Paolo Machi

University Hospital of Geneva

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Document Type

Co-Authors

Alain Bonafé

Hôpital Gui de Chauliac

Vincent Costalat

Hôpital Gui de Chauliac

Karl‐Olof Lövblad

University of Geneva

Olivier Brina

University Hospital of Geneva

Philippe Reymond

University of Geneva

Gianmarco Bernava

University Hospital of Geneva

Jérémy Hofmeister

University Hospital of Geneva

Kyriakos Lobotesis

Imperial College Healthcare NHS Trust

María Isabel Vargas

University Hospital of Geneva

Andrea Rosi

University Hospital of Geneva

Cooperative Institutions

Health and Education Research Management and Epidemiologic Services (United States)

1,243

Boston University

599

Boston Medical Center

573

Inserm

531

The Royal Melbourne Hospital

396

Université Paris Cité

321

Hospital de Clínicas de Porto Alegre

320

Grady Memorial Hospital

311

Foothills Medical Centre

308

Erasmus MC

294

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Transient Neurovascular Interface for Minimally Invasive Neural Recording and Stimulation

Advanced Materials Technologies (2021)

Adele Fanelli Laura Ferlauto Elodie Geneviève Zollinger Olivier Brina Philippe Reymond

Abstract Neural interfaces are used to mitigate the burden of traumatic injuries, neurodegenerative diseases, and mental disorders. However, the transient or permanent placement of an interface in close contact with the neural tissue requires invasive surgery, potentially entailing both short‐ and long‐term complications. To tackle this problem, a transient neurovascular interface for neural recording and stimulation is developed. This endovascular array has been fabricated with facile molding techniques using solely polymeric materials. In vitro experiments have shown promising electrochemical performance for both recording and stimulation, together with a lack of cytotoxicity in cultured cells. The device is compatible with standard endovascular catheters and, once deployed, provide good apposition to a cylindrical structure mimicking a blood vessel. The advantage of this device is twofold. On the one hand, the exploitation of the cerebrovascular system as an access route to the neural tissue avoids invasive surgeries. On the other hand, a transient device may reduce the inflammatory reaction and avoid additional surgeries for removal or replacement. This neurovascular interface combines the benefits of both transient bioelectronics and stent technology in a single device to broaden the range of applications of neural interfaces from neurological diseases and mental disorders to bioelectronics medicine.

Neurovascular bundle

Bioelectronics

Neuroprosthetics

Transient (computer programming)

Interface (matter)

Biocompatible material

10.1002/admt.202100176

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Citations (9)

Can clot density predict recanalization in acute ischemic stroke treated with intravenous tPA?

Clinical and Translational Neuroscience (2017)

Laurie Bouchez S. Altrichter Alain Pellaton Rafik Ouared Zsolt Kulcsár

Stroke has become an absolute emergency that is treated by additional endovascular means or by replacing pharmacological options. Modern neuroradiological techniques such as computed tomography (CT) allow us to examine multiple parameters of the diseased brain. These focused on the parenchyma and hemodynamics for pretherapeutic decisions. However, it has become evident that the clot is the current target for interventional measures. Clot length is established as a marker for recanalization. The dense artery sign is known as an acute CT sign of stroke that is readily visible on acute nonenhanced CT. The rationale behind our study was to study if clot density might represent clot vulnerability or resistance to treatment. We conducted a prospective study of all consecutive stroke patients admitted to our hospital over 1 year, who presented with signs of acute middle cerebral artery stroke within the therapeutic window, and who underwent either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated with a complete stroke CT protocol, transcranial color-coded duplex sonography monitoring, and clinical evaluation with the National Institutes of Health Stroke Scale (NIHSS) score. We measured clot length using planimetry on unenhanced CT and measured Hounsfield units in the clots on the same images. A total of 31 patients were included in the study (19 men, 12 women, aged 35–90 years). We found that patients with a longer clot on the unenhanced CT had a higher NIHSS score, confirming previous literature. However, we found that patients with a lower clot density recanalized to a more marked degree and had a better clinical outcome. Patients who did not recanalize had a higher clot density (49 Hounsfield units) than those who did recanalize (23 Hounsfield units). Overall, measuring the clot seems to be an important additional parameter to be taken into account. In our study, CT clot density seems to correlate with clinical outcome and recanalization. The higher density seems to represent a higher red blood cell content. This is evidence that clot composition could play a much more important role in acute stroke than thought until now and characterizing it with imaging may help in choosing the adequate treatment modality. Higher density seems to reflect erythrocyte content. Therefore, patients with a longer and denser clot may necessitate direct thrombectomy.

