B. Bartolini - Academia.edu (original) (raw)

Papers by B. Bartolini

Research paper thumbnail of P-008 on intent to treat adapt technique for 201 cases of anterior circulation acute ischemic stroke

Journal of NeuroInterventional Surgery, 2015

Conclusions In our cohort, baseline CT ASPECTS inversely correlated with admission NLR in anterio... more Conclusions In our cohort, baseline CT ASPECTS inversely correlated with admission NLR in anterior circulation AIS patients who had favorable perfusion imaging profile for IA reperfusion therapy. Additionally, in this subgroup of patients, NLR of 5 or less discriminated favorable from unfavorable ASPECTS.

Research paper thumbnail of Sonoelastography may help in the differential diagnosis between rheumatoid nodules and tophi

Clinical and experimental rheumatology

ABSTRACT

Research paper thumbnail of Angiographic factors influencing the success of endovascular treatment of arteriovenous malformations involving the corpus callosum

Journal of NeuroInterventional Surgery, 2014

Arteriovenous malformations (AVMs) of the corpus callosum are rare lesions, accounting for 9-11% ... more Arteriovenous malformations (AVMs) of the corpus callosum are rare lesions, accounting for 9-11% of brain AVMs. Microsurgical resection of such lesions is difficult because of their deep location, and also because of possible neuropsychological disasters resulting from extended callosal resection. The introduction of endovascular and radiation therapies has fundamentally changed the outcome of these lesions. We prospectively collected clinical and angiographic data on cerebral AVMs from 1995. We reviewed data from patients treated for an AVM of the corpus callosum and identified the factors influencing the endovascular approach of such lesions. 38 patients (mean age 31 years) were consecutively treated by endovascular techniques. 78.9% (30 cases) of patients presented with intracranial hemorrhage. 15 AVMs (39.5%) were anterior, 18 (47.4%) were posterior, and five (13.1%) were holocallosal. The Spetzler-Martin grade was I in two cases (5.2%), II in 20 cases (52.6%), III in nine cases (23.7%), IV in six cases (15.8%), and V in one case (2.6%). The nidus was compact in 19 cases (50%), diffuse in 13 (34.2%), and multifocal in six (15.8%). Both anterior and posterior circulation branches fed 14 nidi (36.8%). Venous drainage was superficial in three cases (7.9%), deep in 28 (73.7%), and both in seven cases (18.4%). 104 sessions were performed, with a procedural complication rate of 6.7%. Mean follow-up was 43.6 months, with the last modified Rankin Scale score <3 in 33 cases (86.8%). 22 patients (57.9%) were totally cured. Univariate analysis of factors influencing the success of endovascular treatment showed that Spetzler-Martin grade ≥3 (p=0.046), nidus >30 mm (p=0.02), extension in an eloquent area (p=0.03), and holocallosal type (p0.005) significantly diminished the chances of cure of the AVM. AVMs of the corpus callosum seems to be difficult to treat with endovascular therapy alone. The goal of embolization should be prevention of (re) bleeding and a decrease in nidus size. Our experience regarding this sub-pathology suggests that a combination of endovascular therapy and radiotherapy may be the best option.

Research paper thumbnail of E-054 Angiographic Factors Influencing the Success of Endovascular Treatment of Arteriovenous Malformations involving the Corpus Callosum

Journal of NeuroInterventional Surgery, 2014

intra-operative aneurysm ruptures (5.6%), 2 of previously-ruptured aneurysms (16.7%) and 1 of an ... more intra-operative aneurysm ruptures (5.6%), 2 of previously-ruptured aneurysms (16.7%) and 1 of an unruptured aneurysm (2.4%), hemostasis was achieved by immediate balloon inflation in all cases and no patient developed a new neurological deficit. There was 1 distal branch vessel rupture during balloon inflation performed to reduce an intra-aneurysmal catheter loop for a wire exchange prior to stenting, resulting in the patient's death (2.2%). There was 1 ipsilateral intracerebral haemorrhage on post-operative day 2 in a hypertensive patient with a clopidogrel hyper-response leading to permanent contralateral hemiparesis (2.2%). Overall, 2 complications led to either a new permanent disabling neurological deficit or the patient's death (mRS ≥ 3, 4.4%). Conclusion The Sceptre XC balloon is a valuable adjunctive device for the endovascular treatment of cerebral aneurysms, allowing high treatment success rates and packing densities, achievement of immediate hemostasis in the event of an intraoperative aneurysm rupture, and reduction in the overall need of stent-assistance for cerebral aneurysm treatment. Disclosures J.

Research paper thumbnail of 416 Magnetic Resonance Imaging as a Structural Refinement to the American College of Rheumathology Clinical Classification Criteria for Knee Osteoarthritis

Osteoarthritis and Cartilage, 2008

cartilage injury, which were also observed in dGEMRIC as low GAG concentration areas. In one case... more cartilage injury, which were also observed in dGEMRIC as low GAG concentration areas. In one case with grade III cartilage injury, drilling was performed as a mesenchymal stimulating method to form fibrocartilage. Conclusions: This study suggested that dGEMRIC had the potential to detect the cartilage lesions of the ankle even in an early stage. For the clinical application of cartilage repair techniques, our evaluation method using MR imaging may be useful for observing the maturation process and long-term durability of reparative cartilage non-invasively.

