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1. Arterial hypotension "magnitude" and neurological outcome during mechanical thrombectomy under general anesthesia.

Author

L'Allinec V, Bouizegarene M, Palka O, Godard S, Mazighi M, Lasocki S, Rineau E, and Léger M

Subjects
Humans, Retrospective Studies, Female, Male, Aged, Treatment Outcome, Middle Aged, Time Factors, Risk Factors, Aged, 80 and over, Disability Evaluation, Recovery of Function, Risk Assessment, Functional Status, Anesthesia, General adverse effects, Hypotension physiopathology, Hypotension etiology, Hypotension diagnosis, Ischemic Stroke therapy, Ischemic Stroke physiopathology, Ischemic Stroke diagnosis, Thrombectomy adverse effects, Arterial Pressure
Abstract

Introduction: Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) with large vessel occlusion (LVO), but unfavorable outcomes remain common. Procedural arterial hypotension is associated with poor patient outcome. This study aimed to assess the impact of arterial hypotension "magnitude" (a combination of the depth, defined as the percentage relative to baseline arterial blood pressure, and the duration of hypotensive episodes)" during MT on neurological outcome., Methods: This is a monocentric retrospective study. Charts were reviewed between January 2018 and June 2021. "Patients were eligible if they were 18 years or older, anterior LVO was diagnosed on cerebral imaging" and MT performed under general anesthesia. Mean arterial pressure (MAP) was recorded every 5 min throughout the procedure, and the arterial hypotension "magnitude" was estimated by the area under the curve (AUC) for different thresholds of MAP drops., Main Outcome Measure: The modified Rankin Scale (mRS) at 90 days., Main Results: Among the 117 patients analyzed, 46% had poor neurological outcome. Our study showed correlations between poor outcome and a greater procedural AUC of arterial hypotension for the different thresholds: 5% (k 0.18; 95% CI 0.06-0.30; P = 0.007), 10% (k 0.18; 95% CI 0.05-0.30; P = 0.008), 15% (k 0.18; 95% CI 0.04-0.30; P = 0.011), 20% (k 0.18; 95% CI 0.05-0.30; P = 0.010) and 30% (k 0.19; 95% CI 0.05-0.31; P = 0.010). This association persisted after controlling for age, baseline NIHSS score, and ASPECT score., Conclusion: The magnitude of hypotension during MT under general anesthesia for AIS is an independent factor of poor outcome at 90 days. These associations have been observed in patients with mild and severe hypotensive episodes., Competing Interests: Declaration of competing interest All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence the work., (Copyright © 2024. Published by Elsevier Inc.)

Published
2024
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2. Safety and efficacy of stent retrievers plus contact aspiration in patients with acute ischaemic anterior circulation stroke and positive susceptibility vessel sign in France (VECTOR): a randomised, single-blind trial.

Author

Bourcier R, Marnat G, Dargazanli C, Zhu F, Consoli A, Shotar E, Premat K, Eugene F, Janot K, L'Allinec V, Ognard J, Desilles JP, Blanc R, Gentric JC, Bourdain F, Labreuche J, Liao L, Clarençon F, Barreau X, Ifergan H, Hak JF, Kerleroux B, Pop R, Soize S, Bricout N, Caroff J, Richter JS, Desal H, Lapergue B, and Rouchaud A

Subjects
Humans, Female, Male, Aged, France, Single-Blind Method, Middle Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures instrumentation, Prospective Studies, Treatment Outcome, Suction methods, Ischemic Stroke surgery, Ischemic Stroke therapy, Ischemic Stroke diagnostic imaging, Thrombectomy methods, Thrombectomy instrumentation, Stents
Abstract

