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1. Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

Author: Candice Sabben, Frédérique Charbonneau, François Delvoye, Davide Strambo, Mirjam R. Heldner, Elodie Ong, Adrien Ter Schiphorst, Hilde Henon, Wagih Ben Hassen, Thomas Agasse-Lafont, Loïc Legris, Igor Sibon, Valérie Wolff, Denis Sablot, Mahmoud Elhorany, Cécile Preterre, Nour Nehme, Sébastien Soize, David Weisenburger-Lile, Aude Triquenot-Bagan, Gioia Mione, Andreea Aignatoaie, Jérémie Papassin, Roxana Poll, Yannick Béjot, Emmanuel Carrera, Pierre Garnier, Patrik Michel, Guillaume Saliou, Pasquale Mordasini, Yves Berthezene, Vincent Costalat, Nicolas Bricout, Gregory W. Albers, Mikael Mazighi, Guillaume Turc, Pierre Seners, Kateryna Antonenko, Caroline Arquizan, Lynda Benammar, Claire Boutet, Frédéric Clarençon, Pierre-Olivier Comby, Hubert Desal, Olivier Detante, François Eugene, Emmanuel Gerardin, Benjamin Gory, Stéphane Kremer, Sylvain Ledure, Mathieu Krug, Bertrand Lapergue, Philippe Niclot, Christophe Magni, Michael Obadia, Canan Ozsancak, Fernando Pico, Sara Pilgram-Pastor, Raoul Pop, Sébastien Richard, Charlotte Rosso, Julien Savatovsky, Solène Moulin, Clément Tracol, and Martin Zbinden
Subjects: Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown. Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0–2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0–1), symptomatic intracranial hemorrhage, and early neurological deterioration. Results: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63–82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4–10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66–1.01]; P =0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95–1.43]; P =0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35–4.67]; P =0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64–3.84]; P Conclusions: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.
Published: 2023

2. Successful thrombectomy is beneficial in patients with pre-stroke disability: Results from an international multicenter cohort study

Author: Célina Ducroux, Laurent Derex, Mikaïl Nourredine, Julie Haesebaert, Marielle Buisson, Walid Alesefir, William Boisseau, Nicole Daneault, Yan Deschaintre, Jose Danilo B. Diestro, Omer Eker, Johanna Eneling, Laura C. Gioia, Daniella Iancu, Grégory Jacquin, Céline Odier, Christian Stapf, Jean Raymond, Daniel Roy, Alain Weill, Bertrand Lapergue, Alexandre Y. Poppe, Michel Piotin, Raphael Blanc, Hocine Redjem Simon Escalard, Jean-Philippe Desilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Solène Hebert, Mikael Mazighi, 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 Savatovsky, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, 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, Francis Turjman, Tae-Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, Anne-Evelyne Vallet, Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon, Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Nolwenn Riou-Comte, Gérard Audibert, Marcela Voicu, Ionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar, Francisco Macian-montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Vincent Costalat, Caroline Arquizan, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst, 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, Olivier Naggara, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Guillaume Turc, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun, Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calviere, Jean Darcourt, Philippe Tall, Guillaume Bellanger, Louis Fontaine, Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Serge Timsit, Jean-christophe Gentric, Julien Ognard, Francois Mathias Merrien, Ozlem Ozkul Wermester, Evelyne Massardier, Chrysanthi Papagiannaki, Frédéric Bourdain, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue, Valérie Wolff, Raoul Pop, Rémi Beaujeux, Mihoc Dan-Sorin, Monica Manisor, Anthony Le Bras, Sarah Evain, Arnaud Le Guen, Sebastian Richter, Regis Hubrecht, Stéphanie Demasles, Bruno Barroso, Denis Sablot, Geoffroy Farouil, Maxime Tardieu, Philippe Smadja, Sabine Aptel, and Ian Seiler
Subjects: Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Abstract: Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion.Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes.Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048).In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.
Published: 2023

3. Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020

Author: Aguiar de Sousa, Diana, primary, Wilkie, Arlene, additional, Norrving, Bo, additional, Macey, Chris, additional, Bassetti, Claudio, additional, Tiu, Cristina, additional, Roth, Greg, additional, Lunde, Grethe, additional, Christensen, Hanne, additional, Fiehler, Jens, additional, Pezzella, Francesca Romana, additional, Dichgans, Martin, additional, Roaldsen, Melinda B, additional, Kelly, Peter, additional, Mikulik, Robert, additional, Sacco, Simona, additional, Caso, Valeria, additional, Fischer, Urs, additional, Basha, Entela, additional, Yeghiazaryan, Nune, additional, Kiechl, Stefan, additional, Shiraliyeva, Rana, additional, Vanacker, Peter, additional, Bender, Marija, additional, Emilov Tsalta-Mladenov, Mihael, additional, Budincevic, Hrvoje, additional, Tomek, Ales, additional, Kaponides, Georgios, additional, Klingenberg Iversen, Helle, additional, Faiss, Jürgen, additional, Kõrv, Janika, additional, Sairanen, Tiina, additional, Igor, Sibon, additional, Tsiskaridze, Alexander, additional, Ntaios, George, additional, Tsivgoulis, Georgios, additional, Szapary, Laszlo, additional, Logi Thorarinsson, Bjorn, additional, Harbison, Joe, additional, Bornstein, Natan M., additional, Toni, Danilo, additional, Fisnik, Jashari, additional, Karbozova, Kunduz, additional, Miglane, Evija, additional, Dalius, Jatužis, additional, Droste, Dirk, additional, Mallia, Maria, additional, Jevto, Erakovic, additional, Arsovska, Anita, additional, Fromm, Annette, additional, Kobayashi, Adam, additional, Azevedo, Elsa, additional, Groppa, Stanislav, additional, Cristina, Tiu, additional, Guekht, Alla, additional, Zivanovic, Zeljko, additional, Nosal, Vladimir, additional, Zvan, Bojana, additional, López-Cancio, Elena, additional, Pérez de la Ossa, Natàlia, additional, Nedeltchev, Krassen, additional, Vrijhoef, Bert, additional, Akif Topcuoglu, Mehmet, additional, Flomin, Yuriy, additional, Ahmed, Rubina, additional, Shelesko, Andrey, additional, Petrela, Mentor, additional, Zubalova, Lina, additional, Hasanov, Rovshan, additional, Raedt, Sylvie De, additional, Nevena, Mahmutbegović, additional, Peteva Andonova, Silva, additional, Poljakovic, Zdravka, additional, Skoda, Ondrej, additional, Søren Paaske, Johnsen, additional, med. Helmuth Steinmetz, Prof. Dr., additional, Denis, Sablot, additional, Lobjanidze, Nino, additional, Milionis, Haralambos, additional, Mitsias, Panagiotis, additional, Tarkanyi MD, Gabor, additional, Elisabeth Klinke, Marianne, additional, Tanne, David, additional, Luca, Petraglia, additional, Dren, Boshnjaku, additional, Turgumbaev, Dzhamal, additional, Guntis, Karelis, additional, Mladen, Debeljevic, additional, Kurz, Martin, additional, Anna, Czlonkowska, additional, Eremei, Zota, additional, Elena Oana, Terecoasa, additional, Martinov, Mikhail, additional, Jovanović, Dejana, additional, Gdovinova, Zuzana, additional, Camps Renom, Pol, additional, Kwa, Vincent, additional, Murat Arsava, Ethem, additional, Gulyayeva, Maryna, additional, Dharmasiri, Michelle, additional, Korompoki, Eleni, additional, Vadikolias, Konstantinos, additional, Bereczki MD, Daniel, additional, Bryndis Einarsdottir, Anna, additional, Afrim, Blyta, additional, Mamytova, Elmira, additional, Kristaps, Jurjans, additional, Daiva, Rastenytė, additional, Costache, Oana, additional, Milovan, Roganovic, additional, Michal, Karlinski, additional, Alexandru, Gasnas, additional, Sorin, Tuta, additional, Fidler, Mikhail, additional, Raičević, Ranko, additional, Zaletel, Marjan, additional, Castellanos, Mar, additional, Gómez-Choco, Manuel, additional, Sirin, Hadiye, additional, Lebedynets, Dmytro, additional, Khaira, Jattinder, additional, Enesi, Eugen, additional, Sahakyan, David, additional, Mammadbayli, Ayten, additional, Lemmens, Robin, additional, Dževdet, Smajlović, additional, Sramek, Martin, additional, Nabavi, med. Darius, additional, Vibo, Riina, additional, Strbian, Daniel, additional, Aliyev, Rahim, additional, Ozretic, David, additional, Rocek, Miloslav, additional, Trine, Stavngaard, additional, med. Claus Zimmer, Prof. Dr., additional, Malikov, Vladislav, additional, Lappalainen, Kimmo, additional, Jerome, Berge, additional, Khinikadze, Mirza, additional, Brountzos, Elias, additional, Vilmarsson, Vilhjalmur, additional, Karlis, Kupcs, additional, Marius, Kurminas, additional, Hoffmann, Michel, additional, Grech, Reuben, additional, Marija, Mitric, additional, Kjellevold Wathle, Gaute, additional, Wojciech, Poncyljusz, additional, Igor, Crivorucica, additional, Bogdan, Dorobat, additional, Till, Viktor, additional, Klepanec, Andrej, additional, Milosevic, Zoran, additional, Macho, Juan, additional, Ozdemir, Ozcan, additional, Shchehlov, Dmytro, additional, Dorte, Damgaard, additional, Hermanek, Peter, additional, Sturua, Lela, additional, Siskou, Olga, additional, Libruder, Carmit, additional, Indredavik, Bent, additional, Elena, Manole, additional, Mijajlović, Milija, additional, Turcani, Peter, additional, Bonati, Leo, additional, Nederkoorn, Paul, additional, Ertuğrul Eğin, Muhammed, additional, Samofalov, Dmytro, additional, Diana, Ose, additional, and Rita, Gaidelytė, additional
Published: 2023
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4. Endovascular treatment for acute ischemic stroke at a primary stroke center: First results of the Perpignan center

Author: Denis Sablot, Adrian Dumitrana, Anais Dutray, Snejana Jurici, Philippe Smadja, Sabine Aptel, Caroline Arquizan, A. Ferraro, I. Seiller, Nadège Olivier, Franck Leibinger, M.-J. Ibanez-Julia, Maxime Tardieu, Vincent Costalat, L. Bonafe, L. Nguyen Them, Gregory Gascou, Geoffroy Farouil, L. Van Damme, Julie Mas, and Bénédicte Fadat
Subjects: medicine.medical_specialty, Brain Ischemia, Time-to-Treatment, Internal medicine, medicine, Humans, Favorable outcome, Endovascular treatment, Stroke, Acute ischemic stroke, Ischemic Stroke, Retrospective Studies, Thrombectomy, business.industry, Mortality rate, Endovascular Procedures, medicine.disease, Clinical trial, Treatment Outcome, Neurology, Cardiology, Observational study, Neurology (clinical), business, Large vessel occlusion
Abstract: Introduction Converting a high-volume primary stroke center (PSC) into a stroke center that can perform emergency endovascular treatment (EVT) could reduce the time to thrombectomy . We report the first results of a newly established EVT facility at the Perpignan PSC and their comparison with the targets defined by the established guidelines. Patients and method For this comprehensive observational study, data of patients with acute ischemic stroke (AIS) due to proximal large vessel occlusion (LVO) and treated by EVT at the Perpignan PSC from December 5, 2019 to September 15, 2020 were extracted from an ongoing prospective database. Results During the study period, 37 patients underwent EVT at the Perpignan PSC. The median (range) symptom-onset to recanalization time was 262 min (100–485 min). The median (range) intra-hospital times were: 20 min (2–58 min) for door-to-imaging, 57 min (30–155 min) for imaging-to-puncture, 55 min (15–180 min) for puncture-to-recanalization, and 137 min (59–319 min) for door-to-recanalization. At 3 months post-AIS, the favorable outcome (modified Ranking Score: 0–2) rate was 50% and the mortality rate was 19.4%. These results are comparable to those of previous clinical trials, and meet the targets defined by the current consensus statements for EVT. Discussion and conclusion Our results show the feasibility and safety of EVT in a PSC for patients with AIS due to LVO. The implementation of this strategy may be important for shortening the time to thrombectomy.
Published: 2022

5. Neuropathie sensitive sous anti-TNF alpha (infliximab) : à propos d’un cas

Author: Mahamadou Sacko, François Cassarini Jean, Keita Boubacar Mady, and Denis Sablot
Subjects: Neurology, Neurology (clinical)
Published: 2023

6. Predictive value of DWI posterior-circulation lesion volume for 90-day clinical outcome after endovascular treatment of acute basilar artery occlusion: a retrospective single-center study

Author: Frederique Pavillard, Julien Labreuche, Federico Cagnazzo, Adrien Ter Schiphorst, Emmanuelle Lebars, Imad Derraz, Caroline Arquizan, Mehdi Mahmoudi, Vincent Costalat, Denis Sablot, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, and Cyril Dargazanli
Subjects: medicine.medical_specialty, business.industry, Mortality rate, Endovascular Procedures, Area under the curve, Arterial Occlusive Diseases, Odds ratio, Single Center, medicine.disease, Confidence interval, Treatment Outcome, Predictive Value of Tests, Modified Rankin Scale, Interquartile range, Basilar Artery, Internal medicine, Cardiology, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Stroke, Retrospective Studies
Abstract: Purpose The relationship between posterior-circulation lesion volume (PCLV) and clinical outcomes is poorly investigated. We aimed to analyze, in patients with acute basilar artery occlusion (ABAO), if pre-endovascular treatment (EVT) PCLV was a predictor of outcomes. Methods We analyzed consecutive MRI selected, endovascularly treated ABAO patients. Baseline PCLV was measured in milliliters on apparent diffusion-coefficient map reconstruction. Univariable and multivariable logistic models were used to test if PCLV was a predictor of 90-day outcomes. After the received operating characteristic (ROC) analysis, the optimal cut-off was determined to evaluate the prognostic value of PCLV. Results A total of 110 ABAO patients were included. The median PCLV was 4.4 ml (interquartile range, 1.3-21.2 ml). Successful reperfusion was achieved in 81.8% of cases after EVT. At 90 days, 31.8% of patients had a modified Rankin scale ≤ 2, and the mortality rate was 40.9%. PCLV was an independent predictor of functional independence and mortality (odds ratio [OR]:0.57, 95% confidence interval [CI], 0.34-0.93 and 1.84, 95% CI, 1.23-2.76, respectively). The ROC analysis showed that a baseline PCLV ≤ 8.7 ml was the optimal cut-off to predict the 90-day functional independence (area under the curve [AUC] = 0.68, 95% CI, 0.57-0.79, sensitivity 88.6%, and specificity 49.3%). In addition, a PCLV ≥ 9.1 ml was the optimal cut-off for the prediction of 90-day mortality (AUC = 0.71, 95% CI, 0.61-0.82, sensitivity 80%, and specificity 60%). Conclusions Pre-treatment PCLV was an independent predictor of 90-day outcomes in ABAO. A PCLV ≤ 8.7 and ≥ 9.1 ml may identify patients with a higher possibility to achieve independence and a higher risk of death at 90 days, respectively.
Published: 2021

7. Présentation clinique et paraclinique de l’encéphalite à AK5 : à propos d’un cas

Author: Mahamadou Sacko, François Cassarini Jean, Keita Boubacar Mady, and Denis Sablot
Subjects: Neurology, Neurology (clinical)
Published: 2023

8. Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed?

