Marie Christine Picot

Are preoperative patterns of alcohol consumption predictive of relapse after liver transplantation for alcoholic liver disease

Predictive factors for alcoholic relapse after liver transplantation (LT) performed for alcoholic liver disease (ALD) have been assessed in numerous studies, often with contradictory results. The aim of the study was to assess pretransplantation alcohol consumption characteristics on alcoholic relapse after LT. Patients transplanted for ALD for at least 6 months were included. An anonymous questionnaire assessed socio‐demographic characteristics, medical history, and alcohol consumption before and after LT. Relapse was defined as any alcohol use after LT. Severe relapse was defined by heavy drinking: more than 21 units/week for males and 14 units/week for females. A total of 61 patients were studied. The mean follow up after LT was 49 ± 34 months. Alcoholic relapse occurred in 32 of 61 patients (52%) and severe relapse in eight of 61 patients (13%). Risk factors for severe relapse were: length of abstinence before LT (P = 0.0001), more than one alcohol withdrawal before LT (P = 0.001), alcohol dependence (P = 0.05), alcohol abuse in first relatives (P = 0.05), and younger age (P = 0.05). Information on previous alcohol consumption (dependence, number of withdrawals, family history) helps to predict severe relapse after LT in patients with ALD, allowing early awareness and specific postoperative care.

Diffusion-weighted imaging score of the brain stem: A predictor of outcome in acute basilar artery occlusion treated with the Solitaire FR device.

BACKGROUND AND PURPOSE: The prognosis for ischemic stroke due to acute basilar artery occlusion is very poor: Early recanalization remains the main factor that can improve outcomes. The baseline extent of brain stem ischemic damage can also influence outcomes. We evaluated the validity of an easy-to-use DWI score to predict clinical outcome in patients with acute basilar artery occlusion treated by mechanical thrombectomy. MATERIALS AND METHODS: We analyzed the baseline clinical and DWI parameters of 31 patients with acute basilar artery occlusion, treated within 24 hours of symptom onset by using a Solitaire FR device. The DWI score of the brain stem was assessed with a 12-point semiquantitative score that separately considered each side of the medulla, pons, and midbrain. Clinical outcome was assessed at 180 days by using the mRS. According to receiver operating characteristic analyses, the cutoff score determined the optimal positive predictive value for outcome. The Spearman rank correlation coefficient assessed the correlation between the DWI brain stem score and baseline characteristics. RESULTS: Successful recanalization (Thrombolysis in Cerebral Infarction 3–2b) was achieved in 23 patients (74%). A favorable outcome (mRS ≤ 2) was observed in 11 patients (35%). An optimal DWI brain stem score of <3 predicted a favorable outcome. The probability of a very poor outcome (mRS ≥ 5) if the DWI brain stem score was ≥5 reached 80% (positive predictive value) and 100% if this score was ≥6. Interobserver reliability of the DWI brain stem score was excellent, with an intraclass correlation coefficient of 0.97 (95% CI, 0.96–0.99). The DWI brain stem score was significantly associated with baseline tetraplegia (P = .001) and coma (P = .005). CONCLUSIONS: In patients with acute basilar artery occlusion treated by mechanical thrombectomy, the baseline DWI brain lesion score seems to predict clinical outcome.

Traitement endovasculaire des anévrysmes rompus À la phase aiguë : Résultat d'une étude prospective monocentrique. Pronostic à court terme

