275 results on '"Y Béjot"'
Search Results
2. Prise en charge aiguë des hémorragies intracérébrales spontanées
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G. Duloquin, M. Graber, L. Baptiste, S. Mohr, L. Garnier, M. Ndiaye, Q. Thomas, M. Hervieu-Bègue, G.-V. Osseby, M. Giroud, and Y. Béjot
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Gastroenterology ,Internal Medicine - Published
- 2022
3. [Idiopathic intracranial hypertension: From physiopathological mechanisms to therapeutic decision]
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F, Robelin, M, Lenfant, F, Ricolfi, Y, Béjot, and P-O, Comby
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Pseudotumor Cerebri ,Transverse Sinuses ,Quality of Life ,Humans ,Female ,Stents ,Constriction, Pathologic - Abstract
Clinical features include visual disturbances, headaches, and pulsatile tinnitus that can be associated with reduced quality of life, and a risk of irreversible visual impairment in some cases. Obese women of childbearing age represent the main at-risk population, and the incidence of the disease is increasing because of rising prevalence of obesity worldwide. In addition, an imbalance in sex hormones is reported as a contributing risk factor. The pathophysiology of idiopathic intracranial hypertension involves a disturbance of the evacuation pathway of intracranial fluids caused by the increase in intracranial venous pressure. Brain imaging is useful for diagnosis with several signs including bilateral stenosis of the transverse sinuses that plays a major role in the pathogenesis of the disease by creating a positive feedback loop that increases intracranial venous hypertension and contributes to clinical manifestations. Treatment aims to relieve symptoms and prevent permanent visual impairment. Drug therapies including acetazolamide and topiramate have moderate effectiveness. Among invasive treatments, transverse sinus stenting seems to be the most interesting option to consider in drug-resistant patients. Weight loss remains essential to achieve a sustainable improvement by reducing central venous pressure. Future randomized trials are expected to reach a consensus on this treatment.
- Published
- 2022
4. [Acute management of spontaneous intracerebral hemorrhage]
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G, Duloquin, M, Graber, L, Baptiste, S, Mohr, L, Garnier, M, Ndiaye, Q, Thomas, M, Hervieu-Bègue, G-V, Osseby, M, Giroud, and Y, Béjot
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Stroke ,Hematoma ,Humans ,France ,Prognosis ,Cerebral Hemorrhage - Abstract
Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients' outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.
- Published
- 2021
5. High efficiency and clinical relevance of exome sequencing in the daily practice of neurogenetics
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Arthur Sorlin, Antonio Vitobello, Benoit Daubail, Christel Thauvin-Robinet, Marie Hervieu-Bègue, Laurence Faivre, Agnès Fromont, Ange-Line Bruel, Frédéric Tran Mau-Them, Thibault Moreau, Julian Delanne, Guy-Victor Osseby, Quentin Thomas, Patrick Callier, Christophe Philippe, Sébastien Moutton, Maurice Giroud, Anne-Sophie Denommé-Pichon, Agnès Jacquin-Piques, Sophie Nambot, Yannis Duffourd, Philippine Garret, Y Béjot, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Lipides - Nutrition - Cancer [Dijon - U1231] (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, Service de Neurophysiologie Clinique (CHU Dijon), Equipe GAD (LNC - U1231), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon), Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon] (PEC2), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), and Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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Proband ,Pediatrics ,medicine.medical_specialty ,Movement disorders ,Neurology ,Neurodegeneration with brain iron accumulation ,[SDV]Life Sciences [q-bio] ,Encephalopathy ,Neurogenetics ,03 medical and health sciences ,0302 clinical medicine ,Exome Sequencing ,Genetics ,Humans ,Medicine ,Exome ,Clinical significance ,030212 general & internal medicine ,Genetic Testing ,Genetics (clinical) ,Exome sequencing ,ComputingMilieux_MISCELLANEOUS ,030304 developmental biology ,0303 health sciences ,business.industry ,medicine.disease ,Phenotype ,[SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Neurology (clinical) ,Nervous System Diseases ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
ObjectiveTo assess the efficiency and relevance of clinical exome sequencing (cES) as a first-tier or second-tier test for the diagnosis of progressive neurological disorders in the daily practice of Neurology and Genetic Departments.MethodsSixty-seven probands with various progressive neurological disorders (cerebellar ataxias, neuromuscular disorders, spastic paraplegias, movement disorders and individuals with complex phenotypes labelled ‘other’) were recruited over a 4-year period regardless of their age, gender, familial history and clinical framework. Individuals could have had prior genetic tests as long as it was not cES. cES was performed in a proband-only (60/67) or trio (7/67) strategy depending on available samples and was analysed with an in-house pipeline including software for CNV and mitochondrial-DNA variant detection.ResultsIn 29/67 individuals, cES identified clearly pathogenic variants leading to a 43% positive yield. When performed as a first-tier test, cES identified pathogenic variants for 53% of individuals (10/19). Difficult cases were solved including double diagnoses within a kindred or identification of a neurodegeneration with brain iron accumulation in a patient with encephalopathy of suspected mitochondrial origin.ConclusionThis study shows that cES is a powerful tool for the daily practice of neurogenetics offering an efficient (43%) and appropriate approach for clinically and genetically complex and heterogeneous disorders.
- Published
- 2021
6. Réhospitalisations précoces après un accident vasculaire cérébral en France : étude des parcours de soins ambulatoires et des facteurs associés à partir des données du Système national des données de santé
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C. Zabawa, J. Cottenet, M. Zeller, Y. Béjot, and C. Quantin
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Epidemiology ,Public Health, Environmental and Occupational Health - Published
- 2022
7. [Management of ischemic stroke in the acute phase]
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G, Duloquin, M, Graber, L, Baptiste, S, Mohr, L, Garnier, M, Ndiaye, C, Blanc-Labarre, M, Hervieu-Bègue, G-V, Osseby, M, Giroud, and Y, Béjot
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Stroke ,Intensive Care Units ,Treatment Outcome ,Humans ,Ischemic Stroke - Abstract
Ischemic stroke accounts for 80% of overall stroke, and is one of the leading causes of death, disability and dementia in worldwide. Management of patients with acute ischemic stroke dramatically improved over time with the implementation of intensive care stroke units, the development of acute recanalization strategies, the optimization of the management of post-stroke complications, and the prevention of early stroke recurrence. The objective of this article is to provide a general overview of the current management of patients with acute ischemic stroke aiming at improving post-stroke outcome.
- Published
- 2021
8. Gestione degli accidenti vascolari cerebrali in urgenza
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B. Daubail, N. Legris, D. Serradj, D. Honnart, C. Tissier, M. Freysz, F. Ricolfi, M. Hervieu-Bègue, G.-V. Osseby, M. Giroud, and Y. Béjot
- Published
- 2018
9. Traitement de l'accident vasculaire cérébral
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Philippe Fagnoni, Y Béjot, Pauline Mondoloni, and Pauline Gueneau
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- 2018
10. [Screening and clinical implications of silent atrial fibrillation]
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C, Guenancia, F, Garnier, B, Mouhat, Y, Béjot, N, Maillot, M, Fichot, L, Fauchier, and Y, Cottin
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Stroke ,Electrocardiography ,Risk Factors ,Incidence ,Asymptomatic Diseases ,Atrial Fibrillation ,Humans ,Mass Screening - Abstract
Each year, 5 million new cases of atrial fibrillation (AF) are diagnosed, and the data for the last 20 years show that its incidence has continued to grow. The aging of the population is considered a major explanation for this pandemic phenomenon. The complications associated with atrial arrhythmia are numerous and frequent, with in the first place thromboembolic events. In addition to symptomatic atrial fibrillation, AF may be diagnosed by chance during a systematic ECG, an external Holter or a continuous ECG monitor, or in the memories of implanted cardiac devices. This is called silent AF. Despite numerous studies, silent AF is still largely under-diagnosed and unrecognized in everyday clinical practice, although it is a frequent condition with potentially serious consequences (especially thromboembolic events). Thanks to the development of new diagnostic tools, which are scientifically validated and readily available, the detection of AF has improved significantly, leading to better therapeutic management, in particular anticoagulant therapy. From this perspective, mass screening for silent AF using these new technologies is a major step forward in e-health development. The cost of screening and the heterogeneity of populations affected by silent AF, however, remain major obstacles.
- Published
- 2017
11. Prevención de los accidentes cerebrovasculares
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M Giroud, Emmanuel Touzé, and Y Béjot
- Abstract
Los accidentes cerebrovasculares, dados su frecuencia e impacto, tanto en el plano humano como social o economico, originan un problema de salud publica cuya importancia no cesa de crecer en los paises industrializados a causa del envejecimiento progresivo de la poblacion. A pesar de los importantes progresos conseguidos a lo largo de los ultimos anos en el control de la fase aguda, la prevencion sigue siendo el metodo mas eficaz de lucha contra esta enfermedad, lucha que se optimiza mediante una mejor comprension de las relaciones entre factores de riesgo vasculares y enfermedad cerebrovascular. La prevencion del infarto cerebral o del accidente isquemico transitorio esta basada en tres pilares que son la correccion de los factores de riesgo, el tratamiento antitrombotico y la revascularizacion en caso de estenosis arterial segun unos criterios bien definidos. Los datos relativos a la prevencion de las hemorragias intracerebrales son mas escasos. El medico general lucha por bajar la presion arterial en estos pacientes, mientras que el tratamiento de las malformaciones vasculares causales atane al especialista y se basa en decisiones individualizadas en ausencia de ensayo aleatorizado.
