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2. Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study

Author

Paciaroni, Maurizio, primary, Caso, Valeria, additional, Romoli, Michele, additional, Becattini, Cecilia, additional, Salerno, Alexander, additional, Rapillo, Costanza, additional, Simonnet, Fanny, additional, Strambo, Davide, additional, Canavero, Isabella, additional, Zedde, Marialuisa, additional, Pascarella, Rosario, additional, Sohn, Sung-Il, additional, Sacco, Simona, additional, Ornello, Raffaele, additional, Barlinn, Kristian, additional, Schoene, Daniela, additional, Rahmig, Jan, additional, Mosconi, Maria Giulia, additional, Leone De Magistris, Ilaria, additional, Alberti, Andrea, additional, Venti, Michele, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Padroni, Marina, additional, Laudisi, Michele, additional, Zini, Andrea, additional, Gentile, Luana, additional, Kargiotis, Odysseas, additional, Tsivgoulis, Georgios, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Karapanayiotides, Theodore, additional, Engelter, Stefan T, additional, Polymeris, Alexandros A, additional, Zietz, Annaelle, additional, Bandini, Fabio, additional, Caliandro, Pietro, additional, Reale, Giuseppe, additional, Moci, Marco, additional, Zauli, Aurelia, additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Giorli, Elisa, additional, Toni, Danilo, additional, Andrighetti, Marco, additional, Falcou, Anne, additional, Palaiodimou, Lina, additional, Ntaios, George, additional, Sagris, Dimitrios, additional, Karagkiozi, Efstathia, additional, Adamou, Anastasia, additional, Halvatsiotis, Panagiotis, additional, Flomin, Yuriy, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Popovic, Nemanja, additional, Pantoni, Leonardo, additional, Mele, Francesco, additional, Molitierno, Nicola, additional, Lochner, Piergiorgio, additional, Pezzini, Alessandro, additional, Del Sette, Massimo, additional, Sassos, Davide, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Lotti, Enrico Maria, additional, Mastrangelo, Vincenzo, additional, Chiti, Alberto, additional, Naldi, Andrea, additional, Vanacker, Peter, additional, Ferrante, Mario, additional, Volodina, Vera, additional, Mancuso, Michelangelo, additional, Giannini, Nicola, additional, Baldini, Marco, additional, Vadikolias, Kostantinos, additional, Kitmeridou, Sofia, additional, Saggese, Carlo Emanuele, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, and Michel, Patrik, additional

Published
2023
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3. Antiphospholipid antibodies in patients with stroke during COVID-19: A role in the signaling pathway leading to platelet activation

Author

Capozzi, Antonella, primary, Riitano, Gloria, additional, Recalchi, Serena, additional, Manganelli, Valeria, additional, Longo, Agostina, additional, Falcou, Anne, additional, De Michele, Manuela, additional, Garofalo, Tina, additional, Pulcinelli, Fabio M., additional, Sorice, Maurizio, additional, and Misasi, Roberta, additional

Published
2023
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4. SARS-CoV-2 infection predicts larger infarct volume in patients with acute ischemic stroke

Author

De Michele, Manuela, primary, Lorenzano, Svetlana, additional, Piscopo, Paola, additional, Rivabene, Roberto, additional, Crestini, Alessio, additional, Chistolini, Antonio, additional, Stefanini, Lucia, additional, Pulcinelli, Fabio M., additional, Berto, Irene, additional, Campagna, Roberta, additional, Amisano, Paolo, additional, Iacobucci, Marta, additional, Cirelli, Carlo, additional, Falcou, Anne, additional, Nicolini, Ettore, additional, Schiavo, Oscar G., additional, and Toni, Danilo, additional

Published
2023
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5. The risk of stroke recurrence in patients with atrial fibrillation and reduced ejection fraction

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Caso, Valeria, Becattini, Cecilia, Mosconi, Maria Giulia, Giustozzi, Michela, Tsivgoulis, Georgios, Seiffge, David Julian, Engelter, Stefan T., Lyrer, Philippe, Polymeris, Alexandros A., Dittrich, Tolga, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna M., Yperzeele, Laetitia, Loos, Caroline M.J., Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Mac Grory, Brian, Jayaraman, Mahesh, Yaghi, Shadi, Furie, Karen L., Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, De Magistris, Ilaria Leone, Cancelloni, Virginia, Kargiotis, Odysseas, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Moci, Marco, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D’Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrios, Giannopoulos, Sotirios, Kosmidou, Maria, Ntais, Evangelos, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Morotti, Andrea, Magoni, Mauro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Carletti, Monica, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Lanari, Alessia, Tatlisumak, Turgut, Acciarresi, Monica, Vannucchi, Vieri, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Sohn, Sung-Il, Mumoli, Nicola, Tadi, Prasanna, Letteri, Federica, Maccarrone, Miriam, Galati, Franco, Tiseo, Cindy, Gourbali, Vanessa, Halvatsiotis, Panagiotis, Orlandi, Giovanni, Giuntini, Martina, Corea, Francesco, Bellesini, Marta, Baronello, Mario Maimone, Karapanayiotides, Theodore, Rueckert, Christina, Csiba, Laszló, Szabó, Lilla, Rigatelli, Alberto, Imberti, Davide, Zabzuni, Dorjan, Pieroni, Alessio, Barlinn, Kristian, Pallesen, Lars-Peder, Barlinn, Jessica, Doronin, Boris, Volodina, Vera, Deleu, Dirk, Bonetti, Bruno, Porta, Cesare, Gentile, Luana, Eskandari, Ashraf, and De Marchis, Gian Marco

Abstract

Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF.Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding).Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84–1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03–1.77).Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.

