253 results on '"Gregoire Boulouis"'
Search Results
2. Abstract 034: Value of Immediate Flat Panel Perfusion Imaging After Endovascular Therapy: A proof of concept study
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Adnan Mujanovic, Christoph Kurmann, Michael Manhart, Eike Piechowiak, Sara Pilgram‐Pastor, Bettina Serrallach, Gregoire Boulouis, Thomas Meinel, David Seiffge, Simon Jung, Marcel Arnold, Thanh Nguyen, Urs Fischer, Jan Gralla, Tomas Dobrocky, Pasquale Mordasini, and Johannes Kaesmacher
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Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction Clinical utility and diagnostic sensitivity of new‐generation flat‐panel computed tomography perfusion imaging (FPCTP) performed immediately after mechanical thrombectomy (MT) is unknown. We aimed to assess whether FPCTP obtained directly after MT could provide additional potentially relevant information on tissue reperfusion status. Methods Qualitative, single‐center analysis of all consecutive acute stroke patients admitted between 06/2019 and 03/2021 who underwent MT and post‐interventional FPCTP (n=26). A core‐lab blinded to technical details and clinical data performed reperfusion grading on post‐interventional digital subtraction angiography (DSA) images and time‐sensitive FPCTP maps. All patients were classified according to agreement between DSA and FPCTP. Results In 10/26 patients FPCTP revealed new, potentially clinically relevant information. Core‐lab adjudicated dichotomized detection of hypoperfusion (present/absent) was concurring in 21/26 (81%) patients. Of these, reperfusion findings showed perfect agreement on location and size in 16 (62%) patients, while in 5 (19%) patients with incomplete reperfusion, FPCTP showed additional hypoperfused areas missed on DSA. Of the remaining five patients subject to disagreement regarding the presence or absence of hypoperfusion, three showed complete reperfusion on DSA but hypoperfusion was noted on FPCTP, whereas two showed incomplete reperfusion on DSA without detectable hypoperfusion on FPCTP. FPCTP findings could have avoided Thrombolysis in Cerebral Infarction (TICI) overestimation in all false‐positive operator‐rated TICI3 cases. Conclusion In both core‐lab and real‐world operator assessment, FPCTP may provide additional clinically relevant information in a considerable percentage of patients undergoing MT. Hence, FPCTP may constitute a new standard for evaluating reperfusion efficacy and informed decision making in the angiography suite.
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- 2023
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3. Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion
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Andrea Morotti, Gregoire Boulouis, Jawed Nawabi, Qi Li, Andreas Charidimou, Marco Pasi, Frieder Schlunk, Ashkan Shoamanesh, Aristeidis H. Katsanos, Federico Mazzacane, Giorgio Busto, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Andrew D. Warren, Michele Laudisi, Anna Cavallini, Edip M. Gurol, Anand Viswanathan, Andrea Zini, Ilaria Casetta, Enrico Fainardi, Steven M. Greenberg, Alessandro Padovani, Jonathan Rosand, and Joshua N. Goldstein
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Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign. Methods: Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994–2015, prospective), Hamilton, Canada (2010–2016, retrospective), Berlin, Germany (2014–2019, retrospective), Chongqing, China (2011–2015, retrospective), Pavia, Italy (2017–2019, prospective), Ferrara, Italy (2010–2019, retrospective), Brescia, Italy (2020–2021, retrospective), and Bologna, Italy (2015–2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison. Results: A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55–3.80]; P P =0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64–0.73] versus 0.74 [95% CI, 0.70–0.78]; P =0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70–0.78]). Conclusions: Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA.
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- 2023
4. Influence de la thrombolyse intraveineuse chez les patients traites par thrombectomie mecanique pour une occlusion M2: une analyse du registre etis
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Agathe Le Floch, Frederic Clarencon, Aymeric Rouchaud, Maeva Khyeng, Julien Labreuche, Igor Sibon, Gregoire Boulouis, Benjamin Gory, Sebastien Richard, Jildaz Caroff, Raphael Blanc, Pierre Seners, Omer Eker, Tae-Hee Cho, Arturo Consoli, Romain Bourcier, Benoit Guillon, Cyril Dargazanli, Caroline Arquizan, Christian Denier, Francois Eugene, Stephanie Vannier, Jean-Christophe Gentric, Maxime Gauberti, Olivier Nagarra, Charlotte Rosso, Guillaume Turc, Ozlem Ozkul-Wermester, Christophe Cognard, Jean-Francois Albucher, Serge Timsit, Frederic Bourdain, Anthony Le Bras, Sebastian Richter, Solene Moulin, Raoul Pop, Olivier Heck, Ricardo Moreno, Vincent L'Allinec, Bertrand Lapergue, and Gaultier Marnat
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Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Published
- 2023
5. Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results
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Louis Thiery, Xavier Carle, Benoit Testud, Gregoire Boulouis, Paul Habert, Farouk Tradi, Anthony Reyre, Pierre Lehmann, Philippe Dory-Lautrec, Jan-Patrick Stellmann, Nadine Girard, Herve Brunel, Jean-Francois Hak, Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - APHM] (CEMEREM), Hôpital de la Timone [CHU - APHM] (TIMONE)-Centre de résonance magnétique biologique et médicale (CRMBM), and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)
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[SDV]Life Sciences [q-bio] ,Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundBalloon-assisted mechanical angioplasty for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) has a number of limitations, including transient occlusion of the spastic blood vessel. Comaneci is an FDA-approved device for temporary coil embolization assistance which has recently also been approved for the treatment of distal symptomatic refractory vasospasm. We aimed to report the feasibility, efficacy and safety of our experience with Comaneci angioplasty for refractory distal vasospasm (up to the second segment of the cerebral arteries) following aSAH.MethodsThis is a retrospective analysis of a prospective series of 18 patients included between April 2019 and June 2021 with aSAH and symptomatic vasospasm refractory to medical therapy, who were treated using Comaneci-17-asssisted mechanical distal angioplasty. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed. Inter-rater reliability of the scores was determined using the intraclass correlation coefficient.ResultsComaneci-assisted distal angioplasty was performed in 18 patients, corresponding to 31 target arteries. All distal anterior segments were easily accessible with the Comaneci-17 device. Vasospasm improvement after Comaneci mechanical angioplasty was seen in 22 distal arteries (71%) (weighted Cohen’s kappa (κw) 0.73, 95% CI 0.69 to 0.93). Vasospasm recurrence occurred in three patients (16.67%) and delayed cerebral infarction in three patients (16.67%), with a mean±SD delay between onset of symptoms and imaging follow-up (MRI/CT) of 32.61±8.93 days (κw0.98, 95% CI 0.88 to 1).ConclusionThis initial experience suggests that distal mechanical angioplasty performed with the Comaneci-17 device for refractory vasospasm following aSAH seems to be safe, with good feasibility and efficacy.
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- 2022
6. A comprehensive framework for cerebral amyloid angiopathy diagnosis: Diagnostic accuracy meta-analyses of different biomarkers (S36.008)
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Antreas Charidimou and Gregoire Boulouis
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- 2023
7. Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion
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Adam, de Havenon, Mahmoud, Elhorany, Gregoire, Boulouis, Olivier, Naggara, Jean, Darcourt, Frédéric, Clarençon, Sébastien, Richard, Gaultier, Marnat, Romain, Bourcier, Igor, Sibon, Caroline, Arquizan, Cyril, Dargazanli, Benjamin, Maïer, Pierre, Seners, Bertrand, Lapergue, Arturo, Consoli, Francois, Eugene, Stephane, Vannier, Jildaz, Caroff, Christian, Denier, Marion, Boulanger, Maxime, Gauberti, Aymeric, Rouchaud, Francisco, Macian, Charlotte, Rosso, Guillaume, Turc, Ozlem, Ozkul-Wermester, Chrisanthi, Papagiannaki, Jean François, Albucher, Anthony, Le Bras, Sarah, Evain, Valerie, Wolff, Raoul, Pop, Serge, Timsit, Jean-Christophe, Gentric, Frédéric, Bourdain, Louis, Veunac, Robert, Fahed, Stephanos Nikolaos, Finitsis, Benjamin, Gory, and Arnaud Le, Guen
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundThe number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes.MethodsWe used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0–3 at 90 days. We fit mixed multiple regression models, with center as a random effect.ResultsWe included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901).ConclusionsWe found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
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- 2022
8. Comment je fais un prélèvement veineux par cathétérisme des sinus pétreux inférieurs ?
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Estelle Acko-Ohui, Kevin Janot, Nourou Dine Adeniran Bankole, Heloise Ifergan, Richard Bibi, Denis Herbreteau, Jean-Philippe Cottier, and Gregoire Boulouis
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- 2022
9. Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey
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Jildaz, Caroff, Laurent, Aubert, Cécile, Lavenu-Bombled, Samy, Figueiredo, Kamelia, Habchi, Jonathan, Cortese, Francois, Eugene, Julien, Ognard, Florence, Tahon, Géraud, Forestier, Heloise, Ifergan, François, Zhu, Jean-Francois, Hak, Anthony, Reyre, Morgane, Laubacher, Abdoulaye, Traore, Jean Philippe, Desilles, Imad, Derraz, Ricardo, Moreno, Marc, Bintner, Guillaume, Charbonnier, Anthony, Le Bras, Louis, Veunac, Florent, Gariel, Hocine, Redjem, Jacques, Sedat, Guillaume, Tessier, Victor, Dumas, Maxime, Gauberti, Cyril, Chivot, Arturo, Consoli, Nicolas, Bricout, Titien, Tuilier, Alexis, Guedon, Raoul, Pop, Pierre, Thouant, Guillaume, Bellanger, Riccardo, Zannoni, Sebastien, Soize, Johann Sebastian, Richter, Olivier, Heck, Cristian, Mihalea, Julien, Burel, Jean-Baptiste, Girot, Eimad, Shotar, Sebastian, Gazzola, Gregoire, Boulouis, Basile, Kerleroux, Laurent, Spelle, Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], CHRU Brest - Service d'Imagerie médicale (CHU - Brest - HM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Optimisation Continue des Actions Thérapeutiques par l'Intégration d'Informations Multimodales, Université de Brest (UBO)-Télécom Bretagne-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Privé Clairval [Marseille], CHU Limoges, Service de neuroradiologie [Tours], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hospices Civils de Lyon (HCL), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de Neurologie [Hôpitaux Civils de Colmar], Hôpitaux Civils Colmar, Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Clermont-Ferrand, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Service de Neuroradiologie Interventionnelle [CHU Besançon], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Le CHCB, Centre Hospitalier de la Côte Basque, CHU de Bordeaux Pellegrin [Bordeaux], Clinique des Cèdres, Centre Hospitalier Universitaire de Nice (CHU Nice), Département de Neuroradiologie [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Amiens-Picardie, Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], CHU Lille, CHU Henri Mondor, Hôpital Lariboisière-Fernand-Widal [APHP], CHU Strasbourg, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Toulouse [Toulouse], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre hospitalier de Pau, Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Rouen, Normandie Université (NU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service de Neuroradiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Saint Anne Military Teaching Hospital [Toulon, France], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), and Centre Hospitalier Saint-Anne (GHU Paris)
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Surgery ,Neurology (clinical) ,General Medicine ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.MethodsIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).ResultsAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.ConclusionThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.