- Published
- 2011
12. Pression artérielle et cerveau
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M Giroud, E Touzé, and Y Béjot
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,business - Published
- 2011
13. Prévention des accidents vasculaires cérébraux
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Maurice Giroud, Y Béjot, and E Touzé
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business.industry ,Medicine ,business - Published
- 2010
14. L’accident vasculaire cérébral : puissance 4 !
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B Daubail, M. Giroud, Y Béjot, B. Mangola, and Frédéric Ricolfi
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Emergency Medicine ,medicine ,Cardiology ,Thrombolysis ,Critical Care and Intensive Care Medicine ,medicine.disease ,business ,Stroke - Published
- 2015
15. [Moyamoya disease: Diagnosis, clinical features, evolution and treatment in 10 patients]
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C, Blanc, S, Janoura, C, Pallot, L, Mettey, F, Bardin, F, Ricolfi, A, Chavent, G-V, Osseby, M, Giroud, and Y, Béjot
- Subjects
Adult ,Angiography ,Disease Progression ,Humans ,Moyamoya Disease ,Child ,Cerebral Angiography - Abstract
Moyamoya disease is a rare chronic cerebrovascular disease. The objective of this article is to report the different clinical and radiological presentations and describe treatments and clinical course of this disease.We searched for patients with Moyamoya disease diagnosed at a French university hospital. The diagnosis was based on arteriographic records showing uni- or bilateral stenosis of distal intracranial internal carotid arteries or middle cerebral arteries associated with a classic collateral network imparting a puff of smoke aspect. Data about clinical and radiological symptoms were analyzed for all identified patients.Ten patients were recorded between 2009 and 2014 including one child and nine adults. The initial presentation was intracerebral hemorrhage in two patients, ischemic stroke in six, and either exercice-related transient ischemic attacks or syncope in two. Recurrent events were noted in four patients. Four patients had one or several recurrent vascular events. Eight patients were given medical treatment and none underwent surgery. Secondary Moyamoya syndrome was suspected in two patients, all the others one were considered idiopathic.Moyamoya disease is a rare but potentially severe illness. The initial presentation is more frequently an ischemic stroke; recurrences are frequent. The diagnosis is based on arteriography, which is also recommended to search for a cause.
- Published
- 2014
16. One-year survival of demented stroke patients: data from the Dijon Stroke Registry, France (1985-2008)
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Y, Béjot, A, Jacquin, O, Rouaud, J, Durier, C, Aboa-Eboulé, M, Hervieu, G-V, Osseby, and M, Giroud
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Adult ,Aged, 80 and over ,Male ,Analysis of Variance ,Time Factors ,Age Factors ,Middle Aged ,Neuropsychological Tests ,Stroke ,Survival Rate ,Risk Factors ,Humans ,Dementia ,Female ,France ,Registries ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post-stroke dementia was a predictor of 1-year case-fatality and to evaluate factors that could influence survival in demented stroke patients.From 1985 to 2008, all first-ever strokes were recorded in the population-based stroke registry of Dijon, France (150, 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM-III and DSM-IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors. We recorded 3948 first-ever strokes. Among these stroke patients, 3201 (81%) were testable, and of these, 653 (20.4%) had post-stroke dementia (337 women and 316 men). Demented patients had lower 1-year survival than patients without dementia (82.9% vs. 86.9%, P = 0.013). However, in multivariate analysis, dementia did not appear as an independent predictor of 1-year death. In demented stroke patients, age80 years old, severe handicap at discharge, recurrent stroke within the first year and subarachnoid haemorrhage were associated with a higher risk of 1-year death, and the risk was lower in the study period 2003-2008. Dementia after stroke is not independently associated with an increased risk of death at 1 year. In recent years, 1-year case-fatality decreased in demented as well as in and non-demented patients suggesting that improvements in the management of stroke also benefited the most fragile patients.
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- 2011
17. [Rupture of intracranial dermoid cyst with disseminated lipid droplets]
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A, Jacquin, Y, Béjot, M, Hervieu, D, Biotti, M, Caillier, F C, Ricolfi, T, Moreau, and M, Giroud
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Adult ,Male ,Rupture ,Young Adult ,Brain Neoplasms ,Headache ,Brain ,Humans ,Lipid Metabolism ,Magnetic Resonance Imaging ,Dermoid Cyst - Abstract
Dermoid cysts are rare slow-growing benign tumors of the central nervous system generally diagnosed in the third to fifth decade. They are formed from inclusion of ectodermal elements during neural tube closure, and are mostly located along the cranial or spinal midline axis. They cause many non specific symptoms such as headache and seizures, and may spontaneously rupture spreading fatty droplets into the ventricles and subarachnoid spaces. Rupture of dermoid cysts causes sequelae which may vary from no symptoms to death. In general, subtotal surgical removal is required for ruptured dermoid cysts.We report two cases of ruptured intracranial dermoid tumor with non-specific clinical presentations. The first rupture was asymptomatic and discovered on brain magnetic resonance imaging (MRI) performed for other purposes. The second case was identified on brain imaging performed because of daily headache. These dermoid cysts were not surgically treated. Surveillance was advised because of the spontaneously favourable outcome observed in both cases.Surgical removal is not the only treatment of ruptured dermoid cyst. Monitoring with brain MRI can be sufficient if the rupture has no severe clinical impact.
- Published
- 2009
18. [Lafora's disease presenting with progressive myoclonus epilepsy]
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Y, Béjot, M, Lemesle-Martin, F, Contégal, A, Graule-Petot, C, Thauvin, M-H, Aubriot-Lorton, T, Moreau, and M, Giroud
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Male ,Adolescent ,Lafora Disease ,Ubiquitin-Protein Ligases ,Mutation ,Humans ,Anticonvulsants ,Electroencephalography ,Carrier Proteins ,Protein Tyrosine Phosphatases, Non-Receptor ,Sweat Glands - Abstract
Lafora's disease is a progressive myoclonus epilepsy and must be evocated if myoclonus, occipital seizures and progressive cognitive impairment are present. We report the case of a 14-year-old boy who suffered from several occipital seizures and two generalised seizures. The diagnosis of Lafora's disease was made six years after these inaugural symptoms because of occurrence of myoclonus, aggravation of the epilepsy with paharmacoresistance and psychic deterioration. Axila sweat gland duct biopsy was performed to conclude to the disease. A mutation was found on the gene EPM2A. Lafora's disease is a genetic autosomal-recessive pathology. Two genes have been recently identified. They code for two proteins, malin and laforin, involved in glycogen metabolism in the cellular endoplasmic reticulum. Mutations of these genes are responsible for intracytoplasmic polyglucosan inclusions called Lafora bodies and pathognomonic of the disease.
- Published
- 2007
19. [Leptomeningeal dissemination after ethmoidal sinus adenocarcinoma surgery: a rare complication]
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Y, Béjot, A, Catteau, M, Hervieu, P, Giré, M, Caillier, I, Bénatru, G-V, Osseby, P, Soichot, T, Moreau, and M, Giroud
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Male ,Fatal Outcome ,Ethmoid Sinus ,Meningeal Neoplasms ,Humans ,Adenocarcinoma ,Middle Aged ,Polyradiculopathy ,Cranial Nerve Diseases ,Paranasal Sinus Neoplasms - Abstract
Although rare, adenocarcinoma is the most frequent neoplasm of the ethmoid sinus and must be regarded as an occupational disease secondary to chronic wood dust exposure. Few cases with neurological metastasis have been reported.We report the cases of two patients who developed a multiple cranial nerve disorder for the first case and a cauda equina syndrome for the second, after ethmoid adenocarcinoma surgery.Diagnosis of carcinomatous meningitis is difficult and is based on clinical data, CSF analysis and gadolinium-enhanced T1-weighted brain and spinal cord MRI. The implication of surgery is discussed. Prognosis of such a disorder is poor.
- Published
- 2007
20. Atrial Fibrillation Already Known Versus Detected After Stroke: Same Battle?
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Guenancia C and Béjot Y
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- Humans, Risk Factors, Atrial Fibrillation diagnosis, Atrial Fibrillation complications, Atrial Fibrillation physiopathology, Stroke etiology
- Published
- 2024
- Full Text
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21. Prevalence of major embolic findings and incidental findings on early cardiac CT in patients with suspected ischemic stroke.
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Philippe D, Bernard A, Ricolfi F, Béjot Y, Duloquin G, Comby PO, and Guenancia C
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- Humans, Male, Female, Aged, Retrospective Studies, Aged, 80 and over, Middle Aged, Prevalence, Embolism diagnostic imaging, Incidental Findings, Ischemic Stroke diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Purpose: The purpose of this study was to assess the type and prevalence of stroke and non-stroke-related findings diagnosed on early cardiac computed tomography (CT) in patients with suspected stroke. The secondary objective was to assess the clinical consequences on the management of patients with non-stroke-related conditions identified by early cardiac CT., Materials and Methods: This single-center, retrospective, observational study included 1111 consecutive patients with suspected ischemic stroke between November 2018 and March 2020 who underwent cardiac CT examination in addition to the usual brain CT protocol (i.e., non-enhanced brain CT, perfusion brain CT when needed, aortic arch and supra-aortic CT angiography, and post contrast brain CT). There were 562 women and 549 men with a median age of 74 years (range: 60-85 years). Of these, 415 (415/1111; 37.4%) patients had ischemic stroke and 692 (692/1111; 62.3%) had no stroke. Cardiac CT examinations were retrospectively reviewed for cardiac CT findings at high embolic risk and clinically significant extracardiac incidental findings., Results: Among 1111 included patients, 89 (89/1111; 8.0%) had a stroke-related condition identified on early cardiac CT. This was significantly more frequent in patients with ischemic stroke (66/415; 15.9%) by comparison with those without ischemic stroke (23/696; 3.3%) (P < 0.001), with 41 patients (41/415; 9.9%) diagnosed with left atrial thrombus. Cardiac CT revealed a clinically significant non-stroke-related finding in 173 patients (173/1111; 15.6%), including 17 pulmonary embolisms (1.5%), seven suspicious pulmonary lesions (0.6%), and three breast lesions suspected to be malignant (0.3%). Twenty out of 173 patients (20/173; 11.5%) with incidental findings on early cardiac CT had a change in their management., Conclusion: This study shows that adding early cardiac CT to brain CT during the acute phase of an ischemic stroke leads to a higher rate of etiological diagnoses and highlights the major interest of looking at the bigger picture., Competing Interests: Declaration of competing interest The authors declare no actual or potential conflict of interest related to this study., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2024
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22. Efficacy and clinical implications of a stepwise screening strategy for atrial fibrillation after stroke: Insights from the SAFAS study.
