33 results on '"Gregoire Boulouis"'
Search Results
2. Abstract 034: Value of Immediate Flat Panel Perfusion Imaging After Endovascular Therapy: A proof of concept study
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Adnan Mujanovic, Christoph Kurmann, Michael Manhart, Eike Piechowiak, Sara Pilgram‐Pastor, Bettina Serrallach, Gregoire Boulouis, Thomas Meinel, David Seiffge, Simon Jung, Marcel Arnold, Thanh Nguyen, Urs Fischer, Jan Gralla, Tomas Dobrocky, Pasquale Mordasini, and Johannes Kaesmacher
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Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction Clinical utility and diagnostic sensitivity of new‐generation flat‐panel computed tomography perfusion imaging (FPCTP) performed immediately after mechanical thrombectomy (MT) is unknown. We aimed to assess whether FPCTP obtained directly after MT could provide additional potentially relevant information on tissue reperfusion status. Methods Qualitative, single‐center analysis of all consecutive acute stroke patients admitted between 06/2019 and 03/2021 who underwent MT and post‐interventional FPCTP (n=26). A core‐lab blinded to technical details and clinical data performed reperfusion grading on post‐interventional digital subtraction angiography (DSA) images and time‐sensitive FPCTP maps. All patients were classified according to agreement between DSA and FPCTP. Results In 10/26 patients FPCTP revealed new, potentially clinically relevant information. Core‐lab adjudicated dichotomized detection of hypoperfusion (present/absent) was concurring in 21/26 (81%) patients. Of these, reperfusion findings showed perfect agreement on location and size in 16 (62%) patients, while in 5 (19%) patients with incomplete reperfusion, FPCTP showed additional hypoperfused areas missed on DSA. Of the remaining five patients subject to disagreement regarding the presence or absence of hypoperfusion, three showed complete reperfusion on DSA but hypoperfusion was noted on FPCTP, whereas two showed incomplete reperfusion on DSA without detectable hypoperfusion on FPCTP. FPCTP findings could have avoided Thrombolysis in Cerebral Infarction (TICI) overestimation in all false‐positive operator‐rated TICI3 cases. Conclusion In both core‐lab and real‐world operator assessment, FPCTP may provide additional clinically relevant information in a considerable percentage of patients undergoing MT. Hence, FPCTP may constitute a new standard for evaluating reperfusion efficacy and informed decision making in the angiography suite.
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- 2023
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3. Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion
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Andrea Morotti, Gregoire Boulouis, Jawed Nawabi, Qi Li, Andreas Charidimou, Marco Pasi, Frieder Schlunk, Ashkan Shoamanesh, Aristeidis H. Katsanos, Federico Mazzacane, Giorgio Busto, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Andrew D. Warren, Michele Laudisi, Anna Cavallini, Edip M. Gurol, Anand Viswanathan, Andrea Zini, Ilaria Casetta, Enrico Fainardi, Steven M. Greenberg, Alessandro Padovani, Jonathan Rosand, and Joshua N. Goldstein
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Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign. Methods: Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994–2015, prospective), Hamilton, Canada (2010–2016, retrospective), Berlin, Germany (2014–2019, retrospective), Chongqing, China (2011–2015, retrospective), Pavia, Italy (2017–2019, prospective), Ferrara, Italy (2010–2019, retrospective), Brescia, Italy (2020–2021, retrospective), and Bologna, Italy (2015–2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison. Results: A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55–3.80]; P P =0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64–0.73] versus 0.74 [95% CI, 0.70–0.78]; P =0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70–0.78]). Conclusions: Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA.
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- 2023
4. Influence de la thrombolyse intraveineuse chez les patients traites par thrombectomie mecanique pour une occlusion M2: une analyse du registre etis
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Agathe Le Floch, Frederic Clarencon, Aymeric Rouchaud, Maeva Khyeng, Julien Labreuche, Igor Sibon, Gregoire Boulouis, Benjamin Gory, Sebastien Richard, Jildaz Caroff, Raphael Blanc, Pierre Seners, Omer Eker, Tae-Hee Cho, Arturo Consoli, Romain Bourcier, Benoit Guillon, Cyril Dargazanli, Caroline Arquizan, Christian Denier, Francois Eugene, Stephanie Vannier, Jean-Christophe Gentric, Maxime Gauberti, Olivier Nagarra, Charlotte Rosso, Guillaume Turc, Ozlem Ozkul-Wermester, Christophe Cognard, Jean-Francois Albucher, Serge Timsit, Frederic Bourdain, Anthony Le Bras, Sebastian Richter, Solene Moulin, Raoul Pop, Olivier Heck, Ricardo Moreno, Vincent L'Allinec, Bertrand Lapergue, and Gaultier Marnat
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Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Published
- 2023
5. Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results
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Louis Thiery, Xavier Carle, Benoit Testud, Gregoire Boulouis, Paul Habert, Farouk Tradi, Anthony Reyre, Pierre Lehmann, Philippe Dory-Lautrec, Jan-Patrick Stellmann, Nadine Girard, Herve Brunel, Jean-Francois Hak, Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - APHM] (CEMEREM), Hôpital de la Timone [CHU - APHM] (TIMONE)-Centre de résonance magnétique biologique et médicale (CRMBM), and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)
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[SDV]Life Sciences [q-bio] ,Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundBalloon-assisted mechanical angioplasty for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) has a number of limitations, including transient occlusion of the spastic blood vessel. Comaneci is an FDA-approved device for temporary coil embolization assistance which has recently also been approved for the treatment of distal symptomatic refractory vasospasm. We aimed to report the feasibility, efficacy and safety of our experience with Comaneci angioplasty for refractory distal vasospasm (up to the second segment of the cerebral arteries) following aSAH.MethodsThis is a retrospective analysis of a prospective series of 18 patients included between April 2019 and June 2021 with aSAH and symptomatic vasospasm refractory to medical therapy, who were treated using Comaneci-17-asssisted mechanical distal angioplasty. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed. Inter-rater reliability of the scores was determined using the intraclass correlation coefficient.ResultsComaneci-assisted distal angioplasty was performed in 18 patients, corresponding to 31 target arteries. All distal anterior segments were easily accessible with the Comaneci-17 device. Vasospasm improvement after Comaneci mechanical angioplasty was seen in 22 distal arteries (71%) (weighted Cohen’s kappa (κw) 0.73, 95% CI 0.69 to 0.93). Vasospasm recurrence occurred in three patients (16.67%) and delayed cerebral infarction in three patients (16.67%), with a mean±SD delay between onset of symptoms and imaging follow-up (MRI/CT) of 32.61±8.93 days (κw0.98, 95% CI 0.88 to 1).ConclusionThis initial experience suggests that distal mechanical angioplasty performed with the Comaneci-17 device for refractory vasospasm following aSAH seems to be safe, with good feasibility and efficacy.
