Search

Your search keyword '"Niclot, Philippe"' showing total 14 results
Start Over Author "Niclot, Philippe"
14 results on '"Niclot, Philippe"'

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

Author

Sabben, Candice, Charbonneau, Frédérique, Delvoye, François, Strambo, Davide, Heldner, Mirjam R., Ong, Elodie, Ter Schiphorst, Adrien, Henon, Hilde, Ben Hassen, Wagih, Agasse-Lafont, Thomas, Legris, Loïc, Sibon, Igor, Wolff, Valérie, Sablot, Denis, Elhorany, Mahmoud, Preterre, Cécile, Nehme, Nour, Soize, Sébastien, Weisenburger-Lile, David, Triquenot-Bagan, Aude, Mione, Gioia, Aignatoaie, Andreea, Papassin, Jérémie, Poll, Roxana, Béjot, Yannick, Carrera, Emmanuel, Garnier, Pierre, Michel, Patrik, Saliou, Guillaume, Mordasini, Pasquale, Berthezene, Yves, Costalat, Vincent, Bricout, Nicolas, Albers, Gregory W., Mazighi, Mikael, Turc, Guillaume, Seners, Pierre, Antonenko, Kateryna, Arquizan, Caroline, Benammar, Lynda, Boutet, Claire, Clarençon, Frédéric, Comby, Pierre-Olivier, Desal, Hubert, Detante, Olivier, Eugene, François, Gerardin, Emmanuel, Gory, Benjamin, Kremer, Stéphane, Ledure, Sylvain, Krug, Mathieu, Lapergue, Bertrand, Niclot, Philippe, Magni, Christophe, Obadia, Michael, Ozsancak, Canan, Pico, Fernando, Pilgram-Pastor, Sara, Pop, Raoul, Richard, Sébastien, Rosso, Charlotte, Savatovsky, Julien, Moulin, Solène, Tracol, Clément, and Zbinden, Martin

Published
2023
Full Text
View/download PDF

7. La médecine désincarnée

Author

Niclot philippe and Niclot philippe

Abstract

L'exercice médical s'est transformé sous l'effet de l'évolution technique et scientifique. L'évaluation clinique est remplacée par la réalisation d'examens complémentaires. La recherche est dominée par les sciences biologiques. Les soins sont déterminés par les résultats des essais thérapeutiques. Malgré ces avancées, les bénéfices pour les malades se réduisent. Coupée des réalités cliniques, la médecine universitaire s'égare dans l'évaluation de protocoles sans pertinence. La médecine est aujourd'hui désincarnée. La pandémie de COVID-19 a révélé les limites d'un système de santé devenu inefficace et injuste. La montée de la pauvreté et les bouleversements épidémiologiques à venir nécessiteront la remise en cause du système de soins et le retour vers une médecine humaniste : une révolution.