Published
2023
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6. Risk of recurrent stroke in patients with atrial fibrillation treated with oral anticoagulants alone or in combination with anti-platelet therapy

Author

Caliandro, Pietro, Cancelloni, Virginia, Marco, Moci, Reale, Giuseppe, Zauli, Aurelia, Agnelli, Giancarlo, Caso, Valeria, Becattini, Cecilia, Calabresi, Paolo, Giulia Mosconi, Maria, Giustozzi, Michela, Tsivgoulis, Georgios, Julian Seiffge, David, Engelter, Stefan T., Lyrer, Philippe, Polymeris, Alexandros A., Dittrich, Tolga, Zietz, Annaelle, Marco De Marchis, Gian, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna, Yperzeele, Laetitia, Loos, Caroline M.J., Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil, Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Mac Grory, Brian, Jayaraman, Mahesh, McTaggart, Ryan, Yaghi, Shadi, Furie, Karen L., Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Maria Lotti, Enrico, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, Leone De Magistris, Ilaria, Kargiotis, Odysseas, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D’Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrios, Giannopoulos, Sotirios, Kosmidou, Maria, Ntais, Evangelos, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Emanuele Saggese, Carlo, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Chiara Caselli, Maria, Ulivi, Leonardo, Giannini, Nicola, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Halvatsiotis, Panagiotis, Carletti, Monica, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Lanari, Alessia, Tatlisumak, Turgut, Acciarresi, Monica, Vannucchi, Vieri, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Sohn, Sung-Il, Mumoli, Nicola, Tadi, Prasanna, Letteri, Federica, Maccarrone, Miriam, Poli, Loris, Magoni, Mauro, Galati, Franco, Tiseo, Cindy, Gourbali, Vanessa, Orlandi, Giovanni, Giuntini, Martina, Corea, Francesco, Bellesini, Marta, Girardi, Laura, Maimone Baronello, Mario, Karapanayiotides, Theodore, Rueckert, Christina, Csiba, Laszló, Szabó, Lilla, Rigatelli, Alberto, Imberti, Davide, Zabzuni, Dorjan, Pieroni, Alessio, Barlinn, Kristian, Pallesen, Lars-Peder, Barlinn, Jessica, Doronin, Boris, Volodina, Vera, Deleu, Dirk, Bonetti, Bruno, Porta, Cesare, Gentile, Luana, Eskandari, Ashraf, and Paciaroni, Maurizio

Abstract

Introduction: Ischaemic stroke patients with atrial fibrillation (AF) are at high risk of stroke recurrence despite oral anticoagulation therapy. Patients with cardiovascular comorbidities may take both antiplatelet and oral anticoagulation therapy (OAC/AP). Our study aims to evaluate the safety and efficacy of OAC/AP therapy as secondary prevention in people with AF and ischaemic stroke.Patients and methods: We performed a post-hoc analysis of pooled individual data from multicenter prospective cohort studies and compared outcomes in the OAC/AP cohort and patients on DOAC/VKA anticoagulation alone (OAC cohort). Primary outcome was a composite of ischaemic stroke, systemic embolism, intracranial bleeding, and major extracranial bleeding, while secondary outcomes were ischaemic and haemorrhagic events considered separately. A multivariable logistic regression analysis was performed to identify independent predictors for outcome events. To compare the risk of outcome events between the two cohorts, the relation between the survival function and the set of explanatory variables were calculated by Cox proportional hazard models and the results were reported as adjusted hazard ratios (HR). Finally another analysis was performed to compare the overall risk of outcome events in both OAC/AP and OAC cohorts after propensity score matching (PSM).Results: During a mean follow-up time of 7.5 ± 9.1 months (median follow-up time 3.5 months, interquartile range ±3), 2284 stroke patients were on oral anticoagulants and 215 were on combined therapy. The multivariable model demonstrated that the composite outcome is associated with age (OR: 1.03, 95% CI: 1.01–1.04 for each year increase) and concomitant antiplatelet therapy (OR: 2.2, 95% CI: 1.48–3.27), the ischaemic outcome with congestive heart failure (OR: 1.55, 95% CI: 1.02–2.36) and concomitant antiplatelet therapy (OR: 1.93, 95% CI: 1.19–3.13) and the haemorrhagic outcome with age (OR: 1.03, 95% CI: 1.01–1.06 for each year increase), alcoholism (OR: 2.15, 95% CI: 1.06–4.39) and concomitant antiplatelet therapy (OR: 2.22, 95% CI: 1.23–4.02). Cox regression demonstrated a higher rate of the composite outcome (hazard ratio of 1.93 [95% CI, 1.35–2.76]), ischaemic events (HR: 2.05 [95% CI: 1.45–2.87]) and bleeding outcomes (HR: 1.90 [95% CI, 1.06–3.40]) in OAC/AP cohort. After PSM analysis, the composite outcome remained more frequent in people treated with OAC + AP (RR: 1.70 [95% CI, 1.05–2.74]).Discussion: Secondary prevention with combination of oral anticoagulant and antiplatelet therapy after ischaemic stroke was associated with worse outcomes in our cohort.Conclusion: Further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischaemic stroke in patients with atrial fibrillation.

Published
2023
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7. Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study