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- 2022
6. A comprehensive framework for cerebral amyloid angiopathy diagnosis: Diagnostic accuracy meta-analyses of different biomarkers (S36.008)
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Antreas Charidimou and Gregoire Boulouis
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- 2023
7. Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion
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Adam, de Havenon, Mahmoud, Elhorany, Gregoire, Boulouis, Olivier, Naggara, Jean, Darcourt, Frédéric, Clarençon, Sébastien, Richard, Gaultier, Marnat, Romain, Bourcier, Igor, Sibon, Caroline, Arquizan, Cyril, Dargazanli, Benjamin, Maïer, Pierre, Seners, Bertrand, Lapergue, Arturo, Consoli, Francois, Eugene, Stephane, Vannier, Jildaz, Caroff, Christian, Denier, Marion, Boulanger, Maxime, Gauberti, Aymeric, Rouchaud, Francisco, Macian, Charlotte, Rosso, Guillaume, Turc, Ozlem, Ozkul-Wermester, Chrisanthi, Papagiannaki, Jean François, Albucher, Anthony, Le Bras, Sarah, Evain, Valerie, Wolff, Raoul, Pop, Serge, Timsit, Jean-Christophe, Gentric, Frédéric, Bourdain, Louis, Veunac, Robert, Fahed, Stephanos Nikolaos, Finitsis, Benjamin, Gory, and Arnaud Le, Guen
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundThe number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes.MethodsWe used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0–3 at 90 days. We fit mixed multiple regression models, with center as a random effect.ResultsWe included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901).ConclusionsWe found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
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- 2022
8. Comment je fais un prélèvement veineux par cathétérisme des sinus pétreux inférieurs ?
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Estelle Acko-Ohui, Kevin Janot, Nourou Dine Adeniran Bankole, Heloise Ifergan, Richard Bibi, Denis Herbreteau, Jean-Philippe Cottier, and Gregoire Boulouis
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- 2022
9. Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey
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Jildaz, Caroff, Laurent, Aubert, Cécile, Lavenu-Bombled, Samy, Figueiredo, Kamelia, Habchi, Jonathan, Cortese, Francois, Eugene, Julien, Ognard, Florence, Tahon, Géraud, Forestier, Heloise, Ifergan, François, Zhu, Jean-Francois, Hak, Anthony, Reyre, Morgane, Laubacher, Abdoulaye, Traore, Jean Philippe, Desilles, Imad, Derraz, Ricardo, Moreno, Marc, Bintner, Guillaume, Charbonnier, Anthony, Le Bras, Louis, Veunac, Florent, Gariel, Hocine, Redjem, Jacques, Sedat, Guillaume, Tessier, Victor, Dumas, Maxime, Gauberti, Cyril, Chivot, Arturo, Consoli, Nicolas, Bricout, Titien, Tuilier, Alexis, Guedon, Raoul, Pop, Pierre, Thouant, Guillaume, Bellanger, Riccardo, Zannoni, Sebastien, Soize, Johann Sebastian, Richter, Olivier, Heck, Cristian, Mihalea, Julien, Burel, Jean-Baptiste, Girot, Eimad, Shotar, Sebastian, Gazzola, Gregoire, Boulouis, Basile, Kerleroux, Laurent, Spelle, Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], CHRU Brest - Service d'Imagerie médicale (CHU - Brest - HM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Optimisation Continue des Actions Thérapeutiques par l'Intégration d'Informations Multimodales, Université de Brest (UBO)-Télécom Bretagne-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Privé Clairval [Marseille], CHU Limoges, Service de neuroradiologie [Tours], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hospices Civils de Lyon (HCL), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de Neurologie [Hôpitaux Civils de Colmar], Hôpitaux Civils Colmar, Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Clermont-Ferrand, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Service de Neuroradiologie Interventionnelle [CHU Besançon], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Le CHCB, Centre Hospitalier de la Côte Basque, CHU de Bordeaux Pellegrin [Bordeaux], Clinique des Cèdres, Centre Hospitalier Universitaire de Nice (CHU Nice), Département de Neuroradiologie [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Amiens-Picardie, Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], CHU Lille, CHU Henri Mondor, Hôpital Lariboisière-Fernand-Widal [APHP], CHU Strasbourg, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Toulouse [Toulouse], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre hospitalier de Pau, Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Rouen, Normandie Université (NU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service de Neuroradiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Saint Anne Military Teaching Hospital [Toulon, France], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), and Centre Hospitalier Saint-Anne (GHU Paris)
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Surgery ,Neurology (clinical) ,General Medicine ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.MethodsIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).ResultsAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.ConclusionThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.
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- 2022
10. Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children
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Francis Brunelle, Gregoire Boulouis, Vincent Vidal, Nadine Girard, Olivier Naggara, Philippe Meyer, Thomas Blauwblomme, Basile Kerleroux, Florent Gariel, Manoelle Kossorotoff, Sarah Stricker, Nathalie Boddaert, Lorenzo Garzelli, Jean François Hak, Volodia Dangouloff Ros, and Sandro Benichi
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Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,Adolescent ,Fistula ,Computed tomography ,Lesion ,medicine ,Humans ,Prospective Studies ,Registries ,Child ,Stroke ,Cerebral Hemorrhage ,Retrospective Studies ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Magnetic resonance imaging ,medicine.disease ,Cerebrovascular Circulation ,Child, Preschool ,Arteriovenous Fistula ,Arterial spin labeling ,Etiology ,Female ,Spin Labels ,Neurology (clinical) ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose: Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. Methods: Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. Results: A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8–13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%–99.1%) and 79.0% (95% CI, 54.4%–94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect interrater agreement (κ=0.963 [95% CI, 0.912–1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. Conclusions: ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: 3618210420, 2217698.
