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1. Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation

Author

Grandone, E, Tiscia, G, Pesavento, R, De Laurenzo, A, Ceccato, D, Sartori, M, Mirabella, L, Cinnella, G, Mastroianno, M, Dalfino, L, Colaizzo, D, Vettor, R, Intrieri, M, Ostuni, A, Margaglione, M, Alboini, P, Antonioni, A, Aucella, F, Bochicchio, G, Carbonelli, C, Carella, M, Castori, M, Centonze, A, Ciliberti, G, Copetti, M, Corritore, M, De Cosmo, S, D'Aloiso, L, D'Errico, M, de Matthaeis, A, Del Gaudio, A, Di Giorgio, A, Giambra, V, Greco, A, Florio, L, Fontana, A, Inchingolo, V, Inglese, M, Labonia, M, La Marca, A, Latiano, T, Leone, M, Maiello, E, Mangia, A, Marciano, C, Massa, V, Massafra, S, Orciuli, G, Palladino, N, Perna, R, Piscitelli, P, Piemontese, M, Prencipe, M, Raggi, P, Rodriquenz, M, Russo, R, Sancarlo, D, Simeone, A, Trischitta, V, Zarrelli, M, Vaira, P, Vergara, D, Vescovi, A, Grandone E., Tiscia G., Pesavento R., De Laurenzo A., Ceccato D., Sartori M. T., Mirabella L., Cinnella G., Mastroianno M., Dalfino L., Colaizzo D., Vettor R., Intrieri M., Ostuni A., Margaglione M., Alboini P. E., Antonioni A., Aucella F., Bochicchio G. B., Carbonelli C., Carella M., Castori M., Centonze A., Ciliberti G., Copetti M., Corritore M., De Cosmo S., D'Aloiso L., D'Errico M. M., de Matthaeis A., Del Gaudio A., Di Giorgio A., Giambra V., Greco A., Florio L., Fontana A., Inchingolo V., Inglese M., Labonia M., La Marca A., Latiano T., Leone M., Maiello E., Mangia A., Marciano C., Massa V., Massafra S., Orciuli G., Palladino N., Perna R., Piscitelli P., Piemontese M., Prencipe M. A., Raggi P., Rodriquenz M. G., Russo R., Sancarlo D., Simeone A., Trischitta V., Zarrelli M., Vaira P., Vergara D., Vescovi A., Grandone, E, Tiscia, G, Pesavento, R, De Laurenzo, A, Ceccato, D, Sartori, M, Mirabella, L, Cinnella, G, Mastroianno, M, Dalfino, L, Colaizzo, D, Vettor, R, Intrieri, M, Ostuni, A, Margaglione, M, Alboini, P, Antonioni, A, Aucella, F, Bochicchio, G, Carbonelli, C, Carella, M, Castori, M, Centonze, A, Ciliberti, G, Copetti, M, Corritore, M, De Cosmo, S, D'Aloiso, L, D'Errico, M, de Matthaeis, A, Del Gaudio, A, Di Giorgio, A, Giambra, V, Greco, A, Florio, L, Fontana, A, Inchingolo, V, Inglese, M, Labonia, M, La Marca, A, Latiano, T, Leone, M, Maiello, E, Mangia, A, Marciano, C, Massa, V, Massafra, S, Orciuli, G, Palladino, N, Perna, R, Piscitelli, P, Piemontese, M, Prencipe, M, Raggi, P, Rodriquenz, M, Russo, R, Sancarlo, D, Simeone, A, Trischitta, V, Zarrelli, M, Vaira, P, Vergara, D, Vescovi, A, Grandone E., Tiscia G., Pesavento R., De Laurenzo A., Ceccato D., Sartori M. T., Mirabella L., Cinnella G., Mastroianno M., Dalfino L., Colaizzo D., Vettor R., Intrieri M., Ostuni A., Margaglione M., Alboini P. E., Antonioni A., Aucella F., Bochicchio G. B., Carbonelli C., Carella M., Castori M., Centonze A., Ciliberti G., Copetti M., Corritore M., De Cosmo S., D'Aloiso L., D'Errico M. M., de Matthaeis A., Del Gaudio A., Di Giorgio A., Giambra V., Greco A., Florio L., Fontana A., Inchingolo V., Inglese M., Labonia M., La Marca A., Latiano T., Leone M., Maiello E., Mangia A., Marciano C., Massa V., Massafra S., Orciuli G., Palladino N., Perna R., Piscitelli P., Piemontese M., Prencipe M. A., Raggi P., Rodriquenz M. G., Russo R., Sancarlo D., Simeone A., Trischitta V., Zarrelli M., Vaira P., Vergara D., and Vescovi A.

Abstract

It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann–Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13–0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.

Published
2021

2. Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation

Author

Grandone, E., Tiscia, G., Pesavento, R., De Laurenzo, A., Ceccato, D., Sartori, M. T., Mirabella, L., Cinnella, G., Mastroianno, M., Dalfino, L., Colaizzo, D., Vettor, R., Intrieri, M., Ostuni, A., Margaglione, M., Alboini, P. E., Antonioni, A., Aucella, F., Bochicchio, G. B., Carbonelli, C., Carella, M., Castori, M., Centonze, A., Ciliberti, G., Copetti, M., Corritore, M., De Cosmo, S., D'Aloiso, L., D'Errico, M. M., de Matthaeis, A., Del Gaudio, A., Di Giorgio, A., Giambra, V., Greco, A., Florio, L., Fontana, A., Inchingolo, V., Inglese, M., Labonia, M., La Marca, A., Latiano, T., Leone, M., Maiello, E., Mangia, A., Marciano, C., Massa, V., Massafra, S., Orciuli, G., Palladino, N., Perna, R., Piscitelli, P., Piemontese, M., Prencipe, M. A., Raggi, P., Rodriquenz, M. G., Russo, R., Sancarlo, D., Simeone, A., Trischitta, V., Zarrelli, M., Vaira, P., Vergara, D., Vescovi, A., Grandone, E, Tiscia, G, Pesavento, R, De Laurenzo, A, Ceccato, D, Sartori, M, Mirabella, L, Cinnella, G, Mastroianno, M, Dalfino, L, Colaizzo, D, Vettor, R, Intrieri, M, Ostuni, A, Margaglione, M, Alboini, P, Antonioni, A, Aucella, F, Bochicchio, G, Carbonelli, C, Carella, M, Castori, M, Centonze, A, Ciliberti, G, Copetti, M, Corritore, M, De Cosmo, S, D'Aloiso, L, D'Errico, M, de Matthaeis, A, Del Gaudio, A, Di Giorgio, A, Giambra, V, Greco, A, Florio, L, Fontana, A, Inchingolo, V, Inglese, M, Labonia, M, La Marca, A, Latiano, T, Leone, M, Maiello, E, Mangia, A, Marciano, C, Massa, V, Massafra, S, Orciuli, G, Palladino, N, Perna, R, Piscitelli, P, Piemontese, M, Prencipe, M, Raggi, P, Rodriquenz, M, Russo, R, Sancarlo, D, Simeone, A, Trischitta, V, Zarrelli, M, Vaira, P, Vergara, D, and Vescovi, A

Subjects
Male, Time Factors, 030204 cardiovascular system & hematology, Logistic regression, law.invention, 0302 clinical medicine, law, Risk Factors, 80 and over, 030212 general & internal medicine, Hospital Mortality, Hematology, Low-Molecular-Weight, COVID-19, Low-molecular-weight heparin, Mortality, Ventilation, Aged, Aged, 80 and over, Anticoagulants, Clinical Decision-Making, Female, Heparin, Low-Molecular-Weight, Hospitalization, Humans, Middle Aged, Protective Factors, Risk Assessment, Thromboembolism, Treatment Outcome, Blood Transfusion, Heparin, Intensive care unit, Cohort, Breathing, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.drug_class, Low molecular weight heparin, Article, 03 medical and health sciences, Internal medicine, medicine, low-molecular-weight heparin, mortality, ventilation, aged, aged 80 and over, anticoagulants, clinical decision-making, female, low-molecular-weight, hospital mortality, hospitalization, humans, male, middle aged, protective factors, risk assessment, risk factors, thromboembolism, time factors, treatment outcome, blood transfusion, business.industry, business
Abstract

It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann–Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13–0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.