Author

Paciaroni, Maurizio, primary, Caso, Valeria, additional, Agnelli, Giancarlo, additional, Mosconi, Maria Giulia, additional, Giustozzi, Michela, additional, Seiffge, David Julian, additional, Engelter, Stefan T., additional, Lyrer, Philippe, additional, Polymeris, Alexandros A., additional, Kriemler, Lilian, additional, Zietz, Annaelle, additional, Putaala, Jukka, additional, Strbian, Daniel, additional, Tomppo, Liisa, additional, Michel, Patrik, additional, Strambo, Davide, additional, Salerno, Alexander, additional, Remillard, Suzette, additional, Buehrer, Manuela, additional, Bavaud, Odessa, additional, Vanacker, Peter, additional, Zuurbier, Susanna, additional, Yperzeele, Laetitia, additional, Loos, Caroline M.J., additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Zedde, Marialuisa, additional, Abdul-Rahim, Azmil, additional, Dawson, Jesse, additional, Cronshaw, Robert, additional, Schirinzi, Erika, additional, Del Sette, Massimo, additional, Stretz, Christoph, additional, Kala, Narendra, additional, Reznik, Michael, additional, Schomer, Ashley, additional, Grory, Brian Mac, additional, Jayaraman, Mahesh, additional, McTaggart, Ryan, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Toni, Danilo, additional, Risitano, Angela, additional, Falcou, Anne, additional, Petraglia, Luca, additional, Lotti, Enrico Maria, additional, Padroni, Marina, additional, Pavolucci, Lucia, additional, Lochner, Piergiorgio, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Alberti, Andrea, additional, Venti, Michele, additional, Traballi, Laura, additional, Urbini, Chiara, additional, Kargiotis, Odysseas, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Marcheselli, Simona, additional, Caliandro, Pietro, additional, Zauli, Aurelia, additional, Reale, Giuseppe, additional, Antonenko, Kateryna, additional, Rota, Eugenia, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, Palmerini, Francesco, additional, Aridon, Paolo, additional, Arnao, Valentina, additional, Monaco, Serena, additional, Cottone, Salvatore, additional, Baldi, Antonio, additional, D’Amore, Cataldo, additional, Ageno, Walter, additional, Pegoraro, Samuela, additional, Ntaios, George, additional, Sagris, Dimitrios, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Romoli, Michele, additional, Pantoni, Leonardo, additional, Rosa, Silvia, additional, Bertora, Pierluigi, additional, Chiti, Alberto, additional, Canavero, Isabella, additional, Saggese, Carlo Emanuele, additional, Plocco, Maurizio, additional, Giorli, Elisa, additional, Palaiodimou, Lina, additional, Bakola, Eleni, additional, Tsivgoulis, Georgios, additional, Bandini, Fabio, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Pezzini, Alessandro, additional, Ornello, Raffaele, additional, Sacco, Simona, additional, Popovic, Nemanja, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Denti, Licia, additional, Flomin, Yuriy, additional, Mancuso, Michelangelo, additional, Ferrari, Elena, additional, Caselli, Maria Chiara, additional, Ulivi, Leonardo, additional, Giannini, Nicola, additional, and De Marchis, Gian Marco, additional

Published
2022
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8. Early neurological deterioration in patients with minor stroke due to isolated M2 occlusion undergoing medical management: a retrospective multicenter study

Author

Broccolini, Aldobrando, Brunetti, Valerio, Colò, Francesca, M Alexandre, Andrea, Valente, Iacopo, Falcou, Anne, Frisullo, Giovanni, Pedicelli, Alessandro, Scarcia, Luca, Scala, Irene, Rizzo, Pier Andrea, Bellavia, Simone, Camilli, Arianna, Milonia, Luca, Piano, Mariangela, Macera, Antonio, Commodaro, Christian, Ruggiero, Maria, Da Ros, Valerio, Bellini, Luigi, A Lazzarotti, Guido, Cosottini, Mirco, A Caragliano, Armando, L Vinci, Sergio, D Gabrieli, Joseph, Causin, Francesco, Panni, Pietro, Roveri, Luisa, Limbucci, Nicola, Arba, Francesco, Pileggi, Marco, Bianco, Giovanni, G Romano, Daniele, Frauenfelder, Giulia, Semeraro, Vittorio, P Ganimede, Maria, Lozupone, Emilio, Fasano, Antonio, Lafe, Elvi, Cavallini, Anna, Russo, Riccardo, Bergui, Mauro, Calabresi, Paolo, Della Marca, Giacomo, Aldobrando Broccolini (ORCID:0000-0001-8295-9271), Valerio Brunetti, Iacopo Valente, Giovanni Frisullo, Alessandro Pedicelli (ORCID:0000-0002-2558-8838), Irene Scala, Pier Andrea Rizzo, Simone Bellavia, Arianna Camilli, Emilio Lozupone, Paolo Calabresi (ORCID:0000-0003-0326-5509), Giacomo Della Marca (ORCID:0000-0001-6914-799X), Broccolini, Aldobrando, Brunetti, Valerio, Colò, Francesca, M Alexandre, Andrea, Valente, Iacopo, Falcou, Anne, Frisullo, Giovanni, Pedicelli, Alessandro, Scarcia, Luca, Scala, Irene, Rizzo, Pier Andrea, Bellavia, Simone, Camilli, Arianna, Milonia, Luca, Piano, Mariangela, Macera, Antonio, Commodaro, Christian, Ruggiero, Maria, Da Ros, Valerio, Bellini, Luigi, A Lazzarotti, Guido, Cosottini, Mirco, A Caragliano, Armando, L Vinci, Sergio, D Gabrieli, Joseph, Causin, Francesco, Panni, Pietro, Roveri, Luisa, Limbucci, Nicola, Arba, Francesco, Pileggi, Marco, Bianco, Giovanni, G Romano, Daniele, Frauenfelder, Giulia, Semeraro, Vittorio, P Ganimede, Maria, Lozupone, Emilio, Fasano, Antonio, Lafe, Elvi, Cavallini, Anna, Russo, Riccardo, Bergui, Mauro, Calabresi, Paolo, Della Marca, Giacomo, Aldobrando Broccolini (ORCID:0000-0001-8295-9271), Valerio Brunetti, Iacopo Valente, Giovanni Frisullo, Alessandro Pedicelli (ORCID:0000-0002-2558-8838), Irene Scala, Pier Andrea Rizzo, Simone Bellavia, Arianna Camilli, Emilio Lozupone, Paolo Calabresi (ORCID:0000-0003-0326-5509), and Giacomo Della Marca (ORCID:0000-0001-6914-799X)

Abstract

Background: Patients with minor stroke and M2 occlusion undergoing best medical management (BMM) may face early neurological deterioration (END) that can lead to poor long-term outcome. In case of END, rescue mechanical thrombectomy (rMT) seems beneficial. Our study aimed to define factors relevant to clinical outcome in patients undergoing BMM with the possibility of rMT on END, and find predictors of END. Methods: Patients with M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score≤5 that received either BMM only or rMT on END after BMM were extracted from the databases of 16 comprehensive stroke centers. Clinical outcome measures were a 90-day modified Rankin Scale (mRS) score of 0-1 or 0-2, and occurrence of END. Results: Among 10 169 consecutive patients with large vessel occlusion admitted between 2016 and 2021, 208 patients were available for analysis. END was reported in 87 patients that were therefore all subjected to rMT. In a logistic regression model, END (OR 3.386, 95% CI 1.428 to 8.032), baseline NIHSS score (OR 1.362, 95% CI 1.004 to 1.848) and a pre-event mRS score=1 (OR 3.226, 95% CI 1.229 to 8.465) were associated with unfavorable outcome. In patients with END, successful rMT was associated with favorable outcome (OR 4.549, 95% CI 1.098 to 18.851). Among baseline clinical and neuroradiological features, presence of atrial fibrillation was a predictor of END (OR 3.547, 95% CI 1.014 to 12.406). Conclusion: Patients with minor stroke due to M2 occlusion and atrial fibrillation should be closely monitored for possible worsening during BMM and, in this case, promptly considered for rMT.

