkas
- Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - E Magro
- Department of Neurosurgery (E.M.), Centre Hospitalier Universitaire Cavale Blanche, UBO L'Institut National de la Santé et de la Recherche Médicale, LaTIM UMR 1101, Brest, France
| | - Q Holay
- Department of Radiology (Q.H.), Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - J Zehr
- Department of Mathematics and Statistics (J.Z.), Pavillon André-Aisenstadt,Montreal, Québec, Canada
| | - D Iancu
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - J Raymond
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
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6
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Skutecki J, Audibert G, Finitsis S, Consoli A, Lapergue B, Blanc R, Bourcier R, Sibon I, Eugène F, Vannier S, Dargazanli C, Arquizan C, Anxionnat R, Richard S, Fahed R, Marnat G, Gory B. General anesthesia or conscious sedation for endovascular therapy of basilar artery occlusions: ETIS registry results. Rev Neurol (Paris) 2022; 178:771-779. [PMID: 35871014 DOI: 10.1016/j.neurol.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Acute basilar artery occlusions (BAO) are associated with poor outcome despite modern endovascular treatment (EVT). The best anesthetic management during EVT is not known and may affect the procedure and clinical outcome. We compared the efficacy and safety of general anesthesia (GA) and conscious sedation/local anesthesia (CS/LA) in a large cohort of stroke patients with BAO treated with EVT in current clinical practice. METHODS Data from the ongoing prospective multicenter Endovascular Treatment In Ischemic Stroke Registry of consecutive acute BAO patients who had EVT indication from January 1st, 2015, to December 31st, 2021, were retrospectively analyzed. Two groups were compared: patients treated with CS/LA versus GA (both types of anesthesia being performed in the angiosuite). Good outcome was defined as modified Rankin Scale (mRS) score 0-3 at 90 days. RESULTS Among the 524 included patients, 266 had GA and 246 had CS/LA (67 LA). Fifty-three patients finally did not undergo EVT: 15 patients (5.9%) in the GA group and 38 patients (16.1%) in the CS/LA group (P < 0.001). After matching, two groups of 129 patients each were retained for primary analysis. The two groups were well balanced in terms of baseline characteristics. After adjustment, CS/LA compared to GA was not associated with good outcome (OR=0.90 [95%CI 0.46-1.77] P=0.769) or mortality (OR=0.75 [0.37-1.49] P=0.420) or modified thrombolysis in cerebral infarction score 2b-3 (OR=0.43 [0.16-1.16] P=0.098). On mixed ordinal logistic regression, the modality of anesthesia was not associated with any significant change in the overall distribution of the 90-day mRS (adjusted OR=1.08 [0.62-1.88] P=0.767). CONCLUSIONS Safety, outcome and quality of EVT under either CS/LA or GA for stroke due to acute BAO appear similar. Further randomized trials are warranted.
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Affiliation(s)
- J Skutecki
- Department of Anesthesiology and Surgical Intensive Care, CHRU-Nancy, Université de Lorraine, 54000 Nancy, France
| | - G Audibert
- Department of Anesthesiology and Surgical Intensive Care, CHRU-Nancy, Université de Lorraine, 54000 Nancy, France
| | - S Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece.
| | - A Consoli
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Foch Hospital, Suresnes, France
| | - B Lapergue
- Department of Neurology, Versailles Saint-Quentin en Yvelines University, Foch Hospital, Suresnes, France
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - R Bourcier
- Inserm 1087, Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, CNRS, University of Nantes, Nantes, France
| | - I Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - F Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | - S Vannier
- Stroke Unit, Department of Neurology, University Hospital of Rennes, Rennes, France
| | - C Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui-de-Chauliac, Montpellier, France
| | - C Arquizan
- Department of Neurology, CHRU Gui-de-Chauliac, Montpellier, France
| | - R Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, 54000 Nancy, France; Inserm U1254, IADI, Université de Lorraine, 54000 Nancy, France
| | - S Richard
- Stroke Unit, Department of Neurology, CHRU-Nancy, Université de Lorraine, 54000 Nancy, France; CIC 1433 Plurithematic, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - R Fahed
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - G Marnat
- Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, 54000 Nancy, France; Inserm U1254, IADI, Université de Lorraine, 54000 Nancy, France
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7
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Janot K, Fahed R, Rouchaud A, Zuber K, Boulouis G, Forestier G, Mounayer C, Piotin M. Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion. AJNR Am J Neuroradiol 2022; 43:87-92. [PMID: 34794946 PMCID: PMC8757548 DOI: 10.3174/ajnr.a7350] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial stents for the treatment of aneurysms can be responsible for parent artery straightening, a phenomenon with potential consequences for aneurysmal occlusion. We aimed to evaluate parent artery straightening following flow-diverter stent placement in patients with intracranial aneurysms and explored the association between parent artery straightening and subsequent aneurysm occlusion. MATERIALS AND METHODS All patients treated with flow-diverter stents for anterior circulation aneurysms located downstream from the carotid siphon between January 2009 and January 2018 were screened for inclusion. Parent artery straightening was defined as the difference (α-β) in the parent artery angle at the neck level before (α angle) and after flow-diverter stent deployment (β angle). We analyzed the procedural and imaging factors associated with parent artery straightening and the associations between parent artery straightening and aneurysmal occlusion. RESULTS Ninety-five patients met the inclusion criteria (n = 64/95 women, 67.4%; mean age, 54.1 [SD, 11.2] years) with 97 flow-diverter stents deployed for 99 aneurysms. Aneurysms were predominantly located at the MCA bifurcation (n = 44/95, 44.4%). Parent artery straightening was found to be more pronounced in patients treated with cobalt chromium stents than with nitinol stents (P = .02). In multivariate analysis, parent artery straightening (P = .04) was independently associated with aneurysm occlusion after flow-diverter stent deployment. CONCLUSIONS The use of flow-diverter stents for distal aneurysms induces a measurable parent artery straightening, which is associated with higher occlusion rates. Parent artery straightening, in our sample, appeared to be more prominent with cobalt chromium stents than with nitinol stents. This work highlights the necessary trade-off between navigability and parent artery straightening and may help tailor the selection of flow-diverter stents to aneurysms and parent artery characteristics.
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Affiliation(s)
- K. Janot
- From the Department of Interventional Neuroradiology (K.J., G.B.), University Hospital of Tours, Tours, France
| | - R. Fahed
- Department of Interventional Neuroradiology (R.F., M.P.)
| | - A. Rouchaud
- Department of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
| | - K. Zuber
- Research and Biostatistics Unit (K.Z.), Rothschild Foundation Hospital, Paris, France
| | - G. Boulouis
- From the Department of Interventional Neuroradiology (K.J., G.B.), University Hospital of Tours, Tours, France
| | - G. Forestier
- Department of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
| | - C. Mounayer
- Department of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
| | - M. Piotin
- Department of Interventional Neuroradiology (R.F., M.P.)
