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1. Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Author: 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
Subjects: 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.
Published: 2022

2. Approche originale en deux étapes d’une grossesse ectopique dans une corne rudimentaire : un rapport de cas unique avec une revue de la littérature

Author: I. Thomassin–Naggara, G. Miailhe, V. Castaigne, Bassam Haddad, Yohann Dabi, L. Ebanga, Edouard Lecarpentier, and M. Lefebvre
Subjects: Gynecology, medicine.medical_specialty, Reproductive Medicine, Ectopic pregnancy, French horn, business.industry, medicine, Obstetrics and Gynecology, Unicornuate uterus, medicine.disease, business, Uterine rupture
Published: 2021

3. Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SAR Uterine and Ovarian Cancer Disease-Focused Panel and the ESUR Female Pelvic Imaging Working Group

Author: Priyanka Jha, Atul B. Shinagare, Liina Poder, Elizabeth A. Sadowski, Jeanne M. Horowitz, H. A. Vargas, Marcia C. Javitt, Lucia Manganaro, Aki Kido, Katherine E. Maturen, Andrea Rockall, Hye Sun Park, Yulia Lakhman, Olivera Nikolic, Stephanie Nougaret, Isabelle Thomassin-Naggara, Gaiane M. Rauch, Evis Sala, Neil S. Horowitz, Rosemarie Forstner, Olga R. Brook, Susanna I. Lee, Aradhana M. Venkatesan, Caroline Reinhold, and S. Wallace
Subjects: Ovarian Neoplasms, medicine.medical_specialty, Isoflurophate, Magnetic Resonance Spectroscopy, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Interventional radiology, General Medicine, Gynecologic oncology, Disease, medicine.disease, Lexicon, Magnetic Resonance Imaging, Article, Humans, Medicine, Female, Radiology, Nuclear Medicine and imaging, Radiology, Tomography, X-Ray Computed, business, Ovarian cancer, Radiation treatment planning, Neuroradiology
Abstract: Objectives Imaging evaluation is an essential part of treatment planning for patients with ovarian cancer. Variation in the terminology used for describing ovarian cancer on computed tomography (CT) and magnetic resonance (MR) imaging can lead to ambiguity and inconsistency in clinical radiology reports. The aim of this collaborative project between Society of Abdominal Radiology (SAR) Uterine and Ovarian Cancer (UOC) Disease-focused Panel (DFP) and the European Society of Uroradiology (ESUR) Female Pelvic Imaging (FPI) Working Group was to develop an ovarian cancer reporting lexicon for CT and MR imaging. Methods Twenty-one members of the SAR UOC DFP and ESUR FPI working group, one radiology clinical fellow, and two gynecologic oncology surgeons formed the Ovarian Cancer Reporting Lexicon Committee. Two attending radiologist members of the committee prepared a preliminary list of imaging terms that was sent as an online survey to 173 radiologists and gynecologic oncologic physicians, of whom 67 responded to the survey. The committee reviewed these responses to create a final consensus list of lexicon terms. Results An ovarian cancer reporting lexicon was created for CT and MR Imaging. This consensus-based lexicon has 6 major categories of terms: general, adnexal lesion-specific, peritoneal carcinomatosis-specific, lymph node-specific, metastatic disease -specific, and fluid-specific. Conclusions This lexicon for CT and MR imaging evaluation of ovarian cancer patients has the capacity to improve the clarity and consistency of reporting disease sites seen on imaging. Key points • This reporting lexicon for CT and MR imaging provides a list of consensus-based, standardized terms and definitions for reporting sites of ovarian cancer on imaging at initial diagnosis or follow-up. • Use of standardized terms and morphologic imaging descriptors can help improve interdisciplinary communication of disease extent and facilitate optimal patient management. • The radiologists should identify and communicate areas of disease, including difficult to resect or potentially unresectable disease that may limit the ability to achieve optimal resection.
Published: 2021

4. Influence of prior intravenous thrombolysis on outcome after failed mechanical thrombectomy: ETIS registry analysis

Author: Claire, Rozes, Benjamin, Maier, Benjamin, Gory, Romain, Bourcier, Maeva, Kyheng, Julien, Labreuche, Arturo, Consoli, Mikael, Mazighi, Raphaël, Blanc, Jildaz, Caroff, Francois, Eugene, Olivier, Naggara, Florent, Gariel, Igor, Sibon, Bertrand, Lapergue, Gaultier, Marnat, Ian, Seiler, CHU Bordeaux [Bordeaux], Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de neuroradiologie [Suresnes], Hôpital Foch [Suresnes], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Service de Neuroradiologie [CHU de Bicêtre], Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Sainte Anne [Paris], Centre de Psychiatrie et Neurosciences (U894), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), Institut de Neurosciences cognitives et intégratives d'Aquitaine (INCIA), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-SFR Bordeaux Neurosciences-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Mechanical Thrombolysis, medicine.medical_treatment, Intervention, Arterial Occlusive Diseases, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Brain Ischemia, Hematoma, Fibrinolytic Agents, Modified Rankin Scale, Statistical significance, Clinical endpoint, Humans, Medicine, Thrombolytic Therapy, Registries, Stroke, Ischemic Stroke, Retrospective Studies, Thrombectomy, business.industry, Cerebral infarction, General Medicine, Thrombolysis, medicine.disease, Mechanical thrombectomy, Treatment Outcome, Anesthesia, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Surgery, Neurology (clinical), business, Intracranial Hemorrhages
Abstract: BackgroundDespite constant improvements in recent years, sufficient reperfusion after mechanical thrombectomy (MT) is not reached in up to 15% of patients with large vessel occlusion stroke (LVOS). The outcome of patients with unsuccessful reperfusion after MT especially after intravenous thrombolysis (IVT) use is not known. We investigated the influence of initial IVT in this particular group of patients with failed intracranial recanalization.MethodsWe conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry from January 2015 to December 2019. Patients presenting with LVOS of the anterior circulation and final modified Thrombolysis in Cerebral Infarction score (mTICI) of 0, 1 or 2a were included. Posterior circulation, isolated cervical carotid occlusions and successful reperfusions (mTICI 2b, 2c or 3) were excluded. The primary endpoint was favorable outcome (modified Rankin Scale score of 0–2) after 3 months. Secondary endpoints were safety outcomes including mortality, any intracranial hemorrhage (ICH), parenchymal hematoma (PH) and symptomatic intracranial hemorrhage (sICH) rates.ResultsAmong 5076 patients with LVOS treated with MT, 524 patients with insufficient recanalization met inclusion criteria, of which 242 received IVT and 282 did not. Functional outcome was improved in the MT+IVT group compared with the MT alone group, although the difference did not reach statistical significance (23.0% vs 12.9%; adjusted OR=1.82; 95% CI 0.98 to 3.38; p=0.058). However, 3 month mRS shift analysis showed a significant benefit of IVT (adjusted OR=1.68; 95% CI 1.56 to 6.54). ICH and sICH rates were similar in both groups, although PH rate was higher in the MT+IVT group (adjusted OR=3.20; 95% CI 1.56 to 6.54).ConclusionsAmong patients with LVOS in the anterior circulation and unsuccessful MT, IVT was associated with improved functional outcome even after unsuccessful MT. Despite recent trials questioning the place of IVT in the LVOS reperfusion strategy, these findings emphasize a subgroup of patients still benefiting from IVT.
Published: 2021

5. Tissue outcome prediction in hyperacute ischemic stroke: Comparison of machine learning models

Author: Sylvain Charron, Guillaume Turc, Jean-Claude Baron, Joseph Benzakoun, Bertrand Thirion, Wagih Ben Hassen, Gregoire Boulouis, Catherine Oppenheim, Olivier Naggara, Laurence Legrand, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), GHU Paris Psychiatrie et Neurosciences, Université de Paris - UFR Médecine Paris Centre [Santé] (UP Médecine Paris Centre), Université de Paris (UP), Modelling brain structure, function and variability based on high-field MRI data (PARIETAL), Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Service NEUROSPIN (NEUROSPIN), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Service NEUROSPIN (NEUROSPIN), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Inria Saclay - Ile de France, and Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)
Subjects: Male, Clinical Decision-Making, 030204 cardiovascular system & hematology, Machine learning, computer.software_genre, Machine Learning, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Medicine, Acute ischemic stroke, Stroke, Aged, Ischemic Stroke, Retrospective Studies, Neuroradiology, Aged, 80 and over, business.industry, Penumbra, Brain, Original Articles, Middle Aged, Prognosis, medicine.disease, Patient management, Diffusion Magnetic Resonance Imaging, Neurology, Infarction, Reperfusion, Ischemic stroke, Female, Neurology (clinical), Artificial intelligence, Treatment decision making, Cardiology and Cardiovascular Medicine, Outcome prediction, business, computer, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Machine Learning (ML) has been proposed for tissue fate prediction after acute ischemic stroke (AIS), with the aim to help treatment decision and patient management. We compared three different ML models to the clinical method based on diffusion-perfusion thresholding for the voxel-based prediction of final infarct, using a large MRI dataset obtained in a cohort of AIS patients prior to recanalization treatment. Baseline MRI (MRI0), including diffusion-weighted sequence (DWI) and Tmax maps from perfusion-weighted sequence, and 24-hr follow-up MRI (MRI24h) were retrospectively collected in consecutive 394 patients AIS patients (median age = 70 years; final infarct volume = 28mL). Manually segmented DWI24h lesion was considered the final infarct. Gradient Boosting, Random Forests and U-Net were trained using DWI, apparent diffusion coefficient (ADC) and Tmax maps on MRI0 as inputs to predict final infarct. Tissue outcome predictions were compared to final infarct using Dice score. Gradient Boosting had significantly better predictive performance (median [IQR] Dice Score as for median age, maybe you can replace the comma with an equal sign for consistency 0.53 [0.29–0.68]) than U-Net (0.48 [0.18–0.68]), Random Forests (0.51 [0.27–0.66]), and clinical thresholding method (0.45 [0.25–0.62]) ( P
Published: 2021

6. Impact of Repeated Clot Retrieval Attempts on Infarct Growth and Outcome After Ischemic Stroke

Author: Olivier Naggara, Martin Bretzner, Nicolas Bricout, Guillaume Turc, C Rodriguez, Laurence Legrand, Pierre Seners, Alice Le Berre, Joseph Benzakoun, Charlotte Cordonnier, Caroline Touloupas, Hilde Hénon, Wagih Ben Hassen, Gregoire Boulouis, and Catherine Oppenheim
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Arterial Occlusive Diseases, 030204 cardiovascular system & hematology, Neurosurgical Procedures, 03 medical and health sciences, 0302 clinical medicine, Meta-Analysis as Topic, Risk Factors, Modified Rankin Scale, Internal medicine, medicine, Humans, Thrombolytic Therapy, Binary logistic regression analysis, Prospective Studies, Aged, Ischemic Stroke, Thrombectomy, Aged, 80 and over, Cerebral infarction, business.industry, Cerebral Infarction, Thrombolysis, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Mechanical thrombectomy, Diffusion Magnetic Resonance Imaging, Treatment Outcome, Ischemic stroke, Cardiology, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: ObjectiveTo determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).MethodsData were extracted from 2 pooled multicentric prospective registries of consecutive patients with anterior AIS-LVO treated with mechanical thrombectomy (MT) between January 2016 and 2019. Patients with pretreatment and 24-hour posttreatment diffusion-weighted imaging (DWI) achieving successful recanalization, defined as expanded Thrombolysis in Cerebral Infarction Scale score of 2B, 2C, or 3, were included. ENT were assessed and IG was measured by voxel-based segmentation after DWI coregistration. Associations between number of CRA, ENT, IG, and 3-month outcome were analyzed.ResultsFour hundred nineteen patients achieving successful recanalization were included. ENT occurrence was strongly correlated with increasing CRA (ρ = 0.73, p = 10−4). In multivariable linear analysis, IG was independently associated with CRA (β = 1.6 per retrieval attempt, 95% confidence interval [CI] 0.97–9.74, p = 0.03) and ENT (β = 2.7 [95% CI 1.21–4.1], p = 0.03). Unfavorable functional outcome (3-month modified Rankin Scale score >2) increased with each additional CRA. IG was an independent predictor of unfavorable outcome (odds ratio 1.05 [95% CI 1.02–1.07] per 1-mL IG increase, p = 10−4) in binary logistic regression analysis.ConclusionsIncreasing number of CRA in acute stroke is correlated with an increased ENT rate and increased IG volume, affecting functional outcome even when successful recanalization is achieved.Classification of EvidenceThis study provides Class II evidence that, for patients with acute stroke undergoing successful recanalization, an increasing number of CRA is associated with poorer functional outcome.
Published: 2021

7. Mortality and functional outcome after pediatric intracerebral hemorrhage: cohort study and meta-analysis

Author: Lorenzo Garzelli, Sandro Benichi, Florent Gariel, Fanny Bajolle, Gregoire Boulouis, Thomas Blauwblomme, Nathalie Boddaert, Annie Harroche, Philippe Meyer, Jean-François Hak, Sarah Stricker, Manoelle Kossorotoff, Quentin Alias, Nicolas Garcelon, and Olivier Naggara
Subjects: Male, medicine.medical_specialty, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Recovery rate, Internal medicine, medicine, Humans, Pediatric stroke, Child, Cerebral Hemorrhage, Retrospective Studies, Intracerebral hemorrhage, business.industry, Recovery of Function, General Medicine, medicine.disease, Child, Preschool, 030220 oncology & carcinogenesis, Meta-analysis, Cohort, Etiology, Female, business, 030217 neurology & neurosurgery, Cohort study
Abstract: OBJECTIVE The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH. METHODS Children who received treatment for pICH at the authors’ institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes. RESULTS Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6–12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13–63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%–36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%–57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%–24%; Q = 101.6; I2 = 81%). CONCLUSIONS Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.
Published: 2021

8. First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry

Author: Benjamin, Maïer, Stephanos, Finitsis, Romain, Bourcier, Panagiotis, Papanagiotou, Sébastien, Richard, Gaultier, Marnat, Igor, Sibon, Cyril, Dargazanli, Caroline, Arquizan, Raphael, Blanc, Michel, Piotin, Bertrand, Lapergue, Arturo, Consoli, Francois, Eugene, Stephane, Vannier, Suzana, Saleme, Francisco, Macian, Frédéric, Clarençon, Charlotte, Rosso, Olivier, Naggara, Guillaume, Turc, Alain, Viguier, Christophe, Cognard, Valerie, Wolff, Raoul, Pop, Mikael, Mazighi, Benjamin, Gory, Thomas, Ronziere, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Aristotle University of Thessaloniki, Centre hospitalier universitaire de Nantes (CHU Nantes), Klinikum Bremen-Mitte, National and Kapodistrian University of Athens (NKUA), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Département de neurologie [Montpellier], Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], Département de Radiologie [Rennes], Université de Rennes (UR), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Limoges, Service de Neurologie [CHU Limoges], Service de Neuroradiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Sorbonne Paris Nord, Service d'Urgences Cérébro-Vasculaires [CHU Pitié-Salpêtrière], Service de Neurologie [CH Saint-Anne], Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurologie Vasculaire [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Pôle Neurosciences [CHU Toulouse], Service de Neurologie [Strasbourg], CHU Strasbourg-Hopital Civil, Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Institut de Chirurgie guidée par l'Image, and Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Subjects: medicine.medical_specialty, MESH: Endovascular Procedures, medicine.medical_treatment, Arterial Occlusive Diseases, MESH: Stroke, Brain Ischemia, law.invention, Randomized controlled trial, Modified Rankin Scale, law, medicine.artery, Internal medicine, Stent, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, medicine, Humans, Device, MESH: Thrombectomy, Prospective Studies, Stroke, Ischemic Stroke, Retrospective Studies, Thrombectomy, MESH: Treatment Outcome, Catheter, MESH: Arterial Occlusive Diseases, MESH: Humans, Cerebral infarction, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, Endovascular Procedures, MESH: Brain Ischemia, MESH: Retrospective Studies, General Medicine, Thrombolysis, medicine.disease, MESH: Prospective Studies, MESH: Stents, Treatment Outcome, Cardiology, Stents, Surgery, Neurology (clinical), Internal carotid artery, business, MESH: Ischemic Stroke
Abstract: BackgroundThe best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA).ObjectiveTo compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT.MethodsWe analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0–2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes.ResultsWe included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA.ConclusionsDespite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.
Published: 2021

9. Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage

Author: Andrea Morotti, Sarah Stricker, Gregoire Boulouis, Basile Kerleroux, Florent Gariel, Lorenzo Garzelli, Thomas Blauwblomme, Jean-François Hak, Marie Bourgeois, Quentin Alias, Philippe Meyer, Nathalie Boddaert, Manoelle Kossorotoff, Sandro Benichi, Olivier Naggara, and Nicolas Garcelon
Subjects: Male, medicine.medical_specialty, Adolescent, Computed tomography, Cohort Studies, Risk Factors, Odds Ratio, Prevalence, Craniocerebral Trauma, Humans, Medicine, Glasgow Coma Scale, Child, Coagulation Disorder, Cerebral Hemorrhage, Retrospective Studies, Advanced and Specialized Nursing, Intracerebral hemorrhage, medicine.diagnostic_test, business.industry, Odds ratio, Blood Coagulation Disorders, medicine.disease, Treatment Outcome, Child, Preschool, Female, Neurology (clinical), Radiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Background and Purpose: Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children. Methods: Children admitted between January 2000 and March 2020 at a quaternary care pediatric hospital were screened for inclusion. Sample was restricted to children with 2 computed tomography scans within 72 hours of ICH onset, and a minimal clinical follow-up of months. sHE was defined as an increase from baseline ICH volume by 6 cc or 33% on follow-up computed tomography. Clinical outcome was assessed at 12 months with the King’s Outcome Scale for Childhood Head Injury score and defined as favorable for scores ≥5. Results: Fifty-two children met inclusion criteria, among which 8 (15%) demonstrated sHE, and 18 (34.6%) any degree of expansion. Children with sHE had more frequent coagulation disorders (25.0% versus 2.3%; P =0.022). After multivariable adjustment, only the presence of coagulation disorders at baseline remained independently associated with sHE (adjusted odds ratio, 14.4 [95% CI, 1.04–217]; P =0.048). sHE was independently associated with poor outcome (King’s Outcome Scale for Childhood Head Injury P =0.043). Conclusions: sHE is a frequent phenomenon after admission for a pediatric ICH and more so in children with coagulation defects. As sHE was strongly associated with poorer clinical outcomes, these data mandate a baseline coagulation work up and questions the need for protocolized repeat head computed tomography in children admitted for pediatric ICH.
Published: 2021

10. Late Pediatric Mechanical Thrombectomy for Embolic Stroke as Bridge Reinforcement From LVAD to Heart Transplantation

Author: Charles-Joris Roux, Basile Kerleroux, Anne Moreau de Bellaing, Olivier Naggara, Jean-François Hak, Manoelle Kossorotoff, Lucile Houyel, Olivier Raisky, Gregoire Boulouis, and Damien Bonnet
Subjects: 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, heart, 030105 genetics & heredity, 03 medical and health sciences, mechanical thrombectomy, 0302 clinical medicine, Internal medicine, medicine, ischemic stroke, left ventricular assist device, Diseases of the circulatory (Cardiovascular) system, cardiovascular diseases, collateral circulation, Heart transplantation, business.industry, Collateral circulation, medicine.disease, Embolic stroke, CT, computed tomography, Transplantation, Mechanical thrombectomy, Bridge (graph theory), pediatric, Mini-Focus Issue: Vascular Medicine, CICU, cardiac intensive care unit, RC666-701, Ventricular assist device, Heart failure, MT, mechanical thrombectomy, Cardiology, LVAD, left ventricular assist device, Case Report: Clinical Case, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, PedNISS, Pediatric National Institutes of Health Stroke Scale, transplantation
Abstract: Although the left ventricular assist device is an important bridge to heart transplantation for patients with end-stage heart failure, it can also be a source of embolic stroke. We present a case of late intracranial mechanical thrombectomy performed for embolic stroke beyond the recommended 6 h, thus allowing for heart transplantation 4 days after intracranial mechanical thrombectomy. (Level of Difficulty: Advanced.), Central Illustration
Published: 2021

11. Hyperacute Recanalization Strategies and Childhood Stroke in the Evidence Age

Author: Augustin Ozanne, Manoelle Kossorotoff, Stéphane Chabrier, Gregoire Boulouis, B. Husson, and Olivier Naggara
Subjects: medicine.medical_specialty, medicine.medical_treatment, Disease, Pediatrics, medicine, Humans, Pediatric stroke, Thrombolytic Therapy, Child, Intensive care medicine, Stroke, Advanced and Specialized Nursing, Evidence-Based Medicine, business.industry, Infant, Newborn, Infant, Thrombolysis, Childhood stroke, medicine.disease, Safety profile, Clot lysis, Child, Preschool, Observational study, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract: No controlled pharmacological studies are available in the field of pediatric stroke, except for sickle cell disease. Therefore, while pharmacological and mechanical recanalization treatments have repeatedly shown clinical benefit in adults with arterial ischemic stroke, pediatric strokologists still cannot base their therapeutic management (including hyperacute strategies) on high-level evidence. Once again, pediatricians face the same dichotomic choice: adapting adult procedures now versus waiting—for a long time—for the corresponding pediatric trials. One way out is building a compromise based on observational studies with large, longitudinal, comprehensive, real-life, and multisource dataset. Two recent high-quality observational studies have delivered promising conclusions on recanalization treatments in pediatric arterial ischemic stroke. TIPSTER (Thrombolysis in Pediatric Stroke Extended Results) showed that the risk of severe intracranial hemorrhage after intravenous thrombolysis is low; the Save Childs Study reported encouraging data about pediatric thrombectomy. Beyond the conclusion of a satisfactory global safety profile, a thorough analysis of the methods, populations, results, and therapeutic complications of these studies helps us to refine indications/contraindications and highlights the safeguards we need to rely on when discussing thrombolysis and thrombectomy in children. In conclusion, pediatric strokologists should not refrain from using clot lysis/retrieval tools in selected children with arterial ischemic stroke. But the implementation of hyperacute care is only feasible if the right candidate is identified through the sharing of common adult/pediatric protocols and ward collaboration, formalized well before the child’s arrival. These anticipated protocols should never undervalue contraindications from adult guidelines and must involve the necessary pediatric expertise when facing specific causes of stroke, such as focal cerebral arteriopathy of childhood.
Published: 2021