Published
2021

3. Correction to: Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation

Author

Grandone, E., Tiscia, G., Pesavento, R., De Laurenzo, A., Ceccato, D., Sartori, M. T., Mirabella, L., Cinnella, G., Mastroianno, M., Dalfino, L., Colaizzo, D., Vettor, R., Intrieri, M., Ostuni, A., Margaglione, M., Alboini, P. E., Antonioni, A., Aucella, F., Bochicchio, G. B., Carbonelli, C., Carella, M., Castori, M., Centonze, A., Ciliberti, G., Copetti, M., Corritore, M., De Cosmo, S., D'Aloiso, L., D'Errico, M. M., de Matthaeis, A., Del Gaudio, A., Di Giorgio, A., Giambra, V., Greco, A., Florio, L., Fontana, A., Inchingolo, V., Inglese, M., Labonia, M., La Marca, A., Latiano, T., Leone, M., Maiello, E., Mangia, A., Marciano, C., Massa, V., Massafra, S., Orciulo, G., Palladino, N., Perna, R., Piscitelli, P., Piemontese, M., Prencipe, M. A., Raggi, P., Rodriquenz, M. G., Russo, R., Sancarlo, D., Simeone, A., Trischitta, V., Zarrelli, M., Vaira, P., Vergara, D., and Vescovi, A.

Subjects
Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Time Factors, Coronavirus disease 2019 (COVID-19), medicine.drug_class, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Clinical Decision-Making, Low molecular weight heparin, Risk Assessment, Risk Factors, Internal medicine, Thromboembolism, medicine, Humans, Blood Transfusion, Hospital Mortality, Aged, Aged, 80 and over, Hematology, business.industry, Correction, Anticoagulants, COVID-19, Heparin, Low-Molecular-Weight, Middle Aged, Protective Factors, CSS COVID-19 Group, Covid-19, research groups, Hospitalization, Treatment Outcome, Emergency medicine, Breathing, Female, Cardiology and Cardiovascular Medicine, business
Abstract

It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann-Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13-0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.

Published
2021

4. Correction to: Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation (Journal of Thrombosis and Thrombolysis, (2021), 52, 3, (772-778), 10.1007/s11239-021-02429-z)

Author

Grandone, E., Tiscia, G., Pesavento, R., De Laurenzo, A., Ceccato, D., Sartori, M. T., Mirabella, L., Cinnella, G., Mastroianno, M., Dalfino, L., Colaizzo, D., Vettor, R., Intrieri, M., Ostuni, A., Margaglione, M., Alboini, P. E., Antonioni, A., Aucella, F., Bochicchio, G. B., Carbonelli, C., Carella, M., Castori, M., Centonze, A., Ciliberti, G., Copetti, M., Corritore, M., De Cosmo, S., D'Aloiso, L., D'Errico, M. M., de Matthaeis, A., Del Gaudio, A., Di Giorgio, A., Giambra, V., Greco, A., Florio, L., Fontana, A., Inchingolo, V., Inglese, M., Labonia, M., La Marca, A., Latiano, T., Leone, M., Maiello, E., Mangia, A., Marciano, C., Massa, V., Massafra, S., Orciulo, G., Palladino, N., Perna, R., Piscitelli, P., Piemontese, M., Prencipe, M. A., Raggi, P., Rodriquenz, M. G., Russo, R., Sancarlo, D., Simeone, A., Trischitta, V., Zarrelli, M., Vaira, P., Vergara, D., and Vescovi, A.

Published
2021

5. The Synergistic Effect of Time of Exposure, Distance and No Use of Personal Protective Equipment in the Determination of SARS-CoV-2 Infection: Results of a Contact Tracing Follow-Up Study in Healthcare Workers

Author

La Torre, G., Marte, M., Previte, C. M., Barone, L. C., Picchioni, F., Chiappetta, M., Faticoni, A., Marotta, D., Mazzalai, E., Barletta, V. I., Kibi, S., Cammalleri, V., Dorelli, B., Giffi, M., Pocino, R. N., Massetti, A. P., Fimiani, C., Turriziani, O., Romano, F., Antonelli, G., Deales, A., Mastroianni, C. M., Vasaturo, F., Rossi, N., D'Ambrogio, M. G., Calogero, C., Falasconi, G., Mazza, S., Limongi, A., Drago, G., Del Parco, F., Nicoli, F., Colazingari, V., Renzi, S., Celani, M., Buzatu, A., Andreski, A., Koteva, M., Mazza, E., Morgante, L., Masi, P., Bruccoleri, G., La Penna, V., Casertano, F., Vespa, G., Vannozzi, A., Attardo, I., Candeloro, C., Apuzzo, D., Terzo, D., Olbes, A., Addari, S., Cinti, N. A., Bolettieri, A., Campanella, G., Silvestri, G., Sorrentino, A., Taibi, C., Ponzi, B., Marceline, N. K., Colelli, C., Cupelloni, L., Festucci, S., Bellenzier, C., Ribezzo, G., Fabbri, S., Tenore, G., Pacheco, R. M. V., Caprini, D., Andreacchio, S., Antico, R., Catherine, S. M., Pepe, P., Ricci, D., D'Intino, P., Chiaravallotti, S., Napolitano, D., Panarello, C., Galbera, M., Iobbi, N., Lomartire, F., and Inchingolo, V.

Subjects
safety, Infectious Disease Transmission, Patient-to-Professional, Health Personnel, Health, Toxicology and Mutagenesis, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), education, Article, contact tracing, synergism, Environmental health, time of exposure, Health care, Humans, Medicine, COVID-19, cistance, personal protective equipment, SARS-CoV-2, female, follow-up studies, health personnel, humans, infectious disease transmission, patient-to-professional, middle aged, pandemics, distance, Pandemics, Personal protective equipment, Univariate analysis, business.industry, Proportional hazards model, Hazard ratio, Public Health, Environmental and Occupational Health, Follow up studies, virus diseases, Middle Aged, Female, business, Contact tracing, Follow-Up Studies
Abstract

The aim of this study is to assess the effect of contact time, contact distance and the use of personal protective equipment on the determination of SARS-CoV-2 infection in healthcare workers (HCWs). This study consists of an analysis of data gathered for safety reasons at the Sapienza Teaching Hospital Policlinico Umberto I in Rome through the surveillance system that was put into place after the worsening of the COVID-19 pandemic. The studied subjects consist of HCWs who were put under health surveillance, i.e., all employees who were in contact with subjects who were confirmed to have tested positive for SARS-CoV-2. The HCWs under surveillance were monitored for a period encompassing ten days after the date of contact, during which they undertook nasopharyngeal swab tests analysed through RT-PCR (RealStar® SARS-CoV-2 Altona Diagnostic–Germany). Descriptive and univariate analyses have been undertaken, considering the following as risk factors: (a) no personal protective equipment use (PPE), (b) Distance &lt, 1 m between the positive and contact persons, (c) contact time &gt, 15′. Finally, a Cox regression and an analysis of the level of synergism between factors, as specified by Rothman, were carried out. We analysed data from 1273 HCWs. Of these HCWs, 799 (62.8%) were females, with a sample average age of 47.8 years. Thirty-nine (3.1%) tested positive during surveillance. The overall incidence rate was 0.4 per 100 person-days. Time elapsed from the last exposure and a positive RT-PCR result ranged from 2 to 17 days (mean = 7, median = 6 days). In the univariate analysis, a distance &lt, 1 m and a contact time &gt, 15′ proved to be risk factors for the SARS-CoV-2 infection, with a hazard ratio (HR) of 2.62 (95% CI: 1.11–6.19) and 3.59 (95% IC: 1.57–8.21), respectively. The synergism analysis found the highest synergism between the “no PPE use” x “Contact time”. The synergy index S remains strongly positive also in the analysis of the factors “no PPE use” x “Distance” and “Time of contact” x “Distance”. This study confirms the absolute need to implement safety protocols during the pandemic and to use the correct PPE within health facilities in order to prevent SARS-CoV-2 infection. The analysis shows that among the factors considered (contact time and distance, no use of PPE), there is a strong synergistic effect.

Published
2021

7. Continuing medical education activityin echocardiography

Author

Fan P, Vigna C, Marchese N, Zanchetta M, Chessa M, Inchingolo V, Pacilli MA, Amico C, Fanelli M, Fanelli R, Loperfido F., Fan, P, Vigna, C, Marchese, N, Zanchetta, M, Chessa, M, Inchingolo, V, Pacilli, Ma, Amico, C, Fanelli, M, Fanelli, R, and Loperfido, F.

