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16 results on '"Stéphane, Velasco"'

1. Delayed thromboembolic events after coiling of unruptured intracranial aneurysms in a prospective cohort of 335 patients

Author

Sophie Gallas, Anne-Christine Januel, Chrysanthi Papagiannaki, Laurent Spelle, Georges Rodesch, Emmanuel Chabert, Fouzi Bala, Frédéric Ricolfi, Mohamed Aggour, Frédéric Clarençon, Hubert Desal, Stéphane Velasco, Jacques Sedat, Laurent Pierot, Denis Herbreteau, Denis Trystram, Jean-Yves Gauvrit, Phil White, Gaultier Marnat, and Coralie Barbe

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Autosomal dominant polycystic kidney disease, 030218 nuclear medicine & medical imaging, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Risk Factors, Thromboembolism, Occlusion, medicine, Humans, In patient, Prospective Studies, Prospective cohort study, Aged, business.industry, Endovascular Procedures, Intracranial Aneurysm, General Medicine, Middle Aged, medicine.disease, Surgery, Clinical trial, Treatment Outcome, Multicenter study, Multivariate Analysis, Neurology (clinical), Complication, business, 030217 neurology & neurosurgery
Abstract

BackgroundCoiling is the first-line treatment for the management of unruptured intracranial aneurysms (UIAs), but delayed thromboembolic events (TEEs) can occur after such treatment. ARETA (Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm) is a prospective multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed TEEs in the UIA subgroup.MethodsSixteen neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015. Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. Data were analyzed from participants with UIA treated by coiling or balloon-assisted coiling. We assessed the rates, timing, management, clinical outcomes, and risk factors for delayed TEEs using univariable and multivariable analyses.ResultsThe rate of delayed TEEs was 2.4% (95% CI 1.0% to 4.6%) in patients with unruptured aneurysms, with all events occurring in the week following the procedure. In multivariate analysis, two factors were associated with delayed TEEs: autosomal dominant polycystic kidney disease (ADPKD): 20.0% in patients with ADPKD vs 1.9% in patients without ADPKD (OR 27.3 (95% CI 3.9 to 190.2), p=0.0008) and post-procedure aneurysm remnant: 9.4% in patients with post-procedure aneurysm remnant vs 1.6% in patients with adequate occlusion (OR 9.9 (95% CI 1.0 to 51.3), p=0.006). We describe modalities of management as well as clinical outcomes.ConclusionsDelayed TEE is a relatively rare complication after coiling of UIAs. In this series, all occurred in the week following the initial procedure. Two factors were associated with delayed TEE: ADPKD and aneurysm remnant at procedure completion.Clinical trial registrationNCT01942512

Published
2020
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2. Intraoperative Complications of Endovascular Treatment of Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective Multicenter Cohort of 1088 Participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Author

Sophie Gallas, Philip White, Denis Trystram, Denis Herbreteau, Jean-Yves Gauvrit, Gaultier Marnat, Anne-Christine Januel, Sébastien Soize, Jacques Sedat, Emmanuel Chabert, Hubert Desal, Coralie Barbe, Fouzi Bala, Mohamed Aggour, Pierre-Olivier Comby, Laurent Spelle, Georges Rodesch, Huu An Nguyen, Stéphane Velasco, Frédéric Clarençon, Matthias Gawlitza, and Laurent Pierot

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Odds ratio, medicine.disease, 030218 nuclear medicine & medical imaging, Surgery, 03 medical and health sciences, Anterior communicating artery, symbols.namesake, 0302 clinical medicine, Aneurysm, Modified Rankin Scale, 030220 oncology & carcinogenesis, medicine.artery, Middle cerebral artery, medicine, symbols, Radiology, Nuclear Medicine and imaging, Embolization, business, Prospective cohort study, Fisher's exact test
Abstract

Background Thromboembolic events and intraoperative rupture are the most frequent neurologic complications of intracranial aneurysm coiling. Their frequency has not been evaluated in recent series. Purpose To provide an analysis of complications, clinical outcome, and participant and aneurysm risk factors after aneurysm coiling or balloon-assisted coiling within the Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm, or ARETA, cohort. Materials and Methods Sixteen neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms between December 2013 and May 2015. Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. Data were analyzed from participants within the overall cohort treated with coiling or balloon-assisted coiling for a single aneurysm. Rates of neurologic complications were analyzed, and associated factors were studied by using univariable analyses (Student t test, χ2 test, or Fisher exact test, as appropriate) and multivariable analyses (logistic regressions). Results A total of 1088 participants (mean age ± standard deviation, 54 years ± 13; 715 women [65.7%]) were analyzed. Thromboembolic events and intraoperative rupture were reported in 113 of 1088 participants (10.4%) and 34 of 1088 participants (3.1%), respectively. Poor clinical outcome (defined as modified Rankin Scale score of 3-6) was reported in 29 of 113 participants (25.7%) with thromboembolic events and in 11 of 34 participants (32.4%) with intraoperative rupture (P = .44). Factors associated with thromboembolic events were female sex (odds ratio [OR], 1.7; 95% confidence interval [CI]: 1.1, 2.8; P = .02) and middle cerebral artery location (OR, 1.9; 95% CI: 1.2, 3.0; P = .008). Factors associated with intraoperative rupture were anterior communicating artery location (OR, 2.2; 95% CI: 1.1, 4.7; P = .03) and small aneurysm size (OR, 3.0; 95% CI: 1.5, 6.3; P = .003). Conclusion During aneurysm coiling or balloon-assisted coiling, thromboembolic events were more frequent than were intraoperative rupture. Both complications were associated with poor clinical outcome in a similar percentage of participants. Risk factors for thromboembolic events were female sex and middle cerebral artery location. Risk factors for intraoperative rupture were small aneurysm size and anterior cerebral or communicating artery location. © RSNA, 2020.