Published
2022

9. Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis

Author

Alexandre, Andrea M, Colò, Francesca, Brunetti, Valerio, Valente, Iacopo, Frisullo, Giovanni, Pedicelli, Alessandro, Scarcia, Luca, Rollo, Claudia, Falcou, Anne, Milonia, Luca, Andrighetti, Marco, Piano, Mariangela, Macera, Antonio, Commodaro, Christian, Ruggiero, Maria, Da Ros, Valerio, Bellini, Luigi, Lazzarotti, Guido A, Cosottini, Mirco, Caragliano, Armando A, Vinci, Sergio L, Gabrieli, Joseph D, Causin, Francesco, Panni, Pietro, Roveri, Luisa, Limbucci, Nicola, Arba, Francesco, Pileggi, Marco, Bianco, Giovanni, Romano, Daniele G, Diana, Francesco, Semeraro, Vittorio, Burdi, Nicola, Ganimede, Maria P, Lozupone, Emilio, Fasano, Antonio, Lafe, Elvi, Cavallini, Anna, Russo, Riccardo, Bergui, Mauro, Calabresi, Paolo, Della Marca, Giacomo, Broccolini, Aldobrando, Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Della Marca, Giacomo (ORCID:0000-0001-6914-799X), Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Alexandre, Andrea M, Colò, Francesca, Brunetti, Valerio, Valente, Iacopo, Frisullo, Giovanni, Pedicelli, Alessandro, Scarcia, Luca, Rollo, Claudia, Falcou, Anne, Milonia, Luca, Andrighetti, Marco, Piano, Mariangela, Macera, Antonio, Commodaro, Christian, Ruggiero, Maria, Da Ros, Valerio, Bellini, Luigi, Lazzarotti, Guido A, Cosottini, Mirco, Caragliano, Armando A, Vinci, Sergio L, Gabrieli, Joseph D, Causin, Francesco, Panni, Pietro, Roveri, Luisa, Limbucci, Nicola, Arba, Francesco, Pileggi, Marco, Bianco, Giovanni, Romano, Daniele G, Diana, Francesco, Semeraro, Vittorio, Burdi, Nicola, Ganimede, Maria P, Lozupone, Emilio, Fasano, Antonio, Lafe, Elvi, Cavallini, Anna, Russo, Riccardo, Bergui, Mauro, Calabresi, Paolo, Della Marca, Giacomo, Broccolini, Aldobrando, Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Della Marca, Giacomo (ORCID:0000-0001-6914-799X), and Broccolini, Aldobrando (ORCID:0000-0001-8295-9271)

Abstract

Background The purpose of this study was to evaluate the effectiveness of mechanical thrombectomy (MT) in patients with isolated M2 occlusion and minor symptoms and identify possible baseline predictors of clinical outcome. Methods The databases of 16 high-volume stroke centers were retrospectively screened for consecutive patients with isolated M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score <= 5 who received either early MT (eMT) or best medical management (BMM) with the possibility of rescue MT (rMT) on early neurological worsening. Because our patients were not randomized, we used propensity score matching (PSM) to estimate the treatment effect of eMT compared with the BMM/rMT. The primary clinical outcome measure was a 90-day modified Rankin Scale score of 0-1. Results 388 patients were initially selected and, after PSM, 100 pairs of patients receiving eMT or BMM/rMT were available for analysis. We found no significant differences in clinical outcome and in safety measures between patients receiving eMT or BMM/rMT. Similar results were also observed after comparison between eMT and rMT. Concerning baseline predicting factors of outcome, the involvement of the M2 inferior branch was associated with a favorable outcome. Conclusion Our multicenter retrospective analysis has shown no benefit of eMT in minor stroke patients with isolated M2 occlusion over a more conservative therapeutic approach. Although our results must be viewed with caution, in these patients it appears reasonable to consider BMM as the first option and rMT in the presence of early neurological deterioration.