Published
2012

9. RANDOMIZED CONTROLLED TRIAL OF STREPTOKINASE, ASPIRIN, AND COMBINATION OF BOTH IN TREATMENT OF ACUTE ISCHEMIC STROKE

Author

CANDELISE L, ARITZU E, CICCONE A, RICCI S, WARDLAW J, TOGNONI G, RONCAGLIONI MC, NEGRI E, COLOMBO F, BOCCARDI E, DEGRANDI C, SCIALFA G, ARGENTINO C, BERTELE V, MAGGIONI AP, PERRONE P, BARNETT HJM, BOGOUSSLAVSKY J, DELFAVERO A, LOI U, PETO R, WARLOW C, CANZI S, COMPARETTI S, CLERICI F, PALUMBO A, SGARONI G, POLONARA S, REGINELLI R, CERAVOLO MG, PROVINCIALI L, DELGOBBO M, SCARPINO O, BOTTACCHI E, DALESSANDRO G, DIGIOVANNI M, BLANC S, ROVEYAZ L, RALLI L, VANNI D, REFI C, FEDERICO F, CONTE C, INCHINGOLO V, INSABATO R, SALSA F, LORIZIO A, ROTTOLI MR, BRUNI L, DEFANTI CA, FERA L, CAMERLINGO M, CASTO L, CENSORI B, MAMOLI A, PORAZZI D, GRAMPA G, LASPINA I, GIGLIA L, AVENIA V, GUELI S, LOLLI V, MIELE V, SANTANGELO M, COPPOLA G, TRIANNI G, MARRA M, GRECO E, TONTI D, PRETOLANI E, STELLIO M, ARNABOLDI M, CIOLA R, DANIELI G, REZZONICO M, GUIDOTTI M, PELLEGRINI G, RAUDINO F, DELFAVERO C, FRATTINI T, RICCARDI T, LEVIMINZI C, LOCATELLI F, PASSERI F, LOMBARDO G, COCCO F, PRATESI M, SANTINI S, CARDOPATRI F, TAFANI O, LANDINI GC, PIERAGNOLI E, BELLESI R, BAGNOLI L, GHETTI A, MARRAZZA OB, MENEGAZZO P, SPOLVERI S, CAPPELLETTI C, CANDELIERE G, COSTANTINO G, DACUNO F, LOMUZIO T, RIZZITELLI FP, BOVIO G, GRILLI GP, ZOCCHI M, MAZZANTI I, PISAPIA G, NUZZI R, RUSSO G, LAMA G, BALDASSARRI G, BETTINI R, CANI E, CERIOLI E, DEGIORGI M, GARAGNANI A, PASQUALI S, CHIOMA V, FINI C, MARZARA G, BALOTTA A, BERTUZZI D, MASINA M, MATACENA C, MICHELINI M, PIRAZZOLI G, SACCHET C, MAROTTA P, CALVI L, SCACCABAROZZI C, MENOZZI C, SASANELLI F, BASCELLI C, PONTRELLI V, SCHIERONI F, BELVEDERE D, DECAPITANI E, DICOSTANZO M, RASCAROLI M, CITTERIO O, MILANI R, CAPIALBI R, ARENA G, MUSOLINO R, DIPERRI R, BONAVENTI C, FINZI F, MESSINA A, ROMANAZZI V, STERZI R, BOTTINI G, SANTILLI I, BRUCATO A, DEJULI E, PALMIERI G, RAGAINI S, THIELLA G, ALLI C, CAROSELLA L, RIZZATO G, BIANCHI M, MOTTO C, PINARDI G, SCARLATO G, BETTINELLI A, PORRO F, RANDAZZO A, MARINI U, LATTUADA P, PIETRA A, FRANCESCHI M, VOLOUTE MA, MALFERRARI G, BONDI M, GARUTI W, MELINI L, COLOMBO A, ALBORINI G, PANZETTI P, SCARPA M, SORGATO P, CRISI G, BONASERA N, BASSO F, NATALI E, MONACO P, GASPARRO AM, TRIOLO F, LECHI A, COLONNA F, DASCOLA I, GIORGI C, SCODITTI U, BASSI P, MENOZZI R, PIAZZA P, DEGLIANTONI G, DESIMONI M, GIANNINI A, MICILI G, BOSONE D, CAVALLINI A, MARTELLI A, BARZIZZA F, POLI M, BIAGINI S, CAPOCCHI G, CELANI MG, PICCHIARELLI A, RIGHETTI E, ZAMPOLINI M, CAPUTO N, BARTOLINI S, SANTONI M, SITA D, TAGLIOLI M, VOLPI G, ROSSI F, ALOY F, CASTELLANO AE, MINOTTA F, GATTA A, VINATTIERI A, CANTINI A, REBUCCI GG, BISSI G, DEBLASI F, PASCARELLI E, TURIAMO F, GUIDETTI D, BARATTI M, FERRARINI G, GHIDONI E, GRECO G, MARCELLO N, MOTTI L, SOLIME F, TERENZIANI S, ZUCCO R, TROISO A, VENEZIANI M, IORI I, CURATOLA L, BOLLETTINI G, CARBONI T, GOBBATO R, INFRICCIOLO P, SABATINI D, SFRAPPINI M, FANCELLU A, CASU G, DELEDDA MG, SPANU MA, PIRISI A, MARRAS FA, ROSATI G, BRAMBILLA A, ERLI GC, FELICE B, GRANDI R, MIRABILE D, ZADRA M, CAVESTRI R, GORI D, LONGHINI E, MIELE N, DIVIZIA G, GRASSELLI S, PEZZELLA F, ZUCCARI F, SALLUSTO L, LINCESSO F, SCARPATI C, IANNONE G, BARTOCCI A, COSTANTINI F, DESANTIS L, LANCIA G, MOSCHINI E, PACI A, SENSIDONI A, TRENTA A, BARTOLINI N, OTTAVIANO P, BISCOTTINI B, ALUNNI G, BARTOLINI I, BELLADONNA D, BOCCALI A, CRUCIANI M, IBBA R, LUCCIOLI R, MARCECA A, PACINI M, PALLONE M, GIRARDI P, ORRICO D, LANZA E, BALLINI A, GRANDI FC, MUSCO G, STEIDL L, SANTORO G, VEMCO A, DUDINE P, MILONE FF, MUNARI L, PERRETI A, PORTA M, LONGONI C, FERANI R, WATT M, SANDERCOCK P, FENNETRY A, BANNISTER P, CLARKE CE, BAMFORD J, VENABLES G, CORREIA M, CANDELISE L, ARITZU E, CICCONE A, RICCI S, WARDLAW J, TOGNONI G, RONCAGLIONI MC, NEGRI E, COLOMBO F, BOCCARDI E, DEGRANDI C, SCIALFA G, ARGENTINO C, BERTELE V, MAGGIONI AP, PERRONE P, BARNETT HJM, BOGOUSSLAVSKY J, DELFAVERO A, LOI U, PETO R, WARLOW C, CANZI S, COMPARETTI S, CLERICI F, PALUMBO A, SGARONI G, POLONARA S, REGINELLI R, CERAVOLO MG, PROVINCIALI L, DELGOBBO M, SCARPINO O, BOTTACCHI E, DALESSANDRO G, DIGIOVANNI M, BLANC S, ROVEYAZ L, RALLI L, VANNI D, REFI C, FEDERICO F, CONTE C, INCHINGOLO V, INSABATO R, SALSA F, LORIZIO A, ROTTOLI MR, BRUNI L, DEFANTI CA, FERA L, CAMERLINGO M, CASTO L, CENSORI B, MAMOLI A, PORAZZI D, GRAMPA G, LASPINA I, GIGLIA L, AVENIA V, GUELI S, LOLLI V, MIELE V, SANTANGELO M, COPPOLA G, TRIANNI G, MARRA M, GRECO E, TONTI D, PRETOLANI E, STELLIO M, ARNABOLDI M, CIOLA R, DANIELI G, REZZONICO M, GUIDOTTI M, PELLEGRINI G, RAUDINO F, DELFAVERO C, FRATTINI T, RICCARDI T, LEVIMINZI C, LOCATELLI F, PASSERI F, LOMBARDO G, COCCO F, PRATESI M, SANTINI S, CARDOPATRI F, TAFANI O, LANDINI GC, PIERAGNOLI E, BELLESI R, BAGNOLI L, GHETTI A, MARRAZZA OB, MENEGAZZO P, SPOLVERI S, CAPPELLETTI C, CANDELIERE G, COSTANTINO G, DACUNO F, LOMUZIO T, RIZZITELLI FP, BOVIO G, GRILLI GP, ZOCCHI M, MAZZANTI I, PISAPIA G, NUZZI R, RUSSO G, LAMA G, BALDASSARRI G, BETTINI R, CANI E, CERIOLI E, DEGIORGI M, GARAGNANI A, PASQUALI S, CHIOMA V, FINI C, MARZARA G, BALOTTA A, BERTUZZI D, MASINA M, MATACENA C, MICHELINI M, PIRAZZOLI G, SACCHET C, MAROTTA P, CALVI L, SCACCABAROZZI C, MENOZZI C, SASANELLI F, BASCELLI C, PONTRELLI V, SCHIERONI F, BELVEDERE D, DECAPITANI E, DICOSTANZO M, RASCAROLI M, CITTERIO O, MILANI R, CAPIALBI R, ARENA G, MUSOLINO R, DIPERRI R, BONAVENTI C, FINZI F, MESSINA A, ROMANAZZI V, STERZI R, BOTTINI G, SANTILLI I, BRUCATO A, DEJULI E, PALMIERI G, RAGAINI S, THIELLA G, ALLI C, CAROSELLA L, RIZZATO G, BIANCHI M, MOTTO C, PINARDI G, SCARLATO G, BETTINELLI A, PORRO F, RANDAZZO A, MARINI U, LATTUADA P, PIETRA A, FRANCESCHI M, VOLOUTE MA, MALFERRARI G, BONDI M, GARUTI W, MELINI L, COLOMBO A, ALBORINI G, PANZETTI P, SCARPA M, SORGATO P, CRISI G, BONASERA N, BASSO F, NATALI E, MONACO P, GASPARRO AM, TRIOLO F, LECHI A, COLONNA F, DASCOLA I, GIORGI C, SCODITTI U, BASSI P, MENOZZI R, PIAZZA P, DEGLIANTONI G, DESIMONI M, GIANNINI A, MICILI G, BOSONE D, CAVALLINI A, MARTELLI A, BARZIZZA F, POLI M, BIAGINI S, CAPOCCHI G, CELANI MG, PICCHIARELLI A, RIGHETTI E, ZAMPOLINI M, CAPUTO N, BARTOLINI S, SANTONI M, SITA D, TAGLIOLI M, VOLPI G, ROSSI F, ALOY F, CASTELLANO AE, MINOTTA F, GATTA A, VINATTIERI A, CANTINI A, REBUCCI GG, BISSI G, DEBLASI F, PASCARELLI E, TURIAMO F, GUIDETTI D, BARATTI M, FERRARINI G, GHIDONI E, GRECO G, MARCELLO N, MOTTI L, SOLIME F, TERENZIANI S, ZUCCO R, TROISO A, VENEZIANI M, IORI I, CURATOLA L, BOLLETTINI G, CARBONI T, GOBBATO R, INFRICCIOLO P, SABATINI D, SFRAPPINI M, FANCELLU A, CASU G, DELEDDA MG, SPANU MA, PIRISI A, MARRAS FA, ROSATI G, BRAMBILLA A, ERLI GC, FELICE B, GRANDI R, MIRABILE D, ZADRA M, CAVESTRI R, GORI D, LONGHINI E, MIELE N, DIVIZIA G, GRASSELLI S, PEZZELLA F, ZUCCARI F, SALLUSTO L, LINCESSO F, SCARPATI C, IANNONE G, BARTOCCI A, COSTANTINI F, DESANTIS L, LANCIA G, MOSCHINI E, PACI A, SENSIDONI A, TRENTA A, BARTOLINI N, OTTAVIANO P, BISCOTTINI B, ALUNNI G, BARTOLINI I, BELLADONNA D, BOCCALI A, CRUCIANI M, IBBA R, LUCCIOLI R, MARCECA A, PACINI M, PALLONE M, GIRARDI P, ORRICO D, LANZA E, BALLINI A, GRANDI FC, MUSCO G, STEIDL L, SANTORO G, VEMCO A, DUDINE P, MILONE FF, MUNARI L, PERRETI A, PORTA M, LONGONI C, FERANI R, WATT M, SANDERCOCK P, FENNETRY A, BANNISTER P, CLARKE CE, BAMFORD J, VENABLES G, and CORREIA M