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Lau L, Kandil I, Charlebois A, Chan K, Suh K, Fahed R, Garuba H, Law A, Chan V, Boodhwani M, Auclair F, Messika-Zeitoun D, Rubens F. IT TAKES A TEAM: IMPLEMENTATION OF A MULTIDISCIPLINARY ENDOCARDITIS HEART TEAM AT A CANADIAN TERTIARY CARE REFERRAL CENTRE. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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Benomar A, Farzin B, Gevry G, Boisseau W, Roy D, Weill A, Iancu D, Guilbert F, Létourneau-Guillon L, Jacquin G, Chaalala C, Bojanowski MW, Labidi M, Fahed R, Volders D, Nguyen TN, Gentric JC, Magro E, Boulouis G, Forestier G, Hak JF, Ghostine JS, Kaderali Z, Shankar JJ, Kotowski M, Darsaut TE, Raymond J. Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study. AJNR Am J Neuroradiol 2021; 42:1615-1620. [PMID: 34326106 DOI: 10.3174/ajnr.a7236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Noninvasive angiography is commonly used to assess the outcome of surgical or endovascular treatment of intracranial aneurysms in clinical series or randomized trials. We sought to assess whether a standardized 3-grade classification system could be reliably used to compare the CTA and MRA results of both treatments. MATERIALS AND METHODS An electronic portfolio composed of CTAs of 30 clipped and MRAs of 30 coiled aneurysms was independently evaluated by 24 raters of diverse experience and training backgrounds. Twenty raters performed a second evaluation 1 month later. Raters were asked which angiographic grade and management decision (retreatment; close or long-term follow-up) would be most appropriate for each case. Agreement was analyzed using the Krippendorff α (αK) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests. RESULTS Interrater agreement was substantial (αK = 0.63; 95% CI, 0.55-0.70); results were slightly better for MRA results of coiling (αK = 0.69; 95% CI, 0.56-0.76) than for CTA results of clipping (αK = 0.58; 95% CI, 0.44-0.69). Intrarater agreement was substantial to almost perfect. Interrater agreement regarding clinical management was moderate for both clipped (αK = 0.49; 95% CI, 0.32-0.61) and coiled subgroups (αK = 0.47; 95% CI, 0.34-0.54). The choice of clinical management was strongly associated with the size of the residuum (mean Cramer V = 0.77 [SD, 0.14]), but complete occlusions (grade 1) were followed more closely after coiling than after clipping (P = .01). CONCLUSIONS A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.
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Affiliation(s)
- A Benomar
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - B Farzin
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - G Gevry
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - W Boisseau
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - D Roy
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - A Weill
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - D Iancu
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - F Guilbert
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - L Létourneau-Guillon
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - G Jacquin
- Department of Medicine, Division of Neurology (G.J.)
| | - C Chaalala
- Division of Neurosurgery (C.C., M.W.B., M.L.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M W Bojanowski
- Division of Neurosurgery (C.C., M.W.B., M.L.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M Labidi
- Division of Neurosurgery (C.C., M.W.B., M.L.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - R Fahed
- Division ofNeurology (R.F.), The Ottawa Hospital Ottawa, Ontario, Canada
| | - D Volders
- Department of Diagnostic Radiology (D.V.), Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - T N Nguyen
- Departments of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
| | - J-C Gentric
- Departments of Interventional Neuroradiology (J.-C.G.)
| | - E Magro
- Neurosurgery (E.M.), Hôpital de la Cavale Blanche, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - G Boulouis
- Department of Neuroradiology (G.B.), Centre Hospitalier Régional et Universitaire de Tours, Tours, France
| | - G Forestier
- Department of Neuroradiology (G.F.), University Hospital of Limoges, Limoges, France
| | - J-F Hak
- Department of Medical Imaging (J.-F.H.), University Hospital Timone Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - J S Ghostine
- Department of Radiology (J.S.G.), Jean-Talon Hospital, Montreal, Quebec, Canada
| | | | - J J Shankar
- Department of Radiology (J.J.S.), Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - M Kotowski
- Department of Neurosurgery (M.K.), Hôpital de la Providence, Neuchâtel, Switzerland
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery,Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J Raymond
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
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Dhundass S, Savatovsky J, Duron L, Fahed R, Escalard S, Obadia M, Zuber K, Metten MA, Mejdoubi M, Blanc R, Sadik JC, Collin A, Lecler A. Erratum to: «Improved detection and characterization of arterial occlusion in acute ischemic stroke using Contrast Enhanced MRA» [J Neuroradiol 2020;47(4):278-283]. J Neuroradiol 2021; 48:495. [PMID: 34090696 DOI: 10.1016/j.neurad.2021.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah Dhundass
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neuroradiology, University Hospital of Martinique, Fort-de-France, Martinique
| | - Julien Savatovsky
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Loïc Duron
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Simon Escalard
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Michael Obadia
- Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Kevin Zuber
- Department of Clinical Research, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Marie Astrid Metten
- Department of Clinical Research, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Mehdi Mejdoubi
- Department of Neuroradiology, University Hospital of Martinique, Fort-de-France, Martinique
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Jean-Claude Sadik
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Adrien Collin
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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Boisseau W, Benaissa A, Fahed R, Amegnizin JL, Smajda S, Benadjaoud S, Benadjaoud AM, Saint-Val L, Alias Q, Iorio P, Yang S, Zuber K, Kalsoum E, Hodel J. Delayed Contrast-Enhanced MR Angiography for the Assessment of Internal Carotid Bulb Patency in the Context of Acute Ischemic Stroke: An Accuracy, Interrater, and Intrarater Agreement Study. AJNR Am J Neuroradiol 2021; 42:1116-1122. [PMID: 33707285 DOI: 10.3174/ajnr.a7054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CTA has shown limited accuracy and reliability in distinguishing tandem occlusions and pseudo-occlusions on initial acute stroke imaging. The utility of early and delayed contrast-enhanced MRA in this setting is unknown. We aimed to assess the accuracy and reliability of early and delayed contrast-enhanced MRA for carotid bulb patency in patients with acute ischemic stroke. MATERIALS AND METHODS We retrospectively reviewed patients who had ICA occlusion and underwent thrombectomy with preprocedural early and delayed contrast-enhanced MRA in a single comprehensive stroke center. During 2 sessions, 10 raters independently assessed 32 cases with early contrast-enhanced MRA (with an additional delayed contrast-enhanced MRA sequence during the second reading session). Their judgments were compared with DSA as a reference standard. Accuracy and interrater agreement were measured. Five raters undertook a third reading session to assess intrarater agreement. RESULTS Accuracy for the assessment of carotid bulb patency with early contrast-enhanced MRA was limited (69%; 95% CI, 59%-79%), with moderate interrater agreement (κ = 0.42; 95% CI, 0.27-0.55). The second reading with an additional delayed contrast-enhanced MRA sequence improved both accuracy (82%; 95% CI, 73%-91%; P < .001) (raters corrected 43%-77% of incorrect diagnoses with early contrast-enhanced MRA alone; mean = 59%) and interrater agreement (κ = 0.56; 95% CI, 0.41-0.73; P = .07). Intrarater agreement was almost perfect, substantial, and moderate for 3, 1, and 1 raters. CONCLUSIONS Early contrast-enhanced MRA has limited accuracy and repeatability for the evaluation of carotid bulb patency in acute ischemic stroke. The additional delayed contrast-enhanced MRA sequence may improve accuracy and reliability.