Published
2022

14. Gender-related determinants of adherence to the Mediterranean diet in adults with ischemic heart disease

Author

Raparelli, V., Romiti, G. F., Spugnardi, V., Borgi, M., Cangemi, R., Basili, S, Proietti, M., Lenzi, Andrea, Tiberti, Claudio, Panimolle, Francesca, Isidori, Andrea, Giannetta, Elisa, Venneri, Mary Anna, Napoleone, Laura, Quattrino, Silvia, Ceccarelli, Simona, Anastasiadou, Eleni, Megiorni, Francesca, Marchese, Cinzia, Gaudio, Carlo, Mangieri, Enrico, Tanzilli, Gaetano, Viceconte, Giuseppe Nicola, Barilla&apos, Francesco, Paravati, Vincenzo, Tellan, Guglielmo, Ettorre, Evaristo, Servello, Adriana Debora, Miraldi, Fabio, Moretti, Andrea, Tanzilli, Alessandra, Mazzonna, Piergiovanni, Suleyman Al Kindy, Riccardo, Iorio, Di Iorio, Martina, Petriello, Gennaro, Gioffre&apos, Laura, Indolfi, Eleonora, Pero, Gaetano, Cocco, Nino, Iannetta, Loredana, Giannuzzi, Sara, Centaro, Emilio, Sergi, Sonia Cristina, Bartimoccia, Simona, Fraioli, Antonio, Nocchi, Silvia, Fontana, Mario, Morelli, Sergio, Pignatelli, Pasquale, Minisola, Salvatore, Violi, Francesco, Toriello, Filippo, Ruscio, Eleonora, Todisco, Tommaso, Sperduti, Nicolo&apos, Santangelo, Giuseppe, Visioli, Giacomo, Vano, Marco, Antonini, Ludovica Maria, Silvia, Robuffo, Corica, Bernadette, Tucci, Claudia, Rossoni, Agostino, Vernile, Annarita, Santoliquido, Mariateresa, Verdiana, Santori, Tosti, Giulia, Recchia, Fabrizio, Morricone, Francesco, Scacciavillani, Roberto, Alice, Lipari, Zito, Andrea, Testa, Floriana, Ricci, Giulia, Vellucci, Ilaria, Marianna, Vincenti, Silvia, Pietropaolo, Scala, Camilla, Nicol&#242, Rubini, Marta, Tomassi, Ciancarella, Claudia, Scotti, Biagio, Claudio, Cantelmi, Santomenna, Floriana, Giacomo, Costanzo, Rozzi, Gloria, Lucas, Rumbol&#224, Giarrizzo, Salvatore, Sapia, Carlotta, Cusano, Giuseppina, Palladino, Andrea, Villani, Francesca, Antonella, Cacciani, Granata, Massimo, Stefanini, Lucia, Talerico, Giovanni, Filetti, Sebastiano, Fiorilli, Massimo, Toni, Danilo, Falcou, Anne Albertine, Louise, Pilote, Uri, Bender, Vestri, Anna Rita, Ferroni, Patrizia, Clara, Crescioli, Antinozzi, Cristina, Pignataro, Francesca Serena, Tiziana, Bellini, Alessandro, Trentini, Carnevale, Roberto, Nocella, Cristina, Catalano, Carlo, Carbone, Iacopo, Galea, Nicola, Bertazzoni, Giuliano, Suppa, Marianna, Rosa, Antonello, Gioacchino, Galardo, Alessandroni, Maria, Cipollone, Lorena, Coppola, Alessandro, Mariangela, Palladino, Illuminati, Giulio, Consorti, Fabrizio, Mariani, Paola, Neri, Fabrizio, Salis, Paolo, Segatori, Antonio, Tellini, Laurent, and Gianluca, Costabile

Subjects
Adult, Male, medicine.medical_specialty, Mediterranean diet, Ischemic heart disease, Psychological intervention, Myocardial Ischemia, lcsh:TX341-641, Disease, 030204 cardiovascular system & hematology, Diet, Mediterranean, Article, NO, Settore MED/11, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Internal medicine, Diabetes mellitus, Surveys and Questionnaires, medicine, gender, Humans, sex, 030212 general & internal medicine, adherence, Aged, Nutrition and Dietetics, business.industry, Vascular disease, mediterranean diet, Gender Identity, Odds ratio, Middle Aged, medicine.disease, Bem Sex-Role Inventory, Confidence interval, Patient Compliance, Female, business, lcsh:Nutrition. Foods and food supply, Stress, Psychological, Food Science
Abstract

Background: The reasons behind low adherence to the Mediterranean diet (Med-diet) are still not entirely known. We aimed to evaluate the effect of biological (i.e., sex-related) and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence. Methods: Baseline Med-diet adherence was measured using a self-administered questionnaire among adults with ischemic heart disease (IHD) from the EVA (Endocrine Vascular Disease Approach) study. A multivariable analysis was performed to estimate the effect of sex- and gender-related factors (i.e., identity, roles, relations, and institutionalized gender) on low adherence. Results: Among 366 participants (66 ± 11 years, 31% women), 81 (22%) adults with low adherence demonstrated higher rates of diabetes, no smoking habit, lower male BSRI (Bem Sex Role Inventory) (median (IQR) 4.8 (4.1 to 5.5) vs. 5.1 (4.5 to 5.6) and p = 0.048), and higher Perceived Stress Scale 10 items (PSS-10) (median (IQR) 19 (11 to 23) vs. 15 (11 to 20) and p = 0.07) scores than those with medium-high adherence. In the multivariable analysis, only active smoking (odds ratio, OR = 2.10, 95% confidence interval, CI 1.14 to 3.85 and p = 0.017), PPS-10 (OR = 1.04, 95% CI 1.00 to 1.08, and p = 0.038) and male BSRI scores (OR = 0.70, 95% CI 0.52 to 0.95, and p = 0.021) were independently associated with low adherence. Conclusions: Male personality traits and perceived stress (i.e., gender identity) were associated with low Med-diet adherence regardless of the sex, age, and comorbidities. Therefore, gender-sensitive interventions should be explored to improve adherence in IHD.

Published
2020

15. Copeptin Kinetics in Acute Ischemic Stroke May Differ According to Revascularization Strategies

Author

Spagnolello, Ornella, primary, De Michele, Manuela, additional, Lorenzano, Svetlana, additional, Cerulli Irelli, Emanuele, additional, Naitana, Federico, additional, Falcou, Anne, additional, Letteri, Federica, additional, Bachetoni, Alessandra, additional, Collepardo, Daniela, additional, Bertazzoni, Giuliano, additional, and Toni, Danilo, additional

Published
2019
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16. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke

Author

Cappellari, Manuel, Mangiafico, Salvatore, Saia, Valentina, Pracucci, Giovanni, Nappini, Sergio, Nencini, Patrizia, Konda, Daniel, Sallustio, Fabrizio, Vallone, Stefano, Zini, Andrea, Bracco, Sandra, Tassi, Rossana, Bergui, Mauro, Cerrato, Paolo, Pitrone, Antonio, Grillo, Francesco, Saletti, Andrea, De Vito, Alessandro, Gasparotti, Roberto, Magoni, Mauro, Puglielli, Edoardo, Casalena, Alfonsina, Causin, Francesco, Baracchini, Claudio, Castellan, Lucio, Malfatto, Laura, Menozzi, Roberto, Scoditti, Umberto, Comelli, Chiara, Duc, Enrica, Comai, Alessio, Franchini, Enrica, Cosottini, Mirco, Mancuso, Michelangelo, Peschillo, Simone, De Michele, Manuela, Giorgianni, Andrea, Delodovici, Maria Luisa, Lafe, Elvis, Denaro, Maria Federica, Burdi, Nicola, Internò, Saverio, Cavasin, Nicola, Critelli, Adriana, Chiumarulo, Luigi, Petruzzellis, Marco, Doddi, Marco, Carolei, Antonio, Auteri, William, Petrone, Alfredo, Padolecchia, Riccardo, Tassinari, Tiziana, Pavia, Marco, Invernizzi, Paolo, Turcato, Gianni, Forlivesi, Stefano, Ciceri, Elisa Francesca Maria, Bonetti, Bruno, Inzitari, Domenico, Toni, Danilo, Limbucci, Nicola, Consoli, Arturo, Renieri, Leonardo, Fainardi, Enrico, Gandini, Roberto, Pampana, Enrico, Diomedi, Marina, Koch, Giacomo, Verganti, Luca, Sacchetti, Federico, Zelent, Gabriele, Bigliardi, Guido, Picchetto, Livio, Vandelli, Laura, Romano, Daniele Giuseppe, Cioni, Samuele, Gennari, Paola, Cerase, Alfonso, Martini, Giuseppe, Stura, Guido, Daniele, Dino, Naldi, Andrea, Papa, Rosario, Vinci, Sergio Lucio, Bernava, Gianmarco, Velo, Mariano, Caragliano, Antonio, Tessitore, Agostino, Buonomo, Orazio, Musolino, Rossella, La Spina, Paolino, Casella, Carmela, Carolina Fazio, Maria, Cotroneo, Masina, Onofrio, Marcello, Azzini, Cristiano, Casetta, Ilaria, Mardighian, Dikran, Frigerio, Michele, Costa, Angelo, Di Egidio, Vincenzo, Lattanzi, Ruggero, Assetta, Maurizio, Cester, Giacomo, Mavilio, Nicola, Serrati, Carlo, Piazza, Paolo, Epifani, Enrico, Andreone, Andrea, Castellini, Paola, Latte, Lilia, Grisendi, Ilaria, Vaudano, Giacomo, Comelli, Simone, Cavallo, Roberto, Chianale, Gigliola, Simonetti, Luigi, Taglialatela, Francesco, Isceri, Salvatore, Procaccianti, Gaetano, Zaniboni, Anna, Borghi, Annamaria, Bonatti, Giampietro, Ferro, Federica, Bonatti, Matteo, Dall’Ora, Elisa, Currò Dossi, Roberto, Turri, Emanuela, Turri, Mara, Puglioli, Michele, Lazzarotti, Guido, Lauretti, DARIO LUCA, Giannini, Nicola, Maccarone, Miriam, Orlandi, Giovanni, Chiti, Alberto, Guidetti, Giulio, Biraschi, Francesco, Falcou, Anne, Anzini, Alexia, Mancini, Alessandra, Fausti, Silvia, Di Mascio, Maria Teresa, Durastanti, Laura, Sbardella, Emilia, Mellina, Vittorio, Baruzzi, Fabio, Pellegrino, Carlo, Terrana, Alberto, Carimati, Federico, Ruggiero, Maria, Sanna, Antioco, Passarin, Maria Grazia, Colosimo, Cesare, Pedicelli, Alessandro, D’Argento, Francesco, Alexandre, Andrea, Frisullo, Giovanni, Zappoli, Federico, Martignoni, Alessandra, Cavallini, Anna, Persico, Alessandra, Valvassori, Luca, Piano, Mariangela, Agostoni, Elio, Motto, Cristina, Gatti, Antonella, Longoni, Marco, Guccione, Angelo, Tortorella, Rachele, Zampieri, Piergiuseppe, Zimatore, Domenico Sergio, Grazioli, Andrea, Ricciardi, Giuseppe Kenneth, Augelli, Raffaele, Bovi, Paolo, Tomelleri, Giampaolo, Micheletti, Nicola, Semeraro, Vittorio, Lucarelli, Nicola, Ganimede, Maria, Tinelli, Angelica, Pia Prontera, Maria, Pesare, Angela, Cagliari, Enrico, Quatrale, Rocco, Federico, Francesco, Passalacqua, Giovanni, Filauri, Pietro, Orlandi, Berardino, De Santis, Federica, Gabriele, Amleto, Tiseo, Cindy, Armentano, Antonio, Di Benedetto, Olindo, Silvagni, Umberto, Perrotta, Paolo, Crispino, Emanuela, Stancati, Furio, Rizzuto, Stefano, Pugliese, Pierfrancesco, Pisani, Ermanno, Siniscalchi, Antonio, Gaudiano, Carmen, Pirritano, Domenico, Del Giudice, Francesco, Calia, Stefano, Ganci, Giuseppe, Sugo, Annalisa, Scomazzoni, Francesco, Simionato, Franco, Roveri, Luisa, De Nicola, Maurizio, Giannoni, Mirko, Bruni, Stefano, Gambelli, Elena, Provinciali, Leandro, Carriero, Alessandro, Coppo, Lorenzo, Baldan, Julika, Paolo Nuzzi, Nunzio, Marcheselli, Simona, Corato, Manuel, Cotroneo, Enrico, Ricciardi, Fabrizio, Gigli, Renato, Pozzessere, Claudio, Pezzella, Francesca Romana, Corsi, Fabio, Squassina, Guido, Cobelli, Milena, Morassi, Mauro, Magni, Eugenio, Pepe, Fulvio, Bigni, Barbara, Costa, Paolo, Crabbio, Massimo, Griffini, Simona, Palmerini, Francesco, Piras, Maria Paola, Natrella, Massimiliano, Fanelli, Gianluca, Cristoferi, Massimo, Bottacchi, Edo, Corso, Giovanni, Tosi, Piera, Amistà, Pietro, Russo, Monia, Tettoni, Serena, Gallesio, Ivan, Mascolo, Maria Carmela, Meloni, Giovanni Battista, Fabio, Claudio, Maiore, Mario, Pintus, Francesco, Pischedda, Aldo, Manca, Antonio, Mongili, Claudia, Zanda, Bastianina, Sanna, Antonella, Baule, Antonio, Pappalardo, Maria Pia, Craparo, Giuseppe, Gallo, Cristina, Monaco, Serena, Mannino, Marina, Terruso, Valeria, Muto, Mario, Guarnieri, Gianluigi, Andreone, Vincenzo, Dui, Giovanni, Ticca, Anna, Salmaggi, Andrea, Iannucci, Giuseppe, Pinna, Vittore, Di Clemente, Loris, Perini, Francesco, De Boni, Antonella, De Luca, Cristina, De Giorgi, Franco, Corraine, Simona, Enne, Paolo, Ganau, Claudio, and Piras, Valeria

