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Sahin C, Giraud A, Jabrah D, Patil S, Messina P, Bozsak F, Darcourt J, Sacchetti F, Januel AC, Bellanger G, Pagola J, Juega J, Imamura H, Ohta T, Spelle L, Chalumeau V, Mircic U, Stanarčević P, Vukašinović I, Ribo M, Sakai N, Cognard C, Doyle K. Electrical impedance measurements can identify red blood cell-rich content in acute ischemic stroke clots ex vivo associated with first-pass successful recanalization. Res Pract Thromb Haemost 2024; 8:102373. [PMID: 38617048 PMCID: PMC11015511 DOI: 10.1016/j.rpth.2024.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Background Electrochemical impedance spectroscopy can determine characteristics such as cell density, size, and shape. The development of an electrical impedance-based medical device to estimate acute ischemic stroke (AIS) clot characteristics could improve stroke patient outcomes by informing clinical decision making. Objectives To assess how well electrical impedance combined with machine learning identified red blood cell (RBC)-rich composition of AIS clots ex vivo, which is associated with a successfully modified first-pass effect. Methods A total of 253 clots from 231 patients who underwent thrombectomy in 5 hospitals in France, Japan, Serbia, and Spain between February 2021 and October 2023 were analyzed in the Clotbase International Registry. Electrical impedance measurements were taken following clot retrieval by thrombectomy, followed by Martius Scarlet Blue staining. The clot components were quantified via Orbit Image Analysis, and RBC percentages were correlated with the RBC estimations made by the electrical impedance machine learning model. Results Quantification by Martius Scarlet Blue staining identified RBCs as the major component in clots (RBCs, 37.6%; white blood cells, 5.7%; fibrin, 25.5%; platelets/other, 30.3%; and collagen, 1%). The impedance-based RBC estimation correlated well with the RBC content determined by histology, with a slope of 0.9 and Spearman's correlation of r = 0.7. Clots removed in 1 pass were significantly richer in RBCs and clots with successful recanalization in 1 pass (modified first-pass effect) were richer in RBCs as assessed using histology and impedance signature. Conclusion Electrical impedance estimations of RBC content in AIS clots are consistent with histologic findings and may have potential for clinically relevant parameters.
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Affiliation(s)
- Cansu Sahin
- Department of Physiology, University of Galway, Galway, Ireland
- Centre for Research in Medical Devices (CÚRAM)- Science Foundation Ireland (SFI), University of Galway, Galway, Ireland
| | | | - Duaa Jabrah
- Department of Physiology, University of Galway, Galway, Ireland
| | - Smita Patil
- Department of Physiology, University of Galway, Galway, Ireland
- Centre for Research in Medical Devices (CÚRAM)- Science Foundation Ireland (SFI), University of Galway, Galway, Ireland
| | | | | | - Jean Darcourt
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Federico Sacchetti
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Guillaume Bellanger
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Jorge Pagola
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Jesus Juega
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Laurent Spelle
- Department of Interventional Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Uros Mircic
- Department of Neuroradiology, Centre for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Ivan Vukašinović
- Department of Neuroradiology, Centre for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Center of Serbia, Belgrade, Serbia
| | - Marc Ribo
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France
| | - Karen Doyle
- Department of Physiology, University of Galway, Galway, Ireland
- Centre for Research in Medical Devices (CÚRAM)- Science Foundation Ireland (SFI), University of Galway, Galway, Ireland
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Rodriguez-Erazú F, Cortese J, Mihalea C, Popica A, Chalumeau V, Vasconcellos N, Gallas S, Ikka L, Grimaldi L, Caroff J, Spelle L. Thromboembolic Events With the Woven Endobridge Device: Incidence, Predictive Factors, and Management. Neurosurgery 2024; 94:183-192. [PMID: 37728333 DOI: 10.1227/neu.0000000000002696] [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: 05/24/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Woven EndoBridge (WEB) device has been increasingly used to treat wide-neck aneurysms showing a safe and effective profile, but a relatively high number of thromboembolic events (TEEs) have been reported with such treatment. We aimed to evaluate the incidence and management of TEEs and possible predictive factors related to WEB embolization of ruptured and unruptured intracranial aneurysms. METHODS A single-center database with consecutive aneurysms treated with a WEB device between July 2012 and May 2022 was reviewed for intraoperative and delayed TEEs. Univariate and multivariable analyses were used to determine factors associated with TEEs. RESULTS A total of 266 independent aneurysms were treated with WEB devices in 245 patients (mean age 55.78 ± 11.64 years, 169 (63.5%) females, 80 (30%) ruptured). The overall rate of TEEs is 13% (35/266), including 8.7% intraoperative. Symptomatic TEEs with clinical sequelae at a 3-month follow-up are reported to be 2.6% (7/266) with no TEE-related mortality. Both the replacement of a WEB device during the procedure (adjusted odds ratio = 2.61, 95% CI 1.24-5.49; P = .01) and ruptured aneurysms (adjusted odds ratio = 2.74, 95% CI 1.31-5.7; P = .007) were independent predictors of TEEs. A case-by-case management of intraprocedural TEE is also presented; tirofiban was successfully used in most cases of this cohort. CONCLUSION In this study, we demonstrated that ruptured aneurysms and WEB device replacement during the procedure were independent predictive factors for TEEs. As a result, making the correct choice of WEB is crucial for improving treatment outcomes. Moreover, with proper medical management of TEEs, minimal morbidity and no mortality could be achieved, which reinforces the safety of the technique.
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Affiliation(s)
- Fernanda Rodriguez-Erazú
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Department of Neurological Surgery, University Hospital Dr Manuel Quintela, Montevideo , Uruguay
| | - Jonathan Cortese
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1195, Paris , France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Adrian Popica
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Natalia Vasconcellos
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Sophie Gallas
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Leon Ikka
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux , France
- CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris , France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1176, Paris , France
| | - Laurent Spelle
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1195, Paris , France
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Spelle L, Costalat V, Caroff J, Wodarg F, Fischer S, Herbreteau D, Möhlenbruch MA, Januel AC, Papagiannaki C, Klisch J, Numminen J, Rautio R, Berlis A, Mihalea C, Chalumeau V, Downer J, Cortese J, Ikka L, Gallas S, Bester M, Liebig T, Velasco S, Grimaldi L, Byrne J, Szikora I, Pierot L, Cognard C. CLinical EValuation of WEB 17 device in intracranial aneuRysms (CLEVER): procedural, 30-day and 1-year safety results for ruptured and unruptured aneurysms. J Neurointerv Surg 2023:jnis-2023-020866. [PMID: 37914392 DOI: 10.1136/jnis-2023-020866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Intrasaccular flow disruption is an endovascular approach for the treatment of wide-neck aneurysms and, more specifically, wide-neck bifurcation aneurysms, which are challenging to treat with previously developed technologies. The Woven EndoBridge (WEB) device has demonstrated its efficacy and safety, for both unruptured and ruptured aneurysms. METHODS The CLEVER study was an observational, multicenter, prospective study conducted in 17 European investigational sites using the WEB 17 device, for the treatment of ruptured and unruptured aneurysms. The study objective was to provide safety and efficacy data on the WEB 17 device in the treatment of wide-neck bifurcation aneurysms. Imaging results were assessed independently by a Corelab and adverse events adjudicated by a Clinical Event Adjudicator. This analysis reports procedural results and safety at 30 days and 12 months. RESULTS A total of 163 patients (mean age 58.1 years; 68.1% women) with 103 unruptured aneurysms and 60 ruptured aneurysms were enrolled. Most aneurysms were located on the anterior communicating artery (ACom) (37.4%) or the middle cerebral artery (MCA) bifurcation (30.1%). Aneurysm widths ranged from 2.0-9.2 mm, and the mean sac width was 5.0 mm. The WEB procedure was successfully completed in 163 patients (100%). At the 12-month follow-up, major stroke events occurred in 3 of 163 patients (1.8%), and no device-related mortality was observed. CONCLUSION Endovascular treatment of ruptured and unruptured wide-neck bifurcation aneurysms using WEB 17 is safe, with a low complication rate and no device-related mortality. In particular, none of the ruptured aneurysms bled again up to 1 year of follow-up. TRIAL REGISTRATION NUMBER NCT03844334.
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Affiliation(s)
- Laurent Spelle
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Vincent Costalat
- Interventional Neuroradiology, Gui de Chauliac University hospital, Montpellier, France
| | - Jildaz Caroff
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Sebastian Fischer
- Neuroradiology, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Nordrhein-Westfalen, Germany
| | - Denis Herbreteau
- Inreventional Neuroradiology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Markus A Möhlenbruch
- Neuroradiology, UniversitätsKlinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Anne-Christine Januel
- Diagnostic and Therapeutic Neuroradiology, Hospital Pierre Paul Riquet, Toulouse, Occitanie, France
| | | | - Joachim Klisch
- Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Thüringen, Germany
| | - Jussi Numminen
- Interventional Neuroradiology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | | | - Ansgar Berlis
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Cristian Mihalea
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Jonathan Downer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Jonathan Cortese
- Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- UMR CNRS no 7252, XLIM, Limoges, Aquitaine, France
| | - Léon Ikka
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Sophie Gallas
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | | | - Lamiae Grimaldi
- Clinical Research Unit Bicetre hospital, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - James Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Istvan Szikora
- Interventional Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Budapest, Hungary
| | - Laurent Pierot
- Department of Interventional Neuroradiology, CHU de Reims, Reims, Grand Est, France
- Champagne University Hospital Group, Reims, Grand Est, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, Occitanie, France
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Caroff J, Janot K, Soize S, Marnat G, Cortese J, Mihalea C, Popescu SD, Ikka L, Chalumeau V, Gallas S, Ozanne A, Eltantawy E, Grimaldi L, Barreau X, Herbreteau D, Pierot L, Spelle L. Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment. J Neurointerv Surg 2023; 15:939-942. [PMID: 36288976 DOI: 10.1136/jnis-2022-019645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Around 10% of Woven EndoBridge device (WEB)-treated intracranial aneurysms will need retreatment, and it is generally believed to be more challenging than retreatment after an initial coiling. We aim to report retreatment strategies and outcomes after initial WEB embolizations. METHODS Databases from four treatment centers, containing consecutive aneurysms treated with a WEB between 2013 and 2022, were reviewed. Demographics, aneurysm characteristics, retreatment strategies and outcomes were collected and analyzed. RESULTS From a 756 WEB database, 57 aneurysms were included. The global retreatment rate was 7.5% (95% CI 5.6% to 9.4%). The retreatment rate was significantly higher in the ruptured compared with the unruptured population (13% vs 3.9%, respectively, P<0.0001). Aneurysms were retreated on average 21.2 months after the initial WEB treatment (range 4.8-70 months). Surgery was performed in 11% and endovascular treatment in 89% of cases, consisting of flow diversion (48%), stent-assisted coiling (30%), coiling (12%), and second WEB placement (10%). Imaging follow-up was available in 88% of all WEB retreatments (50/57) (average 17 months, 49% digital subtraction angiography), demonstrating complete occlusion in 56% and 'adequate' occlusion in 88%. Morbidity was 5.3% (95% CI 0% to 12.0%) and mortality 0%. No patient experienced rebleeding during the follow-up period. CONCLUSION The retreatment rate after an initial WEB treatment seems to compare favorably with that of coiling. Endovascular treatment of recurrence following WEB implantation is feasible in most situations; it generally requires the use of a stent and leads to a high rate of satisfactory occlusion.
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Affiliation(s)
- Jildaz Caroff
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Kevin Janot
- Neuroradiology, CHU Tours, Tours, Centre, France
| | - Sebastien Soize
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
- Neuroradiology, CHU Reims, Reims, France
- Champagne-Ardenne University, Reims, France
| | | | - Jonathan Cortese
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Cristian Mihalea
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Septimiu Daniel Popescu
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Léon Ikka
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Vanessa Chalumeau
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Sophie Gallas
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Augustin Ozanne
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Eman Eltantawy
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
- Neurology, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Lamiae Grimaldi
- Clinical Research Unit; University, Faculty of Medicine Simone Veil, Versailles Saint Quentin University ; INSERM, CESP, Hospital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Xavier Barreau
- Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | | | - Laurent Pierot
- Neuroradiology, CHU Reims, Reims, France
- Champagne-Ardenne University, Reims, France
| | - Laurent Spelle
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicetre, France
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5
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Sabuzi F, Cortese J, Da Ros V, Mihalea C, Chalumeau V, Moret J, Caroff J, Spelle L. How a decade of aneurysms embolization with the Woven EndoBridge has changed our understanding and practices? J Neuroradiol 2023; 50:518-522. [PMID: 36868371 DOI: 10.1016/j.neurad.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Safety and efficacy of the WEB (Woven EndoBridge) device have been extensively evaluated in several good clinical practice studies. Nonetheless, the WEB had several structural evolutions overtime up to the fifth generation WEB device (WEB17). Here, we tried to understand how this may have modified our practices and enlarged our indications for its use. METHODS We retrospectively analyzed data from all patients with aneurysms treated (or intended to be treated) with a WEB at our institution between July 2012 and February 2022. The time frame was split in two periods: before and after the arrival of the WEB17 in our center (February 2017). RESULTS 252 patients with 276 wide-necked aneurysms were included; 78 aneurysms (28.2%) were ruptured. Successful embolization with a WEB device was achieved in 263/276 aneurysms (95.3%). With the availability of WEB17, treated aneurysms were significantly smaller (8.2 mm versus 5.9 mm, p<0.001) and off-label location significantly increased (4.4% versus 17.3%, p = 0.02) with an increase of sidewall aneurysm (4.4% versus 11.6%, p = 0.06). Also, WEB were more significantly oversized (1.05 versus 1.11, p<0.01). Adequate and complete occlusion rates increased constantly during the two periods (54.8% versus 67.5%, p = 0.08 and 74.2% versus 83.7%, p = 0.10, respectively). The proportion of ruptured aneurysms slightly increased between the two periods (24.6% versus 29.5%, p = 0.44). CONCLUSIONS Over the first decade of its availability, the WEB device usage shifted towards smaller aneurysms and broader indications, including ruptured aneurysms. The oversizing strategy also became the standard of practice for WEB deployment in our institution.