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- 2022
10. Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children
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Francis Brunelle, Gregoire Boulouis, Vincent Vidal, Nadine Girard, Olivier Naggara, Philippe Meyer, Thomas Blauwblomme, Basile Kerleroux, Florent Gariel, Manoelle Kossorotoff, Sarah Stricker, Nathalie Boddaert, Lorenzo Garzelli, Jean François Hak, Volodia Dangouloff Ros, and Sandro Benichi
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Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,Adolescent ,Fistula ,Computed tomography ,Lesion ,medicine ,Humans ,Prospective Studies ,Registries ,Child ,Stroke ,Cerebral Hemorrhage ,Retrospective Studies ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Magnetic resonance imaging ,medicine.disease ,Cerebrovascular Circulation ,Child, Preschool ,Arteriovenous Fistula ,Arterial spin labeling ,Etiology ,Female ,Spin Labels ,Neurology (clinical) ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose: Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. Methods: Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. Results: A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8–13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%–99.1%) and 79.0% (95% CI, 54.4%–94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect interrater agreement (κ=0.963 [95% CI, 0.912–1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. Conclusions: ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: 3618210420, 2217698.
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- 2022
11. Perfusion gradients promote delayed perihaematomal oedema in intracerebral haemorrhage
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Enrico Fainardi, Giorgio Busto, Elisa Scola, Ilaria Casetta, Katsuhiro Mizutani, Arturo Consoli, Gregoire Boulouis, Alessandro Padovani, and Andrea Morotti
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Cellular and Molecular Neuroscience ,Psychiatry and Mental health ,Neurology ,Biological Psychiatry - Abstract
Perihaematomal oedema is a potential therapeutic target to improve outcome of patients with intracerebral haemorrhage, but its pathophysiology remains poorly elucidated. We investigated the longitudinal changes of cerebral perfusion and their influence on perihaematomal oedema development in 150 patients with intracerebral haemorrhage who underwent computed tomography perfusion within 6 h from onset, at 24 h and at 7 days. Perfusion parameters were measured in haemorrhagic core, perihaematomal rim, surrounding normal appearing and contralateral brain tissue. Computed tomography perfusion parameters gradually improved from the core to the periphery in each time interval with an early increase at 24 h followed by a delayed decline at 7 days compared with admission values (P < 0.001). Multivariable linear regression analysis showed that haematoma volume and cerebral blood flow gradient between normal appearing and perihaematomal rim were independently associated with absolute perihaematomal oedema volume in the different time points (within 6 h, B = 0.128, P = 0.032; at 24 h, B = 0.133, P = 0.016; at 7 days, B = 0.218, P < 0.001). In a secondary analysis with relative perihaematomal oedema as the outcome of interest, cerebral blood flow gradient between normal appearing and perihaematomal rim was an independent predictor of perihaematomal oedema only at 7 days (B = 0.239, P = 0.002). Our findings raise the intriguing hypothesis that perfusion gradients promote perihaematomal oedema development in the subacute phase after intracerebral haemorrhage.
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- 2023
12. Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study
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Gregoire, Boulouis, Sebastien, Soize, Volker, Maus, Sebastian, Fischer, Donald, Lobsien, Joachim, Klisch, Hanna, Styczen, Cornelius, Deuschl, Nuran, Abdullayev, Christoph, Kabbasch, Daniel, Kaiser, Ala, Jamous, Daniel, Behme, Kevin, Janot, Guillaume, Bellanger, Cristophe, Cognard, Laurent, Pierot, Matthias, Gawlitza, and Jennifer, Linn
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Carotid Artery Diseases ,medicine.medical_specialty ,Medizin ,Fusiform Aneurysm ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Occlusion ,medicine ,Humans ,Retrospective Studies ,Flow diverter ,Flow diversion ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,3. Good health ,Surgery ,Treatment Outcome ,Multicenter study ,Cohort ,Stents ,Neurology (clinical) ,Internal carotid artery ,business ,Carotid Artery, Internal ,030217 neurology & neurosurgery - Abstract
BackgroundScientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments.ObjectiveTo investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates.MethodsAll patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included.ResultsWe treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1±10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13±10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0–0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms.ConclusionFDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.
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- 2021
13. Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion
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Michel Piotin, Gregoire Boulouis, Robert Fahed, Kevin Janot, Charbel Mounayer, Kevin Zuber, G. Forestier, and A. Rouchaud
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Nitinol stent ,medicine.medical_specialty ,Parent artery ,Carotid siphon ,Aneurysm ,Stent deployment ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Flow diverter ,Interventional ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Middle Aged ,equipment and supplies ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,Female ,Stents ,Neurology (clinical) ,business ,Carotid Artery, Internal - Abstract
BACKGROUND AND PURPOSE: Intracranial stents for the treatment of aneurysms can be responsible for parent artery straightening, a phenomenon with potential consequences for aneurysmal occlusion. We aimed to evaluate parent artery straightening following flow-diverter stent placement in patients with intracranial aneurysms and explored the association between parent artery straightening and subsequent aneurysm occlusion. MATERIALS AND METHODS: All patients treated with flow-diverter stents for anterior circulation aneurysms located downstream from the carotid siphon between January 2009 and January 2018 were screened for inclusion. Parent artery straightening was defined as the difference (α–β) in the parent artery angle at the neck level before (α angle) and after flow-diverter stent deployment (β angle). We analyzed the procedural and imaging factors associated with parent artery straightening and the associations between parent artery straightening and aneurysmal occlusion. RESULTS: Ninety-five patients met the inclusion criteria (n = 64/95 women, 67.4%; mean age, 54.1 [SD, 11.2] years) with 97 flow-diverter stents deployed for 99 aneurysms. Aneurysms were predominantly located at the MCA bifurcation (n = 44/95, 44.4%). Parent artery straightening was found to be more pronounced in patients treated with cobalt chromium stents than with nitinol stents (P = .02). In multivariate analysis, parent artery straightening (P = .04) was independently associated with aneurysm occlusion after flow-diverter stent deployment. CONCLUSIONS: The use of flow-diverter stents for distal aneurysms induces a measurable parent artery straightening, which is associated with higher occlusion rates. Parent artery straightening, in our sample, appeared to be more prominent with cobalt chromium stents than with nitinol stents. This work highlights the necessary trade-off between navigability and parent artery straightening and may help tailor the selection of flow-diverter stents to aneurysms and parent artery characteristics.
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- 2021
14. Non-ischemic cerebral enhancing lesions after intracranial aneurysm endovascular repair: a retrospective French national registry
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Romain Bourcier, Alexis Guédon, Federico Di Maria, Hocine Redjem, Nader-Antoine Sourour, Benjamin Daumas-Duport, Gaultier Marnat, Zakaria Guetarni, Frédéric Clarençon, Caterina Michelozzi, Suzana Saleme, Kamel Boubagra, Pierre Thouant, Kevin Premat, Charles Arteaga, Denis Herbreteau, Marc-Antoine Labeyrie, Jean-Christophe Ferré, Eimad Shotar, Alessandra Biondi, S. Velasco, Didier Dormont, Laurent Pierot, Emmanuel Chabert, Gregoire Boulouis, Arturo Consoli, Guillaume Saliou, René Anxionnat, Léon Ikka, Florence Tahon, Kevin Janot, Nicolas Bricout, François Eugène, Stéphanie Lenck, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Michallon, CHU Rothschild [AP-HP], CHU Lille, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hopital d'instruction des armées Sainte-Anne [Toulon] (HIA), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU Clermont-Ferrand, Hôpital Foch [Suresnes], CHU Limoges, Hôpital Sud [CHU Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Bordeaux [Bordeaux], Algorithms, models and methods for images and signals of the human brain (ARAMIS), Sorbonne Université (SU)-Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-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)-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)-Centre National de la Recherche Scientifique (CNRS), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)
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Adult ,medicine.medical_specialty ,[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging ,[SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology ,Nice ,Asymptomatic ,Embolic ,Aneurysm ,Modified Rankin Scale ,Edema ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,medicine ,Humans ,Registries ,Retrospective Studies ,computer.programming_language ,Inflammation ,business.industry ,Endovascular Procedures ,[INFO.INFO-CV]Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV] ,Intracranial Aneurysm ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,[INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV] ,Surgery ,Neurology (clinical) ,National registry ,Radiology ,Non ischemic ,medicine.symptom ,Complication ,business ,[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing ,computer - Abstract
BackgroundNon-ischemic cerebral enhancing (NICE) lesions are exceptionally rare following aneurysm endovascular therapy (EVT).ObjectiveTo investigate the presenting features and longitudinal follow-up of patients with NICE lesions following aneurysm EVT.MethodsPatients included in a retrospective national multicentre inception cohort were analysed. NICE lesions were defined, using MRI, as delayed onset punctate, nodular or annular foci enhancements with peri-lesion edema, distributed in the vascular territory of the aneurysm EVT, with no other confounding disease.ResultsFrom a pool of 58 815 aneurysm endovascular treatment procedures during the study sampling period (2006–2019), 21/37 centres identified 31 patients with 32 aneurysms of the anterior circulation who developed NICE lesions (mean age 45±10 years). Mean delay to diagnosis was 5±9 months, with onset occurring a month or less after the index EVT procedure in 10 out of 31 patients (32%). NICE lesions were symptomatic at time of onset in 23 of 31 patients (74%). After a mean follow-up of 25±26 months, 25 patients (81%) were asymptomatic or minimally symptomatic without disability (modified Rankin Scale (mRS) score 0–1) at last follow-up while 4 (13%) presented with mild disability (mRS score 2). Clinical follow-up data were unavailable for two patients. Follow-up MRI (available in 27 patients; mean time interval after onset of 22±22 months) demonstrated persistent enhancement in 71% of cases.ConclusionsThe clinical spectrum of NICE lesions following aneurysm EVT therapy spans a wide range of neurological symptoms. Clinical course is most commonly benign, although persistent long-term enhancement is frequent.
