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1. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19

Author

Marto, J, Strambo, D, Ntaios, G, Nguyen, T, Herzig, R, Czlonkowska, A, Demeestere, J, Mansour, O, Salerno, A, Wegener, S, Baumgartner, P, Cereda, C, Bianco, G, Beyeler, M, Arnold, M, Carrera, E, Machi, P, Altersberger, V, Bonati, L, Gensicke, H, Bolognese, M, Peters, N, Wetzel, S, Magrico, M, Ramos, J, Sargento-Freitas, J, Machado, R, Maia, C, Machado, E, Nunes, A, Ferreira, P, Pinho E Melo, T, Dias, M, Paula, A, Correia, M, Castro, P, Azevedo, E, Albuquerque, L, Alves, J, Ferreira-Pinto, J, Meira, T, Pereira, L, Rodrigues, M, Araujo, A, Rocha, M, Pereira-Fonseca, A, Ribeiro, L, Varela, R, Malheiro, S, Cappellari, M, Zivelonghi, C, Sajeva, G, Zini, A, Gentile, M, Forlivesi, S, Migliaccio, L, Sessa, M, La Gioia, S, Pezzini, A, Sangalli, D, Zedde, M, Pascarella, R, Ferrarese, C, Beretta, S, Diamanti, S, Schwarz, G, Frisullo, G, Marcheselli, S, Seners, P, Sabben, C, Escalard, S, Piotin, M, Maier, B, Charbonnier, G, Vuillier, F, Legris, L, Cuisenier, P, Vodret, F, Marnat, G, Liegey, J, Sibon, I, Flottmann, F, Broocks, G, Gloyer, N, Bohmann, F, Schaefer, J, Nolte, C, Audebert, H, Siebert, E, Sykora, M, Lang, W, Ferrari, J, Mayer-Suess, L, Knoflach, M, Gizewski, E, Stolp, J, Stolze, L, Coutinho, J, Nederkoorn, P, Van Den Wijngaard, I, De Meris, J, Lemmens, R, De Raedt, S, Vandervorst, F, Rutgers, M, Guilmot, A, Dusart, A, Bellante, F, Calleja-Castano, P, Ostos, F, Gonzalez-Ortega, G, Martin-Jimenez, P, Garcia-Madrona, S, Cruz-Culebras, A, Vera, R, Matute, M, Fuentes, B, Alonso-De-Lecinana, M, Rigual, R, Diez-Tejedor, E, Perez-Sanchez, S, Montaner, J, Diaz-Otero, F, Perez-De-La-Ossa, N, Flores-Pina, B, Munoz-Narbona, L, Chamorro, A, Rodriguez-Vazquez, A, Renu, A, Ayo-Martin, O, Hernandez-Fernandez, F, Segura, T, Tejada-Meza, H, Sagarra-Mur, D, Serrano-Ponz, M, Hlaing, T, See, I, Simister, R, Werring, D, Kristoffersen, E, Nordanstig, A, Jood, K, Rentzos, A, Simunek, L, Krajickova, D, Krajina, A, Mikulik, R, Cvikova, M, Vinklarek, J, Skoloudik, D, Roubec, M, Hurtikova, E, Hruby, R, Ostry, S, Skoda, O, Pernicka, M, Jurak, L, Eichlova, Z, Jira, M, Kovar, M, Pansky, M, Mencl, P, Palouskova, H, Tomek, A, Jansky, P, Olserova, A, Sramek, M, Havlicek, R, Maly, P, Trakal, L, Fiksa, J, Slovak, M, Karlinski, M, Nowak, M, Sienkiewicz-Jarosz, H, Bochynska, A, Wrona, P, Homa, T, Sawczynska, K, Slowik, A, Wlodarczyk, E, Wiacek, M, Tomaszewska-Lampart, I, Sieczkowski, B, Bartosik-Psujek, H, Bilik, M, Bandzarewicz, A, Dorobek, M, Zielinska-Turek, J, Nowakowska-Kotas, M, Obara, K, Urbanowski, P, Budrewicz, S, Guzinski, M, Switonska, M, Rutkowska, I, Sobieszak-Skura, P, Labuz-Roszak, B, Debiec, A, Staszewski, J, Stepien, A, Zwiernik, J, Wasilewski, G, Tiu, C, Terecoasa, E, Radu, R, Negrila, A, Dorobat, B, Panea, C, Tiu, V, Petrescu, S, Ozdemir, A, Mahmoud, M, El-Samahy, H, Abdelkhalek, H, Al-Hashel, J, Ismail, I, Salmeen, A, Ghoreishi, A, Sabetay, S, Gross, H, Klein, P, Abdalkader, M, Jabbour, P, El Naamani, K, Tjoumakaris, S, Abbas, R, Mohamed, G, Chebl, A, Min, J, Hovingh, M, Tsai, J, Khan, M, Nalleballe, K, Onteddu, S, Masoud, H, Michael, M, Kaur, N, Maali, L, Abraham, M, Khandelwal, P, Bach, I, Ong, M, Babici, D, Khawaja, A, Hakemi, M, Rajamani, K, Cano-Nigenda, V, Arauz, A, Amaya, P, Llanos, N, Arango, A, Vences, M, Barrientos