Subjects
Male, medicine.medical_specialty, Fibrinolytic Agents/therapeutic use Humans Male Middle Aged *Nomograms Postoperative Complications/etiology Risk Assessment Risk Factors Stroke/complications/drug therapy/*surgery Thrombectomy/*adverse effects Thrombolytic Therapy/adverse effects, medicine.medical_treatment, contraindications, Risk Assessment, NO, Brain Ischemia, Brain ischemia, Postoperative Complications, Fibrinolytic Agents, Risk Factors, contraindications ◼ logistic models ◼ nomograms ◼ standard of care ◼ thrombectomy, medicine, 80 and over, Humans, Thrombolytic Therapy, Stroke, contraindications, logistic models, nomograms, standard of care, thrombectomy, Aged, Cerebral Hemorrhage, Aged, 80 and over, Advanced and Specialized Nursing, Intracerebral hemorrhage, Receiver operating characteristic, business.industry, Thrombolysis, Nomogram, Middle Aged, medicine.disease, logistic models, nomograms, standard of care, thrombectomy, Female, Thrombectomy, Tissue Plasminogen Activator, Nomograms, Settore MED/26 - NEUROLOGIA, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business, Fibrinolytic agent, Cohort study
Abstract

Background and Purpose— As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set). Methods— We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline ≤24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve. Results— National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779). Conclusions— The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management.

Published
2019

22. Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack

Author

De Matteis, Eleonora, Ornello, Raffaele, De Santis, Federico, Foschi, Matteo, Romoli, Michele, Tassinari, Tiziana, Saia, Valentina, Cenciarelli, Silvia, Bedetti, Chiara, Padiglioni, Chiara, Censori, Bruno, Puglisi, Valentina, Vinciguerra, Luisa, Guarino, Maria, Barone, Valentina, Zedde, Marialuisa, Grisendi, Ilaria, Diomedi, Marina, Bagnato, Maria Rosaria, Petruzzellis, Marco, Mezzapesa, Domenico Maria, Di Viesti, Pietro, Inchingolo, Vincenzo, Cappellari, Manuel, Zenorini, Mara, Candelaresi, Paolo, Andreone, Vincenzo, Rinaldi, Giuseppe, Bavaro, Alessandra, Cavallini, Anna, Moraru, Stefan, Querzani, Pietro, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Frisullo, Giovanni, Muscia, Francesco, Paciaroni, Maurizio, Mosconi, Maria Giulia, Zini, Andrea, Leone, Ruggiero, Palmieri, Carmela, Cupini, Letizia Maria, Marcon, Michela, Tassi, Rossana, Sanzaro, Enzo, Paci, Cristina, Viticchi, Giovanna, Orsucci, Daniele, Falcou, Anne, Diamanti, Susanna, Tarletti, Roberto, Nencini, Patrizia, Rota, Eugenia, Sepe, Federica Nicoletta, Ferrandi, Delfina, Caputi, Luigi, Volpi, Gino, Spada, Salvatore La, Beccia, Mario, Rinaldi, Claudia, Mastrangelo, Vincenzo, Di Blasio, Francesco, Invernizzi, Paolo, Pelliccioni, Giuseppe, De Angelis, Maria Vittoria, Bonanni, Laura, Ruzza, Giampietro, Caggia, Emanuele Alessandro, Russo, Monia, Tonon, Agnese, Acciarri, Maria Cristina, Anticoli, Sabrina, Roberti, Cinzia, Manobianca, Giovanni, Scaglione, Gaspare, Pistoia, Francesca, Fortini, Alberto, De Boni, Antonella, Sanna, Alessandra, Chiti, Alberto, Barbarini, Leonardo, Caggiula, Marcella, Masato, Maela, Del Sette, Massimo, Passarelli, Francesco, Roberta Bongioanni, Maria, Toni, Danilo, Ricci, Stefano, and Sacco, Simona

Abstract

Background and purpose: Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs.Methods: READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD2score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment.Results: We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score ⩽5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24 h after symptom onset was associated with a lower likelihood of bleeding.Conclusions: In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start.

Published
2024
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24. Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study

Author

Maurizio Paciaroni, Valeria Caso, Giancarlo Agnelli, Maria Giulia Mosconi, Michela Giustozzi, David Julian Seiffge, Stefan T. Engelter, Philippe Lyrer, Alexandros A. Polymeris, Lilian Kriemler, Annaelle Zietz, Jukka Putaala, Daniel Strbian, Liisa Tomppo, Patrik Michel, Davide Strambo, Alexander Salerno, Suzette Remillard, Manuela Buehrer, Odessa Bavaud, Peter Vanacker, Susanna Zuurbier, Laetitia Yperzeele, Caroline M.J. Loos, Manuel Cappellari, Andrea Emiliani, Marialuisa Zedde, Azmil Abdul-Rahim, Jesse Dawson, Robert Cronshaw, Erika Schirinzi, Massimo Del Sette, Christoph Stretz, Narendra Kala, Michael Reznik, Ashley Schomer, Brian Mac Grory, Mahesh Jayaraman, Ryan McTaggart, Shadi Yaghi, Karen L. Furie, Luca Masotti, Elisa Grifoni, Danilo Toni, Angela Risitano, Anne Falcou, Luca Petraglia, Enrico Maria Lotti, Marina Padroni, Lucia Pavolucci, Piergiorgio Lochner, Giorgio Silvestrelli, Alfonso Ciccone, Andrea Alberti, Michele Venti, Laura Traballi, Chiara Urbini, Odysseas Kargiotis, Alessandro Rocco, Marina Diomedi, Simona Marcheselli, Pietro Caliandro, Aurelia Zauli, Giuseppe Reale, Kateryna Antonenko, Eugenia Rota, Tiziana Tassinari, Valentina Saia, Francesco Palmerini, Paolo Aridon, Valentina Arnao, Serena Monaco, Salvatore Cottone, Antonio Baldi, Cataldo D’Amore, Walter Ageno, Samuela Pegoraro, George Ntaios, Dimitrios Sagris, Sotirios Giannopoulos, Maria Kosmidou, Evangelos Ntais, Michele Romoli, Leonardo Pantoni, Silvia Rosa, Pierluigi Bertora, Alberto Chiti, Isabella Canavero, Carlo Emanuele Saggese, Maurizio Plocco, Elisa Giorli, Lina Palaiodimou, Eleni Bakola, Georgios Tsivgoulis, Fabio Bandini, Antonio Gasparro, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Raffaele Ornello, Simona Sacco, Nemanja Popovic, Umberto Scoditti, Antonio Genovese, Licia Denti, Yuriy Flomin, Michelangelo Mancuso, Elena Ferrari, Maria Chiara Caselli, Leonardo Ulivi, Nicola Giannini, Gian Marco De Marchis, Paciaroni, Maurizio, Caso, Valeria, Agnelli, Giancarlo, Mosconi, Maria Giulia, Giustozzi, Michela, Seiffge, David Julian, Engelter, Stefan T, Lyrer, Philippe, Polymeris, Alexandros A, Kriemler, Lilian, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna, Yperzeele, Laetitia, Loos, Caroline M J, Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil, Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Grory, Brian Mac, Jayaraman, Mahesh, McTaggart, Ryan, Yaghi, Shadi, Furie, Karen L, Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, Traballi, Laura, Urbini, Chiara, Kargiotis, Odyssea, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D'Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrio, Giannopoulos, Sotirio, Kosmidou, Maria, Ntais, Evangelo, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Tsivgoulis, Georgio, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, De Marchis, Gian Marco, and Neurology

