Publications by authors named "Christian Denier"
Article Synopsis
- Thrombolysis and endovascular thrombectomy (EVT) are standard stroke treatments, and this study investigates their effectiveness specifically in nonagenarians (patients aged 90 and older), hypothesizing that their prognosis may be worse than that of younger patients.
- The study analyzed outcomes of 96 nonagenarians treated with these therapies, finding that they had more pre-existing health conditions and lower independence before the stroke compared to patients aged 80-89.
- Results indicated that while treatment timelines and successful reperfusion rates were similar, nonagenarians had significantly poorer functional recovery at 3 months (14.3% vs. 34.0%) and a much higher mortality rate (60.2% compared to 16
Article Synopsis
- The study examined cerebral venous thrombosis (CVT) characteristics in elderly patients (65 years and older) across nine hospitals in the Paris-Ile-de-France region from 2011 to 2021.
- Researchers found that the annual incidence of CVT in this demographic was lower compared to the national average, with headaches and focal deficits being the most common initial symptoms.
- The results indicated that elderly patients had a distinct clinical profile, with higher rates of underlying conditions like cancer and a worse prognosis than younger adults, highlighting the need for specialized care in this age group.
Background: Timely revascularization in acute arterial ischemic stroke (AIS) is paramount for optimal outcomes. However, factors causing treatment delays in pediatric AIS remain understudied. We investigated determinants affecting the time from symptom onset or last-known-well to the start of recanalization treatment in pediatric AIS.
View Article and Find Full Text PDFBackground: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.
Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group).
Article Synopsis
- - The study investigates the use of rescue intracranial stenting (RIS) combined with best medical treatment (BMT) versus BMT alone for patients experiencing acute ischemic strokes (AIS) due to large vessel occlusions that do not respond to mechanical thrombectomy (MT).
- - Conducted across 11 French University hospitals, the PISTAR trial involves randomizing 346 adult patients to evaluate the effectiveness of RIS in improving functional outcomes at 3 months and monitoring for complications and adverse events.
- - The primary outcome is measured by the modified Rankin Scale, aiming to determine if RIS improves patient outcomes compared to BMT alone; this is the first randomized trial specifically targeting this issue in acute stroke management.
Objective: The stroke risk for persons living with human immunodeficiency virus (PLHIVs) doubled compared to uninfected individuals. Stroke-unit (SU)-access, acute reperfusion therapy-use and outcome data on PLHIVs admitted for acute ischemic stroke (AIS) are scarce.
Methods: AIS patients admitted (01 January 2017 to 31 January 2021) to 10 representative Paris-area SUs were screened retrospectively from the National Hospitalization Database.
Rationale: Mechanical thrombectomy (MT) associated with the best medical treatment (BMT) has recently shown efficacy for the management of acute ischemic stroke (AIS) secondary to a large vessel occlusion. However, evidence is lacking regarding the benefit of MT for more distal occlusions.
Aim: To evaluate the efficacy in terms of good clinical outcome at 3 months of MT associated with the BMT over the BMT alone in AIS related to a distal occlusion.
Background: Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented.
Aims: In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units.
Background: The Alberta Stroke Program Early CT scan Score (ASPECTS) is a reliable imaging biomarker of infarct extent on admission but the value of 24-hour ASPECTS evolution in day-to-day practice is not well studied, especially after successful reperfusion. We aimed to assess the association between ASPECTS evolution after successful reperfusion with functional and safety outcomes, as well as to identify the predictors of ASPECTS evolution.
Methods: We used data from an ongoing prospective multicenter registry.
Background: Hemorrhagic transformation (HT) is an uncommon complication of posterior circulation acute ischemic stroke (PCS) compared to anterior circulation stroke. Nevertheless, it remains a major concern especially following reperfusion therapy. This study aimed at identifying potential predictive factors associated with HT in PCS.
View Article and Find Full Text PDFAutosomal recessive systemic microangiopathy associated with Fanconi anaemia.
J Neurol Neurosurg Psychiatry
December 2023
Background: Behçet's disease (BD) is a rare form of vasculitis involving both veins and arteries of all calibers. Psychological symptoms and cognitive impairment appear to be frequent, but few data are available.
Methods: All consecutive patients in our center fulfilling the 2013 BD criteria underwent a psychometric evaluation with auto- (SCL-90-R and Modified Fatigue Index) and hetero-questionnaires (MINI).
Background: Management of extracranial internal carotid artery steno-occlusive lesion during endovascular therapy remains debated. Stent occlusion within 24 hours of endovascular therapy is a frequent event after acute carotid artery stenting, and we currently lack large population results. We investigated the incidence, predictors, and clinical impact of stent occlusion after acute carotid artery stenting in current clinical practice.
View Article and Find Full Text PDFArticle Synopsis
- Intravenous thrombolysis (IVT) combined with mechanical thrombectomy (MT) for patients with M2 occlusions shows a significantly better 90-day functional outcome compared to MT alone, according to a study analyzing data from the Endovascular Treatment in Ischemic Stroke (ETIS) registry.
- The analysis included 1,132 patients, with 570 receiving prior IVT, and found that combining IVT with MT resulted in a 59.8% favorable outcome versus 44.7% for MT alone, without increasing complications.
- These findings suggest that administering IVT prior to MT in M2 occlusions could enhance patient recovery, highlighting the potential benefits of this combined treatment approach.
Importance: There is to date limited evidence that revascularization strategies are associated with improved functional outcome in children with acute ischemic stroke (AIS).
Objectives: To report clinical outcomes and provide estimates of revascularization strategy safety and efficacy profiles of intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) in children with AIS.
Design, Setting, And Participants: The KidClot multicenter nationwide cohort study retrospectively collected data of children (neonates excluded) with AIS and recanalization treatment between January 1, 2015, and May 31, 2018.
Background And Purpose: Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure.
View Article and Find Full Text PDFBackground: The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes.
View Article and Find Full Text PDFArticle Synopsis
- Endovascular treatment (EVT) for blocked arteries in the brain (basilar artery occlusions) doesn't always lead to good results, even if doctors successfully restore blood flow.
- A study looked at data from stroke patients in France and found that many patients didn’t have a good recovery after treatment, even when their blood flow was restored.
- Factors like age, stroke severity, and the type of successful blood flow restoration were important in predicting how well patients would do after treatment.
Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke.
Clin Neuroradiol
December 2022
Purpose: To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice.
Methods: We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr.
Background: The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown.
View Article and Find Full Text PDFBackground: It is unknown whether collateral status modifies the effect of pretreatment intravenous thrombolysis (IVT) on the outcomes of patients with large vessel occlusions treated with endovascular therapy (EVT). We aimed to assess whether collateral status modifies the effect of IVT on the outcomes of EVT in clinical practice.
Methods: We used data from the ongoing prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France.
Five trials published in 2015 showed the benefit of endovascular thrombectomy (ET) in patients with stroke and large vessel occlusion, extending the treatment window has become an obsession of all physicians. In 2018, the DAWN and DEFUSE-3 trials showed that, with careful selection of patients, the procedure could be carried out up to 24 hours after symptom onset with good outcomes. In addition, there have been cases where the DAWN criteria were met, and treatment occurred >24 hours after symptom onset.
View Article and Find Full Text PDFBackground And Purpose: Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice.
Methods: We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France.