Guerra, J, Caetano, R, Martins, R, Scollo, S, Yalung, P, Nagendra, S, Gaikwad, A, Seo, K, Georgiopoulos, G, Nogueira, R, Michel, P, Marto J. P., Strambo D., Ntaios G., Nguyen T. N., Herzig R., Czlonkowska A., Demeestere J., Mansour O. Y., Salerno A., Wegener S., Baumgartner P., Cereda C. W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magrico M., Ramos J. N., Sargento-Freitas J., Machado R., Maia C., Machado E., Nunes A. P., Ferreira P., Pinho E Melo T., Dias M. C., Paula A., Correia M. A., Castro P., Azevedo E., Albuquerque L., Alves J. N., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araujo A. P., Rocha M., Pereira-Fonseca A., Ribeiro L., Varela R., Malheiro S., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., La Gioia S., Pezzini A., Sangalli D., Zedde M., Pascarella R., Ferrarese C., Beretta S., Diamanti S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F. R., Marnat G., Liegey J. -S., Sibon I., Flottmann F., Broocks G., Gloyer N. -O., Bohmann F. O., Schaefer J. H., Nolte C., Audebert H. J., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E. R., Stolp J., Stolze L. J., Coutinho J. M., Nederkoorn P., Van Den Wijngaard I., De Meris J., Lemmens R., De Raedt S., Vandervorst F., Rutgers M. P., Guilmot A., Dusart A., Bellante F., Calleja-Castano P., Ostos F., Gonzalez-Ortega G., Martin-Jimenez P., Garcia-Madrona S., Cruz-Culebras A., Vera R., Matute M. C., Fuentes B., Alonso-De-Lecinana M., Rigual R., Diez-Tejedor E., Perez-Sanchez S., Montaner J., Diaz-Otero F., Perez-De-La-Ossa N., Flores-Pina B., Munoz-Narbona L., Chamorro A., Rodriguez-Vazquez A., Renu A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Sagarra-Mur D., Serrano-Ponz M., Hlaing T., See I., Simister R., Werring D., Kristoffersen E. S., Nordanstig A., Jood K., Rentzos A., Simunek L., Krajickova D., Krajina A., Mikulik R., Cvikova M., Vinklarek J., Skoloudik D., Roubec M., Hurtikova E., Hruby R., Ostry S., Skoda O., Pernicka M., Jurak L., Eichlova Z., Jira M., Kovar M., Pansky M., Mencl P., Palouskova H., Tomek A., Jansky P., Olserova A., Sramek M., Havlicek R., Maly P., Trakal L., Fiksa J., Slovak M., Karlinski M. A., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiacek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielinska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guzinski M., Switonska M., Rutkowska I., Sobieszak-Skura P., Labuz-Roszak B. M., Debiec A., Staszewski J., Stepien A., Zwiernik J., Wasilewski G., Tiu C., Terecoasa E. O., Radu R. A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Ozdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ismail I. I., Salmeen A., Ghoreishi A., Sabetay S. I., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G. A., Chebl A., Min J., Hovingh M., Tsai J. P., Khan M., Nalleballe K., Onteddu S., Masoud H., Michael M., Kaur N., Maali L., Abraham M. G., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A. M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M. A., Barrientos Guerra J. D., Caetano R., Martins R. T., Scollo S. D., Yalung P. M., Nagendra S., Gaikwad