Published
2021

8. Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study

Author

Ducroux, C., Fahed, R., Khoury, N. N., Gevry, G., Kalsoum, E., Labeyrie, M-A, Ziegler, D., Sauve, C., Chagnon, M., Darsaut, T. E., Raymond, J., Niclot, Philippe, Ameri, Alain, Hodel, Jerome, Gentric, Jean-Christophe, Merrien, Francois-Mathias, Jourdain, Aurore, Rouhart, Francois, Viakhireva, Irina, Timsit, Serge, Clarencon, Frederic, Pistocchi, Silvia, Rosso, Charlotte, Zavanone, Chiara, Houdart, Emmanuel, Labeyrie, Marc-Antoine, Reiner, Peggy, Gory, Benjamin, Riva, Roberto, Nighoghossian, Norbert, Cho, Tae-Hee, Derex, Laurent, Eugene, Francois, Ferré, Jean-Christophe, Le Bras, Anthony, Vannier, Stephane, Lassalle, Maria, Chivot, Cyril, Arnoux, Audrey, Alla, Philippe, Veyrieres, Jean-Brice, Marnat, Gaultier, Berge, Jerome, Olindo, Stephane, Sibon, Igor, Lapergue, Bertrand, Wang, Adrien, Consoli, Arturo, Di Maria, Federico, Obadia, Michael, Sabben, Candice, Mazighi, Mikael, Redjem, Hocine, Piotin, Michel, Boisseau, William, Razlog, Lilia, Pop, Raoul, Beaujeux, Remy, Mihoc, Dan, Richter, Sebastian, Manisor, Monica, Wolff, Valerie, Quenardelle, Veronique, Zinchenko, Lisa, Diaconu, Mihaela, Yger, Marion, Delorme, Stephen, Iosif, Christina, Moulin, Thierry, Zekri, Hatem, Lallement, Francois, Vercruysse, Olivier, Papagiannaki, Christanthi, Ozkul-Wermester, Ozlem, Dargazanli, Cyril, Costalat, Vincent, Gaillard, Nicolas, Arquizan, Caroline, Cayrecastel, Mireille, Bracard, Serge, Derelle, Anne-Laure, Richard, Sebastien, Humbertjean, Lisa, Herve, Yann, Favrole, Pascal, Le Coz, Patrick, de Brouker, Thomas, Force, Marie-Isabelle, Akono, Serge, Cakmak, Serkan, Florea, Alexandru, Lalu, Thibault, Taurin, Gregory, Duong, Duc Long, Chadenat, Marie-Laure, Pico, Fernando, Allibert, Remi, Evain, Sarah, Tassan, Philippe, Berthier, Eric, Ducrocq, Xavier, Rigal, Matthieu, Boulanger, Marion, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), CHU Henri Mondor [Créteil], Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Département de Mathématiques et de statistique [UdeM- Montréal] (DMS), Université du Québec à Montréal = University of Québec in Montréal (UQAM), Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Service de Neurologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Génétique et Physiopathologie des Maladies Cérébro-Vasculaires (U1161 / UMR_S 1161), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hospices Civils de Lyon (HCL), Department of Stroke Medicine [Lyon], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hospices Civils de Lyon, Departement de Neurologie (HCL), Cerebrovascular Unit [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Neuroimagerie: méthodes et applications (Empenn), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Département de Radiologie [CHU de Rennes], Université de Rennes (UR), Institut de Recherche Technologique b-com (IRT b-com), Service de Neurologie [CHU Rennes], Laboratoire de Psychologie et NeuroCognition (LPNC ), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Bordeaux (CHU de Bordeaux), Université de Bordeaux (UB), Hôpital Foch [Suresnes], CHU Rothschild [AP-HP], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Equipe de Recherche Médicale Appliquée (ERMA), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Service de neurologie [CHRU Nancy], Service de Neurologie [Aix-en-Provence], Centre Hospitalier du Pays d'Aix, Neuroépidémiologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de radiologie [Vannes], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Physiopathologie et imagerie des troubles neurologiques (PhIND), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
medicine.medical_specialty, Consensus, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Decision Making, Single Center, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Combined treatment, Cohen's kappa, Randomized controlled trial, Fibrinolytic Agents, law, Medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Infusions, Intravenous, Acute ischemic stroke, Thrombectomy, business.industry, Reproducibility of Results, Thrombolysis, Mechanical thrombectomy, Stroke, Inter-rater reliability, Neurology, Acute Disease, Physical therapy, Administration, Intravenous, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

International audience; Purpose. - We aimed to assess agreement on intravenous tissue-plasminogen activator (IV tPA) and mechanical thrombectomy (MT) management decisions in acute ischemic stroke (AIS) patients. Secondary objectives were to assess agreement on Diffusion-Weighted-Imaging-Alberta-Stroke-Program-EArly-CT-Score (DWI-ASPECTS), and clinicians' willingness to recruit patients in a randomized controlled trial (RCT) comparing medical management with or without MT. Materials and Methods. - Studies assessing agreement of IV tPA and MT were systematically reviewed. An electronic portfolio of 41 AIS patients was sent to randomly selected providers at French stroke centers. Raters were asked 4 questions for each case: (1) What is the DWI-ASPECTS? (2) Would you perform IV tPA? (3) Would you perform MT? (4) Would you include the patient in a RCT comparing standard medical therapy with or without MT? Twenty responders were randomly selected to study intrarater agreement. Agreement was assessed using Fleiss' Kappa statistics. Results. - The review yielded two single center studies involving 2-5 raters, with various results. The electronic survey was answered by 86 physicians (60 vascular neurologists and 26 interventional neuroradiologists). The interrater agreement was moderate for IV tPA treatment decisions (kappa = 0.565 [0.420-0.680]), but only fair for MT (kappa = 0.383 [0.289-0.491]) and for combined treatment decisions (kappa = 0.399 [0.320-0.486]). The intrarater agreement was at least substantial for the majority of raters. The interrater agreement for DWI-ASPECTS was fair (kappa = 0.325 [0.276-0.387]). Physicians were willing to include a mean of 14 +/- 9 patients (33.1% +/- 21.7%) in a RCT. Conclusion. - Disagreements regarding the use of IVtPA or MT in the management of AIS patients remain frequent. Further trials are needed to resolve the numerous areas of uncertainty. (C) 2019 Elsevier Masson SAS. All rights reserved.

