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Checkouri T, Sablot D, Varnier Q, Fryder I, Collemiche FL, Azais B, Dargazanli C, Leibinger F, Cagnazzo F, Mahmoudi M, Lefevre PH, Van Damme L, Gascou G, Schmidt J, Arquizan C, Plantard C, Farouil G, Costalat V. Becoming a thrombectomy-capable stroke center: Clinical and medico-economical effectiveness at the hospital level. Eur Stroke J 2024:23969873241254239. [PMID: 38760934 DOI: 10.1177/23969873241254239] [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: 05/20/2024] Open
Abstract
INTRODUCTION Too few patients benefit from endovascular therapy (EVT) in large vessel occlusion acute stroke (LVOS), and various acute stroke care paradigms are currently investigated to reduce these inequalities in health access. We aimed to investigate whether newly set-up thrombectomy-capable stroke centers (TSC) offered a safe, effective and cost-effective procedure. PATIENTS AND METHODS This French retrospective study compared the outcomes of LVOS patients with an indication for EVT and treated at the Perpignan hospital before on-site thrombectomy was available (Primary stroke center), and after formation of local radiology team for neurointervention (TSC). Primary endpoints were 3-months functional outcomes, assessed by the modified Rankin scale. Various safety endpoints for ischemic and hemorragic procedural complications were assessed. We conducted a medico-economic analysis to estimate the cost-benefit of becoming a TSC for the hospital. RESULTS The differences between 422 patients in the PSC and 266 in the TSC were adjusted by the means of weighted logistic regression. Patients treated in the TSC had higher odds of excellent functional outcome (aOR 1.77 [1.16-2.72], p = 0.008), with no significant differences in the rates of procedural complications. The TSC setting shortened onset-to-reperfusion times by 144 min (95% CI [131-155]; p < 0.0001), and was cost-effective after 21 treated LVOS patients. On-site thrombectomy saves 10.825€ per patient for the hospital. DISCUSSION Our results demonstrate that the TSC setting improves functional outcomes and reduces intra-hospital costs in LVOS patients. TSCs could play a major public health role in acute stroke care and access to EVT.
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Affiliation(s)
- Thomas Checkouri
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Denis Sablot
- Department of Neurology, St. Jean Hospital, Perpignan, France
| | - Quentin Varnier
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Ivan Fryder
- Department of Radiology, St. Jean Hospital, Perpignan, France
| | | | - Benoit Azais
- Department of Radiology, St. Jean Hospital, Perpignan, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | | | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Mehdi Mahmoudi
- Department of Radiology, St. Jean Hospital, Perpignan, France
| | | | | | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Julia Schmidt
- Department of Neurology, St. Jean Hospital, Perpignan, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France
| | - Carole Plantard
- Department of Neurology, St. Jean Hospital, Perpignan, France
| | | | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
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Cagnazzo F, Ducros A, Risi G, Charif M, Corti L, Rapido F, Le Bars E, Lonjon N, Costalat V. Safety and efficacy of transvenous embolization of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension. Interv Neuroradiol 2024:15910199241247698. [PMID: 38651327 DOI: 10.1177/15910199241247698] [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: 04/25/2024] Open
Abstract
BACKGROUND Transvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH). METHODS Participants were selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described. RESULTS Twenty-one consecutive patients (median age 63 years, IQR = 58-71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively (p < 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) (p < 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) (p < 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) (p < 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) (p < 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%. CONCLUSION Transvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Anne Ducros
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Gaetano Risi
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Mahmoud Charif
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Lucas Corti
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Francesca Rapido
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac Montpellier, France
| | - Emmanuelle Le Bars
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Nicolas Lonjon
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
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Dargazanli C, Blaquière M, Moynier M, de Bock F, Labreuche J, Ter Schiphorst A, Derraz I, Radu RA, Gascou G, Lefevre PH, Rapido F, Fendeleur J, Arquizan C, Bourcier R, Marin P, Machi P, Cagnazzo F, Hirtz C, Costalat V, Marchi N. Inflammation biomarkers in the intracranial blood are associated with outcome in patients with ischemic stroke. J Neurointerv Surg 2024:jnis-2023-021365. [PMID: 38514190 DOI: 10.1136/jnis-2023-021365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Performing endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling. OBJECTIVE To test the hypothesis that specific immune players are molecular contributors to disease, outcome biomarkers, and potential targets for modifying AIS. METHODS We examined 75 subjects presenting with large vessel occlusion of the anterior circulation and undergoing EVT. Intracranial blood samples were obtained by microcatheter aspiration, as positioned for stent deployment. Peripheral blood samples were collected from the femoral artery. Plasma samples were quality controlled by electrophoresis and analyzed using a Mesoscale multiplex for targeted inflammatory and vascular factors. RESULTS We measured 37 protein biomarkers in our sample cohort. Through multivariate analysis, adjusted for age, intravenous thrombolysis, pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores, we found that post-clot blood levels of interleukin-6 (IL-6) were significantly correlated (adjusted P value <0.05) with disability assessed by the modified Rankin Scale (mRS) score at 90 days, with medium effect size. Chemokine (C-C) ligand 17 CCL17/TARC levels were inversely correlated with the mRS score. Examination of peripheral blood showed that these correlations did not reach statistical significance after correction. Intracranial biomarker IL-6 level was specifically associated with a lower likelihood of favorable outcome, defined as a mRS score of 0-2. CONCLUSIONS Our findings show a signature of blood inflammatory factors at the cerebrovascular occlusion site. The correlations between these acute-stage biomarkers and mRS score outcome support an avenue for add-on and localized immune modulatory strategies in AIS.
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Affiliation(s)
- Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Marine Blaquière
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Marinette Moynier
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | - Frédéric de Bock
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Julien Labreuche
- Unité Statistique, Évaluation Économique, Data-management, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Adrien Ter Schiphorst
- Department of Neurology, CHRU Gui de Chauliac, University Hospital Centre Montpellier, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | - Răzvan Alexandru Radu
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | - Pierre Henri Lefevre
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | - Francesca Rapido
- Department of Anesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Julien Fendeleur
- Department of Anesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, CHRU Gui de Chauliac, University Hospital Centre Montpellier, Montpellier, France
| | - Romain Bourcier
- Department of Neuroradiology, Université de Nantes, Nantes, France
| | - Philippe Marin
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, Geneva University Hospitals, Geneve, Switzerland
| | - Federico Cagnazzo
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | | | - Vincent Costalat
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Nicola Marchi
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
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Radu RA, Cagnazzo F, Schiphorst AT, Machi P, Dargazanli C, Lefevre PH, Gascou G, Costalat V. A proposed modern standardized technical approach for symptomatic chronic carotid total occlusion management. Interv Neuroradiol 2024:15910199231224006. [PMID: 38166519 DOI: 10.1177/15910199231224006] [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: 01/04/2024] Open
Abstract
Chronic carotid total occlusion (CCTO) is a known cause of ischemic stroke and transient ischemic attack. Symptomatic CCTO is associated with up to 30% risk of recurrent ischemic stroke, despite optimal medical treatment. Notably, a randomized controlled trial reported that previous surgical management did not improve the overall prognosis of these patients. Endovascular treatment of CCTO has been proposed as a feasible strategy to re-establish cerebral perfusion in symptomatic patients. However, its use is controversial and not supported by evidence from randomized clinical trials. Recently, a meta-analysis reported a reasonably high procedural success without an excess periprocedural complication rate, but several steps are needed before the procedure is mature enough to be tested in randomized controlled trials. This review highlights the developments in the endovascular recanalization of CCTO and emphasizes key steps towards standardizing the procedure.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania
- Departments of Neurology and Interventional Radiology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Adrien Ter Schiphorst
- Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, Geneva University Hospital, Geneva, Switzerland
| | - Cyril Dargazanli
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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5
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Costalat V, Lapergue B, Albucher JF, Labreuche J, Henon H, Gory B, Sibon I, Boulouis G, Cognard C, Nouri N, Richard S, Marnat G, Di Maria F, Annan M, Duhamel A, Cagnazzo F, Jovin T, Arquizan C. Evaluation of acute mechanical revascularization in large stroke (ASPECTS ⩽5) and large vessel occlusion within 7 h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol. Int J Stroke 2024; 19:114-119. [PMID: 37462028 DOI: 10.1177/17474930231191033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/01/2023]
Abstract
RATIONALE Mechanical thrombectomy (MT), the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO), is generally not offered to patients with large baseline infarct (core). Recent studies demonstrated MT benefit in patients with anterior circulation stroke and large core (i.e. Alberta Stroke Program Early Computed Tomography Score, ASPECTS 3-5). However, its benefit in patients with the largest core (ASPECTS 0-2) remains unproven. AIM To compare the efficacy and safety of MT plus best medical treatment (BMT) and of BMT alone in patients with ASPECTS 0-5 (baseline computed tomography (CT) or magnetic resonance imaging (MRI)) and anterior circulation LVO within 7 h of last-seen-well. SAMPLE SIZE ESTIMATE To detect with a two-sided test at 5% significance level (80% power) a common odds ratio of 1.65 for 1-point reduction in the 90-day modified Rankin Scale (mRS) score in the MT + BMT arm versus BMT arm and to anticipate 10% of patients with missing primary endpoint, 450 patients are planned to be included by 36 centers in France, Spain, and the United States. METHODS AND DESIGN LArge Stroke Therapy Evaluation (LASTE) is an international, multicenter, Prospectively Randomized into two parallel (1:1) arms, Open-label, with Blinded Endpoint (PROBE design) trial. Eligibility criteria are diagnosis of AIS within 6.5 h of last-seen-well (or negative fluid-attenuated inversion recovery (FLAIR) if unknown stroke onset time), ASPECTS 0-5 (ASPECTS 4-5 for ⩾80-year-old patients), and LVO in the anterior circulation (intracranial internal carotid artery (ICA) and M1 or M1-M2 segment of the middle cerebral artery (MCA)). STUDY OUTCOMES The primary endpoint is the day-90 mRS score distribution (shift analysis) with mRS categories 5 and 6 coalesced into one category. Secondary endpoints include day-180 mRS score, rates of 90-day and 180-day mRS score = 0-2 and 0-3, rate of decompressive craniectomy, the National Institutes of Health Stroke Scale (NIHSS) score change, revascularization and infarct volume growth at 24 h, and quality of life at day 90 and 180. Safety outcomes (90-day all-cause mortality, procedural complications, symptomatic intracerebral hemorrhage, and early NIHSS score worsening) are recorded. A dynamic balanced randomization (1:1) is used to distribute eligible patients into the experimental arm and control arm, by incorporating the center and these pre-specified factors: baseline ASPECTS (0-3 vs 4-5), age (⩽70 vs >70 years), baseline NIHSS (<20 vs ⩾20), intravenous thrombolysis (no vs yes), admission mode (Drip-and-Ship vs Mothership), occlusion site (intracranial ICA vs MCA-M1 or M1-M2), intravenous fibrinolysis (no vs yes), and last-seen-well to randomization time (0-4.5 vs >4.5-6.5 h). DISCUSSION The LASTE trial will determine MT efficacy and safety in patients with ASPECTS 0-5 and LVO in the anterior circulation. TRIAL REGISTRATION LASTE Trial NCT03811769.
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Affiliation(s)
- Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | | | - J F Albucher
- Department of Neurology, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Julien Labreuche
- Department of Biostatistics, Lille University Hospital, Lille, France
| | - Hilde Henon
- Department of Neurology, Hôpital Salengro, Lille, France
| | - Benjamin Gory
- Department of Neuroradiology, Hôpital Central, Nancy, France
| | - Igor Sibon
- Department of Neurology, Hôpital Pellegrin, Bordeaux, France
| | | | - Christophe Cognard
- Department of Neuroradiology, Hôpital Pierre-Paul Riquet, Toulouse, France
| | | | | | - Gauthier Marnat
- Department of Neuroradiology, Hôpital Pellegrin, Bordeaux, France
| | | | - Mariam Annan
- Department of Neurology, Hôpital Bretonneau, Tours, France
| | - Alain Duhamel
- Department of Biostatistics, Lille University Hospital, Lille, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Tudor Jovin
- Cooper Neurological Institute, Camden, NJ, USA
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France
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6
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Cagnazzo F, Radu RA, Rapido F, Fendeleur J, Charif M, Corti L, Lonjon N, Ducros A, Costalat V. A technique to localize posteriorly located spinal dural leaks associated with spontaneous intracranial hypotension: Dorsal-decubitus dynamic CT myelography. Interv Neuroradiol 2023:15910199231222672. [PMID: 38151024 DOI: 10.1177/15910199231222672] [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: 12/29/2023] Open
Abstract
BACKGROUND Precise localization and understanding of the origin of cerebrospinal fluid (CSF) leak is crucial to allow targeted treatment. We report the technical feasibility and utility of dorsal-decubitus dynamic computed tomography (DDDCT) myelography to localize posteriorly located dural defects in patients with suspicion of posterolateral dural tears. METHODS This study reports a series of four consecutive patients with posteriorly located SLEC and suspicion of posterolateral CSF leak who received DDDCT to localize the site of the leak. Patients were collected between October 2022 and October 2023. The technique of DDDCT and its efficacy to detect the site of CSF leak are reported. RESULTS In all four patients (three females, one male, mean age 39 years), DDDCT myelography was technically successful and precisely demonstrated the site of the CSF leak. In one patient with both anterior and posterior SLEC, DDDCT allowed to exclude the presence of a posteriorly located leak, while a subsequent ventral decubitus dynamic CT myelography localized the leak. Leak sites were all thoracic, except for one that was cervical. Information obtained from the DDDCT myelography was considered useful to target the treatment of the leak. CONCLUSIONS Based on our experience, DDDCT provided sufficient spatial and temporal resolution to pinpoint fast CSF leaks and it may be considered to localize posterolateral dural defects.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Răzvan Alexandru Radu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucarest, Romania
| | - Francesca Rapido
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac, Montpellier, France
| | - Julien Fendeleur
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac, Montpellier, France
| | - Mahmoud Charif
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Lucas Corti
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Nicolas Lonjon
- Neurosurgical Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Anne Ducros
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
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Radu RA, Cagnazzo F, Derraz I, Gascou G, Costalat V. Retrograde endovascular recanalization of chronic common carotid total occlusion: a technical video. J Neurointerv Surg 2023; 16:107. [PMID: 37019625 DOI: 10.1136/jnis-2023-020099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
Common carotid artery (CCA) occlusion with patency of the internal carotid artery (ICA) is a rare cause of stroke with no consensus on optimal management.1 Open surgery, most often CCA-subclavian or CCA-aortic arch bypass techniques, have been used to recanalize short proximal occlusions.1 2 Endovascular revascularization of chronic total ICA occlusion was proposed with promising results in previous reports.3-5 However, endovascular recanalization for chronic CCA occlusion has rarely been described in the literature, and the reports involved mainly right-sided occlusions or occlusions with residual CCA stumps.6 Anterograde endovascular management of chronic long left-sided CCA occlusions is problematic due to lack of support, notably when no proximal stump is present.4 In this video, we present a case of known long-chronic CCA occlusion managed by retrograde echo-guided ICA puncture and stent-assisted reconstruction.(video 1) neurintsurg;16/1/107/V1F1V1Video 1 .
