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Engrand N, Salardaine Q, Desilles JP, Echard C, Bourdillon P, Williams M, Baille G. Case report: Simultaneous measurement of intracranial pressure and lumbar intrathecal pressure during epidural patch therapy for treating spontaneous intracranial hypotension syndrome. Spontaneous intracranial hypotension or spontaneous intraspinal hypovolume? Front Neurol 2024; 15:1308462. [PMID: 38576535 PMCID: PMC10991849 DOI: 10.3389/fneur.2024.1308462] [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: 10/06/2023] [Accepted: 01/24/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives Spontaneous intracranial hypotension (SIH) is frequently complicated by subacute subdural hematoma (SDH) and more rarely by bilateral thalamic ischemia. Here, we report a case of SIH-related SDH treated with three epidural patches (EPs), with follow-up of the intracranial pressure and lumbar intrathecal pressure. Methods A 46-year-old man presented bilateral thalamic ischemia, then a growing SDH. After failure of urgent surgical evacuation, he underwent three saline EPs, two dynamic myelography examinations and one digital subtraction angiography-phlebography examination. However, because of no dural tear and no obstacle to the venous drainage of the vein of Galen, no therapeutic procedure was available, and the patient died. Results The case exhibited a progressive increase in the transmission of lumbar intrathecal pressure to intracranial pressure during the three EPs. The EPs may have successfully treated the SIH, but the patient did not recover consciousness because of irreversible damage to both thalami. Conclusion Clinicians should be aware of the bilateral thalamic ischemia picture that may be the presenting sign of SIH. Moreover, the key problem in the pathophysiology of SIH seems to be intraspinal and intracranial volumes rather than pressures. Therefore, intracranial hypotension syndrome might actually be an intraspinal hypovolume syndrome.
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Affiliation(s)
- Nicolas Engrand
- Neuro-Intensive Care Unit-Anesthesiology, Rothschild Foundation Hospital, Paris, France
| | | | | | - Cécile Echard
- Neuro-Intensive Care Unit-Anesthesiology, Rothschild Foundation Hospital, Paris, France
| | - Pierre Bourdillon
- Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Marc Williams
- Diagnostic Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Guillaume Baille
- Neurology Department, Delafontaine Hospital, Saint-Denis, France
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Perrin G, Molinier E, Gory B, Kyheng M, Labreuche J, Pasi M, Janot K, Bourcier R, Sibon I, Consoli A, Desilles JP, Olivot JM, Papagiannaki C, Soize S, Gentric JC, Dargazanli C, Caroff J, Pop R, Naggara O, Moulin S, Eker O, Alias Q, Clarençon F, Lapergue B, Marnat G. Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy. J Neuroradiol 2024; 51:196-203. [PMID: 38309578 DOI: 10.1016/j.neurad.2024.01.076] [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: 11/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome. METHODS We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT. RESULTS During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results. CONCLUSION ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.
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Affiliation(s)
| | | | - Benjamin Gory
- Neuroradiology Department, Nancy University Hospital, INSERM 1254, IADI, Université de Loraine, Nancy, France
| | - Maeva Kyheng
- Biostatistic Department - Lille University Hospital, Lille, France
| | - Julien Labreuche
- Biostatistic Department - Lille University Hospital, Lille, France
| | - Marco Pasi
- Neurology department, Tours University Hospital, Tours, France
| | - Kevin Janot
- Neuroradiology department, Tours University Hospital, Tours, France
| | - Romain Bourcier
- Neuroradiology Department, Nantes University Hospital, Nantes, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Arturo Consoli
- Neuroradiology Department, Foch Hospital, Suresnes, France
| | | | - Jean-Marc Olivot
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | | | - Sebastien Soize
- Neuroradiology Department, Reims University Hospital, Reims, France
| | | | - Cyril Dargazanli
- Neuroradiology Department, Montpellier University Hospital, Montpellier, France
| | - Jildaz Caroff
- Neuroradiology Department, Kremlin-Bicêtre University Hospital, Kremlin-Bicêtre, France
| | - Raoul Pop
- Neuroradiology Department, Strabsourg University Hospital, Strasbourg, France
| | - Olivier Naggara
- Neuroradiology Department, Sainte-Anne University Hospital, Paris, France
| | - Solene Moulin
- Neurology Department, Reims University Hospital, Reims, France
| | - Omer Eker
- Neuroradiology Department, Lyon University Hospital, Lyon, France
| | - Quentin Alias
- Neuroradiology Department, Rennes University Hospital, Rennes, France
| | - Frederic Clarençon
- Neuroradiology Department, Pitié-Salpêtriere University Hospital, Paris, France
| | | | - Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
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Bourrienne MC, Le Cam Duchez V, Faille D, Farkh C, Solo Nomenjanahary M, Gay J, Loyau S, Journé C, Dupont S, Ollivier V, Villeval JLJL, Plo I, Edmond V, Jandrot-Perrus M, Labrouche-Colomer S, Cassinat B, Verger E, Desilles JP, Ho Tin Noé BH, Triquenot Bagan A, Mazighi M, Ajzenberg N. Exacerbation of thrombo-inflammation by JAK2V617F mutation worsens the prognosis of cerebral venous sinus thrombosis. Blood Adv 2024:bloodadvances.2023011692. [PMID: 38386979 DOI: 10.1182/bloodadvances.2023011692] [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: 09/21/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon venous thromboembolic event accounting for <1% of strokes resulting in brain parenchymal injuries. JAK2V617F mutation, the most frequent driving mutation of myeloproliferative neoplasms has been reported to be associated with worse clinical outcomes in patients with CVST. We investigated whether hematopoietic JAK2V617F expression predisposes to specific pathophysiological processes and/or worse prognosis after CVST. Using an in vivo mouse model of CVST, we analyzed clinical, biological and imaging outcomes in mice with hematopoietic-restricted Jak2V617F expression, compared to Jak2WT mice. In parallel, we studied a human cohort of JAK2V617F-positive or negative CVST. Early after CVST, mice with hematopoietic Jak2V617F expression had increased adhesion of platelets and neutrophils in cerebral veins located in the vicinity of CVST. On day 1, Jak2V617F mice had a worse outcome characterized by significantly more frequent and severe intracranial hemorrhages (ICH) and higher mortality rates. Peripheral neutrophil activation was enhanced, as indicated by higher circulating platelet-neutrophil aggregates, upregulated CD11b expression, and higher myeloperoxydase (MPO) plasma level. Concurrently, immunohistological and brain homogenates analysis showed higher neutrophil infiltration and increased blood-brain-barrier disruption. Similarly, JAK2V617F-positive CVST patients tended to present higher thrombotic burden and had significantly higher SII, a systemic thrombo-inflammatory marker, compared to JAK2V617F-negative patients. In mice with CVST, our study corroborates that Jak2V617F mutation leads to a specific pattern including increased thrombotic burden, ICH and mortality. The exacerbated thrombo-inflammatory response, observed both in mice and JAK2V617F-positive patients, could contribute to hemorrhagic complications.
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Affiliation(s)
| | - Véronique Le Cam Duchez
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit, F 76000 Rouen, France, Rouen, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sylvie Labrouche-Colomer
- University Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France, PESSAC, France
| | - Bruno Cassinat
- Hopital Saint-Louis, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Jean-Philippe Desilles
- Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France
| | | | - Aude Triquenot Bagan
- Rouen University Hospital, Department of Neurology and INSERM CIC-CRB 1404, F-76000 Rouen , France, Rouen, France
| | - Mikaël Mazighi
- Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France
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Olindo S, Gaillard N, Chausson N, Turpinat C, Dargazanli C, Bourgeois-Beauvais Q, Signate A, Joux J, Mejdoubi M, Piotin M, Obadia M, Desilles JP, Delvoye F, Holay Q, Gory B, Richard S, Denier C, Robinet-Borgomano E, Carle X, Desal H, Guillon B, Viguier A, Lamy M, Pico F, Landais A, Boulanger M, Renou P, Gariel F, Jean P, Yann L, Papillon L, Marnat G, Smadja D. Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry. Int J Stroke 2024; 19:180-188. [PMID: 37724713 DOI: 10.1177/17474930231204343] [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: 09/21/2023]
Abstract
BACKGROUND Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented. AIMS In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. METHODS CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study. RESULTS Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2-15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27-14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24-0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89-0.97), p = 0.001). CONCLUSION CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials.
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Affiliation(s)
- Stephane Olindo
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Nicolas Chausson
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Cedric Turpinat
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | | | - Aissatou Signate
- Department of Neurology, University Hospital of Martinique, Fort-de-France, France
| | - Julien Joux
- Department of Neurology, University Hospital of Martinique, Fort-de-France, France
| | - Mehdi Mejdoubi
- Department of Neuroradiology, University Hospital of Martinique, Fort-de-France, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mickael Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Quentin Holay
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Gory
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | | | | | - Xavier Carle
- Department of Neurology, Hôpital de La Timone, Marseille University Hospital, Marseille, France
| | - Hubert Desal
- Department of Neuroradiology, Nantes University Hospital, Nantes, France
| | - Benoit Guillon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Alain Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Matthias Lamy
- Department of Neurology, Poitiers University Hospital, Poitiers, France
| | - Fernando Pico
- Department of Neurology, Versailles Hospital, Versailles, France
| | - Anne Landais
- Department of Neurology, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | | | - Pauline Renou
- Stroke Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Florent Gariel
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Papaxanthos Jean
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Lhermitte Yann
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Lisa Papillon
- Stroke Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Didier Smadja
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
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Sgreccia A, Desilles JP, Costalat V, Dargazanli C, Bourcier R, Tessier G, Rouchaud A, Saleme S, Spelle L, Caroff J, Marnat G, Barreau X, Clarençon F, Shotar E, Eugene F, Houdart E, Gory B, Zhu F, Labreuche J, Piotin M, Lapergue B, Consoli A. Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial. Stroke 2024; 55:376-384. [PMID: 38126181 DOI: 10.1161/strokeaha.123.045227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions. METHODS Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III [European Cooperative Acute Stroke Study] grades, and 3-month modified Rankin Scale). RESULTS Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32-60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39-11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA. CONCLUSIONS First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03290885.
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Affiliation(s)
- Alessandro Sgreccia
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Guillaume Tessier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Aymeric Rouchaud
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Suzana Saleme
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Laurent Spelle
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Jildaz Caroff
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Xavier Barreau
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - François Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (F.E.)
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, Paris, France (E.H.)
| | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - François Zhu
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Equipe d'accueil 2694 Santé Publique: Epidémiologie et Qualité des Soins, University Lille, France (J.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Bertrand Lapergue
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
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6
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Maïer B, Di Meglio L, Desilles JP, Solo Nomenjanahary M, Delvoye F, Kyheng M, Boursin P, Ollivier V, Dupont S, Rambaud T, Hamdani M, Labreuche J, Blanc R, Piotin M, Halimi JM, Mazighi M, Ho-Tin-Noe B. Neutrophil activation in patients treated with endovascular therapy is associated with unfavorable outcomes and mitigated by intravenous thrombolysis. J Neurointerv Surg 2024; 16:131-137. [PMID: 37068937 DOI: 10.1136/jnis-2022-020020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/21/2022] [Accepted: 03/25/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Accumulating evidence indicates that neutrophil activation (NA) contributes to microvascular thromboinflammation in acute ischemic stroke (AIS) due to a large vessel occlusion. Preclinical data have suggested that intravenous thrombolysis (IVT) before endovascular therapy (EVT) could dampen microvascular thromboinflammation. In this study we investigated the association between NA dynamics and stroke outcome, and the impact of IVT on NA in patients with AIS treated with EVT. METHODS A single-center prospective study was carried out, including patients treated with EVT for whom three blood samples (before, within 1 hour, 24 hours post-EVT) were drawn to measure plasma myeloperoxidase (MPO) concentration as a marker of NA. Unfavorable outcome was defined as a modified Rankin score of 3-6 at 3 months. RESULTS Between 2016 and 2020, 179 patients were included. The plasma MPO concentration peaked significantly 1 hour post-EVT (median increase 21.0 ng/mL (IQR -2.1-150)) and returned to pre-EVT baseline values 24 hours after EVT (median change from baseline -0.8 ng/mL (IQR -7.6-6.7)). This peak was strongly associated with unfavorable outcomes at 3 months (aOR 0.53 (95% CI 0.34 to 0.84), P=0.007). IVT before EVT abolished this 1 hour post-EVT MPO peak. Changes in plasma MPO concentration (baseline to 1 hour post-EVT) were associated with unfavorable outcomes only in patients not treated with IVT before EVT (aOR 0.54 (95% CI 0.33 to 0.88, P=0.013). However, we found no significant heterogeneity in the associations between changes in plasma MPO concentration and outcomes. CONCLUSIONS A peak in plasma MPO concentration occurs early after EVT and is associated with unfavorable outcomes. IVT abolished the post-EVT MPO peak and may modulate the association between NA and outcomes.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
- Neurology Department, Hôpital Saint-Joseph, Paris, France
- FHU NeuroVasc, Paris, France
| | - Lucas Di Meglio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
- FHU NeuroVasc, Paris, France
| | - Mialitiana Solo Nomenjanahary
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Maeva Kyheng
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Véronique Ollivier
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Sébastien Dupont
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Thomas Rambaud
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | | | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Jean-Michel Halimi
- Nephrology Department, Tours Hospital, Tours, France
- EA4245-Transplantation, Immunology and Inflammation, University of Tours, Tours, France
| | - Mikaël Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
- FHU NeuroVasc, Paris, France
- Department of Neurology, Lariboisiere Hospital, Université Paris Cité, Paris, France
| | - Benoit Ho-Tin-Noe
- UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France, Université de Paris Cité, Inserm, Paris, France
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Freiherr Von Seckendorff A, Nomenjanahary MS, Labreuche J, Ollivier V, Di Meglio L, Dupont S, Hamdani M, Brikci-Nigassa N, Brun A, Boursin P, Piotin M, Mazighi M, Ho-Tin-Noé B, Desilles JP, Delbosc S. Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes. Res Pract Thromb Haemost 2024; 8:102313. [PMID: 38318152 PMCID: PMC10840352 DOI: 10.1016/j.rpth.2023.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background Periodontitis is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association remain unclear. Objectives Our objective was to determine whether Porphyromonas gingivalis (Pg), a periodontal bacterium, could be detected within thrombus aspirates, modify thrombus composition, and endovascular therapy responses. Methods The presence of Pg gingipain in 175 consecutive thrombi from patients with large vessel occlusion stroke enrolled in the multicenter research cohort compoCLOT was investigated by immunostaining. Thrombus blood cell composition according to gingipain status was analyzed in a subset of 63 patients. Results Pg gingipain immunostaining was positive in 33.7% of thrombi (95% CI, 26.7%-40.8%). The percentage of near to complete reperfusion (modified Thrombolysis in Cerebral Infarction Score 2c/3) at the end of the procedure was lower in the Pgpos group than the Pgneg group (39.0% vs 57.8% respectively; adjusted odds ratio, 0.38; 95% CI, 0.19-0.77). At 3 months, 35.7% of patients in the Pgpos group had a favorable neurological outcome vs 49.5% in the Pgneg group (odds ratio, 0.65; 95% CI, 0.30-1.40). Quantitative analysis of a subset of 63 thrombi showed that neutrophil elastase content was significantly (P < .05) higher in Pgpos thrombi than in Pgneg thrombi. Conclusion Our results indicate that intrathrombus Pg gingipain is associated with increased neutrophil content and resistance to endovascular therapy.