Published
2020
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3. Role of distal cerebral vasculature in vessel constriction after aneurysm treatment with flow diverter stents

Author

Christophe Cognard, Alberto Marzo, Frédéric Patat, Fernando Silva de Moura, Anne-Christine Januel, Ignacio Larrabide, René Chapot, Ana Paula Narata, Ayache Bouakaz, and Stéphane Velasco

Subjects
medicine.medical_specialty, Hemodynamics, Constriction, Pathologic, 030218 nuclear medicine & medical imaging, Constriction, 03 medical and health sciences, Cerebral circulation, 0302 clinical medicine, Aneurysm, Internal medicine, medicine, Humans, Flow diverter, business.industry, Ultrasound, Intracranial Aneurysm, General Medicine, Blood flow, medicine.disease, Radiography, Treatment Outcome, medicine.anatomical_structure, Hydrodynamics, Cardiology, Vascular resistance, Stents, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

BackgroundTreatment of intracranial aneurysms with flow diverter stent (FDS) procedures can lead to caliber changes of jailed vessels. The reason some branches remain unchanged and others are affected by narrowing remains unknown.ObjectiveTo investigate the influence of resistance to flow from distal vasculature on stent-induced hemodynamic modifications affecting bifurcating vessels.Materials and methodsRadiological images and demographic data were acquired for 142 aneurysms treated with a FDS. Vascular resistance was estimated from patient-specific anatomic data. Correlation analysis was used to identify correspondence between anatomic data and clinical outcome. Computational Fluid Dynamics was performed on a typical patient-specific model to evaluate the influence of FDS on flow. Relevant hemodynamic variables along the bifurcating vessels were quantitatively analyzed and validated with in vitro data obtained using power Doppler ultrasound.ResultsStatistical analysis showed a correlation between clinical outcome and FDS resistance to flow considering overall jailed vessel vascular resistance (r=0.5, PConclusionsJailed vessels are affected by narrowing when resistance to flow from the FDS constitutes a larger proportion of the overall vessel resistance to flow. This knowledge may contribute to better understanding of intracranial hemodynamics after a FDS procedure and reinforce indications for flow diversion in the treatment of intracranial aneurysms.

Published
2020
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4. Mechanical thrombectomy practices in France: Exhaustive survey of centers and individual operators

Author

A. Kastler, Christophe Paya, Romain Bourcier, J. Sedat, O. Zurlinden, Alexis Guédon, A. Marchal, Pierre Thouant, Thomas Personnic, Sébastien Soize, Aymeric Rouchaud, Florent Gariel, Olivier Naggara, Kevin Premat, Kevin Janot, Hubert Desal, Mohamed Aggour, Eimad Shotar, R. Hanafi, J.-B. Veyrieres, O. Heck, Pierre-François Manceau, Guillaume Charbonnier, X. Carle, C. Bogey, T. Tuilier, J. Le Moa, Géraud Forestier, Emmanuel Chabert, Simon Escalard, M. Mejdoubi, Nicolas Raynaud, Gregoire Boulouis, Cyril Dargazanli, Omer Eker, Pierre-Olivier Comby, P. Lebedinsky, Raoul Pop, Denis Herbreteau, Jérôme Berge, Victor Dumas, Vincent L'Allinec, Stéphane Velasco, Frédéric Clarençon, J.S. Richter, E. Ducouret, Jean-Christophe Gentric, Arturo Consoli, Caterina Michelozzi, Lili Detraz, Jean-François Hak, Marc Bintner, François Eugène, Charlotte Barbier, J. Caroff, Imad Derraz, Robert Fahed, Jean Darcourt, Jean-Baptiste Girot, Benjamin Gory, Alessandra Biondi, C. Papagiannaki, François Zhu, Gautier Marnat, Julien Ognard, Wagih Ben Hassen, F. Di-Maria, Basile Kerleroux, A. Le Bras, C. Arteaga, Vanessa Chalumeau, P. Guedin, V. Civelli, Service de Radiologie et Imagerie Médicale [CHU Limoges], CHU Limoges, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service de neuroradiologie [Tours], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital de la Milétrie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Marseille, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Reims Champagne-Ardenne (URCA), Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, XLIM (XLIM), Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS), Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Amiens-Picardie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Neuroradiologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Clermont-Ferrand, Hôpital pasteur [Colmar], CHU Henri Mondor [Créteil], Service de neuroradiologie, imagerie des urgences [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Service de neuroradiologie [Grenoble], CHU Grenoble, Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Services de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de neuroradiologie diagnostique et interventionnelle, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), 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), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Universitaire de Nice (CHU Nice), Centre hospitalier territorial Gaston-Bourret [Nouméa], Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Centre Hospitalier de Polynésie Française, Département de Radiologie [CHU de Rennes], Université de Rennes (UR), Service de Radiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Sud Saint Pierre [Ile de la Réunion], Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Foch [Suresnes], Hopital d'instruction des armées Sainte-Anne [Toulon] (HIA), 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), Centre hospitalier de Vannes, Service de Neuroradiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Henri Mondor, Hôpital Gui de Chauliac [Montpellier], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CCSD, Accord Elsevier, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), 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], Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service de neuroradiologie diagnostique et fonctionnelle [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)

Subjects
Male, medicine.medical_specialty, [INFO.INFO-IM] Computer Science [cs]/Medical Imaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Suction, Stroke care, Radiography, Interventional, Nationwide survey, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Practice Patterns, Physicians', Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Ischemic Stroke, Thrombectomy, Neuroradiology, Aged, 80 and over, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Radiological and Ultrasound Technology, business.industry, Public health, Continuity of Patient Care, Middle Aged, medicine.disease, Magnetic Resonance Imaging, 3. Good health, Mechanical thrombectomy, Female, Stents, Continuity of care, France, Neurology (clinical), Medical emergency, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background and purpose Mechanical thrombectomy (MT) has dramatically changed the landscape of stroke care as well as stroke care organization. Public health institutions are faced with the challenge of swiftly providing equal access to this high technical level procedure with rapidly broadening indications, and constantly developing techniques. The aim of this study was to present a current nationwide overview of technical MT practices in France as well as local organizations. Materials and methods Thrombectomy capable French stroke centers, and physicians performing MT were invited to participate to a nationwide survey, disseminated through an existing trainee-led research network (the JENI-RC) under the aegis of the French Society of Neuroradiology. The survey was composed of 64 questions to collect both individual practices and general center-based information. Results All French centers (100%) answered the survey, and 74% (110/148) of active interventional neuroradiologists (INR) performing MT completed individual questionnaires. The mean number of INR per center performing MT was 3.7 ± 1.85, and 85% of the centers were organized for 24/7 continuity of care. MRI was the most commonly used imaging modality for stroke diagnosis and patients’ selection, and perfusion imaging was routinely available in 85% of the centers. Half of centers performed yearly between 100 and 200 MT. Anesthesiologic, and technical considerations are also developed in the manuscript. Conclusions This nationwide survey highlights the impressive response to the challenge of reorganization of stroke care with regards to mechanical thrombectomy in France. Technical and management disparities remain. Most centers remain understaffed to properly function in the long term, but the inflow of INT trainees is substantial.

