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Your search keyword '"Desal, Hubert"' showing total 6 results
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6 results on '"Desal, Hubert"'

1. Safety and efficacy of stent retrievers plus contact aspiration in patients with acute ischaemic anterior circulation stroke and positive susceptibility vessel sign in France (VECTOR): a randomised, single-blind trial.

Author

Bourcier R, Marnat G, Dargazanli C, Zhu F, Consoli A, Shotar E, Premat K, Eugene F, Janot K, L'Allinec V, Ognard J, Desilles JP, Blanc R, Gentric JC, Bourdain F, Labreuche J, Liao L, Clarençon F, Barreau X, Ifergan H, Hak JF, Kerleroux B, Pop R, Soize S, Bricout N, Caroff J, Richter JS, Desal H, Lapergue B, and Rouchaud A

Subjects
Humans, Female, Male, Aged, France, Single-Blind Method, Middle Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures instrumentation, Prospective Studies, Treatment Outcome, Suction methods, Ischemic Stroke surgery, Ischemic Stroke therapy, Ischemic Stroke diagnostic imaging, Thrombectomy methods, Thrombectomy instrumentation, Stents
Abstract

Background: Positive susceptibility vessel sign (SVS) in patients with acute ischaemic stroke has been associated with friable red blood cell-rich clots and more effective recanalisation using stent retrievers versus contact aspiration. We compared the safety and efficacy of stent retrievers plus contact aspiration (combined technique) versus contact aspiration alone as the first-line thrombectomy technique in patients with acute ischaemic anterior circulation stroke and SVS-positive occlusions., Methods: Adaptive Endovascular Strategy to the Clot MRI in Large Intracranial Vessel Occlusion (VECTOR) was a prospective, randomised, open-label study with blinded evaluation. Patients with SVS-positive anterior circulation occlusions on pretreatment MRI and arterial puncture within 24 h of symptom onset were enrolled from 22 centres in France. A centralised web-based method was used by interventional neuroradiologists for dynamic randomisation by minimisation. Patients were randomly assigned 1:1 to the combined technique or contact aspiration alone. The primary outcome was expanded Thrombolysis in Cerebral Infarction (eTICI) grade 2c or 3 reperfusion after three or fewer passes on post-treatment angiogram, adjudicated by a blinded independent central imaging core laboratory. The intention-to-treat population was used to assess the primary and secondary outcomes. This trial is registered with ClinicalTrials.gov (NCT04139486) and is complete., Findings: Between Nov 26, 2019, and Feb 14, 2022, 526 patients were enrolled, of whom 521 constituted the intention-to-treat population (combined technique, n=263; contact aspiration alone, n=258). The median age of participants was 74·9 years (IQR 64·4-83·3); 284 (55%) were female and 237 (45%) male. The primary outcome did not differ significantly between groups (152 [58%] of 263 patients for the combined technique vs 135 [52%] of 258 for contact aspiration; odds ratio [OR] 1·27; 95% CI 0·88-1·83; p=0·19). Procedure-related adverse events occurred in 32 (12%) of 263 patients in the combined technique group and 27 (11%) of 257 in the contact aspiration group (OR 1·14; 0·65-2·00; p=0·65). The most common adverse event was intracerebral haemorrhage (146 [56%] of 259 patients for the combined technique vs 123 [49%] of 251 for contact aspiration; OR 1·32; 0·91-1·90; p=0·13). All-cause mortality at 3 months occurred in 57 (23%) of 251 patients in the combined technique group and 48 (19%) of 247 in the contact aspiration group (OR 1·19; 0·76-1·86; p=0·45), none of which was treatment-related., Interpretation: The results of the VECTOR trial do not show superiority of the combined stent retriever plus contact aspiration technique over contact aspiration alone in patients with SVS-positive occlusion with respect to achieving eTICI 2c-3 within three passes. These findings support the use of either the combined technique or contact aspiration alone as the initial thrombectomy strategy in patients with acute anterior circulation stroke with SVS on pretreatment MRI., Funding: Cerenovus., Competing Interests: Declaration of interests RB reports paid lectures for Microvention, Medtronic, Penumbra, and Johnson & Johnson (Cerenovus). GM reports consulting for Balt, Microvention Europe, and Stryker Neurovascular; and paid lectures for Phenox, Medtronic, Johnson & Johnson (Cerenovus), and Bracco. KJ reports consulting for Balt. J-CG reports consulting for Balt, Stryker, Phenox, and Medtronic. FC reports consulting for Medtronic, Balt Extrusion, Penumbra, Microvention, and Stryker; being a board member of Artedrone; and having stock options with Intradys and Letsgetproof. XB reports consulting for Stryker and Microvention. SS reports consulting for Phillips Healthcare; support for attending meetings and travel from Cerenovus, Microvention, and Balt; and paid lectures for EISAI. JSR reports paid lectures for Medtronic and Johnson & Johnson (Cerenovus). All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Published
2024
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2. Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER2 Randomized Clinical Trial.