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- 2022
11. Perfusion gradients promote delayed perihaematomal oedema in intracerebral haemorrhage
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Enrico Fainardi, Giorgio Busto, Elisa Scola, Ilaria Casetta, Katsuhiro Mizutani, Arturo Consoli, Gregoire Boulouis, Alessandro Padovani, and Andrea Morotti
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Cellular and Molecular Neuroscience ,Psychiatry and Mental health ,Neurology ,Biological Psychiatry - Abstract
Perihaematomal oedema is a potential therapeutic target to improve outcome of patients with intracerebral haemorrhage, but its pathophysiology remains poorly elucidated. We investigated the longitudinal changes of cerebral perfusion and their influence on perihaematomal oedema development in 150 patients with intracerebral haemorrhage who underwent computed tomography perfusion within 6 h from onset, at 24 h and at 7 days. Perfusion parameters were measured in haemorrhagic core, perihaematomal rim, surrounding normal appearing and contralateral brain tissue. Computed tomography perfusion parameters gradually improved from the core to the periphery in each time interval with an early increase at 24 h followed by a delayed decline at 7 days compared with admission values (P < 0.001). Multivariable linear regression analysis showed that haematoma volume and cerebral blood flow gradient between normal appearing and perihaematomal rim were independently associated with absolute perihaematomal oedema volume in the different time points (within 6 h, B = 0.128, P = 0.032; at 24 h, B = 0.133, P = 0.016; at 7 days, B = 0.218, P < 0.001). In a secondary analysis with relative perihaematomal oedema as the outcome of interest, cerebral blood flow gradient between normal appearing and perihaematomal rim was an independent predictor of perihaematomal oedema only at 7 days (B = 0.239, P = 0.002). Our findings raise the intriguing hypothesis that perfusion gradients promote perihaematomal oedema development in the subacute phase after intracerebral haemorrhage.
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- 2023
12. Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study
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Gregoire, Boulouis, Sebastien, Soize, Volker, Maus, Sebastian, Fischer, Donald, Lobsien, Joachim, Klisch, Hanna, Styczen, Cornelius, Deuschl, Nuran, Abdullayev, Christoph, Kabbasch, Daniel, Kaiser, Ala, Jamous, Daniel, Behme, Kevin, Janot, Guillaume, Bellanger, Cristophe, Cognard, Laurent, Pierot, Matthias, Gawlitza, and Jennifer, Linn
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Carotid Artery Diseases ,medicine.medical_specialty ,Medizin ,Fusiform Aneurysm ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Occlusion ,medicine ,Humans ,Retrospective Studies ,Flow diverter ,Flow diversion ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,3. Good health ,Surgery ,Treatment Outcome ,Multicenter study ,Cohort ,Stents ,Neurology (clinical) ,Internal carotid artery ,business ,Carotid Artery, Internal ,030217 neurology & neurosurgery - Abstract
BackgroundScientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments.ObjectiveTo investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates.MethodsAll patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included.ResultsWe treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1±10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13±10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0–0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms.ConclusionFDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.
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- 2021
13. Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion
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Michel Piotin, Gregoire Boulouis, Robert Fahed, Kevin Janot, Charbel Mounayer, Kevin Zuber, G. Forestier, and A. Rouchaud
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Nitinol stent ,medicine.medical_specialty ,Parent artery ,Carotid siphon ,Aneurysm ,Stent deployment ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Flow diverter ,Interventional ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Middle Aged ,equipment and supplies ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,Female ,Stents ,Neurology (clinical) ,business ,Carotid Artery, Internal - Abstract
BACKGROUND AND PURPOSE: Intracranial stents for the treatment of aneurysms can be responsible for parent artery straightening, a phenomenon with potential consequences for aneurysmal occlusion. We aimed to evaluate parent artery straightening following flow-diverter stent placement in patients with intracranial aneurysms and explored the association between parent artery straightening and subsequent aneurysm occlusion. MATERIALS AND METHODS: All patients treated with flow-diverter stents for anterior circulation aneurysms located downstream from the carotid siphon between January 2009 and January 2018 were screened for inclusion. Parent artery straightening was defined as the difference (α–β) in the parent artery angle at the neck level before (α angle) and after flow-diverter stent deployment (β angle). We analyzed the procedural and imaging factors associated with parent artery straightening and the associations between parent artery straightening and aneurysmal occlusion. RESULTS: Ninety-five patients met the inclusion criteria (n = 64/95 women, 67.4%; mean age, 54.1 [SD, 11.2] years) with 97 flow-diverter stents deployed for 99 aneurysms. Aneurysms were predominantly located at the MCA bifurcation (n = 44/95, 44.4%). Parent artery straightening was found to be more pronounced in patients treated with cobalt chromium stents than with nitinol stents (P = .02). In multivariate analysis, parent artery straightening (P = .04) was independently associated with aneurysm occlusion after flow-diverter stent deployment. CONCLUSIONS: The use of flow-diverter stents for distal aneurysms induces a measurable parent artery straightening, which is associated with higher occlusion rates. Parent artery straightening, in our sample, appeared to be more prominent with cobalt chromium stents than with nitinol stents. This work highlights the necessary trade-off between navigability and parent artery straightening and may help tailor the selection of flow-diverter stents to aneurysms and parent artery characteristics.