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- 2021
15. Ovarian arteries embolization in women with persistent symptoms following uterine arteries embolization for uterus fibroids
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Denis Herbreteau, Basile Kerleroux, Thomas Perus, Jonathan Ifergan, Kevin Janot, R. Bibi, Henri Azaïs, Héloïse Ifergan, Gregoire Boulouis, and Henri Marret
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Adult ,medicine.medical_specialty ,Uterine fibroids ,Urology ,medicine.medical_treatment ,Uterus ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Retrospective Studies ,Hysterectomy ,Leiomyoma ,Radiological and Ultrasound Technology ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,Uterine Artery Embolization ,Hepatology ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Uterine Artery ,Treatment Outcome ,medicine.anatomical_structure ,Uterine Neoplasms ,Cohort ,Quality of Life ,Female ,business - Abstract
In patients with persisting symptoms after uterine arteries embolization (UAE), ovarian arteries embolization (OAE) may play a role to improve symptoms and decrease subsequent surgery rates. In a retrospective cohort, we aimed to investigate the efficacy and safety of OAE in females with recurrent or persistent symptoms following UAE. We performed a retrospective analysis of prospectively collected cases at a single reference academic hospital; we identified patients who benefited from OAE for persisting symptoms following UAE from 2008 to 2021. Outcome variables included the rates of subsequent surgery, a quality-of-life questionnaire with the UFS-QOL tool, the MRI reduction in uterine and fibroids volumes and the fibroid devascularization rate. Among 1300 women treated with UAE during the study period, 18 eventually received OAE and were included (mean age 44 ± 4.3 SD). There was no OAE procedural complication. There was a decrease in uterine volume and a complete devascularization of the dominant fibroid in 10/11 (90.9%) patients who underwent 12 months MRI. Three women underwent subsequent hysterectomy. Among 10/18 patients who answered the quality-of-life questionnaire after a mean follow-up of 70 months, eight reported an improvement or stability of symptoms. OAE for persisting symptoms after UAE was associated with improvement or stability of quality-of-life in most study subjects and less than a fifth of the cohort underwent hysterectomy after OAE. This study highlights the role of OAE as an adjunct to UAE.
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- 2021
16. Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry
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Agathe, Le Floch, Frédéric, Clarençon, Aymeric, Rouchaud, Maeva, Kyheng, Julien, Labreuche, Igor, Sibon, Gregoire, Boulouis, Benjamin, Gory, Sébastien, Richard, Jildaz, Caroff, Raphaël, Blanc, Pierre, Seners, Omer F, Eker, Tae-Hee, Cho, Arturo, Consoli, Romain, Bourcier, Benoit, Guillon, Cyril, Dargazanli, Caroline, Arquizan, Christian, Denier, Francois, Eugene, Stephane, Vannier, Jean-Christophe, Gentric, Maxime, Gauberti, Olivier, Naggara, Charlotte, Rosso, Guillaume, Turc, Ozlem, Ozkul-Wermester, Christophe, Cognard, Jean François, Albucher, Serge, Timsit, Frederic, Bourdain, Anthony, Le Bras, Sebastian, Richter, Solène, Moulin, Raoul, Pop, Olivier, Heck, Ricardo, Moreno, Vincent, L'Allinec, Bertrand, Lapergue, Gaultier, Marnat, and Alessandra, Biondi
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundIntravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone.MethodsWe conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0–2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients.ResultsAmong 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004).ConclusionsIn cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.
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- 2022
17. Clinical Diagnosis of Probable Cerebral Amyloid Angiopathy: Diagnostic Accuracy Meta-Analysis of the Boston Criteria
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Andreas Charidimou and Gregoire Boulouis
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Advanced and Specialized Nursing ,Cerebral Amyloid Angiopathy ,Humans ,Brain ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Magnetic Resonance Imaging ,Sensitivity and Specificity ,Retrospective Studies ,Cerebral Hemorrhage - Abstract
Background: The Boston criteria are used widely for the noninvasive diagnosis of sporadic cerebral amyloid angiopathy (CAA) and hence clinical decision-making, as well as research in the field. Yet, their exact diagnostic accuracy and validity remain (paradoxically) poorly studied. We performed a meta-analysis to synthesize evidence on the value and accuracy of the Boston criteria in diagnosing probable CAA patients. Methods: In a systematic literature search, we identified studies with extractable data relevant for sensitivity and specificity of probable CAA diagnosis per the magnetic resonance imaging Boston criteria and neuropathological CAA verification. We included studies that have classified patients according to any version of the Boston criteria, based on available brain magnetic resonance imaging blood-sensitive sequences (index test) and had neuropathologic evaluation for CAA presence from brain tissue samples (diagnostic reference standard). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy for probable CAA diagnosis. Results: Seven studies, including 193 patients, 121 with neuropathologically verified CAA versus 72 non-CAA based on neuropathology definition, were included in the meta-analysis. The studies were of low-to-moderate quality and varied in several methodological aspects. The overall pooled sensitivity for probable CAA diagnosis was 66.7% (95% CI, 45.9%–82.6%) and specificity was 88.2% (95% CI, 68.5%–96.3%). A predefined subgroup analysis of 4 studies on Boston criteria v.1.0 (n=151) demonstrated a pooled sensitivity and specificity of 60% (95% CI, 45.1%–72.9%) and 93.1% (95% CI, 81.8%–97.6%), respectively. Five studies had data on Boston criteria v.1.5 (n=123): the pooled sensitivity and specificity for probable CAA diagnosis was 73.1% (95% CI, 45%–90.1%) and 86% (95% CI, 41.4%–98.1%), respectively. Conclusions: The Boston criteria v.1.0 and v.1.5 appear to have moderate-to-good diagnostic accuracy for probable CAA in symptomatic patients, with high specificity but low-to-moderate sensitivity. Data are based on limited retrospective studies of overall low quality and at high risk of bias.
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- 2022
18. Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results
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Gaultier Marnat, Stefanos Finistis, Ricardo Moreno, Igor Sibon, Raoul Pop, Mikaël Mazighi, Frédéric Clarençon, Charlotte Rosso, Cyril Dargazanli, Jean Darcourt, Jean-Marc Olivot, Gregoire Boulouis, Kevin Janot, Solène Moulin, Romain Bourcier, Arturo Consoli, Sébastien Richard, Caroline Arquizan, Stephane Vannier, Sebastian Richter, Jean-Christophe Gentric, Chrisanthi Papagiannaki, Olivier Naggara, Omer F Eker, Bertrand Lapergue, Jildaz Caroff, and Benjamin Gory
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundPatients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice.MethodsThe Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up.ResultsAmong the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0–2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158).ConclusionsIn tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.
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- 2022
19. Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study
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Marc Kotowski, Jean-François Hak, G. Forestier, Guylaine Gevry, Elsa Magro, Laurent Létourneau-Guillon, Chiraz Chaalala, François Guilbert, Jai Jai Shiva Shankar, Jimmy Ghostine, Moujahed Labidi, Tim E. Darsaut, William Boisseau, Behzad Farzin, Dana Iancu, Michel W. Bojanowski, Gregoire Boulouis, David Volders, Daniel Roy, Grégory Jacquin, Jean Raymond, Jean-Christophe Gentric, Anass Benomar, Z. Kaderali, Robert Fahed, Thanh N. Nguyen, and Alain Weill
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medicine.medical_specialty ,law.invention ,symbols.namesake ,Randomized controlled trial ,law ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Noninvasive angiography ,Endovascular treatment ,Fisher's exact test ,Clipping (audio) ,Interventional ,business.industry ,Intraobserver reliability ,Angiography ,Reproducibility of Results ,Intracranial Aneurysm ,Surgical Instruments ,Embolization, Therapeutic ,Inter-rater reliability ,Treatment Outcome ,symbols ,Neurology (clinical) ,Radiology ,business - Abstract
BACKGROUND AND PURPOSE: Noninvasive angiography is commonly used to assess the outcome of surgical or endovascular treatment of intracranial aneurysms in clinical series or randomized trials. We sought to assess whether a standardized 3-grade classification system could be reliably used to compare the CTA and MRA results of both treatments. MATERIALS AND METHODS: An electronic portfolio composed of CTAs of 30 clipped and MRAs of 30 coiled aneurysms was independently evaluated by 24 raters of diverse experience and training backgrounds. Twenty raters performed a second evaluation 1 month later. Raters were asked which angiographic grade and management decision (retreatment; close or long-term follow-up) would be most appropriate for each case. Agreement was analyzed using the Krippendorff α (α(K)) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests. RESULTS: Interrater agreement was substantial (α(K) = 0.63; 95% CI, 0.55–0.70); results were slightly better for MRA results of coiling (α(K) = 0.69; 95% CI, 0.56–0.76) than for CTA results of clipping (α(K) = 0.58; 95% CI, 0.44–0.69). Intrarater agreement was substantial to almost perfect. Interrater agreement regarding clinical management was moderate for both clipped (α(K) = 0.49; 95% CI, 0.32–0.61) and coiled subgroups (α(K) = 0.47; 95% CI, 0.34–0.54). The choice of clinical management was strongly associated with the size of the residuum (mean Cramer V = 0.77 [SD, 0.14]), but complete occlusions (grade 1) were followed more closely after coiling than after clipping (P = .01). CONCLUSIONS: A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.