Published
2020
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5. 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

6. Aneurysm Treatment With Woven EndoBridge in the Cumulative Population of 3 Prospective, Multicenter Series: 2-Year Follow-Up

Author

Werner Weber, Laurent Spelle, Francis Turjman, Joachim Klisch, Anne-Christine Januel, Xavier Barreau, Laurent Pierot, Joachim Berkefeld, Andrew J. Molyneux, Hubert Desal, Thomas Liebig, Luc Stockx, Jacques Moret, James V. Byrne, Denis Herbreteau, Jean-Yves Gauvrit, Stéphane Velasco, Jens Fiehler, Vincent Costalat, István Szikora, Markus Holtmannspötter, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims (CHU Reims), Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU de Bordeaux Pellegrin [Bordeaux], National Institute of Clinical Neurosciences [Budapest] (NICN), Service de neuroradiologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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), Rigshospitalet [Copenhagen], Copenhagen University Hospital, 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], Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Helios Klinikum [Erfurt], Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], Universitätsklinikum Knappschaftskrankenhaus [Bochum], Département de Neuroradiologie [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Ludwig Maximilian University [Munich] (LMU), Ziekenhuis Oost-Limburg (ZOL), Klinikum der Johann Wolfgang Goethe-Universität, Nuffield Department of Clinical Neurosciences [Oxford], University of Oxford [Oxford], and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)

Subjects
Neuros/1, Male, Neuros/4, Flow disruption, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Occlusion, Prospective Studies, MESH: Treatment Outcome, MESH: Aged, education.field_of_study, MESH: Middle Aged, Endovascular Procedures, WEB device, MESH: Follow-Up Studies, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Embolization, Therapeutic, 3. Good health, Europe, Research—Human—Clinical Studies, medicine.anatomical_structure, Treatment Outcome, Middle cerebral artery, cardiovascular system, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Internal carotid artery, Aneurysms, Artery, Adult, medicine.medical_specialty, MESH: Endovascular Procedures, AcademicSubjects/MED00930, Population, MESH: Intracranial Aneurysm, 03 medical and health sciences, Aneurysm, medicine.artery, medicine, Basilar artery, Neurosurgery 20/20: Concise, Clear Content, Humans, Endovascular treatment, cardiovascular diseases, education, Adverse effect, Aged, ComputingMethodologies_COMPUTERGRAPHICS, MESH: Humans, business.industry, Intracranial Aneurysm, MESH: Adult, medicine.disease, MESH: Prospective Studies, MESH: Male, Surgery, Editor's Choice, MESH: Embolization, Therapeutic, Neurology (clinical), MESH: Europe, business, MESH: Female, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

BACKGROUND Woven EndoBridge (WEB; Sequent Medical) treatment is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown high safety with good efficacy at short term confirmed by trials conducted in United States (WEB-Intrasaccular Therapy) and in Europe (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy [WEBCAST], French Observatory, and WEBCAST-2). OBJECTIVE To report the 2-yr clinical and anatomical results of WEB treatment in the combined population of 3 European trials. METHODS In a French Observatory, 2-yr clinical and anatomical data were collected. In WEBCAST and WEBCAST-2, 2-yr follow-up was optional, and data were collected when follow-up was performed. Aneurysm occlusion was evaluated using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The population for safety was 138/168 patients (82.1%), including 89 females (64.5%), with mean age of 55.5 ± 10.2 yr. The population for efficacy was 121/169 aneurysms (71.6%). Aneurysm locations were middle cerebral artery in 65/121 aneurysms (53.7%), anterior-communicating artery in 25/121 (20.7%), basilar artery in 17/121 (14.0%), and internal carotid artery terminus in 14/121 (11.6%). No clinically relevant adverse events occurred between years 1 and 2. At 2 yr, complete occlusion was observed in 62/121 (51.2%) aneurysms, neck remnant in 36/121 (29.8%) aneurysms, and aneurysm remnant in 23/121 (19.0%) aneurysms. The global retreatment rate at 2 yr was 9.3%. CONCLUSION This analysis confirms the high safety profile of WEB treatment at 2 yr. Aneurysm occlusion is generally stable at 2 yr, and the retreatment rate between 1 yr and 2 yr is low (2.0%)., Graphical Abstract Graphical Abstract

Published
2021
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7. Ovarian and peritoneal psammocarcinoma: Results of a multicenter study on 25 patients

Author

Jean-Baptiste Delhorme, Jordan Ohayon, Sébastien Gouy, Gerlinde Averous, Catherine Genestie, Léopold Gaichies, Olivier Glehen, Jean-Marc Guilloit, Denis Pezet, Francois Quenet, Gwenaël Ferron, Cécile Brigand, Philippe Morice, Charles Honoré, Julio Abba, Karine Abboud, Mohammad Alyami, Catherine Arvieux, Naoual Bakrin, Gisèle Balagué, Vincent Barrau, Houda Ben Rejeb, Jean-Marc Bereder, Isabelle Berton-Rigaud, Frédéric Bibeau, Isabelle Bonnefoy, Dominique Bouzard, Ivan Bricault, Sébastien Carrère, Cécile de Chaisemartin, Madleen Chassang, Anne Chevallier, Thomas Courvoisier, Peggy Dartigues, Anthony Dohan, Julien Dubreuil, Frédéric Dumont, Clarisse Eveno, Marie Faruch-Bilfeld, Juliette Fontaine, Laure Fournier, Johan Gagniere, Delphine Geffroy, Laurent Ghouti, François-Noël Gilly, Laurence Gladieff, Diane Goéré, Aymeric Guibal, Frédéric Guyon, Bruno Heyd, Christine Hoeffel, Constance Hordonneau, Sylvie Isaac, Peggy Jourdan-Enfer, Rachid Kaci, Reza Kianmanesh, Catherine Labbé-Devilliers, Joëlle Lacroix, Bernard Lelong, Agnès Leroux-Broussier, Yoann Lherm, Réa Lo Dico, Gérard Lorimier, Caroline Malhaire, Frédéric Marchal, Pascale Mariani, Emilie Mathiotte, Pierre Meeus, Eliane Mery, Simon Msika, Cédric Nadeau, Pablo Ortega-Deballon, Guillaume Passot, Olivier Pellet, Patrice Peyrat, Nicolas Pirro, Marc Pocard, Flora Poizat, Jack Porcheron, Anaïs Poulet, François Quenet, Patrick Rat, Pierre Rousselot, Pascal Rousset, Hélène Senellart, Martine Serrano, Vincent Servois, Olivia Sgabura, Andrea Skanjeti, Magali Svrcek, Raphaël Tetreau, Emilie Thibaudeau, Yann Touchefeu, Jean-Jacques Tuech, Séverine Valmary-Degano, Delphine Vaudoyer, Stéphane Velasco, Véronique Verriele-Beurrier, Laurent Villeneuve, Romuald Wernert, Franck Zinzindohoue, Département de chirurgie générale et digestive [CHU Strasbourg], Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Service d'anatomie pathologique [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université de Caen Normandie - UFR Santé (UNICAEN Santé), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU), Hôpital Nord, Hôpital nord, Service d'Oncologie Médicale [Centre hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), CHU Grenoble, Hôpitaux Universitaires de Strasbourg, Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Laboratoire d'anatomo-pathologie, CRLCC Val d'Aurelle - Paul Lamarque, Département de chirurgie, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Département de biologie et pathologie médicales [Gustave Roussy], Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France., Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Toulouse [Toulouse], Institut Claudius Regaud, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Hospices Civils de Lyon (HCL), Département de chirurgie générale [Gustave Roussy], Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Service de chirurgie viscérale et digestive - Unité de transplantation hépatique, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Reims (CHU Reims), Service de Radiologie, Service de pathologie, Service de Chirurgie Générale, Digestive et Endocrine [CHU Reims], Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Service de Radiologie [CLCC Baclesse], Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Centre de recherches (CRT), Société Lafarge, Service de Chirurgie d'Oncologie Digestive [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 Paul Papin(Angers), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Institut Curie [Paris], Centre Léon Bérard [Lyon], Institut Claudius Regaud. Department of pathology, Hôpital Louis Mourier - AP-HP [Colombes], Department of Gynecology and Obstetrics, 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), Service de Chirurgie Digestive (AP-HM), Université de la Méditerranée - Aix-Marseille 2, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service de Biopathologie [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Chirurgie digestive, Centre Hospitalier Universitaire de Saint-Etienne, Laboratoire Joliot Curie, École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS), CRLC Val d'Aurelle-Paul Lamarque, Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire d'Anatomie Pathologique, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Department of Radiology, Centre René Gauducheau, CRLCC René Gauducheau, Université de Lyon, (le programme) Cartes d'identité des tumeurs (CIT), Ligue Nationales Contre le Cancer (LNCC), Institut du Cancer de Montpellier (ICM), Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), Service de Pathologie, Centro de Investigaciones Oceanograficas e Hidrograficas (CIOH), DIMAR, Ministerio de Defensa Nacional, Colombie, Unité de Méthodologie en Recherche Clinique, Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Service de chirurgie digestive, générale et cancérologique [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), École normale supérieure de Lyon (ENS de Lyon)-Centre National de la Recherche Scientifique (CNRS), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), and Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP]