PURPOSE We prospectively reviewed the clinical results of acutely ruptured cerebral aneurysms treated with GDC over a 5 year period, in order to characterize death and dependency factors. METHODS Between 1997 and 2002, 229 patients (254 aneurysms treated, 140 females, 89 males; mean age: 51 years) with aneurysmal subarachnoid hemorrhage were treated with GDC (Boston Scientific Neurovascular, Fremont, CA) once the anatomical conditions of feasibility had been achieved. Over 90% of the aneurysms treated (mean size: 5,8 mm) were located in the anterior circulation. The anterior communicating artery complex (87 cases), the posterior aspect of the internal carotid artery (65 cases), and the middle cerebral artery (49 cases) were most commonly treated. RESULTS At the end of the initial hospitalization period, 14 patients (6.1%) died. Major procedural complications were associated with perforation of the aneurysmal sac in 9 patients (3.9%), thromboembolic events in 10 patients (4.3%) which resulted in 2 deaths (0.8%) and permanent neurologic morbidity in 7 patients (3%). The univariate analysis demonstrated no correlation between death and time-to-treatment, the topography of the aneurysm, or the occurrence of treatment related complications. The results of the logistical regression model demonstrated that the clinical score upon entry, and the occurrence of delayed ischemia were the only independent factors correlated with patient death. The prognostic factors affecting the degree of sequellae identified by the logistical regression model were the clinical score upon admission, age, treatment related complications, and pulmonary complications. CONCLUSIONS Endovascular treatment of ruptured anterior circulation aneurysms with GDC, including MCA aneurysms, is associated with low morbidity and allows good overall outcomes in patients with subarachnoid hemorrhage. A better understanding of dependency factors associated with endovascular coiling will foster further technical advances in order to improve the treatment of small and medium sized ruptured aneurysms.Resume Objectif Revoir les resultats du traitement endovasculaire et le pronostic a court terme d’anevrysmes rompus traites a la phase aigue. Methode Entre 1997 et 2002, 229 patients (254 anevrysmes traites, 140 femmes, 89 hommes, âge moyen : 51 ans), presentant une hemorragie sous-arachnoidienne, ont ete traites par coils GDC® (Bost®n Scientific Neurovascular, Fremont, CA) des lors que les conditions anatomiques d’operabilite etaient reunies. Plus de 90 % des anevrysmes traites (taille moyenne : 5,8 mm) etaient localises au niveau de la circulation anterieure. Les anevrysmes de l’artere communicante anterieure (87 cas) de la face posterieure de l’artere carotide interne (65 cas) et l’artere cerebrale moyenne (49 cas) sont les localisations les plus frequentes. Resultats A la fin de la periode initiale d’hospitalisation, 14 patients (6,1 %) sont decedes. Les complications liees au traitement sont associees soit a une perforation du sac anevrysmal pour 9 patients (3,9 %), un accident thromboembolique pour 10 patients (4,3 %) responsable de deux deces (0,8 %) et de sequelles neurologiques permanentes pour 7 patients (3 %). L’analyse univariee ne montre pas de relation entre le deces et le delai du traitement, le siege de l’anevrysme ou la survenue de complications liees au geste. Les resultats du modele de regression logistique montrent que le score clinique a l’entree et la survenue d’un vasospasme sont les deux seuls facteurs predictifs independants du deces du malade. Les facteurs pronostiques predictifs du degre de sequelle, identifies par le modele de regression logistique, sont le score clinique a l’entree, l’âge, les complications liees au traitement et les complications pulmonaires. Conclusions Le traitement endovasculaire des anevrysmes rompus de la circulation anterieure, incluant les anevrysmes de l’artere cerebrale moyenne, par GDC est associe a une morbidite et une mortalite faible. Cependant, l’impact des complications techniques sur le niveau de sequelles montre que des ameliorations techniques doivent etre recherchees pour le traitement des anevrysmes rompus de petite taille et de taille moyenne.

