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1. Does the Brush-Sign Reflect Collateral Status and DWI-ASPECTS in Large Vessel Occlusion?

Author

Lucie Rascle, Alexandre Bani Sadr, Camille Amaz, Nathan Mewton, Marielle Buisson, Marc Hermier, Elodie Ong, Julia Fontaine, Laurent Derex, Yves Berthezène, Omer Faruk Eker, Tae-Hee Cho, Norbert Nighoghossian, and Laura Mechtouff

Subjects
brush-sign, collaterality, lesion volume, thrombectomy, MRI, DWI-ASPECTS, Neurology. Diseases of the nervous system, RC346-429
Abstract

IntroductionThe relevance of the brush-sign remained poorly documented in large vessel occlusion (LVO). We aimed to assess the relationship between the brush-sign and collateral status and its potential impact on baseline diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) in acute ischemic stroke (AIS) patients eligible to mechanical thrombectomy (MT).MethodsConsecutive patients admitted in the Lyon Stroke Center with anterior circulation AIS due to intracranial internal carotid artery (ICA) and/or M1 or M2 segment of the middle cerebral artery (MCA) occlusion eligible for MT were included. The brush-sign was assessed on T2-gradient-echo MRI. Collateral status was assessed on digital subtraction angiography according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score.ResultsIn this study, 504 patients were included, among which 171 (33.9%) patients had a brush-sign. Patients with a brush-sign more frequently had a poor collateral status [72 (42.1%) vs. 103 (30.9%); p = 0.017]. In univariable analysis, a DWI-ASPECTS < 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS < 7 while the latter remained associated with younger age [odds ratio (OR) 0.97, 95% CI.96–0.99], male sex (OR 1.79, 95% CI 1.08–2.99), a higher National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, 95% CI 1.1–1.21), a poor collateral status (OR 9.35, 95% CI 5.59-16.02), MCA segment (OR 2.54, 95% CI 1.25–5.38), and intracranial ICA (OR 3.01, 95% CI 1.16–8) occlusion.Conclusions and RelevanceThe brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT04620642.

Published
2022
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2. Multimodal Imaging with NanoGd Reveals Spatiotemporal Features of Neuroinflammation after Experimental Stroke

Author

Violaine Hubert, Ines Hristovska, Szilvia Karpati, Sarah Benkeder, Arindam Dey, Chloé Dumot, Camille Amaz, Naura Chounlamountri, Chantal Watrin, Jean‐Christophe Comte, Fabien Chauveau, Emmanuel Brun, Patrice Marche, Fréderic Lerouge, Stéphane Parola, Yves Berthezène, Thomas Vorup‐Jensen, Olivier Pascual, and Marlène Wiart

Subjects
intravital two‐photon microscopy, magnetic resonance imaging, microglia/macrophage, multimodal nanoprobe, neuroinflammation, stroke, Science
Abstract

Abstract The purpose of this study is to propose and validate a preclinical in vivo magnetic resonance imaging (MRI) tool to monitor neuroinflammation following ischemic stroke, based on injection of a novel multimodal nanoprobe, NanoGd, specifically designed for internalization by phagocytic cells. First, it is verified that NanoGd is efficiently internalized by microglia in vitro. In vivo MRI coupled with intravenous injection of NanoGd in a permanent middle cerebral artery occlusion mouse model results in hypointense signals in the ischemic lesion. In these mice, longitudinal two‐photon intravital microscopy shows NanoGd internalization by activated CX3CR1‐GFP/+ cells. Ex vivo analysis, including phase contrast imaging with synchrotron X‐ray, histochemistry, and transmission electron microscopy corroborate NanoGd accumulation within the ischemic lesion and uptake by immune phagocytic cells. Taken together, these results confirm the potential of NanoGd‐enhanced MRI as an imaging biomarker of neuroinflammation at the subacute stage of ischemic stroke. As far as it is known, this work is the first to decipher the working mechanism of MR signals induced by a nanoparticle passively targeted at phagocytic cells by performing intravital microscopy back‐to‐back with MRI. Furthermore, using a gadolinium‐based rather than an iron‐based contrast agent raises future perspectives for the development of molecular imaging with emerging computed tomography technologies.

Published
2021
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3. Impact of the reperfusion status for predicting the final stroke infarct using deep learning

Author

Noëlie Debs, Tae-Hee Cho, David Rousseau, Yves Berthezène, Marielle Buisson, Omer Eker, Laura Mechtouff, Norbert Nighoghossian, Michel Ovize, and Carole Frindel

Subjects
Stroke, Prediction, Convolutional neural network, Magnetic resonance imaging, Reperfusion status, Computer applications to medicine. Medical informatics, R858-859.7, Neurology. Diseases of the nervous system, RC346-429
Abstract

Background: Predictive maps of the final infarct may help therapeutic decisions in acute ischemic stroke patients. Our objectives were to assess whether integrating the reperfusion status into deep learning models would improve their performance, and to compare them to current clinical prediction methods. Methods: We trained and tested convolutional neural networks (CNNs) to predict the final infarct in acute ischemic stroke patients treated by thrombectomy in our center. When training the CNNs, non-reperfused patients from a non-thrombectomized cohort were added to the training set to increase the size of this group. Baseline diffusion and perfusion-weighted magnetic resonance imaging (MRI) were used as inputs, and the lesion segmented on day-6 MRI served as the ground truth for the final infarct. The cohort was dichotomized into two subsets, reperfused and non-reperfused patients, from which reperfusion status specific CNNs were developed and compared to one another, and to the clinically-used perfusion-diffusion mismatch model. Evaluation metrics included the Dice similarity coefficient (DSC), precision, recall, volumetric similarity, Hausdorff distance and area-under-the-curve (AUC). Results: We analyzed 109 patients, including 35 without reperfusion. The highest DSC were achieved in both reperfused and non-reperfused patients (DSC = 0.44 ± 0.25 and 0.47 ± 0.17, respectively) when using the corresponding reperfusion status-specific CNN. CNN-based models achieved higher DSC and AUC values compared to those of perfusion-diffusion mismatch models (reperfused patients: AUC = 0.87 ± 0.13 vs 0.79 ± 0.17, P

Published
2021
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4. Impact of the Thrombectomy Trials on the Management and Outcome of Large Vessel Stroke: Data From the Lyon Stroke Center

Author

Louis Viannay, Julie Haesebaert, Fannie Florin, Roberto Riva, Laura Mechtouff, Benjamin Gory, Elodie Ong, Paul-Emile Labeyrie, Laurent Derex, Marc Hermier, Leila Chamard, Lise-Prune Berner, Roxana Ameli, Yves Berthezène, Francis Turjman, Norbert Nighoghossian, and Tae-Hee Cho

Subjects
acute ischemic stroke, large-vessel stroke, thrombectomy, endovascular procedures, clinical outcome, systems of care, Neurology. Diseases of the nervous system, RC346-429
Abstract

Introduction: Randomized trials (RT) have recently validated the superiority of thrombectomy over standard medical care, including intravenous thrombolysis (IVT). However, data on their impact on routine clinical care remains scarce.Methods: Using a prospective observational registry, we assessed: (1) the clinical and radiological characteristics of all consecutive patients treated with thrombectomy; (2) the outcome of all patients with M1 occlusion (treated with thrombectomy or IVT alone). Two periods were compared: before (2013–2014) and after (2015–2016) the publication of RT.Results: Endovascular procedures significantly increased between the two periods (N = 82 vs. 314, p < 0.0001). In 2015–2016, patients were older (median [IQR]: 69 [57-80]; vs. 66 [53-74]; p = 0.008), had shorter door-to-clot times (69 [47-95]; vs. 110 [83-155]; p < 0.0001) resulting in a trend toward shorter delay from symptom onset to reperfusion (232 [185-300]; vs. 250 [200-339]; p = 0.1), with higher rates of reperfusion (71 vs. 48%; p = 0.0001). Conversely, no significant differences in baseline NIHSS scores, ASPECTS, delay to IVT or intracranial hemorrhage were found. In 2015–2016, patients with M1 occlusion were treated with thrombectomy more often than in 2013–2014 (87 vs. 32%, respectively; p < 0.0001), with a significant improvement in clinical outcome (shift analysis, lower modified Rankin scale scores: OR = 1.68; 95% CI: 1.10–2.57; p = 0.017).Conclusion: Following the publication of RT, thrombectomy was rapidly implemented with significant improvements in intrahospital delay and reperfusion rates. Treatment with thrombectomy increased with better clinical outcomes in patients with M1 occlusion.

Published
2018
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5. Effect of Cyclosporine on Lesion Growth and Infarct Size within the White and Gray Matter

Author

Tae-Hee Cho, Elodie Ong, Nathan Mewton, Julien Bouvier, Fabien Chauveau, Thomas Ritzenthaler, Laura Mechtouff, Laurent Derex, Marielle Buisson, Yves Berthezène, Michel Ovize, and Norbert Nighoghossian

Subjects
ischemic stroke, thrombolysis, neuroprotection, recanalization, cyclosporin, Neurology. Diseases of the nervous system, RC346-429
Abstract

BackgroundIn a recent trial, cyclosporine A (CsA) failed to reduce infarct size in acute stroke patients treated with intravenous thrombolysis. White matter (WM) and gray matter (GM) may have distinct vulnerability to ischemia and response to therapy. Using final infarct size and lesion growth as endpoints, our objectives were to (1) investigate any tissue-specific effect of CsA and (2) compare WM and GM response to thrombolysis.Materials and methodsWe analyzed 84 patients from the randomized and placebo-controlled CsA-Stroke trial, who underwent MRI both on admission and at 1 month. Lesion growth was defined voxel-wise as infarcted tissue at 1 month with no visible lesion on baseline diffusion-weighted imaging. After automatic segmentation of GM/WM, final infarct size and lesion growth were compared within the GM and WM.ResultsOcclusion level was distal (>M1) in 51% of cases. No significant difference in GM/WM proportions was observed within final infarcts between treatment groups (P = 0.21). Infarct size within the GM or WM was similar between the CsA and control groups [GM: 9.2 (2.4; 22.8) with CsA vs 8.9 (3.7; 28.4) mL with placebo, P = 0.74; WM: 9.9 (4.7; 25.4) with CsA vs 14.1 (5.6; 34.1) mL with placebo, P = 0.26]. There was no significant effect of CsA on lesion growth in either the GM or WM. Pooling all patients, a trend for increased relative lesion growth in WM compared to GM was observed [49.0% (14.7; 185.7) vs 43.1% (15.4; 117.1), respectively; P = 0.12].ConclusionNo differential effect of CsA was observed between WM and GM. Pooling all patients, a trend toward greater lesion growth in WM was observed.

Published
2017
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6. In vitro and in vivo models of cerebral ischemia show discrepancy in therapeutic effects of M2 macrophages.

Author

Virginie Desestret, Adrien Riou, Fabien Chauveau, Tae-Hee Cho, Emilie Devillard, Marilena Marinescu, René Ferrera, Catherine Rey, Marie Chanal, Denis Angoulvant, Jérôme Honnorat, Norbert Nighoghossian, Yves Berthezène, Serge Nataf, and Marlène Wiart

Subjects
Medicine, Science
Abstract

THE INFLAMMATORY RESPONSE FOLLOWING ISCHEMIC STROKE IS DOMINATED BY INNATE IMMUNE CELLS: resident microglia and blood-derived macrophages. The ambivalent role of these cells in stroke outcome might be explained in part by the acquisition of distinct functional phenotypes: classically (M1) and alternatively activated (M2) macrophages. To shed light on the crosstalk between hypoxic neurons and macrophages, an in vitro model was set up in which bone marrow-derived macrophages were co-cultured with hippocampal slices subjected to oxygen and glucose deprivation. The results showed that macrophages provided potent protection against neuron cell loss through a paracrine mechanism, and that they expressed M2-type alternative polarization. These findings raised the possibility of using bone marrow-derived M2 macrophages in cellular therapy for stroke. Therefore, 2 million M2 macrophages (or vehicle) were intravenously administered during the subacute stage of ischemia (D4) in a model of transient middle cerebral artery occlusion. Functional neuroscores and magnetic resonance imaging endpoints (infarct volumes, blood-brain barrier integrity, phagocytic activity assessed by iron oxide uptake) were longitudinally monitored for 2 weeks. This cell-based treatment did not significantly improve any outcome measure compared with vehicle, suggesting that this strategy is not relevant to stroke therapy.

Published
2013
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7. Spontaneous reperfusion after in situ thromboembolic stroke in mice.

Author

Anne Durand, Fabien Chauveau, Tae-Hee Cho, Radu Bolbos, Jean-Baptiste Langlois, Laure Hermitte, Marlène Wiart, Yves Berthezène, and Norbert Nighoghossian

Subjects
Medicine, Science
Abstract

Injection of thrombin into the middle cerebral artery (MCA) of mice has been proposed as a new model of thromboembolic stroke. The present study used sequential multiparametric Magnetic Resonance Imaging (MRI), including Magnetic Resonance Angiography (MRA), Diffusion-Weighted Imaging (DWI) and Perfusion-Weighted Imaging (PWI), to document MCA occlusion, PWI-DWI mismatch, and lesion development. In the first experiment, complete MCA occlusion and reproducible hypoperfusion were obtained in 85% of animals during the first hour after stroke onset. In the second experiment, 80% of animals showed partial to complete reperfusion during a three-hour follow-up. Spontaneous reperfusion thus contributed to the variability in ischemic volume in this model. The study confirmed the value of the model for evaluating new thrombolytic treatments, but calls for extended MRI follow-up at the acute stage in therapeutic studies.

