Mechanical thrombectomy practices in France: Exhaustive survey of centers and individual operators - 16/10/20

Doi : 10.1016/j.neurad.2020.05.001

Géraud Forestier ^a,^⁎ , Basile Kerleroux ^b, Kévin Janot ^c, François Zhu ^d, Victor Dumas ^e, Jean-François Hak ^f, Eimad Shotar ^g, Wagih Ben Hassen ^b, Romain Bourcier ^h, Sébastien Soize ⁱ, Jérome Berge ^j, Olivier Naggara ^b, Hubert Desal ^h, Grégoire Boulouis ^b,^{^{1
Both authors contribute equally to this work.}}, Aymeric Rouchaud ^a,^k,^{^{1
Both authors contribute equally to this work.}}
JENI Research collaboration
R. Hanafi ^l, V. L’Allinec ^m, J.-B. Girot ^m, G. Charbonnier ⁿ, A. Biondi ⁿ, F. Gariel ^o, G. Marnat ^o, J. Ognard ^p, J.-C. Gentric ^p, C. Barbier ^q, E. Chabert ^r, P. Lebedinsky ^s, T. Tuilier ^t, P. Thouant ^u, P.-O. Comby ^u, M. Mejdoubi ^v, O. Heck ^w, A. Kastler ^w, V. Chalumeau ^x, J. Caroff ^x, T. Personnic ^y, A. Marchal ^y, C. Bogey ^z, O. Eker ^aa, X. Carle ^ab, C. Dargazanli ^ac, I. Derraz ^ac, B. Gory ^ad, L. Detraz ^ae, J. Sedat ^af, O. Zurlinden ^ag, S. Escalard ^ah, R. Fahed ^ah, A. Guedon ^ai, V. Civelli ^ai, K. Premat ^aj, F. Clarençon ^aj, E. Ducouret ^ak, N. Raynaud ^al, S. Velasco ^am, P.-F. Manceau ^am, C. Paya ^an, F. Eugene ^an, J. Le Moa ^ao, C. Papagiannaki ^ao, M. Aggour ^ap, M. Bintner ^aq, J.-B. Veyrieres ^aq, J.S. Richter ^ar, R. Pop ^ar, A. Consoli ^as, F. Di-Maria ^as, C. Arteaga ^at, J. Darcourt ^au, C. Michelozzi ^au, P. Guedin ^av, D. Herbreteau ^aw, A. Le Bras ^aw
^l CHU Amiens-Picardie, 80054 Amiens cedex 1, France
^m Radiology department, Angers university hospital, Angers, France
ⁿ Department of Neuroradiology and Endovascular Therapy, CHU Besançon, France
^o Department of neuroradiology, hopital Pellegrin, university hospital of Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
^p Functional unit of interventional neuroradiology, medical imaging department, Brest university hospital, La Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
^q University hospital of Caen, Caen, France
^r Department of neuroradiology, CHU Clermont-Ferrand, France
^s Departement of radiology, hospital of Colmar, France
^t Department of neuroradiology, Henry-Mondor hospital, AP–HP, 94000 Créteil, France
^u Department of neuroradiology, CHU Dijon, France
^v University Hospital of Martinique, CHU de Martinique, Martinique
^w Service de neuroradiologie diagnostique et interventionnelle, CHU Grenoble, CS 10217, 38043 Grenoble cedex 9, France
^x Department of interventional neuroradiology, CHU Bicêtre, Le Kremlin-Bicêtre, France
^y Department of diagnostic and interventional neuroradiology, hopital Roger Salengro, CHR Lille, Lille cedex, France
^z Service de neuroradiologie interventionnelle, CHRU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
^aa Department of interventional neuroradiology, hospices civils de Lyon, France
^ab Department of neuroradiology, CHU Marseille, France
^ac Neuroradiology department, Gui de Chauliac hospital, Montpellier, France
^ad Service de neuroradiologie diagnostique et thérapeutique, CHRU Nancy, France
^ae Neuroradiology department, Nantes university hospital, France
^af Department of neuroradiology, CHU Nice, France
^ag Service de radiologie, centre hospitalier Territorial Gaston-Bourret, Nouvelle-Calédonie, France
^ah Department of interventional neuroradiology, Fondation Rothschild, 25, rue Manin, 75019 Paris, France
^ai Department of neuroradiology, Lariboisière hospital, Paris, France
^aj Service de neuroradiologie interventionnelle, hôpital de la Pitié-Salpêtrière, AP–HP, Paris, France
^ak Centre hospitalier de la Polynésie Française, French Polynesia
^al Department of diagnostic and interventional neuroradiology, La Miletrie hospital, Poitiers, France
^am Department of diagnostic and interventional neuroradiology, hôpital Maison Blanche, université Reims-Champagne-Ardenne, CHU Reims, France
^an Service de radiologie, unité de neuroradiologie interventionnelle, CHU, Rennes, France
^ao Service de radiologie, unité de neuroradiologie interventionnelle, CHU Charles Nicolle, Rouen, France
^ap Department of neuroradiology, CHU Saint-Étienne, France
^aq Service de neuroradiologie, CHU groupe hospitalier Sud-Réunion, Saint-Pierre, France
^ar Department of interventional neuroradiology, university hospital of Strasbourg, Strasbourg, France
^as Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
^at Service de radiologie, hôpital d’Instruction des armées Sainte-Anne, Toulon France
^au Service de neuroradiologie diagnostique et interventionnelle du CHU de Toulouse, hôpital Pierre-Paul Riquet, France
^av Service de radiologie, clinique Des Cèdres, Chateau D’Alliez, 31700 Cornebarrieu, France
^aw Department of Radiology, Centre Hospitalier de Vannes, Vannes, France

