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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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Benguerfi S, Reizine F, Eugène F, Tattevin P, Maamar A. Remarkable resolution of COVID-19-associated cerebral vasculitis with methylprednisolone. Infect Dis Now 2022; 52:181-182. [PMID: 35172219 PMCID: PMC8841007 DOI: 10.1016/j.idnow.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- S Benguerfi
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - F Reizine
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - F Eugène
- CHU Rennes, Service de Radiologie, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - P Tattevin
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - A Maamar
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
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Dissaux B, Eugène F, Ognard J, Gauvrit JY, Gentric JC, Ferré JC. Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study. AJNR Am J Neuroradiol 2020; 42:340-346. [PMID: 33334853 DOI: 10.3174/ajnr.a6903] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/27/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated. Our aim was to evaluate its diagnostic performance at 3T in the follow-up of embolized dural arteriovenous fistulas using DSA as the standard of reference. MATERIALS AND METHODS Patients treated for dural arteriovenous fistulas in 2 centers between 2008 and 2019 were included if they met the following criteria: 1) dural arteriovenous fistula embolization, and 2) follow-up imaging with <6 months between DSA and 4D contrast-enhanced MRA. Two readers reviewed the 4D contrast-enhanced MRA images, first independently, then in consensus to detect any residual/recurrent dural arteriovenous fistula and to grade cases according to the Cognard classification system. Interobserver and intermodality agreement for the detection of a residual dural arteriovenous fistula and stratification of bleeding risk (0-I-IIa; IIb-IIa+b-III-IV-V) was calculated using κ coefficients. RESULTS A total of 51 pairs of examinations for 44 patients (median age, 65 years; range, 25-81 years) were analyzed. Interobserver agreement for the detection and stratification of bleeding risk was, respectively, κ = 0.8 (95% CI, 0.6-1) and κ = 0.8 (95% CI, 0.5-1). After consensus review, the sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% (95% CI, 40.7%-82.8%) and 96.6% (95% CI, 82.2%-99.9%), respectively. The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% (95% CI, 68.1%-99.8%) and 77.8% (95% CI, 60.8%-89.9%). Intermodality agreement for the detection and stratification of bleeding risk was good, with κ = 0.60 (95% CI, 0.3-0.8). CONCLUSIONS 4D contrast-enhanced MRA at 3T is of interest in the follow-up of treated dural arteriovenous fistulas but lacks the sensitivity to replace arteriography.
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Affiliation(s)
- B Dissaux
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France .,Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.,GETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
| | - F Eugène
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - J Ognard
- Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.,LATIM U1101 (J.O.), INSERM, Université de Bretagne Occidentale, Brest, France
| | - J-Y Gauvrit
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France.,Empenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France
| | - J-C Gentric
- Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.,GETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
| | - J-C Ferré
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France.,Empenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France
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Parat B, Lassalle M, Eugène F, Le Bras A, Ferré J, Rousseau C, Gauvrit J, Laviolle B, Raoult H. Le Brush sign en sequence IRM-SWI pré-thrombectomie : méthode d’évaluation et valeur pronostique. J Neuroradiol 2020. [DOI: 10.1016/j.neurad.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Raoult H, Lassalle MV, Parat B, Rousseau C, Eugène F, Vannier S, Evain S, Le Bras A, Ronziere T, Ferre JC, Gauvrit JY, Laviolle B. DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke. AJNR Am J Neuroradiol 2020; 41:274-279. [PMID: 32001446 DOI: 10.3174/ajnr.a6379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The reasons for poor clinical outcome after thrombectomy for acute stroke, concerning around half of all patients, are misunderstood. We developed a hierarchic algorithm based on DWI to better identify patients at high risk of disability. MATERIALS AND METHODS Our single-center, retrospective study included consecutive patients with acute ischemic stroke who underwent thrombectomy for large anterior artery occlusion and underwent pretreatment DWI. The primary outcome was the mRS at 3 months after stroke onset. Multivariable regression was used to identify independent clinical and imaging predictors of poor prognosis (mRS > 2) at 3 months, and a hierarchic algorithm predictive of disability was developed. RESULTS A total of 149 patients were analyzed. In decreasing importance, DWI lesion volume of >80 mL, baseline NIHSS score of >14, age older than 75 years, and time from stroke onset to groin puncture of >4 hours were independent predictors of poor prognosis. The predictive hierarchic algorithm developed from the multivariate analysis predicted the risk of disability at 3 months for up to 100% of patients with a high predictive value. The area under the receiver operating characteristic curve was 0.87. CONCLUSIONS The DWI-based hierarchic algorithm we developed is highly predictive of disability at 3 months after thrombectomy and is easy to use in routine practice.