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- 2021
14. Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry
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Agathe, Le Floch, Frédéric, Clarençon, Aymeric, Rouchaud, Maeva, Kyheng, Julien, Labreuche, Igor, Sibon, Gregoire, Boulouis, Benjamin, Gory, Sébastien, Richard, Jildaz, Caroff, Raphaël, Blanc, Pierre, Seners, Omer F, Eker, Tae-Hee, Cho, Arturo, Consoli, Romain, Bourcier, Benoit, Guillon, Cyril, Dargazanli, Caroline, Arquizan, Christian, Denier, Francois, Eugene, Stephane, Vannier, Jean-Christophe, Gentric, Maxime, Gauberti, Olivier, Naggara, Charlotte, Rosso, Guillaume, Turc, Ozlem, Ozkul-Wermester, Christophe, Cognard, Jean François, Albucher, Serge, Timsit, Frederic, Bourdain, Anthony, Le Bras, Sebastian, Richter, Solène, Moulin, Raoul, Pop, Olivier, Heck, Ricardo, Moreno, Vincent, L'Allinec, Bertrand, Lapergue, Gaultier, Marnat, and Alessandra, Biondi
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundIntravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone.MethodsWe conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0–2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients.ResultsAmong 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004).ConclusionsIn cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.
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- 2022
15. Clinical Diagnosis of Probable Cerebral Amyloid Angiopathy: Diagnostic Accuracy Meta-Analysis of the Boston Criteria
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Andreas Charidimou and Gregoire Boulouis
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Advanced and Specialized Nursing ,Cerebral Amyloid Angiopathy ,Humans ,Brain ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Magnetic Resonance Imaging ,Sensitivity and Specificity ,Retrospective Studies ,Cerebral Hemorrhage - Abstract
Background: The Boston criteria are used widely for the noninvasive diagnosis of sporadic cerebral amyloid angiopathy (CAA) and hence clinical decision-making, as well as research in the field. Yet, their exact diagnostic accuracy and validity remain (paradoxically) poorly studied. We performed a meta-analysis to synthesize evidence on the value and accuracy of the Boston criteria in diagnosing probable CAA patients. Methods: In a systematic literature search, we identified studies with extractable data relevant for sensitivity and specificity of probable CAA diagnosis per the magnetic resonance imaging Boston criteria and neuropathological CAA verification. We included studies that have classified patients according to any version of the Boston criteria, based on available brain magnetic resonance imaging blood-sensitive sequences (index test) and had neuropathologic evaluation for CAA presence from brain tissue samples (diagnostic reference standard). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy for probable CAA diagnosis. Results: Seven studies, including 193 patients, 121 with neuropathologically verified CAA versus 72 non-CAA based on neuropathology definition, were included in the meta-analysis. The studies were of low-to-moderate quality and varied in several methodological aspects. The overall pooled sensitivity for probable CAA diagnosis was 66.7% (95% CI, 45.9%–82.6%) and specificity was 88.2% (95% CI, 68.5%–96.3%). A predefined subgroup analysis of 4 studies on Boston criteria v.1.0 (n=151) demonstrated a pooled sensitivity and specificity of 60% (95% CI, 45.1%–72.9%) and 93.1% (95% CI, 81.8%–97.6%), respectively. Five studies had data on Boston criteria v.1.5 (n=123): the pooled sensitivity and specificity for probable CAA diagnosis was 73.1% (95% CI, 45%–90.1%) and 86% (95% CI, 41.4%–98.1%), respectively. Conclusions: The Boston criteria v.1.0 and v.1.5 appear to have moderate-to-good diagnostic accuracy for probable CAA in symptomatic patients, with high specificity but low-to-moderate sensitivity. Data are based on limited retrospective studies of overall low quality and at high risk of bias.
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- 2022
16. Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results
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Gaultier Marnat, Stefanos Finistis, Ricardo Moreno, Igor Sibon, Raoul Pop, Mikaël Mazighi, Frédéric Clarençon, Charlotte Rosso, Cyril Dargazanli, Jean Darcourt, Jean-Marc Olivot, Gregoire Boulouis, Kevin Janot, Solène Moulin, Romain Bourcier, Arturo Consoli, Sébastien Richard, Caroline Arquizan, Stephane Vannier, Sebastian Richter, Jean-Christophe Gentric, Chrisanthi Papagiannaki, Olivier Naggara, Omer F Eker, Bertrand Lapergue, Jildaz Caroff, and Benjamin Gory
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundPatients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice.MethodsThe Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up.ResultsAmong the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0–2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158).ConclusionsIn tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.
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- 2022
17. Closing the Gap in Pediatric Hemorrhagic Stroke: A Systematic Review
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Samyami S. Chowdhury, Alfred P. See, Lars P. Eriksson, Gregoire Boulouis, Laura L. Lehman, Dana B. Hararr, Veda Zabih, Nomazulu Dlamini, Christine Fox, and Michaela Waak
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Stroke ,Hemorrhagic Stroke ,Seizures ,Pediatrics, Perinatology and Child Health ,Outcome Assessment, Health Care ,Humans ,Brain ,Neurology (clinical) ,Child ,Prognosis ,Cerebral Hemorrhage - Abstract
Pediatric hemorrhagic stroke (HS) accounts for a large proportion of childhood strokes, 1 of the top 10 causes of pediatric deaths. Morbidity and mortality lead to significant socio-economic and psychosocial burdens. To understand published data on recognizing and managing children with HS, we conducted a systematic review of the literature presented here. We searched PubMed, Embase, CINAHL and the Cochrane Library databases limited to English language and included 174 studies, most conducted in the USA (52%). Terminology used interchangeably for HS included intraparenchymal/intracranial hemorrhage, spontaneous ICH, and cerebrovascular accident (CVA). Key assessments informing prognosis and management included clinical scoring (Glasgow coma scale), and neuroimaging. HS etiologies reported were systemic coagulopathy (genetic, acquired pathologic, or iatrogenic), or focal cerebrovascular lesions (brain arteriovenous malformations, cavernous malformations, aneurysms, or tumor vascularity). Several scales were used to measure outcome: Glasgow outcome score (GOS), Kings outcome score for head injury (KOSCHI), modified Rankin scale (mRS) and pediatric stroke outcome measure (PSOM). Most studies described treatments of at-risk lesions. Few studies described neurocritical care management including raised ICP, seizures, vasospasm, or blood pressure. Predictors of poor outcome included ethnicity, comorbidity, location of bleed, and hematomagt;2% of total brain volume. Motor and cognitive outcomes followed independent patterns. Few studies reported on cognitive outcomes, rehabilitation, and transition of care models. Interdisciplinary approach to managing HS is urgently needed, informed by larger cohort studies targeting key clinical question (eg development of a field-guide for the clinician managing patients with HS that is reproducible internationally).