A., Seo K. -D., Georgiopoulos G., Nogueira R. G., Michel P., Marto, J, Strambo, D, Ntaios, G, Nguyen, T, Herzig, R, Czlonkowska, A, Demeestere, J, Mansour, O, Salerno, A, Wegener, S, Baumgartner, P, Cereda, C, Bianco, G, Beyeler, M, Arnold, M, Carrera, E, Machi, P, Altersberger, V, Bonati, L, Gensicke, H, Bolognese, M, Peters, N, Wetzel, S, Magrico, M, Ramos, J, Sargento-Freitas, J, Machado, R, Maia, C, Machado, E, Nunes, A, Ferreira, P, Pinho E Melo, T, Dias, M, Paula, A, Correia, M, Castro, P, Azevedo, E, Albuquerque, L, Alves, J, Ferreira-Pinto, J, Meira, T, Pereira, L, Rodrigues, M, Araujo, A, Rocha, M, Pereira-Fonseca, A, Ribeiro, L, Varela, R, Malheiro, S, Cappellari, M, Zivelonghi, C, Sajeva, G, Zini, A, Gentile, M, Forlivesi, S, Migliaccio, L, Sessa, M, La Gioia, S, Pezzini, A, Sangalli, D, Zedde, M, Pascarella, R, Ferrarese, C, Beretta, S, Diamanti, S, Schwarz, G, Frisullo, G, Marcheselli, S, Seners, P, Sabben, C, Escalard, S, Piotin, M, Maier, B, Charbonnier, G, Vuillier, F, Legris, L, Cuisenier, P, Vodret, F, Marnat, G, Liegey, J, Sibon, I, Flottmann, F, Broocks, G, Gloyer, N, Bohmann, F, Schaefer, J, Nolte, C, Audebert, H, Siebert, E, Sykora, M, Lang, W, Ferrari, J, Mayer-Suess, L, Knoflach, M, Gizewski, E, Stolp, J, Stolze, L, Coutinho, J, Nederkoorn, P, Van Den Wijngaard, I, De Meris, J, Lemmens, R, De Raedt, S, Vandervorst, F, Rutgers, M, Guilmot, A, Dusart, A, Bellante, F, Calleja-Castano, P, Ostos, F, Gonzalez-Ortega, G, Martin-Jimenez, P, Garcia-Madrona, S, Cruz-Culebras, A, Vera, R, Matute, M, Fuentes, B, Alonso-De-Lecinana, M, Rigual, R, Diez-Tejedor, E, Perez-Sanchez, S, Montaner, J, Diaz-Otero, F, Perez-De-La-Ossa, N, Flores-Pina, B, Munoz-Narbona, L, Chamorro, A, Rodriguez-Vazquez, A, Renu, A, Ayo-Martin, O, Hernandez-Fernandez, F, Segura, T, Tejada-Meza, H, Sagarra-Mur, D, Serrano-Ponz, M, Hlaing, T, See, I, Simister, R, Werring, D, Kristoffersen, E, Nordanstig, A, Jood, K, Rentzos, A, Simunek, L, Krajickova, D, Krajina, A, Mikulik, R, Cvikova, M, Vinklarek, J, Skoloudik, D, Roubec, M, Hurtikova, E, Hruby, R, Ostry, S, Skoda, O, Pernicka, M, Jurak, L, Eichlova, Z, Jira, M, Kovar, M, Pansky, M, Mencl, P, Palouskova, H, Tomek, A, Jansky, P, Olserova, A, Sramek, M, Havlicek, R, Maly, P, Trakal, L, Fiksa, J, Slovak, M, Karlinski, M, Nowak, M, Sienkiewicz-Jarosz, H, Bochynska, A, Wrona, P, Homa, T, Sawczynska, K, Slowik, A, Wlodarczyk, E, Wiacek, M, Tomaszewska-Lampart, I, Sieczkowski, B, Bartosik-Psujek, H, Bilik, M, Bandzarewicz, A, Dorobek, M, Zielinska-Turek, J, Nowakowska-Kotas, M, Obara, K, Urbanowski, P, Budrewicz, S, Guzinski, M, Switonska, M, Rutkowska, I, Sobieszak-Skura, P, Labuz-Roszak, B, Debiec, A, Staszewski, J, Stepien, A, Zwiernik, J, Wasilewski, G, Tiu, C, Terecoasa, E, Radu, R, Negrila, A, Dorobat, B, Panea, C, Tiu, V, Petrescu, S, Ozdemir, A, Mahmoud, M, El-Samahy, H, Abdelkhalek, H, Al-Hashel, J, Ismail, I, Salmeen, A, Ghoreishi, A, Sabetay, S, Gross, H, Klein, P, Abdalkader, M, Jabbour, P, El Naamani, K, Tjoumakaris, S, Abbas, R, Mohamed, G, Chebl, A, Min, J, Hovingh, M, Tsai, J, Khan, M, Nalleballe, K, Onteddu, S, Masoud, H, Michael, M, Kaur, N, Maali, L, Abraham, M, Khandelwal, P, Bach, I, Ong, M, Babici, D, Khawaja, A, Hakemi, M, Rajamani, K, Cano-Nigenda, V, Arauz, A, Amaya, P, Llanos, N, Arango, A, Vences, M, Barrientos