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Affiliation(s)
- H Raoult
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | | | - B Parat
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | - C Rousseau
- Clinical Pharmacology (C.R., B.L.), Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique de Rennes, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - F Eugène
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | | | - S Evain
- Departments of Neurology (S.E.)
| | - A Le Bras
- Radiology (A.L.B.), Centre Hospitalier Universitaire Bretagne Atlantique, Vannes, France
| | | | - J C Ferre
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | - J Y Gauvrit
- From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.)
| | - B Laviolle
- Clinical Pharmacology (C.R., B.L.), Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique de Rennes, Centre Hospitalier Universitaire Rennes, Rennes, France
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Bourcier R, Abed D, Piotin M, Redjem H, Ferré J, Eugène F, Raoult H, Mirza M, Chapot R, Desal H, Nordmeyer H. Multicenter initial experience with the EmboTrap device in acute anterior ischemic stroke. J Neuroradiol 2018; 45:230-235. [DOI: 10.1016/j.neurad.2018.01.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/04/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
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Alexandre PL, Bourcier R, Eugène F, Delasalle-Guyomarch B, Guillon B, Kerleroux B, Saleme S, Marnat G, Boucebci S, Mirza M, Ferré JC, Papagiannaki C, Desal H. La thérapie combinée par fibrinolyse intraveineuse et thrombectomie est-elle requise en cas d’occlusion de la terminaison carotidienne ? J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.01.023] [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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Eugène F, Gauvrit JY, Ferré JC, Gentric JC, Besseghir A, Ronzière T, Raoult H. One-year MR angiographic and clinical follow-up after intracranial mechanical thrombectomy using a stent retriever device. AJNR Am J Neuroradiol 2014; 36:126-32. [PMID: 25125665 DOI: 10.3174/ajnr.a4071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about the consequences of arterial wall damage that may be due to mechanical endovascular thrombectomy. Our aim was to perform 1-year MR angiographic and clinical follow-up of patients treated with mechanical endovascular thrombectomy using the Solitaire device. MATERIALS AND METHODS Patients with stroke treated between August 2010 and July 2012 were prospectively evaluated with a minimum follow-up of 1 year after mechanical endovascular thrombectomy. Angiographic follow-up was performed on a 3T MR imaging scanner and included intracranial artery TOF MRA and supra-aortic artery gadolinium-enhanced MRA. Images were assessed to detect arterial abnormalities (stenosis, occlusion, dilation) and were compared with the final post-mechanical endovascular thrombectomy run to differentiate delayed and pre-existing abnormalities. Clinical evaluation was performed with the mRS and the 36-Item Short-Form Health Survey questionnaire quality-of-life scale. RESULTS Thirty-nine patients were angiographically assessed at the mean term of 19 ± 4 months. MRA showed intracranial artery abnormalities in 10 patients, including 5 delayed intracranial artery abnormalities in 4 patients (4 stenoses and 1 dilation), 4 cases of pre-existing intracranial artery stenosis, and 2 occlusions. Pre-existing etiologic cervical artery stenosis or occlusion was observed in 2 patients. All these patients remained asymptomatic during the follow-up period. A significant clinical improvement was observed at 1-year follow-up in comparison with 3-month follow-up (P < .0001), with a good outcome achieved in 62.5% of patients and an acceptable quality of life restored. CONCLUSIONS One-year follow-up identifies delayed asymptomatic arterial abnormalities in patients treated with the Solitaire device.
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Affiliation(s)
- F Eugène
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
| | - J-Y Gauvrit
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
| | - J-C Ferré
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
| | - J-C Gentric
- Department of Neuroradiology (J.-C.G.), Centre Hospitalier Universitaire, Brest, France
| | | | - T Ronzière
- Neurology (T.R.), Centre Hospitalier Universitaire, Rennes, France
| | - H Raoult
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
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Blanton RE, Cooney RE, Joormann J, Eugène F, Glover GH, Gotlib IH. Pubertal stage and brain anatomy in girls. Neuroscience 2012; 217:105-12. [PMID: 22569152 DOI: 10.1016/j.neuroscience.2012.04.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/04/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
Studies of puberty have focused primarily on changes in hormones and on observable physical bodily characteristics. Little is known, however, about the nature of the relation between pubertal status and brain physiology. This is particularly important given findings that have linked the onset of puberty with both changes in cognitive functioning and increases in the incidence of depression and anxiety. The present study examined relations between pubertal stage, as assessed by Tanner staging, and brain anatomy in a sample of 54 girls aged 9-15 years. Brain morphometric analysis was conducted using high-resolution magnetic resonance imaging (MRI). The hippocampus and amygdala were manually traced on MRI scans in all participants. Stepwise regression analyses were conducted with total intracranial volume (ICV), age, and pubertal status as the predictor variables and hippocampus and amygdala volumes as outcome variables. Pubertal status was significantly associated with left amygdala volume, after controlling for both age and ICV. In addition, puberty was related to right hippocampus and amygdala volumes, after controlling for ICV. In contrast, no significant associations were found between age and hippocampal and amygdala volumes after controlling for pubertal status and ICV. These findings highlight the importance of the relation between pubertal status and morphometry of the hippocampus and amygdala, and of limbic and subcortical structures that have been implicated in emotional and social behaviors.
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Affiliation(s)
- R E Blanton
- Department of Psychiatry, Yale University, USA.
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Terrien G, Eugène F, Lemeunier-Lelievre P, Lebas F. Une mediastinite pseudo-tumorale. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)74279-1] [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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