PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusio... more PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent.MethodsMulticenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries.ResultsOverall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), resp...
Introduction: The ADAPT (a direct aspiration first pass technique for acute stroke thrombectomy),... more Introduction: The ADAPT (a direct aspiration first pass technique for acute stroke thrombectomy), using large bore aspiration catheters, has been reported to be a fast, safe, simple and effective method of mechanical thrombectomy (MT) that has facilitated the treatment of acute ischemic strokes. Hypothesis: An attempt to determinate the favorable factors leading to a satisfactory reperfusion (TICI 2b/3) with ADAPT in anterior circulation ischemic stroke patients with confirmed large vessel occlusions. Methods: Based on our prospectively gathered database we extracted patients who were admitted for MT in anterior circulation ischemic strokes since August 2013 and for whom ADAPT was used as the first MT option. Patient demographics, initial NIHSS, localization and lateralization of the occlusion, DWI-ASPECTS, IV thrombolysis prior to MT, time from stroke onset to femoral puncture, final TICI score and 3-month mRS were analyzed. Results: ADAPT was effective in achieving a TICI2b/3 in 5...
Introduction: Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation ac... more Introduction: Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation acute ischemic stroke (AIS) improves functional outcome at 3-month. However, elderly patients (≥80 years old) are a growing and fragile population for whom data are scarce. Hypothesis: To determine the factors associated with a favorable functional outcome after endovascular treatment for anterior circulation AIS in elderly patients. Methods: All patients aged≥ 80 years old with anterior circulation AIS and a primary functional independence (mRS<2) referred for MT were included. Reperfusion success was defined as TICI2b/3. Functional outcome at 3-month (mRS), mortality, symptomatic intracranial hemorrhage (SIH), NIHSS at 24h and at discharge were collected. Initial NIHSS, gender, age, AIS and coronaropathy anteriority, glycemia and diabetes, hyperlipemia, hypertension, time to IV thrombolysis, time to groin puncture, successful recanalization, general anesthesia, DWI-ASPECTS, 24h intrac...
Purpose To assess the importance of arterial supply of intracranial dural arteriovenous fistulas ... more Purpose To assess the importance of arterial supply of intracranial dural arteriovenous fistulas (DAVFs) in strategizing the endovascular treatment. Material & Methods Forty-two patients treated for DAVFs between January 1997 and August 2000, were reviewed retrospectively. The clinical and angiographic aspects were analyzed. Patients were divided into three separate groups based on the arterial supply of the DAVF: osteo-dural (transosseous and dural arteries), duro-dural (exclusively dural arteries), and duro-pial (dural and pial supply). The endovascular procedures were analyzed regarding the approach (arterial vs venous). The final outcome of the treatment was considered complete or partial, according to the control angiogram. Results Osteo-dural and duro-dural supply tended to predominate in the convexity, while duro-pial supply predominated around the dural and cavernous sinuses. When there was a predominant osteo-dural or duro-dural supply, the venous approach had been preferre...
IntroductionEndovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is... more IntroductionEndovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT.MethodsA multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (≥90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications...
Introduction: Previous studies showed that mechanical thrombectomy (MT) is safe and effective in ... more Introduction: Previous studies showed that mechanical thrombectomy (MT) is safe and effective in tandem steno-occlusive lesion. The effect on initial tandem extracranial internal carotid artery (ICA) lesion severity on outcome is unknown. In this study, we aimed to compare angiographic, functional and hemorrhagic outcomes according to initial lesion severity Methods: A multicenter international retrospective study that included 18 stroke centers. Patients were included if they presented with ischemic stroke due to tandem lesion and were treated with MT with or without carotid stenting. Tandem lesion was defined as proximal intracranial occlusion (distal ICA, M1/M2) and extracranial internal carotid artery (ICA) occlusion or ≥90% stenosis NASCET. We divided patients into two groups based on extracranial ICA lesion severity (severe stenosis vs. complete occlusion) at the first angiographic run. Outcome measures included 90 day mRS, final mTICI score, procedural complications and sympt...