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Affiliation(s)
- W Boisseau
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - A Benaissa
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - R Fahed
- Department of Interventional Neuroradiology (R.F., S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J-L Amegnizin
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - S Smajda
- Department of Interventional Neuroradiology (R.F., S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Benadjaoud
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - A M Benadjaoud
- Department of Radiobiology and Epidemiology (A.M.B.), Institute for Radiological Protection and Nuclear Safety, Fontenay-Aux-Roses, France
| | - L Saint-Val
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - Q Alias
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - P Iorio
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - S Yang
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - K Zuber
- Clinical Research Unit (K.Z.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E Kalsoum
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - J Hodel
- Department of Radiology, (J.H.), Groupe-Hospitalier-Paris-Saint-Joseph, Paris, France
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Darsaut TE, Fahed R, Raymond J. Unruptured aneurysms: Why observational studies fall short no matter how "Big" the Data. Neurochirurgie 2021; 67:330-335. [PMID: 33713661 DOI: 10.1016/j.neuchi.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 02/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The best management of unruptured intracranial aneurysms (UIAs) remains unknown, despite multiple observational studies. A randomized trial (RCT) is in order. Yet, a National Institute Neurological Disorders and Stroke workshop has once again proposed to use prospective observational studies (POS) of large databases to address such problems. METHODS We review the historical misconceptions that have been associated with observations of UIAs and their treatments. We critically examine some recent methods that have been proposed to address shortcomings of observational studies. We finally review the ethical principles underlying the use of trial methods in the care of patients. RESULTS Replacing RCTs with POS submits patients to management options that have never been proven beneficial, while making them involuntary research subjects of studies that are inevitably biased. A science of practice cannot be an outsider's examination of the behavior of clinicians incapable of questioning their practice. The thesis we propose is that a science of practice must not only eventually determine what best practice will be; It must engage agents involved in medical practice to transparently reveal the uncertainty that calls for management options to be offered under the guidance of declared and controlled care research, to optimize patient outcomes in spite of the uncertainty. CONCLUSION To use POS rather than RCTs in medical practice is to renege on scientific and ethical principles that characterize modern medicine. Instead, we must learn to integrate care research into our practice to provide optimal medical care in real time.
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Affiliation(s)
- T E Darsaut
- Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Center, University of Alberta hospital, 8440 112th Street, Edmonton, T6G 2B7 Alberta, Canada.
| | - R Fahed
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Civic Campus, 1053, Carling Avenue, K1Y 4E9 Ottawa, Ontario, Canada.
| | - J Raymond
- Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, Saint-Denis, D03.5462B, H2X 0C1 Montreal, Quebec, Canada.
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13
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Darsaut TE, Derksen C, Farzin B, Keough MB, Fahed R, Boisseau W, Letourneau-Guillon L, Januel AC, Weill A, Roy D, Nguyen TN, Finitsis S, Gentric JC, Volders D, Carlson A, Chow MM, O'Kelly C, Rempel JL, Ashforth RA, Chagnon M, Zehr J, Findlay JM, Gevry G, Raymond J. Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study. AJNR Am J Neuroradiol 2021; 42:501-507. [PMID: 33509923 DOI: 10.3174/ajnr.a7021] [Citation(s) in RCA: 9] [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: 07/09/2020] [Accepted: 09/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. MATERIALS AND METHODS Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. RESULTS The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14-0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). CONCLUSIONS Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.
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Affiliation(s)
- T E Darsaut
- From the Department of Surgery (T.E.D., M.B.K., M.M.C., C.O., J.M.F.), Division of Neurosurgery
| | - C Derksen
- Stroke Program (C.D.), Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - B Farzin
- Research Center (B.F., G.G., J.R.)
| | - M B Keough
- From the Department of Surgery (T.E.D., M.B.K., M.M.C., C.O., J.M.F.), Division of Neurosurgery
| | - R Fahed
- Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - W Boisseau
- Department of Radiology (W.B., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Province du Québec, Canada
| | - L Letourneau-Guillon
- Department of Radiology (W.B., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Province du Québec, Canada
| | - A-C Januel
- Service de Neuroradiologie (A.-C.J.), Hôpital Purpan, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - A Weill
- Department of Radiology (W.B., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Province du Québec, Canada
| | - D Roy
- Department of Radiology (W.B., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Province du Québec, Canada
| | - T N Nguyen
- Service of Interventional Neurology and Neuroradiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
| | - S Finitsis
- Department of Radiology (S.F.), Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - J-C Gentric
- Department of Radiology (J.-C.G.), Division of Neuroradiology, Centre Hospitalier Universitaire Cavale Blanche, Brest, France
| | - D Volders
- Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Carlson
- Department of Neurosurgery (A.C.), University of New Mexico, Albuquerque, New Mexico
| | - M M Chow
- From the Department of Surgery (T.E.D., M.B.K., M.M.C., C.O., J.M.F.), Division of Neurosurgery
| | - C O'Kelly
- From the Department of Surgery (T.E.D., M.B.K., M.M.C., C.O., J.M.F.), Division of Neurosurgery
| | - J L Rempel
- Department of Radiology and Diagnostic Imaging (J.L.R., R.A.A.), University of Alberta hospital, Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - R A Ashforth
- Department of Radiology and Diagnostic Imaging (J.L.R., R.A.A.), University of Alberta hospital, Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - M Chagnon
- Department of Mathematics and Statistics (M.C., J.Z.), Université de Montréal, Montreal, Province du Québec, Canada
| | - J Zehr
- Department of Mathematics and Statistics (M.C., J.Z.), Université de Montréal, Montreal, Province du Québec, Canada
| | - J M Findlay
- From the Department of Surgery (T.E.D., M.B.K., M.M.C., C.O., J.M.F.), Division of Neurosurgery
| | - G Gevry
- Research Center (B.F., G.G., J.R.)
| | - J Raymond
- Research Center (B.F., G.G., J.R.) .,Department of Radiology (W.B., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Province du Québec, Canada
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Constant Dit Beaufils P, Preterre C, De Gaalon S, Labreuche J, Mazighi M, Di Maria F, Sibon I, Marnat G, Gariel F, Blanc R, Gory B, Consoli A, Zhu F, Richard S, Fahed R, Desal H, Lapergue B, Guillon B, Bourcier R. Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study. Eur J Neurol 2020; 28:229-237. [PMID: 32935401 DOI: 10.1111/ene.14539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT. METHODS Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22-36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4-6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. RESULTS Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44-2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47-2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22-2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77-5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. CONCLUSIONS Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
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Affiliation(s)
| | - C Preterre
- Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France
| | - S De Gaalon
- Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France
| | - J Labreuche
- CHU Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, University of Lille, Lille, France
| | - M Mazighi
- Department of Interventional Neuroradiology Fondation Ophtalmologique A. De Rothschild, Unité INSERM 1148, Université de Paris, Paris, France
| | - F Di Maria
- Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - I Sibon
- Department of Neurology, CHU Bordeaux, Stroke Unit, Université de Bordeaux, Bordeaux, France
| | - G Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - F Gariel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - R Blanc
- Department of Interventional Neuroradiology Fondation Ophtalmologique A. De Rothschild, Unité INSERM 1148, Université de Paris, Paris, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - A Consoli
- Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - F Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - S Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine (S.R.), Nancy, France.,INSERM U1116, CHRU-Nancy, Nancy, France
| | - R Fahed
- Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France.,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - H Desal
- Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France.,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - B Lapergue
- Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - B Guillon
- Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France
| | - R Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France.,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
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15
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Guenego A, Bourcier R, Guillen M, Weisenburger-Lile D, Lapergue B, Gory B, Richard S, Ducroux C, Piotin M, Blanc R, Labreuche J, Lucas L, Detraz L, Aubertin M, Dargazanli C, Benali A, Vannier S, Eugene F, Lun R, Walker G, Consoli A, Fahed R. Neurological improvement predicts clinical outcome after acute basilar artery stroke thrombectomy. Eur J Neurol 2020; 28:117-123. [PMID: 32812674 DOI: 10.1111/ene.14487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO. METHODS We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI. RESULTS A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI. CONCLUSION Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.