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Grégory Gascou
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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8
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Cagnazzo F, Radu RA, Derraz I, Lefevre PH, Dargazanli C, Machi P, Morganti R, Gascou G, Fendeleur J, Rapido F, Costalat V. Efficacy and safety of low dose intravenous cangrelor in a consecutive cohort of patients undergoing neuroendovascular procedures. J Neurointerv Surg 2023; 16:88-93. [PMID: 36922032 DOI: 10.1136/jnis-2023-020094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Cangrelor is an intravenous P2Y12 inhibitor with rapid onset and fast offset of antiplatelet action. Dose adjusted cangrelor based on platelet function testing is suggested to be advantageous for use during neuroendovascular procedures. In this study, we aimed to assess the efficacy and safety of this strategy. METHODS This retrospective study included consecutive patients who received low dose intravenous cangrelor (5 µg/kg; infusion 1 µg/kg/min) for ruptured (RIA) and unruptured (UIA) intracranial aneurysms, and acute ischemic stroke (AIS). Indications were acute stenting or intraluminal thrombus. Outcomes were assessed at 24 hours by brain CT and CT angiography. The primary efficacy outcome was the rate of stent occlusion or persistent intraluminal thrombus. The primary safety outcome was the rate of major hemorrhages. RESULTS 101 patients (56 men; median age (IQR) 59 (51-70) years) received low dose cangrelor for acute stenting (79/101 (78%)) and intraprocedural thrombus (22/101 (22%)). Overall, 5 (4.9%) patients experienced stent occlusion within 24 hours (RIA 3/28; AIS 2/52). There were no cases of failure among UIA patients. Stent mis-opening (fish mouthing or stenosis >50%) was significantly associated with stent occlusion (P<0.001). The overall rate of major hemorrhage was 2% (2/101), which occurred in AIS patients. Platelet reactivity unit (PRU) values were lower in those presenting with major hemorrhage (PRU 4 (SD 1.4) vs PRU 60 (SD 63); P=0.043). Mortality rate after cangrelor related hemorrhage was 1%. CONCLUSIONS Low dose cangrelor appears to be effective in preventing stent thrombosis and arterial patency with a low hemorrhagic risk.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Hôpital Gui de Chauliac, Montpellier, France
| | | | - Imad Derraz
- Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pierre Henri Lefevre
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, University of Geneva, Geneve, Switzerland
| | | | - Gregory Gascou
- Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Julien Fendeleur
- Anaesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Francesca Rapido
- Anaesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Ter Schiphorst A, Lippi A, Corti L, Mourand I, Prin P, Agullo A, Cagnazzo F, Macia JC, Arquizan C. In young patients with stroke of undetermined etiology, large vessel occlusions are less frequent in the group with high-risk patent foramen ovale. Rev Neurol (Paris) 2023:S0035-3787(23)01146-3. [PMID: 38102053 DOI: 10.1016/j.neurol.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Patent foramen ovale (PFO) is present in a significant proportion of young patients with stroke of undetermined etiology, but is not always causal. Therefore, classifications (RoPE, PASCAL) have been developed to determine the probability that PFO is the stroke cause. However, the presence of an initial arterial occlusion as a prediction factor was not studied when these classifications were built. Our aim was to evaluate the presence of arterial occlusion in young patients with stroke of undetermined etiology with/without high-risk PFO. METHODS From a prospectively-built monocentric database, we identified patients aged≥18 to<60-years with strokes of undetermined etiology and complete etiological work-up, including transesophageal echocardiography. We divided patients in two groups: (i) with high-risk PFO [i.e. PFO with large interatrial shunt (>30 microbubbles) or associated with atrial septal aneurysm] and (ii) with low-risk/without PFO. We recorded the presence of arterial occlusion and large vessel occlusion (LVO) in the acute phase. RESULTS We included 96 patients; 55 (57%) had high-risk PFO. Their median age was 48 (40-52) years, and 28 (29%) were women. The percentages of patients with arterial occlusion and with LVO were lower in the high-risk PFO group than in the low-risk/without PFO group: 11 (20%) versus 19 (46%) (P=0.008), and 5 (9%) versus 15 (37%) (P=0.002), respectively. There was no difference in the median RoPE score between groups (P=0.30). CONCLUSION The presence of LVO could represent a "red flag" of PFO causality in stroke of undetermined etiology, and could be implemented in future PFO-related stroke classifications.
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Affiliation(s)
- A Ter Schiphorst
- Department of Neurology, CHU Gui-de-Chauliac, Montpellier, France.
| | - A Lippi
- Department of Neurology, CHU Gui-de-Chauliac, Montpellier, France
| | - L Corti
- Department of Neurology, CHU Gui-de-Chauliac, Montpellier, France
| | - I Mourand
- Department of Neurology, CHU Gui-de-Chauliac, Montpellier, France
| | - P Prin
- Department of Neurology, CHU Gui-de-Chauliac, Montpellier, France
| | - A Agullo
- Department of Cardiology, CHU Arnaud-de-Villeneuve, Montpellier, France
| | - F Cagnazzo
- Department of Neuroradiology, CHU Gui-de-Chauliac, Montpellier, France
| | - J-C Macia
- Department of Cardiology, CHU Arnaud-de-Villeneuve, Montpellier, France
| | - C Arquizan
- Department of Neurology, CHU Gui-de-Chauliac, Montpellier, France
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Radu RA, Gascou G, Machi P, Capirossi C, Costalat V, Cagnazzo F. Current and future trends in acute ischemic stroke treatment: direct-to-angiography suite, middle vessel occlusion, large core, and minor strokes. Eur J Radiol Open 2023; 11:100536. [PMID: 37964786 PMCID: PMC10641156 DOI: 10.1016/j.ejro.2023.100536] [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: 05/28/2023] [Revised: 09/18/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
Since the publication of the landmark thrombectomy trials in 2015, the field of endovascular therapy for ischemic stroke has been rapidly growing. The very low number needed to treat to provide functional benefits shown by the initial randomized trials has led clinicians and investigators to seek to translate the benefits of endovascular therapy to other patient subgroups. Even if the treatment effect is diminished, currently available data has provided sufficient information to extend endovascular therapy to large infarct core patients. Recently, published data have also shown that sophisticated imaging is not necessary for late time- window patients. As a result, further research into patient selection and the stroke pathway now focuses on dramatically reducing door-to-groin times and improving outcomes by circumventing classical imaging paradigms altogether and employing a direct-to-angio suite approach for selected large vessel occlusion patients in the early time window. While the results of this approach mainly concern patients with severe deficits, there are further struggles to provide evidence of the efficacy and safety of endovascular treatment in minor stroke and large vessel occlusion, as well as in patients with middle vessel occlusions. The current lack of good quality data regarding these patients provides significant challenges for accurately selecting potential candidates for endovascular treatment. However, current and future randomized trials will probably elucidate the efficacy of endovascular treatment in these patient populations.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Stroke Unit, Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Gregory Gascou
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, University of Geneva Medical Center, Switzerland
| | - Carolina Capirossi
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Department of Neurointerventional Radiology, Careggi Hospital, Florence, Italy
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Capirossi C, Radu RA, Gascou G, Lefevre PH, Dargazanli C, Machi P, Costalat V, Cagnazzo F. Safety and efficacy of braided stents as stent monotherapy for the treatment of small intracranial aneurysms. Interv Neuroradiol 2023:15910199231208345. [PMID: 37847777 DOI: 10.1177/15910199231208345] [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: 10/19/2023] Open
Abstract
BACKGROUND The safety and efficacy of low-profile braided stent as stent monotherapy require further investigation. OBJECTIVE To analyze patient outcomes after treatment with braided stents used as "light" flow diverters. MATERIAL/METHODS Retrospective study to evaluate the occlusion rate of aneurysms treated with braided stent and remodeling of covered side branches and perforators. Several factors potentially influencing aneurysm occlusion were analyzed. RESULTS Thirty-five aneurysms in 31 patients were included. Six aneurysms (17.1%) had an acute subarachnoid hemorrhage. Braided stent was used as retreatment among 9 previously coiled aneurysms (25.7%). A total occlusion was achieved in 18 aneurysms (51.4%), entry remnant in 3 aneurysms (8.6%), incomplete filling in 6 aneurysms (17.1%) and complete filling in 8 aneurysms (22.9%). None of the aneurysms ruptured during the follow-up period. Of 32 stents deployed, we observed 3 cases (9.4%) of asymptomatic mild stenosis and 3 cases (10.7%) of narrowing of covered branches among 28 covered arteries. There were no cases of perforator infarction and no mortality or permanent morbidity associated with the treatment. Moreover, aneurysms <2.5 mm, aneurysms with a neck <1.8 mm, those with a mean aspect-ratio of 1.4, and lateral wall aneurysms had a higher frequency of adequate occlusion. CONCLUSION Braided stents used as stent monotherapy appear to be sufficiently effective in the treatment of very small intracranial aneurysms, despite a lower overall occlusion rate compared to a standard flow diversion strategy. However, given the low morbidity rate, this strategy may be an alternative to flow-diverter stents for small and distally located lesions.
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Affiliation(s)
- Carolina Capirossi
- Neuroradiology Department, Hospital Gui de Chauliac, Montpellier, France
- Interventional Neuroradiology Unit, University Hospital Careggi, Florence, Italy
| | - Razvan A Radu
- Neuroradiology Department, Hospital Gui de Chauliac, Montpellier, France
- Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Gregory Gascou
- Neuroradiology Department, Hospital Gui de Chauliac, Montpellier, France
| | | | - Cyril Dargazanli
- Neuroradiology Department, Hospital Gui de Chauliac, Montpellier, France
| | - Paolo Machi
- Neuroradiology Department, University of Geneva, Geneve, Switzerland
| | - Vincent Costalat
- Neuroradiology Department, Hospital Gui de Chauliac, Montpellier, France
| | - Federico Cagnazzo
- Neuroradiology Department, Hospital Gui de Chauliac, Montpellier, France
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Radu RA, Cagnazzo F, Derraz I, Dargazanli C, Rapido F, Lefevre PH, Gascou G, Costalat V. Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges. J Neurointerv Surg 2023; 15:851-857. [PMID: 36190941 DOI: 10.1136/jnis-2022-019219] [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: 06/01/2022] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The optimal management of chronic total carotid artery occlusion (CTO) is still debated. Endovascular treatment is being increasingly used with heterogeneous technical and clinical results. METHODS Patients with CTO treated with modern endovascular approaches during the past several years (January 2018-December 2021) were retrospectively reviewed. RESULTS Twenty patients, with a mean age of 63.7 years, were treated during the study period. Indications for treatment were recurrent stroke in 12 (60%), hemodynamic impairment in 4 (20%), and progressive stroke in 4 (20%) patients. In 6 (30%) patients, the occlusion was limited to the cervical portion, in 5 (25%) to the petrous segment, and in 9 (45%) to the cavernous segment. Technical treatment success was achieved in 80% of cases. In patients with successful recanalization, median pretreatment hypoperfusion volumes dropped from 126 mL (25-75 IQR, 33-224 mL) to 0 mL (25-75 IQR, 0-31.5 mL). Symptomatic procedure-related complications were 30% and permanent procedure-related morbidity-mortality was 5%. Early stent occlusion occurred in 5 (25%) cases. Two cases were asymptomatic and were not retreated, 3 cases presented transient symptoms of which two were successfully recanalized. Stent occlusion was not associated with permanent symptoms. In successfully recanalized patients no intraprocedural emboli were observed. CONCLUSIONS In the modern endovascular era, revascularization of CTO is a feasible procedure in most cases, and it may be offered in selected patients. However, the high re-occlusion rate is still a limitation of the technique, underlining the need for more research on the technical procedural and periprocedural management.
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Affiliation(s)
- Răzvan Alexandru Radu
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Federico Cagnazzo
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Francesca Rapido
- Anesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Grégory Gascou
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Cagnazzo F, Cloft HJ, Lanzino G, Brinjikji W. WEB (Woven EndoBridge) device for intracranial aneurysm treatment: technical, radiological, and clinical findings in a consecutive North American cohort. Acta Neurochir (Wien) 2023; 165:2077-2086. [PMID: 37365349 DOI: 10.1007/s00701-023-05668-6] [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: 12/06/2022] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Utilization of Woven EndoBridge (WEB) for treatment of intracranial aneurysms has increased due to increasing operator experience. We aimed to report our contemporary series of a North American center with the WEB, examining factors associated with occlusion rates. METHOD Consecutive patients (2019-2022) with intracranial aneurysms treated with WEB device were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (RR1/RR2) were examined. Procedural and clinical results were reported. RESULTS A total of 104 consecutive aneurysms/patients (25 men/79 women; median age, 63 years, IQR: 55-71) were treated with single-layer WEB-SL in our institution. Seventeen patients (16%) had a ruptured aneurysm. The median aneurysm dome size was 5.5 mm (IQR = 4.5-6.5), and the most common locations were AcomA (36/104 = 34.6%), MCA bifurcation (29/104 = 27.9%), and BT (22/104 = 21.2%). The rate of technical failure was 0.9%. The median intervention time was 32 min (IQR = 25-43). Overall, 8 (7.6%) cases needed additional interventions: 4 (3.8%) additional stenting, 3 cases (3.8%) of intravenous tirofiban infusion (because of the excessive WEB protrusion), and one case (0.9%) of additional coiling (need to complete the neck occlusion). At 12-month follow-up, 67 patients were available showing 59/67 (88%) and 6/67 (9%) of complete occlusion and neck remnant, respectively on dual-energy CTA. There were no cases necessitating retreatment. Ruptured presentation (OR = 0.09, 95% CI = 0.008-0.9, p = .024), undersized WEB (OR = 15, 95% CI = 1.2-50, p = .006), WEB shape change (OR = 0.07, 95% CI = 0.001-0.6, p = .05), aneurysm neck diameter (OR = 0.4, 95% CI = 0.2-0.9, p = .05), and angle between the parent artery and the aneurysm dome (OR = 0.2, 95% CI = 0.01-0.8, p = .008) were significantly associated with occlusion status (RR1-2) at follow-up. However, in the multivariate logistic regression, these factors did not reach the statistical significance. The overall rate of morbidity was 0.9%. CONCLUSIONS Our contemporary North American experience on consecutive intracranial aneurysms treated with WEB confirms the medium-term efficacy of this strategy, with low procedural time and morbidity. Further research is needed to demonstrate long-term occlusion rates.