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- 2021
20. Tissue outcome prediction in hyperacute ischemic stroke: Comparison of machine learning models
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Sylvain Charron, Guillaume Turc, Jean-Claude Baron, Joseph Benzakoun, Bertrand Thirion, Wagih Ben Hassen, Gregoire Boulouis, Catherine Oppenheim, Olivier Naggara, Laurence Legrand, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), GHU Paris Psychiatrie et Neurosciences, Université de Paris - UFR Médecine Paris Centre [Santé] (UP Médecine Paris Centre), Université de Paris (UP), Modelling brain structure, function and variability based on high-field MRI data (PARIETAL), Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Service NEUROSPIN (NEUROSPIN), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Service NEUROSPIN (NEUROSPIN), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Inria Saclay - Ile de France, and Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)
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Male ,Clinical Decision-Making ,030204 cardiovascular system & hematology ,Machine learning ,computer.software_genre ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,Humans ,Medicine ,Acute ischemic stroke ,Stroke ,Aged ,Ischemic Stroke ,Retrospective Studies ,Neuroradiology ,Aged, 80 and over ,business.industry ,Penumbra ,Brain ,Original Articles ,Middle Aged ,Prognosis ,medicine.disease ,Patient management ,Diffusion Magnetic Resonance Imaging ,Neurology ,Infarction ,Reperfusion ,Ischemic stroke ,Female ,Neurology (clinical) ,Artificial intelligence ,Treatment decision making ,Cardiology and Cardiovascular Medicine ,Outcome prediction ,business ,computer ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Machine Learning (ML) has been proposed for tissue fate prediction after acute ischemic stroke (AIS), with the aim to help treatment decision and patient management. We compared three different ML models to the clinical method based on diffusion-perfusion thresholding for the voxel-based prediction of final infarct, using a large MRI dataset obtained in a cohort of AIS patients prior to recanalization treatment. Baseline MRI (MRI0), including diffusion-weighted sequence (DWI) and Tmax maps from perfusion-weighted sequence, and 24-hr follow-up MRI (MRI24h) were retrospectively collected in consecutive 394 patients AIS patients (median age = 70 years; final infarct volume = 28mL). Manually segmented DWI24h lesion was considered the final infarct. Gradient Boosting, Random Forests and U-Net were trained using DWI, apparent diffusion coefficient (ADC) and Tmax maps on MRI0 as inputs to predict final infarct. Tissue outcome predictions were compared to final infarct using Dice score. Gradient Boosting had significantly better predictive performance (median [IQR] Dice Score as for median age, maybe you can replace the comma with an equal sign for consistency 0.53 [0.29–0.68]) than U-Net (0.48 [0.18–0.68]), Random Forests (0.51 [0.27–0.66]), and clinical thresholding method (0.45 [0.25–0.62]) ( P
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- 2021
21. Impact of Repeated Clot Retrieval Attempts on Infarct Growth and Outcome After Ischemic Stroke
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Olivier Naggara, Martin Bretzner, Nicolas Bricout, Guillaume Turc, C Rodriguez, Laurence Legrand, Pierre Seners, Alice Le Berre, Joseph Benzakoun, Charlotte Cordonnier, Caroline Touloupas, Hilde Hénon, Wagih Ben Hassen, Gregoire Boulouis, and Catherine Oppenheim
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Arterial Occlusive Diseases ,030204 cardiovascular system & hematology ,Neurosurgical Procedures ,03 medical and health sciences ,0302 clinical medicine ,Meta-Analysis as Topic ,Risk Factors ,Modified Rankin Scale ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Binary logistic regression analysis ,Prospective Studies ,Aged ,Ischemic Stroke ,Thrombectomy ,Aged, 80 and over ,Cerebral infarction ,business.industry ,Cerebral Infarction ,Thrombolysis ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Mechanical thrombectomy ,Diffusion Magnetic Resonance Imaging ,Treatment Outcome ,Ischemic stroke ,Cardiology ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
ObjectiveTo determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).MethodsData were extracted from 2 pooled multicentric prospective registries of consecutive patients with anterior AIS-LVO treated with mechanical thrombectomy (MT) between January 2016 and 2019. Patients with pretreatment and 24-hour posttreatment diffusion-weighted imaging (DWI) achieving successful recanalization, defined as expanded Thrombolysis in Cerebral Infarction Scale score of 2B, 2C, or 3, were included. ENT were assessed and IG was measured by voxel-based segmentation after DWI coregistration. Associations between number of CRA, ENT, IG, and 3-month outcome were analyzed.ResultsFour hundred nineteen patients achieving successful recanalization were included. ENT occurrence was strongly correlated with increasing CRA (ρ = 0.73, p = 10−4). In multivariable linear analysis, IG was independently associated with CRA (β = 1.6 per retrieval attempt, 95% confidence interval [CI] 0.97–9.74, p = 0.03) and ENT (β = 2.7 [95% CI 1.21–4.1], p = 0.03). Unfavorable functional outcome (3-month modified Rankin Scale score >2) increased with each additional CRA. IG was an independent predictor of unfavorable outcome (odds ratio 1.05 [95% CI 1.02–1.07] per 1-mL IG increase, p = 10−4) in binary logistic regression analysis.ConclusionsIncreasing number of CRA in acute stroke is correlated with an increased ENT rate and increased IG volume, affecting functional outcome even when successful recanalization is achieved.Classification of EvidenceThis study provides Class II evidence that, for patients with acute stroke undergoing successful recanalization, an increasing number of CRA is associated with poorer functional outcome.
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- 2021
22. Diffusion-Weighted-Imaging infarct volume measurement tools show discrepancies leading to diverging thrombectomy decisions
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Marie Bitar, Cyril Dargazanli, Gregoire Boulouis, Stanislas Smajda, Claire Ancelet, Célina Ducroux, Robert Fahed, Wagih Ben Hassen, Naim Khoury, and Kevin Zuber
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medicine.medical_specialty ,Intraclass correlation ,Brain Ischemia ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Stroke ,Thrombectomy ,Radiological and Ultrasound Technology ,business.industry ,medicine.disease ,Triage ,Clinical trial ,Diffusion Magnetic Resonance Imaging ,Infarction ,Infarct volume ,Neurology (clinical) ,Treatment decision making ,Radiology ,business ,030217 neurology & neurosurgery ,Kappa ,Diffusion MRI - Abstract
Background and purpose Recent clinical trials demonstrated the benefit of thrombectomy beyond 6 h based on the automated measurement of infarct volume exclusively with the RAPID software. We aimed to compare eight tools commonly used for the measurement of infarct volume and see whether they would lead to similar thrombectomy decisions based on the Diffusion-weighted-imaging or computerized-tomography-perfusion Assessment with clinical mismatch in the triage of Wake-up and late-presenting strokes undergoing Neurointervention with Trevo (DAWN) trial imaging inclusion criteria. Materials and Methods The diffusion-weighted-imaging (DWI) infarct volume of 36 patients was measured with 3 automated tools (including RAPID) and 5 non-automated tools. The agreement for the measurements of DWI infarct volume and the resulting thrombectomy decisions were assessed with intraclass correlation coefficient (ICC) and Fleiss’ Kappa (K) statistics. Results The correlation for the measurement of DWI infarct volume between all 9 tools was excellent (ICC > 0.8). After dichotomization, agreement was substantial for any of the cut-points used in DAWN trial. Discrepancies involving at least one of the tools for thrombectomy decisions based on DAWN criteria occurred in one third of cases. Compared with RAPID, the use of any other tool for treatment decision based on DAWN criteria would have led to contradictory decisions in 6% to 19% of cases. Conclusion There are several currently available tools for the measurement of DWI infarct volume with excellent correlation. Despite the high agreement demonstrated in our study, frequent discrepancies between measurements in some dichotomized configurations led to frequent diverging thrombectomy decisions when applying DAWN criteria.
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- 2021
23. Mortality and functional outcome after pediatric intracerebral hemorrhage: cohort study and meta-analysis
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Lorenzo Garzelli, Sandro Benichi, Florent Gariel, Fanny Bajolle, Gregoire Boulouis, Thomas Blauwblomme, Nathalie Boddaert, Annie Harroche, Philippe Meyer, Jean-François Hak, Sarah Stricker, Manoelle Kossorotoff, Quentin Alias, Nicolas Garcelon, and Olivier Naggara
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Male ,medicine.medical_specialty ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Recovery rate ,Internal medicine ,medicine ,Humans ,Pediatric stroke ,Child ,Cerebral Hemorrhage ,Retrospective Studies ,Intracerebral hemorrhage ,business.industry ,Recovery of Function ,General Medicine ,medicine.disease ,Child, Preschool ,030220 oncology & carcinogenesis ,Meta-analysis ,Cohort ,Etiology ,Female ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
OBJECTIVE The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH. METHODS Children who received treatment for pICH at the authors’ institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes. RESULTS Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6–12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13–63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%–36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%–57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%–24%; Q = 101.6; I2 = 81%). CONCLUSIONS Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.
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- 2021
24. Closing the Gap in Pediatric Hemorrhagic Stroke: A Systematic Review
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Samyami S. Chowdhury, Alfred P. See, Lars P. Eriksson, Gregoire Boulouis, Laura L. Lehman, Dana B. Hararr, Veda Zabih, Nomazulu Dlamini, Christine Fox, and Michaela Waak
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Stroke ,Hemorrhagic Stroke ,Seizures ,Pediatrics, Perinatology and Child Health ,Outcome Assessment, Health Care ,Humans ,Brain ,Neurology (clinical) ,Child ,Prognosis ,Cerebral Hemorrhage - Abstract
Pediatric hemorrhagic stroke (HS) accounts for a large proportion of childhood strokes, 1 of the top 10 causes of pediatric deaths. Morbidity and mortality lead to significant socio-economic and psychosocial burdens. To understand published data on recognizing and managing children with HS, we conducted a systematic review of the literature presented here. We searched PubMed, Embase, CINAHL and the Cochrane Library databases limited to English language and included 174 studies, most conducted in the USA (52%). Terminology used interchangeably for HS included intraparenchymal/intracranial hemorrhage, spontaneous ICH, and cerebrovascular accident (CVA). Key assessments informing prognosis and management included clinical scoring (Glasgow coma scale), and neuroimaging. HS etiologies reported were systemic coagulopathy (genetic, acquired pathologic, or iatrogenic), or focal cerebrovascular lesions (brain arteriovenous malformations, cavernous malformations, aneurysms, or tumor vascularity). Several scales were used to measure outcome: Glasgow outcome score (GOS), Kings outcome score for head injury (KOSCHI), modified Rankin scale (mRS) and pediatric stroke outcome measure (PSOM). Most studies described treatments of at-risk lesions. Few studies described neurocritical care management including raised ICP, seizures, vasospasm, or blood pressure. Predictors of poor outcome included ethnicity, comorbidity, location of bleed, and hematomagt;2% of total brain volume. Motor and cognitive outcomes followed independent patterns. Few studies reported on cognitive outcomes, rehabilitation, and transition of care models. Interdisciplinary approach to managing HS is urgently needed, informed by larger cohort studies targeting key clinical question (eg development of a field-guide for the clinician managing patients with HS that is reproducible internationally).
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- 2022
25. Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage
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Andrea Morotti, Sarah Stricker, Gregoire Boulouis, Basile Kerleroux, Florent Gariel, Lorenzo Garzelli, Thomas Blauwblomme, Jean-François Hak, Marie Bourgeois, Quentin Alias, Philippe Meyer, Nathalie Boddaert, Manoelle Kossorotoff, Sandro Benichi, Olivier Naggara, and Nicolas Garcelon
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Male ,medicine.medical_specialty ,Adolescent ,Computed tomography ,Cohort Studies ,Risk Factors ,Odds Ratio ,Prevalence ,Craniocerebral Trauma ,Humans ,Medicine ,Glasgow Coma Scale ,Child ,Coagulation Disorder ,Cerebral Hemorrhage ,Retrospective Studies ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,medicine.diagnostic_test ,business.industry ,Odds ratio ,Blood Coagulation Disorders ,medicine.disease ,Treatment Outcome ,Child, Preschool ,Female ,Neurology (clinical) ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background and Purpose: Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children. Methods: Children admitted between January 2000 and March 2020 at a quaternary care pediatric hospital were screened for inclusion. Sample was restricted to children with 2 computed tomography scans within 72 hours of ICH onset, and a minimal clinical follow-up of months. sHE was defined as an increase from baseline ICH volume by 6 cc or 33% on follow-up computed tomography. Clinical outcome was assessed at 12 months with the King’s Outcome Scale for Childhood Head Injury score and defined as favorable for scores ≥5. Results: Fifty-two children met inclusion criteria, among which 8 (15%) demonstrated sHE, and 18 (34.6%) any degree of expansion. Children with sHE had more frequent coagulation disorders (25.0% versus 2.3%; P =0.022). After multivariable adjustment, only the presence of coagulation disorders at baseline remained independently associated with sHE (adjusted odds ratio, 14.4 [95% CI, 1.04–217]; P =0.048). sHE was independently associated with poor outcome (King’s Outcome Scale for Childhood Head Injury P =0.043). Conclusions: sHE is a frequent phenomenon after admission for a pediatric ICH and more so in children with coagulation defects. As sHE was strongly associated with poorer clinical outcomes, these data mandate a baseline coagulation work up and questions the need for protocolized repeat head computed tomography in children admitted for pediatric ICH.