Research paper thumbnail of P-011 initial experience with the lazarus cover device to prevent embolization in new territories during mechanical thombectomy

Journal of NeuroInterventional Surgery, 2015

Research paper thumbnail of E-018 Treatment of Ruptured Blood-blister-like Aneurysms in the Subacute Phase: Clinical and Angiographic Outcome

Journal of NeuroInterventional Surgery, 2016

Results HRMRI provides a detailed benchmark for validation of lumen geometry (Figure 1A, top). Qu... more Results HRMRI provides a detailed benchmark for validation of lumen geometry (Figure 1A, top). Quantitative evaluation of the lumen diameter in the vicinity of the stenosis using imaging data acquired from 7 different centers is presented as weighted mean and standard deviation (Figure 1A, bottom). It was observed that along the centerline of the lumen, the radius ranged from 0.8-1.6 mm and was highly reproducible across all imaging platforms. The highest CNRs were observed for comparisons between lipid and vessel wall (Figure 1B). CNR mean variation between the two phantom models for each comparison between plaque components was 3.68-6.09, demonstrating excellent reliability in manufacturing technique. Conclusion A plaque phantom composed of a stenotic vessel wall and plaque components, including fibrous cap and a lipid core, was successfully constructed for multi-center HRMRI standardization.

Research paper thumbnail of Caution; Confusion Ahead…

American Journal of Neuroradiology, 2017

Research paper thumbnail of A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study

American Journal of Neuroradiology, 2016

BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers is now the standard therapy... more BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers is now the standard therapy for selected patients with ischemic stroke. The technique of A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) appears promising with a high rate of recanalization. We compared ADAPT versus stent retrievers (the Solitaire device) for efficacy and safety as a front-line endovascular procedure. MATERIALS AND METHODS: We analyzed 243 consecutive patients with large intracranial artery occlusions of the anterior circulation, treated within 6 hours with mechanical thrombectomy by either ADAPT or the Solitaire stent. Th primary outcome was complete recanalization (modified TICI Ն 2b); secondary outcomes included complication rates and procedural and clinical outcomes. RESULTS: From November 2012 to June 2014, 119 patients were treated with stent retriever (Solitaire FR) and 124 by using the ADAPT with Penumbra reperfusion catheters. The median baseline NIHSS score was the same for both groups (Solitaire, 17 [interquartile range, 11-21] versus ADAPT, 17 [interquartile range, 12-21]). Time from groin puncture to recanalization (Solitaire, 50 minutes [range, 25-80 minutes] versus ADAPT, 45 minutes [range, 27-70 minutes], P ϭ .42) did not differ significantly. However, compared with the Solitaire group, patients treated with ADAPT achieved higher final recanalization rates (82.3% versus 68.9%; adjusted relative risk, 1.18; 95% CI, 1.02-1.37; P ϭ .022), though differences in clinical outcomes between the cohorts were not significant. Use of an adjunctive device was more frequent in the ADAPT group (45.2% versus 13.5%, P Ͻ .0001). The rate of embolization in new territories or symptomatic hemorrhage did not differ significantly between the 2 groups. CONCLUSIONS: Front-line ADAPT achieved higher recanalization rates than the Solitaire device. Further randomized controlled trials are warranted to define the best strategy for mechanical thrombectomy.

Research paper thumbnail of Endovascular treatment of posterior fossa arteriovenous malformations

Journal of Clinical Neuroscience, 2016

Infratentorial arteriovenous malformations (AVM) are rare, representing only 7-15% of cerebral AV... more Infratentorial arteriovenous malformations (AVM) are rare, representing only 7-15% of cerebral AVM. The concentration of eloquent neurological structures and the high rate of bleeding presentation of AVM in this location complicate the management of such lesions. New therapeutic options, especially in endovascular therapy, have fundamentally modified the treatment strategy and also the outcome of posterior fossa AVM. Between 1999 and 2013, baseline, clinical and angiographic data of cerebral AVM were prospectively collected. We analyzed data from patients treated for a posterior fossa AVM, focusing on risk factors for bleeding, and clinical and angiographic outcomes. Sixty-nine patients (mean age 34 years, male to female ratio 2:1) were consecutively treated for an infratentorial AVM. Fifty-seven presented with hemorrhage, six with focal neurologic deficits, and the remaining six patients were diagnosed incidentally. The Spetzler-Martin grade was <3 in 39 (56.5%) patients. Associated aneurysms were noted in 43.5% of patients. All patients were treated using endovascular procedures, associated with microsurgical resection in nine patients and with stereotactic radiosurgery in six. Mean follow-up was 28.5 months, with angiographic exclusion of the AVM in 72.5% of patients; 21.7% of patients presented a modified Rankin Score P3 at follow-up. Endovascular embolization seems to be a secure approach for posterior fossa AVM although a large number of sessions are necessary to achieve complete obliteration. Multidisciplinary discussion and management is crucial to obtain the best cure rate without increasing procedural risks.

Research paper thumbnail of Thrombectomie mécanique avec le dispositif « ERIC »™ : expérience multicentrique française sur 25 cas