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Affiliation(s)
- Federico Cagnazzo
- Departments of Neurologic Surgery and Radiology, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Harry J Cloft
- Departments of Neurologic Surgery and Radiology, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Giuseppe Lanzino
- Departments of Neurologic Surgery and Radiology, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Waleed Brinjikji
- Departments of Neurologic Surgery and Radiology, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Radu RA, Costalat V, Machi P, Derraz I, Dargazanli C, Meyer P, Cagnazzo F. Thrombectomy for a basilar artery occlusion in a 2-year-old child: A focus on anatomical and technical aspects. Interv Neuroradiol 2023:15910199231169602. [PMID: 37063049 DOI: 10.1177/15910199231169602] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Endovascular treatment (EVT) for large vessel, acute ischemic stroke in children remains a subject of debate, with evidence for its benefits derived from case series and individual case reports. At present, guidelines are cautious in recommending EVT for children under 5 years of age, mainly due to a lack of data and incomplete cerebral and femoral vessel development. However, based on the small number of cases reported in the literature, EVT appears to be safe and effective for pediatric use and arterial diameters can accommodate currently available devices. Available evidence shows that in patients with a normal arterial development, a 6-Fr femoral approach can be safely used by 2 years of age. We describe the case of a 2-year-old child who benefited from late-window EVT for a basilar occlusion. The procedure was safely performed using a 6-Fr femoral introducer, a 6-Fr guide catheter, and a 5-Fr aspiration catheter. We discuss also normal cerebral and femoral vessel development, providing descriptive tables of compatibility between femoral and cerebral arterial diameters by age groups and currently available endovascular devices.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Paolo Machi
- Service of Neuroradiology, Geneva University Hospital, Geneva, Switzerland
| | - Imad Derraz
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Pierre Meyer
- Department of Pediatric Neurology, Montpellier University Medical Center, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Abdelrady M, Derraz I, Dargazanli C, Cheddad El Aouni M, Lefevre PH, Cagnazzo F, Riquelme C, Gascou G, Arquizan C, Mourand I, Ben Salem D, Costalat V, Gentric JC, Ognard J. Complete recanalization predicts favorable outcome in patients with distal M2-M3 middle cerebral artery occlusions following endovascular thrombectomy. J Neuroradiol 2023; 50:230-236. [PMID: 36436611 DOI: 10.1016/j.neurad.2022.11.007] [Citation(s) in RCA: 2] [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: 07/08/2022] [Revised: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND - scanty articles illustrate the prognostic factors for favorable outcome after endovascular thrombectomy (EVT) in distal vessel occlusion (DMVO). Moreover, the current literature is diversified; conglomerating both primary, secondary, and anterior, posterior circulations embolic strokes in the same shell. PURPOSE to identify the association between complete reperfusion and favorable outcome following EVT for DMVO in the middle cerebral artery (MCA) territory. METHODS -we performed a retrospective analysis of prospectively maintained EVT registries at two comprehensive stroke centers between January 2015 and December 2019 for consecutive stroke patients with MCA-DMVO. DMVO was defined as an occlusion of distal M2 and M3 segments of the MCA. Only patients with primary isolated occlusions were included. A multivariate logistic regression was utilized to identify clinical and procedural-related factors associated with the 90-day favorable clinical outcome [defined as modified Rankin score (mRS) 0-2] after EVT. RESULTS -Out of 1823 within the registries; 66 patients (median age was 72 (60-78) and 59% were males) with primary isolated DMVO of the MCA were eligible for inclusion in the current study. Complete reperfusion was achieved in 56% (37/66) of the patients with no difference among the reperfusion strategies while the favorable outcome was observed in 68% (45/66). In the multivariate analysis, final complete reperfusion [modified Thrombolysis In Cerebral Infarction (mTICI) score 2c-3] was significantly associated with favorable outcome [aOR=7.69; (95% CI 1.73-34.17); p=.01], while higher baseline NIHSS score [aOR=0.82; (95% CI 0.69-0.98); p=.03] and increased imaging to puncture interval [aOR=0.99; (95% CI 0.98, 1.00); p=.01] decreased the probability of the favorable outcome. CONCLUSION according to our results, complete reperfusion was the most significant predictor of the favorable outcome, while higher baseline NIHSS and longer imaging to puncture interval decreased the probability of the favorable outcome.
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Affiliation(s)
- Mohamed Abdelrady
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France; Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France; Department of Neuroradiology, El-Demerdash university hospital, Cairo, Egypt.
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Mourad Cheddad El Aouni
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Douraied Ben Salem
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France
| | - Jean-Christophe Gentric
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France
| | - Julien Ognard
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France
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Radu RA, Cagnazzo F, Derraz I, Dargazanli C, Gascou G, Lefevre PH, Arquizan C, Costalat V. Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and technical discussion. Interv Neuroradiol 2023:15910199221150472. [PMID: 36628417 DOI: 10.1177/15910199221150472] [Citation(s) in RCA: 2] [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] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified. METHODS This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions. RESULTS We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB. CONCLUSION Intravascular OCT is a feasible and safe approach to identifying patients with covert carotid wall abnormalities, like carotid WEBs and ulcerated plaques, that are amenable to carotid stenting to reduce recurrent stroke risk.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Grégory Gascou
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Caroline Arquizan
- 568017Department of Neurology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, 26905Montpellier University Medical Center, Montpellier, France
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Allard J, Delvoye F, Pop R, Labreuche J, Maier B, Marnat G, Sibon I, Zhu F, Lapergue B, Consoli A, Spelle L, Denier C, Richard S, Piotin M, Gory B, Mazighi M, Redjem H, Escalard S, Dessilles JP, Delvoye F, Smajda S, Maier B, Solène H, Mazighi M, Obadia M, Sabben C, Pierre S, Igor R, Corabianu O, de Broucker T, Manchon E, Taylor G, Maacha MB, Thion LA, Augustin L, Julien S, Wang A, Evrard S, Tchikviladze M, Ajili N, WeisenburgerLile D, Gorza L, Buard G, Coskun O, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Barreau X, Berge J, Menegon P, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey JS, Briau P, Pangon N, Coussy A, Papillon L, Papaxanthos J, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Humbertjean L, Lacour JC, Riou-Comte N, Voicu M, Alb L, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Macian-Montoro F, Saleme S, Mounayer C, Rouchaud A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, Ter Schiphorst A, Ferre JC, Raoult H, Ronziere T, Lassale M, Paya C, Gauvrit JY, Tracol C, Langnier-Lemercier S. 24-Hour Carotid Stent Patency and Outcomes After Endovascular Therapy: A Multicenter Study. Stroke 2023; 54:124-131. [PMID: 36542074 DOI: 10.1161/strokeaha.122.039797] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Management of extracranial internal carotid artery steno-occlusive lesion during endovascular therapy remains debated. Stent occlusion within 24 hours of endovascular therapy is a frequent event after acute carotid artery stenting, and we currently lack large population results. We investigated the incidence, predictors, and clinical impact of stent occlusion after acute carotid artery stenting in current clinical practice. METHODS Patients treated by endovascular therapy with acute carotid artery stenting between 2015 and 2019 in 5 large-volume endovascular-capable centers were retrospectively analyzed. Patients were separated in 2 groups according to the stent patency at 24 hours after carotid artery stenting. We compared baseline characteristics, treatment modalities, and clinical outcome depending on 24-hour stent patency. Primary end point was favorable outcome, defined as a modified Rankin Scale score 0-2 at 3 months. RESULTS A stent occlusion was observed in 47/225 patients (20.9%). Patients with stent patency had a lower baseline National Institutes of Health Stroke Scale (median [interquartile range]: 13 [7-17] versus 18 [12-21]) and had more often stroke of atherothrombotic origin (77.0% versus 53.2%). A higher stent patency rate was found for patients treated with P2Y12 antagonists at the acute phase (odds ratio [OR]' 2.95 [95% CI' 1.10-7.91]; P=0.026) and treated with angioplasty (OR' 2.42 [95% CI' 1.24-4.67]; P=0.008). A better intracranial angiographic reperfusion was observed in patients with 24-hour stent patency compared with patients without stent patency (OR' 8.38 [95% CI' 3.07-22.78]; P<0.001). Patients with a stent patency at 24 hours had a higher chance of favorable outcome (OR' 3.29 [95% CI, 1.66-6.52]; P<0.001) and a lower risk of death (OR' 0.32 [95% CI, 0.13-0.76]; P=0.009). CONCLUSIONS One out of 5 patients treated with carotid artery stenting during endovascular therapy presented a stent occlusion within 24 hours. This event was associated with worse functional outcome. Stroke etiology, P2Y12 antagonist administration, quality of intracranial reperfusion, and angioplasty were associated with 24-hour stent patency.
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Affiliation(s)
- Julien Allard
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.).,University of Paris' France (J.A., M.M.)
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.)
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, France (R.P.).,Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France (R.P.).,University of Strasbourg, INSERM UMR-S1255, France (R.P.)
| | - Julien Labreuche
- Department of Biostatistics, CHU Lille, University of Lille, France (J.L.)
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.).,LVTS, INSERM U1148, University of Paris, France (BM., M.M.)
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France (G.M.)
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France (I.S.)
| | - François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, France (B.G., F.Z.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (B.L.)
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (A.C.)
| | - Laurent Spelle
- Department of Neuroradiolology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France (L.S.)
| | - Christian Denier
- Department of Neurology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France (C.D.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, France (S.R.).,CIC-P 1433, INSERM U1116, CHRU-Nancy, France (S.R.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, France (B.G., F.Z.).,IADI, INSERM U1254, Université de Lorraine, Nancy, France (B.G.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (J.A., F.D., B.M., MP, M.M.).,LVTS, INSERM U1148, University of Paris, France (BM., M.M.).,University of Paris' France (J.A., M.M.)
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Abdelrady M, Ognard J, Cagnazzo F, Derraz I, Lefevre PH, Riquelme C, Gascou G, Arquizan C, Dargazanli C, Cheddad El Aouni M, Ben Salem D, Mourand I, Costalat V, Gentric JC. Frontline thrombectomy strategy and outcome in acute basilar artery occlusion. J Neurointerv Surg 2023; 15:27-33. [PMID: 34992148 DOI: 10.1136/neurintsurg-2021-018180] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 08/25/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO). PURPOSE To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO. METHODS Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0-2. RESULTS Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate. CONCLUSION Among BAO patients, the combined technique effectively contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.
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Affiliation(s)
- Mohamed Abdelrady
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France .,Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Julien Ognard
- Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Federico Cagnazzo
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Imad Derraz
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Pierre-Henri Lefevre
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Carlos Riquelme
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Gregory Gascou
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Caroline Arquizan
- Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Cyril Dargazanli
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | | | - Douraied Ben Salem
- Diagnostic neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Isabelle Mourand
- Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Vincent Costalat
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
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Abdelrady M, Dargazanli C, Derraz I, Cagnazzo F, Costalat V. Successful WEBectomy during embolization of temporal arteriovenous malformation-associated flow-related basilar aneurysms. Interv Neuroradiol 2022; 28:644-649. [PMID: 34775869 PMCID: PMC9706264 DOI: 10.1177/15910199211057693] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Intra-procedural WEB device migration is a scarcely reported complication that necessitates prompt intervention. CASE PRESENTATION Endovascular treatment of two broad necked flow-related aneurysms was planned aided by WEB-SL (Woven EndoBridge-single layer) devices in a 71-year-old female with known left temporal arteriovenous malformation. Inadvertent distal migration occurred while performing a control angiogram with an automated iodine injector. Immediate retrieval was successfully performed using a Solitaire stent-retriever. CONCLUSION To our knowledge, we report for the first time the successful retrieval of a distally migrated WEB using a stent-retriever device.
