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

Author

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

Subjects
dual antiplatelet treatment, functional outcome, intravenous thrombolysis, ischemic stroke, real world, safety, Diseases of the circulatory (Cardiovascular) system, RC666-701
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

Published
2024
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2. Association of the careggi collateral score with radiological outcomes after thrombectomy for stroke with an occlusion of the middle cerebral artery

Author

Manuel, Cappellari, Valentina, Saia, Giovanni, Pracucci, Enrico, Fainardi, Patrizia, Nencini, Laura, Malfatto, Rossana, Tassi, Paolo, Cerrato, Michelangelo, Mancuso, Angela, Pesare, Paolino, La Spina, Enrico Maria, Lotti, Alfonsina, Casalena, Marco, Petruzzellis, Claudio, Baracchini, Alessandra Giai, Via, Carmen, Gaudiano, Fabrizio, Sallustio, Tiziana, Tassinari, Adriana, Critelli, Maurizio, Melis, Alessandra, Persico, Ilaria, Casetta, Simona, Sacco, Delfina, Ferrandi, Simona, Marcheselli, Monia, Russo, Cecilia, Zivelonghi, Nicolò, Mandruzzato, Paolo, Invernizzi, Daniele, Romano, Ettore, Nicolini, Umberto, Scoditti, Mauro, Magoni, Lucia Princiotta, Cariddi, Stefano, Vallone, Domenico, Inzitari, Danilo, Toni, and Salavatore, Mangiafico

Subjects
Collateral score, Middle Cerebral Artery, Endovascular Procedures, Infarct growth, Brain Edema, Infarction, Middle Cerebral Artery, Hematology, Cerebral edema, Intracerebral hemorrhage, Stroke, Thrombectomy, Treatment Outcome, Humans, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

We aimed to examine the association between Careggi Collateral Score (CCS) and radiological outcomes in a large multicenter cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA). We conducted a study on prospectively collected data from 1785 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA). Radiological outcomes at 24 h were the presence and severity of infarct growth defined by the absolute change in ASPECTS from baseline to 24 h; presence and severity of cerebral bleeding defined as no ICH, HI-1, HI-2, PH-1, or PH-2; presence and severity of cerebral edema (CED) defined as no CED, CED-1, CED-2, or CED-3. Using CCS = 0 as reference, ORs of CCS grades were significantly associated in the direction of better radiological outcome on infarct growth (0.517 for CCS = 1, 0.413 for CCS = 2, 0.358 for CCS = 3, 0.236 for CCS = 4), cerebral bleeding grading (0.485 for CCS = 1, 0.445 for CCS = 2, 0.400 for CCS = 3, 0.379 for CCS = 4), and CED grading (0.734 for CCS = 1, 0.301 for CCS = 2, 0.295 for CCS = 3, 0.255 for CSS = 4) shift in ordinal regression analysis after adjustment for pre-defined variables (age, NIHSS score, ASPECTS, occlusion site, onset-to-groin puncture time, procedure time, and TICI score). Using CCS = 4 as reference, ORs of CCS grades were significantly associated in the direction of worse radiological outcome on infarct growth (1.521 for CCS = 3, 1.754 for CCS = 2, 2.193 for CCS = 1, 4.244 for CCS = 0), cerebral bleeding grading (2.498 for CCS = 0), and CED grading (1.365 for CCS = 2, 2.876 for CCS = 1, 3.916 for CCS = 0) shift. The CCS could improve the prognostic estimate of radiological outcomes in patients receiving thrombectomy for stroke with MCA occlusion.