Published
2012
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8. In vivo targeting and multimodal imaging of cerebral amyloid-β aggregates using hybrid GdF3 nanoparticles

Author

Frédéric Lerouge, Elodie Ong, Hugo Rositi, Francis Mpambani, Lise-Prune Berner, Radu Bolbos, Cécile Olivier, Françoise Peyrin, Vinu K Apputukan, Cyrille Monnereau, Chantal Andraud, Frederic Chaput, Yves Berthezène, Bettina Braun, Mathias Jucker, Andreas KO Åslund, Sofie Nyström, Per Hammarström, K Peter R Nilsson, Mikael Lindgren, Marlène Wiart, Fabien Chauveau, Stephane Parola, Laboratoire de Chimie - UMR5182 (LC), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hospices Civils de Lyon (HCL), Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant (CERMEP - imagerie du vivant), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Eberhard Karls Universität Tübingen = Eberhard Karls University of Tuebingen, Linköping University (LIU), Norwegian University of Science and Technology (NTNU), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), ANR-15-CE18-0026,NanoBrain,Imagerie de l'inflammation cérébrale dans l'AVC ischémique : développement d'une sonde nanoparticulaire multimodale & méthodes d'imagerie cérébrale(2015), and European Project: 242098,EC:FP7:HEALTH,FP7-HEALTH-2009-single-stage,LUPAS(2009)

Subjects
[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, [SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology, Biomedical Engineering, Medicine (miscellaneous), multimodal imaging, General Materials Science, Bioengineering, luminescent-conjugated polythiophenes, Development, gadolinium fluoride nanoparticles, amyloid-beta
Abstract

Aim: To propose a new multimodal imaging agent targeting amyloid-β (Aβ) plaques in Alzheimer’s disease. Materials & methods: A new generation of hybrid contrast agents, based on gadolinium fluoride nanoparticles grafted with a pentameric luminescent-conjugated polythiophene, was designed, extensively characterized and evaluated in animal models of Alzheimer’s disease through MRI, two-photon microscopy and synchrotron x-ray phase-contrast imaging. Results & conclusion: Two different grafting densities of luminescent-conjugated polythiophene were achieved while preserving colloidal stability and fluorescent properties, and without affecting biodistribution. In vivo brain uptake was dependent on the blood–brain barrier status. Nevertheless, multimodal imaging showed successful Aβ targeting in both transgenic mice and Aβ fibril-injected rats.

Published
2022
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9. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy

Author

Alexandre Bani-Sadr, Raphaël Escande, Laura Mechtouff, Dylan Pavie, Marc Hermier, Laurent Derex, Tae-Hee Choc, Omer F. Eker, Norbert Nighoghossian, and Yves Berthezène

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, General Medicine
Published
2023
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10. Predictors of Outcome After Mechanical Thrombectomy in Stroke Patients Aged ≥85 Years

Author

Céline Odier, Julie Haesebaert, Norbert Nighoghossian, Omer Eker, Marlène Lapierre, Laura C. Gioia, Alexandre Y Poppe, Jean Raymond, Marielle Buisson, Walid Alesefir, Nicole Daneault, Grégory Jacquin, Daniel Roy, Yan Deschaintre, Christian Stapf, Yves Berthezène, Dana Iancu, Alain Weill, Fatine Karkri, Laurent Derex, Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Direction générale (DG), Centre national du machinisme agricole, du génie rural, des eaux et forêts (CEMAGREF), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CarMeN, laboratoire, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon

Subjects
medicine.medical_specialty, Stroke patient, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030204 cardiovascular system & hematology, Logistic regression, Brain Ischemia, 03 medical and health sciences, Elderly, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, medicine, Humans, Aged, Retrospective Studies, Thrombectomy, Aged, 80 and over, Ischemic stroke, business.industry, General Medicine, Thrombolysis, Odds ratio, 3. Good health, Stroke, [SDV] Life Sciences [q-bio], Mechanical thrombectomy, Treatment Outcome, Neurology, Reperfusion, Cohort, Neurology (clinical), business, Lower mortality, 030217 neurology & neurosurgery
Abstract

Background:The effectiveness of mechanical thrombectomy (MT) in elderly stroke patients remains debated. We aimed to describe outcomes and their predictors in a cohort of patients aged ≥ 85 years treated with MT.Methods:Data from consecutive patients aged ≥ 85 years undergoing MT at two stroke centers between January 2016 and November 2019 were reviewed. Admission National Institutes of Health Stroke Scale (NIHSS), pre-stroke, and 3-month modified Rankin scale (mRS) were collected. Successful recanalization was defined as modified thrombolysis in cerebral ischemia score ≥ 2b. Good outcome was defined as mRS 0–3 or equal to pre-stroke mRS at 3 months.Results:Of 151 included patients, successful recanalization was achieved in 74.2%. At 3 months, 44.7% of patients had a good outcome and 39% had died. Any intracranial hemorrhage (ICH) and symptomatic ICH occurred in 20.3% and 3.6%, respectively. Logistic regression analysis identified lower pre-stroke mRS score (adjusted odds ratio [aOR], 0.52; 95% CI, 0.36–0.76), lower admission NIHSS score (aOR, 0.90; 95% CI, 0.83–0.97), successful recanalization (aOR, 3.65; 95% CI, 1.32–10.09), and absence of ICH on follow-up imaging (aOR, 0.42; 95% CI, 0.08–0.75), to be independent predictors of good outcome. Patients with successful recanalization had a higher proportion of good outcome (45.3% vs 34.3%, p = 0.013) and lower mortality at 3 months (35.8% vs 48.6%, p = 0.006) compared to patients with unsuccessful recanalization.Conclusions:Among patients aged ≥ 85 years, successful recanalization with MT is relatively common and associated with better 3-month outcome and lower mortality than failed recanalization. Attempting to achieve recanalization in elderly patients using MT appears reasonable.

Published
2021
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11. Association of Interleukin-6 Levels and Futile Reperfusion After Mechanical Thrombectomy

Author

Laura Mechtouff, Elodie Ong, Michel Ovize, Omer Eker, Nathalie Dufay, Norbert Nighoghossian, Alexandre Paccalet, Nathan Mewton, Laurent Derex, Claire Crola Da Silva, Camille Amaz, Thomas Bochaton, Marielle Buisson, Tae-Hee Cho, Yves Berthezène, CarMeN, laboratoire, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Service de neuroradiologie [Lyon], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Neurobiotec [HCL, Lyon], Hospices Civils de Lyon, Departement de Neurologie (HCL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, medicine.artery, Internal medicine, Diabetes mellitus, Occlusion, Odds Ratio, medicine, Humans, Treatment Failure, 030212 general & internal medicine, Stroke, Aged, Ischemic Stroke, Thrombectomy, Aged, 80 and over, Interleukin-6, Cerebral infarction, business.industry, Endovascular Procedures, Thrombolysis, Odds ratio, Middle Aged, Prognosis, medicine.disease, [SDV] Life Sciences [q-bio], Treatment Outcome, Multivariate Analysis, Cardiology, Female, Neurology (clinical), Internal carotid artery, business, Medical Futility, 030217 neurology & neurosurgery
Abstract

ObjectiveTo assess whether interleukin-6 (IL-6) level is a marker of futile reperfusion in patients with acute ischemic stroke (AIS) with large vessel occlusion treated with mechanical thrombectomy (MT).MethodsThe Cohort of Patients to Identify Biological and Imaging Markers of Cardiovascular Outcomes in Stroke (HIBISCUS-STROKE) includes patients with AIS treated with MT after MRI. We performed a sequential assessment of IL-6 (admission, 6 hours, 24 hours, 48 hours and 3 months from admission). Among patients with successful reperfusion (Thrombolysis in Cerebral Infarction scale 2b/3), reperfusion was considered effective if 3-month modified Rankin Scale (mRS) score was 0 to 2 and futile if 3-month mRS score was 3 to 6. Our model was adjusted for the main confounding variables.ResultsOne hundred sixty-four patients represent the study population. One hundred thirty-three patients had successful reperfusion (81.1%), while in 46 (34.6%), reperfusion was classified as futile. In single-variable analyses, high IL-6 levels at 6, 24, and 48 hours in combination with a higher age, a prestroke mRS score >2, a history of hypertension or diabetes, lack of current smoking, a higher baseline NIH Stroke Scale score, the absence of associated intravenous thrombolysis, an intracranial internal carotid artery or a tandem occlusion, and an increased infarct growth were associated with futile reperfusion. After multivariable analyses, a high IL-6 level at 24 hours (odds ratio 6.15, 95% confidence interval 1.71–22.10) remained associated with futile reperfusion.ConclusionsIL-6 is a marker of futile reperfusion in the setting of MT.

Published
2020
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12. Matrix Metalloproteinase-9 and Monocyte Chemoattractant Protein-1 Are Associated With Collateral Status in Acute Ischemic Stroke With Large Vessel Occlusion

Author

Camille Amaz, Nathan Mewton, Yves Berthezène, Claire Crola Da Silva, Marielle Buisson, Thomas Bochaton, Nathalie Dufay, Elodie Ong, Omer Eker, Alexandre Paccalet, Norbert Nighoghossian, Laurent Derex, Michel Ovize, Tae-Hee Cho, Laura Mechtouff, Stroke Department, Neurological Hospital, Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Virologie et pathogenèse virale (VPV), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Imagerie et modélisation Vasculaires, Thoraciques et Cérébrales (MOTIVATE), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Neuroradiology Department, Neurological Hospital, Department of Cardiology, and Imagerie Tomographique et Radiothérapie

Subjects
Monocyte Chemoattractant Proteins, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, digital subtraction angiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, collateral circulation, Acute ischemic stroke, brain edema, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, Matrix metalloproteinase 9, Digital subtraction angiography, Collateral circulation, Inflammatory biomarkers, Cardiology, matrix metalloproteinase 9, Neurology (clinical), monocyte chemoattractant proteins, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Large vessel occlusion, Monocyte chemoattractant protein
Abstract

Background and Purpose: In ischemic stroke, inflammatory status may condition the development of collateral circulation. Here we assessed the relationship between systemic inflammatory biomarkers and collateral status in large vessel occlusion before mechanical thrombectomy. Methods: HIBISCUS-STROKE is a cohort study including acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. MMP-9 (matrix metalloproteinase-9) and MCP-1 (monocyte chemoattractant protein-1) were measured on blood sampling collected at admission. Collateral status was assessed on pretreatment Digital subtraction angiography and categorized into poor (Higashida score, 0–2) and good (Higashida score, 3–4). A multiple logistic regression model was performed to detect independent markers of good collateral status. Results: One hundred and twenty-two patients were included, of them 71 patients (58.2%) had a good collateral status. In univariate analysis, low MMP-9 levels ( P =0.01), high MCP-1 levels ( P P =0.046), a high diastolic blood pressure ( P =0.049), the absence of tandem occlusion ( P =0.046), a high Alberta Stroke Program Early CT Score ( P P P =0.02) and high MCP-1 levels ( P Conclusions: Low MMP-9 and high MCP-1 levels were associated with good pretreatment collateral status in patients with acute ischemic stroke with large vessel occlusion. These results might suggest a relationship between collateral status and inflammation.

Published
2020
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13. Multifocal arterial wall contrast – enhancement in ischemic stroke: A mirror of systemic inflammatory response in acute stroke

Author

Laura Mechtouff, T.-H. Cho, Lise-Prune Berner, Monica Sigovan, Omer Eker, Norbert Nighoghossian, Roxana Ameli, Yves Berthezène, M. Hermier, and Hospices Civils de Lyon (HCL)

Subjects
Male, Middle Cerebral Artery, medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Gadolinium, Contrast Media, chemistry.chemical_element, Single Center, Asymptomatic, Culprit, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Humans, Carotid Stenosis, 030212 general & internal medicine, Stage (cooking), Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Ischemic Stroke, Aged, 80 and over, business.industry, Brain, Arteries, Middle Aged, Image Enhancement, Intracranial Arteriosclerosis, medicine.disease, Plaque, Atherosclerotic, Systemic Inflammatory Response Syndrome, Neurology, chemistry, Ischemic stroke, Middle cerebral artery, Cardiology, Female, Neurology (clinical), medicine.symptom, business, Carotid Artery, Internal, Magnetic Resonance Angiography, 030217 neurology & neurosurgery
Abstract

Purpose Intracranial plaque gadolinium enhancement revealed by high-resolution MRI imaging (HR MRI) is considered as a marker of plaque inflammation, a contributing factor of plaque unstability. The aim of the present study was to assess the distribution of gadolinium enhancement in intracranial atherosclerosis. Methods Single center analysis of ischemic stroke patients with intracranial atherosclerotic stenosis of M1 or M2 segments of middle cerebral artery, or terminal internal carotid artery (ICA) based on CT-angio or MR-angio. High-resolution MRI imaging (HRMRI) was performed within 6 first weeks following the index event, with 3DT2 BB (black-blood) and 3D T1 BB MR sequences pre and post-contrast administration. Results We identified 8 patients with 14 plaques, 4 were deemed non-culprit and 10 culprit. All culprit plaques (10/10 plaques) and 3 out of 4 non-culprit plaques showed a gadolinium enhancement. Conclusion At the acute/subacute stage of stroke, a gadolinium enhancement may affect multiple asymptomatic intracranial plaques and may reflect a global inflammatory state.

