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1. Predictors for clinical and functional outcomes in stroke patients with first-pass complete recanalization after thrombectomy

Author

Cappellari, M, Saia, V, Pracucci, G, Fainardi, E, Casetta, I, Sallustio, F, Nencini, P, Bigliardi, G, Saletti, A, Ruggiero, M, Da Ros, V, Castellan, L, Tassi, R, Mandruzzato, N, Toni, D, and Mangiafico, S

Subjects
thrombectomy, first-pass complete reperfusion, clinical outcome, Settore MED/37 - Neuroradiologia, reperfusion injury, stroke, functional outcome
Published
2023

2. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke

Author

Gentile, L, Pracucci, G, Saia, V, Falcou, A, Biraschi, F, Zini, A, Simonetti, L, Riva, L, Bigliardi, G, Vallone, S, Nencini, P, Limbucci, N, Diomedi, M, Da Ros, V, Longoni, M, Ruggiero, M, Tassinari, T, Allegretti, L, Cerrato, P, Rubino, E, Bergui, M, Cavallo, R, Naldi, A, Comelli, C, Cappellari, M, Zivelonghi, C, Plebani, M, De Vito, A, Merli, N, Saletti, A, Musolino, Rf, Ferraù, L, Vinci, Sl, Sacco, S, Orlandi, B, De Santis, F, Filauri, P, Ruiz, L, Sepe, Fn, Gallesio, I, Petruzzellis, M, Chiumarulo, L, Sangalli, D, Salmaggi, A, Filizzolo, M, Moller, J, Melis, M, Comelli, S, Magoni, M, Gilberti, N, Gasparotti, R, Invernizzi, P, Pavia, M, Pinto, V, Laspada, S, Marcheselli, S, Ajello, D, Viaro, F, Baracchini, C, Causin, F, Giannini, N, Caselli, Mc, Mancuso, M, Cosottini, M, Scoditti, U, Menozzi, R, Russo, M, Amistá, P, Napoletano, R, Romano, Dg, Tassi, R, Bracco, S, Carimati, F, Versino, M, Giorgianni, A, De Boni, A, Fasano, A, Barbarini, L, Paladini, A, Franchini, E, Dall'Ora, E, Comai, A, Giovanni, F, Pedicelli, A, Sallustio, F, Casetta, I, Fainardi, E, Mangiafico, S, and Toni, D

Subjects
Left ventricular ejection fraction, Acute ischemic stroke, Heart failure, Mechanical thrombectomy, Settore MED/37 - Neuroradiologia, Settore MED/26
Published
2023

3. E-028 The impact of time delays on endovascular reperfusion success in late window stroke patients

Author

Alhabli, I, primary, Benali, F, additional, Murphy, S, additional, Toni, D, additional, Michel, P, additional, Hill, M, additional, Herlihy, D, additional, Casetta, I, additional, Power, S, additional, Saia, V, additional, Hegarty, A, additional, Pracucci, G, additional, Demchuk, A, additional, Mangiafico, S, additional, Boyle, K, additional, Goyal, M, additional, Nannoni, S, additional, Fainardi, E, additional, Thornton, J, additional, Kim, B, additional, Menon, B, additional, Almekhlafi, M, additional, and Bala, F, additional

Published
2022
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5. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke

Author

Sallustio, Fabrizio, Pracucci, Giovanni, Cappellari, Manuel, Saia, Valentina, Mascolo, Alfredo Paolo, Marrama, Federico, Gandini, Roberto, Koch, Giacomo, Diomedi, Marina, D’Agostino, Federica, Rocco, Alessandro, Da Ros, Valerio, Wlderk, Andrea, Nezzo, Marco, Argirò, Renato, Morosetti, Daniele, Renieri, Leonardo, Nencini, Patrizia, Vallone, Stefano, Zini, Andrea, Bigliardi, Guido, Pitrone, Antonio, Grillo, Francesco, Bracco, Sandra, Tassi, Rossana, Bergui, Mauro, Naldi, Andrea, Carità, Giuseppe, Casetta, Ilaria, Gasparotti, Roberto, Magoni, Mauro, Simonetti, Luigi, Haznedari, Nicolò, Paolucci, Matteo, Mavilio, Nicola, Malfatto, Laura, Menozzi, Roberto, Genovese, Antonio, Cosottini, Mirco, Orlandi, Giovanni, Comai, Alessio, Franchini, Enrica, Pedicelli, Alessandro, Frisullo, Giovanni, Puglielli, Edoardo, Casalena, Alfonsina, Cester, Giacomo, Baracchini, Claudio, Castellano, Davide, Di Liberto, Alessandra, Ricciardi, Giuseppe Kenneth, Chiumarulo, Luigi, Petruzzellis, Marco, Lafe, Elvis, Persico, Alessandra, Cavasin, Nicola, Critelli, Adriana, Semeraro, Vittorio, Tinelli, Angelica, Giorgianni, Andrea, Carimati, Federico, Auteri, William, Rizzuto, Stefano, Biraschi, Francesco, Nicolini, Ettore, Ferrari, Antonio, Melis, Maurizio, Calia, Stefano, Tassinari, Tiziana, Nuzzi, Nunzio Paolo, Corato, Manuel, Sacco, Simona, Squassina, Guido, Invernizzi, Paolo, Gallesio, Ivan, Ruiz, Luigi, Dui, Giovanni, Carboni, Nicola, Amistà, Pietro, Russo, Monia, Maiore, Mario, Zanda, Bastianina, Craparo, Giuseppe, Mannino, Marina, Inzitari, Domenico, Toni, Danilo, Mangiafico, Salvatore, Gasparotti, R., Inzitari, D., Mangiafico, S., Toni, D., Vallone, S., Zini, A., Bergui, M., Causin, F., Ciccone, A., Nencini, P., Saletti, A., Sallustio, F., Tassi, R., Thyrion, F. Zappoli, Pracucci, G., Saia, V., Gandini, R., Da Ros, V., Greco, L., Morosetti, D., Diomedi, M., Nappini, S., Limbucci, N., Renieri, L., Fainardi, E., Verganti, L., Sacchetti, F., Zelent, G., Bigliardi, G., Dell’Acqua, M. L., Picchetto, L., Vandelli, L., Pentore, R., Maffei, S., Nichelli, P., Longo, M., Pitrone, A., Vinci, S. L., Velo, M., Caragliano, A., Tessitore, A., Bonomo, O., Musolino, R., La Spina, P., Casella, C., Fazio, M. C., Grillo, F., Cotroneo, M., Dell’Aera, C., Francalanza, I., Bracco, S., Cioni, S., Gennari, P., Vallone, I. M., Cerase, A., Martini, G., Stura, G., Daniele, D., Cerrato, P., Naldi, A., Onofrio, M., De Vito, A., Azzini, C., Casetta, I., Mardighian, D., Frigerio, M., Magoni, M., Costa, A., Simonetti, L., Cirillo, L., Taglialatela, F., Isceri, S., Princiotta, C., Dall’Olio, M., Cellerini, M., Gentile, M., Piccolo, L., Migliaccio, L., Brancaleoni, L., Naldi, F., Romoli, M., Zaniboni, A., Ruggiero, M., Sanna, A., Haznedari, N., Commodaro, C., Longoni, M., Biguzzi, S., Cordici, F., Malatesta, E., Castellan, L., Mavilio, N., Salsano, G., Malfatto, L., Finocchi, C., Menozzi, R., Piazza, P., Epifani, E., Andreone, A., Scoditti, U., Castellini, P., Latte, L., Grisendi, I., Cosottini, M., Puglioli, M., Lazzarotti, G., Lauretti, D., Mancuso, M., Giannini, N., Maccarone, M., Orlandi, G., Comai, A., Bonatti, G., Nano, G., Ferro, F., Bonatti, M., Dall’Ora, E., Dossi, R. Currò, Turri, E., Turri, M., Colosimo, C., Pedicelli, A., D’Argento, F., Alexandre, A., Frisullo, G., Di Egidio, V., Puglielli, E. G., Ruggero, L., Assetta, M., Casalena, A., Cester, G., Baracchini, C., Viaro, F., Pieroni, A., Vaudano, G., Comelli, C., Di Maggio, L., Castellano, D., Cavallo, R., Duc, E., Chianale, G., Ciceri, E. F. M., Plebani, M., Augelli, R., Zampieri, P., Grazioli, A., Cappellari, M., Forlivesi, S., Tomelleri, G., Micheletti, N., Chiumarulo, L., Zimatore, D. S., Federico, F., Petruzzelli, M., Zappoli, F., Lafe, E., Sanfilippo, G., Sgreccia, A., Martignoni, A., Cavallini, A., Denaro, F., Persico, A., Cagliari, E., Cavasin, N., Quatrale, R., Critelli, A., Burdi, N., Semeraro, V., Lucarelli, N., Ganimede, M. P., Internò, S., Tinelli, A., Prontera, M. P., Pesare, A., Cotroneo, E., Pampana, E., Ricciardi, F., Gigli, R., Pezzella, F. R., Corsi, F., Giorgianni, A., Baruzzi, F., Pellegrino, C., Terrana, A., Versino, M., Delodovici, M. L., Carimati, F., Cariddi, L. Princiotta, Auteri, W., Di Benedetto, O., Silvagni, U., Perrotta, P., Crispino, E., Petrone, A., Stancati, F., Rizzuto, S., Pugliese, P., Pisani, E., Siniscalchi, A., Gaudiano, C., Pirritano, D., Del Giudice, F., Piano, M., Agostoni, E., Motto, C., Gatti, A., Guccione, A., Tortorella, R., Stecco, A., Guzzardi, G., Del Sette, B., Coppo, L., Baldan, J., Romano, D., Siani, A., Locatelli, G., Saponiero, R., Napolitano, R., De Gregorio, M., Volpe, G., Tenuta, M., Guidetti, G., Biraschi, F., Wulbek, A., Falcou, A., Anzini, A., Mancini, A., De Michele, M., Fausti, S., Di Mascio, M. T., Durastanti, L., Sbardella, E., Mellina, V., Nicolini, E., Comelli, S., Ganau, C., Corraine, S., Fusaro, F., Ferrari, A., Schirru, F., Ledda, V., Secci, S., Melis, M., Piras, V., Moller, J., Padolecchia, R., Allegretti, L., Caldiera, V., Calia, S., Ganci, G., Tassinari, T., Sugo, A., De Nicola, M., Giannoni, M., Bruni, S., Gambelli, E., Provinciali, L., Nuzzi, N. P., Marcheselli, S., Corato, M., Scomazzoni, F., Simionato, F., Roveri, L., Filauri, P., Sacco, S., Orlandi, B., De Santis, F., Tiseo, C., Notturno, F., Ornello, R., Pavia, M., Squassina, G., Cobelli, M., Morassi, M., Magni, E., Invernizzi, P., Pepe, F., Bigni, B., Costa, P., Crabbio, M., Griffini, S., Palmerini, F., Piras, M. P., Gallesio, I., Barbero, S., Ferrandi, D., Dui, G., Fancello, M. C., Zedda, S., Ticca, A., Saddi, M. V., Deiana, G., Rossi, R., Carboni, N., Mela, A., Amistà, P., Russo, M., Iannucci, G., Pinna, V., Di Clemente, L., Santi, M., De Boni, A., De Luca, C., Natrella, M., Fanelli, G., Cristoferi, M., Bottacchi, E., Corso, G., Tosi, P., Sessa, M., Giossi, A., Baietti, Null, Romano, G., Meineri, P., Armentano, A., Versace, P., Arcudi, L., Galvano, G., Petralia, B., Feraco, P., Luppi, G., Giometto, B., Bignamini, V., Piffer, S., Meloni, G. B., Fabio, C., Maiore, M., Pintus, F., Pischedda, A., Manca, A., Mongili, C., Zanda, B., Baule, A., Florio, F., Ciccarese, G., Leone, M., Di Viesti, P., Pappalardo, M. P., Craparo, G., Gallo, C., Monaco, S., Mannino, M., Muto, M., Guarnieri, Gl., Andreone, V., Passalacqua, G., Allegritti, M., Caproni, S., Filizzolo, M., Salmaggi, A., Giordano, A., Marini, C., Frattale, I., Lucente, G., Nozzoli, C., and Lupo, F. A.

