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Artigo Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial”(2017-09) Khoury, Naim N.; Darsaut, Tim E.; Ghostine, Jimmy; Deschaintre, Yan; Daneault, Nicole; Durocher, André; Lanthier, Sylvain; Poppe, Alexandre Y.; Odier, Céline; Lebrun, Louise-Hélène; Guilbert, François; Gentric, Jean-Christophe; Batista, André Lima; Weill, Alain; Roy, Daniel; Bracard, Serge; Raymond, JeanBackground. – Until recently, the benefits of endovascular treatment in stroke were not proven. Care trials have been designed to simultaneously offer yet-to-be validated interventions and verify treatment outcomes. Our aim was to implement a care trial for patients with acute ischemic stroke. Methods. – The study was offered to all patients considered for endovascular management of acute ischemic stroke in one Canadian hospital. Inclusion criteria were broad: onset of symptoms ≤ 5 h or at any time in the presence of clinical-imaging mismatch and suspected or demonstrated proximal large vessel occlusion. Exclusion criteria were few: established infarction or hemorrhagic transforma tion of the target symptomatic territory and poor 3-month prognosis. The primary outcome was mRS ≤ 2 at 3 months. Patients were randomly allocated to standard care or standard care plus endovascular treatment. ClinicalTrials.gov: Identifier NCT02157532. Results. – Seventy-seven patients were recruited in 19 months (March 2013–October 2014) at a single center. Randomized allocation was interrupted when other trials showed the benefits of endovascular therapy. At 3 months, 20 of 40 patients (50.0%; 95% CI: 35%–65%) in the intervention group had reached the primary outcome, compared to 14 of 37 patients (37.8%; 95% CI: 24%–54%) in the control group (P = 0.36). Eleven patients in the intervention group died within 3 months compared to 9 patients in the standard care group. Conclusion. – A care trial was implemented to offer verifiable care to acute stroke patients. This approach offers a promising means to manage clinical dilemmas and guide uncertain practices.Artigo Endovascular treatment of aneurysms and platinum coil caliber: study protocol of a randomized, controlled trial(American Society of Neuroradiology, 2016-12) Ghostine, Jimmy; Khoury, Naim; Cloutier, Francis; Kotowski, Marc; Gentric, Jean-Christophe; Batista, André Lima; Weill, Alain; Roy, Daniel; Darsaut, Tim E; Raymond, JeanBackgroundEndovascular coil embolization of cerebral aneurysms is an effective treatment for the prevention of aneurysm rebleeding after subarachnoid hemorrhage. It is also often used in unruptured aneurysms, but it is associated with aneurysm remnants and recurrences in up to 20%–33% of patients. We hypothesized that better aneurysm occlusion rates can be achieved with coils of larger caliber. MethodsThe Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) trial is an investigator-initiated, multicenter, prospective, randomized, controlled clinical trial. To test the hypothesis that 15-caliber coiling systems are superior to 10-caliber coils, 564 patients with aneurysms measuring 4–12 mm will be randomized 1:1 to embolization with either 10-caliber coils exclusively (control group) or the highest safely achievable proportion of 15-caliber coils (intervention group). The primary efficacy endpoint of the trial is the occurrence of a major recurrence or a residual aneurysm at one year. A pilot phase of 165 patients will be conducted to verify feasibility of the coiling strategy, compliance to treatment allocation, safety of a 15-caliber platinum coil embolization strategy, recruitment rates, and the capacity to improve packing density. DiscussionThe DELTA trial will test the hypothesis that the use of coils of larger caliber can improve angiographic results of endovascular coiling.Artigo Safety of Abciximab injection during endovascular treatment of ruptured aneurysms(Interventional Neuroradiology, 2015-05) Gentric, Jean-Christophe; Brisson, Joelle; Batista, André Lima; Ghostine, Jimmy; Raymond, Jean; Roy, Daniel; Weill, AlainBackground and purpose: We aimed to determine the safety of intra-arterial Abciximab injection in the management of thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms. Methods: In a monocentric consecutive series of endovascular treatment of 783 ruptured aneurysms, 42 (5.3%) patients received Abciximab after the aneurysm was secured. Bleeding complications were registered and dichotomized as follows: new intracranial hemorrhage and peripheral bleeding. For each patient, World Federation of Neurosurgery (WFNS) sub arachnoid hemorrhage (SAH) grade, shunting, and clinical outcomes in the post-operative period and at 3–6 months were recorded. Results: SAH WFNS grades were as follows: grade I n ¼ 14, grade II n ¼ 10, grade III n ¼ 11, grade IV n ¼ 4, grade V n ¼ 3. Ten patients had intracranial hematoma additionally to the SAH prior to embolization. Four patients (9.5%) presented more blood on the post-embolization CT but only one suffered a new clinically relevant intracranial hemorrhage. Two patients (4.8%) experienced significant peripheral bleeding but none were associated with long-term disabilities. Fourteen patients had a shunt installed less than 24 h prior to Abciximab injection and one less than 48 h later. At 3–6-month follow-up, 31 patients (74%) achieved a modified Rankin Scale score (mRS) of 2 or less, six patients (14%) had a mRS of 3–5, three were dead (7%), and two were lost at follow-up. Conclusion: When the aneurysm is secured, intra-arterial Abciximab injection is a low complication rate treatment modality for thromboembolic events during embolization of cerebral ruptured aneurysm