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Affiliation(s)
- Mohamed Abdelrady
- Interventional Neuroradiology Unit, Ain Shams University hospitals, Cairo, Egypt
| | - Cyril Dargazanli
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
| | - Imad Derraz
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
| | - Federico Cagnazzo
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
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20
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Olivot J, Finitsis S, Lapergue B, Marnat G, Sibon I, Richard S, Viguier A, Cognard C, Mazighi M, Gory B, Piotin M, Blanc R, Redjem H, Escalard S, Desilles J, Delvoye F, Smajda S, Maïer B, Hebert S, Mazighi M, Obadia M, Sabben C, Seners P, Raynouard I, Corabianu O, de Broucker T, Manchon E, Taylor G, Maacha MB, Thion L, Lecler A, Savatovsjy J, Wang A, Evrard S, Tchikviladze M, Ajili N, Lapergue B, Weisenburger‐Lile D, Gorza L, Buard G, Coskun O, Consoli A, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Nighoghossian N, Riva R, Eker O, Turjman F, Derex L, Cho T, Mechtouff L, Lukaszewicz A, Philippeau F, Cakmak S, Blanc‐Lasserre K, Vallet A, Marnat G, Gariel F, Barreau X, Berge J, Menegon P, Sibon I, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey J, Briau P, Pangon N, Bourcier R, Detraz L, Daumas‐Duport B, Alexandre P, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C, Gory B, Bracard S, Anxionnat R, Braun M, Derelle A, Liao L, Zhu F, Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour J, Douarinou M, Audibert G, Voicu M, Alb I, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Bourst P, Beaumont M, Chen (Mitchelle) B, Guy S, Georges V, Bechiri F, Macian‐Montoro F, Saleme S, Mounayer C, Rouchaud A, Gimenez L, Cosnard A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre P, Derraz I, Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, ter Schiphorst A, Alias Q, Boustia F, Ferre J, Raoult H, Gauvrit J, Vannier S, Guillen M, Ronziere T, Lassalle V, Tracol C, Malrain C, Boinet S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Samson Y, Léger A, Crozier S, Baronnet F, Alamowitch S, Bottin L, Yger M, Degos V, Spelle L, Denier C, Chassin O, Chalumeau V, Caroff J, Chassin O, Venditti L, Sarov M, Legris N, Naggara O, Hassen WB, Boulouis G, Rodriguez‐Régent C, Trystram D, Kerleroux B, Turc G, Domigo V, Lamy C, Birchenall J, Isabel C, Lun F, Viguier A, Cognard C, Januel A, Olivot J, Raposo N, Bonneville F, Albucher J, Calviere L, Darcourt J, Bellanger G, Tall P, Touze E, Barbier C, Schneckenburger R, Boulanger M, Cogez J, Guettier S, Gauberti M, Timsit S, Gentric J, Ognard J, Merrien FM, Wermester OO, Massardier E, Papagiannaki C, Triquenot A, Lefebvre M, Bourdain F, Bernady P, Lagoarde‐Segot L, Cailliez H, Veunac L, Higue D, Wolff V, Quenardelle V, Lauer V, Gheoca R, Pierre‐Paul I, Pop R, Beaujeux R, Mihoc D, Manisor M, Pottecher J, Meyer A, Chamaraux‐Tran T, Le Bras A, Evain S, Le Guen A, Richter S, Hubrecht R, Demasles S, Barroso B, Sablot D, Farouil G, Tardieu M, Smadja P, Aptel S, Seiler I. Parenchymal hemorrhage rate is associated with time to reperfusion and outcome. Ann Neurol 2022; 92:882-887. [DOI: 10.1002/ana.26478] [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] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Bertrand Lapergue
- Department of Neurology Foch Hospital Versailles Saint‐Quentin en Yvelines University Suresnes France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology University Hospital of Bordeaux France
| | - Igor Sibon
- Department of Neurology, Stroke Center University Hospital of Bordeaux France
| | - Sebastien Richard
- Université de Lorraine, CHRU‐Nancy, Department of Neurology, Stroke Unit F‐54000 Nancy France
- CIC‐P 1433 , INSERM U1116, CHRU‐Nancy, F‐54000 Nancy France
| | - Alain Viguier
- Acute Stroke Unit‐ CIC 1436‐UMR 1214, CHU Toulouse France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiolology CHU Toulouse France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology FHU Neurovasc, INSERM 1148, Université de Paris Cité Rothschild Foundation, Paris France
- Diagnostic and Therapeutic Neuroradiology, F‐54000 Nancy France
| | - Benjamin Gory
- Université de Lorraine, IADI, INSERM U1254 F‐54000 Nancy France
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Radu RA, Gascou G, Derraz I, Cagnazzo F, Costalat V. Micro-snare retrieval as bail-out technique for a distally migrated WEB-device: A case report. Interv Neuroradiol 2022:15910199221118709. [PMID: 35929103 DOI: 10.1177/15910199221118709] [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] Open
Abstract
Intra-procedural intrasaccular device migration is an uncommon complication of endovascular treatment of wide-neck aneurysms. We report the case of a 52-years old Caucasian male who presented with a 3 × 3 mm posterior facing top of the basilar aneurysm in which treatment with WEB-SL (Woven EndoBridge-single layer) device was tempted. Inadvertent WEB migration in the right posterior cerebral artery occurred after detachment. Two retrieval attempts were performed using a combined technique with two different stent-retrievers and a 5-Fr distal access catheter. Upon WEBectomy attempt, the device rolled over the stents, and the passages were unsuccessful. The device was successfully removed using a microSnare, catching and retrieving it inside the 5-Fr distal access catheter. Micro-Snare is an effective bail-out technique to recover migrated intrasaccular WEB devices in cerebral arteries.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- 87267"Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Grégory Gascou
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Trandafir C, Renard D, Cagnazzo F, Ion IM. Symmetrical isolated globus pallidus infarction due to bilateral carotid artery dissection. Neurol Sci 2022; 43:6597-6599. [PMID: 35915270 PMCID: PMC9343219 DOI: 10.1007/s10072-022-06278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/09/2022] [Indexed: 11/04/2022]
Abstract
A 43-year-old woman presented 1 day after whiplash injury with behavior change, hypersomnia, and abulia. MRI showed symmetrical globus pallidus infarction and bilateral watershed hypoperfusion. Magnetic resonance angiography (MRA) showed bilateral carotid artery dissection. To our knowledge, isolated symmetrical globus pallidus infarction related to bilateral carotid dissection has never been reported earlier.
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Derraz I, Ahmed R, Mourand I, Dargazanli C, Cagnazzo F, Gaillard N, Gascou G, Riquelme C, Lefevre PH, Bonafe A, Arquizan C, Costalat V. FLAIR vascular hyperintensities predict functional outcome after endovascular thrombectomy in patients with large ischemic cores. Eur Radiol 2022; 32:6136-6144. [PMID: 35394187 DOI: 10.1007/s00330-022-08683-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish whether collateral circulation was associated with functional outcome in stroke patients with large infarct size (Alberta Stroke Program Early CT Score [ASPECTS] ≤ 5) undergoing endovascular thrombectomy (EVT) METHODS: Consecutive patients with acute ischemic stroke due to large-vessel occlusion in the anterior circulation and an ASPECTS of ≤ 5 were analyzed. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-ASPECTS rating system (score ranging from 0 [no FVH] to 7 [FVHs abutting all ASPECTS cortical areas]) by two independent neuroradiologists. Good functional outcome was defined by modified Rankin Scale (mRS) score of 0 to 3 at 3 months. We determined the association between FVH score and clinical outcome using multivariable regression analyses. RESULTS A total of 139 patients (age, 63.1 ± 20.8 years; men, 51.8%) admitted between March 2012 and December 2017 were included. Good functional outcome (mRS 0-3) was observed in 65 (46.8%) patients, functional independence (mRS 0-2) was achieved in 43 (30.9%) patients, and 33 (23.7%) patients died at 90 days. The median FVH score was 4 (IQR, 3-5). FVH score was independently correlated with good outcome (adjusted OR = 1.41 [95% CI, 1.03-1.92]; p = 0.03 per 1-point increase). CONCLUSIONS In stroke patients with large-volume infarcts, good collaterals as measured by the FVH-ASPECTS rating system are associated with improved outcomes and may help select patients for reperfusion therapy. KEY POINTS • Endovascular thrombectomy can allow almost 1 in 2 patients with large infarct cores to achieve good functional outcome (modified Rankin Scale [mRS] of 0-3) and 1 in 3 patients to regain functional independence (mRS 0-2) at 3 months. • The extent of FVH score (as reflected by FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is associated with functional outcome at 3 months in this patient group.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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Derraz I, Abdelrady M, Ahmed R, Gaillard N, Morganti R, Cagnazzo F, Dargazanli C, Lefevre PH, Riquelme C, Corti L, Gascou G, Mourand I, Arquizan C, Costalat V. Impact of White Matter Hyperintensity Burden on Outcome in Large-Vessel Occlusion Stroke. Radiology 2022; 304:145-152. [PMID: 35348382 DOI: 10.1148/radiol.210419] [Citation(s) in RCA: 7] [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: 11/11/2022]
Abstract
Background White matter hyperintensity (WMH) has been linked to poor clinical outcomes after acute ischemic stroke. Purpose To assess whether the WMH burden on pretreatment MRI scans is associated with an increased risk for symptomatic intracranial hemorrhage (sICH) or poor functional outcome in patients with acute ischemic stroke treated with endovascular thrombectomy (EVT). Materials and Methods In this retrospective study, consecutive patients treated with EVT for anterior circulation acute ischemic stroke at a comprehensive stroke center (where MRI was the first-line pretreatment imaging strategy; January 2015 to December 2017) were included and analyzed. WMH volumes were assessed with semiautomated volumetric analysis at fluid-attenuated inversion recovery MRI by readers who were blinded to clinical data. The associations of WMH burden with sICH and 3-month functional outcome (modified Rankin Scale [mRS] score) were assessed. Results A total of 366 patients were included (mean age, 69 years ± 19 [SD]; 188 women [51%]). Median total WMH volume was 3.61 cm3 (IQR, 1.10-10.83 cm3). Patients demonstrated higher mRS scores with increasing WMH volumes (odds ratio [OR], 1.020 [95% CI: 1.003, 1.037] per 1.0-cm3 increase for each mRS point increase; P = .018) after adjustment for patient and clinical variables. There were no significant associations between WMH severity and 90-day mortality (OR, 1.007 [95% CI: 0.990, 1.024]; P = .40) or the occurrence of sICH (OR, 1.001 [95% CI: 0.978, 1.024]; P = .94). Conclusion Higher white matter hyperintensity burden was associated with increased risk for poor 3-month functional outcome after endovascular thrombectomy for large-vessel occlusive stroke. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mossa-Basha and Zhu in this issue.
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Affiliation(s)
- Imad Derraz
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Mohamed Abdelrady
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Raed Ahmed
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Nicolas Gaillard
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Riccardo Morganti
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Federico Cagnazzo
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Cyril Dargazanli
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Pierre-Henri Lefevre
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Carlos Riquelme
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Lucas Corti
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Grégory Gascou
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Isabelle Mourand
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Caroline Arquizan
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Vincent Costalat
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
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Ion IM, Villessot M, Goulabchand R, Cagnazzo F, Thouvenot E. Tumefactive lesion revealing neuro-Behçet disease. Rheumatology (Oxford) 2022; 61:e352-e353. [PMID: 35333305 DOI: 10.1093/rheumatology/keac194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ioana Maria Ion
- Department of Neurology, Nîmes University Hospital, Nîmes, France
| | | | - Radjiv Goulabchand
- Department of Internal Medicine, Nîmes University Hospital, Nîmes, France
| | | | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France.,Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Université de Montpellier, Montpellier, France
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Cagnazzo F. Comparison of woven endobridge device sizing with conventional measurements and virtual simulation using the sim&size software: a multicenter experience. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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28
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Ter Schiphorst A, Duflos C, Mourand I, Gaillard N, Dargazanli C, Corti L, Prin P, Lippi A, Ayrignac X, Charif M, Wacongne A, Bouly S, Lalu T, Sablot D, Blanchet-Fourcade G, Landragin N, Jacob F, Sayad C, Derraz I, Cagnazzo F, Lefevre PH, Gascou G, Beaufils O, Costalat V, Arquizan C. A regional strategy to decrease the time to thrombectomy in patients with low probability of treatment by thrombolysis. Rev Neurol (Paris) 2021; 178:558-568. [PMID: 34903351 DOI: 10.1016/j.neurol.2021.11.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The best transportation strategy for patients with suspected large vessel occlusion (LVO) is unknown. Here, we evaluated a new regional strategy of direct transportation to a Comprehensive Stroke Center (CSC) for patients with suspected LVO and low probability of receiving intravenous thrombolysis (IVT) at the nearest Primary Stroke Center (PSC). METHODS Patients could be directly transported to the CSC (bypass group) if they met our pre-hospital bypass criteria: high LVO probability (i.e., severe hemiplegia) with low IVT probability (contraindications) and/or travel time difference between CSC and PSC<15 minutes. The other patients were transported to the PSC according to a "drip-and-ship" strategy. Treatment time metrics were compared in patients with pre-hospital bypass criteria and confirmed LVO in the bypass and drip-and-ship groups. RESULTS In the bypass group (n=79), 54/79 (68.3%) patients met the bypass criteria and 29 (36.7%) had confirmed LVO. The positive predictive value of the hemiplegia criterion for LVO detection was 0.49. In the drip-and-ship group (n=457), 92/457 (20.1%) patients with confirmed LVO met our bypass criteria. Among the 121 patients with bypass criteria and confirmed LVO, direct routing decreased the time between symptom discovery and groin puncture by 55 minutes compared with the drip-and-ship strategy (325 vs. 229 minutes, P<0.001), without significantly increasing the time to IVT (P=0.19). CONCLUSIONS Our regional strategy led to the correct identification of LVO and a significant decrease of the time to mechanical thrombectomy, without increasing the time to IVT, and could be easily implemented in other territories.
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Affiliation(s)
- A Ter Schiphorst
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - C Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, University Montpellier, Montpellier, France
| | - I Mourand
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - N Gaillard
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - C Dargazanli
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - L Corti
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - P Prin
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - A Lippi
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - X Ayrignac
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - M Charif
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - A Wacongne
- Department of Neurology, CHRU Carémeau, Nîmes, France
| | - S Bouly
- Department of Neurology, CHRU Carémeau, Nîmes, France
| | - T Lalu
- Department of Neurology, CH de Béziers, Béziers, France
| | - D Sablot
- Department of Neurology, CH de Perpignan, Perpignan, France
| | | | - N Landragin
- Department of Neurology, Clinique du Millénaire, Montpellier, France
| | - F Jacob
- Emergency Department, CH de Millau, Millau, France
| | - C Sayad
- Emergency Department, CH de Mende, Mende, France
| | - I Derraz
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - F Cagnazzo
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - P-H Lefevre
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - G Gascou
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - O Beaufils
- Emergency Department, CHRU Gui de Chauliac, Montpellier, France
| | - V Costalat
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - C Arquizan
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France.
