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1. Simple and rapid validated HPLC-fluorescence determination of perampanel in the plasma of patients with epilepsy

Author: Susan Mohamed, Carmina Candela, Roberto Riva, and Manuela Contin
Subjects: Perampanel, Epilepsy, Antiepileptic drugs, HPLC-F, Clinical pharmacokinetics, Medicine (General), R5-920, Chemistry, QD1-999
Abstract: We present a simple and fast high-performance liquid chromatography method with fluorescence detection for the determination of the antiepileptic drug perampanel in human plasma. The chromatographic separation was performed on a Kinetex PFP (100 × 2.6 mm, 4.6 µm) column, using a mobile phase of sodium acetate 0.03 M pH 3.7 and acetonitrile (40/60, v/v), at a flow rate of 0.8 mL/min. Total chromatography time for each run was 5 min. Sample preparation (250 µL) involved only one simple precipitation step by acetonitrile spiked with mirtazapine as internal standard. The method was validated over a concentration range of 20–1000 ng/mL and successfully applied to measure perampanel concentrations in plasma samples obtained from patients with epilepsy. This assay combines the high specificity of fluorescence detection with a very simple and fast sample pretreatment and can offer real advantages over existing methods in terms of simplicity and transferability to a therapeutic drug monitoring setting.
Published: 2018
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2. Impact of the Thrombectomy Trials on the Management and Outcome of Large Vessel Stroke: Data From the Lyon Stroke Center

Author: Louis Viannay, Julie Haesebaert, Fannie Florin, Roberto Riva, Laura Mechtouff, Benjamin Gory, Elodie Ong, Paul-Emile Labeyrie, Laurent Derex, Marc Hermier, Leila Chamard, Lise-Prune Berner, Roxana Ameli, Yves Berthezène, Francis Turjman, Norbert Nighoghossian, and Tae-Hee Cho
Subjects: acute ischemic stroke, large-vessel stroke, thrombectomy, endovascular procedures, clinical outcome, systems of care, Neurology. Diseases of the nervous system, RC346-429
Abstract: Introduction: Randomized trials (RT) have recently validated the superiority of thrombectomy over standard medical care, including intravenous thrombolysis (IVT). However, data on their impact on routine clinical care remains scarce.Methods: Using a prospective observational registry, we assessed: (1) the clinical and radiological characteristics of all consecutive patients treated with thrombectomy; (2) the outcome of all patients with M1 occlusion (treated with thrombectomy or IVT alone). Two periods were compared: before (2013–2014) and after (2015–2016) the publication of RT.Results: Endovascular procedures significantly increased between the two periods (N = 82 vs. 314, p < 0.0001). In 2015–2016, patients were older (median [IQR]: 69 [57-80]; vs. 66 [53-74]; p = 0.008), had shorter door-to-clot times (69 [47-95]; vs. 110 [83-155]; p < 0.0001) resulting in a trend toward shorter delay from symptom onset to reperfusion (232 [185-300]; vs. 250 [200-339]; p = 0.1), with higher rates of reperfusion (71 vs. 48%; p = 0.0001). Conversely, no significant differences in baseline NIHSS scores, ASPECTS, delay to IVT or intracranial hemorrhage were found. In 2015–2016, patients with M1 occlusion were treated with thrombectomy more often than in 2013–2014 (87 vs. 32%, respectively; p < 0.0001), with a significant improvement in clinical outcome (shift analysis, lower modified Rankin scale scores: OR = 1.68; 95% CI: 1.10–2.57; p = 0.017).Conclusion: Following the publication of RT, thrombectomy was rapidly implemented with significant improvements in intrahospital delay and reperfusion rates. Treatment with thrombectomy increased with better clinical outcomes in patients with M1 occlusion.
Published: 2018
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3. Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis

Author: Benjamin Maïer, Benjamin Gory, Guillaume Taylor, Julien Labreuche, Raphaël Blanc, Michael Obadia, Marie Abrivard, Stanislas Smajda, Jean‐Philippe Desilles, Hocine Redjem, Gabriele Ciccio, Anne Claire Lukaszewicz, Francis Turjman, Roberto Riva, Paul Emile Labeyrie, Alain Duhamel, Jacques Blacher, Michel Piotin, Bertrand Lapergue, and Mikael Mazighi
Subjects: blood pressure, ischemic, stroke, stroke management, thrombectomy, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundHigh blood pressure (BP) is associated with worse clinical outcomes in the setting of acute ischemic stroke, but the optimal blood pressure target is still a matter of debate. We aimed to study the association between baseline BP and mortality in acute ischemic stroke patients treated by mechanical thrombectomy. Methods and ResultsA total of 1332 acute ischemic stroke patients treated by mechanical thrombectomy were enrolled (from January 2012 to June 2016) in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Linear and polynomial logistic regression models were used to assess the association between BP and mortality and functional outcome at 90 days. Highest mortality was found at lower and higher baseline systolic blood pressure (SBP) values following a J‐ or U‐shaped relationship, with a nadir at 157 mm Hg (95% confidence interval 143‐170). When SBP values were categorized in 10–mm Hg increments, the odds ratio for all‐cause mortality was 3.78 (95% confidence interval 1.50‐9.55) for SBP
Published: 2017
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4. Daily Variation in the Occurrence of Different Subtypes of Stroke

Author: Luciana Ripamonti, Roberto Riva, Fabiola Maioli, Corrado Zenesini, and Gaetano Procaccianti
Subjects: Neurology. Diseases of the nervous system, RC346-429
Abstract: Three thousand two hundred and ninety-eight patients admitted to our Stroke Unit with hemorrhagic, large artery atherosclerosis, cardioembolic, small-vessel occlusion, and undetermined etiology-cryptogenic strokes were included in the study. The circadian variability in onset in each stroke subgroup and the associations with various risk factors were analyzed. In each subgroup, a significant minority of patients suffered from stroke during sleep. In the ischemic group, hypercholesterolemia, paroxysmal atrial fibrillation, and previous myocardial infarction facilitated the onset during waking. During waking, stroke onset was significantly higher in the morning compared to the afternoon both in the hemorrhagic and in the ischemic type. In hemorrhagic stroke, a previous stroke was associated with a lower early morning occurrence. In large artery atherosclerosis stroke, males were at higher risk of early morning occurrence (p
Published: 2017
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5. Patient Selection in a Pragmatic Study on the Management of Patients with Brain Arteriovenous Malformations

Author: Jean Raymond, Anass Benomar, Jean-Christophe Gentric, Elsa Magro, Lorena Nico, Emma Bacchus, Ruby Klink, Daniela Iancu, Alain Weill, Daniel Roy, Michel W. Bojanowski, Chiraz Chaalala, Omer Eker, Isabelle Pelissou-Guyotat, Michel Piotin, Sorin Aldea, Charlotte Barbier, Thomas Gaberel, Chrysanthi Papagiannaki, Stéphane Derrey, Thanh N. Nguyen, Mohamad Abdalkader, Christophe Cognard, Anne-Christine Januel, Jean-François Sabatier, Vincent Jecko, Xavier Barreau, Vincent Costalat, Marine Le Corre, Jean-Yves Gauvrit, Xavier Morandi, Alessandra Biondi, Laurent Thines, Hubert Desal, Romain Bourcier, Rémy Beaujeux, François Proust, Geraldine Viard, Guylaine Gevry, Tim E. Darsaut, Cian J. O'Kelly, Michael MC. Chow, J. Max Findlay, Jeremy L. Rempel, Robert Fahed, Howard Lesiuk, Brian Drake, Marlene dos Santos, Michel Nonent, Julien Ognard, Mourad Cheddad El-Aouni, Romuald Seizeur, Serge Timsit, Olivier Pradier, Romain Boursier, François Thillays, Vincent Roualdes, Raphael Blanc, Lionel Calviere, Jean Yves Gauvrit, Hélène Raoult, François Eugene, Anthony Le Bras, Jean-Christophe Ferre, Christophe Paya, Isabelle Lecouillard, Elodie Nouhaud, Thomas Ronziere, Denis Trystram, Olivier Naggara, Christine Rodriguez-Regent, Basile Kerleroux, Evelyne Emery, Emmanuel Touze, Roberto Riva, Isabelle Pellisou-Guyotat, Jacques Guyotat, Monsef Berhouma, Chloé Dumot, Nassim Bougaci, Guillaume Charbonnier, Serge Bracard, René Anxionnat, Benjamin Gory, Thierry Civit, Valérie Bernier-Chastagner, Gaultier Marnat, Guillaume Penchet, Edouard Gimbert, Aymeri Huchet, Denis Herbreteau, Grégoire Boulouis, Richard Bibi, Héloïse Ifergan, Kévin Janot, Stéphane Velut, Hervé Brunel, Pierre-Hugues Roche, Thomas Graillon, Hadrien Peyriere, Jean-Marc Kaya, Adamou Touta, Lucas Troude, Sébastien Boissonneau, Frédéric Clarençon, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Anne-Laure Boch, Philippe Cornu, Aurélien Nouet, Alain Bonafe, Cyril Dargazanli, Gregory Gascou, Pierre-Henri Lefevre, Carlos Riquelme, Raoul Pop, Hélène Cebula, Irène Ollivier, Giorgio Spatola, Laurent Spell, Vanessa Chalumeau, Sophie Gallas, Léon Ikka, Cristian Mihalea, Augustin Ozanne, Jildaz Caroff, Emmanuel Chabert, Charbel Mounayer, Aymeric Rouchaud, François Caire, Frédéric Ricolfi, Pierre Thouant, Catherine Cao, Klaus-Luc Mourier, Walid Farah, Thien Huynh, Rabih G. Tawk, Andrew P. Carlson, Luciana Alves Oliveira Silva, Nayara de Lima Froio, Gisele Sampaio Silva, Francisco J.A. Mont’Alverne, Jose Luri Martins, George Nunes Mendes, and Rodrigo Rivera Miranda
Subjects: Surgery, Neurology (clinical)
Published: 2023

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

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

7. Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial

Author: Jean Raymond, Jean-Christophe Gentric, Elsa Magro, Lorena Nico, Emma Bacchus, Ruby Klink, Christophe Cognard, Anne-Christine Januel, Jean-François Sabatier, Daniela Iancu, Alain Weill, Daniel Roy, Michel W. Bojanowski, Chiraz Chaalala, Xavier Barreau, Vincent Jecko, Chrysanthi Papagiannaki, Stéphane Derrey, Eimad Shotar, Philippe Cornu, Omer F. Eker, Isabelle Pelissou-Guyotat, Michel Piotin, Sorin Aldea, Rémy Beaujeux, François Proust, René Anxionnat, Vincent Costalat, Marine Le Corre, Jean-Yves Gauvrit, Xavier Morandi, Hervé Brunel, Pierre-Hugues Roche, Thomas Graillon, Emmanuel Chabert, Denis Herbreteau, Hubert Desal, Denis Trystram, Charlotte Barbier, Thomas Gaberel, Thanh N. Nguyen, Geraldine Viard, Guylaine Gevry, Tim E. Darsaut, Cian J. O’Kelly, Michael M. C. Chow, J. Max Findlay, Jeremy L. Rempel, Robert Fahed, Howard Lesiuk, Brian Drake, Marlene dos Santos, Michel Nonent, Julien Ognard, Mourad Cheddad El-Aouni, Romuald Seizeur, Serge Timsit, Olivier Pradier, Romain Boursier, François Thillays, Vincent Roualdes, Raphael Blanc, Lionel Calviere, Jean Yves Gauvrit, Hélène Raoult, François Eugene, Anthony Le Bras, Jean-Christophe Ferre, Christophe Paya, Isabelle Lecouillard, Elodie Nouhaud, Thomas Ronziere, Olivier Naggara, Christine Rodriguez-Regent, Basile Kerleroux, Evelyne Emery, Emmanuel Touze, Roberto Riva, Isabelle Pellisou-Guyotat, Jacques Guyotat, Monsef Berhouma, Chloé Dumot, Alessandra Biondi, Laurent Thines, Nassim Bougaci, Guillaume Charbonnier, Serge Bracard, Benjamin Gory, Thierry Civit, Valérie Bernier-Chastagner, Gaultier Marnat, Guillaume Penchet, Edouard Gimbert, Aymeri Huchet, Grégoire Boulouis, Richard Bibi, Héloïse Ifergan, Kévin Janot, Stéphane Velut, Hadrien Peyriere, Jean-Marc Kaya, Adamou Touta, Lucas Troude, Sébastien Boissonneau, Frédéric Clarençon, Nader Sourour, Stéphanie Lenck, Kévin Premat, Anne-Laure Boch, Aurélien Nouet, Alain Bonafe, Cyril Dargazanli, Gregory Gascou, Pierre-Henri Lefevre, Carlos Riquelme, Raoul Pop, Hélène Cebula, Irène Ollivier, Giorgio Spatola, Laurent Spell, Vanessa Chalumeau, Sophie Gallas, Léon Ikka, Cristian Mihalea, Augustin Ozanne, Jildaz Caroff, Charbel Mounayer, Aymeric Rouchaud, François Caire, Frédéric Ricolfi, Pierre Thouant, Catherine Cao, Klaus-Luc Mourier, Walid Farah, Mohamad Abdalkader, Thien Huynh, Rabih G. Tawk, Andrew P. Carlson, Luciana Alves Oliveira Silva, Nayara de Lima Froio, Gisele Sampaio Silva, Francisco J. A. Mont’Alverne, Jose Luri Martins, George Nunes Mendes, and Rodrigo Rivera Miranda
Subjects: General Medicine
Abstract: OBJECTIVE The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study that comprises two randomized trials and multiple registries. METHODS Results from the TOBAS curative and pre-embolization registries are reported. The primary outcome for this report is death or dependency (modified Rankin Scale [mRS] score > 2) at last follow-up. Secondary outcomes include angiographic results, perioperative serious adverse events (SAEs), and permanent treatment-related complications leading to an mRS score > 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited in TOBAS. Embolization was chosen as the primary curative treatment for 116 patients and pre-embolization prior to surgery or SRS for 92 patients. Clinical and angiographic outcomes were available in 106 (91%) of 116 and 77 (84%) of 92 patients, respectively. In the curative embolization registry, 70% of AVMs were ruptured, and 62% were low-grade AVMs (Spetzler-Martin grade I or II), while the pre-embolization registry had 70% ruptured AVMs and 58% low-grade AVMs. The primary outcome of death or disability (mRS score > 2) occurred in 15 (14%, 95% CI 8%–22%) of the 106 patients in the curative embolization registry (4 [12%, 95% CI 5%–28%] of 32 unruptured AVMs and 11 [15%, 95% CI 8%–25%] of 74 ruptured AVMs) and 9 (12%, 95% CI 6%–21%) of the 77 patients in the pre-embolization registry (4 [17%, 95% CI 7%–37%] of 23 unruptured AVMs and 5 [9%, 95% CI 4%–20%] of 54 ruptured AVMs) at 2 years. Embolization alone was confirmed to occlude the AVM in 32 (30%, 95% CI 21%–40%) of the 106 curative attempts and in 9 (12%, 95% CI 6%–21%) of 77 patients in the pre-embolization registry. SAEs occurred in 28 of the 106 attempted curative patients (26%, 95% CI 18%–35%, including 21 new symptomatic hemorrhages [20%, 95% CI 13%–29%]). Five of the new hemorrhages were in previously unruptured AVMs (n = 32; 16%, 95% CI 5%–33%). Of the 77 pre-embolization patients, 18 had SAEs (23%, 95% CI 15%–34%), including 12 new symptomatic hemorrhages [16%, 95% CI 9%–26%]). Three of the hemorrhages were in previously unruptured AVMs (3/23; 13%, 95% CI 3%–34%). CONCLUSIONS Embolization as a curative treatment for brain AVMs was often incomplete. Hemorrhagic complications were frequent, even when the specified intent was pre-embolization before surgery or SRS. Because the role of endovascular treatment remains uncertain, it should preferably, when possible, be offered in the context of a randomized trial.
Published: 2022

8. Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial

Author: Tim E. Darsaut, Elsa Magro, Michel W. Bojanowski, Chiraz Chaalala, Lorena Nico, Emma Bacchus, Ruby Klink, Daniela Iancu, Alain Weill, Daniel Roy, Jean-Francois Sabatier, Christophe Cognard, Anne-Christine Januel, Isabelle Pelissou-Guyotat, Omer Eker, Pierre-Hugues Roche, Thomas Graillon, Hervé Brunel, Francois Proust, Rémy Beaujeux, Sorin Aldea, Michel Piotin, Philippe Cornu, Eimad Shotar, Thomas Gaberel, Charlotte Barbier, Marine Le Corre, Vincent Costalat, Vincent Jecko, Xavier Barreau, Xavier Morandi, Jean-Yves Gauvrit, Stéphane Derrey, Chrysanthi Papagiannaki, Thanh N. Nguyen, Mohamad Abdalkader, Rabih G. Tawk, Thien Huynh, Geraldine Viard, Guylaine Gevry, Jean-Christophe Gentric, Jean Raymond, Jeremy L. Rempel, Cian J. O’Kelly, Michael M. C. Chow, J. Max Findlay, Robert Fahed, Howard Lesiuk, Brian Drake, Marlene dos Santos, Romuald Seizeur, Michel Nonent, Serge Timsit, Olivier Pradier, Julien Ognard, Mourad Cheddad El-Aouni, Hubert Desal, Romain Boursier, François Thillays, Vincent Roualdes, Raphael Blanc, Jean-François Sabatier, Lionel Calviere, Jean Yves Gauvrit, Isabelle Lecouillard, Elodie Nouhaud, Hélène Raoult, François Eugene, Anthony Le Bras, Jean-Christophe Ferre, Christophe Paya, Thomas Ronziere, Denis Trystram, Olivier Naggara, Christine Rodriguez-Regent, Basile Kerleroux, Evelyne Emery, Emmanuel Touze, Stephane Derrey, Isabelle Pellisou-Guyotat, Jacques Guyotat, Monsef Berhouma, Roberto Riva, Chloé Dumot, Alessandra Biondi, Laurent Thines, Guillaume Charbonnier, Nassim Bougaci, Serge Bracard, René Anxionnat, Valérie Bernier-Chastagner, Thierry Civit, Benjamin Gory, Guillaume Penchet, Edouard Gimbert, Gaulthier Marnat, Aymeri Huchet, Denis Herbreteau, Grégoire Boulouis, Stéphane Velut, Richard Bibi, Héloïse Ifergan, Kévin Janot, Hadrien Peyriere, Jean-Marc Kaya, Adamou Touta, Lucas Troude, Sébastien Boissonneau, Anne-Laure Boch, Frédéric Clarençon, Nader Sourour, Aurélien Nouet, Stéphanie Lenck, Kévin Premat, Alain Bonafe, Cyril Dargazanli, Gregory Gascou, Pierre-Henri Lefevre, Carlos Riquelme, Hélène Cebula, Irène Ollivier, Raoul Pop, Giorgio Spatola, Laurent Spelle, Vanessa Chalumeau, Sophie Gallas, Léon Ikka, Cristian Mihalea, Augustin Ozanne, Jildaz Caroff, Emmanuel Chabert, Charbel Mounayer, Aymeric Rouchaud, Francois Caire, Frédéric Ricolfi, Catherine Cao, Klaus-Luc Mourier, Pierre Thouant, Walid Farah, Andrew P. Carlson, Luciana Alves Oliveira Silva, Nayara de Lima Froio, Gisele Sampaio Silva, Francisco J. A. Mont’Alverne, Jose Luri Martins, George Nunes Mendes, and Rodrigo Rivera Miranda
Subjects: General Medicine
Abstract: OBJECTIVE The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I–II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%–93%) and 105/110 low-grade (95%, 95% CI 90%–98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%–18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%–28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%–9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 (ClinicalTrials.gov)
Published: 2022

