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Gahide G, Phaneuf SC, Cossette M, Banine A, Budimir M, Maghsoudloo K, Fei P, Dou BY, Bouthillier M, Alain C, Bradette S, Noel-Lamy M, Belzile F, Bui BT, Despatis MA, Vendrell JF. Paclitaxel and mortality in patients with claudication and de novo femoropopliteal lesions: a historical cohort study. CVIR Endovasc 2021; 4:65. [PMID: 34424424 PMCID: PMC8382808 DOI: 10.1186/s42155-021-00255-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the mortality rates of patients with claudication and de novo femoropopliteal lesions treated with and without paclitaxel coated devices (PCD). Background A recent meta-analysis, mostly including patients with claudication and de novo femoropopliteal lesions but also with recurrent stenoses and critical limb ischemia, has shown a significant excess mortality in patients treated with PCD. Methods Comparison of two historical cohorts of patients presenting with claudication and de novo femoropopliteal lesions treated with and without PCD between 2008 and 2018. Results After review of 5219 arteriograms in patients presenting with peripheral artery disease, 700 consecutive patients were included consisting in 72.6% of male (n = 508). Mean age was 68.1 ± 8.5 years. 45.7% of the patients (n = 320) had a treatment including a PCD. Mean femoropopliteal lesion length was 123 ± 91 mm including 44.6% of occlusions. Patients of the control group were censored at crossover to paclitaxel when applicable. Mortality rates at 1, 2 and 5 years were 4.6%, 7.5%, 19.4% and 1.6%, 6.2%, 16.6% in the non-PCD and PCD groups respectively. The relative risks of death when using PCD were 0.35 (p = 0.03), 0.83 (p = NS) and 0.86 (p = NS) at 1, 2 and 5 years respectively. Conclusion There was no excess mortality in patients with claudication and de novo femoropopliteal lesions treated with paclitaxel coated devices at 1, 2 and 5 years of follow-up in this cohort. The current study suggests that additional prospective randomized studies properly powered to study mortality are necessary.
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Affiliation(s)
- Gérald Gahide
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada. .,Centre de Recherche du CHUS, Etienne Le Bel, Université de Sherbrooke, 12e Avenue Nord Porte 6, Sherbrooke, Québec, J1H 5N4, Canada. .,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada.
| | - Samuel C Phaneuf
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Mathilde Cossette
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Amine Banine
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Martina Budimir
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Kourosh Maghsoudloo
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Phillip Fei
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Bo Yi Dou
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Maxime Bouthillier
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Charles Alain
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Simon Bradette
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Maxime Noel-Lamy
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Francois Belzile
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Bao The Bui
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Marc Antoine Despatis
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada.,Service de Chirurgie Vasculaire, Département de Chirurgie, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada
| | - Jean Francois Vendrell
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
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Machi P, Costalat V, Lobotesis K, Lima Maldonado I, Vendrell JF, Riquelme C, Bonafé A. Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 2018; 10:i27-i32. [PMID: 30037950 PMCID: PMC6241203 DOI: 10.1136/jnis.2010.004051.rep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 03/07/2011] [Indexed: 11/26/2022]
Abstract
Background and purpose Prompt recanalization of cerebral arteries in patients diagnosed with acute ischemic
stroke is known to be associated with a better clinical outcome. The aim of this study
was to present our initial experience regarding the efficacy and safety of the Solitaire
FR as a revascularization device. Methods 56 consecutive patients presenting with acute ischemic stroke underwent intra-arterial
therapy using the Solitaire FR revascularization device. Immediate angiographic results
and early clinical outcomes are presented. Results Solitaire FR was successful in achieving recanalization in 50 out of 56 patients (89%)
with a final Thrombolysis in Cerebral Infarction score ≥2b. Five out of 56
patients had procedure related complications: two asymptomatic subarachnoid hemorrhages,
two thromboembolic events and one symptomatic intracranial hemorrhage (PH2). Thirty
patients (53.5%) demonstrated at discharge a National Institutes of Health Stroke Scale
Score of ≤1 or an improvement of at least 10 points from baseline, and 26
patients (46%) had a modified Rankin Score ≤2. Conclusions Solitaire FR is successful in achieving a high rate of arterial recanalization with a
low complication rate. The Solitaire FR is a promising thrombectomy tool with a high
degree of effectiveness, safety and ease of use.