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Mourand I, Mahmoudi M, Lebars E, Pavillard F, Dargazanli C, Labreuche J, Gaillard N, Ter Schiphorst A, Derraz I, Sablot D, Corti L, Costalat V, Arquizan C, Cagnazzo F. Predictive value of DWI posterior-circulation lesion volume for 90-day clinical outcome after endovascular treatment of acute basilar artery occlusion: a retrospective single-center study. Neuroradiology 2021; 64:1231-1238. [PMID: 34825967 DOI: 10.1007/s00234-021-02849-x] [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] [Received: 08/06/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The relationship between posterior-circulation lesion volume (PCLV) and clinical outcomes is poorly investigated. We aimed to analyze, in patients with acute basilar artery occlusion (ABAO), if pre-endovascular treatment (EVT) PCLV was a predictor of outcomes. METHODS We analyzed consecutive MRI selected, endovascularly treated ABAO patients. Baseline PCLV was measured in milliliters on apparent diffusion-coefficient map reconstruction. Univariable and multivariable logistic models were used to test if PCLV was a predictor of 90-day outcomes. After the received operating characteristic (ROC) analysis, the optimal cut-off was determined to evaluate the prognostic value of PCLV. RESULTS A total of 110 ABAO patients were included. The median PCLV was 4.4 ml (interquartile range, 1.3-21.2 ml). Successful reperfusion was achieved in 81.8% of cases after EVT. At 90 days, 31.8% of patients had a modified Rankin scale ≤ 2, and the mortality rate was 40.9%. PCLV was an independent predictor of functional independence and mortality (odds ratio [OR]:0.57, 95% confidence interval [CI], 0.34-0.93 and 1.84, 95% CI, 1.23-2.76, respectively). The ROC analysis showed that a baseline PCLV ≤ 8.7 ml was the optimal cut-off to predict the 90-day functional independence (area under the curve [AUC] = 0.68, 95% CI, 0.57-0.79, sensitivity 88.6%, and specificity 49.3%). In addition, a PCLV ≥ 9.1 ml was the optimal cut-off for the prediction of 90-day mortality (AUC = 0.71, 95% CI, 0.61-0.82, sensitivity 80%, and specificity 60%). CONCLUSIONS Pre-treatment PCLV was an independent predictor of 90-day outcomes in ABAO. A PCLV ≤ 8.7 and ≥ 9.1 ml may identify patients with a higher possibility to achieve independence and a higher risk of death at 90 days, respectively.
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Affiliation(s)
- Isabelle Mourand
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France.
| | - Mehdi Mahmoudi
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Emmanuelle Lebars
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Frederique Pavillard
- Department of Reanimation, Centre Hospitalier Universitaire, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Julien Labreuche
- Biostatistics department, Centre Hospitalier Universitaire, Lille, France
| | - Nicolas Gaillard
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Adrien Ter Schiphorst
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Imad Derraz
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Denis Sablot
- Neurology department, Centre Hospitalier, Perpignan, France
| | - Lucas Corti
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Caroline Arquizan
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Federico Cagnazzo
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
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30
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Kerleroux B, Janot K, Hak JF, Kaesmacher J, Hassen WB, Benzakoun J, Oppenheim C, Herbreteau D, Ifergan H, Bricout N, Henon H, Yoshimoto T, Inoue M, Consoli A, Costalat V, Naggara O, Lapergue B, Cagnazzo F, Boulouis G. Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis. J Stroke 2021; 23:358-366. [PMID: 34649380 PMCID: PMC8521249 DOI: 10.5853/jos.2021.00724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.
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Affiliation(s)
- Basile Kerleroux
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Kevin Janot
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Jean François Hak
- Department of Neuroradiology, University Hospital of Marseille La Timone, Marseille, France
| | - Johannes Kaesmacher
- Institute of Diagnostic, Interventional and Pediatric Radiology and Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Wagih Ben Hassen
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Joseph Benzakoun
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Catherine Oppenheim
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Denis Herbreteau
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Heloise Ifergan
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Nicolas Bricout
- Diagnostic and Interventional Neuroradiology, University Hospital of Lille, Lille, France
| | - Hilde Henon
- Neuroradiology Department and Stroke Unit, University Hospital of Lille, Lille, France
| | - Takeshi Yoshimoto
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center, Suita, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center, Suita, Japan
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Vincent Costalat
- Neuroradiology Department, University Hospital of Gui de Chauliac, Montpellier, France
| | - Olivier Naggara
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Bertrand Lapergue
- Department of Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Federico Cagnazzo
- Neuroradiology Department, University Hospital of Gui de Chauliac, Montpellier, France
| | - Grégoire Boulouis
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France.,Department of Neuroradiology, University Hospital of Tours, Tours, France
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Derraz I, Abdelrady M, Gaillard N, Ahmed R, Cagnazzo F, Dargazanli C, Lefevre PH, Corti L, Riquelme C, Mourand I, Gascou G, Bonafe A, Arquizan C, Costalat V. White Matter Hyperintensity Burden and Collateral Circulation in Large Vessel Occlusion Stroke. Stroke 2021; 52:3848-3854. [PMID: 34517773 DOI: 10.1161/strokeaha.120.031736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensity (WMH), a marker of chronic cerebral small vessel disease, might impact the recruitment of leptomeningeal collaterals. We aimed to assess whether the WMH burden is associated with collateral circulation in patients treated by endovascular thrombectomy for anterior circulation acute ischemic stroke. METHODS Consecutive acute ischemic stroke due to anterior circulation large vessel occlusion and treated with endovascular thrombectomy from January 2015 to December 2017 were included. WMH volumes (periventricular, deep, and total) were assessed by a semiautomated volumetric analysis on fluid-attenuated inversion recovery-magnetic resonance imaging. Collateral status was graded on baseline catheter angiography using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system (good when ≥3). We investigated associations of WMH burden with collateral status. RESULTS A total of 302 patients were included (mean age, 69.1±19.4 years; women, 55.6%). Poor collaterals were observed in 49.3% of patients. Median total WMH volume was 3.76 cm3 (interquartile range, 1.09-11.81 cm3). The regression analyses showed no apparent relationship between WMH burden and the collateral status measured at baseline angiography (adjusted odds ratio, 0.987 [95% CI, 0.971-1.003]; P=0.12). CONCLUSIONS WMH burden exhibits no overt association with collaterals in large vessel occlusive stroke.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Mohamed Abdelrady
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Raed Ahmed
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Lucas Corti
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
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Daubé P, Cagnazzo F, Barreau X, Morganti R, Ferreira I, Gariel F, Dargazanli C, Gascou G, Riquelme C, Derraz I, Berge J, Lefevre PH, Costalat V, Marnat G. Influence of operator experience on the technical and clinical results of Woven EndoBridge endovascular treatment for intracranial aneurysms. Clin Neurol Neurosurg 2021; 208:106900. [PMID: 34454205 DOI: 10.1016/j.clineuro.2021.106900] [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: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND & PURPOSE The safety and efficacy of the Woven EndoBridge (WEB) device has been proven in recent multicenter trials. This study investigated whether operator experience influences WEB treatment-related outcomes. MATERIAL AND METHODS This was a retrospective analysis of a prospectively collected multicenter database. The data of all patients who underwent WEB treatment for an intracranial aneurysm from March 2014 to June 2020 in two high-volume centers were pooled. Operator experience was indexed by the number of WEB treatments performed previously. The primary endpoint was the overall complication rate. Secondary endpoints were long-term adequate (Raymond-Roy classification of 1-2.) angiographic occlusion, WEB-related complications, number of WEB not deployed, procedure duration, and radiation exposure (air kerma). RESULTS Among 237 patients (mean age 59.4 +/- 11.5 years) treated with WEB (median aneurysm diameter, 5.8 mm; interquartile range 4.5-7 mm), WEB-related complications occurred in 28 patients (11.8%) and adequate long-term occlusion was achieved for 154 aneurysms (86%). The median number of WEB treatment performed previously per operator was 20 (IQR, 9-41). The overall complication rate, WEB-related complication rate and aneurysm occlusion rate were not significantly correlated with WEB operator experience. There were also no significant correlations between the WEB operator experience and the number of WEB not deployed, procedure duration or radiation exposure. CONCLUSION There was no significant association between the number of WEB treatments previously performed per operator and any technical or clinical results after intracranial aneurysm treatment with WEB. These results imply a relatively short learning curve for this device in high-volume neurovascular centers.
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Affiliation(s)
- P Daubé
- Department of Neuroradiology, CHU Poitiers, Poitiers, France.
| | - F Cagnazzo
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - X Barreau
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
| | - R Morganti
- Section of Statistics, University Hospital of Pisa, Pisa, Italy.
| | - I Ferreira
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - F Gariel
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
| | - C Dargazanli
- Department of Neuroradiology, CHU Montpellier, Montpellier, France; Institut de Génomique Fonctionnelle, Université Montpellier, CNRS, INSERM, Montpellier, France.
| | - G Gascou
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - C Riquelme
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - I Derraz
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - J Berge
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
| | - P H Lefevre
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - V Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France; Institut de Génomique Fonctionnelle, Université Montpellier, CNRS, INSERM, Montpellier, France.
| | - G Marnat
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
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Cagnazzo F, Derraz I, Dargazanli C, Lefevre PH, Coelho Ferreira I, Gascou G, Riquelme C, Fanti A, Ahmed R, Frandon J, Bonafe A, Costalat V. Flow-Diversion Treatment for Unruptured ICA Bifurcation Aneurysms with Unfavorable Morphology for Coiling. AJNR Am J Neuroradiol 2021; 42:1087-1092. [PMID: 33858823 DOI: 10.3174/ajnr.a7125] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few reports described flow diversion for ICA bifurcation aneurysms. Our aim was to provide further insight into flow diversion for ICA bifurcation aneurysms difficult to treat with other strategies. MATERIALS AND METHODS Consecutive patients receiving flow diverters for unruptured ICA bifurcation aneurysms were collected. Aneurysm occlusion (O'Kelly-Marotta grading scale) and clinical outcomes were evaluated. RESULTS Twenty saccular ICA bifurcation aneurysms were treated with the Pipeline Embolization Device deployed from the M1 to the ICA, covering the aneurysm and the A1 segment. All patients presented with an angiographic visualized contralateral flow from the anterior communicating artery. Mean aneurysm size was 6.5 (SD, 3.2) mm (range, 4.5-20 mm). All lesions had an unfavorable dome-to-neck ratio (mean/median, 1.6/1.6; range, 0.8-2.8; interquartile range = 0.5) or aspect ratio for coiling (mean/median = 1.5/1.55; range, 0.8-2.5; interquartile range = 0.6). One was a very large aneurysm (20 mm). Nineteen medium-sized lesions were completely occluded during the angiographic follow-up (13 months). No cases of aneurysm rupture or retreatment were reported. No adverse events were described. Aneurysm occlusion was associated with the asymptomatic flow modification of the covered A1 that was occluded and contralaterally filled among 10 patients (50%), narrowed among 9 patients (45%), and unchanged in 1 subject (5%). There was no difference in the mean initial diameter of the occluded (2.1 [SD 0.4] mm; range, 1.6-3 mm) and narrowed (2 [SD, 0.2] mm; range, 1.7-2.6 mm) A1 segments. CONCLUSIONS Medium-sized unruptured ICA bifurcation aneurysms with unfavorable morphology for coiling can be treated with M1 ICA flow diversion. Aneurysm occlusion is associated with flow modifications of the covered A1 that seems safe in the presence of a favorable collateral anatomy through the anterior communicating artery complex.
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Affiliation(s)
- F Cagnazzo
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - I Derraz
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P-H Lefevre
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - I Coelho Ferreira
- Neurosurgical Department (I.C.F.), Hospital Santa Lucia, Distrito Federal, Brazil
| | - G Gascou
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Riquelme
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Fanti
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - R Ahmed
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - J Frandon
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Bonafe
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Turpinat C, Collemiche FL, Arquizan C, Molinari N, Cagnazzo F, Mourand I, Lefèvre PH, Henneton P, Corti L, Gascou G, Derraz I, Olindo S, Costalat V, Dargazanli C, Gaillard N. Prevalence of carotid web in a French cohort of cryptogenic stroke. J Neurol Sci 2021; 427:117513. [PMID: 34098374 DOI: 10.1016/j.jns.2021.117513] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/09/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Carotid webs (CaW) may be an under-recognized cause of anterior circulation cryptogenic ischemic stroke (ACIS). Prevalence is still unknown in European patients with ACIS. OBJECTIVE To evaluate the prevalence of CaW in ACIS and describe patients with CaW phenotype in a cohort of patients from a French stroke center. METHODS We conducted a retrospective monocentric cohort study from 01/01/2015 to 31/12/2019 (Montpellier University Hospital, France), in consecutive anterior ischemic stroke (AIS) patients ≤65 years old from a prospective stroke database. Using ASCOD phenotyping, ACIS patients were selected and cervical CTA were reviewed to find CaW. RESULTS Among 1053 consecutive AIS patients, 266 ACIS patients with CTA were included. Among patients included (mean age 50, women 58%), CaW was in the ipsilateral carotid (iCaW) in 21 patients: 7.9% (95%CI [4.6-11.1]), (mean age 51, 11 women, 16 Caucasian). iCaW were uncovered during study review of CTA in 6/21 (29%) patients. Comparison between patients with iCaW and those without iCaW showed no differences except that of a higher rate of intracranial large vessel occlusion (LVO) (62.4 vs 37.6%; p = 0.03). Patients with iCaW under conservative medical therapy had an annualized stroke recurrence rate (SRR) of 11.4% (95%CI [8.4-15.1]. CONCLUSIONS iCaW was identified as a source of stroke in about 8% of a French population ≤65 years with ACIS. iCaW was associated with a higher rate of LVO and a high SRR under conservative medical therapy.