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Affiliation(s)
- A Guenego
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.,Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - R Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France
| | - M Guillen
- Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - B Lapergue
- Neurovascular Unit, Foch Hospital, Suresnes, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - S Richard
- Stroke Unit, Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France.,INSERM U1116, CHRU-Nancy, Nancy, France
| | - C Ducroux
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - R Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - J Labreuche
- ULR 2694-METRICS: Evaluation Des Technologies De Santé et des Pratiques Médicales, Univ. Lille, CHU Lille, Lille, France
| | - L Lucas
- Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - L Detraz
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France
| | - M Aubertin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - C Dargazanli
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - A Benali
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - S Vannier
- Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - F Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - R Lun
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - G Walker
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, Division of Neurology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - A Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | - R Fahed
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.,Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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Smajda S, Ciccio G, Fahed R, Robert T, Blanc R, Piotin M. Pronostic visuel après traitement endovasculaire des malformations artérioveineuses occipitales. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Smajda S, Ciccio G, Fahed R, Robert T, Blanc R, Piotin M. Traitement endovasculaire d’une malformation artérioveineuse hypothalamique. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Sabben C, Desilles JP, Charbonneau F, Savatovsky J, Morvan E, Obadia A, Raynouard I, Fela F, Escalard S, Redjem H, Smajda S, Ciccio G, Blanc R, Fahed R, Le Guerinel C, Engrand N, Ben Maacha M, Labreuche J, Mazighi M, Piotin M, Obadia M. Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion-weighted imaging lesions. Eur J Neurol 2020; 27:1988-1995. [PMID: 32431009 DOI: 10.1111/ene.14330] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. METHODS Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were <65 years old with severe anterior circulation AIS with a National Institutes of Health Stroke Scale score >15, baseline Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 6 and baseline diffusion-weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score ≥ 2b. Occurrence of MMI was the primary endpoint. RESULTS A total of 66 EVT-treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%; P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%; P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10-1.12) for MMI and 2.77 (0.84-10.43) for 3-month favorable outcome occurrence. CONCLUSIONS Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI.
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Affiliation(s)
- C Sabben
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - J P Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - F Charbonneau
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris
| | - J Savatovsky
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris
| | - E Morvan
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - A Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - I Raynouard
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - F Fela
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - S Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - H Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - S Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - G Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - R Fahed
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - C Le Guerinel
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris
| | - N Engrand
- Neuro Intensive Care Unit, Rothschild Foundation Hospital, Paris
| | - M Ben Maacha
- Research and Biostatistics Unit, Rothschild Foundation Hospital, Paris
| | - J Labreuche
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, CHU Lille, Université de Lille, Lille, France
| | - M Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - M Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris
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Guenego A, Fahed R, Albers GW, Kuraitis G, Sussman ES, Martin BW, Marcellus DG, Olivot J, Marks MP, Lansberg MG, Wintermark M, Heit JJ. Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion. Eur J Neurol 2020; 27:864-870. [DOI: 10.1111/ene.14181] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A. Guenego
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | - R. Fahed
- Department of Medicine Division of Neurology Ottawa Hospital Ottawa ON Canada
| | - G. W. Albers
- Stanford Stroke Center Stanford University School of Medicine Stanford CA USA
| | - G. Kuraitis
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | - E. S. Sussman
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | - B. W. Martin
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | - D. G. Marcellus
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | | | - M. P. Marks
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | - M. G. Lansberg
- Stanford Stroke Center Stanford University School of Medicine Stanford CA USA
| | - M. Wintermark
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
| | - J. J. Heit
- Interventional and Diagnostic Neuroradiology Stanford Medical Center Stanford CA USA
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21
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Darsaut T, Roy D, Weill A, Bojanowski M, Chaalala C, Bilocq A, Findlay J, Rempel J, Chow M, O’Kelly C, Ashforth R, Kotowski M, Magro E, Lemus M, Fahed R, Arikan F, Arrese I, Sarabia R, Altschul D, Chagnon M, Guilbert F, Shankar J, Proust F, Nolet S, Gevry G, Raymond J. A randomized trial of endovascular versus surgical management of ruptured intracranial aneurysms: Interim results from ISAT2. Neurochirurgie 2019; 65:370-376. [DOI: 10.1016/j.neuchi.2019.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 01/08/2023]
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22
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Ducroux C, Fahed R, Khoury NN, Gevry G, Kalsoum E, Labeyrie MA, Ziegler D, Sauve C, Chagnon M, Darsaut TE, Raymond J. Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study. Rev Neurol (Paris) 2019; 175:380-389. [PMID: 31047687 DOI: 10.1016/j.neurol.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/23/2018] [Accepted: 10/19/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE We aimed to assess agreement on intravenous tissue-plasminogen activator (IV tPA) and mechanical thrombectomy (MT) management decisions in acute ischemic stroke (AIS) patients. Secondary objectives were to assess agreement on Diffusion-Weighted-Imaging-Alberta-Stroke-Program-EArly-CT-Score (DWI-ASPECTS), and clinicians' willingness to recruit patients in a randomized controlled trial (RCT) comparing medical management with or without MT. MATERIALS AND METHODS Studies assessing agreement of IV tPA and MT were systematically reviewed. An electronic portfolio of 41 AIS patients was sent to randomly selected providers at French stroke centers. Raters were asked 4 questions for each case: (1) What is the DWI-ASPECTS? (2) Would you perform IV tPA? (3) Would you perform MT? (4) Would you include the patient in a RCT comparing standard medical therapy with or without MT? Twenty responders were randomly selected to study intrarater agreement. Agreement was assessed using Fleiss' Kappa statistics. RESULTS The review yielded two single center studies involving 2-5 raters, with various results. The electronic survey was answered by 86 physicians (60 vascular neurologists and 26 interventional neuroradiologists). The interrater agreement was moderate for IV tPA treatment decisions (κ=0.565 [0.420-0.680]), but only fair for MT (κ=0.383 [0.289-0.491]) and for combined treatment decisions (κ=0.399 [0.320-0.486]). The intrarater agreement was at least substantial for the majority of raters. The interrater agreement for DWI-ASPECTS was fair (κ=0.325 [0.276-0.387]). Physicians were willing to include a mean of 14±9 patients (33.1%±21.7%) in a RCT. CONCLUSION Disagreements regarding the use of IVtPA or MT in the management of AIS patients remain frequent. Further trials are needed to resolve the numerous areas of uncertainty.
