FHU NEUROVASC : Reduce the “gap” between the different medical specialties 

Neurology, neurosurgery, neuroradiology, critical care, rehabilitation, genetics

To promote both, vertical and horizontal translation of CeVD research

through a better integration of clinicians and basic scientists at different levels of research projects

To foster ambitious research programs on well-defined CeVD subtypes

using cutting edge technologies and innovative methodologies.

Cerebrovascular disease (CeVD) is a major public health issue. In France, about 130,000 new strokes occur each year, including 30,000 with chronic handicap requiring long-term health insurance coverage. Stroke is the main cause of acquired disability in adults, the second cause of dementia and cognitive decline, and the first cause of death in women.

The long-term burden and associated health care costs are likely to increase with aging populations, and many countries have called for improved prevention plans. The majority of strokes are cerebral infarcts due to arterial occlusion, whereas 15-20% correspond to cerebral or subarachnoid hemorrhage due to intracranial vessel rupture.

new strokes per year

CeVD is an extremely heterogeneous condition not only in terms of clinical presentation, but also in respect to pathophysiological mechanisms, prognosis and treatment strategies. Underlying causes include atherosclerosis, cardioembolic sources, ischemic or hemorrhagic small vessel disease, arterial dissection, cerebral venous thrombosis, vascular malformations, and rare or hereditary vasculopathies. In many patients, the underlying causes remain undetermined.

The FHU NeuroVasc is a joint « federation hospitalo-universitaire » combining: different clinical and imaging departments of Lariboisière hospital (AP-HP) and of Sainte-Anne hospital ( GHU-PPN), University of Paris, INSERM research laboratories as core members and a network clinical of partner teams : Neuroradiology at Fondation ophtalmomlogique de Rothschild, neurology departments at Foch hospital , St Joseph hospital,  at CHU Amiens, CHU de Caen, clinical research units and biological ressources centre  at Lariboisière hospital ,sainte anne hospital and Caen as well as the imaging research centre Neurospin of CEA, all together as associate members.

News

FHU NeuroVasc Workshop – Save the date – 8th, March, 2023 « Intelligence artificielle pour la prise en charge de l’AVC »

Intelligence Artificielle et prise en charge de l'AVC Inscription gratuite  Centre de congrès Edouard VII, Paris  

Workshop – Save the date – 8th, March 2022

" Intelligence artificielle : des outils pour mieux prendre en charge les AVC" Edouard VII business center, Paris

Phenotypic variability in 446 CADASIL patients: Impact of NOTCH3 gene mutation location in addition to the effects of age, sex and vascular risk factors

The recent discovery that the prevalence of cysteine mutations in the NOTCH3 gene responsible for CADASIL was more than 100 times higher in the general population than that estimated in patients highlighted that the mutation location in EGFr-like-domains of the NOTCH3 receptor could have a major effect on the phenotype of the disease. The exact impact of such mutations locations on the multiple facets of the disease has not been fully evaluated.

Framework for Clinical Trials in Cerebral Small Vessel Disease (FINESSE): A Review

Importance: Cerebral small vessel disease (SVD) causes a quarter of strokes and is the most common pathology underlying vascular cognitive impairment and dementia. An important step to developing new treatments is better trial methodology. Disease mechanisms in SVD differ from other stroke etiologies; therefore, treatments need to be evaluated in cohorts in which SVD has been well characterized. Furthermore, SVD itself can be caused by a number of different pathologies, the most common of which are arteriosclerosis and cerebral amyloid angiopathy. To date, there have been few sufficiently powered high-quality randomized clinical trials in SVD, and inconsistent trial methodology has made interpretation of some findings difficult.

Quantitative analysis of early-stage EEG reactivity predicts awakening and recovery of consciousness in patients with severe brain injury

Background: Decisions of withdrawal of life-sustaining therapy for patients with severe brain injury are often based on prognostic evaluations such as analysis of electroencephalography (EEG) reactivity (EEG-R). However, EEG-R usually relies on visual assessment, which requires neurophysiological expertise and is prone to inter-rater variability. We hypothesised that quantitative analysis of EEG-R obtained 3 days after patient admission can identify new markers of subsequent awakening and consciousness recovery.

Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure

Importance: The Patent Foramen Ovale (PFO)-Associated Stroke Causal Likelihood classification system combines information regarding noncardiac patient features (vascular risk factors, infarct topography) and PFO features (shunt size and presence of atrial septal aneurysm [ASA]) to classify patients into 3 validated categories of responsiveness to treatment with PFO closure. However, the distinctive associations of shunt size and ASA, alone and in combination, have not been completely delineated.

Objective: To evaluate the association of PFO closure with stroke recurrence according to shunt size and/or the presence of an ASA.