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Affiliation(s)
- Federico Sabuzi
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Jonathan Cortese
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France.
| | - Valerio Da Ros
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | - Jacques Moret
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France
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6
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Soize S, Mihalea C, Caroff J, Chalumeau V, Cortese J, Gallas S, Ikka L, Ozanne A, Moret J, Spelle L. Embolisation transveineuse des MAV cérébrales au centre neuri. J Neuroradiol 2023. [DOI: 10.1016/j.neurad.2023.01.027] [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: 03/03/2023]
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7
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Caroff J, Popescu SD, Mihalea C, Popica DA, Ikka L, Gallas S, Ozanne A, Chalumeau V, Moret J, Cortese J, Spelle L. Persistent Opacification of the Woven EndoBridge Device: A Conebeam CT Analysis of the Bicêtre Occlusion Scale Score 1 Phenomenon. AJNR Am J Neuroradiol 2023; 44:291-296. [PMID: 36759143 PMCID: PMC10187822 DOI: 10.3174/ajnr.a7783] [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: 10/26/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND PURPOSE Some Woven EndoBridge devices present a persistent intradevice opacification at imaging follow-up, described as the Bicêtre Occlusion Scale Score 1 (BOSS 1) phenomenon. The clinical implications remain unknown. We aimed here to analyze the factors influencing this occurrence and to precisely describe the evolution of BOSS 1 with time using conebeam CT. MATERIALS AND METHODS We retrospectively analyzed a prospectively maintained Woven EndoBridge database at our tertiary center and included all patients with isolated BOSS 1 and BOSS 1 associated with small neck remnant (BOSS 1 + 2). RESULTS Two hundred sixty-seven aneurysms were treated with a Woven EndoBridge device between July 2012 and December 2021. Follow-up with DSA was available for 220 aneurysms (median, 5 months), among which BOSS 1 and 1 + 2 were found in 9.1% (20/220) (95% CI, 5.5%-12.7%). A second DSA follow-up (median, 17 months) was performed in 15 of these 20 aneurysms, which revealed that 40% had evolved to complete Woven EndoBridge occlusion, 33% showed a decreased persistent opacification, and 27% remained stable. BOSS 1 was significantly associated with postoperative antiplatelet medication, a lower aneurysm aspect ratio, and the use of the Woven EndoBridge 17 (P < .05). The average Woven EndoBridge shape modification was less pronounced in the BOSS 1 population (P < .02). None of the BOSS 1 or 1 + 2 aneurysms required retreatment or were associated with hemorrhage occurrence. CONCLUSIONS Isolated persistent flow inside the Woven EndoBridge device at follow-up is rare and notably associated with antiplatelet prescription. It seems to present a benign course in most cases.
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Affiliation(s)
- J Caroff
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- INSERM Unit 1176 (J. Caroff)
| | - S D Popescu
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - C Mihalea
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - D A Popica
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - L Ikka
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - S Gallas
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - A Ozanne
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - J Moret
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - J Cortese
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- INSERM Unit 1195 (J. Cortese, L.S.), Le Kremlin-Bicêtre, France
| | - L Spelle
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Paris-Saclay University Faculty of Medicine (L.S.), Le Kremlin-Bicêtre, France
- INSERM Unit 1195 (J. Cortese, L.S.), Le Kremlin-Bicêtre, France
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Raymond J, Gentric JC, Magro E, Nico L, Bacchus E, Klink R, Cognard C, Januel AC, Sabatier JF, Iancu D, Weill A, Roy D, Bojanowski MW, Chaalala C, Barreau X, Jecko V, Papagiannaki C, Derrey S, Shotar E, Cornu P, Eker OF, Pelissou-Guyotat I, Piotin M, Aldea S, Beaujeux R, Proust F, Anxionnat R, Costalat V, Corre ML, Gauvrit JY, Morandi X, Brunel H, Roche PH, Graillon T, Chabert E, Herbreteau D, Desal H, Trystram D, Barbier C, Gaberel T, Nguyen TN, Viard G, Gevry G, Darsaut TE, _ _, _ _, Raymond J, Roy D, Weill A, Iancu D, Bojanowski MW, Chaalala C, Darsaut TE, O’Kelly CJ, Chow MMC, Findlay JM, Rempel JL, Fahed R, Lesiuk H, Drake B, Santos MD, Gentric JC, Nonent M, Ognard J, El-Aouni MC, Magro E, Seizeur R, Timsit S, Pradier O, Desal H, Boursier R, Thillays F, Roualdes V, Piotin M, Blanc R, Aldea S, Cognard C, Januel AC, Sabatier JF, Calviere L, Gauvrit JY, Raoult H, Eugene F, Bras AL, Ferre JC, Paya C, Morandi X, Lecouillard I, Nouhaud E, Ronziere T, Trystram D, Naggara O, Rodriguez-Regent C, Kerleroux B, Barbier C, Gaberel T, Emery E, Touze E, Papagiannaki C, Derrey S, Eker OF, Riva R, Pellisou-Guyotat I, Guyotat J, Berhouma M, Dumot C, Biondi A, Thines L, Bougaci N, Charbonnier G, Bracard S, Anxionnat R, Gory B, Civit T, Bernier-Chastagner V, Barreau X, Marnat G, Jecko V, Penchet G, Gimbert E, Huchet A, Herbreteau D, Boulouis G, Bibi R, Ifergan H, Janot K, Velut S, Brunel H, Roche PH, Graillon T, Peyriere H, Kaya JM, Touta A, Troude L, Boissonneau S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Boch AL, Cornu P, Nouet A, Costalat V, Bonafe A, Dargazanli C, Gascou G, Lefevre PH, Riquelme C, Corre ML, Beaujeux R, Pop R, Proust F, Cebula H, Ollivier I, Spatola G, Spell L, Chalumeau V, Gallas S, Ikka L, Mihalea C, Ozanne A, Caroff J, Chabert E, Mounayer C, Rouchaud A, Caire F, Ricolfi F, Thouant P, Cao C, Mourier KL, Farah W, Nguyen TN, Abdalkader M, Huynh T, Tawk RG, Carlson AP, Silva LAO, Froio NDL, Silva GS, Mont’Alverne FJA, Martins JL, Mendes GN, Miranda RR. Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2022; 138:1393-1402. [PMID: 37132535 DOI: 10.3171/2022.9.jns22987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study that comprises two randomized trials and multiple registries.
METHODS
Results from the TOBAS curative and pre-embolization registries are reported. The primary outcome for this report is death or dependency (modified Rankin Scale [mRS] score > 2) at last follow-up. Secondary outcomes include angiographic results, perioperative serious adverse events (SAEs), and permanent treatment-related complications leading to an mRS score > 2.
RESULTS
From June 2014 to May 2021, 1010 patients were recruited in TOBAS. Embolization was chosen as the primary curative treatment for 116 patients and pre-embolization prior to surgery or SRS for 92 patients. Clinical and angiographic outcomes were available in 106 (91%) of 116 and 77 (84%) of 92 patients, respectively. In the curative embolization registry, 70% of AVMs were ruptured, and 62% were low-grade AVMs (Spetzler-Martin grade I or II), while the pre-embolization registry had 70% ruptured AVMs and 58% low-grade AVMs. The primary outcome of death or disability (mRS score > 2) occurred in 15 (14%, 95% CI 8%–22%) of the 106 patients in the curative embolization registry (4 [12%, 95% CI 5%–28%] of 32 unruptured AVMs and 11 [15%, 95% CI 8%–25%] of 74 ruptured AVMs) and 9 (12%, 95% CI 6%–21%) of the 77 patients in the pre-embolization registry (4 [17%, 95% CI 7%–37%] of 23 unruptured AVMs and 5 [9%, 95% CI 4%–20%] of 54 ruptured AVMs) at 2 years. Embolization alone was confirmed to occlude the AVM in 32 (30%, 95% CI 21%–40%) of the 106 curative attempts and in 9 (12%, 95% CI 6%–21%) of 77 patients in the pre-embolization registry. SAEs occurred in 28 of the 106 attempted curative patients (26%, 95% CI 18%–35%, including 21 new symptomatic hemorrhages [20%, 95% CI 13%–29%]). Five of the new hemorrhages were in previously unruptured AVMs (n = 32; 16%, 95% CI 5%–33%). Of the 77 pre-embolization patients, 18 had SAEs (23%, 95% CI 15%–34%), including 12 new symptomatic hemorrhages [16%, 95% CI 9%–26%]). Three of the hemorrhages were in previously unruptured AVMs (3/23; 13%, 95% CI 3%–34%).
CONCLUSIONS
Embolization as a curative treatment for brain AVMs was often incomplete. Hemorrhagic complications were frequent, even when the specified intent was pre-embolization before surgery or SRS. Because the role of endovascular treatment remains uncertain, it should preferably, when possible, be offered in the context of a randomized trial.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | - Elsa Magro
- Department of Neurosurgery, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | - Lorena Nico
- Department of Radiology, CHU Saint-Etienne, France
| | - Emma Bacchus
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ruby Klink
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | | | - Jean-François Sabatier
- Neurosurgery, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Daniela Iancu
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Alain Weill
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Michel W. Bojanowski
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Chiraz Chaalala
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Xavier Barreau
- Neuroradiology Department, Pellegrin Hospital Group, CHU Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, Pellegrin Hospital Group, CHU Bordeaux, France
| | | | - Stéphane Derrey
- Neurosurgery, Charles Nicolle Hospital, Rouen Normandy University Hospital, Rouen, France
| | | | - Philippe Cornu
- Neurosurgery, Mercy Salpetriere Hospital AP-HP, Paris, France
| | | | | | | | - Sorin Aldea
- Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | | | - François Proust
- Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - René Anxionnat
- Interventional Neuroradiology Department, University of Lorraine, Laboratory IADI INSERM U1254, CHRU Nancy, France
| | | | | | | | | | - Hervé Brunel
- Departments of Interventional Neuroradiology and
| | | | | | - Emmanuel Chabert
- Interventional Neuroradiology Department, CHU Clermont-Ferrand, France
| | - Denis Herbreteau
- Interventional Neuroradiology Department, Bretonneau Hospital, Tours, France
| | - Hubert Desal
- Interventional Neuroradiology Department, CHU de Nantes, France
| | - Denis Trystram
- Interventional Neuroradiology Department, University of Paris, INSERM U1266, IPNP, GHU Paris, France
- Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | | | | | - Thanh N. Nguyen
- Departments of Radiology,
- Neurology, and
- Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and
| | | | - Guylaine Gevry
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Tim E. Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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9
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Olivot J, Finitsis S, Lapergue B, Marnat G, Sibon I, Richard S, Viguier A, Cognard C, Mazighi M, Gory B, Piotin M, Blanc R, Redjem H, Escalard S, Desilles J, Delvoye F, Smajda S, Maïer B, Hebert S, Mazighi M, Obadia M, Sabben C, Seners P, Raynouard I, Corabianu O, de Broucker T, Manchon E, Taylor G, Maacha MB, Thion L, Lecler A, Savatovsjy J, Wang A, Evrard S, Tchikviladze M, Ajili N, Lapergue B, Weisenburger‐Lile D, Gorza L, Buard G, Coskun O, Consoli A, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Nighoghossian N, Riva R, Eker O, Turjman F, Derex L, Cho T, Mechtouff L, Lukaszewicz A, Philippeau F, Cakmak S, Blanc‐Lasserre K, Vallet A, Marnat G, Gariel F, Barreau X, Berge J, Menegon P, Sibon I, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey J, Briau P, Pangon N, Bourcier R, Detraz L, Daumas‐Duport B, Alexandre P, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C, Gory B, Bracard S, Anxionnat R, Braun M, Derelle A, Liao L, Zhu F, Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour J, Douarinou M, Audibert G, Voicu M, Alb I, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Bourst P, Beaumont M, Chen (Mitchelle) B, Guy S, Georges V, Bechiri F, Macian‐Montoro F, Saleme S, Mounayer C, Rouchaud A, Gimenez L, Cosnard A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre P, Derraz I, Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, ter Schiphorst A, Alias Q, Boustia F, Ferre J, Raoult H, Gauvrit J, Vannier S, Guillen M, Ronziere T, Lassalle V, Tracol C, Malrain C, Boinet S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Samson Y, Léger A, Crozier S, Baronnet F, Alamowitch S, Bottin L, Yger M, Degos V, Spelle L, Denier C, Chassin O, Chalumeau V, Caroff J, Chassin O, Venditti L, Sarov M, Legris N, Naggara O, Hassen WB, Boulouis G, Rodriguez‐Régent C, Trystram D, Kerleroux B, Turc G, Domigo V, Lamy C, Birchenall J, Isabel C, Lun F, Viguier A, Cognard C, Januel A, Olivot J, Raposo N, Bonneville F, Albucher J, Calviere L, Darcourt J, Bellanger G, Tall P, Touze E, Barbier C, Schneckenburger R, Boulanger M, Cogez J, Guettier S, Gauberti M, Timsit S, Gentric J, Ognard J, Merrien FM, Wermester OO, Massardier E, Papagiannaki C, Triquenot A, Lefebvre M, Bourdain F, Bernady P, Lagoarde‐Segot L, Cailliez H, Veunac L, Higue D, Wolff V, Quenardelle V, Lauer V, Gheoca R, Pierre‐Paul I, Pop R, Beaujeux R, Mihoc D, Manisor M, Pottecher J, Meyer A, Chamaraux‐Tran T, Le Bras A, Evain S, Le Guen A, Richter S, Hubrecht R, Demasles S, Barroso B, Sablot D, Farouil G, Tardieu M, Smadja P, Aptel S, Seiler I. Parenchymal hemorrhage rate is associated with time to reperfusion and outcome. Ann Neurol 2022; 92:882-887. [DOI: 10.1002/ana.26478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Bertrand Lapergue
- Department of Neurology Foch Hospital Versailles Saint‐Quentin en Yvelines University Suresnes France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology University Hospital of Bordeaux France
| | - Igor Sibon
- Department of Neurology, Stroke Center University Hospital of Bordeaux France
| | - Sebastien Richard
- Université de Lorraine, CHRU‐Nancy, Department of Neurology, Stroke Unit F‐54000 Nancy France
- CIC‐P 1433 , INSERM U1116, CHRU‐Nancy, F‐54000 Nancy France
| | - Alain Viguier
- Acute Stroke Unit‐ CIC 1436‐UMR 1214, CHU Toulouse France
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiolology CHU Toulouse France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology FHU Neurovasc, INSERM 1148, Université de Paris Cité Rothschild Foundation, Paris France
- Diagnostic and Therapeutic Neuroradiology, F‐54000 Nancy France
| | - Benjamin Gory
- Université de Lorraine, IADI, INSERM U1254 F‐54000 Nancy France
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Spelle L, Herbreteau D, Caroff J, Barreau X, Ferré JC, Fiehler J, Januel AC, Costalat V, Liebig T, Bourcier R, Möhlenbruch MA, Berkefeld J, Weber W, Mihalea C, Ikka L, Ozanne A, Cognard C, Narata AP, Bibi RE, Gauvrit JY, Raoult H, Velasco S, Buhk JH, Chalumeau V, Bester M, Desal H, du Mesnil de Rochemont R, Bohner G, Fischer S, Gallas S, Biondi A, Grimaldi L, Moret J, Byrne J, Pierot L. CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): 12-month angiographic results of a multicenter study. J Neurointerv Surg 2022:neurintsurg-2022-018749. [PMID: 35882550 DOI: 10.1136/neurintsurg-2022-018749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS) study has shown that the endovascular treatment of ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) is safe and effective and provides protection against rebleeding at 1 month and 1 year. The 12-month angiographic follow-up is an important endpoint of the study. METHODS The CLARYS study is a prospective multicenter study conducted in 13 European centers. The study enrolled 60 patients with 60 ruptured aneurysms of the anterior and posterior circulation. The study was conducted with an independent assessment of safety outcomes and imaging. RESULTS Sixty patients with 60 ruptured bifurcation aneurysms to be treated with the WEB were included. Fifty-three aneurysms (88.3%) had a broad base with a dome to neck ratio <2 (mean 1.6). Of these, 46 patients were evaluated by an independent core laboratory with follow-up imaging performed at 12 months or before eventual retreatment. At 1 year, 19/46 aneurysms (41.3%) were completely occluded (Raymond-Roy grade I), 21/46 (45.7%) had a residual neck and 6/46 (13.0%) had residual aneurysm filling. Adequate occlusion was reported in 40/46 (87%) aneurysms. Six patients underwent target aneurysm retreatment. CONCLUSIONS The CLARYS study has previously shown that the use of the WEB in the endovascular treatment of ruptured bifurcation aneurysms provides effective protection against rebleeding with a good safety profile. The angiographic occlusion rates at 1 year reported here are comparable to those already seen in previous multicenter studies which primarily included unruptured aneurysms.
