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van Ravestyn C, Gerardin E, Térémetz M, Hamdoun S, Baron JC, Calvet D, Vandermeeren Y, Turc G, Maier MA, Rosso C, Mas JL, Dupin L, Lindberg PG. Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity. Neurorehabil Neural Repair 2024; 38:373-385. [PMID: 38572686 DOI: 10.1177/15459683241245416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.
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Affiliation(s)
- Coralie van Ravestyn
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Eloïse Gerardin
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Maxime Térémetz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
| | - Sonia Hamdoun
- Service de Médecine Physique et de Réadaptation, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Claude Baron
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - David Calvet
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Yves Vandermeeren
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Marc A Maier
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Mas
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Lucile Dupin
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Påvel G Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
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Baron JC. Predicting Stroke Recurrence in Occlusive Disease Using Noninvasive Quantitative Mapping of Cerebrovascular Reserve. Stroke 2024; 55:622-624. [PMID: 38328925 DOI: 10.1161/strokeaha.124.046235] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, FHU NeuroVasc, France. Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France
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Seners P, Baron JC, Olivot JM, Albers GW. Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion? Curr Opin Neurol 2024; 37:1-7. [PMID: 38038427 DOI: 10.1097/wco.0000000000001235] [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] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW In this review, we summarize current evidence regarding potential benefits and limitations of using perfusion imaging to estimate presence and extent of irreversibly injured ischemic brain tissue ('core') and severely ischemic yet salvageable tissue ('penumbra') in acute stroke patients with large vessel occlusion (LVO). RECENT FINDINGS Core and penumbra volumes are strong prognostic biomarkers in LVO patients. Greater benefits of both intravenous thrombolysis and endovascular therapy (EVT) are observed in patients with small core and large penumbra volumes. However, some current definitions of clinically relevant penumbra may be too restrictive and exclude patients who may benefit from reperfusion therapies. Alongside other clinical and radiological factors, penumbral imaging may enhance the discussion regarding the benefit/risk ratio of EVT in common clinical situations, such as patients with large core - for whom EVT's benefit is established but associated with a high rate of severe disability -, or patients with mild symptoms or medium vessel occlusions - for whom EVT's benefit is currently unknown. Beyond penumbral evaluation, perfusion imaging is clinically relevant for optimizing patient's selection for neuroprotection trials. SUMMARY In an emerging era of precision medicine, perfusion imaging is a valuable tool in LVO-related acute stroke.
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Affiliation(s)
- Pierre Seners
- Neurology Department, A. de Rothschild Foundation Hospital
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Paris
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, Toulouse, France
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ter Schiphorst A, Turc G, Hassen WB, Oppenheim C, Baron JC. Incidence, severity and impact on functional outcome of persistent hypoperfusion despite large-vessel recanalization, a potential marker of impaired microvascular reperfusion: Systematic review of the clinical literature. J Cereb Blood Flow Metab 2024; 44:38-49. [PMID: 37871624 PMCID: PMC10905632 DOI: 10.1177/0271678x231209069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/02/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
The reported incidence of persistent hypoperfusion despite complete recanalization as surrogate for impaired microvascular reperfusion (IMR) has varied widely among clinical studies, possibly due to differences in i) definition of complete recanalization, with only recent Thrombolysis in Cerebral Infarction (TICI) grading schemes allowing distinction between complete (TICI3) and partial recanalization with distal occlusions (TICI2c); ii) operational definition of IMR; and iii) consideration of potential alternative causes for hypoperfusion, notably carotid stenosis, re-occlusion and post-thrombectomy hemorrhage. We performed a systematic review to identify clinical studies that carried out brain perfusion imaging within 72 hrs post-thrombectomy for anterior circulation stroke and reported hypoperfusion rates separately for TICI3 and TICI2c grades. Authors were contacted if this data was missing. We identified eight eligible articles, altogether reporting 636 patients. The incidence of IMR after complete recanalization (i.e., TICI3) tended to decrease with the number of considered alternative causes of hypoperfusion: range 12.5-42.9%, 0-31.6% and 0-9.1% in articles that considered none, two or all three causes, respectively. No study reported the impact of IMR on functional outcome separately for TICI-3 patients. Based on this systematic review, IMR in true complete recanalization appears relatively rare, and reported incidence highly depends on definition used and consideration of confounding factors.
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Affiliation(s)
- Adrien ter Schiphorst
- Department of Neurology, University Hospital of Montpellier, CHU Gui de Chauliac, Montpellier, France
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université Paris Cité, Inserm U1266, FHU NeuroVasc, Paris, France
| | - Wagih Ben Hassen
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université Paris Cité, Inserm U1266, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université Paris Cité, Inserm U1266, Paris, France
| | - Jean-Claude Baron
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université Paris Cité, Inserm U1266, FHU NeuroVasc, Paris, France
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5
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Poli S, Mbroh J, Baron JC, Singhal AB, Strbian D, Molina C, Lemmens R, Turc G, Mikulik R, Michel P, Tatlisumak T, Audebert HJ, Dichgans M, Veltkamp R, Hüsing J, Graessner H, Fiehler J, Montaner J, Adeyemi AK, Althaus K, Arenillas JF, Bender B, Benedikt F, Broocks G, Burghaus I, Cardona P, Deb-Chatterji M, Cviková M, Defreyne L, De Herdt V, Detante O, Ernemann U, Flottmann F, García Guillamón L, Glauch M, Gomez-Exposito A, Gory B, Sylvie Grand S, Haršány M, Hauser TK, Heck O, Hemelsoet D, Hennersdorf F, Hoppe J, Kalmbach P, Kellert L, Köhrmann M, Kowarik M, Lara-Rodríguez B, Legris L, Lindig T, Luntz S, Lusk J, Mac Grory B, Manger A, Martinez-Majander N, Mengel A, Meyne J, Müller S, Mundiyanapurath S, Naggara O, Nedeltchev K, Nguyen TN, Nilsson MA, Obadia M, Poli K, Purrucker JC, Räty S, Richard S, Richter H, Schilte C, Schlemm E, Stöhr L, Stolte B, Sykora M, Thomalla G, Tomppo L, van Horn N, Zeller J, Ziemann U, Zuern CS, Härtig F, Tuennerhoff J. Penumbral Rescue by normobaric O = O administration in patients with ischemic stroke and target mismatch proFile (PROOF): Study protocol of a phase IIb trial. Int J Stroke 2024; 19:120-126. [PMID: 37515459 PMCID: PMC10759237 DOI: 10.1177/17474930231185275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
RATIONALE Oxygen is essential for cellular energy metabolism. Neurons are particularly vulnerable to hypoxia. Increasing oxygen supply shortly after stroke onset could preserve the ischemic penumbra until revascularization occurs. AIMS PROOF investigates the use of normobaric oxygen (NBO) therapy within 6 h of symptom onset/notice for brain-protective bridging until endovascular revascularization of acute intracranial anterior-circulation occlusion. METHODS AND DESIGN Randomized (1:1), standard treatment-controlled, open-label, blinded endpoint, multicenter adaptive phase IIb trial. STUDY OUTCOMES Primary outcome is ischemic core growth (mL) from baseline to 24 h (intention-to-treat analysis). Secondary efficacy outcomes include change in NIHSS from baseline to 24 h, mRS at 90 days, cognitive and emotional function, and quality of life. Safety outcomes include mortality, intracranial hemorrhage, and respiratory failure. Exploratory analyses of imaging and blood biomarkers will be conducted. SAMPLE SIZE Using an adaptive design with interim analysis at 80 patients per arm, up to 456 participants (228 per arm) would be needed for 80% power (one-sided alpha 0.05) to detect a mean reduction of ischemic core growth by 6.68 mL, assuming 21.4 mL standard deviation. DISCUSSION By enrolling endovascular thrombectomy candidates in an early time window, the trial replicates insights from preclinical studies in which NBO showed beneficial effects, namely early initiation of near 100% inspired oxygen during short temporary ischemia. Primary outcome assessment at 24 h on follow-up imaging reduces variability due to withdrawal of care and early clinical confounders such as delayed extubation and aspiration pneumonia. TRIAL REGISTRATIONS ClinicalTrials.gov: NCT03500939; EudraCT: 2017-001355-31.
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Affiliation(s)
- Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Joshua Mbroh
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Jean-Claude Baron
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris, Paris, France
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carlos Molina
- Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Guillaume Turc
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris, Paris, France
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences INSERM U1266 Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Robert Mikulik
- Department of Neurology, St. Anne’s University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Patrik Michel
- Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Heinrich J Audebert
- Department of Neurology and Center for Stroke Research Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Johannes Hüsing
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
- Landeskrebsregister Nordrhein-Westfalen, Bochum, Germany
| | - Holm Graessner
- Center for Rare Diseases, Eberhard-Karls University, Tubingen, Germany
| | - Jens Fiehler
- Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Eppdata GmbH, Hamburg, Germany
| | - Joan Montaner
- Vall d’Hebron Institut de Recerca, Neurovascular Research Lab, Barcelona, Spain
| | | | | | | | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Frank Benedikt
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ina Burghaus
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Pere Cardona
- Department of Neurology, Hospital University de Bellvitge, Barcelona, Spain
| | - Milani Deb-Chatterji
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Cviková
- Department of Neurology, St. Anne’s University Hospital in Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium
| | - Veerle De Herdt
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Olivier Detante
- Neurology, CHU Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Fabian Flottmann
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Monika Glauch
- Center for Rare Diseases, Eberhard-Karls University, Tubingen, Germany
| | - Alexandra Gomez-Exposito
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospital Regional Universitaire de Nancy, Universite de Lorraine, INSERM U1254, Nancy, France
| | - Sylvie Sylvie Grand
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
- Neuroradiology / MRI Department, CHU Grenoble Alpes, Grenoble, France
| | - Michal Haršány
- Department of Neurology, St. Anne’s University Hospital in Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
- International Clinical Research Centre, St. Anne’s University Hospital in Brno, Brno, Czech Republic
| | - Till Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Olivier Heck
- Neuroradiology / MRI Department, CHU Grenoble Alpes, Grenoble, France
| | | | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Julia Hoppe
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pia Kalmbach
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Martin Köhrmann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Markus Kowarik
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | | | - Loic Legris
- Neurology, CHU Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Steffen Luntz
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Jay Lusk
- Duke University School of Medicine, Durham, NC, USA
| | - Brian Mac Grory
- Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Andreas Manger
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tubingen, Germany
| | | | - Annerose Mengel
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Johannes Meyne
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Susanne Müller
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | | | - Olivier Naggara
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences INSERM U1266 Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Krassen Nedeltchev
- Department of Neurology, KSA Kantonsspital Aarau and University of Bern, Bern, Switzerland
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | - Maike A Nilsson
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Michael Obadia
- Department of Neurology and Stroke Center, Hopital fondation Adolphe de Rothschild, Paris, France
| | - Khouloud Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Jan C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hardy Richter
- Department of Infectiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Clotilde Schilte
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Stöhr
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Benjamin Stolte
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marek Sykora
- Department of Neurology, St. John’s Hospital, Vienna, Austria
| | - Götz Thomalla
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Noel van Horn
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Zeller
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Christine S Zuern
- Department of Cardiology, Universitatsspital Basel, Basel, Switzerland
| | - Florian Härtig
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tubingen, Germany
| | - Johannes Tuennerhoff
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
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6
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Checkouri T, Gerschenfeld G, Seners P, Yger M, Ben Hassen W, Chausson N, Olindo S, Caroff J, Marnat G, Clarençon F, Baron JC, Turc G, Alamowitch S. Early Recanalization Among Patients Undergoing Bridging Therapy With Tenecteplase or Alteplase. Stroke 2023; 54:2491-2499. [PMID: 37622385 DOI: 10.1161/strokeaha.123.042691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) with alteplase or tenecteplase before mechanical thrombectomy is the recommended treatment for large-vessel occlusion acute ischemic stroke. There are divergent data on whether these agents differ in terms of early recanalization (ER) rates before mechanical thrombectomy, and little data on their potential differences stratified by ER predictors such as IVT to ER evaluation (IVT-to-EReval) time, occlusion site and thrombus length. METHODS We retrospectively compared the likelihood of ER after IVT with tenecteplase or alteplase in anterior circulation large-vessel occlusion acute ischemic stroke patients from the PREDICT-RECANAL (alteplase) and Tenecteplase Treatment in Ischemic Stroke (tenecteplase) French multicenter registries. ER was defined as a modified Thrombolysis in Cerebral Infarction score 2b-3 on the first angiographic run, or noninvasive vascular imaging in patients with early neurological improvement. Analyses were based on propensity score overlap weighting (leading to exact balance in patient history, stroke characteristics, and initial management between groups) and confirmed with adjusted logistic regression (sensitivity analysis). A stratified analysis based on pre-established ER predictors (IVT-to-EReval time, occlusion site, and thrombus length) was conducted. RESULTS Overall, 1865 patients were included. ER occurred in 156/787 (19.8%) and 199/1078 (18.5%) patients treated with tenecteplase or alteplase, respectively (odds ratio, 1.09 [95% CI, 0.83-1.44]; P=0.52). A differential effect of tenecteplase versus alteplase on the probability of ER according to thrombus length was observed (Pinteraction=0.003), with tenecteplase being associated with higher odds of ER in thrombi >10 mm (odds ratio, 2.43 [95% CI, 1.02-5.81]; P=0.04). There was no differential effect of tenecteplase versus alteplase on the likelihood of ER according to the IVT-to-EReval time (Pinteraction=0.40) or occlusion site (Pinteraction=0.80). CONCLUSIONS Both thrombolytics achieved ER in one-fifth of patients with large-vessel occlusion acute ischemic stroke without significant interaction with IVT-to-EReval time and occlusion site. Compared with alteplase, tenecteplase was associated with a 2-fold higher likelihood of ER in larger thrombi.
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Affiliation(s)
- Thomas Checkouri
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
| | - Gaspard Gerschenfeld
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
| | - Pierre Seners
- Service de Neurologie, GHU Paris Psychiatrie et Neurosciences, France (P.S.)