Subjects
Stent, Acute stroke, Settore MED/37 - Neuroradiologia, Acute stroke Internal carotid artery diseases Stent Thrombectomy, Neurology (clinical), General Medicine, Settore MED/26, Internal carotid artery diseases, Thrombectomy
Abstract

The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage.Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively.Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.

Published
2022

6. LB-006 Collateral imaging of stroke patients in the late window prior to endovascular thrombectomy results from a pooled individual patient-level multicenter analysis

Author

Almekhlafi, M, primary, Thornton, J, additional, Casetta, I, additional, Goyal, M, additional, Stefania, N, additional, Herlihy, D, additional, Fainardi, E, additional, Power, S, additional, Saia, V, additional, Hegarty, A, additional, Pracucci, G, additional, Demchuk, A, additional, Mangiafico, S, additional, Boyle, K, additional, Michel, P, additional, Bala, F, additional, Gill, R, additional, Kuczynski, A, additional, Ademola, A, additional, Hill, M, additional, Toni, D, additional, Murphy, S, additional, Kim, B, additional, and Menon, B, additional

Published
2021
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7. Risk Factors for Intracerebral Hemorrhage in Patients with Atrial Fibrillation on Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Author

Paciaroni, M. Agnelli, G. Giustozzi, M. Caso, V. Toso, E. Angelini, F. Canavero, I. Micieli, G. Antonenko, K. Rocco, A. Diomedi, M. Katsanos, A.H. Shoamanesh, A. Giannopoulos, S. Ageno, W. Pegoraro, S. Putaala, J. Strbian, D. Sallinen, H. Mac Grory, B.C. Furie, K.L. Stretz, C. Reznik, M.E. Alberti, A. Venti, M. Mosconi, M.G. Vedovati, M.C. Franco, L. Zepponi, G. Romoli, M. Zini, A. Brancaleoni, L. Riva, L. Silvestrelli, G. Ciccone, A. Zedde, M.L. Giorli, E. Kosmidou, M. Ntais, E. Palaiodimou, L. Halvatsiotis, P. Tassinari, T. Saia, V. Ornello, R. Sacco, S. Bandini, F. Mancuso, M. Orlandi, G. Ferrari, E. Pezzini, A. Poli, L. Cappellari, M. Forlivesi, S. Rigatelli, A. Yaghi, S. Scher, E. Frontera, J.A. Masotti, L. Grifoni, E. Caliandro, P. Zauli, A. Reale, G. Marcheselli, S. Gasparro, A. Terruso, V. Arnao, V. Aridon, P. Abdul-Rahim, A.H. Dawson, J. Saggese, C.E. Palmerini, F. Doronin, B. Volodina, V. Toni, D. Risitano, A. Schirinzi, E. Del Sette, M. Lochner, P. Monaco, S. Mannino, M. Tassi, R. Guideri, F. Acampa, M. Martini, G. Lotti, E.M. Padroni, M. Pantoni, L. Rosa, S. Bertora, P. Ntaios, G. Sagris, D. Baldi, A. D'Amore, C. Mumoli, N. Porta, C. Denti, L. Chiti, A. Corea, F. Acciarresi, M. Flomin, Y. Popovic, N. Tsivgoulis, G.

