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

Author: Raffaele Ornello, Matteo Foschi, Federico De Santis, Michele Romoli, Tiziana Tassinari, Valentina Saia, Silvia Cenciarelli, Chiara Bedetti, Chiara Padiglioni, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Maria Guarino, Valentina Barone, Marialuisa Zedde, Ilaria Grisendi, Marina Diomedi, Maria Rosaria Bagnato, Marco Petruzzellis, Domenico Maria Mezzapesa, Pietro Di Viesti, Vincenzo Inchingolo, Manuel Cappellari, Cecilia Zivelonghi, Paolo Candelaresi, Vincenzo Andreone, Giuseppe Rinaldi, Alessandra Bavaro, Anna Cavallini, Stefan Moraru, Pietro Querzani, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Giovanni Frisullo, Francesco Muscia, Maurizio Paciaroni, Maria Giulia Mosconi, Andrea Zini, Ruggiero Leone, Carmela Palmieri, Letizia Maria Cupini, Michela Marcon, Rossana Tassi, Enzo Sanzaro, Cristina Paci, Giovanna Viticchi, Daniele Orsucci, Anne Falcou, Simone Beretta, Roberto Tarletti, Patrizia Nencini, Eugenia Rota, Federica Nicoletta Sepe, Delfina Ferrandi, Luigi Caputi, Gino Volpi, Salvatore La Spada, Mario Beccia, Claudia Rinaldi, Vincenzo Mastrangelo, Francesco Di Blasio, Paolo Invernizzi, Giuseppe Pelliccioni, Maria Vittoria De Angelis, Laura Bonanni, Giampietro Ruzza, Emanuele Alessandro Caggia, Monia Russo, Agnese Tonon, Maria Cristina Acciarri, Sabrina Anticoli, Cinzia Roberti, Giovanni Manobianca, Gaspare Scaglione, Francesca Pistoia, Alberto Fortini, Antonella De Boni, Alessandra Sanna, Alberto Chiti, Leonardo Barbarini, Marcella Caggiula, Maela Masato, Massimo Del Sette, Francesco Passarelli, Maria Roberta Bongioanni, Danilo Toni, Stefano Ricci, Eleonora De Matteis, and Simona Sacco
Subjects: dual antiplatelet treatment, functional outcome, intravenous thrombolysis, ischemic stroke, real world, safety, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS. Methods and Results This is a prespecified propensity score‐matched analysis from a prospective multicentric real‐world study (READAPT [Real‐Life Study on Short‐Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]). We included patients with MIS (National Institutes of Health Stroke Scale score at admission ≤5), without prestroke disability (modified Rankin scale [mRS] score ≤2). The primary outcomes were 90‐day mRS score of 0 to 2 and ordinal mRS distribution. The secondary outcomes included 90‐day risk of stroke and other vascular events and 24‐hour early neurological improvement or deterioration (≥2‐point National Institutes of Health Stroke Scale score decrease or increase from the baseline, respectively). From 1373 patients with MIS, 240 patients treated with IVT plus DAPT were matched with 427 patients treated with DAPT alone. At 90 days, IVT plus DAPT versus DAPT alone showed similar frequency of mRS 0 to 2 (risk difference, 2.3% [95% CI −2.0% to 6.7%]; P=0.295; risk ratio, 1.03 [95% CI 0.98–1.08]; P=0.312) but more favorable ordinal mRS scores distribution (odds ratio, 0.57 [95% CI 0.41–0.79]; P
Published: 2024
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2. History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)

Author: Valeria De Giuli, Michele Besana, Mario Grassi, Marialuisa Zedde, Andrea Zini, Corrado Lodigiani, Simona Marcheselli, Anna Cavallini, Giuseppe Micieli, Maurizia Rasura, Maria Luisa DeLodovici, Giampaolo Tomelleri, Nicoletta Checcarelli, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Lucia Tancredi, Antonella Toriello, Massimiliano Braga, Andrea Morotti, Loris Poli, Filomena Caria, Massimo Gamba, Rosalba Patella, Alessandra Spalloni, Anna Maria Simone, Rosario Pascarella, Sandro Beretta, Enrico Fainardi, Alessandro Padovani, Roberto Gasparotti, and Alessandro Pezzini
Subjects: brain ischemia, cortical spreading depression, migraine disorders, risk factors, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and Purpose Migraine has been shown to increase cerebral excitability, promote rapid infarct expansion into tissue with perfusion deficits, and result in larger infarcts in animal models of focal cerebral ischemia. Whether these effects occur in humans has never been properly investigated. Methods In a series of consecutive patients with acute ischemic stroke, enrolled in the setting of the Italian Project on Stroke at Young Age, we assessed acute as well as chronic infarct volumes by volumetric magnetic resonance imaging, and compared these among different subgroups identified by migraine status. Results A cohort of 591 patients (male, 53.8%; mean age, 37.5±6.4 years) qualified for the analysis. Migraineurs had larger acute infarcts than non-migraineurs (median, 5.9 cm3 [interquartile range (IQR), 1.4 to 15.5] vs. 2.6 cm3 [IQR, 0.8 to 10.1], P
Published: 2019
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3. Longitudinal changes in MoCA performances in patients with mild cognitive impairment and small vessel disease. Results from the VMCI-Tuscany Study

Author: Emilia Salvadori, Anna Poggesi, Giovanni Pracucci, Alberto Chiti, Laura Ciolli, Alessandra Del Bene, Ilaria Di Donato, Sandro Marini, Serena Nannucci, Giovanni Orlandi, Marco Pasi, Francesca Pescini, Raffaella Valenti, Antonio Federico, Maria Teresa Dotti, Ubaldo Bonuccelli, Domenico Inzitari, and Leonardo Pantoni
Subjects: Montreal Cognitive Assessment, Cerebral small vessel disease, Mild cognitive impairment, Major neurocognitive disorder, Specialties of internal medicine, RC581-951, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract: Objectives: The Montreal Cognitive Assessment (MoCA) is a cognitive screening test largely employed in vascular cognitive impairment, but there are no data about MoCA longitudinal changes in patients with cerebral small vessel disease (SVD). We aimed to describe changes in MoCA performance in patients with mild cognitive impairment (MCI) and SVD during a 2-year follow-up, and to evaluate their association with transition to major neurocognitive disorder (NCD). Materials and Methods: Within the prospective observational VMCI-Tuscany Study, patients with MCI and SVD underwent a comprehensive clinical, neuropsychological, and functional evaluation at baseline, and after 1 and 2 years. Results: Among the 138 patients (mean age 74.4 ± 6.9 years; males: 57%) who completed the study follow-up, 44 (32%) received a major NCD diagnosis. Baseline MoCA scores (mean±SD) were lower in major NCD patients (20.5 ± 5) than in reverter/stable MCI (22.2 ± 4.3), and the difference approached the statistical threshold of significance (p=.051). The total cohort presented a decrease in MoCA score (mean±SD) of -1.3 ± 4.2 points (-2.6 ± 4.7 in major NCD patients, -0.7 ± 3.9 in reverter/stable MCI). A multivariate logistic model on the predictors of transition from MCI to major NCD, showed MoCA approaching the statistical significance (OR=1.09, 95% CI=1.00–1.19, p=.049). Discussion: In our sample of MCI patients with SVD, longitudinal changes in MoCA performances were consistent with an expected more pronounced deterioration in patients who received a diagnosis of major NCD. MoCA sensitivity to change and predictive utility need to be further explored in VCI studies based on larger samples and longer follow-up periods.
Published: 2021
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4. Application of the DSM-5 Criteria for Major Neurocognitive Disorder to Vascular MCI Patients

Author: Emilia Salvadori, Anna Poggesi, Giovanni Pracucci, Alberto Chiti, Laura Ciolli, Mirco Cosottini, Alessandra Del Bene, Nicola De Stefano, Stefano Diciotti, Ilaria Di Donato, Andrea Ginestroni, Sandro Marini, Mario Mascalchi, Serena Nannucci, Giovanni Orlandi, Marco Pasi, Francesca Pescini, Raffaella Valenti, Antonio Federico, Maria Teresa Dotti, Ubaldo Bonuccelli, Domenico Inzitari, and Leonardo Pantoni
Subjects: Mild cognitive impairment, Dementia, Cerebrovascular diseases, Neuropsychology, Small vessel disease, Neurology. Diseases of the nervous system, RC346-429, Geriatrics, RC952-954.6
Abstract: Aims: The DSM-5 introduced the term “major neurocognitive disorders” (NCDs) to replace the previous term “dementia.” However, psychometric and functional definitions of NCDs are missing. We aimed to apply the DSM-5 criteria for diagnosing the transition to NCD to patients with mild cognitive impairment (MCI) and small vessel disease (SVD), and to define clinically significant thresholds for this transition. Methods: The functional and cognitive features of the NCD criteria were evaluated as change from baseline and operationalized according to hierarchically ordered psychometric rules. Results: According to the applied criteria, out of 138 patients, 44 were diagnosed with major NCD (21 with significant cognitive worsening in ≥1 additional cognitive domain), 84 remained stable, and 10 reverted to normal. Single-domain MCI patients were the most likely to revert to normal, and none progressed to major NCD. The amnestic multiple-domain MCI patients had the highest rate of progression to NCD. Conclusion: We provide rules for the DSM-5 criteria for major NCD based on cognitive and functional changes over time, and define psychometric thresholds for clinically significant worsening to be used in longitudinal studies. According to these operationalized criteria, one-third of the MCI patients with SVD progressed to major NCD after 2 years, but only within the multiple-domain subtypes.
Published: 2018
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5. Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes

Author: Maurizio Paciaroni, Fabio Bandini, Giancarlo Agnelli, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H. Abdul‐Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D'Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Riccardo Altavilla, Giacomo Volpi, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Manuel Cappellari, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Luca Masotti, Vieri Vannucchi, Sung‐Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrissoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Gino Gialdini, Tiziana Tassinari, Maria Luisa De Lodovici, Giorgio Bono, Christina Rueckert, Antonio Baldi, Sebastiano D'Anna, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars‐Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, and Valeria Caso
Subjects: atrial fibrillation, hemorrhagic transformation, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3–8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0–6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24–2.35). Conclusions In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.
Published: 2018
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6. Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study

Author: Maurizio Paciaroni, Giancarlo Agnelli, Nicola Falocci, Georgios Tsivgoulis, Kostantinos Vadikolias, Chrysoula Liantinioti, Maria Chondrogianni, Paolo Bovi, Monica Carletti, Manuel Cappellari, Marialuisa Zedde, George Ntaios, Efstathia Karagkiozi, George Athanasakis, Kostantinos Makaritsis, Giorgio Silvestrelli, Alessia Lanari, Alfonso Ciccone, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Azmil H. Abdul‐Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D'Amore, Cecilia Becattini, Maria Giulia Mosconi, Ludovica Anna Cimini, Rossana Soloperto, Luca Masotti, Vieri Vannucchi, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, Sung‐Il Sohn, Simona Marcheselli, Nicola Mumoli, Maria Luisa De Lodovici, Giorgio Bono, Karen L. Furie, Prasanna Tadi, Shadi Yaghi, Danilo Toni, Federica Letteri, Tiziana Tassinari, Odysseas Kargiotis, Enrico Maria Lotti, Yuriy Flomin, Michelangelo Mancuso, Miriam Maccarrone, Nicola Giannini, Fabio Bandini, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Umberto Scoditti, Licia Denti, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Vanessa Gourbali, Giovanni Orlandi, Martina Giuntini, Alberto Chiti, Elisa Giorli, Gino Gialdini, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Serena Monaco, Mario Maimone Baronello, Theodore Karapanayiotides, and Valeria Caso
Subjects: acute stroke, anticoagulants, atrial fibrillation, secondary prevention, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundThe optimal timing to administer non–vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention. Methods and ResultsRecurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA2DS2‐VASc score >4 and less reduced renal function. Thirty‐two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke. ConclusionsIn patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.
Published: 2017
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7. Investigation on breeding birds in Lunigiana montane grasslands

Author: Alberto Chiti Batelli and Paolo Sposimo
Subjects: Zoology, QL1-991
Abstract: On the basis of surveys carried out on June 2005 and 2006 we produced an Atlas of montane grassland breeding birds in Lunigiana (MS), in the Northern Apennines. We determined distribution and abundance of populations of 41 recorded species. The most frequent species resulted, in order, Tree Pipit, Skylark, Red-Backed Shrike, Wood Lark, Black Redstart. Study data allowed the extension of known home ranges of eight species and the recording of new sites of chorologic concern for three species. The realization of a Vegetation Map highlighted significant correlations between species distribution and different vegetation typologies. Many areas of high ornithological value are outside Natura 2000 and Protected Areas network.
Published: 2012
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8. Risk and Determinants of Dementia in Patients with Mild Cognitive Impairment and Brain Subcortical Vascular Changes: A Study of Clinical, Neuroimaging, and Biological Markers—The VMCI-Tuscany Study: Rationale, Design, and Methodology

Author: Anna Poggesi, Emilia Salvadori, Leonardo Pantoni, Giovanni Pracucci, Francesca Cesari, Alberto Chiti, Laura Ciolli, Mirco Cosottini, Alessandra Del Bene, Nicola De Stefano, Stefano Diciotti, Maria Teresa Dotti, Andrea Ginestroni, Betti Giusti, Anna Maria Gori, Serena Nannucci, Giovanni Orlandi, Francesca Pescini, Raffaella Valenti, Rosanna Abbate, Antonio Federico, Mario Mascalchi, Luigi Murri, and Domenico Inzitari
Subjects: Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Geriatrics, RC952-954.6
Abstract: Dementia is one of the most disabling conditions. Alzheimer’s disease and vascular dementia (VaD) are the most frequent causes. Subcortical VaD is consequent to deep-brain small vessel disease (SVD) and is the most frequent form of VaD. Its pathological hallmarks are ischemic white matter changes and lacunar infarcts. Degenerative and vascular changes often coexist, but mechanisms of interaction are incompletely understood. The term mild cognitive impairment defines a transitional state between normal ageing and dementia. Pre-dementia stages of VaD are also acknowledged (vascular mild cognitive impairment, VMCI). Progression relates mostly to the subcortical VaD type, but determinants of such transition are unknown. Variability of phenotypic expression is not fully explained by severity grade of lesions, as depicted by conventional MRI that is not sensitive to microstructural and metabolic alterations. Advanced neuroimaging techniques seem able to achieve this. Beside hypoperfusion, blood-brain-barrier dysfunction has been also demonstrated in subcortical VaD. The aim of the Vascular Mild Cognitive Impairment Tuscany Study is to expand knowledge about determinants of transition from mild cognitive impairment to dementia in patients with cerebral SVD. This paper summarizes the main aims and methodological aspects of this multicenter, ongoing, observational study enrolling patients affected by VMCI with SVD.
Published: 2012
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9. Practical '1-2-3-4-Day' Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study

Author: Shunsuke Kimura, Kazunori Toyoda, Sohei Yoshimura, Kazuo Minematsu, Masahiro Yasaka, Maurizio Paciaroni, David J. Werring, Hiroshi Yamagami, Takehiko Nagao, Shinichi Yoshimura, Alexandros Polymeris, Annaelle Zietz, Stefan T. Engelter, Bernd Kallmünzer, Manuel Cappellari, Tetsuya Chiba, Takeshi Yoshimoto, Masayuki Shiozawa, Takanari Kitazono, Masatoshi Koga, Kenichi Todo, Kazumi Kimura, Yoshiki Yagita, Eisuke Furui, Ryo Itabashi, Tadashi Terasaki, Yoshiaki Shiokawa, Teruyuki Hirano, Kenji Kamiyama, Jyoji Nakagawara, Shunya Takizawa, Kazunari Homma, Satoshi Okuda, Yasushi Okada, Keisuke Tokunaga, Tomoaki Kameda, Kazuomi Kario, Yoshinari Nagakane, Yasuhiro Hasegawa, Hisanao Akiyama, Satoshi Shibuya, Hiroshi Mochizuki, Yasuhiro Ito, Takahiro Nakashima, Hideki Matsuoka, Kazuhiro Takamatsu, Kazutoshi Nishiyama, Shoichiro Sato, Shoji Arihiro, Manabu Inoue, Masahito Takagi, Kanta Tanaka, Kazuyuki Nagatsuka, Takenori Yamaguchi, Yoichiro Hashimoto, Kiyohiro Houkin, Kazuo Kitagawa, Masayasu Matsumoto, Norio Tanahashi, Yasuo Terayama, Shinichiro Uchiyama, Etsuro Mori, Yutaka Furukawa, Takeshi Kimura, Yoshiaki Kumon, Ken Nagata, Shigeru Nogawa, Tomohiro Sakamoto, Toshinori Hirai, Kohsuke Kudo, Makoto Sasaki, Shotai Kobayashi, Toshimitsu Hamasaki, Michela Giustozzi, Monica Acciarresi, Giancarlo Agnelli, Valeria Caso, Fabio Bandini, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H Abdul-Rahim, Kennedy R Lees, Andrea Alberti, Michele Venti, Cataldo D’Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Vieri Vannucchi, Sung-Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrissoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Franco Galati, Simona Sacco, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Tiziana Tassinari, Maria Luisa De Lodovici, Christina Rueckert, Antonio Baldi, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars-Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, Luca Masotti, Adrian Parry-Jones, Chris Patterson, Christopher Price, Abduelbaset Elmarimi, Anthea Parry, Arumug Nallasivam, Azlisham Mohd Nor, Bernard Esis, David Bruce, Christine Roffe, Clare Holmes, David Cohen, David Hargroves, David Mangion, Dinesh Chadha, Djamil Vahidassr, Dulka Manawadu, Elio Giallombardo, Elizabeth Warburton, Enrico Flossman, Gunaratam Gunathilagan, Harald Proschel, Hedley Emsley, Ijaz Anwar, James Okwera, Janet Putterill, Janice O’Connell, John Bamford, John Corrigan, Jon Scott, Jonathan Birns, Karen Kee, Kari Saastamoinen, Kath Pasco, Krishna Dani, Lakshmanan Sekaran, Lillian Choy, Liz Iveson, Maam Mamun, Mahmud Sajid, Martin Cooper, Matthew Burn, Matthew Smith, Michael Power, Michelle Davis, Nigel Smyth, Roland Veltkamp, Pankaj Sharma, Paul Guyler, Paul O’Mahony, Peter Wilkinson, Prabel Datta, Prasanna Aghoram, Rachel Marsh, Robert Luder, Sanjeevikumar Meenakishundaram, Santhosh Subramonian, Simon Leach, Sissi Ispoglou, Sreeman Andole, Timothy England, Aravindakshan Manoj, Frances Harrington, Habib Rehman, Jane Sword, Julie Staals, Karim Mahawish, Kirsty Harkness, Louise Shaw, Michael McCormich, Nikola Sprigg, Syed Mansoor, Vinodh Krishnamurthy, Philippe A Lyrer, Leo H Bonati, David J Seiffge, Christopher Traenka, Nils Peters, Gian Marco De Marchis, Sebastian Thilemann, Nikolaos S Avramiotis, Henrik Gensicke, Lisa Hert, Benjamin Wagner, Fabian Schaub, Louisa Meya, Joachim Fladt, Tolga Dittrich, Urs Fisch, Bruno Bonetti, Giampaolo Tomelleri, Nicola Micheletti, Cecilia Zivelonghi, Andrea Emiliani, Kosmas Macha, Gabriela Siedler, Svenja Stoll, Ruihao Wang, Bastian Volbers, Stefan Schwab, David Haupenthal, and Luise Gaßmann
Subjects: Advanced and Specialized Nursing, acute ischemic stroke, Time Factors, Administration, Oral, Anticoagulants, Hemorrhage, cardioembolism, Hospitals, United States, Brain Ischemia, anticoagulation, atrial fibrillation, stroke prevention, Cohort Studies, Stroke, Treatment Outcome, Ischemic Attack, Transient, Atrial Fibrillation, Humans, Prospective Studies, Neurology (clinical), Cardiology and Cardiovascular Medicine, Ischemic Stroke
Abstract: Background: The “1-3-6-12-day rule” for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severity. Methods: The combined data of prospective registries in Japan, Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-nonvalvular atrial fibrillation (September 2011 to March 2014) and RELAXED (February 2014 to April 2016) were used. Patients were divided into transient ischemic attack and 3 stroke subgroups by the National Institutes of Health Stroke Scale score: mild (0–7), moderate (8–15), and severe (≥16). The early treatment group was defined as patients starting DOACs earlier than the median initiation day in each subgroup. Outcomes included a composite of recurrent stroke or systemic embolism, ischemic stroke, and severe bleeding within 90 days. Six European prospective registries were used for validation. Results: In the 1797 derivation cohort patients, DOACs were started at median 2 days after transient ischemic attack and 3, 4, and 5 days after mild, moderate, and severe strokes, respectively. Stroke or systemic embolism was less common in Early Group (n=785)—initiating DOACS within 1, 2, 3, and 4 days, respectively—than Late Group (n=1012) (1.9% versus 3.9%; adjusted hazard ratio, 0.50 [95% CI, 0.27–0.89]), as was ischemic stroke (1.7% versus 3.2%, 0.54 [0.27–0.999]). Major bleeding was similarly common in the 2 groups (0.8% versus 1.0%). On validation, both ischemic stroke (2.4% versus 2.2%) and intracranial hemorrhage (0.2% versus 0.6%) were similarly common in Early (n=547) and Late (n=1483) Groups defined using derivation data. Conclusions: In Japanese and European populations, early DOAC initiation within 1, 2, 3, or 4 days according to stroke severity seemed to be feasible to decrease the risk of recurrent stroke or systemic embolism and no increase in major bleeding. These findings support ongoing randomized trials to better establish the optimal timing of DOAC initiation.
Published: 2022