Traitement endovasculaire des anévrysmes rompus à la phase aiguë

PURPOSE We prospectively reviewed the clinical results of acutely ruptured cerebral aneurysms treated with GDC over a 5 year period, in order to characterize death and dependency factors. METHODS Between 1997 and 2002, 229 patients (254 aneurysms treated, 140 females, 89 males; mean age: 51 years) with aneurysmal subarachnoid hemorrhage were treated with GDC (Boston Scientific Neurovascular, Fremont, CA) once the anatomical conditions of feasibility had been achieved. Over 90% of the aneurysms treated (mean size: 5,8 mm) were located in the anterior circulation. The anterior communicating artery complex (87 cases), the posterior aspect of the internal carotid artery (65 cases), and the middle cerebral artery (49 cases) were most commonly treated. RESULTS At the end of the initial hospitalization period, 14 patients (6.1%) died. Major procedural complications were associated with perforation of the aneurysmal sac in 9 patients (3.9%), thromboembolic events in 10 patients (4.3%) which resulted in 2 deaths (0.8%) and permanent neurologic morbidity in 7 patients (3%). The univariate analysis demonstrated no correlation between death and time-to-treatment, the topography of the aneurysm, or the occurrence of treatment related complications. The results of the logistical regression model demonstrated that the clinical score upon entry, and the occurrence of delayed ischemia were the only independent factors correlated with patient death. The prognostic factors affecting the degree of sequellae identified by the logistical regression model were the clinical score upon admission, age, treatment related complications, and pulmonary complications. CONCLUSIONS Endovascular treatment of ruptured anterior circulation aneurysms with GDC, including MCA aneurysms, is associated with low morbidity and allows good overall outcomes in patients with subarachnoid hemorrhage. A better understanding of dependency factors associated with endovascular coiling will foster further technical advances in order to improve the treatment of small and medium sized ruptured aneurysms.Resume Objectif Revoir les resultats du traitement endovasculaire et le pronostic a court terme d’anevrysmes rompus traites a la phase aigue. Methode Entre 1997 et 2002, 229 patients (254 anevrysmes traites, 140 femmes, 89 hommes, âge moyen : 51 ans), presentant une hemorragie sous-arachnoidienne, ont ete traites par coils GDC® (Bost®n Scientific Neurovascular, Fremont, CA) des lors que les conditions anatomiques d’operabilite etaient reunies. Plus de 90 % des anevrysmes traites (taille moyenne : 5,8 mm) etaient localises au niveau de la circulation anterieure. Les anevrysmes de l’artere communicante anterieure (87 cas) de la face posterieure de l’artere carotide interne (65 cas) et l’artere cerebrale moyenne (49 cas) sont les localisations les plus frequentes. Resultats A la fin de la periode initiale d’hospitalisation, 14 patients (6,1 %) sont decedes. Les complications liees au traitement sont associees soit a une perforation du sac anevrysmal pour 9 patients (3,9 %), un accident thromboembolique pour 10 patients (4,3 %) responsable de deux deces (0,8 %) et de sequelles neurologiques permanentes pour 7 patients (3 %). L’analyse univariee ne montre pas de relation entre le deces et le delai du traitement, le siege de l’anevrysme ou la survenue de complications liees au geste. Les resultats du modele de regression logistique montrent que le score clinique a l’entree et la survenue d’un vasospasme sont les deux seuls facteurs predictifs independants du deces du malade. Les facteurs pronostiques predictifs du degre de sequelle, identifies par le modele de regression logistique, sont le score clinique a l’entree, l’âge, les complications liees au traitement et les complications pulmonaires. Conclusions Le traitement endovasculaire des anevrysmes rompus de la circulation anterieure, incluant les anevrysmes de l’artere cerebrale moyenne, par GDC est associe a une morbidite et une mortalite faible. Cependant, l’impact des complications techniques sur le niveau de sequelles montre que des ameliorations techniques doivent etre recherchees pour le traitement des anevrysmes rompus de petite taille et de taille moyenne.