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Affiliation(s)
- Laurent Spelle
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France .,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilians University, Munich Faculty of Medicine, Munchen, Germany
| | - Romain Bourcier
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | - Markus A Möhlenbruch
- Department of Neuroradiology, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Joachim Berkefeld
- Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Werner Weber
- Department of Neuroradiology, Ruhr-Universitat Bochum Medizinische Fakultat, Bochum, Germany
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Léon Ikka
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Augustin Ozanne
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Richard Edwige Bibi
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jean-Yves Gauvrit
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Hélène Raoult
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Stéphane Velasco
- Department of Radiology, Regional University Hospital, Poitiers, France
| | - Jan-Hendrik Buhk
- Department of Neuroradiology, Asklepios Hospital Group, Hamburg, Germany
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hubert Desal
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Georg Bohner
- Neuroradiology, Charite Universitatsmedizin, Berlin, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, Ruhr-Universitat Bochum Medizinische Fakultat, Bochum, Germany
| | - Sophie Gallas
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Jean Minjoz University Hospital, Besancon, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,CESP Anti-Infective Evasion and Pharmacoepidemiology Team, Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-Le-Bretonneux, France
| | - Jacques Moret
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - James Byrne
- Department of Neuroradiology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, Reims, France.,Champagne-Ardenne University, Reims, France
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11
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Cortese J, Caroff J, Chalumeau V, Gallas S, Ikka L, Moret J, Sabuzi F, Popescu SD, Ozanne A, Grimaldi L, Mihalea C, Spelle L. Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up. J Neurointerv Surg 2022; 15:446-451. [PMID: 35428742 DOI: 10.1136/neurintsurg-2022-018780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/07/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
Abstract
BackgroundWoven EndoBridge (WEB) devices are becoming a reliable option for the treatment of wide-neck bifurcation aneurysms, but clear predictive factors are still missing to understand the one in five aneurysm remnant rate.ObjectiveTo evaluate occlusion outcomes after WEB treatment to identify potential determinants of aneurysm occlusion.MethodsA single-center database with consecutive aneurysms treated with WEB between July 2012 and October 2021 was reviewed for potential determinants of aneurysm adequate occlusion (defined as a Bicêtre Occlusion Scale Score (BOSS) of 0, 0’, 1 or 2), through univariate and multivariable analysis. Patients without angiographic follow-up were excluded.Results215 of 247 individual aneurysms were included in the final analysis, of which 59 (27%) were ruptured. Mean age of patients was 56 years (range 23–90 years) and 65% were female. Mean angiographic follow-up was at 18 months (range 3–97 months). Adequate and complete occlusion were achieved in 171/215 (79.5%) and 135/215 (62.8%) of cases, respectively. Aneurysm irregular shape (aOR=0.42, 95% CI 0.20 to 0.88; p=0.02), aneurysm height (aOR=0.79, 95% CI 0.66 to 0.94; p<0.01), and WEB shape modification (aOR=0.98, 95% CI 0.97 to 1.00; p=0.02) were all independent predictors of aneurysm recurrence, whereas the WEB oversizing ratio (WEB width/aneurysm mean width) (aOR=16.4, 95% CI 1.4 to 266.7; p=0.04) was an independent predictor of adequate occlusion.ConclusionIn this study we demonstrated that a width oversizing strategy of the WEB device was an independent predictor of aneurysm angiographic occlusion. Conversely, aneurysm height, irregular aneurysm, and WEB shape modification were all independent determinants of angiographic aneurysm remnant. These results may help to select aneurysms suitable for the WEB device and WEB sizing.
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Affiliation(s)
- Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
- INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Federico Sabuzi
- Interventional Radiology Department, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Septimiu Daniel Popescu
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP Paris-Saclay, Université de Versailles Saint-Quentin- en- Yvelines UFR des sciences de la santé Simone Veil, Montigny-Le- Bretonneux, France
- CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
- INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
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12
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Marnat G, Finistis S, Delvoye F, Sibon I, Desilles JP, Mazighi M, Gariel F, Consoli A, Rosso C, Clarençon F, Elhorany M, Denier C, Chalumeau V, Caroff J, Veunac L, Bourdain F, Darcourt J, Olivot JM, Bourcier R, Dargazanli C, Arquizan C, Richard S, Lapergue B, Gory B. Safety and Efficacy of Cangrelor in Acute Stroke Treated with Mechanical Thrombectomy: Endovascular Treatment of Ischemic Stroke Registry and Meta-analysis. AJNR Am J Neuroradiol 2022; 43:410-415. [PMID: 35241418 PMCID: PMC8910798 DOI: 10.3174/ajnr.a7430] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke. MATERIALS AND METHODS We performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion). RESULTS In the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%). CONCLUSIONS Cangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.
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Affiliation(s)
- G. Marnat
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - S. Finistis
- Aristotle University of Thessaloniki (S.F.), AhepaHospital, Thessaloniki, Greece
| | - F. Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - I. Sibon
- Department of Neurology (I.S.), Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - J.-P. Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M. Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - F. Gariel
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - A. Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | | | - F. Clarençon
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | - M. Elhorany
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | | | - V. Chalumeau
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - J. Caroff
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - L. Veunac
- Neuroradiolology (L.V.), Centre Hospitalier Cõte Basque, Bayonne, France
| | | | - J. Darcourt
- Neuroradiolology (J.D.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - R. Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - C. Dargazanli
- Departments of Interventional Neuroradiology (C. Dargazanli)
| | - C. Arquizan
- Neurology (C.A.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S. Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France
| | - B. Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - B. Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France,Université de Lorraine (B.G.), Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Nancy, France
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13
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de Aguiar GB, Ozanne A, Elawady A, Samoyeau T, Niknejad HR, Caroff J, Vergara Martinez J, Mihalea C, Gallas S, Chalumeau V, Ikka L, Moret J, Spelle L. Intracranial Aneurysm in Pediatric Population: A Single-Center Experience. Pediatr Neurosurg 2022; 57:270-278. [PMID: 35398842 DOI: 10.1159/000524523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Pediatric intracranial aneurysms (PIA) are rarer and more complex when compared to adult aneurysms. In general, the clinical presentation of PIA is due to a mass effect, but the presenting symptoms can be also related to ischemia, subarachnoid hemorrhage (SAH), or in a combination of different symptoms. This paper aimed to report a single-center experience with clinical and angiographic aspects of brain aneurysm in children. METHODS We retrospectively reviewed our prospectively maintained database for patients with intracranial aneurysms in our institution from July 2015 to February 2021. Among these, all patients under 18 years of age submitted to a diagnostic or therapeutic procedure for an intracranial aneurysm were included. RESULTS Twelve patients were submitted to diagnostic or therapeutic procedures in our department. Three of them had multiple aneurysms, and in total, 17 intracranial aneurysms were assessed in this study. The most frequent location was in the middle cerebral artery (7 cases/41%). Five out of twelve children (42%) presented SAH due to ruptured aneurysm. Three patients (25%) had symptoms due to the mass effect from large aneurysms, with compression of cranial nerves or brainstem. Aneurysms diameters ranged from 1.5 mm to 34 mm (mean 14.2 mm), with six aneurysms being giant and eight being nonsaccular/fusiform. Twelve aneurysms were submitted to endovascular treatment, with one treatment-related clinical complication and later death. CONCLUSION PIAs are rare diseases that can arise from a variety of different underlying pathological mechanisms. The management of these conditions requires a detailed understanding of the pathology and a multidisciplinary approach. Despite the availability of new technologies, parent vessel occlusion remains a valid option for aneurysms in the pediatric population.
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Affiliation(s)
- Guilherme Brasileiro de Aguiar
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Ahmed Elawady
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Thomas Samoyeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Hamid Reza Niknejad
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France,
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Jeickson Vergara Martinez
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicêtre, France
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14
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Pagiola I, Chassin O, Gallas S, Riviere MS, Legris N, Mihalea C, Caroff J, Ikka L, Chalumeau V, Aguiar GBD, Ozanne A, Moret J, Denier C, Spelle L. Extending the stroke treatment window beyond DAWN in patients with very slow progressor type collaterals: How far can we go? J Cerebrovasc Endovasc Neurosurg 2021; 23:354-358. [PMID: 34915608 PMCID: PMC8743825 DOI: 10.7461/jcen.2021.e2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Five trials published in 2015 showed the benefit of endovascular thrombectomy (ET) in patients with stroke and large vessel occlusion, extending the treatment window has become an obsession of all physicians. In 2018, the DAWN and DEFUSE-3 trials showed that, with careful selection of patients, the procedure could be carried out up to 24 hours after symptom onset with good outcomes. In addition, there have been cases where the DAWN criteria were met, and treatment occurred >24 hours after symptom onset. We present the case of a 68-year-old female whose groin puncture occurred 52 hours after the time last known well (TLKW), after neurological worsening of the initial situation, with a large mismatch ratio observed on magnetic resonance imaging, achieving TICI (the Thrombolysis in Cerebral Infarction scale) grade 3 recanalization. Five days after the procedure, the patient was discharged with NIHSS (National Institutes of Health Stroke Scale) score of 3. Some types of collateral circulation (slow progressors and “turtle” progressors, our term for very slow progressors) can extend the treatment window beyond 24 hours of the TLKW but can lead to a hyperperfusion-like syndrome immediately after the ET. Further studies are needed to evaluate the reproducibility of this hypothetical syndrome.
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Affiliation(s)
- Igor Pagiola
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France.,Department of Interventional Neuroradiology, Hospital Estadual Central, Vitória-Espírito, Brazil.,Department of Neurology, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Hospital da Santa Casa de Vitória, Vitória ES, Brazil
| | - Olivier Chassin
- Department of Neurology, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | | | - Nicolas Legris
- Department of Neurology, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Leon Ikka
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Guilherme Brasileiro de Aguiar
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Jacques Moret
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Christian Denier
- Department of Neurology, Hopital Bicetre, APHP, Paris Sud Université, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuri Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, France
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15
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Dumas V, Kaesmacher J, Ognard J, Forestier G, Dargazanli C, Janot K, Behme D, Shotar E, Chabert E, Velasco S, Bricout N, Ben Hassen W, Veunac L, Geismar M, Eugene F, Detraz L, Darcourt J, L'Allinec V, Eker OF, Consoli A, Maus V, Gariel F, Marnat G, Papanagiotou P, Papagiannaki C, Escalard S, Meyer L, Lobsien D, Abdullayev N, Chalumeau V, Neau JP, Guillevin R, Boulouis G, Rouchaud A, Styczen H, Fauché C. Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study. J Neurointerv Surg 2021; 14:1180-1185. [PMID: 34916267 DOI: 10.1136/neurintsurg-2021-017935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access. METHODS We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications. RESULTS From January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0-2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043). CONCLUSION In this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT.
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Affiliation(s)
- Victor Dumas
- Radiology Department, Poitiers University Medical Center, LabCom I3M, DACTIM-MIS team, LMA CNRS 7348, Poitiers, Vienne, France
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Julien Ognard
- Interventional Neuroradiology, CHRU de Brest, Brest, Bretagne, France
| | - Géraud Forestier
- Neuroradiology Department, XLIM CNRS, UMR7252, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Cyril Dargazanli
- Department of Neuroradiology, INSERM U1191, University Hospital Center Montpellier, Montpellier, Occitanie, France
| | - Kevin Janot
- Neuroradiology Department, University Hospital of Tours, Tours, Indre et Loire, France
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University of Gottingen, Goettingen, Germany
| | - Eimad Shotar
- Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Chabert
- Neuroradiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Stéphane Velasco
- Radiology Department, Poitiers University Medical Center, Poitiers, Vienne, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Wagih Ben Hassen
- Interventional Neuroradiology, CH Sainte-Anne, INSERM UMR 1266, Paris, Île-de-France, France
| | - Louis Veunac
- Department of Radiology, Bayonne Hospital, Bayonne, France
| | - Maxime Geismar
- Neuroradiology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Lili Detraz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Jean Darcourt
- Neuroradiology Department, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | | | - Omer F Eker
- Neuroradiology Department, Neurologic Hospital, Bron, France
| | - Arturo Consoli
- Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Volker Maus
- Institute of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Florent Gariel
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, Aquitaine, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, Aquitaine, France
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospitals Bremen-Mitte, Bremen-Ost, Germany
| | | | - Simon Escalard
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, Ile de France, France
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Nuran Abdullayev
- Diagnostic and Interventional Radiology Department, University Hospital Cologne, Köln, Germany
| | - Vanessa Chalumeau
- Interventional Neuroradiology, CHU Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | | | - Rémy Guillevin
- Radiology Department, Poitiers University Medical Center, LabCom I3M, DACTIM-MIS team, LMA CNRS 7348, Poitiers, Vienne, France
| | - Gregoire Boulouis
- Neuroradiology Department, University Hospital of Tours, Tours, Indre et Loire, France
| | - Aymeric Rouchaud
- Neuroradiology Department, XLIM CNRS, UMR7252, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cédric Fauché
- Radiology Department, Poitiers University Medical Center, Poitiers, Vienne, France
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Spelle L, Herbreteau D, Caroff J, Barreau X, Ferré JC, Fiehler J, Januel AC, Costalat V, Liebig T, Bourcier R, Möhlenbruch M, Berkefeld J, Weber W, Mihalea C, Ikka L, Ozanne A, Cognard C, Narata AP, Bibi RE, Gauvrit JY, Raoult H, Velasco S, Buhk JH, Chalumeau V, Bester M, Desal H, du Mesnil de Rochemont R, Bohner G, Fischer S, Biondi A, Grimaldi L, Moret J, Byrne J, Pierot L. CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): results of 1-month and 1-year assessment of rebleeding protection and clinical safety in a multicenter study. J Neurointerv Surg 2021; 14:807-814. [PMID: 34493578 PMCID: PMC9304095 DOI: 10.1136/neurintsurg-2021-017416] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022]
Abstract
Background The primary goal of the CLARYS study is to assess the protection against rebleeding when treating ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) device. Methods The CLARYS study is a prospective, multicenter study conducted in 13 European centers. Patients with ruptured bifurcation aneurysms were consecutively included between February 2016 and September 2017. The primary endpoint was defined as the rebleeding rate of the target aneurysm treated with the WEB within 30 days postprocedure. Secondary endpoints included periprocedural and postprocedural adverse events, total procedure and fluoroscopy times, and modified Rankin Scale score at 1 month and 1 year. Results Sixty patients with 60 ruptured bifurcation aneurysms to be treated with the WEB were included. A WEB device was successfully implanted in 93.3%. The rebleeding rate at 1 month and 1 year was 0%. The mean fluoroscopy time was 27.0 min. Twenty-three periprocedural complications were observed in 18 patients and resolved without sequelae in 16 patients. Two of these complications were attributed to the procedure and/or the use of the WEB, leading to a procedure/device-related intraoperative complication rate of 3.3%. Overall mortality at 1 month and 1 year was 1.7% and 3.8%, respectively and overall morbidity at 1 month and 1 year was 15% and 9.6%, respectively. WEB-related 1-month and 1-year morbidity and mortality was 0%. Conclusions The interim results of CLARYS show that the endovascular treatment of ruptured bifurcation aneurysms with the WEB is safe and effective and, in particular, provides effective protection against rebleeding. It may induce profound change in the endovascular management of ruptured bifurcation aneurysms.