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Benali K, Duloquin G, Noto-Campanella C, Garnier L, Didier R, Pommier T, Laurent G, Vergely C, Béjot Y, and Guenancia C
- Abstract
Background: Although guidelines recommend screening patients for atrial fibrillation (AF) after stroke, the optimal timing and combination of screening tools remain unclear., Aims: We evaluated the suitability of a sequential combination of screening techniques for AF detected after stroke (AFDAS). We also compared patient characteristics according to the timing of AFDAS., Methods: Patients without previous AF admitted for acute ischaemic stroke were prospectively enrolled. After a stepwise screening approach for AFDAS based on electrocardiogram, telemetry monitoring and in-hospital long-term Holter, patients with cryptogenic stroke underwent implantation of an implantable cardiac monitor (ICM). Early AFDAS was defined as AF diagnosed during hospitalization and late AFDAS as AF diagnosed on an ICM., Results: Of the 240 patients included, 104 (43.3%) had a documented cause of stroke not related to AF. Among the 136 remaining patients, AFDAS was detected in 82 (60.3%) during the acute screening phase or during the 3-year follow-up by ICM. Early AFDAS was diagnosed by ECG, telemetry and in-hospital long-term Holter monitoring in 17 (20.7%), 25 (30.5%) and 18 (22.0%) patients, respectively. Among 76 patients who had an ICM implanted for cryptogenic stroke, AF was detected in 22 patients (28.9%). Except for age and stroke location, patients with early AFDAS did not differ from those with late AFDAS, particularly with regard to the prevalence of atrial cardiomyopathy markers., Conclusion: A stepwise approach to AFDAS screening allows early detection of AF in a considerable number of patients during their hospitalization. ICMs remain complementary to non-invasive screening tools for the detection of remote episodes of AF., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)
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- 2024
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23. Are we ready to cure post-stroke cognitive impairment? Many key prerequisites can be achieved quickly and easily.
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Godefroy O, Aarabi A, Béjot Y, Biessels GJ, Glize B, Mok VC, Schotten MT, Sibon I, Chabriat H, and Roussel M
- Abstract
Purpose: Post-stroke (PS) cognitive impairment (CI) is frequent and its devastating functional and vital consequences are well known. Despite recent guidelines, they are still largely neglected. A large number of recent studies have re-examined the epidemiology, diagnosis, imaging determinants and management of PSCI. The aim of this update is to determine whether these new data answer the questions that are essential to reducing PSCI, the unmet needs, and steps still to be taken., Methods: Literature review of stroke unit-era studies examining key steps in the management of PSCI: epidemiology and risk factors, diagnosis (cognitive profile and assessments), imaging determinants (quantitative measures, voxelwise localization, the disconnectome and associated Alzheimer's disease [AD]) and treatment (secondary prevention, symptomatic drugs, rehabilitation and noninvasive brain stimulation) of PSCI., Findings: (1) the prevalence of PSCI of approximately 50% is probably underestimated; (2) the sensitivity of screening tests should be improved to detect mild PSCI; (3) comprehensive assessment is now well-defined and should include apathy; (4) easily available factors can identify patients at high risk of PSCI; (5) key imaging determinants are the location and volume of the lesion and the resulting disconnection, associated AD and brain atrophy; WMH, ePVS, microhemorrhages, hemosiderosis, and cortical microinfarcts may contribute to cognitive impairment but are more likely to be markers of brain vulnerability or associated AD that reduce PS recovery; (6) remote and online assessment is a promising approach for selected patients; (7) secondary stroke prevention has not been proven to prevent PSCI; (8) symptomatic drugs are ineffective in treating PSCI and apathy; (9) in addition to cognitive rehabilitation, the benefits of training platforms and computerized training are yet to be documented; (10) the results and the magnitude of improvement of noninvasive brain stimulation, while very promising, need to be substantiated by large, high-quality, sham-controlled RCTs., Discussion and Conclusion: These major advances pave the way for the reduction of PSCI. They include (1) the development of more sensitive screening tests applicable to all patients and (2) online remote assessment; crossvalidation of (3) clinical and (4) imaging factors to (5) identify patients at risk, as well as (6) factors that prompt a search for associated AD; (7) the inclusion of cognitive outcome as a secondary endpoint in acute and secondary stroke prevention trials; and (8) the validation of the benefit of noninvasive brain stimulation through high-quality, randomized, sham-controlled trials. Many of these objectives can be rapidly and easily attained., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Olivier Godefroy: has served on scientific advisory boards (Novartis and Astra Zeneca), received funding for travel and meetings from Novartis, Lilly, Genzyme, Astrazeneca, Biogen, Teva, Pfizer, CSL-Behring, GSK, Boehringer-Ingelheim, Ipsen, Covidien, Bristol-Myers Squibb. Ardalan Aarabi: none related to this study. Yannick Béjot meeting speaker: BMS, Pfizer, Boehringher-Ingelheim, Servier, Medtronic, Amgen; Consulting: Medtronic, NovoNordisk, Novartis. Geert J Biessels: Consulting : Nestle HealthScience. Bertrand Glize: Consulting: IPSEN. Vincent MT Mok: none related to this study. Michel Thiebaut de Schotten: none related to this study. Igor Sibon: meeting speaker: BMS, Pfizer, Boehringher-Ingelheim, Servier, Medtronic, Novonordisk, Novartis, Sanofi, Astra-Zeneca; Consulting: Medtronic, NovoNordisk, Novartis, Sanofi, Astra-Zeneca. Hugues Chabriat: none related to this study. M Roussel: none related to this study.
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- 2024
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24. Incidence and nationwide estimates of cryptogenic ischemic stroke or TIA eligible for prolonged cardiac rhythm monitoring.
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Béjot Y, Duloquin G, and Guenancia C
- Abstract
Introduction: Current guidelines indicate prolonged cardiac rhythm monitoring for atrial fibrillation screening in patients with cryptogenic ischemic stroke (IS) or transient ischemic attack (TIA). This study aimed to assess the incidence of cryptogenic IS/TIA eligible for such investigation, and to estimate the number of patients potentially concerned in whole France annually., Methods: All cryptogenic acute IS/TIA cases ⩾35 years old were retrieved from the population-based Dijon Stroke Registry, France (2013-2020). Patients eligible for prolonged cardiac rhythm monitoring were defined after excluding those who died in-hospital or within the first 30 days, or with preexisting major impairment. Annual incidence rates of eligible cryptogenic IS/TIA were calculated by age groups and sex. The total number of eligible patients in France was estimated by standardization to age- and sex-specific incidence., Results: Among 2811 IS/TIA patients recorded in the Dijon Stroke Registry, 1239 had cryptogenic IS/TIA of whom 1045 were eligible for prolonged cardiac rhythm monitoring (517 IS and 528 TIA, mean age 73.6 ± 14.6 years old, 55.4% women). Crude incidence rates of eligible cryptogenic IS/TIA were 169/100,000 per year (95% CI: 159-179) in overall sexes, 83/100,000 per year (95% CI: 76-91) for IS, and 85/100,000 per year (95% CI: 78-93) for TIA. The total number of patients with cryptogenic IS/TIA eligible for prolonged cardiac rhythm monitoring in France was estimated to be 66,125 (95% CI: 65,622-66,630) for the calendar year 2022, including 32,764 (95% CI: 32,410-33,120) with IS and 33,361 (95% CI: 33,004-33,721) with TIA., Conclusions: This study demonstrated a high incidence of cryptogenic IS/TIA eligible for prolonged cardiac rhythm monitoring. Estimates at a national level pointed out the large number of patients who may require access to such atrial fibrillation screening, with attention to be paid on regarding organization of care networks and related costs., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Charles Guenancia reports personal fees from MicroPort CRM, Medtronic, Astra-Zeneca, BMS, Pfizer, Abbott, outside the submitted work. Yannick Béjot reports personal fees from BMS, Pfizer, Medtronic, Amgen, Servier, NovoNordisk, Novartis, outside the submitted work. Other authors: none.
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- 2024
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25. Atrial fibrillation and preexisting cognitive impairment in ischemic stroke patients: Dijon Stroke Registry.
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Pommier T, Duloquin G, Pinguet V, Comby PO, Guenancia C, and Béjot Y
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- Humans, Male, Female, Aged, France epidemiology, Risk Factors, Prospective Studies, Aged, 80 and over, Prevalence, Middle Aged, Dementia epidemiology, Dementia complications, Tomography, X-Ray Computed, Registries, Cognitive Dysfunction epidemiology, Ischemic Stroke epidemiology, Ischemic Stroke complications, Ischemic Stroke diagnostic imaging, Atrial Fibrillation epidemiology, Atrial Fibrillation complications
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Background: Atrial Fibrillation (AF) is a common cause of ischemic stroke (IS), and is associated with cognitive impairment in the general population. We aimed to compare the prevalence of preexisting cognitive impairment between IS patients with and without AF, and to assess whether prior brain damage could contribute to the observed differences., Methods: Patients with acute IS were prospectively identified from the population-based Dijon Stroke Registry, France. Patients who had a CT-scan as brain imaging modality were included in this analysis to assess the presence of preexisting leukoaraiosis, old vascular brain lesions, and cerebral atrophy. Characteristics of patients including prior-to-stroke cognitive status (normal cognition, mild cognitive impairment (MCI), or dementia) were compared between those with and without AF., Results: Among 916 IS patients, 288 (31.4 %) had AF, of whom 88 had newly diagnosed AF. AF patients had more frequent prior MCI (17.8 % versus 10.2 %) or dementia (22.4 % versus 13.1 %) (p = 0.001), vascular risk factors, and preexisting brain damage. In unadjusted model, preexisting cognitive impairment was associated with AF (OR=2.24; 95 % CI: 1.49-3.37, p < 0.001 for MCI; OR=2.20; 95 % CI: 1.52-3.18, p < 0.001 for dementia). After adjustment for clinical and imaging variables, preexisting mild cognitive impairment (OR=1.87; 95 % CI: 1.06-3.32, p = 0.032) and dementia (OR=1.98; 95 % CI: 1.15-3.40, p = 0.013) were independently associated with AF., Conclusion: AF is a common condition in IS patients and is associated with preexisting cognitive impairment. Brain lesions visible on imaging did not seem to fully account for this association that may involve other mechanisms yet to be elucidated., Competing Interests: Declaration of competing interest Charles Guenancia reports personal fees from MicroPort CRM, Medtronic, Astra-Zeneca, BMS, Pfizer, Abbott, outside the submitted work. Yannick Béjot reports personal fees from BMS, Pfizer, Boehringer-Ingelheim, Medtronic, Amgen, Servier, NovoNordisk, Novartis, outside the submitted work. Other authors: none, (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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26. Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.