Abstract

In ischaemic stroke, thrombolytic drugs speed the recanalisation of intracerebral arteries. The effects of aspirin are not known. A trial was conducted to determine whether, separately or together, streptokinase and aspirin have clinical benefits in acute ischaemic stroke similar to those in acute myocardial infarction. 622 patients with acute ischaemic stroke within 6 hours of symptom onset were randomised with a 2x2 factorial design to (i) a 1-hour intravenous infusion of 1 . 5 MU streptokinase, (ii) 300 mg/day buffered aspirin for 10 days, (iii) both active treatments, or (iv) neither. Early results raised a question whether the trial should be continued. Streptokinase (alone or with aspirin) was associated with an excess of 10-day case fatality (odds ratio 2 . 7; 95% confidence interval 1 . 7-4 . 3; 2p

Published
1995

10. RANDOMIZED CONTROLLED TRIAL OF STREPTOKINASE, ASPIRIN, AND COMBINATION OF BOTH IN TREATMENT OF ACUTE ISCHEMIC STROKE

Author

CANDELISE, L, ARITZU, E, CICCONE, A, RICCI, S, WARDLAW, J, TOGNONI, G, RONCAGLIONI, M, NEGRI, E, COLOMBO, F, BOCCARDI, E, DEGRANDI, C, SCIALFA, G, ARGENTINO, C, BERTELE, V, MAGGIONI, A, PERRONE, P, BARNETT, H, BOGOUSSLAVSKY, J, DELFAVERO, A, LOI, U, PETO, R, WARLOW, C, CANZI, S, COMPARETTI, S, CLERICI, F, PALUMBO, A, SGARONI, G, POLONARA, S, REGINELLI, R, CERAVOLO, M, PROVINCIALI, L, DELGOBBO, M, SCARPINO, O, BOTTACCHI, E, DALESSANDRO, G, DIGIOVANNI, M, BLANC, S, ROVEYAZ, L, RALLI, L, VANNI, D, REFI, C, FEDERICO, F, CONTE, C, INCHINGOLO, V, INSABATO, R, SALSA, F, LORIZIO, A, ROTTOLI, M, BRUNI, L, DEFANTI, C, FERA, L, CAMERLINGO, M, CASTO, L, CENSORI, B, MAMOLI, A, PORAZZI, D, GRAMPA, G, LASPINA, I, GIGLIA, L, AVENIA, V, GUELI, S, LOLLI, V, MIELE, V, SANTANGELO, M, COPPOLA, G, TRIANNI, G, MARRA, M, GRECO, E, TONTI, D, PRETOLANI, E, STELLIO, M, ARNABOLDI, M, CIOLA, R, DANIELI, G, REZZONICO, M, GUIDOTTI, M, PELLEGRINI, G, RAUDINO, F, DELFAVERO, C, FRATTINI, T, RICCARDI, T, LEVIMINZI, C, LOCATELLI, F, PASSERI, F, LOMBARDO, G, COCCO, F, PRATESI, M, SANTINI, S, CARDOPATRI, F, TAFANI, O, LANDINI, G, PIERAGNOLI, E, BELLESI, R, BAGNOLI, L, GHETTI, A, MARRAZZA, O, MENEGAZZO, P, SPOLVERI, S, CAPPELLETTI, C, CANDELIERE, G, COSTANTINO, G, DACUNO, F, LOMUZIO, T, RIZZITELLI, F, BOVIO, G, GRILLI, G, ZOCCHI, M, MAZZANTI, I, PISAPIA, G, NUZZI, R, RUSSO, G, LAMA, G, BALDASSARRI, G, BETTINI, R, CANI, E, CERIOLI, E, DEGIORGI, M, GARAGNANI, A, PASQUALI, S, CHIOMA, V, FINI, C, MARZARA, G, BALOTTA, A, BERTUZZI, D, MASINA, M, MATACENA, C, MICHELINI, M, PIRAZZOLI, G, SACCHET, C, MAROTTA, P, CALVI, L, SCACCABAROZZI, C, MENOZZI, C, SASANELLI, F, BASCELLI, C, PONTRELLI, V, SCHIERONI, F, BELVEDERE, D, DECAPITANI, E, DICOSTANZO, M, RASCAROLI, M, CITTERIO, O, MILANI, R, CAPIALBI, R, ARENA, G, MUSOLINO, R, DIPERRI, R, BONAVENTI, C, FINZI, F, MESSINA, A, ROMANAZZI, V, STERZI, R, BOTTINI, G, SANTILLI, I, BRUCATO, A, DEJULI, E, PALMIERI, G, RAGAINI, S, THIELLA, G, ALLI, C, CAROSELLA, L, RIZZATO, G, BIANCHI, M, MOTTO, C, PINARDI, G, SCARLATO, G, BETTINELLI, A, PORRO, F, RANDAZZO, A, MARINI, U, LATTUADA, P, PIETRA, A, FRANCESCHI, M, VOLOUTE, M, MALFERRARI, G, BONDI, M, GARUTI, W, MELINI, L, COLOMBO, A, ALBORINI, G, PANZETTI, P, SCARPA, M, SORGATO, P, CRISI, G, BONASERA, N, BASSO, F, NATALI, E, MONACO, P, GASPARRO, A, TRIOLO, F, LECHI, A, COLONNA, F, DASCOLA, I, GIORGI, C, SCODITTI, U, BASSI, P, MENOZZI, R, PIAZZA, P, DEGLIANTONI, G, DESIMONI, M, GIANNINI, A, MICILI, G, BOSONE, D, CAVALLINI, A, MARTELLI, A, BARZIZZA, F, POLI, M, BIAGINI, S, CAPOCCHI, G, CELANI, M, PICCHIARELLI, A, RIGHETTI, E, ZAMPOLINI, M, CAPUTO, N, BARTOLINI, S, SANTONI, M, SITA, D, TAGLIOLI, M, VOLPI, G, ROSSI, F, ALOY, F, CASTELLANO, A, MINOTTA, F, GATTA, A, VINATTIERI, A, CANTINI, A, REBUCCI, G, BISSI, G, DEBLASI, F, PASCARELLI, E, TURIAMO, F, GUIDETTI, D, BARATTI, M, FERRARINI, G, GHIDONI, E, GRECO, G, MARCELLO, N, MOTTI, L, SOLIME, F, TERENZIANI, S, ZUCCO, R, TROISO, A, VENEZIANI, M, IORI, I, CURATOLA, L, BOLLETTINI, G, CARBONI, T, GOBBATO, R, INFRICCIOLO, P, SABATINI, D, SFRAPPINI, M, FANCELLU, A, CASU, G, DELEDDA, M, SPANU, M, PIRISI, A, MARRAS, F, ROSATI, G, BRAMBILLA, A, ERLI, G, FELICE, B, GRANDI, R, MIRABILE, D, ZADRA, M, CAVESTRI, R, GORI, D, LONGHINI, E, MIELE, N, DIVIZIA, G, GRASSELLI, S, PEZZELLA, F, ZUCCARI, F, SALLUSTO, L, LINCESSO, F, SCARPATI, C, IANNONE, G, BARTOCCI, A, COSTANTINI, F, DESANTIS, L, LANCIA, G, MOSCHINI, E, PACI, A, SENSIDONI, A, TRENTA, A, BARTOLINI, N, OTTAVIANO, P, BISCOTTINI, B, ALUNNI, G, BARTOLINI, I, BELLADONNA, D, BOCCALI, A, CRUCIANI, M, IBBA, R, LUCCIOLI, R, MARCECA, A, PACINI, M, PALLONE, M, GIRARDI, P, ORRICO, D, LANZA, E, BALLINI, A, GRANDI, F, MUSCO, G, STEIDL, L, SANTORO, G, VEMCO, A, DUDINE, P, MILONE, F, MUNARI, L, PERRETI, A, PORTA, M, LONGONI, C, FERANI, R, WATT, M, SANDERCOCK, P, FENNETRY, A, BANNISTER, P, CLARKE, C, BAMFORD, J, VENABLES, G, and CORREIA, M