Subjects
Hyperthermic Intraperitoneal Chemotherapy, Intraperitoneal chemotherapy, chemistry.chemical_compound, 0302 clinical medicine, Infusions, Parenteral, Peritoneal Neoplasms, Ovarian Neoplasms, Univariate analysis, 030219 obstetrics & reproductive medicine, General Medicine, Cytoreduction Surgical Procedures, Middle Aged, Neoadjuvant Therapy, Progression-Free Survival, 3. Good health, Survival Rate, medicine.anatomical_structure, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Female, France, Peritoneum, Pancreas, Adult, medicine.medical_specialty, Adolescent, Ovary, Antineoplastic Agents, Psammocarcinoma, 03 medical and health sciences, Young Adult, medicine, Humans, Aged, business.industry, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Carboplatin, Surgery, chemistry, Multicenter study, Conventional PCI, Neoplasm Grading, business, Neoplasms, Cystic, Mucinous, and Serous, Rare disease
Abstract

International audience; Purpose: Psammocarcinoma (PK) is a rare disease of unknown origin. We aimed to report the characteristics, management and survival of patients operated on for PK within the French Network for Rare Peritoneal Malignancies (RENAPE) expert centers.Patients and methods: All consecutive cases of PK operated within all 26 RENAPE centers between 1997 and 2018 were retrospectively analyzed.Results: Twenty-five patients were identified. The median age was 53 years [range 17–78]. None of the patients had extra peritoneal metastases at diagnosis. A median of 6 cycles of carboplatin-based systemic chemotherapy was delivered in 52% preoperatively (n = 13) and 56% postoperatively (n = 14); associated with placlitaxel for 12 patients. All patients were operated on. The median PCI was 23 [0–33]. Eighty-four percent had a complete cytoreductive surgery through digestive (n = 7), spleen (n = 3), pancreas (n = 1) resections and/or multiple peritonectomies (n = 11). Five patients (20%) had intraperitoneal chemotherapy. Morbidity (Dindo-Clavien ≥3) was 12%. No postoperative death occurred. After a median follow-up of 42 months (range [2–194]), the median overall (OS) and progression-free (DFS) survival times were respectively 128 months and 31 months. Eighteen patients recurred (72%), mainly in the peritoneum (n = 16). Four of them (22%) were reoperated. The 5 and 10-year DFS rates were both 20.3%. The 5 and 10-year OS rates were 62% and 51.7%, respectively. A complete cytoreductive surgery was associated with a better OS and DFS in a univariate analysis.Conclusion: Complete cytoreductive surgery is the cornerstone of the PK's management as a primary treatment. Recurrence remains common and new adjuvant strategies seem needed.

Published
2019
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8. Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials

Author

Andrew M. Demchuk, Wagih Ben Hassen, Serge Bracard, Bruce C.V. Campbell, Luis San Roman, Scott Brown, Romain Bourcier, Antoni Dávalos, Hubert Desal, Diederik W.J. Dippel, Michael D. Hill, Adnan H. Siddiqui, Wim H. van Zwam, Tudor G Jovin, Robert J. van Oostenbrugge, Paul A Burns, Christian Weimar, Marieke E. S. Sprengers, Imad Derraz, Phil White, Geoffrey Cloud, Elad I. Levy, Charles B. L. M. Majoie, Mayank Goyal, Olvert A. Berkhemer, Yvo B.W.E.M. Roos, Aad van der Lugt, Stephen M. Davis, David S Liebeskind, Geoffrey A. Donnan, Stéphane Velasco, Hana Chloe, Olivier Naggara, Marc Ribó, Peter Mitchell, Emmanuel Chabert, Timo Krings, Keith W. Muir, Gary A. Ford, Reza Jahan, Michael Kelly, Geert J. Lycklama à Nijeholt, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, 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, and Radiology & Nuclear Medicine

Subjects
Male, IMPACT, medicine.medical_treatment, Medizin, RECANALIZATION, law.invention, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, THROMBUS, Randomized controlled trial, law, Occlusion, medicine, Humans, 030212 general & internal medicine, 10. No inequality, Stroke, Original Investigation, Aged, Randomized Controlled Trials as Topic, Thrombectomy, SUSCEPTIBILITY VESSEL SIGN, THROMBOLYSIS, Cerebral infarction, business.industry, Endovascular Procedures, Thrombolysis, Odds ratio, Middle Aged, medicine.disease, 3. Good health, COLLATERALS, ENDOVASCULAR THROMBECTOMY, Treatment Outcome, ISCHEMIC-STROKE, Anesthesia, Inclusion and exclusion criteria, Reperfusion, Female, REVASCULARIZATION, Neurology (clinical), business, 030217 neurology & neurosurgery, Cohort study
Abstract

IMPORTANCE Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results.OBJECTIVE To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS.DESIGN, SETTING, AND PARTICIPANTS We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015.MAIN OUTCOMES AND MEASURES Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression.RESULTS Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22% relative reduction (odds ratio. 0.78; 95% CI, 0.64-0.95) per additional hour between admission and puncture and a 26% relative reduction (odds ratio, 0.74; 95% CI, 0.59-0.93) per additional hour between imaging and puncture.CONCLUSIONS AND RELEVANCE Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke.

