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PURPOSE: To update the medical literature on the diagnostic and therapeutic approach to polypoidal choroidal vasculopathy (PCV) and to propose a treatment algorithm in agreement with French market approval, supported by the France Macula Federation (FFM). METHODS: Literature review and expert opinion. RESULTS: The diagnosis of PCV is based on multimodal imaging, including indocyanine green angiography (ICGA), which is considered the gold standard for the diagnosis of PCV. Regarding the therapeutic management of PCV, the FFM recommends treating PCV first-line either by monotherapy with intra-vitreal anti-vascular endothelial growth factor (anti-VEGF) injections, or by a combined treatment of photodynamic therapy (PDT) with Verteporfin and intra-vitreal anti-VEGF injections, depending on the location of the PCV.; Objectif : Mettre à jour la littérature médicale sur l’approche diagnostique et thérapeutique de la vasculopathie polypoïdale choroïdienne (VPC) et proposer un algorithme de traitement adapté aux recommandations françaises et à la bonne utilisation des autorisations de mise sur le marché (AMM), soutenu par la Fédération France Macula (FFM).Méthodes : Analyse de la littérature et avis d’experts.Résultats : Le diagnostic de la VPC repose sur l’imagerie multimodale, néanmoins, l’angiographie au vert d’indocyanine est recommandée par la FFM et reste le Gold Standard. Concernant la prise en charge thérapeutique de la VPC, la FFM recommande de traiter la VPC en 1ère intention soit par monothérapie avec des injections intra-vitréennes d’anti-VEGF, soit par traitement combiné associant photothérapie dynamique (PDT) à la Verteporfine et injections intra-vitréennes d’anti-VEGF en fonction de la localisation de la VPC.

L'édème papillaire est un gonflement liquidien et /ou axonal de la tête du nerf optique du à un blocage du flux axoplasmique au niveau de la lame criblée. Nous rapportons le cas d'une jeune adolescente âgée de 17 ans, qui présenta un édème papillaire bilatéral secondaire à une hypertension intracrânienne idiopathique.

Background Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. Objective We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. Methods Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. Results In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful. Conclusion ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.

La maladie de Moya Moya est une maladie angiogénique, caractérisée par un rétrécissement de l'artère carotide interne distale qui s'étend aux segments proximaux des artères cérébrales moyennes et antérieures, induisant la formation de vaisseaux de suppléance. Ces derniers proviennent des collatérales parenchymateuses, perforantes, leptoméningées et autres anastomoses transdurales. Ces vaisseaux collatéraux ont un aspect caractéristique à l'angiographie formant un nuage de fumée : réseau Moya Moya. Son étiologie reste encore mal élucidée et représente 10 à 15% des causes d'accidents vasculaires cérébraux (AVC), avec 2 pics d'âge où l'atteinte est plus fréquente: les enfants autour de 5 ans et les adultes autour de 40 ans. Son évolution peut être lente avec des symptômes intermittents ou être fulminante avec un déclin neurologique rapide. Les données actuelles montrent l'importance du traitement chirurgical comme méthode de référence pour la prise en charge du syndrome de Moya en particulier chez les patients avec des symptômes progressifs et récidivants.Mots clés: Moya, vascularite, AVC, angioscanner, angio-IRM, angiographieEnglish Title: Moya moya disease: a rare cause of ischemic stroke in children: about a caseEnglish AbstractMoya moya disease is an angiogenic disease characterized by the narrowing of the distal internal carotid artery extending to the proximal segments of the middle and anterior cerebral arteries, inducing collateral vessels formation. These vessels come from the collateral parenchymal vessels, the perforating vessels, leptomeningeal vessels and other transdural anastomoses. These collateral vessels have a characteristic appearance on angiography, forming a cloud of smoke: net-like moyamoya. Its etiology is still poorly understood. Moyamoya disease accounts for 10-15% of the causes of stroke, with 2 age peaks at which its occurrence is more frequent: children around 5 years old and adults around 40 years old. Its evolution can be slow with intermittent symptoms or fulminant with fast neurological deterioration. The current data show the role of surgery as the gold standard for the treatment of moyamoya syndrome, in particular in patients with progressive and recurrent symptoms.Keywords: Moya, vasculitis, stroke, angioscanner, angio-MRI, angiography