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Affiliation(s)
- Aurélien Freiherr Von Seckendorff
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mialitiana Solo Nomenjanahary
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
| | - Véronique Ollivier
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Lucas Di Meglio
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Sebastien Dupont
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Nahida Brikci-Nigassa
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Adrian Brun
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France
- Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Perrine Boursin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
- Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France
| | - Benoit Ho-Tin-Noé
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
| | - Sandrine Delbosc
- Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| | - compoCLOT study group
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France
- Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
- Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
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Malka D, Janot K, Pasi M, Desilles JP, Marnat G, Sibon I, Consoli A, Dargazanli C, Arquizan C, Gory B, Richard S, Naggara O, Clarençon F, Rosso C, Bourcier R, Eker O, Caroff J, Lapergue B, Boulouis G. Effects of weather conditions on endovascular treatment case volume for patients with ischemic stroke. J Neuroradiol 2023; 50:593-599. [PMID: 37442271 DOI: 10.1016/j.neurad.2023.07.001] [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: 04/26/2023] [Revised: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Weather conditions have been shown to influence the occurrence of cardiovascular events. We tested the hypothesis that weather parameters may be associated with variations of case volume of endovascular treatment (EVT) for acute ischemic stroke. METHODS Individual data from the ETIS (Endovascular Treatment in Ischemic Stroke) French national registry were matched to local weather stations. Meteorological parameters (rainfall, humidity, atmospheric pressure, air temperature) were gathered from national online resources. Weather readings and EVT case volumes were annually standardized per weather station and EVT center, and their associations tested with non-parametric univariable and generalized linear statistical models. RESULTS Between 2015 and 2021, 9913 EVT procedures addressed by 135 primary stroke units were matched to weather conditions. The mean daily case volume per center was 0.41 [StDev 0.33], and there was a median of 0.84 procedures daily linked to a weather station [StDev 0.47]. We found lower atmospheric pressure (β estimate -0.04; 95%CI[-0.07;-0.03], p<0.001), higher humidity (β estimate 0.07; 95%CI [0.05;0.09], p<0.001) and lower temperatures (β estimate -0.08; 95%CI[-0.10;-0.06], p<0.001) to be associated with higher standardized EVT daily case volumes. These associations were stable when testing them across strata of binned EVT standardized case volumes. CONCLUSIONS Our study suggests that lower ambient temperature, lower atmospheric pressure, and higher air humidity are associated with significantly more daily EVT cases in a European temperate country. These results may provide insight into both system of care optimization at times of climate change and intracranial LVO pathophysiology. REGISTRATION-URL: https://clinicaltrials.gov/ct2/show/NCT03776877.
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Affiliation(s)
- David Malka
- Diagnostic and Interventional Neuroradiology Department, Tours University Hospital, INSERM UMR 1253 iBrain, 2 Bd Tonnellé, Centre Val de Loire, Tours, France
| | - Kevin Janot
- Diagnostic and Interventional Neuroradiology Department, Tours University Hospital, INSERM UMR 1253 iBrain, 2 Bd Tonnellé, Centre Val de Loire, Tours, France
| | - Marco Pasi
- Stroke Unit, Tours University Hospital, INSERM UMR 1253 iBrain, Tours, Centre Val de Loire, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Arturo Consoli
- Department of Neuroradiology and Stroke Unit, Foch Hospital, Suresnes, France, University of Versailles Saint-Quentin-des-Yvelines, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Caroline Arquizan
- Stroke Unit, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Nancy F-54000, France; IADI, INSERM U1254, Université de Lorraine (B.G.), Nancy F-54000, France
| | - Sébastien Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Nancy F-54000, France; CHRU-Nancy, CIC-P 1433 (S.R.), INSERM U1116, Nancy F-54000, France
| | - Olivier Naggara
- Department of Neuroradiology, INSERM 1266 IMABRAIN, Saint Anne Hospital Centre, Île-de-France, Paris, France
| | | | - Charlotte Rosso
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Inserm U 1127, CNRS UMR 7225, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Paris F-75013, France
| | - Romain Bourcier
- CHU Nantes, CNRS, INSERM, l'institut du thorax, Institut du thorax Nantes Université, 14 Lyon HCL, Nantes F-44000, France
| | - Omer Eker
- Neuroradiolology Department, Hospices Civils de Lyon, Lyon, France
| | - Jildaz Caroff
- Neuroradiolology Department, CHU Kremlin Bicêtre, Paris, France
| | - Bertrand Lapergue
- Department of Neuroradiology and Stroke Unit, Foch Hospital, Suresnes, France, University of Versailles Saint-Quentin-des-Yvelines, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, Tours University Hospital, INSERM UMR 1253 iBrain, 2 Bd Tonnellé, Centre Val de Loire, Tours, France.
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9
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Gory B, Finitsis S, Desilles JP, Consoli A, Mazighi M, Marnat G, Sibon I, Pop R, Raposo N, Wolff V, Cognard C, Richard S, Moulin S, Soize S, Lapergue B, Olivot JM. Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core. World Neurosurg 2023; 178:e282-e291. [PMID: 37473866 DOI: 10.1016/j.wneu.2023.07.043] [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: 04/18/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Emergent stenting in tandem occlusions and mechanical thrombectomy (MT) of acute ischemic stroke related to large vessel occlusion (LVO-AIS) with a large core are tested independently. We aim to assess the impact of reperfusion with MT in patients with LVO-AIS with a large core and a tandem occlusion and to compare the safety of reperfusion between large core with tandem and nontandem occlusions in current practice. METHODS We analyzed data of all consecutive patients included in the prospective Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and March 2023 who presented with a pretreatment ASPECTS (Alberta Stroke Program Early CT Score) of 0-5 and angiographically proven tandem occlusion. The primary end point was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0-3 at 90 days. RESULTS Among 262 included patients with a tandem occlusion and ASPECTS 0-5, 203 patients (77.5%) had a successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3). Reperfused patients had a favorable shift in the overall mRS score distribution (adjusted odds ratio [aOR], 1.57 [1.22-2.03]; P < 0.001), higher rates of mRS score 0-3 (aOR, 7.03 [2.60-19.01]; P < 0.001) and mRS score 0-2 at 90 days (aOR, 3.85 [1.39-10.68]; P = 0.009) compared with nonreperfused. There was a trend between the occurrence of successful reperfusion and a decreased rate of symptomatic intracranial hemorrhage (aOR, 0.5 [0.22-1.13]; P = 0.096). Similar safety outcomes were observed after large core reperfusion in tandem and nontandem occlusions. CONCLUSIONS Successful reperfusion was associated with a higher rate of favorable outcome in large core LVO-AIS with a tandem occlusion, with a safety profile similar to nontandem occlusion.
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Affiliation(s)
- Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, IADI, INSERM U1254, CHRU-Nancy, Nancy, France.
| | - Stephanos Finitsis
- Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | | | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - Raoul Pop
- Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Raposo
- Department of Neurology, Acute Stroke Unit, CIC 1436-UMR 1214, CHU Toulouse, Toulouse, France
| | - Valérie Wolff
- Stroke Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | - Sébastien Richard
- Department of Neurology, Stroke Unit, Université de Lorraine, INSERM U1116, CHRU-Nancy, Nancy, France
| | - Solène Moulin
- Department of Neurology, Hôpital Maison Blanche, University Hospital of Reims, Université Reims Champagne-Ardenne, Reims, France
| | - Sébastien Soize
- Department of Neuroradiology, Hôpital Maison Blanche, University Hospital of Reims, Université Reims Champagne-Ardenne, Reims, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Jean-Marc Olivot
- Department of Neurology, Acute Stroke Unit, CIC 1436-UMR 1214, CHU Toulouse, Toulouse, France
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10
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Anadani M, Maier B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Mistry EA, Gory B, Spiotta AM, Richard S, Sibon I, Desilles JP, Blanc R, Piotin M, Mazighi M. Safety and efficacy of intensive systolic blood pressure lowering after successful endovascular therapy: a post hoc analysis of the BP TARGET trial. J Neurointerv Surg 2023; 15:e142-e147. [PMID: 36220337 DOI: 10.1136/jnis-2022-019130] [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: 05/07/2022] [Accepted: 08/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Safety and Efficacy of Intensive Blood Pressure Lowering after Successful Endovascular Therapy in Acute Ischaemic Stroke (BP TARGET) trial demonstrated no benefit from intensive systolic blood pressure (SBP) treatment after successful reperfusion with endovascular therapy. However, it remains unknown if the response to blood pressure treatment is modified by other factors. OBJECTIVE To carry out a post hoc analysis of the BP TARGET trial data to determine if the response to blood pressure treatment is modified by factors such as age, history of hypertension, recanalization status, location of occlusion, diabetes, hyperglycemia, or pretreatment with intravenous thrombolysis. METHODS This is a post hoc analysis of the BP TARGET trial. Patients were divided into groups based on age, diabetes, blood glucose, site of occlusion, history of hypertension, and pretreatment with intravenous thrombolysis. The primary outcome was any intraparenchymal hemorrhage. RESULTS 318 patients were included. Diabetes modified the treatment effect on favorable functional outcome (Pheteogenity=0.041). There was a trend towards benefit from intensive SBP treatment in diabetic patients (OR=2.81; 95% CI 0.88 to 8.88; p=0.08) but not in non-diabetic patients (OR=0.75; 95% 0.45 to 126; p 0.28). Age, location of occlusion, admission SBP, pretreatment with intravenous thrombolysis, and history of hypertension did not modify the effect of intensive SBP treatment on any of the outcomes. CONCLUSION The effect of SBP lowering treatment was not modified by age, location of occlusion history of hypertension, intravenous thrombolysis, and admission SBP. Diabetes modified the effect of intensive SBP lowering treatment, and there was a trend towards benefit from intensive SBP treatment in diabetic patients. This finding is hypothesis generating and requires further validation.