Background: Positive susceptibility vessel sign (SVS) in patients with acute ischaemic stroke has been associated with friable red blood cell-rich clots and more effective recanalisation using stent retrievers versus contact aspiration. We compared the safety and efficacy of stent retrievers plus contact aspiration (combined technique) versus contact aspiration alone as the first-line thrombectomy technique in patients with acute ischaemic anterior circulation stroke and SVS-positive occlusions., Methods: Adaptive Endovascular Strategy to the Clot MRI in Large Intracranial Vessel Occlusion (VECTOR) was a prospective, randomised, open-label study with blinded evaluation. Patients with SVS-positive anterior circulation occlusions on pretreatment MRI and arterial puncture within 24 h of symptom onset were enrolled from 22 centres in France. A centralised web-based method was used by interventional neuroradiologists for dynamic randomisation by minimisation. Patients were randomly assigned 1:1 to the combined technique or contact aspiration alone. The primary outcome was expanded Thrombolysis in Cerebral Infarction (eTICI) grade 2c or 3 reperfusion after three or fewer passes on post-treatment angiogram, adjudicated by a blinded independent central imaging core laboratory. The intention-to-treat population was used to assess the primary and secondary outcomes. This trial is registered with ClinicalTrials.gov (NCT04139486) and is complete., Findings: Between Nov 26, 2019, and Feb 14, 2022, 526 patients were enrolled, of whom 521 constituted the intention-to-treat population (combined technique, n=263; contact aspiration alone, n=258). The median age of participants was 74·9 years (IQR 64·4-83·3); 284 (55%) were female and 237 (45%) male. The primary outcome did not differ significantly between groups (152 [58%] of 263 patients for the combined technique vs 135 [52%] of 258 for contact aspiration; odds ratio [OR] 1·27; 95% CI 0·88-1·83; p=0·19). Procedure-related adverse events occurred in 32 (12%) of 263 patients in the combined technique group and 27 (11%) of 257 in the contact aspiration group (OR 1·14; 0·65-2·00; p=0·65). The most common adverse event was intracerebral haemorrhage (146 [56%] of 259 patients for the combined technique vs 123 [49%] of 251 for contact aspiration; OR 1·32; 0·91-1·90; p=0·13). All-cause mortality at 3 months occurred in 57 (23%) of 251 patients in the combined technique group and 48 (19%) of 247 in the contact aspiration group (OR 1·19; 0·76-1·86; p=0·45), none of which was treatment-related., Interpretation: The results of the VECTOR trial do not show superiority of the combined stent retriever plus contact aspiration technique over contact aspiration alone in patients with SVS-positive occlusion with respect to achieving eTICI 2c-3 within three passes. These findings support the use of either the combined technique or contact aspiration alone as the initial thrombectomy strategy in patients with acute anterior circulation stroke with SVS on pretreatment MRI., Funding: Cerenovus., Competing Interests: Declaration of interests RB reports paid lectures for Microvention, Medtronic, Penumbra, and Johnson & Johnson (Cerenovus). GM reports consulting for Balt, Microvention Europe, and Stryker Neurovascular; and paid lectures for Phenox, Medtronic, Johnson & Johnson (Cerenovus), and Bracco. KJ reports consulting for Balt. J-CG reports consulting for Balt, Stryker, Phenox, and Medtronic. FC reports consulting for Medtronic, Balt Extrusion, Penumbra, Microvention, and Stryker; being a board member of Artedrone; and having stock options with Intradys and Letsgetproof. XB reports consulting for Stryker and Microvention. SS reports consulting for Phillips Healthcare; support for attending meetings and travel from Cerenovus, Microvention, and Balt; and paid lectures for EISAI. JSR reports paid lectures for Medtronic and Johnson & Johnson (Cerenovus). All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Published
2024
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3. "Adaptative endovascular strategy to the CloT MRI in large intracranial vessel occlusion" (VECTOR): Study protocol of a randomized control trial.

Author

Janot K, Zhu F, Kerleroux B, Boulouis G, Shotar E, Premat K, Eugene F, Dargazanli C, Chalumeau V, L'Allinec V, Benhassen W, Marnat G, Lebras A, Detraz L, Ognard J, Personnic T, Chivot C, Cappucci M, Forestier G, Soize S, Bourdain F, Consoli A, Labreuche J, Desal H, Lapergue B, Rouchaud A, and Bourcier R

Subjects
Humans, Multicenter Studies as Topic, Prospective Studies, Randomized Controlled Trials as Topic, Endovascular Procedures methods, Intracranial Thrombosis diagnostic imaging, Intracranial Thrombosis surgery, Magnetic Resonance Imaging methods, Thrombectomy methods
Abstract

A correlation between the susceptibility vessel sign (SVS) and red thrombi has been identified in MRI. We hypothesized that the Embotrap allow better retrieving of SVS+ thrombi. The AdaptatiVe Endovascular strategy to the CloT MRI in large intracranial vessel Occlusion (VECTOR) trial is a multicenter, prospective and randomized study designed to compare a first-line strategy combining Embotrap added to contact aspiration (CA) versus CA alone in patients with SVS+ occlusions., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Published
2020
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4. Endovascular Stroke Treatment and Risk of Intracranial Hemorrhage in Anticoagulated Patients.