12. Percutaneous alcohol-based sclerotherapy in aneurysmal bone cyst in children and adolescents

Author: Stéphanie Pannier, Francis Brunelle, Christophe Glorion, Eric Mascard, Laila El Sayed, Laura Marie-Hardy, Younes Ouchrif, Olivier Naggara, Alexandra Alves, and Sylvain Breton
Subjects: Male, medicine.medical_specialty, Percutaneous, Adolescent, medicine.medical_treatment, Lesion, 03 medical and health sciences, 0302 clinical medicine, Sclerotherapy, medicine, Humans, Orthopedics and Sports Medicine, Femur, Cyst, Child, Bone cyst, Retrospective Studies, 030222 orthopedics, Ethanol, business.industry, Retrospective cohort study, 030229 sport sciences, Aneurysmal bone cyst, medicine.disease, Surgery, Bone Cysts, Aneurysmal, Treatment Outcome, medicine.symptom, business
Abstract: Introduction Aneurysmal bone cyst (ABC) is a benign bone lesion of childhood and adolescence. It can be locally aggressive, with risk of fracture. Management is controversial. The aim of the present study was to assess the efficacy, simplicity and tolerance of percutaneous alcohol-bases sclerotherapy in ABC. Hypothesis Alcohol-based sclerotherapy for ABC under radiographic control is safe and effective. Material and Methods A single-center retrospective study for the period 2008–2016 included all of the 55 ABCs, in 54 patients, confirmed on pathology and treated by alcohol-based sclerotherapy under radiographic control. Mean age at diagnosis was 9.6 years. ABC involved the humerus in 30 cases (54%), tibia in 7 (13%) and femur in 5 (9%). Mean follow-up was 50.9 months (range, 16–117 months). Mean number of applications was 1.7 (range, 1–4). Results were assessed clinically (pain, return to sport, limb length and alignment, revision surgery) and radiologically. The main endpoint was lesion volume reduction. The secondary endpoint was failure, defined by open revision surgery or pain preventing return to a sports activity. Results Clinical progression was favorable in 36 patients (67%), and radiological progression in 45 (85%). Only 1 cyst required secondary resection. One patient experienced spontaneously resolving intraoperative bradycardia. Male gender and young age emerged as factors for poorer response. Discussion ABC management in children can be made difficult by lesion size, aggressiveness, location, proximity to the growth plate and small bone stock. Alcohol-based sclerotherapy is simple, reliable and effective in childhood ABC, and may be a first-line attitude, avoiding recourse to invasive surgery. Level of evidence IV, retrospective study.
Published: 2020

13. Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients

Author: Thomas Blauwblomme, Florent Gariel, Lorenzo Garzelli, Frédéric Clarençon, Philippe Meyer, Nader Sourour, Francis Brunelle, Olivier Naggara, Q. Alias, Gregoire Boulouis, Bertrand Mathon, Nathalie Boddaert, Manoelle Kossorotoff, S. Stricker, and Eimad Shotar
Subjects: Adult, Intracranial Arteriovenous Malformations, Male, medicine.medical_specialty, Adolescent, Neuroimaging, Pediatrics, 030218 nuclear medicine & medical imaging, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Age groups, Risk Factors, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Young adult, Child, Proportional Hazards Models, Retrospective Studies, Rupture, Adult patients, business.industry, Proportional hazards model, Mean age, Retrospective cohort study, Middle Aged, medicine.disease, Arteriovenous Fistula, Female, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery, Cohort study
Abstract: BACKGROUND AND PURPOSE: Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life. MATERIALS AND METHODS: Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture. RESULTS: Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, P
Published: 2020

14. Magnetic Resonance and Ultrasound Fusion Imaging to Characterise Ovarian Masses: A Feasibility Study

Author: Dounia Skalli, Adrien Crestani, Jean-Marc Levaillant, Isabelle Thomassin-Naggara, Claire Théodore, Yohann Dabi, GrÉgoire Miaihle, Bassam Haddad, and Cyril Touboul
Subjects: Adult, Cancer Research, medicine.medical_specialty, Adolescent, Likelihood ratios in diagnostic testing, Adnexal mass, Young Adult, Ovarian tumor, medicine, Humans, Single-Blind Method, Aged, Ultrasonography, Aged, 80 and over, Ovarian Neoplasms, Cervical cancer, Image fusion, medicine.diagnostic_test, business.industry, Ovary, Ultrasound, Retrospective cohort study, Magnetic resonance imaging, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Oncology, Feasibility Studies, Female, Radiology, business
Abstract: Background/aim Magnetic resonance (MR) and ultrasound (US) fusion imaging (MR-US fusion) is already used to guide prostate biopsies and has been proven accurate for diagnosing cervical cancer. In this study, we aimed to evaluate the feasibility and performance of MR-US fusion for characterizing adnexal masses. Patients and methods A retrospective study was conducted between 2014 and 2018 including women referred to our Gynaecological Oncology Department for characterization of an adnexal mass (n=106). Performance of MR-US fusion was evaluated in a subgroup of patients who underwent surgery (n=26). Two readers, blinded to final histology, performed and rated US findings according to the International Ovarian Tumor Analysis simple rules score, MR according to Ovarian-Adnexal Reporting Data System Magnetic score, and MR-US fusion through a tailored score. The reference outcome was the final pathology. Results MR-US fusion had a sensitivity of 100% (95%CI=80-100), specificity of 89% (95%CI=52-99), positive likelihood ratio of 9 (95%CI=1.4-57), and accuracy of 96% (95%CI=80-99). Conclusion MR-US fusion is feasible for characterizing adnexal masses to predict ovarian cancer.
Published: 2020

15. Stratégies ganglionnaires dans les cancers de l’endomètre

Author: Isabelle Thomassin-Naggara, Marc Bazot, Sandrine Richard, Aude Jayot, Clémentine Owen, Sofiane Bendifallah, Anne Sophie Boudy, Anna Ilenko, Alexandra Arfi, Emile Daraï, J. Varinot, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Expert en Endométriose [CHU Tenon] (GRC6 C3E), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Alliance Pour la Recherche En Cancérologie [CHU Tenon] (APREC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Saint-Antoine [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: 0301 basic medicine, Cancer Research, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Sentinel lymph node, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endometrial cancer, Biopsy, Adjuvant therapy, medicine, Radiology, Nuclear Medicine and imaging, Lymph node, medicine.diagnostic_test, business.industry, Cancer, Lymphadenectomy, Hematology, General Medicine, Prognosis, medicine.disease, 3. Good health, 030104 developmental biology, medicine.anatomical_structure, Oncology, chemistry, 030220 oncology & carcinogenesis, Radiology, business, Indocyanine green
Abstract: International audience; In 2018, around 382,100 new cases of endometrial cancer (EC) were reported worldwide, accounting for about 4.4% of all new cases of cancer in women. In France, in 2018, the EC is the first gynecological cancer in incidence and the fourth cancer in women. The rationale for the therapeutic management of EC is based on the estimation of a theoretical risk of recurrence and lymph node metastasis using MRI and preoperative biopsy criteria. However, lymph node status remains the determining factor of adjuvant treatment. In order to reduce the morbidity of lymphadenectomy, the concept of sentinel lymph node biopsy (SLN) has been developed. The SLN technique has evolved in recent years, thanks to the advent of robotics and the creation of fluorescence detection cameras. It has been shown that detection of SLN with Indocyanine Green (ICG) allows for more frequent bilateral migration of 88 to 100% and better detection of pelvic GS in 97% of cases with a decrease in morbidity. Recently, in view of the absence of a therapeutic role of lymph node staging, the operational risks and the delay of adjuvant treatments, in case of pelvic lymph node metastasis on definitive histological examination, the question of secondarily performing paraaortic lymphadenectomy arises. The SLN procedure, extended to all early-stage endometrial cancers, should lead to a major reduction in the use of secondary staging and better adaptation of adjuvant therapy.
Published: 2020

16. First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations

Author: Quentin Alias, Thomas Blauwblomme, Francis Brunelle, Lorenzo Garzelli, Florent Gariel, Philippe Meyer, Olivier Naggara, Sandro Benichi, Manoelle Kossorotoff, Nathalie Boddaert, Gregoire Boulouis, and Kevin Beccaria
Subjects: Intracranial Arteriovenous Malformations, medicine.medical_specialty, Neurology, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Humans, Medicine, Dimethyl Sulfoxide, Radiology, Nuclear Medicine and imaging, Embolization, Child, Interventional neuroradiology, Retrospective Studies, Neuroradiology, Intracerebral hemorrhage, business.industry, Onyx embolization, medicine.disease, Embolization, Therapeutic, Surgery, Treatment Outcome, Female, Polyvinyls, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery
Abstract: Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs. Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated. In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1–12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1–3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV–V, respectively. It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.
Published: 2019

17. Nontraumatic Pediatric Intracerebral Hemorrhage

Author: Mark T Mackay, Adam Kirton, Thomas Blauwblomme, Charlotte Cordonnier, Gregoire Boulouis, Sandro Benichi, Mathilde Chevignard, Elisabeth Tournier-Lasserve, Philippe Meyer, Olivier Naggara, Stéphane Chabrier, Jean François Hak, and Manoelle Kossorotoff
Subjects: Intracranial Arteriovenous Malformations, Hemangioma, Cavernous, Central Nervous System, Adolescent, Computed Tomography Angiography, Vomiting, Arteriovenous fistula, Anemia, Sickle Cell, Neurosurgical Procedures, Magnetic resonance angiography, Cognition, Activities of Daily Living, medicine, Humans, Cognitive Dysfunction, Social Integration, Moyamoya disease, Child, Cerebral Hemorrhage, Central Nervous System Vascular Malformations, Advanced and Specialized Nursing, Intracerebral hemorrhage, Academic Success, medicine.diagnostic_test, Brain Neoplasms, business.industry, Headache, Anticoagulants, Infant, Blood Coagulation Disorders, Physical Functional Performance, Childhood stroke, Decompression, Surgical, Prognosis, medicine.disease, Clinical neurology, Child, Preschool, Education, Special, Anesthesia, Arteriovenous Fistula, Ischemic stroke, Drainage, Neurology (clinical), Moyamoya Disease, Cardiology and Cardiovascular Medicine, business, Magnetic Resonance Angiography
Published: 2019

18. Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry

Author: Ngankou, Emmanuel Happi, Gory, Benjamin, Marnat, Gaultier, Richard, Sébastien, Bourcier, Romain, Sibon, Igor, Dargazanli, Cyril, Arquizan, Caroline, Maïer, Benjamin, Blanc, Raphaël, Lapergue, Bertrand, Consoli, Arturo, Vannier, Stéphane, Spelle, Laurent, Denier, Christian, Boulanger, Marion, Gauberti, Maxime, Saleme, Suzana, Macian, Francisco, Clarençon, Frédéric, Rosso, Charlotte, Naggara, Olivier, Turc, Guillaume, Ozkul-Wermester, Ozlem, Papagiannaki, Chrysanthi, Viguier, Alain, Cognard, Christophe, Lebras, Anthony, Evain, Sarah, Wolff, Valérie, Pop, Raoul, Timsit, Serge, Gentric, Jean Christophe, Bourdain, Frédéric, Veunac, Louis, Eugène, François, Finitsis, Stephanos Nikolaos, Piotin, Michel, Redjem, Hocine, Escalard, Simon, Dessilles, Jean Philippe, Delvoye, François, Smajda, Stanislas, Solène, Hebert, Mazighi, Mikael, Obadia, Mikael, Sabben, Candice, Seners, Pierre, Raynouard, Igor, Corabianu, Ovide, de Broucker, Thomas, Manchon, Eric, Taylor, Guillaume, Maacha, Malek Ben, Thion, Laurie Anne, Lecler, Augustin, Savatovsjy, Julien, Hospital, Foch, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Weisenburgerlile, David, Gorza, Lucas, Buard, Géraldine, Coskun, Oguzhan, Di Maria, Federico, Rodesh, Georges, Zimatore, Sergio, Leguen, Morgan, Gratieux, Julie, Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Gariel, Florent, Barreau, Xavier, Berge, Jerome, Menegon, Patrice, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Rouanet, François, Tourdias, Thomas, Liegey, Jean Sebastien, Briau, Pierre, Pangon, Nicolas, Detraz, Lili, Daumas-Duport, Benjamin, Alexandre, Pierre Louis, Roy, Monica, Lenoble, Cédric, Desal, Hubert Armand, Guillon, Benoît, de Gaalon, Solène, Preterre, Cécile, Bracard, Serge, Anxionnat, René, Braun, Marc, Derelle, Anne Laure, Romain, Tonnelet, Liao, Liang, Zhu, François, Schmitt, Emmanuelle, Planel, Sophie, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean Christophe, Riou-Comte, Nolwenn, Audibert, Gérard, Voicu, Marcela, Alb, Lionel, Reitter, Marie, Brezeanu, Madalina, Masson, Agnès, Tabarna, Adriana, Podar, Iona, Guy, Sarah, Bechiri, Fatiha, Bourst, Pauline, Macian-Montoro, Francisco, Saleme, Suzanna, Mounayer, Charbel, Rouchaud, Aymeric, Gimenez, Laetitia, Cosnard, Alexandre, Costalat, Vincent, Gascou, Grégory, Lefèvre, Pierre Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Cagnazzo, Federico, ter Schiphorst, Adrien, Ferré, Jean-Christophe, Raoult, Hélène, Ronziere, Thomas, Lassale, Maria, Paya, Christophe, Gauvrit, Jean Yves, Tracol, Clément, Langnier-Lemercier, Sophie, Maurice, Axelle, Cochennec, Sabrina, Pinault, Mélanie, Shotar, Eimad, Sourour, Nader Antoine, Lenck, Stéphanie, Premat, Kévin, Anne Léger, Yves Samson, Crozier, Sophie, Baronnet, Flore, Alamowitch, Sonia, Bottin, Laure, Yger, Marion, Degos, Vincent, Chassin, Olivier, Chalumeau, Vanessa, Caroff, Jildaz, Venditti, Laura, Sarov, Mariana, Legris, Nicolas, Hassen, Wagih Ben, Boulouis, Grégoire, Rodriguez-Régent, Christine, Trystram, Denis, Kerleroux, Basile, Domigo, Valérie, Lamy, Catherine, Birchenall, Julia, Isabel, Clothilde, Lun, François, Januel, Anne Christine, Olivot, Jean Marc, Fontaine, Louis, Raposo, Nicolas, Bonneville, Fabrice, Albucher, Jean François, Calviere, Lionel, Darcourt, Jean, Bellanger, Guillaume, Tall, Philippe, Touzé, Emmanuel, Barbier, Charlotte, Schneckenburger, Romain, Cogez, Julien, Guettier, Sophie, Ognard, Julien, Merrien, François Mathias, Wermester, Ozlem Ozku, Massardier, Evelyne Guégan, Triquenot, Aude Bagan, Lefebvre, Margeaux, Bernady, Patricia, Lagoarde-Segot, Laurent, Cailliez, Hélène, Higue, David, Quenardelle, Véronique, Lauer, Valérie, Gheoca, Roxana, Pierre-Paul, Irène Nora, Beaujeux, Remy, Mihoc, Dan, Manisor, Monica, Pottecher, Julien, Meyer, Alain, Chamaraux-Tran, Thiên Nga, Le Bras, Anthony, Le Guen, Arnaud, Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CHU Bordeaux [Bordeaux], Service de neurologie [CHRU Nancy], Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre hospitalier universitaire de Nantes (CHU Nantes), Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Neurologie [CHU Rennes], CHU Pontchaillou [Rennes], Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [Le Kremlin Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Neurologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Départment de Neuroradiologie [CHU Caen], Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Limoges, Service de Neurologie [CHU Limoges], CHU Pitié-Salpêtrière [AP-HP], Service de Neurologie [CH Saint-Anne], Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Département de Neuroradiologie [CHU Rouen], Normandie Université (NU)-Normandie Université (NU), Neurologie Vasculaire [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de radiologie [Vannes], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Service de Neurologie [Strasbourg], CHU Strasbourg-Hopital Civil, Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Service de Neurologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Neuroradiologie [Brest], Neurologie - Côte Basque, Centre Hospitalier de la Côte Basque (CHCB), Aristotle University of Thessaloniki, Neuroimagerie: méthodes et applications (Empenn), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), and Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)
Subjects: Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Embolism, Large vessel, Dissection (medical), Brain ischemia, Postoperative Complications, Risk Factors, Thromboembolism, medicine, Humans, Registries, Aged, Ischemic Stroke, Thrombectomy, Advanced and Specialized Nursing, business.industry, Incidence (epidemiology), Dissection, Incidence, Endovascular Procedures, Middle Aged, medicine.disease, Surgery, Cerebrovascular Disorders, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background and Purpose: Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice. Methods: We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications. Results: Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31]; P P =0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63]; P P P =0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%; P =0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years; P =0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique. Conclusions: Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.
Published: 2021

19. Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI)

Author: Pascal A. T. Baltzer, A. Athanasiou, Ruud M. Pijnappel, Julia Camps Herrero, Christiane K. Kuhl, Veronica Magni, Ritse M. Mann, Pietro Panizza, Federica Pediconi, Thomas H. Helbich, Katja Pinker, Sophia Zackrisson, Michael Fuchsjäger, Simone Schiaffino, Fleur Kilburn-Toppin, Isabelle Thomassin-Naggara, Mihai Lesaru, Gabor Forrai, Fiona J. Gilbert, Eva M. Fallenberg, Andrea Cozzi, Paola Clauser, Tamar Sella, Francesco Sardanelli, Athanasiou, Alexandra [0000-0003-4530-0210], Sardanelli, Francesco [0000-0001-6545-9427], and Apollo - University of Cambridge Repository
Subjects: medicine.medical_specialty, Breast imaging, mammography, R895-920, Lymphadenopathy, Context (language use), Guideline, Malignancy, Covid-19 Vaccines, Medical physics. Medical radiology. Nuclear medicine, Breast cancer, All institutes and research themes of the Radboud University Medical Center, medicine, Axillary Lymphadenopathy, Mammography, Radiology, Nuclear Medicine and imaging, skin and connective tissue diseases, Ultrasonography (Breast), medicine.diagnostic_test, business.industry, medicine.disease, Magnetic Resonance Imaging, COVID-19 vaccines, lymphadenopathy, magnetic resonance imaging, ultrasonography (breast), Women's cancers Radboud Institute for Health Sciences [Radboudumc 17], Vaccination, Axilla, medicine.anatomical_structure, Radiology, business
Abstract: Insights into imaging 12(1), 119 (2021). doi:10.1186/s13244-021-01062-x, Published by Springer, Heidelberg
Published: 2021
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20. Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results

Author: Marie Couture, Stephanos Finitsis, Gaultier Marnat, Sébastien Richard, Romain Bourcier, Pacôme Constant-dits-Beaufils, Cyril Dargazanli, Caroline Arquizan, Mikaël Mazighi, Raphaël Blanc, François Eugène, Stéphane Vannier, Laurent Spelle, Christian Denier, Emmanuel Touzé, Charlotte Barbier, Suzana Saleme, Francisco Macian, Charlotte Rosso, Frédéric Clarençon, Olivier Naggara, Guillaume Turc, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Alain Viguier, Christophe Cognard, Anthony Lebras, Sarah Evain, Valérie Wolff, Raoul Pop, Serge Timsit, Jean-Christophe Gentric, Frédéric Bourdain, Louis Veunac, Bertrand Lapergue, Arturo Consoli, Benjamin Gory, Igor Sibon, Michel Piotin, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Hebert Solène, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David WeisenburgerLile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, Romain Tonnelet, François Liao, Emmanuelle Zhu, Sophie Schmitt, Sébastien Planel, Lisa Richard, Gioia Humbertjean, Jean-Christophe Mione, Nolwenn Lacour, Gérard Riou-Comte, Marcela Audibert, Lionel Voicu, Marie Alb, Madalina Reitter, Agnès Brezeanu, Adriana Masson, Iona Tabarna, Sarah Podar, Fatiha Guy, Fatiha Bechiri, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Laura Venditti, Mariana Sarov, Nicolas Legris, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti, Julien Ognard, Francois Mathias Merrien., Ozlem Ozku Wermester, Evelyne Massardier, Aude Triquenot, Margeaux Lefebvre, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, David Higue, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran, Anthony Le Bras, Arnaud Le Guen, Norbert Nighoghossian, Roberto Riva, Omer Eker, Francis turjman, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, and Anne-Evelyne Vallet
Subjects: Adult, Male, medicine.medical_specialty, Endovascular therapy, Brain ischemia, Internal medicine, medicine, Humans, Registries, Endovascular treatment, Prospective cohort study, Acute ischemic stroke, Acute stroke, Aged, Ischemic Stroke, Advanced and Specialized Nursing, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Embolic stroke, Treatment Outcome, Ischemic stroke, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Abstract: Background and Purpose: The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset. Methods: We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT−) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences. Results: A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT− group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88–1.34]; P =0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7–1.2]; P =0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63–1.37]; P =0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0–2; aOR, 0.98 [95% CI, 0.77–1.25]; P =0.89), and mortality (aOR, 0.95 [95% CI, 0.72–1.26]; P =0.76) at 90 days did not differ between the groups. Conclusions: Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.
Published: 2021

21. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Author: Götz Thomalla, Florent Boutitie, Henry Ma, Masatoshi Koga, Peter Ringleb, Lee H Schwamm, Ona Wu, Martin Bendszus, Christopher F Bladin, Bruce C V Campbell, Bastian Cheng, Leonid Churilov, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Mayumi Fukuda-Doi, Manabu Inoue, Timothy J Kleinig, Lawrence L Latour, Robin Lemmens, Christopher R Levi, Didier Leys, Kaori Miwa, Carlos A Molina, Keith W Muir, Norbert Nighoghossian, Mark W Parsons, Salvador Pedraza, Peter D Schellinger, Stefan Schwab, Claus Z Simonsen, Shlee S Song, Vincent Thijs, Danilo Toni, Chung Y Hsu, Nils Wahlgren, Haruko Yamamoto, Nawaf Yassi, Sohei Yoshimura, Steven Warach, Werner Hacke, Kazunori Toyoda, Geoffrey A Donnan, Stephen M Davis, Christian Gerloff, Boris Raul Acosta, Karen Aegidius, Christian Albiker, Anna Alegiani, Miriam Almendrote, Angelika Alonso, Katharina Althaus, Pierre Amarenco, Hemasse Amiri, Bettina Anders, Adriana Aniculaesei, Jason Appleton, Juan Arenillas, Christina Back, Christian Bähr, Jürgen Bardutzky, Flore Baronnet-Chauvet, Rouven Bathe-Peters, Anna Bayer-Karpinska, Juan L. Becerra, Christoph Beck, Olga Belchí Guillamon, Amandine Benoit, Nadia Berhoune, Daniela Bindila, Julia Birchenall, Karine Blanc-Lasserre, Miguel Blanco Gonzales, Tobias Bobinger, Ulf Bodechtel, Eric Bodiguel, Urszula Bojaryn, Louise Bonnet, Benjamin Bouamra, Paul Bourgeois, Lorenz Breuer, Ludovic Breynaert, David Broughton, Raf Brouns, Sébastian Brugirard, Bart Bruneel, Florian Buggle, Serkan Cakmak, Ana Calleja, David Calvet, David Carrera, Hsin-Chieh Chen, Bharath Cheripelli, Tae-Hee Cho, Chi-un Choe, Lillian Choy, Hanne Christensen, Mareva Ciatipis, Geoffrey Cloud, Julien Cogez, Elisa Cortijo, Sophie Crozier, Dorte Damgaard, Krishna Dani, Beatrijs De Coene, Isabel De Hollander, Jacques De Keyser, Nina De Klippel, Charlotte De Maeseneire, Ann De Smedt, Maria del Mar Castellanos Rodrigo, Sandrine Deltour, Jelle Demeestere, Laurent Derex, Philippe Desfontaines, Ralf Dittrich, Anand Dixit, Laurens Dobbels, Valérie Domigo, Laura Dorado, Charlotte Druart, Kristina Hougaard Dupont, Anne Dusart, Rainer Dziewas, Matthias Ebner, Myriam Edjali-Goujon, Philipp Eisele, Salwa El Tawil, Ahmed Elhfnawy, Ana Etexberria, Nicholas Evans, Simon Fandler, Franz Fazekas, Sandra Felix, Jochen B. Fiebach, Jens Fiehler, Alexandra Filipov, Katharina Filipski, Robert Fleischmann, Christian Foerch, Ian Ford, Alexandra Gaenslen, Ivana Galinovic, Elena Meseguer Gancedo, Ramanan Ganeshan, Carlos García Esperón, Alicia Garrido, Thomas Gattringer, Olivia Geraghty, Rohat Geran, Stefan Gerner, Sylvie Godon-Hardy, Jos Göhler, Amir Golsari, Meritxell Gomis, David Gorriz, Verena Gramse, Laia Grau, Martin Griebe, Cristina Guerrero, Damla Guerzoglu, Sophie Guettier, Vincent Guiraud, Christoph Gumbinger, Ignaz Gunreben, Florian Haertig, Christian Hametner, Bernard Hanseeuw, Andreas Hansen, Jakob Hansen, Thomas Harbo, Andreas Harloff, Peter Harmel, Karl Georg Häusler, Florian Heinen, Valentin Held, Simon Hellwig, Dimitri Hemelsoet, Michael Hennerici, Juliane Herm, Sylvia Hermans, María Hernández, Jose Hervas Vicente, Niels Hjort, Cristina Hobeanu, Carsten Hobohm, Elmar Höfner, Katharina Hohenbichler, Marc Hommel, Julia Hoppe, Eva Hornberger, Carolin Hoyer, Xuya Huang, Nils Ipsen, Irina Isern, Lourdes Ispierto, Helle Iversen, Lise Jeppesen, Marta Jimenez, Jan Jungehülsing, Eric Jüttler, Dheeraj Kalladka, Bernd Kallmünzer, Arindam Kar, Lars Kellert, André Kemmling, Tobias Kessler, Usman Khan, Matthias Klein, Christoph Kleinschnitz, Matti Klockziem, Michael Knops, Luzie Koehler, Martin Koehrmann, Heinz Kohlfürst, Rainer Kollmar, Peter Kraft, Thomas Krause, Bo Kristensen, Jan M. Kröber, Natalia Kurka, Alexandre Ladoux, Patrice Laloux, Catherine Lamy, Emmanuelle Landrault, Arne Lauer, Claire Lebely, Jonathan Leempoel, Kennedy Lees, Anne Leger, Laurence Legrand, Lin Li, Anna-Mareike Löbbe, Frederic London, Elena Lopez-cancio, Matthias Lorenz, Stephen Louw, Caroline Lovelock, Manuel Lozano Sánchez, Giuseppe Lucente, Janos Lückl, Alain Luna, Kosmas Macha, Alexandre Machet, Daniel Mackenrodt, Dominik Madzar, Charles Majoie, Anika Männer, Vicky Maqueda, Jacob Marstrand, Alicia Martinez, Annika Marzina, Laura Mechthouff, Per Meden, Guy Meersman, Julia Meier, Charles Mellerio, Oliver Menn, Nadja Meyer, Dominik Michalski, Peter Michels, Lene Michelsen, Monica Millán Torne, Jens Minnerup, Boris Modrau, Sebastian Moeller, Anette Møller, Nathalie Morel, Fiona Moreton, Ludovic Morin, Thierry Moulin, Barry Moynihan, Anne K. Mueller, Keith W. Muir, Patricia Mulero, Sibu Mundiyanapurath, Johannes Mutzenbach, Simon Nagel, Oliver Naggara, Arumugam Nallasivan, Irene Navalpotro, Alexander H. Nave, Paul Nederkoorn, Lars Neeb, Hermann Neugebauer, Tobias Neumann-Haefelin, Stefan Oberndorfer, Christian Opherk, Lorenz Oppel, Catherine Oppenheim, Johannes Orthgieß, Leif Ostergaard, Perrine Paindeville, Ernest Palomeras, Verena Panitz, Bhavni Patel, Andre Peeters, Dirk Peeters, Anna Pellisé, Johann Pelz, Anthony Pereira, Natalia Pérez de la Ossa, Richard Perry, Salvador Petraza, Stéphane Peysson, Waltraud Pfeilschifter, Alexander Pichler, Alexandra Pierskalla, Hans-Werner Pledl, Sven Poli, Katrin Pomrehn, Marika Poulsen, Luis Prats, Silvia Presas, Elisabeth Prohaska, Volker Puetz, Josep Puig, Josep Puig Alcántara, Jan Purrucker, Veronique Quenardelle, Sankaranarayanan Ramachandran, Soulliard Raphaelle, Nicolas Raposo, Tilman Reiff, Michel Remmers, Pauline Renou, Martin Ribitsch, Hardy Richter, Martin Ritter, Thomas Ritzenthaler, Gilles Rodier, Christine Rodriguez-Regent, Manuel Rodríguez-Yáñez, Maria Roennefarth, Christine Roffe, Sverre Rosenbaum, Charlotte Rosso, Joachim Röther, Michal Rozanski, Noelia Ruiz de Morales, Francesca Russo, Matthieu Rutgers, Sharmilla Sagnier, Yves Samson, Josep Sánchez, Tamara Sauer, Jan H. Schäfer, Simon Schieber, Josef Schill, Dennis Schlak, Ludwig Schlemm, Sein Schmidt, Wouter Schonewille, Julian Schröder, Andreas Schulz, Johannes Schurig, Sönke Schwarting, Alexander Schwarz, Christopher Schwarzbach, Matthias Seidel, Alexander Seiler, Jochen Sembill, Joaquin Serena Leal, Ashit Shetty, Igor Sibon, Claus Z. Simonsen, Oliver Singer, Aravinth Sivagnanaratham, Ide Smets, Craig Smith, Peter Soors, Nikola Sprigg, Maximilian Spruegel, David Stark, Susanne Steinert, Sebastian Stösser, Markus Stuermlinger, Bart Swinnen, Ruben Tamazyan, Jose Tembl, Mikel Terceno Izaga, Emmanuel Touze, Thomas Truelsen, Guillaume Turc, Gaetane Turine, Serdar Tütüncü, Pippa Tyrell, Xavier Ustrell, Wilfried Vadot, Anne-Evelyne Vallet, Pauline Vallet, Lucie van den Berg, Sophie van den Berg, Cecile van Eendenburg, Robbert-Jan Van Hooff, Isabelle van Sloten, Peter Vanacker, Evelien Vancaester, Patrick Vanderdonckt, Yves Vandermeeren, Frederik Vanhee, Roland Veltkamp, Karsten Vestergaard, Alain Viguier, Dolores Vilas, Kersten Villringer, Dieke Voget, Jörg von Schrader, Paul von Weitzel, Elisabeth Warburton, Claudia Weber, Jörg Weber, Karl Wegscheider, Mirko Wegscheider, Christian Weimar, Karin Weinstich, Christopher Weise, Gesa Weise, Chris Willems, Klemens Winder, Matthias Wittayer, Marc Wolf, Martin Wolf, Valerie Wolff, Christian Wollboldt, Frank Wollenweber, Anke Wouters, Bertrand Yalo, Marion Yger, Nadia Younan, Laetita Yperzeele, Vesna Zegarac, Pia Zeiner, Ulf Ziemann, Thomas Zonneveld, Mathieu Zuber, Tsugio Akutsu, Junya Aoki, Shuji Arakawa, Ryosuke Doijiri, Yusuke Egashira, Yukiko Enomoto, Eisuke Furui, Konosuke Furuta, Seiji Gotoh, Toshimitsu Hamasaki, Yasuhiro Hasegawa, Teryuki Hirano, Kazunari Homma, Masahiko Ichijyo, Toshihiro Ide, Shuichi Igarashi, Yasuyuki Iguchi, Masafumi Ihara, Hajime Ikenouchi, Tsuyoshi Inoue, Ryo Itabashi, Yasuhiro Ito, Toru Iwama, Kenji Kamiyama, Shoko Kamiyoshi, Haruka Kanai, Yasuhisa Kanematsu, Takao Kanzawa, Kazumi Kimura, Jiro Kitayama, Takanari Kitazono, Rei Kondo, Kohsuke Kudo, Masayoshi Kusumi, Ken Kuwahara, Shoji Matsumoto, Hideki Matsuoka, Ban Mihara, Kazuo Minematsu, Ken Miura, Naomi Morita, Wataru Mouri, Kayo Murata, Yoshinari Nagakane, Taizen Nakase, Hiromi Ohara, Nobuyuki Ohara, Hideyuki Ohnishi, Hajime Ohta, Masafumi Ohtaki, Ryo Ohtani, Toshiho Ohtsuki, Hideo Ohyama, Takashi Okada, Yasushi Okada, Masato Osaki, Nobuyuki Sakai, Yoshiki Sanbongi, Naoshi Sasaki, Makoto Sasaki, Shoichiro Sato, Kenta Seki, Wataru Shimizu, Yoshiaki Shiokawa, Takashi Sozu, Junichiro Suzuki, Rieko Suzuki, Yasushi Takagi, Shunya Takizawa, Norio Tanahashi, Eijiro Tanaka, Ryota Tanaka, Yohei Tateishi, Tomoaki Terada, Tadashi Terasaki, Kenichi Todo, Azusa Tokunaga, Akira Tsujino, Toshihiro Ueda, Yoshikazu Uesaka, Mihoko Uotani, Takao Urabe, Masao Watanabe, Yoshiki Yagita, Yusuke Yakushiji, Keizo Yasui, Toshiro Yonehara, Shinichi Yoshimura, K. Aarnio, F. Alemseged, C. Anderson, T. Ang, M.L. Archer, J. Attia, P. Bailey, A. Balabanski, A. Barber, P.A. Barber, J. Bernhardt, A. Bivard, D. Blacker, C.F. Bladin, A. Brodtmann, D. Cadilhac, B.C.V. Campbell, L. Carey, S. Celestino, L. Chan, W.H. Chang, A. ChangI, C.H. Chen, C.-I. Chen, H.F. Chen, T.C. Chen, W.H. Chen, Y.Y. Chen, C.A. Cheng, E. Cheong, Y.W. Chiou, P.M. Choi, H.J. Chu, C.S. Chuang, T.C. Chung, L. Churilov, B. Clissold, A. Connelly, S. Coote, B. Coulton, E. Cowley, J. Cranefield, S. Curtze, C. D'Este, S.M. Davis, S. Day, P.M. Desmond, H.M. Dewey, C. Ding, G.A. Donnan, R. Drew, S. Eirola, D. Field, T. Frost, C. Garcia-Esperon, K. George, R. Gerraty, R. Grimley, Y.C. Guo, G. Hankey, J. Harvey, S.C. Ho, K. Hogan, D. Howells, P.M. Hsiao, C.H. Hsu, C.T. Hsu, C.-S. Hsu, J.P. Hsu, Y.D. Hsu, Y.T. Hsu, C.J. Hu, C.C. Huang, H.Y. Huang, M.Y. Huang, S.C. Huang, W.S. Huang, D. Jackson, J.S. Jeng, S.K. Jiang, L. Kaauwai, O. Kasari, J. King, T.J. Kleinig, M. Koivu, J. Kolbe, M. Krause, C.W. Kuan, W.L. Kung, C. Kyndt, C.L. Lau, A. Lee, C.Y. Lee, J.T. Lee, Y. Lee, Y.C. Lee, C. Levi, C.R. Levi, L.M. Lien, J.C. Lim, C.C. Lin, C.H. Lin, C.M. Lin, D. Lin, C.H. Liu, J. Liu, Y.C. Lo, P.S. Loh, E. Low, C.H. Lu, C.J. Lu, M.K. Lu, J. Ly, H. Ma, L. Macaulay, R. Macdonnell, E. Mackey, M. Macleod, J. Mahadevan, V. Maxwell, R. McCoy, A. McDonald, S. McModie, A. Meretoja, S. Mishra, P.J. Mitchell, F. Miteff, A. Moore, C. Muller, F. Ng, F.C. Ng, J-L. Ng, W. O'Brian, V. O'Collins, T.J. Oxley, M.W. Parsons, S. Patel, G.S. Peng, L. Pesavento, T. Phan, E. Rodrigues, Z. Ross, A. Sabet, M. Sallaberger, P. Salvaris, D. Shah, G. Sharma, G. Sibolt, M. Simpson, S. Singhal, B. Snow, N. Spratt, R. Stark, J. Sturm, M.C. Sun, Y. Sun, P.S. Sung, Y.F. Sung, M. Suzuki, M. Tan, S.C. Tang, T. Tatlisumak, V. Thijs, M. Tiainen, C.H. Tsai, C.K. Tsai, C.L. Tsai, H.T. Tsai, L.K. Tsai, C.H. Tseng, L.T. Tseng, J. Tsoleridis, H. Tu, H.T-H. Tu, W. Vallat, J. Virta, W.C. Wang, Y.T. Wang, M. Waters, L. Weir, T. Wijeratne, C. Williams, W. Wilson, A.A. Wong, K. Wong, T.Y. Wu, Y.H. Wu, B. Yan, F.C. Yang, Y.W. Yang, N. Yassi, H.L. Yeh, J.H. Yeh, S.J. Yeh, C.H. Yen, D. Young, C.L. Ysai, W.W. Zhang, H. Zhao, L. Zhao, Katharina Althaus-Knaurer, Jörg Berrouschot, Erich Bluhmki, Paolo Bovi, Gilles Chatellier, Lynda Cove, Stephen Davis, A. Dixit, Geoffrey Donnan, Christina Ehrenkrona, Christoph Eschenfelder, Marc Fatar, Juan Francisco Arenillas, Franz Gruber, Lalit Kala, Peter Kapeller, Markku Kaste, Christof Kessler, Martin Köhrmann, Rico Laage, Kennedy R. Lees, Alain Luna Rodriguez, Jean-Louis Mas, Robert Mikulik, Carlos Molina, Girish Muddegowda, Keith Muir, Kurt Niederkorn, Xavier Nuñez, Peter Schellinger, Joaquin Serena, Jan Sobesky, Thorsten Steiner, Ann-Sofie Svenson, Rüdiger von Kummer, Joanna Wardlaw, Rebecca A. Betensky, Gregoire Boulouis, Raphael A. Carandang, William A. Copen, Pedro Cougo, Shawna Cutting, Kendra Drake, Andria L. Ford, John Hallenbeck, Gordon J. Harris, Robert Hoesch, Amie Hsia, Carlos Kase, Lawrence Latour, Michael H. Lev, Alona Muzikansky, Nandakumar Nagaraja, Lee H. Schwamm, Eric Searls, Shlee S. Song, Sidney Starkman, Albert J. Yoo, Ramin Zand, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon, Monash University [Melbourne], National Cerebral and Cardiovascular Center (NCCC - OSAKA), Osaka University [Osaka], University of Heidelberg, Medical Faculty, Massachusetts General Hospital [Boston], University of Melbourne, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Royal Adelaide Hospital [Adelaide Australia], National Institute of Neurological Disorders and Stroke [Bethesda] (NINDS), National Institutes of Health [Bethesda] (NIH), University Hospitals Leuven [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Flanders Make [Leuven], Flanders Make, University of Newcastle [Australia] (UoN), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Vall d'Hebron University Hospital [Barcelona], University of Glasgow, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Girona Biomedical Research Institute [Girona, Spain] (IDIBGI), Ruhr-Universität Bochum [Bochum], Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Aarhus University Hospital, Cedars-Sinai Medical Center, Florey Institute of Neuroscience and Mental Health [Melbourne, Victoria, Australia], Austin Health, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], China Medical University Hospital [Taichung], Karolinska Institutet [Stockholm], The Walter and Eliza Hall Institute of Medical Research (WEHI), University of Texas at Austin [Austin], Collaborators Evaluation of unknown Onset Stroke thrombolysis trials (EOS) investigators: Boris Raul Acosta, Karen Aegidius, Christian Albiker, Anna Alegiani, Miriam Almendrote, Angelika Alonso, Katharina Althaus, Pierre Amarenco, Hemasse Amiri, Bettina Anders, Adriana Aniculaesei, Jason Appleton, Juan Arenillas, Christina Back, Christian Bähr, Jürgen Bardutzky, Flore Baronnet-Chauvet, Rouven Bathe-Peters, Anna Bayer-Karpinska, Juan L Becerra, Christoph Beck, Olga Belchí Guillamon, Amandine Benoit, Nadia Berhoune, Daniela Bindila, Julia Birchenall, Karine Blanc-Lasserre, Miguel Blanco Gonzales, Tobias Bobinger, Ulf Bodechtel, Eric Bodiguel, Urszula Bojaryn, Louise Bonnet, Benjamin Bouamra, Paul Bourgeois, Florent Boutitie, Lorenz Breuer, Ludovic Breynaert, David Broughton, Raf Brouns, Sébastian Brugirard, Bart Bruneel, Florian Buggle, Serkan Cakmak, Ana Calleja, David Calvet, David Carrera, Hsin-Chieh Chen, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Chi-Un Choe, Lillian Choy, Hanne Christensen, Mareva Ciatipis, Geoffrey Cloud, Julien Cogez, Elisa Cortijo, Sophie Crozier, Dorte Damgaard, Krishna Dani, Beatrijs De Coene, Isabel De Hollander, Jacques De Keyser, Nina De Klippel, Charlotte De Maeseneire, Ann De Smedt, Maria Del Mar Castellanos Rodrigo, Sandrine Deltour, Jelle Demeestere, Laurent Derex, Philippe Desfontaines, Ralf Dittrich, Anand Dixit, Laurens Dobbels, Valérie Domigo, Laura Dorado, Charlotte Druart, Kristina Hougaard Dupont, Anne Dusart, Rainer Dziewas, Martin Ebinger, Matthias Ebner, Myriam Edjali-Goujon, Philipp Eisele, Salwa El Tawil, Ahmed Elhfnawy, Matthias Endres, Ana Etexberria, Nicholas Evans, Simon Fandler, Franz Fazekas, Sandra Felix, Jochen B Fiebach, Jens Fiehler, Alexandra Filipov, Katharina Filipski, Robert Fleischmann, Christian Foerch, Ian Ford, Alexandra Gaenslen, Ivana Galinovic, Elena Meseguer Gancedo, Ramanan Ganeshan, Carlos García Esperón, Alicia Garrido, Thomas Gattringer, Olivia Geraghty, Rohat Geran, Christian Gerloff, Stefan Gerner, Sylvie Godon-Hardy, Jos Göhler, Amir Golsari, Meritxell Gomis, David Gorriz, Verena Gramse, Laia Grau, Martin Griebe, Cristina Guerrero, Damla Guerzoglu, Sophie Guettier, Vincent Guiraud, Christoph Gumbinger, Ignaz Gunreben, Florian Haertig, Christian Hametner, Bernard Hanseeuw, Andreas Hansen, Jakob Hansen, Thomas Harbo, Andreas Harloff, Peter Harmel, Karl Georg Häusler, Florian Heinen, Valentin Held, Simon Hellwig, Dimitri Hemelsoet, Michael Hennerici, Juliane Herm, Sylvia Hermans, María Hernández, Jose Hervas Vicente, Niels Hjort, Cristina Hobeanu, Carsten Hobohm, Elmar Höfner, Katharina Hohenbichler, Marc Hommel, Julia Hoppe, Eva Hornberger, Carolin Hoyer, Xuya Huang, Nils Ipsen, Irina Isern, Lourdes Ispierto, Helle Iversen, Lise Jeppesen, Marta Jimenez, Jan Jungehülsing, Eric Jüttler, Dheeraj Kalladka, Bernd Kallmünzer, Arindam Kar, Lars Kellert, André Kemmling, Tobias Kessler, Usman Khan, Matthias Klein, Christoph Kleinschnitz, Matti Klockziem, Michael Knops, Luzie Koehler, Martin Koehrmann, Heinz Kohlfürst, Rainer Kollmar, Peter Kraft, Thomas Krause, Bo Kristensen, Jan M Kröber, Natalia Kurka, Alexandre Ladoux, Patrice Laloux, Catherine Lamy, Emmanuelle Landrault, Arne Lauer, Claire Lebely, Jonathan Leempoel, Kennedy Lees, Anne Leger, Laurence Legrand, Robin Lemmens, Lin Li, Anna-Mareike Löbbe, Frederic London, Elena Lopez-Cancio, Matthias Lorenz, Stephen Louw, Caroline Lovelock, Manuel Lozano Sánchez, Giuseppe Lucente, Janos Lückl, Alain Luna, Kosmas Macha, Alexandre Machet, Daniel Mackenrodt, Dominik Madzar, Charles Majoie, Anika Männer, Vicky Maqueda, Jacob Marstrand, Alicia Martinez, Annika Marzina, Laura Mechthouff, Per Meden, Guy Meersman, Julia Meier, Charles Mellerio, Oliver Menn, Nadja Meyer, Dominik Michalski, Peter Michels, Lene Michelsen, Monica Millán Torne, Jens Minnerup, Boris Modrau, Sebastian Moeller, Anette Møller, Nathalie Morel, Fiona Moreton, Ludovic Morin, Thierry Moulin, Barry Moynihan, Anne K Mueller, Keith W Muir, Patricia Mulero, Sibu Mundiyanapurath, Johannes Mutzenbach, Simon Nagel, Oliver Naggara, Arumugam Nallasivan, Irene Navalpotro, Alexander H Nave, Paul Nederkoorn, Lars Neeb, Hermann Neugebauer, Tobias Neumann-Haefelin, Norbert Nighoghossian, Stefan Oberndorfer, Christian Opherk, Lorenz Oppel, Catherine Oppenheim, Johannes Orthgieß, Leif Ostergaard, Perrine Paindeville, Ernest Palomeras, Verena Panitz, Bhavni Patel, Andre Peeters, Dirk Peeters, Anna Pellisé, Johann Pelz, Anthony Pereira, Natalia Pérez de la Ossa, Richard Perry, Salvador Petraza, Stéphane Peysson, Waltraud Pfeilschifter, Alexander Pichler, Alexandra Pierskalla, Hans-Werner Pledl, Sven Poli, Katrin Pomrehn, Marika Poulsen, Luis Prats, Silvia Presas, Elisabeth Prohaska, Volker Puetz, Josep Puig, Josep Puig Alcántara, Jan Purrucker, Veronique Quenardelle, Sankaranarayanan Ramachandran, Soulliard Raphaelle, Nicolas Raposo, Tilman Reiff, Michel Remmers, Pauline Renou, Martin Ribitsch, Hardy Richter, Peter Ringleb, Martin Ritter, Thomas Ritzenthaler, Gilles Rodier, Christine Rodriguez-Regent, Manuel Rodríguez-Yáñez, Maria Roennefarth, Christine Roffe, Sverre Rosenbaum, Charlotte Rosso, Joachim Röther, Michal Rozanski, Noelia Ruiz de Morales, Francesca Russo, Matthieu Rutgers, Sharmilla Sagnier, Yves Samson, Josep Sánchez, Tamara Sauer, Jan H Schäfer, Simon Schieber, Josef Schill, Dennis Schlak, Ludwig Schlemm, Sein Schmidt, Wouter Schonewille, Julian Schröder, Andreas Schulz, Johannes Schurig, Sönke Schwarting, Alexander Schwarz, Christopher Schwarzbach, Matthias Seidel, Alexander Seiler, Jochen Sembill, Joaquin Serena Leal, Ashit Shetty, Igor Sibon, Claus Z Simonsen, Oliver Singer, Aravinth Sivagnanaratham, Ide Smets, Craig Smith, Peter Soors, Nikola Sprigg, Maximilian Spruegel, David Stark, Susanne Steinert, Sebastian Stösser, Markus Stuermlinger, Bart Swinnen, Ruben Tamazyan, Jose Tembl, Mikel Terceno Izaga, Vincent Thijs, Götz Thomalla, Emmanuel Touze, Thomas Truelsen, Guillaume Turc, Gaetane Turine, Serdar Tütüncü, Pippa Tyrell, Xavier Ustrell, Wilfried Vadot, Anne-Evelyne Vallet, Pauline Vallet, Lucie van den Berg, Sophie van den Berg, Cecile van Eendenburg, Robbert-Jan Van Hooff, Isabelle van Sloten, Peter Vanacker, Evelien Vancaester, Patrick Vanderdonckt, Yves Vandermeeren, Frederik Vanhee, Roland Veltkamp, Karsten Vestergaard, Alain Viguier, Dolores Vilas, Kersten Villringer, Dieke Voget, Jörg von Schrader, Paul von Weitzel, Elisabeth Warburton, Claudia Weber, Jörg Weber, Karl Wegscheider, Mirko Wegscheider, Christian Weimar, Karin Weinstich, Christopher Weise, Gesa Weise, Chris Willems, Klemens Winder, Matthias Wittayer, Marc Wolf, Martin Wolf, Valerie Wolff, Christian Wollboldt, Frank Wollenweber, Anke Wouters, Bertrand Yalo, Marion Yger, Nadia Younan, Laetita Yperzeele, Vesna Zegarac, Pia Zeiner, Ulf Ziemann, Thomas Zonneveld, Mathieu Zuber, Tsugio Akutsu, Junya Aoki, Junya Aoki, Shuji Arakawa, Ryosuke Doijiri, Yusuke Egashira, Yukiko Enomoto, Mayumi Fukuda-Doi, Eisuke Furui, Konosuke Furuta, Seiji Gotoh, Toshimitsu Hamasaki, Yasuhiro Hasegawa, Teryuki Hirano, Kazunari Homma, Masahiko Ichijyo, Toshihiro Ide, Shuichi Igarashi, Yasuyuki Iguchi, Masafumi Ihara, Hajime Ikenouchi, Manabu Inoue, Tsuyoshi Inoue, Ryo Itabashi, Yasuhiro Ito, Toru Iwama, Kenji Kamiyama, Shoko Kamiyoshi, Haruka Kanai, Yasuhisa Kanematsu, Takao Kanzawa, Kazumi Kimura, Jiro Kitayama, Takanari Kitazono, Masatoshi Koga, Rei Kondo, Kohsuke Kudo, Masayoshi Kusumi, Ken Kuwahara, Shoji Matsumoto, Hideki Matsuoka, Ban Mihara, Kazuo Minematsu, Ken Miura, Kaori Miwa, Naomi Morita, Wataru Mouri, Kayo Murata, Yoshinari Nagakane, Taizen Nakase, Hiromi Ohara, Nobuyuki Ohara, Hideyuki Ohnishi, Hajime Ohta, Masafumi Ohtaki, Ryo Ohtani, Toshiho Ohtsuki, Hideo Ohyama, Takashi Okada, Yasushi Okada, Masato Osaki, Nobuyuki Sakai, Yoshiki Sanbongi, Naoshi Sasaki, Makoto Sasaki, Shoichiro Sato, Kenta Seki, Wataru Shimizu, Yoshiaki Shiokawa, Takashi Sozu, Junichiro Suzuki, Rieko Suzuki, Yasushi Takagi, Shunya Takizawa, Norio Tanahashi, Eijiro Tanaka, Ryota Tanaka, Yohei Tateishi, Tomoaki Terada, Tadashi Terasaki, Kenichi Todo, Azusa Tokunaga, Kazunori Toyoda, Akira Tsujino, Toshihiro Ueda, Yoshikazu Uesaka, Mihoko Uotani, Takao Urabe, Masao Watanabe, Yoshiki Yagita, Yusuke Yakushiji, Haruko Yamamoto, Keizo Yasui, Toshiro Yonehara, Sohei Yoshimura, Shinichi Yoshimura, K Aarnio, F Alemseged, C Anderson, T Ang, M L Archer, J Attia, P Bailey, A Balabanski, A Barber, P A Barber, J Bernhardt, A Bivard, D Blacker, C F Bladin, A Brodtmann, D Cadilhac, B C V Campbell, L Carey, S Celestino, L Chan, W H Chang, A ChangI, C H Chen, C-I Chen, H F Chen, T C Chen, W H Chen, Y Y Chen, C A Cheng, E Cheong, Y W Chiou, P M Choi, H J Chu, C S Chuang, T C Chung, L Churilov, B Clissold, A Connelly, S Coote, B Coulton, E Cowley, J Cranefield, S Curtze, C D'Este, S M Davis, S Day, P M Desmond, H M Dewey, C Ding, G A Donnan, R Drew, S Eirola, D Field, T Frost, C Garcia-Esperon, K George, R Gerraty, R Grimley, Y C Guo, G Hankey, J Harvey, S C Ho, K Hogan, D Howells, P M Hsiao, C H Hsu, C T Hsu, C-S Hsu, J P Hsu, Y D Hsu, Y T Hsu, C J Hu, C C Huang, H Y Huang, M Y Huang, S C Huang, W S Huang, D Jackson, J S Jeng, S K Jiang, L Kaauwai, O Kasari, J King, T J Kleinig, M Koivu, J Kolbe, M Krause, C W Kuan, W L Kung, C Kyndt, C L Lau, A Lee, C Y Lee, J T Lee, Y Lee, Y C Lee, C Levi, C R Levi, L M Lien, J C Lim, C C Lin, C H Lin, C M Lin, D Lin, C H Liu, J Liu, Y C Lo, P S Loh, E Low, C H Lu, C J Lu, M K Lu, J Ly, H Ma, L Macaulay, R Macdonnell, E Mackey, M Macleod, J Mahadevan, V Maxwell, R McCoy, A McDonald, S McModie, A Meretoja, S Mishra, P J Mitchell, F Miteff, A Moore, C Muller, F Ng, F C Ng, J-L Ng, W O'Brian, V O'Collins, T J Oxley, M W Parsons, S Patel, G S Peng, L Pesavento, T Phan, E Rodrigues, Z Ross, A Sabet, M Sallaberger, P Salvaris, D Shah, G Sharma, G Sibolt, M Simpson, S Singhal, B Snow, N Spratt, R Stark, J Sturm, M C Sun, Y Sun, P S Sung, Y F Sung, M Suzuki, M Tan, S C Tang, T Tatlisumak, V Thijs, M Tiainen, C H Tsai, C K Tsai, C L Tsai, H T Tsai, L K Tsai, C H Tseng, L T Tseng, J Tsoleridis, H Tu, H T-H Tu, W Vallat, J Virta, W C Wang, Y T Wang, M Waters, L Weir, T Wijeratne, C Williams, W Wilson, A A Wong, K Wong, T Y Wu, Y H Wu, B Yan, F C Yang, Y W Yang, N Yassi, H L Yeh, J H Yeh, S J Yeh, C H Yen, D Young, C L Ysai, W W Zhang, H Zhao, L Zhao, Katharina Althaus-Knaurer, Martin Bendszus, Jörg Berrouschot, Erich Bluhmki, Paolo Bovi, Gilles Chatellier, Lynda Cove, Stephen Davis, A Dixit, Geoffrey Donnan, Rainer Dziewas, Christina Ehrenkrona, Christoph Eschenfelder, Marc Fatar, Juan Francisco Arenillas, Franz Gruber, Werner Hacke, Lalit Kala, Peter Kapeller, Markku Kaste, Christof Kessler, Martin Köhrmann, Rico Laage, Kennedy R Lees, Didier Leys, Alain Luna Rodriguez, Jean-Louis Mas, Robert Mikulik, Carlos Molina, Girish Muddegowda, Keith Muir, Kurt Niederkorn, Xavier Nuñez, Catherine Oppenheim, Sven Poli, Peter Ringleb, Peter Schellinger, Stefan Schwab, Joaquin Serena, Jan Sobesky, Thorsten Steiner, Ann-Sofie Svenson, Danilo Toni, Roland Veltkamp, Rüdiger von Kummer, Nils Wahlgren, Joanna Wardlaw, Rebecca A Betensky, Gregoire Boulouis, Raphael A Carandang, William A Copen, Pedro Cougo, Shawna Cutting, Kendra Drake, Andria L Ford, John Hallenbeck, Gordon J Harris, Robert Hoesch, Amie Hsia, Carlos Kase, Lawrence Latour, Arne Lauer, Michael H Lev, Alona Muzikansky, Nandakumar Nagaraja, Lee H Schwamm, Eric Searls, Shlee S Song, Sidney Starkman, Steven Warach, Ona Wu, Albert J Yoo, Ramin Zand, University of Newcastle [Callaghan, Australia] (UoN), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CarMeN, laboratoire, Yperzeele, Laetitia, Evaluation of Unknown Onset Stroke Thrombolysis trials (EOS) investigators, UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, Supporting clinical sciences, UZB Other, Physical Medicine and Rehabilitation, Clinical sciences, Neuroprotection & Neuromodulation, Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, Graduate School, Center of Experimental and Molecular Medicine, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
Subjects: medicine.medical_treatment, [SDV]Life Sciences [q-bio], Ischemic Stroke/*diagnostic imaging/*drug therapy, Tomography, X-Ray Computed/methods, Fibrinolytic Agents/adverse effects/*therapeutic use, 030204 cardiovascular system & hematology, Ischemic Stroke/diagnostic imaging, surgery, 0302 clinical medicine, Modified Rankin Scale, 030212 general & internal medicine, 10. No inequality, Infusions, Intravenous, Stroke, Tomography, Time-to-Treatment, General Medicine, Thrombolysis, X-Ray Computed/methods, Tissue Plasminogen Activator/adverse effects, 3. Good health, [SDV] Life Sciences [q-bio], Diffusion Magnetic Resonance Imaging/methods, Treatment Outcome, Meta-analysis, Tissue Plasminogen Activator, Intravenous, medicine.medical_specialty, Infusions, Intravenous thrombolysis, Neuroimaging, Neuroscience(all), Placebo, Tissue Plasminogen Activator/adverse effects/*therapeutic use, 03 medical and health sciences, Fibrinolytic Agents, Internal medicine, medicine, Humans, ddc:610, Ischemic Stroke, business.industry, neurology, Fibrinolytic Agents/adverse effects, Odds ratio, Recovery of Function, medicine.disease, Clinical research, Diffusion Magnetic Resonance Imaging, Human medicine, business, Tomography, X-Ray Computed, Fibrinolytic agent
Abstract: International audience; BACKGROUND: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. METHODS: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0-1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0-2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4-6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. FINDINGS: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10-2·03]; p=0·011), with low heterogeneity across studies (I(2)=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05-1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06-2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4-6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52-1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03-4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [\textless1%], adjusted OR 5·58 [1·22-25·50]; p=0·024). INTERPRETATION: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. FUNDING: None.
Published: 2020

22. Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma

Author: Anne-Sophie Boudy, Cyril Touboul, Joseph Gligorov, Lise Selleret, Emile Daraï, Jacques Cadranel, Isabelle Thomassin-Naggara, and Noémie Grausz
Subjects: Pulmonary and Respiratory Medicine, Oncology, Cancer Research, medicine.medical_specialty, Lung Neoplasms, medicine.drug_class, Population, Tyrosine-kinase inhibitor, Trastuzumab, Pregnancy, Internal medicine, Carcinoma, Non-Small-Cell Lung, medicine, Carcinoma, Humans, Osimertinib, Molecular Targeted Therapy, education, Lung cancer, Protein Kinase Inhibitors, education.field_of_study, business.industry, Infant, Newborn, Cancer, medicine.disease, respiratory tract diseases, ErbB Receptors, Mutation, Female, business, medicine.drug
Abstract: Introduction Lung cancer associated with pregnancy is rare but on the increase. The use of tyrosine kinase inhibitor (TKI) therapy for advanced oncogenic-driven non-small cell lung carcinoma (NSCLC) has improved overall survival. Oncological and obstetric outcomes of patients diagnosed with NSCLC and treated by TKIs during pregnancy have been poorly evaluated. Methods Three cases of NSCLC treated by TKIs during pregnancy were collected from the prospective database of the Cancer Associe a La Grossesse (CALG) network (France) in addition to eight cases identified by a systematic review performed between 2000 and 2021. Results Among the eleven reported patients, six received an EGFR- and five an ALK-TKI. All patients were young nonsmokers and four had brain metastases at diagnosis. TKI treatment was initiated during the first trimester for three patients. Premature delivery was induced in 10/11 patients. Anamnios occurred in one patient treated by osimertinib and trastuzumab. Five newborns were hypotrophic. No newborn malformations were observed. Diffusion of the TKIs, confirmed by blood cord sampling, represented about 1/3 (EGFR-TKI) and 1/8 (ALK-TKI) of the maternal concentration. No developmental abnormalities were observed in the children (follow-up 30 months). The anti-tumor efficacy and tolerance of TKIs, when reported, appears similar to that described in the general population. Conclusions Our results support the rationale for using TKIs during pregnancy, both in terms of maternal NSCLC disease control and the relatively mild effects on the fetus. Our data will serve to better inform patients about the risks associated with TKIs used during pregnancy, contributing to shared decision making.
Published: 2021

23. Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study

Author: François Zhu, Wagih Ben Hassen, Nicolas Bricout, Basile Kerleroux, Kevin Janot, Benjamin Gory, René Anxionnat, Sébastien Richard, Adrien Marchal, Raphael Blanc, Michel Piotin, Arturo Consoli, Denis Trystram, Christine Rodriguez Regent, Jean-Philippe Desilles, David Weisenburger-Lile, Simon Escalard, Denis Herbreteau, Heloise Ifergan, Igor Lima Maldonado, Julien Labreuche, Hilde Henon, Olivier Naggara, Bertrand Lapergue, Grégoire Boulouis, Redjem Hocine, Ciccio Gabriele, Smajda Stanislas, Maier Benjamin, Mazighi Mikael, Obadia Mikael, Sabben Candice, Peres Roxanne, Corabianu Ovide, De Broucker Thomas, Smadja Didier, Alamowitch Sonia, Ille Olivier, Manchon Eric, Garcia Pierre-Yves, Taylor Guillaume, Ben Maacha Malek, Wang Adrien, Evrard Serge, Tchikviladze Maya, Ajili Nadia, Gorza Lucas, Buard Géraldine, Coskun Oguzhan, Di Maria Federico, Rodesh Georges, Zimatore Sergio, Leguen Morgan, Gratieux Julie, Pico Fernando, Rakotoharinandrasana Haja, Tassan Philippe, Poll Roxanna, Marinier Sylvie, Nighoghossian Norbert, Riva Roberto, Eker Omer, Turjman Francis, Derex Laurent, Cho Tae-Hee, Mechtouff Laura, Claire Lukaszewicz Anne, Philippeau Frédéric, Cakmak Serkan, Blanc-Lasserre Karine, Vallet Anne-Evelyne, Marnat Gaultier, Gariel Florent, Barreau Xavier, Berge Jérôme, Menegon Patrice, Sibon Igor, Liegey Sebastien, Olindo Stéphane, Renou Pauline, Sagnier Sharmila, Poli Mathilde, Debruxelles Sabrina, Pangon Nicolas, Bourcier Romain, Detraz Lili, Daumas-Duport Benjamin, Alexandre Pierre-Louis, Roy Monica, Lenoble Cédric, L’allinec Vincent, Girot Jean-Baptiste, Desal Hubert, Bracard Serge, Braun Marc, Derelle Anne-Laure, Tonnelet Romain, Liao Liang, Muszynski Patricio, Schmitt Emmanuelle, Planel Sophie, Humbertjean Lisa, Mione Gioia, Lacour Jean-Christophe, Riou-Comte Nolwenn, Audibert Gérard, Voicu Marcela, Alb Ionel, Reitter Marie, Brezeanu Madalina, Masson Agnès, Tabarna Adriana, Podar Ioana, Macian-Montoro Francisco, Saleme Suzanna, Mounayer Charbel, Rouchaud Aymeric, Costalat Vincent, Arquizan Caroline, Dargazanli Cyril, Gascou Grégory, Lefèvre Pierre-Henri, Derraz Imad, Riquelme Carlos, Gaillard Nicolas, Mourand Isabelle, Corti Lucas, Francois Eugene, Vannier Stéphane, Ferre Jean-Christophe, Raoult Helene, Ronziere Thomas, Lassale Maria, Paya Christophe, Gauvrit Jean-Yves, Tracol Clément, Langnier-Lemercier Sophie, Samson Yves, Rosso Charlotte, Leger Anne, Deltour Sandrine, Clarencon Frederic, Shotar Eimad, Spelle Laurent, Denier Christian, Chassin Olivier, Chalumeau Vanessa, Caroff Jildaz, Venditti Laura, Turc Guillaume, Seners Pierre, Domigo Valérie, Lamy Catherine, Birchenall Julia, Isabel Clothilde, Viguier Alain, Cognard Christophe, Christine Januel Anne, Olivot Jean-Marc, Raposo Nicolas, Bonneville Fabrice, François Albucher Jean, Calviere Lionel, Touze Emmanuel, Barbier Charlotte, Schneckenburger Romain, Boulanger Marion, Cogez Julien, Guettier Sophie, Timsit Serge, Gentric Jean-Christophe, Ognard Julien, Mathias Merrien Francois, Ozkul Wermester Ozlem, Massardier Evelyne, Papagiannaki Chrysanthi, Bourdain Frédéric, Patricia Bernady, Lagoarde-Segot Laurent, Cailliez Hélène, Veunac Louis, Higue David, Wolff Valérie, Pop Raoul, Beaujeux Rémi, Mihoc Dan-Sorin, Manisor Monica, Le Bras Anthony, Evain Sarah, Le Guen Arnaud, Richter Sebastian, Hubrecht Regis, Demasles Stéphanie, Barroso Bruno, Zuber Mathieu, Farhat Wassim, Alias Quentin, Lun François, Stenvenoot Delphine, Heinzlef Olivier, Godon Hardy Sylvie, Bohotin Valentin, and Grimaud Jérôme
Subjects: medicine.medical_specialty, Standard of care, Time Factors, Neuroradiologist, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Operator (computer programming), Medicine, Humans, Registries, Thrombectomy, Advanced and Specialized Nursing, Surgeons, business.industry, Cerebral infarction, Endovascular Procedures, Cerebral Infarction, medicine.disease, Mechanical thrombectomy, Stroke, Multicenter study, Ischemic stroke, Reperfusion, Physical therapy, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose: We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. Methods: Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator’s experience and procedural metrics. Results: A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57–170.2) over the study period. Higher operator’s experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (β estimate, −3.98 [95% CI, −5.1 to −2.8]; P P =0.013). Conclusions: In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators’ recertification processes tailored to individual case volume and prior experience.
Published: 2021

24. Imaging of postoperative endometriosis

Author: A. Setúbal, A. Loureiro, Emile Daraï, Isabelle Thomassin-Naggara, Sofiane Bendifallah, A. Guerra, and F. Osório
Subjects: medicine.medical_specialty, Endometriosis, Tissue Adhesions, English language, Disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Recurrence, medicine, Humans, Radiology, Nuclear Medicine and imaging, Postoperative Period, Pelvic endometriosis, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, General surgery, Magnetic resonance imaging, Genitalia, Female, General Medicine, medicine.disease, Magnetic Resonance Imaging, Systematic review, 030220 oncology & carcinogenesis, Female, business
Abstract: Endometriosis is a chronic gynecological condition that affects primarily young women. Imaging plays a pivotal role for the diagnosis and pre-surgical mapping of the disease. By comparison, the role of imaging in the identification of disease recurrence and postoperative complications are not well established. The goal of this review is to report the postoperative findings, including normal postoperative findings, initial disease recurrence and complications, with a special emphasis on magnetic resonance imaging (MRI), in women who have undergone surgery for pelvic endometriosis. This review is based on a literature search of manuscripts published between 2000 and 2018. Meta-analyses, systematic reviews and original scientific articles published in English language were included.
Published: 2019