Journal of Neuroradiology, 2014

lyse intraveineuse. Les facteurs prédictifs d'échec de recanalisation et de complication emboliqu... more lyse intraveineuse. Les facteurs prédictifs d'échec de recanalisation et de complication embolique ou hémorragique étaient analysés. Résultats.-L'âge médian était de 69,5 ans et le score médian NIHSS était de 18 à l'examen initial. Cinquante patients (34,7 %) ont bénéficié du seul traitement par stent-retriever, 94 (65,3 %) ont eu un traitement combiné. Le taux d'échec de recanalisation était de 13,9 %. Les complications emboliques étaient rapportées dans 12,5 % des cas et les complications hémorragiques symptomatiques dans 7,6 %. Le taux global d'échec, de complication et/ou de décès était 39,6 %. Le taux de mortalité périopératoire était 18,4 %, majoré en cas d'échec (45 %, p = 0,003), de complication embolique (38,9 %, p = 0,0176), ou hémorragique symptomatique (45,5 %, p = 0,0236) et en cas de sténose intracrânienne (50 %, p = 0,0176). Le taux d'échec de recanalisation, les taux de complication embolique ou hémorragique n'étaient pas influencés par le traitement fibrinolytique. L'âge élevé était le seul facteur prédictif de complication hémorragique (p = 0,043). Conclusion.-Le taux de mortalité périopératoire était augmenté de manière significative en cas de complication embolique et hémorragique ainsi qu'en cas d'échec de recanalisation ou de sténose intracrânienne. L'ajout d'un traitement fibrinolytique n'améliorait pas le taux de recanalisation ni le taux de complication embolique. Le taux de complication hémorragique symptomatique n'était pas plus élevé en cas de traitement combiné.

Research paper thumbnail of « Y » stenting des anévrismes intracrâniens de forme complexe localises sur la bifurcation de l’artère sylvienne : résultats angiographiques et cliniques

Journal of Neuroradiology, 2012

Research paper thumbnail of Traitement mécanique endovasculaire à la phase aiguë des infarctus cérébraux : résultats de trois ans d’expérience d’un centre de neuroradiologie interventionnelle

Journal of Neuroradiology, 2012

Congrès SFNR 2012 lorsque la procédure est effectuée en présence d'un caillot endoluminal préalab... more Congrès SFNR 2012 lorsque la procédure est effectuée en présence d'un caillot endoluminal préalablement injecté (p = 0,04). Conclusion.-Les dispositifs de revascularisation mécanique provoquent certaines lésions de la paroi artérielle dans cette étude à la phase aiguë. Le niveau d'agression pariétale est différent selon le design et le mode d'action du système de revascularisation.

Research paper thumbnail of P-031 Single Center Experience with the ADAPT Technique for Acute Ischemic Stroke

Journal of NeuroInterventional Surgery, 2014

We report our single center experience of endovascular treatment of stroke by a technique of dire... more We report our single center experience of endovascular treatment of stroke by a technique of direct aspiration with large bore catheter. From September 2013 to March 2014 we included prospectively on intent to treat 80 patients presenting with large vessels occlusion in the settings of acute ischemic stroke. The ADAPT technique was utilised in first intention in all patients and was associated with stentriever technique when necessary. Procedural and clinical data were collected for analysis. Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 15 (1-26). The localization of arterial occlusion was the MCA in 40/80 (50%), the ICA in 10/80 (12.5%), a tandem occlusion in 24/80 (30%) and the vertebro basilar territory in 6/80 (7.5%). The aspiration technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 43% of cases (38/80). The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 87.5%. With ADAPT alone, the average time from groin puncture to at least TICI 2b recanalization was 37 min (from clot contact to recanalization: 17 min). Ninety day functional outcomes was available for 35 patients were 50% (modified Rankin Scale (mRS) 0-2) and 15% (mRS 6). For the overall series there were 8 cases (10%) of procedural complications (one non occlusive dissection 4 distal emboli, and 5 Subarachnoid haemorrhages) and 2 symptomatic intracerebral haemorrhages (2.5%). The Aspiration technique utilising large bore aspiration catheters technique alone was effective in 43% of the cases being fast, safe and simple, nevertheless in our experience to achieve a recanalization rate of 87.5% it add to be completed by the use of stentrievers in the other cases. The relevance of this technique needs to studied in larger prospective multicentric studies. R. Blanc: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus. R. Fahed: None. H. Redjem: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. B. Bartolini: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. S. Pistocchi: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. M. Piotin: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus.

Research paper thumbnail of O-028 Endovascular Treatment of Small-Unruptured Cerebral Aneurysms with Flow Diverters

Journal of NeuroInterventional Surgery, 2014

To assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptu... more To assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptured cerebral aneurysms. Retrospective review of a prospectively gathered database of endovascularly treated aneurysms since the introduction of FD. From September 2008 (when treatment aneurysms with FD was initiated at our institution) to January 2014, 519 small (&lt;10 mm), unruptured aneurysms were treated by endovascular means. Four treatment modalities were individualised: simple coiling, balloon-assisted coiling, stent-assisted coiling and aneurysm neck coverage with FD. (87/519) 16.8% (mean sac size: 5.0 mm, 70.1.4% bifurcation) of aneurysms were simply coiled. (189/519) 36.4% (mean sac size: 4.9 mm, 54.5% bifurcation) of aneurysms were coiled with balloon assistance. (166/519) 32.0% (mean sac size: 6.1 mm, 75.3% bifurcation) of aneurysms were coiled with stent-assistance. (77/519) 14.8% (mean sac size: 5.0 mm, 14.5% bifurcation) aneurysms were treated with FD. Procedural perioperative and delayed (up to 180 days) permanent neurological complications were 0.0%, 4.0%, 10.1% and 3.1% respectively, with a marked trend for more complications with stent-assisted coiling (P = 0.0037). Total immediate aneurysm occlusion was obtained in 49.4% (43/87), 53.4% (101/189), 59.0% (98/166) and 3.9% (3/77) respectively, with a marked trend toward better occlusion with stent-assisted coiling technique (P &lt; 0.0001). At a mean angiographic follow-up of 16 months for aneurysms treated with FD and 23 months for the others, total aneurysm occlusion was 59.2% (32/54), 70.4% (88/125), 85.4% (111/130) and 70.7% (41/58) respectively, with a trend toward better occlusion with stent-assisted coiling (P = 0.0011). FD for the treatment of small-unruptured aneurysms confer a good safety profile that compares favorably with those of balloon-assisted technique, but are mostly indicated for sidewall aneurysms. Occlusion rates at follow-up are better with stent-assisted-coiling than FD but with higher morbidity. M. Piotin: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect. B. Bartolini: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. H. Redjem: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. S. Pistocchi: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. R. Blanc: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect.