Published
2022

3. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study

Author

Ilaria, Casetta, Enrico, Fainardi, Giovanni, Pracucci, Valentina, Saia, Fabrizio, Sallustio, Valerio, da Ros, Sergio, Nappini, Patrizia, Nencini, Guido, Bigliardi, Sergio, Vinci, Francesco, Grillo, Sandra, Bracco, Rossana, Tassi, Mauro, Bergui, Paolo, Cerrato, Andrea, Saletti, Alessandro, De Vito, Roberto, Gasparotti, Mauro, Magoni, Luigi, Simonetti, Andrea, Zini, Maria, Ruggiero, Marco, Longoni, Lucio, Castellan, Laura, Malfatto, Paola, Castellini, Mirco, Cosottini, Alessio, Comai, Enrica, Franchini, Emilio, Lozupone, Giacomo, Della Marca, Edoardo, Puglielli, Alfonsina, Casalena, Claudio, Baracchini, Daniele, Savio, Enrica, Duc, Giuseppe, Ricciardi, Manuel, Cappellari, Luigi, Chiumarulo, Marco, Petruzzellis, Anna, Cavallini, Nicola, Cavasin, Adriana, Critelli, Nicola, Burdi, Giovanni, Boero, Andrea, Giorgianni, Maurizio, Versino, Francesco, Biraschi, Ettore, Nicolini, Simone, Comelli, Maurizio, Melis, Riccardo, Padolecchia, Tiziana, Tassinari, Nunzio, Paolo Nuzzi, Simona, Marcheselli, Simona, Sacco, Paolo, Invernizzi, Ivan, Gallesio, Delfina, Ferrandi, Maria, Fancello, Maria, Valeria Saddi, Monia, Russo, Aldo, Pischedda, Antonio, Baule, Marina, Mannino, Francesco, Florio, Vincenzo, Inchingolo, Maria, Elena Flacco, Daniele, Romano, Umberto, Silvagni, Domenico, Inzitari, Salvatore, Mangiafico, and Danilo, Toni

Subjects
Ischemic stroke, thrombectomy, Original Research Articles, sex, Neurology (clinical), Cardiology and Cardiovascular Medicine, NO, Ischemic stroke, thrombectomy, sex
Abstract

Background and purpose We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients. Methods From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set. Results Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p Conclusions Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment.

Published
2022

4. Reduced Admissions for Cerebrovascular Events during COVID-19 Outbreak in Italy

Author

Simona Sacco, Stefano Ricci, Raffaele Ornello, Paolo Eusebi, Luca Petraglia, Danilo Toni, Eugenia Rota, Gianluca Bruzzone, Lucia Testa, Roberta Bongioanni, Mara Rosso, Carmelo Labate, Roberto Tarletti, Roberto Cantello, Thomas Fleetwood, Fabio Melis, Daniele Imperiale, Salvatore Amarù, Monica Reggiani, Luigi Ruiz, Elia Cipriano, Delfina Ferrandi, Patrizia Julita, Liana Africa, Piero Meinieri, Maria Federica Grasso, Serena Servo, Roberto Cavallo, Gigliola Chianale, Andrea Naldi, Paolo Cerrato, Elisa Rubino, Alessia Giossi, Valentina Puglisi, Luisa Vinciguerra, Ignazio Santilli, Bianca Maria Bordo, Simona Marcheselli, Julia Bottini, Caterina Mariotto D’Alessandro, Giuseppe Micieli, Anna Cavallini, Isabella Canavero, Francesco Muscia, Graziamaria Nuzzaco, Alfonso Ciccone, Giorgio Silvestrelli, Andrea Salmaggi, Davide Sangalli, Carla Zanferrari, Simona Fanucchi, Michela Ranieri, Simone Beretta, Carlo Ferrarese, Francesco Pasini, Francesco Santangelo, Nicoletta Checcarelli, Sandro Beretta, Paola Bazzi, Massimo Camerlingo, Marcello Tognozzi, Giorgio Caneve, Alessandro Adami, Rocco Quatrale, Adriana Critelli, Luigi Bartolomei, Maela Masato, Francesco Perini, Antonella De Boni, Caterina Disco, Claudio Baracchini, Alessio Pieroni, Roberto Lerario, Monia Russo, Alberto Polo, Alessandra Danese, Luca Valentinis, Antonio Baldi, Simone Tonello, Francesco Paladin, Agnese Tonon, Bruno Bonetti, Manuel Cappellari, Francesco Teatini, Roberto Currò Dossi, Enrica Franchini, Bruno Giometto, Valeria Bignamini, Paolo Manganotti, Marcello Naccarato, Gian Luigi Gigli, Simone Lorenzut, Giovanni Merlino, Mariarosaria Valente, Michele Rana, Carolina Gentile, Tiziana Tassinari, Annalisa Sugo, Valentina Saia, Maurizio Balestrino, Alberto Coccia, Cinzia Finocchi, Franco Valzania, Maria Luisa Zedde, Giulia Toschi, Marco Longoni, Matteo Paolucci, Valeria Tugnoli, Pietro Querzani, Marina Padroni, Stefano Meletti, Guido Bigliardi, Maria Luisa Dall’Acqua, Andrea Zini, Mauro Gentile, Ludovica Migliaccio, Alberto Chiti, Rossana Tassi, Giuseppe Martini, Patrizia Nencini, Maria Lamassa, Michelangelo Mancuso, Giovanni Orlandi, Elena Ferrari, Roberto Marconi, Simone Gallerini, Vincenzo Groggia, Gino Volpi, Chiara Menichetti, Stefano Spolveri, Mauro Silvestrini, Giovanna Viticchi, Laura Buratti, Giuseppe Pelliccioni, Eleonora Potente, Tatiana Mazzoli, Erica Marsili, Silvia Cenciarelli, Antonella Picchioni, Franco Costantini, Carlo Colosimo, Maurizio Paciaroni, Valeria Caso, Maurizia Rasura, Mario Beccia, Nicola Falcone, Marisa Di Stefano, Emanuela Cecconi, Sabrina Anticoli, Francesca Romana Pezzella, Marilena Mangiardi, Maurizio Plocco, Maria Magarelli, Carlo Emanuele Saggese, Irene Berto, Maria Concetta Altavista, Cinzia Roberti, Marina Diomedi, Fabrizio Sallustio, Alessandro Rocco, Letizia Maria Cupini, Novella Bonaffini, Maria Vittoria De Angelis, Anna Digiovanni, Marianna Rispoli, Berardino Orlandi, Federica De Santis, Enrico Colangeli, Francesco Di Blasio, Caterina Di Carmine, Pierluigi Tocco, Maurizio Melis, Jessica Moller, Valeria Saddi, Antonio Manca, Antonio Baule, Antonello Caddeo, Nicola Iorio, Rosa Napoletano, Maria di Gregorio, Giampiero Volpe, Florindo D’Onofrio, Daniele Spitaleri, Leonardo Barbarini, Gaetano Barbagallo, Marcella Caggiula, Bonaventura Ardito, Domenico Di Noia, Pietro Di Viesti, Maurizio Angelo Leone, Vincenzo Inchingolo, Marco Petruzzellis, Federica Rizzo, Mariantonietta Savarese, Alfredo Petrone, Franco Galati, Luciano Arcudi, Damiano Branca, Paolo Aridon, Valentina Arnao, Rosa Musolino, Cristina Dell’Aera, Isabella Francalanza, Luigi Grimaldi, Matilde Gammino, Antonello Giordano, Giuseppe Zelante, Enzo Sanzaro, Antonio Gasparro, Sacco, Simona, Ricci, Stefano, Ornello, Raffaele, Eusebi, Paolo, Petraglia, Luca, Toni, Danilo, and paolo, aridon

