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Papers by Francois Rouanet
Journal of Neuroradiology, 2006
Journal of Neuroradiology, 2006
Annals of Physical and Rehabilitation Medicine, 2014
Most studies focus on so-called objective outcomes. However, the trend now for evidence-based med... more Most studies focus on so-called objective outcomes. However, the trend now for evidence-based medicine is the outcomes should be of importance for the person. Then the question is; who owns the truth-the professional assessor or the person with the stroke? The talk will go through some of the discrepancies between assessed and perceived functioning. Also the influence of personal factors on perception will be discussed. Maybe the perception of the person with stroke should have a higher importance in deciding the content of the rehabilitation program offered for that individual?
Revue Neurologique, 2013
Atherosclerosis is a major cause of ischemic stroke. Despite important therapeutic advances, the ... more Atherosclerosis is a major cause of ischemic stroke. Despite important therapeutic advances, the risk of recurrence of vascular events remains very high. The partial failure of these strategies is to some extent related to the lack of patient adherence to their treatments and to the fact that therapeutic targets are not reached. The aim of the present study was to evaluate the influence of a short atherosclerosis prevention program on vascular risk reduction in stroke patients. Ninety-five patients with a first ischemic stroke related to atherosclerosis or with a high vascular risk profile were recruited. Three months later, a global evaluation of the atherosclerotic disease and of the vascular risk factors was performed combined with several education sessions on vascular risk factors and way of life. A follow-up evaluation was performed several months later to investigate the number of vascular events and the vascular risk profile. Median follow-up was 684 days after stroke. At follow-up, 91.3% of patients were taking a cholesterol-lowering drug, 95.6% an anti-thrombotic agent, and 78% an angiotensin converting enzyme inhibitor. A persistent decrease in tobacco use and an improvement in glycemic control were observed. During follow-up, 3.2% of patients died; none of the deaths were related to a vascular event. During the 22-month follow-up, 7.6% of patients experienced a major vascular event, acute coronary syndrome or stroke. Compared with results in the literature, this study illustrates the positive influence of a short atherosclerosis prevention program combining depiction of atherosclerotic lesions and education of vascular risk factors on the quality of long-term post-stroke prevention.
Journal Européen des Urgences, 2008
Stroke, 2007
Background and Purpose— In the concept of ischemic penumbra, the volume of salvaged penumbra is c... more Background and Purpose— In the concept of ischemic penumbra, the volume of salvaged penumbra is considered as the volume of FLAIR normalization on follow-up MRI compared with early diffusion and perfusion abnormalities. Using magnetization transfer imaging, very sensitive to macromolecular disruption, we investigated whether FLAIR normalization was a good marker for tissue full recovery. Methods— We prospectively included 30 patients with acute middle cerebral artery stroke. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging were performed within 12 hours after onset (MRI.1), and the final infarct was documented by MRI with FLAIR and magnetization transfer at 1-month follow-up (MRI.2). We compared magnetic transfer ratio of a normal region with values measured at 1 month (MRI.2) in 4 regions of interest: (1) the initial DWI hypersignal (CORE=DWI_MRI.1); (2) the infarct growth area (infarct growth=FLAIR_MRI.2−DWI_MRI.1); (3) the hypoperfused area that normalized (reversi...
Journal of Magnetic Resonance Imaging, 2009
To evaluate the reproducibility of fluid attenuated inversion recovery (FLAIR) and four other mag... more To evaluate the reproducibility of fluid attenuated inversion recovery (FLAIR) and four other magnetic resonance imaging (MRI) sequences in the quantitative assessment of final cerebral infarct volume. FLAIR, T1-3D, magnetization transfer ratio (MTR)-map, diffusion-weighted trace (DWI)-trace, and apparent diffusion coefficient (ADC)-map, were acquired and measured in 33 patients 30-45 days after onset of a first-ever ischemic stroke. The infarct area was visually detected and manually delineated two times by two readers separately after images and sequences randomization. The reliability was assessed by using an intraclass correlation coefficient (ICC) and its two-sided 95% confidence interval (95% CI). DWI-trace had the best reliability, with an ICC of 0.96 (95% CI = 0.93-0.98). FLAIR had an ICC of 0.86 (95% CI = 0.73-0.93), and a much higher volume. T1-3D, MTR-map and ADC-map had lower reliability or excessive volume values equal to 0 in comparison to DWI-trace. DWI-trace performed within 30th and 45th day following onset of acute ischemic stroke was the most reliable sequence for final infarct volume quantification. This sequence should be added to FLAIR evaluation to strengthen the statistical results of the pharmacological trials and reduce their variability.
