Eimad Shotar

• Doctor of Medicine
• Praticien Hospitalier at Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")

The Woven EndoBridge (WEB) device is FDA-approved for the treatment of bifurcation aneurysms. Despite its wide popularity, it has been under scrutiny for its association with potential aneurysm recanalization and retreatment due to device shape modification. This study aims to analyze the shape modification rate of WEB devices and identify factors...

Objective: Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck...

Background Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment. Methods Databases from 39 centers were retrospectively reviewed for unruptured DACA aneury...

INTRODUCTION Cementoplasty is used to treat lytic bone lesions that are critically located, painful, or fractured. It is particularly useful in multiple myeloma. Hematological therapeutic improvements have considerably extended the life expectancy of myeloma patients. This study aimed to evaluate the long-term clinical efficacy, mechanical stabilit...

Background Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke from large vessel occlusion (LVO). While embolization to a new territory (ENT) after MT is well-documented, data on embolization in the same distal territory (EDT) are limited. Achieving modified Treatment In Cerebral Infarction (mTICI) 3 reperfusion present...

Background Regression or disappearance of MRI abnormalities is usually observed after treatment of spinal dural arteriovenous fistulae (sDAVF). Objective To assess the correlation between spinal MRI (sMRI) changes with sDAVF exclusion and clinical outcome. Methods Imaging data of patients treated with endovascular embolization for sDAVF between 2...

OBJECTIVE The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their si...

Objective: Many patients recruited in the Treatment of Brain Arteriovenous Malformations Study (TOBAS) are managed conservatively. The aim of this study was to monitor what happened to those patients. Methods: TOBAS comprises two randomized controlled trials and multiple prospective registries. All patients with brain arteriovenous malformations...

Introduction Regression or disappearance of MRI abnormalities is usually observed after treatment of spinal arterio-venous fistulae (sDAVF). Aim of Study We aimed to assess the correlation between MRI changes with sDAVF exclusion and clinical outcome. Methods Imaging data of patients treated with endovascular embolization for sDAVF between 2007 a...

Purpose This study aims to explore the impact of ultra-early neurological deterioration (U-END) on the outcome (mortality and poor neurological status) following a brain arteriovenous malformation (BAVM) rupture and identify determinants of U-END. Methods Patients with BAVM ruptures admitted to a single tertiary care center were retrospectively re...

Background and Purpose So-called contrast-induced encephalopathy (CIE) is a rare but worrying condition occurring after cerebral angiography or neuroendovascular interventions using iodine contrast media. This study aimed to compare cerebral iodine concentrations in patients suspected of having CIE after endovascular procedures to those in matched...

Background Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond–Roy classification 1 or 2) remains challenging. Objective Our study sought to develop and validate a predictive calculator for adequate o...

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB C...

Traumatic intracranial aneurysm (TICA) is a rare and aggressive pathology that requires prompt treatment. Nevertheless, early vascular imaging following head trauma may yield falsely negative results, underscoring the importance of subsequent imaging within the first week to detect delayed TICAs. This study aims to report our experience with delaye...

Background and purpose: Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment. Materials and methods: This is a review of a prospectively maintaine...

OBJECTIVE This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the...

BACKGROUND AND OBJECTIVES Endovascular embolization of brain arteriovenous malformations (AVMs) is sometimes intentionally partial, in the case of staged treatment for instance. Residual AVMs may be prone to angioarchitectural modification during follow-up. The objective of this work is to evaluate the nature and extent of these modifications. MET...

Background Mechanical thrombectomy (MT) has become a standard treatment for acute ischemic strokes (AIS). However, MT failure occurs in approximately 10–30% of cases, leading to severe repercussions (with mortality rates up to 40% according to observational data). Among the available rescue techniques, rescue intracranial stenting (RIS) appears as...

Background The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devic...

OBJECTIVE The pathogenesis of intracranial dural arteriovenous fistulas (icDAVFs) is controversial. Cerebral vein thrombosis (CVT) and venous hypertension are recognized predisposing factors. This study aimed to evaluate the incidence of association between icDAVF and CVT and describe baseline aggressiveness and clinical outcomes for icDAVFs associ...

Background Middle meningeal artery (MMA) embolization has been proposed as a treatment of chronic subdural hematoma (CSDH). The benefit of the procedure has yet to be demonstrated in a randomized controlled trial. We aim to assess the efficacy of MMA embolization in reducing the risk of CSDH recurrence 6 months after burr-hole surgery compared with...