9. Cervicobrachial neuralgia due to vertebral artery loop

Author: Marine Rigal, Sylvain Portet, Emmanuel Jouanneau, Roberto Riva, Omer Eker, and Timothée Jacquesson
Subjects: Neck Pain, Cervical Vertebrae, Brachial Plexus Neuritis, Humans, Female, Radiology, Nuclear Medicine and imaging, Surgery, Middle Aged, Anatomy, Spinal Nerve Roots, Vertebral Artery, Pathology and Forensic Medicine
Abstract: The main anatomic variations should be taught along with the classical anatomy curriculum, since they can mislead both diagnosis and treatment. We report here a clinical and radiological case of left C6 cervicobrachial neuralgia recurrence due to a vertebral artery loop, we then describe 13 published cases of such neurovascular conflicts.A 51-year-old woman suffered from recurrence of C6 cervicobrachial neuralgia after an initial C5-C6 decompression-fusion. Additional cervical angio-MR and CT scans found a tortuous aspect of the left vertebral artery that came into conflict with the left C6 spinal root, just after its emergence of the C5-C6 intervertebral foramen. A large posterior decompression was performed including a C5 and C6 left lateral mass resection to enlarge the foraminal space. The vertebral artery was kept in place. The patient reported a slow but consistent decrease in pain that disappeared after 3 months. Thirteen cases of a compressive vertebral loop are thereafter detailed.Vascular precursors disarrangements can lead to a vertebral artery loop in contact with emerging cervical roots and potential clinical impact. This differential diagnosis should be considered for cervico-brachial neuralgia management. Moreover, the present case highlights the key role of a careful preoperative imaging assessment, as well as the need for robust knowledge of anatomy.
Published: 2022

10. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial

Author: Urs Fischer, Johannes Kaesmacher, Daniel Strbian, Omer Eker, Christoph Cognard, Patricia S Plattner, Lukas Bütikofer, Pasquale Mordasini, Sandro Deppeler, Vitor M Pereira, Jean François Albucher, Jean Darcourt, Romain Bourcier, Guillon Benoit, Chrysanthi Papagiannaki, Ozlem Ozkul-Wermester, Gerli Sibolt, Marjaana Tiainen, Benjamin Gory, Sébastien Richard, Jan Liman, Marielle Sophie Ernst, Marion Boulanger, Charlotte Barbier, Laura Mechtouff, Liqun Zhang, Gaultier Marnat, Igor Sibon, Omid Nikoubashman, Arno Reich, Arturo Consoli, Bertrand Lapergue, Marc Ribo, Alejandro Tomasello, Suzana Saleme, Francisco Macian, Solène Moulin, Paolo Pagano, Guillaume Saliou, Emmanuel Carrera, Kevin Janot, María Hernández-Pérez, Raoul Pop, Lucie Della Schiava, Andreas R Luft, Michel Piotin, Jean Christophe Gentric, Aleksandra Pikula, Waltraud Pfeilschifter, Marcel Arnold, Adnan H Siddiqui, Michael T Froehler, Anthony J Furlan, René Chapot, Martin Wiesmann, Paolo Machi, Hans-Christoph Diener, Zsolt Kulcsar, Leo H Bonati, Claudio L Bassetti, Mikael Mazighi, David S Liebeskind, Jeffrey L Saver, Jan Gralla, Angelika Alonso, Caroline Arquizan, Xavier Barreau, Rémy Beaujeux, Daniel Behme, Tobias Boeckh-Behrens, Christian Boehme, Martí Boix, Grégoire Boulouis, Nicolas Bricout, Nicolas Broc, Carlo W. Cereda, Emmanuel Chabert, Tae-Hee Cho, Alessandro Cianfoni, Vincent Costalat, Christian Denier, Frederico Di Maria, Richard du Mesnil de Rochemont, Patricia Fearon, Anna Ferrier, Sebastian Fischer, Maxime Gauberti, Marie Gaudron, Laetitia Gimenez, Christoph Globas, Michael Görtler, Mayank Goyal, Ruediger Hilker-Roggendorf, Michael D. Hill, Vi Tuan Hua, Lisa Humbertjean, Olav Jansen, Simon Jung, Georg Kägi, Michael E. Kelly, Ilka Kleffner, Michael Knoflach, Krassen Nedeltchev, Lars Udo Krause, Kimmo Lappalainen, Margaux Lefebvre, Joe Leyon, Liang Liao, Jean-Sebastien Liegey, Christian Loehr, Patrik Michel, Stefania Nannoni, Patrick Nicholson, Lorena Nico, Michael Obadia, Julien Ognard, Ayokunle Ogungbemi, Jean-Marc Olivot, Simon Escalard, Marco Pasi, Lissa Peeling, Jane Perez, Martina Petersen, Eike Piechowiak, Roberto Raposo, Silja Räty, Sarah C. Reitz, Sebastià Remollo, Luca Remonda, Ian Rennie, Manuel Requena, Alexander Riabikin, Roberto Riva, Aymeric Rouchaud, Andrea Rosi, Marta Rubiera, Laurent Spelle, Marlena Schnieder, Joanna D. Schaafsma, Tilman Schubert, Jörg B. Schulz, Mohammed Siddiqui, Sébastien Soize, Michael Sonnberger, Emmanuel Touze, Aude Triquenot, Guillaume Turc, Lucy Vieira, Wagih Ben Hassen, Judith N. Wagner, Katrin Wasser, Johannes Weber, Holger Wenz, David Weisenburger-Lile, Fritz Wodarg, Valérie Wolff, Silke Wunderlich, University of Bern, Bern University Hospital [Berne] (Inselspital), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), CHU Toulouse [Toulouse], Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], University of Toronto, Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Radiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Service de neurologie [Rouen], Helsinki University Hospital [Finland] (HUS), 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), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de neurologie [CHRU Nancy], University Medical Center Göttingen (UMG), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Interférométrie, In situ et Instrumentation pour la Microscopie Electronique (CEMES-I3EM), Centre d'élaboration de matériaux et d'études structurales (CEMES), Institut National des Sciences Appliquées - Toulouse (INSA Toulouse), Institut National des Sciences Appliquées (INSA)-Université Fédérale Toulouse Midi-Pyrénées-Institut National des Sciences Appliquées (INSA)-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Toulouse (INSA Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Institut de Neurosciences cognitives et intégratives d'Aquitaine (INCIA), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-SFR Bordeaux Neurosciences-Centre National de la Recherche Scientifique (CNRS), Universitätsklinikum RWTH Aachen - University Hospital Aachen [Aachen, Germany] (UKA), Rheinisch-Westfälische Technische Hochschule Aachen University (RWTH), Hôpital Foch [Suresnes], Institut de Ciencies del Cosmos (ICCUB), Universitat de Barcelona (UB), Observatoire océanologique de Banyuls (OOB), Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Limoges, Environnement, Bioénergie, Microalgues et Plantes (EBMP), Institut de Biosciences et Biotechnologies d'Aix-Marseille (ex-IBEB) (BIAM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-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)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-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), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Hôpitaux Universitaires de Genève (HUG), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain] (GTPUH), Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), CHU Lille, University hospital of Zurich [Zurich], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), 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)-Université de Brest (UBO), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Toronto Western Hospital, Frankfurt University Hospital, University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Vanderbilt University Medical Center [Nashville], Vanderbilt University [Nashville], Case Western Reserve University [Cleveland], Alfried Krupp Krankenhaus [Essen], Geneva University Hospitals and Geneva University, Institute of Medical Informatics, Biometrics and Epidemiology [ Essen, Germany] (IMIBE), University Hospital Basel [Basel], University of Basel (Unibas), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), University of California (UC), SWIFT DIRECT Collaborators: Angelika Alonso, Caroline Arquizan, Xavier Barreau, Rémy Beaujeux, Daniel Behme, Tobias Boeckh-Behrens, Christian Boehme, Martí Boix, Grégoire Boulouis, Nicolas Bricout, Nicolas Broc, Carlo W Cereda, Emmanuel Chabert, Tae-Hee Cho, Alessandro Cianfoni, Vincent Costalat, Christian Denier, Frederico Di Maria, Richard du Mesnil de Rochemont, Patricia Fearon, Anna Ferrier, Sebastian Fischer, Maxime Gauberti, Marie Gaudron, Laetitia Gimenez, Christoph Globas, Michael Görtler, Mayank Goyal, Ruediger Hilker-Roggendorf, Michael D Hill, Vi Tuan Hua, Lisa Humbertjean, Olav Jansen, Simon Jung, Georg Kägi, Michael E Kelly, Ilka Kleffner, Michael Knoflach, Krassen Nedeltchev, Lars Udo Krause, Kimmo Lappalainen, Margaux Lefebvre, Joe Leyon, Liang Liao, Jean-Sebastien Liegey, Christian Loehr, Patrik Michel, Stefania Nannoni, Patrick Nicholson, Lorena Nico, Michael Obadia, Julien Ognard, Ayokunle Ogungbemi, Jean-Marc Olivot, Simon Escalard, Marco Pasi, Lissa Peeling, Jane Perez, Martina Petersen, Eike Piechowiak, Roberto Raposo, Silja Räty, Sarah C Reitz, Sebastià Remollo, Luca Remonda, Ian Rennie, Manuel Requena, Alexander Riabikin, Roberto Riva, Aymeric Rouchaud, Andrea Rosi, Marta Rubiera, Laurent Spelle, Marlena Schnieder, Joanna D Schaafsma, Tilman Schubert, Jörg B Schulz, Mohammed Siddiqui, Sébastien Soize, Michael Sonnberger, Emmanuel Touze, Aude Triquenot, Guillaume Turc, Lucy Vieira, Wagih Ben Hassen, Judith N Wagner, Katrin Wasser, Johannes Weber, Holger Wenz, David Weisenburger-Lile, Fritz Wodarg, Valérie Wolff, Silke Wunderlich., Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), St George’s University Hospitals, Vall d'Hebron University Hospital [Barcelona], and CarMeN, laboratoire
Subjects: [SDV] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], General Medicine, 610 Medicine & health
Abstract: Background Whether thrombectomy alone is equally as effective as intravenous alteplase plus thrombectomy remains controversial. We aimed to determine whether thrombectomy alone would be non-inferior to intravenous alteplase plus thrombectomy in patients presenting with acute ischaemic stroke. Methods In this multicentre, randomised, open-label, blinded-outcome trial in Europe and Canada, we recruited patients with stroke due to large vessel occlusion confirmed with CT or magnetic resonance angiography admitted to endovascular centres. Patients were randomly assigned (1:1) via a centralised web server using a deterministic minimisation method to receive stent-retriever thrombectomy alone or intravenous alteplase plus stent-retriever thrombectomy. In both groups, thrombectomy was initiated as fast as possible with any commercially available Solitaire stent-retriever revascularisation device (Medtronic, Irvine, CA, USA). In the combined treatment group, intravenous alteplase (0.9 mg/kg bodyweight, maximum dose 90 mg per patient) was administered as early as possible after randomisation for 60 min with 10% of the calculated dose given as an initial bolus. Personnel assessing the primary outcome were masked to group allocation; patients and treating physicians were not. The primary binary outcome was a score of 2 or less on the modified Rankin scale at 90 days. We assessed the non-inferiority of thrombectomy alone versus intravenous alteplase plus thrombectomy in all randomly assigned and consenting patients using the one-sided lower 95% confidence limit of the Mantel-Haenszel risk difference, with a prespecified non-inferiority margin of 12%. The main safety endpoint was symptomatic intracranial haemorrhage assessed in all randomly assigned and consenting participants. This trial is registered with ClinicalTrials.gov, NCT03192332, and is closed to new participants. Findings Between Nov 29, 2017, and May 7, 2021, 5215 patients were screened and 423 were randomly assigned, of whom 408 (201 thrombectomy alone, 207 intravenous alteplase plus thrombectomy) were included in the primary efficacy analysis. A modified Rankin scale score of 0-2 at 90 days was reached by 114 (57%) of 201 patients assigned to thrombectomy alone and 135 (65%) of 207 patients assigned to intravenous alteplase plus thrombectomy (adjusted risk difference -7 .3%, 95% CI -16.6 to 2.1, lower limit of one-sided 95% CI -15.1%, crossing the non-inferiority margin of - 12%). Symptomatic intracranial haemorrhage occurred in five (2%) of 201 patients undergoing thrombectomy alone and seven (3%) of 202 patients receiving intravenous alteplase plus thrombectomy ( risk difference -1.0%, 95% CI -4.8 to 2 .7). Successful reperfusion was less common in patients assigned to thrombectomy alone (182 [ 91%] of 201 vs 199 [96%] of 207, risk difference -5.1%, 95% CI -10.2 to 0. 0, p=0.047). Interpretation Thrombectomy alone was not shown to be non-inferior to intravenous alteplase plus thrombectomy and resulted in decreased reperfusion rates. These results do not support omitting intravenous alteplase before thrombectomy in eligible patients. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
Published: 2022

11. Assessment of three MR perfusion software packages in predicting final infarct volume after mechanical thrombectomy

Author: Alexandre Bani-Sadr, Tae-Hee Cho, Matteo Cappucci, Marc Hermier, Roxana Ameli, Andrea Filip, Roberto Riva, Laurent Derex, Charles De Bourguignon, Laura Mechtouff, Omer F Eker, Norbert Nighoghossian, and Yves Berthezene
Subjects: Surgery, Neurology (clinical), General Medicine
Abstract: AimsTo evaluate the performance of three MR perfusion software packages (A: RAPID; B: OleaSphere; and C: Philips) in predicting final infarct volume (FIV).MethodsThis cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were post-processed by three packages to quantify ischemic core and perfusion deficit volume (PDV). Automatic package outputs (uncorrected volumes) were collected and corrected by an expert. Successful revascularization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B. Uncorrected and corrected volumes were compared between each package and with FIV according to mTICI score.ResultsNinety-four patients were included, of whom 67 (71.28%) had a mTICI score ≥2B. In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (p>0.15). Conversely, assessment of PDV showed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference −40.9 mL) and B (median absolute difference −67.0 mL) overestimated FIV to a lesser degree than package C (median absolute difference −118.7 mL; p=0.03 and p=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (p≥0.99).ConclusionsAutomated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same dataset. This highlights the need for routine expert evaluation and correction of automated package output data for appropriate patient management.
Published: 2022

12. Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results

Author: Marie Couture, Stephanos Finitsis, Gaultier Marnat, Sébastien Richard, Romain Bourcier, Pacôme Constant-dits-Beaufils, Cyril Dargazanli, Caroline Arquizan, Mikaël Mazighi, Raphaël Blanc, François Eugène, Stéphane Vannier, Laurent Spelle, Christian Denier, Emmanuel Touzé, Charlotte Barbier, Suzana Saleme, Francisco Macian, Charlotte Rosso, Frédéric Clarençon, Olivier Naggara, Guillaume Turc, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Alain Viguier, Christophe Cognard, Anthony Lebras, Sarah Evain, Valérie Wolff, Raoul Pop, Serge Timsit, Jean-Christophe Gentric, Frédéric Bourdain, Louis Veunac, Bertrand Lapergue, Arturo Consoli, Benjamin Gory, Igor Sibon, Michel Piotin, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Hebert Solène, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David WeisenburgerLile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, Romain Tonnelet, François Liao, Emmanuelle Zhu, Sophie Schmitt, Sébastien Planel, Lisa Richard, Gioia Humbertjean, Jean-Christophe Mione, Nolwenn Lacour, Gérard Riou-Comte, Marcela Audibert, Lionel Voicu, Marie Alb, Madalina Reitter, Agnès Brezeanu, Adriana Masson, Iona Tabarna, Sarah Podar, Fatiha Guy, Fatiha Bechiri, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Laura Venditti, Mariana Sarov, Nicolas Legris, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti, Julien Ognard, Francois Mathias Merrien., Ozlem Ozku Wermester, Evelyne Massardier, Aude Triquenot, Margeaux Lefebvre, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, David Higue, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran, Anthony Le Bras, Arnaud Le Guen, Norbert Nighoghossian, Roberto Riva, Omer Eker, Francis turjman, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, and Anne-Evelyne Vallet
Subjects: Adult, Male, medicine.medical_specialty, Endovascular therapy, Brain ischemia, Internal medicine, medicine, Humans, Registries, Endovascular treatment, Prospective cohort study, Acute ischemic stroke, Acute stroke, Aged, Ischemic Stroke, Advanced and Specialized Nursing, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Embolic stroke, Treatment Outcome, Ischemic stroke, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Abstract: Background and Purpose: The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset. Methods: We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT−) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences. Results: A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT− group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88–1.34]; P =0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7–1.2]; P =0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63–1.37]; P =0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0–2; aOR, 0.98 [95% CI, 0.77–1.25]; P =0.89), and mortality (aOR, 0.95 [95% CI, 0.72–1.26]; P =0.76) at 90 days did not differ between the groups. Conclusions: Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.
Published: 2021

13. Évaluation des logiciels de perfusion irm dans la prédiction du volume final de l'infarctus après thrombectomie mécanique

Author: Alexandre Bani-Sadr, Tae-Hee Cho, Matteo Cappucci, Marc Hermier, Roxana Ameli, Andrea Filip, Charles De Bourguignon, Roberto Riva, Laurent Derex, Laura Mechtouff, Omer Eker, Norbert Nighoghossian, and Yves Berthezène
Subjects: Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Published: 2022

14. Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency

Author: Benjamin Maïer, Erwan Robichon, Romain Bourcier, Cyril Dargazanli, Julien Labreuche, Laurie-Anne Thion, Morgan Leguen, Romuald Riem, Jean-Philippe Desilles, Grégoire Boulouis, François Delvoye, Solène Hebert, Hocine Redjem, Stanislas Smajda, Simon Escalard, Raphaël Blanc, Michel Piotin, Bertrand Lapergue, Mikael Mazighi, Robert Fahed, Malek Ben Maacha, Georges Rodesch, Arturo Consoli, Aguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean-Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Delphine Lopez, Francis Turjman, Benjamin Gory, Paul-Emile Labeyrie, Roberto Riva, Charbel Mounayer, Suzanna Saleme, Vincent Costalat, Alain Bonafé, Omer Eker, Grégory Gascou, Cyril Darganzali, Serge Bracard, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Hubert Desal, Benjamin Daumas Duport, Jérome Berge, Xavier Barreau, Gauthier Margnat, Lynda Djemmane, and Alain Duhamel
Subjects: medicine.medical_specialty, Hemodynamics, Blood Pressure, Endovascular therapy, 030218 nuclear medicine & medical imaging, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Humans, Posterior communicating artery, Acute ischemic stroke, Ischemic Stroke, Thrombectomy, Advanced and Specialized Nursing, business.industry, Endovascular Procedures, Stroke, Blood pressure, Treatment Outcome, Ischemic stroke, Cardiology, Neurology (clinical), Hypotension, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose: Hypotension during endovascular therapy for acute ischemic stroke is associated with worse functional outcomes (FO). Given its important role in intracranial hemodynamics, we investigated whether hypotension during endovascular therapy had the same effect on FO according to the posterior communicating artery (PComA) patency. Methods: We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Patients were included if they had middle cerebral artery occlusions. Primary outcome was favorable FO, defined by a modified Rankin Scale scores between 0 and 2 at 3 months. Results: One hundred forty-eight patients with middle cerebral artery occlusion were included. In patients with no PComA, an increase in minimum mean arterial pressure was positively associated with favorable FO (odds ratio per 10 mm Hg increase, 1.59 [95%CI, 1.11–2.25]; P =0.010), whereas no association was found in patients with a PComA (odds ratio, 0.77 [95% CI, 0.54–1.08]; P =0.12). Patients with no PComA and longer cumulative time with mean arterial pressure P =0.010) and 0.74 (95% CI, 0.60–0.91; P =0.003), but not in patients with a PComA. Conclusions: Hypotension during endovascular therapy for middle cerebral artery occlusion is consistently associated with worse FO in patients with no PComA but not in those with a PComA. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02523261.
Published: 2021

