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1. 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
Humans, Thrombectomy adverse effects, Treatment Outcome, Registries, Retrospective Studies, Ischemic Stroke etiology, Stroke epidemiology, Stroke surgery, Heart Failure complications, Brain Ischemia complications, Brain Ischemia diagnostic imaging, Brain Ischemia epidemiology, Endovascular Procedures adverse effects
Abstract

Background: Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF., Methods: The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receiving MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings on admission were analysed., Results: Of 8924 patients, 642 (7.2%) had HF. Compared to the no-HF group, HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalisation (TICI 2b-3) was 76.9% in HF vs 78.1% in no-HF group (p = 0.481). Rate of symptomatic intracerebral haemorrhage at 24-h non-contrast computed tomography (NCCT) was 7.6% in HF vs 8.3% in no-HF patients (p = 0.520). At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p < 0.001) had mRS 0-2, and mortality was, respectively, 30.7% and 18.5% (p < 0.001). In multivariate logistic regression, HF was independently associated with mortality at 3 months (OR 1.53, 1.24-1.88 95% CI, p < 0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05-1.44 95% CI, p = 0.012). The propensity score analysis of two groups matched for age, sex, and NIHSS at admission yielded the same results., Conclusion: MT is safe and effective in HF patients with AIS. Patients with HF and AIS suffered from higher 3-month mortality and unfavourable outcome regardless of acute treatments., (© 2023. Fondazione Società Italiana di Neurologia.)

Published
2023
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2. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke.

Author

Sallustio F, Pracucci G, Cappellari M, Saia V, Mascolo AP, Marrama F, Gandini R, Koch G, Diomedi M, D'Agostino F, Rocco A, Da Ros V, Wlderk A, Nezzo M, Argirò R, Morosetti D, Renieri L, Nencini P, Vallone S, Zini A, Bigliardi G, Pitrone A, Grillo F, Bracco S, Tassi R, Bergui M, Naldi A, Carità G, Casetta I, Gasparotti R, Magoni M, Simonetti L, Haznedari N, Paolucci M, Mavilio N, Malfatto L, Menozzi R, Genovese A, Cosottini M, Orlandi G, Comai A, Franchini E, Pedicelli A, Frisullo G, Puglielli E, Casalena A, Cester G, Baracchini C, Castellano D, Di Liberto A, Ricciardi GK, Chiumarulo L, Petruzzellis M, Lafe E, Persico A, Cavasin N, Critelli A, Semeraro V, Tinelli A, Giorgianni A, Carimati F, Auteri W, Rizzuto S, Biraschi F, Nicolini E, Ferrari A, Melis M, Calia S, Tassinari T, Nuzzi NP, Corato M, Sacco S, Squassina G, Invernizzi P, Gallesio I, Ruiz L, Dui G, Carboni N, Amistà P, Russo M, Maiore M, Zanda B, Craparo G, Mannino M, Inzitari D, Toni D, and Mangiafico S

Subjects
Humans, Cohort Studies, Treatment Outcome, Stents, Thrombectomy, Registries, Hematoma etiology, Carotid Arteries, Retrospective Studies, Carotid Artery, Internal, Ischemic Stroke complications, Carotid Stenosis complications, Endovascular Procedures, Stroke, Brain Ischemia surgery, Brain Ischemia complications
Abstract

Purpose: 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., Methods: 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., Results: 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., Conclusions: 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., (© 2022. The Author(s) under exclusive licence to Belgian Neurological Society.)

Published
2023
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3. SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy.

Author

Pezzini A, Grassi M, Silvestrelli G, Locatelli M, Rifino N, Beretta S, Gamba M, Raimondi E, Giussani G, Carimati F, Sangalli D, Corato M, Gerevini S, Masciocchi S, Cortinovis M, La Gioia S, Barbieri F, Mazzoleni V, Pezzini D, Bonacina S, Pilotto A, Benussi A, Magoni M, Premi E, Prelle AC, Agostoni EC, Palluzzi F, De Giuli V, Magherini A, Roccatagliata DV, Vinciguerra L, Puglisi V, Fusi L, Diamanti S, Santangelo F, Xhani R, Pozzi F, Grampa G, Versino M, Salmaggi A, Marcheselli S, Cavallini A, Giossi A, Censori B, Ferrarese C, Ciccone A, Sessa M, and Padovani A