Article originalTraitement endovasculaire des anévrysmes rompus à la phase aiguë: Résultat d’une étude prospective monocentrique. Pronostic à court termeAcutely ruptured intracranial aneurysms treated with GDC coils. Results from a single center over a period of 5 years

PURPOSE We prospectively reviewed the clinical results of acutely ruptured cerebral aneurysms treated with GDC over a 5 year period, in order to characterize death and dependency factors. METHODS Between 1997 and 2002, 229 patients (254 aneurysms treated, 140 females, 89 males; mean age: 51 years) with aneurysmal subarachnoid hemorrhage were treated with GDC (Boston Scientific Neurovascular, Fremont, CA) once the anatomical conditions of feasibility had been achieved. Over 90% of the aneurysms treated (mean size: 5,8 mm) were located in the anterior circulation. The anterior communicating artery complex (87 cases), the posterior aspect of the internal carotid artery (65 cases), and the middle cerebral artery (49 cases) were most commonly treated. RESULTS At the end of the initial hospitalization period, 14 patients (6.1%) died. Major procedural complications were associated with perforation of the aneurysmal sac in 9 patients (3.9%), thromboembolic events in 10 patients (4.3%) which resulted in 2 deaths (0.8%) and permanent neurologic morbidity in 7 patients (3%). The univariate analysis demonstrated no correlation between death and time-to-treatment, the topography of the aneurysm, or the occurrence of treatment related complications. The results of the logistical regression model demonstrated that the clinical score upon entry, and the occurrence of delayed ischemia were the only independent factors correlated with patient death. The prognostic factors affecting the degree of sequellae identified by the logistical regression model were the clinical score upon admission, age, treatment related complications, and pulmonary complications. CONCLUSIONS Endovascular treatment of ruptured anterior circulation aneurysms with GDC, including MCA aneurysms, is associated with low morbidity and allows good overall outcomes in patients with subarachnoid hemorrhage. A better understanding of dependency factors associated with endovascular coiling will foster further technical advances in order to improve the treatment of small and medium sized ruptured aneurysms.Resume Objectif Revoir les resultats du traitement endovasculaire et le pronostic a court terme d’anevrysmes rompus traites a la phase aigue. Methode Entre 1997 et 2002, 229 patients (254 anevrysmes traites, 140 femmes, 89 hommes, âge moyen : 51 ans), presentant une hemorragie sous-arachnoidienne, ont ete traites par coils GDC® (Bost®n Scientific Neurovascular, Fremont, CA) des lors que les conditions anatomiques d’operabilite etaient reunies. Plus de 90 % des anevrysmes traites (taille moyenne : 5,8 mm) etaient localises au niveau de la circulation anterieure. Les anevrysmes de l’artere communicante anterieure (87 cas) de la face posterieure de l’artere carotide interne (65 cas) et l’artere cerebrale moyenne (49 cas) sont les localisations les plus frequentes. Resultats A la fin de la periode initiale d’hospitalisation, 14 patients (6,1 %) sont decedes. Les complications liees au traitement sont associees soit a une perforation du sac anevrysmal pour 9 patients (3,9 %), un accident thromboembolique pour 10 patients (4,3 %) responsable de deux deces (0,8 %) et de sequelles neurologiques permanentes pour 7 patients (3 %). L’analyse univariee ne montre pas de relation entre le deces et le delai du traitement, le siege de l’anevrysme ou la survenue de complications liees au geste. Les resultats du modele de regression logistique montrent que le score clinique a l’entree et la survenue d’un vasospasme sont les deux seuls facteurs predictifs independants du deces du malade. Les facteurs pronostiques predictifs du degre de sequelle, identifies par le modele de regression logistique, sont le score clinique a l’entree, l’âge, les complications liees au traitement et les complications pulmonaires. Conclusions Le traitement endovasculaire des anevrysmes rompus de la circulation anterieure, incluant les anevrysmes de l’artere cerebrale moyenne, par GDC est associe a une morbidite et une mortalite faible. Cependant, l’impact des complications techniques sur le niveau de sequelles montre que des ameliorations techniques doivent etre recherchees pour le traitement des anevrysmes rompus de petite taille et de taille moyenne.