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Costalat V, Jovin TG, Albucher JF, Cognard C, Henon H, Nouri N, Gory B, Richard S, Marnat G, Sibon I, Di Maria F, Annan M, Boulouis G, Cardona P, Obadia M, Piotin M, Bourcier R, Guillon B, Godard S, Pasco-Papon A, Eker OF, Cho TH, Turc G, Naggara O, Velasco S, Lamy M, Clarençon F, Alamowitch S, Renu A, Suissa L, Brunel H, Gentric JC, Timsit S, Lamy C, Chivot C, Macian-Montoro F, Mounayer C, Ozkul-Wermester O, Papagiannaki C, Wolff V, Pop R, Ferrier A, Chabert E, Ricolfi F, Béjot Y, Lopez-Cancio E, Vega P, Spelle L, Denier C, Millán M, Arenillas JF, Mazighi M, Houdart E, Del Mar Freijo M, Duhamel A, Sanossian N, Liebeskind DS, Labreuche J, Lapergue B, and Arquizan C
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Cerebral Hemorrhage etiology, Combined Modality Therapy, Endovascular Procedures, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Brain Infarction diagnostic imaging, Brain Infarction etiology, Brain Infarction therapy, Acute Disease, Cerebral Arteries diagnostic imaging, Cerebral Arteries surgery, Cerebral Arterial Diseases complications, Cerebral Arterial Diseases diagnostic imaging, Cerebral Arterial Diseases pathology, Cerebral Arterial Diseases surgery, Stroke diagnostic imaging, Stroke etiology, Stroke therapy, Thrombectomy, Thrombolytic Therapy adverse effects, Thrombolytic Therapy methods, Infarction, Anterior Cerebral Artery diagnostic imaging, Infarction, Anterior Cerebral Artery pathology, Infarction, Anterior Cerebral Artery surgery
- Abstract
Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied., Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group). The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). The primary safety outcome was death from any cause at 90 days, and an ancillary safety outcome was symptomatic intracerebral hemorrhage., Results: A total of 333 patients were assigned to either the thrombectomy group (166 patients) or the control group (167 patients); 9 were excluded from the analysis because of consent withdrawal or legal reasons. The trial was stopped early because results of similar trials favored thrombectomy. Approximately 35% of the patients received thrombolysis therapy. The median modified Rankin scale score at 90 days was 4 in the thrombectomy group and 6 in the control group (generalized odds ratio, 1.63; 95% confidence interval [CI], 1.29 to 2.06; P<0.001). Death from any cause at 90 days occurred in 36.1% of the patients in the thrombectomy group and in 55.5% of those in the control group (adjusted relative risk, 0.65; 95% CI, 0.50 to 0.84), and the percentage of patients with symptomatic intracerebral hemorrhage was 9.6% and 5.7%, respectively (adjusted relative risk, 1.73; 95% CI, 0.78 to 4.68). Eleven procedure-related complications occurred in the thrombectomy group., Conclusions: In patients with acute stroke and a large infarct of unrestricted size, thrombectomy plus medical care resulted in better functional outcomes and lower mortality than medical care alone but led to a higher incidence of symptomatic intracerebral hemorrhage. (Funded by Montpellier University Hospital; LASTE ClinicalTrials.gov number, NCT03811769.)., (Copyright © 2024 Massachusetts Medical Society.)
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- 2024
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27. Assessment of Mendelian and risk-factor genes in Alzheimer disease: A prospective nationwide clinical utility study and recommendations for genetic screening.
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Nicolas G, Zaréa A, Lacour M, Quenez O, Rousseau S, Richard AC, Bonnevalle A, Schramm C, Olaso R, Sandron F, Boland A, Deleuze JF, Andriuta D, Anthony P, Auriacombe S, Balageas AC, Ballan G, Barbay M, Béjot Y, Belliard S, Benaiteau M, Bennys K, Bombois S, Boutoleau-Bretonnière C, Branger P, Carlier J, Cartz-Piver L, Cassagnaud P, Ceccaldi MP, Chauviré V, Chen Y, Cogez J, Cognat E, Contegal-Callier F, Corneille L, Couratier P, Cretin B, Crinquette C, Dauriat B, Dautricourt S, de la Sayette V, de Liège A, Deffond D, Demurger F, Deramecourt V, Derollez C, Dionet E, Doco Fenzy M, Dumurgier J, Dutray A, Etcharry-Bouyx F, Formaglio M, Gabelle A, Gainche-Salmon A, Godefroy O, Graber M, Gregoire C, Grimaldi S, Gueniat J, Gueriot C, Guillet-Pichon V, Haffen S, Hanta CR, Hardy C, Hautecloque G, Heitz C, Hourregue C, Jonveaux T, Jurici S, Koric L, Krolak-Salmon P, Lagarde J, Lanoiselée HM, Laurens B, Le Ber I, Le Guyader G, Leblanc A, Lebouvier T, Levy R, Lippi A, Mackowiak MA, Magnin E, Marelli C, Martinaud O, Maureille A, Migliaccio R, Milongo-Rigal E, Mohr S, Mollion H, Morin A, Nivelle J, Noiray C, Olivieri P, Paquet C, Pariente J, Pasquier F, Perron A, Philippi N, Planche V, Pouclet-Courtemanche H, Rafiq M, Rollin-Sillaire A, Roué-Jagot C, Saracino D, Sarazin M, Sauvée M, Sellal F, Teichmann M, Thauvin C, Thomas Q, Tisserand C, Turpinat C, Van Damme L, Vercruysse O, Villain N, Wagemann N, Charbonnier C, and Wallon D
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- Humans, Female, Male, Aged, Risk Factors, Prospective Studies, Middle Aged, Presenilin-1 genetics, Pedigree, Age of Onset, Amyloid beta-Protein Precursor genetics, Aged, 80 and over, Alzheimer Disease genetics, Alzheimer Disease diagnosis, Genetic Testing methods, Genetic Predisposition to Disease, Exome Sequencing, Presenilin-2 genetics, Membrane Glycoproteins, Receptors, Immunologic
- Abstract
Purpose: To assess the likely pathogenic/pathogenic (LP/P) variants rates in Mendelian dementia genes and the moderate-to-strong risk factors rates in patients with Alzheimer disease (AD)., Methods: We included 700 patients in a prospective study and performed exome sequencing. A panel of 28 Mendelian and 6 risk-factor genes was interpreted and returned to patients. We built a framework for risk variant interpretation and risk gradation and assessed the detection rates among early-onset AD (EOAD, age of onset (AOO) ≤65 years, n = 608) depending on AOO and pedigree structure and late-onset AD (66 < AOO < 75, n = 92)., Results: Twenty-one patients carried a LP/P variant in a Mendelian gene (all with EOAD, 3.4%), 20 of 21 affected APP, PSEN1, or PSEN2. LP/P variant detection rates in EOAD ranged from 1.7% to 11.6% based on AOO and pedigree structure. Risk factors were found in 69.5% of the remaining 679 patients, including 83 (12.2%) being heterozygotes for rare risk variants, in decreasing order of frequency, in TREM2, ABCA7, ATP8B4, SORL1, and ABCA1, including 5 heterozygotes for multiple rare risk variants, suggesting non-monogenic inheritance, even in some autosomal-dominant-like pedigrees., Conclusion: We suggest that genetic screening should be proposed to all EOAD patients and should no longer be prioritized based on pedigree structure., Competing Interests: Conflict of Interest The authors have no conflict of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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28. Climate Change and Stroke: A Topical Narrative Review.
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Ranta A, Kang J, Saad A, Wasay M, Béjot Y, Ozturk S, Giroud M, Reis J, and Douwes J
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- Humans, Climate Change, Air Pollution adverse effects, Greenhouse Gases adverse effects
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The impacts of accumulating atmospheric greenhouse gases on the earth's climate are now well established. As a result, there have been increases in ambient temperatures and resultant higher frequency and duration of temperature extremes and other extreme weather events, which have been linked to a wide range of adverse health outcomes. This topical narrative review provides a summary of published evidence on the links between climate change and stroke. There is consistent evidence of associations between stroke incidence and mortality and increasing ambient temperature and air pollution. Associations have also been shown for changes in barometric pressure, wildfires, and desert dust and sandstorms, but current evidence is limited. Flooding and other extreme weather events appear to primarily cause service disruption, but more direct links to stroke may emerge. Synergies between dietary changes that reduce stroke risk and may also reduce carbon footprint are being explored. We also discuss the impact on vulnerable populations, proposed pathophysiologic mechanisms, mitigation strategies, and current research priorities. In conclusion, climate change increasingly impacts the stroke community, warranting elevated attention., Competing Interests: Disclosures Dr Ranta discloses employment at Capital Coast District Health Board and University of Otago Wellington, consultancy for Ministry of Health, and research funding from the Ministry of Health and Health Research Council of New Zealand. Dr Douwes discloses research funding from Health Research Council of New Zealand and Marsden Fund. The other authors report no conflicts.
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- 2024
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29. Is COVID-19 Infection a Multiorganic Disease? Focus on Extrapulmonary Involvement of SARS-CoV-2.
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Duloquin G, Pommier T, Georges M, Giroud M, Guenancia C, Béjot Y, Laurent G, and Rabec C
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First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation.
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- 2024
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30. Factors associated with patent foramen ovale-related stroke: SAFAS study.