Background and purposeFlow diversion is an innovative and increasingly used endovascular treatmen... more Background and purposeFlow diversion is an innovative and increasingly used endovascular treatment for intracranial aneurysms. Its initial evaluation with the first devices available showed good efficacy of this treatment with variable safety results. The Flow Direction Endoluminal Device (FRED) has a specific design and was evaluated in a single-arm, multicenter, prospective, Good Clinical Practice study: SAFE (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment). This analysis reports clinical results at 1 year and anatomical results at 6 months and 1 year.MethodsPatients with unruptured and recanalized aneurysms located in the anterior circulation treated with FRED and FRED Jr were prospectively included. A Clinical Event Committee and a Core Laboratory independently evaluated clinical outcome and anatomical results.ResultsThirteen interventional neuroradiology centers included 103 patients/aneurysms. Aneurysm locations were supraclinoid internal carotid art...
Journal of neurointerventional surgery, Jan 24, 2017
To evaluate the safety and effectiveness of the low-profile braided intracranial stents called th... more To evaluate the safety and effectiveness of the low-profile braided intracranial stents called the Low Profile Visualized Intraluminal Support (LVIS) devices for stent-assisted coil embolization of wide-necked intracranial aneurysms. This was a prospective, multicenter, observational study of unruptured and ruptured intracranial aneurysms treated with the LVIS devices. Imaging and clinical data were independently analyzed respectively by CoreLab and Clinical Event Committee. Primary endpoints were clinical safety, effectiveness, and angiographic stability of the results at 6 and 18 months. Ten centers participated in the study; 102 patients were included and 90 patients (42.2% men, 57.8% women) were eventually analyzed, among which 27 (30.0%) had multiple aneurysms. Twenty-three (25.6%) were ruptured aneurysms, four of which (4.4%) were treated in the acute phase. One aneurysm was treated per patient; 92 LVIS and LVIS Jr devices were placed overall. The total aneurysm occlusion rate...
Objectif Une reperfusion TICI 2b (quasi-complete) ou TICI 3 (complete) est consideree comme un bo... more Objectif Une reperfusion TICI 2b (quasi-complete) ou TICI 3 (complete) est consideree comme un bon resultat angiographique et reconnue comme un facteur pronostic majeur apres traitement endovasculaire des infarctus cerebraux. Cependant, il n’est pas clairement etabli que le pronostic fonctionnel entre ces deux groupes soit identique. L’objectif de cette etude etait de comparer le pronostic fonctionnel des patients presentant une recanalisation TICI 3 avec ceux presentant une recanalisation TICI 2b. Materiels et methodes Etude retrospective bicentrique a partir de donnees angiographiques et cliniques collectees prospectivement. Cent quatre-vingt-deux patients presentant une occlusion intracrânienne (artere carotide interne et/ou artere cerebrale moyenne) traites par voie endovasculaire dans 2 centres avec un score de reperfusion final TICI 2b ou TICI 3 ont ete evalues a 3 mois selon le score de Rankin modifie (mRS). Les caracteristiques initiales (âge, score NIH, delai debut des symptomes-reperfusion, ASPECTS), le devenir clinique favorable (mRS ≤ 2) ou tres favorable (mRS 0-1), le taux d’hemorragie intracrânienne et la mortalite ont ete recueillis et compares par analyse uni-, puis multivariee. Resultats Les patients avec un score de recanalisation TICI 3 avaient un meilleur pronostic compares aux TICI 2b avec respectivement 75,9 % (72/95) contre 50,6 % (44/87) (p = 0,0004) de patients avec un mRS ≤ 2 et 63,1 % (60/95) vs 40,2 % (35/87) (p = 0,002) de patients avec un mRS 0-1. Les caracteristiques cliniques, la mortalite et le taux d’hemorragie etaient identique entre les 2 groupes. Conclusion Les patients presentant une reperfusion TICI 3 ont un meilleur pronostic fonctionnel que les patients TICI 2b. Ces resultats incitent a considerer dans les futures etudes cliniques les patients TICI 2b et TICI 3 de facon separee.