Published
2019

9. 5 CLARYS: clinical assessment of WEB® device in ruptured aneurysms: 1-month clinical results

Author

Joachim Berkefeld, Benjamin Daumas-Duport, Jean-Christophe Ferré, R. Bibi, C Cognard, Denis Herbreteau, Jean-Yves Gauvrit, M Bester, J. Moret, Cristian Mihalea, Romain Bourcier, L. Pierot, Ana-Paula Narata, Léon Ikka, Jan-Hendrik Buhk, Hélène Raoult, Anne-Christine Januel, Xavier Barreau, James V. Byrne, Werner Weber, Alessandra Biondi, Laurent Spelle, Markus A Möhlenbruch, Jildaz Caroff, J Fiehler, R. du Mesnil de Rochemont, Stéphane Velasco, Vincent Costalat, Thomas Liebig, and Hubert Desal

Subjects
medicine.medical_specialty, business.industry, medicine.disease, 030218 nuclear medicine & medical imaging, Surgery, 03 medical and health sciences, Anterior communicating artery, 0302 clinical medicine, Aneurysm, medicine.artery, Occlusion, medicine, Anterior cerebral artery, Clinical endpoint, media_common.cataloged_instance, Posterior communicating artery, Internal carotid artery, European union, business, 030217 neurology & neurosurgery, media_common
Abstract

Introduction The intrasaccular flow diversion device WEB is a system used in the treatment of wide necked bifurcation aneurysm. The large number of clinical studies conducted have included mainly unruptured aneurysms. The CLARYS study has been set up to evaluate the efficacy and the safety of the WEB system used to treat bifurcation ruptured aneurysms. Materials and methods The CLARYS study is a prospective, multicenter evaluation conducted in 13 interventional neuroradiological departments in France and Germany. The study design meets the Good Clinical Practice (GCP) standards with data collected in an eDC 100% monitored and endpoints independently evaluated. The primary endpoint is defined as the re-bleeding rate at 1 month post procedure. The secondary endpoints are the rate of adverse events related to the device, the procedure or the disease, the neurological evaluation at 1 month and 1 year based on mRS, the occlusion at 1 year based on the WEB Occlusion Scale (WOS) and the procedure and fluoroscopy time. Results From February 2016 to September 2017, 60 patients (women: 31, 51.7%; mean age: 54.5±1.49 years) with 60 aneurysms were included in the study. The aneurysms locations were at the anterior communicating artery (26/60, 43.3%), the middle cerebral artery bifurcation (23/60, 38.3%), the basilar apex (7/60, 11.7%), the anterior cerebral artery (2/60, 3.3%), the internal carotid artery terminus (1/60, 1.7%) and the posterior communicating artery (1/60, 1.7%). The WEB device was successfully implanted in 56/60 cases (95.0%) The adverse events reported by the sites and adjudicated by the Clinical Event Adjudicator (CEA) were described based on timeline occurrence (per procedure or post procedure), category of events, clinical impact and relationship to device, procedure or disease. The primary endpoint will be presented as well as the morbidity and mortality at 1 month. The 12 months data are under collection so will not be available. Conclusion The study results at 1 month will be presented to address the rate of re bleeding and the safety of the device used in the treatment of ruptured bifurcation aneurysm, following clinical evaluation conducted according to study GCP. Disclosures D. Herbreteau: 2; C; MicroVention. A. Narata: None. R. Bibi: None. L. Ikka: None. C. Mihalea: None. J. Caroff: None. J. Moret: 2; C; MicroVention, Medtronic, Balt. 4; C; Sensome. X. Barreau: None. J. Ferre: None. J. Gauvrit: None. H. Raoult: None. J. Fiehler: 1; C; German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-und Forderbank (IFB), Medtronic, MicroVention, Philips, Stryker. 2; C; Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Medtronic, Medina, MicroVention, Penumbra, Route 92, Stryker. J. Buhk: 2; C; Sequent, MicroVention. V. Costalat: 2; C; Medtronic, Stryker, Balt, Cerenovus, MicroVention. A. Januel: None. C. Cognard: 2; C; Stryker, MicroVention, Medtronic, Cerenovus. T. Liebig:None. M. Bester: None. H. Desal: None. B. Daumas-Duport: None. R. Bourcier: None. M. Mohlenbruch: None. J. Berkefeld: 2; C; Sequent/MicroVention. R. Du Mesnil de Rochemont: 2; C; Sequent. W. Weber: 2; C; Phenox, MicroVention, Medtronic, Penumbra, Stryker. S. Velasco:None. A. Biondi: None. J. Byrne: 2; C; Oxford Endovascular Ltd. L. Pierot: 2; C; Balt, Cerus Endovascular, MicroVention/Sequent, Phenox, Vesalio, Penumbra.

Published
2018
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10. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series

Author

István Szikora, Hubert Desal, Joachim Klisch, James V. Byrne, Thomas Liebig, Stéphane Velasco, Jens Fiehler, Vincent Costalat, Anne-Christine Januel, Laurent Pierot, Werner Weber, Luc Stockx, Joachim Berkefeld, Francis Turjman, Denis Herbreteau, Jean-Yves Gauvrit, Jacques Moret, Laurent Spelle, Xavier Barreau, Markus Holtmannspötter, Andrew J. Molyneux, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims (CHU Reims), Mécanismes Adaptatifs et Evolution (MECADEV), Muséum national d'Histoire naturelle (MNHN)-Centre National de la Recherche Scientifique (CNRS), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU de Bordeaux Pellegrin [Bordeaux], National Institute of Clinical Neurosciences [Budapest] (NICN), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Rigshospitalet [Copenhagen], Copenhagen University Hospital, CHU Toulouse [Toulouse], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Helios Klinikum [Erfurt], Vision, Action et Gestion d'informations en Santé (VisAGeS), SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), 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)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), 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), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Universitätsklinikum Knappschaftskrankenhaus [Bochum], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Universitätsklinikum Köln (Uniklinik Köln), Ziekenhuis Oost-Limburg (ZOL), Universitätsklinikum Frankfurt, University of Oxford [Oxford], Sequent, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), 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), 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 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), Universitätsklinikum Knappschaftskrankenhaus = University Hospital Knappschaftskrankenhaus [Bochum], University of Oxford, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-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 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 Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes 1 (UR1), and Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-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 Bretagne-Pays de la Loire (IMT Atlantique)