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Pommier T, Lafont A, Didier R, Garnier L, Duloquin G, Meloux A, Sagnard A, Graber M, Dogon G, Laurent G, Vergely C, Béjot Y, and Guenancia C
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- Humans, Growth Differentiation Factor 15, Osteoprotegerin, Prospective Studies, Galectin 3, Biomarkers, Risk Factors, Foramen Ovale, Patent diagnosis, Foramen Ovale, Patent diagnostic imaging, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Stroke etiology, Stroke complications, Ischemic Stroke
- Abstract
Background: Persistent foramen ovale (PFO) contributes to cryptogenic stroke and is associated with stroke recurrence, although the exact mechanism of ischemic events is not fully understood. Several biomarkers have been developed for the prediction of atrial fibrillation after stroke, but there are currently only limited data on their potential value for the diagnosis of PFO-related stroke., Methods: This study was a prospective single-center study that included all patients hospitalized between March 31, 2018, and January 18, 2020, in the stroke department of the Dijon University Hospital for ischemic stroke without obvious cause and without a history of atrial fibrillation. PFO was systematically screened by transthoracic echocardiography and images were reviewed by an independent cardiologist blinded from clinical data. PFO was defined according to the CLOSE trial criteria: PFO associated with interatrial septal aneurysm or significant interatrial shunt (> 30 microbubbles in the left atrium within three cardiac cycles after right atrial opacification). The potential association of PFO-related stroke with biomarkers of cardiac fibrosis and inflammation such as galectin-3, GDF-15, ST-2, osteoprotegerin and NT-proBNP was tested using multivariate backward stepwise logistic regression., Results: Of the 240 patients included in the SAFAS study, 229 had complete echocardiographic data, and 23 (10%) had PFO-related stroke. Patients with PFO-related stroke were significantly younger (58±14 vs. 69±14, P<0.001), had less frequent previous arterial hypertension (30 vs. 60%, P=0.008), and more frequent cerebellar territory involvement (26 vs. 9%, P=0.014) compared to the other patients. In addition, they had less frequently left atrial dilatation (left atrial index volume>34mL/m
2 [9 vs. 35%, P=0.009]). After ROC curve analysis for definition of thresholds, PFO-related stroke patients more often had galectin-3<9.5ng/mL (59 vs. 27%, P=0.002), ST2<13380pg/ml (23 vs. 50%, P=0.007), GDF-15<1200ng/mL (59 vs. 27%, P=0.002), osteoprotegerin<1133pg/mL (82 vs. 58%, P=0.033) and NT-proBNP<300pg/mL (88 vs. 55%, P=0.009). After multivariate analysis, only galectin-3<9.5ng/mL (OR [95% CI] 3.4 [1.18; 9.8], P=0.024) and osteoprotegerin<1133pg/L (OR [95% CI] 5.0 [1.1; 22.9], P=0.038) were independently associated with PFO-related stroke., Conclusion: Patients in whom cryptogenic stroke is attributed to a significant PFO have a specific clinical and biological phenotype. Low levels of galectin-3 and osteoprotegerin may help identify patients with PFO-related strokes., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)- Published
- 2024
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31. Prevalence and Characteristics of Known versus Newly Detected Atrial Fibrillation in Ischemic Stroke: A Population-Based Study.
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Mitaine A, Duloquin G, Pommier T, Vergely C, Guenancia C, and Béjot Y
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- Humans, Female, Male, Aged, Prevalence, Aged, 80 and over, France epidemiology, Electrocardiography, Atrial Fibrillation epidemiology, Atrial Fibrillation complications, Ischemic Stroke epidemiology, Ischemic Stroke diagnostic imaging, Registries
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Background: Atrial fibrillation (AF) is frequently diagnosed during the acute stage of ischemic stroke (IS), and it may reflect undiagnosed AF before stroke, thus representing a missed opportunity for stroke prevention. This population-based study aimed to assess the prevalence of known AF (KAF) and AF diagnosed early after IS (AFDAS) and to compare clinical and brain/arterial imaging characteristics between patients., Methods: Among patients with acute IS recorded in the population-based Dijon Stroke Registry, France (2013-2020), we identified those with KAF or AFDAS. AFDAS was considered when AF was diagnosed during the initial work-up based on electrocardiograms, in-hospital continuous electrocardiographic and/or Holter monitoring. Clinical and imaging characteristics on brain CT scan or angio-CT scan when available including old parenchymal lesions, arterial territory of the index IS, and aortic arch, cervical and intracranial arteries atheroma were compared between groups (KAF vs. AFDAS). Regression logistic models were used to assess factors associated with AFDAS (compared to KAF)., Results: Among 1,756 IS patients, 550 (31.3%) had AF (mean age: 83.6 ± 10.3 years old, 60.5% women), of whom 367 (66.7%) presented with KAF and 183 (33.3%) had AFDAS. In multivariable model, hypertension (OR = 0.37; 95% CI: 0.21-0.64, p < 0.001), chronic heart failure (OR = 0.34; 95% CI: 0.18-0.67, p = 0.002), previous stroke (OR = 0.42; 95% CI: 0.26-0.67, p < 0.001), and preexisting dementia (OR = 0.36; 95% CI: 0.21-0.63, p < 0.001) were inversely associated with AFDAS, whereas NIHSS score was associated with AFDAS (OR = 1.02; 95% CI: 1.00-1.05, p = 0.012)., Conclusions: Our findings indicate a more advanced stage of the atrial cardiomyopathy in KAF as compared with AFDAS patients and may thus contribute to the fact that in these latter patients AF had not been diagnosed prior to stroke. This group of patients undeniably represents a missed opportunity for stroke prevention., (© 2024 S. Karger AG, Basel.)
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- 2024
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32. Value of HAVOC and Brown ESUS-AF scores for atrial fibrillation on implantable cardiac monitors after embolic stroke of undetermined source.
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Grygorowicz C, Benali K, Serzian G, Mouhat B, Duloquin G, Pommier T, Didier R, Laurent G, Béjot Y, Maille B, Vuillier F, Badoz M, and Guenancia C
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- Humans, Retrospective Studies, Risk Factors, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Stroke diagnosis, Stroke etiology, Stroke therapy, Embolic Stroke complications, Ischemic Stroke complications
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Objectives: Up to 20 % of ischemic strokes are associated with overt atrial fibrillation (AF). Furthermore, silent AF was detected by an implantable cardiac monitor (ICM) in 1 in 3 cryptogenic strokes in the CRYSTAL AF study. An ESC position paper has suggested a HAVOC score ≥ 4 or a Brown ESUS-AF score ≥ 2 as criteria for ICM implantation after cryptogenic stroke, but neither of these criteria has been developed or validated in ICM populations. We assessed the performance of HAVOC and Brown ESUS-AF scores in a cohort of ICM patients implanted after embolic stroke of undetermined source (ESUS)., Methods: All patients implanted with an ICM for ESUS between February 2016 and February 2022 at two French University Hospitals were retrospectively included. Demographic data, cardiovascular risk factors, and clinical and biological data were collected after a review of electronic medical records. HAVOC and Brown ESUS-AF scores were calculated for all patients., Findings: Among the 384 patients included, 106 (27 %) developed AF during a mean follow-up of 33 months. The scores performances for predicting AF during follow-up were: HAVOC= AUC: 68.5 %, C-Index: 0.662, and Brown ESUS-AF=AUC: 72.9 %, C-index 0.712. Compared with the CHA
2 DS2 -VASc score, only the Brown ESUS-AF score showed significant improvement in NRI/IDI. Furthermore, classifying patients according to the suggested HAVOC and Brown ESUS-AF thresholds, only 24 % and 31 % of the cohort, respectively, would have received an ICM, and 58 (55 %) and 47 (44 %) of the AF patients, respectively, would not have been implanted with an ICM., Conclusion: HAVOC and Brown ESUS-AF scores showed close and moderate performance in predicting AF on ICM after cryptogenic stroke, with a significant lack of sensitivity. Specific risk scores should be developed and validated in large ICM cohorts., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2024
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33. Environmental factors and stroke: Risk and prevention.
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Ranta A, Ozturk S, Wasay M, Giroud M, Béjot Y, and Reis J
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- Adult, Humans, Risk Factors, Incidence, Environmental Exposure adverse effects, Air Pollution adverse effects, Stroke epidemiology, Stroke etiology, Stroke prevention & control
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Stroke is a leading cause of death and adult disability globally. In addition to traditional risk factors, environmental risk factors have emerged over the recent past and are becoming increasingly important. The disproportionate rise of stroke incidence in low- and middle-income countries has been attributed, at least in part, to environmental factors. This narrative review provides details on the interplay between the environment and health generally and stroke specifically, covering topics including air pollution, atmospheric brown clouds, desert dust storms, giant wildfires, chemical contamination, biological aggressors, urbanization, and climate change. It also covers some beneficial environmental effects such as can be harnessed from the exposure to green spaces. It concludes with a summary of pragmatic actions that can be taken to help address some of these challenges at individual, community, and political advocacy levels., Competing Interests: Declaration of Competing Interest Authors declare no conflict of interest relevant to this manuscript., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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34. IV Thrombolysis With or Without Endovascular Treatment for Suspected Ischemic Stroke in Patients With Intracranial Tumors.
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Seystahl K, Martinez-Majander N, Salerno A, Beyeler M, Erdur H, Marto JP, Hametner C, Zedde M, Pezzini A, Leker R, Altersberger V, Costamagna G, Serôdio M, Migliaccio L, Pascarella R, Zini A, Mannismäki L, Béjot Y, Jung S, Gensicke H, Padjen V, Ringleb PA, Nolte C, Heldner MR, Michel P, Engelter ST, Curtze S, Weller M, and Wegener S
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- Humans, Fibrinolytic Agents therapeutic use, Thrombolytic Therapy adverse effects, Prospective Studies, Intracranial Hemorrhages etiology, Intracranial Hemorrhages chemically induced, Treatment Outcome, Ischemic Stroke drug therapy, Brain Ischemia diagnostic imaging, Brain Ischemia drug therapy, Brain Ischemia complications, Pituitary Neoplasms complications, Stroke diagnostic imaging, Stroke drug therapy, Stroke complications
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Background and Objectives: IV thrombolysis (IVT) for suspected ischemic stroke in patients with intracranial neoplasms is off-label. However, data on risks of intracranial hemorrhage (ICH) are scarce., Methods: In a multicenter registry-based analysis within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration, we assessed frequencies of symptomatic and fatal ICH after IVT for suspected ischemic stroke in patients with intracranial tumors by descriptive statistics and analyzed associations with clinical and imaging characteristics by binary logistic regression. Definition of symptomatic ICH was based on the clinical criteria of the European Cooperative Acute Stroke-II trial including hemorrhage at any site in cranial imaging and concurrent clinical deterioration., Results: Screening data of 21,289 patients from 14 centers, we identified 105 patients receiving IVT; among them were 29 patients (28%) with additional endovascular treatment, with suspected, that is, imaging-based, or histologically confirmed diagnosis of intracranial tumors. Among 104 patients with CT or MRI after IVT available, symptomatic and fatal ICH were observed in 9 and 4 patients (9% and 4%, respectively). Among 82 patients with suspected or confirmed meningioma, symptomatic and fatal ICH occurred in 6 and 3 patients (7% and 4%), respectively. In 18 patients with intra-axial suspected or confirmed primary or secondary brain tumors, there was 1 symptomatic nonfatal ICH (6%). Of 4 patients with tumors of the pituitary region, 2 patients (50%) had symptomatic ICH including 1 fatal ICH (25%). Tumor size was not associated with the occurrence of symptomatic ICH (odds ratio 2.8, 95% CI 0.3-24.8, p = 0.34)., Discussion: In our dataset from routine clinical care, we provide insights on the safety of IVT for suspected ischemic stroke in patients with intracranial tumors, a population that is commonly withheld thrombolysis in clinical practice and prospective trials. Except for a potential high risk of symptomatic ICH after IVT in patients with tumors of the pituitary region, frequencies of symptomatic ICH in patients with intracranial tumors in our cohort seem to be in the upper range of rates observed in previous studies within the TRISP cooperation. These results may guide individual treatment decisions in patients with acute stroke and intracranial tumors with potential benefit of IVT., (© 2023 American Academy of Neurology.)