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Affiliation(s)
- Paolo Machi
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Kyriakos Lobotesis
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Igor Lima Maldonado
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France.,Department of Neurological Surgery, Montpellier University Hospital, Montpellier, France
| | | | - Carlos Riquelme
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Alain Bonafé
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
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Danière F, Lobotesis K, Machi P, Eker O, Mourand I, Riquelme C, Ayrignac X, Vendrell JF, Gascou G, Fendeleur J, Dargazanli C, Schaub R, Brunel H, Arquizan C, Bonafé A, Costalat V. Patient selection for stroke endovascular therapy--DWI-ASPECTS thresholds should vary among age groups: insights from the RECOST study. AJNR Am J Neuroradiol 2015; 36:32-9. [PMID: 25273535 DOI: 10.3174/ajnr.a4104] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the benefits of endovascular intervention in large-vessel occlusion strokes, depending on age class. MATERIALS AND METHODS A clinical management protocol including intravenous treatment and mechanical thrombectomy was instigated in our center in 2009 (Prognostic Factors Related to Clinical Outcome Following Thrombectomy in Ischemic Stroke [RECOST] study). All patients with acute ischemic stroke with an anterior circulation major-vessel occlusion who presented within 6 hours were evaluated with an initial MR imaging examination and were analyzed according to age subgroups (younger than 50 years, 50-59 years, 60-69 years, 70-79 years; 80 years or older). The mRS score at 3 months was the study end point. RESULTS One hundred sixty-five patients were included in the analysis. The mean age was 67.4 years (range, 29-90 years). The mean baseline NIHSS score was 17.24 (range, 3-27). The mean DWI-derived ASPECTS was 6.4. Recanalization of TICI 2b/3 was achieved in 80%. At 3 months, 41.72% of patients had a good outcome, with a gradation of prognosis depending on the age subgroup and a clear cutoff at 70 years. Only 19% of patients older than 80 years had a good outcome at 3 months (mean ASPECTS = 7.4) with 28% for 70-79 years (mean ASPECTS = 6.8), but 58% for 60-69 years (mean ASPECTS = 6), 52% for 50-59 years (mean ASPECTS = 5.91), and 72% for younger than 50 years (mean ASPECTS = 6.31). In contrast, the mortality rate was 35% for 80 years and older, and 26% for 70-79 versus 5%-9% for younger than 70 years. CONCLUSIONS The elderly may benefit from thrombectomy when their ischemic core volume is low in comparison with younger patients who still benefit from acute recanalization despite larger infarcts. Stroke volume thresholds should, therefore, be related and adjusted to the patient's age group.
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Affiliation(s)
- F Danière
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - K Lobotesis
- Imaging Department (K.L.), Imperial College Healthcare National Health Service Trust, Charing Cross Hospital, London, United Kingdom
| | - P Machi
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - O Eker
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | | | - C Riquelme
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | | | - J F Vendrell
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - G Gascou
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - J Fendeleur
- Anesthesiology (J.F.), CHU Montpellier, Montpellier, France
| | - C Dargazanli
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - R Schaub
- Department of Medical Statistics (R.S.), CHU Montpellier, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France
| | - H Brunel
- Department of Neuroradiology (H.B.), CHU Marseille, Hôpital La Timone, Marseille, France
| | | | - A Bonafé
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - V Costalat
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
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Gascou G, Lobotesis K, Machi P, Maldonado I, Vendrell JF, Riquelme C, Eker O, Mercier G, Mourand I, Arquizan C, Bonafé A, Costalat V. Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period. AJNR Am J Neuroradiol 2013; 35:734-40. [PMID: 24157734 DOI: 10.3174/ajnr.a3746] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Stent retriever-assisted thrombectomy promotes high recanalization rates in acute ischemic stroke. Nevertheless, complications and failures occur in more than 10% of procedures; hence, there is a need for further investigation. MATERIALS AND METHODS A total of 144 patients with ischemic stroke presenting with large-vessel occlusion were prospectively included. Patients were treated with stent retriever-assisted thrombectomy ± IV fibrinolysis. Baseline clinical and imaging characteristics were incorporated in univariate and multivariate analyses. Predictors of recanalization failure (TICI 0, 1, 2a), and of embolic and hemorrhagic complications were reported. The relationship between complication occurrence and periprocedural mortality rate was studied. RESULTS Median age was 69.5 years, and median NIHSS score was 18 at presentation. Fifty patients (34.7%) received stand-alone thrombectomy, and 94 (65.3%) received combined therapy. The procedural failure rate was 13.9%. Embolic complications were recorded in 12.5% and symptomatic intracranial hemorrhage in 7.6%. The overall rate of failure, complications, and/or death was 39.6%. The perioperative mortality rate was 18.4% in the overall cohort but was higher in cases of failure (45%; P = .003), embolic complications (38.9%; P = .0176), symptomatic intracranial hemorrhages (45.5%; P = .0236), and intracranial stenosis (50%; P = .0176). Concomitant fibrinolytic therapy did not influence the rate of recanalization or embolic complication, or the intracranial hemorrhage rate. Age was the only significant predictive factor of intracranial hemorrhage (P = .043). CONCLUSIONS The rate of perioperative mortality was significantly increased in cases of embolic and hemorrhagic complications, as well as in cases of failure and underlying intracranial stenoses. Adjunctive fibrinolytic therapy did not improve the recanalization rate or collateral embolic complication rate. The rate of symptomatic intracranial hemorrhage was not increased in cases of combined treatment.
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Affiliation(s)
- G Gascou
- From CHU Montpellier, Neuroradiology (G.G., P.M., I.M., J.F.V., C.R., O.E., A.B., V.C.)
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