15. Effect of Operator’s Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study

Author: Zhu, François, primary, Ben Hassen, Wagih, additional, Bricout, Nicolas, additional, Kerleroux, Basile, additional, Janot, Kevin, additional, Gory, Benjamin, additional, Anxionnat, René, additional, Richard, Sébastien, additional, Marchal, Adrien, additional, Blanc, Raphael, additional, Piotin, Michel, additional, Consoli, Arturo, additional, Trystram, Denis, additional, Rodriguez Regent, Christine, additional, Desilles, Jean-Philippe, additional, Weisenburger-Lile, David, additional, Escalard, Simon, additional, Herbreteau, Denis, additional, Ifergan, Heloise, additional, Lima Maldonado, Igor, additional, Labreuche, Julien, additional, Henon, Hilde, additional, Naggara, Olivier, additional, Lapergue, Bertrand, additional, Boulouis, Grégoire, additional, Hocine, Redjem, additional, Gabriele, Ciccio, additional, Stanislas, Smajda, additional, Benjamin, Maier, additional, Mikael, Mazighi, additional, Mikael, Obadia, additional, Candice, Sabben, additional, Roxanne, Peres, additional, Ovide, Corabianu, additional, Thomas, De Broucker, additional, Didier, Smadja, additional, Sonia, Alamowitch, additional, Olivier, Ille, additional, Eric, Manchon, additional, Pierre-Yves, Garcia, additional, Guillaume, Taylor, additional, Malek, Ben Maacha, additional, Adrien, Wang, additional, Serge, Evrard, additional, Maya, Tchikviladze, additional, Nadia, Ajili, additional, Lucas, Gorza, additional, Géraldine, Buard, additional, Oguzhan, Coskun, additional, Maria Federico, Di, additional, Georges, Rodesh, additional, Sergio, Zimatore, additional, Morgan, Leguen, additional, Julie, Gratieux, additional, Fernando, Pico, additional, Haja, Rakotoharinandrasana, additional, Philippe, Tassan, additional, Roxanna, Poll, additional, Sylvie, Marinier, additional, Norbert, Nighoghossian, additional, Roberto, Riva, additional, Omer, Eker, additional, Francis, Turjman, additional, Laurent, Derex, additional, Tae-Hee, Cho, additional, Laura, Mechtouff, additional, Lukaszewicz Anne, Claire, additional, Frédéric, Philippeau, additional, Serkan, Cakmak, additional, Karine, Blanc-Lasserre, additional, Anne-Evelyne, Vallet, additional, Gaultier, Marnat, additional, Florent, Gariel, additional, Xavier, Barreau, additional, Jérôme, Berge, additional, Patrice, Menegon, additional, Igor, Sibon, additional, Sebastien, Liegey, additional, Stéphane, Olindo, additional, Pauline, Renou, additional, Sharmila, Sagnier, additional, Mathilde, Poli, additional, Sabrina, Debruxelles, additional, Nicolas, Pangon, additional, Romain, Bourcier, additional, Lili, Detraz, additional, Benjamin, Daumas-Duport, additional, Pierre-Louis, Alexandre, additional, Monica, Roy, additional, Cédric, Lenoble, additional, Vincent, L’allinec, additional, Jean-Baptiste, Girot, additional, Hubert, Desal, additional, Serge, Bracard, additional, Marc, Braun, additional, Anne-Laure, Derelle, additional, Romain, Tonnelet, additional, Liang, Liao, additional, Patricio, Muszynski, additional, Emmanuelle, Schmitt, additional, Sophie, Planel, additional, Lisa, Humbertjean, additional, Gioia, Mione, additional, Jean-Christophe, Lacour, additional, Nolwenn, Riou-Comte, additional, Gérard, Audibert, additional, Marcela, Voicu, additional, Ionel, Alb, additional, Marie, Reitter, additional, Madalina, Brezeanu, additional, Agnès, Masson, additional, Ioana, Tabarna Adriana, Podar, additional, Francisco, Macian-Montoro, additional, Suzanna, Saleme, additional, Charbel, Mounayer, additional, Aymeric, Rouchaud, additional, Vincent, Costalat, additional, Caroline, Arquizan, additional, Cyril, Dargazanli, additional, Grégory, Gascou, additional, Pierre-Henri, Lefèvre, additional, Imad, Derraz, additional, Carlos, Riquelme, additional, Nicolas, Gaillard, additional, Isabelle, Mourand, additional, Lucas, Corti, additional, Eugene, Francois, additional, Stéphane, Vannier, additional, Jean-Christophe, Ferre, additional, Helene, Raoult, additional, Thomas, Ronziere, additional, Maria, Lassale, additional, Christophe, Paya, additional, Jean-Yves, Gauvrit, additional, Clément, Tracol, additional, Sophie, Langnier-Lemercier, additional, Yves, Samson, additional, Charlotte, Rosso, additional, Anne, Leger, additional, Sandrine, Deltour, additional, Frederic, Clarencon, additional, Eimad, Shotar, additional, Laurent, Spelle, additional, Christian, Denier, additional, Olivier, Chassin, additional, Vanessa, Chalumeau, additional, Jildaz, Caroff, additional, Laura, Venditti, additional, Guillaume, Turc, additional, Pierre, Seners, additional, Valérie, Domigo, additional, Catherine, Lamy, additional, Julia, Birchenall, additional, Clothilde, Isabel, additional, Alain, Viguier, additional, Christophe, Cognard, additional, Anne, Christine Januel, additional, Jean-Marc, Olivot, additional, Nicolas, Raposo, additional, Fabrice, Bonneville, additional, Albucher Jean, François, additional, Lionel, Calviere, additional, Emmanuel, Touze, additional, Charlotte, Barbier, additional, Romain, Schneckenburger, additional, Marion, Boulanger, additional, Julien, Cogez, additional, Sophie, Guettier, additional, Serge, Timsit, additional, Jean-Christophe, Gentric, additional, Julien, Ognard, additional, Francois, Mathias Merrien, additional, Ozlem, Ozkul Wermester, additional, Evelyne, Massardier, additional, Chrysanthi, Papagiannaki, additional, Frédéric, Bourdain, additional, Bernady, Patricia, additional, Laurent, Lagoarde-Segot, additional, Hélène, Cailliez, additional, Louis, Veunac, additional, David, Higue, additional, Valérie, Wolff, additional, Raoul, Pop, additional, Rémi, Beaujeux, additional, Dan-Sorin, Mihoc, additional, Monica, Manisor, additional, Anthony, Le Bras, additional, Sarah, Evain, additional, Arnaud, Le Guen, additional, Sebastian, Richter, additional, Regis, Hubrecht, additional, Stéphanie, Demasles, additional, Bruno, Barroso, additional, Mathieu, Zuber, additional, Wassim, Farhat, additional, Quentin, Alias, additional, François, Lun, additional, Delphine, Stenvenoot, additional, Olivier, Heinzlef, additional, Sylvie, Godon Hardy, additional, Valentin, Bohotin, additional, and Jérôme, Grimaud, additional
Published: 2021
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16. Clinical pharmacokinetics of pramipexole, ropinirole and rotigotine in patients with Parkinson's disease

Author: Giovanna Calandra-Buonaura, Alessandro Perrone, Manuela Contin, Roberto Riva, Sabina Capellari, Giovanna Lopane, Stefania Nassetti, Susan Mohamed, Luisa Sambati, Cesa Scaglione, Patrizia De Massis, Pietro Cortelli, Contin, Manuela, Lopane, Giovanna, Mohamed, Susan, Calandra-Buonaura, Giovanna, Capellari, Sabina, De Massis, Patrizia, Nassetti, Stefania, Perrone, Alessandro, Riva, Roberto, Sambati, Luisa, Scaglione, Cesa, and Cortelli, Pietro
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Indoles, Parkinson's disease, Tetrahydronaphthalenes, Clinical pharmacokinetic, Urology, Thiophenes, Single Center, 03 medical and health sciences, Pramipexole, Sex Factors, 0302 clinical medicine, Pharmacokinetics, medicine, Humans, In patient, Aged, Morning, Dopaminergic agonist, Aged, 80 and over, business.industry, Age Factors, Parkinson Disease, Rotigotine, Middle Aged, medicine.disease, 030104 developmental biology, Ropinirole, Neurology, Delayed-Action Preparations, Dopamine Agonists, Female, Neurology (clinical), Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: Introduction: Pramipexole (PRA), ropinirole (ROP) and rotigotine (ROT) are non-ergoline dopaminergic agonists (DAs) used to treat Parkinson's disease (PD). Clinical pharmacokinetics of DAs is poorly characterized in PD. The main purpose of our study was to investigate the effect of dose, age and sex on steady-state plasma concentrations of DAs in real life PD patients on chronic DAs therapy. Methods: The study was single center, open and prospective. Blood samples for measurement of DAs plasma concentrations were drawn in the morning, at a median 18-h distance from the last DA dose. Results: Ninety-one patients treated with PRA, 50 with ROP and 37 with ROT were enrolled in the study. Plasma concentration of DAs significantly correlated with weight-adjusted daily dose in all subgroups, although at a given dose, matched plasma concentrations highly varied among patients. Median PRA plasma concentration-to-daily dose ratio (C/D) [(ng/mL)/(mg/kg/d)] was 68% higher in patients >65 years than ≤65 years (158 vs 94, p < 0.001), while was not affected by age in ROP and ROT subgroups. No sex-mediated differences in C/D ratios were observed in any group. Conclusion: These are the first observations on DAs pharmacokinetics in PD patients’ everyday clinical practice. Of relevance, patients over 65yrs may require about one third of PRA dose compared to under 65yrs to achieve the same plasma concentration. Due to the high intersubject variability in plasma concentrations at the same dosage, we speculate that monitoring of plasma DAs might be helpful in the individualization of treatment in selected patients.
Published: 2019

17. Higher Annual Operator Volume Is Associated With Better Reperfusion Rates in Stroke Patients Treated by Mechanical Thrombectomy

Author: Rody El Nawar, Bertrand Lapergue, Michel Piotin, Benjamin Gory, Raphael Blanc, Arturo Consoli, Georges Rodesch, Mikael Mazighi, Frederic Bourdain, Maéva Kyheng, Julien Labreuche, Fernando Pico, Raphaël Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, Gabriele Ciccio, Stanislas Smajda, Robert Fahed, Michael Obadia, Candice Sabben, Ovide Corabianu, Thomas de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre-Yves Garcia, Guillaume Taylor, Malek Ben Maacha, Frédéric Bourdain, Jean-Pierre Decroix, Adrien Wang, Serge Evrard, Maya Tchikviladze, Oguzhan Coskun, Federico Di Maria, Morgan Leguen, Marie Tisserand, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Paul Emile Labeyrie, Roberto Riva, Francis Turjman, Norbert Nighoghossian, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne-Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, Anne-Evelyne Vallet, Centre Hospitalier de Versailles André Mignot (CHV), Lebanese American University (LAU), Hôpital Foch [Suresnes], Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], 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), Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), ETIS Investigators: Michel Piotin, Raphaël Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Robert Fahed, Michael Obadia, Candice Sabben, Ovide Corabianu, Thomas de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre-Yves Garcia, Guillaume Taylor, Malek Ben Maacha, Frédéric Bourdain, Jean-Pierre Decroix, Adrien Wang, Serge Evrard, Maya Tchikviladze, Bertrand Lapergue, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesch, Morgan Leguen, Marie Tisserand, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Benjamin Gory, Paul Emile Labeyrie, Roberto Riva, Francis Turjman, Norbert Nighoghossian, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne-Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, Anne-Evelyne Vallet, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, and CCSD, Accord Elsevier
Subjects: medicine.medical_specialty, acute ischemic stroke, Intraclass correlation, medicine.medical_treatment, [INFO.INFO-IM] Computer Science [cs]/Medical Imaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, mechanical thrombectomy, operator volume, 0302 clinical medicine, Internal medicine, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, 030212 general & internal medicine, Stroke, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Interventional cardiology, Cerebral infarction, business.industry, Thrombolysis, Odds ratio, ETIS register, medicine.disease, Confidence interval, Cardiology, Cardiology and Cardiovascular Medicine, business, Complication, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Objectives: The aim of this study was to determine whether individual operator characteristics have an impact on reperfusion and procedural complication rates.Background: Mechanical thrombectomy (MT) is a Level IA treatment in acute ischemic stroke (AIS) patients. The operator's effect has been found to be an independent predictor for clinical outcome and technical performance in interventional cardiology.Methods: From the ETIS (Endovascular Treatment in Ischemic Stroke) study, a prospective, multicenter, observational real-world MT registry, the authors included all AIS patients consecutively treated by MT between January 2012 and March 2017 in 3 high-volume comprehensive stroke centers by 19 operators. We assessed the effect of individual operator characteristics on successful reperfusion, defined as modified Thrombolysis In Cerebral Infarction 2b/3 at the end of MT, and procedural complications using multivariable hierarchical logistic regression models.Results: A total of 1,541 patients with anterior and posterior AIS were enrolled (mean age 67 years; median NIHSS 16). There was a significant operator effect on successful reperfusion, with an intraclass correlation coefficient of 0.036 (p = 0.046), but not on complications (intraclass correlation coefficient = 0). There was a dose-response relationship between annual operator volume and successful reperfusion rate (p = 0.003) with an adjusted odds ratio for successful reperfusion equal to 2.52 (95% confidence interval: 1.37 to 4.64) for patients treated by an operator with an annual volume ≥40 MT/year compared with those treated by an operator with
Published: 2019

18. European Multicenter Study of ET-COVID-19

Author: Federico Cagnazzo, Michel Piotin, Simon Escalard, Benjamin Maier, Marc Ribo, Manuel Requena, Raoul Pop, Anca Hasiu, Roberto Gasparotti, Dikran Mardighian, Mariangela Piano, Amedeo Cervo, Omer Faruk Eker, Vincent Durous, Nader-Antoine Sourour, Mahmoud Elhorany, Andrea Zini, Luigi Simonetti, Simona Marcheselli, Nuzzi Nunzio Paolo, Emmanuel Houdart, Alexis Guédon, Noémie Ligot, Benjamin Mine, Arturo Consoli, Bertrand Lapergue, Pere Cordona Portela, Xabier Urra, Alejandro Rodriguez, Federico Bolognini, Pablo Ariel Lebedinsky, Anne Pasco-Papon, Sophie Godard, Gaultier Marnat, Igor Sibon, Nicola Limbucci, Patrizia Nencini, Sergio Nappini, Valentina Saia, Valentina Caldiera, Daniele Romano, Giulia Frauenfelder, Ivan Gallesio, Giuliano Gola, Roberto Menozzi, Antonio Genovese, Alberto Terrana, Andrea Giorgianni, Manuel Cappellari, Raffaele Augelli, Paolo Invernizzi, Marco Pavia, Elvis Lafe, Anna Cavallini, Alessia Giossi, Michele Besana, Luca Valvassori, Antonio Macera, Lucio Castellan, Giancarlo Salsano, Fortunato Di Caterino, Alessandra Biondi, Caroline Arquizan, Julien Lebreuche, Gianluca Galvano, Alfio Cannella, Mirco Cosottini, Guido Lazzarotti, Giuseppe Guizzardi, Alessandro Stecco, Rossana Tassi, Sandra Bracco, Elena Bianchini, Camilla Micieli, Rosario Pascarella, Manuela Napoli, Francesco Causin, Hubert Desal, François Cotton, Vincent Costalat, François Delvoye, Gabriele Ciccio, Stanislas Smajda, Hocine Redjem, Solène Hébert, Raphaël Blanc, Mikael Mazighi, Jean-Philippes Desilles, Dan Mihoc, Monica Manisor, Rémy Beaujeux, Véronique Quenardelle, Roxana Gheoca, Valérie Wolff, Guiglielmo Pero, Giussani Giuditta, Ceresa Chiara, Roberto Riva, Matteo Cappucci, Morgane Laubacher, Celia Tuttle, Lorenzo Piergallini, Francis Turjman, Frédéric Clarençon, Eimad Shotar, Stéphanie Lenck, Kevin Premat, Vincent Degos, Yves Samson, Charlotte Rosso, Sonia Alamowitch, Luigi Cirillo, Mauro Gentile, Ludovica Migliaccio, Salvatore Isceri, Simone Rossi, Tommaso Baldini, Massimo Dall’Olio, Martino Cellerini, Jean-Pierre Saint-Maurice, Vittorio Civelli, Matteo Fantoni, Naeije Gilles, Jodaïtis Lise, Lubicz Boris, Stephanie Elens, Bonnet Thomas, Guenego Adrien, Sadeghi Niloufar, Van Nuffelen Marc, Federico Di Maria, Oguzhan Coskun, Georges Rodesch, Sergio Zimatore, Gariel Florent, Jérôme Berge, Patrice Menegon, Xavier Barreau, Thomas Tourdias, Stéphane Olindo, Ludovic Lucas, Jean-Sebastien Liegey, Sharmila Sagnier, Pauline Renou, Marie Couture, Sabrina Debruxelles, Mathilde Poli, Mariano Musacchio, Mariette Delaitre, Riccardo Padolecchia, Giuseppe Ganci, Annalisa Sugo, Barbero Stefano, Taverna Giacomo Giovanni, Umberto Scoditti, Paola Castellini, Lilia Latte, Ilaria Grisendi, Enrico Epifani, Francesco Vizzari, Stefano Molinaro, Luca Nativo, Gabriele Vinacci, Bruno Bonetti, Nicola Micheletti, Giampaolo Tomelleri, Piergiuseppe Zampieri, Mauro Plebani, Andrea Grazioli, Giuseppe Kenneth Ricciardi, Alessandra Polistena, Sgreccia Alessando, Giuseppina Sanfilippo, Alessandra Persico, William Boadu, Maria Giovanna Cuzzoni, Serena Magno, Gianpaolo Toscano, Maria Federica Denaro, Piera Tosi, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Valeria De Giuli, Nicola Mavillo, Leonardo Renieri, Enrico Fainardi, Giovanni Vitale, Primikiris Panagiotis, Guillaume Charbonnier, Moratti Claudio, Fabrizio Sallustio, Andrea Wlderk, Riccardo Russo, Mauro Bergui, Chiara Comelli, Andrea Boghi, Marinette Moynier, Elisa Francesca Maria Ciceri, Danilo Toni, Julien Frandon, Isabelle Mourand, Nicolas Gaillard, Salvatore Mangiafico, Imad Derraz, Cyril Dargazanli, Pierre-Henri Lefevre, Carlos Riquelme, Gregory Gascou, Alain Bonafe, Cagnazzo F., Piotin M., Escalard S., Maier B., Ribo M., Requena M., Pop R., Hasiu A., Gasparotti R., Mardighian D., Piano M., Cervo A., Eker O.F., Durous V., Sourour N.-A., Elhorany M., Zini A., Simonetti L., Marcheselli S., Paolo N.N., Houdart E., Guedon A., Ligot N., Mine B., Consoli A., Lapergue B., Cordona Portela P., Urra X., Rodriguez A., Bolognini F., Lebedinsky P.A., Pasco-Papon A., Godard S., Marnat G., Sibon I., Limbucci N., Nencini P., Nappini S., Saia V., Caldiera V., Romano D., Frauenfelder G., Gallesio I., Gola G., Menozzi R., Genovese A., Terrana A., Giorgianni A., Cappellari M., Augelli R., Invernizzi P., Pavia M., Lafe E., Cavallini A., Giossi A., Besana M., Valvassori L., MacEra A., Castellan L., Salsano G., Di Caterino F., Biondi A., Arquizan C., Lebreuche J., Galvano G., Cannella A., Cosottini M., Lazzarotti G., Guizzardi G., Stecco A., Tassi R., Bracco S., Bianchini E., Micieli C., Pascarella R., Napoli M., Causin F., Desal H., Cotton F., Costalat V., Luigi Cirillo, Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Strasbourg, Hospices Civils de Lyon (HCL), 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), Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Hôpital Foch [Suresnes], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CH Colmar, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Bordeaux [Bordeaux], CHU Lille, Université de Lille, and Centre hospitalier universitaire de Nantes (CHU Nantes)
Subjects: Registrie, Male, MESH: Registries, [SDV]Life Sciences [q-bio], Brain ischemia, Cohort Studies, MESH: Aged, 80 and over, MESH: Risk Factors, Risk Factors, Epidemiology, Medicine, MESH: Thrombectomy, MESH: COVID-19, Registries, MESH: Cohort Studies, MESH: Treatment Outcome, Thrombectomy, MESH: Aged, Aged, 80 and over, MESH: Middle Aged, Cerebral infarction, Endovascular Procedures, Middle Aged, cerebral infarction, COVID-19, intracranial hemorrhage, lymphocyte count, thrombectomy, Europe, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, COVID-19/*complications/epidemiology Cohort Studies *Endovascular Procedures/mortality Europe Female Humans Ischemic Stroke/*complications/mortality/*surgery Male Middle Aged Registries Risk Factors SARS-CoV-2 *Thrombectomy/mortality Treatment Outcome Covid-19 cerebral infarction intracranial hemorrhage lymphocyte count thrombectomy, Cohort study, MESH: Ischemic Stroke, Human, medicine.medical_specialty, MESH: Endovascular Procedures, Coronavirus disease 2019 (COVID-19), Internal medicine, Humans, MESH: SARS-CoV-2, Risk factor, Aged, Ischemic Stroke, Advanced and Specialized Nursing, Endovascular Procedure, MESH: Humans, business.industry, SARS-CoV-2, Risk Factor, medicine.disease, MESH: Male, Clinical trial, Neurology (clinical), MESH: Europe, Cohort Studie, business, Complication, MESH: Female
Abstract: Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090.
Published: 2020