Published
1995

12. 99Tcm-HMPAO SPET and 1HMRS proton magnetic resonance spectroscopy in patients with ischaemic cerebral infarction

Author

LAURIERO, F., FEDERICO, F., RUBINI, G., CONTE, C., SIMONE, IL., INCHINGOLO, V., and D'ADDABBO, A.

Abstract

Brain 99Tcm-HMPAO single photon emission tomography (SPET) and 1H-MRS (proton magnetic resonance spectroscopy) were used to determine correlations between alterations in regional cerebral blood flow (rCBF) and changes in neuronal metabolites in 21 patients (28 examinations) with ischaemic cerebral infarction examined in different phases. rCBF was determined semi-quantitatively using Lassen's linearization algorithm. SPET provided evidence of the hypoperfused site of necrosis within a few hours after the acute event and alterations in rCBF were detected in both the infarcted and diaschistic areas at all stages. 1H-MRS was used to monitor the concentration of the following metabolites: N-acetyl-aspartate (NAA), creatine and phosphocreatine (CRPCr), compounds containing choline (Cho) and lactate (Lac). A significant correlation was found between reduction in rCBF and a fall in NAA and CrPCr in both the acute and chronic phases, but not during ‘luxury perfusion’ in the subacute phase. The presence of LAC in the infarcted area up to 9 months post-ictus was totally unexpected. Simultaneous SPET and 1H-MRS thus provides additional information regarding the physiopathogenesis of cerebral ictus by clarifying the relation between alterations in rCBF and biochemical neuronal changes. We believe that NAA and CrPCr concentrations are the best expression of agreement between flow and metabolism in infarcted areas, particularly with regard to hypoperfused areas not clearly detectable by magnetic resonance imaging in the early post-ictus stage.

Published
1996

13. Defining short-term outcomes of minor ischemic stroke due to small artery occlusion in the era of dual antiplatelet treatment: A READAPT study sub-analysis.

Author

Foschi M, De Matteis E, 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, Diamanti 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, Sacco S, and Ornello R

Abstract

Background: The outcomes of minor ischemic stroke resulting from small artery occlusion (SAO-MIS) have not yet been characterized after dual antiplatelet treatment (DAPT) has become the standard of care. We provided updated figures on the short-term prognosis of SAO-MIS treated with early short-term DAPT and compared the outcomes of SAO-MIS versus non-SAO-MIS patients., Methods: This is a prespecified sub-analysis from a prospective multicentric real-world study (READAPT, NCT05476081) including patients with minor (NIHSS≤5) non-cardioembolic ischemic stroke treated with DAPT. The primary outcome was a composite of 90-day symptomatic ischemic stroke or major cardiovascular events. Secondary outcomes were the 90-day ordinal distribution of modified Rankin Scale (mRS) scores, 90-day excellent functional outcome (mRS of 0 to 1), and 24-h early neurological deterioration (END). Safety outcomes were 90-day intracerebral hemorrhage, moderate-to-severe and any bleedings. All outcomes were compared between SAO-MIS and non-SAO-MIS patients., Results: We included 678 MIS, of whom 253 (37.3 %) were SAO-related. At 90 days, 3 patients with SAO-MIS had primary outcome (1.2 % [95 % CI 0.2 %-3.5 %]), which were all SAO-related ischemic strokes. For the secondary outcomes, most SAO-MIS patients (n = 191, 75.5 %) had 90-day excellent functional outcome and 12 had 24-h END (4.7 % [95 % CI 2.5 %-8.3 %]). Referring to safety outcomes, 90-day intracerebral hemorrhage occurred only in one patient with SAO-MIS (0.4 % [95 % CI 0.0 %- 2.2 %]). Compared to non-SAO-MIS, the 90-day risk of recurrent vascular events was significantly lower among SAO-MIS (aHR 0.24 [95 % CI 0.08-0.68]; p = 0.007), while there were not significant differences in other secondary outcomes, nor in the risk of safety events., Conclusions: Our findings show overall favorable short-term prognosis after SAO-MIS treated with DAPT. Future studies should investigate factors associated with residual stroke risk and long-term outcomes of SAO-MIS., Competing Interests: Declaration of competing interest Andrea Zini reports compensation from Angels Initiative, Boehringer-Ingelheim, Daiichi Sankyo for consultant services; from Angels Initiative, Boehringer-Ingelheim, CSL Behring for speaking honoraria or other education services; from Daiichi Sankyo for meeting; from Bayer, and Astra Zeneca for participation on a Data Safety, Monitoring Board or Advisory Board; and he is member of ESO guidelines, ISA-AII guidelines, and IRETAS steering committee. Raffaele Ornello reports grants from Novartis and Allergan; compensation from Teva Pharmaceutical Industries, Eli Lilly and Company, and Novartis for other services; and travel support from Teva Pharmaceutical Industries. Simona Sacco reports compensation from Novartis, NovoNordisk, Allergan, AstraZeneca, Pfizer Canada, Inc., Eli Lilly and Company, Teva Pharmaceutical Industries, H. Lundbeck A/S, and Abbott Canada for consultant services; employment by University of L'Aquila; and compensation from Novartis for other services. Maurizio Paciaroni reports compensation from Daiichi Sankyo Company, Bristol Myers Squibb, Bayer, and Pfizer Canada, Inc., for consultant services. Danilo Toni reports compensation from Alexion, Astra Zeneca, Medtronic, and Pfizer for consultant services and participation on a Data Safety, Monitoring Board or Advisory Board. The other authors report no conflicts., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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14. 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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15. Thrombectomy in ischemic stroke patients with tandem occlusion in the posterior versus anterior circulation.