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Affiliation(s)
- C Turpinat
- Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - F L Collemiche
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - C Arquizan
- Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - N Molinari
- IMAG, CNRS, Univ Montpellier, CHU, Montpellier, France
| | - F Cagnazzo
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - I Mourand
- Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - P H Lefèvre
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - P Henneton
- Service de Médecine Vasculaire et angiologie, Département de Médecine Interne, Hopital Saint Eloi, Montpellier, France
| | - L Corti
- Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - G Gascou
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - I Derraz
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - S Olindo
- Unité Neurovasculaire, Département de Neurologie, Hôpital Pellegrin, Bordeaux, France
| | - V Costalat
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - C Dargazanli
- Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France
| | - N Gaillard
- Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
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35
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Derraz I, Benali A, Ahmed R, Cagnazzo F, Dargazanli C, Gascou G, Riquelme C, Corti L, Lefevre PH, Bonafe A, Arquizan C, Costalat V. Impact of endovascular reperfusion therapy in nonagenarians with anterior circulation large-vessel ischaemic stroke. Age Ageing 2021; 50:787-794. [PMID: 33206940 DOI: 10.1093/ageing/afaa243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 10/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The benefit of endovascular thrombectomy (EVT) among nonagenarians (90 years or older) is poorly documented. We aimed to investigate the clinical and imaging factors associated with good outcomes and mortality at 90 days in nonagenarians undergoing EVT for acute ischemic stroke (AIS). METHODS Data from a prospectively maintained institutional registry of consecutive AIS patients treated with EVT from January 2012 to December 2018 were retrospectively analysed. Comorbid conditions were classified with a modified version of the Charlson Comorbidity Index (CCI). The degree of disability was assessed by the modified Rankin Scale (mRS). Outcomes included good functional outcome (mRS scores of 0-3) and mortality at 90 days. RESULTS Among 110 patients (age, 92.3 ± 2.5 years; men, 28.2%) treated with EVT, good outcome was achieved in 39 (35.5%) patients, successful reperfusion (modified Thrombolysis in Cerebral Infarction grades of 2b-3) was achieved in 78 (70.9%) patients and 38 (34.5%) patients died at 90 days. The functional outcome at 3 months was associated with pre-stroke status (CCI and pre-stroke mRS score). Successful reperfusion (adjusted odds ratio [OR], 11.6; 95% CI, 1.3-104.2; P = 0.03) and early neurologic improvement at 24 h (adjusted OR, 16.4; 95% CI, 5.2-51.5; P < 0.001) were independent predictors of a good outcome. Early neurological improvement (adjusted OR, 0.06; 95% CI, 0.02-0.23; P < 0.001) was an independent predictor of 90-day mortality. CONCLUSIONS Successful reperfusion therapy improves the functional outcome of nonagenarians who should not be excluded from EVT. The presence and severity of comorbidities should be considered in the procedural management of this vulnerable population.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Lucas Corti
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
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Derraz I, Ahmed R, Benali A, Corti L, Cagnazzo F, Dargazanli C, Gascou G, Riquelme C, Lefevre PH, Bonafe A, Arquizan C, Costalat V. FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy. Eur Radiol 2021; 31:7406-7416. [PMID: 33851277 DOI: 10.1007/s00330-021-07866-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To establish whether imaging assessments of irreversibly injured ischemic core and potentially salvageable penumbral volumes and collateral circulation were associated with functional outcome in nonagenarians (90 years or older) undergoing endovascular thrombectomy (EVT). METHODS Data from a prospectively maintained institutional registry of consecutive stroke patients treated with EVT from January 2012 to December 2018 were retrospectively analyzed. Functional outcome was evaluated with the modified Rankin scale (mRS) at 3 months. mRS score of 0-3 was defined as a good clinical outcome. Ischemic core and penumbral volumes were calculated using the RAPID software. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-Alberta Stroke Program Early CT Score (ASPECTS) rating system. RESULTS Among 85 patients (age, 92.4 ± 2.6 years; men, 30.6%) treated with EVT, good outcome (mRS 0-3) was achieved in 29 (34.1%) patients and 31 (36.5%) patients died at 90 days. The median estimated ischemic core volume was 15 mL (IQR, 7-27 mL). The median mismatch volume was 83 mL (IQR, 43-120 mL). The median FVH score was 4 (IQR, 3-4). FVH score was independently associated with good functional outcome (adjusted OR = 1.96 [95% CI, 1.16-3.32]; p = 0.01 per 1-point increase) and mortality (adjusted OR = 0.54 [95% CI, 0.34-0.85]; p = 0.007 per 1-point increase). Ischemic core and mismatch volumes were associated with neither good outcome nor mortality. CONCLUSIONS In nonagenarians with anterior circulation large-vessel ischemic stroke, good collaterals as measured by the FVH-ASPECTS rating system are independently associated with improved outcomes and may help select patients for reperfusion therapy in this frail population. KEY POINTS • Endovascular thrombectomy can allow at least 1 in 3 patients older than 90 years of age to achieve good functional outcome (modified Rankin scale of 0-3) at 3 months. • Functional outcome at 3 months is associated with pre-stroke status (number and severity of patients' comorbidities). • A higher FVH score (as reflected by higher FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is independently associated with better 3-month functional outcome and mortality in nonagenarians with anterior circulation ischemic stroke.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lucas Corti
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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Benali A, Moynier M, Dargazanli C, Deverdun J, Cagnazzo F, Mourand I, Bonafe A, Arquizan C, Derraz I, Menjot de Champfleur N, Molino F, Ducros A, Le Bars E, Costalat V. Mechanical Thrombectomy in Nighttime Hours: Is There a Difference in 90-Day Clinical Outcome for Patients with Ischemic Stroke? AJNR Am J Neuroradiol 2021; 42:530-537. [PMID: 33478943 DOI: 10.3174/ajnr.a6997] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few data are available regarding the influence of the timing of ischemic stroke management, such as daytime and nighttime hours, on the delay of mechanical thrombectomy, the effectiveness of revascularization, and clinical outcomes. We aimed to investigate whether admission during nighttime hours could impact the clinical outcome (mRS at 90 days) of patients with acute ischemic stroke treated by mechanical thrombectomy. MATERIALS AND METHODS We retrospectively analyzed 169 patients (112 treated during daytime hours and 57 treated during nighttime hours) with acute ischemic stroke in the anterior cerebral circulation. The main outcome was the rate of patients achieving functional independence at 90 days (mRS ≤2), depending on admission time. RESULTS In patients admitted during nighttime hours, the rate of mRS ≤ 2 at 90 days was significantly higher (51% versus 35%, P = .05) compared with those admitted in daytime hours. Patients in daytime and nighttime hours were comparable regarding admission and treatment characteristics. However, patients in nighttime hours tended to have a higher median NIHSS score at admission (P = .08) and to be younger (P = .08), especially among the mothership group (P = .09). The multivariate logistic regression analysis confirmed that patients in nighttime hours had better functional outcomes at 90 days than those in daytime hours (P = .018; 95% CI, 0.064-0.770; OR = 0.221). CONCLUSIONS In a highly organized stroke care network, mechanical thrombectomy is quite effective in the nighttime hours among acute ischemic stroke presentations. Unexpectedly, we found that those patients achieved favorable clinical outcomes more frequently than those treated during daytime hours. Larger series are needed to confirm these results.
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Affiliation(s)
- A Benali
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - M Moynier
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - C Dargazanli
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - J Deverdun
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - F Cagnazzo
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - I Mourand
- Neurology (I.M., C.A., A.D.), Gui de Chauliac Hospital, Montpellier, France
| | - A Bonafe
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - C Arquizan
- Neurology (I.M., C.A., A.D.), Gui de Chauliac Hospital, Montpellier, France
| | - I Derraz
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - N Menjot de Champfleur
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - F Molino
- Department of Physics (F.M.), Charles Coulomb Laboratory, Montpellier, France
| | - A Ducros
- Neurology (I.M., C.A., A.D.), Gui de Chauliac Hospital, Montpellier, France
| | - E Le Bars
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - V Costalat
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
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Derraz I, Cagnazzo F, Gaillard N, Morganti R, Dargazanli C, Ahmed R, Lefevre PH, Riquelme C, Mourand I, Gascou G, Bonafe A, Arquizan C, Costalat V. Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Endovascular Thrombectomy. Neurology 2021; 96:e1724-e1731. [PMID: 33495380 DOI: 10.1212/wnl.0000000000011566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether pretreatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). METHODS Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin Scale score >2). RESULTS Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH; 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03-1.36 per 1-CMB increase; p = 0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, IV thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92-1.20 per 1-CMB increase; p = 0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, or presumed pathogenesis were not independently correlated with ICH. CONCLUSIONS Poor functional outcome or ICH were not correlated with CMB presence or burden on pre-EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.
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Affiliation(s)
- Imad Derraz
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy.
| | - Federico Cagnazzo
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Nicolas Gaillard
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Riccardo Morganti
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Cyril Dargazanli
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Raed Ahmed
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Pierre-Henri Lefevre
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Carlos Riquelme
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Isabelle Mourand
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Gregory Gascou
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Alain Bonafe
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Caroline Arquizan
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Vincent Costalat
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
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Cagnazzo F, Marnat G, Ferreira I, Daube P, Derraz I, Dargazanli C, Lefevre PH, Gascou G, Riquelme C, Morganti R, Berge J, Gariel F, Barreau X, Costalat V. Comparison of Woven EndoBridge device sizing with conventional measurements and virtual simulation using the Sim&Size software: a multicenter experience. J Neurointerv Surg 2020; 13:924-929. [PMID: 33361275 DOI: 10.1136/neurintsurg-2020-017060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Selection of the appropriate device size mandatory during aneurysm treatment with a Woven EndoBridge (WEB). We aimed to investigate if virtual simulation with Sim&Size software may have an impact on technical, angiographic, and clinical outcomes after WEB treatment. METHODS Data from two large-volume centers were collected and compared (January 2017-January 2020). Virtual simulation was systematically adopted in one center, while conventional sizing was used in the other one. Outcomes were the duration of intervention, the radiation dose (in milligrays, the number of corrective interventions for inappropriate WEB size, the number of WEBs not deployed, angiographic occlusion, and complications. Univariate and multivariate linear models were adopted. RESULTS A total of 186 aneurysms were treated with WEB (109 with and 77 without virtual simulation). Patient characteristics and aneurysm features were comparable among virtual and conventional sizing, except for mean age (62.2±11.8 years and 56.2±10.1 years, P=0.0004) and median aspect ratio (1.6, IQR=1.2-2 and 1.2, IQR=1-1.6, P=0.0001). Years of operator experience were comparable. Virtual simulation was independently associated with shorter intervention time (45 min, IQR=33-63.5 min vs 63.5 min, IQR=41-84.7 min, P=0.0001), lower radiation dose (1051 mGy, IQR=815-1399 mGy vs 1207 mGy, IQR=898-2084 mGy, P=0.0001), and lower number of WEBs not deployed (26/77=33.7% vs 8/109=7.3%, P=0.0001). The need for additional maneuvers was significantly lower in the virtual simulation group (5/109=4.6% vs 12/77=15.6%, P=0.021). Angiographic outcomes and complications were comparable. CONCLUSIONS In this multicenter experience, virtual simulation with Sim&Size software seems to facilitate the selection of the appropriate WEB device for aneurysm treatment, reducing the time of intervention, the radiation dose, the number of devices not deployed, and the need for corrective interventions. TRIAL REGISTRATION NUMBER clinicaltrials.gov Identifier: NCT04621552.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Ivan Ferreira
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Pierre Daube
- Interventional Radiology, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France
| | - Imad Derraz
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Pierre-Henri Lefevre
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Gregory Gascou
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Carlos Riquelme
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | | | - Jérôme Berge
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Florent Gariel
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Xavier Barreau
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Vincent Costalat
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, 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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Mourand I, Mahmoudi M, Dargazanli C, Pavillard F, Arquizan C, Labreuche J, Derraz I, Gaillard N, Blanchet-Fourcade G, Lefevre PH, Boukriche Y, Gascou G, Corti L, Costalat V, Le Bars E, Cagnazzo F. DWI cerebellar infarct volume as predictor of outcomes after endovascular treatment of acute basilar artery occlusion. J Neurointerv Surg 2020; 13:995-1001. [PMID: 33243771 DOI: 10.1136/neurintsurg-2020-016804] [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: 08/27/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preprocedural predictors of outcome in patients with acute basilar artery occlusion (ABAO) who have undergone endovascular treatment (EVT) remain controversial. Our aim was to determine if pre-EVT diffusion-weighted imaging cerebellar infarct volume (CIV) is a predictor of 90-day outcomes. METHODS We analyzed consecutive MRI-selected endovascularly treated patients with ABAO within the first 24 hours after symptom onset. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3. Using the initial MRI, baseline CIV was calculated in mL on an apparent diffusion coefficient map reconstruction (Olea Sphere software). CIV was analyzed in univariate and multivariable models as a predictor of 90-day functional independence (modified Rankin Scale (mRS) 0-2) and mortality. According to receiver operating characteristic (ROC) analysis, the optimal cut-off was determined by maximizing the Youden index to evaluate the prognostic value of CIV. RESULTS Of the 110 MRI-selected patients with ABAO, 64 (58.18%) had a cerebellar infarct. The median CIV was 9.6 mL (IQR 2.7-31.4). Successful reperfusion was achieved in 81.8% of the cases. At 90 days the proportion of patients with mRS ≤2 was 31.8% and the overall mortality rate was 40.9%. Baseline CIV was significantly associated with 90-day mRS 0-2 (p=0.008) in the univariate analysis and was an independent predictor of 90-day mortality (adjusted OR 1.79, 95% CI 1.25 to 2.54, p=0.001). The ROC analysis showed that a CIV ≥4.7 mL at the initial MRI was the optimal cut-off to discriminate patients with a higher risk of death at 90 days (area under the ROC curve (AUC)=0.74, 95% CI 0.61 to 0.87, sensitivity and specificity of 87.9% and 58.1%, respectively). CONCLUSIONS In our series of MRI-selected patients with ABAO, pre-EVT CIV was an independent predictor of 90-day mortality. The risk of death was increased for baseline CIV ≥4.7 mL.