Author

Meinel TR, Kniepert JU, Seiffge DJ, Gralla J, Jung S, Auer E, Frey S, Goeldlin M, Mordasini P, Mosimann PJ, Nogueira RG, Haussen DC, Rodrigues GM, Uphaus T, L'Allinec V, Krajíčková D, Alonso A, Costalat V, Hajdu SD, Olivé-Gadea M, Maegerlein C, Pierot L, Schaafsma J, Suzuki K, Arnold M, Heldner MR, Fischer U, and Kaesmacher J

Subjects
Administration, Oral, Aged, Anticoagulants adverse effects, Female, Follow-Up Studies, Humans, Male, Meta-Analysis as Topic, Middle Aged, Registries, Systematic Reviews as Topic, Anticoagulants administration & dosage, Intracranial Hemorrhages etiology, Intracranial Hemorrhages mortality, Intracranial Hemorrhages prevention & control, Stroke complications, Stroke mortality, Stroke therapy, Thrombectomy
Abstract

Background and Purpose- We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods- In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic. Results- Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62-82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio [aOR], 2.55 [95% CI, 1.35-4.84] and 1.64 [95% CI, 1.09-2.47]) as compared with the control group, whereas no association with DOAC intake was observed (aOR, 0.98 [95% CI, 0.29-3.35] and 1.35 [95% CI, 0.72-2.53]). Sensitivity analyses considering only patients within the confirmed therapeutic anticoagulation range did not alter the findings. A study-level meta-analysis incorporating data from 7462 patients (855 VKAs, 318 DOACs, and 6289 controls) from 15 observational cohorts corroborated these observations, yielding an increased rate of sICH in VKA patients (aOR, 1.62 [95% CI, 1.22-2.17]) but not in DOAC patients (aOR, 1.03 [95% CI, 0.60-1.80]). Conclusions- Patients taking VKA have an increased risk of sICH and mortality after mechanical thrombectomy. The lower risk of sICH associated with DOAC may also be noticeable in the acute setting. Improved selection might be advisable in VKA-treated patients. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064. Systematic Review and Meta-Analysis: CRD42019127464.

Published
2020
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5. MT in anticoagulated patients: Direct oral anticoagulants versus vitamin K antagonists.

Author

L'Allinec V, Sibon I, Mazighi M, Labreuche J, Kyheng M, Boissier E, Roy M, Gory B, Dargazanli C, Desal H, Lapergue B, and Bourcier R

Subjects
Aged, Anticoagulants adverse effects, Dabigatran adverse effects, Dabigatran therapeutic use, Female, Humans, Male, Pyrazoles adverse effects, Pyrazoles therapeutic use, Pyridones adverse effects, Pyridones therapeutic use, Registries, Reperfusion statistics & numerical data, Rivaroxaban adverse effects, Rivaroxaban therapeutic use, Stroke mortality, Stroke surgery, Treatment Outcome, Anticoagulants therapeutic use, Hemorrhage epidemiology, Stroke drug therapy, Thrombectomy statistics & numerical data, Vitamin K antagonists & inhibitors
Abstract