Subjects
Oral, Advanced and Specialized Nursing, hypertension, recurrence, anticoagulant, Administration, Oral, Anticoagulants, Hemorrhage, Settore MED/26, Brain Ischemia, Stroke, Risk Factors, Administration, Atrial Fibrillation, Humans, Settore MED/26 - Neurologia, Human medicine, Neurology (clinical), Prospective Studies, Cardiology and Cardiovascular Medicine, atrial fibrillation, ischemic stroke, Ischemic Stroke
Abstract

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA 2 DS 2 -VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P =0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P =0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P =0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P =0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P =0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.

Published
2022

25. Combining Intravenous Thrombolysis and Dual Antiplatelet Treatment in Patients With Minor Ischemic Stroke: A Propensity Matched Analysis of the READAPT Study Cohort.

Author

Ornello R, Foschi M, De Santis F, Romoli M, Tassinari T, Saia V, Cenciarelli S, Bedetti C, Padiglioni C, Censori B, Puglisi V, Vinciguerra L, Guarino M, Barone V, Zedde M, Grisendi I, Diomedi M, Bagnato MR, Petruzzellis M, Mezzapesa DM, Di Viesti P, Inchingolo V, Cappellari M, Zivelonghi C, Candelaresi P, Andreone V, Rinaldi G, Bavaro A, Cavallini A, Moraru S, Querzani P, Terruso V, Mannino M, Pezzini A, Frisullo G, Muscia F, Paciaroni M, Mosconi MG, Zini A, Leone R, Palmieri C, Cupini LM, Marcon M, Tassi R, Sanzaro E, Paci C, Viticchi G, Orsucci D, Falcou A, Beretta S, Tarletti R, Nencini P, Rota E, Sepe FN, Ferrandi D, Caputi L, Volpi G, La Spada S, Beccia M, Rinaldi C, Mastrangelo V, Di Blasio F, Invernizzi P, Pelliccioni G, De Angelis MV, Bonanni L, Ruzza G, Caggia EA, Russo M, Tonon A, Acciarri MC, Anticoli S, Roberti C, Manobianca G, Scaglione G, Pistoia F, Fortini A, De Boni A, Sanna A, Chiti A, Barbarini L, Caggiula M, Masato M, Del Sette M, Passarelli F, Bongioanni MR, Toni D, Ricci S, De Matteis E, and Sacco S

Subjects
Humans, Female, Male, Aged, Prospective Studies, Middle Aged, Treatment Outcome, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Time Factors, Administration, Intravenous, Risk Assessment, Drug Therapy, Combination, Aged, 80 and over, Risk Factors, Ischemic Stroke diagnosis, Ischemic Stroke drug therapy, Propensity Score, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Thrombolytic Therapy methods, Thrombolytic Therapy adverse effects, Dual Anti-Platelet Therapy methods
Abstract

Background: The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS., Methods and Results: This is a prespecified propensity score-matched analysis from a prospective multicentric real-world study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]). We included patients with MIS (National Institutes of Health Stroke Scale score at admission ≤5), without prestroke disability (modified Rankin scale [mRS] score ≤2). The primary outcomes were 90-day mRS score of 0 to 2 and ordinal mRS distribution. The secondary outcomes included 90-day risk of stroke and other vascular events and 24-hour early neurological improvement or deterioration (≥2-point National Institutes of Health Stroke Scale score decrease or increase from the baseline, respectively). From 1373 patients with MIS, 240 patients treated with IVT plus DAPT were matched with 427 patients treated with DAPT alone. At 90 days, IVT plus DAPT versus DAPT alone showed similar frequency of mRS 0 to 2 (risk difference, 2.3% [95% CI -2.0% to 6.7%]; P =0.295; risk ratio, 1.03 [95% CI 0.98-1.08]; P =0.312) but more favorable ordinal mRS scores distribution (odds ratio, 0.57 [95% CI 0.41-0.79]; P <0.001). Compared with patients treated with DAPT alone, those combining IVT and DAPT had higher 24-hour early neurological improvement (risk difference, 20.9% [95% CI 13.1%-28.6%]; risk ratio, 1.59 [95% CI 1.34-1.89]; both P <0.001) and lower 90-day risk of stroke and other vascular events (hazard ratio, 0.27 [95% CI 0.08-0.90]; P =0.034). There were no differences in safety outcomes., Conclusions: According to findings from this observational study, patients with MIS may benefit in terms of better functional outcome and lower risk of recurrent events from combining IVT and DAPT versus DAPT alone without safety concerns., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05476081.

Published
2024
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