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- 2023
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35. Reader Response: Teaching NeuroImage: Reinhold Hemimedullary Syndrome.
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Béjot Y
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- Humans, Magnetic Resonance Imaging, Lateral Medullary Syndrome
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- 2023
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36. Symptomatic Intracranial Hemorrhage after Ischemic Stroke Treated with Bridging Revascularization Therapy.
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Amaral S, Duloquin G, and Béjot Y
- Abstract
(1) Background: bridging revascularization therapy is now the standard of care in patients with ischemic stroke due to large vessel occlusion. This study aimed to determine the frequency of symptomatic intracranial hemorrhage (sICH) related to this treatment, and to assess contributing factors and patients' outcomes. (2) Methods: consecutive ischemic stroke patients treated with bridging therapy were prospectively enrolled. sICH (intracranial hemorrhage with an increase in NIHSS score of ≥4 points) was assessed on imaging at 24 h. The functional status of patients was measured at 6 months using the mRS score; (3) Results: 176 patients were included (mean age 68.7 ± 1.2 years, 52.3% women), among whom 15 (8.5%) had sICH. Patients with sICH had more frequent alcohol abuse (30.1% versus 9.7%, p = 0.023), prestroke use of dual antiplatelet therapy (14.3% versus 1.3%, p = 0.002), higher NIHSS scores at admission (median score 20.5 versus 15, p = 0.01), greater systolic blood pressure upon admission, more frequent vascular intracranial calcifications ( p = 0.004), leukoaraiosis ( p = 0.001), and intracranial atheroma ( p = 0.02), and higher neutrophil-to-lymphocyte ratios ( p = 0.02) and neutrophil-to-platelet ratios ( p = 0.04). At 6-month follow-up, 9 (60%) patients with sICH died, versus 18% of patients without sICH ( p < 0.001). Only 1 (7%) patient with sICH had a good functional outcome, defined as an mRS score of 0 to 2, versus 51% of patients without sICH. (4) Conclusions: one in twelve ischemic stroke patients treated with bridging therapy suffered sICH. Given the observed poor outcomes after sICH, further studies are required to better identify patients at risk to help clinicians in guiding therapeutic strategies.
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- 2023
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37. Functional outcomes of ischemic stroke patients aged over 80 years treated with acute revascularization therapy according to pre-morbid disability: a PARADISE study.
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Ruel S, Baptiste L, Duloquin G, and Béjot Y
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Introduction: Aging population leads to changes in the profile of patients with acute ischemic stroke (IS), and older adults were largely excluded from randomized clinical trials of acute revascularization therapy. This study aimed to assess functional outcomes of treated IS patients > 80 years old according to prior disability and identify associated factors., Methods: Consecutively older patients with acute IS treated with either IV thrombolysis and/or mechanical thrombectomy were enrolled between 2016 and 2019. Pre-morbid disability was assessed using the modified Rankin Scale (mRS) score, and patients were classified as being independent (mRS score, 0-2) or having pre-existing disability (mRS score, 3-5). A multivariable logistic regression analysis was performed to assess factors associated with a poor functional outcome (mRS score > 3) at 3 and 12 months in each group of patients., Results: Among 300 included patients (mean age: 86.3 ± 4.6 years, 63% women, median NIHSS score: 14, IQR: 8-19), 100 had a pre-existing disability. In patients with a pre-morbid mRS score of 0-2, 51% had mRS >3 including 33% of deaths at 3 months. At 12 months, 50% had a poor outcome including 39% of deaths. In patients with a pre-morbid mRS score of 3-5, 71% had a poor outcome at 3 months including 43% of deaths, and at 12 months, 76% had mRS >3 including 52% of deaths. In multivariable models, the NIHSS score at 24 h was independently associated with poor outcomes at 3 and 12 months in both patients with (OR = 1.32; 95% CI: 1.16-1.51, p < 0.001 for 12 months outcome) or without (OR = 1.31; 95% CI: 1.19-1.44, p < 0.001 for 12 months outcome) pre-morbid disability., Conclusion: Although a large proportion of older patients with a pre-existing disability had a poor functional outcome, they did not differ from their non-impaired counterparts regarding prognostic factors. This means that there were no factors in our study that would help clinicians identify patients at risk of poor functional outcomes after revascularization therapy among those with prior disability. Further studies are needed to better understand the post-stroke trajectory of older IS patients with a pre-morbid disability., Competing Interests: YB received honoraria for lectures or consulting fees from BMS, Pfizer, Medtronic, Amgen, Servier, NovoNordisk and Boehringer-Ingelheim, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ruel, Baptiste, Duloquin and Béjot.)
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- 2023
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38. Comparison of Stroke Recurrence, Cardiovascular Events, and Death Among Patients With Pregnancy-Associated vs Non-Pregnancy-Associated Stroke.
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Béjot Y, Olié V, Lailler G, Grave C, Regnault N, Duloquin G, Blacher J, and Gabet A
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- Humans, Female, Pregnancy, Adolescent, Young Adult, Adult, Middle Aged, Cohort Studies, Cerebral Hemorrhage, Acute Coronary Syndrome, Venous Thromboembolism, Stroke epidemiology, Ischemic Stroke
- Abstract
Importance: Women with pregnancy-associated stroke might have different risks of stroke recurrence, including during subsequent pregnancies, and other cardiovascular events due to pregnancy-specific stroke risk factors, such as gestational hypertension, preeclampsia, or gestational diabetes., Objective: To estimate the rate of stroke recurrence, cardiovascular hospitalization, and death in women with pregnancy-associated stroke compared with women with non-pregnancy-associated stroke., Design, Setting, and Participants: This cohort study included all women aged 15 to 49 years in France who were affiliated with the general scheme of French health care insurance (94% of women) and had a first hospitalization for stroke between January 1, 2010, and December 31, 2018. Women were followed up until December 31, 2020, with the registration of stroke recurrence, hospitalization for cardiovascular conditions, and death. Data were from the French health care database Système National des Données de Santé. Statistical analyses were conducted between December 2021 and September 2022., Exposure: Pregnancy status at the time of stroke., Main Outcomes and Measures: Poisson regressions were used to estimate incidence rates of these events with 95% CIs. We used Cox proportional hazards regression models to estimate the hazard ratios (HRs) of each event during the follow-up for women with a pregnancy-associated stroke vs women with a non-pregnancy-associated stroke., Results: Among women aged between 15 and 49 years between 2010 and 2018 and living in France, 1204 had a pregnancy-associated stroke at a mean (SD) age of 31.5 (5.8) years, and 31 697 had a non-pregnancy-associated stroke at a mean age of 39.6 (8.2) years. Among the 1204 women with a pregnancy-associated stroke, the incidence rate was 11.4 (95% CI, 9.0-14.3) per 1000 person-years, with 2 recurrent events during a subsequent pregnancy. Compared with women with non-pregnancy-associated stroke, women with pregnancy-associated stroke had lower risks of ischemic stroke (adjusted HR, 0.53; 95% CI, 0.36-0.77), cardiovascular events (adjusted HR, 0.58; 95% CI, 0.49-0.69), and death (adjusted HR, 0.42; 95% CI, 0.22-0.79). In contrast, the risk of recurrent intracerebral hemorrhage and cerebral venous thrombosis did not differ significantly, whereas the risks of venous thromboembolism (HR, 2.02; 95% CI, 1.14-3.58) and acute coronary syndrome with ST-segment elevation (HR, 3.93; 95% CI, 1.10-14.0) were increased., Conclusions and Relevance: In this cohort study, although the risks of ischemic stroke, overall cardiovascular events, and mortality were lower after a pregnancy-associated stroke than after a non-pregnancy-associated stroke, the risks of venous thromboembolism and acute coronary syndrome with ST-segment elevation were higher. Recurrent stroke during a subsequent pregnancy remained rare.
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- 2023
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39. Acute revascularization therapy for ischemic stroke during pregnancy and post-partum in France.
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Béjot Y, Olié V, Lailler G, Grave C, Regnault N, Blacher J, Duloquin G, and Gabet A
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- Humans, Pregnancy, Female, Cross-Sectional Studies, Postpartum Period, Intracranial Hemorrhages complications, Ischemic Stroke complications, Stroke epidemiology
- Abstract
Introduction: Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in women with ischemic stroke (IS) during pregnancy/post-partum is challenging, and recent guidelines claimed for additional information to better argue its effectiveness and safety. This observational national study aimed to describe characteristics, rates and outcomes of pregnant/post-partum women receiving acute revascularization therapy for IS compared to their non-pregnant counterparts, and pregnant women with IS not receiving such therapy., Patients and Methods: In this cross-sectional study, all women aged 15-49 years hospitalized in France for IS between 2012 and 2018 were retrieved from the French hospital discharge databases. Pregnant or post-partum (⩽6 weeks after delivery) women were identified. Data about patients' characteristics, risk factors, revascularization therapy, delivery, post-stroke survival, and recurrent vascular events during follow-up were recorded., Results: Over the study period, 382 women with pregnancy-related IS were registered. Among them, 7.3% ( n = 28) received a revascularization therapy, including nine cases during pregnancy, one the same day as delivery, and 18 during the post-partum period, compared with 8.5% ( n = 1285) in women with non-pregnancy-related IS ( n = 15,084). Treated pregnant/post-partum women had more severe IS than not-treated pregnant/post-partum. Compared with treated not-pregnant women, they were younger, but did not differ regarding other characteristics including stroke severity. There were no differences in systemic or intracranial hemorrhages or in the length of hospital stay between pregnant/post-partum women compared with treated not-pregnant women. All women receiving revascularization during pregnancy had a live baby. After a mean follow-up of 4.3 years, all pregnant/post-partum women were alive, one had recurrent IS and none had other vascular events., Discussion and Conclusion: Only a few women with pregnancy-related IS were treated with acute revascularization therapy, but this was proportionately similar to their non-pregnant counterparts, from whom they did not differed regarding characteristics, survival, and risk of recurrent events. These findings suggest that stroke physicians applied treatment strategies of IS in a similar way regardless of pregnancy in France, and this attitude was an anticipation but consistent with the recently published guidelines on the topic.