19. Surface-modified flow diverter p48-MW-HPC: Preliminary clinical experience in 28 patients treated in two centers

Author: Roberto Riva, Laurent Pierot, Pierre-François Manceau, Matteo Cappucci, Sébastien Soize, and Omer Eker
Subjects: medicine.medical_specialty, Aneurysm, Ruptured, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Thromboembolism, Occlusion, Complete occlusion, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Endovascular treatment, Flow diverter, Retrospective Studies, Radiological and Ultrasound Technology, Flow diversion, business.industry, Surface modified, Endovascular Procedures, Intracranial Aneurysm, Perioperative, medicine.disease, Embolization, Therapeutic, Surgery, Treatment Outcome, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Background and purpose Flow diversion is increasingly used for endovascular treatment of distal intracranial aneurysms and has led to the development of small diameter flow diverters such as p48-MW (phenox, Bochum, Germany). Use of flow diverters is limited, however, as patients require dual antiplatelet treatment to avoid thromboembolic complications. Hydrophilic Polymer Coating was developed to reduce platelet aggregation on the p48-MW (p48-MW-HPC). This study reports preliminary experience with p48-MW-HPC in aneurysm treatment in two centers. Materials and methods Patients with ruptured, unruptured, and recanalized aneurysms treated with p48-MW-HPC were prospectively included and retrospectively analyzed for safety and efficacy. Safety was evaluated by analyzing intra- and postoperative complications as well as thromboembolic events depicted by DWI in the 72 h post-procedure. Efficacy was evaluated at 6 months based on aneurysm occlusion. Results From April 2019 to May 2020, 28 patients aged 25–82 years with 29 aneurysms were treated. Two thromboembolic events (7.1%) were reported with good clinical outcome. Final morbidity and mortality were both 0.0%. Post-operative DWI-MRI was depicting lesions in 70.0% of patients. Short-term (6 months) anatomical results were complete aneurysm occlusion in 87.0% of aneurysms, neck remnant in 8.7%, and aneurysm remnant in 4.3%. Conclusion This preliminary clinical evaluation conducted in a relatively small sample size shows high feasibility (100.0%) of p48-MW-HPC aneurysm treatment, without morbidity or mortality, and high efficacy (complete occlusion in 90.0%). Additional larger comparative studies are needed to confirm these results and optimize perioperative antiplatelet treatment.
Published: 2020

20. Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke

Author: Jean-Baptiste Girot, Sébastien Richard, Florent Gariel, Igor Sibon, Julien Labreuche, Maéva Kyheng, Benjamin Gory, Cyril Dargazanli, Benjamin Maier, Arturo Consoli, Benjamin Daumas-Duport, Bertrand Lapergue, Romain Bourcier, Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Mikael Obadia, Candice Sabben, Roxanne Peres, Ovide Corabianu, Thomas de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre-Yves Garcia, Guillaume Taylor, Malek Ben Maacha, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David Weisenburger, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Norbert Nighoghossian, Roberto Riva, Omer Eker, Francis Turjman, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, Anne-Evelyne Vallet, Gaultier Marnat, Xavier Barreau, Jérôme Berge, Louis Veunac, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, Thomas Tourdias et Jean-Sebastien Liegey, Lili Detraz, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Vincent L’allinec, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Mathieu Bonnerot, Nolwenn Riou-Comte, Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Vincent Costalat, Caroline Arquizan, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Eugene Francois, Stéphane Vannier, Jean-Christophe Ferre, Helene Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Yves Samson, Charlotte Rosso, Anne Leger, Sandrine Deltour, Frederic Clarencon, Eimad Shotar, Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Laura Venditti, Guillaume Turc, Glivier Naggara, Gregoire Boulouis, Waghih Ben Hassen, Pierre Seners, Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Département de Neuro-Radiologie [Angers] (DNR - Angers), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Département de Neuroradiologie [St Herblain], Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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), 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), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Foch [Suresnes], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, Internal medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, In patient, Prospective Studies, Registries, Endovascular treatment, Stroke, Acute ischemic stroke, Aged, Thrombectomy, Advanced and Specialized Nursing, Aged, 80 and over, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Combined Modality Therapy, 3. Good health, Blood pressure, Treatment Outcome, Ischemic stroke, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background and Purpose: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. Methods: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. Results: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32–3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09–4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51–4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01–1.20]), age (OR, 1.38 [95% CI, 1.14–1.67]), number of passes (OR, 1.16 [95% CI, 1.04–1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30–0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52–0.81]). Conclusions: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.
Published: 2020

21. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Author: Michel Ovize, Lucie Rascle, Axel Benhamed, Julia Fontaine, Karim Tazarourte, Laurent Derex, Cécile Plumereau, Tae-Hee Cho, Matteo Cappucci, Marielle Buisson, Elodie Ong, David Schiavo, Norbert Nighoghossian, Thomas Bony, Yves Berthezène, Célia Tuttle, Omer Eker, Roberto Riva, Camille Amaz, Marion Douplat, Laura Mechtouff, Hospices Civils de Lyon (HCL), Service de Neurologie [Lyon], CHU Lyon, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Département de Neuroradiologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Université de Lyon, Hôpital Edouard Herriot [CHU - HCL], Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), 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), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and CarMeN, laboratoire
Subjects: medicine.medical_specialty, Neurology, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, [SDV]Life Sciences [q-bio], Clinical Neurology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Internal medicine, Pandemic, Medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Prospective Studies, Stroke, Pandemics, Neuroradiology, Retrospective Studies, Thrombectomy, Original Communication, business.industry, Thrombolysis, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Reperfusion, Emergency medical dispatch, Cardiology, Neurology (clinical), France, business, Covid-19, 030217 neurology & neurosurgery
Abstract: BackgroundThe coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period.MethodsWe conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods.ResultsA total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period (55 (54.5%) vs 74 (69.2%); p=0.03) and was mainly due to time delay among patients treated with MT. The volume of MT remains stable over the two periods (72 (71.3%) vs 65 (60.8%); p=0.14) but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; pConclusionsOur study showed a decrease of the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.
Published: 2020
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22. Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays

Author: Basile Kerleroux, Thibaut Fabacher, Nicolas Bricout, Martin Moïse, Benoit Testud, Sivadji Vingadassalom, Héloïse Ifergan, Kévin Janot, Arturo Consoli, Wagih Ben Hassen, Eimad Shotar, Julien Ognard, Guillaume Charbonnier, Vincent L’Allinec, Alexis Guédon, Federico Bolognini, Gaultier Marnat, Géraud Forestier, Aymeric Rouchaud, Raoul Pop, Nicolas Raynaud, François Zhu, Jonathan Cortese, Vanessa Chalumeau, Jérome Berge, Simon Escalard, Grégoire Boulouis, Cyril Chivot, Riyad Hanafi, Anne Pasco, Jean-Baptiste Girot, Alessandra Biondi, Fortunato Di Caterino, Panagiotis Primikiris, Giovanni Vitale, Louise Bonnet, Florent Gariel, Xavier Barreau, Sabrina Debruxelles, Ludovic Lucas, Patrice Menegon, Stéphane Olindo, Mathilde Poli, Pauline Renou, Sharmila Sagnier, Igor Sibon, Louis Veunac, Jean-Christophe Gentric, Charlotte Barbier, Marion Boulanger, Julien Cogez, Sophie Guettier, Romain Schneckenburger, Emmanuel Touze, Mariette Delaitre, Pablo Lebendinsky, Mariano Musacchio, Frédéric Ricolfi, Pierre Thouant, François Caparros, Barbara Casolla, Lucie Della Schiava, Nelly Dequatre, Hilde Henon, Marco Pasi, Apolline Kazemi, Fouzi Bala, Laurent Estrade, Charbel Mounayer, Susanna Saleme, Francisco Macian-Montoro, Omer Eker, François Cotton, Karine Blanc-Lasserre, Serkan Cakmak, Tae-Hee Cho, Laurent Derex, Anne-Claire Lukaszewicz, Laura Mechtouff, Norbert Nighoghossian, Frédéric Philippeau, Roberto Riva, Francis Turjman, Anne-Evelyne Vallet, Xavier Carle, Philippe Dory-Lautrec, Anthony Reyre, Jean-François Hak, Hervé Brunel, Amel Benali, François-Louis Collemiche, Cyril Dargazanli, Frederico Cagnazzo, Imad Derraz, Caroline Arquizan, Lucas Corti, Vincent Costalat, Nicolas Gaillard, Grégory Gascou, Pierre-Henri Lefèvre, Isabelle Mourand, Carlos Riquelme, Anne Laure Derelle, Benjamin Gory, Liang Liao, Romain Tonnelet, René Anxionnat, Mathieu Bonnerot, Serge Bracard, Marc Braun, Lisa Humbertjean, Jean-Christophe Lacour, Gioia Mione, Sophie Planel, Sébastien Richard, Nolwenn Riou-Comte, Emmanuelle Schmitt, Romain Bourcier, Lili Detraz, Hubert Desal, Pierre-Louis Alexandre, Benjamin Daumas-Duport, Cédric Lenoble, Monica Roy, Oghuzan Coskun, Frederico Di Maria, Bertrand Lapergue, Georges Rodesch, Adrien Wang, David Weisenburger-Lile, Sergio Zimatore, Nadia Ajili, Géraldine Buard, Serge Evrard, Lucas Gorza, Julie Gratieux, Morgan Leguen, Sylvie Marinier, Fernando Pico, Roxanna Poll, Haja Rakotoharinandrasana, Philippe Tassan, Maya Tchikviladze, François Delvoye, Solène Hebert, Raphaël Blanc, Gabriele Ciccio, Jean-Philippe Desilles, Benjamin Maier, Mikael Mazighi, Michel Piotin, Hocine Redjem, Stanislas Smajda, Malek Ben Maacha, Ovide Corabianu, Thomas De Broucker, Olivier Ille, Eric Manchon, Michael Obadia, Mickael Obadia, Igor Raynouard, Roxanne Peres, Candice Sabben, Didier Smadja, Guillaume Taylor, Laurie-Anne Thion, Augustin Lecler, Laurent Spelle, Christian Denier, Jildaz Caroff, Olivier Chassin, laurent Spelle, Laura Venditti, Armand Aymard, Jean Betty, Vittorio Civelli, Michael Eliezer, Matteo Fantoni, Emmanuel Houdart, Marc-Antoine Labeyrie, Jean-Pierre Saint Maurice, Erwah Kalsoum, Aurelien Pacini, Chawkat Ramadane, Titien Tuilier, Adrien Villain, Frédéric Clarencon, Vincent Degos, Ahmed Elhfnawy, Mahmoud Elhorany, Stéphanie Lenck, Kevin Premat, Nader-Antoine Sourour, Sonia Alamowitch, Flore Baronnet, Sophie Crozier, Sandrine Deltour, Anne Leger, Charlotte Rosso, Nadya Pyatigorskaya, Christine Rodriguez Regent, Denis Trystram, Olivier Naggara, Pierre Seners, Guillaume Turc, Myriam Edjlali, Rémi Agbonon, Mohammed Alotaibi, Antoine Sonchet, Catherine Oppenheim, Jean François Meder, Joseph Benzakoun, Laurence Legrand, Cédric Fauché, Stéphane Velasco, Pierre François Manceau, Sebastien Solène Soize Moulin, François Eugene, Jean-Christophe Ferre, Christophe Paya, Jean-Yves Gauvrit, Sophie Langnier-Lemercier, Maria Lassale, helene Raoult, thomas Ronziere, Clément Tracol, Stéphane Vannier, Julien Burel, Julien Le Moal, Chrysanthi Papagiannaki, Mohamed Aggour, Marina Sachet, Claire Boutet, Remy Beaujeux, Anca Hasiu, Monica Manisor, Dan Mihoc, Stéphane Kremer, Charles Arteaga, Sébastien Gazzola, Jean Darcourt, Christophe Cognard, Fabrice Bonneville, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Alain Viguier, Richard Bibi, Fakhreddine Boustia, Denis Herbreteau, Igor Maldonado, and Ana-Paula Narata
Subjects: Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Mechanical Thrombolysis, Pneumonia, Viral, 030204 cardiovascular system & hematology, medicine.disease_cause, Brain Ischemia, Time-to-Treatment, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Patient Admission, Pandemic, Medicine, Humans, Prospective Studies, Acute ischemic stroke, Pandemics, Coronavirus, Aged, Advanced and Specialized Nursing, Aged, 80 and over, business.industry, SARS-CoV-2, Outbreak, COVID-19, Middle Aged, 3. Good health, Mechanical thrombectomy, Hospitalization, Stroke, Emergency medicine, Female, Neurology (clinical), France, Cardiology and Cardiovascular Medicine, business, Coronavirus Infections, Delivery of Health Care, 030217 neurology & neurosurgery, Procedures and Techniques Utilization
Abstract: Background and Purpose: The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT). Methods: We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period. Secondary end points included care delays between onset, imaging, and groin puncture. To analyze the primary end point, we used a Poisson regression model. We then analyzed the correlation between the number of MTs and the number of COVID-19 cases hospitalizations, using the Pearson correlation coefficient (compared with the null value). Results: A total of 1513 patients were included at 32 centers, in all French administrative regions. There was a 21% significant decrease (0.79; [95%CI, 0.76–0.82]; P P P R 2 −0.51; P =0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both P Conclusions: Our study showed a significant decrease in patients treated with MTs during the first stages of the COVID epidemic in France and alarming indicators of lengthened care delays. These findings prompt immediate consideration of local and regional stroke networks preparedness in the varying contexts of COVID-19 pandemic evolution.
Published: 2020

23. Development and Validation of an UHPLC-MS/MS Assay for the Therapeutic Monitoring of Brivaracetam Plasma Concentrations in Patients with Epilepsy

Author: Susan Mohamed, Manuela Contin, and Roberto Riva
Subjects: Bioanalysis, Brivaracetam, 030226 pharmacology & pharmacy, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Tandem Mass Spectrometry, medicine, Humans, Pharmacology (medical), Sample preparation, In patient, Chromatography, High Pressure Liquid, Pharmacology, Chromatography, medicine.diagnostic_test, Chemistry, Reproducibility of Results, medicine.disease, Pyrrolidinones, Therapeutic monitoring, Therapeutic drug monitoring, Plasma concentration, Anticonvulsants, Drug Monitoring, medicine.drug
Abstract: BACKGROUND Brivaracetam is an antiepileptic drug used as an add-on therapy for partial-onset seizures in subjects aged 4 years and older. Owing to potential drug interactions and intersubject variability in plasma concentrations, therapeutic monitoring for brivaracetam may be useful. The aim of this study was to develop a simplified method for measuring brivaracetam plasma concentrations applicable to therapeutic drug monitoring in epilepsy. METHODS An ultra high-pressure liquid chromatography-tandem mass spectrometry method was developed and validated according to current guidelines for bioanalytical methods. Sample preparation (100 µL) involved only a simple precipitation step by acetonitrile. Brivaracetam-d7 was used as internal standard. The chromatographic analysis was performed by a Synergi Fusion column using 0.1% formic acid in water/acetonitrile as a binary gradient mobile phase, at a flow rate of 0.3 mL/min. Both brivaracetam and the internal standard eluted at 1.01 minutes. This method was applied to measure trough and 1-hour postmorning dose brivaracetam plasma concentrations of 11 patients with epilepsy. RESULTS The method was validated over a concentration range of 0.10-10 mcg/mL. The mean recovery was 95%. Both intra- and inter-assay imprecision and inaccuracy were
Published: 2020

24. DNMT1 mutations leading to neurodegeneration paradoxically reflect on mitochondrial metabolism

Author: Susan Mohamed, Mirko Zaffagnini, Elena Antelmi, Luca Morandi, Leonardo Caporali, Mariantonietta Capristo, Valentina Del Dotto, Roberto Riva, Emanuela Scimonelli, Paola Loguercio Polosa, Giuseppe Plazzi, Claudia Zanna, Martina Cappelletti, Francesco Musiani, Rocco Liguori, Concetta Valentina Tropeano, Francesca Tagliavini, Jacopo Rossi, Valerio Carelli, Chiara La Morgia, Manuela Contin, Emmanuel Mignot, Alessandra Maresca, Marina Roberti, Letizia Scandiffio, Fabio Pizza, Maresca, Alessandra, Del Dotto, Valentina, Capristo, Mariantonietta, Scimonelli, Emanuela, Tagliavini, Francesca, Morandi, Luca, Tropeano, Concetta Valentina, Caporali, Leonardo, Mohamed, Susan, Roberti, Marina, Scandiffio, Letizia, Zaffagnini, Mirko, Rossi, Jacopo, Cappelletti, Martina, Musiani, Francesco, Contin, Manuela, Riva, Roberto, Liguori, Rocco, Pizza, Fabio, La Morgia, Chiara, Antelmi, Elena, Polosa, Paola Loguercio, Mignot, Emmanuel, Zanna, Claudia, Plazzi, Giuseppe, and Carelli, Valerio
Subjects: AcademicSubjects/SCI01140, DNA (Cytosine-5-)-Methyltransferase 1, Male, Mitochondrial DNA, Mitochondrial disease, Mutant, Oxidative phosphorylation, Mitochondrion, Biology, Deafness, DNA methyltransferase, Oxidative Phosphorylation, ADCA-DN, HSN-IE, DNMT1gene, mutations, mitochondria, metabolism deregulation, oxidative stress, neurodegeneration, 03 medical and health sciences, 0302 clinical medicine, Genetics, medicine, Humans, Spinocerebellar Ataxias, Genetic Predisposition to Disease, Hereditary Sensory and Autonomic Neuropathies, Molecular Biology, Genetics (clinical), 030304 developmental biology, Narcolepsy, 0303 health sciences, Neurodegeneration, General Medicine, DNA Methylation, Fibroblasts, medicine.disease, DNMT1 mutations, Cell biology, Mitochondria, Phenotype, Urea cycle, Mutation, Nerve Degeneration, Female, General Article, Protein Processing, Post-Translational, 030217 neurology & neurosurgery
Abstract: ADCA-DN and HSN-IE are rare neurodegenerative syndromes caused by dominant mutations in the replication foci targeting sequence (RFTS) of the DNA methyltransferase 1 (DNMT1) gene. Both phenotypes resemble mitochondrial disorders, and mitochondrial dysfunction was first observed in ADCA-DN. To explore mitochondrial involvement, we studied the effects of DNMT1 mutations in fibroblasts from four ADCA-DN and two HSN-IE patients. We documented impaired activity of purified DNMT1 mutant proteins, which in fibroblasts results in increased DNMT1 amount. We demonstrated that DNMT1 is not localized within mitochondria, but it is associated with the mitochondrial outer membrane. Concordantly, mitochondrial DNA failed to show meaningful CpG methylation. Strikingly, we found activated mitobiogenesis and OXPHOS with significant increase of H2O2, sharply contrasting with a reduced ATP content. Metabolomics profiling of mutant cells highlighted purine, arginine/urea cycle and glutamate metabolisms as the most consistently altered pathways, similar to primary mitochondrial diseases. The most severe mutations showed activation of energy shortage AMPK-dependent sensing, leading to mTORC1 inhibition. We propose that DNMT1 RFTS mutations deregulate metabolism lowering ATP levels, as a result of increased purine catabolism and urea cycle pathways. This is associated with a paradoxical mitochondrial hyper-function and increased oxidative stress, possibly resulting in neurodegeneration in non-dividing cells.
Published: 2020