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Affiliation(s)
- Laurent Spelle
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France .,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Vincent Costalat
- Department of Neuroradiology, University Hospital Gui de Chauliac, Montpellier, France
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital, Munchen, Germany
| | - Romain Bourcier
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Joachim Berkefeld
- Institut für Neuroradiologie, Universitätsklinikum, Frankfurt am Main, Germany.,Goethe-Universität, Frankfurt am Main, Germany
| | - Werner Weber
- Department of Neuroradiology, University Hospital of the Ruhr, Bochum, Germany
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Léon Ikka
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Augustin Ozanne
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Richard Edwige Bibi
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jean-Yves Gauvrit
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Hélène Raoult
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Stéphane Velasco
- Department of Radiology, Regional University Hospital, Poitiers, France
| | - Jan-Hendrik Buhk
- Department of Neuroradiology, Asklepios Hospital Group, Hamburg, Germany
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hubert Desal
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Georg Bohner
- Department of Neuroradiology, Charité Universitatsmedizin, Berlin, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, University Hospital of the Ruhr, Bochum, Germany
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Jean-Minjoz University Hospital, Besancon, France
| | - Lamiae Grimaldi
- Assistance Publique - Hopitaux de Paris, Paris, France.,Clinical Research Unit AP-HP Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux, France.,CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris, France
| | - Jacques Moret
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - James Byrne
- Department of Neuroradiology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, Reims, France.,Reims Champagne-Ardenne University, Reims, France
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Marnat G, Delvoye F, Finitsis S, Lapergue B, Gariel F, Consoli A, Desilles JP, Mazighi M, Dargazanli C, Bourcier R, Darcourt J, Chalumeau V, Elhorany M, Clarençon F, Richard S, Gory B, Sibon I. A Multicenter Preliminary Study of Cangrelor following Thrombectomy Failure for Refractory Proximal Intracranial Occlusions. AJNR Am J Neuroradiol 2021; 42:1452-1457. [PMID: 34117019 DOI: 10.3174/ajnr.a7180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Rescue endovascular and pharmacologic approaches are increasingly being adopted after recanalization failure of acute large-vessel occlusion strokes with mechanical thrombectomy, with encouraging results. The safety and efficacy of glycoprotein IIb/IIIa inhibitors in ischemic stroke have been investigated, though cangrelor, a recent intravenous P2Y12-receptor inhibitor with a rapid onset/offset of action and a short half-life, may be a valuable option. We compared the safety and efficacy of cangrelor with those of glycoprotein IIb/IIIa inhibitors for refractory occlusions. MATERIALS AND METHODS We performed a retrospective analysis of the ongoing prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke Registry in France between May 2012 and February 2020. Refractory intracranial occlusions of the anterior and posterior circulation were included and defined as recanalization failure of large-vessel occlusion stroke, perioperative target artery reocclusion, or high risk of early reocclusion related to an arterial wall lesion. The primary end point was a favorable outcome, defined as a 90-day mRS of 0-2. Secondary end points were reperfusion, intracranial hemorrhage, and procedural complications. RESULTS Among 69 patients, 15 were treated with cangrelor, and 54, with glycoprotein IIb/IIIa inhibitors. The favorable outcome (adjusted OR = 2.22; 95% CI, 0.42-11.75; P = .348) and mortality (adjusted OR = 0.44; 95% CI, 0.06-3.16; P = .411) rates were similar in both groups. There was no difference in the rates of any intracranial hemorrhage (adjusted OR = 0.40; 95% CI, 0.08-2.09; P = .280), symptomatic intracranial hemorrhage (6.7% versus 0.0%, P = .058), or procedural complications (6.7% versus 20.4%, P = .215). Reperfusion rates were higher in the cangrelor group, though the difference did not reach statistical significance (93.3% versus 75.0% for modified TICI 2b-3; adjusted OR =10.88; 95% CI, 0.96-123.84; P = .054). CONCLUSIONS Cangrelor seems to be as safe as glycoprotein IIb/IIIa inhibitors for managing refractory intracranial occlusion and leads to satisfactory brain reperfusion. Cangrelor is a promising agent in this setting, and additional studies are warranted to confirm our findings.
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Affiliation(s)
- G Marnat
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - F Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - S Finitsis
- Aristotle University of Thessaloniki (S.F.), Ahepa Hospital, Thessaloniki, Greece
| | - B Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - F Gariel
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - A Consoli
- Department s of Neuroradiology (A.C.) and Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - J-P Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - C Dargazanli
- Department of Neuroradiology (C.D.), Centre Hospitalier Régional Universitaire Gui de Chauliac, Montpellier, France
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), University Hospital of Toulouse, Toulouse, France
| | - V Chalumeau
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - M Elhorany
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - F Clarençon
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - S Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Régional Universitaire-Nancy, Stroke Unit, Nancy, France
- Institut national de la santé et de la recherche médicale U1116 (S.R.), Centre Hospitalier Régional Universitaire-Nancy, Nancy, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, CHRU-Nancy, Nancy, France
- Institut National de la Santé et de la Recherche Mmédicale U1254 (B.G.), Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
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18
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Girot JB, Caroff J, Cortese J, Mihalea C, Rouchaud A, Ros VD, Martinez JV, Contreras L, Ikka L, Chalumeau V, Ozanne A, Aguiar GBD, Gallas S, Moret J, Spelle L. Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device. AJNR Am J Neuroradiol 2021; 42:1276-1281. [PMID: 33926902 DOI: 10.3174/ajnr.a7115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge has proved to be a safe and effective treatment, especially for wide-neck intracranial aneurysms. The recent fifth-generation Woven EndoBridge came with smaller devices. The purpose of this study was to assess the safety and efficiency of Woven EndoBridge treatment of small and very small aneurysms. MATERIALS AND METHODS Between September 2017 and March 2020, all consecutive patients treated with a 3- or 3.5 mm-width Woven EndoBridge device were included in this retrospective intention-to-treat study. Clinical and radiologic findings were evaluated at immediate and last-available follow-up. Angiographic outcome was assessed by an external expert reader. RESULTS One hundred twenty-eight aneurysms were treated with a fifth-generation Woven EndoBridge device including 29 with a width of ≤3.5 mm. Ten aneurysms were ruptured (34%). In 3 cases (10%), Woven EndoBridge treatment could not be performed because the aneurysm was still too small for the smallest available Woven EndoBridge device and another endovascular strategy was chosen. The median follow-up time was 11.2 months. Complete and adequate occlusion was obtained in 71% and 90% of the treated aneurysms, respectively. Retreatment was needed in 2 cases (10%). Symptomatic ischemic complications leading to transient neurologic deficits occurred in 2 cases (7%) (1 procedure-related and 1 device-related) but with full spontaneous recovery at discharge. CONCLUSIONS The fifth-generation Woven EndoBridge device seems to be a safe and technically feasible treatment for both ruptured and unruptured small and very small intracranial aneurysms, with satisfactory occlusion rates on midterm follow-up. However, further study is needed to evaluate longer-term efficiency.
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Affiliation(s)
- J-B Girot
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Radiology Department (J.-B.G.), Angers University Hospital, Angers, France
| | - J Caroff
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - J Cortese
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - C Mihalea
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - A Rouchaud
- Department of Radiology (A.R.), Centre Hospitalier et Universitaire Dupuytren, Centre National de la Recherche Scientifique, XLIM, Unité Mixte de Recherche Limoges, France
| | - V Da Ros
- Department of Biomedicine and Prevention (V.D.R.), University Hospital of Rome Tor Vergata, Rome, Italy
| | - J V Martinez
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - L Contreras
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Department of Neurosurgery (L.C.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - L Ikka
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - A Ozanne
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - G B D Aguiar
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Department of Surgery, Discipline Neurosurgery (G.B.D.A.), Santa Casa de Sao Paulo School of Medical Sciences. São Paulo, Brazil
| | - S Gallas
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - J Moret
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Université Paris Sud, faculté de Médecine (J.M., L.S.), Le Kremlin-Bicêtre, France
| | - L Spelle
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Université Paris Sud, faculté de Médecine (J.M., L.S.), Le Kremlin-Bicêtre, France
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Cortese J, Caroff J, Girot JB, Mihalea C, Da Ros V, Aguiar G, Elawady A, Ikka L, Gallas S, Ozanne A, Chalumeau V, Rouchaud A, Moret J, Spelle L. Impact of A1 Asymmetry on the Woven EndoBridge Device in Anterior Communicating Artery Aneurysms. AJNR Am J Neuroradiol 2021; 42:1479-1485. [PMID: 34117022 DOI: 10.3174/ajnr.a7189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Woven EndoBridge (WEB) devices are increasingly used to treat intracranial aneurysms. A1 asymmetry contributes to anterior communicating artery aneurysm formation and to treatment instability after coiling. We sought to evaluate whether A1 asymmetry had an impact on angiographic outcome in anterior communicating artery aneurysms treated with the WEB. MATERIALS AND METHODS Anterior communicating artery aneurysms treated between July 2012 and July 2020 with the WEB from an institutional review board-approved database were reviewed. A1 asymmetry was categorized as the following: absence of the A1 segment on 1 side (unilateral A1) versus bilateral A1. Univariate and multivariable analyses assessed independent predictors of adequate (WEB Occlusion Scale A, B, and C) and complete occlusion (WEB Occlusion Scale A and B). RESULTS Forty-eight individual aneurysms (47 patients) were included in the final analysis, of which 16 (33%) were acutely ruptured. The mean size was 6.5 (SD, 2.2) mm. Adequate and complete occlusion was achieved in 33 (69%) and 30 (63%) cases, respectively. Unilateral A1 was associated with significantly higher rates of adequate (92% versus 60% for bilateral A1; P = .03) and complete occlusion (92% versus 50% for bilateral A1; P < .01). Multivariable logistic regression confirmed unilateral A1 as an independent predictor of both adequate (OR = 10.6; 95% CI, 1.6-220.7; P = .04) and complete occlusion (OR = 9.5, 95% CI, 1.5-190.2; P = .04. A sensitivity analysis comparing unilateral "functional" A1 with bilateral "functional" A1 showed similar results. WEB shape modification was not influenced by the unilateral A1 configuration (P = .70). CONCLUSIONS Anterior communicating artery aneurysms with a unilateral A1 configuration treated with WEB devices are associated with better angiographic outcome than those with bilateral A1. This finding supports the hypothesis that WEB devices are resistant to unilateral flow in the aneurysm as opposed to coils.
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Affiliation(s)
- J Cortese
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J Caroff
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J-B Girot
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Department of Radiology (J.-B.G.), Angers University Hospital, Angers, France
| | - C Mihalea
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Da Ros
- Department of Biomedicine (V.D.R.), Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - G Aguiar
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Elawady
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Ikka
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - S Gallas
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Ozanne
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Rouchaud
- Department of Interventional Neuroradiology (A.R.), Limoges University Hospital, Limoges, France.,University of Limoges (A.R.), XLIM UMR CNRS 7252, Limoges, France
| | - J Moret
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Spelle
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
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Aguiar G, Caroff J, Mihalea C, Cortese J, Girot JB, Elawady A, Vergara Martinez J, Ikka L, Gallas S, Chalumeau V, Ozanne A, Moret J, Spelle L. WEB device for treatment of posterior communicating artery aneurysms. J Neurointerv Surg 2021; 14:362-365. [PMID: 33975921 DOI: 10.1136/neurintsurg-2021-017405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Woven EndoBridge (WEB) device treatment of wide-neck bifurcation aneurysms has proved to be safe and effective, but the use of these devices in sidewall aneurysms has been reported only in a small number of case series. OBJECTIVE To report our results in a cohort of consecutive patients in whom a WEB device was used as first-line treatment for posterior communicating artery (PComA) aneurysms. METHODS We conducted a retrospective analysis of a prospectively maintained database of PComA aneurysms treated with a WEB device in our institution from June 1, 2012 to November 15, 2020. Clinical and radiological findings were evaluated at immediate and last follow-up. RESULTS A total of 219 aneurysms were treated with a WEB device, including 15 PComA aneurysms in 15 patients, 10 of which were ruptured. Aneurysms were wide necked, with a mean aspect ratio of 1.6 (range 0.7-3.0) and a mean neck size of 4.2 mm (range 2.6-7.4 mm). No intraoperative rupture occurred and only one thromboembolic event was noted. Among the group with at least a 3-month digital subtraction angiography (DSA) follow-up, complete and adequate occlusion were obtained in 54% and 72%, respectively (average follow-up 13 months). Re-treatment was needed for two initially ruptured aneurysms. No procedure-related morbidity or mortality was reported. CONCLUSION This series suggests the high safety profile of WEB devices even when used in off-label indications. Treatment with these devices seems to be a valuable strategy for ruptured wide-neck PComA aneurysms, avoiding the need for antiplatelet medication. However, occlusion rates should be investigated in further larger studies.