Published
2020
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14. Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial

Author

Laure Peter-Derex, Frédéric Philippeau, Pierre Garnier, Nathalie André-Obadia, Sébastien Boulogne, Hélène Catenoix, Philippe Convers, Laure Mazzola, Michel Gouttard, Maud Esteban, Julia Fontaine, Laura Mechtouff, Elodie Ong, Tae-Hee Cho, Norbert Nighoghossian, Nathalie Perreton, Anne Termoz, Julie Haesebaert, Anne-Marie Schott, Muriel Rabilloud, Christine Pivot, Carole Dhelens, Andrea Filip, Yves Berthezène, Sylvain Rheims, Florent Boutitie, Laurent Derex, CarMeN, laboratoire, Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Fleyriat [Bourg en Bresse], CHU Saint-Etienne, Service de neurologie fonctionnelle et d'épileptologie [Hôpital Pierre Wertheimer-HCL], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle de Santé Publique [Lyon], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Stroke, [SDV] Life Sciences [q-bio], Epilepsy, Levetiracetam, Treatment Outcome, Seizures, [SDV]Life Sciences [q-bio], Humans, Neurology (clinical), United States, Cerebral Hemorrhage
Abstract

International audience; BACKGROUND: The incidence of early seizures (occurring within 7 days of stroke onset) after intracerebral haemorrhage reaches 30% when subclinical seizures are diagnosed by continuous EEG. Early seizures might be associated with haematoma expansion and worse neurological outcomes. Current guidelines do not recommend prophylactic antiseizure treatment in this setting. We aimed to assess whether prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral haemorrhage. METHODS: The double-blind, randomised, placebo-controlled, phase 3 PEACH trial was conducted at three stroke units in France. Patients (aged 18 years or older) who presented with a non-traumatic intracerebral haemorrhage within 24 h after onset were randomly assigned (1:1) to levetiracetam (intravenous 500 mg every 12 h) or matching placebo. Randomisation was done with a web-based system and stratified by centre and National Institutes of Health Stroke Scale (NIHSS) score at baseline. Treatment was continued for 6 weeks. Continuous EEG was started within 24 h after inclusion and recorded over 48 h. The primary endpoint was the occurrence of at least one clinical seizure within 72 h of inclusion or at least one electrographic seizure recorded on continuous EEG, analysed in the modified intention-to-treat population, which comprised all patients who were randomly assigned to treatment and who had a continuous EEG performed. This trial was registered at ClinicalTrials.gov, NCT02631759, and is now closed. Recruitment was prematurely stopped after 48% of the recruitment target was reached due to a low recruitment rate and cessation of funding. FINDINGS: Between June 1, 2017, and April 14, 2020, 50 patients with mild-to-moderate severity intracerebral haemorrhage were included: 24 were assigned to levetiracetam and 26 to placebo. During the first 72 h, a clinical or electrographic seizure was observed in three (16%) of 19 patients in the levetiracetam group versus ten (43%) of 23 patients in the placebo group (odds ratio 0·16, 95% CI 0·03-0·94, p=0·043). All seizures in the first 72 h were electrographic seizures only. No difference in depression or anxiety reporting was observed between the groups at 1 month or 3 months. Depression was recorded in three (13%) patients who received levetiracetam versus four (15%) patients who received placebo, and anxiety was reported for two (8%) patients versus one (4%) patient. The most common treatment-emergent adverse events in the levetiracetam group versus the placebo group were headache (nine [39%] vs six [24%]), pain (three [13%] vs ten [40%]), and falls (seven [30%] vs four [16%]). The most frequent serious adverse events were neurological deterioration due to the intracerebral haemorrhage (one [4%] vs four [16%]) and severe pneumonia (two [9%] vs two [8%]). No treatment-related death was reported in either group. INTERPRETATION: Levetiracetam might be effective in preventing acute seizures in intracerebral haemorrhage. Larger studies are needed to determine whether seizure prophylaxis improves functional outcome in patients with intracerebral haemorrhage. FUNDING: French Ministry of Health.

Published
2022
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15. Évaluation des logiciels de perfusion irm dans la prédiction du volume final de l'infarctus après thrombectomie mécanique

Author

Alexandre Bani-Sadr, Tae-Hee Cho, Matteo Cappucci, Marc Hermier, Roxana Ameli, Andrea Filip, Charles De Bourguignon, Roberto Riva, Laurent Derex, Laura Mechtouff, Omer Eker, Norbert Nighoghossian, and Yves Berthezène

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Published
2022
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16. Diffusion tensor imaging abnormalities of the trigeminal nerve root in patients with classical trigeminal neuralgia: a pre- and postoperative comparative study 4 years after microvascular decompression

Author

M. Hermier, Paulo Roberto Lacerda Leal, Yves Berthezène, Marc Sindou, and Jean Amédée Roch

Subjects
Adult, Male, medicine.medical_specialty, Neurology, medicine.medical_treatment, Microvascular decompression, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Trigeminal neuralgia, medicine, Humans, Effective diffusion coefficient, Trigeminal Nerve, Aged, Neuroradiology, Trigeminal nerve, business.industry, Middle Aged, Trigeminal Neuralgia, medicine.disease, Microvascular Decompression Surgery, Diffusion Tensor Imaging, Female, Surgery, Neurology (clinical), Neurosurgery, Nuclear medicine, business, 030217 neurology & neurosurgery, Diffusion MRI
Abstract

As diffusion tensor imaging (DTI) is able to assess tissue integrity, authors used diffusion to detect abnormalities in trigeminal nerves (TGN) in patients with trigeminal neuralgia (TN) caused by neurovascular compression (NVC) who had undergone microvascular decompression (MVD). The authors also studied anatomical TGN parameters (cross-sectional area [CSA] and volume [V]). The study compared pre- and postoperative findings.Using DTI sequencing on a 3-T MRI scanner, we measured the fraction of anisotropy (FA) and apparent diffusion coefficient (ADC) of the TGN in 10 patients who had undergone MVD for TN and in 6 normal subjects. We compared data between affected and unaffected nerves in patients and both nerves in normal subjects (controls). We then correlated these data with CSA and V. Data from the affected side and the unaffected side before and 4 years after MVD were compared.Before MVD, the FA of the affected side (0.37 ± 0.03) was significantly lower (p 0.05) compared to the unaffected side in patients (0.48 ± 0.03) and controls (0.52 ± 0.02), and the ADC in the affected side (5.6 ± 0.34 mmDTI revealed a loss of anisotropy and an increase in diffusivity in affected nerves before surgery. Diffusion alterations correlated with atrophic changes in patients with TN caused by NVC. After removal of the compression, the loss of FA remained, but ADC normalized in the affected nerves, suggesting improvement in the diffusion of the trigeminal root.

Published
2019
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17. Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion

Author

Cyril Dargazanli, Yves Berthezène, Sébastien Richard, Vincent Costalat, Serge Bracard, Pierre Seners, Séverine Debiais, Ana-Paula Narata, Caroline Arquizan, Canan Ozsancak, Christophe Magni, Jean-Philippe Cottier, Jean-Louis Mas, Benjamin Gory, Laurence Legrand, Stéphanie Lion, Guillaume Turc, Jean-Claude Baron, Catherine Oppenheim, Norbert Nighoghossian, Tae-Hee Cho, Olivier Naggara, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Service de neuroradiologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de neurologie [Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Régional d'Orléans (CHRO), Service de Neurologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Département de Neuroradiologie[Montpellier], Service de neurologie [CHRU Nancy], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Martinez Rico, Clara, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)

Subjects
Male, thrombolysis, medicine.medical_specialty, Mechanical Thrombolysis, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Ischemia, Perfusion scanning, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Cerebral perfusion, Internal medicine, ischemic stroke, medicine, Humans, magnetic resonance imaging, Prospective Studies, Registries, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], cardiovascular diseases, Thrombus, Stroke, Aged, Retrospective Studies, Acute stroke, Aged, 80 and over, business.industry, Brain, Original Articles, Thrombolysis, Middle Aged, medicine.disease, Perfusion, [SDV] Life Sciences [q-bio], Diffusion Magnetic Resonance Imaging, Neurology, thrombectomy, Cardiology, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Magnetic Resonance Angiography, 030217 neurology & neurosurgery, Large vessel occlusion
Abstract

In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax ≥ 10 s volume/ Tmax ≥ 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR ( P = 0.006), shorter thrombus on T2*-imaging ( P

Published
2019
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18. A lower admission level of interleukin-6 is associated with first-pass effect in ischemic stroke patients

Author

Claire Crola Da Silva, Yves Berthezène, Laura Mechtouff, Nathalie Dufay, Nathan Mewton, Marielle Buisson, Camille Amaz, Tae-Hee Cho, Laurent Derex, Omer Eker, Elodie Ong, Alexandre Paccalet, Thomas Bochaton, Michel Ovize, Norbert Nighoghossian, CarMeN, laboratoire, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Department of Stroke Medicine [Lyon], Hospices Civils de Lyon (HCL), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hôpital Louis Pradel [CHU - HCL], Service de neuroradiologie [Lyon], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Occlusion, medicine, Humans, Thrombus, Interleukin 6, Stroke, Aged, Ischemic Stroke, Retrospective Studies, Thrombectomy, biology, Cerebral infarction, business.industry, Interleukin-6, Interleukin, inflammatory response, General Medicine, Thrombolysis, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Cohort, Cardiology, biology.protein, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

BackgroundFirst-pass effect (FPE) defined as a complete or near-complete reperfusion achieved after a single thrombectomy pass is predictive of favorable outcome in acute ischemic stroke (AIS) patients. We aimed to assess whether admission levels of inflammatory markers are associated with FPE.MethodsHIBISCUS-STROKE (CoHort of Patients to Identify Biological and Imaging markerS of CardiovascUlar Outcomes in Stroke) includes AIS patients with large vessel occlusion treated with mechanical thrombectomy following brain MRI. C-reactive protein, interleukin (IL)-6, IL-8, IL-10, monocyte chemoattractant protein-1, soluble tumor necrosis factor receptor I, soluble form suppression of tumorigenicity 2, matrix metalloproteinase-9 (MMP-9), soluble P-selectin, and vascular cellular adhesion molecule-1 were measured in admission sera using an ELISA assay. FPE was defined as a complete or near-complete reperfusion (thrombolysis in cerebral infarction scale (TICI) 2c or 3) after the first pass. A multivariate logistic regression analysis was performed to assess independent factors associated with FPE.ResultsA total of 151 patients were included. Among them, 43 (28.5%) patients had FPE. FPE was associated with low admission levels of IL-6, MMP-9, and platelet count, an older age, lack of hypertension, lack of tandem occlusion, a shorter thrombus length, and a reduced procedural time. Following multivariate analysis, a low admission level of IL-6 was associated with FPE (OR 0.66, 95% CI 0.46 to 0.94). Optimal cut-off of IL-6 level for distinguishing FPE from non-FPE was 3.0 pg/mL (sensitivity 92.3%, specificity 42.3%).ConclusionA lower admission level of IL-6 is associated with FPE.

Published
2021
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19. Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone

Author

Aïcha Lyoubi, Charles Arteaga, Caroline Arquizan, Philippe Niclot, Aude Triquenot, Charlotte Rosso, Laurent Suissa, Laurie Fraticelli, Frédéric Klapczynski, Marion Boulanger, Christine Pires, Patrik Michel, Didier Leys, Philippe Smadja, Mathilde Delpech, Stéphane Vannier, Yves Berthezène, Sébastien Richard, Sébastien Gazzola, Serge Timsit, Valérie Wolff, Jérémie Papassin, Laurent Spelle, Christian Denier, Yannick Béjot, Jean-Louis Mas, Anne-Evelyne Vallet, Catherine Oppenheim, Séverine Debiais, Serge Bracard, Olivier Detante, Andreea Aignatoaie, Frédéric Philippeau, François Lun, Denis Sablot, Emmanuel Touzé, Valer Grigoras, Sébastien Marcel, Hervé Brunel, Laura Mechtouff, Hubert Desal, Mirjam Rachel Heldner, Bertrand Lapergue, Vincent Costalat, Serkan Cakmak, Duc-Long Duong, Isabelle Serre, François Mounier-Vehier, Audrey Courselle-Arnoux, Sébastien Soize, Ludovic Lucas, Pierre Agius, Sonia Alamowitch, Isabelle Girard Buttaz, Michel Piotin, Pierre Garnier, Gauthier Duloquin, Davide Strambo, Nicolas Bricout, Omar Bennani, Emmanuel Carrera, Marion Yger, Hilde Hénon, Jean-Philippe Cottier, Nicolae Crainic, Michael Obadia, Cécile Preterre, Guillaume Turc, Steven Hajdu, Pierre Seners, Mathieu Zuber, Jean-Claude Baron, C. Lamy, Wagih Ben Hassen, Claire Perrin, Claire Boutet, Matthieu Krug, Clement Tracol, Amélie Tuffal, Norbert Nighoghossian, Arnaud Malbranque, Jan Gralla, Yves Samson, Benoit Guillon, Alexandre Obadia, Nadia Laksiri, Ruben Tamazyan, Mylène Masson, Frédéric Clarençon, Canan Ozsancak, Fernando Pico, Gioia Mione, Simon Jung, Mohamed Chbicheb, Igor Sibon, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Hôpital Foch [Suresnes], Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Bern University Hospital [Berne] (Inselspital), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Saint Jean de Perpignan, Centre hospitalier [Valenciennes, Nord], Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier de Saint-Nazaire, Hôpital de la Timone [CHU - APHM] (TIMONE), Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier de Versailles André Mignot (CHV), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier de Lens, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux], CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre Hospitalier Métropole Savoie [Chambéry], Centre Hospitalier Régional d'Orléans (CHRO), CHU Rouen, Normandie Université (NU), Hôpitaux Universitaires de Genève (HUG), Centre Hospitalier René Dubos [Pontoise], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hôpital Delafontaine, Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Strasbourg, Centre Hospitalier Universitaire [Rennes], Centre Hospitalier Fleyriat [Bourg en Bresse], CHU Amiens-Picardie, Centre Hospitalier Universitaire de Reims (CHU Reims), MINOR-STROKE Collaborators : Sonia Alamowitch, Charles Arteaga, Omar Bennani, Yves Berthezene, Marion Boulanger, Claire Boutet, Serge Bracard, Nicolas Bricout, Hervé Brunel, Serkan Cakmak, Mohamed Chbicheb, Frédéric Clarençon, Vincent Costalat, Audrey Courselle-Arnoux, Séverine Debiais, Mathilde Delpech, Christian Denier, Hubert Desal, Olivier Detante, Gauthier Duloquin, Laurie Fraticelli, Sébastien Gazzola, Jan Gralla, Valer Grigoras, Benoit Guillon, Matthieu Krug, Steven Hajdu, Simon Jung, Frédéric Klapczynski, Didier Leys, François Lun, Arnaud Malbranque, Sébastien Marcel, Patrik Michel, Jean-Louis Mas, Mylène Masson, Norbert Nighoghossian, Michael Obadia, Catherine Oppenheim, Canan Ozsancak, Fernando Pico, Michel Piotin, Christine Pires, Sébastien Richard, Yves Samson, Isabelle Serre, Igor Sibon, Philippe Smadja, Laurent Spelle, Laurent Suissa, Serge Timsit, Emmanuel Touzé, Amélie Tuffal, Anne-Evelyne Vallet, Marion Yger, Stéphane Vannier, Mathieu Zuber., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), and Martinez Rico, Clara