Guerra, J, Caetano, R, Martins, R, Scollo, S, Yalung, P, Nagendra, S, Gaikwad, A, Seo, K, Georgiopoulos, G, Nogueira, R, Michel, P, Marto J. P., Strambo D., Ntaios G., Nguyen T. N., Herzig R., Czlonkowska A., Demeestere J., Mansour O. Y., Salerno A., Wegener S., Baumgartner P., Cereda C. W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magrico M., Ramos J. N., Sargento-Freitas J., Machado R., Maia C., Machado E., Nunes A. P., Ferreira P., Pinho E Melo T., Dias M. C., Paula A., Correia M. A., Castro P., Azevedo E., Albuquerque L., Alves J. N., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araujo A. P., Rocha M., Pereira-Fonseca A., Ribeiro L., Varela R., Malheiro S., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., La Gioia S., Pezzini A., Sangalli D., Zedde M., Pascarella R., Ferrarese C., Beretta S., Diamanti S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F. R., Marnat G., Liegey J. -S., Sibon I., Flottmann F., Broocks G., Gloyer N. -O., Bohmann F. O., Schaefer J. H., Nolte C., Audebert H. J., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E. R., Stolp J., Stolze L. J., Coutinho J. M., Nederkoorn P., Van Den Wijngaard I., De Meris J., Lemmens R., De Raedt S., Vandervorst F., Rutgers M. P., Guilmot A., Dusart A., Bellante F., Calleja-Castano P., Ostos F., Gonzalez-Ortega G., Martin-Jimenez P., Garcia-Madrona S., Cruz-Culebras A., Vera R., Matute M. C., Fuentes B., Alonso-De-Lecinana M., Rigual R., Diez-Tejedor E., Perez-Sanchez S., Montaner J., Diaz-Otero F., Perez-De-La-Ossa N., Flores-Pina B., Munoz-Narbona L., Chamorro A., Rodriguez-Vazquez A., Renu A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Sagarra-Mur D., Serrano-Ponz M., Hlaing T., See I., Simister R., Werring D., Kristoffersen E. S., Nordanstig A., Jood K., Rentzos A., Simunek L., Krajickova D., Krajina A., Mikulik R., Cvikova M., Vinklarek J., Skoloudik D., Roubec M., Hurtikova E., Hruby R., Ostry S., Skoda O., Pernicka M., Jurak L., Eichlova Z., Jira M., Kovar M., Pansky M., Mencl P., Palouskova H., Tomek A., Jansky P., Olserova A., Sramek M., Havlicek R., Maly P., Trakal L., Fiksa J., Slovak M., Karlinski M. A., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiacek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielinska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guzinski M., Switonska M., Rutkowska I., Sobieszak-Skura P., Labuz-Roszak B. M., Debiec A., Staszewski J., Stepien A., Zwiernik J., Wasilewski G., Tiu C., Terecoasa E. O., Radu R. A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Ozdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ismail I. I., Salmeen A., Ghoreishi A., Sabetay S. I., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G. A., Chebl A., Min J., Hovingh M., Tsai J. P., Khan M., Nalleballe K., Onteddu S., Masoud H., Michael M., Kaur N., Maali L., Abraham M. G., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A. M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M. A., Barrientos Guerra J. D., Caetano R., Martins R. T., Scollo S. D., Yalung P. M., Nagendra S., Gaikwad A., Seo K. -D., Georgiopoulos G., Nogueira R. G., and Michel P.