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Affiliation(s)
- Mohammad Anadani
- Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Simon Escalard
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Candice Sabben
- Department of Neurology, Fondation Rothschild Hospital, paris, France
| | | | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | | | | | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Michel Piotin
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Mikaël Mazighi
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
- Department of Neurology, GH Lariboisiere Fernand-Widal, Paris, France
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11
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Bourcier R, Consoli A, Desilles JP, Labreuche J, Kyheng M, Desal H, Alias Q, Gory B, Dargazanli C, Janot K, Zhu F, Lapergue B, Marnat G. Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study. Eur Stroke J 2023; 8:655-666. [PMID: 37288701 PMCID: PMC10472952 DOI: 10.1177/23969873231180338] [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: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Technical improvements in devices, changes in angiographic grading scales and various confounding factors have made difficult the detection of the temporal evolution of angiographic and clinical results after endovascular treatment (EVT) for acute ischemic Stroke (AIS). We analyzed this evolution in time using the Endovascular Treatment in Ischemic Stroke (ETIS) registry. MATERIALS AND METHODS We analyzed the efficacy outcomes of EVT performed from January 2015 to January 2022, and modelized the temporal trends using mixed logistic regression models, further adjusted for age, intravenous thrombolysis prior to EVT, general anesthesia, occlusion site, balloon catheter use and the type of first-line EVT strategy. We assessed heterogeneity in temporal trends according to occlusion site, balloon catheter use, cardio embolic etiology, age (<80 years vs ⩾80 years) and first-line EVT strategy. RESULTS Among 6104 patients treated from 2015 to 2021, the rates of successful reperfusion (71.1%-89.6%) and of complete first pass effect (FPE) (4.6%-28.9%) increase, whereas the rates of patients with >3 EVT device passes (43.1%-17.5%) and favorable outcome (35.8%-28.9%) decrease significantly over time. A significant heterogeneity in temporal trends in successful reperfusion according to the first-line EVT strategy was found (p-het = 0.018). The temporal trend of increasing successful reperfusion rate was only significant in patients treated with contact aspiration in first-line (adjusted overall effect p = 0.010). CONCLUSION In this 7-year-old large registry of ischemic stroke cases treated with EVT, we observed a significant increase with time in the rate of recanalization whereas there was a tendency toward a decrease in the rate of favorable outcome over the same period.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Arturo Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Saint Quentin-en-Yvelines, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, INSERM unit 1148, Paris-Cité University, Paris, France
| | - Julien Labreuche
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, Lille, France
| | - Maeva Kyheng
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, Lille, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Quentin Alias
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Benjamin Gory
- IADI, University of Lorraine, INSERM U1254, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Guy de Chauliac University Hospital, Montpellier, France
| | - Kévin Janot
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Tours, Tours, France
| | - François Zhu
- IADI, University of Lorraine, INSERM U1254, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Bordeaux, France
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12
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Ho-Tin-Noé B, Desilles JP, Mazighi M. Thrombus composition and thrombolysis resistance in stroke. Res Pract Thromb Haemost 2023; 7:100178. [PMID: 37538503 PMCID: PMC10394565 DOI: 10.1016/j.rpth.2023.100178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/17/2022] [Revised: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 08/05/2023] Open
Abstract
A State of the Art lecture titled "Thrombus Composition and Thrombolysis Resistance in Stroke" was presented at the ISTH Congress in 2022. Intravenous thrombolysis (IVT) remains the only pharmacologic option to re-establish cerebral perfusion at the acute phase of ischemic stroke. IVT is based on the administration of recombinant tissue plasminogen activator with the objective of dissolving fibrin, the major fibrillar protein component of thrombi. Almost 30 years on from its introduction, although the clinical benefits of IVT have been clearly demonstrated, IVT still suffers from a relatively low efficacy, with a rate of successful early recanalization below 50% overall. Analyses of thrombectomy-recovered acute ischemic stroke (AIS) thrombi have shown that apart from occlusion site, thrombus length, and collateral status, AIS thrombus structure and composition are also important modulators of IVT efficacy. In this article, after a brief presentation of IVT principle and current knowledge on IVT resistance, we review recent findings on how compaction and structural alterations of fibrin together with nonfibrin thrombus components such as neutrophil extracellular traps and von Willebrand factor interfere with IVT in AIS. We further discuss how these new insights could soon result in the development of original adjuvant therapies for improved IVT in AIS. Finally, we summarize relevant new data presented during the 2022 ISTH Congress.
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Affiliation(s)
- Benoit Ho-Tin-Noé
- Université Paris Cité, Inserm, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Jean-Philippe Desilles
- Université Paris Cité, Inserm, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- Université Paris Cité, Inserm, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
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Brauner R, Gory B, Lapergue B, Sibon I, Richard S, Kyheng M, Labreuche J, Desilles JP, Blanc R, Piotin M, Halimi JM, Mazighi M, Maïer B. Effect of small vessel disease severity on blood pressure management after endovascular therapy in the BP TARGET trial. Eur J Neurol 2023; 30:1676-1685. [PMID: 36852526 DOI: 10.1111/ene.15759] [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: 11/23/2022] [Revised: 01/31/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND AND PURPOSE Acute ischaemic stroke patients with cerebral small vessel disease (CSVD), including cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs), have worse outcomes. The effect was investigated of two blood pressure strategies (intensive vs. standard) and blood pressure variability (BPV) after reperfusion according to CSVD burden in the BP TARGET trial. METHODS Patients with available magnetic resonance imaging at baseline were included. CMBs were described as absent or present and WMH severity was described according to the Fazekas classification (0-1, absent-mild; 2-3, moderate to severe). Outcomes consisted of any intracerebral hemorrhage (ICH) at 24 h and favorable outcome at 90 days (modified Rankin Scale score between 0 and 2). RESULTS In all, 246 patients were included. The intensive systolic blood pressure target was not associated with lower rates of ICH or favorable outcome according to CSVD subgroups (all p values >0.35). Several BPV parameters were associated with increased odds of ICH in patients with CMBs but not in patients without CMBs (diastolic blood pressure coefficient of variation, odds ratio 2.06, 95% confidence interval [CI] 1.13-3.77, in patients with ≥1 CMB vs. 0.94, 95% CI 0.68-1.31, in patients without CMBs, phet = 0.026). Several diastolic BPV parameters were associated with worse outcomes in patients with severe WMHs but not in patients without WMHs (diastolic blood pressure coefficient of variation, odds ratio 0.32, 95% CI 0.17-0.61, in patients with severe WMHs vs. 1.09, 95% CI 0.67-1.79, in patients without WMHs; phet = 0.003). CONCLUSION No effect of the intensive systolic blood pressure management strategy was found on ICH occurrence or functional outcome according to CSVD burden. BPV was associated with higher odds of ICH in patients with CMBs and worse outcome in patients with moderate-to-severe WMHs.
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Affiliation(s)
- Ran Brauner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France.,Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Sebastien Richard
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Maeva Kyheng
- Department of Biostatistics, CHU Lille,, Lille, France
| | | | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Université de Paris Cité, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Jean-Michel Halimi
- Nephrology Department, Tours Hospital, Tours, France.,Université de Tours, Tours, France.,EA4245-Transplantation, Immunology and Inflammation, University of Tours, Tours, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Université de Paris Cité, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France.,Department of Neurology, Hopital Lariboisière, APHP Nord, Paris, France
| | - Benjamin Maïer
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Université de Paris Cité, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France.,Neurology and Neurovascular Departments, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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14
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Maïer B, Tsai AS, Einhaus JF, Desilles JP, Ho-Tin-Noé B, Gory B, Sirota M, Leigh R, Lemmens R, Albers G, Olivot JM, Mazighi M, Gaudillière B. Neuroimaging is the new "spatial omic": multi-omic approaches to neuro-inflammation and immuno-thrombosis in acute ischemic stroke. Semin Immunopathol 2023; 45:125-143. [PMID: 36786929 PMCID: PMC10026385 DOI: 10.1007/s00281-023-00984-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
Ischemic stroke (IS) is the leading cause of acquired disability and the second leading cause of dementia and mortality. Current treatments for IS are primarily focused on revascularization of the occluded artery. However, only 10% of patients are eligible for revascularization and 50% of revascularized patients remain disabled at 3 months. Accumulating evidence highlight the prognostic significance of the neuro- and thrombo-inflammatory response after IS. However, several randomized trials of promising immunosuppressive or immunomodulatory drugs failed to show positive results. Insufficient understanding of inter-patient variability in the cellular, functional, and spatial organization of the inflammatory response to IS likely contributed to the failure to translate preclinical findings into successful clinical trials. The inflammatory response to IS involves complex interactions between neuronal, glial, and immune cell subsets across multiple immunological compartments, including the blood-brain barrier, the meningeal lymphatic vessels, the choroid plexus, and the skull bone marrow. Here, we review the neuro- and thrombo-inflammatory responses to IS. We discuss how clinical imaging and single-cell omic technologies have refined our understanding of the spatial organization of pathobiological processes driving clinical outcomes in patients with an IS. We also introduce recent developments in machine learning statistical methods for the integration of multi-omic data (biological and radiological) to identify patient-specific inflammatory states predictive of IS clinical outcomes.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, Paris, France
- Neurology Department, Hôpital Saint-Joseph, Paris, France
- Université Paris-Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France
- FHU NeuroVasc, Paris, France
| | - Amy S Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room S238, Stanford, CA, 94305-5117, USA
| | - Jakob F Einhaus
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room S238, Stanford, CA, 94305-5117, USA
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, Paris, France
- Université Paris-Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France
- FHU NeuroVasc, Paris, France
| | - Benoît Ho-Tin-Noé
- Université Paris-Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France
| | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, F-54000, Nancy, France
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Richard Leigh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences Division of Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
- VIB, Centre for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Gregory Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jean-Marc Olivot
- Vascular Neurology Department, University Hospital of Toulouse, Toulouse, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, Paris, France.
- Université Paris-Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France.
- FHU NeuroVasc, Paris, France.
- Neurology Department, Lariboisière Hospital, Université Paris-Cité, Paris, France.
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room S238, Stanford, CA, 94305-5117, USA.
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15
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Marnat G, Holay Q, Darcourt J, Desilles JP, Obadia M, Viguier A, Caroff J, Denier C, Papillon L, Barreau X, Cognard C, Berge J, Bourgeois-Beauvais Q, Landais A, Boulanger M, Macian F, Guillon B, Pico F, Lamy M, Robinet-Borgomano E, Richard S, Gory B, Sibon I, Gaillard N, Chausson N, Olindo S. Dual-layer carotid stenting for symptomatic carotid web: Results from the Caroweb study. J Neuroradiol 2022; 50:444-448. [PMID: 36563743 DOI: 10.1016/j.neurad.2022.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & PURPOSE Carotid Web (CaW) is a growingly recognized cause of ischemic stroke, associated with a high recurrence risk. Several therapeutic strategies have been proposed as a tertiary prevention including carotid stenting, endarterectomy and antithrombotic medications. Among these, carotid stenting with dual-layer stent may be promising to adequately cover the focal arterial dysplasia. Our aim was to investigate the safety and efficacy of the Casper stent in the treatment of symptomatic CaW. METHODS We conducted a retrospective analysis of consecutive patients presenting with a symptomatic CaW and included in the ongoing prospective observational multicenter CAROWEB registry. The study period was January 2015 to December 2021. Inclusion criteria were CaW treated with dual-layer Casper stent. Patients treated with other types of carotid stent, endarterectomy or antithrombotic medication were excluded. Clinical and radiological initial data and outcomes were recorded. RESULTS twenty-seven patients (with 28 caw) were included. median age was 52 (iqr: 46-68). median delay between index cerebrovascular event and cervical stenting was 9 days (IQR: 6-101). In all cases, the cervical carotid stenting was successfully performed. No major perioperative complication was recorded. No recurrent stroke or transient ischemic attack was observed during a median follow-up time of 272 days (IQR: 114-635). Long-term imaging follow-up was available in 25/28 (89.3%) stented CaW with a median imaging follow-up of 183 days (IQR: 107-676; range: 90-1542). No in-stent occlusion or stenosis was detected. CONCLUSION In this study, carotid stenting with dual-layer Casper stent in the treatment of symptomatic CaW was effective regarding stroke recurrence prevention and safe, without procedural nor delayed detected adverse event. However, the optimal therapeutic approach of symptomatic CaW still needs to be explored through randomized trials.
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Affiliation(s)
- Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Quentin Holay
- Department of Interventional Neuroradiology, Rothschild foundation hospital, Paris, France
| | - Jean Darcourt
- Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild foundation hospital, Paris, France
| | - Michael Obadia
- Department of Neurology, Rothschild foundation hospital Paris, France
| | - Alain Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, CHU Bicêtre APHP, Kremlin Bicêtre, France
| | - Christian Denier
- Department of Neurology, CHU Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Lisa Papillon
- Department of Neurology, Stroke Unit, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jerome Berge
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | - Anne Landais
- Department of Neurology, Point à Pitre Hospital, Pointe à Pitre, France
| | - Marion Boulanger
- Department of Neurology, Caen University Hospital, Caen, University Caen Normandy, France
| | - Francisco Macian
- Department of Neurology, Limoges University Hospital, Limoges, France
| | - Benoit Guillon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Fernando Pico
- Department of Neurology, Versailles Hospital, Le Chesnay, France
| | - Mathias Lamy
- Department of Neurology, Poitiers University Hospital, Poitiers, France
| | | | - Sébastien Richard
- Neurology Department, Nancy University Hospital, Nancy, France - INSERM U1116, Nancy, France
| | - Benjamin Gory
- France Department of Interventional and Diagnostic Neuroradiology, Nancy University Hospital, Nancy, France
| | - Igor Sibon
- Department of Neurology, Martinique University Hospital, Fort-de-France, France
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Nicolas Chausson
- Department of Neurology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Stephane Olindo
- Department of Neurology, Martinique University Hospital, Fort-de-France, France
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16
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Maïer B, Brauner R, Escalard S, Gory B, Lapergue B, Sibon I, Richard S, Labreuche J, Kyheng M, Desilles JP, Blanc R, Piotin M, Halimi JM, Mazighi M. Association of Contrast Enhancement After Reperfusion With Outcomes According to Blood Pressure Lowering in Acute Ischemic Stroke Patients. Neurology 2022; 99:e2385-e2394. [PMID: 36041869 DOI: 10.1212/wnl.0000000000201173] [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: 12/16/2021] [Accepted: 07/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Observational studies described associations between higher systolic blood pressure (SBP) values and intracranial hemorrhages (ICH) and worse outcomes after successful reperfusion by endovascular therapy (EVT). However, the BP-TARGET trial [BP-Target in Acute Ischemic Stroke to Reduce Hemorrhage after EVT] found that an intensive SBP target did not reduce ICH rates after successful EVT. The presence of contrast enhancement (CE) immediately after reperfusion is also associated with higher odds of ICH and worse outcomes. Our research question was to investigate the effect of two SBP strategies after reperfusion on ICH rates and functional outcomes according to the presence of CE in the BP-TARGET trial. We hypothesized that patients with CE could benefit from an intensive SBP control. METHODS We included BP-TARGET patients in whom a brain flat-panel was performed immediately after reperfusion. We described CE as present or absent, ICH consisted of any radiographic ICH 24 hours after EVT, unfavorable outcome consisted of a modified Rankin scale between 3-6 at 3 months. RESULTS Among the 324 patients randomized in BP-TARGET, 164 were included in this analysis, of whom 113 (68.9%) presented CE after reperfusion. The 24-hour mean SBP was significantly lower in the intensive SBP group compared with the standard group (129.7 versus 138.3 mmHg, p<0.001). Patients with CE and randomized in the intensive and standard SBP group had increased ICH rates: aOR=11.26, 95%CI 4.59-27.63 and aOR=4.08, 95%CI 1.75-9.50, respectively. However, the test of heterogeneity did not reach the significant level (aOR=2.76, 95%CI 0.80 to 9.48, p=0.11). Patients with CE and randomized in the intensive SBP group had also higher odds of unfavorable outcomes (aOR=2.91, 95%CI 1.24-6.82) but this association was not significant in the standard SBP group (aOR=1.89, 95%CI 0.85-4.23). No significant of heterogeneity was found between the two groups (aOR, 1.54, 95%CI 0.48 to 4.97, p=0.47). DISCUSSION Altogether, patients with CE and randomized in the intensive SBP group did not have lower rates of ICH or improved outcomes compared to the standard SBP group, as CE was associated with higher odds of ICH in both groups, without significant heterogeneity. TRIAL REGISTRATION INFORMATION NCT03160677. CLASSIFICATION OF EVIDENCE This study provides class IV evidence that for adults with contrast-enhancing lesions after successful EVT of an AIS, intensive blood pressure management did not significantly increase the risk of ICH.