Resume Introduction Les anevrysmes de l’artere cerebrale moyenne (ACM) presentent souvent une par... more Resume Introduction Les anevrysmes de l’artere cerebrale moyenne (ACM) presentent souvent une particularite anatomique jugee jadis non favorable au traitement endovasculaire ce qui a souvent amene a leur clipage chirurgical. L’etude ISAT, bien qu’elle concerne les anevrysmes rompus, a compare les risques de l’embolisation a ceux du clipage chirurgical seulement lorsque les deux techniques etaient envisageables. Or, les idees recues par certains operateurs endovasculaires quant a l’impossibilite de l’embolisation, a reduit considerablement le nombre d’anevrysmes de l’ACM integres dans cette etude. Nous rapportons notre experience dans le traitement endovasculaire des anevrysmes de l’ACM non rompus et nous la comparons aux resultats de la bibliographie neurochirurgicale. Patients et Methodes Cette etude retrospective concerne les patients porteurs d’anevrysmes de l’ACM non rompus qui ont ete traites dans notre service entre Novembre 1998 et Decembre 2003. Une imagerie rotationelle a ete realisee dans tous les cas afin de determiner precisement les rapports entre l’anevrysme et son artere porteuse. En fin de procedures et aux controles angiographiques ulterieurs, le degre de l’occlusion du sac anevrysmal a ete estime selon la classification de Raymond. L’etat neurologique a ete evalue selon l’echelle de Rankin et reevalue a chaque hospitalisation pour controle arteriographique. Resultats 84 patients consecutifs porteurs de 100 anevrysmes non rompus de l’ACM sont rapportes. 90 anevrysmes ont pu etre traites par voie endovasculaire. 9 anevrysmes (9 %) ont ete confies au traitement chirurgical, d’emblee apres la visualisation de l’imagerie 3D (6 cas) ou apres echec de l’embolisation (3 cas). Compte tenu la configuration tres complexe de l’anevrysme, nous n’avons retenu aucun traitement invasif dans un cas. 4 anevrysmes geants ont ete traites par l’occlusion de l’axe porteur et 86 anevrysmes ont ete traites selectivement. La technique de remodelage au ballonnet a ete utilisee dans 50 cas (58,1 %). 8 patients (8,9 %) ont presente un deficit neurologique suite au traitement. Dans 6 cas (6,7 %) le deficit etait transitoire et dans 2 cas (2,2 %) permanent. Aucune mortalite n’a ete relevee dans cette serie. Des 86 anevrysmes selectivement traites, 75 (87,2 %) appartenaient aux groupes A et B de la classification de Raymond. 71 anevrysmes (82,5 %) traites ont ete controles entre 3 et 58 mois avec une moyenne de 19,6 mois. La recanalisation a ete observee dans 18 cas (25,3 %). Dans 7 cas (9,8 %) elle etait majeure et a necessite un retraitement. Aucune complication neurologique n’a ete relevee au decours des procedures de retraitement. Conclusion Les etudes multicentriques comparatives entre le traitement endovasculaire et la chirurgie d’ouverture (ISAT, ISUIA) rapportees ces dernieres annees ont oriente notre strategie face au traitement des anevrysmes intracrâniens. L’embolisation est a considerer en premiere intention lorsque les deux techniques, endovasculaire et chirurgicale, sont envisageables. Nous rapportons la faisabilite du traitement endovasculaire des anevrysmes de l’ACM jadis considere comme inenvisageable. L’imagerie tridimensionnelle per therapeutique et la maitrise de la technique de remodelage par ballonnet nous ont ete d’un apport fondamental dans la gestion de ces anevrysmes.