Subjects
cardiovascular diseases
Abstract

Background and Purpose: Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patients. The aims of this prospective, multicenter, multinational, unmatched, case-control study were (1) to investigate for risk factors that could predict ICH occurring in patients with atrial fibrillation during NOAC treatment and (2) to evaluate the role of CHA2DS2-VASc and HAS-BLED scores in the same setting. Methods: Cases were consecutive patients with atrial fibrillation who had ICH during NOAC treatment. Controls were consecutive patients with atrial fibrillation who did not have ICH during NOAC treatment. As within the CHA2DS2-VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. Results: Four hundred nineteen cases (mean age, 78.8±8.1 years) and 1526 controls (mean age, 76.0±10.3 years) were included in the study. From the different models performed, independent predictors of ICH were increasing age, concomitant use of antiplatelet agents, active malignancy, high risk of fall, hyperlipidemia, low clearance of creatinine, peripheral artery disease, and white matter changes. Low doses of NOACs (given according to label or not) and congestive heart failure were inversely associated with the risk of ICH. HAS-BLED and CHA2DS2-VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468-0.525) and 0.530 (95% CI, 0.500-0.560), respectively. Conclusions: Several risk factors were associated to ICH in patients treated with NOACs for stroke prevention but not HAS-BLED and CHA2DS2-VASc scores. © 2021 Lippincott Williams and Wilkins. All rights reserved.

Published
2021

11. Endovascular Thrombectomy for Acute Ischemic Stroke beyond 6 Hours from Onset: A Real-World Experience

Author

Casetta, I., Fainardi, E., Saia, V., Pracucci, G., Padroni, M., Renieri, L., Nencini, P., Inzitari, D., Morosetti, D., Sallustio, F., Vallone, S., Bigliardi, G., Zini, A., Longo, M., Francalanza, I., Bracco, S., Vallone, I. M., Tassi, R., Bergui, M., Naldi, A., Saletti, A., De Vito, A., Gasparotti, R., Magoni, M., Castellan, L., Serrati, C., Menozzi, R., Scoditti, U., Causin, F., Pieroni, A., Puglielli, E., Casalena, A., Sanna, A., Ruggiero, M., Cordici, F., Di Maggio, L., Duc, E., Cosottini, M., Giannini, N., Sanfilippo, G., Zappoli, F., Toni, D., Cavasin, N., Critelli, A., Ciceri, E., Plebani, M., Cappellari, M., Chiumarulo, L., Petruzzellis, M., Terrana, A., Cariddi, L. P., Burdi, N., Tinelli, A., Auteri, W., Silvagni, U., Biraschi, F., Nicolini, E., Padolecchia, R., Tassinari, T., Filauri, P., Sacco, S., Pavia, M., Invernizzi, P., Nuzzi, N. P., Marcheselli, S., Amista, P., Russo, M., Gallesio, I., Craparo, G., Mannino, M., and Mangiafico, S.

Subjects
Male, medicine.medical_specialty, Middle Cerebral Artery, Time Factors, cerebral blood volume, collateral circulation, groin, intracranial hemorrhage, middle cerebral artery, thrombectomy, Ischemia, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Humans, 030212 general & internal medicine, Acute ischemic stroke, Stroke, Aged, Advanced and Specialized Nursing, medicine.diagnostic_test, Groin, business.industry, Endovascular Procedures, Ambientale, Middle Aged, medicine.disease, Collateral circulation, Intracranial Hemorrhages/*surgery Ischemia/surgery Male Middle Aged Middle Cerebral Artery/physiopathology/surgery Stroke/*surgery Thrombectomy/methods Time Factors cerebral blood volume collateral circulation, Cerebral Angiography, medicine.anatomical_structure, Middle cerebral artery, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Thrombectomy, Cerebral angiography
Abstract

Background and Purpose: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. Results: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). Conclusions: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.

Published
2020

12. Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset

Author

Cappellari, M., primary, Saia, V., additional, Pracucci, G., additional, Sallustio, F., additional, Gandini, R., additional, Nappini, S., additional, Nencini, P., additional, Vallone, S., additional, Zini, A., additional, Bigliardi, G., additional, Granata, F., additional, Grillo, F., additional, Cioni, S., additional, Tassi, R., additional, Bergui, M., additional, Cerrato, P., additional, Saletti, A., additional, De Vito, A., additional, Gasparotti, R., additional, Magoni, M., additional, Taglialatela, F., additional, Ruggiero, M., additional, Longoni, M., additional, Castellan, L., additional, Malfatto, L., additional, Menozzi, R., additional, Castellini, P., additional, Cosottini, M., additional, Mancuso, M., additional, Comai, A., additional, Franchini, E., additional, Lozupone, E., additional, Della Marca, G., additional, Ciceri, E. F. M., additional, Bonetti, B., additional, Zampieri, P., additional, Inzitari, D., additional, Mangiafico, S., additional, and Toni, D., additional

Published
2020
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14. Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke

Author

Casetta, I, Pracucci, G, Saletti, A, Saia, V, Padroni, M, De Vito, A, Inzitari, D, Zini, A, Vallone, S, Bergui, M, Cerrato, P, Bracco, S, Tassi, R, Gandini, R, Sallustio, F, Piano, M, Motto, C, Spina, P, Vinci, Sl, Causin, F, Baracchini, C, Gasparotti, R, Magoni, M, Castellan, L, Serrati, C, Mangiafico, S, Toni, D, and The Italian Registry of Endovascular Treatment in Acute Stroke

Subjects
Brain Infarction, Male, medicine.medical_specialty, medicine.medical_treatment, Stroke/therapy, Fibrinolytic Agents, 80 and over, medicine, ischemic stroke, Humans, Aged, 80 and over, Endovascular procedures, Thrombolytic Therapy, intravenous thrombolysis, Registries, acute stroke therapy, thrombectomy, Endovascular treatment, Stroke, Acute stroke therapy, Cerebral infarction, Intravenous thrombolysis, iIchemic stroke, Thrombectomy, Stroke, Aged, Acute stroke, Cerebral infarction, business.industry, Ambientale, Thrombolysis, Middle Aged, medicine.disease, cerebral infarction, Combined Modality Therapy, Surgery, Mechanical thrombectomy, Treatment Outcome, Italy, Neurology, Ischemic stroke, Female, business
Abstract

Background Whether mechanical thrombectomy alone may achieve better or at least equal clinical outcome than mechanical thrombectomy combined with intravenous thrombolysis is a matter of debate. Methods From the Italian Registry of Endovascular Stroke Treatment, we extracted all cases treated with intravenous thrombolysis followed by mechanical thrombectomy or with primary mechanical thrombectomy for anterior circulation stroke due to proximal vessel occlusion. We included only patients who would have qualified for intravenous thrombolysis. We compared outcomes of the two groups by using multivariate regression analysis and propensity score method. Results We included 1148 patients, treated with combined intravenous thrombolysis and mechanical thrombectomy therapy (n = 635; 55.3%), or with mechanical thrombectomy alone (n = 513; 44.7%). Demographic and baseline clinical characteristics did not differ between the two groups, except for a shorter onset to groin puncture time (p Conclusion These data seem to indicate that combined intravenous thrombolysis and mechanical thrombectomy could be associated with lower probability of death or severe dependency after three months from stroke due to large vessel occlusion, supporting the current guidelines of treating eligible patients with intravenous thrombolysis before mechanical thrombectomy.