Research paper thumbnail of Traitement endovasculaire des petits anévrismes intracrâniens à large collet : quel traitement en 2012 ?

Journal of Neuroradiology, 2012

Research paper thumbnail of Stenting des sinus veineux : nouvelle modalité thérapeutique pour les thromboses veineuses cérébrales

Journal of Neuroradiology, 2012

Research paper thumbnail of Traitement endovasculaire des AVC ischémiques du territoire carotidien : efficacité, facteurs pronostiques cliniques, radiologiques et angiographiques

Journal of Neuroradiology, 2014

Congrès SFNR 2014 modification du flux intra-sacculaire à J0. Les 5 ont par la suite progressé ve... more Congrès SFNR 2014 modification du flux intra-sacculaire à J0. Les 5 ont par la suite progressé vers une thrombose complète à distance. Conclusions.-Malgré le nombre limité de patients dans cette série, la stagnation de flux au temps veineux sur le contrôle postprocédure semble être un bon prédicteur de thrombose partielle à J1 chez les patients traités par FDS ; de même, les anévrysmes ayant montré une thrombose partielle à J1 semblent montrer une probabilité de thrombose complète à distance plus élevée.

Research paper thumbnail of Thrombectomie mécanique à la phase aiguë des AVC ischémiques par occlusion en tandem

Journal of Neuroradiology, 2014

Objectif.-La place du traitement endovasculaire dans les occlusions aiguës symptomatiques de l'ar... more Objectif.-La place du traitement endovasculaire dans les occlusions aiguës symptomatiques de l'artère carotide interne (ACI) n'est pas bien connue. L'objectif de cette étude est de déterminer des facteurs prédictifs du devenir de patients traités par voie endovasculaire pour un accident vasculaire cérébral ischémique sur occlusion de l'ACI, à court et moyen terme à la fois démographiques, cliniques, d'imagerie et thérapeutiques. Patients et méthodes.-Entre juin 2007 et février 2013, 61 patients ont été traités pour une occlusion aiguë symptomatique de L'ACI par voie endovasculaire seule ou précédée d'une thrombolyse intraveineuse (IV). Toutes les données ont été recueillies de façon rétrospective. Résultats.-L'occlusion concernait l'ACI cervicale dans 56 % des cas, le siphon carotidien dans 11 % des cas et une occlusion en T était retrouvée dans 33 % des cas. Les occlusions en tandem représentaient 44 % des cas. Le National Institute of Health Stroke Scale (NIHSS) médian à l'admission était de 17. Une bonne reperfusion [TICI (Thrombolysis In Myocardial Infraction) 0-2] a été obtenue chez 41 % des patients. Le taux de transformations hémorragiques était de 57 % quel que soit le degré de gravité. Le taux d'hémorragie intraparenchymateuse [PH (parenchymal hemorrhage) 1 et 2] était de 19,7 %. Le NIHSS médian à 24 heures du déficit était de 15. Le score de Rankin modifié à moyen terme était favorable (0-2) chez 37 % des patients, modéré (0-3) chez 56 % des patients. Vingt et un pour cent des patients sont décédés. Les facteurs prédictifs du devenir retrouvés sont l'âge, le mismatch diffusion-perfusion en IRM, les occlusions en tandem et l'étiologie de l'occlusion. Conclusion.-Le pronostic des occlusions aiguës symptomatiques de l'CAI est sombre même après une thrombolyse IV. Cependant, le traitement endovasculaire pourrait améliorer le pronostic chez une certaine catégorie de patients notamment en présence d'un mismatch diffusion-perfusion en IRM.

Research paper thumbnail of Stent retriever capture : expérience chez 26 patients ayant présenté un AVC ischémique

Journal of Neuroradiology, 2014

complexes de bifurcation à collet large. Nous décrivons ici notre expérience initiale avec le sys... more complexes de bifurcation à collet large. Nous décrivons ici notre expérience initiale avec le système WEB à la phase aiguë des hémorragies méningées. Patients et méthodes.-Entre février et décembre 2013, 6 patients adressés pour hémorragie méningée anévrismale ont été inclus dans cette étude. L'indication d'utiliser un dispositif WEB a été posée en raison des difficultés techniques attendues devant ces anévrismes de bifurcation à collet large avec un risque élevé de recanalisation en cas de traitement à l'aide de coils. Résultats.-Trois anévrismes sylviens et 3 communicants antérieurs ont été traités dans notre institution entre j1 et j14 après la rupture. Le déploiement satisfaisant du dispositif WEB a été possible dans tous les cas. Aucune rupture peropératoire n'a été constatée. Les contrôles en fin de procédure montrent 4 occlusions complètes et 2 occlusions partielles avec stagnation du produit de contraste dans le sac anévrismal. Le mRS à la sortie était de 0 pour tous les patients. Conclusion.-L'utilisation du système WEB semble prometteuse pour le traitement des anévrismes rompus complexes car ce dispositif permet de traiter des lésions de bifurcation à collet large avec un taux de faisabilité élevé sans nécessiter l'utilisation d'une anti-agrégation plaquettaire.

