Publications by authors named "Gory B"
Background: Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments.
View Article and Find Full Text PDFBackground: Increased time from symptom onset to puncture (TSOP) and time from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 h). However, these associations are less described in the late window (>6 h), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.
View Article and Find Full Text PDFBackground: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.
Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe.
Background: Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.
Methods: We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries.
Article Synopsis
- Medium vessel occlusion (MeVO) strokes, especially in the M2 segment of the middle cerebral artery, are a significant challenge in stroke management, necessitating effective prediction of patient outcomes after mechanical thrombectomy (MT).
- This study analyzed data from the MAD-MT registry to evaluate the relationship between follow-up infarct volume (FIV) and 90-day functional outcomes, using the modified Rankin Scale (mRS) as a measurement.
- Results showed that FIV is a strong predictor of outcomes, with specific volume thresholds indicating favorable prognosis; notably, an FIV of ≤15 ml had the best predictive capability, outperforming traditional recanalization scores.
Article Synopsis
- The study investigates the effectiveness and safety of two treatment methods for acute ischemic stroke (AIS) caused by distal medium vessel occlusion (DMVO): intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) versus IVT alone.
- Data was collected from 37 centers worldwide, involving over 1,000 patients, with the primary focus on functional independence at 90 days and secondary outcomes including mortality and intracerebral hemorrhage.
- Findings suggest that both treatment options yield similar functional and mortality outcomes for DMVO patients, but the MT-IVT approach carries a higher risk of hemorrhagic complications, indicating that it may not provide significant advantages over IVT alone for every patient.
Background And Purpose: Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra-arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied.
View Article and Find Full Text PDFBackground: Periprocedural antiplatelet treatment is a key determinant for the risk-benefit balance of emergent carotid artery stenting (eCAS) during stroke endovascular treatment (EVT). We aimed to assess the safety and efficacy profile of cangrelor compared with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors or aspirin monotherapy.
Methods: Data were extracted from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective nationwide observational registry of stroke EVT in France.
Article Synopsis
- The study investigates how different anesthesia techniques (general anesthesia vs. non-general anesthesia) affect outcomes in mechanical thrombectomy for stroke, with a focus on the location of the blood clot.
- Researchers analyzed data from nearly 2800 patients, finding that general anesthesia did not lead to better overall outcomes but was linked to increased risk of complications in some cases.
- The results suggest that the type of anesthesia used during mechanical thrombectomy should be chosen based on the specific location of the occlusion to enhance safety and effectiveness.
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: It is unknown whether the influence of age on clinical outcomes post endovascular treatment (EVT) is similar in posterior circulation stroke (PCS) compared to anterior circulation stroke (ACS).
Methods: Data were extracted from the ETIS registry, a nationwide prospective, multicenter, observational registry for stroke EVT procedures in France. We included patients treated with EVT for PCS or ACS between January 2015 and August 2023.
Background: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized.
Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed.
Article Synopsis
- A study was conducted to compare the safety and effectiveness of endovascular treatment (EVT) versus best medical management (BMM) for patients with acute ischaemic stroke caused by distal medium vessel occlusion (DMVO).
- The analysis involved 2,125 patients, showing no significant difference in achieving functional independence at 90 days between EVT and BMM, despite EVT being associated with higher rates of hemorrhagic complications.
- The results suggest that EVT does not provide better functional outcomes than BMM in DMVO cases while increasing the risk of bleeding, indicating the need for cautious use of EVT and further research to improve treatment approaches.
Article Synopsis
- Acute ischemic stroke (AIS) from distal medium vessel occlusions (DMVOs) is common, and while IV thrombolysis is standard, mechanical thrombectomy (MT) is becoming more prevalent for treatment.
- A study reviewed data from 1708 DMVO patients treated with MT, finding that 8.7% experienced symptomatic intracerebral hemorrhage (sICH) and identified several risk factors, including older age, distal occlusion location, prior antiplatelet use, lower ASPECT scores, higher pre-op blood glucose, more passes during MT, and successful recanalization status.
- Understanding these risk factors can help healthcare providers better assess and manage the risk of sICH in patients undergoing MT for DM
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 And Objectives: IV tenecteplase is an alternative to alteplase before mechanical thrombectomy (MT) in patients with large-vessel occlusion (LVO) ischemic stroke. Little data are available on its use in patients with large ischemic core. We aimed to compare the efficacy and safety of both thrombolytics in this population.
View Article and Find Full Text PDFBackground: We evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC).
Methods: This retrospective study included consecutive stroke patients enrolled in the Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and June 2023. We compared the outcomes of carotid stenting vs no stenting in tandem lesion with pre-treatment LIC (Alberta Stroke Program Early CT Score (ASPECTS) 3-5) and stenting in tandem lesion vs thrombectomy alone for isolated intracranial occlusions with pre-treatment LIC.
Background: The effect of multiple attempts on the outcome of endovascular treatment (EVT) of anterior circulation large ischemic core (LIC) stroke has not been fully explored.
Methods: We analyzed data from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective, observational, multicenter study of acute ischemic stroke patients treated with EVT at 21 centers in France between January 1, 2015 and June 31, 2023. We included patients with proximal intracranial occlusion and LIC defined as Alberta Stroke Program Early CT Score (ASPECTS) of 0-5 up to 24 hours after last being seen well.
Background: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood.
Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023.
Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.
Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group).
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: A direct aspiration first pass technique (ADAPT) is an effective alternative to stent retriever thrombectomy for patients with large vessel occlusion (LVO). The PERFECT study evaluated direct aspiration with the EMBOVAC large bore aspiration catheter in patients with LVO strokes.
Methods: PERFECT was a prospective, post-market, single-arm, multicenter, observational study of patients enrolled across 11 European centers between October 2020 and July 2022.
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.
Stenting of the dural venous sinuses has emerged as a therapeutic option for intracranial hypertension and pulsatile tinnitus. However, venous endovascular navigation faces challenges due to lower-quality roadmaps compared to arterial navigation. This study explores the application of three-dimensional (3D) rotational venography in assessing the cerebral venous vasculature and its potential for venous navigation.
View Article and Find Full Text PDFBackground: 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.