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
- Service de Neurologie, Hôpital Fondation Rothschild, Paris, France (P.S.)
| | - Marion Yger
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
| | - Wagih Ben Hassen
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, France (W.B.H.)
| | - Nicolas Chausson
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
- Service de Neurologie, Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes (N.C.)
| | | | - Jildaz Caroff
- AP-HP, Service de Neuroradiologie interventionnelle (NEURI), Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France (J.C.)
| | - Gaultier Marnat
- Service de Neuroradiologie diagnostique et interventionnelle (G.M.), France
- CHU de Bordeaux, France (G.M.)
| | - Frédéric Clarençon
- AP-HP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France (F.C.)
| | - Jean-Claude Baron
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
| | - Guillaume Turc
- Université de Paris, INSERM U1266, FHU Neurovasc, France (P.S., W.B.H., N.C., J.-C.B., G.T.)
| | - Sonia Alamowitch
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, Sorbonne Université, Paris, France (T.C., G.G., M.Y., S.A.)
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France (T.C., G.G., M.Y., S.A.)
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Térémetz M, Hamdoun S, Colle F, Gerardin E, Desvilles C, Carment L, Charron S, Cuenca M, Calvet D, Baron JC, Turc G, Maier MA, Rosso C, Mas JL, Lindberg PG. Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial. J Neuroeng Rehabil 2023; 20:93. [PMID: 37464404 PMCID: PMC10355015 DOI: 10.1186/s12984-023-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. METHODS A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. RESULTS BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs - 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). CONCLUSIONS Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered).
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Affiliation(s)
- Maxime Térémetz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sonia Hamdoun
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Médecine Physique et de Réadaptation, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - Florence Colle
- SSR Neurologique, Hôpitaux de Saint-Maurice, 12/14 Rue du Val d'Osne, 94410, Saint-Maurice, France
| | - Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain/CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Claire Desvilles
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sylvain Charron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Macarena Cuenca
- Centre de Recherche Clinique, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - David Calvet
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Marc A Maier
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, 75006, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jean-Louis Mas
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France.
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Seners P, Yuen N, Mlynash M, Snyder SJ, Heit JJ, Lansberg MG, Christensen S, Albucher JF, Cognard C, Sibon I, Obadia M, Savatovsky J, Baron JC, Olivot JM, Albers GW. Quantification of Penumbral Volume in Association With Time From Stroke Onset in Acute Ischemic Stroke With Large Vessel Occlusion. JAMA Neurol 2023; 80:523-528. [PMID: 36939736 PMCID: PMC10028542 DOI: 10.1001/jamaneurol.2023.0265] [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: 11/02/2022] [Accepted: 01/20/2023] [Indexed: 03/21/2023]
Abstract
Importance The benefit of reperfusion therapies for acute ischemic stroke decreases over time. This decreasing benefit is presumably due to the disappearance of salvageable ischemic brain tissue (ie, the penumbra). Objective To study the association between stroke onset-to-imaging time and penumbral volume in patients with acute ischemic stroke with a large vessel occlusion. Design, Setting, and Participants A retrospective, multicenter, cross-sectional study was conducted from January 1, 2015, to June 30, 2022. To limit selection bias, patients were selected from (1) the prospective registries of 2 comprehensive centers with systematic use of magnetic resonance imaging (MRI) with perfusion, including both thrombectomy-treated and untreated patients, and (2) 1 prospective thrombectomy study in which MRI with perfusion was acquired per protocol but treatment decisions were made with clinicians blinded to the results. Consecutive patients with acute stroke with intracranial internal carotid artery or first segment of middle cerebral artery occlusion and adequate quality MRI, including perfusion, performed within 24 hours from known symptoms onset were included in the analysis. Exposures Time from stroke symptom onset to baseline MRI. Main Outcomes and Measures Penumbral volume, measured using automated software, was defined as the volume of tissue with critical hypoperfusion (time to maximum >6 seconds) minus the volume of the ischemic core. Substantial penumbra was defined as greater than or equal to 15 mL and a mismatch ratio (time to maximum >6-second volume/core volume) greater than or equal to 1.8. Results Of 940 patients screened, 516 were excluded (no MRI, n = 19; no perfusion imaging, n = 59; technically inadequate perfusion imaging, n = 75; second segment of the middle cerebral artery occlusion, n = 156; unwitnessed stroke onset, n = 207). Of 424 included patients, 226 (53.3%) were men, and mean (SD) age was 68.9 (15.1) years. Median onset-to-imaging time was 3.8 (IQR, 2.4-5.5) hours. Only 16 patients were admitted beyond 10 hours from symptom onset. Median core volume was 24 (IQR, 8-76) mL and median penumbral volume was 58 (IQR, 29-91) mL. An increment in onset-to-imaging time by 1 hour resulted in a decrease of 3.1 mL of penumbral volume (β coefficient = -3.1; 95% CI, -4.6 to -1.5; P < .001) and an increase of 3.0 mL of core volume (β coefficient = 3.0; 95% CI, 1.3-4.7; P < .001) after adjustment for confounders. The presence of a substantial penumbra ranged from approximately 80% in patients imaged at 1 hour to 70% at 5 hours, 60% at 10 hours, and 40% at 15 hours. Conclusions and Relevance Time is associated with increasing core and decreasing penumbral volumes. Despite this, a substantial percentage of patients have notable penumbra in extended time windows; the findings of this study suggest that a large proportion of patients with large vessel occlusion may benefit from therapeutic interventions.
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Affiliation(s)
- Pierre Seners
- Stanford Stroke Center, Palo Alto, California
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris, U1266, Inserm, Paris, France
| | - Nicole Yuen
- Stanford Stroke Center, Palo Alto, California
| | | | - Sarah J. Snyder
- Radiology Department, Stanford University, Palo Alto, California
| | - Jeremy J. Heit
- Radiology Department, Stanford University, Palo Alto, California
| | | | | | - Jean-François Albucher
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, Toulouse, France
| | - Christophe Cognard
- Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Igor Sibon
- Stroke Unit, Bordeaux University Hospital, Bordeaux, France
| | - Michael Obadia
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Julien Savatovsky
- Radiology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris, U1266, Inserm, Paris, France
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, Toulouse, France
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Posener S, Hmeydia G, Benzakoun J, Oppenheim C, Baron JC, Turc G. Remote Diffusion-Weighted Imaging Lesions and Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Stroke 2023; 54:e133-e137. [PMID: 36866676 DOI: 10.1161/strokeaha.122.040689] [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] [Indexed: 03/04/2023]
Abstract
BACKGROUND Remote diffusion-weighted imaging lesions (RDWILs) in the context of spontaneous intracerebral hemorrhage (ICH) are associated with an increased risk of recurrent stroke, worse functional outcome, and death. To update current knowledge on RDWILs, we conducted a systematic review and meta-analysis of the prevalence, associated factors and presumed causes of RDWILs. METHODS We searched Pubmed, Embase, and Cochrane up to June 2022 for studies reporting RDWILs in adults with symptomatic ICH of no-identified-cause, assessed by magnetic resonance imaging, and analyzed associations between baseline variables and RDWILs in random-effects meta-analyses. RESULTS Eighteen observational studies (7 prospective), reporting 5211 patients were included, of whom 1386 had ≥1 RDWIL (pooled prevalence: 23.5% [19.0-28.6]). RDWIL presence was associated with neuroimaging features of microangiopathy, atrial fibrillation (odds ratio, 3.67 [1.80-7.49]), clinical severity (mean difference in National Institutes of Health Stroke Scale score, 1.58 points [0.50-2.66]), elevated blood pressure (mean difference, 14.02 mmHg [9.44-18.60]), ICH volume (mean difference, 2.78 mL [0.97-4.60]), and subarachnoid (odds ratio, 1.80 [1.00-3.24]) or intraventricular (odds ratio, 1.53 [1.28-1.83]) hemorrhage. RDWIL presence was associated with poor 3-month functional outcome (odds ratio, 1.95 [1.48-2.57]). CONCLUSIONS RDWILs are detected in approximately 1-in-4 patients with acute ICH. Our results suggest that most RDWILs result from disruption of cerebral small vessel disease by ICH-related precipitating factors such as elevated intracranial pressure and cerebral autoregulation impairment. Their presence is associated with worse initial presentation and outcome. However, given the mostly cross-sectional designs and heterogeneity in study quality, further studies are needed to investigate whether specific ICH treatment strategies may reduce the incidence of RDWILs and in turn improve outcome and reduce stroke recurrence.
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Affiliation(s)
- Sacha Posener
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, FHU NeuroVasc, France. (S.P., J.-C.B., G.T.).,INSERM U1266, Paris, France (S.P., J.-C.B., G.T., G.H., J.B., C.O.)
| | - Ghazi Hmeydia
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, FHU NeuroVasc, France. (G.H., J.B., C.O.).,INSERM U1266, Paris, France (S.P., J.-C.B., G.T., G.H., J.B., C.O.)
| | - Joseph Benzakoun
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, FHU NeuroVasc, France. (G.H., J.B., C.O.).,INSERM U1266, Paris, France (S.P., J.-C.B., G.T., G.H., J.B., C.O.)
| | - Catherine Oppenheim
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, FHU NeuroVasc, France. (G.H., J.B., C.O.).,INSERM U1266, Paris, France (S.P., J.-C.B., G.T., G.H., J.B., C.O.)
| | - Jean-Claude Baron
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, FHU NeuroVasc, France. (S.P., J.-C.B., G.T.).,INSERM U1266, Paris, France (S.P., J.-C.B., G.T., G.H., J.B., C.O.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, FHU NeuroVasc, France. (S.P., J.-C.B., G.T.).,INSERM U1266, Paris, France (S.P., J.-C.B., G.T., G.H., J.B., C.O.)
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10
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Bouchereau E, Marchi A, Hermann B, Pruvost-Robieux E, Guinard E, Legouy C, Schimpf C, Mazeraud A, Baron JC, Ramdani C, Gavaret M, Sharshar T, Turc G. Quantitative analysis of early-stage EEG reactivity predicts awakening and recovery of consciousness in patients with severe brain injury. Br J Anaesth 2023; 130:e225-e232. [PMID: 36243578 DOI: 10.1016/j.bja.2022.09.005] [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: 04/08/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Decisions of withdrawal of life-sustaining therapy for patients with severe brain injury are often based on prognostic evaluations such as analysis of electroencephalography (EEG) reactivity (EEG-R). However, EEG-R usually relies on visual assessment, which requires neurophysiological expertise and is prone to inter-rater variability. We hypothesised that quantitative analysis of EEG-R obtained 3 days after patient admission can identify new markers of subsequent awakening and consciousness recovery. METHODS In this prospective observational study of patients with severe brain injury requiring mechanical ventilation, quantitative EEG-R was assessed using standard 11-lead EEG with frequency-based (power spectral density) and functional connectivity-based (phase-lag index) analyses. Associations between awakening in the intensive care unit (ICU) and reactivity to auditory and nociceptive stimulations were assessed with logistic regression. Secondary outcomes included in-ICU mortality and 3-month Coma Recovery Scale-Revised (CRS-R) score. RESULTS Of 116 patients, 86 (74%) awoke in the ICU. Among quantitative EEG-R markers, variation in phase-lag index connectivity in the delta frequency band after noise stimulation was associated with awakening (adjusted odds ratio=0.89, 95% confidence interval: 0.81-0.97, P=0.02 corrected for multiple tests), independently of age, baseline severity, and sedation. This new marker was independently associated with improved 3-month CRS-R (adjusted β=-0.16, standard error 0.075, P=0.048), but not with mortality (adjusted odds ratio=1.08, 95% CI: 0.99-1.18, P=0.10). CONCLUSIONS An early-stage quantitative EEG-R marker was independently associated with awakening and 3-month level of consciousness in patients with severe brain injury. This promising marker based on functional connectivity will need external validation before potential integration into a multimodal prognostic model.
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Affiliation(s)
- Eléonore Bouchereau
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France; Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France.
| | - Angela Marchi
- Epileptology and Cerebral Rhythmology Department, APHM, Timone Hospital, Marseille, France
| | - Bertrand Hermann
- ICU Department, Hôpital Européen Georges Pompidou, Paris, France; Institut du Cerveau et de la Moelle épinière - ICM, Paris, France; Université Paris Cité, Paris, France
| | - Estelle Pruvost-Robieux
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurophysiology Department, Sainte Anne Hospital, Paris, France
| | - Eléonore Guinard
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurophysiology Department, Sainte Anne Hospital, Paris, France
| | - Camille Legouy
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France
| | - Caroline Schimpf
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France
| | - Aurélien Mazeraud
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France; Université Paris Cité, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte Anne Hospital, Paris, France; FHU NeuroVasc, Paris, France
| | - Céline Ramdani
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
| | - Martine Gavaret
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurophysiology Department, Sainte Anne Hospital, Paris, France; FHU NeuroVasc, Paris, France
| | - Tarek Sharshar
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France; Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte Anne Hospital, Paris, France; FHU NeuroVasc, Paris, France
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11
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Roumi A, Ben Hassen W, Hmeydia G, Posener S, Pallud J, Sharshar T, Calvet D, Mas JL, Baron JC, Oppenheim C, Naggara O, Turc G. Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage. Front Neurol 2023; 13:1085806. [PMID: 36776575 PMCID: PMC9911434 DOI: 10.3389/fneur.2022.1085806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Identification of treatable causes of intracranial hemorrhage (ICH) such as intracranial arteriovenous shunt is crucial to prevent recurrence. However, diagnostic approaches vary considerably across centers, partly because of limited knowledge of the diagnostic performance of first-line vascular imaging techniques. We assessed the diagnostic performance of dynamic three-dimensional magnetic resonance angiography (dynamic 3D MRA) in daily practice to detect intracranial arteriovenous shunts in ICH patients against subsequent digital subtraction angiography (DSA) as reference standard. Methods We reviewed all adult patients who underwent first-line dynamic 3D MRA and subsequent DSA for non-traumatic ICH between January 2016 and September 2021 in a tertiary center. Sensitivity, specificity, accuracy, positive and negative predictive values of dynamic 3D MRA for the detection of intracranial arteriovenous shunt were calculated with DSA as reference standard. Results Among 104 included patients, 29 (27.9%) had a DSA-confirmed arteriovenous shunt [19 pial arteriovenous malformations, 10 dural arteriovenous fistulae; median onset-to-DSA: 17 (IQR: 3-88) days]. The sensitivity and specificity of dynamic 3D MRA [median onset-to-dynamic 3D MRA: 14 (3-101) h] for the detection of intracranial arteriovenous shunt were 66% (95% CI: 48-83) and 91% (95% CI: 84-97), respectively. The corresponding accuracy, positive and negative predictive values were 84% (95% CI: 77-91), 73% (95% CI: 56-90), and 87% (95% CI: 80-95), respectively. Conclusion This study suggests that although first-line evaluation with dynamic 3D MRA may be helpful for the detection of intracranial arteriovenous shunts in patients with ICH, additional vascular imaging work-up should not be withheld if dynamic 3D MRA is negative. Comparative prospective studies are needed to determine the best imaging strategy to diagnose arteriovenous shunts after non-traumatic ICH.