Author: Naouel Boulenoir, Guillaume Turc, Adrien Ter Schiphorst, Mirjam R. Heldner, Davide Strambo, Nadia Laksiri, Isabelle Girard Buttaz, Jérémie Papassin, Igor Sibon, Nicolas Chausson, Patrik Michel, Charlotte Rosso, Frédéric Bourdain, Chantal Lamy, David Weisenburger-Lile, Pierre Agius, Marion Yger, Michael Obadia, Denis Sablot, Nicolas Legris, Simon Jung, Sara Pilgram-Pastor, Hilde Henon, Lucy Bernardaud, Caroline Arquizan, Jean-Claude Baron, Pierre Seners, Wagih Ben Hassen, Bertrand Lapergue, Ludovic Lucas, Didier Leys, Frédéric Philippeau, Omar Bennani, Laura Mechtouff, Frédéric Klapczynski, Olivier Detante, Vincent Costalat, Gioia Mione, Sébastien Gazzola, Séverine Debiais, Serkan Cakmak, Valer Grigoras, Christian Denier, Didier Smadja, François Mounier-Vehier, Roxane Peres, Laurent Spelle, Nicolas Bricout, Serge Bracard, Aude Triquenot, Aïcha Lyoubi, Jean-Philippe Cottier, Duc-Long Duong, Camille Ollivier, 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), 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), GHU Paris Psychiatrie et Neurosciences, Département de neurologie [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), Université de Montpellier (UM), Université de Lausanne = University of Lausanne (UNIL), Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Grenoble, [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), CHU Bordeaux [Bordeaux], Centre Hospitalier Sud Francilien, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Neurologie - Côte Basque, Centre Hospitalier de la Côte Basque (CHCB), CHU Amiens-Picardie, Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), Hôpital Foch [Suresnes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier de Saint-Nazaire, CHU Saint-Antoine [AP-HP], Infrastructure de recherche clinique en psychiatrie adulte [ICM Paris] (iCRIN psychiatrie), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Saint Jean de Perpignan, Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lille Neurosciences & Cognition - U 1172 (LilNCog), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Saint-Anne (GHU Paris), FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité)
Subjects: Advanced and Specialized Nursing, Carotid Artery Diseases, carotid artery, anticoagulant, 360 Soziale Probleme, Sozialdienste, Anticoagulants, Arterial Occlusive Diseases, Thrombosis, embolism, Brain Ischemia, Stroke, Treatment Outcome, Fibrinolytic Agents, thrombus, internal, Humans, Thrombolytic Therapy, Neurology (clinical), Cardiology and Cardiovascular Medicine, 610 Medizin und Gesundheit, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Carotid Artery, Internal, Ischemic Stroke, Retrospective Studies, Thrombectomy
Abstract: Background: We recently reported a worrying 30% rate of early neurological deterioration (END) occurring within 24 hours following intravenous thrombolysis (IVT) in minor stroke with isolated internal carotid artery occlusion (ie, without additional intracranial occlusion), mainly due to artery-to-artery embolism. Here, we hypothesize that in this setting IVT—as compared to no-IVT—may foster END, in particular by favoring artery-to-artery embolism from thrombus fragmentation. Methods: From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score 7d ) and 3-month modified Rankin Scale score 0 to 1. Results: Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END 7d occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07–3.92]; P =0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P =0.09). However, END 7d and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END 7d : adjusted hazard ratio, 1.29 [95% CI, 0.75–2.23]; P =0.37; modified Rankin Scale score of 0–1: adjusted odds ratio, 1.1 [95% CI, 0.6–2.2]; P =0.71). END 7d occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9–10.1) versus 20.4 hours (interquartile range, 7.8–34.4), respectively, P Conclusions: In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END—particularly END due to artery-to-artery embolism—occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.
Published: 2022
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9. Pathologic and MRI analysis in acute atypical inflammatory demyelinating lesions

Author: Thierry Vincent, A.-M. Guennoc, Pierre Labauge, Anne Kerbrat, François Cotton, Stéphane Kremer, Béatrice Carsin-Nicol, Mahmoud Charif, Sandra Vukusic, Thibaut Allou, Jérôme De Seze, Aurélie Ruet, Laurent Magy, Nicolas Menjot de Champfleur, Clarisse Carra-Dalliere, Guido Ahle, Eric Thouvenot, Françoise Durand-Dubief, Hélène Oesterle, Valérie Rigau, Denis Sablot, Romain Marignier, Nicolas Collongues, Gilles Edan, Mikael Cohen, Sonia Hebbadj, Benoit Lhermitte, Frederic Taithe, M. P. Boncoeur-Martel, Xavier Ayrignac, Grelier, Elisabeth, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Neurosciences de Montpellier (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service d'Anatomie Pathologique Générale, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Département d’Immunologie, 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 Neurologie [Strasbourg], CHU Strasbourg-Hopital Civil, Service de radiologie [Strasbourg], Service de Neurologie [Hôpitaux Civils de Colmar], Hôpitaux Civils Colmar, Hôpitaux Civils de Colmar, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), 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 Claude Bernard Lyon 1 (UCBL), 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), Pierre Wertheimer, Département de Neurologie, Service de Neurologie [Lyon], CHU Lyon, Service de Neurologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Pasteur [Nice] (CHU), Service de Neurologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Service de neurologie [Rennes], Université de Rennes (UR), Service de neurochirurgie [Rennes] = Neurosurgery [Rennes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Neurologie [CHU Nimes] (Pôle NIRR), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Neuroinflammation: imagerie et thérapie de la sclérose en plaques, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de Radiologie et Imagerie Médicale [CHU Limoges], Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), 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)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-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), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, Atypical inflammatory demyelinating syndrome, medicine.medical_specialty, Pathology, Multiple Sclerosis, Histopathology, Context (language use), Immunopathology, Cohort Studies, Lesion, Young Adult, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Pathological, Aged, Retrospective Studies, Neuroradiology, Aquaporin 4, medicine.diagnostic_test, business.industry, Multiple sclerosis, Brain biopsy, Neuromyelitis Optica, food and beverages, Magnetic resonance imaging, Middle Aged, medicine.disease, Atypical demyelinating lesions, Magnetic Resonance Imaging, 3. Good health, Neurology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Acute Disease, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Neurology (clinical), medicine.symptom, business, Aquaporin-4, 030217 neurology & neurosurgery, Demyelinating Diseases
Abstract: The diagnosis of atypical inflammatory demyelinating lesions can be difficult. Brain biopsy is often required to exclude neoplasms. Moreover, the relationship between these lesions and multiple sclerosis and NMOSD is not clear. Our objectives were to describe radiological and pathological characteristics of patients with acute inflammatory demyelinating lesions. We retrospectively identified patients with brain biopsy performed for diagnostic uncertainty revealing a demyelinating lesion. A complete clinical, biological, radiological and pathological analysis was performed. Twenty patients (15 with a single lesion) were included. MRI disclosed a wide range of lesions including infiltrative lesions (40%), ring-like lesion (15%) Balo-like lesion (15%) and acute haemorrhagic leukoencephalitis (20%). In spite of a marked heterogeneity, some findings were common: a peripheral B1000 hyperintense rim (70%), a slight oedema with mild mass effect (75%) and an open-rim peripheral enhancement (75%). Histopathology revealed that all cases featured macrophages distributed throughout, extensive demyelination, axonal preservation and absence of haemorrhagic changes. In the majority of cases, macrophages were the predominant inflammatory infiltrate and astrocytes were reactive and dystrophic. Aquaporin-4 staining was systematically preserved. After a mean follow-up of 5 years (1–12), 16/20 patients had a diagnosis of monophasic acute atypical inflammatory demyelinating lesion. One patient was diagnosed with MS and 3 with AQP4 negative NMOSD. Although imaging findings in patients with atypical inflammatory demyelinating lesions are heterogeneous, some common features such as peripheral DWI hyperintense rim with open-rim enhancement and absence of oedema argue in favour of a demyelinating lesion and should preclude a brain biopsy. In this context, AQP4 staining is systematically preserved and argues against an AQP4-positive NMOSD. Moreover, long-term follow-up is characterized by low recurrence rate.
Published: 2019

10. Patent foramen ovale closure in stroke patients with migraine in the CLOSE trial. The CLOSE-MIG study

Author: Yannick Béjot, Benoit Guillon, Emmanuel Teiger, Caroline Arquizan, Serge Timsit, Olivier Detante, Geneviève Derumeaux, Emmanuel Touzé, Close investigators, Fabrice Vuillier, Sonia Alamowitch, Céline Guidoux, Gilles Chatellier, Denis Sablot, Pierre Aubry, Laurent Derex, Jean-Louis Mas, Anaïs Charles-Nelson, Sandrine Canaple, Evelyne Massardier, Igor Sibon, V. Domigo, Nelly Dequatre-Ponchelle, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Centre hospitalier universitaire de Nantes (CHU Nantes), CIC - HEGP (CIC 1418), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-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)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), GHU Paris Psychiatrie et Neurosciences, 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), Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, CHU Rouen, Normandie Université (NU), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Neurologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Registre Dijonnais des Accidents Vasculaires Cérébraux (AVC) - Dijon Stroke Registry, Centre d'épidémiologie des populations (CEP), Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire [Grenoble] (CHU), [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Saint Jean de Perpignan, Agence Régionale de Santé Occitanie (ARS Occitanie), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), 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), Physiopathologie et imagerie des troubles neurologiques (PhIND), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de neurologie [Amiens], CHU Amiens-Picardie, Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), CHU Saint-Antoine [AP-HP], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), 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), Université Paris Cité - UFR Médecine [Santé] (UPCité UFR Médecine), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-SFR Bordeaux Neurosciences-Centre National de la Recherche Scientifique (CNRS), Service de Neurologie [CHU Saint-Antoine], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Adult, medicine.medical_specialty, Stroke patient, Aura, Septal Occluder Device, [SDV]Life Sciences [q-bio], Migraine Disorders, Foramen Ovale, Patent, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Ischaemic stroke, medicine, Humans, 030212 general & internal medicine, Closure (psychology), Foramen ovale (heart), business.industry, Middle Aged, medicine.disease, Clinical trial, Stroke, medicine.anatomical_structure, Treatment Outcome, Neurology, Migraine, Cardiology, Patent foramen ovale, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Platelet Aggregation Inhibitors
Abstract: International audience; Background and purpose The efficacy of patent foramen ovale (PFO) closure to reduce the frequency of migraine attacks remains controversial. Methods This was a planned sub-study in migraine patients enrolled in a randomized, clinical trial designed to assess the superiority of PFO closure plus antiplatelet therapy over antiplatelet therapy alone to prevent stroke recurrence in patients younger than 60 years with a PFO-associated cryptogenic ischaemic stroke. The main outcome was the mean annual number of migraine attacks in migraine patients with aura and in those without aura, as recorded at each follow-up visit by study neurologists. Results Of 473 patients randomized to PFO closure or antiplatelet therapy, 145 (mean age 41.9 years; women 58.6%) had migraine (75 with aura and 70 without aura). Sixty-seven patients were randomized to PFO closure and 78 to antiplatelet therapy. During a mean follow-up of about 5 years, there were no differences between antiplatelet-only and PFO closure groups in the mean annual number of migraine attacks, both in migraine patients with aura (9.2 [11.9] vs. 12.0 [19.1], p = 0.81) and in those without aura (12.1 [16.1] vs. 11.8 [18.4], p > 0.999). There were no differences between treatment groups regarding cessation of migraine attacks, migraine-related disability at 2 years and use of migraine-preventive drugs during follow-up. Conclusions In young and middle-aged adults with PFO-associated cryptogenic stroke and migraine, PFO closure plus antiplatelet therapy did not reduce the mean annual number of migraine attacks compared to antiplatelet therapy alone, in migraine patients both with and without aura.
Published: 2021

11. Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke

Author: Bénédicte Fadat, Thibaut Allou, Denis Sablot, Vincent Costalat, Caroline Arquizan, Wael Chaabane, Majo Ibanez, Alain Bonafe, Philippe Smadja, Marlène Lachcar, Franck Leibinger, Alexandre Laverdure, Adrian Dumitrana, Isabelle Mourand, Chawki Jebali, Maxime Tardieu, Laurent Ortega, Adelaïde Ferraro, Ludovic Nguyen Them, Zoubir Mourad Bensalah, Julie Mas, Laurène Van Damme, Jean-Christophe Blenet, Nicolas Gaillard, Snejana Jurici, Gregory Gascou, Geoffroy Farouil, Frederique Damon, Ali Ousji, Sabine Aptel, D. Heve, Anais Dutray, Nadège Olivier, Centre Hospitalier Saint Jean de Perpignan, Département de neurologie [Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Agence Régionale de Santé Occitanie (ARS Occitanie), Université de Montpellier (UM), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Subjects: Male, Emergency Medical Services, medicine.medical_specialty, Neurology, Stroke management, medicine.medical_treatment, MESH: Stroke, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Stroke, Aged, Neuroradiology, Thrombectomy, MESH: Aged, Palsy, MESH: Humans, business.industry, MESH: Brain Ischemia, Thrombolysis, medicine.disease, Stroke unit, MESH: Male, MESH: Emergency Service, Hospital, Pre-hospital triage, Cardiology, MESH: Emergency Medical Services, Female, Observational study, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), Triage, Emergency Service, Hospital, business, MESH: Female, 030217 neurology & neurosurgery, MESH: Triage, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, First aid, Large vessel occlusion
Abstract: International audience; Background: In acute stroke, large vessel occlusion (LVO) should be promptly identified to guide patient's transportation directly to comprehensive stroke centers (CSC) for mechanical thrombectomy (MT). In many cases, prehospital multi-parameter scores are used by trained emergency teams to identify patients with high probability of LVO. However, in several countries, the first aid organization without intervention of skilled staff precludes the on-site use of such scores. Here, we assessed the accuracy of LVO prediction using a single parameter (i.e. complete hemiplegia) obtained by bystander's telephone-based witnessing.Patients and methods: This observational, single-center study included consecutive patients who underwent intravenous thrombolysis at the primary stroke center and/or were directly transferred to a CSC for MT, from January 1, 2015 to March 1, 2020. We defined two groups: patients with initial hemiplegia (no movement in one arm and leg and facial palsy) and patients without initial hemiplegia, on the basis of a bystander's witnessing.Results: During the study time, 874 patients were included [mean age 73 years (SD 13.8), 56.7% men], 320 with initial hemiplegia and 554 without. The specificity of the hemiplegia criterion to predict LVO was 0.88, but its sensitivity was only 0.53.Conclusion: Our results suggest that the presence of hemiplegia as witnessed by a bystander can predict LVO with high specificity. This single criterion could be used for decision-making about direct transfer to CSC for MT when the absence of emergency skilled staff precludes the patient's on-site assessment, especially in regions distant from a CSC.
Published: 2021

12. Intended Bridging Therapy or Intravenous Thrombolysis Alone in Minor Stroke With Basilar Artery Occlusion

Author: Laurent Suissa, Philippe Niclot, Denis Sablot, Bertrand Lapergue, Gioia Mione, Aude Triquenot, Isabelle Girard-Buttaz, Nadia Laksiri, Cyril Dargazanli, Michael Obadia, Cécile Preterre, Aïcha Lyoubi, Igor Sibon, Pierre Seners, Séverine Debiais, Duc-Long Duong, Caroline Arquizan, Guillaume Turc, Jean-Claude Baron, Jérémie Papassin, C. Lamy, Hilde Hénon, Pierre Garnier, Claire Perrin, Michel Piotin, Jean-Louis Mas, Serge Bracard, RANCHON, GUILLAUME, 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), FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Saint Jean de Perpignan, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier René Dubos [Pontoise], and MINOR-STROKE Collaborators: Claire Perrin, Caroline Arquizan, Chantal Lamy, Igor Sibon, Michael Obadia, Jérémie Papassin, Hilde Henon, Cécile Preterre, Laurent Suissa, Séverine Debiais, Aïcha Lyoubi, Pierre Garnier, Isabelle Girard-Buttaz, Bertrand Lapergue, Aude Triquenot, Duc-Long Duong, Nadia Laksiri, Gioia Mione, Jean-Louis Mas
Subjects: Male, medicine.medical_specialty, Bridging (networking), [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine.artery, Internal medicine, Fibrinolysis, ischemic stroke, Basilar artery, medicine, Vertebrobasilar Insufficiency, Humans, basilar artery, Thrombolytic Therapy, Propensity Score, Aged, Retrospective Studies, Thrombectomy, Advanced and Specialized Nursing, Aged, 80 and over, business.industry, Basilar artery occlusion, Minor stroke, Thrombolysis, Middle Aged, Combined Modality Therapy, [SDV] Life Sciences [q-bio], Mechanical thrombectomy, Stroke, Treatment Outcome, Ischemic stroke, Cardiology, fibrinolysis, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose: Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with basilar artery occlusion remains uncertain. Methods: Multicentric retrospective observational study of consecutive minor stroke patients (National Institutes of Health Stroke Scale score ≤5) with basilar artery occlusion intended for IVT alone or bridging therapy. Propensity-score weighting was used to reduce baseline between-groups differences, and residual imbalance was addressed through adjusted logistic regression, with excellent outcome (3-month modified Rankin Scale score 0–1) as the dependent variable. Results: Fifty-seven patients were included (28 and 29 in the bridging therapy and IVT alone groups, respectively). Following propensity-score weighting, the distribution of baseline clinical and radiological variables was similar across the 2 patient groups, except age, posterior circulation Alberta Stroke Program Early CT Score, history of hypertension and smoking, and onset-to-IVT time. Compared with IVT alone, bridging therapy was associated with excellent outcome (adjusted odds ratio=3.37 [95% CI, 1.13–10.03]; P =0.03). No patient experienced symptomatic intracranial hemorrhage. Conclusions: Our results suggest that bridging therapy may be superior to IVT alone in minor stroke with basilar artery occlusion.
Published: 2021

13. Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone

Author: Aïcha Lyoubi, Charles Arteaga, Caroline Arquizan, Philippe Niclot, Aude Triquenot, Charlotte Rosso, Laurent Suissa, Laurie Fraticelli, Frédéric Klapczynski, Marion Boulanger, Christine Pires, Patrik Michel, Didier Leys, Philippe Smadja, Mathilde Delpech, Stéphane Vannier, Yves Berthezène, Sébastien Richard, Sébastien Gazzola, Serge Timsit, Valérie Wolff, Jérémie Papassin, Laurent Spelle, Christian Denier, Yannick Béjot, Jean-Louis Mas, Anne-Evelyne Vallet, Catherine Oppenheim, Séverine Debiais, Serge Bracard, Olivier Detante, Andreea Aignatoaie, Frédéric Philippeau, François Lun, Denis Sablot, Emmanuel Touzé, Valer Grigoras, Sébastien Marcel, Hervé Brunel, Laura Mechtouff, Hubert Desal, Mirjam Rachel Heldner, Bertrand Lapergue, Vincent Costalat, Serkan Cakmak, Duc-Long Duong, Isabelle Serre, François Mounier-Vehier, Audrey Courselle-Arnoux, Sébastien Soize, Ludovic Lucas, Pierre Agius, Sonia Alamowitch, Isabelle Girard Buttaz, Michel Piotin, Pierre Garnier, Gauthier Duloquin, Davide Strambo, Nicolas Bricout, Omar Bennani, Emmanuel Carrera, Marion Yger, Hilde Hénon, Jean-Philippe Cottier, Nicolae Crainic, Michael Obadia, Cécile Preterre, Guillaume Turc, Steven Hajdu, Pierre Seners, Mathieu Zuber, Jean-Claude Baron, C. Lamy, Wagih Ben Hassen, Claire Perrin, Claire Boutet, Matthieu Krug, Clement Tracol, Amélie Tuffal, Norbert Nighoghossian, Arnaud Malbranque, Jan Gralla, Yves Samson, Benoit Guillon, Alexandre Obadia, Nadia Laksiri, Ruben Tamazyan, Mylène Masson, Frédéric Clarençon, Canan Ozsancak, Fernando Pico, Gioia Mione, Simon Jung, Mohamed Chbicheb, Igor Sibon, 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), Hôpital Foch [Suresnes], Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Bern University Hospital [Berne] (Inselspital), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Saint Jean de Perpignan, Centre hospitalier [Valenciennes, Nord], Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier de Saint-Nazaire, Hôpital de la Timone [CHU - APHM] (TIMONE), Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier de Versailles André Mignot (CHV), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier de Lens, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), 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], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux], CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre Hospitalier Métropole Savoie [Chambéry], Centre Hospitalier Régional d'Orléans (CHRO), CHU Rouen, Normandie Université (NU), Hôpitaux Universitaires de Genève (HUG), Centre Hospitalier René Dubos [Pontoise], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hôpital Delafontaine, Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Strasbourg, Centre Hospitalier Universitaire [Rennes], Centre Hospitalier Fleyriat [Bourg en Bresse], CHU Amiens-Picardie, Centre Hospitalier Universitaire de Reims (CHU Reims), MINOR-STROKE Collaborators : Sonia Alamowitch, Charles Arteaga, Omar Bennani, Yves Berthezene, Marion Boulanger, Claire Boutet, Serge Bracard, Nicolas Bricout, Hervé Brunel, Serkan Cakmak, Mohamed Chbicheb, Frédéric Clarençon, Vincent Costalat, Audrey Courselle-Arnoux, Séverine Debiais, Mathilde Delpech, Christian Denier, Hubert Desal, Olivier Detante, Gauthier Duloquin, Laurie Fraticelli, Sébastien Gazzola, Jan Gralla, Valer Grigoras, Benoit Guillon, Matthieu Krug, Steven Hajdu, Simon Jung, Frédéric Klapczynski, Didier Leys, François Lun, Arnaud Malbranque, Sébastien Marcel, Patrik Michel, Jean-Louis Mas, Mylène Masson, Norbert Nighoghossian, Michael Obadia, Catherine Oppenheim, Canan Ozsancak, Fernando Pico, Michel Piotin, Christine Pires, Sébastien Richard, Yves Samson, Isabelle Serre, Igor Sibon, Philippe Smadja, Laurent Spelle, Laurent Suissa, Serge Timsit, Emmanuel Touzé, Amélie Tuffal, Anne-Evelyne Vallet, Marion Yger, Stéphane Vannier, Mathieu Zuber., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), 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), and Martinez Rico, Clara
Subjects: medicine.medical_specialty, medicine.medical_treatment, Population, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, medicine.artery, Occlusion, medicine, 030212 general & internal medicine, 10. No inequality, education, 610 Medicine & health, Stroke, Original Investigation, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, [SCCO.NEUR] Cognitive science/Neuroscience, Retrospective cohort study, Thrombolysis, medicine.disease, ddc:616.8, Cohort, Cardiology, Neurology (clinical), Internal carotid artery, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Importance The best reperfusion strategy in patients with acute minor stroke and large vessel occlusion (LVO) is unknown. Accurately predicting early neurological deterioration of presumed ischemic origin (ENDi) following intravenous thrombolysis (IVT) in this population may help to select candidates for immediate transfer for additional thrombectomy. Objective To develop and validate an easily applicable predictive score of ENDi following IVT in patients with minor stroke and LVO. Design, Setting, and Participants This multicentric retrospective cohort included 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5 or less) and LVO (basilar artery, internal carotid artery, first [M1] or second [M2] segment of middle cerebral artery) intended for IVT alone in 45 French stroke centers, ie, including those who eventually received rescue thrombectomy because of ENDi. For external validation, another cohort of 347 patients with similar inclusion criteria was collected from 9 additional centers. Data were collected from January 2018 to September 2019. Main Outcomes and Measures ENDi, defined as 4 or more points' deterioration on NIHSS score within the first 24 hours without parenchymal hemorrhage on follow-up imaging or another identified cause. Results Of the 729 patients in the derivation cohort, 335 (46.0%) were male, and the mean (SD) age was 70 (15) years; of the 347 patients in the validation cohort, 190 (54.8%) were male, and the mean (SD) age was 69 (15) years. In the derivation cohort, the median (interquartile range) NIHSS score was 3 (1-4), and the occlusion site was the internal carotid artery in 97 patients (13.3%), M1 in 207 (28.4%), M2 in 395 (54.2%), and basilar artery in 30 (4.1%). ENDi occurred in 88 patients (12.1%; 95% CI, 9.7-14.4) and was strongly associated with poorer 3-month outcomes, even in patients who underwent rescue thrombectomy. In multivariable analysis, a more proximal occlusion site and a longer thrombus were independently associated with ENDi. A 4-point score derived from these variables-1 point for thrombus length and 3 points for occlusion site-showed good discriminative power for ENDi (C statistic = 0.76; 95% CI, 0.70-0.82) and was successfully validated in the validation cohort (ENDi rate, 11.0% [38 of 347]; C statistic = 0.78; 95% CI, 0.70-0.86). In both cohorts, ENDi probability was approximately 3%, 7%, 20%, and 35% for scores of 0, 1, 2 and 3 to 4, respectively. Conclusions and Relevance The substantial ENDi rates observed in these cohorts highlights the current debate regarding whether to directly transfer patients with IVT-treated minor stroke and LVO for additional thrombectomy. Based on the strong associations observed, an easily applicable score for ENDi risk prediction that may assist decision-making was derived and externally validated.
Published: 2021

14. Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion

Author: Vincent Costalat, Julien Labreuche, Isabelle Mourand, Pierre-Henri Lefevre, I. Derraz, G. Gascou, Mehdi Mahmoudi, Cyril Dargazanli, Caroline Arquizan, Denis Sablot, F. Cagnazzo, Nicolas Gaillard, C. Scott, Alain Bonafe, A. Wacogne, Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Saint Jean de Perpignan, Département d'anesthésie-réanimation[Montpellier], and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]
Subjects: Male, Multivariate analysis, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Interquartile range, Medicine, MESH: Basilar Artery / pathology, MESH: Treatment Outcome, Thrombectomy, MESH: Thrombotic Stroke / surgery, MESH: Cerebral Angiography / methods, MESH: Middle Aged, Interventional, Mortality rate, MESH: Magnetic Resonance Imaging / methods, Endovascular Procedures, Atrial fibrillation, Thrombolysis, Middle Aged, Magnetic Resonance Imaging, MESH: Basilar Artery / surgery, medicine.anatomical_structure, Treatment Outcome, Basilar Artery, Cardiology, Female, medicine.medical_specialty, MESH: Endovascular Procedures / methods, MESH: Arterial Occlusive Diseases / surgery, Arterial Occlusive Diseases, MESH: Thrombectomy / methods, 03 medical and health sciences, Internal medicine, medicine.artery, Basilar artery, Humans, Radiology, Nuclear Medicine and imaging, Posterior communicating artery, Aged, Retrospective Studies, MESH: Humans, Groin, business.industry, MESH: Retrospective Studies, medicine.disease, MESH: Arterial Occlusive Diseases / complications, MESH: Reperfusion, Cerebral Angiography, Reperfusion, Neurology (clinical), Thrombotic Stroke, business, 030217 neurology & neurosurgery
Abstract: International audience; Background and purpose: Clinical outcomes after endovascular treatment for acute basilar artery occlusions need further investigation. Our aim was to analyze predictors of a 90-day good functional outcome defined as mRS 0-2 after endovascular treatment in MR imaging-selected patients with acute basilar artery occlusions.Materials and methods: We analyzed consecutive MR imaging-selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b-3 and 3, respectively. Outcome at 90 days was analyzed in univariate and multivariate analysis regarding baseline patient treatment characteristics and periprocedural outcomes.Results: One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases (n = 90; 95% CI, 73.3%-88.6%). At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes (interquartile range, 280-540 minutes). In multivariable analysis, complete reperfusion (OR = 6.59; 95% CI, 2.17-20.03), lower pretreatment NIHSS (OR = 0.77; 95% CI, 0.64-0.94), the presence of posterior communicating artery collateral flow (OR = 2.87; 95% CI, 1.05-7.84), the absence of atrial fibrillation (OR = 0.18; 95% CI, 0.03-0.99), and intravenous thrombolysis administration (OR = 2.75; 95% CI, 1.04-7.04) were associated with 90-day favorable outcome.Conclusions: In our series of MR imaging-selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome.
Published: 2020

15. Bridging therapy or IV thrombolysis in minor stroke with large vessel occlusion

Author: Gioia Mione, Pierre Seners, Isabelle Girard Buttaz, Claire Perrin, Guillaume Turc, Ruben Tamazyan, Jean-Claude Baron, Hilde Hénon, Denis Sablot, Bertrand Lapergue, Cécile Preterre, Nadia Laksiri, Ludovic Lucas, Séverine Debiais, Caroline Arquizan, 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), Hôpital Foch [Suresnes], Département de neurologie[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Centre Hospitalier Saint Jean de Perpignan, Neurologie - Centre Hospitalier de Valenciennes (CHV), Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de neurologie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, MINOR-STROKE collaborators : Achard S, Agius P, Alamowitch S, Arteaga C, Bennani O, Ben Hassen W, Ben Maacha M, Berthezene Y, Boulanger M, Boutet C, Bracard S, Bricout N, Brunel H, Cakmak S, Charron S, Charron V, Chassin O, Clarençon F, Chbicheb M, Consoli A, Cottier JP, Courselle-Arnoux A, Dargazanli C, Denier C, Dereeper O, Derex L, Desal H, Detante O, Duong DL, Fraticelli L, Gazzola S, Garnier P, Grigoras V, Gouttard S, Guedon A, Hattinguais J, Henri C, Klapczynski F, Lamy C, Ledure S, Leys D, Lopez D, Lun F, Lyoubi A, Malbranque A, Marcel S, Louis Mas J, Masson M, Mechtouff L, Mounier-Vehier F, Niclot P, Nighoghossian N, Obadia A, Oppenheim C, Papagiannaki C, Papassin J, Philippeau F, Pico F, Piotin M, Pires C, Rosso C, Samson Y, Serre I, Sibon I, Soize S, Smadja P, Spelle L, Suissa L, Triquenot A, Tuffal A, Vallet AE, Yger M, Zuber M., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Département de neurologie [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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 Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Martinez Rico, Clara
Subjects: 0301 basic medicine, Male, medicine.medical_specialty, Bridging (networking), medicine.medical_treatment, [SDV]Life Sciences [q-bio], Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Internal medicine, Occlusion, Medicine, Humans, Thrombolytic Therapy, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Aged, Retrospective Studies, Thrombectomy, Aged, 80 and over, business.industry, Endovascular Procedures, Minor stroke, Retrospective cohort study, Odds ratio, Thrombolysis, Middle Aged, Combined Modality Therapy, Confidence interval, 3. Good health, [SDV] Life Sciences [q-bio], Stroke, 030104 developmental biology, Treatment Outcome, Neurology, Cardiology, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), business, 030217 neurology & neurosurgery, Large vessel occlusion
Abstract: OBJECTIVE Whether bridging therapy (intravenous thrombolysis [IVT] followed by endovascular treatment) is superior to IVT alone in minor stroke with large vessel occlusion (LVO) is unknown. METHODS Multicentric retrospective observational study including, in intention-to-treat, consecutive IVT-treated minor strokes (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with LVO, with or without additional mechanical thrombectomy. Propensity-score (inverse probability of treatment weighting) was used to reduce baseline between-groups differences. The primary outcome was excellent outcome, that is, modified Rankin score 0 to 1 at 3 months follow-up. RESULTS Overall, 598 patients were included (214 and 384 in the bridging therapy and IVT groups, respectively). Following propensity-score weighting, the distribution of baseline clinical and radiological variables was similar across the two patient groups. Compared with IVT alone, bridging therapy was not associated with excellent outcome (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.75-1.24; p = 0.76), but was associated with symptomatic intracranial hemorrhage (OR = 3.01; 95% CI = 1.77-5.11; p
Published: 2020

16. Résultat de l’enquête UNV 2020

Author: Denis Sablot
Subjects: Neurology, Neurology (clinical)
Abstract: Introduction Nombre d’UNV rencontrent des difficultes de fonctionnement du fait d’un effectif medical insuffisant. Cela perturbe la filiere AVC et met en peril les autres activites des services de Neurologie. L’objectif de cette etude est de realiser un etat des lieux de la demographie medicale dans les UNV en France, d’en preciser les difficultes actuelles (notamment sur la PDSES), d’en projeter l’evolution dans les 5 prochaines annees et de quantifier les besoins en terme de recrutement medical et de formation des internes. Methodologie Il s’agit d’une enquete declarative envoyee aux 146 responsables d’UNV Francaises en Decembre 2019. Les questions portaient sur l’activite de l’UNV (nombre d’AIC et de thrombolyses en 2019), le nombre de lignes UNV (activite de jour), le nombre de lignes de gardes/d’astreintes (Senior et junior) sur l’etablissement ou inter-etablissement, lignes pour faire fonctionner l’UNV, medecins exercant dans l’UNV en journee (avec leur statut, temps de travail, âge, diplome qualifiant, quota de gardes/astreintes), le nombre de praticiens participant aux gardes/astreintes, les difficultes de recrutement praticiens, les difficultes specifiques rencontrees pendant les periodes scolaires, les postes vacants et la duree de vacance, le recours a des medecins interimaires, les postes de DES et la vacance de ces postes, le recours a des FFI/AFS, le ratio IDE et AS/lit dans l’UNV, et les pistes d’amelioration du fonctionnement et d’attractivite de l’UNV. Resultats et conclusion A ce jour, 76 UNV ont renseigne l’enquete. Les resultats definitifs et la discussion seront livres lors des JNLF, laissant place a une controverse qui suivra cette presentation.
Published: 2021

17. Thrombectomy accessibility after transfer from a primary stroke center: Analysis of a three-year prospective registry

Author: Alain Bonafe, Jean-Marie Bonnec, Denis Sablot, Nicolas Gaillard, and Philippe Smadja
Subjects: Male, Patient Transfer, medicine.medical_specialty, 030204 cardiovascular system & hematology, Health Services Accessibility, Brain Ischemia, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Prospective Studies, Registries, Stroke, Interventional neuroradiology, Aged, Thrombectomy, business.industry, Brain, Stroke units, medicine.disease, Magnetic Resonance Imaging, Mechanical thrombectomy, Treatment Outcome, Neurology, Emergency medicine, Ischemic stroke, Physical therapy, Female, business, 030217 neurology & neurosurgery
Abstract: Background No comprehensive study exists about mechanical thrombectomy accessibility for patients admitted to a primary stroke center without onsite interventional neuroradiology service. Aims To evaluate mechanical thrombectomy accessibility within 6 h after transfer from a primary stroke center to a distant (156 km apart; 1.5 h by car) comprehensive stroke center. Methods Analysis of data collected in a three-year prospective registry on patients admitted to a primary stroke center within 4.5 h after symptom onset and selected for transfer to a comprehensive stroke center for mechanical thrombectomy. Eligible patients had confirmed proximal arterial occlusion and no large cerebral infarction on MRI images (DWI-ASPECTS ≥ 5). The rate of transfer, transfer without mechanical thrombectomy, mechanical thrombectomy, reperfusion (TICI score ≥ 2b-3), and the main relevant time measures were determined. Results Among the 385 patients selected for intravenous thrombolysis and/or potential mechanical thrombectomy, 211 were considered as transferrable for mechanical thrombectomy. The rate of transfer was 56.4% (n = 119/211), transfer without mechanical thrombectomy 56.3% (n = 67/119), mechanical thrombectomy 24.6% (n = 52/211), and reperfusion by MT (TICI score 2b/3) 18% (n = 38/211). The relevant median times (interquartile range) were: 130 min (62) for intravenous thrombolysis start to comprehensive stroke center door, 95 minutes (39) for primary stroke center door-out to comprehensive stroke center door-in, 191 min (44) for intravenous thrombolysis start to mechanical thrombectomy puncture, 354 min (107) for symptom onset to mechanical thrombectomy puncture and 417 min (124) for symptom onset to recanalization. Conclusions Our study suggests that transfer to a distant comprehensive stroke center is associated with reduced access to early mechanical thrombectomy in patients with acute ischemic stroke and large artery occlusion. These results could be translated to other high volume distant primary stroke center.
Published: 2017

18. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study

Author: O. Fain, Denis Sablot, C. Héroum, Thomas Ronzière, M. Gaudron, S. Di Legge, A. Lecluse, Olivier Detante, F. Dumont, S. Marcel, Sonia Alamowitch, D. Gobert, Isabelle Boccon-Gibod, Guillaume Marc, D. Smadja, Michael Obadia, D. Launay, S. Lefèvre, M. Sévin, Laurence Bouillet, Laurent Suissa, Stéphane Gayet, M. B. Vlaicu, Emilie Doche, Clara Vigneron, Nicolas Javaud, Igor Sibon, I. Ion, I. Arnaud, and P. Girard‐Madoux
Subjects: 0301 basic medicine, Male, medicine.medical_specialty, medicine.medical_treatment, Bradykinin, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Sex Factors, Risk Factors, Internal medicine, Internal Medicine, medicine, Humans, Thrombolytic Therapy, Angioedema, Aged, Mechanical ventilation, business.industry, Case-control study, Odds ratio, Thrombolysis, Stroke, 030104 developmental biology, chemistry, Case-Control Studies, Ischemic stroke, Cardiology, Female, France, medicine.symptom, business, Complication
Abstract: BACKGROUND Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS In a case-control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. RESULTS Fifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P
Published: 2019

19. Mechanical Recanalization after Transfer from a Distant Primary Stroke Center: Effectiveness and Future Directions

Author: Lucie Desmond, Ludovic Nguyen Them, Alain Bonafe, Franck Leibinger, Maxime Tardieu, Snejana Jurici, Adrian Dumitrana, Adelaïde Ferraro-Allou, Laurent Benayoun, Nicolas Gaillard, Julie Mas, Bénédicte Fadat, Sabine Aptel, Anais Dutray, Nadège Olivier, Philippe Smadja, Aziz Akouz, Caroline Arquizan, Jean Louis Bertrand, Geoffroy Farouil, Thibaut Allou, Denis Sablot, Majo Ibanez, Vincent Costalat, Isabelle Mourand, Laurène Van Damme, Jean-Marie Bonnec, Zoubir Mourad Bensalah, and Francis Coll
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Health Services Accessibility, Regional Health Planning, Time-to-Treatment, 03 medical and health sciences, Disability Evaluation, 0302 clinical medicine, Modified Rankin Scale, Interquartile range, Risk Factors, Internal medicine, medicine, Humans, Favorable outcome, Symptom onset, Prospective Studies, Registries, Stroke, Aged, Aged, 80 and over, Cerebral infarction, business.industry, Rehabilitation, Endovascular Procedures, Thrombolysis, Recovery of Function, Middle Aged, medicine.disease, Transportation of Patients, Treatment Outcome, Cardiology, Surgery, Female, Neurology (clinical), Comprehensive Health Care, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Large vessel occlusion
Abstract: Introduction: Little is known about the effectiveness of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) admitted to a primary stroke center (PSC). The aim of this study was to assess EVT effectiveness after transfer from a PSC to a distant (156 km apart; 1.5 hour by car) comprehensive stroke center (CSC), and to discuss perspectives to improve access to EVT, if indicated. Patients and Method: Analysis of the data collected in a 6-year prospective registry of patients admitted to a PSC for AIS due to LVO and selected for transfer to a distant CSC for EVT. The rate of transfer, futile transfer, EVT, reperfusion (thrombolysis in cerebral infarction score ≥2b-3), and relevant time measures were determined. Results: Among the 529 patients eligible, 278 (52.6%) were transferred and 153 received EVT (55% of transferred patients) followed by reperfusion in 115 (overall reperfusion rate: 21.7%). Median times (interquartile range) were: 90 minutes (76-110) for PSC-door-in to PSC-door-out, 88 minutes (65-104) for PSC-door-out to CSC-door-in, 262 minutes (239-316) for PSC-imaging to reperfusion, and 393 minutes (332-454) for symptom onset to reperfusion. At 3 months, rates of favorable outcome (modified Rankin Scale 0-2) were not significantly different between patients eligible for EVT (42.4%), transferred patients (49.1%) and patients who underwent EVT (34.1%). Discussion and Conclusions: Our study suggests that transfer to a distant CSC is associated with reduced access to early EVT. These results argue in favor of on-site EVT at high volume PSCs that are distant from the CSC.
Published: 2019

20. Which Patients Require Physician-Led Inter-Hospital Transport in View of Endovascular Therapy?

Author: Nicolas Gaillard, Adrian Dumitrana, Maxime Tardieu, Vincent Costalat, Ana-Maria Marquez, Sandra Cardini, Nadège Olivier, Laurent Benayoun, Celine Pujol, Francis Coll, Denis Sablot, Thibaut Allou, Majo Ibanez, Alain Bonafe, Snejana Jurici, Anais Dutray, Ludovic Nguyen Them, Caroline Arquizan, Nathalie Duchateau, Isabelle Mourand, Adelaïde Ferraro-Allou, Geoffroy Farouil, Julie Mas, Bénédicte Fadat, Philippe Smadja, Marlène Lachcar, Laurène Van Damme, Jean-Marie Bonnec, Sabine Aptel, and Franck Leibinger
Subjects: Male, Patient Transfer, medicine.medical_specialty, Multivariate analysis, Time Factors, medicine.medical_treatment, Clinical Decision-Making, 030204 cardiovascular system & hematology, Risk Assessment, Health Services Accessibility, Brain Ischemia, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Occlusion, medicine, Humans, Adverse effect, Physician's Role, Stroke, Aged, Retrospective Studies, Mechanical ventilation, Aged, 80 and over, business.industry, Endovascular Procedures, Atrial fibrillation, Middle Aged, medicine.disease, Prognosis, Emergency Medical Technicians, Neurology, Emergency medicine, Observational study, Female, Neurology (clinical), France, Cardiology and Cardiovascular Medicine, Complication, business, 030217 neurology & neurosurgery
Abstract: Introduction: The current guidelines advocate the implementation of stroke networks to organize endovascular treatment (ET) for patients with acute ischemic stroke due to large vessel occlusion (LVO) after transfer from a Primary Stroke Centre (PSC) to a Comprehensive Stroke Centre (CSC). In France and in many other countries around the world, these transfers are carried out by a physician-led mobile medical team. However, with the recent broadening of ET indications, their availability is becoming more and more critical. Here, we retrospectively analysed data of patients transferred from a PSC to a CSC for potential ET to identify predictive factors of major complications (MC) at departure and during transport that absolutely require the presence of a physician during interhospital transfer. Methods: This observational, single-centre study included patients with evidence of intracranial LVO transferred for ET from Perpignan to a 156 km-distant CSC between January 1, 2015 and December 31, 2018. We compared 2 groups: MC group (patients who required emergency intervention by the medical team due to life-threatening complications, including need of mechanical ventilation at departure) and non-MC group (all other patients who experienced no or only minor complications that could be managed by the emergency paramedics alone). Results: Among the 253 patients who were transferred to the CSC, 185 (73.1%) had no complication, 57 (22.6%) minor complications, and 11 (4.3%) had MC. In multivariate analysis, MC was associated with basilar artery (BA) occlusion (p < 0.0001), initial National Institute of Health Stroke Scale (NIHSS) score >22 (p < 0.005), and history of atrial fibrillation (p < 0.04). Among the 168 patients treated with intravenous thrombolysis (IVT), only 1 patient (0.6%) had MC due to an IVT-related adverse event during transfer. Conclusions: Physician-led inter-hospital transports are warranted for patients with BA occlusion, initial NIHSS score >22, or history of atrial fibrillation. For the other patients, transfer without a physician may be considered, even if treated with IVT.
Published: 2019

21. Shortening time to reperfusion after transfer from a primary to a comprehensive stroke center

Author: Geoffroy Farouil, Denis Sablot, Alexandre Laverdure, A. Bonafé, and Caroline Arquizan
Subjects: medicine.medical_specialty, business.industry, Research, 030204 cardiovascular system & hematology, medicine.disease, Mechanical thrombectomy, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Internal medicine, Cohort, medicine, Cardiology, Neurology (clinical), Symptom onset, business, Stroke, 030217 neurology & neurosurgery
Abstract: BackgroundThis study assessed whether a quality improvement (QI) process to streamline transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) could reduce the delay of reperfusion by mechanical thrombectomy (MT).MethodsFrom 2015 to 2017, a QI process was implemented with specific interventions to reduce door-in-to-door-out (DIDO) time in a high volume PSC, and speed up interhospital transfer and inhospital processes at the CSC. Clinical characteristics and time metrics were compared in the QI (2015–2017; n = 157) and pre-QI cohorts (2012–2014; n = 121).ResultsDuring the QI process, the median symptom onset to reperfusion time was reduced by 50 minutes (367 vs 417 minutes in the pre-QI cohort, p < 0.04), with a substantial 40-minute DIDO reduction (78 vs 118 minutes, p < 0.01), related to the faster administration of IV thrombolysis (median door-to-needle time: 49 vs 82 minutes, p = 0.0001). The door-to-door time was shortened (170 vs 205 minutes, p = 0.002), but not the transfer time (92 vs 87 minutes, p = 0.5). The QI process had no effect on the prehospital phase (77 vs 76 minutes, p = 0.83) and on the time from MRI imaging at the PSC to reperfusion (252 vs 288 minutes, p = 0.12). The rate of modified Rankin Scale score 0–2 at 90 days was comparable in the pre-QI and QI cohorts.ConclusionsA QI process can reduce the reperfusion therapy delay in a distant CSC; however, we could not demonstrate that it can also improve the outcome of patients who undergo MT.
Published: 2018

22. A Regional Network Organization for Thrombectomy for Acute Ischemic Stroke in the Anterior Circulation; Timing, Safety, and Effectiveness

Author: Mohamed Chbicheb, Denis Sablot, Alain Bonafe, Olivier Beaufils, Pauline Malissart, Cyril Dargazanli, Caroline Arquizan, Vincent Costalat, Stephane Bouly, Erika Nogue, Lucas Corti, Marie-Christine Picot, Yassine Boukriche, Isabelle Mourand, Nicolas Gaillard, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Gui de Chauliac [Montpellier], Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and Centre Hospitalier Saint Jean de Perpignan
Subjects: endovascular treatment, Male, Time Factors, medicine.medical_treatment, Logistic regression, Cerebral circulation, Disability Evaluation, 0302 clinical medicine, Modified Rankin Scale, Risk Factors, Medicine, Infusions, Intravenous, Stroke, Acute ischemic stroke, Thrombectomy, Cerebral infarction, Delivery of Health Care, Integrated, Rehabilitation, Thrombolysis, Middle Aged, 3. Good health, srip-and-ship, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, Brain Infarction, Patient Transfer, medicine.medical_specialty, thrombolysis, outcome, Mechanical Thrombolysis, Regional Health Planning, Time-to-Treatment, 03 medical and health sciences, Fibrinolytic Agents, Internal medicine, Humans, Aged, Retrospective Studies, business.industry, Odds ratio, Recovery of Function, medicine.disease, Feasibility Studies, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND:Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship).METHODS:We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH).RESULTS:Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P = .562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P = .256), and sICH (7.0% versus 9.7%, P = .515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] -5years= 1.32, P < .001), initial NIHSS (OR -5points = 1.59, P = .010), absence of diabetes (OR = 3.35, P = .075), and the delay magnetic resonance imagining-puncture (OR -30min = 1.16, P = .048).CONCLUSIONS:Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.
Published: 2018

23. Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

Author: Franck Leibinger, Khaled Khlifa, Zoubir Mourad Bensalah, Philippe Smadja, Caroline Arquizan, Aymeric Guibal, Maxime Tardieu, Jean-Louis Bertrand, Geoffroy Farouil, Anais Dutray, Adrian Dumitrana, Thibaut Allou, Nadège Olivier, Nicolas Gaillard, Adelaïde Ferraro-Allou, Jean-Marie Bonnec, Snejana Jurici, Julie Mas, Bénédicte Fadat, Ioana Ion, Alexandre Laverdure, Alain Bonafe, Denis Sablot, Département de neurologie [Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: Male, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Tissue plasminogen activator, Workflow, Disability Evaluation, 0302 clinical medicine, Patient Admission, Modified Rankin Scale, 80 and over, Thrombolytic Therapy, Hospital Mortality, Infusions, Intravenous, Stroke, Aged, 80 and over, medicine.diagnostic_test, Thrombolysis, Middle Aged, Quality Improvement, Magnetic Resonance Imaging, Stroke unit, Treatment Outcome, Neurology, Anesthesia, Predictive value of tests, Tissue Plasminogen Activator, Cohort, Female, France, Cardiology and Cardiovascular Medicine, Intravenous, Intracranial Hemorrhages, medicine.drug, Infusions, Time-to-Treatment, 03 medical and health sciences, Fibrinolytic Agents, Predictive Value of Tests, medicine, Humans, Quality Indicators, Health Care, Aged, business.industry, Magnetic resonance imaging, Recovery of Function, medicine.disease, Health Care, Quality Indicators, Neurology (clinical), business, 030217 neurology & neurosurgery, Fibrinolytic agent
Abstract: Objective: The purpose of this study was to demonstrate that the median door-to-needle (DTN) time for intravenous tissue plasminogen activator (tPA) treatment can be reduced to 45 min in a primary stroke centre with MRI-based screening for acute ischaemic stroke (AIS). Methods: From February 2015 to February 2017, the stroke unit of Perpignan general hospital, France, implemented a quality-improvement (QI) process. During this period, patients who received tPA within 4.5 h after AIS onset were included in the QI cohort. Their clinical characteristics and timing metrics were compared each semester and also with those of 135 consecutive patients with AIS treated by tPA during the 1-year pre-QI period (pre-QI cohort). Results: In the QI cohort, 274 patients (92.5%) underwent MRI screening. While the demographic and baseline characteristics were not significantly different between cohorts, the median DTN time was significantly lower in the QI than in the pre-QI cohort (52 vs. 84 min; p < 0.00001). Within the QI cohort, the median DTN time for each semester decreased from 65 to 44 min (p < 0.00001) and the proportion of treated patients with a DTN time ≤45 min increased from 25 to 58.9% (p < 0.0001). Overall, DTN time improvement was associated with a better outcome at 3 months (patients with a modified Rankin Scale score between 0 and 2: 61.8% in the QI vs. 39.3% in the pre-QI cohort; p < 0.0001). Conclusions: A QI process can reduce the DTN within 45 min with MRI as a screening tool.
Published: 2018

24. Living Lab AVC-LR : accident vasculaire cérébral en Languedoc-Roussillon

Author: D. Heve, Denis Sablot, Stephane Bouly, Céline Vergne-Richard, and Chérif Heroum
Subjects: Pediatrics, medicine.medical_specialty, Patient care team, Health promotion, business.industry, medicine, Public-Private Sector Partnership, MEDLINE, General Medicine, Medical emergency, medicine.disease, business
Abstract: La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 16 octobre 2015
Published: 2015

25. Recurrent cryptogenic stroke in young adult linked to congenital left ventricular diverticulum

Author: Jean Louis Bertrand, Frederic Targosz, Zoubir Mourad Bensalah, Nicolas Gaillard, and Denis Sablot
Subjects: Heart Defects, Congenital, Male, medicine.medical_specialty, medicine.medical_treatment, Heart Ventricles, Congenital left ventricular diverticulum, 030204 cardiovascular system & hematology, Functional Laterality, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Young adult, Stroke, medicine.diagnostic_test, business.industry, Brain, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Cryptogenic stroke, Diverticulum, Cardiology, Neurology (clinical), Cardiac monitoring, business, 030217 neurology & neurosurgery
Abstract: A 47-year-old man had an acute ischemic stroke (IS); brain MRI revealed multiple silent old IS (figure 1A). A comprehensive workup, including prolonged cardiac monitoring (cumulated duration of 25 days) and cardiac transthoracic/transesophageal echography, was negative. Eleven months later, despite statin and aspirin therapy, a new symptomatic embolic IS of undetermined source occurred (figure 1B). Cardiac MRI1 revealed a left apical dyskinetic saccular evagination (figure 2, A–C) consistent with a congenital left ventricular diverticulum confirmed on left ventriculography (figure 2D) and the presumed source of recurrent embolic IS.2 No IS occurred after 30 months of warfarin therapy.
Published: 2016

26. Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening

Author: Julie Mas, Bénédicte Fadat, C. Heroum, Denis Sablot, P. Perucho, C. Gely, C. Pujol, Y. Garcia, Stephane Bouly, Nicolas Gaillard, A. Laverdure, H. Touzani, C. Sagnes-Raffy, S. Jurici, J.-M. Bonnec, A. Dutray, G. Farouil, C. Richard, A. Dumitrana, P. Smadja, C. Colas, Thierry Moulin, D. Heve, M. Jantac, T. Allou, Nadège Olivier, and A. Ferraro-Allou
Subjects: Male, medicine.medical_specialty, Emergency Medical Services, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Tissue plasminogen activator, Brain Ischemia, Time-to-Treatment, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Internal medicine, medicine, Emergency medical services, Humans, Stroke, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Thrombolysis, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Quality Improvement, Surgery, Neurology, Needles, Cohort, Administration, Intravenous, Female, Neurology (clinical), France, business, 030217 neurology & neurosurgery, Fibrinolytic agent, medicine.drug
Abstract: To determine the effects of a 1-year quality-improvement (QI) process to reduce door-to-needle (DTN) time in a secondary general hospital in which multimodal MRI screening is used before tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke (AIS).The QI process was initiated in January 2015. Patients who received intravenous (iv) tPA4.5h after AIS onset between 26 February 2015 to 25 February 2016 (during implementation of the QI process; the "2015 cohort") were identified (n=130), and their demographic and clinical characteristics and timing metrics compared with those of patients treated by iv tPA in 2014 (the "2014 cohort", n=135).Of the 130 patients in the 2015 cohort, 120 (92.3%) of them were screened by MRI. The median DTN time was significantly reduced by 30% (from 84min in 2014 to 59min; P0.003), while the proportion of treated patients with a DTN time≤60min increased from 21% to 52% (P0.0001). Demographic and baseline characteristics did not significantly differ between cohorts, and the improvement in DTN time was associated with better outcomes after discharge (patients with a 0-2 score on the modified rankin scale: 59% in the 2015 cohort vs 42.4% in the 2014 cohort; P0.01). During the 1-year QI process, the median DTN time decreased by 15% (from 65min in the first trimester to 55min in the last trimester; P≤0.04) with a non-significant 1.5-fold increase in the proportion of treated patients with a DTN time≤60min (from 41% to 62%; P=0.09).It is feasible to deliver tPA to patients with AIS within 60min in a general hospital, using MRI as the routine screening modality, making this QI process to reduce DTN time widely applicable to other secondary general hospitals.
Published: 2016

27. Angioplastie-stenting transluminale percutanée après dissection des troncs supra-aortiques

Author: A. Bonafe, J.-F. Cassarini, D. Cerutti, G. Runavot, Z. Kassem, R. Filipov, G.-A. Pelouze, and Denis Sablot
Subjects: Neurology, Neurology (clinical)
Abstract: Resume Introduction La dissection spontanee des arteres a destinee cerebrale est une cause classique d’accident vasculaire cerebral ischemique du sujet jeune. Un traitement medical par anticoagulation curative est classiquement recommande, mais peut etre mis a defaut dans certains cas. La mise en place de protheses endovasculaires (angioplastie-stenting) peut alors representer une alternative therapeutique. Observation Nous rapportons le cas d’une dissection spontanee des quatre axes arteriels a destinee cerebrale chez une patiente de 47 ans. Devant l’hypoperfusion cerebrale persistant sous traitement medical, une recanalisation arterielle a ete obtenue apres angioplastie-stenting de l’artere carotide interne droite. Cette procedure a ameliore les temps circulatoires intracrâniens et a autorise la reprise d’une activite normale sans complication apres un suivi de 16 mois. Conclusion L’angioplastie-stenting peut representer une solution therapeutique a certains cas selectionnes de dissections des troncs supra-aortiques entrainant une hypoperfusion cerebrale.
Published: 2010

28. Intérêt d’une médicalisation préhospitalière des accidents vasculaires cérébraux de moins de 3heures en milieu semi-rural

Author: Jany Rey, Ruxandra Filipov, Jean-Christophe Blenet, Mathieu Magnaudeix, Michel Mora, Gwanaele Runavot, Yves Garcia, Denis Sablot, Jean-Francois Cassarini, Laurent Ortega, Christophe De la Vega, Aziz Akouz, Jean-Emmanuel de La Coussaye, and Diane Cerutti
Subjects: Gynecology, medicine.medical_specialty, business.industry, Medicine, General Medicine, business, Rural environment
Abstract: Resume Objectifs Nous avons teste l’hypothese que l’appel du centre 15 et qu’une medicalisation prehospitaliere permettrait de fluidifier la filiere des infarctus cerebraux de moins de 3 heures, et de reduire les delais avant administration du rt-PA. Methodes Nous avons compare les delais prehospitaliers (delai d’admission) et hospitaliers (delai d’imagerie et de traitement) d’une cohorte observationnelle de 53 patients consecutifs traites, en fonction de leur mode d’admission (groupe 1 : sortie Smur et groupe 2 : acheminement sans medicalisation apres [2a] ou sans appel du 15 [2b]). Resultats Vingt-sept patients (51,9 %) ont ete admis apres sortie Smur (groupe 1), 16 (30,8 %) regules sans sortie Smur (groupe 2a), 9 (17,3 %) directement admis au SAU (groupe 2b) et 1 exclu de l’analyse car deja hospitalise lors de l’infarctus cerebral. L’appel du centre 15 a diminue les delais totaux de 24 min (p = 0,034). Lors d’une sortie Smur, le delai total moyen n’etait pas significativement reduit (152 versus 162 min ; p = 0,27), mais pour une distance moyenne superieure (25 versus 11 km ; p = 0,02) le delai d’admission moyen etait augmente (86 versus 69 min ; p = 0,044), compense par une reduction du delai intrahospitalier moyen (66 versus 93 min ; p = 0,0001) essentiellement au benefice du delai d’imagerie (22 versus 45 min ; p = 0,0001). Conclusion Pour les infarctus cerebraux, l’appel du Samu a permis de reduire le delai total moyen avant administration du rt-PA. Le retentissement d’une sortie Smur est plus nuance du fait d’une distance moyenne superieure mais permet de mieux coordonner la prise en charge intrahospitaliere.
Published: 2008

29. Le site de référence du Partenariat européen d’innovation pour un vieillissement actif et en bonne santé MACVIA-LR (contre les maladies chroniques pour un vieillissement en bonne santé en Languedoc-Roussillon)

Author: Miren David, Ariane Sultan, Guillaume Pandraud, Benoît G. Bardy, Jacques Morel, Giacomo Cavalli, Sylvain Jacquemin, Christine Rolland, Cyril Breuker, Philippe Boulet, Gregoire Mercier, Stéphane Bouly, Valérie Bruguière, Gwen Mathieu, Marc Meissonnier, Hervé Tassery, Vincent Marmelat, Michel Dauzat, Hubert Blain, Gérard Dray, Cyril Laurent, Christine Viarouge-Reunier, Marie Virginie Calmels, François Rivier, Gérard Dupeyron, Gérard Bourrel, Jacquie Berthe, Philippe Domy, Béatrice Lognos, Martine Aoustin, Davide Caimmi, Michel Kaczorek, Mélanie Badin, Pierre Nicolas, Alain Le Quellec, Sylvie Boichot, Vincent Le Moing, C. Boegner, Jérôme Fernandes, Michel Amouyal, Matthieu Desplan, Jean Paul Cristol, T. Camuzat, Karima Bakhti, Jean Michel Verdier, Paule Adnet, Christophe Jorgensen, Denis Sablot, Jean Ribstein, Henriette Dhivert-Donnadieu, Céline Vergne-Richard, Emilie Porte, Christine Azevedo, Isabelle Quéré, Dominique Jakovenko, Marion Gellerat-Rogier, Michel Tanfin, Karen Ritchie, Flavia Oana Coroian, Bernard Guillot, Fabrice Nouvel, J. Pelissier, Anna Bedbrook, Daniel Laune, Jean-Luc Bourrain, Yves Marie Pers, Jean Luc Savy, Chantal Marion, Cherif Heroum, Marianna Danko, Grégoire Vergotte, Françoise Radier-Pontal, Jean Luc Pasquié, Olivier Bénézet, Bernard Combe, Sylvain Richard, Liliane Landreau, Valérie Cros, Isabelle Rédini-Martinez, Emilie Viollet, David Guiraud, François Roubille, Jérôme Froger, Bertrand Coulet, Laurent Journot, Marie Suzanne Léglise, Sylvie Arnavieilhe, Isabel Tavares, Samir Jaber, Olivier Jonquet, David Morquin, Philippe Van de Perre, Roland Sicard, Raphaël Chiron, Vincent Tribout, Pierre Senesse, Xavier Quantin, Jacques Touchon, Kevin Mandrick, Alain Uziel, Vincent Bouix, Marie Christine Picot, Philippe Augé, Martine Lapierre, Antoine Avignon, Eric Pastor, Pascal Demoly, Kjerstin Torre, Jacques Mercier, Jean-Marie Robine, Dominique Larrey, D. J. Costa, Grégory Ninot, Laurent Schifano, Baya Soua, Anne Wojtusciszyn, Jean-Christophe Gris, Didier Delignières, Florence Gressard, Marie Pierre Pasdelou, Fabienne Portejoie, Michel Mondain, Philippe Nérin, Olivier Hantkié, Xavier Bobia, Delphine Paccard, Pierre Géraud Claret, Maxime Villiet, Jacques Burille, Christian Hérisson, Guillaume Tallon, V. Attalin, Jean Emmanuel de la Coussaye, William Camu, Didier Hoa, Chokri Boubakri, Jacques Reynes, Michel Enjalbert, Pascal Kouyoumdjian, Anthony Gellis, Jean Marc Lussert, Jean Philippe Pin, Christian Bourquin, Jean-Marc Lemaitre, Rodolphe Bourret, Isabelle Laffont, Claudine Berr, Marie Christine Courrouy-Michel, Nicolas Giraudeau, Trias Asteriou, Catherine Leblond, Cyril Meunier, Sylvain Lehmann, M. Nogues, Denise Strubel, Raul Punta-Morales, Alain Makinson, Jacques Bringer, Stéphane Perrey, Nathalie Pinto, Yannick Stephan, Charles Fattal, Jean Marc Davy, Arnaud Bourdin, Emilie Royère, Arnaud Dupeyron, Claire Daien, François Vialla, Frédéric Viart, Joël Bockaert, Arnaud Yves Goucham, Pierre Aubas, Huei Yune Bonnin, Fares Gouzi, Véronique Carre, Nicolas Best, Jean Pierre Riso, Jérome Cottalorda, Max Villain, Philippe Dauenhauer, Patrick Messner, Amélie Matheron, Claude Jeandel, Roxana Taddei-Ologeanu, Bernard Alomène, Sylvie Albert, Stéphane Cade, Gérard Canovas, Pauline Coignard, Karine Patte, Sofiane Ramdani, Frédéric Abecassis, Maurice Hayot, Marc Ychou, Anne Laure Coupet, Nathalie Raffort, D. Heve, Philippe Gabrion, Pierre Mares, Pierre Labauge, Marie Pierre Battesti, Denis Mottet, Philippe Fraisse, Jean Bousquet, Jean Louis Pujol, Emilie Galano, Pierre Fesler, Vincent Dufour, Gregory Baptista, Pierre Louis Bernard, Mireille Fouletier, Pierre Dujol, Xavier Vasquez, Jean Paul Ortiz, Pierre Martin-Gousset, Philippe Courtet, Oude Engberink, Valérie Handweiler, S. Granier, Laurence Vian, Françoise Leclercq, Frédéric Cuisinier, Pierre Costa, Guillaume Cayla, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Department of Geriatrics - Efficiency and Deficiency Laboratory, Hadassah Hebrew University Medical Center [Jerusalem], IMT - MINES ALES (IMT - MINES ALES), Institut Mines-Télécom [Paris] (IMT), Département de Biostatistiques, Agence Régionale de Santé Languedoc Roussillon (ARS), Institut de Recherche en Infectiologie de Montpellier (IRIM), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Roche Pharma Research and Early Development [Basel] (pRED), F. Hoffmann-La Roche [Basel], Service de gynécologie-obstétrique, Mécanismes adaptatifs : des organismes aux communautés (MAOAC), Centre National de la Recherche Scientifique (CNRS)-Collège de France (CdF)-Muséum national d'Histoire naturelle (MNHN), Laboratoire de Géochimie Isotopique Environnementale (GIS) / Université de Nîmes (GIS), Université de Nîmes (UNIMES)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Genre (LARHRA GENRE), LAboratoire de Recherche Historique Rhône-Alpes - UMR5190 (LARHRA), Centre National de la Recherche Scientifique (CNRS)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Université Lumière - Lyon 2 (UL2)-École normale supérieure - Lyon (ENS Lyon)-Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Université Lumière - Lyon 2 (UL2)-École normale supérieure - Lyon (ENS Lyon)-Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Grenoble Alpes (UGA), Département de Médecine générale, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Control of Artificial Movement and Intuitive Neuroprosthesis (CAMIN), Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier (LIRMM), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Inria Sophia Antipolis - Méditerranée (CRISAM), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Département de médecine générale, Université de Montpellier (UM), Euromov (EuroMov), Centre Européen de Réalité Virtuelle (CERV), École Nationale d'Ingénieurs de Brest (ENIB), Laboratoire de Mathématiques Blaise Pascal (LMBP), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS), Pathologies du système nerveux : recherche épidémiologique et clinique, Université Montpellier 1 (UM1)-IFR76-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), CERFRANCE Nord Est - Ile de France, Réseau de Vigilance en Dermato-Allergologie - Groupe d'Etudes et de Recherches en DERmato-Allergologie (Revidal-Gerda), Réseau de Vigilance en Dermato-Allergologie (Revidal), Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de KERPAPE [Ploemeur] (CMRRF), Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de Kerpape, Laboratoire de Bioingénierie et NanoSciences (LBN), Institut de Génétique Moléculaire de Montpellier (IGMM), Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UM3)-Université de Montpellier (UM), Laboratory of Cardio-Vascular Physiology (LCVP), Université Montpellier 1 (UM1), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Rééducation et Réadaptation Neuro Orthopédique [Nîmes] (Pôle NACRRE), Hôpital Universitaire Carémeau [Nîmes], Centre Mutualiste de Réeducation Neurologique Propara (PROPARA), Languedoc Mutualité, Oc Santé Montpellier, Artificial movement and gait restoration (DEMAR), Unité de Rééducation Neurologique, Centre Hélio-Marin CHU Nîmes, Department de Dermatologie, Médecine physique et de réadaptation, Hôpital Lapeyronie [Montpellier] (CHU), Institut de Génomique Fonctionnelle - Montpellier GenomiX (IGF MGX), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Orthopédique, Département de neurologie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Centre Bouffard-Vercelli, Laboratoire de Mécanique et Technologie (LMT), École normale supérieure - Cachan (ENS Cachan)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Plateforme de Protéomique Clinique, CHU Saint-Eloi, Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Département Conception et conduite des véhicules Aéronautiques et Spatiaux (DCAS), Institut Supérieur de l'Aéronautique et de l'Espace (ISAE-SUPAERO), Lab-STICC_TB_CID_TOMS, Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de recherche souterrain de Meuse/Haute-Marne, Agence Nationale de gestion des Déchets Radioactifs, Aix-Marseille Université - Faculté des Sciences du Sport (AMU FSS), Aix Marseille Université (AMU), HORIBA Medical (HORIBA ABX SAS), HORIBA Scientific [France], Unité Mathématique, Informatique et Génome (MIG), Institut National de la Recherche Agronomique (INRA), Interactions, Corpus, Apprentissages, Représentations (ICAR), École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines-Centre National de la Recherche Scientifique (CNRS), Unité clinique d'Immuno-Rhumatologie & Thérapeutique des maladies ostéo-articulaires, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Institut de Chimie des Substances Naturelles (ICSN), Centre National de la Recherche Scientifique (CNRS), UNICANCER - Institut régional du Cancer [Montpellier] (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Biocommunication en Cardio-Métabolique (BC2M), Neuropsychiatrie : recherche épidémiologique et clinique, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département d'oncologie médicale et digestive, Centre de cancérologie Val d'Aurelle, Complexité, Innovation, Activités Motrices et Sportives (CIAMS), Université d'Orléans (UO)-Université Paris-Sud - Paris 11 (UP11), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie et thérapie des déficits sensoriels et moteurs, Université Montpellier 2 - Sciences et Techniques (UM2)-IFR76-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche et de Diagnostic sur le Sida (CeDreS), CHU Treichville, Interaction entre Systèmes Protéiques et Différenciation dans la Cellule Tumorale (ISPDCT), Université de la Méditerranée - Aix-Marseille 2-Centre National de la Recherche Scientifique (CNRS), Dynamiques du droit (DD), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Centre National de la Recherche Scientifique (CNRS), Centre de pharmacologie et innovation dans le diabète (CPID), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre National de la Recherche Scientifique (CNRS), Recherche en épidémiologie et biostatistique, Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), IMT - Mines Alès Ecole Mines - Télécom ( IMT - MINES ALES ), Agence Régionale de Santé Languedoc Roussillon ( ARS ), Institut de Recherche en Infectiologie de Montpellier ( IRIM ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ), Roche Pharma Research and Early Development [Basel] ( pRED ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Mécanismes adaptatifs : des organismes aux communautés ( MAOAC ), Muséum National d'Histoire Naturelle ( MNHN ) -Collège de France ( CdF ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire de Géochimie Isotopique Environnementale (GIS) / Université de Nîmes ( GIS ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Nîmes ( UNIMES ), Institut de recherche en cancérologie de Montpellier ( IRCM ), Université Montpellier 1 ( UM1 ) -CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon ( MACVIA-LR ), Université Montpellier 1 ( UM1 ) -World Health Organization ( WHO/OMS ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ) -Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -European Innovation Partnership on Active and Healthy Ageing Reference Site, Agence Nationale de Sécurité Sanitaire, de l'Alimentation, de l'environnement et du Travail ( ANSES ), ANSES, Genre ( LARHRA GENRE ), LAboratoire de Recherche Historique Rhône-Alpes - UMR5190 ( LARHRA ), Centre National de la Recherche Scientifique ( CNRS ) -Université Jean Moulin - Lyon III-Université Lumière - Lyon 2 ( UL2 ) -École normale supérieure - Lyon ( ENS Lyon ) -Université Pierre Mendès France - Grenoble 2 ( UPMF ) -Université Grenoble Alpes ( UGA ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Jean Moulin - Lyon III-Université Lumière - Lyon 2 ( UL2 ) -École normale supérieure - Lyon ( ENS Lyon ) -Université Pierre Mendès France - Grenoble 2 ( UPMF ) -Université Grenoble Alpes ( UGA ), Université Montpellier 1 ( UM1 ), Artificial movement and gait restoration ( DEMAR ), Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier ( LIRMM ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Inria Sophia Antipolis - Méditerranée ( CRISAM ), Institut National de Recherche en Informatique et en Automatique ( Inria ) -Institut National de Recherche en Informatique et en Automatique ( Inria ), Université de Montpellier ( UM ), Euromov ( EuroMov ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), Centre Européen de Réalité Virtuelle ( CERV ), École Nationale d'Ingénieurs de Brest ( ENIB ), Laboratoire de Mathématiques Blaise Pascal ( LMBP ), Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Centre National de la Recherche Scientifique ( CNRS ), Université Montpellier 1 ( UM1 ) -IFR76-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de Génomique Fonctionnelle ( IGF ), Centre National de la Recherche Scientifique ( CNRS ) -Université Montpellier 2 - Sciences et Techniques ( UM2 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Montpellier 1 ( UM1 ) -Université de Montpellier ( UM ), Réseau de Vigilance en Dermato-Allergologie - Groupe d'Etudes et de Recherches en DERmato-Allergologie ( Revidal-Gerda ), Réseau de Vigilance en Dermato-Allergologie ( Revidal ), Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de KERPAPE [Ploemeur] ( CMRRF ), Laboratoire de Bioingénierie et NanoScience-UM, Université Montpellier 1 ( UM1 ) -Université de Montpellier ( UM ), Institut de Génétique Moléculaire de Montpellier ( IGMM ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Dynamique des capacités humaines et des conduites de santé ( EPSYLON ), Université Paul-Valéry - Montpellier 3 ( UM3 ) -Université Jean Monnet [Saint-Étienne] ( UJM ) -Université Montpellier 1 ( UM1 ) -Université de Montpellier ( UM ), Laboratory of Cardio-Vascular Physiology ( LCVP ), Institut Pierre Louis d'Epidémiologie et de Santé Publique ( iPLESP ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département de Rééducation et Réadaptation Neuro Orthopédique [Nîmes] ( Pôle NACRRE ), Centre Mutualiste de Réeducation Neurologique Propara ( PROPARA ), Hôpital Lapeyronie [Montpellier] ( CHU ), Institut de Génomique Fonctionnelle - Montpellier GenomiX ( IGF MGX ), Laboratoire de Mécanique et Technologie ( LMT ), École normale supérieure - Cachan ( ENS Cachan ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Saint-Eloi-Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), Recherches Translationnelles sur le VIH et les maladies infectieuses ( TransVIHMI ), Université Montpellier 1 ( UM1 ) -Université Cheikh Anta Diop ( UCAD ) -Universtié Yaoundé 1 (Cameroun)-Université de Montpellier ( UM ), Département Conception et conduite des véhicules Aéronautiques et Spatiaux ( DCAS ), Institut Supérieur de l'Aéronautique et de l'Espace ( ISAE-SUPAERO ), Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance ( Lab-STICC ), École Nationale d'Ingénieurs de Brest ( ENIB ) -Université de Bretagne Sud ( UBS ) -Université de Brest ( UBO ) -Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université européenne de Bretagne ( UEB ) -ENSTA Bretagne-Institut Mines-Télécom [Paris]-Centre National de la Recherche Scientifique ( CNRS ) -École Nationale d'Ingénieurs de Brest ( ENIB ) -Université de Bretagne Sud ( UBS ) -Université de Brest ( UBO ) -Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université européenne de Bretagne ( UEB ) -ENSTA Bretagne-Institut Mines-Télécom [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Aix-Marseille Université - Faculté des Sciences du Sport ( AMU FSS ), Aix Marseille Université ( AMU ), HORIBA Medical ( HORIBA ABX SAS ), Unité Mathématique, Informatique et Génome ( MIG ), Institut National de la Recherche Agronomique ( INRA ), Interactions, Corpus, Apprentissages, Représentations ( ICAR ), École normale supérieure - Lyon ( ENS Lyon ) -Université Lumière - Lyon 2 ( UL2 ) -INRP-Ecole Normale Supérieure Lettres et Sciences Humaines-Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Institut de Chimie des Substances Naturelles ( ICSN ), Centre National de la Recherche Scientifique ( CNRS ), UNICANCER - Institut régional du Cancer [Montpellier] ( ICM ), Efficience Déficience Motrice [Montpellier] ( EDM ), Centre de pharmacologie et innovation dans le diabète ( CPID ), Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Centre National de la Recherche Scientifique ( CNRS ), Complexité, Innovation, Activités Motrices et Sportives ( CIAMS ), Université Paris-Sud - Paris 11 ( UP11 ) -Université d'Orléans ( UO ), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Montpellier 2 - Sciences et Techniques ( UM2 ) -IFR76-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche et de Diagnostic sur le Sida ( CeDreS ), Interaction entre Systèmes Protéiques et Différenciation dans la Cellule Tumorale ( ISPDCT ), Université de la Méditerranée - Aix-Marseille 2-Centre National de la Recherche Scientifique ( CNRS ), Dynamiques du droit ( DD ), Centre National de la Recherche Scientifique ( CNRS ) -Université Montpellier 1 ( UM1 ) -Université de Montpellier ( UM ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CERMES3 - Centre de recherche Médecine, sciences, santé, santé mentale, société (CERMES3 - UMR 8211 / U988 / UM 7), École des hautes études en sciences sociales (EHESS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Génie Informatique et Ingénierie de Production (LGI2P), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Agence Régionale de la Santé (ARS), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université Pierre Mendès France - Grenoble 2 (UPMF)-École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Université Pierre Mendès France - Grenoble 2 (UPMF)-École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Inria Sophia Antipolis - Méditerranée (CRISAM), Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UPVM)-Université de Montpellier (UM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Oc Santé [Montpellier], Interactive Digital Humans (IDH), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Service de Rhumatologie [CHRU Montpellier], École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines (ENS LSH)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC), Institut du Cancer de Montpellier (ICM), Université Paris-Sud - Paris 11 (UP11)-Université d'Orléans (UO), Centre de recherche et de Diagnostic sur le Sida [Abidjan, Côte d'Ivoire] (CeDreS), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Université Montpellier 1 (UM1), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1), Muséum national d'Histoire naturelle (MNHN)-Collège de France (CdF)-Centre National de la Recherche Scientifique (CNRS), and CRLCC Val d'Aurelle - Paul Lamarque-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Aging, [ SDV ] Life Sciences [q-bio], business.industry, [SDV]Life Sciences [q-bio], General Medicine, MESH: Accidental Falls, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Medicine, 030211 gastroenterology & hepatology, Accidental Falls, MESH: Aging, 030212 general & internal medicine, business, Humanities, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Le site de référence du Partenariat européen d'innovation pour un vieillissement actif et en bonne santé MACVIA-LR (contre les maladies chroniques pour un vieillissement en bonne santé en Languedoc-Roussillon)
Published: 2015