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- 2021
26. Comment j’explore en imagerie un déficit neurologique brutal focal ?
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Catherine Oppenheim, Basile Kerleroux, Gregoire Boulouis, and C. Boutet
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03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030218 nuclear medicine & medical imaging - Abstract
Resume Introduction L’imagerie cerebrale joue un role central en presence d’une symptomatologie neurologique aigue en permettant notamment le diagnostic des pathologies neurovasculaires pour lesquelles on dispose de therapeutiques specifiques a la phase aigue pour diminuer la morbidite et le handicap. Nous decrivons ici les principales pathologies a rechercher et le bilan d’imagerie a realiser devant un deficit neurologique brutal focal. Messages principaux Les deux principales pathologies a rechercher sont l’ischemie cerebrale et l’hematome intraparenchymateux aigu. Un scanner ou une IRM est realise et devra comporter systematiquement une exploration des arteres cerebrales. Devant un AVC ischemique, le point clef du compte rendu est la presence ou non d’une occlusion d’une artere intracrânienne proximale, qui doit alors faire discuter la realisation d’une thrombectomie mecanique en urgence. Maitriser l’imagerie de perfusion, en scanner ou en IRM, peut s’averer utile dans certaines situations comme l’AVC ischemique d’heure de debut inconnue, pour identifier le sous-groupe de patients susceptibles de beneficier d’une thrombectomie mecanique. En presence d’un hematome intracrânien, l’urgence est d’antagoniser une eventuelle anticoagulation. On recherchera ensuite les elements de gravite immediate ainsi qu’une etiologie sous-jacente curable. Conclusion Devant un deficit neurologique brutal focal, un bilan d’imagerie concis et cible fait partie integrante de la prise en charge neurovasculaire d’urgence et contribue pleinement a modifier l’histoire naturelle de ces pathologies en guidant la therapeutique.
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- 2021
27. Late Pediatric Mechanical Thrombectomy for Embolic Stroke as Bridge Reinforcement From LVAD to Heart Transplantation
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Charles-Joris Roux, Basile Kerleroux, Anne Moreau de Bellaing, Olivier Naggara, Jean-François Hak, Manoelle Kossorotoff, Lucile Houyel, Olivier Raisky, Gregoire Boulouis, and Damien Bonnet
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0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,heart ,030105 genetics & heredity ,03 medical and health sciences ,mechanical thrombectomy ,0302 clinical medicine ,Internal medicine ,medicine ,ischemic stroke ,left ventricular assist device ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,collateral circulation ,Heart transplantation ,business.industry ,Collateral circulation ,medicine.disease ,Embolic stroke ,CT, computed tomography ,Transplantation ,Mechanical thrombectomy ,Bridge (graph theory) ,pediatric ,Mini-Focus Issue: Vascular Medicine ,CICU, cardiac intensive care unit ,RC666-701 ,Ventricular assist device ,Heart failure ,MT, mechanical thrombectomy ,Cardiology ,LVAD, left ventricular assist device ,Case Report: Clinical Case ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,PedNISS, Pediatric National Institutes of Health Stroke Scale ,transplantation - Abstract
Although the left ventricular assist device is an important bridge to heart transplantation for patients with end-stage heart failure, it can also be a source of embolic stroke. We present a case of late intracranial mechanical thrombectomy performed for embolic stroke beyond the recommended 6 h, thus allowing for heart transplantation 4 days after intracranial mechanical thrombectomy. (Level of Difficulty: Advanced.), Central Illustration
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- 2021
28. Rescue intracranial permanent stenting for refractory occlusion following thrombectomy: a propensity matched analysis
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Heloise Ifergan, Cyril Dargazanli, Wagih Ben Hassen, Jean-Francois Hak, Benjamin Gory, Julien Ognard, Kevin Premat, Gaultier Marnat, Basile Kerleroux, François Zhu, Guillaume Bellanger, Peter B Sporns, Guillaume Charbonnier, Géraud Forestier, Jildaz Caroff, Cédric Fauché, Frédéric Clarençon, Kevin Janot, Bertrand Lapergue, and Gregoire Boulouis
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundRescue intracranial stenting (RIS) can be used in refractory large vessel occlusion (LVO) after mechanical thrombectomy (MT). We aimed to assess the safety and efficacy of RIS versus a propensity matched sample of patients with persistent LVO.MethodsWe retrospectively analysed a multicenter retrospective pooled cohort of patients with anterior LVO (2015−2021) treated with MT, and identified patients with at least three passes and a modified Thrombolysis In Cerebral Infarction (mTICI) score of 0 to 2a. Propensity score matching was used to account for determinants of outcome in patients with or without RIS. The study outcomes included 3 months modified Rankin Scale (mRS) and symptomatic hemorrhagic transformation (HT).Results420 patients with a refractory anterior occlusion were included, of which 101 were treated with RIS (mean age 69 years). Favorable outcome (mRS 0–2) was more frequent in patients with a patent stent at day 1 (53% vs 6%, PConclusionIn selected patients with a refractory intracranial occlusion despite at least three thrombectomy passes, RIS may be associated with an overall shift towards more favorable clinical outcome, and no significant increase in the odds of symptomatic HT or death.
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- 2023
29. Hyperacute Recanalization Strategies and Childhood Stroke in the Evidence Age
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Augustin Ozanne, Manoelle Kossorotoff, Stéphane Chabrier, Gregoire Boulouis, B. Husson, and Olivier Naggara
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medicine.medical_specialty ,medicine.medical_treatment ,Disease ,Pediatrics ,medicine ,Humans ,Pediatric stroke ,Thrombolytic Therapy ,Child ,Intensive care medicine ,Stroke ,Advanced and Specialized Nursing ,Evidence-Based Medicine ,business.industry ,Infant, Newborn ,Infant ,Thrombolysis ,Childhood stroke ,medicine.disease ,Safety profile ,Clot lysis ,Child, Preschool ,Observational study ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
No controlled pharmacological studies are available in the field of pediatric stroke, except for sickle cell disease. Therefore, while pharmacological and mechanical recanalization treatments have repeatedly shown clinical benefit in adults with arterial ischemic stroke, pediatric strokologists still cannot base their therapeutic management (including hyperacute strategies) on high-level evidence. Once again, pediatricians face the same dichotomic choice: adapting adult procedures now versus waiting—for a long time—for the corresponding pediatric trials. One way out is building a compromise based on observational studies with large, longitudinal, comprehensive, real-life, and multisource dataset. Two recent high-quality observational studies have delivered promising conclusions on recanalization treatments in pediatric arterial ischemic stroke. TIPSTER (Thrombolysis in Pediatric Stroke Extended Results) showed that the risk of severe intracranial hemorrhage after intravenous thrombolysis is low; the Save Childs Study reported encouraging data about pediatric thrombectomy. Beyond the conclusion of a satisfactory global safety profile, a thorough analysis of the methods, populations, results, and therapeutic complications of these studies helps us to refine indications/contraindications and highlights the safeguards we need to rely on when discussing thrombolysis and thrombectomy in children. In conclusion, pediatric strokologists should not refrain from using clot lysis/retrieval tools in selected children with arterial ischemic stroke. But the implementation of hyperacute care is only feasible if the right candidate is identified through the sharing of common adult/pediatric protocols and ward collaboration, formalized well before the child’s arrival. These anticipated protocols should never undervalue contraindications from adult guidelines and must involve the necessary pediatric expertise when facing specific causes of stroke, such as focal cerebral arteriopathy of childhood.
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- 2021
30. Consensus Guidelines of the French Society of Neuroradiology (SFNR) on the use of Gadolinium-Based Contrast agents (GBCAs) and related MRI protocols in Neuroradiology
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René Anxionnat, Myriam Edjlali-Goujon, Suzana Saleme, Hubert Desal, Nadya Pyatigorskaya, Stéphane Kremer, Douraied Ben Salem, Claire Boutet, Apolline Kazemi, Gregoire Boulouis, François Cotton, Olivier Clément, Basile Kerleroux, Jérôme Berge, Augustin Lecler, François Lersy, CCSD, Accord Elsevier, Les Hôpitaux Universitaires de Strasbourg (HUS), 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), GHU Paris Psychiatrie et Neurosciences, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Neuro-Radiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CHU 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), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Fondation Ophtalmologique Adolphe de Rothschild [Paris], CHU Limoges, Laboratoire de Traitement de l'Information Medicale (LaTIM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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), Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Gadolinium ,Gadolinium-based contrast agents ,Contrast Media ,chemistry.chemical_element ,Neuroimaging ,Recommendations ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pituitary adenoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,Intracerebral hemorrhage ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Multiple sclerosis ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,3. Good health ,[SDV] Life Sciences [q-bio] ,Venous thrombosis ,chemistry ,Nephrogenic systemic fibrosis ,France ,Neurology (clinical) ,Radiology ,business ,Brain MRI protocols ,030217 neurology & neurosurgery - Abstract
International audience; Gadolinium-based contrast agents (GBCAs) are used in up to 35% of magnetic resonance imaging (MRI) examinations and are associated with an excellent safety profile. Nevertheless, two main issues have arisen in the last two decades: the risk of nephrogenic systemic fibrosis and the risk of gadolinium deposition and retention. As a first step, this article reviews the different categories of GBCAs available in neuroradiology, their issues, and provides updates regarding the use of these agents in routine daily practice. Recent advances in MRI technology, as well as the development of new MRI sequences, have made GBCA injection avoidable in many indications, especially in patients with chronic diseases when iterative MRIs are required and when essential diagnostic information can be obtained without contrast enhancement. These recent advances also lead to changes in recommended MRI protocols. Thus, in a second step, this review focuses on consensus concerning brain MRI protocols in 10 common situations (acute ischemic stroke, intracerebral hemorrhage, cerebral venous thrombosis, multiple sclerosis, chronic headache, intracranial infection, intra- and extra-axial brain tumors, vestibular schwannoma and pituitary adenoma). The latter allowing the standardization of practices in neuroradiology. Recommendations were also made concerning the use of GBCAs in neuroradiology, based on evidence in the literature and/or by consensus between the different coauthors.
