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International audience; ABSTRACT: After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.; RÉSUMÉ : Les normes de pratique recommandées à l’échelle internationale lors d’interventions consécutives à un accident ischémique cérébral aigu . En octobre 2017, à Budapest, une rencontre pluridisciplinaire de spécialistes s’est organisée dans le cadre du 17 e congrès de la World Federation of Interventional and Therapeutic Neuroradiology . Cette rencontre portait sur l’établissement de normes relatives aux interventions consécutives à des accidents ischémiques aigus. Elle a eu lieu, précisons-le, après que cinq essais randomisés contrôlés (ERC) ont montré les avantages de la thrombectomie mécanique dans la prise en charge de patients victimes d’un accident ischémique cérébral aigu montrant des signes naissants d’occlusion des plus gros vaisseaux sanguins. Les normes dont il a été alors question visaient aussi à atteindre un consensus quant aux exigences minimales auxquelles devaient se conformer les établissements de santé offrant la thrombectomie mécanique. Dans l’idéal, tous les patients devraient être traités dans un établissement offrant un éventail complet de soins neuro-endovasculaires (de niveau 1). Toutefois, en raison de l’éloignement géographique, quelques patients demeurent incapables de se rendre dans un tel établissement dans des délais raisonnables. Dans cette optique, le groupe réuni à Budapest a défini de façon particulière des recommandations définissant les aspects permettant aux autres établissements (de niveau 2) d’organiser en amont des soins en thrombectomie destinés à des patients victimes d’accidents ischémiques cérébraux aigus mais pas d’autres maladies neurovasculaires. Enfin, d’autres établissements (de niveau 3) pourront compter sur une unité de traitement des AVC, notamment au moyen de la thrombolyse intraveineuse; toutefois, ils ne pourront offrir aucune autre thérapie endovasculaire. Réunis, l’ensemble de ces établissements de niveaux 1, 2 et 3 constitue un réseau complet de soins destinés aux patients victimes d’un AVC. Le groupe multidisciplinaire réuni lors de cette rencontre a ainsi élaboré des recommandations et un cadre de référence visant le développement de la thrombectomie dans le monde entier.

International audience; Interventional Neuroradiology (INR) is not bound by the classical limits of a speciality, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.

SUMMARY: The association between the formation of intracranial aneurysms and situations of increased blood flow in certain areas of the brain is well accepted today. It has been seen in association with arteriovenous malformations of the brain, carotid occlusion, and Moyamoya disease. The occurrence of aneurysms in small arteries of the skull base, with the exception of the intracavernous carotid artery, however, is rare. We report a case of a 55-year-old woman who presented with an intracerebral hemorrhage caused by a ruptured anterior ethmoidal artery aneurysm. To the best of our knowledge, this is only the second case of documented intracranial bleeding from such a lesion.

BACKGROUND AND PURPOSE: Inadvertent foreign body embolization is a rarely diagnosed and neglected complication of cerebral angiography that has not been studied systematically. METHODS: We undertook a comprehensive 5-year retrospective study of all available postmortem cases of postangiographic neurologic complications, as well as a comprehensive histologic examination of all surgically resected central nervous system arteriovenous malformations, at our institution. RESULTS: Among the autopsy series, we found 3 patients for whom cerebral infarction, sometimes catastrophic, is attributable to inadvertent cotton fiber, Gelfoam, or polyvinyl alcohol particulate emboli during cerebral angiography. All cases described had concurrent atherosclerotic vascular disease. Particulate embolization, which is usually cotton fiber, is present in as many as 25% of resected arteriovenous malformations: the risk of finding such emboli is in part dependent on a history of prior interventional (as opposed to diagnostic) angiographic procedures. It is not surprising that the amount of tissue examined also increases the risk of finding such emboli. CONCLUSIONS: Unintentional foreign body emboli remain common in modern angiographic practice and are probably underappreciated clinically. Although such emboli are usually asymptomatic, they can be clinically devastating, and a high index of suspicion is required for diagnosis. Foreign body emboli should be included in the differential diagnosis of postangiographic ischemia or infarction.