Published
2019

15. Causes and Risk Factors of Cerebral Ischemic Events in Patients with Atrial Fibrillation Treated with Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention: The RENo Study

Author

Paciaroni, M. Agnelli, G. Caso, V. Silvestrelli, G. Seiffge, D.J. Engelter, S. De Marchis, G.M. Polymeris, A. Zedde, M.L. Yaghi, S. Michel, P. Eskandari, A. Antonenko, K. Sohn, S.-I. Cappellari, M. Tassinari, T. Tassi, R. Masotti, L. Katsanos, A.H. Giannopoulos, S. Acciarresi, M. Alberti, A. Venti, M. Mosconi, M.G. Vedovati, M.C. Pierini, P. Giustozzi, M. Lotti, E.M. Ntaios, G. Kargiotis, O. Monaco, S. Lochner, P. Bandini, F. Liantinioti, C. Palaiodimou, L. Abdul-Rahim, A.H. Lees, K. Mancuso, M. Pantoni, L. Rosa, S. Bertora, P. Galliazzo, S. Ageno, W. Toso, E. Angelini, F. Chiti, A. Orlandi, G. Denti, L. Flomin, Y. Marcheselli, S. Mumoli, N. Rimoldi, A. Verrengia, E. Schirinzi, E. Del Sette, M. Papamichalis, P. Komnos, A. Popovic, N. Zarkov, M. Rocco, A. Diomedi, M. Giorli, E. Ciccone, A. Grory, B.C.M. Furie, K.L. Bonetti, B. Saia, V. Guideri, F. Acampa, M. Martini, G. Grifoni, E. Padroni, M. Karagkiozi, E. Perlepe, K. Makaritsis, K. Mannino, M. MacCarrone, M. Ulivi, L. Giannini, N. Ferrari, E. Pezzini, A. Doronin, B. Volodina, V. Baldi, A. D'Amore, C. Deleu, D. Corea, F. Putaala, J. Santalucia, P. Nardi, K. Risitano, A. Toni, D. Tsivgoulis, G.

Abstract

Background and Purpose-Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non-Vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods-Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results-Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95-5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63-9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83-3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58-1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33-0.61). Conclusions-In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events. © 2019 American Heart Association, Inc.

Published
2019

16. Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10‐point ASPECTS.

Author

Cappellari, M., Saia, V., Pracucci, G., Sallustio, F., Gandini, R., Nappini, S., Nencini, P., Vallone, S., Zini, A., Bigliardi, G., Granata, F., Grillo, F., Cioni, S., Tassi, R., Bergui, M., Cerrato, P., Saletti, A., De Vito, A., Gasparotti, R., and Magoni, M.

Subjects
*THROMBECTOMY, *STROKE patients, *INTRACEREBRAL hematoma, *ENDOVASCULAR surgery, *CEREBRAL hemorrhage, *PROPENSITY score matching
Abstract

Background and purpose: The aim was to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy) versus direct mechanical thrombectomy (MT) in unknown onset stroke patients. Methods: A cohort study was conducted on prospectively collected data from unknown onset stroke patients who received endovascular procedures at ≤6 h from symptom recognition or awakening time. Results: Of the 349 patients with a 10‐point Alberta Stroke Program Early Computed Tomography Score (ASPECTS), 248 received bridging and 101 received direct MT. Of the 134 patients with 6–9‐point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre‐stroke disability, stroke severity, type of stroke onset, symptom recognition to groin time (or awakening to groin time), ASPECTS and procedure time. In the two matched groups with 10‐point ASPECTS (n = 73 vs. n = 73), bridging was associated with higher rates of excellent outcome (46.6% vs. 28.8%; odds ratio 2.302, 95% confidence interval 1.010–5.244) and successful recanalization (83.6% vs. 63%; odds ratio 3.028, 95% confidence interval 1.369–6.693) compared with direct MT; no significant association was found between bridging and direct MT with regard to rate of symptomatic intracerebral hemorrhage (0% vs. 1.4%). In the two matched groups with 6–9‐point ASPECTS (n = 45 vs. n = 45), no significant associations were found between bridging and direct MT with regard to rates of excellent functional outcome (44.4% vs. 31.1%), successful recanalization (73.3% vs. 76.5%) and symptomatic intracerebral hemorrhage (0% vs. 0%). Conclusions: Bridging at ≤ 6 h of symptom recognition or awakening time was associated with better functional and radiological outcomes in unknown onset stroke patients with 10‐point ASPECTS. [ABSTRACT FROM AUTHOR]

Published
2021
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17. Erratum to: The Italian Registry of Endovascular Treatment in Acute Stroke: rationale, design and baseline features of patients (Neurol Sci (2015), 36, (985-993), 10.1007/s10072-014-2053-5)

Author

Mangiafico, S., Pracucci, G., Saia, V., Nencini, P., Inzitari, D., Nappini, S., Vallone, S., Zini, A., Fuschi, M., Cerone, D., Bergui, M., Cerrato, P., Gandini, R., Sallustio, F., Saletti, A., De Vito, A., Romano, D. G., Tassi, R., Causin, F., Baracchini, C., Piano, M., Motto, C., Ciccone, A., Gasparotti, R., Magoni, M., Giorgianni, A., Delodovici, M., Cavasin, N., Critelli, A., Gallucci, M., Carolei, A., Meloni, T., Corso, G., Vaudano, G., Duc, E., Zappoli, F., Cavallini, A., Padolecchia, R., Tassinari, T., Longoni, M., Salmaggi, A., Zampieri, P. G., Bovi, P., Puglioli, M., Chiti, A., Guidetti, G., Simonetti, L., Procaccianti, G., Menozzi, R., Scoditti, U., Ricciardi, F., Pezzella, F. R., Guarnieri, G., Andreone, V., and Toni, D.

Published
2015

23. Blood levels of homocysteine, cysteine, glutathione, folic acid, and vitamin B12 in the acute phase of atherothrombotic stroke.

Author

Salemi, Giuseppe, Gueli, M. C., D'Amelio, M., Saia, V., Mangiapane, P., Aridon, P., Ragonese, P., and Lupo, I.

Subjects
HOMOCYSTEINE, GLUTATHIONE, BLOOD vessels, CEREBROVASCULAR disease, FOLIC acid
Abstract

Blood levels of total homocysteine (tHcy), cysteine (Cys), total and reduced glutathione (tGSH and rGSH), folic acid (FA), and vitamin B12 (B12) change during ischemic stroke as accompaniment of the tissue damage. The relationship between these changes remains scantly investigated. We evaluated the variation of these molecules in the 48 h after acute large artery atherothrombotic stroke (LAAS) and searched for the presence of matched variation of them. The study involved 50 subjects affected by acute LAAS and 49 healthy controls. Plasma levels of tHcy and Cys were significantly higher and serum levels of FA and B12 and plasma levels of rGSH were significantly lower in the patients than in the control group. Acute LAAS was associated with increased Hcy—decreased tGSH and decreased FA/tGSH. Pathways involved in cellular stress and in tissue repair are activated during acute LAAS. [ABSTRACT FROM AUTHOR]

Published
2009
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24. COMBINED VERSUS DIRECT ENDOVASCULAR THERAPY IN BASILAR ARTERY OCCLUSION

Author

Arba, F., Nappini, S., Pracucci, G., Caimano, D., Saia, V., Zini, A., Vallone, S., Bigliardi, G., Sallustio, F., Tassi, R., Mancuso, M., Naldi, A., Bergui, M., Andrea, N., Da Ros, V., Carita, G., Vito, A., Auteri, W., Silvagni, U., Gasparotti, R., Magoni, M., Bracco, S., Padolecchia, R., Lucio Castellan, Malfatto, L., Cosottini, M., Puglielli, E., Assetta, M., Longo, M., Francalanza, I., Comelli, C., Duc, E., Ruggiero, M., Chiumarulo, L., Petruzzellis, M., Sacco, S., Ganimede, M. P., Tinelli, A., Filizzolo, M., Filauri, P., Biraschi, F., Nicolini, E., Gallesio, I., Barbero, S., Sgreccia, A., Toscano, G., Plebani, M., Ricciardi, G., Pavia, M., Invernizzi, P., Toni, D., and Mangiafico, S.

25. The effects of sustained COVID-19 emergency and restrictions on the mental health of subjects with serious mental illness: A prospective study

Author

Annarita Barone, Martina Billeci, Sofia D'Amore, Michele De Prisco, Giuseppe De Simone, Eleonora Ermini, Vittorio Freda, Federica Iannotta, Adalgisa Luciani, Luca Pistone, Lorenza M. Rifici, Viviana M. Saia, Giancarlo Spennato, Francesco Subosco, Licia Vellucci, Giordano D'Urso, Diana Galletta, Michele Fornaro, Felice Iasevoli, Andrea de Bartolomeis, Barone, A., Billeci, M., D'Amore, S., De Prisco, M., De Simone, G., Ermini, E., Freda, V., Iannotta, F., Luciani, A., Pistone, L., Rifici, L. M., Saia, V. M., Spennato, G., Subosco, F., Vellucci, L., D'Urso, G., Galletta, D., Fornaro, M., Iasevoli, F., and de Bartolomeis, A.