Subjects
medicine.medical_specialty, medicine.medical_treatment, Population, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, medicine.artery, Occlusion, medicine, 030212 general & internal medicine, 10. No inequality, education, 610 Medicine & health, Stroke, Original Investigation, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, [SCCO.NEUR] Cognitive science/Neuroscience, Retrospective cohort study, Thrombolysis, medicine.disease, ddc:616.8, Cohort, Cardiology, Neurology (clinical), Internal carotid artery, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Importance The best reperfusion strategy in patients with acute minor stroke and large vessel occlusion (LVO) is unknown. Accurately predicting early neurological deterioration of presumed ischemic origin (ENDi) following intravenous thrombolysis (IVT) in this population may help to select candidates for immediate transfer for additional thrombectomy. Objective To develop and validate an easily applicable predictive score of ENDi following IVT in patients with minor stroke and LVO. Design, Setting, and Participants This multicentric retrospective cohort included 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5 or less) and LVO (basilar artery, internal carotid artery, first [M1] or second [M2] segment of middle cerebral artery) intended for IVT alone in 45 French stroke centers, ie, including those who eventually received rescue thrombectomy because of ENDi. For external validation, another cohort of 347 patients with similar inclusion criteria was collected from 9 additional centers. Data were collected from January 2018 to September 2019. Main Outcomes and Measures ENDi, defined as 4 or more points' deterioration on NIHSS score within the first 24 hours without parenchymal hemorrhage on follow-up imaging or another identified cause. Results Of the 729 patients in the derivation cohort, 335 (46.0%) were male, and the mean (SD) age was 70 (15) years; of the 347 patients in the validation cohort, 190 (54.8%) were male, and the mean (SD) age was 69 (15) years. In the derivation cohort, the median (interquartile range) NIHSS score was 3 (1-4), and the occlusion site was the internal carotid artery in 97 patients (13.3%), M1 in 207 (28.4%), M2 in 395 (54.2%), and basilar artery in 30 (4.1%). ENDi occurred in 88 patients (12.1%; 95% CI, 9.7-14.4) and was strongly associated with poorer 3-month outcomes, even in patients who underwent rescue thrombectomy. In multivariable analysis, a more proximal occlusion site and a longer thrombus were independently associated with ENDi. A 4-point score derived from these variables-1 point for thrombus length and 3 points for occlusion site-showed good discriminative power for ENDi (C statistic = 0.76; 95% CI, 0.70-0.82) and was successfully validated in the validation cohort (ENDi rate, 11.0% [38 of 347]; C statistic = 0.78; 95% CI, 0.70-0.86). In both cohorts, ENDi probability was approximately 3%, 7%, 20%, and 35% for scores of 0, 1, 2 and 3 to 4, respectively. Conclusions and Relevance The substantial ENDi rates observed in these cohorts highlights the current debate regarding whether to directly transfer patients with IVT-treated minor stroke and LVO for additional thrombectomy. Based on the strong associations observed, an easily applicable score for ENDi risk prediction that may assist decision-making was derived and externally validated.

Published
2021
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20. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Author

Michel Ovize, Lucie Rascle, Axel Benhamed, Julia Fontaine, Karim Tazarourte, Laurent Derex, Cécile Plumereau, Tae-Hee Cho, Matteo Cappucci, Marielle Buisson, Elodie Ong, David Schiavo, Norbert Nighoghossian, Thomas Bony, Yves Berthezène, Célia Tuttle, Omer Eker, Roberto Riva, Camille Amaz, Marion Douplat, Laura Mechtouff, Hospices Civils de Lyon (HCL), Service de Neurologie [Lyon], CHU Lyon, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Département de Neuroradiologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Université de Lyon, Hôpital Edouard Herriot [CHU - HCL], Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and CarMeN, laboratoire

Subjects
medicine.medical_specialty, Neurology, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, [SDV]Life Sciences [q-bio], Clinical Neurology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Internal medicine, Pandemic, Medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Prospective Studies, Stroke, Pandemics, Neuroradiology, Retrospective Studies, Thrombectomy, Original Communication, business.industry, Thrombolysis, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Reperfusion, Emergency medical dispatch, Cardiology, Neurology (clinical), France, business, Covid-19, 030217 neurology & neurosurgery
Abstract

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period.MethodsWe conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods.ResultsA total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period (55 (54.5%) vs 74 (69.2%); p=0.03) and was mainly due to time delay among patients treated with MT. The volume of MT remains stable over the two periods (72 (71.3%) vs 65 (60.8%); p=0.14) but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; pConclusionsOur study showed a decrease of the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

Published
2020
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21. Simultaneous assessment of microcalcifications and morphological criteria of vulnerability in carotid artery plaque using hybrid 18F-NaF PET/MRI

Author

Alexandre Paccalet, Laura Mechtouff, Emmanuelle Canet-Soulas, Nicolas Costes, Stephane Luong, Antoine Millon, Yves Berthezène, Patrick Feugier, Thomas Bochaton, Salim Si-Mohamed, Claire Crola Da Silva, Alexandre Bani-Sadr, Didier Le Bars, Norbert Nighoghossian, Monica Sigovan, Diane Collet-Benzaquen, David Magne, Adeline Mansuy, Julie Haesebaert, Philippe Douek, Jérémie Tordo, and Hospices Civils de Lyon, Departement de Neurologie (HCL)

Subjects
medicine.diagnostic_test, business.industry, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Magnetic resonance imaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, medicine.disease, Asymptomatic, Culprit, 030218 nuclear medicine & medical imaging, body regions, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Carotid artery plaque, medicine, Mineral metabolism, Radiology, Nuclear Medicine and imaging, Tomography, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Nuclear medicine, Stroke, ComputingMilieux_MISCELLANEOUS
Abstract

Previous studies have suggested the role of microcalcifications in plaque vulnerability. This exploratory study sought to assess the potential of hybrid positron-emission tomography (PET)/magnetic resonance imaging (MRI) using 18F-sodium fluoride (18F-NaF) to check simultaneously 18F-NaF uptake, a marker of microcalcifications, and morphological criteria of vulnerability. We included 12 patients with either recently symptomatic or asymptomatic carotid stenosis. All patients underwent 18F-NaF PET/MRI. 18F-NaF target-to-background ratio (TBR) was measured in culprit and nonculprit (including contralateral plaques of symptomatic patients) plaques as well as in other arterial walls. Morphological criteria of vulnerability were assessed on MRI. Mineral metabolism markers were also collected. 18F-NaF uptake was higher in culprit compared to nonculprit plaques (median TBR 2.6 [2.2-2.8] vs 1.7 [1.3-2.2]; P = 0.03) but was not associated with morphological criteria of vulnerability on MRI. We found a positive correlation between 18F-NaF uptake and calcium plaque volume and ratio but not with circulating tissue-nonspecific alkaline phosphatase (TNAP) activity and inorganic pyrophosphate (PPi) levels. 18F-NaF uptake in the other arterial walls did not differ between symptomatic and asymptomatic patients. 18F-NaF PET/MRI may be a promising tool for providing additional insights into the plaque vulnerability.

Published
2020
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22. Le seuil optimal de tmax identifiant les volumes de déficit de perfusion varie-t-il d'un logiciel de perfusion irm à l'autre dans l'accident ischémique cérébral aigu ? Une étude pilote

Author

Alexandre Bani-Sadr, Mathile Trintignac, Laura Mechtouff, Marc Hermier, Matteo Cappucci, Roxana Ameli, Charles De Bourguignon, Laurent Derex, Tae-Hee Cho, Norbert Nighoghossian, Omer Eker, and Yves Berthezène

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Published
2022
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23. Brush sign et apport artériel collatéral comme marqueurs potentiels de la croissance de l'infarctus après une thrombectomie réussie

Author

Alexandre Bani-Sadr, Dylan Pavie, Laura Mechtouff, Marc Hermier, Matteo Cappucci, Roxana Ameli, Laurent Derex, Charles De Bourguignon, Tae-Hee Cho, Omer Eker, Norbert NIghoghossian, and Yves Berthezène

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Published
2022
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24. Radiological Characteristics and Natural History of Adult IDH-Wildtype Astrocytomas with TERT Promoter Mutations

Author

Stéphanie Cartalat, Cristina Izquierdo, Jacques Guyotat, Jordi Bruna, Delphine Poncet, François Ducray, Tanguy Fenouil, Emmanuel Jouanneau, Yves Berthezène, Alexandre Vasiljevic, David Meyronet, Bastien Joubert, Jérôme Honnorat, and Marc Barritault

Subjects
Adult, Pathology, medicine.medical_specialty, Contrast enhancement, Gliomatosis cerebri, Tert promoter, 03 medical and health sciences, 0302 clinical medicine, Glioma, medicine, Humans, Promoter Regions, Genetic, Telomerase, neoplasms, Aged, Retrospective Studies, Brain Neoplasms, business.industry, Wild type, Astrocytoma, Middle Aged, medicine.disease, Isocitrate Dehydrogenase, nervous system diseases, Natural history, 030220 oncology & carcinogenesis, Radiological weapon, Mutation, Disease Progression, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Adult IDH-wildtype astrocytomas with TERT promoter mutations (TERTp) are associated with a poor prognosis.To analyze the radiological presentation and natural history of adult IDH-wildtype astrocytomas with TERTp.We retrospectively reviewed the characteristics of 40 IDH-wildtype TERTp-mutant astrocytomas (grade II n = 19, grade III n = 21) and compared them to those of 114 IDH-mutant lower grade gliomas (LGG), of 92 IDH-wildtype TERTp-mutant glioblastomas, and of 15 IDH-wildtype TERTp-wildtype astrocytomas.Most cases of IDH-wildtype TERTp-mutant astrocytomas occurred in patients aged50 yr (88%) and presented as infiltrative lesions without contrast enhancement (73%) that were localized in the temporal and/or insular lobes (37.5%) or corresponded to a gliomatosis cerebri (43%). Thalamic involvement (33%) and extension to the brainstem (27%) were frequently observed, as was gyriform infiltration (33%). This radiological presentation was different from that of IDH-mutant LGG, IDH-wildtype TERTp-mutant glioblastomas, and IDH-wildtype TERTp-wildtype astrocytomas. Tumor evolution before treatment initiation was assessable in 17 cases. Ten cases demonstrated a rapid growth characterized by the apparition of a ring-like contrast enhancement and/or a median velocity of diametric expansion (VDE) ≥8 mm/yr but 7 cases displayed a slow growth (VDE8 mm/yr) that could last several years before anaplastic transformation. Median overall survival of IDH-wildtype TERTp-mutant astrocytomas was 27 mo.IDH-wildtype TERTp-mutant astrocytomas typically present as nonenhancing temporo-insular infiltrative lesions or as gliomatosis cerebri in patients aged50 yr. In the absence of treatment, although rapid tumor growth is frequent, an initial falsely reassuring, slow growth can be observed.