Author

Cappellari M, Pracucci G, Saia V, Mandruzzato N, Valletta F, Sallustio F, Casetta I, Fainardi E, Da Ros V, Diomedi M, Capasso F, Nencini P, Vallone S, Bigliardi G, Tessitore A, La Spina P, Bracco S, Tassi R, Bergui M, Cerrato P, Ruggiero M, Longoni M, Castellan L, Malfatto L, Saletti A, De Vito A, Menozzi R, Scoditti U, Simonetti L, Zini A, Lafe E, Cavallini A, Lazzarotti GA, Giannini N, Boghi A, Naldi A, Romano D, Napoletano R, Comai A, Franchini E, Cavasin N, Critelli A, Giorgianni A, Cariddi LP, Semeraro V, Boero G, Zimatore DS, Petruzzellis M, Biraschi F, Nicolini E, Pedicelli A, Frisullo G, Calzoni A, Tassinari T, Gallesio I, Sepe F, Filauri P, Sacco S, Lozupone E, Rizzo A, Besana M, Giossi A, Pavia M, Invernizzi P, Amistà P, Russo M, Florio F, Inchingolo V, Filizzolo M, Mannino M, Mangiafico S, and Toni D

Subjects
Humans, Male, Female, Aged, Middle Aged, Aged, 80 and over, Cohort Studies, Endovascular Procedures methods, Italy, Treatment Outcome, Prospective Studies, Ischemic Stroke surgery, Ischemic Stroke therapy, Thrombectomy methods, Registries
Abstract

Background: Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO., Methods: We conducted a cohort study on prospectively collected data of patients registered in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) who were treated with MT within 24 h from last known well time for acute ischemic stroke with p-TO (n = 275) or a-TO (n = 1853)., Results: After adjustment for unbalanced pre-procedure variables (year 2015-2021, age, sex, NIHSS score, ASPECTS, and time strata for puncture groin) and pre-stroke mRS score as pre-defined predictor, p-TO was significantly associated with lower probability of mRS score 0-2 (OR 0.415, 95% CI 0.268-0.644) and with higher risk of death (OR 2.813, 95% CI 2.080-3.805) at 3 months. After adjustment for unbalanced procedural and post-procedure variables (IVT, general anesthesia, TICI 3, and 24-h HT) and pre-stroke mRS score as pre-defined predictor, association between p-TO and lower probability of mRS score 0-2 (OR 0.444, 95% CI 0.304-0.649) and association between p-TO and with higher risk of death (OR 2.971, 95% CI 1.993-4.429) remained significant., Conclusions: MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO was associated with worse outcomes at 3 months., (© 2024. Fondazione Società Italiana di Neurologia.)

Published
2024
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16. Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack.

Author

De Matteis E, Ornello R, De Santis F, Foschi M, 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, Zenorini M, 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, Diamanti S, Tarletti R, Nencini P, Rota E, Sepe FN, Ferrandi D, Caputi L, Volpi G, 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, Roberta Bongioanni M, Toni D, Ricci S, and Sacco S

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 ABCD 2 score 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., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AZ reports compensation from Angels Initiative, Boehringer-Ingelheim, Daiichi Sankyo, CSL Behring, Bayer, and Astra Zeneca; and he is member of ESO guidelines, ISA-AII guidelines, and IRETAS steering committee. RO reports compensations from Novartis and Allergan, Teva Pharmaceutical Industries, Eli Lilly and Company, SS reports compensations from Novartis, NovoNordisk, Allergan, AstraZeneca, Pfizer Canada, Inc, Eli Lilly and Company, Teva Pharmaceutical Industries, H. Lundbeck A/S, and Abbott Canada; employment by Università degli Studi dell’Aquila. MPa reports compensation from Daiichi Sankyo Company, Bristol Myers Squibb, Bayer, and Pfizer Canada, Inc. DT reports compensation from Alexion, AstraZeneca, Medtronic, and Pfizer. The other authors report no conflicts.

Published
2024
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17. Role of Advanced Hemodynamic Ultrasound Evaluation in the Differential Diagnosis of Middle Cerebral Artery Stenosis: Introducing Morphological Criteria.

Author

Malferrari G, Merli N, Inchingolo V, Siniscalchi A, Laterza D, Monaco D, Arnone G, Zini A, Prada F, Azzini C, and Pugliatti M

Subjects
Humans, Constriction, Pathologic, Diagnosis, Differential, Ultrasonography, Doppler, Transcranial methods, Hemodynamics, Middle Cerebral Artery diagnostic imaging, Cerebrovascular Disorders
Abstract

Objective: The aim of the work described here was to determine the possible impact of the new technique advanced hemodynamic ultrasound evaluation (AHUSE) in identification of severe intracranial stenosis. Transcranial Doppler (TCD) and transcranial color-coded Doppler (TCCD) provide reliable velocimetric data, the indirect analysis of which allows us to obtain information on the patency of vessels and assumed stenosis range. However, very tight stenoses (>95%) cannot be detected with velocimetric criteria because of spectrum drops and the absence of high velocities, so that the right curve of the Spencer equation cannot be solved. Likewise, high velocities are not detected when analyzing morphologically long stenosis. Furthermore, the current classifications based on velocimetric criteria do not provide any categorization on stenoses with multiple acceleration points (MAPs)., Methods: With this Technical Note we aim to introduce, in addition to velocimetric criteria, more morphological criteria based on TCCD with the algorithm of AHUSE to optimize the characterization of intracranial stenosis (IS). TCCD-AHUSE relies on intensity-based next-generation techniques and can be used to identify IS with MAPs and simultaneously perform a morphological assessment of the stenosis length., Results: We introduce a new technical ultrasound (U) approach that we tested in a sample of four different types of stenoses combining velocimetric data and AHUSE using Esaote Microvascularization (MicroV) technique to the M1 tract of the middle cerebral artery (MCA)., Conclusion: The authors believe that a multiparametric evaluation is more sensitive and supports the clinician by introducing the morphological concept, not just the velocimetric concept, to differentiate the IS pattern of MCA. The potential for developing a diagnostic/prognostic algorithm is discussed., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2023
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18. Reversible cerebral vasoconstriction syndrome: strategies to early diagnosis and the role of transcranial color-coded doppler ultrasonography (TCCD).

Author

Merli N, Padroni M, Azzini C, Bernardoni A, Marcialis C, Tugnoli V, Inchingolo V, and Pugliatti M

Subjects
Female, Humans, Middle Aged, Early Diagnosis, Headache complications, Magnetic Resonance Angiography adverse effects, Ultrasonography, Doppler, Transcranial methods, Vasoconstriction physiology, Cerebrovascular Disorders diagnosis, Headache Disorders, Primary diagnostic imaging, Vasospasm, Intracranial diagnostic imaging, Vasospasm, Intracranial complications
Abstract

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular transitory condition characterized by severe headache, possible concomitant acute neurological symptoms, evidence of diffuse multifocal segmental constriction of cerebral arteries, and usually spontaneously resolving within 3 months. Putative causes and/or precipitating factors are vasoactive drugs-e.g., antidepressants, α-sympathomimetics, triptans-post-partum, and immunosuppressants., Case Presentation: We report the case of a middle-aged woman referred to the emergency room (ER) with a 7-day long intense headache and vomit. Cerebral non-contrast computed tomography (CT) was negative for acute ischemic lesions or intracranial bleedings. She was again referred to ER 7 days later with additional fluctuating episodes of weakness in left arm and both lower limbs. A new brain CT was negative. Due to worsening headache, a transcranial color-coded Doppler (TCCD) was performed, which showed diffuse multifocal blood flow acceleration in all principal intracranial vessels, and particularly on the right hemisphere. These findings were subsequently confirmed at MR angiogram and digital subtraction angiography., Conclusion: TCCD imaging is a non-invasive and relatively inexpensive tool which provides real-time information on cerebrovascular function, blood flow velocities, and hemodynamic changes. TCCD may be a powerful tool in the early detection of acute infrequent cerebrovascular conditions, as well as in monitoring their course and the therapeutic response., (© 2023. The Author(s).)

Published
2023
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19. Divergence Between Clinical Trial Evidence and Actual Practice in Use of Dual Antiplatelet Therapy After Transient Ischemic Attack and Minor Stroke.

