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Legrand L, Le Berre A, Seners P, Benzakoun J, Ben Hassen W, Lion S, Boulouis G, Cottier JP, Costalat V, Bracard S, Berthezene Y, Ozsancak C, Provost C, Naggara O, Baron JC, Turc G, Oppenheim C. FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters. AJNR Am J Neuroradiol 2023; 44:26-32. [PMID: 36521962 PMCID: PMC9835925 DOI: 10.3174/ajnr.a7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.
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Affiliation(s)
- L Legrand
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - A Le Berre
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - P Seners
- Department of Neurology (P.S.), Hôpital Fondation Rothschild, Paris, France
| | - J Benzakoun
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - W Ben Hassen
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - S Lion
- Edmus Services (S.L.), Fondation Edmus, Lyon, France
| | - G Boulouis
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - J-P Cottier
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - V Costalat
- Department of Interventional Neuroradiology (V.C.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S Bracard
- Department of Diagnostic and Interventional Neuroradiology (S.B.), University Hospital of Nancy, Institut National de la Santé et de la Recherche Médicale U947, Nancy, France
| | - Y Berthezene
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Lyon, France
| | - C Ozsancak
- Department of Neurology (C. Ozsancak), Orleans Hospital, Orleans, France
| | - C Provost
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - O Naggara
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - J-C Baron
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - G Turc
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - C Oppenheim
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
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Raymond J, Iancu D, Boisseau W, Diestro JDB, Klink R, Chagnon M, Zehr J, Drake B, Lesiuk H, Weill A, Roy D, Bojanowski MW, Chaalala C, Rempel JL, O'Kelly C, Chow MM, Bracard S, Darsaut TE. Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial. AJNR Am J Neuroradiol 2022; 43:1244-1251. [PMID: 35926886 PMCID: PMC9451626 DOI: 10.3174/ajnr.a7597] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion is a recent endovascular treatment for intracranial aneurysms. We compared the safety and efficacy of flow diversion with the alternative standard management options. MATERIALS AND METHODS A parallel group, prerandomized, controlled, open-label pragmatic trial was conducted in 3 Canadian centers. The trial included all patients considered for flow diversion. A Web-based platform 1:1 randomly allocated patients to flow diversion or 1 of 4 alternative standard management options (coiling with/without stent placement, parent vessel occlusion, surgical clipping, or observation) as prespecified by clinical judgment. Patients ineligible for alternative standard management options were treated with flow diversion in a registry. The primary safety outcome was death or dependency (mRS > 2) at 3 months. The composite primary efficacy outcome included the core lab-determined angiographic presence of a residual aneurysm, aneurysm rupture, progressive mass effect during follow-up, or death or dependency (mRS > 2) at 3-12 months. RESULTS Between May 2011 and November 2020, three hundred twenty-three patients were recruited: Two hundred seventy-eight patients (86%) had treatment randomly allocated (139 to flow diversion and 139 to alternative standard management options), and 45 (14%) received flow diversion in the registry. Patients in the randomized trial frequently had unruptured (83%), large (52% ≥10 mm) carotid (64%) aneurysms. Death or dependency at 3 months occurred in 16/138 patients who underwent flow diversion and 12/137 patients receiving alternative standard management options (relative risk, 1.33; 95% CI, 0.65-2.69; P = .439). A poor primary efficacy outcome was found in 30.9% (43/139) with flow diversion and 45.6% (62/136) of patients receiving alternative standard management options, with an absolute risk difference of 14.7% (95% CI, 3.3%-26.0%; relative risk, 0.68; 95% CI, 0.50-0.92; P = .014). CONCLUSIONS For patients with mostly unruptured, large, anterior circulation (carotid) aneurysms, flow diversion was more effective than the alternative standard management option in terms of angiographic outcome.
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Affiliation(s)
- J Raymond
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - D Iancu
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
- Departments of Radiology (D.I.)
| | - W Boisseau
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - J D B Diestro
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - R Klink
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - M Chagnon
- Department of Mathematics and Statistics (M.C., J.Z.), Université de Montréal, Montreal, Canada
| | - J Zehr
- Department of Mathematics and Statistics (M.C., J.Z.), Université de Montréal, Montreal, Canada
| | - B Drake
- Surgery (B.D., H.L.), Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - H Lesiuk
- Surgery (B.D., H.L.), Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - A Weill
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - D Roy
- From the Department of Radiology (J.R., D.I., W.B., J.D.B.D., R.K., A.W., D.R.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - M W Bojanowski
- Department of Neurosurgery (M.W.B., C.C.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - C Chaalala
- Department of Neurosurgery (M.W.B., C.C.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | | | - C O'Kelly
- Surgery (C.O., M.M.C., T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - M M Chow
- Surgery (C.O., M.M.C., T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - S Bracard
- Neuroradiology (S.B.), CHRU de Nancy, Nancy, Lorraine, France
| | - T E Darsaut
- Surgery (C.O., M.M.C., T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Derraz I, Pou M, Labreuche J, Legrand L, Soize S, Tisserand M, Rosso C, Piotin M, Boulouis G, Oppenheim C, Naggara O, Bracard S, Clarençon F, Lapergue B, Bourcier R. Clot Burden Score and Collateral Status and Their Impact on Functional Outcome in Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:42-48. [PMID: 33184069 DOI: 10.3174/ajnr.a6865] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Collateral status and thrombus length have been independently associated with functional outcome in patients with acute ischemic stroke. It has been suggested that thrombus length would influence functional outcome via interaction with the collateral circulation. We investigated the individual and combined effects of thrombus length assessed by the clot burden score and collateral status assessed by a FLAIR vascular hyperintensity-ASPECTS rating system on functional outcome (mRS). MATERIALS AND METHODS Patients with anterior circulation acute ischemic stroke due to large-vessel occlusion from the ASTER and THRACE trials treated with endovascular thrombectomy were pooled. The clot burden score and FLAIR vascular hyperintensity score were determined on MR imaging obtained before endovascular thrombectomy. Favorable outcome was defined as an mRS score of 0-2 at 90 days. Association of the clot burden score and the FLAIR vascular hyperintensity score with favorable outcome (individual effect and interaction) was examined using logistic regression models. RESULTS Of the 326 patients treated by endovascular thrombectomy with both the clot burden score and FLAIR vascular hyperintensity assessment, favorable outcome was observed in 165 (51%). The rate of favorable outcome increased with clot burden score (smaller clots) and FLAIR vascular hyperintensity (better collaterals) values. The association between clot burden score and functional outcome was significantly modified by the FLAIR vascular hyperintensity score, and this association was stronger in patients with good collaterals, with an adjusted OR = 6.15 (95% CI, 1.03-36.81). CONCLUSIONS The association between the clot burden score and functional outcome varied for different collateral scores. The FLAIR vascular hyperintensity score might be a valuable prognostic factor, especially when contrast-based vascular imaging is not available.