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Affiliation(s)
- Isabelle Mourand
- Neurology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Mehdi Mahmoudi
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Cyril Dargazanli
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Frederique Pavillard
- Reanimation, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Caroline Arquizan
- Neurology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Julien Labreuche
- Biostatistics, University Hospital Center Lilles, Lilles, France
| | - Imad Derraz
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nicolas Gaillard
- Neurology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | | | - Pierre Henri Lefevre
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Yassine Boukriche
- Neurology, Hospital Center Beziers, Beziers, Languedoc-Roussillon, France
| | - Gregory Gascou
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Lucas Corti
- Neurology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Vincent Costalat
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Emmanuelle Le Bars
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Federico Cagnazzo
- Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
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Dargazanli C, Zub E, Deverdun J, Decourcelle M, de Bock F, Labreuche J, Lefèvre PH, Gascou G, Derraz I, Riquelme Bareiro C, Cagnazzo F, Bonafé A, Marin P, Costalat V, Marchi N. Machine Learning Analysis of the Cerebrovascular Thrombi Proteome in Human Ischemic Stroke: An Exploratory Study. Front Neurol 2020; 11:575376. [PMID: 33240201 PMCID: PMC7678741 DOI: 10.3389/fneur.2020.575376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Mechanical retrieval of thrombotic material from acute ischemic stroke patients provides a unique entry point for translational research investigations. Here, we resolved the proteomes of cardioembolic and atherothrombotic cerebrovascular human thrombi and applied an artificial intelligence routine to examine protein signatures between the two selected groups. Methods: We specifically used n = 32 cardioembolic and n = 28 atherothrombotic diagnosed thrombi from patients suffering from acute stroke and treated by mechanical thrombectomy. Thrombi proteins were successfully separated by gel-electrophoresis. For each thrombi, peptide samples were analyzed by nano-flow liquid chromatography coupled to tandem mass spectrometry (nano-LC-MS/MS) to obtain specific proteomes. Relative protein quantification was performed using a label-free LFQ algorithm and all dataset were analyzed using a support-vector-machine (SVM) learning method. Data are available via ProteomeXchange with identifier PXD020398. Clinical data were also analyzed using SVM, alone or in combination with the proteomes. Results: A total of 2,455 proteins were identified by nano-LC-MS/MS in the samples analyzed, with 438 proteins constantly detected in all samples. SVM analysis of LFQ proteomic data delivered combinations of three proteins achieving a maximum of 88.3% for correct classification of the cardioembolic and atherothrombotic samples in our cohort. The coagulation factor XIII appeared in all of the SVM protein trios, associating with cardioembolic thrombi. A combined SVM analysis of the LFQ proteome and clinical data did not deliver a better discriminatory score as compared to the proteome only. Conclusion: Our results advance the portrayal of the human cerebrovascular thrombi proteome. The exploratory SVM analysis outlined sets of proteins for a proof-of-principle characterization of our cohort cardioembolic and atherothrombotic samples. The integrated analysis proposed herein could be further developed and retested on a larger patients population to better understand stroke origin and the associated cerebrovascular pathophysiology.
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Affiliation(s)
- Cyril Dargazanli
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France.,Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Emma Zub
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
| | - Jeremy Deverdun
- I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, Montpellier, France
| | - Mathilde Decourcelle
- BioCampus Montpellier, CNRS, INSERM, Université de Montpellier, Montpellier, France
| | - Frédéric de Bock
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
| | - Julien Labreuche
- Santé Publique: Epidémiologie et Qualité des Soins, CHU Lille, University of Lille, Lille, France
| | - Pierre-Henri Lefèvre
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Grégory Gascou
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Imad Derraz
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Carlos Riquelme Bareiro
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Federico Cagnazzo
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Alain Bonafé
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Philippe Marin
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
| | - Vincent Costalat
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France.,Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Nicola Marchi
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
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Cagnazzo F, Piotin M, Escalard S, Maier B, Ribo M, Requena M, Pop R, Hasiu A, Gasparotti R, Mardighian D, Piano M, Cervo A, Eker OF, Durous V, Sourour NA, Elhorany M, Zini A, Simonetti L, Marcheselli S, Paolo NN, Houdart E, Guédon A, Ligot N, Mine B, Consoli A, Lapergue B, Cordona Portela P, Urra X, Rodriguez A, Bolognini F, Lebedinsky PA, Pasco-Papon A, Godard S, Marnat G, Sibon I, Limbucci N, Nencini P, Nappini S, Saia V, Caldiera V, Romano D, Frauenfelder G, Gallesio I, Gola G, Menozzi R, Genovese A, Terrana A, Giorgianni A, Cappellari M, Augelli R, Invernizzi P, Pavia M, Lafe E, Cavallini A, Giossi A, Besana M, Valvassori L, Macera A, Castellan L, Salsano G, Di Caterino F, Biondi A, Arquizan C, Lebreuche J, Galvano G, Cannella A, Cosottini M, Lazzarotti G, Guizzardi G, Stecco A, Tassi R, Bracco S, Bianchini E, Micieli C, Pascarella R, Napoli M, Causin F, Desal H, Cotton F, Costalat V. European Multicenter Study of ET-COVID-19. Stroke 2020; 52:31-39. [PMID: 33222617 DOI: 10.1161/strokeaha.120.031514] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. METHODS Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. SECONDARY OUTCOMES early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0-1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. RESULTS We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59-79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11-21) and 8 (interquartile range, 7-9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3-87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20-39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8-29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7-12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21-5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22-5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43-12.91] per SD-log increase in LDH). CONCLUSIONS The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient's profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04406090.
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Affiliation(s)
- Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France (F. Cagnazzo, V. Costalat)
| | - Michel Piotin
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France (M. Piotin, S.E., B. Maier)
| | - Simon Escalard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France (M. Piotin, S.E., B. Maier)
| | - Benjamin Maier
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France (M. Piotin, S.E., B. Maier)
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Catalonia, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Catalonia, Spain (M. Ribo, M. Requena)
| | - Raoul Pop
- Department of Interventional Neuroradiology, Strasbourg University Hospitals (R.P., A.H.)
| | - Anca Hasiu
- Department of Interventional Neuroradiology, Strasbourg University Hospitals (R.P., A.H.)
| | - Roberto Gasparotti
- Neuroradiology and Stroke Units, Spedali Civili, Brescia, Italy (R.G., D.M.)
| | - Dikran Mardighian
- Neuroradiology and Stroke Units, Spedali Civili, Brescia, Italy (R.G., D.M.)
| | - Mariangela Piano
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (M. Piano, A. Cervo)
| | - Amedeo Cervo
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (M. Piano, A. Cervo)
| | - Omer Faruk Eker
- Department of Diagnostic and Interventional Neuroradiology, Hospices Civils, Lyon, France (O.F.E., V.D., F. Cotton)
| | - Vincent Durous
- Department of Diagnostic and Interventional Neuroradiology, Hospices Civils, Lyon, France (O.F.E., V.D., F. Cotton)
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France (N.-A.S., M.E.)
| | - Mahmoud Elhorany
- Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France (N.-A.S., M.E.)
| | - Andrea Zini
- Department of Neurology and Stroke Center (A.Z.), IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Luigi Simonetti
- Neuroradiology Unit (L.S.), IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Simona Marcheselli
- Neurologia d'Urgenza e Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (S.M., N.N.P.)
| | - Nuzzi Nunzio Paolo
- Neurologia d'Urgenza e Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (S.M., N.N.P.)
| | - Emmanuel Houdart
- Department of Neurology, Hôpital Lariboisière, University of Paris, France (E.H., A. Guédon)
| | - Alexis Guédon
- Department of Neurology, Hôpital Lariboisière, University of Paris, France (E.H., A. Guédon)
| | - Noémie Ligot
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium (N. Ligot, B. Mine)
| | - Benjamin Mine
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium (N. Ligot, B. Mine)
| | - Arturo Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, France (A. Consoli, B.L.)
| | - Bertrand Lapergue
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, France (A. Consoli, B.L.)
| | | | - Xabier Urra
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Catalonia, Spain (X.U., A.R.)
| | - Alejandro Rodriguez
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Catalonia, Spain (X.U., A.R.)
| | - Federico Bolognini
- Interventional Neuroradiology Department, CHRU Colmar, France (F.B., P.A.L.)
| | | | - Anne Pasco-Papon
- Department of Radiology, University Hospital of Angers, France (A.P.-P.)
| | - Sophie Godard
- Department of Neurology, Angers University Hospital, France (S.G.)
| | - Gaultier Marnat
- Interventional Neuroradiology Department, CHRU Bordeaux, France (G.M.)
| | - Igor Sibon
- Stroke Unit, Department of Neurology, Bordeaux University, CHRU Bordeaux; France (I.S.)
| | - Nicola Limbucci
- Department of Interventional Neuroradiology, University of Florence, Italy (N. Limbucci, S.N.)
| | - Patrizia Nencini
- Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy (P.N.)
| | - Sergio Nappini
- Department of Interventional Neuroradiology, University of Florence, Italy (N. Limbucci, S.N.)
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S., V. Caldiera)
| | - Valentina Caldiera
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S., V. Caldiera)
| | - Daniele Romano
- Department of Neuroradiology, "San Giovanni di Dio e Ruggi d'Aragona" Hospital, Salerno, Italy (D.R., G.F.)
| | - Giulia Frauenfelder
- Department of Neuroradiology, "San Giovanni di Dio e Ruggi d'Aragona" Hospital, Salerno, Italy (D.R., G.F.)
| | - Ivan Gallesio
- Department of Radiology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy (I.G., G. Gola)
| | - Giuliano Gola
- Department of Radiology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy (I.G., G. Gola)
| | - Roberto Menozzi
- Headache Centre, Department of Medicine and Surgery, Parma, Italy (R.M., A. Genovese)
| | - Antonio Genovese
- Headache Centre, Department of Medicine and Surgery, Parma, Italy (R.M., A. Genovese)
| | - Alberto Terrana
- Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy (A.T., A. Giorgianni)
| | - Andrea Giorgianni
- Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy (A.T., A. Giorgianni)
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., R.A.)
| | - Raffaele Augelli
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., R.A.)
| | - Paolo Invernizzi
- Neuroradiology and Neurology Units, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (P.I., M. Pavia)
| | - Marco Pavia
- Neuroradiology and Neurology Units, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (P.I., M. Pavia)
| | - Elvis Lafe
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.)
| | - Anna Cavallini
- Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini)
| | - Alessia Giossi
- SC Neurologia, Dipartimento Interaziendale Neuroscienze, Cremona, Italy (A. Giossi, M.B.)
| | - Michele Besana
- SC Neurologia, Dipartimento Interaziendale Neuroscienze, Cremona, Italy (A. Giossi, M.B.)
| | - Luca Valvassori
- Department of Neuroradiology, ASST Monza, Italy (L.V., A.M.)
| | - Antonio Macera
- Department of Neuroradiology, ASST Monza, Italy (L.V., A.M.)
| | - Lucio Castellan
- RCCS Ospedale Policlinico San Martino, Genova, Italia (L.C., G.S.)
| | | | - Fortunato Di Caterino
- Department of Neuroradiology and Endovascular Therapy, Besancon, France (F.D.C., A.B.)
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Besancon, France (F.D.C., A.B.)
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France (C.A.)
| | - Julien Lebreuche
- Department of Biostatistics, University of Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.)
| | | | - Alfio Cannella
- ARNAS Garibaldi, Catania, Italy (G. Galvano, A. Cannella)
| | - Mirco Cosottini
- Neuroradiology Unit, Ospedale Cisanello, Pisa, Italy (M.C., G.L.)
| | - Guido Lazzarotti
- Neuroradiology Unit, Ospedale Cisanello, Pisa, Italy (M.C., G.L.)
| | | | | | - Rossana Tassi
- Interventional Neuroradiology and Stroke Units, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (R.T., S.B.)
| | - Sandra Bracco
- Interventional Neuroradiology and Stroke Units, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (R.T., S.B.)
| | - Elena Bianchini
- Neuroradiology Unit, ASST West Milan, Legnano Hospital (E.B., C.M.)
| | - Camilla Micieli
- Neuroradiology Unit, ASST West Milan, Legnano Hospital (E.B., C.M.)
| | - Rosario Pascarella
- Neuroradiology Unit, IRCCS Santa Maria Nuova, Hospital Reggio Emilia (R.P. M.N.)
| | - Manuela Napoli
- Neuroradiology Unit, IRCCS Santa Maria Nuova, Hospital Reggio Emilia (R.P. M.N.)
| | - Francesco Causin
- Interventional Neuroradiology Unit and Stroke Unit, Padova, Italy (F. Causin)
| | - Hubert Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle du CHU de Nantes, France (H.D.)
| | - François Cotton
- Department of Diagnostic and Interventional Neuroradiology, Hospices Civils, Lyon, France (O.F.E., V.D., F. Cotton)
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France (F. Cagnazzo, V. Costalat)
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Limbucci N, Leone G, Renieri L, Nappini S, Cagnazzo F, Laiso A, Muto M, Mangiafico S. Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas. Neurosurgery 2020; 86:S85-S94. [PMID: 31838532 PMCID: PMC6911737 DOI: 10.1093/neuros/nyz334] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the “off-label” use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.