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Affiliation(s)
- Arnaud Roumi
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Wagih Ben Hassen
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Ghazi Hmeydia
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Sacha Posener
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Johan Pallud
- Neurosurgery Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Tarek Sharshar
- Neuro-Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - David Calvet
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Jean-Louis Mas
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Jean-Claude Baron
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Catherine Oppenheim
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France
| | - Guillaume Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, France,*Correspondence: Guillaume Turc ✉
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12
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Ter Schiphorst A, Oppenheim C, Baron JC. Reader Response: Prevalence and Significance of Impaired Microvascular Tissue Reperfusion Despite Macrovascular Angiographic Reperfusion (No-Reflow). Neurology 2023; 100:217-218. [PMID: 36669895 DOI: 10.1212/wnl.0000000000206786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 01/22/2023] Open
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13
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Baron JC, Jensen-Kondering U, Sacco S, Posener S, Benzakoun J, Pallud J, Oppenheim C, Varlet P, Turc G. Correction to: Can novel CT-and MR-based neuroimaging biomarkers further improve the etiological diagnosis of lobar intra-cerebral hemorrhage? J Neurol 2023; 270:589. [PMID: 36370188 DOI: 10.1007/s00415-022-11475-3] [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: 11/13/2022]
Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris Cité, Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.
| | - Ulf Jensen-Kondering
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sacha Posener
- Department of Neurology, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris Cité, Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Joseph Benzakoun
- Department of Neuroradiology, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris Cité, Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris CitéInserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris Cité, Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- Department of Pathology, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris CitéInserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Guillaume Turc
- Department of Neurology, Groupe Hospitalier Paris Neurosciences et Psychiatrie, Université Paris Cité, Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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14
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Baron JC. Elevated Cortical Tau Positron Emission Tomography Binding in Misery Perfusion: Novel, Puzzling, and Heuristic. Stroke 2022; 53:e504-e506. [DOI: 10.1161/strokeaha.122.041406] [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: 11/09/2022]
Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, INSERM U1266, Université Paris Cité, France
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15
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Boulenoir N, Turc G, Ter Schiphorst A, Heldner MR, Strambo D, Laksiri N, Girard Buttaz I, Papassin J, Sibon I, Chausson N, Michel P, Rosso C, Bourdain F, Lamy C, Weisenburger-Lile D, Agius P, Yger M, Obadia M, Sablot D, Legris N, Jung S, Pilgram-Pastor S, Henon H, Bernardaud L, Arquizan C, Baron JC, Seners P. Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed? Stroke 2022; 53:3304-3312. [PMID: 36073368 DOI: 10.1161/strokeaha.122.039228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We recently reported a worrying 30% rate of early neurological deterioration (END) occurring within 24 hours following intravenous thrombolysis (IVT) in minor stroke with isolated internal carotid artery occlusion (ie, without additional intracranial occlusion), mainly due to artery-to-artery embolism. Here, we hypothesize that in this setting IVT-as compared to no-IVT-may foster END, in particular by favoring artery-to-artery embolism from thrombus fragmentation. METHODS From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score <6) isolated internal carotid artery occlusion patients treated within 4.5 hours of symptoms onset with either IVT or antithrombotic therapy between 2006 and 2020 (inclusion date varied among centers). Primary outcome was END within 24 hours (≥4 National Institutes of Health Stroke Scale points increase within 24 hours), and secondary outcomes were END within 7 days (END7d) and 3-month modified Rankin Scale score 0 to 1. RESULTS Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END7d occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07-3.92]; P=0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P=0.09). However, END7d and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END7d: adjusted hazard ratio, 1.29 [95% CI, 0.75-2.23]; P=0.37; modified Rankin Scale score of 0-1: adjusted odds ratio, 1.1 [95% CI, 0.6-2.2]; P=0.71). END7d occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9-10.1) versus 20.4 hours (interquartile range, 7.8-34.4), respectively, P<0.01. CONCLUSION In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END-particularly END due to artery-to-artery embolism-occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.
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Affiliation(s)
- Naouel Boulenoir
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France (N.B., M.O., L.B., P.S.).,Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc, France (N.B., G.T., J.-C.B.)
| | - Guillaume Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc, France (N.B., G.T., J.-C.B.)
| | | | - Mirjam R Heldner
- Neurology Department, Inselspital, University Hospital and University of Bern, Switzerland (M.R.H., S.J.)
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne (D.S., P.M.)
| | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France (N.L.)
| | | | - Jérémie Papassin
- Stroke Unit, Grenoble University Hospital, France (J.P.).,Neurology Department, Chambery Hospital, France (J.P.)
| | - Igor Sibon
- Stroke Unit, Bordeaux University Hospital, France (I.S.)
| | - Nicolas Chausson
- Neurology Department, Centre Hospitalier du Sud Francilien, Corbeil-Essones, France (N.C., L.B.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne (D.S., P.M.)
| | - Charlotte Rosso
- Sorbonne Université, Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, AP-HP; Urgences Cérébro-Vasculaires; ICM Infrastructure Stroke Network, Hôpital Pitié-Salpêtrière, F-75013, Paris, France (C.R.)
| | - Frédéric Bourdain
- Neurology Department, Centre Hospitalier de la Cote Basque, Bayonne, France (F.B.)
| | - Chantal Lamy
- Neurology Department, Amiens University Hospital, France (C.L.)
| | | | - Pierre Agius
- Neurology Department, St Nazaire Hospital, France (P.A.)
| | - Marion Yger
- Neurology Department, Saint-Antoine Hospital, Paris, France (M.Y.)
| | - Michael Obadia
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France (N.B., M.O., L.B., P.S.)
| | - Denis Sablot
- Neurology Department, Centre Hospitalier de Perpignan, France (D.S.)
| | - Nicolas Legris
- Neurology Department, CHU Kremlin Bicêtre, France (N.L.)
| | - Simon Jung
- Neurology Department, Inselspital, University Hospital and University of Bern, Switzerland (M.R.H., S.J.)
| | - Sara Pilgram-Pastor
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Switzerland (S.P.-P.)
| | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (H.H.)
| | - Lucy Bernardaud
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France (N.B., M.O., L.B., P.S.).,Neurology Department, Centre Hospitalier du Sud Francilien, Corbeil-Essones, France (N.C., L.B.)
| | - Caroline Arquizan
- Neurology Department, CHRU Gui de Chauliac, Montpellier, France (A.T.S., C.A.)
| | - Jean-Claude Baron
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc, France (N.B., G.T., J.-C.B.)
| | - Pierre Seners
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France (N.B., M.O., L.B., P.S.)
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16
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Charidimou A, Boulouis G, Frosch MP, Baron JC, Pasi M, Albucher JF, Banerjee G, Barbato C, Bonneville F, Brandner S, Calviere L, Caparros F, Casolla B, Cordonnier C, Delisle MB, Deramecourt V, Dichgans M, Gokcal E, Herms J, Hernandez-Guillamon M, Jäger HR, Jaunmuktane Z, Linn J, Martinez-Ramirez S, Martínez-Sáez E, Mawrin C, Montaner J, Moulin S, Olivot JM, Piazza F, Puy L, Raposo N, Rodrigues MA, Roeber S, Romero JR, Samarasekera N, Schneider JA, Schreiber S, Schreiber F, Schwall C, Smith C, Szalardy L, Varlet P, Viguier A, Wardlaw JM, Warren A, Wollenweber FA, Zedde M, van Buchem MA, Gurol ME, Viswanathan A, Al-Shahi Salman R, Smith EE, Werring DJ, Greenberg SM. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21:714-725. [PMID: 35841910 PMCID: PMC9389452 DOI: 10.1016/s1474-4422(22)00208-3] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [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: 12/31/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations. METHODS In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy. FINDINGS The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard. INTERPRETATION The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations. FUNDING US National Institutes of Health (R01 AG26484).
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France
| | - Matthew P Frosch
- C S Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean-Claude Baron
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Marco Pasi
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean Francois Albucher
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Barbato
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Fabrice Bonneville
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Sebastian Brandner
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Lionel Calviere
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - François Caparros
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Barbara Casolla
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Charlotte Cordonnier
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Marie-Bernadette Delisle
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Vincent Deramecourt
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) and German Center for Neurodegenerative Diseases, Munich, Germany
| | - Elif Gokcal
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Zane Jaunmuktane
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Linn
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Dresden, Germany
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elena Martínez-Sáez
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Mawrin
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Biomedicine of Seville, Hospital Universitario Virgen Macarena, Consejo Superior de Investigaciones Científicas, University of Seville, Spain
| | - Solene Moulin
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean-Marc Olivot
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laurent Puy
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Nicolas Raposo
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jose Rafael Romero
- Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | | | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Stefanie Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Corentin Schwall
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Levente Szalardy
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Pascale Varlet
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Alain Viguier
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Warren
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Helios Dr Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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17
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Seners P, Arquizan C, Fontaine L, Ben Hassen W, Heldner MR, Strambo D, Nagel S, Carrera E, Mechtouff L, McCullough-Hicks M, Mohammaden MH, Cottier JP, Henon H, Aignatoaie A, Laksiri N, Papassin J, Lucas L, Garnier P, Triquenot A, Mione G, Hajdu S, Costalat V, Potreck A, Detante O, Bonneville F, Berthezene Y, Bracard S, Sibon I, Bricout N, Boutet C, Mordasini P, Michel P, Oppenheim C, Olivot JM, Nogueira RG, Albers GW, Baron JC, Turc G, Cognard C, Marnat G, Menegon P, Ledure S, Dargazanli C, Cho TH, Nighoghossian N, Eker O, Gouttard S, Haussen D, Debiais S, Charron V, Charron N, Leys D, Ozsancak C, Delpech M, Brunel H, Papagiannaki C, Girardin E, Richard S, Gory B, Zbinden M, Dobrocky T, Ringelb P, Möhlenbruch M. Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion. Stroke 2022; 53:3429-3438. [DOI: 10.1161/strokeaha.122.039182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with large vessel occlusion is unknown. Perfusion imaging may identify subsets of large vessel occlusion–related minor stroke patients with distinct response to bridging therapy.
METHODS:
We conducted a multicenter international observational study of consecutive IVT-treated patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) who had an anterior circulation large vessel occlusion and perfusion imaging performed before IVT, with a subset undergoing immediate thrombectomy. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month modified Rankin Scale score 0 to 1. We searched for an interaction between treatment group and mismatch volume (critical hypoperfusion–core volume).
RESULTS:
Overall, 569 patients were included (172 and 397 in the bridging therapy and IVT groups, respectively). After propensity-score weighting, the distribution of baseline variables was similar across the 2 groups. In the entire population, bridging was associated with lower odds of achieving modified Rankin Scale score 0 to 1: odds ratio, 0.73 [95% CI, 0.55–0.96];
P
=0.03. However, mismatch volume modified the effect of bridging on clinical outcome (
P
interaction
=0.04 for continuous mismatch volume); bridging was associated with worse outcome in patients with, but not in those without, mismatch volume <40 mL (odds ratio, [95% CI] for modified Rankin Scale score 0–1: 0.48 [0.33–0.71] versus 1.14 [0.76–1.71], respectively). Bridging was associated with higher incidence of symptomatic intracranial hemorrhage in the entire population, but this effect was present in the small mismatch subset only (
P
interaction
=0.002).
CONCLUSIONS:
In our population of large vessel occlusion-related minor stroke patients, bridging therapy was associated with lower rates of good outcome as compared with IVT alone. However, mismatch volume was a strong modifier of the effect of bridging therapy over IVT alone, notably with worse outcome with bridging therapy in patients with mismatch volume ≤40 mL. Randomized trials should consider adding perfusion imaging for patient selection.
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Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM U1266, FHU NeuroVasc, France (P.S., J.-C.B., G.T.)
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France (P.S.)
| | - Caroline Arquizan
- Neurology Department, CHRU Gui de Chauliac, Montpellier, France (C.A.)
| | - Louis Fontaine
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (L.F., J.-M.O.)
| | - Wagih Ben Hassen
- Radiology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc,France (W.B.H., C.O.)
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (M.R.H.)
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switerland (D.S., S.H., P. Michel)
| | - Simon Nagel
- Neurology Department, Heidelberg University Hospital, Germany (S.N.)