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Affiliation(s)
| | - Ran Brauner
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simon Escalard
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Benjamin Gory
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France.,Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Sebastien Richard
- Université de Lorraine, CHRU-Nancy, Department of Neurology, Nancy, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Maeva Kyheng
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Université de Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Jean-Michel Halimi
- EA4245-Transplantation, Immunology and Inflammation, University of Tours, 37032, Tours, France.,Nephrology Department, Tours Hospital, Tours, France.,Université de Tours, Tours, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France .,Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Université de Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
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17
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Delvoye F, Di Meglio L, Consoli A, Nomenjanahary MS, Dupont S, Labreuche J, Maier B, Piotin M, Blanc R, Escalard S, Boursin P, Hamdani M, Redjem H, Smajda S, Hébert S, Sabben C, de Noordhout AM, Jandrot-Perrus M, Lapergue B, Mazighi M, Ho-Tin-Noé B, Desilles JP. High thrombus platelet content is associated with a lower rate of first pass effect in stroke treated by endovascular therapy. Eur Stroke J 2022; 7:376-383. [DOI: 10.1177/23969873221108740] [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: 02/07/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background and purpose: First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays. Patients and methods: Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass. Results: AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content. Discussion and conclusion: Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.
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Affiliation(s)
- François Delvoye
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- University of Liege, Liège, Belgium
| | - Lucas Di Meglio
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Arturo Consoli
- Interventional Neuroradiology Department, Hopital Foch, Suresnes, France
| | | | - Sébastien Dupont
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | | | - Benjamin Maier
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Solène Hébert
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Candice Sabben
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | | | - Martine Jandrot-Perrus
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | | | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
- Université de Paris, Paris, France
- FHU Neurovasc, Department of Neurology, Hopital Lariboisère, APHP Nord, Paris, France
| | - Benoit Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
- Université de Paris, Paris, France
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18
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Desilles JP, Di Meglio L, Delvoye F, Maïer B, Piotin M, Ho-Tin-Noé B, Mazighi M. Composition and Organization of Acute Ischemic Stroke Thrombus: A Wealth of Information for Future Thrombolytic Strategies. Front Neurol 2022; 13:870331. [PMID: 35873787 PMCID: PMC9298929 DOI: 10.3389/fneur.2022.870331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/18/2022] [Indexed: 01/01/2023] Open
Abstract
During the last decade, significant progress has been made in understanding thrombus composition and organization in the setting of acute ischemic stroke (AIS). In particular, thrombus organization is now described as highly heterogeneous but with 2 preserved characteristics: the presence of (1) two distinct main types of areas in the core—red blood cell (RBC)-rich and platelet-rich areas in variable proportions in each thrombus—and (2) an external shell surrounding the core composed exclusively of platelet-rich areas. In contrast to RBC-rich areas, platelet-rich areas are highly complex and are mainly responsible for the thrombolysis resistance of these thrombi for the following reasons: the presence of platelet-derived fibrinolysis inhibitors in large amounts, modifications of the fibrin network structure resistant to the tissue plasminogen activator (tPA)-induced fibrinolysis, and the presence of non-fibrin extracellular components, such as von Willebrand factor (vWF) multimers and neutrophil extracellular traps. From these studies, new therapeutic avenues are in development to increase the fibrinolytic efficacy of intravenous (IV) tPA-based therapy or to target non-fibrin thrombus components, such as platelet aggregates, vWF multimers, or the extracellular DNA network.
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Affiliation(s)
- Jean-Philippe Desilles
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Paris, France.,Université Paris Cité, Paris, France.,FHU Neurovasc, Paris, France
| | - Lucas Di Meglio
- Laboratory of Vascular Translational Science, U1148 INSERM, Paris, France
| | - Francois Delvoye
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France.,University of Liège, Liege, Belgium
| | - Benjamin Maïer
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France.,Université Paris Cité, Paris, France.,FHU Neurovasc, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Paris, France
| | - Benoît Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 INSERM, Paris, France.,Université Paris Cité, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Paris, France.,Université Paris Cité, Paris, France.,FHU Neurovasc, Paris, France.,Department of Neurology, Hopital Lariboisère, APHP Nord, Paris, France
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Desilles JP, Solo Nomenjanahary M, Consoli A, Ollivier V, Faille D, Bourrienne MC, Hamdani M, Dupont S, Di Meglio L, Escalard S, Maier B, Blanc R, Piotin M, Lapergue B, Ajzenberg N, Vasse M, Mazighi M, Ho-Tin-Noé B, Désilles JP, Mazighi M, Piotin M, Blanc R, Redjem H, Smajda S, Seners P, Escalard S, Delvoye F, Maier B, Hebert S, Ben Maacha M, Hamdani M, Sabben C, Obadia M, Deschildre C, Lapergue B, Consoli A, Rodesch G, Maria F, Coskun O, Lopez D, Bourcier R, Detraz L, Desal H, Roy M, Clavier D, Marnat G, Gariel F, Lucas L, Sibon I, Eugene F, Vannier S, Ferre JC, LeBras A, Raoult H, Paya C, Gauvrit JY, Richard S, Gory B, Barbier C, Vivien D, Touze E, Gauberti M, Blaizot G, Ifergan H, Herbreteau D, Bibi R, Janot K, Charron V, Boulouis G. Impact of COVID-19 on thrombus composition and response to thrombolysis: Insights from a monocentric cohort population of COVID-19 patients with acute ischemic stroke. J Thromb Haemost 2022; 20:919-928. [PMID: 35032088 PMCID: PMC9906142 DOI: 10.1111/jth.15646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Resistance to fibrinolysis, levels of procoagulant/antifibrinolytic neutrophil extracellular traps (NETs), and the severity of acute ischemic stroke (AIS) are increased by COVID-19. Whether NETs are components of AIS thrombi from COVID-19 patients and whether COVID-19 impacts the susceptibility of these thrombi to thrombolytic treatments remain unknown, however. OBJECTIVES We aimed to characterize AIS thrombi from COVID-19 patients by immunohistology and to compare their response to thrombolysis to that of AIS thrombi from non-COVID-19 patients. PATIENTS/METHODS For this monocentric cohort study, 14 thrombi from COVID-19 AIS patients and 16 thrombi from non-COVID-19 patients, all recovered by endovascular therapy, were analyzed by immunohistology or subjected to ex vivo thrombolysis by tissue-type plasminogen (tPA)/plasminogen. RESULTS COVID-19 AIS thrombi were rich in neutrophils and contained NETs, but not spike protein. Thrombolysis assays revealed a mean resistance profile to tPA/plasminogen of COVID-19 AIS thrombi similar to that of non-COVID-19 AIS thrombi. The addition of DNase 1 successfully improved thrombolysis by potentiating fibrinolysis irrespective of COVID-19 status. Levels of neutrophil, NETs, and platelet markers in lysis supernatants were comparable between AIS thrombi from non-COVID-19 and COVID-19 patients. CONCLUSIONS These results show that COVID-19 does not impact NETs content or worsen fibrinolysis resistance of AIS thrombi, a therapeutic hurdle that could be overcome by DNase 1 even in the context of SARS-CoV-2 infection.
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Affiliation(s)
- Jean-Philippe Desilles
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | | | - Arturo Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Véronique Ollivier
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Dorothée Faille
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | | | - Mylène Hamdani
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Sébastien Dupont
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Lucas Di Meglio
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Bertrand Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Nadine Ajzenberg
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Marc Vasse
- Biology Department, UMR-S 1176, Foch Hospital, Suresnes, France
| | - Mikael Mazighi
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Benoît Ho-Tin-Noé
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France.
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Maïer B, Gory B, Lapergue B, Sibon I, Richard S, Kyheng M, Labreuche J, Desilles JP, Blanc R, Piotin M, Mazighi M, Halimi JM. Effect of Baseline Antihypertensive Treatments on Stroke Severity and Outcomes in the BP TARGET Trial. Stroke 2022; 53:1837-1846. [PMID: 35321558 DOI: 10.1161/strokeaha.121.037548] [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: 11/16/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) patients with a history of hypertension experience worse outcomes, which may be explained by a deleterious impact of the renin-angiotensin system (RAS) overactivation. We sought to investigate whether prestroke antihypertensive treatments (AHT) influenced baseline stroke severity and neurological outcomes, in patients with AIS successfully treated by endovascular therapy. METHODS We performed a post hoc analysis of the BP TARGET trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) and included hypertensive patients with available data regarding AHT at admission, categorized as RAS inhibitors (ACE [angiotensin-converting enzyme] inhibitors, ARBs [angiotensin 2 receptor blockers], and β-blockers) and non-RAS inhibitors (calcium channel blockers and diuretics). Associations of each AHT with National Institutes of Health Stroke Scale (NIHSS) score at baseline were investigated in linear mixed model adjusted for the number of treatments and center. Associations of each AHT with 24-hour NIHSS change, intracranial hemorrhage were performed using linear mixed model adjusted for baseline NIHSS, the number of treatments, center, age, and sex and adjusted for age, sex, diabetes, and current smoking for favorable outcome. All analyses were performed on cases-available data regarding the low number of missing data. RESULTS Overall, 203 patients with at least one AHT were included. Patients under non-RAS inhibitor treatments had a higher NIHSS score at baseline (adjusted mean difference=3.28 [95% CI, 1.33-5.22]; P=0.001). Conversely, patients under RAS inhibitor treatments had a lower baseline NIHSS score (adjusted mean difference=-2.81 [95% CI, -5.37 to -0.25]; P=0.031). Intracranial hemorrhage occurrence was significantly more frequent in patients under non-RAS inhibitor treatments (adjusted odds ratio of 2.48 [95% CI, 1.12-5.47]; P=0.025). Conversely, the use of RAS inhibitor treatments before AIS was not associated with higher odds of radiographic intracranial hemorrhage. Patients with non-RAS inhibitor treatments had less improvement of NIHSS at 24 hours compared with patients without (adjusted mean difference, 2.83 [95% CI, -0.16 to 5.81]; P=0.063). Baseline RAS inhibitor or noninhibitor treatments were not associated with favorable outcome. CONCLUSIONS We showed an opposite effect of baseline AHT, based on their effect on the RAS. Patients treated with RAS inhibitor agents before AIS exhibited less severe AIS compared with patients under non-RAS inhibitor treatments, developed less intracranial hemorrhage at 24 hours and had a trend toward better NIHSS score at 24 hours. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03160677.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., M.M.).,FHU NeuroVasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,EA4245-Transplantation, Immunology and Inflammation, University of Tours, France (B.M., J.-M.H.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, France.,CHRU-Nancy and IADI, INSERM U1254 (B.G.), Université de Lorraine, France
| | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France (B.L.)
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, Université de Bordeaux, France (I.S.)
| | | | - Maeva Kyheng
- CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, France (M.L., J.L.)
| | - Julien Labreuche
- CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, France (M.L., J.L.)
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., M.M.).,FHU NeuroVasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - Raphael Blanc
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,FHU NeuroVasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - Michel Piotin
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,FHU NeuroVasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., M.M.).,FHU NeuroVasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - Jean-Michel Halimi
- EA4245-Transplantation, Immunology and Inflammation, University of Tours, France (B.M., J.-M.H.).,Nephrology Department, Tours Hospital, France (J.-M.H.). Université de Tours, France (J.M.H.)
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Ifergan H, Hak JF, Darcourt J, Charbonnier G, Biondi A, Guedon A, Houdart E, Desilles JP, Holay Q, Shotar E, Bonnet B, Kerleroux B, Janvier P, Forestier G, Rouchaud A, Cortese J, Sporns P, Schulze-Zachau V, Marnat G, Papaxanthos J, Testud B, Pop R, Burel J, Lefebvre M, Tessier G, Bibi R, Herbreteau D, Janot K, Labreuche J, Turjman F, Boulouis G. Étude rétrospective multicentrique pour évaluer l'efficacité et la sécurité de la prise en charge thérapeutique des anévrysmes fusiformes et dolichoectasies du tronc basilaire. cohorte collaborative du jeni. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Anadani M, Maïer B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Gory B, Richard S, Sibon I, Desilles JP, Blanc R, Piotin M, Mazighi M. Magnitude of Blood Pressure Change After Endovascular Therapy and Outcomes: Insight From the BP-TARGET Trial. Stroke 2022; 53:719-727. [PMID: 35109685 DOI: 10.1161/strokeaha.121.036701] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To assess the association between systolic blood pressure change (ΔSBP) at different time intervals after successful reperfusion with radiographic and clinical outcomes. METHODS This is a post hoc analysis of the BP-TARGET multicenter trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy). ΔSBP was defined as end of procedure SBP minus mean SBP at different time intervals (15-60 minutes, 1-6 hours, and 6-24 hours postprocedure). The primary outcome was the poor functional outcome (90-day modified Rankin Scale score 3-6). RESULTS We included a total of 267 patients (130 in the intensive treatment group). Compared with patients with favorable outcome, patients with poor outcome had lower ΔSBP (less SBP reduction) at all times intervals. After adjusting for potential confounders including baseline SBP, both ΔSBP15-60M and ΔSBP6-24H were associated with lower odds of poor outcome (adjusted odds ratio per 5 mm Hg SBP reduction, 0.89 [95% CI, 0.81-0.99], and adjusted odds ratio 0.82 [95% CI, 0.73-0.92], respectively). Concerning safety outcomes, patients with intraparenchymal hemorrhage had lower ΔSBP at all time intervals. ΔSBP15-60M was associated with lower odds of any intraparenchymal hemorrhage (adjusted odds ratio per 5 mm Hg SBP reduction 0.91 [95% CI, 0.83-0.99]). Conversely, ΔSBP was not associated with mortality or neurological deterioration at any time interval. CONCLUSIONS After successful reperfusion, ΔSBP had a linear relationship with poor outcome and the risk of poor outcome was higher with less reduction from the baseline SBP. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03160677.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University, St Louis, MO (M.A.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (M.A.)
