GREAT — a randomized aneurysm trial. Design of a randomized controlled multicenter study comparing HydroSoft/HydroFrame and bare platinum coils for endovascular aneurysm treatment

International audienceThe effectiveness of a hybrid hydrogel platinum detachable coil (HydroCoil; MicroVention Inc., Tustin, CA) for endovascular aneurysm treatment has been proven in a recently published RCT. Due to technical restrictions (coil stiffness, time restriction for placement), the HydroSoft coil as well as a corresponding 3D framing coil, the HydroFrame coil (MicroVention Inc., Tustin, CA), a class of new softer coils containing less hydrogel and swelling more slowly than the HydroCoil, have been developed and brought to clinical practice. The present study aims to compare the effectiveness of endovascular aneurysm treatment with coil embolization between patients allocated HydroSoft/HydroFrame versus bare platinum coiling. GREAT is a randomized, controlled, multicentre trial in patients bearing cerebral aneurysms to be treated by coil embolization. Eligible patients were randomized to either coil embolization with HydroSoft/HydroFrame coils (>50 % of administered coil length), or bare platinum coils. Inclusion criteria were as follows: age 18-75, ruptured aneurysm (WFNS 1-3) and unruptured aneurysm with a diameter between 4 and 12 mm. Anatomy such that endovascular coil occlusion deemed possible and willingness of the neurointerventionalist to use either HydroSoft/HydroFrame or bare platinum coils. Exclusion criteria were as follows: aneurysms previously treated by coiling or clipping. Primary endpoint is a composite of major aneurysm recurrence on follow-up angiography and poor clinical outcome (modified Rankin scale 3 or higher), both assessed at 18 months post treatment. Risk differences for poor outcomes will be estimated in a modified intention-to-treat analysis stratified by rupture status (DRKS-ID: DRKS00003132)

Sclérose percutanée des malformations lymphatiques superficielles (étude rétrospective de 48 cas)

TOURS-BU Médecine (372612103) / SudocSudocFranceF

Apport de la radiologie interventionnelle dans la prise en charge des malformations veineuses superficielles (étude de 67 cas)

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Molecular minimal residual disease in resected non-small cell lung cancer (NSCLC): results of specifically designed interventional clinical trials eagerly awaited

International audienceNo abstract availabl

Prospective evaluation of two screening methods for molecular testing of metastatic melanoma: Diagnostic performance of BRAF V600E immunohistochemistry and of a NRAS-BRAF fully automated real-time PCR-based assay.

Screening for theranostic biomarkers is mandatory for the therapeutic management of cutaneous melanoma. BRAF and NRAS genes must be tested in routine clinical practice. The methods used to identify these alterations must be sensitive to detect mutant alleles in a background of wild type alleles, and specific to identify the correct mutation. They should not require too much material, since in some cases the available samples are small biopsies. Finally, they should also be quick enough to allow a rapid therapeutic management of patients. Sixty five consecutive formalin-fixed paraffin-embedded (FFPE) melanoma samples were prospectively tested for BRAF mutations with the VE1 (anti-BRAF V600E) antibody and for both BRAF and NRAS mutations with the Idylla NRAS-BRAF-EGFR S492R Mutation Assay cartridges. Results were compared to our routine laboratory practice, allele specific amplification and/or Sanger sequencing and discordant cases confirmed by digital PCR. Excluding discordant by-design-mutations, system failures and DNA quantity or quality failures, BRAF IHC demonstrated an overall concordance of 89% for BRAF V600E mutation detection, the Idylla system gave a concordance of 100% for BRAF mutation detection and of 92.1% for NRAS mutation detection when compared to our reference. When discrepancies were observed, all routine results were confirmed by digital PCR. Finally, BRAF IHC positive predictive value (PPV) was of 82% and negative predictive value (NPV) of 92%. The Idylla cartridges showed a PPV and NPV of both 100% for BRAF mutation detection and a PPV and NPV of 100% and 87% respectively, for NRAS mutation detection. In conclusion, BRAF V600E immunohistochemistry is efficient for detecting the V600E mutation, but negative cases should be further evaluated by molecular approaches for other BRAF mutations. Since 3 NRAS mutations have not been detected by the Idylla NRAS-BRAF-EGFR S492R Mutation Assay, these cartridges should not be used as a substitute for traditional molecular methods in the conventional patient therapeutic care process without the expertise needed to have a critical view of the produced results

Angiomes superficiels : traitements

Article in pressNational audienceBeta-blockers are efficient for treating complicated infantile hemangiomas; propranolol is currently the first-line treatment. Superficial vascular malformations have to be managed by multidisciplinary teams. T2 FAT-SAT MRI is the most interesting sequence to explore superficial vascular malformations. Recent advances in molecular biology allow exploring new genetic mutations which could be involved in vascular malformations and be the target of new drugs. Mammalian target of rapamycin (mTOR) inhibitors are promising drugs for slow-flow malformations. Arteriovenous malformations are aggressive lesions with very few treatment options.Les bêta-bloquants sont très efficaces dans le traitement des hémangiomes infantiles compliqués ; le propanolol constitue aujourd'hui le traitement de première ligne. La prise en charge des patients porteurs de malformations vasculaires superficielles doit se faire en consultation pluridisciplinaire dans un centre de référence ou de compétence. La séquence IRM T2 avec saturation de graisse (T2 FAT-SAT) est la séquence de choix pour l'exploration des malformations vasculaires par imagerie en coupe. Les progrès réalisés en biologie moléculaire ont permis d'identifier de nouvelles mutations génétiques potentiellement impliquées dans la survenue de malformations vasculaires, qui pourront être la cible de nouvelles thérapeutiques. Les études récentes sont marquées par l'intérêt porté aux inhibiteurs de mammalian target of rapamycin (mTOR) dans la prise en charge des malformations vasculaires à flux lents. Les malformations artério-veineuses sont des lésions vasculaires à haut débit, très agressives pour lesquelles les traitements disponibles aujourd'hui sont encore limités

Angiomes de la bouche

National audienceHemangiomas are benign tumors that occur after a few days of life. The capillary malformations are isolated or constitute part of a complex angiomatosis. Venous malformations are low flow malformations with a blue color. They are of different types. The arteriovenous malformations are high flow lesions. They are difficult to treat. Lymphatic malformations are micro- or macrocystic. MRI is the gold standard for explorations. Some patients undergo maxillofacial surgical procedures and interventional radiology techniques for venous malformations, macrocystic lymphatic malformations, arteriovenous malformations.Les hémangiomes sont des tumeurs bénignes qui apparaissent après quelques jours de vie. Les malformations capillaires sont isolées ou font partie d’une angiomatose complexe. Les malformations veineuses sont à bas débit, elles ont une couleur bleue. Elles sont de différents types. Les malformations artério-veineuses sont à haut débit. Elles sont difficiles à traiter. Les malformations lymphatiques sont micro- ou macrokystiques. L’IRM est l’examen de référence. Certains patients nécessitent des interventions de chirurgie maxillofaciale et l’utilisation de techniques de radiologie interventionnelle pour des malformations veineuses, des malformations lymphatiques macrokystiques, certaines malformations artério-veineuses

Long‐term follow‐up of intracranial arteriovenous malformations with frontal capillary malformation (Wyburn‐Mason syndrome or Bonnet‐Dechaume‐Blanc syndrome): three case reports

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