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Affiliation(s)
- I Derraz
- From the Department of Neuroradiology (I.D.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - M Pou
- Department of Neuroradiology (M.P., F.C.)
| | - J Labreuche
- Santé publique: épidémiologie et qualité des soins (J.L.), University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - L Legrand
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - S Soize
- Department of Neuroradiology (S.S.), Centre Hospitalier Universitaire Reims, Reims, France
| | | | - C Rosso
- Institut du Cerveau et de la Moelle épinière (C.R.), Sorbonne Université, Institut du Cerveau, National Institute for Health and Medical Research U 1127, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology (M.P.), Rothschild Fondation, Paris, France
| | - G Boulouis
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - C Oppenheim
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - O Naggara
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - S Bracard
- Department of Neuroradiology (S.B.), Regional and University Hospital Centre Nancy, Nancy, France
| | | | - B Lapergue
- Stroke Center (B.L.), Foch Hospital, Suresnes, France
| | - R Bourcier
- Department of Diagnostic and Interventional Neuroradiology (R.B.), Guillaume et René Laennec University Hospital, Nantes, France
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Riou-Comte N, Guillemin F, Gory B, Lapergue B, Zhu F, Soudant M, Piotin M, Humbertjean L, Mione G, Lacour JC, Anxionnat R, Hossu G, Bracard S, Richard S. Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy. Eur J Neurol 2020; 28:141-151. [PMID: 32916042 DOI: 10.1111/ene.14509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis plus mechanical thrombectomy (IVT + MT) is the best current management of acute stroke due to large-vessel occlusion and results in optimal reperfusion for most patients. Nevertheless, some of these patients do not subsequently achieve functional independence. The aim was to identify baseline factors associated with 3-month independence after optimal reperfusion and to validate a prediction model. METHODS All consecutive patients with intracranial anterior large-vessel occlusion, with indication for IVT + MT and achieving optimal reperfusion (defined as modified Treatment in Cerebral Ischaemia score 2b-3), from the THRACE trial and the ETIS registry, were included in order to identify a prediction model. The primary outcome was 3-month independence [modified Rankin Scale (mRS) score ≤ 2]. Multivariate inferences invoked forward logistic regression, multiple imputation and bootstrap resampling. Predictive performance was assessed by c-statistic. Model validation was conducted on patients from the ASTER trial. RESULTS Amongst 139 patients (mean age 65.5 years; 54.3% female), predictors of 3-month mRS ≤ 2 (n = 82) were younger age [odds ratio 0.62 per 10-year increase; 95% confidence interval (CI) 0.53-0.72] and higher Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (odds ratio 1.65 per 1-point increase; 95% CI 1.47-1.86) with c-statistic 0.77. Model validation (n = 104/181 patients with 3-month mRS ≤ 2) demonstrated a moderate discrimination (c-statistic 0.74; 95% CI 0.66-0.81) combining age and ASPECTS. The validation model was improved by the adjunction of three candidate variables that were found to be predictors. Addition of baseline National Institutes of Health Stroke Scale (NIHSS) score, history of vascular risk factor and onset-to-reperfusion time significantly improved discrimination (c-statistic 0.85; 95% CI 0.83-0.87). CONCLUSIONS After optimal reperfusion, younger age, higher ASPECTS, lower NIHSS score, shorter onset-to-reperfusion time and absence of vascular risk factor were predictive of independence and could help to guide patient management.
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Affiliation(s)
| | - F Guillemin
- Clinical Investigation Centre 1433, INSERM, University Hospital, Université de Lorraine, Nancy, France
| | - B Gory
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - B Lapergue
- Stroke Center, Foch Hospital, Suresnes, France
| | - F Zhu
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - M Soudant
- Clinical Investigation Centre 1433, INSERM, University Hospital, Université de Lorraine, Nancy, France
| | - M Piotin
- Neuroradiology, Fondation Ophtalmologique Rothschild, Paris, France
| | | | - G Mione
- Stroke Unit, University Hospital, Nancy, France
| | - J-C Lacour
- Stroke Unit, University Hospital, Nancy, France
| | - R Anxionnat
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - G Hossu
- Clinical Investigation Centre 1433, INSERM, University Hospital, Université de Lorraine, Nancy, France.,Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - S Bracard
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - S Richard
- Stroke Unit, University Hospital, Nancy, France
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Riou-Comte N, Guillemin F, Gory B, Zhu F, Soudant M, Hossu G, Bracard S, Richard S. Facteurs prédictifs d’une indépendance fonctionnelle après infarctus cérébral sur occlusion artérielle proximale. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Proust F, Bracard S, Thines L, Pelissou-Guyotat I, Leclerc X, Penchet G, Bergé J, Morandi X, Gauvrit JY, Mourier K, Ricolfi F, Lonjon M, Sedat J, Bataille B, Drouineau J, Civit T, Magro E, Cebula H, Chassagne P, David P, Emery E, Gaberel T, Vignes JR, Aghakani N, Troude L, Gay E, Roche PH, Irthum B, Lejeune JP. Functional outcome 1 year after aneurysmal subarachnoid hemorrhage due to ruptured intracranial aneurysm in elderly patients. Neurochirurgie 2019; 66:1-8. [PMID: 31863744 DOI: 10.1016/j.neuchi.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/13/2019] [Accepted: 11/03/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Population aging raises questions about extending treatment indications in elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). We therefore assessed functional status 1 year after treatment. METHODS This study involved 310 patients, aged over 70 years, with ruptured brain aneurysm, enrolled between 2008 and 2014 in a prospective multicentre trial (FASHE study: NCT00692744) but considered unsuitable for randomisation and therefore analysed in the observational arms of the study: endovascular occlusion (EV), microsurgical exclusion (MS) and conservative treatment. The aims were to assess independence, cognition, autonomy and quality of life (QOL) at 1 year post-treatment, using questionnaires (MMSE, ADLI, IADL, EORTC-QLQ-C30) filled in by independent nurses after discharge. RESULTS The 310 patients received the following treatments: 208 underwent EV (67.1%), 54 MS (17.4%) and 48 were conservatively managed (15.5%). At 1 year, independence rates for patients admitted with good clinical status (WFNS I-III) were, according to the aneurysm exclusion procedure (EV, MS or conservative), 58.9%, 50% and 12.1% respectively. MMSE score was pathological in 26 of the 112 EV patients (23.2%), 10 of the 25 MS patients (40%) and 4 of the 9 patients treated conservatively (44%), without any statistically significant difference [Pearson's Chi2 test, F ratio=4.29; P=0.11]. Regarding QoL, overall score was similar between the EV and MS cohorts, but significantly lower with conservative treatment. CONCLUSION Elderly patients in good clinical condition with aSAH should be treated regardless of associated comorbidities. Curative treatment (EV or MS) reduced mortality without increasing dependence, in comparison with conservative treatment.
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Affiliation(s)
- F Proust
- Department of Neurosurgery, Hautepierre Hospital, Strasbourg University Hospital, 67098, Strasbourg, France; Department of Neurosurgery, Charles-Nicolle Hospital, Rouen University Hospital, 76000, Rouen, France.