Author

Lapergue B, Blanc R, Costalat V, Desal H, Saleme S, Spelle L, Marnat G, Shotar E, Eugene F, Mazighi M, Houdart E, Consoli A, Rodesch G, Bourcier R, Bracard S, Duhamel A, Ben Maacha M, Lopez D, Renaud N, Labreuche J, Gory B, and Piotin M

Subjects
Aged, Arterial Occlusive Diseases complications, Combined Modality Therapy, Female, Humans, Ischemic Stroke etiology, Ischemic Stroke therapy, Male, Reperfusion methods, Treatment Outcome, Arterial Occlusive Diseases surgery, Device Removal, Ischemic Stroke surgery, Stents, Thrombectomy methods
Abstract

Importance: Mechanical thrombectomy using a stent retriever or contact aspiration is widely used for treatment of patients with acute ischemic stroke due to anterior circulation large vessel occlusion, but the additional benefit of combining contact aspiration with stent retriever is uncertain., Objective: To determine whether mechanical thrombectomy for treatment of anterior circulation large vessel occlusion stroke with initial contact aspiration and stent retriever combined results in better final angiographic outcome than with standard stent retriever alone., Design, Setting, and Participants: This trial was a multicenter randomized, open-label, blinded end point evaluation that enrolled 408 patients from October 16, 2017, to May 29, 2018, in 11 French comprehensive stroke centers, with a 12-month outcome follow-up. Patients with a large vessel occlusion in the anterior circulation were included up to 8 hours after symptom onset. The final date of follow-up was June, 19, 2019., Interventions: Patients were randomly assigned (1:1 allocation) to receive initial thrombectomy with contact aspiration and stent retriever combined (205) or stent retriever alone (203)., Main Outcomes and Measures: The primary outcome was the rate of expanded Thrombolysis In Cerebral Infarction score of 2c or 3 (eTICI 2c/3; ie, scores indicate near-total and total reperfusion grades) at the end of the procedure., Results: Among the 408 patients who were randomized, 3 were excluded, and 405 (99.3%) patients (mean age, 73 years; 220 [54%] women and 185 [46%] men) were included in the primary analysis. The rate of eTICI 2c/3 at the end of the endovascular procedure was not significantly different between the 2 thrombectomy groups (64.5% [131 of 203 patients] for contact aspiration and stent retriever combined vs 57.9% [117 of 202 patients] for stent retriever alone; risk difference, 6.6% [95% CI, -3.0% to 16.2%]; adjusted odds ratio [OR], 1.33 [95% CI, 0.88 to 1.99]; P = .17). Of 14 prespecified secondary efficacy end points, 12 showed no significant difference. A higher rate of successful reperfusion was achieved in the contact aspiration combined with stent retriever group vs the stent retriever alone group (eTICI 2b50/2c/3, 86.2% vs 72.3%; adjusted OR, 2.54 [95% CI, 1.51 to 4.28]; P < .001) and of near-total or total reperfusion (eTICI 2c/3, 59.6% vs 49.5%; adjusted OR, 1.52 [95% CI, 1.02 to 2.27]; P = .04) after the assigned initial intervention alone., Conclusions and Relevance: Among patients with acute ischemic stroke due to large vessel occlusion, an initial thrombectomy technique consisting of contact aspiration and stent retriever combined, compared with stent retriever alone, did not significantly improve the rate of near-total or total reperfusion (eTICI 2c/3) at the end of the endovascular procedure, although the trial may have been underpowered to detect smaller differences between groups., Trial Registration: ClinicalTrials.gov Identifier: NCT03290885.