Published
2018
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25. Collateral circulation assessment within the 4.5 h time window in patients with and without DWI/FLAIR MRI mismatch

Author

Omer Eker, Norbert Nighoghossian, Roxana Ameli, Maxime Bettan, Yves Berthezène, Aurélie Chabrol, Laurent Derex, Elodie Ong, Götz Thomalla, Jean-Claude Baron, Salvador Pedraza, M. Hermier, Tae-Hee Cho, Laura Mechtouff, Lise-Prune Berner, Nikolaos Makris, Irene K. Mikkelsenm, Leif Østergaard, and Adeline Mansuy

Subjects
Male, Time from symptom onset, medicine.medical_specialty, Time Factors, Collateral Circulation, Context (language use), 030204 cardiovascular system & hematology, Fluid-attenuated inversion recovery, computer.software_genre, Brain Ischemia, Lesion, 03 medical and health sciences, 0302 clinical medicine, Voxel, medicine, Humans, Thrombolytic Therapy, In patient, Prospective Studies, cardiovascular diseases, Perfusion-weighted-imaging, Aged, Aged, 80 and over, Ischemic stroke, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Middle Aged, Collateral circulation, Magnetic Resonance Imaging, Stroke, Diffusion Magnetic Resonance Imaging, Fluid-Attenuated-Inversion-Recovery, Neurology, Collateral, Female, Neurology (clinical), Radiology, medicine.symptom, business, Perfusion, computer, Magnetic Resonance Angiography, 030217 neurology & neurosurgery
Abstract

Objectives: The aim of the present study was to assess the association between collateral status and DWI-FLAIR mismatch in patients with acute ischemic stroke within the 4.5 h time-window. Methods: We analysed DWI, FLAIR, and PWI data in patients within 4.5 h after symptom onset from the I-KNOW European database. Collateral flow maps were graded by analyzing contrast ‘staining’ extent over the early, mid and late perfusion phases. ADC values, DWI lesion volume, and normalised perfusion parameters (CBV,Tmax) within DWI lesions were determined. Visibility of parenchymal hyperintensivty on FLAIR was evaluated (“FLAIR positive”), and DWI-FLAIR mismatch was assessed. Spontaneously reperfused regions were defined as voxels with Tmax

Published
2018
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26. Spontaneous multiple cervical artery dissections after alemtuzumab

Author

Judith Cottin, Françoise Durand-Dubief, Romain Marignier, Norbert Nighoghossian, Yves Berthezène, and Sandra Vukusic

Subjects
Adult, Vertebral Artery Dissection, medicine.medical_specialty, Cervical Artery, business.industry, Multiple sclerosis, Carotid Artery, Internal, Dissection, medicine.disease, Magnetic Resonance Imaging, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Neurology, medicine, Humans, Immunologic Factors, Alemtuzumab, Female, 030212 general & internal medicine, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

We report a case of multiple cervical artery dissections that occurred 4 days after a first course of alemtuzumab in a woman with relapsing–remitting multiple sclerosis and discuss its potential relationship and mechanisms of action. In particular, an arterial inflammatory process, secondary to cytokine release, could potentially lead to intimal thickening, luminal irregularities, stenosis, and ultimately occlusion. Occurrence of an unexpected serious adverse event, in our case, multiple cervical artery dissections, especially in a close time window after drug administration, questions a potential causal relationship with the drug or a simple coincidence.

Published
2019
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27. MRI Profile and Collateral Status in Patients with a Transient Ischemic Attack and an Intracranial Artery Occlusion

Author

Leila Chamard, Laura Mechtouff, Omer Eker, Norbert Nighoghossian, Elodie Ong, Yves Berthezène, Laurent Derex, Marielle Buisson, and T.-H. Cho

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Perfusion scanning, Intracranial Artery, medicine.disease, Arterial occlusion, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Occlusion, Medicine, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Radiology, business, Perfusion, Stroke, 030217 neurology & neurosurgery
Abstract

Background and purpose Transient ischemic attack may rarely reveal an intracranial artery occlusion. We analyzed acute magnetic resonance imaging (MRI) patterns and early outcome after reperfusion therapy in these cases. Method Clinical and imaging data were taken retrospectively from our comprehensive stroke center registry. Two MRI patterns were determined. Pattern A: full mismatch with negative diffusion-weighted imaging (DWI) and perfusion defect. Pattern B: large mismatch with positive DWI and perfusion defect. MRI-derived collateral flow maps were automatically generated from the raw of dynamic susceptibility contrast MRI. Patients were treated either by recombinant tissue plasminogen activator (rtPA) alone or in combination with mechanical thrombectomy. Results From October 1, 2010 to May 15, 2016, 1,019 patients were admitted and treated by t-PA within 4.5 hours of stroke onset of them; 14 had a transient ischemic attack (TIA) within the 6 hours preceding MRI. Perfusion imaging was performed in 11 patients. An arterial occlusion was found in all of them, 11 patients had a distal anterior circulation occlusion, whereas 3 patients (21%) had a proximal occlusion. According to MRI, 6 patients showed pattern A, whereas 5 patients had pattern B. Good collaterals were observed in 10 patients (6 patients with grade 3 and 4 patients with grade 4), whereas 1 patient had poor collaterals (grade 2). The day 1 National Institutes of Health Stroke Scale median was 0. Modified Rankin Scale median at 3 months was 0. Conclusion TIAs may reveal acute intracranial artery occlusion. Acute MRI may able to assist in therapeutic decision.

Published
2018
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28. Combined analysis of MGMT methylation and dynamic-susceptibility-contrast MRI for the distinction between early and pseudo-progression in glioblastoma patients

Author

Emmanuel Jouanneau, A. d’Hombres, J Guyotat, Leila Chamard, Alexandre Bani-Sadr, Yves Berthezène, Omer Eker, Jérôme Honnorat, C. Iziquierdo, David Meyronet, Lise-Prune Berner, M. Hermier, C.M. Bidet, François Ducray, S. Gouttard, Marc Barritault, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, and Hospices Civils de Lyon (HCL)

Subjects
Oncology, Male, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Contrast Media, 0302 clinical medicine, 030212 general & internal medicine, Prospective cohort study, DNA Modification Methylases, Univariate analysis, medicine.diagnostic_test, Brain Neoplasms, Chemoradiotherapy, Middle Aged, Prognosis, Magnetic Resonance Imaging, Treatment Outcome, Neurology, Disease Progression, Female, medicine.symptom, medicine.drug, Adult, medicine.medical_specialty, Lesion, Diagnosis, Differential, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, Biomarkers, Tumor, Humans, Radiation Injuries, neoplasms, Dexamethasone, Aged, Retrospective Studies, Temozolomide, business.industry, Tumor Suppressor Proteins, Magnetic resonance imaging, DNA Methylation, eye diseases, Radiation therapy, DNA Repair Enzymes, Neurology (clinical), business, Glioblastoma, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

INTRODUCTION Currently, no single diagnostic modality allows the distinction between early progression (EP) and pseudo-progression (Psp) in glioblastoma patients. Herein we aimed to identify the characteristics associated with EP and Psp, and to analyze their diagnostic value alone and in combination. MATERIAL AND METHODS We reviewed the clinical, conventional magnetic resonance imaging (MRI), and molecular characteristics (MGMT promoter methylation, IDH mutation, and EGFR amplification) of glioblastoma patients who presented an EP (n=59) or a Psp (n=24) within six months after temozolomide radiochemotherapy. We analyzed relative cerebral blood volume (rCBV) and relative vessel permeability on K2 maps (rK2) in a subset of 33 patients using dynamic-susceptibility-contrast MRI. RESULTS In univariate analysis, EP was associated with neurological deterioration, higher doses of dexamethasone, appearance of a new enhanced lesion, subependymal enhancement, higher rCBV and rK2 values. Psp occurred earlier after radiotherapy completion and was associated with IDH1 R132H mutation, and MGMT methylation. In multivariate analysis, rCBV, rK2, and MGMT methylation status were independently associated with EP and Psp. All patients with a methylated MGMT promoter and a low rCBV (

Published
2019
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29. White matter burden does not influence the outcome of mechanical thrombectomy

Author

Norbert Nighoghossian, Marielle Buisson, Laurent Derex, Elodie Ong, Tae-Hee Cho, Yves Berthezène, Camille Amaz, Laura Mechtouff, and Omer Eker

Subjects
Male, medicine.medical_specialty, Neurology, Multivariate analysis, Neuroimaging, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, medicine, Humans, 030212 general & internal medicine, Stroke, Neuroradiology, Aged, Retrospective Studies, Thrombectomy, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, White Matter, Hyperintensity, Cerebral Angiography, Treatment Outcome, Cardiology, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

The significance of white matter hyperintensities (WMHs) in the setting of mechanical thrombectomy (MT) remains poorly documented. We assessed whether pre-existing WMHs burden was associated with baseline clinical and imaging factors and neurological outcome in patients undergoing MT. This retrospective single-center study included consecutive acute ischemic stroke (AIS) patients with stroke due to large vessel occlusion treated with MT. WMHs were assessed on baseline T2 fluid-attenuated inversion recovery magnetic resonance imaging. Neurological outcome was assessed at day 90 by the modified Rankin Scale (mRS). We analyzed the association between WMH burden and clinical and imaging factors by univariate and multivariate logistic regression analyses. Between July 2013 and June 2019, 293 patients with anterior circulation AIS met the inclusion criteria. WMHs burden was not associated to baseline NIHSS score severity (OR 0.89, 95% CI 0.54–1.49, p = 0.66), poor collateral status, Higashida score

Published
2019

30. Author response for 'Individualized Quantification of the Benefit from Reperfusion Therapy using Stroke Predictive Models'

Author

Jean-Claude Baron, Götz Thomalla, N. Nighoghossian, Pascal Roy, Salvador Pedraza, Brice Ozenne, Cho Tae-Hee, Irene Klærke Mikkelsen, Yves Berthezène, Leif Østergaard, Delphine Maucort-Boulch, and M. Hermier

Subjects
medicine.medical_specialty, Reperfusion therapy, business.industry, Internal medicine, Cardiology, medicine, medicine.disease, business, Stroke
Published
2019
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31. Does Small Vessel Disease Burden Impact Collateral Circulation in Ischemic Stroke Treated by Mechanical Thrombectomy?

Author

Norbert Nighoghossian, Lucie Rascle, Elodie Ong, Omer Eker, Tae-Hee Cho, Yves Berthezène, Laura Mechtouff, and Laurent Derex

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Collateral Circulation, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Humans, Stroke, Aged, Thrombectomy, Advanced and Specialized Nursing, Aged, 80 and over, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, Magnetic resonance imaging, Odds ratio, Thrombolysis, Digital subtraction angiography, Middle Aged, Collateral circulation, medicine.disease, Cerebral Small Vessel Diseases, Cerebrovascular Circulation, Middle cerebral artery, Angiography, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose— The development of leptomeningeal collateral artery network might be adversely affected by small vessel wall alteration. We sought to determine whether small vessel disease (SVD) burden may impact collateral development in patients treated by mechanical thrombectomy for anterior circulation acute ischemic stroke. Methods— The patients admitted in our center for anterior circulation acute ischemic stroke and (1) treated by mechanical thrombectomy with or without thrombolysis and (2) who underwent a baseline magnetic resonance imaging were included in the study. The SVD burden and the pial collaterality were assessed through the cerebral SVD score (severe when ≥1) and the Higashida score (favorable when ≥ 3) on magnetic resonance imaging and digital subtraction angiography, respectively. Any association between the cerebral SVD score and the collaterality were assessed through comparative and regression analyses. Results— Between January 2013 and March 2018, 240 patients met the inclusion criteria (68.7±16.1 years old; 49.2 % female). The cerebral SVD scores were of 0 in 125 (52.1%), 1 in 74 (30.8%), 2 in 30 (12.5%), and 3 in 11 (4.6%) patients. Hundred and thirty-six patients (58.1%) presented a favorable collaterality score. The favorable collaterality subgroup presented a significantly higher proportion of female (79%), lower baseline National Institutes of Health Stroke Scale ( P P P =0.51). Conclusions— In patients with anterior circulation acute ischemic stroke, collateral flow status does not seem to be influenced by SVD burden.

Published
2019

32. MRI Assessment of Oxygen Metabolism and Hemodynamic Status in Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study

Author

Thomas Jurkovic, Olivier Montigon, Yves Berthezène, Emmanuel L. Barbier, Roxana Ameli, Omer Eker, Nikolaos Makris, Norbert Nighoghossian, T.-H. Cho, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon, Departement de Neurologie (HCL), [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and ANR-19-P3IA-0003,MIAI,MIAI @ Grenoble Alpes(2019)

Subjects
Male, medicine.medical_specialty, Hemodynamics, Pilot Projects, Constriction, Pathologic, CMRO 2, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, medicine.diagnostic_test, business.industry, Intracranial Artery, Magnetic resonance imaging, Oxygenation, Middle Aged, medicine.disease, Intracranial Arteriosclerosis, Magnetic Resonance Imaging, Oxygen, Stenosis, Cerebral blood flow, brain metabolism, Cerebrovascular Circulation, Cardiology, intracranial stenosis, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Neurology (clinical), perfusion MRI, business, Perfusion, 030217 neurology & neurosurgery
Abstract

Background and purpose Hemodynamic and metabolic impairment in intracranial atherosclerotic stenosis (ICAS) may promote stroke vulnerability particularly in borderzone areas. Perfusion and oxygen mapping magnetic resonance imaging (MRI) may provide useful information in this setting. Methods In this pilot study, patients with symptomatic atherosclerotic anterior circulation stenosis ≥60%, without other sources of ischemic stroke, were included. High-resolution vessel wall MRI quantified the stenosis degree, and hemodynamic and metabolic impairment was assessed at baseline using dynamic susceptibility contrast perfusion and multiparametric quantitative blood-oxygen-level-dependent (mqBOLD) oxygenation MRI. All parameters were assessed within both hemispheres and in borderzone areas. Results Forty-three subjects with intracranial artery narrowing were screened from November 2014 to January 2016. Eleven patients met the study criteria (mean ± standard deviation age = 64.4 ± 10.6 years, the mean degree of stenosis was 76.9 ± 23.4%). No interhemispheric differences were observed across oxygen (cerebral metabolic rate of oxygen and tissular saturation of oxygen) or perfusion (mean transit time, time to maximum, Tmax , normalized cerebral blood volume [nCBV], and normalized cerebral blood flow) parameters. A positive correlation was observed between the stenosis degree and ipsilateral nCBV (R = .77, P = .008). In addition, a significant increase in CBV was observed in anterior cortical borderzones ipsilateral to stenosis (nCBV = 7.20 ± 1.81 vs. 5.45 ± 1.40 mL/100 g, P = .02). Conclusion Symptomatic ICAS had no global impact on perfusion and oxygen mapping MRI at resting state. A significant increase in nCBV was found within anterior borderzone areas.