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- 2023
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40. Nationwide projections of ischemic stroke with large vessel occlusion of the anterior circulation by 2050: Dijon Stroke Registry.
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Duloquin G and Béjot Y
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- Humans, Aged, Infant, Newborn, Aged, 80 and over, Registries, Aging, France epidemiology, Ischemic Stroke, Stroke epidemiology
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Introduction: Data on the epidemiology of ischemic stroke (IS) with large vessel occlusion (LVO) are scarce although there is a need to better assess future demands for dedicated facilities in an aging population. This study aimed to estimate the number of expected cases of IS with LVO of the anterior circulation in the French population by 2050., Methods: IS were retrieved from the population-based registry of Dijon, France (2013-2017). Patients with LVO were identified and age-and sex-standardized incidence rates were calculated to estimate the number of expected cases in the whole French population by 2050 according three scenarios: stable incidence; a decrease in incidence rates of 0.5%/year in people >65 years old; a decrease in incidence rates of 0.5%/year in overall population., Results: 1,067 cases of IS with LVO were recorded in Dijon over the study period, corresponding to crude incidence rate of 22/100,000/year (95% CI: 18-25). By 2050, the number of cases is expected to increase by 51 to 81% according to the various scenarios, to reach between 22,457 cases (95% CI: 10,839 - 43,639) and 26,763 cases (95% CI: 12,918 - 52,008) annually. This increase will be mainly driven by patients >80 years old, with a rise of cases between +103% and +42% in this age group. The proportion of patients >80 years old among overall IS with LVO will increase from 43 to 57% approximately., Conclusion: The expected massive increase in IS with LVO highlights the need for a rapid action to cover stroke care requirements., Competing Interests: YB received honoraria for lectures or consulting fees from BMS, Pfizer, Medtronic, Amgen, Servier, and Novo-Nordisk, outside the submitted work. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Duloquin and Béjot.)
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- 2023
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41. Plasma growth differentiation factor - 8 / Myostatin level as prognostic biomarker of patients with ischemic stroke and acute revascularization therapy. PARADISE study.
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Jakubina P, Meloux A, Duloquin G, Aho S, Vergely C, and Béjot Y
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- Humans, Female, Aged, Male, Prognosis, Myostatin, Biomarkers, Treatment Outcome, Thrombectomy methods, Ischemic Stroke, Stroke diagnosis, Stroke surgery, Brain Ischemia surgery
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Background: Identifying biological markers of ischemic stroke (IS) is an important research approach to develop innovative therapeutic strategies. This study aimed to assess the association between plasma Growth Differentiation Factor-8 (GDF-8)/Myostatin levels and outcome of IS patients., Methods: Consecutive patients with acute IS treated with either intravenous thrombolysis and/or mechanical thrombectomy at Dijon University Hospital, France were prospectively included. Clinical variables were recorded, and plasma GDF-8 was collected just after the revascularization procedure. Primary endpoint was functional outcome at 3 months assessed by the modified Rankin Scale (mRS) score. Secondary endpoints included mRS scores at 6 and 12 months, and overall mortality over 1-year of follow-up., Results: Among the 173 included patients (median age: 76 years, Interquartile range (IQR): 66-85; 49% women), median plasma GDF-8 levels at admission were significantly lower in those with a poor outcome at 3 months defined as a mRS score > 2 (2073 (IQR: 1564-2757) pg/mL versus 1471 (1192-2241) pg/mL, p < 0.001). Lower GDF-8 levels at admission were associated with higher 3-months mRS score in multivariable ordinal logistic regression analysis (OR = 0.9995; 95% CI: 0.9991-0.9999, p = 0.011). The association was also observed with 6- and 12-month mRS scores. Although mortality was higher in patients with lower GDF-8 levels, the association was not significant in multivariable Cox analysis., Conclusion: Lower plasma GDF-8 levels were associated with a poorer functional outcome in IS patients treated with acute revascularization therapy. Underlying pathophysiological mechanisms involving GDF-8 in post-stroke outcome remain to be elucidated., Competing Interests: Declaration of Competing Interest Yannick Béjot received honoraria for lectures or consulting fees from BMS, Pfizer, Medtronic, Amgen, Servier, and NovoNordisk, outside the submitted work. Other authors: none., (Copyright © 2023. Published by Elsevier B.V.)
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- 2023
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42. Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration.
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Traenka C, Lorscheider J, Hametner C, Baumgartner P, Gralla J, Magoni M, Martinez-Majander N, Casolla B, Feil K, Pascarella R, Papanagiotou P, Nordanstig A, Padjen V, Cereda CW, Psychogios M, Nolte CH, Zini A, Michel P, Béjot Y, Kastrup A, Zedde M, Kägi G, Kellert L, Henon H, Curtze S, Pezzini A, Arnold M, Wegener S, Ringleb P, Tatlisumak T, Nederkoorn PJ, Engelter ST, and Gensicke H
- Abstract
Background and Purpose: This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD)., Methods: This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015-2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0-2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching., Results: Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10-19] vs. 4 [2-7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24-1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28-18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group., Conclusion: We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.
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- 2023
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43. Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study.
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Béjot Y, Soilly AL, Bardou M, Duloquin G, Pommier T, Laurent G, Cottin Y, Vadot L, Adam H, Boulin M, and Giroud M
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- Adolescent, Humans, Follow-Up Studies, Multicenter Studies as Topic, Prospective Studies, Quality of Life, Randomized Controlled Trials as Topic, Pragmatic Clinical Trials as Topic, Ischemic Attack, Transient drug therapy, Myocardial Infarction prevention & control, Stroke
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Introduction: The ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care., Methods and Analysis: The DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost-utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost-utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area., Ethics and Dissemination: Ethical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal., Trial Registration Number: ClinicalTrials.gov Identifier: NCT04188457. Registered on 6 December 2019., Competing Interests: Competing interests: YB received honoraria for lectures or consulting fees from BMS, Pfizer, Medtronic, Amgen, Servier, Boehringer-Ingelheim and NovoNordisk, outside the submitted work. GL received honoraria for lectures or consulting fees from Abbott, Biotronik, Boston, Medtronic, MicroPort, Novo Nordisk, BMS and Pfizer, outside the submitted work. YC received honoraria for lectures or consulting fees from Bayer, BMS, Pfizer, Boehringer-Ingelheim, Novartis, Sanofi and Servier, outside the submitted work., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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44. Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study.
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Sabben C, Charbonneau F, Delvoye F, Strambo D, Heldner MR, Ong E, Ter Schiphorst A, Henon H, Ben Hassen W, Agasse-Lafont T, Legris L, Sibon I, Wolff V, Sablot D, Elhorany M, Preterre C, Nehme N, Soize S, Weisenburger-Lile D, Triquenot-Bagan A, Mione G, Aignatoaie A, Papassin J, Poll R, Béjot Y, Carrera E, Garnier P, Michel P, Saliou G, Mordasini P, Berthezene Y, Costalat V, Bricout N, Albers GW, Mazighi M, Turc G, and Seners P
- Subjects
- Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Thrombolytic Therapy, Posterior Cerebral Artery, Thrombectomy, Intracranial Hemorrhages, Treatment Outcome, Ischemic Stroke, Stroke therapy, Endovascular Procedures, Brain Ischemia surgery
- Abstract
Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown., Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0-2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0-1), symptomatic intracranial hemorrhage, and early neurological deterioration., Results: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63-82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4-10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66-1.01]; P =0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95-1.43]; P =0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35-4.67]; P =0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64-3.84]; P <0.0001)., Conclusions: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.
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- 2023
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45. Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants.
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Meinel TR, Wilson D, Gensicke H, Scheitz JF, Ringleb P, Goganau I, Kaesmacher J, Bae HJ, Kim DY, Kermer P, Suzuki K, Kimura K, Macha K, Koga M, Wada S, Altersberger V, Salerno A, Palanikumar L, Zini A, Forlivesi S, Kellert L, Wischmann J, Kristoffersen ES, Beharry J, Barber PA, Hong JB, Cereda C, Schlemm E, Yakushiji Y, Poli S, Leker R, Romoli M, Zedde M, Curtze S, Ikenberg B, Uphaus T, Giannandrea D, Portela PC, Veltkamp R, Ranta A, Arnold M, Fischer U, Cha JK, Wu TY, Purrucker JC, Seiffge DJ, Kägi G, Engelter S, Nolte CH, Kallmünzer B, Michel P, Kleinig TJ, Fink J, Rønning OM, Campbell B, Nederkoorn PJ, Thomalla G, Kunieda T, Poli K, Béjot Y, Soo Y, Garcia-Esperon C, Ntaios G, Cordonnier C, Marto JP, Bigliardi G, Lun F, Choi PMC, Steiner T, Ustrell X, Werring D, Wegener S, Pezzini A, Du H, Martí-Fàbregas J, Cánovas-Vergé D, Strbian D, Padjen V, Yaghi S, Stretz C, and Kim JT
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- Adult, Humans, Female, Aged, Aged, 80 and over, Male, Cerebral Hemorrhage complications, Fibrinolytic Agents therapeutic use, Thrombolytic Therapy, Retrospective Studies, Intracranial Hemorrhages chemically induced, Intracranial Hemorrhages complications, Anticoagulants therapeutic use, Eating, Ischemic Stroke drug therapy, Ischemic Stroke complications, Brain Ischemia complications, Stroke therapy
- Abstract
Importance: International guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC)., Objective: To determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion., Design, Setting, and Participants: This international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021., Exposures: Prior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no prior oral anticoagulation., Main Outcomes and Measures: The main outcome was sICH within 36 hours after IVT, defined as worsening of at least 4 points on the National Institutes of Health Stroke Scale and attributed to radiologically evident intracranial hemorrhage. Outcomes were compared according to different selection strategies (DOAC-level measurements, DOAC reversal treatment, IVT with neither DOAC-level measurement nor idarucizumab). The association of sICH with DOAC plasma levels and very recent ingestions was explored in sensitivity analyses., Results: Of 33 207 included patients, 14 458 (43.5%) were female, and the median (IQR) age was 73 (62-80) years. The median (IQR) National Institutes of Health Stroke Scale score was 9 (5-16). Of the 832 patients taking DOAC, 252 (30.3%) received DOAC reversal before IVT (all idarucizumab), 225 (27.0%) had DOAC-level measurements, and 355 (42.7%) received IVT without measuring DOAC plasma levels or reversal treatment. The unadjusted rate of sICH was 2.5% (95% CI, 1.6-3.8) in patients taking DOACs compared with 4.1% (95% CI, 3.9-4.4) in control patients using no anticoagulants. Recent DOAC ingestion was associated with lower odds of sICH after IVT compared with no anticoagulation (adjusted odds ratio, 0.57; 95% CI, 0.36-0.92). This finding was consistent among the different selection strategies and in sensitivity analyses of patients with detectable plasma levels or very recent ingestion., Conclusions and Relevance: In this study, there was insufficient evidence of excess harm associated with off-label IVT in selected patients after ischemic stroke with recent DOAC ingestion.