Subjects
Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, Self Expandable Metallic Stents, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, medicine.artery, Occlusion, medicine, Humans, Prospective Studies, cardiovascular diseases, education, Prospective cohort study, Aged, education.field_of_study, business.industry, Endovascular Procedures, Intracranial Aneurysm, General Medicine, Middle Aged, medicine.disease, Embolization, Therapeutic, 3. Good health, Surgery, Clinical trial, Hemorrhagic Stroke, Anterior communicating artery, Treatment Outcome, Middle cerebral artery, cardiovascular system, Female, France, Neurology (clinical), Radiology, Internal carotid artery, business, 030217 neurology & neurosurgery
Abstract

BackgroundFlow disruption with the WEB is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown a low complication rate with good efficacy.PurposeTo report clinical and anatomical results of the WEB treatment in the cumulative population of three Good Clinical Practice (GCP) studies: WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm), French Observatory, and WEBCAST-2.MethodsWEBCAST, French Observatory, and WEBCAST-2 are single-arm, prospective, multicenter, GCP studies dedicated to the evaluation of WEB treatment. Clinical data were independently evaluated. Postoperative and 1-year aneurysm occlusion was independently evaluated using the 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant.ResultsThe cumulative population comprised 168 patients with 169 aneurysms, including 112 female subjects (66.7%). The patients' ages ranged between 27 and 77 years (mean 55.5±10.2 years). Aneurysm locations were middle cerebral artery in 86/169 aneurysms (50.9%), anterior communicating artery in 36/169 (21.3%), basilar artery in 30/169 (17.8%), and internal carotid artery terminus in 17/169 (10.1%). The aneurysm was ruptured in 14/169 (8.3%). There was no mortality at 1 month and procedure/device-related morbidity was 1.2% (2/168). At 1 year, complete aneurysm occlusion was observed in 81/153 aneurysms (52.9%), neck remnant in 40/153 aneurysms (26.1%), and aneurysm remnant in 32/153 aneurysms (20.9%). Re-treatment was carried out in 6.9%.ConclusionsThis series is at the moment the largest prospective, multicenter, GCP series of patients with aneurysms treated with WEB. It shows the high safety and good mid-term efficacy of this treatment.Clinical trial registrationFrench Observatory: Unique identifier (NCT18069); WEBCAST and WEBCAST-2: Unique identifier (NCT01778322).

Published
2018
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11. The Role of Hemodynamics in Intracranial Bifurcation Arteries after Aneurysm Treatment with Flow-Diverter Stents

Author

Cecile M. Perrault, René Chapot, R. Bibi, F.S. de Moura, Alberto Marzo, Frédéric Patat, Ignacio Larrabide, Anne Christine Januel, Charles A. Sennoga, Christophe Cognard, Ana Paula Narata, Ayache Bouakaz, and Stéphane Velasco

Subjects
Male, Subacute phase, CIENCIAS MÉDICAS Y DE LA SALUD, Hemodynamics, TRATAMIENTO, 030218 nuclear medicine & medical imaging, Biotecnología de la Salud, 03 medical and health sciences, 0302 clinical medicine, Aneurysm treatment, Occlusion, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Bifurcation, Aged, Flow diverter, Interventional, business.industry, Flow disruption, Models, Cardiovascular, Intracranial Aneurysm, ANEURISMASCEREBRALES, Middle Aged, Caliber, Cerebrovascular Circulation, Hydrodynamics, Female, Stents, Neurology (clinical), business, Nuclear medicine, 030217 neurology & neurosurgery, Otras Biotecnologías de la Salud
Abstract

BACKGROUND AND PURPOSE: Treatment of intracranial bifurcation aneurysms with flow-diverter stents can lead to caliber changes of the distal vessels in a subacute phase. This study aims to evaluate whether local anatomy and flow disruption induced by flow-diverter stents are associated with vessel caliber changes in intracranial bifurcations. MATERIALS AND METHODS: Radiologic images and demographic data were acquired for 25 patients with bifurcation aneurysms treated with flow-diverter stents. Whisker plots and Mann-Whitney rank sum tests were used to evaluate if anatomic data and caliber changes could be linked. Symmetry/asymmetry were defined as diameter ratio 1 symmetric and diameter ratio 1 asymmetric. Computational fluid dynamics was performed on idealized and patient-specific anatomies to evaluate flow changes induced by flow-diverter stents in the jailed vessel. RESULTS: Statistical analysis identified a marked correspondence between asymmetric bifurcation and caliber change. Symmetry ratios were lower for cases showing narrowing or subacute occlusion (medium daughter vessel diameter ratio 0.59) compared with cases with posttreatment caliber conservation (medium daughter vessel diameter ratio 0.95). Computational fluid dynamics analysis in idealized and patient-specific anatomies showed that wall shear stress in the jailed vessel was more affected when flow-diverter stents were deployed in asymmetric bifurcations (diameter ratio 0.65) and less affected when deployed in symmetric anatomies (diameter ratio 1.00). CONCLUSIONS: Anatomic data analysis showed statistically significant correspondence between caliber changes and bifurcation asymmetry characterized by diameter ratio 0.7 (P .001). Similarly, computational fluid dynamics results showed the highest impact on hemodynamics when flow-diverter stents are deployed in asymmetric bifurcations (diameter ratio 0.65) with noticeable changes on wall sheer stress fields. Further research and clinical validation are necessary to identify all elements involved in vessel caliber changes after flow-diverter stent procedures. Fil: Narata, A. P.. Centre Hospitalier Regional Et Universitaire de Tours; Francia Fil: De Moura, F. S.. Universidade Federal Do Abc; Brasil Fil: Larrabide, Ignacio. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina Fil: Perrault, C. M.. University Of Sheffield; Reino Unido Fil: Patat, F.. Universite de Tours; Francia Fil: Bibi, R.. Centre Hospitalier Regional Et Universitaire de Tours; Francia Fil: Velasco, S.. Université de Poitiers; Francia Fil: Januel, A. C.. Centre Hospitalier Universitaire de Toulouse; Francia Fil: Cognard, C.. Centre Hospitalier Universitaire de Toulouse; Francia Fil: Chapot, R.. Alfried Krupp Krankenhaus; Alemania Fil: Bouakaz, A.. Universite de Tours; Francia Fil: Sennoga, C. A.. Universite de Tours; Francia Fil: Marzo, A.. University Of Sheffield; Reino Unido