25. Simple and rapid validated HPLC-fluorescence determination of perampanel in the plasma of patients with epilepsy

Author: Carmina Candela, Manuela Contin, Susan Mohamed, and Roberto Riva
Subjects: AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, VPA, valproic acid, CBZ, carbamazepine, Antiepileptic drugs, Clinical Biochemistry, PHT, phenytoin, Clinical pharmacokinetics, LLOQ, lower limit of quantification, Pharmacology, Perampanel, 030226 pharmacology & pharmacy, Article, LLOD, lower limit of detection, lcsh:Chemistry, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Hplc fluorescence, TDM, therapeutic drug monitoring, medicine, Sample preparation, IS, internal standard, MS/MS, tandem mass spectrometer, Acetonitrile, lcsh:R5-920, Epilepsy, Chromatography, Radiological and Ultrasound Technology, medicine.diagnostic_test, AED, antiepileptic drug, Plasma, Fluorescence, LLE, liquid-liquid extraction, QC, quality control, lcsh:QD1-999, chemistry, Therapeutic drug monitoring, OXC, oxcarbazepine, PER, perampanel, HPLC-F, high performance liquid chromatography-fluorescence detector, MIR, mirtazapine, lcsh:Medicine (General), Sodium acetate, HPLC-F, 030217 neurology & neurosurgery
Abstract: We present a simple and fast high-performance liquid chromatography method with fluorescence detection for the determination of the antiepileptic drug perampanel in human plasma. The chromatographic separation was performed on a Kinetex PFP (100 × 2.6 mm, 4.6 µm) column, using a mobile phase of sodium acetate 0.03 M pH 3.7 and acetonitrile (40/60, v/v), at a flow rate of 0.8 mL/min. Total chromatography time for each run was 5 min. Sample preparation (250 µL) involved only one simple precipitation step by acetonitrile spiked with mirtazapine as internal standard. The method was validated over a concentration range of 20–1000 ng/mL and successfully applied to measure perampanel concentrations in plasma samples obtained from patients with epilepsy. This assay combines the high specificity of fluorescence detection with a very simple and fast sample pretreatment and can offer real advantages over existing methods in terms of simplicity and transferability to a therapeutic drug monitoring setting., Highlights • A very simple assay for the determination of perampanel in human plasma is proposed. • The analysis is based on HPLC-F coupled with an only deproteinization step. • No time consuming liquid-liquid extractions and evaporations are required. • This assay significantly simplifies existing ones in terms of transferability to TDM.
Published: 2018

26. Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation

Author: Cyril Dargazanli, Caroline Arquizan, Benjamin Gory, Arturo Consoli, Julien Labreuche, Hocine Redjem, Omer Eker, Jean-Pierre Decroix, Astrid Corlobé, Isabelle Mourand, Nicolas Gaillard, Xavier Ayrignac, Mahmoud Charif, Alain Duhamel, Paul-Emile Labeyrie, Carlos Riquelme, Gabriele Ciccio, Stanislas Smajda, Jean-Philippe Desilles, Grégory Gascou, Pierre-Henri Lefèvre, Daniel Mantilla-García, Federico Cagnazzo, Oguzhan Coskun, Mikael Mazighi, Roberto Riva, Frédéric Bourdain, Pierre Labauge, Georges Rodesch, Michael Obadia, Alain Bonafé, Francis Turjman, Vincent Costalat, Michel Piotin, Raphaël Blanc, Bertrand Lapergue, Adrien Wang, Serge Evrard, Maya Tchikviladzé, Jaime Gonzalez-Valcarcel, Federico Di Maria, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Ovide Corabianu, Thomas de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, and Pierre-Yves Garcia
Subjects: Male, medicine.medical_specialty, Anterior Cerebral Artery, Endpoint Determination, medicine.medical_treatment, Arterial Occlusive Diseases, 030204 cardiovascular system & hematology, Brain Ischemia, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Randomized controlled trial, law, Modified Rankin Scale, medicine, Clinical endpoint, Humans, Thrombolytic Therapy, Stroke, Aged, Thrombectomy, Aged, 80 and over, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, Thrombolysis, Middle Aged, medicine.disease, Surgery, Mechanical thrombectomy, Treatment Outcome, Tissue Plasminogen Activator, Angiography, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Follow-Up Studies, Cohort study
Abstract: Background and Purpose— Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of Methods— Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months. Results— Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. Conclusions— Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.
Published: 2017

27. Effect of valproic acid on perampanel pharmacokinetics in patients with epilepsy

Author: Manuela Contin, Francesca Bisulli, Margherita Santucci, Roberto Riva, Francesca Tonon, Susan Mohamed, Lorenzo Ferri, Carlotta Stipa, Paolo Tinuper, on behalf of the Perampanel Study Group, A. Parmeggiani, L. Licchetta, and Manuela Contin, Francesca Bisulli,| Margherita Santucci, Roberto Riva,| Francesca Tonon, Susan Mohamed, Lorenzo Ferri, Carlotta Stipa, Paolo Tinuper, on behalf of the Perampanel Study Group*, A. Parmeggiani, L. Licchetta
Subjects: Adult, Male, Phenytoin, Adolescent, Lacosamide, Pyridones, Pharmacology, 030226 pharmacology & pharmacy, Young Adult, 03 medical and health sciences, Perampanel, chemistry.chemical_compound, 0302 clinical medicine, Nitriles, medicine, Cytochrome P-450 Enzyme Inhibitors, Humans, Drug Interactions, antiepileptic drugs, epilepsy, pharmacokinetic interaction, Prospective Studies, Enzyme inducer, Child, Oxcarbazepine, Aged, Cytochrome P-450 Enzyme Inducers, Valproic Acid, Epilepsy, biology, business.industry, Carbamazepine, Middle Aged, Neurology, chemistry, biology.protein, Anticonvulsants, Drug Therapy, Combination, Female, Phenobarbital, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract: We prospectively examined the effect of antiepileptic (AED) cotherapy on steady state plasma concentrations of perampanel (PMP) in epileptic patients. We classified AEDs as strong enzyme inducers (carbamazepine, phenobarbital, phenytoin, oxcarbazepine), not strong enzyme inducers/not inhibitors (levetiracetam, lamotrigine, topiramate, rufinamide, lacosamide, zonisamide, clobazam), and enzyme inhibitors (valproic acid [VPA]). The main outcome was the comparison of PMP plasma concentration to weight-adjusted dose ratio (C/D; [μg/mL]/mg kg-1 d-1 ) among comedication subgroups. From 79 patients (42 females, 37 males) aged (mean ± standard deviation) 33 ± 13 years (range = 12-66 years), 114 plasma samples were collected. Twenty-eight patients (44 samples) were cotreated with enzyme inducers (group A), 21 (27 samples) with not strong enzyme inducers/not inhibitors (group B), 21 (31 samples) with not strong enzyme inducers/not inhibitors + VPA (group C), and 9 (12 samples) with enzyme inducers + VPA (group D). PMP C/D was reduced (-56%, P
Published: 2018

28. The pCONus Device for Treatment of Complex Wide-Neck Anterior Communicating Artery Aneurysms

Author: Francis Turjman, Marta Aguilar-Pérez, Roberto Riva, Paul Emile Labeyrie, Elisa Pomero, Benjamin Gory, Alessandra Biondi, and Hans Henkes
Subjects: Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Modified Rankin Scale, medicine.artery, Occlusion, medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, Aged, 80 and over, Endovascular coiling, business.industry, Endovascular Procedures, Stent, Intracranial Aneurysm, Middle Aged, medicine.disease, Embolization, Therapeutic, Surgery, Stenosis, Anterior communicating artery, Treatment Outcome, cardiovascular system, Female, Stents, Neurology (clinical), Radiology, business, Platelet Aggregation Inhibitors, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Background and Purpose Anterior communicating artery (AcomA) aneurysms with a wide neck are often not feasible for endovascular coiling. Emerging devices for neck protection, such as the pCONus stent, are promising for endovascular treatment of challenging intracranial aneurysms. We report the preliminary results with pCONus in the treatment of wide-neck AcomA aneurysms. Methods All consecutive patients harboring AcomA aneurysms treated with pCONus in 3 European centers were retrospectively reviewed. Results Thirty-six patients (mean age, 61 years) harboring 36 saccular AcomA aneurysms (mean dome size, 7.3 mm; mean neck size, 5.4 mm) were included, of which 7 were treated in the setting of subarachnoid hemorrhage. A procedural angiographic complication was reported in 3 patients without clinical impact at 3 months. Five patients presented a postoperative neurological deficit without angiographic complication. Procedure-related permanent morbidity and mortality rates were 11% (3/33) and 0 at 3 months, respectively. Postoperative angiographic results showed a complete aneurysm occlusion in 56% (20/36), a neck remnant in 25% (9/36), and an aneurysm remnant in 19% (7/36) of cases. Four patients were retreated after early angiographic follow-up (mean, 3.2 months). Twenty-two patients were followed (mean, 12.9 months), and a complete aneurysm occlusion was observed in 59% of patients (13/22), and a neck remnant in 41% (9/22). There was no in-stent stenosis or jailed branch occlusion. Recanalization rate was 9%. Conclusions The pCONus device allows endovascular coiling of wide-necked AcomA aneurysms.
Published: 2017

29. PulseRider for Treatment of Wide-Neck Bifurcation Intracranial Aneurysms: 6-Month Results

Author: Roberto Riva, Salvatore Mangiafico, Leonardo Renieri, Alessandra Biondi, Francis Turjman, Paul-Emile Labeyrie, Benjamin Gory, Franscesco Di Paola, Arturo Consoli, and Alejandro M Spiotta
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, medicine.artery, Occlusion, Humans, Medicine, cardiovascular diseases, Aged, Retrospective Studies, Aged, 80 and over, Endovascular coiling, business.industry, Mortality rate, Endovascular Procedures, Angiography, Digital Subtraction, Stent, Intracranial Aneurysm, Middle Aged, medicine.disease, Thrombosis, Cerebral Angiography, Surgery, Anterior communicating artery, Stenosis, Treatment Outcome, Female, Stents, Neurology (clinical), Radiology, business, Magnetic Resonance Angiography, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Background/Objective PulseRider is a new endovascular stent dedicated to treat bifurcation intracranial aneurysms with a wide neck. Our purpose was to evaluate 6-month clinical and anatomic results of the device when used to facilitate endovascular coiling of wide-neck bifurcation aneurysms. Methods Unruptured intracranial aneurysms coiled with PulseRider, in 6 European centers and 1 U.S. center, were retrospectively reviewed from June 2014 to October 2015. Immediate and 6-month results were evaluated independently by using the Raymond classification scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement on the Raymond scale. Results Nineteen patients (10 women, 9 men; mean age, 63 years) harboring 19 bifurcation aneurysms (mean dome size, 8.8 mm; mean neck size, 5.8 mm) were included. Immediate angiographic outcome showed 11 complete aneurysm occlusions, 6 neck remnants, and 2 residual aneurysms. Follow-up at 6 months, obtained in all patients, included 12 complete aneurysm occlusions (63.1%), 6 neck remnants (31.6%), and 1 residual aneurysm (5.3%). Adequate occlusion (defined as complete occlusion and neck remnant combined) was observed in 94.7%. Progressive thrombosis was observed in 2 cases (10.6%) and recanalization in 1 case (5.3%). There was no in-stent stenosis or jailed branch occlusion. No bleeding was observed during the follow-up period. Permanent morbidity rate was 5.3% (1/19), and the mortality rate was 0% at 6 months. Conclusions The PulseRider allows endovascular treatment of wide-neck bifurcation intracranial aneurysms. Larger series are needed to confirm our preliminary results.
Published: 2017

30. Contents Vol. 43, 2017

Author: Rajat Dhar, Mikael Mazighi, Mayra Becerril, Linxin Li, Armin J. Grau, Agnieszka Stadnik, Masaki Chin, Robert J. Brown, Gabriele Ciccio, Nerissa U. Ko, Yuanli Zhao, Sen Yamagata, Roland Hardt, Christoph Burmeister, Alexandra S. Gersing, Hans-Jakob Steiger, Cristian Preda, Zhongzhao Teng, Christian Maegerlein, Daniel Hänggi, Hocine Redjem, Benjamin Friedrich, Daniel F. Hanley, Miriam Koome, Sarah T. Pendlebury, Alice Pang, Steven Mayo, Druckerei Stückle, Leandro Provinciali, Xiao Hu, Justus F Kleine, Xiao-Lin Chen, Yoshitaka Kurosaki, Stanislas Smajda, Peter M. Rothwell, Hitoshi Fukuda, Silke Wunderlich, Claus Zimmer, Oguzhan Coskun, Leonid Churilov, Gabriel Mauricio Longo, Michael G. Hennerici, Rhoda Frost, Jean-Philippe Desilles, Raphaël Blanc, Rachel Dlugash, Sara Mazzucco, Jillian Naylor, Rose Wharton, Ziyi Chen, Bertrand Lapergue, Li Ma, Wendy C. Ziai, Christian Mathys, Christian Rubbert, Yu-Bo Wang, Tobias Boeckh-Behrens, Kazumichi Yoshida, Michel Piotin, Shawn C. Shadden, Johannes Kaesmacher, Jun Ma, Mauro Silvestrini, Simona Lattanzi, Jean-Pierre Decroix, Antonio Arauz, Michael Jesselson, Jaiyoung Ryu, Cyril Dargazanli, Paul-Emile Labeyrie, Bernd Turowski, Frédéric Bourdain, Martin Eicke, Arturo Consoli, Louise D. McCullough, Helen Kim, Jonathan H. Gillard, Sieghard Dienlin, Amr Abdulazim, Julien Labreuche, Ziyuan Chen, Akira Handa, Maged D Fam, Edgar Nathal, Lingjiao Zhang, Mónica Chavarria-Medina, Bernard Yan, Francis Turjman, Roberto Riva, Adam J. Brown, Benjamin Gory, Hernán M. Patiño-Rodriguez, Issam A. Awad, Maria A. Tuna, Chun-Xue Wu, Eberhard Schmitt, Bhaskar Roy, Mirjam Kaesmacher, Hua Su, Nima Etminan, Claudia Cagnetti, James J. Grady, Georges Rodesch, Dorothea Reichelt, Patrick Kwan, and Hussein A. Zeineddine
Subjects: Neurology, Traditional medicine, business.industry, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published: 2017

31. Is Reperfusion Useful in Ischaemic Stroke Patients Presenting with a Low National Institutes of Health Stroke Scale and a Proximal Large Vessel Occlusion of the Anterior Circulation?

Author: Cyril, Dargazanli, Arturo, Consoli, Benjamin, Gory, Raphaël, Blanc, Julien, Labreuche, Cristian, Preda, Frédéric, Bourdain, Jean-Pierre, Decroix, Hocine, Redjem, Gabriele, Ciccio, Mikael, Mazighi, Stanislas, Smajda, Jean-Philippe, Desilles, Roberto, Riva, Paul-Emile, Labeyrie, Oguzhan, Coskun, Georges, Rodesch, Francis, Turjman, Michel, Piotin, Bertrand, Lapergue, and Pierre-Yves, Garcia
Subjects: Male, Time Factors, Stroke patient, medicine.medical_treatment, Mild stroke, 030218 nuclear medicine & medical imaging, Disability Evaluation, 0302 clinical medicine, Risk Factors, Ischaemic stroke, Odds Ratio, Medicine, Carotid Stenosis, Registries, Stroke, Thrombectomy, Aged, 80 and over, education.field_of_study, Endovascular Procedures, Infarction, Middle Cerebral Artery, Middle Aged, Treatment Outcome, Neurology, Cerebrovascular Circulation, Cardiology, Female, France, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, Adult, medicine.medical_specialty, Population, Revascularization, 03 medical and health sciences, Internal medicine, Humans, education, Aged, Retrospective Studies, Chi-Square Distribution, business.industry, Stroke scale, Recovery of Function, medicine.disease, Logistic Models, Reperfusion, Neurology (clinical), business, 030217 neurology & neurosurgery, Large vessel occlusion
Abstract: Background: In population-based studies, patients presenting with minor or mild stroke symptoms represent about two-thirds of stroke patients, and almost one-third of these patients are unable to ambulate independently at the time of discharge. Although mechanical thrombectomy (MT) has become the standard of care for acute ischaemic stroke with proximal large vessel occlusion (LVO) in the anterior circulation, the management of patients harbouring proximal occlusion and minor-to-mild stroke symptoms has not yet been determined by recent trials. The purpose of this study was to evaluate the impact of reperfusion on clinical outcome in low National Institutes of Health Stroke Scale (NIHSS) patients treated with MT. Methods: We analysed 138 consecutive patients with acute LVO of the anterior circulation (middle cerebral artery M1 or M2 segment, internal carotid artery or tandem occlusion) with NIHSS Results: Successful reperfusion was achieved in 81.2% of patients (TICI 2B, n = 47; TICI 3, n = 65). Excellent outcome (mRs 0-1) was achieved in 69 patients (65.0%) and favourable outcome (mRs ≤2) in 108 (78.3%). Death occurred in 7 (5.1%). Excellent outcome increased with reperfusion grades, with a rate of 34.6% in patients with failed/poor reperfusion, 61.7% in patients with TICI 2B reperfusion, and 78.5% in patients with TICI 3 reperfusion (p < 0.001). In multivariate analysis adjusted for patient characteristics associated with excellent outcome, the reperfusion grade remained significantly associated with an increase in excellent outcome; the OR (95% CI) was 3.09 (1.06-9.03) for TICI 2B and 6.66 (2.27-19.48) for TICI 3, using the failed/poor reperfusion grade as reference. Similar results were found regarding favourable outcome (90-day mRs 0-2) or overall mRS distribution (shift analysis). Conclusion: Successful reperfusion is strongly associated with better functional outcome among patients with proximal LVO in the anterior circulation and minor-to-mild stroke symptoms. Randomized controlled studies are mandatory to assess the benefit of MT compared with optimal medical management in this subset of patients.
Published: 2017

32. Development and validation of volumetric absorptive microsampling coupled with UHPLC-MS/MS for the analysis of gamma-hydroxybutyric acid in human blood