| | - S Bracard
- University Hospital, neuroradiology department, 54000 Nancy, France
| | - L Thines
- University Hospital, neurosurgery department, 25000 Besancon, France
| | | | - X Leclerc
- University Hospital, neuroradiology department, 59000 Lille, France
| | - G Penchet
- University Hospital, neurosurgery department, 33000 Bordeaux, France
| | - J Bergé
- University Hospital, neurosurgery department, 33000 Bordeaux, France
| | - X Morandi
- University Hospital, neurosurgery department, 35000 Rennes, France
| | - J-Y Gauvrit
- University Hospital, neurosurgery department, 35000 Rennes, France
| | - K Mourier
- University Hospital, neurosurgery department, 21000 Dijon, France
| | - F Ricolfi
- University Hospital, neurosurgery department, 21000 Dijon, France
| | - M Lonjon
- University Hospital, neurosurgery department, 06000 Nice, France
| | - J Sedat
- University Hospital, neurosurgery department, 06000 Nice, France
| | - B Bataille
- University Hospital, neurosurgery department, 86000 Poitiers, France
| | - J Drouineau
- University Hospital, neurosurgery department, 86000 Poitiers, France
| | - T Civit
- University Hospital, neurosurgery department, 54000 Nancy, France
| | - E Magro
- University Hospital, neurosurgery department, 29000 Brest, France
| | - H Cebula
- University Hospital, neurosurgery department, 67000 Strasbourg, France
| | - P Chassagne
- University Hospital, Geriatry department, 76000 Rouen, France
| | - P David
- Bicêtre University Hospital, neurosurgery department, 94270 Le Kremlin-Bicêtre, France
| | - E Emery
- University Hospital, neurosurgery department, 14000 Caen, France
| | - T Gaberel
- University Hospital, neurosurgery department, 14000 Caen, France
| | - J R Vignes
- University Hospital, neurosurgery department, 33000 Bordeaux, France
| | - N Aghakani
- Bicêtre University Hospital, neurosurgery department, 94270 Le Kremlin-Bicêtre, France
| | - L Troude
- University Hospital, neurosurgery department, 13000 Marseille, France
| | - E Gay
- University Hospital, neurosurgery department, 38000 Grenoble, France
| | - P H Roche
- University Hospital, neurosurgery department, 13000 Marseille, France
| | - B Irthum
- University Hospital, neurosurgery department, 63000 Clermont Ferrand, France
| | - J-P Lejeune
- Lille University Hospital, neurosurgery department, 59000 Lille, France
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- Department of Neurosurgery, Hautepierre Hospital, Strasbourg University Hospital, 67098, Strasbourg, France; Department of Neurosurgery, Charles-Nicolle Hospital, Rouen University Hospital, 76000, Rouen, France
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7
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Bracard S, Liao L, Zhu F, Gory B, Anxionnat R, Braun M. The ophthalmic artery: a new variant involving two branches from the supracavernous internal carotid artery. Surg Radiol Anat 2019; 42:201-205. [PMID: 31570956 DOI: 10.1007/s00276-019-02339-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/09/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE We report an extremely rare, double ophthalmic artery configuration. METHODS We present 2D- and 3D-angiographic features of an anomalous origin of the ophthalmic artery. RESULTS The double ophthalmic artery was the result of the persistence of the primitive dorsal ophthalmic artery combined with the presence of a second orbital artery originating from the supracavernous internal carotid artery, passing through the superior orbital fissure and into the orbit to furnish the muscular, lacrimal and ethmoidal arteries and the medial long posterior ciliary artery. CONCLUSIONS A heretofore undocumented instance of ophthalmic artery duplication is presented. Knowledge of such variations is important for the planning of endovascular treatments and the comprehension of unusual angiographic images. Such fine arterial variants may very well be frequent, but difficult to demonstrate on simple 2D angiographies. Multiplanar reconstructions of 3D angiography data make it possible to diagnose rare, but embryologically predictable arterial variants.
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Affiliation(s)
- S Bracard
- Department of Diagnostic and Interventional Neuroradiology, Central Hospital, CHRU Nancy, Université de Lorraine, 29 Avenue Marechal de Lattre de Tassigny, 54035, Nancy, France. .,IADI, Inserm, Université de Lorraine, 54000, Nancy, France.
| | - L Liao
- Department of Diagnostic and Interventional Neuroradiology, Central Hospital, CHRU Nancy, Université de Lorraine, 29 Avenue Marechal de Lattre de Tassigny, 54035, Nancy, France.,Department of Anatomy, Université de Lorraine, Nancy, France
| | - F Zhu
- Department of Diagnostic and Interventional Neuroradiology, Central Hospital, CHRU Nancy, Université de Lorraine, 29 Avenue Marechal de Lattre de Tassigny, 54035, Nancy, France.,IADI, Inserm, Université de Lorraine, 54000, Nancy, France
| | - B Gory
- Department of Diagnostic and Interventional Neuroradiology, Central Hospital, CHRU Nancy, Université de Lorraine, 29 Avenue Marechal de Lattre de Tassigny, 54035, Nancy, France.,IADI, Inserm, Université de Lorraine, 54000, Nancy, France
| | - R Anxionnat
- Department of Diagnostic and Interventional Neuroradiology, Central Hospital, CHRU Nancy, Université de Lorraine, 29 Avenue Marechal de Lattre de Tassigny, 54035, Nancy, France.,IADI, Inserm, Université de Lorraine, 54000, Nancy, France
| | - M Braun
- Department of Diagnostic and Interventional Neuroradiology, Central Hospital, CHRU Nancy, Université de Lorraine, 29 Avenue Marechal de Lattre de Tassigny, 54035, Nancy, France.,Department of Anatomy, Université de Lorraine, Nancy, France.,IADI, Inserm, Université de Lorraine, 54000, Nancy, France
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8
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Finitsis S, Anxionnat R, Gory B, Planel S, Liao L, Bracard S. Susceptibility-Weighted Angiography for the Follow-Up of Brain Arteriovenous Malformations Treated with Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2019; 40:792-797. [PMID: 31023658 DOI: 10.3174/ajnr.a6053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/10/2019] [Indexed: 11/07/2022]
Abstract
The criterion standard for assessing brain AVM obliteration postradiosurgery is DSA. To explore the value of susceptibility-weighted angiography, we followed 26 patients with brain AVMs treated by radiosurgery using susceptibility-weighted angiography and DSA. Studies were evaluated by 2 independent readers for residual nidi. Susceptibility-weighted angiography demonstrated good intermodality (κ = 0.71) and interobserver (κ = 0.64) agreement, and good sensitivity (85.7%) and specificity (85.7%). Susceptibility-weighted angiography is a useful radiation- and contrast material-free technique to follow-up brain AVM obliteration postradiosurgery.
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Affiliation(s)
- S Finitsis
- AHEPA Hospital (S.F.), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - R Anxionnat
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - B Gory
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - S Planel
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - L Liao
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - S Bracard
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
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9
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Bourcier R, Derraz I, Bracard S, Oppenheim C, Naggara O. Two-Layered Susceptibility Vessel Sign and High Overestimation Ratio on MRI Are Predictive of Cardioembolic Stroke. AJNR Am J Neuroradiol 2018; 40:65-67. [PMID: 30442692 DOI: 10.3174/ajnr.a5865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/05/2018] [Indexed: 11/07/2022]
Abstract
In a prospective study among patients in the THRombectomie des Artères Cerebrales trial, we analyzed the diagnostic accuracy of 2 imaging biomarkers, the 2-layered susceptibility vessel sign and a high overestimation ratio, obtained on pretreatment brain T2* sequences, to identify cardioembolic stroke etiology (107/260 patients). In combination, these 2 biomarkers, on 1.5T or 3T systems (159 and 101 patients, respectively), demonstrated high specificity (0.77 at 1.5T and 1 at 3T) and their simultaneous presence is highly associated with cardioembolism.
