Publications by authors named "Forestier G"
Article Synopsis
- Mechanical thrombectomy (MT) has significantly improved outcomes for acute ischemic stroke, but the challenge lies in ensuring widespread access and sufficient training for interventional neuroradiologists (INRs) across Europe.
- A survey conducted among European Society of Minimally Invasive Neurological Therapy (ESMINT) members collected responses from 240 INRs across 33 countries, revealing that many thrombectomy-capable stroke centers perform fewer than 150 MT procedures yearly and mostly use specific techniques for recanalization.
- The findings highlight a disparity in MT practices among centers and suggest a need for more staffing and training programs to meet the increasing demand for MT in Europe.
Article Synopsis
- * Data from 670 patients revealed that while IVT may improve some outcomes, such as higher chances of achieving a modified Rankin Scale score of 0-2 in univariable analysis, this benefit was not consistently observed in more rigorous multivariable analyses.
- * Overall, the findings suggest that adjunctive IVT may not significantly enhance clinical outcomes or safety compared to MT alone for this patient population.
Introduction: Recently, four randomized controlled trials (RCTs) have demonstrated the benefits of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) and a large ischemic core at baseline (LIC). The purpose of this study was to investigate the features influencing the clinical outcome and the benefits of mechanical thrombectomy in this subgroup.
Methods: We conducted a multicenter retrospective aggregate cohort study of patients with AIS-LVO and a LIC, assessed with quantitative core volume measures, treated with MT between 2012 and 2019.
Article Synopsis
- Mechanical thrombectomy is the standard treatment for large vessel occlusions, but there's limited evidence for its effectiveness in treating distal and medium vessel occlusions, particularly for patients with low stroke scale scores (≤6).
- A study analyzed data from 41 academic centers, comparing outcomes of low versus higher stroke scale score patients who underwent thrombectomy, revealing high successful reperfusion rates in both groups.
- Results showed that patients with lower stroke scale scores experienced better functional outcomes and lower mortality rates, but the treatment's effectiveness compared to intravenous thrombolysis (IVT) is still uncertain.
Background: Flow diverting stents (FDS) have transformed the treatment of intracranial aneurysms; however, their metallic structure associated with their intra-luminal positioning hamper angiographic and clinical outcomes. Therefore, there is a need to develop FDS with optimized surfaces that reduce thrombogenicity while promoting the healing process and endothelialization.
Methods: P8RI, a peptide mimicking the CD31 protein, was previously developed and grafted onto Silk Vista (SV) FDS.
Background: Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.
Methods: We conducted an international retrospective study of MeVO cases.
Background: Retrospective studies suggest the superiority of first-line contact aspiration (CA) thrombectomy over stent-retriever (SR) in basilar artery occlusions (BAO). We aimed to investigate the impact of first-line mechanical thrombectomy per the occlusion level, considering differences in stroke etiology prevalence between proximal and distal BAO.
Methods: A retrospective, multicentric analysis of the Endovascular Treatment in Ischemic Stroke Registry (ETIS) included consecutive BAO patients treated from January 2016 to May 2022.
Background: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO.
Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021.
Background And Purpose: The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions.
Materials And Methods: A portfolio of 60 cases was sent to clinicians with varying backgrounds and experience.
Background And Purpose: To evaluate the reliability and accuracy of nonaneurysmal perimesencephalic subarachnoid hemorrhage (NAPSAH) on Noncontrast Head CT (NCCT) between numerous raters.
Materials And Methods: 45 NCCT of adult patients with SAH who also had a catheter angiography (CA) were independently evaluated by 48 diverse raters; 45 raters performed a second assessment one month later. For each case, raters were asked: 1) whether they judged the bleeding pattern to be perimesencephalic; 2) whether there was blood anterior to brainstem; 3) complete filling of the anterior interhemispheric fissure (AIF); 4) extension to the lateral part of the sylvian fissure (LSF); 5) frank intraventricular hemorrhage; 6) whether in the hypothetical presence of a negative CT angiogram they would still recommend CA.
Article Synopsis
- The study aimed to evaluate the effectiveness and safety of the pRESET LITE stent retriever for treating medium vessel occlusions in acute ischemic stroke patients.
- A retrospective analysis included 227 patients from 37 institutions, distinguishing between proximal and distal occlusions, revealing successful reperfusion rates of 85% and 97%, respectively.
- Despite a 7% complication rate and a significant percentage of patients experiencing hemorrhagic transformations, the procedure showed a favorable outcome in 58% of cases after three months.
Article Synopsis
- The study aimed to determine if pre-existing cerebral small vessel disease (cSVD), including cerebral microbleeds (CMBs), is linked to symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke undergoing endovascular therapy (EVT).
- Researchers analyzed data from 445 patients who had pre-treatment MRIs, finding that CMBs were present in only 15.7%, but did not significantly correlate with the occurrence of sICH (p=0.805).
- The only factors showing a significant association with increased risk of sICH were the Alberta Stroke Program Early CT Score (ASPECTs) and the status of collateral circulation, suggesting that CMBs should not restrict patient eligibility
Article Synopsis
- The study investigates the first pass effect (FPE) in endovascular treatment (EVT) for medium vessel occlusion strokes, focusing on its predictors and impact on patient outcomes.