Published
2018
Full Text
View/download PDF

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

Author

Seners, Pierre, Ben Hassen, Wagih, Lapergue, Bertrand, Arquizan, Caroline, Heldner, Mirjam R., Henon, Hilde, Perrin, Claire, Strambo, Davide, Cottier, Jean-Philippe, Sablot, Denis, Girard Buttaz, Isabelle, Tamazyan, Ruben, Preterre, Cécile, Agius, Pierre, Laksiri, Nadia, Mechtouff, Laura, Béjot, Yannick, Duong, Duc-Long, Mounier-Vehier, François, Mione, Gioia, Rosso, Charlotte, Lucas, Ludovic, Papassin, Jérémie, Aignatoaie, Andreea, Triquenot, Aude, Carrera, Emmanuel, Niclot, Philippe, Obadia, Alexandre, Lyoubi, Aïcha, Garnier, Pierre, Crainic, Nicolae, Wolff, Valérie, Tracol, Clément, Philippeau, Frédéric, Lamy, Chantal, Soize, Sébastien, Baron, Jean-Claude, and Turc, Guillaume

Abstract

IMPORTANCE: The best reperfusion strategy in patients with acute minor stroke and large vessel occlusion (LVO) is unknown. Accurately predicting early neurological deterioration of presumed ischemic origin (ENDi) following intravenous thrombolysis (IVT) in this population may help to select candidates for immediate transfer for additional thrombectomy. OBJECTIVE: To develop and validate an easily applicable predictive score of ENDi following IVT in patients with minor stroke and LVO. DESIGN, SETTING, AND PARTICIPANTS: This multicentric retrospective cohort included 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5 or less) and LVO (basilar artery, internal carotid artery, first [M1] or second [M2] segment of middle cerebral artery) intended for IVT alone in 45 French stroke centers, ie, including those who eventually received rescue thrombectomy because of ENDi. For external validation, another cohort of 347 patients with similar inclusion criteria was collected from 9 additional centers. Data were collected from January 2018 to September 2019. MAIN OUTCOMES AND MEASURES: ENDi, defined as 4 or more points’ deterioration on NIHSS score within the first 24 hours without parenchymal hemorrhage on follow-up imaging or another identified cause. RESULTS: Of the 729 patients in the derivation cohort, 335 (46.0%) were male, and the mean (SD) age was 70 (15) years; of the 347 patients in the validation cohort, 190 (54.8%) were male, and the mean (SD) age was 69 (15) years. In the derivation cohort, the median (interquartile range) NIHSS score was 3 (1-4), and the occlusion site was the internal carotid artery in 97 patients (13.3%), M1 in 207 (28.4%), M2 in 395 (54.2%), and basilar artery in 30 (4.1%). ENDi occurred in 88 patients (12.1%; 95% CI, 9.7-14.4) and was strongly associated with poorer 3-month outcomes, even in patients who underwent rescue thrombectomy. In multivariable analysis, a more proximal occlusion site and a longer thrombus were independently associated with ENDi. A 4-point score derived from these variables—1 point for thrombus length and 3 points for occlusion site—showed good discriminative power for ENDi (C statistic = 0.76; 95% CI, 0.70-0.82) and was successfully validated in the validation cohort (ENDi rate, 11.0% [38 of 347]; C statistic = 0.78; 95% CI, 0.70-0.86). In both cohorts, ENDi probability was approximately 3%, 7%, 20%, and 35% for scores of 0, 1, 2 and 3 to 4, respectively. CONCLUSIONS AND RELEVANCE: The substantial ENDi rates observed in these cohorts highlights the current debate regarding whether to directly transfer patients with IVT-treated minor stroke and LVO for additional thrombectomy. Based on the strong associations observed, an easily applicable score for ENDi risk prediction that may assist decision-making was derived and externally validated.