Author: Giuseppe Plazzi, Manuela Contin, Monica Moresco, Roberto Riva, Susan Mohamed, Mohamed, Susan, Riva, Roberto, Moresco, Monica, Plazzi, Giuseppe, and Contin, Manuela
Subjects: Formic acid, Clinical Biochemistry, Hydroxybutyrates, Mass spectrometry, 030226 pharmacology & pharmacy, 01 natural sciences, Biochemistry, Uhplc ms ms, Analytical Chemistry, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Limit of Detection, Tandem Mass Spectrometry, Drug Discovery, medicine, Humans, Acetonitrile, Molecular Biology, Chromatography, High Pressure Liquid, Narcolepsy, Pharmacology, VAMS, Blood Specimen Collection, Chromatography, Human blood, Chemistry, 010401 analytical chemistry, Reproducibility of Results, gamma-Hydroxybutyric acid, General Medicine, Venous blood, ultra-high-performance liquid chromatography-tandem mass spectrometry, γ-hydroxybutyric acid, 0104 chemical sciences, Volumetric flow rate, Linear Models, medicine.drug
Abstract: A volumetric microsampling (VAMS) device (20 μl) was evaluated and validated for the analysis of γ-hydroxybutyric acid (GHB) in venous blood using a simple ultra-high-pressure liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method. GHB was extracted from VAMS device by acetonitrile, after a re-hydration step in a temperature-controlled ultrasonic bath at 60°C for 10 min. Chromatographic analysis was carried out on a Kinetex C18 column using 0.1% formic acid in water and acetonitrile as binary gradient mobile phase (from 5 to 95% of acetonitrile from 1 to 2.5 min) at a flow rate of 0.3 ml/min. The VAMS method was fully validated according to current guidelines with satisfactory results in terms of linearity, selectivity, precision, absolute recovery, matrix effect and stability. The linearity was determined from 0.5 to 200 μg/ml and the lower limit of quantitation was 0.5 μg/ml. The novel VAMS-UHPLC-MS/MS method was successfully compared with plasma-based method in a GHB-treated patient as a proof of concept.
Published: 2019

33. Cerebrospinal Fluid Concentrations of Nimodipine Correlate With Long-term Outcome in Aneurysmal Subarachnoid Hemorrhage: Pilot Study

Author: Roberto Riva, Marco Zanello, Susan Mohamed, Alessandro Perrone, Manuela Contin, and Marianna Pegoli
Subjects: Adult, Male, Subarachnoid hemorrhage, Ischemia, Pilot Projects, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Modified Rankin Scale, medicine, Humans, Pharmacology (medical), In patient, Dosing, Nimodipine, Aged, Pharmacology, business.industry, Vasospasm, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, 030227 psychiatry, Anesthesia, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract: Objectives The aim was to evaluate plasma and cerebrospinal fluid (CSF) nimodipine concentrations in patients with aneurysmal subarachnoid hemorrhage and their correlation with clinical outcome. Methods Nimodipine infusion was started at 1 mg/h and increased up to 2 mg/h and continued up to 21 days in surviving patients. Arterial and CSF samples were collected at least after 24 hours of stable nimodipine dosing. Delayed cerebral ischemia and vasospasm were documented by new neurological deficits and neuroimaging. The clinical outcome was assessed at 9 months by the modified Rankin scale. Results Twenty-three patients were enrolled. Nimodipine dose was 13 to 38 μg/kg per hour. Nimodipine arterial and CSF concentrations were 24.9 to 71.8 ng/mL and 37 to 530 pg/mL, respectively. Dose did not correlate with arterial or CSF concentrations. Arterial concentrations did not correlate with corresponding CSF concentrations. Doses and arterial concentrations did not correlate with the clinical outcome and were not associated with the occurrence of delayed cerebral ischemia. However, patients with no significant disability after 9 months of hemorrhage showed significantly higher CSF nimodipine concentrations (P = 0.015) and CSF-to-plasma ratios (P = 0.011) compared with patients who showed some degree of disability or who died. Conclusions Cerebrospinal fluid nimodipine concentrations measured during hospital drug infusion showed a correlation with long-term clinical outcome in patients with aneurysmal subarachnoid hemorrhage. These very preliminary data suggest that CSF concentrations monitoring may have some value in managing these patients.
Published: 2019

34. A quest for Q fever

Author: Laura Olivier-Gougenheim, Sophie Collardeau-Frachon, Sylvie Di Filippo, Jean-Christophe Lega, Caroline Freychet, Alexandre Belot, Chantal Roure-Sobas, Roberto Riva, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Department of Interventional Neuroradiology, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Service de Biostatistiques [Lyon], Hospices Civils de Lyon (HCL), Biostatistiques santé, Département des maladies chroniques et traumatismes, Institut de Veille Sanitaire (INVS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: medicine.medical_specialty, Intracranial Hemorrhages, [SDV]Life Sciences [q-bio], 030231 tropical medicine, Treatment outcome, Intracranial Hemorrhages/diagnostic imaging/etiology, Q fever, Doxycycline/therapeutic use, Status epilepticus, Gastroenterology, Intracranial Aneurysm/complications/*diagnostic imaging/etiology, Q Fever/complications/*diagnosis/drug therapy, 03 medical and health sciences, Status Epilepticus, 0302 clinical medicine, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Child, Doxycycline, business.industry, Brain, Intracranial Aneurysm, Hydroxychloroquine, General Medicine, Status Epilepticus/diagnostic imaging/drug therapy/*etiology, medicine.disease, Brain/diagnostic imaging, Treatment Outcome, Phenobarbital, Female, Phenobarbital/therapeutic use, medicine.symptom, Q Fever, business, medicine.drug
Published: 2019

35. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Author: Bruce C V Campbell, Charles B L M Majoie, Gregory W Albers, Bijoy K Menon, Nawaf Yassi, Gagan Sharma, Wim H van Zwam, Robert J van Oostenbrugge, Andrew M Demchuk, Francis Guillemin, Philip White, Antoni Dávalos, Aad van der Lugt, Kenneth S Butcher, Aboubaker Cherifi, Henk A Marquering, Geoffrey Cloud, Juan M Macho Fernández, Jeremy Madigan, Catherine Oppenheim, Geoffrey A Donnan, Yvo B W E M Roos, Jai Shankar, Hester Lingsma, Alain Bonafé, Hélène Raoult, María Hernández-Pérez, Aditya Bharatha, Reza Jahan, Olav Jansen, Sébastien Richard, Elad I Levy, Olvert A Berkhemer, Marc Soudant, Lucia Aja, Stephen M Davis, Timo Krings, Marie Tisserand, Luis San Román, Alejandro Tomasello, Debbie Beumer, Scott Brown, David S Liebeskind, Serge Bracard, Keith W Muir, Diederik W J Dippel, Mayank Goyal, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D Williams, D Tampieri, AY Poppe, D Dowlatshahi, JH Wong, AP Mitha, S Subramaniam, G Hull, MW Lowerison, M Salluzzi, M Maxwell, S Lacusta, E Drupals, K Armitage, PA Barber, EE Smith, WF Morrish, SB Coutts, C Derdeyn, B Demaerschalk, D Yavagal, R Martin, R Brant, Y Yu, RA Willinsky, A Weill, C Kenney, H Aram, PK Stys, TW Watson, G Klein, D Pearson, P Couillard, A Trivedi, D Singh, E Klourfeld, O Imoukhuede, D Nikneshan, S Blayney, R Reddy, P Choi, M Horton, T Musuka, V Dubuc, TS Field, J Desai, S Adatia, A Alseraya, V Nambiar, R van Dijk, NJ Newcommon, B Schwindt, KS Butcher, T Jeerakathil, B Buck, K Khan, SS Naik, DJ Emery, RJ Owen, TB Kotylak, RA Ashforth, TA Yeo, D McNally, M Siddiqui, M Saqqur, D Hussain, H Kalashyan, A Manosalva, M Kate, L Gioia, S Hasan, A Mohammad, M Muratoglu, A Cullen, P Brennan, A O'Hare, S Looby, D Hyland, S Duff, M McCusker, B Hallinan, S Lee, J McCormack, A Moore, M O'Connor, C Donegan, L Brewer, A Martin, S Murphy, K O'Rourke, S Smyth, P Kelly, T Lynch, T Daly, P O'Brien, A O'Driscoll, M Martin, R Collins, T Coughlan, D McCabe, D O'Neill, M Mulroy, O Lynch, T Walsh, M O'Donnell, T Galvin, J Harbison, P McElwaine, K Mulpeter, C McLoughlin, M Reardon, E Harkin, E Dolan, M Watts, N Cunningham, C Fallon, S Gallagher, P Cotter, M Crowe, R Doyle, I Noone, M Lapierre, VA Coté, S Lanthier, C Odier, A Durocher, J Raymond, N Daneault, Y Deschaintre, B Jankowitz, L Baxendell, L Massaro, C Jackson-Graves, S Decesare, P Porter, K Armbruster, A Adams, J Billigan, J Oakley, A Ducruet, A Jadhav, D-V Giurgiutiu, A Aghaebrahim, V Reddy, M Hammer, M Starr, V Totoraitis, L Wechsler, S Streib, S Rangaraju, D Campbell, M Rocha, D Gulati, T Krings, L Kalman, A Cayley, J Williams, R Wiegner, LK Casaubon, C Jaigobin, JM del Campo, E Elamin, JD Schaafsma, R Agid, R Farb, K ter Brugge, BL Sapkoda, BW Baxter, K Barton, A Knox, A Porter, A Sirelkhatim, T Devlin, C Dellinger, N Pitiyanuvath, J Patterson, J Nichols, S Quarfordt, J Calvert, H Hawk, C Fanale, A Bitner, A Novak, D Huddle, R Bellon, D Loy, J Wagner, I Chang, E Lampe, B Spencer, R Pratt, R Bartt, S Shine, G Dooley, T Nguyen, M Whaley, K McCarthy, J Teitelbaum, W Poon, N Campbell, M Cortes, C Lum, R Shamloul, S Robert, G Stotts, M Shamy, N Steffenhagen, D Blacquiere, M Hogan, M AlHazzaa, G Basir, H Lesiuk, D Iancu, M Santos, H Choe, DC Weisman, K Jonczak, A Blue-Schaller, Q Shah, L MacKenzie, B Klein, K Kulandaivel, O Kozak, DJ Gzesh, LJ Harris, JS Khoury, J Mandzia, D Pelz, S Crann, L Fleming, K Hesser, B Beauchamp, B Amato-Marzialli, M Boulton, P Lopez- Ojeda, M Sharma, S Lownie, R Chan, R Swartz, P Howard, D Golob, D Gladstone, K Boyle, M Boulos, J Hopyan, V Yang, L Da Costa, CA Holmstedt, AS Turk, R Navarro, E Jauch, S Ozark, R Turner, S Phillips, J Shankar, J Jarrett, G Gubitz, W Maloney, R Vandorpe, M Schmidt, J Heidenreich, G Hunter, M Kelly, R Whelan, L Peeling, PA Burns, A Hunter, I Wiggam, E Kerr, M Watt, A Fulton, P Gordon, I Rennie, P Flynn, G Smyth, S O'Leary, N Gentile, G Linares, P McNelis, K Erkmen, P Katz, A Azizi, M Weaver, C Jungreis, S Faro, P Shah, H Reimer, V Kalugdan, G Saposnik, A Bharatha, Y Li, P Kostyrko, T Marotta, W Montanera, D Sarma, D Selchen, J Spears, JH Heo, K Jeong, DJ Kim, BM Kim, YD Kim, D Song, K-J Lee, J Yoo, OY Bang, S Rho, J Lee, P Jeon, KH Kim, J Cha, SJ Kim, S Ryoo, MJ Lee, S-I Sohn, C-H Kim, H-G Ryu, J-H Hong, H-W Chang, C-Y Lee, J Rha, Bruce CV Campbell, Leonid Churilov, Bernard Yan, Richard Dowling, Thomas J Oxley, Teddy Y Wu, Gabriel Silver, Amy McDonald, Rachael McCoy, Timothy J Kleinig, Rebecca Scroop, Helen M Dewey, Marion Simpson, Mark Brooks, Bronwyn Coulton, Martin Krause, Timothy J Harrington, Brendan Steinfort, Kenneth Faulder, Miriam Priglinger, Susan Day, Thanh Phan, Winston Chong, Michael Holt, Ronil V Chandra, Henry Ma, Dennis Young, Kitty Wong, Tissa Wijeratne, Hans Tu, Elizabeth Mackay, Sherisse Celestino, Christopher F Bladin, Poh Sien Loh, Amanda Gilligan, Zofia Ross, Skye Coote, Tanya Frost, Mark W Parsons, Ferdinand Miteff, Christopher R Levi, Timothy Ang, Neil Spratt, Lara Kaauwai, Monica Badve, Henry Rice, Laetitia de Villiers, P. Alan Barber, Ben McGuinness, Ayton Hope, Maurice Moriarty, Patricia Bennett, Andrew Wong, Alan Coulthard, Andrew Lee, Jim Jannes, Deborah Field, Simon Salinas, Elise Cowley, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Cate D'Este, Hans-Christoph Diener, Elad I. Levy, Vitor Mendes Pereira, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. Yavagal, Rüdiger von Kummer, Wade Smith, Francis Turjman, Scott Hamilton, Richard Chiacchierini, Arun Amar, Nerses Sanossian, Yince Loh, B Baxter, VK Reddy, A Horev, M Star, A Siddiqui, LN Hopkins, K Snyder, R Sawyer, S Hall, V Costalat, C Riquelme, P Machi, E Omer, C Arquizan, I Mourand, M Charif, X Ayrignac, N Menjot de Champfleur, N Leboucq, G Gascou, M Moynier, R du Mesnil de Rochemont, O Singer, J Berkefeld, C Foerch, M Lorenz, W Pfeilschifer, E Hattingen, M Wagner, SJ You, S Lescher, H Braun, S Dehkharghani, SR Belagaje, A Anderson, A Lima, M Obideen, D Haussen, R Dharia, M Frankel, V Patel, K Owada, A Saad, L Amerson, C Horn, S Doppelheuer, K Schindler, DK Lopes, M Chen, R Moftakhar, C Anton, M Smreczak, JS Carpenter, S Boo, A Rai, T Roberts, A Tarabishy, L Gutmann, C Brooks, J Brick, J Domico, G Reimann, K Hinrichs, M Becker, E Heiss, C Selle, A Witteler, S Al-Boutros, M-J Danch, A Ranft, S Rohde, K Burg, C Weimar, V Zegarac, C Hartmann, M Schlamann, S Göricke, A Ringlestein, I Wanke, C Mönninghoff, M Dietzold, R Budzik, T Davis, G Eubank, WJ Hicks, P Pema, N Vora, J Mejilla, M Taylor, W Clark, A Rontal, J Fields, B Peterson, G Nesbit, H Lutsep, H Bozorgchami, R Priest, O Ologuntoye, S Barnwell, A Dogan, K Herrick, C Takahasi, N Beadell, B Brown, S Jamieson, MS Hussain, A Russman, F Hui, D Wisco, K Uchino, Z Khawaja, I Katzan, G Toth, E Cheng-Ching, M Bain, S Man, A Farrag, P George, S John, L Shankar, A Drofa, R Dahlgren, A Bauer, A Itreat, A Taqui, R Cerejo, A Richmond, P Ringleb, M Bendszus, M Möhlenbruch, T Reiff, H Amiri, J Purrucker, C Herweh, M Pham, O Menn, I Ludwig, I Acosta, C Villar, W Morgan, C Sombutmai, F Hellinger, E Allen, M Bellew, R Gandhi, E Bonwit, J Aly, RD Ecker, D Seder, J Morris, M Skaletsky, J Belden, C Baker, LS Connolly, P Papanagiotou, C Roth, A Kastrup, M Politi, F Brunner, M Alexandrou, H Merdivan, C Ramsey, C Given II, S Renfrow, V Deshmukh, K Sasadeusz, F Vincent, JT Thiesing, J Putnam, A Bhatt, A Kansara, D Caceves, T Lowenkopf, L Yanase, J Zurasky, S Dancer, B Freeman, T Scheibe-Mirek, J Robison, J Roll, D Clark, M Rodriguez, B-FM Fitzsimmons, O Zaidat, JR Lynch, M Lazzaro, T Larson, L Padmore, E Das, A Farrow-Schmidt, A Hassan, W Tekle, C Cate, O Jansen, C Cnyrim, F Wodarg, C Wiese, A Binder, C Riedel, A Rohr, N Lang, H Laufs, S Krieter, L Remonda, M Diepers, J Añon, K Nedeltchev, T Kahles, S Biethahn, M Lindner, V Chang, C Gächter, C Esperon, M Guglielmetti, JF Arenillas Lara, M Martínez Galdámez, AI Calleja Sanz, E Cortijo Garcia, P Garcia Bermejo, S Perez, P Mulero Carrillo, E Crespo Vallejo, M Ruiz Piñero, L Lopez Mesonero, FJ Reyes Muñoz, C Brekenfeld, J-H Buhk, A Krützelmann, G Thomalla, B Cheng, C Beck, J Hoppe, E Goebell, B Holst, U Grzyska, G Wortmann, S Starkman, G Duckwiler, R Jahan, N Rao, S Sheth, K Ng, A Noorian, V Szeder, M Nour, M McManus, J Huang, J Tarpley, S Tateshima, N Gonzalez, L Ali, D Liebeskind, J Hinman, M Calderon-Arnulphi, C Liang, J Guzy, S Koch, K DeSousa, G Gordon-Perue, M Elhammady, E Peterson, V Pandey, S Dharmadhikari, P Khandelwal, A Malik, R Pafford, P Gonzalez, K Ramdas, G Andersen, D Damgaard, P Von Weitzel-Mudersbach, C Simonsen, N Ruiz de Morales Ayudarte, M Poulsen, L Sørensen, S Karabegovich, M Hjørringgaard, N Hjort, T Harbo, K Sørensen, E Deshaies, D Padalino, A Swarnkar, JG Latorre, E Elnour, Z El-Zammar, M Villwock, H Farid, A Balgude, L Cross, K Hansen, M Holtmannspötter, D Kondziella, J Hoejgaard, S Taudorf, H Soendergaard, A Wagner, M Cronquist, T Stavngaard, M Cortsen, LH Krarup, T Hyldal, H-P Haring, S Guggenberger, M Hamberger, J Trenkler, M Sonnberger, K Nussbaumer, C Dominger, E Bach, BD Jagadeesan, R Taylor, J Kim, K Shea, R Tummala, H Zacharatos, D Sandhu, M Ezzeddine, A Grande, D Hildebrandt, K Miller, J Scherber, A Hendrickson, M Jumaa, S Zaidi, T Hendrickson, V Snyder, M Killer-Oberpfalzer, J Mutzenbach, F Weymayr, E Broussalis, K Stadler, A Jedlitschka, A Malek, N Mueller-Kronast, P Beck, C Martin, D Summers, J Day, I Bettinger, W Holloway, K Olds, S Arkin, N Akhtar, C Boutwell, S Crandall, M Schwartzman, C Weinstein, B Brion, S Prothmann, J Kleine, K Kreiser, T Boeckh-Behrens, H Poppert, S Wunderlich, ML Koch, V Biberacher, A Huberle, G Gora-Stahlberg, B Knier, T Meindl, D Utpadel-Fischler, M Zech, M Kowarik, C Seifert, B Schwaiger, A Puri, S Hou, A Wakhloo, M Moonis, N Henninger, R Goddeau, F Massari, A Minaeian, JD Lozano, M Ramzan, C Stout, A Patel, A Tunguturi, S Onteddu, R Carandang, M Howk, M Ribó, E Sanjuan, M Rubiera, J Pagola, A Flores, M Muchada, P Meler, E Huerga, S Gelabert, P Coscojuela, A Tomasello, D Rodriguez, E Santamarina, O Maisterra, S Boned, L Seró, A Rovira, CA Molina, M Millán, L Muñoz, N Pérez de la Ossa, M Gomis, L Dorado, E López-Cancio, E Palomeras, J Munuera, P García Bermejo, S Remollo, C Castaño, R García-Sort, P Cuadras, P Puyalto, M Hernández-Pérez, M Jiménez, A Martínez-Piñeiro, G Lucente, A Dávalos, A Chamorro, X Urra, V Obach, A Cervera, S Amaro, L Llull, J Codas, M Balasa, J Navarro, H Ariño, A Aceituno, S Rudilosso, A Renu, JM Macho, L San Roman, J Blasco, A López, N Macías, P Cardona, H Quesada, F Rubio, L Cano, B Lara, MA de Miquel, L Aja, J Serena, E Cobo, Kennedy R Lees, J Arenillas, R Roberts, F Al-Ajlan, L Zimmel, S Patel, J Martí-Fàbregas, M Salvat-Plana, S Bracard, Xavier Ducrocq, René Anxionnat, Pierre-Alexandre Baillot, Charlotte Barbier, Anne-Laure Derelle, Jean-Christophe Lacour, Yves Samson, Nader Sourour, Flore Baronnet-Chauvet, Frédéric Clarencon, Sophie Crozier, Sandrine Deltour, Federico Di Maria, Raphael Le Bouc, Anne Leger, Gurkan Mutlu, Charlotte Rosso, Zoltan Szatmary, Marion Yger, Chiara Zavanone, Serge Bakchine, Laurent Pierot, Nathalie Caucheteux, Laurent Estrade, Krzysztof Kadziolka, Alexandre Leautaud, Céline Renkes, Isabelle Serre, Hubert Desal, Benoît Guillon, Claire Boutoleau-Bretonniere, Benjamin Daumas-Duport, Solène De Gaalon, Pascal Derkinderen, Sarah Evain, Fanny Herisson, David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Olivier Naggara, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Anand Dixit, Andrew Clifton, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, Clinical Neurophysiology, Weimar, Christian (Beitragende*r), Radiology and nuclear medicine, Rheumatology, ACS - Atherosclerosis & ischemic syndromes, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), The Royal Melbourne Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Stanford University, University of Calgary, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University [Maastricht], Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Neuroscience [Newcastle] (ION), Newcastle University [Newcastle], Universitat Autònoma de Barcelona (UAB), Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Alberta, Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Monash University [Melbourne], St George’s University Hospitals, Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dalhousie University [Halifax], Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], St. Michael's Hospital, University of California [Los Angeles] (UCLA), University of California, University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Toronto Western Hospital, Hôpital Foch [Suresnes], Vall d'Hebron University Hospital [Barcelona], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Glasgow, Queen Elizabeth University Hospital (Glasgow), David Geffen School of Medicine [Los Angeles], University of California-University of California, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Radiology & Nuclear Medicine, Public Health, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ACS - Amsterdam Cardiovascular Sciences, Graduate School, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, Biomedical Engineering and Physics, APH - Personalized Medicine, APH - Quality of Care, and AMS - Restoration & Development
Subjects: SELECTION, COMPUTED TOMOGRAPHIC PERFUSION, Medizin, Perfusion scanning, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Modified Rankin Scale, REPERFUSION, Stroke, ComputingMilieux_MISCELLANEOUS, Thrombectomy, Aged, 80 and over, medicine.diagnostic_test, Penumbra, Endovascular Procedures, Brain, Middle Aged, Magnetic Resonance Imaging, 3. Good health, Treatment Outcome, Cerebral blood flow, Tissue Plasminogen Activator, INFARCT, Cardiology, Female, TRIAL, CT, medicine.medical_specialty, Perfusion Imaging, Neuroimaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, Fibrinolytic Agents, ALTEPLASE, Internal medicine, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Aged, business.industry, MECHANICAL THROMBECTOMY, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Magnetic resonance imaging, Odds ratio, medicine.disease, Neurology (clinical), business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Fibrinolytic agent, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome.Methods In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1,2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 mu m(2)/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0-2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered.Findings We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0.47 [95% CI 0.30-0.72], p=0.0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0.77 [0.69-0.86] per 10 mL, p(interaction)=0.29; diffusion MRI OR 0.87 [0.81-0.94] per 10 mL, p(interaction)=0.94). Mismatch volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic core volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low.Interpretation Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imagingto-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Copyright (C) 2018 Elsevier Ltd. All rights reserved.
Published: 2019