Mechanical thrombectomy (MT) is one of the main treatments for acute ischemic stroke (AIS) in patients on effective anticoagulation. The use of direct oral anticoagulants (DOA) has increased, given their efficacy and safety profile compared to vitamin K antagonists (VKA). We compared procedural and clinical outcomes of MT in patients on DOA and VKA treatment before stroke onset. We analyzed 2 groups from the Endovascular Treatment in Ischemic Stroke prospective registry: patients on DOA and patients on VKA treated by MT without thrombolysis. Generalized linear mixed models including center as random effect were used to compare angiographic (rates of reperfusion at end of procedure, number of passes >2, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to anticoagulation subgroups. Comparisons were adjusted for prespecified confounders (age, admission NIH Stroke Scale score) as well as for meaningful baseline between-group differences. Among 221 patients included, more DOA-treated patients (n = 115, 52%) achieved successful (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b/3) or near complete (mTICI 2c/3) reperfusion at the procedure end than did VKA-treated patients, with an adjusted odds ratio (OR) for DOA vs VKA of 3.27 (95% confidence interval [CI], 1.40-7.65) and 2.00 (95% CI, 1.08-3.73), respectively. DOA-treated patients had a lower 90-day mortality risk with an adjusted OR of 0.47 (95% CI, 0.24-0.89) and a better excellent outcome OR of 2.40 (1.10-5.27). There was no significant between-group difference in hemorrhagic or procedural complications. The study highlights the benefits of DOA compared to VKA. Regarding mortality, excellent outcomes, and recanalization rate, DOA appears to provide a favorable setting for MT treatment in AIS., (© 2020 American Academy of Neurology.)

Published
2020
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6. Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion

Author

Anadani, Mohammad, Marnat, Gaultier, Consoli, Arturo, Papanagiotou, Panagiotis, Nogueira, Raul, Spiotta, Alejandro, Bourcier, Romain, Kyheng, Maeva, Labreuche, Julien, Siddiqui, Adnan, Ribo, Marc, de Havenon, Adam, Fischer, Urs, Sibon, Igor, Dargazanli, Cyril, Arquizan, Caroline, Cognard, Christophe, Olivot, Jean Marc, Anxionnat, René, Audibert, Gérard, Mazighi, Mikael, Blanc, Raphaël, Lapergue, Bertrand, Richard, Sébastien, Gory, Benjamin, Turjman, Francis, Piotin, Michel, Steglich-Arnholm, Henrik, Holtmannspötter, Markus, Taschner, Christian, Eiden, Sebastian, Haussen, Diogo C., Muhammad, Waqas, Boutchakova, Maria, Dorn, Franziska, Killer-Oberpfalzer, Monika, Mangiafico, Salvatore, Psychogios, Marios-Nikos, Labeyrie, Marc-Antoine, Biondi, Alessandra, Bracard, Serge, Andrew Grossberg, Jonathan, Guenego, Adrien, Darcourt, Julien, Vukasinovic, Isabelle, Pomero, Elisa, Davies, Jason, Renieri, Leonardo, Hecker, Corentin, Muchada Muchada, Maria, Rodesch, Georges, Houdart, Emmanuel, Lockau, Johanna, Kastrup, Andreas, Redjem, Hocine, Behme, Daniel, Shallwani, Hussain, Christopher, Maurer, Mione, Gioia, Humbertjean, Lisa, Riou-Comte, Nolwenn, Zhu, François, Borderelle, Anne-Laure, Liao, Liang, Escalard, Simon, Desilles, Jean-Philippes, Ciccio, Gabriele, Smajda, Stanislas, Obadia, Mikael, Sabben, Candice, Corabianu, Ovide, de Broucker, Thomas, Smadja, Didier, Alamowitch, Sonia, Ille, Olivier, Manchon, Éric, Garcia, Pierre-Yves, Taylor, Guillaume, Ben Maacha, Malek, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Weisenburger, David, Gorza, Lucas, Coskun, Oguzhan, Di Maria, Federico, Rodesh, Georges, Leguen, Morgan, Gratieux, Julie, Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Gariel, Florent, Barreau, Xavier, Berge, Jérôme, Veunac, Louis, Menegon, Patrice, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Tourdias, Thomas, Liegey, Jean-Sébastien, Daumas-Duport, Benjamin, Alexandre, Pierre-Louis, Roy, Monica, Lenoble, Cédric, L'Allinec, Vincent, Girot, Jean-Baptiste, Desal, Hubert, Braun, Marc, Derelle, Anne-Laure, Tonnelet, Romain, Schmitt, Emmanuelle, Planel, Sophie, Lacour, Jean-Christophe, Hossu, Gabriela, Beaumont, Marine, Bailang, Mitchelle, Reitter, Marie, Masson, Agnès, Alb, Lionel, Tabarna, Adriana, Voicu, Marcela, Podar, Iona, Brezeanu, Madalina, Costalat, Vincent, Gascou, Gregory, Lefevre, Pierre-Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Medical University of South Carolina [Charleston] (MUSC), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Foch [Suresnes], National and Kapodistrian University of Athens (NKUA), Emory University School of Medicine, Emory University [Atlanta, GA], Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Vall d'Hebron University Hospital [Barcelona], University of Utah, Inselspital Bern, Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], Neurochirurgie [Hôpital Gui de Chauliac], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], 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], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [CHRU Nancy], Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Nantes Université - pôle Santé, Nantes Université (Nantes Univ), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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 Universitaire de Toulouse (CHU Toulouse), Département de Neurologie [Toulouse], Institut des Neurosciences [Toulouse], Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Institut de Génomique Fonctionnelle (IGF), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Endovascular therapy, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Modified Rankin Scale, medicine.artery, Internal medicine, Occlusion, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, medicine, Humans, Thrombolytic Therapy, Stroke, Ischemic Stroke, Thrombectomy, business.industry, Cerebral infarction, Endovascular Procedures, General Medicine, Thrombolysis, medicine.disease, 3. Good health, Treatment Outcome, Propensity score matching, Cardiology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Surgery, Neurology (clinical), Internal carotid artery, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030217 neurology & neurosurgery
Abstract