Research paper thumbnail of P-008 on intent to treat adapt technique for 201 cases of anterior circulation acute ischemic stroke

Journal of NeuroInterventional Surgery, 2015

Conclusions In our cohort, baseline CT ASPECTS inversely correlated with admission NLR in anterio... more Conclusions In our cohort, baseline CT ASPECTS inversely correlated with admission NLR in anterior circulation AIS patients who had favorable perfusion imaging profile for IA reperfusion therapy. Additionally, in this subgroup of patients, NLR of 5 or less discriminated favorable from unfavorable ASPECTS.

Research paper thumbnail of Sonoelastography may help in the differential diagnosis between rheumatoid nodules and tophi

Clinical and experimental rheumatology

ABSTRACT

Research paper thumbnail of Angiographic factors influencing the success of endovascular treatment of arteriovenous malformations involving the corpus callosum

Journal of NeuroInterventional Surgery, 2014

Arteriovenous malformations (AVMs) of the corpus callosum are rare lesions, accounting for 9-11% ... more Arteriovenous malformations (AVMs) of the corpus callosum are rare lesions, accounting for 9-11% of brain AVMs. Microsurgical resection of such lesions is difficult because of their deep location, and also because of possible neuropsychological disasters resulting from extended callosal resection. The introduction of endovascular and radiation therapies has fundamentally changed the outcome of these lesions. We prospectively collected clinical and angiographic data on cerebral AVMs from 1995. We reviewed data from patients treated for an AVM of the corpus callosum and identified the factors influencing the endovascular approach of such lesions. 38 patients (mean age 31 years) were consecutively treated by endovascular techniques. 78.9% (30 cases) of patients presented with intracranial hemorrhage. 15 AVMs (39.5%) were anterior, 18 (47.4%) were posterior, and five (13.1%) were holocallosal. The Spetzler-Martin grade was I in two cases (5.2%), II in 20 cases (52.6%), III in nine cases (23.7%), IV in six cases (15.8%), and V in one case (2.6%). The nidus was compact in 19 cases (50%), diffuse in 13 (34.2%), and multifocal in six (15.8%). Both anterior and posterior circulation branches fed 14 nidi (36.8%). Venous drainage was superficial in three cases (7.9%), deep in 28 (73.7%), and both in seven cases (18.4%). 104 sessions were performed, with a procedural complication rate of 6.7%. Mean follow-up was 43.6 months, with the last modified Rankin Scale score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3 in 33 cases (86.8%). 22 patients (57.9%) were totally cured. Univariate analysis of factors influencing the success of endovascular treatment showed that Spetzler-Martin grade ≥3 (p=0.046), nidus &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30 mm (p=0.02), extension in an eloquent area (p=0.03), and holocallosal type (p0.005) significantly diminished the chances of cure of the AVM. AVMs of the corpus callosum seems to be difficult to treat with endovascular therapy alone. The goal of embolization should be prevention of (re) bleeding and a decrease in nidus size. Our experience regarding this sub-pathology suggests that a combination of endovascular therapy and radiotherapy may be the best option.

Research paper thumbnail of E-054 Angiographic Factors Influencing the Success of Endovascular Treatment of Arteriovenous Malformations involving the Corpus Callosum

Journal of NeuroInterventional Surgery, 2014

intra-operative aneurysm ruptures (5.6%), 2 of previously-ruptured aneurysms (16.7%) and 1 of an ... more intra-operative aneurysm ruptures (5.6%), 2 of previously-ruptured aneurysms (16.7%) and 1 of an unruptured aneurysm (2.4%), hemostasis was achieved by immediate balloon inflation in all cases and no patient developed a new neurological deficit. There was 1 distal branch vessel rupture during balloon inflation performed to reduce an intra-aneurysmal catheter loop for a wire exchange prior to stenting, resulting in the patient's death (2.2%). There was 1 ipsilateral intracerebral haemorrhage on post-operative day 2 in a hypertensive patient with a clopidogrel hyper-response leading to permanent contralateral hemiparesis (2.2%). Overall, 2 complications led to either a new permanent disabling neurological deficit or the patient's death (mRS ≥ 3, 4.4%). Conclusion The Sceptre XC balloon is a valuable adjunctive device for the endovascular treatment of cerebral aneurysms, allowing high treatment success rates and packing densities, achievement of immediate hemostasis in the event of an intraoperative aneurysm rupture, and reduction in the overall need of stent-assistance for cerebral aneurysm treatment. Disclosures J.

Research paper thumbnail of 416 Magnetic Resonance Imaging as a Structural Refinement to the American College of Rheumathology Clinical Classification Criteria for Knee Osteoarthritis

Osteoarthritis and Cartilage, 2008

cartilage injury, which were also observed in dGEMRIC as low GAG concentration areas. In one case... more cartilage injury, which were also observed in dGEMRIC as low GAG concentration areas. In one case with grade III cartilage injury, drilling was performed as a mesenchymal stimulating method to form fibrocartilage. Conclusions: This study suggested that dGEMRIC had the potential to detect the cartilage lesions of the ankle even in an early stage. For the clinical application of cartilage repair techniques, our evaluation method using MR imaging may be useful for observing the maturation process and long-term durability of reparative cartilage non-invasively.