Published
2021
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3. Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry

Author

Ngankou, Emmanuel Happi, Gory, Benjamin, Marnat, Gaultier, Richard, Sébastien, Bourcier, Romain, Sibon, Igor, Dargazanli, Cyril, Arquizan, Caroline, Maïer, Benjamin, Blanc, Raphaël, Lapergue, Bertrand, Consoli, Arturo, Vannier, Stéphane, Spelle, Laurent, Denier, Christian, Boulanger, Marion, Gauberti, Maxime, Saleme, Suzana, Macian, Francisco, Clarençon, Frédéric, Rosso, Charlotte, Naggara, Olivier, Turc, Guillaume, Ozkul-Wermester, Ozlem, Papagiannaki, Chrysanthi, Viguier, Alain, Cognard, Christophe, Lebras, Anthony, Evain, Sarah, Wolff, Valérie, Pop, Raoul, Timsit, Serge, Gentric, Jean Christophe, Bourdain, Frédéric, Veunac, Louis, Eugène, François, Finitsis, Stephanos Nikolaos, Piotin, Michel, Redjem, Hocine, Escalard, Simon, Dessilles, Jean Philippe, Delvoye, François, Smajda, Stanislas, Solène, Hebert, Mazighi, Mikael, Obadia, Mikael, Sabben, Candice, Seners, Pierre, Raynouard, Igor, Corabianu, Ovide, de Broucker, Thomas, Manchon, Eric, Taylor, Guillaume, Maacha, Malek Ben, Thion, Laurie Anne, Lecler, Augustin, Savatovsjy, Julien, Hospital, Foch, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Weisenburgerlile, David, Gorza, Lucas, Buard, Géraldine, Coskun, Oguzhan, Di Maria, Federico, Rodesh, Georges, Zimatore, Sergio, Leguen, Morgan, Gratieux, Julie, Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Gariel, Florent, Barreau, Xavier, Berge, Jerome, Menegon, Patrice, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Rouanet, François, Tourdias, Thomas, Liegey, Jean Sebastien, Briau, Pierre, Pangon, Nicolas, Detraz, Lili, Daumas-Duport, Benjamin, Alexandre, Pierre Louis, Roy, Monica, Lenoble, Cédric, Desal, Hubert Armand, Guillon, Benoît, de Gaalon, Solène, Preterre, Cécile, Bracard, Serge, Anxionnat, René, Braun, Marc, Derelle, Anne Laure, Romain, Tonnelet, Liao, Liang, Zhu, François, Schmitt, Emmanuelle, Planel, Sophie, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean Christophe, Riou-Comte, Nolwenn, Audibert, Gérard, Voicu, Marcela, Alb, Lionel, Reitter, Marie, Brezeanu, Madalina, Masson, Agnès, Tabarna, Adriana, Podar, Iona, Guy, Sarah, Bechiri, Fatiha, Bourst, Pauline, Macian-Montoro, Francisco, Saleme, Suzanna, Mounayer, Charbel, Rouchaud, Aymeric, Gimenez, Laetitia, Cosnard, Alexandre, Costalat, Vincent, Gascou, Grégory, Lefèvre, Pierre Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Cagnazzo, Federico, ter Schiphorst, Adrien, Ferré, Jean-Christophe, Raoult, Hélène, Ronziere, Thomas, Lassale, Maria, Paya, Christophe, Gauvrit, Jean Yves, Tracol, Clément, Langnier-Lemercier, Sophie, Maurice, Axelle, Cochennec, Sabrina, Pinault, Mélanie, Shotar, Eimad, Sourour, Nader Antoine, Lenck, Stéphanie, Premat, Kévin, Anne Léger, Yves Samson, Crozier, Sophie, Baronnet, Flore, Alamowitch, Sonia, Bottin, Laure, Yger, Marion, Degos, Vincent, Chassin, Olivier, Chalumeau, Vanessa, Caroff, Jildaz, Venditti, Laura, Sarov, Mariana, Legris, Nicolas, Hassen, Wagih Ben, Boulouis, Grégoire, Rodriguez-Régent, Christine, Trystram, Denis, Kerleroux, Basile, Domigo, Valérie, Lamy, Catherine, Birchenall, Julia, Isabel, Clothilde, Lun, François, Januel, Anne Christine, Olivot, Jean Marc, Fontaine, Louis, Raposo, Nicolas, Bonneville, Fabrice, Albucher, Jean François, Calviere, Lionel, Darcourt, Jean, Bellanger, Guillaume, Tall, Philippe, Touzé, Emmanuel, Barbier, Charlotte, Schneckenburger, Romain, Cogez, Julien, Guettier, Sophie, Ognard, Julien, Merrien, François Mathias, Wermester, Ozlem Ozku, Massardier, Evelyne Guégan, Triquenot, Aude Bagan, Lefebvre, Margeaux, Bernady, Patricia, Lagoarde-Segot, Laurent, Cailliez, Hélène, Higue, David, Quenardelle, Véronique, Lauer, Valérie, Gheoca, Roxana, Pierre-Paul, Irène Nora, Beaujeux, Remy, Mihoc, Dan, Manisor, Monica, Pottecher, Julien, Meyer, Alain, Chamaraux-Tran, Thiên Nga, Le Bras, Anthony, Le Guen, Arnaud, 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), CHU Bordeaux [Bordeaux], Service de neurologie [CHRU Nancy], 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), 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 hospitalier universitaire de Nantes (CHU Nantes), Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Neurologie [CHU Rennes], CHU Pontchaillou [Rennes], Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [Le Kremlin Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Neurologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Départment de Neuroradiologie [CHU Caen], Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Limoges, Service de Neurologie [CHU Limoges], CHU Pitié-Salpêtrière [AP-HP], Service de Neurologie [CH Saint-Anne], Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Département de Neuroradiologie [CHU Rouen], Normandie Université (NU)-Normandie Université (NU), Neurologie Vasculaire [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), 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), Service de radiologie [Vannes], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Service de Neurologie [Strasbourg], CHU Strasbourg-Hopital Civil, Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Service de Neurologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Neuroradiologie [Brest], Neurologie - Côte Basque, Centre Hospitalier de la Côte Basque (CHCB), Aristotle University of Thessaloniki, Neuroimagerie: méthodes et applications (Empenn), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), and Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)