European Heart Journal, 2008
Clinical Nuclear Medicine, 2010
Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome is a rare complication of c... more Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome is a rare complication of cranial irradiation. Radiation is well-known to impair vascular vessel architecture and function. We investigated the hypothesis of radiation-induced cerebral vascular reserve dysfunction as the underlying mechanism of SMART. Interictal cerebrovascular reactivity was investigated using Tc-99m hexamethylpropyleneamine oxime-SPECT and acetazolamide challenge in 3 patients. We found interictal hypoperfusion and normal cerebrovascular reactivity in all patients. Neither ictal restriction of the apparent diffusion coefficient nor MR angiography abnormalities were observed. These findings do not support a vascular mechanism in SMART syndrome. Postradiation neuronal dysfunction may be the underlying mechanism. Further investigations on larger series are needed to confirm this hypothesis.
Cerebrovascular Diseases, 2010
Background: Postthrombolysis brain haemorrhagic transformations (HT) are often categorized with t... more Background: Postthrombolysis brain haemorrhagic transformations (HT) are often categorized with the CT-based classification of the European Cooperative Acute Stroke Study (ECASS). However, little is known about the reliability of this classification and its extension to MRI. Our objective was to compare the inter- and intraobserver reliability of this classification on CT and 3 MRI sequences. Methods: Forty-three patients with postthrombolysis HT on CT or at least 1 of the 3 MRI sequences: fluid-attenuation inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and T2* gradient recalled echo (T2*GRE) were selected. Twelve control patients without any bleeding were added to avoid a bias based on a pure HT-positive cohort. Each series of images were independently classified with the ECASS method by 6 blinded observers. Inter- and intraobserver reproducibility was categorized from poor to excellent depending on ĸ values. Results: The inter- and intraobserver overall concordance ...
The American Journal of Emergency Medicine, 2014
ABSTRACT Stroke is the leading cause of acute neurological deficit. However, several potentially ... more ABSTRACT Stroke is the leading cause of acute neurological deficit. However, several potentially life threatening diseases can mimic stroke symptoms. Herein we report 3 cases of sudden onset neurological deficits with a final diagnosis of hyperacute Guillain-Barré syndrome (GBS). Two cases mimicked brain stem stroke while the last suggested a spinal cord infarct. No specific characteristics in terms of electrophysiological parameter, underlying etiology, response to treatment or prognosis was found between these hyperacute forms of hyperacute GBS and more common subacute forms. These cases remind us that acute inflammatory demyelinating neuropathy should always be evoked in front of stroke-like symptoms with negative brain imaging study.
Journal of Neuroradiology, 2006
Journal of Neuroradiology, 2006
Revue Neurologique
Calcified aortic stenosis (CAS) is an unusual cause of cerebral infarct. The presence of cerebral... more Calcified aortic stenosis (CAS) is an unusual cause of cerebral infarct. The presence of cerebral intra-vascular or intra-parenchymatous calcifications, symptomatic or not, is suggestive of the diagnosis of CAS. We report two patients who experienced stroke induced by spontaneous calcic emboli from a calcified aortic valve and underline the importance of brain CT scan.
Journal of neuroradiology. Journal de neuroradiologie, 1999
Stroke, 2014
Background and Purpose— We aimed at comparing the long-term benefit–risk balance of carotid stent... more Background and Purpose— We aimed at comparing the long-term benefit–risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. Methods— Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. Results— During a median follow-up of 7.1 years (interquartile range, 5.1–8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0% (95% confidence interval, 7.9–15.2) versus 6.3% (4.0–9.8) in the endarterectomy group at the 5-year follow-up (h...
Journal of Neuroradiology, 2005
Objectif : L'objectif principal est de déterminer la séquence IRM la plus reproductible pour éval... more Objectif : L'objectif principal est de déterminer la séquence IRM la plus reproductible pour évaluer le volume de tissu infarci à 1 mois. Matériel et méthode : Le recrutement des patients se fait dans le cadre du PHRC national VIRAGE (Valeur prédictive des paramètres d'Imagerie par Résonance Magnétique précoces dans l'infarctus cérébral aigu). L'étude porte sur 31 patients explorés dans 7 centres. Tous ont bénéficié d'un examen IRM entre J30 et J45 après leur infarctus. Les séquences réalisées sont : T1 3D, T2 FLAIR, Diffusion single shot, Transfert d'Aimantation (TM). Deux re lecteurs effectuent une double lecture. L'analyse du volume d'infarctus (en mm 3) est randomisée en aveugle grâce à un logiciel dédié, et porte sur cinq types d'images : T13D, T2 flair, Diffusion isotrope, ADC, ratio de TM. L'analyse des données est assurée par l'Unité de Soutien Méthodologique à la Recherche de Bordeaux2 à partir de cahiers d'observation électronique. La méthode statistique utilisée pour évaluer la séquence la plus reproductible est le coefficient intra-classe (part de la variabilité expliquée par la différence entre les patients). Résultats : Séquences CCI* **IC95 % cci § volume (mm 3) µvaleurs « 0 » A
Journal of Neuroradiology, 2006
Journal of Neuroradiology, 2006
Annals of Physical and Rehabilitation Medicine, 2014
Most studies focus on so-called objective outcomes. However, the trend now for evidence-based med... more Most studies focus on so-called objective outcomes. However, the trend now for evidence-based medicine is the outcomes should be of importance for the person. Then the question is; who owns the truth-the professional assessor or the person with the stroke? The talk will go through some of the discrepancies between assessed and perceived functioning. Also the influence of personal factors on perception will be discussed. Maybe the perception of the person with stroke should have a higher importance in deciding the content of the rehabilitation program offered for that individual?