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Affiliation(s)
- Nicola Limbucci
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Giuseppe Leone
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy.,Department of Neuroradiology, Cardarelli Hospital, Naples, Italy
| | - Leonardo Renieri
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Sergio Nappini
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Federico Cagnazzo
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Laiso
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Mario Muto
- Department of Neuroradiology, Cardarelli Hospital, Naples, Italy
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Cagnazzo F, Arquizan C, Derraz I, Dargazanli C, Lefevre PH, Riquelme C, Gaillard N, Mourand I, Gascou G, Bonafe A, Costalat V. Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature. J Neurol 2020; 268:2656-2665. [PMID: 33125542 PMCID: PMC7597753 DOI: 10.1007/s00415-020-10285-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 05/18/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
Objective To perform an updated review of the literature on the neurological manifestations of COVID-19-infected patients Methods A PRISMA-guideline-based systematic review was conducted on PubMed, EMBASE, and SCOPUS. Series reporting neurological manifestations of COVID-19 patients were studied. Results 39 studies and 68,361 laboratory-confirmed COVID-19 patients were included. Up to 21.3% of COVID-19 patients presented neurological symptoms. Headache (5.4%), skeletal muscle injury (5.1%), psychiatric disorders (4.6%), impaired consciousness (2.8%), gustatory/olfactory dysfunction (2.3%), acute cerebrovascular events (1.4%), and dizziness (1.3%), were the most frequently reported neurological manifestations. Ischemic stroke occurred among 1.3% of COVID-19 patients. Other less common neurological manifestations were cranial nerve impairment (0.6%), nerve root and plexus disorders (0.4%), epilepsy (0.7%), and hemorrhagic stroke (0.15%). Impaired consciousness and acute cerebrovascular events were reported in 14% and 4% of patients with a severe disease, respectively, and they were significantly higher compared to non-severe patients (p < 0.05). Individual patient data from 129 COVID-19 patients with acute ischemic stroke (AIS) were extracted: mean age was 64.4 (SD ± 6.2), 78.5% had anterior circulation occlusions, the mean NIHSS was 15 (SD ± 7), and the intra-hospital mortality rate was 22.8%. Admission to the intensive care unit (ICU) was required among 63% of patients. Conclusion This updated review of literature, shows that headache, skeletal muscle injury, psychiatric disorders, impaired consciousness, and gustatory/olfactory dysfunction were the most common neurological symptoms of COVID-19 patients. Impaired consciousness and acute cerebrovascular events were significantly higher among patients with a severe infection. AIS patients required ICU admission in 63% of cases, while intra-hospital mortality rate was close to 23%. Electronic supplementary material The online version of this article (10.1007/s00415-020-10285-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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Cagnazzo F, Lefevre PH, Derraz I, Dargazanli C, Gascou G, di Carlo DT, Perrini P, Ahmed R, Hak JF, Riquelme C, Bonafe A, Costalat V. Flow-Diversion Treatment for Unruptured Nonsaccular Intracranial Aneurysms of the Posterior and Distal Anterior Circulation: A Meta-Analysis. AJNR Am J Neuroradiol 2020; 41:134-139. [PMID: 31924605 DOI: 10.3174/ajnr.a6352] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/14/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Treatment management and outcomes of unruptured nonsaccular aneurysms are different compared with their saccular counterparts. PURPOSE Our aim was to analyze the outcomes after flow diversion among nonsaccular unruptured lesions. DATA SOURCES A systematic search of 3 data bases (2005-2019) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION We included studies reporting flow diversion for nonsaccular unruptured aneurysms of the posterior and distal anterior circulations. Anterior circulation lesions were included if located distal to the petrocavernous and supraclinoid ICA (MCA, A1, anterior communicating artery, A2). Giant dolichoectatic holobasilar lesions were excluded because of their poor treatment outcomes. DATA ANALYSIS Aneurysm occlusion and complication rates were calculated (random effects meta-analysis). DATA SYNTHESIS We included 15 studies (213 aneurysms). The long-term adequate occlusion rate was 85.3% (137/168; 95% CI, 78.2%-92.4%; I2 = 42.3%). Treatment-related complications were 17.4% (41/213; 95% CI, 12.45%-22.4%; I2 = 0%). Overall, 15% (37/213; 95% CI, 10%-20%; I2 = 0%) were ischemic events. Procedure-related morbidity was 8% (20/213; 95% CI, 5%-12%; I2 = 0%). Fusiform or dissecting types had comparable adequate occlusion (116/146 = 83%; 95% CI, 74%-92%; I2 = 48% versus 33/36 = 89%; 95% CI, 80%-98%; I2 = 0%; P = .31) and complication rates (35/162 = 17%; 95% CI, 10%-25%; I2 = 24% versus 11/51 = 19%; 95% CI, 10%-31%; I2 = 0%; P = .72). Aneurysm size (>10 versus ≤10 mm) was independently associated with a higher rate of complications (OR = 6.6; 95% CI, 1.3-15; P = .02). The rate of ischemic events after discontinuation of the antiplatelet therapy was 5% (5/93; 95% CI, 2%-9%; I2 = 0%). LIMITATIONS Small and retrospective studies were available for this meta-analysis. CONCLUSIONS Unruptured nonsaccular aneurysms located in the posterior and distal anterior circulations can be effectively treated with flow diversion. Nevertheless, treatment-related complications are not negligible, with about 15% ischemic events and 8% morbidity. Larger size (>10 mm) significantly increases the risk of procedure-related adverse events.
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Affiliation(s)
- F Cagnazzo
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - P-H Lefevre
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - I Derraz
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - D T di Carlo
- Department of Neurosurgery (D.T.d.C., P.P.), University of Pisa, Pisa, Italy
| | - P Perrini
- Department of Neurosurgery (D.T.d.C., P.P.), University of Pisa, Pisa, Italy
| | - R Ahmed
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - J F Hak
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - C Riquelme
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - A Bonafe
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (F.C., P.-H.L., I.D., C.D., G.G., R.A., J.F.H., C.R., A.B., V.C.), CHU Gui De Chauliac, Montpellier, France
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Di Carlo DT, Capo G, Fava A, Cagnazzo F, Margil-Sànchez M, Champagne PO, Voormolen EHJ, Morganti R, Froelich S, Perrini P. Petroclival meningiomas: the risk of post-operative cranial nerve deficits among different surgical approaches-a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162:2135-2143. [PMID: 32424566 DOI: 10.1007/s00701-020-04395-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The surgical resection of petroclival meningiomas (PCMs) remains a challenge. Both the relationship with neurovascular structures and the deep location of the tumor can affect the extent of resection and the rate of post-operative morbidity. METHODS The authors performed a systematic review and meta-analysis of the literature examining the rate of new cranial nerve (CN) deficits after resection of PCM. A systematic search of two databases was performed for studies published between 1990 and 2018. Random-effect meta-analysis was used to pool the rate of post-operative CN deficits, mortality rate, and rate of radical resection. RESULTS We included twelve studies and 334 patients harboring PCM. The overall rate of complete resection was 68% (95% CI 57.9-78.2%; p < 0.01; I2 = 83%). The rate of early and late post-operative CN deficits was the following: 3.8 and 2.7% (III CN), 6.6 and 3% (IV), 7.3 and 5.5% (V CN), 8 and 3.6% (VI CN), 8.9 and 8.9%% (VIII), and 4 and 2.7% (IX-XI CNs) (I2 = 0%, and p < 0.01 for all analyses). The risk of post-operative deficit of the IV CN was higher among the petrosal group (7.6%; I2 = 0% vs 2.1%; I2 = 0%), whereas the impairment of VII CN function was higher among retrosigmoid group (16.6%; I2 = 64.6% vs 11.4%; I2 = 52.8%), but it was transient in the majority of cases. CONCLUSIONS This systematic review and meta-analysis provides a detailed overview of post-operative CN deficits ensuing surgical resection of PCMs. These findings should be acknowledged when counseling patients with PCMs regarding the more appropriate approach for their tumor.
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Affiliation(s)
- Davide Tiziano Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy.
- Neurosurgical Department, Lariboisière Hospital, Université Paris Diderot, Paris, France.
| | - Gabriele Capo
- Neurosurgical Department, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - Arianna Fava
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
- Neurosurgical Department, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - Federico Cagnazzo
- Neuroradiology Department, University Hospital Gui-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Miguel Margil-Sànchez
- Neurosurgical Department, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | | | - Eduard H J Voormolen
- Neurosurgical Department, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Sébastien Froelich
- Neurosurgical Department, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
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Mahmoudi M, Dargazanli C, Cagnazzo F, Derraz I, Arquizan C, Wacogne A, Labreuche J, Bonafe A, Sablot D, Lefevre PH, Gascou G, Gaillard N, Scott C, Costalat V, Mourand I. Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol 2020; 41:1670-1676. [PMID: 32819893 DOI: 10.3174/ajnr.a6741] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Clinical outcomes after endovascular treatment for acute basilar artery occlusions need further investigation. Our aim was to analyze predictors of a 90-day good functional outcome defined as mRS 0-2 after endovascular treatment in MR imaging-selected patients with acute basilar artery occlusions. MATERIALS AND METHODS We analyzed consecutive MR imaging-selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b-3 and 3, respectively. Outcome at 90 days was analyzed in univariate and multivariate analysis regarding baseline patient treatment characteristics and periprocedural outcomes. RESULTS One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases (n = 90; 95% CI, 73.3%-88.6%). At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes (interquartile range, 280-540 minutes). In multivariable analysis, complete reperfusion (OR = 6.59; 95% CI, 2.17-20.03), lower pretreatment NIHSS (OR = 0.77; 95% CI, 0.64-0.94), the presence of posterior communicating artery collateral flow (OR = 2.87; 95% CI, 1.05-7.84), the absence of atrial fibrillation (OR = 0.18; 95% CI, 0.03-0.99), and intravenous thrombolysis administration (OR = 2.75; 95% CI, 1.04-7.04) were associated with 90-day favorable outcome. CONCLUSIONS In our series of MR imaging-selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome.
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Affiliation(s)
- M Mahmoudi
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - F Cagnazzo
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - I Derraz
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Arquizan
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - A Wacogne
- Neurology Department (A.W.), Centre Hospitalier Universitaire Caremeau, Nimes, France
| | - J Labreuche
- Biostatistics Department (J.L.), Centre Hospitalier Universitaire Lille, Lille, France
| | - A Bonafe
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - D Sablot
- Neurology Department (D.S.), Centre Hospitalier de Perpignan, Perpignan, France
| | - P H Lefevre
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - N Gaillard
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Scott
- Department of Reanimation (C.S.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - I Mourand
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
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Cagnazzo F, Zannoni R, Lefevre PH, Dargazanli C, Derraz I, Gascou G, Riquelme C, Bonafe A, Costalat V. A symptomatic atherosclerotic persistent pharyngo-hyo-stapedial artery: Treatment management and embryological considerations. Interv Neuroradiol 2020; 26:675-680. [PMID: 32746662 DOI: 10.1177/1591019920949095] [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: 11/17/2022] Open
Abstract
The stapedial artery (SA) is an embryonic vessel connecting the internal carotid artery (ICA) to the branches of the future external carotid artery (ECA). It passes through the primordium of the stapes that progressively develops around the SA. Normally, SA disappears during the tenth week in utero. Approximately 0.4% of the population can have a persistent SA. It can persist as four types of embryological variations, of which the pharyngo-hyo-stapedial variant has been rarely described before. We reported a case of a 61-year-old woman presented with transient ischemic attacks (TIAs). Computed tomography angiography showed an unusual "duplicated" aspect of the left ICA. Digital subtraction angiography depicted a persistent pharyngo-hyo-stapedial artery with an atherosclerotic wall and was considered the cause of the TIAs. After failure of the antiplatelet therapy in preventing recurrent TIAs, stenting of the artery was planned and successfully performed. Patient was asymptomatic during 12-month follow-up. The pharyngo-hyo-stapedial artery is a very rare variation in which the SA is supplied by the inferior tympanic (rising from the ascending pharyngeal artery) and the hyoid artery (rising from the ICA). To our knowledge, this is a unique case of a pharyngo-hyo-stapedial artery in a patient presenting associated ischemic symptoms. Radiological and embryological findings are discussed.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Riccardo Zannoni
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Pierre-Henri Lefevre
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Imad Derraz
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Gegory Gascou
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Carlos Riquelme
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Alain Bonafe
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
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Cagnazzo F, Chalard K, Lefevre PH, Garnier O, Derraz I, Dargazanli C, Gascou G, Riquelme C, Bonafe A, Perrini P, Di Carlo DT, Morganti R, Le Corre M, Pavillard F, Perrigault PF, Costalat V. Optimal intracranial pressure in patients with aneurysmal subarachnoid hemorrhage treated with coiling and requiring external ventricular drainage. Neurosurg Rev 2020; 44:1191-1204. [PMID: 32458277 DOI: 10.1007/s10143-020-01322-2] [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: 02/25/2020] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Abstract
Optimal management of intracranial pressure (ICP) among aneurysmal subarachnoid hemorrhage (aSAH) patients requiring external ventricular drainage (EVD) is controversial. To analyze predictors of delayed cerebral ischemia (DCI)-related cerebral infarction after aSAH and the influence of ICP values on DCI, we prospectively collected consecutive patients with aSAH receiving coiling and requiring EVD. Predictors of DCI-related cerebral infarction (new CT hypodensities developed within the first 3 weeks not related to other causes) were studied. Vasospasm and brain hypoperfusion were studied with CT angiography and CT perfusion (RAPID-software). Among 50 aSAH patients requiring EVD, 21 (42%) developed DCI-related cerebral infarction, while 27 (54%) presented vasospasm. Mean ICP ranged between 2 and 19 mmHg. On the multivariate analysis, the mean ICP (OR = 2, 95%CI = 1.01-3.9, p = 0.042) and the mean hypoperfusion volume on Tmax delay > 6 (OR = 1.2, 95%CI = 1.01-1.3, p = 0.025) were independent predictors of DCI. To predict DCI-related cerebral infarction, Tmax delay > 6 s presented the highest AUC (0.956, SE = 0.025), with a cutoff value of 18 ml showing sensitivity, specificity, PPV, NPV, and accuracy of 90.5% (95%CI = 69-98.8%), 86.2% (95%CI = 68.4-96%), 82.6% (95%CI = 65.4-92%), 92.5% (95%CI = 77-98%), and 88% (95%CI = 75-95%), respectively. The AUC of the mean ICP was 0.825 (SE = 0.057), and the best cutoff value was 6.7 mmHg providing sensitivity, specificity, PPV, NPV, and accuracy of 71.4% (95%CI = 48-89%), 62% (95%CI = 42-79%), 58% (95%CI = 44-70%), 75% (95%CI = 59-86%), and 66% (95%CI = 51-79%) for the prediction of DCI-related cerebral infarction, respectively. Among aSAH patients receiving coiling and EVD, lower ICP (< 6.7 mmHg in our study) could potentially be beneficial in decreasing DCI-related cerebral infarction. Brain hypoperfusion with a volume > 18 ml at Tmax delay > 6 s presents a high sensibility and specificity in prediction of DCI-related cerebral infarction.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France.
| | - Kevin Chalard
- Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Pierre-Henri Lefevre
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Ocean Garnier
- Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Imad Derraz
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Gregory Gascou
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Carlos Riquelme
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Alain Bonafe
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Paolo Perrini
- Department of Neurosurgery, University of Pisa, Pisa, Italy
| | | | | | - Marine Le Corre
- Service de neurochirurgie, Centre hospitalier universitaire de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
| | - Frederique Pavillard
- Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Pierre-Francois Perrigault
- Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Vincent Costalat
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
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