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Affiliation(s)
- C Ducroux
- Interventional Neuroradiology Department-Fondation Ophtalmologique Adolphe de Rothschild Hospital, 75019 Paris, France; Radiology Department-Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal, Canada
| | - R Fahed
- Interventional Neuroradiology Department-Fondation Ophtalmologique Adolphe de Rothschild Hospital, 75019 Paris, France; Radiology Department-Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal, Canada
| | - N N Khoury
- HSHS Neuroscience Center - HSHS St. John's Hospital, 62769 Springfield, IL, USA
| | - G Gevry
- Radiology Department-Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal, Canada
| | - E Kalsoum
- Neuroadiology Department-Henri Mondor Hospital, 94010 Créteil, France
| | - M-A Labeyrie
- Neuroadiology Department-Lariboisière Hospital, 75010 Paris, France
| | - D Ziegler
- CHUM Library - Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal-Québec, Canada
| | - C Sauve
- CHUM Library - Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal-Québec, Canada
| | - M Chagnon
- Department of Mathematics and Statistic-Université de Montréal, H2X 3E4 Montreal-Québec, Canada
| | - T E Darsaut
- Department of Surgery, Division of Neurosurgery - University of Alberta Hospital, Mackenzie Health Sciences Centre, T6G 2B7 Edmonton-Alberta, Canada
| | - J Raymond
- Radiology Department-Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal, Canada.
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Nico L, Magro E, Ognard J, Fahed R, Salazkin I, Gevry G, Darsaut T, Raymond J, Gentric J. Pénétration de cyanoacrylates d’alpha-hexil et de n-butyle à l’aide de la technique modifiée de « pressure cooker technique » : une étude expérimentale chez l’animal. J Neuroradiol 2019. [DOI: 10.1016/j.neurad.2019.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baharvahdat H, Blanc R, Fahed R, Smajda S, Ciccio G, Desilles JP, Redjem H, Escalard S, Mazighi M, Chauvet D, Robert T, Sasannejad P, Piotin M. Endovascular Treatment for Low-Grade (Spetzler-Martin I-II) Brain Arteriovenous Malformations. AJNR Am J Neuroradiol 2019; 40:668-672. [PMID: 30792251 DOI: 10.3174/ajnr.a5988] [Citation(s) in RCA: 15] [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: 09/25/2018] [Accepted: 01/08/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Surgical resection is usually considered as the first-line curative strategy for low-grade (Spetzler-Martin grade I-II) brain arteriovenous malformations because it has a high cure rate and low complications. The role of endovascular treatment remains to be clarified in this indication, especially after A Randomized Trial of Unruptured Brain Arteriovenous Malformations. Our objective was to assess the safety and efficacy of first-line endovascular treatment in low-grade brain arteriovenous malformation management at our institution. MATERIALS AND METHODS Patients with low-grade brain arteriovenous malformations treated primarily with embolization in our department between January 2005 and December 2015 were retrieved from our prospectively collected registry. The primary outcome was the brain arteriovenous malformation obliteration rate, and secondary outcomes were disability or death secondary to brain arteriovenous malformation embolization assessed through modification of the modified Rankin Scale. RESULTS Two hundred twenty-four patients completed endovascular treatment during the study period and represent our study population. Complete exclusion of brain arteriovenous malformations was achieved in 205 patients (92%), including 62.1% of brain arteriovenous malformation exclusions after a single endovascular treatment session. One patient died of a hemorrhagic complication after endovascular treatment, leading to a mortality rate of 0.4%. Twelve patients (5%) kept a permanent neurologic deficit secondary to a complication of the endovascular treatment. An overall good outcome (mRS 0-2) was reported in 179 patients (80%). CONCLUSIONS Endovascular treatment might be a suitable alternative to surgical resection for complete exclusion of selected low-grade brain arteriovenous malformations.
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Affiliation(s)
- H Baharvahdat
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - R Blanc
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - R Fahed
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - S Smajda
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - G Ciccio
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - J-P Desilles
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - H Redjem
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - S Escalard
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - M Mazighi
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - D Chauvet
- Neurosurgical Department (D.C.), Rothschild Foundation, Paris, France
| | - T Robert
- Neurosurgical Department (T.R.), Ente-Ospedaliero-Cantonale Ospedale Civico di Lugano, Lugano, Switzerland
| | - P Sasannejad
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
| | - M Piotin
- From the Department of Interventional Neuroradiology (H.B., R.B., R.F., S.S., G.C., J.-P.D, H.R., S.E., M.M., P.S., M.P.)
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25
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Guenego A, Lecler A, Raymond J, Sabben C, Khoury N, Premat K, Botta D, Boisseau W, Maïer B, Ciccio G, Redjem H, Smajda S, Ducroux C, Di Meglio L, Davy V, Olivot JM, Wang A, Duplantier J, Roques M, Krystal S, Koskas P, Collin A, Ben Maacha M, Hamdani M, Zuber K, Blanc R, Piotin M, Fahed R. Hemorrhagic transformation after stroke: inter- and intrarater agreement. Eur J Neurol 2018; 26:476-482. [PMID: 30414302 DOI: 10.1111/ene.13859] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation (HT) is a complication of stroke that can occur spontaneously or after treatment. We aimed to assess the inter- and intrarater reliability of HT diagnosis. METHODS Studies assessing the reliability of the European Cooperative Acute Stroke Study (ECASS) classification of HT or of the presence (yes/no) of HT were systematically reviewed. A total of 18 raters independently examined 30 post-thrombectomy computed tomography scans selected from the Aspiration versus STEnt-Retriever (ASTER) trial. They were asked whether there was HT (yes/no), what the ECASS classification of the particular scan (0/HI1/HI2/PH1/PH2) (HI indicates hemorrhagic infarctions and PH indicates parenchymal hematomas) was and whether they would prescribe an antiplatelet agent if it was otherwise indicated. Agreement was measured with Fleiss' and Cohen's κ statistics. RESULTS The systematic review yielded four studies involving few (≤3) raters with heterogeneous results. In our 18-rater study, agreement for the presence of HT was moderate [κ = 0.55; 95% confidence interval (CI), 0.41-0.68]. Agreement for ECASS classification was only fair for all five categories, but agreement improved to substantial (κ = 0.72; 95% CI, 0.69-0.75) after dichotomizing the ECASS classification into 0/HI1/HI2/PH1 versus PH2. The inter-rater agreement for the decision to reintroduce antiplatelet therapy was moderate for all raters, but substantial among vascular neurologists (κ = 0.70; 95% CI, 0.57-0.84). CONCLUSION The ECASS classification may involve too many categories and the diagnosis of HT may not be easily replicable, except in the presence of a large parenchymal hematoma.