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Affiliation(s)
- R Bourcier
- From the Department of Neuroradiology (R.B.), University Hospital Guillaume et René Laennec, Nantes, France .,Department of Neuroradiology (R.B.), University Hospital of Nancy, Nancy, France
| | - I Derraz
- Department of Neuroradiology and Institut National de la Santé et de la Recherche Médicale CIC 1433 Innovation Technologique (I.D., S.B.), Université Paris-Descartes, Paris, France
| | - S Bracard
- Department of Neuroradiology and Institut National de la Santé et de la Recherche Médicale CIC 1433 Innovation Technologique (I.D., S.B.), Université Paris-Descartes, Paris, France
| | - C Oppenheim
- Institut National de la Santé et de la Recherche Médicale U894 (C.O., O.N.), Sainte-Anne Hospital, Paris, France
| | - O Naggara
- Institut National de la Santé et de la Recherche Médicale U894 (C.O., O.N.), Sainte-Anne Hospital, Paris, France.,Pediatric Radiology Department (O.N.), Necker Enfants Malades, Paris, France
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10
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky 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Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Sadeh-Gonik U, Tau N, Friehmann T, Bracard S, Anxionnat R, Derelle AL, Tonnelet R, Liao L, Richard S, Armoiry X, Gory B. Thrombectomy outcomes for acute stroke patients with anterior circulation tandem lesions: a clinical registry and an update of a systematic review with meta-analysis. Eur J Neurol 2018; 25:693-700. [DOI: 10.1111/ene.13577] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/11/2018] [Indexed: 11/26/2022]
Affiliation(s)
- U. Sadeh-Gonik
- Radiology Department; Rabin Medical Center (Beilinson Campus); Petach Tikva Israel
| | - N. Tau
- Joint Department of Medical Imaging; University of Toronto; Toronto Ontario Canada
| | - T. Friehmann
- Radiology Department; Rabin Medical Center (Beilinson Campus); Petach Tikva Israel
| | - S. Bracard
- Department of Diagnostic and Interventional Neuroradiology; University Hospital of Nancy; Nancy France
- IADI; INSERM U1254; University of Lorraine; Vandoeuvre-lès-Nancy France
| | - R. Anxionnat
- Department of Diagnostic and Interventional Neuroradiology; University Hospital of Nancy; Nancy France
- IADI; INSERM U1254; University of Lorraine; Vandoeuvre-lès-Nancy France
| | - A.-L. Derelle
- Department of Diagnostic and Interventional Neuroradiology; University Hospital of Nancy; Nancy France
| | - R. Tonnelet
- Department of Diagnostic and Interventional Neuroradiology; University Hospital of Nancy; Nancy France
| | - L. Liao
- Department of Diagnostic and Interventional Neuroradiology; University Hospital of Nancy; Nancy France
| | - S. Richard
- Department of Neurology; Stroke Unit; University Hospital of Nancy; Nancy France
- Centre d'Investigation Clinique Plurithématique CIC-P 1433; INSERM U1116; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - X. Armoiry
- Hospices Civils de Lyon/UMR-CNRS 5510/MATEIS; Bron France
- Warwick Medical School; Division of Health Sciences; University of Warwick; Coventry UK
| | - B. Gory
- Department of Diagnostic and Interventional Neuroradiology; University Hospital of Nancy; Nancy France
- IADI; INSERM U1254; University of Lorraine; Vandoeuvre-lès-Nancy France
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer 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Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Raymond J, Klink R, Chagnon M, Barnwell SL, Evans AJ, Mocco J, Hoh BH, Turk AS, Turner RD, Desal H, Fiorella D, Bracard S, Weill A, Guilbert F, Lanthier S, Fox AJ, Darsaut TE, White PM, Roy D. Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial. AJNR Am J Neuroradiol 2017; 38:432-441. [PMID: 28082261 DOI: 10.3174/ajnr.a5101] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Some patients are at high risk of aneurysm recurrence after endovascular treatment: patients with large aneurysms (Patients Prone to Recurrence After Endovascular Treatment PRET-1) or with aneurysms that have previously recurred after coiling (PRET-2). We aimed to establish whether the use of hydrogel coils improved efficacy outcomes compared with bare platinum coils. MATERIALS AND METHODS PRET was an investigator-led, pragmatic, multicenter, parallel, randomized (1:1) trial. Randomized allocation was performed separately for patients in PRET-1 and PRET-2, by using a Web-based platform ensuring concealed allocation. The primary outcome was a composite of a residual/recurrent aneurysm, adjudicated by a blinded core laboratory, or retreatment, intracranial bleeding, or mass effect during the 18-month follow-up. Secondary outcomes included adverse events, mortality, and morbidity (mRS > 2). The hypothesis was that hydrogel would decrease the primary outcome from 50% to 30% at 18 months, necessitating 125 patients per group (500 for PRET-1 and PRET-2). RESULTS The trial was stopped once 250 patients in PRET-1 and 197 in PRET-2 had been recruited because of slow accrual. A poor primary outcome occurred in 44.4% (95% CI, 35.5%-53.2%) of those in PRET-1 allocated to platinum compared with 52.5% (95% CI, 43.4%-61.6%) of patients allocated to hydrogel (OR, 1.387; 95% CI, 0.838-2.295; P = .20) and in 49.0% (95% CI, 38.8%-59.1%) in PRET-2 allocated to platinum compared with 42.1% (95% CI, 32.0%-52.2%) allocated to hydrogel (OR, 0.959; 95% CI, 0.428-1.342; P = .34). Adverse events and morbidity were similar. There were 3.6% deaths (1.4% platinum, 5.9% hydrogel; P = .011). CONCLUSIONS Coiling of large and recurrent aneurysms is safe but often poorly effective according to angiographic results. Hydrogel coiling was not shown to be better than platinum.
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Affiliation(s)
- J Raymond
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
| | - R Klink
- Laboratory of Interventional Neuroradiology (R.K.), Research Centre of the Centre Hospitalier de l'Université de Montreal, Quebec, Canada
| | - M Chagnon
- Department of Mathematics and Statistics (M.C.), Université de Montréal, Montreal, Quebec, Canada
| | - S L Barnwell
- Department of Neurological Surgery (S.L.B.), Oregon Health and Science University, Portland, Oregon
| | - A J Evans
- Department of Radiology and Medical Imaging (A.J.E.), University of Virginia, Charlottesville, Virginia
| | - J Mocco
- Department of Neurosurgery (J.M.), Mount Sinai Health System, New York, New York
| | - B H Hoh
- Department of Neurosurgery (B.H.H.), University of Florida, Gainesville, Florida
| | - A S Turk
- Department of Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
| | - R D Turner
- Department of Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
| | - H Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - D Fiorella
- Cerebrovascular Center (D.F.), Stony Brook University Medical Center, Stony Brook, New York
| | - S Bracard
- Département de Neuroradiologie Diagnostique et Interventionnelle (S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - A Weill
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
| | - F Guilbert
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
| | - S Lanthier
- Neurosciences (S.L.), Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - A J Fox
- Department of Medical Imaging (A.J.F.), University of Toronto, Toronto, Ontario, Canada
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - P M White
- Stroke Research Group (P.M.W.), Institute of Neuroscience, Newcastle Upon Tyne, UK
| | - D Roy
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
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Abstract
To evaluate the interest of 3D angiography in the diagnosis, treatment and follow-up of aneurysms with special regard with endovascular GDC treatment. Spin angiography with 44 subtracted views (512×512 image matrix) is first acquired with a rotation of a C-arm through 200 degrees at 40° per second in an angiographic room prototype LCV+ single plane (GEMS). 3D reconstruction ART (Algebraic Reconstruction Technique) is automatically applied and interactive visualisation of the 3D angiography is available on a workstation (UltraSparc 2, Sun microsystems) 10 minutes after the spin angiography acquisition. 3D angiography is displayed in MIP, surface rendering and endovascular views (virtual angioscopy). 52 2D and 3D angiographies were performed in 40 patients with 49 intracranial aneurysms whith the same protocol of acquisition (AP, lateral and spin angiography). Each 3D angiography (MIP and surface rendering) was analysed by 2 senior radiologists and compared with the corresponding 2D angiographies (AP, lateral and spin views). Artefacts due to GDC were present in 24 cases, but bothering in only 12 cases. Analysis of the aneurysm was better in MIP than in 2D in 32 cases, equivalent in 18 and worse in 2 due to patient movements during acquisition. Surface rendering gave additional information in 29 cases. The impact was judged important for decision making or choice of treatment in 25 cases. 3D angiography improves the analysis of the aneurysms, gives crucial information to make the decision for treatment and is now routinely used in our institution for the diagnosis of intracranial aneurysms and follow-up after GDC treatment.