Revue Neurologique, 2013
Atherosclerosis is a major cause of ischemic stroke. Despite important therapeutic advances, the ... more Atherosclerosis is a major cause of ischemic stroke. Despite important therapeutic advances, the risk of recurrence of vascular events remains very high. The partial failure of these strategies is to some extent related to the lack of patient adherence to their treatments and to the fact that therapeutic targets are not reached. The aim of the present study was to evaluate the influence of a short atherosclerosis prevention program on vascular risk reduction in stroke patients. Ninety-five patients with a first ischemic stroke related to atherosclerosis or with a high vascular risk profile were recruited. Three months later, a global evaluation of the atherosclerotic disease and of the vascular risk factors was performed combined with several education sessions on vascular risk factors and way of life. A follow-up evaluation was performed several months later to investigate the number of vascular events and the vascular risk profile. Median follow-up was 684 days after stroke. At follow-up, 91.3% of patients were taking a cholesterol-lowering drug, 95.6% an anti-thrombotic agent, and 78% an angiotensin converting enzyme inhibitor. A persistent decrease in tobacco use and an improvement in glycemic control were observed. During follow-up, 3.2% of patients died; none of the deaths were related to a vascular event. During the 22-month follow-up, 7.6% of patients experienced a major vascular event, acute coronary syndrome or stroke. Compared with results in the literature, this study illustrates the positive influence of a short atherosclerosis prevention program combining depiction of atherosclerotic lesions and education of vascular risk factors on the quality of long-term post-stroke prevention.
Journal Européen des Urgences, 2008
Stroke, 2007
Background and Purpose— In the concept of ischemic penumbra, the volume of salvaged penumbra is c... more Background and Purpose— In the concept of ischemic penumbra, the volume of salvaged penumbra is considered as the volume of FLAIR normalization on follow-up MRI compared with early diffusion and perfusion abnormalities. Using magnetization transfer imaging, very sensitive to macromolecular disruption, we investigated whether FLAIR normalization was a good marker for tissue full recovery. Methods— We prospectively included 30 patients with acute middle cerebral artery stroke. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging were performed within 12 hours after onset (MRI.1), and the final infarct was documented by MRI with FLAIR and magnetization transfer at 1-month follow-up (MRI.2). We compared magnetic transfer ratio of a normal region with values measured at 1 month (MRI.2) in 4 regions of interest: (1) the initial DWI hypersignal (CORE=DWI_MRI.1); (2) the infarct growth area (infarct growth=FLAIR_MRI.2−DWI_MRI.1); (3) the hypoperfused area that normalized (reversi...
Journal of Magnetic Resonance Imaging, 2009
To evaluate the reproducibility of fluid attenuated inversion recovery (FLAIR) and four other mag... more To evaluate the reproducibility of fluid attenuated inversion recovery (FLAIR) and four other magnetic resonance imaging (MRI) sequences in the quantitative assessment of final cerebral infarct volume. FLAIR, T1-3D, magnetization transfer ratio (MTR)-map, diffusion-weighted trace (DWI)-trace, and apparent diffusion coefficient (ADC)-map, were acquired and measured in 33 patients 30-45 days after onset of a first-ever ischemic stroke. The infarct area was visually detected and manually delineated two times by two readers separately after images and sequences randomization. The reliability was assessed by using an intraclass correlation coefficient (ICC) and its two-sided 95% confidence interval (95% CI). DWI-trace had the best reliability, with an ICC of 0.96 (95% CI = 0.93-0.98). FLAIR had an ICC of 0.86 (95% CI = 0.73-0.93), and a much higher volume. T1-3D, MTR-map and ADC-map had lower reliability or excessive volume values equal to 0 in comparison to DWI-trace. DWI-trace performed within 30th and 45th day following onset of acute ischemic stroke was the most reliable sequence for final infarct volume quantification. This sequence should be added to FLAIR evaluation to strengthen the statistical results of the pharmacological trials and reduce their variability.