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,University of Paris, France (B.M., J.-P.D., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Simon Escalard
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.)
| | - Julien Labreuche
- University of Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, France (J.L.).,CHU Lille, Department of Biostatistics, France (J.L.)
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City (A.d.H.)
| | | | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France (B.L.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France (B.G.).,Université de Lorraine, IADI, INSERM U1254, Nancy, France (B.G.)
| | | | | | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,University of Paris, France (B.M., J.-P.D., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,University of Paris, France (B.M., J.-P.D., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
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Smajda S, Ciccio G, Fahed R, Robert T, Botta D, Redjem H, Desilles JP, Mazighi M, Zuber K, Escalard S, Baharvahdat H, Blanc R, Chauvet D, Philibert M, Chokron S, Piotin M. Visual Field Defect Before and After Endovascular Treatment of Occipital Arteriovenous Malformations. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa280_s054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maïer B, Gory B, Lapergue B, Sibon I, Escalard S, Kyheng M, Labreuche J, de Havenon A, Petersen N, Anadani M, Gayat E, Boursin P, Ben Maacha M, Desilles JP, Blanc R, Piotin M, Halimi JM, Mazighi M. Effect of blood pressure variability in the randomized controlled BP TARGET trial. Eur J Neurol 2021; 29:771-781. [PMID: 34821437 DOI: 10.1111/ene.15194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The Blood Pressure Target in Acute Ischemic Stroke to Reduce Hemorrhage After Endovascular Therapy (BP TARGET) trial evaluated whether an intensive systolic blood pressure (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful endovascular therapy (EVT) but did not assess the effect of blood pressure variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BP TARGET trial. METHODS We performed a post hoc analysis of the BP TARGET trial and included patients with at least 50% of blood pressure (BP) recordings during the first 24 h after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum (max-min), successive variation (SV), and time rate. The primary outcome was favorable functional outcome (3-month modified Rankin Scale between 0 and 2); the secondary outcome was the rate of ICH at 24 h. RESULTS We included 290 patients (mean number of BP measures = 30.4, SD = 8.0). BPV parameters (SBPSD , SBPmax-min , SBPCV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBPSD , DBPmax-min , DBPCV , and DBPSV ), but not after adjustment. Higher SBPmax-min was associated with worse functional outcomes in Thrombolysis in Cerebral Infarction 2B patients (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.38-1.02), but not in patients with complete reperfusion (OR = 1.27, 95% CI = 0.80-2.02, p for heterogeneity (phet =0.037). None of the BPV parameters was associated with ICH, regardless of the randomization group or the reperfusion grade. CONCLUSIONS BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, University of Lorraine, Nancy, France.,IADI, INSERM U1254, University of Lorraine, Nancy, France
| | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Center, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Maeva Kyheng
- University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
| | - Julien Labreuche
- University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
| | - Adam de Havenon
- Neurology Department, University of Utah, Salt Lake City, Utah, USA
| | - Nils Petersen
- Neurocritical Care and Emergency Neurology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Etienne Gayat
- University of Paris, Paris, France.,Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, Paris, France.,INSERM UMR-S 942, Cardiovascular Makers in Stress Conditions, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Malek Ben Maacha
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Jean-Michel Halimi
- EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France.,Nephrology Department, Tours Hospital, Tours, France.,University of Tours, Tours, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
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Maïer B, Desilles JP, Mazighi M. Intraparenchymal haemorrhages as a primary outcome measure - Authors' reply. Lancet Neurol 2021; 20:595-596. [PMID: 34302779 DOI: 10.1016/s1474-4422(21)00184-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neurology, Université de Paris, Paris, France; FHU Neurovasc, Paris, France; INSERM U1148, Laboratory of Vascular Translational Science, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neurology, Université de Paris, Paris, France; FHU Neurovasc, Paris, France; INSERM U1148, Laboratory of Vascular Translational Science, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neurology, Université de Paris, Paris, France; FHU Neurovasc, Paris, France; INSERM U1148, Laboratory of Vascular Translational Science, Paris, France.
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Zhu F, Ben Hassen W, Bricout N, Kerleroux B, Janot K, Gory B, Anxionnat R, Richard S, Marchal A, Blanc R, Piotin M, Consoli A, Trystram D, Rodriguez Regent C, Desilles JP, Weisenburger-Lile D, Escalard S, Herbreteau D, Ifergan H, Lima Maldonado I, Labreuche J, Henon H, Naggara O, Lapergue B, Boulouis G. Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study. Stroke 2021; 52:2736-2742. [PMID: 34233462 DOI: 10.1161/strokeaha.120.031940] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. METHODS Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator's experience and procedural metrics. RESULTS A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57-170.2) over the study period. Higher operator's experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (β estimate, -3.98 [95% CI, -5.1 to -2.8]; P<0.001), along with local anesthesia and M1 occlusion location in multivariable models. Increasing experience was associated with better Thrombolysis in Cerebral Infarction scores (estimate, 1.02 [1-1.04]; P=0.013). CONCLUSIONS In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators' recertification processes tailored to individual case volume and prior experience.
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Affiliation(s)
- François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.)
| | - Wagih Ben Hassen
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Nicolas Bricout
- Department of Neuroradiology, CHRU Lille, France (N.B., A.M.)
| | - Basile Kerleroux
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).,Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | - Kevin Janot
- Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.)
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, CHRU Nancy and INSERM U1116, F-54000, Université de Lorraine, Nancy, France (S.R.)
| | - Adrien Marchal
- Department of Neuroradiology, CHRU Lille, France (N.B., A.M.)
| | - Raphael Blanc
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | - Michel Piotin
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France (A.C.)
| | - Denis Trystram
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Christine Rodriguez Regent
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Jean-Philippe Desilles
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | | | - Simon Escalard
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | - Denis Herbreteau
- Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | - Heloise Ifergan
- Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | | | - Julien Labreuche
- CHRU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, Lille, France (J.L.)
| | - Hilde Henon
- Department of Neurology, Stroke Unit, CHRU Lille, Lille, France (H.H.)
| | - Olivier Naggara
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Bertrand Lapergue
- Department of Neurology, Stroke Unit, Foch Hospital, Suresnes, France (D.W.-L., B.L.)
| | - Grégoire Boulouis
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).,Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
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Jadoui S, Le Chapelain O, Ollivier V, Mostefa-Kara A, Di Meglio L, Dupont S, Gros A, Nomenjanahary MS, Desilles JP, Mazighi M, Nieswandt B, Loyau S, Jandrot-Perrus M, Mangin PH, Ho-Tin-Noé B. Glenzocimab does not impact glycoprotein VI-dependent inflammatory haemostasis. Haematologica 2021; 106:2000-2003. [PMID: 33375772 PMCID: PMC8252939 DOI: 10.3324/haematol.2020.270439] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Angèle Gros
- Université de Paris, LVTS, Inserm U1148, F-75018 Paris
| | | | - Jean-Philippe Desilles
- Université de Paris, LVTS, Inserm U1148, F-75018 Paris, France; Rothschild Foundation Hospital, Paris, France. Department of Interventional Neuroradiology
| | - Mikaël Mazighi
- Université de Paris, LVTS, Inserm U1148, F-75018 Paris, France; Rothschild Foundation Hospital, Paris, France. Department of Interventional Neuroradiology
| | - Bernhard Nieswandt
- University Hospital Würzburg, Rudolf Virchow Center for Experimental Biomedicine, Würzburg
| | | | | | - Pierre H Mangin
- Université de Strasbourg, INSERM, EFS Grand-Est, BPPS UMR-S1255, FMTS, F-67065 Strasbourg, France
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28
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Maïer B, Robichon E, Bourcier R, Dargazanli C, Labreuche J, Thion LA, Leguen M, Riem R, Desilles JP, Boulouis G, Delvoye F, Hebert S, Redjem H, Smajda S, Escalard S, Blanc R, Piotin M, Lapergue B, Mazighi M. Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency. Stroke 2021; 52:2964-2967. [PMID: 34134507 DOI: 10.1161/strokeaha.121.034542] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Hypotension during endovascular therapy for acute ischemic stroke is associated with worse functional outcomes (FO). Given its important role in intracranial hemodynamics, we investigated whether hypotension during endovascular therapy had the same effect on FO according to the posterior communicating artery (PComA) patency. METHODS We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Patients were included if they had middle cerebral artery occlusions. Primary outcome was favorable FO, defined by a modified Rankin Scale scores between 0 and 2 at 3 months. RESULTS One hundred forty-eight patients with middle cerebral artery occlusion were included. In patients with no PComA, an increase in minimum mean arterial pressure was positively associated with favorable FO (odds ratio per 10 mm Hg increase, 1.59 [95%CI, 1.11-2.25]; P=0.010), whereas no association was found in patients with a PComA (odds ratio, 0.77 [95% CI, 0.54-1.08]; P=0.12). Patients with no PComA and longer cumulative time with mean arterial pressure <90 mm Hg or systolic blood pressure <140 mm Hg had significantly lower rates of favorable FO, with an odds ratio per 10-minute increase of 0.75 (95% CI, 0.59-0.94; P=0.010) and 0.74 (95% CI, 0.60-0.91; P=0.003), but not in patients with a PComA. CONCLUSIONS Hypotension during endovascular therapy for middle cerebral artery occlusion is consistently associated with worse FO in patients with no PComA but not in those with a PComA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02523261.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Erwan Robichon
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | | | - Cyril Dargazanli
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France (C.D.)
| | - Julien Labreuche
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, France (J.L.)
| | - Laurie-Anne Thion
- Anesthesiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (L.-A.T.)
| | - Morgan Leguen
- Anesthesiology Department, Foch Hospital, France (M.L.)
| | - Romuald Riem
- Anesthesiology Department, Nantes Hospital, France (R.R.)
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | | | - François Delvoye
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Solène Hebert
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.)
| | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.).,Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Inserm 1087, CNRS, UNIV Nantes (R.B.)
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | | | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M.).,Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
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Charbonnier G, Desilles JP, Escalard S, Maier B, Ciccio G, Smajda S, Fahed R, Delvoye F, Redjem H, Blanc R, Piotin M, Mazighi M. Timing and Spectrum of Neurological Complications After Flow Diverter Implantation for Intracranial Aneurysms. Front Neurol 2021; 12:590383. [PMID: 33959085 PMCID: PMC8093792 DOI: 10.3389/fneur.2021.590383] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications. Methods: This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD. Results: Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186–1,210). Sixty-one patients presented with ischemic complications, 13 with hemorrhagic ones and 10 with compressive processes. Among 89 neurological complications 64.5% were peri-operative (occurring within the 30 days following the procedure) and 35.5% were delayed after 1 month. Conclusions: Overall, neurological complications after FD implantation were overrepresented by cerebrovascular ischemic events occurring during the peri-operative period, but also in a delayed manner after 1 year. Long-term follow-up is relevant after aneurysm intervention using FD.
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Affiliation(s)
| | | | - Simon Escalard
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Delvoye F, Loyau S, Labreuche J, Taylor G, Maier B, Piotin M, Blanc R, Escalard S, Di Meglio L, Ben Maacha M, Redjem H, Smajda S, Ciccio G, Hébert S, Sabben C, Jandrot-Perrus M, Maertens De Noordhout A, Mazighi M, Ho-Tin-Noé B, Desilles JP. Intravenous abciximab as a rescue therapy for immediate reocclusion after successful mechanical thrombectomy in acute ischemic stroke patients. Platelets 2021; 33:285-290. [PMID: 33840346 DOI: 10.1080/09537104.2021.1894326] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background - Immediate reocclusion after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is a rare but devastating condition associated with poor functional outcome.Objective - The aim of this study was to gain insights into the mechanisms underlying immediate reocclusion, and to evaluate the efficacy and safety of the glycoprotein IIb/IIIa antagonist abciximab, for its treatment.Methods - Clinical data were collected from April 2015 to April 2019 in a monocentric prospective registry of AIS patients treated by MT. All patients with immediate reocclusion were retrospectively selected and subdivided into 2 groups according to abciximab treatment status. In vitro, the separate and combined effects of abciximab and alteplase on clot formation in whole blood under flow conditions were further investigated in microfluidic chambers.Results - From 929 MT-treated patients, 21 had post-MT immediate reocclusion. Abciximab treatment in reocclusion patients (n = 10) led to higher rate of final recanalization (p < .001) while it did not increase bleeding complications. Flow chamber experiments revealed that, in contrast to alteplase, abciximab efficiently limits thrombus accretion from flowing blood by blocking platelet aggregation.Conclusions - Our results underscore a key role for platelet aggregation and the potential of Glycoprotein IIb/IIIa antagonists as a rescue therapy in post-MT immediate reocclusion.