Published
2019
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33. Better Collaterals Are Independently Associated With Post-Thrombolysis Recanalization Before Thrombectomy

Author

Stéphanie Lion, Wagih Ben Hassen, Caroline Arquizan, Jean-Philippe Cottier, Vincent Costalat, Pierre Seners, Christophe Magni, Séverine Debiais, Yves Berthezène, Sébastien Richard, Pauline Roca, Catherine Oppenheim, Tae-Hee Cho, Guillaume Turc, Jean-Claude Baron, Jean-Louis Mas, Olivier Naggara, Canan Ozsancak, Laurence Legrand, Serge Bracard, Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Service de neuroradiologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Cerebrovascular Unit [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Régional d'Orléans (CHRO), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL)

Subjects
Male, medicine.medical_specialty, Collateral circulation, MESH: Administration, intravenous, Brain/diagnostic imaging, Fibrinolytic agents/therapeutic use, medicine.medical_treatment, Perfusion scanning, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Internal medicine, Occlusion, medicine, Thrombolytic Agent, Humans, Thrombolytic Therapy, Registries, Thrombus, Stroke, Aged, Thrombectomy, Advanced and Specialized Nursing, Aged, 80 and over, medicine.diagnostic_test, business.industry, Brain, Magnetic resonance imaging, Thrombolysis, Middle Aged, medicine.disease, Perfusion imaging, Magnetic Resonance Imaging, 3. Good health, Treatment Outcome, Tissue Plasminogen Activator, Cardiology, Administration, Intravenous, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background and Purpose— In acute stroke patients with large vessel occlusion, the goal of intravenous thrombolysis (IVT) is to achieve early recanalization (ER). Apart from occlusion site and thrombus length, predictors of early post-IVT recanalization are poorly known. Better collaterals might also facilitate ER, for instance, by improving delivery of the thrombolytic agent to both ends of the thrombus. In this proof-of-concept study, we tested the hypothesis that good collaterals independently predict post-IVT recanalization before thrombectomy. Methods— Patients from the registries of 6 French stroke centers with the following criteria were included: (1) acute stroke with large vessel occlusion treated with IVT and referred for thrombectomy between May 2015 and March 2017; (2) pre-IVT brain magnetic resonance imaging, including diffusion-weighted imaging, T2*, MR angiography, and dynamic susceptibility contrast perfusion-weighted imaging; and (3) ER evaluated ≤3 hours from IVT start on either first angiographic run or noninvasive imaging. A collateral flow map derived from perfusion-weighted imaging source data was automatically generated, replicating a previously validated method. Thrombus length was measured on T2*-based susceptibility vessel sign. Results— Of 224 eligible patients, 37 (16%) experienced ER. ER occurred in 10 of 83 (12%), 17 of 116 (15%), and 10 of 25 (40%) patients with poor/moderate, good, and excellent collaterals, respectively. In multivariable analysis, better collaterals were independently associated with ER ( P =0.029), together with shorter thrombus ( P P =0.010). Conclusions— In our sample of patients with stroke imaged with perfusion-weighted imaging before IVT and intended for thrombectomy, better collaterals were independently associated with post-IVT recanalization, supporting our hypothesis. These findings strengthen the idea that advanced imaging may play a key role for personalized medicine in identifying patients with large vessel occlusion most likely to benefit from IVT in the thrombectomy era.

Published
2019
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34. Individualized quantification of the benefit from reperfusion therapy using stroke predictive models

Author

Tae-Hee Cho, Jean-Claude Baron, Delphine Maucort-Boulch, Yves Berthezène, Leif Østergaard, Marc Hermier, Götz Thomalla, Brice Ozenne, Irene Klærke Mikkelsen, Pascal Roy, Norbert Nighoghossian, and Salvador Pedraza

Subjects
Male, medicine.medical_specialty, computer.software_genre, Logistic regression, Tissue plasminogen activator, Lesion, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Patient Admission, Fibrinolytic Agents, Voxel, Internal medicine, medicine, magnetic resonance imaging, Humans, Prospective Studies, Precision Medicine, Stroke, 030304 developmental biology, Aged, Retrospective Studies, 0303 health sciences, medicine.diagnostic_test, business.industry, General Neuroscience, Brain, Magnetic resonance imaging, medicine.disease, stroke, Magnetic Resonance Imaging, reperfusion, Treatment Outcome, Tissue Plasminogen Activator, Reperfusion, Cardiology, Female, medicine.symptom, business, predictive modelling, computer, 030217 neurology & neurosurgery, Predictive modelling, medicine.drug, Follow-Up Studies
Abstract

Purpose: Recent imaging developments have shown the potential of voxel-based models in assessing infarct growth after stroke. Many models have been proposed but their relevance in predicting the benefit of a reperfusion therapy remains unclear. We searched for a predictive model whose volumetric predictions would identify stroke patients who are to benefit from tissue plasminogen activator (t-PA)-induced reperfusion. Material and Methods: Forty-five cases were used to study retrospectively stroke progression from admission to end of follow-up. Predictive approaches based on various statistical models, predictive variables and spatial filtering methods were compared. The optimal approach was chosen according to the area under the precision-recall curve (AUPRC). The final lesion volume was then predicted assuming that the patient would or would not reperfuse. Patients, with an acute lesion of ≤50 ml and a predicted reduction in the presence of reperfusion >6 ml and >25% of the acute lesion, were classified as responders. Results: The optimal model was a logistic regression using the voxel distance to the acute lesion, the volume of the acute lesion and Gaussian-filtered MRI contrast parameters as predictive variables. The predictions gave a median AUPRC of 0.655, a median AUC of 0.976 and a median volumetric error of 8.29 ml. Nineteen patients matched the responder profile. A non-significant trend of improved reduction in NIHSS score (−42.8%, p =.09) and in lesion volume (−78.1%, p = 0.21) following reperfusion was observed for responder patients. Conclusion: Despite limited volumetric accuracy, predictive stroke models can be used to quantify the benefit of reperfusion therapies.

Published
2019
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35. Thrombus Length Predicts Lack of Post-Thrombolysis Early Recanalization in Minor Stroke With Large Vessel Occlusion

Author

Ana-Paula Narata, Michel Piotin, Julie Delepierre, Jean-Louis Mas, Séverine Debiais, Nicolas Bricout, Caroline Arquizan, Cyril Dargazanli, Hilde Hénon, Catherine Oppenheim, Serge Bracard, Marie Tisserand, Mikaël Mazighi, Jean-Philippe Cottier, Benjamin Gory, Yves Berthezène, Sébastien Richard, Guillaume Turc, Michael Obadia, Tae-Hee Cho, Jean-Claude Baron, Pierre Seners, Bertrand Lapergue, Arturo Consoli, Vincent Costalat, Laurence Legrand, Norbert Nighoghossian, Olivier Naggara, Xavier Leclerc, Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Roger Salengro [Lille], Hôpital Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de neurologie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Imagerie Tomographique et Radiothérapie, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon, Departement de Neurologie (HCL), Hôpital Foch [Suresnes], Imagerie et cerveau (iBrain - Inserm U1253 - UNIV Tours ), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Sainte Anne [Paris], Services de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service d'Imagerie Morphologique et Fonctionnel [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de Neuroradiologie[Montpellier], Service de Radiologie [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de neuroradiologie [Tours], Département de neuro-radiologie, CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Service de neuroradiologie [Paris], Hôpital Sainte-Anne, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)

Subjects
Male, medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, Population, Arterial Occlusive Diseases, 030204 cardiovascular system & hematology, Sensitivity and Specificity, Cohort Studies, 03 medical and health sciences, Brain ischemia, 0302 clinical medicine, Predictive Value of Tests, Interquartile range, Internal medicine, Occlusion, medicine, Humans, Thrombolytic Therapy, Thrombus, education, Stroke, Aged, Thrombectomy, Aged, 80 and over, Advanced and Specialized Nursing, education.field_of_study, Surrogate endpoint, business.industry, Fibrinolysis, Thrombosis, Odds ratio, Thrombolysis, Middle Aged, medicine.disease, Combined Modality Therapy, Magnetic Resonance Imaging, 3. Good health, Treatment Outcome, Cardiology, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Disease Susceptibility, France, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose— Whether bridging therapy, that is, intravenous thrombolysis [IVT] followed by mechanical thrombectomy, is beneficial as compared with IVT alone in minor stroke (National Institutes of Health Stroke Scale ≤5) with large vessel occlusion is unknown and should be tested in randomized trials. To help select the most appropriate candidates for such trials, we aimed to identify strong predictors of lack of post-IVT early recanalization (ER)—a surrogate marker of poor outcome. Methods— From a large multicenter French registry of patients with large vessel occlusion referred for thrombectomy immediately after IVT start between 2015 and 2017, we extracted 97 minor strokes with ER evaluated on first angiographic run or noninvasive imaging ≤3 hours from IVT start. Thrombus length was measured using the susceptibility vessel sign on T2* imaging. Results— Median National Institutes of Health Stroke Scale was 3 (interquartile range, 2–4), and occlusion sites were proximal (intracranial carotid or M1) and distal (M2) in 50% and 50% of patients, respectively. On pre-IVT MRI, median length of susceptibility vessel sign (visible in 90%) was 9.2 mm (interquartile range, 7.4–13.3). ER was present in 34% of patients, and susceptibility vessel sign length was the only clinical or radiological variable associated with no-ER after stepwise variable selection into a multivariable model (odds ratio, 1.53 per 1-mm increase; 95% CI, 1.21–1.92; P Conclusions— ER was frequent in this cohort of IVT-treated minor stroke patients with large vessel occlusion considered for thrombectomy, and thrombus length was a powerful independent predictor of no-ER. These findings may help design randomized trials aiming to test bridging therapy versus IVT alone in this population.

Published
2019
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36. Comparison of classification methods for tissue outcome after ischemic stroke

Author

Norbert Nighoghossian, Tae-Hee Cho, Laurent Derex, M. Hermier, Brice Ozenne, Jens Fiehler, Yves Berthezène, Irene Klærke Mikkelsen, Salvador Pedraza, Jean-Claude Baron, Leif Østergaard, Ceren Tozlu, and Delphine Maucort-Boulch

Subjects
medicine.medical_specialty, Boosting (machine learning), medicine.diagnostic_test, Receiver operating characteristic, business.industry, Magnetic resonance imaging, Logistic regression, computer.software_genre, Random forest, Support vector machine, Neuroimaging, Voxel, Medicine, Radiology, business, computer
Abstract

In acute ischemic stroke, identifying brain tissue at high risk of infarction is important for clinical decision-making. This tissue may be identified with suitable classification methods from magnetic resonance imaging (MRI) data. The aim of the present study was to assess comparatively the performance of five popular classification methods (Adaptive Boosting (ADA), Logistic Regression (LR), Artificial Neural Networks (ANN), Random Forest (RF), and Support Vector Machine (SVM)) in identifying tissue at high risk of infarction on human voxel-based brain imaging data. The classification methods were used with eight MRI parameters including diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) obtained in 55 patients. Sensitivity, specificity, the area under the receiver operating curve (ROC) as well as the area under the precision-recall curve criteria were used to compare the method performances. The methods performed equally in terms of sensitivity and specificity while the results of the area under the ROC were significantly better for ADA, LR, ANN and RF. However, there was no statistically significant difference between the performances of these five classification methods regarding the area under the precision-recall curve, which was the main comparison metric.