^a Neuroradiology department, Dupuytren, university hospital of Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
^b Inserm UMR 1266, department of neuroradiology, université Paris-Descartes, centre hospitalier Sainte-Anne, Paris, France
^c Neuroradiology department, university hospital of Tours, Tours, France
^d University hospital of Nancy, Nancy, France
^e Department of diagnostic and interventional neuroradiology, La Miletrie hospital, Poitiers, France
^f University hospital of Marseille, Marseille, France
^g University hospital, Pitié-Salpêtrière, Paris, France
^h University hospital of Nantes, Nantes, France
ⁱ Department of diagnostic and interventional neuroradiology, hôpital Maison-Blanche, université Reims-Champagne-Ardenne, CHU Reims, Reims, France
^j Department of neuroradiology, hopital Pellegrin, university hospital of Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
^k XLIM CNRS, UMR 7252, université de Limoges, Limoges, France

^⁎Corresponding author.

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Highlights

•	The number of mechanical thrombectomies has increased a sevenfold since 2012 in France.
•	The mean number of interventional neuroradiologist per center performing mechanical thrombectomy increased from 2.9±0.9 to 3.7±1.85.
•	Majority of interventional neuroradiologist use combined (stent and distal aspiration) approach (54.5%), and the use of balloon guide catheter is not standard, with a third of them never using it.
•	The majority of centers performing mechanical thrombectomy would require at least one more interventional neuroradiologist to stabilize team and insure continuity of care.

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Abstract

Background and purpose

Mechanical thrombectomy (MT) has dramatically changed the landscape of stroke care as well as stroke care organization. Public health institutions are faced with the challenge of swiftly providing equal access to this high technical level procedure with rapidly broadening indications, and constantly developing techniques. The aim of this study was to present a current nationwide overview of technical MT practices in France as well as local organizations.

Materials and methods

Thrombectomy capable French stroke centers, and physicians performing MT were invited to participate to a nationwide survey, disseminated through an existing trainee-led research network (the JENI-RC) under the aegis of the French Society of Neuroradiology. The survey was composed of 64 questions to collect both individual practices and general center-based information.

Results

All French centers (100%) answered the survey, and 74% (110/148) of active interventional neuroradiologists (INR) performing MT completed individual questionnaires. The mean number of INR per center performing MT was 3.7±1.85, and 85% of the centers were organized for 24/7 continuity of care. MRI was the most commonly used imaging modality for stroke diagnosis and patients’ selection, and perfusion imaging was routinely available in 85% of the centers. Half of centers performed yearly between 100 and 200 MT. Anesthesiologic, and technical considerations are also developed in the manuscript.

Conclusions

This nationwide survey highlights the impressive response to the challenge of reorganization of stroke care with regards to mechanical thrombectomy in France. Technical and management disparities remain. Most centers remain understaffed to properly function in the long term, but the inflow of INT trainees is substantial.

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Abbreviations : AIS, ASPECTS, DWI, INR, JENI, LVO, MRS, MT, NIHSS, PWI, SFNR, TCSC

Keywords : Stroke, Thrombectomy, Endovascular, Report, Survey

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Introduction

Materials and methods

Results

Case volume, centers, and teams

Patients selection and imaging follow-up

Endovascular procedure

Comparison with 2012 survey

Discussion

Conclusions

Disclosure of interest

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Vol 47 - N° 6

P. 410-415 - novembre 2020 Regresar al número

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Mechanical thrombectomy practices in France: Exhaustive survey of centers and individual operators - 16/10/20

Highlights

Abstract

Background and purpose

Materials and methods

Results

Conclusions

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