25. Optimal 4DFlow MR sequence parameters for the assessment of internal carotid artery stenosis: a simulation study

Author: Myriam Edjlali, Catherine Oppenheim, Pauline Roca, Marie-Pierre Gobin-Metteil, Joseph Benzakoun, Victoria Cavero, Olivier Naggara, David Calvet, Sylvain Charron, Stéphanie Lion, and Jean-François Meder
Subjects: Adult, Male, Systole, Sensitivity and Specificity, Magnetic resonance angiography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, symbols.namesake, Imaging, Three-Dimensional, 0302 clinical medicine, Reference Values, Risk Factors, medicine, Humans, Carotid Stenosis, Computer Simulation, Radiology, Nuclear Medicine and imaging, Internal carotid artery stenosis, Stroke, Image resolution, Aged, Neuroradiology, medicine.diagnostic_test, Cardiac cycle, business.industry, Hemodynamics, Middle Aged, medicine.disease, Stenosis, Ultrasonography, Doppler, Pulsed, symbols, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Nuclear medicine, Doppler effect, Blood Flow Velocity, Carotid Artery, Internal, Magnetic Resonance Angiography, 030217 neurology & neurosurgery
Abstract: In patients with ICA stenosis, increased peak systolic velocity is a marker of stenosis at risk of ischemic stroke. 4DFlow MRI is a reproducible technique to evaluate velocities in ICA stenosis, although it seems to underestimate velocities as compared with Doppler ultrasonography. The purpose of our study was to confirm that velocities were underestimated on a new set of data acquired with a clinical 4DFlow sequence, and to devise optimal acquisition parameters for ICA stenosis exploration based on a numerical simulation. After review board approval, 15 healthy controls and 12 patients presenting ICA stenosis were explored with Doppler ultrasonography and 4DFlow MRI. We created a 2-dimensional simulation of ICA stenosis and its corresponding 4DFlow acquisition, and compared its mean peak systolic velocity underestimation to real MRI and Doppler. We then simulated the acquisition for voxel size ranging from 0.5 to 1.25 mm and number of phases per cardiac cycle ranging from 10 to 25. On acquired data, 4DFlow MR underestimated peak systolic velocities (mean difference between Doppler and 4DFlow: − 35 cm/s), especially high velocities. With spatial and temporal resolutions equivalent to MR acquisition, our simulation yielded similar underestimation (mean difference: − 31 cm/s, P = 0.30). Simulations showed that 0.7-mm resolution and 20 phases per cardiac cycle would be necessary to record peak systolic velocities up to 250 cm/s. Higher spatial resolution can provide accurate peak systolic velocities measurement with 4DFlow MRI, thus allowing better ICA stenosis assessment. Further studies are needed to validate the proposed parameters.
Published: 2019

26. Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion

Author: Cyril Dargazanli, Yves Berthezène, Sébastien Richard, Vincent Costalat, Serge Bracard, Pierre Seners, Séverine Debiais, Ana-Paula Narata, Caroline Arquizan, Canan Ozsancak, Christophe Magni, Jean-Philippe Cottier, Jean-Louis Mas, Benjamin Gory, Laurence Legrand, Stéphanie Lion, Guillaume Turc, Jean-Claude Baron, Catherine Oppenheim, Norbert Nighoghossian, Tae-Hee Cho, Olivier Naggara, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Service de neuroradiologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de neurologie [Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Régional d'Orléans (CHRO), Service de Neurologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Département de Neuroradiologie[Montpellier], Service de neurologie [CHRU Nancy], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Martinez Rico, Clara, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)
Subjects: Male, thrombolysis, medicine.medical_specialty, Mechanical Thrombolysis, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Ischemia, Perfusion scanning, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Cerebral perfusion, Internal medicine, ischemic stroke, medicine, Humans, magnetic resonance imaging, Prospective Studies, Registries, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], cardiovascular diseases, Thrombus, Stroke, Aged, Retrospective Studies, Acute stroke, Aged, 80 and over, business.industry, Brain, Original Articles, Thrombolysis, Middle Aged, medicine.disease, Perfusion, [SDV] Life Sciences [q-bio], Diffusion Magnetic Resonance Imaging, Neurology, thrombectomy, Cardiology, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Magnetic Resonance Angiography, 030217 neurology & neurosurgery, Large vessel occlusion
Abstract: In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax ≥ 10 s volume/ Tmax ≥ 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR ( P = 0.006), shorter thrombus on T2*-imaging ( P
Published: 2019

27. Valeur diagnostique de l’imagerie (échographie, doppler, scanner, IRM et TEP-TDM) pour le diagnostic d’une masse ovarienne suspecte et le bilan d’extension d’un cancer de l’ovaire, des trompes ou péritonéal primitif. Article rédigé sur la base de la recommandation nationale de bonnes pratiques cliniques en cancérologie intitulée « Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire » élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY sous l’égide du CNGOF et labellisée par l’INCa

Author: Emile Daraï, Laure Fournier, Fabrice Lecuru, and Isabelle Thomassin-Naggara
Subjects: PET-CT, medicine.medical_specialty, business.industry, Obstetrics and Gynecology, Iodinated Contrast Agent, Malignancy, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Reproductive Medicine, 030220 oncology & carcinogenesis, Medicine, Abdomen, Radiology, business, Lymph node, Contraindication, Pelvis, Fallopian tube
Abstract: Transvaginal ultrasound is the first-line examination allowing characterizing 80 to 90% of adnexal masses (LP1). If performed by an expert, a subjective analysis is optimal. If performed by a non-expert, combining the use of Simple Rules with subjective analysis can achieve the diagnostic performance of an expert (LP1). Whichever the chosen model (subjective analysis by an expert or combination of the Simple Rules with a subjective analysis by a non-expert), a second-line examination will have to be proposed in the complex or indeterminate cases (about 20% of the masses) (grade A). The best-performing second-line test for characterization is pelvic MRI (LP1). If read by an expert, a pathological hypothesis can or should be suggested (grade D). In case of non-expert reading, the use of the ADNEXMR score allows a reliable assessment of the positive predictive value of malignancy to guide the patient towards the best management (gradeC). For preoperative assessment and evaluation of resectability of ovarian, fallopian tube or primary peritoneal cancer, it is recommended to perform a chest abdomen and pelvis CT with contrast agent injection (LP2, grade B). In the event of a contraindication to the injection of iodinated contrast agent (severe renal insufficiency, GFR
Published: 2019

28. Comparison of 3-Tesla to 1.5-Tesla Magnetic Resonance Enterography to assess multifocal and multicentric bowel endometriosis: Results in routine practice

Author: Krystel Nyangoh Timoh, Emile Daraï, Patrick Aristizabal, Isabelle Thomassin-Naggara, Sofiane Bendifallah, Edith Kermarrec, and Lucie Allegre
Subjects: Adult, medicine.medical_specialty, Endometriosis, Routine practice, Sensitivity and Specificity, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Positive predicative value, medicine, Humans, In patient, Retrospective Studies, Likelihood Functions, 030219 obstetrics & reproductive medicine, business.industry, Area under the curve, Obstetrics and Gynecology, Middle Aged, medicine.disease, University hospital, Magnetic resonance enterography, Magnetic Resonance Imaging, Intestines, Intestinal Diseases, Multicentric Lesion, ROC Curve, Reproductive Medicine, Area Under Curve, 030220 oncology & carcinogenesis, Female, Radiology, business
Abstract: Study objective To compare 1.5-Tesla (1.5 T) to 3-Tesla (3 T) Magnetic resonance enterography (MRE) in assessing multifocal (multiple lesions affecting the same segment) and multicentric (multiple lesions affecting several digestive segments) bowel endometriosis in patients with suspected-colorectal endometriosis, in routine practice. Study design We conducted a retrospective, comparative study in Tenon University Hospital, Paris, France. We included patients scheduled for colorectal resection from April 2014 to February 2018. All patients underwent 1.5 T or 3 T MRE before surgery and endometriosis lesions were confirmed by surgery. The diagnostic performance of 1.5 T and 3 T MRE was evaluated by sensitivity, specificity, positive and negative predictive values (PPV and NPV), accuracy, positive and negative likelihood ratios (LR) and area under the curve of receiver operating curves (AUC ROC). Results Ninety-eight patients were included. Fifty-two (53%) patients presented unifocal lesions, 31 (32%) multifocal lesions, and 23 (24%) multicentric lesions. In assessment of multifocal lesions, the sensitivity, specificity, positive and negative LRs were 0.57 (12/21), 0.89 (23/26), 4.95 and 0.58 for 1.5 T MRE, and 0.10 (1/10), 0.95 (39/41), 2.05 and 0.95 for 3 T MRE. For the diagnosis of multicentric lesions, 1.5 T MRE showed sensitivity, specificity, positive and negative LRs of 0.46 (5 of 11), 0.92 (33 of 36), 5.45 and 0.60 respectively and 3 T MRE showed sensitivity, specificity, and negative LRs of 0.33 (4/12), 1.00 (39/39), and 0.67, respectively. 1.5 T MRE was more accurate than 3 T MRE for diagnosing multifocal lesions (p = 0.02), but there was no difference for multicentric lesion assessment (p = 0.66). Conclusion In routine conditions, 3 T MRE and 1.5 T MRE are of similar low performance for diagnosing multifocal and multicentric bowel endometriosis.
Published: 2018

29. Predicting the likelihood of recurrence of pregnancy-associated breast cancer: Nomogram based on analysis of the French cancer network: Cancer Associé à La Grossesse

Author: Joseph Gligorov, Sonia Zilberman, Elise Larouzee, Clémentine Owen, Anna Ilenko, Nathalie Chabbert-Buffet, Sofiane Bendifallah, Lise Selleret, Anne-Sophie Boudy, Lucie Allegre, Emile Daraï, Isabelle Thomassin-Naggara, Sandrine Richard, Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Oncologie médicale [CHU Tenon], Service de Radiologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and CCSD, Accord Elsevier
Subjects: Oncology, Adult, medicine.medical_specialty, Concordance, [SDV]Life Sciences [q-bio], Breast Neoplasms, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Pregnancy, Internal medicine, Medicine, Humans, Retrospective Studies, Univariate analysis, 030219 obstetrics & reproductive medicine, business.industry, Proportional hazards model, Obstetrics and Gynecology, Cancer, Reproducibility of Results, Retrospective cohort study, Nomogram, Middle Aged, medicine.disease, Prognosis, Confidence interval, 3. Good health, [SDV] Life Sciences [q-bio], Survival Rate, Nomograms, Reproductive Medicine, 030220 oncology & carcinogenesis, Female, France, Neoplasm Recurrence, Local, business, Pregnancy Complications, Neoplastic
Abstract: Objective Pregnancy associated breast cancer (PABC) are defined as breast cancer diagnosed during pregnancy and during the year following delivery. The prediction of poor prognosis events (PPE) such as recurrence is a major medical challenge of management for women with PABC. The aim of this study was to build a nomogram based on selected clinical and histological variables to predict recurrence. Study Design This retrospective study included 96 patients with PABC from January 2002 to January 2018. A multivariate Cox analysis of selected risk factors was performed and a nomogram to predict recurrence was built. The nomogram was internally validated. Results The overall recurrence rate was 22% (21/95) and the 3-years recurrence rate was 13% (12/95). Age at diagnosis, histological type, immuno-histological class, tumor stage (TNM), node stage (TNM) were associated with PPE in univariate analysis, and were included in the final Cox model to develop the nomogram. The predictive model had a concordance index of 0.83 (95% Confidence Interval (CI), 0.81-0.85) and 0.78 (95% CI, 0.76-0.80) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. Conclusion Our results support the use of the present nomogram based on 5 clinical and pathological characteristics to predict PPE in PABC with a high concordance. External validation is required to recommend this nomogram in routine practice.
Published: 2021

30. Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results

Author: Bertrand Lapergue, Gaultier Marnat, Maxime Gauberti, Arturo Consoli, Stephane Vannier, François Eugène, Romain Bourcier, Frédéric Bourdain, Suzana Saleme, Caroline Arquizan, Marion Boulanger, Sébastien Richard, Louis Veunac, Ozlem Ozkul-Wermester, Anthony Le Bras, Benjamin Gory, Cyril Dargazanli, Jean-Christophe Gentric, Stephanos Nikolaos Finitsis, Mohammad Anadani, C. Papagiannaki, Valérie Wolff, Christophe Cognard, Benjamin Maïer, Laurent Spelle, Christian Denier, Patricio Muszynski, Sarah Evain, Francisco Macian, Guillaume Turc, Raoul Pop, Raphaël Blanc, Frédéric Clarençon, Alain Viguier, Serge Timsit, Olivier Naggara, Igor Sibon, and Charlotte Rosso
Subjects: medicine.medical_specialty, medicine.medical_treatment, Brain Ischemia, Modified Rankin Scale, Internal medicine, medicine, Humans, Favorable outcome, Prospective Studies, Registries, Endovascular treatment, Stroke, Acute ischemic stroke, Ischemic Stroke, Thrombectomy, business.industry, Cerebral infarction, Stroke scale, Endovascular Procedures, General Medicine, Thrombolysis, medicine.disease, Treatment Outcome, Reperfusion, Cardiology, Surgery, Neurology (clinical), business
Abstract: BackgroundThe predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice.MethodsPatients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0–2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram.ResultsA total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; pConclusionsSuccessful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.
Published: 2021

31. Acute surgical management of children with ruptured brain arteriovenous malformation

Author: Basile Kerleroux, Manoelle Kossorotoff, Quentin Alias, Sarah Stricker, Lorenzo Garzelli, Thomas Blauwblomme, Anaïs Chivet, Michel Zerah, Florent Gariel, Syril James, Sandro Benichi, Olivier Naggara, Nathalie Boddaert, Giovanna Paternoster, Stéphanie Puget, Gregoire Boulouis, Timothée de Saint Denis, Philippe Meyer, Francis Brunelle, Jean-François Hak, Marie Bourgeois, Kevin Beccaria, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Paris (UP), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Martinez Rico, Clara
Subjects: Intracranial Arteriovenous Malformations, Male, nidal surgery, medicine.medical_specialty, arteriovenous malformation, 030204 cardiovascular system & hematology, vascular disorders, Brain herniation, Neurosurgical Procedures, 03 medical and health sciences, 0302 clinical medicine, hematoma evacuation, medicine, Humans, Paracentesis, Child, Cerebral Hemorrhage, Retrospective Studies, Intracerebral hemorrhage, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Head injury, Glasgow Coma Scale, Arteriovenous malformation, General Medicine, Odds ratio, medicine.disease, intracerebral hemorrhage, 3. Good health, Surgery, Arteriovenous Fistula, Etiology, Female, business, RUPTURED AVM, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: OBJECTIVE Rupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM. METHODS This study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King’s Outcome Scale for Childhood Head Injury. RESULTS A total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71–0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13–26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3–10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I–II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently. CONCLUSIONS HE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.
Published: 2021

32. Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors

Author: Bakker, Mark K., van der Spek, Rick A.A., van Rheenen, Wouter, Morel, Sandrine, Bourcier, Romain, Hostettler, Isabel C., Alg, Varinder S., van Eijk, Kristel R., Koido, Masaru, Akiyama, Masato, Terao, Chikashi, Matsuda, Koichi, Walters, Robin G., Lin, Kuang, Li, Liming, Millwood, Iona Y., Chen, Zhengming, Rouleau, Guy A., Zhou, Sirui, Rannikmäe, Kristiina, Sudlow, Cathie L.M., Houlden, Henry, van den Berg, Leonard H., Dina, Christian, Naggara, Olivier, Gentric, Jean-Christophe, Shotar, Eimad, Eugène, François, Desal, Hubert, Winsvold, Bendik S., Børte, Sigrid, Johnsen, Marianne Bakke, Brumpton, Ben M., Sandvei, Marie Søfteland, Willer, Cristen J., Hveem, Kristian, Zwart, John-Anker, Verschuren, W. M. Monique, Friedrich, Christoph M., Hirsch, Sven, Schilling, Sabine, Dauvillier, Jérôme, Martin, Olivier, Martinsen, Amy E, Aamodt, Anne Hege, Skogholt, Anne Heidi, Sandset, Else Charlotte, Kristoffersen, Espen S, Ellekjaer, Hanne, Heuch, Ingrid, Nielsen, Jonas Bille, Hagen, Knut, Fritsche, Lars, Thomas, Laurent F., Pedersen, Linda, Gabrielsen, Maiken E, Vigeland, Maria Dehli, Holmen, Oddgeir, Zhou, Wei, Chen, Junshi, Chen (PI), Zhengming, Clarke, Robert, Collins, Rory, Guo, Yu, Li (PI), Liming, Liu, Depei, Lv, Jun, Peto, Richard, Walters, Robin, Avery, Daniel, Boxall, Ruth, Bennett, Derrick, Chang, Yumei, Chen, Yiping, Du, Huaidong, Gan, Wei, Gilbert, Simon, Hacker, Alex, Hill, Michael, Holmes, Michael, Iona, Andri, Kartsonaki, Christiana, Kerosi, Rene, Kong, Ling, Lancaster, Garry, Lewington, Sarah, McDonnell, John, Millwood, Iona, Nie, Qunhua, Ryder, Paul, Sansome, Sam, Schmidt-Valle, Dan, Sherliker, Paul, Sohoni, Rajani, Stevens, Becky, Turnbull, Iain, Wang, Lin, Wright, Neil, Yang, Ling, Yang, Xiaoming, Yao, Pang, Bian, Zheng, Han, Xiao, Hou, Can, Pei, Pei, Liu, Chao, Yu, Canqing, Pang, Zengchang, Gao, Ruqin, Li, Shanpeng, Wang, Shaojie, Liu, Yongmei, Du, Ranran, Cheng, Liang, Tian, Xiaocao, Zhang, Hua, Zhai, Yaoming, Ning, Feng, Sun, Xiaohui, Li, Feifei, Lv, Silu, Wang, Junzheng, Hou, Wei, Zou, Mingyuan, Yan, Shichun, Zhou, Xue, Yu, Bo, Li, Yanjie, Xu, Qinai, Kang, Quan, Guo, Ziyan, Wang, Dan, Hu, Ximin, Chen, Jinyan, Fu, Yan, Wang, Xiaohuan, Weng, Min, Guo, Zhendong, Wu, Shukuan, Li, Yilei, Li, Huimei, Wu, Ming, Zhou, Yonglin, Zhou, Jinyi, Tao, Ran, Yang, Jie, Su, Jian, liu, Fang, Zhang, Jun, Hu, Yihe, Lu, Yan, Ma, Liangcai, Tang, Aiyu, Hua, Yujie, Jin, Jianrong, Liu, Jingchao, Tang, Zhenzhu, Chen, Naying, Huang, Ying, Li, Mingqiang, Meng, Jinhuai, Pan, Rong, Jiang, Qilian, Lan, Jian, Liu, Yun, Wei, Liuping, Zhou, Liyuan, Chen, Ningyu, Wang, Ping, Meng, Fanwen, Qin Sisi Wang, Yulu, Wu, Xianping, Zhang, Ningmei, Chen, Xiaofang, Zhou, Weiwei, Luo, Guojin, Li, Jianguo, Zhong, Xunfu, Liu, Jiaqiu, Sun, Qiang, Ge, Pengfei, Ren, Xiaolan, Dong, Caixia, Zhang, Hui, Mao, Enke, Wang, Xiaoping, Wang, Tao, Zhang, Xi, Zhou, Ding Zhang, Zhou, Gang, Feng, Shixian, Chang, Ling, Fan, Lei, Gao, Yulian, He, Tianyou, Sun, Huarong, He, Pan, Hu, Chen, Zhang, Xukui, Wu, Huifang, Yu, Min, Hu, Ruying, Wang, Hao, Gong, Weiwei, Wang, Meng, Xie, Kaixu, Chen, Lingli, Pan, Dongxia, Gu, Qijun, Huang, Yuelong, Chen, Biyun, Yin, Li, Liu, Huilin, Fu, Zhongxi, Xu, Qiaohua, Xu, Xin, Zhang, Hao, Long, Huajun, Zhang, Libo, Nagai, Akiko, Muto, Kaori, Hirata, Makoto, Morisaki, Takayuki, Yamashita, Yasushi, Kamatani, Yoichiro, Kambara, Yoko, Murakami, Yoshinori, Masumoto, Akihide, Nagayama, Satoshi, Miki, Yoshio, Yoshimori, Kozo, Fujioka, Tomoaki, Takata, Ryo, Yamaji, Ken, Takahashi, Kazuhisa, Asai, Satoshi, Takahashi, Yasuo, Minami, Shiro, Yamaguchi, Hiroki, Koretsune, Yukihiro, Nishizawa, Yasuko, Kodama, Ken, Kutsumi, Hiromu, Suzuki, Takao, Sinozaki, Nobuaki, Murayama, Shigeo, Furukawa, Yoichi, Yamanashi, Yuji, Papagiannaki, Chrisanthi, Piotin, Michel, Trystram, Denis, Edjlali-Goujon, Myriam, Boulouis, Grégoire, Rodriguez, Christine, Hassen, Waghi Ben, Saleme, Suzanna, Mounayer, Charbel, Rouchaud, Aymeric, Levrier, Olivier, Aguettaz, Pierre, Combaz, Xavier, Pasco, Anne, l’Allinec, Vincent, Bintner, Marc, Molho, Marc, Pascale, Gauthier, Chivot, Cyril, Costalat, Vincent, Darganzil, Cyril, Bonafé, Alain, Januel, Anne Christine, Michelozzi, Caterina, Cognard, Christophe, Bonneville, Fabrice, Tall, Philippe, Darcourt, Jean, Biondi, Alessandra, Iosif, Cristina, Ferre, Jean Christophe, Gauvrit, Jean Yves, Eugene, François, Raoult, Hélène, Gentric, Jean Christophe, Ognard, Julien, Anxionnat, René, Gory, Benjamin, Bracard, Serge, Derelle, Anne Laure, Tonnelet, Romain, Spelle, Laurent, Ikka, Léon, Ozanne, Augustin, Gallas, Sophie, Caroff, Jildaz, Achour, Nidal Ben, Moret, Jacques, Chabert, Emmanuel, Berge, Jérôme, Marnat, Gaultier, Barreau, Xavier, Gariel, Florent, Clarencon, Frédéric, Aggour, Mohammed, Ricolfi, Frédéric, Chavent, Adrien, Thouant, Pierre, Lebidinsky, Pablo, Lemogne, Brivael, Herbreteau, Denis, Bibi, Richard, Janot, Kevin, Pierot, Laurent, Soize, Sébastien, Labeyrie, Marc Antoine, Vandendries, Christophe, Kazemi, Appoline, Leclerc, Xavier, Pruvo, Jean Pierre, Bricout, Nicolas, Velasco, Stéphane, Boucebci, Samy, Lemmens, Robin, Pandolfo, Massimo, Bodenant, Marie, Louillet, Fabien, Mas, Jean-Louis, Deltour, Sandrine, Leder, Sara, Léger, Anne, Canaple, Sandrine, Godefroy, Olivier, Giroud, Maurice, Jacquin, Agnès, Moulin, Thierry, Vuillier, Fabrice, Tzourio, Christophe, Santos, Michael Dos, Malik, Rainer, Hausser, Ingrid, Thomas-Feles, Constanze, Weber, Ralf, Grond-Ginsbach, Caspar, Hacke, Werner, Giossi, Alessia, Volonghi, Irene, Costa, Paolo, del Zotto, Elisabetta, Morotti, Andrea, Poli, Loris, Muiesan, Maria Lorenza, Salvetti, Massimo, Rosei, Enrico Agabiti, Lanfranconi, Silvia, Baron, Pierluigi, Ferrarese, Carlo, Susani, Emanuela, Giacalone, Giacomo, Paolucci, Stefano, Palmirotta, Raffaele, Guadagni, Fiorella, Paciaroni, Maurizio, Ballabio, Elena, Parati, Eugenio A., Fluri, Felix, Hatz, Florian, Gisler, Dominique, Amort, Margareth, Bevan, Steve, James, Tom, Olsson, Sandra, Holmegaard, Lukas, Altintas, Ayse, Martin, Juan José, Kittner, Steven, Mitchell, Braxton, Stine, Colin, O’Connell, Jeff, Dueker, Nicole, Koudstaal, Peter J., de Lau, Lonneke M.L., Hofman, Albert, Verhaaren, Benjamin F, Uitterlinden, Andre G, Montaner, Joan, Mendioroz, Maite, Yadav, Sunaina, Khan, Muhammad Saleem, Wilder, Michael, van Dijk, Ewoud, Maaijwee, Noortje, Rutten-Jacobs, Loes, Kramer, Jamie, Malik, Shaneela, Brott, Thomas G, Brown, Robert D, Singleton, Andrew, Hardy, John, Rich, Stephen S, Tanislav, Christian, Jungehülsing, Jan, Werring, David, Alg, Varinder, Hostettler, Isabel, Bonner, Stephen, Walsh, Daniel, Bulters, Diederik, Kitchen, Neil, Brown, Martin, Grieve, Joan, Roberts, Gareth, Jones, Timothy, Critchley, Giles, Sharma, Pankaj, Nelson, Richard, Whitfield, Peter, Ross, Stuart, Patel, Hiren, Eldridge, Paul, Saastamoinen, Kari, Patel, Umang, Lawrance, Enas, Vandabona, Subha, Mendelow, David, Teal, Rachel, Warner, Orlando, Kirkpatrick, Peter, Seshadri, Sudha, Kilarski, Laura, Hyacinth, Hyacinth I, Oliveira, Jamary, Marini, Sandro, Nyquist, Paul, Lewis, Cathryn, Norrving, Bo, Smith, Gustav, Rosand, Jonathan, Biffi, Alessandro, Kourkoulis, Christina, Anderson, Chris, Giese, Anne-Katrin, Bang, Oh Young, Chung, Jong-Won, Kim, Gyeong-Moon, Zhuang, Qishuai, Sheu, Wayne, Smalley, June, Howson, Joanna, Granata, Alessandra, Markus, Hugh, Wardlaw, Joanna, Cole, John, Thalamuthu, Anbupalam, Hopewell, Jemma, Worrall, Bradford, Bis, Josh, Tirschwell, David, Reiner, Alex, Dhar, Raj, Lee, Jin-Moo, Mortenson, Janne, Wassertheil-Smoller, Sylvia, Prasad, Kameshwar, Fisher, Mark, Traenka, Christopher, Wang, Xingwu, Wang, Yongjun, Rouanet, Francois, Sibon, Igor, Sarnowski, Chloé, Maillard, Pauline, Aparicio, Hugo Javier, Dupuis, Josee, Yang, Qiong, Luvizutto, Gustavo, Chasman, Daniel, Rexrode, Kathryn, Harriot, Andrea, Phuah, Chia-Ling, Santo, Gustavo, Gerard, Jen, Liu, Guiyou, Aaron, Sanjith, Christudass, Christhunesa S., Salomi, BSB, Sanghera, Dharambir, Boehme, Amelia, Elkind, Mitchell, Gretarsdottir, Solveig, Lange, Leslie, Rost, Natalia, James, Michael, Stewart, Jill, Goldstein, Larry, Waddy, Salina, Vojinovic, Dina, Ikram, Arfan, Thijs, Vincent, Parati, Eugenio, Boncoraglio, Giorgio, Kooperberg, Charles, Abboud, Sherrine, Zand, Ramin, Bijlenga, Philippe, Selim, Magdy, Happola, Olli, Strbian, Daniel, Tomppo, Liisa, Pathak, Abhishek, Pfeiffer, Dorothea, Aires, de Buenos, de Carvalho, Joao Jose Freitas, Ribeiro, Priscila, Torres, Nuria, Barboza, Miguel, Plomaritoglou, Androniki, Bjorkegren, Johan, Chan, Yu-Feng Yvonne, Gudnason, Villi, Jimenez-Conde, Jordi, Soriano, Carolina, Roquer, Jaume, Bentley, Paul, Tournier-Lasserve, Elisabeth, Dufouil, Carole, Debette, Stephanie, Mishra, Aniket, Wee, Lawrence, Siddiqi, Saima, Wu, Jer-Yuarn, Ko, Tai-Ming, Bione, Silvia, Jood, Katarina, Tatlisumak, Turgut, Arauz, Antonio, Korostynski, Michal, Launer, Lenore, Yue, Suo, bersano, anna, Juchniewicz, Karol Józef, Mateusz, Adamski, Pera, Joanna, Wnuk, Marcin, Levi, Christopher, Gusdon, Aaron, Kostulas, Konstantinos, Maxwell, Jessye, Duering, Marco, Jagiella, Jeremiasz, Hata, Jun, Ninomiya, Toshiharu, Nguyen, Vinh, Thorarinsson, Bjorn Logi, Lee, Tsong-Hai, Rakitko, Alexandr, Dichgans, Martin, Lindgren, Arne, Wasselius, Johan, Drake, Mattias, Stenman, Martin, Ilinca, Andreea, Staals, Julie, Sadr-Nabavi, Ariane, Crawford, Katherine, Lena, Umme, Mateen, Farrah, Ay, Hakan, Wu, Ona, Schirmer, Markus, Romero, Javier, Cramer, Steve, Golland, Polina, Mueller, Bertram, Brown, Robert, Meschia, James, Ross, Owen A., Pare, Guillaume, Chong, Mike, mansour, Ossama yassin, Karaszewski, Bartosz, Enzinger, Christian, Schmidt, Reinhold, Seiler, Stephan, Pichler, Alexander, Ovbiagele, Bruce, Yamada, Yoshiji, Rundek, Tatjana, Blanton, Susan, P, John, Chern, Joseph, O'Donnell, Chris, Corriveau, Roderick, Bhattacharya, Pallab, Gwinn, Katrina, CHANDRA, BHARATENDU, Chen, Christopher, Kalaria, Raj, Koenig, Jim, Singh, Om Prakash, Olugbodi, Akintomi, Giralt, Eva, Saleheen, Danish, de Leeuw, Frank-Erik, Klijn, Karin, Olesen, Jes, Kubo, Michiaki, Spence, David, Pedersen, Annie, Olsson, Maja, Martín, Juan José, Braga, Gabriel, Xu, Huichun, Assimes, Tim, Raskurazhev, Anton, Lee, Wei Ling, Burri, Philippe, Frid, Petrea, GmbH, Heilbronn, Deng, Zhen, Habibi-koolaee, Mahdi, Vijayan, Murali, Leung, Thomas, Wong, Lawrence, Mok, Vincent, Choy, Richard, Jern, Christina, Lebedeva, Elena, Farrall, Martin, Jiayuan, Xu, Loo, Keat Wei, Rinkel, Gabriel, Magnus, Rudolf, Goncalves, Anderson, Franca, Paulo, Cendes, Iscia, Carrera, Caty, Fernandez-Cadenas, Israel, Kim, Helen, Rolfs, Arndt, Owolabi, Mayowa, Bakker, Mark, Ruigrok, Ynte, Hauer, Allard, Pulit, Sara L., Algra, Ale, van der Laan, Sander W., Macleod, Mary, Howard, George, Tiwari, Hemant, Irvin, Ryan, Albright, Karen C., Perry, Rodney, Kidwell, Chelsea, Pavlovic, Aleksandra, Sargurupremraj, Murali, Schilling, Sabrina, Pezzini, Alessandro, Abd-Allah, Foad, DeCarli, Charles, Liebeskind, David, Traylor, Matthew, Tan, Rhea, Danesh, John, Larsson, Susanna C., Rutten, Loes, Donatti, Amanda, Avelar, Wagner, Broderick, Joseph, Woo, Daniel, Kissela, Brett, Ibenez, Laura Garcia, Salman, Rustam, Sudlow, Cathie, McDonough, Caitrin Wheeler, Silliman, Scott, Magvanjav, Oyunbileg, van Agtmael, Tom, Walters, Matthew, Lorentzen, Erik, Stanne, Tara, Olsson, Martina, Nakagawa, Kazuma, Akinyemi, Rufus, Cotlatciuc, Ioana, O'Connell, Jeff, Sparks, Mary, Sorkin, John, Dave, Tushar, Naylor, Jill, Brown, Devin, Du, Rose, Kulik, Tobias B., Attia, John, Faber, James E, Rothwell, Peter, Márquez, Elsa Valdés, Mancuso, Michelangelo, Souza, Doralina Brum, de Silva, Ranil, Vibo, Riina, Korv, Janika, Maguire, Jane, Fornage, Myriam, Illoh, Kachikwu, Milewicz, Dianna, Majersik, Jennifer, DeHavenon, Adam, Kalani, Yashar, Alexander, Matthew, Cushman, Mary, Sale, Michele, Owens, Debra, Keene, Keith, Rich, Stephe, Psaty, Bruce, Longstreth, Will, Atadzhanov, Masharip, Wolfe, Stacey Quintero, Langefeld, Carl, Bushnell, Cheryl, Cruchaga, Carlos, Konrad, Jan, Liu, Junfeng, Sheth, Kevin, Falcone, Guido, Donahue J, Kathleen, Jones, Gregory T., Bown, Matthew J., Ko, Nerissa U., Coleman, Jonathan R.I., Breen, Gerome, Zaroff, Jonathan G., Klijn, Catharina J.M., Sargurupremraj, Muralidharan, Amouyel, Philippe, Debette, Stéphanie, Rinkel, Gabriel J.E., Worrall, Bradford B., Slowik, Agnieszka, Gaál-Paavola, Emilia I., Niemelä, Mika, Jääskeläinen, Juha E., von Und Zu Fraunberg, Mikael, Lindgren, Antti, Broderick, Joseph P., Werring, David J., Redon, Richard, Veldink, Jan H., Ruigrok, Ynte M., Stroke, HUNT All-In, Group, China Kadoorie Biobank Collaborative, Consortium, BioBank Japan Project, Group, ICAN Study, Group, CADISP, investigators, Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study, (ISGC), International Stroke Genetics Consortium, Morel, Sandrine, and Bijlenga, Philippe Alexandre Pierre
Subjects: genetics [Blood Pressure], Medizin, Genome-wide association study, Blood Pressure, Disease, ddc:616.07, Bioinformatics, 616: Innere Medizin und Krankheiten, 0302 clinical medicine, Risk Factors, physiopathology [Hypertension], genetics [Genetic Predisposition to Disease], Genetic risk factor, Stroke, 0303 health sciences, Smoking, genetics [Smoking], genetics [Intracranial Aneurysm], Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Cerebrovascular disorder, 3. Good health, genetics [European Continental Ancestry Group], Hypertension, genetics [Polymorphism, Single Nucleotide], Subarachnoid hemorrhage, pathology [Intracranial Aneurysm], genetics [White People], Biology, Genetic correlation, pathology [Endothelial Cells], Polymorphism, Single Nucleotide, Article, White People, 03 medical and health sciences, Aneurysm, Asian People, ddc:570, Genetics, medicine, Humans, Genetic Predisposition to Disease, cardiovascular diseases, 030304 developmental biology, genetics [Subarachnoid Hemorrhage], genetics [Asian Continental Ancestry Group], 572: Biochemie, genetics [Asian People], pathology [Subarachnoid Hemorrhage], adverse effects [Smoking], Endothelial Cells, Subarachnoid Hemorrhage, medicine.disease, Intracranial aneurysm, Genetic architecture, ddc:616.8, Case-Control Studies, genetics [Hypertension], 030217 neurology & neurosurgery, Genome-Wide Association Study
Abstract: An author correction to this article published in December 2020 is available at https://doi.org/10.1038/s41588-020-00760-4. Rupture of an intracranial aneurysm leads to subarachnoid hemorrhage, a severe type of stroke. To discover new risk loci and the genetic architecture of intracranial aneurysms, we performed a cross-ancestry, genome-wide association study in 10,754 cases and 306,882 controls of European and East Asian ancestry. We discovered 17 risk loci, 11 of which are new. We reveal a polygenic architecture and explain over half of the disease heritability. We show a high genetic correlation between ruptured and unruptured intracranial aneurysms. We also find a suggestive role for endothelial cells by using gene mapping and heritability enrichment. Drug-target enrichment shows pleiotropy between intracranial aneurysms and antiepileptic and sex hormone drugs, providing insights into intracranial aneurysm pathophysiology. Finally, genetic risks for smoking and high blood pressure, the two main clinical risk factors, play important roles in intracranial aneurysm risk, and drive most of the genetic correlation between intracranial aneurysms and other cerebrovascular traits.
Published: 2021

33. Clot Burden Score and Collateral Status and Their Impact on Functional Outcome in Acute Ischemic Stroke

Author: L Legrand, Serge Bracard, Romain Bourcier, Sébastien Soize, Bertrand Lapergue, C. Rosso, Gregoire Boulouis, Imad Derraz, M. Pou, Marie Tisserand, Michel Piotin, Julien Labreuche, O Naggara, C Oppenheim, Frédéric Clarençon, Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Universitaire de Reims (CHU Reims), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service des Urgences Cérébro-Vasculaires [CHU Pitié-Salpétriêre], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Foch [Suresnes], Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service d'Urgences Cérébro-Vasculaires [CHU Pitié-Salpêtrière], and Gestionnaire, Hal Sorbonne Université
Subjects: Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Collateral Circulation, Fluid-attenuated inversion recovery, Logistic regression, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Occlusion, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Thrombus, Acute ischemic stroke, Aged, Ischemic Stroke, Thrombectomy, Aged, 80 and over, business.industry, Adult Brain, Endovascular Procedures, Thrombosis, Middle Aged, Collateral circulation, medicine.disease, Magnetic Resonance Imaging, Hyperintensity, [SDV] Life Sciences [q-bio], Treatment Outcome, Cardiology, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: International audience; Background and purpose: Collateral status and thrombus length have been independently associated with functional outcome in patients with acute ischemic stroke. It has been suggested that thrombus length would influence functional outcome via interaction with the collateral circulation. We investigated the individual and combined effects of thrombus length assessed by the clot burden score and collateral status assessed by a FLAIR vascular hyperintensity-ASPECTS rating system on functional outcome (mRS).Materials and methods: Patients with anterior circulation acute ischemic stroke due to large-vessel occlusion from the ASTER and THRACE trials treated with endovascular thrombectomy were pooled. The clot burden score and FLAIR vascular hyperintensity score were determined on MR imaging obtained before endovascular thrombectomy. Favorable outcome was defined as an mRS score of 0-2 at 90 days. Association of the clot burden score and the FLAIR vascular hyperintensity score with favorable outcome (individual effect and interaction) was examined using logistic regression models.Results: Of the 326 patients treated by endovascular thrombectomy with both the clot burden score and FLAIR vascular hyperintensity assessment, favorable outcome was observed in 165 (51%). The rate of favorable outcome increased with clot burden score (smaller clots) and FLAIR vascular hyperintensity (better collaterals) values. The association between clot burden score and functional outcome was significantly modified by the FLAIR vascular hyperintensity score, and this association was stronger in patients with good collaterals, with an adjusted OR = 6.15 (95% CI, 1.03-36.81).Conclusions: The association between the clot burden score and functional outcome varied for different collateral scores. The FLAIR vascular hyperintensity score might be a valuable prognostic factor, especially when contrast-based vascular imaging is not available.
Published: 2021

34. Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study

Author: Constant Dit Beaufils, Pacôme, Labreuche, Julien, Richard, Śebastien, Fahed, Robert, Desal, Hubert Armand, Piotin, Michel P., Blanc, Raphaël, Redjem, Hocine, Escalard, Simon, Desilles, Jean Philippe, Ciccio, Gabriele, Smajda, Stanislas, Maier, Benjamin, Mazighi, Mikael, Obadia, Mikael, Sabben, Candice, Peres, Roxanne, Corabianu, Ovide, De Broucker, Thomas, Smadja, Didier, Alamowitch, Sonia, Ille, Olivier, Manchon, Eric, Garcia, Pierre Yves, Taylor, Guillaume, Ben Maacha, Malek, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Lapergue, Bertrand, Weisenburger, David, Gorza, Lucas, Buard, Géraldine, Coskun, Oguzhan, Consoli, Arturo, Di Maria, Federico, Rodesh, Georges, Zimatore, Sergio, Leguen, Morgan, Gratieux, Julie D., Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Nighoghossian, Norbert, Riva, Roberto, Eker, Omer faruk, Turjman, Francis, Derex, Laurent, Cho, Tae-Hee, Mechtouff, Laura, Lukaszewicz, Anne Claire, Philippeau, Frédéric, Cakmak, Serkan, Blanc-Lasserre, Karine, Vallet, Anne Evelyne, Marnat, Gaultier, Gariel, Florent, Barreau, Xavier, Berge, Jerome, Veunac, Louis, Menegon, Patrice, Sibon, Igor, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Tourdias, Thomas, Liegey, Jean Sebastien, Bourcier, Romain, Detraz, Lili, Daumas-Duport, Benjamin, Alexandre, Pierre Louis, Roy, Monica, Lenoble, Cédric, L’Allinec, Vincent, Girot, Jean Baptiste, Desal, Hubert, Guillon, Benoît, De Gaalon, Solène, Preterre, Cécile, Gory, Benjamin, Bracard, Serge R., Anxionnat, René, Braun, Marc, Derelle, Anne Laure, Tonnelet, Romain, Liao, Liang, Zhu, François, Schmitt, Emmanuelle, Planel, Sophie, Richard, Sébastien, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean Christophe, Bonnerot, Mathieu, Riou-Comte, Nolwenn, Macian-Montoro, Francisco, Saleme, Suzanna, Mounayer, Charbel, Rouchaud, Aymeric M., Costalat, Vincent, Arquizan, Caroline, Dargazanli, Cyril, Gascou, Grégory, Lefèvre, Pierre Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Francois, Eugene, Vannier, Stéphane, Ferré, Jean-Christophe, Raoult, Hélène, Ronziere, Thomas, Lassale, Maria, Paya, Christophe, Gauvrit, Jean Yves, Tracol, Clément, Langnier-Lemercier, Sophie, Samson, Yves, Rosso, Charlotte, Leger, Anne, Deltour, Sandrine, Clarencon, Frédéric, Shotar, Eimad, Spelle, Laurent, Denier, Christian, Chalumeau, Vanessa, Caroff, Jildaz, Chassin, Olivier, Venditti, Laura, Turc, G., Naggara, Olivier N., Boulouis, Grégoire, Ben Hassen, Wagih, Seners, Pierre, Viguier, Alain, Cognard, Christophe H., Januel, Anne Christine, Olivot, Jean Marc, Raposo, Nicolas, Bonneville, Fabrice, Touze, Emmanuel, Barbier, Charlotte N., Schneckenburger, Romain, Boulanger, Marion, Cogez, Julien, Guettier, Sophie, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), P.C.D.B. and J.L. have nothing to disclose. R. Blanc, R. Bourcier, A.C., H.D., F.D.M., R.F., F.G., B. Gory, G.M., C.P., S.R., I.S. and F.Z. have nothing to disclose. M.M. reports personal fees from Amgen, personal fees from Boerhinger, personal fees from Acticor, and personal fees from Air Liquide, outside the submitted work. B.L. reports grants from Stryker, Penumbra and Microventino, outside the submitted work. S.D.G. reports personal fees and non‐financial support from Boerhinger, outside the submitted work. B. Guillon reports personal fees from Boerhinger‐Ingelheim France and Bristol‐Myers‐Squibb, outside the submitted work., Centre hospitalier universitaire de Nantes (CHU Nantes), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Service de neuroradiologie [Suresnes], Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de neurologie [CHRU Nancy], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), and The Ottawa Hospital
Subjects: Male, endovascular treatment, medicine.medical_specialty, Asymptomatic, Brain Ischemia, Cohort Studies, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Modified Rankin Scale, Internal medicine, Humans, Medicine, asymptomatic, Registries, 030212 general & internal medicine, Stroke, Thrombectomy, Intracerebral hemorrhage, business.industry, Endovascular Procedures, Odds ratio, medicine.disease, intracerebral hemorrhage, stroke, Confidence interval, 3. Good health, Treatment Outcome, Neurology, Cardiology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), prognosis, medicine.symptom, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Cohort study
Abstract: International audience; Background and purpose: Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT. Methods: Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22–36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4–6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. Results: Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44–2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47–2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22–2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77–5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. Conclusions: Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
Published: 2021