36. Simple and validated UHPLC–MS/MS analysis of nimodipine in plasma and cerebrospinal fluid of patients with subarachnoid haemorrhage

Author: Susan Mohamed, Roberto Riva, and Manuela Contin
Subjects: Formic acid, Clinical Biochemistry, Mass spectrometry, 01 natural sciences, Biochemistry, Uhplc ms ms, Analytical Chemistry, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Cerebrospinal fluid, Limit of Detection, Tandem Mass Spectrometry, medicine, Humans, Nimodipine, Chromatography, High Pressure Liquid, Chromatography, 010401 analytical chemistry, Cell Biology, General Medicine, Plasma, Subarachnoid Hemorrhage, Calcium Channel Blockers, 0104 chemical sciences, chemistry, Gradient elution, Subarachnoid haemorrhage, Drug Monitoring, 030217 neurology & neurosurgery, medicine.drug
Abstract: We present a simple, fast and validated method for the determination of nimodipine in plasma and cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage using ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Plasma or CSF 250μL aliquots were pretreated with acetonitrile spiked with lacosamide as internal standard. The chromatographic separation was performed on a Fusion (3μm) 50×2.0mm I.D. column with gradient elution of 0.1% (v/v) formic acid in water and 0.1% (v/v) formic acid in acetonitrile at a flow rate of 0.35mL/min. The MS/MS ion transitions were 419.1→343 for nimodipine and 251.1→91 for the internal standard. The linearity was determined from 2.0 to 40.0ng/mL in plasma and 40.0-800.0pg/mL in CSF. The lower limit of quantitation (LLOQ) of nimodipine was 0.4ng/mL in plasma and 40pg/mL in CSF. The mean recovery for nimodipine was ≥75% in plasma and ≥90% in CSF at all three considered concentrations. Intra- and interassay precision and accuracy were ≤15% at all quality control concentrations in plasma and CSF. The method was applied to measure plasma and CSF concentrations of nimodipine in a series of patients with subarachnoid haemorrhage treated with intravenous nimodipine. The present procedure, omitting time-consuming liquid-liquid extraction and drying steps, is faster, simpler and cheaper than published LC-MS/MS analytical methods for nimodipine in plasma and the first validated one for nimodipine in CSF.
Published: 2016

37. Thermodynamic Data Digitalization: Workflow and Benefits of a Well-Structured Database

Author: Roberto Riva, Enrico Drei, Ernesto Della Rossa, Paolo Diatto, Marco Martin, and Giuseppe Ciriello
Subjects: Workflow, 020401 chemical engineering, Database, Computer science, 02 engineering and technology, Data architecture, 0204 chemical engineering, 010502 geochemistry & geophysics, computer.software_genre, 01 natural sciences, computer, 0105 earth and related environmental sciences
Abstract: The knowledge of reservoir fluids phase behavior has always played an important role in oilfield development planning, reserves evaluation and screening of the potential for enhanced oil recovery. Nowadays operators aim more and more at fast-track development of discovered resources, therefore, any anticipation of thermodynamic properties is a business challenge: looking for "PVT-analogues" is the solution proposed in this paper. What adversely impacts massive scouting of PVT data usually is the limit of a small amount of readily available information, also due to the intrinsic complexity of the datasets and of the variety of output formats produced by different laboratories all over the world and over the years. In Eni a new tool for data mining based on the reorganization and thorough digitalization of the PVT archive is in advanced development. Standardization of the laboratory outcomes by templates, automatic loading into a corporate repository, in-house development of software tools for quality control, data mining and advanced statistical analyses, easy access through a properly designed interface: each of these steps is integrated in an upgraded data-driven approach to fluid properties prediction allowing an earlier understanding of the reservoir fluid system.
Published: 2018

38. Carotid Stenting With Antithrombotic Agents and Intracranial Thrombectomy Leads to the Highest Recanalization Rate in Patients With Acute Stroke With Tandem Lesions

Author: Panagiotis Papanagiotou, Diogo C. Haussen, Francis Turjman, Julien Labreuche, Michel Piotin, Andreas Kastrup, Henrik Steglich-Arnholm, Markus Holtmannspötter, Christian Taschner, Sebastian Eiden, Raul G. Nogueira, Maria Boutchakova, Adnan Siddiqui, Bertrand Lapergue, Franziska Dorn, Christophe Cognard, Monika Killer, Salvatore Mangiafico, Marc Ribo, Marios N. Psychogios, Alejandro Spiotta, Marc Antoine Labeyrie, Alessandra Biondi, Mikaël Mazighi, Sébastien Richard, René Anxionnat, Serge Bracard, Benjamin Gory, Jonathan Andrew Grossberg, Adrien Guenego, Julien Darcourt, Isabelle Vukasinovic, Elisa Pomero, Jason Davies, Leonardo Renieri, Corentin Hecker, Maria Muchada Muchada, Arturo Consoli, Georges Rodesch, Emmanuel Houdart, Raymond Turner, Aquilla Turk, Imran Chaudry, Paul-Emile Labeyrie, Roberto Riva, Johanna Lockau, Raphaël Blanc, Hocine Redjem, Daniel Behme, Hussain Shallwani, Maurer Christopher, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, Camille Amaz, Klinikum Bremen-Mitte, Emory University School of Medicine, Emory University [Atlanta, GA], Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Freiburg University Medical Center, State University of New York (SUNY), Hôpital Foch [Suresnes], University-Hospital Munich-Großhadern [München], Neuroradiologie Diagnostique et Thérapeutique [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Azienda Ospedaliero-Universitaria Careggi (AOU Careggi), Vall d'Hebron University Hospital [Barcelona], University Medical Center Göttingen (UMG), Medical University of South Carolina [Charleston] (MUSC), Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Universitäts Klinikum Freiburg = University Medical Center Freiburg (Uniklinik), Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Azienda Ospedaliero-Universitaria Careggi [Firenze] (AOUC)
Subjects: Carotid Artery Diseases, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, Internal medicine, Angioplasty, medicine.artery, Antithrombotic, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, cardiovascular diseases, Registries, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Thrombectomy, Intracerebral hemorrhage, Univariate analysis, Cerebral infarction, business.industry, Endovascular Procedures, Thrombolysis, Middle Aged, medicine.disease, United States, 3. Good health, Europe, Stroke, Treatment Outcome, Cardiology, Female, Stents, Internal carotid artery, Carotid stenting, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Objectives The aim of this study was to identify the optimal endovascular approach in patients with acute stroke with tandem lesions. Background At present, there is no consensus about the ideal technical strategy for the endovascular treatment of patients with acute ischemic stroke with tandem lesions of the extracranial internal carotid artery (ICA) and intracranial cerebral arteries. Methods This was an international, multicenter registry with a total of 482 patients with acute ischemic stroke and tandem lesions. Patients were treated by intracranial thrombectomy as well as 1 of the following 4 strategies: 1) acute carotid artery stenting of the extracranial ICA with antithrombotic agents; 2) acute carotid artery stenting of the extracranial ICA without antithrombotic agents; 3) balloon angioplasty of the extracranial ICA; and 4) intracranial thrombectomy alone. The main outcome endpoints of the study were the degree of recanalization and the 90-day clinical outcome. The safety endpoints were symptomatic intracerebral hemorrhage and all causes of mortality at 90 days. Results Using univariate analysis, the rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction grades 2B and 3) and favorable clinical outcome after 90 days were significantly higher after acute carotid stenting with antithrombotic therapy and thrombectomy compared with the group with thrombectomy alone. After adjusting for confounding variables, acute stenting with antithrombotic therapy was independently associated with successful recanalization (odds ratio: 2.4; 95% confidence interval: 1.25 to 4.59; p = 0.008). The rates of symptomatic intracerebral hemorrhage and 90-day mortality were comparable among all 4 treatment groups. Conclusions Acute stenting of the extracranial ICA with antithrombotic therapy in combination with intracranial thrombectomy is associated with higher recanalization rates in treatment of patients with acute stroke with tandem lesions.
Published: 2018

39. The easy driver for placement of palatal mini-implants and a maxillary expander in a single appointment

Author: Oronzo, De Gabriele, Gianluca, Dallatana, Roberto, Riva, Sivabalan, Vasudavan, and Benedict, Wilmes
Subjects: Dental Implants, Male, Palatal Expansion Technique, Malocclusion, Angle Class III, Printing, Three-Dimensional, Orthodontic Anchorage Procedures, Humans, Retrognathia, Child, Orthodontics, Corrective
Published: 2018

40. Transarterial Onyx Embolization of Intracranial Dural Fistulas: A Prospective Cohort, Systematic Review, and Meta-Analysis

Author: Jean-Jacques Lehot, Xavier Armoiry, Benjamin Gory, Anne-Claire Lukaszewicz, Francis Turjman, Roberto Riva, Paul Emile Labeyrie, Nicolas Magand, Udi Sadeh-Gonike, Bernadette Lamy, Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Matériaux, ingénierie et science [Villeurbanne] (MATEIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), University of Warwick [Coventry], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques - EA 7426 (PI3), and Université de Lyon-Université de Lyon
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Arteriovenous fistula, 030218 nuclear medicine & medical imaging, [SPI.MAT]Engineering Sciences [physics]/Materials, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Occlusion, Humans, Medicine, Dimethyl Sulfoxide, Registries, Embolization, Prospective cohort study, Aged, Central Nervous System Vascular Malformations, business.industry, Mortality rate, Endovascular Procedures, Middle Aged, medicine.disease, Embolization, Therapeutic, 3. Good health, Surgery, Treatment Outcome, Embolism, Meta-analysis, Female, Polyvinyls, Neurology (clinical), business, Complication, 030217 neurology & neurosurgery
Abstract: International audience; BACKGROUND: Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined. OBJECTIVE: To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF METHODS: We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE. RESULTS: In the prospective study, 41 transarterial procedures were performed in 33 consecutive patients harboring 36 DAVFs. Complete initial exclusion was obtained in 32 of 36 (88.9%) fistulas; 31 fistulas were followed up showing 4 (12.9%) recurrences. Procedure-related morbidity and mortality were 3% and 0%, respectively. The literature review identified 19 studies involving a total of 425 patients with 463 DAVFs. Meta-analysis, including our registry data, showed an initial complete occlusion rate of 82% (95% confidence interval [CI]: 74%, 88%; I-2, 70.6%), and recurrence rate at midterm of 2% (95% CI: 0%, 5%; I-2, 21.5%). Pooled postoperative neurological deficit, procedure-related morbidity, and mortality rates were 4% (95% CI: 2%, 6%; I-2, 0%), 3% (95% CI: 1%, 5%; I-2, 0%), and 0%, respectively. CONCLUSION: This meta-analysis suggests that transarterial embolization with Onyx is a safe treatment modality for DAVFs. Although Onyx showed a low recurrence rate at midterm, the long-term risk is poorly addressed in our study and should warrant a longer follow-up.
Published: 2018

41. Contact Aspiration Versus Stent Retriever in Patients With Acute Ischemic Stroke With M2 Occlusion in the ASTER Randomized Trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization)

Author: Benjamin Gory, Bertrand Lapergue, Raphael Blanc, Julien Labreuche, Malek Ben Machaa, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Robert Fahed, Jean Philippe Desilles, Georges Rodesch, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Francis Turjman, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Alain Bonafé, Omer Eker, Grégory Gascou, Cyril Dargazanli, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Romain Bourcier, Benjamin Daumas-Duport, Jérome Berge, Xavier Barreau, Lynda Djemmane, Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Foch [Suresnes], Hôpital Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Limoges, Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Université de Montpellier (UM), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), and Institut des Neurosciences de Montpellier (INM)
Subjects: Male, medicine.medical_specialty, Middle Cerebral Artery, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Revascularization, 030218 nuclear medicine & medical imaging, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, medicine.artery, Occlusion, medicine, Humans, ComputingMilieux_MISCELLANEOUS, Cerebral Hemorrhage, Thrombectomy, Advanced and Specialized Nursing, Intracerebral hemorrhage, Cerebral Revascularization, business.industry, Cerebral infarction, Endovascular Procedures, Thrombolysis, medicine.disease, Confidence interval, Stroke, Treatment Outcome, Middle cerebral artery, Cardiology, Female, Stents, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose— Middle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion. The safety of mechanical thrombectomy, especially contact aspiration (CA), in such distal intracranial occlusions is still under debate. We compared reperfusion, adverse events, neurological recovery, and functional outcome of patients with isolated M2 occlusions according to the first-line strategy mechanical thrombectomy devices (CA versus stent retriever [SR]). Methods— This is a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). The primary outcome was successful reperfusion at the end of all endovascular procedures, defined as modified Thrombolysis in Cerebral Infarction (mTICI) scores 2b/3. Secondary outcomes were mTICI 2c/3 and mTICI 3, 90-day functional outcome, assessed with the modified Rankin Scale score. Safety outcomes included 90-day mortality and any symptomatic intracerebral hemorrhage. Results— Seventy-nine patients were included: 48 were allocated to the CA group and 31 to the SR group. There were no significant differences between CA and SR groups in reperfusion after all endovascular procedures regarding mTICI 2b/3 (89.6% versus 83.9%; P =0.36), mTICI 2c/3 (54.2% versus 54.8%; P =0.90), and mTICI 3 (35.4% versus 41.9%; P =0.36) rates. There were no significant differences between CA and SR groups in 90-day modified Rankin Scale ≤2 rate (54.4% versus 50.0%; P =0.84), 24-hour change in National Institutes of Health Stroke Scale (mean difference, −3.9; 95% confidence interval, −7.9 to 0.01), and Alberta Stroke Program Early Computed Tomography score (mean difference, 0.9; 95% confidence interval, −0.1 to 2.0) scores. Safety parameters were well balanced between the 2 groups except for a higher 90-day mortality rate in the CA group (19.6% versus 3.3%; P =0.078). Conclusions— First-line mechanical thrombectomy with CA compared with SR did not result in an increased successful revascularization rate in patients with acute stroke with isolated M2 occlusion.
Published: 2018

42. Tetrahydrocannabinol/Cannabidiol Oromucosal Spray in Patients With Multiple Sclerosis: A Pilot Study on the Plasma Concentration-Effect Relationship

Author: Manuela Contin, Alessandro Perrone, Susan Mohamed, Alessandra Lugaresi, Roberto Riva, Loredana Sabattini, Cinzia Scandellari, Matteo Foschi, L. Mancinelli, Veria Vacchiano, Contin, Manuela, Mancinelli, Luca, Perrone, Alessandro, Sabattini, Loredana, Mohamed, Susan, Scandellari, Cinzia, Foschi, Matteo, Vacchiano, Veria, Lugaresi, Alessandra, and Riva, Roberto
Subjects: Adult, Male, Multiple Sclerosis, Pilot Projects, 03 medical and health sciences, 0302 clinical medicine, Drug Combination, Multiple Sclerosi, Oral Spray, Medicine, Humans, Cannabidiol, Pharmacology (medical), pharmacokinetics-pharmacodynamics, Pilot Project, 030212 general & internal medicine, Dosing, Spasticity, Dronabinol, Prospective Studies, Tetrahydrocannabinol, Prospective cohort study, Morning, Pharmacology, 9-tetrahydrocannabinol, business.industry, Venous blood, Middle Aged, Drug Combinations, Muscle Spasticity, Anesthesia, cannabidiol, oromucosal spray, multiple sclerosis, Female, Neurology (clinical), medicine.symptom, Oral Sprays, business, 030217 neurology & neurosurgery, medicine.drug, Human
Abstract: OBJECTIVES: We aimed to assess the potential relationship between intrasubject 9-tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray plasma profiles and clinical effects elicited by subacute dosing in chronically treated patients with multiple sclerosis (MS). METHODS: The study design was pilot, single center, open, and prospective. The patients were challenged with a morning test dose of 2 THC/CBD sprays at a 15-minute interval. Venous blood samples were collected before the first spray administration and every 30 minutes after the second spray, until 240 minutes postdosing. Patients rated their spasticity by the Numerical Rating Scale (NRS) simultaneously with blood drawings. Postural and motor tests were performed before the first spray and 90 and 180 minutes thereafter. RESULTS: Twelve patients were recruited. Peak plasma concentrations of THC/CBD largely varied among patients, from 0.60 to 13.29 ng/mL for THC and 0.55 to 11.93 ng/mL for CBD. Time to peak plasma concentrations ranged from 150 to 240 minutes for THC and 90 to 240 minutes for CBD. Patients' NRS serial scores decreased after dosing, from a median value of 6 to 3.5 (P < 0.001). A significant inverse correlation was observed between median intrasubject repeated NRS scores and corresponding median values of both THC (P < 0.01) and CBD (P < 0.002) plasma concentrations. No significant effect of cannabinoids dosing could be appreciated according to posturographic and motor tests. CONCLUSIONS: Our kinetic dynamic findings from THC/CBD oromucosal spray are the first obtained in real MS patients. Although preliminary, they suggest that subacute dosing might elicit a subjective clinically significant effect on MS-related spasticity, paralleling cannabinoids measurable plasma concentrations.
Published: 2018