Hounsfield scale

Stroke

Midline shift

Acute stroke

10.1177/2514183x17718310

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Citations (8)

Experimental comparison of first-pass effect between direct thromboaspiration and combined thrombectomy in the setting of distal basilar occlusion

Interventional Neuroradiology (2024)

Reza Seiffert Olivier Brina Philippe Reymond Jérémy Hofmeister Gianmarco Bernava

Studies investigating endovascular therapy in vertebro-basilar stroke have led to controversial results in the past, but recent randomized trials seem to show an effectiveness superiority of endovascular therapy versus best medical treatment. However, uncertainty remains concerning many aspects of thrombectomy in acute basilar artery occlusion, notably technical considerations. This study compared the first-pass effect of direct thromboaspiration and combined thrombectomy in the setting of distal basilar occlusion.

Stroke

10.1177/15910199241254412

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Citations (0)

Trans-venous embolization of a basal ganglia ruptured arteriovenous malformation with open surgical arterial control: A hybrid technique

Journal of Neuroradiology (2018)

Zsolt Kulcsár Paolo Machi Karl Schaller Karl‐Olof Lövblad Philippe Bijlenga

Arteriovenous malformation

Intracranial Arteriovenous Malformations

10.1016/j.neurad.2017.12.021

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Citations (3)

Evaluation expérimentale des propriétés mécaniques et de l'efficacité d'enlèvement des thrombus des stent retrievers

Paolo Machi

Un certain nombre d'essais cliniques controles, randomises et publies recemment en litterature a demontre que la thrombectomie mecanique, offerte aux patients presentant un AVC ischemique aigu, est liee a une meilleure evolution clinique en comparaison au traitement standard de fibrinolyse intraveineuse. Les stents retriever ont ete reconnus dans ces essais comme les dispositifs les plus efficaces pour la thrombectomie intracrânienne. Actuellement, toutes les industries produisant des dispositifs neuro-interventionnels lancent sur le marche un nombre croissant de stents retriever. Chaque nouveau dispositif propose est cense avoir une particularite permettant de meilleures performances par rapport aux dispositifs deja disponibles sur le marche. Neanmoins, aucune etude clinique n'a demontre, jusqu'a present, la superiorite en termes de resultats anatomiques et cliniques d'un stent retriever donne. En outre, le mecanisme d'interaction entre les stents retriever et le thrombus n'a pas ete evalue jusqu'ici de facon exhaustive. Dans la presente etude, nous avons analyse experimentalement les performances de tous les stents retriever disponibles sur le marche francais jusqu'a juin 2015. Le but de cette etude etait d'identifier toutes les caracteristiques des dispositifs fonctionnels a la capture du thrombus. Chaque dispositif a ete evalue par des tests mecaniques et fonctionnels : les tests mecaniques ont ete effectues afin d'etudier la force radiale des dispositifs. L'objectif etait d'evaluer la force radiale exercee par le stent dans deux conditions specifiques : lors du deploiement et pendant le retrait. Les tests fonctionnels ont vise a evaluer visuellement la capacite du stent a rester en apposition sur la paroi des vaisseaux et a maintenir le thrombus a l'interieur de ses mailles au cours du retrait. Nous avons evalue l'interaction des dispositifs avec thrombus de taille et de caracteristiques differentes que nous avons generees en utilisant du sang humain afin d'obtenir deux types de caillot : un souple « de type rouge » compose par tous les elements du sang et un dur « de type blanc» qui a ete principalement compose de plasma riche en plaquettes. Ces essais ont ete effectues en utilisant un modele vasculaire rigide reproduisant la circulation cerebrale anterieure. Deux neuro-interventionnels ayant une experience dans les procedures de thrombectomie ont effectue les tests fonctionnels. Chaque experience a ete filmee et deux auteurs par la suite ont effectue une analyse visuelle des resultats. Les essais mecaniques ont montre un comportement different en termes de variation de pression radiale au cours du retrait pour chaque stent. Une pression radiale constante pendant le retrait est liee a une cohesion constante sur la paroi arterielle pendant le retrait, avec un taux plus important de retrait du caillot. Tous les stents retriever glissent sur le caillot blanc de grande taille (diametre>6 mm) ayant un tres bas taux d'efficacite en termes de retrait.