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Affiliation(s)
- François Delvoye
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,University of Liege, Belgium
| | - Stephane Loyau
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | | | - Guillaume Taylor
- Rothschild Foundation Hospital, Intensive Care Department, Paris, France
| | - Benjamin Maier
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Michel Piotin
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Raphael Blanc
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Simon Escalard
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Lucas Di Meglio
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Malek Ben Maacha
- Clinical Research Unit, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Stanislas Smajda
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Gabriele Ciccio
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Solène Hébert
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
| | - Candice Sabben
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Martine Jandrot-Perrus
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | | | - Mikael Mazighi
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France.,Université De Paris, France.,DHU Neurovasc
| | - Benoit Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
| | - Jean-Philippe Desilles
- Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France.,Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France.,Université De Paris, France
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Bourrienne MC, Loyau S, Benichi S, Gay J, Solo-Nomenjanahary M, Journé C, Di Meglio L, Freiherr von Seckendorff A, Desilles JP, Ho-Tin-Noé B, Ajzenberg N, Mazighi M. A Novel Mouse Model for Cerebral Venous Sinus Thrombosis. Transl Stroke Res 2021; 12:1055-1066. [PMID: 33675011 DOI: 10.1007/s12975-021-00898-1] [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: 08/28/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 02/08/2023]
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke resulting in parenchymal injuries associated with heterogeneous clinical symptoms and prognosis. Therefore, an experimental animal model is required to further study underlying mechanisms involved in CVST. This study is aimed at developing a novel murine model suitable and relevant for evaluating injury patterns during CVST and studying its clinical aspects. CVST was achieved in C57BL/6J mice by autologous clot injection into the superior sagittal sinus (SSS) combined with bilateral ligation of external jugular veins. Clot was prepared ex vivo using thrombin before injection. On days 1 and 7 after CVST, SSS occlusion and associated-parenchymal lesions were monitored using different modalities: in vivo real-time intravital microscopy, magnetic resonance imaging (MRI), and immuno-histology. In addition, mice were subjected to a neurological sensory-motor evaluation. Thrombin-induced clot provided fibrin- and erythrocyte-rich thrombi that lead to reproducible SSS occlusion at day 1 after CVST induction. On day 7 post-CVST, venous occlusion monitoring (MRI, intravital microscopy) showed that initial injected-thrombus size did not significantly change demonstrating no early spontaneous recanalization. Microscopic histological analysis revealed that SSS occlusion resulted in brain edema, extensive fibrin-rich venular thrombotic occlusion, and ischemic and hemorrhagic lesions. Mice with CVST showed a significant lower neurological score on post-operative days 1 and 7, compared to the sham-operated group. We established a novel clinically CVST-relevant model with a persistent and reproducible SSS occlusion responsible for symptomatic ischemic and hemorrhagic lesions. This method provides a reliable model to study CVST physiopathology and evaluation of therapeutic new regimens.
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Affiliation(s)
- Marie-Charlotte Bourrienne
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France.
| | - Stéphane Loyau
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France
| | - Sandro Benichi
- Pediatric Neurosurgery Department, AP-HP, Necker Children Hospital, Paris, France
| | - Juliette Gay
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France
| | | | - Clément Journé
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France.,Fédération de Recherche en Imagerie Multimodalités (FRIM), Faculté de Médecine X. Bichat, INSERM UMS34, Université de Paris, 75018, Paris, France
| | - Lucas Di Meglio
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France
| | | | - Jean-Philippe Desilles
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Benoît Ho-Tin-Noé
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France
| | - Nadine Ajzenberg
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France.,Laboratory of Hematology, AP-HP, Bichat Hospital, 75877, Paris Cedex 18, France
| | - Mikaël Mazighi
- Laboratory for Vascular Translational Science (LVTS), INSERM UMR 1148, Université de Paris, 75018, Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.,Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
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Rousseau O, Karakachoff M, Gaignard A, Bellanger L, Bijlenga P, Constant Dit Beaufils P, L'Allinec V, Levrier O, Aguettaz P, Desilles JP, Michelozzi C, Marnat G, Vion AC, Loirand G, Desal H, Redon R, Gourraud PA, Bourcier R. Location of intracranial aneurysms is the main factor associated with rupture in the ICAN population. J Neurol Neurosurg Psychiatry 2021; 92:122-128. [PMID: 33097563 DOI: 10.1136/jnnp-2020-324371] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The ever-growing availability of imaging led to increasing incidentally discovered unruptured intracranial aneurysms (UIAs). We leveraged machine-learning techniques and advanced statistical methods to provide new insights into rupture intracranial aneurysm (RIA) risks. METHODS We analysed the characteristics of 2505 patients with intracranial aneurysms (IA) discovered between 2016 and 2019. Baseline characteristics, familial history of IA, tobacco and alcohol consumption, pharmacological treatments before the IA diagnosis, cardiovascular risk factors and comorbidities, headaches, allergy and atopy, IA location, absolute IA size and adjusted size ratio (aSR) were analysed with a multivariable logistic regression (MLR) model. A random forest (RF) method globally assessed the risk factors and evaluated the predictive capacity of a multivariate model. RESULTS Among 994 patients with RIA (39.7%) and 1511 patients with UIA (60.3 %), the MLR showed that IA location appeared to be the most significant factor associated with RIA (OR, 95% CI: internal carotid artery, reference; middle cerebral artery, 2.72, 2.02-3.58; anterior cerebral artery, 4.99, 3.61-6.92; posterior circulation arteries, 6.05, 4.41-8.33). Size and aSR were not significant factors associated with RIA in the MLR model and antiplatelet-treatment intake patients were less likely to have RIA (OR: 0.74; 95% CI: 0.55-0.98). IA location, age, following by aSR were the best predictors of RIA using the RF model. CONCLUSIONS The location of IA is the most consistent parameter associated with RIA. The use of 'artificial intelligence' RF helps to re-evaluate the contribution and selection of each risk factor in the multivariate model.
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Affiliation(s)
- Olivia Rousseau
- INSERM, CIC 1413, Clinique des données, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Matilde Karakachoff
- INSERM, CIC 1413, Clinique des données, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Alban Gaignard
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Lise Bellanger
- Laboratoire de Mathématiques Jean Leray, University of Nantes, Nantes, Pays de la Loire, France
| | - Philippe Bijlenga
- Department of Clinical Neurosciences, University of Geneva, Geneva, Switzerland
| | | | - Vincent L'Allinec
- Department Neuroradiology, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Olivier Levrier
- Department of Neuroradiology, Hôpital Clairval - Ramsay-Générale de santé, Marseille, France
| | - Pierre Aguettaz
- Department of Neuroradiology, Hospital Clairval, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Caterina Michelozzi
- Department of Neuroradiology, Hopital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Anne-Clémence Vion
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Gervaise Loirand
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, Pays de la Loire, FR, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Richard Redon
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Pierre-Antoine Gourraud
- INSERM, CIC 1413, Clinique des données, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, Pays de la Loire, FR, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
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Delvoye F, Maier B, Escalard S, Labreuche J, Thion LA, Aknouche S, Hebert S, Redjem H, Smajda S, Ciccio G, Allard J, Sabben C, Obadia M, Maertens de Noordhout A, Olivot JM, Blanc R, Piotin M, Desilles JP, Mazighi M. Corrigendum to 'Antiplatelet Therapy During Emergent Extracranial Internal Carotid Artery Stenting: Comparison of Three Intravenous Antiplatelet Perioperative Strategies' [Journal of Stroke and Cerebrovascular Diseases, Vol. 30, No. 2, (2020) 105521]. J Stroke Cerebrovasc Dis 2020; 30:105560. [PMID: 33358118 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Francois Delvoye
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Universit'e de Li'ege, Belgique
| | - Benjamin Maier
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Sci- ence, U1148 INSERM, Universit'e de Paris, 46 rue Henri Huchard 75018 Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Julien Labreuche
- University of Lille, CHU Lille, EA 2694 - Sant'e Publique: E'pid'emiologie et Qualit'e des Soins, F-59000 Lille, France
| | - Laurie-Anne Thion
- Anesthesiology Department, Rothschild Foundation Hospital, Paris, France
| | - Soufiane Aknouche
- Clinical Research Unit, Rothschild Foundation Hospital, Paris, France
| | - Sol'ene Hebert
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Julien Allard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Candice Sabben
- Neurology Department, Rothschild Foundation Hospital, Paris, France
| | - Michael Obadia
- Neurology Department, Rothschild Foundation Hospital, Paris, France
| | | | | | - Raphael Blanc
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Sci- ence, U1148 INSERM, Universit'e de Paris, 46 rue Henri Huchard 75018 Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Sci- ence, U1148 INSERM, Universit'e de Paris, 46 rue Henri Huchard 75018 Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Sci- ence, U1148 INSERM, Universit'e de Paris, 46 rue Henri Huchard 75018 Paris, France; Universit'e de Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Sci- ence, U1148 INSERM, Universit'e de Paris, 46 rue Henri Huchard 75018 Paris, France; Universit'e de Paris, France; FHU Neurovasc, France.
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Hebert S, Clavel P, Maier B, Mizutani K, Delvoye F, Lapergue B, Maacha MB, Fahed R, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Gory B, Richard S, Blanc R, Piotin M, Mazighi M. Corrigendum to 'Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase' [Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 10 (October), 2020: 105052]. J Stroke Cerebrovasc Dis 2020; 30:105465. [PMID: 33309126 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105465] [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: 10/22/2022] Open
Affiliation(s)
- Solène Hebert
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France.
| | - Pierre Clavel
- Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | | | - François Delvoye
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | | | - Malek Ben Maacha
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Simon Escalard
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Jean-Philippe Desilles
- Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Hocine Redjem
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Gory
- Professor, Interventional Neuroradiology Unit, Centre Hospitalier et Régional Universitaire de Nancy, Nancy, France, 03 83 85 16 18
| | - Sébastien Richard
- Professor, Neurology unit, Centre Hospitalier et Régional Universitaire de Nancy, Nancy, France, 03 83 85 22 5
| | - Raphael Blanc
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Michel Piotin
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
| | - Mikael Mazighi
- Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Sant'e et de la Recherche M'edicale (INSERM), Paris, France; Universit'e Paris Denis Diderot, Sorbonne Paris Cite, France
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Delvoye F, Maier B, Escalard S, Labreuche J, Thion LA, Aknouche S, Hebert S, Redjem H, Smajda S, Ciccio G, Allard J, Sabben C, Obadia M, Maertens de Noordhout A, Olivot JM, Blanc R, Piotin M, Desilles JP, Mazighi M. Antiplatelet Therapy During Emergent Extracranial Internal Carotid Artery Stenting: Comparison of Three Intravenous Antiplatelet Perioperative Strategies. J Stroke Cerebrovasc Dis 2020; 30:105521. [PMID: 33310073 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting. MATERIAL AND METHODS Clinical data were collected from January 2015 to December 2019 in a monocentric prospective registry of AIS patients treated by EVT. All patients who underwent emergent EC-ICA stenting were sorted regarding the intravenous antiplatelet agent used during the procedure. RESULTS Among 218 patients treated by EVT for an EC-ICA occlusion of the anterior circulation during the study period, 70 underwent an emergent stenting of the EC-ICA. 60 were included in the present study, 9 received intravenous (IV) Cangrelor, 8 IV abciximab and 43 Aspirin. The rate of favorable neurological outcome, defined as modified Rankin Scale (mRS) ≤ 2 at three months were better in the Cangrelor and Aspirin groups (66,7% and 58,1%, respectively) than in the Abciximab group (37,5%), as well as, the rate of any intracranial ICH (22,2% and 37,2% vs 62,5%). The rate of acute stent reocclusion was similar between groups. CONCLUSION When used as a rescue treatment during emergent stenting of EC-ICA, Cangrelor and Aspirin present a better safety profile than Abciximab, with less intracranial hemorrhages and a higher rate of good clinical outcome. Additional studies are needed to confirm these findings.
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Affiliation(s)
- François Delvoye
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Université de Liège, Belgique.
| | - Benjamin Maier
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Simon Escalard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Julien Labreuche
- University of Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France.
| | - Laurie-Anne Thion
- Anesthesiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Soufiane Aknouche
- Clinical Research Unit, Rothschild Foundation Hospital, Paris, France.
| | - Solène Hebert
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Hocine Redjem
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Julien Allard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Candice Sabben
- Neurology Department, Rothschild Foundation Hospital, Paris, France.
| | - Michael Obadia
- Neurology Department, Rothschild Foundation Hospital, Paris, France.
| | | | | | - Raphael Blanc
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Michel Piotin
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France.
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France; FHU Neurovasc, France.
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Mertens JC, Boisseau W, Leenaerts D, Di Meglio L, Loyau S, Lambeir AM, Ducroux C, Jandrot-Perrus M, Michel JB, Mazighi M, Hendriks D, Desilles JP. Selective inhibition of carboxypeptidase U may reduce microvascular thrombosis in rat experimental stroke. J Thromb Haemost 2020; 18:3325-3335. [PMID: 32869423 DOI: 10.1111/jth.15071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/31/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Carboxypeptidase U (CPU, CPB2, TAFIa) is a potent attenuator of fibrinolysis. The inhibition of CPU is thus an interesting strategy for improving thrombolysis. OBJECTIVES The time course of CPU generation and proCPU consumption were assessed in an experimental rat model of acute ischemic stroke (AIS). In addition, the effects of the selective CPU inhibitor AZD9684 on CPU kinetics, microvascular thrombosis (MT), and AIS outcome were evaluated. METHODS Rats were subjected to transient middle cerebral artery occlusion (tMCAO) and received recombinant tissue-type plasminogen activator (tPA), a specific CPU inhibitor (AZD9684), combination therapy of tPA and AZD9684, or saline for 1 hour using a randomized treatment regime. CPU and proCPU levels were determined at five time points and assessed in light of outcome parameters (a.o.: infarct volume and fibrin[ogen] deposition as a measure for MT). RESULTS Clear activation of the CPU system was observed after AIS induction, in both saline- and tPA-treated rats. Maximal CPU activities were observed at treatment cessation and were higher in tPA-treated animals compared to the saline group. Concomitant proCPU consumption was more pronounced in tPA-treated rats. AZD9684 suppressed the CPU activity and reduced fibrin(ogen) deposition, suggesting a reduction of MT. Nonetheless, a significant decrease in infarct volume was not observed. CONCLUSIONS A pronounced activation of the CPU system was observed during tMCAO in rats. Selective inhibition of CPU with AZD9684 was able to reduce fibrin(ogen) deposition and brain edema, suggesting a reduction of MT but without a significant effect on final infarct volume.