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- 2022
18. Rescue intracranial permanent stenting for refractory occlusion following thrombectomy: a propensity matched analysis
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Heloise Ifergan, Cyril Dargazanli, Wagih Ben Hassen, Jean-Francois Hak, Benjamin Gory, Julien Ognard, Kevin Premat, Gaultier Marnat, Basile Kerleroux, François Zhu, Guillaume Bellanger, Peter B Sporns, Guillaume Charbonnier, Géraud Forestier, Jildaz Caroff, Cédric Fauché, Frédéric Clarençon, Kevin Janot, Bertrand Lapergue, and Gregoire Boulouis
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundRescue intracranial stenting (RIS) can be used in refractory large vessel occlusion (LVO) after mechanical thrombectomy (MT). We aimed to assess the safety and efficacy of RIS versus a propensity matched sample of patients with persistent LVO.MethodsWe retrospectively analysed a multicenter retrospective pooled cohort of patients with anterior LVO (2015−2021) treated with MT, and identified patients with at least three passes and a modified Thrombolysis In Cerebral Infarction (mTICI) score of 0 to 2a. Propensity score matching was used to account for determinants of outcome in patients with or without RIS. The study outcomes included 3 months modified Rankin Scale (mRS) and symptomatic hemorrhagic transformation (HT).Results420 patients with a refractory anterior occlusion were included, of which 101 were treated with RIS (mean age 69 years). Favorable outcome (mRS 0–2) was more frequent in patients with a patent stent at day 1 (53% vs 6%, PConclusionIn selected patients with a refractory intracranial occlusion despite at least three thrombectomy passes, RIS may be associated with an overall shift towards more favorable clinical outcome, and no significant increase in the odds of symptomatic HT or death.
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- 2023
19. Impact of White Matter Hyperintensity Volume on Prognosis After Mechanical Thrombectomy in Ischemic Stroke Patients
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Théo Hancer, Maéva Kyheng, Julien Labreuche, Maxime Gauberti, Emmanuel Touzé, Grégoire Boulouis, Bertrand Lapergue, and Marion Boulanger
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Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Uncertainties remain about the impact of white matter hyperintensity (WMH) on prognosis after mechanical thrombectomy. Methods In this retrospective study from a national prospective registry of patients with ischemic stroke due to large vessel occlusion treated with mechanical thrombectomy, we assessed WMH volume using a quantitative semi‐automatized segmentation on baseline magnetic resonance imaging. We determined the association between WMH volume and the prognosis of patients with ischemic stroke presenting between 2019 and 2022. Results Among 902 patients (mean age 70.4 years, 50% women) with a baseline magnetic resonance imaging, the median WMH volume was 2.79 (0.75–9.14) mL. In multivariate analyses, increasing WMH volume was associated with a reduced probability of favorable outcome (modified Rankin Scale score 0–2) (adjusted odds ratio per 1 log+1 increase = 0.66, 95% confidence interval 0.54–0.82) and an increased risk of mortality at 90 days (adjusted odds ratio per 1 log+1 increase = 1.53, 95% confidence interval 1.23–1.90), with the greatest risk in patients with the highest WMH volume (>11 mL) compared to those with the lowest WMH volume (
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- 2024
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20. Recurrence leading to retreatment in the long-term follow-up after endovascular treatment of carotid-ophthalmic artery aneurysm
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Nourou Dine Adeniran Bankole, Kevin Janot, Ulrick Sidney Kamounye, Valere Barrot, Heloise Ifergan, Richard Bibi, and Gregoire Boulouis
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Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Published
- 2022
21. Imaging markers of intracerebral hemorrhage expansion in patients with unclear symptom onset
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Andrea Morotti, Gregoire Boulouis, Andreas Charidimou, Loris Poli, Paolo Costa, Valeria De Giuli, Eleonora Leuci, Federico Mazzacane, Giorgio Busto, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Michele Laudisi, Anna Cavallini, Massimo Gamba, Mauro Magoni, Claudio Cornali, Marco M Fontanella, Andrew D Warren, Edip M Gurol, Anand Viswanathan, Roberto Gasparotti, Ilaria Casetta, Enrico Fainardi, Andrea Zini, Alessandro Pezzini, Alessandro Padovani, Steven M Greenberg, Jonathan Rosand, and Joshua N Goldstein
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Male ,Hematoma ,Anticoagulants ,unclear onset ,intracerebral hemorrhage ,Stroke ,Economica ,Neurology ,hematoma expansion ,outcome ,Humans ,Female ,CT ,Prospective Studies ,Biomarkers ,Retrospective Studies ,Cerebral Hemorrhage - Abstract
Background: Hematoma expansion (HE) is common and associated with poor outcome in intracerebral hemorrhage (ICH) with unclear symptom onset (USO). Aims: We tested the association between non-contrast computed tomography (NCCT) markers and HE in this population. Methods: Retrospective analysis of patients with primary spontaneous ICH admitted at five centers in the United States and Italy. Baseline NCCT was analyzed for presence of the following markers: intrahematoma hypodensities, heterogeneous density, blend sign, and irregular shape. Variables associated with HE (hematoma growth > 6 mL and/or > 33% from baseline to follow-up imaging) were explored with multivariable logistic regression. Results: Of 2074 patients screened, we included 646 subjects (median age = 75, 53.9% males), of whom 178 (27.6%) had HE. Hypodensities (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.79–3.98), heterogeneous density (OR = 2.16, 95% CI = 1.46–3.21), blend sign (OR = 2.28, 95% CI = 1.38–3.75) and irregular shape (OR = 1.82, 95% CI = 1.21–2.75) were independently associated with a higher risk of HE, after adjustment for confounders (ICH volume, anticoagulation, and time from last seen well (LSW) to NCCT). Hypodensities had the highest sensitivity for HE (0.69), whereas blend sign was the most specific marker (0.90). All NCCT markers were more frequent in early presenters (time from LSW to NCCT ⩽ 6 h, n = 189, 29.3%), and more sensitive in this population as well (hypodensities had 0.77 sensitivity). Conclusion: NCCT markers are associated with HE in ICH with USO. These findings require prospective replication and suggest that NCCT features may help the stratification of HE in future studies on USO patients.