Background and Purpose— Stent-assisted coiling has expanded the treatment of intracranial aneurys... more Background and Purpose— Stent-assisted coiling has expanded the treatment of intracranial aneurysms, but the rates of procedure-related neurological complications and the incidence of angiographic aneurysm recurrence of this novel treatment are not yet well known. We present our experience with stent-assisted coiling with special emphasis on procedure-related neurological complications and incidence of angiographic recurrence. Methods— Clinical and angiographic outcomes of 1137 consecutive patients (1325 aneurysms) coiled with and without stent-assisted coiling technique from January 2002 to January 2009 were retrospectively analyzed. Results— There were 1109 aneurysms (83.5%) treated without and 216 (16.5%) treated with stents (15 of 216; 6.9% balloon-expandable versus 201 of 216; 93.1% self-expandable stents). Stents were delivered after coiling in 55.1% (119 of 216) and before coiling in 44.9% (97 of 216) of the cases. Permanent neurological procedure-related complications occurr...
Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with t... more 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 evalua...
Background and Purpose: The best anesthetic management for mechanical thrombectomy of large vesse... more Background and Purpose: The best anesthetic management for mechanical thrombectomy of large vessel occlusion strokes is still uncertain and could impact the quality of reperfusion and clinical outcome. We aimed to compare the efficacy and safety outcomes between local anesthesia (LA) and conscious sedation in a large cohort of acute ischemic stroke patients with anterior circulation large vessel occlusion strokes treated with mechanical thrombectomy in current, everyday clinical practice. Methods: Patients undergoing mechanical thrombectomy for anterior large vessel occlusion strokes at 4 comprehensive stroke centers in France between January 1, 2018, and December 31, 2018, were pooled from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. Intention-to-treat and per-protocol analyses were used. Results: Among the included 1034 patients, 762 were included in the conscious sedation group and 272 were included in the LA grou...
Background and Purpose: Endovascular therapy for tandem occlusion strokes of the anterior circula... more Background and Purpose: Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice. Methods: Individual patients’ data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA l...
PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusio... more PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent.MethodsMulticenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries.ResultsOverall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), resp...
Introduction: The ADAPT (a direct aspiration first pass technique for acute stroke thrombectomy),... more Introduction: The ADAPT (a direct aspiration first pass technique for acute stroke thrombectomy), using large bore aspiration catheters, has been reported to be a fast, safe, simple and effective method of mechanical thrombectomy (MT) that has facilitated the treatment of acute ischemic strokes. Hypothesis: An attempt to determinate the favorable factors leading to a satisfactory reperfusion (TICI 2b/3) with ADAPT in anterior circulation ischemic stroke patients with confirmed large vessel occlusions. Methods: Based on our prospectively gathered database we extracted patients who were admitted for MT in anterior circulation ischemic strokes since August 2013 and for whom ADAPT was used as the first MT option. Patient demographics, initial NIHSS, localization and lateralization of the occlusion, DWI-ASPECTS, IV thrombolysis prior to MT, time from stroke onset to femoral puncture, final TICI score and 3-month mRS were analyzed. Results: ADAPT was effective in achieving a TICI2b/3 in 5...
Introduction: Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation ac... more Introduction: Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation acute ischemic stroke (AIS) improves functional outcome at 3-month. However, elderly patients (≥80 years old) are a growing and fragile population for whom data are scarce. Hypothesis: To determine the factors associated with a favorable functional outcome after endovascular treatment for anterior circulation AIS in elderly patients. Methods: All patients aged≥ 80 years old with anterior circulation AIS and a primary functional independence (mRS<2) referred for MT were included. Reperfusion success was defined as TICI2b/3. Functional outcome at 3-month (mRS), mortality, symptomatic intracranial hemorrhage (SIH), NIHSS at 24h and at discharge were collected. Initial NIHSS, gender, age, AIS and coronaropathy anteriority, glycemia and diabetes, hyperlipemia, hypertension, time to IV thrombolysis, time to groin puncture, successful recanalization, general anesthesia, DWI-ASPECTS, 24h intrac...