Subjects
Social Psychology, perceived stre, serious mental illne, COVID-19, telepsychiatry, vaccines, anxiety, mental health
Abstract

Few longitudinal studies have so far investigated the impact of sustained COVID-19 among people with pre-existing psychiatric disorders. We conducted a prospective study involving people with serious mental illness (n = 114) and healthy controls (n = 41) to assess changes in the Perceived Stress Scale, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Specific Psychotic Experiences Questionnaire scores 18 months after the COVID-19 pandemic outset. Subjects underwent interviews with a mental health professional in April 2020 and at the end of the local third wave (October 2021). A significant increase in perceived stress was found in healthy controls, especially females. Psychiatric patients showed a significant worsening of anxiety symptoms compared to baseline records (t = -2.3, p = 0.036). Patients who rejected vaccination had significantly higher paranoia scores compared to those willing to get vaccinated (U = 649.5, z = -2.02, p = 0.04). These findings indicate that COVID-19's sustained emergency may cause enduring consequences on mental health, soliciting further investigations.

Published
2023

26. European Multicenter Study of ET-COVID-19

Author

Federico Cagnazzo, Michel Piotin, Simon Escalard, Benjamin Maier, Marc Ribo, Manuel Requena, Raoul Pop, Anca Hasiu, Roberto Gasparotti, Dikran Mardighian, Mariangela Piano, Amedeo Cervo, Omer Faruk Eker, Vincent Durous, Nader-Antoine Sourour, Mahmoud Elhorany, Andrea Zini, Luigi Simonetti, Simona Marcheselli, Nuzzi Nunzio Paolo, Emmanuel Houdart, Alexis Guédon, Noémie Ligot, Benjamin Mine, Arturo Consoli, Bertrand Lapergue, Pere Cordona Portela, Xabier Urra, Alejandro Rodriguez, Federico Bolognini, Pablo Ariel Lebedinsky, Anne Pasco-Papon, Sophie Godard, Gaultier Marnat, Igor Sibon, Nicola Limbucci, Patrizia Nencini, Sergio Nappini, Valentina Saia, Valentina Caldiera, Daniele Romano, Giulia Frauenfelder, Ivan Gallesio, Giuliano Gola, Roberto Menozzi, Antonio Genovese, Alberto Terrana, Andrea Giorgianni, Manuel Cappellari, Raffaele Augelli, Paolo Invernizzi, Marco Pavia, Elvis Lafe, Anna Cavallini, Alessia Giossi, Michele Besana, Luca Valvassori, Antonio Macera, Lucio Castellan, Giancarlo Salsano, Fortunato Di Caterino, Alessandra Biondi, Caroline Arquizan, Julien Lebreuche, Gianluca Galvano, Alfio Cannella, Mirco Cosottini, Guido Lazzarotti, Giuseppe Guizzardi, Alessandro Stecco, Rossana Tassi, Sandra Bracco, Elena Bianchini, Camilla Micieli, Rosario Pascarella, Manuela Napoli, Francesco Causin, Hubert Desal, François Cotton, Vincent Costalat, François Delvoye, Gabriele Ciccio, Stanislas Smajda, Hocine Redjem, Solène Hébert, Raphaël Blanc, Mikael Mazighi, Jean-Philippes Desilles, Dan Mihoc, Monica Manisor, Rémy Beaujeux, Véronique Quenardelle, Roxana Gheoca, Valérie Wolff, Guiglielmo Pero, Giussani Giuditta, Ceresa Chiara, Roberto Riva, Matteo Cappucci, Morgane Laubacher, Celia Tuttle, Lorenzo Piergallini, Francis Turjman, Frédéric Clarençon, Eimad Shotar, Stéphanie Lenck, Kevin Premat, Vincent Degos, Yves Samson, Charlotte Rosso, Sonia Alamowitch, Luigi Cirillo, Mauro Gentile, Ludovica Migliaccio, Salvatore Isceri, Simone Rossi, Tommaso Baldini, Massimo Dall’Olio, Martino Cellerini, Jean-Pierre Saint-Maurice, Vittorio Civelli, Matteo Fantoni, Naeije Gilles, Jodaïtis Lise, Lubicz Boris, Stephanie Elens, Bonnet Thomas, Guenego Adrien, Sadeghi Niloufar, Van Nuffelen Marc, Federico Di Maria, Oguzhan Coskun, Georges Rodesch, Sergio Zimatore, Gariel Florent, Jérôme Berge, Patrice Menegon, Xavier Barreau, Thomas Tourdias, Stéphane Olindo, Ludovic Lucas, Jean-Sebastien Liegey, Sharmila Sagnier, Pauline Renou, Marie Couture, Sabrina Debruxelles, Mathilde Poli, Mariano Musacchio, Mariette Delaitre, Riccardo Padolecchia, Giuseppe Ganci, Annalisa Sugo, Barbero Stefano, Taverna Giacomo Giovanni, Umberto Scoditti, Paola Castellini, Lilia Latte, Ilaria Grisendi, Enrico Epifani, Francesco Vizzari, Stefano Molinaro, Luca Nativo, Gabriele Vinacci, Bruno Bonetti, Nicola Micheletti, Giampaolo Tomelleri, Piergiuseppe Zampieri, Mauro Plebani, Andrea Grazioli, Giuseppe Kenneth Ricciardi, Alessandra Polistena, Sgreccia Alessando, Giuseppina Sanfilippo, Alessandra Persico, William Boadu, Maria Giovanna Cuzzoni, Serena Magno, Gianpaolo Toscano, Maria Federica Denaro, Piera Tosi, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Valeria De Giuli, Nicola Mavillo, Leonardo Renieri, Enrico Fainardi, Giovanni Vitale, Primikiris Panagiotis, Guillaume Charbonnier, Moratti Claudio, Fabrizio Sallustio, Andrea Wlderk, Riccardo Russo, Mauro Bergui, Chiara Comelli, Andrea Boghi, Marinette Moynier, Elisa Francesca Maria Ciceri, Danilo Toni, Julien Frandon, Isabelle Mourand, Nicolas Gaillard, Salvatore Mangiafico, Imad Derraz, Cyril Dargazanli, Pierre-Henri Lefevre, Carlos Riquelme, Gregory Gascou, Alain Bonafe, Cagnazzo F., Piotin M., Escalard S., Maier B., Ribo M., Requena M., Pop R., Hasiu A., Gasparotti R., Mardighian D., Piano M., Cervo A., Eker O.F., Durous V., Sourour N.-A., Elhorany M., Zini A., Simonetti L., Marcheselli S., Paolo N.N., Houdart E., Guedon A., Ligot N., Mine B., Consoli A., Lapergue B., Cordona Portela P., Urra X., Rodriguez A., Bolognini F., Lebedinsky P.A., Pasco-Papon A., Godard S., Marnat G., Sibon I., Limbucci N., Nencini P., Nappini S., Saia V., Caldiera V., Romano D., Frauenfelder G., Gallesio I., Gola G., Menozzi R., Genovese A., Terrana A., Giorgianni A., Cappellari M., Augelli R., Invernizzi P., Pavia M., Lafe E., Cavallini A., Giossi A., Besana M., Valvassori L., MacEra A., Castellan L., Salsano G., Di Caterino F., Biondi A., Arquizan C., Lebreuche J., Galvano G., Cannella A., Cosottini M., Lazzarotti G., Guizzardi G., Stecco A., Tassi R., Bracco S., Bianchini E., Micieli C., Pascarella R., Napoli M., Causin F., Desal H., Cotton F., Costalat V., Luigi Cirillo, Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Strasbourg, Hospices Civils de Lyon (HCL), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Hôpital Foch [Suresnes], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CH Colmar, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Bordeaux [Bordeaux], CHU Lille, Université de Lille, and Centre hospitalier universitaire de Nantes (CHU Nantes)