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Affiliation(s)
| | | | | | | | - Y. Trousset
- General Electric Medical Systems; Buc, France
| | - R. Vaillant
- General Electric Medical Systems; Buc, France
| | - L. Launay
- General Electric Medical Systems; Buc, France
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Bracard S, MacHo-Fernández J, Wang X, Anxionnat R, Picard L. Influence of Temperature on Embolisation with Cyanoacrylate. Interv Neuroradiol 2016; 4:301-5. [PMID: 20673426 DOI: 10.1177/159101999800400406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/1998] [Accepted: 09/20/1998] [Indexed: 11/16/2022] Open
Abstract
We evaluated the influence of temperature on the viscosity of mixtures with different histoacryl/lipiodol concentrations and on injection control, to test the radiological visualization of these mixtures. A viscosimeter was used to measure the viscosity of different histoacryl and lipiodol combinations at various temperatures. After introduction of these blends into the polyethylene tubes, their radiological densities were evaluated by means of CT and DSA. Viscosity was found to be directly proportional to the percentage of lipiodol and inversely proportional to the temperature. By digital subtraction, the mixtures were still visible when the percentage of histoacryl reached 90%. Warming histoacryl and lipiodol mixtures to a temperature that is close to 40° C decreases the mixture's viscosity significantly and makes the injection easier to manage. Tantalum and tungsten powders do not necessarly have to be added to visualize mixtures containing less than 90% histoacryl.
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Affiliation(s)
| | | | - X. Wang
- LEMTA, URA CNRS 7563; Vandoeuvre Cedex, France
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Bracard S, Anxionnat R, Da Costa E, Lebedinsky A, Scomazzoni F, Picard L. Combined Endovascular Stenting and Endosaccular Coiling for the Treatment of a Wide-Necked Intracranial Vertebral Aneurysm. Interv Neuroradiol 2016; 5:245-9. [DOI: 10.1177/159101999900500307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/1999] [Accepted: 07/25/1999] [Indexed: 11/16/2022] Open
Abstract
We describe a clinical case of the combined application of endovascular stent placement and GDCoils packing in the management of a ruptured wide necked intracranial aneurysm. A 27-year-old man had a subarachnoid haemorrhage secondary to the rupture of a large wide necked left vertebral aneurysm. This aneurysm was judged to be inoperable. A functional occlusion test failed because of poor collateral flow and combined stenting and coiling was used to occlude the aneurysm with preservation of the parent artery. A femoral approach was used. An 18 mm long ACS® Duet stent was placed across the base of aneurysm and expanded to 4mm to act as a buttress. A microcatheter was then advanced through the stent mesh and GDC's were deposited for occlusion. This technique provides new possibilities for wide-necked intracranial aneurysms. Further studies are required on the mechanical and thrombogenic properties of stents and on the long-term follow-up, but this technology may play a role in some cases of aneurysm treatment.
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Affiliation(s)
- S. Bracard
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - R. Anxionnat
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - E. Da Costa
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - A. Lebedinsky
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - F. Scomazzoni
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - L. Picard
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
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Argoullon L, Weber M, Bonneville A, Bracard S, May I. DI-010 Bleomycin sclerotherapy in vascular malformations. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Raulot L, Mione G, Hoffmann C, Bracard S, Braun M, Brunner A, Vezain A, Langard S, Lesage F, Durupt L, Richard S. Intravenous thrombolytic therapy for ischemic stroke via telemedicine compared with bedside treatment in an experienced stroke unit. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.eurtel.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Anxionnat R, Tonnelet R, Derelle AL, Liao L, Barbier C, Bracard S. Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results. Diagn Interv Imaging 2015; 96:667-75. [PMID: 26160704 DOI: 10.1016/j.diii.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- R Anxionnat
- Department of diagnostic and therapeutic neuroradiology, Neurology Hospital, Central Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy cedex, France.
| | - R Tonnelet
- Department of diagnostic and therapeutic neuroradiology, Neurology Hospital, Central Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy cedex, France
| | - A L Derelle
- Department of diagnostic and therapeutic neuroradiology, Neurology Hospital, Central Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy cedex, France
| | - L Liao
- Department of diagnostic and therapeutic neuroradiology, Neurology Hospital, Central Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy cedex, France
| | - C Barbier
- Department of diagnostic and therapeutic neuroradiology, Neurology Hospital, Central Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy cedex, France
| | - S Bracard
- Department of diagnostic and therapeutic neuroradiology, Neurology Hospital, Central Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy cedex, France
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Beuret F, Schmitt E, Planel S, Lesanne G, Bracard S. Subtentorial cerebral nocardiosis in immunocompetent patients: CT and MR imaging findings. Diagn Interv Imaging 2015; 96:953-7. [PMID: 25981212 DOI: 10.1016/j.diii.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) appearances of subtentorial nocardia cerebral abscesses developing in immunocompetent patients. PATIENTS AND METHODS The clinical findings and the results of CT and MRI examinations of three immunocompetent patients with nocardiosis located initially only in the subtentorial region were studied. Three patients underwent CT examination and two patients had MRI. RESULTS Clinically, two patients had cerebellar syndrome and the third had meningism with fever. The diagnosis of nocardiosis was bacteriologically confirmed by demonstrating the organism in lumbar puncture fluid in one patient and by an aspiration biopsy of the abscess in the other two. Two of the patients improved under targeted antibiotic therapy whereas the third patient died. The main imaging features of the lesions were a multiloculated appearance with peripheral enhancement after intravenous administration of iodinated contrast material on CT and a multicystic appearance on MRI, with a peripheral hypointense rim on T2-weighted images, a relatively minor mass effect and a multiloculated appearance on gadolinium-chelate enhanced T1-weighted images. CONCLUSION The clinical presentation of cerebral nocardiosis is relatively non-specific. A microcystic lesion surrounded by hypointensity on T2-weighted MR images with a multiloculated pattern after gadolinium chelate administration on T1-weighted MR images in association with a relatively minor mass effect should suggest this diagnosis even if the lesion is single and in the absence of immunosuppression.