10. Subclinical Vascular Brain Lesions in Young Adults With Acute Ischemic Stroke

Author: Valeria De Giuli, Mario Grassi, Michele Besana, Marialuisa Zedde, Andrea Zini, Corrado Lodigiani, Simona Marcheselli, Anna Cavallini, Giuseppe Micieli, Maurizia Rasura, Maria Luisa DeLodovici, Giampaolo Tomelleri, Nicoletta Checcarelli, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Lucia Tancredi, Antonella Toriello, Massimiliano Braga, Andrea Morotti, Debora Pezzini, Martina Locatelli, Valentina Mazzoleni, Sonia Bonacina, Massimo Gamba, Mauro Magoni, Rosalba Patella, Alessandra Spalloni, Anna Maria Simone, Rosario Pascarella, Sandro Beretta, Alessandro Padovani, Roberto Gasparotti, Alessandro Pezzini, Nicola Gilberti, Paola Ferrazzi, Elena Banfi, Luca Librè, Elisabetta Traverso, Erika Schirinzi, Federico Carimati, Manuel Cappellari, Giampiero Locatelli, Laura Demelas, Davide Ferrario, Alessandra Persico, Giovanni Orlandi, Manuela Napoli, Claudio Moratti, and Mario Guidotti
Subjects: Adult, Male, medicine.medical_specialty, Brain Ischemia, Brain ischemia, White matter, Young Adult, Internal medicine, medicine, Humans, Myocardial infarction, Young adult, Stroke, Acute ischemic stroke, Aged, Ischemic Stroke, Subclinical infection, Advanced and Specialized Nursing, business.industry, Brain, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Cerebral Small Vessel Diseases, Cardiology, Brain lesions, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract: Background: Subclinical vascular brain lesions are highly prevalent in elderly patients with stroke. Little is known about predisposing factors and their impact on long-term outcome of patients with stroke at a young age. Methods: We quantified magnetic resonance-defined subclinical vascular brain lesions, including lacunes and white matter hyperintensities, perivascular spaces and cerebral microbleeds, and assessed total small-vessel disease (SVD) score in patients with first-ever acute ischemic stroke aged 18 to 45 years, and followed them up, as part of the multicentre Italian Project on Stroke in Young Adults. The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. We assessed the predictive accuracy of magnetic resonance features and whether the addition of these markers improves outcome prediction over a validated clinical tool, such as the Italian Project on Stroke in Young Adults score. Results: Among 591 patients (males, 53.8%; mean age, 37.5±6.4 years), 117 (19.8%) had subclinical vascular brain lesions. Family history of stroke was associated with lacunes (odds ratio, 2.24 [95% CI, 1.30–3.84]) and total SVD score (odds ratio, 2.06 [95% CI, 1.20–3.53] for score≥1), hypertension with white matter hyperintensities (odds ratio, 2.29 [95% CI, 1.22–4.32]). After a median follow-up of 36.0 months (25th–75th percentile, 38.0), lacunes and total SVD score were associated with primary end point (hazard ratio, 2.13 [95% CI, 1.17–3.90] for lacunes; hazard ratio, 2.17 [95% CI, 1.20–3.90] for total SVD score ≥1), and the secondary end point brain ischemia (hazard ratio, 2.55 [95% CI, 1.36–4.75] for lacunes; hazard ratio, 2.61 [95% CI, 1.42–4.80] for total SVD score ≥1). The predictive performances of the models, including magnetic resonance features were comparable to those of the random model. Adding individual magnetic resonance features to the Italian Project on Stroke in Young Adults score did not improve model prediction. Conclusions: Subclinical vascular brain lesions affect ≈2 in 10 young adults with ischemic stroke. Although lacunes and total SVD score are associated with thrombotic recurrence, they do not improve accuracy of outcome prediction over validated clinical predictors.
Published: 2022

11. Effect of an educational intervention to increase stroke awareness among Italian high school students: A prospective study in Tuscany

Author: Antonio Di Carlo, Marzia Baldereschi, Francesca Bovis, Benedetta Piccardi, Giovanni Linoli, Giovanni Orlandi, Gino Volpi, Alberto Chiti, Rossana Tassi, Alfonso Brescia, and Domenico Inzitari
Subjects: Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: Stroke in young people shares traditional modifiable risk factors with older groups, and greatly affects quality of life. However, evidence on the effectiveness of educational interventions in young populations, aiming at spreading stroke knowledge and enhancing prevention, is still scarce. We evaluated baseline knowledge of stroke and possible improvements after an educational intervention among Italian high school students, also considering differences related to sex and type of school. Subjects and methods: Using a mixed educational strategy, a prospective evaluation of stroke knowledge was performed in five humanities and sciences (lyceums) and five vocational high schools of Tuscany (students of the 12th and 13th grade). A baseline assessment with a structured questionnaire (21 questions) was followed by a standardized oral presentation, using audiovisual materials. After 3 months, the same questionnaire was re-administered to evaluate the long-term impact of the educational intervention. Results: Overall, 573 students (50.8% males; age range, 17–19 years) were enrolled; 288 (50.3%) were from lyceums and 285 (49.7%) from vocational schools. Follow-up participation was 97.2%. Baseline performances were comparable between groups for most variables examined. At 3 months, all groups showed a significant improvement from baseline regarding reaction to a stroke event, identification of stroke risk factors, such as smoking (from 62.9% to 83.7%; p Conclusions: Our educational intervention improved stroke awareness in high school students. The effects persisted after 3 months. Improved knowledge in young populations may reduce stroke burden in adult life, increase timely access to therapies, and spread knowledge across families.
Published: 2023

12. Age-dependent effect of susceptibility factors on the risk of intracerebral haemorrhage: Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy)

Author: Martina Locatelli, Rosa Musolino, Monica Acciarresi, Paolo La Spina, Valentina Saba, Sonia Bonacina, Mauro Magoni, Cristiano Azzini, Mario Grassi, Giovanni de Gaetano, Debora Pezzini, Cinzia Finocchi, Alessandro De Vito, Giampaolo Tomelleri, Domenico Marco Bonifati, Augusto Di Castelnuovo, Giorgio Silvestrelli, Massimo Del Sette, Francesco Grillo, Simona Marcheselli, Corrado Lodigiani, Alfonso Ciccone, Marialuisa Zedde, Andrea Zini, Lucia Princiotta Cariddi, Rocco Salvatore Calabrò, Andrea Morotti, Alessandro Pezzini, Carlo Gandolfo, Marco Ritelli, Massimo Gamba, Licia Iacovello, Anna Cavallini, Giuseppe Martini, Maurizio Paciaroni, Marina Colombi, Maria Luisa DeLodovici, Alberto Chiti, Alessia Giossi, Rossana Tassi, Valentina Mazzoleni, Alessandro Padovani, and Antonella Toriello
Subjects: Male, Risk, medicine.medical_specialty, Databases, Factual, Age dependent, 030204 cardiovascular system & hematology, Logistic regression, cerebrovascular, stroke, Stroke risk, Databases, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Internal medicine, 80 and over, medicine, Humans, Stroke, Factual, Aged, Cerebral Hemorrhage, Aged, 80 and over, business.industry, Incidence, Age Factors, Middle Aged, medicine.disease, Case-Control Studies, Female, Italy, Psychiatry and Mental health, Quartile, Multicenter study, Surgery, Alcohol intake, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: ObjectiveTo investigate the age-dependent impact of traditional stroke risk factors on the occurrence of intracerebral haemorrhage (ICH).MethodsWe performed a case–control analysis, comparing consecutive patients with ICH with age-matched and sex-matched stroke-free controls, enrolled in the setting of the Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy) between 2002 and 2014 by multivariable logistic regression model within subgroups stratified by age quartiles (Q1–Q4).ResultsWe analysed 3492 patients and 3492 controls. The impact of untreated hypertension on the risk of ICH was higher in the lower than in the upper age quartile (OR 11.64, 95% CI 7.68 to 17.63 in Q1 vs OR 6.05, 95% CI 3.09 to 11.85 in Q4 with intermediate ORs in Q2 and Q3), while the opposite trend was observed for untreated hypercholesterolaemia (OR 0.63, 95% CI 0.45 to 0.97 in Q1 vs OR 0.36, 95% CI 0.26 to 0.56 in Q4 with intermediate ORs in Q2 and Q3). The effect of untreated diabetes and excessive alcohol intake was detected only in the older age group (OR 3.63, 95% CI 1.22 to 10.73, and OR 1.69, 95% CI 1.13 to 2.51, respectively).ConclusionsOur findings provide evidence of age-dependent differences in the effects of susceptibility factors on the risk of ICH.
Published: 2021

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

Author: Maurizio Paciaroni, Valeria Caso, Giancarlo Agnelli, Maria Giulia Mosconi, Michela Giustozzi, David Julian Seiffge, Stefan T. Engelter, Philippe Lyrer, Alexandros A. Polymeris, Lilian Kriemler, Annaelle Zietz, Jukka Putaala, Daniel Strbian, Liisa Tomppo, Patrik Michel, Davide Strambo, Alexander Salerno, Suzette Remillard, Manuela Buehrer, Odessa Bavaud, Peter Vanacker, Susanna Zuurbier, Laetitia Yperzeele, Caroline M.J. Loos, Manuel Cappellari, Andrea Emiliani, Marialuisa Zedde, Azmil Abdul-Rahim, Jesse Dawson, Robert Cronshaw, Erika Schirinzi, Massimo Del Sette, Christoph Stretz, Narendra Kala, Michael Reznik, Ashley Schomer, Brian Mac Grory, Mahesh Jayaraman, Ryan McTaggart, Shadi Yaghi, Karen L. Furie, Luca Masotti, Elisa Grifoni, Danilo Toni, Angela Risitano, Anne Falcou, Luca Petraglia, Enrico Maria Lotti, Marina Padroni, Lucia Pavolucci, Piergiorgio Lochner, Giorgio Silvestrelli, Alfonso Ciccone, Andrea Alberti, Michele Venti, Laura Traballi, Chiara Urbini, Odysseas Kargiotis, Alessandro Rocco, Marina Diomedi, Simona Marcheselli, Pietro Caliandro, Aurelia Zauli, Giuseppe Reale, Kateryna Antonenko, Eugenia Rota, Tiziana Tassinari, Valentina Saia, Francesco Palmerini, Paolo Aridon, Valentina Arnao, Serena Monaco, Salvatore Cottone, Antonio Baldi, Cataldo D’Amore, Walter Ageno, Samuela Pegoraro, George Ntaios, Dimitrios Sagris, Sotirios Giannopoulos, Maria Kosmidou, Evangelos Ntais, Michele Romoli, Leonardo Pantoni, Silvia Rosa, Pierluigi Bertora, Alberto Chiti, Isabella Canavero, Carlo Emanuele Saggese, Maurizio Plocco, Elisa Giorli, Lina Palaiodimou, Eleni Bakola, Georgios Tsivgoulis, Fabio Bandini, Antonio Gasparro, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Raffaele Ornello, Simona Sacco, Nemanja Popovic, Umberto Scoditti, Antonio Genovese, Licia Denti, Yuriy Flomin, Michelangelo Mancuso, Elena Ferrari, Maria Chiara Caselli, Leonardo Ulivi, Nicola Giannini, Gian Marco De Marchis, Paciaroni, Maurizio, Caso, Valeria, Agnelli, Giancarlo, Mosconi, Maria Giulia, Giustozzi, Michela, Seiffge, David Julian, Engelter, Stefan T, Lyrer, Philippe, Polymeris, Alexandros A, Kriemler, Lilian, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna, Yperzeele, Laetitia, Loos, Caroline M J, Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil, Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Grory, Brian Mac, Jayaraman, Mahesh, McTaggart, Ryan, Yaghi, Shadi, Furie, Karen L, Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, Traballi, Laura, Urbini, Chiara, Kargiotis, Odyssea, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D'Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrio, Giannopoulos, Sotirio, Kosmidou, Maria, Ntais, Evangelo, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Tsivgoulis, Georgio, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, De Marchis, Gian Marco, and Neurology
Subjects: Oral, Advanced and Specialized Nursing, hypertension, recurrence, anticoagulant, Administration, Oral, Anticoagulants, Hemorrhage, Settore MED/26, Brain Ischemia, Stroke, Risk Factors, Administration, Atrial Fibrillation, Humans, Settore MED/26 - Neurologia, Human medicine, Neurology (clinical), Prospective Studies, Cardiology and Cardiovascular Medicine, atrial fibrillation, ischemic stroke, Ischemic Stroke
Abstract: Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA 2 DS 2 -VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P =0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P =0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P =0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P =0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P =0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.
Published: 2022

14. Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Author: Panagiotis Halvatsiotis, Giuseppe Reale, Jennifer A. Frontera, Giuseppe Martini, S. Pegoraro, Leonardo Pantoni, Aristeidis H. Katsanos, Piergiorgio Lochner, Daniel Strbian, Giorgia Zepponi, Valentina Saia, Karen L. Furie, Giancarlo Agnelli, Elisa Giorli, Erica Scher, Lina Palaiodimou, Valentina Arnao, Giorgio Silvestrelli, Simona Marcheselli, Letizia Riva, Andrea Zini, Angela Risitano, Tiziana Tassinari, Carlo Emanuele Saggese, Francesco Palmerini, Erika Schirinzi, Michael E. Reznik, Marina Mannino, Jukka Putaala, Maria Kosmidou, Michela Giustozzi, Cesare Porta, Maurizio Paciaroni, Marina Padroni, Loris Poli, Maria Cristina Vedovati, Danilo Toni, Manuel Cappellari, Alessandro Rocco, Alessandro Pezzini, Ashkan Shoamanesh, Stefano Forlivesi, Serena Monaco, Raffaele Ornello, Simona Sacco, Silvia Rosa, Shadi Yaghi, Valeria Terruso, Andrea Alberti, Francesco Corea, Elena Ferrari, Christoph Stretz, Marialuisa Zedde, Monica Acciarresi, Cataldo D'Amore, Kateryna Antonenko, Nemanja Popovic, Francesca Guideri, Evangelos Ntais, Boris Doronin, Luca Masotti, Filippo Angelini, Giovanni Orlandi, Licia Denti, Nicola Mumoli, Sotirios Giannopoulos, Elisabetta Toso, Maria Giulia Mosconi, Paolo Aridon, Aurelia Zauli, Giuseppe Micieli, Azmil H. Abdul-Rahim, Laura Brancaleoni, Marina Diomedi, Elisa Grifoni, Georgios Tsivgoulis, Maurizio Acampa, Michele Venti, Walter Ageno, Pietro Caliandro, Alfonso Ciccone, Isabella Canavero, Laura Franco, George Ntaios, Fabio Bandini, Vera Volodina, Pierluigi Bertora, Dimitrios Sagris, Antonio Baldi, Michele Romoli, Hanne Sallinen, Michelangelo Mancuso, Yuriy Flomin, Rossana Tassi, Valeria Caso, Massimo Del Sette, Enrico Maria Lotti, Antonio Gasparro, Alberto Chiti, Jesse Dawson, Brian Mac Grory, Alberto Rigatelli, Paciaroni, Maurizio, Agnelli, Giancarlo, Giustozzi, Michela, Caso, Valeria, Toso, Elisabetta, Angelini, Filippo, Canavero, Isabella, Micieli, Giuseppe, Antonenko, Kateryna, Rocco, Alessandro, Diomedi, Marina, Katsanos, Aristeidis H, Shoamanesh, Ashkan, Giannopoulos, Sotirio, Ageno, Walter, Pegoraro, Samuela, Putaala, Jukka, Strbian, Daniel, Sallinen, Hanne, Mac Grory, Brian C, Furie, Karen L, Stretz, Christoph, Reznik, Michael E, Alberti, Andrea, Venti, Michele, Mosconi, Maria Giulia, Vedovati, Maria Cristina, Franco, Laura, Zepponi, Giorgia, Romoli, Michele, Zini, Andrea, Brancaleoni, Laura, Riva, Letizia, Silvestrelli, Giorgio, Ciccone, Alfonso, Zedde, Maria Luisa, Giorli, Elisa, Kosmidou, Maria, Ntais, Evangelo, Palaiodimou, Lina, Halvatsiotis, Panagioti, Tassinari, Tiziana, Saia, Valentina, Ornello, Raffaele, Sacco, Simona, Bandini, Fabio, Mancuso, Michelangelo, Orlandi, Giovanni, Ferrari, Elena, Pezzini, Alessandro, Poli, Lori, Cappellari, Manuel, Forlivesi, Stefano, Rigatelli, Alberto, Yaghi, Shadi, Scher, Erica, Frontera, Jennifer A, Masotti, Luca, Grifoni, Elisa, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Marcheselli, Simona, Gasparro, Antonio, Terruso, Valeria, Arnao, Valentina, Aridon, Paolo, Abdul-Rahim, Azmil H, Dawson, Jesse, Saggese, Carlo Emanuele, Palmerini, Francesco, Doronin, Bori, Volodina, Vera, Toni, Danilo, Risitano, Angela, Schirinzi, Erika, Del Sette, Massimo, Lochner, Piergiorgio, Monaco, Serena, Mannino, Marina, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Lotti, Enrico Maria, Padroni, Marina, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Ntaios, George, Sagris, Dimitrio, Baldi, Antonio, D'Amore, Cataldo, Mumoli, Nicola, Porta, Cesare, Denti, Licia, Chiti, Alberto, Corea, Francesco, Acciarresi, Monica, Flomin, Yuriy, Popovic, Nemanja, and Tsivgoulis, Georgios
Subjects: Male, Administration, Oral, 030204 cardiovascular system & hematology, Settore MED/11, 0302 clinical medicine, 80 and over, risk factors, Medicine, atrial fibrillation, Prospective Studies, Aged, 80 and over, cerebral hemorrhage, logistic models, white matter, Aged, Antithrombins, Atrial Fibrillation, Case-Control Studies, Cerebral Hemorrhage, Female, Humans, Middle Aged, Risk Factors, Stroke, Atrial fibrillation, Vitamin K antagonist, 3. Good health, Administration, Settore MED/26 - Neurologia, Cardiology and Cardiovascular Medicine, medicine.drug, Oral, medicine.medical_specialty, medicine.drug_class, Settore MED/26, Lower risk, 03 medical and health sciences, Internal medicine, cardiovascular diseases, logistic model, Advanced and Specialized Nursing, Intracerebral hemorrhage, business.industry, Warfarin, medicine.disease, Clinical trial, Concomitant, Heart failure, Neurology (clinical), business, 030217 neurology & neurosurgery
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 CHA 2 DS 2 -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 CHA 2 DS 2 -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 CHA 2 DS 2 -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 CHA 2 DS 2 -VASc scores.
Published: 2021

15. Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes

Author: Michele Venti, Walter Ageno, Alfonso Ciccone, Luana Gentile, Vanessa Gourbali, Antonio Baldi, Elisa Grifoni, László Csiba, Cataldo D'Amore, Prasanna Tadi, Yuriy Flomin, Rossana Tassi, Sung Il Sohn, Bruno Bonetti, Patrik Michel, Erika Schirinzi, Alessandro Padovani, Cindy Tiseo, Maria Luisa De Lodovici, Odysseas Kargiotis, Konstantinos Vadikolias, Shadi Yaghi, Maurizio Paciaroni, Georgios Tsivgoulis, Enrico Maria Lotti, Manuel Cappellari, Lilla Szabó, Ashraf Eskandari, Federica Letteri, Leonardo Ulivi, Chrissoula Liantinioti, Valeria Caso, Lina Palaiodimou, Dirk Deleu, Jesse Dawson, Licia Denti, Konstantinos Makaritsis, Gianni Lorenzini, Marina Mannino, Monica Acciarresi, Miriam Maccarrone, Nicola Mumoli, Marta Bellesini, Simona Sacco, George Athanasakis, Umberto Scoditti, Maurizio Acampa, Giuseppe Martini, Brian Mac Grory, Alberto Rigatelli, Kristian Barlinn, Vieri Vannucchi, Serena Monaco, Efstathia Karagkiozi, Elisa Giorli, Francesca Guideri, Martina Giuntini, Dorjan Zabzuni, Davide Imberti, Giorgio Silvestrelli, Luca Masotti, Loris Poli, Karen L. Furie, Alessio Pieroni, Marialuisa Zedde, Franco Galati, Andrea Alberti, Giancarlo Agnelli, Jessica Barlinn, Turgut Tatlisumak, Maria Chiara Caselli, Boris Doronin, Liisa Tomppo, Kennedy R. Lees, Mario Maimone Baronello, Maria Giulia Mosconi, Jukka Putaala, Tiziana Tassinari, Azmil H. Abdul-Rahim, Peter Vanacker, Christina Rueckert, Valentina Bogini, Alessandro Pezzini, Francesco Corea, Giovanni Orlandi, Simona Marcheselli, Michela Giustozzi, Theodore Karapanayiotides, Michelangelo Mancuso, George Ntaios, Fabio Bandini, Vera Volodina, Nicola Giannini, Cesare Porta, Danilo Toni, Alberto Chiti, and Massimo Del Sette
Subjects: Severe bleeding, medicine.medical_specialty, Stroke recurrence, Infarction, stroke recurrence, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Original Research Articles, Internal medicine, Ischaemic stroke, Acute stroke, Medicine, atrial fibrillation, In patient, Acute ischemic stroke, business.industry, Atrial fibrillation, medicine.disease, Cardiology, Human medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Introduction The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing. Materials and Methods Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39–2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16–1.80). Discussion our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events. Conclusions Patients with PS or AS and AF appear to have similar risks of ischaemic or haemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT.
Published: 2020

16. Fabry-Stroke Italian Registry (FSIR): a nationwide, prospective, observational study about incidence and characteristics of Fabry-related stroke in young-adults. Presentation of the study protocol

Author: Danilo Toni, Ilaria Romani, Gino Volpi, Carmela Casella, Bruno Bonetti, Silvia Biagini, Anna Cavallini, Roberto Currò Dossi, Giovanni Pracucci, Lucia Princiotta Cariddi, Michele Ragno, Marina Diomedi, Cristina Sarti, Giovanni Linoli, Marialuisa Zedde, Donata Guidetti, Daniele Orsucci, Rita Bella, Stefano Ricci, Umberto Scoditti, Vincenza Pinto, Simona Sacco, Leonardo Barbarini, Marta Melis, Donatella Accavone, Rossana Tassi, Domenico M. Mezzapesa, Guido Bigliardi, Vittoria Cianci, Emanuela Cecconi, Patrizia Nencini, Domenico Consoli, Domenico Inzitari, Antonello Giordano, Alberto Chiti, Maurizia Rasura, Antonia Nucera, Jessica Moller, and Pasquale Palumbo
Subjects: Adult, medicine.medical_specialty, Pediatrics, Neurology, Fabry disease, Genetic disorders, Intracerebral hemorrhage, Ischemic stroke, Prevention, TIA, Dermatology, Settore MED/26, medicine, Humans, Prospective Studies, Registries, cardiovascular diseases, Stroke, Neuroradiology, business.industry, Incidence, Incidence (epidemiology), General Medicine, Middle Aged, medicine.disease, Psychiatry and Mental health, Italy, Ischemic Attack, Transient, Observational study, Neurology (clinical), Neurosurgery, business
Abstract: Background TIA and stroke, both ischemic and hemorrhagic, may complicate Fabry disease at young-adult age and be the first manifestation that comes to the clinician’s attention. No definite indications have yet been elaborated to guide neurologists in Fabry disease diagnostics. In current practice, it is usually sought in case of cryptogenic strokes (while Fabry-related strokes can also occur by classical pathogenic mechanisms) or through screening programs in young cerebrovascular populations. Data on recurrence and secondary prevention of Fabry’s stroke are scanty. Methods The study had a prospective observational design involving 33 Italian neurological Stroke Units. Considering the incidence of TIA/stroke in the European population aged Discussion The potential implications of this study are as follows: (i) to add information about the yield of systematic screening for Fabry disease in a prospective large cohort of acute cerebrovascular patients; (ii) to deepen knowledge of clinical, pathophysiological, and prognostic characteristics of Fabry-related stroke.
Published: 2022

17. History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)

Author: Rosalba Patella, Nicoletta Checcarelli, Valeria De Giuli, Corrado Lodigiani, Massimiliano Braga, Andrea Zini, Lucia Tancredi, Antonella Toriello, Alberto Chiti, Anna Cavallini, Marialuisa Zedde, Michele Besana, Massimo Gamba, Alessandro Padovani, Elisa Giorli, Giampaolo Tomelleri, Rosario Pascarella, Anna Maria Simone, Massimo Del Sette, Loris Poli, Enrico Fainardi, Roberto Gasparotti, Maria Luisa DeLodovici, Filomena Caria, Mario Grassi, A. Spalloni, Simona Marcheselli, Andrea Morotti, Alessandro Pezzini, Maurizia Rasura, Sandro Beretta, and Giuseppe Micieli
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Ischemia, 030204 cardiovascular system & hematology, Brain ischemia, 03 medical and health sciences, Animal data, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, cardiovascular diseases, Stroke, business.industry, medicine.disease, Migraine with aura, Risk factors, Migraine, lcsh:RC666-701, Cortical spreading depression, brain ischemia, cortical spreading depression, migraine disorders, risk factors, stroke, Migraine disorders, Cardiology, Original Article, Neurology (clinical), medicine.symptom, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Brain ischemia Cortical spreading depression Migraine disorders Risk factors Stroke
Abstract: Background and PURPOSE Migraine has been shown to increase cerebral excitability, promote rapid infarct expansion into tissue with perfusion deficits, and result in larger infarcts in animal models of focal cerebral ischemia. Whether these effects occur in humans has never been properly investigated. METHODS In a series of consecutive patients with acute ischemic stroke, enrolled in the setting of the Italian Project on Stroke at Young Age, we assessed acute as well as chronic infarct volumes by volumetric magnetic resonance imaging, and compared these among different subgroups identified by migraine status. RESULTS A cohort of 591 patients (male, 53.8%; mean age, 37.5±6.4 years) qualified for the analysis. Migraineurs had larger acute infarcts than non-migraineurs (median, 5.9 cm3 [interquartile range (IQR), 1.4 to 15.5] vs. 2.6 cm3 [IQR, 0.8 to 10.1], P
Published: 2019

18. Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Author: Panagiotis Papamichalis, Marina Padroni, Katiuscia Nardi, Maria Cristina Vedovati, Erika Schirinzi, Konstantinos Makaritsis, Serena Monaco, Valentina Saia, Karen L. Furie, Giancarlo Agnelli, Kennedy R. Lees, Dirk Deleu, Sotirios Giannopoulos, Azmil H. Abdul-Rahim, Miriam Maccarrone, Tiziana Tassinari, Jukka Putaala, Alexandros A Polymeris, Marina Diomedi, Elena Ferrari, Shadi Yaghi, Alexandra Rimoldi, Monica Acciarresi, Apostolos Komnos, Efstathia Karagkiozi, Elisabetta Toso, Gian Marco De Marchis, Maria Giulia Mosconi, Francesca Guideri, Aristeidis H. Katsanos, Luca Masotti, Piergiorgio Lochner, Angela Risitano, Danilo Toni, Elisa Giorli, Silvia Rosa, Alessandro Pezzini, Francesco Corea, Leonardo Pantoni, Boris Doronin, Filippo Angelini, Giovanni Orlandi, Simona Marcheselli, Chrysoula Liantinioti, Michela Giustozzi, Licia Denti, Manuel Cappellari, Marialuisa Zedde, Cataldo D'Amore, Patrizia Pierini, Elena Pinuccia Verrengia, Kateryna Antonenko, Stefan T. Engelter, Giorgio Silvestrelli, Patrik Michel, Bruno Bonetti, Leonardo Ulivi, Alessandro Rocco, Nicola Mumoli, Lina Palaiodimou, Andrea Alberti, Marina Mannino, Maurizio Paciaroni, Nemanja Popovic, Sung Il Sohn, Marija Zarkov, Odysseas Kargiotis, Ashraf Eskandari, Antonio Baldi, Massimo Del Sette, Michelangelo Mancuso, Michele Venti, Walter Ageno, Alfonso Ciccone, Alberto Chiti, Kalliopi Perlepe, George Ntaios, Silvia Galliazzo, Fabio Bandini, Vera Volodina, Pierluigi Bertora, Nicola Giannini, Georgios Tsivgoulis, Maurizio Acampa, David J. Seiffge, Elisa Grifoni, Brian Mac Grory, Paola Santalucia, Yuriy Flomin, Rossana Tassi, Valeria Caso, Enrico Maria Lotti, and Giuseppe Martini
Subjects: Oral, Male, medicine.medical_specialty, medicine.drug_class, Administration, Oral, 030204 cardiovascular system & hematology, Risk Assessment, Brain Ischemia, Settore MED/11, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, atrial fibrillation, humans, prevention and control, risk factors, stroke, 80 and over, medicine, Humans, In patient, Stroke, Aged, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Age Factors, Warfarin, Anticoagulants, Atrial fibrillation, Middle Aged, Vitamin K antagonist, medicine.disease, 3. Good health, Stroke prevention, Administration, Cardiology, Settore MED/26 - Neurologia, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, medicine.drug
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 CHA 2 DS 2 -VASc score (OR, 1.72 for each point increase; 95% CI, 1.58–1.88) were associated with ischemic events. Among the CHA 2 DS 2 -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 CHA 2 DS 2 -VASc score were associated with increased risk of cerebrovascular events.
Published: 2019

19. Anticoagulation After Stroke in Patients With Atrial Fibrillation

Author: Francesca Guideri, Martina Giuntini, Luca Masotti, Sung Il Sohn, László Csiba, Marta Bellesini, Ludovica Anna Cimini, Lars-Peder Pallesen, Michele Venti, Walter Ageno, Efstathia Karagkiozi, Davide Imberti, Leonardo Ulivi, Alessandro Padovani, Giancarlo Agnelli, Giovanni Orlandi, Danilo Toni, Gianni Lorenzini, Alfonso Ciccone, Dirk Deleu, Licia Denti, Federica Letteri, Giorgio Bono, Karen L. Furie, Vieri Vannucchi, Miriam Maccarrone, Cecilia Becattini, Theodore Karapanayiotides, Domenico Consoli, Monica Carletti, Jukka Putaala, Cataldo D'Amore, Nicola Mumoli, Maria Chondrogianni, Alberto Chiti, Peter Vanacker, Marialuisa Zedde, Michelangelo Mancuso, Boris Doronin, Giorgio Silvestrelli, Vanessa Gourbali, Simona Sacco, Manuel Cappellari, Giuseppe Martini, Christina Rueckert, Faisal Ibrahim, George Ntaios, Serena Monaco, Franco Galati, Antonio Carolei, Alessio Pieroni, Dorjan Zabzuni, Simona Marcheselli, Naveed Akhtar, Prasanna Tadi, Loris Poli, Mario Maimone Baronello, Antonio Baldi, Fabio Bandini, Vera Volodina, George Athanasakis, Yuriy Flomin, Chrysoula Liantinioti, Nicola Giannini, Umberto Scoditti, Elisa Giorli, Gayane Melikyan, Alessandro Pezzini, Alessia Lanari, Andrea Alberti, Konstantinos Makaritsis, Cindy Tiseo, Francesco Corea, Rossana Tassi, Georgios Tsivgoulis, Maria Luisa De Lodovici, Enrico Maria Lotti, Odysseas Kargiotis, Jessica Barlinn, Massimo Del Sette, Konstantinos Vadikolias, Paolo Bovi, Kennedy R. Lees, Riccardo Altavilla, Turgut Tatlisumak, Liisa Tomppo, Maurizio Paciaroni, Lilla Szabó, Alberto Rigatelli, Kristian Barlinn, Monica Acciarresi, Patrik Michel, Tiziana Tassinari, Maurizio Acampa, Maria Giulia Mosconi, Shadi Yaghi, Jessica Fusaro, Valeria Caso, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Gino Gialdini, HUS Neurocenter, Department of Neurosciences, and Neurologian yksikkö
Subjects: anticoagulants, medicine.medical_specialty, LEUKOARAIOSIS, ARTERIAL TERRITORIES, 030204 cardiovascular system & hematology, 3124 Neurology and psychiatry, 03 medical and health sciences, 0302 clinical medicine, atrial fibrillation, humans, incidence, secondary prevention, Internal medicine, medicine, In patient, ACUTE ISCHEMIC-STROKE, Stroke, METAANALYSIS, Cerebral Hemorrhage, RISK, Advanced and Specialized Nursing, Secondary prevention, OUTCOMES, Cardioembolic stroke, Heparin, business.industry, Incidence (epidemiology), Low-Molecular-Weight, 3112 Neurosciences, Atrial fibrillation, HUMAN BRAIN, medicine.disease, Anticoagulants, Atrial Fibrillation, Heparin, Low-Molecular-Weight, Humans, Secondary Prevention, 3. Good health, Heparin.low molecular weight, 3121 General medicine, internal medicine and other clinical medicine, Cardiology, Human medicine, HEMORRHAGIC TRANSFORMATION, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: Background and Purpose— Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods— We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results— Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients ( P =0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4–3.7; P P =0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2–4.9; P =0.01) end points separately. Conclusions— Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.
Published: 2019

20. The clinical spectrum of reversible cerebral vasoconstriction syndrome: The Italian Project on Stroke at Young Age (IPSYS)

Author: Alessandro Padovani, Valeria De Giuli, Andrea Morotti, Alessandro Pezzini, Carlo Piantadosi, Carlo Gandolfo, Filomena Caria, Cristiano Azzini, Antonella Toriello, Piergiorgio Lochner, Alessandro Adami, Paolo Cerrato, Carlo Dallocchio, Maurizio Paciaroni, Cristina Motto, Serena Monaco, Valeria Bignamini, Loris Poli, Enrico Maria Lotti, Carla Zanferrari, Marialuisa Zedde, Alberto Chiti, Paolo Costa, Simona Marcheselli, Luca Quartuccio, Massimo Del Sette, Sabrina Anticoli, Maria Luisa DeLodovici, Anna Bersano, Maurizia Rasura, Sandro Sanguigni, Massimo Gamba, Maurizio Melis, Giorgio Silvestrelli, Fabio Melis, Mauro Gentile, Andrea Zini, and Corrado Lodigiani
Subjects: intracranial, medicine.medical_specialty, Headache Disorders, Primary, male, Neuroimaging, Internal medicine, primary, italy, middle aged, medicine, Vasospasm, Intracranial, humans, Stroke, vasospasm, Thunderclap headaches, reversible cerebral vasoconstriction syndrome (rcvs), business.industry, adult, stroke, thunderclap headache, female, headache disorders, primary, retrospective studies, syndrome, General Medicine, medicine.disease, Reversible cerebral vasoconstriction syndrome, Large cohort, Young age, headache disorders, Cardiology, Neurology (clinical), medicine.symptom, business, Vasoconstriction
Abstract: Introduction To describe clinical, neuroimaging, and laboratory features of a large cohort of Italian patients with reversible cerebral vasoconstriction syndrome. Methods In the setting of the multicenter Italian Project on Stroke at Young Age (IPSYS), we retrospectively enrolled patients with a diagnosis of definite reversible cerebral vasoconstriction syndrome according to the International Classification of Headache Disorders (ICHD)-3 beta criteria (6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome, imaging-proven). Clinical manifestations, neuroimaging, treatment, and clinical outcomes were evaluated in all patients. Characteristics of reversible cerebral vasoconstriction syndrome without typical causes (“idiopathic reversible cerebral vasoconstriction syndrome”) were compared with those of reversible cerebral vasoconstriction syndrome related to putative causative factors (“secondary reversible cerebral vasoconstriction syndrome”). Results A total of 102 patients (mean age, 47.2 ± 13.9 years; females, 85 [83.3%]) qualified for the analysis. Thunderclap headache at presentation was reported in 69 (67.6%) patients, and it typically recurred in 42 (60.9%). Compared to reversible cerebral vasoconstriction syndrome cases related to putative etiologic conditions (n = 21 [20.6%]), patients with idiopathic reversible cerebral vasoconstriction syndrome (n = 81 [79.4%]) were significantly older (49.2 ± 13.9 vs. 39.5 ± 11.4 years), had more frequently typical thunderclap headache (77.8% vs. 28.6%) and less frequently neurological complications (epileptic seizures, 11.1% vs. 38.1%; cerebral infarction, 6.1% vs. 33.3%), as well as concomitant reversible brain edema (25.9% vs. 47.6%). Conclusions Clinical manifestations and putative etiologies of reversible cerebral vasoconstriction syndrome in our series are slightly different from those observed in previous cohorts. This variability might be partly related to the coexistence of precipitating conditions with a putative etiologic role on disease occurrence.
Published: 2019

21. Functional magnetic resonance imaging with encoding task in patients with mild cognitive impairment and different severity of leukoaraiosis