Subjects
disease outbreak, Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, Italy, cerebral hemorrhage, disease outbreaks, incidence, ischemic attack, transient, 0302 clinical medicine, Epidemiology, 80 and over, Medicine, Thrombolytic Therapy, Acute ischemic stroke, Thrombectomy, Aged, 80 and over, Ischemic Attack, Transient, Incidence (epidemiology), Endovascular Procedures, Middle Aged, Hospitalization, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Settore MED/26 - Neurologia, Female, Cardiology and Cardiovascular Medicine, Aged, COVID-19, Cerebral Hemorrhage, Humans, Ischemic Attack, Transient, Ischemic Stroke, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Revascularization, Settore MED/26, 03 medical and health sciences, Advanced and Specialized Nursing, business.industry, Outbreak, Emergency medicine, Brief Reports, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Supplemental Digital Content is available in the text., Background and Purpose: We aimed to investigate the rate of hospital admissions for cerebrovascular events and of revascularization treatments for acute ischemic stroke in Italy during the coronavirus disease 2019 (COVID-19) outbreak. Methods: The Italian Stroke Organization performed a multicenter study involving 93 Italian Stroke Units. We collected information on hospital admissions for cerebrovascular events from March 1 to March 31, 2020 (study period), and from March 1 to March 31, 2019 (control period). Results: Ischemic strokes decreased from 2399 in 2019 to 1810 in 2020, with a corresponding hospitalization rate ratio (RR) of 0.75 ([95% CI, 0.71–0.80] P