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Affiliation(s)
- Joachim C Mertens
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - William Boisseau
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Dorien Leenaerts
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Lucas Di Meglio
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
| | - Stéphane Loyau
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
| | - Anne-Marie Lambeir
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Célina Ducroux
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
| | - Martine Jandrot-Perrus
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
| | - Jean-Baptiste Michel
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
| | - Mikael Mazighi
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Dirk Hendriks
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Jean-Philippe Desilles
- Laboratory for Vascular Translational Sciences, UMR_S1148 Inserm, University of Paris, Paris, France
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Marnat G, Lapergue B, Sibon I, Gariel F, Bourcier R, Kyheng M, Labreuche J, Dargazanli C, Consoli A, Blanc R, Piotin M, Mazighi M, Richard S, Gory B, Redjem H, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Ben Maacha M, Bourdain F, Decroix JP, Wang A, Evrard S, Tchikviladze M, Coskun O, Di Maria F, Rodesh G, Leguen M, Tisserand M, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Nighoghossian N, Riva R, Eker O, turjman F, Derex L, Cho TH, Mechtouff L, Claire Lukaszewicz A, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE, Barreau X, Berge J, Menegon P, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey JS, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, L’allinec V, Girot JB, Desal H, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Humbertjean L, Mione G, Lacour JC, Bonnerot M, Riou-Comte N, Costalat V, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Arquizan C, Gaillard N, Mourand I, Corti L, Cagnazzo F, Anadani M, Spiotta A, Alawieh A, Turjman F, Haussen D, Nogueira R, Papanagiotou P, Siddiqui AH, Dorn F, Cognard C, Ribo M, Psychogios M, Labeyrie MA, Biondi A, Andrew Grossberg J, Guenego A, Darcourt J, Vukasinovic I, Pomero E, Davies J, Renieri L, Hecker C, Muchada Muchada M, Houdart E, Turner R, Turk A, Chaudry I, Lockau J, Kastrup A, Behme D, Shallwani H, Christopher M, Mione G. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions. Stroke 2020; 51:3713-3718. [DOI: 10.1161/strokeaha.120.030038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose:
The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice.
Methods:
We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed.
Results:
The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome.
Conclusions:
Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.
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Affiliation(s)
- Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, France (G.M., F.G.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France (B.L.)
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, France (I.S.)
| | - Florent Gariel
- Department of Neuroradiology, University Hospital of Bordeaux, France (G.M., F.G.)
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (R.B.)
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Maeva Kyheng
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins—Lille—France (M.K., J.L.)
| | - Julien Labreuche
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins—Lille—France (M.K., J.L.)
| | - Cyril Dargazanli
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France (C.D.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (A.C.)
| | | | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Sebastien Richard
- Université de Lorraine, CHRU-Nancy, Department of Neurology, Stroke Unit, F-54000 Nancy, France (S.R.)
- INSERM U1116, CHRU-Nancy, F-54000 Nancy, France (S.R.)
| | - Benjamin Gory
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France (B.G.)
- Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.)
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Maïer B, Delvoye F, Labreuche J, Escalard S, Desilles JP, Redjem H, Hébert S, Smajda S, Ciccio G, Lapergue B, Blanc R, Piotin M, Mazighi M. Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review. Front Neurol 2020; 11:573382. [PMID: 33193021 PMCID: PMC7659685 DOI: 10.3389/fneur.2020.573382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose: Optimal blood pressure (BP) targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) still need to be assessed, especially according to the recanalization status. Facing the lack of randomized controlled trials addressing this question, we performed a systematic review of studies assessing the post-EVT BP impact on functional outcome and symptomatic intracranial hemorrhage (sICH). Methods: Studies published after January 1, 2012 were included in the systematic review. The PRISMA checklist and flow diagram were followed for the design and reporting of this work. Results: Five studies were included in the present analysis. Despite a significant heterogeneity among studies which precluded a meta-analysis, systolic BP (SBP) was the most frequently used parameter to describe BP. BP variability (standard deviation, successive variability) after EVT was associated with worse functional outcome, especially in studies without specific BP targets after successful EVT. Lower BP values after successful EVT were associated with lower odds of sICH. Four studies evaluated the post-EVT BP impact on recanalized patients solely, with only one specifically addressing the impact of a TICI 2B vs. 2C. Interestingly, SBP reduction was inversely associated with worse outcomes in TICI 3 patients but not in TICI 2B patients, pointing to the potential value of BP management according to the exact TICI. Conclusions: BP post-EVT seems to be associated with worse functional outcomes and sICH. However, given the important heterogeneity depicted among the included studies, no decisive conclusion can be made from this systematic review, thus underlying the urgent need of randomized controlled trials evaluating this question.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Université de Paris, Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Julien Labreuche
- University Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Solène Hébert
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | | | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France.,FHU Neurovasc, Paris, France
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Allard J, Ghazanfari S, Mahmoudi M, Labreuche J, Escalard S, Delvoye F, Ciccio G, Smajda S, Redjem H, Hebert S, Consoli A, Costalat V, Desilles JP, Mazighi M, Piotin M, Dargazanli C, Lapergue B, Blanc R, Maïer B. Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review. J Neurointerv Surg 2020; 13:809-815. [PMID: 33077577 DOI: 10.1136/neurintsurg-2020-016725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT. METHODS Patients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates ( ≥ TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP. RESULTS 25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73-92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2-6) vs 6 (4-6), p=0.011). CONCLUSION RCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.
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Affiliation(s)
- Julien Allard
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Sam Ghazanfari
- Stroke Center, Hôpital Foch, Suresnes, Île-de-France, France
| | - Mehdi Mahmoudi
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Julien Labreuche
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille University Hospital Center, Lille, Hauts-de-France, France
| | - Simon Escalard
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - François Delvoye
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Gabriele Ciccio
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Stanislas Smajda
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Hocine Redjem
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Solène Hebert
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Arturo Consoli
- Neuroradiology, Hopital Foch, Suresnes, Île-de-France, France
| | - Vincent Costalat
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | | | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Benjamin Maïer
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, France.,Laboratory of Vascular Translational Science, U1148, Paris, France
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40
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Hebert S, Clavel P, Maier B, Mizutani K, Delvoye F, Lapergue B, Maacha MB, Fahed R, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Blanc R, Piotin M, Mazighi M. Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase. J Stroke Cerebrovasc Dis 2020; 29:105052. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022] Open
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41
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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Escalard S, Chalumeau V, Escalard C, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Maïer B, Piotin M. Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients. Stroke 2020; 51:3366-3370. [PMID: 32813602 PMCID: PMC7446979 DOI: 10.1161/strokeaha.120.031011] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19. METHODS We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019. RESULTS Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger (P=0.032) and had a history of diabetes mellitus more frequently (P=0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging (P=0.18 and P=0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P=0.016), higher rate of multivessel occlusion (50% versus 8.8%, P=0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores; median: 5 versus 8, P=0.006), and higher infarct core volume (median: 58 versus 6 mL, P=0.004). Successful recanalization rate was similar in both groups (P=0.767). In-hospital mortality was higher in the COVID-19 patients' group (41.7% versus 11.8%, P=0.025). CONCLUSIONS Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.
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Affiliation(s)
- Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, CHU Bicêtre, France (V.C.)
| | - Clément Escalard
- Department of Radiology, Centre Hospitalier Universitaire de Caen, France (C.E.)
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Solène Hébert
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Stanislas Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Gabriele Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
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Di Meglio L, Desilles JP, Solonomenjanahary M, Labreuche J, Ollivier V, Dupont S, Deschildre C, Maacha MB, Consoli A, Lapergue B, Piotin M, Blanc R, Ho-Tin-Noe B, Mazighi M. DNA Content in Ischemic Stroke Thrombi Can Help Identify Cardioembolic Strokes Among Strokes of Undetermined Cause. Stroke 2020; 51:2810-2816. [PMID: 32811390 DOI: 10.1161/strokeaha.120.029134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Identification of acute ischemic stroke (AIS) cause is crucial for guidance of secondary prevention. Previous studies have yielded inconsistent results regarding possible correlations between AIS cause and thrombus composition, as assessed by semiquantitative histological analysis. Here, we performed a correlation analysis between AIS cause and AIS thrombus cellular composition and content, as assessed using quantitative biochemical assays. METHODS Homogenates of 250 patients with AIS thrombi were prepared by mechanical grinding. Platelet, red blood cell, and leukocyte content of AIS thrombi were estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. AIS cause was defined as cardioembolic, noncardioembolic, or embolic stroke of undetermined source, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment). RESULTS Cardioembolic thrombi were richer in DNA (35.8 versus 13.8 ng/mg, P<0.001) and poorer in GPVI (0.104 versus 0.117 ng/mg, P=0.045) than noncardioembolic ones. The area under the receiver operating characteristic curve of DNA content to discriminate cardioembolic thrombi from noncardioembolic was 0.72 (95% CI, 0.63-0.81). With a threshold of 44.7 ng DNA/mg thrombus, 47% of thrombi from undetermined cause would be classified as cardioembolic with a specificity of 90%. CONCLUSIONS Thrombus DNA content may provide an accurate biomarker for identification of cardioembolic thrombi in patients with AIS with embolic stroke of undetermined source. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03268668.
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Affiliation(s)
- Lucas Di Meglio
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.).,Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Jean-Philippe Desilles
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.).,Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Mialitiana Solonomenjanahary
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, France (J.L.)
| | - Véronique Ollivier
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Sebastien Dupont
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Catherine Deschildre
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Malek Ben Maacha
- Department of Clinical Research, Rothschild Foundation Hospital, Paris, France (M.B.M.)
| | - Arturo Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France (A.C., B.L.)
| | - Bertrand Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France (A.C., B.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Benoit Ho-Tin-Noe
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Mikael Mazighi
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.).,Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
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Smajda S, Ciccio G, Fahed R, Robert T, Botta D, Redjem H, Desilles JP, Mazighi M, Zuber K, Escalard S, Baharvahdat H, Blanc R, Chauvet D, Philibert M, Chokron S, Piotin M. Visual Field Defect Before and After Endovascular Treatment of Occipital Arteriovenous Malformations. Neurosurgery 2020; 87:E663-E671. [PMID: 32629471 DOI: 10.1093/neuros/nyaa280] [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: 08/08/2019] [Accepted: 04/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Occipital arteriovenous malformations (AVMs) carry a high risk of postoperative morbidity because of their anatomic relation to the visual cortex and optic radiations. Data regarding endovascular management of these lesions are scant. OBJECTIVE To report our single-center experience with occipital AVMs, most of which were treated endovascularly, with a special interest for postoperative visual impairment. METHODS From a prospective database, we assessed the clinical and radiological data of all patients with an occipital AVM managed between 1997 and 2018. The extension of the nidus to the primary visual cortex was assessed and correlated to the pre- and postintervention visual symptomatology. Modified Rankin Scale and visual fields (VFs) were assessed pre- and post-treatment and at the last follow-up. RESULTS A total of 83 patients (47 males [56.6%]) with an occipital AVM were included in the study. Mean age at presentation was 33.5 ± 15.0 yr (min-max = 7-76). A total of 34 patients (41%) presented with hemorrhage related to the AVM. A total of 57 patients (68.7%) underwent endovascular treatment (EVT) alone, 20 (24.1%) underwent embolization and surgery, 3 (3.6%) underwent embolization and radiosurgery, and 3 (3.6%) were conservatively managed. A complete obliteration of the AVM was achieved in 53 patients (66.3%). A post-treatment worsening of the VF was found in 24 of the treated patients (30%), 3 patients (9%) for ruptured AVMs, and in 21 patients (46%) for unruptured AVMs. Morbidity rate was 3.7% and mortality rate was 2.5%. CONCLUSION EVT of occipital AVM carries a non-negligible rate of complications, especially regarding visual functions.
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Affiliation(s)
- Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France.,Department of Medicine (Neurology), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - Thomas Robert
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Civico di Lugano, Lugano, Switzerland.,University of Southern Switzerland, USI, Lugano, Switzerland
| | - Daniele Botta
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | | | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Kevin Zuber
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Humain Baharvahdat
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Dorian Chauvet
- Department of Neurosurgery, Fondation Rothschild Hospital, Paris, France
| | - Manon Philibert
- Department of Neuro-Ophtalmology, Fondation Rothschild Hospital, Paris, France
| | - Sylvie Chokron
- Unité Vision et Cognition, Fondation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
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45
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Sabben C, Desilles JP, Charbonneau F, Savatovsky J, Morvan E, Obadia A, Raynouard I, Fela F, Escalard S, Redjem H, Smajda S, Ciccio G, Blanc R, Fahed R, Le Guerinel C, Engrand N, Ben Maacha M, Labreuche J, Mazighi M, Piotin M, Obadia M. Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion-weighted imaging lesions. Eur J Neurol 2020; 27:1988-1995. [PMID: 32431009 DOI: 10.1111/ene.14330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. METHODS Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were <65 years old with severe anterior circulation AIS with a National Institutes of Health Stroke Scale score >15, baseline Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 6 and baseline diffusion-weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score ≥ 2b. Occurrence of MMI was the primary endpoint. RESULTS A total of 66 EVT-treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%; P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%; P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10-1.12) for MMI and 2.77 (0.84-10.43) for 3-month favorable outcome occurrence. CONCLUSIONS Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI.