43. Modified Thrombolysis in Cerebral Infarction 2C/Thrombolysis in Cerebral Infarction 3 Reperfusion Should Be the Aim of Mechanical Thrombectomy: Insights From the ASTER Trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization)

Author: Cyril Dargazanli, Robert Fahed, Raphael Blanc, Benjamin Gory, Julien Labreuche, Alain Duhamel, Gaultier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin, Bertrand Lapergue, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Jean Philippe Desilles, Georges Rodesch, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Omer Eker, Francis Turjman, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Suzanna Saleme, Alain Bonafé, Grégory Gascou, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Romain Bourcier, Benjamin Daumas-Duport, Jérome Berge, Xavier Barreau, Lynda Djemmane, 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), Université de Montpellier (UM), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Limoges, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Hôpital Foch [Suresnes], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hôpital Rothschild [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Revascularization, Patient Care Planning, 030218 nuclear medicine & medical imaging, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, Occlusion, Odds Ratio, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Randomized Controlled Trials as Topic, Thrombectomy, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Cerebral infarction, Endovascular Procedures, Cerebral Infarction, Thrombolysis, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Stroke, Treatment Outcome, Reperfusion, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose— Although successful reperfusion is usually defined as a modified Thrombolysis in Cerebral Infarction (mTICI) 2B or 3 at the end of the procedure, studies have shown that mTICI 2B patients had poorer functional outcomes than TICI 3 patients. An mTICI 2C category has been recently introduced for patients with near-complete perfusion except for slow flow in a few distal cortical vessels or presence of small distal cortical emboli after mechanical thrombectomy. The purpose of this study was to evaluate the difference in functional outcome between patients achieving successful reperfusion (ie, mTICI 2B, mTICI 2C, and TICI 3 scores). Methods— Ancillary study from the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) prospective multicenter blinded end point trial. Reperfusion results are reported as the mTICI score, including the mTICI 2C grade. Primary outcome was the percentage of patients with favorable outcome defined as a 90-day modified Rankin Scale score of 0 to 2. Results— Two hundred ninety patients with successful reperfusion (mTICI ≥2B), harboring ischemic stroke secondary to occlusion of the anterior circulation within 6 hours of onset of symptoms, undergoing mechanical thrombectomy by contact aspiration or stent retriever were included. Favorable outcome (pre-specified as primary outcome of this ancillary study) did not differ significantly between the 3 reperfusion grades, with a similar positive effect of 2C (odds ratio, 1.71; 95% confidence interval, 0.98–3.00) and 3 (odds ratio, 1.73; 95% confidence interval, 0.88–3.41) grades compared with 2B grade. After combining grades 2C and 3, patients had a significantly higher rate of favorable outcome than patients with 2B (odds ratio, 1.72; 95% confidence interval, 1.01–2.90; P =0.043). Favorable outcome rate decreased with increasing onset-to-reperfusion time, with no significant interaction between mTICI 2C/3 grade and onset-to-reperfusion time on favorable outcome. Conclusions— Combining mTICI 2C and TICI 3 grades helps to determine a subgroup of patients achieving better functional outcomes than mTICI 2B patients. Achieving mTICI 2C/3 reperfusion should be the new aim of mechanical thrombectomy for anterior circulation LVO.
Published: 2018

44. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Author: Bruce C V Campbell, Wim H van Zwam, Mayank Goyal, Bijoy K Menon, Diederik W J Dippel, Andrew M Demchuk, Serge Bracard, Philip White, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Gary A Ford, Natalia Pérez de la Ossa, Michael Kelly, Romain Bourcier, Geoffrey A Donnan, Yvo B W E M Roos, Oh Young Bang, Raul G Nogueira, Thomas G Devlin, Lucie A van den Berg, Frédéric Clarençon, Paul Burns, Jeffrey Carpenter, Olvert A Berkhemer, Dileep R Yavagal, Vitor Mendes Pereira, Xavier Ducrocq, Anand Dixit, Helena Quesada, Jonathan Epstein, Stephen M Davis, Olav Jansen, Marta Rubiera, Xabier Urra, Emilien Micard, Hester F Lingsma, Olivier Naggara, Scott Brown, Francis Guillemin, Keith W Muir, Robert J van Oostenbrugge, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Debbie Beumer, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D Williams, D Tampieri, AY Poppe, D Dowlatshahi, JH Wong, AP Mitha, S Subramaniam, G Hull, MW Lowerison, M Salluzzi, M Maxwell, S Lacusta, E Drupals, K Armitage, PA Barber, EE Smith, WF Morrish, SB Coutts, C Derdeyn, B Demaerschalk, D Yavagal, R Martin, R Brant, Y Yu, RA Willinsky, A Weill, C Kenney, H Aram, PK Stys, TW Watson, G Klein, D Pearson, P Couillard, A Trivedi, D Singh, E Klourfeld, O Imoukhuede, D Nikneshan, S Blayney, R Reddy, P Choi, M Horton, T Musuka, V Dubuc, TS Field, J Desai, S Adatia, A Alseraya, V Nambiar, R van Dijk, NJ Newcommon, B Schwindt, KS Butcher, T Jeerakathil, B Buck, K Khan, SS Naik, DJ Emery, RJ Owen, TB Kotylak, RA Ashforth, TA Yeo, D McNally, M Siddiqui, M Saqqur, D Hussain, H Kalashyan, A Manosalva, M Kate, L Gioia, S Hasan, A Mohammad, M Muratoglu, A Cullen, P Brennan, A O'Hare, S Looby, D Hyland, S Duff, M McCusker, B Hallinan, S Lee, J McCormack, A Moore, M O'Connor, C Donegan, L Brewer, A Martin, S Murphy, K O'Rourke, S Smyth, P Kelly, T Lynch, T 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David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Hélène Raoult, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Martin M Brown, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Geoffrey Cloud, Andrew Clifton, Jeremy Madigan, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, University of Melbourne, University of Calgary, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Amsterdam [Amsterdam] (UvA), Universitat Autònoma de Barcelona (UAB), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Neurology, Graduate School, Other Research, APH - Personalized Medicine, APH - Quality of Care, Biomedical Engineering and Physics, ARD - Amsterdam Reproduction and Development, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, Radiology & Nuclear Medicine, Public Health, Weimar, Christian (Beitragende*r), Molecular cell biology and Immunology, Pathology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Rheumatology, Beeldvorming, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: CARIM - R3.11 - Imaging, MUMC+: DA BV Medisch Specialisten Radiologie (9), Klinische Neurowetenschappen, and MUMC+: MA Neurologie (3)
Subjects: Male, medicine.medical_specialty, Sedation, Medizin, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Anesthesia, General, CONTROLLED-TRIAL, THERAPY, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Randomized controlled trial, law, Modified Rankin Scale, Journal Article, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, General anaesthesia, Stroke, Aged, Randomized Controlled Trials as Topic, Thrombectomy, Aged, 80 and over, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, MR, Middle Aged, Outcome and Process Assessment (Health Care), medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Surgery, Outcome and Process Assessment, Health Care, Meta-analysis, Observational study, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Meta-Analysis
Abstract: BACKGROUND: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care.METHODS: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered.FINDINGS: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09-2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75-3·10, pINTERPRETATION: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons.FUNDING: Medtronic.
Published: 2018

45. Single and Aggregate Salivary Cortisol Measures in Working Women Living in High and Low Status Neighborhoods in Sweden

Author: Roberto Riva, Petra Lindfors, and Ulf Lundberg
Subjects: Adult, Gerontology, Cortisol secretion, endocrine system, Cortisol awakening response, Hydrocortisone, Residence Characteristics, medicine, Humans, Saliva, Poverty, General Psychology, Salivary cortisol, Sweden, Analysis of Variance, Stressor, Health Status Disparities, Middle Aged, Health equity, Socioeconomic Factors, Female, Analysis of variance, Psychology, hormones, hormone substitutes, and hormone antagonists, Women, Working, medicine.drug, Demography
Abstract: Contextual factors including neighborhood status have consistently been associated with health disparities. This may relate to a poorer neighborhood status involving an exposure to chronic stressors, which dysregulates cortisol secretion. This study investigated single and aggregate cortisol measures in 88 working women living in high and low status neighborhoods. Results showed significantly lower waking cortisol among women in low status neighborhoods. However, there were no group differences in aggregate cortisol measures. The lower morning cortisol among women in the low status neighborhoods follows previous research suggesting hypocortisolism as a pathway linking neighborhood status and health disparities, albeit a less consistent finding across cortisol measures in this sample. This may relate to the Swedish welfare state and its fostering of equality.
Published: 2015

46. DWI lesions reversal in posterior circulation stroke after reperfusion: Two illustrative cases and review of the literature

Author: Paul-Emile Labeyrie, Francis Turjman, Francesco Signorelli, Islam Eldesouky, Roberto Riva, Udi Sadeh-Gonike, Benjamin Gory, and Rotem Sivan-Hoffmann
Subjects: medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, General surgery, Medicine, Radiology, Nuclear Medicine and imaging, Circulation (currency), Neurology (clinical), business, medicine.disease, Stroke, Neuroradiology, Surgery
Abstract: Journal of Neuroradiology - In Press.Proof corrected by the author Available online since jeudi 23 avril 2015
Published: 2015

47. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review

Author: Alexis Turjman, Benjamin Gory, Murielle Rabilloud, Dorin Nicolae Gherasim, Roberto Riva, Rotem Sivan-Hoffmann, Francis Turjman, Elodie Ong, Norbert Nighoghossian, Islam Eldesouky, Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Vertebrobasilar Insufficiency, medicine, Humans, cardiovascular diseases, Stroke, ComputingMilieux_MISCELLANEOUS, Retrospective Studies, Thrombectomy, Stent retriever, business.industry, Cerebral infarction, Mortality rate, Thrombolysis, medicine.disease, 3. Good health, Surgery, Clinical trial, Psychiatry and Mental health, Treatment Outcome, Stents, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Background Basilar artery occlusion (BAO) remains one of the most devastating subtypes of stroke with high mortality and poor outcome. Early recanalisation is the most powerful predictor of favourable outcome in patients with stroke, and may be improved with mechanical thrombectomy using stent retriever devices. However, the benefit in functional outcome and safety of stent retrievers are not yet well known. The aim of this study was to assess efficacy and safety profiles of stent retriever thrombectomy in BAO patients with stroke. Methods We analysed data retrospectively from our consecutive clinical series and conducted a systematic review and meta-analysis of all previous studies of stent retriever thrombectomy in BAO patients with stroke between November 2010 and April 2014. Results From March 2010 to March 2013, 22 patients with acute BAO were treated with a Solitaire stent retriever in our series. Favourable outcome was significantly associated with younger age and distal BAO. The literature search identified 15 previous studies involving a total of 312 subjects. In the meta-analysis, including our series data, the recanalisation rate (Thrombolysis In Cerebral Infarction (TICI) score ≥2b) reached 81% (95% CI 73% to 87%). The rate of symptomatic intracranial haemorrhage was 4% (95% CI 2% to 8%), favourable outcome (modified Rankin Scale (mRS) ≤2 at 3 months) was found in 42% (95% CI 36% to 48%) and mortality rate was 30% (95% CI 25% to 36%). Conclusions Stent retriever thrombectomy is a safe treatment modality for patients with stroke presenting with BAO. Although the stent retrievers showed a good recanalisation rate, there are currently no randomised clinical trials to assess its clinical efficacy in comparison with the reference treatment.
Published: 2015

48. Can Repetitive Transcranial Magnetic Stimulation (rTMS) Promote Neurogenesis and Axonogenesis in Subacute Human Ischemic Stroke?

Author: Manuela De Michele, Paola Piscopo, Matteo Costanzo, Svetlana Lorenzano, Alessio Crestini, Roberto Rivabene, Valeria Manzini, Luca Petraglia, Marta Iacobucci, Irene Berto, Oscar Gaetano Schiavo, Antonella Conte, Daniele Belvisi, Alfredo Berardelli, and Danilo Toni
Subjects: neurogenesis, stroke, humans, rTMS, miRNA, Netrin-1, Biology (General), QH301-705.5
Abstract: Background: Ischemic stroke may trigger neuroplastic changes via proliferation, migration towards the lesion, and differentiation of neuroprogenitor cells into mature neurons. Repetitive Transcranial Magnetic Stimulation (rTMS) may promote brain plasticity. This study aimed to assess rTMS’s effect on post-stroke endogenous neuroplasticity by dosing plasma miRs 17~92, Netrin-1, Sema3A, and BDNF. Methods: In this case-controlled study, we randomized 19 ischemic stroke patients within five days from symptoms onset (T0) to neuronavigated-rTMS or sham stimulation. Stimulation was applied on the stroke hemisphere daily between the 7th and 14th day from stroke onset. Blood samples were collected at T0, before the first rTMS section (T7), and at the end of the last rTMS session (T14). Five healthy controls were also enrolled in this study. Results: Of 19 patients, 10 received rTMS and 9 sham stimulation. Compared with the sham group, in the rTMS group, plasma levels of miRs17~92 and Ntn-1 significantly increased whereas Sema3A levels tended to decrease. In multivariate linear regression analyses, rTMS was independently related to Ntn-1 and miR-25 levels at T14. Conclusions: We found an association between rTMS and neurogenesis/axonogenesis biomarker enhancement. Our preliminary data suggest that rTMS may positively interfere with natural endogenous plasticity phenomena of the post-ischemic human brain.
Published: 2024
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49. Filosofia del cocktail

Author: Roberto Riva and Roberto Riva
Abstract: Roberto Riva ha costruito la sua fama di “re dei barman” in anni di aperitivi e nottate interminabili spese dietro al bancone di alcuni dei bar più noti della Lombardia. I suoi studi di chimico lo hanno reso un fine miscelatore di spiriti, mentre la sua passione per i libri e per il pensiero fi losofi co lo ha portato nel corso del tempo a sviluppare una vera e propria fi losofi a del cocktail che fi nalmente trova dimora nelle pagine di questo libro. Una lettura divertente, che mescola il piacere “moderno” del drink con il pensiero arcaico, tracciando così un itinerario non soltanto concettuale, ma gustativo, olfattivo e visivo. In questo viaggio attraverso luoghi e personaggi, l'interazione tra fi losofi a, musica, scrittura e ricette (sia classiche sia innovative) ci conduce verso la consapevolezza che la preparazione di un cocktail rappresenta quasi un percorso alchemico. Non resta che prendere posto al bancone di Roberto Riva e lasciarsi raccontare da un barman-alchimista la magia del cocktaill.
Published: 2017

50. One-year efficacy and safety of the Trufill DCS Orbit and Orbit Galaxy detachable coils in the endovascular treatment of intracranial aneurysms: Results from the TRULINE study

Author: Roberto Riva, A. Nicolas, Benjamin Gory, Paul Emile Labeyrie, Emmanuel Chabert, Ariel Pablo Lebedinsky, Raphaël Blanc, Francis Turjman, Hubert Desal, Laurent Derex, Laure Huot, Hervé Brunel, Evelyne Emery, Georges Rodesch, O. Levrier, Jean-Yves Gauvrit, Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229 (CNC), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Department of Interventional Neuroradiology, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), 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), Hôpital de la Timone [CHU - APHM] (TIMONE), Winogradsky Institute of Microbiology, Russian Academy of Sciences [Moscow] (RAS), Department of Neuroradiology, Vision, Action et Gestion d'informations en Santé (VisAGeS), 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), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Fondation Rothschild, Département Recherches Subatomiques (DRS-IPHC), Institut Pluridisciplinaire Hubert Curien (IPHC), Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Service de Neurochirurgie [CHU Caen], Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), DePuy Synthes [Zuchwil], Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Foch [Suresnes], Barillot, Christian, Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-CentraleSupélec-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL), Service de Radiologie [Hôpital Clairval - Marseille], Hôpital Privé Clairval [Marseille], Service de radiologie et imagerie médicale [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Fondation Ophtalmologique Adolphe de Rotschild, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229 ( CNC ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Centre d’Infection et d’Immunité de Lille (CIIL) - U1019 - UMR 8204 ( CIIL ), Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR142-Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), 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 ), Hôpital de la Timone [CHU - APHM] ( TIMONE ), Russian Academy of Sciences [Moscow] ( RAS ), Vision, Action et Gestion d'informations en Santé ( VisAGeS ), 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 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National des Sciences Appliquées - Rennes ( INSA Rennes ) -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 Bretagne-Pays de la Loire ( IMT Atlantique ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National des Sciences Appliquées - Rennes ( INSA Rennes ) -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 Bretagne-Pays de la Loire ( IMT Atlantique ) -Institut de Recherche en Informatique et Systèmes Aléatoires ( IRISA ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National des Sciences Appliquées - Rennes ( INSA Rennes ) -Université de Bretagne Sud ( UBS ) -École normale supérieure - Rennes ( ENS Rennes ) -CentraleSupélec-Centre National de la Recherche Scientifique ( CNRS ) -IMT Atlantique Bretagne-Pays de la Loire ( IMT Atlantique ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Département Recherches Subatomiques ( DRS-IPHC ), Institut Pluridisciplinaire Hubert Curien ( IPHC ), Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ), Health Service and Performance Research ( HESPER ), Neurosurgery Department, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France., Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229 (ISC-MJ), Fondation Ophtalmologique Adolphe de Rothschild [Paris], and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)
Subjects: endovascular treatment, Male, medicine.medical_specialty, medicine.medical_treatment, Population, Aneurysm, Ruptured, recanalization, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Recurrence, medicine, Clinical endpoint, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Prospective Studies, Endovascular treatment, education, ComputingMilieux_MISCELLANEOUS, Aged, education.field_of_study, Endovascular coiling, business.industry, Incidence (epidemiology), Intracranial Aneurysm, Middle Aged, medicine.disease, Embolization, Therapeutic, Confidence interval, 3. Good health, Surgery, Cerebral Angiography, Treatment Outcome, [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], coiling, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Female, Radiology, France, Orbit (control theory), business, Intracranial aneurysms, 030217 neurology & neurosurgery
Abstract: Background and purpose No series reported the mid-term results of Trufill DCS Orbit and Orbit Galaxy detachable coils with independent evaluation. We present the one-year safety and efficacy of these coils in real-life routine clinical practice. Methods A total of 167 patients with 167 aneurysms (39.1% ruptured) were enrolled in the prospective TRULINE study. The primary endpoint was the safety, assessed by the combined morbidity-mortality rate observed since the time of the procedure and up to one-year follow-up. For safety, primary analyses were performed on intent-to-treat population (attempted coils procedure) and all adverse events have been reviewed by an independent Data Safety Monitoring Board. For efficacy, primary analyses were performed on the per-protocol population (patients treated with more than 70% of Trufill coils and not retreated during the follow-up period) and an independent core laboratory evaluated angiographic results. Results At one-year post-procedure, neurologic impairment was observed in 6.5% (95% confidence interval: 3.5–11.8) of the patients, and 2.6% (95% confidence interval: 1.0–6.8) had a permanent neurological deterioration. Three deaths were observed, unrelated to the procedure or coils. At one year, complete occlusion was seen in 52 aneurysms (54.2%), neck remnant in 28 aneurysms (29.2%), and aneurysm remnant in 16 aneurysms (16.7%). During the one-year follow-up, the overall incidence of recurrence was 30.2% with a mean interval of 13.8 ± 4.5 months and the retreatment for major recanalization was needed in nine patients (6.3%). Conclusions The TRULINE study confirms that endovascular coiling with Trufill DCS Orbit and Orbit Galaxy detachable coils is safe and effective.
Published: 2017

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