Subjects
Registrie, Male, MESH: Registries, [SDV]Life Sciences [q-bio], Brain ischemia, Cohort Studies, MESH: Aged, 80 and over, MESH: Risk Factors, Risk Factors, Epidemiology, Medicine, MESH: Thrombectomy, MESH: COVID-19, Registries, MESH: Cohort Studies, MESH: Treatment Outcome, Thrombectomy, MESH: Aged, Aged, 80 and over, MESH: Middle Aged, Cerebral infarction, Endovascular Procedures, Middle Aged, cerebral infarction, COVID-19, intracranial hemorrhage, lymphocyte count, thrombectomy, Europe, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, COVID-19/*complications/epidemiology Cohort Studies *Endovascular Procedures/mortality Europe Female Humans Ischemic Stroke/*complications/mortality/*surgery Male Middle Aged Registries Risk Factors SARS-CoV-2 *Thrombectomy/mortality Treatment Outcome Covid-19 cerebral infarction intracranial hemorrhage lymphocyte count thrombectomy, Cohort study, MESH: Ischemic Stroke, Human, medicine.medical_specialty, MESH: Endovascular Procedures, Coronavirus disease 2019 (COVID-19), Internal medicine, Humans, MESH: SARS-CoV-2, Risk factor, Aged, Ischemic Stroke, Advanced and Specialized Nursing, Endovascular Procedure, MESH: Humans, business.industry, SARS-CoV-2, Risk Factor, medicine.disease, MESH: Male, Clinical trial, Neurology (clinical), MESH: Europe, Cohort Studie, business, Complication, MESH: Female
Abstract

Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090.

Published
2020

27. Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries: The Italian Registry of Endovascular Treatment in Acute Stroke

Author

Simona Marcheselli, Giovanni Orlandi, Sara Biguzzi, Marta Iacobucci, Marco Nezzo, Jessica Moller, Alfredo Paolo Mascolo, Valerio Da Ros, Raffaele Augelli, Marco Pavia, Sandro Zedda, Manuela De Michele, Andrea Boghi, Edoardo Puglielli, Alessandro De Vito, Federico Marrama, Lucio Castellan, Roberto Gandini, Rosario Rossi, Piera Tosi, Christian Commodaro, Alessandro Sgreccia, Ilaria Grisendi, Vittorio Semeraro, Paolo Invernizzi, Mauro Magoni, Giovanni Boero, Roberto Menozzi, Simona Sacco, Monia Russo, Francesco D'Argento, Patrizia Nencini, Marco Petruzzellis, Salvatore Mangiafico, Andrea Wlderk, Guido Bigliardi, Leonardo Renieri, Mauro Bergui, Francesco Causin, Andrea Saletti, Renato Argirò, Pierfrancesco Pugliese, Laura Malfatto, Giacomo Koch, Lucia Princiotta Cariddi, Giovanni Pracucci, Daniele Morosetti, Marina Mannino, Rossana Tassi, Adriana Critelli, Mirco Cosottini, Giovanni Frisullo, Nicola Cavasin, Manuel Cappellari, Nunzio Paolo Nuzzi, Olindo Di Benedetto, Francesco Vizzari, Enrica Franchini, Danilo Toni, Alessandra Sanna, Marina Diomedi, Andrea Zini, Federico Fusaro, Alessio Comai, Alfonsina Casalena, Andrea Naldi, Tiziana Tassinari, Stefano Vallone, Isabella Francalanza, Alessandro Rocco, Domenico Inzitari, Fabrizio Sallustio, Roberto Gasparotti, Antonio Caragliano, Francesco Pintus, Pietro Amistà, Luigi Ruiz, Claudio Baracchini, Valentina Saia, Luigi Chiumarulo, Giuseppe Craparo, Federica D’Agostino, Ivan Gallesio, Gigliola Chianale, Sandra Bracco, Luca Allegretti, Luigi Cirillo, and Sallustio F., Saia V., Marrama F., Pracucci G., Gandini R., Koch G., Mascolo A.P., D'Agostino F., Rocco A., Argiro' R., Nezzo M., Morosetti D., Wlderk A., Da Ros V., Diomedi M., Renieri L., Nencini P., Vallone S., Zini A., Bigliardi G., Caragliano A., Francalanza I., Bracco S., Tassi R., Bergui M., Naldi A., Saletti A., De Vito A., Gasparotti R., Magoni M., Cirillo L., Commodaro C., Biguzzi S., Castellan L., Malfatto L., Menozzi R., Grisendi I., Cosottini M., Orlandi G., Comai A., Franchini E., D'Argento F., Frisullo G., Puglielli E., Casalena A., Causin F., Baracchini C., Boghi A., Chianale G., Augelli R., Cappellari M., Chiumarulo L., Petruzzellis M., Sgreccia A., Tosi P., Cavasin N., Critelli A., Semeraro V., Boero G., Vizzari F., Cariddi L.P., Di Benedetto O., Pugliese P., Iacobucci M., De Michele M., Fusaro F., Moller J., Allegretti L., Tassinari T., Nuzzi N.P., Marcheselli S., Sacco S., Pavia M., Invernizzi P., Gallesio I., Ruiz L., Zedda S., Rossi R., Amista P., Russo M., Pintus F., Sanna A., Craparo G., Mannino M., Inzitari D., Mangiafico S., Toni D.

Subjects
medicine.medical_specialty, Cervical Artery, Settore MED/26, Registries Retrospective Studies Stroke/diagnostic imaging/surgery Thrombectomy Treatment Outcome Circle of Willis Endovascular treatment, 030218 nuclear medicine & medical imaging, Brain Ischemia, NO, 03 medical and health sciences, 0302 clinical medicine, Settore MED/36, Internal medicine, medicine.artery, Occlusion, medicine, Humans, Radiology, Nuclear Medicine and imaging, Endovascular treatment, Registries, cardiovascular diseases, Neuroradiology, Aged, Retrospective Studies, Thrombectomy, Outcome, Univariate analysis, Circle of Willi, business.industry, Endovascular Procedures, Odds ratio, Stroke, Circle of Willis, Stroke severity, Large vessel occlusion, Endovascular treatment, Outcome, Stroke severity, Carotid Arteries, Treatment Outcome, Italy, Carotid artery occlusion, Cardiology, Circle of Willis, Large vessel occlusion, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery
Abstract

Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

Published
2020

28. Frequency and determinants for hemorrhagic transformation of cerebral infarction

Author

Marco D'Amelio, Paolo Ragonese, Giorgia Famoso, Lupo I, Paolo Aridon, Maria Antonietta Mazzola, Valentina Saia, Norma Di Benedetto, Giovanni Savettieri, Caterina Sarno, Valeria Terruso, Terruso V, D'Amelio M, Di Benedetto N, Lupo I, Saia V, Famoso G, Mazzola MA, Aridon P, Sarno C, Ragonese P, and Savettieri G.