Published
2020

5. General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke

Author

Rosa Musolino, Marco Petruzzelli, Roberto Gasparotti, Simona Sacco, Laura Greco, Monia Russo, Wiliam Auteri, Paolo Invernizzi, Andrea Giorgianni, Nicola Cavasin, Salvatore Mangiafico, Francesco Causin, Elvis Lafe, Guido Bigliardi, Mauro Bergui, Roberto Menozzi, Pietro Amistà, Antonio Pitrone, Lucio Castellan, Francesco Grillo, Valentina Saia, Umberto Scoditti, Manuel Cappellari, Paolo Cerrato, Maria Porzia Ganimede, Andrea Saletti, Rossana Tassi, Laura Malfatto, Maria Ruggiero, Andrea Zini, Angelica Tinelli, Ettore Nicolini, Claudio Baracchini, Chiara Comelli, Giuseppe Craparo, Alfonsina Casalena, Michelangelo Mancuso, Luca Allegretti, Adriana Critelli, Emanuele Malatesta, Dario Luca Lauretti, Anna Cavallini, Tiziana Tassinari, Patrizia Nencini, Mauro Magoni, Bruno Bonetti, Stefano Vallone, Giulio Guidetti, Marco Pavia, Danilo Toni, Rebecca Tinturini, Simona Corraine, Elisa Francesca Maria Ciceri, Fabrizio Sallustio, Pietro Filauri, Giovanni Pracucci, Ilaria Casetta, Edoardo Puglielli, Nunzio Paolo Nuzzi, Maurizio Versino, Delfina Ferrandi, Marina Mannino, Luigi Chiumarulo, Domenico Inzitari, Gigliola Chianale, Sandra Bracco, Stefano Forlivesi, Alfredo Petrone, Maria Carmela Spinelli, Alessandro De Vito, Luigi Simonetti, and Sergio Nappini

Subjects
Male, Anesthesia, General/adverse effects Brain Ischemia/*therapy Endovascular Procedures/methods, Sedation, Ischemia, Anesthesia, General, anesthesia, Brain Ischemia, Brain ischemia, 80 and over, medicine, Humans, odds ratio, Local anesthesia, conscious sedation, groin, thrombectomy, Aged, Aged, 80 and over, Endovascular Procedures, Female, Middle Aged, Registries, Stroke, Thrombectomy, General, Adverse effect, Advanced and Specialized Nursing, Groin, business.industry, Ambientale, medicine.disease, medicine.anatomical_structure, General/adverse effects Brain Ischemia/*therapy Endovascular Procedures/methods, Anesthesia, Anesthetic, Neurology (clinical), medicine.symptom, Cardiology and Cardiovascular Medicine, business, anesthesia, conscious sedation, groin, odds ratio, thrombectomy, medicine.drug
Abstract

Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0–1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602–1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515–0.990). The rates of modified Rankin Scale score of 0–2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689–1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566–0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644–1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844–1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262–0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337–0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

Published
2020

6. Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Author

Nicola Cavasin, Delfina Ferrandi, Danilo Toni, Monia Russo, Simona Sacco, Salvatore Mangiafico, William Auteri, Nunzio Paolo Nuzzi, Mirco Cosottini, Luca Di Maggio, Monica Bandettini di Poggio, Paolo Invernizzi, Valentina Saia, Edoardo Puglielli, Marco Mauri, Lilia Latte, Maria Porzia Ganimede, Anne Falcou, Andrea Grazioli, Francesco Causin, Mauro Magoni, Pietro Amistà, Roberto Menozzi, Alessio Comai, Giacomo Della Marca, Valeria Piras, Andrea Naldi, Enrica Franchini, Tiziana Tassinari, Salvatore Isceri, Alfonsina Casalena, Roberto Gasparotti, Stefano Vallone, Isabella Francalanza, Marco Petruzzellis, Andrea Zini, Francesco Cordici, Christian Commodaro, Andrea Wlderk, Francesco Pintus, Stefano Forlivesi, Nicola Mavilio, Giuseppe Carità, Antonio Baule, Mariano Velo, Giuseppina Sanfilippo, Manuel Corato, Nicola Limbucci, Lucio Castellan, Marina Mannino, Gianpaolo Toscano, Maria Pia Prontera, Laura Malfatto, Giancarlo Salsano, Paolo Cerrato, Critelli Adriana, Giorgianni Andrea, Alfredo Petrone, Andrea Alexandre, Gianluca Deiana, Giuseppe Ganci, Giovanni Pracucci, Rossana Tassi, Giovanni Dui, Cristiano Azzini, Guido Squassina, Guido Bigliardi, Mauro Bergui, Claudio Baracchini, Giuseppe Craparo, Michelangelo Mancuso, Carlo Cirelli, Simona Corraine, Patrizia Nencini, Luigi Chiumarulo, Paola Gennari, Ivan Gallesio, and Fabrizio Sallustio