Abstract

Background and Objectives COVID-19–related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. Methods This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Results Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16–2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20–2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23–1.99), 24-hour mortality (OR 2.47; 95% CI 1.58–3.86), and 3-month mortality (OR 1.88; 95% CI 1.52–2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26–1.60). Discussion Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non–COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment r

Published
2023

3. Prediction and Mitigation of Wind Farm Blockage Losses Considering Mesoscale Atmospheric Response

Author

Legris, L, Pahus, ML, Nishino, T, and Perez-Campos, E

Subjects
Control and Optimization, Renewable Energy, Sustainability and the Environment, turbine load control, two-scale momentum theory, wake models, wind extractability, wind farm optimisation, wind resource assessment, Energy Engineering and Power Technology, Building and Construction, Electrical and Electronic Engineering, Engineering (miscellaneous), Energy (miscellaneous)
Abstract

The engineering wind farm models currently used in industry can assess power losses due to turbine wake effects, but the prediction of power losses due to farm blockage is still a challenge. In this study we demonstrate a new prediction method of farm blockage losses and a possible strategy to mitigate them for a large offshore wind farm in the North Sea, by combining a common engineering wind farm model ’FLORIS’ with the ’two-scale momentum theory’ of Nishino and Dunstan (2020). Results show that the farm blockage losses depend significantly on the ’wind extractability’ factor, which reflects the strength of mesoscale atmospheric response. For a typical range of the extractability factor (assessed using a numerical weather prediction model) the farm blockage losses are shown to vary between about 5% and 15% of the annual energy production (AEP). However, these losses may be mitigated by adjusting turbine operating points taking into account the wind extractability. It is shown that a simple adjustment of the blade pitch angle and tip-speed ratio used below the rated wind speed may increase the AEP by up to about 2%.

Published
2022
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15. Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management.

Author

Sabben C, Charbonneau F, Obadia M, Strambo D, Ong E, Heldner MR, Henon H, Ter Schiphorst A, Legris L, Agasse-Lafont T, Sablot D, Nehme N, Sibon I, Triquenot-Bagan A, Wolff V, Preterre C, Rosso C, Mione G, Poll R, Papassin J, Aignatoaie A, Weisenburger Lile D, Béjot Y, Moulin S, Carrera E, Garnier P, Michel P, Mordasini P, Albers GW, Turc G, Mazighi M, and Seners P

Abstract

Background and Aims: The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population., Methods: We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6 h from symptoms onset in 26 stroke centers in France, Switzerland, and the United States, treated with the best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ⩾2 at 3 months or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable and then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables., Results: Overall, 585 patients were included. The median age was 74 years (interquartile range (IQR) = 63-83), median National Institutes of Health Stroke Scale (NIHSS) was 6 (3-10), 80% received intravenous thrombolysis (IVT), and 22% and 78% had P1 and P2 occlusions, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted odds ratio (OR) = 1.12 per 5-year increase [95% confidence interval (CI) = 1.05-1.20]; p  = 0.001), NIHSS score (aOR = 1.12 per each point increase [1.08-1.18]; p  < 0.001), infarct volume (aOR = 1.16 per 5 mL increase [1.07-1.25]; p  < 0.001), and the lack of IVT use (aOR = 1.79 [1.10-2.94], p  = 0.020) were independently associated with poor outcome. Regarding 24-h follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR = 0.37 [95% CI = 0.21-0.65], p  < 0.001) and parenchymal hematoma occurrence (aOR = 2.37 [95% CI = 1.01-5.56], p  = 0.048) were independently associated with poor 3-month outcome., Conclusions: Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr M.R.H. reports grants from Swiss National Science Foundation, SITEM Research Support Funds, and Swiss Heart Foundation, not directly related to this manuscript. Professor C.R. receives fees from OTR3 for her participation in a DSMB. Y.B. reports personal fees from BMS, Pfizer, Medtronic, Amgen, Servier, NovoNordisk, Novartis, and Laboratoire XO, outside the submitted work. Dr G.W.A. reports stock holdings in iSchemaView; compensation from Biogen, iSchemaView, and Genentech for consultant services. Dr G.T. reports lecture fees from Guerbert France and consultant services for AI-Stroke. Professor M.M. reports consulting fees from Acticor Biotech, and Boerhinger. Dr P.S. receives speaker fees from Acticor Biotech. Other authors have nothing to disclose.