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- 2023
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46. Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke.
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Braillon A, Bernard A, Leclercq T, Duloquin G, Pommier T, Benali K, Comby PO, Loffroy R, Midulla M, Ricolfi F, Béjot Y, and Guenancia C
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- Humans, Aged, 80 and over, Risk Factors, Brain, Tomography, X-Ray Computed adverse effects, Atrial Fibrillation diagnosis, Ischemic Stroke complications, Stroke complications
- Abstract
Introduction: Atrial fibrillation (AF) is one of the most common causes of ischemic stroke. It is essential to target patients at highest risk of AF detected after stroke (AFDAS), who should benefit from a prolonged rhythm screening strategy. Cardiac-CT angiography (CCTA) was added to the stroke protocol used in our institution in 2018. We sought to assess, for AFDAS, the predictive value of atrial cardiopathy markers by a CCTA performed on admission for acute ischemic stroke., Patients and Methods: From November 2018 to October 2019, consecutive stroke patients with no history of AF were included. Let atrial volume (LAV), epicardial adipose tissue (EAT) attenuation and volume, and LAA characteristics were measured on CCTA. The primary endpoint was the presence of AFDAS at follow-up, diagnosed by continuous electrocardiographic monitoring, long-term external Holter monitoring during hospital stay, or implantable cardiac monitor (ICM)., Results: Sixty of the 247 included patients developed AFDAS. Multivariable analysis shows independent predictors of AFDAS: age >80 years (HR 2.46; 95%CI (1.23-4.92), p = 0.011), indexed LAV >45 mL/m
2 (HR 2.58; 95%CI (1.19-5.62), p = 0.017), EAT attenuation > -85HU (HR 2.16; 95%CI (1.13-4.15), p = 0.021) and LAA thrombus (HR 2.50; 95%CI (1.06-5.93), p = 0.037). Added consecutively to AFDAS prediction AS5F score (combining age and NIHSS >5), these markers had an incrementally better predictive value compared with the global Chi2 of the initial model ( p = 0.001, 0.035, and 0.015 respectively)., Discussion and Conclusion: Adding CCTA to the acute stroke protocol to assess markers of atrial cardiopathy associated with AFDAS may help to better stratify the AF screening strategy, including the use of an ICM., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© European Stroke Organisation 2022.)- Published
- 2023
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47. Pre-existing brain damage and association between severity and prior cognitive impairment in ischemic stroke patients.
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Pinguet V, Duloquin G, Thibault T, Devilliers H, Comby PO, Crespy V, Ricolfi F, Vergely C, Giroud M, and Béjot Y
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- Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Brain diagnostic imaging, Brain pathology, Atrophy pathology, Stroke complications, Stroke diagnostic imaging, Stroke pathology, Ischemic Stroke pathology, Leukoaraiosis pathology, Cognitive Dysfunction pathology, Dementia diagnostic imaging, Dementia complications, Dementia pathology
- Abstract
Background: We evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS)., Methods: IS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity., Results: Among the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages., Conclusion: Impaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
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- 2023
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48. Age Gap between Stroke Patients Included in Randomized Clinical Trials of Acute Revascularization Therapy and Those in Population-Based Studies: A Review.
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Béjot Y
- Subjects
- Humans, Aged, Child, Child, Preschool, Tissue Plasminogen Activator therapeutic use, Tenecteplase therapeutic use, Fibrinolytic Agents therapeutic use, Thrombolytic Therapy adverse effects, Treatment Outcome, Randomized Controlled Trials as Topic, Ischemic Stroke drug therapy, Brain Ischemia complications, Stroke drug therapy, Stroke epidemiology
- Abstract
Background: The ongoing aging population in high-income countries is responsible for a dramatic rise in the number of elderly stroke patients in whom many questions remain regarding the use of acute revascularization therapy. This review aimed to compare stroke patients from population-based studies to those included in RCTs in terms of age., Summary: Population-based incidence studies conducted in high income that complied with the defined quality criteria were reviewed (period 1985-2020). RCTs of acute ischemic stroke therapy including intravenous thrombolysis (IVT) with either alteplase or tenecteplase and mechanical thrombectomy (MT) were retrieved from systematic reviews performed in recent guidelines from the European Stroke Organisation. When available, information on either mean and/or median age was extracted from each selected article. As a result, 36 population-based registries were included, 34 of which recorded patients with first-ever stroke over 63 distinct time periods with a total of 38,188 patients. Twenty-nine RCTs enrolling 11,666 patients were identified including 13 RCTs related to IVT with alteplase, 11 RCTs about MT, and 5 RCTs on IVT with tenecteplase. A gap in age between stroke patients in the RCTs and those in population-based studies was observed. With few exceptions, mean age of patients in the RCTs was about 4 years younger than in population-based studies, while the median age was approximately 7 years younger. Thirty-five (83%) population-based incidence studies and 8 RCTs (32%) reported a mean age of patients >70 years old. Mean age ≥75 years was observed in 9 (21%) population-based studies and in only 1 (4%) RCT. All population-based studies and half of the RCTs reported a median age >70 years., Key Messages: The gap in age between patients enrolled in acute stroke therapy RCTs and those from population-based studies highlights an under-representation of elderly stroke patients in RCTs. With the current aging of the population, this trend is likely to increase in the coming years, and there is a need to promote the inclusion of older patients, particularly those with disabilities, in future trials to reflect the true population of stroke patients and to help clinicians have evidence-based data to guide their decision-making., (© 2023 S. Karger AG, Basel.)
- Published
- 2023
- Full Text
- View/download PDF
49. A New Presenilin-1 Missense Variant Associated With a Progressive Supranuclear Palsy-like Phenotype.
- Author
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Thomas Q, Nambot S, Béjot Y, Philippe C, Faivre L, Duffourd Y, Thauvin-Robinet C, and Dupont G
- Subjects
- Humans, Amyloid beta-Protein Precursor genetics, Presenilin-1 genetics, Mutation, Phenotype, Presenilin-2 genetics, Supranuclear Palsy, Progressive, Alzheimer Disease genetics
- Abstract
Early-onset forms of Alzheimer disease (AD) have been associated with pathogenic variants in the APP , PSEN1 , and PSEN2 genes. Mutations in presenilin-1 ( PSEN1 ) account for the majority of cases of autosomal dominant AD. Numerous phenotypes have been associated with PSEN1 -pathogenic variants, including cerebellar ataxia and spastic paraplegia. Here, we describe a patient with early-onset AD presenting with extrapyramidal symptoms and supranuclear gaze palsy, mimicking progressive supranuclear palsy., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
50. Long-Term Survival of Ischemic Stroke Patients according to Prior Cognitive Status: Dijon Stroke Registry.
- Author
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Béjot Y, Pinguet V, and Duloquin G
- Subjects
- Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Registries, Cognition, Risk Factors, Ischemic Stroke, Stroke complications, Stroke diagnostic imaging, Stroke epidemiology, Cognitive Dysfunction epidemiology, Dementia epidemiology, Arterial Occlusive Diseases complications
- Abstract
Introduction: Understanding the influence of preexisting cognitive impairment on the poststroke outcome is a critical challenge in the context of current aging and growing population. This study aimed to assess long-term survival of patients with acute ischemic stroke (IS) according to their premorbid cognitive status and to identify contributing factors of death., Methods: Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). The association between case fatality at 5 years and prestroke cognitive status was assessed by multivariable Cox models adjusted for other clinical characteristics and preexisting brain damage on the initial CT scan including leukoaraiosis, old vascular brain lesions, and cortical and central brain atrophy, as well as major arterial occlusion., Results: 1,049 patients were included (mean age ± SD: 76.3 ± 15.2 years old, 54% women). Case fatality rates at 5 years were 38.1% in patients without cognitive impairment, 65.9% in patients with prior mild cognitive impairment (MCI, n = 132, 12.6%), and 86.6% in patients with dementia (n = 164, 15.6%) (p < 0.001). MCI (HR = 1.39; 95% CI: 1.06-1.81, p = 0.016) and dementia (HR = 1.89; 95% CI: 1.45-2.46, p < 0.001) were both independently associated with higher case fatality after adjustment for clinical variables. The association remained significant after further adjustment for preexisting brain damage and major arterial occlusion (HR = 1.47; 95% CI: 1.10-1.98, p = 0.009, for MCI and HR = 1.90; 95% CI: 1.43-2.53, p < 0.001, for dementia) among patients with available data on the CT scan (n = 916). Factors associated with death were roughly similar across groups., Conclusion: This study highlighted a poor long-term survival of IS patients with preexisting cognitive impairment, independently of other contributing factors of death. It is critical to better understand the trajectory of IS patients with preexisting cognitive impairment and to identify prognostic markers to guide clinicians in their management strategies., (© 2023 S. Karger AG, Basel.)
- Published
- 2023
- Full Text
- View/download PDF
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