Purpose To assess the importance of arterial supply of intracranial dural arteriovenous fistulas ... more Purpose To assess the importance of arterial supply of intracranial dural arteriovenous fistulas (DAVFs) in strategizing the endovascular treatment. Material & Methods Forty-two patients treated for DAVFs between January 1997 and August 2000, were reviewed retrospectively. The clinical and angiographic aspects were analyzed. Patients were divided into three separate groups based on the arterial supply of the DAVF: osteo-dural (transosseous and dural arteries), duro-dural (exclusively dural arteries), and duro-pial (dural and pial supply). The endovascular procedures were analyzed regarding the approach (arterial vs venous). The final outcome of the treatment was considered complete or partial, according to the control angiogram. Results Osteo-dural and duro-dural supply tended to predominate in the convexity, while duro-pial supply predominated around the dural and cavernous sinuses. When there was a predominant osteo-dural or duro-dural supply, the venous approach had been preferre...
IntroductionEndovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is... more IntroductionEndovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT.MethodsA multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (≥90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications...
Introduction: Previous studies showed that mechanical thrombectomy (MT) is safe and effective in ... more Introduction: Previous studies showed that mechanical thrombectomy (MT) is safe and effective in tandem steno-occlusive lesion. The effect on initial tandem extracranial internal carotid artery (ICA) lesion severity on outcome is unknown. In this study, we aimed to compare angiographic, functional and hemorrhagic outcomes according to initial lesion severity Methods: A multicenter international retrospective study that included 18 stroke centers. Patients were included if they presented with ischemic stroke due to tandem lesion and were treated with MT with or without carotid stenting. Tandem lesion was defined as proximal intracranial occlusion (distal ICA, M1/M2) and extracranial internal carotid artery (ICA) occlusion or ≥90% stenosis NASCET. We divided patients into two groups based on extracranial ICA lesion severity (severe stenosis vs. complete occlusion) at the first angiographic run. Outcome measures included 90 day mRS, final mTICI score, procedural complications and sympt...
Background and purposeFlow diversion is an innovative and increasingly used endovascular treatmen... more Background and purposeFlow diversion is an innovative and increasingly used endovascular treatment for intracranial aneurysms. Its initial evaluation with the first devices available showed good efficacy of this treatment with variable safety results. The Flow Direction Endoluminal Device (FRED) has a specific design and was evaluated in a single-arm, multicenter, prospective, Good Clinical Practice study: SAFE (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment). This analysis reports clinical results at 1 year and anatomical results at 6 months and 1 year.MethodsPatients with unruptured and recanalized aneurysms located in the anterior circulation treated with FRED and FRED Jr were prospectively included. A Clinical Event Committee and a Core Laboratory independently evaluated clinical outcome and anatomical results.ResultsThirteen interventional neuroradiology centers included 103 patients/aneurysms. Aneurysm locations were supraclinoid internal carotid art...
Journal of neurointerventional surgery, Jan 24, 2017
To evaluate the safety and effectiveness of the low-profile braided intracranial stents called th... more To evaluate the safety and effectiveness of the low-profile braided intracranial stents called the Low Profile Visualized Intraluminal Support (LVIS) devices for stent-assisted coil embolization of wide-necked intracranial aneurysms. This was a prospective, multicenter, observational study of unruptured and ruptured intracranial aneurysms treated with the LVIS devices. Imaging and clinical data were independently analyzed respectively by CoreLab and Clinical Event Committee. Primary endpoints were clinical safety, effectiveness, and angiographic stability of the results at 6 and 18 months. Ten centers participated in the study; 102 patients were included and 90 patients (42.2% men, 57.8% women) were eventually analyzed, among which 27 (30.0%) had multiple aneurysms. Twenty-three (25.6%) were ruptured aneurysms, four of which (4.4%) were treated in the acute phase. One aneurysm was treated per patient; 92 LVIS and LVIS Jr devices were placed overall. The total aneurysm occlusion rate...