Published
2018

12. WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory

Author

Denis Herbreteau, Jean-Yves Gauvrit, Laurent Spelle, Xavier Barreau, Patrick Courtheoux, Jacques Moret, Anne Christine Januel, James V. Byrne, Stéphane Velasco, Hélène Raoult, Christophe Cognard, Hubert Desal, Laurent Pierot, Francis Turjman, Andrew J. Molyneux, Université de Reims Champagne-Ardenne (URCA), Mécanismes Adaptatifs et Evolution (MECADEV), Muséum national d'Histoire naturelle (MNHN)-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), Department of Neuroradiology, Hôpital Bretonneau, 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), CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-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)-CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-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), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Department of Neuroradiology (X.B.), CHU Bordeaux, Centro de Investigaciones Oceanograficas e Hidrograficas (CIOH), DIMAR, Ministerio de Defensa Nacional, Colombie, Centre hospitalier universitaire de Nantes (CHU Nantes), 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], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Oxford Neurovascular & Neuroradiology Research Unit, University of Oxford [Oxford], The University of Sydney, Service de Neuroradiologie Interventionnelle et Fonctionnelle, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-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 Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-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)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), 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)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-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)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-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)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), 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), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), University of Oxford, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Commowick, Olivier

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Aneurysm, Ruptured, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Aneurysm, Recurrence, medicine.artery, Occlusion, Basilar artery, Humans, Medicine, Radiology, Nuclear Medicine and imaging, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Prospective Studies, cardiovascular diseases, Embolization, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, Aged, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Interventional, business.industry, Intracranial Aneurysm, Cerebral Arteries, Middle Aged, medicine.disease, Embolization, Therapeutic, Surgery, Anterior communicating artery, Treatment Outcome, Middle cerebral artery, cardiovascular system, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Female, Stents, France, Neurology (clinical), Radiology, Internal carotid artery, business, Platelet Aggregation Inhibitors, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

BACKGROUND AND PURPOSE: Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up. MATERIALS AND METHODS: Patients with bifurcation aneurysms for which WEB treatment was indicated were included in this prospective, multicenter Good Clinical Practice study. Clinical data, including adverse events and clinical status at 1 month and 1 year, were collected and independently analyzed by a medical monitor. An independent core laboratory evaluated the anatomic results at 1 year following the procedure. RESULTS: Ten French neurointerventional centers included 62 patients (39 women), 33–74 years of age (mean, 56.6 ± 9.80 years) with 63 aneurysms. Aneurysm locations were the middle cerebral artery in 32 aneurysms (50.8%), anterior communicating artery in 16 (25.4%), basilar artery in 9 (14.3%), and internal carotid artery terminus in 6 (9.5%). Morbidity and mortality at 1 month were, respectively, 3.2% (2/62 patients) and 0.0% (0/62). Morbidity and mortality (unrelated to the treatment) at 1 year were, respectively, 0.0% (0/59) and 3.4% (2/59 patients). At 1 year, complete occlusion was observed in 30/58 aneurysms (51.7%); neck remnant, in 16/58 aneurysms (27.6%); and aneurysm remnant, in 12/58 aneurysms (20.7%). CONCLUSIONS: This prospective French Observatory study showed very good safety of aneurysm treatment with the WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%).

Published
2015
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13. Rare Coding Variants in ANGPTL6 Are Associated with Familial Forms of Intracranial Aneurysm

Author

Romain Bourcier, Solena Le Scouarnec, Stéphanie Bonnaud, Matilde Karakachoff, Emmanuelle Bourcereau, Sandrine Heurtebise-Chrétien, Céline Menguy, Christian Dina, Floriane Simonet, Alexis Moles, Cédric Lenoble, Pierre Lindenbaum, Stéphanie Chatel, Bertrand Isidor, Emmanuelle Génin, Jean-François Deleuze, Jean-Jacques Schott, Hervé Le Marec, Gervaise Loirand, Hubert Desal, Richard Redon, Benjamin Daumas-Duport, Jérôme Connault, Pierre Lebranchu, Thierry Le Tourneau, Marie Pierre Viarouge, Chrisanthi Papagiannaki, Michel Piotin, Hocine Redjem, Mikael Mazighi, Jean Philippe Desilles, Olivier Naggara, Denis Trystram, Myriam Edjlali-Goujon, Christine Rodriguez, Waghi Ben Hassen, Suzanna Saleme, Charbel Mounayer, Olivier Levrier, Pierre Aguettaz, Xavier Combaz, Anne Pasco, Emeline Berthier, Marc Bintner, Marc Molho, Pascale Gauthier, Cyril Chivot, Vincent Costalat, Cyril Darganzil, Alain Bonafé, Anne Christine Januel, Caterina Michelozzi, Christophe Cognard, Fabrice Bonneville, Philippe Tall, Jean Darcourt, Alessandra Biondi, Cristina Iosif, Elisa Pomero, Jean Christophe Ferre, Jean Yves Gauvrit, François Eugene, Hélène Raoult, Jean Christophe Gentric, Julien Ognard, René Anxionnat, Serge Bracard, Anne Laure Derelle, Romain Tonnelet, Laurent Spelle, Léon Ikka, Robert Fahed, Aymeric Rouchaud, Augustin Ozanne, Jildaz Caroff, Nidal Ben Achour, Jacques Moret, Emmanuel Chabert, Jérôme Berge, Gaultier Marnat, Xavier Barreau, Florent Gariel, Frédéric Clarencon, Mohammed Aggour, Frédéric Ricolfi, Adrien Chavent, Pierre Thouant, Pablo Lebidinsky, Brivael Lemogne, Denis Herbreteau, Richard Bibi, Laurent Pierot, Sébastien Soize, Marc Antoine Labeyrie, Christophe Vandendries, Emmanuel Houdart, Appoline Kazemi, Xavier Leclerc, Jean Pierre Pruvo, Sophie Gallas, Stéphane Velasco, Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de Recherche en Génomique Humaine (CNRGH), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Laboratoire des Sciences du Numérique de Nantes (LS2N), IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de neuroradiologie [Paris], Hôpital Sainte-Anne, Service de Neuroradiologie interventionnelle [CHU Limoges], CHU Limoges, BIO-INGENIERIE (XLIM-BIO-INGENIERIE), XLIM (XLIM), Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS)-Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Microbiologie Environnement Digestif Santé (MEDIS), INRA Clermont-Ferrand-Theix-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), 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], 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), Toulouse Neuro Imaging Center (ToNIC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Département de Radiologie [CHU de Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], 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), Université de Lorraine (UL), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Department of Neuroradiology, Université Paris-Sud - Paris 11 (UP11)-Hôpital Bicêtre, CHU de Bordeaux Pellegrin [Bordeaux], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Registre Dijonnais des Accidents Vasculaires Cérébraux (AVC) - Dijon Stroke Registry, Centre d'épidémiologie des populations (CEP), Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Reims Champagne-Ardenne (URCA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Services de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), ANR-15-CE17-0008,I-CAN,Anévrismes intracraniens : des formes familiales aux méchanismes physiopathologiques(2015), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Unité de recherche de l'institut du thorax (ITX-lab), EFS-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 Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), 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), Institut des Neurosciences de Montpellier (INM), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université de Rennes (UR), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Subarachnoid hemorrhage, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, [SDV]Life Sciences [q-bio], Gastroenterology, Article, 03 medical and health sciences, Exon, Open Reading Frames, 0302 clinical medicine, Aneurysm, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Internal medicine, Genetics, medicine, Humans, Family, Genetic Predisposition to Disease, Angiopoietin-Like Protein 6, Allele, Index case, Gene, Genetics (clinical), Exome sequencing, Cells, Cultured, business.industry, Intracranial Aneurysm, Middle Aged, medicine.disease, Pedigree, 030104 developmental biology, Blood pressure, Angiopoietin-like Proteins, HEK293 Cells, [SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics, Codon, Nonsense, Mutation, Female, business, 030217 neurology & neurosurgery
Abstract