- The analysis included 836 patients, revealing that FPE occurred in 36.1% and was linked to better functional outcomes as well as lower rates of mortality and intracranial hemorrhage.
- FPE was significantly associated with favorable outcomes at 90 days, suggesting its importance in improving recovery and reducing complications in stroke patients.
Background: The Low profile visualized intraluminal support (LVIS)/LVIS Jr is a self-expanding braiding stent for the treatment of intracranial aneurysm. This study is to determine the safety and effectiveness of the LVIS/LVIS Jr for the treatment of intracranial aneurysms in a real-world setting.
Methods: This prospective, observational, multicenter study enrolled patients with unruptured, ruptured and recanalized intracranial aneurysms treated with the LVIS stents, between February 2018 to December 2019.
Background: Aneurysm location is a key element in predicting the rupture risk of an intracranial aneurysm. A common impression suggests that pure ophthalmic aneurysms are under-represented in ruptured intracranial aneurysms (RIAs). The purpose of this study was to specifically evaluate the risk of rupture of ophthalmic aneurysms compared with other aneurysm locations.
View Article and Find Full Text PDFBackground: Non-ischemic cerebral enhancing (NICE) lesions following aneurysm endovascular therapy are exceptionally rare, with unknown longitudinal evolution.
Objective: To evaluate the radiological behavior of individual NICE lesions over time.
Methods: Patients included in a retrospective national multicentric inception cohort were analyzed.
Article Synopsis
- The study compares the endothelial coverage of new coated and uncoated flow diverters (FDs) in rabbits, focusing on the effects of different antiplatelet therapies.
- Three types of FDs were implanted in rabbits, and their integration into the arterial wall was assessed after four weeks using various imaging and histopathological techniques.
- Results show that the integration of coated and uncoated FDs is similar, while the antiplatelet regimen influenced the rates of coverage, with no therapy showing the highest rate of neointimal formation.
Article Synopsis
- Recanalization of coiled aneurysms is a persistent issue, and the study tests fucoidan-coated coils to enhance healing after embolization compared to bare platinum and dextran-coated coils.
- The research involved a feasibility study on rabbits, where aneurysms were treated and assessed for healing through imaging and histological analysis one month post-embolization.
- Findings indicate the fucoidan group exhibited significantly improved collagen presence and healing at the aneurysm neck compared to the bare platinum group, suggesting it may be a promising approach for enhancing aneurysm healing in future applications.
Background: The occurrence of persistent intra-device filling (BOSS 1, using the Bicêtre Occlusion Scale Score (BOSS)) in aneurysms treated with a Woven Endobridge (WEB) device is infrequent based on angiographic follow-up. To date, three monocentric case series were published studying BOSS 1 cases. Through a multicenter retrospective study, we aimed to report the incidence, and risk factors of intra-WEB persistent filling.
View Article and Find Full Text PDFWEB shape modifications: angiography-histopathology correlations in rabbits.
J Neurointerv Surg
February 2024
Background: WEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in rabbits treated with the Woven EndoBridge (WEB) procedure.
Methods: Quantitative WSM was assessed using flat-panel computed tomography (FPCT) during follow-up by calculating height and width ratio (HR, WR), defined as the ratio between either measurement at an index time point and the measurement immediately after WEB implantation.
Background: Treatment of brain arteriovenous malformations (b-AVM) carries a risk of iatrogenic injury to eloquent brain regions. Intraoperative neuro-monitoring (IONM) has increasingly been used to monitor spontaneous or evoked neural activity during neurosurgery, but its use is not as well characterized in the endovascular treatment (EVT) of b-AVMs. We aimed to provide a systematic review and meta-analysis of studies reporting any neurological deficit after b-AVM embolization with IONM, with or without provocative test (PT), and no-IONM.
View Article and Find Full Text PDFBackground: Rescue intracranial stenting (RIS) can be used in refractory large vessel occlusion (LVO) after mechanical thrombectomy (MT). We aimed to assess the safety and efficacy of RIS versus a propensity matched sample of patients with persistent LVO.
Methods: We retrospectively analysed a multicenter retrospective pooled cohort of patients with anterior LVO (2015-2021) treated with MT, and identified patients with at least three passes and a modified Thrombolysis In Cerebral Infarction (mTICI) score of 0 to 2a.
Objectives: The aim of this study was to identify imaging protocols in patients with infective endocarditis through a nationwide survey.
Methods: An electronic evolutionary survey was sent to interventional Neuroradiologists among neuroradiological centers, under the aegis of the Société Française de Neuroradiologie. Among 33 contacted centers, 25 completed the survey (21 universitary hospitals and 4 peripheric hospitals).
Purpose: The purpose of this study was to assess the performance of a decision-tree for head-CT indication in elderly patients presenting minor traumatic injuries MATERIALS AND METHODS: A single-centre retrospective study was performed and analyses were based on emergency CT scans of all patients aged 65 and over who experienced minor head trauma due to falls. The primary judgement criteria was the diagnosis of a traumatic intracranial haemorrhagic lesion (tICH) depicted on the CT scan. Focal neurological deficit and history of tICH on a previous CT scan were used to create the decision-tree.
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