European Heart Journal, 2008
Clinical Nuclear Medicine, 2010
Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome is a rare complication of c... more Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome is a rare complication of cranial irradiation. Radiation is well-known to impair vascular vessel architecture and function. We investigated the hypothesis of radiation-induced cerebral vascular reserve dysfunction as the underlying mechanism of SMART. Interictal cerebrovascular reactivity was investigated using Tc-99m hexamethylpropyleneamine oxime-SPECT and acetazolamide challenge in 3 patients. We found interictal hypoperfusion and normal cerebrovascular reactivity in all patients. Neither ictal restriction of the apparent diffusion coefficient nor MR angiography abnormalities were observed. These findings do not support a vascular mechanism in SMART syndrome. Postradiation neuronal dysfunction may be the underlying mechanism. Further investigations on larger series are needed to confirm this hypothesis.
Cerebrovascular Diseases, 2010
Background: Postthrombolysis brain haemorrhagic transformations (HT) are often categorized with t... more Background: Postthrombolysis brain haemorrhagic transformations (HT) are often categorized with the CT-based classification of the European Cooperative Acute Stroke Study (ECASS). However, little is known about the reliability of this classification and its extension to MRI. Our objective was to compare the inter- and intraobserver reliability of this classification on CT and 3 MRI sequences. Methods: Forty-three patients with postthrombolysis HT on CT or at least 1 of the 3 MRI sequences: fluid-attenuation inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and T2* gradient recalled echo (T2*GRE) were selected. Twelve control patients without any bleeding were added to avoid a bias based on a pure HT-positive cohort. Each series of images were independently classified with the ECASS method by 6 blinded observers. Inter- and intraobserver reproducibility was categorized from poor to excellent depending on ĸ values. Results: The inter- and intraobserver overall concordance ...
The American Journal of Emergency Medicine, 2014
ABSTRACT Stroke is the leading cause of acute neurological deficit. However, several potentially ... more ABSTRACT Stroke is the leading cause of acute neurological deficit. However, several potentially life threatening diseases can mimic stroke symptoms. Herein we report 3 cases of sudden onset neurological deficits with a final diagnosis of hyperacute Guillain-Barré syndrome (GBS). Two cases mimicked brain stem stroke while the last suggested a spinal cord infarct. No specific characteristics in terms of electrophysiological parameter, underlying etiology, response to treatment or prognosis was found between these hyperacute forms of hyperacute GBS and more common subacute forms. These cases remind us that acute inflammatory demyelinating neuropathy should always be evoked in front of stroke-like symptoms with negative brain imaging study.
Journal of Neuroradiology, 2006
Journal of Neuroradiology, 2006
Revue Neurologique
Calcified aortic stenosis (CAS) is an unusual cause of cerebral infarct. The presence of cerebral... more Calcified aortic stenosis (CAS) is an unusual cause of cerebral infarct. The presence of cerebral intra-vascular or intra-parenchymatous calcifications, symptomatic or not, is suggestive of the diagnosis of CAS. We report two patients who experienced stroke induced by spontaneous calcic emboli from a calcified aortic valve and underline the importance of brain CT scan.
Journal of neuroradiology. Journal de neuroradiologie, 1999
Stroke, 2014
Background and Purpose— We aimed at comparing the long-term benefit–risk balance of carotid stent... more Background and Purpose— We aimed at comparing the long-term benefit–risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. Methods— Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. Results— During a median follow-up of 7.1 years (interquartile range, 5.1–8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0% (95% confidence interval, 7.9–15.2) versus 6.3% (4.0–9.8) in the endarterectomy group at the 5-year follow-up (h...
Journal of Neuroradiology, 2005
Objectif : L'objectif principal est de déterminer la séquence IRM la plus reproductible pour éval... more Objectif : L'objectif principal est de déterminer la séquence IRM la plus reproductible pour évaluer le volume de tissu infarci à 1 mois. Matériel et méthode : Le recrutement des patients se fait dans le cadre du PHRC national VIRAGE (Valeur prédictive des paramètres d'Imagerie par Résonance Magnétique précoces dans l'infarctus cérébral aigu). L'étude porte sur 31 patients explorés dans 7 centres. Tous ont bénéficié d'un examen IRM entre J30 et J45 après leur infarctus. Les séquences réalisées sont : T1 3D, T2 FLAIR, Diffusion single shot, Transfert d'Aimantation (TM). Deux re lecteurs effectuent une double lecture. L'analyse du volume d'infarctus (en mm 3) est randomisée en aveugle grâce à un logiciel dédié, et porte sur cinq types d'images : T13D, T2 flair, Diffusion isotrope, ADC, ratio de TM. L'analyse des données est assurée par l'Unité de Soutien Méthodologique à la Recherche de Bordeaux2 à partir de cahiers d'observation électronique. La méthode statistique utilisée pour évaluer la séquence la plus reproductible est le coefficient intra-classe (part de la variabilité expliquée par la différence entre les patients). Résultats : Séquences CCI* **IC95 % cci § volume (mm 3) µvaleurs « 0 » A