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Biomedical subjects

Thierry Moulin

Publications and source records attributed to Thierry Moulin.

6 recordsLinked to original sources
PubMed2006

Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.

BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Aged↗
PubMed2005

The discovery of encephalic arteries. From Johann Jacob Wepfer to Charles Foix.

Up until the 17th century, ideas surrounding the discovery of encephalic arteries were to remain largely influenced by the political and religious ideologies of the era. Parts of the encephalic arterial system have been called after several anatomists from this earlier period. From the 18th century onwards, scientists and doctors in particular, liberated themselves from the political and religious trends which had governed their work in previous centuries. Some progress was made by applying the clinico-anatomical method to neurology, but it was only at the end of the 19th century and the beginning of the 20th century that discoveries about encephalic arteries had gained ground. During the same period, anatomists in several countries were producing detailed descriptions of this arterial system. Moreover, this period saw the advent of the first generation of vascular neurologists, one of whom, Charles Foix, is considered as the founder of the discipline.

Cerebral Arteries↗
PubMed2005

Blood Pressure, smoking and oral contraceptive control after cryptogenic stroke in young adults in the PFO-ASA Study.

BACKGROUND: Management of vascular risk factors is not optimal in stroke patients. We assessed the control of hypertension, smoking and stopping of oral contraceptive in 581 consecutive young cryptogenic ischemic stroke patients followed in the PFO-ASA study and we identified factors associated with inadequate management. METHODS: At each follow-up visit, blood pressure (BP), smoking and use of oral contraceptive were recorded. Data were analyzed at 6 months, 1 and 2 years. Hypertension was defined as systolic BP > or = 140 or diastolic BP > or = 90 mm Hg, recorded in at least two follow-up visits. Current smoking was defined as more than one cigarette per day reported during at least one follow-up visit. RESULTS: During follow-up, 36% of patients were hypertensive and 30% were smokers. Among the 90 hypertensive patients at baseline, 60-68% remained with high BP and among the 278 patients who were current smokers at baseline, 54-58% still smoked during follow-up. Age (OR = 1.05, 95% CI 1.02-1.08), male sex (OR = 1.42, 95% CI 0.93-2.18), body mass index > or = 27 (OR = 2, 95% CI 1.27-3.17) and known hypertension (OR = 3.08, 95% CI 1.80-5.28) were significantly associated with hypertension during follow-up. Tobacco consumption at baseline (OR = 35.2, 95% CI, 19.3-64.2), alcohol consumption at baseline (OR = 2.7, 95% CI 1.4-5.2) and Rankin < or = 2 (OR = 2.6, 95% CI 1.4-4.9) were independently associated with persistent smoking. Among the 114 women who were using combined estrogen-progesterone pills at baseline, 96.5% stopped. CONCLUSIONS: Major risk factors for stroke are poorly controlled after stroke, even in the context of a prospective clinical study in young adults.

Blood Pressure↗
PubMed2004

[Circumstances of the diagnosis of carotid or vertebrobasilar arteriopathy].

Cerebral ischaemia is a dynamic process affecting the cerebral parenchyma, with transient or permanent clinical symptoms, of varying duration and severity, and which is due to the occlusion of an artery in most cases. The clinical characteristics of cerebral ischaemia include sudden focal cerebral or ocular deficits, which may or may not resolve and have further clinical repercussions. On more rare occasions, ischaemia can be detected in an inadvertent fashion during a general or neurological check-up. In 80% of cases, the anterior (carotid) arterial system is affected, while in the remaining 20%, the posterior (vertebrobasilar) system is involved. Cerebral ischaemia is a medical emergency requiring prompt management and a thorough understanding of clinical semiology as soon as acute manifestations appear. The detection and prediction of cerebral ischaemia will be facilitated through the use of novel neuroimaging techniques, aiding therapeutic decision-making.

Brain Ischemia↗
PubMed2003

Impact of emergency room neurologists on patient management and outcome.

UNLABELLED: The frequency and impact of in-patient assessment by a neurologist in the emergency room (ER) setting remain largely underestimated. The objective of our study was to analyse the impact of neurologist in-patient management. METHODS: Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the ER, the ER team's tentative neurological diagnosis, the neurology team's final diagnosis and patient outcomes. The time interval between admission, call for a neurologist and the assessment by the neurologist were recorded. RESULTS: Assessments by neurologists were performed in 14.7% (1,679/11,421) of all patients admitted to the ER. The mean time between admission and examination was 32 (+/- 36) min, irrespective of the day of the week, and dependent on the tentative diagnosis: shorter for stroke and status epilepticus (p < 0.05) and longer for confusion and vertigo (p < 0.05). The initial causes for examination were: stroke (33.1%), epilepsy (20%), loss of consciousness (9%), headaches (9%), confusion (5.4%), peripheral nervous system disorders (4.4%), vertigo (4.2%), cognitive dysfunctions (4%), gait disorders (3.2%) and miscellaneous (7.1%). Overall, false positive or negative diagnoses were produced by the ER in 37.3 and 36.6% of ER admissions, respectively. A complete change of diagnosis by the neurologist was found in 52.5% of patients. Of the patients undergoing a neurological examination, 18.4% were able to go home, 31.8% were admitted to the stroke unit, 32.4% to the general neurology unit and 17.4% to other departments. CONCLUSION: Our study stresses the need for a neurologist in the ER, both in quantitative terms and for the benefit of patient management.

Brain Diseases↗