Author: Ubaldo Bonuccelli, Eva Terni, Leonardo Pantoni, Antonio Federico, Gabriele Siciliano, Emilia Salvadori, Irene Ghicopulos, Cristina Pagni, Mirco Cosottini, Anna Poggesi, Gloria Tognoni, Domenico Inzitari, Alberto Chiti, Gino Gialdini, Nicola Giannini, Maria Teresa Dotti, Leda Volpi, Paolo Cecchi, Giovanni Orlandi, and Ilaria Pesaresi
Subjects: medicine.medical_specialty, Functional magnetic resonance imaging, Neuroscience (miscellaneous), Verbal learning, Severity of Illness Index, behavioral disciplines and activities, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Nuclear Medicine and Imaging, Internal medicine, Cortex (anatomy), mental disorders, medicine, Humans, Cingulum (brain), Dementia, Cognitive Dysfunction, Radiology, Nuclear Medicine and imaging, In patient, Aged, Aged, 80 and over, Cerebral Cortex, Leukoaraiosis, Mild cognitive impairment, Radiology, Nuclear Medicine and Imaging, Psychiatry and Mental Health, medicine.diagnostic_test, business.industry, Brain, Middle Aged, medicine.disease, Magnetic Resonance Imaging, White Matter, Pathophysiology, Psychiatry and Mental health, medicine.anatomical_structure, nervous system, Cardiology, Female, Radiology, business, Psychomotor Performance, 030217 neurology & neurosurgery
Abstract: Leukoaraiosis is one of the main contributors to mild cognitive impairment due to vascular damage (vascular MCI, VMCI), whose pathophysiology has not been fully elucidated yet. We aimed to shed light on such issue using functional MRI (fMRI). Sixteen patients with VMCI were enrolled and compared with twenty-five patients with MCI but without significant vascular damage (non-vascular MCI, NVMCI) and with fifteen healthy controls (HC). They all underwent fMRI with incidental verbal learning paradigm, using a 3T scanner. Differently from cases with NVMCI (versus HC), VMCI patients presented a higher BOLD activation in the right parieto-occipital cortex and a lower activation in the left superior and middle frontal gyri, anterior cingulum and in left fronto-opercular area when compared to HC. Cortical activation evaluated by fMRI may reflect specific patterns of damage and attempt of compensation in patients with MCI and different severity of leukoaraiosis.
Published: 2018

22. Migraine and Cryptogenic Ischemic Stroke

Author: R. Musolino, Sonia Bonacina, Nicoletta Checcarelli, Alessandro Padovani, Domenico Marco Bonifati, Paolo Cerrato, Elisa Giorli, Massimiliano Braga, Antonella Toriello, Debora Pezzini, Mauro Magoni, Massimo Del Sette, Carlo Gandolfo, Giorgio Dalla Volta, Alessandro Pezzini, Simona Marcheselli, Maurizio Paciaroni, Mario Grassi, Martina Locatelli, Maurizio Melis, Giorgio Silvestrelli, Alberto Chiti, Marialuisa Zedde, Lucia Tancredi, Maurizia Rasura, Valentina Mazzoleni, Giacomo Giacalone, Giuseppe Micieli, Sandro Sanguigni, Corrado Lodigiani, Anna Cavallini, Alessia Giossi, Andrea Zini, Rocco Salvatore Calabrò, Maria Luisa DeLodovici, Alessandro Adami, Valeria Bignamini, and Paolo Bovi
Subjects: medicine.medical_specialty, Humans, Young Adult, Brain Ischemia, Foramen Ovale, Patent, Ischemic Stroke, Migraine Disorders, Stroke, business.industry, MEDLINE, medicine.disease, Neurology, Migraine, Internal medicine, Ischemic stroke, medicine, Cardiology, Patent, Neurology (clinical), business, Foramen Ovale
Published: 2021

23. Longitudinal changes in MoCA performances in patients with mild cognitive impairment and small vessel disease. Results from the VMCI-Tuscany Study

Author: Laura Ciolli, Sandro Marini, Antonio Federico, Maria Teresa Dotti, Ilaria Di Donato, Domenico Inzitari, Leonardo Pantoni, Emilia Salvadori, Alberto Chiti, Ubaldo Bonuccelli, Raffaella Valenti, Giovanni Pracucci, Francesca Pescini, Serena Nannucci, Giovanni Orlandi, Marco Pasi, Alessandra Del Bene, and Anna Poggesi
Subjects: medicine.medical_specialty, business.industry, Neuropsychology, Cerebral small vessel disease, Mild cognitive impairment, Specialties of internal medicine, Montreal Cognitive Assessment, Neurosciences. Biological psychiatry. Neuropsychiatry, General Medicine, Disease, Logistic regression, RC581-951, Internal medicine, Statistical significance, Cohort, Medicine, Observational study, business, Neurocognitive, Major neurocognitive disorder, RC321-571
Abstract: Objectives : The Montreal Cognitive Assessment (MoCA) is a cognitive screening test largely employed in vascular cognitive impairment, but there are no data about MoCA longitudinal changes in patients with cerebral small vessel disease (SVD). We aimed to describe changes in MoCA performance in patients with mild cognitive impairment (MCI) and SVD during a 2-year follow-up, and to evaluate their association with transition to major neurocognitive disorder (NCD). Materials and Methods : Within the prospective observational VMCI-Tuscany Study, patients with MCI and SVD underwent a comprehensive clinical, neuropsychological, and functional evaluation at baseline, and after 1 and 2 years. Results : Among the 138 patients (mean age 74.4 ± 6.9 years; males: 57%) who completed the study follow-up, 44 (32%) received a major NCD diagnosis. Baseline MoCA scores (mean±SD) were lower in major NCD patients (20.5 ± 5) than in reverter/stable MCI (22.2 ± 4.3), and the difference approached the statistical threshold of significance (p=.051). The total cohort presented a decrease in MoCA score (mean±SD) of -1.3 ± 4.2 points (-2.6 ± 4.7 in major NCD patients, -0.7 ± 3.9 in reverter/stable MCI). A multivariate logistic model on the predictors of transition from MCI to major NCD, showed MoCA approaching the statistical significance (OR=1.09, 95% CI=1.00–1.19, p=.049). Discussion : In our sample of MCI patients with SVD, longitudinal changes in MoCA performances were consistent with an expected more pronounced deterioration in patients who received a diagnosis of major NCD. MoCA sensitivity to change and predictive utility need to be further explored in VCI studies based on larger samples and longer follow-up periods.
Published: 2020

24. Ticagrelor Added to Aspirin in Acute Nonsevere Ischemic Stroke or Transient Ischemic Attack of Atherosclerotic Origin

Author: Pierre Amarenco, Hans Denison, Scott R. Evans, Anders Himmelmann, Stefan James, Mikael Knutsson, Per Ladenvall, Carlos A. Molina, Yongjun Wang, S. Claiborne Johnston, Kenneth Butcher, Shuya Li, Huaguang Zheng, David Skoloudik, Lawrence Wong, Ketevana Meshkova, Nijasri C. Suwanwela, Sebastian Ameriso, Leonardo Gonzalez, Pablo Ioli, Lorena Jure, Guillermo Povedano, Guadalupe Bruera, Gustavo Herrera, Juan Jose Martin Artesi, Virginia A. Pujol Lereis, Conrado J. Estol, Maia Gomez Schneider, Santiago Pigretti, Fernando Lipovestky, María Cristina Zurru, Stephen Davis, Andrew Wong, Tissa Wijeratne, Arman Sabet, Andrew Lee, Vincent Thijs, Robin Lemmens, Laetitia Yperzeele, Geert Vanhooren, Peter Vanacker, Iris Vansteenkiste, Vicky Maqueda, André Peeters, Marie-Christine Hasenbroekx, Van Daele, Wendy Hasenbroekx, Adinda De Pauw, Regilio Oedit, Wouter De Vooght, Philippe Desfontaines, Yves Vandermeeren, Marianna D.A. Dracoulakis, Rodrigo Bazan, Octavio M. Pontes Neto, Daniel D.C. Bezerra, Luiz C. Marrone, Pedro A. Kowacs, Carla H.C. Moro, Paulo C.O. Macelino, Marco Tulio A. Pedatella, Ekaterina Titianova, Ivan Staikov, Dimitar Maslarov, Plamen Petkov, Tanya Beleva, Borislav Kralev, Nikolay Sotirov, Dimcho Hristov, Rumeliya M. Ivanova, Margarita V. Mihailova, Ashfaq M. Shuaib, Andrew Demchuk, Michel Beaudry, Anthony R. Winder, Sumiti Nayar, Xingquan Zhao, Guoqiang Wen, Xueshuang Dong, Guozhong Li, Zhaohui Zhang, Huisheng Chen, Dong Wang, Xiaohong Li, Yuncheng Wu, Xu Zhang, Baorong Zhang, Wenke Hong, Xiaogang Li, Lijuan Wang, Li Liu, Xiaolin Xu, Peifu Wang, Weihong Zheng, Jinsheng Zeng, Yukai Wang, Yan Jia, Yongqiu Li, Bo Hu, Wei Shen, Zhi Song, Zhiping Hu, Yunhai Liu, Kaifu Ke, Deqin Geng, Shigang Zhao, Runxiu Zhu, Qiumin Qu, Xiuli Zhao, Qi Wan, Yunhua Yue, Huishan Du, Meiyun Zhang, Yan Wang, Dongfang Li, Dongyu Wang, Yongqiang Li, Xufang Xie, Tingmin Yu, Qi Liu, Mingxiu Yang, Xiaoping Pan, Lijun Xu, Deen Xu, Gang Li, Anding Xu, Martin Roubec, Petr Geier, Daniel Vaclavik, Jiri Neumann, Jana Bednarova, Robert Mikulik, David Hlinovsky, Charlotte Cordonnier, Igor Sibon, Caroline Arquizan, Sonia Alamowitch, Bertrand Lapergue, Jean-Marc Olivot, Nicolas Raposo, Marie-Hélène Mahagne, Emmanuel Touze, Gilles Rodier, Stéphane Vannier, Yves Samson, Michael Obadia, Emmanuel Ellie, Benoît Guillon, Serge Timsit, Yannick Bejot, Valérie Wolff, Didier Smadja, Aude Bagan-Triquenot, Pierre Garnier, Xavier Ducrocq, Peggy Reiner, Thierry Moulin, Frédéric Philippeau, Fernando Pico, Sébastien Richard, Joachim Röther, Jörg Berrouschot, Hassan Soda, Carsten Pohlmann, Christoph Terborg, Darius G. Nabavi, Rainer Dziewas, Martin Köhrmann, Jörg Glahn, Lars Marquardt, Bernd Kallmünzer, Karin Weißenborn, Yannie Oi-Yan Soo, Richard Li, Wing Chi Fong, Siu Hung Li, Raymond Cheung, Kin Keung Yip, Joshua Wai Ming Fok, Michael Y.P. Fu, Norbert Szegedi, Krisztián Pozsegovits, Attila Valikovics, Gyula Pánczél, Csilla Rózsa, Péter Diószeghy, Attila Csányi, Levente Kerényi, Valéria Nagy, László Szapáry, Dániel Bereczki, Sándor Molnár, Gyula Timár, András G. Folyovich, Mária Sátori, Ildikó Vastagh, Praveen S. Kumar, Rajnish Kumar, Atul Prasad, Vikram Sharma, Alok Verma, Indraneel Basu, Abu Z. Ansari, Vijaya Pamidimukkala, Raghavendra B, null S, Vivek D. Junewar, Sumit Singh, Advait Prakash Kulkarni, Padma M.V. Srivastava, K. Pramod, Sanjay G. Ramteke, Jaideep Bansal, Kewal Krishan, Hrishikesh Kumar, Priyanka V. Kashyap, T.C.R. Ramakrishnan, Gopal R. Adrasetty, Amit Yeole, Rahul B. Baviskar, Giancarlo Agnelli, Danilo Toni, Stefano Ricci, Rossana Tassi, Giuseppe Micieli, Michelangelo Mancuso, Giovanni Orlandi, Alberto Chiti, Marialuisa Delodovici, Federico Carimati, Alessandro De Vito, Francesco Perini, Cinzia Finocchi, Tiziana Tassinari, Massimo Del Sette, Luisa Roveri, Andrea Zini, Guido Bigliardi, Francesca R. Pezzella, Letizia Cupini, Alessandro Adami, Giampaolo Tomelleri, Carla Zanferrari, Angel A. Arauz Góngora, Minerva López Ruíz, Angelica Ruíz Franco, José O.J. Chacon Romero, Fernando Cruz Castillo, Jose L. Ruiz-Sandoval, Jesús D. López Tapia, Edgar A. Castillo Vargas, Juan F. Gongora Rivera, Guillermo Rivera Martinez, Jorge Villarreal Careaga, Nilton Custodio, Oscar G. Pamo Reyna, Cesar A. Castañeda, Edwin J. Pretell, Nestor Najar, Julio C. Perez, Luisa Cardoza, Carlos Chavez, Maria Reyes, Anna Członkowska, Waldemar Fryze, Piotr Sobolewski, Ryszard Nowak, Dorota Szkopek, Zbigniew Bąk, Sławomir Brzozowski, Waldemar Brola, Marek Zalisz, Konrad Rejdak, Marta Bilik, Małgorzata Fudala, Andrzej Tutaj, Anetta Lasek-Bal, Jan Kochanowicz, Bartosz Karaszewski, Tomasz Berkowicz, Beata Zwiernik, Dorota Różański, Jan P. Mejnartowicz, Szymon Jurga, Jacek Rożniecki, Maciej Świat, Ovidiu A. Bajenaru, Cristina A. Panea, Mihaela A. Simu, Rodica Balasa, Dan I. Cuciureanu, Bogdan O. Popescu, Monica Sabau, Corina Roman-Filip, Liudmila Odnopozova, Oleg Artyukov, Anna Milto, Liudmila V. Stakhovskaya, Sergei Aksentiev, Svetlana E. Chuprina, Elena B. Kuznetsova, Ilya I. Sholomov, Alexander Malygin, Elena Mordvintseva, Rostislav Y. Nilk, Inna Ershova, Dina Khasanova, Leila Akhmadeeva, Aida Iakupova, Ekaterina A. Drozdova, Marine Tanashyan, Evgenij Pudov, Lybov A. Shpagina, Svetlana Berns, Liudmila G. Lenskaya, Konstantin Golikov, Andrey V. Kovalenko, Elena Vasilieva, Elena Reznik, Mikhail Zykov, Evgeniy Kovalchuk, Dmitry Popov, Andrey Belkin, Olga Androfagina, Tatyana Lokshtanova, Elena V. Melnikova, Fahmi Al-Senani, Nouf Almansour, Fawaz Alhussein, Ali Alkhathaami, Saeed Alghamdi, Miroslav Brozman, Marta Mikloskova, Georgi Krastev, Vlastimil Serdahely, Michal Kovacik, Ladislav Gurcik, Miloslav Dvorak, Egon Kurca, Andrea Cimprichova, Marian Kycina, Erika Zacharova, Richard Risnovsky, Hee-Joon Bae, Kyung Bok Lee, Yong-Jin Cho, Jong-Moo Park, Joon-Tae Kim, Jun Lee, Jae-Kwan Cha, Sung-Il Sohn, Dong-Ick Shin, Soo Joo Lee, Byung-Chul Lee, Jay Chol Choi, Moo Seok Park, Dae-Il Chang, Joung-Ho Rha, Sang Min Sung, Yangha Hwang, Jaume Roquer González, Jaime Masjuan Vallejo, Meritxell Gomis Cortina, Francisco Moniche Álvarez, Miguel Ángel Gamero García, Soledad Pérez Sánchez, Francisco Purroy García, Santiago Trillo Senín, Tomás Segura Martín, Joaquín Serena Leal, Juan Arenillas Lara, Joan Martí-Fàbregas, Aida Lago Martín, Carlos Tejero Juste, Javier Marta Moreno, Nicolás López Hernández, Lars Sjöblom, Ann Charlotte Laska, Margarita Callander, Thomas Mooe, Jan-Erik Karlsson, Mihaela Oana Romanitan, Arne Lindgren, Niaz Ahmed, Björn Cederin, Christine Kremer, Tsong-Hai Lee, Jiann-Shing Jeng, Chih-Hung Chen, Helen L. Po, Chia-Wei Liou, Huey-Juan Lin, Ruey-Tay Lin, Hsiu-Fen Lin, Li-Ming Lien, Lung Chan, Wei-Shih Huang, Wen-Yi Huang, Ta-Cheng Chen, Chin-I Chen, Po-Lin Chen, Chun-Pai Yang, Yu Sun, Aurauma Chutinet, Tasanee Tantirittisak, Sombat Muengtaweepongsa, Yongchai Nilanont, Somsak Tiamkao, Chesda Udommongkol, Witoon Jantararotai, Tabtim Chongsuvivatwong, Suwat Srisuwananukorn, Wasutha Khaykhaew, Supachai Paiboonpol, Makorn Limudomporn, Saengduan Mayotarn, Kanoksri Samintharapanya, Arkhom Arayawichanon, Thanoot Thamangraksat, Duangpol Srimanee, Galyna Chmyr, Nataliya Tomakh, Alla Cherkez, Sergii Moskovko, Vadym Nikonov, Svitlana Shkrobot, Lyudmyla Shulga, Hanna Hrebeniuk, Valentyna Yavorska, Nataliia Lytvynenko, Marta Khavunka, Iryna Kobets, Nataliia Chemer, Ivanna Tashchuk, Olha Myronova, Thang H. Nguyen, Tan V. Vo, Thanh T. Tran, Nga T.P. Nguyen, Anh D. Nguyen, Binh T. Nguyen, Thang B. Nguyen, Ngoc H. Nguyen, Quang D. Nguyen, Nhan D. Le, Dai D. Pham., UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, Yperzeele, Laetitia, and THALES Steering Committee and Investigators
Subjects: Male, Atherosclerotic stenosis, Ticagrelor, Neurology, Neurologi, Original Contributions, population, Constriction, Pathologic, Severity of Illness Index, Recurrence, Secondary Prevention, Medicine, Cardiac and Cardiovascular Systems, Stroke, education.field_of_study, Aspirin, Kardiologi, Dual Anti-Platelet Therapy, Ischemic strokes, Middle Aged, stroke, Ischemic Attack, Transient, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Cardiology, ÍNDICE DE GRAVIDADE DA DOENÇA, Female, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, aspirin, Population, atherosclerosis, death, ticagrelor, transient ischemic attack, Clinical and Population Sciences, Internal medicine, Humans, education, Aged, Ischemic Stroke, Proportional Hazards Models, Advanced and Specialized Nursing, business.industry, Atherosclerosis, medicine.disease, Cerebrovascular Disorders, Ischemic stroke, Human medicine, Neurology (clinical), business, Platelet Aggregation Inhibitors
Abstract: Supplemental Digital Content is available in the text., Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events. Methods: In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–30) or placebo added to aspirin (300–325 mg on day 1 followed by 75–100 mg daily for days 2–30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days. Results: Of 11 016 randomized patients, 2351 (21.3%) patients had an ipsilateral atherosclerotic stenosis. After 30 days, a primary end point occurred in 92/1136 (8.1%) patients with ipsilateral stenosis randomized to ticagrelor and in 132/1215 (10.9%) randomized to placebo (hazard ratio 0.73 [95% CI, 0.56–0.96], P=0.023) resulting in a number needed to treat of 34 (95% CI, 19–171). In patients without ipsilateral stenosis, the corresponding event rate was 211/4387 (4.8%) and 230/4278 (5.4%), respectively (hazard ratio, 0.89 [95% CI, 0.74–1.08]; P=0.23, Pinteraction=0.245). Severe bleeding occurred in 4 (0.4%) and 3 (0.2%) patients with ipsilateral atherosclerotic stenosis on ticagrelor and on placebo, respectively (P=NS), and in 24 (0.5%) and 4 (0.1%), respectively, in 8665 patients without ipsilateral stenosis (hazard ratio=5.87 [95% CI, 2.04–16.9], P=0.001). Conclusions: In this exploratory analysis comparing ticagrelor added to aspirin to aspirin alone, we found no treatment by ipsilateral atherosclerosis stenosis subgroup interaction but did identify a higher absolute risk and a greater absolute risk reduction of stroke or death at 30 days in patients with ipsilateral atherosclerosis stenosis than in those without. In this easily identified population, ticagrelor added to aspirin provided a clinically meaningful benefit with a number needed to treat of 34 (95% CI, 19–171). Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03354429.
Published: 2020