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- 2020
31. Thrombolysis in Cerebral Infarction 2b Reperfusions
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Johanna M. Ospel, Urs Fischer, Johannes Kaesmacher, Bruce C.V. Campbell, Jan Gralla, Gregoire Boulouis, Thomas Raphael Meinel, Jens Fiehler, and Mayank Goyal
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medicine.medical_specialty ,medicine.medical_treatment ,Clinical Decision-Making ,Collateral Circulation ,Infarction ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,medicine ,Humans ,Infusions, Intra-Arterial ,Thrombolytic Therapy ,In patient ,Infusions, Intravenous ,Intensive care medicine ,Stroke ,Ischemic Stroke ,Thrombectomy ,Advanced and Specialized Nursing ,Cerebral infarction ,business.industry ,Endovascular Procedures ,Cerebral Infarction ,Thrombolysis ,medicine.disease ,Cerebral Angiography ,Mechanical thrombectomy ,Treatment Outcome ,Functional independence ,Observational study ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Medical Futility ,030217 neurology & neurosurgery - Abstract
In patients undergoing mechanical thrombectomy, achieving complete (Thrombolysis in Cerebral Infarction 3) rather than incomplete successful reperfusion (Thrombolysis in Cerebral Infarction 2b) is associated with better functional outcome. Despite technical improvements, incomplete reperfusion remains the final angiographic result in 40% of patients according to recent trials. As most incomplete reperfusions are caused by distal vessel occlusions, they are potentially amenable to rescue strategies. While observational data suggest a net benefit of up to 20% in functional independence of incomplete versus complete reperfusions, the net benefit of secondary improvement from Thrombolysis in Cerebral Infarction 2b to 3 reperfusion might differ due to lengthier procedures and delayed reperfusion. Current strategies to tackle distal vessel occlusions consist of distal (microcatheter) aspiration, small adjustable stent retrievers, and administration of intra-arterial thrombolytics. While there are promising reports evaluating those techniques, all available studies show relevant limitations in terms of selection bias, single-center design, or nonconsecutive patient inclusion. Besides an assessment of risks associated with rescue maneuvers, we advocate that the decision-making process should also include a consideration of potential outcomes if complete reperfusion would successfully be achieved. These include (1) a futile angiographic improvement (hypoperfused territory is already infarcted), (2) an unnecessary angiographic improvement (the patient would not have developed infarction if no rescue maneuver was performed), and (3) a successful rescue maneuver with clinical benefit. Currently there is paucity of data on how these scenarios can be predicted and the decision whether to treat or to stop in a patient with incomplete reperfusion involves many unknowns. To advance the status quo, we outline current knowledge gaps and avenues of potential research regarding this clinically important question.
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- 2020
32. Acouphènes pulsatiles : rôle du neuroradiologue interventionnel — « Le cauchemar est guérissable »
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Kevin Janot, R. Bibi, Héloïse Ifergan, Denis Herbreteau, Gregoire Boulouis, Valère Barrot, and Igor Lima Maldonado
- Abstract
Points essentiels Les acouphenes pulsatiles sont a distinguer des acouphenes continus non pulsatiles car ils sont dans la plupart des cas d’origine vasculaire et curables. Un bilan ORL est essentiel dans la prise en charge d’un acouphene mais un acouphene pulsatile necessite egalement un bilan d’imagerie vasculaire et l’avis d’un neuroradiologue interventionnel. Lorsque la manœuvre de compression vasculaire cervicale modifie l’acouphene pulsatile, elle prouve l’origine vasculaire de l’acouphene. L’arteriographie cerebrale n’est plus l’examen d’imagerie a realiser en premiere intention pour un bilan d’acouphene pulsatile. Elle reste neanmoins necessaire lorsque l’on envisage un geste therapeutique. Le retentissement fonctionnel de l’acouphene est determinant pour poser l’indication d’un geste endovasculaire.
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- 2020
33. Le diaphragme carotidien : une cause méconnue d’AVC chez le sujet jeune
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Héloïse Ifergan, Gregoire Boulouis, Denis Herbreteau, Valère Barrot, R. Bibi, and Kevin Janot
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business.industry ,Medicine ,business - Published
- 2021
34. Impact of White Matter Hyperintensity Volume on Prognosis After Mechanical Thrombectomy in Ischemic Stroke Patients
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Théo Hancer, Maéva Kyheng, Julien Labreuche, Maxime Gauberti, Emmanuel Touzé, Grégoire Boulouis, Bertrand Lapergue, and Marion Boulanger
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Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Uncertainties remain about the impact of white matter hyperintensity (WMH) on prognosis after mechanical thrombectomy. Methods In this retrospective study from a national prospective registry of patients with ischemic stroke due to large vessel occlusion treated with mechanical thrombectomy, we assessed WMH volume using a quantitative semi‐automatized segmentation on baseline magnetic resonance imaging. We determined the association between WMH volume and the prognosis of patients with ischemic stroke presenting between 2019 and 2022. Results Among 902 patients (mean age 70.4 years, 50% women) with a baseline magnetic resonance imaging, the median WMH volume was 2.79 (0.75–9.14) mL. In multivariate analyses, increasing WMH volume was associated with a reduced probability of favorable outcome (modified Rankin Scale score 0–2) (adjusted odds ratio per 1 log+1 increase = 0.66, 95% confidence interval 0.54–0.82) and an increased risk of mortality at 90 days (adjusted odds ratio per 1 log+1 increase = 1.53, 95% confidence interval 1.23–1.90), with the greatest risk in patients with the highest WMH volume (>11 mL) compared to those with the lowest WMH volume (
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- 2024
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35. Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients
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Thomas Blauwblomme, Florent Gariel, Lorenzo Garzelli, Frédéric Clarençon, Philippe Meyer, Nader Sourour, Francis Brunelle, Olivier Naggara, Q. Alias, Gregoire Boulouis, Bertrand Mathon, Nathalie Boddaert, Manoelle Kossorotoff, S. Stricker, and Eimad Shotar
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Adult ,Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,Adolescent ,Neuroimaging ,Pediatrics ,030218 nuclear medicine & medical imaging ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Age groups ,Risk Factors ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Young adult ,Child ,Proportional Hazards Models ,Retrospective Studies ,Rupture ,Adult patients ,business.industry ,Proportional hazards model ,Mean age ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Arteriovenous Fistula ,Female ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
BACKGROUND AND PURPOSE: Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life. MATERIALS AND METHODS: Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture. RESULTS: Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, P
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- 2020
36. Association of Cerebral Small Vessel Disease and Cognitive Decline After Intracerebral Hemorrhage
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M. Edip Gurol, Thanakit Pongpitakmetha, Gregoire Boulouis, Andreas Charidimou, Marco Pasi, Sanjula D. Singh, Li Xiong, Kristin Schwab, Christopher D. Anderson, Alessandro Biffi, Steven M. Greenberg, Christina Kourkoulis, Jonathan Rosand, Lansing Sugita, and Anand Viswanathan
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Male ,medicine.medical_specialty ,Article ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,Dementia ,Cognitive Dysfunction ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,Cognitive decline ,Prospective cohort study ,Aged ,Cerebral Hemorrhage ,Retrospective Studies ,Aged, 80 and over ,Intracerebral hemorrhage ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Confidence interval ,Cerebral Small Vessel Diseases ,Cardiology ,Female ,Neurology (clinical) ,Cerebral amyloid angiopathy ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
ObjectiveTo determine whether MRI-based cerebral small vessel disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous intracerebral hemorrhage (ICH).MethodsWe analyzed data from ICH survivors enrolled in a single-center prospective study. We employed 3 validated CSVD burden scores: global, cerebral amyloid angiopathy (CAA)–specific, and hypertensive arteriopathy (HTNA)–specific. We quantified cognitive performance by administering the modified Telephone Interview for Cognitive Status test. We utilized linear mixed models to model cognitive decline rates, and survival models for new-onset dementia. We calculated CSVD scores' cutoffs to maximize predictive performance for dementia diagnosis.ResultsWe enrolled 612 ICH survivors, and followed them for a median of 46.3 months (interquartile range 35.5–58.7). A total of 214/612 (35%) participants developed dementia. Higher global CSVD scores at baseline were associated with faster cognitive decline (coefficient −0.25, standard error [SE] 0.02) and dementia risk (sub–hazard ratio 1.35, 95% confidence interval 1.10–1.65). The global score outperformed the CAA and HTNA scores in predicting post-ICH dementia (all p < 0.05). Compared to a model including readily available clinical and CT data, inclusion of the global CSVD score resulted in improved prediction of post-ICH dementia (area under the curve [AUC] 0.89, SE 0.02 vs AUC 0.81, SE 0.03, p = 0.008 for comparison). Global CSVD scores ≥2 had highest sensitivity (83%) and specificity (91%) for dementia diagnosis.ConclusionsA validated MRI-based CSVD score is associated with cognitive performance after ICH and improved diagnostic accuracy for predicting new onset of dementia.
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- 2020
37. Comment je fais une thrombectomie mécanique intracrânienne ?
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Gregoire Boulouis, Kevin Janot, Olivier Naggara, W. Ben Hassen, Eimad Shotar, Basile Kerleroux, G. Forestier, and Jean-François Hak
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03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030218 nuclear medicine & medical imaging - Abstract
Resume Introduction La thrombectomie mecanique a revolutionne la prise en charge des patients souffrant d’un AVC ischemique par occlusion aigue d’une artere intracrânienne proximale, dans les 24 h suivant le debut des symptomes. Nous decrivons ici les etapes techniques cles pour la realisation pratique de cette procedure. Messages principaux La thrombectomie mecanique commence lors de la selection de patients susceptibles de beneficier d’une revascularisation. L’installation et l’environnement anesthesique sont des elements cles de la reussite et de la securite du geste. La ponction arterielle, le franchissement de l’arche aortique, et la navigation extra/intracrânienne font appel a des techniques specifiques dans ce contexte. Une fois au contact du caillot, un stent-retriever et/ou un catheter d’aspiration distale sont utilises pour l’extraction mecanique de celui-ci et la revascularisation arterielle. Conclusion La realisation d’une thrombectomie mecanique intracrânienne necessite une formation specifique, et une experience du catheterisme supra-aortique. Une fois integrees, les etapes de realisation de la procedure sont stereotypees.
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- 2020
38. Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy
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Peter B. Sporns, Basel Maamari, Laurent Pierot, Vitor Mendes Pereira, Gregoire Boulouis, Patrik Michel, Manuel Requena, Martina Goeldlin, Jan Gralla, Johanna M. Ospel, Pasquale Mordasini, Thomas Raphael Meinel, Eike I. Piechowiak, Johannes Kaesmacher, Alex Brehm, Marcel Arnold, Maria Berndt, Tomas Dobrocky, Pascal J. Mosimann, Tobias Boeckh-Behrens, Urs Fischer, Amel Benali, and BEYOND-SWIFT Investigators
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Male ,medicine.medical_specialty ,Time Factors ,Post hoc ,workflow ,Original Contributions ,610 Medicine & health ,030204 cardiovascular system & hematology ,Brain Ischemia ,Time-to-Treatment ,Clinical and Population Sciences ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,odds ratio ,Registries ,Acute ischemic stroke ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,business.industry ,reperfusion ,thrombectomy ,Odds ratio ,Middle Aged ,Magnetic Resonance Imaging ,ddc ,Stroke ,Clinical trial ,Mechanical thrombectomy ,Treatment Outcome ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Cardiology ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Supplemental Digital Content is available in the text., Background and Purpose: Post hoc analyses of randomized controlled clinical trials evaluating mechanical thrombectomy have suggested that admission-to-groin-puncture (ATG) delays are associated with reduced reperfusion rates. Purpose of this analysis was to validate this association in a real-world cohort and to find associated factors and confounders for prolonged ATG intervals. Methods: Patients included into the BEYOND-SWIFT cohort (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the Solitaire FR With the Intention for Thrombectomy; https://www.clinicaltrials.gov; Unique identifier: NCT03496064) were analyzed (n=2386). Association between baseline characteristics and ATG was evaluated using mixed linear regression analysis. The effect of increasing symptom-onset-to-admission and ATG intervals on successful reperfusion (defined as Thrombolysis in Cerebral Infarction [TICI] 2b-3) was evaluated using logistic regression analysis adjusting for potential confounders. Results: Median ATG was 73 minutes. Prolonged ATG intervals were associated with the use of magnetic resonance imaging (+19.1 [95% CI, +9.1 to +29.1] minutes), general anesthesia (+12.1 [95% CI, +3.7 to +20.4] minutes), and borderline indication criteria, such as lower National Institutes of Health Stroke Scale, late presentations, or not meeting top-tier early time window eligibility criteria (+13.8 [95% CI, +6.1 to +21.6] minutes). There was a 13% relative odds reduction for TICI 2b-3 (adjusted odds ratio [aOR], 0.87 [95% CI, 0.79–0.96]) and TICI 2c/3 (aOR, 0.87 [95% CI, 0.79–0.95]) per hour ATG delay, while the reduction of TICI 2b-3 per hour increase symptom-onset-to-admission was minor (aOR, 0.97 [95% CI, 0.94–0.99]) and inconsistent regarding TICI 2c/3 (aOR, 0.99 [95% CI, 0.97–1.02]). After adjusting for identified factors associated with prolonged ATG intervals, the association of ATG delay and lower rates of TICI 2b-3 remained tangible (aOR, 0.87 [95% CI, 0.76–0.99]). Conclusions: There is a great potential to reduce ATG, and potential targets for improvement can be deduced from observational data. The association between in-hospital delay and reduced reperfusion rates is evident in real-world clinical data, underscoring the need to optimize in-hospital workflows. Given the only minor association between symptom-onset-to-admission intervals and reperfusion rates, the causal relationship of this association warrants further research. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064.