Background: The Woven EndoBridge (WEB) device is frequently used for the treatment of intracranial aneurysms. Postoperative management, including the use of aspirin, varies among clinicians and institutions, but its impact on the outcomes of the WEB has not been thoroughly investigated. Methods: This was a retrospective, multicenter study involvin...

BACKGROUND The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined techniqu...

The evolution and development of the head have long captivated researchers due to the crucial role of the head as the gateway for sensory stimuli and the intricate structural complexity of the head. Although significant progress has been made in understanding head development in various vertebrate species, our knowledge of early human head ontogeny...

Rationale Mechanical thrombectomy (MT) associated with the best medical treatment (BMT) has recently shown efficacy for the management of acute ischemic stroke (AIS) secondary to a large vessel occlusion. However, evidence is lacking regarding the benefit of MT for more distal occlusions. Aim To evaluate the efficacy in terms of good clinical outc...

Background Aneurysm location is a key element in predicting the rupture risk of an intracranial aneurysm. A common impression suggests that pure ophthalmic aneurysms are under-represented in ruptured intracranial aneurysms (RIAs). The purpose of this study was to specifically evaluate the risk of rupture of ophthalmic aneurysms compared with other...

OBJECTIVE The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors a...

Background Non-ischemic cerebral enhancing (NICE) lesions following aneurysm endovascular therapy are exceptionally rare, with unknown longitudinal evolution. Objective To evaluate the radiological behavior of individual NICE lesions over time. Methods Patients included in a retrospective national multicentric inception cohort were analyzed. NICE...

Background Spinal arteriovenous fistulas can be treated either by surgery or by endovascular means, using different strategies. The main drawback of embolization is the risk of recurrence. Our objective is to evaluate the angiographic occlusion rate and the predictive factors of angiographic cure of spinal arteriovenous fistulas at 3 months or more...

Introduction Spinal arteriovenous fistulas can be treated either by surgery or by endovascular means, using different strategies. The main drawback of embolization is the risk of recurrence. Aim of Study To evaluate the angiographic occlusion rate and the predictive factors of angiographic cure of spinal arteriovenous fistulae at 3 months or more...

Introduction Aneurysm location is a key element in predicting an intracranial aneurysm’s rupture risk. Ophthalmic aneurysms, superior hypophyseal/carotid cave aneurysms, internal carotid artery termination aneurysms are grouped together under the ‘internal carotid artery aneurysm’ label in studies evaluating the rupture risk of unruptured intracran...

Background The balloon pressure technique (BPT) is an alternative to the pressure cooker technique. A dual lumen balloon (DLB) is used to inject the liquid embolic agent through the working lumen while the balloon is inflated. The purpose of our study was to report our early experience using the Scepter Mini dual lumen balloons for BPT in brain art...

Background: The occurrence of persistent intra-device filling (BOSS 1, using the Bicêtre Occlusion Scale Score (BOSS)) in aneurysms treated with a Woven Endobridge (WEB) device is infrequent based on angiographic follow-up. To date, three monocentric case series were published studying BOSS 1 cases. Through a multicenter retrospective study, we ai...

Background and Objective A compact nidus is a well-known feature of good outcome after treatment in brain arteriovenous malformations (bAVM). This item, included in the “Supplementary AVM grading system” by Lawton, is subjectively evaluated on DSA. The present study aimed to assess whether quantitative nidus compacity along with other angio-archite...

Background Predicting functional outcome in critically ill patients with traumatic brain injury (TBI) strongly influences end-of-life decisions and information for surrogate decision makers. Despite well-validated prognostic models, clinicians most often rely on their subjective perception of prognosis. In this study, we aimed to compare physicians...

Background and purpose: Mechanical thrombectomy appears to be a promising option for distal medium-vessel occlusions, for which intravenous thrombolysis is effective but may be insufficient when used alone. This study aimed to determine the optimal technique for these distal mechanical thrombectomies using the human placenta model. Materials and...

OBJECTIVE The management of Spetzler-Martin grade (SMG) III brain arteriovenous malformations (bAVMs) may be challenging, whatever the exclusion treatment modality chosen. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment (EVT) as a first-line treatment of SMG III bAVMs. METHODS The authors performed...

Introduction Refractory intracranial hypertension (rICH) is a severe complication among patients with severe traumatic brain injury (sTBI). Medical treatment may be insufficient, and in some cases, the only viable treatment option is decompressive hemicraniectomy. The assessment of a corticosteroid therapy against vasogenic edema secondary to sever...

Background and purpose: Intracranial aneurysms are frequent in patients with sickle cell anemia, while subarachnoid hemorrhage is a major cause of death and disability in young adult patients. Several characteristics, such as younger age and smaller size at rupture, may incline therapeutic decision towards exclusion treatments. Clinical guidelines...