Author

De Matteis E, De Santis F, Ornello R, Censori B, Puglisi V, Vinciguerra L, Giossi A, Di Viesti P, Inchingolo V, Fratta GM, Diomedi M, Bagnato MR, Cenciarelli S, Bedetti C, Padiglioni C, Tassinari T, Saia V, Russo A, Petruzzellis M, Mezzapesa DM, Caccamo M, Rinaldi G, Bavaro A, Paciaroni M, Mosconi MG, Foschi M, Querzani P, Muscia F, Gallo Cassarino S, Candelaresi P, De Mase A, Guarino M, Cupini LM, Sanzaro E, Zini A, La Spada S, Palmieri C, Sepe FN, Beretta S, Paci C, Caggia EA, De Angelis MV, Bonanni L, Volpi G, Tassi R, Pistoia F, Scoditti U, Tonon A, Viticchi G, Ruzza G, Nencini P, Cavallini A, Toni D, Ricci S, and Sacco S

Subjects
Adolescent, Female, Humans, Male, Drug Therapy, Combination, Platelet Aggregation Inhibitors therapeutic use, Ischemic Attack, Transient drug therapy, Ischemic Stroke drug therapy, Stroke drug therapy
Abstract

Background: Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs., Methods: READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers. The study comprises a 90-day follow-up from symptom onset. In the present work, we reported descriptive statistics of baseline data of patients recruited up to July 31, 2022, and proportions of patients who would have been excluded from RCTs. We compared categorical data through the χ² test., Results: We evaluated 1070 patients, who had 72 (interquartile range, 62-79) years median age, were mostly Caucasian (1045; 97.7%), and were men (711; 66.4%). Among the 726 (67.9%) patients with ischemic stroke, 226 (31.1%) did not meet the RCT inclusion criteria because of National Institutes of Health Stroke Scale score >3 and 50 (6.9%) because of National Institutes of Health Stroke Scale score >5. Among the 344 (32.1%) patients with TIA, 69 (19.7%) did not meet the RCT criteria because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <4 and 252 (74.7%) because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <6 and no symptomatic arterial stenosis. Additionally, 144 (13.5%) patients would have been excluded because of revascularization procedures. Three hundred forty-five patients (32.2%) did not follow the RCT procedures because of late (>24 hours) DAPT initiation; 776 (72.5%) and 676 (63.2%) patients did not take loading doses of aspirin and clopidogrel, respectively. Overall, 84 (7.8%) patients met the RCT inclusion/exclusion criteria., Conclusions: The real-world use of DAPT is broader than RCTs. Most patients did not meet the RCT criteria because of the severity of ischemic stroke, lower risk of TIA, late DAPT start, or lack of antiplatelet loading dose., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT05476081.

Published
2023
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20. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study.

Author

Casetta I, Fainardi E, Pracucci G, Saia V, Sallustio F, da Ros V, Nappini S, Nencini P, Bigliardi G, Vinci S, Grillo F, Bracco S, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Gasparotti R, Magoni M, Simonetti L, Zini A, Ruggiero M, Longoni M, Castellan L, Malfatto L, Castellini P, Cosottini M, Comai A, Franchini E, Lozupone E, Della Marca G, Puglielli E, Casalena A, Baracchini C, Savio D, Duc E, Ricciardi G, Cappellari M, Chiumarulo L, Petruzzellis M, Cavallini A, Cavasin N, Critelli A, Burdi N, Boero G, Giorgianni A, Versino M, Biraschi F, Nicolini E, Comelli S, Melis M, Padolecchia R, Tassinari T, Paolo Nuzzi N, Marcheselli S, Sacco S, Invernizzi P, Gallesio I, Ferrandi D, Fancello M, Valeria Saddi M, Russo M, Pischedda A, Baule A, Mannino M, Florio F, Inchingolo V, Elena Flacco M, Romano D, Silvagni U, Inzitari D, Mangiafico S, and Toni D

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  < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p  < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02-1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09-1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62-0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04-1.51), and complete recanalization (OR 1.29; 95% CI 1.09-1.53)., 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., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MB: Consultant for Penumbra Inc., Stryker Italia; AS: Consultant for Stryker; ADV: Consultant for Boehringer Ingelheim, Daichi Sankyo; AZ: speaker fees and consulting fees from Boehringer-Ingelheim, Medtronic, Cerenovus and advisory board from Daiichi Sankyo and Boehringer-Ingelheim and Stryker; MC: speaker fees and consulting fees from Daiichi Sankyo and Bristol Myers Squibb, advisory board from Boehringer-Ingelheim; NPN: Consultant for Penumbra Inc., Acandis GmbH; SS: personal fees and non-financial support from Allergan, Abbott, Eli Lilly, Novartis, TEVA, participation to Advisory Board for Astra Zeneca, and research support from Laborest; AM: Consultant for Boehringer Ingelheim, DR: Proctor for Penumbra. Other Authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors., (© European Stroke Organisation 2022.)

Published
2022
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21. Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study.

Author

Di Giorgio A, Mirijello A, De Gennaro C, Fontana A, Alboini PE, Florio L, Inchingolo V, Zarrelli M, Miscio G, Raggi P, Marciano C, Antonioni A, De Cosmo S, Aucella F, Greco A, Carella M, Copetti M, and Leone MA

Abstract

Background: A significant proportion of patients with coronavirus disease 2019 (COVID-19) suffer from delirium during hospitalization. This single-center observational study investigates the occurrence of delirium, the associated risk factors and its impact on in-hospital mortality in an Italian cohort of COVID 19 inpatients., Methods: Data were collected in the COVID units of a general medical hospital in the South of Italy. Socio-demographic, clinical and pharmacological features were collected. Diagnosis of delirium was based on a two-step approach according to 4AT criteria and DSM5 criteria. Outcomes were: dates of hospital discharge, Intensive Care Unit (ICU) admission, or death, whichever came first. Univariable and multivariable proportional hazards Cox regression models were estimated, and risks were reported as hazard ratios (HR) along with their 95% confidence intervals (95% CI)., Results: A total of 47/214 patients (22%) were diagnosed with delirium (21 hypoactive, 15 hyperactive, and 11 mixed). In the multivariable model, four independent variables were independently associated with the presence of delirium: dementia, followed by age at admission, C-reactive protein (CRP), and Glasgow Coma Scale. In turn, delirium was the strongest independent predictor of death/admission to ICU (composite outcome), followed by Charlson Index (not including dementia), CRP, and neutrophil-to-lymphocyte ratio. The probability of reaching the composite outcome was higher for patients with the hypoactive subtype than for those with the hyperactive subtype., Conclusions: Delirium was the strongest predictor of poor outcome in COVID-19 patients, especially in the hypoactive subtype. Several clinical features and inflammatory markers were associated with the increased risk of its occurrence. The early recognition of these factors may help clinicians to select patients who would benefit from both non-pharmacological and pharmacological interventions in order to prevent delirium, and in turn, reduce the risk of admission to ICU or death.

Published
2022
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22. Cerebral Infarcts After Coronary Angiography and Percutaneous Coronary Intervention: A Prospective Propensity-Score-Adjusted Comparison of Right Radial, Left Radial, and Femoral Approaches.

Author

Marchese N, Copetti M, Inchingolo V, Popolizio T, Fontana A, Simeone A, and Vigna C

Subjects
Aged, Aged, 80 and over, Cerebral Infarction diagnostic imaging, Diffusion Magnetic Resonance Imaging, Female, Humans, Incidence, Italy epidemiology, Male, Middle Aged, Prevalence, Propensity Score, Punctures, Risk Assessment, Risk Factors, Catheterization, Peripheral adverse effects, Cerebral Infarction epidemiology, Coronary Angiography adverse effects, Femoral Artery, Percutaneous Coronary Intervention adverse effects, Radial Artery
Abstract

Background: New cerebral infarcts (CIs) detected at magnetic resonance imaging (MRI) are reported after cardiac procedures. Clinical and procedural aspects are implicated as potential causal factors. The aim of this study was to evaluate the incidence of new CIs after coronary angiography and percutaneous coronary intervention according to the arterial access site., Methods: 180 patients undergoing elective coronary angiography were studied with cerebral MRI the day before and the day after the procedure. Unadjusted and propensity score (PS) analyses were performed comparing the occurrence of CIs in right radial (RR), left radial (LR) and transfemoral (TF) access groups., Results: New CIs were observed in 14 patients (7.8% of the total sample, one with neurological sequelae). CIs were detected in 15.5% vs 4.9% vs 3.3% of RR, LR and TF groups, respectively (p = .026). In PS adjusted analyses, the RR approach was associated with more CIs compared with the TF approach (odds ratio [OR] estimate from logistic regression adjusted by PS quartiles: 0.158; 95% confidence interval: 0.031 to 0.814; p = .027) and the LR approach (OR: 0.266; 95% confidence interval: 0.066 to 1.080; p = .064). In a secondary analysis, a comparison of RR vs non-RR approach (TF + LR) was performed, showing that post-procedural CIs were more frequent in the RR group (OR: 0.170; 95% confidence interval: 0.050 to 0.574; p = .004)., Conclusions: Our study suggests that the RR approach may be associated with a higher rate of new CIs after coronary angiography compared with LR and TF approaches., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2020
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23. Isolated pons involvement in Posterior Reversible Encephalopathy Syndrome: Case report and review of the literature.