Réunion de lancement – 28/09/2020

Aujourd'hui , les membres du FHU NeuroVasc se réunissent pour l'ouverture officielle du réseau. Un temps de présentation et d'échange Au programme Présentation générale du FHU NeuroVascOutils et Moyens à dispositionLes workpackagesLa vie du réseau

The aims of FHU NeuroVAsc are

N

to reduce the “gap” between the different medical specialties

(neurology, neurosurgery, neuroradiology, critical care,rehabilitation, genetics) involved in the clinical management of CeVD, through sharing of competences, expertise, research, and innovation projects;

N

to promote both, vertical and horizontal translation of CeVD research

through a better integration of clinicians and basic scientists at different levels of research projects;

N

to foster ambitious research programs on well-defined CeVD subtypes

using cutting edge technologies and innovative methodologies including high throughput genetic studies, unique animal models, new generation biomarkers, advanced statistical analysis and multimodal imaging methods.

Workpackages

The care and research program will particularly focus on the following objectives, defined in four workpackages :

  • Develop innovative tools, experimental models and therapeutic approaches that can help tailoring individualized acute ischemic stroke therapy in future;
  • Better understand the pathophysiology of familial and common forms of SVD, their exact consequences at cerebral and clinical level through targeted experiments and innovative clinical and imaging approaches;
  • Refine risk stratification and preventive treatments in patients with carotid arterial disease and patent foramen ovale;
  • Optimize prognostication and improve therapeutic decisions in patients with intracranial hemorrhage;
  • Identify novel biomarkers that can help therapeutic evaluation through the set-up of common highly phenotyped cohorts of CeVD patients and shared biobanks.

Click on the images below for more details :

WP1 – Pr. Mikaël Mazighi

Towards personalized therapies
in acute ischemic stroke

WP2 – Pr. Eric Jouvent

Novel tools and targets for the development of disease-modifying treatments in Small vessel disease

WP3 – Pr. David Calvet

Future targeted prevention in
cerebrovascular diseases patients

WP4 – Dr. Peggy Reiner

Intracerebral hemorrhage: from optimized multidisciplinary care to improved outcome and recurrence prediction

Publications

Phenotypic variability in 446 CADASIL patients: Impact of NOTCH3 gene mutation location in addition to the effects of age, sex and vascular risk factors

The recent discovery that the prevalence of cysteine mutations in the NOTCH3 gene responsible for CADASIL was more than 100 times higher in the general population than that estimated in patients highlighted that the mutation location in EGFr-like-domains of the NOTCH3 receptor could have a major effect on the phenotype of the disease. The exact impact of such mutations locations on the multiple facets of the disease has not been fully evaluated.

Framework for Clinical Trials in Cerebral Small Vessel Disease (FINESSE): A Review

Importance: Cerebral small vessel disease (SVD) causes a quarter of strokes and is the most common pathology underlying vascular cognitive impairment and dementia. An important step to developing new treatments is better trial methodology. Disease mechanisms in SVD differ from other stroke etiologies; therefore, treatments need to be evaluated in cohorts in which SVD has been well characterized. Furthermore, SVD itself can be caused by a number of different pathologies, the most common of which are arteriosclerosis and cerebral amyloid angiopathy. To date, there have been few sufficiently powered high-quality randomized clinical trials in SVD, and inconsistent trial methodology has made interpretation of some findings difficult.

Quantitative analysis of early-stage EEG reactivity predicts awakening and recovery of consciousness in patients with severe brain injury

Background: Decisions of withdrawal of life-sustaining therapy for patients with severe brain injury are often based on prognostic evaluations such as analysis of electroencephalography (EEG) reactivity (EEG-R). However, EEG-R usually relies on visual assessment, which requires neurophysiological expertise and is prone to inter-rater variability. We hypothesised that quantitative analysis of EEG-R obtained 3 days after patient admission can identify new markers of subsequent awakening and consciousness recovery.

Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure

Importance: The Patent Foramen Ovale (PFO)-Associated Stroke Causal Likelihood classification system combines information regarding noncardiac patient features (vascular risk factors, infarct topography) and PFO features (shunt size and presence of atrial septal aneurysm [ASA]) to classify patients into 3 validated categories of responsiveness to treatment with PFO closure. However, the distinctive associations of shunt size and ASA, alone and in combination, have not been completely delineated.

Objective: To evaluate the association of PFO closure with stroke recurrence according to shunt size and/or the presence of an ASA.

Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone

Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone JAMA Neurol, . 2021 Jan 11;e204557. doi: 10.1001/jamaneurol.2020.4557. Online ahead of print. PMID: 33427887 PMCID:...

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion

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