Objectif Une reperfusion TICI 2b (quasi-complete) ou TICI 3 (complete) est consideree comme un bo... more Objectif Une reperfusion TICI 2b (quasi-complete) ou TICI 3 (complete) est consideree comme un bon resultat angiographique et reconnue comme un facteur pronostic majeur apres traitement endovasculaire des infarctus cerebraux. Cependant, il n’est pas clairement etabli que le pronostic fonctionnel entre ces deux groupes soit identique. L’objectif de cette etude etait de comparer le pronostic fonctionnel des patients presentant une recanalisation TICI 3 avec ceux presentant une recanalisation TICI 2b. Materiels et methodes Etude retrospective bicentrique a partir de donnees angiographiques et cliniques collectees prospectivement. Cent quatre-vingt-deux patients presentant une occlusion intracrânienne (artere carotide interne et/ou artere cerebrale moyenne) traites par voie endovasculaire dans 2 centres avec un score de reperfusion final TICI 2b ou TICI 3 ont ete evalues a 3 mois selon le score de Rankin modifie (mRS). Les caracteristiques initiales (âge, score NIH, delai debut des symptomes-reperfusion, ASPECTS), le devenir clinique favorable (mRS ≤ 2) ou tres favorable (mRS 0-1), le taux d’hemorragie intracrânienne et la mortalite ont ete recueillis et compares par analyse uni-, puis multivariee. Resultats Les patients avec un score de recanalisation TICI 3 avaient un meilleur pronostic compares aux TICI 2b avec respectivement 75,9 % (72/95) contre 50,6 % (44/87) (p = 0,0004) de patients avec un mRS ≤ 2 et 63,1 % (60/95) vs 40,2 % (35/87) (p = 0,002) de patients avec un mRS 0-1. Les caracteristiques cliniques, la mortalite et le taux d’hemorragie etaient identique entre les 2 groupes. Conclusion Les patients presentant une reperfusion TICI 3 ont un meilleur pronostic fonctionnel que les patients TICI 2b. Ces resultats incitent a considerer dans les futures etudes cliniques les patients TICI 2b et TICI 3 de facon separee.
Resume Introduction Les anevrysmes de l’artere cerebrale moyenne (ACM) presentent souvent une par... more Resume Introduction Les anevrysmes de l’artere cerebrale moyenne (ACM) presentent souvent une particularite anatomique jugee jadis non favorable au traitement endovasculaire ce qui a souvent amene a leur clipage chirurgical. L’etude ISAT, bien qu’elle concerne les anevrysmes rompus, a compare les risques de l’embolisation a ceux du clipage chirurgical seulement lorsque les deux techniques etaient envisageables. Or, les idees recues par certains operateurs endovasculaires quant a l’impossibilite de l’embolisation, a reduit considerablement le nombre d’anevrysmes de l’ACM integres dans cette etude. Nous rapportons notre experience dans le traitement endovasculaire des anevrysmes de l’ACM non rompus et nous la comparons aux resultats de la bibliographie neurochirurgicale. Patients et Methodes Cette etude retrospective concerne les patients porteurs d’anevrysmes de l’ACM non rompus qui ont ete traites dans notre service entre Novembre 1998 et Decembre 2003. Une imagerie rotationelle a ete realisee dans tous les cas afin de determiner precisement les rapports entre l’anevrysme et son artere porteuse. En fin de procedures et aux controles angiographiques ulterieurs, le degre de l’occlusion du sac anevrysmal a ete estime selon la classification de Raymond. L’etat neurologique a ete evalue selon l’echelle de Rankin et reevalue a chaque hospitalisation pour controle arteriographique. Resultats 84 patients consecutifs porteurs de 100 anevrysmes non rompus de l’ACM sont rapportes. 90 anevrysmes ont pu etre traites par voie endovasculaire. 9 anevrysmes (9 %) ont ete confies au traitement chirurgical, d’emblee apres la visualisation de l’imagerie 3D (6 cas) ou apres echec de l’embolisation (3 cas). Compte tenu la configuration tres complexe de l’anevrysme, nous n’avons retenu aucun traitement invasif dans un cas. 4 anevrysmes geants ont ete traites par l’occlusion de l’axe porteur et 86 anevrysmes ont ete traites selectivement. La technique de remodelage au ballonnet a ete utilisee dans 50 cas (58,1 %). 