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Affiliation(s)
- Guilherme Aguiar
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jildaz Caroff
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Cristian Mihalea
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jonathan Cortese
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jean-Baptiste Girot
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Ahmed Elawady
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jeickson Vergara Martinez
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Léon Ikka
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Sophie Gallas
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Augustin Ozanne
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jacques Moret
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Laurent Spelle
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France
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21
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Nogueira RG, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, Qiu Z, Farhoudi M, Siegler JE, Yaghi S, Raz E, Sakai N, Ohara N, Piotin M, Mechtouff L, Eker O, Chalumeau V, Kleinig TJ, Pop R, Liu J, Winters HS, Shang X, Vasquez AR, Blasco J, Arenillas JF, Martinez-Galdamez M, Brehm A, Psychogios MN, Lylyk P, Haussen DC, Al-Bayati AR, Mohammaden MH, Fonseca L, Luís Silva M, Montalverne F, Renieri L, Mangiafico S, Fischer U, Gralla J, Frei D, Chugh C, Mehta BP, Nagel S, Mohlenbruch M, Ortega-Gutierrez S, Farooqui M, Hassan AE, Taylor A, Lapergue B, Consoli A, Campbell BC, Sharma M, Walker M, Van Horn N, Fiehler J, Nguyen HT, Nguyen QT, Watanabe D, Zhang H, Le HV, Nguyen VQ, Shah R, Devlin T, Khandelwal P, Linfante I, Izzath W, Lavados PM, Olavarría VV, Sampaio Silva G, de Carvalho Sousa AV, Kirmani J, Bendszus M, Amano T, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Morris JG, Griffin E, Thornton J, Lavoie P, Matouk C, Hill MD, Demchuk AM, Killer-Oberpfalzer M, Nahab F, Altschul D, Ramos-Pachón A, Pérez de la Ossa N, Kikano R, Boisseau W, Walker G, Cordina SM, Puri A, Luisa Kuhn A, Gandhi D, Ramakrishnan P, Novakovic-White R, Chebl A, Kargiotis O, Czap A, Zha A, Masoud HE, Lopez C, Ozretic D, Al-Mufti F, Zie W, Duan Z, Yuan Z, Huang W, Hao Y, Luo J, Kalousek V, Bourcier R, Guile R, Hetts S, Al-Jehani HM, AlHazzani A, Sadeghi-Hokmabadi E, Teleb M, Payne J, Lee JS, Hong JM, Sohn SI, Hwang YH, Shin DH, Roh HG, Edgell R, Khatri R, Smith A, Malik A, Liebeskind D, Herial N, Jabbour P, Magalhaes P, Ozdemir AO, Aykac O, Uwatoko T, Dembo T, Shimizu H, Sugiura Y, Miyashita F, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Beer-Furlan A, Joshi K, Catanese L, Abud DG, Neto OG, Mehrpour M, Al Hashmi A, Saqqur M, Mostafa A, Fifi JT, Hussain S, John S, Gupta R, Sivan-Hoffmann R, Reznik A, Sani AF, Geyik S, Akıl E, Churojana A, Ghoreishi A, Saadatnia M, Sharifipour E, Ma A, Faulder K, Wu T, Leung L, Malek A, Voetsch B, Wakhloo A, Rivera R, Barrientos Iman DM, Pikula A, Lioutas VA, Thomalla G, Birnbaum L, Machi P, Bernava G, McDermott M, Kleindorfer D, Wong K, Patterson MS, Fiorot JA, Huded V, Mack W, Tenser M, Eskey C, Multani S, Kelly M, Janardhan V, Cornett O, Singh V, Murayama Y, Mokin M, Yang P, Zhang X, Yin C, Han H, Peng Y, Chen W, Crosa R, Frudit ME, Pandian JD, Kulkarni A, Yagita Y, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Yamazaki H, Sakaguchi M, Todo K, Yamamoto N, Sonoda K, Yoshida T, Hashimoto H, Nakahara I, Cora E, Volders D, Ducroux C, Shoamanesh A, Ospel J, Kaliaev A, Ahmed S, Rashid U, Rebello LC, Pereira VM, Fahed R, Chen M, Sheth SA, Palaiodimou L, Tsivgoulis G, Chandra R, Koyfman F, Leung T, Khosravani H, Dharmadhikari S, Frisullo G, Calabresi P, Tsiskaridze A, Lobjanidze N, Grigoryan M, Czlonkowska A, de Sousa DA, Demeestere J, Liang C, Sangha N, Lutsep HL, Ayo-Martín Ó, Cruz-Culebras A, Tran AD, Young CY, Cordonnier C, Caparros F, De Lecinana MA, Fuentes B, Yavagal D, Jovin T, Spelle L, Moret J, Khatri P, Zaidat O, Raymond J, Martins S, Nguyen T. Global impact of COVID-19 on stroke care. Int J Stroke 2021; 16:573-584. [PMID: 33459583 PMCID: PMC8010375 DOI: 10.1177/1747493021991652] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March–31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). Methods Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, −19.7 to −18.7), 11.5% (95%CI, −12.6 to −10.6), and 12.7% (95%CI, −13.6 to −11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (−20.5%) had greater declines in mechanical thrombectomy volumes than mid- (−10.1%) and low-volume (−8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.
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Affiliation(s)
- Raul G Nogueira
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Muhammed M Qureshi
- Radiology, Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Michael R Frankel
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Ossama Yassin Mansour
- Neurology Department, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt
| | - Hiroshi Yamagami
- Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
| | - Zhongming Qiu
- Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China
| | | | - James E Siegler
- Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Shadi Yaghi
- Neurology, Radiology, New York University School of Medicine, New York, USA
| | - Eytan Raz
- Radiology, Neurology, New York University School of Medicine, New York, USA
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michel Piotin
- Fondation Ophtalmologique Adolphe de Rothschild, France
| | | | - Omer Eker
- Neuroradiologie, Hospices Civils de Lyon, France
| | | | | | - Raoul Pop
- Hôpitaux Universitaires de Strasbourg, France
| | | | | | | | | | - Jordi Blasco
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Spain
| | | | | | | | | | - Pedro Lylyk
- Clínica Sagrada Familia, Buenos Aires, Argentina
| | - Diogo C Haussen
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | | | | | - Luísa Fonseca
- Stroke, Centro Hospitalar Universitário de São João, Portugal
| | - M Luís Silva
- Neuroradiology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | | | - Urs Fischer
- Neurology, University Hospital Bern, Switzerland
| | - Jan Gralla
- Interventional Neuroradiology, University Hospital Bern, Switzerland
| | | | | | | | - Simon Nagel
- Neurology, University Hospital Heidelberg, Germany
| | | | | | | | - Ameer E Hassan
- Neurosciences, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Allan Taylor
- Neurosurgery, University of Cape Town, South Africa
| | | | | | | | | | | | - Noel Van Horn
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | - Hao Zhang
- Affiliated Hangzhou First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Naoki Tokuda
- Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Fadi Nahab
- Emory University School of Medicine, USA
| | | | | | | | | | | | | | | | - Ajit Puri
- University of Massachusetts Medical Center, USA
| | | | | | | | | | | | | | | | - Alicia Zha
- UTHealth McGovern Medical School, Houston, USA
| | | | | | | | | | - Wenjie Zie
- Xinqiao Hospital of the Army Medical University, China
| | | | - Zhengzhou Yuan
- Affiliated Hospital of Southwest Medical University, China
| | - Wenguo Huang
- Maoming Traditional Chinese Medicine Hospital, China
| | | | - Jun Luo
- Mianyang 404 Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alice Ma
- Royal North Shore Hospital, Australia
| | | | - Teddy Wu
- Christchurch Hospital, Christchurch , New Zealand
| | | | | | | | - Ajay Wakhloo
- Interventional Neuroradiology, Beth Israel Lahey Health, USA
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia Dr. Asengo, Chile
| | | | | | | | - Gotz Thomalla
- Neurology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | | | | | - Ken Wong
- Royal London Hospital, United Kingdom
| | | | | | | | | | | | - Clifford Eskey
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | | | | | | | | | | | | | - Congguo Yin
- Affiliated Hangzhou First People's Hospital, China
| | | | - Ya Peng
- First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenichi Todo
- Osaka University Graduate School of Medicine, Japan
| | - Nobuaki Yamamoto
- Tokushima University Graduate School of Biomedical Sciences, Japan
| | | | | | | | | | - Elena Cora
- Dalhousie University, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Conrad Liang
- Neurointerventional Radiology, Kaiser Permanente, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thanh Nguyen
- Radiology, Neurology, Boston Medical Center, USA
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22
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Nguyen TN, Haussen DC, Qureshi MM, Yamagami H, Fujinaka T, Mansour OY, Abdalkader M, Frankel M, Qiu Z, Taylor A, Lylyk P, Eker OF, Mechtouff L, Piotin M, Lima FO, Mont'Alverne F, Izzath W, Sakai N, Mohammaden M, Al-Bayati AR, Renieri L, Mangiafico S, Ozretic D, Chalumeau V, Ahmad S, Rashid U, Hussain SI, John S, Griffin E, Thornton J, Fiorot JA, Rivera R, Hammami N, Cervantes-Arslanian AM, Dasenbrock HH, Vu HL, Nguyen VQ, Hetts S, Bourcier R, Guile R, Walker M, Sharma M, Frei D, Jabbour P, Herial N, Al-Mufti F, Ozdemir AO, Aykac O, Gandhi D, Chugh C, Matouk C, Lavoie P, Edgell R, Beer-Furlan A, Chen M, Killer-Oberpfalzer M, Pereira VM, Nicholson P, Huded V, Ohara N, Watanabe D, Shin DH, Magalhaes PS, Kikano R, Ortega-Gutierrez S, Farooqui M, Abou-Hamden A, Amano T, Yamamoto R, Weeks A, Cora EA, Sivan-Hoffmann R, Crosa R, Möhlenbruch M, Nagel S, Al-Jehani H, Sheth SA, Lopez Rivera VS, Siegler JE, Sani AF, Puri AS, Kuhn AL, Bernava G, Machi P, Abud DG, Pontes-Neto OM, Wakhloo AK, Voetsch B, Raz E, Yaghi S, Mehta BP, Kimura N, Murakami M, Lee JS, Hong JM, Fahed R, Walker G, Hagashi E, Cordina SM, Roh HG, Wong K, Arenillas JF, Martinez-Galdamez M, Blasco J, Rodriguez Vasquez A, Fonseca L, Silva ML, Wu TY, John S, Brehm A, Psychogios M, Mack WJ, Tenser M, Todaka T, Fujimura M, Novakovic R, Deguchi J, Sugiura Y, Tokimura H, Khatri R, Kelly M, Peeling L, Murayama Y, Winters HS, Wong J, Teleb M, Payne J, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Uno M, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Morimoto M, Iida J, Saini V, Yavagal D, Bushnaq S, Huang W, Linfante I, Kirmani J, Liebeskind DS, Szeder V, Shah R, Devlin TG, Birnbaum L, Luo J, Churojana A, Masoud HE, Lopez CY, Steinfort B, Ma A, Hassan AE, Al Hashmi A, McDermott M, Mokin M, Chebl A, Kargiotis O, Tsivgoulis G, Morris JG, Eskey CJ, Thon J, Rebello L, Altschul D, Cornett O, Singh V, Pandian J, Kulkarni A, Lavados PM, Olavarria VV, Todo K, Yamamoto Y, Silva GS, Geyik S, Johann J, Multani S, Kaliaev A, Sonoda K, Hashimoto H, Alhazzani A, Chung DY, Mayer SA, Fifi JT, Hill MD, Zhang H, Yuan Z, Shang X, Castonguay AC, Gupta R, Jovin TG, Raymond J, Zaidat OO, Nogueira RG. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic. Stroke Vasc Neurol 2021; 6:542-552. [PMID: 33771936 PMCID: PMC8006491 DOI: 10.1136/svn-2020-000695] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/15/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Background During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation. Findings There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170–1035 procedures, respectively, representing an 11.5% (95%CI −13.5% to −9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI −28.0% to −22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. Interpretation There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
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Affiliation(s)
- Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Diogo C Haussen
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Muhammad M Qureshi
- Radiology, Radiation Oncology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hiroshi Yamagami
- Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Toshiyuki Fujinaka
- Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | | | - Michael Frankel
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital, Chongqing, China
| | - Allan Taylor
- Neurosurgery, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Pedro Lylyk
- Neurosurgery, Interventional Neuroradiology, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Omer F Eker
- Neuroradiologie, Neurologie Vasculaire, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Laura Mechtouff
- Neurologie Vasculaire, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | | | | | - Wazim Izzath
- Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Mahmoud Mohammaden
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Alhamza R Al-Bayati
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Leonardo Renieri
- Interventional Neurovascular Unit, University Hospital Careggi, Firenze, Toscana, Italy
| | - Salvatore Mangiafico
- Interventional Neurovascular Unit, University Hospital Careggi, Firenze, Toscana, Italy
| | - David Ozretic
- Neuroradiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vanessa Chalumeau
- Interventional Neuroradiology, Hopital Bicetre, Le Kremlin-Bicetre, France
| | - Saima Ahmad
- Stroke and Interventional Neuroradiology, Lahore General Hospital, Lahore, Pakistan
| | - Umair Rashid
- Stroke and Interventional Neuroradiology, Lahore General Hospital, Lahore, Pakistan
| | | | - Seby John
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Emma Griffin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - John Thornton
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia Dr Asengo, Santiago, Chile
| | - Nadia Hammami
- Interventional Neuroradiology, Institut National de Neurologie, Tunis, Tunisia
| | | | | | - Huynh Le Vu
- Stroke Center, Hue Central Hospital, Hue, Thua Thien Hue, Vietnam
| | - Viet Quy Nguyen
- Stroke Center, Hue Central Hospital, Hue, Thua Thien Hue, Vietnam
| | - Steven Hetts
- Radiology, University of California San Francisco, San Francisco, California, USA.,Interventional Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Romain Bourcier
- Neuroradiologie Diagnostique et Interventionnelle, Hôpital Guillaume & René Laennec, CHU Nantes, Nantes, France
| | - Romain Guile
- Neuroradiologie Diagnostique et Interventionnelle, Hôpital Guillaume & René Laennec, CHU Nantes, Nantes, France
| | - Melanie Walker
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Malveeka Sharma
- Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Don Frei
- Radiology, Swedish Medical Center, Englewood, Colorado, USA
| | - Pascal Jabbour
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel Herial
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Fawaz Al-Mufti
- Neurology, Neurosurgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Atilla Ozcan Ozdemir
- Stroke and Neurointervention Unit, Eskisehir OsmangaziUniversity, Eskisehir, Turkey
| | - Ozlem Aykac
- Stroke and Neurointervention Unit, Eskisehir OsmangaziUniversity, Eskisehir, Turkey
| | - Dheeraj Gandhi
- Radiology, Neurology, Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chandril Chugh
- Interventional Neurology, MAX Superspecialty Hospital, Saket, New Delhi, India
| | - Charles Matouk
- Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pascale Lavoie
- Neurosurgery, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Randall Edgell
- Neurology, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Andre Beer-Furlan
- Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Chen
- Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Monika Killer-Oberpfalzer
- Neurology, Research Institute of Neurointervention, University Hospital Salzburg /Paracelsus Medical University, Salzburg, Austria
| | - Vitor Mendes Pereira
- Neurosurgery, Medical Imaging, Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Neurosurgery, Medical Imaging, Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vikram Huded
- Neurology, NH Mazumdar Shah Medical Center, Bangalore, India
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Daisuke Watanabe
- Stroke and Neurovascular Surgery, IMS Tokyo-Katsushika General Hospital, Tokyo, Japan
| | - Dong Hun Shin
- Gachon University, Seongnam, Korea (the Republic of)
| | - Pedro Sc Magalhaes
- Stroke Unit, Hospital Municipal Sao Jose, Joinville, Santa Catarina, Brazil
| | - Raghid Kikano
- Interventional Neuroradiology, Lau Medical Center, Beirut, Lebanon
| | | | - Mudassir Farooqui
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Amal Abou-Hamden
- Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tatsuo Amano
- Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Ryoo Yamamoto
- Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Adrienne Weeks
- Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elena A Cora
- Radiology, QEII Health Sciences Centre, Dalhousie University, Dalhousie, Nova Scotia, Canada
| | | | - Roberto Crosa
- Centro Endovascular Neurologico Medica Uruguaya, Montevideo, Uruguay
| | - Markus Möhlenbruch
- Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Simon Nagel