Subjects
Hospital Mortality, Humans, Italy epidemiology, Male, Retrospective Studies, Risk Factors, SARS-CoV-2, Brain Ischemia complications, Brain Ischemia epidemiology, COVID-19, Ischemic Stroke, Stroke epidemiology
Abstract

Objective: To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients., Methods: In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19., Results: Among 1013 patients, 160 (15.8%) had SARS-CoV-2 infection. Male sex (OR 1.53; 95% CI 1.06-2.27) and atrial fibrillation (OR 1.60; 95% CI 1.05-2.43) were independently associated with COVID-19 status. Patients with COVID-19 had increased stroke severity at admission [median NIHSS score, 9 (25th to75th percentile, 13) vs 6 (25th to75th percentile, 9)] and increased risk of in-hospital death (38.1% deaths vs 7.2%; HR 3.30; 95% CI 2.17-5.02). The RF model based on six clinical and laboratory parameters exhibited high cross-validated classification accuracy (0.86) and precision (0.87), good recall (0.72) and F1-score (0.79) in predicting in-hospital death., Conclusions: Ischemic strokes in COVID-19 patients have distinctive risk factor profile and etiology, increased clinical severity and higher in-hospital mortality rate compared to non-COVID-19 patients. A simple model based on clinical and routine laboratory parameters may be useful in identifying ischemic stroke patients with SARS-CoV-2 infection who are unlikely to survive the acute phase., (© 2021. The Author(s).)

Published
2022
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4. Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network.

Author

Pezzini A, Grassi M, Silvestrelli G, Locatelli M, Rifino N, Beretta S, Gamba M, Raimondi E, Giussani G, Carimati F, Sangalli D, Corato M, Gerevini S, Masciocchi S, Cortinovis M, La Gioia S, Barbieri F, Mazzoleni V, Pezzini D, Bonacina S, Pilotto A, Benussi A, Magoni M, Premi E, Prelle AC, Agostoni EC, Palluzzi F, De Giuli V, Magherini A, Roccatagliata DV, Vinciguerra L, Puglisi V, Fusi L, Xhani R, Pozzi F, Diamanti S, Santangelo F, Grampa G, Versino M, Salmaggi A, Marcheselli S, Cavallini A, Giossi A, Censori B, Ferrarese C, Ciccone A, Sessa M, and Padovani A

Subjects
Aged, Hospital Mortality, Humans, Italy epidemiology, Male, Reperfusion, Retrospective Studies, SARS-CoV-2, Thrombectomy, Brain Ischemia complications, Brain Ischemia epidemiology, Brain Ischemia therapy, COVID-19, Ischemic Stroke, Stroke epidemiology, Stroke therapy
Abstract

Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62-80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5-270) minutes vs. 190 (IQR 150-245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82-13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10-0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04-4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85-14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions., (© 2021. Springer-Verlag GmbH, DE part of Springer Nature.)

Published
2021
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5. Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis.

Author

Cappellari M, Pracucci G, Forlivesi S, Saia V, Limbucci N, Nencini P, Inzitari D, Da Ros V, Sallustio F, Vallone S, Bigliardi G, Zini A, Vinci SL, Dell'Aera C, Bracco S, Cioni S, Tassi R, Bergui M, Naldi A, Carità G, Azzini C, Casetta I, Gasparotti R, Magoni M, Castellan L, Finocchi C, Menozzi R, Scoditti U, Causin F, Viaro F, Puglielli E, Casalena A, Ruggiero M, Biguzzi S, Castellano D, Cavallo R, Lazzarotti GA, Orlandi G, Sgreccia A, Denaro MF, Cavasin N, Critelli A, Ciceri EFM, Bonetti B, Chiumarulo L, Petruzzelli M, Pellegrino C, Carimati F, Burdi N, Prontera MP, Auteri W, Petrone A, Guidetti G, Nicolini E, Ganci G, Sugo A, Filauri P, Sacco S, Squassina G, Invernizzi P, Nuzzi NP, Corato M, Amistà P, Gentile M, Barbero S, Schirru F, Craparo G, Mannino M, Simonetti L, Mangiafico S, and Toni D

Subjects
Cohort Studies, Fibrinolytic Agents therapeutic use, Humans, Thrombectomy, Thrombolytic Therapy, Treatment Outcome, Brain Ischemia drug therapy, Stroke diagnostic imaging, Stroke drug therapy
Abstract