35. Pediatric Brain Arteriovenous Malformation Recurrence: A Cohort Study, Systematic Review and Meta-Analysis

Author: Florent Gariel, Thomas Blauwblomme, Volodia Dangouloff-Ros, Lorenzo Garzelli, Gregoire Boulouis, Basile Kerleroux, Nathalie Boddaert, Olivier Naggara, Manoelle Kossorotoff, Francis Brunelle, Vincent Vidal, Nadine Girard, Sarah Stricker, Jean-François Hak, Heather J. Fullerton, Philippe Meyer, Sandro Benichi, Steven W. Hetts, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Radiologie pédiatrique et prénatale [Hôpital de la Timone - APHM], and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)
Subjects: Intracranial Arteriovenous Malformations, medicine.medical_specialty, medicine.medical_treatment, Radiosurgery, Cohort Studies, Recurrence, clin, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, snc, Child, Stroke, Retrospective Studies, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, Brain, Arteriovenous malformation, General Medicine, medicine.disease, Surgery, Treatment Outcome, Pediatric brain, Relative risk, Meta-analysis, Cohort, Neurology (clinical), business, Cohort study, Follow-Up Studies
Abstract: BackgroundRecurrence following obliteration of brain arteriovenous malformations (AVMs) is common in children surgically treated, but recurrences following endovascular (EVT) and radiosurgical approaches are scantily reported.ObjectiveTo analyze the rates and risk factors for AVM recurrence after obliteration in a single-center cohort of children with ruptured AVMs treated with multimodal approaches, and to carry out a comprehensive review and meta-analysis of current data.MethodsChildren with ruptured AVMs between 2000 and 2019 enrolled in a prospective registry were retrospectively screened and included after angiographically determined obliteration to differentiate children with/without recurrence. A complementary systematic review and meta-analysis of studies investigating AVM recurrence in children between 2000 and 2020 was aggregated to explore the overall recurrence rates across treatment modalities by analyzing surgery versus other treatments.ResultsSeventy children with obliterated AVMs were included. AVM recurrences (n=10) were more commonly treated with EVT as final treatment (60% in the recurrence vs 13.3% in the no-recurrence group, p=0.018). Infratentorial locations were associated with earlier and more frequent recurrences (adjusted relative risk=4.62, 95% CI 1.08 to 19.04; p=0.04).In the aggregate analysis, the pooled rate of AVM recurrence was 10.9% (95% CI 8.7% to 13.5%). Younger age at presentation was associated with more frequent recurrences (RR per year increase, 0.97, 95% CI 0.93 to 0.99; p=0.046).ConclusionLocation of infratentorial AVMs and younger age at presentation may be associated with earlier and more frequent recurrences. The higher rates of recurrence in patients with AVMs obliterated with EVT questions its role in an intent-to-cure approach and reinforces its position as an adjunct to surgery and/or radiosurgery.
Published: 2021

36. Etiology of intracerebral hemorrhage in children: cohort study, systematic review, and meta-analysis

Author: Florent Gariel, Lorenzo Garzelli, Sandro Benichi, Thomas Blauwblomme, Nathalie Boddaert, Rossella Letizia Mancusi, Olivier Naggara, Timothée de Saint Denis, Quentin Alias, Nicolas Garcelon, Fanny Bajolle, Francis Brunelle, Sarah Stricker, Manoelle Kossorotoff, Stéphanie Puget, Kevin Beccaria, Jean-François Hak, Marie Bourgeois, Gregoire Boulouis, Annie Harroche, Giovanna Paternoster, Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Saint-Anne (GHU Paris), University Hospital Basel [Basel], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire [Rennes], École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA)
Subjects: Intracranial Arteriovenous Malformations, Pediatrics, medicine.medical_specialty, Adolescent, Disease, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Child, ComputingMilieux_MISCELLANEOUS, Cerebral Hemorrhage, Intracerebral hemorrhage, business.industry, Infant, Arteriovenous malformation, General Medicine, medicine.disease, 3. Good health, Cerebrovascular Disorders, Child, Preschool, 030220 oncology & carcinogenesis, Meta-analysis, Cohort, Etiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Complication, business, 030217 neurology & neurosurgery, Cohort study
Abstract: OBJECTIVEUnderstanding the etiological spectrum of nontraumatic pediatric intracerebral hemorrhage (pICH) is key to the diagnostic workup and care pathway. The authors aimed to evaluate the etiological spectrum of diseases underlying pICH.METHODSChildren treated at the authors’ institution for a pICH were included in an inception cohort initiated in 2008 and retrospectively inclusive to 2000, which was analyzed in October 2019. They then conducted a systematic review of relevant articles in PubMed published between 1990 and 2019, identifying cohorts with pICH. Identified populations and patients from the authors’ cohort were pooled in a multicategory meta-analysis.RESULTSA total of 243 children with pICH were analyzed in the cohort study. The final primary diagnosis was an intracranial vascular lesion in 190 patients (78.2%), a complication of a cardiac disease in 17 (7.0%), and a coagulation disorder in 14 (5.8%). Hematological and cardiological etiologies were disproportionately more frequent in children younger than 2 years (p < 0.001). The systematic review identified 1309 children in 23 relevant records pooled in the meta-analysis. Overall, there was significant heterogeneity. The dominant etiology was vascular lesion, with an aggregate prevalence of 0.59 (95% CI 0.45–0.64; p < 0.001, Q = 302.8, I2 = 92%). In 18 studies reporting a detailed etiological spectrum, arteriovenous malformation was the dominant etiology (68.3% [95% CI 64.2%–70.9%] of all vascular causes), followed by cavernoma (15.7% [95% CI 13.0%–18.2%]).CONCLUSIONSThe most frequent etiology of pICH is brain arteriovenous malformation. The probability of an underlying vascular etiology increases with age, and, conversely, hematological and cardiac causes are dominant causes in children younger than 2 years.
Published: 2021

37. Acute enlargement, morphological changes, and rupture of intracranial infectious aneurysm in infective endocarditis. Serial imaging

Author: Olivier Naggara, Jean-Pierre Laissy, Monique Boukobza, Xavier Duval, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Sainte Anne [Paris], Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, and CCSD, Accord Elsevier
Subjects: Aortic valve, medicine.medical_specialty, Transcatheter aortic, [SDV]Life Sciences [q-bio], Morphologic change, Magnetic resonance angiography, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Aneurysm, Physiology (medical), Aneurysm morphological change, Medicine, Aneurysm rupture, medicine.diagnostic_test, business.industry, General Medicine, Intracranial infectious aneurysm, medicine.disease, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, Neurology, Serial imaging, Contrast-enhanced MRA, 030220 oncology & carcinogenesis, Infective endocarditis, cardiovascular system, Neurology (clinical), business, Aneurysm enlargement, 030217 neurology & neurosurgery
Abstract: International audience; A 72-year-old man received a transcatheter aortic valve implantation (TAVI) 2 years ago for leakage of the degenerative bioprosthesis with Corevalve n°31 implantation, presented infective endocarditis (IE) (streptococcus sanguinis) of the bioprosthetic aortic valve. One month after antibiotic treatment was initiated, he presented a left-sided hemiplegia, a right frontal hematoma. MRI/contrast-enhanced magnetic resonance angiography (CE-MRA) revealed 2 infectious intracranial aneurysms (IIAs) of the right (10 mm) and left middle cerebral artery (MCA) (M2 segment, 5 mm). The right MCA IIA was treated within 1 day by glue-embolization. Seven days later, the patient acutely developed motor aphasia. CE-MRA showed significant enlargement (15 mm) and morphologic change of the ruptured left MCA IIA. This IIA was treated with Onyx-embolization. This case adds additional evidence that IIAs, during IE, can show rapid growth and morphological change over a 7 day course and emphasizes the imperative need of close imaging follow-up when IIAs are managed by antibiotic therapy.
Published: 2020

38. Comparison of breast density assessment between human eye and automated software on digital and synthetic mammography: Impact on breast cancer risk

Author: Audrey Milon, Asma Bekhouche, M. Le Boulc’h, Isabelle Thomassin-Naggara, Nathalie Chabbert-Buffet, Edith Kermarrec, Sonia Zilberman, C. Abdel Wahab, Service de Radiologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Institut des Sciences du Calcul et des Données (ISCD), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Adult, medicine.medical_specialty, Artificial intelligence, Digital mammography, Intraclass correlation, [SDV]Life Sciences [q-bio], education, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, medicine, Personal history, Image Processing, Computer-Assisted, Mammography, Humans, Radiology, Nuclear Medicine and imaging, Breast density, Aged, Retrospective Studies, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Reproducibility of Results, Mean age, General Medicine, Middle Aged, MammoRisk®, medicine.disease, 3. Good health, Mammographic breast density, 030220 oncology & carcinogenesis, Female, Radiology, Breast neoplasms, business, Software
Abstract: Purpose To evaluate the agreement between automatic assessment software of breast density based on artificial intelligence (AI) and visual assessment by a senior and a junior radiologist, as well as the impact on the assessment of breast cancer risk (BCR) at 5 years. Materials and methods We retrospectively included 311 consecutive women (mean age, 55.6 ± 8.5 [SD]; range: 40–74 years) without a personal history of breast cancer who underwent routine mammography between January 1, 2019 and February 28, 2019. Mammographic breast density (MBD) was independently evaluated by a junior and a senior reader on digital mammography (DM) and synthetic mammography (SM) using BI-RADS (5th edition) and by an AI software. For each MBD, BCR at 5 years was estimated per woman by the AI software. Interobserver agreement for MBD between the two readers and the AI software were evaluated by quadratic κ coefficients. Reproducibility of BCR was assessed by intraclass correlation coefficient (ICC). Results Agreement for MBD assessment on DM and SM was almost perfect between senior and junior radiologists (κ = 0.88 [95% CI: 0.84–0.92] and κ = 0.86 [95% CI: 0.82–0.90], respectively) and substantial between the senior radiologist and AI (κ = 0.79; 95% CI: 0.73–0.84). There was substantial agreement between DM and SM for the senior radiologist (κ = 0.79; 95% CI: 0.74–0.84). BCR evaluation at 5 years was highly reproducible between the two radiologists on DM and SM (ICC = 0.98 [95% CI: 0.97–0.98] for both), between BCR evaluation based on DM and SM evaluated by the senior (ICC = 0.96; 95% CI: 0.95–0.97) or junior radiologist (ICC = 0.97; 95% CI: 0.96–0.98) and between the senior radiologist and AI (ICC = 0.96; 95% CI: 0.95–0.97). Conclusion This preliminary study demonstrates a very good agreement for BCR evaluation based on the evaluation of MBD by a senior radiologist, junior radiologist and AI software.
Published: 2020

39. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI

Author: Marie-Aude Lefrère-Belda, Pietro Andrea Bonaffini, Camille Bourillon, Caroline Reinhold, Alexandre Bellucci, Isabelle Thomassin-Naggara, Anne-Sophie Jannot, Anne-Sophie Bats, C Cornou, Cendos Abdel Wahab, Laure Fournier, Université de Paris - UFR Médecine Paris Centre [Santé] (UP Médecine Paris Centre), Université de Paris (UP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), and ANR-19-P3IA-0001,PRAIRIE,PaRis Artificial Intelligence Research InstitutE(2019)
Subjects: Adult, Endometrium, Malignancy, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Effective diffusion coefficient, Humans, Radiology, Nuclear Medicine and imaging, 10. No inequality, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Leiomyoma, business.industry, Retrospective cohort study, Sarcoma, Middle Aged, medicine.disease, Confidence interval, 3. Good health, medicine.anatomical_structure, Diffusion Magnetic Resonance Imaging, Case-Control Studies, 030220 oncology & carcinogenesis, Uterine Neoplasms, Female, business, Algorithm, Algorithms, Diffusion MRI
Abstract: Background Improving the differentiation of uterine sarcomas from atypical leiomyomas remains a clinical challenge and is needed to avoid inappropriate surgery. Purpose To develop a diagnostic algorithm including diffusion-weighted MRI criteria to differentiate malignant uterine sarcomas from benign atypical leiomyomas. Materials and Methods This case-control retrospective study identified women with an atypical uterine mass at MRI between January 2000 and April 2017, with surgery or MRI follow-up after 1 year or longer. A diagnostic algorithm including T2-weighted MRI and diffusion-weighted imaging (DWI) signal and apparent diffusion coefficient (ADC) values was developed to predict for sarcoma. The training set consisted of 51 sarcomas and 105 leiomyomas. Two external validation sets were used to evaluate interreader reproducibility (16 sarcomas; 26 leiomyomas) and impact of reader experience (29 sarcomas; 30 leiomyomas). Wilson confidence intervals (CIs) were calculated for sensitivity and specificity. Results Evaluated were 156 women (median age, 50 years; interquartile range, 44-63 years). Predictive MRI criteria for malignancy were enlarged lymph nodes or peritoneal implants, high DWI signal greater than that in endometrium, and ADC less than or equal to 0.905 × 10-3 mm2/sec. Conversely, a global or focal area of low T2 signal intensity and a low or an intermediate DWI signal less than that in endometrium or lymph nodes allowed readers to confidently diagnose as benign a uterine mass demonstrating one or more of these signs (P < .001) in 100% cases in all three data sets. The sensitivities and specificities of the algorithm for diagnosis of malignancy were 98% (50 of 51 masses; 95% CI: 90%, 100%) and 94% (99 of 105 masses; 95% CI: 88%, 98%) in the training set; 88% (14 of 16 masses; 95% CI: 64%, 97%) and 100% (26 of 26 masses; 95% CI: 87%, 100%) in the validation set; and 83% (24 of 29 masses; 95% CI: 65%, 92%) and 97% (29 of 30 masses; 95% CI: 83%, 99%) for the less experienced reader, respectively. Conclusion A diagnostic algorithm with predictive features including lymphadenopathy, high diffusion-weighted imaging signal with reference to endometrium, and low apparent diffusion coefficient enabled differentiation of malignant sarcomas from atypical leiomyomas, and it may assist inexperienced readers. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Mendez in this issue.
Published: 2020

40. Outcome and recanalization rate of tandem basilar artery occlusion treated by mechanical thrombectomy

Author: Stéphanie Lenck, Wael Fadel, Ossama Mansour, Frédéric Clarençon, Gregoire Boulouis, Sonia Alamowitch, Mahmoud Elhorany, El-Sayed Ali Tag El-din, Wagih Ben Hassen, Robert Fahed, Kevin Premat, Ahmed Mohamed Elhfnawy, Sophie Crozier, Olivier Naggara, Nader-Antoine Sourour, Yves Samson, Vincent Degos, Eimad Shotar, BIOSFAST [CHU Pitié-Salpêtrière] (GRC 14), Unité de recherche sur les maladies cardiovasculaires et métaboliques, UMR S 1166, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Tanta, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Université d'Alexandrie, CHU Saint-Antoine [AP-HP], and CCSD, Accord Elsevier
Subjects: Male, medicine.medical_specialty, Résultat, Vertebral artery, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Occlusion de l’artère vertébrale, Tandem, Occlusion de l’artère basilaire, 030218 nuclear medicine & medical imaging, Recanalisation, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, medicine.artery, Occlusion, Vertebrobasilar Insufficiency, medicine, Basilar artery, Humans, Radiology, Nuclear Medicine and imaging, Vertebral Artery, Aged, Retrospective Studies, Thrombectomy, Radiological and Ultrasound Technology, Cerebral infarction, business.industry, Angiography, Digital Subtraction, Thrombolysis, Middle Aged, medicine.disease, Thrombectomie mécanique, Cerebral Angiography, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Mechanical thrombectomy, Basilar Artery, Concomitant, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: International audience; Arrière-plan: Les occlusions de l’artère basilaire en tandem (tBAO) sont définies comme des occlusions concomitantes de l’artère basilaire basilaire et de l’artère vertébrale dominante extracrânienne. Le pronostic d’une telle tBAO traitée par thrombectomie mécanique (MT) a été peu rapporté. Le but de notre étude était de comparer l’innocuité et l’efficacité de la MT chez les patients atteints de tBAO par rapport à ceux présentant des occlusions d’artères basilaires non tandem (ntBAO).Patients et méthodes: Analyse rétrospective d’une base de données de patients ayant subi une MT dans deux centres universitaires. Tous les patients traités pour BAO ont été récupérés. Les patients atteints de tBAO, défini comme une BAO concomitante et une occlusion extracrânienne de l’artère vertébrale (VA) ou une sténose sévère ≥70% (segment V1 ou proximal V2) ont été comparés aux patients atteints de ntBAO.Résultats: Au total, 15 patients atteints de tBAO et 74 patients atteints de ntBAO ont été recrutés. Une reperfusion réussie (thrombolyse modifiée dans le score d’infarctus cérébral ≥2b) a été obtenue dans 73,3 % contre 90,5 % (RC = 0,29, IC à 95 % : 0,07-1,15), un bon résultat clinique (échelle de Rankin modifiée à 3 mois ≤2) a été atteint par 26,7 % contre 32,4 % (RC = 0,76 ; IC à 95 % : 0,24-2,63) et la mortalité à 3 mois était de 46,7 % contre 31 % (RC = 1,94 ; IC à 95 % : 0,63-6) des patients atteints de tBAO par rapport à ntBAO, respectivement. Deux patients (13,3 %) atteints de tBAO et trois (4 %) de ntBAO présentaient une hémorragie intracrânienne symptomatique (RC = 3,64 ; IC à 95 % : 0,55-24).Conclusion: La thrombectomie mécanique chez les patients présentant une occlusion de l’artère basilaire en tandem a tendance à être associée à des taux plus faibles de reperfusion réussie et à de bons résultats cliniques, ainsi qu’à un taux de mortalité plus élevé. Des études multicentriques plus vastes sont justifiées pour mieux préciser la sélection et la prise en charge appropriées de ces patients.
Published: 2020

41. Fertility preservation in women with malignant and borderline ovarian tumors: Experience of the French ESGO-certified center and pregnancy-associated cancer network (CALG)

Author: S. Geoffron, Isabelle Thomassin-Naggara, Sofiane Bendifallah, Nathalie Chabbert-Buffet, Emile Daraï, A. Lier, E. de Kermadec, J. Varinot, Kamila Kolanska, and N. Sermondade
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, endocrine system diseases, Universities, Carcinoma, Ovarian Epithelial, 03 medical and health sciences, Ovarian tumor, 0302 clinical medicine, Pregnancy, medicine, Humans, Ovarian tissue cryopreservation, Fertility preservation, Gynecology, Ovarian Neoplasms, business.industry, Pregnancy Outcome, Obstetrics and Gynecology, Cancer, Fertility Preservation, Histology, medicine.disease, female genital diseases and pregnancy complications, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Female, France, Ovarian cancer, business, Cohort study
Abstract: Objective To describe strategy and results of fertility preservation (FP) in patients with malignant and borderline ovarian tumors. Methods Consecutive cohort study of 43 women with malignant or borderline ovarian tumors who underwent FP between February 2013 and July 2019. The study was conducted in national expert center in Tenon University Hospital, Sorbonne University: French ESGO-certified ovarian cancer center and pregnancy-associated cancer network (CALG). Main outcome measure was FP technique proposed by multidisciplinary committee, FP technique used, time after surgery, number of fragments, histology and follicle density (if ovarian tissue freezing), number of expected, retrieved and frozen oocytes (if ovarian stimulation). Results Pathological diagnosis was malignant epithelial ovarian tumor in five women (11.6%), rare malignant ovarian tumor in 14 (32.6%), borderline in 24 (55.8%), and mostly unilateral (79.1%) and stage I (76.7%). Mean age at diagnosis was 26.8 ± 6.9 years and mean tumor size 109.7 ± 61 mm. Before FP, mean AFC was 11.0 ± 6.1 and AMH levels were 2.7 ± 4.6 ng/mL. Six ovarian tissue-freezing procedures were performed (offered to 13). Twenty-four procedures of ovarian stimulation and oocyte freezing were performed after surgical treatment for 19 women (offered to 28) with a median interval of 188 days. The mean number of mature oocytes retrieved per stimulation was 12.4 ± 12.8. At least 10 mature oocytes were frozen for 52.6% of the women. No FP was offered to five women. Conclusion Oocyte and ovarian tissue cryopreservation should be offered to patients with malignant and borderline ovarian tumors. More data are needed to confirm ovarian stimulation and ovarian tissue grafting safety.
Published: 2020