- Klinikum Ludwigshafen am Rhein gGmbH, Germany (S.N.)
| | - Emmanuel Carrera
- Neurology Department, Geneve University Hospital, Switzerland (E.C.)
| | | | | | - Mahmoud H. Mohammaden
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine, Atlanta, GA (M.H.M., R.G.N.)
| | | | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (H.H.)
| | | | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France (N.L.)
| | - Jérémie Papassin
- Neurology Department, Stroke Unit, CHU Grenoble Alpes, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, France (J.P., O.D., I.S.)
| | - Ludovic Lucas
- Stroke Unit, Bordeaux University Hospital, France (L.L.)
| | - Pierre Garnier
- Neurology Department, St Etienne University Hospital, France (P.G.)
| | - Aude Triquenot
- Neurology Department, Rouen University Hospital, France (A.T.)
| | - Gioia Mione
- Neurology Department, Nancy University Hospital, France (G.M.)
| | - Steven Hajdu
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switerland (D.S., S.H., P. Michel)
| | - Vincent Costalat
- Radiology Department, CHRU Gui de Chauliac, Montpellier, France (V.C.)
| | - Arne Potreck
- Neuroradiology Department, Heidelberg University Hospital, Germany (A.P.)
| | - Olivier Detante
- Neurology Department, Stroke Unit, CHU Grenoble Alpes, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, France (J.P., O.D., I.S.)
| | - Fabrice Bonneville
- Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, France (F.B.)
| | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, France (Y.B.)
| | - Serge Bracard
- Neuroradiology Department, Nancy University Hospital, France (S.B.)
| | - Igor Sibon
- Neurology Department, Stroke Unit, CHU Grenoble Alpes, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, France (J.P., O.D., I.S.)
| | | | - Claire Boutet
- Radiology Department, St Etienne University Hospital, France (C.B.)
| | - Pasquale Mordasini
- Neuroradiology Department, Inselspital, University Hospital and University of Bern, Switzerland (P. Mordasini)
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switerland (D.S., S.H., P. Michel)
| | - Catherine Oppenheim
- Radiology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM UMR 1266, FHU NeuroVasc,France (W.B.H., C.O.)
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (L.F., J.-M.O.)
| | - Raul G. Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine, Atlanta, GA (M.H.M., R.G.N.)
| | | | - Jean-Claude Baron
- Neurology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM U1266, FHU NeuroVasc, France (P.S., J.-C.B., G.T.)
| | - Guillaume Turc
- Neurology Department, GHU Paris psychiatrie et neurosciences, Sainte-Anne Hospital, Université de Paris, INSERM U1266, FHU NeuroVasc, France (P.S., J.-C.B., G.T.)
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18
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Carrera E, Baron JC. Patient Selection for Thrombectomy Using Brain Imaging: Does Time Still Matter? Neurology 2022; 98:867-868. [PMID: 35450965 DOI: 10.1212/wnl.0000000000200719] [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: 11/15/2022] Open
Affiliation(s)
- Emmanuel Carrera
- From the Stroke Center, Department of Clinical Neurosciences (E.C.), Geneva University Hospital; Faculty of Medicine (E.C.), Geneva, Switzerland; Department of Neurology (J.-C.B.), Hôpital Sainte-Anne and Université de Paris; INSERM U1266 (J.-C.B.), Institut de Psychiatrie et Neurosciences de Paris, France
| | - Jean-Claude Baron
- From the Stroke Center, Department of Clinical Neurosciences (E.C.), Geneva University Hospital; Faculty of Medicine (E.C.), Geneva, Switzerland; Department of Neurology (J.-C.B.), Hôpital Sainte-Anne and Université de Paris; INSERM U1266 (J.-C.B.), Institut de Psychiatrie et Neurosciences de Paris, France
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19
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Camps-Renom P, McCabe J, Martí-Fàbregas J, Giannotti N, Fernández-León A, McNulty JP, Baron JC, Barry M, Coutts SB, Cronin S, Delgado-Mederos R, Dolan E, Foley S, Guasch-Jiménez M, Guisado-Alonso D, Harbison JA, Horgan G, Kavanagh EC, Marnane M, Martinez-Domeño A, McDonnell C, Sharma VK, Williams D, Connell MO, Murphy S, Prats-Sanchez L, Kelly PJ. Association of Plaque Inflammation With Stroke Recurrence in Patients With Unproven Benefit From Carotid Revascularization. Neurology 2022; 99:e109-e118. [PMID: 35418461 DOI: 10.1212/wnl.0000000000200525] [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: 08/24/2021] [Accepted: 03/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated SCAIL score includes stenosis severity and inflammation measured by Positron-Emission Tomography (PET) and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated if the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials. METHODS We did an individual-participant data pooled analysis of three prospective cohort studies (DUCASS, 2008-2011; BIOVASC, 2014-2018; Barcelona Plaque Study, 2015-2018). Eligible patients had a recent non-severe (modified Rankin Score≤3) anterior circulation ischaemic stroke/TIA and either: ipsilateral mild carotid stenosis (<50%); ipsilateral moderate carotid stenosis (50-69%) plus at least one of female sex, age <65 years, diabetes mellitus, TIA, or delay >14 days to revascularization; or monocular loss of vision. Patients underwent co-registered carotid 18F-FDG PET/CT angiography (≤7 days from inclusion). The primary outcome was 90-day ipsilateral ischaemic stroke. Multivariable Cox regression modelling was performed. RESULTS We included 135 patients. All patients started optimal modern-era medical treatment at admission and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least one stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0-1, 15.1% scoring 2-3 and 26.7% scoring 4-5; p=0.04). The adjusted (age, smoking, hypertension, diabetes mellitus, carotid revascularization, antiplatelets and statins) Hazard Ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32-3.53; p=0.002). A score ≥2 had a sensitivity of 100% for recurrence. DISCUSSION The SCAIL score improved the identification of early recurrent stroke in subgroups that did not experience benefit in endarterectomy trials. Randomized trials are needed to test if a combined stenosis-inflammation strategy will improve selection for carotid revascularization where benefit is currently uncertain. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
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Affiliation(s)
- Pol Camps-Renom
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - John McCabe
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Joan Martí-Fàbregas
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Nicola Giannotti
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin. Ireland.,Discipline of Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, University of Sydney
| | | | - Jonathan P McNulty
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin. Ireland
| | - Jean-Claude Baron
- Department of Neurology, Université de Paris, Hopital Sainte-Anne. Paris, France
| | - Mary Barry
- Department of Vascular Surgery, St Vincent's University Hospital, and University College Dublin Ireland
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Simon Cronin
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Department of Neurology, Cork University Hospital, and Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Ireland
| | - Raquel Delgado-Mederos
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Eamon Dolan
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Connolly Hospital Dublin and Royal College of Surgeons Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin. Ireland
| | - Marina Guasch-Jiménez
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Daniel Guisado-Alonso
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Joseph A Harbison
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Stroke Service, Department of Geriatric Medicine, St James' Hospital and Trinity College Dublin Ireland
| | - Gillian Horgan
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater University Hospital and University College Dublin Ireland
| | - Michael Marnane
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Alejandro Martinez-Domeño
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Ciaran McDonnell
- Department of Vascular Surgery, Mater University Hospital, and University College Dublin Ireland
| | - Vijay K Sharma
- Division of Neurology, National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore
| | - David Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences/Beaumont Hospital Dublin Ireland
| | - Martin O Connell
- Department of Radiology, Mater University Hospital and University College Dublin Ireland
| | - Sean Murphy
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Luis Prats-Sanchez
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Peter J Kelly
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
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20
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Benzakoun J, Deslys MA, Legrand L, Hmeydia G, Turc G, Hassen WB, Charron S, Debacker C, Naggara O, Baron JC, Thirion B, Oppenheim C. Synthetic FLAIR as a Substitute for FLAIR Sequence in Acute Ischemic Stroke. Radiology 2022; 303:153-159. [PMID: 35014901 DOI: 10.1148/radiol.211394] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background In acute ischemic stroke (AIS), fluid-attenuated inversion recovery (FLAIR) is used for treatment decisions when onset time is unknown. Synthetic FLAIR could be generated with deep learning from information embedded in diffusion-weighted imaging (DWI) and could replace acquired FLAIR sequence (real FLAIR) and shorten MRI duration. Purpose To compare performance of synthetic and real FLAIR for DWI-FLAIR mismatch estimation and identification of patients presenting within 4.5 hours from symptom onset. Materials and Methods In this retrospective study, all pretreatment and early follow-up (<48 hours after symptom onset) MRI data sets including DWI (b = 0-1000 sec/mm2) and FLAIR sequences obtained in consecutive patients with AIS referred for reperfusion therapies between January 2002 and May 2019 were included. On the training set (80%), a generative adversarial network was trained to produce synthetic FLAIR with DWI as input. On the test set (20%), synthetic FLAIR was computed without real FLAIR knowledge. The DWI-FLAIR mismatch was evaluated on both FLAIR data sets by four independent readers. Interobserver reproducibility and DWI-FLAIR mismatch concordance between synthetic and real FLAIR were evaluated with κ statistics. Sensitivity and specificity for identification of AIS within 4.5 hours were compared in patients with known onset time by using McNemar test. Results The study included 1416 MRI scans (861 patients; median age, 71 years [interquartile range, 57-81 years]; 375 men), yielding 1134 and 282 scans for training and test sets, respectively. Regarding DWI-FLAIR mismatch, interobserver reproducibility was substantial for real and synthetic FLAIR (κ = 0.80 [95% CI: 0.74, 0.87] and 0.80 [95% CI: 0.74, 0.87], respectively). After consensus, concordance between real and synthetic FLAIR was almost perfect (κ = 0.88; 95% CI: 0.82, 0.93). Diagnostic value for identifying AIS within 4.5 hours did not differ between real and synthetic FLAIR (sensitivity: 107 of 131 [82%] vs 111 of 131 [85%], P = .2; specificity: 96 of 104 [92%] vs 96 of 104 [92%], respectively, P > .99). Conclusion Synthetic fluid-attenuated inversion recovery (FLAIR) had diagnostic performances similar to real FLAIR in depicting diffusion-weighted imaging-FLAIR mismatch and in helping to identify early acute ischemic stroke, and it may accelerate MRI protocols. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Carroll and Hurley in this issue.
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Affiliation(s)
- Joseph Benzakoun
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Marc-Antoine Deslys
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Laurence Legrand
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Ghazi Hmeydia
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Guillaume Turc
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Wagih Ben Hassen
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Sylvain Charron
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Clément Debacker
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Olivier Naggara
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Jean-Claude Baron
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Bertrand Thirion
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Catherine Oppenheim
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
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21
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Dupin L, Cuenca M, Baron JC, Maier MA, Lindberg PG. Shrinking of spatial hand representation but not of objects across the lifespan. Cortex 2021; 146:173-185. [PMID: 34883309 DOI: 10.1016/j.cortex.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/02/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Perception and action are based on cerebral spatial representations of the body and the external world. However, spatial representations differ from the physical characteristics of body and external space (e.g., objects). It remains unclear whether these discrepancies are related to functional requirements of action and are shared between different spatial representations, indicating common brain processes. We hypothesized that distortions of spatial hand representation would be affected by age, sensorimotor practice and external space representation. We assessed hand representations using tactile and verbal localization tasks and quantified object representation in three age groups (20-79 yrs, total n = 60). Our results show significant shrinking of spatial hand representations (hand width) with age, unrelated to sensorimotor functions. No such shrinking occurred in spatial object representations despite some common characteristics with hand representations. Therefore, spatial properties of body representation partially share characteristics of object representation but also evolve independently across the lifespan.
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Affiliation(s)
- Lucile Dupin
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France.
| | - Macarena Cuenca
- Centre de Recherche Clinique, GHU, Hôpital Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Marc A Maier
- Université de Paris, INCC UMR 8002, CNRS, Paris, France
| | - Påvel G Lindberg
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
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22
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Benzakoun J, Charron S, Turc G, Hassen WB, Legrand L, Boulouis G, Naggara O, Baron JC, Thirion B, Oppenheim C. Tissue outcome prediction in hyperacute ischemic stroke: Comparison of machine learning models. J Cereb Blood Flow Metab 2021; 41:3085-3096. [PMID: 34159824 PMCID: PMC8756479 DOI: 10.1177/0271678x211024371] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Machine Learning (ML) has been proposed for tissue fate prediction after acute ischemic stroke (AIS), with the aim to help treatment decision and patient management. We compared three different ML models to the clinical method based on diffusion-perfusion thresholding for the voxel-based prediction of final infarct, using a large MRI dataset obtained in a cohort of AIS patients prior to recanalization treatment. Baseline MRI (MRI0), including diffusion-weighted sequence (DWI) and Tmax maps from perfusion-weighted sequence, and 24-hr follow-up MRI (MRI24h) were retrospectively collected in consecutive 394 patients AIS patients (median age = 70 years; final infarct volume = 28mL). Manually segmented DWI24h lesion was considered the final infarct. Gradient Boosting, Random Forests and U-Net were trained using DWI, apparent diffusion coefficient (ADC) and Tmax maps on MRI0 as inputs to predict final infarct. Tissue outcome predictions were compared to final infarct using Dice score. Gradient Boosting had significantly better predictive performance (median [IQR] Dice Score as for median age, maybe you can replace the comma with an equal sign for consistency 0.53 [0.29-0.68]) than U-Net (0.48 [0.18-0.68]), Random Forests (0.51 [0.27-0.66]), and clinical thresholding method (0.45 [0.25-0.62]) (P < 0.001). In this benchmark of ML models for tissue outcome prediction in AIS, Gradient Boosting outperformed other ML models and clinical thresholding method and is thus promising for future decision-making.