Published
2021
Full Text
View/download PDF

12. Is acute stroke treatment heading towards a more endovascular approach?

Author

Menon, Bijoy K, Demchuk, Andrew M, Mazighi, Mikael, Serfaty, Jean-Michel, Labreuche, Julien, Laissy, Jean-Pierre, Meseguer, Elena, Lavallée, Philippa C, Cabrejo, Lucie, Slaoui, Tarik, Guidoux, Céline, Lapergue, Bertrand, Klein, Isabelle F, Olivot, Jean-Marc, Abboud, Halim, Simon, Olivier, Niclot, Philippe, Nifle, Chantal, Touboul, Pierre-Jean, and Raphaeli, Gai

Subjects
*TISSUE plasminogen activator, *COMBINED modality therapy, *ENDOVASCULAR surgery, *INTRAVENOUS therapy, *STROKE, *THERAPEUTICS
Abstract

Background: The efficacy of intravenous (IV) alteplase is restricted by the speed of recanalisation and the site of the occlusion. The aim of this study was to ascertain the effect of a combined IV-endovascular approach (intra-arterial alteplase and, if required, additional thrombectomy) in patients with stroke due to arterial occlusion. Methods: We compared recanalisation rates, neurological improvement at 24 h, and functional outcome at 3 months between two periods (February, 2002, to March, 2007, vs April, 2007, to October, 2008) in patients in a prospective registry who were treated with different regimens of alteplase within 3 h of symptom onset. Patients with confirmed occlusion who were treated before April, 2007, were treated with IV alteplase; after April, 2007, patients were treated with a systematic IV-endovascular approach. Analysis was by intention to treat. Findings: 46 (87%) of 53 patients treated with the IV-endovascular approach achieved recanalisation versus 56 (52%) of 107 patients in the IV group (adjusted relative risk [RR] 1.49, 95% CI 1.21-1.84; p=0.0002). Early neurological improvement (NIHSS score of 0 or 1 or an improvement of 4 points or more at 24 h) occurred in 32 (60%) patients in the IV-endovascular group and 42 (39%) patients in the IV group (adjusted RR 1.36, 0.97-1.91; p=0.07). Favourable outcome (mRS of 0-2 at 90 days) occurred in 30 (57%) patients in the IV-endovascular group and 47 (44%) patients in the IV group (adjusted RR 1.16, 0.85-1.58; p=0.35). The mortality rate at 90 days was 17% in both groups, and symptomatic intracranial haemorrhage was reported in five (9%) patients in the IV-endovascular group and in 12 (11%) patients in the IV group. Better clinical outcome was associated with recanalisation in both groups and with time to recanalisation in the IV-endovascular group. Interpretation: An IV-endovascular approach is associated with higher recanalisation rates than is IV alteplase in patients with stroke and confirmed arterial occlusion. In patients treated with an IV-endovascular approach, a shorter time from symptom onset to recanalisation is associated with better clinical outcomes. [ABSTRACT FROM AUTHOR]

Published
2009
Full Text
View/download PDF

13. Errata

Author

Chollet, François, Tardy, Jean, Albucher, Jean-François, Thalamas, Claire, Berard, Emilie, Lamy, Catherine, Bejot, Yannick, Deltour, Sandrine, Jaillard, Assia, Niclot, Philippe, Guillon, Benoit, Moulin, Thierry, Marque, Philippe, Pariente, Jérémie, Arnaud, Catherine, and Loubinoux, Isabelle

Subjects
*CONVALESCENCE, *FLUOXETINE, *LONGITUDINAL method, *MOTOR ability, *STROKE, *RANDOMIZED controlled trials, *TREATMENT effectiveness, *BLIND experiment, *ACUTE diseases, *PHARMACODYNAMICS, *THERAPEUTICS
Abstract