Research paper thumbnail of P-011 initial experience with the lazarus cover device to prevent embolization in new territories during mechanical thombectomy

Journal of NeuroInterventional Surgery, 2015

Research paper thumbnail of E-018 Treatment of Ruptured Blood-blister-like Aneurysms in the Subacute Phase: Clinical and Angiographic Outcome

Journal of NeuroInterventional Surgery, 2016

Results HRMRI provides a detailed benchmark for validation of lumen geometry (Figure 1A, top). Qu... more Results HRMRI provides a detailed benchmark for validation of lumen geometry (Figure 1A, top). Quantitative evaluation of the lumen diameter in the vicinity of the stenosis using imaging data acquired from 7 different centers is presented as weighted mean and standard deviation (Figure 1A, bottom). It was observed that along the centerline of the lumen, the radius ranged from 0.8-1.6 mm and was highly reproducible across all imaging platforms. The highest CNRs were observed for comparisons between lipid and vessel wall (Figure 1B). CNR mean variation between the two phantom models for each comparison between plaque components was 3.68-6.09, demonstrating excellent reliability in manufacturing technique. Conclusion A plaque phantom composed of a stenotic vessel wall and plaque components, including fibrous cap and a lipid core, was successfully constructed for multi-center HRMRI standardization.

Research paper thumbnail of Caution; Confusion Ahead…

American Journal of Neuroradiology, 2017

Research paper thumbnail of A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study

American Journal of Neuroradiology, 2016

BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers is now the standard therapy... more BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers is now the standard therapy for selected patients with ischemic stroke. The technique of A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) appears promising with a high rate of recanalization. We compared ADAPT versus stent retrievers (the Solitaire device) for efficacy and safety as a front-line endovascular procedure. MATERIALS AND METHODS: We analyzed 243 consecutive patients with large intracranial artery occlusions of the anterior circulation, treated within 6 hours with mechanical thrombectomy by either ADAPT or the Solitaire stent. Th primary outcome was complete recanalization (modified TICI Ն 2b); secondary outcomes included complication rates and procedural and clinical outcomes. RESULTS: From November 2012 to June 2014, 119 patients were treated with stent retriever (Solitaire FR) and 124 by using the ADAPT with Penumbra reperfusion catheters. The median baseline NIHSS score was the same for both groups (Solitaire, 17 [interquartile range, 11-21] versus ADAPT, 17 [interquartile range, 12-21]). Time from groin puncture to recanalization (Solitaire, 50 minutes [range, 25-80 minutes] versus ADAPT, 45 minutes [range, 27-70 minutes], P ϭ .42) did not differ significantly. However, compared with the Solitaire group, patients treated with ADAPT achieved higher final recanalization rates (82.3% versus 68.9%; adjusted relative risk, 1.18; 95% CI, 1.02-1.37; P ϭ .022), though differences in clinical outcomes between the cohorts were not significant. Use of an adjunctive device was more frequent in the ADAPT group (45.2% versus 13.5%, P Ͻ .0001). The rate of embolization in new territories or symptomatic hemorrhage did not differ significantly between the 2 groups. CONCLUSIONS: Front-line ADAPT achieved higher recanalization rates than the Solitaire device. Further randomized controlled trials are warranted to define the best strategy for mechanical thrombectomy.

Research paper thumbnail of Endovascular treatment of posterior fossa arteriovenous malformations

Journal of Clinical Neuroscience, 2016

Infratentorial arteriovenous malformations (AVM) are rare, representing only 7-15% of cerebral AV... more Infratentorial arteriovenous malformations (AVM) are rare, representing only 7-15% of cerebral AVM. The concentration of eloquent neurological structures and the high rate of bleeding presentation of AVM in this location complicate the management of such lesions. New therapeutic options, especially in endovascular therapy, have fundamentally modified the treatment strategy and also the outcome of posterior fossa AVM. Between 1999 and 2013, baseline, clinical and angiographic data of cerebral AVM were prospectively collected. We analyzed data from patients treated for a posterior fossa AVM, focusing on risk factors for bleeding, and clinical and angiographic outcomes. Sixty-nine patients (mean age 34 years, male to female ratio 2:1) were consecutively treated for an infratentorial AVM. Fifty-seven presented with hemorrhage, six with focal neurologic deficits, and the remaining six patients were diagnosed incidentally. The Spetzler-Martin grade was <3 in 39 (56.5%) patients. Associated aneurysms were noted in 43.5% of patients. All patients were treated using endovascular procedures, associated with microsurgical resection in nine patients and with stereotactic radiosurgery in six. Mean follow-up was 28.5 months, with angiographic exclusion of the AVM in 72.5% of patients; 21.7% of patients presented a modified Rankin Score P3 at follow-up. Endovascular embolization seems to be a secure approach for posterior fossa AVM although a large number of sessions are necessary to achieve complete obliteration. Multidisciplinary discussion and management is crucial to obtain the best cure rate without increasing procedural risks.

Research paper thumbnail of Thrombectomie mécanique avec le dispositif « ERIC »™ : expérience multicentrique française sur 25 cas