BackgroundEndovascular therapy (EVT) is effective and safe in patients with tandem occlusion. The benefit of intravenous thrombolysis (IVT) prior to EVT in acute tandem occlusion is debatable.ObjectiveTo compare EVT alone with EVT plus IVT in patients with acute ischemic stroke due to anterior circulation tandem occlusions.MethodsThis is an individual patient pooled analysis of the Thrombectomy In TANdem lesions (TITAN) and Endovascular Treatment in Ischemic Stroke (ETIS) Registries. Patients were divided into two groups based on prior IVT treatment: (1) IVT+ group, which included patients who received IVT prior to EVT, (2) IVT− group, which included patients who did not receive IVT prior to EVT. Propensity score (inverse probability of treatment weighting (IPTW)) was used to reduce baseline between-group differences. The primary outcome was favorable outcome—that is, modified Rankin Scale (mRS) score 0 to 2 at 90 days.ResultsOverall, 602 consecutive patients with an acute stroke with tandem occlusion were included (380 and 222 in the bridging therapy and EVT alone groups, respectively). Onset to imaging time was shorter in the IVT+ group (median 103 vs 140 min). In contrast, imaging to puncture time was longer in the IVT+ group (median 107 vs 91 min). In IPTW analysis, the IVT+ group had higher odds of favorable outcome, excellent outcome (90-day mRS score 0–1), and successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b/3 at the end of EVT). There was no difference in the risk of significant hemorrhagic complications between groups. In secondary analysis of patients treated with acute cervical internal carotid artery stenting, bridging therapy was associated with higher odds of favorable outcome and lower odds of mortality at 90 days.ConclusionsOur results suggest that bridging therapy in patients with acute ischemic stroke due to anterior tandem occlusion is safe and may improve functional outcome, even in the setting of acute cervical internal carotid artery stenting during EVT.

Published
2021
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7. 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

8. Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study.

Author

Dumas, Victor, Kaesmacher, Johannes, Ognard, Julien, Forestier, Geraud, Dargazanli, Cyril, Janot, Kevin, Behme, Daniel, Shotar, Eimad, Chabert, Emmanuel, Velasco, Stephane, Bricout, Nicolas, Hassen, Wagih Ben, Veunac, Louis, Geismar, Maxime, Eugene, Francois, Detraz, Lili, Darcourt, Jean, L'Allinec, Vincent, Eker, Omer F., and Consoli, Arturo

Subjects
SURGICAL complication risk factors, CAROTID artery, CONFIDENCE intervals, ISCHEMIC stroke, ARTERIAL puncture, RETROSPECTIVE studies, TREATMENT effectiveness, RISK assessment, TREATMENT failure, THROMBECTOMY, DESCRIPTIVE statistics, PATIENT safety, EVALUATION
Abstract

Background In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access. Methods We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications. Results From January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0-2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043). Conclusion In this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT. [ABSTRACT FROM AUTHOR]

Published
2022
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9. 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
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