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Affiliation(s)
- A Guenego
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris.,Interventional Neuroradiology Department, Toulouse University Hospital, Paris
| | - A Lecler
- Diagnostic Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - J Raymond
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - C Sabben
- Neurology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - N Khoury
- HSHS Neuroscience Center, HSHS St John's Hospital, Springfield, IL, USA
| | - K Premat
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - D Botta
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - W Boisseau
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - B Maïer
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - G Ciccio
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - H Redjem
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - S Smajda
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - C Ducroux
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - L Di Meglio
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - V Davy
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - J M Olivot
- Vascular Neurology Department, Toulouse University Hospital, Paris
| | - A Wang
- Vascular Neurology Department, Foch Hospital, Suresnes
| | - J Duplantier
- Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse
| | - M Roques
- Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse
| | - S Krystal
- Diagnostic Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - P Koskas
- Diagnostic Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - A Collin
- Diagnostic Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - M Ben Maacha
- Biostatistics, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - M Hamdani
- Biostatistics, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - K Zuber
- Biostatistics, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris, France
| | - R Blanc
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - M Piotin
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
| | - R Fahed
- Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, Paris
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Escalard S, Piotin M, Fahed R. No evidence for considering wake-up and daytime unwitnessed strokes differently for thrombectomy. Eur J Neurol 2018; 25:e64. [PMID: 29756318 DOI: 10.1111/ene.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S Escalard
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - R Fahed
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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27
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Ducroux C, Khoury N, Lecler A, Blanc R, Chetrit A, Redjem H, Ciccio G, Smajda S, Escalard S, Desilles J, Mazighi M, Ben Maacha M, Piotin M, Fahed R. Application of the
DAWN
clinical imaging mismatch and
DEFUSE
3 selection criteria: benefit seems similar but restrictive volume cut‐offs might omit potential responders. Eur J Neurol 2018; 25:1093-1099. [DOI: 10.1111/ene.13660] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. Ducroux
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - N. Khoury
- HSHS Neuroscience Center HSHS St John's Hospital Springfield IL USA
| | - A. Lecler
- Diagnostic Radiology Unit Fondation Rothschild Hospital ParisFrance
| | - R. Blanc
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - A. Chetrit
- Diagnostic Radiology Unit Fondation Rothschild Hospital ParisFrance
| | - H. Redjem
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - G. Ciccio
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - S. Smajda
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - S. Escalard
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - J.‐P. Desilles
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - M. Mazighi
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - M. Ben Maacha
- Research and Biostatistics Unit Fondation Rothschild Hospital Paris France
| | - M. Piotin
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - R. Fahed
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
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Escalard S, Gory B, Kyheng M, Desilles JP, Redjem H, Ciccio G, Smajda S, Labreuche J, Mazighi M, Piotin M, Blanc R, Lapergue B, Fahed R. Unknown-onset strokes with anterior circulation occlusion treated by thrombectomy after DWI-FLAIR mismatch selection. Eur J Neurol 2018; 25:732-738. [DOI: 10.1111/ene.13580] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- S. Escalard
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - B. Gory
- Department of Interventional Neuroradiology; Hôpital Neurologique Pierre Wertheimer; Bron France
| | - M. Kyheng
- EA 2694-Santé Publique: Epidémiologie et Qualité des Soins; CHU Lille; University of Lille; Lille France
| | - J.-P. Desilles
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
| | - H. Redjem
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - G. Ciccio
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - S. Smajda
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - J. Labreuche
- EA 2694-Santé Publique: Epidémiologie et Qualité des Soins; CHU Lille; University of Lille; Lille France
| | - M. Mazighi
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
- Paris Diderot and Sorbonne Paris Cite Universities; Paris France
- DHU NeuroVasc; Paris France
| | - M. Piotin
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
| | - R. Blanc
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
| | - B. Lapergue
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
- Department of Neurology; Stroke Center; Foch Hospital; University Versailles Saint-Quentin en Yvelines; Suresnes France
| | - R. Fahed
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
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Robert T, Blanc R, Sylvestre P, Ciccio G, Smajda S, Botta D, Redjem H, Fahed R, Piotin M. A proposed grading system to evaluate the endovascular curability of deep-seated arteriovenous malformations. J Neurol Sci 2017; 377:212-218. [PMID: 28477698 DOI: 10.1016/j.jns.2017.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/14/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Aggressive treatment of deep-seated AVMs is paramount because of their high tendency to bleed (or to re-bleed). In the literature concerning endovascular therapy, AVMs of the basal ganglia, the semi-ovale center and the midbrain are always considered as a single entity. In this study, the authors address the anatomical classification of these AVMs and propose a classification that considers factors influencing their endovascular curability. METHODS From 1995 to 2013, clinical and angiographic data of cerebral AVMs were prospectively collected. We reviewed data from patients treated for a deep-seated AVM with the goal to distinguish factors that influence the curability and the outcome of these AVMs. RESULTS 134 patients (mean age: 28years) were consecutively treated by endovascular techniques. We describe an anatomical classification concerning the exact location of the nidus and distinguish 5 different sub-types (anterior, lateral, medial, posterior and midbrain). Then, we propose a grading system based on statistical analysis of our series to evaluate the curability of a deep AVM. This comprehensive score is calculated with the Spetzler-Martin grade, the location of the nidus, its type, arterial feeders and venous drainage. CONCLUSIONS Deep-seated AVMs may be classified according to their exact location; we can distinguish 5 different sub-types (anterior, lateral, medial, posterior and midbrain). Each group presented different arterial supplies and venous drainage that influenced treatment possibilities. The comprehensive grading system that we propose in this study must be tested in another deep-seated AVMs population.
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Affiliation(s)
- Th Robert
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - P Sylvestre
- University of Montreal, Montreal, Quebec, Canada
| | - G Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - S Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - D Botta
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - H Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - R Fahed
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Robert T, Blanc R, Ciccio G, Smajda S, Botta D, Redjem H, Fahed R, Piotin M. Score pronostique pour évaluer la curabilité par voie endovasculaire des malformations artérioveineuses profondes. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fahed R, Darsaut TE, Salazkin I, Gentric JC, Mazighi M, Raymond J. Testing Stenting and Flow Diversion Using a Surgical Elastase-Induced Complex Fusiform Aneurysm Model. AJNR Am J Neuroradiol 2016; 38:317-322. [PMID: 27884881 DOI: 10.3174/ajnr.a5018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rabbit elastase-induced saccular aneurysms have been commonly used for preclinical testing of endovascular devices, including flow diverters. However, all tested devices have been shown to be capable of aneurysm occlusion with this model. We aimed to create a more challenging model to test and discriminate among neurovascular devices of varying efficacies. MATERIALS AND METHODS With a surgical approach that included elastase infusion and balloon dilation, we attempted the creation of complex fusiform aneurysms in 16 rabbits, with standard saccular carotid aneurysms created in 15 other animals. Aneurysms were randomly allocated to one of the following treatments: flow diversion (n = 8), high-porosity stent (n = 6), double high-porosity stent (n = 5), and control (n = 6). Angiographic assessment and pathologic analyses were performed at 3 months. RESULTS Creation of complex fusiform and standard saccular aneurysms was successful in 12/16 and 13/15 attempts, respectively. All saccular (n = 4) or complex fusiform (n = 4) aneurysms treated with flow diverters were successfully occluded. Three of 3 saccular compared with 0/2 complex fusiform aneurysms were occluded by double high-porosity stents. One of 3 saccular and 0/3 complex fusiform aneurysms were occluded by a single high-porosity stent. Both aneurysm types shared the same pathologic findings when untreated: The aneurysm wall lacked an elastic layer and smooth muscle cells, while the lumen was lined with neointima of varying thickness. Neointimal coverage of the devices was complete when aneurysms were occluded, while leaks were always associated with aneurysm remnants. CONCLUSIONS Challenging fusiform aneurysms can be created in rabbits by using a surgical modification of the elastase method.