Subjects
Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Embolism, Large vessel, Dissection (medical), Brain ischemia, Postoperative Complications, Risk Factors, Thromboembolism, medicine, Humans, Registries, Aged, Ischemic Stroke, Thrombectomy, Advanced and Specialized Nursing, business.industry, Incidence (epidemiology), Dissection, Incidence, Endovascular Procedures, Middle Aged, medicine.disease, Surgery, Cerebrovascular Disorders, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background and Purpose: Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice. Methods: We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications. Results: Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31]; P P =0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63]; P P P =0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%; P =0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years; P =0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique. Conclusions: Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.

Published
2021

4. Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study

Author

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

Subjects
medicine.medical_specialty, Standard of care, Time Factors, Neuroradiologist, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Operator (computer programming), Medicine, Humans, Registries, Thrombectomy, Advanced and Specialized Nursing, Surgeons, business.industry, Cerebral infarction, Endovascular Procedures, Cerebral Infarction, medicine.disease, Mechanical thrombectomy, Stroke, Multicenter study, Ischemic stroke, Reperfusion, Physical therapy, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose: We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. Methods: Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator’s experience and procedural metrics. Results: A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57–170.2) over the study period. Higher operator’s experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (β estimate, −3.98 [95% CI, −5.1 to −2.8]; P P =0.013). Conclusions: In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators’ recertification processes tailored to individual case volume and prior experience.

Published
2021

5. Magnetic resonance imaging quantitative T2* mapping to predict the red blood cell content of in vivo thrombi retrieved from patients with large vessel occlusions in acute ischemic stroke.