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

Author: Simona Sacco, Stefano Ricci, Raffaele Ornello, Paolo Eusebi, Luca Petraglia, Danilo Toni, Eugenia Rota, Gianluca Bruzzone, Lucia Testa, Roberta Bongioanni, Mara Rosso, Carmelo Labate, Roberto Tarletti, Roberto Cantello, Thomas Fleetwood, Fabio Melis, Daniele Imperiale, Salvatore Amarù, Monica Reggiani, Luigi Ruiz, Elia Cipriano, Delfina Ferrandi, Patrizia Julita, Liana Africa, Piero Meinieri, Maria Federica Grasso, Serena Servo, Roberto Cavallo, Gigliola Chianale, Andrea Naldi, Paolo Cerrato, Elisa Rubino, Alessia Giossi, Valentina Puglisi, Luisa Vinciguerra, Ignazio Santilli, Bianca Maria Bordo, Simona Marcheselli, Julia Bottini, Caterina Mariotto D’Alessandro, Giuseppe Micieli, Anna Cavallini, Isabella Canavero, Francesco Muscia, Graziamaria Nuzzaco, Alfonso Ciccone, Giorgio Silvestrelli, Andrea Salmaggi, Davide Sangalli, Carla Zanferrari, Simona Fanucchi, Michela Ranieri, Simone Beretta, Carlo Ferrarese, Francesco Pasini, Francesco Santangelo, Nicoletta Checcarelli, Sandro Beretta, Paola Bazzi, Massimo Camerlingo, Marcello Tognozzi, Giorgio Caneve, Alessandro Adami, Rocco Quatrale, Adriana Critelli, Luigi Bartolomei, Maela Masato, Francesco Perini, Antonella De Boni, Caterina Disco, Claudio Baracchini, Alessio Pieroni, Roberto Lerario, Monia Russo, Alberto Polo, Alessandra Danese, Luca Valentinis, Antonio Baldi, Simone Tonello, Francesco Paladin, Agnese Tonon, Bruno Bonetti, Manuel Cappellari, Francesco Teatini, Roberto Currò Dossi, Enrica Franchini, Bruno Giometto, Valeria Bignamini, Paolo Manganotti, Marcello Naccarato, Gian Luigi Gigli, Simone Lorenzut, Giovanni Merlino, Mariarosaria Valente, Michele Rana, Carolina Gentile, Tiziana Tassinari, Annalisa Sugo, Valentina Saia, Maurizio Balestrino, Alberto Coccia, Cinzia Finocchi, Franco Valzania, Maria Luisa Zedde, Giulia Toschi, Marco Longoni, Matteo Paolucci, Valeria Tugnoli, Pietro Querzani, Marina Padroni, Stefano Meletti, Guido Bigliardi, Maria Luisa Dall’Acqua, Andrea Zini, Mauro Gentile, Ludovica Migliaccio, Alberto Chiti, Rossana Tassi, Giuseppe Martini, Patrizia Nencini, Maria Lamassa, Michelangelo Mancuso, Giovanni Orlandi, Elena Ferrari, Roberto Marconi, Simone Gallerini, Vincenzo Groggia, Gino Volpi, Chiara Menichetti, Stefano Spolveri, Mauro Silvestrini, Giovanna Viticchi, Laura Buratti, Giuseppe Pelliccioni, Eleonora Potente, Tatiana Mazzoli, Erica Marsili, Silvia Cenciarelli, Antonella Picchioni, Franco Costantini, Carlo Colosimo, Maurizio Paciaroni, Valeria Caso, Maurizia Rasura, Mario Beccia, Nicola Falcone, Marisa Di Stefano, Emanuela Cecconi, Sabrina Anticoli, Francesca Romana Pezzella, Marilena Mangiardi, Maurizio Plocco, Maria Magarelli, Carlo Emanuele Saggese, Irene Berto, Maria Concetta Altavista, Cinzia Roberti, Marina Diomedi, Fabrizio Sallustio, Alessandro Rocco, Letizia Maria Cupini, Novella Bonaffini, Maria Vittoria De Angelis, Anna Digiovanni, Marianna Rispoli, Berardino Orlandi, Federica De Santis, Enrico Colangeli, Francesco Di Blasio, Caterina Di Carmine, Pierluigi Tocco, Maurizio Melis, Jessica Moller, Valeria Saddi, Antonio Manca, Antonio Baule, Antonello Caddeo, Nicola Iorio, Rosa Napoletano, Maria di Gregorio, Giampiero Volpe, Florindo D’Onofrio, Daniele Spitaleri, Leonardo Barbarini, Gaetano Barbagallo, Marcella Caggiula, Bonaventura Ardito, Domenico Di Noia, Pietro Di Viesti, Maurizio Angelo Leone, Vincenzo Inchingolo, Marco Petruzzellis, Federica Rizzo, Mariantonietta Savarese, Alfredo Petrone, Franco Galati, Luciano Arcudi, Damiano Branca, Paolo Aridon, Valentina Arnao, Rosa Musolino, Cristina Dell’Aera, Isabella Francalanza, Luigi Grimaldi, Matilde Gammino, Antonello Giordano, Giuseppe Zelante, Enzo Sanzaro, Antonio Gasparro, Sacco, Simona, Ricci, Stefano, Ornello, Raffaele, Eusebi, Paolo, Petraglia, Luca, Toni, Danilo, and paolo, aridon
Subjects: disease outbreak, Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, Italy, cerebral hemorrhage, disease outbreaks, incidence, ischemic attack, transient, 0302 clinical medicine, Epidemiology, 80 and over, Medicine, Thrombolytic Therapy, Acute ischemic stroke, Thrombectomy, Aged, 80 and over, Ischemic Attack, Transient, Incidence (epidemiology), Endovascular Procedures, Middle Aged, Hospitalization, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Settore MED/26 - Neurologia, Female, Cardiology and Cardiovascular Medicine, Aged, COVID-19, Cerebral Hemorrhage, Humans, Ischemic Attack, Transient, Ischemic Stroke, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Revascularization, Settore MED/26, 03 medical and health sciences, Advanced and Specialized Nursing, business.industry, Outbreak, Emergency medicine, Brief Reports, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Supplemental Digital Content is available in the text., Background and Purpose: We aimed to investigate the rate of hospital admissions for cerebrovascular events and of revascularization treatments for acute ischemic stroke in Italy during the coronavirus disease 2019 (COVID-19) outbreak. Methods: The Italian Stroke Organization performed a multicenter study involving 93 Italian Stroke Units. We collected information on hospital admissions for cerebrovascular events from March 1 to March 31, 2020 (study period), and from March 1 to March 31, 2019 (control period). Results: Ischemic strokes decreased from 2399 in 2019 to 1810 in 2020, with a corresponding hospitalization rate ratio (RR) of 0.75 ([95% CI, 0.71–0.80] P
Published: 2020

26. Safety of anticoagulation in patients treated with urgent reperfusion for ischemic stroke related to atrial fibrillation

Author: Antonio Baldi, Licia Denti, Kennedy R. Lees, Nicola Mumoli, Panagiotis Halvatsiotis, Massimo Del Sette, Alberto Chiti, Peter Vanacker, Marta Bellesini, Tiziana Tassinari, Paolo Bovi, Alessandro Padovani, Christina Rueckert, Jessica Barlinn, Dorjan Zabzuni, Cataldo D'Amore, Loris Poli, Maria Luisa De Lodovici, Federica Letteri, Odysseas Kargiotis, Manuel Cappellari, Prasanna Tadi, Turgut Tatlisumak, Cecilia Becattini, Ludovica Anna Cimini, Liisa Tomppo, Yuriy Flomin, Giancarlo Agnelli, Aikaterini Theodorou, Serena Monaco, Elena Ferrari, Rossana Tassi, Monica Acciarresi, Patrik Michel, Alessio Pieroni, Enrico Maria Lotti, Michele Venti, Walter Ageno, Sung Il Sohn, Leonardo Ulivi, Maurizio Paciaroni, Konstantinos Vadikolias, Jukka Putaala, Cindy Tiseo, Valeria Caso, Alessandro Pezzini, Giorgio Silvestrelli, Alfonso Ciccone, Francesco Corea, Lilla Szabó, Francesca Guideri, Martina Giuntini, Gianni Lorenzini, Efstathia Karagkiozi, Davide Imberti, Luca Masotti, Azmil H. Abdul-Rahim, Theodore Karapanayiotides, Alessia Lanari, Andrea Alberti, Simona Marcheselli, Vieri Vannucchi, Giuseppe Martini, Shadi Yaghi, Marialuisa Zedde, Michela Giustozzi, Karen L. Furie, Danilo Toni, Chrissoula Liantinioti, Dirk Deleu, Franco Galati, Elisa Giorli, Monica Carletti, Vanessa Gourbali, Michelangelo Mancuso, George Ntaios, George Athanasakis, Fabio Bandini, Vera Volodina, Nicola Giannini, Umberto Scoditti, Mario Maimone Baronello, Boris Doronin, Simona Sacco, Maria Giulia Mosconi, Georgios Tsivgoulis, László Csiba, Alberto Rigatelli, Kristian Barlinn, Konstantinos Makaritsis, Maurizio Acampa, and Giovanni Orlandi
Subjects: Male, anticoagulants, medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, Brain Ischemia, Dabigatran, Brain ischemia, Internal medicine, 80 and over, medicine, Humans, atrial fibrillation, Prospective Studies, Prospective cohort study, Blood Coagulation, Stroke, Aged, thrombolytic therapy, Aged, 80 and over, Advanced and Specialized Nursing, Rivaroxaban, business.industry, Warfarin, Atrial fibrillation, Thrombolysis, Middle Aged, medicine.disease, secondary prevention, thrombectomy, Anticoagulants, Atrial Fibrillation, Female, Reperfusion, Thrombectomy, Thrombolytic Therapy, Treatment Outcome, Cardiology, Neurology (clinical), Human medicine, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background and Purpose: The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention. Methods: We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features. Results: A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50–1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53–2.02]). Conclusions: Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation–related acute ischemic stroke, who started on oral anticoagulant.
Published: 2020

27. Stroke chameleon (cortical hand syndrome) in a patient with moderate carotid stenosis: a neurological double-trouble

Author: Andrea Ciarmiello, G. Celoria, M. Del Sette, Alberto Chiti, and Elisa Giorli
Subjects: medicine.medical_specialty, Neurology, business.industry, Dermatology, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, Psychiatry and Mental health, Stenosis, 0302 clinical medicine, Text mining, Internal medicine, medicine, Cardiology, Neurology (clinical), Neurosurgery, business, Stroke, 030217 neurology & neurosurgery, Neuroradiology
Published: 2018

28. Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy

Author: Jan Beyer-Westendorf, Cecilia Becattini, Domenico Consoli, Fulvio Pomero, Alessandro De Vito, Alberto Chiti, Alessia Giossi, Giancarlo Agnelli, Giorgia Manina, Roberta Re, Simone Vanni, Valeria Terruso, Simona Sacco, Laura Franco, Maria Lotti Enrico, Umberto Scoditti, Cinzia Nitti, Francesca Guideri, Maurizio Paciaroni, and Roberto Cappelli
Subjects: medicine.medical_specialty, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Fibrinolytic Agents, Internal medicine, Antithrombotic, Internal Medicine, medicine, Humans, In patient, cardiovascular diseases, 030212 general & internal medicine, Prospective Studies, Mortality, Prospective cohort study, Stroke, Cerebral Hemorrhage, Retrospective Studies, Intracerebral hemorrhage, business.industry, Mortality rate, Antiplatelet agents, Anticoagulants, Cerebral hemorrhage, medicine.disease, Population study, business, Platelet Aggregation Inhibitors
Abstract: The association between preceding treatment with antiplatelet agents (APs), vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) and mortality after intracerebral hemorrhage (ICH) remains unclear. The aim of this multicenter, prospective cohort study was to assess the risk for death after ICH in consecutive patients who were on treatment with APs, VKAs, DOACs, or no antithrombotic agent. The primary outcome was in-hospital death by day 30. ICH volume at admission and volume expansion were centrally assessed. Out of 598 study patients, in-hospital death occurred in 21% of patients who were on treatment with APs, 25% with VKAs, 30% with DOACs, and 13% with no antithrombotics. Crude death rate was higher in patients on antithrombotics as compared to patients receiving no antithrombotic agent. At multivariate analysis, age (HR 1.07; 95% CI 1.04-1.10), previous stroke (HR 1.83; 95% CI 1.14-2.93), GCS ≤8 at admission (HR 6.06; 95% CI 3.16-9.74) and GCS 9-12 (HR 3.38; 95% CI 1.81-6.33) were independent predictors of death. Treatment with APs (HR 1.29; 95% CI 0.61-2.76), VKAs (HR 1.42; 95% CI 0.70-2.88) or DOACs (HR 1.28; 95% CI 0.61-2.73) were not predictors of death in the overall study population, in non-trauma associated ICH as well as when GCS was not included in the model. ICH volume and volume expansion were independent predictors of death. In conclusion, preceding treatment with antithrombotic is associated with the severity of ICH. Age, previous stroke and clinical severity at presentation were independent predictors of in-hospital death in patients with ICH.
Published: 2019

29. Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation

Author: David, Seiffge, Gian Marco De Marchis, Masatoshi, Koga, Maurizio, Paciaroni, Duncan, Wilson, Manuel, Cappellari, Kosmas, Macha, Georgios, Tsivgoulis, Gareth, Ambler, Shoji, Arihiro, Leo, H Bonati, Bruno, Bonetti, Bernd, Kallmünzer, Keith, W Muir, Paolo, Bovi, Henrik, Gensicke, Manabu, Inoue, Stefan, Schwab, Shadi, Yaghi, Martin, M Brown, Philippe, Lyrer, Masahito, Takagi, Monica, Acciarrese, Hans Rolf Jager, Alexandros, A Polymeris, Kazunori, Toyoda, Michele, Venti, Christopher, Traenka, Hiroshi, Yamagami, Andrea, Alberti, Sohei, Yoshimura, Valeria, Caso, Stefan, T Engelter, David, J Werring, Kenichi, Todo, Kazumi, Kimura, Kensaku, Shibazaki, Yoshiki, Yagita, Eisuke, Furui, Ryo, Itabashi, Tadashi, Terasaki, Yoshiaki, Shiokawa, Teruyuki, Hirano, Rieko, Suzuki, Kenji, Kamiyama, Jyoji, Nakagawara, Shunya, Takizawa, Kazunari, Homma, Satoshi, Okuda, Yasushi, Okada, Koichiro, Maeda, Tomoaki, Kameda, Kazuomi, Kario, Yoshinari, Nagakane, Yasuhiro, Hasegawa, Hisanao, Akiyama, Satoshi, Shibuya, Hiroshi, Mochizuki, Yasuhiro, Ito, Takahiro, Nakashima, Hideki, Matsuoka, Kazuhiro, Takamatsu, Kazutoshi, Nishiyama, Kanta, Tanaka, Kaoru, Endo, Tetsuya, Miyagi, Masato, Osaki, Junpei, Kobayashi, Takuya, Okata, Eijiro, Tanaka, Yuki, Sakamoto, Keisuke, Tokunaga, Hotake, Takizawa, Junji, Takasugi, Soichiro, Matsubara, Kyoko, Higashida, Takayuki, Matsuki, Naoto, Kinoshita, Masayuki, Shiozawa, Toshihiro, Ide, Takeshi, Yoshimoto, Daisuke, Ando, Kyohei, Fujita, Masaya, Kumamoto, Teppei, Kamimura, Muneaki, Kikuno, Tadataka, Mizoguchi, Takeo, Sato, Karen, L Furie, Prasanna, Tadi, Cecilia, Becattini, Nicola, Falocci, Marialuisa, Zedde, Azmil, H Abdul-Rahim, Kennedy, R Lees, Cataldo, D’Amore, Maria, G Mosconi, Ludovica, A Cimini, Monica, Carletti, Alberto, Rigatelli, Jukka, Putaala, Liisa, Tomppo, Turgut, Tatlisumak, Fabio, Bandini, Simona, Marcheselli, Alessandro, Pezzini, Loris, Poli, Alessandro, Padovani, Luca, Masotti, Vieri, Vannucchi, Sung-Il, Sohn, Gianni, Lorenzini, Rossana, Tassi, Francesca, Guideri, Maurizio, Acampa, Giuseppe, Martini, George, Ntaios, Efstathia, Karagkiozi, George, Athanasakis, Kostantinos, Makaritsis, Kostantinos, Vadikolias, Chrysoula, Liantinioti, Maria, Chondrogianni, Nicola, Mumoli, Domenico, Consoli, Franco, Galati, Simona, Sacco, Antonio, Carolei, Cindy, Tiseo, Francesco, Corea, Walter, Ageno, Marta, Bellesini, Giorgio, Silvestrelli, Alfonso, Ciccone, Umberto, Scoditti, Licia, Denti, Mancuso, Michelangelo, Miriam, Maccarrone, Orlandi, Giovanni, Nicola, Giannini, Gino, Gialdini, Tiziana, Tassinari, Maria Luisa De Lodovici, Giorgio, Bono, Christina, Rueckert, Antonio, Baldi, Danilo, Toni, Federica, Letteri, Martina, Giuntini, Enrico, M Lotti, Yuriy, Flomin, Alessio, Pieroni, Odysseas, Kargiotis, Theodore, Karapanayiotides, Serena, Monaco, Laszló, Csiba, Lilla, Szabó, Alberto, Chiti, Elisa, Giorli, Massimo Del Sette, Davide, Imberti, Dorjan, Zabzuni, Boris, Doronin, Vera, Volodina, Patrik, Michel, Peter, Vanacker, Kristian, Barlinn, Lars, P Pallesen, Ulf, Bodechtel, Leonardo, Ulivi, Dirk, Deleu, Gayane, Melikyan, Jessica, Bourlinn, Naveed, Akhar, Falsal, Ibrahin, Gourbali, Vanessa, Hawone, Baronello, Lisa, Hert, Nils, Peters, Marina, Maurer, and Martina, Wiegert
Subjects: 0301 basic medicine, medicine.medical_specialty, Vascular disease, business.industry, Hazard ratio, Ischemia, 610 Medicine & health, Atrial fibrillation, medicine.disease, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Neurology, Interquartile range, Internal medicine, Heart failure, medicine, Neurology (clinical), Prospective cohort study, business, Stroke, 030217 neurology & neurosurgery, Research Articles, Research Article
Abstract: Objective:\ud It is not known whether patients with atrial fibrillation (AF) with ischemic stroke despite oral anticoagulant therapy are at increased risk for further recurrent strokes or how ongoing secondary prevention should be managed.\ud \ud Methods:\ud We conducted an individual patient data pooled analysis of 7 prospective cohort studies that recruited patients with AF and recent cerebral ischemia. We compared patients taking oral anticoagulants (vitamin K antagonists [VKA] or direct oral anticoagulants [DOAC]) prior to index event (OACprior ) with those without prior oral anticoagulation (OACnaive ). We further compared those who changed the type (ie, from VKA or DOAC, vice versa, or DOAC to DOAC) of anticoagulation (OACchanged ) with those who continued the same anticoagulation as secondary prevention (OACunchanged ). Time to recurrent acute ischemic stroke (AIS) was analyzed using multivariate competing risk Fine-Gray models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).\ud \ud Results:\ud We included 5,413 patients (median age = 78 years [interquartile range (IQR) = 71-84 years]; 5,136 [96.7%] had ischemic stroke as the index event, median National Institutes of Health Stroke Scale on admission = 6 [IQR = 2-12]). The median CHA2 DS2 -Vasc score (congestive heart failure, hypertension, age≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category) was 5 (IQR = 4-6) and was similar for OACprior (n = 1,195) and OACnaive (n = 4,119, p = 0.103). During 6,128 patient-years of follow-up, 289 patients had AIS (4.7% per year, 95% CI = 4.2-5.3%). OACprior was associated with an increased risk of AIS (HR = 1.6, 95% CI = 1.2-2.3, p = 0.005). OACchanged (n = 307) was not associated with decreased risk of AIS (HR = 1.2, 95% CI = 0.7-2.1, p = 0.415) compared with OACunchanged (n = 585).\ud \ud Interpretation:\ud Patients with AF who have an ischemic stroke despite previous oral anticoagulation are at a higher risk for recurrent ischemic stroke despite a CHA2 DS2 -Vasc score similar to those without prior oral anticoagulation. Better prevention strategies are needed for this high-risk patient group.
Published: 2019

30. Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke

Author: Karen L. Furie, Franco Galati, Antonio Carolei, Simona Sacco, Naveed Akhtar, Andrea Alberti, Vanessa Gourbali, Elisa Giorli, Federica Letteri, Filippo Angelini, Georgios Tsivgoulis, Simona Marcheselli, L.-P. Pallesen, Nicola Falocci, Serena Monaco, Giovanni Orlandi, Maria Luisa De Lodovici, Maria Giulia Mosconi, Michele Venti, Walter Ageno, Mario Maimone Baronello, László Csiba, Alfonso Ciccone, Odysseas Kargiotis, Kostantinos Vadikolias, Massimo Del Sette, Chrysoula Liantinioti, Maurizio Paciaroni, Valeria Caso, Cecilia Becattini, Danilo Toni, Peter Vanacker, Alessandro Padovani, Azmil H. Abdul-Rahim, Gino Gialdini, Christina Rueckert, Patrik Michel Pd-Mer, Giorgio Silvestrelli, Marialuisa Zedde, Cataldo D'Amore, Sung Il Sohn, Monica Acciarresi, Monica Carletti, George Ntaios, Kennedy R. Lees, Maria Chondrogianni, Gayane Melikyan, Domenico Consoli, Faisal Ibrahim, Francesca Guideri, Martina Giuntini, Alessandro Pezzini, Fabio Bandini, Vera Volodina, Alberto Rigatelli, Kristian Barlinn, Luca Masotti, Licia Denti, Boris Doronin, Tiziana Tassinari, Cindy Tiseo, Dorjan Zabzuni, Alberto Chiti, Francesco Corea, Nicola Giannini, Loris Poli, Nicola Mumoli, Jessica Kepplinger, Maurizio Acampa, Riccardo Altavilla, George Athanasakis, Theodore Karapanayiotides, Antonio Baldi, Prasanna Tadi, Umberto Scoditti, Turgut Tatlisumak, Yuriy Flomin, Rossana Tassi, Michelangelo Mancuso, Liisa Tomppo, Vieri Vannucchi, Efstathia Karagkiozi, Davide Imberti, Enrico Maria Lotti, Alessio Pieroni, Lilla Szabó, Dirk Deleu, Giancarlo Agnelli, Giorgio Bono, Miriam Maccarrone, Jukka Putaala, Giuseppe Martini, Marta Bellesini, Shadi Yaghi, Ludovica Anna Cimini, Gianni Lorenzini, K. Makaritsis, Paolo Bovi, Manuel Cappellari, HUS Neurocenter, Department of Neurosciences, Neurologian yksikkö, and University of Helsinki
Subjects: medicine.medical_specialty, ANTICOAGULATED PATIENTS, anticoagulation, atrial fibrillation, paroxysmal atrial fibrillation, Stroke, stroke recurrence, sustained atrial fibrillation, Early Recurrence, Paroxysmal atrial fibrillation, Stroke recurrence, macromolecular substances, 030204 cardiovascular system & hematology, 3124 Neurology and psychiatry, EVENTS, 03 medical and health sciences, PERSISTENT, 0302 clinical medicine, Original Research Articles, Internal medicine, Ischaemic stroke, medicine, ORAL ANTICOAGULATION, In patient, cardiovascular diseases, Prospective cohort study, OUTCOMES, business.industry, DEATH, 3112 Neurosciences, Atrial fibrillation, medicine.disease, PATTERN, Cardiology, cardiovascular system, Human medicine, Neurology (clinical), HIGHER RISK, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)). Conclusions After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.
Published: 2019

31. Anticoagulation After Stroke in Patients With Atrial Fibrillation

Author: Riccardo, Altavilla, Valeria, Caso, Fabio, Bandini, Giancarlo, Agnelli, Georgios, Tsivgoulis, Shadi, Yaghi, Karen L, Furie, Prasanna, Tadi, Cecilia, Becattini, Marialuisa, Zedde, Azmil H, Abdul-Rahim, Kennedy R, Lees, Andrea, Alberti, Michele, Venti, Monica, Acciarresi, Cataldo, D'Amore, Maria Giulia, Mosconi, Ludovica, Anna Cimini, Jessica, Fusaro, Paolo, Bovi, Monica, Carletti, Alberto, Rigatelli, Manuel, Cappellari, Jukka, Putaala, Liisa, Tomppo, Turgut, Tatlisumak, Simona, Marcheselli, Alessandro, Pezzini, Loris, Poli, Alessandro, Padovani, Luca, Masotti, Vieri, Vannucchi, Sung-Il, Sohn, Gianni, Lorenzini, Rossana, Tassi, Francesca, Guideri, Maurizio, Acampa, Giuseppe, Martini, George, Ntaios, George, Athanasakis, Konstantinos, Makaritsis, Efstathia, Karagkiozi, Konstantinos, Vadikolias, Chrysoula, Liantinioti, Maria, Chondrogianni, Nicola, Mumoli, Domenico, Consoli, Franco, Galati, Simona, Sacco, Antonio, Carolei, Cindy, Tiseo, Francesco, Corea, Walter, Ageno, Marta, Bellesini, Giorgio, Silvestrelli, Alfonso, Ciccone, Alessia, Lanari, Umberto, Scoditti, Licia, Denti, Michelangelo, Mancuso, Miriam, Maccarrone, Leonardo, Ulivi, Giovanni, Orlandi, Nicola, Giannini, Gino, Gialdini, Tiziana, Tassinari, Maria Luisa, De Lodovici, Giorgio, Bono, Christina, Rueckert, Antonio, Baldi, Sebastiano, D'Anna, Danilo, Toni, Federica, Letteri, Martina, Giuntini, Enrico, Maria Lotti, Yuriy, Flomin, Alessio, Pieroni, Odysseas, Kargiotis, Theodore, Karapanayiotides, Serena, Monaco, Mario, Maimone Baronello, Laszló, Csiba, Lilla, Szabó, Alberto, Chiti, Elisa, Giorli, Massimo, Del Sette, Davide, Imberti, Dorjan, Zabzuni, Boris, Doronin, Vera, Volodina, Patrik, Michel, Peter, Vanacker, Kristian, Barlinn, Lars-Peder, Pallesen, Jessica, Barlinn, Dirk, Deleu, Gayane, Melikyan, Faisal, Ibrahim, Naveed, Akhtar, Vanessa, Gourbali, and Maurizio, Paciaroni
Subjects: Stroke, anticoagulants, atrial fibrillation, humans, incidence, secondary prevention, Heparin, Low-Molecular-Weight, Cerebral Hemorrhage
Abstract: Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2-4.9; P=0.01) end points separately. Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.
Published: 2019

32. Serum cholesterol levels, HMG-CoA reductase inhibitors and the risk of intracerebral haemorrhage. The Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy)

Author: Giancarlo Agnelli, Alessandro Padovani, Augusto Di Castelnuovo, Valeria De Giuli, R. Musolino, Giovanni Malferrari, Corrado Lodigiani, Simona Marcheselli, Loris Poli, Paolo Bovi, Domenico Marco Bonifati, Maria Luisa DeLodovici, Maurizio Paciaroni, Nicola Pugliese, Silvia Bonaiti, Licia Iacoviello, Giuseppe Micieli, Andrea Zini, Marialuisa Zedde, Rocco Salvatore Calabrò, Alfonso Ciccone, Marco Ritelli, Antonella Toriello, Laura Vandelli, Giorgio Silvestrelli, Massimo Gamba, Norina Marcello, Alberto Chiti, Anna Cavallini, Massimo Del Sette, Rossana Tassi, Elisabetta Del Zotto, Giampaolo Tomelleri, Alessia Lanari, Giovanni de Gaetano, Paolo Costa, Cristiano Azzini, Giuseppe Martini, Mario Grassi, Marina Colombi, Maria Sessa, Carlo Gandolfo, Andrea Morotti, Alessandro Pezzini, Alessandro De Vito, and Paolo La Spina
Subjects: Male, medicine.medical_specialty, Statin, medicine.drug_class, Low Density Lipoprotein Cholesterol, 030204 cardiovascular system & hematology, Reductase, Surgery, Arts and Humanities (miscellaneous), Neurology (clinical), Psychiatry and Mental Health, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, cardiovascular diseases, Stroke, Serum cholesterol, Aged, Cerebral Hemorrhage, Hydroxymethylglutaryl-Coa Reductase Inhibitor, Cerebral Hemorrhage, Low Density Lipoprotein Cholesterol, biology, Cholesterol, business.industry, Case-control study, Brain, medicine.disease, Psychiatry and Mental health, Endocrinology, Italy, Multicenter study, chemistry, Case-Control Studies, HMG-CoA reductase, biology.protein, Female, lipids (amino acids, peptides, and proteins), Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hydroxymethylglutaryl-Coa Reductase Inhibitor, business, 030217 neurology & neurosurgery
Abstract: Objective Although a concern exists that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) might increase the risk of intracerebral haemorrhage (ICH), the contribution of these agents to the relationship between serum cholesterol and disease occurrence has been poorly investigated. Methods We compared consecutive patients having ICH with age and sex-matched stroke-free control subjects in a case–control analysis, as part of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy), and tested the presence of interaction effects between total serum cholesterol levels and statins on the risk of ICH. Results A total of 3492 cases (mean age, 73.0±12.7 years; males, 56.6%) and 3492 control subjects were enrolled. Increasing total serum cholesterol levels were confirmed to be inversely associated with ICH. We observed a statistical interaction between total serum cholesterol levels and statin use for the risk of haemorrhage (Interaction OR (IOR), 1.09; 95% CI 1.05 to 1.12). Increasing levels of total serum cholesterol were associated with a decreased risk of ICH within statin strata (average OR, 0.87; 95% CI 0.86 to 0.88 for every increase of 0.26 mmol/l of total serum cholesterol concentrations), while statin use was associated with an increased risk (OR, 1.54; 95% CI 1.31 to 1.81 of the average level of total serum cholesterol). The protective effect of serum cholesterol against ICH was reduced by statins in strictly lobar brain regions more than in non-lobar ones. Conclusions Statin therapy and total serum cholesterol levels exhibit interaction effects towards the risk of ICH. The magnitude of such effects appears higher in lobar brain regions.
Published: 2016

33. NIRS Monitoring During Carotid Endarterectomy May Decrease the Need for Shunting

Author: Cinzia Sani, Celoria G, Maria Rossi, Alessio Amico, Giovanni Brancaccio, Alberto Chiti, Francesco Benassi Franciosi, Antonio Mannironi, Elisa Giorli, Debora Musio, Alessandro Beronio, David Russo, and Sabrina Nappi
Subjects: Shunting, medicine.medical_specialty, business.industry, medicine.medical_treatment, Internal medicine, medicine, Cardiology, Surgery, Carotid endarterectomy, Cardiology and Cardiovascular Medicine, business
Published: 2019

34. Headache secondary to cervical artery dissections: practice pointers

Author: Caterina Marotti, Simone Gallerini, Roberto Marconi, Manuele Bartalucci, Luca Marsili, and Alberto Chiti
Subjects: Adult, Male, medicine.medical_specialty, Neurology, Cervical Artery, Vertebral artery dissection, Dermatology, Carotid artery dissection, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Neuroradiology, Aged, Retrospective Studies, Aged, 80 and over, Neurologic Examination, Vertebral Artery Dissection, business.industry, Headache, General Medicine, Emergency department, Middle Aged, medicine.disease, Surgery, Psychiatry and Mental health, International Classification of Headache Disorders, Female, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Cervical artery dissections may present with mild and misleading symptoms such as a headache or cervical pain. In the absence of early diagnosis and therapy, such patients may have a high risk of cerebrovascular events. In order to refine evaluation of cervical artery dissections, we report the experience of a single center, focusing on clinical findings (e.g., headache and pain-related features at onset). From 2012 to 2017, 49 patients with cervical arteries dissections were admitted to our institution; 28 out of 49 patients (57%) presented with a headache or cervical pain, which were evaluated according to the International Classification of Headache Disorders (ICHD-III beta). Item C3a of ICHD-III beta (“pain is severe and continuous for days or longer”) was present in all patients symptomatic for a headache. Another common characteristic was the recent onset, with an average (± SD) timing from the onset of a headache to the first neurologic evaluation of 3 (± 2) days (range 1–5). A refined clinical evaluation of patients presenting with a headache at the Emergency Department could improve the early detection and management of patients with cervical artery dissections, in particular when presenting without other associated neurological symptoms.
Published: 2018

35. Application of the DSM-5 Criteria for Major Neurocognitive Disorder to Vascular MCI Patients

Author: Stefano Diciotti, Mario Mascalchi, Anna Poggesi, Ubaldo Bonuccelli, Domenico Inzitari, Laura Ciolli, Alberto Chiti, Leonardo Pantoni, Mirco Cosottini, Marco Pasi, Andrea Ginestroni, Alessandra Del Bene, Giovanni Orlandi, Emilia Salvadori, Sandro Marini, Maria Teresa Dotti, Francesca Pescini, Nicola De Stefano, Ilaria Di Donato, Giovanni Pracucci, Serena Nannucci, Raffaella Valenti, Antonio Federico, Salvadori, Emilia, Poggesi, Anna, Pracucci, Giovanni, Chiti, Alberto, Ciolli, Laura, Cosottini, Mirco, Del Bene, Alessandra, De Stefano, Nicola, Diciotti, Stefano, Di Donato, Ilaria, Ginestroni, Andrea, Marini, Sandro, Mascalchi, Mario, Nannucci, Serena, Orlandi, Giovanni, Pasi, Marco, Pescini, Francesca, Valenti, Raffaella, Federico, Antonio, Dotti, Maria Teresa, Bonuccelli, Ubaldo, Inzitari, Domenico, and Pantoni, Leonardo
Subjects: Pediatrics, medicine.medical_specialty, Cognitive Neuroscience, Cerebrovascular diseases, Disease, Cognitive neuroscience, lcsh:Geriatrics, lcsh:RC346-429, DSM-5, 03 medical and health sciences, 0302 clinical medicine, Neuropsychology, medicine, Dementia, Original Research Article, Cerebrovascular disease, lcsh:Neurology. Diseases of the nervous system, 030214 geriatrics, business.industry, Mild cognitive impairment, Cognition, medicine.disease, Small vessel disease, lcsh:RC952-954.6, Psychiatry and Mental Health, Small vessel, business, Neurocognitive, 030217 neurology & neurosurgery
Abstract: Aims: The DSM-5 introduced the term “major neurocognitive disorders” (NCDs) to replace the previous term “dementia.” However, psychometric and functional definitions of NCDs are missing. We aimed to apply the DSM-5 criteria for diagnosing the transition to NCD to patients with mild cognitive impairment (MCI) and small vessel disease (SVD), and to define clinically significant thresholds for this transition. Methods: The functional and cognitive features of the NCD criteria were evaluated as change from baseline and operationalized according to hierarchically ordered psychometric rules. Results: According to the applied criteria, out of 138 patients, 44 were diagnosed with major NCD (21 with significant cognitive worsening in ≥1 additional cognitive domain), 84 remained stable, and 10 reverted to normal. Single-domain MCI patients were the most likely to revert to normal, and none progressed to major NCD. The amnestic multiple-domain MCI patients had the highest rate of progression to NCD. Conclusion: We provide rules for the DSM-5 criteria for major NCD based on cognitive and functional changes over time, and define psychometric thresholds for clinically significant worsening to be used in longitudinal studies. According to these operationalized criteria, one-third of the MCI patients with SVD progressed to major NCD after 2 years, but only within the multiple-domain subtypes.
Published: 2017

36. Cerebral sinus venous thrombosis

Author: Marco Brondi, Daniele Orsucci, Eva Terni, Giovanni Orlandi, Gino Gialdini, Nicola Giannini, Michelangelo Mancuso, Ubaldo Bonuccelli, V. Montano, and Alberto Chiti
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Sinus Thrombosis, Thrombophilia, Cohort Studies, Sinus Thrombosis, Intracranial, Young Adult, Risk Factors, 80 and over, medicine, Humans, Stroke, oral contraceptives, thrombophilia, Aged, Retrospective Studies, Aged, 80 and over, Venous Thrombosis, business.industry, Medicine (all), cerebral sinus venous thrombosis, Retrospective cohort study, Hematology, General Medicine, Middle Aged, medicine.disease, stroke, Intracranial, Surgery, Venous thrombosis, Treatment Outcome, smoke, Italy, Migraine, Vomiting, Etiology, Female, medicine.symptom, business, risk factors, Cohort study
Abstract: Cerebral sinus venous thrombosis (CSVT) is a rare condition representing the 0.5-1% of all stroke cases which can have serious consequences. Early diagnosis and complete screening for acquired or inherited risk factors is crucial for decreasing morbidity and mortality. We have investigated clinical and aetiological factors in an Italian cohort of 43 patients with cerebral sinus venous thrombosis. Common presentation complaints were headache (81.4%), focal signs (20.9%), vomiting (11.6%) and seizures (6.9%). Acquired or inherited conditions were observed in more than 80% of cases. The commonest aetiological factors were contraceptives (74.1% of women), congenital thrombophilia (34.9%), infections and dysthyroidism (16.3%), hyperhomocysteinemia (9.3%), migraine (11.6%), cranial trauma (9.3%) and chronic myeloproliferative diseases (11.6%). Outcome was favourable in more than 80% of patients. Early diagnosis and anticoagulant treatment may decrease mortality and/or morbidity rates related with CVST in these patients. Thrombophilic abnormalities, either inherited or acquired, are worthy to be widely investigated.
Published: 2015

37. Association Between Migraine and Cervical Artery Dissection The Italian Project on Stroke in Young Adults

Author: Cristiano Azzini, Valeria De Giuli, Andrea Zini, Lucia Tancredi, Giovanni Malferrari, Davide Massucco, Nicoletta Checcarelli, Maurizio Melis, A. Spalloni, Giorgio Silvestrelli, Marialuisa Zedde, Paola Ferrazzi, Giampaolo Tomelleri, Domenico Marco Bonifati, Alessandro De Vito, Filomena Di Lisi, Masina Cotroneo, Valeria Piras, Giuseppe Micieli, Elisa Coloberti, Rosalba Patella, Maria Luisa DeLodovici, Rocco Salvatore Calabrò, Andrea Morotti, Alessandro Pezzini, Licia Iacoviello, Mario Grassi, Alessandro Adami, Loris Poli, Giacomo Giacalone, Enrico Maria Lotti, Carlo Gandolfo, Alessandro Padovani, Maurizia Rasura, Paolo Cerrato, Corrado Lodigiani, Filomena Caria, R. Musolino, Elisabetta Del Zotto, Anna Cavallini, Paolo Bovi, Elisa Giorli, Simona Marcheselli, Antonella Toriello, Paolo Costa, Anna Maria Simone, Massimo Gamba, Laura Cucurachi, Maria Sessa, Maurizio Paciaroni, Alessia Giossi, Cataldo D'Amore, Ilaria Casetta, Alessia Lanari, Alberto Chiti, and Massimo Del Sette
Subjects: Male, Migraine without Aura, Aura, Migraine with Aura, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Prospective Studies, Registries, Young adult, Prospective cohort study, Stroke, Vertebral Artery Dissection, Age Factors, Middle Aged, Digital Subtraction Angiography, Carotid Arteries, Italy, Anesthesia, Female, medicine.symptom, Adult, medicine.medical_specialty, Adolescent, Artery dissection, Young stroke, Migraine, Young stroke, Socio-culturale, Case-Control Studies, Humans, Intracranial Arterial Diseases, Sex Factors, Young Adult, Vertebral Artery Dissection, Carotid Arteries, Digital Subtraction Angiography, 03 medical and health sciences, Internal medicine, Diabetes mellitus, Artery dissection, medicine, cervical artery dissection, Migraine, business.industry, Case-control study, medicine.disease, Migraine with aura, Neurology (clinical), business, 030217 neurology & neurosurgery, migraine
Abstract: Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine.Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P .99).In patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.
Published: 2017

38. Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study

Author: Francesca Guideri, Martina Giuntini, Luca Masotti, Alessandro Padovani, Danilo Toni, Maria Chondrogianni, Monica Carletti, Cecilia Becattini, Loris Poli, Theodore Karapanayiotides, Monica Acciarresi, Giuseppe Martini, Giovanni Orlandi, Maurizio Acampa, Nicola Falocci, Vieri Vannucchi, Valeria Caso, Cindy Tiseo, Enrico Maria Lotti, Giancarlo Agnelli, Michelangelo Mancuso, Giorgio Bono, Serena Monaco, Jukka Putaala, Prasanna Tadi, Yuriy Flomin, Miriam Maccarrone, Georgios Tsivgoulis, Kennedy R. Lees, George Ntaios, Simona Sacco, Fabio Bandini, Rossana Tassi, Odysseas Kargiotis, Tiziana Tassinari, Nicola Giannini, Elisa Giorli, Simona Marcheselli, Efstathia Karagkiozi, Michele Venti, Walter Ageno, Chrysoula Liantinioti, Kostantinos Vadikolias, Alfonso Ciccone, Federica Letteri, Domenico Consoli, Alessia Lanari, Andrea Alberti, Turgut Tatlisumak, Marialuisa Zedde, Vanessa Gourbali, Alberto Chiti, Manuel Cappellari, Cataldo D'Amore, Alessandro Pezzini, Francesco Corea, Maurizio Paciaroni, Liisa Tomppo, Giorgio Silvestrelli, Gianni Lorenzini, K. Makaritsis, Paolo Bovi, Marta Bellesini, Ludovica Anna Cimini, Shadi Yaghi, Azmil H. Abdul-Rahim, Gino Gialdini, Licia Denti, Nicola Mumoli, Mario Maimone Baronello, Maria Luisa De Lodovici, Sung Il Sohn, Giovanna Colombo, Rossana Soloperto, Karen L. Furie, Franco Galati, Antonio Carolei, Maria Giulia Mosconi, George Athanasakis, Umberto Scoditti, Clinicum, Department of Neurosciences, Neurologian yksikkö, and HUS Neurocenter
Subjects: Male, Time Factors, Vitamin K, ARTERIAL TERRITORIES, Administration, Oral, 030204 cardiovascular system & hematology, GUIDELINES, 3124 Neurology and psychiatry, Brain Ischemia, EARLY MANAGEMENT, Brain ischemia, 0302 clinical medicine, Rivaroxaban, Recurrence, 80 and over, Acute stroke, Anticoagulants, Atrial fibrillation, Secondary prevention, Acute Disease, Aged, Aged, 80 and over, Atrial Fibrillation, Dabigatran, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Hemorrhage, Humans, Incidence, Middle Aged, Prospective Studies, Pyrazoles, Pyridones, Survival Rate, Treatment Outcome, Medicine, atrial fibrillation, WRITING COMMITTEE, Prospective cohort study, Original Research, ASSOCIATION, HUMAN BRAIN, 3. Good health, Stroke, Cardiology and Cardiovascular Medicine, Administration, Cardiology, Drug, secondary prevention, medicine.drug, Oral, medicine.medical_specialty, anticoagulants, acute stroke, WARFARIN, Dose-Response Relationship, 03 medical and health sciences, Internal medicine, Survival rate, Ischemic Stroke, HEALTH-CARE PROFESSIONALS, business.industry, 3112 Neurosciences, Warfarin, medicine.disease, Observational study, HEMORRHAGIC TRANSFORMATION, business, 030217 neurology & neurosurgery, TASK-FORCE
Abstract: Background The optimal timing to administer non–vitamin K oral anticoagulants ( NOAC s) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOAC s for secondary prevention. Methods and Results Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA 2 DS 2 ‐ VAS c score >4 and less reduced renal function. Thirty‐two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOAC s within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke. Conclusions In patients with acute ischemic stroke and atrial fibrillation, treatment with NOAC s was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.
Published: 2017

39. Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

Author: Umberto Scoditti, Suzette Remillard, Maria Giulia Mosconi, Serena Monaco, Giancarlo Agnelli, Maurizio Paciaroni, Dorjan Zabzuni, Boris Doronin, Giorgio Bono, Simona Sacco, Ulf Bodechtel, Simona Marcheselli, Maria Luisa De Lodovici, Kennedy R. Lees, Alessio Pieroni, Lilla Szabó, Gianni Lorenzini, Cecilia Becattini, Nicola Falocci, Tiziana Tassinari, Jukka Putaala, Peter Vanacker, László Csiba, Giovanni Orlandi, Maria Cordier, Giuseppe Martini, Danilo Toni, Domenico Consoli, Christina Rueckert, Davide Imberti, Chrissoula Liantinioti, Monica Acciarresi, Paolo Costa, Sung Il Sohn, Monica Carletti, Dirk Deleu, Johannes Gerber, Francesca Guideri, Paolo Bovi, Rossana Tassi, Luca Masotti, Alberto Chiti, Licia Denti, Valeria Caso, Georgios Tsivgoulis, Antonio Baldi, Naveed Akhtar, Massimo Del Sette, Alberto Rigatelli, Kristian Barlinn, Cindy Tiseo, Franco Galati, Antonio Carolei, Andrea Morotti, Alessandro Pezzini, Francesco Corea, Patrik Michel, Vera Volodina, Cataldo D'Amore, Lars-Peder Pallesen, Andrea Alberti, Faisal Ibrahim, Mario Maimone Baronello, Jessica Kepplinger, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Michele Venti, Walter Ageno, Gino Gialdini, Kostantinos Vadikolias, Gayane Melikyan, Turgut Tatlisumak, Alessandro Padovani, Neurologian yksikkö, Department of Neurosciences, Clinicum, University of Helsinki, and HUS Neurocenter
Subjects: Male, atrial fibrillation, CHA, 2, DS, VASc score, Ischemic stroke, outcome, scores, severity, Aged, Aged, 80 and over, Area Under Curve, Asia, Atrial Fibrillation, Chi-Square Distribution, Disability Evaluation, Europe, Female, Humans, Linear Models, Logistic Models, Magnetic Resonance Imaging, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Risk Factors, Severity of Illness Index, Stroke, Time Factors, Tomography, X-Ray Computed, Decision Support Techniques, CHA2DS2-VASc score, Surgery, Rehabilitation, Neurology (clinical), Cardiology and Cardiovascular Medicine, ARTERIAL TERRITORIES, 030204 cardiovascular system & hematology, Logistic regression, CHADS(2), 3124 Neurology and psychiatry, 0302 clinical medicine, Modified Rankin Scale, 80 and over, Medicine, Elméleti orvostudományok, ACUTE ISCHEMIC-STROKE, Prospective cohort study, Tomography, OUTCOMES, Area under the curve, Atrial fibrillation, Orvostudományok, HUMAN BRAIN, X-Ray Computed, CHA(2)DS(2)-VASc score, Cardiology, medicine.medical_specialty, education, macromolecular substances, 03 medical and health sciences, Internal medicine, cardiovascular diseases, ischemic stroke, surgery, rehabilitation, neurology (clinical), cardiology and cardiovascular medicine, Receiver operating characteristic, business.industry, 3112 Neurosciences, medicine.disease, 3121 General medicine, internal medicine and other clinical medicine, CHA2DS2–VASc score, Physical therapy, Human medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose: The aim of this study was to investigate for a possible association between both prestroke CHA(2)DS(2)-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). Methods: This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS >= 10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS = 3). Multiple logistic regression was used to correlate prestroke CHA(2)DS(2)-VASc and severity of stroke, as well as disability and mortality at 90 days. Results: Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS >= 3. A linear correlation was found between the prestroke CHA(2)DS(2)-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA(2)DS(2)-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS = 3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA(2)DS(2)-VASc score and lesion size. Conclusions: In patients with AF, in addition to the risk of stroke, a high CHA(2)DS(2)-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
Published: 2017

40. A case of isolated syncope due to bilateral carotid artery dissection: a lesson from ancient Greece?

Author: Alberto Chiti, Simone Gallerini, Luca Marsili, Manuele Bartalucci, and Roberto Marconi
Subjects: medicine.medical_specialty, Neurology, biology, business.industry, Syncope (genus), Dermatology, General Medicine, biology.organism_classification, Surgery, Ancient Greece, Psychiatry and Mental health, medicine, Neurology (clinical), Neurosurgery, business, Bilateral carotid artery dissection, Neuroradiology
Published: 2014

41. Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

Author: Francesca Guideri, Martina Giuntini, Luca Masotti, Alessandro Padovani, Danilo Toni, Maria Chondrogianni, Monica Carletti, Cecilia Becattini, Dorjan Zabzuni, Loris Poli, Theodore Karapanayiotides, Monica Acciarresi, Antonio Procopio, Giuseppe Martini, Giovanni Orlandi, Maurizio Acampa, Nicola Falocci, Vieri Vannucchi, Valeria Caso, Cindy Tiseo, Enrico Maria Lotti, László Csiba, Giancarlo Agnelli, Michelangelo Mancuso, Giorgio Bono, Lilla Szabó, Antonio Baldi, Serena Monaco, Jukka Putaala, Faisal Ibrahim, Dirk Deleu, Prasanna Tadi, Yuriy Flomin, Miriam Maccarrone, Georgios Tsivgoulis, Kennedy R. Lees, George Ntaios, Massimo Del Sette, Alberto Rigatelli, Kristian Barlinn, Naveed Akhtar, Jessica Kepplinger, Simona Sacco, Fabio Bandini, Vera Volodina, Lars-Peder Pallesen, Rossana Tassi, Odysseas Kargiotis, Peter Vanacker, Tiziana Tassinari, Nicola Giannini, Christina Rueckert, Ulf Bodechtel, Elisa Giorli, Simona Marcheselli, Efstathia Karagkiozi, Davide Imberti, Michele Venti, Walter Ageno, Chrysoula Liantinioti, Kostantinos Vadikolias, Alfonso Ciccone, Federica Letteri, Domenico Consoli, Andrea Alberti, Turgut Tatlisumak, Marialuisa Zedde, Vanessa Gourbali, Alberto Chiti, Manuel Cappellari, Cataldo D'Amore, Alessandro Pezzini, Francesco Corea, Maurizio Paciaroni, Liisa Tomppo, Giorgio Silvestrelli, Gayane Melikyan, Gianni Lorenzini, K. Makaritsis, Paolo Bovi, Marta Bellesini, Patrik Michel, Ludovica Anna Cimini, Alessio Pieroni, Shadi Yaghi, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Gino Gialdini, Licia Denti, Nicola Mumoli, Mario Maimone Baronello, Maria Luisa De Lodovici, Sung Il Sohn, Johannes Gerber, Giovanna Colombo, Boris Doronin, Karen L. Furie, Franco Galati, Antonio Carolei, Maria Giulia Mosconi, George Athanasakis, and Umberto Scoditti
Subjects: Male, medicine.medical_specialty, atrial fibrillation, myocardial infarction, risk stratification, stroke, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Internal medicine, Thromboembolism, Atrial Fibrillation, 80 and over, Medicine, Humans, Myocardial infarction, Aged, Aged, 80 and over, Anticoagulants, Female, Ischemic Attack, Transient, Prospective Studies, Stroke, Warfarin, Prospective cohort study, Advanced and Specialized Nursing, business.industry, Ischemic Attack, Transient, Neurology (clinical), Cardiology and Cardiovascular Medicine, atrial fibrillation, myocardial infarction, risk stratification, stroke, Atrial fibrillation, medicine.disease, Cardiology, Observational study, Human medicine, business, Risk assessment, Complication, 030217 neurology & neurosurgery, medicine.drug
Abstract: Background and Purposes— This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods— The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08–2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P =0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30–1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632–0.763; P =0.0001) for ischemic outcome events and 0.585 (0.493–0.678; P =0.10) for major bleedings. Results— The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529–0.763; P =0.009) for ischemic outcome events and 0.407 (0.275–0.540; P =0.14) for hemorrhagic outcome events. Conclusions— In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.
Published: 2016

42. Propensity Score-Based Analysis of Percutaneous Closure Versus Medical Therapy in Patients With Cryptogenic Stroke and Patent Foramen Ovale: The IPSYS Registry (Italian Project on Stroke in Young Adults)

Author: Antonella Toriello, Davide Guido, Giuseppe Micieli, Valeria De Giuli, Paolo Bovi, Mario Grassi, Paolo Costa, Alessandro Padovani, Nicoletta Checcarelli, Loris Poli, Simona Marcheselli, Anna Maria Simone, Davide Massucco, Valeria Piras, Sara La Starza, Massimo Gamba, Domenico Marco Bonifati, Elisa Giorli, Elisabetta Del Zotto, Paola Ferrazzi, Rosalba Patella, Giampaolo Tomelleri, Alessandro Adami, Maurizio Melis, Giorgio Silvestrelli, Silvia Bonaiti, Maurizia Rasura, Giacomo Giacalone, Maria Sessa, Carlo Gandolfo, Andrea Morotti, Maria Luisa DeLodovici, Alessandro Pezzini, R. Musolino, Paolo Cerrato, Anna Cavallini, Licia Iacoviello, A. Spalloni, Andrea Zini, Rocco Salvatore Calabrò, Lucia Tancredi, Marialuisa Zedde, Corrado Lodigiani, Massimo Del Sette, Maurizio Paciaroni, Cataldo D'Amore, and Alberto Chiti
Subjects: Male, Cardiac Catheterization, Percutaneous, Time Factors, patent foramen ovale, 030204 cardiovascular system & hematology, Brain Ischemia, Brain ischemia, 0302 clinical medicine, Risk Factors, Secondary Prevention, atrial septum, follow-up studies, secondary prevention, stroke, cardiology and cardiovascular medicine, Registries, Young adult, Hazard ratio, Age Factors, Middle Aged, Stroke, Treatment Outcome, Intracranial Embolism, Italy, Cardiology, Female, Cardiology and Cardiovascular Medicine, Embolism, Paradoxical, Adult, medicine.medical_specialty, Adolescent, Foramen Ovale, Patent, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, Propensity Score, Proportional Hazards Models, Chi-Square Distribution, business.industry, Cardiovascular Agents, medicine.disease, Confidence interval, Surgery, Embolism, Propensity score matching, Patent foramen ovale, Patent Foramen Ovale, Paradoxical Embolism, Transesophageal Echocardiography, business, 030217 neurology & neurosurgery
Abstract: Background— We sought to compare the benefit of percutaneous closure to that of medical therapy alone for the secondary prevention of embolism in patients with patent foramen ovale (PFO) and otherwise unexplained ischemic stroke, in a propensity scored study. Methods and Results— Between 2000 and 2012, we selected consecutive first-ever ischemic stroke patients aged 18 to 45 years with PFO and no other cause of brain ischemia, as part of the IPSYS registry (Italian Project on Stroke in Young Adults), who underwent either percutaneous PFO closure or medical therapy for comparative analysis. Primary end point was a composite of ischemic stroke, transient ischemic attack, or peripheral embolism. Secondary end point was brain ischemia. Five hundred and twenty-one patients qualified for the analysis. The primary end point occurred in 15 patients treated with percutaneous PFO closure (7.3%) versus 33 patients medically treated (10.5%; hazard ratio, 0.72; 95% confidence interval, 0.39–1.32; P =0.285). The rates of the secondary end point brain ischemia were also similar in the 2 treatment groups (6.3% in the PFO closure group versus 10.2% in the medically treated group; hazard ratio, 0.64; 95% confidence interval, 0.33–1.21; P =0.168). Closure provided a benefit in patients aged 18 to 36 years (hazard ratio, 0.19; 95% confidence interval, 0.04–0.81; P =0.026) and in those with a substantial right-to-left shunt size (hazard ratio, 0.19; 95% confidence interval, 0.05–0.68; P =0.011). Conclusions— PFO closure seems as effective as medical therapy for secondary prevention of cryptogenic ischemic stroke. Whether device treatment might be more effective in selected cases, such as in patients younger than 37 years and in those with a substantial right-to-left shunt size, deserves further investigation.
Published: 2016

43. Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Author: Domenico Consoli, Alberto Chiti, Antonio Baldi, Massimo Del Sette, Alessandro Padovani, Cecilia Becattini, Kostantinos Vadikolias, Vera Volodina, Patrik Michel, Chrissoula Liantinioti, Davide Imberti, Naveed Akhtar, Cataldo D'Amore, Umberto Scoditti, Simona Sacco, Dirk Deleu, Michele Venti, Walter Ageno, Cindy Tiseo, Serena Monaco, Turgut Tatlisumak, Paolo Bovi, Valeria Caso, Francesca Guideri, Ulf Bodechtel, Luca Masotti, Faisal Ibrahim, Sebastiano D'Anna, Dorjan Zabzuni, Loris Poli, Azmil H. Abdul-Rahim, Kennedy R. Lees, Boris Doronin, Gino Gialdini, Lilla Szabó, Gayane Melikyan, Alberto Rigatelli, Kristian Barlinn, Giuseppe Martini, Alessio Pieroni, Tiziana Tassinari, Andrea Alberti, Nicola Falocci, Gianni Lorenzini, Jessica Kepplinger, Peter Vanacker, Maria Giulia Mosconi, Lars-Peder Pallesen, Christina Rueckert, Monica Acciarresi, Mario Maimone Baronello, Suzette Remillard, Danilo Toni, Rossana Tassi, Monica Carletti, Maurizio Paciaroni, Simona Marcheselli, Giancarlo Agnelli, László Csiba, Giorgio Bono, Jukka Putaala, Georgios Tsivgoulis, Johannes Gerber, Alessandro Pezzini, Francesco Corea, Giovanni Orlandi, Maria Cordier, Franco Galati, Antonio Carolei, Maria Luisa De Lodovici, Sung Il Sohn, and Licia Denti
Subjects: Male, medicine.medical_specialty, Neurology, Atrial enlargement, 030204 cardiovascular system & hematology, Klinikai orvostudományok, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, Internal medicine, medicine, Left atrial enlargement, Secondary Prevention, Humans, Acute stroke, cardiovascular diseases, Stroke, Neuroradiology, Aged, Acute stroke, Atrial fibrillation, Echocardiography, Outcome, Outcome, business.industry, Atrial fibrillation, Orvostudományok, medicine.disease, Prognosis, Thrombosis, Echocardiography, Atrial Fibrillation, Female, Neurology (clinical), Cardiology, Human medicine, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 +/- A 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06-4.29, p = 0.033) and CHA(2)DS(2)-VASc score (OR 1.22; 95 % CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.
Published: 2016

44. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Author: László Csiba, Francesca Guideri, Luca Masotti, Davide Imberti, Sokratis G. Papageorgiou, Dorjan Zabzuni, Giancarlo Agnelli, Loris Poli, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Gino Gialdini, Umberto Scoditti, Giorgio Bono, Naveed Akhtar, Gianni Lorenzini, Alessandro Padovani, Dirk Deleu, Serena Monaco, Nicola Falocci, Cecilia Becattini, Jukka Putaala, Simona Sacco, Patrik Michel, Alberto Rigatelli, Kristian Barlinn, Maria Luisa De Lodovici, Gayane Melikyan, Ulf Bodechtel, Georgios Tsivgoulis, Boris Doronin, Cindy Tiseo, Monica Acciarresi, Alessandro Pezzini, Lilla Szabó, Rossana Tassi, Francesco Corea, Giovanni Orlandi, Maria Giulia Mosconi, Maria Cordier, Paolo Bovi, Licia Denti, Valeria Caso, Turgut Tatlisumak, Sung Il Sohn, Simona Marcheselli, Alessio Pieroni, Mario Maimone Baronello, Suzette Remillard, Maurizio Paciaroni, Danilo Toni, Cataldo D'Amore, Kateryna Antonenko, Monica Carletti, Antonio Baldi, Peter Vanacker, Christina Rueckert, Kennedy R. Lees, Michele Venti, Walter Ageno, Andrea Alberti, Lars-Peder Pallesen, Tiziana Tassinari, Johannes Gerber, Faisal Ibrahim, Domenico Consoli, Jessica Kepplinger, Kostantinos Vadikolias, Alberto Chiti, Massimo Del Sette, Vera Volodina, Franco Galati, Antonio Carolei, and Giuseppe Martini
Subjects: medicine.medical_specialty, anticoagulation therapy, atrial fibrillation, ischemic stroke, secondary prevention, Sex differences, stroke outcome, Early Recurrence, Internal medicine, Original Research Articles, Medicine, In patient, cardiovascular diseases, Risk factor, Acute ischemic stroke, Stroke, Fibrillation, business.industry, Atrial fibrillation, medicine.disease, Cardiology, Neurology (clinical), medicine.symptom, Cardiology and Cardiovascular Medicine, business, Cerebral Bleeding
Abstract: Introduction Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes. Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable outcome, 3–6 unfavorable outcome). Results Of the 1029 patients enrolled, 561 were women (54.5%) ( p Conclusions Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes.
Published: 2016

45. Operationalizing mild cognitive impairment criteria in small vessel disease: The VMCI-Tuscany Study

Author: Antonio Giorgio, Stefano Magnolfi, Guido Gori, Laura Stromillo, Enza Zicari, Renato Galli, Patrizia Formichi, Emilia Salvadori, Francesca Cesari, Stefania Brotini, Roberto Marconi, Rossana Tassi, Alessandro Rossi, Luca Massacesi, Marco Vista, Serena Nannucci, Maria Boddi, Anna Maria Gori, Francesca Pescini, Veronica Caleri, Gloria Tognoni, Nicola De Stefano, Carlo Biagini, Renzo Cisbani, Sandro Marini, Stefania Boschi, Antonella Notarelli, Claudia Pozzi, Paola Vanni, Claudia Gambetti, Paolo Zolo, Carla Giorgi, Laura Bracco, Stefania Mugnai, Giovanni Pracucci, Tiziano Borgogni, Filippo Baldacci, Sandro Sorbi, Giuseppe Meucci, Domenico Inzitari, Giovanni Orlandi, Giovanna Bellini, Leonardo Pantoni, Ilaria Di Donato, Rosanna Abbate, Luciano Gabrielli, Laura Ciolli, Francesca Rossi, Francesco Pinto, Carlo Valente, Alberto Chiti, Ubaldo Bonuccelli, Cristina Frittelli, Gabriele Siciliano, Mario Mancuso, Massimo Cadelo, Antonio Federico, Gaetano Zaccara, Raffaella Valenti, Pasquale Palumbo, Stefano Bartolini, Paolo Cecchi, Stefano Diciotti, Andrea Ginestroni, Mario Mascalchi, Monica Mazzoni, Donatella Calvani, Luciano Gabbani, Anna Poggesi, Leonello Guidi, Maria Lombardi, Maristella Piccininni, Marco Paganini, Marco Pasi, Enrico Mossello, Alessandro Tiezzi, Mirco Cosottini, Mirella Coppo, Maria Teresa Dotti, E Bertini, Betti Giusti, Lorella Lambertucci, G Gambaccini, Cristina Pagni, Alessandra Del Bene, Salvadori, Emilia, Poggesi, Anna, Valenti, Raffaella, Pracucci, Giovanni, Pescini, Francesca, Pasi, Marco, Nannucci, Serena, Marini, Sandro, Del Bene, Alessandra, Ciolli, Laura, Ginestroni, Andrea, Diciotti, Stefano, Orlandi, Giovanni, Di Donato, Ilaria, De Stefano, Nicola, Cosottini, Mirco, Chiti, Alberto, Federico, Antonio, Dotti, Maria Teresa, Bonuccelli, Ubaldo, Inzitari, Domenico, and Pantoni, Leonardo
Subjects: Male, Epidemiology, Cerebrovascular disease, Cognitive aging, Mild cognitive impairment, Neuropsychology, Vascular dementia, Health Policy, Developmental Neuroscience, Geriatrics and Gerontology, Neurology (clinical), Cellular and Molecular Neuroscience, Psychiatry and Mental Health, Neuropsychological Tests, 0302 clinical medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, medicine.diagnostic_test, Magnetic Resonance Imaging, White Matter, Temporal Lobe, medicine.anatomical_structure, Italy, Disease Progression, Cardiology, Female, Psychology, medicine.medical_specialty, Prodromal Symptoms, behavioral disciplines and activities, Temporal lobe, White matter, 03 medical and health sciences, Atrophy, Neuroimaging, Internal medicine, mental disorders, medicine, Humans, Cognitive Dysfunction, Psychiatry, Aged, Magnetic resonance imaging, medicine.disease, nervous system diseases, Cerebrovascular Disorders, human activities, 030217 neurology & neurosurgery
Abstract: Introduction Mild cognitive impairment (MCI) prodromic of vascular dementia is expected to have a multidomain profile. Methods In a sample of cerebral small vessel disease (SVD) patients, we assessed MCI subtypes distributions according to different operationalization of Winblad criteria and compared the neuroimaging features of single versus multidomain MCI. We applied three MCI diagnostic scenarios in which the cutoffs for objective impairment and the number of considered neuropsychological tests varied. Results Passing from a liberal to more conservative diagnostic scenarios, of 153 patients, 5% were no longer classified as MCI, amnestic multidomain frequency decreased, and nonamnestic single domain increased. Considering neuroimaging features, severe medial temporal lobe atrophy was more frequent in multidomain compared with single domain. Discussion Operationalizing MCI criteria changes the relative frequency of MCI subtypes. Nonamnestic single domain MCI may be a previously nonrecognized type of MCI associated with SVD.
Published: 2016

46. Periprocedural outcome for patients with carotid stenosis treated with endovascular therapy: a single center evaluation

Author: Giovanni Orlandi, Marta Gennaro, Michele Puglioli, Gino Gialdini, G Lazzarotti, Nicola Giannini, Alberto Chiti, and Eva Terni
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Dermatology, Single Center, Revascularization, Asymptomatic, Postoperative Complications, Internal medicine, Angioplasty, medicine, Humans, Carotid Stenosis, cardiovascular diseases, Survival rate, Stroke, Aged, Retrospective Studies, Aged, 80 and over, Chi-Square Distribution, medicine.diagnostic_test, business.industry, Endovascular Procedures, General Medicine, Middle Aged, medicine.disease, Surgery, Survival Rate, Psychiatry and Mental health, Stenosis, Treatment Outcome, Angiography, Cardiology, Female, Neurology (clinical), medicine.symptom, business
Abstract: Endovascular procedures are a less invasive revascularization strategies than endoarterectomy for carotid stenosis, but to date Guidelines recommend surgery for a major periprocedural safety. Evidences come from randomized studies where operator’s experience in endovascular group was not considered. We retrospectively evaluated 524 endovascular procedures (carotid angioplasty ± stenting, CAS) performed between 1996 and 2010 on 486 patients (mean age 71.3 ± 7.8 years) with symptomatic or asymptomatic carotid stenosis from a single center. We evaluated efficacy (residual stenosis ≤30 % after postprocedural angiography) and safety [minor (TIAs or myocardial infarcts) and major (stroke or death) complications in the first 30 days] of procedures and correlated them with the increasing experience of the operator. CAS was successful in 504/524 cases (96.2 %); unsuccessful procedures occurred more frequently in case of angioplasty alone rather than angioplasty and stenting (13/61, 21.3 % vs. 7/463, 1.5 %, OR 17.64, 95 % CI 6.69–46.06). 17/524 (3.2 %) CAS met the combined safety endpoint: stroke in 2.4 % and death in 0.8 %; the rate of disabling stroke/death was 1.6 %. Center experience was inversely related to the rate of stroke/death (R 2 = 0.9375), passing from 5.0 % after 100 CAS to 2.8 % after 500 CAS; for disabling stroke/death (R 2 = 0.9386), the rate was 4 % after 100 CAS and 1.6 % after 500 CAS. CAS is an effective and safe revascularization procedure in both symptomatic and asymptomatic patients, if effected in experienced centers. The use of carotid artery stenting than angioplasty alone and emboli protection devices can much more improve the previous considerations.
Published: 2012

47. Contents Vol. 34, 2012

Author: Toshiho Ohtsuki, Druck Reinhardt Druck Basel, Alessandro Pezzini, Danilo Toni, Stephen Meairs, Karin Ernstrom, Hisashi Masugata, Simon Jung, S. Domènech, Heinrich Mattle, Valeria Caso, Luca Remonda, Giovanni Orlandi, Katsuhiko Matsuo, Takeshi Aoki, Randolph S. Marshall, Michael G. Hennerici, Joanna M. Wardlaw, Hiroaki Dobashi, Akira Ogawa, Xin Wang, Hidetoshi Matsukawa, Yasushi Okada, Mauro Silvestrini, Gino Gialdini, Oliver Findling, Manuel Cappellari, Koji Murao, Hideki Origasa, Eric Jouvent, Russell V. Luepker, Naoki Nakayama, A. Dávalos, Takanari Kitazono, Masakazu Kobayashi, Kazushi Deguchi, Marco Duering, Nassira Allili, Patrizia Nencini, Karen C. Albright, P. Cuadras, Andrea Zini, Dawn M Meyer, Alexander Karameshev, David Rodriguez-Luna, Alessandro Padovani, Osamu Yasuda, Alessio Pieroni, David S Liebeskind, Brett C. Meyer, Giorgio Bono, Yuichi Izumi, Ekkehart Jenetzky, Carlo Ferrarese, Francesca M Chappell, Claudia Trentini, Giampiero Galletti, Kenji Yoshida, Werner Hacke, Hiroyuki Imamura, Sean I Savitz, Joseph P. Broderick, Masahito Katoh, Marcia Spindler, Ivânia Alves, David C. Anderson, Naohisa Hosomi, Michele Venti, Markus A Möhlenbruch, Ming Yao, Falk Mueller-Riemenschneider, Saqib A Chaudhry, Wondwossen G Tekle, E. López-Cancio, Rakesh Khatri, José Alvarez-Sabín, Tiziana Tassinari, Takenori Yamaguchi, Hiroki Kuroda, Rossana Tassi, Timolaos Rizos, José G. Merino, Kohsuke Kudo, Gerhard Schroth, Carole Stuker, Marc Ribó, Cataldo D’Amore, Atsushi Murakata, Maria del C. Valdés Hernández, Carlos Veira, Kiyohiro Houkin, Tomohisa Nezu, M. Millán, Masahiro Kamouchi, Toshimitsu Aida, Christoph Gumbinger, Luis Ruano, Kuniaki Ogasawara, Takeo Abumiya, Julie Staals, Rema Raman, Roland Veltkamp, Gian Marco De Marchis, Stefan N. Willich, Alfonso Ciccone, Andria L. Ford, Hirofumi Soejima, Masayasu Matsumoto, Adnan I Qureshi, Àngels Pedragosa, Hisao Ogawa, Makoto Sasaki, Albert W Tsai, Caroline M. J. Loos, Joan Brugués, Motoharu Fujii, Masaki Shinoda, A. Massuet, Olga Maisterra, Maria Luisa DeLodovici, Shiro Aoki, Junko Tanaka, Alessia Lanari, Andrea Alberti, Osamu Takahashi, M. Gomis, Fergus N. Doubal, Satz Mengensatzproduktion, Rudolf Luedi, Hideo Ohyama, Shunrou Fujiwara, Krassen Nedeltchev, Giancarlo Agnelli, Andrei V. Alexandrov, Paolo Frigio Nichelli, Sheryl Martin-Schild, Isabel Araújo, Marta Rubiera, M. Hernández-Pérez, Marie-Luise Mono, Ameer E Hassan, Ximena Castillo, Paolo Bovi, Emilio Luda, Massimo Del Sette, Martin Dichgans, C. Berthet, Paolo Previdi, Robert J. van Oostenbrugge, Vítor Tedim Cruz, Maurizio Riva, Dawn Kleindorfer, Taro Suzuki, Naoko Kumagai, Noriko Ichihara, N. Pérez de la Ossa, Rui Barreto, Peter A. Ringleb, Mascia Nesi, Solveig Horstmann, Domenico Consoli, Domenico Inzitari, Alberto Chiti, Marcel Arnold, Natalia S. Rost, Giuseppe Martini, Carlos A. Molina, Stephan Rieks, Takuya Moriwaki, Kamakshi Lakshminarayan, Raffaella Cerqua, Maurizio Paciaroni, Lorenz Hirt, Claus Kiefer, Marwan El-Koussy, Elisabetta Traverso, Hideaki Nishimoto, Masakazu Kohno, Simone Beretta, Dominique Hervé, Johannes Slotboom, Ryoichi Ishikawa, Masami Yoshino, Giorgio Silvestrelli, Pierre J. Magistretti, Serena Monaco, Aekaterini Galimanis, Monica Acciarresi, James M. Peacock, L. Dorado, Simona Marcheselli, Hugues Chabriat, and Takamasa Nanba
Subjects: Neurology, Traditional medicine, business.industry, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published: 2012

48. Prestroke CHA

Author: Monica, Acciarresi, Maurizio, Paciaroni, Giancarlo, Agnelli, Nicola, Falocci, Valeria, Caso, Cecilia, Becattini, Simona, Marcheselli, Christina, Rueckert, Alessandro, Pezzini, Andrea, Morotti, Paolo, Costa, Alessandro, Padovani, Laszló, Csiba, Lilla, Szabó, Sung-Il, Sohn, Tiziana, Tassinari, Azmil H, Abdul-Rahim, Patrik, Michel, Maria, Cordier, Peter, Vanacker, Suzette, Remillard, Andrea, Alberti, Michele, Venti, Cataldo, D'Amore, Umberto, Scoditti, Licia, Denti, Giovanni, Orlandi, Alberto, Chiti, Gino, Gialdini, Paolo, Bovi, Monica, Carletti, Alberto, Rigatelli, Jukka, Putaala, Turgut, Tatlisumak, Luca, Masotti, Gianni, Lorenzini, Rossana, Tassi, Francesca, Guideri, Giuseppe, Martini, Georgios, Tsivgoulis, Kostantinos, Vadikolias, Chrissoula, Liantinioti, Francesco, Corea, Massimo, Del Sette, Walter, Ageno, Maria Luisa, De Lodovici, Giorgio, Bono, Antonio, Baldi, Sebastiano, D'Anna, Simona, Sacco, Antonio, Carolei, Cindy, Tiseo, Davide, Imberti, Dorjan, Zabzuni, Boris, Doronin, Vera, Volodina, Domenico, Consoli, Franco, Galati, Alessio, Pieroni, Danilo, Toni, Serena, Monaco, Mario Maimone, Baronello, Kristian, Barlinn, Lars-Peder, Pallesen, Jessica, Kepplinger, Ulf, Bodechtel, Johannes, Gerber, Dirk, Deleu, Gayane, Melikyan, Faisal, Ibrahim, Naveed, Akhtar, Maria Giulia, Mosconi, and Kennedy R, Lees
Subjects: Male, Asia, Time Factors, Risk Assessment, Severity of Illness Index, Decision Support Techniques, Disability Evaluation, Predictive Value of Tests, Risk Factors, Atrial Fibrillation, Odds Ratio, Humans, Prospective Studies, Aged, Aged, 80 and over, Chi-Square Distribution, Prognosis, Magnetic Resonance Imaging, Europe, Stroke, Logistic Models, ROC Curve, Area Under Curve, Multivariate Analysis, Linear Models, Female, Tomography, X-Ray Computed
Abstract: The aim of this study was to investigate for a possible association between both prestroke CHAThis prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHAOf the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHAIn patients with AF, in addition to the risk of stroke, a high CHA
Published: 2015

49. Vertebral Artery Dissection Onset Mimics Migraine With Aura in a Graphic Designer

Author: and Antonio Tartaglione Md, Giovanni Orlandi, Nicola Morelli, Luigi Murri, Gianfranco Cafforio, Sara Gori, Michelangelo Mancuso, Enrico Ceretti, Alberto Chiti, and Maria Rosaria Maluccio
Subjects: Male, medicine.medical_specialty, Aura, Cervical Artery, Vertebral artery dissection, Vertebral artery, Migraine with Aura, Dissection (medical), Neurological disorder, Diagnosis, Differential, medicine.artery, Humans, Medicine, Vertebral Artery Dissection, Aspirin, Heparin, business.industry, Anticoagulants, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Migraine with aura, Surgery, Neurology, Migraine, Neurology (clinical), medicine.symptom, business, Magnetic Resonance Angiography
Abstract: Headache is the most common symptom in patients with cervical artery dissection. This symptom, however, rarely occurs in isolation, and more commonly is associated with other neurological symptoms and signs. Visual symptoms associated with vertebral artery dissection (VD) have also been observed, but do not typically mimic the migraine aura. Here, we report a young patient who presented VD, embolic ischemic lesions, and visual symptoms with the features of aura, followed by migraine headache. The suggestion of VD dissection should be kept in mind in those cases complaining of the first attack of headache that mimics migraine with aura. In these cases, an extensive neuroimaging study is advisable.
Published: 2008

50. Third International Stroke Summit

Author: Tae-Hee Cho, Rina Torisu, Christine Roffe, G. Cesana, F. Vancheri, Elisa Giorli, Jung Im Seok, Marc Hermier, Shahram Oveisgharan, Nizal Sarrafzadegan, Seung Soo Sheen, Allan Hackshaw, Seung Hyeon Yeo, Kotaro Yasumori, Takahiro Nakano, Hiroki Ohkuma, Karel Fuentes, Jean-Claude Froment, Diosely C. Silveira, Nikolaos I.H. Papamitsakis, Shahin Shirani, Kwang Ho Lee, Shidokht Hosseini, Elizabeth Cheek, Sheila Sills, Yves Berthezène, Sandeep Gupta, Oh Young Bang, L. Palmieri, Chin Sang Chung, Stefan Söderberg, Noriko Hagiwara, Gyeong Moon Kim, A. Barchielli, Ingegerd Söderström, M. Uguccioni, Peter Crome, Laurent Derex, Yasushi Okada, Magnus Strand, Parisa Hasanzadeh, Lars Weinehall, Guy Louis-Tisserand, Alireza Khosravi, Simona Fanucchi, Alberto Chiti, S. Giampaoli, Jung Han Yoon, Nicola Morelli, Per-Gunnar Wiklund, Akira Munakata, Norihito Shimamura, Tooru Inoue, Joseph Ngeh, Göran Hallmans, Marlène Wiart, Sa Rah Yoon, Virginie Desestret, C Sonnoli, Jérôme Honnorat, Kazunori Toyoda, Setsuro Ibayashi, P. Spolaore, Tommy Olsson, E. de Campora, Giovanni Orlandi, P. Ciccarelli, C.A. Goldoni, Norbert Nighoghossian, D. Vanuzzo, Khalid Ali, and S. Cakmak
Subjects: geography, medicine.medical_specialty, Summit, geography.geographical_feature_category, Neurology, business.industry, Family medicine, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, medicine.disease, Stroke
Published: 2007

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