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Inflammation biomarkers in the intracranial blood are associated with outcome in patients with ischemic stroke

Journal of NeuroInterventional Surgery (2024)

Cyril Dargazanli Marine Blaquière Marinette Moynier Frédéric de Bock Julien Labreuche

Performing endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling.

Stroke

Brain ischemia

Blood sampling

Port (circuit theory)

10.1136/jnis-2023-021365

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Citations (1)

Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study

Acta Neurochirurgica (2019)

Daniele Starnoni Rodolfo Maduri Khalid Al Taha David Bervini D. Zumofen

Pica (typography)

Neuroradiology

Interventional radiology

10.1007/s00701-019-03894-5

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Citations (12)

Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study

Journal of Clinical Medicine (2024)

Guillaume Herpe Alexandra Platon Pierre‐Alexandre Poletti Karl‐Olof Lövblad Paolo Machi

We aimed to evaluate whether virtual non-contrast cerebral computed tomography (VNCCT) reconstructed from intravenous contrast-enhanced dual-energy CT (iv-DECT) could replace non-contrast CT (NCCT) in patients with suspected acute cerebral ischemia.

Acute stroke

Dual energy

Stroke

10.3390/jcm13133647

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O-020 Early experience in treating ruptured or unruptured dissecting cerebral aneurysms with pipeline embolization device

Journal of NeuroInterventional Surgery (2011)

Paolo Machi Kyriakos Lobotesis Igor Lima Maldonado Alain Bonafé

Background and Purpose The optimal treatment of intracranial dissecting aneurysms is a challenging issue. In the present study we report our experience using Pipeline Embolization Device for the treatment of such lesions. Methods We retrospectively reviewed our institutional prospectively maintained Pipeline database to identify patient treated with this device for a cerebral dissecting aneurysm. The clinical, procedural and radiological data were reviewed. Results Between July 2009 and December 2010 seven patients (4F/3M, mean age 48 years) underwent endovascular treatment of cerebral dissecting aneurysms with the Pipeline Embolization Device. In two cases the procedure was performed in the setting of acute or subacute subarachnoid hemorrhage. In 2 cases the Pipeline Embolization device was used for the retreatment of a previous unsuccessful stenting and coiling procedures. Three lesions were located in the posterior circulation and four in the anterior circulation. Optimal deployment of the Pipeline Embolization Device was achieved in all patients. No periprocedural complications were reported. One ischemic stroke, with permanent morbidity, was recorded 14 days after the procedure in a patient who did not comply with their antiplatelet therapy. Midterm follow-up results (average 9.8 months) including angiography or MR examinations, were available for six patient and demonstrated complete resolution of the aneurysm in all patient. All six patients demonstrated with an mRS=0 at follow-up. Conclusion The Pipeline Embolization Device achieved optimal clinical and radiological results in six out of seven patients with a cerebral dissecting aneurysm. This device represents a promising option in the treatment of these challenging lesions.

10.1136/neurintsurg-2011-010097.20

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Carotid endarterectomy versus stenting in patients with contralateral carotid artery occlusion

Italian Journal of Vascular and Endovascular Surgery (2012)

Bracale Um L Del Guercio Paolo Machi Ettore Dinoto Mg La Marca

Carotid stenting

Endarterectomy

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Citations (2)