Publications by authors named "Velasco Stephane"
Background: The Woven EndoBridge (WEB) device is designed to treat wide-necked bifurcation aneurysms. The WEB 17 is the latest iteration and can be delivered through a 0.017″ microcatheter.
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.
Background: Intrasaccular flow disruption is an endovascular approach for the treatment of wide-neck aneurysms and, more specifically, wide-neck bifurcation aneurysms, which are challenging to treat with previously developed technologies. The Woven EndoBridge (WEB) device has demonstrated its efficacy and safety, for both unruptured and ruptured aneurysms.
Methods: The CLEVER study was an observational, multicenter, prospective study conducted in 17 European investigational sites using the WEB 17 device, for the treatment of ruptured and unruptured aneurysms.
Background: 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.
Background: There is no consensus regarding the influence of infarct laterality in patients with acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT), particularly in low-ASPECT (0-5) patients who were excluded from the initial MT studies and that participated in dedicated randomized-controlled trials that do not consider the side of the occlusion. We aimed to evaluate the role of infarct laterality on the clinical outcome in low-ASPECT AIS patients treated with MT.
Material And Methods: We retrospectively analyzed our institutional stroke database in our Thrombectomy-Capable Stroke Center (TCSC), including patient characteristics, procedural variables, and outcomes, between January 2015 and January 2022.
Background: The CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS) study has shown that the endovascular treatment of ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) is safe and effective and provides protection against rebleeding at 1 month and 1 year. The 12-month angiographic follow-up is an important endpoint of the study.
Methods: The CLARYS study is a prospective multicenter study conducted in 13 European centers.
Background: Palliative biliary drainage in patients with unresectable malignant biliary obstruction (MBO) frequently leads to biliary stent infection (BI), which could impact medical care. The aim of this study was to assess the risk factors for BI occurrence in patients after stenting procedure and the impact of BI on patient survival.
Methods: All consecutive patients hospitalized from 2014 to 2018 for MBO and biliary stenting were retrospectively included.
Background: In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access.
Methods: We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019.
Article Synopsis
- The ARETA study investigates the risk factors that lead to recanalization of intracranial aneurysms after endovascular treatments like coiling and balloon-assisted coiling.
- The study involved 1289 patients across multiple centers, revealing a recanalization rate of 29.5% at mid-term follow-up, with notable differences based on factors such as smoking status, aneurysm size, and whether the aneurysm was ruptured.
- Key findings showed that current smokers and larger aneurysms (≥10 mm) had higher recanalization rates, highlighting the importance of these risk factors in managing post-treatment aneurysm care.
Article Synopsis
- NICE lesions are rare complications that can happen after a procedure called aneurysm endovascular therapy (EVT) to treat bulging blood vessels in the brain.
- In a study of many patients, 31 people were found to have these lesions, most showing symptoms a month or so after the treatment.
- After follow-up, many patients either had no or very few lasting problems, but some still showed signs of the lesions on their brain scans even a long time later.
Background: The primary goal of the CLARYS study is to assess the protection against rebleeding when treating ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) device.
Methods: The CLARYS study is a prospective, multicenter study conducted in 13 European centers. Patients with ruptured bifurcation aneurysms were consecutively included between February 2016 and September 2017.
Article Synopsis
- Coiling, particularly balloon-assisted coiling (BAC), is a top strategy for treating both ruptured and unruptured aneurysms, with effectiveness gauged by rates of bleeding and the degree of aneurysm closure post-treatment.* -
- A study involving 1135 participants analyzed immediate post-coiling outcomes, finding 57.8% had complete occlusion, while 34.4% had a neck remnant, and 7.8% had an aneurysm remnant; smaller aneurysms and narrow necks were linked to better results.* -
- Overall, 92.2% achieved adequate occlusion immediately after coiling, with factors like being under 70 years old and having aneurys
Background: Coiling is the first-line treatment for the management of unruptured intracranial aneurysms (UIAs), but delayed thromboembolic events (TEEs) can occur after such treatment. ARETA (Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm) is a prospective multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed TEEs in the UIA subgroup.
View Article and Find Full Text PDFBackground: Endovascular treatment is the first line therapy for the management of ruptured and unruptured intracranial aneurysms, but delayed aneurysm rupture leading to bleeding/rebleeding can occur subsequently. ARETA (Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm) is a prospective, multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed bleeding and rebleeding in this large cohort.
View Article and Find Full Text PDFBackground Thromboembolic events and intraoperative rupture are the most frequent neurologic complications of intracranial aneurysm coiling. Their frequency has not been evaluated in recent series. Purpose To provide an analysis of complications, clinical outcome, and participant and aneurysm risk factors after aneurysm coiling or balloon-assisted coiling within the Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm, or ARETA, cohort.
View Article and Find Full Text PDFBackground: Woven EndoBridge (WEB; Sequent Medical) treatment is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown high safety with good efficacy at short term confirmed by trials conducted in United States (WEB-Intrasaccular Therapy) and in Europe (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy [WEBCAST], French Observatory, and WEBCAST-2).
Objective: To report the 2-yr clinical and anatomical results of WEB treatment in the combined population of 3 European trials.
Background: Treatment of intracranial aneurysms with flow diverter stent (FDS) procedures can lead to caliber changes of jailed vessels. The reason some branches remain unchanged and others are affected by narrowing remains unknown.
Objective: To investigate the influence of resistance to flow from distal vasculature on stent-induced hemodynamic modifications affecting bifurcating vessels.
Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results.
Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS.
Background And Purpose: Intracranial aneurysm recanalization after endovascular treatment (EVT) remains a major problem. The goal of this study was to find new predictive factors of recanalization after EVT of middle cerebral artery (MCA) bifurcation aneurysms.
Methods: 96 MCA bifurcationaneurysms, ruptured or unruptured, treated by EVT between Septembre 2009 and December 2014, were retrospectively included.
Background: Flow disruption with the WEB is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown a low complication rate with good efficacy.
Purpose: To report clinical and anatomical results of the WEB treatment in the cumulative population of three Good Clinical Practice (GCP) studies: WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm), French Observatory, and WEBCAST-2.
Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction.
View Article and Find Full Text PDFPancreatic adenocarcinoma has a very poor prognosis. Complete surgical resection remains the only current curative treatment. Locally advanced pancreatic cancers are considered as unresectable because of involvement of celiac and/or mesenteric vessels.
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