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Affiliation(s)
- F Beuret
- Université de Lorraine, 54000 Nancy, France; Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France.
| | - E Schmitt
- Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - S Planel
- Université de Lorraine, 54000 Nancy, France; Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - G Lesanne
- Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - S Bracard
- Université de Lorraine, 54000 Nancy, France; IADI-Inserm U 947, Vandœuvre-lès-Nancy, France; Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
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Raymond J, Klink R, Chagnon M, Barnwell SL, Evans AJ, Mocco J, Hoh BL, Turk AS, Turner RD, Desal H, Fiorella D, Bracard S, Weill A, Guilbert F, Roy D. Patients prone to recurrence after endovascular treatment: periprocedural results of the PRET randomized trial on large and recurrent aneurysms. AJNR Am J Neuroradiol 2014; 35:1667-76. [PMID: 24948508 DOI: 10.3174/ajnr.a4035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Some patients with large or recurrent aneurysms may be at increased risk of recurrence postcoiling. The Patients Prone to Recurrence after Endovascular Treatment (PRET) trial was designed to assess whether hydrogel coils were superior to platinum coils in these high-risk patients. This article reports periprocedural safety and operator-assessed angiographic results from the PRET trial. MATERIALS AND METHODS PRET was a pragmatic, multicenter, randomized controlled trial. Patients had ≥10-mm aneurysms (PRET-1) or a major recurrence after coiling of an aneurysm of any size (PRET-2). Patients were randomly allocated to hydrogel or control arms (any platinum coil) by using concealed allocation with minimization. Assist devices could be used as clinically required. Aneurysms could be unruptured or recently ruptured. Analyses were on an intent-to-treat basis. RESULTS Four hundred forty-seven patients were recruited (250 PRET-1; 197 PRET-2). Aneurysms were recently ruptured in 29% of PRET-1 and 4% of PRET-2 patients. Aneurysms were ≥10 mm in all PRET-1 and in 50% of PRET-2 patients. They were wide-neck (≥4 mm) in 70% and in the posterior circulation in 24% of patients. Stents were used in 28% of patients (35% in PRET-2). Coiling was successful in 98%. Adverse events occurred in 28 patients with hydrogel and 23 with platinum coils. Mortality (n=2, unrelated to treatment) and morbidity (defined as mRS>2 at 1 month) occurred in 25 patients (5.6%; 12 hydrogel, 13 platinum), related to treatment in 10 (4 hydrogel; 6 platinum) (or 2.3% of 444 treated patients). No difference was seen between hydrogel and platinum for any of the indices used to assess safety up to at least 30 days after treatment. At 1 month, 95% of patients were home with a good outcome (mRS≤2 or unchanged). Operator-assessed angiographic outcomes were satisfactory (complete occlusion or residual neck) in 339 of 447 or 76.4% of patients, with no significant difference between groups. CONCLUSIONS Endovascular treatment of large and recurrent aneurysms can be performed safely with platinum or hydrogel coils.
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Affiliation(s)
- J Raymond
- From the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal Laboratory of Interventional Neuroradiology (J.R., R.K.), Centre de recherche du Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - R Klink
- Laboratory of Interventional Neuroradiology (J.R., R.K.), Centre de recherche du Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - M Chagnon
- Département de mathématiques et de statistique (M.C.), Université de Montréal, Montreal, Quebec, Canada
| | - S L Barnwell
- Department of Neurological Surgery (S.L.B.), Oregon Health & Science University, Portland, Oregon
| | - A J Evans
- Department of Radiology and Medical Imaging (A.J.E.), University of Virginia Health System, Charlottesville, Virginia
| | - J Mocco
- Department of Neurosurgery (J.M., B.L.H.), University of Florida, Gainesville, Florida
| | - B L Hoh
- Department of Neurosurgery (J.M., B.L.H.), University of Florida, Gainesville, Florida
| | - A S Turk
- Departments of Radiology and Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
| | - R D Turner
- Departments of Radiology and Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
| | - H Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - D Fiorella
- Department of Neurological Surgery (D.F.), Stony Brook University Medical Center, Stony Brook, New York
| | - S Bracard
- Département de Neuroradiologie Diagnostique et Interventionnelle (S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - A Weill
- From the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
| | - F Guilbert
- From the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
| | - D Roy
- From the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
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Watfa G, Heck O, Micard E, Lamiral Z, Hossu G, Felblinger J, Rossignol P, Benetos A, Zannad F, Bracard S. P076: Analysis of MRI-DTI diffusion values as an alternative to the Fazekas score. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Martin C, Bracard S, Garbacz M. Hémorragie sous arachnoïdienne : amélioration de la prise en charge de la douleur en neuroradiologie clinique. Retour d’expérience. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heck O, Anxionnat R, Bracard S, Cai X, Han S, Feske S, Chou S. Pearls & Oy-sters: Small but consequential: Intracerebral hemorrhage caused by lenticulostriate artery aneurysm. Neurology 2013; 81:1881. [DOI: 10.1212/01.wnl.0000435757.50996.ae] [Citation(s) in RCA: 5] [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: 11/15/2022] Open
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Bracard S, Barbier C, Derelle A, Anxionnat R. Endovascular treatment of aneurisms: Pre, intra and post operative management. Eur J Radiol 2013; 82:1633-7. [DOI: 10.1016/j.ejrad.2013.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
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Calvet D, Bracard S, Mas JL. [Treatment of arterial and venous brain ischemia. Experts' recommendations: stroke management in the intensive care unit]. Rev Neurol (Paris) 2012; 168:512-21. [PMID: 22647807 DOI: 10.1016/j.neurol.2012.01.587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 12/30/2011] [Accepted: 01/03/2012] [Indexed: 12/20/2022]
Abstract
With thrombolysis, intravenous alteplase (0.9 mg/kg body weight, maximum 90 mg), with 10% of the dose given as a bolus followed by a 60-minute infusion, is recommended within 4.5 hours of onset of ischemic stroke. When indicated, intravenous thrombolysis must be initiated as soon as possible. It is possible to use intravenous alteplase in patients with seizures at stroke onset, if the neurological deficit is related to acute cerebral ischemia. Intravenous alteplase can be discussed for use on a case-by-case basis, according to risk of bleeding, in selected patients under 18 years and over 80 years of age, although for the current European recommendations this would be an off-label use. In hospitals with a stroke unit, intravenous thrombolysis is prescribed by a neurologist (current French labelling) or a physician having the French certification for neurovascular diseases (outside the current French labelling). The patient must be monitored in the stroke unit or in case of multiple organ failure in an intensive and critical care unit. In hospitals without a stroke unit, thrombolysis must be decided by the neurologist from the corresponding stroke unit via telemedicine. It is recommended to perform brain imaging 24 hours after thromboysis. Intra-arterial thrombolysis can be contemplated on a case-by-case basis after multidisciplinary discussion within a 6-hour time window for patients with acute middle cerebral artery or carotid occlusions, and within a larger time window for patients with basilar artery occlusion, because of their very poor spontaneous prognosis. Mechanical thrombectomy can also be contemplated in the same situations. With antiplatelet agents, it is recommended that patients receive aspirin (160 mg-325 mg) within 48 hours of ischemic stroke onset. When thrombolysis is performed or contemplated, it is recommended to delay the initiation of aspirin or other antithrombotic drugs for 24 hours. The use of antiplatelet agents that inhibit the glycoprotein IIb/IIIa receptor is not recommended. Urgent anticoagulation using heparin, low-molecular-weight heparins or danaparoid with the goal to treat ischemic stroke patients is not recommended. Secondary prevention by anticoagulation can be used, immediately or within the first days, after minor ischemic stroke or TIA in patients with a high risk for cardioembolism, if uncontrolled hypertension is absent. In patients with large infarcts and a high risk for cardioembolism, the timing for initiating anticoagulation must be decided on a case-by-case basis. In patients with anticoagulation who had an ischemic stroke, the decision to temporarily stop or maintain anticoagulation must be made on a case-by-case basis, depending on thromboembolic risk, level of anticoagulation at stroke onset and estimated risk of hemorrhagic transformation. It is not recommended to use neuroprotective agents in ischemic stroke patients. Patients with cerebral venous thrombosis must be treated with therapeutic doses of heparin, even in case of concomitant intracranial hemorrhage related to cerebral venous thrombosis. If the patient's status worsens despite adequate anticoagulation, thrombolysis may be used in selected cases. The optimal administration route (local or intravenous), thrombolytic agent (urokinase or alteplase) and dose are unknown. There is currently no recommendation with regard to local thrombolytic therapy in patients with dural sinus thrombosis. Urgent blood transfusions are recommended to reduce hemoglobin S to <30% in patients with sickle cell disease and acute ischemic stroke.