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Affiliation(s)
- R Fahed
- From the Centre Hospitalier de l'Université de Montréal (R.F., I.S., J.R.), Interventional Neuroradiology Research Laboratory, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - I Salazkin
- From the Centre Hospitalier de l'Université de Montréal (R.F., I.S., J.R.), Interventional Neuroradiology Research Laboratory, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - J-C Gentric
- Department of Radiology (J.-C.G.), Division of Neuroradiology, Centre Hospitalo-Universitaire Cavale Blanche, Brest, France
| | - M Mazighi
- Department of Interventional Neuroradiology (M.M.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J Raymond
- From the Centre Hospitalier de l'Université de Montréal (R.F., I.S., J.R.), Interventional Neuroradiology Research Laboratory, Notre-Dame Hospital, Montreal, Quebec, Canada
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Robert T, Botta D, Blanc R, Fahed R, Ciccio G, Smajda S, Redjem H, Piotin M. Ocular Signs Caused by Dural Arteriovenous Fistula without Involvement of the Cavernous Sinus: A Case Series with Review of the Literature. AJNR Am J Neuroradiol 2016; 37:1870-1875. [PMID: 27231228 DOI: 10.3174/ajnr.a4831] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/31/2016] [Indexed: 11/07/2022]
Abstract
Carotid cavernous fistula is a well-known clinical and angiographic entity responsible for ocular signs and symptoms. On the contrary, ocular signs are unusual in the presentation of cranial dural arteriovenous fistulas at locations other than the cavernous sinus. We retrospectively analyzed data focusing on the pathophysiology of ophthalmologic signs and their angiographic explanations. Thirteen patients were included with a mean age of 50 years. The most common signs were chemosis (61.5%), loss of visual acuity (38.5%), exophthalmia (38.5%), and ocular hypertension (7.7%). Dural arteriovenous fistulas presenting with ocular signs could be classified into 4 types due to their pathologic mechanism (local venous reflux into the superior ophthalmic vein, massive venous engorgement of the cerebrum responsible for intracranial hypertension, compression of an oculomotor nerve by a venous dilation, or intraorbital fistula with drainage into the superior ophthalmic vein).
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Affiliation(s)
- T Robert
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
| | - D Botta
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - R Blanc
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - R Fahed
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - G Ciccio
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - S Smajda
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - H Redjem
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Piotin
- From the Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Fahed R, Gentric JC, Salazkin I, Gevry G, Raymond J, Darsaut TE. Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model. J Neurointerv Surg 2016; 9:311-315. [PMID: 27067714 DOI: 10.1136/neurintsurg-2015-012240] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverters (FDs) are increasingly used for bifurcation aneurysms. Failure of aneurysm occlusion may be caused by residual flow maintaining patency of the jailed branch along with the aneurysm. Our aim was to test whether endovascular occlusion of the jailed branch could improve efficacy of flow diversion of bifurcation aneurysms. MATERIALS AND METHODS Sixteen wide-necked lingual-carotid artery bifurcation aneurysms were created in eight canines. Patent aneurysms were randomly allocated 4 weeks later to flow diversion combined with jailed branch occlusion using coils and/or Onyx (n=6) or flow diversion alone (n=8). Angiographic results of aneurysm occlusion at 3 months were scored using an ordinal scale. Pathology specimens were photographed and neointimal coverage estimated using a semiquantitative scoring system. RESULTS Fourteen aneurysms were patent at 1 month. FD deployment was successful in all cases but, at 3-month follow-up, three devices had prolapsed into the aneurysm. None of the bifurcation aneurysms treated with FD alone were occluded at 3 months. Endovascular branch occlusion combined with flow diversion significantly improved aneurysm occlusion rates compared with flow diversion alone (median angiographic scores 2 vs 0: p=0.0137). Flow-limiting parent vessel stenosis was not observed in any arteries. Devices were covered with thick neointima in most cases, but patent aneurysms were associated with leaks or holes in the neointima covering the aneurysm neck. CONCLUSIONS Treatment failures following flow diversion of bifurcation aneurysms can be caused by persistent flow to the jailed branch. Branch occlusion combined with flow diversion may improve angiographic occlusion scores of a canine bifurcation aneurysm model.
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Affiliation(s)
- R Fahed
- Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - J C Gentric
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
| | - I Salazkin
- Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - G Gevry
- Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - J Raymond
- Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
| | - T E Darsaut
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Robert T, Blanc R, Ciccio G, Gilboa B, Fahed R, Boissonnet H, Redjem H, Pistocchi S, Bartolini B, Piotin M. Endovascular treatment of posterior fossa arteriovenous malformations. J Clin Neurosci 2016; 25:65-8. [PMID: 26549679 DOI: 10.1016/j.jocn.2015.05.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/07/2015] [Accepted: 05/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- T Robert
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France.
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - G Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - B Gilboa
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - R Fahed
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - H Boissonnet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - H Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - S Pistocchi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - B Bartolini
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019 Paris, France
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Darsaut TE, Fahed R, Raymond J. Could we clinicians be the greatest barrier to real progress in our field? J Neurointerv Surg 2016; 9:425-426. [PMID: 26847332 DOI: 10.1136/neurintsurg-2016-012282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 11/03/2022]
Affiliation(s)
- T E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Fahed
- Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - J Raymond
- Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
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Jamali S, Fahed R, Gentric JC, Letourneau-Guillon L, Raoult H, Bing F, Estrade L, Nguyen TN, Tollard É, Ferre JC, Iancu D, Naggara O, Chagnon M, Weill A, Roy D, Fox AJ, Kallmes DF, Raymond J. Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA. AJNR Am J Neuroradiol 2015; 37:879-84. [PMID: 26659336 DOI: 10.3174/ajnr.a4609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients treated with coiling are often followed by MR angiography. Our objective was to assess the inter- and intraobserver agreement in diagnosing aneurysm remnants and recurrences by using multimodality imaging, including TOF MRA. MATERIALS AND METHODS A portfolio composed of 120 selected images from 56 patients was sent to 15 neuroradiologists from 10 institutions. For each case, raters were asked to classify angiographic results (3 classes) of 2 studies (32 MRA-MRA and 24 DSA-MRA pairs) and to provide a final judgment regarding the presence of a recurrence (no, minor, major). Six raters were asked to independently review the portfolio twice. A second study, restricted to 4 raters having full access to all images, was designed to validate the results of the electronic survey. RESULTS The proportion of cases judged to have a major recurrence varied between 16.1% and 71.4% (mean, 35.0% ± 12.7%). There was moderate agreement overall (κ = 0.474 ± 0.009), increasing to nearly substantial (κ = 0.581 ± 0.014) when the judgment was dichotomized (presence or absence of a major recurrence). Agreement on cases followed-up by MRA-MRA was similarly substantial (κ = 0.601 ± 0.018). The intrarater agreement varied between fair (κ = 0.257 ± 0.093) and substantial (κ= 0.699 ± 0.084), improving with a dichotomized judgment concerning MRA-MRA comparisons. Agreement was no better when raters had access to all images. CONCLUSIONS There is an important variability in the assessment of angiographic outcomes of endovascular treatments. Agreement on the presence of a major recurrence when comparing 2 MRA studies or the MRA with the last catheter angiographic study can be substantial.