Published
2025
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16. Cell Therapy and Functional Recovery of Stroke.

Author

Detante O, Legris L, Moisan A, and Rome C

Subjects
Humans, Animals, Cell- and Tissue-Based Therapy methods, Stem Cell Transplantation methods, Mesenchymal Stem Cell Transplantation methods, Recovery of Function physiology, Stroke therapy, Stroke physiopathology
Abstract

Stroke is the most common cause of disability. Brain repair mechanisms are often insufficient to allow a full recovery. Stroke damage involve all brain cell type and extracellular matrix which represent the crucial "glio-neurovascular niche" useful for brain plasticity. Regenerative medicine including cell therapies hold great promise to decrease post-stroke disability of many patients, by promoting both neuroprotection and neural repair through direct effects on brain lesion and/or systemic effects such as immunomodulation. Mechanisms of action vary according to each grafted cell type: "peripheral" stem cells, such as mesenchymal stem cells (MSC), can provide paracrine trophic support, and neural stem/progenitor cells (NSC) or neurons can act as direct cells' replacements. Optimal time window, route, and doses are still debated, and may depend on the chosen medicinal product and its expected mechanism such as neuroprotection, delayed brain repair, systemic effects, or graft survival and integration in host network. MSC, mononuclear cells (MNC), umbilical cord stem cells and NSC are the most investigated. Innovative approaches are implemented concerning combinatorial approaches with growth factors and biomaterials such as injectable hydrogels which could protect a cell graft and/or deliver drugs into the post-stroke cavity at chronic stages. Through main publications of the last two decades, we provide in this review concepts and suggestions to improve future translational researches and larger clinical trials of cell therapy in stroke., (Copyright © 2023 IBRO. Published by Elsevier Inc. All rights reserved.)

Published
2024
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17. Penumbral Rescue by normobaric O = O administration in patients with ischemic stroke and target mismatch proFile (PROOF): Study protocol of a phase IIb trial.

Author

Poli S, Mbroh J, Baron JC, Singhal AB, Strbian D, Molina C, Lemmens R, Turc G, Mikulik R, Michel P, Tatlisumak T, Audebert HJ, Dichgans M, Veltkamp R, Hüsing J, Graessner H, Fiehler J, Montaner J, Adeyemi AK, Althaus K, Arenillas JF, Bender B, Benedikt F, Broocks G, Burghaus I, Cardona P, Deb-Chatterji M, Cviková M, Defreyne L, De Herdt V, Detante O, Ernemann U, Flottmann F, García Guillamón L, Glauch M, Gomez-Exposito A, Gory B, Sylvie Grand S, Haršány M, Hauser TK, Heck O, Hemelsoet D, Hennersdorf F, Hoppe J, Kalmbach P, Kellert L, Köhrmann M, Kowarik M, Lara-Rodríguez B, Legris L, Lindig T, Luntz S, Lusk J, Mac Grory B, Manger A, Martinez-Majander N, Mengel A, Meyne J, Müller S, Mundiyanapurath S, Naggara O, Nedeltchev K, Nguyen TN, Nilsson MA, Obadia M, Poli K, Purrucker JC, Räty S, Richard S, Richter H, Schilte C, Schlemm E, Stöhr L, Stolte B, Sykora M, Thomalla G, Tomppo L, van Horn N, Zeller J, Ziemann U, Zuern CS, Härtig F, and Tuennerhoff J

Subjects
Humans, Multicenter Studies as Topic, Oxygen therapeutic use, Quality of Life, Thrombectomy methods, Treatment Outcome, Clinical Trials, Phase II as Topic, Brain Ischemia complications, Endovascular Procedures methods, Ischemic Stroke complications, Ischemic Stroke diagnosis
Abstract