Introduction The aim of this study was to describe the anatomical landmarks for maxillary nerve block in the pterygopalatine fossa. The risk of injury to the skull base and maxillary artery was assessed. Methods This retrospective study was based on the analysis of 61 consecutive computed tomography angiographies obtained from patients suffering from different pathologies. Anatomical relationships between optic canal (OC), foramen rotundum (FR), inferior orbital fissure (IOF) and puncture point (PP) were assessed. A “maxillary section” was virtually carried out on the CTs, following a plane passing through PP, IOF and FR in order to mimic the anaesthesia needle route. Results No gender difference was observed except for the PP-OC distance that was longer in men. The mean PP-IOF distance was of 31.9 (± 0.7 mm). PP-OC (43.9 ± 0.5) and PP-FR (44.2 ± 0.7) distances increased significantly with the patients height (PP-FR = 17.25 + 0.16 × height (cm); PP-OC = 20.54 + 0.13 × height (cm)). The route to the skull base was curved, with an angle of 168 ± 1.6° at the FR level. The angle to reach the OC was greater than 7°. Discussion With a 35-mm needle length, the probability to reach the IOF was high (79%), while the risk to injure the skull base (2%) and the optical nerve (0%) was low. Artery injuries were only found in 13% of cases. Therefore, a 35-mm needle length allows for the best efficacy/risk ratio in maxillary nerve block.

To evaluate the hemodynamic effect of percutaneous transluminal intervention (PTI) on stenosis of the superficial femoral (SFA) and popliteal arteries (PA) using time-density curves (TDCs) derived from digital subtraction angiography (DSA) series in correlation with ultrasound peak systolic velocity ratio (PSVR) and ankle brachial index (ABI). DSA series of SFA or PA of patients with symptomatic peripheral arterial occlusive disease was obtained with a flat-panel angiography system with intention-to-treat. In DSA series acquired before and after PTI, TDCs were analyzed proximal and distal of each stenosis using parametric color coding (PCC). For correlation, ABI and PSVR measurements pre- and post-PTI were recorded for all patients. In total, 25 stenoses of the SFA or PA were treated by PTI in 22 patients (17 male, 5 female, mean age 68 years). After treatment, peak-to-peak (PTP) times between TDCs proximal and distal to the treated vessel segment decreased statistically significantly (p = 0.01) on average from PTP = 1.9 +/- A 1.7 s to mean PTP = 1 +/- A 1 s. ABI and PSVR also changed statistically significantly after treatment (pretreatment ABI = 0.7 +/- A 0.2, PSVR = 4.2 +/- A 1.9; post-ABI = 0.9 +/- A 0.2, PSVR = 1.3 +/- A 0.4, both p < 0.05). Correlation parameters did not show a strong correlation between change in TDC and clinical parameters ABI and PSVR. Using PCC for analyzing contrast medium dynamics in DSA series is clinically useful for evaluating stenoses of the SFA and PA and for immediate treatment control after PTA.

International audience; PURPOSE. To evaluate the association between retinal microvasculature (vascular density) on optical coherence tomography-angiography (OCT-A) and the cardiovascular profile of patients hospitalized for acute coronary syndrome (ACS). METHODS. EYE-Myocardial Infarction (EYE-MI) study is a prospective cross-sectional study in the Cardiology Intensive Care Unit of Dijon University Hospital. Retinal OCT-A was performed for each patient within 2 days after admission. Superficial retinal capillary plexus (SCP) vascular density was measured. The population was divided into tertiles according to OCT-A data. RESULTS. Overall, 237 cases were retained for analysis. Patients in the tertile with the lowest retinal vascular density (RVD) were older, and more frequently had systemic hypertension and diabetes. Moreover, American Heart Association (AHA) risk and Global Registry of Acute Coronary Events (GRACE) scores were higher and left ventricular ejection fraction (LVEF) was lower in these patients. In multivariate analysis, the AHA risk score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.04–1.09; P < 0.001) and LVEF (OR, 0.95; 95% CI, 0.93–0.98; P ¼ 0.001) were significantly associated with the lowest tertile of RVD. The association between RVD and a high-risk cardiovascular profile was confirmed by a moderate correlation with the GRACE scores (Spearman r ¼ _0.33, P < 0.001). CONCLUSIONS. SCP density measured on OCT-A was associated with the cardiovascular risk profile and with impaired LVEF in patients with a high-risk cardiovascular status. In the future, quantitative retinal microvascular data could be considered a good surrogate of the cardiovascular risk profile and could improve cardiovascular risk assessments.

Nous rapportons un cas d'anévrysme post-traumatique de l'artère carotide interne chez un enfant de 11 ans, ayant présenté une ophtalmoplégie droite. Un faux anévrisme de la carotide interne droite a été diagnostiqué par angiographie cérébrale. Le malade a bénéficié d'un traitement endovasculaire et l'évolution fut favorable. Malgré leur rareté, le diagnostic des anévrysmes post traumatiques devrait être évoqué chez tout traumatisé crânien en cas d'aggravation clinique secondaire, afin de réaliser une exploration angiographique avant d'envisager un traitement radical soit chirurgical soit par voie endovasculaire.