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Affiliation(s)
- D Calvet
- Service de neurologie et unité neurovasculaire, INSERM UMR 894, université Paris Descartes, centre hospitalier Sainte-Anne, 1 rue Cabanis, Paris cedex 14, France.
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Braun M, Lasanne G, Hossu G, Anxionnat R, Bracard S. Anatomie morphologique et fonctionnelle de la moelle épinière. Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gundelwein L, Lesanne G, Bracard S. Angioscanner veineux cérébral à faible volume d’iode : protocole technique et traitement de l’image. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Lesanne G, Millon D, Derelle AL, Bracard S. Angioscanner veineux cérébral : intérêt pour l’étude de l’anatomie normale et de la pathologie. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leclercq D, Perlbarg V, Fave G, Sanchez P, Menjot De Champfleur N, Tollard E, Ibarolla D, Soto Ares G, Bracard S, Tshibanda L, Dormont D, Benali H, Puybasset L, Galanaud D. Étude prospective multicentrique du tenseur de diffusion dans l’hémorragie méningée grave. Résultats préliminaires. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Heck O, Derelle AL, Lacour JC, Richard S, Bracard S, Anxionnat R. Ruptures d’anévrismes lenticulo-stries à propos de trois cas. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Holveck A, Grand S, Boini S, Kirchin M, Le Bas JF, Dietemann JL, Bracard S, Kremer S. Dynamic susceptibility contrast-enhanced MRI evaluation of cerebral intraventricular tumors: preliminary results. J Neuroradiol 2011; 37:269-75. [PMID: 20435349 DOI: 10.1016/j.neurad.2009.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/11/2009] [Accepted: 11/12/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aims of the present study were to determine the perfusion characteristics of several types of intraventricular tumors and to evaluate the usefulness of dynamic contrast-enhanced MRI in making the differential diagnosis. METHODS A total of 28 patients with intraventricular tumors (five meningiomas, five papillomas, three ependymomas, four subependymomas, seven central neurocytomas, two subependymal giant cell astrocytomas and two metastases) underwent conventional and dynamic susceptibility contrast-enhanced MRI. Cerebral blood volume (CBV) maps were obtained and the relative CBV (rCBV) calculated for each tumor. Mean rCBV(max) values were compared across the different types of tumors (ANOVA, P=0.05). RESULTS Intraventricular tumors presented with three different patterns of vascularization: highly vascularized tumors (mean rCBV(max)>3), including papillomas, meningiomas and renal carcinoma metastases; poorly vascularized tumors (mean rCBV(max)<2), including ependymomas and subependymomas; and intermediately vascularized tumors (mean rCBV(max)>2 but<3), including central neurocytomas and lung metastases. There was a significant difference between the highly vascularized (papillomas, meningiomas) and poorly vascularized (subependymomas) tumors. In cases of suspected meningioma, papilloma or neurocytoma, low rCBV values (<3) point to a diagnosis of neurocytoma rather than either of the other tumor types. CONCLUSION Susceptibility contrast-enhanced MRI can provide additional information on the vascularization of intraventricular cerebral tumors and may help in making the differential diagnosis.
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Affiliation(s)
- A Holveck
- Neuroradiology Department, hôpital Central, CHU de Nancy, 54000 Nancy, France.
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Tisserand M, Le Guennec L, Touze E, Hess A, Charbonnier C, Devauchelle AD, Bracard S, Mas JL, Meder JF, Oppenheim C. Prevalence of MRI-defined recent silent ischemia and associated bleeding risk with thrombolysis. Neurology 2011; 76:1288-95. [DOI: 10.1212/wnl.0b013e3182152855] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Finitsis S, Anxionnat R, Lebedinsky A, Albuquerque PC, Clayton MF, Picard L, Bracard S. Endovascular treatment of ACom intracranial aneurysms. Report on series of 280 patients. Interv Neuroradiol 2010; 16:7-16. [PMID: 20377974 DOI: 10.1177/159101991001600101] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 12/03/2009] [Indexed: 11/16/2022] Open
Abstract
The immediate and long-term outcomes, complications, recurrences and the need for retreatment were analyzed in a series of 280 consecutive patients with anterior communicating artery aneurysms treated with the endovascular technique. From October 1992 to October 2001 280 patients with 282 anterior communicating artery aneurysms were addressed to our center. For the analysis, the population was divided into two major groups: group 1, comprising 239 (85%) patients with ruptured aneurysms and group 2 comprising of 42 (15%) patients with unruptured aneurysms. In group 1, 185 (77.4%) patients had a good initial pre-treatment Hunt and Hess grade of I-III. Aneurysm size was divided into three categories according to the larger diameter: less than 4 mm, between 4 and 10 mm and larger than 10 mm. The sizes of aneurysms in groups 1 and 2 were identical but a less favorable neck to depth ratio of 0.5 was more frequent in group 2. Endovascular treatment was finally performed in 234 patients in group 1 and 34 patients in group 2. Complete obliteration was more frequently obtained in group 2 unlike a residual neck or opacification of the sac that were more frequently seen in group 1. No peri-treatment complications were recorded in group 2. In group 1 the peri-treatment mortality and overall peri-treatment morbidity were 5.1% and 8.1% respectively. Eight patients (3.4%) in group 1 presented early post treatment rebleeding with a mortality of 88%. The mean time to follow-up was 3.09 years. In group 1, 51 (21.7%) recurrences occurred of which 14 were minor and 37 major. In group 2, eight (23.5%) recurrences occurred, five minor and three major. Two patients (0.8%) presented late rebleeding in group 1. Twenty-seven second endovascular retreatments were performed, 24 (10.2%) in group 1 and three (8.8%) in group 2, seven third endovascular retreatments and two surgical clippings in group 1 only. There was no additional morbidity related to retreatments. Endovascular treatment is an effective method for the treatment of anterior communicating artery aneurysms allowing late rebleeding prevention. Peri-treatment rebleeding warrants caution in anticoagulation management. This is a single center experience and the follow-up period is limited. Patients should be followed-up in the long-term as recurrences may occur and warrant additional treatment.
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Affiliation(s)
- S Finitsis
- Diagnostic and Interventional Neuroradiology Service, Nancy University Hospital, Nancy, France.