42. Mechanical thrombectomy practices in France: Exhaustive survey of centers and individual operators

Author: A. Kastler, Christophe Paya, Romain Bourcier, J. Sedat, O. Zurlinden, Alexis Guédon, A. Marchal, Pierre Thouant, Thomas Personnic, Sébastien Soize, Aymeric Rouchaud, Florent Gariel, Olivier Naggara, Kevin Premat, Kevin Janot, Hubert Desal, Mohamed Aggour, Eimad Shotar, R. Hanafi, J.-B. Veyrieres, O. Heck, Pierre-François Manceau, Guillaume Charbonnier, X. Carle, C. Bogey, T. Tuilier, J. Le Moa, Géraud Forestier, Emmanuel Chabert, Simon Escalard, M. Mejdoubi, Nicolas Raynaud, Gregoire Boulouis, Cyril Dargazanli, Omer Eker, Pierre-Olivier Comby, P. Lebedinsky, Raoul Pop, Denis Herbreteau, Jérôme Berge, Victor Dumas, Vincent L'Allinec, Stéphane Velasco, Frédéric Clarençon, J.S. Richter, E. Ducouret, Jean-Christophe Gentric, Arturo Consoli, Caterina Michelozzi, Lili Detraz, Jean-François Hak, Marc Bintner, François Eugène, Charlotte Barbier, J. Caroff, Imad Derraz, Robert Fahed, Jean Darcourt, Jean-Baptiste Girot, Benjamin Gory, Alessandra Biondi, C. Papagiannaki, François Zhu, Gautier Marnat, Julien Ognard, Wagih Ben Hassen, F. Di-Maria, Basile Kerleroux, A. Le Bras, C. Arteaga, Vanessa Chalumeau, P. Guedin, V. Civelli, Service de Radiologie et Imagerie Médicale [CHU Limoges], CHU Limoges, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service de neuroradiologie [Tours], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital de la Milétrie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Marseille, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Reims Champagne-Ardenne (URCA), Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, XLIM (XLIM), Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS), Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Amiens-Picardie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Neuroradiologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Clermont-Ferrand, Hôpital pasteur [Colmar], CHU Henri Mondor [Créteil], Service de neuroradiologie, imagerie des urgences [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Service de neuroradiologie [Grenoble], CHU Grenoble, Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Services de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de neuroradiologie diagnostique et interventionnelle, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Universitaire de Nice (CHU Nice), Centre hospitalier territorial Gaston-Bourret [Nouméa], Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Centre Hospitalier de Polynésie Française, Département de Radiologie [CHU de Rennes], Université de Rennes (UR), Service de Radiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Sud Saint Pierre [Ile de la Réunion], Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Foch [Suresnes], Hopital d'instruction des armées Sainte-Anne [Toulon] (HIA), Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre hospitalier de Vannes, Service de Neuroradiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Henri Mondor, Hôpital Gui de Chauliac [Montpellier], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CCSD, Accord Elsevier, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Neuroradiologie Diagnostique et Thérapeutique [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service de neuroradiologie diagnostique et fonctionnelle [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, [INFO.INFO-IM] Computer Science [cs]/Medical Imaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Suction, Stroke care, Radiography, Interventional, Nationwide survey, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Practice Patterns, Physicians', Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Ischemic Stroke, Thrombectomy, Neuroradiology, Aged, 80 and over, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Radiological and Ultrasound Technology, business.industry, Public health, Continuity of Patient Care, Middle Aged, medicine.disease, Magnetic Resonance Imaging, 3. Good health, Mechanical thrombectomy, Female, Stents, Continuity of care, France, Neurology (clinical), Medical emergency, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background and purpose Mechanical thrombectomy (MT) has dramatically changed the landscape of stroke care as well as stroke care organization. Public health institutions are faced with the challenge of swiftly providing equal access to this high technical level procedure with rapidly broadening indications, and constantly developing techniques. The aim of this study was to present a current nationwide overview of technical MT practices in France as well as local organizations. Materials and methods Thrombectomy capable French stroke centers, and physicians performing MT were invited to participate to a nationwide survey, disseminated through an existing trainee-led research network (the JENI-RC) under the aegis of the French Society of Neuroradiology. The survey was composed of 64 questions to collect both individual practices and general center-based information. Results All French centers (100%) answered the survey, and 74% (110/148) of active interventional neuroradiologists (INR) performing MT completed individual questionnaires. The mean number of INR per center performing MT was 3.7 ± 1.85, and 85% of the centers were organized for 24/7 continuity of care. MRI was the most commonly used imaging modality for stroke diagnosis and patients’ selection, and perfusion imaging was routinely available in 85% of the centers. Half of centers performed yearly between 100 and 200 MT. Anesthesiologic, and technical considerations are also developed in the manuscript. Conclusions This nationwide survey highlights the impressive response to the challenge of reorganization of stroke care with regards to mechanical thrombectomy in France. Technical and management disparities remain. Most centers remain understaffed to properly function in the long term, but the inflow of INT trainees is substantial.
Published: 2020

43. Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study

Author: Sylvain Charron, Adrien Ter Schiphorst, Wagih Ben Hassen, Corentin Provost, Pierre Seners, Guillaume Turc, Jean-Claude Baron, Joseph Benzakoun, Catherine Oppenheim, Olivier Naggara, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Département de neurologie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Service de neuroradiologie [Paris], Hôpital Sainte-Anne, Département de Neurologie [Hôpital Sainte-Anne - APHP] (Paris CB2 2QQ), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Martinez Rico, Clara
Subjects: medicine.medical_specialty, medicine.medical_treatment, cerebral blood flow, Infarction, Key-words: perfusion, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, large vessel occlusion, medicine, cardiovascular diseases, Stroke, Proximal occlusion, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, cerebral infarction diaschisis, Cerebral infarction, business.industry, Thrombolysis, medicine.disease, cerebral infarction, arterial spin labeling, Perfusion, Neurology, Cerebral blood flow, Cohort, Cardiology, Neurology (clinical), arterial spin labelling, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Despite early thrombectomy, a sizeable fraction of acute stroke patients with large vessel occlusion have poor outcome. The no-reflow phenomenon, i.e. impaired microvascular reperfusion despite complete recanalization, may contribute to such "futile recanalizations". Although well reported in animal models, no-reflow is still poorly characterized in man. From a large prospective thrombectomy database, we included all patients with intracranial proximal occlusion, complete recanalization (modified thrombolysis in cerebral infarction score 2c-3), and availability of both baseline and 24 h follow-up MRI including arterial spin labeling perfusion mapping. No-reflow was operationally defined as i) hypoperfusion ≥40% relative to contralateral homologous region, assessed with both visual (two independent investigators) and automatic image analysis, and ii) infarction on follow-up MRI. Thirty-three patients were eligible (median age: 70 years, NIHSS: 18, and stroke onset-to-recanalization delay: 208 min). The operational criteria were met in one patient only, consistently with the visual and automatic analyses. This patient recanalized 160 min after stroke onset and had excellent functional outcome. In our cohort of patients with complete and stable recanalization following thrombectomy for intracranial proximal occlusion, severe ipsilateral hypoperfusion on follow-up imaging associated with newly developed infarction was a rare occurrence. Thus, no-reflow may be infrequent in human stroke and may not substantially contribute to futile recanalizations.
Published: 2020

44. Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke

Author: Jean-Baptiste Girot, Sébastien Richard, Florent Gariel, Igor Sibon, Julien Labreuche, Maéva Kyheng, Benjamin Gory, Cyril Dargazanli, Benjamin Maier, Arturo Consoli, Benjamin Daumas-Duport, Bertrand Lapergue, Romain Bourcier, Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Mikael Obadia, Candice Sabben, Roxanne Peres, Ovide Corabianu, Thomas de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre-Yves Garcia, Guillaume Taylor, Malek Ben Maacha, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David Weisenburger, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Norbert Nighoghossian, Roberto Riva, Omer Eker, Francis Turjman, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, Anne-Evelyne Vallet, Gaultier Marnat, Xavier Barreau, Jérôme Berge, Louis Veunac, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, Thomas Tourdias et Jean-Sebastien Liegey, Lili Detraz, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Vincent L’allinec, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Mathieu Bonnerot, Nolwenn Riou-Comte, Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Vincent Costalat, Caroline Arquizan, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Eugene Francois, Stéphane Vannier, Jean-Christophe Ferre, Helene Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Yves Samson, Charlotte Rosso, Anne Leger, Sandrine Deltour, Frederic Clarencon, Eimad Shotar, Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Laura Venditti, Guillaume Turc, Glivier Naggara, Gregoire Boulouis, Waghih Ben Hassen, Pierre Seners, Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Département de Neuro-Radiologie [Angers] (DNR - Angers), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Département de Neuroradiologie [St Herblain], Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Foch [Suresnes], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, Internal medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, In patient, Prospective Studies, Registries, Endovascular treatment, Stroke, Acute ischemic stroke, Aged, Thrombectomy, Advanced and Specialized Nursing, Aged, 80 and over, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Combined Modality Therapy, 3. Good health, Blood pressure, Treatment Outcome, Ischemic stroke, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background and Purpose: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. Methods: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. Results: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32–3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09–4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51–4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01–1.20]), age (OR, 1.38 [95% CI, 1.14–1.67]), number of passes (OR, 1.16 [95% CI, 1.04–1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30–0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52–0.81]). Conclusions: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.
Published: 2020

45. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee

Author: Rochelle F. Andreotti, Andrea Rockall, Rosemarie Forstner, Isabelle Thomassin-Naggara, Katherine E. Maturen, Caroline Reinhold, Evan S. Siegelman, Phyllis Glanc, Hebert Alberto Vargas, and Elizabeth A. Sadowski
Subjects: medicine.medical_specialty, Consensus, business.industry, Adnexal lesions, Unnecessary Surgery, Lexicon, medicine.disease, Magnetic Resonance Imaging, Adnexal mass, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Structured reporting, Adnexal Diseases, Medicine, Data Systems, Humans, Radiology, Nuclear Medicine and imaging, Female, Radiology, Ovarian mass, business, Ovarian cancer, Ultrasonography
Abstract: MRI is used in the evaluation of ovarian and adnexal lesions. MRI can further characterize lesions seen on ultrasound to help decrease the number of false-positive lesions and avoid unnecessary surgery in benign lesions. Currently, the reporting of ovarian and adnexal findings on MRI is inconsistent due to the lack of standardized descriptor terminology. The development of uniform reporting descriptors can lead to improved interpretation agreement and communication between radiologists and referring physicians. The Ovarian-Adnexal Reporting and Data Systems MRI Committee was formed under the direction of the ACR to create a standardized lexicon for adnexal lesions with the goal of improving the quality and consistency of imaging reports. This white paper describes the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions for MRI and the resultant lexicon.
Published: 2020

46. Acute Stroke Management During the COVID-19 Pandemic: Does Confinement Impact Eligibility for Endovascular Therapy?

Author: Patrícia Ferreira, Sergio Nappini, Manuel A. Correia, Juan Macho, Marie Teresa Nawka, Jean-Christophe Ferré, Alexis Guédon, Eytan Raz, Pierre Lehmann, Maksim Shapiro, Patrick Nicholson, Steven D. Hajdu, Nicolo Mandruzzato, Valérie Pittet, Nicola Limbucci, Teresa Pinho-e-Melo, Guillaume Saliou, Emmanuel Houdart, Frédéric Clarençon, Paolo Machi, Noel van Horn, Eimad Shotar, Michel Piotin, Gabriel Broocks, João Reis, Olivier Naggara, Raphaël Blanc, Timo Krings, Bruno Bartolini, João Pedro Marto, Francesco Puccinelli, Sandra Bracco, Malek Ben Maacha, François Eugène, Vitor Mendes Pereira, João Nuno Ramos, Wagih Ben Hassen, Tommaso Casseri, Lausanne University Hospital, University of Lausanne (UNIL), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Fondation Ophtalmologique Adolphe de Rothschild [Paris], University Hospital of Siena [Italy], Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pontchaillou [Rennes], Empenn, Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-CentraleSupélec-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Département de Radiologie [CHU de Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Hôpital Lariboisière-Fernand-Widal [APHP], Toronto Western Hospital, CHU Marseille, Careggi University Hospital [Florence, Italie], Geneva University Hospital (HUG), Hospital Clínic de Barcelona [Catalonia, Spain], Hospital De Egas Moniz [Lisbon, Portugal] (Centro Hospitalar Lisboa Ocidental), Centro Hospitalar Universitário Lisboa Norte [Lisbon, Portugal] (CHULN), New York University Langone Medical Center (NYU Langone Medical Center), NYU System (NYU), Centro Hospitalar de Lisboa Central E.P.E, Université de Lausanne = University of Lausanne (UNIL), University Hospital of Siena, Neuroimagerie: méthodes et applications (Empenn), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Université de Rennes (UR), Azienda Ospedaliero-Universitaria Careggi [Firenze] (AOUC), Clinic Barcelona Hospital Universitari, Hospital De Egas Moniz [Lisbon], and Ferré, Jean-Christophe
Subjects: Male, Eligibility Determination, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Pandemic, Stroke, Endovascular Procedures, Disease Management, Brain Ischemia/therapy, Coronavirus Infections, Endovascular Procedures/statistics & numerical data, Female, Humans, Middle Aged, Pandemics, Pneumonia, Viral, Quarantine, Retrospective Studies, Spain, Stroke/therapy, Time-to-Treatment, Treatment Outcome, COVID-19, goal, groin, pandemic, standard of care, 3. Good health, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Endovascular therapy, World health, 03 medical and health sciences, medicine, Special Report, Acute stroke, Advanced and Specialized Nursing, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, [SCCO.NEUR] Cognitive science/Neuroscience, Retrospective cohort study, medicine.disease, Emergency medicine, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8–10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5–7.7]), ( P P
Published: 2020

47. Hydrocephalus in children with ruptured cerebral arteriovenous malformation

Author: Stéphanie Puget, Lorenzo Garzelli, Marie Bourgeois, Gregoire Boulouis, Florent Gariel, Thomas Blauwblomme, Sandro Benichi, Olivier Naggara, Sarah Stricker, Philippe Meyer, G. Paternoster, Timothée de Saint Denis, Kevin Beccaria, Michel Zerah, Nathalie Boddaert, Syril James, Anaïs Chivet, Francis Brunelle, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Sainte Anne [Paris], Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Martinez Rico, Clara
Subjects: medicine.medical_specialty, AUC = area under the curve, arteriovenous malformation, external ventricular drain, Logistic regression, vascular disorders, mGS = modified Graeb Scale, 03 medical and health sciences, 0302 clinical medicine, VPS = ventriculoperitoneal shunt, medicine, KOSCHI = King’s Outcome Scale for Childhood Head Injury, ventriculoperitoneal shunt, Prospective cohort study, EVD = external ventricular drainage, Intracerebral hemorrhage, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Ruptured cerebral arteriovenous malformation, business.industry, Glasgow Coma Scale, Arteriovenous malformation, General Medicine, medicine.disease, bAVM = brain arteriovenous malformation, iGCS = initial Glascow Coma Scale, intracerebral hemorrhage, 3. Good health, Hydrocephalus, Surgery, 030220 oncology & carcinogenesis, ICH = intracerebral hemorrhage, IVH = intraventricular hemorrhage, business, hydrocephalus, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, External ventricular drain
Abstract: OBJECTIVEHydrocephalus is a strong determinant of poor neurological outcome after intracerebral hemorrhage (ICH). In children, ruptured brain arteriovenous malformations (bAVMs) are the dominant cause of ICH. In a large prospective cohort of pediatric patients with ruptured bAVMs, the authors analyzed the rates and predictive factors of hydrocephalus requiring acute external ventricular drainage (EVD) or ventriculoperitoneal shunt (VPS).METHODSThe authors performed a single-center retrospective analysis of the data from a prospectively maintained database of children admitted for a ruptured bAVM since 2002. Admission clinical and imaging predictors of EVD and VPS placement were analyzed using univariate and multivariate statistical models.RESULTSAmong 114 patients (mean age 9.8 years) with 125 distinct ICHs due to ruptured bAVM, EVD and VPS were placed for 55/125 (44%) hemorrhagic events and 5/114 patients (4.4%), respectively. A multivariate nominal logistic regression model identified low initial Glasgow Coma Scale (iGCS) score, hydrocephalus on initial CT scan, the presence of intraventicular hemorrhage (IVH), and higher modified Graeb Scale (mGS) score as strongly associated with subsequent need for EVD (all p < 0.001). All children who needed a VPS had initial hydrocephalus requiring EVD and tended to have higher mGS scores.CONCLUSIONSIn a large cohort of pediatric patients with ruptured bAVM, almost half of the patients required EVD and 4.4% required permanent VPS. Use of a low iGCS score and a semiquantitative mGS score as indicators of the IVH burden may be helpful for decision making in the emergency setting and thus improve treatment.
Published: 2020

48. Increased Wall Enhancement During Follow-Up as a Predictor of Subsequent Aneurysmal Growth

Author: Florent Gariel, Olivier Naggara, Catherine Oppenheim, Gregoire Boulouis, Christine Rodriguez-Régent, Wagih Ben Hassen, Denis Trystram, Laurence Legrand, David Saloner, Myriam Edjlali, and Romain Bourcier
Subjects: Male, medicine.medical_specialty, Databases, Factual, Magnetic resonance angiography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Internal medicine, Medicine, Humans, Arterial wall, Prospective Studies, Aged, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Intracranial Aneurysm, Cerebral Arteries, Middle Aged, medicine.disease, Predictive value, Intensity (physics), Cerebral Angiography, Relative risk, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Magnetic Resonance Angiography, Follow-Up Studies
Abstract: Background and Purpose— Absence of arterial wall enhancement (AWE) of unruptured intracranial aneurysms (UIA) has shown promise at predicting which aneurysms will not rupture. We here tested the hypothesis that increased enhancement during follow-up (increased intensity, extension, or thickness or appearance of de novo enhancement), assessed using vessel wall magnetic resonance imaging, was associated with higher rates of subsequent growth. Methods— Patients with UIA were included between 2012 and 2018. Two readers independently rated AWE modification on 3T vessel wall magnetic resonance imaging, and morphological changes on time-of-flight magnetic resonance angiography during follow-up. Results— A total of 129 patients harboring 145 UIA (mean size 4.1 mm) met study criteria, of which 12 (8.3%) displayed morphological growth at 2 years. Of them, 8 demonstrated increased AWE during follow-up before or concurrently to morphological growth, and 4 had preexisting AWE that remained stable before growth. In the remaining 133 (nongrowing) UIAs, no AWE modifications were found. In multivariable analysis, increased AWE, not size, was associated with UIA growth (relative risk, 26.1 [95% CI, 7.4–91.7], P Conclusions— Increased AWE during follow-up of conservatively managed UIAs predicts aneurysm growth over a 2-year period. This may impact UIA management towards closer monitoring or preventive treatment. Replication in a different setting is warranted.
Published: 2020

49. Benefit of first-pass complete reperfusion in thrombectomy is mediated by limited infarct growth

Author: Laurence Legrand, Catherine Oppenheim, Gregoire Boulouis, Olivier Naggara, Joseph Benzakoun, Pierre Seners, Mickael Tordjman, W. Ben Hassen, Nicolas Bricout, Myriam Edjlali, Guillaume Turc, Charlotte Cordonnier, Martin Bretzner, and Hilde Hénon
Subjects: medicine.medical_specialty, Population, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, education, Retrospective Studies, Thrombectomy, First pass, education.field_of_study, medicine.diagnostic_test, business.industry, Cerebral infarction, Confounding, Endovascular Procedures, Magnetic resonance imaging, Odds ratio, medicine.disease, Confidence interval, Stroke, Treatment Outcome, Neurology, Infarction, Reperfusion, Cardiology, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Background and purpose The number of clot retrieval attempts required to achieve complete reperfusion by mechanical thrombectomy impacts functional outcome in acute ischaemic stroke (AIS). Complete reperfusion [expanded Treatment In Cerebral Infarction (eTICI) score = 3] at first pass (FP), is associated with the highest rates of favorable outcome compared to complete reperfusion by multiple passes. The aim of the present study was to investigate the relationship between FP complete reperfusion and infarct growth (IG). Methods Anterior AIS patients with baseline and 24-h diffusion-weighted magnetic resonance imaging were included from two prospective registries. IG was measured by voxel-based segmentation of initial and 24-h diffusion-weighted imaging lesions. IG and favorable 3-month modified Rankin Scale (mRS) score (≤ 2) were compared between patients in whom complete reperfusion (eTICI 3) was achieved with a single pass (FP group) and those for whom multiple passes were required (MP group), after matching for confounding factors. Mediation analysis was performed to examine the association between FP and 3-month mRS score, with IG as mediating variable. Results A total of 200 patients were included, of whom 118 (28.9%) had FP complete reperfusion. In case-control analysis, the FP group had lower IG than the MP group [8.7 (5.4-12.9) ml vs. 15.2 (11-22.6) ml, respectively; P = 0.03). Favorable outcome was higher in the FP population compared to a matched MP population (70.9% vs. 53.2%, respectively; P = 0.04). FP compete reperfusion (eTICI 3) was independently associated with favorable outcome in multivariable regression analysis [odds ratio 1.86, 95% confidence interval (CI) 1.01-4.39; P = 0.04]. The effect of complete reperfusion at FP on functional outcome was explained by limited IG in mediation analysis [indirect effect: -0.32 (95% CI -0.47 to -0.09)]. Conclusion Complete reperfusion at FP is independently associated with significant decrease in IG compared to complete reperfusion by multiple attempts, explaining better functional outcomes.
Published: 2020

50. Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management

Author: Samia Lamrabet, Emile Daraï, Asma Bekhouche, Cyril Touboul, Edith Kermarrec, Adrien Crestani, Cendos Abdel Wahab, and Isabelle Thomassin-Naggara
Subjects: Adult, medicine.medical_specialty, Endometriosis, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pathological, Pelvis, Retrospective Studies, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Rehabilitation, Rectum, Obstetrics and Gynecology, Magnetic resonance imaging, Odds ratio, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Reproductive Medicine, Disease Presentation, 030220 oncology & carcinogenesis, Radiological weapon, Vagina, Female, Radiology, business
Abstract: STUDY QUESTION Is an MRI classification of deep pelvic endometriosis (DE) able to correctly predict the risk of DE surgery. SUMMARY ANSWER A new radiological classification, that we have called the deep pelvic endometriosis index (dPEI) classification, is accurate and reproducible to assess the extension of the disease in central and lateral compartments and well correlated with operating time, hospital stay duration and the risk of voiding dysfunction. WHAT IS KNOWN ALREADY Few imaging classifications are currently available to predict the extent of DE to help preoperative assessment of surgical outcomes and provide the patient with objective information about the risk of surgical complications. STUDY DESIGN, SIZE, DURATION Retrospective monocentric observational study was conducted between 01 January 2017 and 31 December 2018 and included 150 women (mean age = 34.5 years, 20–52 years) with DE on MRI and who subsequently underwent surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Two radiologists independently graded the disease according to MRI-based Enzian classification (A (rectovaginal septum and vagina locations), B (uterosacral locations) and C (rectosigmoid locations)) and a new radiological classification, that we have called the dPEI, that grades the severity of DE as: mild, moderate or severe DE. MRI findings and classification were correlated with surgical and pathological results. MAIN RESULTS AND THE ROLE OF CHANCE MRI-based and surgical Enzian classifications were concordant for A lesions in 78.7% (118/150), for B lesions in 34.7% (52/150) and for C lesions in 82.7% (124/150). Operating time and hospital stays were longer in Group A2 (rectovaginal septum and vagina, 1–3 cm) compared to A0, B2 (uterosacral, 1–3 cm) compared to B0, C3 (rectosigmoid >3 cm) compared to C2 (rectosigmoid 1–3 cm) or C0 (P LIMITATIONS, REASONS FOR CAUTION The study was conducted in an expert center and needs to be validated in a multicenter study. There is a limited number of patients with lateral pelvic endometriosis beyond the parietal fascia, probably due to the low prevalence of this disease presentation. WIDER IMPLICATIONS OF THE FINDINGS MRI imaging can be used to accurately predict postoperative complications for women with DE. This may help the clinician to preoperatively inform a patient about the risks of surgery. Larger clinical studies are required to validate these results. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. I.T.N.: Remunerated lecture GE, Hologic, Guerbet, Canon; Advisory board: Siemens - These relationships are on the topic of breast imaging, not related to the topic of this paper. Other coauthors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
Published: 2020

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