30. Utilisation du rt-PA intraveineux dans l’ischémie cérébrale en Centre Hospitalier Général : l’expérience de l’Hôpital Saint-Jean de Perpignan

Author: C. Negre, J.-F. Cassarini, B. Arnoud, X. Faillie, E. Vidry, J.-M. Benejean, L. Sinaya, A. Akouz, S. Castro, Y. Garcia, F. Leibinger, Denis Sablot, J.-L. Bertrand, and X. Ayrignac
Subjects: Gynecology, medicine.medical_specialty, Neurology, business.industry, medicine, Neurology (clinical), General hospital, business
Abstract: Resume Introduction Depuis l’autorisation de mise sur le marche dans l’ischemie cerebrale de moins de trois heures en 2003, le « recombinant tissue plasminogen activator » (rt-PA) a rarement ete utilise en pratique clinique courante dans un centre hospitalier general (CHG). En l’absence de serie provenant d’un CHG, on ne peut extrapoler les resultats positifs des etudes pivots emanant de centres specialises a des CHG, moins aguerris a la prise en charge des AVC. Methodes Nous rapportons les resultats d’une cohorte observationnelle de patients traites par du rt-PA intra-veineux (selon le protocole de l’etude NINDS) a l’Hopital Saint Jean de Perpignan, du 1er mars 2002 au 31 aout 2005. Nous en comparons l’evolution a celle observee dans le bras traite de l’etude NINDS. Resultats Trente-neuf patients (1,2 p. 100 des AIC) ont ete traites. L’evolution clinique est favorable (score modifie de Rankin (mRS) a 0 ou 1) chez 44 p. 100 des patients (39 p. 100 dans NINDS (X2 = 0,34 ; p = 0,5)). Il n’a pas ete retrouve de difference statistiquement significative avec le bras traite de l’etude NINDS, en terme de taux de deces et d’evolution clinique a 3 mois (respectivement X2 = 0,09 ; p = 0,75 et X2 = 0,77 ; p = 0,75). Par ailleurs, il n’a pas ete observe d’hematome intra-infarctus symptomatique lie a l’utilisation du rt-PA. Conclusion Nos resultats indiquent que l’utilisation du rt-PA dans l’ischemie cerebrale peut etre aussi sure et efficace en centre hospitalier general qu’en centre specialise.
Published: 2006

31. Syndromes anatomocliniques des infarctus du territoire de l'artère carotide

Author: Fabrice Vuillier, Thierry Moulin, Denis Sablot, Faouzi Belahsen, and Laurent Tatu
Subjects: Gynecology, medicine.medical_specialty, business.industry, medicine, business
Published: 2004

32. The outcomes of stroke patients in health territory

Author: Denis Sablot, Michel Enjalbert, and André Maillard
Subjects: medicine.medical_specialty, Neurology, Rehabilitation, Stroke patient, business.industry, Mortality rate, Public health, medicine.medical_treatment, medicine.disease, Follow-up consultation, Acute care, medicine, Orthopedics and Sports Medicine, Neurosurgery, Medical emergency, business
Abstract: Objective The follow-up of stroke patients after the stroke center is a public health issue that motivate the implementation of the stroke plan and follow-up consultation. Its organization conduces us to evaluate patients flows from acute care to the rehabilitation ones. Material/patients and methods We studied these flows from the hospital stays, according with the French system of valuation (PMSI) and from the transfers in rehabilitation centers, according with the French system of transfers (Via Trajectoire), to observe the follow-up of these stroke patients and to provide the organization of consultation. The data were obtained along the year 2015. Results During 2015, 1408 stroke patients were treated in the stroke center of the Perpignan hospital. This rate represents 90% of the stroke patients treated on the health territory. In total, 71,3% were treated in the neurology unit, 27,7% in the neurosurgery or medicine ones. The death rate is 10%. It is finally 1270 stroke patients that enter in the care spectrum. In total, 50% of them return directly to home and 50% participate in a rehabilitation program (30% in a specialized program, 20% in a polyvalent one). Discussion – conclusion This study conduces us developing a repertoire of stroke patients and sharing follow-up consultations between the different operators on the heath territory. It is extended to the neighboring territory, around the Narbonne hospital, linked with the Perpignan one, into a hospital association (GHT).
Published: 2017

33. Microaneurysms in primary angiitis of the central nervous system revealed by MRI

Author: Nicolas Gaillard, Adrian Dumitrana, Denis Sablot, and Jean Louis Bertrand
Subjects: Adult, medicine.medical_specialty, Time Factors, Treatment outcome, Central nervous system, Magnetic resonance angiography, Remission induction, Predictive Value of Tests, medicine, Humans, Vasculitis, Central Nervous System, medicine.diagnostic_test, business.industry, Remission Induction, Mr angiography, Magnetic resonance imaging, Intracranial Aneurysm, medicine.disease, medicine.anatomical_structure, Diffusion Magnetic Resonance Imaging, Treatment Outcome, Neurology, Drug Therapy, Combination, Female, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business, Vasculitis, Immunosuppressive Agents, Magnetic Resonance Angiography, Cerebral vasculitis
Published: 2014

34. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial

Author: Jean François Albucher, Maurice Giroud, Denis Sablot, Didier Leys, Loic Milandre, Xavier Ducrocq, Bernard Beyssen, Pascal Favrole, Philippe Piquet, Thierry Moulin, François Rouanet, Pierre Amarenco, Fausto Viader, Jean Philippe Neau, Hassan Hosseini, Grégoire Hinzelin, Vincent Larrue, Hilde Henon, David Calvet, Valérie Wolff, Caroline Arquizan, Denis Saudeau, Jean-Louis Mas, Pierre Garnier, Marie Hélène Mahagne, Michel Lievre, Raymond Padovani, Gilles Chatellier, Alain Viguier, Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], 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 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)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), and 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)
Subjects: Male, Risk, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Endarterectomy, law.invention, Randomized controlled trial, law, Interquartile range, Angioplasty, Internal medicine, medicine, Humans, Carotid Stenosis, Prospective Studies, cardiovascular diseases, Stroke, Aged, Advanced and Specialized Nursing, business.industry, Hazard ratio, Middle Aged, medicine.disease, 3. Good health, Surgery, Stenosis, Treatment Outcome, Cardiology, Female, Stents, France, Neurology (clinical), Carotid stenting, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Background and Purpose— We aimed at comparing the long-term benefit–risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. Methods— Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. Results— During a median follow-up of 7.1 years (interquartile range, 5.1–8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0% (95% confidence interval, 7.9–15.2) versus 6.3% (4.0–9.8) in the endarterectomy group at the 5-year follow-up (hazard ratio, 1.85; 1.00–3.40; P =0.04) and 11.5% (8.2–15.9) versus 7.6% (4.9–11.8; hazard ratio, 1.70; 0.95–3.06; P =0.07) at the 10-year follow-up. No difference was observed between treatment groups in the rates of ipsilateral stroke beyond the procedural period, severe carotid restenosis (≥70%) or occlusion, death, myocardial infarction, and revascularization procedures. Conclusions— The long-term benefit–risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis favored endarterectomy, a difference driven by a lower risk of procedural stroke after endarterectomy. Both techniques were associated with low and similar long-term risks of recurrent ipsilateral stroke beyond the procedural period. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00190398.
Published: 2014

35. Letter by Gaillard et al Regarding Article, 'Thrombolysis Despite Recent Stroke: A Case Series'

Author: Denis Sablot, Nicolas Gaillard, and Nadège Olivier
Subjects: Advanced and Specialized Nursing, Pediatrics, medicine.medical_specialty, Series (stratigraphy), business.industry, medicine.medical_treatment, Infarction, Thrombolysis, Consecutive case series, medicine.disease, Asymptomatic, Parenchymal hemorrhage, Surgery, medicine, Neurology (clinical), Hemorrhagic risk, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: To the Editor: We read with great interest the article by Alhazzaa et al,1 reporting a retrospective analysis of a case series of 6 patients with previous ischemic stroke within the previous 3 months treated with recombinant tissue-type plasminogen activator (rtPA) for acute ischemic stroke beyond current guidelines. They found a 50% (3/6) post-thrombolysis hemorrhagic transformation rate among remote prior infarction, asymptomatic in all cases and without any parenchymal hemorrhage according to European Cooperative Acute Stroke Study trial definition. These results, as underlined by the authors, are encouraging and provide further evidence that thrombolysis beyond guidelines in this particular subgroup of patients could be safe and useful, given a low presumed hemorrhagic risk. This is in agreement with 2 other published retrospective consecutive case series, which lead to same conclusions in the setting of subacute recent silent …
Published: 2013

36. Mechanical thrombectomy with the Solitaire device in acute basilar artery occlusion

Author: D. Milhaud, Chérif Heroum, Thibault Lalu, Marie-Christine Picot, Kyriakos Lobotesis, Paolo Machi, Denis Sablot, Isabelle Mourand, Alain Bonafe, Caroline Arquizan, Vincent Costalat, and Stéphane Bouly
Subjects: Male, medicine.medical_specialty, Solitaire Cryptographic Algorithm, medicine.medical_treatment, Arterial Occlusive Diseases, Revascularization, Severity of Illness Index, Brain Ischemia, Postoperative Complications, Fibrinolytic Agents, medicine, Humans, Glasgow Coma Scale, Thrombolytic Therapy, Prospective Studies, Prospective cohort study, Stroke, Aged, Thrombectomy, Univariate analysis, business.industry, General Medicine, Thrombolysis, Middle Aged, medicine.disease, Prognosis, Combined Modality Therapy, Magnetic Resonance Imaging, Surgery, Cerebral Angiography, Treatment Outcome, Basilar Artery, Tissue Plasminogen Activator, Female, Neurology (clinical), business, Fibrinolytic agent, Follow-Up Studies
Abstract: Aims To evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire FR device in revascularization of patients with acute basilar artery occlusion (ABAO) and to identify the predictive factors for clinical outcome. Methods This prospective single-center study included 31 patients with acute ischemic stroke attributable to ABAO treated within the first 24 h after onset of symptoms with the Solitaire device. Nineteen patients simultaneously received intravenous thrombolysis. Recanalization rates after stent retrieval were determined and the clinical outcome and mortality rate were assessed 180 days after treatment. Results The mean ±SD age of the patients was 61±17 years, the median prethrombectomy NIH Stroke Scale score was 38 (IQR 9–38) and the median Glasgow Coma Scale (GCS) score was 7 (IQR 4–14). Successful recanalization (TICI 3 or 2b) was achieved in 23 patients (74%). Five symptomatic intracranial hemorrhages were related to the procedure. Ten symptomatic distal migrations of thrombotic material occurred. A favorable outcome, defined as a modified Rankin Score (mRS) of 0–2, was observed in 35% of patients (11/31). Overall mortality rate was 32% (10/31). In the univariate analysis, elevated baseline glucose (p=0.008) was significantly associated with a poor outcome (mRS >2), whereas a tendency towards significance was observed with age (p=0.06), GCS on admission (p=0.07) and symptom-related lesions on T2 sequences (p=0.10). Patients with successful recanalization tended to have a better outcome (p=0.20). Conclusion Mechanical thrombectomy with the Solitaire FR device can rapidly and effectively contribute to a high rate of recanalization and improve functional outcome in patients with ABAO and has an acceptable complication rate.
Published: 2013