Author

Gilbert, Alize, Detraz, Lili, Alexandre, Pierre-Louis, Serfaty, Jean-Michel, Desal, Hubert, Toquet, Claire, and Bourcier, Romain

Subjects
ERYTHROCYTES, ISCHEMIC stroke, MAGNETIC resonance imaging, GROIN pain, STROKE patients, ENDOVASCULAR surgery
Abstract

Background and purpose: Magnetic resonance imaging quantitative T2* mapping has shown reliable identification of thrombus red blood cell content in vitro. The thrombus composition has been in vivo, associated with outcomes after endovascular therapy for acute ischemic stroke. We aim to analyze the red blood cell content of thrombi retrieved from patients with large vessel occlusions in relation to the thrombus-T2* relaxation time in magnetic resonance imaging. Material and methods: Consecutive acute ischemic stroke patients treated by endovascular therapy were scanned with an magnetic resonance imaging quantitative T2* mapping sequence. Quantitative histologic evaluations of red blood cell content were performed. A linear regression assessed the association between vascular risk factors, comorbidities, antithrombotic drugs intake, baseline National Institutes of Health Stroke Scale (NIHSS), intravenous thrombolysis before endovascular therapy, time between onset and groin puncture, patient's outcome at 3 months, magnetic resonance imaging quantitative T2* mapping results, and the red blood cell content of thrombi. The correlation between the mean thrombus-T2* relaxation time and red blood cell content was assessed by calculating the Pearson correlation coefficient. Results: Among 31 thrombi, 16 were "Fibrin rich" and 15 "red blood cell dominant." The median red blood cell content was 39 (range, 0–90; interquartile range, 37). The median (interquartile range) thrombus-T2* relaxation time was shorter in "red blood cell dominant" thrombi (21, interquartile range 6) than in "Fibrin rich" thrombi (24, interquartile range 7), without significant difference (p = 0.15), as shown in the Box plot. An inverse correlation between thrombus-T2* relaxation time and red blood cell content was found, with a correlation coefficient of −0.41 (95% CI, −0.67 to −0.08, p = 0.02). Conclusion: Our study shows that a shorter thrombus-T2* relaxation time is related to a higher red blood cell content within in vivo thrombi. [ABSTRACT FROM AUTHOR]

Published
2022
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6. Success of Thrombectomy in Management of Ischemic Stroke in Two Patients with SynCardia Total Artificial Heart in Bridge-to-Transplantation.

Author

Le Picault, Brendan, David, Charles-Henri, Alexandre, Pierre-Louis, Lenoble, Cédric, Bizouarn, Philippe, Lepoivre, Thierry, Groleau, Nicolas, Rozec, Bertrand, Desal, Hubert, Roussel, Jean-Christian, and Sénage, Thomas

Subjects
ISCHEMIC stroke, STROKE patients, THROMBECTOMY, ARTIFICIAL hearts, HEART failure, HEART transplantation, HEART assist devices, CARDIAC pacing
Abstract

Introduction: Circulatory assistance from a SynCardia Total Artificial Heart (SynCardia-TAH) is a reliable bridge-to-transplant solution for patients with end-stage biventricular heart failure. Ischemic strokes affect about 10% of patients with a SynCardia-TAH. We report for the first time in the literature two successful thrombectomies to treat the acute phase of ischemic stroke in two patients treated with a SynCardia-TAH in the bridge-to-transplant (BTT). Case report: We follow two patients with circulatory support from a SynCardia-TAH in the bridge-to-transplant for terminal biventricular cardiac failure with ischemic stroke during the support period. An early in-hospital diagnosis enables the completion of a mechanical thrombectomy within the first 6 h of the onset of symptoms. There was no intracranial hemorrhagic complication during or after the procedure and the patients fully recovered from neurological deficits, allowing a successful heart transplant. Conclusion: This case report describes the possibility of treating ischemic strokes under a SynCardia-TAH by mechanical thrombectomy following the same recommendations as for the general population with excellent results and without any hemorrhagic complication during or after the procedure. [ABSTRACT FROM AUTHOR]

Published
2021
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