Background: Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown. We therefore aimed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits.Methods: In this double-blind, placebo-controlled trial, patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis, had Fugl-Meyer motor scale (FMMS) scores of 55 or less, and were aged between 18 years and 85 years were eligible for inclusion. Patients were randomly assigned, using a computer random-number generator, in a 1:1 ratio to fluoxetine (20 mg once per day, orally) or placebo for 3 months starting 5-10 days after the onset of stroke. All patients had physiotherapy. The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug. Participants, carers, and physicians assessing the outcome were masked to group assignment. Analysis was of all patients for whom data were available (full analysis set). This trial is registered with ClinicalTrials.gov, number NCT00657163.Findings: 118 patients were randomly assigned to fluoxetine (n=59) or placebo (n=59), and 113 were included in the analysis (57 in the fluoxetine group and 56 in the placebo group). Two patients died before day 90 and three withdrew from the study. FMMS improvement at day 90 was significantly greater in the fluoxetine group (adjusted mean 34·0 points [95% CI 29·7-38·4]) than in the placebo group (24·3 points [19·9-28·7]; p=0·003). The main adverse events in the fluoxetine and placebo groups were hyponatraemia (two [4%] vs two [4%]), transient digestive disorders including nausea, diarrhoea, and abdominal pain (14 [25%] vs six [11%]), hepatic enzyme disorders (five [9%] vs ten [18%]), psychiatric disorders (three [5%] vs four [7%]), insomnia (19 [33%] vs 20 [36%]), and partial seizure (one [<1%] vs 0).Interpretation: In patients with ischaemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Modulation of spontaneous brain plasticity by drugs is a promising pathway for treatment of patients with ischaemic stroke and moderate to severe motor deficit.Funding: Public French National Programme for Clinical Research. [ABSTRACT FROM AUTHOR]

Published
2011
Full Text
View/download PDF

14. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study.

Author

Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallée PC, Cabrejo L, Slaoui T, Guidoux C, Lapergue B, Klein IF, Olivot JM, Abboud H, Simon O, Niclot P, Nifle C, Touboul PJ, Raphaeli G, Gohin C, Claeys ES, and Amarenco P

Subjects
Aged, Aged, 80 and over, Cerebral Arteries diagnostic imaging, Cerebral Arteries drug effects, Cerebral Arteries pathology, Clinical Protocols, Cohort Studies, Drug Administration Routes, Female, Fibrinolytic Agents adverse effects, Humans, Injections, Intra-Arterial adverse effects, Injections, Intra-Arterial statistics & numerical data, Injections, Intravenous statistics & numerical data, Intracranial Thrombosis complications, Intracranial Thrombosis physiopathology, Male, Middle Aged, Postoperative Complications etiology, Prospective Studies, Radiography, Recovery of Function drug effects, Recovery of Function physiology, Stroke etiology, Stroke physiopathology, Thrombolytic Therapy adverse effects, Thrombolytic Therapy statistics & numerical data, Tissue Plasminogen Activator adverse effects, Treatment Outcome, Fibrinolytic Agents administration & dosage, Intracranial Thrombosis drug therapy, Stroke drug therapy, Thrombolytic Therapy methods, Tissue Plasminogen Activator administration & dosage
Abstract

Background: The efficacy of intravenous (IV) alteplase is restricted by the speed of recanalisation and the site of the occlusion. The aim of this study was to ascertain the effect of a combined IV-endovascular approach (intra-arterial alteplase and, if required, additional thrombectomy) in patients with stroke due to arterial occlusion., Methods: We compared recanalisation rates, neurological improvement at 24 h, and functional outcome at 3 months between two periods (February, 2002, to March, 2007, vs April, 2007, to October, 2008) in patients in a prospective registry who were treated with different regimens of alteplase within 3 h of symptom onset. Patients with confirmed occlusion who were treated before April, 2007, were treated with IV alteplase; after April, 2007, patients were treated with a systematic IV-endovascular approach. Analysis was by intention to treat., Findings: 46 (87%) of 53 patients treated with the IV-endovascular approach achieved recanalisation versus 56 (52%) of 107 patients in the IV group (adjusted relative risk [RR] 1.49, 95% CI 1.21-1.84; p=0.0002). Early neurological improvement (NIHSS score of 0 or 1 or an improvement of 4 points or more at 24 h) occurred in 32 (60%) patients in the IV-endovascular group and 42 (39%) patients in the IV group (adjusted RR 1.36, 0.97-1.91; p=0.07). Favourable outcome (mRS of 0-2 at 90 days) occurred in 30 (57%) patients in the IV-endovascular group and 47 (44%) patients in the IV group (adjusted RR 1.16, 0.85-1.58; p=0.35). The mortality rate at 90 days was 17% in both groups, and symptomatic intracranial haemorrhage was reported in five (9%) patients in the IV-endovascular group and in 12 (11%) patients in the IV group. Better clinical outcome was associated with recanalisation in both groups and with time to recanalisation in the IV-endovascular group., Interpretation: An IV-endovascular approach is associated with higher recanalisation rates than is IV alteplase in patients with stroke and confirmed arterial occlusion. In patients treated with an IV-endovascular approach, a shorter time from symptom onset to recanalisation is associated with better clinical outcomes.

Published
2009
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results