Published
2019
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37. Comparison of classification methods for tissue outcome after ischaemic stroke

Author

Jean-Claude Baron, Salvador Pedraza, Ceren Tozlu, Brice Ozenne, Laurent Derex, Jens Fiehler, Delphine Maucort-Boulch, M. Hermier, Norbert Nighoghossian, Tae-Hee Cho, Yves Berthezène, Leif Østergaard, Irene Klærke Mikkelsen, Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Rigshospitalet [Copenhagen], Copenhagen University Hospital, University of Copenhagen = Københavns Universitet (UCPH), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Aarhus University [Aarhus], Hospital Universitari de Girona Doctor Josep Trueta [Girona, Spain], Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Aarhus University Hospital, University of Cambridge [UK] (CAM), Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Berthezene, Yves, and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Boosting (machine learning), [SDV]Life Sciences [q-bio], diffusion-weighted imaging, Logistic regression, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Sørensen–Dice coefficient, Neuroimaging, Journal Article, Medicine, magnetic resonance imaging, Humans, Comparative Study, 030304 developmental biology, Aged, 0303 health sciences, perfusion-weighted imaging, Artificial neural network, Receiver operating characteristic, business.industry, Research Support, Non-U.S. Gov't, General Neuroscience, Brain, Pattern recognition, Magnetic Resonance Imaging, Random forest, Multicenter Study, Support vector machine, [SDV] Life Sciences [q-bio], Stroke, machine learning, classification, Area Under Curve, Data Interpretation, Statistical, brain ischaemia, Female, Artificial intelligence, business, 030217 neurology & neurosurgery, Algorithms
Abstract

In acute ischaemic stroke, identifying brain tissue at high risk of infarction is important for clinical decision-making. This tissue may be identified with suitable classification methods from magnetic resonance imaging data. The aim of the present study was to assess and compare the performance of five popular classification methods (adaptive boosting, logistic regression, artificial neural networks, random forest and support vector machine) in identifying tissue at high risk of infarction on human voxel-based brain imaging data. The classification methods were used with eight MRI parameters, including diffusion-weighted imaging and perfusion-weighted imaging obtained in 55 patients. The five criteria used to assess the performance of the methods were the area under the receiver operating curve (AUCroc), the area under the precision–recall curve (AUCpr), sensitivity, specificity and the Dice coefficient. The methods performed equally in terms of sensitivity and specificity, while the results of AUCroc and the Dice coefficient were significantly better for adaptive boosting, logistic regression, artificial neural networks and random forest. However, there was no statistically significant difference between the performances of these five classification methods regarding AUCpr, which was the main comparison metric. Machine learning methods can provide valuable prognostic information using multimodal imaging data in acute ischaemic stroke, which in turn can assist in developing personalized treatment decision for clinicians after a thorough validation of methods with an independent data set.

Published
2019
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38. Impact of Collateral Status on Neuroprotective Effect of Cyclosporine A in Acute Ischemic Stroke

Author

Roxana Ameli, Omer Eker, Norbert Nighoghossian, Lise Prune Berner, Lucie Cornut, Yves Berthezène, Camille Amaz, Nathan Mewton, Michel Ovize, T.-H. Cho, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Imagerie Tomographique et Radiothérapie, Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Department of Cardiology, Hospices Civils de Lyon (HCL), Imagerie et modélisation Vasculaires, Thoraciques et Cérébrales (MOTIVATE), Neuroradiology Department, Neurological Hospital, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL)

Subjects
0301 basic medicine, Male, medicine.medical_specialty, acute ischemic stroke, [SDV]Life Sciences [q-bio], Phases of clinical research, Collateral Circulation, Lesion volume, Neuroprotection, Brain Ischemia, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, collateral flow, Developmental Neuroscience, Internal medicine, medicine, Humans, In patient, cyclosporine, Acute ischemic stroke, Aged, Aged, 80 and over, business.industry, Brain, Middle Aged, Infarct size, Collateral circulation, Magnetic Resonance Imaging, reperfusion, Stroke, 030104 developmental biology, Collateral flow, Neuroprotective Agents, Treatment Outcome, Neurology, Cardiology, Female, neuroprotection, business, 030217 neurology & neurosurgery, Mri
Abstract

Background: Neuroprotection for acute ischemic stroke remains an elusive goal. Intracranial collaterals may favor neuroprotective drugs delivery at the acute stage of ischemic stroke. A recent phase 2 study showed that cyclosporine A (CsA) reduced ischemic damage in patients with a proximal occlusion who experienced effective recanalization. Collateral flow may improve this benefit. Materials & Methods: Collateral supply was assessed using dynamic susceptibility contrast MRI in 47 patients among the 110 patients from the original study and were graded in two groups: good collaterals and poor collaterals. Patients with good collaterals had significantly smaller initial infarct in both CsA group (p = 0.003) and controls (p = 0.016). Similarly, the final lesion volume was significantly lower in patients with good collaterals in both groups. Results: In patients with either good or poor collaterals CsA showed no additional benefit on ischemic lesion progression and final infarct size at day 30. Conclusion: We failed to demonstrate any significant additional benefit of CsA in patients with good collateral circulation.

Published
2019
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39. Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis

Author

Vincent Cottaz, Carlos El Khoury, Leila Chamard, Laurent Derex, Louis Guy Tisserand, M. Hermier, Tae-Hee Cho, Elie Janecek, Anne-Marie Schott, Fatima Abbas, Norbert Nighoghossian, Ana Filipa Geraldo, Yves Berthezène, Roxana Amelie, Magali Bischoff, and Laura Mechtouff

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Comorbidity, 030204 cardiovascular system & hematology, Logistic regression, Sensitivity and Specificity, White matter, Lesion, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Prevalence, medicine, Humans, Thrombolytic Therapy, Radiology, Nuclear Medicine and imaging, Stroke, Cerebral Hemorrhage, Neuroradiology, Aged, 80 and over, medicine.diagnostic_test, business.industry, Leukoaraiosis, Reproducibility of Results, Magnetic resonance imaging, Thrombolysis, Prognosis, medicine.disease, Magnetic Resonance Imaging, Causality, Treatment Outcome, medicine.anatomical_structure, Cardiology, Female, France, Neurology (clinical), Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis. We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis. HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03). In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size.

Published
2016
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40. Pseudotumoral presentation of cerebral amyloid angiopathy–related inflammation

Author

David Meyronet, Françoise Durand-Dubief, Solène Ronsin, Virginie Desestret, Jérôme Honnorat, Laure Thomas-Maisonneuve, Gianluca Deiana, Yves Berthezène, Maïté Formaglio, François Ducray, Ana Filipa Geraldo, and Norbert Nighoghossian

Subjects
Male, medicine.medical_specialty, Granuloma, Plasma Cell, Article, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Glioma, Biopsy, medicine, Humans, Cognitive decline, Aged, Retrospective Studies, Aged, 80 and over, Inflammation, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Hyperintensity, Cerebral Amyloid Angiopathy, Cerebral blood flow, Neurology (clinical), Cerebral amyloid angiopathy, Radiology, Headaches, medicine.symptom, Differential diagnosis, business, 030217 neurology & neurosurgery
Abstract

Objective: To identify the clinical and radiologic features that should raise suspicion for the pseudotumoral presentation of cerebral amyloid angiopathy–related inflammation (CAA-I). Methods: We retrospectively reviewed the characteristics of 5 newly diagnosed and 23 previously reported patients in whom the CAA-I imaging findings were initially interpreted as CNS neoplasms. Results: Most cases (85%) occurred in patients >60 years old. The clinical characteristics at presentation included subacute cognitive decline (50%), confusion (32%), focal deficits (32%), seizures (25%), and headaches (21%). Brain MRI demonstrated infiltrative white matter lesions that exhibited a loco-regional mass effect without parenchymal enhancement (93%). In general, these findings were interpreted as low-grade glioma or lymphoma. Eighteen patients (64%) underwent a biopsy, which was nondiagnostic in 4 patients (14%), and 6 patients (21%) underwent a surgical resection. The primary reason for the misinterpretation of the imaging findings was the absence of T2*-weighted gradient recalled echo (T2*-GRE) sequences on initial imaging (89%). When subsequently performed (39%), the T2*-GRE sequences demonstrated multiple characteristic cortical and subcortical microhemorrhages in all cases. Perfusion MRI and magnetic resonance spectroscopy (MRS), which were performed on a subset of patients, indicated markedly reduced relative cerebral blood flow and a normal metabolic ratio. Conclusion: The identification of one or several nonenhancing space-occupying lesions, especially in elderly patients presenting with cognitive impairment, should raise suspicion for the pseudotumoral presentation of CAA-I and lead to T2*-GRE sequences. Perfusion MRI and MRS appear to be useful techniques for the differential diagnosis of this entity.

Published
2016
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41. Contents Vol. 41, 2016

Author

Bernd-Otto Huetter, Daniel Agustin Godoy, Rene Schmidt, Konstantinos Tziomalos, Michel Piotin, Jason Mackey, Didier Smadja, Alicia M. Zha, Yung-Tai Chen, Yves Berthezène, Thomas Robert, Hocine Redjem, Masaki Watanabe, Wolfram Schwindt, Brian B. Koo, Eric Jüttler, Yuji Suzuki, Kiyotaka Suzuki, Mario Di Napoli, Thomas Niederstadt, Niels Hjort, Wolf-Dirk Niesen, Shuu-Jiun Wang, Ulrich Sure, Javier Arpa, Maria Tsopozidi, Johannes Woitzik, Lauren A. Tobias, Daawn M. Bravata, Jong Ling Fuh, Tsutomu Nakada, Laurent Derex, Diogo C Haussen, Ramazan Jabbarli, Alexandra Pinczolits, Réza Behrouz, Christian Taschner, Roland Roelz, Michael Frankel, Juan José Ríos-Blanco, Ralf Dittrich, Apostolos I. Hatzitolios, Gabriele Ciccio, Lise-Prune Berner, Jens Minnerup, Matthias Reinhard, Marianna Spanou, Jens Witsch, Li Qin, Norbert Nighoghossian, Marianne S. Matthias, Walter Heindel, Yukihiko Fujii, Robert Fahed, Julien Bouvier, Carlos A. Vaz Fragoso, Wondwossen G Tekle, Tarek Zoubi, Mukesch Shah, Klaus Kaier, Mikayel Grigoryan, Satoshi Kurabe, Peter B. Sporns, Stella D. Bouziana, Henry Klar Yaggi, Neriman Oezkan, Vera Van Velthoven, Ingo Fiss, Aurel Popa-Wagner, Christian Cnyrim, Hermann Neugebauer, Rainer Dziewas, Vasilios Giampatzis, Jonathan A Grossberg, Julie Haesebaert, I. E. Sandalcioglu, Tae-Hee Cho, Raphaël Blanc, Jean-Claude Baron, Kouichirou Okamoto, Ameer E Hassan, Luca Masotti, Stella-Maria Angelopoulou, Michael Forsting, Raul G Nogueira, André Kemmling, Peter Vajkoczy, Edward J. Miech, Götz Thomalla, Floris H.B.M. Schreuder, Chun-Pai Yang, Maria Papadopoulou, Leif Østergaard, Marlène Wiart, Nora F. Dengler, Jason J. Sico, Inés González-Suárez, Stephanie M. Stahl, Hisothi Matsuzawa, Irene Klærke Mikkelsen, Linda S. Williams, Uta Hanning, Christos Savopoulos, Druckerei Stückle, Chu-Peng Hoi, Salvador Pedraza, Rachel Lampert, Andrey Lima, Stanislas Smajda, Stavroula Kostaki, Klaus-Peter Stein, Astrid Weyerbrock, Philipp Heermann, Leticia C Rebello, Isabel Wanke, Nils Hecht, and Julien Labreuche

Subjects
Neurology, Traditional medicine, business.industry, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
2016
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42. Early lesion reversal on DWI and FLAIR after thrombectomy reperfusion in acute ischemic stroke

Author

Benjamin Gory, L. Chamard, Norbert Nighoghossian, Yves Berthezène, F. Turjman, and Anne-Claire Lukaszewicz

Subjects
medicine.medical_specialty, business.industry, Treatment outcome, Fluid-attenuated inversion recovery, 030218 nuclear medicine & medical imaging, Lesion, 03 medical and health sciences, 0302 clinical medicine, Neurology, Medicine, Neurology (clinical), Radiology, medicine.symptom, business, Acute ischemic stroke, 030217 neurology & neurosurgery
Abstract

Revue Neurologique - In Press.Proof corrected by the author Available online since samedi 6 mai 2017

Published
2017
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43. Dynamics of Water Diffusion Changes in Different Tissue Compartments From Acute to Chronic Stroke-A Serial Diffusion Tensor Imaging Study

Author

Simon MacLean, Christian Gerloff, Anna Alegiani, Götz Thomalla, Hanna Braass, Laurent Derex, Norbert Nighoghossian, Tae-Hee Cho, Yves Berthezène, M. Hermier, Susanne Gellißen, and Jens Fiehler

Subjects
acute stroke, Fluid-attenuated inversion recovery, lcsh:RC346-429, 030218 nuclear medicine & medical imaging, Lesion, 03 medical and health sciences, 0302 clinical medicine, Nuclear magnetic resonance, Fractional anisotropy, medicine, Effective diffusion coefficient, magnetic resonance imaging, Diffusion (business), Stroke, lcsh:Neurology. Diseases of the nervous system, Original Research, medicine.diagnostic_test, Chemistry, Magnetic resonance imaging, medicine.disease, diffusion tensor imaging, stroke, Neurology, Neurology (clinical), medicine.symptom, 030217 neurology & neurosurgery, fractional anisotropy, Diffusion MRI
Abstract

Background and Purpose: The immediate decrease of the apparent diffusion coefficient (ADC) is the main characteristic change of water diffusion in acute ischemic stroke. There is only limited information on the time course of diffusion parameters in different tissue compartments of cerebral ischemia. Materials and Methods: In a longitudinal study, we examined 21 patients with acute ischemic stroke by diffusion tensor imaging within 5 h after symptom onset, 3 h later, 2 days, and 1 month after symptom onset. Acute diffusion lesion and the fluid-attenuated inversion recovery (FLAIR) after 2 days were used as volumes of interest to define persistent core, lesion growth, and reversible acute diffusion lesion. For all diffusion parameters ratios between the stroke lesion VOIs and the mirror VOIs were calculated for each time point. ADC ratio, fractional anisotropy ratios, and eigenvalues ratios were measured in these volumes of interest and in contralateral mirror regions at each time points. Results: In the persistent core, ADC ratio (0.772) and all eigenvalues ratios were reduced on admission up to 1 day after stroke and increased after 1 month (ADC ratio 1.067). Within the region of infarct growth time course of diffusion parameter changes was similar, but delayed. In the brain area with reversible diffusion lesion, a partial normalization of diffusion parameters over the time was observed, while after 1 month diffusion parameters did not show the signature of healthy brain tissue. There were significantly different trends for all parameters over time between the three tissue compartments. Conclusion: Diffusion tensor imaging displays characteristic changes of water diffusion in different tissue compartments over time in acute ischemic stroke. Even regions with reversible diffusion lesion show diffusion signatures of persisting tissue alterations.