Subjects
Male, medicine.medical_specialty, Time Factors, Epidemiology, MEDLINE, Text mining, Risk Factors, Medicine, Humans, Aged, Cerebral Hemorrhage, Retrospective Studies, Aged, 80 and over, hemorrhagic transformation , ischemic stroke, business.industry, Cerebral infarction, Follow up studies, Retrospective cohort study, Cerebral Infarction, Middle Aged, medicine.disease, Surgery, Emergency medicine, Ischemic stroke, Female, Neurology (clinical), business, Complication, Follow-Up Studies
Abstract

Background: Frequency and associated risk factors for hemorrhagic transformation (HT), a worrying complication of ischemic stroke (IS), are not clearly defined. Our aim was to estimate the overall frequency and risk factors for HT in a hospital-based population. Methods: A retrospective review of medical records of patients discharged from our department during the period 2004–2006 with a diagnosis of anterior IS. Demographic, clinical and hematological information was collected. Uni- and multivariate logistic regression analyses were used to estimate risk for spontaneous HT. Results: We included 240 patients (125 males, 52%), mean age at admission was 72.5 years. HT was observed in 29 patients (12%). At univariate analysis, consciousness impairment at admission (OR 5.6, 95% CI 1.3–28.2), the presence of early CT signs (OR 2.4, 95% CI 1.1–5.3), infarcts of medium-large size (OR 11.3, 95% CI 4.1–30.8), cardioembolic stroke (OR 2.3, 95% CI 1.1–5.2) and low total cholesterol levels (OR 3.3, 95% CI 1.3–8.2) were significantly associated with HT. At multivariate analysis, only infarct size (OR 10.2, 95% CI 3.2–32.1) was still significantly associated with HT. Conclusions: Frequency of HT in our study was 12%. Consistently with previous results, HT was associated with the size of ischemic area. As patients included in our study did not receive thrombolytic therapy, our results are applicable to those patients whom clinicians, working in a hospital setting, usually deal with.

Published
2009

29. Effects of cerebellar TMS on motor cortex of patient with focal dystonia: a preliminary report

Author

Giuseppe Giglia, M. Romano, Filippo Brighina, Francesca Giglia, Valentina Saia, Angela Rita Puma, Brigida Fierro, Brighina, F, Romano, M, Giglia, G, Saia, V, Puma, A, Giglia, F, and Fierro, B

Subjects
Adult, Male, medicine.medical_specialty, Cerebellum, Neurology, cerebellum, medicine.medical_treatment, Stimulus (physiology), Motor Activity, Settore BIO/09 - Fisiologia, focal dystonia, medicine, Humans, Dystonia, Analysis of Variance, business.industry, General Neuroscience, Motor Cortex, Neural Inhibition, Focal dystonia, Neurophysiology, medicine.disease, Transcranial Magnetic Stimulation, Transcranial magnetic stimulation, medicine.anatomical_structure, TMS, Arm, Female, Settore MED/26 - Neurologia, business, human activities, Neuroscience, Motor cortex
Abstract

Recent evidence suggests a role for cerebellum in pathophysiology of dystonia. Here we explored, the cerebellar modulation of motor cortex in patients with focal upper limb dystonia. Eight patients and eight controls underwent a transcranial magnetic stimulation protocol to study the cerebellar-brain-inhibition (CBI): a conditioning cerebellar stimulus (CCS) was followed 5 ms after by the contralateral motor cortex stimulation (test stimulus: TS). We explored the effects of CBI on MEP amplitude, short intracortical inhibition (SICI) and intracortical facilitation (ICF) measures. At baseline no differences in TS-MEP amplitude, SICI or ICF were found between patients and controls. Cerebellar-conditioning significantly reduced TS-MEP amplitude, increased ICF, and decreased SICI in control subjects. In contrast, no changes in these neurophysiological measures were observed in the motor cortex of patients, regardless of which side was tested. If further confirmed, these findings suggest a reduced cerebellar modulation of motor cortex excitability in patients with focal dystonia.

Published
2009

30. Blood levels of homocysteine, cysteine, glutathione, folic acid, and vitamin B12 in the acute phase of atherothrombotic stroke

Author

Paolo Aridon, Lupo I, Valentina Saia, Marco D'Amelio, Paolo Ragonese, Maria Concetta Gueli, Paola Mangiapane, Giuseppe Salemi, Salemi, G, Gueli, MC, D'Amelio, M, Saia, V, Mangiapane, P, Aridon, P, Ragonese, P, and Lupo, I

Subjects
Male, medicine.medical_specialty, Large artery atherothrombotic stroke, Homocysteine, Atherothrombotic stroke, Hyperhomocysteinemia, Dermatology, Brain Ischemia, chemistry.chemical_compound, Folic Acid, Risk Factors, Settore BIO/10 - Biochimica, Internal medicine, medicine, Humans, Vitamin B12, Cysteine, Vitamin B(12), Aged, Aged, 80 and over, business.industry, Large artery, General Medicine, Glutathione, Plasma levels, Vitamins, Middle Aged, Reduced glutathione, Stroke, Psychiatry and Mental health, Vitamin B 12, Endocrinology, chemistry, Folic acid, Biochemistry, Acute Disease, Settore MED/26 - Neurologia, Female, Neurology (clinical), Intracranial Thrombosis, business
Abstract

Blood levels of total homocysteine (tHcy), cysteine (Cys), total and reduced glutathione (tGSH and rGSH), folic acid (FA), and vitamin B(12) (B(12) change during ischemic stroke as accompaniment of the tissue damage. The relationship between these changes remains scantly investigated. We evaluated the variation of these molecules in the 48 h after acute large artery atherothrombotic stroke (LAAS) and searched for the presence of matched variation of them. The study involved 50 subjects affected by acute LAAS and 49 healthy controls. Plasma levels of tHcy and Cys were significantly higher and serum levels of FA and B(12) and plasma levels of rGSH were significantly lower in the patients than in the control group. Acute LAAS was associated with increased Hcy-decreased tGSH and decreased FA/tGSH. Pathways involved in cellular stress and in tissue repair are activated during acute LAAS.

Published
2008

31. FREQUENCY AND DETETRIMINANTS OF HEMORRHAGIC TRASFORMATION OF CEREBRAL INFARCTION

Author

TERRUSO, Valeria, MAZZOLA MA, ARIDON, Paolo, RAGONESE, Paolo, LUPO, Innocenzo, D'AMELIO, Marco, SAVETTIERI, Giovanni, DI BENEDETTO, Norma, FAMOSO, Giorgia, SAIA, Valentina, SARNO, Celeste, TERRUSO V, DI BENEDETTO N, FAMOSO G, MAZZOLA MA, SAIA V, ARIDON P, RAGONESE P, LUPO I, SARNO C, D'AMELIO M, and SAVETTIERI G

Subjects
Stroke, hemorragic transformation, Settore MED/26 - Neurologia
Published
2008

34. CEREBELLUM AND TIME PERCEPTION: A LOW-FREQUENCY STIMULATION STUDY IN HEALTHY SUBJECTS

Author

BRIGHINA, Filippo, GIGLIA, Giuseppe, PUMA, Angela Rita, SCALIA, Simona, SAIA, Valentina, DANIELE, Ornella, FIERRO, Brigida, COSENSTINO G, MANETTA M, PALERMO A, PP S. ISBNISSN MILANO SPRINGER ITALY, BRIGHINA F, GIGLIA G, COSENSTINO G, MANETTA M, PUMA A, SCALIA S, PALERMO A, SAIA V, DANIELE O, FIERRO B, and PP S ISBNISSN - MILANO SPRINGER ITALY

Published
2007

35. Frequency and Determinants for Hemorrhagic Transformation of Cerebral Infarction

Author

D'AMELIO, Marco, TERRUSO, Valeria, SAIA, Valentina, DI BENEDETTO, Norma, FAMOSO, Giorgia, LUPO, Innocenzo, RAGONESE, Paolo, SAVETTIERI, Giovanni, M. A. MAZZOLA, D'AMELIO M, TERRUSO V, SAIA V, DI BENEDETTO N, FAMOSO G, MAZZOLA M, LUPO I, RAGONESE P, SAVETTIERI G, M D'AMELIO, V TERRUSO, V SAIA, N DI BENEDETTO, G FAMOSO, M A MAZZOLA, I LUPO, and P RAGONESE

Published
2007

36. Effects of cerebellar TMS on motor cortex of patients with focal dystonia

Author

GIGLIA, Giuseppe, PANETTA, Maristella, PUMA, Angela Rita, SAIA, Valentina, SCALIA, Simona, COSENTINO, Giuseppe, BRIGHINA, Filippo, FIERRO, Brigida, ROMANO M, PALERMO A, PP S. S. ISBNISSN MILANO SPRINGER ITALY, GIGLIA G, ROMANO M, PANETTA ML, PUMA A, SAIA V, PALERMO A, SCALIA S, COSENTINO G, BRIGHINA F, FIERRO B VOL, and PP S-S ISBNISSN MILANO SPRINGER ITALY