International audience; Intracranial aneurysms (IAs) are acquired cerebrovascular abnormalities characterized by localized dilation and wall thinning in intracranial arteries, possibly leading to subarachnoid hemorrhage and severe outcome in case of rupture. Here, we identified one rare nonsense variant (c.1378A>T) in the last exon of ANGPTL6 (Angiopoietin-Like 6)—which encodes a circulating pro-angiogenic factor mainly secreted from the liver—shared by the four tested affected members of a large pedigree with multiple IA-affected case subjects. We showed a 50% reduction of ANGPTL6 serum concentration in individuals heterozygous for the c.1378A>T allele (p.Lys460Ter) compared to relatives homozygous for the normal allele, probably due to the non-secretion of the truncated protein produced by the c.1378A>T transcripts. Sequencing ANGPTL6 in a series of 94 additional index case subjects with familial IA identified three other rare coding variants in five case subjects. Overall, we detected a significant enrichment (p = 0.023) in rare coding variants within this gene among the 95 index case subjects with familial IA, compared to a reference population of 404 individuals with French ancestry. Among the 6 recruited families, 12 out of 13 (92%) individuals carrying IA also carry such variants in ANGPTL6, versus 15 out of 41 (37%) unaffected ones. We observed a higher rate of individuals with a history of high blood pressure among affected versus healthy individuals carrying ANGPTL6 variants, suggesting that ANGPTL6 could trigger cerebrovascular lesions when combined with other risk factors such as hypertension. Altogether, our results indicate that rare coding variants in ANGPTL6 are causally related to familial forms of IA.

Published
2018
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14. Abstract 122: Intra-aneurysmal Flow Disruption: A New Approach for the Endovascular Treatment of Intracranial Aneurysms. Clinical Experience in a Multicenter Series of 66 Patients with 68 Aneurysms

Author

Krzysztof Kadziolka, Laurent Pierot, Laurent Spelle, Paolo Macchi, Hubert Desal, Denis Herbreteau, Jean-Yves Gauvrit, Anne-Christine Januel, Xavier Brreau, Jacques Moret, Francis Turjman, Stéphane Velasco, Vincent Costalat, Christophe Cognard, Chrysanthi Papagiannaki, Hélène Raoult, Alain Bonafe, and Patrick Courtheoux

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, business.industry, Flow disruption, medicine.disease, Surgery, Anterior communicating artery, Hematoma, Aneurysm, medicine.artery, Middle cerebral artery, medicine, Basilar artery, cardiovascular diseases, Neurology (clinical), Radiology, Internal carotid artery, Endovascular treatment, Cardiology and Cardiovascular Medicine, business
Abstract

Purpose: Standard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalizations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Clinical experience with this new technique is analyzed in a series collected in 11 French centers. Materials and Methods: The WEB (Sequent, Aliso Viejo, CA) is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal. 66 patients (49F/17M, age: 36-75 years) harbouring 68 aneurysms (ruptured: 5, unruptured: 57 or recanalized: 6) were treated between June 2011 and July 2013. Aneurysm location was middle cerebral artery (39 aneurysms), basilar artery (16), anterior communicating artery (7), and internal carotid artery (6). Results: The device was successfully deployed in all but 4 cases (failure rate: 5.9%). Additional coiling was performed in 6 aneurysms, remodeling in 2 cases, and stenting in 1 case. One intraoperative rupture was observed in a ruptured aneurysm (1.5%). Six thromboembolic events (8.8%) were observed with transient clinical worsening and good clinical outcome in 5 cases (mRS ≤2). No delayed rupture or remote hematoma was observed. Finally mortality was 0.0% and morbidity 1.5% (in a patient who both had intraoperative rupture and thromboembolic complication). Anatomical follow-up was obtained in 32 patients 3 to 15 months after the treatment. Total occlusion was obtained in 15/32 aneurysms (46.9%), neck remnant in 14/32 aneurysms (43.8%), and aneurysm remnant in 3/32 aneurysms (9.4%). Conclusion: In the present series reporting the initial clinical experience with intra-saccular flow disruption using WEB in 11 French centers, the feasibility of treatment is high, the safety profile similar to coiling, and anatomical results are quite satisfactory knowing that some neck remnants are in fact just opacification of the proximal recess of the device.

Published
2014
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15. Acquired systemic-to-pulmonary venous shunt or persistent left superior vena cava? A rare right-to-left shunt case-based discussion

Author

Luc Christiaens, Pascale Raud-Raynier, Thomas Kerforne, Alexandre Gamet, and Stéphane Velasco

Subjects
medicine.medical_specialty, Right-to-left shunt, Catheter-related thrombosis, Case Report, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Pulmonary vein, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, Medicine, Radiology, Nuclear Medicine and imaging, Persistent left superior vena cava, thrombosis, business.industry, computed tomography, Cardiac shunt, Perioperative, medicine.disease, contrast echocardiography, Thrombosis, shunt, Catheter, Cardiology, Cardiology and Cardiovascular Medicine, business, Shunt (electrical)
Abstract

Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction. After medico-surgical discussion, a first-line conservative treatment with oxygen therapy was chosen, due to the stability of symptoms and high predicted risk of perioperative mortality. The particularities of this case are that we cannot determine if the origin of this shunt is a latent persistent left SVC becoming symptomatic after the SVC obstruction or an abnormal collateral pathway due to the thrombosis and the unusual indirect communication through a pulmonary vein.

Published
2017
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16. Repetitive gas embolisms after central catheter removal

Author

Rémy Coudroy, Stéphane Velasco, Julie Badin, Delphine Chatellier, and René Robert

Subjects
medicine.medical_specialty, business.industry, Anesthesiology, Pain medicine, Anesthesia, Central catheter, Gas Embolisms, medicine, Critical Care and Intensive Care Medicine, business
Published
2011
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