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- 2022
22. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study
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Andreas Charidimou, Gregoire Boulouis, Matthew P Frosch, Jean-Claude Baron, Marco Pasi, Jean Francois Albucher, Gargi Banerjee, Carmen Barbato, Fabrice Bonneville, Sebastian Brandner, Lionel Calviere, François Caparros, Barbara Casolla, Charlotte Cordonnier, Marie-Bernadette Delisle, Vincent Deramecourt, Martin Dichgans, Elif Gokcal, Jochen Herms, Mar Hernandez-Guillamon, Hans Rolf Jäger, Zane Jaunmuktane, Jennifer Linn, Sergi Martinez-Ramirez, Elena Martínez-Sáez, Christian Mawrin, Joan Montaner, Solene Moulin, Jean-Marc Olivot, Fabrizio Piazza, Laurent Puy, Nicolas Raposo, Mark A Rodrigues, Sigrun Roeber, Jose Rafael Romero, Neshika Samarasekera, Julie A Schneider, Stefanie Schreiber, Frank Schreiber, Corentin Schwall, Colin Smith, Levente Szalardy, Pascale Varlet, Alain Viguier, Joanna M Wardlaw, Andrew Warren, Frank A Wollenweber, Marialuisa Zedde, Mark A van Buchem, M Edip Gurol, Anand Viswanathan, Rustam Al-Shahi Salman, Eric E Smith, David J Werring, Steven M Greenberg, Charidimou, A, Boulouis, G, Frosch, M, Baron, J, Pasi, M, Albucher, J, Banerjee, G, Barbato, C, Bonneville, F, Brandner, S, Calviere, L, Caparros, F, Casolla, B, Cordonnier, C, Delisle, M, Deramecourt, V, Dichgans, M, Gokcal, E, Herms, J, Hernandez-Guillamon, M, Jäger, H, Jaunmuktane, Z, Linn, J, Martinez-Ramirez, S, Martínez-Sáez, E, Mawrin, C, Montaner, J, Moulin, S, Olivot, J, Piazza, F, Puy, L, Raposo, N, Rodrigues, M, Roeber, S, Romero, J, Samarasekera, N, Schneider, J, Schreiber, S, Schreiber, F, Schwall, C, Smith, C, Szalardy, L, Varlet, P, Viguier, A, Wardlaw, J, Warren, A, Wollenweber, F, Zedde, M, van Buchem, M, Gurol, M, Viswanathan, A, Al-Shahi Salman, R, Smith, E, Werring, D, and Greenberg, S
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diagnoisi ,Amyloid beta-Peptides ,pathology [Cerebral Hemorrhage] ,Middle Aged ,MED/46 - SCIENZE TECNICHE DI MEDICINA DI LABORATORIO ,Magnetic Resonance Imaging ,diagnostic imaging [Cerebral Amyloid Angiopathy] ,Cerebral Amyloid Angiopathy ,methods [Magnetic Resonance Imaging] ,biomarker ,Humans ,Neurology (clinical) ,ddc:610 ,Neuropathology ,MRI ,Aged ,Cerebral Hemorrhage ,Retrospective Studies - Abstract
BACKGROUND: Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations.METHODS: In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy.FINDINGS: The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard.INTERPRETATION: The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations.FUNDING: US National Institutes of Health (R01 AG26484).
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- 2021
23. Added value of non-contrast CT and CT perfusion markers for prediction of intracerebral hemorrhage expansion and outcome
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Andrea Morotti, Giorgio Busto, Gregoire Boulouis, Elisa Scola, Alessandro Padovani, Ilaria Casetta, and Enrico Fainardi
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Male ,Perfusion ,Hematoma ,Cytidine Triphosphate ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,General Medicine ,Tomography, X-Ray Computed ,Retrospective Studies ,Cerebral Hemorrhage - Abstract
To test the hypothesis that the combined analysis of non-contrast CT (NCCT) and CT perfusion (CTP) imaging markers improves prediction of hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH).Retrospective, single-center analysis of patients with primary ICH undergoing NCCT and CTP within 6 h from onset. NCCT images were assessed for the presence of intrahematomal hypodensity and shape irregularity. Perihematomal cerebral blood volume and spot sign were assessed on CTP. The main outcomes of the analysis were HE (growth6 mL and/or33%) and poor functional prognosis (90 days modified Rankin Scale 3-6). Predictors of HE and outcome were explored with logistic regression.A total of 150 subjects were included (median age 68, 47.1% males) of whom 54 (36%) had HE and 52 (34.7%) had poor outcome. The number of imaging markers on baseline imaging was independently associated with HE (odds ratio 2.66, 95% confidence interval 1.70-4.17, p0.001) and outcome (odds ratio 1.64, 95% CI 1.06-2.56, p = 0.027). Patients with the simultaneous presence of all the four markers had the highest risk of HE and unfavorable prognosis (mean predicted probability of 91% and 79% respectively). The combined-markers analysis outperformed the sensitivity of the single markers analyzed separately. In particular, the presence of at least one marker identified patients with HE and poor outcome with 91% and 87% sensitivity respectively.NCCT and CTP markers provide additional yield in the prediction of HE and ICH outcome.• Perihematomal hypoperfusion is associated with hematoma expansion and poor outcome in acute intracerebral hemorrhage. • Non-contrast CT and CT perfusion markers improve prediction of hematoma expansion and unfavorable prognosis. • A multimodal CT protocol including CT perfusion will help the identification of patients at high risk of clinical deterioration and poor outcome.