Subjects
medicine.medical_specialty, acute ischemic stroke, thrombolysis, Complications, Italy, cerebral infarction, endovascular stroke therapy, mechanical thrombectomy, risk factors, stroke incidence, medicine.medical_treatment, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Humans, Incidence, Registries, Risk Factors, Thrombectomy, Treatment Outcome, Endovascular Procedures, Ischemic Stroke, Stroke, Internal medicine, medicine, Clinical significance, Cumulative incidence, Endovascular treatment, Acute ischemic stroke, Cerebral infarction, business.industry, Incidence (epidemiology), Thrombolysis, medicine.disease, Brain Ischemia/epidemiology *Ischemic Stroke Italy/epidemiology Registries Risk Factors *Stroke/epidemiology/therapy Thrombectomy/*adverse effects Treatment Outcome Complications Italy acute ischemic stroke cerebral infarction endovascular stroke therapy mechanical thrombectomy stroke incidence thrombolysis, Mechanical thrombectomy, Neurology, Cardiology, business, 030217 neurology & neurosurgery
Abstract

Background There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. Aims We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. Methods From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. Results The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p Conclusions Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.

Published
2020

7. Acute myelopathies associated to SARS-CoV-2 infection: Viral or immune-mediated damage?☆

Author

Rodolfo Schizzi, Elena Colombo, Marco Mussa, Francesca Valentino, Pietro Businaro, Delfina Ferrandi, Isabella Canavero, Paolo Prunetti, Sabrina Ravaglia, Giuseppe Cosentino, Kalliopi Marinou, Diego Franciotta, Elisa Rognone, Anna Pichiecchio, Giuseppe Micieli, Carla Zanferrari, and Lisa Maria Farina

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, SARS-CoV-2, Acute myelopathy, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Acute flaccid paraplegia, Public Health, Environmental and Occupational Health, Myelitis, COVID-19, Spinal Cord Diseases, medicine.disease, Virology, Demyelinating myelitis, Infectious Diseases, Immune system, Polio-like syndrome, Correspondence, Medicine, business
Published
2021

8. Topiramate in migraine progression

Author

Delfina Ferrandi and Luigi Ruiz

Subjects
Topiramate, Migraine progression, medicine.medical_specialty, Neurology, Migraine Disorders, Clinical Neurology, Fructose, Review Article, Neurological disorder, Disease, Epilepsy, Chronic Migraine, Internal medicine, Humans, Medicine, Randomized Controlled Trials as Topic, Chronic migraine, Subclinical infection, Neurons, business.industry, Brain, General Medicine, medicine.disease, Treatment Outcome, Anesthesiology and Pain Medicine, Migraine, Anesthesia, Chronic Disease, Disease Progression, Anticonvulsants, Neurology (clinical), business, Preventive treatment, medicine.drug
Abstract

Increasing evidence shows that migraine, typically considered as an episodic disease, is a chronic and, in some patients, progressive disorder. Among neuromodulators used for migraine prevention, topiramate has a high level of evidence-based efficacy. Through its wide range of mechanisms of action topiramate increases the activation threshold resulting in neuronal stabilization and thereby reducing cortical neurons hyperexcitability, which is believed to be an important electrophysiological feature underlying the pathogenesis of epilepsy and migraine. Recent studies show that migraineurs have subclinical structural brain changes and persistent alteration of pain perception, in some cases correlated with the duration of the disease and the frequency of attacks that might play a role in the transformation of episodic migraine to chronic forms. An early and prolonged preventive treatment might reduce the risk of such transformation. Recent evidence suggests that topiramate, by reducing migraine frequency and use of acute medication, may prevent the negative progression of migraine. Furthermore, two recently completed multicenter, randomised, placebo-controlled trials have shown that treatment with topiramate 100 mg/day is effective and well tolerated in patients already progressed to chronic migraine and difficult to treat conditions associated with medication-overuse. Topiramate seems to be a preventive treatment, which might be able to act at different levels of the migraine cycle: reduction of frequency in episodic migraine, prevention, and treatment of chronic migraine.

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