Rationale: Oxygen is essential for cellular energy metabolism. Neurons are particularly vulnerable to hypoxia. Increasing oxygen supply shortly after stroke onset could preserve the ischemic penumbra until revascularization occurs., Aims: PROOF investigates the use of normobaric oxygen (NBO) therapy within 6 h of symptom onset/notice for brain-protective bridging until endovascular revascularization of acute intracranial anterior-circulation occlusion., Methods and Design: Randomized (1:1), standard treatment-controlled, open-label, blinded endpoint, multicenter adaptive phase IIb trial., Study Outcomes: Primary outcome is ischemic core growth (mL) from baseline to 24 h (intention-to-treat analysis). Secondary efficacy outcomes include change in NIHSS from baseline to 24 h, mRS at 90 days, cognitive and emotional function, and quality of life. Safety outcomes include mortality, intracranial hemorrhage, and respiratory failure. Exploratory analyses of imaging and blood biomarkers will be conducted., Sample Size: Using an adaptive design with interim analysis at 80 patients per arm, up to 456 participants (228 per arm) would be needed for 80% power (one-sided alpha 0.05) to detect a mean reduction of ischemic core growth by 6.68 mL, assuming 21.4 mL standard deviation., Discussion: By enrolling endovascular thrombectomy candidates in an early time window, the trial replicates insights from preclinical studies in which NBO showed beneficial effects, namely early initiation of near 100% inspired oxygen during short temporary ischemia. Primary outcome assessment at 24 h on follow-up imaging reduces variability due to withdrawal of care and early clinical confounders such as delayed extubation and aspiration pneumonia., Trial Registrations: ClinicalTrials.gov: NCT03500939; EudraCT: 2017-001355-31., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2024
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18. Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study.

Author

Sabben C, Charbonneau F, Delvoye F, Strambo D, Heldner MR, Ong E, Ter Schiphorst A, Henon H, Ben Hassen W, Agasse-Lafont T, Legris L, Sibon I, Wolff V, Sablot D, Elhorany M, Preterre C, Nehme N, Soize S, Weisenburger-Lile D, Triquenot-Bagan A, Mione G, Aignatoaie A, Papassin J, Poll R, Béjot Y, Carrera E, Garnier P, Michel P, Saliou G, Mordasini P, Berthezene Y, Costalat V, Bricout N, Albers GW, Mazighi M, Turc G, and Seners P

Subjects
Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Thrombolytic Therapy, Posterior Cerebral Artery, Thrombectomy, Intracranial Hemorrhages, Treatment Outcome, Ischemic Stroke, Stroke therapy, Endovascular Procedures, Brain Ischemia surgery
Abstract

Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown., Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0-2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0-1), symptomatic intracranial hemorrhage, and early neurological deterioration., Results: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63-82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4-10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66-1.01]; P =0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95-1.43]; P =0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35-4.67]; P =0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64-3.84]; P <0.0001)., Conclusions: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.

Published
2023
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19. Pearls & Oy-sters: De Novo Seizure and Stroke in the Elderly: The Issue of Chicken and Egg.

Author

Bratanov C, Legris L, and Martin G

Subjects
Aged, Humans, Magnetic Resonance Angiography, Magnetic Resonance Imaging adverse effects, Seizures complications, Seizures etiology, Epilepsy etiology, Stroke complications, Stroke diagnostic imaging
Abstract

Seizures immediately preceding the occurrence of an ischemic or hemorrhagic stroke are a rare but well-documented phenomenon, for which the term "heraldic seizure" has been proposed. Cerebrovascular disease is the most common cause of epileptic seizures in elderly patients; thus, screening and management of vascular risk factors should be performed systematically in cases of late-onset epilepsy. MRI may help to distinguish heraldic seizure from stroke-elicited seizure by showing abnormalities confined to the cortex that spare vascular territories, increased magnetic resonance angiography flow in the ipsilateral cerebral arteries, and enhancement of the leptomeninges on postcontrast MRI. We present a case report that illustrates the difficulty of making the diagnosis of a heraldic seizure at onset., (© 2022 American Academy of Neurology.)

Published
2022
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20. [The same, yet different].

Author

Legris LF

Subjects
Adult, Counseling methods, Female, Humans, Nurse-Patient Relations, Psychiatric Nursing methods
Published
1985

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