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Affiliation(s)
- Joseph Benzakoun
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Sylvain Charron
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Guillaume Turc
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Faculté de médecine, Université de Paris, Paris, France.,Department of Neurology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | - Wagih Ben Hassen
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | - Laurence Legrand
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | - Grégoire Boulouis
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Olivier Naggara
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Faculté de médecine, Université de Paris, Paris, France.,Department of Neurology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | | | - Catherine Oppenheim
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
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23
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Baron JC, Boulouis G, Benzakoun J, Schwall C, Oppenheim C, Turc G, Varlet P. Cerebral amyloid angiopathy-related acute lobar intra-cerebral hemorrhage: diagnostic value of plain CT. J Neurol 2021; 269:2126-2132. [PMID: 34510255 PMCID: PMC8940847 DOI: 10.1007/s00415-021-10796-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diagnosing probable cerebral amyloid angiopathy (CAA) after lobar intra-cerebral hemorrhage (l-ICH) currently relies on the MR-based modified Boston criteria (mBC). However, MRI has limited availability and the mBC have moderate sensitivity, with isolated l-ICH being classified as "possible CAA". A recent autopsy-based study reported potential value of finger-like projections (FLP) and subarachnoid hemorrhage (SAH) on acute CT. Here we assessed these markers' performance in a cohort most of whom survived the index episode. METHODS We included all patients from a prospective pathology database with non-traumatic l-ICH, admission CT and available tissue sample showing no alternative cause. CT was assessed by two blinded independent neuroradiologists. Interobserver reproducibility was almost perfect for SAH and substantial for FLP. RESULTS Sixteen patients were eligible [age 65.8 ± 7.2 yrs; hematoma volume: 39(26, 71)mls; hematoma evacuation sample 15 patients; autopsy one patient]. MRI was available in 11 patients. ICH-related death affected six patients. Aβ40-42 immunohistochemistry revealed CAA in seven patients (44%). SAH and FLP were present in 12/16 (75%) and 10/16 (62%) patients, respectively. SAH had 100% sensitivity for CAA but low specificity; FLP had lower performance. Using either pathology or MRI as reference standard yielded essentially similar results. All patients with possible CAA on MRI but CAA on pathology had SAH. CONCLUSIONS In patients with moderate-size l-ICH who mostly survived the index event, SAH had perfect sensitivity and better performance than FLP. In addition, SAH appeared to add onto MRI in possible CAA, the clinically most relevant scenario. Studies in larger samples are however warranted.
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Groupe Hospitalier Universitaire de Paris, Université de Paris, Paris, France. .,Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France.
| | - Grégoire Boulouis
- Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France.,Department of Radiology, CHU de Tours, Tours, France
| | - Joseph Benzakoun
- Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France.,Department of Imaging, Groupe Hospitalier Universitaire de Paris, Université de Paris, Paris, France
| | - Corentin Schwall
- Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France.,Department of Pathology, Groupe Hospitalier Universitaire de Paris, Université de Paris, Paris, France
| | - Catherine Oppenheim
- Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France.,Department of Imaging, Groupe Hospitalier Universitaire de Paris, Université de Paris, Paris, France
| | - Guillaume Turc
- Department of Neurology, Groupe Hospitalier Universitaire de Paris, Université de Paris, Paris, France.,Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France
| | - Pascale Varlet
- Inserm U1266, Institut de Neurosciences et de Psychiatrie de Paris, Paris, France.,Department of Pathology, Groupe Hospitalier Universitaire de Paris, Université de Paris, Paris, France
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24
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Seners P, Baron JC, Turc G. Questions on Predicting Early Neurological Deterioration in Patients With Minor Stroke and Large-Vessel Occlusion-Reply. JAMA Neurol 2021; 78:1020-1021. [PMID: 34228095 DOI: 10.1001/jamaneurol.2021.2025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Pierre Seners
- Neurology Department, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, Institut National de la Santé et de la Recherche Médicale Unité 1266, Université de Paris, FHU NeuroVasc, Paris, France.,Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Jean-Claude Baron
- Neurology Department, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, Institut National de la Santé et de la Recherche Médicale Unité 1266, Université de Paris, FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Neurology Department, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, Institut National de la Santé et de la Recherche Médicale Unité 1266, Université de Paris, FHU NeuroVasc, Paris, France
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25
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hopital Sainte-Anne, Université de Paris, Paris, France
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26
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Seners P, Oppenheim C, Turc G, Albucher JF, Guenego A, Raposo N, Christensen S, Calvière L, Viguier A, Darcourt J, Januel AC, Mlynash M, Sommet A, Thalamas C, Sibon I, Rousseau V, Tourdias T, Menegon P, Bonneville F, Mazighi M, Charron S, Legrand L, Cognard C, Albers GW, Baron JC, Olivot JM. Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core. Ann Neurol 2021; 90:417-427. [PMID: 34216396 DOI: 10.1002/ana.26152] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/02/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue ("core"). Perfusion imaging may identify a subset of patients with large core who benefit from MT. METHODS We compared two cohorts of LVO-related patients with large core (>50 ml on diffusion-weighted-imaging or CT-perfusion using RAPID), available perfusion imaging, and treated within 6 hours from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre-MT era from a prospective registry. Primary outcome was 90-day modified Rankin Scale ≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio = critical hypoperfusion/core volume). RESULTS Overall, 107 patients were included (56 MT + BMM and 51 BMM): Mean age was 68 ± 15 years, median core volume 99 ml (IQR: 72-131) and MMRatio 1.4 (IQR: 1.0-1.9). Baseline clinical and radiological variables were similar between the two groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (pinteraction < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95% CI] = 6.8 [1.7-27.0] vs 0.7 [0.1-6.2], respectively). Similar findings were present for MMRatio ≥1.8 in the subgroup with core ≥70 ml. Parenchymal hemorrhage on follow-up imaging was more frequent in the MT + BMM group regardless of the MMRatio. INTERPRETATION Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021.
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Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Catherine Oppenheim
- Radiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Guillaume Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Jean-François Albucher
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Adrien Guenego
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Raposo
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Lionel Calvière
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Alain Viguier
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean Darcourt
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne-Christine Januel
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Agnes Sommet
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Claire Thalamas
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Igor Sibon
- Unité Neurovasculaire, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Vanessa Rousseau
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thomas Tourdias
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Patrice Menegon
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Fabrice Bonneville
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Hôpital Fondation A. de Rothschild, Paris, France
| | - Sylvain Charron
- Radiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Laurence Legrand
- Radiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Christophe Cognard
- Department of Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Jean-Claude Baron
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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Baron JC. The core/penumbra model: implications for acute stroke treatment and patient selection in 2021. Eur J Neurol 2021; 28:2794-2803. [PMID: 33991152 DOI: 10.1111/ene.14916] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/10/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022]
Abstract
Despite major advances in prevention, ischaemic stroke remains one of the leading causes of death and disability worldwide. After centuries of nihilism and decades of failed neuroprotection trials, the discovery, initially in non-human primates and subsequently in man, that ischaemic brain tissue termed the ischaemic penumbra can be salvaged from infarction up to and perhaps beyond 24 h after stroke onset has underpinned the development of highly efficient reperfusion therapies, namely intravenous thrombolysis and endovascular thrombectomy, which have revolutionized the management of the acute stroke patient. Animal experiments have documented that how long the penumbra can survive depends not only on time elapsed since arterial occlusion ('time is brain'), but also on how severely perfusion is reduced. Novel imaging techniques allowing the penumbra and the already irreversibly damaged core in the individual subject to be mapped have documented that the time course of core growth at the expense of the penumbra widely differs from patient to patient, and hence that individual physiology should be considered in addition to time since stroke onset for decision-making. This concept has been implemented to optimize patient selection in pivotal trials of reperfusion therapies beyond 3 h after stroke onset and is now routinely applied in clinical practice, using computed tomography or magnetic resonance imaging. The notion that, in order to be both efficient and harmless, treatment should be tailored to each patient's physiological characteristics represents a radical move towards precision medicine.
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Affiliation(s)
- Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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28
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Plantin J, Verneau M, Godbolt AK, Pennati GV, Laurencikas E, Johansson B, Krumlinde-Sundholm L, Baron JC, Borg J, Lindberg PG. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology 2021; 97:e706-e719. [PMID: 34400568 PMCID: PMC8377875 DOI: 10.1212/wnl.0000000000012366] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/09/2020] [Accepted: 05/20/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. METHOD In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC). RESULTS Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point (r > 0.88, p < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome (R 2 = 0.81) and degree of recovery (R 2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R 2 = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm3 strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery. CONCLUSION Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery. CLINICALTRIALSGOV IDENTIFIER NCT02878304. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
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Affiliation(s)
- Jeanette Plantin
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France.
| | - Marion Verneau
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Alison K Godbolt
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Gaia Valentina Pennati
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Evaldas Laurencikas
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Birgitta Johansson
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Lena Krumlinde-Sundholm
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jean-Claude Baron
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jörgen Borg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Påvel G Lindberg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
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29
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Pruvost-Robieux E, Benzakoun J, Turc G, Marchi A, Mancusi RL, Lamy C, Domigo V, Oppenheim C, Calvet D, Baron JC, Mas JL, Gavaret M. Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial. Stroke 2021; 52:1951-1960. [PMID: 33866820 DOI: 10.1161/strokeaha.120.032056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Estelle Pruvost-Robieux
- Neurophysiology Department (E.P.-R., A.M., M.G.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Joseph Benzakoun
- Neuroradiology Department (J.B., C.O.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Guillaume Turc
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Angela Marchi
- Neurophysiology Department (E.P.-R., A.M., M.G.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Rossella Letizia Mancusi
- Délégation à la Recherche Clinique et à l'Innovation (R.L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris
| | - Catherine Lamy
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris
| | - Valérie Domigo
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris
| | - Catherine Oppenheim
- Neuroradiology Department (J.B., C.O.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - David Calvet
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Jean-Claude Baron
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Jean-Louis Mas
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Martine Gavaret
- Neurophysiology Department (E.P.-R., A.M., M.G.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
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Crassard I, Berthet K, Lavallée P, Houot M, Payen D, Baron JC, Amarenco P, Lukaszewicz AC. Temporary application of lower body positive pressure improves intracranial velocities in symptomatic acute carotid occlusion or tight stenosis: A pilot study. Int J Stroke 2021; 17:308-314. [PMID: 33759644 DOI: 10.1177/17474930211008003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with isolated cervical carotid artery occlusion not eligible to recanalization therapies but with compromised intracranial hemodynamics may be at risk of further clinical events. Apart from lying flat until spontaneous recanalization or adjustment of the collateral circulation hopefully occurs, no specific treatment is currently implemented. Improving collateral flow is an attractive option in this setting. Lower body positive pressure (LBPP) is known to result in rapid venous blood shift from the lower to the upper body part, in turn improving cardiac preload and output, and is routinely used in acute hemorrhagic shock. We report here cerebral blood flow velocities measured during LBPP in this patient population. METHODS This is a retrospective analysis of the clinical, physiological, and transcranial Doppler monitoring data collected during and 15 min after LBPP in 21 consecutive patients (10 females, median age: 54 years) with recently symptomatic isolated carotid occlusion/tight stenosis (unilateral in 18) mostly due to atherosclerosis or dissection. LBPP was applied for 90 min at a median 5 days after symptom onset. RESULTS At baseline, middle-cerebral artery velocities were markedly lower on the symptomatic, as compared to asymptomatic, side. LBPP significantly improved blood flow velocities in both the symptomatic and asymptomatic middle-cerebral artery as well as the basilar artery, which persisted 15 min after discontinuing the procedure. LBPP also resulted in mild but significant increases in mean arterial blood pressure. CONCLUSIONS LBPP improved intracranial hemodynamics downstream recently symptomatic carotid occlusion/tight stenosis as well as in the contralateral and posterior circulations, which persisted after LBPP deflation. Randomized trials should determine if this easy-to-use, noninvasive, nonpharmacologic approach has long-lasting benefits on the intracranial circulation and improves functional outcome.
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Affiliation(s)
| | - Karine Berthet
- Neurology Department, Hôpital Lariboisière, Paris, France.,Neuraltide, iPEPS, Brain and Spine Institute, Paris, France
| | - Philippa Lavallée
- Department of Neurology and Stroke Center, Hôpital Bichat, Paris, France
| | - Marion Houot
- Centre of Excellence for Neurodegenerative Disease (CoEN), Hôpital Salpêtrière, Paris, France.,Institute of Memory and Alzheimer's disease (IM2A), Department of Neurology, Hôpital Salpêtrière, AP-HP, Paris, France.,Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Hôpital Salpêtrière, Paris, France
| | - Didier Payen
- Université de Paris, UFR de Médecine Sorbonne, Paris, France
| | - Jean-Claude Baron
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), 27102INSERM U1266, Paris, France.,Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Hôpital Bichat, Paris, France
| | - Anne-Claire Lukaszewicz
- Department of Anesthesiology and Intensive Care, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.,EA 7426 PI3, Université de Lyon-BioMerieux, Lyon, France
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31
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Seners P, Ben Hassen W, Lapergue B, Arquizan C, Heldner MR, Henon H, Perrin C, Strambo D, Cottier JP, Sablot D, Girard Buttaz I, Tamazyan R, Preterre C, Agius P, Laksiri N, Mechtouff L, Béjot Y, Duong DL, Mounier-Vehier F, Mione G, Rosso C, Lucas L, Papassin J, Aignatoaie A, Triquenot A, Carrera E, Niclot P, Obadia A, Lyoubi A, Garnier P, Crainic N, Wolff V, Tracol C, Philippeau F, Lamy C, Soize S, Baron JC, Turc G. Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone. JAMA Neurol 2021; 78:321-328. [PMID: 33427887 DOI: 10.1001/jamaneurol.2020.4557] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance The best reperfusion strategy in patients with acute minor stroke and large vessel occlusion (LVO) is unknown. Accurately predicting early neurological deterioration of presumed ischemic origin (ENDi) following intravenous thrombolysis (IVT) in this population may help to select candidates for immediate transfer for additional thrombectomy. Objective To develop and validate an easily applicable predictive score of ENDi following IVT in patients with minor stroke and LVO. Design, Setting, and Participants This multicentric retrospective cohort included 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5 or less) and LVO (basilar artery, internal carotid artery, first [M1] or second [M2] segment of middle cerebral artery) intended for IVT alone in 45 French stroke centers, ie, including those who eventually received rescue thrombectomy because of ENDi. For external validation, another cohort of 347 patients with similar inclusion criteria was collected from 9 additional centers. Data were collected from January 2018 to September 2019. Main Outcomes and Measures ENDi, defined as 4 or more points' deterioration on NIHSS score within the first 24 hours without parenchymal hemorrhage on follow-up imaging or another identified cause. Results Of the 729 patients in the derivation cohort, 335 (46.0%) were male, and the mean (SD) age was 70 (15) years; of the 347 patients in the validation cohort, 190 (54.8%) were male, and the mean (SD) age was 69 (15) years. In the derivation cohort, the median (interquartile range) NIHSS score was 3 (1-4), and the occlusion site was the internal carotid artery in 97 patients (13.3%), M1 in 207 (28.4%), M2 in 395 (54.2%), and basilar artery in 30 (4.1%). ENDi occurred in 88 patients (12.1%; 95% CI, 9.7-14.4) and was strongly associated with poorer 3-month outcomes, even in patients who underwent rescue thrombectomy. In multivariable analysis, a more proximal occlusion site and a longer thrombus were independently associated with ENDi. A 4-point score derived from these variables-1 point for thrombus length and 3 points for occlusion site-showed good discriminative power for ENDi (C statistic = 0.76; 95% CI, 0.70-0.82) and was successfully validated in the validation cohort (ENDi rate, 11.0% [38 of 347]; C statistic = 0.78; 95% CI, 0.70-0.86). In both cohorts, ENDi probability was approximately 3%, 7%, 20%, and 35% for scores of 0, 1, 2 and 3 to 4, respectively. Conclusions and Relevance The substantial ENDi rates observed in these cohorts highlights the current debate regarding whether to directly transfer patients with IVT-treated minor stroke and LVO for additional thrombectomy. Based on the strong associations observed, an easily applicable score for ENDi risk prediction that may assist decision-making was derived and externally validated.