- Neurology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Hosam Al-Jehani
- Neurosurgery, Interventional Radiology and Critical Care Medicine, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
| | - Sunil A Sheth
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - James E Siegler
- Neurology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | | | - Ajit S Puri
- Neurointerventional Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anna Luisa Kuhn
- Neurointerventional Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gianmarco Bernava
- Interventional Neuroradiology, University Hospitals Geneva, Geneva, Switzerland
| | - Paolo Machi
- Interventional Neuroradiology, University Hospitals Geneva, Geneva, Switzerland
| | - Daniel G Abud
- Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Octavio M Pontes-Neto
- Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ajay K Wakhloo
- Interventional Neuroradiology, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Barbara Voetsch
- Neurology, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Eytan Raz
- Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Shadi Yaghi
- Neurology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Brijesh P Mehta
- Memorial Neuroscience Institute, Pembroke Pines, Florida, USA
| | - Naoto Kimura
- Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | | | - Jin Soo Lee
- Ajou University Hospital, Suwon, Gyeonggi-do, South Korea
| | - Ji Man Hong
- Ajou University Hospital, Suwon, Gyeonggi-do, South Korea
| | - Robert Fahed
- Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory Walker
- Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Eiji Hagashi
- Cerebrovascular Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Steve M Cordina
- Neurology, Neurosurgery, Radiology, University of South Alabama, Mobile, Alabama, USA
| | - Hong Gee Roh
- Konkuk University, Gwangjin-gu, Seoul, South Korea
| | - Ken Wong
- Interventional Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Juan F Arenillas
- Neurology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Mario Martinez-Galdamez
- Interventional Neuroradiology, Hospital Clínico Universitario, Universidad de Valladolid, Valladolid, Spain
| | - Jordi Blasco
- INR, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | | | - Luisa Fonseca
- Stroke Unit, Department of Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M Luis Silva
- Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teddy Y Wu
- Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Simon John
- Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - Alex Brehm
- Interventional and Diagnostic Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Marios Psychogios
- Interventional and Diagnostic Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - William J Mack
- Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Matthew Tenser
- Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Tatemi Todaka
- Neurosurgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan
| | - Miki Fujimura
- Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | | | - Jun Deguchi
- Endovascular Neurosurgery, Nara City Hospital, Nara, Nara, Japan
| | - Yuri Sugiura
- Neurology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hiroshi Tokimura
- Neurosurgery and Stroke Center, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | | | - Michael Kelly
- Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lissa Peeling
- Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yuichi Murayama
- Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | | | - Johnny Wong
- Neurosurgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mohamed Teleb
- Neurosciences, Banner Desert Medical Center, Mesa, Arizona, USA
| | - Jeremy Payne
- Neurosciences, Banner Desert Medical Center, Mesa, Arizona, USA
| | - Hiroki Fukuda
- Neurology, Japanese Red Cross Matsue Hospital, Shimane, Japan
| | - Kosuke Miyake
- Neurology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Junsuke Shimbo
- Cerebrovascular Medicine, Niigata City General Hospital, Niigata, Niigata, Japan
| | | | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Yuji Matsumaru
- Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoshi Yamada
- Neurology, Stroke Center and Neuroendovascular Therapy, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Ryuhei Kono
- Neurology, Kinikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Kanamaru
- Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masafumi Morimoto
- Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan
| | - Junichi Iida
- Neurosurgery, Osaka General Medical Center, Osaka, Japan
| | - Vasu Saini
- Neurology, Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Dileep Yavagal
- Neurology, Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Saif Bushnaq
- Neurology, Bon Secours Mercy Health System, Toledo, Ohio, USA
| | - Wenguo Huang
- Neurology, Maoming City Hospital, Guandong, China
| | - Italo Linfante
- Interventional Neuroradiology, Endovascular Neurosurgery, Miami Cardiac & Vascular Institute, Miami, Florida, USA
| | - Jawad Kirmani
- Neurology, Hackensack Meridian Health, Edison, New Jersey, USA
| | - David S Liebeskind
- Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Ruchir Shah
- Neurology, Erlanger Medical Center, University of Tennessee, Chattanooga, Tennessee, USA
| | - Thomas G Devlin
- Neurology, Erlanger Medical Center, University of Tennessee, Chattanooga, Tennessee, USA
| | - Lee Birnbaum
- Neurology, Neurosurgery, Radiology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jun Luo
- Neurology, Mianyang 404 Hospital, Mianyang, Sichuan, China
| | | | - Hesham E Masoud
- Neurology, Neurosurgery, Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Carlos Ynigo Lopez
- Neurology, Neurosurgery, Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Brendan Steinfort
- Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alice Ma
- Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ameer E Hassan
- Neurosciences, The University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Amal Al Hashmi
- Central Stroke Unit, Directorate of Neuroscience, Khoula Hospital, Ministry of Health, Muscat, Oman
| | | | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Alex Chebl
- Neurology, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Georgios Tsivgoulis
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jane G Morris
- Neurology, Maine Medical Center, Portland, Maine, USA
| | - Clifford J Eskey
- Neuroradiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jesse Thon
- Neurology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Leticia Rebello
- Neurology, Hospital Universitario de Brasilia, Brasilia, Distrito Federal, Brazil
| | - Dorothea Altschul
- Neurointerventional Neurosurgery, The Valley Hospital, Ridgewood, New Jersey, USA
| | - Oriana Cornett
- Neurosciences, Stroke Program, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Varsha Singh
- Neurosciences, Stroke Program, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jeyaraj Pandian
- Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Anirudh Kulkarni
- Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Pablo M Lavados
- Vascular Neurology Unit, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Veronica V Olavarria
- Vascular Neurology Unit, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Kenichi Todo
- Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Yamamoto
- Neurology, Tokushima University Hospital, Tokushima, Japan
| | | | - Serdar Geyik
- Istanbul Aydin University, Istanbul, İstanbul, Turkey
| | - Jasmine Johann
- Radiology, Swedish Medical Center, Englewood, Colorado, USA
| | - Sumeet Multani
- Neurology, Bayhealth Medical Center, Dover, Delaware, USA
| | - Artem Kaliaev
- Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Kazutaka Sonoda
- Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Hiroyuki Hashimoto
- Division of Stroke, Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Adel Alhazzani
- Neurology Division, Department of Medicine, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
| | - David Y Chung
- Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Stephan A Mayer
- Neurology, Neurosurgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Johanna T Fifi
- Neurology, Mount Sinai Health System, New York, New York, USA
| | - Michael D Hill
- Neurology, Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Hao Zhang
- Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhengzhou Yuan
- Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xianjin Shang
- Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | | | - Rishi Gupta
- Neuroscience, WellStar Health System, Marietta, Georgia, USA
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Jean Raymond
- Neuroradiologie Interventionelle, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Osama O Zaidat
- Neurology, Bon Secours Mercy Health System, Toledo, Ohio, USA
| | - Raul G Nogueira
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
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23
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Caroff J, Cortese J, Girot JB, Mihalea C, Aguiar G, Vergara Martinez J, Ikka L, Chalumeau V, Rehem M, Gallas S, Ozanne A, Moret J, Spelle L. Woven EndoBridge device shape modification can be mitigated with an appropriate oversizing strategy: a VasoCT based study. J Neurointerv Surg 2021; 14:neurintsurg-2020-017232. [PMID: 33727411 DOI: 10.1136/neurintsurg-2020-017232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Woven EndoBridge (WEB) shape modification (WShM) during follow-up may be a potential cause of poor angiographic outcomes. WShM predisposing factors have not yet been determined. Our systematic use of rotational cone beam computed tomography (VasoCT) imaging during follow-up allowed us to perform the first quantitative analysis of the shape of WEBs over time. Our goal was to identify possible strategies to reduce the occurrence of this phenomenon. METHODS All patients treated in our hospital with a WEB device between October 2015 and January 2019 were included. Using VasoCT acquisitions, systematically performed after implantation and during follow-up, we analyzed WEB morphology. WShM was defined as the percentage reduction in the distance between the two WEB markers. RESULTS Sixty-three aneurysms treated with a WEB device were finally included in this analysis. At the last follow-up (mean 15.5 months), mean WShM was 48%±24. The mean WShM was significantly higher in the aneurysm recurrence group than in the adequate occlusion group (51±6.5% vs 36±3.4%, difference 15% points (95% CI 0.7 to 30); p<0.05). Conversely, the extent of WShM did not directly correlate with occlusion rates. Indeed, 32% of completely occluded aneurysms presented severe WShM (≥50%). Importantly, the absence of WShM guaranteed complete occlusion in our study (n=12). We demonstrated that oversizing the width of the WEB significantly correlated with WShM reduction during follow-up (r=-0.38, p=0.002). CONCLUSION WShM can be partly overcome by use of an appropriate width oversizing strategy that could lead to improved angiographic results.
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Affiliation(s)
- Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | | | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Guilherme Aguiar
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Jeickson Vergara Martinez
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Marcelle Rehem
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France.,Faculty of Medicine, Paris - Saclay University, Le Kremlin-Bicêtre, France
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24
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Nguyen TN, Haussen DC, Qureshi MM, Yamagami H, Fujinaka T, Mansour OY, AbdalKader M, Frankel MR, Qiu Z, Taylor A, Lylyk P, Eker OF, MECHTOUFF L, Piotin M, Lima FO, Mont’Alverne F, Izzath W, Sakai N, Mohammaden M, Renieri L, Mangiafico S, Ozretic D, Chalumeau V, Ahmed S, Rashid U, Hussain SI, JOHN SEBY, Griffin E, Thornton JM, Fiorot JA, Rivera R, Hammami N, Vu HL, Hetts S, Nogueira RG. Abstract 14: Global Impact of the Covid-19 Pandemic on Subarachnoid Hemorrhage. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The objective was to examine whether subarachnoid hemorrhage(SAH) hospitalizations and ruptured aneurysm coiling interventions demonstrated similar declines.
Methods:
We conducted a global, retrospective, observational study across 6 continents, 37 countries, and 140 comprehensive stroke centers. Patients with diagnosis of SAH, ruptured aneurysm coiling interventions, COVID-19 were identified using ICD-10 codes or by prospectively maintained stroke databases. The 3-month cumulative volume, monthly volumes for SAH hospitalizations and ruptured aneurysm coiling procedures were compared for the period before (1-year and immediately before) and during the COVID-19 pandemic (March 1 to May 31, 2020).
Results:
There was a significant decline in SAH hospitalizations with 2,044 admissions in the 3 months immediately before and 1,585 admissions during the pandemic, representing a decline of 22.5% (95%CI, -24.3 to -20.7, p<0.0001). Embolization of ruptured aneurysms declined with 1,170 to 1,035 procedures, respectively, representing an 11.5%(95%CI, -13.5 to -9.8, p=0.002) drop. Hospitals with higher COVID-19 hospitalization burden demonstrated greater declines in SAH and ruptured aneurysm coiling compared to lower COVID-19 burden. A relative increase in coiling of ruptured aneurysms was noted in low coiling volume hospitals of 41.1% (95%CI, 32.3-50.6, p=0.008) despite a decrease in SAH admissions in this tertile.
Conclusions:
There was a global decrease in subarachnoid hemorrhage admissions and ruptured aneurysm embolizations during the COVID-19 pandemic. Among low-volume coiling SAH hospitals, there was an increase in the ruptured aneurysm coiling intervention. These findings in SAH are consistent with a global decrease in other emergencies such as stroke and myocardial infarction.*On behalf of the SVIN COVID-19 Collaborators
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zhongming Qiu
- Neurology, Xinqiao Hosp of the Army Med Univ, Chongqing, China
| | - Allan Taylor
- Neurosurgery, Univ of Cape Town, Cape Town, South Africa
| | - Pedro Lylyk
- ENERI CLINICA LA SAGRADA FAMILIA, Caba, Argentina
| | | | | | | | | | | | - Wazim Izzath
- Neuroradiology, Queen’s Med Cntr, Nottingham, United Kingdom
| | | | | | | | | | | | | | | | | | - Syed I Hussain
- Neurological Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - SEBY JOHN
- Neurology, Neurological Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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25
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Venditti L, Chassin O, Ancelet C, Legris N, Sarov M, Lapergue B, Mihalea C, Ozanne A, Gallas S, Cortese J, Chalumeau V, Ikka L, Caroff J, Labreuche J, Spelle L, Denier C. Pre-procedural predictive factors of symptomatic intracranial hemorrhage after thrombectomy in stroke. J Neurol 2021; 268:1867-1875. [PMID: 33389028 DOI: 10.1007/s00415-020-10364-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Symptomatic intracerebral hemorrhage (sICH) is a common complication of acute ischemic stroke (AIS) associated with limited treatments and poor outcomes. We aimed to identify predictive factors of sICH in patients with AIS following mechanical thrombectomy (MT) in a real-world setting. METHODS Patients with large vessel occlusion of the anterior circulation treated with MT were consecutively included in a prospective monocentric cohort. Clinical, biological, and radiological parameters were collected to identify pre-procedural predictors for sICH. RESULTS 637 patients were included in our study. Magnetic resonance imaging was performed on most patients (86.7%). sICH occurred in 55 patients (8.6%). 428 patients (67.2%) were treated with intravenous thrombolysis. After multivariate analysis, prior use of antiplatelet therapies (odd ratio (OR) 1.84, 95% confidence interval (CI) 1.01-3.32), high C-reactive protein (OR per standard deviation (SD) increase 1.28, 95% 1.01-1.63), elevated mean arterial blood pressure (OR per 10 mmHg increase 1.22, 95% CI 1.03-1.44), hyperglycemia (OR per one SD-log increase 1.38, 95% CI 1.02-1.87), and low ASPECTS (OR per 1-point decrease 1.42, 95% CI 1.12-1.80) were found to be independent predictive factors of sICH. The pre-procedural predictors did not change when the absence of successful recanalization was considered as a covariate. Patients with strokes of unknown onset time were not especially vulnerable for sICH. CONCLUSION sICH after MT was associated with several pre-procedural risk factors: prior use of antiplatelet therapies, high C-reactive protein and hyperglycemia at baseline, elevated mean arterial blood pressure, and low ASPECTS.