Published
2018

44. OS3.3 Radiological characteristics and natural history of adult IDH wild type astrocytomas with TERT promoter mutations

Author

Jérôme Honnorat, Jacques Guyotat, Alexandre Vasiljevic, Marc Barritault, Tanguy Fenouil, Yves Berthezène, Bastien Joubert, Stéphanie Cartalat, Cristina Izquierdo, David Meyronet, Emmanuel Jouanneau, Delphine Poncet, François Ducray, and Jordi Bruna

Subjects
Cancer Research, Mutation, Wild type, Gliomatosis cerebri, Astrocytoma, Biology, medicine.disease, medicine.disease_cause, Tert promoter, nervous system diseases, Natural history, Oncology, Glioma, medicine, Cancer research, Oral Presentations, Neurology (clinical), Glioblastoma
Abstract

BACKGROUND: Adult IDH-wildtype astrocytomas with TERT promoter mutations (TERTp) are associated with a poor prognosis. The aim of the present study was to analyze their radiological presentation and natural history. MATERIAL AND METHODS: We retrospectively reviewed the characteristics of 40 IDH-wildtype TERTp-mutant astrocytomas (grade II n=19, grade III n=21) and compared them to those of 114 IDH-mutant lower grade gliomas (LGG), of 92 IDH-wildtype TERTp-mutant glioblastomas and of 15 IDH-wildtype TERTp-wildtype astrocytomas. RESULTS: Most cases of IDH-wildtype TERTp-mutant astrocytomas occurred in patients aged >50 years (88%) and presented as infiltrative lesions without contrast enhancement (73%) that were localized in the temporal and/or insular lobes (37.5%) or corresponded to a gliomatosis cerebri (43%). Thalamic involvement (33%) and extension to the brainstem (27%) were frequently observed, as was gyriform infiltration (33%). This radiological presentation was different from that of IDH-mutant LGG, IDH-wildtype TERTp-mutant glioblastomas, and IDH-wildtype TERTp-wildtype astrocytomas. Tumor evolution before treatment initiation was assessable in 17 cases. Ten cases demonstrated a rapid growth characterized by the apparition of a ring-like contrast enhancement and/or a median velocity of diametric expansion (VDE) ≥ 8 mm/year but 7 cases displayed a slow growth (VDE < 8 mm/year) that could last several years before anaplastic transformation. Median overall survival of IDH-wildtype TERTp-mutant astrocytomas was 27 months. CONCLUSION: IDH-wildtype TERTp-mutant astrocytomas typically present as non-enhancing temporo-insular infiltrative lesions or as gliomatosis cerebri in patients aged >50 years. In the absence of treatment, although rapid tumor growth is frequent, an initial falsely reassuring, slow growth can be observed.

Published
2018

45. 18 F-NaF PET-MRI: an innovative tool to assess carotid artery plaque vulnerability

Author

Laura Mechtouff, N. Costes, Norbert Nighoghossian, Philippe Douek, Yves Berthezène, Monica Sigovan, D. Collet‐Benzaquen, Stroke Department, Neurological Hospital, Hospices Civils de Lyon (HCL), Imagerie et modélisation Vasculaires, Thoraciques et Cérébrales (MOTIVATE), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant (CERMEP - imagerie du vivant), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Department of Radiology, Cardiological Hospital, Hospices Civils de Lyon, Laboratoire Technipath, Neuroradiology Department, Neurological Hospital, and ANR-10-IBHU-0003,CESAME,Institut Cerveau et Santé Mentale(2010)

Subjects
0301 basic medicine, business.industry, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Vulnerability, 03 medical and health sciences, chemistry.chemical_compound, 030104 developmental biology, Carotid artery plaque, positron emission tomography computed tomography, Neurology, chemistry, Sodium fluoride, sodium fluoride, Medicine, carotid stenosis, Neurology (clinical), business, Nuclear medicine, ComputingMilieux_MISCELLANEOUS, Positron Emission Tomography-Computed Tomography
Abstract

International audience

Published
2018
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46. Acute reperfusion without recanalization: Serial assessment of collaterals within 6 h of using perfusion-weighted magnetic resonance imaging

Author

Nikolaos Makris, Irene Klærke Mikkelsen, Tae-Hee Cho, Leif Østergaard, Salvador Pedraza, Norbert Nighoghossian, Götz Thomalla, Laurent Derex, Jean-Claude Baron, Yves Berthezène, M. Hermier, Leila Chamard, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL), Aarhus University [Aarhus], Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta - Girona Biomedical Research Institute (IDIBGI), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), University of Cambridge [UK] (CAM), Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Berthezene, Yves

Subjects
Male, medicine.medical_specialty, Collateral circulation, Databases, Factual, [SDV]Life Sciences [q-bio], Collateral Circulation, Perfusion scanning, recanalization, Magnetic resonance angiography, 030218 nuclear medicine & medical imaging, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, Occlusion, ischemic stroke, medicine, magnetic resonance imaging, Humans, Aged, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Original Articles, Perfusion-Weighted Magnetic Resonance Imaging, Middle Aged, Arterial occlusion, reperfusion, Cerebral Angiography, [SDV] Life Sciences [q-bio], Neurology, Cerebrovascular Circulation, Reperfusion, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Magnetic Resonance Angiography
Abstract

International audience; Acute reperfusion despite persistent arterial occlusion may occur in up to 30% of ischemic stroke patients. Recruitment of leptomeningeal collaterals may explain this phenomenon. Using dynamic susceptibility-contrast perfusion imaging (DSC-PI), we assessed acute changes in collateral flow among patients without recanalization. From a multicenter prospective database (I-KNOW), 46 patients with magnetic resonance angiography visible occlusion in whom both reperfusion and recanalization were assessed within 6 h of onset were identified. Maps of collateral flow at arterial, capillary and late venous phases were generated from DSC-PI through inter-frame registration, baseline signal subtraction and temporal summation, and graded blind to all other relevant clinical and radiological data using the Higashida scale. Flow direction and the acute evolution of collaterals were evaluated against the reperfusion status. Among patients without recanalization ( n = 33), flow direction remained retrograde. Collateral grades significantly improved between admission and acute follow-up in patients who reperfused (OR: 4.57; 95% CI: 1.1–22.7; p = 0.048), but not in those without reperfusion (OR: 1.34; 95% CI: 0.4–4.5; p = 0.623). Our study confirmed that acute reperfusion without recanalization is associated with a significant improvement of retrograde collateral flow. DSC-PI can detect acute changes in collateral flow, and may help evaluate novel treatments targeting leptomeningeal collaterals.

Published
2018
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47. Sequential MR Assessment of the Susceptibility Vessel Sign and Arterial Occlusion in Acute Stroke

Author

Guy Louis Tisserand, Yves Berthezène, Jean-Claude Baron, Salvador Pedraza, Thomas Ritzenthaler, Audrey Lacalm, Lars Riisgaard Ribe, Jens Fiehler, Irene Klærke Mikkelsen, Tae-Hee Cho, Leif Østergaard, Niels Hjort, Norbert Nighoghossian, and Delphine Maucort-Boulch

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Thrombolysis, medicine.disease, Tissue plasminogen activator, Arterial occlusion, Magnetic resonance angiography, Gradient echo imaging, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, medicine, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Radiology, business, Stroke, Acute ischemic stroke, 030217 neurology & neurosurgery, medicine.drug, Acute stroke
Abstract

PURPOSE Susceptibility vessel sign (SVS) may likely influence recanalization after thrombolysis. We assessed, through the European sequential MRI database “I-KNOW,” the relationship between the presence of SVS on T2-weighted gradient echo imaging, its angiographic counterpart on magnetic resonance angiography and its subsequent impact on recanalization after thrombolysis. MATERIALS AND METHODS Initial clinical and MRI characteristics and early follow up were analyzed in acute ischemic stroke patients treated with rt-Pa within 4.5 hours. Patients underwent multimodal MRI at admission. Sequential imaging performed 3 hours, 2 days and 1 month later allowed the analysis of SVS changes and recanalization. RESULTS Fifty patients were included in the study. SVS was observed in 54% of cases at admission. SVS was still present in 46% patients at 3 hours, 16% at 2 days, and 0% at 1 month. It was an independent predictor of no recanalization after thrombolysis (P = .04). After 3 hours, SVS disappeared in only 4 cases, and was not linked with recanalization on MRA. Conversely, when SVS persisted, a partial or complete recanalization was observed in 9 and 6 cases, respectively. CONCLUSIONS SVS is a predictor of lower recanalization rate. Its disappearance is not necessarily correlated with recanalization.

Published
2015
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48. Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke

Author

Irene Klærke Mikkelsen, Brice Ozenne, Norbert Nighoghossian, Tae-Hee Cho, Jean-Claude Baron, Lars Riisgaard Ribe, Leif Østergaard, Salvador Pedraza, Pascal Roy, Delphine Maucort-Boulch, M. Hermier, Götz Thomalla, and Yves Berthezène

Subjects
medicine.medical_specialty, Receiver operating characteristic, business.industry, Mean transit time, Predictive value, Surgery, Modified Rankin Scale, Internal medicine, Cardiology, medicine, Time to peak, Biomarker (medicine), Radiology, Nuclear Medicine and imaging, Neurology (clinical), Symptom onset, business, Acute ischemic stroke
Abstract

BACKGROUND AND PURPOSE Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke. METHODS Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated. RESULTS MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification. CONCLUSIONS TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.

Published
2015
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49. Imagery of pineal tumors

Author

Marc Hermier, Yves Berthezène, C Mottolese, Guy Louis-Tisserand, and G. Deiana

Subjects
endocrine system, Pathology, medicine.medical_specialty, Pineocytomas, Astrocytoma, Pineal Gland, Meningioma, Pineal gland, otorhinolaryngologic diseases, medicine, Humans, Papillary tumors of the pineal region, Pineal Tumors, Brain Neoplasms, business.industry, Neoplasms, Germ Cell and Embryonal, medicine.disease, medicine.anatomical_structure, nervous system, Pinealoma, Surgery, Neurology (clinical), Germ cell tumors, business, hormones, hormone substitutes, and hormone antagonists
Abstract

Pineal tumors are rare and include a large variety of entities. Germ cell tumors are relatively frequent and often secreting lesions. Pineal parenchymal tumors include pineocytomas, pineal parenchymal tumor of intermediate differentiation, pineoblastomas and papillary tumors of the pineal region. Other lesions including astrocytomas and meningiomas as well as congenital malformations i.e. benign cysts, lipomas, epidermoid and dermoid cysts, which can also arise from the pineal region. Imagery is often non-specific but detailed analysis of the images compared with the hormone profile can narrow the spectrum of possible diagnosis.

Published
2015
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50. Early Blood Brain Barrier Changes in Acute Ischemic Stroke: A Sequential MRI Study

Author

Yves Berthezène, Leif Østergaard, Norbert Nighoghossian, Laurent Derex, Jens Fiehler, Delphine Maucort-Boulch, Salvador Pedraza, Tae-Hee Cho, Gianluca Deiana, Marc Giraud, and Jean-Claude Baron

Subjects
0303 health sciences, Pathology, medicine.medical_specialty, Contrast enhancement, business.industry, Hemodynamics, Lesion volume, Fluid-attenuated inversion recovery, Blood–brain barrier, Stroke onset, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, nervous system, Ischemic stroke, cardiovascular system, medicine, Radiology, Nuclear Medicine and imaging, sense organs, Neurology (clinical), skin and connective tissue diseases, business, Acute ischemic stroke, 030217 neurology & neurosurgery, 030304 developmental biology
Abstract

BACKGROUND AND PURPOSE We sought to identify MRI factors associated with BBB changes at the acute stage of ischemic stroke. METHODS We analyzed BBB changes on admission and within 3 hours after the first scan. BBB changes was defined as the presence of leptomeningeal and parenchymal contrast enhancement on T1-weighted imaging. Tmax, CBV, and DWI lesion volume were assessed on baseline MRI. Clinical and MRI factors associated with BBB changes were assessed by univariate and multivariate logistic regressions analyses. RESULTS Forty-four patients were included. BBB changes on baseline MRI was observed in 2 of 44 patients (3%). BBB disruption on H3-MRI was present in 19 of 44 patients (43%). Hemodynamic status and baseline ischemic core size were not different between patients with or without BBB changes. BBB alteration on H3 MRI was strongly associated with FLAIR MRI sequence positivity, 16/19 patients (83%) P = .001. CONCLUSION BBB changes are exceptional during the first 3 hours after stroke onset. Delayed BBB alteration was associated with FLAIR positivity mainly reflecting vasogenic edema.

Published
2015
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