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Affiliation(s)
- C Sabben
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - J P Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - F Charbonneau
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris
| | - J Savatovsky
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris
| | - E Morvan
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - A Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - I Raynouard
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - F Fela
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - S Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - H Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - S Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - G Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - R Fahed
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - C Le Guerinel
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris
| | - N Engrand
- Neuro Intensive Care Unit, Rothschild Foundation Hospital, Paris
| | - M Ben Maacha
- Research and Biostatistics Unit, Rothschild Foundation Hospital, Paris
| | - J Labreuche
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, CHU Lille, Université de Lille, Lille, France
| | - M Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - M Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris
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46
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Escalard S, Maïer B, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Piotin M. Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris. Stroke 2020; 51:2540-2543. [PMID: 32466736 PMCID: PMC7282400 DOI: 10.1161/strokeaha.120.030574] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. METHODS All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. RESULTS We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. CONCLUSIONS Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.
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Affiliation(s)
- Simon Escalard
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maïer
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Hocine Redjem
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - François Delvoye
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Solène Hébert
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Gabriele Ciccio
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Desilles
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
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Ducroux C, Desilles JP, Mawhin MA, Delbosc S, Ho-Tin-Noé B, Ollivier V, Di Meglio L, Lapergue B, Michel JB, Amarenco P. Protective Effect of ApoA1 (Apolipoprotein A1)-Milano in a Rat Model of Large Vessel Occlusion Stroke. Stroke 2020; 51:1886-1890. [PMID: 32404037 DOI: 10.1161/strokeaha.119.027898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and Purpose- Previous experimental studies found that the infusion of human purified nascent HDL (high-density lipoprotein) significantly reduced infarct volume and hemorrhagic transformation rate by decreasing neutrophil recruitment. ApoA1-M (apolipoprotein A1-Milano) is a natural variant of human ApoA1 that confers protection against atherosclerosis. Recombinant ApoA1-M has been formulated as a complex with phospholipids to mimic the properties of nascent HDL. The aim of this study was to assess the impact of intravenous ApoA1-M in a transient middle cerebral artery occlusion stroke model in rats. Methods- In a first experiment, rats were subjected to 120-minute transient middle cerebral artery occlusion and intravenous ApoA1-M was infused immediately or 4 hours after occlusion. In a second experiment, rats were subjected to 240-minute transient middle cerebral artery occlusion and intravenous ApoA1-M was infused with or without recombinant tPA (tissue-type plasminogen activator) immediately after recanalization. Primary outcome criteria were the infarct volume and hemorrhagic transformation rate measured at 24 hours. Platelets, coagulation, and neutrophil activation biomarkers were measured in brain homogenates and plasma. Additional in vitro experiments studied the effects of ApoA1-M on platelet aggregation and platelet-neutrophil interactions. Results- The infusion of ApoA1-M immediately or 4 hours after 120-minute transient middle cerebral artery occlusion significantly reduced the infarct volume compared with saline (P=0.034 and P=0.036, respectively). Compared with tPA alone, co-administration of ApoA1-M and tPA showed similar rates of hemorrhagic transformation. ApoA1-M had no significant inhibition effect on neutrophil activation biomarkers. Platelet activation was slightly decreased in rats treated with ApoA1-M compared with saline. In vitro, the incubation of human and rat platelet-rich plasma with ApoA1-M significantly reduced ADP-induced platelet aggregation (P=0.001 and P=0.02, respectively). Conclusions- ApoA1-Milano significantly decreased the infarct volume through an inhibition of platelet aggregation but did not reduce hemorrhagic transformation and neutrophils activation as expected after previous experimental studies with nascent HDL. Visual Overview- An online visual overview is available for this article.
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Affiliation(s)
- Célina Ducroux
- From the Department of neurology and stroke center, Bichat hospital, Paris, France (C.D., P.A.).,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Jean-Philippe Desilles
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Marie-Anne Mawhin
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Sandrine Delbosc
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Benoit Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Véronique Ollivier
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Lucas Di Meglio
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Bertrand Lapergue
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Jean-Baptiste Michel
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
| | - Pierre Amarenco
- From the Department of neurology and stroke center, Bichat hospital, Paris, France (C.D., P.A.).,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris, France (C.D., J.-P.D., M.-A.M., S.D., B.H.-T.-N., V.O., L.D.M., B.L., J.-B.M., P.A.)
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Di Maria F, Kyheng M, Consoli A, Desilles JP, Gory B, Richard S, Rodesch G, Labreuche J, Girot JB, Dargazanli C, Marnat G, Lapergue B, Bourcier R. Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry. Int J Stroke 2020; 16:20-28. [PMID: 32380902 DOI: 10.1177/1747493020923051] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The first-pass effect, defined as a complete or near-complete recanalization after one pass (first-pass effect) of a mechanical thrombectomy device, has been related to better clinical outcome than good recanalization after more than one pass in acute ischemic stroke. We searched for predictors of first-pass effect by analyzing the results within a large prospective multicentric registry. METHODS We included patients treated by mechanical thrombectomy for isolated anterior intracranial occlusions. A multi-variate logistic regression analysis was carried out to search for predictors of first-pass effect. We also analyzed the percentage of patients with 90-day modified Rankin Scale score 0 to 2, excellent outcome (90-day modified Rankin Scale 0 to 1), 24-h NIHSS change, and 90-day all-cause mortality. RESULTS Among the 1832 patients included, clinical outcome at 90 days was significantly better in first-pass effect patients (50.6% vs. 38.9% in patients without first-pass effect), with a center-adjusted OR associated with first-pass effect of 1.74 (95%CI, 1.24 to 1.77). Older age, a lower systolic blood pressure, an MCA-M1 occlusion, higher DWI-ASPECTS at admission, mechanical thrombectomy under local anesthesia, and combined first-line device strategy were independent predictors of first-pass effect. CONCLUSIONS In this study, a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-pass effect. In addition, we confirm that clinical outcome was better in patients with first-pass effect compared to non-first-pass effect patients.
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Affiliation(s)
- Federico Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | | | - Arturo Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Fondation Ophtalmologique A. De Rothschild, Paris France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,University of Lorraine, INSERM U1254, Nancy, France
| | - Sébastien Richard
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,University of Lorraine, INSERM U1254, Nancy, France
| | - Georges Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | | | | | - Cyril Dargazanli
- Department of Neuroradiology, Guy de Chauliac University Hospital, Montpellier, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Bertrand Lapergue
- Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France
| | - Romain Bourcier
- 0Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
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Di Meglio L, Derraz I, Solonomenjanahary M, Daly D, Chodraui Filho S, Ben Maacha M, Labreuche J, Desal H, Consoli A, Lapergue B, Blanc R, Piotin M, Mazighi M, Ho-Tin-Noé B, Desilles JP, Bourcier R. Two-layered susceptibility vessel sign is associated with biochemically quantified thrombus red blood cell content. Eur J Neurol 2020; 27:1264-1271. [PMID: 32243692 DOI: 10.1111/ene.14241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Better characterization of the thrombus could be useful to determine acute ischaemic stroke (AIS) aetiology and predict response to thrombolysis and endovascular therapy (EVT). To test the hypothesis that susceptibility vessel sign (SVS) on baseline magnetic resonance imaging (MRI) is related to red blood cell (RBC) content of AIS thrombi, the total haemoglobin contents (HbCs) of AIS thrombi retrieved by EVT from patients with or without SVS or two-layered SVS (TLSVS) were compared. METHODS Baseline MRI of 84 anterior AIS patients was reviewed by neuro-radiologists blinded to clinical and biochemical data. Thrombi from these patients were retrieved by EVT and analysed for HbC by quantitative enzyme-linked immunosorbent assay and measurement of haem concentration. RESULTS Susceptibility vessel sign and TLSVS were respectively observed in 85.7% and 50.0% of cases. The median HbC content was 253 µg/mg thrombus (interquartile range 177-333) and the median haem content was 219 µg/mg thrombus (131-264). Thrombus HbC and haem content were highly correlated with thrombus RBC content determined by flow cytometry (r = 0.94). Thrombi from patients with TLSVS weighed more [31.1 (16.5-68.3) mg vs. 17.7 (11.7-33.3) mg; P = 0.005] and had a higher HbC content [278 (221-331) µg/mg vs. 196 (139-301) µg/mg; P = 0.010] compared to thrombi from patients without TLSVS. There was no difference in thrombus weight or HbC content according to SVS status. CONCLUSIONS Our study shows that TLSVS is significantly associated with a higher thrombus weight and RBC content, as determined by quantitative assays.
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Affiliation(s)
- L Di Meglio
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - I Derraz
- Department of Neuroradiology, University Hospital Gui de Chauliac of Montpellier, Montpellier, France
| | - M Solonomenjanahary
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - D Daly
- Department of Neuroradiology, University Hospital Gui de Chauliac of Montpellier, Montpellier, France
| | - S Chodraui Filho
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Ben Maacha
- Department of Clinical Research, Rothschild Foundation Hospital, Paris, France
| | - J Labreuche
- EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Univ. Lille, CHU Lille, Lille, France
| | - H Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - A Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - B Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - R Blanc
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Piotin
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Mazighi
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - B Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - J P Desilles
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - R Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
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Maïer B, Dargazanli C, Bourcier R, Kyheng M, Labreuche J, Mosimann PJ, Puccinelli F, Taylor G, Le Guen M, Riem R, Desilles JP, Boisseau W, Fahed R, Redjem H, Smajda S, Ciccio G, Escalard S, Blanc R, Piotin M, Lapergue B, Mazighi M. Effect of Steady and Dynamic Blood Pressure Parameters During Thrombectomy According to the Collateral Status. Stroke 2020; 51:1199-1206. [PMID: 32156204 DOI: 10.1161/strokeaha.119.026769] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Guidelines regarding blood pressure (BP) management during endovascular therapy (EVT) for anterior circulation strokes are questionable since the optimal BP target is a matter of debate. To evaluate the importance of hemodynamic control during EVT, we investigated the impact of dynamic and steady BP parameters during EVT on functional outcome (part 1) and according to the collateral status (CS; part 2). Methods- We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Recanalization). BP was measured noninvasively during EVT and CS assessed on the angiographic run before EVT. We studied dynamic BP parameter using BP variability (coefficient of variation) and steady BP parameter (hypotension time defined as systolic BP <140 mm Hg and mean arterial pressure <90 mm Hg). The primary outcome was favorable outcome defined as a 3-month modified Rankin Scale score between 0 and 2. Results- Among the 381 patients of the ASTER study, 172 patients were included in part 1 and 159 in part 2. Systolic BP, diastolic BP, and mean arterial pressure variability were negatively associated with favorable outcome regardless of CS: per 10-unit increase, adjusted odds ratios were 0.45 (95% CI, 0.20-0.98), 0.37 (95% CI, 0.19-0.72), and 0.35 (95% CI, 0.16-0.76), respectively. According to CS, the hypotension time with periprocedural mean arterial pressure <90 mm Hg was negatively associated with favorable outcome in patients with poor CS (adjusted odds ratio, 0.88 [95% CI, 0.72-1.09]) but not in patients with good CS (adjusted odds ratio, 1.24 [95% CI, 0.91-1.67]; Phet=0.047). Conclusions- The CS did not modify the association between dynamic parameters and functional outcomes, but some findings suggest that the CS modifies the association between steady parameter and functional outcomes. Hypotension time according to the CS was not statistically predictive of poor outcomes but displayed a trend toward worse outcomes for patients with poor CS only.
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Affiliation(s)
- Benjamin Maïer
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Cyril Dargazanli
- Diagnostic and Interventional Neuroradiology Department, Guy de Chauliac Hospital, Montpellier, France (C.D.).,Laboratory of Cerebrovascular Mechanisms of Brain Disorders, Department of Neuroscience, Institute of Functional Genomics (UMR 5203 CNRS- U1191 INSERM), University of Montpellier, France (C.D.)
| | - Romain Bourcier
- Interventional Neuroradiology Department (R.B.), Nantes Hospital, France
| | - Maëva Kyheng
- CHU Lille, EA 2694 Santé publique: épidémiologie et qualité des soins, University of Lille, France (M.K., J.L.)
| | - Julien Labreuche
- CHU Lille, EA 2694 Santé publique: épidémiologie et qualité des soins, University of Lille, France (M.K., J.L.)
| | - Pascal J Mosimann
- Diagnostic and Interventional Neuroradiology Department, Bern University Hospital, Switzerland (P.J.M.)
| | - Francesco Puccinelli
- Diagnostic and Interventional Neuroradiology Department, Lausanne Hospital, Switzerland (F.P.)
| | - Guillaume Taylor
- Intensive Care Unit Department, Fondation Rothschild, Paris, France (G.T.)
| | - Morgan Le Guen
- Intensive Care Unit Department (M.L.G.), Foch Hospital, Suresnes, France
| | - Romuald Riem
- Intensive Care Unit Department (R.R.), Nantes Hospital, France
| | - Jean-Philippe Desilles
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - William Boisseau
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Robert Fahed
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Hocine Redjem
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Stanislas Smajda
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Gabriele Ciccio
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Simon Escalard
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Raphaël Blanc
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - Michel Piotin
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | | | - Mikael Mazighi
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.).,Paris University, France (M.M.)
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