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- 2020
39. Comment je fais : une imagerie pour une céphalée en coup de tonnerre
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Gregoire Boulouis, Catherine Oppenheim, Basile Kerleroux, and C. Boutet
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03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030218 nuclear medicine & medical imaging - Abstract
Resume Introduction L’imagerie cerebrale joue un role majeur en presence d’une symptomatologie neurologique aigue, en permettant notamment le diagnostic des pathologies neuro-vasculaires pour lesquelles on dispose de therapeutiques specifiques a la phase aigue permettant de diminuer la morbidite et le handicap. Nous decrivons ici les principales pathologies a rechercher et le bilan d’imagerie a realiser devant une cephalee en coup de tonnerre. Messages principaux Devant une cephalee en coup de tonnerre, l’examen d’imagerie a realiser en premiere intention est le couple scanner — angioscanner cerebral. Il sera realise en urgence a la recherche d’une hemorragie sous-arachnoidienne par rupture d’anevrisme intracrânien. Une prise en charge rapide de ces patients en milieu specialise est indispensable pour lutter contre les complications aigues (recidive hemorragique et hydrocephalie principalement), mais aussi pour prevenir l’ischemie cerebrale retardee. L’IRM avec la sequence FLAIR est a privilegier pour la detection de l’hemorragie sous-arachnoidienne au-dela de 24 h. L’angiographie cerebrale avec acquisitions rotationnelles 3D reste l’examen de reference pour le diagnostic d’anevrisme intracrânien devant une hemorragie sous-arachnoidienne profonde, et la ponction lombaire le seul moyen d’eliminer une hemorragie meningee. Le syndrome de vasoconstriction cerebrale reversible se manifeste sous la forme de stenoses intracrâniennes d’evolution centripete. En l’absence d’hemorragie meningee, les deux principaux diagnostics a eliminer sont une dissection arterielle cervicale, et une thrombose veineuse cerebrale. Conclusion Devant une cephalee en coup de tonnerre, l’imagerie joue un role crucial pour identifier l’hemorragie meningee par rupture d’anevrisme et orienter vers les principaux diagnostics differentiels.
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- 2020
40. Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy
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François Zhu, Aymeric Rouchaud, Wagih Benhassen, Joseph Benzakoun, Kevin Janot, Jean François Hak, Florent Gariel, Lili Detraz, Gaultier Marnat, Cyril Dargazanli, Gregoire Boulouis, Charline Perot, Basile Kerleroux, Romain Bourcier, Géraud Forestier, Dimitri Daly-Eraya, Johannes Kaesmacher, Pasquale Mordasini, Benjamin Gory, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Hôpital Guillaume-et-René-Laennec [Saint-Herblain], CHU Limoges, Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Bern University Hospital [Berne] (Inselspital), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), 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 Paris Cité (UPCité), and Martinez Rico, Clara
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,[SDV]Life Sciences [q-bio] ,610 Medicine & health ,Perfusion scanning ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,Internal medicine ,Medicine ,Acute stroke ,Endovascular treatment ,030212 general & internal medicine ,Prospective cohort study ,Thrombectomy ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Ischemic stroke ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Odds ratio ,Perfusion imaging ,Confidence interval ,[SDV] Life Sciences [q-bio] ,lcsh:RC666-701 ,Cardiology ,Original Article ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background and Purpose Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT.Methods This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≥70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0–3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI).Results A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12; 95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups.Conclusions In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted.
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- 2020
41. Recurrence leading to retreatment in the long-term follow-up after endovascular treatment of carotid-ophthalmic artery aneurysm
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Nourou Dine Adeniran Bankole, Kevin Janot, Ulrick Sidney Kamounye, Valere Barrot, Heloise Ifergan, Richard Bibi, and Gregoire Boulouis
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Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Published
- 2022
42. Imaging markers of intracerebral hemorrhage expansion in patients with unclear symptom onset
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Andrea Morotti, Gregoire Boulouis, Andreas Charidimou, Loris Poli, Paolo Costa, Valeria De Giuli, Eleonora Leuci, Federico Mazzacane, Giorgio Busto, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Michele Laudisi, Anna Cavallini, Massimo Gamba, Mauro Magoni, Claudio Cornali, Marco M Fontanella, Andrew D Warren, Edip M Gurol, Anand Viswanathan, Roberto Gasparotti, Ilaria Casetta, Enrico Fainardi, Andrea Zini, Alessandro Pezzini, Alessandro Padovani, Steven M Greenberg, Jonathan Rosand, and Joshua N Goldstein
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Male ,Hematoma ,Anticoagulants ,unclear onset ,intracerebral hemorrhage ,Stroke ,Economica ,Neurology ,hematoma expansion ,outcome ,Humans ,Female ,CT ,Prospective Studies ,Biomarkers ,Retrospective Studies ,Cerebral Hemorrhage - Abstract
Background: Hematoma expansion (HE) is common and associated with poor outcome in intracerebral hemorrhage (ICH) with unclear symptom onset (USO). Aims: We tested the association between non-contrast computed tomography (NCCT) markers and HE in this population. Methods: Retrospective analysis of patients with primary spontaneous ICH admitted at five centers in the United States and Italy. Baseline NCCT was analyzed for presence of the following markers: intrahematoma hypodensities, heterogeneous density, blend sign, and irregular shape. Variables associated with HE (hematoma growth > 6 mL and/or > 33% from baseline to follow-up imaging) were explored with multivariable logistic regression. Results: Of 2074 patients screened, we included 646 subjects (median age = 75, 53.9% males), of whom 178 (27.6%) had HE. Hypodensities (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.79–3.98), heterogeneous density (OR = 2.16, 95% CI = 1.46–3.21), blend sign (OR = 2.28, 95% CI = 1.38–3.75) and irregular shape (OR = 1.82, 95% CI = 1.21–2.75) were independently associated with a higher risk of HE, after adjustment for confounders (ICH volume, anticoagulation, and time from last seen well (LSW) to NCCT). Hypodensities had the highest sensitivity for HE (0.69), whereas blend sign was the most specific marker (0.90). All NCCT markers were more frequent in early presenters (time from LSW to NCCT ⩽ 6 h, n = 189, 29.3%), and more sensitive in this population as well (hypodensities had 0.77 sensitivity). Conclusion: NCCT markers are associated with HE in ICH with USO. These findings require prospective replication and suggest that NCCT features may help the stratification of HE in future studies on USO patients.
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- 2022
43. First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations
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Quentin Alias, Thomas Blauwblomme, Francis Brunelle, Lorenzo Garzelli, Florent Gariel, Philippe Meyer, Olivier Naggara, Sandro Benichi, Manoelle Kossorotoff, Nathalie Boddaert, Gregoire Boulouis, and Kevin Beccaria
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Intracranial Arteriovenous Malformations ,medicine.medical_specialty ,Neurology ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Humans ,Medicine ,Dimethyl Sulfoxide ,Radiology, Nuclear Medicine and imaging ,Embolization ,Child ,Interventional neuroradiology ,Retrospective Studies ,Neuroradiology ,Intracerebral hemorrhage ,business.industry ,Onyx embolization ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,Female ,Polyvinyls ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs. Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated. In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1–12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1–3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV–V, respectively. It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.