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Affiliation(s)
- S Jamali
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - R Fahed
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - J-C Gentric
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada Groupe d'étude de la Thrombose en Bretagne Occidentale (J.-C.G.), Brest, France
| | - L Letourneau-Guillon
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - H Raoult
- Service de radiologie et imagerie médicale (H.R., J.-C.F.), Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - F Bing
- Service imagerie médicale et interventionnelle (F.B.), Centre Hospitalier Annecy Genevois, St-Julien en Genevois, France
| | - L Estrade
- Service Imagerie, Médecine nucléaire et Explorations fonctionnelles (L.E.), Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - T N Nguyen
- Departments of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
| | - É Tollard
- Service d'Imagerie Médicale (E.T.), Centre Hospitalier Universitaire Hôpitaux de Rouen, Charles Nicolle, Rouen, France
| | - J-C Ferre
- Service de radiologie et imagerie médicale (H.R., J.-C.F.), Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - D Iancu
- Service of Diagnostic Imaging (D.I.), The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - O Naggara
- Service d'Imagerie Morphologique et Fonctionnelle (O.N.), Centre Hospitalier Sainte Anne, Paris, France
| | - M Chagnon
- Department of Mathematics and Statistics (M.C.), University of Montreal, Montreal, Quebec, Canada
| | - A Weill
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - D Roy
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - A J Fox
- Department of Medical Imaging (A.J.F.), University of Toronto, Toronto, Ontario, Canada
| | - D F Kallmes
- Department of Neurointerventional Radiology (D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - J Raymond
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
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Robert T, Blanc R, Ciccio G, Redjem H, Fahed R, Smajda S, Piotin M. Anatomic and angiographic findings of cerebellar arteriovenous malformations: Report of a single center experience. J Neurol Sci 2015; 358:357-61. [PMID: 26412159 DOI: 10.1016/j.jns.2015.09.361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/10/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
Abstract
Cerebellar arteriovenous malformations (AVM) are rare and comprise only 5-10% of cerebral AVM. The concentration of eloquent neurological systems and the high rate of bleeding presentation of AVMs particularly in this location complicate the management of such lesions. New therapeutic options, especially in endovascular neurosurgery, have fundamentally modified the strategy and, also, the outcome of cerebellar AVMs. Between 1995 and 2013, demographic, clinical and angiographic data of cerebral AVMs have been prospectively collected. We analyzed data of patients treated for a cerebellar AVM, focusing on the angiographic anatomy. Fifty-nine patients (mean age : 35 years, male to female ratio : 2) were consecutively treated for a cerebellar AVM. 81.4% of them presented bleeding at admission. 20 AVMs (33.9%) were in eloquent areas. The Spetzler-Martin grade was I or II in 36 cases (51%). An associated aneurysm was noted in more than 40% of cases and a venous drainage anomaly in 70%. The vast majority of cases of this series presented an anatomical risk factor of bleeding. Patients with cerebellar AVMs presented with bleeding more often than patients with supratentorial AVMs, justifying an aggressive management. The analysis of angio-architecture highlighted the high rate of associated aneurysm and/or venous drainage anomalies that could explain the tendency to bleed of such lesion.
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Affiliation(s)
- Th Robert
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - G Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - H Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - R Fahed
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - S Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Blanc R, Fahed R, Redjem H, Bartolini B, Pistocchi S, Piotin M. P-031 Single Center Experience with the ADAPT Technique for Acute Ischemic Stroke. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Robert T, Blanc R, Gilboa B, Ciccio G, Fahed R, Redjem H, Pistocchi S, Bartolini B, Piotin M. E-055 Incidence of External Ventricular Drainage Placement on Rebleeding of Ventricular Arteriovenous Malformations. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.122] [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: 11/04/2022]
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Robert T, Blanc R, Ciccio G, Gilboa B, Boissonnet H, Fahed R, Redjem H, Pistocchi S, Bartolini B, Piotin M. E-053 Multi-Modality Management of Posterior Fossa Arteriovenous Malformations: Clinical and Angiographic Outcomes. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.120] [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: 11/03/2022]
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Robert T, Blanc R, Gilboa B, Ciccio G, Fahed R, Redjem H, Pistocchi S, Bartolini B, Piotin M. E-054 Angiographic Factors Influencing the Success of Endovascular Treatment of Arteriovenous Malformations involving the Corpus Callosum. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.121] [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: 11/04/2022]
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Clarençon F, Sourour N, Di Maria F, Cormier E, Shotar E, Fahed R, Gabrieli J, Chiras J. Intérêt de l’angioscanner avec injection intra-aortique pour l’analyse de l’angio-architecture des malformations vasculaires médullaires. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fahed R, Redjem H, Blanc R, Bartolini B, Pistocchi S, Rouchaud A, Shotar E, Ciccio G, Gilboa B, Robert T, Piotin M. Traitement endovasculaire des AVC ischémiques du territoire carotidien : efficacité, facteurs pronostiques cliniques, radiologiques et angiographiques. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fahed R, Menassa-Moussa L, Sader-Ghorra C, Haddad-Zebouni S. [Intrathoracic acute appendicitis. A case report]. Arch Pediatr 2012; 19:1334-6. [PMID: 23116984 DOI: 10.1016/j.arcped.2012.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 08/01/2012] [Accepted: 09/25/2012] [Indexed: 12/29/2022]
Abstract
Intrathoracic appendicitis is an uncommon diagnosis. We report the case of a 6-year-old boy with elevated CRP and no fever, who complained of nonspecific abdominal pain. A diaphragmatic hernia was suspected on a chest X-ray and confirmed by an ultrasound examination. A multidetector CT scan revealed intrathoracic acute appendicitis associated with a right posterolateral Bochdalek hernia. Abdominal diseases associated with late-presenting congenital diaphragmatic hernia are often manifested by an atypical clinical presentation, which can be a source of delay or error in diagnosis. We recommend radiological exploration in the case of diaphragmatic hernia, even with subtle clinical findings in the search of associated gastrointestinal complications.
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Affiliation(s)
- R Fahed
- Service d'imagerie médicale, Hôtel-Dieu de France, boulevard Alfred-Nacchache, Achrafieh, Beyrouth, Liban.
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