Journal of Neuroradiology, 2014

lyse intraveineuse. Les facteurs prédictifs d'échec de recanalisation et de complication emboliqu... more lyse intraveineuse. Les facteurs prédictifs d'échec de recanalisation et de complication embolique ou hémorragique étaient analysés. Résultats.-L'âge médian était de 69,5 ans et le score médian NIHSS était de 18 à l'examen initial. Cinquante patients (34,7 %) ont bénéficié du seul traitement par stent-retriever, 94 (65,3 %) ont eu un traitement combiné. Le taux d'échec de recanalisation était de 13,9 %. Les complications emboliques étaient rapportées dans 12,5 % des cas et les complications hémorragiques symptomatiques dans 7,6 %. Le taux global d'échec, de complication et/ou de décès était 39,6 %. Le taux de mortalité périopératoire était 18,4 %, majoré en cas d'échec (45 %, p = 0,003), de complication embolique (38,9 %, p = 0,0176), ou hémorragique symptomatique (45,5 %, p = 0,0236) et en cas de sténose intracrânienne (50 %, p = 0,0176). Le taux d'échec de recanalisation, les taux de complication embolique ou hémorragique n'étaient pas influencés par le traitement fibrinolytique. L'âge élevé était le seul facteur prédictif de complication hémorragique (p = 0,043). Conclusion.-Le taux de mortalité périopératoire était augmenté de manière significative en cas de complication embolique et hémorragique ainsi qu'en cas d'échec de recanalisation ou de sténose intracrânienne. L'ajout d'un traitement fibrinolytique n'améliorait pas le taux de recanalisation ni le taux de complication embolique. Le taux de complication hémorragique symptomatique n'était pas plus élevé en cas de traitement combiné.

Research paper thumbnail of « Y » stenting des anévrismes intracrâniens de forme complexe localises sur la bifurcation de l’artère sylvienne : résultats angiographiques et cliniques

Journal of Neuroradiology, 2012

Research paper thumbnail of Traitement mécanique endovasculaire à la phase aiguë des infarctus cérébraux : résultats de trois ans d’expérience d’un centre de neuroradiologie interventionnelle

Journal of Neuroradiology, 2012

Congrès SFNR 2012 lorsque la procédure est effectuée en présence d'un caillot endoluminal préalab... more Congrès SFNR 2012 lorsque la procédure est effectuée en présence d'un caillot endoluminal préalablement injecté (p = 0,04). Conclusion.-Les dispositifs de revascularisation mécanique provoquent certaines lésions de la paroi artérielle dans cette étude à la phase aiguë. Le niveau d'agression pariétale est différent selon le design et le mode d'action du système de revascularisation.

Research paper thumbnail of P-031 Single Center Experience with the ADAPT Technique for Acute Ischemic Stroke

Journal of NeuroInterventional Surgery, 2014

We report our single center experience of endovascular treatment of stroke by a technique of dire... more We report our single center experience of endovascular treatment of stroke by a technique of direct aspiration with large bore catheter. From September 2013 to March 2014 we included prospectively on intent to treat 80 patients presenting with large vessels occlusion in the settings of acute ischemic stroke. The ADAPT technique was utilised in first intention in all patients and was associated with stentriever technique when necessary. Procedural and clinical data were collected for analysis. Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 15 (1-26). The localization of arterial occlusion was the MCA in 40/80 (50%), the ICA in 10/80 (12.5%), a tandem occlusion in 24/80 (30%) and the vertebro basilar territory in 6/80 (7.5%). The aspiration technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 43% of cases (38/80). The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 87.5%. With ADAPT alone, the average time from groin puncture to at least TICI 2b recanalization was 37 min (from clot contact to recanalization: 17 min). Ninety day functional outcomes was available for 35 patients were 50% (modified Rankin Scale (mRS) 0-2) and 15% (mRS 6). For the overall series there were 8 cases (10%) of procedural complications (one non occlusive dissection 4 distal emboli, and 5 Subarachnoid haemorrhages) and 2 symptomatic intracerebral haemorrhages (2.5%). The Aspiration technique utilising large bore aspiration catheters technique alone was effective in 43% of the cases being fast, safe and simple, nevertheless in our experience to achieve a recanalization rate of 87.5% it add to be completed by the use of stentrievers in the other cases. The relevance of this technique needs to studied in larger prospective multicentric studies. R. Blanc: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus. R. Fahed: None. H. Redjem: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. B. Bartolini: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. S. Pistocchi: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. M. Piotin: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus.

Research paper thumbnail of O-028 Endovascular Treatment of Small-Unruptured Cerebral Aneurysms with Flow Diverters

Journal of NeuroInterventional Surgery, 2014

To assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptu... more To assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptured cerebral aneurysms. Retrospective review of a prospectively gathered database of endovascularly treated aneurysms since the introduction of FD. From September 2008 (when treatment aneurysms with FD was initiated at our institution) to January 2014, 519 small (&lt;10 mm), unruptured aneurysms were treated by endovascular means. Four treatment modalities were individualised: simple coiling, balloon-assisted coiling, stent-assisted coiling and aneurysm neck coverage with FD. (87/519) 16.8% (mean sac size: 5.0 mm, 70.1.4% bifurcation) of aneurysms were simply coiled. (189/519) 36.4% (mean sac size: 4.9 mm, 54.5% bifurcation) of aneurysms were coiled with balloon assistance. (166/519) 32.0% (mean sac size: 6.1 mm, 75.3% bifurcation) of aneurysms were coiled with stent-assistance. (77/519) 14.8% (mean sac size: 5.0 mm, 14.5% bifurcation) aneurysms were treated with FD. Procedural perioperative and delayed (up to 180 days) permanent neurological complications were 0.0%, 4.0%, 10.1% and 3.1% respectively, with a marked trend for more complications with stent-assisted coiling (P = 0.0037). Total immediate aneurysm occlusion was obtained in 49.4% (43/87), 53.4% (101/189), 59.0% (98/166) and 3.9% (3/77) respectively, with a marked trend toward better occlusion with stent-assisted coiling technique (P &lt; 0.0001). At a mean angiographic follow-up of 16 months for aneurysms treated with FD and 23 months for the others, total aneurysm occlusion was 59.2% (32/54), 70.4% (88/125), 85.4% (111/130) and 70.7% (41/58) respectively, with a trend toward better occlusion with stent-assisted coiling (P = 0.0011). FD for the treatment of small-unruptured aneurysms confer a good safety profile that compares favorably with those of balloon-assisted technique, but are mostly indicated for sidewall aneurysms. Occlusion rates at follow-up are better with stent-assisted-coiling than FD but with higher morbidity. M. Piotin: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect. B. Bartolini: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. H. Redjem: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. S. Pistocchi: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. R. Blanc: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect.