Enfant âgé de 10 ans, sans antécédents particuliers, qui présente une baisse d'acuité visuelle progressive évoluant depuis 3mois, chez qui l'examen du fond d'œil montre une maculopathie au niveau des deux yeux donnant un aspect de fibrose (A, B). Une angiographie à la fluorescéine a montré, au niveau de l'œil droit une trainée d'hyper fluorescence entourant une zone d'hypo fluorescence confirmant l'aspect de fibrose observé au fond d'œil (C), au niveau de l'œil gauche une hyper fluorescence limitée à la lésion, dès le temps précoce qui augmente progressivement d'intensité jusqu'au temps tardif, irrégulière au centre, évoquant une néo vascularisation (D). La tomographie par cohérence optique montre au niveau de l'œil droit un œdème maculaire, un décollement de l'épithélium pigmentaire avec dédoublement du complexe membrane de Bruch / épithélium pigmentaire centré par une zone d'hyper réflectivité (E), au niveau de l'œil gauche un œdème maculaire avec un épaississement irrégulier intéressant les couches de l'épithélium pigmentaire, avec une hyper réflectivité confirmant d'emblée la néo vascularisation observée à l'angiographie (F). Une enquête familiale a été ouverte à la recherche d'une dystrophie maculaire héréditaire. L'examen du père et de la sœur a trouvé au niveau des deux yeux, une maculopathie d'aspect vitelliforme, ce qui est en faveur d'une transmission autosomique dominante. Devant cette maculopathie familiale, et le bilan inflammatoire et infectieux jusque-là normal on a évoqué le diagnostic d'une dystrophie maculaire juvénile de Best.

Summary Background There is a lack of Tunisian data on the frequency and clinical significance of different coronary artery anomalies. Methods All patients who underwent coronary angiography from March 1996 to December 2006 were considered. Only patients with congenital anomalous aortic origin of the coronary artery were included. Results Among 7330 adult patients who underwent diagnostic coronary angiography, 20 (0.27%) patients (13 men; mean age 53.3 years) had anomalies of the coronary artery origin. The right coronary artery was the vessel involved most frequently ( n = 10); it originated separately from the left sinus of Valsalva (SV) in three patients and from the posterior sinus of Valsalva in one patient. In the other patients, it arose from the left main coronary artery or its branches in a single coronary artery originating from the left sinus of Valsalva. Isolated anomalous left circumflex artery was the second most frequent anomaly ( n = 6). Isolated anomalous left anterior descending artery was seen in one patient. A single coronary artery arising from the right SV was seen in three patients. Atheroslerotic lesions were seen in eight cases. Four patients underwent coronary revascularization; the remainder received medical management. All 20 patients are alive and had an uneventful follow-up (mean 34.2 months). Conclusions In Tunisia, the incidence of congenital anomalous aortic origin of the coronary artery in adults is 0.27%. The right coronary artery is involved most frequently. Medical management seems promising.

International audience; OBJECTIVE: Intravascular ultrasound (IVUS) is a cornerstone tool for the diagnosis of plaque rupture (PR) but is usually used secondary to the suspicion of PR on angiography; the true incidence of PR may therefore be overestimated. We sought to evaluate predictors of angiographic diagnosis of PR using a non-angiographically driven IVUS examination. METHODS AND RESULTS: Diagnosis of PR on IVUS required agreement between two operators blinded to the results of angiography. Any irregular lesion with ulceration, flap or aneurysm on a qualitative angiogram was considered suspicious for PR. IVUS-detected PR and non-PR lesions were compared with the corresponding angiograms. A total of 224 distinct (ruptured or non-ruptured) lesions were detected by IVUS in 65 patients; 49 of the 105 IVUS-detected non-culprit PRs were suspected on angiography. The positive and negative predictive values for correct angiographic diagnosis of PR were 96% and 61%, respectively. Proximal coronary location, wide cavity, and counterflow rupture were strong predictors of correct angiographic diagnosis, enabling four specific angiographic patterns to be identified using three-dimensional IVUS PR reconstruction. CONCLUSION: Against IVUS as the gold standard, angiographic diagnosis of PR showed good specificity but low sensitivity. However, better angiographic diagnosis should enable medical treatment to be optimized, especially with respect to statin therapy.

International audience; Scanning-laser ophthalmoscopy is a technique for confocal imaging of the eye in vivo. The use of lasers of different wavelengths allows to obtain information about specific tissues and layers due to their reflection and transmission characteristics. In addition, fluorescent dyes excitable in the blue and infrared range offer a unique access to the vascular structures associated with each layer. In animal models, a further enhancement in specificity can be obtained by GFP expression under control of tissue-specific promotors. Important fields of application are studies in retinal degenerations and the follow-up of therapeutic intervention.