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Affiliation(s)
- Laura Venditti
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Olivier Chassin
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Claire Ancelet
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Nicolas Legris
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Mariana Sarov
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | | | - Cristian Mihalea
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Jonathan Cortese
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Leon Ikka
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Julien Labreuche
- Épidémiologie et Qualité des Soins, CHU Lille, Université de Lille, EA2694, Santé Publique, Statistiques, Lille, France
| | - Laurent Spelle
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Christian Denier
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France.
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26
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Escalard S, Chalumeau V, Escalard C, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Maïer B, Piotin M. Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients. Stroke 2020; 51:3366-3370. [PMID: 32813602 PMCID: PMC7446979 DOI: 10.1161/strokeaha.120.031011] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19. METHODS We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019. RESULTS Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger (P=0.032) and had a history of diabetes mellitus more frequently (P=0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging (P=0.18 and P=0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P=0.016), higher rate of multivessel occlusion (50% versus 8.8%, P=0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores; median: 5 versus 8, P=0.006), and higher infarct core volume (median: 58 versus 6 mL, P=0.004). Successful recanalization rate was similar in both groups (P=0.767). In-hospital mortality was higher in the COVID-19 patients' group (41.7% versus 11.8%, P=0.025). CONCLUSIONS Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.
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Affiliation(s)
- Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, CHU Bicêtre, France (V.C.)
| | - Clément Escalard
- Department of Radiology, Centre Hospitalier Universitaire de Caen, France (C.E.)
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - François Delvoye
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Solène Hébert
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Stanislas Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Gabriele Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (S.E., H.R., F.D., S.H., S.S., G.C., J.-P.D., M.M., R.B., B.M., M.P.)
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Kerleroux B, Fabacher T, Bricout N, Moïse M, Testud B, Vingadassalom S, Ifergan H, Janot K, Consoli A, Ben Hassen W, Shotar E, Ognard J, Charbonnier G, L'Allinec V, Guédon A, Bolognini F, Marnat G, Forestier G, Rouchaud A, Pop R, Raynaud N, Zhu F, Cortese J, Chalumeau V, Berge J, Escalard S, Boulouis G. Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays. Stroke 2020; 51:2012-2017. [PMID: 32432994 DOI: 10.1161/strokeaha.120.030373] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT). METHODS We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period. Secondary end points included care delays between onset, imaging, and groin puncture. To analyze the primary end point, we used a Poisson regression model. We then analyzed the correlation between the number of MTs and the number of COVID-19 cases hospitalizations, using the Pearson correlation coefficient (compared with the null value). RESULTS A total of 1513 patients were included at 32 centers, in all French administrative regions. There was a 21% significant decrease (0.79; [95%CI, 0.76-0.82]; P<0.001) in MT case volumes during the epidemic period, and a significant increase in delays between imaging and groin puncture, overall (mean 144.9±SD 86.8 minutes versus 126.2±70.9; P<0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67; P<0.001). After the instatement of strict epidemic mitigation measures, there was a significant negative correlation between the number of hospitalizations for COVID and the number of MT cases (R2 -0.51; P=0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both P<0.05). CONCLUSIONS Our study showed a significant decrease in patients treated with MTs during the first stages of the COVID epidemic in France and alarming indicators of lengthened care delays. These findings prompt immediate consideration of local and regional stroke networks preparedness in the varying contexts of COVID-19 pandemic evolution.
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Affiliation(s)
- Basile Kerleroux
- Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.)
| | | | - Nicolas Bricout
- Interventional Neuroradiology Department, CHRU Lille, France (N.B., M.M.)
| | - Martin Moïse
- Interventional Neuroradiology Department, CHRU Lille, France (N.B., M.M.)
| | - Benoit Testud
- Interventional Neuroradiology Department, CHRU Marseille La Timone, France (B.T., S.V.)
| | - Sivadji Vingadassalom
- Interventional Neuroradiology Department, CHRU Marseille La Timone, France (B.T., S.V.)
| | - Héloïse Ifergan
- Interventional Neuroradiology Department, CHRU Tours, France (H.I., K.J.)
| | - Kévin Janot
- Interventional Neuroradiology Department, CHRU Tours, France (H.I., K.J.)
| | - Arturo Consoli
- Interventional Neuroradiology Department, CH Foch, France (A.C.)
| | - Wagih Ben Hassen
- Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.)
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (E.S.)
| | - Julien Ognard
- Interventional Neuroradiology Department, CHRU Brest, France (J.O.)
| | | | | | - Alexis Guédon
- Department of Neuroradiology, Lariboisière Hospital, Paris, France (A.G.)
| | | | - Gaultier Marnat
- Interventional Neuroradiology Department, CHRU Bordeaux, France (G.M., J.B.)
| | - Géraud Forestier
- Interventional Neuroradiology Department, CHU Limoges, France (G.F., A.R.)
| | - Aymeric Rouchaud
- Interventional Neuroradiology Department, CHU Limoges, France (G.F., A.R.)
| | - Raoul Pop
- Interventional Neuroradiology Department, CHRU Strasbourg, France (R.P.)
| | - Nicolas Raynaud
- Interventional Neuroradiology Department, CHRU Poitiers, France (N.R.)
| | - François Zhu
- Interventional Neuroradiology Department, CHRU Nancy, France (F.Z.)
| | - Jonathan Cortese
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, Bicêtre, France (J.C., V.C.)
| | - Vanessa Chalumeau
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, Bicêtre, France (J.C., V.C.)
| | - Jérome Berge
- Interventional Neuroradiology Department, CHRU Bordeaux, France (G.M., J.B.)
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (S.E.)
| | - Grégoire Boulouis
- Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.)
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28
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Pagiola I, Caroff J, Mihalea C, Aghakhani N, Ikka L, Chalumeau V, Iacobucci M, Ozanne A, Gallas S, Carrete H, Marques MC, Nalli D, Caldas JG, Frudit ME, Moret J, Parker F, Spelle L. Republished: Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option? J Neurointerv Surg 2020; 12:e4. [PMID: 32184273 DOI: 10.1136/neurintsurg-2019-015268.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 11/03/2022]
Abstract
This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient's neurological condition (modified Rankin Scale score 2).
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Affiliation(s)
- Igor Pagiola
- NEURI, Hôpital Bicêtre, Le Kremlin-Bicêtre, France .,Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | | | | | | | - Léon Ikka
- NEURI, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | - Henrique Carrete
- DDI, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Marcio Chaves Marques
- Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | - Darcio Nalli
- Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | | | - Michel Eli Frudit
- Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | | | - Fabrice Parker
- Neurosurgery, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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29
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Pagiola I, Caroff J, Mihalea C, Aghakhani N, Ikka L, Chalumeau V, Iacobucci M, Ozanne A, Gallas S, Carrete H, Marques MC, Nalli D, Caldas JG, Frudit ME, Moret J, Parker F, Spelle L. Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option? BMJ Case Rep 2020; 13:13/3/e015268. [PMID: 32132099 DOI: 10.1136/bcr-2019-015268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient's neurological condition (modified Rankin Scale score 2).
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Affiliation(s)
- Igor Pagiola
- NEURI, Hôpital Bicêtre, Le Kremlin-Bicêtre, France .,Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | | | | | | | - Léon Ikka
- NEURI, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | - Henrique Carrete
- DDI, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Marcio Chaves Marques
- Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | - Darcio Nalli
- Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | | | - Michel Eli Frudit
- Neurorradiologia Intervencionista, UNIFESP, Escola Paulista de Medicina, São Paulo, Brazil
| | | | - Fabrice Parker
- Neurosurgery, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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30
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Janot K, Zhu F, Kerleroux B, Boulouis G, Shotar E, Premat K, Eugene F, Dargazanli C, Chalumeau V, L'Allinec V, Benhassen W, Marnat G, Lebras A, Detraz L, Ognard J, Personnic T, Chivot C, Cappucci M, Forestier G, Soize S, Bourdain F, Consoli A, Labreuche J, Desal H, Lapergue B, Rouchaud A, Bourcier R. "Adaptative endovascular strategy to the CloT MRI in large intracranial vessel occlusion" (VECTOR): Study protocol of a randomized control trial. J Neuroradiol 2019; 47:382-385. [PMID: 31726072 DOI: 10.1016/j.neurad.2019.11.001] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
A correlation between the susceptibility vessel sign (SVS) and red thrombi has been identified in MRI. We hypothesized that the Embotrap allow better retrieving of SVS+ thrombi. The AdaptatiVe Endovascular strategy to the CloT MRI in large intracranial vessel Occlusion (VECTOR) trial is a multicenter, prospective and randomized study designed to compare a first-line strategy combining Embotrap added to contact aspiration (CA) versus CA alone in patients with SVS+ occlusions.
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Affiliation(s)
- Kevin Janot
- Department of Neuroradiology, University Hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France.
| | | | - Basile Kerleroux
- Department of Neuroradiology, University Hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | | | | | | | | | | | | | | | | | | | | | - Lili Detraz
- University Hospital of Nantes, Nantes, France
| | | | | | | | | | | | | | | | | | - Julien Labreuche
- Department of Biostatistics, University Hospital of Lille, Lille, France
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31
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Pagiola I, Mihalea C, Caroff J, Ikka L, Chalumeau V, Iacobucci M, Ozanne A, Gallas S, Marques M, Nalli D, Carrete H, Caldas JG, Frudit ME, Moret J, Spelle L. The PHASES score: To treat or not to treat? Retrospective evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage. J Neuroradiol 2019; 47:349-352. [PMID: 31400432 DOI: 10.1016/j.neurad.2019.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The PHASES score was formulated to predict the 5-year risk of rupture for intracranial aneurysms. We retrospectively analyzed all patients treated in our institution for aneurysmal SAH and applied the PHASES score to estimate the probable predicted risk of bleeding in this group of patients. METHODS Between February 2015 and August 2018, all patients with aneurysmal SAH were retrospectively analyzed and the PHASES score was applied. A total of 155 patients were included with a mean age of 53.8years, including 60 males and 95 females. RESULTS Of our patients 110 (70.9%) had a PHASES score of below or equal to 5, with a hemorrhagic risk of up to 1.3% over 5years. If we analyze the patients with a risk of below 2% this figure increases to 122 patients (78.7%). Of these 99.3% were European and 0.6% were Japanese (1 patient). In 86 patients (55.4%), the aneurysm was smaller than 5mm and in 10 patients (6.4%) the aneurysm was located in the posterior circulation. CONCLUSION Of our patients 78.7% had less than a 2% 5-year rupture risk based on their PHASES score, highlighting the discrepancy of the rupture risk calculated with the PHASES score when hypothetically applied to this group of patients. In the hypothetical scenario that our patients had unruptured aneurysms, our retrospective analysis shows that the PHASES score may only provide a weak tool for clinicians to use in the decision-making process as to whether or not to treat these aneurysms.
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Affiliation(s)
- Igor Pagiola
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil.
| | - Cristian Mihalea
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Leon Ikka
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marta Iacobucci
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marcio Marques
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Darcio Nalli
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Henrique Carrete
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Universidade de São Paulo, São Paulo SP, Brazil
| | - Michel Eli Frudit
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Jacques Moret
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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32
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Pagiola I, Mihalea C, Caroff J, Ikka L, Chalumeau V, Yasuda T, Marenco de la Torre J, Iacobucci M, Ozanne A, Gallas S, Marques MC, Carrete H, Frudit ME, Moret J, Spelle L. Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should 'I' use? A single center experience. J Neurointerv Surg 2019; 11:1118-1122. [PMID: 30975737 DOI: 10.1136/neurintsurg-2019-014858] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/18/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Aneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable. METHODS All patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment. RESULTS We analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3). CONCLUSION Flow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the 'I technique' is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.
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Affiliation(s)
- Igor Pagiola
- NEURI, Hopital Bicetre, Le Kremlin-Bicetre, France.,Neurorradiologia Intervencionista, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Cristian Mihalea
- NEURI, Hopital Bicetre, Le Kremlin-Bicetre, France.,Neurosurgery, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Timisoara, Romania
| | | | - Léon Ikka
- NEURI, Hopital Bicetre, Le Kremlin-Bicetre, France
| | | | | | | | | | | | | | - Marcio Chaves Marques
- Neurorradiologia Intervencionista, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Henrique Carrete
- DDI, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Michel Eli Frudit
- Neurorradiologia Intervencionista, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
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33
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Gallas S, Ozanne A, Ikka L, Mihaela C, Caroff J, Chalumeau V, Iacobucci M, Moret J, Spelle L. Stroke de l’enfant, que faire et comment faire ? J Neuroradiol 2019. [DOI: 10.1016/j.neurad.2019.01.068] [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: 11/24/2022]
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34
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Khoury N, Dargazanli C, Guenego A, Zuber K, Ekmen A, Charbonnier G, Hebert S, Capron J, Sabben C, Morvan E, Boisseau W, Maier B, Premat K, Clarençon F, Smajda S, Redjem H, Chalumeau V, Boulouis G, Chetrit A, Lecler A, Koskas P, Duron L, Ciccio G, Ducroux C, Escalard S, Desilles JP, Hamdani M, Lapergue B, Mazighi M, Ben Maacha M, Brikci-Nigassa N, Blanc R, Piotin M, Fahed R. Visual assessment of diffusion weighted imaging infarct volume lacks accuracy and reliability. J Neurointerv Surg 2019; 11:947-954. [DOI: 10.1136/neurintsurg-2018-014613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 11/04/2022]
Abstract
PurposeThe DAWN trial (Diffusion weighted imaging or CT perfusion Assessment with clinical mismatch in the triage of Wake-up and late presenting strokes undergoing Neurointervention with Trevo) has demonstrated the benefits of thrombectomy in patients with unknown or late onset strokes, using automated software (RAPID) for measurement of infarct volume. Because RAPID is not available in all centers, we aimed to assess the accuracy and repeatability of visual infarct volume estimation by clinicians and the consequences for thrombectomy decisions based on the DAWN criteria.Materials and methods18 physicians, who routinely depend on MRI for acute stroke imaging, assessed 32 MR scans selected from a prospective databaseover two independent sessions. Raters were asked to visually estimate the diffusion weighted imaging (DWI) infarct volume for each case. Sensitivity, specificity, and accuracy of the estimated volumes were compared with the available RAPID measurements for various volume cut-off points. Thrombectomy decisions based on DAWN criteria with RAPID measurements and raters’ visual estimates were compared. Inter-rater and intra-rater agreement was measured using kappa statistics.ResultsThe mean accuracy of raters was <90% for all volume cut-points. Inter-rater agreement was below substantial for each DWI infarct volume cut-off points. Intra-rater agreement was substantial for 55–83% of raters, depending on the selected cut-off points. Applying DAWN criteria with visual estimates instead of RAPID measurements led to 19% erroneous thrombectomy decisions, and showed a lack of reproducibility.ConclusionThe visual assessment of DWI infarct volume lacks accuracy and repeatability, and could lead to a significant number of erroneous decisions when applying the DAWN criteria.