Background: Intravenous thrombolysis (IVT)-ineligible patients undergoing direct thrombectomy tended to have poorer functional outcome as compared with IVT-eligible patients undergoing bridging therapy. We aimed to assess radiological and functional outcomes in large vessel occlusion-related stroke patients receiving direct thrombectomy in the presence of absolute exclusion criteria for IVT vs relative exclusion criteria for IVT and vs non-exclusion criteria for IVT., Methods: A cohort study on prospectively collected data from 2282 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke cohort for treatment with direct thrombectomy (n = 486, absolute exclusion criteria for IVT alone; n = 384, absolute in combination with relative exclusion criteria for IVT; n = 777, relative exclusion criteria for IVT alone; n = 635, non-exclusion criteria for IVT)., Results: After adjustment for unbalanced variables (model 1), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.595, 95% CI 1.042-2.440) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.235, 95% CI 1.014-1.504). After adjustment for predefined variables (model 2: age, sex, pre-stroke mRS ≤ 1, NIHSS, occlusion in the anterior circulation, onset-to-groin time, and procedure time), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.235, 95% CI 1.014-1.504) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.246, 95% CI 1.039-1.495). No significant difference was found between the groups as regards any type of intracerebral hemorrhage and parenchymal hematoma within 24 h, successful and complete recanalization after procedure, and modified Rankin Scale score 0-2 at 3 months. After adjustment for predefined variables of model 2, ORs for death were higher in the presence of recent administration of IV heparin (OR: 2.077), platelet count < 100,000/mm 3 (OR: 4.798), bacterial endocarditis (OR: 15.069), neoplasm with increased hemorrhagic risk (OR: 6.046), and severe liver disease (OR: 6.124)., Conclusions: Radiological outcomes were similar after direct thrombectomy in patients with absolute, relative, and non- exclusion criteria for IVT, while an increase of fatal outcome was observed in the presence of some absolute exclusion criterion for IVT.

Published
2020
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6. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke

Author

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

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

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

Published
2019

7. Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults

Author

Poli, L., Zedde, Marialuisa, Zini, Andrea, Del Sette, Massimo, Lodigiani, Corrado, Spalloni, Alessandra, Di Lisi, Filomena, Toriello, Antonella, Piras, Valeria, Stilo, Cesare, Tomelleri, Giampaolo, Tancredi, Lucia, Paciaroni, Maurizio, Silvestrelli, Giorgio, Adami, Alessandro, Costa, P., Morotti, A., De Giuli, V., Caria, F., Gamba, Massimo, Malferrari, Giovanni, Simone, Anna Maria, Musolino, Rossella, Giorli, Elisa, Banfi, Elena, Marcheselli, Simona, Rasura, Maurizia, Pugliese, Nicola, Melis, Maurizio, Bovi, Paolo, Padovani, A., Burlina, A., Pezzini, A, Del Zotto, Elisabetta, Giossi, Alessia, Sessa, Maria, Gilberti, Nicola, Magoni, Mauro, Ferrazzi, Paola, Librã¨, Luca, Rota, Lidia Luciana, Patella, Rosalba, Calabrã², Rocco Salvatore, Bramanti, Placido, La Spina, Paolo, Finocchi, Cinzia, Balestrino, Maurizio, Bruno, Chiara, Massucco, Davide, Gandolfo, Carlo, Traverso, Elisabetta, Delodovici, Maria Luisa, Verrengia, Elena Pinuccia, Carimati, Federico, Bono, GIORGIO GIOVANNI, Dell'Acqua, Maria Luisa, Bigliardi, Guido, Vandelli, Laura, Nichelli, Paolo Frigio, Carletti, Monica, Cerrato, Paolo, Iacoviello, Licia, Di Castelnuovo, Augusto, de Gaetano, Giovanni, Grassi, Mario, Locatelli, Giampiero, Caso, Valeria, D'Amore, Cataldo, Agnelli, Giancarlo, Checcarelli, Nicoletta, Guidotti, Mario, Arnaboldi, Marco, Giacalone, Giacomo, Zanoli, Elisa, Cavallini, Anna, Persico, Alessandra, Micieli, Giuseppe, Chiti, Alberto, Orlandi, Giovanni, Marchi, Piernicola, Lanari, Alessia, Ciccone, Alfonso, Cucurachi, Laura, Bonifati, Marco Domenico, and Marcello, Norina