Background: The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study comprising 2 randomized clinical trials (RCTs). Patients excluded from RCTs are followed in parallel treatment and observation registries, allowing a comparison between RCT and registry patients. Methods: The first RCT (RCT-1) offers 1:1 randomized allocati...

Objectives To assess the feasibility and technical outcomes of pelvic bone cementoplasty using an electromagnetic navigation system (EMNS) in standard practice.Materials and methodsMonocentric retrospective study of all consecutive patients treated with cementoplasty or reinforced cementoplasty of the pelvic bone with EMNS-assisted procedures. The...

Objective: The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmat...

Background and purpose: MCA aneurysms are still commonly clipped surgically despite the recent development of a number of endovascular tools and techniques. We measured clinical uncertainty by studying the reliability of decisions made for patients with middle cerebral artery (MCA) aneurysms. Materials and methods: A portfolio of 60 MCA aneurysm...

Indications for mechanical thrombectomy in acute ischemic stroke are increasing, resulting in the continuous development of new devices and techniques. Therefore, there is a need for a realistic testing and training environment that offers the opportunity to practice different procedures and test the latest devices. Some authors have described the...

Objective: The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. Methods: TOBAS patients are managed according to an algorithm that combines clinical judgment and...

Background The Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status. Methods Our data were taken from the Wor...

Background Little is known about incidence, time of onset, clinical presentation, and risk factors of epileptic seizure following brain arteriovenous malformation (bAVM) rupture. Methods We performed a monocentric retrospective cohort study from January 2003 to March 2021. The main objective of this study was to determine the incidence of seizures...

Aggressive vertebral hemangiomas usually exhibit extraosseous expansion that can result in spinal cord or radicular compression.1 In symptomatic cases, treatment by alcohol embolization and percutaneous vertebroplasty has been reported as feasible, safe, and effective with long-term benefits on neurological symptoms.2 Safety rules before vertebral...

Purpose Middle meningeal artery (MMA) particle embolization is a promising treatment of chronic subdural hematomas (CSDH). The main purpose of this study is to measure MMA proximal caliber and assess the visibility of the two main MMA branches as a surrogate for long-term distal arterial patency following MMA CSDH embolization with trisacryl gelati...

Purpose The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level. Objective In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid hemorrhage would have predicted a high risk of aneu...

PurposeTectum mesencephali arteriovenous malformations (TM-AVMs) are rare lesions deeply located close to eloquent structures making them challenging to treat. We aimed to present clinical presentation, angiographic features and treatment strategies of TM-AVMs through a single center retrospective case series.MethodsA TM-AVMs is defined as a nidus...

In the last years, we have faced a blooming of mechanical thrombectomy (MT). Numerous randomized controlled trials have shown the benefit of MT, combined with the best medical treatment, in the setting of acute ischemic stroke with large vessel occlusion. Thus, the management and triage of patients with acute ischemic stroke have become crucial in...

Embolization of the middle meningeal artery has gained substantial interest as a therapy for chronic subdural hematomas. For the results of the currently running chronic subdural hematoma trials to inform clinical practice, sufficient accuracy and matching definitions are necessary. We summarized the current practice in chronic subdural hematoma ev...

Objective To evaluate the feasibility, safety, and rate of radial artery occlusion (RAO) after the treatment of intracranial aneurysms using a 6F Neuron MAX (Penumbra, Alameda, CA, USA) long sheath directly into the radial artery. Methods All consecutive patients treated for unruptured intracranial aneurysms with TRA using a 6F Neuron MAX catheter...

Purpose Spetzler-Martin grade (SMG) I–II (low-grade) brain arteriovenous malformations (BAVMs) are often considered safe for microsurgical resection; however, the role of endovascular treatment (EVT) remains to be clarified in this indication, especially for unruptured BAVMs. The purpose of our study was to assess the safety and effectiveness of en...

Background: Geometrical parameters, including arterial bifurcation angle, tortuosity, and arterial diameters, have been associated with the pathophysiology of intracranial aneurysm (IA) formation. The aim of this study was to investigate whether these parameters were present before or if they resulted from IA formation and growth. Methods: Patie...

Objectives: To describe a novel long-axis multimodal navigation assisted technique - the so-called Eiffel Tower technique - aimed at integrating recent technological improvements for the routine treatment of sacral insufficiency fractures. Materials and methods: The long-axis approach described in the present study aimed at consolidating the sac...