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Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Wagih Ben Hassen
- Radiology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | | | | | - Mirjam R Heldner
- Neurology Department, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Hilde Henon
- Neurology Department, CHU Lille, Université de Lille, INSERM U1171, Lille, France
| | - Claire Perrin
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Davide Strambo
- Stroke Center, Neurology Service, CHU Vaudois, Lausanne University, Lausanne, Switzerland
| | | | - Denis Sablot
- Neurology Department, Perpignan Hospital, Perpignan, France
| | | | - Ruben Tamazyan
- Neurology Department, Saint Joseph Hospital, Paris, France
| | - Cécile Preterre
- Neurology Department, Nantes University Hospital, Nantes, France
| | - Pierre Agius
- Neurology Department, Nantes University Hospital, Nantes, France.,Neurology Department, St Nazaire Hospital, Saint-Nazaire, France
| | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France
| | - Laura Mechtouff
- Department of Stroke Medicine, Hospices Civils de Lyon, Lyon, France
| | - Yannick Béjot
- Neurology Department, Dijon University Hospital, Dijon, France
| | - Duc-Long Duong
- Neurology Department, Versailles University Hospital, Versailles, France
| | | | - Gioia Mione
- Neurology Department, Nancy University Hospital, Nancy, France
| | - Charlotte Rosso
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, INSERM U 1127, CNRS UMR 7225, AP-HP, Urgences Cérébro-Vasculaires, ICM Infrastructure Stroke Network, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ludovic Lucas
- Stroke Unit, Bordeaux University Hospital, Bordeaux, France
| | - Jérémie Papassin
- Stroke Unit, Grenoble University Hospital, Grenoble, France.,Neurology Department, Centre Hospitalier Metropole-Savoie, Chambery, France
| | - Andreea Aignatoaie
- Neurology Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Emmanuel Carrera
- Neurology Department, Geneve University Hospital, Geneve, Switzerland
| | | | - Alexandre Obadia
- Neurology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Aïcha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France
| | - Pierre Garnier
- Stroke Unit, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nicolae Crainic
- Neurology Department, Brest University Hospital, Brest, France
| | - Valérie Wolff
- Neurology Department, Strasbourg University Hospital, Strasbourg, France
| | - Clément Tracol
- Neurology Department, Rennes University Hospital, Rennes, France
| | | | - Chantal Lamy
- Neurology Department, Amiens University Hospital, Amiens, France
| | - Sébastien Soize
- Neuroradiology Department, Reims University Hospital, Reims, France
| | - Jean-Claude Baron
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Guillaume Turc
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
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Charidimou A, Boulouis G, Frosch M, Baron JC, Pasi M, van Buchem MA, Gurol EM, Viswanathan A, Al-Shahi Salman R, Smith EE, Werring DJ, GREENBERG SM. Abstract 36: The Boston Criteria V2.0 for Cerebral Amyloid Angiopathy: Updated Criteria and Multicenter MRI-Neuropathology Validation. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The Boston criteria are used worldwide for
in vivo
diagnosis of cerebral amyloid angiopathy (CAA). Given substantial advances in CAA research, we aimed to update the Boston criteria and externally validate their diagnostic accuracy across the spectrum of CAA-related presentations and across international sites.
Methods:
As part of an International CAA Association multicenter study, we identified patients age 50 or older with potential CAA-related clinical presentations (spontaneous intracerebral hemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathologic assessment for the diagnosis of CAA. We derived Boston criteria v2.0 by selecting MRI features to optimize diagnostic specificity and sensitivity in a pre-specified derivation sample (Boston cases 1994 to 2012, n=159), then externally validated in pre-specified temporal (Boston cases 2012-2018, n=59) and geographical (non-Boston cases 2004-2018; n=123) validation samples and compared their diagnostic accuracy to the currently used modified Boston criteria.
Results:
Based on exploratory analyses in the derivation sample, we derived provisional criteria for probable CAA requiring presence of at least 2 strictly lobar hemorrhagic lesions (intracerebral hemorrhage, cerebral microbleed, or cortical superficial siderosis focus) or at least 1 strictly lobar hemorrhagic lesion and 1 white matter characteristic (severe degree of visible perivascular spaces in centrum semiovale or white matter hyperintensities multispot pattern). Sensitivity/specificity of the criteria were 74.8/84.6% in the derivation sample, 92.5/89.5% in the temporal validation sample, 80.2/81.5% in the geographic validation sample, and 74.5/95.0% in cases across all samples with autopsy as the diagnostic gold standard. The v2.0 criteria for probable CAA had superior accuracy to the currently modified Boston criteria (p<0.005) in the autopsied cases.
Conclusion:
The Boston criteria v.2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their high specificity. Validation of the criteria across independent patient settings firmly supports their adoption into clinical practice and research.
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Bergeret S, Queneau M, Rodallec M, Landeau B, Chetelat G, Hong YT, Dumurgier J, Hugon J, Paquet C, Farid K, Baron JC. Brain Glucose Metabolism in Cerebral Amyloid Angiopathy: An FDG-PET Study. Stroke 2021; 52:1478-1482. [PMID: 33611942 DOI: 10.1161/strokeaha.120.032905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The in vivo diagnosis of cerebral amyloid angiopathy (CAA) is currently based on the Boston criteria, which largely rely on hemorrhagic features on brain magnetic resonance imaging. Adding to these criteria 18F-fluoro-deoxy-D-glucose (FDG) positron emission tomography, a widely available imaging modality, might improve their accuracy. Here we tested the hypothesis that FDG uptake is reduced in posterior cortical areas, particularly the primary occipital cortex, which pathologically bear the brunt of vascular Aβ deposition. METHODS From a large memory clinic database, we retrospectively included all patients in whom both brain magnetic resonance imaging and FDG positron emission tomography had been obtained as part of routine clinical care and who fulfilled the Boston criteria for probable CAA. None had a history of symptomatic intracerebral hemorrhage. FDG data processing involved (1) spatial normalization to the Montreal Neurology Institute/International Consortium for Brain Mapping 152 space and (2) generation of standardized FDG uptake (relative standardized uptake value; relative to the pons). The relative standardized uptake value data obtained in 13 regions of interest sampling key cortical areas and the cerebellum were compared between the CAA and age-matched control groups using 2 separate healthy subject databases and image-processing pipelines. The presence of significant hypometabolism (2-tailed P<0.05) was assessed for the bilaterally averaged regions-of-interest relative standardized uptake values. RESULTS Fourteen patients fulfilling the Boston criteria for probable CAA (≥2 exclusively lobar microbleeds) were identified. Significant hypometabolism (P range, 0.047 to <0.0001) consistently affected the posterior cortical areas, including the superior and inferior parietal, primary visual, lateral occipital, lateral temporal, precuneus, and posterior cingulate regions of interest. The anterior cortical areas were marginally or not significantly hypometabolic, and the cerebellum was spared. CONCLUSIONS Supporting our hypothesis, significant glucose hypometabolism predominantly affected posterior cortical regions, including the visual cortex. These findings from a small sample may have diagnostic implications but require replication in larger prospective studies. In addition, whether they generalize to CAA-related symptomatic intracerebral hemorrhage warrants specific studies.
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Affiliation(s)
- Sébastien Bergeret
- Department of Nuclear Medicine, CHU de Martinique, Université des Antilles, Fort-de-France (S.B., K.F.)
| | - Mathieu Queneau
- Department of Nuclear Medicine (M.Q.), Centre Cardiologique du Nord, Saint-Denis, France
| | - Mathieu Rodallec
- Department of Radiology (M.R.), Centre Cardiologique du Nord, Saint-Denis, France
| | - Brigitte Landeau
- INSERM U1237, Université Caen Normandie, France (G.C., B.L.).,CYCERON Biomedical Imaging Platform, Caen, France (G.C., B.L.)
| | - Gaël Chetelat
- INSERM U1237, Université Caen Normandie, France (G.C., B.L.).,CYCERON Biomedical Imaging Platform, Caen, France (G.C., B.L.)
| | - Young T Hong
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, United Kingdom (Y.T.H.)
| | - Julien Dumurgier
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France
| | - Jacques Hugon
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France.,Assistance Publique-Hopitaux de Paris, Cognitive Neurology Center, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Paris, France (J.H., C.P.)
| | - Claire Paquet
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France.,Assistance Publique-Hopitaux de Paris, Cognitive Neurology Center, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Paris, France (J.H., C.P.)
| | - Karim Farid
- Department of Nuclear Medicine, CHU de Martinique, Université des Antilles, Fort-de-France (S.B., K.F.).,INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital (J.-C.B.), Université de Paris, France.,INSERM U1266 (J.-C.B.), Université de Paris, France
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34
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Bergeret S, Queneau M, Rodallec M, Curis E, Dumurgier J, Hugon J, Paquet C, Farid K, Baron JC. [ 18 F]FDG PET may differentiate cerebral amyloid angiopathy from Alzheimer's disease. Eur J Neurol 2021; 28:1511-1519. [PMID: 33460498 DOI: 10.1111/ene.14743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is a frequent cause of both intracerebral hemorrhage (ICH) and cognitive impairment in the elderly. Diagnosis relies on the Boston criteria, which use magnetic resonance imaging markers including ≥2 exclusively lobar cerebral microbleeds (lCMBs). Although amyloid positron emission tomography (PET) may provide molecular diagnosis, its specificity relative to Alzheimer's disease (AD) is limited due to the prevalence of positive amyloid PET in cognitively normal elderly. Using early-phase 11 C-Pittsburgh compound B as surrogate for tissue perfusion, a significantly lower occipital/posterior cingulate (O/PC) tracer uptake ratio in probable CAA relative to AD was recently reported, consistent with histopathological lesion distribution. We tested whether this finding could be reproduced using [18 F]fluorodeoxyglucose (FDG)-PET, a widely available modality that correlates well with early-phase amyloid PET in both healthy subjects and AD. METHODS From a large memory clinic database, we retrospectively included 14 patients with probable CAA (Boston criteria) and 21 patients with no lCMB fulfilling AD criteria including cerebrospinal fluid biomarkers. In all, [18 F]FDG-PET/computed tomography (CT) was available as part of routine care. No subject had a clinical history of ICH. Regional standardized [18 F]FDG uptake values normalized to the pons (standard uptake value ratio [SUVr]) were obtained, and the O/PC ratio was calculated. RESULTS The SUVr O/PC ratio was significantly lower in CAA versus AD (1.02 ± 0.14 vs. 1.19 ± 0.18, respectively; p = 0.024). CONCLUSIONS Despite the small sample, our findings are consistent with the previous early-phase amyloid PET study. Thus, [18 F]FDG-PET may help differentiate CAA from AD, particularly in cases of amyloid PET positivity. Larger prospective studies, including in CAA-related ICH, are however warranted.
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Affiliation(s)
- Sébastien Bergeret
- Department of Nuclear Medicine, CHU French West Indies, Fort-de-France, France
| | - Mathieu Queneau
- Department of Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France
| | - Mathieu Rodallec
- Department of Radiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Emmanuel Curis
- Laboratoire de Biomathématiques, EA 7537 "BioSTM", Faculté de Pharmacie, Université de Paris, Paris, France.,Service de Biostatistiques et d'Information Médicale, Hôpital Saint-Louis, APHP, Paris, France
| | - Julien Dumurgier
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France
| | - Jacques Hugon
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France.,Cognitive Neurology Center, APHP, Saint-Louis Lariboisière Fernand-Widal Hospital Group, Paris, France
| | - Claire Paquet
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France.,Cognitive Neurology Center, APHP, Saint-Louis Lariboisière Fernand-Widal Hospital Group, Paris, France
| | - Karim Farid
- Department of Nuclear Medicine, CHU French West Indies, Fort-de-France, France.,INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital, Université de Paris, Paris, France.,INSERM U1266: Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France
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35
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Ter Schiphorst A, Charron S, Hassen WB, Provost C, Naggara O, Benzakoun J, Seners P, Turc G, Baron JC, Oppenheim C. Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study. J Cereb Blood Flow Metab 2021; 41:253-266. [PMID: 32960688 PMCID: PMC8370008 DOI: 10.1177/0271678x20954929] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite early thrombectomy, a sizeable fraction of acute stroke patients with large vessel occlusion have poor outcome. The no-reflow phenomenon, i.e. impaired microvascular reperfusion despite complete recanalization, may contribute to such "futile recanalizations". Although well reported in animal models, no-reflow is still poorly characterized in man. From a large prospective thrombectomy database, we included all patients with intracranial proximal occlusion, complete recanalization (modified thrombolysis in cerebral infarction score 2c-3), and availability of both baseline and 24 h follow-up MRI including arterial spin labeling perfusion mapping. No-reflow was operationally defined as i) hypoperfusion ≥40% relative to contralateral homologous region, assessed with both visual (two independent investigators) and automatic image analysis, and ii) infarction on follow-up MRI. Thirty-three patients were eligible (median age: 70 years, NIHSS: 18, and stroke onset-to-recanalization delay: 208 min). The operational criteria were met in one patient only, consistently with the visual and automatic analyses. This patient recanalized 160 min after stroke onset and had excellent functional outcome. In our cohort of patients with complete and stable recanalization following thrombectomy for intracranial proximal occlusion, severe ipsilateral hypoperfusion on follow-up imaging associated with newly developed infarction was a rare occurrence. Thus, no-reflow may be infrequent in human stroke and may not substantially contribute to futile recanalizations.