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- 2019
44. Nontraumatic Pediatric Intracerebral Hemorrhage
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Mark T Mackay, Adam Kirton, Thomas Blauwblomme, Charlotte Cordonnier, Gregoire Boulouis, Sandro Benichi, Mathilde Chevignard, Elisabeth Tournier-Lasserve, Philippe Meyer, Olivier Naggara, Stéphane Chabrier, Jean François Hak, and Manoelle Kossorotoff
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Intracranial Arteriovenous Malformations ,Hemangioma, Cavernous, Central Nervous System ,Adolescent ,Computed Tomography Angiography ,Vomiting ,Arteriovenous fistula ,Anemia, Sickle Cell ,Neurosurgical Procedures ,Magnetic resonance angiography ,Cognition ,Activities of Daily Living ,medicine ,Humans ,Cognitive Dysfunction ,Social Integration ,Moyamoya disease ,Child ,Cerebral Hemorrhage ,Central Nervous System Vascular Malformations ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,Academic Success ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Headache ,Anticoagulants ,Infant ,Blood Coagulation Disorders ,Physical Functional Performance ,Childhood stroke ,Decompression, Surgical ,Prognosis ,medicine.disease ,Clinical neurology ,Child, Preschool ,Education, Special ,Anesthesia ,Arteriovenous Fistula ,Ischemic stroke ,Drainage ,Neurology (clinical) ,Moyamoya Disease ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography - Published
- 2019
45. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study
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Andreas Charidimou, Gregoire Boulouis, Matthew P Frosch, Jean-Claude Baron, Marco Pasi, Jean Francois Albucher, Gargi Banerjee, Carmen Barbato, Fabrice Bonneville, Sebastian Brandner, Lionel Calviere, François Caparros, Barbara Casolla, Charlotte Cordonnier, Marie-Bernadette Delisle, Vincent Deramecourt, Martin Dichgans, Elif Gokcal, Jochen Herms, Mar Hernandez-Guillamon, Hans Rolf Jäger, Zane Jaunmuktane, Jennifer Linn, Sergi Martinez-Ramirez, Elena Martínez-Sáez, Christian Mawrin, Joan Montaner, Solene Moulin, Jean-Marc Olivot, Fabrizio Piazza, Laurent Puy, Nicolas Raposo, Mark A Rodrigues, Sigrun Roeber, Jose Rafael Romero, Neshika Samarasekera, Julie A Schneider, Stefanie Schreiber, Frank Schreiber, Corentin Schwall, Colin Smith, Levente Szalardy, Pascale Varlet, Alain Viguier, Joanna M Wardlaw, Andrew Warren, Frank A Wollenweber, Marialuisa Zedde, Mark A van Buchem, M Edip Gurol, Anand Viswanathan, Rustam Al-Shahi Salman, Eric E Smith, David J Werring, Steven M Greenberg, Charidimou, A, Boulouis, G, Frosch, M, Baron, J, Pasi, M, Albucher, J, Banerjee, G, Barbato, C, Bonneville, F, Brandner, S, Calviere, L, Caparros, F, Casolla, B, Cordonnier, C, Delisle, M, Deramecourt, V, Dichgans, M, Gokcal, E, Herms, J, Hernandez-Guillamon, M, Jäger, H, Jaunmuktane, Z, Linn, J, Martinez-Ramirez, S, Martínez-Sáez, E, Mawrin, C, Montaner, J, Moulin, S, Olivot, J, Piazza, F, Puy, L, Raposo, N, Rodrigues, M, Roeber, S, Romero, J, Samarasekera, N, Schneider, J, Schreiber, S, Schreiber, F, Schwall, C, Smith, C, Szalardy, L, Varlet, P, Viguier, A, Wardlaw, J, Warren, A, Wollenweber, F, Zedde, M, van Buchem, M, Gurol, M, Viswanathan, A, Al-Shahi Salman, R, Smith, E, Werring, D, and Greenberg, S
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diagnoisi ,Amyloid beta-Peptides ,pathology [Cerebral Hemorrhage] ,Middle Aged ,MED/46 - SCIENZE TECNICHE DI MEDICINA DI LABORATORIO ,Magnetic Resonance Imaging ,diagnostic imaging [Cerebral Amyloid Angiopathy] ,Cerebral Amyloid Angiopathy ,methods [Magnetic Resonance Imaging] ,biomarker ,Humans ,Neurology (clinical) ,ddc:610 ,Neuropathology ,MRI ,Aged ,Cerebral Hemorrhage ,Retrospective Studies - Abstract
BACKGROUND: Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations.METHODS: In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy.FINDINGS: The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard.INTERPRETATION: The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations.FUNDING: US National Institutes of Health (R01 AG26484).
- Published
- 2021
46. Added value of non-contrast CT and CT perfusion markers for prediction of intracerebral hemorrhage expansion and outcome
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Andrea Morotti, Giorgio Busto, Gregoire Boulouis, Elisa Scola, Alessandro Padovani, Ilaria Casetta, and Enrico Fainardi
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Male ,Perfusion ,Hematoma ,Cytidine Triphosphate ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,General Medicine ,Tomography, X-Ray Computed ,Retrospective Studies ,Cerebral Hemorrhage - Abstract
To test the hypothesis that the combined analysis of non-contrast CT (NCCT) and CT perfusion (CTP) imaging markers improves prediction of hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH).Retrospective, single-center analysis of patients with primary ICH undergoing NCCT and CTP within 6 h from onset. NCCT images were assessed for the presence of intrahematomal hypodensity and shape irregularity. Perihematomal cerebral blood volume and spot sign were assessed on CTP. The main outcomes of the analysis were HE (growth6 mL and/or33%) and poor functional prognosis (90 days modified Rankin Scale 3-6). Predictors of HE and outcome were explored with logistic regression.A total of 150 subjects were included (median age 68, 47.1% males) of whom 54 (36%) had HE and 52 (34.7%) had poor outcome. The number of imaging markers on baseline imaging was independently associated with HE (odds ratio 2.66, 95% confidence interval 1.70-4.17, p0.001) and outcome (odds ratio 1.64, 95% CI 1.06-2.56, p = 0.027). Patients with the simultaneous presence of all the four markers had the highest risk of HE and unfavorable prognosis (mean predicted probability of 91% and 79% respectively). The combined-markers analysis outperformed the sensitivity of the single markers analyzed separately. In particular, the presence of at least one marker identified patients with HE and poor outcome with 91% and 87% sensitivity respectively.NCCT and CTP markers provide additional yield in the prediction of HE and ICH outcome.• Perihematomal hypoperfusion is associated with hematoma expansion and poor outcome in acute intracerebral hemorrhage. • Non-contrast CT and CT perfusion markers improve prediction of hematoma expansion and unfavorable prognosis. • A multimodal CT protocol including CT perfusion will help the identification of patients at high risk of clinical deterioration and poor outcome.
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- 2021
47. Bifurcation geometry remodelling of vessels in de novo and growing intracranial aneurysms: a multicenter study
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Julien, Boucherit, Basile, Kerleroux, Gregoire, Boulouis, Guillaume, Tessier, Christine, Rodriguez, Peter B, Sporns, Haroun, Ghannouchi, Eimad, Shotar, Florent, Gariel, Gaultier, Marnat, Julien, Burel, Heloise, Ifergan, Géraud, Forestier, Aymeric, Rouchaud, Hubert, Desal, Anass, Nouri, Florent, Autrusseau, Gervaise, Loirand, Romain, Bourcier, Vincent, L'Allinec, and Planty-Bonjour, Alexia
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundGeometrical parameters, including arterial bifurcation angle, tortuosity, and arterial diameters, have been associated with the pathophysiology of intracranial aneurysm (IA) formation. The aim of this study was to investigate whether these parameters were present before or if they resulted from IA formation and growth.MethodsPatients from nine academic centers were retrospectively identified if they presented with a de novo IA or a significant IA growth on subsequent imaging. For each patient, geometrical parameters were extracted using a semi-automated algorithm and compared between bifurcations with IA formation or growth (aneurysmal group), and their contralateral side without IA (control group). These parameters were compared at two different times using univariable models, multivariable models, and a sensitivity analysis with paired comparison.Results46 patients were included with 21 de novo IAs (46%) and 25 significant IA growths (54%). The initial angle was not different between the aneurysmal and control groups (129.7±42.1 vs 119.8±34.3; p=0.264) but was significantly wider at the final stage (140.4±40.9 vs 121.5±34.1; p=0.032), with a more important widening of the aneurysmal angle (10.8±15.8 vs 1.78±7.38; p=0.001). Variations in other parameters were not significant. These results were confirmed by paired comparisons.ConclusionOur study suggests that wider bifurcation angles that have long been deemed causal factors for IA formation or growth may be secondary to IA formation at pathologic bifurcation sites. This finding has implications for our understanding of IA formation pathophysiology.
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- 2021
48. The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure
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Douraied Ben Salem, Jean-Christophe Gentric, Gregoire Boulouis, Julien Ognard, Fanny Bourhis-Guizien, and Brieg Dissaux
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medicine.medical_specialty ,medicine.medical_treatment ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Aneurysm, Ruptured ,Article ,Aneurysm ,Parenchyma ,Humans ,Medicine ,magnetic resonance imaging ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Magnetic Phenomena ,Endovascular Procedures ,Stent ,Magnetic resonance imaging ,magnetic susceptibility artifacts ,Odds ratio ,medicine.disease ,equipment and supplies ,intracranial aneurysm ,medicine.anatomical_structure ,stents ,Susceptibility weighted imaging ,Radiology ,Artifacts ,business ,Platelet Aggregation Inhibitors ,intracranial hemorrhage ,Artery - Abstract
The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76, 11.76] vs. 0.78 [0.32, 1.25], respectively, p <, 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p <, 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43, 6.92] vs. 3.08 [1.79, 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24, 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p <, 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.
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- 2021
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49. Global white matter structural integrity mediates the effect of age on ischemic stroke outcomes
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Natalia S. Rost, Mark R Etherton, Maria Clara Zanon Zotin, Ona Wu, Markus D. Schirmer, Arne Lauer, Pamela M. Rist, and Gregoire Boulouis
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medicine.medical_specialty ,business.industry ,Leukoaraiosis ,Structural integrity ,medicine.disease ,Logistic regression ,White matter ,medicine.anatomical_structure ,Neurology ,Neuroimaging ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,Brain magnetic resonance imaging ,business ,Stroke - Abstract
Background The relationship of global white matter microstructural integrity and ischemic stroke outcomes is not well understood. Aims To investigate the relationship of global white matter microstructural integrity with clinical variables and functional outcomes after acute ischemic stroke. Methods A retrospective analysis of neuroimaging data from 300 acute ischemic stroke patients with magnetic resonance imaging brain obtained within 48 hours of stroke onset and long-term functional outcomes (modified Rankin, mRS) was performed. Peak width of skeletonized mean diffusivity (PSMD), as a measure of global white matter microstructural injury, was calculated in the hemisphere contralateral to the acute infarct. Multivariable linear and logistic regression analyses were performed to identify variables associated with PSMD and excellent functional outcome (mRS Results White matter hyperintensity volume, age, pre-stroke disability, and normal-appearing white matter mean diffusivity were independently associated with increased PSMD. In logistic regression analysis, increased infarct volume and PSMD were independent predictors of excellent functional outcome. Additionally, the effect of age on functional outcomes was indirectly mediated by PSMD ( P Conclusions As a marker of global white matter microstructural injury, increased PSMD mediates the effect of increased age to contribute to poor acute ischemic stroke functional outcomes. PSMD could serve as a putative radiographic marker of brain age for stroke outcomes prognostication.
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- 2021
50. Standardized Reporting of Workflow Metrics in Acute Ischemic Stroke Treatment: Why and How?
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Ashutosh P Jadhav, Shinichi Yoshimura, Charles B. L. M. Majoie, Christian Taschner, Martin W. Kurz, Gregoire Boulouis, Yvo B.W.E.M. Roos, Marios-Nikos Psychogios, Mayank Goyal, Staffan Holmin, Jeffrey L. Saver, Michael D. Hill, B. Gory, Johanna M. Ospel, Romain Bourcier, Brian Buck, Ronil V. Chandra, Rosalie McDonough, Aravind Ganesh, and Dileep R. Yavagal
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medicine.medical_specialty ,Workflow ,business.industry ,health care facilities, manpower, and services ,health services administration ,education ,Ischemic stroke ,Emergency medicine ,Medicine ,business ,Acute ischemic stroke ,health care economics and organizations - Abstract
The benefit of acute ischemic stroke (AIS) treatment is highly time dependent. Although studies on workflow improvement in AIS are increasingly gaining attention, there is a lack of consensus and consistency regarding the definition, measurement, and reporting of AIS workflow times. We discuss the challenges related to defining and measuring workflow times in AIS and propose a basic set of time intervals that should be reported in AIS workflow studies. We particularly focus on patients undergoing mechanical thrombectomy. Importantly, endovascular treatment workflow times should always be reported in conjunction with reperfusion quality because one is not informative without the other. We further suggest standardized reporting of workflow times that includes the 90th percentile in addition to medians and interquartile ranges, means, and SDs. The proposed methodology serves as a framework for AIS studies and aids further discussion on workflow‐related AIS research.
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- 2021
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