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- 2021
24. Bifurcation geometry remodelling of vessels in de novo and growing intracranial aneurysms: a multicenter study
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Julien, Boucherit, Basile, Kerleroux, Gregoire, Boulouis, Guillaume, Tessier, Christine, Rodriguez, Peter B, Sporns, Haroun, Ghannouchi, Eimad, Shotar, Florent, Gariel, Gaultier, Marnat, Julien, Burel, Heloise, Ifergan, Géraud, Forestier, Aymeric, Rouchaud, Hubert, Desal, Anass, Nouri, Florent, Autrusseau, Gervaise, Loirand, Romain, Bourcier, Vincent, L'Allinec, and Planty-Bonjour, Alexia
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundGeometrical parameters, including arterial bifurcation angle, tortuosity, and arterial diameters, have been associated with the pathophysiology of intracranial aneurysm (IA) formation. The aim of this study was to investigate whether these parameters were present before or if they resulted from IA formation and growth.MethodsPatients from nine academic centers were retrospectively identified if they presented with a de novo IA or a significant IA growth on subsequent imaging. For each patient, geometrical parameters were extracted using a semi-automated algorithm and compared between bifurcations with IA formation or growth (aneurysmal group), and their contralateral side without IA (control group). These parameters were compared at two different times using univariable models, multivariable models, and a sensitivity analysis with paired comparison.Results46 patients were included with 21 de novo IAs (46%) and 25 significant IA growths (54%). The initial angle was not different between the aneurysmal and control groups (129.7±42.1 vs 119.8±34.3; p=0.264) but was significantly wider at the final stage (140.4±40.9 vs 121.5±34.1; p=0.032), with a more important widening of the aneurysmal angle (10.8±15.8 vs 1.78±7.38; p=0.001). Variations in other parameters were not significant. These results were confirmed by paired comparisons.ConclusionOur study suggests that wider bifurcation angles that have long been deemed causal factors for IA formation or growth may be secondary to IA formation at pathologic bifurcation sites. This finding has implications for our understanding of IA formation pathophysiology.
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- 2021
25. The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure
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Douraied Ben Salem, Jean-Christophe Gentric, Gregoire Boulouis, Julien Ognard, Fanny Bourhis-Guizien, and Brieg Dissaux
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medicine.medical_specialty ,medicine.medical_treatment ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Aneurysm, Ruptured ,Article ,Aneurysm ,Parenchyma ,Humans ,Medicine ,magnetic resonance imaging ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Magnetic Phenomena ,Endovascular Procedures ,Stent ,Magnetic resonance imaging ,magnetic susceptibility artifacts ,Odds ratio ,medicine.disease ,equipment and supplies ,intracranial aneurysm ,medicine.anatomical_structure ,stents ,Susceptibility weighted imaging ,Radiology ,Artifacts ,business ,Platelet Aggregation Inhibitors ,intracranial hemorrhage ,Artery - Abstract
The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76, 11.76] vs. 0.78 [0.32, 1.25], respectively, p <, 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p <, 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43, 6.92] vs. 3.08 [1.79, 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24, 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p <, 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.
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- 2021
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26. Global white matter structural integrity mediates the effect of age on ischemic stroke outcomes
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Natalia S. Rost, Mark R Etherton, Maria Clara Zanon Zotin, Ona Wu, Markus D. Schirmer, Arne Lauer, Pamela M. Rist, and Gregoire Boulouis
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medicine.medical_specialty ,business.industry ,Leukoaraiosis ,Structural integrity ,medicine.disease ,Logistic regression ,White matter ,medicine.anatomical_structure ,Neurology ,Neuroimaging ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,Brain magnetic resonance imaging ,business ,Stroke - Abstract
Background The relationship of global white matter microstructural integrity and ischemic stroke outcomes is not well understood. Aims To investigate the relationship of global white matter microstructural integrity with clinical variables and functional outcomes after acute ischemic stroke. Methods A retrospective analysis of neuroimaging data from 300 acute ischemic stroke patients with magnetic resonance imaging brain obtained within 48 hours of stroke onset and long-term functional outcomes (modified Rankin, mRS) was performed. Peak width of skeletonized mean diffusivity (PSMD), as a measure of global white matter microstructural injury, was calculated in the hemisphere contralateral to the acute infarct. Multivariable linear and logistic regression analyses were performed to identify variables associated with PSMD and excellent functional outcome (mRS Results White matter hyperintensity volume, age, pre-stroke disability, and normal-appearing white matter mean diffusivity were independently associated with increased PSMD. In logistic regression analysis, increased infarct volume and PSMD were independent predictors of excellent functional outcome. Additionally, the effect of age on functional outcomes was indirectly mediated by PSMD ( P Conclusions As a marker of global white matter microstructural injury, increased PSMD mediates the effect of increased age to contribute to poor acute ischemic stroke functional outcomes. PSMD could serve as a putative radiographic marker of brain age for stroke outcomes prognostication.
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- 2021
27. Standardized Reporting of Workflow Metrics in Acute Ischemic Stroke Treatment: Why and How?
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Ashutosh P Jadhav, Shinichi Yoshimura, Charles B. L. M. Majoie, Christian Taschner, Martin W. Kurz, Gregoire Boulouis, Yvo B.W.E.M. Roos, Marios-Nikos Psychogios, Mayank Goyal, Staffan Holmin, Jeffrey L. Saver, Michael D. Hill, B. Gory, Johanna M. Ospel, Romain Bourcier, Brian Buck, Ronil V. Chandra, Rosalie McDonough, Aravind Ganesh, and Dileep R. Yavagal
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medicine.medical_specialty ,Workflow ,business.industry ,health care facilities, manpower, and services ,health services administration ,education ,Ischemic stroke ,Emergency medicine ,Medicine ,business ,Acute ischemic stroke ,health care economics and organizations - Abstract
The benefit of acute ischemic stroke (AIS) treatment is highly time dependent. Although studies on workflow improvement in AIS are increasingly gaining attention, there is a lack of consensus and consistency regarding the definition, measurement, and reporting of AIS workflow times. We discuss the challenges related to defining and measuring workflow times in AIS and propose a basic set of time intervals that should be reported in AIS workflow studies. We particularly focus on patients undergoing mechanical thrombectomy. Importantly, endovascular treatment workflow times should always be reported in conjunction with reperfusion quality because one is not informative without the other. We further suggest standardized reporting of workflow times that includes the 90th percentile in addition to medians and interquartile ranges, means, and SDs. The proposed methodology serves as a framework for AIS studies and aids further discussion on workflow‐related AIS research.