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Affiliation(s)
- Adrien Ter Schiphorst
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Sylvain Charron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Wagih Ben Hassen
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Corentin Provost
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Olivier Naggara
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Joseph Benzakoun
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Pierre Seners
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Guillaume Turc
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Jean-Claude Baron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Catherine Oppenheim
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
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36
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Seners P, Dargazanli C, Piotin M, Sablot D, Bracard S, Niclot P, Baron JC, Turc G. Intended Bridging Therapy or Intravenous Thrombolysis Alone in Minor Stroke With Basilar Artery Occlusion. Stroke 2021; 52:699-702. [PMID: 33406868 DOI: 10.1161/strokeaha.120.030992] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with basilar artery occlusion remains uncertain. METHODS Multicentric retrospective observational study of consecutive minor stroke patients (National Institutes of Health Stroke Scale score ≤5) with basilar artery occlusion intended for IVT alone or bridging therapy. Propensity-score weighting was used to reduce baseline between-groups differences, and residual imbalance was addressed through adjusted logistic regression, with excellent outcome (3-month modified Rankin Scale score 0-1) as the dependent variable. RESULTS Fifty-seven patients were included (28 and 29 in the bridging therapy and IVT alone groups, respectively). Following propensity-score weighting, the distribution of baseline clinical and radiological variables was similar across the 2 patient groups, except age, posterior circulation Alberta Stroke Program Early CT Score, history of hypertension and smoking, and onset-to-IVT time. Compared with IVT alone, bridging therapy was associated with excellent outcome (adjusted odds ratio=3.37 [95% CI, 1.13-10.03]; P=0.03). No patient experienced symptomatic intracranial hemorrhage. CONCLUSIONS Our results suggest that bridging therapy may be superior to IVT alone in minor stroke with basilar artery occlusion.
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Affiliation(s)
- Pierre Seners
- Neurology Department, Ste Anne Hospital, INSERM U1266, FHU Neurovasc, Paris, France (P.S., J.-C.B., G.T.)
| | | | - Michel Piotin
- Neuroradiology Department, Fondation Rothschild, Paris, France (M.P.)
| | - Denis Sablot
- Neurology Department, Perpignan Hospital, France (D.S.)
| | - Serge Bracard
- Neuroradiology Department, CHRU Nancy, France (S.B.)
| | - Philippe Niclot
- Neurology Department, René Dubos Hospital, Pontoise, France (P.N.)
| | - Jean-Claude Baron
- Neurology Department, Ste Anne Hospital, INSERM U1266, FHU Neurovasc, Paris, France (P.S., J.-C.B., G.T.)
| | - Guillaume Turc
- Neurology Department, Ste Anne Hospital, INSERM U1266, FHU Neurovasc, Paris, France (P.S., J.-C.B., G.T.)
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37
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Abstract
The discovery that brain tissue could potentially be salvaged from ischaemia due to stroke, has led to major advances in the development of therapies for ischemic stroke. In this review, we detail the advances in the understanding of this area termed the ischaemic penumbra, from its discovery to the evolution of imaging techniques, and finally some of the treatments developed. Evolving from animal studies from the 70s and 80s and translated to clinical practice, the field of ischemic reperfusion therapy has largely been guided by an array of imaging techniques developed to positively identify the ischemic penumbra, including positron emission tomography, computed tomography and magnetic resonance imaging. More recently, numerous penumbral identification imaging studies have allowed for a better understanding of the progression of the ischaemic core at the expense of the penumbra, and identification of patients than can benefit from reperfusion therapies in the acute phase. Importantly, 40 years of critical imaging research on the ischaemic penumbra have allowed for considerable extension of the treatment time window and better patient selection for reperfusion therapy. The translation of the penumbra concept into routine clinical practice has shown that "tissue is at least as important as time."
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Affiliation(s)
- Charlotte M Ermine
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Andrew Bivard
- Department of Medicine, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Australia.,Department of Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Australia
| | - Mark W Parsons
- Department of Medicine, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Australia.,Department of Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Australia
| | - Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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38
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Hughes JL, Beech JS, Jones PS, Wang D, Menon DK, Aigbirhio FI, Fryer TD, Baron JC. Early-stage 11C-Flumazenil PET predicts day-14 selective neuronal loss in a rodent model of transient focal cerebral ischemia. J Cereb Blood Flow Metab 2020; 40:1997-2009. [PMID: 31637947 PMCID: PMC7786851 DOI: 10.1177/0271678x19883040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Predicting tissue outcome early after stroke is an important goal. MRI >3 h accurately predicts infarction but is insensitive to selective neuronal loss (SNL). Previous studies suggest that chronic-stage 11C-flumazenil PET (FMZ-PET) is a validated marker of SNL in rats, while early-stage FMZ-PET may predict infarction. Whether early FMZ-PET also predicts SNL is unknown. Following 45-min distal MCA occlusion, adult rats underwent FMZ-PET at 1 h and 48 h post-reperfusion to map distribution volume (VT), which reflects GABA-A receptor binding. NeuN immunohistochemistry was performed at Day 14. In each rat, VT and %NeuN loss were determined in 44 ROIs spanning the hemisphere. NeuN revealed isolated SNL and cortical infarction in five and one rats, respectively. In the SNL subgroup, VT-1 h was mildly reduced and only weakly predicted SNL, while VT-48 h was significantly increased and predicted SNL both individually (p < 0.01, Kendall) and across the group (p < 0.001), i.e. the higher the VT, the stronger the SNL. Similar correlations were found in the rat with infarction. Our findings suggest GABA-A receptors are still present on injured neurons at the 48 h timepoint, and the increased 48 h VT observed here is consistent with earlier rat studies showing early GABA-A receptor upregulation. That FMZ binding at 48 h was predictive of SNL may have clinical implications.
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Affiliation(s)
- Jessica L Hughes
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John S Beech
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Dechao Wang
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jean-Claude Baron
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Inserm U1266, Paris Descartes University, Sainte-Anne Hospital, Paris, France
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39
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Seners P, Perrin C, Lapergue B, Henon H, Debiais S, Sablot D, Girard Buttaz I, Tamazyan R, Preterre C, Laksiri N, Mione G, Arquizan C, Lucas L, Baron JC, Turc G. Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion. Ann Neurol 2020; 88:160-169. [PMID: 32350929 DOI: 10.1002/ana.25756] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Whether bridging therapy (intravenous thrombolysis [IVT] followed by endovascular treatment) is superior to IVT alone in minor stroke with large vessel occlusion (LVO) is unknown. METHODS Multicentric retrospective observational study including, in intention-to-treat, consecutive IVT-treated minor strokes (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with LVO, with or without additional mechanical thrombectomy. Propensity-score (inverse probability of treatment weighting) was used to reduce baseline between-groups differences. The primary outcome was excellent outcome, that is, modified Rankin score 0 to 1 at 3 months follow-up. RESULTS Overall, 598 patients were included (214 and 384 in the bridging therapy and IVT groups, respectively). Following propensity-score weighting, the distribution of baseline clinical and radiological variables was similar across the two patient groups. Compared with IVT alone, bridging therapy was not associated with excellent outcome (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.75-1.24; p = 0.76), but was associated with symptomatic intracranial hemorrhage (OR = 3.01; 95% CI = 1.77-5.11; p < 0.0001). Occlusion site was a strong modifier of the effect of bridging therapy on outcome (pinteraction < 0.0001), with bridging therapy associated with higher odds of excellent outcome in proximal M1 (OR = 3.26; 95% CI = 1.67-6.35; p = 0.0006) and distal M1 (OR = 1.69; 95% CI = 1.01-2.82; p = 0.04) occlusions, but with lower odds of excellent outcome for M2 (OR = 0.53; 95% CI = 0.38-0.75; p = 0.0003) occlusions. Bridging therapy was associated with higher rates of symptomatic intracranial hemorrhage in M2 occlusions only (OR = 4.40; 95% CI = 2.20-8.83; p < 0.0001). INTERPRETATION Although overall outcomes were similar in intended bridging therapy as compared to intended IVT alone in minor strokes with LVO, our results suggest that intended bridging therapy may be beneficial in M1 occlusions, whereas the benefit-risk profile may favor IVT alone in M2 occlusions. ANN NEUROL 2020 ANN NEUROL 2020;88:160-169.
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Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, FHU NeuroVasc, Institute of Psychiatrie and Neuroscience of Paris (IPNP), INSERM UMR 1266, Paris, France
| | - Claire Perrin
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, FHU NeuroVasc, Institute of Psychiatrie and Neuroscience of Paris (IPNP), INSERM UMR 1266, Paris, France
| | | | - Hilde Henon
- Department of Neurology, Université de Lille, INSERM UMR 1171, CHU Lille, Lille, France
| | | | - Denis Sablot
- Neurology Department, Perpignan Hospital, Perpignan, France
| | | | - Ruben Tamazyan
- Neurology Department, Saint Joseph Hospital, Paris, France
| | - Cécile Preterre
- Neurology Department, Nantes University Hospital, Nantes, France
| | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France
| | - Gioia Mione
- Neurology Department, Nancy University Hospital, Nancy, France
| | | | - Ludovic Lucas
- Stroke Unit, Pellegrin University Hospital, Bordeaux, France
| | - Jean-Claude Baron
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, FHU NeuroVasc, Institute of Psychiatrie and Neuroscience of Paris (IPNP), INSERM UMR 1266, Paris, France
| | - Guillaume Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, FHU NeuroVasc, Institute of Psychiatrie and Neuroscience of Paris (IPNP), INSERM UMR 1266, Paris, France
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40
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université de Paris, France
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Paris, France
| | - Hugh S Markus
- Department of Clinical Neurosciences, Stroke Research Group, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - John D Pickard
- Department of Clinical Neurosciences, Neurosurgery Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Stephen M Davis
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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41
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Kelly PJ, Camps-Renom P, Giannotti N, Martí-Fàbregas J, McNulty JP, Baron JC, Barry M, Coutts SB, Cronin S, Delgado-Mederos R, Dolan E, Fernández-León A, Foley S, Harbison J, Horgan G, Kavanagh E, Marnane M, McCabe J, McDonnell C, Sharma VK, Williams DJ, O’Connell M, Murphy S. A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke. Stroke 2020; 51:838-845. [DOI: 10.1161/strokeaha.119.027268] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque
18
F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque
18
F-fluorodeoxyglucose would improve the identification of early recurrent stroke.
Methods—
We derived the score in a prospective cohort study of recent (<30 days) non-severe (modified Rankin Scale score ≤3) stroke/transient ischemic attack. We derived the SCAIL (symptomatic carotid atheroma inflammation lumen-stenosis) score (range, 0–5) including
18
F-fluorodeoxyglucose standardized uptake values (SUV
max
<2 g/mL, 0 points; SUV
max
2–2.99 g/mL, 1 point; SUV
max
3–3.99 g/mL, 2 points; SUV
max
≥4 g/mL, 3 points) and stenosis (<50%, 0 points; 50%–69%, 1 point; ≥70%, 2 points). We validated the score in an independent pooled cohort of 2 studies. In the pooled cohorts, we investigated the SCAIL score to discriminate recurrent stroke after the index stroke/transient ischemic attack, after positron emission tomography-imaging, and in mild or moderate stenosis.
Results—
In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score (
P
=0.002, C statistic 0.71 [95% CI, 0.56–0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2–4.5,
P
=0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9–5],
P
<0.001; C statistic 0.77 [95% CI, 0.67–0.87]). The SCAIL score independently predicted recurrent stroke after positron emission tomography-imaging (adjusted hazard ratio, 4.52 [95% CI, 1.58–12.93],
P
=0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46–0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66–0.97],
P
=0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39–5.39],
P
=0.004).
Conclusions—
The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain.
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Affiliation(s)
- Peter J. Kelly
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Nicola Giannotti
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin (N.G., J.P.M., S.F.), Mater University Hospital, University College Dublin, Ireland
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Jonathan P. McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin (N.G., J.P.M., S.F.), Mater University Hospital, University College Dublin, Ireland
| | - Jean-Claude Baron
- Department of Neurology, Université de Paris, Hopital Sainte-Anne, Inserm U1266, Paris, France (J.-C.B.)
| | - Mary Barry
- Department of Vascular Surgery, St Vincent’s University Hospital (M.B.), Mater University Hospital, University College Dublin, Ireland
| | - Shelagh B. Coutts
- Hotchkiss Brain Institute, Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (S.B.C.)
| | - Simon Cronin
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Department of Neurology and Clinical Neuroscience, Cork University Hospital/University College Cork, Ireland (S.C.)
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Eamon Dolan
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Connolly Hospital Dublin/Royal College of Surgeons Ireland (E.D.)
| | - Alejandro Fernández-León
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.F.-L.)
| | - Shane Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin (N.G., J.P.M., S.F.), Mater University Hospital, University College Dublin, Ireland
| | - Joseph Harbison
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Stroke Service, Department of Geriatric Medicine, St James’ Hospital/Trinity College Dublin (J.H.)
| | - Gillian Horgan
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - Eoin Kavanagh
- Department of Radiology (E.K., M.O.), Mater University Hospital, University College Dublin, Ireland
| | - Michael Marnane
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - John McCabe
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - Ciaran McDonnell
- Department of Vascular Surgery (C.M.), Mater University Hospital, University College Dublin, Ireland
| | - Vijay K. Sharma
- Division of Neurology, National University Health System/Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.)
| | - David J. Williams
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Royal College of Surgeons in Ireland/Beaumont Hospital, Dublin (D.J.W.)
| | - Martin O’Connell
- Department of Radiology (E.K., M.O.), Mater University Hospital, University College Dublin, Ireland
| | - Sean Murphy
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Royal College of Surgeons in Ireland, Dublin (S.M.)