Subjects
Pediatrics, medicine.medical_specialty, Neurology, 030204 cardiovascular system & hematology, Fabry disease, ischaemic, stroke, young, Neurology (clinical), Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Ischaemic stroke, Medicine, In patient, cardiovascular diseases, Young adult, Stroke, business.industry, medicine.disease, Young age, business, 030217 neurology & neurosurgery
Published
2017
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8. Caring for acute coronary syndrome and other time-sensitive medical emergencies during the coronavirus disease 2019 pandemic in Northern Italy: report from a hub centre

Author

Davide Locatelli, Alberto Zoli, Luca Cabrini, Vinicio Conti, Elisa Candeloro, Sergio Balbi, Dario Franchi, Lorenzo Maffioli, Fabio Baruzzi, Marianna Sartorelli, Rita Pradella, Walter Ageno, Giuliano Zocchi, Carlo Capra, Battistina Castiglioni, Roberto De Ponti, Paolo Severgnini, Matteo Tozzi, Giovanni Landoni, Giancarlo Gini, Maurizio Versino, Andrea Giorgianni, Federico Carimati, Cabrini, Luca, Ageno, Walter, Balbi, Sergio, Baruzzi, Fabio, Candeloro, Elisa, Capra, Carlo, Carimati, Federico, Castiglioni, Battistina, Conti, Vinicio, De Ponti, Roberto, Franchi, Dario, Gini, Giancarlo, Giorgianni, Andrea, Sartorelli, Marianna, Landoni, Giovanni, Locatelli, Davide, Maffioli, Lorenzo, Pradella, Rita, Severgnini, Paolo, Tozzi, Matteo, Versino, Maurizio, Zocchi, Giuliano, and Zoli, Alberto

Subjects
Acute coronary syndrome, business.industry, Outbreak, Emergency department, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Operating theater, Health care, Pandemic, Medicine, 030212 general & internal medicine, Medical emergency, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract

Background The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from timesensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies. Methods We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year. Results Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed. Conclusions Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.

Published
2020
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9. Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study: (TESI study: "Trombolisi/Trombectomia e crisi Epilettiche precoci nello Stroke Ischemico").

Author

Belcastro, Vincenzo, Brigo, Francesco, Ferlazzo, Edoardo, Gasparini, Sara, Mastroianni, Giovanni, Cianci, Vittoria, Lattanzi, Simona, Silvestrini, Mauro, Versino, Maurizio, Banfi, Paola, Carimati, Federico, Grampa, Giampiero, Lochner, Piergiorgio, Gigli, Gian Luigi, Bax, Francesco, Merlino, Giovanni, Valente, Mariarosaria, Vidale, Simone, and Aguglia, Umberto

Subjects
*SEIZURES (Medicine), *TISSUE plasminogen activator, *REPERFUSION, *STROKE, *LONGITUDINAL method, *HYPERPERFUSION
Abstract

The aim of this study was to prospectively investigate the occurrence of early poststroke seizures (within 7 days of stroke) in patients undergoing reperfusion therapies (intravenous rtPA [recombinant tissue plasminogen activator] and/or endovascular thrombectomy) in comparison to those not undergoing these procedures. Patients aged ≥ 18 years with acute ischemic stroke admitted in five Italian centers were prospectively recruited. Clinical data, details on stroke type and etiology, stroke treatment, and radiological data were collected. The frequency of early poststroke seizures was assessed, and predictive factors for their occurrence were evaluated. Five hundred and sixteen patients (262 in the reperfusion therapies group) were included. Stroke severity on admission and at discharge was higher among patients undergoing reperfusion therapies. Ten patients (3.8%) undergoing reperfusion therapies and 6 (2.3%) of those not receiving these treatments experienced early poststroke seizures (p = 0.45). There were no differences in any of the baseline characteristics between patients experiencing and those not experiencing early seizures. The incidence of early poststroke seizures was overall rare, and no significant differences emerged between patients receiving and those not receiving reperfusion therapies. This article is part of the Special Issue "Seizures and Stroke". • Few conflicting data exist on the risk of early seizures in stroke patients undergoing reperfusion. • This study investigated the occurrence of early post-stroke seizures in patients undergoing reperfusion procedures. • Early post-stroke seizures are rare in patients receiving reperfusion therapies. [ABSTRACT FROM AUTHOR]

Published
2020
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