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Sanou R, Foscolo S, Weinbreck N, Voirin J, Vignaud J, Blum A, Bracard S. [Solid variant of aneurysmal bone cyst presenting with cord compression]. ACTA ACUST UNITED AC 2010; 91:69-71. [PMID: 20212380 DOI: 10.1016/s0221-0363(10)70009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Derelle AL, Anxionnat R, Lebedinski A, Delmiro V, Million D, Bracard S. Critères diagnostics des fistules hypoglosses : à propos de neuf cas. J Neuroradiol 2010. [DOI: 10.1016/j.neurad.2010.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watfa G, Rossignol P, Kearney-Schwartz A, Fay R, Bracard S, Felblinger J, Boivin J, Lacolley P, Zannad F, Benetos A. P10.05 CALCIUM CHANNEL BLOCKERS USE IS ASSOCIATED WITH A BETTER COGNITIVE PERFORMANCE IN OLDER HYPERTENSIVE PATIENTS WITH SUBJECTIVE MEMORY COMPLAINTS. Artery Res 2010. [DOI: 10.1016/j.artres.2010.10.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Benziada-Boudour A, Schmitt E, Kremer S, Foscolo S, Rivière AS, Tisserand M, Boudour A, Bracard S. Posterior reversible encephalopathy syndrome: A case of unusual diffusion-weighted MR images. J Neuroradiol 2009; 36:102-5. [DOI: 10.1016/j.neurad.2008.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- S Bracard
- Department of Diagnostic and Interventional Neuroradiology, CHU Nancy; France -
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Raymond J, White P, Kallmes DF, Spears J, Marotta T, Roy D, Guilbert F, Weill A, Nguyen T, Molyneux AJ, Cloft H, Cekirge S, Saatci I, Bracard S, Meder JF, Moret J, Cognard C, Qureshi AI, Turk AS, Berenstein A. ICONE: An International Consortium of Neuro Endovascular Centres. Interv Neuroradiol 2008; 14:203-8. [PMID: 20557763 DOI: 10.1177/159101990801400213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 05/30/2008] [Indexed: 11/15/2022] Open
Abstract
SUMMARY The proliferation of new endovascular devices and therapeutic strategies calls for a prudentand rational evaluation of their clinical benefit. This evaluation must be done in an effective manner and in collaboration with industry. Such research initiative requires organisation a land methodological support to survive and thrive in a competitive environment. We propose the formation of an international consortium, an academic alliance committed to the pursuit of effective neurovascular therapies. Such a consortium would be dedicated to the designand execution of basic science, device developmentand clinical trials. The Consortium is owned and operated by its members. Members are international leaders in neurointerventional research and clinical practice. The Consortium brings competency, knowledge, and expertise to industry as well as to its membership across aspectrum of research initiatives such as: expedited review of clinical trials, protocol development, surveys and systematic reviews; laboratory expertise and support for research design and grant applications to public agencies. Once objectives and protocols are approved, the Consortium provides a stable network of centers capable of timely realization of clinical trials or pre clinical investigations in an optimal environment. The Consortium is a non-profit organization. The potential revenue generated from clientsponsored financial agreements will be redirected to the academic and research objectives of the organization. The Consortium wishes to work inconcert with industry, to support emerging trends in neurovascular therapeutic development. The Consortium is a realistic endeavour optimally structured to promote excellence through scientific appraisal of our treatments, and to accelerate technical progress while maximizing patients' safety and welfare.
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Affiliation(s)
- J Raymond
- Interventional Neuroradiology Research Unit, Department of Radiology, Université de Montreal, CHUM Notre-Dame Hospital, Montréal, Canada -
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Antoine V, Moret C, Schmitt E, Klein M, Bracard S. Imagerie par résonance magnétique nucléaire de la neurohypohyse. Annales d'Endocrinologie 2008; 69:181-92. [DOI: 10.1016/j.ando.2008.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 02/08/2008] [Accepted: 02/27/2008] [Indexed: 10/22/2022]
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Anxionnat R, Bracard S, Lebedinsky A, Jr NP, Iancu D, Roca F, Picard L. Prise en charge des anévrismes intracrâniens non rompus. Enquête de pratique des équipes neurochirurgicales et neuroradiologiques françaises. J Neuroradiol 2008; 35:90-8. [DOI: 10.1016/j.neurad.2008.02.005] [Citation(s) in RCA: 8] [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: 11/29/2022]
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Raymond J, Roy D, White PM, Fiorella D, Chapot R, Bracard S, Kallmes DF. A Randomized Trial Comparing Platinum and Hydrogel-coated Coils in Patients Prone to Recurrence after Endovascular Treatment (The PRET Trial). Interv Neuroradiol 2008; 14:73-83. [PMID: 20557789 PMCID: PMC3313709 DOI: 10.1177/159101990801400110] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 02/29/2008] [Indexed: 11/17/2022] Open
Abstract
SUMMARY New coils have been designed to preserve the safety of coil embolization while improving on long-term efficacy. There is currently no scientific evidence that one type of coil material is better than another. The recurrence problem may be more pressing in certain types of patients, such as patients with large aneurysms or those already presenting with angiographic recurrences.
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Affiliation(s)
- J Raymond
- Interventional Neuroradiology Research Unit, Department of Radiology, Université de Montréal, CHUM Notre-Dame Hospital, Montreal; Canada -
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Amsalem Y, Tahon F, Ricolfi F, Anxionnat R, Bonafé A, Chapot R, Gabrillargues J, Levrier O, Bracard S, Turjman F. Hydrocoïl : évaluation des performances : étude française du traitement endovasculaire des anévrismes par hydrocoïl : résultats périprocéduraux. J Neuroradiol 2008. [DOI: 10.1016/j.neurad.2008.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lebedinsky A, Bracard S, Anxionnat R, Roca F, Louis M, Picard L. Occlusion en « T » du siphon carotidien : intérêt de la thrombolyse intra-artérielle chez 21 patients. J Neuroradiol 2008. [DOI: 10.1016/j.neurad.2008.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chastagner P, Kalifa C, Doz F, Bouffet E, Gentet JC, Ruchoux MM, Bracard S, Desandes E, Frappaz D. Outcome of children treated with preradiation chemotherapy for a high-grade glioma: results of a French Society of Pediatric Oncology (SFOP) Pilot Study. Pediatr Blood Cancer 2007; 49:803-7. [PMID: 17096408 DOI: 10.1002/pbc.21051] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the efficacy of BCNU, cisplatin, and vincristine (BCV regimen) in a prospective nonrandomized study among newly diagnosed children with high-grade glioma. PROCEDURE Following surgery, patients received a combination of BCNU + cisplatin + VP16 (BCV), over 3 consecutive days. Patients with residual tumor continued this regimen unless no further improvement was observed on MRI, for a maximum of six courses. Patients who underwent complete surgical resection received six courses of adjuvant BCV. RESULTS Seventy-three patients were enrolled. Out of 66 eligible patients with central pathology review, the diagnosis of high-grade glioma was confirmed in 53 cases. The response rate was 20%. With a median follow-up of 128 months, 5- and 10-year event free survival rates are 16 +/- 9 and 13.3 +/- 9.4%. In univariate analysis, two prognostic factors were statistically significant: extent of resection and tumor location, while macroscopic total resection was the only significant prognostic factor in the multivariate analysis. The response to BCV did not translate into improved event free survival. Interstitial pneumonitis occurred in seven patients, leading to six deaths. CONCLUSION This BCV regimen could not be recommended in the treatment of high-grade gliomas in children, according to its lack of efficacy and its unacceptable pulmonary toxicity.
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Affiliation(s)
- P Chastagner
- Department of Pediatric Oncology, CHU Nancy, Hôpital d'Enfants, Vandoeuvre Lès Nancy, France.
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Mathias J, Koessler L, Brissart H, Foscolo S, Schmitt E, Bracard S, Braun M, Kremer S. Giant cystic widening of Virchow-Robin spaces: an anatomofunctional study. AJNR Am J Neuroradiol 2007; 28:1523-5. [PMID: 17846204 PMCID: PMC8134401 DOI: 10.3174/ajnr.a0622] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe 2 patients with unusual white matter cystic dilations, which could correspond to widening of the perivascular spaces. They underwent morphologic MR imaging with tractography, functional MR imaging (fMRI), and neuropsychological evaluation. fMRI examination showed no functional reorganization of cortical areas. Tractography showed an apparent decrease of white matter tract vectors into the regions of concern. Findings of the neuropsychological examination were normal. It seems that even an extensive cystic dilation of white matter does not deteriorate brain function.
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Affiliation(s)
- J Mathias
- Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier et Universitaire de Nancy, France
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