Published
2007

39. EFFECTS OF LEFT DLPFC RTMS ON PAIN INDUCED BY CAPSAICIN IN HEALTHY SUBJECT

Author

PALERMO A, COSENSTINO G, DE TOMMASO M, PP S. ISBNISSN ITALY, FIERRO, Brigida, SAIA, Valentina, SCALIA, Simona, PANETTA, Maristella, GIGLIA, Giuseppe, BRIGHINA, Filippo, PALERMO A, FIERRO B, SAIA V, SCALIA S, PANETTA M, COSENSTINO G, GIGLIA G, DE TOMMASO M, BRIGHINA F, and PP S ISBNISSN - ITALY

Published
2007

44. Effetti indotti dal PD 128907, potente agonista D3, sulla sequenza di sazietà, nel ratto

Author

SORBERA, Filippina, CASARRUBEA, Maurizio, SAIA, Valentina, CRESCIMANNO, Giuseppe, SORBERA F, CASARRUBEA M, SAIA V, and CRESCIMANNO G

Abstract

The fixed behavioral sequence exhibited by rat in response to food ingestion is called behavioral satiety sequence (BSS): cessation of feeding is followed by a period of grooming and activity endings with a period of resting. This profile of BSS is closely linked to satiety. In different experimental design, BSS has been used to investigate whether reduction of food intake, induced by different drugs like D1 and D2 receptor agonist, was determined by an influence on processes underlying satiety or on specific behaviors associated to feeding. Our recent data have shown that PD 128907, a D3 receptor agonist, produced a decrease of food intake. In order to assess the mechanism involved in D3 receptors control of feeding, an experiment was performed in which effect of PD 128907 was analysed on BSS. Male Wistar rats, injected IP with different dosages of PD 128907, were used. Our data show that PD 128907, determined an altered pattern of BSS with significative increases of activity duration and decreases of the resting one. This result suggests that hyperactivity may represent one of the possible mechanisms of food intake inhibition caused by D3 receptor manipulation.

Published
2004

46. Levetiracetam in the treatment of vascular chorea: a case report

Author

Paolo Ragonese, Lupo I, Matilde Gammino, Marco D'Amelio, Valentina Saia, Giuseppe Salemi, Graziella Callari, Giovanni Savettieri, D'AMELIO M, CALLARI G, GAMMINO M, SAIA V, LUPO I, SALEMI G, RAGONESE P, and SAVETTIERI G

Subjects
Pharmacology, Levetiracetam, Hemichorea, business.industry, Pharmacology toxicology, Chorea, General Medicine, Bioinformatics, Medicine, Pharmacology (medical), Levetiracetam, medicine.symptom, business, Adverse effect, medicine.drug
Published
2004

47. Headache in cerebrospinal fluid volume depletion syndrome: A case report

Author

Lupo I, Salemi G, Fierro B, Brighina F, Daniele O, Caronia A, Valentina Saia, Savettieri G, LUPO I, SALEMI G, FIERRO B, BRIGHINA F, DANIELE O, CARONIA A, SAIA V, and SAVETTIERI G

Subjects
cerebrospinal fluid volume depletion syndrome, paradoxical postural headache, spontaneous intracranial hypotension, Settore MED/26 - Neurologia
Abstract

Cerebrospinal fluid (CSF) volume depletion syndrome is due to leakage of cerebrospinal fluid through lesions of the dural sac at the level of the cranial base or of the spine. When past medical history is negative for recent trauma or surgery, the term spontaneous intracranial hypotension (SIH) is used. SIH is characterized clinically by orthostatic headache, neck pain, nausea, emesis, horizontal diplopia, tinnitus, plugged ear, hearing difficulties, blurring of vision, facial numbness, and upper limb radicular symptoms. In SIH, brain and cervical MR scans show a diffuse pachymeningeal gadolinium enhancement that ends at the site of CSF leakage. The application of epidural blood patches has been proposed as an effective therapy for SIH. Here we describe a case of SIH with very unusual headache features; the patient reported a paradoxical pattern of postural headache provoked by clinostatic position. The CSF leakage was identified at the convexity of the skull and headache disappeared following treatment with fluid, analgesics and steroids.

48. 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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49. Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke.

Author

Sallustio F, Nicolini E, Saia V, Pracucci G, Mascolo AP, Marrama F, Gandini R, Da Ros V, Diomedi M, Alemseged F, Casetta I, Fainardi E, Castellan L, Del Sette M, Limbucci N, Nencini P, Bergui M, Cerrato P, Saletti A, De Vito A, Cioni S, Tassi R, Simonetti L, Zini A, Ruggiero M, Longoni M, Tessitore A, Ferraù L, Cavasin N, Critelli A, Vallone S, Bigliardi G, Zimatore DS, Petruzzellis M, Boghi A, Naldi A, Comai A, Dall'Ora E, Sanfilippo G, Persico A, Gallesio I, Sepe F, Menozzi R, Pezzini A, Besana M, Giossi A, Sanna A, Tassinari T, Burdi N, Boero G, Augelli R, Cappellari M, Cosottini M, Giannini N, Romano DG, Frauenfelder G, Nuzzi PN, Spinelli MC, Paladini A, Rizzo A, Filizzolo M, Mannino M, Timpani C, De Santis F, Carità G, Russo M, Galvano G, Sicurella L, Mangiafico S, and Toni D

Subjects
Humans, Male, Female, Aged, Middle Aged, Italy, Aged, 80 and over, Cohort Studies, Time Factors, Treatment Outcome, Outcome Assessment, Health Care, Ischemic Stroke surgery, Ischemic Stroke therapy, Registries, Thrombectomy adverse effects, Thrombectomy methods, Endovascular Procedures adverse effects
Abstract

Background: We aim to assess the association between procedural time and outcomes in patients in unsuccessful mechanical thrombectomy (MT) for anterior circulation acute stroke., Methods: We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0-1 at the end of procedure. Primary outcome was 90-day poor outcome. Secondary outcomes were early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH) according to ECASS II and sICH according to SITS-MOST., Results: Among 852 patients, after comparing characteristics of favourable and poor outcome groups, logistic regression analysis showed age (OR: 1.04; 95%CI: 1.02-1.05; p < 0.001), previous TIA/stroke (OR: 0.23; 95%CI: 0.12-0.74; p = 0.009), M1 occlusion (OR: 1.69; 95%CI: 1.13-2.50; p = 0.01), baseline NIHSS (OR: 1.01; 95%CI: 1.06-1.13; p < 0.001) and procedural time (OR:1.00; 95% CI: 1.00-1.01; p = 0.003) as independent predictors poor outcome at 90 days. Concerning secondary outcomes, logistic regression analysis showed NIHSS (OR:0.96; 95%CI: 0.93-0.99; p = 0.008), general anaesthesia (OR:2.59; 95%CI: 1.52-4.40; p < 0.001), procedural time (OR: 1.00; 95% CI: 1.00-1.01; p = 0.002) and intraprocedural complications (OR: 1.89; 95%CI: 1.02-3.52; p = 0.04) as independent predictors of END. Bridging therapy (OR:2.93; 95%CI: 1.21-7.09; p = 0.017) was associated with sICH per SITS-MOST criteria whereas M1 occlusion (OR: 0.35; 95%CI: 0.18-0.69; p = 0.002), bridging therapy (OR: 2.02; 95%CI: 1.07-3.82; p = 0.03) and intraprocedural complications (OR: 5.55; 95%CI: 2.72-11.31; p < 0.001) were independently associated with sICH per ECASS II criteria. No significant association was found between the number of MT attempts and analyzed outcomes., Conclusions: Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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50. 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

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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