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Seners P, Turc G, Lion S, Cottier JP, Cho TH, Arquizan C, Bracard S, Ozsancak C, Legrand L, Naggara O, Debiais S, Berthezene Y, Costalat V, Richard S, Magni C, Nighoghossian N, Narata AP, Dargazanli C, Gory B, Mas JL, Oppenheim C, Baron JC. Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion. J Cereb Blood Flow Metab 2020; 40:667-677. [PMID: 30890074 PMCID: PMC7026851 DOI: 10.1177/0271678x19836288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax ≥ 10 s volume/ Tmax ≥ 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR (P = 0.006), shorter thrombus on T2*-imaging (P < 0.001) and more distal occlusion (P = 0.006). However, the relationship between HIR and early recanalization was robust only for thrombus length <14 mm. In summary, the present study disclosed an association between lower HIR and early post-thrombolysis recanalization. Early post-thrombolysis recanalization is therefore determined not only by thrombus site and length but also by severity of ischemia.
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Affiliation(s)
- Pierre Seners
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Guillaume Turc
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Stéphanie Lion
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Jean-Philippe Cottier
- Department of Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSALyon, Lyon, France
| | | | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U 947, Nancy, France
| | | | - Laurence Legrand
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Olivier Naggara
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Séverine Debiais
- Department of Neurology, Bretonneau Hospital, University of Tours, Tours, France
| | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | | | - Norbert Nighoghossian
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSALyon, Lyon, France
| | - Ana-Paula Narata
- Department of Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U 947, Nancy, France
| | - Jean-Louis Mas
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Catherine Oppenheim
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Jean-Claude Baron
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
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43
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Abstract
Background and Purpose- Dexterous object manipulation, requiring generation and control of finger forces, is often impaired after stroke. This study aimed to describe recovery of precision grip force control after stroke and to determine clinical and imaging predictors of 6-month performance. Methods- Eighty first-ever stroke patients with varying degrees of upper limb weakness were evaluated at 3 weeks, 3 months, and 6 months after stroke. Twenty-three healthy individuals of comparable age were also studied. The Strength-Dexterity test was used to quantify index finger and thumb forces during compression of springs of varying length in a precision grip. The coordination between finger forces (CorrForce), along with Dexterity-score and Repeatability-score, was calculated. Anatomical magnetic resonance imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL). Results- CorrForce, Dexterity-score, and Repeatability-score in the affected hand were dramatically lower at each time point compared with the less-affected hand and the control group, even in patients with mild motor impairment according to Fugl-Meyer assessment. Improved performance over time occurred in CorrForce and Dexterity-score but not in Repeatability-score. The Fugl-Meyer assessment hand subscale, sensory function, and wCST-LL best predicted CorrForce and Dexterity-score status at 6 months (R2=0.56 and 0.87, respectively). wCST-LL explained substantial variance in CorrForce (R2=0.34) and Dexterity-score (R2=0.50) at 6 months; two-point discrimination and Fugl-Meyer score accounted for considerable additional variance. Absence of recovery in CorrForce was predicted by wCST-LL >4 cc and in Dexterity-score by wCST-LL >6 cc. Conclusions- Findings highlight persisting deficits in the ability to grasp and control finger forces after stroke. wCST-LL was the strongest predictor of performance at 6 months, but early two-point discrimination and Fugl-Meyer score had substantial additional predictive value. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02878304.
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Affiliation(s)
- Gaia Valentina Pennati
- From the Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (G.V.P., J.P., E.P., J.B., P.G.L.)
| | - Jeanette Plantin
- From the Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (G.V.P., J.P., E.P., J.B., P.G.L.)
| | - Loïc Carment
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (L.C., P.G.L.)
| | - Pauline Roca
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Hôpital Sainte-Anne, Université Paris Descartes, France (P.R., J.-C.B.)
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Hôpital Sainte-Anne, Université Paris Descartes, France (P.R., J.-C.B.)
| | - Elena Pavlova
- From the Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (G.V.P., J.P., E.P., J.B., P.G.L.)
| | - Jörgen Borg
- From the Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (G.V.P., J.P., E.P., J.B., P.G.L.)
| | - Påvel G Lindberg
- From the Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (G.V.P., J.P., E.P., J.B., P.G.L.)
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (L.C., P.G.L.)
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Lagarde J, Olivieri P, Caillé F, Gervais P, Baron JC, Bottlaender M, Sarazin M. [18F]-AV-1451 tau PET imaging in Alzheimer’s disease and suspected non-AD tauopathies using a late acquisition time window. J Neurol 2019; 266:3087-3097. [DOI: 10.1007/s00415-019-09530-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023]
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Charidimou A, Frosch MP, Al-Shahi Salman R, Baron JC, Cordonnier C, Hernandez-Guillamon M, Linn J, Raposo N, Rodrigues M, Romero JR, Schneider JA, Schreiber S, Smith EE, van Buchem MA, Viswanathan A, Wollenweber FA, Werring DJ, Greenberg SM. Advancing diagnostic criteria for sporadic cerebral amyloid angiopathy: Study protocol for a multicenter MRI-pathology validation of Boston criteria v2.0. Int J Stroke 2019; 14:956-971. [PMID: 31514686 DOI: 10.1177/1747493019855888] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
RATIONALE The Boston criteria are used worldwide for the in vivo diagnosis of cerebral amyloid angiopathy and are the basis for clinical decision-making and research in the field. Given substantial advances in cerebral amyloid angiopathy's clinical aspects and MRI biomarkers, we designed a multicenter study within the International cerebral amyloid angiopathy Association aimed at further validating the diagnostic accuracy of the Boston and potentially improving and updating them. AIM We aim to derive and validate an updated "version 2.0" of the Boston criteria across the spectrum of cerebral amyloid angiopathy-related presentations and MRI biomarkers. SAMPLE SIZE ESTIMATES Participating centers with suitable available data (see Methods) were identified from existing collaborations and an open invitation to the International Cerebral Amyloid Angiopathy Association emailing list. Our study sample will include: (1) a derivation cohort - Massachusetts General Hospital (MGH), Boston cases from inception to 2012 (∼150 patients); (2) temporal external validation cohort - MGH, Boston cases from 2012 to 2018 (∼100 patients); and (3) geographical external validation cohort - non-Boston cases (∼85 patients). METHODS AND DESIGN Multicenter collaborative study. We will collect and analyze data from patients' age ≥ 50 with any potential sporadic cerebral amyloid angiopathy-related clinical presentations (spontaneous intracerebral hemorrhage, transient focal neurological episodes and cognitive impairment), available brain MRI ("index test"), and histopathologic assessment for cerebral amyloid angiopathy ("reference standard" for diagnosis). Trained raters will assess MRI for all prespecified hemorrhagic and non-hemorrhagic small vessel disease markers of interest, according to validated criteria and a prespecified protocol, masked to clinical and histopathologic features. Brain tissue samples will be rated for cerebral amyloid angiopathy, defined as Vonsattel grade ≥2 for whole brain autopsies and ≥1 for cortical biopsies or hematoma evacuation. Based on our estimated available sample size, we will undertake pre-specified cohort splitting as above. We will: (a) pre-specify variables and statistical cut-offs; (b) examine univariable and multivariable associations; and (c) then assess classification measures (sensitivity, specificity etc.) for each MRI biomarker individually, in relation to the cerebral amyloid angiopathy diagnosis reference standard on neuropathology in a derivation cohort. The MRI biomarkers strongly associated with cerebral amyloid angiopathy diagnosis will be selected for inclusion in provisional (probable and possible cerebral amyloid angiopathy) Boston criteria v2.0 and validated using appropriate metrics and models. STUDY OUTCOMES Boston criteria v2.0 for clinical cerebral amyloid angiopathy diagnosis. DISCUSSION This work aims to potentially update and improve the diagnostic test accuracy of the Boston criteria for cerebral amyloid angiopathy and to provide wider validation of the criteria in a large sample. We envision that this work will meet the needs of clinicians and investigators and help accelerate progress towards better treatment of cerebral amyloid angiopathy.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew P Frosch
- C.S. Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital, Université Paris Descartes, INSERM U894, Paris, France
| | - Charlotte Cordonnier
- Department of Neurology, INSERM U1171-Degenerative and Vascular Cognitive Disorders, CHU Lille, University of Lille, Lille, France
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jennifer Linn
- Department of Neuroradiology, University Hospital Carl Gustav Carus', Technische Universität Dresden, Dresden, SN, Germany
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Medical Center, Toulouse, France
| | - Mark Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jose Rafael Romero
- Department of Neurology, Boston University School of Medicine, MA and the Framingham Heart Study, MA, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | | | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig Maximilians University, Munich, Germany
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Tozlu C, Ozenne B, Cho TH, Nighoghossian N, Mikkelsen IK, Derex L, Hermier M, Pedraza S, Fiehler J, Østergaard L, Berthezène Y, Baron JC, Maucort-Boulch D. Comparison of classification methods for tissue outcome after ischaemic stroke. Eur J Neurosci 2019; 50:3590-3598. [PMID: 31278787 DOI: 10.1111/ejn.14507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Abstract
In acute ischaemic stroke, identifying brain tissue at high risk of infarction is important for clinical decision-making. This tissue may be identified with suitable classification methods from magnetic resonance imaging data. The aim of the present study was to assess and compare the performance of five popular classification methods (adaptive boosting, logistic regression, artificial neural networks, random forest and support vector machine) in identifying tissue at high risk of infarction on human voxel-based brain imaging data. The classification methods were used with eight MRI parameters, including diffusion-weighted imaging and perfusion-weighted imaging obtained in 55 patients. The five criteria used to assess the performance of the methods were the area under the receiver operating curve (AUCroc ), the area under the precision-recall curve (AUCpr ), sensitivity, specificity and the Dice coefficient. The methods performed equally in terms of sensitivity and specificity, while the results of AUCroc and the Dice coefficient were significantly better for adaptive boosting, logistic regression, artificial neural networks and random forest. However, there was no statistically significant difference between the performances of these five classification methods regarding AUCpr , which was the main comparison metric. Machine learning methods can provide valuable prognostic information using multimodal imaging data in acute ischaemic stroke, which in turn can assist in developing personalized treatment decision for clinicians after a thorough validation of methods with an independent data set.
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Affiliation(s)
- Ceren Tozlu
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Brice Ozenne
- Neurobiology Research Unit, Rigshospitalet, Copenhagen O, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Tae-Hee Cho
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Derex
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Marc Hermier
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yves Berthezène
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France.,Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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Baron JC. Selective neuronal loss progression in chronic carotid or middle cerebral artery obstruction is accentuated by lower follow-up systolic blood pressure. J Neurol Neurosurg Psychiatry 2019; 90:964. [PMID: 31203210 DOI: 10.1136/jnnp-2019-320943] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Université de Paris, INSERM U1266, Saint Anne Hospital Centre, Paris 75014, France
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48
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Abstract
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization. Novel therapies aiming to 'freeze' the penumbra - that is, prevent core growth until recanalization is complete - hold potential as adjuncts to mechanical thrombectomy. This Review focuses on nonpharmacological approaches that aim to restore the physiological balance between oxygen delivery to and oxygen demand of the penumbra. Particular emphasis is placed on normobaric oxygen therapy, hypothermia and sensory stimulation. Preclinical evidence and early pilot clinical trials are critically reviewed, and future directions, including clinical translation and trial design issues, are discussed.
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université Paris 5, INSERM U894, Paris, France.
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49
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Plantin J, Pennati GV, Roca P, Baron JC, Laurencikas E, Weber K, Godbolt AK, Borg J, Lindberg PG. Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery. Front Neurol 2019; 10:836. [PMID: 31456734 PMCID: PMC6699580 DOI: 10.3389/fneur.2019.00836] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022] Open
Abstract
Objective: This longitudinal observational study investigated how neural stretch-resistance in wrist and finger flexors develops after stroke and relates to motor recovery, secondary complications, and lesion location. Methods: Sixty-one patients were assessed at 3 weeks (T1), three (T2), and 6 months (T3) after stroke using the NeuroFlexor method and clinical tests. Magnetic Resonance Imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL) and to perform voxel-based lesion symptom mapping. Results: NeuroFlexor assessment demonstrated spasticity (neural component [NC] >3.4N normative cut-off) in 33% of patients at T1 and in 51% at T3. Four subgroups were identified: early Severe spasticity (n = 10), early Moderate spasticity (n = 10), Late developing spasticity (n = 17) and No spasticity (n = 24). All except the Severe spasticity group improved significantly in Fugl-Meyer Assessment (FMA-HAND) to T3. The Severe and Late spasticity groups did not improve in Box and Blocks Test. The Severe spasticity group showed a 25° reduction in passive range of movement and more frequent arm pain at T3. wCST-LL correlated positively with NC at T1 and T3, even after controlling for FMA-HAND and lesion volume. Voxel-based lesion symptom mapping showed that lesioned white matter below cortical hand knob correlated positively with NC. Conclusion: Severe hand spasticity early after stroke is negatively associated with hand motor recovery and positively associated with the development of secondary complications. Corticospinal tract damage predicts development of spasticity. Early quantitative hand spasticity measurement may have potential to predict motor recovery and could guide targeted rehabilitation interventions after stroke.
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Affiliation(s)
- Jeanette Plantin
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Gaia V Pennati
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Pauline Roca
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Paris, France.,Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Evaldas Laurencikas
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.,Division of Radiology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Karin Weber
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Alison K Godbolt
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Jörgen Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Påvel G Lindberg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.,Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Paris, France
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50
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Calautti C, Jones PS, Naccarato M, Sharma N, Carpenter TA, Warburton EA, Baron JC. Further evidence for a non-cortical origin of mirror movements after stroke. Brain 2019; 142:e1. [PMID: 30596902 DOI: 10.1093/brain/awy308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cinzia Calautti
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - P Simon Jones
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Marcello Naccarato
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Nikhil Sharma
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - T Adrian Carpenter
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Elisabeth A Warburton
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Jean-Claude Baron
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.,Department of Neurology, Sainte-Anne Hospital, Université Paris Descartes, INSERM U894, Paris, France
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