Author

Ferrara M, Di Viesti P, Inchingolo V, Latino RR, Popolizio T, De Cosmo SA, Pugliese F, and Leone MA

Abstract

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-radiological syndrome, usually reversible and with a favorable prognosis, which recognizes a variety of etiologies and clinical patterns and is likely due to an impairment in cerebral blood flow autoregulation. It is typically characterized by subcortical, predominantly parieto-occipital, vasogenic brain oedema in patients with acute-subacute neurological symptoms. Infratentorial oedema on neuroimaging has been mostly described in association with the typical supratentorial pattern and seldom as isolated., Case Report: We report a case of PRES with isolated pons involvement on MRI. A woman affected by Turner syndrome, epilepsy, slight mental deficiency, obesity and hypothyroidism, experienced a progressive gait and standing impairment, worsening in the last 2 weeks. At admission blood pressure was 220/110 mmHg. Brain MRI showed a wide FLAIR signal hyperintensity on T2-weighted sequences affecting the entire pons, without contrast enhancement. Clonidine, doxazosine, furosemide and telmisartan were effective in restoring normal blood pressure. Pons hyperintensity completely resolved on MRI 3 weeks later, together with return to normal neurological examination., Conclusions: Though isolated infratentorial involvement in PRES recognizes several causes, hypertension, which is a common feature in Turner syndrome, would have played a key role in our case with solely pons MRI T2-hyperintensity.

Published
2016
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24. Residual shunt after percutaneous closure of patent foramen ovale with AMPLATZER occluder devices - influence of anatomic features: a transcranial Doppler and intracardiac echocardiography study.

Author

Marchese N, Pacilli MA, Inchingolo V, Fanelli R, Loperfido F, and Vigna C

Subjects
Adult, Cardiac Catheterization adverse effects, Embolism diagnostic imaging, Embolism etiology, Embolism physiopathology, Female, Foramen Ovale, Patent complications, Foramen Ovale, Patent diagnostic imaging, Foramen Ovale, Patent physiopathology, Heart Aneurysm complications, Humans, Ischemic Attack, Transient diagnostic imaging, Ischemic Attack, Transient etiology, Ischemic Attack, Transient physiopathology, Logistic Models, Male, Middle Aged, Migraine Disorders diagnostic imaging, Migraine Disorders etiology, Migraine Disorders physiopathology, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Prosthesis Design, Risk Factors, Stroke diagnostic imaging, Stroke etiology, Stroke physiopathology, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Color, Cardiac Catheterization instrumentation, Cerebrovascular Circulation, Echocardiography, Foramen Ovale, Patent therapy, Hemodynamics, Septal Occluder Device, Ultrasonography, Doppler, Transcranial
Abstract

Aims: To evaluate the relationship between the anatomic features of the fossa ovalis (FO) and residual right-to-left shunt (RLS) after percutaneous patent foramen ovale (PFO) closure with AMPLATZER PFO occluder devices., Methods and Results: FO anatomic features were assessed by intracardiac echocardiography in 127 patients with large RLS at contrast-enhanced transcranial colour Doppler (TCCD) undergoing percutaneous PFO closure with an AMPLATZER device. Residual RLS was evaluated by TCCD three and 12 months after the procedure. PFO closure was successful in all but two patients. At TCCD, a significant residual RLS (grade ≥2) was observed in 27 (21.6%) and 17 (13.6%) patients at three and 12 months, respectively. Larger baseline RLS, presence of atrial septal aneurysm, greater longitudinal and transverse FO dimensions, and use of larger devices were associated with significant residual RLS. At multivariate analysis, the presence of atrial septal aneurysm (OR 7.6; 95% CI: 1.38-42.35; p=0.02) and longitudinal FO dimension >20.8 mm (OR 8.5; 95% CI: 1.55-46.95; p=0.014) were identified as independent predictors of significant residual RLS at 12 months., Conclusions: Our study suggests that a large FO and the presence of atrial septal aneurysm are independent predictors of persistent residual RLS after PFO closure with AMPLATZER devices.

Published
2013
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25. Improvement of migraine after patent foramen ovale percutaneous closure in patients with subclinical brain lesions: a case-control study.

Author

Vigna C, Marchese N, Inchingolo V, Giannatempo GM, Pacilli MA, Di Viesti P, Impagliatelli M, Natali R, Russo A, Fanelli R, and Loperfido F

Subjects
Adult, Brain Diseases diagnosis, Case-Control Studies, Confidence Intervals, Female, Foramen Ovale, Patent complications, Foramen Ovale, Patent diagnostic imaging, Humans, Magnetic Resonance Imaging, Male, Migraine Disorders complications, Migraine Disorders diagnostic imaging, Odds Ratio, Prospective Studies, Recurrence, Severity of Illness Index, Ultrasonography, Angioplasty, Balloon, Coronary, Brain Diseases physiopathology, Foramen Ovale, Patent therapy, Migraine Disorders therapy
Abstract

Objectives: We sought to evaluate the benefits on frequency and severity of migraine recurrence after patent foramen ovale (PFO) closure in patients with subclinical brain lesions at magnetic resonance imaging (MRI)., Background: Migraine improvement has been reported after PFO closure in patients with cerebrovascular symptomatic events. Subclinical brain MRI lesions are detectable in patients with PFO and in migraineurs., Methods: A total of 82 patients with moderate/severe migraine, PFO, large right-to-left shunt, and subclinical brain MRI lesions were prospectively examined for a 6-month period. Patients were subdivided into closure (n = 53) and control (n = 29) group according to their consent to undergo percutaneous PFO closure. In controls, therapy for migraine was optimized. Six-month frequency and severity of migraine recurrence were compared with baseline., Results: The number of total attacks decreased more in the closure group (32 +/- 9 to 7 +/- 7, p < 0.001) than in the control group (36 +/- 13 to 30 +/- 21, p = NS) (p < 0.001). A significant reduction in disabling attacks was observed only in the closure group (20 +/- 12 to 2 +/- 2, p < 0.001; controls: 15 +/- 12 to 12 +/- 12, p = NS). Migraine disappeared in 34% of the closure group patients and 7% of controls (p = 0.007); >50% reduction of attacks was reported by 87% and 21%, respectively (p < 0.001). Disabling attacks disappeared in 53% of closure group patients and 7% of controls (p < 0.001); >50% reduction occurred in 89% and 17%, respectively (p < 0.001)., Conclusions: In migraineurs with a large PFO and subclinical brain MRI lesions, a significant reduction in frequency and severity of migraine recurrence can be obtained by PFO closure when compared with frequency and severity in controls.

Published
2009
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26. Clinical and brain magnetic resonance imaging follow-up after percutaneous closure of patent foramen ovale in patients with cryptogenic stroke.

Author

Vigna C, Inchingolo V, Giannatempo G, Pacilli MA, Di Viesti P, Fusilli S, Amico CM, Santoro T, Lanna P, Fanelli R, Simone P, and Loperfido F

Subjects
Adult, Female, Follow-Up Studies, Foramen Ovale, Patent complications, Humans, Magnetic Resonance Imaging, Male, Stroke etiology, Treatment Outcome, Cardiac Catheterization methods, Foramen Ovale, Patent therapy, Prosthesis Implantation, Stroke diagnosis
Abstract

Patent foramen ovale (PFO) closure is reported to result in fewer episodes of clinically manifest recurrent cerebral ischemia than medical treatment. We evaluated by means of magnetic resonance imaging (MRI) whether silent cerebral ischemic episodes are also decreased by PFO closure. Seventy-one patients with PFO were selected for percutaneous closure of PFO at our center. All had PFO with large right-to-left shunt documented by transcranial Doppler ultrasound and transesophageal echocardiography, > or =1 previous stroke or transient ischemic attack with MRI documentation at the index event, and no alternative cause for cerebral ischemia. MRI studies were performed in all patients 24 hours before the procedure and at 1-year follow-up (or before in the case of a suspected new neurologic event). Eight patients (11%) had >1 clinical event before the procedure. Comparing the 2 MRI studies before the procedure, silent ischemic lesions were observed in 14 other patients (20%). Thus, considering clinical and silent events together, >1 event was present at baseline in 22 patients (31%). After PFO closure (follow-up 16 +/- 7 months), 1 recurrent neurologic event occurred (1%, p = 0.02 vs preprocedural clinical events); however, urgent brain MRI results were negative. Moreover, only 1 patient showed 1 new silent lesion at brain MRI at follow-up (1%, p <0.001 vs preprocedural silent brain lesions). Considering clinical and silent events, relapses occurred in 2 patients only (p <0.001 vs before procedure). Recurrent events were limited to those with incomplete PFO closure at postprocedural transcranial Doppler ultrasound (p = 0.02). In conclusion, percutaneous PFO closure results in few clinical or silent events after 1-year follow-up, especially when complete PFO closure is successfully accomplished.

Published
2008
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