8 patients (8,9 %) ont presente un deficit neurologique suite au traitement. Dans 6 cas (6,7 %) le deficit etait transitoire et dans 2 cas (2,2 %) permanent. Aucune mortalite n’a ete relevee dans cette serie. Des 86 anevrysmes selectivement traites, 75 (87,2 %) appartenaient aux groupes A et B de la classification de Raymond. 71 anevrysmes (82,5 %) traites ont ete controles entre 3 et 58 mois avec une moyenne de 19,6 mois. La recanalisation a ete observee dans 18 cas (25,3 %). Dans 7 cas (9,8 %) elle etait majeure et a necessite un retraitement. Aucune complication neurologique n’a ete relevee au decours des procedures de retraitement. Conclusion Les etudes multicentriques comparatives entre le traitement endovasculaire et la chirurgie d’ouverture (ISAT, ISUIA) rapportees ces dernieres annees ont oriente notre strategie face au traitement des anevrysmes intracrâniens. L’embolisation est a considerer en premiere intention lorsque les deux techniques, endovasculaire et chirurgicale, sont envisageables. Nous rapportons la faisabilite du traitement endovasculaire des anevrysmes de l’ACM jadis considere comme inenvisageable. L’imagerie tridimensionnelle per therapeutique et la maitrise de la technique de remodelage par ballonnet nous ont ete d’un apport fondamental dans la gestion de ces anevrysmes.
Background and Purpose— Stent-assisted coiling has expanded the treatment of intracranial aneurys... more Background and Purpose— Stent-assisted coiling has expanded the treatment of intracranial aneurysms, but the rates of procedure-related neurological complications and the incidence of angiographic aneurysm recurrence of this novel treatment are not yet well known. We present our experience with stent-assisted coiling with special emphasis on procedure-related neurological complications and incidence of angiographic recurrence. Methods— Clinical and angiographic outcomes of 1137 consecutive patients (1325 aneurysms) coiled with and without stent-assisted coiling technique from January 2002 to January 2009 were retrospectively analyzed. Results— There were 1109 aneurysms (83.5%) treated without and 216 (16.5%) treated with stents (15 of 216; 6.9% balloon-expandable versus 201 of 216; 93.1% self-expandable stents). Stents were delivered after coiling in 55.1% (119 of 216) and before coiling in 44.9% (97 of 216) of the cases. Permanent neurological procedure-related complications occurr...
Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with t... more 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 evalua...
Background and Purpose: The best anesthetic management for mechanical thrombectomy of large vesse... more Background and Purpose: The best anesthetic management for mechanical thrombectomy of large vessel occlusion strokes is still uncertain and could impact the quality of reperfusion and clinical outcome. We aimed to compare the efficacy and safety outcomes between local anesthesia (LA) and conscious sedation in a large cohort of acute ischemic stroke patients with anterior circulation large vessel occlusion strokes treated with mechanical thrombectomy in current, everyday clinical practice. Methods: Patients undergoing mechanical thrombectomy for anterior large vessel occlusion strokes at 4 comprehensive stroke centers in France between January 1, 2018, and December 31, 2018, were pooled from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. Intention-to-treat and per-protocol analyses were used. Results: Among the included 1034 patients, 762 were included in the conscious sedation group and 272 were included in the LA grou...
Background and Purpose: Endovascular therapy for tandem occlusion strokes of the anterior circula... more Background and Purpose: Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice. Methods: Individual patients’ data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA l...
Uploads