Research paper thumbnail of Traitement endovasculaire des petits anévrismes intracrâniens à large collet : quel traitement en 2012 ?

Journal of Neuroradiology, 2012

Research paper thumbnail of Stenting des sinus veineux : nouvelle modalité thérapeutique pour les thromboses veineuses cérébrales

Journal of Neuroradiology, 2012

Research paper thumbnail of Traitement endovasculaire des AVC ischémiques du territoire carotidien : efficacité, facteurs pronostiques cliniques, radiologiques et angiographiques

Journal of Neuroradiology, 2014

Congrès SFNR 2014 modification du flux intra-sacculaire à J0. Les 5 ont par la suite progressé ve... more Congrès SFNR 2014 modification du flux intra-sacculaire à J0. Les 5 ont par la suite progressé vers une thrombose complète à distance. Conclusions.-Malgré le nombre limité de patients dans cette série, la stagnation de flux au temps veineux sur le contrôle postprocédure semble être un bon prédicteur de thrombose partielle à J1 chez les patients traités par FDS ; de même, les anévrysmes ayant montré une thrombose partielle à J1 semblent montrer une probabilité de thrombose complète à distance plus élevée.

Research paper thumbnail of Thrombectomie mécanique à la phase aiguë des AVC ischémiques par occlusion en tandem

Journal of Neuroradiology, 2014

Objectif.-La place du traitement endovasculaire dans les occlusions aiguës symptomatiques de l'ar... more Objectif.-La place du traitement endovasculaire dans les occlusions aiguës symptomatiques de l'artère carotide interne (ACI) n'est pas bien connue. L'objectif de cette étude est de déterminer des facteurs prédictifs du devenir de patients traités par voie endovasculaire pour un accident vasculaire cérébral ischémique sur occlusion de l'ACI, à court et moyen terme à la fois démographiques, cliniques, d'imagerie et thérapeutiques. Patients et méthodes.-Entre juin 2007 et février 2013, 61 patients ont été traités pour une occlusion aiguë symptomatique de L'ACI par voie endovasculaire seule ou précédée d'une thrombolyse intraveineuse (IV). Toutes les données ont été recueillies de façon rétrospective. Résultats.-L'occlusion concernait l'ACI cervicale dans 56 % des cas, le siphon carotidien dans 11 % des cas et une occlusion en T était retrouvée dans 33 % des cas. Les occlusions en tandem représentaient 44 % des cas. Le National Institute of Health Stroke Scale (NIHSS) médian à l'admission était de 17. Une bonne reperfusion [TICI (Thrombolysis In Myocardial Infraction) 0-2] a été obtenue chez 41 % des patients. Le taux de transformations hémorragiques était de 57 % quel que soit le degré de gravité. Le taux d'hémorragie intraparenchymateuse [PH (parenchymal hemorrhage) 1 et 2] était de 19,7 %. Le NIHSS médian à 24 heures du déficit était de 15. Le score de Rankin modifié à moyen terme était favorable (0-2) chez 37 % des patients, modéré (0-3) chez 56 % des patients. Vingt et un pour cent des patients sont décédés. Les facteurs prédictifs du devenir retrouvés sont l'âge, le mismatch diffusion-perfusion en IRM, les occlusions en tandem et l'étiologie de l'occlusion. Conclusion.-Le pronostic des occlusions aiguës symptomatiques de l'CAI est sombre même après une thrombolyse IV. Cependant, le traitement endovasculaire pourrait améliorer le pronostic chez une certaine catégorie de patients notamment en présence d'un mismatch diffusion-perfusion en IRM.

Research paper thumbnail of Stent retriever capture : expérience chez 26 patients ayant présenté un AVC ischémique

Journal of Neuroradiology, 2014

complexes de bifurcation à collet large. Nous décrivons ici notre expérience initiale avec le sys... more complexes de bifurcation à collet large. Nous décrivons ici notre expérience initiale avec le système WEB à la phase aiguë des hémorragies méningées. Patients et méthodes.-Entre février et décembre 2013, 6 patients adressés pour hémorragie méningée anévrismale ont été inclus dans cette étude. L'indication d'utiliser un dispositif WEB a été posée en raison des difficultés techniques attendues devant ces anévrismes de bifurcation à collet large avec un risque élevé de recanalisation en cas de traitement à l'aide de coils. Résultats.-Trois anévrismes sylviens et 3 communicants antérieurs ont été traités dans notre institution entre j1 et j14 après la rupture. Le déploiement satisfaisant du dispositif WEB a été possible dans tous les cas. Aucune rupture peropératoire n'a été constatée. Les contrôles en fin de procédure montrent 4 occlusions complètes et 2 occlusions partielles avec stagnation du produit de contraste dans le sac anévrismal. Le mRS à la sortie était de 0 pour tous les patients. Conclusion.-L'utilisation du système WEB semble prometteuse pour le traitement des anévrismes rompus complexes car ce dispositif permet de traiter des lésions de bifurcation à collet large avec un taux de faisabilité élevé sans nécessiter l'utilisation d'une anti-agrégation plaquettaire.