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Chalumeau V, Nguyen TNP, Cortese J, Chassin O, Mihalea C, Caroff J, Ikka L, Ozanne A, Gallas S, Iacobucci M, Rouchaud A, Yasuda T, Marenco J, Pagiola I, Bani Hashemi G, Naderi S, Ahmed A, Ebrahimi R, Denier C, Moret J, Spelle L. Abstract WP47: Efficacy and Safety of Nimodipin During Mechanical Thrombectomy. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp47] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Randomized controlled trials for calcium antagonists therapy in patients with acute ischemic stroke have failed to show a benefit as a stand-alone therapy, due largely to the reduction of blood pressure, especially in the absence of early recanalization. Since mechanical thrombectomy (MT) has led to high successful recanalization rates, the effect of nimodipin as an adjuvant therapy during MT has not been evaluated.
Materials and Methods:
We retrospectively reviewed all consecutive cases of MT for which Nimodipin was used as an adjuvant therapy after at least one pass of any device. Clinical and angiographic characteristics, as well as immediate vessel caliber modifications, reperfusion status and early neurological improvement were collected between January 2016 and December 2017.
Results:
Procedural intra-arterial nimodipin infusion was administered in 10.3 % (58/559; 95%CI 7.8-12.8 %) of patients, after at least one pass of MT device. In 52/58 patients, < 3 manoeuvers of MT were performed. Angiographic vasospasm was identified on the carotid artery in 17/58 (29.3%) cases, on the middle cerebral artery in 35/58 (60.4%) cases and in vertebro-basilar artery in 6/58 (10.3%) cases. The vasospasm was responsible for an immediate reocclusion in 12% of the patients. Angiographic effect of nimodipin with the restauration of a normal vessel caliber and the improvement of the reperfusion without supplementary maneuver was observed in 77.5% % of the cases. Successful recanalization TICI 2b/3 was reached in 81% patients. Significant drop of blood pressure (BP) with need for additional vasopressive drugs was observed in 6 cases. Symptomatic hemorrhage occurred in 3 patients (5%). Concomitant fibrinolytic therapy did not influence the rate of intracranial hemorrhage rate after procedural nimodipin infusion (p=0.912). Early neurological improvement was reached in 46% and was not associated with a high initial systolic and diastolic BP at the admission (p=0.89) or with the modality of anesthesia (p =0.76).
Conclusion:
Nimodipin can be an efficient and safe adjuvant therapy in the setting of vasospasm due to MT, by normalizing the caliber of the recanalized artery and then, improving the reperfusion status without supplementary maneuver of MT.
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Affiliation(s)
| | | | | | | | | | | | - Léon Ikka
- Kremlin Bicetre Hosp, Kremlin Bicetre, France
| | | | | | | | | | | | | | | | | | | | - Awais Ahmed
- Kremlin Bicetre Hosp, Kremlin Bicetre, France
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Mihalea C, Caroff J, Pagiola I, Ikka L, Hashemi GB, Naderi S, Chalumeau V, Ples H, Popa BV, Yasuda T, Marenco de la Torre JJ, Iacobucci M, Ozanne A, Gallas S, Rouchaud A, Pescariu S, Moret J, Spelle L. Safety and efficiency of the fifth generation Woven EndoBridge device: technical note. J Neurointerv Surg 2019; 11:511-515. [PMID: 30655358 DOI: 10.1136/neurintsurg-2018-014343] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/27/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 11/03/2022]
Abstract
BACKROUND The treatment of wide neck bifurcation aneurysms remains challenging despite the introduction of new techniques (Y stenting, waffle cone technique, or flow diverter stents). The Woven EndoBridge (WEB) device is an innovative solution for this type of cerebral aneurysm. A new WEB 17 is now available and has been designed to offer smaller sized devices to optimize navigability and delivery. METHODS Between February 2017 and April 2018 all patients treated with the WEB 17 device in our center were retrospectively reviewed. 25 patients with 28 non-ruptured aneurysms were identified and analyzed. Three patients with two aneurysms both treated with the WEB device were identified. RESULTS The device was successfully deployed in all cases. Procedure related morbidity was 4% and mortality was 0%. In one case, a delayed postprocedural thromboembolic event occurred owing to device protrusion. Technical success, complications, angiographic outcomes, procedural data, and follow-ups are reported. The modified Rankin Scale score at discharge was 0 for 24 patients (96%). At the 3, 6, or 9 month follow-up, angiograms were taken of 21 of the 25 patients (84%) (24 of 28 aneurysms had been controlled); 3 patients (3 aneurysms) did not receive angiographic follow-up at the time of submission of this work. Complete occlusion was achieved in 22 of 24 aneurysms (91.66%), and 2 of 24 aneurysm (8.33%) showed a neck remnant. CONCLUSIONS The WEB 17 is safe and technically feasible, according to this retrospective single center analysis. For very small bifurcation aneurysms, the WEB 17 seems to have lower complication rates than stent assisted techniques. However, further studies are needed to evaluate the complication rate and long term efficiency.
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Affiliation(s)
- Cristian Mihalea
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France.,Department of Neurosurgery, University of Medicine and Pharmacy 'Victor Babes', Timisoara, Romania
| | - Jildaz Caroff
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Igor Pagiola
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France.,Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Leon Ikka
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Gelareh Bani Hashemi
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Soheil Naderi
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Horia Ples
- Department of Neurosurgery, University of Medicine and Pharmacy 'Victor Babes', Timisoara, Romania
| | - Bogdan Valeriu Popa
- Department of Radiology and Medical Imaging, 'Floresca' Clinical Emergency Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Thomas Yasuda
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Joaquin Jose Marenco de la Torre
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Marta Iacobucci
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | | | - Sorin Pescariu
- Department of Cardiology, Victor Babes', University of Medicine and Pharmacy, Timisoara, Romania
| | - Jacques Moret
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Le Kremlin-Bicetre, Île-de-France, France
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Caroff J, Iacobucci M, Rouchaud A, Mihalea C, de Carvalho FM, Jocson VED, Chalumeau V, Da Ros V, King RM, Arslanian R, Ikka L, Ben Achour N, Moret J, Spelle L. The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design. J Neurointerv Surg 2018; 11:610-613. [DOI: 10.1136/neurintsurg-2018-014441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022]
Abstract
BackgroundNeo-intimal hyperplasia (NIH) is frequently observed after flow-diverter stent (FDS) implantation. Although mostly asymptomatic, this vascular response can sometimes lead to delayed ischemic strokes. This study intended to evaluate the factors potentially influencing the rates of NIH following FDS treatment.Material and MethodsAll aneurysm treatments performed with a Pipeline embolization device (PED) or a SILK stent from May 2011 to May 2015 were collected in a prospectively maintained database. Patient demographics, clinical, and angiographic outcomes including both digital subtraction angiography and C-arm cone-beam CT were registered. Two blind reviewers rated the presence of NIH on a binary scale (present/absent).ResultsFrom 148 patients, 63 datasets were available for analysis. Inter-reader agreement was excellent (Kappa=0.88). NIH was positively correlated with smoking, dyslipidemia, and high blood pressure, but not with aneurysm characteristics. At early follow-up (<12 months), NIH was more frequently associated with the use of the SILK stent (68%) rather than the PED (38%): P<0.02. At long-term follow-up, the NIH rate in the total population dropped from 55% to 26% with no more significant difference between the two stents. The complete occlusion rate as seen in early follow-up was higher in the SILK group with 76% vs 65% but without statistical significance (P=0.4).ConclusionNIH is a dual-vessel reaction after FDS implant. When planning a treatment in locations at risk of ischemic complications if severe NIH would occur, then the stent design should be considered. However, minimal NIH might also be needed as it is involved in aneurysm healing. Before treatment patients should be recommended best medical management of their cardiovascular risks factors to prevent an excessive NIH reaction.
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Chalumeau V, Blanc R, Redjem H, Ciccio G, Smajda S, Desilles JP, Botta D, Escalard S, Boisseau W, Maïer B, Labreuche J, Obadia M, Piotin M, Mazighi M. Anterior cerebral artery embolism during thrombectomy increases disability and mortality. J Neurointerv Surg 2018; 10:1057-1062. [DOI: 10.1136/neurintsurg-2018-013793] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveDuring thrombectomy, thromboembolic migration in previously unaffected territory may occur and is not systematically notified. We report our data on the incidence, predictors, and clinical outcome of anterior cerebral artery emboli (ACAE).MethodsFrom a prospectively collected thrombectomy database of consecutive patients with anterior circulation stroke between January 2012 and December 2016, 690 angiographic images were analyzed to assess ACAE. The primary outcome was a favorable outcome, defined as a 3 month modified Rankin Scale score of 0–2 or equal to the pre-stroke score.ResultsACAE occurred in 65 patients (9.4%; 95% CI 7.2% to 11.6%). Internal carotid artery occlusion (tandem or terminal), Alberta Stroke Program Early CT Score <7, increasing number of passes, and use of stent retriever alone (compared with distal aspiration alone or combined with stent retriever) were found to be independent predictors of ACAE. Compared with patients without ACAE, patients with ACAE had lower rates, with an adjusted OR (95% CI) of 0.48 (0.25 to 0.92; P=0.027) for favorable outcome and 0.49 (0.25 to 0.96; P=0.038) for early neurologic improvement. ACAE was significantly associated with a higher mortality (adjusted OR 1.93; 95% CI 1.03 to 3.61; P=0.039) and intracranial hemorrhagic complications (adjusted OR 2.45; 95% CI 1.33 to 4.47; P=0.004). Despite a successful reperfusion modified Thrombolysis in Cerebral Infarction score of 2b–3 at the end of the procedure, a favorable outcome was reached in 30% of patients with ACAE compared with 52.4% in the other patients (OR 0.39; 95% CI 0.19 to 0.78; P=0.008).ConclusionsProcedural ACAE was not an uncommon condition, and was associated with increased mortality and disability rates, regardless of the success of reperfusion.
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Fahed R, Lecler A, Sabben C, Khoury N, Ducroux C, Chalumeau V, Botta D, Kalsoum E, Boisseau W, Duron L, Cabral D, Koskas P, Benaïssa A, Koulakian H, Obadia M, Maïer B, Weisenburger-Lile D, Lapergue B, Wang A, Redjem H, Ciccio G, Smajda S, Desilles JP, Mazighi M, Ben Maacha M, Akkari I, Zuber K, Blanc R, Raymond J, Piotin M. DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates: An Intrarater and Interrater Agreement Study. Stroke 2017; 49:223-227. [PMID: 29191851 DOI: 10.1161/strokeaha.117.019508] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/05/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. METHODS Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics. RESULTS Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. CONCLUSIONS Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.
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Affiliation(s)
- Robert Fahed
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.).
| | - Augustin Lecler
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Candice Sabben
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Naim Khoury
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Célina Ducroux
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Vanessa Chalumeau
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Daniele Botta
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Erwah Kalsoum
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - William Boisseau
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Loïc Duron
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Dominique Cabral
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Patricia Koskas
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Azzedine Benaïssa
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Hasmik Koulakian
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Michael Obadia
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Benjamin Maïer
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - David Weisenburger-Lile
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Bertrand Lapergue
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Adrien Wang
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Hocine Redjem
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Gabriele Ciccio
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Stanislas Smajda
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Jean-Philippe Desilles
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Mikaël Mazighi
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Malek Ben Maacha
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Inès Akkari
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Kevin Zuber
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Raphaël Blanc
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Jean Raymond
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Michel Piotin
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
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de Carvalho FM, Caroff J, Pereira Dos Santos Neto E, Chalumeau V, Abdel Khalek H, Neki H, Saliou G, Rouchaud A, Moret J, Spelle L. Flow changes in the posterior communicating artery related to flow-diverter stents in carotid siphon aneurysms. J Neurointerv Surg 2016; 9:674-678. [PMID: 27387710 DOI: 10.1136/neurintsurg-2016-012443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/26/2016] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow-diverter stent (FDS) placement for treatment of intracranial aneurysms can cause flow changes in the covered branches. OBJECTIVE To assess the impact of the treatment of carotid siphon aneurysms with FDS on the posterior communicating artery (PComA) flow. MATERIALS AND METHODS Between February 2011 and January 2015, 125 carotid siphon aneurysms were treated with FDS. We retrospectively analyzed all cases with PComA ostial coverage. The circle of Willis anatomy was also studied as the flow changes in PComA postoperatively and during angiographic follow-up. Data from neurological examination were also collected. RESULTS Eighteen aneurysms of the carotid siphon in 17 patients were treated with FDS covering the ostium of the PComA. Based on the initial angiography, patients were divided into two groups: the first with a P1/PComA size ratio >1 (10 cases) and the second with a ratio ≤1 (8 cases). Follow-up angiography (mean time of 10 months) showed 90% of PComA flow changes in group 1 but only 12.5% in group 2. There was a significant difference between the two groups (p=0.002). Nevertheless, no patient had new symptoms related to these flow changes during the follow-up period. CONCLUSIONS In our experience, covering the PComA by FDS when treating carotid siphon aneurysms appeared safe and the P1/PComA ratio is a good predictor of flow changes in PComA.
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Affiliation(s)
- Fernando Mota de Carvalho
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France.,Department of Neurorradiologia Diagnóstica e Terapêutica, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - Jildaz Caroff
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France
| | | | - Vanessa Chalumeau
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France
| | | | - Hiroaki Neki
- Department of Neurosurgery, Saitama University, Saitama, Japan
| | - Guillaume Saliou
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France
| | - Aymeric Rouchaud
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France
| | - Jacques Moret
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France
| | - Laurent Spelle
- Department of Neuroradiologie Interventionnelle, Hôpital Bicetre, Le Kremlin-Bicetre, île-de-France
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