- Published
- 2021
28. Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage
- Author
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Tommaso Amadori, Fabrizio Montecucco, Gregoire Boulouis, Federico Carbone, Ilaria Casetta, Enrico Fainardi, Andrea Bernardoni, Giorgio Busto, Alessandro Fiorenza, Andrea Morotti, and Elisa Scola
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,cerebral blood flow ,Clinical Biochemistry ,Perfusion scanning ,CT perfusion ,intracerebral hemorrhage ,outcome ,stroke ,Biochemistry ,Economica ,Modified Rankin Scale ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Stroke ,Aged ,Cerebral Hemorrhage ,Intracerebral hemorrhage ,intracerebral haemorrhage ,business.industry ,General Medicine ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,Cerebral blood flow ,Cerebrovascular Circulation ,Cardiology ,Female ,business ,Perfusion - Abstract
BACKGROUND The aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH). METHODS A single-centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. Poor functional prognosis (modified Rankin Scale 3-6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression. RESULTS A total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3-6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change -7.8 vs. -6.0 ml/100 g/min, p
- Published
- 2021
29. Efficacité et sécurité d'une double anti- agrégation par kardégic et ticagrelor pour le traitement par stent à diversion de flux des anévrismes de la circulation cérébrale postérieure
- Author
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Alexandre Crespy, Gregoire Boulouis, Héloïse Ifergan, Valère Barrot, Fakhreddine Boustia, Richard Bibi, Denis Herbreteau, and Kévin Janot
- Subjects
Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Published
- 2022
30. Core Penumbral Mismatch: An Independent Predictor of Stroke Poorer Outcome
- Author
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Basile Kerleroux and Gregoire Boulouis
- Subjects
medicine.medical_specialty ,Core (anatomy) ,Neurology ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Neurology (clinical) ,business ,medicine.disease ,Independent predictor ,Stroke ,Outcome (game theory) - Published
- 2021
31. Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis
- Author
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Marialuisa Zedde, Manuela Napoli, Claudio Moratti, Claudio Pavone, Lara Bonacini, Giovanna Di Cecco, Serena D’Aniello, Ilaria Grisendi, Federica Assenza, Grégoire Boulouis, Thanh N. Nguyen, Franco Valzania, and Rosario Pascarella
- Subjects
PACNS ,tumor-like lesion ,mass-like lesion ,tumefactive lesion ,PCNSL ,glioma ,Medicine (General) ,R5-920 - Abstract
Primary Angiitis of the Central Nervous System (PACNS) is a rare disease and its diagnosis is a challenge for several reasons, including the lack of specificity of the main findings highlighted in the current diagnostic criteria. Among the neuroimaging pattern of PACNS, a tumefactive form (t-PACNS) is a rare subtype and its differential diagnosis mainly relies on neuroimaging. Tumor-like mass lesions in the brain are a heterogeneous category including tumors (in particular, primary brain tumors such as glial tumors and lymphoma), inflammatory (e.g., t-PACNS, tumefactive demyelinating lesions, and neurosarcoidosis), and infectious diseases (e.g., neurotoxoplasmosis). In this review, the main features of t-PACNS are addressed and the main differential diagnoses from a neuroimaging perspective (mainly Magnetic Resonance Imaging—MRI—techniques) are described, including conventional and advanced MRI.
- Published
- 2024
- Full Text
- View/download PDF
32. The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure
- Author
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Fanny Bourhis-Guizien, Brieg Dissaux, Grégoire Boulouis, Douraied Ben Salem, Jean-Christophe Gentric, and Julien Ognard
- Subjects
intracranial aneurysm ,intracranial hemorrhage ,magnetic resonance imaging ,stents ,magnetic susceptibility artifacts ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76; 11.76] vs. 0.78 [0.32; 1.25], respectively, p < 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p < 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43; 6.92] vs. 3.08 [1.79; 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24; 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p < 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.
- Published
- 2021
- Full Text
- View/download PDF
33. Standardized Reporting of Workflow Metrics in Acute Ischemic Stroke Treatment: Why and How?
- Author
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Mayank Goyal, Jeffrey L. Saver, Aravind Ganesh, Rosalie V. McDonough, Yvo B.W.E.M. Roos, Grégoire Boulouis, Martin Kurz, Marios‐Nikos Psychogios, Staffan Holmin, Charles B.L.M. Majoie, Romain Bourcier, Ronil Chandra, Shinichi Yoshimura, Dileep Yavagal, Benjamin Gory, Christian Taschner, Brian Buck, Ashutosh Jadhav, Michael D. Hill, and Johanna Maria Ospel
- Subjects
ischemic stroke ,outcomes ,thrombectomy ,Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The benefit of acute ischemic stroke (AIS) treatment is highly time dependent. Although studies on workflow improvement in AIS are increasingly gaining attention, there is a lack of consensus and consistency regarding the definition, measurement, and reporting of AIS workflow times. We discuss the challenges related to defining and measuring workflow times in AIS and propose a basic set of time intervals that should be reported in AIS workflow studies. We particularly focus on patients undergoing mechanical thrombectomy. Importantly, endovascular treatment workflow times should always be reported in conjunction with reperfusion quality because one is not informative without the other. We further suggest standardized reporting of workflow times that includes the 90th percentile in addition to medians and interquartile ranges, means, and SDs. The proposed methodology serves as a framework for AIS studies and aids further discussion on workflow‐related AIS research.
- Published
- 2021
- Full Text
- View/download PDF
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