To compare the effects on the myometrium of polyvinyl alcohol (PVA) particles and calibrated microspheres (MS) in embolization of the uterine arteries in sheep.Superselective and bilateral embolization of the uterine arteries was performed with PVA particles and calibrated MS within 24 hours after artificial ovulation in 26 adult nonpregnant sheep. PVA particles of four diameters, 150-250, 250-400, 400-600, and 600-1,000 microm, were compared with calibrated MS of similar diameters, 100-300, 300-500, 500-700, and 700-900 microm, in eight groups of sheep. Evaluation was based on histopathologic study of uterus, ovaries, and vascular pedicles after sacrifice 5 days after embolization. The scores of necrosis, the diameter of occluded arteries, and the number of particles were determined. The scores of uterine necrosis were compared by using nonparametric tests (Mann-Whitney U and Kruskal-Wallis). Spearman rank test was used for correlations.PVA particles clumped more readily than did MS. Small particles had a higher score (P =.02) of uterine necrosis than did large particles. PVA particles produced more necrosis than did MS. Size of MS and diameter of occluded arteries showed significant correlation (rho = 0.762, P.001). Size of PVA particles and diameter of occluded arteries showed no correlation. PVA particles occluded vessels of a wider range of size than did calibrated MS.PVA particles are associated with intense uterine necrosis and extensive arterial occlusion regardless of size. Calibrated MS, which are associated with less uterine necrosis, permit a segmental arterial occlusion correlated with size.

Our goal was to study the arterial supply to the sheep uterus to compare its similarity with that of women and to evaluate the interest of this animal model for training in uterine artery embolization.Ten nonpregnant sheep underwent aortography and selective study of the ovarian, internal iliac, uterine, and vaginal arteries.The uterus was supplied mainly by the uterine arteries in all sheep. The ovarian artery, which was identified in five sheep, had a thin anastomosis with the ipsilateral uterine artery at the tubal junction. The vaginal artery provided blood flow to the inferior part of the cervix and anastomosed with the ipsilateral uterine artery.Because uterine vascularization of nonpregnant sheep is similar to that of women, the sheep represents an appropriate model for experimental uterine artery embolization. This model should be used for interventional radiologists in training not familiar with endovascular navigation inside pelvic arteries.

PURPOSE To experimentally evaluate gadolinium (Gd)-, carbon dioxide (CO 2 )-, and iodixanol-enhanced digital subtraction angiography (DSA) versus histomorphometry in the assessment of renal artery stenosis. MATERIALS AND METHODS Fifteen male New Zealand White rabbits weighing 4.0 kg underwent percutaneous catheterization. Renal artery stenosis was induced by bilateral overdilation-deendothelialization (balloon diameter=2 mm). The percentage of artery overdilation was 33%. After 4 weeks, the rabbits were randomized into two groups: group A underwent right-sided therapeutic percutaneous transluminal renal angioplasty (PTRA) (balloon diameter=1.5 mm). After another 4 weeks, the renal arteries were evaluated by gadoterate-, iodixanol-, and CO 2 -enhanced selective quantitative DSA. The rabbits were then killed and renal arteries were perfusion-fixed for 60 minutes. Serial orcein-stained 4-um-thick slices were prepared for histomorphometry. RESULTS Based on morphometric data of single-stenosis versus post-PTRA restenosis lesions, no significant difference was observed between Gdand iodixanol-enhanced quantitative DSA (r 2 > 0.95), although the iodine/Gd density ratio was equal to 3.5. Carbon dioxide less reliably allowed quantitative DSA (r 2 CONCLUSION Gd-based contrast agents represent a highly reliable alternative in experimental quantitative DSA evaluation of renal artery restenosis.

Colloque avec actes et comité de lecture.; Today, 3-D angiography volumes are routinely generated from rotational angiography sequences. In previous work \cite{Kerrien98}, we have studied the precision reached by registering such volumes with classical 2-D angiography images, inferring this matching only from the sensors of the angiography machine. The error led by such a registration can be described as a 3-D rigid motion composed of a large translation and a small rotation. This paper describes the strategy we followed to correct this error. The angiography image is compared in a two-step process to the Maximum Intensity Projection (MIP) of the angiography volume. The first step provides most of the translation by maximizing the cross-correlation. The second step recovers the residual rigid-body motion, thanks to a modified optical flow technique. A fine analysis of the equations encountered in both steps allows for a speed-up of the calculations. This algorithm was validated on 17 images of a phantom, and 5 patients. The residual error was determined by manually indicating points of interest and was found to be around 1 mm.

SummaryFractional flow reserve (FFR) is emerging as a useful clinical tool for assessing the functional significance of coronary atherosclerosis. As opposed to anatomical approaches, physiological measurements (particularly pressure-derived FFR) assess the function of the coronary circulation and offer the possibility of ‘ad hoc’ treatment. The use of FFR is still limited in France because there is no financial support. The present review will focus on coronary pressure-derived FFR.