37. Réduction des délais de prise en charge des AVC aigus : méthode, premiers résultats et perspectives

Author: Elisa De La Cruz, Diane Demailly, Clement Colas, Christophe Gely, Nicolas Gaillard, and Denis Sablot
Subjects: Neurology, Neurology (clinical)
Abstract: Introduction Pour chaque UNV la reduction des delais est un challenge dont l’impact est majeur, evalue en moyenne a 1,8 journee d’autonomie supplementaire pour chaque minute gagnee sur le delai door-to-needle (DTN) median (Meretoja et al. Neurology 2014). Objectifs Nous rapportons un plan d’action visant a reduire la DTN sur le CH de Perpignan et les resultats intermediaires a 8 mois. Patients et methodes Apres un cycle de formation et ajustement des procedures, monitorage prospectif des delais globaux (DTN) et intermediaires pour les patients consecutifs traites de mars 2015 a novembre 2015. Les resultats rapportes mensuellement aux acteurs de la filiere via une newsletter ou toute perte de temps constatee lors d’une phase intermediaire y est signalee. Cela donne lieu a des plans d’action trimestriels axes sur les points bloquants. L’impact est evalue par le DTN median compare au DTN2012–2014. Resultats Sur les 6 premiers mois, 106 dossiers ont ete analyses dont 95 cas traites par tPA-IV, 11 cas transferes sur le CHU de Montpellier pour thrombectomie (Tm) sans thrombolyse IV. Une IRM initiale etait realisee dans 82 cas (96,5 %). Le DTN median est de 63 minutes (min 26, max 171) soit une reduction de 24 minutes (DTN2012–2014 = 87 min.). L’analyse mois par mois fait apparaitre une reduction des delais intermediaires et du DTN (DTN median 8 e mois = 50 min vs DTN median 5 premiers mois = 64 min. ; p Discussion Notre action a permis de reduire le DTN median de 24 minutes ce qui suggere une reduction de la perte d’autonomie evaluee a 4104 jours pour les 95 patients traites sur l’UNV en 8 mois (hors Tm). Les perspectives sont de consolider la reduction des delais (et atteindre l’objectif d’un DTN median a 45 minutes). Ce plan d’action pilote par un animateur filiere ARS pourrait etre reproduit sur d’autres UNV s’inscrivant dans cette demarche. Conclusion Notre action a permis de reduire la DTN de 24 minutes ce qui suggere une reduction de la perte d’autonomie evaluee a 4104 jours pour les 95 patients traites sur l’UNV (hors Tm).
Published: 2016

38. Predicting acute ischaemic stroke outcome using clinical and temporal thresholds

Author: Jean-Francois Cassarini, Pierre Decavel, Fabrice Vuillier, Faouzi Belahsen, Denis Sablot, Elisabeth Medeiros de Bustos, Thierry Moulin, and Laurent Tatu
Subjects: medicine.medical_specialty, Article Subject, business.industry, Neurological status, medicine.disease, computer.software_genre, Outcome (probability), Modified Rankin Scale, Positive predicative value, Internal medicine, Ischaemic stroke, medicine, Cardiology, Cerebral ischaemia, Data mining, cardiovascular diseases, Prospective cohort study, business, Stroke, computer, Research Article
Abstract: Background. Few studies have analysed the natural course of cerebral ischaemia for predicting outcome. We aimed to determine the early clinical findings and the thresholds for deficit severity and symptom duration that make it possible to stratify outcome. Methods. We included 154 patients with transient ischaemic attack or ischaemic stroke. Stroke profiles and neurological status were assessed from onset to 24 hrs, on admission, at 48 hrs, and at discharge. Outcomes were evaluated using the modified Rankin Scale. Positive and negative predictive values were calculated for the different thresholds. The model was subsequently evaluated on a new prospective cohort of 157 patients. Results. Initial National Institute of Health Stroke Scale (NIHSS) score 22 and symptom stability after 1,230 min were predictive of physical dependency or death. Conclusions. Low and high NIHSS cut-off points are effective positive predictive values for good and poor outcomes. Thresholds for symptom duration are less conclusive.
Published: 2011

39. [Impact of mobile intensive care units on treating stroke within the 3-hour time window in a semi-rural area]

Author: Denis, Sablot, Mathieu, Magnaudeix, Aziz, Akouz, Jany, Rey, Christophe, De la Vega, Jean-Christophe, Blenet, Laurent, Ortega, Jean-Francois, Cassarini, Gwanaele, Runavot, Diane, Cerutti, Ruxandra, Filipov, Yves, Garcia, Michel, Mora, and Jean-Emmanuel, De la Coussaye
Subjects: Adult, Aged, 80 and over, Diagnostic Imaging, Male, Emergency Medical Services, Time Factors, Brain, Middle Aged, Injections, Stroke, Intensive Care Units, Fibrinolytic Agents, Tissue Plasminogen Activator, Humans, Female, France, Rural Health Services, Mobile Health Units, Aged
Abstract: We tested the hypothesis that calling emergency medical services ("15", French equivalent of 911 or 999 calls) and response by a mobile intensive care unit staffed by emergency physicians (MICU) reduces the time to treatment to within the 3-hour time window required for administration of recombinant tissue plasminogen activator.This study compared the time from symptom onset to admission (prehospital time), from admission to treatment (imaging and treatment delays, hospital time), and total time from symptom onset to treatment in an observational cohort of 53 consecutive patients, according to how they reached the hospital (Group 1: MICU and group 2: standard emergency ambulance dispatched by EMS center [2a] or direct admission [2b]).The study included 52 patients (1 was excluded because hospitalized at the time of the stroke): 27 (51.9%) in group 1, 16 (30.8%) in group 2a, and 9 (17.3%) in group 2b. Calling "15" shortened total home-to-needle time by 24 minutes (p=0.034). The mean total time was not significantly shorter in group 1 (152 versus 162 min; p=0.27) but MICUs were used for patients farther away (mean distance 25 versus 11 km; p=0.02). The average prehospital time was thus higher in group 1 (86 versus 69 min; p=0.044), but was compensated by a reduction in the average hospital time (66 versus 93 min; p=0.0001), due mainly to shorter waits for imaging (22 versus 45 min; p=0.0001).Calling the emergency services number reduces mean total time. MICUs were associated with a longer prehospital time, mainly due to greater distances, but they facilitated in-hospital management.
Published: 2007

40. Impact of emergency room neurologists on patient management and outcome

Author: Thierry Moulin, Denis Sablot, Eric Berger, Faouzi Belahsen, Laurent Tatu, Lucien Rumbach, Fabrice Vuillier, Elisabeth Vidry, Patrick Lemounaud, Gilles Capellier, Eugeniu Revenco, and Anne Cosson
Subjects: Male, medicine.medical_specialty, Emergency Medical Services, Neurology, Time Factors, Treatment outcome, Neurological examination, Outcome assessment, mental disorders, Health care, Stroke outcome, Outcome Assessment, Health Care, medicine, Humans, False Positive Reactions, False Negative Reactions, Demography, Neurologic Examination, Brain Diseases, medicine.diagnostic_test, business.industry, medicine.disease, nervous system diseases, Surgery, Patient management, Treatment Outcome, Workforce, Female, Neurology (clinical), Medical emergency, business, Emergency Service, Hospital
Abstract: The frequency and impact of in-patient assessment by a neurologist in the emergency room (ER) setting remain largely underestimated. The objective of our study was to analyse the impact of neurologist in-patient management. Methods: Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the ER, the ER team’s tentative neurological diagnosis, the neurology team’s final diagnosis and patient outcomes. The time interval between admission, call for a neurologist and the assessment by the neurologist were recorded. Results: Assessments by neurologists were performed in 14.7% (1,679/11,421) of all patients admitted to the ER. The mean time between admission and examination was 32 (± 36) min, irrespective of the day of the week, and dependent on the tentative diagnosis: shorter for stroke and status epilepticus (p < 0.05) and longer for confusion and vertigo (p < 0.05). The initial causes for examination were: stroke (33.1%), epilepsy (20%), loss of consciousness (9%), headaches (9%), confusion (5.4%), peripheral nervous system disorders (4.4%), vertigo (4.2%), cognitive dysfunctions (4%), gait disorders (3.2%) and miscellaneous (7.1%). Overall, false positive or negative diagnoses were produced by the ER in 37.3 and 36.6% of ER admissions, respectively. A complete change of diagnosis by the neurologist was found in 52.5% of patients. Of the patients undergoing a neurological examination, 18.4% were able to go home, 31.8% were admitted to the stroke unit, 32.4% to the general neurology unit and 17.4% to other departments. Conclusion: Our study stresses the need for a neurologist in the ER, both in quantitative terms and for the benefit of patient management.
Published: 2003

41. Status epilepticus in stroke: report on a hospital-based stroke cohort

Author: Thierry Moulin, Fabrice Vuillier, Laurent Tatu, Lucien Rumbach, Denis Sablot, and Eric Berger
Subjects: Adult, Male, medicine.medical_specialty, Pediatrics, Neurology, Adolescent, Status epilepticus, Cohort Studies, Epilepsy, Status Epilepticus, Recurrence, Medicine, Humans, Prospective Studies, Prospective cohort study, Child, Stroke, Aged, Aged, 80 and over, business.industry, Incidence (epidemiology), Incidence, Middle Aged, medicine.disease, Prognosis, Surgery, Hospitalization, Cohort, Disease Progression, Female, Neurology (clinical), medicine.symptom, business, Cohort study, Follow-Up Studies
Abstract: Objective: To evaluate occurrence rate, clinical data, and prognostic factors of status epilepticus (SE) after stroke. Methods: From 1984 to 1994, 3,205 patients were admitted to the Department of Neurology at our institution with first-time strokes. A total of 159 of these patients had first-time poststroke seizures. Among these 159 patients, cases of SE were identified and evaluated. Results: SE was recognized in 31 patients (19%). In 17 patients, SE was the first epileptic symptom (initial SE), and in 4 patients, stroke began with SE (S-SE). In the 14 remaining patients, SE occurred after one or more seizure(s). After a mean follow-up period of 47 months, neurologic deterioration occurred after SE in 15 patients. This deterioration was permanent in two patients. Fifteen patients died; in five patients, death was directly related to SE. Eight of the 17 patients with initial SE and all 14 patients with SE after one or more seizure(s) developed other seizures or SE. S-SE, however, was not a predictive factor for additional seizure(s). Conclusions: Status epilepticus is common among patients with poststroke seizures. Although the immediate prognosis of patients with status epilepticus is poor, status epilepticus as the presenting sign did not necessarily predict subsequent epilepsy.
Published: 2000

42. Seizures and epilepsy following strokes: recurrence factors

Author: Thierry Moulin, Laurent Tatu, Sophie Berges, Denis Sablot, Eric Berger, Lucien Rumbach, and Bruno Challier
Subjects: Adult, Male, medicine.medical_specialty, Pediatrics, Neurological disorder, Severity of Illness Index, Cohort Studies, Epilepsy, Recurrence, Seizures, Epidemiology, Convulsion, Severity of illness, medicine, Humans, Risk factor, Stroke, Aged, Aged, 80 and over, business.industry, Electroencephalography, Middle Aged, medicine.disease, Surgery, Neurology, Acute Disease, Regression Analysis, Female, Neurology (clinical), medicine.symptom, business, Cohort study, Follow-Up Studies
Abstract: Background and Purpose: Though there have been many reports on poststroke seizures, there is still much we do not know about them. Using a large cohort of stroke patients we analyzed the characteristics of the seizure(s) and the rate and factors involved in seizure recurrence. Methods: Out of the 3,205 patients admitted for a first-ever stroke to our department between 1984 and 1994, we retrospectively studied the data of all patients with a first-ever seizure and analyzed their evolution. Two types of seizure(s) were defined: ‘early-onset’ seizures (occurring within the 14 days following the stroke) and ‘late-onset’ ones (after the 14th day). Results: 159 patients were included in the study, i.e. 4.96%. There were 116 ischemic strokes and 43 primary hematomas. Cortical involvement was found in 87% of the patients. Early-onset seizures occurred in 57 patients and late-onset ones in 102 patients, 76% of which were observed within 2 years. Follow-up was performed in 135 patients with a mean follow-up period of 47 months; 68 of them presented a seizure recurrence. A 2nd seizure occurred more often in the patients with late-onset seizures (p < 0.01); recurrence was either single (24 patients) or multiple (44 patients). Univariate analysis demonstrated 3 factors for multiple recurrences: hemorrhagic component, low Rankin scale after the initial seizure and occipital involvement. Multivariate analysis determined 2 factors: occipital involvement and late onset of the 1st seizure as a predictive model of multiple recurrences. Conclusions: This study confirms that poststroke seizures are frequent and must be divided into 2 types: early-onset (≤14 days) and late-onset seizures. It demonstrates that a significantly lower rate of patients with early-onset seizures develop another seizure, i.e. epilepsy, than do patients with late-onset seizures. Other factors are involved in recurrence suggesting that poststroke epilepsy probably occurs in a chronically injured brain. The problem of treatment remain unanswered.
Published: 1999

43. Apport de l’IRM multimodale et facteurs prédictifs pour le diagnostic d’accident vasculaire cérébral ischémique lors d’un vertige aigu isolé au service d’accueil des urgences : étude prospective monocentrique au CH de Perpignan

Author: N. Gresillon, A. Akouz, A. Dutray, Denis Sablot, J.-L. Bertrand, Nadège Olivier, and Nicolas Gaillard
Subjects: Neurology, Neurology (clinical)
Published: 2013

44. Contents Vol. 50, 2003

Author: Theodor Landis, Ayako Nakano, Tung-Sheng Shih, D Cologno, P. Bertholon, Sándor Túri, D. Michel, Chin-Chang Huang, Soichiro Mochio, Nobuaki Horiuchi, Anne Cosson, Iris Spitzer, Gilles Capellier, M. Rieks, Masakazu Sugino, T.H. Leoh, Takao Mitsui, Toshiaki Hanafusa, Patrick Lemounaud, Eugeniu Revenco, Takuya Nishina, Elisabeth Vidry, Nils Brune, Gian Camillo Manzoni, Toshiyuki Ikemoto, Y.L. Lo, Fumiharu Kimura, C. Martin, Laurent Tatu, Hung-Chou Kuo, Miriam Juschka, Eric Berger, S. Fook-Chong, S. Nurjannah, Ryuichi Yamasaki, Julien Bogousslavsky, Fabrice Vuillier, Kiyoharu Inoue, Faouzi Belahsen, Masayo Morita, Sebastian Schimrigk, Olaf Blanke, Horst Przuntek, Hisayoshi Oka, Krisztina Bencsik, Shuichi Miyazaki, Tzu-Chen Yen, Eszter Karg, Ho-Yuan Chang, Hideto Nakajima, Mei-Chuan Ku, Y.E. Tan, Orhan Aktas, Volker Hoffmann, Lucien Rumbach, Thierry Moulin, Y.F. Dan, Chi-Jen Chen, J.C. Antoine, Denis Sablot, László Vécsei, Akira Shimizu, Masayuki Yoshioka, Péter Klivényi, Dieter Pöhlau, Sizue Ohtsuka, and Makoto Kunishige
Subjects: Neurology, Neurology (clinical)
Published: 2003

45. MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing

Author: C Heroum, P. Martin-Gousset, P Coignard, J. Mercier, M. Danko, R Sicard, Bernard Guillot, K Bakhti, Christian Jorgensen, William Camu, David Guiraud, M Meissonnier, J.-E. de La Coussaye, Jerôme Morel, David Morquin, P Gabrion, M Fouletier, Marie-Christine Picot, Davide Caimmi, M.S. Léglise, Jean-Marie Robine, L Schifano, I Tavares, Samir Jaber, V. Bruguière, Patrick Messner, G. Canovas, V Tribout, Isabelle Quéré, Bertrand Coulet, Jean-Paul Cristol, Claude Jeandel, M.C. Courrouy-Michel, P G Claret, Kjerstin Torre, R Lamoureux, Jacques Reynes, F. Gressard, Denis Sablot, V. Attalin, S. Jacquemin, M. Lapierre, O. Engberink, Jean Ribstein, V. Bouix, A Makinson, G. Dupeyron, F Leclercq, Hervé Tassery, G. Pandraud, A. Bedbrook, V Carre, S Boichot, Philippe Courtet, A. L. Coupet, Joël Ankri, Philippe Augé, A Y Goucham, S. Cade, T. Camuzat, H Y Bonnin, D. Strubel, S. Granier, Karen Ritchie, A Gelis, J.M. Davy, Laurence Vian, J.L. Pujol, F. Portejoie, D. Heve, L Landreau, Hubert Blain, K Patte, Frédéric Cuisinier, F Rivier, C. Laurent, A. Uziel, Jean-Luc Pasquié, C Fattal, Giacomo Cavalli, Didier Delignières, J. Millot-Keurinck, Jacques Touchon, P Kouyoudjian, D. Paccard, R Morales, G. Mathieu, J. Pelissier, Pierre Costa, Michel Mondain, F Coroian, Matteo Cesari, Xavier Quantin, M.P. Pasdelou, Cj M Lussert, Sofiane Ramdani, P Dujols, C Hérisson, Denis Mottet, Philippe Fraisse, Guillaume Cayla, Jean Bousquet, Claudine Berr, Gregoire Mercier, Béatrice Lognos, C Genis, Jean-Marc Lemaitre, Pierre Fesler, Christine Azevedo, C. Rolland, M. Nogues, Olivier Guérin, Kevin Mandrick, J P Riso, D. Hoa, M. Gellerat-Rogier, X Bobia, F Venail, A. Matheron, B Galan, Olivier Jonquet, Grégoire Vergotte, P. Nerin, Isabelle Laffont, J. Desplan, Gérard Bourrel, Nicolas Giraudeau, G. Tallon, Céline Vergne-Richard, C. Boubakri, M Ychou, P.A. Adnet, Pierre Senesse, J. C. Reuzeau, E. Viollet, Yannick Stephan, Raphaël Chiron, Gérard Dray, Daniel Laune, Pascal Demoly, Michel Amouyal, E. Royère, François Roubille, Sylvie Arnavielhe, I. Rédini-Martinez, M.P. Battesti, Jean-Luc Bourrain, Arnaud Dupeyron, P.L. Bernard, Y.M. Pers, F. Viart, Dominique Larrey, D. J. Costa, Sylvain Lehmann, A. Le Quellec, Ariane Sultan, Jean-Christophe Gris, Fares Gouzi, M Tanfin, C Marion, N. Raffort, Jérôme Cottalorda, J.L. Savy, P. Van de Perre, Grégory Ninot, M. Villain, Christine Meunier, V Cros, Maurice Hayot, Sylvain Richard, M Enjalbert, Rodolphe Bourret, Michel David, V. Handweiler, Bruno Vellas, Benoit Bardy, Bernard Combe, P. Dauenhauer, A. Avignon, Pierre Marès, E. Pastor, S Bouly, Jacques Bringer, J Fernandes, F. Nouvel, Claire Daien, François Vialla, B. Alomène, Mélanie Badin, C. Boegner, S. Perrey, D. Jakovenko, Michel Dauzat, P Nicolas, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Biocommunication en Cardio-Métabolique (BC2M), Université de Montpellier (UM), Laboratoire de magnétisme et d'optique de Versailles (LMOV), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Centre National de la Recherche Scientifique (CNRS), Department of Geriatrics - Efficiency and Deficiency Laboratory, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux], Hôpital Lapeyronie [Montpellier] (CHU), Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Nîmes (CHU de Nîmes), Géosciences Environnement Toulouse (GET), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Université Fédérale Toulouse Midi-Pyrénées-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS), Centre d'Estudis del Risc Tecnològic, Universitat Politècnica de Catalunya [Barcelona] (UPC), Hôpital Arnaud de Villeneuve, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), RN, Sciences pour l'environnement (SPE), Université Pascal Paoli (UPP)-Centre National de la Recherche Scientifique (CNRS)-Université Pascal Paoli (UPP)-Centre National de la Recherche Scientifique (CNRS), Conduites Addictives, de Performance et Santé, Université Montpellier 1 (UM1), Neuroscience Paris Seine (NPS), Centre National de la Recherche Scientifique (CNRS)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Neuropsychiatrie : recherche épidémiologique et clinique, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), EDF (EDF), Institut de génétique humaine (IGH), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Épilepsie de l'enfant et plasticité cérébrale (Inserm U663), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Euromov (EuroMov), Service de chirurgie pédiatrique [Hôpital Lapeyronie-Arnaud de Villeneuve], Polymer Institute (PI), Slovak Academy of Science [Bratislava] (SAS), Centre Sciences des Processus Industriels et Naturels (SPIN-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Laboratoire de Physique Nucléaire et de Hautes Énergies (LPNHE (UMR_7585)), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris Diderot - Paris 7 (UPD7)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Centre de recherche du CHUM (CR), CHUM-Hôpital Notre-Dame, Thermodynamique des solutions et des polymères (TSP), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Dept. of Microelectronics, Czech Technical University in Prague (CTU), foreign laboratories (FL), CERN [Genève], Service de Pancréatologie [Hôpital Beaujon], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Beaujon, Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Laboratoire de Spectrochimie Infrarouge et Raman - UMR 8516 (LASIR), Centre National de la Recherche Scientifique (CNRS)-Université de Lille, University of Agricultural Sciences and Veterinary Medicine, Institut de biologie moléculaire des plantes (IBMP), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Centre de Spectrométrie Nucléaire et de Spectrométrie de Masse (CSNSM), Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Service d'ORL, Hôpital Gui de Chauliac (CHRU de Montpellier), Laboratoire d'Etudes et de Recherche en Informatique d'Angers (LERIA), Université d'Angers (UA), Laboratoire composants et systèmes pour télécommunications (LCST), 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 de l'Elevage, Département de médecine interne, centre d'investigation clinique, CHU de Montpellier, Service de gérontologie et de prévention du vieillissement, Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de Recherche en Sciences de la Santé (IRSS) / Centre Muraz, Pathogénèse et contrôle des infections chroniques (PCCI), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Laboratoire Pierre Aigrain (LPA), Fédération de recherche du Département de physique de l'Ecole Normale Supérieure - ENS Paris (FRDPENS), Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS Paris)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS Paris)-Université Paris Diderot - Paris 7 (UPD7)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Institut de biologie et chimie des protéines [Lyon] (IBCP), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre National d'Études Spatiales [Toulouse] (CNES)-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Météo France-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences de l'Univers (INSU - CNRS), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Neurosciences Paris Seine (NPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], Laboratoire Avancé de Spectroscopie pour les Intéractions la Réactivité et l'Environnement - UMR 8516 (LASIRe), Ecole Nationale Supérieure de Chimie de Lille (ENSCL)-Université de Lille-Centre National de la Recherche Scientifique (CNRS), Institut de l'élevage (IDELE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UPVM)-Université de Montpellier (UM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre National de la Recherche Scientifique (CNRS)-Observatoire Midi-Pyrénées (OMP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Centre National d'Études Spatiales [Toulouse] (CNES), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon ( MACVIA-LR ), Université Montpellier 1 ( UM1 ) -World Health Organization ( WHO/OMS ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ) -Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -European Innovation Partnership on Active and Healthy Ageing Reference Site, Biocommunication en Cardio-Métabolique ( EA 7288 ), Université de Montpellier ( UM ), Laboratoire de magnétisme et d'optique de Versailles ( LMOV ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Centre National de la Recherche Scientifique ( CNRS ), IRAMAT-Centre de recherche en physique appliquée à l’archéologie ( IRAMAT-CRP2A ), Institut de Recherches sur les Archéomatériaux ( IRAMAT ), Université de Technologie de Belfort-Montbeliard ( UTBM ) -Université d'Orléans ( UO ) -Université Bordeaux Montaigne-Centre National de la Recherche Scientifique ( CNRS ) -Université de Technologie de Belfort-Montbeliard ( UTBM ) -Université d'Orléans ( UO ) -Université Bordeaux Montaigne-Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Lapeyronie [Montpellier] ( CHU ), Centre Hospitalier Universitaire de Nîmes ( CHU de Nîmes ), Géosciences Environnement Toulouse ( GET ), Institut de Recherche pour le Développement ( IRD ) -Université Paul Sabatier - Toulouse 3 ( UPS ) -Observatoire Midi-Pyrénées ( OMP ) -Centre National de la Recherche Scientifique ( CNRS ), Universitat Politècnica de Catalunya [Barcelona] ( UPC ), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Anthropologie bio-culturelle, Droit, Ethique et Santé ( ADES ), Aix Marseille Université ( AMU ) -EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique ( CNRS ), Sciences pour l'environnement ( SPE ), Université Pascal Paoli ( UPP ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Pascal Paoli ( UPP ) -Centre National de la Recherche Scientifique ( CNRS ), Université Montpellier 1 ( UM1 ), Neuroscience Paris Seine ( NPS ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Departement de Cardiologie, Université Montpellier 1 ( UM1 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), EDF ( EDF ), Institut de génétique humaine ( IGH ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Épilepsie de l'enfant et plasticité cérébrale ( Inserm U663 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale, Euromov ( EuroMov ), Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Polymer Institute ( PI ), Slovak Academy of Science [Bratislava] ( SAS ), Centre Sciences des Processus Industriels et Naturels ( SPIN-ENSMSE ), École des Mines de Saint-Étienne ( Mines Saint-Étienne MSE ), Institut Mines-Télécom [Paris]-Institut Mines-Télécom [Paris], Laboratoire de Physique Nucléaire et de Hautes Énergies ( LPNHE ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Centre de recherche du CHUM ( CR ), Département de Physique des Matériaux ( DPM ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon, Thermodynamique des solutions et des polymères ( TSP ), Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Centre National de la Recherche Scientifique ( CNRS ), Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Czech Technical University in Prague ( CTU ), foreign laboratories ( FL ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Beaujon, Laboratoire de Mécanique et Technologie ( LMT ), École normale supérieure - Cachan ( ENS Cachan ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire de Spectrochimie Infrarouge et Raman - UMR 8516 ( LASIR ), Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Institut de biologie moléculaire des plantes ( IBMP ), Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ), Centre de Spectrométrie Nucléaire et de Spectrométrie de Masse ( CSNSM ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Centre National de la Recherche Scientifique ( CNRS ), Service d'ORL, Hôpital Gui de Chauliac ( CHRU de Montpellier ), Laboratoire d'Etudes et de Recherche en Informatique d'Angers ( LERIA ), Université d'Angers ( UA ), Laboratoire composants et systèmes pour télécommunications ( LCST ), Institut National des Sciences Appliquées ( INSA ), Centre de Thermique de Lyon ( CETHIL ), Centre National de la Recherche Scientifique ( CNRS ) -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 ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Hôpital de la Timone [CHU - APHM] ( TIMONE ), Centre Muraz, Laboratoire Pierre Aigrain ( LPA ), Fédération de recherche du Département de physique de l'Ecole Normale Supérieure - ENS Paris ( FRDPENS ), Centre National de la Recherche Scientifique ( CNRS ) -École normale supérieure - Paris ( ENS Paris ) -Centre National de la Recherche Scientifique ( CNRS ) -École normale supérieure - Paris ( ENS Paris ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de biologie et chimie des protéines [Lyon] ( IBCP ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Institut de recherche en cancérologie de Montpellier ( IRCM ), and Université Montpellier 1 ( UM1 ) -CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM )
Subjects: Gerontology, medicine.medical_specialty, Aging, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Respiratory Tract Diseases, [SHS.PSY]Humanities and Social Sciences/Psychology, Oral Health, Comorbidity, Health Promotion, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Promotion (rank), Medicine, media_common.cataloged_instance, Humans, 030212 general & internal medicine, European Union, Multiple Chronic Conditions, European union, Health policy, health care economics and organizations, ComputingMilieux_MISCELLANEOUS, Preventive healthcare, media_common, Aged, Aged, 80 and over, [ SDV ] Life Sciences [q-bio], business.industry, Health Policy, General Medicine, 3. Good health, Hospitalization, Health promotion, 030228 respiratory system, General partnership, Chronic Disease, Personal Autonomy, Polypharmacy, Quality of Life, Accidental Falls, France, Independent Living, Preventive Medicine, business, Independent living
Abstract: Bousquet J, Bourret R, Camuzat T, Augé P, Bringer J, Noguès M, Jonquet O, de la Coussaye JE, Ankri J, Cesari M, Guérin O, Vellas B, Blain H, Arnavielhe S, Avignon A, Combe B, Canovas G, Daien C, Dray G, Dupeyron A, Jeandel C, Laffont I, Laune D, Marion C, Pastor E, Pélissier JY, Galan B, Reynes J, Reuzeau JC, Bedbrook A, Granier S, Adnet PA, Amouyal M, Alomène B, Bernard PL, Berr C, Caimmi D, Claret PG, Costa DJ, Cristol JP, Fesler P, Hève D, Millot-Keurinck J, Morquin D, Ninot G, Picot MC, Raffort N, Roubille F, Sultan A, Touchon J, Attalin V, Azevedo C, Badin M, Bakhti K, Bardy B, Battesti MP, Bobia X, Boegner C, Boichot S, Bonnin HY, Bouly S, Boubakri C, Bourrain JL, Bourrel G, Bouix V, Bruguière V, Cade S, Camu W, Carre V, Cavalli G, Cayla G, Chiron R, Coignard P, Coroian F, Costa P, Cottalorda J, Coulet B, Coupet AL , Courrouy-Michel MC, Courtet P, Cros V, Cuisinier F, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dujols P, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fouletier M, Fraisse P, Gabrion P, Gellerat-Rogier M, Gelis A, Genis C, Giraudeau N, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hayot M , Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Kouyoudjian P, Lamoureux R, Landreau L, Lapierre M, Larrey D, Laurent C, Léglise MS, Lemaitre JM, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert CM, Makinson A, Mandrick K, Mares P, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G,Messner P, Meunier C, Mondain M, Morales R, Morel J, Mottet D, Nérin P, Nicolas P, Nouvel F, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Portejoie F, Pujol JL, Quantin X, Quéré I, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Robine JM, Rolland C, Royère E, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Stephan Y, Strubel D, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Tribout V, Uziel A, Van de Perre P, Venail F, Vergne-Richard C, Vergotte G, Vian L, Vialla F, Viart F, Villain M, Viollet E, Ychou M, Mercier J.; International audience; The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.

46. Early neurological deterioration following thrombolysis for minor stroke with isolated internal carotid artery occlusion

Author: N, Boulenoir, G, Turc, H, Henon, N, Laksiri, F, Mounier-Véhier, I, Girard Buttaz, D-L, Duong, J, Papassin, M, Yger, A, Triquenot, A, Lyoubi, A, Ter Schiphorst, C, Denier, J-C, Baron, P, Seners, Mylène, Masson, 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 [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), 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), Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Laboratoire de Neurologie [CH Lens], Centre Hospitalier de Lens, Neurologie - Centre Hospitalier de Valenciennes (CHV), Centre Hospitalier de Versailles André Mignot (CHV), Stroke Unit [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Service de Neurologie [CH Chambery], Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Service de neurologie [Saint-Antoine], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de neurologie [CH Saint Denis], Centre Hospitalier de Saint-Denis [Ile-de-France], 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 neurologie [Le Kremlin Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, MINOR-STROKE Collaborators: Wagih Ben Hassen, Bertrand Lapergue, Chantal Lamy, Ludovic Lucas, Frédéric Philippeau, Michael Obadia, Michel Piotin, Omar Bennani, Laura Mechtouff, Frédéric Klapczynski, Olivier Detante, Caroline Arquizan, Gioia Mione, Denis Sablot, Sébastien Gazzola, Séverine Debiais, Serkan Cakmak, Valer Grigoras, Ruben Tamazyan, Cécile Preterre, Charlotte Rosso, Philippe Niclot, Pierre Garnier, Sébastien Soize, François Lun, Amélie Tuffal, Marion Boulanger, Sébastien Gazzola, Mathieu Zuber, Fernando Pico, Frédéric Clarençon, Igor Sibon, Sonia Alamowitch, Laurie Fraticelli, Anne-Evelyne Vallet, Vincent Costalat, Catherine Oppenheim, Jean-Philippe Cottier, Yves Berthezene, Hubert Desal, Pierre Agius, Claire Boutet, Nicolas Bricout, Didier Leys, Mohamed Chbicheb, Arnaud Malbranque, Laurent Spelle, Serge Bracard, Mylène Masson, Martinez Rico, Clara, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), 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 Saint-Antoine], 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), 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), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM)
Subjects: medicine.medical_specialty, medicine.medical_treatment, cerebral ischemia, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Internal medicine, Occlusion, medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Thrombus, Stroke, Retrospective Studies, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Incidence (epidemiology), Thrombosis, Thrombolysis, Odds ratio, medicine.disease, Confidence interval, 3. Good health, Treatment Outcome, thrombolysis, Neurology, thrombectomy, Cardiology, Neurology (clinical), Internal carotid artery occlusion, business, 030217 neurology & neurosurgery, Carotid Artery, Internal, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Background and purpose: Better understanding the incidence, predictors and mechanisms of early neurological deterioration (END) following intravenous thrombolysis (IVT) for acute stroke with mild symptoms and isolated internal carotid artery occlusion (iICAo) may inform therapeutic decisions.Methods: From a multicenter retrospective database, we extracted all patients with both National Institutes of Health Stroke Scale (NIHSS) score
Published: 2020

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