To report the occurrence of non-ischemic cerebral enhancing (NICE) lesions following mechanical thrombectomy (MT) through the retrospective French nationwide registry of NICE lesions. All thrombectomy capable stroke centers (TSC) in France were invited to fill out a questionnaire disseminated through a trainee-led research network (JENI-RC: Jeunes...

Objective Evaluation of chronic subdural hematoma (cSDH) treatment success relies on radiologic measures, in particular hematoma volume, width and midline shift (MLS). Nevertheless, there are no validated standards for MLS measurement in cSDH. Aim of this study was to identify the most reliable measurement location and technique for MLS. Methods A...

Background Spinal arteriovenous fistulas (SAVFs) are challenging lesions to treat by endovascular means. Our purpose was to report our early experience with dual lumen balloons (DLBs) for embolization of SAVFs using ethylene vinyl alcohol (EVOH) (the so-called 'balloon pressure technique' (BPT)). Materials and methods During the inclusion period,...

Purpose: To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determi...

Objectives: Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of reinforced cementoplasty (RC) in painful and unstable lesions involving the pelvic bone in terms of pain relief and functional recovery. Methods: All patients with neopla...

Background Distal vessel occlusions represent about 25-40% of acute ischemic stroke (AIS), either as primary occlusion or secondary occlusion complicating mechanical thrombectomy (MT) for large vessel occlusion. Objective Our aim was to evaluate safety and effectiveness of MT associated with the best medical treatment (BMT) in the management of AI...

Objectives: Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during reinforced cementoplasty may cause vascular, nerve or cartilage injury. Our goal was to evaluate the rate of cement leakage/spindle extraction and describe the techniques used...

Background Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional...

PurposeMiddle meningeal artery (MMA) embolization is emerging as a potential treatment of chronic subdural hematomas (CSDHs). The purpose of this study is to describe MMA angiographic anatomy in relation to CSDH embolization.Methods This retrospective monocentric study was performed on imaging data of MMA embolization procedures for CSDH treatment...

Background Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfus...

Introduction La genèse des fistules artério-veineuses durales intra-crâniennes (FAVDi) est mal connue. Les thromboses veineuses cérébrales (TVC) et l'hypertension intra-crâniennes seraient des facteurs favorisants la survenue d'une FAVDi. L'objectif de notre étude était d’évaluer l'incidence de l'association FAVDi et TVC, et d’étudier l'agressivité...

Contexte — L'encéphalopathie aux produits de contraste iodés (EPDC) est une entité rare mais préoccupante survenant dans les suites de procédures de cathétérisme endovasculaire utilisant des produits de contraste iodé. Cette étude vise à comparer la concentration intra-cérébrale en produit de contraste iodé mesurée à l'aide d'un scanner multi-énerg...

Rationnel et objectif Les fistules artério-veineuses médullaires (FAVm) sont des malformations vasculaires complexes dont le traitement par voie endovasculaire peut s'avérer difficile. L'objectif de notre travail est de rapporter notre expérience préliminaire dans l'utilisation de ballons double-lumière pour l'embolisation des FAVm avec de l’éthylè...

Introduction Les anévrismes fusiformes de l'artère basilaire (AFTB) sont rares (1-13% des anévrysmes de fosse postérieure), de cause encore imparfaitement comprise (dissection, athérosclérose …), mais associés à un taux de morbidité élevé. En effet, 60 % des patients présentent de nouveaux symptômes sans traitement (compression du tronc cérébral, c...

Background The methodology of measuring chronic subdural hematoma (cSDH) extent and its effect on intracranial structures is relevant for patient classification and outcome measurements and affects the external validity of cSDH studies. With embolization of the middle meningeal artery (MMA) as a possible treatment of cSDHs, the topic has gained sub...

Summary Purpose : Mechanical thrombectomies (MT) in patients with large vessel occlusion (LVO) related to calcified cerebral embolus (CCE) have been reported, through small case series, being associated with low reperfusion rate and worse outcome, compared to regular MT. The purpose of the MASC (Mechanical Thrombectomy in Acute Ischemic Stroke Rela...

Avascular necrosis, or Kummel disease, is a potential complication of vertebral compression fractures. It is believed to arise as a result of a failed fracture healing process,1 2 leading to the formation of an air or fluid filled cavity within the vertebral body.3 Percutaneous vertebroplasty seems to provide both pain relief and increased spinal s...

Objectives: Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions. Its role in neurologic diseases of unknown etiology remains controversial, especially in ICU patients. This study was undertaken to determine the feasibility, safety, and the diagnostic yield of brain biopsy in critically ill pa...