54 research outputs found

    Perfusion Imaging to select patients with large ischemic core for mechanical thrombectomy

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    International audienceBackground and purpose: Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT.Methods: This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≄70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0-3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI).Results: A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12; 95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups.Conclusion: s In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted

    Sudden coma onset following simultaneous bilateral carotid occlusion

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    Cytotoxic lesion of the corpus callosum as presenting neuroradiological manifestation of COVID-2019 infection

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    Cicaflow étude animale sur l'endothélialisation des stents à diversion de flux: analyse histologique, en tomographie par cohérence optique, et angiographique chez le lapin

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    International audienceObjectifComparer diffĂ©rents stents Ă  diversion flux (flow-diverters) avec des rĂ©gimes d'anti-agrĂ©gation plaquettaire diffĂ©rents, et analyser le processus d'endothĂ©lialisation de ces dispositifs, et les risques thromboemboliques associĂ©s. Comprendre le processus de cicatrisation et son support, est indispensable pour assurer une sĂ©curitĂ© dans le traitement des anĂ©vrismes intracrĂąniens avec ces dispositifs, et dans notre Ă©tude, nous avons utilisĂ© des stents flow-diverters actuellement utilisĂ©s en pratique clinique et ayant des caractĂ©ristiques diffĂ©rentes en termes de coating, certains ayant des recouvrements Ă  visĂ©e anti-thrombotique. Cependant, aucune Ă©tude n'a Ă©tudiĂ© l'impact de ces traitements de surface sur l'endothĂ©lialisation des dispositifs qui est indispensable Ă  la cicatrisation des anĂ©vrismes.MĂ©thodeDans un premier temps, 3 stents Ă  diversion de flux de diffĂ©rents laboratoires avec des caractĂ©ristiques (et des revĂȘtements) diffĂ©rents ont Ă©tĂ© mis en place dans l'aorte de 9 lapins en alternant l'ordre d'implantation dans le sens cranio-caudal. Puis, les lapins ont Ă©tĂ© rĂ©partis parmi un des 3 rĂ©gimes d'anti-agrĂ©gation plaquettaire suivant: absence d'antiagrĂ©gant plaquettaire, simple anti-agrĂ©gation plaquettaire par aspirine, ou double anti-agrĂ©gation plaquettaire par aspirine et ticagrelor. Chacun des groupes de lapins a reçu une combinaison de stents (mis en place dans le sens cranio-caudal), et un traitement antiagrĂ©gant plaquettaire diffĂ©rent. L'animal et le processus d'endothĂ©lialisation du dispositif ont Ă©tĂ© Ă©valuĂ©s prĂ©cocement aprĂšs mise en place du dispositif par des contrĂŽles radiologiques et biologiques. L'OCT est un des Ă©lĂ©ments clĂ©s qui a Ă©tĂ© utilisĂ© pour monitorer cette Ă©tude, en plus des prĂ©lĂšvements histologiques et des analyses en microscopie Ă©lectronique Ă  balayage, et microscopie biphotonique.RĂ©sultatsL'Ă©tude CICALFOW est terminĂ©e, et l'analyse des rĂ©sultats touche Ă  sa fin (article en cours de rĂ©daction).Ce projet nous a permi d'effectuer des analyses qui ne sont pas rĂ©alisables chez l’ĂȘtre humain afin d’évaluer la rĂ©ponse biologique Ă  l'implantation de stents Ă  diversion de flux, ce qui n'a encore jamais Ă©tĂ© fait de façon indĂ©pendante in vivo. L'analyse de la prolifĂ©ration tissulaire sur le dispositif et sa thrombogĂ©nicitĂ©, apporte des connaissances supplĂ©mentaires et une meilleure comprĂ©hension sur les principes du traitement des anĂ©vrysmes cĂ©rĂ©braux par stents Ă  diversion de flux, permettant d'opter et de dĂ©velopper les dispositifs les plus fiables pour l'Homme. Ce travail Ă©value Ă©galement de façon annexe pour la premiĂšre fois l'utilisation du ticagrĂ©lor (brilique) chez le lapin pour des dispositifs endovasculaires utilisĂ©s en NRI, et la pertinence de son utilisation en remplacement du plavix pour l'ensemble des Ă©tudes animales Ă  venir

    Neurophysiological monitoring during endovascular treatment of brain arteriovenous malformations: A meta-analysis

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    Background: Treatment of brain arteriovenous malformations (b-AVM) carries a risk of iatrogenic injury to eloquent brain regions. Intraoperative neuro-monitoring (IONM) has increasingly been used to monitor spontaneous or evoked neural activity during neurosurgery, but its use is not as well characterized in the endovascular treatment (EVT) of b-AVMs. We aimed to provide a systematic review and meta-analysis of studies reporting any neurological deficit after b-AVM embolization with IONM, with or without provocative test (PT), and no-IONM. Methods: This systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from conception until March 1, 2022 for studies evaluating EVT with IONM and PT. Primary outcome was the rate of postoperative neurological deficits in EVT with IONM versus no-IONM, while secondary outcome was the subanalysis of IONM with or without PT. Meta-analysis was performed using the Mantel-Haenszel method and random effects modeling. Results: Six studies reached synthesis. Out of a total of 192 EVT, 14 events occurred. Results demonstrated a nonsignificant trend favoring IONM compared to no-IONM to prevent neurological deficits (OR 0.09, 95% CI 0-4.68). Among the EVT with IONM, PT was done in 411 branches with 10 events (0.2%) despite a negative PT. There was a nonsignificant trend favoring IONM plus PT compared to IONM without PT (OR 0.16, 95% CI 0.02-1.07). Conclusions: Our study suggests that b-AVM EVT with IONM plus PT might reduce rates of postprocedural neurological deficits compared with EVT without IONM. Further studies are needed to confirm these results

    Bifurcation geometry remodelling of vessels in de novo and growing intracranial aneurysms: a multicenter study

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    International audienceBackground Geometrical parameters, including arterial bifurcation angle, tortuosity, and arterial diameters, have been associated with the pathophysiology of intracranial aneurysm (IA) formation. The aim of this study was to investigate whether these parameters were present before or if they resulted from IA formation and growth. Methods Patients from nine academic centers were retrospectively identified if they presented with a de novo IA or a significant IA growth on subsequent imaging. For each patient, geometrical parameters were extracted using a semi-automated algorithm and compared between bifurcations with IA formation or growth (aneurysmal group), and their contralateral side without IA (control group). These parameters were compared at two different times using univariable models, multivariable models, and a sensitivity analysis with paired comparison. Results 46 patients were included with 21 de novo IAs (46%) and 25 significant IA growths (54%). The initial angle was not different between the aneurysmal and control groups (129.7±42.1 vs 119.8±34.3; p=0.264) but was significantly wider at the final stage (140.4±40.9 vs 121.5±34.1; p=0.032), with a more important widening of the aneurysmal angle (10.8±15.8 vs 1.78±7.38; p=0.001). Variations in other parameters were not significant. These results were confirmed by paired comparisons. Conclusion Our study suggests that wider bifurcation angles that have long been deemed causal factors for IA formation or growth may be secondary to IA formation at pathologic bifurcation sites. This finding has implications for our understanding of IA formation pathophysiology
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